Asthma and Allergy Mobile Apps in 2018

Abstract

Purpose of Review

This paper offers a comprehensive review of interactive mobile allergy and asthma smartphone applications available within the USA in 2018, with an emphasis on interactive asthma apps.

Recent Findings

Primary care and specialty clinicians interested in introducing digital health apps into their practices will soon have more choices, for Apple® and major electronic medical record software companies are investing heavily in the mobile medical marketplace, guaranteeing personal health information and access to care will always be immediately available in one's digital hand.

Summary

Interactive mobile asthma applications are valuable assets for patients and caregivers alike, for they offer immediate communications between patients and those responsible for providing for their needs.

http://bit.ly/2GmD8r8

Primary Prevention of Food Allergy

Abstract

Purpose of Review

The goal of this review is to present an updated summary of the various approaches to prevent childhood food allergies and report recent advances in potential prevention trials for food allergy.

Recent Findings

Several approaches related to maternal dietary supplementation as well as infant GI-based supplementation have been tried and are the subject of ongoing clinical investigation.

Summary

The prevalence of food allergy appears to be increasing but several, varied approaches to prevention are being actively pursued such that an effective strategy may not be too far in the future.

http://bit.ly/2Ts4Jv0

Optimization of the Surgical Field in Endoscopic Sinus Surgery: an Evidence-Based Approach

Abstract

Purpose of Review

The advent of endoscopic sinus surgery (ESS) has enabled the development of minimally invasive surgical procedures in Rhinology. However, proficiency with ESS techniques can still be hampered by poorly controlled bleeding limiting visibility of the surgical field (VSF). This can lead to increased operating time and, more importantly, increased risk of major and minor complications. To optimize the VSF and mitigate the risk of complications, many strategies have been explored.

Recent Findings

This is a narrative review of the relative risks and benefits of pre- and intra-operative interventions aimed at optimizing intraoperative conditions during ESS. The value of these interventions is determined based on their impact on intraoperative blood loss, time of surgery, and the VSF, and weighed against their adverse event profile.

Summary

This review provides a comprehensive overview of the evidence relating to the safety and efficacy of interventions used to improve intraoperative conditions during ESS.

http://bit.ly/2BipHFx

Chemical Composition, Antifungal, and Cytotoxicity Activities of Inga laurina (Sw.) Willd Leaves

The species Inga laurina is native to the Brazilian Cerrado. There are no studies about the chemical composition and biological activities of extracts of this endangered species. The ethanolic extract and its successive fractions are rich in phenolic compounds and presented good antifungal activities. HPLC/MS-MS/MS and H1/C13 analysis led to the identification of seventeen compounds, most of which are gallic acid derivatives, myricetin and quercetin glycosides. The ethyl acetate fraction (EAF) contained high levels of total phenolics, expressed in milligrams of gallic acid equivalents per gram of extract (475.3 ± 1.9 mg GAE ) and flavonoids expressed in milligrams of quercetin equivalents per gram of extract (359.3 ± 10.6 mg QE ). This fraction was active against fungi of the Candida genus. The EAF showed MIC value 11.7 μg mL−1 against C. glabrata and a selectivity index of 1.6 against Vero cells. The flavonol glycoside myricetin-3-O-rhamnoside was isolated for the first time from the Inga laurina. These results make I. laurina a promising plant as a source of pharmaceutical and biological active antifungal compounds.

http://bit.ly/2SqT2Y0

Hepatitis B and C Viral Infection: Prevalence, Knowledge, Attitude, Practice, and Occupational Exposure among Healthcare Workers of Jimma University Medical Center, Southwest Ethiopia

Background. Blood-borne infections have been recognized as an occupational hazard for nearly 50 years. Current treatment for hepatitis B virus (HBV) is very expensive for individuals in developing countries and cannot clear infection after it progresses to the chronic stage. Thus, early screenings of people who are at higher risk like healthcare workers and vaccination and awareness creation on standard precautions (SP) to prevent transmission are mandatory. This study determined seroprevalence of HBV and hepatitis C virus (HCV) among healthcare workers of Jimma University Medical Center (JUMC). Methods. An institution based cross-sectional study was conducted from Nov 2015 to Jan 2016. The lottery method was used to select 240 healthcare workers. Data were collected by a self-administered questionnaire. Five to ten milliliters of whole venous blood was collected from each participant. The blood samples were analyzed (tested) for hepatitis B surface antigen (HBsAg) and anti-HCV antibody using automated Enzyme-Linked Immunosorbent Assay (ELISA). Data were entered into EpiData 3.1 and analyzed by SPSS 23. Results. The positivity of HBsAg was 2.5% (6/240; 95% CI: 0.52-4.48%) and that of anti-HCV antibody was 0.42% (1/240; 95% CI: 0.0-1.23%). Most participants had good knowledge of HBV (73.9%), HCV (60.9%), and SP (82.2%) and positive attitude towards SP (88.7%), but only 42.6% had a good practice of SP. More than half (60%) and nearly half (43%) had a history of ever exposure and exposure in the last one year before the survey, respectively. Females were at lower risk of both having ever exposure (95% CI: (0.241, 0.777)) and exposure in the last one year before the survey (95% CI: (0.297, 0.933)) compared to males. Conclusion. The prevalence of HBV was intermediate according to the endemicity classification by WHO. The practice of SP was poor in most participants and, thus, occupational exposure was high. Therefore, regular screening and vaccination of healthcare workers, regular provision of basic or refresher training and availing logistics, and regular motivation of healthcare workers on the practice of standard precautions are recommended.

http://bit.ly/2GhN9Gg

Adsorption Study for the Removal of Nitrate from Water Using Local Clay

Our research aimed at the removal of nitrate ions through adsorption by local clay. A series of batch experiments were conducted to examine the effects of contact time, adsorbent characteristics, initial concentration of nitrate, pH of the solution, concentration, and granulometry of adsorbent. Adsorption isotherms studies indicated that local clay satisfies Freundlich's model. The rate of reaction follows pseudo-second-order kinetics. Local clay successfully adsorbs nitrates at pH acid. The adsorption capacity under optimal conditions was found to be 5.1 mg/g. The adsorption yield increases with adsorbent dose and decrease with initial concentration of nitrate. The local clay was characterized by the X-ray fluorescence method (XRF), X-ray diffraction (XRD), Fourier transform-infrared spectroscopy (FTIR), scanning electronics microscopy (SEM), and measurement of specific surface area (BET). The results of the study indicated that local clay is useful materials for the removal of nitrates from aqueous solutions which can be used in water treatment without any chemical modification.

http://bit.ly/2GhYw10

Epidemiological Profile of the Pathologies of the Oral Cavity in a Peruvian Population: A 9-Year Retrospective Study of 18,639 Patients

Aim. To determine the epidemiological profile of oral diseases in a marginal urban Peruvian population. Methods. A 9-year retrospective study was conducted, analysing 18,639 clinical records from the María Auxiliadora Hospital between 2006 and 2015 with diagnoses of oral lesions using ICD-10 criteria. Clinical records were analysed for sex, tumour, periapical abscess and sinus, cysts of the oral region, other lesions of the oral mucosa and cavity, gingivitis and periodontal disease, dentofacial anomalies, diseases of pulp, etc. Results. Of 18,639 cases, the prevalence was higher in women for the following pathologies: unspecified dental caries (30.6%); impacted tooth in the category of disorders of tooth development and eruption (2.0%); pulpitis (6.8%) in the category of diseases of pulp and periapical tissues; temporomandibular joint (TMJ) disorders (1.5%) in the category of dentofacial anomalies; acute gingivitis (7.5%); radicular cyst (0.3%) in the category of cysts of the oral region; and periapical abscess without sinus (2.0%). Conclusions. We found a significant association between sex and different types of dental caries, disturbances in tooth eruption, diseases of pulp and periapical tissues, and dentofacial anomalies. The study also shows a statistically significant association between sex and gingivitis, periodontal disease, and periodontal abscess and sinus.

http://bit.ly/2SmtZFr

Cocoa’s Residual Honey: Physicochemical Characterization and Potential as a Fermentative Substrate by Saccharomyces cerevisiae AWRI726

This study aims to characterize the physicochemical properties of cocoa's residual honey and evaluate its fermentative capacity as a substrate, using Saccharomyces cerevisiae AWRI726 as the starter culture for alcoholic fermentation. The research hypothesis was that cocoa's residual honey can be used for the production of fermented beverages. Cocoa's honey has 14.14 g.100 mL−1 of dry material, containing 11.80 g.100 mL−1 of carbohydrates and 1.20% crude protein, in addition to other minor components, such as pectin, lipids, and Fe, Mn, Na, and Zn, with a carbon-to-nitrogen (C/N) ratio (9.8) most suitable for fermentation. Fermentation at 20°C for 240 hours produced a liquid with 16% v/v ethanol (14 g.L−1 in 144 h). However, 24 hours of fermentation produced the maximum ethanol yield (0.373 g.g−1) and volumetric productivity (0.168 g.L−1.h−1), which were associated with a significant increase in the specific cell growth rate. Saccharomyces cerevisiae AWR1726 performed satisfactorily in the alcoholic fermentation of cocoa's residual honey, similar to that observed in other fruit beverages, thus suggesting the suitability of cocoa's residual honey for future commercial applications.

http://bit.ly/2SoW3bw

Effects of Therapy with Light Emitting Diode (LED) in the Calcaneal Tendon Lesions of Rats: A Literature Review

The objective of this review was to analyze original articles about the effects of therapy with LED in experimental models of calcaneal tendon lesions of rats. The search was performed in the period from February to May 2018, in the following electronic databases: MEDLINE, SciELO, and LILACS, besides the Google Scholar, using the descriptors "Achilles tendon", "Rats", "LED", "Tendinopathy", and "Low-level Light Therapy", as well as their matching parts in the Portuguese and Spanish languages, related to and in association with the relevant terms to the content sought. From the descriptors used 215 works were found. After application of eligibility criteria 8 works were selected, in which positive results were found after the application of the LED. Regarding the main results found with phototherapy, we observed a significant reduction in inflammation. Only one article mentioned little reduction of inflammation. In relation to the number of sessions, there was wide variation, with an average of approximately 5 sessions every 24 hours. Studies in this review pointed out, therefore, positive results in the repair of the calcaneal tendon after therapy with irradiation LED; however, carrying out more experimental studies that help the standardization of parameters to be used in this therapy for further clinical studies becomes necessary.

http://bit.ly/2GhYW7A

Persistent sciatic artery resembles a soft-tissue sarcoma in presentation

Hana Kamal Almadani<br />Jan 29, 2019; 12:e227250-e227250<br />

http://bit.ly/2G7ImHZ

Rare case of bladder chondroma causing lower urinary tract symptoms

Simeon Ngweso<br />Jan 18, 2019; 12:bcr-2018-227006-bcr-2018-227006<br />

http://bit.ly/2RzMxhd

Misdiagnosis: Acute Chest Syndrome That Evolved into Acute Respiratory Distress Syndrome in a Patient without a Documented History of Hemoglobinopathy

Acute chest syndrome (ACS) is a feared complication of sickle cell disease. Here is a case of a patient who presented with symptoms suggestive of acute chest syndrome yet had a delayed diagnosis presumably due to the lack of documented history of sickle cell disease of the patient, consequently evolving into acute respiratory distress syndrome (ARDS). He was subsequently diagnosed with heterozygous sickle cell SC disease on hemoglobin electrophoresis. After appropriate management with mechanical ventilator, broad-spectrum empiric intravenous antibiotics, exchange transfusion, and intravenous fluid resuscitation, the patient was medically optimized and safely discharged home, with significant improvement noted on successive follow-up visits.

http://bit.ly/2GhAPpq

Congenital adrenal hyperplasia with salt-wasting crisis and arrhythmia: a case study

Johnny Figueroa Canlas<br />Jan 29, 2019; 12:e227565-e227565<br />

http://bit.ly/2Ry5m4s

Alports syndrome and intracranial aneurysm: mere coincidence or undiscovered causal relationship

Subhasish Bose<br />Jan 29, 2019; 12:e228175-e228175<br />

http://bit.ly/2WzvEXE

Disseminated intestinal basidiobolomycosis with mycotic aneurysm mimicking obstructing colon cancer

Arwa Omar Takrouni<br />Jan 29, 2019; 12:e225054-e225054<br />

http://bit.ly/2Rx6qFv

Diabetes cataract in a 10-year-old girl with new-onset type 1 diabetes mellitus

Jose Bernardo Quintos<br />Jan 29, 2019; 12:e227437-e227437<br />

http://bit.ly/2WDfgp9

Hypocalcaemia and hyponatraemia masquerading the diagnosis of Gitelman syndrome

Bhargav Gopinath<br />Jan 28, 2019; 12:bcr-2018-227886-bcr-2018-227886<br />

http://bit.ly/2RAlimC

Peroneal artery entrapment syndrome (PRAES): a rare cause of ischaemic toes

Alfred Bingchao Tan<br />Jan 28, 2019; 12:bcr-2018-227353-bcr-2018-227353<br />

http://bit.ly/2WxBSaB

Real-time MRI guidance for intra-arterial drug delivery in a patient with a brain tumor: technical note

Michal Zawadzki<br />Jan 27, 2019; 12:bcr-2018-014469-bcr-2018-014469<br />

http://bit.ly/2RAGc5g

Pancoast tumour presenting as shoulder pain with Horners syndrome

Nimlan Shanmugathas<br />Jan 24, 2019; 12:bcr-2018-227873-bcr-2018-227873<br />

http://bit.ly/2WEVl95

Correction: Exclusively plant, whole-food diet for polypharmacy due to persistent atrial fibrillation, ischaemic cardiomyopathy, hyperlipidaemia and hypertension in an octogenarian

<br />Jan 22, 2019; 12:e227059corr1-e227059corr1<br />

http://bit.ly/2RxHoGo

Spontaneous spinal subdural haematoma in a patient on apixaban

Ahmad Mchaourab<br />Jan 22, 2019; 12:e227311-e227311<br />

http://bit.ly/2WzvFuG

Rare cutaneous myiasis of the face due to Lunds fly (Cordylobia rodhaini) in a British traveller returning from Uganda

Nicola Wade<br />Jan 22, 2019; 12:e228070-e228070<br />

http://bit.ly/2RxfYAp

Inguinal hernia containing a native orthotopic kidney

Douglas J Cassidy<br />Jan 18, 2019; 12:bcr-2018-227645-bcr-2018-227645<br />

http://bit.ly/2WvPcvY

Spontaneous anterior dislocation of lens in a case of ectopia lentis et pupillae: a rare entity treated by a novel technique of microscope integrated optical coherence tomography (MIOCT) guided intralenticular lens aspiration

Pranita Sahay<br />Jan 18, 2019; 12:bcr-2018-227047-bcr-2018-227047<br />

http://bit.ly/2RAx0NZ

Focal myositis and contracture secondary to amiodarone extravasation from a peripheral cannula

David Ledingham<br />Jan 18, 2019; 12:bcr-2018-227725-bcr-2018-227725<br />

http://bit.ly/2WDijxq

Urothelial carcinoma with villoglandular differentiation (UCVGD) with small cell neuroendocrine carcinoma of urinary bladder

Shilpy Jha<br />Jan 18, 2019; 12:bcr-2018-228017-bcr-2018-228017<br />

http://bit.ly/2RC7WWU

Hypokalaemic metabolic alkalosis, hypertension and diabetes: what is the link

Marius Vögelin
Jan 18, 2019; 12:bcr-2018-227068-bcr-2018-227068


http://bit.ly/2WDeb0r

Monocytopenia in clozapine-induced agranulocytosis: insights into pathophysiology and treatment

Rajvi Patel<br />Jan 18, 2019; 12:bcr-2018-226016-bcr-2018-226016<br />

http://bit.ly/2WDalED

Asthma Status and Risks among Lesbian, Gay, and Bisexual Adults in the United States: A Scoping Review

Asthma is uncontrolled in up to 71% of adolescents and adults,1 resulting in higher healthcare costs, more school and work absences, and higher mortality.1,2 Sexual minority adults (SM; e.g., people who identify as lesbian, gay, or bisexual, or who have same-sex partners) have higher rates of asthma than heterosexual counterparts.3,4 However, it is unclear whether rates and risk factors differ by sexual identity. To address this critical knowledge gap, we conducted a scoping review to systematically search relevant literature following current guidelines.

http://bit.ly/2t1Xka7

Cartilage conduction as the third pathway for sound transmission

It has been long considered that air and bone are the two major mediators that conduct sounds to the inner ear. In 2004, Hosoi found that vibration of aural cartilage, generated by placing gently a transducer on it, could create audible sound with the same level of clarity as air- and bone-conduction sound. He thus proposed the term "cartilage conduction" for this concept. This research identified a third mediator for sound conduction to the inner ear. Hosoi also proposed the development of novel communication devices, such as hearing aids, telephones, etc.

http://bit.ly/2Rwm1Fu

Dendritic pattern: Unique onychoscopic feature in endonyx

http://bit.ly/2REcxrW

Factors associated with the utilization of Mohs surgery in the treatment of microcystic adnexal carcinoma

http://bit.ly/2WD3PxF

Issue Information

http://bit.ly/2D3azMl

Severe deviated nose treatment: importance of preserving the dorsal septal remnant

Abstract

Purpose

To compare the surgical outcomes of modified extracorporeal septoplasty and anterior septal reconstruction for the management of the severe deviated nose.

Methods

In a prospective cohort study, we selected 86 patients referred for septorhinoplasty to a tertiary center in May 2015–April 2017 with a primary complaint of nasal obstruction and deformity. They had moderate-to-severe septal deviation and severely deviated noses, particularly in the dorsum. Forty-three patients underwent each procedure. The cohorts were age- and sex-matched, and were operated at a similar time point. Surgical outcome was assessed and compared using anthropometric measurement of photographs, acoustic rhinometry, and The Nasal Obstruction Septoplasty Effectiveness questionnaire (including a visual analog scale).

Results

In all patients, MCA1 (initial minimum cross-sectional area) and MCA2 (minimum cross-sectional area after topical decongestion of the nasal mucosa), anthropometric angles (nasolabial, nasofacial and tip projection), and The Nasal Obstruction Septoplasty Effectiveness questionnaire significantly improved after surgery in both groups (p = 0001), with no significant difference in improvement between two groups. However, anthropometric angles and minimal cross-sectional area were better in anterior septal reconstruction group.

Conclusion

Both methods are effective in patients with a severely deviated nose for correction of deviation and obstruction. Anterior septal reconstruction is the preferable method in patients with more deviation.

http://bit.ly/2Gl913t

Is Day Care Tonsillectomy a Safe Procedure?

Abstract

Tonsillectomy with or without adenoidectomy is the commonest procedure performed by an otolaryngologist. It has been performed as an in-patient procedure. To present our experience of 15 years of day care tonsillectomy with or without adenoidectomy and to assess the safety of tonsillectomy as a day care procedure. Design: retrospective study. A retrospective study of all day care tonsillectomies with or without adenoidectomies operated at a Secondary care ENT Hospital from 2002 to 2016 has been carried out. In last 15 years, we have operated 1207 tonsillectomies with or without adenoidectomies as a day care procedure. Postoperatively, the patients were discharged after observing for 6 to 8 h. Out of 1207 patients, 3 patients required readmission due to bleeding and 5 due to pain. Hence the overall readmission rate following tonsillectomy was 8/1027, which equals to 0.778 percent. Two patients with postoperative bleeding within 6 h were taken up for exploration and control of hemostasis. One patient of secondary haemorrhage was managed conservatively. None of the patients required blood transfusion. Day care tonsillectomy with or without adenoidectomy is a safe procedure as long as the patients are carefully selected. It is also cost effective. Level of evidence: Level 4.

http://bit.ly/2Wx41i1

What is a pituitary adenoma? A pituitary adenoma is a fairly common benign growth that occurs in the...

What is a pituitary adenoma? A pituitary adenoma is a fairly common benign growth that occurs in the pituitary gland....

http://bit.ly/2t0T0aX

Is Day Care Tonsillectomy a Safe Procedure?

Abstract

Tonsillectomy with or without adenoidectomy is the commonest procedure performed by an otolaryngologist. It has been performed as an in-patient procedure. To present our experience of 15 years of day care tonsillectomy with or without adenoidectomy and to assess the safety of tonsillectomy as a day care procedure. Design: retrospective study. A retrospective study of all day care tonsillectomies with or without adenoidectomies operated at a Secondary care ENT Hospital from 2002 to 2016 has been carried out. In last 15 years, we have operated 1207 tonsillectomies with or without adenoidectomies as a day care procedure. Postoperatively, the patients were discharged after observing for 6 to 8 h. Out of 1207 patients, 3 patients required readmission due to bleeding and 5 due to pain. Hence the overall readmission rate following tonsillectomy was 8/1027, which equals to 0.778 percent. Two patients with postoperative bleeding within 6 h were taken up for exploration and control of hemostasis. One patient of secondary haemorrhage was managed conservatively. None of the patients required blood transfusion. Day care tonsillectomy with or without adenoidectomy is a safe procedure as long as the patients are carefully selected. It is also cost effective. Level of evidence: Level 4.

http://bit.ly/2Wx41i1

Erratum to “Population-based cross-sectional study to assess newborn hearing screening program in Central Germany” [Int. J. Pediatr. Otorhinolaryngol., 107 (2018) 110–120]

Publication date: Available online 2 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Anke Rissmann, Andrea Koehn, Marja Loderstedt, Cornelia Schwemmle, Gerrit Goetze, Sylva Bartel, Stefan K. Plontke, Joerg Langer, Klaus Begall, Peter Matulat, Friedrich-Wilhelm Roehl, Ulrich Vorwerk

http://bit.ly/2TnVpZ6

Thank you!

Publication date: March 2019

Source: International Journal of Pediatric Otorhinolaryngology, Volume 118

Author(s):

http://bit.ly/2BiRANA

Risk of occurrence and recurrence of otitis media with effusion in children suffering from cleft palate

Publication date: Available online 1 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Caroline Rieu-Chevreau, Nolwenn Lavagen, Cica Gbaguidi, Stéphanie Dakpé, Nathalie Klopp-Dutote, Cyril Page

http://bit.ly/2BiRxBo

Evaluation of hearing in pediatric familial Mediterranean fever patients during attack period and attack-free period

Publication date: Available online 1 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Asif Salimov, Umut Akyol, Bunyamin Cildir, Ezgi Deniz Batu, Seza Ozen

http://bit.ly/2TnVlbO

Direct and antibody-dependent cell-mediated cytotoxicity of head and neck squamous cell carcinoma cells by high-affinity natural killer cells

Publication date: March 2019

Source: Oral Oncology, Volume 90

Author(s): Jay Friedman, Michelle Padget, John Lee, Jeffrey Schlom, James Hodge, Clint Allen

Abstract

High affinity natural killer cells (haNKs) are a cell therapy product capable of mediating both direct and antibody-dependent cell-mediated cytotoxicity (ADCC). These cells may be particularly useful in tumors that escape T-cell anti-tumor immunity by harboring antigen processing and presentation defects. Here, we demonstrated that haNKs directly kill both HPV-positive and negative head and neck squamous cell carcinoma cells. Variable tumor cell sensitivity to haNK direct cytotoxicity did not correlated with MHC class I chain-related protein A or B (MICA or MICB) expression. Importantly, haNK killing was significantly enhanced via ADCC mediated by cetuximab or avelumab in cells with higher baseline EGFR or PD-L1 expression, respectively. The ability of IFNγ to induce tumor cell PD-L1 expression correlated with enhanced PD-L1-specific ADCC. IFNγ induced neither tumor cell EGFR expression nor EGFR-specific ADCC. Although a single dose of 8 Gy IR did not appear to directly enhance susceptibility to haNK killing alone, enhanced PD-L1- and EGFR-mediated ADCC after IR correlated with increased PD-L1 and EGFR expression in one of four models. This pre-clinical evidence supports the investigation of haNK cellular therapy in combination with ADCC-mediating mAbs, with or without IR, in the clinical trial setting for patients with advanced HNSCCs. Given the MHC-unrestricted nature of this treatment, it may represent an opportunity to treat patients with non-T-cell inflamed tumors.

http://bit.ly/2Rwfqux

The prevalence and impact of cervical spine pathologies in patients with nasopharyngeal carcinoma

Publication date: March 2019

Source: Oral Oncology, Volume 90

Author(s): Colin Shing-Yat Yung, Dennis Kwok Chuen Leung, Jason Pui Yin Cheung

Abstract

Objectives

Nasopharyngeal carcinoma (NPC) and its treatment can lead to cervical spine pathologies such as metastases, osteoradionecrosis (ORN) and infection. However, the occurrence rate and relationship between timing of diagnosis and outcomes of the ever-advancing technology of radiation therapy is largely unknown. Hence, the aim of this study is to determine the prevalence and impact of cervical spine pathologies in patients with NPC.

Materials and methods

This was a cross-sectional study of all newly diagnosed cases of NPC from 2007 to 2016 at a tertiary referral oncology and spine centre with minimum 1-year post-treatment follow-up. All cervical spine pathologies, their treatment and outcomes were determined. Presentation, onset time and correlations of the cervical spine pathologies with mortality and risk factors were also analysed.

Results

Out of 605 cases of verified cases of NPC, cervical spine pathologies were seen in 8.9% of patients. New onset neck pain was seen in 5.3%, symptomatic cervical spondylosis in 4.8%, cervical spine metastases in 2.5%, local tumour invasion in 0.8%, cervical ORN in 0.7%, osteomyelitis in 0.7%, radiculopathy in 0.3%, and myelopathy in 0.3%. Cervical spine pathologies were associated with an increased risk (odds ratio: 2.73) in overall mortality. Cervical spine metastases, invasion, ORN and infection were associated with significantly higher risk of mortality (p = 0.01–0.02).

Conclusion

Cervical spine pathologies in patients with NPC are heterogenous but not uncommon. Neck pain is prevalent but is often benign. ORN and osteomyelitis of the cervical spine is uncommon but have large clinical implications including higher mortality with subtle presentations.

http://bit.ly/2WCrhLx

Prognostic value of programed death ligand-1 and ligand-2 co-expression in salivary gland carcinomas

Publication date: March 2019

Source: Oral Oncology, Volume 90

Author(s): Takafumi Nakano, Katsumi Takizawa, Azusa Uezato, Kenichi Taguchi, Satoshi Toh, Muneyuki Masuda

Abstract

Objectives

The aim of the present study was to investigate the molecular basis for the use of immune checkpoint inhibitors to treat salivary gland carcinomas (SGC).

Materials and methods

We examined the clinical and prognostic significance of programed death ligands 1 and 2 (PD-L1 and -L2) expression using immunohistochemistry and in situ hybridization, as well as microsatellite instability (MSI) status using polymerase chain reaction, along with tumor-infiltrating lymphocytes (TILs) in 30 cases of SGC.

Results

The SGC cases studied included adenoid cystic carcinoma (AdCC, 36.7%), salivary duct carcinoma (SDC, 26.7%), mucoepidermoid carcinoma (MEC, 23.3%), and carcinoma ex pleomorphic adenoma (CxPA, 13.3%). Either PD-L1 or PD-L2 overexpression was observed in 36.7% patients. PD-L2 expression was associated with reduced disease-specific survival (DSS) and disease-free survival (DFS) (P = 0.0266 and P = 0.0209, respectively). Simultaneous PD-L1 and PD-L2 overexpression was detected in 13.3% of cases, and was correlated with reduced DSS (P = 0.0113). Among non-AdCCs, all cases that developed distant metastasis were positive for PD-L2 (P = 0.001). Cases showing low-TILs that were positive for either PD-L1 or L2 were associated with poor DFS. No MSI was detected in the SGC cases studied.

Conclusion

To our knowledge, this is the first comprehensive study examining PD-L1 and PD-L2 status, MSI status, and TILs in SGC. Our results indicate that the PD-1/PD-L1 or PD-L2 pathway, which is associated with poor clinical outcomes, may provide promising therapeutic targets against SGC in selected patients. Further experimental and clinical studies are encouraged.

http://bit.ly/2WBgJfs

Effect of prior cancer on trial eligibility and treatment outcomes in nasopharyngeal carcinoma: Implications for clinical trial accrual

Publication date: March 2019

Source: Oral Oncology, Volume 90

Author(s): Ya-Qin Wang, Jia-Wei Lv, Ling-Long Tang, Xiao-Jing Du, Lei Chen, Wen-Fei Li, Xu Liu, Ying Guo, Ai-Hua Lin, Yan-Ping Mao, Ying Sun, Yu-Pei Chen, Jun Ma

Abstract

Objective

In cancer trials, prior cancer is a common exclusion criterion. We evaluated the characteristics of prior cancer exclusion criteria in nasopharyngeal carcinoma (NPC) trials and determined its prognostic effect on patients with NPC.

Methods

We reviewed NPC trials for prior cancer exclusion criteria. Then we estimated the effect of prior cancer among NPC patients using the Surveillance, Epidemiology, and End Results database. Propensity score-matching was used to compensate for differences in baseline characteristics between patients with and without prior cancer.

Results

There were 109 clinical trials involving 10,437 patients; 49 trials (45%) excluded patients with prior cancer. Prior cancer exclusion was more common in recent or phase III trials. We identified 10,195 NPC patients; 6.2% had prior cancer. More than 70% of these cancers were in situ/localized/regional and diagnosed relatively close to the NPC diagnosis (median 3.3 years). Patients with certain prior cancer type (prostate, breast, gynecological, hematological), time of diagnosis (>5 years ago), or stage (in situ/localized) did not have inferior survival compared with patients with no prior cancer. We tested one form of prior cancer exclusion criteria in an NPC cohort resembling a modern trial population: it did not adversely affect overall and NPC-specific survival.

Conclusions

Many NPC trials excluded patients with prior cancer, which impacts trial accrual and generalizability. Our findings suggest that broader inclusion in trials of patients with NPC with prior cancer might not affect trial outcomes. More research is needed to understand the appropriateness of this exclusion policy across cancer types and trials.

http://bit.ly/2Rwfqe1

Cervical nodal metastasis after malignant conversion of sinonasal inverted papilloma: Report of a rare case and literature review

Publication date: March 2019

Source: Oral Oncology, Volume 90

Author(s): Daniel Sharbel, Vipawee Chat, Daniel Blumenthal, Paul Biddinger, J. Kenneth Byrd

Abstract

Malignant conversion of sinonasal inverted papilloma (SNIP) occurs in approximately ten percent of cases. These tumors are classically described as locally destructive, but without metastatic potential. Only four cases of malignant conversion with cervical nodal metastases have been described in the English literature. We present the rare case of a 61-year-old Caucasian male with a nasopharyngeal recurrence of malignant SNIP with cervical and retropharyngeal nodal metastases. The patient underwent endoscopic transpterygoid with nasoseptal flap reconstruction, followed by staged bilateral and retropharyngeal node dissection. Histopathology of the specimens demonstrated poorly differentiated invasive nonkeratinizing squamous cell carcinoma with inverted-type features. Three months after surgery, the patient suffered from C1-C2 fractures consistent with osteoradionecrosis and expired. Although the rate of malignant conversion of SNIP is low, this case highlights the need for aggressive, definitive treatment and surveillance.

http://bit.ly/2WBeJnz

Cartilage conduction as the third pathway for sound transmission

Publication date: Available online 2 February 2019

Source: Auris Nasus Larynx

Author(s): Hiroshi Hosoi, Tadashi Nishimura, Ryota Shimokura, Tadashi Kitahara

Abstract

It has been long considered that air and bone are the two major mediators that conduct sounds to the inner ear. In 2004, Hosoi found that vibration of aural cartilage, generated by placing gently a transducer on it, could create audible sound with the same level of clarity as air- and bone-conduction sound. He thus proposed the term "cartilage conduction" for this concept. This research identified a third mediator for sound conduction to the inner ear. Hosoi also proposed the development of novel communication devices, such as hearing aids, telephones, etc. using his findings.

For cartilage conduction, three sound pathways can be assumed. The transducer vibration may cause airborne sound which passes into the external auditory canal through the canal entrance (direct air pathway). Alternatively, the vibration at the cartilage may generate audible sound in the external auditory canal (cartilage-air pathway), or propagate directly to the inner ear through the skull bone (cartilage-bone pathway). A series of studies has illustrated that the cartilage-air pathway is dominant for hearing sensations in listeners with normal ears. The cartilage-bone pathway works for patients with bony aural atresia. A fourth pathway, the fibrotic-tissue pathway, is considered to act in the case of fibrotic aural atresia.

In this review, we summarize this series of studies and discuss the nature of cartilage conduction.

http://bit.ly/2G85PJ6

Development of conjunctivitis with a conjunctival proliferative lesion in a patient treated with dupilumab for atopic dermatitis

Publication date: Available online 2 February 2019

Source: Allergology International

Author(s): Ken Fukuda, Waka Ishida, Tatsuma Kishimoto, Atsuki Fukushima

http://bit.ly/2D2bUD7

Remerciements aux lecteurs

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s):

http://bit.ly/2SsuZIx

Thrombose post-traumatique du sinus sigmoïde par corps étranger transmastoïdien

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s): G. Badidi, S. Chabrier, J.M. Prades, A. Karkas

http://bit.ly/2GiBWoO

Infection nasosinusienne à burkholderia gladioli

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s): C. Zanotti, S. Munari, G. Brescia, U. Barion

Résumé

Introduction

Burkholderia gladioli est une bactérie aérobie gram-négative en bâtonnets, et non fermentaire, qui a été identifiée la première fois comme pathogène pour les plantes. La plupart des infections à B. gladioli rapportées dans la littérature concernent des adultes et des nouveau-nés immunodéprimés. Chez l'homme, B. gladioli est souvent associée à un pronostic défavorable.

Cas clinique

Nous décrivons le premier cas d'infection nasosinusienne due à B. gladioli et Staphylococcus aureus chez une patiente immunocompétente ayant fait un voyage récent au Congo.

Discussion

Comme dans les quelques autres cas rapportés impliquant des patients immunocompétents, la prise en charge adaptée pour cette infection à B. gladioli multirésistante était une combinaison de chirurgie et d'antibiotiques adaptés à l'antibiogramme.

http://bit.ly/2SnlJoT

Coloration noire récidivante de la langue et des dents

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s): R. Hervochon, Q. Lisan, F. Rubin

http://bit.ly/2GiBSFA

Une masse nasale atypique

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s): E. Drapier, M. Makeieff, X. Dubernard

http://bit.ly/2SjGrGi

Une localisation épiglottique asymptomatique inattendue dans le cadre d’une maladie de Kimura

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s): F. Dezoteux, R. Dubois, G. Lefèvre, J.P. Lecoutre, D. Staumont-Sallé, O. Carpentier

Résumé

Introduction

La maladie de Kimura est un syndrome lymphoprolifératif chronique d'étiologie inconnue qui affecte la peau et les ganglions lymphatiques. Il survient principalement chez les jeunes hommes d'origine asiatique. L'histoire naturelle de l'atteinte épiglottique asymptomatique n'est pas connue. Cette atteinte rare n'est souvent diagnostiquée que lorsque la croissance de la tumeur commence à obstruer les voies respiratoires supérieures.

Observation

Il s'agit d'un homme d'origine nord-africaine âgé de 34 ans présentant un tableau associant fatigue et multiples nodules cutanés fluctuants lentement progressifs dans les régions mandibulaires et rétroauriculaires droites. Un scanner cervical a confirmé une tumeur des tissus mous du corps mandibulaire droit et a également révélé un épaississement inattendu de l'épiglotte. La nasofibroscopie a confirmé les résultats de la tomodensitométrie et a montré un épaississement de l'épiglotte. Notre diagnostic de maladie de Kimura était basé sur l'examen histologique d'échantillons de biopsie prélevées sur la tumeur mandibulaire droite, un ganglion lymphatique cervical et l'épiglotte.

Discussion

La plupart des cas de maladie de Kimura avec atteinte épiglottique sont révélés par dysphonie et dysphagie. Il n'y a pas de consensus sur les examens complémentaires à effectuer. Cette observation soulève la question dépistage systématique des lésions dans des sites anatomiques inhabituels et potentiellement dangereux au cours de cette affection.

http://bit.ly/2Giybjm

Sinusalgies maxillaires radiotransparentes par agenesie de l’ostium membraneux

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s): R. Jankowski, C. Rumeau, D.T. Nguyen, P. Gallet

Résumé

Introduction

L'absence d'opacité scanographique lors du bilan de douleurs faciales conduit classiquement à éliminer une étiologie sinusienne. Nous rapportons une observation qui contredit cet adage et révèle une nouvelle cause de sinusalgie.

Observation

Un homme de 16 ans présentait un tableau de « sinusites aiguës hyperalgiques » récidivantes déclenchées par les changements de pression (altitude, plongée, surf), sans opacité sinusienne au scanner. Pourtant l'exploration chirurgicale a permis de constater l'absence de tout ostium maxillaire (principal ou accessoire). Une antrostomie chirurgicale a mis fin aux douleurs.

Discussion

La physiopathologie de ce faux tableau de « sinusites aiguës récidivantes » et l'efficacité de l'antrostomie s'expliquent par la théorie évo-dévo de la formation et du rôle des sinus paranasaux. Ce cas illustre une absence d'abouchement dans l'ethmoïde du sac membranaire tapissant la cavité sinusienne, formée après dégénérescence de la moelle érythropoïétique dans l'os maxillaire. La production permanente de monoxyde d'azote par l'épithélium sinusien est éliminée par simple diffusion transmembranaire en condition environnementale stable, mais insuffisamment lors des changements pressionnels rapides, provoquant des sinusalgies parfois hyperalgiques. Cette observation ouvre la voie à de plus amples études sur le rôle des sinus dans la pathologie faciale et la physiologie respiratoire.

http://bit.ly/2ShjF1G

Dacryocystocèle congénitale bilatérale

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s): P.C. de Sousa, M. Neves, D. Duarte, P. Azevedo

Résumé

Introduction

Les nouveau-nés respirent exclusivement par le nez. Une obstruction nasale peut donc entraîner une cyanose et une désaturation. Malgré le fait qu'elle soit très rare, la dacryocystocèle congénitale bilatérale est une étiologie possible du syndrome de détresse respiratoire chez le nouveau-né.

Résumé du cas clinique Il s'agit d'un nouveau-né de sexe masculin présentant une détresse respiratoire due à une lésion nasale polypoïde et bleuâtre bilatérale occupant la quasi-totalité des méats inférieurs. L'imagerie a confirmé une dacryocystocèle bilatérale. Le traitement a été symptomatique et une évacuation spontanée est survenue, améliorant la détresse respiratoire.

Discussion

Le diagnostic de dacryocystocèle congénitale est clinique bien que des examens d'imagerie puissent être demandés pour le confirmer. Le traitement est controversé en raison de l'évolution spontanément variable de la maladie. Une prise en charge symptomatique initiale peut être recommandée mais, en l'absence d'amélioration spontanée de l'obstruction des voies aériennes, une prise en charge chirurgicale est obligatoire.

http://bit.ly/2GgOQDT

Fraisage et contrôle du méat auditif interne par endoscope fixé

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s): X. Dubernard, J.-C. Kleiber, M. Makeieff, A. Bazin, A. Chays

Résumé

En cas de résection chirurgicale d'un schwannome vestibulaire par voie rétro sigmoïde, le contrôle des structures vestibulaires en particulier du canal semi-circulaire postérieur est impératif si l'objectif de conservation de l'audition s'ajoute à celui d'une exérèse tumorale totale. Le fraisage du méat acoustique interne (MAI) est une étape délicate au cours de laquelle les structures vestibulaires peuvent être involontairement ouvertes. L'orientation du MAI explique la formation de zone d'ombre propice à leur ouverture si le fraisage est réalisé au microscope. L'endoscopie portée expose en totalité la zone opératoire mais bloque l'une des mains du chirurgien rendant la chirurgie délicate. L'endoscopie fixée est une solution permettant de rendre au chirurgien sa liberté opératoire tout en garantissant un contrôle précis de son geste. Elle permet le repérage et le contournement des structures vestibulaires tout en étant au plus près de la tumeur. Le schwannome peut se laisser cliver en totalité, le fond du MAI étant correctement contrôlé tout en respectant le nerf facial et le nerf cochléaire.

http://bit.ly/2SjGge6

Reconstruction de la paroi antérieure du sinus frontal par prothèse en titane sur-mesure après exérèse d’un ostéome géant du sinus frontal

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s): J. Fanchette, B. Faucon, F. Cartry, M. Ratajczak

Résumé

L'ostéome est une tumeur osseuse bénigne, fréquemment rencontrée au niveau naso-sinusien, le plus souvent asymptomatique. Le traitement est chirurgical et s'impose lorsque le patient devient symptomatique ou présente des complications opthalmologiques ou neurologiques. Bien que l'approche endoscopique soit de plus en plus utilisée si la localisation et/ou la taille de l'ostéome le permettent, la chirurgie par voie ouverte peut être préférable et reste encore la référence. Nous présentons dans cette note technique un cas d'ostéome géant du sinus frontal ayant nécessité une exérèse par voie bicoronale, avec reconstruction par une prothèse en titane réalisée sur-mesure.

http://bit.ly/2GnaGW6

Quelle place pour l’ambulatoire en chirurgie plastique et reconstructrice de la face et du cou en France ?

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s): O. Malard, G. Michel, F. Espitalier

Résumé

Cette mise au point propose d'expliciter des grands principes qui régissent en 2018 la réalisation des soins ambulatoires dans le système de santé français, spécifiquement dans le domaine de la chirurgie plastique et esthétique de la face et du cou. Les aspects réglementaires historiques et l'évolution au cours des dernières années sont exposés, ainsi que les tendances et les attentes des autorités sanitaires pour les années à venir. L'essentiel des contraintes liées à l'exécution des actes en ambulatoire sont communs aux différentes spécialités chirurgicales. La chirurgie plastique et esthétique de la face et du cou n'y déroge pas. Parmi ces contraintes, outre les aspects purement techniques liés à l'acte chirurgical et anesthésique, il faut compter sur l'autorisation du site, l'organisation de la continuité des soins, l'environnement du patient… Dans son rapport de 2012 sur l'évaluation de la tarification des soins hospitaliers et des actes médicaux, l'IGAS, rappelle que : « La chirurgie ambulatoire devient la norme, l'hospitalisation traditionnelle est le défaut » afin de satisfaire à l'exigence « Soigner plus sans dépenser plus ». L'acte ambulatoire en chirurgie plastique et de reconstruction peut être considéré comme accessible à une majorité de patients, mais demeure un acte sous conditions.

http://bit.ly/2Sm8NQ2

Facteurs de risque de sévérité de la papillomatose respiratoire récidivante juvénile lors de la première endoscopie

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s): E. Moreddu, E. Lambert, D. Kacmarynski, R. Nicollas, J.-M. Triglia, R.J. Smith

Résumé

Objectifs

L'objectif de cette étude était de définir les facteurs de risque de sévérité de la papillomatose respiratoire récidivante (PRR) juvénile lors de la première évaluation endoscopique.

Matériels et méthodes

Il d'agit d'une revue de tous les cas opérés pour PRR juvénile dans deux centres d'oto-rhino-laryngologie pédiatrique situés aux États-Unis et en France. Le nombre d'étages laryngés atteints, l'extension sous-glottique et la bilatéralité des lésions ont été analysés comme facteurs de risque de sévérité.

Résultats

Trente-deux patients ont été inclus, pour un total de 571 procédures endoscopiques. Le nombre d'endoscopies par patient était différent selon l'extension initiale de la maladie : 30,67 procédures quand les 3 étages laryngés étaient atteints, 15,57 procédures quand 2 étages étaient atteints et 14,08 quand un seul étage était atteint (p = 0,03). L'odds ratio du risque de subir plus de 14 procédures était de 20,43 (p = 0,047) quand les 3 étages étaient atteints. Les patients présentant une extension sous-glottique des lésions avaient tendance à nécessiter plus de procédures (23,67 contre 15,56, p = 0,16).

Conclusions

La sévérité de la PRRJ est corrélée à l'extension initiale des lésions papillomateuses lors de la première endoscopie. Cette observation a permis de créer une échelle d'évaluation rapide composée de 3 items, complémentaire de l'échelle de Derkay.

http://bit.ly/2GiX8eh

Ablation chirurgicale des amygdales linguales dans le traitement du syndrome d’apnées obstructives du sommeil

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s): C. Mure, M. Blumen, L. Page, F. Chabolle

Résumé

Objectifs

L'espace rétro-basilingual peut être un site obstructif dans le syndrome d'apnées obstructives du sommeil (SAOS) et les amygdales linguales (AL) sont des structures anatomiques qui, quand elles sont hypertrophiées, peuvent y contribuer. L'objectif de cette étude est de mesurer l'efficacité et la tolérance de l'ablation des AL dans le SAOS.

Matériels et méthodes

Nous avons réalisé une étude rétrospective basée sur l'analyse des dossiers médicaux des patients opérés des AL. Nous avons inclus les patients porteurs d'un SAOS confirmé par un enregistrement du sommeil en échec ou refus de traitement médical. L'hypertrophie des AL était diagnostiquée par un examen clinique avec une naso-fibroscopie complété d'une IRM et d'une endoscopie sous sédation (ES). L'intervention chirurgicale était réalisée par voie endoscopique avec utilisation du laser diode ou de la coblation. Le critère de jugement principal était la baisse de l'index d'apnées-hypopnées (IAH) à 6 mois sur l'enregistrement du sommeil. Les critères secondaires étaient la diminution du ronflement, le score de somnolence diurne d'Epworth et la tolérance post-opératoire.

Résultats

Onze patients, âgés de 44,3 ± 12,6 ans, ont été inclus. Nous avons observé une baisse de l'IAH de 29,5 ± 21,7/h à 11,6 ± 9,6/h, soit une réduction de 60 % (p = 0,005). Cinq patients avaient un IAH inférieur à 10/h soit 45 % de guérison complète. Le score d'Epworth a baissé de 13 ± 3,4 à 8,1 ± 4,9 (p = 0,012). Il n'y a eu aucune complication.

Conclusion

Dans le cas d'un SAOS en échec de traitement médical avec une obstruction rétro-basilinguale, l'ablation des AL paraît être un traitement efficace.

Niveau de preuve

4.Mots clés: Amygdales linguales; Apnées du sommeil; Traitement chirurgical, Espace rétro-basilingual

http://bit.ly/2SjG7Y6

Intérêt de la vidéo-otoscopie en médecine générale

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s): L. Damery, E. Lescanne, K. Reffet, C. Aussedat, D. Bakhos

Résumé

Introduction

Le rôle des omnipraticiens est primordial dans la prise en charge des pathologies otologiques. Il demeure cependant des insuffisances diagnostiques concernant les tympans pathologiques. L'objectif de ce travail était de comparer la qualité des diagnostics otoscopiques réalisés par des omnipraticiens avec l'otoscopie conventionnelle versus la vidéo-otoscopie.

Sujets et méthode

Onze généralistes ont examiné 124 patients (193 otoscopies) présentant des plaintes otologiques. Ils devaient réaliser l'examen à l'otoscope puis à la vidéo-otoscopie. Après chacun de ces examens, une grille composée de 10 critères était remplie et un diagnostic était proposé. Chaque cliché issu de la vidéo-otoscopie était relu par 2 ORL qui devaient remplir la même grille et poser un diagnostic. L'appréciation de la vidéo-otoscopie, par les médecins généralistes, était effectuée par une échelle de Likert.

Résultats

Il n'existait pas de différence significative entre les résultats des 3 groupes (otoscopie conventionnelle, vidéo-otoscopie et ORL) sur l'ensemble des examens. Concernant l'analyse des tympans pathologiques, il existait une différence significative entre les résultats des ORL et ceux des omnipraticiens utilisant un otoscope (p = 0,0032). En revanche, il n'était pas mis en évidence de différence entre les scores des omnipraticiens et des ORL dans l'interprétation des tympans issus de la vidéo-otoscopie (p = 0,0754). L'ensemble des omnipraticiens était conquis par cet outil diagnostic même s'ils n'étaient pas décidés à en faire l'acquisition.

Conclusion

La vidéo-otoscopie montre sa supériorité par rapport à l'otoscopie conventionnelle concernant l'interprétation des tympans pathologiques.

http://bit.ly/2GiThy7

Cancer du larynx d’origine professionnelle : tendances en France de 2001 à 2016

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s): J. Grignoux, Q. Durand-Moreau, N. Vongmany, S. Brunel, membres du RNV3P, J.-D. Dewitte

Résumé

Objectifs

Dans le cadre du plan cancer 2014–2019 et de l'amélioration des connaissances en cancérologie professionnelle, nous avons analysé les situations professionnelles à risque de cancer du larynx recensé dans le réseau national de vigilance et de prévention des pathologies professionnelles (RNV3P) de 2001 à 2016.

Matériel et méthodes

L'étude a porté sur les cas de cancers du larynx d'origine professionnelle avec une exposition jugée par le médecin expert en lien direct avec la pathologie (imputabilité moyenne ou forte). Ont été analysés les données démographiques, les circonstances d'exposition professionnelle (nuisances, poste de travail, secteur d'activité), les facteurs de risque extraprofessionnels et l'avis pour une déclaration de maladie professionnelle.

Résultats

Entre 2001 et 2016, 244 cancers du larynx ont été enregistrés. Cent quarante-sept cas ont été conclus d'origine professionnelle dont 87 jugés avec une imputabilité moyenne ou forte. Cette population est exclusivement masculine, d'un âge médian de 59 ans. On recense 97 expositions différentes dont l'amiante pour 78 cas. Les secteurs d'activité majoritaires sont ceux des travaux de construction spécialisés (14 cas) et de la métallurgie (7 cas). Une déclaration de maladie professionnelle a été conseillée à 60 patients et l'amiante est retrouvé dans 80 % des demandes.

Conclusion

L'amiante est le facteur de risque de cancer du larynx le plus décrit dans le réseau de 2001 à 2016. Notre étude confirme l'implication de l'amiante dans la cancérogénicité du larynx, une réflexion sur la création d'un tableau de maladie professionnelle en France paraîtrait ainsi légitime à l'instar de pays voisins européens.

http://bit.ly/2SjG3aO

Évaluation de la déglutition des patients opérés d’une pharyngolaryngectomie totale circulaire. Étude multicentrique du GETTEC

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s): S. Morinière, P. Gorphe, F. Espitalier, D. Blanchard, N. Fakhry, N. Saroul, C. Bach, X. Dufour, C. Fuchsmann, S. Vergez, S. Albert

Résumé

But

Les pharyngolaryngectomies totale circulaires sont réalisées pour des tumeurs évoluées du pharynx ou dans un contexte de récidive post-radique. Plusieurs procédés de reconstruction du pharynx par lambeau libres ou pédiculés sont utilisés et sont choisis selon l'opérateur. Cette étude a pour but d'évaluer les résultats fonctionnels sur la déglutition à long terme de ces patients en fonction du type de lambeau utilisé pour la reconstruction.

Matériel et méthode

Une étude rétrospective multicentrique a été menée de janvier à septembre 2016 dans le groupe Gettec. Tous les patients opérés d'une pharyngolaryngectomie totale circulaire et en rémission étaient inclus et devaient remplir le questionnaire du déglutition handicap index (DHI) et avoir une fibroscopie de déglutition. 46 patients (39 hommes 7 femmes) ont été inclus pendant cette période. Le lambeau ante-brachial tubulisé (groupe LABT) était utilisé dans 19 cas, le grand pectoral en fer à cheval (groupe LGP) dans 15 cas et le jéjunum libre (groupe LJL) dans 12 cas.

Résultats

Le DHI moyen était de 24 : 20 groupes LABT, 23 groupes LJL, 25 groupes LGP, sans différence significative ; 27 patients avaient une déglutition normale, 9 mixée, 8 liquide, 3 étaient alimentés par gastrostomie. La nasofibroscopie de la déglutition obtenait un pourcentage de patient avec une déglutition normale de salive et de yaourt significativement plus important pour les patients reconstruits avec un lambeau libre (LJL et LABT) par rapport au groupe LGP (p = 0,04).

Conclusion

Cette étude a montré que le type de lambeau de reconstruction d'une pharyngolaryngectomie totale circulaire n'a pas d'impact sur la qualité de la déglutition postopératoire évaluée par le patient par autoquestionnaire du DHI.

http://bit.ly/2GmQbct

Menaces sur le facteur d’impact ?

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s): O. Laccourreye, H. Maisonneuve

http://bit.ly/2SjFUEi

Editorial Board

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s):

http://bit.ly/2GgOw89

Spontaneous remission in diffuse large cell lymphoma: a case report

Spontaneous remission in solid malignancies has been documented. However, spontaneous remission in aggressive diffuse large b cell lymphoma is exceedingly rare. Previous reports of lymphoma remission suggest t...

http://bit.ly/2WAujQq

Tetra‐arsenic tetra‐sulfide Ameliorates Lupus Syndromes by Inhibiting IL‐17 producing Double Negative T cells

Abstract

Systemic lupus erythematosus (SLE) is an autoimmune disease of uncertain etiology that affects multiple tissues and organs. Tetra‐arsenic tetra‐sulfide (As₄S₄), a traditional Chinese medicine, is effective on acute promyelocytic leukemia with mild side effects. In our previous study, BXSB lupus‐prone mice treated with As₄S₄ has showed improved monocytosis, decreased serum interleukin‐6 (IL‐6) and suppressed skin, liver and renal lesions with well‐tolerance. In this study, we explored the effect and mechanism of As₄S₄ on the MRL/lpr mice. MRL/lpr and wild MRL/MpJ mice were divided into control and As₄S₄ treatment groups and dosed with As₄S₄ or placebo for 8 weeks. We found that As₄S₄ prevented the skin, renal and lung lesions of MRL/lpr mice. As₄S₄ significantly decreased the double negative T (DN T) cells and reduced the serum levels of IL‐17, IL‐10, and antinuclear antibodies (ANA) titer. Further results revealed that the FasL was decreased, and activated caspases elevated in DN T cells in As₄S₄ treated MRL/lpr mice. Taken together, As₄S₄ could selectively suppresses DN T cells by inducing apoptosis. It also reduced inflammatory cytokines IL‐17, which may be produced by DN T cells. As₄S₄ may represent a new therapy for SLE.

This article is protected by copyright. All rights reserved.

http://bit.ly/2t0qI0f

Oropharyngeal histoplasmosis: a report of 10 cases

Summary

A wide differential diagnosis must be entertained in patients with unusual oral and pharyngeal ulcerations. A mucosal biopsy is essential. We retrospectively reviewed 10 cases from the Infectious Diseases Division at Mayo Clinic Rochester (MN, USA), in which the diagnosis proved to be Histoplasma capsulatum infection. Between 1995 and 2016, 10 patients were diagnosed with oropharyngeal histoplasmosis. Common presenting symptoms included weight loss, weakness and oropharyngeal pain with ulcerations. Despite specialty evaluation at other facilities, diagnostic delay occurred in six patients due to lack of biopsy or fungal staining. Yeast forms consistent with H. capsulatum were identified in the biopsy specimens of all our patients. Treatment included intravenous amphotericin B and prolonged courses of azoles. Oral histoplasmosis occurred in both immunocompetent and immunosuppressed patients, and was a manifestation of disseminated infection. Severe pain involving all areas of the mouth was typical. Diagnostic delay may be avoided by early biopsy using fungal stains.

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Wanted, dead and alive; why a multidisciplinary approach is needed to unlock hair treatment potential

Abstract

Human recorded history is littered with attempts to improve the perceived appearance of scalp hair. Throughout history treatments have included both biological and chemical interventions. Hair "quality" or "perceived appearance" is regulated by multiple biological intervention opportunities: adding more hairs by flipping follicles from Telogen to Anagen, or delaying Anagen follicles transiting into Catagen; altering hair "apparent amount" by modulating shaft diameter or shape; or, in principle, altering shaft physical properties changing its synthesis. By far the most common biological intervention strategy today is to increase the number of hairs, but to date this has proven difficult and has yielded minimal benefits. Chemical intervention primarily consists of active material surface deposition to improve shaft shine, fibre‐fibre interactions, and strength. Real, perceptible benefits will best be achieved by combining opportunity areas across the three primary sciences: biology, chemistry, and physics. Shaft biogenesis begins with biology: proliferation in the germinative matrix, then crossing "Auber's Critical Line" and ceasing proliferation to synthesize shaft components. Biogenesis then shifts to oxidative chemistry, where previously synthesized components are organized and cross‐linked into a shaft. We herein term the crossing point from biology to chemistry as "The Orwin Threshold". Historically, hair biology and chemistry have been conducted in different fields, with biological manipulation residing in biomedical communities and hair shaft chemistry and physics within the consumer care industry, with minimal cross‐fertilization. Detailed understanding of hair shaft biogenesis should enable identification of factors necessary for optimum hair shaft production and new intervention opportunities.

This article is protected by copyright. All rights reserved.

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Microneedle fractional radiofrequency treatment of facial photoageing as assessed in a split‐face model

Summary

Background

A new therapeutic device passes radiofrequency energy through microneedles to targeted tissue. Three‐dimensional photography may be useful for evaluating the clinical efficacy of microneedle fractional radiofrequency (MFR) used on the appearance of rhytids and to improve facial laxity.

Aim

To evaluate the efficacy and safety of MFR in the treatment of facial photoageing.

Methods

In total, participants with facial photoageing were enrolled in the study. All volunteers were randomized to receive split‐face treatments with MFR 2 months apart. The participants self‐evaluated at baseline, Days 1–7, and Months 1 and 3 after the final treatment. Objective evaluation was provided by a three‐dimensional in vivo imaging system. In addition, skin melanin index, erythema index, immediate reactions, healing times and other adverse effects were evaluated.

Results

Compared with the untreated side, the treated side of most participants improved, based on clinical assessments at the 1‐ and 3‐month follow‐up visits after treatment. Both objective and participative assessments were satisfactory. The participants demonstrated a decrease of roughness parameter (Sa) value at each follow‐up visit. Compared with pretreatment value, Sa decreased significantly at Months 1 and 3 on the treated side (P < 0.05). Minimal and reversible adverse effects and rapid healing were recorded.

Conclusions

MFR appears to be an excellent treatment for photodamaged facial skin in Chinese patients.

http://bit.ly/2HKJ7IY

Sunburn and sun protection in black skin

Abstract

Background

People with black skin are much less susceptible to sunburn than white‐skinned individuals, yet there are scarce data on self‐reported incidence of sunburn and sun protection measures in people with deeply‐pigmented skin.

Method

An on‐line survey tool was used to collect self‐assessed data about demographic variables, sunburn incidence, and use of sun protection modalities.

Results

Two‐thirds of respondents with black skin living in the UK claimed never to have been sunburnt; a much higher proportion than those living in South Africa and Nigeria where 34 and 46%, respectively, reported never experiencing sunburn. Similar results were seen in the reported use of sun protection measures between the countries with two‐thirds of black people living in the UK claiming they never used any form of sun protection compared with about one‐third of Black Africans. Black people living in the UK were more likely to use sunscreen as a form of sun protection, whereas sunscreen was the least popular modality in the two African countries with shade being the most common form of limiting sun exposure.

Conclusion

The findings provide some insight into the complexities of skin color perception, incidence of sunburn, and sun protection use among people with deeply‐pigmented skin living in three countries with large differences in the solar UV environment.

http://bit.ly/2TqyIU4

Painful burning sensation on a tattoo during magnetic resonance imaging

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An evaluation of long‐term outcomes and recurrence rates in patients with morphea

http://bit.ly/2TzpNzu

Modified Z‐plasty of the internal nasal valve ‐ to treat mechanical nasal obstruction: How we do it

Abstract

The internal nasal valve (INV) is bound by the nasal septum, inferior turbinate and the upper lateral cartilage (ULC). It is the most important determinant of nasal airflow, and critical for nasal breathing. The normal internal nasal valve angle is 10‐15^o.¹ Even a small change in the INV angle can have a significant impact on nasal airflow.

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Understanding roofers’ sun protection behaviour: A qualitative study

Abstract

The incidence of keratinocyte carcinoma (KC), which includes squamous cell carcinoma (SCC), basal cell carcinoma (BCC), and actinic keratosis (AK), has steadily increased in the last few decades; moreover, KC is the most common malignancy in Caucasians worldwide.¹ As exposure to solar ultraviolet radiation (UVR) is the main risk factor for KC,² outdoor workers bear a high risk for KC.^2,3 Therefore, SCC and AK were officially recognised as occupational diseases in Germany in 2015.³ Despite several efforts to improve sun protection behaviour (SPB),⁴ it remains insufficient among outdoor workers, particularly among those in younger age groups.^4,5 As roofing is one of the most UVR‐exposed professions in Germany,⁶ behavioural change among roofers regarding sun protection is essential.

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http://bit.ly/2t1cj47

Atenolol treatment for severe infantile hemangiomas: comparison with a propranolol group of our centre

Abstract

Infantile hemangiomas (IHs) are common benign vascular tumors of infancy¹. Although most of them tend to resolve spontaneously, it is estimated that approximately 10% require intervention due to complications or disfigurements^2‐4. The discovery of the inhibitory effects of propranolol, a non selective b blocker, during the prolipherative phase of IHs was an important development in the treatment of IHs, though its mechanism of action is not yet clear⁴.

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The influence of adalimumab on the expression profile of mRNAs and miRNAs related to the IL‐12 and IL‐ 23 signal paths

Abstract

This study was financed by the Medical University of Silesia in Katowice/Poland on the basis of decision no. KNW‐1‐029/N/6/O. This research was supported in part by PLGrid Infrastructure.

Consent of the Bioethics Commission of Medical University of Silesia in Katowice/Poland no KNW/0022/KB1/59/I/13/14. Informed consent was obtained from all of the patients recruited.

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http://bit.ly/2HHsbTs

MULTISYSTEM NON‐ARTHROPATHIC RETICULOHISTIOCYTOSIS Problems and pitfalls in the differential diagnosis of multisystem non‐Langerhans cell histiocytoses

Abstract

Histiocytoses are rare proliferative disorders of the mononuclear‐phagocyte system. Within non‐Langerhans‐cell histiocytoses (NLCH), multisystem (MS) cases potentially constitute a subset at high risk of complications and progression. The current 2016 revised classification subdivides histiocytoses in 5 groups, based on highly heterogeneous criteria. Within MS‐NLCH, the "L‐group" includes Erdheim‐Chester disease (ECD) together with Langerhans‐cell histiocytosis, due to their molecular similarity; disseminated juvenile xanthogranuloma, xanthoma disseminatum and multicentric reticulohistiocytosis belong to the "C‐group", because of their predominant dermatological presentation; and lastly, MS‐Rosai‐Dorfman disease (RDD) is listed in the specific "R‐group" due to clinical and pathological findings. However, from a histopathological point of view, MS‐NLCH may be divided into three categories: foamy‐cell NLCH (e.g. ECD), Reticulohistiocytoses and RDD.

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Efficacy of photodynamic therapy combined with topical interventions for the treatment of actinic keratosis: a meta‐analysis

Abstract

Background

Photodynamic therapy (PDT) is a highly effective treatment option for patients with actinic keratoses (AK). However, efficacy can be reduced by insufficient illumination or hyperkeratotic nature of lesions.

Objectives

To investigate if PDT combined with a topical intervention is superior to monotherapy in terms of efficacy and tolerability.

Methods

A systematic literature research was conducted in Medline, Embase, and CENTRAL. Pertinent trial registers were hand‐searched for eligible randomized controlled trials (RCTs) until 20 August 2018. Results were pooled using a random‐effects model to calculate relative risks (RR) or mean differences. The risk of bias was assessed with the Cochrane Risk of Bias Tool. The quality of evidence was estimated for each outcome of interest according to GRADE.

Results

Out of 1,800 references initially identified, 10 RCTs with a total sample size of n=277 were included. Four studies investigated a combination of PDT with imiquimod cream, three with 5‐fluorouracil cream, and one each with ingenol mebutate gel, tazarotene gel, and calcipotriol ointment, respectively. Patients treated with a combination showed higher participant complete (RR 1.63; 95% CI 1.15‐2.33; p=0.007) and partial clearance rates (RR 1.19; 95% CI 0.84‐1.67; p=0.33). Similarly, the lesion‐specific clearance was higher for PDT plus topical intervention compared to monotherapy (RR 1.48; 95% CI 1.04‐2.11; p=0.03). A subgroup analysis was performed for PDT combined with imiquimod, revealing an increased participant complete clearance rate compared to monotherapy (RR 1.57, 95% CI 1.09‐2.25, p=0.02). PDT‐induced pain and local skin reactions after treatment were poorly reported. The studies were estimated at high risk for performance and detection bias.

Conclusion

The combination of PDT with another topical drug intervention does improve AK clearance rates compared to either monotherapy alone. This study highlights that the sequential application of two field‐directed treatments represents an efficient approach in patients with multiple AK and field cancerization.

This article is protected by copyright. All rights reserved.

http://bit.ly/2HOKXZ9

The effects of a multidisciplinary high‐throughput skin clinic on healthcare costs of organ transplant recipients

Abstract

Background

A long‐term complication among organ transplant recipients (OTRs) is skin malignancies which are associated with level and duration of immunosuppressive treatment, sun exposure and age. Dermatological surveillance is recommended for OTRs at high risk of skin malignancies, but evidence is lacking on the benefits of such services.

Objective

To examine the economic impact on patients and on the hospital service of a multidisciplinary high‐throughput skin cancer Clinic in Brisbane, Australia, dedicated to dermatological and surgical care of high‐risk OTRs.

Methods

In a pre‐post design, hospital admission and cost data were obtained for 101 consecutively‐enrolled study participants from 12 months prior to the introduction of the Clinic (to February 2016), the 3‐month 'run‐in' period (March to May 2016), and 12 months subsequent (to June 2017). Differences between pre‐ and post‐Clinic hospital costs were tested using non‐parametric bootstrapping and interrupted time series analysis. A survey of patient out‐of‐pocket costs and perceived financial burden was also undertaken during the Clinic.

Results

Overall hospital costs were higher after the Clinic but 3‐monthly hospital costs for skin procedures trended downwards. Despite 3‐monthly mean hospital visits increasing from 85 to 314, mean 3‐monthly costs reduced by AU$1,491 (p<0.001) indicating greater cost‐efficiency. Total patient out‐of‐pocket costs were AU$18,377 over 3 months.

Conclusion

Clinical costing data revealed higher, more rapid throughput, and significantly lower per patient costs pre‐ and post‐ establishment of a multidisciplinary skin cancer Clinic for OTRs.

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http://bit.ly/2HLavGx

Goblet Cell Hyperplasia as a feature of neutrophilic asthma

Abstract

Background

Goblet Cell Hyperplasia (GCH) is a pathological finding classically reported across asthma severity levels and usually associated with smoking. Multiple biological mechanisms may contribute to excessive mucus production.

Objective

We aimed to decipher the clinical meanings and biological pathways related to GCH in non smokers with asthma.

Methods

Cough And Sputum Assessment Questionnaire (CASA‐Q) responses at entry and one year later were compared to clinical and functional outcomes in 59 asthmatic patients. GCH was assessed through PAS‐staining on endobronchial biopsies obtained at entry in a subset of 32 patients.

Results

PAS staining analysis revealed a double wave distribution discriminating patients with (>10% of the epithelial area) or without GCH. CASA‐Q scores were mostly driven by overall asthma severity (p<.0001). CASA‐Q scores remained stable at one year and was independently associated with BAL eosinophil content irrespective of the presence of GCH. GCH was unrelated to the presence of bronchiectasis at CT, GERD or chronic rhinosinusitis, but correlated well with neutrophilic inflammatory patterns observed upon BAL cellular analysis (p=.002 at multivariate analysis). BALF bacterial loads were unrelated to GCH or to CASA‐Q.

Conclusions and clinical relevance

GCH is disconnected from chronic cough and sputum when assessed by a specific questionnaire. GCH is related to neutrophilic asthma whereas symptoms are related to airway eosinophilia. The clinical counterpart of GCH is unlikely assessed by the CASA‐Q.

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http://bit.ly/2HO67qg

A contemporary review of machine learning in otolaryngology–head and neck surgery

One of the key challenges with big data is leveraging the complex network of information to yield useful clinical insights. The confluence of massive amounts of health data and a desire to make inferences and insights on these data has produced a substantial amount of interest in machine‐learning analytic methods. There has been a drastic increase in the otolaryngology literature volume describing novel applications of machine learning within the past 5 years. In this timely contemporary review, we provide an overview of popular machine‐learning techniques, and review recent machine‐learning applications in otolaryngology–head and neck surgery including neurotology, head and neck oncology, laryngology, and rhinology. Investigators have realized significant success in validated models with model sensitivities and specificities approaching 100%. Challenges remain in the implementation of machine‐learning algorithms. This may be in part the unfamiliarity of these techniques to clinician leaders on the front lines of patient care. Spreading awareness and confidence in machine learning will follow with further validation and proof‐of‐value analyses that demonstrate model performance superiority over established methods. We are poised to see a greater influx of machine‐learning applications to clinical problems in otolaryngology–head and neck surgery, and it is prudent for providers to understand the potential benefits and limitations of these technologies. Laryngoscope, 2019

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Long‐term quality of life after definitive treatment of sinonasal and nasopharyngeal malignancies

Objective

To evaluate long‐term global and site‐specific health‐related quality of life (HRQoL) in patients treated for sinonasal and nasopharyngeal malignancies.

Study Design

Cross‐sectional.

Methods

One hundred fourteen patients with sinonasal and nasopharyngeal malignancies received surgery, radiation, systemic chemotherapy, or a combination thereof, with curative intent. Validated global ([EuroQol‐5D] Visual Analogue Scale [EQ‐5D VAS]) and disease‐specific instruments (MD Anderson Symptom Inventory–Head and Neck [MDASI‐HN], Anterior Skull Base Questionnaire [ASBQ]) were administered to patients who were both free of disease and had completed treatment at least 12 months previously. Associations between instruments, instrument domains, and specific clinical parameters were analyzed.

Results

The median age was 55 years. The mean EQ‐5D VAS, MDASI‐22 composite score, and ASBQ score were 74 (standard deviation [SD] 21), 48 (SD 36), and 130 (SD 27), respectively. The most frequently reported high‐severity items in MDASI‐HN were dry mouth and difficulty tasting food. The most frequently reported high‐severity items in ASBQ were difficulty with smell and nasal secretions. Advanced Tumor (T) classification was associated with worse overall ASBQ sum score (P = 0.02). ASBQ performance at home and MDASI‐HN drowsy symptom items independently predicted worse global HRQoL as measured by the EQ‐5D VAS (P < 0.001).

Conclusion

Global HRQoL for survivors of sinonasal and nasopharyngeal malignancies after multimodality treatment approximates that of the U.S. population for the same age group. ASBQ and MDASI‐HN correlate well with global HRQoL outcomes as measured by EQ‐5D VAS. MDASI‐HN and ASBQ elicited unique symptoms, highlighting the complex symptom burden experienced by these patients. Further studies should identify patients predisposed to reduced long‐term QOL.

Level of Evidence

3. Laryngoscope, 2019

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Clear fluids fasting for elective paediatric anaesthesia: The European Society of Anaesthesiology consensus statement

No abstract available

http://bit.ly/2SpJBYQ

Maternal anaesthesia in open and fetoscopic surgery of foetal open spinal neural tube defects: A retrospective cohort study

BACKGROUND Prenatal myelomeningocele repair by open surgery can improve the neurological prognosis of children with this condition. A shift towards a fetoscopic approach seems to reduce maternal risks and improve obstetric outcomes. OBJECTIVE The aim of this study was to report on the anaesthetic management of women undergoing prenatal open or fetoscopic surgery for neural tube defects. DESIGN A retrospective cohort study. SETTING Prenatal myelomeningocele repair research group, Vall d'Hebron University Hospital, Spain. INTERVENTION Intra-uterine foetal repairs of spina bifida between 2011 and 2016 were reviewed. Anaesthetic and vasoconstrictor drugs, fluid therapy, maternal haemodynamic changes during surgery, blood gas changes during CO2 insufflation for fetoscopic surgery, and maternal and foetal complications were noted. RESULTS Twenty-nine foetuses with a neural tube defect underwent surgery, seven (24.1%) with open and 22 (75.9%) with fetoscopic surgery. There were no significant differences in maternal doses of opioids or neuromuscular blocking agents. Open surgery was associated with higher dose of halogenated anaesthetic agents [maximum medium alveolar concentration (MAC) sevoflurane 1.90 vs. 1.50%, P = 0.01], higher need for intra-operative tocolytic drugs [five of seven (71.4%) and two of 22 (9.1%) required nitroglycerine, P = 0.001], higher volume of colloids (500 vs. 300 ml, P = 0.036) and more postoperative tocolytic drugs (three drugs in all seven cases (100%) of open and in one of 21 (4.76%) of fetoscopic surgery, P 

http://bit.ly/2GiAJOv

Use of the Totaltrack VLM as a rescue device following failed tracheal intubation

No abstract available

http://bit.ly/2SeJ9Nh

Epidemiology and incidence of severe respiratory critical events in ear, nose and throat surgery in children in Europe: A prospective multicentre observational study

BACKGROUND Ear, nose and throat (ENT) surgery, the most frequently performed surgical procedure in children, is a strong predictor for peri-operative respiratory complications. However, there is no clear information about peri-operative respiratory severe critical events (SCEs) associated with anaesthesia management of ENT children in Europe. OBJECTIVE To characterise the epidemiology and incidence of respiratory SCEs during and following ENT surgery in Europe and to identify the risk factors for their occurrence. DESIGN A secondary analysis of the Anaesthesia PRactice In Children Observational Trial, a prospective observational multicentre cohort trial. SETTING The study included 261 centres across 33 European countries and took place over a consecutive 2-week recruitment period between April 2014 and January 2015. PATIENTS We extracted data from 5592 ENT surgical procedures that were performed on 5572 children aged 6.0 (3.6) years (mean (SD)) from the surgical database and compared these with data from 15 952 non-ENT surgical children aged 6.7 (4.8) years. MAIN OUTCOME MEASURES The primary outcome was the incidence of respiratory SCEs (laryngospasm, bronchospasm and new onset of postoperative stridor). Secondary outcomes were the differences in epidemiology between ENT children and non-ENT surgical children and the risk factors for the occurrence of respiratory SCEs. RESULTS The incidence (95% confidence interval) of any respiratory SCE (laryngospasm, bronchospasm and postoperative stridor) was 3.93% (3.46 to 4.48) and was significantly higher than that observed in non-ENT surgical children [2.61% (2.37 to 2.87)], with a relative risk of 1.51 (1.28 to 1.77), P less than 0.0001. Younger age (14% decrease in critical events by increasing year, P 

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Laryngotracheal stenosis in children following cardiac surgery: A retrospective review

No abstract available

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Comparison of rocuronium requirement in children with continuous infusion versus intermittent bolus: A randomised controlled trial

BACKGROUND Minimising rocuronium administration during paediatric surgery helps to reduce the incidence of residual muscular blockade. OBJECTIVE To determine whether intermittent bolus injection (Bolus group) or continuous infusion (group) requires the lesser amount of rocuronium. DESIGN A randomised, single-blind controlled trial. SETTING A single university hospital from March to June 2017. PATIENTS Sixty-six children undergoing general anaesthesia. INTERVENTIONS Dose of rocuronium for maintenance of muscle relaxation in either Bolus or continuous infusion group. Train-of-four (TOF) count of two was maintained during surgery. When TOF count reached three, 0.1 mg kg−1 of rocuronium was administered in Bolus group or infused at an increased rate of 0.1 mg kg−1 h−1 in continuous infusion group. MAIN OUTCOME MEASURES Primary outcome was the dose of rocuronium given (μg kg−1 min−1). The recovery time from the TOF count four to TOF 0.7 (RT0.7), and 0.9 (RT0.9) were recorded. All adverse events were recorded up to 30 min after extubation. RESULTS Mean (SD) rocuronium dose in the Bolus group was 6.1 (0.9), [95% confidence interval (95% CI) 5.7 to 6.4] μg kg−1 min−1 and 4.9 (1.0), (95% CI 4.6 to 5.3) μg kg−1 min−1 in the continuous infusion group (P = 0.001). RT0.7 was 24.0 (13.7), 95% CI 19.3 to 28.7) min in the Bolus group, and 25.7 (16.0), (95% CI 20.2 to 31.2) min in the continuous infusion group (P = 0.73). RT0.9 was 30.7 (17.1), (95% CI 24.9 to 36.5) min in the Bolus group, and 30.0 (17.6), (95% CI 24.0 to 36.0) min in the continuous infusion group (P  = 0.91). The incidence of adverse events was not significantly different between two groups. CONCLUSION In children undergoing general anaesthesia, the dose of rocuronium given by continuous administration was less than that with intermittent bolus. TRIAL REGISTRATION ClinicalTrials.gov (identifier: NCT03060707).

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Use of palonosetron and ondansetron in the prophylaxis of postoperative nausea and vomiting in women 60 years of age or older undergoing laparoscopic cholecystectomy: A randomised double-blind study

No abstract available

http://bit.ly/2SkgbeN

Ultrasound-guided vs. palpation-guided techniques for radial arterial catheterisation in infants: A randomised controlled trial

BACKGROUND The usefulness of ultrasound-guided techniques for radial arterial catheterisation has been well identified; however, its usefulness has not been completely evaluated in infants under 12 months of age, who are generally considered the most difficult group for arterial catheterisation. OBJECTIVE We evaluated whether ultrasound guidance would improve success rates and reduce the number of attempts at radial arterial catheterisation in infants. DESIGN A randomised, controlled and patient-blinded study. SETTING Single-centre trial, study period from June 2016 to February 2017. PATIENTS Seventy-four infants undergoing elective cardiac surgery. INTERVENTION Patients were allocated randomly into either ultrasound-guided group (group US) or palpation-guided group (group P) (each n=37) according to the technique applied for radial arterial catheterisation. All arterial catheterisations were performed by one of two experienced anaesthesiologists based on group assignment and were recorded on video. MAIN OUTCOME MEASURES The primary endpoint was the first-pass success. The number of attempts and total duration of the procedure until successful catheterisation were also analysed. RESULTS The first-pass success rate was significantly higher in the group US than in the group P (68 vs. 38%, P = 0.019). In addition, fewer attempts were needed for successful catheterisation in the group US than in the group P (median 1 [IQR 1 to 2] vs. 2 [1 to 4], P = 0.023). However, the median [IQR] procedural time (s) until successful catheterisation in the two groups was not significantly different (102 [49 to 394] vs. 218 [73 to 600], P = 0.054). CONCLUSION The current study demonstrated that the ultrasound-guided technique for radial arterial catheterisation in infants effectively improved first-pass success rate and also reduced the number of attempts required. TRIAL REGISTRATION ClinicalTrials.gov NCT02795468.

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The effect of virtual reality bronchoscopy simulator training on performance of bronchoscopic-guided intubation in patients: A randomised controlled trial

BACKGROUND The use of a flexible optical bronchoscopic (FOB) for intubation is an essential airway management skill. OBJECTIVE(S) Our primary objective was to compare the effects of simulator training (ORSIM high-fidelity simulator) with no simulation training on the performance of FOB intubation in anaesthetised patients. DESIGN Randomised controlled trial. SETTING Single-centre tertiary hospital; trial conducted between April 2015 to May 2016. PARTICIPANTS Medical students, anaesthesia assistants and anaesthesia residents with experience of less than five FOB intubations from whom informed consent was obtained. INTERVENTION Students, anaesthesia assistants and anaesthesia residents viewed a didactic presentation before performing an initial FOB intubation in an anaesthetised patient. Intubations were recorded and evaluated using the Global Rating Scale (GRS) and checklist scores. Subsequently, participants were randomised to control group (Group CON) and had no simulation training, or to a simulation group (Group SIM) and underwent 60 min of simulation practice. Within a week, participants performed a second FOB intubation and were similarly evaluated. MAIN OUTCOME MEASURES Pretraining and posttraining intubation time, GRS and checklist scores. RESULTS Baseline characteristics were similar between groups. In Group SIM, there was significant improvement between pre and posttraining GRS [22.9 ± 8.1 vs. 28.2 ± 7.3, mean difference (95% CI) 5.3 (0.3 to 10.3), P = 0.04], and intubation time [177.6 ± 77.6 vs. 119.3 ± 52.2 s, mean difference (95% CI) −58.4 (−100.3 to −16.5) s, P = 0.01]. There was no difference in Group CON, between pre and posttraining intubation time, GRS or checklist. CONCLUSION We conclude, posttraining performance of FOB intubation, as measured by intubation time and GRS, improved in Group SIM, while it was unchanged in the Group CON. The ORSIM simulator may be a useful adjunct in acquiring FOB intubation skills. CLINICAL TRIAL NUMBER AND REGISTRY ClinicalTrials.gov ID: NCT02699242.

http://bit.ly/2SpJexq

Bupivacaine infiltration in children for postoperative analgesia after tonsillectomy: A randomised controlled trial

BACKGROUND Adenotonsillectomy is a frequently performed procedure in paediatric day-case surgery. Postoperative pain can be significant and standard analgesia protocols are often insufficient. OBJECTIVE Our primary objective was to investigate if infiltration of the peritonsillar space with bupivacaine would reduce the need for postoperative opioids compared with pre-emptive intravenous tramadol. DESIGN A double-blind, randomised controlled trial. SETTING Ambulatory surgical day care centre, University Hospitals of Leuven, Belgium, from January 2012 to September 2016. PATIENTS Two hundred children, between 4 and 10 years old, undergoing elective adenotonsillectomy were included in the study. INTERVENTION Children were randomly allocated to receive either a bolus of 3 mg kg−1 intravenous tramadol or infiltration of the tonsillar lodge with 5-ml bupivacaine 0.25%. Reasons for exclusion were American Society of Anesthesiologists classification greater than 2, allergies to the investigated products, psychomotor retardation, bleeding disorders and lack of proficiency in Flemish. MAIN OUTCOME MEASURES The primary endpoint was the number of children in need of piritramide postoperatively. Secondary outcomes included the cumulative dose of postoperative piritramide, pain scores and the incidence of postoperative nausea and vomiting during the first 24 postoperative hours, time to discharge and adverse effects. RESULTS The proportion of children in need of postoperative piritramide was significantly lower in the tramadol group than in children with peritonsillar infiltration (57 vs. 81%, P 

http://bit.ly/2Gkg2S7

Calculation improves the estimation of needle depth from skin to thoracic epidural space in infants

No abstract available

http://bit.ly/2SpJ9K8

Use of tracheal ultrasound combined with clinical parameters to select left double-lumen tube size: A prospective observational study

BACKGROUND Left double-lumen tubes (LDLTs) are used in thoracic surgery to allow one-lung ventilation. Their size is usually chosen on the basis of clinical parameters (height, sex). Double-lumen endobronchial tubes are frequently undersized/oversized, risking tube displacement or tracheal trauma. A correlation between ultrasound tracheal diameter and left main bronchus dimension has been demonstrated. OBJECTIVES We hypothesised that the insertion of undersized/oversized double-lumen tubes is frequent when the size is selected using standard criteria, and that the use of ultrasound to estimate tracheal diameter may help to reduce the frequency of insertion of oversized tubes. DESIGN Two-step prospective observational study. SETTING The operating room of a French University hospital from January 2016 to February 2017. PATIENTS We enrolled 102 and 50 consecutive patients undergoing elective thoracic surgery in Steps 1 and 2 (males 63.7 and 60.0%, age 63 (13) and 63 (11) years, height 170 (13) and 169 (9) cm, respectively). INTERVENTION In Step 1, the size of the LDLT inserted was selected on the basis of clinical parameters. Ultrasound data about tracheal diameter were collected to determine cut-off points associating height and tracheal diameter. Cut-off values for ultrasound tracheal diameter were applied retrospectively to test their capability to reduce the insertion rate of oversized tube. In Step 2, the LDLT size was chosen according to the determined combined cut-off values. MAIN OUTCOME MEASURE LDLT size was considered adequate if the bronchial cuff volume required for isolation of the lung (i.e. no difference between inspiratory and expiratory lung volumes) was 0.5 to 2.5 ml of air; undersized and oversized tubes required more than 2.5 ml and less than 0.5 ml, respectively. RESULTS In Step 1, LDLT size was appropriate/undersized/oversized in 40 (39.2%)/23 (22.6%)/39 (38.6%) of patients. Cut-off values derived from ultrasound measurements would have reduced the use of oversized tubes by 20.6% (P 

http://bit.ly/2GmODyO

Intra-operative difficult airway identification and critical airway communication: how effective are we?: A retrospective review of 6318 cases

No abstract available

http://bit.ly/2t4z7je

Measurement of forces applied using a Macintosh direct laryngoscope compared with a Glidescope video laryngoscope in patients with predictors of difficult laryngoscopy: A randomised controlled trial

BACKGROUND In patients with predictive features associated with easy direct laryngoscopy, videolaryngoscoy with the GlideScope has been shown to require less force when compared with Macintosh direct laryngoscopy. OBJECTIVE The aim of this study was to compare forces applied with Glidescope vs. Macintosh laryngoscopes in patients with predictive features associated with difficult direct laryngoscopy. DESIGN A randomised study. SETTING Toronto General Hospital, a university tertiary centre in Canada. PATIENTS Forty-four patients aged over 18 years, with one or more features of difficult intubation, undergoing elective surgery requiring single-lumen tracheal intubation. INTERVENTION We measured the force applied to oropharyngeal tissues by attaching three FlexiForce Sensors (A201-25) to the concave surface of Macintosh and GlideScope laryngoscope blades. Anaesthetists or experienced anaesthesia residents performed laryngoscopies with both devices in a randomised sequence. MAIN OUTCOME MEASURES The primary outcome was peak force. The secondary outcomes were average force and impulse force. The latter is the integral of the force over the time during which the force acted. RESULTS Complete data were available for 40 individuals. Peak and average forces decreased with GlideScope (17 vs. 21 N, P = 0.03, and 6 vs. 11 N, P 

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Levobupivacaine scalp nerve block: haemodynamics and anaesthesia requirements in supratentorial craniotomy P 096: Erratum

No abstract available

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Utility of Pediatric Allergic Disease Quality of Life Questionnaire for childhood eczema

Abstract

Aim

It is important to objectively evaluate quality of life (QoL) impairment in atopic diseases in children. This study aims to investigate the utility of a Pediatric Allergic Disease Quality of Life Questionnaire (PADQLQ) in children with eczema.

Methods

PADQLQ, Patient‐Oriented Eczema Measure (POEM, a short‐term subjective‐symptom score), Nottingham Eczema Severity Score (NESS, a long‐term subjective‐symptom score), Children Dermatology Life Quality Index (CDLQI, a short‐term subjective‐symptom score) were compared and correlations evaluated.

Results

PADQLQ, POEM, NESS, CDLQI correlated well with each other (n=132 sets; spearman's correlations rho =0·48‐0·70, p<0·001). Bland Altman Plot showed a reasonably good agreement between CDLQI and PADQLQ. PADQLQ showed symptoms of asthma, allergic conjunctivitis and allergic rhinitis were present in 20‐30%, 45‐71%, and 58‐67%, respectively. Nevertheless, there was no association of eczema symptomatology by POEM or NESS with the severity of other allergic diseases.

Conclusion

PADQLQ correlates well with AD‐specific severity and QoL scores and reflects all allergic symptoms that holistically influence QoL in children with AD. PADQLQ is hence a composite severity score in terms of clinical symptomatology and QoL impairment for AD.

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Serum cell‐free DNA levels are useful marker for extramammary Paget's disease

Abstract

Although carcinoembryonic antigen (CEA) and cytokeratin 19 fragment (CYFRA) are useful marker for extramammary Paget's disease (EMPD), the serum CEA and CYFRA levels are not elevated in most EMPD patients without metastasis. Therefore, further useful biomarkers are needed for the detection of EMPD including early lesions. Cell‐free DNA (cfDNA) has attracted attention as an indicator of clinical conditions in several cancers, and we studied the clinical implications of cfDNA for EMPD. The serum cfDNA levels were significantly elevated in EMPD patients with or without metastasis compared to those in healthy controls. And serum cfDNA was a better diagnostic marker for the presence of EMPD compared to serum CYFRA. Moreover, the post‐operative serum cfDNA levels were significantly lower than those from the pre‐operative samples, and the change in serum cfDNA levels reflected the clinical courses of EMPD patients treated with chemotherapy. Taken together, serum cfDNA levels may be useful marker for the diagnosis and disease progression in EMPD.

This article is protected by copyright. All rights reserved.

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Case report of cutaneous nodule caused by Gordonia bronchialis in an immunocompetent patient after receiving acupuncture

Abstract

Gordonia species were recently found to cause human infection. Most Gordonia bronchialis infections are associated with sternal wounds and foreign bodies. Here, we present a case of a firm cutaneous nodule caused by G. bronchialis on an immunocompetent patient's lower extremity after receiving acupuncture. Our present case indicates that spontaneous cutaneous infection of G. bronchialis can develop even in a healthy patient. With the popularity of complementary and alternative medicine, physicians should be aware that G. bronchialis infection can be associated with Oriental medicine similar to mycobacterial infection. Recognizing the diverse clinical features of newly emerging Gordonia species will facilitate appropriate diagnosis and management of future patients.

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Role of c‐Met expression on prognosis of head and neck cancer: A literature review and meta‐analysis

Abstract

The prognostic role of c‐Met expression in patients with head and neck cancer were controversial among different studies. Thus, we performed a meta‐analysis to evaluate the relationships between c‐Met expression and survival and clinical parameters of head and neck cancer patients.

Summary hazard ratio (HR) and 95% confidence intervals (CIs) were calculated to analyze the correlations between c‐Met expression and overall survival (OS), and disease‐free survival (DFS). Furthermore, odds ratios (ORs) and 95% CIs were used to describe the relationships between c‐Met expression and different clinicopathological parameters.

A total of 2417 patients from 19 studies were enrolled in the final analysis. The results showed that patients with higher c‐Met expression had a poor OS (HR, 1.65; 95% CI, 1.20‐2.27) and DFS (HR, 1.48; 95% CI, 0.99‐2.20). In addition, c‐Met expression was associated with the N classification of patients with head and neck cancer.

These results suggested that c‐Met expression was a risk factor for head and neck cancer, and increased c‐Met expression would be a predictor of a poorer prognosis for the patients.

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