Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Τετάρτη 5 Απριλίου 2017
High exhaled nitric oxide levels correlate with nonadherence in acute asthmatic children
Nonadherence to asthma controller medication is associated with an increased number of acute exacerbations, increased asthma-related emergency department visits and childhood hospitalizations, and high health care costs.1 The average medication adherence rate in children with asthma tends to be poor (<50%). Improving patient adherence is essential to achieving optimal outcomes.2
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Preventing food allergies with tweaks to the infant diet
The increase in food allergy prevalence during the past few decades is an important public health concern, galvanizing efforts worldwide to understand and curb this trend. An area of particular interest has been the role of early feeding, particularly feeding of commonly allergenic foods, in the development of allergy. During the past several decades, infant feeding recommendations were made based on available evidence at the time. These recommendations continue to evolve as we gain insight into the multiple factors that influence the development of allergic sensitization to foods.
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Author's response
Motivated by the article by Zazzali et al,1 my editorial2 was intended to elaborate on the possibility of having conflicting conclusions concerning clinical significance vs statistical significance. I would like to thank the authors for their constructive letter3 in support of clinical significance of the effects of omalizumab on angioedema in patients with chronic idiopathic/spontaneous urticaria. The statistical significance of the collective primary outcome differences in patients treated with an active intervention compared with a control is often assessed in terms of the difference in the outcome means for the treatments.
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Fungal raw materials used to produce allergen extracts
To review the topic of fungal raw materials used for the production of allergen extracts and the associated challenges and highlight candidate areas for development before standardized fungal allergen extracts can be commercially produced.
http://ift.tt/2oG9SDs
An analysis of anaphylaxis cases at a single pediatric emergency department during a 1-year period
Case series of anaphylaxis can vary regarding causes, treatments, and follow-up of patients. Unfortunately, case series that are specific to the pediatric population are few.
http://ift.tt/2oLGhpm
Mammalian milk allergy: case presentation and review of prevalence, diagnosis, and treatment
A 5-year-old boy with a history of mild intermittent asthma and allergic rhinoconjunctivitis was seen for evaluation of anaphylactic reactions.
http://ift.tt/2oG1m7F
Live attenuated influenza vaccine use and safety in children and adults with asthma
Live attenuated influenza vaccine (LAIV) might increase the risk of wheezing in persons with asthma or children younger than 5 years with a history of recurrent wheezing.
http://ift.tt/2oLGRU0
Biomarkers of oxidative stress and antioxidants in severe asthma
Bronchial airway inflammation is the hallmark of asthma, which may be driven by an imbalance between oxidative stress and antioxidant defenses. Antioxidants deficiency may play a role, but this has remained unconfirmed.
http://ift.tt/2oFZJH2
Re: “Addendum guidelines for the prevention of peanut allergy in the United States: report of the National Institute of Allergy and Infectious Diseases–sponsored expert panel”
The Learning Early About Peanut Allergy (LEAP) Study has shed light on a growing prevalence of allergy to peanuts. The trial concluded that early exposure to peanuts in a child's diet decreases the frequency of developing peanut allergy.1 Based on this trial and expert opinion, the new addendum guidelines2–4 help tailor the introduction of peanut into the diet of children who are at high risk of developing allergy. Although decreasing the incidence of severe peanut allergy is of significant importance, the public has to be equally aware of the danger of allowing the ingestion of solid peanuts in children younger than 2 years because of the risk of aspiration.
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Urticarial vasculitis and associated disorders
Patients often present to allergists with urticarial eruption symptoms. In many instances, these lesions represent chronic idiopathic or spontaneous urticaria.1 Some of these patients may have a condition referred to as urticarial vasculitis (UV), including its variants normocomplementemic urticarial vasculitis (NUV), hypocomplementemic urticarial vasculitis (HUV), and hypocomplementemic urticarial vasculitis syndrome (HUVS) or Schnitzler syndrome.2,3 There are some features that set this condition apart, and in some instances, the disease may be severe enough to require systemic immunosuppressive therapies.
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Celiac disease and nonceliac gluten sensitivity
Celiac disease (CD) is an increasingly common chronic autoimmune disease caused by permanent gluten sensitivity that occurs in people carrying the HLA-DQ2 or HLA-DQ8. It causes both gastroenteropathy (demonstrated by duodenal biopsy) and extraintestinal pathologic conditions (Fig 1A and B). The disease is often diagnosed by the discovery of positive autoantibodies (anti–tissue transglutaminase [anti-tTG] IgA and anti–endomysial antibody [EMA] IgA) in a patient, which might trigger an intestinal biopsy that reveals villous atrophy.
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A systematic review of food protein–induced enterocolitis syndrome from the last 40 years
To provide a complete, exhaustive summary of current literature relevant to food protein–induced enterocolitis syndrome (FPIES).
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Importance of angioedema-free days in patients with chronic idiopathic or spontaneous urticaria
We read with interest Dr Johnson's editorial1 that accompanied our analysis of data from 3 pivotal trials of omalizumab in chronic idiopathic/spontaneous urticaria (CIU/CSU).2 Dr Johnson suggested that, albeit statistically significant, the improvements in angioedema-free days might not be of clinical significance.
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Clinical features of adolescents with chronic idiopathic or spontaneous urticaria
Adults and adolescents were included in 3 phase 3 omalizumab trials in chronic idiopathic urticaria (CIU): ASTERIA I, ASTERIA II, and GLACIAL.
http://ift.tt/2oLPrSQ
Distant metastasis as the sole initial manifestation of well-differentiated thyroid carcinoma
Abstract
Thyroid carcinoma usually presents as a neck lump. Distant metastasis as the sole initial manifestation of well-differentiated thyroid carcinoma (WDTC) is rare and little is known about these patients. The aim of this study is to characterize patients who present with distant metastasis as the sole initial manifestation of WDTC. Retrospective review of case records of WDTC seen at the National Cancer Centre Singapore from 2002 to 2015 was performed. Patients with no prior complaint of neck swelling and whose first presentation was distant metastatic WDTC were included. Patient demographics, disease characteristics, radiological imaging, histopathology, types of treatment administered, and survival outcomes were examined. Nineteen out of seven hundred and thirty-two cases fulfilled inclusion criteria. Mean age was 65.4 years. All patients presented with osseous (36.8%), pulmonary (31.6%), cerebral metastases (5.3%), or a combination of two out of three aforementioned sites (26.3%). Follicular thyroid carcinoma was most common (47.4%), followed by papillary (36.8%) and medullary (15.8%). More than two-thirds of patients had multiple metastatic foci. Thirteen out of nineteen patients (68.4%) underwent total thyroidectomy with or without neck dissection and adjuvant RAI, while the rest declined surgery. The mean length of follow-up was 40.1 ± 5.1 months and 5-year disease-specific survival was 48.0 ± 17.2%. Distant metastasis without a history of neck swelling as the initial presentation of WDTC is extremely rare. Osseous metastasis and follicular thyroid carcinoma are the most common metastatic site and etiology, respectively. Disease-specific survival at 5-year post-diagnosis is lower compared to patients with thyroid carcinoma diagnosed with distant metastasis on further work-up.
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Retrospective evaluation of concomitant cetuximab and radiotherapy tolerance for locoregional advanced head and neck squamous cell carcinoma treatment in patients unfit for platinum-based chemotherapy
Abstract
Radiotherapy associated with cetuximab (Cet-RT) is an alternative treatment to platinum-based chemoradiotherapy in locally advanced head and neck carcinoma (LAHNC). Reviews suggest that the use of cetuximab is associated with poorer tolerance in patients unfit for chemotherapy than in pivotal trial. We retrospectively studied patients first treated by Cet-RT for LAHNC presenting contraindications to chemoradiotherapy. Objectives were treated population description, acute tolerance, progression-free survival (PFS), overall survival (OS), and 3-month clinical response. Eighty-eight patients were included. Treatment was completed without delay for 43 patients. Grade 3–4 acute toxicity was described in 44.3%: mucositis (n = 20), radiodermatitis (n = 25) folliculitis (n = 10), and anaphylaxis (n = 6). Fourteen patients died during treatment. Median PFS and OS were 6.3 and 18.7 months, respectively. We confirm that Cet-RT tolerance in unfit patients is poorer than that in trials. Survival data illustrate patients' frailty and suggest that balanced use of Cet-RT is required in this population.
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Editorial Board
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 4
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Table of Contents
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 4
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Instructions for Authors
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 4
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High exhaled nitric oxide levels correlate with nonadherence in acute asthmatic children
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 4
Author(s): Yi-Giien Tsai, Hai-Lun Sun, Jien-Wen Chien, Chun-Yu Chen, Ching-Hsiung Lin, Ching-Yuang Lin
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Preventing food allergies with tweaks to the infant diet
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 4
Author(s): Julie Wang, Marion Groetch
http://ift.tt/2o5quUf
Celiac disease and nonceliac gluten sensitivity
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 4
Author(s): Chongwei Cui, Tyler Basen, Ami Thakor Philipp, Joseph Yusin, Guha Krishnaswamy
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Information for Readers
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 4
http://ift.tt/2o5s4oQ
Urticarial vasculitis and associated disorders
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 4
Author(s): Ahmad Hamad, Warit Jithpratuck, Guha Krishnaswamy
http://ift.tt/2oLBKU4
Fungal raw materials used to produce allergen extracts
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 4
Author(s): Robert E. Esch, Rosa Codina
ObjectiveTo review the topic of fungal raw materials used for the production of allergen extracts and the associated challenges and highlight candidate areas for development before standardized fungal allergen extracts can be commercially produced.Data SourcesA PubMed search was performed using focused keywords and combined with a review of regulatory documents and industry guidelines. Several books on mycology also were consulted.Study SelectionsThe information obtained through the literature, books, and industry was scrutinized and combined with personal experience and expertise to write this article.ResultsFungi are complex ubiquitous organisms on Earth. They are beneficial and detrimental for humans. Fungi can cause hypersensitivity reactions, including types I, III, and IV. The procurement of fungal raw materials to prepare allergen extracts for diagnosis and possible allergen immunotherapy is complex owing to the intrinsic nature of fungi and their complex genome. Allergen manufacturers produce allergen extracts with variable qualitative and quantitative compositions, which can lead to unpredictable clinical outcomes.ConclusionThe clinician should be aware of the factors responsible for the qualitative and quantitative compositions of fungal allergen extracts and the reasons that currently preclude their standardization. Scientific advances and collaboration and cooperation between allergen manufacturing companies and regulatory agencies are necessary to improve the quality and consistency of fungal extracts. Moreover, clinicians should understand the limitations of currently available fungal extracts.
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Mammalian milk allergy: case presentation and review of prevalence, diagnosis, and treatment
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 4
Author(s): Michele Ngoc Pham, Julie Wang
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Author's response
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 4
Author(s): William D. Johnson
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A systematic review of food protein–induced enterocolitis syndrome from the last 40 years
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 4
Author(s): Sara Manti, Salvatore Leonardi, Annamaria Salpietro, Giuliana Del Campo, Carmelo Salpietro, Caterina Cuppari
ObjectiveTo provide a complete, exhaustive summary of current literature relevant to food protein–induced enterocolitis syndrome (FPIES).Data SourcesData have been extracted from PubMed and Science Direct databases.Study SelectionsFollowing the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, a literature search for peer-reviewed journal articles in English through January 1975 with updates through October 2016 was conducted. Relevant publications were reviewed that included pediatric and adult populations. Information on the study design, sample, intervention, comparators, outcome, timeframe, and risk of bias were abstracted for each article.ResultsOf 135 reviewed reports, 52 were included in this systematic review. In accordance with the age at onset, clinical features, and offending foods, it is possible to distiguish different types of FPIES. An immune systemic involvement can occur in patients with FPIES. In addition to the most common causative foods (cow's milk, soy, and rice), any food can potentially cause FPIES. Although specific diagnostic tests are not available, open food challenge remains the gold standard for FPIES diagnosis. Moreover, because of the lack of randomized clinical trials and of use of different adopted methods, confounding factors might mask critical findings, leading to poor knowledge of this pleiotropic clinical entity.ConclusionMulticenter studies are needed to better develop an evidence-based approach to pathophysiology, prevalence, diagnosis, and natural history of the disease.
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Live attenuated influenza vaccine use and safety in children and adults with asthma
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 4
Author(s): Jonathan Duffy, Melissa Lewis, Theresa Harrington, Roger Baxter, Edward A. Belongia, Lisa A. Jackson, Steven J. Jacobsen, Grace M. Lee, Allison L. Naleway, James Nordin, Matthew F. Daley
BackgroundLive attenuated influenza vaccine (LAIV) might increase the risk of wheezing in persons with asthma or children younger than 5 years with a history of recurrent wheezing.ObjectiveTo describe the use and assess the safety of LAIV in persons with asthma in the Vaccine Safety Datalink population.MethodsWe identified persons with asthma using diagnosis codes and medication records in 7 health care organizations over 3 influenza seasons (2008–2009 through 2010–2011) and determined their influenza vaccination rates. Using the self-controlled risk interval method, we calculated the incidence rate ratio of medically attended respiratory events in the 14 days after LAIV compared with 29 to 42 days after vaccination in persons 2 through 49 years old.ResultsIn our population of 6.3 million, asthma prevalence was 5.9%. Of persons with asthma, approximately 50% received any influenza vaccine but less than 1% received LAIV. The safety study included 12,354 LAIV doses (75% in children; 93% in those with intermittent or mild persistent asthma). The incidence rate ratio for inpatient and emergency department visits for lower respiratory events (including asthma exacerbation and wheezing) was 0.98 (95% confidence interval 0.63–1.51) and the incidence rate ratio for upper respiratory events was 0.94 (95% confidence interval 0.48–1.86). The risk of lower respiratory events was similar for intermittent and mild persistent asthma, across age groups, and for seasonal trivalent LAIV and 2009 H1N1 pandemic monovalent LAIV.ConclusionLAIV use in asthma was mostly in persons with intermittent or mild persistent asthma. LAIV was not associated with an increased risk of medically attended respiratory adverse events.
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Biomarkers of oxidative stress and antioxidants in severe asthma
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 4
Author(s): Abigail Bishopp, Ramamurthy Sathyamurthy, Sarah Manney, Craig Webbster, Mamidipudi Thirumala Krishna, Adel H. Mansur
BackgroundBronchial airway inflammation is the hallmark of asthma, which may be driven by an imbalance between oxidative stress and antioxidant defenses. Antioxidants deficiency may play a role, but this has remained unconfirmed.ObjectiveTo evaluate the oxidative stress burden and antioxidants defenses in patients with increasing asthma severity.MethodsThis prospective case-control study compared fractional exhaled nitric oxide (FeNO), exhaled breath condensate nitrite/nitrate (EBC-NOx), spirometry, and serum vitamins and trace elements among patients with and without asthma.ResultsSixty participants were recruited (30 with severe asthma number; 23 women [76.7%]; mean age, 41.4 years; mean forced expiratory volume in 1 second [FEV1], 2.2 L [72.2% predicted]; mean inhaled corticosteroid dosage, 2,540 μg/d; 18/30 [60%] receiving maintenance oral corticosteroids; 15 with mild asthma; all corticosteroids naïve; 9 women [60%]; mean age, 34.6 years; mean FEV1, 3.48 L [100.5% predicted]; 15 healthy controls; 12 women [80%]; mean age, 37.6 years; and mean FEV1, 3.53 L [111.7% predicted]). The mean FeNO levels increased significantly with increasing asthma severity (P = .01), but the EBC-NOx levels did not change significantly (P = .90). Paradoxically, vitamin A and vitamin E increased with increased disease severity, with vitamin E levels increasing significantly (P = .07 and P < .001, respectively). There was no significant difference between groups in the levels of copper (P = .37), zinc (P = .97), or selenium (P = .90).ConclusionFeNO but not EBC-NOx is increased significantly with asthma severity with no evidence of vitamins or trace elements deficiency in severe asthma. Impaired oxidative stress defenses in severe asthma may be driven by factors other than vitamins or trace elements deficiency.
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An analysis of anaphylaxis cases at a single pediatric emergency department during a 1-year period
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 4
Author(s): Christopher D. Wright, Mindy Longjohn, Phillip L. Lieberman, Jay Adam Lieberman
BackgroundCase series of anaphylaxis can vary regarding causes, treatments, and follow-up of patients. Unfortunately, case series that are specific to the pediatric population are few.ObjectiveTo describe confirmed cases of pediatric anaphylaxis in patients presenting to a pediatric hospital emergency department (ED).MethodsWe identified all ED visits with the International Classification of Diseases, Ninth Revision (ICD-9) codes 995.XX (allergic reactions) and 989.5 (sting or venom reaction) for 1 calendar year (January 1, 2014, through December 31, 2014). Cases were reviewed by an allergist and an emergency medicine physician to identify true anaphylaxis cases using National Institute of Health/National Institute of Allergy and Infectious Diseases criteria. Any questionable or debatable cases were evaluated and adjudicated by a second allergist.ResultsWe identified 927 unique ED visits. Of these visits, 40 were determined to definitively meet anaphylaxis criteria. Median age of the patients was 6.5 years. A total of 70% of patients were male, and 80% were African American. Causes included foods (65%), venom or insect sting (12.5%), and medications (5%), and 17.5% were idiopathic. All patients had multiorgan involvement, with 98% having skin involvement, 78% having lower respiratory tract symptoms, and 40% having gastrointestinal symptoms. There were no deaths. Only 33% of patients received epinephrine at some point in their care. Only 12 patients were referred to an allergist, and only 4 of these were actually seen by an allergist.ConclusionAt our center, foods are the most common trigger for pediatric anaphylaxis. Patients continue to be undertreated, and referral to an allergist from the ED is rare.
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Importance of angioedema-free days in patients with chronic idiopathic or spontaneous urticaria
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 4
Author(s): James L. Zazzali, Allen Kaplan, Marcus Maurer, Karina Raimundo, Benjamin Trzaskoma, Evgeniya N. Antonova, Karin E. Rosén
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Re: “Addendum guidelines for the prevention of peanut allergy in the United States: report of the National Institute of Allergy and Infectious Diseases–sponsored expert panel”
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 4
Author(s): Faisal Zawawi, Paolo Campisi
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Clinical features of adolescents with chronic idiopathic or spontaneous urticaria
Publication date: April 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 4
Author(s): Stanley Goldstein, Susan Gabriel, Farid Kianifard, Benjamin Ortiz, David P. Skoner
BackgroundAdults and adolescents were included in 3 phase 3 omalizumab trials in chronic idiopathic urticaria (CIU): ASTERIA I, ASTERIA II, and GLACIAL.ObjectiveTo describe the baseline clinical profile of adolescent patients with CIU enrolled in the omalizumab trials to add to the limited literature available on CIU in this population.MethodsData for patient demographics, baseline clinical disease characteristics, medical history, and previous CIU medication information (not efficacy assessments) from phase 3 omalizumab trials were pooled and descriptive statistical analyses performed for adolescent (12 to <18 years old) and adult (≥18 years old) subgroups. Inferential analysis was inappropriate, partly because of small sample size in the adolescent subgroup.ResultsThe pooled population of 975 patients with CIU included 39 adolescents (4.0%). Demographics of adolescents and adults with CIU were similar, but compared with adults, fewer adolescents had positive Chronic Urticaria Index test results. Baseline clinical disease characteristics were also similar between the subgroups, with the number of previous CIU medications slightly lower in adolescents compared with adults. Medical history and existing conditions in adolescents tended to be more allergy than cardiovascular related, and fewer experienced angioedema compared with adults.ConclusionPooled data indicate differences in baseline demographic and clinical characteristics between adult and adolescent patient subgroups. This finding helps augment our understanding of the clinical profile of CIU in adolescents, but larger-scale studies in this population are warranted.Trial RegistrationClinicalTrials.gov Identifiers: NCT01287117 (ASTERIA I), NCT01292473 (ASTERIA II), and NCT01264939 (GLACIAL).
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A case of pulsating sternal and clavicular metastases of thyrofollicular carcinoma
DESCRIPTION
Bony metastases are not infrequently encountered with follicular carcinoma of thyroid. Rarely, papillary thyroid carcinoma spreads to bones1; however, anterior chest wall (sternal and clavicular) involvement are rare. A 54-year-old man with long-standing (~25 years) multinodular goitre presented with recent-onset rapid enlargement of the sternoclavicular area beneath the goitre. On examination, the swelling was hard, warm and pulsatile and in addition showed engorged anterior chest wall veins (figure 1). He was clinically and biochemically euthyroid. Chest X-ray (figure 2) showed huge thyroid mass with sternal and clavicular erosion confirmed by CT (figure 3). Fine-needle aspiration cytology of the goitre and bony mass confirmed follicular carcinoma. He underwent total thyroidectomy with excision of the sternal and clavicular metastases and reconstruction of the chest wall defect with Marlex mesh. Following surgery, he underwent radioiodine therapy (200 mCi) and the post-therapy scan showed multiple pulmonary macronodular...
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Autologous platelet-rich plasma versus readymade growth factors in skin rejuvenation: A split face study
Summary
Background
The escalating urge for a youthful-looking skin instigates continuous innovations with minimally invasive procedures. Readymade growth factors and autologous platelet-rich plasma (PRP) represent such therapeutic interventions.
Objective
Compare the efficacy and safety of PRP to readymade growth factors in skin rejuvenation.
Patients and Methods
Twenty adult females with Fitzpatrick skin types III-IV and Glogau photoaging types II and III were enrolled in this study. They underwent a split face therapy where each side was randomly assigned to treatment by either readymade growth factors (area A) or autologous PRP (area B). All patients received six sessions at 2-weeks interval. Evaluation was carried out using Global Aesthetic Improvement Scale (GAIS) and optical coherence tomography (OCT). Patients were followed up for 6 months.
Results
Both procedures yielded significant improvement regarding both GAIS (skin turgor and overall vitality) and OCT (epidermal and dermal thickness) assessment. Significant negative correlation was detected between patients' age, sun exposure, and GAIS. Burning sensation was significantly higher in area A. Patient satisfaction was significantly higher in area B. Improvement was more sustained in area B on follow-up.
Conclusion
Platelet-rich plasma is effective and safe for skin rejuvenation, comparable to readymade growth factors with noticeable higher longevity.
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Effectiveness of topical clove oil on symptomatic treatment of chronic pruritus
Summary
Background
Pruritus is a frequent symptom in the general population and in many skin and systemic diseases. Its frequency demonstrates a high burden and an impaired quality of life.
Aim
Assessment of the efficacy of topically applied clove oil alone in the treatment of chronic pruritus.
Methods
Fifty selected subjects diagnosed with chronic pruritus due to either hepatic, renal, or diabetic causes were studied and divided into two groups of 25 patients each. Group I patients were instructed to hydrate the skin and then apply topical clove oil while group II patients applied petrolatum topically by hand; this application was done on the areas of pruritus, twice daily and for 2 weeks. The severity of the itch was assessed and compared before and after the study by 5-D itch scale. The results were analyzed by SPSS. Statistical methods such as descriptive analysis, independent-samples t-test, paired-samples t-test, and chi-square were employed.
Results
There was a significant improvement regarding all studied individual parameters (5-D itch scale) for the clove oil users with no significance among petrolatum users. Comparison of 5-D itch scale total score between patients of group I and patients of group II favored the improvement following the use of clove oil than using placebo (P value>.05).
Conclusion
The topical treatment of chronic pruritus with clove oils is effective, easy to use, safe, cheap, and more acceptable for whom topical and systemic treatments tend to be irritating, contraindicated, or less well tolerated.
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Poncet’s disease: two case reports
One of the rare presentations of active pulmonary or even extrapulmonary tuberculosis is polyarthropathy which is the involvement of multiple large and small joints in the body; a reactive constellation known ...
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Hommage à Georges Freyss
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 2
Author(s): P. Tran Ba Huy
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Oropharyngectomie par voie transorale et transcervicale sans mandibulotomie et réparation par lambeau libre fasciocutané antébrachial dans les cancers de l’oropharynx : suites opératoires, résultats carcinologiques et fonctionnels, facteurs pronostiques
Publication date: April 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 2
Author(s): M. Roux, O. Dassonville, M. Ettaiche, G. Poissonnet, A. Sudaka, A. Bozec
ObjectifAnalyser les suites opératoires, les résultats carcinologiques et fonctionnels, ainsi que les facteurs pronostiques de la chirurgie des cancers l'oropharynx par voie transorale et transcervicale sans mandibulotomie avec réparation par lambeau libre fasciocutané antébrachial.Matériel et méthodesAnalyse rétrospective des dossiers informatisés de tous les patients ayant bénéficié de ce type de chirurgie entre 2004 et 2014 dans notre institution. Les facteurs prédictifs des résultats carcinologiques et fonctionnels ont été recherchés en analyses univariées et multivariées.RésultatsAu total, 44 patients (37 hommes et 7 femmes, âge moyen=62,3±9,3 ans) ont été inclus dans cette étude. À trois ans, les taux de survie globale, spécifique et sans récidive étaient respectivement de 90, 92 et 79 %. Un score fonctionnel satisfaisant (fonction normale ou légèrement perturbée) a été obtenu pour l'alimentation, l'élocution et l'ouverture buccale dans respectivement 86, 93 et 100 % des cas. Un score ASA ≥ III avait un impact péjoratif statistiquement significatif sur la survie globale (p=0,005), ainsi que sur la qualité de l'alimentation (p=0,01) et de l'élocution (p=0,01).ConclusionLa chirurgie des cancers de l'oropharynx par voie transorale et transcervicale sans mandibulotomie permet d'obtenir d'excellents résultats carcinologiques et fonctionnels et constitue une alternative avantageuse à la classique buccopharyngectomie transmandibulaire conservatrice.
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Endoscopie sous sommeil induit : nouvel examen de référence du SAS ? Partie II : résultats
Publication date: April 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 2
Author(s): M. Blumen, E. Bequignon, F. Chabolle
Les résultats de la chirurgie du syndrome d'apnée du sommeil sont très variables quels que soit la technique utilisée ou le site traité. La plupart des auteurs s'accordent à dire qu'une sélection précise des bons candidats à la chirurgie s'avère logique et nécessaire. Un examen, l'endoscopie sous sommeil induit, a été mis au point en 1991 et redécouvert de façon extensive après les années 2000. Il s'agit d'essayer de mimer le sommeil naturel et d'examiner les voies aériennes supérieures à l'aide d'une nasofibroscopie dans une situation où des obstructions peuvent survenir. Une revue de la littérature a été réalisée comprenant 2 parties. Dans la 2e partie, nous décrivons les résultats retrouvés lors de l'endoscopie sous sommeil induit concernant les sites d'obstruction, l'impact sur l'efficacité des traitements et les indications qui en découlent.
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Monitorage peropératoire des nerfs vagues et récurrents au cours de la chirurgie thyroïdienne et parathyroïdienne : étude prospective
Publication date: April 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 2
Author(s): N. Julien, E. Ferrary, A. Sokoloff, G. Lamas, O. Sterkers, D. Bernardeschi
ObjectifsStimuler électriquement les nerfs vagues et laryngés inférieurs pendant une chirurgie thyroïdienne ou parathyroïdienne, enregistrer les réponses musculaires, interpréter les modifications des paramètres électrophysiologiques et en déduire un pronostic sur la mobilité laryngée.Patients et méthodesIl s'agit d'une étude prospective au cours de laquelle 151 nerfs vagues et 144 nerfs laryngés inférieurs ont été monitorés chez 114 patients. Parmi eux, 7 patients (14 nerfs vagues) ont été monitorés en continu avec l'électrode APS et chez 15 patients (21 nerfs vagues), le seuil de stimulation a été étudié. La réponse musculaire a été recueillie après stimulation directe du nerf vague et/ou du nerf laryngé inférieur par une sonde monopolaire ou après stimulation directe et répétée par une électrode fixée sur le nerf vague. En cas d'altération du signal du premier côté opéré, la totalisation chirurgicale n'était pas réalisée.RésultatsLa stimulation du nerf vague permet de vérifier l'intégrité du nerf laryngé inférieur et son caractère récurrent, sans risque de faux-négatif. Le seuil minimal de stimulation avant et après la dissection du nerf vague entraînant une réponse supérieure ou égale à 100 μV variait de 0,1 à 0,8mA. La similitude des réponses à une stimulation supramaximale de 1mA, en pré- et post-dissection, d'une part et en post-dissection entre le nerf vague et le nerf laryngé inférieur, d'autre part, était corrélée à une mobilité laryngée postopératoire normale. À l'inverse, la diminution de la réponse musculaire en dessous de 100μV et l'augmentation du temps de latence témoignaient d'un risque de paralysie laryngée.ConclusionLa stimulation du nerf vague permet de suspecter ou d'éliminer une lésion bas-située sur le nerf laryngé inférieur et de détecter un nerf laryngé inférieur non récurrent. Le monitorage « intermittent » apprécie la fonction nerveuse à l'instant de la stimulation, alors que le monitorage « permanent » peut détecter les premiers signes de la souffrance nerveuse annonciateurs d'une possible paralysie récurrentielle postopératoire. En cas d'indication de thyroïdectomie totale, la perte du signal électrique du premier côté opéré doit faire reconsidérer la réalisation d'un geste chirurgical controlatéral dans le même temps.
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L’articulation voméroprémaxillaire : un témoin de l’évolution des espèces
Publication date: April 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 2
Author(s): S. Botti, C. Rumeau, P. Gallet, R. Jankowski
ObjectifDans la théorie évo-dévo, les vomers sont des os issus du palais secondaire. La croissance des plaques palatines des maxillaires les pousse à fusionner sur la ligne médiane en arrière du palais primaire qui sert de butée à leur élévation en direction de la cloison du nez primaire, formée du cartilage septal et de la lame perpendiculaire de l'ethmoïde. Dans cette hypothèse, le bord antérieur du vomer s'articule avec la face postérieure du prémaxillaire au niveau du canal incisif (CI).Matériel et méthodeLe but de cette étude rétrospective était de mesurer l'incarcération de l'angle antéro-inférieur du vomer dans le CI sur des scanners montrant un septum nasal non déformé. Trente-deux scanners de sinus sur 506 archivés ont permis les mesures sur des coupes coronales de septums non déformés passant par le CI.RésultatsTrente et un vomers sur 32 étaient incarcérés dans le CI. Lorsque le vomer avait une forme en Y (n=26), 43 % de sa hauteur étaient incarcérés dans 41 % de la hauteur du CI. Dans les formes en I (n=6), 34 % de la hauteur du vomer étaient incarcérés dans 41 % de la hauteur du CI. Le seul vomer non incarcéré avait une forme de Y.ConclusionL'incarcération du vomer dans le CI en arrière du prémaxillaire trouve son explication dans la conception évo-dévo de la formation des fosses nasales. La description embryologique classique de formation de la cloison nasale ne permet pas quant à elle d'expliquer l'incarcération vomérienne.
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Mise au point sur la technique du ganglion sentinelle dans les cancers épidermoïdes des voies aérodigestives supérieures cN0. Guide pour la pratique du GETTEC
Publication date: April 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 2
Author(s): R. Garrel, G. Poissonnet, S. Temam, G. Dolivet, N. Fakhry, D. de Raucourt
La fiabilité de la technique du ganglion sentinelle (GS) est établie depuis plus d'une dizaine d'années dans les carcinomes épidermoïdes T1-T2 de la cavité buccale et de l'oropharynx. Bien que la plupart des auteurs insistent sur la rigueur nécessaire à sa réalisation, il n'existe pas de référence consensuelle. De plus, d'autres indications sont décrites sur d'autres aires anatomiques des voies aérodigestives supérieures (VADS) ainsi qu'en cas d'antécédents chirurgicaux ou de radiothérapie. Les équipes expertes dans cette technique sous l'égide du GETTEC ont réalisé une mise au point sur les points clés de la réalisation de la technique des ganglions sentinelles dans les VADS à travers un guide pour la pratique, ainsi que sur les indications classiques et étendues. La fiabilité de cette technique repose sur le respect des points clés du repérage préopératoire par lymphoscintigraphie, du prélèvement peropératoire et de l'analyse anatomo-pathologique des GS. Cette technique est le meilleur moyen de diagnostiquer une atteinte ganglionnaire occulte quelle que soit la localisation de la tumeur primaire, son stade T ou les antécédents du patient.
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Editorial Board
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 2
http://ift.tt/2p3arUB
La phytothérapie en pratique clinique en otorhinolaryngologie : apport, limites et risques
Publication date: April 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 2
Author(s): O. Laccourreye, A. Werner, L. Laccourreye, P. Bonfils
Dégager l'apport, les limites et les risques de la phytothérapie en pratique clinique en otorhinolaryngologie. Analyse des bases de données PubMed et Cochrane en utilisant comme mots clés les termes « phytothérapie, phytomédecine, plantes, otologie, rhinologie, laryngologie, otite, rhinite, laryngite et otorhinolaryngologie ». Soixante-douze articles (dont 18 études prospectives randomisées, 4 études Cochrane, 4 méta-analyses et 15 revues de la littérature) consacrés aux études clinique ont été analysé. Les articles dédiés aux études in vitro et/ou sur animaux, aux analyses biochimiques, de type cas clinique (moins de dix cas) ainsi que les articles dédiés aux vertus du miel, de l'aromathérapie et/ou des minéraux sont exclus de cette analyse. Le ginkgo biloba per os n'a pas d'indication dans les acouphènes, la presbyaousie et l'anosmie après rhinite virale. La médecine asiatique « traditionnelle » n'a pas fait la preuve de son utilité dans la surdité brusque et la papillomatose laryngée. La prise per os d'extraits de gui après traitement conventionnel des carcinomes épidermoïdes à point de départ cervicofacial n'augmente pas le taux de survie à 5 ans. Diverses plantes, au premier rang desquelles se trouvent l'échinacée, l'eucalyptus, la pétasite hybridus, le pelargonium sidoïdes, le romarin, la spirulina et le thym, ont une efficacité, comparativement aux placebos, dans le traitement des rhinosinusites aiguës ou de la rhinite allergique tout comme le ginkgo biloba dans certains vertiges. Des résultats préliminaires dignes d'intérêt existent quant au rôle d'extraits de plantes en solution huileuses lors de l'otite moyenne aiguë, de l'injection intratumorale d'extraits de gui dans les cancers cervicofaciaux et de l'acupoint herbal patching dans la rhinite allergique. Une consommation de « plantes » doit être systématiquement recherchée devant certains symptômes inexpliqués (épistaxis, céphalées, vertiges) ou signes évoquant une allergie. L'arrêt de la phytothérapie doit être conseillé avant chirurgie et/ou chimiothérapie. La preuve scientifique formelle de l'apport de la phytothérapie en otorhinolaryngologie reste à établir. Les résultats des travaux publiés et la fréquence d'utilisation doit conduire les otorhinolaryngologistes à développer leur connaissance de cette approche thérapeutique.
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Endoscopie sous sommeil induit : nouvel examen de référence du SAS ? Partie I : technique
Publication date: April 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 2
Author(s): M. Blumen, E. Bequignon, F. Chabolle
Les résultats de la chirurgie du syndrome d'apnée du sommeil sont très variables et quelle que soit la technique utilisée ou le site traité. La plupart des auteurs s'accordent à dire qu'une sélection précise et exacte des bons candidats à la chirurgie s'avère logique et nécessaire. Un examen, l'endoscopie sous sommeil induit, a été mis au point en 1991 et redécouvert de façon extensive après les années 2000. Il s'agit d'essayer de mimer le sommeil naturel et d'examiner les voies aériennes supérieures à l'aide d'une nasofibroscopie. Une revue de la littérature a été réalisée comprenant 2 parties. Dans la première partie, nous décrivons la technique d'endoscopie sous sommeil induit : les produits utilisés, les modalités pratiques anesthésiques et ORL, sa reproductibilité et ses limites.
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Comment réaliser une reconstruction tridimensionnelle pour une tumeur de la base du crâne ?
Publication date: April 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 2
Author(s): N.-X. Bonne, F. Dubrulle, M. Risoud, C. Vincent
La prise en charge chirurgicale d'une lésion de la base du crâne est délicate du fait de la complexité anatomique de cette région et des rapports étroits pouvant exister entre la lésion et les structures vasculo-nerveuses environnantes. L'évolution de cette chirurgie se fait vers des voies d'abord moins invasives respectant le plus possible le pronostic fonctionnel. La possibilité de visualiser une reconstruction tridimensionnelle tomodensitométrique (TDM) de la lésion permet au chirurgien une meilleure planification de la chirurgie grâce à une visualisation des rapports dans tous les plans (artères, veines, nerfs, oreille interne) ainsi qu'une simulation de la voie d'abord dans la position opératoire. Un angioscanner spiralé est effectué avec une optimisation de l'injection par rapport à la prise de contraste tumorale et aux vaisseaux. La définition 3D de chaque structure se fait en affectant une couleur spécifique avec seuillage automatique lorsque cela est possible (os, vaisseaux) ou manuel par contourage sur chaque coupe (tumeur, structures nerveuses, oreille interne). La présentation s'effectue généralement dans les 3 plans de l'espace (vues supérieure, frontale antérieure et sagittale) avec simulation du geste opératoire (5 à 6 vues en position opératoire avec différents niveaux en profondeur).
http://ift.tt/2p2ZsKM
Lymphome nasal T/NK : observation dramatique
Publication date: April 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 2
Author(s): L. Taali, M. Abou-Elfadl, M. Fassih, M. Mahtar
IntroductionLe lymphome nasal T/NK est une entité clinicopathologique rare anciennement dénommée granulome malin centrofacial. Depuis les progrès de l'anatomopathologie et l'avènement de l'immunohistochimie en pratique courante, le diagnostic de lymphome nasal T/NK a pu être reconnu par l'OMS en 2001.ObservationNous rapportons l'observation d'une patiente âgée de 22ans, diabétique insulinodépendante, qui a présenté un placard inflammatoire médiofacial à la suite d'un traumatisme facial, et qui a été diagnostiqué et traité comme une cellulite de la face. L'évolution était rapidement progressive et fatale, avec installation d'une nécrose centrofaciale dont les examens anatomopathologiques ont conclu à un lymphome T/NK.DiscussionParmi les diagnostics différentiels du lymphome T N/K, on trouve une cellulite gangréneuse, une rhinosinusite mycosique invasive, une maladie de Wegener, une actinomycose, ou un lymphome T facial… ; sa présentation clinique est atypique d'où le retard diagnostique et thérapeutique. Le traitement repose sur la radiothérapie et la chimiothérapie mais le pronostic reste péjoratif même si le traitement est instauré rapidement.
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Kyste hydatique cervical primitif. Localisation rare et inhabituelle
Publication date: April 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 2
Author(s): K. Oqbani, M. Chraïbi, N. Harchichi, S. Abbaoui
IntroductionLes tuméfactions cervicales isolées d'origine parasitaire, en particulier hydatique sont rares même en pays d'endémie. Notre objectif est d'étudier les aspects épidémiologiques, cliniques et les démarches diagnostiques de l'hydatidose cervico-faciale.ObservationIl s'agit d'un garçon âgé de 3 ans, hospitalisé pour une masse latéro-cervicale gauche isolée et évoluant depuis un an. L'échographie cervicale objectivait une formation latéro-cervicale kystique hypoéchogène de 3,5cm de diamètre. L'étude histologique de la masse reséquée confirmait le diagnostic du kyste hydatique cervical (KHC).DiscussionEn pays d'endémie, toute masse cervicale kystique doit faire évoquer le diagnostic d'hydatidose. Les données épidémiologiques, cliniques, biologiques et radiologiques du kyste hydatique restent des éléments de présomption. La cytoponction permet de rectifier des diagnostics erronés. L'étude histologique permet le diagnostic de certitude devant ces localisations inhabituelles.
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Maladie de Kimura chez un patient tunisien de 50 ans
Publication date: April 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 2
Author(s): M. Drouillard, M. Steve, T. Ranoarivony, J.-B. Souraud
IntroductionAlors que la maladie de Kimura, maladie rare, atteint principalement les hommes trentenaires, originaires d'Asie du Sud et de l'Est, nous rapportons le cas d'un patient tunisien de 50 ans dont le diagnostic de maladie de Kimura a été posé a posteriori.ObservationsLe patient présentait deux lésions nodulaires chroniques de 2cm de diamètre en regard de la mandibule droite, sans signes locaux inflammatoires ni autre atteinte clinique. Une exérèse des 2 lésions a été réalisée sous anesthésie locale. L'anatomopathologie a montré une hyperplasie des centres germinatifs, des micro-abcès à polynucléaires éosinophiles et une hyperplasie des veinules post-capillaires, évoquant une maladie de Kimura. Ce diagnostic a été confirmé par le bilan biologique : IgE augmentée (519g/L), hyperéosinophilie (580/mm3). Le bilan rénal était normal.DiscussionLe diagnostic de maladie de Kimura a été posé devant un faisceau d'arguments : homme, localisation cervico-faciale, aspect histologique très évocateur, augmentation des IgE et hyperéosinophilie, même si l'âge et l'ethnie ne concordaient pas avec le tableau typique. Le principal diagnostic différentiel est l'hyperplasie angiolymphoïde avec éosinophiles (HALE) qu'il convient de différentier en raison de l'atteinte rénale possible au cours de la maladie de Kimura.
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Un diagnostic rare d’une tumeur mandibulaire
Publication date: April 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 2
Author(s): H. Touil, J. Hamila, M. Bouzaiene
http://ift.tt/2p33d2G
Une image laryngée anténatale inhabituelle
Publication date: April 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 2
Author(s): J. Chevreau, C. Rieu, C. Page
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Une tuméfaction nasolabiale
Publication date: April 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 2
Author(s): C.A. Righini, A. Baguant, I. Atallah
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Exérèse d’un schwannome massétérin par voie d’abord transorale assistée par endoscopie
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 2
Author(s): K. Endo, K. Kase, T. Yoshizaki
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Polype fibroépithelial du conduit auditif externe
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 2
Author(s): P. Thomas, P. Rai, R. Meena
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Lettre sur l’article « Une tumeur cervicale rare chez un enfant »
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 2
Author(s): M. Dogan, A.S. Kahraman, İ.O. Yıldırım
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Idiopathic SIADH in young patients: don't forget the nose.
| Related Articles |
Idiopathic SIADH in young patients: don't forget the nose.
Acta Otorhinolaryngol Ital. 2017 Feb;37(1):76-79
Authors: Parrilla C, Lucidi D, Petrone G, Bastanza G, Colosimo C
Abstract
Olfactory neuroblastoma (ONB) is an uncommon neuroendocrine sinonasal cancer associated by many authors to ectopic production of several biologically active substances. We report a case of a 31-year-old male patient who presented with idiopathic syndrome of inappropriate secretion of antidiuretic hormone (SIADH). During diagnostic work-up, a CT scan of the head was performed and an ethmoidal ONB was detected. Endoscopical surgery followed by radiotherapy was carried out. Immediately after surgery natraemia levels normalised. Five years later the patient is disease-free. To our knowledge, 17 cases of SIADH associated to ONB have been published. In nine reports, idiopathic SIADH promptly led to the diagnosis of the sinonasal mass as in our clinical case, however, in many reports, correct diagnosis was accomplished months to years later. In young patients with idiopathic inappropriate antidiuretic hormone secretion, a neuroendocrine malignancy of the sinonasal area must be excluded.
PMID: 28374875 [PubMed - in process]
http://ift.tt/2o2wTiT
A proposal for limited criminal liability in high-accuracy endoscopic sinus surgery.
| Related Articles |
A proposal for limited criminal liability in high-accuracy endoscopic sinus surgery.
Acta Otorhinolaryngol Ital. 2017 Feb;37(1):65-71
Authors: Voultsos P, Casini M, Ricci G, Tambone V, Midolo E, Spagnolo AG
Abstract
The aim of the present study is to propose legal reform limiting surgeons' criminal liability in high-accuracy and high-risk surgery such as endoscopic sinus surgery (ESS). The study includes a review of the medical literature, focusing on identifying and examining reasons why ESS carries a very high risk of serious complications related to inaccurate surgical manoeuvers and reviewing British and Italian legal theory and case-law on medical negligence, especially with regard to Italian Law 189/2012 (so called "Balduzzi" Law). It was found that serious complications due to inaccurate surgical manoeuvers may occur in ESS regardless of the skill, experience and prudence/diligence of the surgeon. Subjectivity should be essential to medical negligence, especially regarding high-accuracy surgery. Italian Law 189/2012 represents a good basis for the limitation of criminal liability resulting from inaccurate manoeuvres in high-accuracy surgery such as ESS. It is concluded that ESS surgeons should be relieved of criminal liability in cases of simple/ordinary negligence where guidelines have been observed.
PMID: 28374874 [PubMed - in process]
http://ift.tt/2o2g4Vd
Beware of the dangers along the path towards the diagnosis of HPV-driven oropharyngeal squamous cell carcinoma.
| Related Articles |
Beware of the dangers along the path towards the diagnosis of HPV-driven oropharyngeal squamous cell carcinoma.
Acta Otorhinolaryngol Ital. 2017 Feb;37(1):63-64
Authors: Boscolo-Rizzo P, Bussu F
PMID: 28374873 [PubMed - in process]
http://ift.tt/2p02u2n
Influence of temporal resolution skills in speech discrimination abilities of older subjects.
| Related Articles |
Influence of temporal resolution skills in speech discrimination abilities of older subjects.
Acta Otorhinolaryngol Ital. 2017 Feb;37(1):58-62
Authors: Nair PG, Basheer BM
Abstract
Compromised temporal resolving power of the auditory system can be one of the main factors contributing to poor speech perception skills in the elderly. Very few of the earlier studies have systematically examined this aspect. Hence, the current study was designed with the following objectives: 1) To establish normative database of Gaps in Noise (GIN) test in elderly population in an Indian context. 2) To determine the relationship between speech discrimination skills and temporal resolution abilities in elderly individuals with normal hearing sensitivity. Thirty normal hearing elderly individuals (age range: 55-75 years; mean age: 59.86 ± 4.11 years) participated in the study. The audiological evaluation comprised of tympanometry, puretone and speech audiometry (Speech Reception Threshold-SRT, Speech Discrimination Score-SDS) and GIN. The results of the present study revealed mean Gap Detection Threshold (GDT) of 8.7 msec (SD = 3.38) in the right ear and 8.83 msec (SD = 2.86) in the left ear for the older participants. The mean Total Percentage Score (TPS) in the right ear was 47% (SD = 11.92) and 45% (SD = 11.29) in the left ear. These results suggest that temporal resolution abilities are poor in the elderly compared to the young and middle-aged group. There was no significant ear based difference on either GDT or TPS. The GDT was inversely correlated with speech discrimination performance. The TPS was positively correlated with SDS. This study clearly demonstrated a positive relationship between temporal resolution abilities and speech discrimination. The current database might be useful when assessing temporal resolution abilities in hearing impaired elderly individuals. Furthermore, all elderly individuals should undergo temporal resolution evaluation, irrespective of their hearing status, during audiological assessment.
PMID: 28374872 [PubMed - in process]
http://ift.tt/2o2jRSj
Quality of life measurements for patients with chronic suppurative otitis media: Italian adaptation of "Chronic Ear Survey".
| Related Articles |
Quality of life measurements for patients with chronic suppurative otitis media: Italian adaptation of "Chronic Ear Survey".
Acta Otorhinolaryngol Ital. 2017 Feb;37(1):51-57
Authors: Ralli G, Milella C, Ralli M, Fusconi M, La Torre G
Abstract
The chronic ear survey (CES) is a sensitive and disease specific quality of life (QoL) measurement tool in patients with chronic suppurative otitis media (CSOM). It is a 13-item survey that evaluates the frequency, duration and severity of problems associated with this disease. It is composed of three subscales that describe activity restrictions, symptoms and medical resource utilisation. Based on patient's answers, it is possible to obtain a score resulting in a scale ranging from 0 to 100; the highest indicates the best health, while the lowest denotes poor health. The questionnaire was originally created in English. The aim of this study is to validate the CES questionnaire in Italian (CES-I). Translation was made following international guidelines. The application follows the stages of translation from English to Italian and linguistic adaptation, and grammatical and idiomatic equivalence review. The CES-I and the Short Form Health Survey 36 (SF-36) questionnaires were administered to 54 patients with CSOM. A cross-sectional design was used to examine the internal consistency (Cronbach's alpha) and concurrent validity (Pearson's product moment correlation). To confirm the external validity of CES-I, Pearson correlation coefficient, considering the total score and single subscales of CES and the 8 scales of the SF-36, was calculated. Cronbach's alpha coefficient for internal consistency was 0.737. The intraclass correlation coefficient, measured through mixed effects, was 0.737 (95% CI: 0.600-0.835, p < 0.001) for average measures and 0.412 (95%CI: 0.273-0.559, p < 0.001) for individual measures. According to our results, CES-I is a reliable tool for evaluation of QoL in patients with CSOM among the Italian-speaking population.
PMID: 28374871 [PubMed - in process]
http://ift.tt/2oZVC4Y
Transoral robotic surgery (TORS): a new tool for high risk tracheostomy decannulation.
| Related Articles |
Transoral robotic surgery (TORS): a new tool for high risk tracheostomy decannulation.
Acta Otorhinolaryngol Ital. 2017 Feb;37(1):46-50
Authors: Montevecchi F, Cammaroto G, Meccariello G, Hoff PT, Corso RM, Galletti C, Al-Rawashdeh MF, Vicini C
Abstract
Tracheostomy decannulation has always been considered a procedure with an attendant risk, especially in patients with a reduced upper airway diameter as is commonly observed in the obstructive sleep apnoea (OSA) population. We report on 4 cases where transoral robotic surgery (TORS) helped in the management of long-term cannulated patients. The aims of our paper are: 1. To demonstrate how the otolaryngology team can help identify patients at high risk for decannulation failure; and 2. To demonstrate how TORS may aid in the decannulation process of patients at high risk for failure due to severe tongue base hypertrophy. From our experience, TORS appears to offer an effective option to aid in the decannulation of patients with a severe hypertrophy of the base of tongue and floppy epiglottis.
PMID: 28374870 [PubMed - in process]
http://ift.tt/2oB5Nkk
Non-surgical management of chronic rhinosinusitis with nasal polyps based on clinical-cytological grading: a precision medicine-based approach.
| Related Articles |
Non-surgical management of chronic rhinosinusitis with nasal polyps based on clinical-cytological grading: a precision medicine-based approach.
Acta Otorhinolaryngol Ital. 2017 Feb;37(1):38-45
Authors: Gelardi M, Iannuzzi L, De Giosa M, Taliente S, De Candia N, Quaranta N, De Corso E, Seccia V, Ciprandi G
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a common inflammatory disorder that strongly impacts patients' quality of life. CRSwNP is still a challenge for ENT specialists due to its unknown pathogenesis, difficult control and frequent relapse. We tested the hypothesis that a new standardised therapeutic approach based on individual clinical-cytological grading (CCG), may improve control of the disease and prevent the needing for surgery. We analysed 204 patients suffering from bilateral CRSwNP, 145 patients of whom regularly assumed therapy, respecting the planned check-up, and were considered cases; 59 patients were not assuming therapy as indicated and were considered as controls. After five years of standardised treatment, 15 of 145 (10.5%) improved endoscopic staging, 61 of 145 (42%) did not change their endoscopic staging, and 69 of 145 (47.5%) were worse. In the control group, 49 of 59 (83%) were worse by at least two stages (p < 0.05). Patients and controls were stratified basing on clinical and cytological grading as mild, moderate and severe. After patient stratification, in the mild group (n = 27) 92% patients had a constant trend, with no worsening and no need for surgery over a 5-year period, whereas in the mild CCG control group 1 of 59 (1.6%) required surgery (p < 0.05). In moderate GCC (n = 83), 44% of patients did not modify or improve endoscopic staging and 3.6% needed surgery, compared to 13.6% of controls with moderate GCC (p < 0.05). In severe CCG (n = 35), even though no patients achieved significant amelioration of endoscopic grading, 40% of patients were considered as "clinically controlled" and 5.7% of patients underwent surgery, but the percentage was significantly higher (49%) in the control group significant (p = 0.0000). Finally, statistical analyses revealed a clear trend that polyp size increased at a faster rate in the control group than in the treatment group and for each subgroup (low, moderate and severe). The present study suggests a new approach in the management of CRS according to clinical cytological grading that allows defining the grade of CRSwNP severity and to adapt the intensity of treatment. This approach limited the use of systemic corticosteroids to only moderate-severe CRSwNP with a low corticosteroid dosage in comparison with those previously suggested. Our protocol seems to improve the adherence by patients, control of disease and the need for surgery in the long-term.
PMID: 28374869 [PubMed - in process]
http://ift.tt/2o28F8i
The value of Nigella sativa in the treatment of experimentally induced rhinosinusitis.
| Related Articles |
The value of Nigella sativa in the treatment of experimentally induced rhinosinusitis.
Acta Otorhinolaryngol Ital. 2017 Feb;37(1):32-37
Authors: Yoruk O, Tatar A, Keles ON, Cakir A
Abstract
The aim of this study was to investigate the effect of Nigella sativa and cephalexin in the therapy of experimental bacterial rhinosinusitis. Bacterial rhinosinusitis was induced with Staphylococcus aureus. Rabbits were divided into five groups; control (n = 6), N. sativa 50 mg/ kg/d (n = 6), N. sativa 100 mg/kg/d (n = 6), N. sativa 200 mg/kg/d (n = 6), and cephalexin 20 mg/kg/d (n = 6) groups. N. sativa was given orally for 7 days. The same volume of normal saline (0.9% NaCl) was given as a vehicle to the control group for the same period. After treatment period, sinus mucosa samples were evaluated using stereological and histopathological methods. Half of the maxillary sinus mucosa samples were frozen at -800C for further analysis of NO levels. Pathology revealed a severe acute inflammatory process in rabbits treated with saline. Only mild inflammation was determined in cephalexin group, N. sativa 100 mg/kg/d and N. sativa 200 mg/kg/d groups. The level of NO increased in the saline group was significantly reduced in all treatment groups. N. sativa may prevent histopathological changes of rhinosinusitis via decreased NO levels in a dose dependent manner and can be used in the treatment of rhinosinusitis diseases.
PMID: 28374868 [PubMed - in process]
http://ift.tt/2oHrITE
Dysphagia screening in subacute care settings using the Italian version of the Royal Brisbane and Women's Hospital (I-RBWH) dysphagia screening tool.
| Related Articles |
Dysphagia screening in subacute care settings using the Italian version of the Royal Brisbane and Women's Hospital (I-RBWH) dysphagia screening tool.
Acta Otorhinolaryngol Ital. 2017 Feb;37(1):25-31
Authors: Mozzanica F, Scarponi L, Pedrali S, Pizzorni N, Pinotti C, Foieni F, Zuccotti G, Schindler A
Abstract
The large majority of the available dysphagia screening tools has been developed for the stroke population. Only few screening tools are suitable for heterogeneous groups of patients admitted to a subacute care unit. The Royal Brisbane and Women's Hospital (RBWH) dysphagia screening tool is a nurse-administered, evidence-based swallow screening tool for generic acute hospital use that demonstrates excellent sensitivity and specificity. No Italian version of this tool is available to date. The aim of this study was to determine the reliability and screening accuracy of the Italian version of the RBWH (I-RBWH) dysphagia screening tool. A total of 105 patients consecutively admitted to a subacute care unit were enrolled. Using the I-RBWH tool, each patient was evaluated twice by trained nurses and once by a speech and language pathologist (SLP) blind to nurses' scores. The SLP also performed standardised clinical assessment of swallowing using the Mann assessment of swallowing ability (MASA). During the first and the second administration of the I-RBWH by nurses, 28 and 27 patients, respectively, were considered at risk of dysphagia, and 27 were considered at risk after SLP assessment. Intra- and inter-rater reliability was satisfactory. Comparison between nurse I-RBWH scores and MASA examination demonstrated a sensitivity and specificity of the I-RBWH dysphagia screening tool up to 93% and 96%, respectively; the positive and negative predictive values were 90% and 97%, respectively. Thus, the current findings support the reliability and accuracy of the I-RBWH tool for dysphagia screening of patients in subacute settings. Its application in clinical practice is recommended.
PMID: 28374867 [PubMed - in process]
http://ift.tt/2oZVwdE
Overexpression of chromatin assembly factor-1/p60 predicts biological behaviour of laryngeal carcinomas.
| Related Articles |
Overexpression of chromatin assembly factor-1/p60 predicts biological behaviour of laryngeal carcinomas.
Acta Otorhinolaryngol Ital. 2017 Feb;37(1):17-24
Authors: Mesolella M, Iorio B, Landi M, Cimmino M, Ilardi G, Iengo M, Mascolo M
Abstract
This study analysed the immunohistochemical expression of the CAF-1/p60 protein in laryngeal cancers. CAF-1/p60 assumes an independent discriminative and prognostic value in laryngeal neoplasms; the presence of this protein in carcinoma in situ compared with laryngeal precancerous and larynx infiltrating tumours. We assessed the immunohistochemical expression of CAF-1/p60 in 30 cases of moderate and/or severe dysplasia, 30 cases of carcinoma in situ and 30 cases of laryngeal squamous cell carcinoma (LSCCs). CAF-1/p60 expression increased significantly according to the high index of neoplastic cellular replication; therefore, CAF-1/p60 was overexpressed in neoplastic cells and its moderate-severe expression is correlated with poorer prognosis compared to less expression. In conclusion, overexpression of the CAF-1/p60 protein is related to a risk of higher morbidity and mortality and is a reliable independent prognostic index of laryngeal carcinoma. CAF1-p60 protein overexpression can be used in cancer management as an indicator of malignant evolution, especially in carcinoma in situ.
PMID: 28374866 [PubMed - in process]
http://ift.tt/2oB69HT
Is prophylactic central neck dissection necessary for cN0 differentiated thyroid cancer patients at initial treatment? A meta-analysis of the literature.
| Related Articles |
Is prophylactic central neck dissection necessary for cN0 differentiated thyroid cancer patients at initial treatment? A meta-analysis of the literature.
Acta Otorhinolaryngol Ital. 2017 Feb;37(1):1-8
Authors: Liang J, Li Z, Fang F, Yu T, Li S
Abstract
Central lymph node metastases are common in patients with differentiated thyroid cancer (DTC). The management of preoperatively nodenegative (cN0) DTC is still under debate. The aim of this study was to analyse the difference in recurrence and surgical complications between thyroidectomy (TT) alone and TT combined with prophylactic central neck dissection (pCND) as initial treatments to DTC patients with cN0 and evaluate the clinic significance of pCND for these patients. PubMed, Ovid, Cochrane Library, and Web of Science databases were systematically searched using multiple search terms. Twenty-three articles with 6,823 patients were identified. The quality of evidence was assessed by Jadad quality scores and the Newcastle-Ottawa Quality assessment scale. The results showed that compared with patients who underwent TT alone, patients who underwent TT plus pCND had a significant higher rate of transient recurrent laryngeal nerve injury (p = 0.023), transient hypocalcaemia (p < 0.01) and permanent hypocalcaemia (p<0.01). There was a trend towards lower central neck recurrence rate in TT plus pCND (p < 0.01). Combined TT and pCND as initial treatment for DTC patients with cN0 may reduce the risk of recurrence, but increases the incidence of some complications. Methodologically high-quality comparative studies are needed for further evaluation.
PMID: 28374865 [PubMed - in process]
http://ift.tt/2o2a1Ql
Treatment of vitiligo with the topical Janus kinase inhibitor ruxolitinib
Existing therapies for vitiligo are limited in efficacy and can be associated with undesirable side effects. Topical Janus kinase inhibitors may offer a new therapeutic option for vitiligo.
http://ift.tt/2obWuGC
A case of extensive pharyngeal vascular malformation successfully treated with Kampo medicine
Source:Auris Nasus Larynx
Author(s): Keiko Ogawa-Ochiai, Keigo Osuga, Kuniaki Hidaka, Kengo Nakahata, Yuko Tazuke, Yoshifumi Yamamoto, Shuichiro Uehara, Hiroomi Okuyama
ObjectiveTo present the efficacy of Japanese-traditional medicine (Kampo) for a case with vascular malformation.MethodsA case study and literature review.PatientA 62-year-old female presented with dysphagia and spitting blood. Esophagogastroduodenoscopy showed a longitudinal lobulated and septated mass in the posterior pharynx. On MR imaging, the mass showed hyperintensity on T2-weighted images and heterogeneous enhancement on Gadlinium-enhanced T1-weighted images, suggestive of a low-flow vascular malformation.InterventionAccording to the Kampo diagnosis, kamisyouyousan and ninjinyoueito were prescribed to this patient. The effect of Kampo medicine was evaluated with improvement of her symptoms and volumetry of MRI findings.ResultThe longitudinal pharyngeal mass was markedly decreased and her symptoms disappeared after 2 years of Kampo administration.ConclusionsKampo medicine can be a novel alternative therapy for VM.
http://ift.tt/2oDtWqk
Features of sinonasal hemangioma: A retrospective study of 31 cases
Source:Auris Nasus Larynx
Author(s): Shinya Takaishi, Daiya Asaka, Tsuguhisa Nakayama, Jiro Iimura, Yoshinori Matsuwaki, Shinichi Hirooka, Hiroyuki Takahashi, Hiromi Kojima, Nobuyoshi Otori
ObjectiveAlthough hemangiomas are common lesions of the head and neck, sinonasal hemangiomas are rare. The purpose of this study was to analyze the clinical features (sex, age, symptoms, and size and anatomical location of the lesion) and the histological findings of sinonasal hemangioma cases, to assess preoperative transarterial embolization, and to evaluate the outcome (recurrence or no recurrence) of endoscopic sinus surgery.MethodsClinical records of 31 patients who underwent endoscopic sinus surgery for resection of sinonasal hemangioma between January 2010 and June 2015 were retrospectively reviewed.ResultsThe study group consisted of 19 men and 12 women. Mean age was 53.3±15.9years. The principal symptom was epistaxis (81%). Mean tumor size was 12.6±8.2mm. The most common origin of hemangioma was the inferior turbinate (45%), followed by the nasal septum (39%), and, in both locations, the origin had a tendency to be located in the anterior portion. Thirty-one specimens were histologically categorized as 9 cavernous hemangiomas and 22 capillary hemangiomas. Preoperative transarterial embolization was performed in 2 cases. Only one recurrence was observed among 31 cases. In the recurrent case, the hemangioma of the nasal septum was resected during pregnancy.ConclusionAccording to our results, the transnasal endoscopic approach can be useful for the resection of sinonasal hemangioma. However, sinonasal hemangioma in connection with pregnancy must be addressed with care to decide the appropriate time for treatment.
http://ift.tt/2nZp8Zi
Evaluation of the diagnostic accuracy of nonverbal signs used by medical staff to assess postoperative pain: A prospective study
No abstract availablehttp://ift.tt/2oFbu0q
Evaluation of augmented pulse pressure variation using the Valsalva manoeuvre as a predictor of fluid responsiveness under open-chest conditions: A prospective observational study
BACKGROUND: Pulse pressure variation (PPV) is a well known dynamic preload indicator of fluid responsiveness. However, its usefulness in open-chest conditions remains controversial. OBJECTIVE: We evaluated whether augmented PPV during a Valsalva manoeuvre can predict fluid responsiveness after sternotomy. DESIGN: A prospective, observational study. SETTING: Single-centre trial, study period from October 2014 to June 2015. PATIENTS: Forty-nine adult patients who underwent off-pump coronary arterial bypass grafting. INTERVENTION: After midline sternotomy, haemodynamic parameters were measured before and after volume expansion (6 ml kg−1 of crystalloids). PPV was calculated both automatically (PPVauto) and manually (PPVmanual). For PPV augmentation, we performed Valsalva manoeuvres with manual holding of the rebreathing bag and constant airway pressure of 30 cmH2O for 10 s before fluid loading and calculated PPV during the Valsalva manoeuvre (PPVVM). MAIN OUTCOME MEASURES: The predictive ability of PPVVM for fluid responsiveness using receiver-operating characteristic curve analysis. Responders were identified when an increase in cardiac index of at least 12% occurred after fluid loading. RESULTS: Twenty-one patients were responders and 28 were nonresponders. PPVVM successfully predicted fluid responsiveness with an area under the curve (AUC) of 0.88 [95% confidence interval (95% CI) 0.75 to 0.95; sensitivity 91%, specificity 79%, P http://ift.tt/2nMptgW
Dobutamine aggravates haemodynamic deterioration induced by pleural effusion: A randomised controlled porcine study
BACKGROUND: Pleural effusion is a common finding in critically ill patients and may contribute to circulatory instability and the need for inotropic support. OBJECTIVE: We hypothesised that dobutamine would affect the physiological determinants preload, afterload, contractility and changes of inferior vena cava characteristics during experimental pleural effusion. DESIGN: A randomised, controlled laboratory study. SETTING: Animal laboratory, conducted from March 2013 to May 2013. ANIMALS: Twenty-four Landrace and Yorkshire female piglets (21.3 ± 1.7 kg). INTERVENTION: Twenty piglets were included in the analyses. After inducing bilateral pleural effusion (30 ml kg−1), the piglets were block randomised to either incremental dobutamine infusion (n = 10) or control (n = 10). MAIN OUTCOME MEASURES: Ultrasonographic measures of left ventricular end-diastolic area, left ventricular afterload, left ventricular fractional area change and inferior vena cava diameter and distensibility were used to assess the basic physiological effect of incremental dobutamine administration during experimental pleural effusion. RESULTS: In the dobutamine group, preload, measured as left ventricular end-diastolic area, decreased from 11.3 ± 2.0 cm2 after creation of the pleural effusion to 8.1 ± 1.5 cm2 at a dobutamine infusion rate of 20 μg kg−1 min−1 (P http://ift.tt/2oF4JeS
Significance of new Q waves and their location in postoperative ECGs after elective on-pump cardiac surgery: An observational cohort study
BACKGROUND: The clinical significance of new pathological Q waves after on-pump cardiac surgery is uncertain. OBJECTIVES: To determine whether or not either the occurrence per se or the location of new pathological Q waves after on-pump cardiac surgery is associated with 12-month, all-cause mortality and/or major adverse cardiac events (MACEs). DESIGN: Observational cohort study. SETTING: Single university hospital from January 2007 to October 2010. PATIENTS: Consecutive adult patients undergoing elective on-pump cardiac surgery with MACE-free survival until at least the 7th postoperative day and available ECGs both preoperatively and on the 7th postoperative day (n = 1464). We conducted a subgroup analysis in patients undergoing isolated coronary artery bypass grafting (n = 740). MAIN OUTCOME MEASURE: Our primary endpoint was 12-month, all-cause mortality and/or MACE, defined as acute coronary syndrome, cardiac arrest, congestive heart failure or re-vascularisation at 12 months. Using logistic regression, we examined the prognostic value of new pathological Q waves according to the Minnesota ECG Code, adjusting for the EuroSCORE II, cardiopulmonary bypass time and peak postoperative troponin T concentrations. RESULTS: We included 1464 patients (74% men; mean ± SD age 66 ± 10 years) and observed 103 (7.0%) all-cause deaths and/or MACEs at 12 months. A total of 236 patients (16.1%) had definite or probable new pathological Q waves according to the Minnesota ECG Code. The occurrence of new pathological Q waves per se was not associated with our primary endpoint [adjusted odds ratio, 0.970 (95% confidence interval, 0.540 to 1.648)]. However, the occurrence of a new pathological Q wave in V1 to V5 (anterior) was a strong independent predictor for poor outcome [adjusted odds ratio, 3.461 (95% confidence interval, 1.501 to 7.242)]. CONCLUSION: The current analysis suggests that for patients undergoing elective on-pump cardiac surgery, only new pathological Q waves in V1 to V5 (anterior) in the 7th postoperative day ECG are associated with 12-month, all-cause mortality and/or MACE. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT00468598.http://ift.tt/2nZrveH
Aprotinin vs. tranexamic acid in isolated coronary artery bypass surgery: A multicentre observational study
BACKGROUND: Aprotinin appears to be more efficacious than lysine analogues to reduce bleeding and transfusion of blood products in high-transfusion-risk cardiac surgical patients. However, in isolated coronary artery bypass graft (CABG) surgery, the results from head-to-head trials remain less conclusive. OBJECTIVE: Our objective was to compare the efficacies and safety of aprotinin and tranexamic acid (TXA) in patients undergoing isolated on-pump CABG. DESIGN: A multicentre before-and-after study pooling individual data from published trials and unpublished data from three other databases. SETTING: Four tertiary care teaching hospitals (Haut-Lévêque Hospital in Bordeaux, Pitié-Salpêtrière Hospital and Bichat-Claude Bernard Hospital in Paris, and Laennec Hospital in Nantes). PATIENTS: We included data of 2496 isolated on-pump CABG surgery patients who received either aprotinin between November 2003 and May 2008 (n = 1267) or TXA between November 2007 and November 2013 (n = 1229). MAIN OUTCOME MEASURES: The primary outcome was total blood loss within 24 h after operation. Secondary outcomes were transfusion of blood products, reoperation for bleeding, renal replacement therapy, ICU length of stay and in-hospital mortality. RESULTS: Adjusted mean (SEM) 24-h blood loss after surgery [483 (11) vs. 634 (11) ml, P http://ift.tt/2oF2W9T
Dipyrone (metamizole) markedly interferes with platelet inhibition by aspirin in patients with acute and chronic pain: A case-control study
BACKGROUND: Nonopioid analgesic drugs may interfere with platelet inhibition by aspirin. Recent in vitro and clinical studies in patients with cardiovascular disease have suggested that this pharmacodynamic interaction may also occur with dipyrone, a nonopioid analgesic popular in Europe, Asia and South America. OBJECTIVE: Dipyrone is used extensively in acute and chronic pain. This study was undertaken to provide clinical data, so far missing, on its interactions in this group of patients. DESIGN: A case-control study. SETTING: Primary care in one European university hospital centre. PATIENTS: In total, 27 patients with stable cardiovascular, cerebrovascular or peripheral arterial disease and acute or chronic pain were identified and given dipyrone for at least 5 days in combination with low-dose aspirin. In total, 10 comparable patients on low-dose aspirin alone served as controls. MAIN OUTCOME MEASURES: Platelet-rich plasma was prepared to determine arachidonic acid-induced aggregation (aggregometry) and thromboxane formation (immunoassay). Platelet sensitivity to aspirin was examined in vitro. The presence of dipyrone (metabolites) in plasma was confirmed by HPLC. Additional in vitro measurements examined the aspirin/dipyrone interaction in healthy donors. RESULTS: Inhibition of aggregation was observed in only six of 27 patients receiving aspirin with dipyrone, with absence of complete inhibition by antiplatelet therapy showing in 78% of patients. In contrast, aggregation was completely inhibited in nine of 10 control patients (P http://ift.tt/2nZvqIi
Quantitative pupillometry to assess nociception in a sedated patient with hemispheric cerebral infarction
No abstract availablehttp://ift.tt/2nZu2pj
Intraoperative monitoring of analgesia using nociceptive reflexes correlates with delayed extubation and immediate postoperative pain: A prospective observational study
BACKGROUND: Immediate postoperative pain could be prevented by the administration of long-lasting analgesics before the end of the anaesthesia. However, to prevent over or underdosing of analgesics under anaesthesia, tools are required to estimate the analgesia–nociception balance. OBJECTIVE: We investigated whether the pupillary dilation reflex (PDR) and the nociceptive flexion reflex (NFR) at the end of general anaesthesia correlate with immediate postoperative pain, as a sign of analgesic underdosing, and with delayed tracheal extubation as a sign of analgesic overdosing. DESIGN: Prospective observational study. SETTING: Klinikum im Friedrichshain, Berlin, Germany, from May 2013 to April 2015. PATIENTS: A total of 110 patients scheduled for primary hip arthroplasty under general anaesthesia. OBSERVATIONS: Psychometric and clinical data were obtained preoperatively. The PDR and the NFR were assessed preoperatively and at the end of anaesthesia. Shortly after extubation of the trachea, patients rated their pain intensity. ENDPOINTS: The primary endpoint was the immediate postoperative numeric rating scale pain intensity (0 to 10) and the secondary endpoint was the length of the time interval between reflex measurements and tracheal extubation. RESULTS: PDR correlated significantly with the immediate postoperative pain intensity (Spearman's ρ = −0.28, P http://ift.tt/2nZrMOB
Postoperative administration of metamizole for one single day: A retrospective cohort study
No abstract availablehttp://ift.tt/2nZkLgL
Time course of copeptin during a model of experimental pain and hyperalgesia: A randomised volunteer crossover trial
BACKGROUND: A reliable biomarker for quantifying pain or hyperalgesia has yet to be found. A surrogate marker of arginine vasopressin, copeptin, is elevated in a number of states of physiological and psychological stress and may have a role in quantifying pain and/or hyperalgesia. OBJECTIVES: To evaluate copeptin as a biomarker for pain or hyperalgesia developing after 120 min of sustained electrical stimulation. DESIGN: Secondary analysis of a randomised, double-blinded, crossover trial. SETTING: Single, tertiary university hospital from September 2014 to January 2015. PARTICIPANTS: A total of 16 healthy, opioid-naïve white men with no confounding medication or history of pain. INTERVENTIONS: Copeptin and cortisol were measured five times during an established model of transdermal electrical stimulation designed to assess pain and hyperalgesia. MAIN OUTCOME MEASURES: The primary outcome was the change in copeptin concentration after 120 min of sustained electrical stimulation. Secondary outcomes were copeptin and cortisol concentrations after a subsequent period of rest and analyses of copeptin and cortisol concentrations were made in high-dose and low-dose fentanyl groups separately. RESULTS: Total copeptin concentrations were not significantly elevated after 120 min [9.15 pmol l−1 (interquartile ranges (IQR), 3.45 to 35.45 pmol l−1); P = 0.150] compared with baseline [6.15 pmol l−1 (IQR, 3.60 to 10.62 pmol l−1)]. In the high-dose fentanyl group, there was a significant increase in copeptin within individuals [P = 0.001; median, 37.9 pmol l−1 (IQR, 8.1 to 62 pmol l−1)] after 120 min, and in the low-dose fentanyl group a significant decrease in copeptin concentrations within individuals [P = 0.006; median, 4.7 pmol l−1 (IQR, 3.13 to 9.35 pmol l−1)]. No correlation between copeptin concentration and either the area under the pain curve or area under the hyperalgesia curve could be found, indicating that the observed differences may be due to other fentanyl-mediated effects. CONCLUSION: Copeptin concentrations do not appear to be associated directly with pain and hyperalgesia. Instead, some fentanyl-mediated effect or effects appear to have greatly increased copeptin concentrations from baseline to 120 min. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT02252458.http://ift.tt/2nZkKcH
Sinonasal Schwannoma: A Rare Sinonasal Neoplasm
Abstract
Neoplasm in sinonasal cavity is dominated by epithelial type. Sinonasal schwannoma is a rare entity represent less than four percent of head and neck schwannoma. Clinically this tumour is commonly misdiagnosed until they are confirmed by histopathological examination. We present a case of schwannoma in sinonasal region with involvement of right side nasal cavity, maxillary sinus and maxillary alveolar process. The tumour was successfully removed by midfacial degloving approach.
http://ift.tt/2oJ9zVN
Myocardial Induction of Type 3 Deiodinase in Dilated Cardiomyopathy
http://ift.tt/2nLUJNp
Pretty Baby: Propranolol for Noncritical IH?
Dr Graeme Lipper reviews an important study on infantile hemangiomas and discusses a potential new protocol for noncritical cases.
Medscape Dermatology
http://ift.tt/2nZ72qi
Optimal timing for telescoping endotracheal tube into an introducer during nasotracheal intubation
Epistaxis or postpharyngeal injury is the most common complication during nasotracheal intubation. Prior thermosoftening of the endotracheal tube [1] and using a red rubber catheter as an introducer [2] were suggested to prevent these complications. When both maneuvers were simultaneously implemented [3], the timing of attaching the red rubber catheter to the endotracheal tube is also crucial to the effectiveness of the injury prevention. If the red rubber catheter telescoped to the endotracheal tube in the beginning of anesthesia induction, even though after warmed water immersion, the tube thermosoftening effect would rapidly disappear after the process of the red rubber catheter manipulation in the cold operating room.
http://ift.tt/2o4xVuS
Phosphorylation of dynamin-related protein 1 at Ser616 regulates mitochondrial fission and is involved in mitochondrial calcium uniporter-mediated neutrophil polarization and chemotaxis
Source:Molecular Immunology, Volume 87
Author(s): Xianchong Zheng, Mimi Chen, Xiaojing Meng, Xinwei Chu, Chunqing Cai, Fei Zou
During an inflammatory response, polarization of neutrophils is necessary for effective chemotaxis and bacterial endocytosis. Ca2+ uptake into mitochondria through the mitochondrial calcium uniporter (MCU) is crucial for cell metabolism, signaling and survival; however, the physiological role of MCU in human neutrophils remains unclear. Here we show that MCU is vital for the polarization and chemotaxis of neutrophils. Activation of MCU by spermine promotes neutrophil polarization and chemotaxis, whereas inhibition of MCU by Ru360 blunts both processes. We also provide evidence that this role of the MCU in neutrophils may result from modulation of mitochondrial fission by increased levels of pDrp1 S616 via accumulation of Ca2+ into the mitochondrial matrix. Thus, our study identifies the dependence of neutrophil polarization and chemotaxis on the MCU and highlights the importance of regulating mitochondrial fission during the anti-inflammatory cascade in human neutrophils.
http://ift.tt/2oKh4vJ
Non-immediate Cutaneous Reactions to Beta-Lactams: Approach to Diagnosis
Abstract
Non-immediate cutaneous reactions (i.e., occurring at least 1 h after the initial drug administration), particularly maculopapular exanthemas and urticarial eruptions, are common during beta-lactam treatments. A T cell-mediated pathogenic mechanism has been demonstrated in some cutaneous reactions, such as maculopapular exanthema, fixed drug eruption, acute generalized exanthematous pustulosis, and drug-induced hypersensitivity syndrome. In the diagnostic work-up, patch testing is useful, together with delayed-reading intradermal testing. Patch tests are a simple and safe diagnostic tool, which in the case of severe reactions should be used as the first line of investigation. However, patch tests are less sensitive than intradermal tests, which are preferable in subjects with mild reactions. Lymphocyte transformation or activation tests and enzyme-linked immunosorbent spot assays can be used as complementary tests. In selected cases of mild or moderate reactions, displaying negative results in the aforesaid allergy tests, a graded challenge with the implicated beta-lactam can be performed.
http://ift.tt/2oBDWAp
Non-immediate Cutaneous Reactions to Beta-Lactams: Approach to Diagnosis
Abstract
Non-immediate cutaneous reactions (i.e., occurring at least 1 h after the initial drug administration), particularly maculopapular exanthemas and urticarial eruptions, are common during beta-lactam treatments. A T cell-mediated pathogenic mechanism has been demonstrated in some cutaneous reactions, such as maculopapular exanthema, fixed drug eruption, acute generalized exanthematous pustulosis, and drug-induced hypersensitivity syndrome. In the diagnostic work-up, patch testing is useful, together with delayed-reading intradermal testing. Patch tests are a simple and safe diagnostic tool, which in the case of severe reactions should be used as the first line of investigation. However, patch tests are less sensitive than intradermal tests, which are preferable in subjects with mild reactions. Lymphocyte transformation or activation tests and enzyme-linked immunosorbent spot assays can be used as complementary tests. In selected cases of mild or moderate reactions, displaying negative results in the aforesaid allergy tests, a graded challenge with the implicated beta-lactam can be performed.
http://ift.tt/2oBDWAp
Suppositories for fever as a major risk for phenobarbital-induced fixed drug eruption in children
Abstract
Phenobarbital, an anticonvulsant agent, is a well-known cause of fixed drug eruption (FDE) in patients with epilepsy. In paediatric population without epilepsy however, phenobarbital-induced FDE is only rarely reported, and exclusively from its use in suppositories for fever. It is included in suppositories, along with acetaminophen or acetyl salicylic acid, because of its sedative properties, and to prevent febrile seizures in children. We herein report two children with FDE from phenobarbital-containing suppositories in order to point out to this uncommon but important side effect of suppositories for fever.
This article is protected by copyright. All rights reserved.
http://ift.tt/2nYEJbz
Reply to sentinel lymph node biopsy (SLNB) plus wide local excision vs. wide local excision alone for primary cutaneous melanoma: a systematic review and meta-analysis – SLNB is not associated with a significantly better outcome in melanoma survival
Abstract
with interest I read the review about sentinel lymph node biopsy (SLNB) and wide local excision (WLE) compared to WLE alone for primary cutaneous melanoma written by Santos-Juanes J. et. al..1 Authors took a heavy burden of work, however I worry that the authors took prematurely conclusions and their analysis leads to inadequate reasoning for a survival benefit in the SLNB group against the evidence of the data.
This article is protected by copyright. All rights reserved.
http://ift.tt/2oDaGJA
Author′s response to a reply to “Sentinel lymph node biopsy (SLNB) plus wide local excision vs. wide local excision alone for primary cutaneous melanoma: a systematic revive and meta-analysis”
Abstract
We sincerely thank to Eisdenle1 their interest in our work2. Despite of some of their comments are pertinent, we really think that others are based on a flawed interpretation of our results.
This article is protected by copyright. All rights reserved.
http://ift.tt/2nLkkpn
Fractures in calciphylaxis patients following intravenous sodium thiosulfate therapy
Abstract
Calciphylaxis is a highly fatal syndrome of small vessel calcification that results in skin ischemia and necrosis.[1] Affected patients present with extremely painful, violaceous skin lesions that progress to non-healing ulcers, and can be complicated by superimposed infections and sepsis.[2] The mortality rate from calciphylaxis is estimated at 60-80%.[2, 3] Sodium thiosulfate (STS), an increasingly popular treatment for calciphylaxis, is theorized to work through vasodilation, antioxidation, and calcium chelation. Known adverse effects include volume overload, metabolic acidosis, and hypotension.[2, 4] We report four patients who experienced unusual fractures during or following treatment with intravenous STS (IVSTS), an adverse effect that has not yet been reported in the literature.
This article is protected by copyright. All rights reserved.
http://ift.tt/2oCVAnA
Apremilast and suicidality: a retrospective analysis of three large databases: the FAERS, EudraVigilance, and a large single-center U.S. patient population
Abstract
Apremilast is a small molecule phosphodiesterase-4 inhibitor approved by the United States Food and Drug Administration (FDA) in 2014 for the treatment of adult patients with moderate-to-severe plaque psoriasis and for psoriatic arthritis.1 Worsening depression, suicide attempts, suicidal ideation, and suicidal behavior have previously been reported in clinical trials and post-marketing surveillance data, and details are included in the Full Prescribing Information.1 Moreover, a post-marketing statement recently issued now indicates that completed suicide has also been reported.2
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The opinion of dermoscopy experts about teledermoscopy involving primary care physicians and dermatologists
Abstract
Many dermatologists use teledermoscopy to seek second advice from experts for difficult lesions. Teledermoscopy by primary care physicians (PCP) is still controversial but already has been implemented in several regions. Since there are only few studies published about teledermoscopy in the hand of PCP with poor level of evidence we asked the opinion of dermoscopy experts (board members of the International Dermoscopy Society (IDS)). 1-6 Furthermore, we investigated the routing of patients with a suspicious pigmented skin lesion and the use of teledermoscopy in different countries.
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Oral ulcers associated with bone destruction as the primary manifestation of histoplasmosis in an immunocompetent patient
Abstract
Histoplasmosis is a systemic fungal infection caused by Histoplasmacapsulatum, a saprophyte fungus commonly found in enriched soils with bat and bird droppings.[1] Oral manifestations of histoplasmosis are associated with the disseminated form of the disease, occurring in general associated with pulmonary infection.[2] We report a rare case of oral histoplasmosis with periodontal bone destruction in an immunocompetent patient without underlying pulmonary disease.
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Atopic dermatitisIL17A and IFN-γ-producing lymphocytes: investigation in blood, chronic lesions and APT
Abstract
After stimulation, skin and blood-derived mononuclear cells were washed with phosphate buffered saline and stained with anti-CD4 FITC, anti-CD3 PerCP and anti-CD45 APC antibodies, then fixed with 2% paraformaldehyde and permeabilized with 0.5% saponin/1% fetal calf serum, before an additional staining with intracytoplasmic anti-IL17A PE or anti-IFN-γ PE or control isotype IgG1 PE. Cells were acquired with FACSCANTO II and analyzed with FlowJo software.
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Neue Entwicklungen in der systemischen Therapie des kleinzelligen Lungenkarzinoms
Zusammenfassung
Hintergrund
Das kleinzellige Lungenkarzinom (SCLC) macht etwa 20 % aller Lungenkarzinome aus. Trotz hoher initialer Sensitivät gegenüber Chemotherapie kommt es schnell zu einer Resistenzentwicklung und innerhalb kurzer Zeit zum Tod des Patienten.
Methode
Der aktuelle Artikel basiert auf einer selektiven Literaturrecherche, die zum Ziel hatte, die aktuellsten und vielversprechendsten Daten zu potenziellen therapeutischen Targets zu identifizieren. Die derzeit bekannte und als Vollpublikation oder auch als Abstract publizierte Datenlage wird dargestellt.
Ergebnisse
Im Gegensatz zum nichtkleinzelligen Lungenkarzinom (NSCLC), das inzwischen molekular charakterisiert ist und bei dem eine Immuntherapie bei etwa 25–30 % der Patienten bereits Standard in der Erstlinientherapie ist, sind die Fortschritte beim SCLC deutlich langsamer. Ein besonderes Augenmerk wird auf die Immuncheckpointinhibitoren und auf eine neue Zielstruktur, „delta-like canonical notch ligand 3" (DLL3), gerichtet. Beide Ansätze befinden sich im fortgeschrittenen Stadium der klinischen Evaluation.
http://ift.tt/2p1TYzQ
Sinonasal Schwannoma: A Rare Sinonasal Neoplasm
Abstract
Neoplasm in sinonasal cavity is dominated by epithelial type. Sinonasal schwannoma is a rare entity represent less than four percent of head and neck schwannoma. Clinically this tumour is commonly misdiagnosed until they are confirmed by histopathological examination. We present a case of schwannoma in sinonasal region with involvement of right side nasal cavity, maxillary sinus and maxillary alveolar process. The tumour was successfully removed by midfacial degloving approach.
http://ift.tt/2oJ9zVN
Pre-harvest aflatoxins and Aspergillus flavus contamination in variable germplasms of red chillies from Kunri, Pakistan
Abstract
Various cultivars of red chilli were collected from a small town named Kunri, located in the province Sindh, Pakistan. This town is a hub of red chilli production in Asia. A total of 69 samples belonging to 6 cultivars were obtained and analysed for the occurrence of aflatoxins and Aspergillus flavus, to explore the potential of resistant and susceptible germplasm. Aflatoxins were detected by thin layer chromatography (TLC) and high performance liquid chromatography (HPLC), while A. flavus was isolated and identified using agar plate, blotter paper, deep freezing and dilution techniques. Molecular characterization using internal transcribed spacer (ITS) 1/4 and A. flavus specific FL1-F/R primers confirmed the identity of A. flavus. The data revealed that 67 and 75% samples contaminated with aflatoxin B1 (AFB1) and with A. flavus, respectively. A highly susceptible chilli cultivar was 'Nagina', showing 78.8% frequency of total aflatoxins (1.2–600 μg/kg) and a mean of 87.7 μg/kg for AFB1 and 121.9 μg/kg for total aflatoxins. A. flavus was detected with 93% frequency and 2.14 × 104 colony forming units. In contrast, cultivars 'Kunri' and 'Drooping Type' were found to be resistant, with low levels of aflatoxins and fungal counts. The study was conducted for the first time to explore two potential cultivars that were less susceptible towards A. flavus and aflatoxin contamination. These cultivars could be preferably cultivated and thereby boost Pakistan's chilli production.
http://ift.tt/2o3Og2C
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