Medicine by Sfakianakis Alexandros: 05/19/17

Παρασκευή 19 Μαΐου 2017

Effects of calcium chloride coadministered with neostigmine on neuromuscular blockade recovery: A double-blind randomised study.

BACKGROUND: Ionised calcium plays an important role in neuromuscular transmission, but its effects on the reversal of nondepolarising neuromuscular blockade have not been fully evaluated. OBJECTIVE: We examined whether calcium chloride coadministered with neostigmine could enhance the rate of neuromuscular recovery. DESIGN: Prospective randomised double-blind trial. SETTING: A tertiary teaching hospital. PATIENTS: In total, 53 patients undergoing elective surgery under general anaesthesia with neuromuscular monitoring by acceleromyography using a TOF-Watch SX monitor. INTERVENTIONS: Patients were randomly allocated to receive either 5 mg kg-1 of calcium chloride (calcium group, n = 26) or the same volume of normal saline (control group, n = 27) coadministered with 25 [mu]g kg-1 of neostigmine and 15 [mu]g kg-1 of atropine at the end of surgery. MAIN OUTCOME MEASURES: The primary end point was the neuromuscular recovery time [time from neostigmine administration to recovery of the TOF ratio (TOFr) to 0.9]. Secondary end points included the TOFr at 5, 10 and 20 min after neostigmine administration and the incidence of postoperative residual curarisation (PORC), defined as a TOFr less than 0.9 at each time point. RESULTS: The neuromuscular recovery time was significantly faster in the calcium group than in the control group (median [Q1 to Q3]; 5.0 [3.0 to 7.0] vs. 6.7 [5.7 to 10.0] min, respectively; P = 0.007). At 5 min after neostigmine administration, the TOFr was higher [87 (74 to 100) vs. 68 (51 to 81)%, respectively; P = 0.002] and the incidence of PORC was lower (50.0 vs. 81.5%, respectively; P = 0.016) in the calcium group than in the control group. There were no differences between the two groups with respect to the TOFr or incidence of PORC at 10 and 20 min after neostigmine administration. CONCLUSION: Calcium chloride coadministered with neostigmine enhanced neuromuscular recovery in the early period of nondepolarising neuromuscular blockade reversal. (C) 2017 European Society of Anaesthesiology

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Intraoperative magnesium sulphate decreases agitation and pain in patients undergoing functional endoscopic surgery: A randomised double-blind study.

BACKGROUND: Postoperative agitation is harmful for the patient as it may be associated with removal of catheters, nasal packs, oxygen masks and self-injury, and pose a danger to operating theatre staff. OBJECTIVE: The current study investigated the potential role of magnesium sulphate in treatment of postoperative agitation following functional endoscopic sinus surgery. DESIGN: A randomised, double-blinded, placebo-controlled trial. SETTING: ENT operating room, Menofia University Hospitals, Egypt. PATIENTS: A total of 312 adult patients (171 men and 141 women) were enrolled in the study. Eighteen patients (10 men and eight women) were excluded; data from 294 patients were analysed. Inclusion criteria were age between 20 and 60 years, American Society of Anesthesiologists' physical status 1 or 2 scheduled for functional endoscopic sinus surgery. Exclusion criteria were hypertension, cardiac ischaemia, cerebrovascular insufficiency, neuromuscular diseases, pregnancy, prolonged treatment with calcium-channel blockers, diabetic neuropathy or a known allergy to magnesium compounds. INTERVENTIONS: Patients were allocated randomly to either the magnesium group (a magnesium infusion of 30 mg kg-1 in the first hour followed by 9 mg kg-1 h-1 until the end of the surgical procedure) or the control group (0.9% saline at the same volume and rate). Hypotensive anaesthesia was induced by nitroglycerine 5 to 20 [mu]g kg-1 min-1. In the postanaesthetic care unit (PACU), patients were assessed for agitation and pain using the Richmond agitation-sedation scale and numerical rating scale, respectively. PRIMARY OUTCOME: The incidence and severity of agitation measured 5 min after admission to the PACU. RESULTS: Magnesium reduced postoperative agitation at time 0 (P = 0.009) and 5, 10, 15 and 30 min after PACU admission (P

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Comparison of laryngeal mask airway insertion methods, including the external larynx lift with pre-inflated cuff, on postoperative pharyngolaryngeal complications: A randomised clinical trial.

BACKGROUND: Postoperative pharyngolaryngeal complications are commonly reported following laryngeal mask airway (LMA) insertion. After induction of anaesthesia, the airway structures fall backwards under the influence of gravity, and this may contribute to difficulty in placement of a LMA. External airway alignment by lifting the larynx during insertion of an airway may avoid collision of the airway with laryngeal structures. OBJECTIVE(S): To compare pharyngolaryngeal complications after either conventional airway insertion with or without cuff semi-inflation and a method, including an external larynx lift. DESIGN: Randomised controlled double blind clinical trial. SETTING: Ambulatory surgical operating rooms of a university hospital. PATIENTS: American Society of Anaesthesiologists class 1 to 3 patients undergoing ambulatory surgery scheduled to receive general anaesthesia for which a LMA was not contraindicated. INTERVENTIONS: Patients were randomised into three groups for LMA placement: G1, deflated airway; G2, pre-inflated cuff; G3, pre-inflated cuff with external lifting of the larynx. Assessment of pharyngolaryngeal complications (blinded assessor) was made at the time of LMA removal and again at 1, 2 and 24 h. MAIN OUTCOME MEASURES: A pharyngolaryngeal complication, defined as a composite of one or more of sore throat, dysphonia or dysphagia at any time point, or blood on the airway at removal. RESULTS: Of the 450 consecutive patients, 441 were studied. There were no differences in insertion times or number of insertion attempts among the groups. There was no difference in pharyngolaryngeal complications among the groups: G1, 57%; G2, 55%; G3, 52%, (P = 0.77). Blood on the airway was observed less frequently in G3 (9%) compared with G1 and G2 combined (17%): difference -8% (95% confidence interval of the difference -0.8 to -16%, P = 0.01). CONCLUSION: The external larynx lift technique was associated with a lower incidence of blood on the airway at removal, suggesting that the method may decrease trauma to the tissues of the upper airway during insertion. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT01749033. (C) 2017 European Society of Anaesthesiology

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Perioperative factors related to the severity of vocal cord paralysis after thoracic cardiovascular surgery: A retrospective review.

BACKGROUND: Vocal cord paralysis (VCP) is a rare complication of thoracic cardiovascular surgery. In severe cases, life-threatening airway obstruction may occur. OBJECTIVE: To evaluate the incidence and severity of VCP among patients who underwent thoracic cardiovascular surgery and to identify possible risk factors. DESIGN: Single-centre retrospective review of adult patients. SETTING: Osaka University Hospital, Suita, Japan, from January 2013 to August 2015. PATIENTS: We included 688 patients in the final analysis. Preoperative, intraoperative and postoperative data were collected from medical records. Patients with preoperative VCP or tracheostomy prior to extubation were excluded. The VCP severity in relation to functional recovery was graded using the following categories: absent; mild, remission at 6 months; moderate, partial or persistent VCP at 6 months; or severe, airway obstruction after extubation requiring reintubation. An otolaryngologist diagnosed all VCP cases. MAIN OUTCOME MEASURES: The incidence and severity of VCP after extubation. RESULTS: The incidence (number) of VCP was 4.7% (32), with those of mild, moderate and severe VCP being 1.7% (12), 1.5% (10) and 1.5% (10), respectively. The ICU stay was significantly longer in patients with severe VCP than in patients without VCP [12.5 days (interquartile range 5.5 to 25.5) vs. 3 days (interquartile range 2 to 5), P = 0.0002]. In our multivariable analysis, type 2 diabetes mellitus [odds ratio (OR) 1.853, P = 0.009], intubation period (OR per 24 h 1.136, P = 0.014), ascending aortic arch surgery with brachiocephalic artery reconstruction (OR 8.708, P

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Effects of dexamethasone on early cognitive decline after cardiac surgery: A randomised controlled trial.

BACKGROUND: Postoperative cognitive decline (POCD), a very common complication after cardiac surgery, is characterised by impairment of both memory function and intellectual ability as well as being associated with increased use of healthcare resources. The investigators focused on the role of the inflammatory response to a surgical procedure as a potential factor involved in the pathogenesis of POCD. OBJECTIVE: The use of prophylactic dexamethasone to attenuate the inflammatory response was hypothesised to reduce the risk of POCD. DESIGN: Randomised controlled study. SETTING: Single university teaching hospital, from March 2015 to January 2016. PATIENTS: A total of 169 patients scheduled for elective cardiac surgery were enrolled, and 161 patients were included in the analyses. INTERVENTION: Patients were randomised to receive a single intravenous bolus of 0.1 mg kg-1 dexamethasone (n = 85) or placebo (n = 84) 10 h before the surgery. MAIN OUTCOME MEASURES: The primary outcome measure in both groups was the incidence of POCD on the 6th day after surgery. The investigators also evaluated the effect of dexamethasone on the incidence of systemic inflammatory response syndrome, postoperative C-reactive protein levels and postoperative serum S100[beta] protein levels. RESULTS: Compared to the placebo group, the dexamethasone group showed statistically significant reductions in the incidence of POCD (relative risk, 0.43; 95% confidence interval, 0.21 to 0.89; P = 0.02), the incidence of systemic inflammatory response syndrome (30.0 versus 58.0%, P

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Anaesthesiology research in the European Union and the European Free Trade Association: An overview from 2001 to 2015.

BACKGROUND: Publication performance in anaesthesiology hints at research activity and attractiveness for a particular centre or country for anaesthetists. OBJECTIVE: The aim of this retrospective bibliographic study is to compare the publication performance of anaesthesiology departments within the countries of the European Union (EU) and European Free Trade Association (EFTA) combined. Outcome measures were the number of publications, the number of original articles, the average impact factor and the number of publications and average impact factor per million inhabitants. METHODS: Articles from anaesthesiology departments within the EU and EFTA countries published between 1 January 2001 and 31 December 2015 were included. Articles were electronically imported from Medline into a database and linked to anaesthesiology departments according to the authors' affiliations. Publication performance was assessed for 2001 to 2005, 2006 to 2010, 2011 to 2015 and 2001 to 2015. RESULTS: From 2001 to 2015, the absolute number of articles increased from 10 513 to 19 037 (+81%), whereas the number of original research articles decreased from 3786 to 1563 (-58%). Germany had the most publications (8948) with 1967 of these being original articles. Denmark achieved not only the highest average impact factor per million inhabitants (319.9) but also the most articles per anaesthesiologist (1.46), and per million habitants (105.7). Countries which moved up the income scale to a higher income class also increased the number of publications. DISCUSSION: In the EU and EFTA countries, the total number of publications increased from 2001 to 2015, but the number of original research articles fell by more than 50%. CONCLUSION: Between 2001 and 2015, in the EU and EFTA countries, the number of publications increased, whereas the number of original articles decreased. Germany published most, but Denmark had most publications per anaesthesiologist and per capita, and also achieved the highest impact factor per article. (C) 2017 European Society of Anaesthesiology

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Subcellular Energetics and Metabolism: A Cross-Species Framework

Although it is generally believed that oxidative phosphorylation and adequate oxygenation are essential for life, human development occurs in a profoundly hypoxic environment and "normal" levels of oxygen during embryogenesis are even harmful. The ability of embryos not only to survive but also to thrive in such an environment is made possible by adaptations related to metabolic pathways. Similarly, cancerous cells are able not only to survive but also to grow and spread in environments that would typically be fatal for healthy adult cells. Many biological states, both normal and pathological, share underlying similarities related to metabolism, the electron transport chain, and reactive species. The purpose of Part I of this review is to review the similarities among embryogenesis, mammalian adaptions to hypoxia (primarily driven by hypoxia-inducible factor-1), ischemia-reperfusion injury (and its relationship with reactive oxygen species), hibernation, diving animals, cancer, and sepsis, with a particular focus on the common characteristics that allow cells and organisms to survive in these states.

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Zika Virus: Obstetric and Pediatric Anesthesia Considerations

As of November 2016, the Florida Department of Health (FDH) and the Centers for Disease Control and Prevention have confirmed more than 4000 travel-related Zika virus (ZIKV) infections in the United States with >700 of those in Florida. There have been 139 cases of locally acquired infection, all occurring in Miami, Florida. Within the US territories (eg, Puerto Rico, US Virgin Islands), >30,000 cases of ZIKV infection have been reported. The projected number of individuals at risk for ZIKV infection in the Caribbean and Latin America approximates 5 million. Similar to Dengue and Chikungunya viruses, ZIKV is spread to humans by infected Aedes aegypti mosquitoes, through travel-associated local transmission, via sexual contact, and through blood transfusions. South Florida is an epicenter for ZIKV infection in the United States and the year-round warm climate along with an abundance of mosquito vectors that can harbor the flavivirus raise health care concerns. ZIKV infection is generally mild with clinical manifestations of fever, rash, conjunctivitis, and arthralgia. Of greatest concern, however, is growing evidence for the relationship between ZIKV infection of pregnant women and increased incidence of abnormal pregnancies and congenital abnormalities in the newborn, now medically termed ZIKA Congenital Syndrome. Federal health officials are observing 899 confirmed Zika-positive pregnancies and the FDH is currently monitoring 110 pregnant women with evidence of Zika infection. The University of Miami/Jackson Memorial Hospital is uniquely positioned just north of downtown Miami and within the vicinity of Liberty City, Little Haiti, and Miami Beach, which are currently "hot spots" for Zika virus exposure and transmissions. As the FDH works fervently to prevent a Zika epidemic in the region, health care providers at the University of Miami and Jackson Memorial Hospital prepare for the clinical spectrum of ZIKV effects as well as the safe perioperative care of the parturients and their affected newborns. In an effort to meet anesthetic preparedness for the care of potential Zika-positive patients and perinatal management of babies born with ZIKA Congenital Syndrome, this review highlights the interim guidelines from the Centers for Disease Control and Prevention and also suggest anesthetic implications and recommendations. In addition, this article reviews guidance for the evaluation and anesthetic management of infants with congenital ZIKV infection. To better manage the perioperative care of affected newborns, this article also reviews the comparative anesthetic implications of babies born with related congenital malformations.

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Coming to a Patient Near You: The Zika Virus and Anesthetic Implications

No abstract available

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Subcellular Hypoxia: A Survival Guide

No abstract available

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Subcellular Energetics and Metabolism: Potential Therapeutic Applications

Part I of this review discussed the similarities between embryogenesis, mammalian adaptions to hypoxia (primarily driven by hypoxia-inducible factor-1 [HIF-1]), ischemia-reperfusion injury (and its relationship with reactive oxygen species), hibernation, diving animals, cancer, and sepsis, and it focused on the common characteristics that allow cells and organisms to survive in these states. Part II of this review describes techniques by which researchers gain insight into subcellular energetics and identify potential future tools for clinicians. In particular, P31 nuclear magnetic resonance to measure high-energy phosphates, serum lactate measurements, the use of near-infrared spectroscopy to measure the oxidation state of cytochrome aa3, and the ability of the protoporphyrin IX-triplet state lifetime technique to measure mitochondrial oxygen tension are discussed. In addition, this review discusses novel treatment strategies such as hyperbaric oxygen, preconditioning, exercise training, therapeutic gases, as well as inhibitors of HIF-1, HIF prolyl hydroxylase, and peroxisome proliferator-activated receptors.

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Sialendoscopic management of autoimmune sialadenitis: a review of literature.

Sialendoscopic management of autoimmune sialadenitis: a review of literature.

Acta Otorhinolaryngol Ital. 2017 Apr;37(2):148-154

Authors: Gallo A, Martellucci S, Fusconi M, Pagliuca G, Greco A, De Virgilio A, De Vincentiis M

Abstract
Autoimmune diseases of major salivary glands include Sjögren's syndrome and a complex of disorders classified as immunoglobulin G4-related diseases. These pathologies are characterised by an autoimmune reaction mediated by T-helper lymphocytes that targets the ducts of exocrine glands in Sjögren's syndrome and glandular parenchyma in immunoglobulin G4-related diseases. Immunoglobulin G4-related diseases represent recently introduced multi-organ diseases that also involve the salivary glands. However, the morbid conditions once known as Mikulicz's disease and Kuttner's tumour were recently considered as two variants of immunoglobulin G4-related diseases affecting the major salivary glands ( immunoglobulin G4-related sialadenitis). This review briefly summarises the pathogenesis and clinical features of autoimmune diseases of the major salivary glands, focusing on the diagnostic and therapeutic role of sialendoscopy.

PMID: 28516978 [PubMed - in process]

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Botulinum toxin therapy: functional silencing of salivary disorders.

Botulinum toxin therapy: functional silencing of salivary disorders.

Acta Otorhinolaryngol Ital. 2017 Apr;37(2):168-171

Authors: Lovato A, Restivo DA, Ottaviano G, Marioni G, Marchese-Ragona R

Abstract
Botulinum toxin (BTX) is a neurotoxic protein produced by Clostridium botulinum, an anaerobic bacterium. BTX therapy is a safe and effective treatment when used for functional silencing of the salivary glands in disorders such as sialoceles and salivary fistulae that may have a post-traumatic or post-operative origin. BTX injections can be considered in sialoceles and salivary fistulae after the failure of or together with conservative treatments (e.g. antibiotics, pressure dressings, or serial aspirations). BTX treatment has a promising role in chronic sialadenitis. BTX therapy is highly successful in the treatment of gustatory sweating (Frey's syndrome), and could be considered the gold standard treatment for this neurological disorder.

PMID: 28516981 [PubMed - in process]

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Modern management of paediatric obstructive salivary disorders: long-term clinical experience.

Modern management of paediatric obstructive salivary disorders: long-term clinical experience.

Acta Otorhinolaryngol Ital. 2017 Apr;37(2):160-167

Authors: Capaccio P, Canzi P, Gaffuri M, Occhini A, Benazzo M, Ottaviani F, Pignataro L

Abstract
Recent technological improvements in head and neck field have changed diagnostic and therapeutic strategies for salivary disorders. Diagnosis is now based on colour Doppler ultrasonography (US), magnetic resonance (MR) sialography and cone beam 3D computed tomography (CT), and extra- and intracorporeal lithotripsy, interventional sialendscopy and sialendoscopy-assisted surgery are used as minimally invasive, conservative procedures for functional preservation of the affected gland. We evaluated the results of our long-term experience in the management of paediatric obstructive salivary disorders. The study involved a consecutive series of 66 children (38 females) whose obstructive salivary symptoms caused by juvenile recurrent parotitis (JRP) (n = 32), stones (n = 20), ranula (n = 9) and ductal stenosis (n = 5). 45 patients underwent interventional sialendoscopy for JRP, stones and stenoses, 12 a cycle of extracorporeal shockwave lithotripsy (ESWL), three sialendoscopy-assisted transoral surgery, one drainage, six marsupialisation, and two suturing of a ranula. Three children underwent combined ESWL and interventional sialendoscopy, and seven a secondary procedure. An overall successful result was obtained in 90.9% of cases. None of the patients underwent traditional invasive sialadenectomy notwithstanding persistence of mild obstructive symptoms in six patients. No major complications were observed. Using a diagnostic work-up based on colour Doppler US, MR sialography and cone beam 3D TC, children with obstructive salivary disorders can be effectively treated in a modern minimally-invasive manner by extracorporeal and intracorporeal lithotripsy, interventional sialendoscopy and sialendoscopy-assisted transoral surgery; this approach guarantees a successful result in most patients, thus avoiding the need for invasive sialadenectomy while functionally preserving the gland.

PMID: 28516980 [PubMed - in process]

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Interventional sialendoscopy for radioiodine-induced sialadenitis: quo vadis?

Interventional sialendoscopy for radioiodine-induced sialadenitis: quo vadis?

Acta Otorhinolaryngol Ital. 2017 Apr;37(2):155-159

Authors: Canzi P, Cacciola S, Capaccio P, Pagella F, Occhini A, Pignataro L, Benazzo M

Abstract
Salivary gland toxicity is a common adverse effect of radioactive iodine ((131)I) for the treatment of thyroid cancers with a prevalence ranging from 2% to 67% of the (131)I exposed population. Recently, sialendoscopy has been introduced as an attractive diagnostic and therapeutic tool for management of patients with radioiodine-induced sialadenitis that is unresponsive to standard medical treatments. The objective of the current review was to assess the impact of this procedure on outcomes in patients suffering from radioiodine sialadenitis. Overall, eight studies were included and 122 patients underwent 264 sialendoscopic procedures. Duct stenosis and mucous plugs were observed in 85.7% of endoscopic findings, supporting the role of ductal obstruction in the pathophysiology of radioiodine sialadenitis. In total, 89.3% of patients experienced complete or partial resolution of sialadenitis recurrences without any major adverse events, and parotidectomy was advocated in only 1 case. However, outcomes mainly concerned subjective reports and only two clinical experiences evaluated objective measurement with dissimilar results. Limited to few studies, xerostomia and obstructive symptoms responded differently after sialendoscopy. The optimal timing of salivary gland videoendoscopy needs to be further analysed in order to define the best management of radioiodine-induced obstructive sialadenitis.

PMID: 28516979 [PubMed - in process]

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Complications of traditional and modern therapeutic salivary approaches.

Complications of traditional and modern therapeutic salivary approaches.

Acta Otorhinolaryngol Ital. 2017 Apr;37(2):142-147

Authors: Nahlieli O

Abstract
The morbidity following traditional surgery of the salivary glands is well documented and includes postsurgical complications such as the Frey's syndrome, complete or partial facial nerve damage, facial scarring, greater auricular nerve numbness, sialocoeles and salivary fistula. The avulsion of the salivary duct, secondary strictures, gland swelling, salivary fistulas and perforations (false rout), traumatic ranulas, and the lingual nerve paraesthesia are the main endoscopy-related complications. In general, the rate of postsurgical complications after modern advanced minimally invasive surgical interventions is significantly lower compared with traditional surgery of the salivary glands. However, such comparisons cannot be performed because up-to-date traditional and minimally invasive surgical techniques are applied to different salivary disorders. Combinations of various minimally invasive techniques are also possible. There is no clear borderline between "traditional" and "modern" surgery of the salivary glands. It is appropriate to write about gradual replacement of old techniques with newer ones, and this process has no traffic lights.

PMID: 28516977 [PubMed - in process]

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Salivary duct stenosis: diagnosis and treatment.

Salivary duct stenosis: diagnosis and treatment.

Acta Otorhinolaryngol Ital. 2017 Apr;37(2):132-141

Authors: Koch M, Iro H

Abstract
The management of stenoses of the major salivary glands had undergone a significant change during the last 15-20 years. Accurate diagnosis forms the basis of adapted minimal invasive therapy. Conventional sialography and MR-sialography are useful examination tools, and ultrasound seems to be a first-line investigational tool if salivary duct stenosis is suspected as cause of gland obstruction. Sialendoscopy is the best choice to establish final diagnosis and characterise the stenosis in order to plan accurate treatment. In all major salivary glands, inflammatory stenosis can be distinguished from fibrotic stenosis. In the parotid duct system, an additional stenosis associated with various abnormalities of the duct system has been reported. Conservative therapy is not sufficient in the majority of cases. The development of a minimally invasive treatment regime, in which sialendoscopy plays a major role, has made the preservation of the gland and its function possible in over 90% of cases. Ductal incision procedures are the most important measure in submandibular duct stenoses, but sialendoscopy becomes more important in the more centrally located stenoses. Sialendoscopic controlled opening and dilation is the dominating method in parotid duct stenoses. In 10-15% of cases, success can be achieved after a combined treatment regime had been applied. This review article aims to give an overview on the epidemiology, diagnostics and current state of the art of the treatment of salivary duct stenoses.

PMID: 28516976 [PubMed - in process]

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Sialendoscopy-assisted transfacial removal of parotid calculi.

Sialendoscopy-assisted transfacial removal of parotid calculi.

Acta Otorhinolaryngol Ital. 2017 Apr;37(2):128-131

Authors: Hills AJ, Holden AM, McGurk M

Abstract
Superficial parotidectomy has significant morbidity, and minimally invasive techniques have therefore been developed, including those involving sialendoscopy, to remove sialoliths and preserve the gland along with its function. The size, mobility and location of the sialolith, alongside the presence of strictures, all dictate management. We outline basic treatment paradigms and describe two sialoendoscopyassisted surgical procedures developed for treating stones, one intraoral and one extraoral.

PMID: 28516975 [PubMed - in process]

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Sialendoscope-assisted transoral removal of hilo-parenchymal sub-mandibular stones: surgical results and subjective scores.

Sialendoscope-assisted transoral removal of hilo-parenchymal sub-mandibular stones: surgical results and subjective scores.

Acta Otorhinolaryngol Ital. 2017 Apr;37(2):122-127

Authors: Capaccio P, Gaffuri M, Rossi V, Pignataro L

Abstract
It has been suggested that a conservative trans-oral approach to proximal and hilo-parenchymal submandibular stones (HPSMS) is a valid alternative to the more frequently used sialadenectomy. The aim of this study was to evaluate the surgical, ultrasonographic and patients' subjective outcomes of results of the trans-oral removal of HPSMS. Between January 2003 and September 2015, sialendoscope-assisted trans-oral surgery was used to remove symptomatic, large (> 7 mm), fixed and palpable HPSMS from 479 patients under general anaesthesia. All patients were followed clinically and ultrasonographically to investigate symptom relief and recurrence of stones, and were telephonically interviewed to assess saliva-related subjective outcomes with a questionnaire. Stones were successfully removed from 472 patients (98.5%); the seven failures (1.5%) concerned pure parenchymal stones. One year after the procedure, 408 patients (85.1%) were symptom free, 59 (12.3%) had recurrent obstructive symptoms and 12 (2.6%) had recurrent infections. Of the 54 patients who developed a recurrent stone (11.2%), 52 underwent a second procedure: 29 interventional sialendoscopies, two sialendoscope-assisted intra-corporeal pneumatic lithotripsy, eight secondary transoral surgery to remove residual stones, six a cycle of extra-corporeal lithotripsy and seven submandibular sialadenectomy. Most patients (75.2%) reported mild surgery-related pain. The symptoms of 454 patients (94.8%) improved after adjunctive treatment and, at the end of follow-up, the affected gland was preserved in 98.5% of patients. A sialendoscope-assisted trans-oral removal of large HPSMS is a safe, effective, conservative surgical procedure, and functional preservation of the main duct and parenchyma of the obstructed gland allows sialendoscopic access through the natural ostium in case of recurrence. Combining a trans-oral approach with other minimally invasive, conservative procedures ensures symptomatic relief and salivary duct system clearance in the majority of patients.

PMID: 28516974 [PubMed - in process]

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Salivary lithotripsy in the era of sialendoscopy.

Salivary lithotripsy in the era of sialendoscopy.

Acta Otorhinolaryngol Ital. 2017 Apr;37(2):113-121

Authors: Capaccio P, Torretta S, Pignataro L, Koch M

Abstract
The traditional management of obstructive salivary disorders has been replaced by minimally-invasive gland-preserving techniques including shock-wave lithotripsy, sialendoscopy, interventional radiology and endoscopically video-assisted trans-oral and cervical stone retrieval, of which sialendoscopy is considered to be the method of first choice. Primary endoscopically controlled stone extraction without prior fragmentation is only possible in 15-20% of cases; in more than 80%, fragmentation is necessary because of the size, impactation and location of the stone, or an alternative treatment such as transoral duct surgery or combined approaches are required. Moreover, about 10-20% of all stones cannot be adequately accessed by means of a sialendoscope or any alternative surgical method and, in such cases, extra-corporeal shock wave lithotripsy (ESWL) is the treatment of choice. However, in endoscopically accessible stones, ESWL is being gradually replaced by endoscopically assisted intra-corporeal techniques, including endoscopically guided laser and pneumatic intracorporeal lithotripsy. We describe the currently most widely used techniques for salivary lithotripsy, including ESWL, and endoscopically guided laser, electrohydraulic, electrokinetic and pneumatic intra-corporeal lithotripsy, and discuss their indications given the widespread use of advanced rehabilitative sialendoscopy and combined therapeutic approaches.

PMID: 28516973 [PubMed - in process]

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Sialendoscopy for salivary stones: principles, technical skills and therapeutic experience.

Sialendoscopy for salivary stones: principles, technical skills and therapeutic experience.

Acta Otorhinolaryngol Ital. 2017 Apr;37(2):102-112

Authors: Carta F, Farneti P, Cantore S, Macrì G, Chuchueva N, Cuffaro L, Pasquini E, Puxeddu R

Abstract
Obstructive sialadenitis is the most common non-neoplastic disease of the salivary glands, and sialendoscopy is increasingly used in both diagnosis and treatment, associated in selected cases with endoscopic laser lithotripsy. Sialendoscopy is also used for combined minimally invasive external and endoscopic approaches in patients with larger and proximal stones that would require excessively long laser procedures. The present paper reports on the technical experience from the Ear, Nose and Throat Unit of the Sant'Orsola-Malpighi Hospital of Bologna, and from the Department of Otorhinolaryngology of the University Hospital of Cagliari, Italy, including the retrospective analysis of the endoscopic and endoscopic assisted procedures performed on 48 patients (26 females and 22 males; median age 45.3; range 8-83 years) treated for chronic obstructive sialadenitis at the University Hospital of Cagliari from November 2010 to April 2016. The results from the Sant'Orsola-Malpighi Hospital of Bologna have been previously published. The technical aspects of sialendoscopy are carefully described. The retrospective analysis of the University Hospital of Cagliari shows that the disease was unilateral in 40 patients and bilateral in 8; a total of 56 major salivary glands were treated (22 submandibular glands and 34 parotids). Five patients underwent bilateral sialendoscopy for juvenile recurrent parotitis. 10 patients were treated for non-lithiasic obstructive disease. In 33 patients (68.75%) the obstruction was caused by salivary stones (bilateral parotid lithiasis in 1 case). Only 8 patients needed a sialectomy (5 submandibular glands and 3 parotids). The conservative approach to obstructive sialadenitis is feasible and can be performed either purely endoscopically or in a combined modality, with a high percentage of success. The procedure must be performed with dedicated instrumentation by a skilled surgeon after proper training since minor to major complications can be encountered. Sialectomy should be the "extrema ratio" after failure of a conservative approach.

PMID: 28516972 [PubMed - in process]

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Salivary biomarkers and proteomics: future diagnostic and clinical utilities.

Salivary biomarkers and proteomics: future diagnostic and clinical utilities.

Acta Otorhinolaryngol Ital. 2017 Apr;37(2):94-101

Authors: Castagnola M, Scarano E, Passali GC, Messana I, Cabras T, Iavarone F, Di Cintio G, Fiorita A, De Corso E, Paludetti G

Abstract
Saliva testing is a non-invasive and inexpensive test that can serve as a source of information useful for diagnosis of disease. As we enter the era of genomic technologies and -omic research, collection of saliva has increased. Recent proteomic platforms have analysed the human salivary proteome and characterised about 3000 differentially expressed proteins and peptides: in saliva, more than 90% of proteins in weight are derived from the secretion of three couples of "major" glands; all the other components are derived from minor glands, gingival crevicular fluid, mucosal exudates and oral microflora. The most common aim of proteomic analysis is to discriminate between physiological and pathological conditions. A proteomic protocol to analyze the whole saliva proteome is not currently available. It is possible distinguish two type of proteomic platforms: top-down proteomics investigates intact naturally-occurring structure of a protein under examination; bottom-up proteomics analyses peptide fragments after pre-digestion (typically with trypsin). Because of this heterogeneity, many different biomarkers may be proposed for the same pathology. The salivary proteome has been characterised in several diseases: oral squamous cell carcinoma and oral leukoplakia, chronic graft-versus-host disease Sjögren's syndrome and other autoimmune disorders such as SAPHO, schizophrenia and bipolar disorder, and genetic diseases like Down's Syndrome and Wilson disease. The results of research reported herein suggest that in the near future human saliva will be a relevant diagnostic fluid for clinical diagnosis and prognosis.

PMID: 28516971 [PubMed - in process]

http://ift.tt/2qZbr0Q

Diagnostic work-up in obstructive and inflammatory salivary gland disorders.

Diagnostic work-up in obstructive and inflammatory salivary gland disorders.

Acta Otorhinolaryngol Ital. 2017 Apr;37(2):83-93

Authors: Ugga L, Ravanelli M, Pallottino AA, Farina D, Maroldi R

Abstract
Inflammatory and obstructive disorders of the salivary glands are caused by very different pathological conditions affecting the gland tissue and/or the excretory system. The clinical setting is essential to address the appropriate diagnostic imaging work-up. According to history and physical examination, four main clinical scenarios can be recognised: (1) acute generalised swelling of major salivary glands; (2) acute swelling of a single major salivary gland; (3) chronic generalised swelling of major salivary glands, associated or not with "dry mouth"; (4) chronic or prolonged swelling of a single major salivary gland. The algorithm for imaging salivary glands depends on the scenario with which the patient presents to the clinician. Imaging is essential to confirm clinical diagnosis, define the extent of the disease and identify complications. Imaging techniques include ultrasound (US), computed tomography (CT) and magnetic resonance (MR) with MR sialography.

PMID: 28516970 [PubMed - in process]

http://ift.tt/2q2BD6N

Voluminous laryngeal schwannoma excision with a mini-invasive external approach: a case report.

Voluminous laryngeal schwannoma excision with a mini-invasive external approach: a case report.

Acta Otorhinolaryngol Ital. 2017 Jun;37(3):242-244

Authors: Tulli M, Bondi S, Bussi M

Abstract
Laryngeal schwannomas are extremely uncommon. We present a case of bulky supraglottic schwannoma with involvement of the preepiglottic and superior paraglottic spaces. Clinical findings, computed tomography and magnetic resonance images are presented. These characteristics are typical, however not specific to schwannomas. For definitive diagnosis, histology and immunohistochemistry are necessary. We present an external mini-invasive approach that allowed us to both obtain diagnosis and provide definitive treatment for this kind of voluminous laryngeal tumour.

PMID: 28516969 [PubMed - in process]

http://ift.tt/2qZrnAi

Preliminary experience with 4K ultra-high definition endoscope: analysis of pros and cons in skull base surgery.

Preliminary experience with 4K ultra-high definition endoscope: analysis of pros and cons in skull base surgery.

Acta Otorhinolaryngol Ital. 2017 Jun;37(3):237-241

Authors: Rigante M, La Rocca G, Lauretti L, D'Alessandris GQ, Mangiola A, Anile C, Olivi A, Paludetti G

Abstract
During the last two decades endoscopic skull base surgery observed a continuous technical and technological development 3D endoscopy and ultra High Definition (HD) endoscopy have provided great advances in terms of visualisation and spatial resolution. Ultra-high definition (UHD) 4K systems, recently introduced in the clinical practice, will shape next steps forward especially in skull base surgery field. Patients were operated on through transnasal transsphenoidal endoscopic approaches performed using Olympus NBI 4K UHD endoscope with a 4 mm 0° Ultra Telescope, 300 W xenon lamp (CLV-S400) predisposed for narrow band imaging (NBI) technology connected through a camera head to a high-quality control unit (OTV-S400 - VISERA 4K UHD) (Olympus Corporation, Tokyo, Japan). Two screens are used, one 31" Monitor - (LMD-X310S) and one main ultra-HD 55" screen optimised for UHD image reproduction (LMD-X550S). In selected cases, we used a navigation system (Stealthstation S7, Medtronic, Minneapolis, MN, US). We evaluated 22 pituitary adenomas (86.3% macroadenomas; 13.7% microadenomas). 50% were not functional (NF), 22.8% GH, 18.2% ACTH, 9% PRL-secreting. Three of 22 were recurrences. In 91% of cases we achieved total removal, while in 9% near total resection. A mean follow-up of 187 days and average length of hospitalisation was 3.09 ± 0.61 days. Surgical duration was 128.18± 30.74 minutes. We experienced only 1 case of intraoperative low flow fistula with no further complications. None of the cases required any post- or intraoperative blood transfusion. The visualisation and high resolution of the operative field provided a very detailed view of all anatomical structures and pathologies allowing an improvement in safety and efficacy of the surgical procedure. The operative time was similar to the standard 2D HD and 3D procedures and the physical strain was also comparable to others in terms of ergonomics and weight.

PMID: 28516968 [PubMed - in process]

http://ift.tt/2rle3pu

Body-worn triaxial accelerometer coherence and reliability related to static posturography in unilateral vestibular failure.

Body-worn triaxial accelerometer coherence and reliability related to static posturography in unilateral vestibular failure.

Acta Otorhinolaryngol Ital. 2017 Jun;37(3):231-236

Authors: Alessandrini M, Micarelli A, Viziano A, Pavone I, Costantini G, Casali D, Paolizzo F, Saggio G

Abstract
Since changes in vestibular function may be one cause of disequilibrium, major advances in measuring postural control and sensory integration in vestibular impairments have been achieved by using posturography. However, in order to overcome problems related to this type of technology, body-worn accelerometers (ACC) have been proposed as a portable, low-cost alternative to posturography for measurements of postural sway in a friendly and ecologic environment. Due to the fact that no study to date has shown the experimental validity of ACC-based measures of body sway with respect to posturography for subjects with vestibular deficits, the aim of the present study was: i) to develop and validate a practical tool that can allow clinicians to measure postural sway derangements in an otoneurological setting by ACC, and ii) to provide reliable, sensitive and accurate automatic analysis of sway that could help in discriminating unilateral vestibular failure (UVF) patients. Thus, a group of 13 patients (seven females, 6 males; mean age 48.6 ± 6.4 years) affected for at least 6 months by UVF and 13 matched healthy subjects were instructed to maintain an upright position during a static forceplate-based posturography (FBP) acquisition while wearing a Movit® sensor (by Captiks) with 3-D accelerometers mounted on the posterior trunk near the body centre of mass. Pearson product moment correlation demonstrated a high level of correspondence of four time-domain and three frequency-domain measures extracted by ACC and FBP testing; in addition, t-test demonstrated that two ACC-based time- and frequency-domain parameters were reliable measures in discriminating UVF subjects. These aspects, overall, should further highlight the attention of clinicians and researchers to this kind of sway recording technique in the field of otoneurological disorders by considering the possibility to enrich the amount of quantitative and qualitative information useful for discrimination, diagnosis and treatment of UVF. In conclusion, we believe the present ACC-based measurement of sway offers a patient-friendly, reliable, inexpensive and efficient alternative recording technique that is useful - together with clinical balance and mobility tests - in various circumstances, as well as in outcome studies involving diagnosis, follow-up and rehabilitation of UVF patients.

PMID: 28516967 [PubMed - in process]

http://ift.tt/2q2BDDP

Expanded transcanal transpromontorial approach to the internal auditory canal and cerebellopontine angle: a cadaveric study.

Expanded transcanal transpromontorial approach to the internal auditory canal and cerebellopontine angle: a cadaveric study.

Acta Otorhinolaryngol Ital. 2017 Jun;37(3):224-230

Authors: Presutti L, Bonali M, Marchioni D, Pavesi G, Feletti A, Anschuetz L, Alicandri-Ciufelli M

Abstract
The aim of this paper is to describe and evaluate the feasibility of an expanded endoscopic transcanal transpromotorial approach (ExpTTA) to the internal auditory canal and the cerebellopontine angle. To this end, we performed a cadaveric dissection study in September 2015. In total, 2 heads (4 sides) were dissected focusing on anatomical landmarks and surgical feasibility. Data from dissections were reviewed and analysed for further consideration. In all 4 sides of the cadavers the procedure was feasible. In all cadavers, it was necessary to extensively drill the temporo-mandibular joint and to calibrate the external ear canal to allow adequate room to manoeuver the instruments and optics and to comfortably access the cerebellopontine angle. In addition, thorough skeletonisation of the carotid artery and the jugular bulb were necessary for the same purpose. In conclusion, ExpTTA appeared to be successful to access the internal auditory canal and cerebellopontine angle region. Potential extensive and routine application of this type of approach in lateral skull base surgery will depend on the development of technology and surgical refinements and on the diffusion of skull base endoscopic skills among otolaryngologists and neurosurgical community.

PMID: 28516966 [PubMed - in process]

http://ift.tt/2pScAqL

Benefits of active middle ear implants over hearing aids in patients with sloping high tone hearing loss: comparison with hearing aids.

Benefits of active middle ear implants over hearing aids in patients with sloping high tone hearing loss: comparison with hearing aids.

Acta Otorhinolaryngol Ital. 2017 Jun;37(3):218-223

Authors: Lee JM, Jeon JH, Moon IS, Choi JY

Abstract
In this retrospective chart review we compared the subjective and objective benefits of active middle ear implants (AMEIs) with conventional hearing aids (HAs) in patients with sloping high tone hearing loss. Thirty-four patients with sensorineural hearing loss were treated with AMEIs. Of these, six had sloping high tone hearing loss and had worn an HA for more than 6 months. Objective assessments, a pure-tone audiogram, as well as a word recognition test, and the Korean version of the Hearing in Noise Test (K-HINT), and a subjective assessment, the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire, were performed. Tests were conducted under three circumstances: 1) the unaided state before surgery; 2) the HA-aided state before surgery; and 3) the AMEI-aided state 3 months after surgery. The average high-frequency hearing gain (≥ 2 kHz) was significantly better with AMEIs than with HAs. Although the result had no statistical significance, AMEIs showed a superior word recognition score (WRS) compared to HAs. However, the most comfortable hearing level at which the WRS was tested was significantly decreased with an AMEI compared to an HA. In the K-HINT, patients with an AMEI showed greater recognition than those fitted with an HA under both quiet and noisy conditions. The APAHB scores revealed that patients were more satisfied with an AMEI rather than an HA on all subscales. The use of vibroplasty in patients with sloping high tone loss resulted in positive hearing outcomes when compared to conventional HAs. Based on the data from this study, AMEIs provided better objective and subjective results and could, therefore, be a better alternative for the treatment of sloping hearing loss.

PMID: 28516965 [PubMed - in process]

http://ift.tt/2rnmQaC

Barbed reposition pharyngoplasty in multilevel robotic surgery for obstructive sleep apnoea.

Barbed reposition pharyngoplasty in multilevel robotic surgery for obstructive sleep apnoea.

Acta Otorhinolaryngol Ital. 2017 Jun;37(3):214-217

Authors: Vicini C, Meccariello G, Cammaroto G, Rashwan M, Montevecchi F

Abstract
The surgical treatment of obstructive sleep apnoea in patients who are non-compliant with continuous positive airway pressure therapy still represents a valid alternative. In recent years, the multilevel approach is becoming more diffuse in routine surgical practice, especially since the introduction of transoral robotic surgery. Barbed reposition pharyngoplasty in multilevel robotic surgery for OSA may represent a valid option to surgically approach the soft palate. Herein, we describe the technique and preliminary results of our experience.

PMID: 28516964 [PubMed - in process]

http://ift.tt/2rnVIbn

The endoscopic evaluation of the oral phase of swallowing (Oral-FEES, O-FEES): a pilot study of the clinical use of a new procedure.

The endoscopic evaluation of the oral phase of swallowing (Oral-FEES, O-FEES): a pilot study of the clinical use of a new procedure.

Acta Otorhinolaryngol Ital. 2017 Jun;37(3):201-206

Authors: Farneti D, Fattori B, Bastiani L

Abstract
Oral FEES (O-FEES) is an endoscopic procedure conceived to directly visualise the oral phase of swallowing. In the perspective of clinical use, the feasibility, safety and acceptability of O-FEES has been evaluated. Subsequently, the procedure was compared with the radiological gold standard. The acceptability of O-FEES was compared to that of FEES using a 10 point questionnaire submitted to a sample of 52 outpatients complaining of swallowing disorders. Repeated measure analysis of variance (rm-ANOVA) models were used to test the mean difference of acceptability in the same subjects after FEES and O-FEES. Subsequently, another sample of 8 male outpatients underwent a simultaneous O-FEES and videofluoroscopic study (VFSS). The inter-rater reliability using 10 radiological landmarks, compared to O-FEES, was blindly determined between two raters. Inter-rater agreement between the two judges for O-FEES and VFSS scores was assessed with the single score intra-class correlation coefficient (ICC). Differences between FEES and O-FEES answers for each question and among all the items considered overall were statistically significant (rm-ANOVA; F-statistic p < 0.001). The inter-rater agreement concerning endoscopic and radiological evaluations between the two raters showed strong values of intra-class correlation coefficient (ICC) (95% confidence interval): 0.875 (0.373-0.979) and 0.921 (0.542-0.986), respectively. The Bland-Altman test showed a bias of -0.24 (95% limits of agreement; -1.77 to +1.19), which suggests that both methods produced almost identical results. In clinical practice and compared with FEES, O-FEES is a well tolerated and safe procedure. Compared with the radiological gold standard, O-FEES offers reliable information about oral preparation and oral propulsion of the bolus.

PMID: 28516963 [PubMed - in process]

http://ift.tt/2pSEfrG

Design of a customised bridging mandibular prosthesis for complex reconstruction: a pilot study.

Design of a customised bridging mandibular prosthesis for complex reconstruction: a pilot study.

Acta Otorhinolaryngol Ital. 2017 Jun;37(3):195-200

Authors: Tarsitano A, Battaglia S, Sandi A, Marchetti C

Abstract
The gold standard for mandibular reconstruction is universally recognised and consists of the replacement of the bony part of the mandible with a bony microvascular free flap supported by a reconstructive plate. Although this procedure is feasible and reproducible in most patients, at times poor oncological prognosis or poor performance status force surgeons to consider other reconstructive solutions. In these cases, the main alternative in reconstructing a mandibular defect is represented by bridging plates combined with soft tissue flaps. However, repairing a mandibular defect with a reconstructive plate only can lead to a series of diverse complications. The most frequent complications reported are rupture and oral exposure of the plate. In this paper, we describe a new method for mandibular reconstruction using a customised bridging mandibular prosthesis (CBMP) without bone free flap.

PMID: 28516962 [PubMed - in process]

http://ift.tt/2ryEO74

Preserved Analgesia With Reduction in Opioids Through the Use of an Acute Pain Protocol in Enhanced Recovery After Surgery for Open Hepatectomy.

Background: Enhanced recovery after surgery (ERAS) pathways are designed to restore baseline physiology, mitigate surgical stressors, and hasten recovery. Paramount to this approach is optimal pain control through multimodal analgesia and limiting reliance on opioid-based medications. Recent studies have fostered growing controversy surrounding the use of epidural analgesia in the ERAS setting, especially for higher-risk procedures. We examine the analgesic end points associated with the use of epidural within the ERAS framework for open hepatectomy. Methods: From November 2013 through March 2016, postoperative analgesic end points including daily morphine equivalent administration and self-reported pain scores were prospectively collected and analyzed for 180 consecutive patients scheduled for open hepatectomy. Patients whose surgeries performed prior to July 2014 were managed using traditional strategy (pre-ERAS, n = 60), and those after July 1 underwent a comprehensive perioperative ERAS pathway (ERAS, n = 120). Results: Patients managed using the ERAS pathway had a significant reduction in morphine equivalent requirements at 24 hours (median, 10.0 vs 116.0 mg; P

http://ift.tt/2qAXKUp

Cytology-Ultrasonography Risk-Stratification Scoring System Based on Fine-Needle Aspiration Cytology and the Korean-Thyroid Imaging Reporting and Data System

Thyroid , Vol. 0, No. 0.

http://ift.tt/2qDsAML

Updated American Joint Committee on Cancer/Tumor-Node-Metastasis Staging System for Differentiated and Anaplastic Thyroid Cancer (Eighth Edition): What Changed and Why?

Thyroid , Vol. 0, No. 0.

http://ift.tt/2rBRl93

A comparison of attitudes to laryngeal cancer treatment outcomes: a time trade-off study

Abstract

Design

Time trade-off choice experiment.

Setting

Two large head and neck cancer centres.

Participants

Patients who have received treatment for head and neck cancer and members of the head and neck cancer multidisciplinary team.

Main outcome measures

Participants were asked to rank the outcome scenarios, assign utility values using time trade-off and rate the importance of survival on treatment choice.

Results

49 head and neck cancer patients and 73 staff members were recruited. Chemoradiotherapy (CRT) optimal outcome was the most preferred health state (34/49, 69% patients and 50/73, 68% staff) and CRT with complications was least preferred (27/49 55% patients and 51/73 70% staff). Using time trade-off, mean utility values were calculated for CRT optimal outcome (0.73 for patients, 0.77 for staff), total laryngectomy (TL) optimal outcome (0.67 for patients, 0.69 for staff), TL outcome with complications (0.46 for patients, 0.51 for staff) and CRT with complications (0.36 for patients, 0.49 for staff). The average survival advantage required for a participant to change their preferred choice was 2.6 years.

Conclusions

We have demonstrated that a significant proportion of head and neck cancer patients and staff members would not choose CRT to manage locally advanced laryngeal cancer. Staff members rated the health states associated with laryngeal cancer treatment higher than patients who have experienced them, and this is particularly evident when considering the poorer outcomes. The head and neck cancer community should develop methods of practice and decision making which incorporate elicitation and reporting of patient values as a central principle.

http://ift.tt/2pV7mL8

Cochlear implantation in patients with otosclerosis of the otic capsule

To evaluate outcomes of cochlear implantation of patients with otosclerosis of the otic capsule.

http://ift.tt/2qAqcWI

Indikatoren für Sprachverständnis bei Kindern mit Migrationshintergrund. Ein Extremgruppenvergleich

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-104771

Hintergrund Kinder mit Migrationshintergrund und Deutsch als Zweitsprache (DaZ) gelten häufig als sprachauffällig, was jedoch mangels fehlender Untersuchungsinstrumente im jungen Alter schwer zu objektivieren ist. Hierfür sollten empirisch Risikofaktoren bestimmt werden. Material und Methoden Aus dem Datenpool einer Entwicklungslängsschnittstudie in 7 Kitas in Frankfurt/M. u. Darmstadt wurden Migrantenkinder im Alter von 3–5;11 Jahren durch ihre Testleistung im oralen Sprachverständnis 2 Extremgruppen zugewiesen: „unauffällig" bei T-Wert ≥46 (N=61) vs. „auffällig" bei T-Wert ≤32 (N=65). Gruppenunterschiede wurden anhand von Testergebnissen (Intelligenz; Verständnis grammatischer Strukturen; sprachliche Begriffsbildung; Erkennen von semantischen und grammatischen Inkonsistenzen) analysiert. Ergebnisse Die Intelligenz war in beiden Gruppen durchschnittlich, in der unauffälligen Gruppe über dem Altersmittel gelegen: T-W 54,1; SD 6,7, in der auffälligen darunter: T-W 42,2; SD 8,8 (p<0,001). In allen Sprachleistungen unterschieden sich die Gruppen durchgängig signifikant. Diskriminanzanalytisch wurden 4 Merkmale für die Güte von DaZ identifiziert: Intelligenzhöhe; Erkennen von Sprachinkonsistenzen; Bildungsstand der Mutter; Grammatikbasiertes Sprachverständnis. Bzgl. der vorhergesagten Gruppenzugehörigkeit wurden 88% der Kinder mit auffälligem und 84% der mit unauffälligem Sprachverständnis korrekt zugeordnet. Schlussfolgerung Die Studie liefert einen akzeptablen Standard, um Migrantenkinder mit gutem Verständnis von DaZ von solchen mit schwachem zu trennen.
[...]

Article in Thieme eJournals:
Table of contents | Abstract | Full text

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Cochlear implantation in patients with otosclerosis of the otic capsule

Publication date: Available online 19 May 2017
Source:American Journal of Otolaryngology
Author(s): Jay Burmeister, Susan Rathgeb, Jacques Herzog
ObjectiveTo evaluate outcomes of cochlear implantation of patients with otosclerosis of the otic capsule.Study designA retrospective case series of 6 patients (7 ears).Patients6 patients (7 ears), 5 patients with severe to profound sensorineural hearing loss; 1 patient with mild to profound sensorineural hearing loss, with radiologic evidence of otosclerosis. All patients were adult males, with or without history of stapes surgery.InterventionCochlear implantation of 7 ears. 5 patients with severe to profound sensorineural hearing loss received the Nucleus Contour Advance peri-modiolar electrode array with binaural implantation performed in one patient. One patient with mild to profound sensorineural hearing loss received a Cochlear® Nucleus Hybrid L24 device.MethodsPreoperative temporal bone CT, audiometric and speech perception testing scores were reviewed, confirming presence of otosclerosis of the cochlea as well as cochlear implant candidacy. Speech perception testing included CNC words, HINT sentences and AZ Bio scores to measure hearing outcomes post implantation.ResultsAll recipients of the contour advance device had a significant improvement in hearing at both 3 and 6month follow up.The hybrid device recipient experienced loss of residual hearing in the implanted ear without improvement at 3months and mild improvement at 6months.ConclusionCochlear implantation has proven to be effective in the treatment of patients with sensorineural hearing loss, including those with otosclerosis of the cochlea.Hybrid candidacy in the setting of otosclerosis of the cochlea may require consideration of alternative electrode devices, most likely a peri-modiolar device.

http://ift.tt/2qGuOJh

Prevalence of hearing-loss among HAART-treated children in the Horn of Africa

Publication date: July 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 98
Author(s): Alden F. Smith, David C. Ianacone, Robbert J.H. Ensink, Abebe Melaku, Margaretha L. Casselbrant, Glenn Isaacson
ObjectivesThe prevalence of hearing loss (HL) in children infected with HIV/AIDS is not well studied. Even fewer studies focus on stable HIV-infected children treated with high-effective antiretroviral therapy (HAART). We aim to compare the prevalence of ear disease and HL in HAART-treated, HIV + children in Addis Ababa, Ethiopia with a well, similarly-aged elementary school population with unknown HIV status (HIVU).MethodsChildren underwent standard head and neck examination and cerumen removal by board certified otolaryngologists. Next, certified audiologists performed hearing screening with pure-tone audiometry using a circumaural headset but without an ambient noise reducing environment. Children failing audiometric screening underwent full behavioral audiometry including air and bone testing. The primary outcome parameter was HL > 25 dB with the audiologist accounting for background noise. A second endpoint was PTA >40 dB (500, 1000, 2000 Hz) without assessment of background noise.Results107 HIV+ and 147 HIVU children met inclusion criteria. In the HIV + cohort 17.8% had evidence of TM perforations and 8.4% had otorrhea. In the HIVU group 2.7% had a TM perforation and 0% had otorrhea. Hearing was significantly worse in HIV + children. (Audiologist determination: 38.3% HL HIV+, 12.2% HIVU, Fisher's-Exact-Test OR: 4.5, 95% CI 2.4–8.3, p-value <0.0001; Worse-hearing-ear PTA > 40 dB: 19.6% HL HIV+, 6.1% HIVU, OR: 3.7, 95% CI 1.7–8.4, p-value <0.001).ConclusionsChronic OM, conductive and mixed hearing losses are significantly more common in HAART-treated HIV + children than in well, similarly-aged controls. Rates of SNHL are similar.

http://ift.tt/2pUcv6e

Free 25(OH)D concentrations are associated with atopy and lung function in children with asthma

Evidence suggests free mono-hydroxyvitamin D (25[OH]D) concentrations are more strongly linked to certain outcomes than total concentrations; however, no studies have examined the relation between free 25(OH)D and respiratory or allergic disease.

http://ift.tt/2rmGKCC

Hochauflösungsmanometrie der pharyngealen Schluckdynamik

Zusammenfassung

Hintergrund

Zum Transport eines Speisebolus aus der Mundhöhle in den Magen ist eine regelrechte Kontraktion der Pharynxmuskulatur und eine koordinierte Funktion des oberen Ösophagussphinkters (oÖS) notwendig. Der durch die Muskelkontraktion erzeugte intraluminale Druck treibt den Bolus kontinuierlich voran. Im Gegensatz zu bildgebenden ermöglichen manometrische Verfahren eine Abschätzung des Druckaufbaus und damit der Muskelfunktion. Sie wurden zunächst für den Ösophagus und seit 7–8 Jahren auch vermehrt im Pharynx angewendet. Die pharyngeale Hochauflösungsmanometrie (pHRM) ermöglicht Druckmessungen in hoher räumlicher und zeitlicher Auflösung und so eine Beurteilung der pharyngealen Schluckmotorik.

Ziel der Arbeit

Es wird eine aktuelle Übersicht über die Durchführung, Auswertung und Interpretation der pHRM und den derzeitigen Forschungsstand gegeben.

Material und Methoden

Eine Recherche in PubMed und Scopus wurde nach den Stichworten „high-resolution manometry" und „pharynx" oder „upper esophageal sphincter" durchgeführt. Arbeiten, die originäre Daten für pHRM beinhalten, sowie Übersichtsarbeiten und Buchbeiträge wurden berücksichtigt.

Ergebnisse

Mit der pHRM können die während des Schluckens auftretenden Druckverhältnisse im Pharynx und oÖS beurteilt werden. Einen Überblick über Veränderungen der pharyngealen Schluckmotorik bietet der Druckkonturplot. Die Bestimmung von Schluckparametern ermöglicht eine differenzierte Bewertung einzelner Komponenten des Schluckvorgangs. Ein Vergleich mit Normwerten erlaubt die Abgrenzung von Störungen im Schluckablauf.

Schlussfolgerung

Auch wenn einzelne Schluckparameter für die klinische Routine noch weiter evaluiert werden müssen, sollte bereits jetzt zur vollständigen Beurteilung des Schluckvorgangs immer eine pHRM durchgeführt werden.

http://ift.tt/2qGnrBr

CHMP Recommends Brodalumab (Kyntheum) for Plaque Psoriasis

The EMA's CHMP has recommended granting marketing authorization for brodalumab (Kyntheum, LEO Pharma, A/S) for the treatment of adults with moderate to severe plaque psoriasis.
International Approvals

http://ift.tt/2qzMasE

Benchmarking of Viral Bronchiolitis Management by General Practitioners in the United Kingdom

Pediatric Allergy, Immunology, and Pulmonology , Vol. 0, No. 0.

http://ift.tt/2pU9XF5

Macrophages produce IL-33 by activating MAPK signaling pathway during RSV infection

Publication date: July 2017
Source:Molecular Immunology, Volume 87
Author(s): Feifei Qi, Song Bai, Dandan Wang, Lei Xu, Haiyan Hu, Sheng Zeng, Ruonan Chai, Beixing Liu
It has been reported that RSV infection can enhance IL-33 production in lung macrophages. However, little is known about specific signaling pathways for activation of macrophages during RSV infection. In the present study, by using real-time RT-PCR as well as western blot assay, it became clear that RSV infection can enhance not only the expression of mRNAs for MAPK molecules (including p38, JNK1/2, and ERK1/2), but also the levels of MAPK proteins in lung macrophages as well as RAW264.7 cells. Furthermore, infection with RSV resulted in an increased level of phosphorylated MAPK proteins in RAW264.7 cells, suggesting that MAPK signaling pathway may participate in the process of RSV-induced IL-33 secretion by macrophages. In fact, the elevated production of IL-33 in RAW264.7 was attenuated significantly by pretreatment of the cells with special MAPK inhibitor before RSV infection, further confirming the function of MAPKs pathway in RSV-induced IL-33 production in macrophages. In contrast, the expression of NF-κB mRNA as well as the production of NF-κB protein in lung macrophages and RAW264.7 cells was not enhanced markedly after RSV infection. Moreover, RSV infection failed to induce the phosphorylation of NF-κB in RAW264.7 cells, suggesting that NF-κB signaling pathway may be not involved in RSV-induced IL-33 production in macrophages. Conclusion, these results indicate that RSV-induced production of IL-33 in macrophages is dependent on the activation of MAPK signaling pathway.

http://ift.tt/2r0OZnX

Benchmarking of Viral Bronchiolitis Management by General Practitioners in the United Kingdom

Pediatric Allergy, Immunology, and Pulmonology , Vol. 0, No. 0.

http://ift.tt/2pTJd7K