A review of in-vitro fibrocartilage tissue engineered therapies with a focus on the temporomandibular joint

Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Jesse Lowe, Alejandro J. Almarza
The inability of fibrocartilage, specifically the temporomandibular joint (TMJ) disc, to regenerate and remodel following injury presents a unique problem for clinicians. Tissue engineering then offers a potential regenerative therapy. In vitro testing provides a valuable screening tool for potential tissue engineered solutions. The conclusions drawn for TMJ in vitro research were compared against state of the art fibrocartilage studies in the knee meniscus, and annulus fibrosus of the intervertebral disc (IVD). For TMJ disc regeneration, in vitro tissue engineered approaches, focused on cellular therapies with fibrochondrocytes, have displayed an inability to produce enough collagen, as well as an inability to recapitulate native mechanical properties. Biomaterial approaches have recapitulated the native properties of the TMJ disc, but their in vivo efficacy has yet to be determined. By comparison, the knee meniscus field is the most progressive in the use of stem cells as a cell source. The knee meniscus field has moved away from measuring mechanical properties, and are instead more focused on biochemistry and gene expression. IVD studies mainly use electrospun scaffolds, and have produced the best success in mechanical properties. The TMJ field, in comparison to knee meniscus and IVD, needs to employ stem cell therapies, new biomaterials and manufacturing techniques, and cutting edge molecular assays, in future in vitro approaches to screen for viable technologies to move to in vivo studies.



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A meta-analysis of randomized trials assessing the effects of probiotic preparations on oral candidiasis in the elderly

Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Ruixue Ai, Jiao Wei, Danhua Ma, Lu Jiang, Hongxia Dan, Yu Zhou, Ning Ji, Xin Zeng, Qianming Chen
ObjectiveOral candidiasis is the most common fungal infection and can be attributed in part to dysbiosis, an imbalance in the resident oral microflora. Therefore, probiotics, which counter pathogenic microorganisms through competitive, antagonistic, and immunological effects, have been used by some clinicians. To date, the effect of probiotics in preventing oral candidiasis in the elderly is controversial. A systematic review that summarizes and critically appraises the available clinical trials is therefore necessary.DesignElectronic searches were performed using the Pubmed, Embase, and Cochrane databases. Only randomized controlled trials were included. The Mantel–Haenszel test was used to appraise the odds ratio for single studies and an overall combined odds ratio for all studies combined.ResultsThree studies matched the inclusion criteria and were homogeneous. The data from one study that estimated candida growth from plaque and saliva were subdivided, thus a total of four studies with 595 people were included. The overall combined odds ratio was 0.54 (95% CI: 0.38–0.77). Three studies provided that active treatment reduced the risk of oral candidiasis more than placebo: Hatakka et al. (OR 0.51, 95% CI 0.26 to 0.97; 192 participants, plaque); Kraft-Bodi et al. (OR 0.46, 95% CI 0.24 to 0.86; 174 participants, palatal); Kraft-Bodi et al. (OR 0.50, 95% CI 0.26 to 0.98; 174 participants, plaque), while one study provided reverse result: Ishikawa et al. (OR 1.24, 95% CI 0.48 to 3.58; 55 participants, saliva).ConclusionProbiotics have a preventative effect on oral candidiasis in the elderly.



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The theory of autoimmunity in Meniere’s disease is lacking evidence

Publication date: Available online 4 August 2017
Source:Auris Nasus Larynx
Author(s): Eerik Kangasniemi, Elina Hietikko
The role of immunological factors in the pathophysiology of Meniere's disease (MD) has been hypothesized. In order to evaluate the current level of evidence on autoimmunity in MD, original articles relevant to the matter (1970–2016) were reviewed. The following has been considered to support the theory of autoimmunity in MD (1) the increased prevalence of autoimmune diseases among MD patients, (2) the elevated levels of antibodies and immunocomplexes in MD patients, (3) the association of MD with HLA-types and genetic polymorphisms and (4) the positive corticosteroid-responsiveness detected in some MD patients. However, all studies have been small and lack positive replication. Studies concerning antibodies, HLA types and genetic polymorphisms have produced conflicting results and no single antibody, HLA type or polymorphism has been found in all or even in a significant subpopulation of MD patients. No convincing basic research evidence of autoimmunity in MD exists hence the field needs further study.



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Copyright-Page

Publication date: September 2017
Source:Anesthesiology Clinics, Volume 35, Issue 3





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Contributors

Publication date: September 2017
Source:Anesthesiology Clinics, Volume 35, Issue 3





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Contents

Publication date: September 2017
Source:Anesthesiology Clinics, Volume 35, Issue 3





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Forthcoming Issues

Publication date: September 2017
Source:Anesthesiology Clinics, Volume 35, Issue 3





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Transplantation

Publication date: September 2017
Source:Anesthesiology Clinics, Volume 35, Issue 3
Author(s): Aman Mahajan, Christopher Wray




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Overview of Immunosuppressive Therapy in Solid Organ Transplantation

Publication date: September 2017
Source:Anesthesiology Clinics, Volume 35, Issue 3
Author(s): Curtis D. Holt

Teaser

Mechanisms of rejection, new pharmacologic approaches, and genomic medicine are major foci for current research in transplantation. It is hoped that these new agents and personalized immunosuppression will provide for less toxic regimens that are effective in preventing both acute and chronic allograft rejection. Until new agents are available, practitioners must use various combinations of currently approved agents to find the best regimens for improved long-term outcomes.


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Reduced immunoglobulin gene diversity in patients with Cornelia de Lange syndrome

Publication date: Available online 5 August 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Andrea Björkman, Likun Du, Mirjam van der Burg, Valerie Cormier-Daire, Guntram Borck, Juan Pié, Britt-Marie Anderlid, Lennart Hammarström, Lena Ström, Jean-Pierre de Villartay, David Kipling, Deborah Dunn Walters, Qiang Pan-Hammarström

Teaser

Altered IGH repertoires with reduced diversity, skewed VH gene usage and reduced frequency of somatic hypermutation were observed in CdLS patients.


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Robotic device-assisted knee extension training during the early postoperative period after opening wedge high tibial osteotomy: a case report

Maintenance or restoration of a good range of motion of the knee is one of the most important outcomes following knee surgery. According to previous studies, opening wedge high tibial osteotomy enables better ...

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Les traitements biologiques du psoriasis freinent la progression de l’athérosclérose coronaire

Publication date: Available online 4 August 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): J.-L. Schmutz




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Papules croûteuses du cuir chevelu révélatrices d’une histiocytose de Langerhans

Publication date: Available online 4 August 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): A. Blind, C. Sachs, G. Blaison, J. Second, H. Herrscher, A. Mahé




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L’acantholyse

Publication date: Available online 5 August 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): A. Welfringer-Morin, M. Battistella




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The association of lifetime physical inactivity with head and neck cancer: a hospital-based case–control analysis

Abstract

Despite mounting epidemiological evidence suggesting an inverse association between recreational physical activity and cancer risk, evidence associated with head and neck cancer is scant. We conducted a case–control analysis to examine the associations of lifetime physical inactivity with the risk of head and neck squamous cell carcinoma (HNSCC). We utilized data from the Patient Epidemiology Data System at Roswell Park Cancer Institute (RPCI). Participants included 246 patients with HNSCC and 504 cancer-free controls who received medical services at RPCI between 1990 and 1998. Participants were considered physically inactive if they did not participate in any regular, weekly recreational physical activity throughout their lifetime, prior to diagnosis. Multivariate logistic regression models were utilized to estimate odds ratios (OR) and 95% confidence intervals (CI) representing the association between lifetime physical inactivity and HNSCC risk. We observed a significant positive association between recreational physical inactivity and HNSCC risk (OR = 2.73, 95% CI 1.87–3.99, p < 0.001). In subgroup analyses by body mass index (BMI) (underweight/normal-weight: OR = 3.40, 95% CI 1.89–6.12, p < 0.001; overweight/obese: OR = 2.40, 95% CI 1.43–4.02, p < 0.001) and smoking status (former smoker: OR = 3.12, 95% CI 1.89–5.14, p < 0.001; never smoker: OR = 2.71, 95% CI 1.21–6.05, p = 0.020; current smoker: OR = 1.61, 95% CI 0.66–3.95, p = 0.300), significant positive associations were also observed. Results of the current analyses suggest that lifetime physical inactivity associates with HNSCC independent of BMI. In addition, physical inactivity may be a modifiable risk factor among never smokers. These data add to the growing body of evidence suggesting that physical inactivity may be an independent risk factor for cancer.

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The role of environmental exposure to peanut in the development of clinical allergy to peanut

Abstract

The presence of peanut allergy has increased over the years and still remains one of the most common causes of food-related anaphylaxis. The way in which peanut sensitization occurs has been explored, such as via maternal consumption in pregnancy, via breast milk and through a disrupted skin barrier. It has previously been shown that environmental exposure to aeroallergens in household dust can be a risk factor for the development of allergic asthma. However, it is likely that the combination of cutaneous sensitisation via a disrupted skin barrier (i.e. children with eczema especially those with filaggrin mutations) and the interaction with environmental peanut exposure influences the development of peanut allergy. This review aims to explore the current evidence of how environmental exposure to peanut affects the development of peanut allergy.

This article is protected by copyright. All rights reserved.

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A novel IFIH1 mutation in the pincer domain underlies the clinical features of both Aicardi–Goutières and Singleton–Merten syndromes in a single patient

Abstract

Gain-of-function mutations in IFIH1 encoding interferon-induced helicase C domain-containing protein 1 were identified in a spectrum of human disease phenotypes^1-4 including the overlap between Aicardi–Goutières syndrome (AGS) and Singleton–Merten syndrome (SMS).⁵ Here we describe a case with a novel IFIH1 missense mutation in the pincer domain.

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Isolated and unilateral facial angiofibromas revealing a type 1 segmental postzygotic mosaicism of tuberous sclerosis complex with c.4949_4982del TSC2 mutation

Abstract

Facial angiofibromas (FAs) are common cutaneous manifestations of tuberous sclerosis complex (TSC), typically occurring as bilateral and symmetric facial papules. To date, unilateral FAs have been reported in 16 cases.^1,2 Most authors have hypothesised that unilateral FAs are a segmental form of TSC mosaicism but this hypothesis has not been proven. We herein describe a patient with isolated unilateral FAs reflecting a type 1 segmental postzygotic mosaicism of TSC with a c.4949_4982del TSC2 mutation.

This article is protected by copyright. All rights reserved.

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The genetic basis for most patients with pustular skin disease remains elusive

Abstract

Background

Rare variants in the genes IL36RN, CARD14 and AP1S3 have been identified to cause/ contribute to pustular skin diseases, primarily generalized pustular psoriasis (GPP).

Objectives

To better understand the disease-relevance of these genes, we screened our cohorts of patients with pustular skin diseases (primarily GPP and palmoplantar pustular psoriasis [PPP]) for coding changes in these three genes. Carriers of single heterozygous IL36RN mutations were screened for a second mutation in IL36RN.

Methods

Coding exons of IL36RN, CARD14 and AP1S3 were sequenced in 67 patients - 61 with GPP, 2 with acute generalized exanthematous pustulosis and 4 with acrodermatitis continua suppurativa Hallopeau. We screened IL36RN and AP1S3 for intragenic copy-number-variants, 258 PPP patients for coding changes in AP1S3. 11 heterozygous IL36RN mutations carriers were analyzed for a 2^nd non-coding IL36RN mutation. Genotype-phenotype-correlations in carriers/ non-carriers of IL36RN mutations were assessed within the GPP cohort.

Results

The majority of patients (GPP:64%) did not carry rare variants in any of the three genes. Bi-allelic and mono-allelic IL36RN mutations were identified in 15 and 5 GPP patients, respectively. Non-coding rare IL36RN variants were not identified in heterozygous carriers. The only significant genotype-phenotype-correlation observed for IL36RN mutation carriers was early age of disease onset. Additional rare CARD14 or AP1S3 variants were identified in 15% of IL36RN mutations carriers.

Conclusions

The identification of IL36RN mutation carriers harboring additional rare variants in CARD14 or AP1S3, indicates a more complex mode of inheritance of pustular psoriasis. Our results suggest additional disease-causing genetic factors in heterozygous IL36RN mutation carriers outside IL36RN.

This article is protected by copyright. All rights reserved.

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Development and Initial Validation of a Consumer Questionnaire to Predict the Presence of Ear Disease.

Related Articles

Development and Initial Validation of a Consumer Questionnaire to Predict the Presence of Ear Disease.

JAMA Otolaryngol Head Neck Surg. 2017 Aug 03;:

Authors: Kleindienst SJ, Zapala DA, Nielsen DW, Griffith JW, Rishiq D, Lundy L, Dhar S

Abstract
Importance: The already large population of individuals with age- or noise-related hearing loss in the United States is increasing, yet hearing aids remain largely inaccessible. The recent decision by the US Food and Drug Administration to not enforce the medical examination prior to hearing aid fitting highlights the need to reengineer consumer protections when increasing accessibility. A self-administered tool to estimate ear disease risk would provide disease surveillance without posing an unreasonable barrier to hearing aid procurement.
Objective: To develop and validate a consumer questionnaire for the self-assessment of risk for ear diseases associated with hearing loss.
Design, Setting, and Participants: The questionnaire was developed using established methods including expert opinion to validate and create questions, and cognitive interviews to ensure that questions were clear to respondents. Exploratory structural equation modeling, logistic regression, and receiver operating characteristic curve analysis were used to determine sensitivity and specificity with blinded neurotologist opinion as the criterion for evaluation. Patients 40 to 80 years old with ear or hearing complaints necessitating a neurotologic examination and a control group of participants with a diagnosis of age- or noise-related hearing loss participated at the Departments of Otorhinolaryngology and Audiology of Mayo Clinic Florida.
Main Outcomes and Measures: Sensitivity and specificity of the prototype questionnaire to identify individuals with targeted diseases.
Results: Of 307 participants (mean [SD] age, 62.9 [9.8] years; 148 [48%] female), 75% (n = 231) were enrolled with targeted disease(s) identified on neurotologic assessment and 25% (n = 76) with age- or noise-related hearing loss. Participants were randomly divided into a training sample (80% [n = 246; 185 with disease, 61 controls]) and a test sample (20% [n = 61; 46 with disease, 15 controls]). Using a simple scoring method, a sensitivity of 94% (95% CI, 89%-97%) and specificity of 61% (95% CI, 47%-73%) were established in the training sample. Applying this cutoff to the test sample resulted in 85% (95% CI, 71%-93%) sensitivity and 47% (95% CI, 22%-73%) specificity.
Conclusions and Relevance: This is the first self-assessment tool designed to assess an individual's risk for ear disease. Our preliminary results demonstrate a high sensitivity to disease detection. A further validated and refined version of this questionnaire may serve as an efficacious tool for improving access to hearing health care while minimizing the risk for missed ear diseases.

PMID: 28772310 [PubMed - as supplied by publisher]

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Transoral Robotic Surgery-Assisted Endoscopy.

Related Articles

Transoral Robotic Surgery-Assisted Endoscopy.

JAMA Otolaryngol Head Neck Surg. 2017 Aug 03;:

Authors: Garden AS, Morrison WH

PMID: 28772299 [PubMed - as supplied by publisher]

http://ift.tt/2vBPRlu

Use of Adult Patient Focus Groups to Develop the Initial Item Bank for a Cochlear Implant Quality-of-Life Instrument.

Related Articles

Use of Adult Patient Focus Groups to Develop the Initial Item Bank for a Cochlear Implant Quality-of-Life Instrument.

JAMA Otolaryngol Head Neck Surg. 2017 Aug 03;:

Authors: McRackan TR, Velozo CA, Holcomb MA, Camposeo EL, Hatch JL, Meyer TA, Lambert PR, Melvin CL, Dubno JR

Abstract
Importance: No instrument exists to assess quality of life (QOL) in adult cochlear implant (CI) users that has been developed and validated using accepted scientific standards.
Objective: To develop a CI-specific QOL instrument for adults in accordance with the Patient Reported Outcomes Measurement Information System (PROMIS) guidelines.
Design, Setting, and Participants: As required in the PROMIS guidelines, patient focus groups participated in creation of the initial item bank. Twenty-three adult CI users were divided into 1 of 3 focus groups stratified by word recognition ability. Three moderator-led focus groups were conducted based on grounded theory on December 3, 2016. Two reviewers independently analyzed focus group recordings and transcripts, with a third reviewer available to resolve discrepancies. All data were reviewed and reported according to the Consolidated Criteria for Reporting Qualitative Research. The setting was a tertiary referral center.
Main Outcomes and Measures: Coded focus group data.
Results: The 23 focus group participants (10 [43%] female; mean [range] age, 68.1 [46.2-84.2] years) represented a wide range of income levels, education levels, listening modalities, CI device manufacturers, duration of CI use, and age at implantation. Data saturation was determined to be reached before the conclusion of each of the focus groups. After analysis of the transcripts, the central themes identified were communication, emotion, environmental sounds, independence and work function, listening effort, social isolation and ability to socialize, and sound clarity. Cognitive interviews were carried out on 20 adult CI patients who did not participate in the focus groups to ensure item clarity. Based on these results, the initial QOL item bank and prototype were developed.
Conclusions and Relevance: Patient focus groups drawn from the target population are the preferred method of identifying content areas and domains for developing the item bank for a CI-specific QOL instrument. Compared with previously used methods, the use of patient-centered item development for a CI-specific QOL instrument will more accurately reflect patient experience and increase our understanding of how CI use affects QOL.

PMID: 28772297 [PubMed - as supplied by publisher]

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Transoral Robotic Surgery-Reply.

Related Articles

Transoral Robotic Surgery-Reply.

JAMA Otolaryngol Head Neck Surg. 2017 Aug 03;:

Authors: Hatten K, Weinstein G, Lin A

PMID: 28772292 [PubMed - as supplied by publisher]

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Do advanced glycation end-products cause food allergy?.

Purpose of review: The aim of this study was to appraise the evidence relating to dietary advanced glycation end-products (AGEs), their influence on innate and adaptive immune responses and their possible role in the increasing rate of food allergy that is being observed globally. Recent findings: The western pattern of diet is high in both AGEs and their substrates and this has been increasing in the last 30 years. AGEs mimic alarmins such as S100 proteins and the high molecular group box 1 (HMBG1), binding to the Receptor for Advanced Glycation End Products (RAGE), which in turn influences innate and adaptive immune responses. AGEs can directly cause mast cell activation and degranulation. Population data from USA and Australia have correlates with the rise in food allergy and sources of AGEs in the diet and this is also reinforced by urban and regional data within countries. The function of the RAGE receptor is inter-twined with Toll-like receptor (TLR) signalling and vitamin D levels. Activation of the RAGE receptor results in loss of epithelial integrity. Animal models studies have shown that dietary compounds that reduce the formation of AGEs can protect from the development of food allergies; however, this has not been shown in humans. Summary: Dietary sources of AGEs and their substrates are a plausible contributor to the increasing prevalence of food allergy, which requires prospective evaluation in human populations. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Component resolved diagnostics for hymenoptera venom allergy.

Purpose of review: Component-resolved diagnostics makes use of defined allergen molecules to analyse IgE-mediated sensitizations at a molecular level. Here, we review recent studies on the use of component-resolved diagnostics in the field of Hymenoptera venom allergy (HVA) and discuss its benefits and limitations. Recent findings: Component resolution in HVA has moved from single molecules to panels of allergens. Detection of specific immunoglobulin E (sigE) to marker and cross-reactive venom allergens has been reported to facilitate the discrimination between primary sensitization and cross-reactivity and thus, to provide a better rationale for prescribing venom immunotherapy (VIT), particularly in patients sensitized to both honeybee and vespid venom. Characterization of IgE reactivity to a broad panel of venom allergens has allowed the identification of different sensitization profiles that in honeybee venom allergy were associated with increased risks for side effects or treatment failure of VIT. In contrast, component resolution so far has failed to provide reliable markers for the discrimination of sensitizations to venoms of different members of Vespidae. Summary: Component-resolved diagnostics allows a better understanding of the complexity of sensitization and cross-reactivities in HVA. In addition, the enhanced resolution and precision may allow identification of biomarkers, which can be used for risk stratification in VIT. Knowledge about the molecular composition of different therapeutic preparations may enable the selection of appropriate preparations for VIT according to individual sensitization profiles, an approach consistent with the goals of personalized medicine. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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“Is Cone Beam Computed Tomography (CBCT) a Potential Imaging Tool in ENT Practice?: A Cross-Sectional Survey Among ENT Surgeons in the State of Odisha, India

Abstract

This questioner survey aimed about awareness of the Cone Beam Computed Tomography (CBCT) machine and its various clinical applications in ENT, among the ENT surgeons in the state of Odisha. 150 questioner forms on CBCT were distributed to the all the participating ENT surgeons at a state level ENT conference, out of which the response rate was 110. The participants were asked to answer 30 multiple choice questions, which were divided into 3 parts; general information on CBCT, general approach to CBCT and practice related to CBCT. The statistical analysis of the data collected was carried out by a Chi square test to compare the means at a significance level of P < 0.05. The response rate for this study was 73%. The mean age of the participant ENT surgeons was 47.9 (±19.2). Of the study population, 71.2% (89) did not ever advice CBCT in their practice. Only 33.9% (38) of the population believed that CBCT is more beneficial in the field of ENT. Only 25% (28) knew that CBCT requires lower radiation dose than conventional CT. 28.1% (31) of population believed that the spatial orientation is better in CBCT than CT. 62.5% (69) of the population did not knew that CBCT can be used in imaging sinusitis of dental origins. 75% (83) of the population did not knew that CBCT can be used in diagnosis of obstructive sleep apnoea and visualizing airway space. Only 18.8% (21) of the study population agreed that the CBCT has the potential to replace conventional CT in ENT imaging in future. In the conclusion, this study clearly showed that the number of ENT surgeons advising CBCT imaging in their practice is very less. The knowledge about various advantages and clinical applications of CBCT had been very limited. However, through continuing medical education and conducting various seminars and workshops on CBCT, imparting chapters on CBCT, in the undergraduate and post graduate curriculum will definitely help increase the awareness on CBCT among ENT fraternity.

http://ift.tt/2wgF8tF

“Is Cone Beam Computed Tomography (CBCT) a Potential Imaging Tool in ENT Practice?: A Cross-Sectional Survey Among ENT Surgeons in the State of Odisha, India

Abstract

This questioner survey aimed about awareness of the Cone Beam Computed Tomography (CBCT) machine and its various clinical applications in ENT, among the ENT surgeons in the state of Odisha. 150 questioner forms on CBCT were distributed to the all the participating ENT surgeons at a state level ENT conference, out of which the response rate was 110. The participants were asked to answer 30 multiple choice questions, which were divided into 3 parts; general information on CBCT, general approach to CBCT and practice related to CBCT. The statistical analysis of the data collected was carried out by a Chi square test to compare the means at a significance level of P < 0.05. The response rate for this study was 73%. The mean age of the participant ENT surgeons was 47.9 (±19.2). Of the study population, 71.2% (89) did not ever advice CBCT in their practice. Only 33.9% (38) of the population believed that CBCT is more beneficial in the field of ENT. Only 25% (28) knew that CBCT requires lower radiation dose than conventional CT. 28.1% (31) of population believed that the spatial orientation is better in CBCT than CT. 62.5% (69) of the population did not knew that CBCT can be used in imaging sinusitis of dental origins. 75% (83) of the population did not knew that CBCT can be used in diagnosis of obstructive sleep apnoea and visualizing airway space. Only 18.8% (21) of the study population agreed that the CBCT has the potential to replace conventional CT in ENT imaging in future. In the conclusion, this study clearly showed that the number of ENT surgeons advising CBCT imaging in their practice is very less. The knowledge about various advantages and clinical applications of CBCT had been very limited. However, through continuing medical education and conducting various seminars and workshops on CBCT, imparting chapters on CBCT, in the undergraduate and post graduate curriculum will definitely help increase the awareness on CBCT among ENT fraternity.

http://ift.tt/2wgF8tF

Comparison of intubation and tracheotomy in patients with deep neck infection

Abstract

Possible airway compromise further complicates treatment of deep neck infections (DNI). Airway management is crucial, but factors affecting the method of choice are unclear. We retrospectively evaluated adult DNIs in a single tertiary center covering 10 years, with special attention on airway management. Patient data were retrieved from electronic data files from 2007 to 2016, and included adult patients with DNI operated through the neck. Of the 202 patients, 127 (63%) were male, with a median age of 47 years. Odontogenic (n = 74; 35%) infection was the most common etiology. Intubation was the most common method of airway management (n = 165; 82%), and most patients (n = 102; 50%) were extubated immediately after surgery. Tracheotomy was performed primarily for 35 (17%) patients, and secondarily for 25 (15%). Two patients were managed in local anesthesia. Altogether 80 (40%) patients required care in the intensive care unit for a median of 7 days. Median hospital stay was 6 days for intubated patients and 10 days for primarily tracheotomized (p = 0.036). DNI extended to the mediastinal space in 25 (12%) patients, most of whom with odontogenic infection (48%), and necrotizing fasciitis (32%). Odontogenic infection was the most common etiology for DNI with increased risk for mediastinal involvement. Intubation was most common type of airway management with high success in immediate extubation after surgery. The need for tracheotomy seemed to lead to a longer hospital care and was associated with a more severe clinical course.

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The European society of regional anesthesia and pain therapy and the American society of regional anesthesia and pain medicine joint committee practice advisory on controversial topics in pediatric regional anesthesia I and II: what do they tell us?.

Purpose of review: To summarize the two recent sets of European and American Societies of Regional Anesthesia (ESRA-ASRA) Practice Advisory Guidelines for the performance of pediatric regional anesthesia (PRA). Recent findings: Owing to the still ongoing debate regarding crucial issues concerning the effective and safe conduct of PRA and because of the lack of any generally accepted guidelines regarding PRA the (ESRA-ASRA) have addressed these in two topical publications. Summary: Following an extensive literature search and an evidence-based approach the ESRA-ASRA task force have now provided a practice advisory on the following hot topics in PRA: the safety and appropriateness of placing block during general anesthesia or deep sedation, the use of test dosing, whether to use air or saline when performing loss-of-resistance, the risk of masking an acute compartment syndrome by use of PRA, dosing of local anesthetics for neuroaxial nerve blocks as well as peripheral nerve blocks, and finally the use of various drugs as adjuncts to local anesthetics. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Adherence to Swedish guidelines for pain treatment in relation to pediatric tonsil surgery: A survey of the multidisciplinary team

Publication date: October 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 101
Author(s): F. Alm, M. Jaensson, S. Lundeberg, E. Ericsson
BackgroundPain management in children after tonsil surgery is essential, and optimal pain treatment has been discussed for many years. Data from the National Tonsil Register in Sweden (NTRS) and a national mapping have demonstrated the need for national pain treatment guidelines for pediatric tonsil surgery. As a result, Swedish national guidelines, together with updated patient information on the website tonsilloperation.se, were developed and implemented in 2013.ObjectivesThe objective of this study was to evaluate the professionals' opinions of and adherence to pain treatment guidelines for pediatric tonsil surgery patients in a two-year follow-up.MethodThis descriptive cross-sectional study was based on data from an inter-professional questionnaire, which was validated by an expert group using a content validity index (S-CVI 0.93). The questionnaire was sent to all Swedish ear, nose and throat (ENT) departments (n = 49) that the NTRS identified as performing tonsil surgery on children younger than 18 years of age. In each clinic, we asked for responses from staff in each of the following professions: ENT physicians, anesthesia physicians, registered nurse anesthetists, and registered nurses in the ENT departments.ResultsRespondents from 48 ENT departments participated, and 139/163 (85%) completed questionnaires were returned. The guidelines were reported as being clear, ensuring patient safety and providing optimal pharmacological treatment. Treatment was given according to the guidelines: Half of the departments gave pre- or intraoperative treatment with clonidine, betamethasone and high-dose paracetamol (acetaminophen). A multimodal pain approach (paracetamol and COX-inhibitors) after hospital discharge was prescribed by all departments after tonsillectomy and, extensively, after tonsillotomy. One-third of the departments prescribed paracetamol with a higher normal dose for the first three postoperative days. Half of the departments prescribed rescue analgesics, clonidine or opioids after tonsillectomy. None of the departments prescribed codeine or tramadol, drugs that are discouraged in the guidelines. The majority of the departments used the website tonsilloperation.se to provide information to the patients and their caregivers.ConclusionThe respondents' opinions of and the ENT departments adherence to the Swedish national guidelines were considered to be good. The national implementation process in Sweden has impacted the manner in which ENT departments treat pain after tonsil surgery.



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Thyroglossal duct cyst surgery: A ten-year single institution experience

Publication date: October 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 101
Author(s): Justin Ross, Alexander Manteghi, Kimberly Rethy, James Ding, Sri Kiran Chennupati
Objective1. Review our institution's experience with thyroglossal duct cyst (TGDC) excision. 2. Determine if TGDC recurrence rate is influenced by surgical technique, preoperative infection, or surgeon specialty.MethodsWe conducted a retrospective analysis of patients at a tertiary care children's hospital who underwent excision of neck mass with proven TGDC histopathology from 2005 to 2015. Patient demographics and presentation, preoperative workup, surgeon specialty, procedural details, lesion characteristics, and complication rates including recurrence were evaluated.Results108 patients (51% male, 49% female), aged 6 months to 20 years (mean 6 years) met inclusion criteria. 121 procedures were performed: 96 (79.3%) for primary disease and 25 (20.7%) for recurrence. 32 patients (27.8%) were infected preoperatively, resulting in a significant increase in complications and recurrence (46.9% and 28.1%, respectively). Lack of preoperative imaging was correlated with increased recurrence (p = 0.0002). Recurrence rate after treatment for primary (11.3%) versus secondary disease (24%) was not significant (p = 0.23). Total recurrence rate differed between ENT (9.1%) and Pediatric Surgery (PS) (27.3%) (p = 0.0172). Difference was not significant for recurrence in primary disease (10% ENT, 14.8% PS, p = 0.49), but was for secondary disease (5.6% ENT, 71.4% PS, p = 0.002). Modifications of Sistrunk's procedure did not result in increased rates of recurrence (p = 0.1273).ConclusionPreoperative TGDC infection and lack of imaging led to a significant increase in postoperative complications, including recurrence. Surgical specialty significantly affected recurrence rates following excision overall and in secondary disease. Recurrence was not affected by surgical technique, age, sex, cyst size, or mucin rich histology.



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Response to ‘Eruptive keratoacanthomas arising in the setting of lichenoid toxicity after PD1 inhibition with nivolumab’

Abstract

We thank Dr. Fung and colleagues for their interest in our publication concerning eruptive keratoacanthomas (KAs) and bullous pemphigoid-like disease in patients on anti-programmed cell death-1 (PD-1) immunotherapy.¹ We agree that nivolumab, like pembrolizumab, seems to share the same immune-related adverse event profile, and in fact our second case occurred in a patient on nivolumab (after no visible reduction in metastatic disease on pembrolizumab).

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Evolution of the anterolateral thigh free flap.

Purpose of review: To review the recent literature on the evolution and advanced uses of the anterolateral thigh (ALT) free flap in reconstruction of oncologic defects of the head and neck. Recent findings: The ALT free flap is a versatile flap that can be harvested in a chimeric fashion with independent, vascularized skin, muscle, fascia, nerve and bone. Various techniques for chimeric flap harvest and flap inset have been described for reconstruction of pharyngocutaneous, oromandibular and radical parotidectomy defects. These reports expand the indications for the ALT free flap while demonstrating good functional and aesthetic outcomes. Summary: The ALT free flap remains popular for reconstruction of head and neck oncologic defects because of its versatility. Continued evolution in chimeric flap harvest techniques for pharyngocutaneous, osseous and radical parotidectomy defects highlights novel advanced reconstructive uses for the ALT free flap. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Evolution of the anterolateral thigh free flap.

Purpose of review: To review the recent literature on the evolution and advanced uses of the anterolateral thigh (ALT) free flap in reconstruction of oncologic defects of the head and neck. Recent findings: The ALT free flap is a versatile flap that can be harvested in a chimeric fashion with independent, vascularized skin, muscle, fascia, nerve and bone. Various techniques for chimeric flap harvest and flap inset have been described for reconstruction of pharyngocutaneous, oromandibular and radical parotidectomy defects. These reports expand the indications for the ALT free flap while demonstrating good functional and aesthetic outcomes. Summary: The ALT free flap remains popular for reconstruction of head and neck oncologic defects because of its versatility. Continued evolution in chimeric flap harvest techniques for pharyngocutaneous, osseous and radical parotidectomy defects highlights novel advanced reconstructive uses for the ALT free flap. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Rapamycin prolongs graft survival and induces CD4+IFN-[gamma]+IL-10+ regulatory type 1 cells in old recipient mice.

Background: Although the elderly represents a rapidly growing population among transplant recipients, age-specific aspects have not been considered sufficiently in clinical trials. Moreover, age-specific effects of immunosuppressive therapies remain poorly understood. Methods: Here, we assessed the impact of Rapamycin on alloimmune responses in old recipients using a fully MHC-mismatched murine transplantation model. Results: Old untreated recipients displayed a prolonged skin graft survival compared to their young counterparts, an observation that confirmed data of our previous experiments. Rapamycin led to a significant prolongation of graft survival in both, young and old recipients. However, graft survival was age-dependent and extended in old vs. young recipients (19 days vs. 12 days, p=0.004). This age-specific effect was not linked to changes in frequencies or subset composition of either CD8+ or CD4+ T cells. Moreover, antiproliferative effects of Rapamycin on CD8+ and CD4+ T cells as assessed by in vivo BrdU-incorporation were comparable and age-independent. In contrast, the systemic production of IL-10 was markedly elevated in old recipients treated with Rapamycin. In parallel to this shift in cytokine balance, IFN-[gamma]/IL-10 double-positive regulatory type 1 cells emerged during Th1-differentiation of old T helper cells in presence of Rapamycin. Similarly, CD4+IFN-[gamma]+IL-10+ cells expanded among Foxp3-negative cells after in vivo treatment of old recipients with Rapamycin. Conclusions: Our results highlight novel aspects of age-dependent immunosuppressive effects of Rapamycin, with relevance for age-specific immunosuppressive regimens. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Preventive effect of a vapocoolant spray on propofol-induced pain: a prospective, double-blind, randomized study

Abstract

Purpose

Propofol causes injection pain. Although lidocaine pre-treatment via venous occlusion is known to be the most effective way, it still has some inconvenience. We implemented this study to compare the effect of a vapocoolant spray with lidocaine pre-treatment.

Methods

Participants (n = 90) were randomized to one of three groups. Group V: after placebo injection and tourniquet, the vapocoolant spray was applied; group L: after lidocaine injection and tourniquet, the placebo spray was applied; group C: after placebo injection and tourniquet, the placebo spray was applied. The intensity of propofol-induced pain, the incidence of metallic taste, and the satisfaction were assessed.

Results

Propofol-induced pain was significantly lower in groups V and L than in group C [0.5 (0–2.25), 0.5 (0–1), and 5 (1–7), median (interquartile range), respectively, p < 0.001]. There was no significant difference in pain intensity between groups V and L. Group L showed a significantly higher incidence of metallic taste than groups V and C (23, 0, and 0%, respectively; p = 0.001). Groups V and L showed higher satisfaction scores than group C [5 (4–5), 4 (3.75–5), and 2 (2–3), respectively; p < 0.001], and there was a significant difference between groups V and L (p = 0.012).

Conclusion

Vapocoolant spray showed a similar effect to lidocaine in analgesia and lowered the incidence of a metallic taste. These resulted in greater satisfaction with the vapocoolant spray compared with lidocaine. Vapocoolant spray is an effective and convenient way to prevent propofol-induced pain.

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Pre-eclampsia and acute pulmonary embolism—the importance of making a differential diagnosis: a case report

Abstract

We describe the case of a 41-year-old pregnant patient who presented at 38 weeks of gestation for an urgent cesarean section, with new onset of pre-eclampsia as the initial diagnosis. The intraoperative course was complicated by seizures and hemodynamic collapse. Initially, the presentation of seizure pointed to pre-eclampsia/eclampsia; however, with careful consideration of each event as it occurred, the correct diagnosis was later determined to be pulmonary embolism and stroke. This case illustrates the importance of considering multiple possible etiologies, even when a particular diagnosis seems obvious.

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