Quality of life after thyroidectomy in patients with nontoxic nodular goiter: A prospective cohort study

Abstract

Background

Using the thoroughly validated Thyroid-Related Quality-of-Life Patient-Reported Outcome (ThyPRO) questionnaire, the purpose of this study was to investigate changes in disease-specific quality of life (QOL) after surgical treatment in patients with benign nontoxic multinodular goiters.

Method

Patients with goiters scheduled for thyroid surgery (n = 106) and individuals from the general population (n = 739) were studied. The ThyPRO data before, 3 months, and 6 months after surgery were compared with normative scores from the general population using a linear mixed model and t tests.

Results

Before surgery, patients with goiters experienced poorer scores on all scales compared to the general population. After surgery, moderate to large improvements were seen in goiter symptoms, tiredness, anxiety, and overall QOL. After surgery, all scales returned to values equal to the general population. The degree of anxiety was, in fact, lower than in the general population.

Conclusion

Thyroid surgery leads to significant benefit among patients with benign nontoxic goiters by restoring QOL equal to that in the general population.

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Role of the microbiota in skin immunity and atopic dermatitis

Publication date: Available online 4 September 2017
Source:Allergology International
Author(s): Yuriko Yamazaki, Yuumi Nakamura, Gabriel Núñez
Atopic dermatitis (AD) is a chronic inflammatory skin disease that affects 15–20% of children and 2–5% of adults in industrialized countries. The pathogen Staphylococcus aureus selectively colonizes the lesional skin of AD patients while this bacterium is absent in the skin of the majority of healthy individuals. However, the role of S. aureus in the pathogenesis of AD remains poorly understood. In addition to S. aureus, recent studies show a contribution of the skin microbiota to the regulation of immune responses in the skin as well as to the development of inflammatory skin disease. This review summarizes current knowledge about the role of the microbiota in skin immune responses and the role of S. aureus virulent factors in the pathogenesis of AD.



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Exposure amount and timing of solar irradiation during pregnancy and the risk of sensitization in children

Publication date: Available online 4 September 2017
Source:Allergology International
Author(s): Hyun Yong Koh, Eunhae Cho, So-Yeon Lee, Woo Kyung Kim, Yong Mean Park, Jihyun Kim, Kangmo Ahn, Seung Won Lee, Mi Ae Kim, Myung-Il Hahm, Yoomi Chae, Kee-Jae Lee, Ho-Jang Kwon, Man Yong Han
BackgroundSolar irradiation affects sensitization to aeroallergens and the prevalence of allergic diseases. Little is known, however, about how the time and amount of solar irradiation during pregnancy affects such risks in children. We aimed to find out how solar irradiation during pregnancy affects sensitization to aero-allergens and the prevalence of allergic diseases in children.MethodsThis population-based cross-sectional study involved 7301 aged 6 years and aged 12 years children. Maternal exposure to solar irradiation during pregnancy was evaluated using data from weather stations closest to each child's birthplace. Monthly average solar irradiation during the second and third trimesters was calculated with rank by quartiles. Risks of allergic sensitization and allergic disease were estimated.ResultsRelative to the first (lowest) quartile, the adjusted odds ratio (aOR) for allergic sensitization in the fourth (highest) quartile was lowest within solar irradiation during pregnancy months 5–6 (aOR = 0.823, 95% CI 0.720–0.942, p < 0.05). During months 9–10, the aOR for allergic sensitization for the fourth was higher than the first quartile of solar irradiation (aOR = 1.167, 95% CI 1.022–1.333, p < 0.05). Similar results were observed when solar irradiation was analyzed as a continuous variable during months 5 (aOR = 0.975, 95% CI 0.962–0.989, p < 0.001) and month 9 (aOR = 1.018, 95% CI 1.004–1.031, p = 0.003). Increased solar irradiation during months 7–8 increased the risk of asthma (aOR = 1.309, 95% CI 1.024–1.674, p = 0.032).ConclusionsMaternal exposure to solar irradiation during the second trimester of pregnancy associated with reduced aeroallergen sensitization, whereas solar irradiation during the third trimester was related to increased sensitization to aeroallergens.



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Targeting histone-acetyltransferase Tip60 inhibits intestinal allergy

Abstract

Background

The over production of IgE plays a critical role in the pathogenesis of allergy; the mechanism is unclear. Histone acetyltransferase (HAT) activities are required in gene transcription of a large number of molecules in the immune system of the body.

Objectives

This study tests a hypothesis that HAT Tat-interactive protein 60 (Tip60) plays an important role in the initiation of IgE-mediated allergy.

Methods

The effects of Tip60 on regulating IgE expression were assessed with B cells. An intestinal allergy mouse model was developed to assess the role of Tip60 in the induction of IgE-mediated allergic inflammation.

Results

High levels of Tip60 were observed in the peripheral B cells of patients with FA. Tip60 was required in the expression of IgE and IgG1 in B cells by inducing the chromatin remolding at the gene locus, in which histone acetylation, signal transducer and activator of transcription 6 (STAT6) and nuclear factor-κB at the locus of Iε promoter were markedly increased. Blocking Tip60 significantly attenuated the allergic inflammation in the mouse intestinal mucosa.

Conclusions

Tip60 plays an important role in the induction of IgE in B cells. Blocking Tip60 inhibits the allergic inflammation in the intestine, suggesting Tip60 inhibitor may be a potential anti-allergy drug.

This article is protected by copyright. All rights reserved.

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Soy isoflavones inducing overt hypothyroidism in a patient with chronic lymphocytic thyroiditis: a case report

Many people have thyroid conditions that make them susceptible to hypothyroidism. If the foods they eat may interfere with the production of thyroid hormone, which can lead to development of serious hypothyroi...

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Dental and oropharyngeal lesions in rats with chronic acid reflux esophagitis

In this study, we evaluated pathological changes in the tooth and pharynx of GERD rats to elucidate the association between gastric acid reflux and oral and pharyngeal diseases.

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Dental and oropharyngeal lesions in rats with chronic acid reflux esophagitis

Publication date: Available online 4 September 2017
Source:Auris Nasus Larynx
Author(s): Rintaro Shimazu, Mihoko Yamamoto, Akimichi Minesaki, Yuichiro Kuratomi
ObjectiveIn this study, we evaluated pathological changes in the tooth and pharynx of GERD rats to elucidate the association between gastric acid reflux and oral and pharyngeal diseases.MethodsAn experimental rat model of chronic acid reflux esophagitis was surgically created. The oral cavities were observed histologically every 2 weeks until 20 weeks after surgery.ResultsAt 10 weeks after surgery, molar crown heights in GERD rats were shorter than that in control rats, and inflammatory cell infiltration by gastric acid reflux was found in the periodontal mucosa of GERD rats. Furthermore, dental erosion progressed in GERD rats at 20 weeks after surgery, and enamel erosion and dentin exposure were observed. During the same period, inflammatory cell infiltration was observed in the mucosa of the posterior part of the tongue. These findings suggest that gastric acid reflux may be one of the exacerbating factors of dental erosion, periodontitis and glossitis.ConclusionWe investigated oral changes in an experimental rat model of GERD and observed development of dental erosion, periodontitis and glossitis. Our findings suggested chronic gastric acid reflux may be involved in the pathogenesis of oral disease.



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VideoEndocrinology™ Top-Viewed Videos

FREE ACCESS through September 14, 2017

Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features
Yuri E. Nikiforov

Thyroidectomy with Wu Gaosong's Procedure
Gaosong Wu, Deguang Kong

Transoral Endoscopic Thyroidectomy Vestibular Approach
Angkoon Anuwong, Thanyawat Sasanakietkul, Pornpeera Jitpratoom

Active Surveillance of Low-Risk Papillary Microcarcinoma of the Thyroid: Kuma Hospital Protocol and Its Outcomes
Akira Miyauchi

Subtotal Parathyroidectomy Under Indocyanine Green Angiography
Jordi Vidal Fortuny, Sébastien Guigard, John Diaper, Wolfram Karenovics, Frédéric Triponez

The post VideoEndocrinology™ Top-Viewed Videos appeared first on American Thyroid Association.

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Hemophagocytic syndrome: primary forms and predisposing conditions

Fernando E Sepulveda | Geneviève de Saint Basile

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Atopic dermatitis and psoriasis: two different immune diseases or one spectrum?

Emma Guttman-Yassky | James G Krueger

http://ift.tt/2gGkrEm

Check point inhibitors as therapies for infectious diseases

Maureen A Cox | Robert Nechanitzky | Tak W Mak

http://ift.tt/2eWHze3

Orthodontic braces come back to bite: a novel presentation of a small bowel volvulus

Talia Shepherd<br />Aug 7, 2017; 2017:bcr-2017-221152-bcr-2017-221152<br />other

http://ift.tt/2ez5uiR

Mediastinitis by Actinomyces meyeri after oesophageal stent placement

Diogo Ferreira Branquinho<br />Jun 5, 2014; 2014:bcr2014204499-bcr2014204499<br />case-report

http://ift.tt/2ezf8C1

Mycoplasma pneumonia-associated mucositis

Cyril Varghese<br />Mar 13, 2014; 2014:bcr2014203795-bcr2014203795<br />case-report

http://ift.tt/2iYx7Hs

Iatrogenic takotsubo cardiomyopathy induced by locally applied epinephrine and cocaine

Jens Sundbøll
Feb 19, 2014; 2014:bcr2013202401-bcr2013202401
case-report

http://ift.tt/2eX4MN6

Vocal cord paralysis associated with Ramsay Hunt syndrome: looking back 50 years

Eva Rye Rasmussen<br />Feb 6, 2014; 2014:bcr2013201038-bcr2013201038<br />case-report

http://ift.tt/2gFFqXE

Fatal hypertriglyceridaemia, acute pancreatitis and diabetic ketoacidosis possibly induced by quetiapine

Kristian Roerbaek Madsen<br />Jan 8, 2014; 2014:bcr2013202039-bcr2013202039<br />case-report

http://ift.tt/2eWxduy

Compression neuropathy of the common peroneal nerve by the fabella

Amit Patel<br />Nov 29, 2013; 2013:bcr2013202154-bcr2013202154<br />case-report

http://ift.tt/2gGeE1A

Postpartum spontaneous pneumomediastinum 'Hamman's syndrome'

Sami Kouki<br />Sep 3, 2013; 2013:bcr2013010354-bcr2013010354<br />case-report

http://ift.tt/2eXcXsC

Clarithromycin-induced haemorrhagic colitis

Ryosuke Miyauchi<br />Aug 20, 2013; 2013:bcr2013009984-bcr2013009984<br />case-report

http://ift.tt/2gHwfG8

Peripheral osteoma of the body of mandible

B S Manjunatha<br />Aug 8, 2013; 2013:bcr2013009857-bcr2013009857<br />case-report

http://ift.tt/2eWCsKT

Brain abscess associated with persistent left superior vena cava in a 58-year-old man

Thomas Barba<br />Mar 18, 2013; 2013:bcr2013009017-bcr2013009017<br />case-report

http://ift.tt/2gF5Gl8

Cutaneous melanoma in Birt-Hogg-Dubé syndrome – part of the clinical spectrum?

Abstract

Birt-Hogg-Dubé syndrome (BHDS) is a rare genetic disorder caused by mutations in the FLCN gene. Clinically, BHDS is highly heterogeneous even within the same family. The most characteristic features of BHDS are fibrofolliculomas, lung cysts that confer the risk of pneumothorax, and benign or malignant renal tumours. Additionally, several other tumours are discussed to be possibly linked to BHDS including colon and breast cancer, thyroid tumors, and parathyroid adenomas.

This article is protected by copyright. All rights reserved.

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Compassion focussed self-help for skin conditions in individuals with insecure attachment: A pilot evaluation of the acceptability and potential effectiveness

Abstract

Further research is needed to develop psychological interventions for people living with skin condition. This research letter reports on a preliminary evaluation of targeted self-help^a encompassing mindful breathing and compassionate imagery (i.e., evoking a self- compassionate mental images), with the aim of reducing skin specific related distress such as shame. The aim of this 4-week preliminary study was to investigate the usability and acceptability of self-help for people living with skin conditions, through a feedback form administered two weeks after the intervention.

This article is protected by copyright. All rights reserved.

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Olmutinib-induced palmoplantar keratoderma

Abstract

olmutinib is a third-generation epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) for the treatment of non-small cell lung cancer (NSCLC), especially for those harboring T790M mutations, the most common reason for other EGFR-TKI resistance. We describe three patients who developed acquired palmoplantar keratoderma (PPK) after taking olmutinib, an adverse event which has not been reported in previous generations of EGFR-TKIs.

This article is protected by copyright. All rights reserved.

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Association of Breast Milk Fatty Acids and Allergic Disease Outcomes – a Systematic Review

Abstract

Introduction

Dietary poly unsaturated fatty acids (PUFA) have immune regulatory properties. Breast milk is rich in PUFA, and it has been hypothesised that these PUFAs may be important in the aetiology of allergic diseases. Despite a growing body of evidence, the associations between breast milk PUFA and allergic disease have not previously been systematically reviewed.

Methods

The search was performed in PubMed and EMBASE databases using breastfeeding, fatty acid and allergic disease terms. Two authors were involved in selecting papers for review according to the inclusion criteria and extracting information on study characteristics and measures of association. Only studies that reported numeric associations between concentration of breast-milk fatty acids and allergic disease outcomes were included.

Results

A total of 18 papers met the inclusion criteria, reporting results from 15 study populations. The majority were cohort studies (n=11), with data from only two case control and two cross sectional studies. Sample size varied between 30 and 352 participants and follow-up time of the cohorts varied between three months and 14 years. Nine studies reported on eczema, seven on sensitisation and only five reported on asthma/wheeze. There was heterogeneity among studies in terms of presenting the association between PUFA and allergy, therefore estimates could not be pooled. Only a few studies observed associations between n-3 and n-6 PUFAs and allergic disease, and the magnitude of this effect varied greatly.

Conclusions

There is insufficient evidence to suggest that colostrum or breast milk poly unsaturated fatty acids influence the risk of childhood allergic diseases.

This article is protected by copyright. All rights reserved.

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Erosive pustular dermatosis of the scalp and Kindler syndrome: a new association

Abstract

Erosive pustular dermatosis of the scalp (EPDS) is a rare inflammatory disease that predominantly affects elderly people, with a chronic course and long-term management.¹ Sterile pustules, superficial erosions and crusted lesions on atrophic skin, resulting in cicatricial alopecia, characterize the typical clinical presentation. ^1-3 Triggering factors include several drugs, actinic damage, local trauma, surgery, and physical or chemical procedures for actinic keratosis.^4-6 To the best of our knowledge, no previous association with Kindler syndrome was found in the literature.

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Quality of life in people with vitiligo: a systematic review and meta-analysis

Abstract

Vitiligo is cosmetically disfiguring and has profound psychosocial effects due to stigmatization, problems in sexual function, anxiety, self-esteem and difficulty finding employment. Previous studies suggest a reduction in quality of life (QoL) due to vitiligo, but to date no systematic review has quantified this in comparison to people without vitiligo. Therefore, the aim of this review was to compare QoL in people with and without vitiligo.

This article is protected by copyright. All rights reserved.

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Functional and quality of life outcomes after partial glossectomy: a multi-institutional longitudinal study of the head and neck research network

Abstract

Background

While aggressive treatment for oral cancer may optimize survival, decrements in speech and swallowing function and quality of life often result. This exploratory study investigated how patients recover their communicative function, swallowing ability, and quality of life after primary surgery [with or without adjuvant (chemo)radiation therapy] for tongue cancer over the course of the first year post-operation.

Methods

Patients treated for oral cancer at three institutions (University of Alberta Hospital, Mount Sinai Beth Israel Medical Center, and Turku University Hospital) were administered patient-reported outcomes assessing speech [Speech Handicap Index (SHI)], swallowing [(M.D. Anderson Dysphagia Inventory (MDADI)] and quality of life [European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Module (EORTC-H&N35)]. Outcome measures were completed pre-operatively and at 1-, 6-, and 12-months post-operatively.

Results

One hundred and seventeen patients undergoing partial glossectomy with reconstruction participated in this study. Results indicated no significant differences in swallowing function (MDADI and EORTC-H&N35 subscales) between baseline and 6 months post-surgery and no significant differences in speech function (SHI subscales) between baseline and 1 year post-surgery. Most quality of life domains (EORTC-H&N35 subscales) returned to baseline levels by 1 year post-operation, while difficulties with dry mouth and sticky saliva persisted. A clear time trend of adjuvant (chemo)radiation therapy negatively affecting dry mouth scores over time was identified in this study, while negative independent effects of chemoradiation on MDADI swallowing, and EORTC-H&N35 swallowing, eating, and opening mouth subscales were found.

Conclusions

Assessment time influenced patient-reported speech, swallowing, and quality of life outcomes, while treatment (by time) effects were found for only swallowing and quality of life outcomes. Results of the present study will help guide clinical care and will be useful for patient counseling on expected short and long-term functional and quality of life outcomes of surgical and adjuvant treatment for oral cavity cancer.

http://ift.tt/2eVjzHZ

Immune profiling of melanoma tumors reflecting aggressiveness in a preclinical model

Abstract

Melanoma, like most solid tumors, is highly heterogeneous in terms of invasive, proliferative, and tumor-initiating potential. This heterogeneity is the outcome of differential gene expression resulting from conditions in the tumor microenvironment and the selective pressure of the immune system. To investigate possible signatures combining immune-related gene expression and lymphocyte infiltration, we established a preclinical model using B16.F1-derived clones, in the context of melanoma aggressiveness. Combinatorial analyses revealed that tumors concomitantly expressing low levels of Tnf-a, Pd-1, Il-10, Il-1ra, Ccl5, Ido, high Il-9, and with low infiltration by CD45⁺, CD3⁺, CD4⁺ and CD8⁺ cells and a high CD4⁺:CD8⁺ T cell ratio exhibited the most aggressive growth characteristics. Overall, these results support the notion that the intratumoral immunologic network molds aggressive melanoma phenotypes.

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Issue Information

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Issue Information

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Professor Stephania Jabłońska, 1920–2017

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Mesenteric panniculitis

A 53-year-old black woman presented with a 3-day history of abdominal pain. Ultrasound of the abdomen showed a gall bladder packed with small stones. She gave a history of abdominal surgery for a gynaecological condition. She had a cholecystectomy done, but her symptoms continued after cholecystectomy. She then had anendoscopic retrograde cholangiopancreatogram (ERCP) and sphincterotomy done, again her symptoms remained the same. A CT scan of the abdomen was done, and mesenteric panniculitis was suspected. A laparoscopic biopsy of the mesentery was performed, and it confirmed mesenteric panniculitis. She was started on a 2-week course of steroids to which she responded very well. Three months after the initial presentation, she was still asymptomatic.

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Thermische Verletzungen

Zusammenfassung

Hintergrund

In Deutschland erleiden jedes Jahr etwa 30.000 Kinder und Jugendliche eine thermische Verletzung. Von diesen sind 6000 so schwer verletzt, dass sie stationär behandelt werden müssen. Bei etwa zwei Drittel der Verletzten handelt es sich um Kleinkinder unter 4 Jahren. Über 70 % der thermischen Verletzungen werden durch Verbrühungen mit heißen Flüssigkeiten verursacht.

Ziel

Die Arbeit soll eine Übersicht über die Besonderheiten von thermischen Verletzungen im Kindesalter darstellen sowie Empfehlungen zur Erstversorgung, operativen Therapie und zur Nachsorge geben. Zusätzlich werden die therapeutischen Möglichkeiten von kleinen Verletzungen in der Praxis dargestellt.

Schlussfolgerung

Verbrennungen im Kindesalter stellen die Behandler vor besondere Herausforderungen. Sie können eine lebenslange Stigmatisierung durch Narbenbildung hinterlassen. Um ein optimales Therapieziel zu erreichen, sollte jede Behandlung von thermisch verletzten Kindern in Kliniken durchgeführt werden, die über eine Expertise in der Behandlung von Kindern jeden Alters verfügen.

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Das rote, schuppende Baby: ein kinderdermatologischer Notfall

Zusammenfassung

Neonatale, ichthyosiforme Erythrodermien sind selten und können mit extrakutanen Komplikationen sowie einem weiten Spektrum potenziell schwerer Grunderkrankungen assoziiert sein. Sie stellen einen kinderdermatologischen Notfall dar, der eine rasche Diagnosestellung und ein effektives, interdisziplinäres Management erfordert. In dieser Übersicht werden primär kutane sowie systemische Erkrankungen dargestellt, die bei Neugeborenen und jungen Säuglingen eine Erythrodermie hervorrufen können.

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Percutaneous sclerotherapy using bleomycin for the treatment of vascular malformations

Abstract

Background

Some vascular malformations are difficult to manage with surgical treatment. Thus, percutaneous sclerotherapy has been utilized with several advantages over surgical treatment. Bleomycin is one of several sclerosing agents used for the treatment of vascular malformations.

Objectives

To evaluate therapeutic efficacy and safety of percutaneous sclerotherapy using bleomycin for the treatment of vascular malformations.

Methods

Thirty patients diagnosed with vascular malformations, including four with capillary malformations with nodular change, nine with lymphatic malformations, and 17 with venous malformations, were involved in the study. Patients received magnetic resonance imaging and pulmonary surveillance prior to the treatment. Clinical assessments for the degree of vascularity disappearance and adverse effects were performed by the investigator.

Results

Percutaneous sclerotherapy using bleomycin was performed in 3.2 sessions (mean) over 3 months (mean). Significant improvement was observed in 90.0% of all lesions. All lesions of capillary malformation with nodular change and lymphatic malformation demonstrated significant improvement, and 82.4% of lesions of venous malformation improved significantly. Seven patients (23.3%) complained of side effects including pain and headache. All occurred within 24 hours and were tolerable.

Conclusions

Percutaneous sclerotherapy using bleomycin is effective and tolerable in the treatment of vascular malformation through a percutaneous approach. Therefore, it could be applied usefully for vascular malformations by dermatologists.

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A Case of a Very Elongated Styloid Process

Eagle syndrome is characterized by recurrent pain in the oropharynx and face due to an elongated styloid process or calcified stylohyoid ligament. In this article, we experienced a case of an elongated styloid process which is very rare in size and detailed treatment process. The patient was a 53-year-old Chinese woman with a chief complaint of frequent episodes of radiating pain in left preauricular region for 2 years. An intraoral approach was chosen to shorten part of her styloid process, and the chief complaint disappeared immediately after the operation.

http://ift.tt/2wybG4K

Severe cutaneous aluminum reaction to quadrivalent human papillomavirus vaccine treated with cyclosporin

http://ift.tt/2xIKpuU

Case of peripheral T-cell lymphoma, not otherwise specified, presenting dyshidrosis-like eruptions as the first clinical manifestation

http://ift.tt/2x4rhdH

Case of lymph node primary perivascular epithelioid cell tumor associated with leukoderma

http://ift.tt/2xIBedT

Six month-old infants with deformational plagiocephaly do not differ from unaffected infants with respect to vocal control

Publication date: November 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 102
Author(s): Kathleen Wermke, Christian Linz, Annette Hasenberg, Felix Kunz, Philipp Meyer-Marcotty, Tilmann Schweitzer
ObjectivesThe recommendation of a supine sleeping position led to a significant reduction of SIDS, but increased positional skull deformities (DP). Here, a quantitative analysis of babbling aims to complement previous studies of language-relevant competence based on items of the Bayley-scales that suggested the presence of developmental language delays in DP infants. Measures of fundamental frequency variability as proxies for vocal control are well suited for testing this assumption, since the laryngeal neuro-muscular system matures early and is coupled with brain function while working rapidly in coordinating the structures and mechanisms involved in infant sound production.MethodsSixty-six healthy, full-term infants with normal hearing and a monolingual background took part: (1) moderately asymmetrical DP group - N = 41; 21 male; (2) severely asymmetrical DP group - N = 10; 8 male; and (3) controls - N = 15; 5 male (group assignment based on stereophotogrammetric 360° scans). Fundamental frequency (fo) measures were taken as proxies for vocal control skills during babbling.ResultsA MANOVA revealed no significant multivariate effect for the shape group, Wilks' λ = 0.86, F(2, 63) = 1.21, p = 0.30, η2 = 0.07 (medium effect-size). The results do not support previous findings based on Bayley scale evaluations that suggested a negative impact of DP on language development during infancy.ConclusionsA strong link between DP and brain dysfunction affecting vocal control, which would cause deviations in otherwise healthy DP infants, was not observed. Objective long-term studies of sound production are necessary to identify and/or understand the potential consequences of DP on early language development.



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Immunonkologie

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Early results of a safety and feasibility clinical trial of a novel single-port flexible robot for transoral robotic surgery

Abstract

The aim of this study was to describe the early results of a phase 1 safety and feasibility clinical trial of the first clinical use of a novel robot for transoral robotic surgery (TORS)—the da Vinci SP (Intuitive Surgical Inc., Sunnyvale, CA, USA). Study design of this study is prospective clinical trial. The methods used in this study are prospective innovation, development, exploration, assessment, and long-term study phase 1 clinical trial. Early results of six patients underwent TORS with the da Vinci SP (Intuitive Surgical Inc., Sunnyvale, CA, USA) demonstrate access the nasopharynx, oropharynx, larynx, and hypopharynx. There were no conversions of the robotic surgical system. There were no serious adverse events or adverse events related to the use of the robot at 30-day follow-up for all six patients. The early results of this safety and feasibility trial of the da Vinci SP (Intuitive Surgical Inc., Sunnyvale, CA, USA) clearly demonstrate that the device is safe and that it is feasible in performing TORS to access the nasopharynx, oropharynx, larynx, and hypopharynx.

http://ift.tt/2gx0j3J

IgE auto-reactivity in bullous pemphigoid: eosinophils and mast cells as major targets of pathogenic immune reactants

Abstract

Background

Bullous pemphigoid (BP) is an autoimmune disease characterised by tense blisters that are usually preceded by urticarial eruptions. Affected patients exhibit IgG and/or IgE auto-antibodies against BP180 and/or BP230. Their relative importance in disease pathogenesis has not been fully elucidated.

Objectives

The aim of this study was to better characterise circulating and tissue-resident IgE in BP patients at the serological, structural and functional level.

Methods

Sera (n=19) and skin (n=33) from BP patients were analysed via ELISA and immunofluorescence, respectively.

Results

Results obtained show that BP patients exhibit elevated IgE levels in the serum and in the skin. Within the latter, it is very rarely and only sparsely found along the basement membrane zone (BMZ), but is prominently present on mast cells and eosinophils. At least a portion of these IgE antibodies are BP-specific, as evidenced by serum ELISA and by the co-localization of BP180 and FcεRI-bound IgE on mast cells and/or eosinophils. An important role of these immune reactants can be implied by our additional finding that cross-linking of IgE, derived from BP sera, on FcεRI-expressing rat basophils with BP180 results in robust degranulation of these cells.

Conclusion

We propose the existence of a disease pathway alternative to IgG and complement that may well be responsible for some of the clinical features of this autoimmune disease.

This article is protected by copyright. All rights reserved.

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A 5-year randomized trial on the safety and efficacy of pimecrolimus in atopic dermatitis: a critical appraisal

Summary

Aim

The PETITE study (Sigurgeirsson et al.) aimed to compare safety and efficacy of pimecrolimus 1% cream (PIM) and low-to-medium-potency topical corticosteroids (TCS) in children with mild-to-moderate atopic dermatitis (AD).

Setting and design

Participants of this 5-year drug-company sponsored multicentre, open-label, parallel-group trial were recruited between April 2004 and October 2005. No details are reported regarding the study sites.

Study exposure

Infants aged ≥ 3 to < 12 months with mild-to-moderate AD were randomly assigned in a 1 : 1 ratio to receive either PIM or a low- or medium-potency TCS cream/ointment for 5 years. No information on specific TCS products used was provided. The topical treatment was applied twice daily 'until complete AD clearance or for as long as allowed by the label of the specific TCS', and was reinitiated at the occurrence of first signs and symptoms of AD flares. In the PIM group, exacerbations not controlled by PIM were treated with short-term TCSs.

Outcomes

Adverse events (AEs) and serious AEs (SAEs) were recorded 'during clinic visits'. In a proportion of the patients, various immunological assessments including antibody titres to common vaccine antigens, immunoglobulin levels, B and T lymphocyte cell counts, and T-cell proliferation tests were performed. The children's growth was assessed by measuring height and weight. AD severity was measured using the Investigator Global Assessment (IGA) score and the percentage of the total body surface area affected. No specific information was provided on the number and scheduling of study visits. Primary outcomes were the incidence of AEs 'of primary clinical interest' and those with a crude incidence of ≥ 5% in either treatment group. Secondary outcome was 'long-term efficacy' defined as IGA ≤ 1 at week 3 and year 5.

Results

Patients in the PIM group experienced significantly more AEs [bronchitis (P = 0·02), infected eczema (P ≤ 0·001), impetigo (P = 0·045), nasopharyngitis (P = 0·04)]. No significant differences were seen for the other AEs. The overall incidence of SAEs was slightly higher for PIM (20·5% vs. 17·3%; P = 0·046). The proportion of participants with IGA ≤ 1 at year 5 was 88·7% for PIM and 92·3% for TCS, a success rate difference of 3·6% (95% confidence interval 0·8–6·4) favouring TCS.

Conclusions

Sigurgeirsson et al. conclude that the long-term management of mild-to-moderate AD in children with both TCS and PIM is safe, and that PIM has similar efficacy to TCS. Further, they conclude that their data support the use of PIM as a first-line treatment of mild-to-moderate AD in children.

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A 17-year-old male with a Small Bowel Neuroendocrine Tumor: flushing differential diagnosis

Neuroendocrine tumors (NETs) are heterogeneous neoplasms that originate from cells with a secretory function. Small bowel NETs (SB-NETs) are related to serotonin hypersecretion which causes: flushing, diarrhea...

http://ift.tt/2wxja7V

Competency-based assessment in surgeon-performed head and neck ultrasonography: A validity study

Objective

Head and neck ultrasonography (HNUS) increasingly is used as a point-of-care diagnostic tool by otolaryngologists. However, ultrasonography (US) is a very operator-dependent image modality. Hence, this study aimed to explore the diagnostic accuracy of surgeon-performed HNUS and to establish validity evidence for an objective structured assessment of ultrasound skills (OSAUS) used for competency-based assessment.

Study Design

A prospective experimental study.

Methods

Six otolaryngologists and 11 US novices were included in a standardized test setup for which they had to perform focused HNUS of eight patients suspected for different head and neck lesions. Their diagnostic accuracy was calculated based on the US reports, and two blinded raters assessed the video-recorded US performance using the OSAUS scale.

Results

The otolaryngologists obtained a high diagnostic accuracy on 88% (range 63%–100%) compared to the US novices on 38% (range 0–63%); P < 0.001. The OSAUS score demonstrated good inter-case reliability (0.85) and inter-rater reliability (0.76), and significant discrimination between otolaryngologist and US novices; P < 0.001. A strong correlation between the OSAUS score and the diagnostic accuracy was found (Spearman's ρ, 0.85; P < P 0.001), and a pass/fail score was established at 2.8.

Conclusion

Strong validity evidence supported the use of the OSAUS scale to assess HNUS competence with good reliability, significant discrimination between US competence levels, and a strong correlation of assessment score to diagnostic accuracy. An OSAUS pass/fail score was established and could be used for competence-based assessment in surgeon-performed HNUS.

Level of Evidence

NA. Laryngoscope, 2017

http://ift.tt/2xJ2dWO

Prophylactic immunization with human papillomavirus vaccines induces oral immunity in mice

Objective

Although it has been shown that prophylactic vaccination can induce genital immunity, there is inadequate information on human papillomavirus (HPV) vaccine-induced oral immunity, which is of particular interest due to HPV-associated oropharyngeal malignancies and recurrent respiratory papillomatosis. Therefore, we assessed the efficacy of various HPV vaccines against oral HPV pseudovirus (PsV) infection in mice.

Study Design

Preclinical scientific investigation.

Methods

C57BL/6 mice were vaccinated three times at 2-week intervals with either Gardasil (Merck, Kenilworth, NJ) (50 µL intramuscular injection) or a candidate pan-HPV L2 vaccine with alum adjuvant (25 µg subcutaneous injection). Additional mice were immunized with passive transfer of either Gardasil (Merck) human antisera or nonimmunized sera (100 µL intraperitoneal injection). All vaccinated and naïve control mice were then challenged with HPV16 E6E7 luciferase PsV in the oral mucosa. Visualization of HPV PsV infection was monitored through in vivo luciferase imaging.

Results

Oral luciferase-expressing HPV16 PsV infection was not detected in Gardasil (Merck), L2 vaccine, and Gardasil (Merck) antisera-immunized mice, whereas robust luciferase expression was observed in all control mice. An in vitro neutralization assay from sera of Gardasil-vaccinated (Merck) mice confirmed that vaccine efficacy was due to neutralizing antibodies.

Conclusion

Oral HPV16 PsV infection in mice was completely prevented with all methods of prophylactic HPV immunization. These findings provide preliminary evidence that human vaccines induce protection against oral HPV infection, which has significant public health implications for HPV-associated oropharyngeal malignancies.

Level of Evidence

NA Laryngoscope, 2017

http://ift.tt/2gErA8b

Clinical characteristics of laryngeal versus nonlaryngeal amyloidosis

Objectives/Hypothesis

Amyloidosis represents a heterogeneous group of disorders marked by abnormal protein formation and deposition. Laryngeal amyloidosis is rare and classically thought to remain isolated with little risk of systemic involvement or associated malignancy. This study sought to further characterize differences in clinical characteristics between patients with laryngeal and nonlaryngeal amyloidosis.

Study Design

Retrospective case-control study.

Methods

The Stanford Translational Research Integrated Database Environment was searched to identify patients with biopsy-confirmed laryngeal amyloidosis and patients with amyloidosis without laryngeal involvement on endoscopy. Mann-Whitney U and χ² tests were used for statistical analysis.

Results

Of 865 patients treated for amyloidosis between 1996 and 2016, 22 (2.5%) patients with biopsy-proven laryngeal amyloidosis were identified. An additional 22 patients with amyloidosis of a different organ and negative laryngoscopy—and therefore without laryngeal amyloidosis—were identified as controls. Compared to these controls with nonlaryngeal amyloidosis, patients with laryngeal amyloidosis were younger (mean age 52.8 years vs. 68.4 years, P < .0006), and 18% had additional organ involvement. Immunoglobulin light-chain amyloidosis was the most common subtype in both groups of patients. Eighty-six percent of patients with laryngeal amyloidosis required surgical excision, and of these patients, over 30% required multiple excisions.

Conclusions

There is a significant rate (18%) of multiorgan involvement in patients with laryngeal amyloidosis, which contradicts conventional concepts that this is an isolated disorder. This finding could have a significant impact on the evaluation and management of patients with laryngeal amyloidosis.

Level of Evidence

3b Laryngoscope, 2017

http://ift.tt/2gDyYka

Kinematic evaluation of penetration and aspiration in laryngeal elevating and descending periods

Objectives

It is important to evaluate swallowing movements by dividing them into periods of laryngeal closure and release. The purpose of this study was to evaluate penetration–aspiration (PA) according to human pathophysiology and to identify the factors for predicting PA.

Study Design

Case-control study.

Methods

Eighty-one patients with complaints of dysphagia caused by various etiologies were enrolled in this study. Videofluoroscopic swallowing studies were conducted, and the spatial and temporal factors were analyzed by computer-assisted motion analysis.

Results

The initiation of laryngeal vestibule closure in the laryngeal elevating period and its duration in the laryngeal descending period were significant factors for evaluating PA.

Conclusion

A knowledge of the delay of laryngeal vestibule closure in the laryngeal elevating period and its short duration in the laryngeal descending period could make it easier to evaluate the risk of PA.

Level of Evidence

3b. Laryngoscope, 2017

http://ift.tt/2eU23E3