Medicine by Sfakianakis Alexandros: 12/06/17

Τετάρτη 6 Δεκεμβρίου 2017

Excess pneumonia and influenza mortality attributable to seasonal influenza in subtropical Shanghai, China

Disease burden attributable to influenza is substantial in subtropical regions. Our study aims to estimate excess pneumonia and influenza (P&I) mortality associated with influenza by subtypes/lineages in Shang...

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Pedicled iliac crest bone flap transfer for the treatment of upper femoral shaft fracture nonunion: An anatomic study and clinical applications

Purpose

We present the results of a study on the anatomy of the ascending branch of the lateral circumflex femoral artery (AB-LCFA) and the use of the pedicled iliac bone flap transfer perfused by AB-LCFA combined with external fixation for the treatment of the nonunion of upper femoral shaft fractures.

Methods

The orientation, diameter, length, and distribution of the AB-LCFA from 40 lower limbs of adult cadavers were dissected and measured. From 2000 to 2012, 13 patients with nonunion of upper femoral shaft fractures underwent pedicled iliac bone flap transfer perfused by the AB-LCFA combined with external fixation. The time of bone fracture union was recorded based on X-ray examination. The functional results of the femoral shaft were evaluated by the Klemm classification.

Results

The lateral circumflex femoral artery (LCFA) divided into ascending, transverse, and descending branches in 32 specimens (80%). The diameter of the AB-LCFA at the origin was 3.15 ± 0.9 mm and the length of the AB-LCFA was 8.51 ± 3.06 cm. The postoperative course of the procedure was uneventful in all 13 patients. The average follow-up was 15 months. Bone union was achieved in all patients and the average union time was 5.3 months. 12 patients achieved excellent or good functional results based on the Klemm classification.

Conclusion

The AB-LCFA has a consistent orientation and abundant blood flow. The transfer of the iliac crest bone flap perfused by the AB-LCFA while combined with external fixation could be an option for treating the nonunion of upper femoral shaft fractures.

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Long-term stability of dental adhesive incorporated by boron nitride nanotubes

Publication date: Available online 6 December 2017
Source:Dental Materials
Author(s): Felipe Weidenbach Degrazia, Vicente Castelo Branco Leitune, Fernanda Visioli, Susana Maria Werner Samuel, Fabrício Mezzomo Collares
ObjectiveThe aim of this study was to evaluate physicochemical properties, long-term microtensile bond strength and cytotoxicity of methacrylate-based adhesive containing boron nitride nanotubes (BNNTs) as fillers.MethodsA dental adhesive was formulated using BisGMA/HEMA, 66/33wt% (control). Inorganic BNNT fillers were incorporated into the adhesive at different concentrations (0.05, 0.075, 0.1 and 0.15wt%). Analyses of degree of conversion (DC), polymerization rate [Rp.(s⁻¹)], contact angle (CA) on dentin, after 24h and 6 months microtensile bond strength (μTBS-24h and 6 months) were assessed. Cytotoxicity was performed through viability of fibroblast cells (%) by sulforhodamine B (SRB) colorimetry.ResultsDC and max. polymerization rate increased (p<0.05) after incorporating 0.075 and 0.1wt% BNNT. The contact angle on dentin increased (p<0.05) after incorporating 0.15wt% BNNT. The μTBS-24h showed no changes (p>0.05) after incorporating up to 0.15wt% BNNT comparing to control. After 6 months, μTBS decreased (p<0.05) for control and 0.15wt% BNNT and BNNT groups up to 0.15wt% showed higher μTBS than control (p<0.05). No difference of fibroblast growth was found among adhesives (p>0.05) and up to 19% of cell viability was found comparing 0.05wt% BNNT to positive control group (100%).SignificanceIncorporating boron nitride nanotubes up to 0.1wt% into dental adhesive increased the long-term stability to dentin without decreasing viability of fibroblast cell growth. Thus, the use of BNNTs as filler may decrease failure rate of current dentinal adhesives.

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Varicella pseudo-Koebner phenomenon associated with vascular access opening

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Successful management of retinal metastasis from renal cancer with everolimus in a monophthalmic patient: a case report

The retina is an uncommon site for metastases, in particular from solid tumors. Some authors have reported a recent increase in the incidence of metastases in infrequent sites, such as brain or bone, probably ...

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Primary sinonasal tuberculosis: Our experiences in a tertiary care hospital of eastern India

Publication date: Available online 6 December 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Santosh Kumar Swain, Ishwar Chandra Behera, Mahesh Chandra Sahu
BackgroundPrimary sinonasal tuberculosis is an extremely rare clinical entity. Often the clinician fail to diagnose the primary sinonasal tuberculosis, so treatment is frequently delayed and leading to complications.ObjectiveTo evaluate the clinical profile, diagnostic tools, treatment and outcome of primary sinonasal tuberculosis.Materials and MethodsRetrospective studies of six cases of primary sinonasal tuberculosis were done over period of five years. The detail clinical profile, diagnosis, treatment and outcome were studied in these patients.ResultsOut of the six cases of primary sinonasal tuberculosis, four cases were female and two were male. The mean age during the time of diagnosis was 35 years (16–67 years). The most common clinical presentations were chronic nasal obstruction, epistaxis and ulcerations at the nasal vestibule and nasal cavity. Diagnosis was confirmed by Histopathological diagnosis in all six cases. All cases received antitubercular therapy for 6–9 months. All six patients successfully responded to antitubercular therapy. Two year follow up showed no relapse, dissemination and death.ConclusionPrimary sinonasal tuberculosis is a rare clinical entity. It is always suspected among the patients with nasal obstruction, epistaxis and ulcerations at nasal vestibule and nasal cavity in the region with high prevalence of Tuberculosis.

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The role of Mannose-binding lectin 2 (MBL2) gene polymorphisms in adenoid hypertrophy among young children

Publication date: Available online 6 December 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Husam Majeed Hameed, Ali S. Dawood
ObjectiveIs to determine the role of Mannose binding lectin (MBL) 2 (SNP 49 C/T rs#5030737) gene polymorphism among patients with adenoidal hypertrophy in Iraqi population.MethodsFrom July through December 2015, a total of 60 adenoid hypertrophy (study group) young child patients (35 males and 25 females) with an age between (4 and 12) years old, were enrolled in this study according to selection criteria. A second group of otherwise healthy young child who did not have any symptoms or signs of adenoid hypertrophy were considered to be a control group. Confirmation of adenoid hypertrophy was achieved by: clinical examination, radiological assessment of postnasal space and an endoscopic nasopharyngoscopy. Blood samples were collected from both groups and genotyping of MBL-2 gene polymorphism was performed using traditional PCR and allele-specific technique.ResultsMBL2 gene polymorphism and allele frequencies among adenoid hypertrophy patients and their control were studied and the results showed that CC = 40 (66.7%), TT = 13(21.7%), and CT = 7 (11.6) in study group, while in control group CC = 5(8.3), TT = 9 (15%).CT = 46 (67.7%). The P-value of genotypes (CC, TT and CT) in study groups versus the control group were P < 0.001 (highly significant), P = 0.435 (non-significant) and P < 0.001 (highly significant) respectively.ConclusionThe difference between the MBL2 (SNP 49 C/T rs#5030737) gene polymorphism among adenoid hypertrophy patients and healthy people may indicate it could be used as an early predictive factor for children whom will be prone to adenoid hypertrophy. The genotype CC could be considered as a risk factor while CT genotype could be considered a protective factor against adenoid hypertrophy in the current study. A further study needed to evaluate the use of the above mentioned polymorphism as a prognostic value foradenoid hypertrophy.

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Surgical strategy for frontal sinus inverted papilloma

Publication date: Available online 6 December 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): A.A. Ibrahim, Haitham Morsi, Mohamed Hassab, Mohamed Eid, Samy Elwany
Inverted papilloma (IP) is a benign tumor with a local aggressive nature and has a tendency to recur after excision. Despite the evolution of endoscopic techniques in the management of IP, external approaches still play a crucial role in frontal sinus involvement.ObjectiveThe present study aimed at planning a strategy for managing IP arising in or involving the frontal recess and/or frontal sinus.Patients and methodsTen patients with frontal sinus IP were enrolled in the present study. The type of surgical procedure was tailored according to the site of origin and extent of the tumor.ResultsFive combined surgeries and five extended endoscopic surgeries were performed in 1 year and 4 months with a follow up period of 2 years. Complete resection of the tumor was achieved in all the cases and no recurrences were reported at the end of the follow up period.ConclusionsThe exact approach to frontal sinus IP differ from one case to the other. Endoscopic frontal surgery is the mainstay in treatment of frontal sinus IP. External or combined approaches still remain a valid option for lesions affecting the mucosa of the frontal sinus extensively or extending far lateral.

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Intracranial metastasis of follicular thyroid carcinoma mimicking cerebellopontine angle tumour

Publication date: Available online 6 December 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Li Yun Lim, Jamuneswary Selvarajoo, Norhafiza Mat Lazim, Ing Ping Tang
Cerebellopontine angle (CPA) tumour is most commonly associated acoustic neuroma. The occurrence of metastatic brain tumour at CPA is rare. Follicular thyroid carcinoma is second most common well differentiated thyroid malignancy and brain metastasis is unusual. We would like to report an unusual presentation of follicular thyroid carcinoma with brain metastasis at the CPA region. A 60 year old gentleman presented with occipital headache, slurred speech with positive cerebellar signs and multiple cranial nerve palsies with no neurological deficit to upper and lower limbs. No other significant findings noted on examination. Imaging investigations revealed a CPA tumour. Transnasal transphenoidal tumour debulking was done and biopsy revealed a metastasis of follicular thyroid carcinoma. After total thyroidectomy, the patient was scheduled for radioactive iodine ablation. Metastasis brain tumour with high vascular supply can contribute to difficult tumour debulking. Embolisation and stereotactic therapy are the supporting and alternative method of treatment.

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Atypical multiple metastasis of recurrent pleomorphic adenoma

Publication date: Available online 6 December 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Darshini Nagarajah, Irfan Mohamad, Norhafiza Mat Lazim, Sharifah Emilia Tuan Sharif, Nur Hidayati Mohamad Pakarul Razy
Pleomorphic adenoma is the commonest benign neoplasm of the parotid gland and minor salivary glands. It is composed of epithelial and myoepithelial cells arranged in various morphological patterns. The concrete reasons contributing to a recurrent disease are obvious or attempts of accidental tumor spillage, enucleation with rupture and incomplete excision during operation. The other solid reasons that could contribute to recurrence are known incomplete pseudocapsule, extracapsular extensions, pseudopods of pleomorphic adenoma tissue, and satellite pleomorphic beyond the pseudocapsule matrix. Most recurrent pleomorphic adenoma are multinodular with different recurrent sites and time duration. We describe a case of 55-year-old lady who underwent left superficial parotidectomy for pleomorphic adenoma 14 years prior to current presentation. After 8 years, she presented with ipsilateral level II lymph node, in which excision showed pleomorphic adenoma. Within 2 years after excision, she experienced another multiple small neck swellings at the level II-III, in which histopathology examination of the excised masses were consistent with pleomorphic adenoma, without evidence of lymph node background to suggest metastasis.

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Issue Information - TOC

No abstract is available for this article.

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Issue Information - Journal Info page

No abstract is available for this article.

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Reply

Publication date: Available online 6 December 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Fernando Sergio Leitao Filho, Seung Won Ra, Andre Mattman, Robert S. Schellenberg, Don D. Sin

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Chronic obstructive pulmonary disease exacerbation frequency and serum IgG levels

Publication date: Available online 6 December 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Juthaporn Cowan, Sunita Mulpuru, Gonzalo Alvarez, Vicente Corrales-Medina, Donald W. Cameron

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Cutometric assessment of elasticity of skin with striae distensae following carboxytherapy

Summary

Objective

The aim of the study was to evaluate the effectiveness of carboxytherapy in the treatment of striae distensae. Additionally, discomfort and side effects associated with the treatment were assessed.

Materials and methods

This study involved 15 women aged 22-40 years. They underwent 3 sessions of carboxytherapy at one-week intervals. Treatment was performed in skin area within stretch marks located on stomach, buttocks, and thighs. Cutometric probe was used to evaluate skin elasticity. Four measurements were performed—immediately before each treatment and one month after the last session. Photographic documentation was made before and after a series of treatment to perform clinical evaluation of changes in skin condition.

Results

Statistical analysis of results obtained with the use of Cutometer (R2 and R8 parameters) demonstrated that carboxytherapy significantly improved skin elasticity within stretch marks (P < .05). The analysis of photographic documentation revealed 58% improvement in stretch mark visibility. The width and length of stretch marks decreased, and their color became more like the natural color of the skin. Carboxytherapy is associated with moderate pain/discomfort. The occurrence of hematoma is the main side effect of this procedure.

Conclusions

Carboxytherapy seems to be an effective method of reducing stretch marks. This procedure is safe, and it can be performed without the risk of complications. Moreover, it does not require special postoperative convalescence. Photographic documentation is a method of assessment of aesthetic procedures effectiveness, which is complementary to other objective methods (eg, the use of MPA probes).

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Toxocara species exposure, symptoms of asthma, and fractional exhaled nitric oxide in the US population

Asthma is a major cause of morbidity in the United States.1 Toxocariasis is caused by exposure to the eggs of the nematodes Toxocara canis and Toxocara cati.2,3 Clinic-based studies have reported the association of Toxocara species with asthma. A study using data from the Third National Health and Nutrition Examination Survey (NHANES III) of 1988 to 1994 examined the association between Toxocara species infection and lung function in the United States.4 Infection was negatively associated with forced expiratory volume in 1 second.

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Spectrum and prevalence of reactions to marijuana in a Colorado allergy practice

Since the legalization of medical marijuana (MJ) and recreational MJ in certain states, an increasing number of patients with allergy are presenting from MJ exposure. Most have substantial exposure from industrial cultivation or are heavy consumers, indicating that cannabis is a mild allergen.

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Could calcium channel blockers treat 2 illnesses with 1 pill?

Ever since Middleton's1 suggestion that excessive permeability of airway cells to calcium ions might play a role in the underlying mechanism of bronchial hyperresponsiveness (BHR) and asthma, researchers have questioned whether calcium channel blockers (CCBs) might be efficacious in the treatment of this illness. Their potential utility makes a great deal of sense, because cytoplasmic calcium is involved in bronchoconstriction, mast cell mediator release, vagal reflex stimulation, airway mucous gland secretion, chemotaxis of eosinophils, and possibly even smooth muscle remodeling.

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Editorial Board

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Innate lymphoid cells and allergic disease

Allergic diseases, including asthma, atopic dermatitis, and allergic rhinitis, are substantial causes of morbidity and mortality in developing and developed countries. An expansive set of cellular mediators and mechanisms have been identified that contribute to the initiation or exacerbation of allergic disease. During the past decade, the discovery of a new subset of leukocytes known as innate lymphoid cells (ILCs) has great expanded our understanding of the pathogenesis of allergic disease.

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Instructions for Authors

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Baseline asthma burden, comorbidities, and biomarkers in omalizumab-treated patients in PROSPERO

The Prospective Observational Study to Evaluate Predictors of Clinical Effectiveness in Response to Omalizumab (PROSPERO) study was designed to better understand the types of patients who are begun on omalizumab in the real-world setting, including asthma burden, comorbidities, and biomarker profiles, and to evaluate what clinical parameters might be associated with better outcomes with the use of this biologic agent. In this month's issue of the Annals, Griffin et al1 report on the first of these 2 outcomes.

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Burden of skin pain in atopic dermatitis

Atopic dermatitis (AD) is associated with itch, skin inflammation and barrier disruption, and scratching, all of which may be associated with skin pain.

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Author Index to Volume 119, 2017

Abraham T, [Letters] 558

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Information for Readers

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Increasing our knowledge base of asthma

During the past decade, there has been an explosion in our knowledge of asthma. There are new descriptions of phenotypes, endotypes, and even genotypes. New approaches to management have been and continue to be developed. The realization and characterization of a spectrum of overlap with chronic obstructive pulmonary disease (COPD) in many patients with asthma have been reported in detail and approaches to management of patients with severe asthma continue on the forefront. These and other aspects of asthma are well represented in the more than 200 articles published on asthma since 2015 in the Annals of Allergy, Asthma and Immunology.

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The clinical role of fractional exhaled nitric oxide in asthma control

The potential role and characteristics of fractional exhaled nitric oxide (FeNO) remain unclear in the treatment of asthma.

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Flat foveal contour simulating macular hole

Description

A 40-year-old healthy female was referred for macular hole in his both eyes detected during routine examination. Visual acuity was 20/20 OU unaided. Ocular examination of OD was unremarkable except for the presence of round red lesion at fovea (figure 1A, arrow) that was more prominent on green reflectance imaging (figure 1B, arrow). Spectral-domain optical coherence tomography showed a flattened foveal contour (figure 1C, arrows), which explained the appearance of macular hole. Similar findings were seen in OS. There were no ocular or systemic features suggestive of albinism.

Figure 1

Multicolour scanning laser image of right eye showing small red lesion (arrow) simulating macular hole (A) that is better seen on red free image (B). Apparent macular hole corresponds to flat foveal contour on optical coherence tomography (C).

The foveal contour and anatomy may vary...

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Complication of deep brain stimulation for Parkinsons disease

Description

A 58-year-old man with advanced Parkinson disease diagnosed 13 years before, was admitted for surgical placing of continuous bilateral high-frequency stimulation of the subthalamic nucleus.

The procedure was uneventful (lead used Medtronic DBS 3387; antibiotic prophylaxis: cefazolin 2 g at time of anaesthetic induction and 1 g every 8 hours in the first 24 hours) with a postoperative control CT scan showing good placement of the electrodes and no abnormalities (figure 1). The stimulation was switched on 72 hours after the procedure and within 24 hours the patient presented two epileptic seizures controlled with diazepam and stimulation was switched off. The head CT showed intra-axial hypodensity more prominent in the frontal area with a gaseous collection and oedema surrounding the right electrode pathway (figure 2). At the time there was no fever, no increase in inflammatory markers and a normal cell count in the lumbar puncture. However, antibiotic therapy (ceftriaxone...

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Mycobacterium tuberculosis of the elbow joint

Mycobacterium tuberculosis(TB) affecting the elbow joint is rarely reported in the developed world. We present the case of an 85-year-old Caucasian female who complained of a chronically discharging and painful wound across her left elbow during her admission for an ischaemic stroke. This was initially deemed to be either a bursitis or local manifestation of amyloid by her general practitioner and dermatologist respectively prior to admission. She was commenced on flucloxacillin by the medical team for presumed cellulitis with minimal response. A synovial fluid sample and repeated wound swabs yielded no growth from routine bacterial culture. Radiological assessment together with knowledge of her husband having previous TB raised the possibility of TB arthritis. Synovial fluid aspirate was subsequently sent for acid–alcohol fast bacilli microscopy and mycobacterial culture that confirmed M. tuberculosis. She was consequently started on multidrug TB therapy, over a year after the onset of her symptoms.

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Lipoid proteinosis: towards predictive clinical clues

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Diagnostic and treatment effects of sialendoscopy for patients with swelling of the parotid gland when sialoliths are undetected with computed tomography

Publication date: Available online 6 December 2017
Source:Auris Nasus Larynx
Author(s): Norio Kondo, Toshio Yoshihara, Yukie Yamamura, Kaoru Kusama, Eri Sakitani, Yukako Seo, Mayako Tachikawa, Keiko Kujirai, Erika Ono, Yasuyo Maeda, Tomohito Nojima, Akiko Tamiya, Emiri Sato, Manabu Nonaka
Between August 2009 and May 2016, 74 patients underwent sialoendoscopic surgery. 32 patients had parotid gland disease and 9 patients had intermittent swelling of the parotid gland and sialoliths were not detected with CT imaging. 4 patients were diagnosed with idiopathic Stensen's duct stenosis. Sialendoscopy directly confirmed Stensen's duct stenosis in 2 patients. However, the sialendoscope was unable to be inserted in the other 2 patients, who had stenosis of the orifice of the Stensen's duct. Balloon expansion of the duct was performed in these 2 patients and a steroid drug was injected into the duct in one patient. Complete remission was archived in one patient treated with sialendoscopy. Three patients had sialolithiasis. Microsialoliths and/or white floating matter was observed and removed using sialendoscopy. All patients experienced complete remission. In cases of Sjögren syndrome and recurrent parotitis, sialendoscopic surgery was performed, but the symptoms showed no improvement. For patients with microsialoliths, sialendoscopy may be most useful for diagnosis and treatment when the sialoliths are not detected with CT imaging. At present, sialendoscopic surgery have limitation in the treatment of Stensen's duct stenosis and may similarly have limitation in the treatment of Sjögren's syndrome and recurrent parotitis.

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Factors influencing recurrent emergency department visits for epistaxis in the elderly

Publication date: Available online 6 December 2017
Source:Auris Nasus Larynx
Author(s): Mohamad R. Chaaban, Dong Zhang, Vicente Resto, James S. Goodwin
ObjectiveOur objective is to determine the risk factors associated with recurrent epistaxis requiring emergency department (ED) visits in the elderly.MethodsWe used a 5% national sample of Medicare data from January 2012 through December 2013. Our cohort included patients with a new diagnosis of epistaxis in the ED, defined as no epistaxis in the prior 12 months. We assessed the rates of ED visits for recurrent epistaxis in the 12 months following the incident visit. Our variables included demographics, geographic location, procedures performed during the incident visit and comorbidities.ResultsOut of the 4120 patients with incident epistaxis, 775 were readmitted with recurrent epistaxis within 12 months. 60% presented in the first 30days and 75% within 90 days. There was a significant increase in ED visits for patients over 75 years of age and in men compared to women. Recurrent ED visits for epistaxis was higher in patients with congestive heart failure, diabetes mellitus, and obstructive sleep apnea compared to those without these comorbidities.ConclusionAdditional ED visits for epistaxis are more common in the elderly and in males. Congestive heart failure, diabetes mellitus and obstructive sleep apnea were found to be independent risk factors.

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Occipitocervical Hemolymphangioma in an Adult with Neck Pain and Stiffness: Case Report and Literature Review

Introduction. Hemolymphangioma is an extremely rare malformation of the lymphatic and blood vessels. A limited number of hemolymphangioma cases occurring in the pancreas, extremities, spleen, and other organs have been reported until September 2017. To the best of our knowledge, no cases of hemolymphangioma in the occipitocervical region have been reported in the literature. Case Presentation. We reported the case of a 23-year-old male patient with an occipitocervical lesion presenting atypically as neck pain and stiffness over a period of five months. Although hemolymphangioma has historically demonstrated a female predilection (2.25 : 1 female to male) and presentation in the third to fourth decades of life, this case is an atypical manifestation occurring in a young male patient. The clinical characteristics and management choices of this uncommon case of hemolymphangioma in the occipitocervical region are discussed, and a review based on the available literature is also presented. Conclusion. Hemolymphangioma of the occipitocervical region is an uncommon presentation of a rare lesion. Although rare, hemolymphangioma should be considered a differential diagnosis for masses occurring in the occipitocervical region. Complete surgical resection is the treatment of choice and affords a good prognosis.

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Risk factors for intraoperative bradycardia during ear, nose, throat and maxillofacial surgery

Abstract

Intraoperative bradycardia (IOB) is one of the most common cardiac arrhythmias observed in clinical anaesthetic practice. Controlled hypotension, as a strategy of lowering patient's blood pressure during anesthesia has been practiced for decades in head and neck surgery. The aim of our study was to determine the incidence and the risk factors for intraoperative bradycardia in maxillofacial, ear, nose and throat surgery, as well as to determine whether controlled hypotension affects the occurrence of IOB. The retrospective study included 2304 patients who underwent maxillofacial, ear, nose or throat surgery. We studied the influence of: sex, age, comorbidity, type of surgery, duration of anesthesia and controlled hypotension on the occurrence of IOB. IOB was registered in 473 patients (20.5%). Patients with controlled hypotension had IOB significantly more often than patients without controlled hypotension (33.9 vs 15.1%) (p = 0.000). The significant predictors of IOB were: age (OR = 1.158; 95% CI = 1.068–1.256; p = 0.000), sex (OR = 0.786; 95% CI = 0.623–0.993; p = 0.043), ischemic heart disease (OR = 2.016; 95% CI = 1.182–3.441; p = 0.010); ear surgery (OR = 1.593; 95% CI = 1.232–2.060; p = 0.000), anesthesia duration, (OR = 1.006; 95% CI = 1.004–1.007; p = 0.000) and controlled hypotension (OR = 2.204; 95% CI = 1.761–2.758; p = 0.000). IOB is common in maxillofacial, ear, nose and throat surgery, particularly in male, older age and patients with ishemic heart disease. The ear surgery, longer anesthesia duration and controlled hypotension raise the risk for occurrence of IOB.

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Overexpression of osteopontin promotes cell proliferation and migration in human nasopharyngeal carcinoma and is associated with poor prognosis

Abstract

Nasopharyngeal carcinoma (NPC), a malignant tumor at the top and side of the nasopharyngeal cavity, highly occurs in the southern region of China. Cancer cell metastasis is one of the leading causes of death in NPC patients. Osteopontin (OPN), is a phosphorylated extracellular matrix protein with a variety of functions, was found to be overexpressed in many cancers. However, the expression and role of OPN in patients with NPC in Guangxi, China are unclear. Here, we observed that NPC patients had upregulated OPN at mRNA protein and levels. Immunochemistry (IHC) analysis of OPN expression in 68 NPC clinical specimens indicated that high expression of OPN had positive correlation with NPC lymph node metastasis (P = 0.012), distant metastasis (P = 0.001) and TNM staging (P = 0.018). Moreover, compared with relatively low OPN, NPC patients with higher expression of OPN showed a poorer overall survival rate (P = 0.001, log rank test). Multivariate analysis showed that OPN expression in NPC was an independent prognostic marker. The proliferation, apoptosis and migration ability of CEN-2Z cancer cells in NPC were determined by MTT, flow cytometry and wound-healing assays, respectively. Upregulation of OPN in CEN-2Z cancer cells promoted cancer cell proliferation and migration, and suppressed apoptosis. In sum, our result suggests OPN could be used as a valuable oncoprotein and show that overexpression of OPN in NPC may serve as a potential prognostic marker.

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Ixekizumab Gets FDA Nod for Active Psoriatic Arthritis

Ixekizumab significantly improves symptoms of psoriatic arthritis in patients naive to prior biologic therapy and in patients who had failed prior to biologic therapy.
FDA Approvals

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Production of Monoclonal Antibody That Recognizes Zika Virus and Other Flaviviruses in Serum-Free Conditions

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy , Vol. 0, No. 0.

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Genomic integration and expression of the Aggregatibacter actinomycetemcomitans catalase gene in Aggregatibacter aphrophilus

Publication date: Available online 5 December 2017
Source:Archives of Oral Biology
Author(s): Yuting Alice Yang, Ya-An Cheng, Casey Chen
ObjectiveTo test the hypothesis that virulence genes of Aggregatibacter actinomycetemcomitans can be expressed and confer fitness advantages in the closely related Aggregatibacter aphrophilus.DesignClinical isolates of A. aphrophilus were screened for natural competence with marked genomic DNA from A. actinomycetemcomitans and A. aphrophilus. The gene katA of A. actinomycetemcomitans D7S-1 and its flanking regions were constructed and inserted into a comparable locus in the genome of naturally competent A. aphrophilus strains by a markerless protocol via natural transformation. Mutants of A. actinomycetemcomitans with or without katA were also constructed by a similar protocol. Discs soaked with either 0.03% hydrogen peroxide or broth culture of Streptococcus gordonii Challis were placed on the agar with cultures of A. actinomycetemcomitans or A. aphrophilus. The size of the growth inhibition zone associated with the disc was measured after 2-day culture.ResultsFive of the 13A. aphrophilus strains exhibited a transformation frequency of 10⁻⁶ or higher. The intra- and inter-species transformation frequencies were comparable. The inhibition zones for katA-negative strains of A. actinomycetemcomitans or A. aphrophilus were 3- to 7-fold larger than those associated with katA-positive strains (p<0.05).ConclusionsThere was no apparent species barrier for the transfer and expression of A. actinomycetemcomitans katA in A. aphrophilus. The inserted A. actinomycetemcomitans-specific katA gene in A. aphrophilus strain NJ8700 conferred resistance to inhibition by hydrogen peroxide or S. gordonii. The potential to swap genes between these two closely related oral species may be an alternative approach for investigating the virulence determinants of A. actinomycetemcomitans.

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Anti-inflammatory Activity of Cannabinoid Receptor 2 Ligands in Primary hPDL Fibroblasts

Publication date: Available online 6 December 2017
Source:Archives of Oral Biology
Author(s): Ammaar H. Abidi, Chaela S. Presley, Mustafa Dabbous, David A. Tipton, Suni M. Mustafa, Bob M. Moore II
ObjectivesApproximately 65 million adults in the US have periodontitis, causing tooth loss and decreased quality of life. Cannabinoids modulate immune responses, and endocannabinoids are prevalent during oral cavity inflammation. Targets for intervention in periodontal inflammation are cannabinoid type 1 and 2 receptors (CB1R, CB2R), particularly CB2R because its levels increase during inflammation. We previously demonstrated that SMM-189 (CB2R inverse agonist) decreased pro-inflammatory cytokine production in primary microglial cells. The hypothesis of this study was that cannabinoids anandamide (AEA), HU308 (CB2R selective agonist), and SMM-189 decrease pro-inflammatory IL-6 and MCP-1 production by primary human periodontal ligament fibroblasts (hPDLFs) stimulated with P.gingivalis LPS, TNFα, or IL-1β.DesignCytotoxic effects of cannabinoid compounds (10⁻⁴ −10^−6.5M), LPS (1–1000ng/ml), TNFα (10ng/ml) and IL-1β (1ng/ml) were assessed by measuring effects on cellular dehydrogenase activity. IL-6 and MCP-1 production were measured using Mesoscale Discovery (MSD) Human Pro-Inflammatory IL-6 and MSD Human Chemokine MCP-1 kits and analyzed using MSD Sector 2400 machine.ResultsEC50 values for AEA, SMM-189, and HU308 were 16μM, 13μM, and 7.3μM respectively. LPS (1μg/ml), TNFα (10ng/ml), and IL-1β (1ng/ml) increased IL-6 and MCP-1 production, which were inhibited by AEA, SMM-189, and HU308. AEA alone significantly increased IL-6, but not MCP-1 levels, but the other cannabinoids alone had no effect.ConclusionThe effective inhibition of LPS, TNFα, IL-1β-stimulated IL-6 and MCP-1 production by CB2R ligands in hPDLFs suggests that targeting the endocannabinoid system may lead to development of novel drugs for periodontal therapy, aiding strategies to improve oral health.

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Dickkopf-1 may regulate bone coupling by attenuating wnt/β-catenin signaling in chronic apical periodontitis

Publication date: February 2018
Source:Archives of Oral Biology, Volume 86
Author(s): Xuelian Tan, Dingming Huang, Wei Zhou, Li Yan, Junli Yue, WanLu Lu, Dongzhe Song, Xuedong Zhou, Ling Ye, Lan Zhang
ObjectiveAlveolar bone loss is a common outcome of chronic apical periodontitis. In this study, we investigated the involvement of the Dickkopf-1-Wnt/β-catenin signaling pathway in the attenuation of osteogenic differentiation induced by Escherichia coli lipopolysaccharide, and we evaluated the use of Dickkopf-1 inhibitor and Dickkopf-1 recombinant protein to reverse bone loss in different phases of osteogenic differentiation.MethodsMC3T3-E1 cells grown in osteogenic medium were treated with Escherichia coli lipopolysaccharide for 24h during osteogenic induction on days 0, 1, 7, 14 and 21. Dickkopf-1 siRNA was added on days 0 and 1, and Dickkopf-1 recombinant was added on days 7, 14, and 21. Quantitative real-time PCR, Western blotting and alkaline phosphatase activity assays were performed to measure osteogenic marker expression and Wnt/β-catenin signaling. A rat apical periodontitis model was used to further evaluate the function of Dickkopf-1 in relation to bone loss.ResultsMC3T3-E1 cells treated with Escherichia coli lipopolysaccharide showed decreased mRNA expression of osteogenic markers. Wnt/β-catenin signaling was also inhibited, and Dickkopf-1 showed corresponding variations as quantified by Western blotting. Using Dickkopf-1 inhibitor or Dickkopf-1 recombinant protein at different phases of osteogenic differentiation in vitro partially reversed the decrease in osteogenic marker expression. The rat apical periodontitis model indicated that the Dickkopf-1 inhibitor could restore bone loss in the periapical area in vivo.ConclusionsDickkopf-1 may play a key regulatory role in determining the outcome for bone in inflammatory environments, and modulating the Wnt/β-catenin signaling pathway via Dickkopf-1 inhibitor or recombinant protein may provide a potential therapeutic option to prevent bone destruction in endodontic disease.

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High-refined carbohydrate diet promotes detrimental effects on alveolar bone and femur microarchitecture

Publication date: February 2018
Source:Archives of Oral Biology, Volume 86
Author(s): C.C. Montalvany-Antonucci, M.C. Zicker, S. Macari, T.S.F. Pereira, I.M.A. Diniz, I. Andrade, A.V.M. Ferreira, T.A. Silva
The impact of high-refined carbohydrate (HC) diet on fat accumulation, adipokines secretion and systemic inflammation is well described. However, it remains unclear whether these processes affect bone remodeling.ObjectiveTo investigate the effects of HC diet in the alveolar bone and femur parameters.MethodsBalbC mice were fed with conventional chow or HC diet for 12 weeks. After experimental time maxillae, femur, blood and white adipose tissue samples were collected.ResultsThe animals feed with HC diet exhibited considerable increase of adiposity index and adipose tissue levels of TNF-α, IL-6, IL-10, IL-1β, TGF-β and leptin. Microtomography analysis of maxillary bone revealed horizontal alveolar bone loss and disruption of trabecular bone in mice feed with HC diet. These deleterious effects were correlated with a disturbance in bone cells and an augmented expression of Rankl/Opg ratio. Consistently, similar effects were observed in femurs, which also exhibited a reduction in bone maximum load and stiffness.ConclusionOur data indicates that HC diet consumption disrupts bone remodeling process, favoring bone loss. Underlying mechanisms relies on fat tissue accumulation and also in systemic and local inflammation.

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Dentin sialophosphoprotein expression in enamel is regulated by Copine-7, a preameloblast-derived factor

Publication date: Available online 6 December 2017
Source:Archives of Oral Biology
Author(s): Su-Jin Park, Hye-Kyung Lee, You-Mi Seo, Chul Son, Hyun Sook Bae, Joo-Cheol Park
ObjectiveDentin sialophosphoprotein (Dspp) is expressed in odontoblasts and transiently expressed in early ameloblasts. However, the origin of Dspp in ameloblasts remains unclear. Our previous studies demonstrated that copine-7 (CPNE7), a molecule that is secreted by the dental epithelium, is expressed in early ameloblasts and is then translocated to differentiating odontoblasts; its expression levels correlate with odontoblast differentiation under the control of Dspp expression. The objective of this study is to figure out the relationship between CPNE7 and Dspp during amelogenesis.DesignThe gene expression patterns of CPNE7 and dentin sialoprotein (DSP) were examined by immunohistochemistry, western blot analysis, and real-time polymerase chain reaction. The effects of CPNE7 on Dspp regulation were investigated using luciferase and chromatin immunoprecipitation assays in ameloblastic HAT-7 cells.ResultsThe gene expression pattern of Cpne7 was similar to that of Dspp during ameloblast differentiation. Moreover, Gene expression omnibus profiles indicated that there is a close correlation between Cpne7 and Dspp expression in various normal human tissues. We also confirmed the effects of CPNE7 on the induction of Dspp in ameloblastic HAT-7 cells. Cpne7 overexpression promoted Dspp expression, whereas Dspp expression was down-regulated by Cpne7 inactivation.ConclusionsThese results suggest that the expression of Dspp in early amelogenesis is linked to CPNE7, a preameloblast-derived factor.

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Race as a Predictor of Patient Preferences for Biopsy Result Communication

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Generational Influence on Patient Learning Preferences in Dermatology

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Do TV Drug Ads Say Too Much About Risks?

The FDA thinks that less may be more when it comes to drug ads on TV and radio.
Medscape Reader Polls

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Hurricane Katrina: Exploring justice and fairness as a sociology of common good(s)

Publication date: Available online 6 December 2017
Source:Critical Perspectives on Accounting
Author(s): Stephanie Perkiss, Lee Moerman
Disasters or crises present opportunities to challenge society's taken-for-granted assumptions about the order of things. This paper applies the sociology of worth (SOW), as detailed by Boltanski & Thévenot, ([1991] 2006), to conceptualize the 'common good' in complex social situations or disputes, in this case a disaster. We use SOW to construct a narrative of Hurricane Katrina according to a nuanced understanding of disruptions to the social order. Previous accounting studies of disasters have demonstrated how accounts play a pivotal role in defining questions of justice and accountability – to whom and for what? SOW provides a framework to accommodate multiple rationalities and experiences in relation to a particular 'situation'. We argue that the common good, evaluated through logic and reasoning within a 'situation' or social reality, is multiple. This study contributes to our understanding of and making visible the contentions, compromises and conflicts that arise from a disaster and mobilize neglected or hidden accounts of what it means to achieve the common good.

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Complete B Cell Deficiency Reduces Allograft Inflammation and Intragraft Macrophages a Rat Kidney Transplant Model

ABSTRACT Background Increasingly it is being appreciated that B cells have broad roles beyond the humoral response, and are able to contribute to and regulate inflammation. The specific role of B cells in the pathogenesis of early allograft inflammation remains unclear. Methods To address this question, we generated B cell deficient Lewis rats via CRISPR technology. In a full mismatch transplant model, kidneys from Brown Norway donors were transplanted into B cell deficient Lewis recipients (B-/-) or wild type Lewis recipients. T cell mediated rejection was attenuated with cyclosporine. Results Renal inflammation was reduced at 1 week after transplant (Banff scores for interstitial inflammation, microvascular inflammation, glomerulitis, and C4d) in allografts from B-/- recipients. The reduction in interstitial inflammation was predominantly due to a decline in graft infiltrating macrophages. Intragraft T cell numbers remained unchanged. In addition, B cell deficiency was associated with increased T regulatory cells and reduced splenic T follicular helper cells at baseline; and significantly increased intragraft and splenic IL-10 mRNA levels after transplant. In vitro, B-/- and wild type splenic T cells produced similar levels of IFN-γ in response to T cell specific activation. Conclusions B cell deficiency in this model produced an anti-inflammatory phenotype with a shift towards regulatory T cell populations, production of anti-inflammatory cytokines (IL-10), and a reduction in allograft inflammation. These findings define a role for B cells to influence the cell populations and mediators involved in the pathogenesis of early allograft inflammation. Corresponding author: Sarah E. Panzer, MD, Division of Nephrology, Department of Medicine, 1685 Highland Avenue, Madison, WI 53705, sepanzer@medicine.wisc.edu Authorship statement: Sarah E. Panzer: concept, study design, performance of research, data analysis, writing of paper Nancy A. Wilson: performance of research, data analysis, writing of paper Bret M. Verhoven: performance of research, data analysis, writing of paper Ding Xiang: performance of research, review of manuscript C. Dustin Rubinstein: performance of research, data analysis, writing of paper Robert R. Redfield: data analysis, review of manuscript Weixiong Zhong: performance of research, review of manuscript Shannon R. Reese: study design, performance of research, data analysis, writing of paper Disclosure: The authors declare no conflict of interest. Funding: This project was supported by the Clinical and Translational Science Award (CTSA) program, through the NIH National Center for Advancing Translational Sciences (NCATS), grant UL1TR000427, and the KL2 training Award (KL2TR000428). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Comparison of Preemptive Therapy and Antiviral Prophylaxis for Prevention of Cytomegalovirus in Seropositive Liver Transplant Recipients

Background Few studies have directly compared preemptive therapy (PET) and antiviral prophylaxis (AP) for prevention of cytomegalovirus disease in CMV seropositive (R+) orthotopic liver transplant (OLT) recipients. Methods We prospectively assessed CMV disease and clinical outcomes among 160 consecutive R+ OLT recipients who received PET (weekly plasma CMV PCR for 3 months, oral valganciclovir 900 mg twice daily for CMV viremia >250 IU/mL, until 2 consecutive negative weekly PCR results) and compared them to a historical cohort of 156 R+ recipients who received AP (valganciclovir 900 mg daily for 3 months). Results Patient characteristics were similar between PET and AP cohorts (p>0.05 all comparisons). In the PET group, 24% (39/160) developed CMV viremia >250 IU/mL at a median of 42 (range 7-93) days post-OLT. CMV monitoring adherence in the PET cohort was 85% (1488/1760 required tests) and 86% (30/36) initiated PET within 3 days of the CMV result. By 12 months post-OLT, the incidence of CMV disease, acute allograft rejection, major infection, or death in the PET and AP cohorts was not significantly different: 2% vs 2%, 19% vs 16%, 10.5% vs 10.8%, and 5% vs 8%, respectively (p > 0.05 all comparisons). The estimated proportion of drug-exposed patients and average antiviral drug exposure were significantly lower with PET vs AP: 24% vs 100%, p

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Influence of Blood Pressure and Calcineurin Inhibitors on Kidney Function After Heart or Liver Transplantation

ABSTRACT Background Chronic kidney disease is common after heart or liver transplantation, with calcineurin inhibitors (CNI) considered the key contributor. A possible influence of posttransplant blood pressure has not been extensively examined. Methods Data from adult recipients of a first heart or liver transplant were analyzed regarding the relationship between blood pressure at year 1, renal function at year 5, and CNI therapy. Results Whereas we confirmed the well-known detrimental effect of increased 1-year systolic blood pressure on 5-year kidney graft survival, heart or liver graft survival were not affected. However, among 2,534 heart transplant recipients with good renal function at year 1, increasing systolic blood pressure at year 1 was associated with higher rates of poor renal function at year 5 posttransplant. This association was confirmed on multivariate analysis overall (odds ratio [OR] 1.25 per 20 mmHg increment, P

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Liver Transplantation in Cryptogenic Cirrhosis: Outcome comparisons between NASH, Alcoholic and AIH cirrhosis

ABSTRACT Background The outcomes of liver transplantation (LT) in patients with cryptogenic cirrhosis (CC) have not been adequately examined except for small case series. We believe that patients currently listed as CC have truly cryptogenic liver disease and may have different post-LT outcomes compared to nonalcoholic steatohepatitis (NASH). Methods: We compared the post-LT outcomes of adults with CC (n=3241) and compared them with cirrhosis from NASH (n=4089), alcohol (AC, n=7837) and autoimmune hepatitis (AIH, n=1435) using the UNOS database from 2002-16. We excluded those who had multi-organ transplantation and hepatocellular carcinoma. In addition to the well-known predictors of liver transplant outcomes, we analyzed the impact of Karnofsky Performance Status (KPS) score at LT on immediate and late outcomes. Results There were significant differences in clinical characteristics between the groups. Despite these differences in clinical characteristics and risk factors, CC had similar graft and patient survival to NASH, AC and AIH when assessed by Kaplan-Meier survival. Multivariate Cox regression analysis showed that graft and patient survival was similar in all 4 groups after adjusting for other confounders. Hispanics had a 24% lower risk of death (Hazard Ratio {HR} 0.76) compared to Whites in these combined cohorts after adjusting for all risk factors. In addition to other known risk factors, KPS score of 30% or less was associated with a 33% increase in risk of death (HR 1.33) on multivariate analysis. Conclusion Patients with CC had similar graft and patient survival when compared to NASH, AC and AIH cirrhosis. Address for correspondence: Paul J. Thuluvath, MD, FAASLD, FRCP, Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore, MD 21202, Tel: 410 332 9308; Fax: 410 659 1178; Email: thuluvath@gmail.com Conflicts of interest: None; Financial support: None Contributions: PJT and SH contributed to the idea, YS did the statistical analysis, PJT wrote the manuscript, SH and YS reviewed the final manuscript Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Variation in Practice Patterns for Listing Patients for Renal Transplantation in the United Kingdom: a National Survey

Introduction Despite the availability of guidelines for the evaluation of candidates for renal transplantation, variation in access to transplantation exists. This national survey investigates whether centre variation exists in the assessment of patients for renal transplantation in the UK. Methods An online survey, informed by qualitative interviews, was distributed to all UK renal centres. This survey examined centre approaches to chronic kidney disease service provision, transplant recipient assessment, education provision and wait-listing decision making processes. Centre re-evaluation policies for patients already listed and priorities for future development were also examined. Results All 71 renal centres responded. Of these, 83% reviewed predialysis patients in a low clearance clinic. In 26% of centres transplantation was not discussed as a treatment option with all patients. Fourteen centres reported having a dedicated transplant assessment clinic whilst 28% did not have a formal assessment protocol. Age was an exclusion criterion for listing in 3 centers, all of which had a cut off at 75 years. 83% of centres excluded patients with a high BMI. Cardiac investigations were risk-stratified in 90% of centres. Surgical involvement varied with 11% of centres listing patients without formal surgical review. There was no formal protocol in place to re-evaluate listed patients in 62% of centres. Conclusions There is wide variation in UK practice patterns for listing patients for renal transplantation, though its impact on access to transplantation is unclear. The extent to which centre-specific and patient-specific factors affect access to transplantation requires further analysis in a prospective cohort of patients. Rommel Ravanan PhD, Paul J. Roderick MD, denotes joint final author Corresponding author: Rishi Pruthi, Consultant Nephrologist, Royal Free Hospital, London NW3 2QG, UK, Tel: 020 7794 0500, Email: rishi.pruthi@nhs.net Authorship The authors declare no conflicts of interest. This article presents independent research funded by the National Institute for Health Research (NIHR) under the Programme Grants for Applied Research scheme (RP-PG-0109-10116). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. All authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analyses. Presented (as an abstract) at the Joint British Transplantation Society and Nederlandse Transplantatie Vereniging Congress, Bournemouth, 2015; and at the American Society of Nephrology Kidney Week, Philadelphia, 2014 Research idea and study design: RP, GL, CE, CT, AB, JLF, CB, JC, CD, CW, HD, RJ, WM, DF, RR, PJR; data acquisition: RP, STC, MC; data analysis/interpretation: RP, STC, GCO, RR, PJR; statistical analysis: RP; supervision or mentorship: RR, CE, GL, RR, PJR. Each author contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved. RP takes responsibility that this study has been reported honestly, accurately, and transparently; and that no important aspects of the study have been omitted. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Recurrence of renal cell cancer after renal transplantation in a multicenter French cohort

ABSTRACT Background Renal cancer accounts for 3% of adult malignancies; renal cell carcinoma (RCC) represents 80% of all renal cancers, and is characterized by late recurrences. Recurrences after kidney transplantation are associated with a high mortality rate. We aimed to determine if recurrences are linked to tumor characteristics and to delays between diagnosis and transplantation. Methods We retrospectively analyzed data from French kidney-transplanted patients with medical histories of pre-transplant renal cancer, focusing on the most common histological subtypes: clear cell and papillary cancers. Characteristics of the tumors, patients, and kidney transplantations were documented, and posttransplant patient survival was analyzed. Results Of 143 patients, 13 experienced cancer recurrence after kidney transplantation. The mean delay in recurrence was 3±2.3 years posttransplantation, and the cumulative incidences of recurrence were 7.7% at 5 years and 14.9% at 10 years. The risk of recurrence was higher in patients with clear cell RCC (13% vs. 0%, p=0.015). There was no correlation between posttransplant recurrence and the interval before transplantation. Factors associated with a higher risk of cancer recurrence were histological clear cell RCC (p=0.025), tumor stage pT2 (p=0.002) and Fuhrman grade IV (p

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An abrupt bleeding of the anteriorly- displaced sigmoid sinus: a rare complication of myringoplasty

Optical Coherence Tomography Features of Dermatophytoma

This case report illustrates the optical coherence tomography features of dermatophytoma.

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Practicing Safe Dermatology—Screening Out Liability

The article "Characteristics of Medical Liability Claims Against Dermatologists From 1991 Through 2015" by Kornmehl and colleagues is a welcome addition in our quest to understand how to reduce dermatology practice risk. The study confirms much of what we already knew or suspected but also provides some new interesting insights. It is reassuring to see that most malpractice cases against dermatologists are "abandoned, withdrawn or dismissed." Similarly, it is comforting to know that there has been a net reduction of 29.2% in paid claims for dermatologists. Is this secondary to improved patient care? The changing landscape of tort reform? Or both?

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Knowledge to Detect Scalp and Neck Melanoma

This study tests the association between a video intervention and hairdresser knowledge of melanoma and self-confidence in skin lesion detection.

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Trends in Medical Liability Claims Against Dermatologists

This study analyzes 24 years of data through 2015 from a nationally representative liability claims registry to compare the medical liability claims against dermatologists vs nondermatologists.

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Immunotherapy and Overall Survival in Elderly Patients With Melanoma

This cohort study evaluates if age influences clinical outcome and immune adverse events in patients treated by immunotherapy for `metastatic melanoma.

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Effect of Tannic acid on skin barrier function

Abstract

In this study, we investigated how tannic acid (TA) protects the skin from inflammation caused by external irritation. The effects of TA were evaluated by using a mouse 12-O-tetradecanoylphorbol 13-acetate (TPA)-induced skin inflammation model and a reconstructed human epidermal model (RHEM). We then used Lucifer Yellow for visual confirmation of TA's suppression effect at the SC surface. TA treatment of the skin prevented Lucifer Yellow from permeating the skin. This result suggests that TA acts as a barrier against external stimulants such as TPA and artificial sweat on the SC surface.

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Efficacy and Safety of Three Cryotherapy Devices for Wart Treatment: A Randomized, Controlled, Investigator-Blinded, Comparative Study

Abstract

Introduction

Cutaneous warts are common skin lesions, caused by human papillomavirus. For years, liquid nitrogen is the cryogen of choice for wart treatment. Alternatively, several cryogenic devices for home treatment are commercially available. The present trial assessed efficacy and safety of a novel nitrous oxide-based cryogenic device for home use (EndWarts Freeze^® in Europe, Compound W^® Nitro-Freeze in the USA).

Methods

This investigator-blinded, controlled, randomized study compared the nitrous oxide device (test product) with a dimethylether propane-based product (Wartner^®; comparator 1). Subjects with common or plantar warts (50/50 ratio) were randomized into two groups (n = 58, test product; n = 40, comparator 1). Sequentially, an extra treatment arm (n = 40) was added to compare with a dimethylether-based product with metal nib (Wortie^®; comparator 2). Main objective implied comparison of the percentage cured subjects after one to maximum three treatments. Efficacy and safety was evaluated by a blinded investigator.

Results

After a maximum of three applications, a significantly (p = 0.001) higher cure rate of 70.7% (Intention-to-Treat analysis) was observed with test product versus 46.2% (comparator 1) and 47.5% (comparator 2). Almost three times more subjects were cured after 1 test product application (29.3%), versus comparator 1 (10.4%) and comparator 2 (12.5%). Reported side effects were transient and typical of cryotherapy. All treatments were well-tolerated.

Conclusion

The superior cure rates for the test product versus two comparators can be explained by its design. Combination of nitrous oxide (cooling agent), the specific activation method (holding the liquid coolant in the cap), and skin-conforming polyurethane foam, results in higher cooling efficiency (− 80 °C) and more effective wart freezing. This trial demonstrated that the nitrous oxide device is a safe, user-friendly and effective wart treatment for home use, comparing favourably to dimethylether (propane) devices with higher freezing temperature, regardless of the applicator type.

Funding

Oystershell Laboratories.

Trial Registration

Clinicaltrials.gov identifier, NCT03129373.

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New Travel Ban Ruling Ripples Through Medical Community

The Supreme Court let stand the latest six-country ban, which continues to affect students, clinicians, and researchers. Recruiter says it could have a chilling effect on countries outside the ban.
Medscape Medical News

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Characterization of PD-L1 expression in Chinese non-small cell lung cancer patients with PTEN expression as a means for tissue quality screening

Abstract

The goal of this study is to evaluate PD-L1 prevalence and its association with major clinical characteristics in Chinese non-small cell lung cancer (NSCLC) patients to inform the clinical development of anti-PD1/PD-L1 agents in this population. We used phosphatase and tensin homolog (PTEN) expression through IHC as a surrogate tissue quality marker to screen surgical NSCLC samples in tissue microarray (TMA; 172 cases) or whole-section (268 cases) format. The samples were then analyzed with a clinically validated PD-L1 IHC assay. The results were correlated with baseline characteristics and clinical outcomes. PTEN IHC showed that 108 TMA samples and 105 whole-section samples qualified for PD-L1 IHC. With a clinically relevant cutoff, 41.7% of the TMA samples were PD-L1 positive. PD-L1 level was much lower in EGFR-mutant patients and seemed to be a favorable prognostic factor for both overall survival (OS) and recurrence-free survival (RFS). These findings were confirmed in the whole-section samples except that their survival data were not mature enough for correlation analysis. In summary, PD-L1 expression was detected in approximately 40% of PTEN-qualified Chinese NSCLC samples, negatively correlated with EGFR mutation and seemed to be a favorable prognostic factor for both OS and RFS. Notably, the different results from PTEN-qualified and PTEN-disqualified samples underscore the importance of tissue quality control prior to biomarker testing.

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An abrupt bleeding of the anteriorly- displaced sigmoid sinus: a rare complication of myringoplasty

Abstract

Background

The location of the sigmoid sinus within the mastoid cavity is quite variable. An anteriorly- displaced vertical segment of the sigmoid sinus constitutes an uncommon but dangerous anatomical variation that surgeons rarely encounter during surgery. In this variation, the sigmoid sinus lays underneath a very thin bony flap, which makes it easily damaged. Thus, an abrupt fatal bleeding might occur. Despite the many hypotheses about its origin (Chronic otitis media, hypopneumatization, etc.), the pathogenesis of this variation is still not completely understood.

Case presentation

We present a case where the vertical segment of the left sigmoid sinus was encountered just underneath a one- millimeter bony flap in the posterior wall of the external auditory canal during an attempted myringoplasty.

Conclusion

Anatomical variations of the sigmoid sinus are not uncommon, and the otolaryngologist should be aware of such variations to prevent unpleasant, intra- operative surprises.

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Evolutionary Biologists Say Recently Discovered Fossil Shows Transition of a Reptile From Life on Land to Life in the Sea

Using modern research tools on a 155-million-year-old reptile fossil, scientists at Johns Hopkins and the American Museum of Natural History report they have filled in some important clues to the evolution of animals that once roamed land and transitioned to life in the water.

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Od Redaktora Naczelnego

Publication date: October–December 2017
Source:Alergologia Polska - Polish Journal of Allergology, Volume 4, Issue 4
Author(s): Rafał Pawliczak

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Editorial Board

Publication date: October–December 2017
Source:Alergologia Polska - Polish Journal of Allergology, Volume 4, Issue 4

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Deux observations de granulome annulaire sous anti-PD1

Publication date: Available online 6 December 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): R. Charollais, F. Aubin, B. Roche-Kubler, E. Puzenat
IntroductionLe granulome annulaire fait partie des réactions granulomateuses qui peuvent être induites par des médicaments. L'immunothérapie par anti-PD1 est utilisée dans le traitement des mélanomes et d'autres cancers solides. Nous rapportons deux cas de granulome annulaire survenus chez des patientes traitées par un anti-PD1, le pembrolizumab.ObservationsDeux femmes traitées par pembrolizumab toutes les 3 semaines pour un mélanome métastatique ont développé un granulome annulaire sous traitement. L'immunothérapie a été maintenue dans les deux cas. Les lésions ont continué d'évoluer par poussées et rémissions chez la première patiente, alors qu'une disparition complète était constatée après un mois de corticothérapie locale chez la seconde.DiscussionLa survenue de réactions granulomateuses sous immunothérapie est connue et décrite dans la littérature, mais aucun cas de granulome annulaire induit par anti-PD1 n'avait été rapporté jusqu'ici. L'hypothèse pathogénique est qu'une dysrégulation de l'immunité cellulaire secondaire au traitement entraînerait un processus réactionnel granulomateux dans les organes cibles. Le granulome annulaire fait donc partie des effets secondaires cutanés possibles sous anti-PD1.BackgroundGranuloma annulare as a granulomatous cutaneous reaction may be drug-induced. Immune checkpoint inhibitors including programmed death-1 (PD-1) inhibitors show remarkable antitumor activity and are approved for melanoma and other cancers. Different immune-related adverse effects have been described. We report herein a rare adverse effect of anti-PD1 therapy given for metastatic melanoma : granuloma annulare.Patients and methodsTwo women receiving pembrolizumab metastatic melanoma presented with granuloma annulare. The therapy was continued in both cases. In the first patient, granuloma annulare appeared and then subsided; in the second patient, the lesion resolved completely with topical corticosteroids.DiscussionWhile there have been reported cases of sarcoidosis induced by immunotherapies, immunotherapy-induced granuloma annulare has not been described. The pathogenesis of drug-induced granulomatous reactions is thought to involve autoimmune dysregulation affecting T cells, especially Th1 cells, which lead to granuloma formation. Granuloma annulare should thus be considered a cutaneous adverse effect of anti-PD1 immunotherapy.

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Le mythe du nettoyage par les vierges : actualité d’un archaïsme magico-religieux

Publication date: Available online 6 December 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): P. Charlier, F. Bou Abdallah, L. Brun, V. Hoang-Oppermann, S. Deo, Y. Mostefai-Dulac, M.-F. Mamzer, C. Hervé
IntroductionAu sein de la consultation d'anthropologie médicale de l'hôpital de Nanterre (France), destinée aux migrants et aux réfugiés, ont été rapportés trois cas de « purification par les vierges » survenus dans des pays d'Afrique sub-saharienne.ObservationsIl s'agissait d'agressions sexuelles (2 viols et 1 attouchement) de sujets féminins immatures (fillettes) par des sujets porteurs d'infections sexuellement transmissibles (VIH, syphilis) espérant une guérison au décours de leur geste.DiscussionCes pratiques sexuelles hétéro-agressives d'une particulière atrocité, appuyées sur des prétextes magiques, présentent un caractère malheureusement universel et non attaché à une culture spécifique. Sur le plan anthropologique médical, la croyance en une purification par les vierges répond à la croyance que le malade est un sujet sale et impur. De la même façon que des émétiques ou des laxatifs sont prescrits en cas de troubles intestinaux (pour « éliminer » la maladie), certains vont user de diurétiques pour des anomalies urinaires ou, littéralement, de « vagins (ou anus) propres » pour y éliminer leurs propres miasmes. L'actualité croissante des migrations de populations (dont certaines sont porteuses d'infections chroniques), de camps de réfugiés, d'incarcérations prolongées, etc. rend d'autant plus fréquente l'observation de tels phénomènes. La croyance en la purification par les vierges (et ses funestes conséquences) seront difficiles à éradiquer. L'éducation des populations et des professionnels de santé devrait permettre de promouvoir le respect absolu du corps de l'enfant, et de l'autre en général, d'autant plus qu'en cette période d'intensification des flux migratoires, cette problématique risque de prendre une triste ampleur.BackgroundIn the medical anthropology section of the Nanterre Hospital (France) for migrants and refugees, three cases were recorded of "virgin cleansing" in sub-Saharan African countries.Patients and methodsThese consisted of sexual assaults (2 instances of rape and 1 of sexual interference) on sexually immature females (young girls) by patients with sexually transmitted infections (mainly HIV, syphilis) hoping they might thereby be cured.DiscussionThese particularly atrocious hetero-aggressive sexual practices based on magical arguments are unfortunately universal and are not limited to a specific culture. At the medical anthropology level, the belief in cleansing by virgins is based on the notion that the patient is dirty and impure. In the same way that emetics and/or laxatives are prescribed in the case of intestinal disorders (to "eliminate" the disease), some subjects use diuretics for urinary abnormalities or, literally, "clean vaginas (or anuses)" to purge their own miasma. The rising tide of population migrations (some of whom carry chronic infections), refugee camps, prolonged incarcerations, etc., makes observations of such phenomena increasingly frequent. Belief in cleansing by virgins (and the fatal consequences thereof) will be difficult to eradicate. The education of populations and health professionals should promote absolute respect for the body of children, and, more generally, of others, particularly since at this time of increasingly marked migratory flows, this problem sadly risks becoming widespread.

http://ift.tt/2AdUWDe

L’immunohistochimie (clone VE1) est une méthode économique, spécifique et sensible pour détecter la présence d’une mutation BRAFV600E dans le mélanome

Publication date: Available online 6 December 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): M. Etienne, F. Oca, D. Prunier-Mirebeau, A. Croué, L. Martin
IntroductionLa détermination du statut mutationnel BRAF est nécessaire à la prise en charge des patients atteints d'un mélanome non résécable stade IIIc ou métastatique stade IV. Actuellement, seules les méthodes de biologie moléculaire (BM) sont validées pour détecter la présence d'une mutation BRAF.ObjectifComparer la sensibilité, la spécificité et le coût de l'immunohistochimie (IHC) (clone VE1) par rapport aux techniques de BM (qPCR et séquençage Sanger).Patients et méthodesTous les prélèvements ayant fait l'objet d'une demande de détermination du statut mutationnel BRAF entre mars 2013 et février 2015 au sein de la plateforme d'analyse cellulaire et moléculaire du CHU d'Angers ont été inclus de manière rétrospective et consécutive. Les analyses en IHC (clone VE1) et en BM étaient faites à partir du même échantillon tumoral inclus en bloc de paraffine. Le coût de ces deux techniques était estimé à partir du coût de la cotation de ces deux actes auprès de l'Assurance maladie.RésultatsDeux cent sept échantillons ont fait l'objet d'une détermination de statut mutationnel BRAF en IHC et en BM. Seul un prélèvement était discordant entre ces deux techniques (positif en IHC, négatif en BM). La sensibilité et la spécificité de l'IHC étaient respectivement de 100 % et de 99,25 %. Le ratio coût IHC/coût BM était de 1:2,1.ConclusionL'IHC (clone VE1) est une technique spécifique, sensible et économique pour déterminer le statut mutationnel BRAFV600E. Néanmoins, il s'agit d'une méthode qui doit être validée pour pouvoir s'intégrer dans un algorithme décisionnel, aux côtés des techniques de BM, afin de déterminer l'indication ou non à la mise en place d'une thérapie ciblée anti-BRAF.BackgroundDetermination of BRAF mutation status is mandatory in the management of patients with inoperable stage IIIC or stage IV melanoma. Currently, molecular biology (MB) has been validated for detecting the presence of BRAF mutations.ObjectiveTo compare the sensitivity, specificity and cost of immunohistochemistry (IHC) (clone VE1) versus BM methods (qPCR and Sanger sequencing).Patients and methodsAll the samples for which BRAF mutation status was requested between March 2013 and February 2015 at the cellular and molecular analysis laboratory of the Angers Hospital were included retrospectively and consecutively. The IHC (clone VE1) and BM analyses were performed with the same formalin-fixed paraffin embedded tumour samples. The cost of these two methods was determined on the basis of the cost for the French Health Insurance.ResultsTwo hundred and seven samples were subjected to a determination of BRAF mutational status in IHC and BM. Only one sample was discordant between these two methods (positive in IHC, negative in BM). The sensitivity and specificity of the IHC was 100% and 99.25% respectively. The ratio of the cost of IHC/BM testing was 1:2.1.ConclusionIHC (clone VE1) is a specific, sensitive and economic method for determining BRAFV600E mutation status. Nevertheless, this method must be validated in order to be integrated into a decisional algorithm, alongside BM methods, to determine whether targeted BRAF-inhibitor therapy is indicated.

http://ift.tt/2B6eJoj

Herpès chronique périnéal résistant à l’aciclovir révélateur d’une leucémie lymphoïde chronique

Publication date: Available online 6 December 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): E.A. Casassa, P. Nicol, R. Viraben, C. Gaudin, C. Bulai Livideanu, C. Mengelle, L. Lamant, F. Fortenfant, C. Paul, M.P. Konstantinou
IntroductionDevant des ulcérations cutanéomuqueuses chroniques, une infection herpétique doit être recherchée. Nous rapportons une observation d'ulcération périnéale due à herpes simplex virus (HSV), résistant à l'aciclovir (ACV), qui a révélé une leucémie lymphoïde chronique (LLC).ObservationUne femme de 85 ans consultait pour une ulcération étendue invalidante de la région périnéale évoluant depuis 8 mois. La patiente n'avait pas d'antécédent d'infection herpétique, ni de traitement antiviral. Un HSV de type 2 était mis en évidence dans le prélèvement cutané. Un traitement par valaciclovir était prescrit, relayé par ACV intraveineux, sans efficacité. La biopsie de l'ulcération montrait une hyperplasie épithéliale bénigne avec marquages positifs pour HSV 1 et HSV 2 en immunohistochimie. Le bilan immunitaire révélait une prolifération lymphocytaire B monoclonale posant le diagnostic de LLC B. La présence d'une souche HSV résistant à l'ACV était suspectée et confirmée par la détection d'une mutation de la thymidine kinase (TK) virale sous forme de décalage du cadre de lecture avec codon stop : M183stop. Un traitement par foscarnet pendant 3 semaines permettait une cicatrisation presque complète ; il était interrompu en raison de l'induction d'une insuffisance rénale aiguë. Les lésions résiduelles étaient traitées par imiquimod crème. Du valaciclovir était par la suite instauré à dose préventive, mais une récidive survenait 11 mois plus tard.DiscussionLa prévalence des HSV ACV-résistants est de 0,32 % chez le sujet immunocompétent et atteint 3,5 % chez le patient immunodéprimé. Cette résistance est due à la sélection locale, sous inhibiteurs de TK à des doses sous-optimales ou en traitement prolongé, de mutants résistants minoritaires préexistants. Ces virus résistants présentent une virulence et une capacité de réactivation plus faible que les virus sauvages. Le foscarnet, un inhibiteur de l'ADN polymérase virale, détruit la majorité de la population virale résistante à l'ACV, ce qui explique que les éventuelles rechutes se fassent avec un virus sauvage, permettant un traitement préventif par valaciclovir. À notre connaissance, aucun cas d'herpès chronique résistant à l'ACV et révélateur d'une LLC n'a été décrit jusqu'ici.ConclusionUn herpès chronique résistant doit faire rechercher une maladie hématologique et, en cas de résistance clinique aux inhibiteurs de la thymidine kinase, envisager un traitement par inhibiteur de l'ADN polymérase.BackgroundChronic HSV infection is a cause of chronic perineal ulcerations. We report a case of a chronic and refractory HSV infection revealing chronic lymphoid leukaemia.Patients and methodsAn 85-year-old woman with an 8-month history of chronic perineal ulcerations was referred to our dermatology department. She had no previous medical history of herpes infection. Skin biopsies ruled out carcinoma but were consistent with HSV infection. A local swab was positive for HSV2. Treatment with valaciclovir and intravenous acyclovir (ACV) at the recommended doses was ineffective. Laboratory tests revealed type-B chronic lymphoid leukaemia. Molecular biology studies confirmed the presence of ACV-resistant HSV via decreased thymidine kinase activity (stop codon: M183stop). Foscarnet was administered for a period of 3 weeks with almost complete healing of the ulcerations. Treatment was stopped prematurely due to acute renal insufficiency and the remaining lesions were treated using imiquimod cream. Valaciclovir was prescribed to prevent further episodes. The condition recurred a mere 11 months later.DiscussionThe prevalence of ACV-resistant HSV is 0.32 % in immunocompetent patients and 3.5 % in immunocompromised patients. Insufficient dosing regimens or prolonged treatment with TK inhibitors result in the local selection of pre-existing mutant HSV viruses. Foscarnet, a DNA polymerase inhibitor, is the treatment of choice in HSV-resistant infections. ACV-resistant HSV is less virulent and replicates less, with reactivations being mainly due to wild-type HSV latent in the neural ganglia. Valaciclovir can be used as a preventive treatment. To our knowledge, this is the first case of ACV-resistant HSV infection revealing chronic lymphoid leukaemia.ConclusionChronic perineal ulcerations can be the first manifestation of immunodeficiency seen for example with haematological diseases. In the event of clinical resistance of an HSV infection to recommended thymidine kinase inhibitor regimens, the use of foscarnet should be considered.

http://ift.tt/2AbftYZ

Les défis de la dépigmentation cosmétique volontaire

Publication date: Available online 6 December 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): A. Mahé

http://ift.tt/2B6dMft

Mélanome avec métastases cutanées zostériformes

Publication date: Available online 6 December 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): V. Carlioz, C. Faivre, B. Balme, H. Joosten, T. Pradier, F. Skowron
IntroductionLes métastases en transit sont fréquentes lors de l'évolution d'un mélanome cutané primitif. Exceptionnellement, elles sont distribuées sur un territoire radiculaire et sont alors appelées « métastases zostériformes ».ObservationNous rapportons le cas d'un patient présentant des métastases cutanées zostériformes de mélanome, évoluant de façon péjorative malgré une exérèse chirurgicale et un traitement par immunothérapie.DiscussionLe mécanisme physiopathologique de la dissémination métamérique reste inconnu à ce jour.IntroductionCutaneous metastases are common in patients with malignant melanoma. In rare cases, they are distributed on a dermatome, in which case they are known as zosteriform metastases.ObservationWe report the case of a patient with zosteriform metastasis of a malignant melanoma, progressing unfavourably despite surgical excision and immunotherapy.DiscussionThe physiopathology of this condition continues to be poorly understood.

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Squamous cell carcinoma of unknown primary of the head and neck: Favorable prognostic factors comparable to those in oropharyngeal cancer

Abstract

Background

Treatment for squamous cell carcinoma (SCC) of unknown primary consists of radiotherapy (RT) +/- chemotherapy or neck dissection +/- adjuvant RT/chemoradiotherapy (CRT). We compared these strategies and identified prognostic factors.

Methods

From 1993 to 2015, 75 patients with SCC of unknown primary had RT-based or surgery-based treatment. Primary endpoints were overall survival (OS) and disease-free survival (DFS). Event-time distributions were estimated using the Kaplan-Meier method.

Results

Five-year OS and DFS for RT-based and surgery-based treatments were similar (OS 73% vs 68%, respectively; DFS 65% vs 64%, respectively). Among 38 patients with p16 data, 76% were p16 positive and showed improved 5-year DFS (90% vs 33%; P = .001) and OS (96% vs 33%; P < .001). Smoking history ≤10 pack-years conferred better 5-year DFS (88% vs 49%; P < .001) and OS (91% vs 59%; P < .001).

Conclusion

RT-based and surgery-based treatments produced similar outcomes. Patients with p16-positive disease with ≤10 pack-years of smoking history and limited nodal stage constitute a "low-risk" group in SCC of unknown primary similar to that in oropharyngeal cancer.

http://ift.tt/2zSnAWi

Value of double mucoperiosteal flaps to prevent restenosis in Draf IIb/III: first clinical report

Abstract

Exposed drilled bone in Draf IIb and III procedures promotes restenosis by inducing osteitis and neo-osteogenesis.

This reaction can be avoided by covering bone with local mucoperiosteal flap that optimize the healing process

In a series of 16 patients, a septoturbinal flap (STF) and lateral based nasoseptal flap (LNSF) are harvested to cover the posterior and anterior edge of the frontal cavity, respectively.

These flaps do not overlap and can be harvested from the same side.

Clinical feasibility of double mucoperiosteal flaps in Draf IIb and III was demonstrated with promising results in terms of frontal cavity restenosis prevention (93.75% success rate). A favorable healing process was noted with minimal crusting during the postoperative period.

http://ift.tt/2AXrEIA

Cross-sectional follow up of voice outcomes in children who have a history of airway reconstruction surgery

Abstract

Objectives

This study reports vocal function in a cross-section of children with subglottic stenosis. Each child had a history of laryngotracheal reconstruction and/or cricotracheal resection surgery. Vocal function was measured using laryngoscopy, acoustic analysis, perceptual evaluation and impact of voice on quality of life.

Design

All patients aged >5 years with history of laryngotracheal reconstruction and/or cricotracheal resection surgery at the Scottish National Complex Airways service were invited to participate.

Setting

Data was gathered in the Royal Hospital for Children in Glasgow in a single out-patient appointment.

Participants

Twelve out of fifty-six former patients (aged 5 – 27) provided a voice sample and eleven consented to awake laryngoscopy. All consented for detailed evaluation of their medical records.

Main outcome measures

Acoustic analysis of fundamental frequency and pitch perturbation was conducted on sustained vowel [a]. Perceptual evaluation was conducted by four trained listeners on a series of spoken sentences. Impact on quality of life was measured using the Paediatric Voice Related Quality of Life questionnaire. Laryngeal function was descriptively evaluated.

Results

Four children had normal voice acoustically, perceptually and in relation to voice related quality of life. One of these had vocal fold nodules unrelated to surgical history. Two other children had 'near normal' vocal function, defined where most voice measurements fell within the normal range.

Conclusions

Normal or 'near normal' voice is a possible outcome for children who have had this surgery. Where there is an ongoing complex medical condition, voice outcome may be poorer.

http://ift.tt/2iYX5LJ

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Τετάρτη 6 Δεκεμβρίου 2017

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