Granulomatous-Lymphocytic Interstitial Lung Disease in 22q11.2 Deletion Syndrome: a Case Report and Literature Review

Abstract

Purpose of Review

Granulomatous-lymphocytic interstitial lung disease (GLILD) has classically been associated with common variable immune deficiency (CVID), but is increasingly being reported in other immunodeficiencies. We describe the second reported case of GLILD in a patient with 22q11.2 deletion syndrome (22q11.2DS) and review the recent literature surrounding GLILD.

Recent Findings

GLILD is characterized by granulomata and lymphoproliferation. Consensus statements and retrospective and case-control studies have better elucidated the clinicopathological and radiographic manifestations of GLILD, allowing for its differentiation from similar conditions like sarcoidosis. Gaps of knowledge remain, however, particularly regarding optimal management strategies. Combination therapies targeting T and B cell populations have recently shown favorable results.

Summary

GLILD is associated with poorer outcomes in CVID. Its recognition as a rare complication of 22q11.2DS and other immunodeficiencies therefore has important therapeutic and prognostic implications. Additional research is needed to better understand the natural history and pathogenesis of GLILD and to develop evidence-based practice guidelines.

http://ift.tt/2FkmW7m

The Effect of Inhalant Organic Dust on Bone Health

Abstract

Purpose of Review

Agriculture remains a major economic sector globally, and workers experience high rates of chronic inflammatory lung and musculoskeletal diseases. Whereas obstructive pulmonary diseases are known risk factors for bone loss, the underlying relationship between lung inflammation and bone health is not well known.

Recent Findings

An agriculture organic dust extract inhalation animal model has recently linked lung injury-induced inflammation to systemic bone loss. This process is dependent upon lipopolysaccharide and the toll-like receptor 4 (TLR4) signaling pathway. Downstream systemic interleukin-6 is a key mediator that subsequently activates osteoclastogenesis. Age is a host factor that impacted bone disease with younger mice demonstrating increased susceptibility to bone loss following inhalant exposures as compared to older mice. Supplemental dietary vitamin D was shown to prevent organic dust-induced bone loss, but not lung disease, in animals.

Summary

Recent animal studies provide new mechanistic insight into the lung-bone inflammatory axis. Host factors, diet, and lipopolysaccharide/TLR4 signaling pathways play a significant role in explaining how inhalant organic dust exposures impact bone health. These investigations might lead to specific targeted therapeutic approaches.

http://ift.tt/2GztiiI

Current Status of Potential Therapies for IgE-Mediated Food Allergy

Abstract

Purpose of Review

The goal of this review is to provide the reader with an updated summary of published trial data regarding the use of oral immunotherapy (OIT), sublingual immunotherapy (SLIT), and epicutaneous immunotherapy (EPIT) for treatment of IgE-mediated food allergies.

Recent Findings

Data from phase 2 trials for treatment of peanut allergy with OIT and EPIT reveal an increase in the threshold of reactivity for peanut-allergic children. Compared to EPIT, OIT promotes a greater increase in the threshold of reactivity; however, adverse events are more common with OIT.

Summary

OIT, EPIT, and SLIT appear to modulate the immune response for some food-allergic individuals. Data regarding utility for treatment of food allergies regardless of modality is limited to few foods, as is investigation into treatment of food-allergic infants, young children, and adults. Future trials are likely to focus on young children, food allergies other than peanut, and treatment of multifood-allergic individuals.

http://ift.tt/2FoinZW

Diagnostic Tools for Inborn Errors of Human Immunity (Primary Immunodeficiencies and Immune Dysregulatory Diseases)

Abstract

Purpose of Review

The purpose of this review is to provide an overview of diagnostic testing in primary immunodeficiency and immune dysregulatory disorders (PIDDs), particularly focusing on flow cytometry and genetic techniques, utilizing specific examples of PIDDs.

Recent Findings

Flow cytometry remains a vital tool in the diagnosis and monitoring of immunological diseases. Its utility ranges from cellular analysis and specific protein quantitation to functional assays and signaling pathway analysis. Mass cytometry combines flow cytometry and mass spectrometry to dramatically increase the throughput of multivariate single-cell analysis. Next-generation sequencing in combination with other molecular techniques and processing algorithms has become more widely available and identified the diverse and heterogeneous genetic underpinnings of these disorders.

Summary

As the spectrum of disease is further clarified by increasing immunological, genetic, and epigenetic knowledge, the careful application of these diagnostic tools and bioinformatics will assist not only in our understanding of these complex disorders, but also enable the implementation of personalized therapeutic approaches for disease management.

http://ift.tt/2GzskTx

Indoor Environmental Interventions and their Effect on Asthma Outcomes

Abstract

Purpose of Review

The use of environmental interventions to improve outcomes in asthmatics has long been an elusive goal. While numerous interventions have been studied, the results of clinical trials have been mixed. This review aims to identify combinations of interventions that have been proven to be effective and to propose a model for using them in a clinical setting.

Recent Findings

An NIH workshop emphasized a need for research to identify effective interventions for reducing indoor exposures and improving asthma outcomes. A number of innovative measures were described, though evidence supporting their use was lacking. A recent systematic review described various interventions for which evidence is available. The greatest challenge for this approach is the same as that for the medical approach to treatment: nonadherence.

Summary

Given evidence for effective interventions, control of environmental exposures should lead to improved asthma outcomes. Methods to improve adherence need to be identified.

http://ift.tt/2FmtfHE

Impact of Particulate Air Pollution on Cardiovascular Health

Abstract

Purpose of Review

Air pollution is established as an independent risk factor for cardiovascular diseases (CVDs). Ambient particulate matter (PM), a principal component of air pollutant, has been considered as a main culprit of the adverse effects of air pollution on human health.

Recent Findings

Extensive epidemiological and toxicological studies have demonstrated particulate air pollution is positively associated with the development of CVDs. Short-term PM exposure can trigger acute cardiovascular events while long-term exposure over years augments cardiovascular risk to an even greater extent and can reduce life expectancy by a few years. Inhalation of PM affects heart rate variability, blood pressure, vascular tone, blood coagulability, and the progression of atherosclerosis. The potential molecular mechanisms of PM-caused CVDs include direct toxicity to the cardiovascular system or indirect injury by inducing systemic inflammation and oxidative stress in circulation.

Summary

This review mainly focuses on the acute and chronic effects of ambient PM exposure on the development of cardiovascular diseases and the possible mechanisms for PM-induced increases in cardiovascular morbidity and mortality. Additionally, we summarized some appropriate interventions to attenuate PM air pollution-induced cardiovascular adverse effects, which may promote great benefits to public health.

http://ift.tt/2GymRwm

Sequential injection of radioactive nanosized colloids followed by indocyanine green for sentinel lymph node detection in oral squamous cell carcinoma: A proof of concept

Publication date: Available online 21 February 2018
Source:Oral Oncology
Author(s): Antoine Digonnet, Romain Barbieux, Marie Quiriny, Esther Willemse, Michel Moreau, Nicolas de Saint Aubain, Matteo Cappello, Pierre Bourgeois




http://ift.tt/2Cbdzbn

Phase II Trial of Carboplatin, 5-FU and Cetuximab in Elderly Fit (no Frailty) Patients With Recurrent/Metastatic HNSCC

Condition:   Metastatic or Recurrent Head and Neck Squamous Cell Cancer
Intervention:   Drug: Carbo, 5FU, Cetuximab
Sponsors:   Groupe Oncologie Radiotherapie Tete et Cou;   Gustave Roussy, Cancer Campus, Grand Paris
Recruiting

http://ift.tt/2FlaIvo

Response to comment: Eustachian tube diameter: Is it associated with chronic otitis media development?

Publication date: Available online 3 February 2018
Source:American Journal of Otolaryngology
Author(s): Ceki Paltura, Tuba Selçuk Can, Behice Kaniye Yılmaz, Mehmet Emre Dinç, Ömer Necati Develioğlu, Mehmet Külekçi




http://ift.tt/2ooLHHq

Salvage of recurrence after surgery and adjuvant therapy: A systematic review

Publication date: Available online 2 February 2018
Source:American Journal of Otolaryngology
Author(s): Joseph Zenga, Jennifer Gross, Susan Fowler, Jenny Chen, Peter Vila, Jeremy D. Richmon, Mark A. Varvares, Patrik Pipkorn
PurposeTo determine the oncologic and functional outcomes of patients undergoing salvage surgery for recurrent head and neck squamous cell carcinoma after initial management with surgery and adjuvant therapy.Data sourcesOvid Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, Cochrane Database of Systematic Reviews, and Clinicaltrials.gov.Review methodsA structured search was performed of the literature to identify studies that included patients undergoing surgical salvage for local, regional, or locoregional recurrent head and neck squamous cell carcinoma without known distant metastases who had been treated with initial surgery and post-operative adjuvant radio- or chemoradiotherapy. Studies were excluded if they did not report at least 1-year survival estimates, included patients who underwent primary non-surgical management, or included those treated with non-surgical salvage therapies or supportive care alone.ResultsThe search strategy yielded 3746 abstracts. After applying exclusion and inclusion criteria, 126 full-texts were reviewed and six studies were included with a total of 222 patients. All studies were retrospective in design and included diverse disease subsites and stages. Complications and functional outcomes were inconsistently reported. Five-year survival estimates ranged between 10% and 40% between studies.ConclusionsPatients undergoing salvage surgery for recurrent head and neck squamous cell carcinoma after initial surgery and adjuvant therapy may have a particularly poor prognosis. Future studies are needed to determine functional and quality of life outcomes in this patient population and to identify specific prognostic factors for re-recurrence and survival.



http://ift.tt/2EIhi1Q

A rare primary leiomyosarcoma of the parotid gland: A case report and literature review

Publication date: Available online 1 February 2018
Source:American Journal of Otolaryngology
Author(s): Lauren E. Yue, Muhammad Qazi, Kimberly Kiplagat, Fred M. Baik, Azita Khorsandi, Margaret Brandwein-Weber, Mark Urken
BackgroundLeiomyosarcoma of the head and neck region is very rare. Primary parotid leiomyosarcoma has only been reported nine times in the medical literature.MethodsA 68-year-old female presented with a left facial mass. Physical examination revealed a firm immobile mass at the level of the left parotid tail. No facial nerve dysfunction or palpable adenopathy was noted at the time of presentation. This patient underwent a superficial parotidectomy with a facial nerve dissection and left selective neck dissection.ResultsPathologic findings revealed a sarcoma of intermediate to high-grade, composed of spindle cells with herringbone pattern, eosinophilic fibrillary cytoplasm, and focal granularity. Immunohistochemistry was positive for vimentin and smooth muscle actin and negative for desmin, S100 and CD34. The findings are consistent with a leiomyosarcoma. Following complete surgical resection, adjuvant radiation therapy was administered.ConclusionPrimary sarcomas of the parotid gland, specifically parotid leiomyosarcomas, are extremely rare. Based on this patient's tumor size, grade and resectability, this case met the criteria for a primary leiomyosarcoma. We present only the tenth case of a primary parotid leiomyosarcoma to be reported in the English literature.



http://ift.tt/2ony633

Systematic review of hearing loss after traumatic brain injury without associated temporal bone fracture

Publication date: Available online 1 February 2018
Source:American Journal of Otolaryngology
Author(s): Jenny X. Chen, Michael Lindeborg, Seth D. Herman, Reuven Ishai, Renata Knolls, Aaron Remenschneider, David Jung, Elliott D. Kozin
ObjectiveWhile hearing loss following temporal bone fracture is a well-described phenomenon, few data exist on auditory dysfunction in patients with traumatic brain injury (TBI) without temporal bone fracture. Herein, we aim to systematically review hearing loss after TBI without bony fracture and describe its etiologies.Data sourcesPubmed, Embase, Cochrane databases.Review methodsA systematic review of the literature from 1966 to January 2017 was performed using Preferred Reporting Items for Systematic Reviews and Meta-analyses recommendations. Data were obtained from studies that investigated hearing loss in TBI without skull fracture according to an a priori protocol with inclusion and exclusion criteria. Variables included type and severity of hearing loss, as well as pathophysiology of hearing loss.ResultsThere were 13 studies with 773 patients that met study criteria. Overall, there was one prospective cohort study, four retrospective cohort studies, two case-control studies, and six case reports. The studies with the highest level of evidence report a change in hearing of at least 10–15 dB across a range of frequencies in as many as 58% percent of TBI patients without bony fracture, which was transient or chronic. The mechanism/severity of injury may impact the rate of hearing loss.ConclusionsHearing loss after TBI in the absence of bony injury appears to be a clinically significant but poorly characterized phenomenon.



http://ift.tt/2EIND8B

Anatomical anomalies of the Eustachian tube and chronic otitis media

Publication date: Available online 1 February 2018
Source:American Journal of Otolaryngology
Author(s): Zhengcai Lou, Zihan Lou




http://ift.tt/2BH5Rol

Prognostic significance of HPV status in the re-irradiation of recurrent and second primary cancers of the head and neck

Publication date: Available online 7 February 2018
Source:American Journal of Otolaryngology
Author(s): Maria A. Velez, Pin-Chieh Wang, Sophia Hsu, Robert Chin, Philip Beron, Elliot Abemayor, Maie St. John, Allen M. Chen
PurposeTo evaluate the prognostic significance of human papillomavirus (HPV) status among patients treated by salvage radiation therapy for local-regional recurrences and second primary cancers of the head and neck arising in a previously irradiated field.Methods and materialsThe medical records of 54 consecutive patients who underwent re-irradiation for squamous cell carcinoma of the head and neck occurring in a previously irradiated field were reviewed. Only patients with biopsy-proven evidence of recurrent disease that had previously been treated with doses of radiation therapy of at least 60 Gy were included. Determination of HPV status at the time of recurrence was performed by p16 immunohistochemistry. The median age at re-irradiation was 58.5 years (range, 27.9 to 81.5 years). Thirty patients (55.5%) were lifelong never-smokers. The Kaplan Meier method was used to calculate overall survival, progression-free survival, and local-regional control, and distant metastasis-free survival with comparisons between groups performed using the log-rank test.ResultsHPV status among tumors that were re-irradiated was as follows: 16 positive (29.7%); 7 negative (12.9%); 31 unknown (57.4%). The median overall survival in the entire cohort was 11.7 months (range, 8 to 27 months), with the 1-year and 2-year estimates of overall survival being 47.2% and 38.4%, respectively. A statistical trend was identified favoring patients with HPV-positive cancers with respect to the endpoints of overall survival (p = 0.06) and progression-free survival (p = 0.08) after re-irradiation when compared to the HPV-negative/unknown population. There was no significant difference in distant control between the two cohorts (p = 0.40).ConclusionsThe favorable prognostic significance of HPV seemingly extends to patients treated by re-irradiation suggesting that this biomarker may be useful in risk stratification in this setting.



http://ift.tt/2EKhSw5

Surgical indications or inclusion/exclusion criteria of explorative tympanotomy on sudden sensorineural hearing

Publication date: Available online 1 February 2018
Source:American Journal of Otolaryngology
Author(s): Zhengcai Lou, Zihan Lou




http://ift.tt/2ooTNjg

Tonsillectomy sparing transoral robot assisted styloidectomy

Publication date: Available online 31 January 2018
Source:American Journal of Otolaryngology
Author(s): Sameep Kadakia, Ameya Jategaonkar, Ansley Roche, Raymond L. Chai
Eagle Syndrome can present with a variety of symptoms and be caused by an elongated styloid process or calcified stylohyoid ligament. Patients failing medical management of this disorder may be treated with surgical excision of the styloid process. In the literature, transoral and transcervical approach have both been described. Although transoral approaches typically begin with a tonsillectomy, tonsil-sparing approaches have also been utilized. With the advent of robotic surgery, the potential for a tonsillectomy sparing approach has become a feasible alternative, preventing the pain and morbidity associated with adult tonsillectomy while continuing to provide superior exposure and instrumentation. We report three successful cases of patients treated with tonsillectomy sparing transoral robot assisted styloidectomy. This represents the first application of this technique in the literature and suggests the potential for a paradigm shift in the surgical management of this disease.



http://ift.tt/2EINCBz

Preoperative laboratory data are associated with complications and surgical site infection in composite head and neck surgical resections

Publication date: Available online 31 January 2018
Source:American Journal of Otolaryngology
Author(s): Nicholas B. Abt, Rosh K. Sethi, Sidharth V. Puram, Mark A. Varvares
Objectives1) Describe normal/abnormal preoperative laboratory testing incidence in head and neck (H&N) composite resections and 2) determine complication, surgical site infection (SSI), and transfusion predictors by laboratory test.MethodsThe 2006 to 2013 NSQIP databases were queried for H&N composite resections. Laboratory data was categorized within, under, or above the normal reference range according to NSQIP definitions. Overall complications and SSI were analyzed with multivariable logistic regression analysis.ResultsFrom 2006 to 2013, there were 1193H&N composite resections, of which 1135 (95.1%) underwent ≥1 preoperative laboratory test. Complete blood counts were obtained in 92.3%, basic metabolic panels in 90.7%, coagulation studies in 56.2%, and liver function tests (LFTs) in 52.6%. Low sodium was found in 11.5%, increasing complication odds by 2.30 (p = 0.005). High AST comprised 10.0% and increased complication odds (OR = 2.93, p = 0.012). Additionally, 9.2% had a high white blood cell (WBC) count and 3.5% had high platelets, increasing complications by 1.92 (p = 0.030) and 3.13 (p = 0.015), respectively. BUN, creatinine, total bilirubin, albumin, alkaline phosphatase, INR, PT, and aPTT abnormal values did not affect postoperative complications. Increased SSI odds were appreciated with low sodium (OR: 2.83, p = 0.002), high AST (OR: 6.85, p < 0.001), and high alkaline phosphatase (OR: 5.46, p = 0.007). Importantly, INR had no effect on transfusion rates. High PT, aPTT, or low platelets did not change transfusion odds.ConclusionInflammatory markers are associated with complications but not SSI. High LFTs and low sodium are associated with complications and SSI. Coagulopathies did not increase transfusion rates. These findings identify laboratory studies to focus on during H&N resection preoperative assessments.



http://ift.tt/2onPuVF

Simple laryngeal suspension procedure by suturing the digastric muscle to the periosteum of the mandible in neck dissection for tongue cancer

Publication date: Available online 31 January 2018
Source:American Journal of Otolaryngology
Author(s): Akira Ohkoshi, Takenori Ogawa, Shun Sagai, Ayako Nakanome, Kenjiro Higashi, Ryo Ishii, Kengo Kato, Yukio Katori
PurposeIn this article, a simple, new laryngeal suspension procedure is described. The effect of hyoid bone suspension by suturing the digastric muscle to the periosteum of the mandible is analyzed.Materials and methodsTo elucidate the effect of hyoid bone suspension, CT scans of 26 patients who underwent ipsilateral neck dissection with primary resection of tongue cancer were retrospectively reviewed, and the distance between the hyoid bone and the mandible was measured on the operated and unoperated sides of the neck. A total of 14 patients who underwent suturing of the digastric muscle to the mandible (digastric muscle-sutured group) and the 12 patients who did not (control group) were compared.ResultsIn the digastric muscle-sutured group, the average distance between the hyoid bone and the mandible was significantly smaller on the operated side (17.8 ± 0.57 mm) than on the unoperated side (19.8 ± 0.93 mm; p < 0.05). In the control group, there was no significant difference between the operated side (21.0 ± 1.42 mm) and the unoperated side (19.7 ± 1.39 mm). The difference in the distance between the operated and unoperated sides was significantly larger in the digastric muscle-sutured group (1.97 ± 0.79 mm) than in the control group (−1.32 ± 0.61; p < 0.05).ConclusionsIt was shown for the first time that suturing of the digastric muscle to the periosteum of the mandible in neck dissection with primary resection of tongue cancer resulted in hyoid bone suspension. This simple procedure can be useful for laryngeal suspension.



http://ift.tt/2GzeUXV

The treatment of vocal process granuloma

Publication date: Available online 31 January 2018
Source:American Journal of Otolaryngology
Author(s): Zhengcai-LouZihan-Lou




http://ift.tt/2FjS2vU

Thirty-day readmissions following parathyroidectomy: Evidence from the National Readmissions Database, 2013–2014

Publication date: Available online 10 January 2018
Source:American Journal of Otolaryngology
Author(s): Adam M. Kravietz, Jessica L. Buicko, Joshua P. Parreco, Michael A. Lopez, Robert A. Kozol
PurposeParathyroidectomy is one of the most common procedures performed in the United States, and are increasingly being performed safely in the outpatient setting. However, complications from surgery can be life-threatening, and thus an understanding of who may be at risk is essential. We analyzed and compared the risk factors for patients readmitted within 30 days following inpatient parathyroidectomy for primary or secondary hyperparathyroidism.Materials and methodsWe reviewed the National Readmissions Database from 2013 to 2014 for patients who received inpatient parathyroidectomy for primary or secondary hyperparathyroidism. The primary outcome was non-elective readmission within 30 days. Multivariate logistic regression was used to analyze risk factor odds ratios for readmission.Results7171 patients underwent inpatient parathyroidectomies in 2013 and 2014. 59.89% of parathyroidectomies were performed for primary hyperparathyroidism, with a 5.6% readmission rate. Most common causes of readmission were septicemia (13.69%), hypocalcemia (12.86%), heart failure (10.79%) and renal failure (9.54%). Having Medicare (OR: 1.71, CI:1.14–2.59, p = .01), Medicaid (OR: 3.24, CI: 2.03–5.17, p < .001), and self-paying (OR: 2.43, CI: 1.11–5.32, p = .02), were associated with increased odds of readmission for those with primary hyperparathyroidism. 21.99% of parathyroidectomies were performed for secondary hyperparathyroidism, with a 19.4% readmission rate. Most common causes of readmission were hypocalcemia (22.88%), hungry bone syndrome (14.38%), electrolyte disorders (13.73%), and renal failure (11.11%).ConclusionPatients with secondary hyperparathyroidism are older, poorer and have more comorbidities than patients with primary hyperparathyroidism, and are more likely to be readmitted within 30 days of parathyroidectomy.



http://ift.tt/2GzeLDR

Paediatric Autoimmune Neuropsychiatric Disorder Associated with Group A Beta-Haemolytic Streptococcal Infection: An Indication for Tonsillectomy? A Review of the Literature

Background. Paediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection (PANDAS) is the acute onset of neuropsychiatric symptoms following group A beta-haemolytic streptococcal infection. The aetiology remains elusive. However, with group A streptococcus being the most common bacterial cause of tonsillitis, surgical intervention in the form of tonsillectomy has often been considered as a potential therapy. Methods. A MEDLINE® search was undertaken using keywords "PANDAS" or "paediatric autoimmune neuropsychiatric disorders associated with streptococcus" combined with "tonsillectomy". Results. Six case reports and 3 case series met the inclusion criteria. Demesh et al. (case series) reported a dramatic reduction in neuropsychiatric symptom severity in the patient cohort undergoing tonsillectomy. Two case series suggest that there is no association between tonsillectomy and resolution of PANDAS. Conclusion. Due to the lack of uniform data and sporadic reports, tonsillectomy should be carefully adopted for the treatment of this disorder. In particular, tonsillectomies/adenoidectomies to alleviate neuropsychiatric symptoms should be avoided until more definitive evidence is at our disposal. This review highlights the importance of a potential collaborative prospective study.

http://ift.tt/2oic2YJ

Cribriform plate width is highly variable within and between subjects

Publication date: Available online 13 February 2018
Source:Auris Nasus Larynx
Author(s): Daniel H. Coelho, Taylor S. Pence, Mostafa Abdel-Hamid, Richard M. Costanzo
ObjectiveAll successful endonasal surgery, including functional endoscopic sinus surgery (FESS), depends on knowledge of both anatomy and the specific variations that can occur between and within patients. Familiarity with these structures is a critical component in preventing complications from these procedures, and failure to understand subtle variation can have disastrous results. The aim of this study was to characterize the anatomical variations (if any) of the cribriform plate using a large cadaveric sample set. Better understanding of the disparities within and between patients may have important implications for surgical planning.MethodsWhole human skull specimens (31 specimens, 62 sides) were examined to obtain dimensional measurements of the cribriform plate on the right and left sides.ResultsThe average length of the cribriform plate was 21.28mm (range 15.25–27.73mm, SD 3.30mm). The average width of the cribriform plate (including the crista galli) was 4.53mm (range 1.75–8.03mm, SD 1.20mm). When comparing side differences in individual specimens, there was more variability between widths, relative standard deviation 26.4%, than between lengths, relative standard deviation 15.5%.ConclusionThere is a range of both length and width of the cribriform plate, between and within individuals. This is particularly true for width. In practice, this emphasizes the importance of pre-operative imaging and recognition of anatomic variability for sinus or anterior skull base procedure.



http://ift.tt/2oohcl5

Treatment of pediatric esthesioneuroblastoma with smell preservation

Publication date: Available online 21 February 2018
Source:Auris Nasus Larynx
Author(s): Giandomenico Maggiore, Maria Silvia Lazio, Oreste Gallo
Olfactory neuroblastoma is a rare malignant tumor of neuroectodermal origin and represents the most common cancer of the nasal cavity in pediatric age. The gold standard of treatment consists of en bloc resection, numerous studies have shown as the endoscopic approaches permit good control of the disease improving the quality of life after the treatment. Herein we describe the case of a 13-year-old patient referred to our outpatient clinic with a polypoid multi-lobed lesion occupying the left nasal cavity and imaging that confirmed a left-sided nasal mass without cribriform plate involvement (Kadish B). We performed an unilateral endoscopic resection with transnasal craniectomy and anterior skull base reconstruction with a flap from the contralateral nasal septum based on the septal branches of the anterior and posterior ethmoidal arteries (Septal Flip Flap, SFF), that provided a faster healing process with reduction of nasal crusting, improvement in the quality of life of patient in the postoperative period and the preservation of the contralateral olfactory bulb that has allowed to save the smell. This treatment strategy of pediatric esthesioneuroblastoma was analyzed in the context of the current literature.



http://ift.tt/2CcnVHU

Combined transoral–transhyoid endoscopic approach for hypopharyngeal cancer

Publication date: Available online 3 February 2018
Source:Auris Nasus Larynx
Author(s): Keigo Honda, Makoto Miura, Yasuyuki Hayashi, Toshiya Kimura
Endoscopic transoral surgery for hypopharyngeal cancer is an effective treatment option to avoid invasive open surgery or chemoradiation. Here we describe the case of a 66-year-old patient with cT2N0M0 pyriform sinus cancer whom we treated using a transoral–transhyoid endoscopic approach. Using this approach, a transhyoid route was created in addition to the transoral route and used to extirpate the tumor. En bloc resection of the tumor was completed without difficulty. A combined transoral–transhyoid approach is a useful surgical option for treatment of selected patients with hypopharyngeal cancer. This technique is straightforward to perform and can be used as a backup technique in endoscopic transoral surgery. Also, more complicated lesions can be resected by this approach than by a single-route transoral approach.



http://ift.tt/2BFZwJY

Editorial Board

Publication date: April 2018
Source:Auris Nasus Larynx, Volume 45, Issue 2





http://ift.tt/2ELxsYx

Usefulness of reconstructed 3D images for cochlear implantation in a case with a facial nerve anomaly

Publication date: Available online 14 February 2018
Source:Auris Nasus Larynx
Author(s): Kenichi Nakamura, Mari Shimada Dias, Toru Sasaki, Hisashi Sugimoto, Miyako Hatano, Makoto Ito
Facial nerve anomalies are a potential problem in patients with cochleovestibular malformations. A case of cochlear implant (CI) surgery in the presence of intra-temporalbone facial nerve bifurcation is presented. During the first surgery, the facial nerve bifurcation obscured the promontory and round window. It was difficult to perform cochleostomy because of the lack of landmarks of the basal turn of the cochlea, and the first surgical attempt at cochleostomy was abandoned. A repeat CT scan was performed after the first surgery with reconstructed 3D images of the temporal bone and the cochlea, and then the cochlea was successfully opened at revision surgery. Reconstructed 3D CT images were very useful to identify the site of cochleostomy in this case with such difficult temporal bone anatomy.



http://ift.tt/2ooKTlQ

Topical therapy for refractory rhinosinusitis caused by methicillin-resistant Staphylococcus aureus: First report in a prospective series

Publication date: Available online 6 February 2018
Source:Auris Nasus Larynx
Author(s): Alan H. Shikani, Nadim Khoueir, Mary Ann Jabra-Rizk, Henry J. Shikani, Randall J. Basaraba, Jeff G. Leid
ObjectiveThe incidence of refractory chronic rhinosinusitis (CRS) associated with methicillin-resistant Staphylococcus aureus (MRSA) is rising and remains a therapeutic challenge. The goal of this study is to demonstrate the efficacy of a non-invasive topical therapy against MRSA in these patients.MethodsSeventeen patients with refractory CRS caused by MRSA were treated with a topical therapy protocol. Treatment consisted of weekly endoscopic sinus debridement followed by intra-sinus installation of a hydroxyl-ethylcellulose gel that releases mometasone and a culture-directed antibiotic for a period of 6 weeks, along with daily nasal nebulization of mometasone with the same antibiotic and saline rinses. Clinical outcome was assessed using the Lund–Kennedy (LK) symptom and endoscopic appearance scores. Sinus mucosal tissue was homogenized and cultured, and microbial biofilm burden was assessed based on colony forming units (CFUs) counts.ResultsRhinotopic therapy resulted in clearance of MRSA in 13 of 16 patients (81.2%). Treated patients also demonstrated significant improvement clinically as measured by the LK scores. In addition, a significant decrease in mucosal CFUs was observed post-therapy.ConclusionOur findings demonstrate that topical therapy is an effective method for treating MRSA-associated refractory CRS.



http://ift.tt/2EK6kcd

Environmental factors associated with allergic rhinitis symptoms in Japanese university students: A cross-sectional study

Publication date: Available online 21 February 2018
Source:Auris Nasus Larynx
Author(s): Hironobu Nishijima, Sayaka Suzuki, Kenji Kondo, Tatsuya Yamasoba, Shintaro Yanagimoto
ObjectiveNumerous studies have reported that various environmental factors during early life are key determinants for developing allergic disease. Herein, we aimed to investigate the impact of environmental factors on allergic rhinitis.MethodsThis cross-sectional study was conducted in a single university in Japan (from April to June, in 2015 and 2016). Students voluntarily answered online questionnaires regarding their allergic rhinitis symptoms and their exposure to various environmental factors during preschool-age.ResultsOverall, 3075 students participated the questionnaire. After excluding those with incomplete datasets, 3016 students were eligible. Of these, 49% had allergic rhinitis symptoms. Female sex was associated with a lower risk of allergic rhinitis symptoms (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.68–0.99). Comorbidity of asthma or atopic dermatitis and a family history of allergy (asthma, atopic dermatitis, or allergic rhinitis) were associated with higher risks of allergic rhinitis symptoms. Regarding the number of household members, compared with subjects with <3 people, those with 5 (OR, 0.74; 95% CI, 0.57–0.97) and ≥6 people (OR, 0.66; 95% CI, 0.49–0.88) in their household showed lower incidences of allergic rhinitis symptoms. No other environmental factors, including birth order, number of siblings, living environment, passive smoking, furry pet ownership, housing, bedding, breastfeeding, dairy product intake, preschool setting, and starting age of preschool, was associated with the incidence of allergic rhinitis symptoms.ConclusionSex, current asthma and atopic dermatitis symptoms, family history of allergies, and the number of people in the household at preschool-age were associated with the incidence of allergic rhinitis symptoms.



http://ift.tt/2oohb0v

Factors affecting the outcome of adenoidectomy in children treated for chronic otitis media with effusion

Publication date: Available online 14 February 2018
Source:Auris Nasus Larynx
Author(s): Sarantis Blioskas, Petros Karkos, George Psillas, Stamatia Dova, Marios Stavrakas, Konstantinos Markou
ObjectiveThe aim of this cohort was to determine potential risk factors, concerning the effectiveness of adenoidectomy in the treatment of chronic otitis media with effusion in children.MethodsNinety six children with chronic otitis media with effusion treated with adenoidectomy were enrolled in this study. A thorough medical history was taken, including family history of otologic disease, parental smoking habits and breast feeding history. Radiographic palatal airway size was measured preoperatively, whereas the presence of allergy was also investigated. All patients were, postoperatively, followed up for a period of two years, in three month intervals. Disease course was classified as "complete remission", "improvement" or "consistence", in every postoperative evaluation, according to strictly established criteria.ResultsChildren's age proved to be a significant factor in the postoperative outcome of adenoidectomy, as a treatment of chronic otitis media with effusion, especially when comparing patients being over and under the fifth year of age. Also, the presence of allergy, family history of otologic disease and palatal airway size, all proved to influence postoperative outcome in a statistical significant way (p<0.05). On the other hand, child's sex, passive smoking, breast feeding and previous acute otitis media infections did not seem to alter the efficacy of adenoidectomy.ConclusionAdenoidectomy remains a cornerstone in the treatment of chronic otitis media with effusion in children. Results document that young age, presence of allergy predisposition, otologic family history and small palatal airway can be important drawbacks and should be intensively sought for and taken into account, during treatment planning.



http://ift.tt/2Cc1djb

The gray scale value of ear tissues undergoing volume-rendering high-resolution cone-beam computed tomography

Publication date: Available online 7 February 2018
Source:Auris Nasus Larynx
Author(s): Masahiro Komori, Shinya Miuchi, Jun Hyodo, Taisuke Kobayashi, Masamitsu Hyodo
ObjectiveWhen the thresholds for VR reconstruction from multi-slice CT images are changed, problems develop when assessing pathologies in the absence of standardized thresholds. The advantages of CBCT include lower radiation exposure compared with other techniques and better visualization of small ear structures. However, a disadvantage is that the scanner provides unstandardized gray scale values, thus not CT numbers (Hounsfield units, HU).MethodsWe analyzed 88 sets of volume data obtained from temporal bones. The gray scale values were measured in aerated areas (two sites), along the ossicular chain (four sites) and in a bone area (one site) in the external and middle ears, and in soft tissue areas (five sites) and bone areas (two sites) in the inner ear.ResultsThe standard male and female gray scale values were 2448–2970 and 2585–3091 for the aerated areas, 3248–4945 and 3359–5223 for the ossicular chains, 3368–4109 and 3371–4147 for soft tissues, and 4790–5776 and 5044–5959 for bone, respectively. Sex significantly affected the values (p<0.05). Significant differences between aerated areas and ossicular chains, and between soft tissues and bone, were evident (all p<0.0001).ConclusionVolume-rendering (VR) images obtained by cone-beam computed tomography (CBCT) can be standardized simply by using fixed thresholds.



http://ift.tt/2oobgsl

Prognostic value of the blink reflex test in Bell’s palsy and Ramsay-Hunt syndrome

Publication date: Available online 3 February 2018
Source:Auris Nasus Larynx
Author(s): Young Min Hah, Sang Hoon Kim, Junyang Jung, Sung Su Kim, Jae Yong Byun, Moon Suh Park, Seung Geun Yeo
ObjectiveThis study was designed to evaluate the prognostic value of the blink reflex (BR) test in patients with Bell's palsy (BP) or Ramsay Hunt syndrome (RHS).MethodsThe House–Brackmann (HB) grade of patients diagnosed with BP and RHS was determined at first visit and 3 months later. Final HB grade III–VI was defined as an incomplete recovery. Factors evaluated as prognostic of poor recovery included electroneurography (ENoG) degeneration rate (DR)>90%, and absence of BR. Rates of complete and incomplete recovery were calculated and the associations between prognostic factors and recovery were determined.ResultsOf the 129 included patients, 98 (76%) had BP and 31 (24%) had RHS. Absence of BR and low mean ENoG value were significantly associated with incomplete recovery in both the BP and RHS groups (p<0.05 each). Initial HB grade V–VI was significantly associated with rate of incomplete recovery in patients with RHS (p<0.05 each). Severe residual palsy (final HB grade V–VI) in the absence of BR was significantly more frequent in patients with RHS than with BP (p<0.05).ConclusionBR test results were a good prognostic indicator in patients with BP and RHS, as were ENoG value. Absence of BR was more frequently associated with severe residual palsy in RHS than in BP.



http://ift.tt/2Cco5z0

Editorial Board

Publication date: February 2018
Source:Auris Nasus Larynx, Volume 45, Issue 1





http://ift.tt/2ooKQqa

Three-Dimensional Printed Facial Models in Rhinoplasty

Facial plast Surg
DOI: 10.1055/s-0038-1632398

Digital patient photography and morphing software have become an important part of rhinoplasty over the past few decades. Presented is a novel technology incorporating 3D photography and printing to produce life-size models for use in patient evaluation and treatment. Surveys were conducted to assess patient response and were universally positive. Early surgeon experience also indicates benefit for intraoperative use. Three-dimensional printing and modeling is a new technology that has exciting applications for rhinoplasty and facial plastic surgery.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

http://ift.tt/2ETT8AR

Facial Asymmetry: Brow and Ear Position

Facial plast Surg
DOI: 10.1055/s-0038-1636903

The purpose of the current study was to analyze brow and ear position, and examine the relationship between these structures in patients presenting for blepharoplasty evaluation. A retrospective chart review was performed, which included all patients presenting to one oculoplastic physician for a blepharoplasty evaluation from November, 2012 to March, 2014. The prevalence of brow ptosis and brow and ear asymmetry was calculated; the proportional distribution was determined, and chi-square analysis and the z-test of proportions were used to calculate the significance. Institutional Review Board approval was obtained for this study. A total of 133 patients met the inclusion criteria. Some degree of brow ptosis was noted in 83% of patients. Brow asymmetry was found in 88% of patients, and ear asymmetry in 77%. Of those patients who had asymmetry, 61% had the right brow lower and 75% had the right ear lower; 73% of all patients had the brow and ear lower on the same side (p < 0.001). In this study, brow ptosis and asymmetry were quite common. In addition, the side of the lower brow correlated strongly with the side of the lower ear, and the right side structures were lower more often than the left. Patients presenting for blepharoplasty evaluation may have an element of generalized facial asymmetry which includes the brows and ears. These observations can be important for preoperative planning and patient counseling.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

http://ift.tt/2sJNht1

Antitumor in situ vaccination effect of TNFα and IL-12 plasmid DNA electrotransfer in a murine melanoma model

Abstract

Gene electrotransfer (GET) is one of the most efficient non-viral gene therapy approaches for the localized transfer of multiple genes into tumors in vivo; therefore, it is especially promising for delivering different cytokines that are toxic if administered systemically. In this study, we used concomitant intratumoral GET of two cytokines: tumor necrosis factor alpha (TNFα), a potent cytotoxic cytokine to induce in situ vaccination, and interleukin 12 (IL-12), an immunostimulatory cytokine to boost the primed local immune response into a systemic one. After performing GET in murine melanoma tumors, both TNFα and IL-12 mRNA levels were significantly increased, which resulted in a pronounced delay in tumor growth of 27 days and a prolonged survival time of mice. An antitumor immune response was confirmed by extensive infiltration of immune cells in the tumor site, and expansion of the effector immune cells in the sentinel lymph nodes. Furthermore, the effect of in situ vaccination was indicated by the presence of vitiligo localized to the treatment area and resistance of the mice to secondary challenge with tumor cells. Intratumoral GET of two cytokines, one for in situ vaccination and one for an immune boost, proved feasible and effective in eliciting a potent and durable antitumor response; therefore, further studies of this approach are warranted.

http://ift.tt/2Fm3bwq

The BCR-ABL inhibitor nilotinib influences phenotype and function of monocyte-derived human dendritic cells

Abstract

In chronic myeloid leukemia (CML), the translocation t(9;22) results in the fusion protein BCR-ABL (breakpoint cluster region-abelson murine leukemia), a tyrosine kinase mediating oncogenic signaling which is successfully targeted by treatment with BCR-ABL inhibitors like imatinib. However, BCR-ABL inhibitors may also affect antitumor immunity. For instance, it was reported that imatinib impairs the function of dendritic cells (DCs) that play a central role in initiating and sustaining T cell responses. Meanwhile, second generation BCR-ABL inhibitors like nilotinib, which inhibits BCR-ABL with enhanced potency have become standard of treatment, at least in patients with BCR-ABL kinase domain mutations. In this study we analyzed the influence of therapeutic concentrations of nilotinib on human monocyte-derived DCs and compared its effects to imatinib. We found that both tyrosine kinase inhibitors (TKI) comparably and significantly impaired differentiation of monocytes to DCs as revealed by curtated downregulation of CD14 and reduced upregulation of CD1a and CD83. This was only partially restored after withdrawal of the TKI. Moreover, both TKI significantly reduced activation-induced IL-12p70 and C-C motif chemokine ligand (CCL) 3 secretion, while divergent TKI effects for CCL2 and CCL5 were observed. In contrast, only nilotinib significantly impaired the migratory capacity of DCs and their capacity to induce T-cell immune responses in MLRs. Our results indicate that imatinib and nilotinib may differ significantly with regard to their influence on antitumor immunity. Thus, for future combinatory approaches and particularly stop studies in CML treatment, choice of the most suitable BCR-ABL inhibitor requires careful consideration.

http://ift.tt/2EXrbbq

Dermoscopy and Overdiagnosis of Melanoma In Situ

In this issue of JAMA Dermatology, Lallas et al state that "our goal today is to detect melanoma, if possible, before it becomes invasive." Given the challenges related to the early detection of melanoma faced by clinicians and patients alike, this goal can only be achieved through further improving clinical training of clinicians, allied health care workers, and consumers alike, combined with heightened individual awareness and advanced imaging technologies.

http://ift.tt/2sMsYeq

Mepolizumab Treatment of Pediatric Eosinophilic Granulomatosis With Polyangiitis

This case report describes the use of mepolizumab to treat both the cutaneous and systemic features of pediatric eosinophilic granulomatosis with polyangiitis.

http://ift.tt/2EVT7fH

Trenchlike Ulcer on a Newborn’s Scalp

A neonate in her second week of life had a thick serosanguineous crust adhering to the scalp; extending laterally in both directions was a deep, trenchlike ulcer with no drainage. What is your diagnosis?

http://ift.tt/2sEZ63q

Association of Patient Satisfaction With Medical Scribe Use in Dermatology

This survey study examines the the association of using medical scribes in an academic dermatology practice with patient satisfaction.

http://ift.tt/2EVT4Ax

Accuracy of Dermoscopic Criteria for the Diagnosis of Melanoma In Situ

This diagnostic accuracy study compares dermoscopic criteria for diagnosis of melanoma in situ.

http://ift.tt/2sGbfp6

Association of Hidradenitis Suppurativa With Body Image

This case-control study investigates whether body image is impaired in patients with hidradenitis suppurativa and whether disease severity, age at onset, disease duration, obesity, depression, and anxiety are linked to body image impairment.

http://ift.tt/2EVT1Vn

Pemphigus and Solid Cancers

This cross-sectional study estimates the association between pemphigus and a wide range of nonhematologic malignancies by examining a large cohort of patients with pemphigus.

http://ift.tt/2sK3XRc

Association Between Pemphigus and Neurologic Diseases

This population-based cross-sectional study estimates the association between pemphigus and 4 neurologic conditions using one of the largest cohorts of patients with pemphigus.

http://ift.tt/2EVT03L

Incidence of Melanoma in the Cardiothoracic Transplant Population

This cohort study examines the incidence and timing of presentation of malignant melanoma in the cardiothoracic (heart and/or lung) transplant population.

http://ift.tt/2sG3eQO

Comorbidities in Autoimmune Skin Diseases

Alvan Feinstein, both a clinician and an epidemiologist, introduced the concept of comorbidity as a peculiar and important feature of chronic diseases almost 50 years ago. This concept may still require a more precise definition and a deeper understanding, but there is no doubt that better knowledge about comorbidities will always be conducive to improvements in clinical care, epidemiology, and health services planning and financing. Also, as noted by Tinetti and Fried nearly 15 years ago, awareness of existing comorbidities of a given chronic disease will facilitate "The End of the Disease Era," as they titled their article, and ultimately bring about the essential paradigm shift in clinical medicine from the "disease-oriented" model to a more "integrated individually tailored model" in which clinical decision making can be "focused primarily on the priorities and preferences of individual patients,"^(p181) and health conditions are recognized as a complex interplay of genetic, environmental, psychological, social, and other factors.

http://ift.tt/2EVSXVD

Light Therapies for Acne

How effective are light-based interventions for acne vulgaris?
The British Journal of Dermatology

http://ift.tt/2HCruXt

Myocardial dysfunction is frequent in systemic capillary-leak syndrome (Clarkson disease) severe episodes

Publication date: Available online 21 February 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Marc Pineton de Chambrun, Alexis Mathian, Charles-Edouard Luyt, Alain Combes, Zahir Amoura




http://ift.tt/2sL3eyT

Early life risk factors for chronic sinusitis: A longitudinal birth cohort study

Publication date: Available online 21 February 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Eugene H. Chang, Debra A. Stern, Amanda L. Willis, Stefano Guerra, Anne L. Wright, Fernando D. Martinez
BackgroundChronic sinusitis is a commonly diagnosed condition in adults who frequently present with late-stage disease and irreversible changes to the sinus mucosa. Understanding the natural history of chronic sinusitis is critical in developing therapies designed to prevent or slow the progression of disease.ObjectiveWe sought to determine early life risk factors for adult sinusitis in a longitudinal cohort study (Tucson Children's Respiratory Study).MethodsPhysician-diagnosed sinusitis was reported at age 6. Adult sinusitis between 22 and 32 years was defined as self-reported sinusitis plus physician-ordered sinus radiologic films. Atopy was assessed by skin prick test. Individuals were grouped into 4 phenotypes: no sinusitis (n = 621), transient childhood sinusitis only (n = 57), late-onset adult sinusitis only (n = 68), and early onset chronic sinusitis (childhood and adult sinusitis, n = 26).ResultsSinusitis was present in 10.8% of children and 12.2% of adults. Childhood sinusitis was the strongest independent risk factor for adult sinusitis (odds ratio = 4.2; 95% CI: 2.5-7.1; P < .0001; n = 772). Early onset chronic sinusitis was associated with increased serum IgE levels as early as at 9 months of age, atopy (assessed by skin prick test reactivity), childhood eczema and allergic rhinitis, frequent childhood colds, maternal asthma, and with increased prevalence of concurrent asthma. No association was found between late-onset adult sinusitis and any of the early life risk factors studied.ConclusionsWe identified an early onset chronic sinusitis phenotype associated with a predisposition to viral infections/colds in early life, allergies, and asthma. Elucidation of the molecular mechanisms for this phenotype may lead to future therapies to prevent the progression of the disease into adult sinusitis.

Graphical abstract

http://ift.tt/2sMl9p4

High number of early respiratory infections in association with allergic sensitization to mold promotes childhood asthma

Publication date: Available online 21 February 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Leilanie Perez Ramirez, Heepke Wendroth, Lisa J. Martin, Valentina V. Pilipenko, Hua He, John Kroner, Patrick H. Ryan, Grace K. LeMasters, James E. Lockey, David I. Bernstein, Gurjit K. Khurana Hershey, Jocelyn M. Biagini Myers




http://ift.tt/2EVK6TT

Critical role of plasmacytoid dendritic cells in induction of oral tolerance

Publication date: Available online 21 February 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Tomofumi Uto, Hideaki Takagi, Tomohiro Fukaya, Junta Nasu, Takehito Fukui, Noriaki Miyanaga, Keiichi Arimura, Takeshi Nakamura, Narantsog Choijookhuu, Yoshitaka Hishikawa, Katsuaki Sato
BackgroundExposure to dietary constituents through the mucosal surface of the gastrointestinal tract generates oral tolerance that prevents deleterious T cell–mediated immunity. Although oral tolerance is an active process that involves emergence of CD4⁺ forkhead box p3 (Foxp3)⁺ regulatory T (Treg) cells in gut-associated lymphoid tissues (GALTs) for suppression of effector T (Teff) cells, how antigen-presenting cells initiate this process remains unclear.ObjectiveWe sought to determine the role of plasmacytoid dendritic cells (pDCs), which are known as unconventional antigen-presenting cells, in establishment of oral tolerance.MethodsGALT-associated pDCs in wild-type mice were examined for their ability to induce differentiation of CD4⁺ Teff cells and CD4⁺Foxp3⁺ Treg cells in vitro. Wild-type and pDC-ablated mice were fed oral antigen to compare their intestinal generation of CD4⁺Foxp3⁺ Treg cells and induction of oral tolerance to protect against Teff cell–mediated allergic inflammation.ResultsGALT-associated pDCs preferentially generate CD4⁺Foxp3⁺ Treg cells rather than CD4⁺ Teff cells, and such generation requires an autocrine loop of TGF-β for its robust production. A deficiency of pDCs abrogates antigen-specific de novo generation of CD4⁺Foxp3⁺ Treg cells occurring in GALT after antigenic feeding. Furthermore, the absence of pDCs impairs development of oral tolerance, which ameliorates the progression of delayed-type hypersensitivity and systemic anaphylaxis, as well as allergic asthma, accompanied by an enhanced antigen-specific CD4⁺ Teff cell response and antibody production.ConclusionpDCs are required for establishing oral tolerance to prevent undesirable allergic responses, and they might serve a key role in maintaining gastrointestinal immune homeostasis.

Graphical abstract

http://ift.tt/2EVJZHX

Impact of food allergy on the growth of children with moderate-severe atopic dermatitis

Publication date: Available online 21 February 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Rekha D. Jhamnani, Samara Levin, Marjohn Rasooly, Kelly D. Stone, Joshua D. Milner, Celeste Nelson, Tom DiMaggio, Nina Jones, Anthony L. Guerrerio, Pamela A. Frischmeyer-Guerrerio




http://ift.tt/2sIQuJr

iNKT cell-mediated XCL1-XCR1 axis promotes allergic airway hyperresponsiveness by recruiting CD103+ dendritic cells

Publication date: Available online 21 February 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Yeon Duk Woo, Jaemoon Koh, Hye-Ryun Kang, Hye Young Kim, Doo Hyun Chung
BackgroundThe XCL1–XCR1 axis has been reported to play a role in immune homeostasis and inflammation. However, it is not known whether this axis has a critical function in allergic asthma.ObjectiveIn the present study, we explored that the iNKT cell-mediated XCL1–XCR1 axis regulated the allergic asthma.MethodsOvalbumin (OVA) or house dust mite (HDM)-induced asthma was developed in XCL1 or XCR1 knockout (KO) mice.ResultsXCL1 or XCR1 KO mice showed attenuation in airway hyperresponsiveness (AHR), numbers of CD103⁺ dendritic cells (DCs), and Th2 responses in the lungs compared with wild-type (WT) mice during OVA or HDM-induced asthma. These effects were reversed by intratracheal administration of recombinant XCL1 or adoptive transfer of CD103⁺ DCs, but not CD11b⁺ DCs into XCL1 KO mice. Moreover, iNKT cells highly expressed XCL1 in vitro and in vivo. Upon intranasal α-galactosyl ceramide challenge, CD103⁺ DC numbers in the lungs were increased in WT, but not XCL1 KO mice. Furthermore, adoptive transfer of WT iNKT cells increased AHR, CD103⁺ DC recruitment, and Th2 responses in the lungs of CD1d KO mice during OVA-induced asthma, whereas that of XCL1-deficient iNKT cells did not. In human, the percentages and XCL1 production capacity of iNKT cells from peripheral blood mononuclear cells were higher in patients with asthma than healthy control.ConclusionThese data demonstrate that the iNKT cell-mediated XCL1–XCR1 axis promotes AHR by recruiting CD103⁺ DCs into the lung in allergic asthma.

Graphical abstract

http://ift.tt/2EVJOMN

Interleukins and their signaling pathways in the Reactome biological pathway database

Publication date: Available online 21 February 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Steve Jupe, Keith Ray, Corina Duenas Roca, Thawfeek Varusai, Veronica Shamovsky, Lincoln Stein, Peter D'Eustachio, Henning Hermjakob
BackgroundThere is a wealth of biological pathway information available in the scientific literature, but it is spread across many thousands of publications. Alongside publications that contain definitive experimental discoveries are many others that have been dismissed as spurious, found to be irreproducible, or are contradicted by later results and consequently now considered controversial. Many descriptions and images of pathways are incomplete stylized representations that assume the reader is an expert and familiar with the established details of the process, which are consequently not fully explained. Pathway representations in publications frequently do not represent a complete, detailed, and unambiguous description of the molecules involved; their precise posttranslational state; or a full account of the molecular events they undergo while participating in a process. Although this might be sufficient to be interpreted by an expert reader, the lack of detail makes such pathways less useful and difficult to understand for anyone unfamiliar with the area and of limited use as the basis for computational models.ObjectiveReactome was established as a freely accessible knowledge base of human biological pathways. It is manually populated with interconnected molecular events that fully detail the molecular participants linked to published experimental data and background material by using a formal and open data structure that facilitates computational reuse. These data are accessible on a Web site in the form of pathway diagrams that have descriptive summaries and annotations and as downloadable data sets in several formats that can be reused with other computational tools. The entire database and all supporting software can be downloaded and reused under a Creative Commons license.MethodsPathways are authored by expert biologists who work with Reactome curators and editorial staff to represent the consensus in the field. Pathways are represented as interactive diagrams that include as much molecular detail as possible and are linked to literature citations that contain supporting experimental details. All newly created events undergo a peer-review process before they are added to the database and made available on the associated Web site. New content is added quarterly.ResultsThe 63rd release of Reactome in December 2017 contains 10,996 human proteins participating in 11,426 events in 2,179 pathways. In addition, analytic tools allow data set submission for the identification and visualization of pathway enrichment and representation of expression profiles as an overlay on Reactome pathways. Protein-protein and compound-protein interactions from several sources, including custom user data sets, can be added to extend pathways. Pathway diagrams and analytic result displays can be downloaded as editable images, human-readable reports, and files in several standard formats that are suitable for computational reuse. Reactome content is available programmatically through a REpresentational State Transfer (REST)-based content service and as a Neo4J graph database. Signaling pathways for IL-1 to IL-38 are hierarchically classified within the pathway "signaling by interleukins." The classification used is largely derived from Akdis et al.ConclusionThe addition to Reactome of a complete set of the known human interleukins, their receptors, and established signaling pathways linked to annotations of relevant aspects of immune function provides a significant computationally accessible resource of information about this important family. This information can be extended easily as new discoveries become accepted as the consensus in the field. A key aim for the future is to increase coverage of gene expression changes induced by interleukin signaling.

Graphical abstract

http://ift.tt/2sJbXSj

Reply

Publication date: Available online 21 February 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Kirk M. Druey, Andrew E. Arai, Samir M. Parikh




http://ift.tt/2EY1TtB

Bartter Syndrome Type 1 Presenting as Nephrogenic Diabetes Insipidus

Bartter syndrome (BS) type 1 (OMIM #601678) is a hereditary salt-losing renal tubular disorder characterized by hypokalemic metabolic alkalosis, hypercalciuria, nephrocalcinosis, polyuria, recurrent vomiting, and growth retardation. It is caused by loss-of-function mutations of the SLC12A1 gene, encoding the furosemide-sensitive Na-K-Cl cotransporter. Recently, a phenotypic variability has been observed in patients with genetically determined BS, including absence of nephrocalcinosis, hypokalemia, and/or metabolic alkalosis in the first year of life as well as persistent metabolic acidosis mimicking distal renal tubular acidosis. We report the case of a child with a genetically determined diagnosis of Bartter syndrome type 1 who presented with a phenotype of nephrogenic diabetes insipidus, with severe hypernatremia and urinary concentrating defect. In these atypical cases, molecular analysis is mandatory to define the diagnosis, in order to establish the correct clinical and therapeutic management.

http://ift.tt/2onSpgO

Bronchogenic Cyst as an Unusual Cause of a Persistent Cough and Wheeze in Children: A Case Report and Literature Review

Wheezing and cough are common case scenarios that pediatricians encountered in their office practices. Although a bronchogenic cyst is an uncommon condition, it is essential to be considered in the differential diagnosis of a chronic cough and wheezing among young children who fail to respond to appropriate medical treatment. A 28-month-old girl was referred to our pediatric pulmonology clinic with persistent symptoms of a cough and wheeze unresponsive to standard asthma therapy. This presentation prompted us to undertake a detailed diagnostic evaluation. The evaluation exposed a cystic mass in the middle mediastinum compressing the trachea and left main bronchus. The cyst was excised and confirmed pathologically to be a benign bronchogenic cyst. Subsequently, the patient recovered well and had been free of respiratory symptoms during follow-up visits. This report highlights one of the rare causes of wheezing and cough in young children and emphasizes the importance of considering it in the differential diagnosis of a child presenting with refractory asthma-like symptoms. This is important for early diagnosis and management and to avoid unpredictable complications of this treatable condition.

http://ift.tt/2EHUT4O

Five Novel Genetic Changes Linked to Pancreatic Cancer Risk

In what is believed to be the largest pancreatic cancer genome-wide association study to date, researchers at the Johns Hopkins Kimmel Cancer Center and the National Cancer Institute, and collaborators from over 80 other institutions worldwide discovered changes to five new regions in the human genome that may increase the risk of pancreatic cancer.

http://ift.tt/2onLxQy

Gastric and duodenal ischaemia after transarterial chemoembolisation for hepatocellular carcinoma: an unexpected but significant complication

Transarterial chemoembolisation (TACE) is commonly used for unresectable intermediate-stage hepatocellular carcinoma (HCC). TACE is usually well-tolerated. We report a case of a patient who presented with a gastrointestinal bleed from TACE. A 64-year-old man presented with chronic hepatitis C cirrhosis and multifocal bilobar HCC. He had previously undergone multiple TACE sessions, radiofrequency ablation and stereotactic body radiation therapy. In the evening of his TACE procedure, he developed abdominal pain and haematemesis. An oesophagogastroduodenoscopy (OGD) showed non-bleeding oesophageal varices and ulcerations in the stomach and duodenum, with pathology demonstrating mucosal necrosis. The patient recovered and was discharged on omeprazole. While TACE is considered safe with most patients only experiencing postembolisation syndrome, vascular complications have been reported. In our patient, OGD revealed ulcerations, with biopsies confirming ischaemic ulceration. The likely aetiology was seepage of the embolic particles into neighbouring arteries. Patients should be carefully selected for TACE and monitored post procedure.

http://ift.tt/2GzcM2m

Systemic lupus erythematosus presenting to haematology with pancytopenia and features of macrophage activation syndrome

Description 

This bone marrow biopsy (figure 1) shows haemophagocytosis consistent with macrophage activation syndrome (MAS) secondary to previously undiagnosed systemic lupus erythematosus (SLE).

Figure 1

Bone marrow biopsy with abundant cell-bound haemosiderin and focal haemophagocytosis with cellular debris identified in macrophage cytoplasm (arrows). This is consistent with, but not specific for, macrophage activation syndrome.

A 44-year-old woman had been unwell for 4 weeks with fever, weight loss and an aphthous ulcer. There were no other clinical features of SLE.

There was pancytopenia (platelet count 65x10⁹/L; neutrophil count 0.5x10⁹/ L; haemoglobin 107 g/L). The reticulocyte count was 20x10⁹/ L. Parvovirus and Epstein-Barr virus IgM were not detected.

A very high ferritin level of 3717 µg/L in the context of cytopenias was suggestive of MAS, a life-threatening hyperinflammatory state.1 Clinical features of MAS include fever, lymphadenopathy and hepatosplenomegaly. Laboratory markers include pancytopenia, altered liver function...

http://ift.tt/2HyeylD

Successful perioperative management in a patient with factor XI deficiency

Factor XI (FXI) deficiency is an autosomal disorder which manifests as bleeding of varying severity. While homozygotes typically experience more dramatic bleeding symptoms, heterozygotes may experience clinically significant bleeding following surgical procedures or trauma, and therefore the condition is not purely recessive. The clinical significance of FXI deficiency is complicated in that FXI levels do not correlate well with bleeding severity, and in fact the bleeding risk is variable even for an individual in response to different haemostatic challenges. We present the case of a 74-year-old man of Ashkenazi Jewish heritage with a family and personal history of bleeding during surgical procedures, who presented with excessive bleeding following total thyroidectomy. He was found to have a FXI level of 52% (low normal). Genetic testing revealed that he was heterozygous for the c.403G>T mutation. This case demonstrates successful work-up and perioperative management of a patient with FXI deficiency.

http://ift.tt/2Gy49EW

Cefepime-induced encephalopathy

Description

A 61-year-old man has been unable to leave his bed since being diagnosed with cerebral palsy at the age of 2 years. He is fed via a gastrostoma and has previously contracted aspiration pneumonitis three times. He has had no history of seizures or myoclonic movements until the time of hospitalisation. He visited a physician with complaints of fever lasting for 1 week and a cough that had been increasing in severity. He was diagnosed with pneumonia and treated with 100 mg oral cefcapene three times a day. As his condition did not improve, he was referred to our hospital for treatment. A chest X-ray and CT scan revealed abscess formation in the right middle lobe of the lung, and he was diagnosed with pulmonary suppuration. Initially, he was given 2 g of ceftriaxone every 24 hours. Following detection of Pseudomonas aeruginosa in the sputum culture, we discontinued ceftriaxone and initiated...

http://ift.tt/2Fk4Mml

It Is Not Always Sepsis: Fatal Tachypnea in a Newborn

Coarctation of the aorta (CoA) is a congenital cardiac malformation that is well understood. Despite being well characterized, CoA is a commonly missed congenital heart disease (CHD) during the newborn period. We report a full-term nine-day-old male who presented to the pediatric emergency department (ED) with isolated tachypnea. After an initial sepsis workup, subsequent investigations revealed critical CoA. Because the primary workup focused on sepsis, there was a significant delay in prostaglandin E1 (PGE1) initiation. This case illustrates the importance of early CoA recognition and timely initiation of PGE1 in newborns who present with suspected sepsis along with tachypnea.

http://ift.tt/2ESHEO1

Gastrointestinal stromal tumour as a rare association with neurofibromatosis type 1

Abstract

Gastrointestinal stromal tumours (GIST) are rare tumours of mesenchymal origin. These can be associated with neurofibromatosis type 1 (NF1), which is an autosomal dominant disorder. The prevalence of GIST in NF1 is estimated at 3.9–25%. This paper describes the presentation of a GIST arising from the jejenum in a 75-year-old lady with NF1, who presented with gastrointestinal bleeding. This was diagnosed by CT angiography. She was managed with laparotomy, with resection of small bowel, and an ischaemic segment of large bowel with two primary anastomoses. Pathology showed GIST of spindle cell type (Figs 3 and 4), 90 mm in size, with complete local excision. The patient was discharged on the eighth post-operative day and is currently undergoing regular clinic follow-up after multidisciplinary team meeting discussion.

http://ift.tt/2olZNJz

Robot-assisted repair of diaphragmatic hernias following ventricular assist device implantation

Abstract

Use of ventricular assist devices (VADs) is increasingly common, as is the need for surgeons to be familiar with the management of common complications in this population. Nonetheless, repair of diaphragmatic hernias which commonly develop following VAD implantation remains technically challenging due to intra-abdominal adhesions and the proximity of vital structures. Despite the potential benefits of improved dexterity and visualization, robotic approaches have thus far not been used to address this. We present the first two described cases of robot-assisted repair of diaphragmatic hernias in the setting of prior or current VAD placement.

http://ift.tt/2oh0xRb

Transanal minimally invasive surgery for resection of retrorectal cyst

Abstract

Tailgut cysts are benign retrorectal embryological remnants, often found incidentally or when evaluating a patient for pelvic symptoms. Transanal minimally invasive surgery (TAMIS) offers patients a low morbidity surgical approach for resection of a variety of low rectal lesions. This is a case report of resection of a tailgut cyst using TAMIS, including images and description of the steps of the procedure.

http://ift.tt/2BEHvvo

Ultrasound-guided bilateral superficial cervical block and preemptive single-dose oral tizanidine for post-thyroidectomy pain: a randomized-controlled double-blind study

Abstract

Purposes

The postoperative analgesic effect of tizanidine has not yet been evaluated sufficiently. The role of bilateral superficial cervical plexus block (BSCPB) for postoperative analgesia after thyroidectomy remains questionable. We aimed to evaluate the analgesic effect of combined use of BSCPB and a single-dose oral tizanidine in patients undergoing elective thyroid surgery.

Methods

Sixty patients undergoing thyroidectomy were randomized into 3 groups. The control group (Group C, n = 20) received BSCPB with 0.9% saline plus oral placebo. The superficial cervical group (Group SC, n = 20) received BSCPB with 0.25% bupivacaine plus oral placebo. The superficial cervical and tizanidine group (Group SC + T, n = 20) received BSCPB with 0.25% bupivacaine plus tizanidine 6 mg capsule. Surgical site pain scores, opioid consumption, rescue analgesia, posterior neck pain, headache, and opioid-related side effects were assessed for the first 24 h.

Results

Compared with Group C, rest and swallowing pain scores in Group SC and Group SC + T were statistically lower at all postoperative time points (p < 0.05). Fentanyl consumption was lower in Group SC and Group SC + T than in Group C at time periods 0–4 and 4–8 h (p < 0.05). Fentanyl consumption was lower in Group SC + T than in Group SC at 0–4 h (p = 0.006). Total fentanyl consumption was higher in Group C than in the other groups (p < 0.001). Postoperative cervical pain and occipital headache were significantly lower in Group SC + T than in the other groups (p < 0.05).

Conclusions

Ultrasound-guided BSCPB with or without preemptive oral tizanidine was effective at reducing postoperative pain and opioid consumption in patients undergoing total thyroidectomy. Addition of preemptive oral tizanidine to BSCPB reduced the early postoperative opioid consumption, posterior neck pain, and occipital headache.

Clinical trials registry

The study was registered with a clinical trials registry (ClinicalTrials.gov. identifier NCT02725359).

http://ift.tt/2ofsQ2d

Transient Receptor Potential Vanilloid 4 (TRPV4) Expression on the Nerve Fibers of Human Dental Pulp is Upregulated under Inflammatory Condition

Publication date: Available online 21 February 2018
Source:Archives of Oral Biology
Author(s): Marina M. Bakri, Farhana Yahya, Khalil Munawar, Junichi Kitagawa, Mohammad Zakir Hossain
ObjectiveTransient receptor potential vanilloid 4 (TRPV4) has been considered as a mechano-, thermo- and osmo-receptor. Under inflammatory conditions in dental pulp, teeth can become sensitive upon exposure to a variety of innocuous stimuli. The objective of the present study was to investigate the expression of the TRPV4 channel on nerve fibers in human dental pulp of non-symptomatic and symptomatic teeth associated with inflammatory conditions.DesignDental pulp from extracted human permanent teeth was processed for fluorescence immunohistochemistry. Ten asymptomatic (normal) and 10 symptomatic (symptoms associated with pulpitis) teeth were used in this study. Nerve fibers were identified by immunostaining for a marker, protein gene product 9.5, and the cells were counterstained with 4',6-diamidino-2-phenylindole. An anti-TRPV4 antibody was used to trace TRPV4 expression.ResultsTRPV4 expression was co-localized with the nerve fiber marker. Immunoreactivity for TRPV4 was more intense (p < 0.05) in the nerves of symptomatic teeth than those of normal teeth. The number of co-localization spots was increased significantly (p < 0.05) in the dental pulp of symptomatic teeth compared with that of asymptomatic (normal) teeth.ConclusionsThere is expression of TRPV4 channels on the nerve fibers of human dental pulp. Our findings suggest upregulation of TRPV4 expression under inflammatory conditions in the pulp. The upregulation of TRPV4 channels may be associated with the exaggerated response of dental pulp to innocuous mechanical, thermal and osmotic stimuli under inflammatory conditions.



http://ift.tt/2EVaOfd

Impact of clinical factors and UGT1A9 and CYP2B6 genotype on inter-individual differences in propofol pharmacokinetics

Abstract

Purpose

Propofol is one of the most widely used fast-acting intravenously administered anesthetics. However, although large inter-individual differences in dose requirements and recovery time have been observed, there are few previous studies in which the association between several potential covariates, including genetic factors such as the UGT1A9 and CYP2B6 genotypes, and propofol pharmacokinetics was simultaneously examined. This study aimed to identify factors determining propofol pharmacokinetics.

Methods

Eighty-three patients were enrolled, and their blood samples were collected 1, 5, 10, and 15 min after administering a single intravenous bolus of propofol at a dose of 2.0 ml/kg to measure propofol plasma concentration. Area under the time–plasma concentration curve from zero up to the last measurable time point (AUC_15min) was determined from the concentration data. The inter-individual variability of the propofol pharmacokinetics was evaluated by investigating relationships between AUC_15min and genotype of UGT1A9 and CYP2B6; clinical factors, such as age, sex, body mass index (BMI), and preoperative hematological examination; and hemodynamic variables measured by a pulse dye densitogram analyzer. The Spearman rank correlation coefficient and the Mann–Whitney U test were used for the statistical analysis of continuous and categorical values, respectively. Subsequently, clinical factors that had p values of < 0.05 in the univariate analysis were examined in a multivariate analysis using multiple linear regression analysis.

Results

Age, BMI, indocyanine green disappearance ratio (K-ICG), hepatic blood flow (HBF), preoperative hemoglobin level, and sex were correlated with AUC_15min (p < 0.05) in univariate analysis. Multivariate analysis performed to adjust for age, BMI, K-ICG, HBF, preoperative hemoglobin level, and sex revealed only BMI as an independent factor associated with AUC_15min.

Conclusions

This study demonstrated that BMI influences propofol pharmacokinetics after its administration as a single intravenous injection, while UGT1A9 and CYP2B6 SNPs, other clinical factors, and hemodynamic variables do not. These results suggest that BMI is an independent factor associated with propofol pharmacokinetics in several potential covariates.

Clinical trials registration number

University Hospital Medical Information Network (UMIN000022948).

http://ift.tt/2EFAVaV

Loss-of-function mutations in filaggrin gene and malignant melanoma

http://ift.tt/2BFZMIR

Forthcoming Events

http://ift.tt/2CarVJk

Announcement

http://ift.tt/2BGdMSU

Dermatoporosis: a further step to recognition

http://ift.tt/2C9BkRf

Issue Information

http://ift.tt/2oqrrFF

Human papillomavirus and immunosuppressive drugs in dermatology – a ‘neoplastic’ combination?

http://ift.tt/2EFCiX7

Rare variant of metaplastic carcinoma of the breast: a case report and review of the literature

Metaplastic carcinoma encompasses a group of neoplasms characterized by differentiation of the neoplastic epithelium into squamous cells and/or mesenchymal-looking elements. Spindle cell carcinoma is a rare va...

http://ift.tt/2CzVyzl

Radiotherapy-induced morphoea of the breast responding to photodynamic therapy

http://ift.tt/2Fk4RXh

Demyelination during anti-tumour necrosis factor therapy for psoriasis

Summary

Anti-tumour necrosis factor (anti-TNF) therapies have been associated with neurological complications, including in rare cases demyelinating disease. It is currently unknown whether patients who have received more than one immunosuppressive agent or anti-TNF have a greater risk of demyelination. We report the case of a 37-year-old woman with psoriasis who presented with an acute episode of demyelination while on anti-TNF therapy. This case was complicated by the fact that progressive multifocal leukoencephalopathy was considered the likely diagnosis initially and was only definitively excluded by brain biopsy. This case demonstrates the difficulty establishing the correct diagnosis in patients with atypical presentations on immunomodulating therapies. We present this rare case of demyelination in a patient who received multiple immunosuppressive therapies to highlight this challenging clinical situation and discuss management with a literature review.

http://ift.tt/2GxsSt0

Ultra–low-dose radiotherapy for definitive management of ocular adnexal B-cell lymphoma

http://ift.tt/2oeV9hj

Orbital exenteration for sinonasal malignancies: indications, rehabilitation and oncologic outcomes

Purpose of review Review the recent literature regarding the management of orbital invasion in sinonasal malignant tumors. Recent findings There is a recent trend in preserving the orbit in cases of minimal invasion of periosteum and limited periorbit involvement, as well as in presence of good response to neoadjuvant chemotherapy, mainly in squamous cell carcinoma and neuroendocrine histologies. Summary The decision about orbital exenteration in cases of sinonasal malignancies is facilitated if the patient already has clear clinical signs of intraconal invasion such as visual loss, restriction of ocular mobility or infiltration of the eyeglobe. However, in borderline situations, confirmation of orbital involvement should be performed intraoperatively. In selected cases with minimal orbital invasion without functional compromise, orbit sparing surgery can be done with acceptable oncological outcomes. Correspondence to Luiz P. Kowalski, MD, PhD, Head and Neck Surgery and Otorhinolaryngology Department, A.C. Camargo Cancer Center, Rua Professor Antonio Prudente, 211, 01509900 Sao Paulo, Brazil. Tel: +55 11 2189 5172; e-mail: lp_kowalski@uol.com.br Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2Gzx23H

Perspectives on voice treatment for unilateral vocal fold paralysis

Purpose of review Unilateral vocal fold paralysis (UVFP) is a common cause of neurogenic dysphonia resulting in glottal insufficiency. To restore glottal sufficiency and reduce the presenting dysphonia, treatment involving either surgical intervention, voice therapy or a combination of the two is typically provided. Currently, there is no consensus for the most effective voice treatment for UVFP. This results in an inability to compare current studies, and a lack of treatment effectiveness for the management of UVFP. This study aims to review the most recent literature for the management of dysphonia due to UVFP to establish the current evidence base for voice treatment options. Recent findings There was found to be a lack of consistency in the rationale, selection and timing of the surgical intervention and/or voice therapy being provided for patients with UVFP. Summary Further consensus is required for the rationale and selection of voice treatment prescriptions for the management of UVFP in order to improve treatment effectiveness and voice outcomes in patients with UVFP. Correspondence to Chloe Walton, Australian Catholic University (ACU), 1100 Nudgee Road, Banyo, QLD 4014, Australia. Tel: +07 3623 7100; e-mail: Chloe.walton@acu.edu.au Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2FiOgCR

Orbital exenteration for sinonasal malignancies: indications, rehabilitation and oncologic outcomes

Purpose of review Review the recent literature regarding the management of orbital invasion in sinonasal malignant tumors. Recent findings There is a recent trend in preserving the orbit in cases of minimal invasion of periosteum and limited periorbit involvement, as well as in presence of good response to neoadjuvant chemotherapy, mainly in squamous cell carcinoma and neuroendocrine histologies. Summary The decision about orbital exenteration in cases of sinonasal malignancies is facilitated if the patient already has clear clinical signs of intraconal invasion such as visual loss, restriction of ocular mobility or infiltration of the eyeglobe. However, in borderline situations, confirmation of orbital involvement should be performed intraoperatively. In selected cases with minimal orbital invasion without functional compromise, orbit sparing surgery can be done with acceptable oncological outcomes. Correspondence to Luiz P. Kowalski, MD, PhD, Head and Neck Surgery and Otorhinolaryngology Department, A.C. Camargo Cancer Center, Rua Professor Antonio Prudente, 211, 01509900 Sao Paulo, Brazil. Tel: +55 11 2189 5172; e-mail: lp_kowalski@uol.com.br Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2Gzx23H

Perspectives on voice treatment for unilateral vocal fold paralysis

Purpose of review Unilateral vocal fold paralysis (UVFP) is a common cause of neurogenic dysphonia resulting in glottal insufficiency. To restore glottal sufficiency and reduce the presenting dysphonia, treatment involving either surgical intervention, voice therapy or a combination of the two is typically provided. Currently, there is no consensus for the most effective voice treatment for UVFP. This results in an inability to compare current studies, and a lack of treatment effectiveness for the management of UVFP. This study aims to review the most recent literature for the management of dysphonia due to UVFP to establish the current evidence base for voice treatment options. Recent findings There was found to be a lack of consistency in the rationale, selection and timing of the surgical intervention and/or voice therapy being provided for patients with UVFP. Summary Further consensus is required for the rationale and selection of voice treatment prescriptions for the management of UVFP in order to improve treatment effectiveness and voice outcomes in patients with UVFP. Correspondence to Chloe Walton, Australian Catholic University (ACU), 1100 Nudgee Road, Banyo, QLD 4014, Australia. Tel: +07 3623 7100; e-mail: Chloe.walton@acu.edu.au Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2FiOgCR