Contemporary considerations in concurrent endoscopic sinus surgery and rhinoplasty

Purpose of review Characterize indications, perioperative considerations, clinical outcomes and complications for concurrent endoscopic sinus surgery (ESS) and rhinoplasty. Recent findings Chronic rhinosinusitis and septal deviation with or without inferior turbinate hypertrophy independently impair patient-reported quality of life. Guidelines implore surgeons to include endoscopy to accurately evaluate patient symptoms. Complication rates parallel those of either surgery (ESS and rhinoplasty) alone and are not increased when performed concurrently. Operative time is generally longer for joint surgeries. Patient satisfaction rates are high. Summary Concurrent functional and/or cosmetic rhinoplasty and ESS is a safe endeavor to perform in a single operative setting and most outcomes data suggest excellent patient outcomes. Additional studies that include patient-reported outcome measures are needed. Correspondence to Toby O. Steele, MD, Department of Otolaryngology – Head and Neck Surgery, University of California Davis, Sacramento, CA, 95817 USA. E-mail: tosteele@ucdavis.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2t1qxBL

Contemporary considerations in concurrent endoscopic sinus surgery and rhinoplasty

Purpose of review Characterize indications, perioperative considerations, clinical outcomes and complications for concurrent endoscopic sinus surgery (ESS) and rhinoplasty. Recent findings Chronic rhinosinusitis and septal deviation with or without inferior turbinate hypertrophy independently impair patient-reported quality of life. Guidelines implore surgeons to include endoscopy to accurately evaluate patient symptoms. Complication rates parallel those of either surgery (ESS and rhinoplasty) alone and are not increased when performed concurrently. Operative time is generally longer for joint surgeries. Patient satisfaction rates are high. Summary Concurrent functional and/or cosmetic rhinoplasty and ESS is a safe endeavor to perform in a single operative setting and most outcomes data suggest excellent patient outcomes. Additional studies that include patient-reported outcome measures are needed. Correspondence to Toby O. Steele, MD, Department of Otolaryngology – Head and Neck Surgery, University of California Davis, Sacramento, CA, 95817 USA. E-mail: tosteele@ucdavis.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2t1qxBL

Improving Clinical Proficiency Using a 3-Dimensionally Printed and Patient-Specific Thoracic Spine Model as a Haptic Task Trainer

Background and Objectives Advanced haptic simulators for neuraxial training are expensive, have a finite life, and are not patient specific. We sought to demonstrate the feasibility of developing a custom-made, low-cost, 3-dimensionally printed thoracic spine simulator model from patient computed tomographic scan data. This study assessed the model's practicality, efficiency as a teaching tool, and the transfer of skill set into patient care. Methods A high-fidelity, patient-specific thoracic spine model was used for the study. Thirteen residents underwent a 1-hour 30-minute training session prior to performing thoracic epidural analgesia (TEA) on patients. We observed another group of 14 residents who were exposed to the traditional method of training during their regional anesthesia rotation for thoracic epidural placement. The TEA was placed for patients under the supervision of attending anesthesiologists, who were blinded to the composition of the study and control groups. As a primary outcome, data were collected on successful TEAs, which was defined as a TEA that provided full relief of sensation across the entire surgical area as assessed by both a pinprick and temperature test. Secondary outcomes included whether any assistance from the attending physician was required and failed epidurals. Results A total of 27 residents completed the study (14 in the traditional training, 13 in the study group). We found that the residents who underwent training with the simulator had a significantly higher success rate (11 vs 4 successful epidural attempts, P = 0.002) as compared with the traditional training group. The control group also required significantly more assistance from the supervising anesthesiologist compared with the study group (5 vs 1 attempt requiring guidance). The number needed to treat (NNT) for the traditional training group was 1.58 patients over the study period with a 95% confidence interval of 1.55 to 1.61. Conclusions By using patient-specific, 3-dimensionally printed, thoracic spine models, we demonstrated a significant improvement in clinical proficiency as compared with traditional teaching models. Accepted for publication January 31, 2018. Address correspondence to: Robina Matyal, MD, Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (e-mail: rmatyal1@bidmc.harvard.edu). Research support was provided by the Foundation for Anesthesia Education and Research Grant. The authors declare no conflict of interest. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

https://ift.tt/2sQxW7s

The impact of unplanned reoperations in head and neck cancer surgery on survival

Publication date: August 2018
Source:Oral Oncology, Volume 83
Author(s): Nayeon Choi, Song I Park, Hyeseung Kim, Insuk Sohn, Han-Sin Jeong
ObjectivesUnplanned reoperation causes physical and psychological stress in patients and it costs more in terms of medical, economic and social resource. The purpose of the study was to evaluate the incidence, risk factors and clinical significance of unplanned reoperation (any unscheduled surgery within 30 days from the initial surgery) in patients who had undergone head and neck cancer (HNC) surgery.Materials and methodsA total of 574 consecutive patients who had received surgery for HNC with or without flap reconstruction from 2010 to 2015 were analyzed. Clinical and biochemical characteristics, cause of unplanned reoperation, cancer subsites, and previous treatment history were compared between unplanned reoperation group (n = 60) and control group (n = 514). Multivariable analyses were performed to identify risk factors for unplanned reoperation. Clinical significance was evaluated by multivariable survival analyses using Cox proportional hazard model.ResultsOverall rate of unplanned reoperation was 10.5%. Flap complication (40.0%) was the most common cause, followed by infection (16.7%), necrosis (11.7%), and bleeding (8.3%). Higher N (N2) classification, long operation time and previous treatment before surgery were identified as risk factors for unplanned reoperation. Based on multivariable survival analyses, recurrence-free survival was significantly decreased in unplanned reoperation group (Hazard ratio = 1.85, 95% confidence interval [1.23–2.80]), but not overall survival.ConclusionUnplanned reoperation significantly decreased recurrence-free survival in patients with HNC surgery. Thus, careful surgical/ perioperative management is needed to reduce unplanned reoperation in HNC patients with advanced nodal disease, long operation time or previous treatment history.



https://ift.tt/2l2sSsr

MicroRNA-based classifiers for diagnosis of oral cavity squamous cell carcinoma in tissue and plasma

Publication date: August 2018
Source:Oral Oncology, Volume 83
Author(s): Nicklas Juel Pedersen, David Hebbelstrup Jensen, Giedrius Lelkaitis, Katalin Kiss, Birgitte Wittenborg Charabi, Henrik Ullum, Lena Specht, Ane Yde Schmidt, Finn Cilius Nielsen, Christian von Buchwald
BackgroundMicroRNAs (miRNAs) hold promise as diagnostic cancer biomarkers. Here we aimed to define the miRNome in oral squamous cell carcinoma (OSCC) and normal oral mucosa (NOM), and to identify and validate new diagnostic miRNAs and miRNA combinations in formalin-fixed paraffin-embedded (FFPE) tissue samples and plasma samples.MethodsWe performed next-generation miRNA sequencing in FFPE tissue samples of OSCC (n = 80) and NOM (n = 8). Our findings were validated by quantitative polymerase chain reaction (qPCR) analysis of OSCC (n = 195) and NOM (n = 103) FFPE tissue samples, and plasma samples from OSCC patients (n = 55) and healthy persons (n = 18).ResultsThe OSCC miRNome included 567 miRNAs, 66 of which were differentially expressed between OSCC and NOM. Using qPCR data, we constructed receiver operating curves to classify patients as NOM or OSCC based on miRNA combinations. The area under the curve was of 0.92 from FFPE tissue (miR-204-5p, miR-370, miR-1307, miR-193b-3p, and miR-144-5p), and 1.0 from plasma samples (miR-30a-5p and miR-769-5p). Model calibration and discrimination were evaluated using 10-fold cross-validation.ConclusionsAnalysis of the miRNome from many OSCC cases improves our knowledge of the importance of individual miRNAs and their predictive potential in OSCC. We successfully identified miRNA classifiers in FFPE OSCC tissue and plasma with a high discriminatory ability between OSCC and NOM. The proposed combination of miR-30a-5p and miR-769-5p in plasma from OSCC patients could serve as a minimal invasive biomarker for diagnosis and control of T-site recurrences.



https://ift.tt/2sWFoNu

Un nouveau cas d’éruption de type pityriasis rubra pilaire associée à l’inhibiteur de tyrosine kinase ponatinib

Publication date: Available online 11 June 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): J. Krygier, G. Leemans, R. Forsyth, A. de Becker, J. Gutermuth, M. Grosber
IntroductionLe pityriasis rubra pilaire (PRP) est un syndrome cutané d'étiologie inconnue dont la plupart des cas sont sporadiques et acquis. Nous rapportons un cinquième cas d'éruption de type PRP associée au ponatinib, un inhibiteur de tyrosine kinase (ITK).ObservationUne femme de 60ans se présentait à la consultation de dermatologie pour une éruption érythémato-squameuse évoluant depuis 2 semaines. La patiente était également suivie en hématologie pour une récidive de leucémie lymphoblastique aiguë. Un traitement par ponatinib avait été débuté 6 semaines plus tôt. Malgré l'aspect peu spécifique de l'histologie cutanée, le diagnostic d'éruption de type PRP induit était posé face à l'image clinique caractéristique. Le traitement par corticoïdes locaux permettait la résolution de l'éruption.DiscussionLa littérature rapporte six cas d'éruption de type PRP associés à la prise d'ITK, dont quatre avec le ponatinib. L'éruption survient dans un délai variant de 2 semaines à 3 mois après le début du traitement. Les corticoïdes locaux prescrits ont donné des résultats mitigés. Une meilleure compréhension de la physiopathologie de ces éruptions associées aux ITK pourrait éclairer les mécanismes pathogéniques du PRP idiopathique.BackgroundPityriasis rubra pilaris (PRP) is a cutaneous syndrome of unknown origin. Most cases are sporadic and acquired. Herein we report a fifth case of PRP-like eruption associated with ponatinib, a tyrosine kinase inhibitor (TKI).Patients and methodsA 60-year-old woman presented at the dermatology department with an erythemato-squamous eruption present for 2weeks. The patient was also being treated in haematology for recurrence of acute lymphoblastic leukaemia. Treatment with ponatinib had been initiated 6weeks earlier. Despite the low specific cutaneous histology, a diagnosis of induced PRP-like eruption was made based on the characteristic clinical aspect. Treatment with local corticosteroids resolved the eruption.DiscussionThe literature contains 6 reported cases of PRP-like eruptions associated with TKI, including 4 with ponatinib. The eruption began from 2weeks to 2–3 months after treatment induction. Prescribed topical corticosteroids have yielded mixed results. A better understanding of the physiopathology of these eruptions associated with TKI could shed light on the pathogenic mechanisms in relation to idiopathic PRP.



https://ift.tt/2sQKvjf

Analyses of dermal innate lymphoid cells in mice lacking T-bet and STAT6

Publication date: Available online 11 June 2018
Source:Allergology International
Author(s): Sohei Makita, Hiroaki Takatori, Tomohiro Tamachi, Akira Suto, Kotaro Suzuki, Hiroshi Nakajima




https://ift.tt/2LJDUho