Efficacy of anti-TNF alpha in severe and refractory major vessel involvement of Behcet's disease: A multicenter observational study of 18 patients

Publication date: Available online 18 August 2018

Source: Clinical Immunology

Author(s): A.C. Desbois, L. Biard, O. Addimanda, M. Lambert, E. Hachulla, D. Launay, F. Ackerman, L. Pérard, A. Hot, F. Maurier, C. Mausservey, F. Bernard, N. Noel, L. Alric, T. Mirault, F. Cohen, S. Boussouar, M. Resche-Rigon, P. Cacoub, D. Saadoun

Abstract

Objective

To describe the outcome and tolerance in patients treated with anti-TNFα in severe and refractory major vessel disease in Behçet's disease (BD).

Methods

A multicenter study evaluating 18 refractory BD patients with major vessel involvement [pulmonary artery (n = 4), aorta (n = 4) or peripheral artery aneurysm (n = 1) and/or pulmonary artery (n = 7), inferior vena cava (n = 5), or intra-cardiac (n = 3) thrombosis or Budd Chiari Syndrome (n = 2)] treated with anti-TNFα agents.

Results

Vascular remission was achieved in 16 (89%) patients. The 9 months risk of relapse was significantly higher with conventional immunosuppressants used prior anti-TNFα agents as compared to anti-TNFα therapy [OR = 8.7 (1.42–62.6), p = 0.03]. The median daily dose of corticosteroids significantly decreased at 12 months. Side effects included infection (n = 4) and pulmonary edema (n = 1).

Conclusion

TNFα-antagonists are safe and might be associated with a decreased risk of relapse at 9 months compared to conventional immunosuppressants in BD patients with major vessels disease.

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Feasibility study of bilateral radical ethmoidectomy in ambulatory surgery

Publication date: Available online 17 August 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): M. Kérimian, P.-L. Bastier, N. Réville, S. Fierens, L. de Gabory

Abstract

Objectives

To assess the feasibility of bilateral radical ethmoidectomy in ambulatory surgery by risk analysis, and to calculate possible medico-economic savings.

Methods

This study was performed retrospectively over a 2-year period and prospectively for 1 year. It included all patients undergoing bilateral ethmoidectomy, associated to sphenoidotomy and/or septoplasty or not, in a university hospital department. Data were collected on demographics, disease etiology, previous surgery, operative details, postoperative course, complications and satisfaction assessed by questionnaire at days 1 and 30. Ambulatory surgery eligibility criteria were applied to this population, and an economic analysis compared savings between inpatient and outpatient management.

Results

Hundred and sixty-five patients were included. Surgical indications comprised nasal polyposis (87%), chronic sinusitis without nasal polyps (6%) or cystic fibrosis (7%). Seventy-five septoplasties were associated (45.5%). Operating time depended on associated septoplasty (P = 0.005), surgeon experience (P < 0.0001) and previous sinus surgery (P = 0.041). Only 37% of the patients wished for same-day discharge; reasons for refusal were home-to-hospital distance and bleeding risk. Considering anesthesia contraindications, immediate complications and operating time, 107 patients were eligible for outpatient treatment, although only 13 patients underwent ambulatory surgery. Medical-economic savings with outpatient management would have been about €20,000 per year.

Conclusions

Bilateral radical ethmoidectomy, associated to septoplasty or not, could be performed on an outpatient basis in more than 60% of cases, without increased risk, and with cost savings of 28.4%.

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Mixed Meal and Intravenous L-Arginine Tests Both Stimulate Incretin Release Across Glucose Tolerance in Man: Lack of Correlation with β Cell Function

Metabolic Syndrome and Related Disorders, Ahead of Print.


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Auto-obliteration of maxillary sinuses through osteoneogenesis in children with cystic fibrosis: A possible new way to reduce morbidity

Publication date: Available online 18 August 2018

Source: American Journal of Otolaryngology

Author(s): Madison Buras, Alberto Simoncini, Anil Gungor

Abstract

Background

Cystic Fibrosis is an autosomal recessive disorder with a mutation in the cystic fibrosis transmembrane regulator gene, leading to dysregulation of epithelial fluid transport, dehydration of airway surfaces and impaired mucociliary function in the sinuses, lungs, pancreas and other organs. This leads to thickened secretion which blocks the sinus ostia and promotes chronic bacterial overgrowth and destruction of the mucosa. Chronic rhinosinusitis in cystic fibrosis patients leads to a decreased quality of life involving increased hospitalizations, infections, pneumonia, and acute exacerbations, warranting multiple sinus surgeries. This study investigates the effects of a more aggressive surgical approach on reducing the need for repeat surgeries.

Methods

A retrospective review of CT scans of nine cystic fibrosis patients who have had aggressive endoscopic sinus surgery for the treatment of chronic rhinosinusitis (CRS) was performed. The decrease in maxillary sinus volume was measured using pre-operative and post-operative scans.

Results

A significant decrease in maxillary sinus volume was observed in all subjects. Volume reduction occurred through osteoneogenesis, causing auto-obliteration of the sinuses with cancellous bone.

Conclusions

Aggressive endoscopic sinus surgery for maxillary sinuses incites an osteoneogenetic reaction that leads to auto-obliteration of the sinus and reduces sinus-related morbidity in children with cystic fibrosis. Through this osteoneogenesis, the sinus is transformed into a shallow cup that does not retain secretions and is easy to clear. It is our impression that this may lead to reduced morbidity and a decreased need for repeat maxillary sinus surgery.

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Viral Epitope Escape in Acute HIV-1 Infection

Viral Immunology, Ahead of Print.


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Discrepant Clinical Significance of CD28+CD8− and CD4+CD25high Regulatory T Cells During the Progression of Hepatitis B Virus Infection

Viral Immunology, Ahead of Print.


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Sequential bilateral cochlear implant: results in children and adolescents

Publication date: Available online 18 August 2018

Source: Brazilian Journal of Otorhinolaryngology

Author(s): Gabriela Felix Lazarini Almeida, Marcella Ferrari Martins, Lucas Bevilacqua Alves da Costa, Orozimbo Alves da Costa, Ana Claudia Martinho de Carvalho

Abstract

Introduction

The use of the bilateral cochlear implants can promote the symmetrical development of the central auditory pathways, thus benefiting the development of auditory abilities and improving sound localization and the ability of auditory speech perception in situations of competitive noise.

Objective

To evaluate the ability of speech perception in children and adolescents using sequential bilateral cochlear implants, considering the association of these variables: age at surgery, time of device use and interval between surgeries.

Methods

14 individuals were assessed, between 10 and 16 years of age, who demonstrated a surgical indication for the use of sequential bilateral cochlear implants as intervention in the auditory habilitation process. The speech perception ability was assessed through sentence lists constructed in the Portuguese language, presented in two situations: in silence, with fixed intensity of 60 dB SPL, and in competitive noise, with a signal-to-noise ratio of +15 dB. The evaluation was performed under the following conditions: unilateral with the first activated cochlear implant, unilateral with the second activated cochlear implant and bilateral with both devices activated.

Results

The results of the speech perception tests showed better performance in both silence and in noise for the bilateral cochlear implant condition when compared to the 1st cochlear implant and the 2nd cochlear implant alone. A worse result of speech perception was found using the 2nd cochlear implant alone. No statistically significant correlation was found between age at the surgical procedure, interval between surgeries and the time of use of the 2nd cochlear implant, and the auditory speech perception performance for all assessed conditions. The use of a personal sound amplification product prior to the 2nd cochlear implant resulted in benefits for auditory speech perception with the 2nd cochlear implant, both in silence and in noise.

Conclusion

The bilateral cochlear implant provided better speech perception in silence and in noise situations when compared to the unilateral cochlear implant, regardless of the interval between surgeries, age at the surgical procedure and the time of use of the 2nd cochlear implant. Speech perception with the 1st cochlear implant was significantly better than with the 2nd cochlear implant, both in silence and in noise. The use of the personal sound amplification product prior to the 2nd cochlear implant influenced speech perception performance with the 2nd cochlear implant, both in silence and in noise.

Resumo

Introdução

A utilização do implante coclear bilateral pode promover o desenvolvimento das vias auditivas centrais de maneira simétrica, beneficiando, assim, o desenvolvimento das habilidades auditivas e melhorando a localização sonora e a habilidade de percepção auditiva da fala em situações de ruído competitivo.

Objetivo

Avaliar a habilidade de reconhecimento de fala em crianças e adolescentes usuários do implante coclear bilateral sequencial, considerando a relação das variáveis: idade cirúrgica, tempo de uso do dispositivo e intervalo entre as cirurgias.

Método

Foram avaliados 14 indivíduos com idades entre 10 e 16 anos, que receberam indicação cirúrgica para a utilização do implante coclear bilateral sequencial como forma de intervenção no processo de habilitação auditiva. A habilidade de reconhecimento de fala foi avaliada por meio de listas de sentenças construídas na língua portuguesa, apresentadas em duas situações: no silêncio, com intensidade fixa de 60 dB NPS, e no ruído competitivo, com a relação sinal/ruído de + 15 dB. A avaliação foi realizada nas seguintes condições: unilateral com o 1° implante coclear ativado, unilateral com o 2° implante coclear ativado e bilateral com ambos os dispositivos ativados.

Resultado

Os resultados dos testes de reconhecimento de fala demonstraram melhor desempenho tanto no silêncio quanto no ruído para a condição implante coclear bilateral, quando comparado ao 1° implante coclear e 2° implante coclear isoladamente. Um pior resultado de reconhecimento de fala foi encontrado com o uso 2° implante coclear isoladamente. Não foi encontrada correlação estatisticamente significante entre idade cirúrgica, intervalo entre as cirurgias e tempo de uso do 2° implante coclear e o desempenho de percepção auditiva da fala para todas as condições avaliadas. O uso do aparelho de amplificação sonora individual anterior ao 2° implante coclear beneficiou os resultados de percepção auditiva da fala com o 2° implante coclear, tanto no silêncio quanto no ruído.

Conclusão

O implante coclear bilateral proporcionou melhor reconhecimento de fala em situações de silêncio e de ruído, quando comparado com o implante coclear unilateral, independente do intervalo entre as cirurgias, da idade cirúrgica e do tempo de uso do 2° implante coclear. O reconhecimento de fala com o 1° implante coclear foi significativamente melhor do que com o 2° implante coclear, tanto no silêncio quanto no ruído. O uso do aparelho de amplificação sonora individual anterior ao 2° implante coclear influenciou o desempenho de reconhecimento de fala com o 2° implante coclear, tanto no silêncio quanto no ruído.

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