Ceria nanocrystals decorated mesoporous silica nanoparticle based ROS-scavenging tissue adhesive for highly efficient regenerative wound healing

Publication date: January 2018
Source:Biomaterials, Volume 151
Author(s): Haibin Wu, Fangyuan Li, Shuaifei Wang, Jingxiong Lu, Jinquan Li, Yang Du, Xiaolian Sun, Xiaoyuan Chen, Jianqing Gao, Daishun Ling
Restoration of tissue integrity and tissue function of wounded skin are both essential for wound repair and regeneration, while synergistic promotion of the two remains elusive. Since elevated reactive oxygen species (ROS) production in the injured site has been implicated in triggering a set of deleterious effects such as cellular senescence, fibrotic scarring, and inflammation, it is speculated that alleviating oxidative stress in the microenvironment of injured site would be beneficial to promote regenerative wound healing. In this study, a highly versatile ROS-scavenging tissue adhesive nanocomposite is synthesized by immobilizing ultrasmall ceria nanocrystals onto the surface of uniform mesoporous silica nanoparticles (MSN). The ceria nanocrystals decorated MSN (MSN-Ceria) not only has strong tissue adhesion strength, but also significantly restricts ROS exacerbation mediated deleterious effects, which efficiently accelerates the wound healing process, and more importantly, the wound area exhibits an unexpected regenerative healing characteristic featured by marked skin appendage morphogenesis and limited scar formation. This strategy can also be adapted to other wound repair where both ROS-scavenging activity and tissue adhesive ability matter.

Graphical abstract

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Non-invasive evaluation of Secukinumab efficacy in severe plaque psoriasis with confocal microscopy and optical coherence tomography: A case report

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Feature analysis of ultrasound elastography image for quantitative assessment of cutaneous carcinoma

Abstract

Background

To evaluate the feasibility of using quantitative texture features computed from high frequency ultrasound and ultrasound elastography (USE) images in the discrimination of benign from malignant skin lesions.

Methods

A commercial ultrasound system with a 14 MHz transducer was used to visualize skin lesions requiring biopsy on clinical evaluation. Patients were enrolled over a 6-month period and imaged prospectively by operators blind to the histopathologic diagnosis. Anatomic ultrasound and USE imaging of the skin lesions was performed using a 2-4 mm gel standoff pad before biopsy and histopathologic evaluation. The ElastoAnalysis software developed for the texture analysis of USE images was provided by Hitachi. The software computes thirteen texture features within a region of interest (ROI), which have demonstrated promise in diagnostic characterization of liver fibrosis staging and in quantitative elastography of breast cancer. This approach has not yet been studied in the quantitative assessment of skin cancer. Results were retrospectively compared to the histopathologic diagnosis and a diagnostic criteria with the goal of maximizing sensitivity was evaluated for each textural feature.

Results

Of the 37 lesions included, among 30 patients who participated, 12 lesions were malignant and 25 were benign. Eleven out of thirteen textural metrics computed by the software were useful in differentiating benign from malignant lesions with 100% sensitivity and specificities ranging from 28% to 85%.

Conclusions

This feasibility study demonstrated that feature analysis of USE may be useful in quantitatively differentiating cancerous from benign primary solitary skin lesions prior to biopsy.

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Sensitive skin in Korean population: An epidemiological approach

Abstract

Background/Purpose

Sensitive skin is characterized by uncomfortable sensations in response to multiple factors that do not normally have irritant properties. We used an epidemiological approach to evaluate the prevalence and characteristics of sensitive skin in a Korean population, and compared the results with those of populations from other countries.

Methods

A representative nationwide sample of 1000 Koreans aged ≥15 years was selected. The methodology used in this study (questionnaires) was the same as that used in similar studies conducted in other countries.

Results

Sensitive skin was present in 56.8% of the Koreans. The prevalence of sensitive skin was highest among countries such as the USA (44.6%), Europe (38.4%), Russia (39.7%), Brazil (34.2%), and Japan (54.5%). Participants with sensitive skin were more likely to accompany skin disorders than those with non-sensitive skin (72.3% vs 38.0%; P < .001). Sensitive skin group were 2-3 times more reactive to climatic and environmental factors, cosmetics, and food items than non-sensitive skin group.

Conclusion

The prevalence of sensitive skin in Korea is the highest among countries in which such investigation has been conducted. The sensitive skin group appears more likely to experience dermatological reactions to unexpected factors than the non-sensitive skin group.

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Haptic augmented skin surface generation toward telepalpation from a mobile skin image

Abstract

Background/purpose

Very little is known about the methods of integrating palpation techniques to existing mobile teleskin imaging that delivers low quality tactile information (roughness) for telepalpation. However, no study has been reported yet regarding telehaptic palpation using mobile phone images for teledermatology or teleconsultations of skincare.

Methods

This study is therefore aimed at introducing a new algorithm accurately reconstructing a haptic augmented skin surface for telehaptic palpation using a low-cost clip-on microscope simply attached to a mobile phone. Multiple algorithms such as gradient-based image enhancement, roughness-adaptive tactile mask generation, roughness-enhanced 3D tactile map building, and visual and haptic rendering with a three-degrees-of-freedom (DOF) haptic device were developed and integrated as one system.

Results

Evaluation experiments have been conducted to test the performance of 3D roughness reconstruction with/without the tactile mask. The results confirm that reconstructed haptic roughness with the tactile mask is superior to the reconstructed haptic roughness without the tactile mask. Additional experiments demonstrate that the proposed algorithm is robust against varying lighting conditions and blurring. In last, a user study has been designed to see the effect of the haptic modality to the existing visual only interface and the results attest that the haptic skin palpation can significantly improve the skin exam performance.

Conclusion

Mobile image-based telehaptic palpation technology was proposed, and an initial version was developed. The developed technology was tested with several skin images and the experimental results showed the superiority of the proposed scheme in terms of the performance of haptic augmentation of real skin images.

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Treatment of hemorrhagic head and neck lesions by direct puncture and nBCA embolization

Life-threatening bleeding in the head and neck region requires urgent management. These hemorrhagic lesions, for example, a ruptured pseudoaneurysm, are often treated by transarterial embolization (TAE), but prior intervention or surgery, inflammation, anatomic variants, and vessel tortuosity may render an endovascular approach challenging, time-consuming, and sometimes impossible. We report two cases of severe head and neck hemorrhages successfully embolized with n-butyl cyanoacrylate via direct puncture, and propose this approach as a fast, safe, and effective alternative to TAE.

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¿Para qué se utiliza la prueba del talón en recién nacidos?

Los Programas de Cribado Neonatal de Enfermedades Endocrino Metabólicas (PCN) empiezan con una punción del talón de todos los recién nacidos en hospitales españoles (tanto públicos como privados) y su análisis posterior para la detección de trastornos que ponen en peligro la salud, condiciones de vida personal y familiar e incluso la vida. Estos programas están reconocidos por el Sistema Nacional de Salud como una actividad encaminada a mejorar la salud de la población, dirigida a promover, mantener y proteger la salud y prevenir enfermedades, lesiones e incapacidades.

Las pruebas de detección (también denominadas de cribado o tamizaje) para recién nacidos se llevan a cabo para detectar de forma precoz enfermedades metabólicas, genéticas o que pueden afectar al desarrollo de los niños. El diagnóstico precoz permite instaurar el tratamiento antes de la presentación de los síntomas.

Las pruebas están diseñadas para identificar casos de enfermedades que, aunque suelen ser muy poco frecuentes, pueden tratarse cuando se diagnostican a tiempo.

Los test de cribado por sí solos no son una forma de diagnóstico de la enfermedad. Sin embargo, son útiles para detectar qué bebés necesitarán pruebas adicionales para descartarla algunas dolencias de forma definitivas o bien diagnosticarlas y comenzar a tratarlas lo antes posible.

Entre otros trastornos, los análisis de la sangre extraída del talón se utilizan para detectar

• Trastornos del metabolismo de los aminoácidos
• Hiperplasia suprarrenal congénita
• Hipotiroidismo congénito
• Fibrosis quística
• Trastornos del metabolismo de los ácidos grasos
• Galactosemia
• Deficiencia de glucosa-6-fosfato deshidrogenasa (G6PD)
• VIH
• Fenilcetonuria (FCU)
• Trastornos de la hemoglobina
• Toxoplasmosis

Hipotiroidismo en recién nacidos

La mayoría de los bebés afectados no presentan síntomas o bien estos son leves, por ese motivo es crucial la prueba del talón. Los bebés con hipotiroidismo grave a menudo tienen una apariencia característica que va acentuándose a medida que avanza la enfermedad:

• Mirada triste
• Cara hinchada
• Lengua gruesa y prominente

Otros signos y síntomas son:

• Atragantamientos o episodios de asfixia
• Estreñimiento
• Ictericia (color amarillento en piel y mucosas)
• Falta de tono muscular
• Dificultades para alimentarse
• Llanto ronco
• Somnolencia excesiva
• Crecimiento insuficiente
• Brazos y piernas cortos
• Manos anchas y dedos cortos
• Separación amplia entre los huesos del cráneo

La mayoría de los efectos del hipotiroidismo congénito son fáciles de contrarrestar siempre que se diagnostique y se trate a tiempo. Sin tratamiento, el hipotiroidismo leve puede llevar a discapacidad intelectual grave y problemas en el crecimiento. Incluso se han descrito casos de hipotiroidismo subclínico en neonatos en los que la administración del tratamiento ha resultado eficaz.

La entrada ¿Para qué se utiliza la prueba del talón en recién nacidos? se publicó primero en Cuida tu tiroides.

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¿Cómo se relacionan celiaquía e hipotiroidismo?

• La enfermedad celiaca es una enfermedad crónica de origen autoinmune causada por una reacción al gluten
• Una de cada cien personas está afectada por esta condición
• Los síntomas incluyen
  • Sensación de hinchazón
  • Diarrea
  • Náuseas
  • Estreñimiento
  • Flatulencias
  • Cansancio
  • Pérdida de peso súbita o sin explicación
  • Pérdida del cabello
  • Anemia
• Una vez diagnosticado, se trata eliminando de por vida el gluten en la dieta
• Su manifestación cutánea se conoce como dermatitis herpetiforme

Las personas con enfermedad tiroidea de origen autoinmune (como enfermedad de Hashimoto) tienen un riesgo más elevado que la población general de desarrollar celiaquía. Entre un 1,5% y un 3,6% de las personas con trastornos tiroideos autoinmunes son celiacos, una proporción que es solo del 1% entre la población general.

La frecuencia de presentación de otra enfermedad autoinmune es del 9,67% en las personas con enfermedad de Graves y del 14,3% entre quienes tiroiditis de Hashimoto. Otras enfermedades concomitantes que se dan en más de un 10% de los pacientes con enfermedad de Graves o de Hashimoto son las siguientes:

• Anemia perniciosa
• Lupus eritematoso sistémico
• Enfermedad de Addison
• Celiaquía
• Vitíligo

Algunos estudios han estimado que hay enfermedad tiroidea patente en 13,9% de los pacientes celiacos (2,1% de los sujetos sanos), y que la enfermedad tiroidea subclínica está presente en algo más del 10% (10,1%) de estos pacientes, mientras que afectaría a un 3,3% de la población sin celiaquía.

Entre las consecuencias más conocidas de la celiaquía están la malabsorción de nutrientes e inflamación de la mucosa del intestino delgado, así como atrofia de las vellosidades del intestino, que remiten cuando se elimina el gluten de la dieta.

Pacientes en riesgo:

• El diagnóstico de la enfermedad celiaca es complicado porque muchos pacientes experimentan síntomas muy leves, en ocasiones ninguno. El riesgo de padecer enfermedad celiaca no diagnosticada es particularmente elevado en las personas que tienen otra enfermedad autoinmune.
• Se recomienda a los médicos endocrinos estar especialmente alerta en cuanto a la posible presentación de enfermedad celiaca, que puede diagnosticarse en un porcentaje que oscila entre el 2% y el 5% de los pacientes con diabetes mellitus dependiente de insulina o con enfermedad de la tiroides de origen autoinmune.
• Los pacientes con trastornos endocrinos diversos
• Personas con enfermedad de Addison, alopecia o hipofisitis

 

Se considera como una explicación generalmente aceptada para estas relaciones que entre algunos pacientes existe una cierta propensión hereditaria a desarrollar enfermedades autoinmunes.

La dieta libre de gluten es clave para prevenir complicaciones de la celiaquía tales como

• Anemia
• Osteoporosis
• Infertilidad

Además, la dieta también puede convertirse en un tratamiento para la enfermedad endocrina subyacente u oculta, ya que la exposición prolongada al gluten puede contribuir al desarrollo de enfermedades autoinmunes.

La entrada ¿Cómo se relacionan celiaquía e hipotiroidismo? se publicó primero en Cuida tu tiroides.

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Síntomas de la menopausia: ¿cómo afecta esta alteración hormonal a las enfermedades tiroideas?

Las enfermedades que afectan a la tiroides pueden desencadenar una menopausia precoz (antes de los 40 o a comienzos de esta década). Algunos síntomas de tiroides hiperactiva (hipertiroidismo) también pueden confundirse con una menopausia precoz:

• Falta de menstruación
• Sofocos
• Dificultad para conciliar el sueño
• Cambios de humor

Tratar el hipertiroidismo puede aliviar los síntomas de la menopausia precoz o prevenirla ¿Tiene dudas sobre el estado de su tiroides? Acceda a nuestro cuestionario.

Hay una prevalencia mayor de niveles elevados de hormona estimulante de la tiroides (TSH) a medida que se van cumpliendo años, sobre todo entre mujeres que ya han pasado la menopausia, entre las cuales es aún más acusado el riesgo.

Incidencia de enfermedad tiroidea:

• Enfermedad tiroidea patente- 2,4%
• Enfermedad tiroidea subclínica- 23,2%

Tiroides y menopausia

No es infrecuente que se culpe de forma errónea a la menopausia de la aparición de síntomas de alteraciones tiroideas. Para confirmar un diagnóstico, es necesario llevar a cabo un análisis de sangre. Cuando los resultados son ambiguos, suele repetirse la prueba transcurrido cierto tiempo o realizar controles con un especialista.

Terapia de sustitución hormonal y fitoestrógenos

En algunas mujeres, los síntomas de la menopausia son severos debido a la deficiencia de estrógeno y en estos casos puede que se recomiende la terapia de sustitución hormonal. Las pacientes que no tenían enfermedad tiroidea antes de llegar a esta fase suelen adaptarse bien a esta terapia y su función tiroidea se mantiene normal. No obstante, las mujeres con hipotiroidismo previo tratado con tiroxina pueden necesitar que se aumente la dosis de ésta al comenzar a tomar la terapia sustitutiva. En consecuencia, es útil realizar las pruebas de función tiroidea después de que se haya instaurado la terapia de sustitución.

Los alimentos que contienen soja son un elemento clásico de la dieta asiática, pero se han extendido por todo el mundo recientemente. Entre otros beneficios, se les atribuye la capacidad de aliviar síntomas de la menopausia como los sofocos, y de prevenir la osteoporosis. Los fitoestrógenos que contienen podrían ser la causa de estos beneficios. Con todo, también se ha advertido que la soja puede interferir en la función tiroidea, aunque hay pocas evidencias al respecto.

Algunos expertos consideran que en las personas cuya función tiroidea está al límite de la normalidad y siguen una dieta pobre en yodo, los alimentos con soja pueden incrementar el riesgo de hipotiroidismo. Por lo tanto, es importante que quienes consuman estos alimentos de forma habitual se aseguren de que su ingesta de yodo es suficiente.

Tiroides y osteoporosis

La tiroides juega un papel crucial en el mantenimiento de los huesos. En mujeres postmenopáusicas, el hipertiroidismo se ha definido como factor de riesgo de fractura de cadera.

En parte, esto se debe a los efectos de un exceso de hormonas tiroideas circulantes en el ciclo de producción y reabsorción del hueso.

• En las pacientes con hipertiroidismo, la fase de producción de hueso es más corta, y la fase de reabsorción se prolonga.
• El hipotiroidismo también se asocia con mayor riesgo de fracturas.
• No está claro si el hipotiroidismo subclínico conlleva mayor riesgo de fracturas.

La entrada Síntomas de la menopausia: ¿cómo afecta esta alteración hormonal a las enfermedades tiroideas? se publicó primero en Cuida tu tiroides.

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Conoce los síntomas de obesidad por enfermedades tiroideas

Es una idea bastante extendida que el hipotiroidismo es la causa de la obesidad. Sin embargo, establecer una relación causa/efecto es un asunto controvertido. El hipotiroidismo patente se ha asociado con aumentos de peso relativamente modestos, pero no se han definido claramente las consecuencias del hipotiroidismo subclínico.

Elementos que intervienen en esta relación:

• El sistema endocrino– Un grupo de glándulas del organismo (hipófisis, tiroides, páncreas…) que segregan hormonas, entre ellas las que regulan el consumo de energía, el crecimiento y la reproducción.
• La tiroides– La mayor de esas glándulas. Tiene forma de mariposa y se encuentra en la base del cuello. Produce tiroxina (T4) triyodotironina (T3) y calcitonina. Las hormonas tiroideas actúan prácticamente en todas las células del organismo, aumentando su actividad. Cuando los niveles de hormonas están por encima o por debajo de lo normal, sus efectos se producen en todo el cuerpo. Como las hormonas T3 y T4 controlan el metabolismo de las células de todo el organismo, cuando son insuficientes éste queda alterado.
• Estudios recientes indican que los cambios en los niveles de la hormona estimulante de la tiroides (TSH) pueden, de hecho, presentarse después de establecida la obesidad. El aumento de la prevalencia de la obesidad hace que se confunda aún más la definición de los niveles normales de TSH en la población.
• Hacer un estudio de anticuerpos puede ayudar a determinar si hay un hipotiroidismo de grado subclínico en casos de obesidad y contribuir a corregirlo.
• Los niveles elevados la proteína llamada leptina también pueden desempeñar una función importante en la hipertirotropinemia (elevación mantenida de los niveles de TSH con niveles normales de otras hormonas tiroideas) y hacer que una persona sea más susceptible de desarrollar anticuerpos y, a consecuencia de esto, hipotiroidismo.

 

Dado que las hormonas tiroideas son importantes para el funcionamiento de todas las células del organismo, los signos y síntomas de niveles inadecuados pueden ser muy diversos, y con frecuencia están poco claros.    

• Fatiga
• Somnolencia
• Cambios de humor
• Alteraciones de la memoria
• Aumento de peso
• Depresión o irritabilidad
• Calambres y dolor muscular
• Debilidad
• Sudoración escasa
• Alteraciones de la presión arterial
• Elevación del colesterol
• Inflamación de las piernas
• Visión borrosa
• Intolerancia al frío
• Ronquera
• Sequedad en piel y cabello
• Caída del cabello o del vello
• Estreñimiento

 

¿Cuál es la relación entre enfermedad tiroidea y peso?

Aunque se ha observado aumento de peso (o dificultad para perderlo) en casos de hipotiroidismo, el vínculo entre esta enfermedad y el índice de masa corporal (IMC, la relación entre el peso y la altura del paciente) y la obesidad no se comprenden aún del todo. Varios estudios realizados en los últimos tiempos han prestado atención a este fenómeno.

Un estudio con más de 6.000 pacientes mostró que las personas con IMC más altos tenían también niveles más elevados de TSH, una hormona que muestra mayores concentraciones en pacientes con hipotiroidismo.

Otro mostraba que 11,5% de los pacientes obesos cuyos casos se estudiaron en una clínica especializada en trastornos del sueño tenían hipotiroidismo subclínico, con una relación estrecha entre el IMC y la circunferencia del cuello.

Son varias las investigaciones que han observado cambios en la TSH en pacientes obesos, con niveles normales de T4 y T3.

¿Cómo me hago una prueba de la tiroides?

Se considera que hay suficientes evidencias científicas de que existe un trastorno tiroideo sin diagnosticar en casos de obesidad. En presencia de sobrepeso u obesidad, probablemente es una buena idea realizar análisis de tiroides en las revisiones médicas habituales, particularmente cuando el sujeto es una mujer o si padece resistencia a la insulina o diabetes, ya que en esas circunstancias el riesgo es mayor. Las pruebas más comunes son:

• Test de TSH
• Test de T3 y T4
• Prueba de anticuerpos
• Otras pruebas: TRH, ecografía de la tiroides, prueba de absorción de yodo radiactivo

La entrada Conoce los síntomas de obesidad por enfermedades tiroideas se publicó primero en Cuida tu tiroides.

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Las enfermedades tiroideas y la lactancia materna

Las hormonas tiroideas cumplen una función importante en la regulación de la lactancia, ya que contribuyen a regular la prolactina y la oxitocina. No obstante, hay pocos estudios que hayan analizado el impacto de la enfermedad de la tiroides en la lactancia. Se cree que el hipotiroidismo puede interferir en la producción de leche, pero las consecuencias del hipertiroidismo y la tiroiditis post-parto siguen siendo asuntos poco explorados por los investigadores.

• Antes de un diagnóstico de enfermedad tiroidea– Hace más de una década que algunos investigadores mostraron que es frecuente que los intentos fallidos de establecer una lactancia adecuada pueden ser la antesala de los síntomas de problemas tiroideas.
• Con diagnóstico establecido de hipotiroidismo- Para algunas madres con hipotiroidismo, es difícil alcanzar un suministro de leche lo suficientemente intenso para alimentar a su bebé, ya que las hormonas tiroideas desempeñan un papel importante en la producción de leche. El hipotiroidismo se trata para recuperar los niveles normales. Algunas pacientes aprecian que el suministro es mejor cuando sus niveles de hormonas tiroideas son elevados (dentro del rango de normalidad).
• Con diagnóstico establecido de hipertiroidismo- Para algunas madres con hipertiroidismo, la producción de leche es abundante, pero también se han documentado casos en los que el "reflejo de eyección" que lleva la leche al pezón no funciona adecuadamente.

En los 12 meses siguientes al parto, es importante que el hipertiroidismo debido a enfermedad de Graves no se confunda con la fase hipertiroide de la tiroiditis post-parto, ya que estas condiciones tienen diferentes causas y –sobre todo- diferente tratamiento.

Medicación

Las mujeres que padecían alguna condición relacionada con la tiroides antes de quedarse embarazadas tienen que someterse a controles frecuentes durante toda la gestación y la lactancia, ya que suele ser necesario ajustar las dosis para que los niveles de hormonas tiroideas se mantengan dentro de los parámetros normales.

¿Tendré problemas para dar el pecho a mi bebé si padezco hipotiroidismo?

 Lo más probable es que si toma la dosis adecuada de terapia de reemplazo, la mujer pueda dar el pecho a su hijo con normalidad. No obstante, según el libro de respuestas de la Liga de La Leche, "es posible que las mujeres con antecedentes de problemas de la tiroides tengan que someterse a las pruebas de nuevo si su hijo no gana peso a un ritmo adecuado, ya que las alteraciones del metabolismo pueden afectar a la producción de leche".

Mejorar la lactancia- Se ha visto que tanto el hipertiroidismo como el hipotiroidismo pueden manifestarse en dificultades para la liberación de la leche en el pecho, más que para su producción. Sin una adecuada circulación de ésta, aumentan las concentraciones de la proteína residual que inhibe la producción de leche. Esto tiene como consecuencia que se detenga la síntesis de leche y se produzca la involución de la glándula (retorno al estado anterior a la lactancia).

En consecuencia, mejorar la liberación de la leche puede mejorar la lactancia cuando las hormonas tiroideas no funcionan debidamente. Puede consultar con su médico la utilidad y la técnica de los masajes y la posibilidad de recurrir a alguna otra estrategia terapéutica que contribuya a mejorar la lactancia.

Es necesario dar a conocer el impacto de las alteraciones de la tiroides, así como hacer un diagnóstico preciso y precoz para elegir el mejor tratamiento en mujeres lactantes y facilitar así la alimentación de los bebés con leche materna.

La entrada Las enfermedades tiroideas y la lactancia materna se publicó primero en Cuida tu tiroides.

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Tiroides y el ciclo menstrual: ¿son normales las alteraciones del mismo?

Las hormonas tiroideas desempeñan un papel importante en el normal funcionamiento de los mecanismos reproductivos. Por lo tanto, las alteraciones tiroideas tienen efectos en el ciclo menstrual, y éste puede ser un indicio de que algo no funciona bien en la tiroides.

En la mayor parte de los libros de texto que tratan sobre hipotiroidismo se menciona el hecho de que este trastorno puede tener como resultado una alteración de la duración del ciclo menstrual (aumentada) y de la cantidad de sangrado (también mayor). También se ha apuntado que este tipo de irregularidades son más frecuentes cuando el hipotiroidismo es más severo.

Por otro lado, en el hipertiroidismo, los niveles excesivos de hormonas tiroideas tienen efectos diferentes, con periodos más cortos, más separados entre sí y sangrados menos profusos.

La función tiroidea afecta a los siguientes procesos:

• Ciclo menstrual
• Fertilidad
• Embarazo
• Pubertad (precoz o tardía)

La disfunción tiroidea se ha asociado con las siguientes alteraciones menstruales:

• Oligomenorrea (menstruación poco frecuente)
• Amenorrea (ausencia de menstruación)
• Menorragia (menstruación abundante)

Además, se ha observado que las mujeres con hipotiroidismo pueden ser más propensas a los abortos espontáneos, una apreciación documentada en diversos estudios, incluso en mujeres que tenían función tiroidea normal antes de quedarse embarazadas.

Por estos motivos, se ha sugerido que es recomendable llevar a cabo análisis de la función tiroidea en aquellas mujeres que experimenten ciclos menstruales anormales, y tratar con levotiroxina a las embarazadas con enfermedad tiroidea en las primeras fases de la gestación.

Puesto que las enfermedades de la tiroides son trastornos endocrinos frecuentes en mujeres en edad fértil, algunos expertos sugieren que la primera prueba a la que debe someterse una mujer que tiene dificultades para quedarse embarazada es una prueba de función tiroidea, sobre todo si existen antecedentes familiares de este tipo de enfermedad.

Tratar la disfunción tiroidea puede devolver a la normalidad los ciclos y mejorar la fertilidad.

En mujeres infértiles, la prevalencia de enfermedad tiroidea autoinmune es significativamente mayor que entre las mujeres sanas. Tanto el hipotiroidismo como el hipertiroidismo se asocian con menor fertilidad.

Mecanismos por los que la enfermedad tiroidea provoca alteraciones de la menstruación

• Los folículos no reciben suficiente hormona tiroidea para desarrollarse y ovular
• El hipotiroidismo está asociado a niveles elevados de estrógeno
• La función tiroidea irregular puede ir acompañada de desajustes en los factores de coagulación

Hay estimaciones que cifran la proporción de mujeres mayores de 60 años afectadas por hipotiroidismo subclínico en el 20%.

La entrada Tiroides y el ciclo menstrual: ¿son normales las alteraciones del mismo? se publicó primero en Cuida tu tiroides.

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Hipotiroidismo y anemia: Conoce la importancia del hierro en la dieta

Las hormonas tiroideas afectan directa e indirectamente al crecimiento de los glóbulos rojos, cuya escasez suele definir el estado de anemia. Cuando no hay suficientes hormonas tiroideas, es común que se desarrolle anemia. De hecho, algunos especialistas han calificado la anemia de "primer signo de hipotiroidismo".

Así, aunque es frecuente que las personas con hipotiroidismo padezcan anemia, rara vez se considera ésta entre las consecuencias del hipotiroidismo subclínico (sin síntomas evidentes). El tipo de anemia y la causa de ésta son diferentes entre personas con un diagnóstico de hipotiroidismo y quienes sufren la forma no manifiesta o subclínica.

Un reciente trabajo de investigación recomienda que se evalúen de forma adecuada la anemia y el hipotiroidismo, ya que el tratamiento es diferente en función de las causas.

Prevalencia de anemia en pacientes con hipotiroidismo

• La frecuencia de anemia en casos de hipotiroidismo subclínico es casi tan elevada como la de los casos diagnosticados (clínico)
• Hipotiroidismo clínico: 43% con anemia
• Hipotiroidismo subclínico: 39% con anemia
• Población general: 26%

Se recomienda realizar pruebas de hipotiroidismo a los pacientes con anemia de origen desconocido.

La anemia asociada a hipotiroidismo suele ser normocítica normocrómica (glóbulos rojos de tamaño y coloración normales), que es a su vez típica en edades avanzadas. Si el hipotiroidismo es de origen autoinmune (enfermedad de Hashimoto), puede darse anemia perniciosa, con niveles bajos de vitamina B 12.

Causas (crónicas) de anemia normocítica

• Infecciones crónicas
• Neoplasias
• Alteraciones reumatológicas
• Malnutrición
• Insuficiencia renal
• Insuficiencia hepática.
• Alteraciones endocrinas
• Síndrome mielodisplásico

Síntomas de anemia

• Fatiga
• Debilidad muscular
• Latidos cardiacos rápidos o irregulares
• Dolor en el pecho
• Dificultad para respirar
• Mareos
• Palidez en la piel o los labios
• Dolor de cabeza
• Dificultad para concentrarse
• Insomnio
• Alteraciones de la temperatura corporal
• Hemorragias

 

Consecuencias de no tratar la anemia

• Fatiga severa. Cuando la anemia es lo suficientemente acusada, puede provocar fatiga en un grado que impide realizar tareas diarias.
• Complicaciones del embarazo. Las mujeres embarazadas con anemia y deficiencia de ácido fólico pueden estar más expuestas a complicaciones, como parto prematuro.
• Problemas cardiacos. La anemia puede desembocar en arritmia cardiaca. El corazón de una persona con anemia tiene que bombear más sangre para compensar la falta de oxígeno. Esto puede hacer que el órgano aumente de tamaño o provocar insuficiencia cardiaca.
• En los últimos años se han publicado diversos estudios que relacionan la anemia con complicaciones durante o después de intervenciones quirúrgicas. Un equipo de investigadores españoles ha medido su impacto en mayor duración de los ingresos hospitalarios, incrementos en la morbilidad (enfermedad) y mortalidad.

La entrada Hipotiroidismo y anemia: Conoce la importancia del hierro en la dieta se publicó primero en Cuida tu tiroides.

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Trastornos autoinmunes: la relación entre hipotiroidismo y diabetes

 La diabetes tipo 1 y la enfermedad tiroidea son enfermedades endocrinas, que afectan a las hormonas del organismo. Tanto el páncreas como la tiroides pertenecen al sistema endocrino del cuerpo. La tiroides es una glándula en forma de mariposa que se encuentra en la parte inferior del cuello, justo por debajo de la piel. Regula el metabolismo, los procesos de almacenamiento y uso de la energía, entre otras importantes funciones, liberando hormonas tiroideas. El páncreas es otra glándula, de forma alargada y cónica, situada detrás del estómago. Segrega enzimas digestivas e insulina, entre otras hormonas.

Cuando se presenta una enfermedad tiroidea en una persona con diabetes, es posible que haga más difícil el control de los niveles de glucosa.

Las enfermedades tiroideas son frecuentes, y su prevalencia se incrementa con la edad.  Las pruebas actuales para evaluar si la función tiroidea es correcta son fiables y baratas. Se suelen realizar análisis de la tiroides en ciertos grupos de riesgo, como recién nacidos y personas mayores.

Se ha observado que los pacientes diabéticos pertenecen a esos grupos de riesgo. Las personas con un trastorno autoinmune (como es la diabetes tipo 1) pueden desarrollar otras enfermedades de este tipo. Las personas con diabetes tipo 2, que no es un trastorno autoinmune, también tienen mayor riesgo, aunque no está claro el motivo de dicha relación, y se ha planteado que tenga que ver con la edad avanzada.

Ya que la disfunción tiroidea es más frecuente entre la población femenina, no es sorprendente que los científicos hayan desvelado los siguientes datos:

• Hasta el 30% de las mujeres con diabetes tipo 1 padecen alguna alteración de la función de la glándula tiroides
• La tiroiditis postparto es tres veces más frecuente entre pacientes diabéticas que entre la población general
• También hay más enfermedad tiroidea en la población con diabetes tipo 2 (sobre todo hipotiroidismo)
• Prevalencia de enfermedad tiroidea en la población general: 6,6%
• Prevalencia de la enfermedad tiroidea en población diabética (general): 10,8%
• Hipotiroidismo: 36%
• Hipotiroidismo subclínico: 513%
• Hipertiroidismo: 12%
• Tiroiditis postparto: 11%

Efectos de las alteraciones de la función de la tiroides en la diabetes

Hipertiroidismo

• Cuando se acelera el metabolismo, los medicamentos que tomamos se procesan con mayor rapidez
• Los niveles de glucosa pueden elevarse porque la dosis de medicamento que se toma no permanece en el organismo el tiempo necesario para surtir el efecto deseado
• Es difícil distinguir la hipoglucemia (descenso de los niveles de glucosa) y el hipertiroidismo, ya que en ambos casos pueden presentarse los siguientes síntomas:
  • Sudor
  • Temblores

Si una persona con estos síntomas cree que tiene la glucosa demasiado baja, puede comer más para elevarlos, lo cual elevaría en exceso la cantidad de glucosa en el organismo. Se recomienda verificar los niveles con el medidor para evitar este problema.

Hipotiroidismo

• Cuando el metabolismo es lento, los niveles de glucosa pueden descender, ya que los medicamentos no se procesan con la rapidez habitual y permanecen en el organismo más tiempo del habitual
• Con frecuencia es necesario ajustar la dosis de los medicamentos antidiabéticos para prevenir hipoglucemias

Ante indicios de enfermedad tiroidea, hable con su médico de los síntomas que experimenta. Un sencillo reconocimiento y un análisis de sangre bastan para identificar tanto el hipertiroidismo como el hipotiroidismo. Puede consultar algunas de las señales más frecuentes en nuestro cuestionario.

La entrada Trastornos autoinmunes: la relación entre hipotiroidismo y diabetes se publicó primero en Cuida tu tiroides.

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Treatment challenges in and outside a specialist network setting: pancreatic neuroendocrine tumours

Publication date: Available online 16 October 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Panagis Lykoudis, Stefano Partelli, Francesca Muffatti, Martyn Caplin, Massimo Falconi, Giuseppe Fusai
Pancreatic Neuroendocrine Neoplasms comprise a group of rare tumours with special biology, an often indolent behaviour and particular diagnostic and therapeutic requirements. The specialized biochemical tests and radiological investigations, the complexity of surgical options and the variety of medical treatments that require individual tailoring, mandate a multidisciplinary approach that can be optimally achieved through an organized network. The present study describes currents concepts in the management of these tumours as well as an insight into the challenges of delivering the pathway in and outside a Network.



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Patient satisfaction with Radioguided Occult Lesion Localisation using Iodine-125 Seeds (‘ROLLIS’) versus conventional hookwire localisation

Publication date: Available online 16 October 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Jeremy S.L. Ong, Joelin Teh, Christobel Saunders, Anita G. Bourke, Catalina Lizama, Jade Newton, Michael Phillips, Donna B. Taylor
BackgroundWomen with impalpable or poorly palpable breast cancer require radiologically guided localisation prior to breast conserving surgery. Radioguided Occult Lesion Localisation using Iodine-125 Seed (ROLLIS) is an emerging alternative to conventional Hookwire Localisation (HWL). We compared ROLLIS with conventional HWL with respect to patient reported stress and discomfort related to the localisation procedure.Patients and methodsFrom September 2013 to January 2016, women who were eligible for breast conserving surgery with impalpable or poorly palpable histologically confirmed invasive or in-situ carcinoma were recruited to the multi-centre ROLLIS randomised controlled trial and underwent either ROLLIS or HWL. Following surgery a questionnaire was administered to each participant regarding the stress and discomfort related to the localisation procedure. Multivariate analysis was performed to compare the primary outcome of patient-reported stress and discomfort between localisation groups.Results218 participants with 220 lesions were randomised and underwent breast conserving surgery following localisation. 201 (92.2%) and 202 (92.7%) of participants provided responses to the stress and discomfort components of the questionnaire respectively. HWL was associated with a statistically significant increased odds of greater stress and discomfort when compared to ROLLIS (OR=2.07, p=0.01 and OR=1.94, p=0.01 respectively). Insertion of multiple localisation devices was also associated with increased stress (OR=5.68, p<0.01) and discomfort (OR=2.96, p<0.01).ConclusionWhen compared with conventional HWL, ROLLIS is associated with significantly less stress and discomfort for patients prior to breast conserving surgery.



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Parenchymal sparing surgery for colorectal liver metastases: the need for a common definition

Publication date: Available online 16 October 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Marie Desjardin, Gregoire Desolneux, Véronique Brouste, Olivier Degrandi, Benjamin Bonhomme, Marianne Fonck, Yves Becouarn, Dominique Béchade, Serge Evrard
BackgroundThe definition of parenchymal sparing surgery (PSS) for colorectal liver metastases (CRLM) diverges requiring a clarification of the concept.MethodA consecutive series of patients were treated by PSS for their CRLMs, either by resection or intra-operative ablation (IOA), whenever possible a one-stage surgery and minimal usage of portal vein embolization. Post-operative complications were the primary endpoint with a special focus on post-operative liver failure.ResultsThree hundred and eighty-seven patients underwent a PSS out of which 328 patients received a median of 9 pre-operative cycles of chemotherapy. One hundred and twenty-eight patients had a major resection, combined with IOA in 137 patients and IOA alone in 50 cases. The 5yr-overall survival was 50.3%. There was no difference in post-operative complications between minor and major resections, validating our PSS definition based on the Tumor burden/Healthy liver ratio and not just the retrieved volume.ConclusionsPSS is defined as a high ratio of tumoral burden per specimen retrieved while favoring one-stage surgery approach. Our series, using combined resections and IOAs, matches this definition well. Furthermore, complications were correlated neither to chemotherapy nor to liver-induced toxicities, contrary to extended hepatectomies.



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Autologous fat tissue grafting improves pulmonary healing after laser metastasectomy

Publication date: Available online 16 October 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Simone Furia, Pierfrancesco Cadenelli, Francesca Andriani, Paolo Scanagatta, Leonardo Duranti, Andrea Spano, Carlotta Galeone, Luca Porcu, Ugo Pastorino
BackgroundExtensive clinical experience has demonstrated the potential usefulness of autologous fat tissue (AFT) graft in tissue reconstruction, repair or regeneration. In the present study, we evaluated the feasibility and safety of AFT in the repair of surgically injured lung surface.MethodsEighty consecutive procedures of pulmonary metastasectomy by laser precision resection, were performed in 66 patients between March 2010 and December 2012. In the first 20 procedures, AFT graft was applied on the wounded pulmonary surface without closure of parenchymal surface. The following 40 procedures were carried on without AFT (20 leaving the resection margins open and 20 closing the resection margins with a running suture). In the remaining 20 procedures, AFT was applied and the resection margins closed. The efficacy of this technique was evaluated by comparing the AFT group with the non-AFT group, with respect to prolonged alveolar air leakage (PAAL), time to drain removal, length of hospital stay, and patient survival at four years.ResultsThe occurrence of PAAL was lower in the AFT group as compared to non-AFT group (17.5% versus 42.5%, p=0.027), and median time to drain removal shorter (4 versus 6 days respectively, p=0.016). Overall 4-year survival was 70% for AFT group, and 59% for non-AFT group (p= 0.34).ConclusionsThis prospective cohort observational study demonstrated the feasibility and safety of AFT pulmonary grafting after laser metastasectomy. AFT graft improved pulmonary healing, by reducing the incidence and severity of PAAL. Moreover, there was no evidence of tumor promotion in the metastatic setting, with a similar overall survival at 4 years.



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An analysis of factors affecting the accuracy of endoscopic biopsy after neoadjuvant chemoradiotherapy in patients with esophageal squamous cell carcinoma

Publication date: Available online 16 October 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Yin-Kai Chao, Yu-Wen Wen, Hsien-Kun Chang, Chen-Kan Tseng, Yun-Hen Liu
PurposeThe accuracy of endoscopic esophageal biopsy after neoadjuvant chemoradiotherapy (nCRT) remains suboptimal. We retrospectively examined the factors that may affect the diagnostic accuracy of post-nCRT endoscopic biopsy in patients with esophageal squamous cell carcinoma (ESCC).Materials and methodsA total of 213 ESCC patients were enrolled. Biopsy findings were cross-checked against the final pathology outcomes (ypT0 versus non-ypT0) to assess their accuracy. The independent predictors of diagnostic accuracy were identified by multivariate logistic regression analysis.ResultsPost-nCRT endoscopic biopsy results were diagnostically consistent with the final pathology outcomes in 116 (54.5%) patients. Multivariate logistic regression analysis identified a long time interval between the completion of nCRT and the endoscopic examination as the only factor independently associated with a higher diagnostic accuracy. Receiver operating characteristic curve analysis showed that the optimal cutoff value for the time interval between nCRT completion and endoscopic biopsy was 45 days. The estimated diagnostic accuracies of biopsies performed before and after the optimal cutoff time were 49.1% and 72.9%, respectively.ConclusionsEndoscopic biopsies performed ≥45 days after nCRT are associated with a higher diagnostic accuracy. This time cutoff may serve as a reference to inform the choice of the optimal treatment strategy following nCRT, especially among complete responders in whom surgery withholding is being considered.



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Perioperative morbidity, bowel function and oncologic outcome after radical cystectomy and ileal orthotopic neobladder reconstruction: Studer-pouch versus I-pouch

Publication date: Available online 20 October 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Johannes Mischinger, Mohamed F. Abdelhafez, Steffen Rausch, Tilman Todenhöfer, Eva Neumann, Stefan Aufderklamm, Arnulf Stenzl, Georgios Gakis
ObjectiveTo investigate whether the length of ileum used for ileal orthotopic neobladder (ONB) reconstruction (60cm vs. 40cm) after radical cystectomy (RC) for bladder cancer (BC) impacts on bowel function, postoperative complications or survival outcome.Material and MethodsIn this retrospective study, we included 56 patients who received an ONB (Studer (S)-Pouch: 23 patients; I-Pouch: 33 patients) after RC for BC between 2003 and 2011. Preoperative comorbidities were assessed by the Charlson Comorbidity Index (CCI) and surgical complications as graded by the Clavien-Dindo classification. Changes of perioperative bowel habits were retrospectively evaluated by the validated Gastrotintestinal Quality of Life Index (GIQLI). Kaplan–Meier analyses calculated survival outcomes between both ONB types.ResultsPreoperative CCI was comparable between S- and I-pouch patients. No significant differences were observed for 30-day major- (p=0.33) and minor (p=0.96) complication rates between both neobladder types. S-Pouch patients reported higher preoperative stool frequencies (S-pouch: mean 2.7; I-pouch: mean 3.4; p=0.049) and tended to suffer from urgency (S: mean 2.9; I: mean 3.4; p=0.059). No significant differences in postoperative bowel disorders were found between both neobladder types (S-Pouch: 15.9, IQR; I-Pouch: 16.6 IQR; p=0.84). Furthermore, we observed no overall-, cancer specific- or recurrence free survival advantage for either of both ONB variants (p=0.81; 0.65 and 0.78), respectively.ConclusionComorbidities, perioperative complication rates and bowel habits were similar between both ONB substitutes and did not influence survival outcomes. These stratified data suggest that the length of ileum used for ONB reconstruction (60- vs. 40cm) does not impact per se on postoperative bowel function.



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Recurrent Metastatic Medullary Thyroid Carcinoma: A Case of Sustained Response to Prolonged Treatment with Somatostatin Analogues

Thyroid , Vol. 0, No. 0.


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Recurrent Metastatic Medullary Thyroid Carcinoma: A Case of Sustained Response to Prolonged Treatment with Somatostatin Analogues

Thyroid , Vol. 0, No. 0.


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Linalool-rich essential oils from the Amazon display antidepressant-type effect in rodents

Publication date: 15 February 2018
Source:Journal of Ethnopharmacology, Volume 212
Author(s): Éverton Renan Q. dos Santos, Cristiane Socorro F. Maia, Enéas A. Fontes Junior, Ademar S. Melo, Bruno G. Pinheiro, José Guilherme S. Maia
Ethnopharmacological relevanceThe essential oils of the leaves of Aniba rosaeodora (pau-rosa), Aniba parviflora (macacaporanga) and Aeollanthus suaveolens (catinga-de-mulata), rich in linalool, are used in the traditional medicine of the Brazilian Amazon for its effects on the central nervous system, such as sedative, anticonvulsant and antidepressant, among other therapeutic properties.Aim of the studyTo analyze the chemical composition of these oils and to evaluate their neurobehavioral effects in rodents, based on different and established behavioral tests.Material and methodsThe oils were distilled and analyzed by GC and GC-MS. Male Wistar rats received intraperitoneal doses of the oils of pau-rosa (3.5 and 35mg/kg), macacaporanga (8.5 and 85mg/kg) and catinga-de-mulata (7.5 and 75mg/kg), in addition to a linalool standard (30mg/kg). The neurobehavioral effects were evaluated using the tests: Open Field (spontaneous locomotion activity), Elevated Plus Maze (anxiolytic- type activity), Splash and Forced Swimming (antidepressive-type activity) and the Inhibitory Avoidance (memory retention).ResultsThe three oils (highest dose) and standard linalool presented significant antidepressant activity in rodents. Linalool was identified as the major constituent of the oils (pau-rosa, 88.6%, macacaporanga, 45%, catinga-de-mulata, 49.3%). The standard linalool used was 97.0%.ConclusionThe pau-rosa, macacaporanga, and catinga-de-mulata oils presented antidepressant activity due to the presence of linalool, which, by the final synergistic action of other constituents found in oils, may have contributed to the increase or reduction of this behavioral effect in the treated animals. A relevant fact is that there was no compromise of spontaneous locomotion and the memory retention in the rodents.

Graphical abstract

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What Can SCORE Web Portal Usage Analytics Tell Us About How Surgical Residents Learn?

Publication date: Available online 24 October 2017
Source:Journal of Surgical Education
Author(s): Amit R.T. Joshi, Aitua Salami, Mark Hickey, Kerry B. Barrett, Mary E. Klingensmith, Mark A. Malangoni
PurposeThe Surgical Council on Resident Education (SCORE) was established in 2004 with 2 goals: to develop a standardized, competency-based curriculum for general surgery residency training; and to develop a web portal to deliver this content. By 2012, 96% of general surgery residency programs subscribed to the SCORE web portal. Surgical educators have previously described the myriad ways they have incorporated SCORE into their curricula. The aim of this study was to analyze user data to describe how and when residents use SCORE.MethodsUsing analytic software, we measured SCORE usage from July, 2013 to June, 2016. Data such as IP addresses, geo-tagging coordinates, and operating system platforms were collected. The primary outcome was the median duration of SCORE use. Secondary outcomes were the time of day and the operating system used when accessing SCORE. Descriptive statistics were performed, and a p < 0.05 was deemed statistically significant.ResultsThere were 42,743 total SCORE subscribers during the study period (75% resident and 25% faculty) with a mean of 14,248 subscribers per year. The overall median duration of SCORE use was 11.9minute/session (interquartile range [IQR]: 6.8). Additionally, there was a significant increase in session length over the 3 academic years; 10.1 (IQR: 6.4), 11.9 (IQR: 7.2), and 13.2minute/session (IQR: 5.4) in 2013 to 2014, 2014 to 2015, and 2015 to 2016, respectively (p < 0.001). SCORE usage was highest in November to February at 21.0minute/session (14.2) compared to July to October and March to June (12.3 [IQR: 3.2] and 9.6minute/session [IQR: 2.2]), respectively (p < 0.001). This seasonal trend continued for all 3 years. We observed an increased number of sessions per day over the 3 years: median of 1500 sessions/d (IQR: 1115) vs 1706 (IQR: 1334) vs 1728 (IQR: 1352), p < 0.001. (Fig.). Most SCORE sessions occurred at night: 38,011 (IQR: 4532) vs 17,529 (IQR: 19,850) during the day (p < 0.001). Windows was the most frequently used operating system at 48.9% (p < 0.001 vs others).ConclusionsSCORE usage has increased significantly over the last 3 years, when measured by number of sessions per day and length of time per session. There are predictable daily, diurnal, and seasonal variations in SCORE usage. The annual in-training examination is a prominent factor stimulating SCORE usage.



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Reap What You Sow: Which Rural Surgery Training Programs Currently Exist and Do Medical Students Know of Their Existence?

Publication date: Available online 24 October 2017
Source:Journal of Surgical Education
Author(s): Isolina R. Rossi, Aaron L. Wiegmann, Pat Schou, David C. Borgstrom, Matthew B. Rossi
BackgroundThere exists an acute need to recruit and train general surgeons for rural communities. To assist medical students interested in rural surgery, the American College of Surgeons (ACS) website lists general surgery residencies, which are tailored to train the rural surgeon by providing exposure to endoscopy, gynecology, urology, orthopedics, and otolaryngology. Another available reference is the American Medical Association Fellowship and Residency Electronic Database (FREIDA). FREIDA allows programs to indicate availability of a rural training scheme. This is an effort to identify programs which demonstrate a commitment to training rural surgeons and evaluate accessibility of this information to medical students.MethodsEach ACGME general surgery residency program in the United States and Canada received an electronic survey. They were queried on commitment to training rural surgeons and their ability to provide 3 to 12 months of subspecialty training.ResultsOf the 261 programs surveyed, 52 (19.9%) responses were obtained; 11 had established rural tracks and 15 were willing to customize a program. We identified 14 additional rural training programs not identified by either the ACS website or FREIDA. In total, 44 programs identified by ACS, FREIDA, and our survey indicate they can accommodate the rural surgical resident.ConclusionsFor a medical student interested in rural surgery, several obstacles must be overcome to find the appropriate residency program. A complete and updated list of established tracks or customizable training schemes does not exist. Review of the ACS website and FREIDA online in addition to our survey has identified 44 of 261 (16.9%) ACGME accredited programs either with an existing rural surgical track or willing to customize their program accommodate a resident. To facilitate the recruitment of medical students into rural surgery, we support the maintenance of a complete and routinely updated list that identifies available training programs.



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Maxillofacial surgery: the impact of the Great War on both sides of the trenches

Abstract

"War is the father and King of all", Heraclitus the obscure philosopher, declares. It certainly appears that the specialty of maxillofacial surgery was greatly advanced during WWI. This article focuses on the circumstances under which the specialty was developed, the significant events and the important figures that played a leading role in the advancement of a new fascinating surgical specialty. The literature leaves no doubt that trench warfare despite its devastating outcome for humanity has forged the shape of modern maxillofacial surgery.

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Rare case report of an aggressive follicular lymphoid hyperplasia in maxilla

Abstract

Follicular lymphoid hyperplasia is a very rare though benign reactive process of an unknown pathogenesis that may resemble a follicular lymphoma, clinically and histologically. Oral reactive follicular hyperplasia (RFH) has been described on the hard or soft palate and at the base of the tongue. We describe here the first case of RFH presenting as an aggressive tumor on the right posterior side of the maxilla in a 24-year-old male patient. The lesion had a clinical evolution of 18 months and was noticed after the surgical extraction of the right third molar, although we cannot assume a cause-effect relation with that surgical event whatsoever. His medical history was unremarkable. Following an incisional biopsy, histological examination revealed lymphoid follicles comprised by germinal centers surrounded by well-defined mantle zones. The germinal centers were positive for Bcl-6, CD10, CD20, CD21, CD23, CD79a, and Ki-67, while negative for Bcl-2, CD2, CD3, CD5, and CD138. The mantle and interfollicular zones were positive for Bcl-2, CD2, CD3, CD5, CD20, and CD138. Both areas were diffusively positive for kappa and lambda, showing polyclonality. The patient underwent a vigorous curettage of the lesion with no reoccurrences at 36 months of follow-up. This case report demonstrates that morphologic and immunohistochemical analyses are crucial to differentiate RFH from follicular lymphoma, leading to proper management.

http://ift.tt/2yLNXPl

Improving margin revision: Characterization of tumor bed margins in early oral tongue cancer

Margin evaluation is performed to assess the adequacy of tumor removal [1]. One of the quality initiatives introduced by the American Head and Neck Society deals with the management of patients with oral squamous cell carcinoma (SCC) extending to margins [2]. There are two major approaches to the sampling of margins [3–7]. In the specimen-driven approach, margin clearance is assessed from en bloc resection specimens. Studies have shown that the most relevant margins are those derived from the resection specimen [8–16].

http://ift.tt/2zClR6H

Unilateral Vocal Fold Paralysis in Parkinson Disease: Case Report and Review of the Literature

The objective of this study was to report the first case of unilateral vocal fold paralysis in a patient with Parkinson disease (PD) and to review the literature.

http://ift.tt/2yHB4a5

Laryngocardiac Reflex: A Case Report and Review of the Literature

The vagus nerve has sensory and motor function in the larynx, as well as parasympathetic function in the thorax and abdomen. Stimulation of the superior laryngeal nerve can cause reflexive bradycardia.

http://ift.tt/2gHiw2t

Is the Voice of Professional Voice Users With no Vocal Cord Lesions Similar to That of Non Professional Voice Users?

The objective of this study was to analyze if the voice of professional voice users (PVU) is comparable with that of a nonprofessional voice users (NPVUs), both of whom have no obvious vocal cord lesions.

http://ift.tt/2gEYkye

Dexamethasone: The wonder drug in perioperative medicine

Anesthesiologist have a greater understanding of the role of the stress response and the development of inflammation following surgery on clinical outcomes [1,2]. Exacerbation of inflammation after surgery has been shown to be associated with multiple negative postsurgical outcomes (e.g., pain, cardiovascular events) [3]. The reduction of inflammation is, therefore, a common target used by anesthesiologists to minimize postoperative complications [4–7].

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A Re-Examination of "Bias" in Human Randomness Perception.

Author: Warren, Paul A.; Gostoli, Umberto; Farmer, George D.; El-Deredy, Wael; Hahn, Ulrike

DOI: 10.1037/xhp0000462

Publication Date: POST AUTHOR CORRECTIONS, 23 October 2017

http://ift.tt/2y4XihJ

Defining and Correcting Asymmetry in Isolated Unilateral Frontosphenoidal Synostosis: Differences in Orbital Shape, Facial Scoliosis, and Skullbase Twist Compared to Unilateral Coronal Synostosis.

Introduction: Isolated frontosphenoidal synostosis (FS) is a rare cause of fronto-orbital plagiocephaly that can be challenging to distinguish from isolated unicoronal synostosis (UC). The purpose of this paper is to analyze differences in fronto-orbital dysmorphology between the 2 conditions, to describe approaches for surgical correction, and to report surgical outcomes between FS and UC patients in a casecontrol fashion. Methods: Patients treated for craniosynostosis over a 12-year period at our institution were retrospectively evaluated under institutional review board approval. Frontosphenoidal synostosis patients who underwent bilateral fronto-orbital correction of anterior plagiocephaly with minimum 2-year follow-up, adequate pre-, and minimum 2-year postoperative computed tomography scans were included in the case-control portion of the study. These patients were randomly age-matched to UC patients meeting the same inclusion criteria. Preoperative and postoperative orbital shape and volumetric analysis was performed using Mimics software. Results: Twelve FS patients were treated during the study period. Seven of these patients met casecontrol inclusion criteria with average follow-up of 47.5 months. The characteristic FS orbit was a relatively wide, short, and shallow trapezoid, while the characteristic UC orbit was a relatively narrow, tall, and deep parallelogram. Frontosphenoidal synostosis orbits were significantly wider, shorter, shallower, and smaller than UC orbits. Surgical correction tailored to the differential dysmorphologies resulted in statistical equalization of these differences between affected and contralateral control orbits at follow-up, with the exception of UC orbital width, which remained significantly narrower than unaffected contralateral control. One patient in each group required cranioplasty for skull defects at follow-up, while no patient underwent surgical readvancement. Conclusions: Frontosphenoidal synostosis and UC orbital shape differ significantly, and can be normalized using fronto-orbital advancement tailored to the distinct orbital dysmorphologies of these 2 groups. (C) 2017 by Mutaz B. Habal, MD.

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Osteogenesis of Crouzon-Mutated Cells in a Murine Model.

Crouzon syndrome is an autosomal-dominant congenital disease due to a mutation in the fibroblast growth factor receptor 2 protein. The purpose of this study is to evaluate wound-healing potential of Crouzon osteoblasts and adipose-derived stem cells (ADSCs) in a murine model. Parietal skull defects were created in Crouzon and mature wild-type (WT) CD-1 mice. One group of WT and Crouzon mice were left untreated. Another group was transplanted with both WT and Crouzon adipose-derived stem cells. Additional groups compared the use of a fibrin glue scaffold and periosteum removal. Skulls were harvested from each group and evaluated histologically at 8-week and/or 16-week periods. Mean areas of defect were quantified and compared via ANOVA F-test. The average area of defect after 8 and 16 weeks in untreated Crouzon mice was 15.37 +/- 1.08 cm2 and 16.69 +/- 1.51 cm2, respectively. The average area of the defect in untreated WT mice after 8 and 16 weeks averaged 14.17 +/- 1.88 cm2 and 14.96 +/- 2.26 cm2, respectively. WT mice with autologous ADSCs yielded an average area of 15.35 +/- 1.34 cm2 after 16 weeks while Crouzon mice with WT ADSCs healed to an average size of 12.98 +/- 1.89 cm2. Crouzon ADSCs transplanted into WT mice yielded an average area of 15.47 +/- 1.29 cm2 while autologous Crouzon ADSCs yielded an area of 14.22 +/- 3.32 cm2. ANOVA F-test yielded P = .415. The fibroblast growth factor receptor 2 mutation in Crouzon syndrome does not promote reossification of critical-sized defects in mature WT and Crouzon mice. Furthermore, Crouzon ADSCs do not possess osteogenic advantage over WT ADSCs. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2gFORqB

Transorbital Penetrating Intracranial Injury by a Battery.

The authors report a patient of transorbital penetrating intracranial injury by a battery. A 59-year-old man presented with a foreign body in the left orbital region after an explosion during waste combustion. Physical examination revealed his left eyelid had been punctured and the eyeball ruptured by what appeared to be a battery, which was lodged in the left orbit. The patient was neurologically intact. Facial computed tomography showed a ca. 6.2 x 1.7 cm sized metallic foreign body, probably an electric battery, penetrating through the left orbit and orbital roof and terminating in the left anterior cranial fossa. Clinical presentation, treatment course, and follow-up are discussed. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2yGuqkd

Cell Polarity and PAR Complex Likely to Be Involved in Dexamethasone-Induced Cleft Palate.

Accumulating studies demonstrated that PAR complex contributed to the establishment and maintenance of cell polarity which was fundamental to many aspects of cell and developmental biology. The purpose of this study was to investigate whether dexamethasone (DEX) could downregulate the PAR complex and disrupt cell polarity in palatal epithelium during palatal fusion in mice. The C57BL/6J mice were selected for the experiment. Pregnant mice in control group and DEX-treated group were injected intraperitoneally with 0.9% sodium chloride 0.1 mL, which contained DEX 6 mg/kg respectively, every day from E10 to E12. The palatal epithelia morphology was observed with hematoxylin and eosin and scanning electron microscopy. Immunofluorescence staining, western blot, and real-time polymerase chain reaction were performed to detect the expression of PAR3/PAR6/aPKC. After being treated with DEX, the palatal shelves showed delayed development and became shorter and smaller. During the process of palatogenesis, PAR3 and PAR6 expressed in the palatal epithelium, and aPKC expressed in both the epithelium and the mesenchyme. Dexamethasone could downregulate the expression levels of PAR3/PAR6/aPKC in both protein and gene level. In conclusions, DEX affected the PAR complex of mouse embryonic palate, and could perturb the PAR complex and the cell polarity of medial edge epithelium cells, and caused the failure of palatal fusion. (C) 2017 by Mutaz B. Habal, MD.

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Corticotomy With a Palatal Bone-Borne Retractor for Correcting Severe Bimaxillary Protrusion.

Background: This article presents an alternate surgical treatment method to correct a severe anterior protrusion in the adult patient with an extremely thin alveolus. Methods: In the maxilla, a wide linear corticotomy was performed under local anesthesia. Cortical alveolar bone of the upper first bicuspids area was widely removed. Orthopedic force for bony block movement was applied by a palatal bone-borne type retractor supported by skeletal anchorage. Residual extraction space closure was performed by biocreative orthodontics strategy (BOS). In the mandible, an anterior segmental osteotomy (ASO) and extraction of 1st premolars were performed under local anesthesia. Results: In the maxilla, bony block movement followed by the wide linear corticotomy with a palatal bone-borne type retractor was implemented without complications. Remaining extraction space after the bony block movement was closed effectively by BOS. In the mandible, anterior segmental retraction was achieved effectively by ASO. Conclusions: Wide linear corticotomy with a palatal bone-borne type retractor and ASO under local anesthesia can be an effective alternative to orthognathic surgery in adults with protrusion and an extremely thin alveolus. The biocreative strategy also provides a simple and effective method to retract the 6 anterior teeth. (C) 2017 by Mutaz B. Habal, MD.

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Primary Central Nervous System Lymphoma of Optic Chiasma: Endoscopic Endonasal Treatment.

Background: Isolated primary central nervous system lymphoma arising from anterior visual pathway is very rare. Patient Presentation: A 76-year-old immunocompetent previously healthy man presented bilateral decreased visual acuity in 1 month. Pituitary magnetic resonans imaging (MRI) showed a lobulated mass with homogeneous enhancement after gadolinium administration that arising from optic chiasm suggested that inflammatory disease or an optic glioma. The patient underwent an extended endoscopic endonasal transsphenoidal surgery. Postoperative course and outcomes were wonderful. Histopathological diagnosis was diffuse large B-cell lymphoma. The patient underwent investigations for systemic lymphomatous involvement, did not detect any evidence of systemic disease. Conclusion: In this case, we claimed that differential diagnoses of anterior visual pathway lesions are difficult because of similarity of lesions on clinical and radiological examinations. Biopsy is essential for these lesions. As a biopsy technique, endoscopic endonasal transsphenoidal approach is safer and more effective than open procedures. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2gGynys

Bioinformatics Associated With Conjoined Twin Separation.

The separation of conjoined twins is a rare event in the medical field and presents many unique challenges to overcome. With the complexities of today's interconnected healthcare technology and electronic medical record, there are many intricate details that need significant attention to guarantee proper care and accurate record keeping for conjoined twins. Items that require attention are how to digitally represent the twins-as 1 patient or 2, how to incorporate the physiological monitors into the medical record, and how to ensure the proper amount of infrastructure, equipment, and space. With careful planning and consideration, technology can be used as an aid in separating conjoined twins at any institution. (C) 2017 by Mutaz B. Habal, MD.

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Method for Securing Methlymethacrylate Bone Cement Using Histoacryl Glue During Cranioplasty for Contour Deformities.

Methylmethacrylate bone cement (MM-BC) is one of the reconstructive methods: during cranioplasty to correct cranial defects following trauma or cranial surgery. Perfect intraoperative immobilization of the MM-BC is crucial to ensure correct subsequent shaping to best improve contour defects. Current immobilization techniques reported are time-consuming and involve complex metalwork. The authors hereby present a technique that may simplify the immobilization process by using histoacryl glue to secure the MM-BC. This provides a quick, inexpensive, and readily available option providing fixation strong enough to withstand final shaping of the MM-BC. (C) 2017 by Mutaz B. Habal, MD.

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Relationship of a Metopic Ridge and Anterior Cranial Volume Measured by a Noninvasive Laser Shape Digitizer.

Cranial dysmorphology observed in patients with metopic craniosynostosis varies along a spectrum of severity including varying degrees of metopic ridging, bitemporal narrowing, and trigonocephaly. Management has been based upon the subjective clinical impression of presence and severity of trigonocephaly. Severity of cranial dysmorphology does not predict the occurrence or severity of associated abnormal neurodevelopment, as children with mild-to-moderate trigonocephaly may also experience developmental delays. The authors sought to determine the relationship between mild-to-moderate trigonocephaly and anterior cranial volume using a noninvasive laser shape digitizer (STARscanner) in patients with abnormal head shape. An IRB-approved retrospective review of a prospectively maintained database and medical records was performed. Two hundred three patients less than 1 year of age with abnormal head shape were categorized as having a metopic ridge with mild-to-moderate trigonocephaly, metopic ridge without trigonocephaly, or no ridge. Measurements of cranial volume, circumference, and symmetry were calculated by the STARscanner, which quantifies three-dimensional shape of the cranial surface. Measures were analyzed using a series of analyses of variance and post-hoc Tukey honest significant difference. The authors results showed ACV was significantly reduced in patients with mild-to-moderate trigonocephaly compared with those without metopic ridge (P = 0.009), and trended toward significance compared with those with a ridge but without trigonocephaly (P = 0.072). The ratio of anterior-to-posterior cranial volume was significantly reduced in those with mild-to-moderate trigonocephaly compared with those without metopic ridge (P = 0.036). In conclusion, patients with milder anterior cranial deformities demonstrated an association between a metopic ridge with mild-to-moderate trigonocephaly and reduced anterior cranial volume. (C) 2017 by Mutaz B. Habal, MD.

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A New Operative One-Wing Technique to Correct Fronto-Orbital Region in Unilateral Nonsyndromic Plagiocephaly.

Anterior plagiocephaly is a premature closing of unilateral coronal suture. This premature suture fusion causes a series of cranial asymmetry and alteration of the fronto-orbital region. The authors described a new surgical technique to correct the facial asymmetry that reduces the operative time and the possible complications. In a period between 2013and 2016, 12 children affected by nonsyndromic anterior plagiocephaly were treated with this new procedure. Clinical, cranial development, and absence of postoperative complication demonstrated that one-wing surgical bone correction is a useful and innovative technique. (C) 2017 by Mutaz B. Habal, MD.

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What's up in the ALPS

Frédéric Rieux-Laucat

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International Society for the Study of Vascular Anomalies (ISSVA) Classification of Soft Tissue Vascular Anomalies: Survey-based Assessment of Musculoskeletal Radiologists′ Use in Clinical Practice

Publication date: Available online 16 October 2017
Source:Current Problems in Diagnostic Radiology
Author(s): Shivani Ahlawat, Laura M. Fayad, Daniel J. Durand, Kate Puttgen, Aylin Tekes
AimThere is controversy regarding the diagnosis and classification of vascular anomalies (VA). Since torso and extremities are the second most common body part for presentation of VAs, musculoskeletal (MSK) radiologists play a central role in VA classification. The purpose of this study was to evaluate the awareness and clinical use of the International Society for the Study of Vascular Anomalies (ISSVA) classification by MSK radiologists. Materials and Methods: A Web-based survey was designed and electronically sent to Society of Skeletal Radiology (SSR) members, with three questions on demographics and 7 questions on ISSVA classification use and knowledge. The Z-test for binomial proportions is used to assess for statistical significance between sub-groups. Results: The response rate was 12% (130/1091), comprised of 64% (83/130) academic and 36% (47/130) non-academic MSK radiologists. VAs accounted for only a small (0–5%) proportion of clinical practice in the majority 92% (119/130). Only 17% (22/130) of MSK radiologists used the ISSVA classification in practice. Of all respondents, 74% (94/127) considered hemangioma a type of vascular malformation (VM). There was no significant difference in the response characteristics between academic and non-academic radiologists. A greater proportion of MSK radiologists with >5years′ experience provided responses that were discordant with the ISSVA classification compared with less experienced radiologists (0–5years) in diagnosing hemangiomas in adult patients (p=0.02), and using the presence of phleboliths to diagnose hemangiomas (p = 0.004).ConclusionOur survey results indicate a lack of familiarity with the ISSVA classification by the MSK radiology community.



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Computed tomography coronary angiography for evaluation of children with Kawasaki disease

Publication date: Available online 23 October 2017
Source:Current Problems in Diagnostic Radiology
Author(s): Manphool Singhal, Surjit Singh, Pankaj Gupta, Avinash Sharma, Niranjan Khandelwal, Jane C Burns
ObjectiveWe sought to assess the feasibility of CTCA on a 128-slice, dual source scanner in children with acute and convalescent phase KD.Materials and MethodsA prospective study of 49 children with KD (12 at presentation and 37 in the convalescent phase) was conducted between November 2013 and April 2015. CTCA was performed with either prospective (n=37) or retrospective (n=12) electrocardiographic gating. A radiologist blinded to clinical profile and echocardiogram evaluated each scan.ResultsMedian age (36 boys, 13 girls) was seven years. Median dose-length product (DLP) value and median effective CT radiation dose was 32 mGy.cm (IQR =21–74) and 0.54mSv (IQR= 0.77–3.2) for all scans and 27 mGy.cm (IQR=18.5–33.75) and 0.48mSv (IQR=0.18–1.17) for prospectively triggered scans (n=37). Fourteen subjects (30 coronary segments) showed abnormalities by CTCA including aneurysms (n=27) and stenoses (n=3). In the acute phase (n=12), aneurysms were detected in five children (18 segments).ConclusionCTCA allows comprehensive evaluation of coronary arteries in children with KD.



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The Influence of Collaboration: Ralph Waters' Friendship With John Lundy and the Spread of Regional Anesthesia.

Ralph Waters, the founder of the anesthesiology department and residency program at the University of Wisconsin-Madison, and John Lundy, the chair at the Mayo Clinic beginning in 1924, collaborated to expand regional anesthetic techniques and knowledge not only at their institutions, but also at institutions around the country through correspondence, meetings, and hosting of other anesthesiologists. The Ralph Waters Collection at the University of Wisconsin Archives was searched for information on Waters' and Lundy's involvement in regional anesthesia. This included publications by Waters and other anesthesiology department faculty, as well as personal correspondence with other leaders in anesthesia at that time. Correspondence between Waters and Lundy from this collection was reviewed in detail. This article underscores the importance of exchange of ideas by physicians through didactics, organizations, and research through the story of Ralph Waters and John Lundy's mutual exchange of ideas and even friendship beginning in the 1920s. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.

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Aminoglycoside or Quinolone Ear Drops in the Postoperative Management of Tympanoplasty: What Choice Do We Have?.

No abstract available

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Resolution of Persistent Post-Stapedotomy Vertigo With Migraine Prophylactic Medication.

Objective: To describe persistent post-stapedotomy vertigo (PSV) and its treatment using migraine prophylaxis. Patients: A retrospective review of all patients with persistent PSV spanning 10 years at a tertiary academic hospital was performed. Patients who experienced persistent vertigo for a minimum of 3 months after surgery were included. Those with possible perilymph fistula, long prosthesis, and benign paroxysmal positional vertigo were excluded. Interventions: All patients received instructions on migraine dietary and lifestyle changes and Vitamin B2 and magnesium. In addition, prophylactic treatment with nortriptyline, verapamil, or a combination thereof was started. Main Outcome Measure: Changes in vertigo frequency was the main outcome variable. The secondary outcome variables included the time period and medications necessary to achieve symptomatic resolution. Results: Four women and one man with an average age of 53 years were identified that met criteria for persistent PSV indicating an incidence of 0.9% at our institution. The onset of vertigo symptoms was on average 20 days postoperatively. All five patients had daily vertigo episodes and experienced complete resolution with no vertigo episodes after treatment. Symptomatic resolution was achieved over an average of 9 weeks after initiating treatments. Conclusions: Persistent PSV beyond 3 months is a rare occurrence and its treatment can be challenging when there is no evidence of an underlying pathology. This subset of patients may be suffering from migraine, which was triggered postoperatively. Treatment with migraine prophylaxis in this cohort of patients may result in resolution of vertigo. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Do Measurements of Inner Ear Structures Help in the Diagnosis of Inner Ear Malformations? A Review of Literature.

Objective: We conducted an extensive review of the literature relevant to inner ear measurements in normal and malformative conditions to select reproducible methods and normative ranges that may be used in clinical practice. Data Sources and Study Selection: A review of the published literature was performed in the English language using PubMed with appropriate keywords. We selected only those articles containing normative values of inner ear structures. Data Extraction and Data Synthesis: The following measurements were identified as reproducible and sensitive for the diagnosis of inner malformations: cochlear height in coronal plane; maximal diameter of bony island of lateral semicircular canal; width of vestibular aqueduct: 1) at midpoint; 2) at operculum in axial plane; cochlear canal and cochlear width in multiplanar reconstructions (MPR)/axial; cochlear length. The following cutoffs for normal inner ears are proposed based on the comparative analysis of the literature: cochlea height: >4.3 mm; lateral semicircular canal bony island: >3 mm; vestibular aqueduct: 1.4 mm and 5.4 mm. Conclusion: Measurements of inner ear structures can help in the interpretation of computed tomography images. They increase the sensitivity in detecting inner ear malformations, especially cochlear hypoplasia now considered more common than previously thought. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Response to Letter to the Editor: "Comparison of Acyclovir and Famciclovir for Ramsay Hunt Syndrome".

No abstract available

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Letter to the Editor Comment on "Ramsay Hunt Syndrome".

No abstract available

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J. Gail Neely, M.D.: Obituary.

No abstract available

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Cochlear Implant Associated Labyrinthitis: A Previously Unrecognized Phenomenon With a Distinct Clinical and Electrophysiological Impedance Pattern.

Objectives: To report a unique clinical entity "cochlear implant associated labyrinthitis," characterized by a distinct constellation of clinical symptoms and pattern of electrode impedance fluctuations. Study Design: Retrospective chart review. Methods: All patients that underwent cochlear implantation between January 2014 and December 2016 were retrospectively reviewed. All subjects with acute onset dizziness, device performance decline, and characteristic erratic pattern of electrode impedances occurring after an asymptotic postoperative interval were identified and reported. Results: Five patients with the above criteria were identified, representing 1.4% of all implant surgeries performed during this time. The median age at time of implantation was 71 years, and the median time interval between implantation and onset of symptoms was 126 days. All patients exhibited acute onset dizziness, subjective performance deterioration, erratic impedance pattern, and two experienced worsening tinnitus. Two of five patients underwent subsequent CT imaging, where good electrode placement was confirmed without cochlear ossification. Two of five patients received oral prednisone therapy. All patients reported a subjective improvement in symptoms and stabilization of electrode impedances. Three patients subsequently received vestibular testing, where significantly reduced peripheral vestibular function was identified. Conclusions: We describe a unique clinical entity, "cochlear implant associated labyrinthitis," characterized by a distinct constellation of clinical symptoms and corresponding electrode impedance anomalies. The exact cause for this event remains unknown, but may be related to viral illness, delayed foreign body reaction to the electrode, or a reaction to electrical stimulation. Future studies characterizing this unique clinical entity are needed to further elucidate cause and optimal management. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Changes in Serum Prestin Concentration After Exposure to Cisplatin.

Hypothesis: There are temporal changes in the outer-hair-cell-specific protein, prestin, in the blood after administration of low-dose cisplatin. Methods: Two rodent models of ototoxicity were used. After control and baseline data collection, mice (n = 30) and guinea pigs (n = 10), respectively, were treated with cisplatin at 8 mg/kg. Auditory brainstem responses were recorded on Days 1, 3, 7, and 14 after treatment. Five mice were sacrificed at each time point and serum samples were obtained. A group of 10 guinea pigs were tested and serum samples were collected at each time point. Serum prestin concentrations were measured using separate enzyme-linked immunosorbent assays for each species. Results: Auditory brainstem responses thresholds changed relatively little in mice, but gradually increased in guinea pigs, as a function of time after cisplatin exposure. In contrast, serum prestin concentrations rose, reaching a peak on Days 3 and 7 after cisplatin treatment in mouse and guinea pig, respectively, before declining back to or below baseline/control levels 14 days after treatment. Conclusion: There was a time-dependent pattern of change in serum prestin after exposure to low-dose cisplatin in a resistant (mouse) and sensitive (guinea pig) rodent models. These comparative results suggest prestin may serve as a biomarker for cisplatin ototoxicity. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Morphological Characteristics of Osseous External Auditory Canal and Its Relationship With External Auditory Canal Cholesteatoma in Patients With Congenital Aural Stenosis.

Objective: To investigate the characteristics of stenotic external auditory canal (EAC) (e.g., shape, length, orientation, and curvature) and to compare them with those of the cholesteatoma and no cholesteatoma groups, which may help to explain cholesteatoma formation to a certain degree. Methods: Computed tomography scans of two groups of patients (with and without EAC cholesteatoma) were analyzed. We determined the degree of microtia, the stenosis of EAC, radius and curvature of osseous EAC bending (abbreviated as OEB-r and OEB-c, respectively), and other anatomic parameters of EAC by using Mimics and Matlab. Results: There was no significant difference in the degree of microtia between the cholesteatoma and no cholesteatoma groups using the Marx grading system. Additionally, no significant difference was found in the stenosis of EAC between the two groups. The OEB-r was smaller in the cholesteatoma group (4.62 +/- 0.62 mm) than in the no cholesteatoma group (7.41 +/- 0.50 mm), and the OEB-c was found to be larger in the cholesteatoma group (1.55 +/- 0.05 x 10 mm-1) than in the no cholesteatoma group (1.10 +/- 0.10 x 10 mm-1). Moreover, the OEB-c (OR, 8.60; 95% CI, 2.67-27.75) was associated with EAC cholesteatoma formation. Conclusion: The curvature of osseous EAC in the cholesteatoma group was significantly larger than that in the no cholesteatoma group. It is suggested that the curvature of osseous EAC was a risk factor for EAC cholesteatoma formation. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Pequena aspiração da pars flacida

Pequena aspiração da pars flacida

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Colesteatoma de meato

Colesteatoma de meato

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Colesteatoma aerado sem secreção

Colesteatoma aerado sem secreção

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Pequena aspiração da pars flacida

Pequena aspiração da pars flacida

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Colesteatoma de meato

Colesteatoma de meato

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Colesteatoma aerado sem secreção

Colesteatoma aerado sem secreção

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InSiCal – A tool for calculating calibration factors and activity concentrations in in situ gamma spectrometry

Publication date: Available online 23 October 2017
Source:Journal of Environmental Radioactivity
Author(s): Alexander Mauring, Tim Vidmar, Torbjörn Gäfvert, Jon Drefvelin, Aldo Fazio
In situ gamma spectrometry is a widely applied analysis technique for the determination of radioactivity levels in soil. Compared to traditional laboratory analysis of soil samples, in situ techniques offer a quick and low-cost way of obtaining accurate results from on-site measurements. However, although the technique is well-known, the dependence of in situ gamma spectrometry on complex and time-consuming calibration procedures as well as in-depth knowledge of the geometric distribution of the source in the ground deters many potential users from employing it in their routine work. Aiming to alleviate this issue, a software tool named InSiCal (In Situ gamma spectrometry Calculator) has been developed to make in situ gamma spectrometry more accessible to both experts and non-experts in the field. This is done by simplifying and streamlining both calibration and activity calculation through a simple and intuitive graphical user interface. Testing in real field conditions show that InSiCal is capable of yielding results which are in very good agreement with soil sample analyses, and that the results may be obtained using different detector types (HPGe, NaI, LaBr and CZT). Overall, InSiCal, provides results which are comparable in accuracy to laboratory measurements, indicating that it fulfills its purpose successfully.



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Fe (III), Co(II), Ni(II), Cu(II) and Zn(II) complexes of schiff bases based-on glycine and phenylalanine: Synthesis, magnetic/thermal properties and antimicrobial activity

Publication date: 15 February 2018
Source:Journal of Molecular Structure, Volume 1154
Author(s): Fatih Sevgi, Ugur Bagkesici, Ahmed Nuri Kursunlu, Ersin Guler
Zinc (II), copper (II), nickel (II), cobalt (II) and iron (III) complexes of Schiff bases (LG, LP) derived from 2-hydroxynaphthaldehyde with glycine and phenylalanine were reported and characterized by ¹H NMR, ¹³C NMR, elemental analyses, melting point, FT-IR, magnetic susceptibility and thermal analyses (TGA). TGA data show that iron and cobalt include to the coordinated water and metal:ligand ratio is 1:2 while the complex stoichiometry for Ni (II), Cu (II) and Zn (II) complexes is 1:1. As expected, Ni (II) and Zn (II) complexes are diamagnetic; Cu (II), Co (II) and Fe (III) complexes are paramagnetic character due to a strong ligand of LG and LP.The LG, LP and their metal complexes were screened for their antimicrobial activities against five Gram-positive (Staphylococcus aureus, Methicillin resistant Staphylococcus aureus (MRSA), Bacillus cereus, Streptococcus mutans and Enterococcus faecalis) and three Gram-negative (Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa) and one fungi (Candida albicans) by using broth microdilution techniques. The activity data show that ligands and their metal complexes exhibited moderate to good activity against Gram-positive bacteria and fungi.

Graphical abstract

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CHRODIS criteria applied to the MASK (MACVIA-ARIA Sentinel NetworK) Good Practice in allergic rhinitis: a SUNFRAIL report

A Good Practice is a practice that works well, produces good results, and is recommended as a model. MACVIA-ARIA Sentinel Network (MASK), the new Allergic Rhinitis and its Impact on Asthma (ARIA) initiative, i...

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Myxofibrosarcoma of unusual sites

Abstract

Introduction

Myxofibrosarcoma classically presents as a painless mass in the proximal extremities. Cutaneous myxofibrosarcomas arising in the head and neck and distal extremities are extremely uncommon. We present a series of six cases of myxofibrosarcoma presenting in the head and neck and acral locations.

Methods

Archives were searched using the term "myxofibrosarcoma" over a 6-year period (2009–2015). The clinicopathologic features of myxofibrosarcoma were recorded. Cases in the head and neck or acral locations were retrieved. When available, the patient's medical records were reviewed.

Results

Ninety-five cases of myxofibrosarcoma were identified over a 6-year period. Six patients were identified with myxofibrosarcoma arising in the head (n = 4, M:F 3:1), hand (n = 1, F), and foot (n = 1, F). Each had typical features of myxofibrosarcoma. Two of the tumors on the head were high-grade and had multiple recurrences, while the remaining two were intermediate grade. Both acral tumors were intermediate grade and one recurred locally within a year of diagnosis.

Conclusions

Myxofibrosarcoma may rarely involve the head and neck and acral locations, and presentation in these sites is a potential source of diagnostic difficulty. Recognition of the characteristic histologic features of myxofibrosarcoma in conjunction with judicial use of immunohistochemical stains should allow for accurate diagnosis.

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Evaluation of 9 health care organizations' respiratory protection programs and respiratory protective device practices: Implications for adoption of elastomerics

Publication date: Available online 24 October 2017
Source:American Journal of Infection Control
Author(s): Linda Morris Brown, Bonnie Rogers, Kathleen Buckheit, John Pat Curran
Interview, observational, and discussion group data at 9 health care organizations (HCOs) were collected to better understand elastomeric half-facepiece respirators' (EHFRs) use. We found that HCOs do not routinely use EHFRs as a respiratory protection device (RPD) for health care workers; compliance with other respirator types was less than expected. This finding has important training implications for proper use of all RPDs and EHFRs as an alternative RPD stockpiled for use during a respiratory infectious outbreak.



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An unusual complication of the traditional treatment of a closed fracture – generalized tetanus: a case report

Tetanus is a severe infectious disease that can lead to death. The clinical manifestations are due to an exotoxin secreted by Clostridium tetani, a spore-producing Gram-positive bacillus. The penetration of the g...

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Successful bridge to recovery in fulminant myocarditis using a biventricular assist device: a case report

Fulminant myocarditis is a life-threatening disease, and myocardial damage expands the right ventricle as well as the left ventricle in some cases. There is a mortality rate of over 40% in patients with fulmin...

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An unusual complication of the traditional treatment of a closed fracture – generalized tetanus: a case report

Tetanus is a severe infectious disease that can lead to death. The clinical manifestations are due to an exotoxin secreted by Clostridium tetani, a spore-producing Gram-positive bacillus. The penetration of the g...

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Successful bridge to recovery in fulminant myocarditis using a biventricular assist device: a case report

Fulminant myocarditis is a life-threatening disease, and myocardial damage expands the right ventricle as well as the left ventricle in some cases. There is a mortality rate of over 40% in patients with fulmin...

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A CD3-bispecific molecule targeting P-cadherin demonstrates T cell-mediated regression of established solid tumors in mice

Abstract

Strong evidence exists supporting the important role T cells play in the immune response against tumors. Still, the ability to initiate tumor-specific immune responses remains a challenge. Recent clinical trials suggest that bispecific antibody-mediated retargeted T cells are a promising therapeutic approach to eliminate hematopoietic tumors. However, this approach has not been validated in solid tumors. PF-06671008 is a dual-affinity retargeting (DART^®)-bispecific protein engineered with enhanced pharmacokinetic properties to extend in vivo half-life, and designed to engage and activate endogenous polyclonal T cell populations via the CD3 complex in the presence of solid tumors expressing P-cadherin. This bispecific molecule elicited potent P-cadherin expression-dependent cytotoxic T cell activity across a range of tumor indications in vitro, and in vivo in tumor-bearing mice. Regression of established tumors in vivo was observed in both cell line and patient-derived xenograft models engrafted with circulating human T lymphocytes. Measurement of in vivo pharmacodynamic markers demonstrates PF-06671008-mediated T cell activation, infiltration and killing as the mechanism of tumor inhibition.

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