Head and Neck Diseases by Alexandros G.Sfakianakis: 11/01/16

Τρίτη 1 Νοεμβρίου 2016

Stapedotomy vs Cochlear Implantation for Advanced Otosclerosis: Systematic Review and Meta-analysis

Objectives

To compare the hearing outcomes of stapedotomy vs cochlear implantation in patients with advanced otosclerosis.

Data Sources

PubMed, EMBASE, and The Cochrane Library were searched for the terms otosclerosis, stapedotomy, and cochlear implantation and their synonyms with no language restrictions up to March 10, 2015.

Methods

Studies comparing the hearing outcomes of stapedotomy with cochlear implantation and studies comparing the hearing outcomes of primary cochlear implantation with salvage cochlear implantation after an unsuccessful stapedotomy in patients with advanced otosclerosis were included. Postoperative speech recognition scores were compared using the weighted mean difference and a 95% confidence interval.

Results

Only 4 studies met our inclusion criteria. Cochlear implantation leads to significantly better speech recognition scores than stapedotomy (P < .0001). However, this appears to be due to the variability in outcomes after stapedotomy. Cochlear implantation does not lead to superior speech recognition scores compared with the subgroup of successful cases of stapedotomy plus hearing aid (P = .47). There is also no significant difference with respect to speech recognition between primary cochlear implantation and those secondary to a failed stapedotomy (P = .22).

Conclusions

Cochlear implantation leads to a statistically greater and consistent improvement in speech recognition scores. Stapedotomy is not universally effective; however, it yields good results comparable to cochlear implantations in at least half of patients. For cases of unsuccessful stapedotomy, the option of cochlear implantation is still open, and the results obtained through salvage cochlear implantation are as good as those of primary cochlear implantation.

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Voice Outcomes following a Single Office-Based Steroid Injection for Vocal Fold Scar

Objective

Persistent dysphonia from vocal fold scar remains a clinical challenge, with current therapies providing inconsistent outcomes. We evaluated voice outcomes after a single office-based steroid injection.

Study Design

Case series with chart review.

Setting

Academic medical center.

Subjects and Methods

This study was based on pre- and postoperative analysis of patient-reported, perceptual, acoustic, aerodynamic, and videostroboscopic parameters. The sample comprised 25 patients undergoing office-based dexamethasone injection into the superficial lamina propria for mild/moderate vocal fold scar. Average follow-up was 13.7 ± 4.4 weeks; patients completed 3.5 ± 2.3 sessions of voice therapy between assessments. Complete data sets were not available for each parameter; sample size is noted with results.

Results

Voice handicap index (n = 24; P < .001) and glottal function index (n = 22; P < .001) decreased after injection. Total GRBAS score (grade, roughness, breathiness, asthenia, strain) decreased (n = 25; P < .001). Fundamental frequency range increased (n = 24; P = .024). Phonation threshold pressure decreased (n = 14; P = .017). Videostroboscopic parameters of vocal fold edge (P = .004), glottic closure (P = .003), and right mucosal wave (P = .016) improved after injection.

Conclusions

Office-based steroid injection combined with voice therapy for mild/moderate vocal fold scar is associated with improved patient-reported and functional voice measures. These findings provide preliminary support for this approach. Importantly, the procedure is low risk and can be performed in the office, thus offering a simple treatment alternative to patients with a disorder that has traditionally been difficult to manage. Prospective studies evaluating the effects of multiple injections are warranted.

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Head and Neck Manifestations of Eosinophilic Granulomatosis with Polyangiitis: A Systematic Review

Objective

To conduct the first and only systematic review of the existing literature on head and neck manifestations of eosinophilic granulomatosis with polyangiitis to guide clinical decision making for the otolaryngologist.

Data Sources

PubMed, Cochrane Library, Scopus, and LILACS.

Review Methods

A systematic review of the aforementioned sources was conducted per the PRISMA guidelines.

Results

From an initial 574 studies, 28 trials and reports were included, accounting for a total of 1175 patients with eosinophilic granulomatosis with polyangiitis. Among clinical and cohort studies, 48.0% to 96.0% of all included patients presented with head and neck manifestations. In a distinct group of patients detailed in case reports describing patients presenting with head and neck manifestations, patients on average fulfilled 4.6 diagnostic criteria per the American College of Rheumatology. Furthermore, 95.8% of reported cases were responsive to steroids, and 60% required additional therapy.

Conclusion

Otolaryngologists are in a unique position for the early diagnosis and prevention of late complications of eosinophilic granulomatosis with polyangiitis. The American College of Rheumatology criteria should be relied on in the diagnostic workup. Close surveillance of these patients in a multidisciplinary fashion and with baseline complete blood counts, chest radiographs, and autoimmune laboratory tests is often necessary. Such patients with head and neck manifestations of the disease are nearly always responsive to steroids and often require additional immunosuppressive therapy or surgical intervention in cases of cranial neuropathies, temporal bone involvement, and refractory symptoms.

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Distribution of corticotropin-releasing factor type 1 receptor-like immunoreactivity in the rat pituitary

Abstract

Corticotropin-releasing factor (CRF) regulates the hypothalamic-pituitary-adrenal axis response to stress through its type 1 receptor (CRF₁) in the corticotrophs of the anterior pituitary. Although CRF₁ mRNA expression has been confirmed in the rat pituitary, the distribution pattern of CRF₁ protein in the pituitary has not been reported. Therefore, we generated an antiserum against the amino acid fragment corresponding to the 177-188 sequence of the first extracellular loop of the rat CRF₁. By using the antiserum, CRF₁-like immunoreactivity (CRF₁-LI) was detected in the anterior lobe cells of the rat pituitary where some of them expressed intense signals. CRF₁-LI also appeared in the intermediate lobe cells and on the fibre-like elements of the posterior lobe of the pituitary. Dual immunofluorescence labelling showed that corticotrophs exhibited the highest percentage of CRF₁ (male: 27.1 ± 3.0%, female: 18.0 ± 3.0%), followed by lactotrophs (male: 6.7 ± 3.0%, female: 12. 1± 1.3%), gonadotrophs (male: 2.6 ± 1.0%, female: 7.5 ± 0.5%), thyrotrophs (male: 2.9 ± 0.1%, female: 5.3 ± 1.2%) and somatotrophs (male: 1.1 ± 0.3%, female: 1.2 ± 0.5%). The percentage of CRF₁-LI-positive cells that were corticotrophs was significantly higher in male rats than in female rats, while CRF₁-LI-positive lactotrophs and gonadotrophs were significantly higher in female rats than in male rats. Almost all of the melanotrophs were positive for CRF₁ in the intermediate lobe (98.9 ± 0.2%). CRF₁-LI and the percentage of CRF₁-LI in corticotrophs were decreased in the anterior pituitary, and the distribution patterns were altered from a diffuse to punctate one by adrenalectomy; the changes were restored by treatment with dexamethasone (100 μg/kg b.w.). These results suggest that CRF₁ is involved in the modulation of the functions of the pituitary; moreover, protein expression and the distribution patterns of CRF₁ are regulated by glucocorticoids in the rat anterior pituitary.

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Tumor Debulking in the Management of Laryngeal Cancer Airway Obstruction

Patients presenting with advanced aerodigestive malignancy and respiratory compromise often undergo tracheotomy as initial airway management. Tumor debulking is a potential alternative. We present a case series with chart review to communicate our institutional experience with this technique. T3/4 glottic and supraglottic cancers treated between 2004 and 2014 underwent review, and 14 patients were identified for this study. Of these, 5 (35.7%) required subsequent tracheotomy, and 9 (64.3%) did not. Patients requiring subsequent tracheotomy had a delay in initiating definitive treatment when compared with those who did not (83.3 vs 31.3 days, P = .0025). No patient required a tracheotomy after initiation of definitive treatment. Our experience suggests that tumor debulking may be a viable option in select patients but that a delay in initiating treatment is associated with patients requiring tracheotomy subsequent to debulking. Further research is needed to better delineate patient scenarios in which tumor debulking alone is sufficient.

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Improving Access to Head and Neck Cancer Surgical Services through the Incorporation of Associate Providers

Objective

The urgent nature of head and neck cancer referrals often results in overbooked schedules, access delays, and patient, physician, and staff dissatisfaction. The goal of this study is to examine how incorporation of associate providers (APs) into a head and neck tumor clinic (HNTC) can improve access.

Methods

Scheduling data for the Dartmouth-Hitchcock HNTC 2 years prior (January 2011 to December 2012) and 2 years subsequent (January 2013 to December 2014) to program initiation were abstracted, including number of new patients seen per month, third available for new and established patients, overbooked hours, surgeon productivity, and patient satisfaction scores.

Results

New patients seen per month increased from 44 ± 4 to 60 ± 5 (P < .001). Third available for new patients decreased from 56 ± 4 to 27 ± 2 days and from 43 ± 3 to 35 ± 2 days for follow-ups (P < .001). Overbooked hours decreased from 14.7 ± 3.1 to 8.6 ± 1.7 hours (P < .001). Surgeon productivity remained stable (109% ± 11% vs 113% ± 6%, P = .56). Patient satisfaction in seeing APs versus surgeons was comparable (94 ± 2 vs 94 ± 3, P = .79).

Discussion

Incorporation of APs into the HNTC increases the number of new patients seen by the surgeon, decreases wait times for all appointments, and decreases overbooking while maintaining patient satisfaction and surgeon productivity.

Implications for Practice

AP incorporation significantly improves access to head and neck surgical services. With improved access, new cancer patients could start treatment sooner, potentially affecting outcome.

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Genetic and Environmental Determinants of Otitis Media in an Indigenous Filipino Population

Objective

To identify genetic and environmental risk factors for otitis media in an indigenous Filipino population.

Study Design

Cross-sectional study.

Setting

Indigenous Filipino community.

Subjects and Methods

Clinical history and information on breastfeeding, tobacco smoke exposure, and swimming were obtained from community members. Heads of households were interviewed for family history and personal beliefs on ear health. Height and weight were measured. Otoscopic findings were described for the presence and character of perforation or discharge. An A2ML1 duplication variant that confers otitis media susceptibility was Sanger sequenced in all DNA samples. Co-occurrence of middle ear bacteria detected by 16S rRNA gene sequencing was determined according to A2ML1 genotype and social cluster.

Results

The indigenous Filipino population has a ~50% prevalence of otitis media. Young age was associated with otitis media (4 age strata; P = .004); however, age was nonsignificant as a bistratal or continuous variable. There was no association between otitis media and sex, body mass index, breastfeeding, tobacco exposure, or deep swimming. In multivariate analyses, A2ML1 genotype is the strongest predictor of otitis media, with an odds ratio of 3.7 (95% confidence interval: 1.3-10.8; P = .005). When otitis media diagnoses were plotted across ages, otitis media was observed within the first year of life, and chronic otitis media persisted up to adulthood, particularly in A2ML1-variant carriers.

Conclusion

Among indigenous Filipinos, A2ML1 genotype is the primary risk factor for otitis media and main determinant of disease progression, although age, the middle ear microbiome, and social clusters might modulate the effect of the A2ML1 genotype.

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Programmatic Assessment of a Comprehensive Quality Improvement Curriculum in an Otolaryngology Residency

To date, there is minimal literature discussing quality improvement curricula in otolaryngology. Herein, we present our program, including didactic, web-based, and experiential learning, developed in the setting of a preexisting institutional quality and safety policy. Nine otolaryngology residents were evaluated with assessments focused on learner satisfaction, learner attitudes, and knowledge acquisition according to the Kirkpatrick framework. Wilcoxon signed-rank test was used to compare results. While the total score increased across all assessments, it was significant for only the Quality Improvement Knowledge Application Tool Revised (P < .05). We find our initial learning outcomes encouraging and hope that our comprehensive curriculum can serve as a resource to other programs, which can be adapted to fit within the context of variable training environments. Furthermore, it is imperative to consider continuous assessment and refinement of any educational program, using the same quality improvement principles that we endeavor to teach.

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Collagen Content Limits Optical Coherence Tomography Image Depth in Porcine Vocal Fold Tissue

Objective

Vocal fold scarring, a condition defined by increased collagen content, is challenging to treat without a method of noninvasively assessing vocal fold structure in vivo. The goal of this study was to observe the effects of vocal fold collagen content on optical coherence tomography imaging to develop a quantifiable marker of disease.

Study Design

Excised specimen study.

Setting

Massachusetts Eye and Ear Infirmary.

Subjects and Methods

Porcine vocal folds were injected with collagenase to remove collagen from the lamina propria. Optical coherence tomography imaging was performed preinjection and at 0, 45, 90, and 180 minutes postinjection. Mean pixel intensity (or image brightness) was extracted from images of collagenase- and control-treated hemilarynges. Texture analysis of the lamina propria at each injection site was performed to extract image contrast. Two-factor repeated measure analysis of variance and t tests were used to determine statistical significance. Picrosirius red staining was performed to confirm collagenase activity.

Results

Mean pixel intensity was higher at injection sites of collagenase-treated vocal folds than control vocal folds (P < .0001). Fold change in image contrast was significantly increased in collagenase-treated vocal folds than control vocal folds (P = .002). Picrosirius red staining in control specimens revealed collagen fibrils most prominent in the subepithelium and above the thyroarytenoid muscle. Specimens treated with collagenase exhibited a loss of these structures.

Conclusion

Collagen removal from vocal fold tissue increases image brightness of underlying structures. This inverse relationship may be useful in treating vocal fold scarring in patients.

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Quality Indicators for Head and Neck Oncologic Surgery: Academic versus Nonacademic Outcomes

Objectives

to determine national benchmarks for established quality indicators in head and neck cancer (HNCA) surgery, focusing on differences between academic and nonacademic institutions.

Study Design

Cross-sectional analysis of national database.

Subjects and Methods

HNCA surgery admissions from the 2009-2011 Nationwide Inpatient Sample were analyzed for preoperative characteristics and postoperative outcomes. Multivariate analyses were used to identify factors influencing quality indicators after HNCA surgery. Quality metrics—including length of stay (LOS), inpatient death, return to the operating room (OR), wound infection, and transfusion—were compared for academic versus nonacademic institutions.

Results

A total of 38,379 HNCA surgery inpatient admissions (mean age, 56.5 years; 52.4% male) were analyzed (28,288 teaching vs 10,091 nonteaching). Nationally representative quality metrics for HNCA surgery were as follows: mean LOS, 4.26 ± 0.12 days; return to OR, 3.3% ± 0.2%; inpatient mortality, 0.7% ± 0.1%; wound infection rate, 0.9% ± 0.1%; wound complication rate, 4.3% ± 0.2%; and transfusion rate, 4.3% ± 0.3%. HNCA surgery patients at teaching hospitals had a greater proportion of males, radiation history, and high-acuity procedures and greater comorbidity scores (all P < .001). Multivariate analyses adjusting for age, sex, income, payer, prior radiation, comorbidity scores, and procedural acuity demonstrated that teaching hospitals had a slightly increased LOS (+0.30 days; P = .009) and odds ratio for wound infection (1.54; 95% CI: 1.22-1.94) versus nonteaching hospitals. There were no significant differences in return to OR (P = .271), inpatient mortality (P = .686), or transfusion rate (P = .960).

Conclusion

Despite caring for substantially more complex HNCA surgery patients with greater comorbidities, teaching hospitals demonstrate only a marginally increased LOS and wound complication rate versus nonteaching hospitals, while other established quality metrics are similar.

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Successful Implementation of a Clinical Care Pathway for Management of Epistaxis at a Tertiary Care Center

Objective

We compare the management of patients with severe epistaxis before and after the implementation a clinical care pathway (CCP) to standardize care, minimize hospital stay, and decrease cost.

Study Design

Single prospective analysis with historical control.

Setting

Tertiary academic hospital.

Subjects and Methods

Patients treated for epistaxis between October 2012 to December 2013 were compared with a prospective analysis of patients treated for severe epistaxis after implementation of a CCP from June 2014 to February 2015. Severe epistaxis was defined as nasal bleeding not able to be controlled with local pressure, topical vasoconstrictors, or simple anterior packing.

Results

Severe epistaxis was similar in the pre- and post-CCP cohorts: 24.7% (n = 42) vs 18.9% (n = 22), respectively. Implementation of early sphenopalatine artery ligation resulted in decreased number of days packed (3.2 ± 1.6 to 1.4 ± 1.6; P = .001), decreased hospital stay (5.2 ± 3.9 to 2.1 ± 1.3 days; P < .001), an increased percentage of sphenopalatine artery ligations (31.0% vs 54.5%; P = .035), admission to an appropriate hospital location with access to key resources (41.7% vs 83.3%; P = .007), and decreased overall cost of hospitalization by 66% ($9435 saved). No patients received embolization after the CCP was implemented.

Conclusions

Implementation of a CCP decreased hospital stay and days of packing, facilitated definitive care in patients with severe epistaxis, improved patient safety, and decreased cost. The results of this study can serve as a model for the management of severe epistaxis and for future quality improvement measures.

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ACS NSQIP Risk Calculator: An Accurate Predictor of Complications in Major Head and Neck Surgery?

The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) calculator is meant to provide an estimation of perioperative risk. Our goal was to determine the clinical applicability of the calculator in major head and neck surgery. A retrospective chart review was completed for major head and neck operations performed at 1 institution from 2013 to 2014. The calculated perioperative complication risks from the ACS NSQIP calculator were compared with observed complication rates. Overall, the ACS NSQIP calculator had little predictive value for pneumonia, surgical site infection, 30-day return to operating room, or length of stay within this cohort (P > .05). The calculator appears to have some value predicting total numbers of complications but has poor performance predicting an individual's risk of suffering a perioperative complication. In conclusion, in our small cohort of patients, the ACS NSQIP calculator was a poor predictor of perioperative complications following major head and neck operations.

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The History and Evolution of Surgery on the Vestibular Labyrinth

The history of surgery on the vestibular labyrinth is rich but sparsely documented in the literature. The story begins over a century ago with the labyrinthectomy in an era that consisted exclusively of ablative surgery for infection or vertigo. Improved understanding of vestibular physiology and pathology produced an era of selective ablation and hearing preservation that includes semicircular canal occlusion for benign paroxysmal positional vertigo. An era of restoration began with a discovery of superior semicircular canal dehiscence and its repair. The final era of vestibular replacement is upon us as the possibility of successful prosthetic vestibular implantation becomes reality.

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Use of Lean and CAHPS Surgical Care Survey to Improve Patients Experiences with Surgical Care

Objectives

(1) Measure patients' experiences with surgical care using the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Surgical Care Survey. (2) Use lean thinking to analyze and improve quality of patient care.

Study Design

A prospective quality improvement study.

Setting

Hospital-based otolaryngology clinic.

Subjects and Methods

The CAHPS Surgical Care Survey was distributed to 17 surgical patients to determine their perception of the current state of care. Survey results were analyzed with lean thinking, and changes were made to improve critical areas. A second set of surveys was distributed to 10 patients to assess the success of the interventions immediately and 2 months later. The data were analyzed with the Mann-Whitney U test.

Results

Seventeen patients completed the CAHPS Surgical Care Survey to determine the initial state. A3 Thinking was used to analyze the results and design an improvement. Overall positive patient experience was 57% at the postoperative visit with 3 key aspects of care: time spent during visit, encouragement to ask questions, show of respect to the patient. Two causes were postulated; then, solution approaches were developed and tested in a series of rapid experiments. Two groups of 10 patients completed the CAHPS Surgical Care Survey to determine the postintervention state. Overall positive patient experience significantly improved to 93% (U = 474, P < .001) and 83% (U = 546, P = .009) immediately and 2 months later, respectively.

Conclusion

Lean thinking helps to eliminate defects by breaking down complex problem solving into a scientific process. When combined with the CAHPS Surgical Care Survey, it can be successfully used to improve patients' surgical experiences.

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Electrophysiologic Evaluation of the Facial Nerve and Blink Reflex Pathways in Asymptomatic Cochlear Implant Users

Objective

To evaluate the functional integrity of the facial nerve and blink reflex (BR) pathways in asymptomatic patients who underwent cochlear implantation (CI).

Study Design

Case series with planned data collection.

Setting

Tertiary referral center.

Subjects and Methods

Twenty-four deafened patients with unilateral CI who had no complications were enrolled. Bilateral compound muscle action potentials (CMAPs) of the facial nerve were recorded over the nasalis and occipitalis muscles, whereas BR responses were recorded over the orbicularis oculi after supraorbital nerve stimulation. All recordings were performed when the external part of the implant was in place (CIp) and after its removal (CIr), except occipitalis recordings, which were performed only after removal. The amplitude and latency of CMAP were measured to evaluate the axonal integrity of the zygomatic and posterior branches of the facial nerve. Latency, amplitude, and duration of the BR were measured to investigate the integrity of trigeminofacial connections.

Results

The amplitude and latency of CMAP over the nasalis muscle were bilaterally normal, and the difference between CIp and CIr was not statistically significant. No CMAP of the occipitalis muscle was recorded in 4 (16.7%) patients, and low-amplitude responses were recorded on the implant side of 20 (83.3%). Amplitudes of the contralateral R2 response were higher in the CIp condition versus the CIr condition (P = .031). There were no differences among other BR components.

Conclusion

During functioning of the CI system, excitability of the facial circuit may increase either through the facial motor nucleus or through removal of the inhibitory effect of the descending pathway.

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Developing Quality Measures for Adult Cochlear Implant Centers: Preliminary Findings

The study objective was to develop quality measures for adult cochlear implant centers. A modified Delphi design beginning with focus groups of surgeons and audiologists was used, as adapted from the American College of Cardiology / American Heart Association method for creating quality measures. Two academic cochlear implant programs and 1 private program participated. Qualitative focus group analysis yielded 58 candidate measures. An additional 5 candidate measures were added from a systematic review of the literature. After exclusion of pediatric measures, structure measures, and process measures and discussion of details and implications of each measure, 8 measures remained as the preliminary Adult Cochlear Implant Outcome (CI-OUTCOME) Measure Set. This study provides a preliminary set of measures for evaluating the quality of adult cochlear implant centers, based on input from implant surgeons and audiologists. The next step will be to gather feedback from implant patients.

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Primary Caregiver Perception of Pain Control following Pediatric Adenotonsillectomy: A Cross-Sectional Survey

Objectives

To (1) review pain medications prescribed following pediatric adenotonsillectomy (T&A), (2) identify pain medications reported to be helpful, and (3) compare parent-reported outcomes among various combinations of pain medications.

Study Design

Case series with planned data collection.

Setting

Multihospital network.

Subjects and Methods

The primary caregivers of children aged 1 to 18 years who underwent isolated T&A from June to December 2014 were contacted 14 to 21 days after surgery. Data collected included pain medications prescribed, medications most helpful in controlling pain, and duration that pain medication was required. Parents rated their children's pain on postoperative days 2, 3, 7, and 14 and reported the time to resumption of normal diet/activity, as well as any hospital return visits.

Results

The study cohort included 672 subjects of 1444 potential participants (46% response rate). The mean age of the patients was 7.9 ± 3.6 years. Narcotics were prescribed in 71.9%, and 70.4% were told to use ibuprofen. Children who took ibuprofen alone were significantly younger (P < .001). Pain was significantly less on postoperative days 2 and 3 in the ibuprofen-only group as compared with the groups taking narcotics only (P < .001) and ibuprofen with narcotics (P = .002). Those taking ibuprofen alone returned to normal activity (P < .001) and diet (P = .026) sooner than those taking ibuprofen with narcotics. No difference was seen in pain control on subgroup analysis comparing oxycodone and hydrocodone.

Conclusions

For pediatric T&A, significant variation exists in the management of postoperative pain. Parents of children given ibuprofen reported less pain than those given narcotics with and without ibuprofen. Further studies are needed to identify the optimal pain regimen for children after T&A.

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Medical Information Exchange: Pattern of Global Mobile Messenger Usage among Otolaryngologists

Objective

Information technology has revolutionized health care. However, the development of dedicated mobile health software has been lagging, leading to the use of general mobile applications to fill in the void. The use of such applications has several legal, ethical, and regulatory implications. We examined the experience and practices governing the usage of a global mobile messenger application (WhatsApp) for mobile health purposes in a national cohort of practicing otolaryngologists in Israel, a known early adaptor information technology society.

Methods

Cross-sectional data were collected from practicing otolaryngologists and otolaryngology residents via self-administered questionnaire. The questionnaire was composed of a demographic section, a section surveying the practices of mobile application use, mobile health application use, and knowledge regarding institutional policies governing the transmission of medical data.

Results

The sample included 22 otolaryngology residents and 47 practicing otolaryngologists. Of the physicians, 83% worked in academic centers, and 88% and 40% of the physicians who worked in a hospital setting or a community clinic used WhatsApp for medical use, respectively. Working with residents increased the medical usage of WhatsApp from 50% to 91% (P = .006). Finally, 72% were unfamiliar with any institutional policy regarding the transfer of medical information by personal smartphones.

Discussion

Mobile health is becoming an integral part of modern medical systems, improving accessibility, efficiency, and possibly quality of medical care.

Implications for Practice

The need to incorporate personal mobile devices in the overall information technology standards, guidelines, and regulation is becoming more acute. Nonetheless, practices must be properly instituted to prevent unwanted consequences.

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Highlights from the Current Issue: November 2016

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Are Online Zenkers Diverticulum Materials Readable and Understandable?

Objective

Patients use a multitude of resources to learn about Zenker's diverticulum (ZD). The objectives of this study were to assess the readability and understandability of online materials on ZD, evaluate them against the existing criteria, and investigate the relationship between readability and understandability.

Methods

The first 50 webpages from an online search for ZD were analyzed. Twenty-one webpages had materials intended for patients and were included in the study. The patient education materials (PEMs) were analyzed using 6 readability tools. Four individuals used the Patient Education Materials Evaluation Tool (PEMAT) to assess the understandability. Fleiss interrater reliability analysis determined consistency among the raters. Finally, Pearson correlation coefficient analyzed the relationship between readability and understandability.

Results

The reading grade level of the materials reviewed ranged from 10th to 16th grade while the understandability ranged from 31% to 74%. Correlation analysis demonstrated a strong negative correlation between readability and understandability (r = –0.62, P < .05). Fleiss' interrater reliability for the raters demonstrated substantial agreement between the 4 raters ( = 0.64).

Conclusion

Online PEMs pertaining to ZD are written well above the recommended reading level. Materials written at a lower reading level are more understandable. A wide range of understandability exists among materials with identical reading grade levels.

Implications for Practice

Health care providers need to create new PEMs for ZD that are available online that are both readable and understandable. The PEMAT and readability formulas can provide a framework for authors to create these materials.

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Gene Methylation Profiling in Sinonasal Adenocarcinoma and Squamous Cell Carcinoma

Objective

To identify epigenetic events in intestinal-type sinonasal adenocarcinoma (ITAC) and sinonasal squamous cell carcinoma (SNSCC) and to evaluate their relation to clinicopathologic features and follow-up data.

Study Design

Retrospective study.

Setting

Academic research hospital.

Subjects and Methods

The methylation status of 23 genes in 50 ITACs and 32 SNSCCs was analyzed by methylation-specific multiplex ligation-dependent probe amplification and its relation to clinicopathologic features and follow-up data.

Results

Gene methylation was observed in 50% of all tumors. Recurrent methylated genes in SNSCC were RASSF1 and CDH13 (for both, 6 of 32 cases), CHFR (4 of 32 cases), and TIMP3 (2 of 32 cases). None of these genes showed significant correlation to clinicopathologic features or overall survival. In ITAC, recurrent methylated genes were CDH13 (18 of 50 cases), ESR1 (13 of 50 cases), APC (7 of 50 cases), TIMP3 (5 of 50 cases), CASP8 (3 of 50 cases), and HIC1 and RASSF1 (for both, 2 of 50 cases). Papillary and colonic ITAC subtypes carried a mean of 1.26 gene methylations per tumor versus 0.63 in solid and mucinous subtypes. Methylation of TIMP3 was associated with a significantly worse survival in ITAC patients.

Conclusion

ITAC carries a higher number and a different profile of gene methylations as compared with SNSCC. Gene methylation plays a greater role in papillary and colonic ITAC subtypes, which may indicate a different tumorigenic pathway for these ITAC subtypes. These findings could be used as prognosticators and may have implications for future individualized therapies based on epigenetic changes.

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Stapedotomy vs Cochlear Implantation for Advanced Otosclerosis: Systematic Review and Meta-analysis

Objectives

To compare the hearing outcomes of stapedotomy vs cochlear implantation in patients with advanced otosclerosis.

Data Sources

PubMed, EMBASE, and The Cochrane Library were searched for the terms otosclerosis, stapedotomy, and cochlear implantation and their synonyms with no language restrictions up to March 10, 2015.

Methods

Results

Conclusions

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Voice Outcomes following a Single Office-Based Steroid Injection for Vocal Fold Scar

Objective

Study Design

Case series with chart review.

Setting

Academic medical center.

Subjects and Methods

Results

Conclusions

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Head and Neck Manifestations of Eosinophilic Granulomatosis with Polyangiitis: A Systematic Review

Objective

Data Sources

PubMed, Cochrane Library, Scopus, and LILACS.

Review Methods

A systematic review of the aforementioned sources was conducted per the PRISMA guidelines.

Results

Conclusion

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Knowledge of cancer symptoms and anxiety affect patient delay in seeking diagnosis in patients with heterogeneous cancer locations

Publication date: Available online 31 October 2016
Source:Current Problems in Cancer
Author(s): Gabriela Chojnacka-Szawłowska, Mikołaj Majkowicz, Krzysztof Basiński, Agata Zdun-Ryżewska, Iwona Wasilewko, Piotr Pankiewicz
PurposeThis research was aimed at identifying factors that predict patient delay in treatment initiation in patients with suspected cancer disease. We sought to determine the differences between delaying and non-delaying patients with reference to their knowledge of cancer symptoms, sociodemographic variables, and the levels of state-anxiety and trait-anxiety.MethodsThe study involved 301 randomly selected patients with suspected cancer disease before their first oncology appointment at a regional oncology centre in Poland. Data were collected by means of a semi-structured interview conducted by a trained psychologist. To evaluate the knowledge of cancer symptoms, the symptoms mentioned by subjects were compared to the list of symptoms from Cancer Awareness Measure. Anxiety levels were assessed using the State-Trait Anxiety Inventory (STAI).ResultsIn the course of logistic regression analysis a model was developed, in which knowledge of cancer symptoms and state-anxiety allowed to predict patient delay. Knowledge of every additional cancer symptom decreased the chance of patient delay by 16.4 percentage point [95% CI: 1.4–29.2]. An increase in state-anxiety for every point of the scale decreased the chance of delay by 2.5 percentage points [95% CI: 0.2–4.6]. Trait-anxiety and the studied sociodemographic variables proved to be nonsignificant predictors of patient delay.ConclusionsKnowledge of cancer symptoms and the level of state-anxiety allowed to predict patient delay in the initiation of treatment. Owing to the heterogeneity of the tumor locations within the sample, the obtained model can be used in large scale prevention programmes designed for the whole population.

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The Role of Helicobacter pylori in Laryngopharyngeal Reflux: A Systematic Review and Meta-analysis

Objective

The primary objective was to determine the prevalence of Helicobacter pylori among patients with laryngopharyngeal reflux. The secondary objective was determining if H pylori eradication leads to greater symptom improvement in patients with laryngopharyngeal reflux as compared with standard proton pump inhibitor therapy alone.

Data Sources

EMBASE, Cumulative Index to Nursing and Allied Health Literature, MEDLINE, World Health Organization International Clinical Trials Registry Platform, European Union Clinical Trials Register, Cochrane Library databases of clinical trials, and ClinicalTrials.gov.

Review Methods

A systematic review was performed of studies assessing the diagnosis or treatment of H pylori among patients with laryngopharyngeal reflux. Randomized controlled trials, cohort studies, case-control studies, and case series were included. A meta-analysis of prevalence data and assessment of heterogeneity was performed on relevant studies.

Results

Fourteen studies were analyzed in the review, with 13 eligible for the meta-analysis. We determined that the prevalence of H pylori among patients with laryngopharyngeal reflux was 43.9% (95% confidence interval, 32.1-56.5). The heterogeneity of studies was high, with an overall I ² value of 92.3%. We were unable to quantitatively assess findings for our secondary outcome, since H pylori identification and treatment were not the primary focus of the majority of studies.

Conclusion

There is a high rate of H pylori infection among patients with laryngopharyngeal reflux. The infection rate in North America and Western Europe has not been adequately studied. There is insufficient evidence to make a recommendation regarding the testing and treatment of H pylori infection among patients with laryngopharyngeal reflux.

http://ift.tt/2eQ5cFZ

The Role of Helicobacter pylori in Laryngopharyngeal Reflux: A Systematic Review and Meta-analysis

Objective

Data Sources

Review Methods

Results

Conclusion

http://ift.tt/2eQ5cFZ

Effect of Botulinum Toxin and Surgery among Spasmodic Dysphonia Patients: A Systematic Review

Objective

The effect of botulinum toxin among patients with adductor spasmodic dysphonia (AdSD) is temporary. To optimize long-term treatment outcome, other therapy options should be evaluated. Alternative treatment options for AdSD comprise several surgical treatments, such as thyroarytenoid myotomy, thyroplasty, selective laryngeal adductor denervation-reinnervation, laryngeal nerve crush, and recurrent laryngeal nerve resection. Here, we present the first systematic review comparing the effect of botulinum toxin with surgical treatment among patients diagnosed with AdSD.

Data Sources

MEDLINE (PubMed), EMBASE, and the Cochrane Library.

Methods

Articles were reviewed by 2 independent authors, and data were compiled in tables for analysis of the objective outcome (voice expert evaluation after voice recording), the subjective outcome (patient self-assessment scores), and voice-related quality of life (Voice Health Index scores).

Results

No clinical trials comparing both treatment modalities were identified. Single-armed studies evaluated either the effect of botulinum toxin or surgical treatment. Thirteen studies reported outcomes after botulinum toxin treatment (n = 419), and 9 studies reported outcomes after surgical treatment (n = 585 patients). A positive effect of bilateral botulinum toxin injections was found for the objective voice outcome, subjective voice outcome, and quality of life. The duration of the beneficial effect ranged from 15 to 18 weeks. Surgical treatment had an overall positive effect on objective voice improvement, subjective voice improvement, and quality of live.

Conclusion

No preference for one treatment could be demonstrated. Prospective clinical trials comparing treatment modalities are recommended to delineate the optimal outcomes by direct comparison.

http://ift.tt/2f8Qrwu

Effect of Botulinum Toxin and Surgery among Spasmodic Dysphonia Patients: A Systematic Review

Objective

Data Sources

MEDLINE (PubMed), EMBASE, and the Cochrane Library.

Methods

Results

Conclusion

No preference for one treatment could be demonstrated. Prospective clinical trials comparing treatment modalities are recommended to delineate the optimal outcomes by direct comparison.

http://ift.tt/2f8Qrwu

Epi-Drugs and Epi-miRs: Moving Beyond Current Cancer Therapies

Epigenetic modifications determine phenotypic characteristics in a reversible, stable and genotype-independent manner. Epigenetic modifications mainly encompass CpG island methylation and histone modifications, both being important in the pathogenesis of malignancies. The reversibility of epigenetic phenomenon provides a suitable therapeutic option that is reactivation of epigenetically silenced tumor-suppressor genes. Inhibition of DNA methyltransferase, histone deacetylase and Aurora B kinase, individually or collectively, could feasibly prevent or reverse the impact of epigenetic silencing. MicroRNAs [miRNAs] are an important layer of epigenetic controlling of gene expression, and serve as diagnostic and prognostic biomarkers as well as treatment targets for several types of cancer. miRNAs are involved inepigenetically silencing or activation of genes, tumor suppressor genes and oncogenes, and their modulation opens new horizons for designing novel cancer therapeutic agents.

http://ift.tt/2dxkL4h

The Use of Biomarkers for Bladder Cancer Diagnosis and Surveillance

Bladder cancer - a propensity that is associated with high recurrence and mortality rates. Various molecular alterations are reflected by diverse cellular morphological manifestations and vast tumor heterogeneity. Many biomarkers have been described that have undergone clinical trials and are approved for clinical use, but most still remain investigational. The question how molecular markers can support surveillance of different patient groups is still a matter of controversy. However, it can be expected that major advancement in the understanding of molecular pathways involved in urothelial carcinogenesis will enable improved patient management. The scope of this review is to discuss the established diagnostic tests and urinary biomarkers and their application for screening and surveillance of bladder cancer.

http://ift.tt/2fA6ypn

Bilateral Ocular Decompression Retinopathy after Ahmed Valve Implantation for Uveitic Glaucoma

Case Report: We report the case of a 29-year-old man who underwent Ahmed valve implantation in both eyes as treatment for uveitic glaucoma, subsequently presenting with bilateral ocular decompression retinopathy in the postoperative period. Discussion: Ocular decompression retinopathy is a rare complication of filtering surgery in patients with glaucoma; however, the course is benign in most cases, with spontaneous resolution of bleedings and improvement of visual acuity.
Case Rep Ophthalmol 2016;7:227–232

http://ift.tt/2f5cq9j

Association Between MRI Exposure During Pregnancy and Fetal and Childhood Outcomes.

http:--jama.jamanetwork.com-images-PUBME

Association Between MRI Exposure During Pregnancy and Fetal and Childhood Outcomes.

JAMA. 2016 Sep 6;316(9):952-61

Authors: Ray JG, Vermeulen MJ, Bharatha A, Montanera WJ, Park AL

Abstract
IMPORTANCE: Fetal safety of magnetic resonance imaging (MRI) during the first trimester of pregnancy or with gadolinium enhancement at any time of pregnancy is unknown.
OBJECTIVE: To evaluate the long-term safety after exposure to MRI in the first trimester of pregnancy or to gadolinium at any time during pregnancy.
DESIGN, SETTING, AND PARTICIPANTS: Universal health care databases in the province of Ontario, Canada, were used to identify all births of more than 20 weeks, from 2003-2015.
EXPOSURES: Magnetic resonance imaging exposure in the first trimester of pregnancy, or gadolinium MRI exposure at any time in pregnancy.
MAIN OUTCOMES AND MEASURES: For first-trimester MRI exposure, the risk of stillbirth or neonatal death within 28 days of birth and any congenital anomaly, neoplasm, and hearing or vision loss was evaluated from birth to age 4 years. For gadolinium-enhanced MRI in pregnancy, connective tissue or skin disease resembling nephrogenic systemic fibrosis (NSF-like) and a broader set of rheumatological, inflammatory, or infiltrative skin conditions from birth were identified.
RESULTS: Of 1 424 105 deliveries (48% girls; mean gestational age, 39 weeks), the overall rate of MRI was 3.97 per 1000 pregnancies. Comparing first-trimester MRI (n = 1737) to no MRI (n = 1 418 451), there were 19 stillbirths or deaths vs 9844 in the unexposed cohort (adjusted relative risk [RR], 1.68; 95% CI, 0.97 to 2.90) for an adjusted risk difference of 4.7 per 1000 person-years (95% CI, -1.6 to 11.0). The risk was also not significantly higher for congenital anomalies, neoplasm, or vision or hearing loss. Comparing gadolinium MRI (n = 397) with no MRI (n = 1 418 451), the hazard ratio for NSF-like outcomes was not statistically significant. The broader outcome of any rheumatological, inflammatory, or infiltrative skin condition occurred in 123 vs 384 180 births (adjusted HR, 1.36; 95% CI, 1.09 to 1.69) for an adjusted risk difference of 45.3 per 1000 person-years (95% CI, 11.3 to 86.8). Stillbirths and neonatal deaths occurred among 7 MRI-exposed vs 9844 unexposed pregnancies (adjusted RR, 3.70; 95% CI, 1.55 to 8.85) for an adjusted risk difference of 47.5 per 1000 pregnancies (95% CI, 9.7 to 138.2).
CONCLUSIONS AND RELEVANCE: Exposure to MRI during the first trimester of pregnancy compared with nonexposure was not associated with increased risk of harm to the fetus or in early childhood. Gadolinium MRI at any time during pregnancy was associated with an increased risk of a broad set of rheumatological, inflammatory, or infiltrative skin conditions and for stillbirth or neonatal death. The study may not have been able to detect rare adverse outcomes.

PMID: 27599330 [PubMed - indexed for MEDLINE]

http://ift.tt/2eiiavk

HER2 Protein Overexpression and Gene Amplification in Plasmacytoid Urothelial Carcinoma of the Urinary Bladder.

http:--images.hindawi.com-linkout-hindaw

HER2 Protein Overexpression and Gene Amplification in Plasmacytoid Urothelial Carcinoma of the Urinary Bladder.

Dis Markers. 2016;2016:8463731

Authors: Kim B, Kim G, Song B, Lee C, Park JH, Moon KC

Abstract
AIM: HER2 overexpression has been reported in a minority of urothelial carcinomas, but little is known about HER2 protein expression and gene alterations in plasmacytoid urothelial carcinoma, a rare and aggressive variant. The aim of this study was to clarify the HER2 status in plasmacytoid urothelial carcinomas.
METHODS: Six cases of plasmacytoid urothelial carcinoma were included, in which we evaluated HER2 protein expression by immunohistochemistry (IHC) and HER2 gene amplification by fluorescence in situ hybridization (FISH).
RESULTS: The patients' ages ranged from 57 to 83 years (mean age, 71 years). Five patients were male and one was female. The ratio of the plasmacytoid component ranged from 30% to 100% (mean, 77%). HER2 expression score was 3+ in 4 cases, 2+ in one case, and negative in one case. HER2 gene amplification was positive in 3 cases, of which 2 cases showed a 3+ HER2 IHC score but one case was negative for HER2 IHC. Another 2 cases showed equivocal HER2 FISH results, and one remaining case was negative for HER2 FISH.
CONCLUSION: Our observation that plasmacytoid urothelial carcinomas frequently demonstrated HER2 protein overexpression provides supporting evidence that HER2 may be a potential therapeutic target for plasmacytoid urothelial carcinoma.

PMID: 27034533 [PubMed - indexed for MEDLINE]

http://ift.tt/2fcGxIf

Genetic Investigation of Uterine Carcinosarcoma: Case Report and Cohort Analysis.

Genetic Investigation of Uterine Carcinosarcoma: Case Report and Cohort Analysis.

Cancer Control. 2016 Jan;23(1):61-6

Authors: Hembree TN, Teer JK, Hakam A, Chiappori AA

Abstract
BACKGROUND: Uterine carcinosarcoma, a rare gynecological malignancy, often presents at the advanced stage with a poor prognosis because current therapies have not improved rates of survival. Genetic characterization of this tumor may lead to novel, specifically targeted drug targets to provide better treatment options for patients with this malignancy.
METHODS: We present a case of a woman aged 61 years with uterine carcinosarcoma and retrospectively analyzed 100 study patients with uterine carcinosarcoma. From this group, 9 study patients underwent targeted sequencing of 1,321 genes.
RESULTS: All 9 study patients had at least 1 mutation in JAK2, KRAS, PIK3CA, CTNNB1, PTEN, FBXW7, TP53, and ERBB2; of these, TP53 was the most frequently mutated gene (6/9). In addition, ARID1A and KMT2C, which have been described and identified as part of a set of chromatin-remodeling genes, were also found in our analyses. From our 100-person cohort clinical analyses, study patients with stage 1 cancer had a median survival rate of 33 months (95% confidence interval, 19-109) compared with a median survival rate of 6 months (95% confidence interval, 3-12) in those with stage 4 disease.
CONCLUSIONS: Disease stage alone predicted the rate of clinical survival. Up to 50% in the study group were identified at having early stage disease (stage 1/2), indicating improved rates of overall detection compared with previously reported data. Our mutational analysis findings add to the number of tumors in which these mutations have been found and suggest that chromatin-remodeling dysregulation may play a role in the tumorigenesis of carcinosarcoma.

PMID: 27009459 [PubMed - indexed for MEDLINE]

http://ift.tt/2fcL9yd

MYB-fusions and other potential actionable targets in adenoid cystic carcinoma.

http:--pt.wkhealth.com-pt-pt-core-templa

MYB-fusions and other potential actionable targets in adenoid cystic carcinoma.

Curr Opin Oncol. 2016 May;28(3):195-200

Authors: Ferrarotto R, Heymach JV, Glisson BS

Abstract
PURPOSE OF REVIEW: Adenoid cystic carcinoma (ACC) is a rare cancer of the secretory glands, typically originating in the salivary glands of the head and neck. The impact of chemotherapy on survival is unclear and there are no standard-of-care treatments for patients with recurrent or metastatic disease. This article reviews recently completed and ongoing clinical trials for patients with ACC and describes recently identified potentially targetable genomic alterations in this orphan disease.
RECENT FINDINGS: In spite of an overall low mutational burden, genotyping of ACC samples has shed some light about the disease biology. In addition to the frequent translocations involving MYB or MYBL, recurrent alterations in genes involved in chromatin deregulation, FGF, PI3K, NOTCH1, and DNA damage repair pathways have been identified. Many of these genomic alterations are targetable and drug screening is ongoing in genotyped ACC patient-derived murine xenografts.
SUMMARY: Clinical studies with targeted agents in unselected ACC patients have not been promising thus far. The identification of potential driver oncogenes suggests that targeted therapy might be effective in molecularly-defined patient subgroups and merits investigation in future clinical studies.

PMID: 26974847 [PubMed - indexed for MEDLINE]

http://ift.tt/2eihTIV

Histological and immunohistochemical features of histiocytic sarcoma in four domestic ferrets (Mustela putorius furo).

Histological and immunohistochemical features of histiocytic sarcoma in four domestic ferrets (Mustela putorius furo).

J Vet Diagn Invest. 2016 Mar;28(2):165-70

Authors: Thongtharb A, Uchida K, Chambers JK, Miwa Y, Murata Y, Nakayama H

Abstract
Four cases of histiocytic sarcoma in domestic ferrets (Mustela putorius furo) are described in the present study. Tumor samples obtained from the abdominal viscera, including the spleen, were submitted for histologic examination. Microscopically, poorly demarcated masses contained numerous round- to pleomorphic-shaped cells with coarsely vacuolated and eosinophilic cytoplasm. Bizarre, binucleated tumor cells and multinucleated giant tumor cells with low phagocytic activity were commonly observed. Immunohistochemically, tumor cells in all of the cases were positive for vimentin, human leukocyte antigen-DR, ionized calcium-binding adapter molecule-1, and lysozyme, but some of them lacked cluster of differentiation (CD)163 or CD208 expression. The survival time after surgical resection was 9 days to 5 months. Histiocytic sarcoma in the ferret is a rare, but highly aggressive, tumor commonly found in the spleen.

PMID: 26965237 [PubMed - indexed for MEDLINE]

http://ift.tt/2fcHd0s

[Secondary chondrosarcoma of rare fibular location: report of a case].

[Secondary chondrosarcoma of rare fibular location: report of a case].

Pan Afr Med J. 2015;22:159

Authors: Guelzim S, El Bardouni A

PMID: 26889340 [PubMed - indexed for MEDLINE]

http://ift.tt/2eias4q

Desmoid tumour: a rare etiology of intestinal obstruction.

Desmoid tumour: a rare etiology of intestinal obstruction.

Pan Afr Med J. 2015;22:158

Authors: Aggarwal G, Shukla S, Maheshwari A, Mathur R

Abstract
Intestinal obstruction is a frequently encountered entity in surgical practice. The signs & symptoms, many a times, are suggestive of the level of obstruction, making the diagnosis of obstruction evident. There are various causes of intestinal obstruction which diversify to an enormous extent, stamping on the famous paradigm for the mysterious nature of the abdomen being referred to as the Pandora's Box. In accordance with the above saying, we report a rare case of a desmoid tumour, presenting as intestinal obstruction, which entices us to strongly believe the same.

PMID: 26889339 [PubMed - indexed for MEDLINE]

http://ift.tt/2eie6ez

Kissing molars: report of three cases and new prospective on aetiopathogenetic theories.

Kissing molars: report of three cases and new prospective on aetiopathogenetic theories.

Int J Clin Exp Pathol. 2015;8(12):15708-18

Authors: Menditti D, Laino L, Cicciù M, Mezzogiorno A, Perillo L, Menditti M, Cervino G, Lo Muzio L, Baldi A

Abstract
Kissing molars (KMs) is an extremely rare condition of impacted third molars, pointed in the opposite direction in a single follicular space; it consists exactly in a full impacted of permanent molars which occurs only in the lower jaw. Actually, about less than thirty cases have been reported in scientific literatures. The aetiology and pathogenesis of this pathological double dental inclusion remain unknown; above all events that lead two molars to appear, as KMs remain mysterious. The association to metabolic connective diseases such as mucopolysaccharidosis was emphasized. KMs considered as an isolated event, may be associated to an abnormal position of the tooth-bud from lower permanent molars, or fourth supernumerary tooth (distomolar). Recently, hyperplastic dental follicle (HDF), with a down regulation of matrix metal-proteinases and up regulation of several genes of collagens, has been mentioned in association with KMs. In this paper, after having analyzed three new cases of KMs that have been treated, we report a new hypothesis. This last is based on the failure in the dental follicle's ability to initiate or continue properly resorption of the overlying alveolar bone, by many exogenous factors which may act on eruptive phase that would lead to its rotation with its contents coming out a pathological situation of KMs. The therapy of choice is related to the surgical removal of KMs through a double odontectomy with transalveolar method. Other treatments can be, eventually, orthodontic therapy of the impacted teeth and a radiological follow-up without surgery.

PMID: 26884840 [PubMed - indexed for MEDLINE]

http://ift.tt/2einbEj

Phaeochromocytoma presenting with ST segment elevation myocardial infarction.

Phaeochromocytoma presenting with ST segment elevation myocardial infarction.

BMJ Case Rep. 2016 Feb 08;2016:

Authors: Ahmed MA, Abdullah AS, Kiernan TJ

Abstract
Phaeochromocytoma is a rare endocrine disorder with different cardiovascular presentations. In this brief report, we discuss a case of a 59-year-old woman who presented with acute ST segment elevation myocardial infarction secondary to phaeochromocytoma. Coronary angiogram showed non-obstructive coronary artery disease.

PMID: 26857585 [PubMed - indexed for MEDLINE]

http://ift.tt/2fcHKQ6

Replacement of Lost Lgr5-Positive Stem Cells through Plasticity of Their Enterocyte-Lineage Daughters.

http:--linkinghub.elsevier.com-ihub-imag

Replacement of Lost Lgr5-Positive Stem Cells through Plasticity of Their Enterocyte-Lineage Daughters.

Cell Stem Cell. 2016 Feb 4;18(2):203-13

Authors: Tetteh PW, Basak O, Farin HF, Wiebrands K, Kretzschmar K, Begthel H, van den Born M, Korving J, de Sauvage F, van Es JH, van Oudenaarden A, Clevers H

Abstract
Intestinal crypts display robust regeneration upon injury. The relatively rare secretory precursors can replace lost stem cells, but it is unknown if the abundant enterocyte progenitors that express the Alkaline phosphate intestinal (Alpi) gene also have this capacity. We created an Alpi-IRES-CreERT2 (Alpi(CreER)) knockin allele for lineage tracing. Marked clones consist entirely of enterocytes and are all lost from villus tips within days. Genetic fate-mapping of Alpi(+) cells before or during targeted ablation of Lgr5-expressing stem cells generated numerous long-lived crypt-villus "ribbons," indicative of dedifferentiation of enterocyte precursors into Lgr5(+) stems. By single-cell analysis of dedifferentiating enterocytes, we observed the generation of Paneth-like cells and proliferative stem cells. We conclude that the highly proliferative, short-lived enterocyte precursors serve as a large reservoir of potential stem cells during crypt regeneration.

PMID: 26831517 [PubMed - indexed for MEDLINE]

http://ift.tt/2eiiwC1

Relationship of Fas, FasL, p53 and bcl-2 expression in human non-small cell lung carcinomas.

Relationship of Fas, FasL, p53 and bcl-2 expression in human non-small cell lung carcinomas.

Int J Clin Exp Pathol. 2015;8(11):13978-86

Authors: Li Y, Xu KP, Jiang D, Zhao J, Ge JF, Zheng SY

Abstract
OBJECTIVE: Lack of surface Fas expression is a main route for apoptotic resistance which is considered an important mechanism of tumorigenesis and tumor progression. Fas and FasL expression in 110 non-small cell lung carcinomas (NSCLCs) were investigated to evaluate their roles in pulmonary carcinogenesis and to examine the clinicopathologic significance of Fas expression with its relationship with p53 and bcl-2 over- expression.
METHODS: Immunohistochemical analysis using tissue microarray demonstrated that a large proportion of NSCLC patients (60%) showed lack of membranous Fas expression. The Fas-negative cases revealed the significantly lower survival rate than Fas-positive ones. Also, the loss of Fas receptor expression was found more frequently in advanced stage and higher nodal status. FasL protein was increased in most NSCLCs (89%) compared to normal lungs.
RESULTS: p53 and bcl-2 overexpression showed no association with Fas expression. Conclusively, reduced membranous Fas expression as a mechanism of apoptotic resistance is considered to play an important part of the pulmonary carcinogenesis, which may predict poor survival and have a negative prognostic influence.
CONCLUSION: Increased FasL expression is thought to be a basis for the immune evasion in NSCLCs. The rare bcl-2 overexpression suggests that this anti-apoptotic protein is unlikely to play a role in the apoptotic resistance of NSCLCs.

PMID: 26823709 [PubMed - indexed for MEDLINE]

http://ift.tt/2fcIS6k

Spindle cell/sclerosing rhabdomyosarcoma: case series from a single institution emphasizing morphology, immunohistochemistry and follow-up.

Spindle cell/sclerosing rhabdomyosarcoma: case series from a single institution emphasizing morphology, immunohistochemistry and follow-up.

Int J Clin Exp Pathol. 2015;8(11):13814-20

Authors: Zhao Z, Yin Y, Zhang J, Qi J, Zhang D, Ma Y, Wang Y, Li S, Zhou J

Abstract
Spindle cell/sclerosing rhabdomyosarcoma is a rare skeletal-muscle tumor with distinctive clinicopathologic characteristics. 10 cases (6 cases of spindle cell rhabdomyosarcoma and 4 cases of scleroisng rhabdomyosarcoma) were composed of 6 males and 4 females aging from 5 months to 57 years, with median age 33 years, most of who represented a painless solid mass. Histologically, the tumors were composed of fascicles of spindle cells or primitive round cells embed in sclerotic matrix with presence of rhabdomyoblasts in varying proportion. Immunohistochemically, the tumor cells expressed MyoD1 (10/10), Desmin (10/10), myogenin (6/10), AE1/AE3 (2/10), EMA (2/10), but were negative for SMA, caldesmon, S-100. All of the patients underwent a complete surgical resection without or with chemotherapy (2/10) or radiotherapy (1/10). During the follow-up period (1 to 24 months), 1 patient was succumbed, and 2 cases showed in situ recurrence with 1 of them adopting metastasis. Our cases further demonstrate there do present some clincopathologic relations between spindle cells rhabdomyosarcoma and sclerosing rhabdomyosarcoma, but the latter seems to have a better prognosis. Exact grading and staging contribute to predict the outcome.

PMID: 26823695 [PubMed - indexed for MEDLINE]

http://ift.tt/2eieh9y

Adrenal lymphoma: presentation, management and prognosis.

Adrenal lymphoma: presentation, management and prognosis.

QJM. 2016 Oct 18;:

Authors: Laurent C, Casasnovas O, Martin L, Chauchet A, Ghesquieres H, Aussedat G, Fornecker LM, Bologna S, Borot S, Laurent K, Bouillet B, Verges B, Petit JM

Abstract
AIM: This study aimed to identify the clinical, radiological and prognostic features of primary adrenal lymphoma (PAL) in order to diagnose the disease more accurately.
MATERIALS AND METHODS: A retrospective multi-centre study was conducted on the clinical, biological and radiological features as well as the treatment and overall survival outcomes in PAL.
RESULTS: Between 1994 and 2014, 28 patients from five regions of eastern France were diagnosed with primary adrenal lymphoma. The revealing symptoms were a worsening general state (77%), weight loss (77%) and abdominal pain (42%). Biological features of PAL were almost omnipresent: increased LDH, β2 microglobulin, CRP or ferritinaemia levels. The PAL was bilateral in 20 cases (71%), adrenal insufficiency was searched for in 11 patients and found in eight (73%). CT scans showed masses of various sizes measuring up to 180 mm. On MRI, the lesions were hypointense in T1 and hyperintense in T2. When done, positron emission tomography with fluorodeoxyglucose (FDG-PET) showed locations not seen on the CT and revealed extra-adrenal locations in 70% of examinations. Adrenalectomy brought no benefit. The overall survival rate was poor (61.9% at 2 years) despite polychemotherapy.
CONCLUSION: The clinical presentation of PAL comprised major general symptoms. Adrenal insufficiency was very common in patients with bilateral involvement but was not systematically tested. PET was an efficient examination to visualize extra-adrenal locations. The preliminary results of MRI to distinguish between PAL and adrenocortical carcinoma should be confirmed. Further studies are needed to establish an optimal strategy for the management of these primary adrenal lymphomas.

PMID: 27795295 [PubMed - as supplied by publisher]

http://ift.tt/2f53CjI

Impact of consultant specialty on discharge decisions in patients admitted as medical emergencies to hospitals in the United Kingdom.

Impact of consultant specialty on discharge decisions in patients admitted as medical emergencies to hospitals in the United Kingdom.

QJM. 2016 Oct 18;:

Authors: Subbe CP, Jeune IL, Ward D, Pradhan S, Masterton-Smith C

Abstract
BACKGROUND: The Society for Acute Medicine's Benchmarking Audit (SAMBA) annually examines Clinical Quality Indicators (CQIs) of the care of patients admitted to UK hospitals as medical emergencies.
AIM: The aim of this study is to review the impact of consultant specialty on discharge decisions in the SAMBA data-set.
DESIGN AND METHODS: Prospective audit of patients admitted to acute medical units (AMUs) on 25 June 2015 to participating hospitals throughout the UK with subgroup analysis.
RESULTS: Eighty-three units submitted patient data from 3138 patients.Nearly 1845 (58%, IQR for units 50-69%) of patients were referrals from Emergency Medicine, 1072 (32%, IQR for units 24-44%) were referrals from Primary Care. The mean age was 65 (SD 20). One hundred and forty-one (4.5%) patients were admitted from care homes and 951 (30%) of patients were at least 'mildly frail' and 407 (13%) had signs of physiological instability. The median and the mean time to being seen by a doctor were 1 h 20 min and 2 h 3 min, respectively. The median and the mean time to being seen by senior specialist were 3 h 55 min and 5 h 56 min, respectively. By 72 h, 29 (1%) patients had died in the AMU, 73 were admitted to critical care units, 1297 (41%) had been discharged to their own home and 60 to nursing or residential homes. For every 100 patients seen specialists in acute medicine discharged 12 more patients than specialists from other disciplines of medicine (P < 0.001). The difference remained significant after adjustment for case mix.
CONCLUSION: Specialist in acute care might facilitate discharge in a higher proportion of patients.

PMID: 27795294 [PubMed - as supplied by publisher]

http://ift.tt/2fq0Y9Y

Famine and disease in Nigerian refugee camps for internally displaced peoples: a sad reflection of our times.

Famine and disease in Nigerian refugee camps for internally displaced peoples: a sad reflection of our times.

QJM. 2016 Oct 18;:

Authors: Taylor-Robinson SD, Oleribe O

PMID: 27795293 [PubMed - as supplied by publisher]

http://ift.tt/2f8aRVO

Proton pump inhibitors, purple gastric juice and peptic ulcer disease.

Proton pump inhibitors, purple gastric juice and peptic ulcer disease.

QJM. 2016 Oct 18;:

Authors: Chang YC, Hsiao PJ, Wu KL, Hsiao CJ

PMID: 27795292 [PubMed - as supplied by publisher]

http://ift.tt/2fq5ncS

Endovascular treatment of carotico-cavernous fistulas with acrylic glue: a series of nine cases.

Endovascular treatment of carotico-cavernous fistulas with acrylic glue: a series of nine cases.

Neuroradiology. 2016 Oct 29;

Authors: Ohlsson M, Consoli A, Rodesch G

Abstract
INTRODUCTION: Injuries to the internal carotid artery close to the cavernous sinus may result in a fistulous connection between the artery and the venous sinus. Symptoms include pulsatile tinnitus, intracranial bruit, ophthalmological symptoms, and risk of intracerebral hematoma in cases of cortical venous reflux. Previous treatment strategies have included detachable latex balloons, coils, covered stents, or combinations thereof. Today, detachable latex balloons are phased out or withdrawn from several markets. Acrylic glue is a proven stable material used for embolization of arteriovenous shunts. It is a precise, fast, and cost-effective method of endovascular embolization, and it does not cause artifacts on MRI or MRA.
METHODS: We treated nine patients suffering from direct fistulas with acrylic glue without any permanent neurological adverse events.
RESULTS: Four patients were treated with glue embolization of the fistula without occlusion of the parent artery. Five patients with long-lasting symptomatology, large tears in the ICA, and with full collateral cerebral circulation were treated with glue embolization of the fistula and sacrifice of the ICA antero- and retrograde via the ICA and the posterior communicating artery.
CONCLUSION: We suggest acrylic glue to be added to the panel of embolic materials used to treat CCFs.

PMID: 27796449 [PubMed - as supplied by publisher]

http://ift.tt/2f8r3qB

APEX/SPIN: a free test platform to measure speech intelligibility.

APEX/SPIN: a free test platform to measure speech intelligibility.

Int J Audiol. 2016 Oct 31;:1-7

Authors: Francart T, Hofmann M, Vanthornhout J, Van Deun L, van Wieringen A, Wouters J

Abstract
OBJECTIVES: Measuring speech intelligibility in quiet and noise is important in clinical practice and research. An easy-to-use free software platform for conducting speech tests is presented, called APEX/SPIN.
DESIGN: The APEX/SPIN platform allows the use of any speech material in combination with any noise. A graphical user interface provides control over a large range of parameters, such as number of loudspeakers, signal-to-noise ratio and parameters of the procedure. An easy-to-use graphical interface is provided for calibration and storage of calibration values. To validate the platform, perception of words in quiet and sentences in noise were measured both with APEX/SPIN and with an audiometer and CD player, which is a conventional setup in current clinical practice.
STUDY SAMPLE: Five normal-hearing listeners participated in the experimental evaluation.
RESULTS: Speech perception results were similar for the APEX/SPIN platform and conventional procedures.
CONCLUSIONS: APEX/SPIN is a freely available and open source platform that allows the administration of all kinds of custom speech perception tests and procedures.

PMID: 27796135 [PubMed - as supplied by publisher]

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Αρχειοθήκη ιστολογίου

! # Ola via Alexandros G.Sfakianakis on Inoreader

Η λίστα ιστολογίων μου

Τρίτη 1 Νοεμβρίου 2016

Abstract

Αρχειοθήκη ιστολογίου