Discriminating Depth of Response to Therapy in Multiple Myeloma Using Whole-body Diffusion-weighted MRI with Apparent Diffusion Coefficient

Publication date: Available online 17 January 2018
Source:Academic Radiology
Author(s): Chao Wu, Juan Huang, Wen-Bin Xu, Yong-Jing Guan, Hua-Wei Ling, Jian-Qing Mi, Hua Yan
Rationale and ObjectivesThis study aimed to measure apparent diffusion coefficient (ADC) in Chinese patients with newly diagnosed multiple myeloma by whole-body diffusion-weighted magnetic resonance imaging (WB-DWI MRI) and assess the diagnostic accuracy of ADC in the discrimination of deep response to induction chemotherapy.Materials and MethodsSeventeen patients underwent WB-DWI MRI before and after induction chemotherapy (week 20). DWI images and ADC maps were produced and 89 regions of interest were chosen. ADC percent changes were compared between deep (complete response or very good partial response) and non–deep responders (partial response, minimal response, stable disease, or progressive disease) as International Myeloma Working Group criteria. Diagnostic accuracy of ADC was calculated using specific cut offs. Predictive positive value of ADC was calculated to predict deep response to consolidation therapy.ResultsLesions reduced in size and number and signal intensity decreased in follow-up DWI, which did not differ between deep and non–deep responders. ADC percent changes were significantly higher in deep responders (36.79%) than in non–deep responders (11.50%) after induction therapy (P = .02) in per lesion analysis. ADC percent increases by 46.96%, 78.0% yielded specificity at 81.4%, 90.7% in discriminating deep response to induction therapy. Predictive positive value predicting deep response to consolidation therapy was 60.5% by using ADC cutoff >1.00 × 10⁻³ mm²/s at week 20.ConclusionsADC from WB-DWI MRI increased remarkably in patients who achieved deep response at the end of induction chemotherapy, which represented a confirmatory diagnostic tool to discriminate deep response to induction therapy for patients with multiple myeloma. ADC may have a potential to predict deep response to consolidation therapy.



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Associations of County-level Radiologist and Mammography Facility Supply with Screening Mammography Rates in the United States

Publication date: Available online 17 January 2018
Source:Academic Radiology
Author(s): Andrew B. Rosenkrantz, Linda Moy, Margaret M. Fleming, Richard Duszak
Rationale and ObjectivesThe present study aims to assess associations of Medicare beneficiary screening mammography rates with local mammography facility and radiologist availability.Materials and MethodsMammography screening rates for Medicare fee-for-service beneficiaries were obtained for US counties using the County Health Rankings data set. County-level certified mammography facility counts were obtained from the United States Food and Drug Administration. County-level mammogram-interpreting radiologist and breast imaging subspecialist counts were determined using Centers for Medicare & Medicaid Services fee-for-service claims files. Spearman correlations and multivariable linear regressions were performed using counties' facility and radiologist counts, as well as counts normalized to counties' Medicare fee-for-service beneficiary volume and land area.ResultsAcross 3035 included counties, average screening mammography rates were 60.5% ± 8.2% (range 26%–88%). Correlations between county-level screening rates and total mammography facilities, facilities per 100,000 square mile county area, total mammography-interpreting radiologists, and mammography-interpreting radiologists per 100,000 county-level Medicare beneficiaries were all weak (r = 0.22–0.26). Correlations between county-level screening rates and mammography rates per 100,000 Medicare beneficiaries, total breast imaging subspecialist radiologists, and breast imaging subspecialist radiologists per 100,000 Medicare beneficiaries were all minimal (r = 0.06–0.16). Multivariable analyses overall demonstrated radiologist supply to have a stronger independent effect than facility supply, although effect sizes remained weak for both.ConclusionMammography facility and radiologist supply-side factors are only weakly associated with county-level Medicare beneficiary screening mammography rates, and as such, screening mammography may differ from many other health-care services. Although efforts to enhance facility and radiologist supply may be helpful, initiatives to improve screening mammography rates should focus more on demand-side factors, such as patient education and primary care physician education and access.



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Does Second Reader Opinion Affect Patient Management in Pancreatic Ductal Adenocarcinoma?

Publication date: Available online 17 January 2018
Source:Academic Radiology
Author(s): Giuseppe Corrias, Sandra Huicochea Castellanos, Ryan Merkow, Russel Langan, Vinod Balachandran, Monica Ragucci, Gabriella Carollo, Marcello Mancini, Luca Saba, Lorenzo Mannelli
Rationale and ObjectivesTo determine the impact of second-opinion assessment on cancer staging and patient management in patients with pancreatic ductal adenocarcinoma.Methods and MaterialsThis retrospective study was approved by our institutional review board with a waiver of informed consent. Second-opinion reports between January 1, 2009 and December 31, 2013, alongside outside reports for 65 consecutive cases of biopsy-proven pancreatic adenocarcinomas, were presented in random order to two experienced abdominal surgeons who independently reviewed them blinded to the origin of the report, images of the examinations, and patient identifier. Each surgeon filled in a questionnaire for each report recommending cancer staging and patient management. Recommended patient management and staging were evaluated against reference standards (actual patient management at 6 months following second-opinion assessment, and pathology or other clinical and imaging reference standards at 6 months or longer, respectively) using Cohen kappa.ResultsCancer staging differed in 13% (9 of 65) of cases for surgeon 1 and in 18.4% (12 of 65) for surgeon 2. Patient management changed in 38.4% (25 of 65) of cases for surgeon 1 and in 20% (13 of 65) for surgeon 2. When compared to the pathologic staging gold standard, second opinion was correct in 85.7% (six of seven) of the time for both surgeons. Recommended patient management from second-opinion reports showed good agreement with the reference standard (weighted k = 0.6467 [0.4014–0.892] and weighted k = 0.6262 [0.3954–0.857] for surgeon 2).ConclusionSecond-opinion review by subspecialized oncologic radiologists can impact patient care, specifically in terms of management decision.



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Automated Radiology-Pathology Module Correlation Using a Novel Report Matching Algorithm by Organ System

Publication date: Available online 17 January 2018
Source:Academic Radiology
Author(s): Bari Dane, Ankur Doshi, Soterios Gfytopoulos, Priya Bhattacharji, Michael Recht, William Moore
Objectives and RationaleRadiology-pathology correlation is time-consuming and is not feasible in most clinical settings, with the notable exception of breast imaging. The purpose of this study was to determine if an automated radiology-pathology report pairing system could accurately match radiology and pathology reports, thus creating a feedback loop allowing for more frequent and timely radiology-pathology correlation.MethodsAn experienced radiologist created a matching matrix of radiology and pathology reports. These matching rules were then exported to a novel comprehensive radiology-pathology module. All distinct radiology-pathology pairings at our institution from January 1, 2016 to July 1, 2016 were included (n = 8999). The appropriateness of each radiology-pathology report pairing was scored as either "correlative" or "non-correlative." Pathology reports relating to anatomy imaged in the specific imaging study were deemed correlative, whereas pathology reports describing anatomy not imaged with the particular study were denoted non-correlative.ResultsOverall, there was 88.3% correlation (accuracy) of the radiology and pathology reports (n = 8999). Subset analysis demonstrated that computed tomography (CT) abdomen/pelvis, CT head/neck/face, CT chest, musculoskeletal CT (excluding spine), mammography, magnetic resonance imaging (MRI) abdomen/pelvis, MRI brain, musculoskeletal MRI (excluding spine), breast MRI, positron emission tomography (PET), breast ultrasound, and head/neck ultrasound all demonstrated greater than 91% correlation. When further stratified by imaging modality, CT, MRI, mammography, and PET demonstrated excellent correlation (greater than 96.3%). Ultrasound and non-PET nuclear medicine studies demonstrated poorer correlation (80%).ConclusionThere is excellent correlation of radiology imaging reports and appropriate pathology reports when matched by organ system. Rapid, appropriate radiology-pathology report pairings provide an excellent opportunity to close feedback loop to the interpreting radiologist.



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Increased serum periostin concentrations are associated with the presence of diabetic retinopathy in patients with type 2 diabetes mellitus

Abstract

Purpose

To determine the association between serum periostin and the presence of diabetic retinopathy (DR).

Methods

Serum periostin was detected in 114 healthy subjects, 122 patients with type 2 diabetes mellitus (T2DM) and 159 patients with DR and compared among groups. Clinical data and other laboratory measurements such as glycated hemoglobin (HbA1c), lipid profiles, serum creatinine (Cr) and high-sensitivity CRP (hsCRP) were also collected and compared among groups. For subgroup analysis, patients with DR were divided into a non-proliferated diabetic retinopathy (NPDR) group and a proliferated diabetic retinopathy (PDR) group. Multivariate analysis was performed using logistic regression models.

Results

The serum periostin level was significantly higher in patients with diabetic retinopathy compared with healthy subjects and patients with T2DM (both P < 0.001, respectively). Also, the periostin level was significantly higher in the PDR group compared to the NPDR group (P = 0.044). Multivariate logistic regression revealed that serum periostin was independently associated with the presence of DR in patients with T2DM (P < 0.001). The receiver operating characteristic (ROC) curves for DR development using serum periostin showed that the area under the receiver operating characteristic curves (AUC) was 0.838 (P < 0.001).

Conclusions

The current study demonstrated that serum periostin is significantly associated with the presence of DR in patients with T2DM and is an independent risk factor of DR.

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Uncertain effect of preventative shoulder rehabilitation for patients who underwent total laryngectomy with neck dissection

Abstract

Introduction

Total laryngectomy (TL) with neck dissection (ND) is considered as crucial management for advanced-stage of laryngeal cancer. Shoulder dysfunction has long been recognized as a potential complication resulting from neck dissection. The aim of this study was to evaluate the effect of early prophylactic rehabilitation program in patients who underwent TL with ND.

Methods

A prospective, nonrandomized design was used. Seventy-six participants who underwent TL with ND were assigned into either an intervention or a control group. The control group received current standard care with no formal shoulder exercise provided, while the intervention group attended early preventive rehabilitation lasting 12 weeks. Participants were assessed at baseline, and at 3 and 6 months after surgery. Measured outcomes included shoulder function and patient-reported quality of life. General linear models with repeated measures were used to examine outcome changes in both groups over the designated assessment intervals.

Results

Improvement in shoulder function and patient-reported quality of life were both statistically significant over time, with no significant difference between control or intervention groups, indicating little or no benefit of preventative intervention on shoulder function outcomes. Analysis involving five subscales and the summary score of the quality of life questionnaire had only statistically significant improvement over time for both the control or intervention groups, except for physical well-being domain which had statistical significance both over time and between the control and intervention groups.

Conclusion

In this study, preventative exercise program initiated immediately after surgery had a limited impact on both shoulder function and perceived quality of life.

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Oral bacterial colonization on dental implants restored with titanium or zirconia abutments: 6-month follow-up

Abstract

Objective

This investigation aimed to characterize in a 6-month follow-up the microbial profile of implants restored with either titanium or zirconia abutments at the genus or higher taxonomic levels.

Methods

Twenty healthy individuals indicative for implant-retained single restorations were investigated. Half of participants were restored with titanium and half with zirconia abutments. Biofilm was collected from the implant-related sites after 1, 3, and 6 months of loading. The 16S rDNA genes were amplified and sequenced with Roche/454 platform.

Results

A total of 596 species were identified in 360 samples and grouped in 18 phyla and 104 genera. Titanium- or zirconia-related sites as well as teeth showed similar total numbers of operational taxonomic units (OTUs) colonizing surfaces over time. Firmicutes, Proteobacteria, Fusobacteria, Bacteroidetes, and Actinobacteria were the most prevalent phyla with significant differences between different surfaces and time point. Unclassified genera were found in lower levels (1.71% up to 9.57%) on titanium and zirconia samples when compared with teeth, with no significant differences.

Conclusion

Titanium- and zirconia-related surfaces are promptly colonized by a bacterial community similar to those found in the remaining adjacent teeth. Results suggest a selective adhesion of different bacterial genotypes for either titanium or zirconia surfaces. Data also indicate a significant interaction between the relative effects taxa, time point, and sampling site.

Clinical relevance

The present study disclosed a wider spectrum of microorganisms colonizing either titanium- or zirconia-related microbiomes in very early stage of implant colonization, revealing differences and suggesting a probably specific mechanism for selective bacterial adhesion.

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Defining limited stage small cell lung cancer: a radiation oncologists perspective

Description

Small cell lung cancer (SCLC) comprises 13%–15% of all diagnosed lung carcinomas and approximately 30% of those will be defined as limited stage-SCLC (LS-SCLC).1 The definition of LS-SCLC has undergone many modifications and there is no universally accepted definition till date (figure 1).2 It was first defined by the Veteran Affairs Lung cancer study Group (VALG) in 1973 and further redefined by the International Association for the Study of Lung Cancer (IASLC) and American Joint Committee on Cancer (AJCC) in 1989 and 2010, respectively.1 2 Considerable heterogeneity exists pertaining to which definition is used for treating patients in routine practice. As a direct consequence of this, discussions often arise in multidisciplinary tumour board meetings in which different oncologists classify the same patient differently. The subsequent images demonstrate the heterogeneity in subjective classification of patients with SCLC and the role of radiotherapy (RT) in...

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Sarcomatoid carcinoma of the duodenum

Description

A 69-year-old Caucasian man presented to the gastroenterology clinic with complaints of nausea, abdominal pain and more than 100-pound unintentional weight loss over the past 1 year. He had a history of colon polyps and was overdue for surveillance colonoscopy. He was subsequently scheduled for an outpatient oesophagogastroduodenoscopy (EGD) and colonoscopy as initial work-up for his symptoms. One week later, the patient underwent endoscopy. EGD showed an ulcerated mass in the second portion of the duodenum (figure 1). Biopsy of the lesion showed features of pleomorphic cells without glandular differentiation (figures 2 and 3). Immunohistochemical studies revealed pleomorphic cells positive for cytokeratin AE1/AE3 (figure 4), CAM 5.2 and vimentin (figure 5), focally positive for CK7 (figure 6), and weakly for CK20. They were negative for neuroendocrine markers chromogranin, synaptophysin, and CD45 which is a lymphoid marker. Additional...

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Morbid jealousy reactivated by mood episodes

A middle-aged man who has been enduring financial constraint experienced a period of irritability, increased goal-directed activities and insomnia occurring along with extreme jealousy with his current wife. The episode was followed by depressed mood and non-prominent auditory hallucination. His previous history revealed a forensic psychiatry case of a murder he committed 20 years ago.

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Bruns nystagmus: an important clinical clue for cerebellopontine angle tumours

Description

A 24-year-old woman presented with gradual-onset left-sided hearing loss, progressive diminution of vision, headache and unsteadiness of gait. Comprehensive clinical evaluation revealed a left-sided lower motor neuron type of facial nerve palsy (figure 1), bilateral papilloedema, sensory loss in the distribution of ophthalmic branch of the left trigeminal nerve and cerebellar ataxia. Sensorineural hearing loss and absent corneal reflex were also observed on the left side. A coarse, left-beating nystagmus with leftward gaze and a fine primary-position right-beating nystagmus which increased on rightward gaze, consistent with Bruns nystagmus (video 1), were appreciated. In view of the clinical findings, a diagnosis of a space-occupying lesion involving the left cerebellopontine angle was considered. MRI of the brain documented a space-occupying lesion (4x3.5 cm) in the left cerebellopontine angle, most likely a vestibular schwannoma (figures 2 and 3). The condition was explained to...

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An unusual case of basilar artery aneurysm presenting with spastic quadriparesis

Unruptured aneurysm usually presents with headache and neuro-ophthalmic features; when it ruptures, it presents with subarachnoid haemorrhage. Basilar artery aneurysm represents only 3–5% of cerebral aneurysms. Non-haemorrhagic symptoms and the signs of unruptured aneurysms are manifested as mass effect, thromboembolic phenomenon or epileptical attacks. Clinical presentation of unruptured aneurysm depends on structures which are involved. In our case, the patient had insidious onset headache and spastic quadriparesis with sixth cranial nerve palsy, which implicate involvement of corticospinal pathways at the level of pons.

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Urinary Bladder Mass Due To Chronic Lymphocytic Leukaemia

Description

A 66-year-old man was diagnosed with chronic lymphocytic leukaemia (CLL) in November 2014. At diagnosis, his lymphocyte count was 169.66x10⁹/L (table 1). The fluorescent in situ hybridisation (FISH) panel revealed 13q deletion, but there was no evidence of 17p deletion, 11q deletion or t (11;14). He then received four cycles of bendamustine and rituximab, and at the end of the treatment complete blood count showed a lymphocyte count of 1.01x10⁹/L (table 1), and an interval bone marrow biopsy showed only small lymphoid aggregate suggestive of partial response.1 In June 2017, his lymphocyte count was found to be elevated at 14.5x10⁹/L (table 1). An immunophenotypic analysis of the peripheral blood demonstrated approximately 78% lymphocytes and 0.5% mature CD14-positive monocytes. A predominant monoclonal B cell population was identified, comprising approximately 85% of lymphocytes and 67% of the processed specimen. It was...

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Budd-Chiari syndrome: a rare and life-threatening complication of Crohns disease

Budd-Chiari syndrome (BCS) is characterised by obstruction of hepatic venous outflow and may be triggered by the prothrombotic state associated with inflammatory bowel disease (IBD). We reported a case of Crohn's disease (CD) that presented with anasarca, ascites, symptomatic hepatomegaly, elevated liver enzymes, increased prothrombin time and low albumin. Oesophagogastroduodenoscopy and colonoscopy confirmed active CD. Abdominal CT showed hepatic vein thrombosis. Liver biopsy revealed severe perivenular sinusoidal dilation with areas of hepatocyte dropout, bands of hepatocyte atrophy and centrizonal fibrosis, suggestive of BCS. The patient was treated with steroids for CD and systemic anticoagulants for BCS. His liver function and enzymes normalised, and he reported symptomatic improvement. The precise mechanism responsible for increased hypercoagulability in IBD remains unclear. Early recognition and treatment for possible thrombotic complications of CD is critical to prevent potentially fatal events like pulmonary embolism or liver failure.

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Recurrent hiccups may signal brainstem pathology and should be investigated

While occasional hiccups are normal, their persistent recurrence is distressing and may have an underlying aetiology. Patients with recurrent hiccups may undergo a long journey and see many physicians before the diagnosis is finally made. The purpose of this report is to increase awareness of central nervous system lesions as a possible cause for recurrent hiccups and provide an illustrative case of an otherwise fit man presenting with ongoing hiccups caused by a medullary haemangioblastoma.

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Vancomycin-induced coronary artery spasm: a case of Kounis syndrome

Kounis syndrome defined as the appearance of acute coronary syndrome in the context of an allergic reaction is a relatively rare phenomenon. There are three variants of this syndrome in which the patient presents with symptoms of an acute chest. Herein, we describe a case of an 83-year-old woman who demonstrated type I variant of Kounis syndrome in response to vancomycin administration. After initialisation of vancomycin, she became unresponsive and an ECG demonstrated ST changes consistent with inferior-lateral myocardial infarction. Once allergic stimulus was removed, ECG normalised. Differential diagnosis includes, myocardial infarctions, angina as well as intravascular stent thrombosis, which must all be ruled out. The patient was monitored and discharged soon thereafter.

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Early intrauterine pregnancy during major surgery: the importance of preoperative assessment and advice

We present a case of a live birth occurring post radical laparoscopic excision of endometriosis, hysteroscopy, curettage and test of tubal patency in the presence of an early intrauterine gestation.

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Acquired pyloric stenosis resulting in hypokalaemic, hyperchloraemic normal anion gap metabolic acidosis. Persistent vomiting in an adult: cause and effect

A 24-year-old woman presented with a history of persistent vomiting for at least 3 months. This resulted in severe dehydration with risk of acute kidney injury. In addition to volume depletion, loss of gastric fluid resulted in a specific metabolic derangement—hypokalaemic, hypochloraemic normal anion gap metabolic alkalosis with a reduced ionised calcium concentration and paradoxical aciduria. These metabolic changes were reflected in her ECG. Investigation demonstrated acquired gastric outflow tract obstruction secondary to a pyloric peptic ulcer. The patient was resuscitated with intravenous crystalloid and electrolyte supplements. The acquired pyloric stenosis was treated medically with a proton pump inhibitor and Helicobacter pylori eradication therapy with excellent recovery.

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Marked cachexia in probable invasive pulmonary aspergillosis with bronchopleural fistula

A 49-year-old man with a medical history of diabetes and heavy smoking was admitted to intensive care with severe bilateral pneumonia associated with marked cachexia. He developed a complex right-sided bronchopleural fistula and was transferred to our tertiary centre for consideration of surgical intervention.

Despite escalation of antibiotic therapy, he did not improve and further investigations led to a diagnosis of invasive pulmonary aspergillosis. Definitive treatment plans required a right pneumonectomy; however, given the severity of cachexia, he remained unable to undergo such a large operation. This case demonstrates an atypical presentation of invasive pulmonary aspergillosis in a mildly immunodeficient individual. It highlights the challenges in assessment and management of critically ill patients' nutrition as well as optimal timing for surgical intervention.

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Portal vein embolisation in a patient with situs inversus

Portal vein embolisation (PVE) is a well-established technique used for patients who require major hepatic resections without sufficient volume of future remnant liver (FRL). We describe a case of PVE in a patient with situs inversus. Computed Tomography (CT) 4 weeks after the procedure demonstrated significant hypertrophy of the FRL. However, the surgical procedure was aborted due to signs of extrahepatic progression.

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'Clinically suspected myocarditis with pseudoinfarct presentation complicated with left ventricular aneurysm

A 51-year-old man presented with chest pain, high troponin level, inflammatory syndrome and ST-segment elevation in the anterior leads. While the transthoracic echocardiogram (TTE) showed anteroseptal hypokinesis and apical akinesis, the coronary angiogram was normal. Cardiac MR demonstrated a typical aspect of myocarditis (multiple areas of mid-myocardial late gadolinium enhancement, sparing the subendocardial layer, along with oedema). The initial diagnosis was clinically suspected myocarditis with pseudoinfarct presentation. However, the short-term evolution was not typical of this syndrome, since an apical transmural scar with aneurysm developed within 2 weeks. Seven years later, the patient remained asymptomatic, while Q waves persisted in anterior leads along with an apical aneurysm on TTE. A transmural myocardial necrosis with aneurysm is an unusual complication of acute myocarditis. The potential mechanisms accounting for the development of these lesions are reviewed, and the clinical implications for the diagnosis and monitoring of acute myocarditis are discussed.

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A ping-pong ball in left atrium

Description

Rheumatic heart disease (RHD) is much prevalent in low/middle-income  country like India with the prevalence ranging from 0.2 to 1.1/1000 for RHD and from 0.0007 to 0.2/1000 for rheumatic fever.1 Factors that precipitate the formation of clot are atrial fibrillation (AF) rhythm, left atrial (LA) size, duration of symptoms, advanced age and severity of mitral stenosis (MS).2 The prevalence of LA clot in patients with MS is 26% in the AF group and 13.5% in the normal sinus rhythm group.3 The risk of thromboembolism is 9–14% of patients suffering from RHD.4 5 Anticoagulation (vitamin K antagonist or heparin) is indicated in patients with MS with (1) AF (paroxysmal, persistent or permanent) or (2) prior embolic event or (3) a LA thrombus.6

We present a case of a 30-year-old man, a known case of RHD who had balloon mitral valvotomy (BMV) 10 years...

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Chronic strongyloidiasis with recurrent asthma exacerbations and steroid-associated 'hives

A 74-year-old man experienced worsening asthma for several years. Oral steroids were required on multiple occasions for asthma treatment. During his steroid courses, he developed a hive-like rash, which would resolve after completion of each steroid course. He was from Romania, and had lived in the USA for many years. Laboratory testing had shown eosinophilia. He was eventually diagnosed with strongyloidiasis by serology. Treatment with ivermectin led to marked improvement but not resolution of his long-term asthma. His hive-like rash, which was likely larva currens, did not recur with a subsequent steroid course. Improved recognition of strongyloidiasis, particularly in steroid-treated patients, is needed.

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Laryngeal tuberculosis: a rare cause of critical airway obstruction

Laryngeal tuberculosis (TB) is a rare condition, occurring in less than 1% of patients infected with pulmonary TB. We present a case of a 57-year-old male patient, who presented in extremis with audible stridor, increased work of breathing and cyanosis. In addition, the patient had a complex medical history, including a recent diagnosis of congenital malformation of the epiglottis. Emergency intervention was required to secure the airway, and after initial attempts at intubation were unsuccessful, an emergency tracheostomy was performed. Four days after initial presentation, his sputum tested positive for acid-fast bacilli, and a subsequent CT chest revealed pulmonary as well as laryngeal TB, which was confirmed on biopsy of the larynx. The patient was commenced on a 24-week course of anti-tuberculous treatment and was successfully decannulated 6 months after the emergency airway was established.

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Unusual 'feathery cause of a parapharyngeal abscess in an infant

A 7-month-old boy presented to the emergency department with reduced oral intake, neck swelling and fever. Clinical examination revealed a 3 cm left parotid and left level I neck swelling with left medialised tonsil but no trismus. Computed imaging confirmed the presence of an abscess in the peritonsillar area with extension into the parapharyngeal space and deep lobe of the parotid gland. The abscess was incised and drained transorally. Following drainage of the abscess, a small 3 mm suspicious foreign body was seen. After extraction, this was revealed to be a 60 mm feather. We would like to highlight this unusual case in an infant and to ensure that foreign body is considered as aetiology. There are only a handful of cases in the literature involving feathers causing neck abscesses and, to our knowledge, this is the first case where the patient presented with a pharyngeal abscess, which was drained transorally.

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Microangiopathies in pregnancy

Thrombotic thrombocytopenic purpura (TTP) is a potentially reversible, life-threatening medical emergency. We present a case of a 21-year-old female with evidence of haemolytic anaemia based on the presence of positive markers of haemolysis. Negative Coomb's test, thrombocytopenia and placental infarcts raised suspicion for a thrombotic microangiopathy. She was diagnosed with TTP and managed with emergency plasma exchange. Her recovery was immediate.

A presumptive diagnosis of TTP should be based on the presence of microangiopathic haemolytic anaemia with thrombocytopenia and plasma exchange should be initiated while complete work up is pending. Using the regular pentad solely for diagnosis of TTP will lead to underdiagnosis of many cases and should be avoided.

Several microangiopathies can be seen during pregnancy including TTP/atypical haemolytic uraemic syndrome, HELLP syndrome, pre-eclampsia, disseminated intravascular coagulopathy and antiphospholipid antibody syndrome. Distinction between each type will be the focus of our discussion as treatment decisions differ accordingly.

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Sinogenic intracranial complications: is adalimumab a culprit?

We present two 11-year-old girls with chronic recurrent multifocal osteomyelitis, treated with adalimumab. Both developed severe intracranial complications to sinusitis. Patient 1 had been treated with adalimumab for 15 months when she developed acute sinusitis complicated by an orbital abscess, forehead swelling, a subdural empyema and osteomyelitis of the frontal bone. She was treated with a rhinosurgical and neurosurgical approach with intravenous antibiotics.Patient 2 had been in adalimumab treatment for 10 weeks. Adalimumab was discontinued 8 weeks prior to developing subdural empyema and subcortical abscesses in combination with sinusitis. She was treated with endoscopic sinus surgery and intravenous antibiotics. Both patients had developed psoriasis and episodes of infection during treatment. They were non-septic and had low fever on presentation. None of the patients suffered any long-term neurological sequelae. The immunosuppressive treatment with adalimumab is considered to be the cause of the sinogenic intracranial complications in our cases.

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In vivo evaluation of some biophysical parameters of the facial skin of Indian subjects living in Mumbai. Part II: Variability with age and gender

Abstract

Background

A previously published work explored the diversity of some biophysical parameters (colour, elasticity, sebum production, skin micro relief….) of the skin of 1204 Indian women, differently aged, living in 4 Indian cities (Chennai, Delhi, Kolkata, Mumbai). The present work aimed at completing such research by focusing on possible gender-related differences in the same skin parameters, between Indian men and women living in the same Indian city (Mumbai).

Methods

297 Indian men, differently aged (18-70y) were recruited in Mumbai, completing the panel of 303 women who were previously recruited in this same city. The same instrumental measurements of facial skin colour and its homogeneity, its mechanical properties, the sebum production, skin pores size, skin relief etc.. as in the previous work, were conducted.

Results

Overall, the facial skin colour shows a darker complexion in men as compared to women, on forehead, ocular region, lips, chin and cheek. The skin colour unevenness, which increases with age, was found higher in men, as compared to women. At comparable age, women and men present a same density of skin pores, whereas those of men appear larger, up to 55y. The deepness of Crow's feet wrinkles does not significantly differ between genders. A lesser extensibility was found on then cheeks of men. In men, the sebum production was found significantly higher than that of women at ages above 40y.

Conclusions

This work indicates some commonly shared age-related skin features between women and men from Mumbai, despite slight different characteristics such as skin pigmentation, forehead/cheek colour contrast, mechanical properties and sebum production.

This article is protected by copyright. All rights reserved.

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Photobiomodulation induces in vitro re-epithelialization via nitric oxide production

Abstract

Photobiomodulation is a widely used tool in regenerative medicine thanks to its ability to modulate a plethora of physiological responses. Wound re-epithelialization is strictly regulated by locally produced chemical mediators, such as nitric oxide (NO), a highly reactive free radical generated by the nitric oxide synthase (NOS) enzymatic family. In this study, it has been hypothesized that a 980-nm low-level laser stimulation could increase NO production in human keratinocytes and that such event might be directly related to the re-epithelialization process. Human keratinocytes were irradiated with increasing energy outputs (10–75 J) in the absence or presence of L-NAME, a NOS inhibitor. Laser stimulation induced an increase in NO production, resulting in an energy-dependent increase in both keratinocytes proliferation and re-epithelialization ability. The direct link between increased NO production and the observed physiological responses was confirmed by their inhibition in L-NAME pre-treated samples. Since NO production increase is a quick event, it is conceivable that it is due to an increase in existing NOS activity rather than to a de novo protein synthesis. For this reason, it could be hypothesized that photobiomodulation-derived NO positive effects on keratinocytes behavior might rely on a near infrared mediated increase in NOS conformational stability and cofactors as well as substrate binding ability, finally resulting in an increased enzymatic activity.

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Treatment of severe periodontitis with a laser and light-emitting diode (LED) procedure adjunctive to scaling and root planing: a double-blind, randomized, single-center, split-mouth clinical trial investigating its efficacy and patient-reported outcomes at 1 year

Abstract

Broad methodological heterogeneity makes the literature on the clinical effects of laser treatment in periodontitis, both as monotherapy and adjunct to non-surgical therapy, which is difficult to interpret. The present split-mouth study was performed: (i) to determine the efficacy and safety of a photoablative-photodynamic diode laser therapy, including antiseptic LED irradiation, in adjunct to scaling and root planing (iPAPD+SRP) vs. sham-treatment+SRP for the treatment of diffuse severe periodontitis and (ii) to estimate the patient-reported outcomes. Twenty-four patients with severe periodontitis were treated with iPAPD+SRP or sham-treatment+SRP. iPAPD+SRP consisted of the following: (1) intra-/extra-pocket de-epithelization with photoablative λ 810 nm laser, (2) disinfection with λ 405 nm LED, (3) SRP, and (4) 10 weekly antiseptic/anti-inflammatory photodynamic treatments with λ 635 nm laser and 0.1% toluidine blue as photosensitizer. Clinical and cytofluorescent periodontal markers and patient-reported results were analyzed. At 1-year follow-up, both groups showed a significant reduction of several severity markers of periodontitis, namely probing depth (PD) and bleeding on probing (BoP), as well as of bacteria, polymorphonuclear cells, erythrocytes and damaged epithelial cells in exfoliative samples, as compared with day 0. The quadrants subjected to iPAPD+SRP showed significantly better values of these parameters as well as of clinical attachment level (CAL) as compared with those undergoing sham-treatment+SRP. The patients' perceived pain/discomfort, and overall liking was also in favor of the iPAPD+SRP treatment. This study confirms the efficacy of combined phototherapy in adjunct to SRP which had emerged from previous clinical trials, extending its field of application to severe periodontitis.

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3D printing of carbon fiber-filled conductive silicon rubber

Publication date: 15 March 2018
Source:Materials & Design, Volume 142
Author(s): Pei Huang, Zhidong Xia, Song Cui
Conductive silicon rubbers (CSRs) are potential candidates for strain sensor application owing to their specific electrical response and superior mechanical flexibility. In this work, carbon fiber-filled CSRs were printed by an extrusion device. Thixotropic agent was added to modify mobility and viscosity of the liquid CSR. It was found that the CSR with 5wt% thixotropic agent addition exhibited better shape-retention. Fibers in matrix were observed to be oriented in the printing direction resulting in an anisotropic electrical and mechanical behavior. The printed CSRs showed better electrical and mechanical properties along the orientation direction of fibers. In particular, the volume resistivity at the orientation direction was 6.8 times lower than that at perpendicular direction. Higher tensile strength, larger elongation at break, and higher Young's modulus were found along the orientation direction when the printed CSRs were stretched, where a large number of fibers were pulled out and visible holes remained at the fractured surface. Electrical responses of the CSRs under various loadings, including stretching, compressing, bending, twisting and cyclic folding, were closely related with deformations of the CSRs. Sandwich strain sensors were finally fabricated to verify a practical application as motion sensor of the printed CSRs.

Graphical abstract

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S and B microalloying of biodegradable Fe-30Mn-1C - Effects on microstructure, tensile properties, in vitro degradation and cytotoxicity

Publication date: 15 March 2018
Source:Materials & Design, Volume 142
Author(s): J. Hufenbach, F. Kochta, H. Wendrock, A. Voß, L. Giebeler, S. Oswald, S. Pilz, U. Kühn, A. Lode, M. Gelinsky, A. Gebert
Austenitic Fe-Mn-C-based alloys are considered as promising candidates for biodegradable vascular implants due to their high strength, ductility and mechanical integrity during degradation.The present study demonstrates that microalloying with S and B is an effective method to further enhance the degradation rate and the mechanical properties of a Fe-30Mn-1C twinning-induced plasticity (TWIP) alloy without deteriorating the biocompatibility. For studying the microstructural changes due to S or B addition, the alloys were analysed by X-ray diffraction (XRD) as well as scanning electron microscopy (SEM) in combination with energy-dispersive X-ray spectroscopy (EDX), wavelength dispersive X-ray analysis (WDX) and electron backscatter diffraction (EBSD). Thereby precipitates of (Fe0.3Mn0.7)S and (Fe,Mn)23(C3B3) types were detected in the austenitic matrix. These precipitates have a distinct influence not only on the mechanical properties under tensile load but also on the occurring corrosion mechanism. This was displayed by potentiodynamic polarization measurements and immersion tests in simulated body fluid (SBF) and associated SEM as well as X-ray photoelectron spectroscopy (XPS) investigations. In vitro cytotoxicity analyses with L929 fibroblast cells indicated that microalloying with S and B does not affect the cytocompatibility.Thus, the novel alloy modifications show a high potential for future application as biodegradable implant material.

Graphical abstract

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Development of new β/α″-Ti-Nb-Zr biocompatible coating with low Young's modulus and high toughness for medical applications

Publication date: 15 March 2018
Source:Materials & Design, Volume 142
Author(s): E. Frutos, M. Karlík, J.A. Jiménez, H. Langhansová, J. Lieskovská, T. Polcar
Ideal biomaterials to fabricate orthopedic implants, especially for load-bearing joint replacements, should include only non-toxic elements with good biocompatibility, high corrosion resistance and surface bioactivity, together with a good combination of mechanical properties. Based on these criteria, a manufacturing approach based on sputtering techniques can be ideal to develop coatings free of toxic elements tailored for advanced applications on pure titanium or titanium alloys used in biomedical applications. In this work, the ternary Ti-Nb-Zr system was used to develop non-toxic β-rich Ti coatings with several complex microstructures by careful control of Nb and Zr concentration and deposition parameters, such as bias voltage. Depending on the alloy chemistry and processing, the coating included variable amounts of α- , α″- and β-phases of Ti with different morphologies and crystallographic texture. Mechanical properties of every coating is largely determined by the micro-structure present, which is directly related to bias voltage used during sputtering process. Thus, hardness values change as a function of the compressive residual stresses magnitude and Young's modulus decreased from 63 GPa, at 0 V, to 47 GPa, at −63 V, being this value close to human bone (~30 GPa). After that, Young's modulus progressively increases to 89 GPa, at −148 V. On the other hand, bioactivity of the coating is practically doubled when compared to Ti6Al4V alloy.

Graphical abstract

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Function-dependent coating architectures by hybrid powder-suspension plasma spraying: Injector design, processing and concept validation

Publication date: 15 March 2018
Source:Materials & Design, Volume 142
Author(s): Stefan Björklund, Sneha Goel, Shrikant Joshi
The attractive properties achieved by Suspension Plasma Spraying (SPS), combined with the availability of high throughput capable plasma spray systems that permit axial feeding, provide encouragement to explore use of suspensions for next generation functional applications. This paper deals with realization of coatings with various pre-determined function-dependent architectures by employing a hybrid powder-suspension feedstock. Some illustrative application-relevant coating architecture designs are discussed, along with the specific benefits that can accrue by deploying a multi-scale powder-suspension feedstock combination. An elegant feedstock delivery arrangement to enable either simultaneous or sequential feeding of powders and suspensions to enable convenient processing of coatings with desired architectures is presented. As proof-of-concept, deposition of layered, composite and functionally graded coatings using the above system is also demonstrated using appropriate case studies.

Graphical abstract

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Fabrication of 3D porous poly(lactic acid)-based composite scaffolds with tunable biodegradation for bone tissue engineering

Publication date: 15 March 2018
Source:Materials & Design, Volume 142
Author(s): Daoyong Mao, Qing Li, Daikun Li, Yashi Chen, Xinhong Chen, Xi Xu
Success of biomimetic scaffold relies on the comparability of its microarchitecture and physicochemical properties to the natural bone. However, porous scaffolds which simultaneously possessed excellent mechanical properties, favorable bioactivity and tunable biodegradation were rarely reported. Herein, to integrate the high stiffness of hydroxyapatite (HA), the formability of lignocellulose (LG), the processability of poly(lactic acid) (PLA) and the bioactivity of sol-gel derived 58S bioactive glass (BG), poly(lactic acid) (PLA)-based composite scaffolds were fabricated by a simple technique of combining the solvent casting/particulate leaching and sol-gel method. The resultant scaffolds showed well-defined interconnected porous structure with pore size of 200–400 μm and rough pore wall, which was reported to be potentially beneficial for cell adhesion and ingrowth. In addition, the mechanical properties were obviously improved by the reinforcements of LG, HA, and BG. In vitro biomineralization studies indicated the incorporation of BG significantly enhanced the bioactivity of composite scaffolds. Specially, the degradation rate of scaffolds could be easily regulated by adjusting the BG content to match the regeneration of new bone. The developed PLA-based composite scaffolds might have a great potential for bone regeneration.

Graphical abstract

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Design, fabrication, and analysis of lattice exhibiting energy absorption via snap-through behavior

Publication date: 5 March 2018
Source:Materials & Design, Volume 141
Author(s): Chan Soo Ha, Roderic S. Lakes, Michael E. Plesha
In this study, an energy absorption lattice, comprised of multiple tetra-beam-plate unit cells with negative stiffness, was designed, fabricated by selective laser sintering method, and analyzed both numerically and experimentally. Snap-through behavior of the unit cell developed due to negative stiffness caused by geometric nonlinearity from large deflection of the constituent elastic beams, resulting in energy absorption. A criterion for the unit cell to achieve the snap-through behavior was investigated numerically in terms of the beam slenderness ratio and the inclined angle. This approach was chosen to facilitate control of energy dissipation performance and further design space such as tuning force threshold. The unit cell with the selected geometric parameters was then created and used to construct the energy absorption lattice. Load-displacement relationships of the lattices obtained from cyclic loading tests disclosed an area enclosed by two distinct loading and unloading curves, which indicates energy dissipation. This was shown both numerically and experimentally. Drop tests were also performed to investigate energy loss of the lattices due to an impact. An energy absorption phenomenon was revealed by observing a reduced rebound height when the lattice exhibited the snap-through behavior.

Graphical abstract

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A study of creep in polycarbonate fused deposition modelling parts

Publication date: 5 March 2018
Source:Materials & Design, Volume 141
Author(s): Antonio G. Salazar-Martín, Marco A. Pérez, Andrés-Amador García-Granada, Guillermo Reyes, Josep M. Puigoriol-Forcada
This paper presents an experimental investigation on the influence of process parameters such as part orientation, air gap and number of contours along with their interactions on the creep behaviour of fused deposition modelling (FDM) processed polycarbonate (PC) parts. Due to the lack of creep curve data with parts processed by FDM, this research gives a first quantitative approach to the time-dependent mechanical properties. This study not only varies significant process parameters viz., part build orientation, raster to raster air gap and number of contours, but also applies different loads to the samples to further understand primary and secondary creep behaviour for PC, providing the creep curves. Furthermore, two mathematical models are used to fit the experimental data, which can be used in numerical modelling. The first model is the well-documented and commonly used Bailey-Norton equation. As a second model, the fractional Voigt Maxwell in series (FVMS) is proposed to use. This model applies fractional calculus to reduce the number of parameters to be calculated. Conclusions obtained about how process parameters affect the creep behaviour are in agreement with previous research in mechanical properties of FDM parts.

Graphical abstract

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A patient with chronic labial oedema and nodular palatal lesions

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A patient with chronic labial oedema and nodular palatal lesions

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Suspected hypersensitivity to cervicovaginal fluid – what can we learn from the seminal plasma allergy story?

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Forthcoming Events

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Announcement

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Issue Information

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Fragrance contact allergy

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Optimization of Permeability in a Series of Pyrrolotriazine Inhibitors of IRAK4

Publication date: Available online 17 January 2018
Source:Bioorganic & Medicinal Chemistry
Author(s): Sébastien L. Degorce, Rana Anjum, Keith S. Dillman, Lisa Drew, Sam D. Groombridge, Christopher T. Halsall, Eva M. Lenz, Nicola A. Lindsay, Michele F. Mayo, Jennifer H. Pink, Graeme R. Robb, James S. Scott, Stephen Stokes, Yafeng Xue
We have developed a series of orally efficacious IRAK4 inhibitors, based on a scaffold hopping strategy and using rational structure based design. Efforts to tackle low permeability and high efflux in our previously reported pyrrolopyrimidine series¹ led to the identification of pyrrolotriazines which contained one less formal hydrogen bond donor and were intrinsically more lipophilic. Further optimisation of substituents on this pyrrolotriazine core culminated with the discovery of 30 as a promising in vivo probe to assess the potential of IRAK4 inhibition for the treatment of MyD88 mutant DLBCL in combination with a BTK inhibitor. When tested in an ABC-DLBCL model with a dual MyD88/CD79 mutation (OCI-LY10), 30 demonstrated tumour regressions in combination with ibrutinib.

Graphical abstract

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Cryolipolysis for the treatment of submental fat: Review of the literature

Summary

Background

Submental fat accumulation is a common cosmetic concern. Cryolipolysis utilizes noninvasive cooling to lyse adipocytes. A cryolipolysis device was recently approved for treatment of submental fat.

Objective

This manuscript provides a review of the preclinical work and clinical trials related to cryolipolysis for the treatment of submental fat. Settings, efficacy, and side effects are also discussed.

Materials and Methods

A literature search was performed through Pubmed, EMBASE, Web of Science, and CINAHL, using the search terms "cryolipolysis," "submental," and "paradoxical adipose hyperplasia". Additional sources from the original source bibliographies were used to further supplement this review.

Results

There are 4 clinical trials and one case series (total 101 patients) that evaluated the use of cryolipolysis for treatment of submental fat. In these studies, there was a statistically significant reduction in submental fat and patients expressed high satisfaction with the treatment. Adverse effects were mild and transient.

Conclusions

Cryolipolysis is a noninvasive cooling technique that is safe and effective for treatment of submental fat. To date, there are no reports of marginal mandibular nerve injury or paradoxical adipose hyperplasia following treatment with this device.

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Cryolipolysis for the treatment of submental fat: Review of the literature

Summary

Background

Submental fat accumulation is a common cosmetic concern. Cryolipolysis utilizes noninvasive cooling to lyse adipocytes. A cryolipolysis device was recently approved for treatment of submental fat.

Objective

This manuscript provides a review of the preclinical work and clinical trials related to cryolipolysis for the treatment of submental fat. Settings, efficacy, and side effects are also discussed.

Materials and Methods

A literature search was performed through Pubmed, EMBASE, Web of Science, and CINAHL, using the search terms "cryolipolysis," "submental," and "paradoxical adipose hyperplasia". Additional sources from the original source bibliographies were used to further supplement this review.

Results

There are 4 clinical trials and one case series (total 101 patients) that evaluated the use of cryolipolysis for treatment of submental fat. In these studies, there was a statistically significant reduction in submental fat and patients expressed high satisfaction with the treatment. Adverse effects were mild and transient.

Conclusions

Cryolipolysis is a noninvasive cooling technique that is safe and effective for treatment of submental fat. To date, there are no reports of marginal mandibular nerve injury or paradoxical adipose hyperplasia following treatment with this device.

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The effects of platelet lysate patches on the activity of tendon-derived cells

Publication date: Available online 16 January 2018
Source:Acta Biomaterialia
Author(s): Raquel Costa-Almeida, Albina R. Franco, Tamagno Pesqueira, Mariana B. Oliveira, Pedro S. Babo, Isabel B. Leonor, João F. Mano, Rui L. Reis, Manuela E. Gomes
Platelet-derived biomaterials are widely explored as cost-effective sources of therapeutic factors, holding a strong potential for endogenous regenerative medicine. Particularly for tendon repair, treatment approaches that shift the injury environment are explored to accelerate tendon regeneration. Herein, genipin-crosslinked platelet lysate (PL) patches are proposed for the delivery of human-derived therapeutic factors in patch augmentation strategies aiming at tendon repair. Developed PL patches exhibited a controlled release profile of PL proteins, including bFGF and PDGF-BB. Additionally, PL patches exhibited an antibacterial effect by preventing the adhesion, proliferation and biofilm formation by S. aureus, a common pathogen in orthopaedic surgical site infections. Furthermore, these patches supported the activity of human tendon-derived cells (hTDCs). Cells were able to proliferate over time and an up-regulation of tenogenic genes (SCX, COL1A1 and TNC) was observed, suggesting that PL patches may modify the behavior of hTDCs. Accordingly, hTDCs deposited tendon-related extracellular matrix proteins, namely collagen type I and tenascin C.In summary, PL patches can act as a reservoir of biomolecules derived from PL and support the activity of native tendon cells, being proposed as bioinstructive patches for tendon regeneration.Statement of significancePlatelet-derived biomaterials hold great interest for the delivery of therapeutic factors for applications in endogenous regenerative medicine. In the particular case of tendon repair, patch augmentation strategies aiming at shifting the injury environment are explored to improve tendon regeneration. In this study, PL patches were developed with remarkable features, including the controlled release of growth factors and antibacterial efficacy. Remarkably, PL patches supported the activity of native tendon cells by up-regulating tenogenic genes and enabling the deposition of ECM proteins. This patch holds great potential towards simultaneously reducing post-implantation surgical site infections and promoting tendon regeneration for prospective in vivo applications.

Graphical abstract

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Bioinspired Capsules based on Nanocellulose, Xyloglucan and Pectin – the influence of Capsule Wall Composition on Permeability Properties

Publication date: Available online 16 January 2018
Source:Acta Biomaterialia
Author(s): T. Paulraj, A.V. Riazanova, A.J. Svagan
Materials based on renewable biopolymers, selective permeability and stimuli-responsive release/loading properties play an important role in biomedical applications. Here, in order to mimic the plant primary cell-wall, microcapsules have been fabricated using cell wall polysaccharides, namely pectin, xyloglucan and cellulose nanofibers. For the first time, a large amount of xyloglucan was successfully included in such capsules. These capsules demonstrated stimuli-responsive (ON/OFF) permeability and biocompatibility. The live cell staining revealed that the microcapsules' surface enhanced cell growth and also the non-toxic nature of the microcapsules. In water, the microcapsules were completely and partially permeable to fluorescent dextrans with an average molecular weight of 70 kDa (hydrodynamic diameter of ca. 12 nm) and 2000 kDa (ca. 54 nm), respectively. On the other hand, the permeability dropped quickly when the capsules were exposed to 250 mM NaCl solution, trapping a fraction of the 70 kDa dextrans in the capsule interior. The decrease in permeability was a direct consequence of the capsule-wall composition, i.e. the presence of xyloglucan and a low amount of charged molecules such as pectin. The low permeability of capsules in saline conditions (and in a model biological medium), combined with a capsule wall that is made from dietary fibers only, potentially enables their use in biological applications, such as colon targeted delivery in the gastro-intestinal tract.Statement of Significance:For the first time, microcapsules have been prepared that possess capsule walls that mimic the primary cell wall found in natural plant cells. The capsules were assembled using pectin, xyloglucan and cellulose in the form of cellulose nanofibers. The capsules demonstrated stimuli-responsive (ON/OFF) permeability and biocompatibility. The low permeability of capsules in saline conditions (and in a model biological medium), combined with a capsule wall that is made from dietary fibers only, potentially enables their use in biological applications, such as colon targeted delivery in the gastro-intestinal tract. Such model plant cell capsules might also further improve the understanding for the digestion and release of nutrients from natural plant cells found in vegetables and fruits.

Graphical abstract

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Giant Cell Arteritis: Practical Pearls and Updates

Abstract

Purpose of Review

The purpose of this review is to summarize recent updates and distill practical points from the literature which can be applied to the care of patients with suspected and confirmed giant cell arteritis (GCA).

Recent Findings

Contemporary thinking implicates a fundamental failure of T regulatory cell function in GCA pathophysiology, representing opportunity for novel therapeutic avenues. Tocilizumab has become the first Food and Drug Administration-approved treatment for GCA following demonstration of efficacy and safety in a phase 3 clinical trial.

Summary

There have been significant parallel advances in both our understanding of GCA pathophysiology and treatment. Tocilizumab, and other agents currently under investigation in phase 2 and 3 clinical trials, presents a new horizon of hope for both disease remission and avoidance of glucocorticoid-related complications.

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The acute effects of erythromycin and oxytetracycline on enhanced biological phosphorus removal system: shift in bacterial community structure

Abstract

Since extensive application, an increasing amount of antibiotics has been released into wastewater treatment plants. In this study, the enhanced biological phosphorus removal (EBPR) system was fed with synthetic wastewater containing erythromycin (ERY) and oxytetracycline (OTC) for 7 days to evaluate the variations of solution ortho-P (SOP), volatile fatty acid (VFA), poly-bhydroxyalkanoates (PHAs), specific oxygen uptake rater (SOUR), and microbial community in the EBPR system. The obtained results showed that the P-removal efficiency decreased to 0.0%, and at the end of the experiment, only less than 20% of the VFA could be consumed. Besides, the variable processes of P and PHAs were destroyed. Moreover, to better grasp the inhibitory mechanism of antibiotics, microbial community compositions of activated sludge sampled in all reactors were investigated by high-throughput sequencing techniques. Results of comparative and evolutionary analysis revealed that high concentrations (5 and 10 mg/L) of ERY and OTC could seriously shift microbial communities, while combined antibiotics could induce more. Additionally, Accumulibacter and Competibacter were two primary microorganisms at the genus level in the EBPR system. Accumulibacter decreased seriously for exposure to antibiotics, while Competibacter increased in all experimental reactors especially in combined antibiotics reactor.

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Does Stroke Rehabilitation Really Matter? Part B: An Algorithm for Prescribing an Effective Intensity of Rehabilitation.

Related Articles

Does Stroke Rehabilitation Really Matter? Part B: An Algorithm for Prescribing an Effective Intensity of Rehabilitation.

Neurorehabil Neural Repair. 2018 Jan 01;:1545968317753074

Authors: Jeffers MS, Karthikeyan S, Gomez-Smith M, Gasinzigwa S, Achenbach J, Feiten A, Corbett D

Abstract
BACKGROUND: The proportional recovery rule suggests that current rehabilitation practices may have limited ability to influence stroke recovery. However, the appropriate intensity of rehabilitation needed to achieve recovery remains unknown. Similarities between rodent and human recovery biomarkers may allow determination of rehabilitation thresholds necessary to activate endogenous biological recovery processes.
OBJECTIVE: We determined the relative influence that clinically relevant biomarkers of stroke recovery exert on functional outcome. These biomarkers were then used to generate an algorithm that prescribes individualized intensities of rehabilitation necessary for recovery of function.
METHODS: A retrospective cohort of 593 male Sprague-Dawley rats was used to identify biomarkers that best predicted poststroke change in pellet retrieval in the Montoya staircase-reaching task using multiple linear regression. Prospective manipulation of these factors using endothelin-1-induced stroke (n = 49) was used to validate the model.
RESULTS: Rehabilitation was necessary to reliably predict recovery across the continuum of stroke severity. As infarct volume and initial impairment increased, more intensive rehabilitation was required to engage recovery. In this model, we prescribed the specific dose of daily rehabilitation required for rats to achieve significant motor recovery using the biomarkers of initial poststroke impairment and infarct volume.
CONCLUSIONS: Our algorithm demonstrates an individualized approach to stroke rehabilitation, wherein imaging and functional performance measures can be used to develop an optimized rehabilitation paradigm for rats, particularly those with severe impairments. Exploring this approach in human patients could lead to an increase in the proportion of individuals experiencing recovery of lost motor function poststroke.

PMID: 29334831 [PubMed - as supplied by publisher]

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Kinematic Visual Biofeedback Improves Accuracy of Learning a Swallowing Maneuver and Accuracy of Clinician Cues During Training.

Related Articles

Kinematic Visual Biofeedback Improves Accuracy of Learning a Swallowing Maneuver and Accuracy of Clinician Cues During Training.

Dysphagia. 2017 Feb;32(1):115-122

Authors: Azola AM, Sunday KL, Humbert IA

Abstract
Submental surface electromyography (ssEMG) visual biofeedback is widely used to train swallowing maneuvers. This study compares the effect of ssEMG and videofluoroscopy (VF) visual biofeedback on hyo-laryngeal accuracy when training a swallowing maneuver. Furthermore, it examines the clinician's ability to provide accurate verbal cues during swallowing maneuver training. Thirty healthy adults performed the volitional laryngeal vestibule closure maneuver (vLVC), which involves swallowing and sustaining closure of the laryngeal vestibule for 2 s. The study included two stages: (1) first accurate demonstration of the vLVC maneuver, followed by (2) training-20 vLVC training swallows. Participants were randomized into three groups: (a) ssEMG biofeedback only, (b) VF biofeedback only, and (c) mixed biofeedback (VF for the first accurate demonstration achieving stage and ssEMG for the training stage). Participants' performances were verbally critiqued or reinforced in real time while both the clinician and participant were observing the assigned visual biofeedback. VF and ssEMG were continuously recorded for all participants. Results show that accuracy of both vLVC performance and clinician cues was greater with VF biofeedback than with either ssEMG or mixed biofeedback (p < 0.001). Using ssEMG for providing real-time biofeedback during training could lead to errors while learning and training a swallowing maneuver.

PMID: 27677733 [PubMed - indexed for MEDLINE]

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A cross-cultural study of acceptability and food pairing for hot sauces

Publication date: 1 April 2018
Source:Appetite, Volume 123
Author(s): Hyun-Jee Kim, Seo-Jin Chung, Kwang-Ok Kim, Belinda Nielsen, Rie Ishii, Michael O'Mahony
This study was conducted to understand the acceptance levels of hot sauces among consumers from different culinary cultures. Two newly developed hot sauces [fermented red chili pepper with soybean-paste-based sauce(GS) and fermented red chili-pepper-based sauce(KS)] were compared with Tabasco sauce(TB) and Sriracha sauce(SR). Two separate cross-cultural home-use tests(HUTs) were conducted: pizza and cream soup were provided as food items in HUT 1, whereas grilled chicken wings and rice noodle soup were provided in HUT 2. Consumers residing in Denmark, South Korea, and US participated in each HUT (n≅100 per country). Acceptance levels and the reasons for (dis)liking particular hot sauces applied to food systems were assessed. The food items that paired well with different hot sauces when the sauces were applied freely to regular meals were also analyzed among the US and Korean subjects. When the hot-sauce samples were applied to pizza and cream soup, the preferred order of the samples exhibited a cross-cultural agreement (GS = KS > TB). In the case of grilled chicken and rice noodle soup, the acceptance rating was similar for the three types of hot sauces among Koreans, whereas the acceptance was higher for SR among the US subjects for both foodstuffs, while Danish subjects preferred GS and KS over SR. The US subjects did not like hot-sauce samples with sweet and weak spiciness, whereas the Korean and Danish subjects disliked the hot-sauce sample when it was too spicy and not sufficiently sweet. These findings indicate that the matching of particular sauces with specific food items is culture-dependent, and this needs to be considered when trying to export food products such as hot sauce to other countries.



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Epidermal permeability barrier function and sphingolipid content in the skin of sphingomyelin synthase 2 deficient mice

Abstract

Background

Sphingomyelin synthase (SMS) is an enzyme that generates sphingomyelin (SM) from ceramide (CER) and phosphatidylcholine. SM in the epidermis is a precursor of CER, an important lipid for epidermal permeability barrier function. However, the physiological role of SMS in skin is unclear.

Objectives

To uncover the function of SMS in skin, we investigated sphingolipid metabolism enzyme activity in skin, SM content in the epidermis, CER content in the stratum corneum (SC) and transepidermal water loss (TEWL) as an indicator of barrier function in SMS2-knockout (KO) mice.

Methods

The activities of sphingolipid metabolism enzymes in skin homogenates were measured using a fluorescently labeled substrate. Enzymatic reaction products were detected by high performance liquid chromatography (HPLC). Lipids in the epidermis or SC were extracted and quantified by high performance thin layer chromatography (HPTLC). TEWL was measured using a Tewameter TM300.

Results

In SMS2-KO mice, SMS activity in skin homogenates, epidermal SM content and SC CER content were significantly decreased relative to wild type (WT) mice. The TEWL of SMS2-KO mice was significantly increased compared to WT mice.

Conclusion

Our data indicate that SMS2 generate SM in the epidermis and contribute to epidermal permeability barrier function and will support understanding of SM related metabolic disorders.

This article is protected by copyright. All rights reserved.

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Hipoacusia: Un nuevo factor de riesgo para demencia

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Quistes de cuerda vocal: Experiencia en 44 pacientes del Centro de Voz del Departamento de Otorrinolaringología de la Pontificia Universidad Católica de Chile

RESUMEN Introducción: Los quistes de cuerda vocal son una causa relativamente frecuente de disfonía. Su origen es aún controversial, y su diagnóstico y manejo continúan siendo un desafío clínico. Objetivo: Exponer y analizar las características clínicas de los quistes de cuerda vocal en nuestra serie de pacientes. Material y método: Estudio retrospectivo descriptivo de los pacientes con diagnóstico de quiste de cuerda vocal atendidos en nuestro centro entre junio de 2012 y diciembre de 2015. Resultados: Se atendieron 44 pacientes con diagnóstico de quiste de cuerda vocal, lo que representa el 4,32% de las consultas en nuestro Centro de Voz. La mayoría de los pacientes fueron adultos, y de ellos el 68,29% correspondió a mujeres. El 34,1% de los pacientes fueron sometidos a tratamíento quirúrgico con técnica de microfonocirugía. El 75% de los pacientes operados presentó mejoría en patrón de onda mucosa videolaringoestroboscópica. Todos los pacientes en los que se disponía de encuestas de valoración subjetiva de la voz pre y posoperatorias demostraron mejoría vocal significativa. Conclusión: Los quistes de cuerda vocal son lesiones que afectan a niños y adultos. La videolaringoestroboscopía es clave en el diagnóstico de estas lesiones, y el tratamiento quirúrgico con microfonocirugía es efectiva en cuanto a resultados vocales desde el punto de vista anatómico y funcional.

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ABSTRACT Introduction: Vocal cord cysts are a relatively frequent cause of dysphonia. Their origin is still controversial, and their diagnosis and management continue to be a clinical challenge. Aim: To describe and analyze the clinical characteristics of vocal cord cysts in our series of patients. Material and method: Descriptive retrospective study of patients with diagnosis of vocal cord cyst attended in our center between June 2012 and December 2015. Results: 44 patients had the diagnosis of vocal cord cyst, which represents 4.32% of the patients that attended our Voice Center during that period. Most of the patients were adults, and among them 68.29% corresponded to women. 34.1% of the patients were submitted to surgical treatment with microphonosurgery technique. 75% of the surgical patients presented an improvement in the pattern of the videolaryngostroboscopic mucosal wave. All the patients in which pre and postsurgical subjective voice assessment polls were available, showed a significant voice improvement. Conclusion: Vocal cord cysts are lesions that affect both children and adults. The videolaryngostroboscopy evaluation is key in the diagnosis of these lesions, and the surgical treatment with microphonosurgery is effective in terms of anatomical and functional vocal results.

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Sinus Tympani y recidiva en cirugía de colesteatoma

RESUMEN Introducción: El sinus tympani (ST) es una de las áreas que más presenta colesteatoma residual. Recientemente se ha clasificado en 3 tipos de acuerdo a su morfología. Objetivos: Determinar el tipo de ST en los pacientes sometidos a cirugía de colesteatoma y analizar su impacto como factor de recidiva. Material y método: Revisión de fichas clínicas de pacientes sometidos a cirugía de colesteatoma entre los años 2004 y 2015 en el Hospital Regional de Concepción. Análisis de la tomografía axial computarizada (TAC) preoperatoria y posterior evaluación clínica de los pacientes operados mediante mastoidectomía canal wall down (CWD). Resultados: En el periodo descrito se operaron 271 oídos. El 60% de los casos analizados presentó ST tipo A y 40% ST tipo B. Se identificaron 12 casos de recidiva, 3 ST tipo B y 9 ST tipo A, sin diferencia estadísticamente significativa entre ambos. Discusión: Distinto a lo reportado en la literatura el tipo de ST más frecuente en nuestro estudio fue el tipo A, lo que podría corresponder a una variable étnica. Conclusión: El estudio preoperatorio con TAC es una herramienta útil para evaluar el tipo y compromiso del ST. Las diferencias anatómicas entre ST tipo A y B parece no ser un factor determinante de recidiva en mastoidectomías CWD.

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ABSTRACT Introduction: Sinus tympani (ST) is one of the areas with the most residual cholesteatoma. Recently it has been classified in 3 types according to its morphology. Aim: To determine the type of ST in patients undergoing cholesteatoma surgery and to analyze its impact as a relapse factor. Material and method: Review of clinical files of patients submitted to cholesteatoma surgery between 2004 and 2015 at the Regional Hospital of Concepción. Preoperative computed axial tomography (CT) analysis and subsequent clinical evaluation of patients operated by canal wall down mastoidectomy (CWD). Results: In the described period 271 ears were operated. 60% of the cases analyzed had ST type A and 40% ST type B. Twelve cases of relapse were identified, 3 ST type B and 9 ST type A, with no statistically significant difference between the two. Discussion: Unlike to what is reported in the literature, the most common ST type in our study was type A, which could correspond to an ethnic variable. Conclusion: The preoperative study with CT is a useful tool to evaluate the type and commitment of ST. The anatomical differences between ST type A and B seems not to be a determinant factor of relapse in CWD mastoidectomies.

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Fibroangioma nasofaríngeo juvenil. Experiencia de 15 años en el Hospital Barros Luco Trudeau

RESUMEN Introducción: El fibroangioma nasofaríngeo juvenil es un tumor vascular benigno localmente agresivo, que afecta casi exclusivamente la nasofaringe de adolescentes de sexo masculino. Su manejo es complejo dada su extensión, naturaleza vascular y sus frecuentes recurrencias. Objetivo: Mostrar la experiencia de 15 años en fibroangioma juvenil en nuestro centro. Material y método: Estudio descriptivo retrospectivo de los pacientes con diagnóstico de ingreso de fibroangioma nasofaríngeo juvenil al Servicio de Otorrinolaringología del Hospital Barros Luco Trudeau entre los años 1997 y 2011, caracterizando al grupo de estudio en cuanto a características clínico-demográficas, vasos aferentes, relación entre etapa tumoral y vascularización, manejo terapéutico, complicaciones y recurrencias. Resultados: Se obtuvo un total de 20 pacientes, todos de sexo masculino, con un promedio de edad de 13,9 años. El síntoma de presentación más frecuente fue la epistaxis a repetición y obstrucción nasal presente en el 90% y 80%, respectivamente. Todos los pacientes se estudiaron con tomografia computarizada y recibieron embolización arterial preoperatoria. La mayoría de los tumores fueron de tipo II (65%) y III (20%), según clasificación de Radkowski. La técnica quirúrgica más empleada fue abierta (57,8%). Radioterapia en un caso. El vaso aferente principal fue la maxilar interno ipsilateral en el 100%. Todos los fibroangiomas etapa III eran además irrigados por la arteria carótida interna. Se encontró 20% de persistencia y 15% de recidiva. Conclusión: Nuestros resultados concuerdan con la gran mayoría de las series publicadas en la literatura. Epistaxis recurrente, obstrucción nasal y tumor nasal unilateral deben hacernos sospechar de esta patología en un adolescente masculino. El tratamiento de elección es la cirugía con embolización preoperatoria. La vía de abordaje endoscópica presenta menor morbilidad posoperatoria en pacientes con estadios I y II de Radkowski. Todos los fibroangiomas con compromiso intracraneano, presentan irrigación también del sistema carotideo interno.

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ABSTRACT Introduction: Nasopharyngeal Fibroangioma is a locally aggressive benign vascular tumor. Its management is complex given its size, vascular nature and its frequent recurrences. Aim: To show the experience of 15 years in Juvenile Fibroangioma in our center. Material and method: Retrospective descriptive study of patients admitted with a diagnosis of Juvenile Fibroangioma Nasopharyngeal in the Department of Otolaryngology Hospital Barros Luco Trudeau between 1997 and 2011. Results: A total of 20 patients was obtained. The most common presenting symptom was recurrent epistaxis and nasal obstruction present in 90% and 80% respectively. The most common surgical technique was open (57.8%). Radiotherapy in one case. The main afferent vessel was the ipsilateral internal maxillary in 100%. All Fibroangioma stage III were also supplied by the internal carotid artery. 20% of persistence and 15% of recurrence was found. Conclusion: Recurrent epistaxis, nasal obstruction and unilateral nasal tumor should raise the suspicion of this disease in a male teenager. The treatment of choice is surgery with preoperative embolization. The route of endoscopic approach has less postoperative morbidity in patients with stage I and II of Radkowski. All Fibroangioma with intracranial commitment, have also the internal carotid irrigation system.

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Causas de rinoplastía secundaria: Análisis de 277 casos

RESUMEN Introducción: La rinoplastía secundaria cada día es más frecuente debido a la creciente popularidad de la cirugía estética y también por las mayores expectativas del paciente y del cirujano. La rinoplastía secundaria ha llegado a ser un campo en evolución con desafíos únicos. Para enfrentarlo adecuadamente el cirujano debe analizar y comprender las necesidades específicas del paciente y las causas anatómicas que generaron el problema y cómo corregirlo. Objetivo: Identificar los problemas anatómicos más frecuentemente encontrados en 277 rinoplastías secundarias y sistematizarlos para una mejor evaluación preoperatoria y planificación quirúrgica. Material y método: Análisis retrospectivo de 1.160 rinoplastías operadas por el otorrinolaringólogo Dr. Luis Villarroel entre el 1 de enero de 2006 y el 31 de marzo de 2015, de las cuales 277 son rinoplastías secundarias (24%). En ellas se encontraron 1.197 problemas o deformidades (4,3 promedio), que se dividieron en tercio superior, medio, inferior y endonasales, con una subdivisión de deformidades individuales dentro de cada grupo. También se comparan los resultados encontrados según si la cirugía primaria fue de otro cirujano (rinoplastías secundarias) o del mismo autor (rinoplastías de revisión). Resultados: El 85% de los pacientes presentó problemas en el tercio inferior. Los problemas más frecuentes fueron desviación del tabique nasal (problema endonasal) (56%), punta hiporotada (47%), desviación del dorso óseo (34%) y desviación del dorso cartilaginoso (30%). Las rinoplastías de revisión, comparadas con las secundarias, presentan un porcentaje mayor de problemas de insuficiente resección del dorso óseo y menos dorsos cartilaginosos estrechos. Conclusión: Existen diferentes razones por las que un paciente busca una rinoplastía secundaria. Es importante conocer las causas más frecuentes con el fin de identificar los errores cometidos en el primer caso y evitar dichas prácticas. Es preferible una cirugía primaria conservadora porque evita problemas difíciles de resolver. Esta clasificación nos ayuda a sistematizar el análisis preoperatorio, a saber, dónde estamos teniendo problemas y así corregirlos y obtener mejores resultados quirúrgicos.

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ABSTRACT Introduction: Secondary rhinoplasty is becoming increasingly common due to the growing popularity of cosmetic surgery and also by higher expectations of the patient and the surgeon. Secondary rhinoplasty has become an evolving field with unique challenges. To repair the surgeon must properly analyze and understand the specific concerns of the patient and the anatomical causes of why you need a new operation. Aim: To identify anatomical problems most frequently found in 277 secondary and systematize rhinoplasty for better preoperative evaluation and surgical planning. Material and method: Retrospective analysis of 1160 rhinoplasty operated by otolaryngologist Dr. Luis Villarroel between January 1006 and March 31, 2015, of which 277 are secondary rhinoplasty (24%). In this study we found 1197 problems or deformities (average 4.3), They were classified into upper, middle, bottom third ,and endonasal, with an individual deformities subdivision within each group. The results are compared if the primary surgery was another surgeon (secondary rhinoplasty of others) or by the same author (revision rhinoplasty). Results: 85% of patients had problems in the lower third. The most common individual problems identificated were deviated septum (56%), drop tip (47%), bone dorsum deviation (34%), and cartilaginous dorsum desviation (30%). The author presents a higher percentage of insufficient bone resection and less cartilaginous dorsum narrow. Conclusion: There are different reasons why a patient seeks a secondary rhinoplasty. It is important to know the most frequent causes in order to identify the mistakes made in the first instance and avoid them. It's preferable one conservative primary surgery because it avoids difficult problems. This classification helps us to systematize the preoperative analysis and better results.

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Revestimiento interno en reconstrucción nasal: Estudio anatómico cadavérico

RESUMEN Introducción: Ante la presencia de un defecto anatómico nasal, se hace necesario considerar alternativas para restituir una correcta función y estética nasal. La estructura osteocartilaginosa nasal debe contar con un soporte o revestimiento interno que aporte una vascularización necesaria. Existen diversas técnicas de colgajos intranasales para lograr reconstituir el revestimiento interno nasal. Objetivos: Describir la técnica quirúrgica de los principales colgajos de revestimiento interno en reconstrucción nasal y su aplicación en modelos ex vivo. Material y método: Se realizó la disección de 7 especímenes de donante cadáver. Se efectuó una resección amplia nasal simulando una pérdida de tejido de las 3 capas de la anatomía nasal para su posterior reconstrucción. Resultados: Se logró replicar las distintas alternativas de técnicas de colgajos intranasales descritas para reconstrucción nasal. Conclusión: El revestimiento interno es de suma importancia en la reconstrucción nasal. Esta es una primera fase en el desarrollo y aprendizaje de la reconstrucción nasal.

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ABSTRACT Introduction: In the presence of a nasal anatomical defect, it is necessary to consider alternatives to restore a correct function and esthetic nasal result. The nasal osteocartilaginous structure must have an internal support or lining that provides a necessary vascularization. There are various techniques of intranasal flaps to achieve reconstitution of the nasal internal lining. Aim: To describe the surgical technique of the main internal lining flaps in nasal reconstruction and its application in ex vivo models. Material and method: We dissected 7 cadaver donor specimens. A broad nasal resection was performed simulating a loss of tissue from the three layers of the nasal anatomy for subsequent reconstruction. Results: It was possible to replicate the different alternatives of intranasal flap techniques described for nasal reconstruction. Conclusion: The inner lining is of paramount importance in nasal reconstruction. This is a first phase in the development and learning of nasal reconstruction.

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Manejo endoscópico de anomalías del cuarto arco branquial: Reporte de tres casos

RESUMEN Las anomalías de cuarto arco branquial corresponden a una entidad patológica infrecuente. Para su manejo existen distintas alternativas terapéuticas siendo una de ellas la cauterización endoscópica. Reportamos 3 casos de senos de cuarto arco branquial tratados mediante cauterización endoscópica en el Hospital Regional de Concepción luego de una revisión de fichas clínicas de todos los pacientes con diagnóstico de anomalías de cuarto arco branquial. Se identificaron tres casos de senos de cuarto arco branquial. Todos corresponden a pacientes de sexo masculino que presentaron cuadro de absceso cervical, diagnosticándose 2 de ellos al presentar recurrencia. Todos fueron tratados mediante cauterización endoscópica de la apertura fistulosa en seno piriforme. Estas anomalías representan vestigios de un trayecto que se origina desde el vértice del seno piriforme. La cauterización endoscópica presenta una serie de ventajas con tasas de recurrencia similares a la cirugía abierta de cuello, menores tasas de complicaciones y costo económico. Las anomalias de cuarto arco branquial constituyen una patología infrecuente y el diagnóstico requiere alta sospecha clínica. El manejo endoscópico ha demostrado ser una alternativa segura y efectiva con menor tasa de complicaciones.

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ABSTRACT Anomalies of the fourth branchial arch correspond to an uncommon pathological entity. There are different therapeutic alternatives being one of them the endoscopic cauterization. We report 3 cases of fourth branchial arch anomalies treated by endoscopic cauterization in the Regional Hospital of Concepción. Review of clinical records of all patients with diagnosis of fourth branchial anomalies operated by endoscopic cauterization at the Regional Hospital of Concepción. Cases: Three cases of fourth branchial arch sinus were identified. All of them were male patients who presented with a cervical abscess, diagnosing 2 of them when they recurred. All 3 cases were treated by endoscopic cauterization of the fistulous opening in the piriform sinus. These anomalies represent vestiges of a path that originates from the apex of the piriform sinus. Endoscopic cauterization presents a number of advantages with recurrence rates similar to open neck surgery, with lower complication rates and economic cost. Fourth branchial anomalies constitute an uncommon pathology and the diagnosis requires high clinical suspicion. Endoscopic management has proven to be a safe and effective alternative with a lower rate of complications.

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Manejo endoscópico de osteoma etmoidal con extensión orbitaria: A propósito de un caso

RESUMEN El osteoma es el tumor más frecuente de los senos paranasales, habitualmente asintomático debido a su lento crecimiento, sin embargo, pueden desarrollarse síntomas dependiendo del tamaño, localización y extensión, con potencial compromiso de órbita y cerebro. La cirugía está indicada en casos sintomáticos pudiendo realizarse abordaje externo, endoscópico o combinado. Presentamos un caso de osteoma etmoidal con compromiso orbitario resuelto, manejado por medio de la cirugía endoscópica nasal, con apoyo de navegación.

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ABSTRACT The osteoma is the most common tumor of the paranasal sinuses, is usually asymptomatic because of their slow growth, however, may develop symptoms depending on the size, location and extent, with potential compromise of orbit and brain. Surgery is indicated in symptomatic cases, with external, endoscopic or combined approach. We present a case of ethmoidal osteoma with orbital involvement managed by endoscopic image guided surgery.

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Paroxismia vestibular: Reporte de un caso

RESUMEN Presentamos el caso de un paciente joven quien presenta 4 a 5 crisis diarias de vértigo espontáneo de segundos de duración, todos o casi todos los días desde hace 9 meses. Estas crisis no tienen gatillo posicional, y hay completa ausencia de sintomatologia entre crisis. Como discutimos en el artículo, este cuadro coíncide con los recientemente publicados criterios para una paroxismia vestibular, entidad supuestamente secundaria a la compresión neurovascular del nervio vestibular. El paciente respondió de forma inmediata y completa a carbamazepina a dosis bajas, el tratamiento de elección en la paroxismia vestibular.

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ABSTRACT We present the case of a young patient, with a 9-month long history of 4 to 5 daily spells of spontaneous vertigo, each lasting only seconds. There is no positional trigger, and there is a complete lack of symptoms between attacks. As is discussed in the article, this matches the recently published criteria for Vestibular Paroxysmia, an entity allegedly secondary to neurovascular compression of the vestibular nerve. The patient responded immediately and completely to carbamazepine at low dosage, the preferred treatment for vestibular paroxysmia.

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Carcinoma parotídeo epitelial-mioepitelial: Presentación de un caso y revisión de la literatura

RESUMEN Se presenta caso de paciente de sexo femenino de 53 años de edad con tumor parotídeo izquierdo de larvada evolución, con crecimiento progresivo y otalgia ipsilateral en los últimos meses, estudiado previamente con tomografía de cuello con contraste y resonancia magnética que destacan masa del lóbulo profundo de la parótida de características imagenológicas benignas. Se realizó parotidectomía del lóbulo profundo con resección tumoral preservando el nervio facial casi en su totalidad con excepción de rama marginal, la biopsia de la pieza quirúrgica fue informada como carcinoma epitelialmioepitelial de bajo grado, un tumor infrecuente de las glándulas salivales. Se decidió completar la parotidectomía superficial y realizar vaciamiento ganglionar selectivo lateral ipsilateral, complementando el tratamiento con radioterapia. Además se presenta una revisión de la literatura correspondiente.

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ABSTRACT We present a case of a 53 years old female patient with a left parotid tumor, with slow evolution, progressive growth and ipsilateral otalgia during later months. She was previously studied by tomography of the neck with contrast and magnetic resonance, which showed the mass of the deep lobe to have benign imaging characteristics. A parotidectomy of deep lobe was performed, with tumoral resection, preserving the facial nerve with the exception of the marginal branch. The biopsy was informed as epithelial-myoephitelial carcinoma, a rare salivary gland tumor. We completed the parotidectomy with neck dissection and Radiotherapy complementary was made. Besides we presented a literature review.

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Carcinosarcoma de laringe: Reporte de dos casos

RESUMEN El carcinosarcoma de laringe es un tumor bifásico raro que representa menos del 1% de todos los tumores malignos de laringe. Debido a su doble naturaleza epitelial y mesenquimal esta neoplasia ha sido denominada de distintas maneras en la literatura, siendo indispensable el estudio mediante inmunohistoquímica para establecer un diagnóstico correcto. Se presentan 2 casos de carcinosarcoma de laringe, confirmados mediante estudio con inmunohistoquímica, ambos tratados mediante laringectomía total. Se elabora una discusión de los principales aspectos clínicos, histopatológicos y terapéuticos de esta infrecuente neoplasia.

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ABSTRACT The larynx carcinosarcoma is a rare biphasic tumor that represents less than 1% of all malignant tumors of the larynx. Because of its biphasic epithelial and mesenchymal nature this neoplasm has been called in different ways in the literature being indispensable the study by immunohistochemistry to establish a proper diagnosis. We present 2 cases of larynx carcinosarcoma confirmed by immunohistochemical study, both treated with total laryngectomy. A discussion of the main clinical, histopathological and therapeutic aspects of this rare neoplasm is made.

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Tuberculosis como causa de adenopatías cervicales

RESUMEN La tuberculosis (TBC) es una enfermedad infecto-contagiosa de distribución mundial causada por Mycobacterium tuberculosis, y otras micobacterias atípicas. La afectación ganglionar es tardía y sus manifestaciones clínicas asociadas suelen ser inespecíficas, por eso, el diagnóstico de tuberculosis ganglionar a menudo se retrasa y es un hallazgo inesperado en numerosas ocasiones. Este artículo pretende realizar una revisión bibliográfica sobre la tuberculosis ganglionar y hacer hincapié en que la TBC ha de ser tenida en cuenta como diagnóstico diferencial en las masas cervicales, que muchas veces se presentan con escasa sintomatología acompañante. En este artículo presentamos dos casos de TBC ganglionar diagnosticados en nuestro servicio en los últimos meses, ambos casos se manifestaron exclusivamente como masa cervical de crecimiento lento, sin síntomas pulmonares acompañante y fueron diagnosticados de TBC tras el estudio anatomopatológico resultante de la exéresis quirúrgica de la lesión.

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ABSTRACT The tuberculosis (TB) is an infect-contagious worldwide distribution disease caused by Mycobacterium Tuberculosis and other atypical Mycobacteria. Lymph node involvement is late, and its associated clinical manifestations are usually unspecifics, therefore the diagnosis of tuberculosis lymph node is often delayed and is an unexpected finding in numerous occasions. This article aims to carry out a literature review of lymph node tuberculosis and to emphasize that TB must be taken into account as differential diagnosis in cervical masses, which often occur with few associated symptoms. In this article we present two cases of lymph node TB diagnosed in our department in last months, both cases presented exclusively as cervical mass of slow growth, without any accompanying pulmonary symptoms and were diagnosed as TB after the surgical removal of the lesion and its histopathological study.

http://ift.tt/2Bbz86E

Revisión sobre los conocimientos actuales de dehiscencia del canal semicircular posterior

RESUMEN La dehiscencia del canal semicircular posterior es una patología rara y con baja incidencia, por ello hemos realizado una revisión de los conocimientos actuales de esta entidad. Se ha realizado una búsqueda bibliográfica desde 1998 hasta diciembre de 2016 de toda la literatura publicada sobre la misma en las bases de datos Allied and Complementary Medicine Database and the Embase, Health Management Information Consortium, Scopus, Consortium, Medline, PsycINFO y Scielo. Se han encontrado y revisado 53 trabajos relacionados con el tema. La dehiscencia del canal semicircular posterior presenta una prevalencia variable; 0,3%-4,5% en adultos y 1,2%-20% en niños. Su localización puede ser hacia el golfo de la yugular o fosa cerebral posterior. Los pacientes pueden ser asintomáticos o presentar clínica auditiva y/o vestibular. La tomografía computarizada y la prueba de potenciales vestibulares miogénicos evocados permiten establecer el diagnóstico de certeza. En el tratamiento quirúrgico la vía de abordaje de elección es la transmastoidea y las técnicas del cierre del canal son el "plugging" y el "resurfacing".

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ABSTRACT The posterior semicircular canal dehiscence is a rare pathology and it has a low incidence. We have realized a review about the current knowledge of this entity. We have performed a bibliographic research from 1998 to 2016 December about the literature published in this subject, in the data basis Allied and Complementary Medicine Database and the Embase, Health Management Information Consortium, Scopus, Consortium, Medline, PsycINFO y Scielo. I thas been found and reviewed 53 papers about the topic. The posterior semicircular canal dehiscence has a variable prevalence: 0,3%-4-5% in adults and 1,2%-20% in children. The location can be in the jugular bulb or in the posterior brain fossa. Some patients can be asymptomatic, whereas others can have auditory and/or vestibular signs and symptoms. Computed tomography and test of vestibular evoked myogenic potentials allow the diagnosis of certainty. In the surgical treatment the approach of choice is transmastoid and techniques to close the canal are plugging and resurfacing.

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Hipertrofia de amígdala lingual y apnea obstructiva del sueño en población pediátrica: Una asociación a considerar

RESUMEN Las amígdalas linguales (AL) forman parte del Anillo de Waldeyer (AW). La hipertrofia de amígdala lingual (HAL) se debe habitualmente a hiperplasia, generalmente asintomática. Su etiología no está precisada, pero se reconoce como causa de Apnea Obstructiva del Sueño (AOS) residual, posterior a adenoamigdalectomía (AA). Su identificación en el examen físico es dificultosa, por lo que resulta relevante la sospecha, junto con una nasofibroscopía. Según condiciones y sintomatología del paciente se puede complementar el estudio con otras técnicas diagnósticas, como polisomnograma (PSG) y resonancia magnética (RM). La cirugía es exitosa para el tratamiento de estos casos. Dentro de las complicaciones descritas para este procedimiento destacan: hemorragia, obstrucción de la vía área, dificultad en la intubación orotraqueal y dolor en el posoperatorio. Actualmente no existe una técnica quirúrgica de elección. Debido a la morbilidad asociada a AOS resulta fundamental el diagnóstico de esta patología, ya que es susceptible de tratamiento.

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ABSTRACT Lingual tonsils are part of Waldeyer`s Ring. The hypertrophy of the lingual tonsils is generally due to hiperplasia, without symptoms. The etiology is not clear, but it is a known cause of residual Obstructive Sleep Apnea (OSA), after adenotonsilectomy. Their identification during the physical exam results dificult, so the suspicious and the nasofibroscopy are relevant. Acording to the particular patient it is posible realize additional exams, like polisomnography and magnetic nuclear resonance. Surgery is succesful for this cases. The complications include: bleeding, airway obstruction, anestesia dificulties and pain. Currently there is not a particular techniqe of choice. OSA is associated to morbidity, therefore it is fundamental to diagnose this pathology, because it is posible to treat it through surgery.

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Crisis otolítica de Tumarkin. Revisión de la literatura

RESUMEN Las crisis de Tumarkin consisten en caídas bruscas al suelo sin pródromos previos ni pérdida de conciencia y de segundos de duración que pueden ocurrir con frecuencia relativa en pacientes con enfermedad de Ménière. Si bien pueden presentarse de manera aislada durante la evolución de la enfermedad, existen casos con crisis recurrentes que comprometen significativamente la calidad de vida de los pacientes. Se postula que las crisis se producen por una alteración de la función del órgano otolítico, específicamente del sáculo. El tratamiento puede ser desde el manejo expectante hasta el uso de laberintectomía química o quirúrgica.

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ABSTRACT Tumarkin´s otolithic crisis is a sudden fall that comes with no loss of consciousness, and without warning or prodrome. It has a short duration and can occur with relative frequency in patients with Meniere disease. When it is present, it significantly compromises life quality of patients. There is no certainty about its mechanism, but it is assumed that the crises are caused by an otolithic organ disfunction, specifically a collapse of the saccule. Treatment can range from observation to chemical or surgical labyrinthectomy.

http://ift.tt/2mPPEFb