Spontaneous nasal cerebrospinal fluid leaks: management of 24 patients over 11 years

Abstract

Purpose

Most cases of non-traumatic nasal cerebrospinal fluid (CSF) leaks occur spontaneously without any obvious reason. Severe and life-threatening complications are possible consequences. Endoscopic repair is considered the gold standard; however, diagnosis and therapy of these CSF leaks stay challenging.

Methods

In this retrospective analysis, patients who presented with spontaneous nasal CSF leaks from 2006 to 2017 were included. Symptoms, diagnostics, localization of the skull base defect, surgical method, outcome, and postoperative treatment were recorded.

Results

Twenty four patients were included. 8 patients presented with symptoms of meningitis. The skull base defects were most commonly located in the anterior ethmoid roof—especially in the cribriform plate—and in the lateral part of the sphenoid sinus. 21 patients had a BMI above 25. In only 13 cases the defect could be detected preoperatively via computed tomography or additional magnetic resonance imaging. In all patients intraoperative visualization of the CSF leak was possible using intrathecal application of sodium-fluorescein. Endoscopic repair was the initial surgical method for all patients and proved to be successful in 80% of the cases. In most cases surgical revision was performed endoscopically; however, in two patients an open transpterygoidal approach was necessary.

Conclusions

Spontaneous nasal CSF leaks often initially present with symptomatic meningitis. Imaging does not always clearly identify the skull base defect. Common localizations are the anterior ethmoid roof and the lateral sphenoid sinus. Obesity seems to be a predisposing factor. In most cases, endoscopic repair with low morbidity is possible; however, an individualized approach is necessary.

https://ift.tt/2B9mDOj

Achilles insertion bone pathology not related to pain in a triathlete with cystic fibrosis

Abstract

This report concerns the unusual case of a 48-year old, world-class triathlete who has won 11 ironman competitions. She has reached the top level of international endurance sport in spite of being diagnosed with cystic fibrosis. This patient presented with Achilles pain and severe bony pathology at her left Achilles insertion. Traditionally this condition is treated via tendon detachment and re-attachment or intra-tendinous surgery, followed by a protracted rehabilitation. These procedures were considered risky due to this patient's chronic disease with vulnerability to immobilization. Instead, she was treated by surgical removal of the superficial bursa alone, under local anaesthetic. This allowed the patient to become active and load her Achilles tendon immediately, and resulted in a significant symptomatic improvement. This case illustrates that despite the presence of severe tendon and bone pathology at the Achilles insertion, pain may originate in the superficial bursa; a structure ignored by traditional operations.

https://ift.tt/2BbuRWg

Merkel-cell carcinoma of the upper limb

Abstract

Merkel-cell carcinoma is a rare form of aggressive cutaneous cancer that is associated with a poor prognosis. Despite significant advances, its pathogenesis is still poorly understood, and treatment remains controversial. Timely diagnosis and early management is essential in improving survival rate. We present a case of a 63-year-old patient with a rapidly growing upper limb Merkel-cell carcinoma. It was treated with wide-local excision and adjuvant radiotherapy.

https://ift.tt/2P85KGT

Unusual lymph node metastasis from cancer of the thoracic esophagus

Abstract

A 76-year-old male received concurrent chemoradiotherapy, at a dose of 60 Gy with low-dose 5-fluorouracil, for cT1bN0M0 squamous cell carcinoma of the mid-thoracic esophagus. Because his primary tumor relapsed with mediastinal and right supraclavicular node metastasis 4 months after completion of chemoradiotherapy, right transthoracic esophagectomy with mediastinal and right cervical lymphadenectomy was performed. However, metastatic tumors developed deep beneath the anterior border of the trapezius muscle 2 months after esophagectomy. En bloc dissection of the adipose tissue including the tumor and the transverse cervical artery was performed, followed by adjuvant radiotherapy of 50.4 Gy to the area of dissection. The patient died of pneumonia 11 months after metastasectomy, with locally recurrent disease. We have had three cases of this unusual lymph nodes metastasis from cancer of the thoracic esophagus to date and here present the characteristic imaging findings and the possible mechanism of this unusual lymph node metastasis.

https://ift.tt/2KQaYn8

Age and adenoma size are independent risk factors for the development of carcinoma ex pleomorphic adenoma

Publication date: September 2018

Source: Oral Oncology, Volume 84

Author(s): E.S. Egal, F.V. Mariano, A.M. Altemani, K. Metze

https://ift.tt/2MnbjCO

ERK-TSC2 signalling in constitutively-active HRAS mutant HNSCC cells promotes resistance to PI3K inhibition

Publication date: September 2018

Source: Oral Oncology, Volume 84

Author(s): Kara M. Ruicci, Nicole Pinto, Mohammed I. Khan, John Yoo, Kevin Fung, Danielle MacNeil, Joe S. Mymryk, John W. Barrett, Anthony C. Nichols

Abstract

Objectives

The PI3K/AKT/mTOR pathway is frequently altered in head and neck squamous cell cancer (HNSCC), making this pathway a logical therapeutic target. However, PI3K targeting is not universally effective. Biomarkers of response are needed to stratify patients likely to derive benefit and exclude those unlikely to respond.

Materials and methods

We examined the sensitivity of cell lines with constitutively-active (G12V mutant) HRAS and wild-type HRAS to PI3K inhibition using flow cytometry and cell viability assays. We then overexpressed and silenced HRAS and measured sensitivity to the PI3K inhibitor BYL719. Immunoblotting was used to determine activation of the PI3K pathway. MEK and mTOR inhibitors were then tested in HRAS mutant cells to determine their efficacy.

Results

HRAS mutant cell lines were non-responsive to PI3K inhibition. Overexpression of HRAS led to reduced susceptibility to PI3K inhibition, while knockdown improved sensitivity. Immunoblotting revealed suppressed AKT phosphorylation upon PI3K inhibition in both wild-type and HRAS mutant cell lines, however mutant lines maintained phosphorylation of S6, downstream of mTOR. Targeting mTOR effectively reduced viability of HRAS mutant cells and we subsequently examined the ERK-TSC2-mTOR cascade as a mediator of resistance to PI3K inhibition.

Conclusions

HRAS mutant cells are resistant to PI3K inhibition and our findings suggest the involvement of a signalling intersection of the MAPK and PI3K pathways at the level of ERK-TSC2, leading to persistent mTOR activity. mTOR inhibition alone or in combination with MAPK pathway inhibition may be a promising therapeutic strategy for this subset of HNSCC tumors.

https://ift.tt/2MJBd0p

Self-reported oral morbidities in long-term oropharyngeal cancer survivors: A cross-sectional survey of 906 survivors

Publication date: September 2018

Source: Oral Oncology, Volume 84

Author(s): Richard C. Cardoso, Ahmad Qazali, Jhankruti Zaveri, Mark S. Chambers, Gary Brandon Gunn, Clifton D. Fuller, Stephen Y. Lai, Frank E. Mott, Katherine A. Hutcheson

Abstract

Objective

The purpose of this study is to estimate the prevalence and severity of late oral morbidities in disease-free oropharyngeal cancer (OPC) survivors using patient reported outcomes.

Materials and methods

Cross-sectional survivorship survey of patients who completed definitive treatment for oropharyngeal carcinoma  > 12-months previously without evidence of recurrence, second primary malignancy, or distant metastasis after index cancer. Using MD Anderson Symptom Inventory- Head and Neck Module (MDASI-HN), scores for 4 self-reported oral morbidities: dry mouth, mucus secretions, mouth and throat sores, and teeth and gum issues were evaluated.

Results

Among 906 survey respondents (57% response rate), (median survival time: 7 years), "dry mouth" and "problems with my mucus" were reported moderate/severe (MDASI-HN item score ≥5) in 39% and 22% of respondents, while 14% reported moderate/severe "problems with teeth and gums". Smoking at the time of survey was significantly associated with the severity of oral symptoms including "mucus" (p = 0.03), "dry mouth" (p = 0.02), "problems with my teeth and gums" (p = 0.001). All the oral morbidities symptom items significantly, positively correlated with the mean interference scores reflecting adverse impact to quality of life (QOL): "mucus" (r = 0.445, p < 0.001), "problems with teeth" (r = 0.446, p < 0.001), "mouth sores" (r = 0.321, p < 0.001) and "dry mouth" (r = 0.459, p < 0.001).

Conclusion

This study showed that 45.5% reported at least one late oral morbidity at moderate/severe level which negatively correlated overall function, even years after treatment.

https://ift.tt/2Mnbdeq

Staging HPV-related oropharyngeal cancer: Validation of AJCC-8 in a surgical cohort

Publication date: September 2018

Source: Oral Oncology, Volume 84

Author(s): Mathew Geltzeiler, Marnie Bertolet, William Albergotti, John Gleysteen, Brennan Olson, Michael Persky, Neil Gross, Ryan Li, Peter Andersen, Seungwon Kim, Robert L. Ferris, Umamaheswar Duvvuri, Daniel Clayburgh

Abstract

Importance

The American Joint Committee on Cancer, 8th edition (AJCC-8) contains a new staging system for human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC). Our study aim was to evaluate the effectiveness of the AJCC-8 relative to the AJCC 7th edition (AJCC-7).

Materials and methods

A retrospective chart review was performed on a multi-institutional, prospectively collected dataset from two tertiary referral centers. All patients had HPV+ OPSCC treated primarily with surgery. The prognostic value of AJCC-7 and AJCC-8 were compared for 5-year overall survival (OS) and disease-specific survival (DFS).

Results

AJCC-8 pathological staging effectively risk stratified patients, creating a Cox model with a better fit (lower Akaike's Information Criterion, p < 0.0001) when compared to AJCC-7 pathological stages for both OS and DFS. The AJCC-8 pathologic staging did not produce a better fit than the AJCC-8 clinical staging (p = 0.15) for OS, however, AJCC-8 pathologic was more effective than AJCC-8 clinical for DFS (p < 0.0001). 76% of patients did not change their stage between clinical and pathologic AJCC-8 staging; 14% were upstaged by 1, <1% were upstaged by 2, 7% were downstaged by 1, and 3% downstaged by 2.

Conclusions and relevance

The new AJCC-8 staging system represents a significant improvement over AJCC-7 for risk stratification into groups that predict overall survival and disease-specific survival of surgically treated HPV+ OPSCC patients. The AJCC- 8 pathologic staging system was not significantly better than the AJCC-8 clinical staging system for overall survival, however, the pathologic staging system was better than the clinical for disease free survival.

https://ift.tt/2MHIlKA

Communication of prognosis in head and neck cancer patients; a descriptive qualitative analysis

Publication date: September 2018

Source: Oral Oncology, Volume 84

Author(s): Emilie A.C. Dronkers, Arta Hoesseini, Maarten F. de Boer, Marinella P.J. Offerman

Abstract

Objectives

In shared decision making it is important to adequately, timely and actively involve patients in treatment decisions. Sharing prognostic information can be of key importance. This study describes whether and how prognostic information on life expectancy is included during communication on diagnosis and treatment plans between physicians and head and neck (H&N) oncologic patients in different phases of disease.

Methods

A descriptive, qualitative study was performed of n = 23 audiotaped physician-patient conversations in which both palliative and curative treatment options were discussed and questions on prognosis were expected. Verbatim transcribed consultations were systematically analyzed. A distinction was made between prognostic information that was provided (a) quantitatively: by giving numerical probability estimates, such as percentages or years or (b) qualitatively: through the use of words such as 'most likely' or 'highly improbable'.

Results

In all consultations, H&N surgeons provided some prognostic information. In 5.9% of the provided prognostic information, a quantitative method was used. In 94.1% prognostic information was provided qualitatively, using six identified approaches. H&N surgeons possibly affect patients' perception of prognostic content with two identified communication styles: directive (more physician-centered) and affective (more patient-centered).

Conclusion

This study is first in providing examples of how H&N surgeons communicate with their patients regarding prognosis in all stages of disease. They often exclude specific prognostic information. The study outcomes can be used as a first step in developing a guideline for sharing prognostic information in H&N oncologic patients, in order enable the process of shared decision making.

https://ift.tt/2P5UUAU

Survival benefit of post-operative chemotherapy for intermediate-risk advanced stage head and neck cancer differs with patient age

Publication date: September 2018

Source: Oral Oncology, Volume 84

Author(s): Michelle M. Chen, A. Dimitrios Colevas, Uchechukwu Megwalu, Vasu Divi

Abstract

Objectives

The National Comprehensive Cancer Network (NCCN) guidelines state that surgical patients with advanced-stage head and neck cancer (HNC) and risk factors other than extranodal extension (ENE) or positive margins should consider post-operative chemoradiation (POCRT). The goal of our study was to determine if POCRT is associated with overall survival (OS) compared with post-operative radiation therapy (PORT) and whether this varies with patient age.

Material and Methods

We conducted a retrospective study of 5319 adult patients with stage III-IV HNC who received primary surgical treatment with POCRT or PORT in the National Cancer Database (2010–2013). Patients with distant metastases, ENE, and positive margins were excluded. Intermediate risk features included pT3-T4, pN2-N3 disease, and lymphovascular invasion. Our main outcome was overall survival (OS). Statistical analysis included chi-squared tests and Cox proportional hazards regressions.

Results

On multivariable analysis for non-oropharyngeal cancer patients <70 years, POCRT was associated with improved OS for T1-4N2-3 disease (hazard ratio [HR], 0.73, 95% confidence interval [CI]; 0.58–0.93) but was not associated with OS for T3-4N0-1 disease (HR, 0.92; 95% CI, 0.71–1.19). For patients ≥70 years, POCRT was not associated with improved OS for patients with T1-4N2-3 disease (HR, 1.21; 95% CI, 0.79–1.86) or T3-4N0-1 disease (HR, 1.08; 95% CI, 0.71–1.65). For oropharyngeal cancer patients with HPV-positive disease, POCRT was associated with decreased OS (HR, 9.52; 95% CI, 2.38–38.08).

Conclusion

Chemoradiation may offer a survival benefit for non-oropharyngeal intermediate-risk advanced-stage HNC patients <70 years of age with T1-4N2-3 disease, but may not benefit those ≥70 years of age or those with T3-4N0-1 disease.

https://ift.tt/2BhdMKK

Induction chemotherapy with carboplatin, nab-paclitaxel and cetuximab for at least N2b nodal status or surgically unresectable squamous cell carcinoma of the head and neck

Publication date: September 2018

Source: Oral Oncology, Volume 84

Author(s): Jared Weiss, Jill Gilbert, Allison Mary Deal, Mark Weissler, Chris Hilliard, Bhishamjit Chera, Barbara Murphy, Trevor Hackman, Jay Justin Liao, Juneko Grilley Olson, David Neil Hayes

Abstract

Background

Although induction studies of TPF in SCCHN have not improved outcomes compared to chemoradiotherapy alone, phase II studies of weekly carboplatin (CbP), paclitaxel and cetuximab (C225) have shown promising results. Nano-albumin-paclitaxel (nab-paclitaxel) based chemotherapy has demonstrated a higher response rate (RR) than solvent-based paclitaxel in squamous cell carcinoma of the lung with favorable toxicity.

Materials and methods

Patients with treatment naïve SCCHN of any site with ≥N2b disease or that was unresectable by strict criteria were eligible. Patients were treated with nab-paclitaxel 100 mg/m², CbP area under the curve (AUC) 2 and C225 400 mg/m² week 1 then 250 mg/m² for six weeks, followed by standard of care chemoradiotherapy (CRT). The primary endpoint was clinical response rate to induction therapy as defined by RECIST version 1.1. Secondary measures included toxicity, progression-free survival, overall survival and quality of life as measured by FACT-HN.

Results

38 eligible subjects were treated. Primary sites were: oropharynx (OPX) (25), larynx (3) oral cavity (OC) (9), hypopharynx (1). The most common grade 3 or 4 toxicity during induction was acneiform rash (26%) followed by neutropenia (16%). RR was 76.3%. Median PFS and OS have not been reached (median follow-up of 3.3 years); they were superior in patients with response.

Conclusions

The combination of nab-paclitaxel, CbP and C225 is feasible, tolerable and active against locally advanced SCCHN.

https://ift.tt/2MnaB8C

Low versus high activity radioiodine remnant ablation for differentiated thyroid carcinoma with gross extrathyroidal extension invading only strap muscles

Publication date: September 2018

Source: Oral Oncology, Volume 84

Author(s): So Young Park, Hye In Kim, Joon Young Choi, Jun-Ho Choe, Jung-Han Kim, Jee Soo Kim, Young Lyun Oh, Soo Yeon Hahn, Jung Hee Shin, Soo Hyun Ahn, Kyunga Kim, Jong Gill Jeong, Sun Wook Kim, Jae Hoon Chung, Tae Hyuk Kim

Abstract

Objectives

The efficacy of radioiodine remnant ablation (RRA) for patients with differentiated thyroid carcinoma (DTC) with gross extrathyroidal extension (ETE) is well described in observational studies. However, its role in gross ETE invading only strap muscles, T3b category in the newly proposed eighth edition of the TNM staging system, is currently unknown.

Methods

This study retrospectively analyzed 260 DTC patients with ETE invading only strap muscles who underwent thyroidectomy at a tertiary Korean hospital between 1994 and 2005. Cancer-specific survival (CSS) and recurrence-free survival (RFS) in the no RRA (n = 13), low RRA activity (<3.7 GBq, n = 80), and high RRA activity (≥3.7 GBq, n = 167) groups were studied.

Results

No significant differences were observed between low and high activity RRA groups in terms of 10-year CSS (97.3% versus 99.3%; HR 0.23, 95% CI 0.02–2.57; p = .235) and RFS (86.8% versus 88.8%; 0.90, 0.40–2.03; p = .804). In the no RRA group, no patients died of cancer, and only one developed structural recurrence. In Cox regression analyses with inverse probability of treatment weighting adjusted for clinicopathologic risk factors, high activity RRA was not related to recurrence outcomes compared to low activity (HR 0.60, 95% CI 0.26–1.35; p = .214).

Conclusions

Long term oncologic outcomes did not significantly differ between low versus high activity RRA groups, which suggests that low activity RRA might be sufficient in patients with DTC with gross ETE invading only strap muscles. Further studies are needed to clarify the optimal activity of RRA in these patients.

https://ift.tt/2MGEEFa

Prospective evaluation of patient reported swallow function with the Functional Assessment of Cancer Therapy (FACT), MD Anderson Dysphagia Inventory (MDADI) and the Sydney Swallow Questionnaire (SSQ) in head and neck cancer patients

Publication date: September 2018

Source: Oral Oncology, Volume 84

Author(s): Luke C. Peng, Xuan Hui, Zhi Cheng, Michael R. Bowers, Joseph Moore, Emilie Cecil, Amanda Choflet, Alex Thompson, Mariah Muse, Ana P. Kiess, Brandi R. Page, Christine G. Gourin, Carole Fakhry, Michal Szczesniak, Julia Maclean, Peter Wu, Ian Cook, Todd R. McNutt, Harry Quon

Abstract

Objectives

The Functional Assessment of Cancer Therapy (FACT) instrument is comprised of a group of related and overlapping quality of life (QoL) questionnaires including a core general form, head and neck cancer (HNC)-specific items, and an expert-selected index (FACT-HNSI). Understanding how these relate to more HNC-specific instruments such as the MD Anderson Dysphagia Inventory (MDADI) and Sydney Swallow Questionnaire (SSQ) is vital for guiding their use in clinical trials.

Materials and methods

HNC patients concurrently completed MDADI, SSQ, and FACT questionnaires at radiation oncology clinic visits (2015–2016). Spearman correlation coefficients were calculated between each FACT instrument and MDADI or SSQ. Unsupervised k-means cluster analyses were performed to identify clusters of similar QoL responses. Principal component analysis (PCA) identified the degree of variability explained by each instrument.

Results

We identified 631 instances (363 patients) where the questionnaires were completed concurrently. Correlations between the various FACT measures and SSQ or MDADI were all significant (p < 0.001), but FACT HNC-specific subscale and FACT-HNSI showed the strongest correlation with MDADI and SSQ. Clustering identified 3 distinct groups of responses when combining instruments either pairwise or three-way. PCA revealed that MDADI and FACT HNC-specific subscale provide similar and likely redundant information.

Conclusion

FACT HNC-subscale and FACT-HNSI may be preferable over other FACT measures for use in clinical trials where patient-reported swallow function is evaluated. MDADI and FACT provide similar insights into HNC patient QoL while SSQ provides additional, complementary information which could serve to better stratify patients into groups with high, medium, and low QoL outcomes.

Graphical abstract

https://ift.tt/2P4qVJH

Clinical analysis of second primary gingival squamous cell carcinoma after radiotherapy

Publication date: September 2018

Source: Oral Oncology, Volume 84

Author(s): Xiaoyan Fu, Shuwei Chen, Weichao Chen, Zhongyuan Yang, Ming Song, Hao Li, Huayong Zhang, Fan Yao, Xuan Su, Tianrun Liu, An-Kui Yang

Abstract

Introduction

Clinically, we have observed that some oral cancer patients have a history of radiotherapy for head and neck cancer; we have named this condition radiotherapy-associated cancer (RAC). Gingival cancer, which is usually juxtaposed with other oral cancer subtypes, is seldom reported individually, and there are few reports on the association between the incidence of oral cancer and history of radiation therapy. Therefore, this study aimed to elucidate the clinicopathological features and prognosis of second primary gingival squamous cell carcinoma after head and neck radiotherapy.

Materials and methods

The data collected included 450 patients diagnosed with gingival squamous cell carcinoma from 1964 to 2012 at Sun Yat-sen University Cancer, among whom 52 patients had a history of radiotherapy for head and neck cancer. We retrospectively analysed the differences in the clinicopathological characteristics and prognosis between sporadic gingival squamous cell carcinoma and radiation-associated gingival carcinoma, with an emphasis on gingival carcinoma.

Results

Sporadic gingival squamous cell carcinoma is less likely to have more advanced T stage, and the second primary tumour is more likely to be located in the molar area of the maxillary gingiva than in the mandibular gingiva (75.6% vs 24.4%, P < 0.05). The 5-year overall survival of patients with second primary gingival carcinoma was influenced by age distribution, T classification, N classification, clinical TNM stage, histological grade and radiation history in head and neck. Mandibular gingival carcinoma was more likely to have an increased neck lymph node metastasis than maxillary gingival carcinoma (P = 0.001), but there was no significant difference in 5-year overall survival between these two groups (P = 0.828). The main therapy for gingiva carcinoma is surgery or comprehensive treatment based on surgery.

Conclusions

Second primary gingival squamous cell carcinoma after radiotherapy demonstrated particular clinicopathologic features, such as prominent sites and TNM stage; and there was statistically significant difference in 5-year overall survival and prognosis between second primary gingival carcinoma after radiotherapy and sporadic gingival carcinoma.

https://ift.tt/2MJmZwB

Survival impact and toxicity of metformin in head and neck cancer: An analysis of the SEER-Medicare dataset

Publication date: September 2018

Source: Oral Oncology, Volume 84

Author(s): William A. Stokes, Megan Eguchi, Arya Amini, Mohammad K. Hararah, Ding Ding, Jessica D. McDermott, Cathy J. Bradley, Sana D. Karam

Abstract

Objectives

Recent preclinical research has renewed interest in the interplay between glucose dysregulation and cancer. Metformin holds promise as an adjunctive antineoplastic agent in head and neck cancer (HNC). We aimed to explore the impact of metformin in HNC patients from a population-based dataset.

Patients & Methods

Patients diagnosed with HNC from 2008 to 2011 were identified from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked dataset and categorized into three groups: non-diabetics (nD), diabetics not taking metformin (DnM), and diabetics taking metformin (D + M). Overall survival (OS) and cancer-specific survival (CSS) were compared between groups using Kaplan-Meier and Cox regression controlling for sociodemographic, clinical, and treatment covariates. The incidence of toxicities associated with HNC therapy was compared among groups using χ² analysis.

Results

Among 1646 patients, there were 1144 nD, 378 DnM, and 124 D + M. 2-year OS rates was 65.6% for nD, 57.7% for DnM, and 73.4% for D + M by Kaplan-Meier (p < 0.01), and corresponding rates of 2-year CSS were 73.7%, 66.1%, and 88.8% (p < 0.01), respectively. On Cox multivariable analysis, OS among the three groups did not significantly differ; however, CSS was significantly worse among both nD versus DnM as compared to D + M. Toxicity rates were not significantly increased among D + M.

Conclusion

HNC patients with diabetes taking metformin experience improved CSS. Prospective investigation of the addition of metformin to standard-of-care HNC therapy is warranted.

https://ift.tt/2MqFLf4

Oral tongue carcinoma among young patients: An analysis of risk factors and survival

Publication date: September 2018

Source: Oral Oncology, Volume 84

Author(s): Douglas R. Farquhar, April M. Tanner, Maheer M. Masood, Sagar R. Patel, Trevor G. Hackman, Andrew F. Olshan, Angela L. Mazul, Jose P. Zevallos

Abstract

Introduction

The incidence of oral tongue squamous cell carcinoma (OTSCC) in younger adults has rapidly increased over the past two decades. While tobacco and alcohol use may be less likely to cause these tumors, it remains controversial whether differences also exist in their prognosis. Our aim is to examine the risk factors for cancer among young (<45 years old) OTSCC patients at our institution, and to compare their recurrence and survival with older patients in a matched cohort.

Materials and methods

All OTSCC patients seen at our institution between 2000 and 2015 were reviewed. Patients under 45 who with sufficient treatment information were matched 1:1 on race, T-stage, and N-stage with patients 45 and older. Three-year recurrence and survival were determined in stratified and adjusted Cox regression models.

Results

Of 397 OTSCC patients were seen at our institution, 117 (29%) were less than 45 years old. Younger patients were significantly more likely to be female, (50% vs. 39%; p = 0.04) and to abstain from tobacco (51% vs. 39%; p < 0.01). Young patients in the matched cohort were significantly more likely to have a recurrence (HR 3.9 95% CI 1.4–10.5). There was no difference in overall survival.

Conclusion

Younger OTSCC patients in a matched cohort were more likely to recur within 3 years, although there was no difference in overall mortality. Differences in risk factors and recurrence between older and younger patients suggest that some cancer among younger patients may be distinct from traditional OTSCC.

https://ift.tt/2MJmRND

Radiation-induced nasopharyngeal ulcers after intensity modulated radiotherapy in primary nasopharyngeal carcinoma patients: A dose-volume-outcome analysis

Publication date: September 2018

Source: Oral Oncology, Volume 84

Author(s): Yujiao Li, Tingting Xu, Wei Qian, Xueguan Lu, Chaosu Hu

Abstract

Objective

This is a retrospective dose-volume-outcome analysis of radiation-induced nasopharyngeal ulcers after intensity modulated radiotherapy in primary nasopharyngeal carcinoma (NPC) patients, with the aim to determine how the radiation doses to nasopharynx influence the occurence of radiation-induced nasopharyngeal ulcer (RINU) and predict the most serious complication of radiotherapy for NPC.

Methods

Data from 6023 consecutive and nonselected histologically proven primary NPC patients treated with definitive IMRT were collected and 25 patients were diagnosed with nasopharyngeal ulcer and met the diagnosis criteria of RINU. Predictive dosimetric factors were identified by using univariate and multivariate analysis.

Results

Paired samples t-tests showed all dosimetric factors were significantly correlated with the development of RINU, and these factors were associated with each other closely. (P < 0.001) Multivariate analysis revealed D3cc (dose to 3 mL of the nasopharynx) was an independent predictor for RINU (P = 0.01); the area under the ROC curve for D3cc was 0.87 (P < 0.001), and the cutoff point 73.67 Gy may be the dose tolerance of the nasopharynx. The primary tumor location, distribution of high dose regions and the location of RINU were consistent.

Conclusions

The study indicates that radiation-induced nasopharyngeal ulcer is consistent with primary tumor location and 'hottest spots' regions and we suggest a D3cc limit of 73.67 Gy for the nasopharynx. Physicians should be cautious of such 'hot spots' in the nasopharynxduring IMRT treatment plan optimization, review and approval to avoid the most serious complication of radiotherapy for NPC.

https://ift.tt/2P88WlV

Clarithromycin as the empiric antibiotic therapy for medication-related osteonecrosis of the jaw in multiple myeloma patients

Publication date: September 2018

Source: Oral Oncology, Volume 84

Author(s): Yehuda Zadik

Abstract

About half of individuals diagnosed with medication-related osteonecrosis of the jaw (MRONJ) are multiple myeloma (MM) patients, and most are treated using antibiotics for long-term courses. The penicillin group is recommended as the empiric drug of choice, and quinolones, metronidazole, clindamycin, doxycycline, and erythromycin as alternatives. This paper suggests the macrolide clarithromycin as the empiric antibiotic therapy of MRONJ in MM patients because of its better pharmacologic properties in comparison to erythromycin, and the beneficial effect of this agent in MM. This empiric antibiotic regimen should be later adjusted according to the response and findings of the microbial cultures.

https://ift.tt/2MJu4x1

Clinical outcomes with therapies for previously treated recurrent/metastatic head-and-neck squamous cell carcinoma (R/M HNSCC): A systematic literature review

Publication date: September 2018

Source: Oral Oncology, Volume 84

Author(s): Mallika Lala, Diana Chirovsky, Jonathan D. Cheng, Kapil Mayawala

Abstract

Objectives

A wide range of objective response rates (ORRs: 0–53%) among available treatments in patients with R/M HNSCC with progression on or after platinum-based chemotherapy (PBT) renders treatment selection a challenge. This systematic literature review (SLR) was intended to aid clinical decision-making by classifying historical studies to accurately characterize the response in second-line (progression on/after platinum-based therapy), and third-line (progression on/after platinum and cetuximab/other drug) settings.

Methods

SLR was performed to characterize the ORR, duration of response (DOR), progression-free survival (PFS) and overall survival (OS) with therapies recommended by the National Comprehensive Cancer Network (NCCN) guidelines. Clinical trials published in English between January 1, 1985, and September 30, 2016 were identified by searching the PubMed (Medline), Cochrane, and Embase databases.

Results

The SLR identified 34 key studies in second-line R/M HNSCC patients, and one of these included a third-line patient cohort. However, several studies did not enrol a strictly second-line population. Response in a true second-line setting was elucidated by categorizing the studies using a novel framework defined according to the extent to which enrolled patients were second-line. Only seven studies were strictly second-line, with an estimated pooled ORR of 4% (95% CI = 2–8%; N = 414) for methotrexate and 11% (95% CI = 7–15%; N = 235) for cetuximab, and a reported ORR of 14% (N = 78) from a single study of paclitaxel. The median DOR was limited with cetuximab (∼4 months) and paclitaxel (∼7 months), and not reported for methotrexate. Median PFS or time to progression (TTP) ranged from 1.7 to 3.5 months, and median OS from 4.3 to 6.7 months. The ORR in the only third-line study was 0% (95% CI = 0–7; N = 53) for the platinum + cetuximab combination.

Conclusion

These findings emphasize the historically bleak prognoses in patients with R/M HNSCC following PBT progression. Anti-PD-1 therapies, namely pembrolizumab and nivolumab, represent novel treatment options that may improve clinical outcomes.

https://ift.tt/2P7Y0o3

Cellular-based immunotherapy in Epstein-Barr virus induced nasopharyngeal cancer

Publication date: September 2018

Source: Oral Oncology, Volume 84

Author(s): Andrea Zhe Ern Lee, Louise Soo Yee Tan, Chwee Ming Lim

Abstract

Undifferentiated Nasopharyngeal carcinoma (NPC) is ubiquitously identified with the Epstein-Barr virus (EBV), making this cancer a suitable candidate for cellular-based immunotherapy (CBI) due to its expression of potentially targetable tumor-associated viral antigens. Various preclinical and clinical studies have explored the use of cytotoxic T cells (CTLs), tumor-infiltrating lymphocytes (TILs), natural killer (NK) cells, and dendritic cells (DCs) in the treatment of both refractory and locally advanced NPC with some success. Notably, immune-mediated antitumor effects were observed even in heavily pre-treated NPC patients, suggesting potential clinical benefit of CBI in this group of patients. These immune anti-tumor effects may be even more clinically evident when used as a first-line treatment, since there may not be an intense immunosuppressive environment which is typically encountered in refractory cancer patients. Additionally, CBI may exert an effect in priming the immune system and diminishing the cancer's acquired resistance to exert a more robust response to previously failed chemotherapy. Although these results are encouraging, further refinements of clinical protocols to boost anti-tumor response and benefit a larger subset of patients proved necessary. Herein, we aim to review the rational of developing CBI in EBV-induced NPC and summarize its current applications in clinical studies.

https://ift.tt/2MJmC5b

Accuracy of computer-assisted surgery in mandibular reconstruction: A systematic review

Publication date: September 2018

Source: Oral Oncology, Volume 84

Author(s): Gustaaf J.C. van Baar, Tymour Forouzanfar, Niels P.T.J. Liberton, Henri A.H. Winters, Frank K.J. Leusink

Abstract

Computer-assisted surgery (CAS) for mandibular reconstruction was developed to improve conventional treatment methods. In the past years, many different software programs have entered the market, offering numerous approaches for preoperative planning and postoperative evaluation of the CAS process of mandibular reconstruction. In this systematic review, we reviewed planning and evaluation methods in studies that quantitatively assessed accuracy of mandibular reconstruction performed with CAS. We included 42 studies describing 413 mandibular reconstructions planned and evaluated using CAS. The commonest software was Proplan/Surgicase CMF (55%). In most cases, the postoperative virtual 3-dimensional model was compared to the preoperative 3-dimensional model, revised to the virtual plan (64%). The commonest landmark for accuracy measurements was the condyle (54%). Accuracy deviations ranged between 0 mm and 12.5 mm and between 0.9° and 17.5°. Because of a lack of uniformity in planning (e.g., image acquisition, mandibular resection size) and evaluation methodologies, the ability to compare postoperative outcomes was limited; meta-analysis was not performed. A practical and simple guideline for standardizing planning and evaluation methods needs to be considered to allow valid comparisons of postoperative results and facilitate meta-analysis in the future.

https://ift.tt/2P6F2hO

Salivary exosomes as potential biomarkers in cancer

Publication date: September 2018

Source: Oral Oncology, Volume 84

Author(s): Soumyalekshmi Nair, Kai Dun Tang, Liz Kenny, Chamindie Punyadeera

Abstract

Over the past decade, there has been emerging research in the field of extracellular vesicles, especially those originating from endosomes, referred to as 'exosomes. Exosomes are membrane-bound nanovesicles secreted by most cell types upon fusion of multivesicular bodies (MVBs) to the cell plasma membrane. These vesicles are present in almost all body fluids such as blood, urine, saliva, breast milk, cerebrospinal and peritoneal fluids. Exosomes participate in intercellular communication by transferring the biologically active molecules like proteins, nucleic acids, and lipids to neighboring cells. Exosomes are enriched in the tumour microenvironment and growing evidence demonstrates that exosomes mediate cancer progression and metastasis. Given the important biological role played by these nanovesicles in cancer pathogenesis, these can be used as ideal non-invasive biomarkers in detecting and monitoring tumours as well as therapeutic targets. The scope of the current review is to provide an overview of exosomes with a special focus on salivary exosomes as potential biomarkers in head and neck cancers.

https://ift.tt/2BkkBv5

Editorial Board/Aims & Scope

Publication date: September 2018

Source: Oral Oncology, Volume 84

Author(s):

https://ift.tt/2P7nke0

Versatility of dermal regeneration templates in the treatment of burn sequelae

Abstract

Background

The management of burn sequelae is a major challenge for every plastic surgeon. The benefits of Integra® Dermal Regeneration Template in the management of burn injuries have been well documented but there is still a paucity of data regarding its use in reconstructive procedures. The aim of this study is to evaluate its effectiveness in the surgical treatment of post-burn scars.

Methods

We performed a retrospective review of burn patients with major burn sequelae treated with Integra® at our hospital during 2016–2017 period. A modified Vancouver Scar Scale (mVSS) was used to provide a more objective measurement of burn scars. All patients were submitted to a two-stage procedure. The first one consisted in complete excision of the lesions and implantation of Integra and the second one in resurfacing the neodermis with a split thickness skin graft.

Results

The average wound size covered with Integra was 741.6 cm². Follow-up ranged from 9 to 16 months. There were no early complications. In all cases, we achieved satisfactory cosmetic results with significant improvements in functionality and quality of life. mVSS score post-op was significantly lower than pre-op in all patients.

Conclusions

Our results suggest that Integra is a very versatile tool for the treatment of burn sequelae. It yields good cosmetic and functional results in most cases with very little donor site morbidity. We believe that Integra should be viewed as one of the best current options for reconstructive procedures in burn patients.

Level of Evidence: Level IV, therapeutic study.

https://ift.tt/2KQS3c2

Comparative study of the direct black removal by Fe, Cu, and Fe/Cu nanoparticles

Abstract

In this study, direct black dye removal was investigated using iron nanoparticles (Fe NPs), copper (Cu NPs), and Fe/Cu (Fe/Cu NPs). NPs were characterized by transmission electron microscopy (TEM) and X-ray diffraction (XRD). Using a dose of 0.25 g L⁻¹ of Fe, Cu, and Fe/Cu NPs, a degradation efficiency of 13, 26, and 43% respectively was obtained. For the 1.00 g L⁻¹ dose, the efficiency increased to 100, 43, and 100%, respectively. Studies in anoxic and oxic conditions presented degradation rates, respectively, of 100 and 30% for Fe NPs, 90 and 50% for Fe/Cu NPs, and 40% in both reactions for Cu NPs, indicating that the mechanism of dye degradation by NPs is predominantly reducing under the conditions studied. The addition of EDTA decreased the dye removal rate for Fe, Cu, and Fe/Cu NPs at 27, 10, and 35%, respectively. In addition to the degradation, the adsorption phenomena of the by-products formed during the reaction were confirmed by the Fourier transform infrared (FTIR) analysis and verified by the desorption tests. Fe and Fe/Cu NPs showed the highest efficiency in direct black dye reductive degradation and adsorption of by-products, removing 100% of the dye at a dose of 1 g L⁻¹ within 10 min of reaction.

Graphical abstracts

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https://ift.tt/2KPONNW

Multiple myeloma concealed by adrenal Cushing syndrome: a case report and review of the literature

Cushing syndrome coexisting with multiple myeloma has been previously described in a few reports. Overlapping clinical manifestations can lead to misdiagnoses.

https://ift.tt/2vC8nsj

Timing of infections in patients with primary immunodeficiencies treated with intravenous immunoglobulin (IVIg)

Patients with common variable immune deficiency and X-linked agammaglobulinemia are unable to produce their own antibodies thus leading to a higher incidence of recurrent infections, particularly those involvi...

https://ift.tt/2MFJbYf

Interleukin‐2 Can Cure Kidney Cancer

https://ift.tt/2MqnQoO

Durable Response to Nivolumab in a Pediatric Patient with Refractory Glioblastoma and Constitutional Biallelic Mismatch Repair Deficiency

AbstractPrimary brain tumors are a leading cause of cancer‐related morbidity and mortality in children. Glioblastoma (GBM) is a high‐grade astrocytoma that occurs in both children and adults and is associated with a poor prognosis. Despite extensive study in recent years, the clinical management of these tumors has remained largely unchanged, consisting of surgical resection, conventional chemotherapy, and radiotherapy. Although the etiology and genomic drivers in GBM are diverse, constitutional mismatch repair‐deficiency (CMMRD) syndrome is a rare, recessively inherited disease with a predisposition to gliomagenesis. CMMRD results from biallelic mutations in one of the mismatch repair genes including mutL homolog 1 (MLH1), mutS homolog 2 (MSH2), mutS homolog 6 (MSH6), and post‐meiotic segregation increased 2 (PMS2). In this report, we present the case of a 5‐year‐old female with GBM and CMMRD due to an MSH6 homozygous c.1883G>A mutation, who continues to experience an exceptional and durable response (9 months) to the immune checkpoint inhibitor (ICPI) nivolumab. Our patient presented with acute neurologic decline and increased intracranial pressure. Neuroimaging studies revealed a large left frontoparietal mass requiring neurosurgical decompression and resection. Histopathologic analyses resulted in a diagnosis of de novo GBM that was BRAF wild type and negative for programmed death‐ligand 1 protein expression. She received standard‐of‐care treatment with surgery, radiation therapy, and temozolomide; however, the tumor recurred 3 months after the initial diagnosis. Molecular analyses of tumor and blood tissues revealed an MSH6 homozygous c.1883G>A mutation consistent with CMMRD. Given her CMMRD status, she was treated with nivolumab (3 mg/kg doses every 2 weeks for 36 weeks) and showed a 60% reduction in tumor size, improved clinical symptoms, and an ongoing durable response lasting 10 months to date. Our study highlights a durable response to the ICPI nivolumab in a pediatric patient with recurrent/refractory CMMRD‐associated GBM. We show that incorporating genomic and/or molecular testing for CMMRD into routine pediatric oncology clinical care can identify a subset of patients likely to benefit from ICPI.Key Points. Constitutional mismatch repair‐deficiency (CMMRD) syndrome, alternatively known as biallelic mismatch repair deficiency syndrome, occurs in subset of pediatric cancer patients, including those with primary brain tumors.Patients from Arab and other developing countries are predicted to have higher incidence of CMMRD due to high prevalence of consanguinity.Integration of molecular and/or genomic testing into routine clinical care for pediatric cancer patients is important to identify patients with CMMRD syndrome.Patient with CMMRD‐associated cancers may show increased responsiveness to immune checkpoint inhibitors.To the authors' knowledge, this is the first report in the Arab world of a durable response to immune checkpoint inhibitors in a pediatric glioblastoma patient.

https://ift.tt/2MFHYjF

Dramatic Response to Concurrent Anti‐PD‐1 Therapy and Radiation in Resistant Tumors with Sarcomatoid Differentiation

AbstractA substantial fraction of patients demonstrate resistance to immune checkpoint inhibitors, which limits their use. Use of radiation concurrently with checkpoint inhibitors has been shown to boost immune responsiveness, resulting in significant tumor regression in patients with metastatic melanoma. However, it is unknown whether radiation could play a role in reversing the inherent resistance to checkpoint inhibition in certain tumor types. Most trials testing this concurrent approach exclude such modestly responsive tumors and pursue checkpoint inhibition using anti‐cytotoxic T‐lymphocyte‐associated protein 4 antibody (anti‐CTLA‐4, ipilimumab). The efficacy of anti‐programmed‐death‐1 (anti‐PD‐1) therapy when used concurrently with radiation is less known but remains an attractive option due to less autoimmune toxicity compared with CTLA‐4 inhibition. In this first reported experience, we have safely and effectively combined anti‐PD‐1 therapy (nivolumab) concurrently with radiation to treat two patients with relapsed sarcomatoid renal carcinoma and heavily pretreated pleomorphic sarcoma. Both patients experienced a dramatic response that was durable.

https://ift.tt/2nEmw3z

Prospective Assessment of Clinical Risk Factors and Biomarkers of Hypercoagulability for the Identification of Patients with Lung Adenocarcinoma at Risk for Cancer‐Associated Thrombosis: The Observational ROADMAP‐CAT Study

AbstractBackground.The aim of this prospective study was to identify the most clinically relevant hypercoagulability biomarkers in lung adenocarcinoma patients for elaboration of an improved risk assessment model (RAM) for venous thromboembolism (VTE).Subjects, Materials, and Methods.One hundred fifty ambulatory patients with lung adenocarcinoma were prospectively enrolled. Thrombin generation, procoagulant phospholipid‐dependent clotting time (Procoag‐PPL), tissue factor activity (TFa), factor VIIa (FVIIa), factor V (FV), antithrombin, D‐Dimers, P‐selectin, and heparanase levels were assessed in platelet‐poor plasma at inclusion (baseline) and at the end of the third chemotherapy cycle (third chemotherapy). Cox regression analysis was used to identify independent VTE predictors.Results.At baseline, patients had significantly attenuated thrombin generation, shorter Procoag‐PPL, higher levels of TFa, D‐Dimers, and heparanase, and lower levels of FVIIa and P‐selectin, compared with controls. A significant increase in Procoag‐PPL, FV, and FVIIa and a decrease of P‐selectin levels were observed between baseline and third chemotherapy. Hospitalization within the last 3 months prior to assessment, time since cancer diagnosis less than 6 months, mean rate index (MRI) of thrombin generation, and Procoag‐PPL were independently associated with symptomatic VTE. Accordingly, a prediction model including Procoag‐PPL and MRI showed significant discriminating capacity (area under the curve: 0.84).Conclusion.Ambulatory patients with lung adenocarcinoma may display pronounced blood hypercoagulability due to decreased Procoag‐PPL, increased endothelial cell activation, and increased degradation of fibrin. Incorporation of Procoag‐PPL and MRI of thrombin generation may improve the accuracy of a VTE‐RAM in the above setting.Implications for Practice.The prospective ROADMAP‐CAT study identified two biomarkers of hypercoagulability, the procoagulant phospholipid‐dependent clotting time (Procoag‐PPL) and the mean rate index (MRI) of the propagation phase of thrombin generation assessed with the Calibrated Automated Thrombinoscope, as being clinically relevant for the classification of ambulatory patients with lung adenocarcinoma receiving a maximum of one cycle of chemotherapy into high and intermediate/low risk for venous thromboembolism. Measurement of Procoag‐PPL and MRI within 1 month after the administration of the first chemotherapy cycle provides significant accuracy of the assessment. Association of the Procoag‐PPL and MRI with the clinical risk assessment model for cancer‐associated thrombosis in ambulatory patients with solid tumors (COMPASS‐CAT RAM) further improved its accuracy.

https://ift.tt/2MJbZ27

The Evolving Treatment Algorithm for Advanced Neuroendocrine Neoplasms: Diversity and Commonalities Across Tumor Types

AbstractNeuroendocrine neoplasms (NEN) most commonly arise in the gastroenteropancreatic system and lungs. The incidence of NEN is increasing globally, with improved diagnostic techniques identifying patients with early‐stage disease. The number of approved therapies for the treatment of advanced disease has grown substantially in the past decade. The treatment algorithm for advanced NEN is evolving from one that is directed by primary site–specific classification to one that is directed by biologic classification, as evidenced by overlapping systemic treatments across the primary tumor sites. Commonalities in biologic characteristics across primary sites include functional status, differentiation status, grade, level of somatostatin receptor expression, and genetic alterations. In this review, we discuss current clinical evidence and available therapies for the treatment of advanced NEN and highlight the need for prospective trials in patients with well‐differentiated, high‐grade NEN.Implications for Practice.This review raises awareness of the evolution of the treatment algorithm for advanced neuroendocrine neoplasms (NEN) from one that is directed by primary tumor site–specific classification to one that is directed by biologic classification. In addition, this review promotes understanding of the new pathologic category of well‐differentiated G3 pancreatic neuroendocrine tumors and highlights the need for prospective trials in this patient population, for whom there is currently no standard of care. This review further provides a conceptual treatment schematic that categorizes the recommendations for systemic treatments for advanced disease by biologic classification, including the new and established categories of NEN.

https://ift.tt/2nCFqYU

Biomarkers of dementia in obstructive sleep apnea

Epidemiologic and mechanistic evidence is increasingly supporting the notion that obstructive sleep apnea is a risk factor for dementia. Hence, the identification of patients at risk of cognitive decline due to obstructive sleep apnea may significantly improve preventive strategies and treatment decision-making. Cerebrospinal fluid and blood biomarkers obtained through genomic, proteomic and metabolomic approaches are improving the ability to predict incident dementia. Therefore, fluid biomarkers have the potential to predict vulnerability to neurodegeneration in individuals with obstructive sleep apnea, as well as deepen our understanding of pathophysiological processes linking obstructive sleep apnea and dementia.

https://ift.tt/2nDtB4K

Fate of febantel in the aquatic environment—the role of abiotic elimination processes

Abstract

Febantel is widely used anthelmintic drug active against a range of gastrointestinal parasites in animals. Despite the fact that it has been detected in the aquatic environment, there is no information on its environmental fate. Therefore, abiotic elimination processes of febantel in the aquatic environment have been studied. The results of direct and indirect photodegradation experiments showed that febantel was persistent against solar radiation. Kinetics of hydrolytic elimination was pH and temperature dependent with half-lives in the range from 210 min to 99 days. Febantel metabolites, fenbendazole and fenbendazole sulfone, were found as major degradation products using high-resolution mass spectrometry. The proposed hydrolytic degradation pathway consisted of the base catalyzed hydrolysis followed by consecutive oxidative cyclization to the five-membered ring of the benzo-imidazole derivative. Aquatic toxicity of febantel and its hydrolytic mixture were evaluated toward the luminescence bacteria Vibrio fischeri. Investigation of febantel sorption onto river sediments showed that the best agreement was obtained with the linear model (R² > 0.99), while the rate of sorption is the best described with the kinetic model of pseudo-second order. The organic carbon-normalized sorption coefficient, K_OC, ranged from 1490 to 3894 L kg⁻¹ for five sediment samples. The results of this research demonstrate that febantel persist in the natural waters and potentially could travel far from the source.

https://ift.tt/2vGEib9

Correction of myopic astigmatism by small incision lenticule extraction: does laterality matter?

Abstract

To evaluate the outcome after astigmatic correction of small incision lenticule extraction (SMILE) and to compare the refractive results of right eyes with left eyes. Patients who underwent SMILE surgery in our clinic between 2014 and 2016 (Visumax, Carl Zeiss Meditec, Germany) were retrospectively reviewed. Preoperative and postoperative manifest refractions and corrected and uncorrected visual acuities were evaluated and changes in refractive astigmatism were evaluated by vector analysis. One hundred twenty-one eyes from 82 patients with myopic astigmatism were included. The mean preoperative spherical equivalent was − 6 ± 1.7 (range from − 9.50 to − 1.25) D and the mean cylinderical power was − 1.5 ± 0.6 (range from − 3.75 to − 1.00) D. Postoperatively 71.8% of eyes had < 0.50 D cylinder magnitude. Vector analysis results based on laterality revealed that correction index was 0.87 ± 0.3 for left eyes and 0.72 ± 0.3 for right eyes (p 0.02). This study revealed that SMILE has favorable astigmatic correction affect but left eyes have better outcomes than right eyes.

https://ift.tt/2MHtgsm

Adverse effect of tocilizumab treatment on split thickness skin graft—a case report

Abstract

Tocilizumab is a biological immunosuppressive drug used in the treatment of psoriasis arthritis. It works by blocking the interleukin 6 receptor and therefor blocking the immune response caused by IL-6 which plays an important role in arthritis. Tocilizumab is commonly used in RA patients who either have experienced insufficient effect of other treatment options or who have had unacceptable side effects from previous treatment. With this case report, we would like to raise awareness of a potentially previously unheard of adverse effect of tocilizumab treatment on split thickness skin graft (STSG). We present a case of a 61-year-old man, treated with tocilizumab for severe poly-articular, erosive psoriasis arthritis. He was diagnosed with BCC on the scalp and underwent excision followed by STSG with no complications. The patient experienced graft loss after commencing tocilizumab treatment days to weeks post grafting on numerous occasions. We find this possible adverse effect of tocilizumab on skin grafts to be of great importance to report as it is not previously mentioned in any literature. We hope that this case report will increase the awareness of this possible adverse effect on STSG in patients treated with tocilizumab (TCZ). As the patient is dependent on arthritis symptoms to be well controlled, it is of great importance to both medical and surgical teams responsible for treatment to be able to collaborate to plan best treatment, timing, and strategy.Level of Evidence: Level V, risk / prognostic study

Level of Evidence: Level V, risk / prognostic study.

https://ift.tt/2w5ppyu

Salivary antioxidant capacity of children with severe early childhood caries before and after complete dental rehabilitation

Publication date: Available online 13 August 2018

Source: Archives of Oral Biology

Author(s): Ghazi S. AlAnazi, Sharat Chandra Pani, Hana J. AlKabbaz

Abstract

Objective

There is a need to determine whether total antioxidant capacity (TAC) in severe early childhood caries (S-ECC) is an indicator of inflammatory response to the lesion or a marker of the disease. This study compared TAC levels in children with ECC before and after dental treatment and compared the results with those of caries-free children.

Design

Prospective study.

Setting

A teaching hospital

Patient selection

Salivary samples were obtained from 20 children aged 5 years and diagnosed with S-ECC, and 20 age- and sex-matched controls.

Intervention details

Complete dental rehabilitation under general anesthesia was performed on the children with S-ECC, and follow-up salivary samples were obtained one week and three months postoperatively. TAC was measured using a commercially available Oxygen Radical Absorbance Antioxidant Assay measurement kit (Zen-Bio ORAC™, AMS Biotechnology, Abington, UK).

Outcome measures

Differences between children with and without dental caries were tested using the Mann-Whitney U test; differences before and after dental treatment were analyzed using Friedman test followed by Wilcoxon sign-rank test with Bonferroni correction to compensate for multiple comparisons.

Results

Median TAC (1.54 mcg/L, CI 1.15-1.92) of the control group was significantly lower than that of the treated group prior to treatment (p = 0.003). Treatment of the dental lesions significantly reduced TAC of the treated group, and no significant differences were observed between the test and control groups at either one week (p = 0.076) recall or three-month recall (p = 0.096). TAC in children posttreatment was significantly reduced compared to their pretreatment values (p < 0.001).

Conclusion

Total antioxidant capacity in the saliva of children with severe early childhood caries undergoes significant reduction following treatment of the carious lesions.

https://ift.tt/2MLHTef

Nail apparatus melanoma: Experience of 10 years in a single institution

Background: Nail apparatus melanoma (NAM) is rare. The higher mortality reported in the literature, compared with melanoma on other sites is probably due to advanced disease associated with a delay in diagnosis and treatment.

https://ift.tt/2vGgsvR

Comparison of noninsulated microneedle and noninvasive fractional radiofrequency devices in an animal model of skin rejuvenation

Background: Radiofrequency (RF) devices based on various delivery systems are clinically effective in treating many dermatologic conditions. However, there are few histologic studies identifying the therapeutic mechanism and its effect.

https://ift.tt/2B883Xm

Sodium thiosulfate injection dissolves calcium hydroxylapatite particles: An animal study

Background and objective: Treatment of certain dermal filler–related serious AEs (e.g., vascular occlusion, granulomatous reactions) may include removal of the injected material. Hyaluronidase can be used to degrade hyaluronic acid fillers; however, no agents have yet been shown to fully dissolve calcium hydroxylapatite (CaHA; Merz North America) filler after placement. Sodium thiosulfate (STS) has been shown to decrease calcium mineral deposits associated with calciphylaxis, calcific uremic arteriolopathy, and kidney stones.

https://ift.tt/2MgMXev

Topical oxymetazoline hydrochloride 1.0% effectively reduces persistent facial erythema of rosacea on day 1

Introduction: Persistent facial erythema is a bothersome, therapeutically challenging feature of rosacea; therapies with clear efficacy at treatment onset are needed. In 2 identically designed, phase 3 pivotal, randomized, multicenter, double-blind, parallel-group, vehicle-controlled, 29-day REVEAL trials, topical oxymetazoline cream 1.0% significantly reduced moderate to severe persistent facial erythema of rosacea. A post hoc analysis of pooled data from both trials assessed erythema reduction on day 1.

https://ift.tt/2B87Q6w

Widespread skin necrosis secondary to gemcitabine

Cutaneous side-effects are relatively common in chemotherapy but vary in frequency and severity depending on the medication, dose, duration, pharmacokinetics, and pharmacodynamics. Gemcitabine, a pyrimidine nucleoside analogue, is an oncologic agent used in the treatment of cutaneous T-cell lymphoma (CTCL). Common dermatologic reactions associated with gemcitabine include alopecia, mild skin rash, and mucositis. Rare reports of other cutaneous reactions include lower extremity skin necrosis, lower extremity pseudocellulitis, and scleroderma-like changes.

https://ift.tt/2MfDJiO

The antiinflammatory properties of ivermectin and brimonidine in the treatment of papulopustular rosacea

Introduction: The pathophysiology of papulopustular rosacea (PPR) is not fully understood; however, there is increasing evidence that immune and inflammatory responses play an important role in the persistent and perilesional erythema of PPR. Multiple trials have demonstrated the efficacy of ivermectin 1% cream (IVM) and brimonidine 0.33% gel (BR) for treatment of the inflammatory lesions and erythema of PPR, respectively. Two recent studies suggest a promising synergy between IVM and BR in PPR.

https://ift.tt/2wdsMn9

Role of activated oligoadenylatesynthetase–ribonuclease L pathways as a novel therapeutic target in psoriasis

Psoriasis (Pso) is predominantly an immune-mediated disease characterized by aberrant epidermal differentiation, surface scale formation, and marked cutaneous inflammation. Immune pathways activated in Pso include amplification of background immune circuits or induction of certain proinflammatory signaling pathways, otherwise latent in normal human skin. These changes include selective induction of antiviral innate immune response genes, differential expression of pathogen associated molecular pattern (PAMP) receptors, cell signaling and cell growth control pathways.

https://ift.tt/2vIhRlQ

Unveiling the hidden: The eclipsed effect of nondermatophyte infection and mixed-infection onychomycosis

Background: Mixed onychomycosis infections with dermatophytes (DMPs) and nondermatophytes (NDMs) have become more common. While the diagnosis of DMPs onychomycosis is based on mycologic laboratory, that of the NDMs onychomycosis still has several other criteria. Moreover, there had been a few studies about the relationship between fungal feet and nail infection.

https://ift.tt/2w3rA5z

Successful vismodegib debulking of a giant basal cell carcinoma of the umbilicus

Introduction: Basal cell carcinoma (BCC) of the umbilicus is an exceptional subtype of BCC with potential slowly progressing deeply invasive and wide growth pattern. Vismodegib is a hedgehog pathway inhibitor indicated for the treatment of large, nonoperable or metastatic BCC.

https://ift.tt/2Mi5Huo

Secukinumab shows sustained efficacy in difficult-to-treat palmoplantar, nail, and scalp psoriasis: Long-term results from three phase III placebo-controlled randomized trials

Introduction: Psoriasis is a chronic, autoimmune inflammatory condition that can affect different parts of the body including scalp, nails, palms and soles. Psoriasis localized in these areas remains difficult-to-treat, and can result in significant physical and psychosocial disability. Secukinumab, a fully human monoclonal antibody that selectively neutralizes IL-17A, has been shown to have significant efficacy in the treatment of moderate to severe plaque psoriasis and psoriatic arthritis, demonstrating a rapid onset of action and sustained responses up to 5 years with a favorable safety profile.

https://ift.tt/2B4IGFQ

Venous treatment of lipodermatosclerosis to improve ambulatory function

Introduction: The manifestations of chronic venous insufficiency (CVI), particularly lipodermatosclerosis (LDS) and venous ulcers, can be devastating to patients as it can adversely affect quality of life, and carry significant psychosocial burden.

https://ift.tt/2MgyKOA

Treatment patterns among psoriasis patients newly initiated on etanercept or apremilast in a dermatology specialty electronic medical record (EMR) database

Background: Plaque psoriasis (PSO) is a common inflammatory skin disorder that can require chronic treatment. Etanercept (ETN) is a self-injectable biologic indicated to treat moderate-to-severe PSO. Apremilast (APR) is a nonbiologic oral therapy recently approved to treat moderate-to-severe PSO. We sought to examine the real-world treatment patterns of these agents.

https://ift.tt/2w3cGfJ

The use of silicone gel to enhance skin wound healing by secondary intention following tumor excision on the scalp and extremities: A descriptive study

Secondary intention (SI) healing is advantageous due to shorter surgical time and lower risk of damage to neighboring structures. It is therefore more tolerable in elderly patients with large wounds and is also indicated for lesions at high risk of recurrence as this facilitates closer surveillance. The main disadvantage however is the need for prolonged wound care. Although there is constant effort in adapting materials designed for chronic wounds as an adjunct to SI healing, a recent Cochrane review expounded on the lack of evidence to support any single method.

https://ift.tt/2McnJOk

Systematic review of placebo responses in randomized clinical trials of systemic therapy for atopic dermatitis

Introduction: Atopic dermatitis (AD) is associated with a variable disease severity and symptom burden and intermittent periods of disease remittance, all of which may contribute to increased placebo responses in randomized clinical trials (RCT). However, little is known about the rates and predictors of placebo responses in RCT of systemic therapy in AD.

https://ift.tt/2B9s0gB

Stem cell–conditioned media as a potential antiaging technology in skin care

Stem cell conditioned media (SCCM) is gaining increasing interest and is a promising prospect in the field of regenerative medicine. The beneficial effects of stem cell therapy on damaged tissue have shown to be accredited to their ability to secrete trophic factors, rather than their capacity to differentiate into the needed cells. Various studies on stem cell–derived conditioned media from various cell lines, such as adipose-derived stem cells and bone marrow–derived mesenchymal stem cells, have demonstrated tissue repair in various conditions that involved tissue damage.

https://ift.tt/2vIhjMO

Silver nanoparticles induce Egr-1–dependent psoriasin expression via the ERK and p38 pathways

Background: Silver nanoparticles (Ag-NPs) have been known to prevent bacterial infection and improve a cutaneous wound healing due to their antimicrobial activity. However, the mechanism of Ag-NPs' antimicrobial activity is poorly understood.

https://ift.tt/2w58iMZ

Scabies mimicking pityriasis rosea: Scabies surrepticius

Background: Scabies is a mite infestation caused by Sarcoptes scabiei that is common worldwide. Scabies is diagnosed based on history and exam of the patient, family, and close contacts. Diagnosis is confirmed based on the demonstration of mites, eggs, or mite feces from scrapings of the lesions. The classic presentation of scabies is extreme pruritus and burrows where the mite penetrates the skin and lays eggs. The most common locations of the lesions include the finger webs, flexor surfaces of the wrists, elbows, axillae, buttocks, and genitalia.

https://ift.tt/2vIgVxQ

Relationship between pruritus and quality of life in patients with atopic dermatitis treated with crisaborole

Introduction: Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by eczematous lesions and pruritus. Pruritus can lead to exacerbation of disease and reduced quality of life (QoL). Crisaborole ointment is a nonsteroidal phosphodiesterase 4 inhibitor for the treatment of mild to moderate AD. Compared with vehicle, use of crisaborole significantly reduced global disease severity and pruritus in 2 large, identically designed phase 3 clinical studies (AD-301: NCT02118766; AD-302: NCT02118792).

https://ift.tt/2B889hx

White fibrous papulosus of the neck

Introduction: Whıte fibrous papulosus of the neck (WFPON) is a newly defined clinical diagnosis by Shimizu in 1985. It consists of smooth, linear, 2-3 mm papules, independent of the hair follicles on the neck and back. White fibrous papulosus of the neck (WFPON) and pseudoxanthoma elastic-like dermal elastosis (PXE-PDE) are thought to be clinical variants of the same disease. For this reason, some authors have described WFPON, PXE-PDE and other noninflammatory middermal elastosis cases as "fibroelastolytic variants of primary skin aging." These clinical pictures are clinically similar to each other in many ways, but histologically they can be separated by intact elastic fibers and increased amounts of collagen in the midreticulary dermis.

https://ift.tt/2MbKqCi

Using intralesional methotrexate to treat recalcitrant cutaneous Crohn’s disease

Introduction: Cutaneous Crohn's disease (CD) is a rare, and not entirely understood, manifestation of CD that has various clinical presentations. Treatment is difficult, as methods detailed in several case reports over the decades demonstrate mixed efficacy in treating cutaneous CD. Few reports have shown promise using intralesional methotrexate. This case report describes a case of recalcitrant cutaneous CD that resolved with intralesional methotrexate.

https://ift.tt/2w5ylUu

Photobiomodulation promotes adenoviral gene transduction in auditory cells

Abstract

Gene therapy is the delivery of a therapeutic gene into target cells to treat disorders by replacing disease-causing mutated genes with healthy ones. Gene therapy of the inner ear has been recently described, with applications for sensorineural hearing loss. However, gene delivery to the location of the inner ear, and thus efficacy of therapy, is challenging. Photobiomodulation (PBM) with a low-level laser has been suggested to have a therapeutic effect and has the potential to augment gene therapy. To investigate whether PBM improves the rate of adenovirus (Ad)-mediated viral delivery, we compared low-level laser therapy (LLLT) and non-LLLT HEI-OC1 cells treated with an Ad viral vector carrying green fluorescent protein (GFP). Cultured HEI-OC1 cells were divided into six groups: no treatment control, LLLT only, 1 μL Ad-GFP, 3 μL Ad-GFP, 1 μL Ad-GFP + LLLT, and 3 μL Ad-GFP + LLLT (LLLT: 808 nm at 15 mW for 15 min). Cells were irradiated twice: at 2 h and again at 24 h. A nonparametric Mann-Whitney U test was used to statistically analyze differences between the control and treatment groups. The viral inoculations used in this study did not change the amount of viable HEI-OC1 cells (N = 4–8). The 1 μL Ad-GFP + LLLT and 3 μL Ad-GFP + LLLT groups showed an increased density of GFP-positive cells compared to 1 μL and 3 μL Ad-GFP cells (N = 5–8, 1 μL: p = 0.0159; 3 μL: p = 0.0168,). The quantitative analysis of the epifluorescence of the 1 μL Ad-GFP + LLLT, and 3 μL Ad-GFP + LLLT groups revealed increased GFP expression/cell compared to 1 μL and 3 μL Ad-GFP cells (N = 6–15, 1 μL: p = 0.0082; 3 μL: p = 0.0012). The RT-qPCR results were consistent (N = 4–5, p = 0.0159). These findings suggest that PBM may enhance the gene delivery of Ad-mediated viral transduction, and the combination of the two may be a promising tool for gene therapy for sensorineural hearing loss.

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What is labial hypertrophy and is it normal?

Each person's vagina and vulva are unique, and there is wide variation between people. Labial hypertrophy is when one or both vaginal lips, or labia, are larger than usual. This is normal and not a cause for concern. Some people choose to have surgery for cosmetic reasons. Learn more about vaginal hypertrophy here.

https://ift.tt/2vJ7z4K

What is labial hypertrophy and is it normal?

Each person's vagina and vulva are unique, and there is wide variation between people. Labial hypertrophy is when one or both vaginal lips, or labia, are larger than usual. This is normal and not a cause for concern. Some people choose to have surgery for cosmetic reasons. Learn more about vaginal hypertrophy here.

https://ift.tt/2vJ7z4K

Preoperative Tranexamic Acid for Treatment of Bleeding, Edema, and Ecchymosis in Patients Undergoing Rhinoplasty: A Systematic Review and Meta-analysis.

Related Articles

Preoperative Tranexamic Acid for Treatment of Bleeding, Edema, and Ecchymosis in Patients Undergoing Rhinoplasty: A Systematic Review and Meta-analysis.

JAMA Otolaryngol Head Neck Surg. 2018 Aug 09;:

Authors: de Vasconcellos SJA, do Nascimento-Júnior EM, de Aguiar Menezes MV, Tavares Mendes ML, de Souza Dantas R, Martins-Filho PRS

Abstract
Importance: Evidence has emerged on the efficacy of tranexamic acid to control blood loss and postoperative complications after rhinoplasty.
Objective: To investigate the results of tranexamic acid use to reduce intraoperative bleeding, postoperative eyelid edema, and periorbital ecchymosis in rhinoplasty.
Data Sources and Study Selection: For this systematic review of randomized clinical trials, searches were performed in PubMed, Cochrane Central Register of Controlled Trials, Web of Science, SCOPUS, Science Direct, Google Scholar, OpenThesis, and ClinicalTrials.gov from inception to December 23, 2017. Key words included tranexamic acid, rhinoplasty, and nasal surgical procedures. The following elements were used to define eligibility criteria: (1) population: patients undergoing rhinoplasty surgery; (2) intervention and controls: tranexamic acid vs placebo solution or no-treatment control group; (3) outcomes: intraoperative bleeding, postoperative eyelid edema and periorbital ecchymosis, and thromboembolic events; and (4) study type: randomized clinical trials.
Data Extraction and Synthesis: Two reviewers extracted data and assessed study quality according to the Cochrane guidelines for randomized clinical trials. Treatment effects were defined as weighted mean difference (WMD) and 95% CIs. The strength of evidence was analyzed using the Grading of Recommendations Assessment, Development, and Evaluation rating system.
Main Outcomes and Measures: Intraoperative bleeding, postoperative eyelid edema and periorbital ecchymosis. To calculate the effect sizes, means and SDs were obtained for each study group and outcome of interest.
Results: Five studies comprising 276 patients were included in the systematic review: 177 patients (64.1%) were women, and mean age was 26.8 (range, 16-42) years. Four studies comprising 246 patients estimated the amount in intraoperative bleeding as a primary outcome and were included in the meta-analysis. Eyelid edema and ecchymosis were evaluated as outcomes in 2 studies. Tranexamic acid was associated with reduced bleeding during rhinoplasty was found (WMD, -42.28 mL; 95% CI, -70.36 to -14.21 mL), with differences (P = .01) between oral (WMD, -61.70 mL; 95% CI, -83.02 to -40.39 mL; I2 = 0%) and intravenous (WMD, -23.88 mL; 95% CI, -45.19 to -2.58 mL; I2 = 56%) administration. Eyelid edema and ecchymosis scores in patients receiving tranexamic acid were significantly lower compared with the control group within the first postoperative week: lower eyelid edema, WMD, -0.76; 95% CI, -1.04 to -0.49 and lower eyelid ecchymosis, WMD, -0.94; 95% CI, -1.80 to -0.08. No cases of thromboembolic events were reported.
Conclusions and Relevance: Current available evidence suggests that preoperative administration of tranexamic acid is safe and may reduce intraoperative bleeding as well as postoperative eyelid edema and ecchymosis in patients undergoing rhinoplasty.

PMID: 30098161 [PubMed - as supplied by publisher]

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Utility of Optical Coherence Tomography for Guiding Laser Therapy Among Patients With Recurrent Respiratory Papillomatosis.

Related Articles

Utility of Optical Coherence Tomography for Guiding Laser Therapy Among Patients With Recurrent Respiratory Papillomatosis.

JAMA Otolaryngol Head Neck Surg. 2018 Aug 09;:

Authors: Benboujja F, Bowe S, Boudoux C, Hartnick C

Abstract
Importance: Recurrent respiratory papillomatosis (RRP) is a viral-induced disease caused by human papillomavirus and the second leading cause of dysphonia in children; however, neither a cure nor a definitive surgical treatment is currently available for RRP. Although laser therapy is often used in the treatment of RRP, the lack of real-time laser-tissue interaction feedback undermines the ability of physicians to provide treatments with low morbidity. Therefore, an intraoperative tool to monitor and control laser treatment depth is needed.
Objective: To investigate the potential of combining optical coherence tomography (OCT) with laser therapy for patient-tailored laryngeal RRP treatments.
Design, Setting, and Participants: This in vivo study was performed at the Massachusetts Eye and Ear Infirmary from February 1, 2017, to September 1, 2017. Three-dimensional OCT images were acquired before, during, and after photoangiolytic laser therapy in 10 pediatric patients with a history of papilloma growth who presented with lesions and hoarseness.
Main Outcomes and Measures: Whether intraoperative OCT monitoring of changes in optical scattering and absorption provides quantitative information to control thermal damage in tissue.
Results: Among the 10 pediatric patients (age range, 4-11 years; 6 male) included in the study, high-resolution OCT images revealed epithelial hyperplasia with clear RRP lesion margins. Images acquired during therapy indicated coagulation deep in tissue, and posttherapy images showed the ability to quantify the amount of tissue ablated by the photoangiolytic laser.
Conclusions and Relevance: Concurrent use of OCT imaging and laser therapy may improve postoperative outcomes for patients with RRP by delivering an optimal, patient-tailored treatment. Additional studies investigating the correlation between optical properties with vocal outcomes are required.

PMID: 30098151 [PubMed - as supplied by publisher]

https://ift.tt/2B7KgH2

Cocaine-Induced Midline Destructive Lesions Associated With Erosion of the Eustachian Tube.

Related Articles

Cocaine-Induced Midline Destructive Lesions Associated With Erosion of the Eustachian Tube.

JAMA Otolaryngol Head Neck Surg. 2018 Aug 09;:

Authors: Bacciu A, Ghirelli M, Ingegnoli A, Bozzetti F

PMID: 30098140 [PubMed - as supplied by publisher]

https://ift.tt/2P6b7Gu

Safety and efficiency of ultrasound-guided low power microwave ablation in the treatment of cervical metastatic lymph node from papillary thyroid carcinoma: a mean of 32 months follow-up study

Abstract

Purpose

To evaluate the safety and efficiency of microwave ablation (MWA) with low power of 20 w, respectively, in the treatment of cervical metastatic lymph node (CMLN) from papillary thyroid carcinoma (PTC) with a mean of 32-month follow-up.

Methods

Eleven patients in total with 24 cervical lymph nodes (LNs) diagnosed with CMLN from PTC underwent MWA at a power of 20 w. We recorded images of the LNs under ultrasound first before MWA and 1, 3, 6, 12, months after MWA, and then every 6 months, respectively. The volumes of the LNs were compared before MWA and at each follow-up point after MWA. The thyroglobulin (Tg) test was performed before MWA and 3 months after MWA.

Results

All patients were successfully treated, and they showed no major complications. Before MWA, the mean volume of the LNs was 364.15 ± 306.89 mm³, which decreased to 234.10 ± 230.34 mm³, 107.51 ± 129.47 mm³, 20.88 ± 39.27 mm³, 3.38 ± 12.74 mm³, and completely disappeared at the follow-up point of 1, 3, 6, 12, and 18 months after MWA, respectively. The mean Tg was 11.81 ± 7.50 ng/ml, a data significantly decreased to 0.43 ± 0.11 ng/ml 3 months after MWA (P = 0.000). In the follow-up period, no recurrent lesions were found.

Conclusions

For the treatment of CMLN from PTC, low power MWA showed good safety and efficacy. MWA is likely to be a candidate for patients with high risks or who refuse reoperation.

https://ift.tt/2w57qIu

The impact of Nd: YAG laser posterior capsulotomy by the use of “the circular pattern with vitreous strand cut” technique on anterior chamber parameters

Abstract

Aim

The purpose of this study is to identify the effect of Nd: YAG laser posterior capsulotomy using an anterior chamber morphology.

Methods

This study included 42 eyes of 33 pseudophakic patients with visually significant PCO after uncomplicated cataract surgery. Exclusion criteria were complications related to cataract surgery, corneal pathology, pseudoexfoliation, glaucoma, uveitis, previous ocular surgery or trauma, and posterior segment pathology. All patients underwent routine ophthalmic examinations. The AS-OCT measurements were performed using NIDEK RS-3000 Lite retinal scan with anterior segment module. The anterior chamber depth (ACD) was measured by Monitor A&B Scan biometer. Nd: YAG laser posterior capsulotomy was done in a single session by the circular pattern with rupture of vitreous strands. Anterior chamber depth (ACD), central corneal thickness (CCT), and intraocular pressure (IOP) were measured. Anterior chamber angle (ACA), angle opening distances (AOD) at 500 mm (AOD500), AOD at 750 mm (AOD750), trabecular-iris space area at 500 (TISA 500), and TISA at 750 (TISA 750) were measured both nasally and temporally.

Results

The mean patient age was 55.56 ± 6.33 years. There were non-significant changes in IOP, ACD, and CCT with P values 0.395, 0.153, and 0.541, respectively. ACA, AOD500, AOD750, TISA 500, and TISA 750 highly significantly increased with P value < 0.001 for all.

Conclusion

Nd: YAG laser posterior capsulotomy with the circular pattern with vitreous strand cut technique is a safe technique for laser posterior capsulotomy.

https://ift.tt/2P2thch

Removal of refractory organic pollutants in reverse-osmosis concentrated leachate by Microwave–Fenton process

Abstract

A microwave–Fenton technology was applied to dispose of the reverse-osmosis concentrated leachate. Influential factors on the treatment of concentrated leachate with the pure Fenton and microwave-Fenton method were investigated. For the conventional Fenton process, the removal efficiencies of chemical oxygen demand (COD_Cr), UV₂₅₄, and the color number (CN) reached 84%, 87%, and 96%, respectively, with the biodegradability (BOD₅/COD_Cr) increased from 0.13 to 0.51 at an initial pH of 5.0, Fe²⁺ of 0.04 mol/L, a n(H₂O₂)/n(Fe²⁺) ratio of 8 after a reaction time of 3 h. When incorporating the Fenton process with microwave irradiation, a comparative COD_Cr and UV₂₅₄, and the CN removal rate of 75%, 83%, and 95%, and a high BOD₅/COD_Cr of 0.62 were achieved under a microwave power of 390 W and an extremely shortened reaction time of only 8 min. Meanwhile, sludge quantity showed a reduction of 24.7%, decreased from 8.50 g/L to 6.40 g/L after the participation of microwave. In addition, molecular-weight fraction (MWF), UV-visible spectrum (UV-vis), and 3D-EEM spectrum tests demonstrated that the macromolecular and complex organic compounds in the wastewater were significantly decomposed into small molecular matters. Our results found that microwave–Fenton is a promising technology for concentrated leachate treatment, with much shorter reaction time, lower sludge production, and enhanced biodegradability, as well as comparative organic matter removal performance.

https://ift.tt/2w4UxOn

Safety and efficiency of ultrasound-guided low power microwave ablation in the treatment of cervical metastatic lymph node from papillary thyroid carcinoma: a mean of 32 months follow-up study

Abstract

Purpose

To evaluate the safety and efficiency of microwave ablation (MWA) with low power of 20 w, respectively, in the treatment of cervical metastatic lymph node (CMLN) from papillary thyroid carcinoma (PTC) with a mean of 32-month follow-up.

Methods

Eleven patients in total with 24 cervical lymph nodes (LNs) diagnosed with CMLN from PTC underwent MWA at a power of 20 w. We recorded images of the LNs under ultrasound first before MWA and 1, 3, 6, 12, months after MWA, and then every 6 months, respectively. The volumes of the LNs were compared before MWA and at each follow-up point after MWA. The thyroglobulin (Tg) test was performed before MWA and 3 months after MWA.

Results

All patients were successfully treated, and they showed no major complications. Before MWA, the mean volume of the LNs was 364.15 ± 306.89 mm³, which decreased to 234.10 ± 230.34 mm³, 107.51 ± 129.47 mm³, 20.88 ± 39.27 mm³, 3.38 ± 12.74 mm³, and completely disappeared at the follow-up point of 1, 3, 6, 12, and 18 months after MWA, respectively. The mean Tg was 11.81 ± 7.50 ng/ml, a data significantly decreased to 0.43 ± 0.11 ng/ml 3 months after MWA (P = 0.000). In the follow-up period, no recurrent lesions were found.

Conclusions

For the treatment of CMLN from PTC, low power MWA showed good safety and efficacy. MWA is likely to be a candidate for patients with high risks or who refuse reoperation.

https://ift.tt/2w57qIu

Faringoplastia de expansión: utilidad de la somnoscopia (DISE)

Publication date: Available online 13 August 2018

Source: Acta Otorrinolaringológica Española

Author(s): Gabriela Bosco, Nuria Pérez-Martín, Miguel A. Racionero, Guillermo Plaza

Resumen

Objetivos

El objetivo de este estudio es presentar las indicaciones y resultados de la faringoplastia de expansión como tratamiento del síndrome de apnea-hipopnea obstructiva del sueño (SAHOS). En segundo lugar, comparar los hallazgos de la somnoscopia (drug-induced sleep endoscopy –DISE–) antes y después de la cirugía.

Material y métodos

El diseño del estudio fue una cohorte prospectiva de pacientes tratados quirúrgicamente de 2015 a 2016. Todos los pacientes fueron diagnosticados de SAHOS leve a grave y no toleraban la CPAP. Todos tenían DISE y polisomnografía previa a la cirugía, y posterior a la misma. Los criterios de inclusión fueron la edad, entre 18 años y 70 años, amígdalas pequeñas (tamaños 1 y 2), estadio clínico de Friedman II y III, y colapso lateral mayoritario en la DISE preoperatoria. Se les realizó únicamente cirugía del paladar, usando la técnica de faringoplastia de expansión.

Resultados

Se incluyeron 17 pacientes, el 52,94% eran pacientes con SAHOS grave. La edad media fue de 42 años, el índice de masa corporal media fue de 28. La tasa de éxito quirúrgico según los criterios de Sher fue del 82,35%. El 41,17% presentó un índice de apnea-hipopnea postoperatoria inferior a 10. El 75% de los pacientes lograron no tener que usar la CPAP.

Conclusión

La faringoplastia de expansión es una técnica segura como tratamiento del SAHOS en pacientes con amígdalas pequeñas, grado Friedman I y II y colapso de paredes laterales en somnoscopia, en ausencia de colapso multinivel. La DISE postoperatoria demostró la mejoría del colapso lateral obtenida con la expansión.

Abstract

Objectives

The aim of this study was first to present the indications and results using expansion sphincter pharyngoplasty to treat obstructive sleep apnoea-hypopnoea syndrome (OSAHS). And second, to compare the findings of drug-induced sleep endoscopy (DISE) before and after the surgery.

Material and methods

The study design was a prospective cohort of patients surgically treated between 2015 and 2016. All patients were diagnosed with mild to severe obstructive sleep apnoea and did not tolerate CPAP. All had pre- and post-surgery DISE and polysomnography. The inclusion criteria were age, between 18 years and 70 years, small tonsils (sizes 1 and 2), Friedman II and III clinical stage, and lateral collapse in preoperative DISE. We performed surgery to the palate only, using expansion sphincter pharyngoplasty.

Results

Seventeen patients were included, 52.94% had severe OSAHS. Average age was 42 years, average body mass index was 28. The surgical success rate according to Sher criteria was 82.35%. 41.17% had a postoperative apnoea-hypopnoea index of less than 10. Seventy-five percent of the patients had no further need for CPAP.

Conclusion

Expansion sphincter pharyngoplasty is a safe technique for treating OSAHS, in patients with small tonsils, Friedman grade I and II and collapse of lateral walls in DISE, in the absence of multilevel collapse. The postoperative DISE showed improvement of the lateral collapse was achieved with the expansion.

https://ift.tt/2OrZwQI

Lapatinib with ECF/X in the first-line treatment of metastatic gastric cancer according to HER2neu and EGFR status: a randomized placebo-controlled phase II study (EORTC 40071)

Abstract

Purpose

HER2-targeted therapy with trastuzumab and (CF/X) prolonged overall survival (OS) in metastatic HER2neu+ gastric carcinoma (GC). Lapatinib inhibits both EGFR and HER2neu. We investigated the efficacy and safety of lapatinib with epirubicin (E) + CF/X in GC according to HER2neu and EGFR status.

Methods

Tumors from chemotherapy-naïve patients were screened centrally by fluorescence in situ hybridization (FISH) and immunohistochemistry (IHC). Patients with EGFR and/or HER2neu expression or amplification were allocated to three strata based on EGFR/HER2neu status and were randomized to lapatinib (arm A) or placebo (arm B), with 6 cycles of ECF or ECX (investigator-selected). The primary endpoint was progression-free survival (PFS) in stratum 3.

Results

29 of 72 screened patients were randomized to strata 1 (HER2neu+: by FISH and IHC, n = 6), 2 (HER2neu−: by FISH/+ by IHC, n = 5) and 3 (HER2neu−/EGFR+, n = 18), of which 28 patients were eligible (14 per arm). Enrollment was curtailed after announcement of the negative LOGiC trial results. Median PFS was 8.0 versus 5.9 months (HR = 0.86, 95% CI 0.37–1.99) in the per protocol population, and 8.0 versus 6.3 months (HR = 0.85, 95% CI 0.30–2.46) for stratum 3, in the lapatinib versus placebo arm respectively. Median OS was 13.8 versus 10.1 months, respectively (HR = 0.90, 95% CI 0.35–2.27). There were no safety concerns.

Conclusions

Central EGFR and HER2neu stratification by IHC and FISH can be used for further pan-HER strategies. Lapatinib with ECF/X was well tolerated, but did not show clear activity in patients with metastatic GC.

https://ift.tt/2w7hAIB

In vitro UGT1A1 inhibition by tyrosine kinase inhibitors and association with drug-induced hyperbilirubinemia

Abstract

Purpose

Hyperbilirubinemia has been observed in patients treated with tyrosine kinase inhibitor (TKI) drugs. Therefore, it would be beneficial to understand whether there is a relationship between inhibition of uridine-5′-diphosphate glucuronosyltransferase (UGT) 1A1 activity and observed bilirubin elevations in TKI drug-treated patients. UGT1A1 is responsible for the glucuronidation of bilirubin which leads to its elimination in the bile.

Methods

To examine this question, an in vitro glucuronidation assay was developed to determine the inhibitory effect of TKI drugs employing human liver microsomes (HLM) with varying UGT1A1 activity. Utilizing β-estradiol as the UGT1A1 probe substrate, 20 TKI drugs were evaluated at concentrations that represent clinical plasma levels. Adverse event reports were searched to generate an empirical Bayes geometric mean (EGBM) score for clinical hyperbilirubinemia with the TKI drugs.

Results

Erlotinib, nilotinib, regorafenib, pazopanib, sorafenib and vemurafenib had IC₅₀ values that were lower than their clinical steady-state C_max concentrations. These TKI drugs had high incidences of hyperbilirubinemia and higher EBGM scores. The IC₅₀ values and C_max/IC₅₀ ratios correlated well with EBGM scores for hyperbilirubinemia (P < 0.005). For the TKI drugs with higher incidence of hyperbilirubinemia in Gilbert syndrome patients, who have reduced UGT1A1 activity, six of eight had smaller ratios in the low UGT1A1 activity microsomes than the wild-type microsomes for drugs, indicating greater sensitivity to the drugs in this phenotype.

Conclusions

These results suggest that in vitro UGT1A1 inhibition assays have the potential to predict clinical hyperbilirubinemia.

https://ift.tt/2nztzdS

The course of lower cranial nerves within the neck: a cadaveric dissection study

Abstract

Purpose

To evaluate the course of lower cranial nerves (CNs) within the neck in relation to surrounding structures and anatomic landmarks via a cadaveric dissection study.

Methods

A total of 70 neck dissections (31 bilateral, 8 unilateral) were performed on 39 adult fresh cadavers [mean (SD) age: 38.5 (11.2) years, 29 male, 10 female] to identify the course of lower CNs [spinal accessory nerve (SAN), vagus nerve and hypoglossal nerve] within the neck in relation to surrounding structures [internal jugular vein (IJV), common carotid artery (CCA)] and distance to anatomical landmarks (cricoid cartilage, hyoid bone, digastric muscle).

Results

SAN travelled most commonly anterior to IJV (51.4%) at the level of jugular foramen, while travelling lateral to IJV at the post belly of digastric (55.7%) and inferior to digastric muscle (90%) in most neck dissections. Vagus nerve travelled lateral to CCA in majority (94.3%) of dissections, while medial (2.9%), posterolateral (1.4%) and posterior (1.4%) positions were also noted. Average distance of hypoglossal nerve was 27.7 (9.7) mm to carotid bifurcation, 9.3 (3.9) mm to hyoid bone, and 54.7 (18.0) mm to the inferior border of cricoid cartilage.

Conclusion

In conclusion, our findings indicate that anatomic variations are not rare in the course of lower CNs within the neck in relation to adjacent structures, and awareness of these variations together with knowledge of distance to certain anatomic landmarks may help the surgeon to identify lower CNs during neck surgery and prevent potential nerve injuries.

https://ift.tt/2OB9Gin

Intraoral voice recording—towards a new smartphone-based method for vocal rehabilitation

Abstract

After laryngectomy, a new voice is needed. We present the first steps in the development of a smartphone-based method. A microphone is placed in the mouth to record the pseudo-whispering voice of laryngectomized patients. This recording is analyzed by voice recognition software followed by voice synthesis. Eventually, this will be performed on a smartphone. We placed a microphone at 10 different places inside and outside the mouth (two in front of the mouth (at 2 and 20 cm), five on the palate and three on the lower jaw) and made voice recordings in eight healthy men. These recordings were analyzed by voice recognition software. The text generated by the software was compared with the original text. Over all positions, the correct detection of words recorded in the mouth was 19.3% vs. 75.2% (p = 0.01) outside the mouth. In the mouth, recording taken on the maxilla (22.8%) was much better than on the mandible (13.5%) (p = 0.01). The optimum position for a microphone on the maxilla was at the highest point of the palate with 31.9% correct word identification there (p = 0.028). Further investigations have to be undertaken with forthcoming development of smartphone processing power and with development of a smartphone-based voice recognition application.

https://ift.tt/2MlHGBQ

Strahlentherapie bei hepatozellulärem Karzinom

Zusammenfassung

Hintergrund

Das hepatozelluläre Karzinom (HCC) war für die Strahlentherapie lange keine typische Behandlungsindikation, da es erst in den letzten 2 Dekaden möglich wurde, nichttumoröses Lebergewebe ausreichend zu schonen. Daher ist eine radioonkologische Behandlung auf den einschlägigen Behandlungspfaden noch nicht abgebildet.

Fragestellung

Ziel dieser Arbeit ist es, die Möglichkeiten und Grenzen der Strahlentherapie für Patienten mit HCC darzustellen.

Material und Methode

Nach einer knappen Einführung in die Besonderheiten der Radiotherapie für intrahepatische Tumoren wird für die einzelnen Situationen dargestellt, welche Rolle eine perkutane oder interstitielle Radiotherapie bei der Behandlung des HCC spielen kann. Dazu wird eine Einordnung in den verbreiteten Behandlungsalgorithmus nach der Barcelona Clinic Liver Cancer(BCLC)-Klassifikation verwendet.

Ergebnisse

Die Radiotherapie wird bei HCC derzeit v. a. als Körperstereotaxie (SBRT [„stereotactic body radiotherapy"]) eingesetzt, darüber hinaus seltener auch als interstitielle Brachy- sowie als Protonentherapie. Nach der BCLC-Klassifikation kommt sie am häufigsten im Stadium C, gefolgt vom Stadium B zum Einsatz. Auch bei Patienten, bei denen eine Lebertransplantation angestrebt wird, stellt die Radiotherapie eine Möglichkeit für die Überbrückung der Wartezeit („bridging") dar. HCC-Tumoren sind als eher radiosensibel einzustufen, weshalb oft dauerhafte Lokalkontrollen erreicht werden können. Die wichtigste Nebenwirkung, die es durch korrekte Indikationsstellung und optimale Technik gezielt zu vermeiden gilt, ist eine strahleninduzierte Leberkrankheit. Kombinationen der Radiotherapie mit anderen lokalen Verfahren sind nach vorliegender Datenlage im Allgemeinen gut möglich.

Schlussfolgerungen

Die Radiotherapie ist noch nicht als Standardtherapie der ersten Wahl anzusehen, kann aber als wirksame Methode für die Behandlung des HCC angesehen werden. Erste prospektive Studien rechtfertigen diese Einschätzung.

https://ift.tt/2nCKaxn