Head and Neck Diseases by Alexandros G.Sfakianakis: 09/11/18

Τρίτη 11 Σεπτεμβρίου 2018

Spotting Zika spots: descriptive features of the rash used in 66 published cases

Clinical and Experimental Dermatology, EarlyView.

https://ift.tt/2NEK476

Spotting Zika spots: descriptive features of the rash used in 66 published cases

Clinical and Experimental Dermatology, EarlyView.

https://ift.tt/2NEK476

Rituximab for the treatment of autoimmune subepidermal blistering diseases

Dermatologic Therapy, EarlyView.

https://ift.tt/2xagT1u

Rituximab for the treatment of autoimmune subepidermal blistering diseases

Dermatologic Therapy, EarlyView.

https://ift.tt/2xagT1u

Single agent efficacy of the HDAC inhibitor DATS in preclinical models of glioblastoma

Abstract

Purpose/introduction

Glioblastoma (GB) remains incurable despite aggressive chemotherapy, radiotherapy, and surgical interventions; immunotherapies remain experimental in clinical practice. Relevant preclinical models that can accurately predict tumor response to therapy are equally challenging. This study aimed to validate the effect of the naturally occurring agent diallyl trisulfide (DATS) in human GB in relevant pre-clinical models.

Methods

Ex vivo slice culture, in vivo cell line derived orthotopic xenograft and patient-derived orthotopic xenograft (PDX) animal models of GB were utilized to assess efficacy of treatment with DATS.

Results

Our results showed 72-h treatments of 25 µM DATS induced cell death in ex vivo human GB slice culture. We treated U87MG orthotopic xenograft models (U87MGOX) and patient-derived orthotopic xenograft models (PDX) with daily intraperitoneal injections of DATS for 14 days. Magnetic resonance (MR) imaging of mice treated with DATS (10 mg/kg) demonstrated reduced tumor size at 5 weeks when compared with saline-treated U87MGOX and PDX controls. Hematoxylin (H&E) staining demonstrated dose-dependent reduction in gross tumor volume with decreased proliferation and decreased angiogenesis. Western blotting showed that DATS was associated with increases in histone acetylation (Ac-Histone H3/H4) and activated caspase-3 in this novel preclinical model. Histological assessment and enzyme assays showed that even the highest dose of DATS did not negatively impact hepatic function.

Conclusions

DATS may be an effective and well-tolerated therapeutic agent in preventing tumor progression and inducing apoptosis in human GB.

https://ift.tt/2QqHAIn

Total and available metal concentrations in soils from six long-term fertilization sites across China

Abstract

Approximately 19% of agricultural soils in China are contaminated by heavy metals. However, the effects of agricultural management practices on soil contamination are not well understood. Taking advantage of six long-term (23–34 years) field sites across China, this study examined the effects of different agricultural fertilization treatments, including control (no fertilization), inorganic nitrogen, phosphorus and potassium fertilization (NPK), manure fertilization (M), and NPK plus manure fertilization (NPKM), on the total and available metal concentrations in soils. The results showed that after 23–34 years of fertilization, the M and NPKM treatments significantly increased the total concentration of cadmium (Cd), copper (Cu), and zinc (Zn) in soils compared with the concentrations measured for the control and NPK treatments. In contrast, the fertilization treatments had almost no influence on soil lead (Pb) and nickel (Ni) concentrations. The results of analysis via diffusive gradients in thin films demonstrated that long-term sheep or cattle manure fertilization increased the available metals, especially Cd, Cu, and Zn, but long-term swine manure application decreased the available metals, except for Cu and Zn, in soils. Further analysis revealed that the manure source, soil pH level, and biogeochemical properties of metals affected the availability of Cd, Cu, Pb, Zn, and Ni in soils. Collectively, organic fertilizers had the potential to reduce metal uptake by crops, but caution should be taken to reduce metal concentrations in manure.

https://ift.tt/2NHwPms

Dermal subcision of Nemoto’s ligaments as a long-lasting treatment for forehead and glabellar wrinkles

Abstract

Background

Ever since the beginning of recorded history, beauty has played a major social role. A youthful look, symmetry, and a soft, smooth skin texture, as well as an even colour, are the main characteristics and parameters of attractive and beautiful faces. The forehead is the first location in the face that shows wrinkles. Facial wrinkles show an increase in depth and severity with age in all faces, in both sexes, but usually, forehead wrinkles develop earlier in men than they do in women. The work published by Nemoto et al. in 2002 revolutionised the concepts about the aetiology and anatomy of forehead wrinkles, thus inspiring the authors to develop a new surgical technique for treatment.

Methods

Sixty-five patients participated in this study (50 females and 15 males). The age range in this series ranged from 26 to 59 years. Through stab incisions at the hairline level, a standard ENT myringotomy knife was used to cut the fibrous septae connecting between the superficial layer of the galea apponeurotica (that covers the frontalis and glabellar muscles) and the dermis.

Results

The results showed a high level of satisfaction among both patients and an objective assessor with no negative comments. Patients rated the operative results excellent in 52.3% of this series, while the operative results were rated excellent in 47.7% of patients by an independent, objective assessment. Kappa analysis showed perfect agreement between the objective and subjective assessments (K = 0.839). The mean Lamperle classification was 3.1 before surgery and 0.7 3 years after surgery. There was a significant reduction in the mean Lamperle classification 3 years after surgery.

Conclusions

The cutting (dermal subcision) of fasciocutaneous ligaments of the forehead described by Nemoto et al. is a safe, economical and effective technique for forehead and glabella rejuvenation with long-lasting results.

Level of Evidence: Level IV, therapeutic study.

https://ift.tt/2CL50Ft

Nuclear magnetic resonance-based metabolomic investigation reveals metabolic perturbations in PM 2.5 -treated A549 cells

Abstract

Exposure to PM_2.5 is associated with an increased risk of lung diseases, and oxidative damage is the main reason for PM_2.5-mediated lung injuries. However, little is known about the early molecular events in PM_2.5-induced lung toxicity. In the present study, the metabolites in PM_2.5-treated A549 cells were examined via a robust and nondestructive nuclear magnetic resonance (NMR)-based metabolic approach to clarify the molecular mechanism of PM_2.5-induced toxicity. NMR analysis revealed that 12 metabolites were significantly altered in PM_2.5-treated A549 cells, including up-regulation of alanine, valine, lactate, ω-6 fatty acids, and citrate and decreased levels of gamma-aminobutyric acid, acetate, leucine, isoleucine, D-glucose, lysine, and dimethylglycine. Pathway analysis demonstrated that seven metabolic pathways which included alanine, aspartate and glutamate metabolism, aminoacyl-tRNA biosynthesis, taurine and hypotaurine metabolism, arginine and proline metabolism, starch and sucrose metabolism, valine, leucine and isoleucine biosynthesis, and tricarboxylic acid cycle were mostly influenced. Our results indicate that NMR technique turns out to be a simple and reliable method for exploring the toxicity mechanism of air pollutant.

https://ift.tt/2Qo9apw

Adipose insulin resistance is associated with cardiovascular risk factors in polycystic ovary syndrome

Abstract

Purpose

The effects of adipose insulin resistance on cardiovascular risk factors in polycystic ovary syndrome (PCOS) remain largely unknown. We aimed to investigate associations between adipose insulin resistance and cardiovascular risk factors in PCOS.

Methods

A total of 207 PCOS and 47 non-PCOS women were recruited from a large reproductive medicine center in this cross-sectional study. The PCOS diagnosis was based on the Rotterdam Criteria. The subjects received a standard oral glucose tolerance test. Adipose insulin resistance was evaluated using a validated index (adipose-IR = fasting insulin × free fatty acid concentrations).

Results

The women with PCOS showed a higher adipose-IR index, and the adipose-IR index was tightly associated with the blood pressure, glucose and lipid parameters. A total of 98.0% of the women with PCOS in the highest adipose-IR quartile showed cardiovascular risk factors (obesity, hypertension, glucose intolerance or dyslipidemia), and this percentage was significantly higher than the percentage of those in the lowest quartile (32.7%). In addition, the percentages of women with three (31.4%) and four (13.7%) cardiovascular risk factors were significantly elevated in the highest adipose-IR quartile. The multivariable logistic regression analysis indicated that each 1-SD increment in the adipose-IR index resulted in higher risks of obesity (OR = 3.18, 95% CI = 2.12–4.76), hypertension (OR = 1.89, 95% CI = 1.31–2.73), glucose intolerance (OR = 2.45, 95% CI = 1.73–3.48), and dyslipidemia (OR = 2.18, 95% CI = 1.57–3.01). The C-reactive protein (CRP) level was positively associated with the adipose-IR index in women with PCOS (r = 0.45, P < 0.001).

Conclusions

The adipose-IR index was associated with cardiovascular risk factors in women with PCOS. Chronic inflammation may induce insulin resistance in the adipose tissue of women with PCOS.

https://ift.tt/2MmzaOL

Developing a Clinical Prototype to Guide Surgeons for Intraoperative Label-Free Identification of Parathyroid Glands in Real Time

Thyroid, Ahead of Print.

https://ift.tt/2CLTtWd

Prevalence of abnormal semen analysis and levels of adherence with fertility preservation in men undergoing therapy for newly diagnosed cancer: A retrospective study in 2906 patients

Clinical Endocrinology, Volume 0, Issue ja, -Not available-.

https://ift.tt/2N6iVdW

Gender as an Independent Risk Factor for the Components of Metabolic Syndrome Among Individuals Within the Normal Range of Body Mass Index

Metabolic Syndrome and Related Disorders, Ahead of Print.

https://ift.tt/2x6eHZN

A 2-year-old girl with chronic crackles after respiratory syncytial virus infection: a case report

Respiratory syncytial virus is the most common cause of lower respiratory tract infections in infants and young children. While the majority of infants display only mild upper respiratory tract infection or oc...

https://ift.tt/2NCxR2R

The effects of adenoidectomy on the smell perception of children

International Forum of Allergy &Rhinology, EarlyView.

https://ift.tt/2x7yyqL

Relevance of low specific IgE levels to egg, milk and peanut in infancy

Clinical &Experimental Allergy, Volume 0, Issue ja, -Not available-.

https://ift.tt/2QnqmLC

Clinical and demographic characteristics of fatal anaphylaxis in Spain (1998‐2011): A comparison between a series from the hospital system and a national forensic series

Clinical &Experimental Allergy, Volume 0, Issue ja, -Not available-.

https://ift.tt/2x81Rt1

The "Italian way" to counteract obstructive sleep apnoea syndrome in children.

The "Italian way" to counteract obstructive sleep apnoea syndrome in children.

Acta Otorhinolaryngol Ital. 2018 Aug;38(4):393-394

Authors: Villa MP, Bellussi LM, De Benedetto M, Garbarino S, Passali D, Sanna A

PMID: 30197431 [PubMed - in process]

https://ift.tt/2OcwcOu

Multi-option therapy vs observation for small acoustic neuroma: hearing-focused management.

Multi-option therapy vs observation for small acoustic neuroma: hearing-focused management.

Acta Otorhinolaryngol Ital. 2018 Aug;38(4):384-392

Authors: Zanoletti E, Cazzador D, Faccioli C, Gallo S, Denaro L, D'Avella D, Martini A, Mazzoni A

Abstract
The current treatment options for acoustic neuromas (AN) - observation, microsurgery and radiotherapy - should assure no additional morbidity on cranial nerves VII and VIII. Outcomes in terms of disease control and facial function are similar, while the main difference lies in hearing. From 2012 to 2016, 91 of 169 patients (54%) met inclusion criteria for the present study, being diagnosed with unilateral, sporadic, intrameatal or extrameatal AN up to 1 cm in the cerebello-pontine angle; the remaining 78 patients (46%) had larger AN and were all addressed to surgery. The treatment protocol for small AN included observation, translabyrinthine surgery, hearing preservation surgery (HPS) and radiotherapy. Hearing function was assessed according to the Tokyo classification and the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) classification. Sixty-one patients (71%) underwent observation, 19 (22%) HPS and 6 (7%) translabyrinthine surgery; 5 patients were lost to follow-up. Median follow-up was 25 months. In the observation group, 24.6% of patients abandoned the wait-and-see policy for an active treatment; the risk of switching from observation to active treatment was significant for tumour growth (p = 0.0035) at multivariate analysis. Hearing deteriorated in 28% of cases without correlation with tumour growth; the rate of hearing preservation for classes C-D was higher than for classes A-B (p = 0.032). Patients submitted to HPS maintained an overall preoperative hearing class of Tokyo and AAO-HNS in 63% and 68% of cases, respectively. Hearing preservation rate was significantly higher for patients presenting with preoperative favourable conditions (in-protocol) (p = 0.046). A multi-option management for small AN appeared to be an effective strategy in terms of hearing outcomes.

PMID: 30197430 [PubMed - in process]

https://ift.tt/2x8CZS0

Anatomical and functional results of ossiculoplasty using titanium prosthesis.

Anatomical and functional results of ossiculoplasty using titanium prosthesis.

Acta Otorhinolaryngol Ital. 2018 Aug;38(4):377-383

Authors: Lahlou G, Sonji G, De Seta D, Mosnier I, Russo FY, Sterkers O, Bernardeschi D

Abstract
Titanium ossicular chain replacement prosthesis is often used for rehabilitation of the columellar effect in otologic surgeries. This retrospective study aims to analyse the anatomical and functional results of surgeries in which a titanium prosthesis was used. Two hundred and eighty procedures in 256 patients operated on in a tertiary referral center were analysed. Aetiologies, preoperative audiograms, peroperative data and postoperative outcomes at 2 and 12 months postoperatively were reviewed. Chronic suppurative otitis media with or without cholesteatoma was the main aetiology (89%). There was no difference in anatomical results between partial and total ossicular replacement prosthesis, with an overall dislocation rate of 6%, and an overall extrusion rate of 3%. Regarding functional results, a postoperative air-bone gap ≤ 20 dB was achieved in 65% of cases, with a better result for partial compared to total ossiculoplasty (p = 0.02). A significant difference in air bone gap closure was found when comparing aetiologies, with a higher air-bone gap closure in malformation cases compared to chronic suppurative otitis media with cholesteatoma or retraction cases (p = 0.03). Ossiculoplasty using titanium prosthesis is a safe and effective procedure for rehabilitation of hearing loss, which allows reaching an air-bone gap ≤ 20 dB in the majority of patients.

PMID: 30197429 [PubMed - in process]

https://ift.tt/2CHUONS

MR imaging of endolymphatic hydrops in Ménière's disease: not all that glitters is gold.

MR imaging of endolymphatic hydrops in Ménière's disease: not all that glitters is gold.

Acta Otorhinolaryngol Ital. 2018 Aug;38(4):369-376

Authors: Conte G, Lo Russo FM, Calloni SF, Sina C, Barozzi S, Di Berardino F, Scola E, Palumbo G, Zanetti D, Triulzi FM

Abstract
Ménière's disease (MD) is a chronic condition characterised by fluctuating hearing loss, intermittent vertigo, tinnitus and aural fullness. Its anatomical and pathological counterpart is represented by endolymphatic hydrops (EH). Recent development and progress in magnetic resonance (MR) imaging techniques has enabled visualisation of EH in living human subjects using a 3 Tesla (T) scanner and gadolinium-based contrast-agent (GBCA) via intravenous (IV) or intra-tympanic (IT) administration. Data emerging from the literature about MR imaging of EH in MD patients are limited, and we therefore reviewed the most common MR imaging findings in the study of the endolymphatic space in both MD and non-MD patients.

PMID: 30197428 [PubMed - in process]

https://ift.tt/2CUWhRh

Hearing threshold estimation by auditory steady state responses (ASSR) in children.

Hearing threshold estimation by auditory steady state responses (ASSR) in children.

Acta Otorhinolaryngol Ital. 2018 Aug;38(4):361-368

Authors: Aimoni C, Crema L, Savini S, Negossi L, Rosignoli M, Sacchetto L, Bianchini C, Ciorba A

Abstract
Hearing threshold identification in very young children is always problematic and challenging. Electrophysiological testing such as auditory brainstem responses (ABR) is still considered the most reliable technique for defining the hearing threshold. However, over recent years there has been increasing evidence to support the role of auditory steady-state response (ASSR). Retrospective study. Forty-two children, age range 3-189 months, were evaluated for a total of 83 ears. All patients were affected by sensorineural hearing loss (thresholds ≥ 40 dB HL according to a click-ABR assessment). All patients underwent ABRs, ASSR and pure tone audiometry (PTA), with the latter performed according to the child's mental and physical development. Subjects were divided into two groups: A and B. The latter performed all hearing investigations at the same time as they were older than subjects in group A, and it was then possible to achieve electrophysiological and PTA tests in close temporal sequence. There was no significant difference between the threshold levels identified at the frequencies tested (0.25, 0.5, 1, 2 and 4 kHz), by PTA, ABR and ASSR between the two groups (Mann Whitney U test, p < 0.05). Moreover, for group A, there was no significant difference between the ASSR and ABR thresholds when the children were very young and the PTA thresholds subsequently identified at a later stage. Our results show that ASSR can be considered an effective procedure and a reliable test, particularly when predicting hearing threshold in very young children at lower frequencies (including 0.5 kHz).

PMID: 30197427 [PubMed - in process]

https://ift.tt/2O8VzRf

Frontal brain asymmetries as effective parameters to assess the quality of audiovisual stimuli perception in adult and young cochlear implant users.

Frontal brain asymmetries as effective parameters to assess the quality of audiovisual stimuli perception in adult and young cochlear implant users.

Acta Otorhinolaryngol Ital. 2018 Aug;38(4):346-360

Authors: Cartocci G, Maglione AG, Vecchiato G, Modica E, Rossi D, Malerba P, Marsella P, Scorpecci A, Giannantonio S, Mosca F, Leone CA, Grassia R, Babiloni F

Abstract
How is music perceived by cochlear implant (CI) users? This question arises as "the next step" given the impressive performance obtained by these patients in language perception. Furthermore, how can music perception be evaluated beyond self-report rating, in order to obtain measurable data? To address this question, estimation of the frontal electroencephalographic (EEG) alpha activity imbalance, acquired through a 19-channel EEG cap, appears to be a suitable instrument to measure the approach/withdrawal (AW index) reaction to external stimuli. Specifically, a greater value of AW indicates an increased propensity to stimulus approach, and vice versa a lower one a tendency to withdraw from the stimulus. Additionally, due to prelingually and postlingually deafened pathology acquisition, children and adults, respectively, would probably differ in music perception. The aim of the present study was to investigate children and adult CI users, in unilateral (UCI) and bilateral (BCI) implantation conditions, during three experimental situations of music exposure (normal, distorted and mute). Additionally, a study of functional connectivity patterns within cerebral networks was performed to investigate functioning patterns in different experimental populations. As a general result, congruency among patterns between BCI patients and control (CTRL) subjects was seen, characterised by lowest values for the distorted condition (vs. normal and mute conditions) in the AW index and in the connectivity analysis. Additionally, the normal and distorted conditions were significantly different in CI and CTRL adults, and in CTRL children, but not in CI children. These results suggest a higher capacity of discrimination and approach motivation towards normal music in CTRL and BCI subjects, but not for UCI patients. Therefore, for perception of music CTRL and BCI participants appear more similar than UCI subjects, as estimated by measurable and not self-reported parameters.

PMID: 30197426 [PubMed - in process]

https://ift.tt/2N7hT1o

Olfactory evaluation in obstructive sleep apnoea patients.

Olfactory evaluation in obstructive sleep apnoea patients.

Acta Otorhinolaryngol Ital. 2018 Aug;38(4):338-345

Authors: Magliulo G, De Vincentiis M, Iannella G, Ciofalo A, Pasquariello B, Manno A, Angeletti D, Polimeni A

Abstract
The sense of smell has a high impact on the quality of life. The aim of the present study was to investigate olfactory dysfunction in patients with obstructive sleep apnoea syndrome (OSAS) and correlate the severity of disease with olfactory dysfunction. The relationships between nasal obstruction, nasal mucociliary cleareance and olfactory tests were also evaluated. Sixty patients with a diagnosis of OSAS were enrolled and underwent olfactory function evaluation. In all patients olfactory performance was tested with the Sniffin' Sticks method. Mucociliary transport times and anterior rhinomanometry were performed to identify eventual nasal obstruction and deficits in nasal mucociliary clearance. Olfactory dysfunction was present in 22 (36.6%) patients of the study group: of these, hyposmia was present in 19 (86.4%) and anosmia in 3 (13.6%). The mean TDI score in the study group was 30. A strong correlation between the olfactory dysfunction and severity of sleep apnoea measured using the AHI was found. Patients with OSA would seem to have a high incidence of olfactory dysfunction. The degree of olfactory dysfunction appears to be related to the severity of disease. However, other co-factors such as nasal obstruction and reduced mucociliary clearance might also play a role in of the aetiology of this condition.

PMID: 30197425 [PubMed - in process]

https://ift.tt/2O8UVTP

Extracorporeal septoplasty with internal nasal valve stabilisation.

Extracorporeal septoplasty with internal nasal valve stabilisation.

Acta Otorhinolaryngol Ital. 2018 Aug;38(4):331-337

Authors: Tasca I, Compadretti GC, Losano TI, Lijdens Y, Boccio C

Abstract
Among various septoplasty techniques, the extracorporeal one is used for severe deformities of the caudal septum and consists essentially in removal of the nasal septum followed by correction of deformities. Reconstruction of the neo-septum is carried out by repositioning the septal fragments in a straight position. The disadvantages of this surgical technique are the septal haematoma, oedema of the mucosa in the valve area and some types of abnormalities of the middle third of the nose such as saddling of the dorsum. All of these conditions can be associated with various degrees of functional disorders. To prevent these possible complications, we developed a suture technique to fix the caudal portion of the neo-septum and avoid alterations or narrowing of the internal nasal valve. The purpose of this study is to describe extracorporeal septoplasty results with this suture technique in stabilising the internal nasal valve. From January 2011 to December 2013, a retrospective review of adult patients treated with extracorporeal septoplasty was performed at the ENT department of Imola Hospital. Pre- and post-operative evaluations were carried out by rhinomanometry and acoustic rhinometry. Statistical analysis was performed with commercially available software (IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp). 133 cases fulfilled inclusion criteria and were enrolled. A significant improvement was evident after surgery based on the results of rhinomanometry and acoustic rhinology. Extracorporeal septoplasty with stabilisation of the internal nasal valve is an effective and reproducible surgical technique that yields optimal functional results.

PMID: 30197424 [PubMed - in process]

https://ift.tt/2N2lkWU

Effectiveness of endoscopic septoplasty in different types of nasal septal deformities: our experience with NOSE evaluation.

Effectiveness of endoscopic septoplasty in different types of nasal septal deformities: our experience with NOSE evaluation.

Acta Otorhinolaryngol Ital. 2018 Aug;38(4):323-330

Authors: Dell'Aversana Orabona G, Romano A, Abbate V, Salzano G, Piombino P, Farina F, Pansini A, Iaconetta G, Califano L

Abstract
Septal deviations are the most frequent cause of nasal obstruction, and represent a common complaint in rhinologic practice. Since the first description of Lanza et al. in 1991, the use of the endoscope for the correction of septal deformities is increasingly more frequent. The purpose of this study is to evaluate the effectivenes of the endoscopic septoplasty for the correction of each of the 7 types of septal deformities according to the Mladina's classification. A retrospective chart review was performed in 59 consecutive patients presenting to our Department for Endoscopic Septoplasty from February 2012 to August 2014. For each deviation, descriptive statistics (mean and standard deviation, significant increase/decrease) was used to asses the corrective capacity and time-dependent effects at follow-up. This study shows that the corrective power of endoscopic septoplasty is different according to the type of deviation. To our knowledge this is the first study that evaluates the corrective capacity of this technique for each deviation by analysing pre- and postoperative objective outcomes as well as subjective outcomes gathered from the validated NOSE questionnaire. Even if endoscopic septoplasty may now be considered a reliable alternative to the classic technique, it is essential to identify the right deformity preoperatively in order to provide the correct therapeutic choice.

PMID: 30197423 [PubMed - in process]

https://ift.tt/2N59ETn

Differential chemokine expression patterns in tonsillar disease.

Differential chemokine expression patterns in tonsillar disease.

Acta Otorhinolaryngol Ital. 2018 Aug;38(4):316-322

Authors: Mandapathil M, Beier UH, Graefe H, Kröger B, Hedderich J, Maune S, Meyer JE

Abstract
Expression profiles of CXC- and CC-chemokines in various forms of tonsillar disease were studied to evaluate whether certain chemokines play a predominant role in a specific subset of tonsillar disease. Total RNA was isolated from 89 biopsies (21 hyperplastic palatine tonsils, 25 adenoids, 16 chronic inflammatory palatine tonsils and 27 chronic inflammatory palatine tonsils with histological prove of acute inflammation), reverse transcribed and subjected to PCR amplifying IL-8, Gro-alpha, eotaxin-1, eotaxin-2, MCP-3, MCP-4 and RANTES. 2% agarose gel electrophoresis revealed a predominance of IL-8 in the chronic inflammatory palatine tonsil group compared to tonsillar hyperplasia. Furthermore, eotaxin-2 was strongly overexpressed in adenoid samples compared to chronic inflammatory specimens. Our data suggest that the majority of diseases related to adenoid formation are mediated via an eotaxin-2 expression, whereas chronic inflammatory tonsillitis is associated with IL-8 upregulation. These data imply that adenoids are related to a Th-2, and chronic inflammatory tonsillitis to a Th-1 based immune response.

PMID: 30197422 [PubMed - in process]

https://ift.tt/2O8wwOs

New frontiers and emerging applications of 3D printing in ENT surgery: a systematic review of the literature.

New frontiers and emerging applications of 3D printing in ENT surgery: a systematic review of the literature.

Acta Otorhinolaryngol Ital. 2018 Aug;38(4):286-303

Authors: Canzi P, Magnetto M, Marconi S, Morbini P, Mauramati S, Aprile F, Avato I, Auricchio F, Benazzo M

Abstract
3D printing systems have revolutionised prototyping in the industrial field by lowering production time from days to hours and costs from thousands to just a few dollars. Today, 3D printers are no more confined to prototyping, but are increasingly employed in medical disciplines with fascinating results, even in many aspects of otorhinolaryngology. All publications on ENT surgery, sourced through updated electronic databases (PubMed, MEDLINE, EMBASE) and published up to March 2017, were examined according to PRISMA guidelines. Overall, 121 studies fulfilled specific inclusion criteria and were included in our systematic review. Studies were classified according to the specific field of application (otologic, rhinologic, head and neck) and area of interest (surgical and preclinical education, customised surgical planning, tissue engineering and implantable prosthesis). Technological aspects, clinical implications and limits of 3D printing processes are discussed focusing on current benefits and future perspectives.

PMID: 30197421 [PubMed - in process]

https://ift.tt/2N3KlBc

Nitinol versus non-Nitinol prostheses in otosclerosis surgery: a meta-analysis.

Nitinol versus non-Nitinol prostheses in otosclerosis surgery: a meta-analysis.

Acta Otorhinolaryngol Ital. 2018 Aug;38(4):279-285

Authors: Reis LR, Donato M, Almeida G, Castelhano L, Escada P

Abstract
The aim of this study is to perform a systematic review and meta-analysis of observational studies in which hearing outcomes after primary stapes surgery have been reported. After the surgical procedure, the effectiveness of stapes surgery using nickel titanium (Nitinol) or other prostheses were systematically compared and evaluated using a meta-analytic method. A systematic search for articles before January 2017 in Embase, Medline and Cochrane Library databases was conducted. Only articles in English were included. Inclusion criteria for qualitative synthesis consisted of a population of otosclerosis patients, intervention with primary stapes surgery using the Nitinol heat-crimping prosthesis compared with other type of stapes stapedotomy prostheses, and hearing outcome. Inclusion criteria for quantitative analysis consisted of application of audiometry guidelines of the American Academy of Otolaryngology Head and Neck Surgery Committee on Hearing and Equilibrium for evaluation of conductive hearing loss. A postoperative air-bone gap (ABG) ≤ 10 dB was considered effective. A bias assessment tool was developed according to Cochrane guidelines. To evaluate the mean age of the samples we used the chi-square test. Of the 4926 papers identified through the electronic database search (3695 in Pubmed/Cochrane and 1231 in Embase), 540 studies matched the selection criteria (436 in Pubmed/Cochrane and 104 in Embase) after application of filters and elimination of duplicate articles. After analysis of the title and abstract, 459 were excluded (396 in Pubmed/Cochrane and 63 in Embase). Of the remaining 81 papers, 74 were excluded according to the study selection criteria. A total of seven eligible studies with 1385 subjects, consisting of 637 in the Nitinol group and 748 in the non-Nitinol group, were included in our study. There were statistically significant differences in the effectiveness of stapes surgery between the Nitinol and non-Nitinol prostheses; the data showed a combined odds ratio (OR) of 2.56 (95% CI 1.38-4.76, p = 0.003). There were no statistically significant differences in the mean pre-operative age between Nitinol and non-Nitinol prostheses (p = 0.931). Our results suggest that the effectiveness of Nitinol was higher than non-Nitinol prostheses, with superiority of the number of patients with ABG ≤ 10 dB.

PMID: 30197420 [PubMed - in process]

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Introduction from the Editors

https://ift.tt/2Nz3vOM

Non-IgE-mediated food hypersensitivity

Non-immunoglobulin E (IgE)-mediated food hypersensitivity includes a spectrum of disorders that predominantly affect the gastrointestinal tract. This review will focus on the following more common non-IgE-medi...

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Allergic rhinitis

Allergic rhinitis is a common disorder that is strongly linked to asthma and conjunctivitis. It is usually a long-standing condition that often goes undetected in the primary-care setting. The classic symptoms...

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An introduction to immunology and immunopathology

Beyond structural and chemical barriers to pathogens, the immune system has two fundamental lines of defense: innate immunity and adaptive immunity. Innate immunity is the first immunological mechanism for fig...

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Anaphylaxis

Anaphylaxis is an acute, potentially fatal systemic allergic reaction with varied mechanisms and clinical presentations. Although prompt recognition and treatment of anaphylaxis are imperative, both patients a...

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Lung protection during one-lung ventilation: Another piece in the puzzle

No abstract available

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An observational study of skill retention and practice adoption after a workshop on ultrasound-guided neuraxial anaesthesia

No abstract available

https://ift.tt/2N9vmpi

Improved lung recruitment and oxygenation during mandatory ventilation with a new expiratory ventilation assistance device: A controlled interventional trial in healthy pigs

BACKGROUND In contrast to conventional mandatory ventilation, a new ventilation mode, expiratory ventilation assistance (EVA), linearises the expiratory tracheal pressure decline. OBJECTIVE We hypothesised that due to a recruiting effect, linearised expiration oxygenates better than volume controlled ventilation (VCV). We compared the EVA with VCV mode with regard to gas exchange, ventilation volumes and pressures and lung aeration in a model of peri-operative mandatory ventilation in healthy pigs. DESIGN Controlled interventional trial. SETTING Animal operating facility at a university medical centre. ANIMALS A total of 16 German Landrace hybrid pigs. INTERVENTION The lungs of anaesthetised pigs were ventilated with the EVA mode (n=9) or VCV (control, n=7) for 5 h with positive end-expiratory pressure of 5 cmH2O and tidal volume of 8 ml kg−1. The respiratory rate was adjusted for a target end-tidal CO2 of 4.7 to 6 kPa. MAIN OUTCOME MEASURES Tracheal pressure, minute volume and arterial blood gases were recorded repeatedly. Computed thoracic tomography was performed to quantify the percentages of normally and poorly aerated lung tissue. RESULTS Two animals in the EVA group were excluded due to unstable ventilation (n=1) or unstable FiO2 delivery (n=1). Mean tracheal pressure and PaO2 were higher in the EVA group compared with control (mean tracheal pressure: 11.6 ± 0.4 versus 9.0 ± 0.3 cmH2O, P 0.99). Minute volume was lower in the EVA group compared with control (5.5 ± 0.2 versus 7.0 ± 1.0 l min−1, P = 0.02) with normoventilation in both groups (PaCO2 5.4 ± 0.3 versus 5.5 ± 0.3 kPa, P > 0.99). In the EVA group, the percentage of normally aerated lung tissue was higher (81.0 ± 3.6 versus 75.8 ± 3.0%, P = 0.017) and of poorly aerated lung tissue lower (9.5 ± 3.3 versus 15.7 ± 3.5%, P = 0.002) compared with control. CONCLUSION EVA ventilation improves lung aeration via elevated mean tracheal pressure and consequently improves arterial oxygenation at unaltered positive end-expiratory pressure (PEEP) and peak inspiratory pressure (PIP). These findings suggest the EVA mode is a new approach for protective lung ventilation.

https://ift.tt/2N44F5o

The feasibility of pressure measurement during an ultrasound-guided thoracic paravertebral block

No abstract available

https://ift.tt/2x9qANG

Efficacy and safety of dexmedetomidine in peripheral nerve blocks: A meta-analysis and trial sequential analysis

BACKGROUND The duration of analgesia provided by nerve blocks is limited if local anaesthetics are administered alone. Therefore, several additives, including dexmedetomidine (DEX), have been investigated in order to prolong postoperative analgesia following single-shot regional anaesthesia. OBJECTIVES The aim of this meta-analysis was to assess the efficacy and safety of the addition of perineural DEX to local anaesthetics compared with local anaesthetics alone or local anaesthetics combined with systemic administration of DEX. DESIGN A systematic review of randomised controlled trials (RCT) with meta-analysis, trial sequential analysis and assessment of the quality of evidence by the GRADE approach. DATA SOURCES The databases MEDLINE, CENTRAL and EMBASE (to May 2017) were systematically searched. ELIGIBILITY CRITERIA All RCTs investigating the efficacy and safety of perineural DEX combined with local anaesthetics compared with local anaesthetics alone or local anaesthetics in combination with systemic DEX in peripheral nerve blocks of adults undergoing surgery were included. RESULTS A total of 46 RCTs (3149 patients) were included. Patients receiving perineural DEX combined with local anaesthetics had a longer duration of analgesia than local anaesthetics alone [mean difference 4.87 h; 95% confidence interval (95% CI) 4.02 to 5.73; P

https://ift.tt/2N44wyS

Ultrasound-guided single injection versus continuous sciatic nerve blockade on pain management and mobilisation after total knee arthroplasty (CoSinUS trial): A randomised, triple-blinded controlled trial

BACKGROUND Combining continuous femoral nerve blockade with single injection sciatic nerve blockade is standard peripheral nerve block practice for total knee arthroplasty (TKA) during the first 24 postoperative hours. OBJECTIVES To assess the analgesic benefits and mobilisation capability of continuous sciatic blockade in conjunction with continuous femoral nerve blockade for 72 h after arthroplasty. DESIGN Randomised, triple-blinded controlled trial. SETTING Single-Centre, German University Hospital. PATIENTS In total, 50 patients receiving continuous femoral nerve blockade (5 ml h−1 ropivacaine 0.2%) for TKA under general anaesthesia. INTERVENTIONS Patients were randomised to receive a sciatic nerve catheter with an initial dose of 10 ml ropivacaine 0.2% followed by either continuous double-blinded application of 5 ml h−1 ropivacaine 0.2% (CO) or 5 ml h−1 saline infusion (SIN). MAIN OUTCOME Measures primary endpoint: cumulative morphine consumption until 48 h postoperatively. Further endpoints included morphine consumption, pain scores, mobilisation, dynamometry until postoperative day 3. RESULTS Median [25th to 75th percentiles] cumulative morphine consumption at postoperative day 2 differed significantly between groups (CO 15 mg [11 to 25] versus SIN, 43 mg [27 to 67.5, P

https://ift.tt/2x86QKx

Removal of entrapped epidural catheter: role of muscle relaxation

No abstract available

https://ift.tt/2x9qAgE

Adding sufentanil to ropivacaine in continuous thoracic paravertebral block fails to improve analgesia after video-assisted thoracic surgery: A randomised controlled trial

BACKGROUND The benefit of adding opioid to a local anaesthetic for continuous thoracic paravertebral analgesia after video-assisted thoracic surgery (VATS) is unclear. OBJECTIVES To analyse the analgesic efficacy of ropivacaine and sufentanil in combination compared with ropivacaine alone after VATS. DESIGN A randomised, double-blinded, single-centre clinical trial. SETTING A tertiary university hospital between March 2010 and April 2014. PATIENTS Ninety patients were recruited, two were not included leaving 88 randomised into two groups. Eighteen patients were excluded from analysis and 70 completed the study. INTERVENTION To receive thoracic paravertebral analgesia with either 2 mg ml−1 ropivacaine and 0.25 μg ml−1 sufentanil (ropivacaine + sufentanil group) or 2 mg ml−1 ropivacaine alone (ropivacaine group) for 48 h postoperatively. Infusion rate was set at 0.15 ml kg−1 h−1 in both groups. MAIN OUTCOME MEASURES The primary endpoint was the mean total amount of self-administered morphine by the patients in each group at 48 h postoperatively. RESULTS The mean ± SD total amount of self-administered morphine was not significantly different between groups (53.1 ± 27.2 mg in the ropivacaine + sufentanil group vs. 58.8 ± 34.3 mg in the ropivacaine group; P = 0.72). No significant differences were found between the two groups in either pain scores at rest or during movement, in opioid-related adverse reactions, in patient satisfaction or length of hospital stay. CONCLUSION Adding 0.25 μg ml−1 sufentanil to 2 mg ml−1 ropivacaine in continuous thoracic paravertebral analgesia for VATS did not reduce morphine consumption or pain scores when compared with ropivacaine alone. We cannot recommend its use for routine clinical practice. Further studies analysing different concentrations and infusion rates of sufentanil are needed before a lack of efficacy can be confirmed. TRIAL REGISTRATION Clinical trial registrations: EudraCT: 2009-014832-38. ClinicalTrials.gov: NCT 01082744.

https://ift.tt/2N9uSQ0

Modified half-the-air technique for continuous pressure monitoring during lumbar plexus block

No abstract available

https://ift.tt/2x79ZKA

Spinal anaesthesia with chloroprocaine 1% versus total intravenous anaesthesia for outpatient knee arthroscopy: A randomised controlled trial

BACKGROUND Both general and spinal anaesthesia with short-acting local anaesthetics are suitable and reliable for knee arthroscopy as an ambulatory procedure. Chloroprocaine (CP) 1% seems to be the ideal spinal local anaesthetic for this indication. OBJECTIVE The aim of this study was to compare spinal anaesthesia using CP 1% with general for outpatient knee arthroscopy with regard to procedure times, occurrence of pain, patient satisfaction and recovery, and also costs. DESIGN A randomised controlled single-centre trial. SETTING University Medical Centre Mannheim, Department of Anaesthesiology and Surgical Intensive Care Medicine, Mannheim, Germany. April 2014 to August 2015. PATIENTS A total of 50 patients (women/men, 18 to 80 years old, ASA I to III) undergoing outpatient knee arthroscopy were included. A contra-indication to an allocated anaesthetic technique or an allergy to medication required in the protocol led to exclusion. INTERVENTIONS Either general anaesthesia with sufentanil, propofol and a laryngeal mask for airway-management or spinal with 40-mg CP 1% were used. We noted procedure times, patient satisfaction/recovery and conducted a 7-day follow-up. MAIN OUTOMES Primary outcome was duration of stay in the day-surgery centre. Secondary outcomes were first occurrence of pain, patient satisfaction, quality of recovery and adverse effects. In addition, we analysed treatment costs. RESULTS Spinal had faster recovery than general anaesthesia with patients reaching discharge criteria significantly earlier [117 min (66 to 167) versus 142 min (82 to 228), P = 0.0047]. Pain occurred significantly earlier in the general anaesthesia group (P = 0.0072). Costs were less with spinal anaesthesia (cost ratio spinal: general 0.57). Patients felt significantly more uncomfortable after general anaesthesia (P = 0.0096). CONCLUSION Spinal anaesthesia with 40-mg CP 1% leads to a significantly earlier discharge and is cheaper compared with general. TRIAL REGISTRATION German Clinical Trials Register, www.drks.de, identifier: DRKS00005989.

https://ift.tt/2N3iGQK

e-learning: the anaesthesiology media lab of Yale University School of Medicine

No abstract available

https://ift.tt/2x7CY0z

Lung protection during one-lung ventilation: Another piece in the puzzle

No abstract available

https://ift.tt/2x9qCVO

An observational study of skill retention and practice adoption after a workshop on ultrasound-guided neuraxial anaesthesia

No abstract available

https://ift.tt/2N9vmpi

Protective ventilation during anaesthesia reduces major postoperative complications after lung cancer surgery: A double-blind randomised controlled trial

BACKGROUND Thoracic surgery for lung resection is associated with a high incidence of postoperative pulmonary complications. Controlled ventilation with a large tidal volume has been documented to be a risk factor for postoperative respiratory complications after major abdominal surgery, whereas the use of low tidal volumes and positive end-expiratory pressure (PEEP) has a protective effect. OBJECTIVE To evaluate the effects of ventilation with low tidal volume and PEEP on major complications after thoracic surgery. DESIGN A double-blind, randomised controlled study. SETTING A multicentre trial from December 2008 to October 2011. PATIENTS A total of 346 patients undergoing lobectomy or pneumonectomy for lung cancer. MAIN OUTCOME MEASURES The primary outcome was the occurrence of major postoperative complications (pneumonia, acute lung injury, acute respiratory distress syndrome, pulmonary embolism, shock, myocardial infarction or death) within 30 days after surgery. INTERVENTIONS Patients were randomly assigned to receive either lung-protective ventilation (LPV group) [tidal volume 5 ml kg−1 ideal body weight + PEEP between 5 and 8 cmH2O] or nonprotective ventilation (control group) (tidal volume 10 ml kg−1 ideal body weight without PEEP) during anaesthesia. RESULTS The trial was stopped prematurely because of an insufficient inclusion rate. Major postoperative complications occurred in 23/172 patients in the LPV group (13.4%) vs. 38/171 (22.2%) in the control group (odds ratio 0.54, 95% confidence interval, 0.31 to 0.95, P = 0.03). The incidence of other complications (supraventricular cardiac arrhythmia, bronchial obstruction, pulmonary atelectasis, hypercapnia, bronchial fistula and persistent air leak) was also lower in the LPV group (37.2 vs. 49.4%, odds ratio 0.60, 95% confidence interval, 0.39 to 0.92, P = 0.02).The duration of hospital stay was shorter in the LPV group, 11 [interquartile range, 9 to 15] days vs. 12 [9 to 16] days, P = 0.048. CONCLUSION Compared with high tidal volume and no PEEP, LPV combining low tidal volume and PEEP during anaesthesia for lung cancer surgery seems to improve postoperative outcomes. TRIALS REGISTRATION ClinicalTrials.gov number: NCT00805077.

https://ift.tt/2x213Ge

A comparison of the incidence of supraventricular arrhythmias between thoracic paravertebral and intercostal nerve blocks in patients undergoing thoracoscopic surgery: A randomised trial

BACKGROUND Postoperative supraventricular arrhythmias are common in patients after thoracoscopic lobectomy. Inadequate pain control has long been recognised as a significant risk factor for arrhythmias. The performance of ultrasound-guided (USG) thoracic paravertebral block (PVB) is increasing as an ideal technique for postoperative analgesia. OBJECTIVE We conducted this study to evaluate whether a single-shot USG thoracic PVB would result in fewer postoperative supraventricular tachycardias (SVT) than intercostal nerve blocks (ICNBs) after thoracoscopic pulmonary resection. DESIGN A randomised controlled study. SETTING A single university hospital. PATIENTS Sixty-eight patients undergoing thoracoscopic lobectomy were randomised into two equal groups of 34. INTERVENTIONS For postoperative pain control, all patients received a total of 0.3 ml kg−1 of a mixture containing 0.5% ropivacaine and 1/200 000 epinephrine after placement of needles for either a single thoracic PVB or two individual ICNBs, both guided by ultrasound. Data were obtained during the first 48 postoperative hours. MAIN OUTCOME MEASURES The primary outcome was the incidence of SVT after thoracoscopic pulmonary resection. RESULTS During the first 48 postoperative hours, the incidences of SVT and atrial fibrillation were lower in the USG thoracic PVB group (14.7 vs. 46.9%, P = 0.004 and 3.0 vs. 18.8%, P = 0.037, respectively). The requirement for β-receptor blockade was more frequent in the ICNBs group than in the PVB group (5.9 vs. 25%, P = 0.033). CONCLUSION After placement of the needle using ultrasound guidance, a single-shot thoracic PVB is a well tolerated and effective technique to reduce the incidences of postoperative SVT and atrial fibrillation in patients undergoing thoracoscopic pulmonary resection. TRIAL REGISTRATION https://ift.tt/2LGPFWU, registration number: ChiCTR-IOR-17010952.

https://ift.tt/2N9vftS

Improved lung recruitment and oxygenation during mandatory ventilation with a new expiratory ventilation assistance device: A controlled interventional trial in healthy pigs

The feasibility of pressure measurement during an ultrasound-guided thoracic paravertebral block

No abstract available

https://ift.tt/2x9qANG

Efficacy and safety of dexmedetomidine in peripheral nerve blocks: A meta-analysis and trial sequential analysis

Ultrasound-guided single injection versus continuous sciatic nerve blockade on pain management and mobilisation after total knee arthroplasty (CoSinUS trial): A randomised, triple-blinded controlled trial

Assessing changes in tissue oxygenation by near-infrared spectroscopy following brachial plexus block for arteriovenous fistula surgery: A prospective observational pilot study

BACKGROUND Near-infrared spectroscopy (NIRS) can be used to measure tissue oxygen saturation (StO2) in different sites and in a wide range of clinical scenarios. Peripheral regional anaesthesia induces vascular changes causing increased arterial blood flow and venodilatation, but its effect on StO2 is still under debate. This is especially so for patients undergoing arteriovenous fistula surgery, wherein latest data suggest an improved outcome under brachial plexus block (BPB) compared with local anaesthesia, but no data are available. OBJECTIVE The aim of this study was to investigate changes in StO2 following BPB prior to arteriovenous fistula surgery using NIRS. DESIGN A prospective observational study. SETTING A secondary teaching hospital from August 2016 to March 2017. PATIENTS Fifteen patients undergoing arteriovenous fistula surgery. INTERVENTION Ultrasound-guided BPB in 15 patients undergoing arteriovenous fistula surgery. OUTCOME MEASURES StO2 at baseline and compared with baseline and the contralateral arm following BPB measured using NIRS of the thenar eminence (NIRSth). RESULTS Baseline values of StO2 assessed by NIRSth were 42.6 ± 7.7% in the arteriovenous fistula arm and 42.7 ± 9.7% in the contralateral arm. There was no significant difference between the two. Five minutes after BPB, there was a significant increase in StO2 of the blocked arm, compared with the control arm expressed as difference of absolute values (7.1 ± 9.7%). At 60 min, an absolute difference of 21.0 ± 13.5% was reached. The absolute increase in StO2 of the blocked arm compared with baseline reached significance after 5 min (8.8 ± 4.6%) and increased up to 23.2 ± 8.2% after 60 min. CONCLUSION NIRSth indicates that BPB significantly increases StO2 of the arteriovenous fistula arm in patients undergoing haemodialysis. TRIAL REGISTRATION: Clinicaltrials.gov: NCT03044496

https://ift.tt/2N44p6q

Removal of entrapped epidural catheter: role of muscle relaxation

No abstract available

https://ift.tt/2x9qAgE

Adding sufentanil to ropivacaine in continuous thoracic paravertebral block fails to improve analgesia after video-assisted thoracic surgery: A randomised controlled trial

Modified half-the-air technique for continuous pressure monitoring during lumbar plexus block

No abstract available

https://ift.tt/2x79ZKA

Spinal anaesthesia with chloroprocaine 1% versus total intravenous anaesthesia for outpatient knee arthroscopy: A randomised controlled trial

e-learning: the anaesthesiology media lab of Yale University School of Medicine

No abstract available

https://ift.tt/2x7CY0z

Nepotism in publication of medical literature! does it exist? may be it does!!

Mridul M Panditrao

Anesthesia: Essays and Researches 2018 12(3):609-610

https://ift.tt/2Nu4Zdh

Possible bias in the publication trends of high impact factor anesthesiology and gastroenterology journals –an analysis of 5 years' data

Basavana Goudra, Divakara Gouda, Gowri Gouda, Akash Singh, Alan Balu, Prabhakara Gouda

Anesthesia: Essays and Researches 2018 12(3):611-617

Background: We hypothesize that being an editorial board member (EBM) in a high impact factor specialty medical journal increases the chances of publishing in the same journal. Materials and Methods: The publication trends of the first five EBMs in the five highest impact factor Anesthesiology and Gastroenterology journals were analyzed. Preceding 5 years' publications appearing on PubMed were grouped into as follows: number of publications in the journal in which the EBM serves (N1), number of publications by the same author in the other four highest impact factor (IF) journals (N2) and number of publications in all the other journals (N3). We evaluated the probability of the observed distribution of publications in the five highest IF journals happening by chance alone, assuming that all the EBMs had the same opportunity of publishing in any of these journals. The probability of publishing in their own journal was assumed to be one fifth. Results: The EBMs published their manuscripts in their own journal at a very high frequency. Encompassing all ten journals, the calculated P value for such a distribution was <0.001. In two journals, Anesthesia and Analgesia and Anaesthesia, the EBMs' publications in their journal were more than twice the cumulative total in the remaining four journals. In three of the five gastroenterology journals analyzed, combined publications of the five EBMs were greater in their own journal than the remaining four journals combined. Conclusions: Despite proclaimed fair peer review process, EBMs seem to get preference in their own journals.

https://ift.tt/2OcqP1I

Role of lignocaine nebulization as an adjunct to airway blocks for awake fiber-optic intubation: A comparative study

Manish Khandelwal, Varun Kumar Saini, Sandeep Kothari, Gaurav Sharma

Anesthesia: Essays and Researches 2018 12(3):735-741

Context: Airway management is a crucial skill and area of concern for the anesthesiologist. Awake fiber-optic intubation (AFOI) remains the gold standard in managing difficult airway. Anaesthetizing the airway along with psychological assurance is the mainstay for Preparation of AFOI. Different topical and regional techniques have been developed to subdue reflexes and facilitate AFOI. Aim: This randomized controlled study was performed to evaluate the effectiveness of using lignocaine nebulization in addition to specific airway blocks for AFOI. Methodology: This was a comparative study conducted in 60 patients with difficult airway (LEMON score >2) and randomly allocated into two groups of 30 each. Group LB and Group NB received nebulization of 2% lignocaine 4 mL and 0.9% normal saline 4 mL, respectively. Both groups were then given airway blocks as bilateral superior laryngeal (2% lignocaine 1–2 mL each) and transtracheal (2% lignocaine 4 mL) block. Two puffs of 10% lignocaine to nose and postnasal space on each side were given in both groups. Fiber-optic bronchoscopy (FOB)-guided tracheal intubation was Performed. Vital parameters, side effects, bronchoscopy-guided intubation time and other parameters as intubation grading scale, patient comfort score, satisfaction score were recorded. Chi-square test and unpaired t-test were used for statistical analysis. Results: Statistically, no significant differences were found in hemodynamic parameters, demographics, intubation time, and intubation grading scale in both groups. However, overall patient comfort and satisfaction score was better in Group LB. Conclusion: Upper airway blocks provide adequate anesthesia for awake FOB, but when lignocaine nebulization is added to these blocks, it improves the quality of anesthesia and patient satisfaction.

https://ift.tt/2NySqx8

Intraoperative meditation music as an adjunct to subarachnoid block for the improvement of postoperative outcomes following cesarean section: A randomized placebo-controlled comparative study

Madhuri S Kurdi, Vinod Gasti

Anesthesia: Essays and Researches 2018 12(3):618-624

Context: Music therapy is a nonpharmacological modality which can provide promising results for postcesarean section recovery. Aims: The aim of this study was to compare the effects of two types of intraoperative meditation music with control group on postcesarean section pain, anxiety, nausea, vomiting, and psychological maternal wellbeing. Settings and Design: A prospective, randomized, controlled study was conducted on 189 patients. Patients and Methods: The inclusion criteria were the American Society of Anaesthesiologists physical status classes 1E and 2E women aged over 18 years posted for emergency cesarean section under spinal anesthesia. The exclusion criteria were patients with hearing/ear abnormalities and psychiatric disorders. Patients were randomly allocated into three groups – soothing meditation music (M) group, binaural beat meditation music (B) group, and control (C) group – where no music was played. After intervention, data were collected and statistically analyzed. Statistical Analysis Used: Student's t-test was applied for calculation of normative distribution and Mann–Whitney U-test for nonnormative distribution. Nominal categorical data between the groups were compared using Chi-squared test. P <0.05 indicated a statistically significant difference. Results: Both intraoperative meditation music groups had statistically significant less postoperative pain and anxiety and a better overall psychological wellbeing as compared to the control. There was no statistically significant difference in the occurrence and severity of postoperative nausea and vomiting across all three groups. Conclusions: Intraoperative meditation music as good adjunct to spinal anesthesia can improve a cesarean section patient's postoperative experience by reducing postoperative pain, anxiety, and psychological wellbeing.

https://ift.tt/2ObhrM5

Comparative study between magnesium sulfate and lidocaine for controlled hypotension during functional endoscopic sinus surgery: A randomized controlled study

Mohamed Ahmed Hamed

Anesthesia: Essays and Researches 2018 12(3):715-718

Background: Intraoperative bleeding impairs surgical field visibility during functional endoscopic sinus surgery (FESS); several methods have been used to decrease blood loss and improve surgical field, one of them is usage of hypotensive anesthetic agents. Aim: We intended to compare magnesium sulfate with lidocaine, regarding their efficiency in inducing controlled hypotension and providing a better surgical field exposure during FESS and the influence of their usage on extubation time. Settings and Design: This study design was a prospective randomized controlled double-blinded clinical study. Patients and Methods: Eighty adult patients with patients' physical status ASA Classes I and II, aged 20–50 years scheduled for FESS were randomly divided into two study groups; each group contains 40 patients: Group L received lidocaine 2 mg/kg/h with maximum of 200 mg/h starting at induction of anesthesia and continuing until the end of surgery and Group M received an iv bolus of magnesium sulfate 50mg/kg in a total of 100ml saline over 10 min followed by infusion of 15mg/kg/h until the end of surgery; patients were observed for the quality of the surgical field, blood loss, and extubation time. Statistical Analysis Used: Student's t-test or Mann–Whitney's U, Chi-square, or Fisher's exact tests were used. Results: Group L showed a significant decrease in blood loss (P = 0.01), better surgical field clarity (P = 0.002), and shorter extubation time (P = 0.001) than Group M, but there was no statistically significant difference between the two study groups as regards hemodynamics. Conclusion: We concluded that both magnesium sulfate and lidocaine successfully induced controlled hypotension in patients undergoing FEES, but lidocaine provided better surgical field clarity and shorter extubation time.

https://ift.tt/2NE2jcQ

Fatty Acids in Pregnancy and Risk of Allergic Sensitization and Respiratory Outcomes in Childhood

Some observational studies have suggested associations of higher prenatal fish intake with protection against offspring asthma, attributing associations to greater exposure to marine n-3 long-chain polyunsaturated fatty acids (n-3 LCPUFAs). Two recent randomized clinical trials have tested that hypothesis. Bisgaard and colleagues1 found that supplementation with n-3 LCPUFAs reduced the risk of persistent wheeze or asthma and lower respiratory tract infections, but not allergic sensitization or eczema, in offspring followed for the first 3 years of life.

https://ift.tt/2MlluDD

The effect of an oral care protocol and honey mouthwash on mucositis in acute myeloid leukemia patients undergoing chemotherapy: a single-blind clinical trial

Abstract

Objectives

The purpose of the study is to evaluate and compare the effectiveness of honey mouthwash and an oral care protocol on mucositis and weight loss in patients with acute myeloid leukemia receiving chemotherapy.

Materials and methods

In this single-blind clinical trial, 53 acute myeloid leukemia (AML) patients receiving chemotherapy were randomly assigned into three groups: honey mouthwash (n = 17), oral care (n = 17), and control (n = 19). The severity of mucositis and weights was examined blindly at the baseline and 4-week follow-up.

Results

The prevalence of grades of mucositis in the study groups was significant at the end of the third (p = 0.002) and fourth (p < 0.001) weeks. The mucositis severity decreased at the end of the third and fourth weeks in the honey mouthwash group (p < 0.05), whereas it increased in the control group (p < 0.001). The difference in the weight was significant between the honey mouthwash and the control groups (p < 0.05, MD = 1.95) at the end of the third week, and between the honey mouthwash group with the control (p < 0.01, MD = 2.92) and oral care groups (p < 0.05, MD = 1.95) at the end of the fourth week.

Conclusions

Honey mouthwash is effective in preventing and reducing the severity of mucositis, and weight loss and can be recommended for patients undergoing chemotherapy.

Clinical relevance

The results of this study suggest that honey mouthwash can reduce the incidence and severity of mucositis in patients, reduce or eliminate the possibility of weight loss in them, as well as encourage some weight gain. Compared to routine oral care, honey mouthwash is also easier to use and handle.

Trial registration

IRCT2015121419919N7

https://ift.tt/2x53YOh

Markov-switching vector autoregressive neural networks and sensitivity analysis of environment, economic growth and petrol prices

Abstract

The paper aims at evaluating the nonlinear and complex relations between CO₂ emissions, economic development, and petrol prices to obtain new insights regarding the shape of the environmental Kuznets curve (EKC) in the USA and in the UK in addition to introducing a newly proposed nonlinear approach. Within this respect, the paper has three purposes: the first one is to combine the multilayer perceptron neural networks (MLP) with Markov-switching vector autoregressive (MS-VAR) type nonlinear models to obtain the MS-VAR-MLP model. The second is to utilize one of the largest datasets in the literature covering the 1871–2016 period, a long span of data starting from the late eighteenth century. Since the emission, economic development, and petrol price relation is subject to nonlinearity and trajectory changes due to many historical events, the development of the MS-VAR-MLP model is a necessity to contribute to the ongoing debate regarding the shape of the EKC curve and the stability of the relation. The third purpose is to develop the MS-VAR-MLP-based regime-dependent sensitivity analysis, which eases the visual interpretation of the nonlinear causal relationships, which are allowed to have asymmetric interactions in different phases of the expansionary and recessionary periods of the business cycles. Our results provide clear deviations from the findings in the literature: (i) the shape of the EKC curve cannot be assumed to be stable and is subject to regime dependency, nonlinearity, and magnitude dependency; (ii) the forecast results suggest that incorporation of regime switching and neural networks provide significant improvement over the MS-VAR counterpart; and (iii) for both USA and UK and for the 1871–2016 period, the positive impacts of economic growth on emissions cannot be rejected for the majority of the phases of the business cycles; however, the magnitude of this effect is at various degrees. In addition, the incorporation of petrol price provides significant findings considering its effects on emission and economic growth rates. The analysis suggest clear deviations from the expected shape of the EKC curve and puts forth the necessity to utilize more complex empirical methodologies to evaluate the EKC since the emissions-economic development relation is more complex than it was assumed. Following these findings, several policy recommendations are provided. Lastly, the proposed MS-VAR-MLP methodology is compared with the MS-VAR model and various advantages and disadvantages are enumerated.

https://ift.tt/2CHGogG

The role of renewable and non-renewable energy consumption in CO 2 emissions: a disaggregate analysis of Pakistan

Abstract

The energy sector has become the largest contributor to greenhouse gas (GHG) emissions. Among these GHG emissions, most threatening is CO₂ emission which comes from the consumption of fossil fuels. This empirical work analyzes the roles of renewable energy consumption and non-renewable energy consumption in CO₂ emissions in Pakistan. The empirical evidence is based on an auto-regressive distributive lag (ARDL) model of data from 1970 to 2016. The disaggregate analysis reveals that renewable energy consumption has an insignificant impact on CO₂ emission in Pakistan and that, in the non-renewable energy model, natural gas and coal are the main contributors to the level of pollution in Pakistan. Economic growth positively contributes to CO₂ emission in the renewable energy model but not in the non-renewable energy model. Policies that emphasize the contribution of renewable energy to economic growth and that add more clean energy into the energy mix are suggested.

https://ift.tt/2CUtJY6

Association between itch and cancer in 16,925 pruritus patients: Experience at a tertiary care center

Pruritus has been associated with underlying malignancy. This article provides a comprehensive analysis of the association between pruritus and a diverse array of malignancies, with additional stratification by race, Knowledge of these associations can guide clinicians in pursuing malignancy workup for patients with unexplained pruritus

https://ift.tt/2QnQGVZ

Myofibroblastic sarcoma: Clinicopathologic features and experience from a sarcoma tertiary referral center

Background: Myofibroblastic sarcomas (MS) are rare malignancies characterized histologically by spindled cells with myofibroblastic differentiation. There is no common consensus on optimal management with surgery and adjuvant chemoradiotherapy yielding variable results.

https://ift.tt/2MlV30A

Oncological outcomes of early glottic carcinoma treated with transoral robotic surgery

Although glottic level is an off-label use of da Vinci system, the feasibility and early-term outcomes of transoral robotic surgery (TORS) for the treatment of early-stage (Tis, T1, T2) glottic carcinoma have been documented. But little is known about the oncological outcomes. We investigated the oncological outcomes of TORS in patients followed at least three years and mean follow-up time was over five years.

https://ift.tt/2OfmfA8

Optic Perineuritis Due to Tuberculosis

Abstract: A 30-year-old man experienced subacute peripheral visual field loss with preserved central vision in his right eye. He was diagnosed with optic perineuritis due to tuberculosis. Optic perineuritis is an uncommon disorder and, at times, can be difficult to distinguish from optic neuritis. The differentiation can have significant impact on diagnostic testing and patient management. Address correspondence to William B. Yates, MD, Sydney Eye Hospital, 8 Macquarie Street, Sydney, Australia; E-mail: yates.willb@gmail.com The authors report no conflicts of interest. © 2018 by North American Neuro-Ophthalmology Society

https://ift.tt/2x7sApT

Effect of Vitamin D Deficiency on Hypertrophic Scarring

BACKGROUND Although many different diseases have been reported with vitamin D deficiency, the authors failed to find any studies on the association of hypertrophic scarring (HS) in the literature. OBJECTIVE The authors aimed to determine the relationship between vitamin D deficiency and HS and investigate the effect of replacement therapy on HS development in patients with vitamin D deficiency. PATIENTS AND METHODS Patients who presented to the authors' outpatient clinic with HS between 2013 and 2016 were included in the study. In the first stage, all the patients with HS complaints were assessed for vitamin D levels. In the second stage, 50 patients with a vitamin D level less than 25 ng/mL and a linear scar after at least 1 year of trauma were randomly divided into 3 groups. Group 1: patients who did not accept any medical or surgical treatment; Group 2: patients who were subjected to vitamin D replacement only; Group 3: patients who underwent surgical excision and suturation after vitamin D replacement. RESULTS A statistically significant correlation was found between HS and vitamin D levels (p

https://ift.tt/2x6wS0H

Computer-Based Video Instruction for Training Medical Students on Skin Biopsies

BACKGROUND The development of procedural skills is necessary for medical students. Computer-based video instruction (CBVI) increases knowledge and procedural skills. OBJECTIVE This pilot study's aim was to investigate the usefulness of CBVI in dermatologic procedure training for medical students and secondarily assess students' overall perception of the field of dermatology. METHODS Twenty-nine first- and second-year medical students were randomly assigned to the CVBI group or control group, in addition to in-person instructor demonstration of shave and punch biopsies using fresh cadaver tissue. Blinded evaluators graded student performances using a five-point Likert scale immediately after demonstration, and 1 week later to assess knowledge retention. RESULTS In overall performance, the CBVI group demonstrated higher scores both in shave (3.54 vs 2.59, p = .01) and punch biopsies (3.63 vs 2.88, p = .01) at immediate recall and knowledge retention (3.68 vs 2.67, p = .01; 4.00 vs 2.99, p

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Methods of Standardizing Photography for Cellulite in the Buttocks and Thighs

No abstract available

https://ift.tt/2x3Ko5h

Recognition of Alkaptonuria During Mohs Micrographic Surgery

No abstract available

https://ift.tt/2NBqk4r

In the Crosshairs: Loss of Vellus Hair Follicles in Basal Cell Carcinoma. A Clue to Clinical Margin

No abstract available

https://ift.tt/2x73W8O

Efficacy, Safety, and Subject Satisfaction After AbobotulinumtoxinA Treatment of Upper Facial Lines

BACKGROUND Botulinum toxins are the treatment of choice for wrinkles in the upper third of the face. OBJECTIVE The purpose of this study was to evaluate the efficacy, safety, and subject satisfaction of abobotulinumtoxinA (ABO) for treatment of upper facial lines. MATERIALS AND METHODS Subjects aged 35 to 50 years with moderate-to-severe upper facial lines were included in this study. Subjects received a maximum of 125 s.U. ABO in at least 2 indications with optional touch-up after 2 weeks. Assessments included wrinkle severity, global aesthetic improvement, subject satisfaction, and adverse events (AEs) 1, 3, and 6 months after treatment. RESULTS At Month 1, 100, 94, and 93% of subjects were responders in dynamic glabellar, lateral canthal, and forehead lines, respectively. All subjects were improved 1 month after treatment, and the majority of the subjects were still improved after 6 months. After treatment, most subjects were satisfied with the appearance of their face, felt better about themselves, and agreed that the treatment made them look the way they feel. Seven subjects (22%) had 8 ABO-related AEs (mild–moderate); headache was most commonly reported (9%). CONCLUSION AbobotulinumtoxinA effectively treated upper facial lines, with high patient satisfaction. Treatment was generally well-tolerated. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Address correspondence and reprint requests to: Doris Hexsel, MD, Brazilian Center for Studies in Dermatology, Rua D. Pedro II 1592, 90550-141 Porto Alegre, RS, Brazil, or e-mail: doris@hexsel.com.br Galderma funded the study and provided the study products. Interim results from this study were previously presented as abstracts/posters at the International Master Course on Aging Science (IMCAS) Annual World Congress; January 26–29, 2017; Paris, France, and at the 15th Aesthetic and Anti-aging Medicine World Congress (AMWC); April 6–8, 2017; Monte Carlo, Monaco. D. Hexsel is a consultant for Galderma and Merz. P. Hedén is a consultant for Allergan, Teoxane, and Galderma. C. Skoglund and C. Edwartz are employed by Galderma. D. Rees of Zenith Healthcare Communications Ltd., provided medical writing assistance, funded by Galderma. P. Kestemont is a consultant for Allergan, Filorga, Galderma, Teoxane, Universkin, and Vivacy. The remaining authors have indicated no significant interest with commercial supporters. © 2018 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

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Epidermolysis Bullosa Patients' Perception of Surgical Wound and Scar Healing

BACKGROUND There is limited evidence to suggest patients with epidermolysis bullosa (EB) have more postoperative wound complications than the general population. Despite this, the authors have noted reluctance among some surgeons to operate on these patients. OBJECTIVE A cross-sectional study was designed to investigate postoperative wound and scar healing outcomes in patients with EB. METHODS Patients were asked to complete the "Surgical Wound and Scar Healing in EB" questionnaire, and data gathered were analyzed. RESULTS Forty-six patients completed the questionnaire for a total of 94 different surgical procedures. Five patients reported blistering at the surgical wound site. All 5 had generalized forms of EB. Four patients reported wound infections, and 1 patient reported wound dehiscence. The postoperative scar healed with keloid or hypertrophic scarring after 26% of the reported surgical procedures. CONCLUSION Blistering at the postoperative site seems to be uncommon and particularly unlikely to occur in localized forms of EB. Postoperative wound infections and dehiscence are uncommon. Patients with EB may have a propensity to develop keloid or hypertrophic scarring. With these data, the authors hope clinicians have greater confidence in referring patients with EB for surgery, and surgeons more reassured about postoperative wound healing. Address correspondence and reprint requests to: Dedee F. Murrell, MA, BMBCh, FAAD, MD, FACD, FRCP(Edin), Department of Dermatology, Ground floor James Laws House, St. George Hospital, Gray Street, Sydney, NSW 2217, Australia, or e-mail: d.murrell@unsw.edu.au The Australasian Blistering Diseases Foundation funded the ethics application for this study. The authors have indicated no significant interest with commercial supporters. © 2018 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

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Randomized Controlled Trial of Preoperative Topical Decolonization to Reduce Surgical Site Infection for Staphylococcus aureus Nasal Swab–Negative Mohs Micrographic Surgery Patients

BACKGROUND Surgical site infection (SSI) is mainly due to endogenous bacteria. Topical decolonization is a preoperative intervention currently advised for proven nasal carriers of Staphylococcus aureus (S. aureus). OBJECTIVE The authors assessed whether topical decolonization could be of benefit for patients who are not nasal carriers of S. aureus. METHODS AND MATERIALS The authors performed a randomized controlled trial of S. aureus nasal swab–negative patients. Five days before Mohs surgery topical decolonization with nasal mupirocin and chlorhexidine, body wash was started. The control group had no intervention. RESULTS In the week after Mohs surgery, the infection rate in the intervention group was 2% (n = 661, 14) and that of the control group was 4% (n = 689, 29). CONCLUSION Topical decolonization reduces SSI in nasal swab–negative Mohs surgery patients. Address correspondence and reprint requests to: Harvey Smith, MD, FACD, Oxford Dermatology, First Floor Suite 4A, 416-418 Oxford Street, Mount Hawthorn, Perth 6016, Western Australia, or e-mail: reception@oxforddermatology.com.au The study was partly funded by a grant from the Australasian College of Dermatologists. The authors have indicated no significant interest with commercial supporters. © 2018 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

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Hidradenitis Suppurativa After Radical Surgery—Long-Term Follow-up for Recurrences and Associated Factors

BACKGROUND Hidradenitis suppurativa (HS) is a chronic debilitating skin disease in inverse body areas. Wide excision is recommended in Hurley Stages II to III, but the rate and symptoms of recurrences in long-term follow-up remain unclear. OBJECTIVE To analyze the allocation of recurrences regarding the operative field, the onset and quality of HS symptoms as well as factors associated with recurrences in long-term follow-up. MATERIAL AND METHODS Forty-eight patients with Hurley Stage III disease who had undergone 91 wide excisions from 2010 to 2015 were clinically examined regarding postoperative complications and allocation and quality of recurrences. To determine the risk of recurrence, possible surgery, and lifestyle-related associated factors were investigated. RESULTS Postoperative recurrences of HS were seen in 54.2%. Most recurrences (inflamed nodules) were detected in a

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Deoxycholic Acid for Submental Fullness and More: Real-World Experience With 202 Patients

No abstract available

https://ift.tt/2NCGVor

Stability of Hyaluronic Acid Fillers After Insulated Microneedle Radiofrequency Treatment

No abstract available

https://ift.tt/2x1kPlc

Mixing of Injectable Fillers: A National Survey

BACKGROUND The mixing of hyaluronic acid or calcium hydroxylapatite fillers with normal saline, plain lidocaine, or lidocaine with epinephrine before injection is a familiar practice among dermatologists. However, the frequency of this practice and rationale behind it has not been well studied. OBJECTIVE To better elucidate the clinical practice of mixing fillers with other solutions before injecting among dermatologists. METHODS A survey was electronically distributed to members of the American Society for Dermatologic Surgery. RESULTS Four hundred seventy-five dermatologists responded to the survey. Thirty-five percent of respondents mix fillers before injection. Solutions used were as follows: plain lidocaine (44%), lidocaine with epinephrine (36%), normal saline (30%), and sterile water (7%). Respondents mix filler for the following reasons: to decrease viscosity (40%), increase anesthesia (30%), decrease swelling (17%), and increase volume (13%). CONCLUSION Despite the lack of evidence, more than one-third of dermatologists surveyed mix fillers with other solutions before injection. Plain lidocaine is most commonly used. The top reason for mixing fillers is to decrease viscosity and facilitate ease of injection. More scientific data are needed to support this practice and better understand the biophysical changes that occur when mixing fillers with other solutions. Addess correspondence and reprint requests to: David Ciocon, MD, Division of Dermatology, 111 E 210th Street, Bronx, NY 10476, or e-mail: dhciocon@gmail.com The authors have indicated no significant interest with commercial supporters. © 2018 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2NtBCb1

Allergy diagnosis from symptoms to molecules, or from molecules to symptoms: a comparative clinical study

Classical allergy diagnostic workup "from symptoms to molecules" comprises 1) clinical investigation, 2) skin prick- and IgE- testing, and recently, 3) molecular allergy testing. We aimed to examine the diagno...

https://ift.tt/2x36PrY

Incision Choices in Nipple-Sparing Mastectomy: A Comparative Analysis of Outcomes and Evolution of a Clinical Algorithm

Background: Nipple-sparing mastectomy (NSM) allows for preservation of the entire nipple-areola complex utilizing various incision patterns. Reconstructive trends and overall risk associated with these diverse NSM incisions have yet to be fully elucidated. Methods: All NSMs from 2006 to 2017 were identified; outcomes were stratified by type of mastectomy incision: lateral or vertical radial, inframammary fold, Wise pattern, previous, and periareolar. Results: A total of 1212 NSMs were performed with 1207 NSMs included for final analysis. Of these, 638 (52.9%) utilized an inframammary fold incision, 294 (24.4%) utilized a lateral radial incision, 161 (13.3%) used a vertical radial incision, 60 (5.0) utilized a Wise pattern incision, 35 (2.9%) used a previous incision, and 19 (1.6%) utilized a periareolar incision. The groups were heterogeneous and differed significantly with regards to various factors including age (p

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Unplanned Emergency Department Visits within 30-Days of Mastectomy and Breast Reconstruction

Background: Unplanned emergency department (ED) visits are often overlooked as an indicator of care quality. Our objectives were to (1) determine the rate of 30-day ED visits following mastectomy with or without immediate reconstruction, (2) perform a risk analysis of potential factors associated with ED return, and (3) assess for potentially preventable visits with a focus on returns for pain. Methods: Using the Healthcare Cost and Utilization Project data, we identified adult women who underwent mastectomy with or without reconstruction. Multivariable logistic regression was performed to evaluate risk of unplanned ED visits. We identified and sorted diagnostic codes to investigate why patients were seeking ED care. Additionally, we performed a subgroup analysis on patients returning with a pain-related diagnosis to evaluate risk. Results: Of 159,275 cases of mastectomy with or without immediate reconstruction, 4,917 (3.1%) experienced an unplanned return to the ED within 30 days of operation. Being younger, having any payer type other than a private payer, or having any number of comorbid conditions resulted in increased odds of revisit to ED. A substantial proportion of those who returned (23%) presented with a pain-related diagnosis. Only 0.9% of cases with a 30-day ED return were readmitted. Conclusions: Numerous patients return to the ED within 30-days of mastectomy with or without immediate reconstruction. There is a need for policy makers and physicians to implement strategies to reduce discretionary ED utilization, specifically among younger or publically insured patients. Combining unplanned ED visits with readmission rates as a care quality indicator warrants consideration. Funding: The work was supported by a Midcareer Investigator Award in Patient-Oriented Research (2 K24-AR053120-06) to Kevin C. Chung. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Additional funding for this work was supported by awards from the Chang Gung Memorial Hospital (project CORPG3G0111 and CORPG3G0161) to Ting-Ting Chung. Corresponding author: Kevin C. Chung, MD, MS, Section of Plastic Surgery, The University of Michigan Health System, 1500 E. Medical Center Drive , 2130 Taubman Center, SPC 5340, Ann Arbor, MI 48109-5340, Phone: 734-936-5885, Fax: 734-763-5354, E-mail: kecchung@med.umich.edu ©2018American Society of Plastic Surgeons

https://ift.tt/2Oa5zda

The Relationship between Bone Remodeling and the Clockwise Rotation of the Facial Skelton – A Computed Tomography Imaging based Evaluation

Objective: Changes in midfacial skeletal angles and widths have been identified to contribute to the appearance of the aging face. However, information on the onset and gender differences of these changes, as well as a complete understanding of the theory behind this clockwise rotation, remain elusive. Material and Methods: 157 Caucasian individuals (10 males and 10 females of each: 20 – 29yrs, 30 – 39yrs, 40 – 49yrs, 50 – 59yrs, 60 – 69yrs, 70 – 79yrs, 80 – 89yrs & 8 males and 9 females 90 – 98 years) were investigated. Multi-planar computed tomographic scans with standardized angle and distance measurements in all 3 anatomical axes (x, y, z) in alignment to the sella – nasion (horizontal) line were conducted. Results: Both males and females displayed an increase in orbital floor angle (p

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! # Ola via Alexandros G.Sfakianakis on Inoreader

Η λίστα ιστολογίων μου

Τρίτη 11 Σεπτεμβρίου 2018

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