Head and Neck Diseases by Alexandros G.Sfakianakis: 10/04/18

Πέμπτη 4 Οκτωβρίου 2018

Food‐induced fatal anaphylaxis: from epidemiological data to general prevention strategies

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

https://ift.tt/2Ryk8tc

Predictors of Therapeutic Outcome to Nucleotide Reverse Transcriptase Inhibitor in Hepatitis B Patients

Viral Immunology, Ahead of Print.

https://ift.tt/2CrWPNs

Meetings Calendar 2018

Rejuvenation Research, Ahead of Print.

https://ift.tt/2OBrM7h

How certainty appraisal might improve both body dissatisfaction and body overestimation in anorexia nervosa: a case report

Abstract

Background

Patients with anorexia nervosa often report a conscious alteration of body image representation, with both body overestimation and body dissatisfaction. Cognitive and behavioural therapy is effective for treating many psychiatric disorders but often fails to treat anorexia nervosa and body image distortions. Although patients are aware of their weight loss, they continue to feel overweight - as if there were a conflict between a previous (maybe already false) body representation and the new one. These distortions are linked to negative emotions focused on the body but which can extend to the self (e.g. disgust and sadness).

Case Presentation

The present case report is the first in which the Appraisal Tendency Framework has been applied to decrease body image distortions in a patient with anorexia nervosa. The Appraisal Tendency Framework is usually used to understand how emotions influence decision making. Here, we report on a 24-year-old woman who suffered from anorexia nervosa and body image distortions, and was treated as an inpatient with conventional cognitive and behavioural therapy for an eating disorder. Body image distortions were assessed before and after the patient completed an adaptation of the Iowa Gambling Task, coupled with the induction of a heuristic processing emotion. We hypothesized that allowing the patient to focus on the emotional cues in the modified Iowa Gambling Task would improve her decisions about her true body shape.

Conclusion

All body image measures were improved after the protocol. Consequently, we suggest that the Appraisal Tendency Framework might be a valuable means of investigating body image issues in eating disorders and anorexia nervosa. Further studies are required to expand and detail these findings.

https://ift.tt/2RrFqIP

Classification of lesions inducing acquired cholesteatomas of the middle ear: a didactic suggestion

Fernando de Andrade Quintanilha Ribeiro
Braz J Otorhinolaryngol.2018;84:529-31

Texto Completo - PDF

https://ift.tt/2PdrCjs

Bacteriology of peritonsillar abscess: the changing trend and predisposing factors

Yi‐Wen Tsai, Yu‐Hsi Liu, Hsing‐Hao Su
Braz J Otorhinolaryngol.2018;84:532-9

Resume - Texto Completo - PDF

https://ift.tt/2xWMeGc

Histopathological comparison of bone healing effects of endonasal and percutaneous lateral osteotomy methods in rabbit rhinoplasty model

Şahin Öğreden, Sedat Rüzgar, Hasan Deniz Tansuker, Ümit Taşkın, Yalçın Alimoğlu, Salih Aydın, Mehmet Faruk Oktay, Uğur İzol
Braz J Otorhinolaryngol.2018;84:540-4

Resume - Texto Completo - PDF

https://ift.tt/2P7NOeW

Endoscopic observation of different repair patterns in human traumatic tympanic membrane perforations

Peng Huang, Shujun Zhang, Xinhong Gong, Xuesong Wang, Zi‐Han Lou
Braz J Otorhinolaryngol.2018;84:545-52

Resume - Texto Completo - PDF

https://ift.tt/2y1oCAd

Familial misophonia or selective sound sensitivity syndrome: evidence for autosomal dominant inheritance?

Tanit Ganz Sanchez, Fúlvia Eduarda da Silva
Braz J Otorhinolaryngol.2018;84:553-9

Resume - Texto Completo - PDF

https://ift.tt/2PbuRIn

Is there a best side for cochlear implants in post‐lingual patients?

Maria Stella Arantes do Amaral, Thiago A. Damico, Alina S. Gonçales, Ana C.M.B. Reis, Myriam de Lima Isaac, Eduardo T. Massuda, Miguel Angelo Hyppolito
Braz J Otorhinolaryngol.2018;84:560-5

Resume - Texto Completo - PDF

https://ift.tt/2xWM95m

Prognostic significance of soft tissue deposits in laryngeal carcinoma

Omer Afsin Ozmen, Melih Alpay, Ozlem Saraydaroglu, Uygar Levent Demir, Fikret Kasapoglu, Hamdi Hakan Coskun, Oguz Ibrahim Basut
Braz J Otorhinolaryngol.2018;84:566-73

Resume - Texto Completo - PDF

https://ift.tt/2P7NNYq

Audiological and electrophysiological alterations in HIV‐infected individuals subjected or not to antiretroviral therapy

Carla Gentile Matas, Alessandra Giannella Samelli, Fernanda Cristina Leite Magliaro, Aluisio Segurado
Braz J Otorhinolaryngol.2018;84:574-82

Resume - Texto Completo - PDF

https://ift.tt/2xYVbyQ

Psychoacoustic classification of persistent tinnitus

Flavia Alencar de Barros Suzuki, Fabio Akira Suzuki, Ektor Tsuneo Onishi, Norma Oliveira Penido
Braz J Otorhinolaryngol.2018;84:583-90

Resume - Texto Completo - PDF

https://ift.tt/2PdfvmL

Disease‐specific quality of life after septoplasty and bilateral inferior turbinate outfracture in patients with nasal obstruction

Lucas Resende, Carolina do Carmo, Leão Mocellin, Rogério Pasinato, Marcos Mocellin
Braz J Otorhinolaryngol.2018;84:591-8

Resume - Texto Completo - PDF

https://ift.tt/2xWM5CE

Association of Ugrp2 gene polymorphisms with adenoid hypertrophy in the pediatric population

Mahmut Huntürk Atilla, Sibel Özdaş, Talih Özdaş, Sibel Baştimur, Sami Engin Muz, Işılay Öz, Kenan Kurt, Afife İzbirak, Mehmet Ali Babademez, Nilgün Vatandaş
Braz J Otorhinolaryngol.2018;84:599-607

Resume - Texto Completo - PDF

https://ift.tt/2PbPaW9

Effects of cavity reconstruction on morbidity and quality of life after canal wall down tympanomastoidectomy

Sinan Uluyol, Omer Ugur, Ilker Burak Arslan, Ozlem Yagiz, Murat Gumussoy, Ibrahim Cukurova
Braz J Otorhinolaryngol.2018;84:608-13

Resume - Texto Completo - PDF

https://ift.tt/2xWM1Tq

Temporomandibular disorder: otologic implications and its relationship to sleep bruxism

Bruno Gama Magalhães, Jaciel Leandro de Melo Freitas, André Cavalcanti da Silva Barbosa, Maria Cecília Scheidegger Neves Gueiros, Simone Guimarães Farias Gomes, Aronita Rosenblatt, Arnaldo de França Caldas Júnior
Braz J Otorhinolaryngol.2018;84:614-9

Resume - Texto Completo - PDF

https://ift.tt/2PbP4Oh

Multidimensional effects of voice therapy in patients affected by unilateral vocal fold paralysis due to cancer

Camila Barbosa Barcelos, Paula Angélica Lorenzon Silveira, Renata Lígia Vieira Guedes, Aline Nogueira Gonçalves, Luciana Dall'Agnol Siqueira Slobodticov, Elisabete Carrara‐de Angelis
Braz J Otorhinolaryngol.2018;84:620-9

Resume - Texto Completo - PDF

https://ift.tt/2y1BiXX

Retro‐ and orthonasal olfactory function in relation to olfactory bulb volume in patients with hypogonadotrophic hypogonadism

Murat Salihoglu, Onuralp Kurt, Seyid Ahmet Ay, Kamil Baskoy, Aytug Altundag, Muzaffer Saglam, Ferhat Deniz, Hakan Tekeli, Arif Yonem, Thomas Hummel
Braz J Otorhinolaryngol.2018;84:630-7

Resume - Texto Completo - PDF

https://ift.tt/2PdsbtJ

Diagnostic validity of methods for assessment of swallowing sounds: a systematic review

Karinna Veríssimo Meira Taveira, Rosane Sampaio Santos, Bianca Lopes Cavalcante de Leão, José Stechman Neto, Leandro Pernambuco, Letícia Korb da Silva, Graziela De Luca Canto, André Luís Porporatti
Braz J Otorhinolaryngol.2018;84:638-52

Resume - Texto Completo - PDF

https://ift.tt/2y1lc0g

The use of tDCS as a therapeutic option for tinnitus: a systematic review

Amanda dos Humildes Maia Santos, Afonso Paranhos Silva Santos, Henrique Souza Santos, Adriana Campos da Silva
Braz J Otorhinolaryngol.2018;84:653-9

Resume - Texto Completo - PDF

https://ift.tt/2PcGMpo

Transoral robotic supraglottic partial laryngectomy: report of the first Brazilian case

Claudio Roberto Cernea, Leandro Luongo Matos, Dorival de Carlucci Junior, Fernando Danelon Leonhardt, Leonardo Haddad, Fernando Walder
Braz J Otorhinolaryngol.2018;84:660-4

Texto Completo - PDF

https://ift.tt/2xZZt98

Bilateral primary histiocytoid eccrine sweat gland carcinoma of eyelids

Malgorzata Seredyka‐Burduk, Pawel Krzysztof Burduk, Magdalena Bodnar, Grazyna Malukiewicz, Andrzej Kopczynski
Braz J Otorhinolaryngol.2018;84:665-8

Texto Completo - PDF

https://ift.tt/2PjByba

Stafne bone cavity containing ectopic parotid gland

Mesut Kaya, Kadriye Serife Ugur, Elif Dagli, Hanifi Kurtaran, Mehmet Gunduz
Braz J Otorhinolaryngol.2018;84:669-72

Texto Completo - PDF

https://ift.tt/2y3j20f

Congenital absence of the deep inferior epigastric system: a case report

Abstract

Preoperative computerised tomographic angiography (CTA) in free flap breast reconstruction outlines the deep inferior epigastric perforator (DIEP). It can identify a single or twin system, measure vessel calibre, and identify iatrogenic/congenital anatomical variations. Evidence of the effect of previous abdominal incisions on this vessel system remain inconclusive. We present the case of a congenital absence of the system identified from routine preoperative CTA. A 61-year-old female presented for immediate unilateral breast reconstruction following mastectomy for ductal carcinoma in situ. She previously had a right-sided Kocher's incision performed for an open cholecystectomy and a gridiron incision. Coincidentally, preoperative CTA demonstrated congenital absence of the left DIEP system, and marked atrophy of the upper right rectus abdominis (RA). As a result, the superior gluteal artery perforator (SGAP) flap was planned. Intraoperatively, a 1.318-kg SGAP was raised on three perforators and coupled to the internal mammary vessels. In the postoperative period, there were no complications. Preoperative CTA demonstrated multiple hazards in raising a DIEP flap, CTA permitted surgical planning, improving patient safety and surgical efficiency. Preoperative CTA identifies vessel abnormalities resulting from abdominal scarring. The rate of congenital anomalies is unknown. This incidental discovery highlights the role CTA has in reducing operative time, facilitating a successful free tissue transfer, therefore improving patient safety.

Level of Evidence: Level V, diagnostic study.

https://ift.tt/2IFGm8r

Risk assessment of some organic contaminants: a case study based on food consumption in Tanta and Ismailia cities, Egypt

Abstract

The impact of some organic pollutants on some residents of Tanta and Ismailia cities of Egypt through their consumption of vegetables, fruits and fish (Nile tilapia and catfish) was examined. Residues of organochlorine (OC_S) and organophosphorus (OP_S) as some polychlorinated biphenyls (PCB_S) were compared with pesticides as well maximum residue limits (MRL_S). Probable health risk to consumers was also assessed. P, P′-DDT, P, P′-DDE, P, P′-DDD, endrin, α-BHC, (lindane), and hexachlorbenzene (HCB) were the most detected organochlorine compounds, but did not exceed MRLs.

However, OP_S residues were the most frequently detected contaminants. PCBs congeners 28, 70, 52, and 180 were detected in tilapia fish from Tanta, but congeners 28 and 180 were the only detected congeners in samples collected from Ismailia region. ∑PCB_S values in all matrices did not exceed MRL_S. Hazard index (HI) exhibited unity for all compounds at 50 the decreasing order: catfish > vegetables > fruits > Nile tilapia in Tanta, while in Ismailia the order was Nile tilapia > fruit > vegetables. Results also revealed that risk values for adults were greater than those of children categories.

https://ift.tt/2RpwEuS

Thyroid® High-Impact Articles

FREE ACCESS

Read now:

Latest Impact Factor: 7.557
The Official Journal of: American Thyroid Association^®

Incidences of Unfavorable Events in the Management of Low-Risk Papillary Microcarcinoma of the Thyroid by Active Surveillance Versus Immediate Surgery
Hitomi Oda, Akira Miyauchi, Yasuhiro Ito, Kana Yoshioka, Ayako Nakayama, Hisanori Sasai, Hiroo Masuoka, Tomonori Yabuta, Mitsuhiro Fukushima, Takuya Higashiyama, Minoru Kihara, Kaoru Kobayashi, and Akihiro Miya

A Clinical Framework to Facilitate Risk Stratification When Considering an Active Surveillance Alternative to Immediate Biopsy and Surgery in Papillary Microcarcinoma
Juan P. Brito, Yasuhiro Ito, Akira Miyauchi, and R. Michael Tuttle

Subclinical Hypothyroidism in Pregnancy: A Systematic Review and Meta-Analysis
Spyridoula Maraka, Naykky M. Singh Ospina, Derek T. O'Keeffe, Ana E. Espinosa De Ycaza, Michael R. Gionfriddo, Patricia J. Erwin, Charles C. Coddington III, Marius N. Stan, M. Hassan Murad, and Victor M. Montori

Preoperative Cytologic Diagnosis of Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features: A Prospective Analysis
Kyle C. Strickland, Marina Vivero, Vickie Y. Jo, Alarice C. Lowe, Monica Hollowell, Xiaohua Qian, Tad J. Wieczorek, Christopher A. French, Lisa A. Teot, Peter M. Sadow, Erik K. Alexander, Edmund S. Cibas, Justine A. Barletta, and Jeffrey F. Krane

An International Multi-Institutional Validation of Age 55 Years as a Cutoff for Risk Stratification in the AJCC/UICC Staging System for Well-Differentiated Thyroid Cancer
Iain J. Nixon, Laura Y. Wang, Jocelyn C. Migliacci, Antoine Eskander, Michael J. Campbell, Ahmad Aniss, Lilah Morris, Fernanda Vaisman, Rossana Corbo, Denise Momesso, Mario Vaisman, Andre Carvalho, Diana Learoyd, William D. Leslie, Richard W. Nason, Deborah Kuk, Volkert Wreesmann, Luc Morris, Frank L. Palmer, Ian Ganly, Snehal G. Patel, Bhuvanesh Singh, R. Michael Tuttle, Ashok R. Shaha, Mithat Gönen, K. Alok Pathak, Wen T. Shen, Mark Sywak, Luis Kowalski, Jeremy Freeman, Nancy Perrier, and Jatin P. Shah

Noninvasive Follicular Variant of Papillary Thyroid Carcinoma and the Afirma Gene-Expression Classifier
Kristine S. Wong, Trevor E. Angell, Kyle C. Strickland, Erik K. Alexander, Edmund S. Cibas, Jeffrey F. Krane, and Justine A. Barletta

Clinical and Pathologic Predictors of Lymph Node Metastasis and Recurrence in Papillary Thyroid Microcarcinoma
Saaduddin Siddiqui, Michael G. White, Tatjana Antic, Raymon H. Grogan, Peter Angelos, Edwin L. Kaplan, and Nicole A. Cipriani

The 2017 Bethesda System for Reporting Thyroid Cytopathology
Edmund S. Cibas and Syed Z. Ali

The post Thyroid® High-Impact Articles appeared first on American Thyroid Association.

https://ift.tt/2P8BKdy

Thyroid® High-Impact Articles

FREE ACCESS

Read now:

Latest Impact Factor: 7.557
The Official Journal of: American Thyroid Association^®

The 2017 Bethesda System for Reporting Thyroid Cytopathology
Edmund S. Cibas and Syed Z. Ali

The post Thyroid® High-Impact Articles appeared first on American Thyroid Association.

https://ift.tt/2P8BKdy

Anatomy of the Superficial Venous Structures of the Neck: A Cadaveric Study to Guide Superficial Injections

BACKGROUND Minimally invasive aesthetic procedures of the neck are becoming more popular. However, anatomical studies on the venous structures of the neck in relation to these procedures are lacking. OBJECTIVE The aims of this study were to identify the locations and communication patterns of the anterior jugular vein and external jugular vein (AJV and EJV) and the communicating vein (CV) based on superficial anatomical landmarks and to determine dangerous areas for dermal filler injections into the neck. MATERIALS AND METHODS Thirty sides of the neck from Korean adult cadavers were dissected for this study. RESULTS Four anatomical variants were identified. In Type Ia, the CV ran along the anterior border of the sternocleidomastoid muscle (SCM) (33.4%); in Type Ib, a single vein was observed connecting the CV and the EJV at the level of laryngeal prominence (23.3%); in Type Ic, the CV proceeded separately from the medial side of the anterior border of the SCM (13.3%); and in Type II, the CV was absent while the EJV and AJV were observed (30%). CONCLUSION Given the 4 anatomical variants identified in this study, the authors recommend exerting caution when performing dermal filler injections approximately 10, 30, and 60 mm lateral to the midsagittal line to avoid iatrogenic side effects. Address correspondence and reprint requests to: Kyung-Seok Hu, DDS, PhD, Room 601, Department of Oral Biology, Yonsei University College of Dentistry 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea, or e-mail: hks318@yuhs.ac Supported by a faculty research grant of Yonsei University College of Dentistry (6-2016-0027). The authors have indicated no significant interest with commercial supporters. H.-J. Lee and S.-Y. Ryu have contributed equally to this work. © 2018 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2ybcmwc

Activation of peroxymonosulfate by Fe-N complexes embedded within SBA-15 for removal of organic contaminants via production of singlet oxygen

Abstract

Persulfates are recognized as promising oxidants and an alternative to Fenton reaction for water treatment. However, activation methods in hand restrict the practical application. Herein, we explore the possibility of Fe-N complexes being a catalyst for persulfate activation for the first time. The catalyst denoted as Fe-Im-SBA was synthesized from ferric chloride, imidazole, and SBA-15 at high temperature. The internal pore structure of Fe-Im-SBA was maintained well; Fe, N and C elements are evenly distributed on the catalyst. This catalyst presents an extraordinarily catalytic activity for Rh B removal by PMS activation with a removal rate of Rh B that reached up to 97.0% in the first 5 min. It also performed well in a wide pH range with complete removal of Rh B in pH ranged from 0.5 to 10, suggesting the stability of this catalyst in both acidic and alkaline conditions. It also showed high adaptability to degrade different kinds of pollutants, which could give an attractive advantage of Fe-Im-SBA for environmental implications. Through X-ray absorption spectroscopies analysis, it shows that the active sites of Fe-Im-SBA are composed of Fe-N₄ sites and Fe₂–N₂ sites. ¹O₂ were proved to generate in the Fe-Im-SBA/PMS system and serve as the major ROS. Meanwhile, graphitic carbon can accelerate the transfer of electrons, which may also be the reason for its high catalytic performance.

https://ift.tt/2y0VCIR

Distribution of organic and inorganic mercury in the tissues and organs of fish from the southern Baltic Sea

Abstract

The aim of this study was to determine the distribution of total mercury (THg), methylmercury (CH₃Hg⁺), and inorganic mercury (Hg_inorg) in the tissues and organs of fish depending on species, tissue, and organ, and their bioaccumulation in tissues and biomagnification throughout the trophic web. The study included four species of fish (herring, sprat, cod, and eel) from the southern Baltic Sea. The concentrations of the different forms of mercury were determined in tissues and internal organs. Intra-specific differences in levels of THg, CH₃Hg⁺, and Hg_inorg in the tissues and organs were determined. Muscle contained the highest proportions of THg and CH₃Hg⁺ in comparison to that in the internal organs. Differences in concentrations of THg, CH₃Hg⁺, and Hg_inorg in the tissues and organs of fish were related to their preferred prey. The bioaccumulation of CH₃Hg+ in the tissues and organs of predatory fish at the highest trophic levels was greater than in the liver and digestive tract of fish species at lower trophic levels, in which Hg_inorg predominated. The high concentrations of CH₃Hg⁺ in eel and cod and the low levels in herring and sprat were linked with their food and the transfer of this element among species. The results suggested that the type of food, feeding habits, and trophic position were important parameters that influenced the transfer and biomagnification of mercury in fish.

https://ift.tt/2Pc5QN2

Dietary propionic acid enhances antibacterial and immunomodulatory effects of oxytetracycline on Nile tilapia, Oreochromis niloticus

Abstract

This study was carried out to evaluate the potential antibacterial and immunomodulatory effects of the dietary acidifier propionic acid (PA) when given alone or in combination with oxytetracycline (OTC) on Nile tilapia (Oreochromis niloticus). Apparently healthy O. niloticus (n = 240; 52 ± 3.75 g) were randomly allocated into four equal groups (n = 60/group): control group fed a basal diet alone and the other three groups fed basal diets supplemented with either PA (200 mg /kg of diet, PA group) or OTC (500 mg/kg of diet, OTC group) alone or in combination (PA + OTC group). Each group was subdivided into two subgroups (n = 30/subgroup, each subgroup had triplicate of 10 fish); subgroup (A) was used to evaluate the antibacterial effects with the aforementioned 2 weeks feeding regime, and subgroup (B) was used to evaluate the immunomodulatory effects against Aeromonas hydrophila infection with similar 2 weeks feeding regime. Among the four groups, PA + OTC group showed the highest significant (p < 0.0001) antibacterial activity as indicated by widest inhibition zones against A. hydrophila and lowest total gastrointestinal bacterial counts. Additionally, this group had the best immunomodulatory effect as noticed by a significant (p < 0.05) increase in total serum protein, globulin, IgM, phagocytic activity and index, lysosome activity, and significant (p < 0.05) upregulation in the expression levels of immunity-related genes (MHC I, MHC IIA, MHC IIB, Tlr7, IgM heavy chain, TNFα, and IL1β) in head-kidney. Notably, the combined dietary PA and OTC improved the hematological parameters and reduced the oxidative damage of hepatopancreas and head-kidney induced by OTC. This data suggests dietary PA as potential adjuvant to OTC in O. niloticus diets to get maximal antibacterial and immunomodulatory effects.

https://ift.tt/2xZzPS6

Real-Time Measurement of Xenon Concentration in a Binary Gas Mixture Using a Modified Ultrasonic Time-of-Flight Anesthesia Gas Flowmeter: A Technical Feasibility Study

BACKGROUND: Xenon (Xe) is an anesthetic gas licensed for use in some countries. Fractional concentrations (%) of gases in a Xe:oxygen (O2) mixture are typically measured using a thermal conductivity meter and fuel cell, respectively. Speed of sound in such a binary gas mixture is related to fractional concentration, temperature, pressure, and molar masses of the component gases. We therefore performed a study to assess the feasibility of developing a novel single sterilizable device that uses ultrasound time-of-flight to measure both real-time flowmetry and fractional gas concentration of Xe in O2. METHODS: For the purposes of the feasibility study, we adapted an ultrasonic time-of-flight flowmeter from a conventional anesthetic machine to additionally measure real-time fractional concentration of Xe in O2. A total of 5095 readings of Xe % were taken in the range 5%–95%, and compared with simultaneous measurements from the gold standard of a commercially available thermal conductivity Xe analyzer. RESULTS: Ultrasonic measurements of Xe (%) showed agreement with thermal conductivity meter measurements, but there was marked discontinuity in the middle of the measurement range. Bland-Altman analysis (95% confidence interval in parentheses) yielded: mean difference (bias) 3.1% (2.9%–3.2%); lower 95% limit of agreement −4.6% (−4.8% to −4.4%); and upper 95% limit of agreement 10.8% (10.5%–11.0%). CONCLUSIONS: The adapted ultrasonic flowmeter estimated Xe (%), but the level of accuracy is insufficient for clinical use. With further work, it may be possible to develop a device to perform both flowmetry and binary gas concentration measurement to a clinically acceptable degree of accuracy. Accepted for publication August 17, 2018. Funding: None. Conflicts of Interest: See Disclosures at the end of the article. Some preliminary data from the first part of this study were presented as a poster at the European Society of Anaesthesia Annual Conference, Geneva, Switzerland, June 5, 2017. Reprints will not be available from the authors. Address correspondence to David J. Williams, FRCA, Department of Anaesthetics, Morriston Hospital, Swansea SA6 6NL, United Kingdom. Address e-mail to davidjwilliams@doctors.org.uk. © 2018 International Anesthesia Research Society

https://ift.tt/2IBXaNw

Predicting the Size of a Left Double-Lumen Tube for Asian Women Based on the Combination of the Diameters of the Cricoid Ring and Left Main Bronchus: A Randomized, Prospective, Controlled Trial

BACKGROUND: There are limited data about how to choose the correct size of a double-lumen tube (DLT). It is especially difficult to select an appropriate DLT for Asian women because of their small stature. The primary aim of this study was to compare the overall accuracy of the DLT selected based on the combination of transverse diameter of cricoid ring and the equivalent diameter of the left main bronchus (ED-LMB) with that based on the ED-LMB alone for Asian women. METHODS: In this study, 80 consecutive and blinded female patients were assigned randomly to 2 groups. The overall accuracy of the selection of DLT was compared between the Combined group and LMB group. The accuracy of the selection of tracheal segment and bronchial segment was also compared between the 2 groups. The postoperative hoarseness and sore throat were investigated by blinded assessors. RESULTS: The overall accuracy of selection of the DLTs was higher in the Combined group than that in the LMB group (87.5% vs 60.0%; P = .010). The accuracy of selection of tracheal segment was also higher in the Combined group (92.5% vs 67.5%; P = .010). The accuracy of selection of bronchial segment was similar between the groups (95.0 % vs 86.1%; P = .246). The severity of sore throat was higher in the LMB group at 24 hours after the operation (P = .001). CONCLUSIONS: The correct size of DLT for Asian women should be selected based on the combination of transverse diameter of cricoid ring and the ED-LMB. Accepted for publication August 29, 2018. Funding: None. The authors declare no conflicts of interest. Clinical trial number and registry URL: ChiCTR-INR-17013040, https://ift.tt/2IBXrA2. Reprints will not be available from the authors. Address correspondence to Dong Youjing, PhD, Shengjing Hospital, China Medical University, No. 36 Sanhao St, Heping District, 110004 Shenyang, China. Address e-mail to dongyj@sj-hospital.org. © 2018 International Anesthesia Research Society

https://ift.tt/2pCC0X0

Regional Anesthesia and Readmission Rates After Total Knee Arthroplasty

BACKGROUND: Total knee arthroplasty is a commonly performed procedure and an important contributor to national health care spending. Reducing the incidence of readmission could have important consequences for patient well-being and relevant financial implications. Whether regional anesthesia techniques are associated with decreased readmission rates and costs among privately insured patients remains unknown. METHODS: Using administrative claims data, we identified 138,362 privately insured patients 18–64 years of age who underwent total knee arthroplasty between 2002 and 2013. We then examined whether the use of a nerve block was associated with decreases in readmission rates and related costs during the 90 days after discharge. Our analyses were adjusted for potential confounding variables including medical comorbidities and previous use of opioids and other medications. RESULTS: After adjusting for patient demographics, comorbidities, and preoperative medication use, the adjusted 90-day readmission rate was 1.8% (95% confidence interval [CI], 1.1–2.4) among patients who did not receive a block compared to 1.7% (95% CI, 1.1–2.4) among patients who did (odds ratio, 0.99; 95% CI, 0.91–1.09; P = .85). The adjusted readmission-related postoperative cost for patients who did not receive a block was $561 (95% CI, 502–619) and $574 (95% CI, 508–639) for patients who did (difference, $13; 95% CI, −75 to 102; P = .74). This lack of statistically significant differences held for subgroup and sensitivity analyses. CONCLUSIONS: Nerve blocks were not associated with improved measures of long-term postoperative resource use in this younger, privately insured study population. Accepted for publication August 24, 2018. Funding: E.C.S. was supported by the National Institute on Drug Abuse (K08DA042314). Conflicts of Interest: See Disclosures at the end of the article. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). This work was presented at the Medical Student Anesthesia Research Fellowship (MSARF) symposium at the annual American Society of Anesthesiologists meeting, Boston, MA, October 22, 2017. Reprints will not be available from the authors. Address correspondence to Eric C. Sun, MD, PhD, Department of Anesthesiology, Perioperative and Pain Medicine, H3580, Stanford University Medical Center, Stanford, CA 94305. Address e-mail to esun1@stanford.edu. © 2018 International Anesthesia Research Society

https://ift.tt/2pCiBFw

Predosing Chemical Stability of Admixtures of Propofol, Ketamine, Fentanyl, and Remifentanil

Admixtures of propofol–ketamine, propofol–ketamine–fentanyl, and propofol–ketamine–remifentanil were subjected to various clinically relevant conditions to study their chemical stability. A novel high-performance liquid chromatography-mass spectrometry method revealed no degradation of any compound by incubation at 37°C, constant mixing, or table-top storage for 6- and 24-hour time periods, except variable recovery of both propofol and fentanyl in the admixtures of propofol–ketamine–fentanyl suggesting possible degradation. Accepted for publication August 1, 2018. Funding: US Army Medical Research and Materiel Command. The authors declare no conflicts of interest. The views expressed in this article are those of the authors and do not reflect the official policy of the Uniformed Services University, Departments of the Army, Navy, or Air Force, Department of Defense, Department of Veterans Affairs, or the US Government. Reprints will not be available from the authors. Address correspondence to Peter Bedocs, MD, PhD, Defense and Veterans Center for Integrative Pain Management, Henry M. Jackson Foundation, 11300 Rockville Pike, Suite 709, Rockville, MD 20852. Address e-mail to peter.bedocs.ctr@usuhs.edu. © 2018 International Anesthesia Research Society

https://ift.tt/2pA6xoh

Resident Competency and Proficiency in Combined Spinal–Epidural Catheter Placement Is Improved Using a Computer-Enhanced Visual Learning Program: A Randomized Controlled Trial

BACKGROUND: Physician educators must balance the need for resident procedural education with clinical time pressures as well as patient safety and comfort. Alternative educational strategies, including e-learning tools, may be beneficial to orient novice learners to new procedures and speed proficiency. We created an e-learning tool (computer-enhanced visual learning [CEVL] neuraxial) to enhance trainee proficiency in combined spinal–epidural catheter placement in obstetric patients and performed a randomized controlled 2-center trial to test the hypothesis that use of the tool improved the initial procedure performed by the anesthesiology residents. METHODS: Anesthesiology residents completing their first obstetric anesthesiology rotation were randomized to receive online access to the neuraxial module (CEVL group) or no access (control) 2 weeks before the rotation. On the first day of the rotation, residents completed a neuraxial procedure self-confidence scale and an open-ended medical knowledge test. Blinded raters observed residents performing combined spinal–epidural catheter techniques in laboring parturients using a procedural checklist (0–49 pts); the time required to perform the procedure was recorded. The primary outcome was the duration of the procedure. RESULTS: The CEVL group had significantly shorter mean (±standard deviation) procedure time compared to the control group 22.5 ± 4.9 vs 39.5 ± 7.1 minutes (P

https://ift.tt/2IBOkiR

Red Blood Cell Transfusion in Pediatric Orthotopic Liver Transplantation: What a Difference a Few Decades Make

BACKGROUND: Liver transplantation in children is often associated with coagulopathy and significant blood loss. Available data are limited. In this observational retrospective study, we assessed transfusion practices in pediatric patients undergoing liver transplantation at a single institution over the course of 9 years. METHODS: Data were retrospectively collected from patient medical records at the Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center. All patients who underwent liver transplantation from January 2008 to June 2017 were included. Primary and secondary outcomes were volume of red blood cells (RBCs) transfused and mortality, respectively. RESULTS: From January 2008 to June 2017, there were 278 liver transplants in 271 patients. The number of primary transplants were 259, second retransplants 15, and third retransplants 4. Average age at transplantation was 6.9 years. Biliary atresia, maple syrup urine disease, urea cycle defect, and liver tumor were the leading indications accounting for 66 (23.7%), 45 (16.2%), 24 (8.6%), and 23 (8.3%) of transplants, respectively. Seventy-six cases (27.3%) did not require RBC transfusions. Among those transfused, 181 (89.6%) of the cases required 12 months of age (0.12 BV). By diagnosis, the group requiring the highest median volume transfusion was patients with total parenteral nutrition–related liver failure (3.41 BV) followed by patients undergoing repeat transplants (0.6 BV). Comparison of primary versus repeat transplants shows a trend toward higher volume transfusions in third transplants (median, 2.71 BV), compared to second transplants (0.43 BV) and primary transplants (0.18 BV). Four of 271 patients (1.5%) died during admission involving liver transplantation. Nine of 271 patients (3.3%) died subsequently. Total mortality was 4.8%. CONCLUSIONS: In contrast to historically reported trends, evaluation of current transfusion practices reveals that most patients undergoing liver transplantation receive

https://ift.tt/2pCx3NW

Statistical Versus Clinical Significance in Subclavian Vein Cross-Sectional Area: Is a 0.10-cm2 Difference Really Meaningful or Just an Example of False Precision?

No abstract available

https://ift.tt/2pAg7ra

Lupin: An Emerging Food Allergen in the United States

Food allergies are on the rise and becoming a global concern.1 Common food allergens are well recognized and have been studied extensively in the US and Europe. However, there is a gradual emergence of new food allergens such as lupin, which are neither as well characterized nor studied.

https://ift.tt/2CvHds6

Sensitization Profiles to Hazelnut Allergens across the United States of America

Hazelnut is a widely consumed tree nut and among the top five most serious instigators of food allergic reactions.1-4 Hazelnut allergy can manifest symptoms that range from mild oral itching to fatal anaphylaxis.4-7 Population-based surveys have found that the incidence of hazelnut allergy varies greatly from location to location, depending on exposure to cross-reacting pollen allergens.8-10 The prevalence of hazelnut allergy is estimated to be 0.2 % in children and up to 4.5 % in adults in regions with heavy exposure to pollen of birch or related tree species.

https://ift.tt/2BUX6ai

Level of competence of primary and secondary school teachers in the management of anaphylaxis

Anaphylaxis is a severe hypersensitivity reaction, with the highest incidence in early childhood.1 It can lead to respiratory arrest, so early detection and immediate reaction is needed.2 However, this is not always simple, as most of the reactions occur far from hospitals, for example, at school.3 Since children spend much of their time in school, teachers should know how to identify and manage these situations. In Spain, training programmes aimed at teachers for the management of anaphylactic reactions, such as the "School Alert (Alerta Escolar) Program",4 have been developed.

https://ift.tt/2CrYliu

The scratch collapse test: a systematic review

The diagnosis of nerve compression relies on collecting diagnostic clues from the history, physical exam, imaging, and diagnostic testing. There are several provocative tests to aide in the diagnosis of nerve compression. The 'Scratch Collapse Test' (SCT) has emerged as a new provocative test to assist in the localization of peripheral nerve compression. This study aims to perform a systematic review of the literature to assess the data on the reliability of the SCT as a diagnostic test for entrapment neuropathy.

https://ift.tt/2Nli4kZ

Use of disposable blade for harvesting epidermal skin graft

https://ift.tt/2O4qq5u

Late growth of infantile hemangiomas in children >3 years of age: A retrospective study

The proliferative phase of infantile hemangiomas (IHs) is usually complete by 9 months of life. Late growth beyond age 3 years is rarely reported.

https://ift.tt/2PajzE5

Distances of root apices to adjacent anatomical structures in the anterior maxilla: an analysis using cone beam computed tomography

Abstract

Objectives

The aim was to assess the anatomical relationship of anterior maxillary teeth to the nasal floor in patients referred for apical surgery.

Materials and methods

Cone beam computed tomographic images (CBCT) of 83 patients were analysed retrospectively to quantify the distances between the root apices of maxillary anterior teeth (canine to canine) to the nasal floor or maxillary sinus (whichever was closer). Secondary outcome variables were the distances of the periapical lesion to the nasal floor, distances of the apices to the labial and palatal bone plates as well as to the neighbouring teeth.

Results

A total of 93 teeth (39 central, 35 lateral incisors and 19 canines) were analysed. The mean shortest distances of the apices to the nasal floor (or maxillary sinus) were 8.54 mm for central incisors, 9.49 mm for lateral incisors and 5.39 mm for the canines. The canines exhibited a significantly shorter distance to the nasal floor/maxillary sinus. In the presence of an osteolysis, the distance to the nasal floor was significantly shorter compared to the teeth without lesions. The lateral and central incisors showed significant proximity to each other at the level of the future surgical resection (3 mm from the apex).

Conclusions

A close proximity between apices and adjacent anatomical structures such as nasal floor, maxillary sinus or adjacent roots could be shown in some cases.

Clinical relevance

CBCT could be a valuable adjunctive imaging tool prior to apical surgery in the anterior maxilla to assess the risk for and decrease the incidence of damage to neighbouring anatomical structures such as the nasal floor, maxillary sinus or adjacent roots.

https://ift.tt/2PcJrPN

Lipid organization in xerosis: The key of the problem?

International Journal of Cosmetic Science, Volume 0, Issue ja, -Not available-.

https://ift.tt/2PfabPT

Two facets of sweat: A defensive factor in skin tissues and an accelerating factor for allergic skin diseases

Publication date: October 2018

Source: Allergology International, Volume 67, Issue 4

Author(s): Hiroo Yokozeki, Kenji Izuhara

https://ift.tt/2DWf66L

Congenital cytomegalovirus infection inducing non-congenital sensorineural hearing loss during childhood; a systematic review

Publication date: Available online 4 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Maria Riga, George Korres, Pantelis Chouridis, Stephanos Naxakis, Vasilios Danielides

Abstract

Background

Congenital cytomegalovirus (CMV) infection is one of the most important risk factors for delayed onset and progressive hearing loss in children. However, the relevant literature is limited, heterogeneous and currently insufficient to provide guidance toward the effective monitoring of hearing acuity in these children.

Objectives

The aim of this study was to provide a systematic review focused on types of hearing loss that may escape diagnosis through universal neonatal hearing screening and/or present significant changes during childhood, such as progressive, fluctuating and late-onset hearing loss.

Data sources

A review of the present literature was conducted via the PubMed database of the US National Library of Medicine (www.pubmed.org) and Scopus database (www.scopus.com) with the search terms "late-onset hearing loss cytomegalovirus", "progressive hearing loss cytomegalovirus" and "fluctuating hearing loss cytomegalovirus".

Study eligibility criteria

Prospective or retrospective clinical studies were included if they presented a detailed audiological assessment, for a follow-up period of >2years.

Methods

The prevalence and time of diagnosis of progressive, fluctuating and late-onset hearing loss were considered as primary outcomes. Results were recorded separately for symptomatic and asymptomatic children, when possible.

Results

This analysis refers to a population of 181 children with CMV-induced hearing loss, who were diagnosed among 1089 with congenital CMV infection. The prevalence of CMV-induced hearing loss was significantly higher among symptomatic children (p<0.0001), who were also significantly more likely to develop bilateral hearing loss (p=0.001). There was not sufficient information on the prevalence, laterality, degree and time of diagnosis of progressive, fluctuating and late-onset hearing loss that could constitute the basis toward the report of specific follow-up guidelines.

Conclusions

Further studies are needed in order to understand and quantify the potential effects of congenital CMV infection in the inner ear and hearing acuity. The results presented in the relative studies should be very carefully evaluated and compared to each other, since they correspond to substantially different cohorts, study designs, and result elaboration. Infants with congenital CMV infection should be closely monitored, regarding their hearing acuity at least during their preschool years, although substantial changes in hearing thresholds have been reported as late as the 16^th year of age. Parental counseling is of outmost importance in order to minimize the numbers of children lost to follow-up.

https://ift.tt/2y15pyx

Urine concentrations changes of cysteinyl leukotrienes in non-obese children with obstructive sleep apnea undergoing adenotonsillectomy

Publication date: Available online 4 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): George Κ. Mousailidis, Vasileios A. Lachanas, Afroditi Vasdeki, Emmanuel I. Alexopoulos, Athanasios G. Kaditis, Petinaki Efthymia, Nick Balatsos, John G. Bizakis, Charalampos E. Skoulakis

Abstract

Objective

The main objective of the study was to compare preoperative to postoperative levels of urine-Cysteinyl leukotrienes (uCysLT) in children undergoing adenotonsillectomy (AT) for obstructive sleep apnea (OSA) in order to investigate whether exaggerated leukotriene activity is the cause or consequence of OSA.

Methods and materials

A prospective study was conducted on non-obese children (4-10 years old) referred for overnight PSG. Children with moderate/severe OSA treated with AT were included. A second PSG study performed 2 months postoperatively to confirm OSA resolution, and those with residual OSA were excluded. Morning urine specimens after both PSG studies were obtained and pre-operative uCysLT levels were compared to postoperative levels.

Results

27 children fulfilled the criteria and underwent a post-operative PSG study with three exclusions for residual OSA (postop-AHI>2), so the study group consisted of 24 children (mean age: 5.7±2.1 years). Mean preoperative and postoperative AHI was 10.96±5.93 and 1.44±0.56 respectively. Mean preop-uCysLT were 21.14±4.65, while after AT they significantly reduced to 12.62±2.67 (P<0.01).

Conclusion

uCysLT levels are significantly reduced after AT in non-obese children with moderate/severe OSA, suggesting that exaggerated leukotriene activity is mainly a consequence of OSA.

https://ift.tt/2y15d2h

Trends in Sociodemographic Disparities of Pediatric Cochlear Implantation over a 15-Year Period

Publication date: Available online 4 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Alex J.F. Tampio, Ronald J. Schroeder, Dongliang Wang, John Boyle, Brian D. Nicholas

Abstract

Objective

Sociodemographic disparities of cochlear implantation in children have been reported. This study sought to determine if disparities in children receiving cochlear implants have narrowed, widened or remained constant.

Methods

Children 18 years or younger who underwent cochlear implantation from 1997-2012 were selected using the Kids' Inpatient Database. Demographic data included primary insurance payer, income quartile and race. The Cochran-Armitage test was used to determine if trends were significant. Prevalence rates of cochlear implantation by race were generated. A Poisson regression model was used to evaluate the rates of cochlear implantation within each racial group.

Results

The proportion of children receiving cochlear implants with private insurance decreased from 79.3% to 42.6% (p < .0001), whereas children with Medicaid increased from 17.4% to 35.2% (p < .0001). Proportion of implanted children from the lowest two income quartiles increased from 15.5% to 24.4% (p < .0001) and 10.3% to 21.8% (p < .0035), respectively. Rates of implantation among children from income quartile four decreased from 50.9% to 35.3% (p < .0001). White children were implanted twice as often as Black or Hispanic children (p = 0.007 and p = 0.0012 respectively). Asian children were implanted more than twice as often as Black or Hispanic Children (p = .0154 and p = .0098 respectively).

Conclusions

Income and insurance disparities have narrowed within the inpatient pediatric cochlear implantation cohort. Racial disparities still exist. White and Asian children are implanted at higher rates than Black or Hispanic children.

https://ift.tt/2P986ok

Corrigendum to 'Epidemiological characteristics of pediatric epistaxis presenting to the emergency department' International Journal of Pediatric Otorhinolaryngology (2017) 121-124

Publication date: Available online 3 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Sophie Shay, Nina L. Shapiro, Neil Bhattacharyya

https://ift.tt/2y151jz

William T. O’Brien Sr. Top 3 Differentials in Radiology. A Case Review

https://ift.tt/2OGTgss

Stress distribution in mandibular donor site after harvesting bone grafts of various sizes from the ascending ramus of a dentate mandible by finite element analysis

Abstract

Purpose

Harvesting bone from the ascending ramus of the mandible is a common procedure. However, mandibular fracture may occur after grafting bone blocks. This study aimed to investigate the resulting force distribution of stress and strain in the mandibular donor site after harvesting bone grafts of different sizes and various loadings.

Methods

Finite element analysis was performed for virtual harvesting of bone blocks of nine different sizes between 15 × 20 and 25 × 30 mm and three different chewing loads (incisal, ipsilateral and contralateral). von Mises stress and first principal stress distributions were measured.

Results

von Mises stress was distributed between 35.01 (10 × 15 mm graft, incisal load) and 333.25 MPa (30 × 20 mm graft ipsilateral load), whereas first principal stress distributions were between 48.27 (10 × 15 mm graft, incisal load) and 414.69 MPa (30 × 20 mm graft ipsilateral load). In general, the least stress was observed with incisal load followed by ipsilateral load and finally contralateral load. The critical value of 133 MPa was found after removing almost all grafts with a width of 20 or 30 mm.

Conclusions

Incisal loading led to less stress compared with contralateral and ipsilateral loads. Increasing graft size led to increasing weakness of the donor site. Graft width exerted a greater influence on stress development than its height.

Clinical relevance

Ipsilateral chewing and increasing width of the bone graft result in maximum stress in the mandibular donor side, and critical values regarding to the possibility of fractures are already to expect from a graft size of 20 × 15 mm.

https://ift.tt/2IC8VDD

Cognitive Impairment Among Older Patients With Hematologic Cancers—Reply

In Reply We appreciate the careful reading of our study by Tanimoto and colleagues and the provocative points they raise. We agree that marked anemia at the time of presentation might influence the physical and/or cognitive function of older patients with blood cancer. In this context, we have now assessed for a potential association between clinically significant anemia (hemoglobin ≤8 g/dL) and outcomes in the cohort of older patients with hematologic cancers in our study. We found no correlation between anemia and survival (χ² = 1.07; P = .30), and no correlation between anemia and frailty status (robust vs prefrail/frail) as defined by the Fried phenotype (χ² = 2.66; P = .10). Finally, we found no correlation between anemia (hemoglobin ≤8 g/dL) and a positive screening test for probable cognitive impairment by 5-word delayed recall (χ² = 0.91; P = .34), even though impaired delayed recall was associated with worse overall survival in our study.

https://ift.tt/2DXydgO

Aspirin and Chemoprevention—Have We Arrived?

https://ift.tt/2RtAd30

How Pharmacy Benefit Managers Add to Financial Toxicity

This Viewpoint examines the role of benefit managers and other mechanisms driving the sustained increases in prescription drug costs in the United States.

https://ift.tt/2DXyL6A

Erectile Dysfunction in Male Survivors of Childhood Cancer

This survey study evaluates the presence of erectile dysfunction in men who had experienced cancer during childhood.

https://ift.tt/2Rrvkb2

Analgesic Use and Risk of Ovarian Cancer in the Nurses’ Health Studies

This cohort study uses data from the Nurses' Health Studies to evaluate associations between use of nonsteroidal anti-inflammatory drugs and risk of epithelial ovarian cancer.

https://ift.tt/2DUbimC

Cognitive Impairment Among Older Patients With Hematologic Cancers

To the Editor Dr Hshieh and colleagues found that, among 360 patients 75 years and older with hematologic cancer, 127 (35.3%) had probable executive dysfunction and 62 (17.2%) had probable impairment in working memory. Executive dysfunction was associated with worse survival only among patients who underwent intensive treatment, and impairment in working memory was associated with worse median (SD) survival in the overall cohort (10.9 [12.9] vs 12.2 [14.7] months; log-rank P < .001) and after adjusting for age, comorbidities, and disease aggressiveness (odds ratio, 0.26; 95% CI, 0.13-0.50). We believe that the results merit the following comments and discussion.

https://ift.tt/2Rr8dNu

Long Live Neutrophil

Memories are faint, for words were fewOr maybe it was me, hearing nothing I knewLost somewhere in jargon of marrow, purpura, blastWas lurking my cancer, as we stood speechless, aghastTherapy would last for months, we were sent to 10-WestStressing me was my homework, algebra and science are my best"I have got things to do," I play treasure hunt and catchTim's birthday was around, and my baseball matchSitting in the care room, listening about the trialsI knew it was time to endure, no more screams or denials.

https://ift.tt/2DXy258

Association Between Aspirin Use and Risk of Hepatocellular Carcinoma

This pooled analysis of the Nurses' Health Study and the Health Professionals Follow-up Study examines the association between long-term use of aspirin and the development of hepatocellular carcinoma in adult men and women.

https://ift.tt/2Romgn8

Leaders In Plastic Surgery The Dingman-Grabb Era 1946-1986. By Robert M. Oneal MD and Lauralee A. Lutz. Pp. 202. Michigan Publishing, Ann Arbor, MI., 2017. Price $19.99.

No abstract available

https://ift.tt/2xYJuZ3

Minimal pain with Prepectoral implant based breast reconstruction

No abstract available

https://ift.tt/2Pa05j5

Does reconstruction preserving the first or first two rays benefit over full transmetatarsal amputation in diabetic foot?

Background: The benefits of total transmetatarsal amputation (TMA) over higher level amputation are well known. However, there are no studies evaluating the effects of first or the first two ray sparing transmetatarsal amputation with flap coverage. We evaluated this approach in regards to functional outcome and to identify long-term complications. Material and Method: Retrospective data of 59 patients were evaluated according to their surgical method. Complete TMA with free flap reconstruction was designated as group TMA with 27 patients and first or first two rays preserving TMA with free flap reconstruction was designated as group Ray with 32 patients. Demographics, flap outcomes, additional procedures after initial healing and functional outcomes were measured and evaluated. Results: There was no statistical significant difference in demographic distribution and flap outcomes in either group except poor blood sugar control in group Ray. Additional procedures after initial healing showed no statistical difference but the tendency of minor procedures was higher in group Ray. The maximum achieved ambulatory function was significantly better in group Ray with an ambulatory function score of 4.4 over 3.7 in group TMA (p= 0.012). Conclusion: The preservation of the first or first two rays with free flap reconstruction may functionally benefit the patients despite the higher tendency of minor procedures after initial healing. Furthermore, the progressive deformity of the preserved first and second toes will inevitably occur requiring patients to undergo further surgery. Further studies are warranted to evaluate this approach. Conflict of interest: The authors have no conflict of interest of any kind regarding this article. Address correspondence to: Joon Pio Hong, M.D., Ph.D., M.M.M., Professor, Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Asan Medical Center, 88 Olympic-ro 43 gil, SongPa-Gu, Seoul 05505, Korea. ©2018American Society of Plastic Surgeons

https://ift.tt/2xXxFCk

Current Use of Biological Scaffolds in Plastic Surgery

Properly designed biodegradable scaffolds facilitate repair or regeneration of stromal tissues. Over the last 50 years, a variety of synthetic, semi-synthetic and decellularized scaffolds have been developed that provide surgeons with tools to reconstruct a wide array of structural defects. We reviewed the literature of biological degradable scaffolds in current clinical use in the US and highlight their design principles as well as products in common use. Host tissues populate scaffolds with inflammatory cells, fibroblasts, blood vessels, nerves and lymphatics. Cells lay down extracellular matrix macromolecules while enzymes degrade the scaffold. Over time the scaffold can be totally replaced by host tissues. The greatest use of scaffolds in plastic surgery is in skin replacement, breast reconstruction, abdominal wall reconstruction and peripheral nerve repair. Other areas of importance are cartilage and bone replacement as well as support for lining replacements such bowel, bladder, mucosa and dura. The wide range of research being done in this field is likely to provide surgeons with more choices and improved materials to repair and regenerate stromal structures. Disclosure: Dr. Orgill receives research funding through grants to Brigham and Women's Hospital from ACell Inc., Integra LifeSciences, Inc. and the Musculoskeletal Transplant Foundation. He is a consultant for Integra LifeSciences Inc., the Musculoskeletal Transplant Foundation (MTF) and Geistlich Pharma North America Inc. All other authors declare no actual or potential conflict of interests: in addition they disclose no commercial or financial associations, personal or other relationships with other people or organizations that could inappropriately influence the reported manuscript or create a conflict of interest with the information presented. Corresponding author: Dennis P. Orgill, M.D., Ph.D., Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital - Harvard Medical School, 75 Francis St., Boston MA 02115, T: 617-525-7837, Email: dorgill@partners.org ©2018American Society of Plastic Surgeons

https://ift.tt/2P8Ys56

Assessing Quality of Life and Patient-Reported Satisfaction with Masculinizing Top Surgery: A Mixed-Methods Descriptive Survey Study

Background: Masculinizing top surgery (bilateral mastectomy with chest wall reconstruction) is an important gender-affirming procedure sought by many transmasculine and non-binary individuals. Current literature is primarily focused on details of surgical technique and complication rates, with limited data available on how top surgery affects subjective quality of life measures. Methods: An anonymous online survey was distributed to 81 of the senior author's former top surgery patients. Survey response rate was 72% (58 respondents). Responses were analyzed to investigate quality of life, sexual confidence, mental health, satisfaction with top surgery, and patient attitudes toward top surgery's role in gender affirmation. Results: Following top surgery, measures of quality of life and sexual confidence significantly improved (P

https://ift.tt/2xXxpDm

Spotlight in Plastic Surgery: January 2019

No abstract available

https://ift.tt/2P7zS4M

Reporting Adverse Events in Plastic Surgery: A Systematic Review of Randomized Controlled Trials

Background: Accurate knowledge of adverse events is critical for evaluation of the safety and efficacy of interventions. Historically, adverse events in surgical trials have been poorly reported. The objective of this study was to systematically evaluate the reporting of adverse events in randomized controlled trials (RCTs) in the plastic surgery literature. Methods: Two independent reviewers conducted a systematic search using MEDLINE, EMBASE, and SCOPUS of the top seven plastic surgery journals with the highest impact factors. RCTs describing a potentially invasive treatment, published between January 2012 and December 2016, were included. Results: One hundred and forty-five RCTs involving 10,266 patients were included, of which 30% were registered. Anticipated adverse events were clearly defined in 15% of trials, and in 70% it was not clear who would be documenting adverse events. Furthermore, 72% of RCTs reported the occurrence of adverse events, of which 61% failed to report events occurring in the intra-interventional period. Of the trials not documenting any adverse event, two-thirds included a statement declaring that no adverse events had occurred. Binary logistic regression revealed that funded RCTs were 4.04 times more likely to report adverse events compared to non-funded RCTs (95% CI 1.41-10.83, p=0.009). Conclusions: Our findings suggest the need for reporting standards for adverse events in the plastic surgery literature, as such reporting remains heterogeneous and is lacking rigor. Improved quality and transparency is needed to strengthen evidenced-based practice and permit a balanced intervention assessment. This study provides a set of recommendations aimed at improving adverse event reporting. Financial Disclosure Statement: The authors have no financial disclosures to declare. Presentation: This article was accepted for presentation at the 71st annual Canadian Society of Plastic Surgeons Meeting in Winnipeg, MB Canada. Corresponding Author: Jason G. Williams, MD MEd FRCSC, Division of Plastic Surgery, Dalhousie University, QEII Health Sciences Centre, Halifax Infirmary, 4447, 1796 Summer Street, Halifax, Nova Scotia, Canada, B3H 3A7, Tel: +1-(902)-473-6315, E-mail address: drjwilliams@gmail.com ©2018American Society of Plastic Surgeons

https://ift.tt/2y02B4I

Tips for Making a Successful Online Microsurgery Educational Platform – The Experience of International Microsurgery Club

The presence of online learning resources has grown tremendously in recent years. They provide powerful and yet easily accessible means of learning and sharing knowledge. Online learning resources now encompass all aspects of medicine, and microsurgery is no exception. International Microsurgery Club (IMC) is a closed, invitation-only group based on the Facebook social media platform. It was initiated on May 6, 2016, with primary objectives of providing a convenient forum for discussing challenging cases, sharing valuable resources, and providing opportunities for research collaboration. The membership of IMC has grown over 8700 at two year of existence, and continues to expand. IMC has become one of the largest online platforms for global microsurgeons. Here, we share our experience on how to establish a successful online platform for medical education. Financial disclosure statement: None of the authors have financial interests in any of the products, devices, or drugs mentioned in this manuscript. This article has been presented at the World Society for Reconstructive Microsurgery, 2017, Seoul, South Korea. Correspondence author and requests for reprints: Tommy Nai-Jen Chang, M.D. Assistant Professor, Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, No. 5, Fu-Hsing St. Kwei-Shan, Taoyuan, Taiwan. Tel: 886-3-3281200 Ext. 3355, Fax: 886-3-3289582, E-mail: tommynjchang@yahoo.com.tw ©2018American Society of Plastic Surgeons

https://ift.tt/2ydBPVX

Identification of Baseline Factors Associated With Development of Depression in Head and Neck Cancer

This ad hoc secondary analysis of a randomized clinical trial of patients with new or recurrent stages II through IV head and neck epidermoid carcinoma assesses the factors that may be associated with the development of moderate or severe depression during treatment.

https://ift.tt/2RpPRfQ

The Role of Otolaryngologists in Eradicating Human Papillomavirus

To the Editor We read the thoughtful Viewpoint by Todd et al that examines the current human papillomavirus (HPV) pandemic and questions the role of otolaryngologists in fighting this disease. Specifically, they discuss that despite the increase in HPV-positive oropharyngeal squamous cell carcinoma (OPSCC), and its expectation of surpassing cervical cancer numbers by 2020, the public is largely unaware of this trend and HPV vaccine uptake is low despite its availability. These gaps yield an important opportunity for otolaryngologists to play.

https://ift.tt/2IERceT

Cognitive Behavioral Therapy for Tinnitus Unbound

In this issue, Beukes and colleagues provide initial evidence that cognitive behavioral therapy (CBT) delivered via the internet, described as internet-based cognitive behavioral therapy (iCBT), may be a noninferior treatment option for patients with bothersome tinnitus compared with standard face-to-face medical care. Their findings, combined with previous evidence that both CBT and iCBT are helpful in managing tinnitus distress, suggest that CBT is a promising approach for patients who experience bothersome tinnitus.

https://ift.tt/2Rqnxdi

The Role of Otolaryngologists in Eradicating Human Papillomavirus—Reply

In Reply We appreciate the response from Dr Laitman and his colleagues to our Viewpoint. Their survey data demonstrating medical students' limited knowledge of human papillomavirus (HPV) in oropharyngeal squamous cell carcinoma is concerning given that these future doctors will be integral in educating patients in years to come. Their argument to advocate for the inclusion of education of HPV's role in oropharyngeal squamous cell carcinoma is compelling. If our nation's future physicians are unaware of the association, how can we expect the general public to be?

https://ift.tt/2ICE5uP

Effectiveness of Internet Cognitive Behavioral Therapy vs Face-to-Face Care for Tinnitus Treatment

This randomized noninferiority clinical trial compares the effectiveness of guided internet-based cognitive behavioral therapy vs face-to-face clinical care among patients receiving medical treatment for tinnitus.

https://ift.tt/2Rqn6Qc

The 2018 American Head and Neck Society Presidential Address—Reflections

This Presidential Address presented at the 2018 meeting of American Head and Neck Society (AHNS) highlights the challenges and opportunities of the AHNS ongoing reorganization in the rapidly changing practice of head and neck surgery and details how AHNS members can harness this change to direct the future of their field.

https://ift.tt/2IH3d3G

Interaction of Group B Streptococcus sialylated capsular polysaccharides with host Siglec-like molecules dampens the inflammatory response in tilapia

Publication date: November 2018

Source: Molecular Immunology, Volume 103

Author(s): Junjian Dong, Yuanzheng Wei, Chengfei Sun, Yuanyuan Tian, Jie Hu, Hongya Shi, Dengfeng Zhang, Maixin Lu, Xing Ye

Abstract

Group B Streptococcus (GBS, S. agalactiae) infection in tilapia (Oreochromis niloticus) causes widespread death of this species and is a significant issue for the aquaculture industry. The major virulence factor for GBS is its sialylated capsular polysaccharides (CPs). These CPs interact with sialic acid-binding immunoglobulin-like lectins (Siglecs) on the host immune cells to regulate the downstream inflammatory response and evade detection. Previously, we cloned multiple Siglec-like molecules from an O. niloticus cDNA library, all of which were shown to interact with the sialylated CPs of GBS. In the present study, we investigated the effects of GBS infection on the expression of pro- and anti-inflammatory cytokines in O. niloticus as well as OnSiglec-like-transfected macrophage cells. Eukaryotic expression vectors containing full-length OnSiglec-1-like, -4b-like, -14-like were constructed and used to transfect RAW264 macrophages in vitro as well as live tilapia in vivo prior to GBS infection. The expression of the anti-inflammatory cytokine interleukin (IL)-10 and the pro-inflammatory cytokines tumor necrosis factor (TNF)-α, IL-6, and interferon (INF)-β were then analyzed by qPCR. Our results indicate that as infection progressed, IL-10 expression was significantly upregulated, while that of TNF-α and IL-6 were significantly downregulated in the OnSiglec-like-transfected cells. INF-β expression was also downregulated in cells transfected with OnSiglec-1-like and -4b-like, but was not significantly effected in OnSiglec-14-like-transfected cells. Notably, the magnitude of these cytokine expression changes was greatly decreased when a ΔneuA GBS mutant was used to infect the OnSiglec-1-like-transfected cells. In GBS-infected tilapia, IL-10 expression was significantly upregulated in all tissues, whereas INF-β expression in the spleen, kidney, and gills was significantly downregulated at 12 hpi. While the expression of TNF-α was slightly upregulated, this change was not significant. In GBS ΔneuA mutant-infected O. niloticus, IL-10 expression in all of the tissues was significantly lower than that observed for the wild-type GBS group, while TNF-α expression was higher in the mutant infected group. There was no significant difference in INF-β expression between the two groups. Taken together, sialylated CPs on GBS appear to interact with host OnSiglec-like molecules to transmit negative regulatory signals via enhanced anti-inflammatory cytokine IL-10 production and reduced pro-inflammatory cytokine production, ultimately leading to dampening of the host immune response. The results of this study further elucidate the molecular mechanism underlying GBS infection in tilapia and also provide candidate drug target molecules.

https://ift.tt/2xXY9n8

Afatinib and Pembrolizumab for Head and Neck Squamous Cell Carcinoma (ALPHA Study)

Condition: Head and Neck Neoplasms
Interventions: Drug: Afatinib Oral Tablet; Drug: Pembrolizumab Injection
Sponsor: National Taiwan University Hospital
Not yet recruiting

https://ift.tt/2xV1jIk

Afatinib and Pembrolizumab for Head and Neck Squamous Cell Carcinoma (ALPHA Study)

Stafne bone cavity containing ectopic parotid gland

Publication date: September–October 2018

Source: Brazilian Journal of Otorhinolaryngology, Volume 84, Issue 5

Author(s): Mesut Kaya, Kadriye Serife Ugur, Elif Dagli, Hanifi Kurtaran, Mehmet Gunduz

https://ift.tt/2O4G3d7

Effects of cavity reconstruction on morbidity and quality of life after canal wall down tympanomastoidectomy

Publication date: September–October 2018

Source: Brazilian Journal of Otorhinolaryngology, Volume 84, Issue 5

Author(s): Sinan Uluyol, Omer Ugur, Ilker Burak Arslan, Ozlem Yagiz, Murat Gumussoy, Ibrahim Cukurova

Abstract

Introduction

Canal wall down tympanomastoidectomy is commonly used to treat advanced chronic otitis media or cholesteatoma. The advantages of canal wall down mastoidectomy are excellent exposure for disease eradication and postoperative control of residual disease; its disadvantages include the accumulation of debris requiring life-long otological maintenance and cleaning, continuous ear drainage, fungal cavity infections, and the occurrence of dizziness and vertigo by changing temperature or pressure.

Objective

To evaluate whether cavity-induced problems can be eliminated and patient comfort can be increased with mastoid cavity reconstruction.

Methods

In total, 11 patients who underwent mastoid cavity reconstruction between March 2013 and June 2013 comprised the study group, and 11 patients who had dry, epithelialized CWD cavities were recruited as the control group. The study examined three parameters: epithelial migration, air caloric testing, and the Glasgow Benefit Inventory. Epithelial migration, air caloric testing, and the Glasgow Benefit Inventory were evaluated in the study and control groups.

Results

The epithelial migration rate was significantly faster in study group (1.63 ± 0.5 mm/week) than control group (0.94 ± 0.37 mm/week) (p = 0.003, p < 0.05). The mean slow component velocity of nystagmus of the study group (13.33 ± 5.36°/s) was significantly lower when compared to control group (32.11 ± 9.12°/s) (p = 0.018). The overall the Glasgow Benefit Inventory score was −7.21, and the general subscale, physical and social health scores were −9.71, −21.09, and +20.35, respectively in the control group. These were +33.93, +35.59, +33.31, and +29.61, respectively in the study group. All but the social health score improved significantly (0.007, 0.008, 0.018, and 0.181, respectively).

Conclusions

Cavity reconstruction improves epithelial migration, normalizes caloric responses and increases the quality of life. Thus, cavity rehabilitation eliminates open-cavity-induced problems by restoring the functional anatomy of the ear.

Resumo

Introdução

A timpanomastoidectomia com a técnica Canal Wall Down, ou técnica aberta, é comumente utilizada para tratar otite média crônica avançada ou colesteatoma. As vantagens da mastoidectomia pela técnica aberta são uma excelente exposição para a erradicação da doença e controle pós-operatório da doença residual; suas desvantagens incluem o acúmulo de detritos que requerem manutenção e limpeza otológica ao longo da vida, drenagem contínua da orelha, infecções fúngicas na cavidade e a ocorrência de tonturas e vertigem com alterações de temperatura ou pressão.

Objetivo

Avaliar se os problemas induzidos pela cavidade podem ser eliminados e o conforto do paciente aumentado com a reconstrução da cavidade mastoide.

Método

No total, 11 pacientes submetidos à reconstrução da cavidade mastoide entre março de 2013 e junho de 2013 constituíram o grupo de estudo, e 11 pacientes com cavidades secas e epitelizadas, operadas pela técnica aberta, foram recrutados como grupo controle. O estudo analisou três parâmetros: migração epitelial, prova calórica com estimulação a ar e o questionário Glasgow Benefit Inventory. A migração epitelial, a prova calórica e o Glasgow Benefit Inventory foram avaliados nos grupos de estudo e controle.

Resultados

A taxa de migração epitelial foi significativamente mais rápida no grupo de estudo (1,63 ± 0,5 mm/semana) do que no grupo controle (0,94 ± 0,37 mm/semana) (p = 0,003, p < 0,05). A velocidade média do componente lento do nistagmo no grupo de estudo (13,33 ± 5,36°/s) foi significativamente menor se comparada ao grupo controle (32,11 ± 9,12°/s) (p = 0,018). O escore global do Glasgow Benefit Inventory foi de -7,21 e os escores da subescala geral, saúde física e social foram -9,71, -21,09 e +20,35, respectivamente, no grupo controle. Esses escores foram +33.93, +35.59, +33.31 e +29.61, respectivamente, no grupo de estudo. Todos, exceto o escore de saúde social, melhoraram significativamente (0,007, 0,008, 0,018 e 0,181, respectivamente).

Conclusões

A reconstrução da cavidade melhora a migração epitelial, normaliza as respostas da prova calórica e aumenta a qualidade de vida. Assim, a reabilitação da cavidade elimina os problemas induzidos por cavidades abertas ao restaurar a anatomia funcional da orelha.

https://ift.tt/2ydtx0g

Association of Ugrp2 gene polymorphisms with adenoid hypertrophy in the pediatric population

Publication date: September–October 2018

Source: Brazilian Journal of Otorhinolaryngology, Volume 84, Issue 5

Author(s): Mahmut Huntürk Atilla, Sibel Özdaş, Talih Özdaş, Sibel Baştimur, Sami Engin Muz, Işılay Öz, Kenan Kurt, Afife İzbirak, Mehmet Ali Babademez, Nilgün Vatandaş

Abstract

Introduction

Adenoid hypertrophy is a condition that presents itself as the chronic enlargement of adenoid tissues; it is frequently observed in the pediatric population. The Ugrp2 gene, a member of the secretoglobin superfamily, encodes a low-molecular weight protein that functions in the differentiation of upper airway epithelial cells. However, little is known about the association of Ugrp2 genetic variations with adenoid hypertrophy.

Objective

The aim of this study is to investigate the association of single nucleotide polymorphisms in the Ugrp2 gene with adenoid hypertrophy and its related phenotypes.

Methods

A total of 219 children, comprising 114 patients suffering from adenoid hypertrophy and 105 healthy patients without adenoid hypertrophy, were enrolled in this study. Genotypes of the Ugrp2 gene were determined by DNA sequencing.

Results

We identified four single nucleotide polymorphisms (IVS1-189G>A, IVS1-89T>G, c.201delC, and IVS2-15G>A) in the Ugrp2 gene. Our genotype analysis showed that the Ugrp2 (IVS1-89T>G) TG and (c.201delC) CdelC genotypes and their minor alleles were associated with a considerable increase in the risk of adenoid hypertrophy compared with the controls (p = 0.012, p = 0.009, p = 0.013, and p = 0.037, respectively). Furthermore, Ugrp2 (GTdelCG, GTdelCA) haplotypes were significantly associated with adenoid hypertrophy (four single nucleotide polymorphisms ordered from 5′ to 3′; p = 0.0001). Polymorfism–Polymorfism interaction analysis indicated a strong interaction between combined genotypes of the Ugrp2 gene contributing to adenoid hypertrophy, as well as an increased chance of its diagnosis (p < 0.0001). In addition, diplotypes carrying the mutant Ugrp2 (c.201delC) allele were strongly associated with an increased risk of adenoid hypertrophy with asthma and with allergies (p = 0.003 and p = 0.0007, respectively).

Conclusion

Some single nucleotide polymorphisms and their combinations in the Ugrp2 gene are associated with an increased risk of developing adenoid hypertrophy. Therefore, we tried to underline the importance of genetic factors associated with adenoid hypertrophy and its related clinical phenotypes.

Resumo

Introdução

A adenoide ou hipertrofia de tonsila faríngea é uma condição que se apresenta como o aumento crônico de tecidos linfóides na rinofaringe e é frequentemente observada na população pediátrica. O gene Ugrp2, um membro da superfamília da secretoglobina, codifica uma proteína de baixo peso molecular que funciona na diferenciação das células epiteliais das vias aéreas superiores. No entanto, pouco se sabe sobre a associação de variações genéticas do Ugrp2 com hipertrofia de tonsila faríngea.

Objetivo

Investigar a associação de polimorfismos de nucleotídeos únicos no gene Ugrp2 com hipertrofia de tonsila faríngea e seus fenótipos relacionados.

Método

Foram incluídos no estudo 219 crianças, 114 pacientes com hipertrofia de tonsila faríngea e 105 saudáveis. Os genótipos do gene Ugrp2 foram determinados por sequenciamento de DNA.

Resultados

Identificamos quatro polimorfismos de nucleotídeo único (IVS1-189G>A, IVS1-89T>G, c.201delC, e IVS2-15G>A) no gene Ugrp2. Nossa análise genotípica mostrou que os genótipos Ugrp2 (IVS1-89T>G) TG e (c.201delC) CdelC e seus alelos menores foram associados a um aumento considerável no risco de HA em comparação com os controles (p = 0,012, p = 0,009, p = 0,013 e p = 0,037, respectivamente). Além disso, os haplótipos Ugrp2 (GTdelCG, GTdelCA) foram significativamente associados com hipertrofia de tonsila faríngea (quatro polimorfismos de nucleot' ordenados de 5' a 3'; p = 0,0001). A análise de interação polimorfismo-polimorfismo indicou uma forte interação entre genótipos combinados do gene Ugrp2 que contribuiu para hipertrofia de tonsila faríngea, bem como uma chance maior de seu diagnóstico (p < 0,0001). Além disso, os diplótipos que transportam o alelo mutante Ugrp2 (c.201delC) foram fortemente associados a um risco aumentado de hipertrofia de tonsila faríngea com asma e com alergias (p = 0,003 e p = 0,0007, respectivamente).

Conclusão

Alguns polimorfismos de nucleotídeo único e suas combinações no gene Ugrp2 estão associados a um risco aumentado de desenvolver hipertrofia de tonsila faríngea. Portanto, tentamos enfatizar a importância dos fatores genéticos e fenótipos clínicos associados à essa hipertrofia.

https://ift.tt/2O4G14Z

Disease-specific quality of life after septoplasty and bilateral inferior turbinate outfracture in patients with nasal obstruction

Publication date: September–October 2018

Source: Brazilian Journal of Otorhinolaryngology, Volume 84, Issue 5

Author(s): Lucas Resende, Carolina do Carmo, Leão Mocellin, Rogério Pasinato, Marcos Mocellin

Abstract

Introduction

Septal deviations might cause nasal obstruction and negative impact on the quality of life of individuals. The efficacy of septoplasty for treatment of septal deviation and the predictors of satisfactory surgical outcomes remain controversial. Technical variability, heterogeneity of research samples and absence of a solid tool for clinical evaluation are the main hindrances to the establishment of reliable statistical data regarding the procedure.

Objective

To evaluate the clinical improvements in the disease-specific quality-of-life between patients submitted to septoplasty with bilateral outfracture of the inferior turbinate under sedation and local anesthesia in a tertiary hospital and to assess possible clinical–epidemiological variables associated with functional outcome.

Methods

Fifty-two patients consecutively submitted to septoplasty with bilateral outfracture of the inferior turbinate for treatment of nasal obstruction filled in forms regarding clinical and epidemiological information during enrollment and had their symptom objectively quantified using the Nose Obstruction Symptom Evaluation (NOSE) scale preoperatively and one and three months after the procedure. Statistical analysis aimed to determine overall and stratified surgical outcomes and to investigate correlations between the clinical–epidemiological variables with the scores obtained.

Results

Statistically significant improvement in the preoperative NOSE questionnaire compared to the scores obtained three months after surgery was demonstrated (p < 0.001, T-Wilcoxon), with strong correlation between the preoperative score and the postoperative improvement during this period (r = −0.614, p < 0.001, Spearman). After one month, patients reached in average 87.15% of the result obtained at the study termination. Smokers and patients with rhinitis and/or pulmonary comorbidity showed increased average preoperative NOSE scores, although without statistical significance (p > 0.05). Gender, age, history of rhinitis and presence of pulmonary comorbidity did not influence significantly surgical outcomes (p > 0.05). Smokers presented greater reduction in NOSE scores during the study (p = 0.043, U-Mann–Whitney).

Conclusion

Septoplasty with bilateral outfracture of the inferior turbinate has proven to significantly improve disease-specific quality-of-life and this favorable outcome seems to occur precociously.

Resumo

Introdução

Os desvios septais podem causar obstrução nasal e impacto negativo na qualidade de vida dos indivíduos. A eficácia da septoplastia para o tratamento do desvio septal e os preditores de resultados cirúrgicos satisfatórios continuam controversos. A variabilidade técnica, a heterogeneidade das amostras de estudo e a ausência de uma ferramenta sólida para avaliação clínica são os principais obstáculos ao estabelecimento de dados estatísticos confiáveis sobre o procedimento.

Objetivo

Avaliar a melhora clínica na qualidade de vida específica da doença entre pacientes submetidos a septoplastia e fratura bilateral da concha inferior sob sedação e anestesia local em um hospital terciário e possíveis variáveis clínico-epidemiológicas associadas ao desfecho funcional.

Método

Cinquenta e dois pacientes consecutivamente submetidos a septoplastia e fratura bilateral da concha inferior para o tratamento da obstrução nasal preencheram formulários com informações clínicas e epidemiológicas durante a inclusão no estudo e tiveram seus sintomas quantificados objetivamente utilizando a escala de Avaliação de Sintomas de Obstrução Nasal (Nose Obstruction Symptom Evaluation - NOSE) no pré-operatório e um e três meses após o procedimento. A análise estatística objetivou determinar resultados cirúrgicos globais e estratificados e investigar correlações entre as variáveis clínico-epidemiológicas e os escores obtidos.

Resultados

Foi demonstrada uma melhora estatisticamente significativa nos escores obtidos no questionário NOSE três meses após a cirurgia (p < 0,001, T-Wilcoxon), quando comparado com os escores obtidos no pré-operatório, com uma forte correlação entre o escore pré-operatório e a melhora pós-operatória durante esse período (r = -0,614, p < 0,001, Spearman). Após um mês, os pacientes atingiram em média 87,15% do resultado obtido ao término do estudo. Fumantes e pacientes com rinite e/ou comorbidade pulmonar apresentaram valores médios pré-operatórios do escore NOSE aumentados, embora sem significância estatística (p > 0,05). Sexo, idade, história de rinite e presença de comorbidade pulmonar não influenciaram significativamente os resultados cirúrgicos (p > 0,05). Os fumantes apresentaram maior redução nos escores de NOSE (p = 0,043, U-Mann-Whitney).

Conclusão

A septoplastia e fratura bilateral da concha inferior demonstraram melhorar significativamente a qualidade de vida específica da doença e este resultado favorável parece ocorrer de forma precoce.

https://ift.tt/2ycOloQ

Psychoacoustic classification of persistent tinnitus

Publication date: September–October 2018

Source: Brazilian Journal of Otorhinolaryngology, Volume 84, Issue 5

Author(s): Flavia Alencar de Barros Suzuki, Fabio Akira Suzuki, Ektor Tsuneo Onishi, Norma Oliveira Penido

Abstract

Introduction

Tinnitus is a difficult to treat symptom, with different responses in patients. It is classified in different ways, according to its origin and associated diseases.

Objective

to propose a single and measurable classification of persistent tinnitus, through its perception as sounds of nature or of daily life and its comparison with pure tone or noise, of high or low pitch, presented to the patient by audiometer sound.

Methods

A total of 110 adult patients, of both genders, treated at the Tinnitus Outpatient Clinic, were enrolled according to the inclusion and exclusion criteria. Otorhinolaryngologic and Audiological, Pitch Matching and Loudness, Visual Analog Scale, Tinnitus Handicap Inventory and Minimum Masking Level assessments were performed.

Results

In these 110 patients, 181 tinnitus complaints were identified accordingly to type and ear, with 93 (51%) Pure Tone, and 88 (49%) Noise type; 19 at low and 162 at high frequency; with a mean in the Pure Tone of 5.47 in the Visual Analog Scale and 12.31 decibel in the Loudness and a mean in the Noise of 6.66 and 10.51 decibel. For Tinnitus Handicap Inventory and Minimum Masking Level, the 110 patients were separated into three groups with tinnitus, Pure Tone, Noise and multiple. Tinnitus Handicap Inventory higher in the group with multiple tinnitus, of 61.38. Masking noises such as White Noise and Narrow Band were used for the Minimum Masking Level at the frequencies of 500 and 6000 Hz. There was a similarity between the Pure Tone and Multiple groups. In the Noise group, different responses were found when Narrow Band was used at low frequency.

Conclusion

Classifying persistent tinnitus as pure tone or noise, present in high or low frequency and establishing its different characteristics allow us to know its peculiarities and the effects of this symptom in patients' lives.

Resumo

Introdução

O zumbido é um sintoma de difícil tratamento, com respostas diferentes nos pacientes. É classificado de formas diversas, de acordo com a origem ou doenças associadas.

Objetivo

Propor uma classificação única e mensurável do zumbido persistente, por meio da sua percepção como sons da natureza ou da vida cotidiana e da sua comparação com o tom puro ou o ruído, de pitch alto ou baixo, apresentados ao paciente pelos sons do audiômetro.

Método

Participaram 110 pacientes adultos, de ambos os sexos, atendidos no Ambulatório de Zumbido, tendo sido observados os critérios de inclusão e exclusão. Realizada avaliação otorrinolaringológica, audiológica, Pitch Matching e Loudness, Visual Analog Scale, Tinnitus Handicap Inventory e Minimum Masking Level.

Resultados

Nesses 110 pacientes foram identificadas 181 queixas de zumbido separadas por tipo e orelha, sendo 93 (51%) tipo tom puro e 88 (49%) tipo ruído; 19 de baixa frequência e 162 de alta frequência; com média do Visual Analog Scale no tom puro de 5,47 e ruído de 6,66; média do Loudness do tom puro de 12,31 dBNS e ruído de 10,51 dBNS. Para o Tinnitus Handicap Inventory e o Minimum Masking Level os 110 pacientes foram separados em três grupos com zumbido, tom puro, ruído e múltiplo, com a média do Tinnitus Handicap Inventory maior no grupo com zumbido múltiplo com 61,38. Para o Minimum Masking Level foram usados os ruídos mascaradores tipo White Noise e Narrow Band nas frequências de 500 Hz e 6000 Hz. Houve semelhança entre os grupos com tom puro e múltiplo. No grupo de ruído foram encontradas respostas diferentes quando usado o Narrow Band em frequência baixa.

Conclusão

Classificar o zumbido persistente em tom puro ou ruído, presentes em frequência alta ou baixa e estabelecer suas diferentes características nos permitem conhecer suas particularidades e a repercussão desse sintoma na vida dos pacientes.

https://ift.tt/2O6Kwfo

Audiological and electrophysiological alterations in HIV-infected individuals subjected or not to antiretroviral therapy

Publication date: September–October 2018

Source: Brazilian Journal of Otorhinolaryngology, Volume 84, Issue 5

Author(s): Carla Gentile Matas, Alessandra Giannella Samelli, Fernanda Cristina Leite Magliaro, Aluisio Segurado

Abstract

Introduction

The Human Immunodeficiency Virus (HIV) and infections related to it can affect multiple sites in the hearing system. The use of High Activity Anti-Retroviral Therapy (HAART) can cause side effects such as ototoxicity. Thus, no consistent patterns of hearing impairment in adults with Human Immunodeficiency Virus / Acquired Immune Deficiency Syndrome have been established, and the problems that affect the hearing system of this population warrant further research.

Objectives

This study aimed to compare the audiological and electrophysiological data of Human Immunodeficiency Virus-positive patients with and without Acquired Immune Deficiency Syndrome, who were receiving High Activity Anti-Retroviral Therapy, to healthy individuals.

Methods

It was a cross-sectional study conducted with 71 subjects (30–48 years old), divided into groups: Research Group I: 16 Human Immunodeficiency Virus-positive individuals without Acquired Immunodeficiency Syndrome (not receiving antiretroviral treatment); Research Group II: 25 Human Immunodeficiency Virus-positive individuals with Acquired Immunodeficiency Syndrome (receiving antiretroviral treatment); Control Group: 30 healthy subjects. All individuals were tested by pure-tone air conduction thresholds at 0.25–8 kHz, extended high frequencies at 9–20 kHz, electrophysiological tests (Auditory Brainstem Response, Middle Latency Responses, Cognitive Potential).

Results

Research Group I and Research Group II had higher hearing thresholds in both conventional and high frequency audiometry when compared to the control group, prolonged latency of waves I, III, V and interpeak I–V in Auditory Brainstem Response and prolonged latency of P300 Cognitive Potential. Regarding Middle Latency Responses, there was a decrease in the amplitude of the Pa wave of Research Group II compared to the Research Group I.

Conclusions

Both groups with Human Immunodeficiency Virus had higher hearing thresholds when compared to healthy individuals (group exposed to antiretroviral treatment showed the worst hearing threshold) and seemed to have lower neuroelectric transmission speed along the auditory pathway in the brainstem, subcortical and cortical regions.

Resumo

Introdução

O HIV e as infecções relacionadas a ele podem afetar vários locais do sistema auditivo. O uso de terapia antirretroviral altamente ativa pode causar efeitos colaterais, como ototoxicidade. Assim, não foram estabelecidos padrões consistentes de deficiência auditiva em adultos com HIV/Aids e os problemas que afetam o sistema auditivo dessa população justificam pesquisas futuras.

Objetivos

Este estudo teve como objetivo comparar os dados audiológicos e eletrofisiológicos de pacientes HIV positivos com e sem Aids que recebiam terapia antirretroviral altamente ativa com os de indivíduos saudáveis.

Método

Estudo transversal com 71 indivíduos (30-48 anos), dividido em grupos: Grupo de Pesquisa I: 16 indivíduos HIV-positivos sem Aids (não recebendo tratamento antirretroviral); Grupo de Pesquisa II: 25 indivíduos HIV-positivos com Aids (recebiam tratamento antirretroviral); Grupo Controle: 30 indivíduos saudáveis. Todos os indivíduos foram testados para limiares de condução aérea de tons puros a 0,25-8 kHz, altas frequências de 9-20 kHz, testes eletrofisiológicos (potencial evocado auditivo de tronco encefálico, potencial evocado auditivo de média latência, potencial cognitivo).

Resultados

Os grupos de pesquisa I e II apresentaram limiares auditivos mais elevados em audiometria convencional e nas frequências altas quando comparados com o grupo controle, latência prolongada das ondas I, III, V e interpico I-V em resposta auditiva de tronco encefálico e latência prolongada de P300. Em relação às respostas de latência média, houve uma diminuição na amplitude da onda Pa do Grupo de pesquisa II em comparação com o grupo de pesquisa I.

Conclusões

Ambos os grupos com HIV apresentaram limiares auditivos mais elevados quando comparados aos indivíduos saudáveis (o grupo exposto ao tratamento antirretroviral apresentou o pior limiar auditivo) e parecem ter menor velocidade de transmissão neuroelétrica ao longo da via auditiva nas regiões do tronco encefálico, subcortical e cortical.

https://ift.tt/2yh6u4W

Αρχειοθήκη ιστολογίου

! # Ola via Alexandros G.Sfakianakis on Inoreader

Η λίστα ιστολογίων μου

Πέμπτη 4 Οκτωβρίου 2018

Abstract

Background

Case Presentation

Conclusion

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Objectives

Materials and methods

Results

Conclusions

Clinical relevance

Abstract

Background

Objectives

Data sources

Study eligibility criteria

Methods

Results

Conclusions

Abstract

Objective

Methods and materials

Results

Conclusion

Abstract

Objective

Methods

Results

Conclusions

Abstract

Purpose

Methods

Results

Conclusions

Clinical relevance

Abstract

Abstract

Introduction

Objective

Methods

Results

Conclusions

Resumo

Introdução

Objetivo

Método

Resultados

Conclusões

Abstract

Introduction

Objective

Methods

Results

Conclusion

Resumo

Introdução

Objetivo

Método

Resultados