Πέμπτη 14 Φεβρουαρίου 2019
Transient Tachypnea of Newborns Is Associated With Maternal Spinal Hypotension During Elective Cesarean Delivery: A Retrospective Cohort Study
BACKGROUND: The risk for transient tachypnea of newborns, a common cause of respiratory distress in the neonatal period, is 2- to 6-fold higher during elective cesarean delivery compared to vaginal delivery. Here, we evaluated the association between transient tachypnea of newborns and the degree and duration of predelivery maternal hypotension during spinal anesthesia for elective cesarean delivery. METHODS: Demographic data, details of anesthetic management, blood pressure measurements, and vasopressor requirement preceding delivery were compared between transient tachypnea newborns (n = 30) and healthy neonates (n = 151) with normal respiratory function born via elective cesarean delivery between July 2015 and February 2016. The degree and duration of hypotension were assessed using area under the curve for systolic blood pressure (SBP) ≤90 mm Hg and area under the curve for mean arterial pressure ≤65 mm Hg. After adjusting for confounders, multivariable logistic regression was used to evaluate the association between area under the curve for SBP and transient tachypnea of newborns. RESULTS: The median area under the curve for SBP was higher in cases of transient tachypnea of newborns (0.94; interquartile range, 0–28.7 mm Hg*min) compared to healthy controls (0; interquartile range, 0–3.30 mm Hg*min; P = .001). Similarly, median area under the curve for mean arterial pressure was also higher in cases of transient tachypnea of newborns (0; interquartile range, 0–18.6 mm Hg*min) compared to controls (0; interquartile range, 0–1.1 mm Hg*min; P = .01). Mothers of transient tachypnea newborns received significantly higher amounts of phenylephrine and ephedrine compared to controls (P = .001 and 0.01, respectively). Hence, the total vasopressor dose given to mothers in the transient tachypnea of newborn group was much higher than for the control group (P = .001). In the multivariable logistic regression, area under the curve for SBP was significantly associated with transient tachypnea of newborns (odds ratio, 1.02; 95% CI, 1.01–1.04, P = .005) after adjusting for gravidity and the type of anesthetic (spinal versus combined spinal epidural). CONCLUSIONS: Our results suggest that the degree and duration of maternal SBP
http://bit.ly/2GrRU0Y
http://bit.ly/2GrRU0Y
Consensus Statement of the Malignant Hyperthermia Association of the United States on Unresolved Clinical Questions Concerning the Management of Patients With Malignant Hyperthermia
At a recent consensus conference, the Malignant Hyperthermia Association of the United States addressed 6 important and unresolved clinical questions concerning the optimal management of patients with malignant hyperthermia (MH) susceptibility or acute MH. They include: (1) How much dantrolene should be available in facilities where volatile agents are not available or administered, and succinylcholine is only stocked on site for emergency purposes? (2) What defines masseter muscle rigidity? What is its relationship to MH, and how should it be managed when it occurs? (3) What is the relationship between MH susceptibility and heat- or exercise-related rhabdomyolysis? (4) What evidence-based interventions should be recommended to alleviate hyperthermia associated with MH? (5) After treatment of acute MH, how much dantrolene should be administered and for how long? What criteria should be used to determine stopping treatment with dantrolene? (6) Can patients with a suspected personal or family history of MH be safely anesthetized before diagnostic testing? This report describes the consensus process and the outcomes for each of the foregoing unanswered clinical questions. Accepted for publication December 2, 2018. Funding: Travel, hotel, and some food expenses for the attendees at the consensus meeting were paid by the Malignant Hyperthermia Association of the United States The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Ronald S. Litman, DO, ML, Department of Anesthesiology & Critical Care, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104. Address e-mail to litmanr@email.chop.edu. © 2019 International Anesthesia Research Society
http://bit.ly/2Ii8YIm
http://bit.ly/2Ii8YIm
Perioperative Epidural Use and Risk of Delirium in Surgical Patients: A Secondary Analysis of the PODCAST Trial
BACKGROUND: Postoperative delirium is an important public health concern without effective prevention strategies. This study tested the hypothesis that perioperative epidural use would be associated with decreased risk of delirium through postoperative day 3. METHODS: This was a secondary, observational, nonrandomized analysis of data from The Prevention of Delirium and Complications Associated With Surgical Treatments Trial (PODCAST; NCT01690988). The primary outcome of the current study was the incidence of delirium (ie, any positive delirium screen, postanesthesia care unit through postoperative day 3) in surgical patients (gastrointestinal, hepatobiliary-pancreatic, gynecologic, and urologic) receiving postoperative epidural analgesia compared to those without an epidural. As a secondary outcome, all delirium assessments were then longitudinally analyzed in relation to epidural use throughout the follow-up period. Given the potential relevance to delirium, postoperative pain, opioid consumption, sleep disturbances, and symptoms of depression were also analyzed as secondary outcomes. A semiparsimonious multivariable logistic regression model was used to test the association between postoperative epidural use and delirium incidence, and generalized estimating equations were used to test associations with secondary outcomes described. Models included relevant covariates to adjust for confounding. RESULTS: In total, 263 patients were included for analysis. Epidural use was not independently associated with reduced delirium incidence (adjusted odds ratio, 0.65 [95% CI, 0.32–1.35]; P= .247). However, when analyzing all assessments over the follow-up period, epidural patients were 64% less likely to experience an episode of delirium (adjusted odds ratio, 0.36 [95% CI, 0.17–0.78]; P= .009). Adjusted pain scores (visual analog scale, 0–100 mm) were significantly lower in the epidural group on postoperative day 1 (morning, −16 [95% CI, −26 to −7], P
http://bit.ly/2IdBE56
http://bit.ly/2IdBE56
American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Perioperative Management of Patients on Preoperative Opioid Therapy
Enhanced recovery pathways have quickly become part of the standard of care for patients undergoing elective surgery, especially in North America and Europe. One of the central tenets of this multidisciplinary approach is the use of multimodal analgesia with opioid-sparing and even opioid-free anesthesia and analgesia. However, the current state is a historically high use of opioids for both appropriate and inappropriate reasons, and patients with chronic opioid use before their surgery represent a common, often difficult-to-manage population for the enhanced recovery providers and health care team at large. Furthermore, limited evidence and few proven successful protocols exist to guide providers caring for these at-risk patients throughout their elective surgical experience. Therefore, the fourth Perioperative Quality Initiative brought together an international team of multidisciplinary experts, including anesthesiologists, nurse anesthetists, surgeons, pain specialists, neurologists, nurses, and other experts with the objective of providing consensus recommendations. Specifically, the goal of this consensus document is to minimize opioid-related complications by providing expert-based consensus recommendations that reflect the strength of the medical evidence regarding: (1) the definition, categorization, and risk stratification of patients receiving opioids before surgery; (2) optimal perioperative treatment strategies for patients receiving preoperative opioids; and (3) optimal discharge and continuity of care management practices for patients receiving opioids preoperatively. The overarching theme of this document is to provide health care providers with guidance to reduce potentially avoidable opioid-related complications including opioid dependence (both physical and behavioral), disability, and death. Enhanced recovery programs attempt to incorporate best practices into pathways of care. By presenting the available evidence for perioperative management of patients on opioids, this consensus panel hopes to encourage further development of pathways specific to this high-risk group to mitigate the often unintentional iatrogenic and untoward effects of opioids and to improve perioperative outcomes. Accepted for publication December 11, 2018. Conflicts of Interest: See Disclosures at the end of the article. Funding: D.A.E. has received research support from Semnur Inc and Grunenthal for research unrelated to the topic or production of this manuscript. T.E.M. received research funding and is a consultant for Edwards Lifesciences and for Mallinckrodt. M.D.E. received research funding from the GE Foundation, Edwards Lifesciences, and Cheetah Medical for projects unrelated to this manuscript. The Perioperative Quality Initiative-4 consensus conference was supported by unrestricted educational grants from the American Society for Enhanced Recovery and the Perioperative Quality Initiative, which have received grants from Baxter, Bev MD, Cadence, Cheetah Medical, Edwards, Heron Pharmaceutical, Mallinckrodt, Medtronic, Merck, Trevena, and Pacira 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 (http://bit.ly/KegmMq). Reprints will not be available from the authors. Address correspondence to David A. Edwards, MD, PhD, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN. Address e-mail to david.a.edwards@vanderbilt.edu. © 2019 International Anesthesia Research Society
http://bit.ly/2Ig8DWu
http://bit.ly/2Ig8DWu
Randomized Trial Comparing Early and Late Administration of Rocuronium Before and After Checking Mask Ventilation in Patients With Normal Airways
BACKGROUND: During induction of general anesthesia, it is common practice to delay neuromuscular blockade until the ability to deliver mask ventilation has been confirmed. However, the benefits of this approach have never been scientifically validated. We thus compared the early and late administration of rocuronium before and after checking mask ventilation to investigate the efficiency of mask ventilation and the time to tracheal intubation in patients with normal airways. METHODS: Patients (n = 114) were randomized to receive IV rocuronium either before (early rocuronium group, n = 58) or after (late rocuronium group, n = 56) checking mask ventilation. Expiratory tidal volumes (VTs) were measured at 10, 20, 30, 40, 50, and 60 seconds after apnea during mask ventilation. We graded the ease of mask ventilation and measured the time from apnea to tracheal intubation. The primary outcome was the average of mask VTs measured at 10, 20, 30, 40, 50, and 60 seconds after apnea. The main secondary outcome was the time from apnea to tracheal intubation. STATA was used for statistical analysis. RESULTS: The average of mask VTs measured at 10, 20, 30, 40, 50, and 60 seconds after apnea was larger in the early rocuronium group than in the late rocuronium group (552 mL breath−1 [165 mL breath−1] vs 393 mL breath−1 [165 mL breath−1], mean difference, 160 mL breath−1; 95% CI, 98−221 mL breath−1; P
http://bit.ly/2IcWEcw
http://bit.ly/2IcWEcw
Drug Calculation Errors in Anesthesiology Residents and Faculty: An Analysis of Contributing Factors
BACKGROUND: Limited data exist regarding computational drug error rates in anesthesia residents and faculty. We investigated the frequency and magnitude of computational errors in a sample of anesthesia residents and faculty. METHODS: With institutional review board approval from 7 academic institutions in the United States, a 15-question computational test was distributed during rounds. Error rates and the magnitude of the errors were analyzed according to resident versus faculty, years of practice (or residency training), duration of sleep, type of question, and institution. RESULTS: A total of 371 completed the test: 209 residents and 162 faculty. Both groups committed 2 errors (median value) per test, for a mean error rate of 17.0%. Twenty percent of residents and 25% of faculty scored 100% correct answers. The error rate for postgraduate year 2 residents was less than for postgraduate year 1 (P = .012). The error rate for faculty increased with years of experience, with a weak correlation (R = 0.22; P = .007). The error rates were independent of the number of hours of sleep. The error rate for percentage-type questions was greater than for rate, dose, and ratio questions (P = .001). The error rates varied with the number of operations needed to calculate the answer (P
http://bit.ly/2Ig8xhA
http://bit.ly/2Ig8xhA
A 14‐year review of a UK teledermatology service: experience of over 40 000 teleconsultations
Summary
Background
There is a paucity of published evidence of established teledermatology (TD) services in the UK. An in‐house TD service using store‐and‐forward technology was set up at a large regional dermatology department in 2004.
Aim
To review the TD service at our centre, including teleconsultation numbers, coding of diagnoses and patient outcomes.
Methods
Retrospective data were retrieved using the electronic patient database, from 31 July 2004 to 31 July 2018. More detailed information on patient outcomes was obtained from patient notes and histology records. A paper questionnaire was distributed to 100 patients to obtain patient feedback.
Results
In total, 40 201 teleconsultations were made over 14 years, and 64% of cases were coded (n = 25 555), of which 77% were lesions. The most common coded lesions were benign naevus (25%), seborrhoeic keratosis (22%) and basal cell carcinoma (19%). Of the total number of cases, 50% were discharged to their general practitioner with advice, 34% were booked for surgery and 16% were booked for a face‐to‐face appointment. In the survey, 82% of patients surveyed felt that the service was 'good' or 'very good'. A detailed study between 1 January 2015 and 1 January 2016 showed that there were 383 patients (10%) with no diagnosis made following teleconsultation, suggesting diagnostic uncertainty. Reasons for this included lack of diagnostic features, possibility of malignancy and service factors. Within this cohort, there was 68% diagnostic concordance.
Conclusions
We have set up a successful TD service at a UK centre, which has prevented 16 282 face‐to‐face appointments over 14 years. Patient feedback has been very good. Review of cases with diagnostic uncertainty provides important information for service improvement and has not previously been documented.
http://bit.ly/2SRmabe
A 14‐year review of a UK teledermatology service: experience of over 40 000 teleconsultations
Summary
Background
There is a paucity of published evidence of established teledermatology (TD) services in the UK. An in‐house TD service using store‐and‐forward technology was set up at a large regional dermatology department in 2004.
Aim
To review the TD service at our centre, including teleconsultation numbers, coding of diagnoses and patient outcomes.
Methods
Retrospective data were retrieved using the electronic patient database, from 31 July 2004 to 31 July 2018. More detailed information on patient outcomes was obtained from patient notes and histology records. A paper questionnaire was distributed to 100 patients to obtain patient feedback.
Results
In total, 40 201 teleconsultations were made over 14 years, and 64% of cases were coded (n = 25 555), of which 77% were lesions. The most common coded lesions were benign naevus (25%), seborrhoeic keratosis (22%) and basal cell carcinoma (19%). Of the total number of cases, 50% were discharged to their general practitioner with advice, 34% were booked for surgery and 16% were booked for a face‐to‐face appointment. In the survey, 82% of patients surveyed felt that the service was 'good' or 'very good'. A detailed study between 1 January 2015 and 1 January 2016 showed that there were 383 patients (10%) with no diagnosis made following teleconsultation, suggesting diagnostic uncertainty. Reasons for this included lack of diagnostic features, possibility of malignancy and service factors. Within this cohort, there was 68% diagnostic concordance.
Conclusions
We have set up a successful TD service at a UK centre, which has prevented 16 282 face‐to‐face appointments over 14 years. Patient feedback has been very good. Review of cases with diagnostic uncertainty provides important information for service improvement and has not previously been documented.
http://bit.ly/2SRmabe
Bacteriotherapy with Streptococcus salivarius 24SMB and Streptococcus oralis 89a oral spray for children with recurrent streptococcal pharyngotonsillitis: a randomized placebo-controlled clinical study
Abstract
Purpose
Group A beta-hemolytic Streptococcus (GABHS) causes a recurrent acute pharyngotonsillitis (RAPT) in children. Moreover, the repeated use of antibiotics contributes to its resistance. However, S. Salivarius 24SMB and S. oralis 89a were effective probiotics in other infections. Thus, we decided to evaluate this combination efficacy compared to placebo in RAPT.
Methods
Patients with microbiologically confirmed GABHS were enrolled in this randomized, placebo-controlled trial. They received the aforementioned combination or placebo as an oral spray. We investigated episodes of frequency and duration, need for antibiotics, school days lost, the treatment impact on life quality, treatment compliance and side effects during a 90-day treatment and a 6-month follow-up.
Results
We included 41 patients in each group. The mean number of GABHS infection was significantly lower during both study periods for the two groups. However, our treatment group showed a lower rate. Moreover, the probiotic group had a lower mean number and a shorter median duration of GABHS episodes during both study periods than controls. Furthermore, the mean duration of antibiotic treatment was lower in the probiotic group during the 90-day and 6-month follow-up periods. Similarly, patients in the probiotic group showed a significantly lower mean number of absence days from school but higher EQ-VAS score. Indeed, all patients included were compliant to treatment.
Conclusions
We identified potential probiotics, possessing desirable features against GABHS pharyngotonsillitis. Our findings represent the first evidence which throws the light on using these probiotics that can reduce antibiotics use which did not have efficient results regarding recurrence.
http://bit.ly/2SNa42X
Age-Related Patterns of DNA Detection and Specific IgG Subclasses in Healthy HHV-6- and HHV-7-Infected Individuals
Viral Immunology, Ahead of Print.
http://bit.ly/2TOyA0F
Patient Satisfaction and Patients' Family or Significant Other Perceptions After OnabotulinumtoxinA Treatment: A Prospective Cross-Sectional Study
BACKGROUND OnabotulinumtoxinA treatment is associated with improved emotional well-being in patients. OBJECTIVE This study aimed to determine satisfaction with onabotulinumtoxinA treatment in patients naive to neurotoxin treatment and patients with previous experience with the procedure and evaluate treatment impact on patients' partners, "significant others," or close family members. MATERIALS AND METHODS Patients' satisfaction and their family's/significant other's perception to treatment outcome were assessed in a prospective, cross-sectional study using standardized questionnaires. RESULTS OnabotulinumtoxinA treatment was associated with high patient satisfaction ranging from 80% to 100%. Study patients (61 patients) reported that their faces appeared to be more balanced and symmetrical (mean difference, 1.05) and that they looked much better in photographs (mean difference, 1.43), with their significant others also noting the improvement in appearance. Overall, 98% of patients expressed that they would undergo retreatment, and 100% expressed that they would recommend the procedure to others. The main obstacle for treatment repetition was economic constraints (26%). CONCLUSION OnabotulinumtoxinA treatment is one of the most precise and predictable cosmetic treatments available, with high patient satisfaction (97%). A positive outcome of onabotulinumtoxinA treatment, as expressed by patients surveyed using standardized questionnaires, was the appreciation and acceptance by those in close contact with them. Address correspondence and reprint requests to: José R. Montes, MD, FACS, FACCS, Ophthalmology Dpeartment, University of Puerto Rico, 735 Ponce de León Avenue, Suite 813, San Juan, Puerto Rico 00917, or e-mail: jrmontes@jrmontes.com J.R. Montes is a speaker and trainer for Allergan, Galderma, and Merz. The study was conducted without any support from Allergan, manufacturer of onabotulinumtoxinA (Botox). Nevertheless, Allergan funded the publication of the study. R.V. Ubale is an employee of Cactus Communications who was funded by Allergan for providing writing and editorial assistance. The authors have indicated no significant interest with commercial supporters. © 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.
http://bit.ly/2TKFcNH
http://bit.ly/2TKFcNH
Desarrollo de lenguaje en niños con implante coclear en centro terciario de salud: Serie clínica
ABSTRACT Introduction: Since the 90s, cochlear implantation has progressed from experimental to standard clinical practice for children with severe and profound hearing loss. Research has produced changes in implant technology and has led to the expansion of implant candidacy to include children younger than 2 years of age. The primary goal of pediatric cochlear implantation is to facilitate spoken language development. Despite the advances in implant technology and the changes to the management of hearing loss, language outcomes for children are still highly variable, participating in this process both timely treatment, the family network and socio economic level among others. Aim: describe outcomes of patients younger than 6 years undergoing cochlear implant surgery in a tertiary care center. Material and method: retrospective longitudinal cohort study, 99 patients implanted in a tertiary health center since the program's inception in 1994 to 2015 was analyzed. Results: 99 patients, 57 % men 43 % women, average age of implantation 16.3 months. 54.8 % of cases were congenital or prematurity. In 74.4 % they had auditory verbal language. Socioeconomic status (SES) showed association with the lack of language development (p =0.009) demonstrating that low SES patients (20%) do not develop language. The disability associated variable (p <0.001) and the SES variable (p =0.036) were independently associated with sign language or no oral language development. Conclusions: Cochlear implants offer an option for hearing rehabilitation in profound hearing loss, for candidates of all ages, however the results depend largely on the environment in which cochlear implants are used.
http://bit.ly/2Idi9tq
Calidad de vida en pacientes con implante coclear en Hospital Barros Luco Trudeau
Abstract Introduction: Quality of life has become very important, and nowadays all health interventions are valued for the impact they can have on it. Profound bilateral hearing loss produces major consequences such as delaying the acquisition of language, which results in a significant decrease in learning and creates difficulties in how the individual develops in their environment. The cochlear implant is the treatment of choice in this pathology, and it is imperative to know the real impact it has on the quality of life of those subjected to this intervention. Aim: To know the overall quality of life of the patients implanted in the Barros Luco Trudeau Hospital between 2015 and 2016, using the KINDL quality of life measurement instrument. Material and method: Prospective analytical cohort study, to measure the quality of life, the KINDL instrument was used. The instrument was applied to implanted minors and their parents through a direct interview in pre-implantation periods at six months and after one year of implantation. The data and statistics tests were made with SPSS 13 software. Results: 16 pediatric patients implanted in the Barros Luco Trudeau Hospital were studied. There were changes in the global quality of life and the subscales of emotional well-being, such as the patient's self-esteem, education, relationships with friends and family, as well as the perception of illness. Conclusions: The cochlear implant in our series demonstrated a positive change in the global quality of life for both patients and their family environments.
http://bit.ly/2GsJ17g
Momento de inicio de radioterapia posoperatoria como factor pronóstico en pacientes con cáncer de laringe avanzado
ABSTRACT Introduction: Among the factors that play a role in the survival and recurrence of disease of patients with operated squamous laryngeal cancer is the time to initiation of postoperative radiotherapy (RT). Aim: To determine the impact of delayed onset of postoperative RT on survival and disease recurrence in patients with advanced operated squamous laryngeal cancer. Material and Method: Retrospective cohort study. Collection of data through review of clinical records. Analysis of survival and disease recurrence using the Kaplan-Meier method, comparison of curves with Log-Rank test and Cox regression model for analysis of prognostic factors. Results: The waiting time between surgery and the initiation of RT in our hospital realities was 11 weeks. The 5-year specific survival in patients who start RT ≤ 6 weeks after surgery is 33.3% and decreases to 20% in those who start > 6 weeks (p = 0.20). Conclusion: Patients who start RT in more than 6 weeks after surgery do not present a statistically significant difference in prognosis.
http://bit.ly/2IfEHKp
Rinosinusitis crónica: Una revisión de su etiopatogenia
RESUMEN La rinosinusitis crónica (RSC) se define como una inflamación sintomática de las cavidades nasales y paranasales. Es una enfermedad altamente prevalente, que conlleva una gran carga económica asociada y cuyo tratamiento médico actual consigue un alivio sintomático en aproximadamente 50% de los pacientes. Tradicionalmente se ha clasificado de acuerdo a la presencia o ausencia de pólipos nasales, sin embargo, no se conoce con total claridad los mecanismos que llevan a la diferenciación de ambos fenotipos. Se estima que existirían tanto factores exógenos como endógenos involucrados que configurarían un origen multifactorial de la enfermedad. La RSC es motivo de intensa investigación científica actual dado su impacto y prevalencia, de manera de determinar con mejor precisión los objetivos de un eventual tratamiento de mayor efectividad. Es por ello que presentamos una revisión actualizada en relación a los mecanismos fisiopatológicos subyacentes en RSC.
ABSTRACT Chronic rhinosinusitis (CRS) is defined as a symptomatic inflammation of the nasal and paranasal cavities. It is a highly prevalent disease carrying a large associated economic burden, and its current medical treatment achieves symptomatic relief in approximately 50% of patients. Traditionally, it has been classified according to the presence or absence of nasal polyps. However, the mechanisms that lead to the differentiation of both phenotypes are not fully understood. It has been estimated that there are both exogenous and endogenous factors involved that would configure a multifactorial origin of the disease. Given its impact and prevalence, CRS is currently a subject of intense scientific research, in order to accurately determine the targets for a more effective treatment. For this reason, we present an updated review in relation to the underlying pathophysiological mechanisms in CRS.
http://bit.ly/2GqBc1S
Tumores de glándula parótida: Experiencia quirúrgica Hospital Guillermo Grant Benavente
Abstract Introduction: Parotid gland is the most common site of salivary gland tumors, corresponding to 75-85% of these and 3% of all head and neck tumors. 80% of them correspond to benign tumors. Aim: To analyze the surgical experience in parotid tumors operated in the Guillermo Grant Benavente Hospital. Material and Method: Review of all patients with parotid tumors operated in the Otorhinolaryngology and Head and Neck Surgery Unit of Hospital Guillermo Grant Benavente between January 2011 and April 2016. All surgeries were performed by the same surgical team. Demographic, clinical, surgical, histological and postoperative results were recorded. Results: In the period described, a total of 94 patients were operated on. 84.3% corresponded to benign tumors and 15.7% to malignant tumors. 62.9% corresponds to female patients and 37.1% male, representing a ratio of 1.69:1. The incidence of transient facial paralysis was 16.1%, and of these, only one patient maintained permanent paralysis. Conclusions: Malignant tumors represented 15.7% of cases, being less than reported in the literature. This article presents a large series of parotid tumors treated surgically in our country, with a low associated complication rate.
http://bit.ly/2GrCXMo
Evaluación de procesamiento auditivo y percepción sonora en sujetos con presbiacusia
RESUMEN Introducción: Pacientes portadores de hipoacusia simétrica en la audiometría pueden percibir su déficit como asimétrico. La explicación de este fenómeno podría tener su origen en variaciones en la conducción del estimulo hablado hacia la corteza auditiva, o procesamiento auditivo. Objetivo: Evaluar el procesamiento auditivo en pacientes que refieren escuchar mejor por un oído en presencia de umbrales audiométricos simétricos. Material y método: Pacientes mayores de 65 años. Criterios de exclusión: patología otológica, deterioro cognitivo (Mini Mental test <21 puntos), usuario de audífono, hipoacusia asimétrica. La batería de procesamiento auditivo incluyó evaluación de comprensión del habla en competencia (habla en ruido), pruebas dicóticas (dígitos dicóticos y la versión en español de Staggered spondaic words, SSW), y evaluación temporal (patrón de frecuencia y discriminación de silencio). Todas estas pruebas estaban previamente validadas en población chilena. Análisis estadístico mediante programa SPSS. Se utilizaron estadísticos descriptivos y pruebas no paramétricas (Kruskal Wallis y Mann Whitney). p <.05. Protocolo aprobado por comité de ética de Investigación, pacientes consienten. Trabajo financiado por Concurso de Proyectos de Investigación de la SOCHIORL y Proyecto Anillo ACT1403. Resultados: 49 pacientes cumplen criterios de ingreso, 37 son de sexo femenino. Se identifican tres grupos: escuchan mejor por oído derecho (n: 19), por oído izquierdo (n: 14), o sin diferencia entre ambos oídos (n: 16). El grupo de pacientes con audición simétrica tenia PTP significativamente menor que los otros dos grupos. Al analizar los distintos tests de procesamiento auditivo no hay diferencia entre los grupos. Al evaluar habla dicótica se observó que el oído derecho tuvo un significativo mejor rendimiento que el oído izquierdo para dígitos dicóticos y SSW (p .000 y .007 respectivamente, test de Mann Whitney) en todo el grupo de pacientes evaluados, sin diferencia al agrupar por percepción auditiva (p .835, test de Kruskal Wallis). Conclusión: Para el grupo de pacientes evaluados no se pudo demostrar una relación entre procesamiento auditivo y percepción asimétrica de la palabra.
Abstract Introduction: Presbycusis corresponds to a symmetrical loss in the audiogram. Nevertheless, some patients complaint that they hear better in one ear. Aim: The purpose of this work is to analyze if this asymmetrical perception relates with auditory processing. Material and method: Subjects older than 65 years of age. Exclusion criteria: ear pathology, cognitive decline (Mini Mental test with score <21 points), previous use of hearing aid, asymmetrical thresholds in audiometry. Auditory processing was evaluated with speech in noise test, dichotic tests (dichotic digits and the Spanish version of Staggered spondaic words, SSW), and temporal resolution (frequency pattern and gap in noise). Statistical analysis with SPSS. Descriptive tests, Kruskal Wallis and Mann Whitney, p <.05. Protocol approved by the local ethics committee. Subjects consented. Financial support by the Chilean Society of Otorhinolaryngology and Proyecto Anillo ACT1403. Results: 49 subjects were recruited, 37 female. 19 of them reported better hearing with the right ear, 14 with the left ear, and 16 no difference among ears. Those subjects with symmetrical perception had better PTP than the other two groups. The three groups had no difference in auditory processing evaluation. In the dichotic hearing assessment most patients had a significant better performance for the right ear both for dichotic digits and SSW, independent of the better ear. Conclusions: For the cases included there was no relation between speech perception and auditory processing. In dichotic tests the right ear had a significant better performance.
http://bit.ly/2IcGcsM
Influencia de las zonas cocleares muertas sobre la autopercepción de las habilidades auditivas en adultos con hipoacusia sensorioneural bilateral
ABSTRACT Introduction: Cochlear dead regions are areas of the basilar membrane where the hair cells and/or auditory nerve fibers are not functional, which can alter the temporal analysis of an acoustic signal. The functional effects that could generate still are not entirely clear, and set through the use of self-perception questionnaires, provide useful information for audiological management of patients. Aim: To investigate the relationship between the presence of cochlear dead regions and the self-reported of listening difficulties of adults with bilateral sensorineural hearing loss. Material and Method: Twenty adults with symmetric bilateral sensorineural hearing loss, aged 51 to 75 years were tested, without previous story of use of hearing aids. Cochlear dead regions were tested using the TEN test at 1, 2, 3 and 4 kHz. The questionnaire of twelve questions, IROS12, was applied to the participants. Results: Cochlear dead regions were present in 10 participants. No significant differences were observed between groups, however lower IROS12 scores were observed in those who had present of dead regions. Conclusion: The perception of hearing difficulties in individuals with bilateral sensorineural hearing loss with cochlear dead regions did not differ significantly from those individuals without cochlear dead regions.
http://bit.ly/2GwsPlB
Influencia auditiva de la pared posterosuperior del conducto auditivo externo, en la hipoacusia de conducción postimpanomastoidectomía
ABSTRACT Introduction: Cholesteatomas treatment is surgical and the goals are complete resection of it, to prevent complications and recurrences. The gold standard operative technique is canal wall down tympanomastoidectomy (CWDT), which reduces the recurrence rate lower than 2%. Studies on human temporal bones have defined that CWDT causes a decrease of 1 to 5 dB at frequencies below 1000 Hz and 0 to 10 dB between 1000 and 3000 Hz. Aim: To determine how many decibels the hearing is improved by reconstituting the posterior wall of the ear canal (EC) in patients after CWDT. Material and method: Experimental study. In patients after CWDT, the posterior wall of EC was reconstructed temporarily. Audiometry was performed before and after the procedure. Results: 23 patients were enrolled (25 ears evaluated). Average age 48.8 years (range 18 to 72 years). In 96% of the ears there was a difference after the procedure with a hearing improvement of 4.2 ± 2.8dB. In frequencies below 1000 Hz, hearing improvement was 6.0 dB (p<0.001), between 1000-3000 Hz, the improvement was 2.6 dB (p<0.001) and >3000 Hz there was no difference. When considering the airway-conduction pure tone average (PTA), the difference was a 4.6 dB improvement (p<0.001). Conclusions: Our study shows that there is a hearing improvement in the vast majority of ears that were evaluated by reconstituting the posterior wall of the EC, reaching a gain of 6 dB at frequencies <1000 Hz and 2,6 dB at mid frequencies. Considering the airway PTA, the improvement is 4.6 dB in the presence of posterior canal wall.
http://bit.ly/2IeUJ7h
Tumores de glándula submandibular: Experiencia clínica del Hospital Guillermo Grant Benavente
ABSTRACT Introduction: Submandibular gland tumors are rare. They represent less than 1% of all head and neck tumors. They correspond to 10% of the tumors of the salivary glands. Approximately 50% are malignant. Aim: To analyze the clinical experience with the submandibulectomies performed in the Otorhinolaryngology and Head and Neck Surgery Service of the Guillermo Grant Benavente Hospital. Material and Method: Retrospective descriptive study. Review of clinical records of patients treated with a submandibulectomy between January 1,2011 and December 31, 2016 in our service. Results: 28 submandibulectomies were performed due to tumor pathology. The average age was 54 years, being 71% female. 21 tumors were benign (75%), being the most frequent the pleomorphic adenoma (14 cases), and 7 malignant tumors (25%), being the most frequent the adenoidequistic carcinoma. Two transient complications (7%) were reported, a paresis of the marginal branch of the facial nerve and a paresis of the hypoglossal nerve. 42% of malignant tumors presented recurrence. Conclusion: Our series presents results according to the literature regarding age of presentation, distribution by sex, histological types, complication rate and recurrence; however, it differs in the lower frequency of malignant tumors, being in our series of 25%. Uncommon pathology. The presence of a submandibular painless mass must be referred to the reference centers for study and possible surgical resolution due to the risk of malignancy.
http://bit.ly/2IdIGH3
Influencia del exceso de peso en el éxito de la adenoamigdalectomía en pacientes con hiperplasia adenoamigdalina sintomática
Resumen Introducción: En población pediátrica con malnutrición por exceso, existe controversia respecto al rol de la hiperplasia adenoamigdalina en la etiología de los trastornos del sueño y de la efectividad de la adenoamigdalectomía sobre dicha sintomatología. Objetivo: Comparar la efectividad de la adenoamigdalectomía entre pacientes pediátricos eutróficos y con malnutrición por exceso sometidos a adenoamigdalectomía por hiperplasia adenoamigdalina, en relación a la disminución de la sintomatología. Materiales y método: Estudio retrospectivo mediante revisión de fichas clínicas entre junio de 2016 y enero de 2017 de pacientes operados de adenoamigdalectomía por hiperplasia adenoamigdalina sintomática. Se clasificaron los pacientes de acuerdo a edad y estado nutricional en 4 grupos y se evaluó la resolución de la sintomatologia mediante interrogación a padres/tutores. Resultados: Se incluyeron 98 pacientes, con una edad media de 6,3 años. 44,9% de los pacientes fueron eutróficos y 55,1% con malnutrición por exceso. El análisis estadístico entre pacientes eutróficos y aquellos con malnutrición no demostró diferencias significativas en relación a la resolución de la sintomatología. Conclusión: La adenoamigdalectomía por hiperplasia adenoamigdalina sintomática se asocia a una reducción de la frecuencia de roncopatía con pausas en pacientes pediátricos, independientemente del estado nutricional.
Abstract Introduction: In pediatric population with malnutrition by excess, the role of the adenotonsillar hyperplasia in the etiology of breathing-related sleep disorders, and the effectivity of the adenotonsillectomy for reducing symptoms remains controversial. Aim: To compare and evaluate the effectiveness of the adenotonsillectomy between eutrophic and malnutrition by excess pediatric patients submitted to adenotonsillectomy by adenotonsillar hyperplasia, regarding to symptoms resolution. Material and method: A retrospective study was performed collecting data from clinical records between June 2016 and January 2017 of patients submitted to adenotonsillectomy by symptomatic adenotonsillar hyperplasia. Patients were assigned to 4 groups according to age and nutrional status and the rate of symptoms resolution was evaluated through interrogation to parents/guardians. Results: We included 98 patients, with an average age of 6.3 years. A 44.9% of patients were eutrophic and 55.1% had malnutrition by excess. Comparing eutrophic and malnutrition by excess patients, no significant differences were observed regarding to symptoms resolution. Conclusion: The adenotonsillectomy by symptomatic adenotonsillar hyperplasia was associated to an amelioration of the rate of snoring and respiratory pauses during sleeping in pediatric patients, independently of the nutritional status.
http://bit.ly/2GsHrC7
Carcinoma adenoideo quístico pulmonar primario con metástasis precoces exclusivas hepáticas, un caso inusual
ABSTRACT Adenoid cystic carcinoma (ACC) is a pathology of the salivary glands, exceptional cases have been described as primary of the bronchus. This is a case of primary adenoid cystic carcinoma of the tracheobronchial tree (PACCTBT), with partial response to radiation therapy, in addition, presents liver metastases, without evidence of metastasis injuries in other parts of the body. Such characteristics mean that we should pay attention to the atypical forms of ACC, especially PACCTBT and its unpredictable behavior.
http://bit.ly/2GrXP67
Plenitud ótica como primer síntoma en patología del espacio parafaríngeo
ABSTRACT Parapharyngeal space (PPS) tumors are infrequent and account for 0.5%-1% of head and neck neoplasms. Therefore, they represent a diagnostic challenge. The distribution of PPS tumors is as follows: 40% salivary tumors, followed by neurogenic tumors and adenopathies. We report a case of a 50 year old woman that presented with a 3-month history of otic fullness and pharyngeal disturbances. The otolaryngological examination showed PPS pathology that was confirmed by radiological images. Surgical excision by transcervical-transparotid approach was performed followed by uncomplicated healing with no recurrence in one year. The histological examination reported a pleomorphic parotid adenoma. The authors provide a discussion of the etiopathogenesis, diagnosis and treatment of this type of lesions. This clinical manuscript may shed light on the importance of a complete otolaryngological examination in a patient with unspecific symptoms considering that the PPS is a complex anatomic region and its pathology can easily go unnoticed.
http://bit.ly/2InkzpM
Hiperparatiroidismo persistente debido a paratiromatosis
ABSTRACT Parathyromatosis is described as a condition in which there are multiple nodules of hyperfunctioning parathyroid tissue disseminated by the neck and mediastinum. Imaging tests are not effective in locating the parathyroid glands and requires the combination of medical and surgical treatment that sometimes is challenging. We describe the case of a 61-year-old woman with recurrent primary hyperparathyroidism. A total of 9 parathyroid glands where removed in 3 different surgeries. We also reviewed the literature.
http://bit.ly/2GsHqhx
Enfermedad de Rosai-Dorfman con compromiso laríngeo: A propósito de un caso
RESUMEN La enfermedad de Rosai-Dorfman (ERD) o histiocitosis sinusal con linfadenopatía masiva es una enfermedad infrecuente, de etiología desconocida caracterizada por linfadenopatías cervicales masivas bilaterales. El compromiso extraganglionar puede ocurrir en diferentes sitios, incluida la vía aérea, en la cual la localización nasosinusal es la más frecuente, pero puede comprometer también otros sitios de la vía aérea superior. Dentro de éstos, el compromiso laríngeo es muy poco frecuente. Se presenta el caso de una paciente de 82 años con antecedentes de ERD localizada en los ganglios linfáticos cervicales en remisión espontánea, que desarrolló posteriormente una obstrucción subaguda de las vías respiratorias. La tomografía computarizada y la nasofaringolaringoscopía mostraron lesiones subglóticas que obstruían severamente las vías respiratorias. Se realizó una traqueostomía de emergencia y biopsia de las lesiones, confirmando el diagnóstico de ERD extranodal.
ABSTRACT Rosai-Dorfman disease or sinus histiocytosis with massive lymphadenopathy is a rare disease of unknown etiology characterized by bilateral massive cervical lymphadenopathy. Extranodal involvement can occur in different sites including airway where nasosinusal involvement is common but this disease may occur in other sites of the upper airway. Laryngeal involvement is rare. We present the case of an 82-year-old female patient with a history of Rosai-Dorfman disease located in cervical lymph nodes in spontaneous remission that subsequently develops airway obstruction. Computed tomographic scan and nasopharyngolaryngoscopy showed subglottic lessons that severely obstructed the airway. Emergency tracheotomy and biopsy were performed, confirming the diagnosis of extranodal RDD. Patient was observed and tracheostomy was maintained with good tolerance.
http://bit.ly/2Ig06TH
Técnica de embalsamiento de cadáver según Thiel. Un método valioso para entrenar y mejorar las destrezas quirúrgicas en el campo de la otorrinolaringología
RESUMEN Los tiempos modernos nos obligan a que la formación de un médico cirujano no se base sólo en conocimientos teóricos, sino que adquiera las mayores habilidades quirúrgicas para así evitar riesgos innecesarios en una sociedad altamente exigente. La disección y el entrenamiento de los procedimientos quirúrgicos juegan un papel primordial para cumplir este objetivo, por lo que recientemente se ha promovido una forma de preservación cadavérica que permite realizar mediante situaciones bastantes realistas dichos adiestramientos. Se realizó una búsqueda bibliográfica electrónica, restringida al idioma inglés en Pubmed, Scopus y WOS donde se pretende describir y analizar las aplicaciones de esta técnica. La revisión ofreció artículos de relevancia que demuestran la aplicación de esta técnica novedosa en la preservación de cadáveres y sus posibles aplicaciones en el campo de otorrinolaringología.
ABSTRACT Nowadays, it is not possible to train a healthcare professional only based on theoretical knowledge, but acquiring the highest surgical skills to avoid unnecessary risks in a highly demanding society, therefore dissection and training of surgical procedures play a key role in fulfilling this objective, which is why a form of cadaveric preservation has recently been promoted, which allows realizing such training through realistic situations. An electronic literature search was carried out, restricted to the English language in MEDLINE, where it is intended to describe and analyze the applications of this technique. The review offered articles of relevance that demonstrate the application of this novel technique in the preservation of corpses and their possible applications in the field of otorhinolaryngology.
http://bit.ly/2GpoqRf
Reconstrucción en cabeza y cuello: Un desafío en oncología
RESUMEN Considerando los avances en las modalidades de tratamiento para el cáncer de cabeza y cuello, el manejo quirúrgico de los defectos ha cambiado significativamente en las últimas décadas. Con la mejoría del manejo previo a la cirugía en la década de los 40s-50s, la cirugía ablativa o resectiva se convirtió en el pilar del tratamiento de los tumores avanzados en esta región, lo cual rutinariamente era seguido de tratamiento con radioterapia. Desafortunadamente, la cirugía reconstructiva no avanzó de la misma forma, no existiendo previamente opciones confiables de rehabilitación de estos pacientes. Además, los cirujanos de cabeza y cuello como otorrinolaringólogos de la época no consideraban la reconstrucción como parte importante del tratamiento quirúrgico. Sin embargo, en las últimas décadas, la cirugía reconstructiva ha presentado distintos avances que han permitido complementar el manejo de estas patologías, entregando una terapia oncológica con menos morbilidad cosmética y funcional. Esta revisión pretende de forma general dar a conocer los distintos tipos de colgajo, sus indicaciones y opciones en cirugía reconstructiva de cabeza y cuello, lo cual es de suma importancia para los servicios que manejen patología oncológica de esta región anatómica.
ABSTRACT Encompassing with the advances in the preferred treatment modalities for head and neck cancer, the management of surgical defects has changed significantly over the last decades. With the advent of improved perioperative management in the 1940-50s, radical ablative surgery became the mainstay for treatment of advanced tumors in this region, which was routinely followed by radiation therapy. Unfortunately, reconstructive surgery did not advance at the same pace, and there were no reliable reconstructive options to rehabilitate these patients. Furthermore, head and neck surgeons and otolaryngologists of the time did not consider reconstruction as an important part of the surgical treatment. However, in the last decades, reconstructive surgery has presented different advances that have made it possible to complement the management of these pathologies, delivering an oncological therapy with less cosmetic and functional morbidity. This review aims in general to make known the different types of flap, its indications and options in reconstructive surgery of the head and neck, of utmost importance for the services that handle oncological pathology of this anatomical region.
http://bit.ly/2IbAoj7
Carta al Editor
RESUMEN La rinosinusitis crónica (RSC) se define como una inflamación sintomática de las cavidades nasales y paranasales. Es una enfermedad altamente prevalente, que conlleva una gran carga económica asociada y cuyo tratamiento médico actual consigue un alivio sintomático en aproximadamente 50% de los pacientes. Tradicionalmente se ha clasificado de acuerdo a la presencia o ausencia de pólipos nasales, sin embargo, no se conoce con total claridad los mecanismos que llevan a la diferenciación de ambos fenotipos. Se estima que existirían tanto factores exógenos como endógenos involucrados que configurarían un origen multifactorial de la enfermedad. La RSC es motivo de intensa investigación científica actual dado su impacto y prevalencia, de manera de determinar con mejor precisión los objetivos de un eventual tratamiento de mayor efectividad. Es por ello que presentamos una revisión actualizada en relación a los mecanismos fisiopatológicos subyacentes en RSC.
ABSTRACT Chronic rhinosinusitis (CRS) is defined as a symptomatic inflammation of the nasal and paranasal cavities. It is a highly prevalent disease carrying a large associated economic burden, and its current medical treatment achieves symptomatic relief in approximately 50% of patients. Traditionally, it has been classified according to the presence or absence of nasal polyps. However, the mechanisms that lead to the differentiation of both phenotypes are not fully understood. It has been estimated that there are both exogenous and endogenous factors involved that would configure a multifactorial origin of the disease. Given its impact and prevalence, CRS is currently a subject of intense scientific research, in order to accurately determine the targets for a more effective treatment. For this reason, we present an updated review in relation to the underlying pathophysiological mechanisms in CRS.
http://bit.ly/2IoEXqa
Fe de errata/Errata
ABSTRACT Chronic rhinosinusitis (CRS) is defined as a symptomatic inflammation of the nasal and paranasal cavities. It is a highly prevalent disease carrying a large associated economic burden, and its current medical treatment achieves symptomatic relief in approximately 50% of patients. Traditionally, it has been classified according to the presence or absence of nasal polyps. However, the mechanisms that lead to the differentiation of both phenotypes are not fully understood. It has been estimated that there are both exogenous and endogenous factors involved that would configure a multifactorial origin of the disease. Given its impact and prevalence, CRS is currently a subject of intense scientific research, in order to accurately determine the targets for a more effective treatment. For this reason, we present an updated review in relation to the underlying pathophysiological mechanisms in CRS.
http://bit.ly/2GrskZM
Clinicopathological characteristics associated with necrosis in pulmonary metastases from colorectal cancer
Abstract
Metastatic lung cancers from the colon and rectum (MLCR) frequently have necrotic components. The aim of this study is to elucidate clinicopathological factors associated with the amount of necrosis in MLCR. Ninety patients who underwent the first pulmonary metastasectomy for MLCR with a tumor diameter ≦ 3.0 cm and without chemotherapy were enrolled in this study. Analyzing digitally scanned pathological slides, we calculated the necrosis percentage (NP, the necrosis area divided by the tumor area). The relationship between NP and clinicopathological factors was analyzed. Moreover, to determine whether NP was affected by tissue hypoxia, vascularization, or tumor cell proliferation, tissues were analyzed by immunohistochemical staining using carbonic anhydrase IX (CAIX), CD34 antibodies, and Ki-67 antibodies, respectively. Median tumor area and NP were 0.69 cm2 (0.11–3.01) and 13.1% (0–71.6), respectively. Although NP was not associated with the tumor area, it was significantly higher in the patients with a positive smoking history (8.14% vs 17.1%, p = 0.045). Other clinicopathological factors were not correlated with NP. Immunohistochemical analysis revealed that CA IX expression on tumor cells, CD34 micro-vessel density, CD34 micro-vessel area, and Ki-67 index were not significantly associated with NP. NP in the primary site was not associated with NP in the pulmonary metastasis. NP was not determined by tumor size, tissue hypoxia, vascularization, or tumor cell proliferation. Positive correlation of NP with smoking history suggests a unique lung microenvironment in smokers which makes necrosis of MLCR more likely to occur.
http://bit.ly/2DJ2pct
A reliable method to avoid contamination during cartilage graft preparation in septorhinoplasty
Abstract
Purpose
The aim of the study is to determine the risk of contamination in the cartilage graft materials prepared on the swester table and those prepared in a sterile package, and to reveal a more reliable method by performing the microbiological examination of these materials.
Methods
Cartilages removed from the nasal septum were divided into four pieces. The first part (Sample A) was directly placed into the medium. Sample B was prepared by being crushed in a sterile package. Sample C was prepared on the auxiliary swester table, and Sample D was prepared on the main swester table actively used by surgery team. All samples were transferred in a 1 ml brain heart(BH) liquid medium. From each BH medium, 100 µl culture was performed on blood agar, eosin–methylene blue–lactose–sucrose agar and chocolate agar.
Results
Bacterial growth was detected in 2 of the samples A, in 4 of the samples B, in 24 of the samples C, and in 36 of the samples D. The number of patients with bacterial growth in the samples C and/or D despite no growth in the sample B was 35. When the samples A/B and C/D were compared in terms of bacterial growth, a significant difference was found in all matchings (p < 0.001 for all comparisons).
Conclusion
These findings showed that preparation of the cartilage grafts on the swester table was extremely risky for microbiological contamination. Arslan and his colleagues suggest that preparing a graft material in a sterile package is extremely simple, cheap, and it also reduces contamination risk significantly.
http://bit.ly/2IcBZFu
African American Ancestry Contribution to Asthma and Atopic Dermatitis
Despite advances in therapeutics and a better understanding of environmental risk factors, racial disparities in both asthma and atopic dermatitis (AD) are profound, and cannot be explained by non-genetic factors alone1,2. Disparities are compounded by a disproportionate under-representation of minority populations in genetic and pharmacogenetic studies of asthma and AD. As a result, genetic risk factors for these clinical conditions are much less well understood in African ancestry populations compared to European populations.
http://bit.ly/2GIqfId
Con: OIT is safe/better than food avoidance
Food allergy (FA) is well-recognized as a major public health problem, affecting 8% of children and 5% of adults in the industrialized countries.1 Despite the relatively high prevalence of this disorder, there is unfortunately no definitive cure. For a long time, the classical approach for the management of IgE-mediated FA has been strict food avoidance and the prescription of epinephrine auto-injector in case of accidental reaction. Regular oral food challenges (OFC) are performed in order to assess spontaneous tolerance acquisition.
http://bit.ly/2GI4GaW
Drug Hypersensitivity Reactions in the Americas: Similarities and Differences
Drugs are the most frequent cause of fatal anaphylaxis worldwide(1). The prevalence of adverse drug reactions (ADRs), including allergy, is known to be related to drug exposure frequency, gender, age, ethnicity and genetic factors, and it varies according to the classes of drugs, definitions of hypersensitivity reactions (HRs) and study design. Drug usage patterns vary significantly with time and geography, both across large countries and around the world(1-3).
http://bit.ly/2tm1c5N
Pro-Con Debate: Component resolved diagnostic testing is not useful for making food allergy diagnoses
Funding: none
http://bit.ly/2GG3GEa
Drug Induced Enterocolitis Syndrome (DIES): a clinical entity which deserves more awareness
Drug induced enterocolitis syndrome (DIES) is a rare, non-IgE mediated hypersensitivity reaction provoked by drugs which can be severe and lead to shock. Despite the potential severity of the reactions, awareness of DIES is low. In contrast, enterocolitis syndrome induced by food proteins (FPIES) has been better documented. Previous studies have reported the occurrence of hypovolemic shock in approximately 15% of reactions, which indicates that FPIES is a potentially life threating disease.(1) To increase clinical awareness on DIES we here report a case of a child who was referred to our pediatric allergy clinic and was diagnosed with DIES by amoxicillin.
http://bit.ly/2tkIX0G
Clinical Thyroidology®High-Impact Articles
FREE ACCESS through February 28, 2019
Read Now:
Greetings From the Editor of Clinical Thyroidology
Angela M. Leung
Treatment of Hyperthyroidism Decreases but Does Not Completely Abolish the Increased Risk of Cardiovascular-Related Hospitalization
Natalia Genere and Marius N. Stan
Iodine Content Is Low or Absent in Some U.S. Multivitamin and Prenatal Vitamin Brands
Charles H. Emerson
Is It Time to Update the Classification for Radioiodine-Refractory Differentiated Thyroid Cancer?
Edward B. Silberstein, Guest Associate Editor
Patients with Advanced Thyroid Cancer Containing TRK Fusions May Benefit from Recently FDA-Approved Larotrectinib
Brian W. Kim
The post Clinical Thyroidology<sup>®</sup>High-Impact Articles appeared first on American Thyroid Association.
http://bit.ly/2N8dcRB
Clinical Thyroidology®High-Impact Articles
FREE ACCESS through February 28, 2019
Read Now:
Greetings From the Editor of Clinical Thyroidology
Angela M. Leung
Treatment of Hyperthyroidism Decreases but Does Not Completely Abolish the Increased Risk of Cardiovascular-Related Hospitalization
Natalia Genere and Marius N. Stan
Iodine Content Is Low or Absent in Some U.S. Multivitamin and Prenatal Vitamin Brands
Charles H. Emerson
Is It Time to Update the Classification for Radioiodine-Refractory Differentiated Thyroid Cancer?
Edward B. Silberstein, Guest Associate Editor
Patients with Advanced Thyroid Cancer Containing TRK Fusions May Benefit from Recently FDA-Approved Larotrectinib
Brian W. Kim
The post Clinical Thyroidology<sup>®</sup>High-Impact Articles appeared first on American Thyroid Association.
http://bit.ly/2N8dcRB
Organo-modification of montmorillonite for enhancing the adsorption efficiency of cobalt radionuclides from aqueous solutions
Abstract
Montmorillonite clay was organically modified with thoron (TH) and was employed as an adsorbent for removal of cobalt(II) radionuclides from aqueous solutions. Batch adsorption experiments, under several operational parameters such as pH, contact time, initial adsorbate concentration, adsorbent dosage, ionic strength, and temperature, were conducted to determine the optimum conditions for efficient removal of cobalt(II) radionuclides. The obtained data showed that almost complete removals were achieved for cobalt(II) at pH values ≥ 3.5 using TH-modified montmorillonite (TMM), while only 63% were obtained by unmodified clay at pH ≥ 5.4. Adsorption kinetic data of cobalt(II) were better fitted by the pseudo-second order kinetic model and its adsorption rate was controlled by film diffusion. Both Langmuir and Freundlich models had the ability to well describe the equilibrium data of cobalt(II) radionuclides at the studied temperatures. The adsorption capacity of TMM (0.85 mmol/g) was found to be not only nine times that of unmodified montmorillonite (0.097 mmol/g), but also higher than those reported in literature using various unmodified and modified clays. Thermodynamic parameters (ΔH°, ΔS°, and ΔG°) were calculated. Among the examined desorbing agents, both Al3+ and EDTA were succeeded to desorb most of cobalt(II) radionuclides (desorption % ~ 90%) loaded onto TMM. The results of this study clarified that TMM can be considered as an effective adsorbent for removal of cobalt(II) radionuclides from aqueous solutions.
http://bit.ly/2tr3IYt
Stratifying clinical complexity of dermatology outpatient visits: validation of a pilot instrument
The United States population is aging and increasing in comorbidity, and patient care is accordingly growing increasingly complex. Complexity impacts patterns of resource consumption, adverse event and medical error rates, health-related quality of life, physician burnout, and more. Tools capturing complexity can be of benefit in the modern value-based reimbursement landscape and have been well-studied in specialties other than dermatology. In this paper, we describe the validation of a tool specific to outpatient dermatologic care that captures the complexity of clinical visit medical decision-making.
http://bit.ly/2GJlQol
Letter to the Editor – Sentinel lymph node biopsy in melanoma: Which hot nodes should be harvested and is blue dye really necessary?
The article by Ranson et al., "Sentinel lymph node biopsy in melanoma: which hot nodes should be harvested and is blue dye really necessary?"1 is generating much academic debate. The responses thus far seem to focus on advocating the continued use of blue dye due to the potential for higher false negative rates using radiocolloid tracer injection alone.
http://bit.ly/2GJ0Ga3
Ammonia exposure induced abnormal expression of cytokines and heat shock proteins via glucose metabolism disorders in chicken neutrophils
Abstract
Ammonia (NH3) is a highly irritant, alkaline gas. Atmospheric emission of NH3 was recognized as an environmental challenge. As a global issue, the NH3 emission survey with spatially detailed information demonstrated that the sources of atmospheric NH3 include agriculture (livestock wastes, fertilizers) and some industrial activities. As an environmental pollution, excessive NH3 exposure can induce many bird dysfunction. Neutrophils respond to multiple invading pathogens through different mechanisms. In order to investigate the effect of NH3 exposure on broilers' neutrophil, 1-day-old broilers were treated with/without NH3 for 28 days. We extracted neutrophils from peripheral blood of chicken with/without NH3 exposure and subsequently stimulated with PMA. Changes of cytokines and inflammatory bodies, heat shock proteins (HSPs), and glucose metabolism of neutrophil were examined in both cases. We not only explored that the index associated with inflammation changed due to NH3 exposure but also observed the status of neutrophils which was treated with PMA stimulation. After NH3 exposure, IL-1β and IL-6 were significantly increased on broilers neutrophil. Inflammatory-related factors (NLRP3, ASC, and caspase-1) were significantly elevated. The mRNA expression of HSP70 and HSP90 was increased significantly. All glucose metabolism indicators were reduced. In summary, we concluded that NH3 enhanced inflammation and disrupted glucose metabolism, and increased the expression of HSPs and inflammatory factors. In addition, the sensitivity of neutrophils to exogenous stimuli was diminished. This information can not only be used to evaluate the damage of NH3-spiked neutrophils to chickens, but also provide clues for human health pathophysiology caused by excess NH3, providing valuable information for NH3 risk management.
http://bit.ly/2BC2TRk
MiRNA-3653 Is a Potential Tissue Biomarker for Increased Metastatic Risk in Pancreatic Neuroendocrine Tumours
Abstract
Pancreatic neuroendocrine tumours (PNETs) are relatively uncommon, accounting for 1–2% of all pancreatic neoplasms. Tumour grade (based on the Ki67 proliferative index and mitotic rate) is associated with metastatic risk across large cohorts; however, predicting the behaviour of individual tumours can be difficult. Therefore, any tool which could further stratify metastatic risk may be clinically beneficial. We sought to investigate microRNA (miRNA) expression as a marker of metastatic disease in PNETs. Tumours from 37 patients, comprising 23 with locoregional disease (L) and 14 with distant metastases (DM), underwent miRNA profiling. In total 506 miRNAs were differentially expressed between the L and DM groups, with four miRNAs (miR-3653 upregulated, and miR-4417, miR-574-3p and miR-664b-3p downregulated) showing statistical significance. A database search demonstrated that miRNA-3653 was associated with ATRX abnormalities. Mean survival between the two groups was correlated with mean expression of miRNA-3653; however, this did not reach statistical significance (p = 0.204). Although this is a small study, we conclude that miRNA-3653 upregulation may be associated with an increased risk of metastatic disease in PNETS, perhaps through interaction with ATRX and the alternate lengthening of telomeres pathway.
http://bit.ly/2DJ5OHV
Different light-activation systems associated with dental bleaching: a systematic review and a network meta-analysis
Abstract
Objectives
A systematic review and a network meta-analysis were performed to answer the following research question: "Is there any light-activation protocol capable of improving color change efficacy when associated with an in-office bleaching gel in adults?"
Material and methods
A search was performed in PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library, and SIGLE without date and/or language restrictions in April 23, 2017 (updated on March 30, 2018). IADR abstracts (1990–2018), unpublished and ongoing trial registries, dissertations, and theses were also searched. Only randomized clinical trials conducted in adults that included at least one group treated with in-office dental bleaching with light activation were included. The risk of bias (RoB) was evaluated using the Cochrane Collaboration tool. A random-effects Bayesian-mixed treatment comparison (MTC) model was used to combine light-activated versus light-free in-office bleaching with direct light-free comparison trials. A meta-analysis with independent analysis (high- and low-concentrate hydrogen peroxide [HP]) was conducted for color change (∆E*, ∆SGU).
Results
After the removal of duplicates, title, and abstract screening, 28 studies remained. Nine were considered to be at a low RoB, five were at a high RoB, and the remaining were at an unclear RoB. The MTC analysis showed no significant difference in color change (ΔE* and ΔSGU) between light-activation protocols and light-free in-office bleaching, regardless of the HP concentration in the efficacy of the bleaching.
Conclusion
No type of light-activated in-office bleaching was superior to light-free in-office bleaching for both high- and low-concentrate in-office bleaching gels (PROSPERO—CRD42017078743).
Clinical relevance
Although many times dental professionals use "laser whitening" as a form of marketing, this study confirmed that no type of light-activation for in-office bleaching can improve the bleaching efficacy.
http://bit.ly/2IeD6UT
Reevaluating a Standardized Sedation Weaning Protocol for Pediatric Laryngotracheal Reconstruction
This quality improvement study examines how a new electronic health record affects a series of process, outcome, and balance measures for sedation weaning management in pediatric patients undergoing laryngotracheal reconstruction.
http://bit.ly/2DGf0wY
http://bit.ly/2DGf0wY
Emergence of Cheyne-Stokes Breathing after Hypoglossal Nerve Stimulator Implant in a Patient with Mixed Sleep Apnea
This is a case report of a man in his 60s with stage 3 chronic kidney disease, hypertension, hyperlipidemia, type 2 diabetes, bladder and kidney cancer, and depression who underwent hypoglossal nerve stimulator implantation and subsequently demonstrated a Cheyne-Stokes breathing pattern.
http://bit.ly/2Sy5pm2
http://bit.ly/2Sy5pm2
Reassessing the Safety of Bicycle Helmets
This Viewpoint proposes a reassessment of the safety of bicycle helmets for the protection of the middle and lower face.
http://bit.ly/2DEALNv
http://bit.ly/2DEALNv
Negative Auswirkungen der Streifenconchotomie auf die intranasale Klimatisierung
Zusammenfassung
Ziel
Die partielle Resektion des kaudalen Anteils der unteren Nasenmuschel einschließlich des Nasenmuschelkopfs ist ein nach wie vor anzutreffendes Verfahren in der Rhinochirurgie („Streifenconchotomie"). Ausgedehnte Resektionen der Nasenmuschel beeinträchtigen allerdings den nasalen Luftstrom und die intranasale Klimatisierung. Das Ziel dieser Studie war es, den Effekt einer partiellen Resektion der unteren Nasenmuschel inklusive des Nasenmuschelkopfs auf die intranasale Luftströmung sowie Erwärmung und Befeuchtung der einströmenden Luft mit Computational Fluid Dynamics zu bestimmen.
Material und Methoden
Basierend auf dem computertomographischen Datensatz eines Patienten wurde ein bilaterales realistisches Nasenmodell erstellt. Eine einseitige Teilresektion der unteren Nasenmuschel auf der rechten Seite war bei erhaltener unterer Muschel links extern erfolgt. Zur Analyse der intranasalen Luftströmungsmuster, der Temperatur der eingeatmeten Luft und der Feuchtigkeitsverteilung wurde eine numerische Simulation durchgeführt.
Ergebnisse
Aufgrund der partiellen Resektion der unteren Nasenmuschel auf der rechten Seite einschließlich des Nasenmuschelkopfs war das Strömungsmuster im Vergleich zur Gegenseite deutlich verändert. Die Resektion führt zu einer zentrierten und höheren Geschwindigkeit im unteren Nasengang sowie zu einer reduzierten Erwärmung und Befeuchtung der eingeatmeten Luft im Vergleich zur nichtoperierten linken Nasenhöhle.
Schlussfolgerung
Die häufig durchgeführte Teilresektion des kaudalen Anteils der unteren Nasenmuschel kann bei extensiver Resektion zu einer gestörten intranasalen Klimatisierung führen. Daher sollte dieses Verfahren, wenn möglich, in der Rhinochirurgie vermieden und stattdessen ein schleimhautschonenderes Verfahren gewählt werden.
http://bit.ly/2N6tIlb
Pentito
I'm sorry I doubted it,and you were right, it waspartially because I'm prone to
http://bit.ly/2tp8fLk
http://bit.ly/2tp8fLk
Quality of Life in Prostate Cancer Patients Receiving Hypofractionated vs Conventional Radiotherapy
This phase 3 randomized clinical trial assesses differences in health-related quality of life between men with low-risk prostate cancer who are treated with hypofractionated vs conventional radiotherapy.
http://bit.ly/2GG4p8g
http://bit.ly/2GG4p8g
Trends in Smoking and e-Cigarette Use Among US Patients With Cancer, 2014-2017
This cross-sectional study of data from the National Health Interview Survey analyzes the prevalence of e-cigarette use in US patients with cancer.
http://bit.ly/2tm3YIl
http://bit.ly/2tm3YIl
Therapeutic Options for Neuroendocrine Tumors
This systematic review and meta-analysis examines randomized clinical trials to assess the safety and efficacy of medications used for patients with gastrointestinal and pancreatic neuroendocrine tumors.
http://bit.ly/2GG49WQ
http://bit.ly/2GG49WQ
Role of Monthly High-Dose Vitamin D Supplementation in Cancer Prevention
To the Editor Scragg et al address an issue of major current interest—the role of vitamin D in cancer prevention. We commend the authors for acknowledging several confounding factors in their study that could nullify any association between vitamin D and cancer incidence. These factors include the proportion of participants (approximately 25%) with vitamin D deficiency.
http://bit.ly/2tnFcI0
http://bit.ly/2tnFcI0
Role of Monthly High-Dose Vitamin D Supplementation in Cancer Prevention—In Reply
In Reply Peiris and colleagues commented on the null effect of vitamin D supplementation on incident cancer in the ViDA study, which is based primarily on possible differential effects on disease risk between daily vs monthly doses of vitamin D supplementation. In our article, we acknowledged that monthly dosing may be less effective than daily dosing for preventing cancer, and we agree that if this finding is true, increased variability in vitamin D levels associated with monthly dosing would be a possible mechanism. For example, daily or weekly dosing of vitamin D is more effective than bolus dosing (ie, monthly) in preventing acute respiratory infections, particularly in people with vitamin D deficiency. However, the recent null findings for incident cancer reported in the VITAL study, in which a daily dose of vitamin D was administered, suggest that the frequency of dosing is not important for cancer prevention.
http://bit.ly/2GLdDjB
http://bit.ly/2GLdDjB
Evaluating Risks and Benefits of Evolving Systemic Treatments of Neuroendocrine Tumors
In recent years, the number of treatments for metastatic, well-differentiated gastrointestinal and pancreatic neuroendocrine tumors (NETs) has expanded significantly. New medications for tumor control as well as symptom control include somatostatin analogues, everolimus, sunitinib, telotristat, and lutetium Lu 177 (177Lu)-dotatate. These new therapies have been approved based on randomized clinical trials—an effort that has required international cooperation given the relative scarcity of metastatic NETs.
http://bit.ly/2tjZbXW
http://bit.ly/2tjZbXW
Error in Figure
In the Original Investigation by Unger et al, published online in JAMA Oncology on January 10, 2019, there was an error in Figure 3C. The number above the bar was 6318 but should have been 6317. This article has been corrected online.
http://bit.ly/2GOXLNh
http://bit.ly/2GOXLNh
Ageing profiles of Caucasian and Chinese cohorts – focus on hands skin
Topographic, colour and biophysic ageing profile of dorsal hand skin from a Caucasian and a Chinese cohort.
Abstract
Objective
In spite of hand care being a dynamic segment of skin care, hands skin physiology has been receiving little attention in comparison to facial skin. In the present study, we aimed at gathering a comprehensive set of skin data from the dorsal part of the hand to study age related‐changes in two ethnic groups (Caucasian and Chinese).
Methods
Skin topographic, skin colour/colour heterogeneities, skin chromophores and skin biophysical measurements of 116 Caucasian and Chinese female volunteers aged 30–65 years old were collected in Ireland and in China as part of a cross‐sectional study.
Results
Topographic alterations happened at both micro and macro scales with a noticeable delay in the onset of 10 years for the Chinese cohort. Similar evolution of skin colour with ageing was observed between the two cohorts and strong dissimilarities were seen when it came to colour heterogeneities and melanin hyper concentration, with a 20‐year delay in severity for the Chinese cohort. A similar sharp drop of skin hydration occurred when reaching the 60's regardless of the group and substantial differences were recorded for skin biomechanical properties of the skin.
Conclusion
These results provide additional insights about hand skin physiology in relation to ageing and ethnic differences, especially when put into perspective with what is currently known about facial ageing. This research yield additional material for hand cream product rationale and strategies for mitigating the appearance of ageing hands.
Résumé
Objectif
Même si le soin pour les mains demeure un segment dynamique en termes de ventes de produits cosmétiques, peu d'études se sont penchées sur la physiologie de la peau des mains en comparaison du visage. Le but de cette étude est d'élucider les changements de la partie dorsale de la main induits par le vieillissement, au sein de deux groupes ethniques (Caucasienne et Chinoise).
Methodes
Des mesures de la topographie, de couleur et de distribution de la couleur, de chromophores et des propriétés biophysiques de la peau de la main ont été collectées sur 116 sujets féminins d'origine caucasienne ou chinoise, âgées entre 30 et 65 ans, en Irlande et en Chine dans le cadre d'une étude cross‐sectionnelle.
Resultats
Des altérations de la topographie de la peau ont été observés à plusieurs échelles, micro et macroscopique, avec néanmoins un délai de 10 ans dans la détérioration de la peau en faveur du panel Chinois. Au niveau de la couleur, des évolutions similaires ont été mesurées dans les deux panels, avec cependant de fortes dissimilarités pour ce qui est de la distribution de la couleur de la peau et de l'hyperconcentration de mélanine, avec des changements retardés de 20 ans en faveur du panel d'origine chinoise. Un déclin d'hydratation significatif s'est produit à partir de la soixantaine dans les deux panels étudiés tandis que des différences flagrantes ont été relevées en ce qui concerne les propriétés biomécaniques de la peau.
Conclusion
Ces résultats offre des données supplémentaires sur la physiologie de la peau des mains lors du vieillissement cutané et sur les différences à prendre en compte entre deux groupes ethniques très distincts, surtout si l'on considère les différences avec le vieillissement du visage. Cette étude fournit un support additionnel pour la conception de crèmes pour les mains et les stratégies à mettre en place pour atténuer l'apparence de mains âgées.
http://bit.ly/2GpQLH6
Identification of the recently described plasminogen gene mutation p.Lys330Glu in a family from Northern Germany with hereditary angioedema
Hereditary angioedema (HAE) is a life-threatening disease characterized by recurrent episodes of subcutaneous and mucosal swellings and abdominal cramping. Corticosteroids and antihistamines, which are usually...
http://bit.ly/2V35c7n
Parotidectomy in patients with head and neck cutaneous melanoma with cervical lymph node involvement
Abstract
Background
Parotidectomy in melanoma of the coronal scalp and face with clinically involved cervical lymph node metastasis is based on predicted cervical lymphatic drainage described by O'Brien.
Methods
In total, 40 parotidectomies with en bloc therapeutic neck dissection were retrospectively analyzed.
Results
Lymphatic spread of melanoma to the parotid lymph nodes was observed in 10 of 40 specimens (25%). Eight of the 10 parotid‐positive patients developed a recurrence vs 17 of the 30 parotid‐negative patients (P = 0.28). There were no differences in overall survival, melanoma‐specific survival, and disease‐free survival between the parotid‐positive and parotid‐negative patients.
Conclusion
Although in this series no survival differences were found, parotidectomy still merits a sustained role in therapeutic neck dissection procedures to improve regional control and to prevent facial nerve damage after surgery for a second relapse from occult metastases in the parotid.
http://bit.ly/2N5cCE3
Decreased ciliary beat responsiveness to acetylcholine in the nasal polyp epithelium
Abstract
Objective
We investigated the difference in ciliary beat responsiveness to acetylcholine in ex vivo and the difference in the expressions of associated molecules (M1/M3 muscarinic receptors, pannexin‐1 and P2X7 purinergic receptor) between the nasal polyp and turbinate mucosa.
Study Design
Laboratorial study.
Participants
Nasal polyp and inferior turbinate were collected from patients with hypertrophic rhinitis and/or nasal polyp during endoscopic sinonasal surgery.
Main outcome measures
The mucosa was cut into thin strips, and ciliary movement was observed under a phase‐contrast light microscope equipped with a high‐speed digital video camera. The samples were also examined by scanning electron microscopy, fluorescence immunohistochemistry, and quantitative reverse transcription‐polymerase chain reaction.
Results
Cilia were well preserved in both tissues at the ultrastructural level. The baseline ciliary beat frequency (CBF) was not different between the two tissues. The CBF of the turbinate was significantly increased by stimulation with acetylcholine (P<0.001), but that of the polyp was not. The ratio of the acetylcholine‐stimulated CBF to the baseline CBF was significantly lower in the polyp than in the turbinate (P<0.001). Immunohistochemical study revealed that immunoreactivities for M3, pannexin‐1 and P2X7 were weaker in the polyp than in the turbinate. The mRNA expressions of M1, M3 and P2X7 were significantly lower and that of pannexin‐1 tended to be lower in the polyp than in the turbinate.
Conclusions
These results indicate that ciliary beat responsiveness to acetylcholine is decreased in the nasal polyp. This may be explained by the decreased expressions of M3, P2X7 and probably pannexin‐1 in this tissue.
Keywords
Nasal polyp, ciliary beat frequency, acetylcholine, muscarinic receptor, pannexin‐1 channel, P2X7 purinergic receptor
This article is protected by copyright. All rights reserved.
http://bit.ly/2N70jan
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