The pivot point in transposition flap planning: concept and surgical implications

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Funktionelle Rehabilitation schwerer laryngopharyngealer Verletzungen nach Suizidversuch durch Erhängen

Zusammenfassung

Hintergrund

Die Mortalitätsrate nach einem Suizidversuch durch Erhängen beträgt etwa 70 %. Die häufigste Todesursache ist hierbei eine zerebrale Hypoxie, aber auch schwere Verletzungen des oberen Aerodigestivtrakts werden selten überlebt. Die klinisch erhobenen Befunde von Patienten, die lebend das Krankenhaus erreichen, können trotz schwerer Verletzungen gering sein. Es ist daher entscheidend, zügig eine multidisziplinäre Diagnostik und Therapie einzuleiten, welche gefolgt ist von einer psychiatrischen Behandlung und der funktionellen Rehabilitation.

Fallbeschreibung und Ergebnisse

Anhand zweier Fälle von Patienten mit einer schweren Verletzung des oberen Aerodigestivtrakts nach suizidalem Erhängen wird die primäre Versorgung sowie die funktionelle Rehabilitation dargestellt. Die anschließende Kanülenversorgung und Schlucktherapie bis zur vollständigen Erholung werden beschrieben. Darüber hinaus wird ein Algorithmus für die Behandlung solcher Fälle vorgeschlagen, der nicht nur die primäre interdisziplinäre Diagnostik und Therapie, sondern auch die funktionelle Rehabilitation und die psychiatrische Behandlung berücksichtigt.

Schlussfolgerung

Minimale Symptome oder äußere Befunde nach Suizidversuchen durch Erhängen schließen schwere Verletzungen des oberen Aerodigestivtrakts nicht aus. Nach der chirurgischen Rekonstruktion sind ein angepasstes Kanülenmanagement sowie eine frühe und intensive Schlucktherapie, begleitet von der psychiatrischen Behandlung, für eine rasche Rehabilitation der Stimme, Luftwege und Schluckfunktion unerlässlich.

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Anteriomediale Maxillektomie zur Verbesserung der Nasenatmung

Zusammenfassung

Das Ziel der klassischen chirurgischen Korrektur bei Nasenatmungsbehinderung besteht darin, durch eine Operation an Nasenscheidewand und unteren Nasenmuscheln den physiologischen Spaltraum in der Nase harmonisch zu erweitern. Hierbei sollen der Durchflusscharakter erhalten bleiben und die Schleimhaut geschont werden, um die respiratorische Funktion der Nase nicht zu gefährden. Die vorliegende Arbeit stellt ein seit wenigen Jahren schrittweise entwickeltes operatives Vorgehen vor, bei dem verschiedene operative Teilschritte entsprechend der individuellen anatomischen Situation und der zugrunde liegenden Schleimhauterkrankung durchgeführt werden. Die anteriomediale partielle Maxillektomie steht im Mittelpunkt.

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Hyperresponsiveness to interferon gamma exposure as a response mechanism to anti-PD-1 therapy in microsatellite instability colorectal cancer

Abstract

Colorectal cancer (CRC) with high-level microsatellite instability (MSI-H) tends to be associated with a better response to programmed death receptor-1 (PD-1) blockade than does microsatellite stable CRC. However, emerging evidence makes the use of programmed death ligand-1 (PD-L1) as a biomarker problematic. Here, we sought to characterize the interactions between PD-L1 expression and the response to PD-1 blockade therapy in BALB/c mice with a subcutaneous tumor challenge. We further focused on interferon gamma (IFNγ)-induced PD-L1 expression in an in vitro setting to evaluate the responsiveness to IFNγ exposure and the specific signaling of PD-1 in HCT116 and SW480 cell lines. In this study, enhanced PD-L1 expression increased survival in CT26 cells, and PD-1 blockade increased the CTL profile and apoptotic cells in mice with CRC. Our in vitro findings showed that PD-L1 expression was significantly upregulated by a low-dose IFNγ treatment, and the MSI-H cell line might exhibit hyperresponsiveness to IFNγ exposure partly through the JAK–STAT pathway. These results suggest that intrinsic PD-L1 in cooperation with extrinsic IFNγ exposure in CRC may be more responsive to anti-PD-1 therapy, mainly through the CTL profile in the tumor microenvironment.

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Instrumental evaluation sensitively detects subclinical skin changes by the epidermal growth factor receptor inhibitors and risk factors for severe acneiform eruption

Abstract

Epidermal growth factor receptor inhibitors (EGFRI), EGFR tyrosine kinase inhibitors (TKI) and anti‐EGFR antibodies commonly develop skin toxicities including acneiform eruption (AfE). However, precise skin changes and risk factors for severe AfE are still unclear. The objective of the current study was elucidation of the useful parameters for early and sensitive detection of the skin changes by EGFRI. Transepidermal water loss (TEWL), skin surface hydration, skin surface lipid levels and erythema/melanin index were serially measured for 2 weeks in 19 EGFR‐TKI afatinib/erlotinib‐treated patients and for 8 weeks in 20 anti‐EGFR antibody cetuximab‐treated patients. The TEWL levels of the cheek in the patients who developed AfE of grade 2 and more (AfE ≥ Gr2) were already elevated at 7 days after the initiation of afatinib/erlotinib therapy compared with those before therapy as well as in patients with grade 1 or less (AfE ≤ Gr1). In patients treated with cetuximab, the skin surface hydration on the cheek in AfE ≥ Gr2 patients significantly decreased compared with that of AfE ≤ Gr1 patients at the 2nd and 6th week. Baseline skin surface lipid levels and erythema index on the cheek of patients with AfE ≥ Gr2 were significantly higher than those with AfE ≤ Gr1. The small sample size of the present study, especially for logistic regression analysis, is a limitation. In conclusion, instrumental evaluation declared rapid inflammatory changes of the skin by EGFRI and elucidated oily skin as a risk for severe AfE.

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Improvement of nail lesions in a patient with psoriatic arthritis by switching the treatment from an anti‐interleukin‐17A antibody to an anti‐tumor necrosis factor‐α antibody

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Determination of nicotine content in teeth submitted to prophylaxis and in-office bleaching by gas chromatography–mass spectrometry (GC-MS)

Abstract

Objectives

The objective of this study was to evaluate the dental color exposed to acute cigarette smoke treatment and quantify the amount of nicotine in samples exposed to cigarette smoke, after dental prophylaxis and after in-office bleaching.

Materials and methods

Sixty-nine healthy human molars were subjected to cigarette smoke in a cigarette machine. The teeth were divided into three groups: positive control, prophylaxis, and bleaching. Forty cycles of smoke exposition with duration of 15 min each were performed using 10 cigarettes (positive control). Dental prophylaxis was performed with a rotating brush and prophylaxis paste; in-office bleaching was performed with 35% hydrogen peroxide, in two sessions of three 15-min applications, with a 1-week interval between sessions. The color was evaluated at the baseline, after exposure to cigarette smoke, after dental prophylaxis, and after in-office bleaching. Teeth from each group were powdered and analyzed by gas chromatography–mass spectrometry in order to measure the amount of nicotine present in each group. Data from quantification of nicotine and color change were analyzed by one-way ANOVA and Tukey's test (α = 0.05).

Data for subjective and objective color evaluation, a perceptible dental darkening occurred in teeth after exposure to cigarette smoke. Dental prophylaxis was able to recover the original color of teeth however, only after bleaching teeth became whiter than at the baseline (p < 0.001). The amount of nicotine was significantly different and higher in positive control group (3.3 ± 1.3 μg/g of tooth), followed by the prophylaxis group (2.1 ± 1.4 μg/g) and the bleaching group (0.8 ± 0.3 μg/g) (p < 0.001).

Conclusions

Cigarette smoke penetrates into the dental structure. Dental prophylaxis and bleaching with 35% hydrogen peroxide can partially remove the nicotine from tobacco smoke. However, when in-office bleaching was applied, a more significant nicotine removal was achieved.

Clinical significance

Dental prophylaxis could remove most of the external nicotine-staining on the tooth surfaces while bleaching could further reduce the external and internal nicotine-staining of teeth.

https://ift.tt/2D73jka