Endoscopic diode laser therapy for chronic radiation proctitis

Abstract

The purpose of this study is to determine the effectiveness of endoscopic diode laser therapy in patients presenting rectal bleeding due to chronic radiation proctitis (CRP). A retrospective analysis of CRP patients who underwent diode laser therapy in a single institution between 2010 and 2016 was carried out. The patients were treated by non-contact fibers without sedation in an outpatient setting. Fourteen patients (median age 77, range 73–87 years) diagnosed with CRP who had undergone high-dose radiotherapy for prostatic cancer and who presented with rectal bleeding were included. Six required blood transfusions. Antiplatelet (three patients) and anticoagulant (two patients) therapy was not suspended during the treatments. The patients underwent a median of two sessions; overall, a mean of 1684 J of laser energy per session was used. Bleeding was resolved in 10/14 (71%) patients, and other two patients showed improvement (93%). Only one patient, who did not complete the treatment, required blood transfusions after laser therapy; no complications were noted during or after the procedures. Study findings demonstrated that endoscopic non-contact diode laser treatment is safe and effective in CRP patients, even in those receiving antiplatelet and/or anticoagulant therapy.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2xZcgqL

Comparative SEM analysis of nine F22 aligner cleaning strategies

The orthodontics industry has paid great attention to the aesthetics of orthodontic appliances, seeking to make them as invisible as possible. There are several advantages to clear aligner systems, including a...

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2eZ831M

Collagen Membrane Over Buccal Fat Pad Versus Buccal Fat Pad in Management of Oral Submucous Fibrosis: A Comparative Prospective Study

Abstract

Objective

The objective of this study was to assess the effectiveness of collagen membrane as biological dressing over buccal fat pad (BFP) during crucial postoperative healing phase in the surgical management of oral submucous fibrosis (OSMF).

Study Design

The study comprised of 40 patients of OSMF of group IVa (Khanna and Andrade). Patients were randomly divided in two groups (20 patients in each group). Group I patients were treated using buccal fat pad only, whereas collagen membrane was used as a covering over harvested BFP in group II patients. Postoperative follow-up was done at 1 week, 3 weeks, 6 months and 1 year.

Result

Mean postoperative mouth opening achieved in both the groups was comparable at every follow-up visit. Infection was evident in four patients of group I at 1-week follow-up, whereas none of the group II patients developed infection. Pain score was lesser in group II patients as compared to group I. Relapse was seen in two patients in group I and one patient in group II. Time taken for epithelialization was 2–3 weeks in both the groups.

Conclusion

Although intraoperative time was increased in group II application of collagen membrane reduced infection when compared with group I. Also, the chances of damage to BFP are reduced during the hygiene maintenance at surgical site and jaw-opening exercise. Reduction in pain scores during postoperative period in group II patients was an additional advantage.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2xqz6uc

20Q: Hearing Loss and Its Comorbidities

From the Desk of Gus MuellerTell me if you've heard this one before.  Your Monday morning patient is in his 50s, has a history of some noise exposure (occasional hunting), and states that over the past few years he is starting to have trou

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2xpcgmJ

Perceptual Visual Skills in Delayed Language Developed Children

Publication date: Available online 9 September 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Eman Mostafa
AimTo evaluate Perceptual visual skills in delayed language developed children.Material and methodsThe relation between visual skills and language has not been rigorously examined in previous investigations. This is a case-control study which comprised of 25 preschool children with Delayed Language Development (DLD) (cases) and 25 typically developed children (control). Exclusion criteria: any neurological or visual impaired disorder. All children had undergone Intelligent Quotient (I.Q) using Stanford Binet (IV edition), Attention Deficit Hyperactivity disorder Test (ADHDT) and Illinois Test of Psycholinguistic Abilities (ITPA). The performance of cases was surprisingly superior to the performance of controls in all visual skills. Moreover, it was significantly different in visual closure (P value=0.027) and visual memory (P value=0.005).ConclusionReading disorders that may develop in children with DLD are more related to language than to visual skills. DLD has some strong perceptual skills such as visual closure and visual memory. This should be taken in consideration while planning a strategy for language therapy.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2gVKw2g

Needs for Professional Education to Optimize Cervical Cancer Screenings in Low-Income Countries: a Case Study from Tanzania

Abstract

Cervical cancer is a significant health problem in many developing countries. Due to limited treatment facilities for cancer in Tanzania, a screening referral program was developed between two urban clinics and Ocean Road Cancer Institute (ORCI), the only cancer treatment center in Tanzania. This study aimed to evaluate the effectiveness of the program and to identify opportunities for professional education. The study included 139 patients who were referred to ORCI from the screening clinics of Magomeni and Temeke between January 2015 and May 2016. Abstracted data from the medical records included patient age, screening results, and treatment. Eight nurses performing screening at the three locations were interviewed about their screening experience. Over half of the referrals (51.9%) were false positives. False positive diagnosis was more common among younger patients (35.68 ± 8.6 years) (p < 0.001) and those referred from Magomeni (59.8%) (p < 0.01) than referrals of older patients (42.46 ± 11.1 years) or those from Temeke (33.3%). Interviews of nurses showed differences among clinics, including resources, experience, and documentation of screening results. The high false positive rates and the variation of accuracy of screening between the two clinics showed a need for professional education of nurses and improvement in the health systems. Continuous education of nurses may increase the effectiveness of cervical screening. Health system enhancement of screening facilities such as provision of Lugol's iodine, more space for screening, and consistency and completion of screening records are needed to increase the accuracy of cervical screening and referrals in Tanzania and other similar low-income countries.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2vP80IL

Gemcitabine and docetaxel in a patient with primary ovarian leiomyosarcoma: a case report and review of literature

Abstract

Primary ovarian leiomyosarcoma (POLMS) is extremely rare, and optimal therapy for this disease is unknown. A 40-year-old woman presented at a local hospital with abdominal pain. Tumor resection of the left ovary was performed. The pathological diagnosis was leiomyoma of the left ovary. Nine months after surgery, she developed of severe back pain and a subcutaneous tumor on her left shoulder. Magnetic resonance imaging and computed tomography revealed left ovarian tumor recurrence, pelvic bone metastasis, and multiple liver masses. Biopsy of the subcutaneous tumor on her left shoulder demonstrated metastatic leiomyosarcoma. The previously resected left ovarian tumor was re-examined, and the tumor was found to be a leiomyosarcoma. The patient received gemcitabine 800 mg/m² and docetaxel 60 mg/m² (GD therapy), administered at 3-week intervals. After three cycles of GD therapy, the patient experienced dyspnea and was diagnosed with mild interstitial pneumonia. Oral corticosteroid therapy resulted in complete symptom improvement. Thereafter, the dosage of GD was decreased, and after 13 cycles of GD therapy, radiofrequency ablation was performed twice for liver metastases. The tumors have shrunk by 65.5% after 23 cycles of GD. She remains alive after undergoing 24 cycles of GD. GD therapy may be effective for POLMS.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wUi8Tw

Needs for Professional Education to Optimize Cervical Cancer Screenings in Low-Income Countries: a Case Study from Tanzania

Abstract

Cervical cancer is a significant health problem in many developing countries. Due to limited treatment facilities for cancer in Tanzania, a screening referral program was developed between two urban clinics and Ocean Road Cancer Institute (ORCI), the only cancer treatment center in Tanzania. This study aimed to evaluate the effectiveness of the program and to identify opportunities for professional education. The study included 139 patients who were referred to ORCI from the screening clinics of Magomeni and Temeke between January 2015 and May 2016. Abstracted data from the medical records included patient age, screening results, and treatment. Eight nurses performing screening at the three locations were interviewed about their screening experience. Over half of the referrals (51.9%) were false positives. False positive diagnosis was more common among younger patients (35.68 ± 8.6 years) (p < 0.001) and those referred from Magomeni (59.8%) (p < 0.01) than referrals of older patients (42.46 ± 11.1 years) or those from Temeke (33.3%). Interviews of nurses showed differences among clinics, including resources, experience, and documentation of screening results. The high false positive rates and the variation of accuracy of screening between the two clinics showed a need for professional education of nurses and improvement in the health systems. Continuous education of nurses may increase the effectiveness of cervical screening. Health system enhancement of screening facilities such as provision of Lugol's iodine, more space for screening, and consistency and completion of screening records are needed to increase the accuracy of cervical screening and referrals in Tanzania and other similar low-income countries.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2vP80IL

Molecular insights into the transcriptional regulatory role of thyroid hormones in ovarian cancer

Abstract

The regulation of cancer-relevant genes by the thyroid hormones, 3, 5, 3'-Triiodo-L-thyronine (T3) and L-thyroxine (T4), was recently acknowledged. However, limited data exists on the hormonal effects on gene expression in ovarian cancer, a gynecological malignancy associated with a low cure rate. The expression of fifteen genes involved in DNA repair, cell cycle, apoptosis and tumor suppression was evaluated in OVCAR-3 and A2780 cell lines, using real-time PCR following short incubation with T3 (1nM) or T4 (100nM). The thyroid hormones downregulated the expression of the majority of genes examined. Support for the involvement of the MAPK and PI3K in thyroid hormone-mediated gene expression was shown for a set of genes. FAS expression was inhibited in A2780 cells, while an unexpected induction was demonstrated in OVCAR-3 cells. An analogous effect on the protein levels of FAS receptor and its soluble form was demonstrated by western blotting. We further established, using primer sets that discriminate between the different RNA isoforms, that the hormones increase the mRNA levels of both coding and non-coding FAS mRNAs. The prevalence of these isoforms, using The Cancer Genome Atlas (TCGA) analysis, was significantly more abundant in seventeen cancer types, including ovarian cancer, compared to normal tissues. Our results highlight the role of thyroid hormones in the expression of cancer-relevant-genes in ovarian cancer and provide an important insight into the pathways by which mitogenic and anti-apoptotic effects are exerted. This article is protected by copyright. All rights reserved

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2vZvvmK

Intralesional excision combined with intralesional cryosurgery for the treatment of oversized and therapy-resistant keloids of the neck and ears

Abstract

This prospective case study presents a new method for the treatment of oversized and therapy-resistant keloids of the neck and ears employing intralesional excision combined with intralesional cryosurgery. The keloids were excised in an intralesional approach, and the remaining base and lateral margins of the scar tissue were frozen using intralesional cryoneedles. After complete thawing of the frozen tissues, the margins of the scar were approximated and sutured. The follow-up period extended over 18–24 months. Over a period of 12 months, the scars gradually flattened with no hypopigmentation. No signs of recurrence of the keloids were seen. Intralesional excision of oversized and therapy-resistant keloids combined with intralesional cryosurgery could well be an additional tool to the plastic surgical armamentarium, for treating this group of patients.

Level of Evidence: Level IV, therapeutic study.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2gWwSYY

The effect of health insurance on childhood cancer survival in the United States

BACKGROUND

The effect of health insurance on childhood cancer survival has not been well studied. Using Surveillance, Epidemiology, and End Results (SEER) data, this study was designed to assess the association between health insurance status and childhood cancer survival.

METHODS

Data on cancers diagnosed among children less than 15 years old from 2007 to 2009 were obtained from the SEER 18 registries. The effect of health insurance at diagnosis on 5-year childhood cancer mortality was estimated with marginal survival probabilities, restricted mean survival times, and Cox proportional hazards (PH) regression analyses, which were adjusted for age, sex, race/ethnicity, and county-level poverty.

RESULTS

Among 8219 childhood cancer cases, the mean survival time was 1.32 months shorter (95% confidence interval [CI], −4.31 to 1.66) after 5 years for uninsured children (n = 131) versus those with private insurance (n = 4297), whereas the mean survival time was 0.62 months shorter (95% CI, −1.46 to 0.22) for children with Medicaid at diagnosis (n = 2838). In Cox PH models, children who were uninsured had a 1.26-fold higher risk of cancer death (95% CI, 0.84-1.90) than those who were privately insured at diagnosis. The risk for those with Medicaid was similar to the risk for those with private insurance at diagnosis (hazard ratio, 1.06; 95% CI, 0.93-1.21).

CONCLUSIONS

Overall, the results suggest that cancer survival is largely similar for children with Medicaid and those with private insurance at diagnosis. Slightly inferior survival was observed for those who were uninsured in comparison with those with private insurance at diagnosis. The latter result is based on a small number of uninsured children and should be interpreted cautiously. Further study is needed to confirm and clarify the reasons for these patterns. Cancer 2017. © 2017 American Cancer Society.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2eZtorI

Tuberculous cervicitis: A brief report with cytohistological correlation and differential diagnosis

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wTSWNd

Intralesional excision combined with intralesional cryosurgery for the treatment of oversized and therapy-resistant keloids of the neck and ears

Abstract

This prospective case study presents a new method for the treatment of oversized and therapy-resistant keloids of the neck and ears employing intralesional excision combined with intralesional cryosurgery. The keloids were excised in an intralesional approach, and the remaining base and lateral margins of the scar tissue were frozen using intralesional cryoneedles. After complete thawing of the frozen tissues, the margins of the scar were approximated and sutured. The follow-up period extended over 18–24 months. Over a period of 12 months, the scars gradually flattened with no hypopigmentation. No signs of recurrence of the keloids were seen. Intralesional excision of oversized and therapy-resistant keloids combined with intralesional cryosurgery could well be an additional tool to the plastic surgical armamentarium, for treating this group of patients.

Level of Evidence: Level IV, therapeutic study.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2gWwSYY

Analysis of outcomes achieved with squamous cell carcinomas of the anus in a single university hospital over the last two decades: Clinical response rate, relapse and survival of 190 patients

Background and Objectives

We reviewed our series of anal squamous cell carcinomas (ASCC) treated over the last two decades.

Methods

ASCC patients undergoing treatment at the Leicester Royal Infirmary between 1998 and 2016 were selected. Age, gender, pathological tumor characteristics, treatment adopted, the overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS) at 5-year follow-up were recorded and calculated.

Results

A total of 190 ASCC were reviewed, of these 64.2% (n = 122) received primary radical chemoradiotherapy. Complete response rate was 92.6% (n = 113) and four patients with residual disease underwent a salvage APER. Twenty-eight patients experienced recurrent disease (23.0%) either systemic (n = 8), local (n = 14), or both (n = 6); six had a salvage APER. Complete follow-up data are available for 63.1% patients (77/122). Overall, the locoregional failure rate of primary chemoradiotherapy (residual + recurrent disease) was present in 29 patients (29/122; 23.8%). OS was 41.6% CSS was 69.2% and DFS 60.0% at 5 years follow-up.

Conclusions

In our series of ASCC primary chemoradiotherapy had achieved significant initial complete response rates, however, long term-follow ups still present systemic and local recurrences. APR is able to treat 30% of the pelvic recurrences (6/20), the others are either associated with systemic disease or locally inoperable masses.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wTUepH

Primary mediastinal paraganglioma associated with a familial variant in the succinate dehydrogenase B subunit gene

Surgical management is the mainstay of therapy for primary cardiac tumors, yet due to the rarity of these malignancies, their management and workup remains a challenge. Here, we report a unique case of a patient with a primary left ventricular cardiac paraganglioma (PGL) and describe the role of a medical genetics assessment leading to the identification of a rare variant in the SDHB gene to be the causative etiology of this cardiac tumor. Due to decreasing costs and accessibility of molecular genetic analysis, genetic testing may become an emerging diagnostic adjunct in cases of cardiac tumors.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wTSfDi

Re: Increased expression of interleukin-23 associated with progression of colorectal cancer. Journal of Surgical Oncology 2017;115(2):208–212

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wTU6GJ

Introduction to the JSO enhanced recover after surgery seminar edition

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wU1EuY

The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy

Abstract

To present current melanoma diagnosis, staging, prognosis, and treatment algorithms and how recent advances in laser pump-probe microscopy will fill in the gaps in our clinical understanding. Expert opinion and significantly cited articles identified in SCOPUS were used in conjunction with a pubmed database search on Melanoma practice guidelines from the last 10 years. Significant advances in melanoma treatment have been made over the last decade. However, proper treatment algorithm and prognostic information per melanoma stage remain controversial. The next step for providers will involve the identification of patient population(s) that can benefit from recent advances. One method of identifying potential patients is through new laser imaging techniques. Pump-probe laser microscopy has been shown to correctly identify nevi from melanoma and furthermore stratify melanoma by aggressiveness. The recent development of effective adjuvant therapies for melanoma is promising and should be utilized on appropriate patient populations that can potentially be identified using pump-probe laser microscopy.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wTEMvf

Genetic variation in the Vitamin D related pathway and breast cancer risk in women of African ancestry in the Root Consortium

Abstract

The vitamin D related pathway has been evaluated in carcinogenesis but its genetic contribution remains poorly understood. We examined single-nucleotide polymorphisms (SNPs) in the vitamin D related pathway genes using data from a genome-wide association study (GWAS) of breast cancer in the African Diaspora that included 3,686 participants (1,657 cases). Pathway- and gene-level analyses were conducted using the adaptive rank truncated product test. Odds ratios (OR) and 95% confidence intervals (CI) were estimated at SNP-level. After stringent Bonferroni corrections, we observed no significant association between variants in the vitamin D pathway and breast cancer risk at the pathway-, gene-, or SNP-level. In addition, no association was found for either the reported signals from GWASs of vitamin D related traits, or the SNPs within vitamin D receptor (VDR) binding regions. Furthermore, a decrease in genetically predicted 25(OH)D levels by Mendelian randomization was not associated with breast cancer (P = 0.23). However, an association for breast cancer with the pigment synthesis/metabolism pathway almost approached significance (pathway-level P = 0.08), driven primarily by a nonsense SNP rs41302073 in TYRP1, with an OR of 1.54 (95% CI = 1.24-1.91, P_adj = 0.007). In conclusion, we found no evidence to support an association between vitamin D status and breast cancer risk in women of African ancestry, suggesting that vitamin D is unlikely to have significant effect on breast carcinogenesis. Interestingly, TYRP1 might be related to breast cancer through a non-vitamin D relevant mechanism but further studies are needed. This article is protected by copyright. All rights reserved.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2xp8bPD

Identifying actionable variants using next generation sequencing in patients with a historical diagnosis of undifferentiated pleomorphic sarcoma

Abstract

There are limited data regarding the molecular characterization of undifferentiated pleomorphic sarcomas (UPS; formerly malignant fibrous histiocytoma). This study aimed to investigate the utility of next generation sequencing (NGS) in UPS to identify subsets of patients who harbour actionable mutations. Patients diagnosed with UPS underwent pathological re-evaluation by a pathologist specializing in sarcoma. Tumor DNA was isolated from archived fresh frozen tissue samples and genotyped using NGS with the Illumina MiSeq TruSeq Amplicon Cancer Panel (48 genes, 212 amplicons). In total, 95 patients initially classified with UPS were identified. Following pathology re-review the histological subtypes were reclassified to include: Myxofibrosarcoma (MFS, N=44); UPS(N=18); and Others (N=27; including undifferentiated spindle cell sarcoma (N=15) and dedifferentiated liposarcoma (N=6)). Seven cases were excluded from further analysis for other reasons. Baseline demographics of the finalized cohort (N=88) showed a median age of 66 years (32-95), primarily with stage I-III disease (92%) and high grade (86%) lesions. Somatic mutations were identified in 31 cases (35%)(Total mutations=36: solitary mutation(n=27); two mutations(n=3); three mutations(n=1)). The most commonly identified mutations were in TP53 (n=24), ATM (n=3) and PIK3CA (n=2). Three of 43 patients with MFS and one of 18 patients with UPS had clinically relevant mutations, mainly related to biomarkers of prediction of response, however few had targetable driver mutations. Somatic mutation status did not influence disease free or overall survival. Based on the small number of clinically relevant mutations, this data does not support the routine use of targeted NGS panels outside of research protocols in UPS. This article is protected by copyright. All rights reserved.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2gW8HtL

Effect of Fixed Media Surface Area on Biofouling and Nutrients Removal in Fixed Film Membrane Bioreactor Treating Sewage at Medium and High Fluxes

Abstract

This study investigates effects of fixed film surface area increment on removal efficacy and biofouling in membrane bioreactor (MBR). For this purpose, a lab-scale membrane bioreactor was used. Domestic wastewater was fed into it. Three different trials were conducted at different fluxes; 15, 20, and 25 L/m²/h (LMH). Every trial was conducted using four different scenarios by varying surface area of fixed media viz. 0, 100, 150, and 200 m²/m³. Removal of pollutants viz. chemical oxygen demand (COD), biochemical oxygen demand (BOD), total organic content (TOC), total Khjdel nitrogen (TKN), and phosphorous was studied. In addition, cake resistance, pore resistance, and total resistance were also observed for aforementioned scenarios. The results demonstrated that pollutant removal efficiencies increased as the surface area per unit volume of bioreactor was increased. Conversely, the removal efficiency decreased with increase in the fluxes. In the case of biofouling, it increased while increasing the surface area or flux. The fixed media surface area increments proved beneficial in terms of removal efficiencies but at the cost of reduced operation time of MBR.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2xpDMk8

Breast cancer risk and germline genomic profiling of women with neurofibromatosis type 1 who developed breast cancer

Abstract

NF1 mutations predispose to neurofibromatosis type1 (NF1) and women with NF1 have a moderately elevated risk for breast cancer, especially under age 50. Germline genomic analysis may better define the risk so screening and prevention can be applied to the individuals who benefit the most. Survey conducted in several neurofibromatosis clinics in the United States has demonstrated a 17.2% lifetime risk of breast cancer in women affected with NF1. Cumulated risk to age 50 is estimated to be 9.27%. For genomic profiling, fourteen women with NF1 and a history of breast cancer were recruited and underwent whole exon sequencing (WES), targeted genomic DNA based and RNA based analysis of the NF1 gene. Deleterious NF1 pathogenic variants were identified in each woman. Frameshift mutations due to deletion/duplication/complex rearrangement were found in 50% (7/14) of the cases, nonsense mutations in 21% (3/14), in-frame splice mutations in 21% (3/14), and one case of missense mutation (7%, 1/14). No deleterious mutation was found in the following high/moderate penetrance breast cancer genes: ATM, BRCA1, BRCA2, BARD1, BRIP1, CDH1, CHEK2, FANCC, MRE11A, NBN, NF1, PALB2, PTEN, RAD50, RAD51C, TP53, and STK11. Twenty-five rare or common variants in cancer related genes were discovered and may have contributed to the breast cancers in these individuals. Breast cancer predisposition modifiers in women with NF1 may involve a great variety of molecular and cellular functions. This article is protected by copyright. All rights reserved.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2vZ4HTJ

Hepatocellular Carcinoma with Bone Metastases: Incidence, Prognostic Significance, and Management—Single-Center Experience

Abstract

Background

Hepatocellular carcinoma (HCC) represents one of the most common causes of cancer-related deaths worldwide, with rising incidence in the USA. Bone metastases with HCC, in particular, have an extremely poor prognosis. We present prevalence, treatment, and survival of patients with bone and more specifically spinal metastases from HCC.

Methods

A retrospective analysis was done at a single tertiary care institution of patients with bone metastases from HCC between January 2005 and December 2015.

Results

Among 1017 patients with HCC, 20 were found to have bone metastases of which 11 had spinal metastases. Seventeen (85%) were male, with median age of 58 years at time of HCC diagnosis. Systemic chemotherapy and sorafenib were used in 12 (60%) patients, and 12 (60%) received radiation therapy. Among patients who did not receive therapy, median survival was 76 days. Median survival after diagnosis of metastasis in patients on sorafenib and radiation were 106 and 100 days, respectively.

Conclusion

Bone metastases in HCC are very rare and aggressive. Due to its rarity, optimal treatment strategies are not well defined. Early diagnosis is important for optimal therapy and improved survival.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2xq2UXU

Characteristics of patients with sorafenib-treated advanced hepatocellular carcinoma eligible for second-line treatment

Summary

Background Regorafenib has been investigated for its efficacy and safety as a second-line treatment in patients with advanced hepatocellular carcinoma (HCC). We assessed the characteristics of patients with HCC treated with sorafenib who might be eligible for second-line treatment in general and regorafenib in particular. Methods Patients with HCC treated with sorafenib were retrospectively analyzed. We defined second-line candidate patients as maintaining Child–Pugh A and ECOG-PS ≤1 at the time of sorafenib failure. We also defined regorafenib candidate patients as follows: 1) continuing sorafenib at the time of radiological progression, 2) maintaining Child–Pugh A and ECOG-PS ≤ 1 at the time of sorafenib failure, and 3) continuing sorafenib 400 mg or more without intolerable adverse events at least 20 days of the last 28 days of treatment. Results Of 185 patients, 130 (70%) and 69 (37%) were candidates for second-line treatment and regorafenib. Child-Pugh score 6 and ECOG-PS 1 at the time of starting sorafenib were significantly lower in both second-line treatment and regorafenib candidate patients. Moreover, hand–foot skin reaction and liver failure during sorafenib treatment were associated with significantly low and high probabilities, respectively, of both Child–Pugh score > 6 and ECOG-PS > 1 at the time of sorafenib failure. Conclusion Regorafenib candidate patients after sorafenib failure are limited, and generally fewer than those who are candidates for second-line treatment. A lower Child–Pugh score and a better ECOG-PS were predictors of eligibility for second-line therapy and regorafenib treatment in sorafenib-treated patients with advanced HCC patients.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2xf4PxG

Issue Information

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2vOEV08

Clinicopathological parameters affecting nodal yields in patients with oral squamous cell carcinoma receiving selective neck dissection

Oral squamous cell carcinoma (OSCC) represents one of the most common malignancies worldwide, and 90% of head and neck cancers (Shah and Gil 2009). 263,000 newly diagnosed cases and 128,000 deaths are registered per year (Shah and Gil 2009).

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wiOXGd

The new targeted therapy in systemic lupus erythematosus: Is the glass half-full or half-empty?

Publication date: Available online 9 September 2017
Source:Autoimmunity Reviews
Author(s): Andrea Doria, Ricard Cervera, Mariele Gatto, Gamal Chehab, Matthias Schneider
Biologic therapy is still limited in lupus, where chronic steroid exposure and wide-spectrum immunosuppression are major triggers of organ damage.In this viewpoint, the authors summarize their views for a "half-full or half-empty" glass on targeted therapy in SLE.The are several reasons for seeing the glass half-empty and in this section the authors propose a critical reflection on scarceness of novel targeted lupus therapies. They show how hard it is to identify suitable biological and clinical targets and to choose the patients that may best fit those targets, as well as to stratify patients according to disease subtype and response, all contributing to the final outcome.On the other hand, reasons are emerging to see the glass half-full, including the growing evidence that disease activity and damage can both be hindered by the proper use of novel drugs and that promising molecules are upcoming. In this section, the authors contextualize potentials and failures of new drugs, providing a critical reading of disappointing results and underlining the concrete benefits obtainable through a wise use of available treatments.Indeed, combining medications with new therapeutic strategies such as the treat-to-target seems the right approach to add some water to a filling glass.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2vZjPAh

Can we withdraw anticoagulation in patients with antiphospholipid syndrome after seroconvertion?

Publication date: Available online 9 September 2017
Source:Autoimmunity Reviews
Author(s): S. Sciascia, E. Coloma-Bazán, M. Radin, M.L. Bertolaccini, C. López-Pedrera, Gerard Espinosa, P.L. Meroni, R. Cervera, M.J. Cuadrado
The current mainstay of treatment in patients with thrombotic antiphospholipid syndrome (APS) is long-term anticoagulation, mainly with Vitamin K antagonist agents. Some recently available studies have created new ground for discussion about the possible discontinuation of anticoagulation therapy in patients with a history of thrombotic APS in whom antiphospholipid antibodies (aPL) are not detected any longer (i.e. aPL seroconversion).We report the main points discussed at the last CORA Meeting regarding the issue whether or not anticoagulation can be stopped after aPL seroconversion. In particular, we systematically reviewed the available evidence investigating the clinical outcome of APS patients with aPL seroconversion in whom anticoagulation was stopped when compared to those in whom therapy was continued regardless the aPL profile. Furthermore, the molecular basis for the aPL pathogenicity, the available evidence of non-criteria aPL and their association with thrombosis are addressed.To date, available evidence is still limited to support the indication to stop oral anticoagulation therapy in patients with a previous diagnosis of thrombotic APS who subsequently developed a negative aPL profile. The identification of the whole risk profile for cardiovascular manifestations and possibly of a second level aPL testing in selected patients with aPL might support the eventual clinical decision but further investigation is warranted.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wTrNIt

Humanistic and cost burden of systemic sclerosis: A review of the literature

Publication date: Available online 9 September 2017
Source:Autoimmunity Reviews
Author(s): Aryeh Fischer, Evelina Zimovetz, Caroline Ling, Dirk Esser, Nils Schoof
BackgroundSystemic sclerosis (SSc), or systemic scleroderma, is a chronic multisystem autoimmune disease characterised by widespread vascular injury and progressive fibrosis of the skin and internal organs. Patients with SSc have decreased survival, with pulmonary involvement as the main cause of death. Current treatments for SSc manage a range of symptoms but not the cause of the disease. Our review describes the humanistic and cost burden of SSc.MethodsA structured review of the literature was conducted, using predefined search strategies to search PubMed, Embase, and the Cochrane Library. Grey literature searches also were conducted.ResultsIn total, 2226 articles were identified in the databases and 52 were included; an additional 10 sources were included from the grey literature. The review identified six studies reporting relevant cost estimates conducted in five different countries and four studies that assessed the humanistic burden of SSc. Total direct annual medical costs per patient for Europe varied from €3544 to €8452. For Canada, these costs were reported to be from Can$5038 to Can$10,673. In the United States, the total direct health care costs were reported to be US$17,365 to US$18,396. Different key drivers of direct costs were reported, including hospitalisations, outpatients, and medication. The total annual costs per patient were reported at Can$18,453 in Canada and varied from €11,074 to €22,459 in Europe. Indirect costs represented the largest component of the total costs. EQ-5D utility scores were lower for patients with SSc than those observed in the general population, with reported mean values of 0.49 and 0.68, respectively. The average value of the Health Assessment Questionnaire for patients with SSc was significantly higher than the control population (0.94), and the average value of the SF-36 was significantly lower than the control population: 49.99 for the physical dimension and 58.42 for the mental dimension.ConclusionsOverall, there is a paucity of information on the burden of SSc. Nonetheless, our review indicates that the quality of life of patients with SSc is considerably lower than that of the general population. In addition, SSc places a considerable economic burden on health care systems and society as a whole.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2vYTyCb

Is PET/CT essential in the diagnosis and follow-up of temporal arteritis?

Publication date: Available online 9 September 2017
Source:Autoimmunity Reviews
Author(s): Carlo Salvarani, Alessandra Soriano, Francesco Muratore, Yehuda Shoenfeld, Daniel Blockmans
The increasing availability and improvement of imaging techniques are deeply influencing diagnosis and work-up of patients affected with vasculitis, particularly those with large vessel vasculitis (LVV). Fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography (PET), especially when integrated with computed tomography (CT), is taking hold as a useful diagnostic technique to examine the aorta and the other large vessels in giant cell arteritis (GCA) with concomitant large vessel involvement (LV-GCA). In this paper we examined the progresses performed in this field in the last twenty years and the evidence available so far according to two different points of view ('pros' and 'cons'), in order to give a comprehensive answer to a still open question about the role of PET/CT in the diagnosis and follow-up of GCA.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wSQUer

Neutrophil extracellular traps (NETs) in autoimmune diseases: A comprehensive review

Publication date: Available online 9 September 2017
Source:Autoimmunity Reviews
Author(s): Keum Hwa Lee, Andreas Kronbichler, David Duck-Young Park, YoungMin Park, Hanwool Moon, Hyungdo Kim, Jun Hyug Choi, YoungSeo Choi, Songjoo Shim, Il Suk Lyu, Byung Hwan Yun, Yeonseung Han, Donghee Lee, Sang Yoon Lee, Byung Hun Yoo, Kyung Hwan Lee, Tai Lim Kim, Heonki Kim, Joo Sung Shim, Wonseok Nam, Heesung So, SooYeon Choi, Sangmok Lee, Jae Il Shin
The structures named neutrophil extracellular traps (NETs) are fibrous networks which protrude from the membrane of activated neutrophils. NETs are found in a variety of conditions, such as infection, malignancy, atherosclerosis, and autoimmune diseases such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV), psoriasis, and gout. The impact of NETs on the development mechanisms of autoimmune diseases are proposed to arise from an imbalance between "NETosis" which is a process of NET formation and NET degradation. Neutrophils, interleukin-8, ANCA and other many inflammatory molecules are considered to play a key role in NET formation. In this way, prolonged exposure to these abnormal cascade of NETs affect autoimmunity and increase the chance of systemic organ damage. In this review, we will discuss the specific roles of various inflammatory molecules in relationship to NETs. We will also provide evidence of the importance of NETs in the pathogenesis of autoimmune diseases and furthermore highlight the potential that target therapies may influence NET formation and associated molecules.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2vYTfre

Should we treat congenital heart block with fluorinated corticosteroids?

Publication date: Available online 9 September 2017
Source:Autoimmunity Reviews
Author(s): Antonio Brucato, Angela Tincani, Micaela Fredi, Silvia Breda, Veronique Ramoni, Nathalie Morel, Nathalie Costedoat-Chalumeau




from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wSQO6z

Bone mineral density and vitamin D status in systemic lupus erythematosus (SLE): A systematic review

Publication date: Available online 9 September 2017
Source:Autoimmunity Reviews
Author(s): Tarek Carlos Salman-Monte, Vicenç Torrente-Segarra, Ana Leticia Vega Vidal, Patricia Corzo, F. Castro-Dominguez, F. Ojeda, Jordi Carbonell Abelló
Despite the improvement in the quality of life of patients with SLE due to scientific and technological advances, SLE remains a disease that over the years may produce irreversible damage to patients. Osteoporosis and secondary bone fractures are two of the major causes of irreparable injury in patients with SLE. Vitamin D insufficiency may play a vital role both in reduced Bone Mineral Density (BMD) and in the appearance of fractures, although its mechanisms of action are still unclear. We performed a systematic review of the literature in order to determine the prevalence and predictors of reduced vitamin D plasma levels, bone loss and the presence of fractures in SLE patients. Our review encompassed all English-language publications using Medline and EMBase electronic databases from their inception (1966 and 1980, respectively) to December 2016. We included all intervention studies and observational studies in which vitamin D plasma levels, BMD and bone loss were measured and applied to patients with SLE. Previous studies suggested an increase in bone loss and fracture in patients with SLE compared with general population and although there is a high prevalence of vitamin D insufficiency in the general population, previous studies had demonstrated lower vitamin D levels in patients with SLE compared to age-matched controls. The etiology of reduced bone mass and reduced vitamin D plasma levels in SLE is multifactorial and includes a variety of intrinsic factors related to the disease itself and treatment side effects. SLE patients are at risk for developing these two comorbidities (reduced vitamin D plasma levels and low BMD) and it is therefore essential to study, monitor, prevent and treat bone metabolism disorders in SLE patients.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2vZjCgt

Is ACPA positivity the main driver for rheumatoid arthritis treatment? Pros and cons

Publication date: Available online 9 September 2017
Source:Autoimmunity Reviews
Author(s): Stefano Alivernini, Mauro Galeazzi, Hagit Peleg, Barbara Tolusso, Elisa Gremese, Gianfranco Ferraccioli, Yaakov Naparstek
Rheumatoid Arthritis (RA) is an autoimmune chronic disease that is characterized by the positivity of various antibodies, the most specific being autoantibodies against citrullinated antigens (ACPA). Despite ACPA are not arthritogenic by themselves, ACPA positive individuals have high risk of RA development and ACPA positivity is associated with severe erosive phenotype and higher mortality rate compared to seronegative RA. Moreover, ACPA status is associated with favorable response to biologics targeting pathways involving autoantibody producing cells as B lymphocytes. In the current review we have discussed the pros and cons on the available scientific evidences, regarding the diagnostic, prognostic and management implications of ACPAs in RA.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2gVmFfl

Clinicopathological parameters affecting nodal yields in patients with oral squamous cell carcinoma receiving selective neck dissection

Publication date: Available online 10 September 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Ali-Farid Safi, Martin Kauke, Andrea Grandoch, Hans-Joachim Nickenig, Uta Drebber, Joachim Zöller, Matthias Kreppel




from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wjenDz

Clinicopathological parameters affecting nodal yields in patients with oral squamous cell carcinoma receiving selective neck dissection

Publication date: Available online 10 September 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Ali-Farid Safi, Martin Kauke, Andrea Grandoch, Hans-Joachim Nickenig, Uta Drebber, Joachim Zöller, Matthias Kreppel




from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wjenDz

Complete sequence of the ATP6 and ND3 mitochondrial genes in breast cancer tissue of postmenopausal women with different body mass indexes

Publication date: Available online 10 September 2017
Source:Annals of Diagnostic Pathology
Author(s): Mónica Martínez-Ramírez, Ramón Mauricio Coral-Vázquez, Alberto Tenorio, Juan Pablo Méndez, Jesús Benítez-Granados, Antonio Maffuz Asis, Sergio Rodríguez Cuevas, Carlos Domínguez Reyes, Aura Erazo-Valle, Patricia Canto
Due to the fact that mitochondrial defects and oxidative stress have been related with obesity and breast cancer is more aggressive in women with obesity, we investigated if postmenopausal Mexican-Mestizo women with breast cancer presented somatic mutations in the sequence of the ATP6 and/or ND3 genes. Twenty one postmenopausal Mexican-Mestizo women with breast cancer who underwent mastectomy or breast conserving surgery were studied. Height and weight were used to calculate body mass index. DNA from tumor tissue samples and blood leukocytes was amplified by polymerase chain reaction and sequenced the ATP6 and ND3 mitochondrial genes. Ages ranged from 46 to 82. According to World Health Organization criteria among the 21 women, 7 had a normal BMI, 7 were overweight and 7 had obesity. In regard to the molecular study, after sequencing the coding region of ATP6 and ND3 genes of the DNA obtained from both leukocytes and tumor tissue, we did not find somatic mutations. All of the changes that we found in both genes were polymorphisms: in ATP6, we identified in ten patients 3 non-synonymous nucleotide changes and in ND3 we observed that six patients presented polymorphisms, three of them were synonymous and two non-synonymous.To our knowledge, this constitutes the first report where the complete sequence of the ATP6 and ND3 genes has been analyzed in postmenopausal Mexican-Mestizo women with breast cancer and diverse BMI. Our results differ with those reported in Caucasian and Asian populations, possibly due to ethnic differences.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2xoAgqr

Cytotoxicity and potential anti-inflammatory activity of velutin on RAW 264.7 cell line differentiation: Implications in periodontal bone loss

Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Carlos Brito, Alexander Stavroullakis, Tatiane Oliveira, Anuradha Prakki
ObjectivesHypoxia-inducible factor-1α (HIF-1α) has been implicated in periodontal tissue inflammation and possibly in osteoclast differentiation, while polyphenols are known to be anti-inflammatory natural compounds that are capable of regulating the NF-κB protein complex pathway. The objective of this study was to investigate cytotoxicity and HIF-1α expression through the NF-κB pathway by polyphenol velutin (Euterpe oleracea Mart.), found in the pulp of acai fruit, during inflammatory RAW 264.7 differentiation.DesignRAW 264.7 mouse monocyte macrophage cells were stimulated with RANKL (30ng/mL) and Porphyromonas gingivalis lipopolysaccharide (1μg/mL). Cells were treated with various concentrations of velutin (0.5–2μM) to check for viability, morphology, osteoclast differentiation, and HIF-1α expression (Western blot).ResultsAlamar blue cell viability assay showed no toxicity to RAW cells with the use of velutin in all concentrations tested (p>0.05). Velutin did not induce cell apoptosis based on caspase 3/7 assay (p>0.05). Fluorescence images stained by DAPI showed no alteration in the morphology of RAW cell nuclei (p>0.05) treated with velutin. TRAP assays demonstrated a dose-dependent reduction in osteoclast formation by velutin when compared with control (p<0.05). Velutin showed a reduction in HIF-1α expression related to IκB phosphorylation when compared with control (p<0.001).ConclusionsAt the tested concentrations, velutin was not cytotoxic to RAW 264.7 and differentiated cells. Velutin reduced osteoclast differentiation and downregulated HIF-1α through the NF-κB pathway.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wQxaun

Neurophysiological localisation of ulnar neuropathy at the elbow: validation of diagnostic criteria developed by a taskforce of the Danish Society of Clinical Neurophysiology

Publication date: Available online 9 September 2017
Source:Clinical Neurophysiology
Author(s): K. Pugdahl, S. Beniczky, B. Wanscher, B. Johnsen, E.Qerama, M. Ballegaard, K. Benedek, A. Juhl, M. Ööpik, P. Selmar, J. Sønderborg, D. Terney, A. Fuglsang-Frederiksen
ObjectiveThis study validates consensus criteria for localisation of ulnar neuropathy at elbow (UNE) developed by a taskforce of the Danish Society of Clinical Neurophysiology and compares them to the existing criteria from the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM). The Danish criteria are based on combinations of conduction slowing in the segments of the elbow and forearm expressed in Z-scores, and difference between the segments in m/s. Examining fibres to several muscles and sensory fibres can increase the certainty of the localisation.MethodsDiagnostic accuracy for UNE was evaluated on 181 neurophysiological studies of the ulnar nerve from 171 peer-reviewed patients from a mixed patient-group. The diagnostic reference standard was the consensus diagnosis based on all available clinical, laboratory, and electrodiagnostic information reached by a group of experienced Danish neurophysiologists.ResultsThe Danish criteria had high specificity (98.4%) and positive predictive value (PPV) (95.2%) and fair sensitivity (76.9%). Compared to the AANEM criteria, the Danish criteria had higher specificity (p < 0.001) and lower sensitivity (p=0.02).ConclusionsThe Danish consensus criteria for UNE are very specific and have high PPV.SignificanceThe Danish criteria for UNE are reliable and well suited for use in different centres as they are based on Z-scores.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2gUTcT1

Testing the effects of adolescent alcohol use on adult conflict-related theta dynamics

Publication date: Available online 9 September 2017
Source:Clinical Neurophysiology
Author(s): Jeremy Harper, Stephen M. Malone, William G. Iacono
ObjectiveAdolescent alcohol use (AAU) is associated with brain anomalies, but less is known about long-term neurocognitive effects. Despite theoretical models linking AAU to diminished cognitive control, empirical work testing this relationship with specific cognitive control neural correlates (e.g., prefrontal theta-band EEG dynamics) remains scarce. A longitudinal twin design was used to test the hypothesis that greater AAU is associated with reduced conflict-related EEG theta-band dynamics in adulthood, and to examine the genetic/environmental etiology of this association.MethodsIn a large (N = 718) population-based prospective twin sample, AAU was assessed at ages 11/14/17. Twins completed a flanker task at age 29 to elicit EEG theta-band medial frontal cortex (MFC) power and medial–dorsal prefrontal cortex (MFC-dPFC) connectivity. Two complementary analytic methods (cotwin control analysis; biometric modeling) were used to disentangle the genetic/shared environmental risk towards AAU from possible alcohol exposure effects on theta dynamics.ResultsAAU was negatively associated with adult cognitive control-related theta-band MFC power and MFC-dPFC functional connectivity. Genetic influences primarily underlie these associations.ConclusionsFindings provide strong evidence that genetic factors underlie the comorbidity between AAU and diminished cognitive control-related theta dynamics in adulthood.SignificanceConflict-related theta-band dynamics appear to be candidate brain-based endophenotypes/mechanisms for AAU.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2xoAAVX

Adaptation of feedforward movement control is abnormal in patients with cervical dystonia and tremor

Publication date: Available online 9 September 2017
Source:Clinical Neurophysiology
Author(s): Laura Avanzino, Andrea Ravaschio, Giovanna Lagravinese, Gaia Bonassi, Giovanni Abbruzzese, Elisa Pelosin
ObjectiveIt is under debate whether the cerebellum plays a role in dystonia pathophysiology and in the expression of clinical phenotypes. We investigated a typical cerebellar function (anticipatory movement control) in patients with cervical dystonia (CD) with and without tremor.MethodsTwenty patients with CD, with and without tremor, and 17 healthy controls were required to catch balls of different load: 15 trials with a light ball, 25 trials with a heavy ball (adaptation) and 15 trials with a light ball (post-adaptation). Arm movements were recorded using a motion capture system. We evaluated: i) the anticipatory adjustment (just before the impact); ii) the extent and rate of the adaptation (at the impact) and (iii) the aftereffect in the post-adaptation phase.ResultsThe anticipatory adjustment was reduced during adaptation in CD patients with tremor respect to CD patients without tremor and controls. The extent and rate of adaptation and the aftereffect in the post-adaptation phase were smaller in CD with tremor than in controls and CD without tremor.ConclusionPatients with cervical dystonia and tremor display an abnormal predictive movement control.SignificanceOur findings point to a possible role of cerebellum in the expression of a clinical phenotype in dystonia.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2gUSR2H

Related Articles Rhinology. 2017 Sep 09;: Authors: Hussain T, Mattheis S,...

Related Articles

Rhinology. 2017 Sep 09;:

Authors: Hussain T, Mattheis S, Dominas N, Hoing B, Lang S, Stuck BA

Abstract
INTRODUCTION: Surgery is the primary treatment option for squamous cell carcinomas of the nasal cavity (NCSCC). Nodal involvement is rare at the time of initial diagnosis, and the role of diagnostic neck dissection as well as potential adjuvant irradiation of the neck remains controversial. The objective of this study was to assess the oncologic outcomes of patients with NCSCC with special emphasis on cervical lymph node treatment and recurrence.
METHODS: 37 previously untreated patients were included in this study. Demographic data, tumor characteristics, therapeutic management, and clinical outcome were analyzed.
RESULTS: Patients with advanced stage tumors were slightly overrepresented in this study and overall 3-year disease-free survival was 63%. A surgical treatment approach was pursued in 89% (n=33) of patients. After total rhinectomy, there were no cases of local recurrence. Overall, 12% (n=4) of all surgically treated patients developed local recurrence. While in 45% of patients (n=15), neck dissection was performed at the time of tumor resection, initial lymph node metastasis was histologically confirmed in only 6% (n=2) of surgically treated patients. Cervical lymph node recurrence occurred in 18% (n=6) of patients, predominantly those with advanced stage tumors, despite prior treatment of the neck.
CONCLUSION: Excellent local control is achievable for patients with NCSCC, especially with radical tumor resection. While cervical lymph node metastasis is rare at the time of diagnosis, regional lymph node recurrence needs to be taken into consideration when planning therapy and follow-up. Multimodal treatment of the neck may be required for patients with advanced stage tumors.

PMID: 28888026 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2jeNAqV

Comparison of different endoscopic scoring systems in patients with chronic rhinosinusitis: reliability, validity, responsiveness and correlation.

Related Articles

Comparison of different endoscopic scoring systems in patients with chronic rhinosinusitis: reliability, validity, responsiveness and correlation.

Rhinology. 2017 Sep 09;:

Authors: Zhang L, Zhang LH

Abstract
OBJECTIVES: Previous studies have proposed various endoscopic scoring systems to assess disease severity of patients with chronic rhinosinusitis (CRS). However, those assessments have not been validated. This study was designed to assess the Modified Lund - Kennedy (MLK) and the discharge, inflammation, and polyps/oedema (DIP) endoscopic scoring systems in patients with CRS.
METHODS: A prospective study including 144 patients who underwent functional endoscopic sinus surgery (FESS). All participants were asked to finish SNOT-22, Lund-Mackay CT score and endoscopic examination evaluations before surgery and at 6 months after surgery. Endoscopic examination videos were evaluated using 3 scoring systems by two blinded rhinologists. The scores were compared in terms of responsiveness, validity, reliability and correlation with other scores.
RESULTS: The MLK and DIP endoscopic scoring systems showed high test-retest reliability and inter-rater reliability. All endoscopic scoring systems showed significant differences between the scores recorded at each time point (all P lower than 0.90 when compared with the Lund - Kennedy (LK) endoscopic scoring system and showed a statistically significant difference in discriminant validity between symptomless and symptomatic cases. The MLK and DIP systems showed high correlations with other subject assessments and no correlation with SNOT-22.
CONCLUSION: MLK and DIP exhibit substantial responsiveness, validity and reliability. MLK and DIP may be well suited for clinical and research use.

PMID: 28888025 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2wSMAMv

Airflow and symptom outcomes between allergic and non-allergic rhinitis patients from turbinoplasty.

Related Articles

Airflow and symptom outcomes between allergic and non-allergic rhinitis patients from turbinoplasty.

Rhinology. 2017 Sep 09;:

Authors: Parthasarathi K, Christensen JM, Alvarado R, Barham HP, Sacks R, Harvey RJ

Abstract
BACKGROUND: Inferior turbinate procedures are applied to relieve medically refractory nasal obstruction. However, the nature of congestion differs between allergic(AR) and non-allergic rhinitis(NAR). This study compares surgical outcomes between AR and NAR patients.
METHODOLOGY: A case-control study of patients undergoing turbinate with or without septoplasty surgery for nasal obstruction was performed. Patient reported outcomes were: nasal obstruction, global nasal function(GNF), and sino-nasal outcome test(SNOT-22) with rhinitis, facial symptom, sleep and psychological sub-scores. Nasal peak inspiratory flow(NPIF) assessed nasal airflow. Measurements were obtained preoperatively and 3 months postoperatively.
RESULTS: 190 patients were assessed. AR had worse obstruction and worse GNF. All outcomes improved post-surgery; nasal obstruction, GNF, SNOT-22, rhinitis-symptoms, facial-symptoms, sleep-function, psychological-function and NPIF. GNF improvement was greater in AR. NPIF improvement was similar between groups.
CONCLUSIONS: Both AR and NAR patients gained benefit from surgery to relieve nasal obstruction. AR patients demonstrate greater improvement in GNF score but allergy management may contribute to this.

PMID: 28888024 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2eXuxjr

Allergy rhinitis: similarities and differences between children and adults.

Related Articles

Allergy rhinitis: similarities and differences between children and adults.

Rhinology. 2017 Sep 09;:

Authors: Izquierdo-Dominguez A, Jauregui I, Del Cuvillo A, Montoro J, Davila I, Sastre J, Bartra J, Ferrer M, Alobid I, Mullol J, Valero AL

Abstract
BACKGROUND: Allergic rhinitis (AR) is a highly prevalent disease worldwide. Although a number of studies have described AR, no studies compared children and adult AR populations. The objective was to compare the AR characteristics between two AR cohorts of children and adults.
METHODS: Two AR cohorts (children and adults) from Spain were studied through observational cross-sectional multicentre studies. AR was classified based on classical (allergen exposure), original (o-ARIA), and modified (m-ARIA) ARIA criteria. AR was evaluated by Total 4-Symptoms Score (T4SS), and disease severity by Visual Analogue Scale (VAS, 0-100 mm). AR comorbidities were also evaluated.
RESULTS: A total of 5,405 patients (1,275 children, 4,130 adults) were studied. According to symptoms duration, intermittent AR was more frequent in children than in adults. Using o-ARIA severity, more children than adults had moderate/severe AR while, using m-ARIA, more children than adults had severe AR. T4SS was higher in adults than in children. Moreover, VAS was also higher in adults than in children. In addition, asthma atopic dermatitis and conjunctivitis were more associated to children than adults with AR, the frequency of this comorbidities increasing according to higher severity.
CONCLUSIONS: AR in children was more intermittent, severe, with less symptoms but with more comorbidities than in adults. These results suggest AR has similarities but also significant differences between children and adults.

PMID: 28887880 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2eXhS0a

Orbital floor fracture repair: the endonasal approach.

Related Articles

Orbital floor fracture repair: the endonasal approach.

Rhinology. 2017 Sep 09;:

Authors: Kuhnel T, Jagle H, Hosemann W, Weber R, Vielsmeier V

Abstract
To avoid the dangers associated with lower eyelid approaches to the orbital floor and to improve visualization, we propose an endoscopic procedure for orbital floor fracture reduction and osteosynthesis using endonasal access via the medial maxillary sinus wall. The technique of endoscopic, endonasal transantral surgery is described, together with a retrospective analysis of 17 patients who had undergone this surgical procedure in the Department of Otorhinolaryngology, University of Regensburg, between July 2013 and June 2016. Fractures without infraorbital margin involvement were successfully repaired and enophthalmos and/or diplopia were corrected in all cases. The endonasal approach described here allows orbital floor fractures to be repaired without injury to the eyelid apparatus. Visualization, in particular across the orbital floor as far as the palatine process, appears to be superior to that achieved with other approaches. The increased time required for the procedure and the difficulties of manipulation within a confined space are offset by rapid wound healing without ocular swelling and a minimal risk of complications.

PMID: 28887879 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2wSxlTz

Alternate dosing regimens of brentuximab vedotin for CD30+ cutaneous T-cell lymphoma: reply from authors

Abstract

We thank the authors Lewis, Kim, and Duvic, for their reaction to our article.

The increasingly personalised medicine should also take into account individual tumour entities and their inter-individual pathways.

Therefore, we can only welcome and sustain the comments. As described in our article, it is possible, in some patients, to reduce the dose and interval frequency of Brentuximab Vedotin (BV), while continuing to have good efficacy.

This article is protected by copyright. All rights reserved.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wimnoF

Chronic actinic dermatitis: successful treatment with PUVA photochemotherapy

Abstract

Chronic actinic dermatitis (CAD) is a debilitating photodermatosis. First line therapy consists of strict photoprotection and topical corticosteroids. Second line therapy uses systemic immunosuppression. However an alternative is needed for patients with severe CAD who cannot use systemic immunosuppressants.^1,2 Case reports and small case series suggest that PUVA may be effective.^3-6

This article is protected by copyright. All rights reserved.+

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2whZhOO

Alternate dosing regimens of brentuximab vedotin for CD30+ cutaneous T-cell lymphoma

Abstract

Stranzenbach et al. propose alternate dosing regimens of brentuximab vedotin (BV) for CD30+ cutaneous T-cell lymphomas (CTCLs) such as mycosis fungoides (MF) and primary cutaneous anaplastic large cell lymphoma (pcALCL).¹ They emphasize that lower doses or less frequent dosing schedules for CTCL may be equally effective while limiting adverse events.

The authors indicate that CTCLs may require less aggressive therapy than systemic lymphomas such as systemic ALCL (sALCL) or Hodgkin lymphoma (HL).

This article is protected by copyright. All rights reserved.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2xn80nO

The value and pitfalls of biologics registries for psoriasis

Abstract

We are pleased that our initial perspective article in the BJD have sparked discussions. As indicated in our initial paper, our main critical point is the exponential growth in publications relating to drug survival as an efficacy assessment based on non-randomized registry data (Figure 1). Indeed, we ourselves have performed such drug survival analyses.¹ While we agree that methods such as propensity score matching could even out some of the between-drug variations in patient characteristics, propensity score matching is a rare sight in drug survival studies.

This article is protected by copyright. All rights reserved.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wiZsJO

Registries as a real-world cohort studies that are useful and necessary in the pyramid of evidence

Abstract

Egeberg et al¹ enriched us by describing the limitations of registries in psoriasis, but focusing their critical perspective on a misguided outcome measure such as "drug survival". We agree that clinicians and researchers should be cautious when using that proxy measure.^2,3However, the frequent use of this poor outcome should not cast doubts over all the capabilities of registries.

This article is protected by copyright. All rights reserved.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2xnLR9d

Harmine promotes periodontal ligament cell-induced tissue regeneration

Abstract

Objective

to investigate whether harmine has a promotive effect on human periodontal ligament cells (hPDLCs)-induced tissue regeneration.

Materials and Methods

Various concentrations of harmine on hPDLCs proliferation were tested. Osteogenic and cementogenic characteristics were examined in hPDLC/rhBMP-2 and hPDLC/harmine by alizarin red S staining, real-time PCR, and Western blotting assay. The activity of harmine was investigated in an ectopic transplantation nude mouse model.

Results

We determined that 10 μM of harmine was the threshold concentration. hPDLC/harmine showed similar mineralized nodule formation in alizarin S staining compared to hPDLC/rhBMP-2. In real-time PCR, a highest gene expression level was observed for Runx2 in hPDLC/harmine at all time points. The level of CEMP-1 in hPDLC/harmine was higher at 7days than hPDLCs alone. Thicker band of Runx2 in hPDLC/harmine was observed than in hPDLC/rhBMP-2 at 7 days by Western blotting. The band for CEMP-1 in hPDLC/harmine was thicker than hPDLCs alone at both 7 and 14 days. In ectopic transplantation, hPDLCs with harmine showed a comparable amount of mineralized tissue formation compared to rhBMP-2. hPDLCs with harmine or rhBMP-2 formed both bone and cementum-like tissue with Sharpey's fiber-like collagen insertion.

Conclusion

Harmine can be a potential candidate for promoting hPDLCs-induced tissue regeneration.

This article is protected by copyright. All rights reserved.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2gUe0de

Associations of oral fluid MMP-8 with periodontitis in Swiss adult subjects

Abstract

Objective

MMP-8 is a prominent collagenase in periodontal disease. This cross-sectional study examined whether MMP-8 levels in saliva and gingival crevicular fluid (GCF) are associated with periodontitis in a Swiss population.

Subjects and methods

258 subjects (107 m, 151 f, mean age: 43.5 yr; range: 21-58 yr) acquired from the Swiss bone marrow donor registry participated in the study. Saliva and GCF samples were collected from subjects followed by a thorough dental and periodontal examination. MMP-8 levels were determined with immunofluorometric assay (IFMA). Associations of MMP-8 levels with periodontal diagnosis, probing pocket depth and bleeding on probing were statistically analysed with Pearson χ² test, Spearman's rhos and logistic regression analysis.

Results

MMP-8 in GCF correlated with MMP-8 in saliva (P<0.001). Periodontitis was more common (P<0.001) among subjects with high levels of MMP-8 in saliva and/or GCF compared with subjects with low levels of MMP-8. Higher MMP-8 levels in GCF and saliva were associated with any periodontal diagnosis (mild, moderate or severe), greater probing pocket depth, and bleeding on probing (P<0.05). When age, gender, smoking, body mass index, number of medications and DMFT were adjusted for, all observed associations remained statistically significant. The area under curve of ROC was 0.67 for saliva and 0.71 for GCF.

Conclusion

Elevated MMP-8 levels both in saliva and GCF are associated with periodontitis in a normal adult population.

This article is protected by copyright. All rights reserved.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2xoaiDg

A review of the biologic and clinical significance of genetic mutations in angioimmunoblastic T-cell lymphoma

Abstract

Angioimmunoblastic T-cell lymphoma (AITL) is an age-related malignant lymphoma, characterized by immune system-dysregulated symptoms. Recent sequencing studies have clarified the recurrent mutations in ras homology family member A (RHOA) and in genes encoding epigenetic regulators, tet methyl cytosine dioxygenase 2 (TET2), DNA methyl transferase 3 alpha (DNMT3A), and isocitrate dehydrogenase 2, mitochondrial (IDH2), as well as those related to the T-cell receptor signaling pathway in AITL. In this review, we will focus on how this genetic information has changed the understanding of the developmental process of AITL and will in future lead to individualized therapies for AITL patients.

This article is protected by copyright. All rights reserved.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2xn0PvS

Mucinous adenocarcinoma with lepidic pattern and with K-RAS mutation in a newborn with antenatal diagnosis of congenital pulmonary airway malformation

Abstract

Olivier Stephanov: substantial contributions to conception and design, acquisition of data, and analysis and interpretation of data; drafting the article and revising it critically for important intellectual content; final approval of the version to be published.

Yohan Robert : substantial contributions to acquisition of data and analysis and interpretation of data; final approval of the version to be published.

Florence De Fraipont substantial contributions to acquisition of data, and analysis and interpretation of data; revising it critically for important intellectual content; final approval of the version to be published.

This article is protected by copyright. All rights reserved.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2xojp78

The epithelioid, BAP1-negative and p16-positive phenotype predicts prolonged survival in pleural mesothelioma

Abstract

Aims

Mesothelioma is a relatively uncommon but highly malignant neoplasm. Most patients die of disease within one year of diagnosis, but some have prolonged survival. Prospective identification of these longer-term survivors may help guide treatment. We therefore sought to investigate the role of p16 immunohistochemistry (IHC) both alone and in combination with other markers as a potential predictor of prolonged survival in mesothelioma.

Methods and Results

P16 IHC was performed on unselected pleural mesotheliomas biopsied from 1991 to 2014. 153 of 208 (74%) cases were p16-negative which significantly correlated with poor overall survival in both univariate (median survival 7.6 v 13.6 months; p = 0.001) and multivariate analysis (HR 1.632; 95% CI 1.103-2.415; p = 0.014). Other independent factors associated with prolonged survival included loss of expression of BAP1, and epithelioid morphology.

We therefore further stratified patients based on these three independent prognostic variables and demonstrated an unusually prolonged survival in mesotheliomas which were epithelioid, BAP1 IHC negative and p16 IHC positive (12% of cases, median survival 31.7 months, p<0.0001).

Conclusions

In conclusion, p16 IHC is an independent prognostic biomarker in pleural mesothelioma. When used in combination with BAP1 IHC and morphological subtyping, which are also readily available in routine clinical care, patients with exceptionally prolonged survival can potentially be identified.

This article is protected by copyright. All rights reserved.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2gTPEnz

Recovery from Repeated Sudden Hearing Loss in a Patient with Takayasu’s Arteritis Treated with Hyperbaric Oxygen Therapy: The First Report in the Literature

Hearing loss has been rarely reported in Takayasu's arteritis, may present as Sudden Sensorineural Hearing Loss, and usually responds well to corticosteroid therapy. Hyperbaric Oxygen Therapy is commonly used as a supplementary treatment to corticosteroids for Sudden Sensorineural Hearing Loss. We present the case of a 36-year-old woman with Takayasu's arteritis who had two episodes of sudden hearing loss involving one ear at a time with an 11-month delay between each episode. During the first episode, the patient was treated with high-dose intramuscular corticosteroids with a temporary improvement of auditory threshold that deteriorated 14 days after cessation of therapy. In the second episode, Hyperbaric Oxygen Therapy was associated with corticosteroids, with improvements in both ears, including the one that was unresponsive in the long term to previous pharmacologic therapy. In this case, Hyperbaric Oxygen Therapy could have acted synergically with corticosteroids playing a role in hearing restoration.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2xY241w

Obstructive sleep apnea and diet-controlled gestational diabetes

Publication date: Available online 9 September 2017
Source:Sleep Medicine
Author(s): Ekasitt Wanitcharoenkul, Naricha Chirakalwasan, Somvang Amnakkittikul, Suranut Charoensri, Sunee Saetung, Suwannee Chanprasertyothin, La-or Chailurkit, Panyu Panburana, Sommart Bumrungphuet, Boonsong Ongphiphadhanakul, Sirimon Reutrakul
BackgroundObstructive sleep apnea (OSA) was shown to be associated with gestational diabetes (GDM). However, prevalence of OSA in GDM women, its relationship to metabolic control and predictive factors have not been studied.Material and MethodsEighty two obese pregnant women with diet-controlled GDM between 24-34 weeks of gestation participated. The Berlin questionnaire was used to assess OSA symptoms. OSA was diagnosed using an overnight monitor. Fasting glucose and hemoglobin A1c(HbA1c) were obtained. Those with OSA underwent meal tolerance test (MTT) to assess their metabolic parameters. Classification tree analysis was used to develop a screening tool for OSA.ResultsAt a median gestational age of 29 weeks, OSA was diagnosed in 52.4% of the women, with a median apnea hypopnea index of 9.4 (interquartile range 6.4, 12.4). More severe OSA was significantly correlated with higher fasting glucose but not HbA1c. For those with OSA, sleep parameters related to oxygen desaturation significantly correlated with higher fasting insulin resistance and more severe β-cell dysfunction as evaluated by MTT.A screening tool involving two variables, neck circumference and Berlin Questionnaire score, was developed. The sensitivity and specificity were 86% and 51%, respectively. An overall accuracy was 70%.ConclusionOSA is prevalent in obese pregnant women with diet controlled GDM in the late second to early third trimester. OSA severity, especially the degree of oxygen desaturation, correlated with fasting glucose, insulin resistance and β-cell function. Simple screening tool involving the Berlin Questionnaire and neck circumference can aid in predicting OSA in this patient group.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wSQLrF

Immediate impact of positive airway pressure on atrial fibrillation

Publication date: Available online 9 September 2017
Source:Sleep Medicine
Author(s): Farzane Saeidifard, Bhanu Prakash Kolla, Moein Foroughi, Meghna P. Mansukhani




from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wSLvnW

Sleep spindles may predict response to cognitive behavioral therapy for chronic insomnia

Publication date: Available online 9 September 2017
Source:Sleep Medicine
Author(s): Thien Thanh Dang-Vu, Benjamin Hatch, Ali Salimi, Melodee Mograss, Soufiane Boucetta, Jordan O'byrne, Marie Brandewinder, Christian Berthomier, Jean-Philippe Gouin
BackgroundWhile cognitive-behavioral therapy for insomnia constitutes the first-line treatment for chronic insomnia, only few reports have investigated how sleep architecture relates to response to this treatment. In this pilot study, we aimed at determining whether sleep spindle density at pre-treatment predicts treatment response to cognitive behavioral therapy for insomnia.MethodsTwenty-four participants with chronic primary insomnia took part in a 6-week cognitive behavioral therapy for insomnia performed in groups of 4 to 6 participants. Treatment response was assessed using the Pittsburgh Sleep Quality Index and the Insomnia Severity Index measured at pre- and post-treatment and at 3- and 12-months follow-up assessments. Secondary outcome measures were extracted from sleep diaries over seven days and one overnight polysomnography, obtained at pre- and post-treatment. Spindle density during stages N2-N3 sleep was extracted from polysomnography at pre-treatment. Hierarchical linear modeling analysis assessed whether sleep spindle density predicted response to cognitive behavioral therapy.ResultsAfter adjusting for age, sex and education level, lower spindle density at pre-treatment predicted poorer response over the 12-months follow-up, as reflected by smaller reduction in Pittsburgh Sleep Quality Index over time. Reduced spindle density also predicted lower improvements in sleep diary sleep efficiency and wake after sleep onset immediately after treatment. There were no significant associations between spindle density and changes in the Insomnia Severity Index or polysomnography variables over time.ConclusionThese preliminary results suggest that inter-individual differences in sleep spindle density in insomnia may represent an endogenous biomarker predicting responsiveness to cognitive behavioral therapy. Insomnia with altered spindle activity might constitute an insomnia subtype characterized by a neurophysiological vulnerability to sleep disruption associated with impaired responsiveness to cognitive behavioral therapy.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2xUi4kG

Adenoid hypertrophy in children and allergic rhinitis.

Related Articles

Adenoid hypertrophy in children and allergic rhinitis.

Eur Arch Otorhinolaryngol. 2017 Sep 08;:

Authors: Lou Z

PMID: 28887688 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2wSrltY

Reply to Dijemeni et al.'s comments concerning: "The comparability of drug-induced sedation classification systems".

Related Articles

Reply to Dijemeni et al.'s comments concerning: "The comparability of drug-induced sedation classification systems".

Eur Arch Otorhinolaryngol. 2017 Sep 08;:

Authors: da Cunha Viana A, Mendes DL, de Andrade Lemes LN, Thuler LCS, Neves DD, de Araújo-Melo MH

PMID: 28887678 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2wSqE3Q

Airflow and symptom outcomes between allergic and non-allergic rhinitis patients from turbinoplasty.

Airflow and symptom outcomes between allergic and non-allergic rhinitis patients from turbinoplasty.

Rhinology. 2017 Sep 09;:

Authors: Parthasarathi K, Christensen JM, Alvarado R, Barham HP, Sacks R, Harvey RJ

Abstract
BACKGROUND: Inferior turbinate procedures are applied to relieve medically refractory nasal obstruction. However, the nature of congestion differs between allergic(AR) and non-allergic rhinitis(NAR). This study compares surgical outcomes between AR and NAR patients.
METHODOLOGY: A case-control study of patients undergoing turbinate with or without septoplasty surgery for nasal obstruction was performed. Patient reported outcomes were: nasal obstruction, global nasal function(GNF), and sino-nasal outcome test(SNOT-22) with rhinitis, facial symptom, sleep and psychological sub-scores. Nasal peak inspiratory flow(NPIF) assessed nasal airflow. Measurements were obtained preoperatively and 3 months postoperatively.
RESULTS: 190 patients were assessed. AR had worse obstruction and worse GNF. All outcomes improved post-surgery; nasal obstruction, GNF, SNOT-22, rhinitis-symptoms, facial-symptoms, sleep-function, psychological-function and NPIF. GNF improvement was greater in AR. NPIF improvement was similar between groups.
CONCLUSIONS: Both AR and NAR patients gained benefit from surgery to relieve nasal obstruction. AR patients demonstrate greater improvement in GNF score but allergy management may contribute to this.

PMID: 28888024 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2eXuxjr

The occipital artery as an alternative donor for low-flow bypass to anterior circulation after ICA occlusion failure prior to exenteration for an atypical cavernous sinus meningioma: A technical case report.

Related Articles

The occipital artery as an alternative donor for low-flow bypass to anterior circulation after ICA occlusion failure prior to exenteration for an atypical cavernous sinus meningioma: A technical case report.

World Neurosurg. 2017 Sep 05;:

Authors: Hanakita S, Lenck S, Labidi M, Watanabe K, Bresson D, Froelich S

Abstract
BACKGROUND: and Importance: In skull-base tumors involving the cavernous sinus (CS), indications for aggressive resection are sparse and must be carefully examined because of their invasiveness. With careful evaluation, techniques including internal carotid artery (ICA) sacrifice with or without extracranial-intracranial (EC-IC) bypass may still be an option in some cases. In addition, previous surgery with the sacrifice of potential donor vessels requires adjusting the revascularization strategy. Here, we describe an OA-MCA bypass prior to the skull-base tumor resection.
CLINICAL PRESENTATION: A 47-year-old woman with a recurrent cavernous sinus meningioma was referred to our department. Because of tumor recurrence after radiotherapy and its rapid progression, radical resection including part of the CS was planned. A balloon test occlusion (BTO) was performed and showed good tolerance. Thus, an endovascular ICA occlusion was performed. The patient eventually experienced motor deficits and aphasia post-surgery. Therefore, bypass surgery using an occipital artery (OA)-middle cerebral artery (MCA) anastomosis was performed. The patient showed no exacerbation of symptoms after bypass surgery, and subsequently underwent tumor resection.
CONCLUSION: The reliability of BTO in the management of giant aneurysms may not be similarly applicable to skull base tumors. If hypo-perfusion symptoms occur following occlusion of the ICA, a surgical revascularization procedure should be considered because of the risk of ischemic stroke following tumor resection. For patients whose superficial temporal artery is not available, the OA can be a valuable alternative donor for low-flow bypass.

PMID: 28887285 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2fcmjko

Cerebrospinal Fluid Leak Rhinorrhea after Systemic Erlotinib Chemotherapy for Metastatic Lung Cancer: A Familiar Problem from an Unfamiliar Culprit.

Related Articles

Cerebrospinal Fluid Leak Rhinorrhea after Systemic Erlotinib Chemotherapy for Metastatic Lung Cancer: A Familiar Problem from an Unfamiliar Culprit.

World Neurosurg. 2017 Sep 05;:

Authors: Priddy B, Hardesty DA, Beer-Furlan A, Otto B, Prevedello DM

Abstract
BACKGROUND: Cerebrospinal fluid (CSF) rhinorrhea after medical therapy for pituitary prolactinoma is a rare but well-described phenomenon. To our knowledge, no CSF leaks have been reported after targeted medical treatment of pituitary or anterior skull base metastases. We report this unusual case to raise awareness of spontaneous CSF leaks in the setting of skull base metastatic disease.
CASE PRESENTATION: A 66-year-old woman presented with EGFR-mutant Stage IV adenocarcinoma of the lung. Headache workup revealed a large sellar and clival lesion consistent with metastatic disease. Systemic erlotinib chemotherapy was initiated with a robust positive response. Approximately 1 week after chemotherapy initiation, she noted clear discharge from the right nostril. Her oncologist first diagnosed her with allergic rhinitis, but she presented with meningitis 4 days after diagnosis of CSF leak, and was admitted for IV antibiotics and definitive repair of a CSF leak via an endoscopic endonasal approach. An erosion of bone and dura was found at the dorsum sellae where tumor had regressed due to the chemotherapy. A multilayer skull base repair was made uneventfully and she recovered fully with no leakage on two month follow-up.
CONCLUSION: All members of the treatment team should be aware of this possibility of CSF leak after initiation of systemic chemotherapy and tumor regression, and urgently refer patients for repair if a leak should develop prior to the development of meningitis.

PMID: 28887281 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2wim90u

Cerebrospinal Fluid Leak Rhinorrhea after Systemic Erlotinib Chemotherapy for Metastatic Lung Cancer: A Familiar Problem from an Unfamiliar Culprit.

Related Articles

Cerebrospinal Fluid Leak Rhinorrhea after Systemic Erlotinib Chemotherapy for Metastatic Lung Cancer: A Familiar Problem from an Unfamiliar Culprit.

World Neurosurg. 2017 Sep 05;:

Authors: Priddy B, Hardesty DA, Beer-Furlan A, Otto B, Prevedello DM

Abstract
BACKGROUND: Cerebrospinal fluid (CSF) rhinorrhea after medical therapy for pituitary prolactinoma is a rare but well-described phenomenon. To our knowledge, no CSF leaks have been reported after targeted medical treatment of pituitary or anterior skull base metastases. We report this unusual case to raise awareness of spontaneous CSF leaks in the setting of skull base metastatic disease.
CASE PRESENTATION: A 66-year-old woman presented with EGFR-mutant Stage IV adenocarcinoma of the lung. Headache workup revealed a large sellar and clival lesion consistent with metastatic disease. Systemic erlotinib chemotherapy was initiated with a robust positive response. Approximately 1 week after chemotherapy initiation, she noted clear discharge from the right nostril. Her oncologist first diagnosed her with allergic rhinitis, but she presented with meningitis 4 days after diagnosis of CSF leak, and was admitted for IV antibiotics and definitive repair of a CSF leak via an endoscopic endonasal approach. An erosion of bone and dura was found at the dorsum sellae where tumor had regressed due to the chemotherapy. A multilayer skull base repair was made uneventfully and she recovered fully with no leakage on two month follow-up.
CONCLUSION: All members of the treatment team should be aware of this possibility of CSF leak after initiation of systemic chemotherapy and tumor regression, and urgently refer patients for repair if a leak should develop prior to the development of meningitis.

PMID: 28887281 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2wim90u

RHEB1 insufficiency in aged male mice is associated with stress-induced seizures

Abstract

The mechanistic target of rapamycin (mTOR), a protein kinase, is a central regulator of mammalian metabolism and physiology. Protein mTOR complex 1 (mTORC1) functions as a major sensor for the nutrient, energy, and redox state of a cell and is activated by ras homolog enriched in brain (RHEB1), a GTP-binding protein. Increased activation of mTORC1 pathway has been associated with developmental abnormalities, certain form of epilepsy (tuberous sclerosis), and cancer. Clinically, those mTOR-related disorders are treated with the mTOR inhibitor rapamycin and its rapalogs. Because the effects of chronic interference with mTOR signaling in the aged brain are yet unknown, we used a genetic strategy to interfere with mTORC1 signaling selectively by introducing mutations of Rheb1 into the mouse. We created conventional knockout (Rheb1 ^+/− ) and gene trap (Rheb1 ^Δ/+ ) mutant mouse lines. Rheb1-insufficient mice with different combinations of mutant alleles were monitored over a time span of 2 years. The mice did not show any behavioral/neurological changes during the first 18 months of age. However, after aging (> 18 months of age), both the Rheb1 ^+/− and Rheb1 ^{Δ /−} hybrid males developed rare stress-induced seizures, whereas Rheb1 ^+/− and Rheb1 ^{Δ /−} females and Rheb1 ^Δ/+ and Rheb1 ^Δ/Δ mice of both genders did not show any abnormality. Our findings suggest that chronic intervention with mTORC1 signaling in the aged brain might be associated with major adverse events.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2vXVB9F

Mutations in KARS cause early-onset hearing loss and leukoencepha lopathy: Potential pathogenic mechanism.

Related Articles

Mutations in KARS cause early-onset hearing loss and leukoencepha lopathy: Potential pathogenic mechanism.

Hum Mutat. 2017 Sep 08;:

Authors: Zhou XL, He LX, Yu LJ, Wang Y, Wang XJ, Wang ED, Yang T

Abstract
Leukoencephalopathies are a broad class of common neurologic deterioration for which the etiology remain unsolved in many cases. In a Chinese Han family segregated with sensorineural hearing loss and leukoencephalopathy, candidate pathogenic variants were identified by targeted next-generation sequencing of 144 genes associated with deafness and 108 genes with leukoencephalopathy. Novel compound heterozygous mutations p.R477H and p.P505S were identified in KARS, which encodes lysyl-tRNA synthetase (LysRS), as the only candidate causative variants. These two mutations were functionally characterized by enzymatic assays, immunofluorescence, circular dichroism analysis and gel filtration chromatography. Despite no alteration in the dimer-tetramer oligomerization and cellular distribution by either mutation, the protein structure was notably influenced by the R477H mutation, which subsequently released the protein from the multiple-synthetase complex (MSC). Mutant LysRSs with the R477H and P505S mutations had decreased tRNA(Lys) aminoacylation and displayed a cumulative effect when introduced simultaneously. Our studies showed that mutations in KARS lead to a newly defined subtype of leukoencephalopathy associated with sensorineural hearing impairment. The combined effect of reduced aminoacylation and release of LysRS from the MSC likely underlies the pathogenesis of the KARS mutations identified in this study. This article is protected by copyright. All rights reserved.

PMID: 28887846 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2jeNy2h

[Back to the future].

Related Articles

[Back to the future].

Bull Cancer. 2017 Sep;104(9):701-702

Authors: Vignot S, L'Allemain G, Bay JO, Comité de Rédaction

PMID: 28886774 [PubMed - in process]

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wib4fV

Injection Volume and Anesthetic Effect in Serratus Plane Block.

Background and Objectives: Serratus plane block is performed for analgesia of the anterior chest wall. However, there has been no study concerning the appropriate volume for this block. This prospective randomized controlled study assesses the dermatomal spread and analgesic effects of serratus plane block. Methods: Ultrasound-guided serratus plane block was performed for breast cancer surgery. The patients were randomly assigned to receive 20 or 40 mL of 0.375% ropivacaine. The primary end point was the number of affected dermatomes as assessed by cold test and pinprick test 20 minutes after the block procedure. Secondary end points were the time until the first postoperative analgesic rescue, adverse effects, and complications. Results: The number of affected dermatomes assessed by the cold test for patients receiving 40 mL of 0.375% ropivacaine was significantly larger than that for patients receiving 20 mL (P = 0.002; 6 [5-7] vs 4 [3-4] dermatomes). Similarly, with the pinprick test, the affected area was larger for the 40 mL group than for the 20 mL group (P = 0.009; 4 [2-6] vs 2 [1-3] dermatomes). There were no differences between the 2 groups in secondary end points. Conclusions: Ultrasound-guided serratus plane block spread in the craniocaudal direction is more widespread with 40 mL than with 20 mL of 0.375% ropivacaine. The time until the first postoperative analgesic rescue dose was not extended by a larger volume of injection. Clinical Trials Registration: UMIN Clinical Trials Registry (identifier UMIN000016549). Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wifvYj

Cancers, Vol. 9, Pages 121: The PI3Kδ Inhibitor Idelalisib Inhibits Homing in an in Vitro and in Vivo Model of B ALL

Cancers, Vol. 9, Pages 121: The PI3Kδ Inhibitor Idelalisib Inhibits Homing in an in Vitro and in Vivo Model of B ALL

Cancers doi: 10.3390/cancers9090121

Authors: Etai Adam Hye Na Kim Eun Ji Gang Caitlin Schnair Solomon Lee Solah Lee Sajad Khazal Osanna Kosoyan Marina Konopleva Chintan Parekh Deepa Bhojwani Alan S. Wayne Hisham Abdel-Azim Nora Heisterkamp Yong-Mi Kim

The quest continues for targeted therapies to reduce the morbidity of chemotherapy and to improve the response of resistant leukemia. Adhesion of acute lymphoblastic leukemia (ALL) cells to bone marrow stromal cells triggers intracellular signals that promote cell-adhesion-mediated drug resistance (CAM-DR). Idelalisib, an U.S. Food and Drug Administration (FDA)-approved PI3Kδ-specific inhibitor has been shown to be effective in CLL in down-regulating p-Akt and prolonging survival in combination with Rituximab; herein we explore the possibility of its use in B ALL and probe the mechanism of action. Primary B ALL in contact with OP9 stromal cells showed increased p-Aktser473. Idelalisib decreased p-Akt in patient samples of ALL with diverse genetic lesions. Addition of idelalisib to vincristine inhibited proliferation when compared to vincristine monotherapy in a subset of samples tested. Idelalisib inhibited ALL migration to SDF-1α in vitro and blocked homing of ALL cells to the bone marrow in vivo. This report tests PI3Kδ inhibitors in a more diverse group of ALL than has been previously reported and is the first published report of idelalisib inhibiting homing of ALL cells to bone marrow. Our data support further pre-clinical evaluation of idelalisib for the therapy of B ALL.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2jcLIig

Correlations Between Patient-Reported Dysphagia Screening and Penetration-Aspiration Scores in Head and Neck Cancer Patients Post-oncological Treatment.

Related Articles

Correlations Between Patient-Reported Dysphagia Screening and Penetration-Aspiration Scores in Head and Neck Cancer Patients Post-oncological Treatment.

Dysphagia. 2017 Sep 08;:

Authors: Hedström J, Tuomi L, Finizia C, Olsson C

Abstract
Dysphagia is a common and severe toxicity after oncological treatment of head and neck cancer (HNC). The study aim was to investigate relationships between patient-reported dysphagia and clinically measured swallowing function in HNC after modern curative radiotherapy with or without chemotherapy to identify possible alarm symptoms for clinically manifest dysphagia. Patients with tumors of the tonsil, base of tongue, hypopharynx, and larynx treated in 2007-2015 were assessed for dysphagia post-treatment by telephone interview and videofluoroscopy (VFS). A study-specific categorized symptom score was used to determine patient-reported dysphagia (DESdC = presence of Drinking, Eating, Swallowing difficulties, and Coughing when eating/drinking (any combination); scores between 0 and 4 with 0 = no symptom); the penetration-aspiration scale (PAS) to determine swallowing function by VFS. Swallowing difficulties were defined as DESdC ≥ 1 and PAS ≥ 2. Relationships between clinically relevant cut-offs for DESdC and PAS were determined by Pearson's correlation coefficient (Pr). Swallowing difficulties according to DESdC were reported by 89% of the patients and according to PAS by 60% at a median of 7 months post-treatment. Averaged correlations between DESdC score 1/2/3/4 and PAS were 0.16/0.10/0.27/0.18. Almost one in two patients with DESdC score ≥3 had severe swallowing difficulties according to PAS. Correlations between individual DESdC:s were highest for swallowing and eating (Pr = 0.53) and lowest for swallowing and coughing (Pr = 0.11). Our data suggest that if a patient reports having swallowing difficulties, it is likely that he or she also has eating difficulties but not necessarily coughing problems when eating/drinking. However, if all these three symptoms are reported, it is likely that the patient will present with moderate or severe impaired swallowing function according to PAS and thus should be referred for further evaluation and treatment.

PMID: 28887707 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/2wS8tgq