OtoRhinoLaryngology News: 11/10/17

Purpose From an array of disciplinary perspectives, the articles in this special section examine opportunities and challenges in the economic, social, and civic participation of individuals across the spectrum of disabilities. Methods At multiple levels of analysis, the contributors consider employment law and policy frameworks, occupational and vocational rehabilitation strategies, and corporate practices in support of the full and equal inclusion of people with disabilities in society. Results and Conclusions The implications for policymakers, public and private sector stakeholders, and occupational rehabilitation professional are presented to help inform future policies, practices, and strategies to improve employment outcomes for people with disabilities.

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Editorial Board ((ofc))

Publication date: October 2017
Source:Acta Histochemica, Volume 119, Issue 8

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Quercetin protects jejunal mucosa from experimental intestinal ischemia reperfusion injury by activation of CD68 positive cells

Publication date: Available online 10 November 2017
Source:Acta Histochemica
Author(s): Kristina Curgali, Stefan Toth, Zuzana Jonecova, Milan Maretta, Theodoros Kalpakidis, Ivana Petriskova, Matus Kusnier, Jan Soltes, Martin Svana, Martin Caprnda, Delian Delev, Luis Rodrigo, Eva Mechirova, Peter Kruzliak
The aim of our study was to analyse the possible protective effect of quercetin application during the jejunal ischemia-reperfusion injury (IRI) in rats. Quercetin was administered intraperitoneally 30min before 1h ischemia of superior mesenteric artery with following 24h lasting reperfusion period. The male specific pathogen-free (SPF) Charles River Wistar rats were used. In the group with applied quercetin, the significantly increased (p<0.001) levels of anti-inflammatory cytokine IL10 were observed both in the blood serum and jejunal tissue. The improvement of the mucosal tissue morphology and proliferating and DNA repairing cell number measured by PCNA activity were recorded by more than 30% higher in the quercetin group. Simultaneously, significant elongation of the intestinal glands (p<0.001) and increase in the number of CD68-positive cells in the lamina propria mucosae (p<0.001) in comparison with control group were found. Based on our results, the preventive application of quercetin before induction of jejunal IRI stimulates faster jejunal mucosa restoration and it seems to have immunomodulatory and anti-inflammatory effects as well. CD68-positive macrophages could have crucial role in this process since they work as both growth factor and cytokine producers.

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IDH mutation testing in gliomas—where do we draw the line?

The classification of brain tumors has classically been dependent on histology. However, with the additional understanding of the genetic basis of tumorigenesis, molecular parameters have also now become integrated with histology in the 2016 World Health Organization (WHO) classification of brain tumors.¹ This concept has been integrated in the classification of the diffuse gliomas. For lower-grade gliomas (LGGs; WHO grades II and III), it is known that mutations in isocitrate dehydrogenase genes (IDH1/2) occur in high proportion, and the detection of these mutations has diagnostic, prognostic, and therapeutic implications.^2–4 Mutations in IDH1/2 lead to reduction of alpha-ketoglutarate and to the production of oncometabolite 2-hydroxyglutarate. This gain of function phenotype can be incurred via multiple different mutations. Mutations in codon 132 resulting in substation of arginine to histidine (R132H) is the most common of these mutations (termed "canonical"), accounting for up to 90% of all IDH mutations.² The development of R132H-specific anti-IDH1 antibodies allows for screening of canonical mutations by immunohistochemistry (IHC). In cases where IDH screening by IHC indicates the absence of R132H mutation, genetic sequencing of IDH may be performed to screen for noncanonical mutations. Although genetic sequencing allows for screening of both canonical and noncanonical mutations, the cost associated with testing as well as time constraints can be issues. Nevertheless, in the setting of a diffuse adult LGG that is negative by R132H-IHC, testing for a noncanonical IDH mutation is expected to conform within an integrated histomolecular diagnosis. In the absence of a complete evaluation for noncanonical IDH mutations in these cases, the "NOS" designation may be warranted for diffuse gliomas.

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Impact of a robotic surgical system on treatment choice for men with clinically organ-confined prostate cancer

Abstract

Background

Introducing a new surgical technology may affect behaviors and attitudes of patients and surgeons about clinical practice. Robot-assisted laparoscopic radical prostatectomy (RALP) was approved in 2012 in Japan. We investigated whether the introduction of this system affected the treatment of organ-confined prostate cancer (PCa) and the use of radical prostatectomy (RP).

Methods

We conducted a retrospective multicenter study on 718 patients with clinically determined organ-confined PCa treated at one of three Japanese academic institutions in 2011 (n = 338) or 2013 (n = 380). Two patient groups formed according to the treatment year were compared regarding the clinical characteristics of PCa, whether referred or screened at our hospital, comorbidities and surgical risk, and choice of primary treatment.

Results

Distribution of PCa risk was not changed by the introduction of RALP. Use of RP increased by 70% (from 127 to 221 cases, p < 0.0001), whereas the number of those undergoing radiotherapy or androgen deprivation therapy decreased irrespective of the disease risk of PCa. Increased use of RP (from 34 to 100 cases) for intermediate- or high-risk PCa patients with mild perioperative risk (American Society of Anesthesiologists score 2) accounted for 70% of the total RP increase, whereas the number of low- or very low-risk PCa patients with high comorbidity scores (Charlson Index ≥ 4) increased from 8 to 25 cases, accounting for 18%. Use of expectant management (active surveillance, watchful waiting) in very low-risk PCa patients was 15% in 2011 and 12% in 2013 (p = 0.791).

Conclusions

Introduction of a robotic surgical system had little effect on the risk distribution of PCa. Use of RP increased, apparently due to increased indications in patients who are candidates for RP but have mild perioperative risk. Although small, there was an increase in the number of RPs performed on patients with severe comorbidities but with low-risk or very low-risk PCa.

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Segmentation of Whole-Body Images into Two Compartments in Model for Bone Marrow Dosimetry Increases the Correlation with Hematological Response in 177Lu-DOTATATE Treatments

Cancer Biotherapy & Radiopharmaceuticals , Vol. 0, No. 0.

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Reintroducing the Sodium–Iodide Symporter to Anaplastic Thyroid Carcinoma

Thyroid , Vol. 0, No. 0.

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Are Evidence-Based Guidelines Reflected in Clinical Practice? An Analysis of Prospectively Collected Data of the Italian Thyroid Cancer Observatory

Thyroid , Vol. 0, No. 0.

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Tasigna (nilotinib) in chronic myeloid leukemia treatment-free remission after nearly 2 years: an interview with Adam Mead

Future Oncology, Ahead of Print.

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Current issues of preoperative radio(chemo)therapy and its future evolution in locally advanced rectal cancer

Future Oncology, Ahead of Print.

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Long noncoding RNA identification in lymphoma

Future Oncology, Ahead of Print.

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Treatment and prognostic factors of patients with thymic epithelial tumors at first recurrence or progression

Future Oncology, Ahead of Print.

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Fluorescence image-guided neurosurgery

Future Oncology, Ahead of Print.

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Image-guided surgery in gynecologic oncology

Future Oncology, Ahead of Print.

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Could gonadotropin-releasing hormone analogs be helpful in the treatment of triple-negative breast cancer?

Future Oncology, Ahead of Print.

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Electronic patient-reported outcomes: a revolutionary strategy in cancer care

Future Oncology, Ahead of Print.

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Developments in optical imaging for gastrointestinal surgery

Future Oncology, Ahead of Print.

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Intraoperative image-guided surgery in neuro-oncology with specific focus on high-grade gliomas

Future Oncology, Ahead of Print.

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Imaging in cutaneous surgery

Future Oncology, Ahead of Print.

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Lack of chronic neuroinflammation in the absence of focal hemorrhage in a rat model of low-energy blast-induced TBI

Blast-related traumatic brain injury (TBI) has been a common cause of injury in the recent conflicts in Iraq and Afghanistan. Blast waves can damage blood vessels, neurons, and glial cells within the brain. Ac...

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Hepatocellular Carcinoma Surveillance—Experience from Croatian Referral Centre for Chronic Liver Diseases

Abstract

Purpose

For patients at high-risk of developing hepatocellular carcinoma (HCC), biannual ultrasound surveillance has long been recommended, in order to detect the tumor in the early, potentially curative stages. However, globally reported HCC surveillance rates vary greatly, ranging from as low as 1.7 to as high as 80%. Our aim was to assess the utilization of surveillance with biannual ultrasound in high-risk Croatian patients and to identify the factors that impact the implementation of the recommended protocol.

Methods

This retrospective study included 145 newly diagnosed HCC patients in the period from January 2010 to September 2015. We identified low-risk and high-risk patients. The latter were further subdivided into the regular biannual ultrasound surveillance group and the non-surveillance group. The groups were compared according to demographic characteristics and BCLC stage at the time of HCC diagnosis.

Results

Among 145 patients, 80 patients were classified as high-risk according to EASL criteria. During the relevant period, 28.7% underwent regular surveillance, while 71.25% did not. Younger patients were more likely to undergo surveillance (OR 0.935 CI 0.874–0.999; p = 0.05). The patients who underwent regular surveillance had a higher chance of being diagnosed at a curative stage (BCLC 0 or A) (OR 3.701 CI 1.279–10.710; p < 0.05).Gender was not a predictor of participation in the regular surveillance protocol. Among the high-risk patients who did not undergo regular surveillance, 56.1% were not aware of the chronic liver disease prior to the HCC diagnosis.

Conclusion

HCC surveillance is still underutilized in high-risk Croatian patients despite its obvious benefits possibly due to the untimely diagnosis of the chronic liver disease.

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"Ear Nose Throat J"[jour]; +21 new citations

21 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

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PubMed comprises more than millions of citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.

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Cortical Correlates of Binaural Temporal Processing Deficits in Older Adults.

Objectives: This study was designed to evaluate binaural temporal processing in young and older adults using a binaural masking level difference (BMLD) paradigm. Using behavioral and electrophysiological measures within the same listeners, a series of stimulus manipulations was used to evaluate the relative contribution of binaural temporal fine-structure and temporal envelope cues. We evaluated the hypotheses that age-related declines in the BMLD task would be more strongly associated with temporal fine-structure than envelope cues and that age-related declines in behavioral measures would be correlated with cortical auditory evoked potential (CAEP) measures. Design: Thirty adults participated in the study, including 10 young normal-hearing, 10 older normal-hearing, and 10 older hearing-impaired adults with bilaterally symmetric, mild-to-moderate sensorineural hearing loss. Behavioral and CAEP thresholds were measured for diotic (So) and dichotic (S[pi]) tonal signals presented in continuous diotic (No) narrowband noise (50-Hz wide) maskers. Temporal envelope cues were manipulated by using two different narrowband maskers; Gaussian noise (GN) with robust envelope fluctuations and low-noise noise (LNN) with minimal envelope fluctuations. The potential to use temporal fine-structure cues was controlled by varying the signal frequency (500 or 4000 Hz), thereby relying on the natural decline in phase-locking with increasing frequency. Results: Behavioral and CAEP thresholds were similar across groups for diotic conditions, while the masking release in dichotic conditions was larger for younger than for older participants. Across all participants, BMLDs were larger for GN than LNN and for 500-Hz than for 4000-Hz conditions, where envelope and fine-structure cues were most salient, respectively. Specific age-related differences were demonstrated for 500-Hz dichotic conditions in GN and LNN, reflecting reduced binaural temporal fine-structure coding. No significant age effects were observed for 4000-Hz dichotic conditions, consistent with similar use of binaural temporal envelope cues across age in these conditions. For all groups, thresholds and derived BMLD values obtained using the behavioral and CAEP methods were strongly correlated, supporting the notion that CAEP measures may be useful as an objective index of age-related changes in binaural temporal processing. Conclusions: These results demonstrate an age-related decline in the processing of binaural temporal fine-structure cues with preserved temporal envelope coding that was similar with and without mild-to-moderate peripheral hearing loss. Such age-related changes can be reliably indexed by both behavioral and CAEP measures in young and older adults. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Olivocochlear Efferent Activity Is Associated With the Slope of the Psychometric Function of Speech Recognition in Noise.

Objectives: The medial olivocochlear (MOC) efferent system can modify cochlear function to improve sound detection in noise, but its role in speech perception in noise is unclear. The purpose of this study was to determine the association between MOC efferent activity and performance on two speech-in-noise tasks at two signal-to-noise ratios (SNRs). It was hypothesized that efferent activity would be more strongly correlated with performance at the more challenging SNR, relative to performance at the less challenging SNR. Design: Sixteen adults aged 35 to 73 years participated. Subjects had pure-tone averages 0.05), contrary to hypothesis. However, contralateral suppression was significantly correlated with the slope of the psychometric function, computed as the difference between performance levels at the two SNRs divided by 3 (decibel difference between the 2 SNRs) for the coordinate response measure task (partial rs = 0.59; p = 0.04) and for the Institute of Electrical and Electronics Engineers task (partial rs = 0.60; p = 0.03). Conclusions: In a group of primarily older adults with normal hearing or mild hearing loss, olivocochlear efferent activity assessed using contralateral suppression of TEOAEs was not associated with speech-in-noise performance at a single SNR. However, auditory efferent activity appears to be associated with the slope of the psychometric function for both a word and sentence recognition task in noise. Results suggest that individuals with stronger MOC efferent activity tend to be more responsive to changes in SNR, where small increases in SNR result in better speech-in-noise performance relative to individuals with weaker MOC efferent activity. Additionally, the results suggest that the slope of the psychometric function may be a more useful metric than performance at a single SNR when examining the relationship between speech recognition in noise and MOC efferent activity. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Tasigna (nilotinib) in chronic myeloid leukemia treatment-free remission after nearly 2 years: an interview with Adam Mead

Future Oncology, Ahead of Print.

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Current issues of preoperative radio(chemo)therapy and its future evolution in locally advanced rectal cancer

Future Oncology, Ahead of Print.

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Long noncoding RNA identification in lymphoma

Future Oncology, Ahead of Print.

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Treatment and prognostic factors of patients with thymic epithelial tumors at first recurrence or progression

Future Oncology, Ahead of Print.

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Fluorescence image-guided neurosurgery

Future Oncology, Ahead of Print.

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Image-guided surgery in gynecologic oncology

Future Oncology, Ahead of Print.

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Could gonadotropin-releasing hormone analogs be helpful in the treatment of triple-negative breast cancer?

Future Oncology, Ahead of Print.

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Electronic patient-reported outcomes: a revolutionary strategy in cancer care

Future Oncology, Ahead of Print.

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Developments in optical imaging for gastrointestinal surgery

Future Oncology, Ahead of Print.

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Intraoperative image-guided surgery in neuro-oncology with specific focus on high-grade gliomas

Future Oncology, Ahead of Print.

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Imaging in cutaneous surgery

Future Oncology, Ahead of Print.

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77. Altered H-reflex following pulsed radiofrequency in patients with lumbosacral radicular pain

Pulsed radiofrequency (PRF) short-lasting bursts allow pain modulation with no tissue necrosis. Neurophysiological evaluation of PRF possible effects has not been described yet. Objective of this study was to investigate the effects of PRF on sensory nerve conduction and H-reflex in patients with lumbosacral radicular pain.We evaluated 23 patients with unilateral L5-S1 root pain who underwent PRF at the corresponding level of radicular symptoms. PRF was applied through a multifunctional electrode introduced via trans-sacral access for 240s.

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76. Vestibular evoked myogenic potentials (c-VEMPS AND o-VEMPS) in the diagnosis of vestibular neuritis

Vestibular neuritis (VN) is a common neuro-otologic syndrome characterized by acute prolonged vertigo lasting several days, nausea, vomiting. Vestibular-evoked myogenic potentials (VEMPs) are becoming the better diagnostic tool in this pathology. VEMPs can be recorded from tonically contracted neck muscles by acoustic and galvanic stimulation or forehead tap (cervical VEMPs, c-VEMPs) or from extraocular muscles, using the same stimuli. (ocular VEMPs, o-VEMPs). The aim of our study was to assess the reliability of c-VEMPs and o-VEMPs in the diagnosis of VN.

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88. The sympathetic skin response as a predictor of recovery of ulnar nerve lesion at wrist

The aim of the study was to evaluate, in the ulnar nerve injuries, distally to the elbow, the role of monitoring the function of sudomotor fibers assessed by Sympathetic Skin Response (SSR) during recovery after surgical treatment and rehabilitation.We recruited 31 patients admitted for rehabilitation after traumatic wrist injury with ulnar nerve and artery lesions. Patients with other nerves or artery involved were excluded. All patients underwent surgical primary nerve repair within 72h and the same rehabilitative program.

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46. Somatosensory evoked potentials in neonatal hypoxic-ischemic encephalopathy

Somatosensory evoked potentials (SEPs) are considered a useful exam for the prognosis of newborns with hypoxic-ischemic encephalopathy (HIE) treated with hypothermia. We examined our data in respect to the MRI, considering the repetitivity of the abnormalities of the SEPs in the time. Of a large number of newborns evaluated with HIE treated with hypothermia in both centers we considered a group of patients with SEPs and MRI just after the completion of hypothermia. 10 patients with abnormal SEPs have repeated the exam after a period ranging from 4days to 7months: in 7 cases the SEPs were normalized (in 3 newborns just after few weeks).

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1. Laser evoked potential in clinical practice: The diagnostic field in small fiber neuropathy

Small fiber neuropathy (SFN) is frequently encountered in clinical practice. Due to the small nerve fiber characteristics, the diagnosis requires the use of not conventional tests like skin biopsy, Quantitative sensory testing (QST) and Laser Evoked Potentials (LEPs). The aim of this study was to evaluate the diagnostic value of A-delta LEPs in clinical practice in a large cohort of patients with diagnosis of "definite" SFN.We screened 296 patients evaluated in our institution with confirmed diagnosis of sensory neuropathy.

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38. Different behavior of cerebrospinal fluid amyloid-β and tau levels in patients with post-traumatic disorders of consciousness

Traumatic brain injury (TBI) is a major risk factor for Alzheimer disease (AD). Although the mechanisms that lead to AD after a TBI are largely unknown, changes in amyloid- (A metabolism and abnormal tau phosphorylation are probably involved. In this study, we evaluated A, total tau (t-tau), and phosphorylated tau (p-tau) levels in the cerebrospinal fluid (CSF) of 15 patients who developed a prolonged disorder of consciousness after a severe TBI (mean time from TBI 271.6±176.5days; range 92–578days).

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2. Pain catastrophizing and features of cortical response to painful stimuli in fibromyalgia

Gamma Band Oscillations (GBO) after laser stimuli are currently considered a correlate of subjective pain perception. Habituation of laser evoked potentials (LEPs) is reduced in patients with central amplification of pain stimuli.To correlate LEPs habituation and GBO induced by laser stimulation with subjective pain rating and pain catastrophizing in patients with Fibromyalgia (FM) and controls.We recorded LEPs in 30 FM patients and 15 healthy controls by stimulating the dorsum of the right hand.

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Announcement

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3. Immunofluorescence characterization of skin nerve misfolded α-synuclein in different synucleinopathies: A confocal study

Intraneural misfolded α-synuclein (syn) characterized different synucleinopathies such as pure autonomic failure (PAF), idiopathic Parkinson disease (IPD) and dementia with Lewy Bodies (DLB). The aim of this study is to characterize by immunofluorescence the skin intraneural α-synuclein (syn) deposits in PAF, IPD and DLB to ascertain conformation-specific differences which may justify a different clinical phenotype.We identified a total of 21 skin intraneural abnormal syn deposits in PAF (3 patients), 22 in IPD (8 patients) and 40 in DLB (7 patients).

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80. Small fiber neuropathy in Amyotrophic Lateral Sclerosis: Contribution of laser-evoked potentials and skin biopsy

Increasing evidence suggests that amyotrophic lateral sclerosis (ALS) is a multisystem neurodegenerative disorder, also determining a small fiber neuropathy (SFN) as recognized by skin biopsy studies in distal legs, irrespective of the disease duration. This study aimed at evaluating the performance of a battery of neurophysiological and morphological tests assessing the small fiber loss occurring in ALS.We recruited 10 consecutive ALS patients (5M, age 64.9±7.3, duration of symptoms 29.1±20.7months).

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4. Does small fiber pathology in PD change over time?

Small fiber pathology is part of the clinical picture of PD. Cross-sectional studies have shown no correlation between intraepidermal nerve fiber (IENF) density and patient disease duration and severity. However, it is not known whether IENF density changes over time. We aimed to assess the progression of small fiber pathology in PD patients along the disease course.We assessed epidermal innervation at time 0 and after 1–9years (mean 3.5) in 17 PD patients (M/F=11/6, age=64.4±15.3) leg on punch biopsies.

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42. Functional Tremor: When neurophysiology makes the difference

Functional tremor (FT) still remains a challenge for clinicians; here, we propose a simple and fast test battery for an early diagnosis of FT.We enrolled ten patients with probable FT and compared them with patients with essential tremor (ET) or tremor-dominant Parkinson's Disease (PD). Surface polymyography was bilaterally performed with arms relaxed, with arms outstretched at shoulder level without or with a 500-g mass attached to the wrist ("mass loading"), during voluntary contralateral motor activation and while performing ballistic movements.

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5. Vocal cord paralysis in children: A new neurophysiological approach for diagnosis and functional prognosis

To establish the possibility to use the methodology of recording corticobulbar motor evoked potentials (CoMEPs) from cricothyroid muscles (CTHY) and vocal cord elicited by transcranial electrical stimulation (TES), as diagnostic tool for predicting function recovery in children with vocal fold immobility (VFI).We included six children (mean age: 4.7years; range: 2–9years) with diagnosis of cord immobility that underwent video-fibro-endoscopy procedure. Under general anaesthesia, we used TES by stimulation over C3/Cz or C4/Cz to elicit CoMEPs.

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50. Inter hemispheric comparison of PAS-induced cortical plasticity: A pilot study in healthy subjects

Dystonia is considered a "network" disease with an abnormal cortical plasticity induced by by paired-associated-stimulation. In this study, we applied the PAS-TMS paradigm in healthy subjects, with the aim to collect reliable data from both hemispheres in order to put the basis to future application in focal dystonia.We studied 7 healthy subjects (4 females; mean age 32.33±6.79years). We applied electrical stimulatrion of median nerve electrical and MEPs from both abductor pollicis brevis (APB) and first dorsal interosseous (FDI) muscles (2), following Stefan et al.

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6. Trigeminal neuralgia typical and atypical. A disease or two?

Trigeminal Neuralgia (TN) is a clinical condition characterized by a sudden, usually unilateral, brief, stabbing, recurrent pain with a distribution consistent with one or more divisions of the fifth cranial nerve. In the classical form, the genesis of paroxysmal pain has been attributed to areas of focal demyelination due to vascular compression on the nerve. The 20–50% of patients with TN have an atypical form characterized by the presence of constant pain, often described as burning continuous or sub-continuous, as well as paroxysmal pain.

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92. Myogenic vestibular-evoked potentials: An extension of the assessment protocol

Vestibular-Evoked-Myogenic-Potentials (VEMPs) represent a muscular response following an intense acoustic stimulation. The cVEMPs explore a reflex arc (from saccule to the neck musculature) and usually are only recorded from sternocleidomastoideus (SCM).1 They are non-invasive, well-tolerated, simple-to-perform and very useful in several diseases. The normal response is a biphasic complex P13/N23. We propose a more extensive protocol. We recruited 31 subjects (mean age±SD:50.8±19.0). VEMPs were recorded symmetrically and simultaneously through surface electromyography from SCM, splenius (SPL), trapezius (TRP) and orbicularis oculi (OO).

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7. Cathodal transcranial direct current stimulation reduces seizure frequency and modulates brain functional connectivity with drug-resistant temporal lobe epilepsy: A sham controlled study

Cathodal transcranial direct current stimulation (ctDCS) is a technique able to non-invasively inhibit cortical excitability, which is abnormally increased in epilepsy, but its efficacy in reducing seizures and in modulating epileptic network is still under debate.We evaluated the efficacy of 20-min 1mA ctDCS vs sham-tDCS in reducing seizure frequency and in modulating the functional connectivity (FC) between epileptic focus (EF) and the other cortical areas, in 10 temporal drug-resistant epilepsy (DRE) patients.

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84. Atypical presentation of Guillain-Barré syndrome in childhood: A clinical case

A 31-months old child was admitted with a 4-day history of fever and weakness. The initial neurological examination revealed a meningeal syndrome with neck stiffness, without consciousness impairment. Head CT was normal. Analysis of CSF showed only increased level of proteins. Based on clinical manifestations, an empirical antibiotics and antiviral therapy was started. During the following 48h, a progressive flaccid tetraparesis occurred. An ENG/EMG study was performed to exclude a peripheral involvement that showed decreased CMAP amplitude, partial motor conduction blocks/pseudo-blocks signs in the forearm segment of median and ulnar nerves and absence of F-waves.

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8. Neurophysiological comparison among tonic, high frequency and burst spinal cord simulation: Novel insights into spinal and brain mechanisms of action

Spinal cord Stimulation (SCS) is an effective option for neuropathic pain treatment. New technological developments, as high-frequency (HF) and Theta Burst Stimulation (TBS), have shown promising results, although putative mechanisms of action are still debated.Twenty-five patients with lower back pain were enrolled and underwent LF, HF and TBS. LEPs were recorded by using a Nd:YAG laser: amplitudes and latencies of the main two components (N1, N2/P2) were compared among different experimental conditions.

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36. Bilateral loss of cortical SEPs predict severe MRI lesions in neonatal hypoxic ischemic encephalopathy treated with hypothermia

The introduction of therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy call for reevaluation of the prognostic role of SEPs. This study aimed to test the prognostic value of SEPs using as outcome measure MRI severity and patterns of injury.Neonates eligible for hypothermia were recruited from four Italian Centers if they performed SEP and MRI at 4–15days of life. SEPs were scored as: normal (bilaterally recorded/unilaterally absent N20) or altered (bilaterally absent N20). The severity of brain injury was measured using a validated MRI scoring system for acute and sub-acute signal abnormalities.

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Editorial Board

Publication date: December 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery, Volume 28, Issue 4

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Future and recent issues

Information for authors

Masthead

Alignment Strategy for Constricted Maxillary Dental Arch in Patients With Unilateral Cleft Lip and Palate Using Fixed Orthodontic Appliance.

The purpose of this study was to compare the alignment pattern of the constricted maxillary dental arch by fixed orthodontic treatment (FOT) in the well-aligned and constricted arches of unilateral cleft lip and palate (UCLP) patients. 19 UCLP patients were divided into Group 1 (well-aligned arch, n = 9) and Group 2 (constricted arch, n = 10). After the cephalometric and maxillary dental arch variables before (T1) and after FOT (T2) were measured, statistical analysis was performed. There were no significant differences in the surgical timing of cheiloplasty, palatoplasty, and secondary alveolar bone grafting and in the surgical method of cheiloplasty between the 2 groups. However, Group 2 had a higher percentage of palatoplasty method, which could leave the denuded bone for secondary healing than Group 1 (P

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Firm Elevation of Reconstructed Auricle Using Polydactyly Digit in Microtia.

Total ear reconstruction for microtia is usually accomplished in 2 stages which is known as Nagata technique. After framework fabrication and implantation, the elevation procedure is required as a second step surgery. The authors are introducing a novel material for augmenting projection of rib cartilage framework in microtia treatment. (C) 2017 by Mutaz B. Habal, MD.

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Valgus Hindfoot Deformity Secondary to Neonatal Intravenous Infiltration.

Orthopedic complications of intravenous (IV) infiltration are rare, with only a handful of cases reported in the literature. Because of the relatively high rate of IV infiltration in neonates, however, such complications do occur and can include growth arrest, limb length discrepancy, and joint deformities that require surgical intervention. The risk of these complications is highest in preterm neonates. A 7-year-old girl presented to our institution with a severe valgus hindfoot deformity that developed secondary to a neonatal IV infiltration injury. Management consisted of a medial displacement calcaneal osteotomy followed 5 years later by a triple arthrodesis, Strayer procedure, and free flap transfer. (C) 2017 by Mutaz B. Habal, MD.

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Comparative Cost Analysis of Single and Mutli-Stage Temporal Deformity Correction Following Neurosurgical Procedures.

Purpose: Temporal hollowing deformity (THD) is a visible concavity/convexity in the temporal fossa; a complication often seen following neurosurgical/craniofacial procedures. Although numerous techniques have been described, no study to date has shown the healthcare costs associated with temporal hollowing correction surgery. Thus, the purpose here is to compare and contrast the direct costs related to temporal cranioplasty using various methods including: liquid poly-methyl-methacrylate (PMMA) implants with screw fixation, prebent, modified titanium mesh implants, and customized cranial implants (CCIs) with dual-purpose design. Understanding the financial implications related to this frequently encountered complication will help to motivate surgeons/healthcare facilities to better prevent and manage THD. Methods: This is a single-surgeon, single-institution retrospective review of 23 THD patients randomly selected from between 2008 and 2015. Cost analysis variables include length of hospital stay, facility/professional fees, implant material fees, payer information, reimbursement rate, and net revenue. Results: Of the 23 patients, ages ranged from 23 to 68 years with a mean of 48.3 years (SD 11.6). Within this cohort, 39.1% received dual-purpose PMMA CCIs (CCI PLUS), 17.4% received modified titanium mesh implants, and 43.5% received hand-molded, liquid PMMA implants with screw fixation. Total facility and/or professional charges ranged from $1978.00 to $126478.00. Average total facility charges per patient with dual-purpose CCIs were $34775.89 (SD +/- $22205.09) versus $35826.00 (SD +/- $23509.93) for modified titanium mesh implants and $46547.90 (SD +/- 81061.70) for liquid PMMA implants with screws. Mean length of inpatient stay was 5.7 days (SD = 8.1), and did not differ between implant types (P = 0.387). Conclusion: Temporal hollowing deformity is an expensive complication post-neurosurgery, and in the most severe form, requires a revision surgery for definitive correction. Therefore, surgeons should take further initiatives to employ reconstructive methods capable of minimizing risk for costly revision surgery, reducing morbidity related to visible deformity and accompanying social stigmata, and improving overall patient satisfaction. (C) 2017 by Mutaz B. Habal, MD.

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Internal Distraction Resulted in Improved Patient-Reported Outcomes for Midface Hypoplasia.

Background: Both internal and external distraction devices have been used successfully in correcting midface hypoplasia. Although the indication for surgery and the osteotomy techniques may be similar, deciding when to use internal versus external devices has not been studied. The authors studied patient-reported outcomes with FACE-Q and functional surveys for internal and external devices for midface distraction patients. Methods: Patients who underwent distraction advancement after Le Fort I and Le Fort III were surveyed using the FACE-Q survey and a functional survey. Equal groups of internal and external device patients were compared (n = 64). Data recorded included: sex, age, follow-up, diagnosis, operating room time, expected blood loss, length of stay, distraction length, consolidation time, and complications. Results: Internal and external device groups were similar with regards to patient diagnosis, operative time, expected blood loss, distraction length but consolidation times differed (internal = 3.6 versus external = 1.1 months). For FACE-Q appearance appraisal, there were similarities in domain and scale. For the functional survey (airway/breathing, ocular/vision, occlusion/eating, speech/articulation), there was also similar scoring. However, internal device patients had superior FACE-Q scores for Quality of Life: Social Function (80.9 versus 68.9), Early Life Impact (92.9 versus 62.4), Dental Anxiety (70.2 versus 48.3), Psychological Well-being (87.8 versus 68.6); and Decision Satisfaction (81.2 versus 56.9) and Outcome Satisfaction (91.0 versus 84.7). Conclusions: Internal and external midface distraction patients had similar patient-reported outcomes for appearance and functional improvement; however, internal device patients were more satisfied with their quality of life and their decision to undergo the procedure. (C) 2017 by Mutaz B. Habal, MD.

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Strengthening Evidence in Cleft and Craniofacial Surgery.

No abstract available

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A Novel Secretome Biotherapeutic Influences Regeneration in Critical Size Bone Defects.

Severe traumatic injuries often result in critical size bone defects, which are unable to heal without treatment. Autologous grafting is the standard of care but requires additional surgeries for graft procurement. Amnion-derived multipotent progenitor cells release a secretome of biomolecules identified as integral to the process of bone regeneration and angiogenesis. This secretome is currently under development as a biotherapeutic. The efficacy of this secretome biotherapeutic was evaluated in vitro on the proliferation and migration of mesenchymal stem cells and osteoprogenitor cells as well as in vivo using a critical size rat calvarial defect model. The secretome biotherapeutic was loaded onto a collagen scaffold and placed into the defect, which was allowed to heal for 4 and 12 weeks. The secretome biotherapeutic enhanced the proliferation and migration of mesenchymal stem cells and proliferation of osteoprogenitor cells. Further, the secretome biotherapeutic improved new bone volume and connectivity by 12 weeks and significantly improved angiogenesis at 4 weeks and bone density at 4 and 12 weeks with no deleterious effects. The improvement in new bone volume, connectivity, and angiogenesis suggests that the secretome biotherapeutic has beneficial effects for bone healing and a higher dose of the secretome biotherapeutic may further improve regeneration. (C) 2017 by Mutaz B. Habal, MD.

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Drug Release: Proper Control to Help Clinical Application.

No abstract available

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Review of "Outcomes of Concurrent Operations: Results From the American College of Surgeons' National Surgical Quality Improvement Program" by Liu JB, Berian JR, Ban KA, Liu Y, Cohen ME, Angelos P, Matthews JB, Hoyt DB, Hall BL, Ko CY in Ann Surg 266:411-420, 2017.

No abstract available

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Treatment of Maxillary Hypoplasia in Cleft Lip and Palate: Segmental Distraction Osteogenesis With Hyrax Device.

The objective of this work is to describe a segmental maxillary distraction osteogenesis (SDO) with segmental Lefort I with an inexpensive device. Four patients who presented severe class III and maxillary hypoplasia due to cleft lip and palate sequel were treated. A SDO was performed using a dental-anchored Hyrax device, achieving enlargement of the upper jaw without altering speech, with adequate and stable occlusion. Dental implants in a new formed bone were installed. The authors can conclude that SDO is a good treatment alternative for patients with maxillary hypoplasia. It preserves velopharyngeal function and is a stable treatment, maintaining the overjet achieved with distraction osteogenesis, without changes in posterior occlusion. The open bite generated with tooth-borne devices can be solved with temporary anchorage devices and intermaxillary elastics during consolidation phase. Modified Hyrax device allows expanding and moving forward the maxillary arch, with a low cost. (C) 2017 by Mutaz B. Habal, MD.

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Cone Beam Computed Tomography Assessment of Accessory Infraorbital Foramen and Determination of Infraorbital Foramen Position.

There is no evidence about evaluating accessory infraorbital foramen by 3-dimensional analysis like multi slice computed tomography or cone beam computed tomography (CBCT) in human subjects. To authors' best knowledge this is a first study to assess the accessory infraorbital foramen and position of infraorbital foramen in relation to crown of maxillary teeth using CBCT. This study primarily aimed to assess the location and number of accessory infraorbital foramen (AIOF), to measure the distance between main infraorbital foramen and AIOF and secondarily to determine the position of infraorbital foramen in relation to crowns of maxillary second premolar, first molar, and second molar. Cone beam computed tomography volumes of 200 patients were retrieved from the digital imaging and communications in medicine archive folder. Accessory infraorbital foramen was recognized in 29% of the patients among whom 46.6% were present on the right side, 31% on the left side, and 22.4% located bilaterally. The most frequent position of infraorbital foramen was found to be in line with crown of second premolar. The presence of AIOF and inability to recognize it in preoperative evaluation could be considered among the other reasons of failure or incomplete anesthesia. (C) 2017 by Mutaz B. Habal, MD.

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A Personal Approach to Bilateral Cleft Lip Repair.

Dr Michael B. Lewis has been using his personal approach to bilateral cleft lip (BCL) repair for 30 years to achieve a loose, pouting upper lip, a 90-degree columellar-labial angle, and a projecting nasal tip. This article describes technique and results. (C) 2017 by Mutaz B. Habal, MD.

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Use of Acellular Dermal Matrix in Craniosynostosis.

In craniofacial surgery, a wide spectrum of pathological conditions are usually treated. The aetiology of these could be congenital, traumatic, infective, post-tumor resection, postradiation, autoimmune, iatrogenic, or other miscellaneous conditions. The surgical approach for the procedures is usually via a coronal incision. In a large proportion of the patients, the frontal bone is removed to obtain intracranial access. The frontal bone is then replaced either in its original form or in a remodeled state. In congenital conditions the supraorbital bar and frontal bone is often also removed, remodeled, and replaced. One of the common late sequelae following craniofacial surgery is contour irregularities of the frontal region. These irregularities can vary in their extent. They are invariably palpable and often visible. Surgeons have attempted various methods to improve the contour irregularities. Despite these measures contour irregularities can still ensue. In the authors' unit, the authors have been using acellular dermal matrix in an attempt to diminish the contour irregularities in the frontal region following craniofacial reconstruction for craniosynostosis. This has been used in 35 patients undergoing craniosynostosis correction. Of the 35 patients, 12 were for plagiocephaly, 7 for brachycephaly, 10 for scaphocephaly, 4 for trigonocephaly, and 2 for combined coronal and metopic synostosis. The age of the patients ranged from 5 months to 12 years (mean 20.5 months). There were 21 males and 14 females. The follow-up ranged from 10 to 48 months (mean 23 months). (C) 2017 by Mutaz B. Habal, MD.

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Effect of Long-Term Use of Facemask With Miniplate on Maxillary Protraction in Patients With Cleft Lip and Palate.

The purpose of this retrospective study was to investigate the effect of a long-term use of facemask with miniplate (FM-MP) on maxillary protraction in cleft lip and palate (CLP) patients. The subjects were 21 CLP patients (16 unilateral CLP and 5 bilateral CLP patients), who were treated with identical lip and palate surgical method and FM-MP therapy performed by single surgeon and single orthodontist. Lateral cephalogram was taken before (T1; mean age, 11.1 years) and after maxillary protraction (T2; mean age, 16.9 years). The mean duration of FM-MP was 68.0 months. After 17 cephalometric variables were measured, statistical analysis was performed. During T1-T2, the maxilla showed significant forward movement ([DELTA]A-vertical reference plane, 4.8 mm, P 0.05). Long-term use of FM-MP is effective on maxillary protraction in adolescent CLP patients without clockwise rotation of the mandible, the main drawback of conventional facemask with tooth-borne anchorage. (C) 2017 by Mutaz B. Habal, MD.

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Oral-Health-Related Quality of Life After Surgical Treatment of Osteonecrosis of the Jaws.

The aim of this study is to analyze the clinical outcome and the change in oral-health-related quality of life (QoL) of osteoporotic patients affected by medication-related osteonecrosis of the jaws (MRONJ). Forty-one patients, consecutively treated for a 10-year period, were retrospectively analyzed. All the patients underwent a marginal osseous resective jaw surgery. A clinical 12 months postoperative evaluation has been performed and the complete mucosal healing, the absence of swelling and suppuration, and no signs of disease recurrence were defined like success parameters. Quality-of-life surveys tests like EORTC QQ-C30 and QLQ-HN35 appendices in conjunction with a perceived oral health visual analog scale (VAS) were administered before (time of diagnosis of MRONJ) and after surgery (at least 6 months) in order to record the different oral health status of the treated patients. The majority of MRONJ-diagnosed patients complained symptoms like pain, eating discomfort, and sense problems, with occasional involvement of the social dimension. There was a prevalence of troubles with social eating and social contact. The complete mucosal healing was achieved in 100% of the patients and the administered survey tests reported a significant improvement in all the investigated spheres. Similarly, an increased mean score of perceived oral health VAS was reported. Marginal-resective surgery of the necrotic jaw bone can be an effective treatment of osteoporotic patients affected by localized MRONJ. Quality-of-life parameters are demonstrated to be useful for recording the patient-centered outcome of MRONJ treatment. (C) 2017 by Mutaz B. Habal, MD.

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Retention of Interstitial Genes between TMPRSS2 and ERG Is Associated with Low-Risk Prostate Cancer

TMPRSS2-ERG gene fusions occur in over 50% of prostate cancers, but their impact on clinical outcomes is not well understood. Retention of interstitial genes between TMPRSS2 and ERG has been reported to influence tumor progression in an animal model. In this study, we analyzed the status of TMPRSS2-ERG fusion genes and interstitial genes in tumors from a large cohort of men treated surgically for prostate cancer, associating alterations with biochemical progression. Through whole-genome mate pair sequencing, we mapped and classified rearrangements driving ETS family gene fusions in 133 cases of very low-, low-, intermediate-, and high-risk prostate cancer from radical prostatectomy specimens. TMPRSS2-ERG gene fusions were observed in 44% of cases, and over 90% of these fusions occurred in ERG exons 3 or 4. ERG fusions retaining interstitial sequences occurred more frequently in very low-risk tumors. These tumors also frequently displayed ERG gene fusions involving alternative 5′-partners to TMPRSS2, specifically SLC45A3 and NDRG1 and other ETS family genes, which retained interstitial TMPRSS2/ERG sequences. Lastly, tumors displaying TMPRSS2-ERG fusions that retained interstitial genes were less likely to be associated with biochemical recurrence (P = 0.028). Our results point to more favorable clinical outcomes in patients with ETS family fusion-positive prostate cancers, which retain potential tumor-suppressor genes in the interstitial regions between TMPRSS2 and ERG. Identifying these patients at biopsy might improve patient management, particularly with regard to active surveillance. Cancer Res; 77(22); 1–11. ©2017 AACR.

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Primary and Acquired Resistance to Immune Checkpoint Inhibitors in Metastatic Melanoma

Immune checkpoint inhibitors have revolutionized the treatment of advanced stage metastatic melanoma patients, as well as patients with many other solid cancers, yielding long lasting responses and improved survival. However, a subset of patients who initially respond to immunotherapy, later relapse and develop therapy resistance (termed acquired resistance), while others do not respond at all (termed primary resistance). Primary and acquired resistance are key clinical barriers to further improving outcomes of patients with metastatic melanoma and the known mechanisms underlying them involve various components of the cancer immune cycle, and interactions between multiple signalling molecules and pathways. Due to this complexity, current knowledge on resistance mechanisms is still incomplete. Overcoming therapy resistance requires a thorough understanding of the mechanisms underlying immune evasion by tumors. In this review, we explore the mechanisms of primary and acquired resistance to immunotherapy in melanoma, and detail potential therapeutic strategies to prevent and overcome them.

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PKC epsilon is a Key Regulator of Mitochondrial Redox Homeostasis in Acute Myeloid Leukemia

Purpose: The intracellular redox environment of acute myeloid leukemia (AML) cells is often highly oxidized compared to healthy hematopoietic progenitors and this is purported to contribute to disease pathogenesis. However, the redox regulators that allow AML cell survival in this oxidized environment remain largely unknown. Experimental Design and Results: We show that RNA interference-mediated inhibition of the serine/threonine kinase PKC-epsilon (PKCe) reduces cell survival in a diverse panel of patient-derived AML samples and significantly delays disease onset in a genetically engineered mouse model (GEMM) of AML driven by MLL-AF9. Utilizing a combination of chemical and genetically-encoded redox sensing probes, we found that PKCe inhibition leads to the induction of multiple reactive oxygen species (ROS) including multiple mitochondrial ROS. We also show that neutralization of mitochondrial ROS with chemical anti-oxidants or co-expression of the mitochondrial ROS-buffering enzymes SOD2 and CAT, mitigate the anti-leukemia effects of PKCe inhibition. Similar to PKCe inhibition, direct inhibition of SOD2 also increases mitochondrial ROS and significantly impedes disease progression in vivo. Furthermore, we report that over-expression of PKCe protects AML cells from otherwise-lethal doses of mitochondrial ROS-inducing agents. Proteomic analysis reveals that PKCe may control mitochondrial ROS by controlling the expression of regulatory proteins of redox homeostasis, electron transport chain flux, as well as outer mitochondrial membrane potential and transport. Conclusions: This study uncovers a previously unrecognized role for PKC in supporting AML cell survival and disease progression by regulating mitochondrial ROS biology and positions mitochondrial redox regulators as potential therapeutic targets in AML.

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RASA1 and NF1 are preferentially co-mutated and define a distinct genetic subset of smokingassociatednon-small cell lung carcinomas sensitive to MEK inhibition.

Purpose: Ras-GTPase activating proteins (RasGAPs), notably NF1 and RASA1, mediate negative control of the RAS/MAPK pathway. We evaluated clinical and molecular characteristics of NSCLC with RASA1 mutations in comparison with NF1-mutated cases. Experimental Design: Large genomic datasets of NSCLC [MSK-IMPACT™ dataset at MSKCC (n=2004), TCGA combined lung cancer dataset (n=1144)] were analyzed to define concurrent mutations and clinical features of RASA1-mutated NSCLCs. Functional studies were performed using immortalized human bronchial epithelial cells (HBECs) and NSCLC lines with RasGAP truncating mutations in RASA1, NF1, or both. Results: Overall, approximately 2% of NSCLCs had RASA1 truncating mutations, and this alteration was statistically, but not completely, mutually exclusive with known activating EGFR (p=0.02) and KRAS (p=0.02) mutations. Unexpectedly, RASA1 truncating mutations had a strong tendency to co-occur with NF1 truncating mutations (p<0.001). Furthermore, all patients (16/16) with concurrent RASA1/NF1 truncating mutations lacked other known lung cancer drivers. Knockdown of RASA1 in HBECs activated signaling downstream of RAS and promoted cell growth. Conversely, restoration of RASA1 expression in RASA1-mutated cells reduced MAPK and PI3K signaling. While growth of cell lines with inactivation of only one of these two RasGAPs showed moderate and variable sensitivity to inhibitors of MEK or PI3K, cells with concurrent RASA1/NF1 mutations were profoundly more sensitive (IC50: 0.040μM trametinib). Finally, simultaneous genetic silencing of RASA1 and NF1 sensitized both HBECs and NSCLC cells to MEK inhibition. Conclusions: Cancer genomic and functional data nominate concurrent RASA1/NF1 loss of function mutations as a strong mitogenic driver in NSCLC which may sensitize to trametinib.

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A Primer on the Use of Equivalence Testing for Evaluating Measurement Agreement.

Purpose: Statistical equivalence testing is more appropriate than conventional tests of difference to assess the validity of physical activity (PA) measures. This paper presents the underlying principles of equivalence testing and gives three examples from PA and fitness assessment research. Methods: The three examples illustrate different uses of equivalence tests. Example 1 uses PA data to evaluate an activity monitor's equivalence to a known criterion. Example 2 illustrates the equivalence of two field-based measures of physical fitness with no known reference method. Example 3 uses regression to evaluate an activity monitor's equivalence across a suite of 23 activities. Results: The examples illustrate the appropriate reporting and interpretation of results from equivalence tests. In the first example, the mean criterion measure is significantly within +/-15% of the mean PA monitor. The mean difference is 0.18 METs and the 90% confidence interval of [-0.15, 0.52] is inside the equivalence region of [-0.65, 0.65]. In the second example, we chose to define equivalence for these two measures as a ratio of mean values between 0.98 and 1.02. The estimated ratio of mean VO2 values is 0.99, which is significantly (p=0.007) inside the equivalence region. In the third example, the PA monitor is not equivalent to the criterion across the suite of activities. The estimated regression intercept and slope are -1.23 and 1.06. Neither confidence interval is within the suggested regression equivalence regions. Conclusions: When the study goal is to show similarity between methods, equivalence testing is more appropriate than traditional statistical tests of differences (e.g., ANOVA and t-tests). This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. (C) 2017 American College of Sports Medicine

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Dopaminergic Genetic Variants and Voluntary Externally Paced Exercise Behavior.

Purpose: Most candidate gene studies on the neurobiology of voluntary exercise behavior have focused on the dopaminergic signaling pathway and its role in the mesolimbic reward system. We hypothesized that dopaminergic candidate genes may influence exercise behavior through additional effects on executive functioning and that these effects are only detected when the types of exercise activity are taken into account. Methods: Data on voluntary exercise behavior and at least one SNP/VNTR were available for 12,929 participants of the Netherlands Twin Registry. Exercise activity was classified as externally paced if a high level of executive function skill was required. The total volume of voluntary exercise (minutes per week) as well as the volume specifically spent on externally paced activities were tested for association with nine functional dopaminergic polymorphisms (DRD1: rs265981, DRD2/ANKK1: rs1800497, DRD3: rs6280, DRD4: VNTR 48bp, DRD5: VNTR 130-166bp, DBH: rs2519152, DAT1: VNTR 40bp, COMT: rs4680, MAOA: VNTR 30bp), a polygenic score (PGS) based on nine alleles leading to lower dopamine responsiveness, and a PGS based on three alleles associated with both higher reward sensitivity and better executive functioning (DRD2/ANKK1: 'G' allele, COMT: Met allele, DAT1: 440bp allele). Results: No association with total exercise volume or externally paced exercise volume was found for individual alleles or the nine-allele polygenic score. The volume of externally paced exercise behavior was significantly associated with the reward and executive function congruent PGS. This association was driven by the DAT1 440bp and COMT Met allele which acted as increaser alleles for externally paced exercise behavior. Conclusion: Taking into account the types of exercise activity may increase the success of identifying genetic variants and unraveling the neurobiology of voluntary exercise behavior. Key words: candidate gene, exercise behavior, reward sensitivity, executive functioning (C) 2017 American College of Sports Medicine

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A phase 2 study of ontuxizumab, a monoclonal antibody targeting endosialin, in metastatic melanoma

Summary

Objectives Ontuxizumab (MORAB-004) is a first-in-class monoclonal antibody that interferes with endosialin function, which is important in tumor stromal cell function, angiogenesis, and tumor growth. This Phase 2 study evaluated the 24-week progression-free survival (PFS) value, pharmacokinetics, and tolerability of 2 doses of ontuxizumab in patients with metastatic melanoma. Patients and methods Patients with metastatic melanoma and disease progression after receiving at least 1 prior systemic treatment were randomized to receive ontuxizumab (2 or 4 mg/kg) weekly, without dose change, until disease progression. Results Seventy-six patients received at least 1 dose of ontuxizumab (40 received 2 mg/kg, 36 received 4 mg/kg). The primary endpoint, 24-week PFS value, was 11.4% (95% Confidence Interval [CI]: 5.3%–19.9%) for all patients (13.5% for 2 mg/kg and 8.9% for 4 mg/kg). The median PFS for all patients was 8.3 weeks (95% CI: 8.1–12.3 weeks). One patient receiving 4 mg/kg had a partial response, as measured by Response Evaluation Criteria in Solid Tumors v1.1. Twenty-seven of 66 response evaluable patients (40.9%) had stable disease. The median overall survival was 31.0 weeks (95% CI: 28.3–44.0 weeks). The most common adverse events overall were headache (55.3%), fatigue (48.7%), chills (42.1%), and nausea (36.8%), mostly grade 1 or 2. Conclusions Ontuxizumab at both doses was well tolerated. The 24-week PFS value was 11.4% among all ontuxizumab-treated patients. The overall response rate was 3.1% at the 4 mg/kg dose, with clinical benefit achieved in 42.4% of response evaluable patients. Efficacy of single-agent ontuxizumab at these doses in melanoma was low.

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Intraventricular vein thrombosis in a patient with cerebral venous thrombosis

José Luiz Ruiz-Sandoval, Juan Didier Parada-Garza, Erwin Chiquete, Ricardo Marian-Magaña, Gerardo Mauricio Figueroa-Sánchez

Neurology India 2017 65(6):1442-1443

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Nurturing Neurosurgery with basics and compassion …Some thoughts

Subhash R Dharker

Neurology India 2017 65(6):1208-1209

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Therapeutic plasma exchange in a patient of myasthenic crisis, refractory to intravenous immunoglobulin and immunosuppressive therapy

Satya Prakash, Rekha Hans, Ratti R Sharma, Vivek Lal, Neelam Marwaha

Neurology India 2017 65(6):1409-1412

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Founders of Indian Neurosciences: Professor Bimal Kumar Bachhawat and Professor Bal Krishan Anand

Prakash N Tandon

Neurology India 2017 65(6):1210-1212

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“Against the tide, nothing to hide”- the saga of a community neurosurgeon

Ramesh C Mishra

Neurology India 2017 65(6):1213-1218

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Small vessel CNS vasculitis-optimism and challenges in imaging diagnosis

Rakesh K Gupta

Neurology India 2017 65(6):1219-1220

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The cover page

Neurology India 2017 65(6):1207-1207

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Central nervous system vasculitis imaging: Simplified

Harsh Rastogi

Neurology India 2017 65(6):1221-1222

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A longitudinal study of retinal nerve fibre layer profile in patients with multiple sclerosis and its significance

Sureshkumar Radhakrishnan, Minu George, Meenakshi Dhar, Niya Reny, Manoj Prathapan, A Anandkumar

Neurology India 2017 65(6):1402-1403

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Cardiomyopathy in acromegaly and the effect of trans-sphenoidal surgery

Subhash Yadav, Eesh Bhatia

Neurology India 2017 65(6):1223-1224

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Unexpected cause of leg pain in a patient with lower back pain

Marine Tanashyan, Polina Kuznetsova, Andrey Chechetkin, Natalia Vuytsik, Maria Zakharkina

Neurology India 2017 65(6):1418-1419

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Dorsolumbar fungal (aspergillus) epidural granuloma in an immunocompetent patient: Review of literature

Satyashiva Munjal, Anshu Warade, Srikant Balasubramaniam, Kedar Deogaonkar, RB Deshpande, Ketan Desai

Neurology India 2017 65(6):1435-1438

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Demonstration of autonomic dysfunction in traumatic brachial plexus injury using quantitative sudomotor axon reflex test

Vanessa Sammons, Rajiv Midha

Neurology India 2017 65(6):1227-1228

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Spinal model for teaching and training

Dattatraya Muzumdar

Neurology India 2017 65(6):1448-1449

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Assessment of autonomic dysfunction in traumatic brachial plexus injury: A regional pain management strategy or merely a research tool?

Manish Singh Sharma

Neurology India 2017 65(6):1229-1230

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The Department of Neurosurgery, G. B. Pant Hospital, New Delhi

Anita Jagetia, Daljit Singh, Arvind K Srivastava, AK Singh

Neurology India 2017 65(6):1366-1377

The history of the prestigious Department of Neurosurgery, Gobind Ballabh Pant Institute of Medical Education Institute and Research, New Delhi, a leading tertiary care centre, is presented. Its eminent faculty and outstanding patient care attracts patients and students from all over the country.The patients opt for this institution to get a standard of care that may be comparable with the highest standards prevalent; and, the students achieve their goal of getting excellent education in Neurosurgery at par with the best institutes of the world. The department has, therefore, over the years, established its place in the country as a premier training facility and an epitome of medical excellence.

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Neurological perspective of globus pallidus interna deep brain stimulation in dystonia

Vinay Goyal

Neurology India 2017 65(6):1231-1231

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Sleep Dentists Win Big With Project Rose

Project Rose Team: Gary Baxter, Dr. Rebecca Lauck, Dr. Brandon Hedgecock, Isiah Robertson, Dr. Harry Sugg, D. Gergen, Dr. Ed Hobbs, Eric Dickerson

As a country, we have satisfaction in being American, but each community also value's their own individual cultures. The American Sleep and Breathing Academy (ASBA) wants to release an official statement of support and pride for the communities in Florida and surrounding areas as well as Houston communities effected by Hurricane Harvey and Hurricane Irma. With different disasters in different areas come different recoveries but, nevertheless, recovery is inevitable.

The resilience of the communities damaged are stunning and marvelous, but not shocking. It is especially magnificent to see Houston rally behind the Houston Astros, major league contenders for the championship of America's pastime, and NFL legend/Rose of Texas Earl Campbell's Project Rose, a project dedicated to enhancing the safety of sports and improving sleep and wellness in communities throughout the country. After the devastating hurricane, Earl Campbell and Gary Baxter wanted to focus on adding to the local economy in Houston. They are doing so by launching sleep and wellness programs in 17 hospitals/clinics throughout Houston.

The wellness program is designed with an emphasis on preventive care and a healthier lifestyle. An ounce of prevention can save a pound of problems. That's why Project Rose Wellness Program is proudly offering the next generation of innovative lab testing, food/nutrition education, mental and physical health exercises, and providing a unique approach to understanding everyone's lifestyle requirements for better health.

Strengthening the ties of communities adds to the fortitude and unity of the entire country. The American Sleep and Breathing Academy thanks everyone involved for their contribution and unwavering capacity to recover quickly from difficult times.

Call David Gergen at 602-478-9713 to see how you can become involved.

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Pendular Seesaw Nystagmus in a Patient With a Giant Pituitary Macroadenoma: Pathophysiology and the Role of the Accessory Optic System.

Seesaw nystagmus is characterized by cyclic eye movements with a conjugate torsional component and a dissociated vertical component. In the first half of the cycle, one eye elevates and intorts, whereas the other eye depresses and extorts. The pattern is reversed in the remaining half of the cycle. We describe a patient with a giant pituitary adenoma who developed pendular seesaw nystagmus. Disturbance in the visuovestibular system is postulated to contribute to this form of seesaw nystagmus. Lesions compressing the optic chiasm and the accessory optic system could interrupt the transmission of retinal error signals to the inferior olivary nucleus and the interstitial nucleus of Cajal, thus interfering with the adaptive mechanism of the vestibulo-ocular reflex and leading to pendular seesaw nystagmus. (C) 2017 by North American Neuro-Ophthalmology Society

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Neuro-Ophthalmology at a Tertiary Eye Care Centre in India.

Background: Neuro-ophthalmology as a specialty is underdeveloped in India. The aim of our study was to determine the spectrum and profile of patients presenting to a tertiary eye care center with neuro-ophthalmic disorders. Methods: A retrospective hospital-based study was conducted, and records of all patients seen at the neuro-ophthalmology clinic of Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India, over a 1-year period were retrieved and evaluated. Results: Of a total of 30,111 patients referred to various specialty clinics in a span of 1 year, 1597 (5%) were referred for neuro-ophthalmology evaluation. The mean patient age was 30.8 +/- 19.5 years, with a male dominance (M:F = 2.02:1). Among these patients, optic nerve disorders were noted in 63.8% (n = 1,020), cranial nerve palsy in 7% (n = 114), cortical visual impairment in 6.5% (n = 105), and others (eye/optic nerve hypophasia, blepharospasm, and optic disc drusen) in 6% (n = 95). Among the patients with optic nerve disorders, optic neuropathy without disc edema/(traumatic optic neuropathy, hereditary, tumor-related, retrobulbar neuritis, toxic, and idiopathic) was noted in 42.8% (n = 685) and optic neuropathy with disc edema (ischemic optic neuropathy, papilledema, post-papilledema optic atrophy, papillitis, neuroretinitis, and inflammatory optic neuropathy) in 20.9% (n = 335). Sixteen percent of patients (n = 263) were incorrect referrals. Conclusion: The neuro-ophthalmic clinic constitutes a significant referral unit in a tertiary eye care center in India. Traumatic and ischemic optic neuropathies are the most common diagnoses. Neuro-ophthalmology requires further development as a subspecialty in India to better serve the nation's population. (C) 2017 by North American Neuro-Ophthalmology Society

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Weighing the Risks and Benefits of Antidepressants in Idiopathic Intracranial Hypertension.

No abstract available

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Optic Nerve Head Drusen: The Relationship Between Intraocular Pressure and Optic Nerve Structure and Function.

Objective: To determine whether at the time of diagnosis, the intraocular pressure (IOP) in patients with optic nerve head drusen (ONHD) correlates with the perimetric mean deviation (PMD) and the mean retinal nerve fiber layer (RNFL) thickness on optical coherence tomography (OCT). Methods: This retrospective chart review included adults with ONHD from 2 academic medical centers. Inclusion criteria were age older than 18 years, definitive diagnosis of ONHD, measurement of IOP, and an automated visual field (VF) within 3 months of diagnosis. Exclusion criteria were unreliable VFs, use of IOP-lowering therapy, and visually significant ocular comorbidities. Data were collected from the initial visit. Age, IOP, method of diagnosis of ONHD, mean RNFL thickness, and PMD were recorded. Multiple and logistic regression models were used to control for potential confounders in statistical analyses. Results: Chart review identified 623 patients, of which 146 patients met inclusion criteria. Mean age was 44.2 years (range: 19-82 years). Average PMD of 236 eyes was -5.22 dB (range, -31.2 to +1.21 dB). Mean IOP was 15.7 mm Hg (range: 6-24 mm Hg). Forty eyes (16.9%) underwent RNFL measurement using OCT; mean RNFL thickness was 79.9 [mu]m (range: 43-117 [mu]m). There was no statistically significant association between IOP and PMD (P = 0.13) or RNFL thickness (P = 0.65). Eyes with ocular hypertension tended to have less depressed PMD than those without (P= 0.031). Stratified analyses of visible and buried subgroups yielded similar results. Conclusions: Lowering IOP in patients with ONHD has been proposed as a means to prevent progression of optic neuropathy. Our study demonstrated that among predominately normotensive eyes, higher IOP was not associated with greater VF loss or thinner RNFL at the time of presentation. This suggests that lowering IOP may not be beneficial in preventing visual loss in normotensive eyes with ONHD. (C) 2017 by North American Neuro-Ophthalmology Society

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Transversalis fascia scoring: a new adjunct to anterior component separation technique

Abstract

Background

Abdominal wall hernia is a significant cause for reoperation following laparotomy. Anterior component separation (ACS) is a widely used technique for closure of large abdominal wall defects. We propose that adding scoring of transversalis fascia to ACS can provide additional midline advancement of the anterior rectus sheath.

Methods

Open ACS was performed in eight cadavers. The medial advancement of the anterior rectus sheath was recorded at three points bilaterally during application of constant load, and again following scoring of the transversalis fascia. This technique was then used on two patients with recurrent, complex ventral hernias which could not be closed with ACS alone.

Results

In the cadaver model, transversalis fascia scoring provides additional 34.01, 27.12, and 25.05% advancement at each point compared to ACS. Results were significant. In both patients, primary fascial closure of defects over 20 cm width at midline was achieved.

Conclusions

Adding transversalis fascia scoring in a controlled standard fashion to ACS may help surgeons achieve closure of abdominal wall defects when ACS alone is not sufficient.

Level of Evidence: Level V, therapeutic study.

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Eine seltene Differentialdiagnose des supraglottischen Larynxödems

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-121343

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents | Full text

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Immunohistochemistry with Anti-BRAF V600E (VE1) Mouse Monoclonal Antibody is a Sensitive Method for Detection of the BRAF V600E Mutation in Colon Cancer: Evaluation of 120 Cases with and without KRAS Mutation and Literature Review

Abstract

The major aim of this study was to evaluate the performance of anti-BRAF V600E (VE1) antibody in colorectal tumors with and without KRAS mutation. KRAS and BRAF are two major oncogenic drivers of colorectal cancer (CRC) that have been frequently described as mutually exclusive, thus the BRAF V600E mutation is not expected to be present in the cases with KRAS mutation. In addition, a review of 25 studies comparing immunohistochemistry (IHC) using the anti-BRAF V600E (VE1) antibody with BRAF V600E molecular testing in 4041 patient samples was included.

One-hundred and twenty cases with/without KRAS or BRAF mutations were acquired. The tissue were immunostained with anti-BRAF V600E (VE1) antibody with OptiView DAB IHC detection kit. The KRAS mutated cases with equivocal immunostaining were further evaluated by Sanger sequencing for BRAF V600E mutation. Thirty cases with BRAF V600E mutation showed unequivocal, diffuse, uniform, positive cytoplasmic staining and 30 cases with wild-type KRAS and BRAF showed negative staining with anti-BRAF V600E (VE1) antibody. Out of 60 cases with KRAS mutation, 56 cases (93.3%) were negative for BRAF V600E mutation by IHC. Four cases showed weak, equivocal, heterogeneous, cytoplasmic staining along with nuclear staining in 25–90% of tumor cells. These cases were confirmed to be negative for BRAF V600E mutation by Sanger sequencing. Overall, IHC with anti-BRAF V600E (VE1) antibody using recommended protocol with OptiView detection is optimal for detection of BRAF V600E mutation in CRC. Our data are consistent with previous reports indicating that KRAS and BRAF V600E mutation are mutually exclusive.

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Sclerosing angiomatoid nodular transformation of the spleen in a patient with Maffucci syndrome: a case report and review of literature

Maffucci syndrome is a congenital, non-hereditary mesodermal dysplasia characterized by multiple enchondromas and hemangiomas. The presence of visceral vascular lesions in this syndrome is exceedingly rare.

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New routes of allergen immunotherapy

Publication date: Available online 10 November 2017
Source:Allergologia et Immunopathologia
Author(s): C.R. Juesas, C.M. Aguilar, S. Vieths

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Chemical Oxygen Demand and Ammonia Nitrogen Removal in a Non-saturated Layer of a Strengthened Constructed Rapid Infiltration System

Abstract

A strengthened constructed rapid infiltration (SCRI) system is a sewage treatment system derived from a constructed rapid infiltration (CRI) system. The SCRI tank structure primarily includes saturated and non-saturated layers. The degradation of the chemical oxygen demand (COD) and the conversion of ammonia nitrogen (NH₄⁺-N) are primarily performed in a non-saturated layer. To study the COD and NH₄⁺-N removal process in a non-saturated layer, two organic glass columns with a radius of 2.5 cm and a height of 70 cm were loaded with layers of soil from the Shunyi district of Beijing. The primary goal of this research is to quantify the removal effect factors and the relationship of the COD and NH₄⁺-N in the non-saturated layer. The SCRI system functioned successfully under a wetting-drying ratio of 1:5 with hydraulic loading at 1.0 m³/ (m²·d) for over 2 months. Our results show that the removal rate of NH₄⁺-N is approximately 69.11%, and the removal efficiency of COD is approximately 90.46%. The removal of COD is only slightly affected by pH, while the removal of NH₄⁺-N is greatly influenced by pH.

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Cramps frequency and severity are correlated with small and large nerve fiber measures in type 1 diabetes

Muscle cramps are defined as sudden sustained and painful contraction of a muscle or muscle group. Muscle cramps are common, with a higher prevalence in the elderly(Abdulla et al. 1999) and in patients with neuropathic conditions,(Katzberg 2015) and are often underreported.(Naylor and Young 1994) The pathogenesis of muscle cramps involves spontaneous discharges of motor nerves, but the exact site of origin of these discharges, and their physiological mechanism remain uncertain.(Layzer 1994) Although the prevailing hypothesis is that muscle cramps originate and are propagated at motor nerves,(Layzer 1994) muscle cramps have also been described in sensory and pure small fiber neuropathies.(Lopate et al.

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Cognitive reserve modulates attention processes in healthy elderly and amnestic mild cognitive impairment: an event-related potential study

Cognitive reserve (CR) is a concept that was proposed to explain susceptibility heterogeneities of different individuals to cognitive impairment while confronting same neural pathology (Barulli et al., 2013). In addition, CR might be associated with lifetime intellectual activities and some other environmental factors including Intelligence Quotient (IQ), education, occupation level and participation in leisure activities, et al (Barulli et al., 2013). There is extensive epidemiological and experimental evidence to support the existence of CR: education, occupation level and participation in leisure activities have been demonstrated to be related to risk for developing dementia (Smith et al., 2010; Stern, 2012; Xu et al., 2015), cognitive impairment while aging (Barulli et al., 2013), and clinical changes in several other neurological and psychiatric disorders (Barnett et al., 2006; Sumowski et al., 2013; Hindle et al., 2014; Nunnari et al., 2014; Mathias et al., 2015).

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Squatting re-education with lumbo-pelvic-thigh muscles cocontraction improves functional performance in patellofemoral pain syndrome: a case report

Anterior knee pain with or without joint crepitus during squatting is the common clinical feature in the individuals with patellofemoral pain syndrome (PFPS). Altered lower extremity alignment and lumbo-pelvic-thigh muscles motor control is often associated with PFPS. Although current interventions recommend individual muscle activation and strength training exercises, the reported benefits of cocontraction based exercises in PFPS is limited. It might be due to the long standing hypothesis that the exercise induced cocontraction of thigh muscles may induce a negative effect by increasing the joint contact forces in individuals with knee osteoarthritis.

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Stabilization of Visual Function After Optic Nerve Sheath Fenestration for Optic Nerve Meningocele

A 10-year-old boy with bilateral colobomatous cavitary disc anomalies presented with a 3-month history of vision loss in his right eye. MRI of the head and orbit revealed bilateral tubular cystic enlargement of the optic nerve/optic sheath complex with thickening of the optic nerves without inflammation or neoplasm, suggestive of bilateral optic nerve meningocele. An optic nerve sheath fenestration was performed OD, and he experienced an improvement and stabilization of vision in his right eye during a 1-year follow-up period. The authors recommend that surgical decompression, particularly optic nerve sheath fenestration, should be considered in cases with progressive vision loss due to optic nerve meningocele.

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Imaging the Canaliculops With Ultrasound Biomicroscopy and Anterior Segment Ocular Coherence Tomography

Canaliculops is a noninflammatory and noninfectious ectasia of the canaliculus with serous fluid accumulation. Currently, the etiology is uncertain. To the best of the authors' knowledge only 6 confirmed cases have been published earlier; however, the imaging features were not described. The authors report the ultrasound biomicroscopic and ocular coherence tomography features of a histopathologically proven canaliculops.

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A Novel Method to Measure Artificial Eye Motility

Purpose: To measure objectively, reproducibly, and noninvasively artificial eye motility, a fundamental aspect in the (cosmetic) outcome of enucleation. Method: A gaze- and pupil-tracking system, the "iView X," was implemented to measure horizontal eye motility. The system, with adjusted software, was tested with patients wearing 1 prosthetic eye after enucleation for retinoblastoma. Measurements were repeated 5 times in every patient and analyses were performed twice by 2 independent observers. Reproducibility was tested via linear mixed models. After the implementation of the method, more data were obtained, including more patients with a history of enucleation for the treatment of retinoblastoma for eye tracker measurement, and differences in motility percentages between implant types and sizes were analyzed via Mann-Whitney U tests. Results: The intraclass correlation coefficient of the interobserver variable in the patient test group (n = 27, 6–53 years) was 0.98 and 0.96 for measurement of left gaze and right gaze, respectively. Intraobserver variation was

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Validation of CADS Grading Scale: An Ophthalmic Specific Grading Instrument for Facial Nerve Palsy

Purpose: To evaluate the inter- and intraobserver reliability of the CADS score, a previously described facial nerve grading instrument for ophthalmic grading of facial nerve palsy. Methods: This is a cross-sectional validation study. Two clinicians independently assessed and graded each patient on the same day, masked to each other's grading. Four parameters are assessed in the CADS scale: Cornea (0–3, ±a), static Asymmetry (0–2), Dynamic function (0–3), and Synkinesis (0–2). One clinician reassessed the patients and performed the grading again at a minimum time interval of 1 hour later. A weighted κ analysis was performed to determine inter- and intraobserver reliability using 95% bootstrapped bias-corrected and accelerated (BCa) confidence intervals (CIs). Results: Thirty-three patients (27 women, mean age 51.7, range 23–80 years) with unilateral facial nerve palsy were graded. The overall interobserver reliability was 0.80 (95% BCa CI: 0.68–0.91) for cornea, 0.93 for resting asymmetry (95% BCa CI: 0.55–1.00), 0.80 for dynamic function (95% BCa CI: 0.50–0.96), and 0.88 (95% BCa CI: 0.71–0.96) for synkinesis. The overall intraobserver reliability was 0.93 for cornea (95% BCa CI: 0.83–0.98), 0.82 for resting asymmetry (95% BCa CI: 0.53–0.96), 0.92 for dynamic function (95% BCa CI: 0.72–1.00), and 0.98 for synkinesis (95% BCa CI: 0.84–1.00). Conclusion: The CADS grading scale demonstrates good interobserver reliability and very good intraobserver reliability. It incorporates all ophthalmic complications for facial nerve palsy and remains easy to use and refer to.

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Orbital Perivenous Abscess Complicating the Diagnosis and Management of Orbital Cellulitis

An 11-year-old female presented with orbital cellulitis, bacterial sinusitis, enlarged left superior ophthalmic vein, dural venous sinuses, and internal jugular vein. The patient underwent endoscopic sinus surgery and was started on intravenous antibiotics and anticoagulation with limited improvement in orbital signs and symptoms. A magnetic resonance imaging/magnetic resonance venography of the orbits and brain revealed a dilated left superior ophthalmic vein with absence of flow but no clearly discernible orbital abscess. Intravenous corticosteroids resulted in dramatic improvement of pain, hypoglobus, proptosis, and extraocular motility, all of which rapidly recurred on discontinuation. Serial imaging revealed progression of what eventually manifested as a well-defined, rim-enhancing peri-superior ophthalmic vein abscess, which was incised and drained with prompt resolution of orbital cellulitis and complete visual recovery.

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Non-Exenteration Management of Sino-Orbital Fungal Disease

Purpose: To describe the non-exenteration management of sino-orbital fungal infection, a life-threatening condition for which orbital exenteration is generally considered a first-line treatment. Methods: A retrospective case series is presented of 7 orbits in 6 consecutive patients admitted and treated at 2 major metropolitan tertiary teaching hospitals in Sydney, New South Wales, Australia. Results: Seven orbits in 6 consecutive patients with sino-orbital fungal infection were treated conservatively with surgical debridement and intravenous antifungal agents. Four patients were immunosuppressed and the other 2 patients were otherwise healthy. All presented with pain, proptosis, or loss of vision. Causative organisms found were Mucormycoses, Aspergillus, and Scedosporium prolificans. Exenteration was avoided in all patients as part of their planned management and 5 patients, including 1 with bilateral disease, survived their disease without exenteration. Medical treatment included intravenous liposomal amphotericin B or voriconazole. A single immunosuppressed patient deteriorated and as a last resort, exenteration was performed, but this made no difference to his clinical course and in retrospect could have been avoided as he died of multiple cerebral metastases diagnosed shortly after his deterioration. Conclusion: The authors recommend that patients with sino-orbital fungal disease preferably be treated conservatively, without orbital exenteration.

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Comparison of Colorado Microdissection Needle Versus Scalpel Incision for Aesthetic Upper and Lower Eyelid Blepharoplasty

Purpose: Traditionally, eyelid skin incisions with electro-cautery devices have been avoided due to the concerns of aesthetically unacceptable scar formation. The purpose of this study is to compare ecchymosis, cosmesis, and histologic tissue damage of incisions made with a scalpel or Colorado needle in patients undergoing upper and lower aesthetic blepharoplasty. To the best of authors' knowledge, no previous study has been performed before to compare these 2 modalities in aesthetic blepharoplasty surgery. Methods: This is a multicenter, prospective, interventional, comparative case series. The study protocol was approved by Institutional Review Board in each institution. Patients underwent bilateral upper and/or transcutaneous lower blepharoplasty with 1 side randomly selected for skin incision with the scalpel, the other side with the Colorado needle. Ecchymosis was evaluated using a 10-point Likert scale and the wounds using a Hollander score. The margins of excised tissues were evaluated histologically. Results: A total of 254 eyelids of 101 patients were included in the study. No significant difference was observed in ecchymosis on postoperative day 1 and 7 and scar cosmesis on day 30 and 180 between the 2 techniques. Histologically, necrosis was noted only with the Colorado needle sides (p = 0.001). No adverse events occurred on the Colorado needle side at any time after surgery. Conclusions: No clinical difference is noted between Colorado needle and scalpel incisions in terms of ecchymosis and scar cosmesis after aesthetic blepharoplasty.

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Chronic Eyelid Edema Following Periocular Hyaluronic Acid Filler Treatment

A 54-year-old woman received multiple injections of hyaluronic acid filler to the brow region to address volume loss over a 21-month period. She then developed significant pitting edema of both upper eyelids, which persisted for 6 years. Hyaluronidase (Hyalase) was injected into the subcutaneous brows and resulted in complete resolution of the edema within 2 days. This confirms that the hyaluronic acid injected into the brows was responsible for this patient's chronic eyelid edema. This case illustrates an unusual long-term complication of periocular hyaluronic acid filler.

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Long-Term Results for Entropion Repair by Tarsal Margin Rotation With Posterior Lamella Superadvancement

Purpose: To report the long-term stability of tarsal margin rotation and posterior lamellar superadvancement (TMR PLS) for the repair of upper eyelid cicatricial entropion. Methods: A retrospective chart review was performed from January 2000 through December 2014 to identify all patients who had TMR PLS at the authors' institution. Charts were reviewed for demographic information, recurrence of entropion or trichiasis, and surgical complications. Failure was defined as return of entropion. Patients with greater than 24 months of follow up were included. Results: A total of 30 TMR PLS procedures were performed during the review period. Nineteen cases from 14 patients were included in the final analysis. None of the 19 cases demonstrated recurrence of entropion over an average follow-up period of 78.3 months. Eight cases demonstrated trichiasis after TMR PLS, 5 of which required treatment. Conclusion: This case series suggests that TMR PLS for the treatment of upper eyelid cicatricial entropion has excellent long-term stability.

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Dacryoadenitis as the Initial Presentation of a Natural Killer T-Cell Lymphoma

Primary orbital natural killer T-cell lymphoma (NKTCL) is a rare condition with only a few published cases in the literature. Over 1 month, an 81-year-old man developed progressive left periocular inflammation unresponsive to treatment. Clinical examination and imaging studies demonstrated a left lacrimal gland enlargement. Bilateral anterior uveitis and erythematous nontender cutaneous lesions were also found. Biopsies of the skin and lacrimal gland on the back revealed histopathologic and immunohistochemical findings confirming Epstein–Barr virus-positive NKTCL. Metastatic work up disclosed multifocal involvement in the pancreas, stomach, and chest wall. Palliative treatment consisting of nonanthracycline-based chemotherapy and radiation was instituted, but the patient died 5 months after the onset of symptoms. This is the first example of acute dacryoadenitis, and the second of bilateral anterior uveitis, in the setting of NKTCL. Absence of naso-sinus involvement in the current case is rare in NKTCL. Despite treatment, the prognosis remains dismal. Orbital specialists should include NKTCL in the differential diagnosis of lacrimal gland/orbital masses and perform an incisional biopsy if the clinical scenario so dictates.

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The Latino Eyelid: Anthropometric Analysis of a Spectrum of Findings

Purpose: Published anthropometric measurements of the Latino eyelid are limited. This study describes features spanning the morphologic range from non-Latino whites to East Asians in the spectrum of the Latino eyelid. Methods: A cross-sectional study of 68 people (32 Latinos, 18 non-Latino whites, and 18 East Asians, ages 18–39), approved by the Institutional Review Board and HIPAA-compliant, was performed. Saliva samples determined genetic components. Indirect anthropometric measurements were performed with ImageJ software. Eyelid measurements included margin reflex distance, palpebral fissure height, eyelid crease height, orbital height, horizontal fissure length, inner and outer canthal distances, medial and lateral canthal angles, and lateral canthal angle of inclination. Additionally, exophthalmometry and epicanthal folds were recorded. Results: Analysis of 184 markers from HumanExome Chip data revealed distinct clustering patterns. Genetically, the Asian participants were in 1 group, the whites in another group, and the Latinos spanned the spectrum between these 2 groups. In Latinos, the inner canthal distance and lateral canthal angle of inclination were similar to Asians, whereas the eyelid crease spanned the range from Asians to whites. Half of the Latinos had epicanthal folds. Conclusions: Latinos possess a spectrum of eyelid features spanning the morphologic characteristics from those of non-Latino whites to those of East Asians. These normative data on Latinos from Texas and Mexico aid in the diagnoses of Latino eyelid disorders and are a reference for optimizing oculofacial surgery outcomes.

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Multifocal Ocular Surface Squamous Neoplasia

A 64-year-old healthy female presented with a papillomatous limbal lesion involving 6 clock hours of superior limbus and diffuse involvement of upper tarsal conjunctiva of left eye of 6 months duration. Excision of superior limbal lesion on histopathology showed carcinoma in situ with focal breach in basement membrane and moderate degree of differentiation. The surgical base and margins were uninvolved. The tarsal lesion was initially treated with subconjunctival interferon alpha 2b (IFN alpha 2b) (3 cycles of IFN alpha 2b) with poor response. Subsequently treatment with topical mitomycin C 0.04% showed a dramatic response in the upper eyelid tarsal lesion. A small residual lesion needed excision. One year after treatment, she was completely tumor-free. In multifocal ocular surface squamous neoplasia, multimodal treatment with excision and topical mitomycin C may be effective in cases refractory to immunotherapy.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zO5BUC

Αρχειοθήκη ιστολογίου

Παρασκευή 10 Νοεμβρίου 2017

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