Symposia & Podiums

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Author Index

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Issue Information

No abstract is available for this article.

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Posters

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Lung cancer: a brief review of epidemiology and screening

Future Oncology, Ahead of Print.


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Validating the total illness burden index for prostate cancer (TIBI-CaP) in men with castration-resistant prostate cancer: data from TRUMPET

Future Oncology, Ahead of Print.


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Ultraearly assessed reperfusion status after middle cerebral artery recanalization predicting clinical outcome

Objectives

Mechanical thrombectomy has high evidence in stroke therapy; however, successful recanalization guarantees not a favorable clinical outcome. We aimed to quantitatively assess the reperfusion status ultraearly after successful middle cerebral artery (MCA) recanalization to identify flow parameters that potentially allow predicting clinical outcome.

Materials and Methods

Sixty-seven stroke patients with acute MCA occlusion, undergoing recanalization, were enrolled. Using parametric color coding, a post-processing algorithm, pre-, and post-interventional digital subtraction angiography series were evaluated concerning the following parameters: pre- and post-procedural cortical relative time to peak (rTTP) of MCA territory, reperfusion time, and index. Functional long-term outcome was assessed by the 90-day modified Rankin Scale score (mRS; favorable: 0-2).

Results

Cortical rTTP was significantly shorter before (3.33 ± 1.36 seconds; P = .03) and after intervention (2.05 ± 0.70 seconds; P = .003) in patients with favorable clinical outcome. Additionally, age (P = .005) and initial National Institutes of Health Stroke Scale score (P = .02) were significantly different between the patients, whereas reperfusion index and time as well as initially estimated infarct size were not. In multivariate analysis, only post-procedural rTTP (P = .005) was independently associated with favorable clinical outcome. 2.29 seconds for post-procedural rTTP might be a threshold to predict favorable clinical outcome.

Conclusions

Ultraearly quantitative assessment of reperfusion status after successful MCA recanalization reveals post-procedural cortical rTTP as possible independent prognostic value in predicting favorable clinical outcome, even determining a threshold value might be possible. In consequence, focusing stroke therapy on microcirculatory patency could be valuable to improve outcome.

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Saliva with reduced calcium and phosphorous concentrations: Effect on erosion dental lesions

Abstract

Objectives

To investigate whether saliva formulations with reduced calcium (Ca) and inorganic phosphorous (Pi) concentration would affect dental erosion caused by hydrochloric acid (HCl).

Methods

Enamel and root dentine bovine slabs were embedded, polished and measured for surface Knoop microhardness (SMH). After reference areas were created, specimens were exposed to HCl solution (0.01M; pH 2; 120s) and immersed in artificial salivas (6h) containing three different Ca/Pi concentrations (n=15), which simulate serum conditions of normo-, mild- or severe hypocalcaemia. The control group was immersed in Ca/Pi-free saliva. The study protocol was carried out 2x/day for 5 days. Surface loss of enamel and root dentine was assessed using an optical profilometer and SMH was remeasured for enamel.

Results

ANOVA (p<0.001) and Tukey's test showed that enamel loss in groups subjected to artificial salivas that simulated mild- or severe hypocalcaemia did not differ from that resembling normocalcemia. %SMH was lower when saliva was mildly- and normally-concentrated in Ca/Pi (p<0.001). Root dentine loss was higher in saliva simulating severe hypocalcaemia than in those referring to mild, hypo- and normocalcemia.

Conclusions

Depending on the dental substrate, salivary formulations resembling serum hypocalcaemia affected surface loss due to erosion and rehardening thereof.

This article is protected by copyright. All rights reserved.

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Posterolateral cervical transpedicular corpectomy for the surgical management of metastatic tumor

Abstract

Management of metastatic spinal disease in the upper cervical spine can be particularly challenging. Depending on the level of the lesion and the patient's anatomy, multiple anterior approaches have been described for resection of the cancer, followed by posterior fixation and instrumentation. Although a single-stage posterolateral approach is now well established for thoracic pathology, less is known about the applicability of these principles when applied as an approach to the cervical spine. The authors present here a case using a posterolateral transpedicular approach for corpectomy and graft placement for circumferential reconstruction as a treatment of metastatic disease in the cervical spine to illustrate the feasibility of this technique, especially in the setting where the patient's anatomy or pathology may impede an anterior or combined circumferential approach.

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Sociocultural beliefs and perceptions about cleft lip-palate and their implications in the management, outcome, and rehabilitation

SS Shirol

Journal of Cleft Lip Palate and Craniofacial Anomalies 2018 5(1):4-5



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Evaluation and comparison between effects of early and late palatoplasty on the mandibular morphology and spatial position with respect to the cranial base and maxilla: A two-dimensional retrospective study

Khushboo Ratnani, Pallavi Daigavane, Sunita Shrivastav, Ranjit Kamble, Kunal Babbar, Shivani Deshmukh

Journal of Cleft Lip Palate and Craniofacial Anomalies 2018 5(1):6-10

Background: This retrospective cephalometric study was designed to clarify the influence of the timing of surgical repair of cleft and its effect on mandibular growth and its position in the cleft patients which is questionable. Aim: The aim of the study was to assess the effect of timing of palate repair on the mandibular spatial position and morphology in relation to cranial base and maxilla in patients born with unilateral cleft lip and palate (UCLP) using Lateral Cephalograms. Material and Methods: This study was carried out on 20 surgically treated UCLP patients within the age group of 8–16 years. Twenty UCLP subjects were further divided into two groups (early palatal repair n = 10 and late palatal repair n = 10) according to their age at which initial hard palate repair was performed. Results: Stage of palatal repair had a significant effect on the Y-axis (P- 0.045) but there is no significant difference in the spatial position, size and morphology of mandible when compared in relation to anterior cranial base and in relation to maxilla. Conclusion: Timing of surgical repair of palate has no detrimental effects on the position and morphology of mandible in patients with unilateral cleft lip and palate.

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A rare case of median cleft of lower lip in Goldenhar syndrome

Khai Luen Koh, M Abd Latib

Journal of Cleft Lip Palate and Craniofacial Anomalies 2018 5(1):45-47

Median cleft on the lower lip (Tessier 30 cleft) is extremely rare with <100 cases reported in literature. Association with other craniofacial anomalies is known to occur, but some combination is extremely rare. We report a unique case of Tessier 30 cleft in a child with constellations of craniofacial cleft associated with Goldenhar syndrome. Rare facial clefts combinations reinforce the embryological basis that they are likely to result from disruption in migration of neural crest cells from rhombomeres to branchial arches rather than other simplistic theories. Case presented is distinct which will contribute to the current literature on rare craniofacial clefts syndrome.

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Evaluation and comparison between effects of early and late palatoplasty on the mandibular morphology and spatial position with respect to the cranial base and maxilla: A two-dimensional retrospective study

N Madhumitha

Journal of Cleft Lip Palate and Craniofacial Anomalies 2018 5(1):11-12



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Kal, aaj, aur kal (yesterday, today, and tomorrow)

Puneet Batra

Journal of Cleft Lip Palate and Craniofacial Anomalies 2018 5(1):1-3



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Use of metacognitive strategies in the speech and language intervention of Marathi speaking individuals with cleft of lip and/or palate

Sonakshi Rajesh Rawal, Anjali Ravindra Kant, SanaZeb AbdulKadir Sheikh, Dhanshree Rajesh Gunjawate, Ashka Bhagyesh Thakar, Bharati V Khandekar

Journal of Cleft Lip Palate and Craniofacial Anomalies 2018 5(1):13-19

Introduction: Compensatory Articulation Disorder (CAD) is frequently seen in individuals with Cleft of lip and Palate (CLP). Speech intervention with metacognitive strategies in these individuals requires a long period of time. Objective: To study the use of metacognitive strategies in therapeutic intervention of individuals with Cleft of Lip and Palate. Methodology: 14 Marathi speaking Children with CLP between 4 to 6 years of age were evaluated for language and articulation. 7 Speech Language Pathologists devised Percentage Correct Consonants on the Photo Articulation Test for Articulation pre and post intervention. Language measures were compared pre and post therapy on the Receptive Expressive Emergent Language Scale. Results: There was a significant difference between articulation and language measures pre and post intervention respectively which is attributed to the use of metacognition strategies. Conclusion: Severity of CAD and effectiveness of strategies used for correcting articulation errors are linked to one another. Assessment of CAD and therapy scaffolding metacognition strategies can be used in Speech treatment of individuals with CLP.

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Pellerin's craniofacial distractor: A boon in low-resource setting

Sunil Richardson, Phillipe Pellerin, Rakshit Khandeparker, Shreya Krishna

Journal of Cleft Lip Palate and Craniofacial Anomalies 2018 5(1):40-44

Aim: The aim is to show the use of a novel Pellerin's distractor in the correction of midfacial and mandibular deformities. Materials and Methods: A total of ten patients were included in the study. Among the ten patients, two presented with Apert syndrome, three with Crouzon syndrome (CS), three with hemifacial microsomia, one with temporomandibular joint ankylosis, and one presented with Pfeiffer syndrome. All cases were treated by the Pellerin's distractor. All patients were followed for a minimum of 1 year. Results: Two patients were lost to follow-up. All the remaining patients achieved satisfactory correction of their deformity. The average amount of advancement achieved was 37.5 mm (32–50 mm). No serious complications were seen in any patient. Pin tract scarring was the most common complication seen in six of the patients. Conclusion: The Pellerin distractor can be used in both the midface and the mandible for correction of the deformities. The device is constructed using easily available hardware that is also resusable. This makes it a cost effective alternative to the currently available distractor appliances, especially for a low-resource setting.

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Bilateral coronoid hyperplasia causing limited mouth opening: A report of two cases

Pooja Jain, Supriya Balchim Gabhale, Sonali Kadam, Prakhar Agrawal

Journal of Cleft Lip Palate and Craniofacial Anomalies 2018 5(1):48-51

Bilateral hyperplasia of the coronoid process of the mandible is an unusual entity which often presents with limited mouth opening. Thorough clinical and radiographic examination can help in the diagnosis and the treatment planning of this condition. This article consists of a case report of two patients. The patient in each case, presented with a reduced mouth opening, and when subjected to further investigations, was diagnosed with bilateral coronoid hyperplasia.

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Z-Plasty technique using a large C-flap to maximize symmetry of Cupid´s bow and minimize scar in unilateral cleft lip repair

Sanjay Naran, Renata Maricevich, Lorelei Grunwaldt

Journal of Cleft Lip Palate and Craniofacial Anomalies 2018 5(1):28-31

Purpose: Gaining symmetry of Cupid's bow can be challenging in cleft lip repair. We describe a technique that utilizes a modified rotation-advancement type repair to gain maximum length and to minimize scar. Methods: A retrospective chart review of unilateral cleft lip repairs performed by a single surgeon between 2010 and 2014, with at least 6 months of postoperative follow-up, Pre-, intra-, and post-operative photographs were reviewed. Patients included were those who had undergone unilateral cleft lip repair using a Z-plasty type rotation of the C-flap. Postoperative photographs were analyzed for overall symmetry of Cupid's bow and scar appearance using a 5-point visual analog scale (VAS) performed by five independent evaluators. Results: Twenty-three patients were analyzed. On VAS assessment by five independent observers, 22 out of 23 patients (96%) had good, very good, or excellent symmetry of Cupid's bow. All patients (100%) had good, very good, or excellent scar appearance. Twenty-two out of 23 patients (96%) had good, very good, or excellent overall appearance of the repaired lip. Conclusion: Z-Plasty with a very large C-flap as the method for the rotation flap in unilateral cleft lip repair is a useful technique for leveling Cupid's bow and for attaining scars that are nearly imperceptible. Further work will include longer-term follow-up, will look at the severity of the preoperative cleft, and will compare this to postoperative appearance of the lip (symmetry of Cupid's bow and scar).

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Incomplete cleft palate in a child with De Barsy syndrome

Devi Prasad Mohapatra, Sireesha Reddy Konda, Preethitha Babu

Journal of Cleft Lip Palate and Craniofacial Anomalies 2018 5(1):56-57

De Barsy syndrome, a rare genetic disorder, is characterized by progeroid features, cutis laxa, ocular abnormalities, growth retardation, and intellectual disability. We present a case of 1½- year-old male child with De Barsy syndrome associated with incomplete cleft palate.

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Manufacturers News

No abstract available

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Training Groups

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Editorial Board

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Intérêt de la mesure du débit inspiratoire de pointe dans l’indication de trachéotomie

Publication date: February 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 1
Author(s): M. Lesnik, J. Sanchez-Guerrero, O. De Crouy Chanel, C. Hervé, J. Guerlain, S. Périé
ObjectifsL'évaluation quantitative du degré d'obstruction des voies aériennes supérieures ne peut pas être réalisée lors d'une dyspnée aiguë, notamment en cas de cancer des voies aérodigestives supérieures. La décision de réaliser ou non un geste de contrôle des voies aériennes peut être difficile à prendre. Le débit inspiratoire de pointe (DIP) est un outil dont l'intérêt a été démontré en situation de décanulation après chirurgie pour cancer des VADS. L'objectif de ce travail a été de montrer son intérêt en tant qu'outil non invasif permettant de mesurer la sévérité des dyspnées inspiratoires nécessitant une trachéotomie en urgence.Matériels et méthodeÉtude pilote, prospective observationnelle et monocentrique. Nous avons analysé les mesures du DIP chez 22 patients présentant une dyspnée aiguë par obstruction des voies aériennes supérieures. La décision de réaliser ou non une trachéotomie était prise avant la réalisation des mesures du DIP. Les valeurs du DIP étaient mesurées par un dispositif portable (In-Check method), et la nasofibroscopie réalisée ensuite. La sévérité de l'obstruction était définie par les valeurs du DIP.RésultatsLa mesure du DIP a pu être réalisée avant la trachéotomie (imminente chez 21 patients, reportée chez un patient) chez tous les patients. Les valeurs de DIP inférieures à 53,1 L/min (i.e 18,3 % de la valeur théorique) semblent être corrélées à la nécessité de réaliser un geste en urgence. Cette valeur est cohérente avec la valeur seuil précédemment retrouvée et au-delà de laquelle la décanulation est possible (60L/min).Conclusionsle DIP est un paramètre quantitatif non invasif permettant d'évaluer la sévérité de l'obstruction des voies aériennes supérieures, utile dans la prise de décision de trachéotomie. Il est simple, rapide et reproductible.



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Contrôle des vertiges dans la maladie de Menière par injections trans-tympaniques de dexaméthasone

Publication date: February 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 1
Author(s): A. Weckel, M. Marx, M.-J. Esteve-Fraysse
ButL'objectif principal était d'évaluer l'efficacité des injections trans-tympaniques (ITT) de dexaméthasone sur le contrôle des vertiges, dans des maladies de Menière unilatérales, réfractaires aux traitements médicamenteux.Matériel et méthodesIl s'agit d'une étude rétrospective, portant sur 25 patients, présentant une maladie de Menière unilatérale, définie selon les critères de l'American Academy of Otorhinolaryngology-Head and Neck Surgery (AAO-HNS), invalidante. Les patients ont bénéficié d'ITT de dexaméthasone durant la période de suivi. Le contrôle des vertiges a été évalué selon l'index de contrôle des vertiges définis en classe selon l'AAO-HNS, à 6 mois, 1 an, et 2 ans après le début de cette thérapeutique. La survenue d'éventuelles complications, et l'évolution de l'audition ont également été évaluées.ObjectifsL'objectif principal était d'évaluer l'efficacité des ITT de dexamethasone dans le contrôle des vertiges dans la maladie de Menière.RésultatsÀ 6 mois un contrôle satisfaisant (classe A ou B) était obtenu chez 92 % des patients (n=23/25), à 1 an le contrôle était satisfaisant chez 68 % des patients (n=17/25), et à 2 ans chez 70 % des patients (n=16/23). Il n'y a pas eu d'aggravation de l'audition chez les patients bien contrôlés par cette thérapeutique. Aucune complication locale ni systémique n'a été observée durant le suivi.ConclusionLa dexaméthasone fait partie de la stratégie de prise en charge des patients présentant une maladie de Menière réfractaire aux traitements conventionnels, avant les traitements destructeurs, et permet un contrôle des vertiges dans 70 % des cas à 2 ans.



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Évaluation de l’impact médico-économique de la chirurgie ambulatoire en rhinologie

Publication date: February 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 1
Author(s): G. Mortuaire, D. Theis, R. Fackeure, D. Chevalier, I. Gengler
ObjectifsCaractériser l'impact médical et économique de la chirurgie rhinologique ambulatoire en termes d'efficacité clinique et de maîtrise des dépenses.Matériel et méthodesUne analyse rétrospective était menée de janvier 2014 à janvier 2016 incluant l'ensemble des patients traités en chirurgie ambulatoire pour une pathologie rhinologique. Les données cliniques étaient recueillies par croisement des dossiers informatiques médical et anesthésique. Les coûts relatifs aux charges logistiques et médicotechniques étaient calculés en s'appuyant sur la « Comptabilité analytique hospitalière 2014 ». Les recettes pour l'établissement étaient estimées sur les dernières versions tarifaires définies pour les groupes homogènes de séjours.RésultatsSur 2 ans, 927 interventions étaient effectuées en chirurgie ambulatoire. Le taux de conversion en hospitalisation conventionnelle était de 2,9 %. Les patients contactés à j1 considéraient la prise en charge comme très satisfaisante dans 85 % des cas. L'ensemble des séjours ambulatoires s'accompagnait d'une réduction statistiquement significative des charges par comparaison à une estimation financière d'un séjour d'une nuit en hospitalisation conventionnelle pour les mêmes patients. Les recettes n'étaient pas modifiées entre les deux modes de séjour.ConclusionCette étude confirme l'efficacité de la prise en charge ambulatoire. La réduction des charges constitue une économie potentielle pour l'assurance-maladie par les réajustements tarifaires calculés sur les coûts. L'estimation précise de l'impact médico-économique de la chirurgie ambulatoire nécessite une approche plus fine dite de « micro-costing » à l'échelle de l'établissement de santé et une évaluation des conséquences sur l'activité chirurgicale conventionnelle et la demande de soins en ville une fois le patient sorti.



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Rhinophyma : notre expérience à propos de 12 cas

Publication date: February 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 1
Author(s): P. Clarós, M.-C. Sarr, F.-B. Nyada, A. Clarós
IntroductionLe rhinophyma est une pathologie rare, bénigne et inesthétique de la peau du nez. Son existence a été signalée il y a fort longtemps, comme l'illustre le portrait du nez bosselé du vieillard tenant son petit-fils peint par Ghirlandaio en 1490, et sa description par Ferdinando Hebra Von (1816–1880), comme 3^e stade d'acné rosacé. L'objectif de cette étude est de rapporter l'expérience de l'auteur et de proposer une nouvelle option thérapeutique dans sa prise en charge.Matériel et méthodesNous décrivons notre expérience sur ce sujet. Nous avons mené une étude rétrospective sur étude des dossiers.RésultatsNous avons recensé 12 cas en 12 ans, largement dominés par le sexe masculin. Le procédé thérapeutique a été le même chez l'ensemble des patients, à savoir l'association dermabrasion, décortication et application de colle de fibrine. L'évolution a été favorable pour tous avec épidermisation complète.ConclusionLe rhinophyma est une affection rare dont la physiopathologie reste incertaine. La prise en charge est chirurgicale et de multiples techniques et procédés ayant été proposés, nous prônons le slogan « à chacun sa technique » en attendant l'adoption d'un consensus. Notre technique associant dermabrasion, décortication et application de colle de fibrine a donné de très bons résultats.



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Editorial Board

Publication date: February 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 1





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Atteintes otologiques du syndrome de Turner

Publication date: February 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 1
Author(s): E. Bois, M. Nassar, D. Zenaty, J. Léger, T. Van Den Abbeele, N. Teissier
IntroductionLes filles porteuses d'un syndrome de Turner (ST) présentent des malformations craniofaciales (hypoplasie et dysfonctionnement des trompes d'Eustache, dysfonctionnement vélo-palatin) qui favorisent la survenue d'otites moyennes aiguës (OMA). L'objectif de cette étude a été d'étudier les affections otologiques à l'âge pédiatrique du syndrome de Turner lors de la première consultation ORL dans notre centre.Patients et méthodesNous avons repris les données des consultations ORL de patientes en âge pédiatrique suivies pour syndrome de Turner dans notre institution entre 2005 et 2015 et relevé : l'otoscopie, le seuil auditif, les antécédents d'OMA et chirurgicaux ORL. Nous avons comparé ces données selon le caryotype des patientes [monosomie (45,X), mosaïque (45,X/46,XX), isochromosome (46,Xi(Xq)), chromosome X en anneau (XrX), contenant du matériel Y et « autres » caryotypes].RésultatsQuatre-vingt-dix patientes, avec un âge moyen de 11,9 ans (± 4,8 ans) lors de la première consultation ORL dans notre institution, ont été incluses : 29 % présentaient une anomalie tympanique à l'otoscopie, 21 % une hypoacousie, et 24 % des antécédents d'OMA à répétition. D'un point de vue chirurgical, 18 % ont été opérées d'une adénoïdectomie, 24 % ont eu une pose d'ATT, 5,6 % ont eu une tympanoplastie. Aucun caryotype ne présentait plus qu'un autre un risque de surdité ou d'OMA.ConclusionCes résultats montrent que les patientes porteuses d'un ST présentent une forte prévalence d'affections otologiques à l'âge pédiatrique et nécessitent un suivi ORL régulier et rapproché.



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Évaluation du retentissement de la surdité chez l’adulte : validation d’un questionnaire de qualité de vie

Publication date: February 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 1
Author(s): E. Ambert-Dahan, C. Laouénan, M. Lebredonchel, S. Borel, C. Carillo, D. Bouccara, O. Sterkers, E. Ferrary, I. Mosnier
ObjectifsL'évaluation de l'impact de la surdité et de sa réhabilitation (aides auditives, implant cochléaire) sur la qualité de vie est fondamentale. Les questionnaires couramment utilisés (Nijmegen, Aphab, GBI) sont longs, compliqués à remplir et peu sensibles aux faibles améliorations/détériorations. L'objectif de cette étude est de valider une échelle de qualité de vie destinée aux patients adultes présentant une perte auditive qu'elle soit réhabilitée ou non.Matériel et méthodesLe questionnaire d'évaluation du retentissement de la surdité chez l'adulte (Ersa) est un questionnaire auto-administré, divisé en quatre sous-domaines comprenant chacun cinq questions notées de 1 à 10. Les questions sont simples et formulées de façon à ce que le patient réponde à l'instant présent. La fiabilité test-retest d'Ersa a été mesurée chez 38 patients. La cohérence interne et la validité par rapport au questionnaire Aphab et aux performances auditives ont été mesurées chez 122 patients lors du bilan de surdité. La sensibilité au changement a été mesurée chez 36 patients avant et 6 à 12 mois après l'implantation cochléaire.RésultatsLa fiabilité du questionnaire Ersa (test/retest) est très satisfaisante (ρ=0,88). La cohérence interne est bonne pour l'ensemble des questions. La validité de structure externe, étudiée en comparant, chez les patients sourds non implantés, les scores Ersa à ceux du questionnaire Aphab, est bonne (ρ=0,52). Le score Ersa est corrélé aux performances auditives dans des situations d'écoute difficiles (mots monosyllabiques : ρ=0,22 ; phrases dans le bruit : ρ=0,19). Chez les patients testés avant et après implantation, l'amélioration des performances auditives dans le silence et dans le bruit est corrélée à l'amélioration du score Ersa (ρ=0,37 à 0,59 selon les tests), mais pas au score GBI.ConclusionLe questionnaire Ersa est un outil facile, rapide d'utilisation, fiable et sensible au changement des performances auditives après une implantation cochléaire.



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Symptômes de rhinite allergique à Parakou, Bénin : prévalence, sévérité et facteurs associés

Publication date: February 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 1
Author(s): M.-C. Flatin, S. Ade, S.-H.-R. Hounkpatin, B. Ametonou, U.-B. Vodouhe, W. Adjibabi
ButsLa rhinite allergique (RA) est une affection extrêmement fréquente. Le but de ce travail était de déterminer la prévalence des symptômes de RA, leur sévérité et les facteurs potentiellement associés à Parakou, une ville du Bénin.Matériel et méthodeIl s'agissait d'une étude transversale menée entre avril et juillet 2016, portant sur les habitants de la ville, âgés entre 6 et 65 ans. Un échantillonnage en grappes était réalisé. Les symptômes de RA étaient définis par la présence simultanée d'une rhinorrhée aqueuse, d'obstruction nasale et d'éternuements sans relation évidente avec une infection respiratoire. Les données étaient analysées dans EpiData Analysis v2.2.2.183 puis R.3.2.1.RésultatsAu total, 395 sujets ont fait partie de l'enquête, le sex-ratio était de 1,32, l'âge médian 19 ans. Parmi eux, 141 (35,7 %) avaient des symptômes de RA, dont 47 (33,3 %) une histoire familiale d'atopie, 87 (61,7 %) une conjonctivite allergique. Les principaux facteurs déclenchants étaient la poussière de maison (139 ; 98,5 %) et la pollution atmosphérique (111 ; 78,7 %). Après analyse multivariée, les facteurs associés étaient un âge inférieur à 18 ans (p<0,05), une exposition à la poussière de maison (p<0,001), une histoire personnelle d'urticaire (p<0,001) ou de conjonctivite allergique (p<0,01). Vingt-huit sujets (19,9 %) avaient des symptômes persistants, 43 (30,5 %), modérés à sévères. Ces derniers étaient associés à un âge supérieur à 18 ans (p<0,01), à une atopie familiale (p<0,01), à une histoire personnelle d'eczéma, de dermatite atopique (p<0,01), et à la présence dans la maison de chien/chat (p=0,01).ConclusionLa prévalence des symptômes de rhinite allergique est élevée. Ces symptômes sont sévères dans une proportion non négligeable. Elle justifie une attention particulière dans la ville.



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Les revues « prédatrices » à l’assaut de la presse médicale scientifique

Publication date: February 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 1
Author(s): O. Laccourreye, F. Rubin, H. Maisonneuve
Dans cet article les auteurs détaillent les révolutions (classement des revues – structuration des articles scientifiques et de leur relecture – impact des technologies de l'information et transformation du modèle économique de la presse médicale) qui, en un temps très court, ont transformé le monde de la rédaction médicale scientifique désormais assailli par les revues « prédatrices ».



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Dysfonctionnement nasal chronique

Publication date: February 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 1
Author(s): R. Jankowski, D.T. Nguyen, A. Russel, B. Toussaint, P. Gallet, C. Rumeau
Le dysfonctionnement nasal chronique (DNC) est un concept clinique de prise en charge diagnostique et thérapeutique de la pathologie rhino-sinusienne, qui s'appuie sur la théorie évo-dévo de formation du nez selon laquelle le nez n'est pas un organe unique mais l'association d'un nez olfactif, d'un nez respiratoire, et de sinus paranasaux. Dans la théorie du DNC le diagnostic étiologique tient compte de l'indépendance physiopathologique possible des symptômes, liée aux origines différentes et à la physiologie propre des trois organes qui composent le nez. Le raisonnement diagnostique dans le concept de DNC a pour objet de démembrer la pathologie en vue d'un traitement adapté à la pathologie du/des organe(s) malade(s) et aux possibilités de récupération physiologique des dysfonctionnements induits par la pathologie de l'un sur les autres organes composant le nez. L'ethmoïde n'étant pas un sinus, la chirurgie endoscopique endonasale fonctionnelle (Functional Endoscopic Endonasal Surgery ou FEES [fi:z]) ne peut se résumer dans le concept de chirurgie endoscopique fonctionnelle des sinus (Functional Endoscopic Sinus Surgery (FESS [fɛs]). La théorie évo-dévo du nez et le concept de DNC offrent une alternative à la conception de rhinosinusite chronique avec ou sans polypose dans la prise en charge des maladies naso-sinusiennes.



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Stimulation magnétique transcrânienne et acouphène subjectif. Revue 2014–2016

Publication date: February 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 1
Author(s): A. Londero, P. Bonfils, J.P. Lefaucheur
L'acouphène subjectif est un symptôme présent dans de nombreuses pathologies ORL pour lequel il n'existe pas de thérapie curative. Il peut être mal toléré par certains patients qui développent des troubles attentionnels ou du sommeil voire des réactions anxio-dépressives majeures entraînant une altération importante de la qualité de vie. Dans la genèse et l'entretien du symptôme acouphène, les modèles physiopathologiques actuels mettent en avant l'importance de phénomènes maladaptatifs de plasticité cérébrale provoqués par un déficit auditif périphérique. Bien qu'imparfaitement élucidées, ces altérations de l'activité neuronale sont la cible de tentatives de neuromodulation, en particulier grâce à la stimulation magnétique transcrânienne répétée (SMTr ou rTMS en acronyme anglais) qui a fait l'objet de différentes études cliniques et méta-analyses. Un consensus récent (Lefaucheur, 2014) a fait état d'un niveau de preuve de grade C (efficacité possible) pour l'utilisation de la SMTr en stimulation tonique basse fréquence (1Hz) ciblant le cortex temporal gauche. De nombreuses questions restent néanmoins en suspens concernant l'emploi de cette technique en pratique quotidienne. Cet article propose une revue de la littérature récente en utilisant les mots clés « tinnitus » et « rTMS » sur les bases de données PubMed et Cochrane entre avril 2014 et décembre 2016.



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Syndrome de Kindler compliqué d’un carcinome épidermoïde agressif du palais

Publication date: February 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 1
Author(s): H. Souldi, M.Y. Bajja, M. Mahtar
IntroductionLe syndrome de Kindler est une génodermatose autosomique récessive très rare. Il est caractérisé par une fragilité et une photosensibilité cutanées qui débutent pendant l'enfance, et par une poïkilodermie progressive.ObservationNous rapportons l'observation d'une jeune femme suivie depuis son enfance pour un syndrome de Kindler, caractérisé par des lésions importantes de la muqueuse oro-pharyngée. La patiente s'est présentée en raison d'une lésion ulcéro-bourgeonnante du palais. Le scanner et la biopsie réalisés ont conclu à un carcinome épidermoïde agressif et non réséquable du palais dur. Une chimiothérapie néoadjuvante a été proposée chez cette patiente, qui est décédée après la première cure de chimiothérapie avec un tableau de mucite digestive sévère compliquée d'un sepsis général.DiscussionDes formes d'atteinte des muqueuses dans le syndrome de Kindler ont été décrites dans la littérature. Cependant, la transformation en carcinome épidermoïde est très peu rapportée, même s'il s'agit d'une complication à long terme connue de ce syndrome. Nous décrivons le second cas de syndrome de Kindler compliqué d'un carcinome épidermoïde du palais.



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Liposarcome bien différencié pédiculé de l’hypopharynx

Publication date: February 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 1
Author(s): C. Eyermann, T. Raguin, P. Hemar, C. Debry
IntroductionLes liposarcomes de l'hypopharynx sont extrêmement rares. Seuls 28 cas sont décrits dans la littérature. Le premier signe clinique est une dysphagie d'aggravation progressive.Présentation du casNous rapportons le cas d'un homme de 71 ans ayant présenté une dysphagie avec une perte de poids importante en quelques semaines et un épisode d'extériorisation d'une masse charnue par la bouche lors d'un épisode de vomissement. L'imagerie retrouvait une masse endo-oesophagienne de structure graisseuse. La panendoscopie associée à une oesogastroscopie a permis de visualiser la tumeur, pédiculée au niveau du sinus piriforme gauche, et de l'extérioriser par la cavité orale. La tumeur a ensuite été réséquée par voie endoscopique, au niveau de son pédicule d'insertion hypopharyngé. L'examen anatomopathologique de la pièce opératoire concluait à un liposarcome bénin bien différencié.DiscussionLe liposarcome bien différencié est le plus fréquent des liposarcomes, mais exceptionnellement décrit au niveau hypopharyngé. Les principaux symptômes sont liés à la compression des structures adjacentes. L'imagerie est aspécifique. Seul l'examen histologique permet de le différencier d'autres tumeurs œsophagiennes bénignes. Le traitement de référence est l'exérèse complète et large, pas toujours réalisable au niveau cervical. Un suivi au long cours des patients est indispensable pour détecter précocement une récidive.



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Modification du lambeau libre fascio-cutané antébrachial radial pour réaliser une fermeture en deux plans lors de la reconstruction de pertes de substance circonférentielles de l’hypopharynx

Publication date: February 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 1
Author(s): M. Abu-Serriah, S. Loughran
Les pertes de substance circonférentielles de l'hypopharynx sont des défis de reconstruction. Différents lambeaux locaux, régionaux et libres ont été décrits avec pour chacun des avantages et des inconvénients en termes de résultats fonctionnels. Le lambeau libre fascio-cutané antébrachial radial (LLFAR) est l'un des lambeaux libres les plus fréquemment utilisés pour reconstruire les pertes de substance circonférentielles de l'hypopharynx. La palette cutanée est souple et ressemble à la paroi hypopharyngée d'origine. Il est facile à prélever, possède une anatomie vasculaire prévisible et un long pédicule. Contrairement au lambeau antérolatéral de la cuisse (LALC), le LLFAR est associé à des taux plus élevés de fistule pharyngo-cutanée. On a pensé que cela était dû à la difficulté de réaliser une fermeture en deux plans. Cependant, dans un cou post-traitement ou chez un patient corpulent, l'utilisation du LALC ou d'autres lambeaux libres peut ne pas être possible, faisant du LLFAR la seule option viable. Afin de réduire le risque de fistule et de déhiscence de la plaie, nous décrivons une nouvelle méthode de LLFAR avec une fermeture en deux plans. Nous croyons que notre méthode offre au chirurgien reconstructeur une alternative dont il serait intéressant de tenir compte dans les cas difficiles de pertes de substance circonférentielles de l' hypopharynx.



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Oropharyngectomie par voie cervico-transorale assistée par robot et lambeau libre antérolatéral de cuisse fin

Publication date: February 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 1
Author(s): P. Gorphe, S. Temam, F. Kolb, Q. Qassemyar
La technique classique de l'oropharyngectomie latérale par voie assistée par robot a été décrite pour l'exérèse simple des lésions T1 et T2 de loge amygdalienne avec une perte de substance le plus souvent laissée en cicatrisation dirigée. Nous proposons une technique modifiée adaptée à la chirurgie de rattrapage et à la chirurgie en terrain irradié, issue de l'expérience des voies d'abord ouvertes. Elle consiste en une résection en monobloc de l'ensemble de l'espace parapharyngé pré- et rétro-stylien avec la pièce opératoire d'oropharyngectomie latérale par une voie d'abord combinée cervicale et transorale assistée par robot. La reconstruction est réalisée par un lambeau libre antérolatéral de cuisse fin disséqué dans le plan du fascia superficialis.



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Une masse linguale

Publication date: February 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 1
Author(s): A. Nurdoğan




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Une colonisation du cornet moyen

Publication date: February 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 1
Author(s): C. Djian, A.-L. Gaultier, S. Chartier, O. Laccourreye




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Abcès avec ostéomyélite du clivus après adénoïdectomie : Une complication exceptionnelle d’un geste fréquent

Publication date: February 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 1
Author(s): E. Moreddu, C. Le Treut, J.-M. Triglia, R. Nicollas




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Rhinorrhée unilatérale : une étiologie atypique

Publication date: February 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 1
Author(s): C. Aussedat, C. Dorbeau, D. Bakhos




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Comparison between early and delayed facial nerve decompression in traumatic facial nerve paralysis - A retrospective study

ABSTRACT Purpose To study the intraoperative findings in case of early and delayed decompression of facial nerve paralysis and compare their results. Methods Retrospective data analysis of 23 cases of longitudinal temporal bone fracture with House-Brackmann grade V and VI facial nerve paralysis. All cases were thoroughly evaluated and underwent facial nerve decompression through the transmastoid approach. All cases were under regular follow-up till the date of manuscript submission. Results Clinical improvement of the facial nerve function was observed for early vs. delayed facial nerve decompression. In the early decompression group, facial nerve function improved to grade II in eight cases (80%) and grade III in two cases (20%), whereas in the delayed decompression group it improved to grade II in one case (7.70%), grade III in four cases (30.76%), grade IV in seven cases (53.84%), and grade V in one case (7.70%). Conclusions Early decompression of facial nerve provides better results than delayed decompression because it enables early expansion of the nerve.

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Prosodic parameters of reading in 2nd to 5th grade students

RESUMO Objetivo Caracterizar a variação melódica e a velocidade de leitura, comparando-as e verificando se há evolução de acordo com o avanço da escolaridade. Método Foi analisada a leitura de 78 escolares do 2° ao 5° ano do Ensino Fundamental I, por meio do Praat, por meio da análise dos parâmetros de variação melódica (F0) e velocidade de leitura (Duração) e foram realizadas medidas estatísticas (média e desvio padrão) e o teste de student (com nível de significância de 5%). Resultados Foi possível observar que a variação melódica e a velocidade de leitura tendem a aumentar com o desenvolvimento da escolaridade, especialmente para o quinto ano. Conclusão A variação melódica aumenta de acordo com o avanço da escolaridade, assim como a velocidade de leitura, sendo maiores os resultados para o quinto ano. Verificou-se que a análise de leitura do primeiro minuto seria necessária para a análise da velocidade de leitura de textos, não sendo necessária a análise do texto completo.

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ABSTRACT Purpose Characterize and compare melodic variation and reading speed and verify their evolution throughout the development of schooling. Methods The reading of 78 Elementary School (2nd to 5th grade) students was analyzed using the Praat program with regards to the parameters of melodic variation (F0) and reading speed (Duration). Statistical measures (mean and standard deviation) were taken and the Student´s t-test was applied at significance level of 5%. Results Melodic variation and reading speed increased as schooling progressed, especially during 5th grade. Conclusion Melodic variation increases as schooling progresses, mainly during 5th grade. First minute of reading analysis is sufficient to assess reading speed, not being necessary to analyze the full text.

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Branchial-Cleft Sinus Manifesting as Recurrent Neck Abscess

A 24-year-old man presented to the otolaryngology clinic with a 2-day history of swelling on the left side of his neck and fever. He had twice had a similar neck abscess, 2 years and 6 years previously, that had been treated with antibiotic agents and incisional drainage. Clinical examination…

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Low Subfrontal Dural Opening for Anterior Clinoid Meningioma

J Neurol Surg B
DOI: 10.1055/s-0038-1624586

Introduction A variety of dural openings are described for frontal–temporal and cranio-orbital craniotomies. As with any surgical technique, the goal is to optimally and safely address the pathology, minimize normal anatomy disruption, and optimize postoperative recovery. This study reports a modified dural opening for frontal–temporal approaches which minimizes brain exposure while facilitating visualization for neoplastic and vascular lesions of the anterior clinoid, supra- and parasellar and adjacent regions. Methods A sample case is presented for which a low subfrontal dural exposure was utilized for tumor resection. The clinical presentation, surgical procedure, and outcome are summarized including a video detailing the surgical technique. Results A 63-year-old female with gradual left eye vision loss and tumor enlargement on serial imaging. The small dural-based tumor arose from the left anterior clinoid and optic canal region compressing the optic nerve. The video shows a left frontal–temporal craniotomy used to perform extradural anterior clinoidectomy and optic canal decompression. The novel low subfrontal dural opening without fixed brain retraction allowed dural opening around the optic canal and clinoidectomy region to resect tumor and complete optic nerve decompression. Postoperatively, the patient did well with significant recovery of vision and follow-up at 2.5 years shows no evidence of tumor recurrence. Conclusion The novel low subfrontal dural opening provides access to lesions of the supra-and para-sellar and adjacent regions, and preservation of much of the dura avoids some of the risks of intradural dissection including Sylvian fissure dissection and brain retractionThe link to the video can be found at: https://youtu.be/Jc7wvR4PTFk.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  open access Full text

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Transcallosal, Transchoroidal Resection of a Recurrent Craniopharyngioma

J Neurol Surg B
DOI: 10.1055/s-0038-1624585

Objective To demonstrate the transchoroidal approach for the resection of a recurrent craniopharyngioma. Design Video case report. Setting Microsurgical resection. Participant The patient was a 27-year-old woman with a history of a craniopharyngioma, resected twice during the year prior to presentation to our unit. Both operations were done via the left anterolateral corridor, and afterward, she was blind in the left eye and was treated with Desmopressin (DDAVP) for diabetes insipidus (DI). Serial magnetic resonance imaging (MRI) showed progression of the tumor residual, and she was referred for further surgical intervention. Main Outcome Measures Pre- and postoperative MRIs measured the degree of resection. Results For this, her third surgery, a transcallosal, transchoroidal approach, was chosen to offer the widest possible exposure. Given her history, an aggressive total resection was the best strategy. The patient was placed supine with the head neutral. A right frontal craniotomy allowed access to the interhemispheric fissure. By opening the corpus callosum, the left lateral ventricle was entered. The transchoroidal approach started with dissection of the tenia fornicis to open the choroidal fissure. After this, sufficient exposure to the posterior parts of the tumor was gained. Resection proceeded to the bottom of the tumor, exposing the basilar apex and interpeduncular cistern, and continued back anteriorly. In the end, a microscopic total resection was achieved. With a long hospital stay to treat her brittle DI, the patient slowly returned to neurological baseline. Conclusion The transchoroidal approach is an effective way to remove large tumors in the third ventricle.The link to the video can be found at: https://youtu.be/2-Aqjaay8dg.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  open access Full text

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Complications of Extended Endoscopic Endonasal Surgery in Elderly Patients

J Neurol Surg B
DOI: 10.1055/s-0038-1625948

Extended endoscopic endonasal procedures are not unique among surgical interventions in carrying increased risk in the elderly population. There are, however, components of the procedure, namely high-flow cerebrospinal fluid leaks, that do result in the potential for increased perioperative morbidity for these patients. We present the case of a 77-year-old male with a large invasive pituitary macroadenoma resected through a transplanum-transtuberculum-transsellar endonasal approach. A gross total resection was obtained with resolution of the patient's preoperative ophthalmologic deficits. One month postoperatively, the patient developed progressive lethargy and cranial imaging demonstrated a left convexity subacute subdural hematoma. This was evacuated through a twist drill craniostomy. Despite measures to limit the operative time of the initial endonasal procedure as well as the absence of a postoperative cerebrospinal fluid fistula, the patient still developed this complication. Along with more typical potential causes of postoperative decline following extended endonasal procedures, problems from high-flow intraoperative cerebrospinal fluid leaks alone can result in morbidity in the elderly population. This should be acknowledged preoperatively and a high suspicion should exist for the presence of intracranial hemorrhage in these patients with any postoperative deficits. Additional intraoperative measures can be utilized to minimize such risks.The link to the video can be found at: https://youtu.be/EkLmt2T8_UE.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  open access Full text

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Endoscopic Transsphenoidal Salvage Surgery for Symptomatic Residual Cystic Craniopharyngioma after Radiotherapy

J Neurol Surg B
DOI: 10.1055/s-0038-1636504

Objectives Ideal treatment of craniopharyngiomas is still controversial. Radiotherapy (RT) is considered effective for recurrences or after subtotal tumor removal (STR). About 40 to 50% of patients may experience tumor cyst expansion soon after RT; in these cases, the role of salvage surgery is debated. Design Operative video. Setting Tertiary care center. Participants An 11-year-old boy diagnosed with persistent craniopharyngioma. In 2015, the patient underwent right frontotemporal craniotomy for STR at another center, complicated by panhypopituitarism. Two years later, fractionated 54-Gy RT was performed on growing residual tumor. After 3 months, he was admitted to our hospital due to persistent malaise, vomiting, pulsating headache, and epistaxis. Ophthalmologic evaluation evidenced left homonymous hemianopsia. Results A contrast-enhanced magnetic resonance imaging (MRI) showed a 27-mm cystic component enlarging from the cranial end of the persistent craniopharyngioma lesion, extending into the third ventricle. Biventricular hydrocephalus and brain midline shift to the right were present. Compared with the early post-RT MRI, the cystic component of the tumor demonstrated growth. The patient underwent external ventricular drainage placement for emergent treatment of hydrocephalus and endoscopic transsphenoidal surgery. After cystic content drainage, the lesion was completely removed with its capsule. A "gasket seal" technique was performed for skull base reconstruction, with autologous fascia lata, septal bone, and mucoperiosteum from inferior turbinate. Histologic examination confirmed the craniopharyngioma diagnosis. Postoperative MRI showed resolution of the hydrocephalus and complete tumor removal. Conclusion Although shrinkage of cystic components of craniopharyngioma residuals may occur within 5 to 6 months after RT, salvage surgery is indicated in symptomatic patients.The link to the video can be found at https://youtu.be/4x6Qe76bf60.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  open access Full text

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Die endonasale endoskopische Resektion von Choanalatresien – wie groß ist der Langzeiterfolg?

Laryngo-Rhino-Otol
DOI: 10.1055/s-0044-101464

Einleitung Die Choanalatresie gehört zur Gruppe der seltenen Fehlbildungen. Sie stellt bei beidseitigem Auftreten einen akut lebensbedrohlichen Notfall dar, da Neugeborene obligate Nasenatmer sind. Die endoskopische Resektion ist eine etablierte Therapie, die Operationstechnik ist bisher jedoch nicht standardisiert. Methodik Die endonasal endoskopische Resektion von kongenitalen Choanalatresien bei 11 Kindern wurde retrospektiv in einem Nachbeobachtungszeitraum von 9 bis 87 Monaten analysiert. Vier Kinder wiesen eine bilaterale, sieben eine unilaterale Atresie auf. Neben der endoskopischen Resektion der Choanalatresie erfolgten die Erweiterung der Choane durch endoskopisches Abtragen des Knochens Richtung Schädelbasis und das Abtragen der hinteren Septumkante. Das intraoperative Handling, intra- und postoperative Komplikationen und die Rezidivrate im Verlauf wurden ermittelt. Eltern bzw. Patienten wurden zur subjektiven Einschätzung der Nasenatmung befragt. Ergebnisse Intraoperative Komplikationen wurden keine beobachtet. Drei Frühgeborene wurden innerhalb der ersten Lebenswoche bei einem durchschnittlichen Geburtsgewicht von 2540 g operiert. Postoperativ kam es zweimal zu Schmierblutungen. Die langfristige Rezidivfreiheit lag bei 73 % (unilateral) bzw. 100 % (bilateral). Schlussfolgerungen Die endonasale endoskopische Resektion von Choanalatresien mit Erweiterung der Choane Richtung Schädelbasis, Reduktion des Nasenbodens und Abtragen der hinteren Septumanteile stellt eine schonende und erfolgreiche Therapieoption dar.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Association of Low Urine pH with Insulin Resistance in Non-Diabetic Japanese Subjects

Exp Clin Endocrinol Diabetes
DOI: 10.1055/s-0043-122943

Background Epidemiology studies have revealed that patients with obesity, hyperglycemia, or hypertension are associated with a decreased urine pH. These metabolic disorders are related to insulin resistance; however, the association between urine pH and insulin resistance remains unclear. Methods To evaluate this association while controlling for covariates, the present study was conducted in 1084 non-diabetic Japanese subjects undergoing health examination. Fasting urine pH was analyzed using an automated urine dipstick analyzer. The subjects were divided into five groups according to urine pH: those with pH <5.5, 5.5, 6.0, 6.5, and >6.5. Insulin resistance was determined using the homeostatic model assessment of insulin resistance (HOMA-IR) and divided into three categories: lower, middle, and higher tertiles of HOMA-IR. Analysis of covariance and multivariate logistic regression analysis were used to control confounding factors including serum uric acid. Results Analysis of covariance showed an increase in the mean HOMA-IR from 1.26, 1.46, 1.69, and 1.75 to 1.89 with a decrease in urine pH (p<0.001). Subjects with urine pH ≤5.5 had a significantly higher HOMA-IR than those with urine pH>6.5. Furthermore, multivariate logistic regression analysis showed that urine pH had an inverse and independent association with HOMA-IR. In subjects with urine pH 5.5 and <5.5, adjusted odds ratio (95% confidence interval) for the incidence of higher tertile of HOMA-IR was 1.34 (1.04–1.73) and 1.52 (1.09–2.13), respectively (reference, subjects with a urine pH>6.5). Conclusion Insulin resistance is independently associated with a lower urine pH, possibly via lower formation of ammonium in the kidneys.
[...]

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The Main Determinants of Serum Resistin Level in Type 2 Diabetic Patients are Renal Function and Inflammation not Presence of Microvascular Complication, Obesity and Insulin Resistance

Exp Clin Endocrinol Diabetes
DOI: 10.1055/s-0043-121262

Aim The association of increased resistin levels in chronic kidney disease with diabetic nephropathy has not yet been clarified. Our aim was to analyze the relationship between serum resistin levels and various diabetic microvascular complications in patients. Methods A total of 83 patients were enrolled in this cross-sectional study. The subjects were divided into 3 groups: 27 patients with type 2 diabetes mellitus (T2DM) having no diabetic retinopathy (DRP) or microalbuminuria and having normal renal function were included in Group-1, 28 patients with T2DM having DRP and normal renal function in Group-2, and 28 patients with T2DM with DRP and microalbuminuria and an estimated glomerular filtration rate (eGFR) of<60 ml/min/1.73 m2 in Group-3. Serum resistin levels were analyzed by enzyme-linked immunosorbent assay. Results The mean age of the patients [46 female (55.4%)] was 54.8±9.1 years. The resistin level in Group-3 was significantly higher than in Group-1 and Group-2 (p<0.001).However the resistin level was not different between Group-1 (without microvascular complications) and Group-2 (with microvascular complications). The resistin level was found to be correlated negatively with eGFR (r=−0.459; p<0.001) and albumin (r=−0.402; p<0.001), and positively with high-sensitivity C-reactive protein (hs-CRP) (r=0.366; p=0.001). In multivariate analysis, it was observed that eGFR and hs-CRP were independent determinants of plasma resistin level. Conclusion The main determinants of resistin level in patients with T2DM are the level of renal function and inflammation rather than presence of microvascular complications, obesity and insulin resistance.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Insulin-Leptin Axis, Cardiometabolic Risk and Oxidative Stress in Elderly with Metabolic Syndrome

Exp Clin Endocrinol Diabetes
DOI: 10.1055/s-0043-123825

Insulin and leptin have an overlapping anorexigenic action as well as opposite effects on glucose and lipid metabolism. The study focuses on the biochemical and clinical relevance of new indices of insulin-leptin axis utilized in the study of the relationships between leptinemia, insulin sensitivity and oxidative stress, in elderly subjects with metabolic syndrome. We conducted clinical studies on elderly people with metabolic syndrome versus control subjects by creating new insulin-adipogenic indices, namely Insulin-to-Leptin Ratio (ILR) and Insulin-Adipogenic Resistance index (IAR-index). Inflammation and oxidative stress biomarkers evaluated were the high-sensitivity C-reactive protein (hsCRP), the advanced oxidation protein products (AOPP), and the serum antioxidant capacity measured as ferric reducing antioxidant potential (FRAP). The metabolic syndrome group showed significantly (p<0.01) lower levels of ILR and not significant (p=0.09) higher values of IAR-index, as compared to the control group. In metabolic syndrome subjects, the IAR-index was significantly positively correlated with uric acid (r=0.313, p<0.05), FRAP (r=0.347, p<0.05) and AOPP (r=0.677, p<0.01), and negatively correlated with HDL-cholesterol (r=− 0.340, p<0.05) as well as with the ratio FRAP/uric acid (r=− 0.315, p<0.05). ILR and IAR-index reflected the biological state of adipose and pancreatic β-cells and seem to depict the adipo-insular axis status related to metabolic and oxidative stress better than individual markers. Therefore, ILR and IAR-index could represent integrated high-potential biomarkers for disease and patient stratification.
[...]

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Combining Various Methods to Assess Insulin Sensitivity in Nonobese Rat after Sleeve Gastrectomy

Exp Clin Endocrinol Diabetes
DOI: 10.1055/s-0043-125315

Background Sleeve gastrectomy (SG) procedure has been proved to improve insulin sensitivity and sustain anti-diabetic effects. Our aim is to co-use several methods to measure insulin sensitivity and investigate the effect of SG on hepatic and peripheral insulin sensitivity at early and long-term stages of postoperation. Methods Thirty 11-week-old male Goto-Kakizaki rats were divided into SG, sham-operated SG (SOSG), and control groups. They were observed before operation and for 36 weeks of postoperation. Insulin tolerance test (ITT) and homeostasis model of assessment for insulin resistance index(HOMA-IR)were used to measure insulin resistance before operations and at 2 and 36 weeks of postoperation; Pyruvate challenge test (PCT) was administrated to assess the gluconeogenesis capability in order to reflect hepatic insulin sensitivity before operation and at 2 and 36 weeks of postoperation; Hyperinsulinemic euglycemic clamps (HIEC) was conducted before operation and at 2 and 36 weeks of postoperation to calculate the endogenous hepatic glucose production (HGP) at the basal and steady-state for evaluation of hepatic insulin sensitivity, and calculate the exogenous glucose infusion rate (GIR) at the steady-state for evaluation of peripheral insulin sensitivity. Results The data showed that compared with rats in the sham and control groups, rats in SG group had 1) significantly lower AUCITT, HOMA-IR and AUC PCT values at 2 and 36 weeks of postoperation, 2) lower basal state HGP, but not steady-state GIR at 2 weeks of postoperation, and 3) significantly different basal and steady-state HGP and steady-state GIR at 36 weeks of postoperation. In addition, the basal and steady-state HGP and the steady-state GIR were significantly different between rats in SG group at 2 and 36 weeks of postoperation. Conclusions This study explored insulin sensitivity of rats after SG by jointly using a variety of techniques. The results showed that SG time-dependently improved the hepatic and peripheral insulin sensitivity.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Serum CTRP3 Level is Associated with Osteoporosis in Postmenopausal Women

Exp Clin Endocrinol Diabetes
DOI: 10.1055/s-0043-124365

Background As a novel adipokine, CTRP3 involves in various functions of energy metabolism. Recent advance reveals a complex interaction between bone and adipose tissue via the secretion of adipokines. Aims A hospital-based case-control study was conducted to investigate the role of serum CTRP3 in osteoporosis among postmenopausal women. Methods Serum levels of CTRP3 and osteocalcin were measured. Bone mineral density (BMD) was obtained on femoral neck and lumbar spines by dual energy X-ray absorptiometry. Results Serum CTRP3 level was lower in subjects with osteoporosis (76.7±22.1 ng/ml) than it in controls (89.4±22.5 ng/ml) (P<0.001). Meanwhile, the frequency of osteoporosis presented a significant decrease (66.4%, 53.9% and 35.9%, P<0.001), in the tertiles of serum CTRP3. Furthermore, serum CTRP3 witnessed an association with a lower risk of osteoporosis (adjusted odds ratio=0.973, 95% confidence interval [0.963–0.983], P<0.001). Lastly, serum CTRP3 level was positively correlated with femoral BMD (r=0.403, P<0.001), lumbar BMD (r=0.368, P<0.001), and HDL-C (r=0.118, P=0.022), among all participants after adjustment. Meanwhile, CTRP3 presented negative correlations with HOMA-IR (r=−0.136, P=0.008) and insulin (r=−0.192, P <0.001). Conclusions It shows that a decreased serum level of CTRP3 was independently associated with osteoporosis.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Impact of Depression and Psychosocial Treatment on Heart Rate Variability in Patients with Type 2 Diabetes Mellitus: An Exploratory Analysis Based on the HEIDIS Trial

Exp Clin Endocrinol Diabetes
DOI: 10.1055/s-0043-125445

Objectives To explore the impact of depression on heart rate (HR) and heart rate variability (HRV) as a marker of autonomic nervous system (ANS) impairment in depressed and non-depressed patients with advanced type 2 diabetes mellitus (T2DM) and to explore possible effects of an acceptance- and mindfulness-based group intervention (MBSR) on HR and HRV. Methods Alongside a prospective clinical trial, we collected demographic, psychosocial and clinical data from 113 chronic T2DM patients in a standardized setting. At baseline and after one year, depressive mood was assessed with the Patient Health Questionnaire (PHQ-9), and autonomic function was determined by measuring HR and HRV markers. A subsample was randomly assigned to take part in eight MBSR sessions. Results Of the 113 T2DM patients (77.9% men; mean age=58.8±7.0 years; diabetes duration 11.5±7.0 years), 33 showed clinically relevant depressive symptoms at baseline. In cross-sectional analysis, we found no association between depression and HR/HRV (all comparisons p>0.05). In prospective regression analysis depression did not predict follow-up scores of HRV. The patients who participated in the MBSR intervention showed a tendency toward improved parasympathetic control (RMSSD, CV, E-I-Ratio) with small-to-moderate effect sizes (d≤0.38). Conclusions Depression was not directly associated with cardiac autonomic control in this sample, but MBSR training may have positively influenced HR and HRV. In advanced diabetes, somatic and behavioral parameters seem to be more predictive than depression for the course of autonomic functioning, but the pathways remain unclear.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Effects of the Reactive Metabolite Methylglyoxal on Cellular Signalling, Insulin Action and Metabolism – What We Know in Mammals and What We Can Learn From Yeast

Exp Clin Endocrinol Diabetes
DOI: 10.1055/s-0043-122382

Levels of reactive metabolites such as reactive carbonyl and oxygen species are increased in patients with diabetes mellitus. The most important reactive dicarbonyl species, methylglyoxal (MG), formed as by-product during glucose metabolism, is more and more recognized as a trigger for the development and progression of diabetic complications. Although it is clear that MG provokes toxic effects, it is currently not well understood what cellular changes MG induces on a molecular level that may lead to pathophysiological conditions found in long-term diabetic complications. Here we review the current knowledge about the molecular effects that MG can induce in a cell. Within the mammalian system, we will focus mostly on the metabolic effects MG exerts when applied systemically to rodents or when applied in vitro to pancreatic β-cells and adipocytes. Due to the common limitations associated with complex model organisms, we then summarize how yeast as a very simple model organism can help to gain valuable comprehensive information on general defence pathways cells exert in response to MG stress. Pioneering studies in additional rather simple eukaryotic model organisms suggest that many cellular reactions in response to MG are highly conserved throughout evolution.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Positive Interictal Epileptiform Discharges in Adults: a Case Series of a Rare Phenomenon

The polarity of interictal epileptiform discharges (IEDs) recorded from scalp EEG is predominantly negative relative to a suitable reference electrode and is generally interpreted as indicative of dipoles oriented perpendicularly to the cortical surface with their negative poles near the surface (Gloor, 1985). The deeper positive poles usually fail to produce a detectable surface potential but can be recorded with invasive electrodes. In some instances, horizontal dipoles such as benign epileptiform discharges of childhood can be recorded from the scalp surface showing both, the positive and the negative potential particularly with generators in the central or Sylvian fissure (Lüders et al., 1987).

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Disruption of cortical synaptic homeostasis in individuals with chronic low back pain

Chronic low back pain (cLBP) is a prevalent and disabling musculoskeletal condition with few effective treatments (Balague et al., 2012). Although precise mechanisms remain unclear, structural and functional reorganization of the sensorimotor cortex has been identified in cLBP, and is associated with pain severity, pain duration and movement dysfunction (Kregel et al., 2015; Masse-Alarie et al., 2016). Cortical reorganisation in cLBP is hypothesised to be a marker of maladaptive synaptic plasticity, and this concept provides the foundation for contemporary theories of pain persistence (Moseley and Flor, 2012).

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Ultrasound-guided Percutaneous Needle Tenotomy for Chronic Proximal Tensor Fascia Lata Tendinopathy: A Report of 2 Cases

Proximal tensor fascia lata (TFL) tendinopathy at its origin on the anterior superior iliac crest is one potential cause of lateral hip pain. However, there is limited literature regarding the mechanism, disease course or management of this condition. There is growing evidence supporting the effective treatment of percutaneous needle tenotomy (PNT) for chronic tendinopathy. Only a single case series has examined the efficacy of PNT for tendinopathy about the hip and pelvis. Presented here are examples of two cases of chronic recalcitrant proximal ultrasound confirmed TFL tendinopathy effectively treated with ultrasound-guided PNT.

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Imaging of Spondylolysis: The Evolving Role of Magnetic Resonance Imaging

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Teachers and Diplomates: “Who Practice What They Teach”

Rani Ben-David, president and founder of Sleep Group Solutions (SGS), Hollywood, Fla, wants SGS seminar attendees to learn from the best, particularly from those who actually practice dental sleep medicine. "Most of the SGS speakers/teachers are diplomates of the American Sleep and Breathing Academy [ASBA]," says Ben-David.

"They are not merely dentists who read studies then come and teach. They practice what they teach."

Offering about 90 dental seminars per year in the United States and Canada, the 13-year-old SGS recently decided to use mostly ASBA diplomates to teach its courses in 2018. The decision comes from a need to tap into the diplomates' expertise, as well as an appreciation for the overall tone set by the ASBA.

"The ASBA is a down to earth academy," says Ben-David. "The board members and everyone involved are so connected. The diplomates are genuinely helpful. Last year when I went to the ASBA conference, the lectures were top of the line and the subjects were great. All the diplomates, board members, and executives were welcoming to the new doctors and new people. It feels like they want to help the other members succeed, and that's how an association/academy should conduct its business. There is no feeling of being an 'outsider' with the ASBA."

Ben-David hopes more members will ultimately join the ASBA as a natural byproduct of the seminars based largely on that welcoming atmosphere. "When someone comes to a new association, they can feel like outsiders," explains Ben-David. "However, at the ASBA, new doctors are welcomed by board members, welcomed by the CEO [David Gergen], the president [Kent Smith, DDS], and Alan Hickey, the executive director who helps run the association."

ASBA diplomates are as experienced on the business side as they are on the clinical side, an aspect of the educational process that should never be neglected.

Ben-David puts it this way: "These docs are highly successful, and they are there to save patients' lives. It's important that new docs who come to SGS seminars see that lecturers are diplomates in a reputable academy like ASBA. Fortunately, the future is bright. I have sleep docs and ENTs asking me, 'Where can we find dentists who treats sleep apnea?' It's not going to stop. Dental sleep medicine is only going to grow."

SOURCE/RELATED LINKS

About Sleep Group Solutions
For more information about the Dental Sleep Medicine CE seminars hosted by Sleep Group Solutions,
visit sleepgroupsolutions.com

 

Learn More about becoming a Diplomate Click Here

 

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Xenon Protects against Blast-Induced Traumatic Brain Injury in an In Vitro Model

Journal of Neurotrauma , Vol. 0, No. 0.


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Essentials of Head Trauma Imaging

Head trauma is a common indication for neuroimaging in the emergency room. CT is the modality of first choice, as it is quick, safe, and effective in evaluating for life threatening intracranial hemorrhage and mass effect. CT is also best for evaluating for skull fractures which may alter management and lead to further imaging studies. MRI is reserved for selected patients, particularly when the clinical exam does not match the CT imaging findings, such as is diffuse axonal injury. Emergency room physicians and radiologists, particularly those in-training, would benefit from a consistent approach and search pattern for evaluating head trauma.

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Study of surgical treatment for elderly patients with head and neck cancer

The aim of this study was to evaluate the clinical results of surgery for head and neck cancer (HNC) in elderly patients and to determine whether surgery for elderly HNC patients is safe and what types of surgery result in the most favourable outcomes for this age group. The cases of 637 elderly patients who were diagnosed with HNC and underwent surgical treatment were studied retrospectively. Patient demographic characteristics and treatment data were extracted from the appropriate patient records and analysed.

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FDA Approves New Treatment for Certain Neuroendocrine Tumors

People with cancerous neuroendocrine tumors (NETs) that affect the digestive tract now have a new treatment option. On January 29, FDA approved the targeted treatment lutetium Lu 177 dotatate (Lutathera®) for adult patients with advanced NETs that affect the pancreas or gastrointestinal tract.

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Sequential injection of radioactive nanosized colloids followed by indocyanine green for sentinel lymph node detection in oral squamous cell carcinoma: A proof of concept

Radioactive colloids are routinely employed in sentinel lymph node (SLN) detection procedures [1–5]. Indocyanine green (ICG) with near-infrared (NIR) fluorescence imaging has also been successfully used in SLN procedures [6–8]. However, minimal skin incisions were not achievable. Hybrid dyes, combining ICG and radioactive colloids, have also been used in SLN procedures [9,10]. However, the use of a hybrid dye will require market authorization and investment to elaborate the tracer. In head and neck cancers, SLN mapping using sequential injection of a radioactive colloid followed by ICG has not been described yet.

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New research directions for areca nut/betel quid and oral submucous fibrosis for holistic prevention and treatment

Areca nut and betel nut use is now a rampant global problem particularly seen in the South Asian countries, with implications for systemic health, oral health and psychological health [1]. The most threatening and direct effect being oral sub-mucous fibrosis (OSMF) and oral cancer [2]. Literature is flooded with policies and guidelines on various aspects of this important global issue. However, we believe the current strategies are weak at the grass root level as they do not address the underlying psychosocial disturbance and poor systemic health status, and correction can generate more effective policies towards holistic prevention and treatment.

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Bowman Birk Inhibitors (BBI) in interception of inflammation and malignant transformation of OPMDs

The most implausible aspect of cancer therapy is to develop drugs to seize the progression of initial stages of carcinogenesis, preferably termed as known as chemopreventive agents [1]. Though studies support oral premalignancy to be an ideal study model for chemopreventive agents [2], curbing oral cancer by concentrating on dietary chemoprevention agents are yet to be developed with time [3]. The example study being of 13-cis-retinoic acid, which was ratified successful till cessation of therapy reverted the premalignancy, making it a gross disappointment [2].

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Chitotriosidase inhibits allergic asthmatic airways via regulation of TGF-β expression and Foxp3+ Treg cells

Abstract

Background

Chitotriosidase (Chitnase 1, Chit1), a major true chitinase in humans, is induced in childhood asthma and has been implicated in the pathogenesis of a variety of inflammatory and tissue remodeling responses. We hypothesized that Chit1 plays a significant role in the pathogenesis of allergic asthma. To identify the role of Chit1, the mechanisms that underlie these contributions and the relevance of these murine findings to childhood asthma.

Methods

Wild type and Chit1-deficient mice and cells in culture were used to define the roles of Chit1 in models of allergic adaptive Th2 inflammation. In addition, the levels of sputum Chit1 were evaluated in pediatric asthma patients and compared to control.

Results

The levels of sputum Chit1 were significantly increased in the patients with childhood asthma. Mice with Chit1 null mutation demonstrated enhanced allergic Th2 inflammatory and cytokine and IgE responses to OVA or house dust mite allergen sensitization and challenge. However, the expression levels of TGF-β1 were significantly decreased with a diminished number of Foxp3⁺ regulatory T cells (Treg) in the lungs of Chit1^-/- mice compared to WT controls. In vitro, the absence of Chit1 significantly reduced TGF-β-stimulated conversion of CD4⁺CD25^- naïve T cells to CD4⁺Foxp3⁺ Treg cells, suggesting Chit1 is required for optimal effect of TGF-β1 in Treg cell differentiation.

Conclusion

Chit1 plays a protective role in the pathogenesis of allergic inflammation and asthmatic airway responses via regulation of TGF-β expression and Foxp3⁺ Treg cells.

This article is protected by copyright. All rights reserved.

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Conscious control of breathing: A key to SUDEP prevention?

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Amygdala stimulation-induced apnea is attention and nasal-breathing dependent

Abstract

Objective:

Evidence suggests disordered breathing is critically involved in Sudden unexplained death in epilepsy (SUDEP). To that end, evaluating structures that are activated by seizures and can activate brain regions that produce cardiorespiratory changes can further our understanding of the pathophysiology of SUDEP. Prior preclinical studies have shown that electrical stimulation of the human amygdala induces apnea, suggesting a role for the amygdala in controlling respiration. In this study, we aimed to both confirm these findings in a larger group of patients with intractable temporal lobe epilepsy (TLE) and also further explore the anatomical and cognitive properties of this effect.

Methods:

Seven surgical TLE patients had depth electrodes implanted in the amygdala that were used to deliver electrical stimulation during functional mapping prior to resection. Real-time respiratory monitoring was performed in each patient to confirm apnea.

Results:

Our data confirm that amygdala stimulation reliably induces apnea (occurring in all seven patients) and further suggest that apnea can be overcome by instructing the patient to inhale, and can be prevented entirely by breathing through the mouth prior to electrical stimulation. Finally, stimulation induced apnea occurred only when stimulating the medial most amygdalar contacts located in the central nucleus.

Interpretation:

These findings confirm a functional connection between the amygdala and respiratory control in humans. Moreover, they suggest specific amygdalar nuclei may be critical in mediating this effect and that attentional state is critical to apnea mediated by amygdala activation - perhaps alluding to future development of strategies for the prevention of SUDEP. This article is protected by copyright. All rights reserved.

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Do subjects with minimal motor features have prodromal PD?

ABSTRACT

Background: Understanding the pathological changes underlying mild motor features of the eldery and defining a patient population with prodromal Parkinson's disease (PD) are of great clinical importance. It remains unclear, however, how to accurately and specifically diagnose prodromal PD. We examined whether older adults with minimal parkinsonian motor features have nigrostriatal degeneration and α-synuclein pathology consistent with prodromal PD.

Methods: Brain sections were obtained from older adults with a clinical diagnosis of PD (N=21) and without a clinical diagnosis of PD (N=27) who underwent motor examination proximate to death. Cases without PD were further dichotomized into no motor deficit (n=9) or minimal motor features (n-18) groups using a modified Unified Parkinson's Disease Rating Scale. We performed quantitative unbiased stereological analyses of dopaminergic neurons/terminals and α-synuclein accumulation in the nigrostriatal system.

Results: In all subjects with minimal motor features, there were significant reductions in dopaminergic neurons and terminals in the substantia nigra and putamen that was intermediate between subjects with no motor deficit and PD. Phosphorylated α-synuclein inclusions were observed in the substantia nigra that were of similar density to what was seen in PD. Furthermore, there was greater Lewy neuritic pathology in the putamen relative to PD patients. Lastly, neurons with α-synuclein inclusions displayed reductions in tyrosine hydroxylase expression that was comparable in subjects with both minimal motor features and PD.

Interpretation: Minimal motor features in older adults may represent prodromal PD and identify at risk individuals for testing putative neuroprotective interventions that could slow or prevent PD progression. This article is protected by copyright. All rights reserved.

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Stereotactic Laser Amygdalohippocampotomy for Mesial Temporal Lobe Epilepsy

Abstract

Objective: To evaluate the outcomes one-year and longer following stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy in a large series of patients treated over a five-year period since introduction of this novel technique.

Methods: Surgical outcomes of a consecutive series of fifty-eight patients with mesial temporal lobe epilepsy who underwent the surgery at our institution with at least 12-months follow-up were retrospectively evaluated. A subgroup analysis was performed comparing patients with and without mesial temporal sclerosis.

Results: One-year following stereotactic laser amygdalohippocampotomy 53.4% (95% confidence interval: 40.8%-65.7%) of all patients were free of disabling seizures (Engel 1). Three of nine patients became seizure free following repeat ablation. Subgroup analysis showed that 60.5% (95% confidence interval: 45.6%-73.7%) of patients with mesial temporal sclerosis were free of disabling seizures as compared to 33.3% (95% confidence interval: 15.0%-58.5%) of patients without mesial temporal sclerosis. Quality of Life in Epilepsy-31 scores significantly improved at the group level, few procedure-related complications were observed, and verbal memory outcome was better than historical open resection data.

Interpretation: In an unselected consecutive series of patients, stereotactic laser amygdalohippocampotomy yielded seizure-free rates for patients with mesial temporal lobe epilepsy lower than, but comparable to, the outcomes typically associated with open temporal lobe surgery. Analogous to results from open surgery, patients without mesial temporal sclerosis fared less well. This novel procedure is an effective minimally invasive alternative to resective surgery. In the minority of patients not free of disabling seizures, laser ablation presents no barrier to additional open surgery. This article is protected by copyright. All rights reserved.

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Alterations of Global DNA Methylation and DNA Methyltransferase Expression in T and B Lymphocytes from Patients with Newly Diagnosed Autoimmune Thyroid Diseases After Treatment: A Follow-Up Study

Thyroid , Vol. 0, No. 0.


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Origins of antidromic activity in sensory afferent fibers and neurogenic inflammation

Abstract

Neurogenic inflammation results from the release of biologically active agents from the peripheral primary afferent terminal. This release reflects the presence of releasable pools of active product and depolarization-exocytotic coupling mechanisms in the distal afferent terminal and serves to alter the physiologic function of innervated organ systems ranging from the skin and meninges to muscle, bone, and viscera. Aside from direct stimulation, this biologically important release from the peripheral afferent terminal can be initiated by antidromic activity arising from five anatomically distinct points of origin: (i) afferent collaterals at the peripheral-target organ level, (ii) afferent collaterals arising proximal to the target organ, (iii) from mid-axon where afferents lacking myelin sheaths (C fibers and others following demyelinating injuries) may display crosstalk and respond to local irritation, (iv) the dorsal root ganglion itself, and (v) the central terminals of the afferent in the dorsal horn where local circuits and bulbospinal projections can initiate the so-called dorsal root reflexes, i.e., antidromic traffic in the sensory afferent.

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Surgeons, Patients See Surgical Scarring Differently

Patients and physicians often disagree about the final outcomes of surgical scars, a systematic review confirms.
Reuters Health Information

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Validity of self-reported tooth counts and masticatory status study of a Japanese adult population

Abstract

Self-reported measures of oral health are often used to assess oral health in populations or groups, but their validity or reliability needs repeated confirmation. The objective of this cross-sectional study was to evaluate the validity of self-reported tooth counts and masticatory status, using data obtained from a sample of Japanese adults. A total of 2,356 adults aged 40 to 75 years participated in a questionnaire survey and a clinical oral examination from 2013 through 2016. Self-reported measures were compared with clinically measured values. For tooth counts, mean clinical and self-reported tooth counts in all participansts were 23.68 and 23.78 teeth, and no significant difference was detected. Spearman's, Pearson's and intra-class correlation coefficients between clinical and self-reported tooth counts were 0.771, 0.845 and 0.843, respectively. According to the Bland-Altman analysis, the mean difference between clinical and self-reported tooth counts was -0.098 (95% CI: -0.242, 0.047). The upper limit of agreement was 6.919 (95% CI: 6.669, 7.169) and lower limit of agreement was -7.115 (95% CI: -7.365, -6.865). No significant fixed or proportional bias was observed. For masticatory status, the crude or age and gender adjusted mean numbers of total teeth, posterior teeth and three kinds of functional tooth units significantly decreased with the deterioration of masticatory status. The current study indicated that self-reports were within an acceptable range of clinical measures. Therefore, self-reports were considered valid alternatives to clinical measures to estimate tooth counts and masticatory status in a current Japanese adult population.

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Analysis of the reliability of the Italian Version of the Oral Behaviors Checklist and the relationship between oral behaviors and trait anxiety in healthy individuals

Abstract

Background

The Oral Behaviors checklist (OBC) is a valid 21-item instrument quantifying the self-reported frequency of oral behaviors. An Italian version (OBC-It) has been released recently.

Anxiety and oral behaviors are known to be associated in individuals with orofacial pain due to temporomandibular disorders (TMD). However, information about this relationship in pain-free individuals is still limited.

Objectives

The aim of this study was to test the reliability of the OBC-It and its reduced version (OBC-It 6), focusing on tooth clenching related wake time oral behaviors, and the effect of patient instructions on reliability. A second aim was to test the association between trait anxiety and oral behaviors in pain-free individuals.

Methods

282 TMD-free students, divided in two groups (Group A, n=139, mean age±SD = 22.6±5.4 years; group B, n=143, 23.7±4.2 years), filled in the State-Trait-Anxiety Inventory and the OBC-It. Group B received instructions about the OBC-It, while Group A did not. After two weeks (T1), both groups filled in the OBC-It again. However, group B was further divided in two subgroups, B₁ and B_2. The first received the same instructions again, while B₂ did not.

Results

The test-retest reliability of the OBC-It (A: ICC=.87, B1: ICC=.94; B2: ICC=.95) and OBC-It 6 (A: ICC=.85, B₁: ICC=.89, B₂: ICC=.93) was excellent in all groups. Trait anxiety was weakly associated with OBC-It only in females (R²=.043, P=.021).

Conclusions

The OBC-It is a reliable tool but further subjects' instructions may be needed. Trait anxiety has a limited effect on oral behaviors in TMD-free subjects.

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Early evaluation of radiation-induced parotid damage in patients with nasopharyngeal carcinoma by T2 mapping and mDIXON Quant imaging: initial findings

Radiation-induced parotid damage is a common complication in patients with nasopharyngeal carcinoma (NPC) treated with radiotherapy to head and neck region, which severely reduce the life quality of those pati...

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