Airway Management and Bronchoscopic Treatment of Subglottic and Tracheal Stenosis Using Holmium Laser with Balloon Dilatation

Abstract

Tracheal and subglottic stenosis are chronic inflammatory processes which can occur as a result of several possible aetiologies, most commonly as a result of prolonged intubation. All consecutive cases of subglottic and tracheal stenosis, secondary to prolonged intubation treated endoscopically over a period of 2 years were reviewed. The surgical approach consisted of radial incision and ablation using Holmium YAG laser, balloon dilatation and topical instillation of mitomycin C through flexible fiberoptic bronchoscope. Ventilation throughout was maintained through LMA. Laser fiber delivered through working channel of bronchoscope. CRA balloon passed through adopter of LMA. Every patient followed for 1 year with 1, 3, 6 months and 1 year interval. Serial balloon dilatation and mitomycin C instillation done in patients during follow up visit. Thirteen patients who underwent airway intervention during study period were studied for clinical outcome. Average follow up was 1 year. Etiology for airway stenosis in all patients of study group was intubation injury. Average frequency of balloon dilatation required was three. Average tracheal lumen achieved at the end of 1 year in our study group was 70%. Symptomatic improvement observed in all patients. Average PEFR achieved was up to 60% of predicted value. Benign subglottic and tracheal stenosis can be safely and effectively managed with flexible bronchoscopy, holmium YAG lasar ablation, balloon dilatation and Mitomycin-C after securing the airway with LMA for general anaesthesia and optimal ventilation.

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Intracranial and Intraocular Pressure at the Lamina Cribrosa: Gradient Effects

Abstract

Purpose of Review

A pressure difference between the intraocular and intracranial compartments at the site of the lamina cribrosa has been hypothesized to have a pathophysiological role in several optic nerve head diseases. This paper reviews the current literature on the translamina cribrosa pressure difference (TLCPD), the associated pressure gradient, and its potential pathophysiological role, as well as the methodology to assess TLCPD.

Recent Findings

For normal-tension glaucoma (NTG), initial studies indicated low intracranial pressure (ICP) while recent findings indicate that a reduced ICP is not mandatory.

Summary

Data from studies on the elevated TLCPD as a pathophysiological factor of NTG are equivocal. From the identification of potential postural effects on the cerebrospinal fluid (CSF) communication between the intracranial and retrolaminar space, we hypothesize that the missing link could be a dysfunction of an occlusion mechanism of the optic nerve sheath around the optic nerve. In upright posture, this could cause an elevated TLCPD even with normal ICP and we suggest that this should be investigated as a pathophysiological component in NTG patients.

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135th Congress of the German Society of Surgery (DGCH)

Eur Surg Res 2018;59:1–68

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Surveillance imaging with FDG-PET/CT in the post-operative follow-up of stage 3 melanoma

Abstract

Background

As early detection of recurrent melanoma maximizes treatment options, patients usually undergo post-operative imaging surveillance, increasingly with FDG-PET/CT (PET). To assess this, we evaluated stage 3 melanoma patients who underwent prospectively applied and sub-stage-specific schedules of PET surveillance.

Patients and Methods

From 2009, patients with stage 3 melanoma routinely underwent PET +/- MRI brain scans via defined schedules based on sub-stage-specific relapse probabilities. Data were collected regarding patient characteristics and outcomes. Contingency analyses were performed of imaging outcomes.

Results

170 patients (stage 3A: 34; 3B: 93; 3C: 43) underwent radiological surveillance. Relapses were identified in 65 (38%) patients, of which 45 (69%) were asymptomatic. False-positive imaging findings occurred in 7%, and 6% had treatable second (non-melanoma) malignancies. Positive predictive values (PPV) of individual scans were 56% - 83%. Negative scans had predictive values of 89% - 96% for true non-recurrence (negative predictive values (NPV)) until the next scan. A negative PET at 18 months had NPVs of 80% - 84% for true non-recurrence at any time in the 47-month (median) follow-up period. Sensitivity and specificity of the overall approach of sub-stage-specific PET surveillance were 70% and 87%, respectively. Of relapsed patients, 33 (52%) underwent potentially curative resection and 10 (16%) remained disease-free after 24 months (median).

Conclusions

Application of sub-stage-specific PET in stage 3 melanoma enables asymptomatic detection of most recurrences, has high NPVs that may provide patient reassurance, and is associated with a high rate of detection of resectable and potentially curable disease at relapse.

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Cytology cell blocks are suitable for immunohistochemical testing for PD-L1 in lung cancer

Abstract

Background

PD-L1 immunohistochemistry (IHC) testing is usually performed on tissue blocks from core needle biopsy or surgical resections. In this study, we assessed the feasibility of using cytology cell blocks for PD-L1 IHC assay.

Methods

A total of 1419 consecutive cases of non-small cell lung cancer (NSCLC), including 371 cytology cell blocks, 809 small biopsies, and 239 surgical specimens, were included in the study. The cytology cell blocks were prepared with formalin only, methanol/alcohol only or both. PD-L1 expression was examined by staining with Dako PD-L1 IHC 22C3 pharmDx kit. A Tumor Proportion Score (TPS) was categorized as < 1%, 1-49% and ≥ 50% tumor cells. A total of 100 viable tumor cells were required for adequacy.

Results

Of the cytology cell blocks, 92% of the specimens had an adequate number of tumor cells, not significantly different from small biopsies. The rate of TPS ≥ 50% differed between sample types and was observed in 42% of cytology cell blocks versus 36% of small biopsies (P=0.04), and 29% of surgical resections (P=0.001). The fixative methods did not affect the immunostaining, with overall PD-L1 high expression (TPS≥50%) rates of 42% in formalin-fixed specimens versus 40% in specimens with combined fixation by methanol/alcohol and formalin (NS). The PD-L1 high expression rate was not associated with EGFR, ALK or KRAS molecular alterations. Higher stage (IV) was associated with higher PD-L1 TPS (P= 0.001).

Conclusion

Our results show that when the TPS ≥50% is used as the endpoint, PD-L1 IHC performs well with cytology cell blocks. Cell blocks should be considered as a valuable resource for PD-L1 testing in advanced NSCLC. The clinical significance of higher PD-L1 IHC scores in cytology specimens needs to be evaluated prospectively.

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Outcome Measurement in the Treatment of Spasmodic Dysphonia: A Systematic Review of the Literature

Publication date: Available online 11 April 2018
Source:Journal of Voice
Author(s): Anna Rumbach, Patrick Aiken, Daniel Novakovic
PurposeThe aim of this review was to systematically identify all available studies reporting outcomes measures to assess treatment outcomes for people with spasmodic dysphonia (SD).MethodsFull-text journal articles were identified through searches of PubMed, Embase, CINAHL, and Cochrane databases and hand searching of journals.ResultsA total of 4,714 articles were retrieved from searching databases; 1,165 were duplicates. Titles and abstracts of 3,549 were screened, with 171 being selected for full-text review. During full-text review, 101 articles were deemed suitable for inclusion. An additional 24 articles were identified as suitable for inclusion through a hand search of reference lists. Data were extracted from 125 studies. A total of 220 outcome measures were identified. Considered in reference to the World Health Organization International Classification of Functioning, Disability and Health (ICF), the majority of outcomes were measured at a Body Function level (n = 212, 96%). Outcomes that explored communication and participation in everyday life and attitudes toward communication (ie, activity and participation domains) were infrequent (n = 8; 4%). Quality of life, a construct not measured within the ICF, was also captured by four outcome measures. No instruments evaluating communication partners' perspectives or burden/disability were identified.ConclusionsThe outcome measures used in SD treatment studies are many and varied. The outcome measures identified predominately measure constructs within the Body Functions component of the ICF. In order to facilitate data synthesis across trials, the development of a core outcome set is recommended.



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ERCP credentialing approaches in Australia and throughout the world

The recent article about credentialing practitioners of ERCP in United States healthcare facilities states the following: "Other countries have national authorities charged with establishing and also policing the quality of endoscopy."1

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Endoscopic submucosal dissection for early Barrett’s esophagus neoplasia

We read with interest the article by Yang et al1 evaluating endoscopic submucosal dissection (ESD) for early Barrett's esophagus (BE) neoplasia. The authors found that ESD for early BE neoplasia is a reasonable choice for the management of BE neoplasia. Because their findings are important to current practice, several questions deserve attention.

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Response:

I thank Dr Thomson for his helpful comments on our recent publication, which exposed the poor state of credentialing for ERCP in the United States.1 He kindly clarified the role of the Conjoint Committee in Australia, which we highlighted because of its pioneering work in enhancing and confirming the quality of their endoscopic practice.

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Too loose to lose: an investigation into endoscopic anastomotic reduction to reestablish weight loss

Failure of weight loss, regain of weight, or both after laparoscopic Roux-en-Y gastric bypass (RYGB) resulting from lack of restriction has been reported in long-term follow-up studies. Shulman et al1 in this study determine the safety and effectiveness of reestablishing the restrictive component of the operation by reducing the outlet of the gastrojejunal anastomosis using an endoscopic approach.

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Focus on...

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Blood urea nitrogen increase is an expected finding in nonvariceal upper GI bleeding patients with underlying moderate or severe renal disease

In a recent article, Kumar et al1 studied the association between increased blood urea nitrogen (BUN) at 24 hours and outcomes in nonvariceal upper GI bleeding in a retrospective study design. The authors speculated that a BUN increase within 24 hours of admission could be a risk factor for worse outcomes, as observed in acute pancreatitis by Wu et al.2 Their study cohort included 357 patients. Of those, 320 (90%) experienced a decrease or no change in BUN, whereas 37 patients (10%) had an increase in BUN at 24 hours after admission.

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Continuing Medical Education Exam: May 2018

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Thoughts of the safety and efficacy of EUS-guided cyst ablation with the use of lauromacrogol

We read with interest the clinical trial by Linghu et al1 investigating the safety and effectiveness of lauromacrogol for EUS-guided ablation of pancreatic cystic neoplasms. The authors reported an adverse event (AE) rate of 8.3% and an overall complete response rate of 37%. They concluded that this approach as safe and efficient. We have a few thoughts, which may be helpful.

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Improving quality of care in patients with Barrett’s esophagus by measuring and improving neoplasia detection rates

The goal of screening and surveillance endoscopy in patients with Barrett's esophagus (BE) is to reduce the rising incidence of esophageal adenocarcinoma (EAC) and ultimately mortality from this lethal cancer.1 However, despite all advances in the field of screening, surveillance, and treatment of BE, we have not made a significant dent in the incidence of this cancer. One potential explanation is the quality gap in the care of patients with BE and dysplasia. Unlike for the management of colonoscopy and colorectal cancer, there are no uniformly agreed-upon quality metrics for the care of BE patients.

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ASGE update

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In upcoming issues...

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Contents

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Response

We thank Drs Gaballa and Moyer1 for their interest in our recently published article.2 Their recommendation to use a standardized lexicon for adverse events (AEs) is of great value. The AE rate in our study was 8.3% (3/36). It was revealed that EUS-guided ablation with ethanol with or without paclitaxel injection was fairly safe, with an AE rate of 10% to 15%.3 The advantage of lauromacrogol seemed to be weak compared with ethanol in treatment safety. In our opinion, lauromacrogol may have an advantage over ethanol for its anesthetic effect of relieving pain during and after surgery.

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Editors

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Information for readers

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Endoscopic removal of obstructing food bolus: Can a cap do the trick?

Foreign body ingestion and food bolus (FB) impaction are commonly encountered indications for emergency endoscopy in clinical practice.1 Foreign body ingestion is commonly seen in children because of accidental swallowing, whereas FB impaction is more frequent in adults.1 FB impaction in the esophagus is mostly seen in edentulous, psychiatric, or intoxicated patients; the majority have an underlying esophageal motility disorder or a luminal pathologic condition like web, ring, stricture, diverticula, external compression, anastomosis, or eosinophilic esophagitis.

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Response:

We thank Li et al1 for their letter to the editor, insightful comments, and interest in our article "Endoscopic submucosal dissection for early Barrett's neoplasia: a meta-analysis."2 In recent years, there has been an increasing interest in endoscopic submucosal dissection (ESD) for the management of superficial GI neoplasms, given its superiority to EMR in terms of en bloc, curative resection, and recurrence.3 Recent systematic reviews and meta-analyses support a role for ESD in the treatment of esophageal neoplasms.

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Response:

We thank Dr Köker for his interest in our study, "Association between an increase in blood urea nitrogen at 24 hours and worse outcomes in acute nonvariceal upper GI bleeding."1 In his letter to the editor, the author notes that renal disease is an independent risk factor for upper GI bleeding (UGIB). Given that blood urea nitrogen (BUN) elevations are more likely to be seen in patients with renal disease, the author expresses concern that the findings of our study were driven by the patients with moderate or severe renal disease in our study sample.

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Small Cell Neuroendocrine Carcinoma: A Rare Nasopharyngeal Malignancy with Aggressive Clinical Course

Abstract

Primary small cell neuroendocrine carcinoma is uncommon in head and neck region, with occasional cases in nasopharynx. Distinction from other round cell tumors is imperative to ensure optimal patient management. We present a case of a 30-year-old woman who presented with a rapidly growing nasopharyngeal mass.

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Global gridded anthropogenic emissions inventory of carbonyl sulfide

Publication date: June 2018
Source:Atmospheric Environment, Volume 183
Author(s): Andrew Zumkehr, Tim W. Hilton, Mary Whelan, Steve Smith, Le Kuai, John Worden, J. Elliott Campbell
Atmospheric carbonyl sulfide (COS or OCS) is the most abundant sulfur containing gas in the troposphere and is an atmospheric tracer for the carbon cycle. Gridded inventories of global anthropogenic COS are used for interpreting global COS measurements. However, previous gridded anthropogenic data are a climatological estimate based on input data that is over three decades old and are not representative of current conditions. Here we develop a new gridded data set of global anthropogenic COS sources that includes more source sectors than previously available and uses the most current emissions factors and industry activity data as input. Additionally, the inventory is provided as annually varying estimates from years 1980–2012 and employs a source specific spatial scaling procedure. We estimate a global source in year 2012 of 406 Gg S y⁻¹ (range of 223–586 Gg S y⁻¹), which is highly concentrated in China and is twice as large as the previous gridded inventory. Our large upward revision in the bottom-up estimate of the source is consistent with a recent top-down estimate based on air-monitoring and Antarctic firn data. Furthermore, our inventory time trends, including a decline in the 1990's and growth after the year 2000, are qualitatively consistent with trends in atmospheric data. Finally, similarities between the spatial distribution in this inventory and remote sensing data suggest that the anthropogenic source could potentially play a role in explaining a missing source in the global COS budget.



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The ethical and deontological charter of the French faculties of medicine and odontology

Publication date: Available online 10 April 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): O. Laccourreye, H. Maisonneuve




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One last Who am I!

Publication date: Available online 10 April 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): O. Laccourreye, A. Werner, I. McGill




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Involvement of prokineticin 2-expressing neutrophil infiltration in 5-fluorouracil-induced aggravation of breast cancer metastasis to lung

Adjuvant chemotherapy is used for human breast cancer patients, even after curative surgery of primary tumor, in order to prevent tumor recurrence primarily as a form of metastasis. However, anti-cancer drugs can accelerate metastasis in several mouse metastasis models. Hence, we examined the effects of post-surgical administration with 5-fluorouracil (5-FU), doxorubicin, and cyclophosphamide, on lung metastasis process, which developed after the resection of the primary tumor arising from the orthotopic injection of a mouse triple-negative breast cancer cell line, 4T1. Only 5-FU markedly increased the numbers and sizes of lung metastasis foci, with enhanced tumor cell proliferation and angiogenesis as evidenced by increases in Ki67-positive cell numbers and CD31-positive areas, respectively. 5-FU-mediated augmented lung metastasis was associated with increases in intrapulmonary neutrophil numbers and expression of neutrophilic chemokines, Cxcl1 and Cxcl2 in tumor cells, with few effects on intrapulmonary T cell or macrophage numbers. 5-FU enhanced Cxcl1 and Cxcl2 expression in 4T1 cells in a NF-kappaB-dependent manner. Moreover, the administration of a neutrophil-depleting antibody or a Cxcr2 antagonist, SB225002, significantly attenuated 5-FU-mediated enhanced lung metastasis with depressed neutrophil infiltration. Furthermore, infiltrating neutrophils and 4T1 cells abundantly expressed prokineticin-2 (Prok2) and its receptor, Prokr1, respectively. Finally, the administration of 5-FU after the resection of the primary tumor, failed to augment lung metastasis in the mice receiving Prokr1-deleted 4T1 cells. Collectively, 5-FU can enhance lung metastasis by inducing tumor cells to produce Cxcl1 and Cxcl2, which induced the migration of neutrophils expressing Prok2 with a capacity to enhance 4T1 cell proliferation.

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Language development in children who stutter: A review of recent research

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Effects of transcranial direct current stimulation over the Broca’s area on tongue twister production

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INPP4B overexpression and c‐KIT downregulation in human achalasia

Neurogastroenterology &Motility, EarlyView.


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Evaluation of Prexasertib, a Checkpoint Kinase 1 Inhibitor, in a Phase Ib Study of Patients with Squamous Cell Carcinoma

Purpose: Prexasertib, a checkpoint kinase 1 inhibitor, demonstrated single-agent activity in patients with advanced squamous cell carcinoma (SCC) in the dose-escalation portion of a Phase I study (NCT01115790). Monotherapy prexasertib was further evaluated in patients with advanced SCC. Experimental Design: Patients were given prexasertib 105 mg/m2 as a 1-hour infusion on day 1 of a 14-day cycle. Expansion cohorts were defined by tumor and treatment line. Safety, tolerability, efficacy, and exploratory biomarkers were analyzed. Results: Prexasertib was given to 101 patients, including 26 with SCC of the anus, 57 with SCC of the head and neck (SCCHN), and 16 with squamous cell non-small cell lung cancer (sqNSCLC). Patients were heavily pretreated (49% ≥3 prior regimens). The most common treatment-related adverse event was grade 4 neutropenia (71%); 12% of patients had febrile neutropenia. Median progression-free survival was 2.8 months (90% CI 1.9, 4.2) for SCC of the anus, 1.6 months (1.4, 2.8) for SCCHN, and 3.0 months (1.4, 3.9) for sqNSCLC. The clinical benefit rate at 3 months (complete response+partial response+stable disease) across tumors was 29% (23% SCC of the anus, 28% SCCHN, 44% sqNSCLC). Four patients with SCC of the anus had partial or complete response (overall response rate [ORR]=15%), and three patients with SCCHN had partial response (ORR=5%). Biomarker analyses focused on genes that altered DNA damage response or increased replication stress. Conclusions: Prexasertib demonstrated an acceptable safety profile and single-agent activity in patients with advanced SCC. The prexasertib maximum-tolerated dose of 105 mg/m² was confirmed as the recommended Phase II dose.

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Exercise and the Total Airway: A Call to Action.

Related Articles

Exercise and the Total Airway: A Call to Action.

Immunol Allergy Clin North Am. 2018 May;38(2):xv-xix

Authors: Olin JT, Hull JH

PMID: 29631744 [PubMed - in process]

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Exercise-Induced Airway Dysfunction in Athletes.

Related Articles

Exercise-Induced Airway Dysfunction in Athletes.

Immunol Allergy Clin North Am. 2018 May;38(2):xiii-xiv

Authors: Tilles SA

PMID: 29631743 [PubMed - in process]

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Food Allergy Point of Care Pearls.

Related Articles

Food Allergy Point of Care Pearls.

Immunol Allergy Clin North Am. 2018 May;38(2):e1-e8

Authors: Bird JA

Abstract
Food allergy should be suspected in individuals with a history of immediate reactivity following ingestion (ie, typically within 20 minutes and almost always within 2 hours) with typical symptoms of immunoglobulin E-mediated reactivity (eg, urticaria, angioedema, coughing, wheezing, vomiting). Testing for food allergy should focus on the most likely allergen to provoke the reaction based on the patient's history. Safe introduction of peanut-containing foods into the diet of an infant at high risk of developing peanut allergy at 4 to 6 months is likely to reduce the risk of peanut allergy.

PMID: 29631742 [PubMed - in process]

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The Future of Exertional Respiratory Problems: What Do We Know About the Total Airway Approach and What Do We Need to Know?

Related Articles

The Future of Exertional Respiratory Problems: What Do We Know About the Total Airway Approach and What Do We Need to Know?

Immunol Allergy Clin North Am. 2018 May;38(2):333-339

Authors: Olin JT, Hull JH

Abstract
Exercise is increasingly viewed as a preventative and therapeutic modality for medical and behavioral health disorders. Therefore, it is imperative that the medical and scientific communities minimize barriers that discourage exercise. This issue of Immunology and Allergy Clinics of North America details a "total airway approach" to the evaluation of exertional respiratory problems. Reviews guide clinicians through evaluation and therapy. Moving forward, there is much room for growth with respect to research in each of these areas as well as for common inflammatory pathways and neurophysiologic coupling across all airway segments.

PMID: 29631741 [PubMed - in process]

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Exercise and Sinonasal Disease.

Related Articles

Exercise and Sinonasal Disease.

Immunol Allergy Clin North Am. 2018 May;38(2):259-269

Authors: Steelant B, Hox V, Hellings PW, Bullens DM, Seys SF

Abstract
Physical exercise requires proper function of the upper and lower airways in order to meet exertional ventilatory requirements. Athletes performing frequent intensive exercise experience more sino-nasal symptoms and demonstrate objective decreases in sino-nasal function when compared with the general population. Sino-nasal dysfunction is known to interfere with sport performance. Nasal epithelial injury, neutrophilic influx, and decreased mucociliary clearance have been associated with intensive training. In this review, the authors provide a comprehensive overview of the prevalence of sino-nasal disease in athletes, the possible underlying pathophysiologic mechanisms, and a summary of diagnostic and treatment options.

PMID: 29631734 [PubMed - in process]

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Nonpharmacologic Strategies to Manage Exercise-Induced Bronchoconstriction.

Related Articles

Nonpharmacologic Strategies to Manage Exercise-Induced Bronchoconstriction.

Immunol Allergy Clin North Am. 2018 May;38(2):245-258

Authors: Dickinson J, Amirav I, Hostrup M

Abstract
Pharmacologic management of exercise-induced bronchoconstriction (EIB) is the mainstay of preventative therapy. There are some nonpharmacologic interventions, however, that may assist the management of EIB. This review discusses these nonpharmacologic interventions and how they may be applied to patients and athletes with EIB.

PMID: 29631733 [PubMed - in process]

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Pharmacologic Strategies for Exercise-Induced Bronchospasm with a Focus on Athletes.

Related Articles

Pharmacologic Strategies for Exercise-Induced Bronchospasm with a Focus on Athletes.

Immunol Allergy Clin North Am. 2018 May;38(2):231-243

Authors: Backer V, Mastronarde J

Abstract
Exercise-induced bronchoconstriction (EIB) is the transient narrowing of the airways during and after exercise that occurs in response to increased ventilation in susceptible individuals. It occurs across the age spectrum in patients with underlying asthma and can occur in athletes without baseline asthma. The inflammatory mechanisms underlying EIB in patients without asthma may be distinct from those underlying EIB in patients with asthma. This review summarizes mechanistic and clinical data that can guide the choice of chronic and acute pharmacologic therapies targeting control of EIB. Relevant regulations from the World Anti-Doping Agency are also discussed.

PMID: 29631732 [PubMed - in process]

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Testing for Exercise-Induced Bronchoconstriction.

Related Articles

Testing for Exercise-Induced Bronchoconstriction.

Immunol Allergy Clin North Am. 2018 May;38(2):215-229

Authors: Brannan JD, Porsbjerg C

Abstract
Exercise-induced bronchoconstriction (EIB) is a form of airway hyperresponsiveness that occurs with or without current symptoms of asthma. EIB is an indicator of active and treatable pathophysiology in persons with asthma. The objective documentation of EIB permits the identification of an individual who may be at risk during a recreational sporting activity or when exercising as an occupational duty. EIB can be identified with laboratory exercise testing or surrogate tests for EIB. These include eucapnic voluntary hyperpnea and osmotic stimuli (eg, inhaled mannitol) and offer improved diagnostic sensitivity to identify EIB and improved standardization when compared with laboratory exercise.

PMID: 29631731 [PubMed - in process]

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Exercise-Induced Bronchoconstriction: Background, Prevalence, and Sport Considerations.

Related Articles

Exercise-Induced Bronchoconstriction: Background, Prevalence, and Sport Considerations.

Immunol Allergy Clin North Am. 2018 May;38(2):205-214

Authors: Bonini M, Silvers W

Abstract
The transient airway narrowing that occurs as a result of exercise is defined as exercise-induced bronchoconstriction (EIB). The prevalence of EIB has been reported to be up to 90% in asthmatic patients, reflecting the level of disease control. However, EIB may develop even in subjects without clinical asthma, particularly in children, athletes, patients with atopy or rhinitis, and following respiratory infections. The intensity, duration, and type of training have been associated with the occurrence of EIB. In athletes, EIB seems to be only partly reversible, and exercise seems to be a causative factor of airway inflammation and symptoms.

PMID: 29631730 [PubMed - in process]

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Exercise-Induced Bronchoconstriction and the Air We Breathe.

Related Articles

Exercise-Induced Bronchoconstriction and the Air We Breathe.

Immunol Allergy Clin North Am. 2018 May;38(2):183-204

Authors: Rundell KW, Smoliga JM, Bougault V

Abstract
An association between airway dysfunction and airborne pollutant inhalation exists. Volatilized airborne fluorocarbons in ski wax rooms, particulate matter, and trichloromines in indoor environments are suspect to high prevalence of exercise-induced bronchoconstriction and new-onset asthma in athletes competing in cross-country skiing, ice rink sports, and swimming. Ozone is implicated in acute decreases in lung function and the development of new-onset asthma from exposure during exercise. Mechanisms and genetic links are proposed for pollution-related new-onset asthma. Oxidative stress from airborne pollutant inhalation is a common thread to progression of airway damage. Key pollutants and mechanisms for each are discussed.

PMID: 29631729 [PubMed - in process]

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Mechanisms and Biomarkers of Exercise-Induced Bronchoconstriction.

Related Articles

Mechanisms and Biomarkers of Exercise-Induced Bronchoconstriction.

Immunol Allergy Clin North Am. 2018 May;38(2):165-182

Authors: Kippelen P, Anderson SD, Hallstrand TS

Abstract
Exercise is a common trigger of bronchoconstriction. In recent years, there has been increased understanding of the pathophysiology of exercise-induced bronchoconstriction. Although evaporative water loss and thermal changes have been recognized stimuli for exercise-induced bronchoconstriction, accumulating evidence points toward a pivotal role for the airway epithelium in orchestrating the inflammatory response linked to exercise-induced bronchoconstriction. Overproduction of inflammatory mediators, underproduction of protective lipid mediators, and infiltration of the airways with eosinophils and mast cells are all established contributors to exercise-induced bronchoconstriction. Sensory nerve activation and release of neuropeptides maybe important in exercise-induced bronchoconstriction, but further research is warranted.

PMID: 29631728 [PubMed - in process]

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Bedside ultrasonography as an alternative to computed tomography scan for the measurement of optic nerve sheath diameter

Uday Yanamandra, Amul Gupta, Sushma Yanamandra, Subrat Kumar Das, Sagarika Patyal, Velu Nair

Journal of Neurosciences in Rural Practice 2018 9(2):252-255

Background: Optic nerve sheath diameter (ONSD) as measured by optic nerve sheath ultrasonography (ONSU) is used as a surrogate marker of intracranial pressure (ICP), especially in resource-limited settings. There is a growing interest in the use of ONSU in emergency and high-altitude setups. Notwithstanding multiple studies done on this subject, there is a paucity of data regarding standardization of techniques and comparison of ONSU with computed tomography (CT). Materials and Methods: Thirty-five patients with a diagnosis of high-altitude cerebral edema were enrolled in the study. ONSD was measured in all patients using ONSU, along visual and coronal axis, and CT scan. We repeated ONSU in these patients on days 3, 7, 10, and 15 (day of discharge). Correlation between visual and coronal axis as well as CT scan was analyzed. Results: The correlation of visual to coronal and coronal to visual was equally significant (both correlation coefficients being R2 = 0.983). Correlation of ONSD by visual axis to CT scan was better than coronal axis (correlation coefficient R2 = 0.986 vs. 0.96, respectively). Conclusion: In our study, we found a strong correlation between the visual and coronal axes. Thus, either of the two axes can be used for monitoring ICP. However, it has been found that measurements along the coronal axis are challenging, especially in the emergency setup. ONSD measured along visual axis correlated better with CT scan as compared to the coronal axis.

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Cranial gravitational (falling) bullet injuries: Point of view

Husain A Abdali, Samer S Hoz, Luis Rafael Moscote-Salazar

Journal of Neurosciences in Rural Practice 2018 9(2):278-280



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Postdecompressive craniectomy surgery, ventriculomegaly, or hydrocephalus development: imaging, prevention, and management

Guru Dutta Satyarthee

Journal of Neurosciences in Rural Practice 2018 9(2):177-179



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Repeated peritoneal catheter blockage caused by neurocysticercosis following ventriculoperitoneal shunt placement for hydrocephalus

Zhi Hua Li, Zhong Quan Wang, Jing Cui, Fu You Guo

Journal of Neurosciences in Rural Practice 2018 9(2):268-271

Cerebral cysticercosis is common, but the possibility for repeated occurrence of peritoneal catheter blockage caused by neurocysticercosis (NCC) after two revisions following ventriculoperitoneal shunt placement for hydrocephalus is unusual. Herein, we describe one rare case in which peritoneal catheter revision was performed two times unsuccessfully. Endoscopic cysternostomy rather than peritoneal catheter adjustment was performed successfully, and histopathological examination of excised cystic samples confirmed NCC in our hospital. The present case highlights the need for awareness of NCC as a possible etiology of hydrocephalus, especially in developing countries. Uncommon findings in both lateral ventricles following low-field magnetic resonance imaging scans as well as the rarity of this infection involved in unusual location play important roles in misdiagnosis and incorrect treatment for hydrocephalus; thus, endoscopic cysternostomy, rather than multiple shunt adjustment of the peritoneal end, is recommended in the selected patient. To the best of our knowledge, this is the first report describing the misdiagnosis and inappropriate treatment of hydrocephalus caused by cerebral cysticercosis in China.

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Caregiver burden among caregivers of mentally ill individuals and their coping mechanisms

Sujata Chodankar Walke, Varalakshmi Chandrasekaran, Shreemathi S Mayya

Journal of Neurosciences in Rural Practice 2018 9(2):180-185

Background: During a given year, almost 30% of the people around the world are affected by mentally ill health. In India, it accounts for about 20%. Caregivers face a lot of strain, ill health, and disrupted family life, with literature suggesting an increasing concern about their ability to cope up. The needs of caregivers of the mentally ill are given low priority in the current health-care setting in India. Aim: The aim of the study was to assess the burden of caregivers of mentally ill individuals and their coping mechanisms. Methods: A cross-sectional study was employed with a quantitative approach. A convenient sample of 320 caregivers was taken from two private tertiary care centers and one public secondary care center in Udupi taluk. This study was conducted using the Burden Assessment Schedule (BAS) and Brief Cope Scale (BCS). Statistical analysis was done on categorical variables, and they were expressed as frequencies and percentages. Continuous variables were measured using mean and standard deviation. Univariate and multivariate analysis using binomial logistic regression was done. SPSS version 15 was used to analyze the data. Results: According to BAS, severe burden accounted for 40.9% and moderate for 59.1%. The highest amount of burden was seen in the areas of physical and mental health, spouse related, and in areas of external support. The BCS showed that the most frequently used coping styles were practicing religion, active coping, and planning. Conclusion: This study concluded that caregivers of the mentally ill individuals do undergo a lot of burden. Hence, there is a need to develop strategies that can help them such as providing them with a support structure as well as counseling services.

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Expert commentary on rare (nonvestibular, nontrigenimal) cranial nerve schwannomas

Murat Alemdar

Journal of Neurosciences in Rural Practice 2018 9(2):175-176



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Curriculum discrepancy in rural practice of neurosurgery

Sina Abdollahzade

Journal of Neurosciences in Rural Practice 2018 9(2):276-276



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The role of ejection fraction to clinical outcome of acute ischemic stroke patients

Fidha Rahmayani, Paryono , Ismail Setyopranoto

Journal of Neurosciences in Rural Practice 2018 9(2):197-202

Aims: The aim of the study was to determine the effect of left ventricular ejection fraction on clinical outcomes of acute ischemic stroke patients. Study Design: This study design was a prospective cohort observational study. Place and Duration of Study: This study was conducted at Stroke Unit, Neurology Ward, and Cardiology Ward at the Dr. Sardjito Hospital, Yogyakarta, Indonesia, between July and December 2016. Materials and Methods: Hospitalized acute ischemic stroke patients were recruited, with sample was taken by consecutive sampling until reaching amount fulfilling inclusion criterion was 62 persons. In this study, clinical outcomes were measured by National Institutes of Health Stroke Scale (NIHSS) scores as well as dependent variables and left ventricular ejection fraction as independent variables. Logistic regression analyses were performed to discover any potential independent variable that can influence the left ventricular ejection fraction role at the clinical outcomes with NIHSS scores. Results: Multivariate analyses revealed that several variables were significantly interacted with the influence of left ventricular ejection fraction at the clinical outcomes with NIHSS scores. These variables were the left ventricular ejection fraction <48% (95% confidence interval [CI]: 0.691–0.925; P = 0.001), left ventricular ejection fraction + low high-density lipoprotein (HDL) (95% CI: 0.73–0.949; P = 0,001), left ventricular ejection fraction + diabetes mellitus (DM) (95% CI: 0.799–0.962; P = 0,001), and left ventricular ejection fraction + low HDL + DM (95% CI: 0.841–0.98; P = 0,001). Conclusion: The influence of the lower left ventricular ejection fraction to clinical outcome of ischemic stroke patients has a worsening of neurological deficit outcome by considering the combination of several independent variables including the DM and low HDL.

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Beware of phenytoin self-harm in children

Varun Kumar Singh, Jayantee Kalita, Usha Kant Misra

Journal of Neurosciences in Rural Practice 2018 9(2):283-284



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Changing pattern of childhood epidemic cerebrospinal meningitis in North-Western Nigeria

Sani Mado, Ibrahim Aliyu, Rabiu Murtala

Journal of Neurosciences in Rural Practice 2018 9(2):203-207

Introduction: Nigeria lies within the meningitis belt which extends from the Gambia, Senegal through Nigeria to Eritrea; however, outbreaks have been shown to extend further south involving countries such as Angola and Namibia. Epidemic outbreaks are often recorded every 8–12 years averaging in a 10 yearly circle however endemic cases still occurs. Materials and Methods: The study was retrospective; all results of cerebrospinal fluid (CSF) samples of children with cases of meningitis from January 2010 to December 2010 were collected from the register of the microbiology laboratory of General Hospital Gusau. Relevant information such as their age, sex, CSF macroscopy/microscopy reports, latex particle agglutination test report, and CSF culture report were retrieved and entered into a pro forma. Results: There were 89 (73%) males and 33 (27%) females with male to female ratio of 2.7:1. The age ranged from 2 months to 14 years; the mean was 6.27 ± 4.00 years. Meningitis was mostly recorded from January to April. W135 was the most common serotype identified. Majority of the samples (54) which were nonreactive for any of the tested antigens had clear CSF (36), while among those that reacted; the W135 group had a high proportion of cases that had turbid CSF (44); (Fisher's exact test = 30.650, P = 0.000). Majority of the samples (99) had no cell count; although those of the W135 group had higher cell counts followed by those in the nonreactive group (Fisher's exact test = 11.226, P = 0.181). Conclusion: Meningitis was highest between January and April, and W135 was the most common serotype.

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Involvement of the spinal cord in mitochondrial disorders

Josef Finsterer, Sinda Zarrouk-Mahjoub

Journal of Neurosciences in Rural Practice 2018 9(2):245-251

This review aims at summarising and discussing the current status concerning the clinical presentation, pathogenesis, diagnosis, and treatment of spinal cord affection in mitochondrial disorders (MIDs). A literature search using the database Pubmed was carried out by application of appropriate search terms and their combinations. Involvement of the spinal cord in MIDs is more frequent than anticipated. It occurs in specific and non-specific MIDs. Among the specific MIDs it has been most frequently described in LBSL, LS, MERRF, KSS, IOSCA, MIRAS, and PCH and only rarely in MELAS, CPEO, and LHON. Clinically, spinal cord involvement manifests as monoparesis, paraparesis, quadruparesis, sensory disturbances, hypotonia, spasticity, urinary or defecation dysfunction, spinal column deformities, or as transverse syndrome. Diagnosing spinal cord involvement in MIDs requires a thoroughly taken history, clinical exam, and imaging studies. Additionally, transcranial magnetic stimulation, somato-sensory-evoked potentials, and cerebro-spinal fluid can be supportive. Treatment is generally not at variance compared to the underlying MID but occasionally surgical stabilisation of the spinal column may be necessary. It is concluded that spinal cord involvement in MIDs is more frequent than anticipated but may be missed if cerebral manifestations prevail. Spinal cord involvement in MIDs may strongly determine the mobility of these patients.

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Does metabolic syndrome determine severity and disability of chronic low backache?

Jayantee Kalita, Kamlesh Kumar Sonkar, Usha Kant Misra, Sanjeev K Bhoi

Journal of Neurosciences in Rural Practice 2018 9(2):208-213

Introduction: Obesity may be associated with more severe and disabling low backache (LBA) due to alteration in biomechanics, but there are no such studies from developing countries. Aims: We report the frequency of metabolic syndrome (MS) in chronic LBA (CLBA) and its association with severity and disability of CLBA. Subjects and Methods: Consecutive patients with CLBA attending to the neurology service from October 2015 to February 2016 were included in the study. Clinical and demographic parameters were recorded. Routine biochemical test was done. The severity of pain was assessed by a 0–10 Numeric Rating Scale (NRS) and disability by Oswestry Disability Index (ODI) version 2. Comparison of variables was done by Chi-square or independent t-test and correlation by Karl Pearson or Spearman's rank correlation test. Results: Seventy-none (39.3%) patients had MS as per the International Diabetic Federation (IDF) criteria and 68 (33.8%) as per the National Cholesterol Education Program Adult Treatment Panel III criteria. Abdominal obesity was the most common (171 [85.1%]) feature of MS. The patients with MS had longer duration of sitting work and did less frequently exercise. The NRS score (6.95 ± 1.06 vs. 6.65 ± 0.95; P = 0.04) and ODI score (54.91 ± 8.42 vs. 51.89 ± 8.54; P = 0.01) were higher in CLBA patients with MS compared to those without MS. Conclusion: About 40% patients with CLBA have metabolic syndrome, and they have more severe pain and disability.

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Diagonal earlobe crease revealing intracranial atherosclerosis

Oscar H Del Brutto, Aldo F Costa

Journal of Neurosciences in Rural Practice 2018 9(2):256-257



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Clinical profile of parkinson's disease: Experience of niger

Hamid Assadeck, Moussa Toudou Daouda, Fatimata Hassane Djibo, Djibo Douma Maiga, Eric Adehossi Omar

Journal of Neurosciences in Rural Practice 2018 9(2):214-218

Background: Parkinson's disease (PD) is a chronic neurodegenerative pathology with unknown etiology. It is characterized clinically by the classic triad that associated tremors, bradykinesia, and rigidity. In Niger, there are no data on PD. Aims: We aimed to provide the demographic and clinical profile of PD in patients from Niger to create a database on PD in Niger. Patients and Methods: We conducted a retrospective study at the Neurology Outpatient Clinic of the Hôpital National de Niamey (HNN, Niger) over a period of 4.42 years from February 2009 to July 2013 collecting all cases of PD. The demographic and clinical features of all patients were collected and analyzed. Results: During the period of the study, 1695 patients consulted at the Neurology Outpatient Clinic of the HNN, among which 76 patients (4.48%) had secondary parkinsonism and 25 patients (1.47%) had features compatible with PD. Only patients with PD were included in this study. The mean age at onset of symptoms was 58 years (range: 42–74 years). The male sex was predominant (60%) with a sex ratio of 1.5. The mean time interval from the onset of symptoms to diagnosis of PD was 1.8 years (range: 1–5 years). The tremor was the most common symptom (84%). Bradykinesia represented 64% of the symptoms and rigidity 20%. At the time of the diagnosis of PD, 8 patients (32%) were in Stage I of the classification of Hoehn and Yahr, 16 patients (64%) in Stage II, and 1 patient (4%) in Stage III. The levodopa/carbidopa combination was the most used antiparkinsonian drug in our patients (88%). The mean time of follow-up of the patients was 2.5 years (range: 1–4.42 years). During the course of the disease, 9 patients (36%) were in Stage II of the classification of Hoehn and Yahr, 13 patients (52%) in Stage III, and 3 patients (12%) in Stage IV. Conclusion: Our study provides demographic and clinical data of PD in patients from Niger and shows that the hospital frequency of this disease is low (1.47%). The demographic and clinical features of our patients are similar to those of the patients of the prior studies reported in sub-Saharan Africa.

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Obsessive-compulsive inventory-revised: Factor structure, reliability, validity, and suicide risk screening characteristics among nigerian patients with schizophrenia

Tolulope Opakunle, Olutayo Aloba, Adesanmi Akinsulore, Olubukola Opakunle, Femi Fatoye

Journal of Neurosciences in Rural Practice 2018 9(2):219-225

Objective: This study attempted to explore the feasibility of use of the 18-item Obsessive-Compulsive Inventory-Revised (OCI-R) as a subjective suicide risk assessment tool in a cross-sectional sample of Nigerian patients with schizophrenia. Materials and Methods: Two hundred and thirty-two outpatients with schizophrenia were recruited from the mental health clinic of a university teaching hospital in Southwestern Nigeria. They completed the OCI-R in addition to the Social and Occupational Functioning Assessment Scale, the Positive and Negative Syndrome Scale, and a sociodemographic and illness-related questionnaire. The patients were objectively interviewed with the Mini-International Neuropsychiatric Interview suicidality module items to assess their suicide risk. Results: The 18-item OCI-R demonstrated satisfactory sensitivity (0.900) and specificity (0.662) at a total cutoff score of 10 in relation to the identification of Nigerian patients with schizophrenia with significant suicide risk. At this cutoff score, the area under the receiver operating characteristic curve was 0.817 (95% confidence interval: 0.735–0.898), and positive predictive value (0.726) and negative predictive value (0.869) were also satisfactory. The OCI-R also demonstrated satisfactory internal consistency and construct validity. Conclusion: The OCI-R has demonstrated to be useful as a subjective suicide risk assessment tool among Nigerian schizophrenia patients.

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Dihydroergotamine complicating reversible cerebral vasoconstriction syndrome in status migrainosus

Naresh Mullaguri, Madihah Hepburn, Christopher Ryan Newey, Premkumar Chandrasekharan Nattanmai

Journal of Neurosciences in Rural Practice 2018 9(2):272-275

Reversible cerebral vasoconstriction syndrome (RCVS) is a clinicoradiological syndrome that occurs due to dysfunction of cerebrovascular autoregulation. It is characterized by recurrent thunderclap headache from cerebral vasoconstriction which can cause ischemic infarction, spontaneous intraparenchymal and subarachnoid hemorrhage. This syndrome can be triggered by a variety of etiologies including medications, infectious, and inflammatory conditions. The diagnosis is often delayed due to unawareness among the health-care providers and delayed neuroimaging evidence of vasoconstriction with or without ischemic and/or hemorrhagic infarction. Status migrainosus is a prevalent condition requiring emergency room visits and inpatient admission. Thus, patients with RCVS can be easily misdiagnosed with migraine. We report a patient with RCVS misdiagnosed as status migrainosus with visual aura, treated with intravenous dihydroergotamine with worsening of cerebral vasoconstriction and lead to ischemic and hemorrhagic complications. We discuss this complication and provide guidance on differentiating between migraine and RCVS.

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Prevalence of the systemic inflammatory response syndrome in patients who underwent orthognathic surgery

Abstract

Purpose

The systemic inflammatory response syndrome (SIRS) is the body's response to an insult, such as infection, trauma, burn, and surgical stress linked to several factors deemed potential for multiple organ failure if left untreated. Thus, the aim of this paper was a prospective study to examine the incidence of SIRS in postoperative patients who underwent orthognathic surgery from June/2013 to July/2016.

Methods

The sample consisted of 80 patients who underwent bimaxillary orthognathic surgery, with data on vital signs and white blood cell count collected preoperatively, and the same data collected in the immediate postoperative period, in addition to CO₂ pressure in arterial blood by blood gas analysis. The data were tabulated and cases of SIRS (2 or more signs out of four pre-set signs) were identified within 24 h after surgery.

Results

From the sample of 80 patients, 26 (32.5% of total) patients had SIRS with higher incidence in females who are 40 years old.

Conclusion

The incidence of patients who develop SIRS after orthognathic surgery is relatively high and we should pay attention to the possible complications that these cases can evolve.

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Oral rehabilitation of patients after maxillectomy. A systematic review

Publication date: Available online 11 April 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): D.M. dos Santos, F.P. de Caxias, S.B. Bitencourt, K.H. Turcio, A.A. Pesqueira, M.C. Goiato
Patients who have maxillectomy can be rehabilitated with reconstructive surgery or obturator prostheses with or without osseointegratable implants. To identify studies on possible treatments in this group, we systematically searched the Scopus, Embase, PubMed/Medline, and Cochrane databases to collect data on patients' characteristics, radiotherapy, and results related to speech, swallowing, mastication or diet, chewing, aesthetics, and quality of life. Of the 1376 papers found, six were included, and one other was included after an additional search of references. A total of 252 patients were included, and of them, 86 had reconstructive surgery, 91 were treated with obturator prostheses, 39 had reconstructive surgery or obturator prostheses associated with implants, and 36 had reconstruction plus an obturator prosthesis. Data on radiotherapy were incomplete. There is a lack of consensus about the indication for rehabilitation, as the treatment must be based on the individual characteristics of each patient.



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Use of the MatrixWAVE™ system with dentures to establish maxillomandibular fixation in edentulous patients

Publication date: Available online 11 April 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): N.B. Agochukwu, J. Maus, D. Wang, D. Stewart
Various methods have been described to establish maxillomandibular fixation in the treatment of fractures of atrophic, edentulous mandibles. We used the Synthes MatrixWAVE™ system (DePuy Synthes) in combination with dentures in two patients with fractured, edentulous, atrophic mandibles. Fixation was maintained for fractures that were not amenable to, or did not require, open reduction and internal fixation, and the mandibles were both well-healed and had good function at the end of treatment.



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Cranial growth in infants─a longitudinal three-dimensional analysis of the first months of life

Publication date: Available online 11 April 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Philipp Meyer-Marcotty, Felix Kunz, Tilmann Schweitzer, Barbara Wachter, Hartmut Böhm, Nina Waßmuth, Christian Linz
PurposeIn the first months of life, any deviation from a physiological growth pattern can cause skull deformity. As there has not been any longitudinal three-dimensional (3D) study investigating the physiological growth of the infant skull, the aim of the present study was to acquire such data.Materials and MethodsWe performed 3D stereophotogrammetric scans of 40 infants without cranial asymmetry at four regular 2-month intervals from the 4^th to the 10^th month of age. Six growth-related parameters (circumference, length, width, height, cranial index [CI; width-length ratio] and total head volume) were used to analyse skull growth longitudinally.ResultsWith exception of the CI, all parameters showed significant increases, with maximum percentage growth from the 4^th to the 6^th month. The CI initially remained unchanged until the 6^th month, before showing a significant reduction that continued throughout the study period. Male infants had larger heads than female infants, but a similar width-length ratio at all measurement times.ConclusionThis prospective study is the first longitudinal 3D analysis to examine the physiological growth dynamics of infants' heads within the first months of life. Understanding patterns of skull growth in all three dimensions is important for gaining further insights into physiological and pathophysiological skull development.



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A series of 240 odontogenic keratocysts: Should we continue to use the terminology of ‘keratocystic odontogenic tumor’ for the solid variant of odontogenic keratocyst?

Publication date: Available online 11 April 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Devrim Kahraman, Omer Gunhan, Bulent Celasun
Most of the odontogenic keratocysts show an indolent behaviour like non-neoplastic lesions. For this reason, the odontogenic keratocyst was reclassified within the odontogenic cysts category in the WHO 2017 classification. Some odontogenic keratocysts may contain satellite cysts or solid squamoid islands within their wall. Recently, a solid form of odontogenic keratocyst has also been described which is composed entirely of multiple epithelial islands and small cysts in a collagenous stroma. The true nature of this variant is unclear yet.In this article, we present a series of 204 odontogenic keratocyst cases. Clinical and histologic findings of the cases in this series were described. These were also categorised according to the presence of satellite lesions. Additionally, the features of two cases of the solid form of odontogenic keratocysts were compared with those of the previous reports and other histologically similar odontogenic lesions. Current evidence suggests that this variant may be neoplastic and it differs from other odontogenic keratocysts, at least histologically. We believe diagnosing a solid lesion as a cyst is counterintuitive and the term "keratocystic odontogenic tumor" better describes this particular variant.



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“Virtual histology uncertainty in Synchrotron x-ray micro-Computed Tomography evaluation”

Publication date: Available online 11 April 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): T. Lauridsen, R. Feidenhans'l, E.M. Pinholt
A three-dimensional (3D) X-ray tomogram evaluation gives a full view of the bone distribution around an entire implant in contrast to the often-used two-dimensional (2D) histological methods. High-resolution X-ray absorption tomography was used to evaluate the 3D bone growth around dental implants in an experimental goat mandible reconstruction model. The tomograms allowed for the construction of virtual histological cross-sections that could be used to evaluate the statistical uncertainty of the histological methods, which was the purpose of this paper. The virtual 2D histological results showed a significantly higher uncertainty within the same sample than did the full 3D volume results.



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Ten Years of Observations and Demographics of Hemimandibular Hyperplasia and Elongation

Publication date: Available online 11 April 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Kamil H. Nelke, Wojciech Pawlak, Monika Morawska-Kochman, Klaudiusz Łuczak
IntroductionThe full epidemiology and etiology of hemimandibular hyperplasia (HH) has not yet been clarified. In most cases it starts before puberty and results in various forms of dento-alveolar and skeletal discrepancies. This study is the first attempt at evaluating and describing some of the authors' key experiences, clinical philosophical approach, and gathered demographic data on hemimandibular hyperplasia and hemimandibular elongation (HE) among the Polish population.Material and methodA total of 45 patients (M=8; F=37; p<0.05) with HE (n=16; 35.6%; p<0.05), HH (n=28; 62.2%; p<0.05), or HH+HE (n=1; 2.2%; p>0.05) had been diagnosed and treated. Epidemiological, geographical, and clinical data concerning the occurrence and treatment protocols in these mandibular malformations were measured in the Polish study groups.ResultsWomen more often suffered from these mandibular malformations (82–87%). The occurrence of the first symptoms was highest at the age of 13–15 years and was statistically significant for both sides (p<0.05). The disorders were found earlier in young girls, therefore an early compensatory orthodontic treatment in some cases had been used with a limited degree of success (p>0.05). All values of bone scintigraphy were significant (p<0.001).ConclusionsA very fast growth with visible major asymmetry and enlarged condylar head should be an indication for condylectomy. Women's expectations from surgery and treatment are more demanding than men's, a fact that is connected with the predominance of females in the study group. Almost all possible treatment alternatives are not only related with the degree of skeletal deformity, but also with the patient's willingness to undergo any necessary treatment protocols, which in most cases involve more than one stage. Skeletal scintigraphy tests are an important factor in estimating bone growth and possible surgical approaches in these disorders.



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Gender differences in morphological and functional outcomes after mandibular setback surgery

Publication date: Available online 11 April 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Khaled Dahy, Katsu Takahashi, Kazuyuki Saito, Honoka Kiso, Ibrahim Rezk, Toru Oga, Ryuji Uozumi, Kazuo Chin, Kazuhisa Bessho
PurposeThe aim of this study was to examine and compare morphological and functional outcomes after either isolated mandibular setback or bimaxillary surgery in males and females.Materials and MethodsA retrospective study was done on 52 patients, in whom surgical correction for mandibular prognathism was performed either by isolated mandibular setback (30 cases) or by bimaxillary surgery (22 cases). Morphological changes were studied using cephalograms and functional changes studied using impulse oscillometry (IOS) taken before surgery (T0), 3 months (T1) and 1 year after surgery (T2). Also 3% oxygen desaturation index (ODI) was measured at T0 and T2.ResultPosterior airway space decreased significantly in both groups and both sexes but more so in males after mandibular setback surgery and in females after bimaxillary surgery. Changes in supine R20 (central airway resistance at 20 Hz) and supine R5 (total airway resistance at 5 Hz) in IOS statistically significantly increased in the period T0–T1 in males compared with females after mandibular setback surgery (p < 0.05).ConclusionGender dimorphism is present according to morphological and functional outcomes, with males at a higher risk for obstructive sleep apnea (OSA) after mandibular setback surgery and females after bimaxillary surgery; howevert, compensatory changes act as a barrier against this.



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Does lag screw fixation of condylar fractures result in adequate stability? A finite element analysis

Publication date: Available online 11 April 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Ricardo Augusto Conci, Eleonor Álvaro Garbin, Geraldo Luiz Griza, Natasha Magro Érnica, Pedro Yoshito Noritomi, Flavio Henrique Silveira Tomazi, Guilherme Genehr Fritscher, Claiton Heitz
The great incidence and controversies related to the diagnosis, treatment, surgical accesses, and type of osteosynthesis materials confer an outstanding role to condylar fractures among facial fractures. Plate configurations, with diverse formats and sizes, may be used to surgically resolve condylar fractures. With the purpose of improving the advantages and minimizing the disadvantages of fixation techniques, the neck screw was developed aiming at the needed stabilization to render a correct fixation through a system of dynamic compression. This is achieved by increasing the contact between the fractured bone stumps, as well as assisting at the time of fracture reduction. The present paper aims at comparing the fixation and stability of mandibular condylar fractures using the neck screw and an overlaid "L"-shaped-4-hole-2mm plate on the one hand, with a system in which the neck screw and the "L"-shaped plate form a single structure, having been joined by a welded point, on the other hand. The results with the neck screw are satisfactory, and, thus, it is an alternative for the reduction and fixation of fractures of the mandibular condyle, whether or not a plate is joined to the structure, provided it is correctly prescribed and with adequate surgical sequence and technique.



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Intraoperative Venovenous Extracorporeal Membrane Oxygenation as Rescue for a Patient With an Inhalational Burn and Iatrogenic Upper Airway Injury: A Case Report.

Related Articles

Intraoperative Venovenous Extracorporeal Membrane Oxygenation as Rescue for a Patient With an Inhalational Burn and Iatrogenic Upper Airway Injury: A Case Report.

A A Pract. 2018 Mar 01;:

Authors: Davis CA, Paladino AD, Lassiter WB, Sharma A, Brady KM

Abstract
Venovenous extracorporeal membrane oxygenation (VV-ECMO) is a well-established alternative oxygenation method for critically ill patients. A 58-year-old male was transferred to our level 1 trauma and burn center after sustaining an inhalational injury from a carburetor explosion, with subsequent iatrogenic tracheal injury and emergent cricothyrotomy before arrival. During attempted surgical airway stabilization, our ability to ventilate and oxygenate was compromised. Intraoperative VV-ECMO enabled rescue from severe hypoxemia and subsequent recovery without lasting neurologic sequelae. This case highlights the utility of VV-ECMO for acute intraoperative rescue.

PMID: 29634536 [PubMed - as supplied by publisher]

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Urine Cotinine Should Be Involved in Initial Evaluation of Tinnitus in Adolescents.

Related Articles

Urine Cotinine Should Be Involved in Initial Evaluation of Tinnitus in Adolescents.

Clin Exp Otorhinolaryngol. 2018 Apr 10;:

Authors: Lee DY, Kim YH

Abstract
Objectives: Smoking is associated with hearing loss, while the correlation between tinnitus and smoking is not fully elucidated. This study aimed to evaluate risk factors of tinnitus in adolescents in terms of smoking, and we identified a rectifiable parameter that can be serially monitored.
Methods: A cross-sectional study was conducted using data from the Korea National Health and Nutrition Examination Survey, with 2,782 participants aged 12 to 18 years, from 2008 through 2011. Participants with history of ear disease, hearing loss, and inadequate responses to questionnaires were excluded. We investigated the prevalence of tinnitus and tinnitus-related annoyance by questionnaire and sought potential risk factors in blood and urine tests and smoking history.
Results: The prevalence of tinnitus in the 12- to 18-year-old population was 17.5%, with 3.3% reporting tinnitus-related annoyance. On univariate analysis, the prevalence of tinnitus increased with age (P<0.001) and was higher among girls (P=0.012). Blood tests and urinalysis showed significant correlation between tinnitus and red blood cell count, alkaline phosphatase levels, and urine cotinine (P=0.002, P<0.001, P=0.018, respectively). In multivariate analysis, the urine cotinine level was the only parameter associated with tinnitus (odds ratio, 1.000; 95% confidence interval, 0.999 to 1.000; P=0.038). Smoking was also significantly correlated with tinnitus (P=0.043), and amount of smoking with tinnitus-related annoyance (P=0.045). However, current smoking and past smoking were not correlated with tinnitus.
Conclusion: Urine cotinine may be a rectifiable marker for management of tinnitus in adolescents. This suggests that smoking cessation should be incorporated in the management of tinnitus in adolescents.

PMID: 29631390 [PubMed - as supplied by publisher]

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Fabrication and characterisation of a novel biomimetic anisotropic ceramic/polymer-infiltrated composite material

Publication date: Available online 10 April 2018
Source:Dental Materials
Author(s): Sara Al-Jawoosh, Anthony Ireland, Bo Su
ObjectiveTo fabricate and characterise a novel biomimetic composite material consisting of aligned porous ceramic preforms infiltrated with polymer.MethodFreeze-casting was used to fabricate and control the microstructure and porosity of ceramic preforms, which were subsequently infiltrated with 40–50% by volume UDMA-TEGDMA polymer. The composite materials were then subjected to characterisation, namely density, compression, three-point bend, hardness and fracture toughness testing. Samples were also subjected to scanning electron microscopy and computerised tomography (Micro-CT).ResultsThree-dimensional aligned honeycomb-like ceramic structures were produced and full interpenetration of the polymer phase was observed using micro-CT. Depending on the volume fraction of the ceramic preform, the density of the final composite ranged from 2.92 to 3.36g/cm³, compressive strength ranged from 206.26 to 253.97MPa, flexural strength from 97.73 to 145.65MPa, hardness ranged from 1.46 to 1.62GPa, and fracture toughness from 3.91 to 4.86MPam^1/2.SignificanceFreeze-casting provides a novel method to engineer composite materials with a unique aligned honeycomb-like interpenetrating structure, consisting of two continuous phases, inorganic and organic. There was a correlation between the ceramic fraction and the subsequent, density, strength, hardness and fracture toughness of the composite material.



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Fifty years of ERCP: a personal review

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La intervención en habilidades narrativas en alumnado con dificultades del lenguaje. Una oportunidad para el trabajo colaborativo entre logopedas, profesorado y familias1

Publication date: April–June 2018
Source:Revista de Logopedia, Foniatría y Audiología, Volume 38, Issue 2
Author(s): Víctor M. Acosta Rodríguez, Nayarit del Valle Hernández, Gustavo Ramírez Santana




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Proficiency-based preparation significantly improves FES certification performance

Abstract

Background

The Fundamentals of Endoscopic Surgery (FES) certification has recently been mandated by the American Board of Surgery but best methods for preparing for the exam are lacking. Our previous work demonstrated a 40% pass rate for PGY5 residents in our program. The purpose of this study was to determine the effectiveness of a proficiency-based skills and cognitive curriculum for FES certification.

Methods

Residents who agreed to participate (n = 15) underwent an orientation session, followed by skills pre-testing using three previously described models (Trus, Operation targeting task, and Kyoto) as well as the actual FES skills exam (vouchers provided by the FES committee). Participants then trained to proficiency on all three models for the skills curriculum and completed the FES online didactic material for the cognitive curriculum. Finally, participants post-tested on the models and took the actual FES certification exam. Values are mean ± SD; p < 0.05 was considered significant.

Results

Of 15 residents who participated, 8 (53%) passed the FES skills exam at baseline. Participants required 2.7 ± 1.3 h to achieve proficiency on the models and approximately 3 h to complete the cognitive curriculum. At post-test, 14 (93%, vs. pre-test 53%, p = 0.041) passed the FES skills exam. 14 (93%) passed the FES cognitive exam and 13/15 (87%) passed both the skills and cognitive exam and achieved FES certification.

Conclusions

Our traditional clinical endoscopy curricula were not sufficient for senior residents to pass the FES exam. Implementation of a proficiency-based flexible endoscopy curriculum using bench-top models and the FES online materials was feasible and effective for the majority of learners. Importantly, with a modest amount of additional training, 87% of our trainees were able to pass the FES examination, which represents a significant improvement for our program. We expect that additional refinements of this curriculum may yield even better results for preparing future residents for the FES examination.

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Oral rehabilitation of patients after maxillectomy. A systematic review

Patients who have maxillectomy can be rehabilitated with reconstructive surgery or obturator prostheses with or without osseointegratable implants. To identify studies on possible treatments in this group, we systematically searched the Scopus, Embase, PubMed/Medline, and Cochrane databases to collect data on patients' characteristics, radiotherapy, and results related to speech, swallowing, mastication or diet, chewing, aesthetics, and quality of life. Of the 1376 papers found, six were included, and one other was included after an additional search of references.

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Use of the MatrixWAVE™ system with dentures to establish maxillomandibular fixation in edentulous patients

Various methods have been described to establish maxillomandibular fixation in the treatment of fractures of atrophic, edentulous mandibles. We used the Synthes MatrixWAVE™ system (DePuy Synthes) in combination with dentures in two patients with fractured, edentulous, atrophic mandibles. Fixation was maintained for fractures that were not amenable to, or did not require, open reduction and internal fixation, and the mandibles were both well-healed and had good function at the end of treatment.

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American Journal of Cancer Research; +16 new citations

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

American Journal of Cancer Research

These pubmed results were generated on 2018/04/11

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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Significance of Testing Anti-Thyroid Autoantibodies in Patients with Deranged Thyroid Profile

Background. We hypothesized that anti-thyroid antibodies are more often positive in individuals with deranged thyroid profile. Methods. This prospective cohort was done in Immunology Department, Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from Jan 2017 to Oct 2017. All the samples that were referred to us for testing anti-thyroid antibodies (anti-TPO or anti-TG antibodies) and thyroid profile were included in the study. There were no exclusion criteria. Tests for anti-thyroid antibodies were performed by ELISA and thyroid profile by chemiluminescence. SPSS 23.0 was used for statistical analysis. Results. Over a course of a ten-month study period, we received a total of 316 serum samples for anti-TPO/TG antibodies along with thyroid profile testing (TSH). These included 115 males (36.4%) and 201 females (63.6%). Their age ranged from 3 to 89 years (mean ± SD, 42.22 ± 18.09). Anti-TPO antibodies were more often positive when TSH was deranged ( value 0.001). Anti-TPO antibodies are more often raised in females, in terms of both prevalence ( 0.001) and mean rank ( 0.002). Conclusion. As anti-thyroid antibodies are more often present when TSH is deranged, such individuals should be screened for anti-thyroid antibodies. This importance of screening is compounded by the fact that anti-thyroid antibodies may be positive in a significant percentage of elderly people.

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Cranial growth in infants─a longitudinal three-dimensional analysis of the first months of life

Publication date: Available online 11 April 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Philipp Meyer-Marcotty, Felix Kunz, Tilmann Schweitzer, Barbara Wachter, Hartmut Böhm, Nina Waßmuth, Christian Linz
PurposeIn the first months of life, any deviation from a physiological growth pattern can cause skull deformity. As there has not been any longitudinal three-dimensional (3D) study investigating the physiological growth of the infant skull, the aim of the present study was to acquire such data.Materials and MethodsWe performed 3D stereophotogrammetric scans of 40 infants without cranial asymmetry at four regular 2-month intervals from the 4^th to the 10^th month of age. Six growth-related parameters (circumference, length, width, height, cranial index [CI; width-length ratio] and total head volume) were used to analyse skull growth longitudinally.ResultsWith exception of the CI, all parameters showed significant increases, with maximum percentage growth from the 4^th to the 6^th month. The CI initially remained unchanged until the 6^th month, before showing a significant reduction that continued throughout the study period. Male infants had larger heads than female infants, but a similar width-length ratio at all measurement times.ConclusionThis prospective study is the first longitudinal 3D analysis to examine the physiological growth dynamics of infants' heads within the first months of life. Understanding patterns of skull growth in all three dimensions is important for gaining further insights into physiological and pathophysiological skull development.



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A series of 240 odontogenic keratocysts: Should we continue to use the terminology of ‘keratocystic odontogenic tumor’ for the solid variant of odontogenic keratocyst?

Publication date: Available online 11 April 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Devrim Kahraman, Omer Gunhan, Bulent Celasun
Most of the odontogenic keratocysts show an indolent behaviour like non-neoplastic lesions. For this reason, the odontogenic keratocyst was reclassified within the odontogenic cysts category in the WHO 2017 classification. Some odontogenic keratocysts may contain satellite cysts or solid squamoid islands within their wall. Recently, a solid form of odontogenic keratocyst has also been described which is composed entirely of multiple epithelial islands and small cysts in a collagenous stroma. The true nature of this variant is unclear yet.In this article, we present a series of 204 odontogenic keratocyst cases. Clinical and histologic findings of the cases in this series were described. These were also categorised according to the presence of satellite lesions. Additionally, the features of two cases of the solid form of odontogenic keratocysts were compared with those of the previous reports and other histologically similar odontogenic lesions. Current evidence suggests that this variant may be neoplastic and it differs from other odontogenic keratocysts, at least histologically. We believe diagnosing a solid lesion as a cyst is counterintuitive and the term "keratocystic odontogenic tumor" better describes this particular variant.



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“Virtual histology uncertainty in Synchrotron x-ray micro-Computed Tomography evaluation”

Publication date: Available online 11 April 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): T. Lauridsen, R. Feidenhans'l, E.M. Pinholt
A three-dimensional (3D) X-ray tomogram evaluation gives a full view of the bone distribution around an entire implant in contrast to the often-used two-dimensional (2D) histological methods. High-resolution X-ray absorption tomography was used to evaluate the 3D bone growth around dental implants in an experimental goat mandible reconstruction model. The tomograms allowed for the construction of virtual histological cross-sections that could be used to evaluate the statistical uncertainty of the histological methods, which was the purpose of this paper. The virtual 2D histological results showed a significantly higher uncertainty within the same sample than did the full 3D volume results.



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Ten Years of Observations and Demographics of Hemimandibular Hyperplasia and Elongation

Publication date: Available online 11 April 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Kamil H. Nelke, Wojciech Pawlak, Monika Morawska-Kochman, Klaudiusz Łuczak
IntroductionThe full epidemiology and etiology of hemimandibular hyperplasia (HH) has not yet been clarified. In most cases it starts before puberty and results in various forms of dento-alveolar and skeletal discrepancies. This study is the first attempt at evaluating and describing some of the authors' key experiences, clinical philosophical approach, and gathered demographic data on hemimandibular hyperplasia and hemimandibular elongation (HE) among the Polish population.Material and methodA total of 45 patients (M=8; F=37; p<0.05) with HE (n=16; 35.6%; p<0.05), HH (n=28; 62.2%; p<0.05), or HH+HE (n=1; 2.2%; p>0.05) had been diagnosed and treated. Epidemiological, geographical, and clinical data concerning the occurrence and treatment protocols in these mandibular malformations were measured in the Polish study groups.ResultsWomen more often suffered from these mandibular malformations (82–87%). The occurrence of the first symptoms was highest at the age of 13–15 years and was statistically significant for both sides (p<0.05). The disorders were found earlier in young girls, therefore an early compensatory orthodontic treatment in some cases had been used with a limited degree of success (p>0.05). All values of bone scintigraphy were significant (p<0.001).ConclusionsA very fast growth with visible major asymmetry and enlarged condylar head should be an indication for condylectomy. Women's expectations from surgery and treatment are more demanding than men's, a fact that is connected with the predominance of females in the study group. Almost all possible treatment alternatives are not only related with the degree of skeletal deformity, but also with the patient's willingness to undergo any necessary treatment protocols, which in most cases involve more than one stage. Skeletal scintigraphy tests are an important factor in estimating bone growth and possible surgical approaches in these disorders.



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Gender differences in morphological and functional outcomes after mandibular setback surgery

Publication date: Available online 11 April 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Khaled Dahy, Katsu Takahashi, Kazuyuki Saito, Honoka Kiso, Ibrahim Rezk, Toru Oga, Ryuji Uozumi, Kazuo Chin, Kazuhisa Bessho
PurposeThe aim of this study was to examine and compare morphological and functional outcomes after either isolated mandibular setback or bimaxillary surgery in males and females.Materials and MethodsA retrospective study was done on 52 patients, in whom surgical correction for mandibular prognathism was performed either by isolated mandibular setback (30 cases) or by bimaxillary surgery (22 cases). Morphological changes were studied using cephalograms and functional changes studied using impulse oscillometry (IOS) taken before surgery (T0), 3 months (T1) and 1 year after surgery (T2). Also 3% oxygen desaturation index (ODI) was measured at T0 and T2.ResultPosterior airway space decreased significantly in both groups and both sexes but more so in males after mandibular setback surgery and in females after bimaxillary surgery. Changes in supine R20 (central airway resistance at 20 Hz) and supine R5 (total airway resistance at 5 Hz) in IOS statistically significantly increased in the period T0–T1 in males compared with females after mandibular setback surgery (p < 0.05).ConclusionGender dimorphism is present according to morphological and functional outcomes, with males at a higher risk for obstructive sleep apnea (OSA) after mandibular setback surgery and females after bimaxillary surgery; howevert, compensatory changes act as a barrier against this.



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Does lag screw fixation of condylar fractures result in adequate stability? A finite element analysis

Publication date: Available online 11 April 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Ricardo Augusto Conci, Eleonor Álvaro Garbin, Geraldo Luiz Griza, Natasha Magro Érnica, Pedro Yoshito Noritomi, Flavio Henrique Silveira Tomazi, Guilherme Genehr Fritscher, Claiton Heitz
The great incidence and controversies related to the diagnosis, treatment, surgical accesses, and type of osteosynthesis materials confer an outstanding role to condylar fractures among facial fractures. Plate configurations, with diverse formats and sizes, may be used to surgically resolve condylar fractures. With the purpose of improving the advantages and minimizing the disadvantages of fixation techniques, the neck screw was developed aiming at the needed stabilization to render a correct fixation through a system of dynamic compression. This is achieved by increasing the contact between the fractured bone stumps, as well as assisting at the time of fracture reduction. The present paper aims at comparing the fixation and stability of mandibular condylar fractures using the neck screw and an overlaid "L"-shaped-4-hole-2mm plate on the one hand, with a system in which the neck screw and the "L"-shaped plate form a single structure, having been joined by a welded point, on the other hand. The results with the neck screw are satisfactory, and, thus, it is an alternative for the reduction and fixation of fractures of the mandibular condyle, whether or not a plate is joined to the structure, provided it is correctly prescribed and with adequate surgical sequence and technique.



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In vitro study of a modified sagittal split osteotomy fixation technique of the mandible: a mechanical test

This study was performed to evaluate the compressive mechanical strength of rigid internal fixation (RIF) using 1.5-mm L-shaped plates fixed with monocortical screws in sagittal split osteotomy (SSO). Thirty synthetic hemimandibles, which had all undergone a 5-mm advancement, were divided into three groups: three 12-mm bicortical titanium screws were placed in an inverted L pattern in group A; one straight 2.0-mm system spaced titanium plate fixed with four 5-mm monocortical screws was used in group B; two 1.5-mm system L-shaped titanium plates, each fixed with four 5-mm monocortical screws, were used in group C.

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Risk factors and clinical outcomes of sinus membrane perforation during lateral window sinus lifting: analysis of 120 patients

The aim of this study was to identify the risk factors associated with sinus membrane perforation and the effect of sinus membrane perforation and other risk factors on graft success and postoperative sinusitis. Sinus membrane perforation, graft failure, and postoperative sinusitis were tested for an association with age, sex, operator experience, side of the operation, residual bone height, presence of septa, presence of a mucous retention cyst, and smoking (χ2 test). Logistic regression analysis was used to model the odds ratio (OR) with corresponding risk factors.

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Palatal orthodontic miniscrew insertion using a CAD-CAM surgical guide: description of a technique

Publication date: Available online 11 April 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): M. Cassetta, F. Altieri, R. Di Giorgio, E. Barbato
The aim of this report was to describe a new computer-guided technique for a controlled site preparation and palatal orthodontic miniscrew insertion using a dedicated software. A surgical guide was designed after planning the appropriate insertion sites on three-dimensional images created by the fusion of cone-beam computed tomography (CBCT) and digital dental model images. Pre- and postoperative CBCT images were compared and the angular, coronal, and apical deviations between the planned and the placed miniscrews were calculated. The mean coronal and apical deviations were 1.38mm (range: 3.48–0.15mm; standard deviation (SD): 0.65) and 1.73mm (range: 5.41–0.10mm; SD: 1.03), respectively, while the mean angular deviation was 4.60° (range: 15.23–0.54°; SD: 2.54). The present surgical guide allows a controlled and accurate palatal miniscrew placement in three dimensions.



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Risk factors and clinical outcomes of sinus membrane perforation during lateral window sinus lifting: analysis of 120 patients

Publication date: Available online 11 April 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): H.C. Tükel, U. Tatli
The aim of this study was to identify the risk factors associated with sinus membrane perforation and the effect of sinus membrane perforation and other risk factors on graft success and postoperative sinusitis. Sinus membrane perforation, graft failure, and postoperative sinusitis were tested for an association with age, sex, operator experience, side of the operation, residual bone height, presence of septa, presence of a mucous retention cyst, and smoking (χ² test). Logistic regression analysis was used to model the odds ratio (OR) with corresponding risk factors. One hundred and twenty patients were included in this study. A total of 22 (18.3%) perforations occurred. A residual bone height of 3–6mm (OR 6.808, P=0.002) and presence of septa (OR 4.023, P=0.025) were identified as significant risk factors. Twenty-eight (23.3%) sinus grafts were classified as failed. Membrane perforation (OR 16.819, P<0.005) and residual bone height of 3–6mm (OR 5.363, P=0.01) were identified as significant risk factors for graft failure. None of the risk factors investigated in this study was significantly associated with postoperative sinusitis. These results suggest that the presence of septa and a residual bone height of 3–6mm are associated with an increased risk of sinus membrane perforation, and that sinus membrane perforation has a negative effect on graft success.



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Clinicopathological investigation of odontogenic fibroma in tuberous sclerosis complex

Publication date: Available online 10 April 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): A. Musha, S. Yokoo, Y. Takayama, H. Sato
Tuberous sclerosis complex (TSC) is an autosomal dominant inherited disease characterized by systemic hamartoma and diverse systemic features. TSC1 and TSC2 are the causative genes, and mental retardation, epileptic seizures, and facial angiofibroma develop in many patients with the disease. The case of a patient with TSC who developed a central odontogenic fibroma of the mandible is reported here. The patient was a 21-year-old woman who was referred with a swelling of the labial gingiva in the region of the right lower lateral incisor and canine. Dental radiography revealed a multilocular radiolucent region with a clear boundary. The right lower lateral incisor and canine were continuous with the lesion and thus were excised en bloc. The lesion was encapsulated and easily dissected. The diagnosis on immunohistological staining was odontogenic fibroma without an epithelial component. TSC1/2 gene mutation causes abnormal activation of mammalian target of rapamycin (mTOR) downstream of the PI3K–AKT pathway. The odontogenic fibroma in this patient was positive for mTOR, suggesting that the development of the odontogenic fibroma was the result of abnormal activation of mTOR, as in angiofibroma. The clinical course of this patient is presented and the developmental mechanism of central odontogenic fibroma is discussed.



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Splanchnic Vein Thrombosis in the Myeloproliferative Neoplasms

Abstract

Purpose of Review

To review the epidemiology, diagnostic challenges, pathogenesis, and treatment strategies for patients with myeloproliferative neoplasm-associated splanchnic vein thrombosis.

Recent Findings

The epidemiology of myeloproliferative neoplasm-associated splanchnic vein thrombosis (MPN-SVT) has been well characterized. While typical MPN-associated thrombosis affects older patients and involves the arterial circulation, MPN-SVT mostly impacts younger women. An association with JAK2 V617F is well-known; recent studies have demonstrated only a weak association with CALR mutations. JAK inhibition may represent a novel treatment strategy, complementing anticoagulation, and management of portal hypertension.

Summary

While the epidemiology has been well characterized, more work is needed to identify novel contributors to disease pathogenesis, beyond the JAK2 V617F mutation itself, and endothelial compromise. Testing for MPN mutations in the setting of non-cirrhotic SVT is commonplace; JAK2 V617F is the most likely to be identified. Testing for CALR or MPL mutations requires clinical judgement, though not unreasonable. The mainstay of therapy is indefinite anticoagulation; the role of direct oral anticoagulants is unclear. JAK inhibition may play a role in addressing associated splenomegaly and portal hypertension.

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An evidence based protocol for managing neonatal middle ear effusions in babies who fail newborn hearing screening

To evaluate the prevalence of middle ear disease in infants referred for failed newborn hearing screening (NBHS) and to review patient outcomes after intervention in order to propose an evidence-based protocol for management of newborns with otitis media with effusion (OME) who fail NBHS.

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