OtoRhinoLaryngology News: 09/08/16

Πέμπτη 8 Σεπτεμβρίου 2016

Treatment Approach for Maxillary Hypoplasia in Cleft Patients: Class III Elastics with Skeletal Anchorage (Report of Two Cases).

Treatment Approach for Maxillary Hypoplasia in Cleft Patients: Class III Elastics with Skeletal Anchorage (Report of Two Cases).

Iran J Otorhinolaryngol. 2016 Jul;28(87):297-302

Authors: Jahanbin A, Kazemian M, Saeedi-Pouya I, Eslami N, Shafaee H

Abstract
INTRODUCTION: Treatment of cleft lip and palate patients requires a multidisciplinary plan. These patients usually have a hypoplastic maxilla due to the prior surgical scars. Orthognathic surgery to advance the maxilla in these patients is not very efficient; therefore, orthopedic interventions during an appropriate age seems to be essential.
CASE REPORT: In this article, two cleft lip and palate patients have been treated with Class III elastics anchored to the maxillary posterior and mandibular anterior miniplates in order to induce maxillary advancement.
CONCLUSION: Both cases showed a significant improvement in their profiles with minimal dentoalveolar compensations. A counterclockwise rotation of the mandible occurred.

PMID: 27602343 [PubMed]

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Unusually Giant Sublingual Epidermoid Cyst: A Case Report.

Unusually Giant Sublingual Epidermoid Cyst: A Case Report.

Iran J Otorhinolaryngol. 2016 Jul;28(87):291-6

Authors: Nishar CC, Ambulgekar VK, Gujrathi AB, Chavan PT

Abstract
INTRODUCTION: Epidermoid cysts are rare, slow‑growing, benign, developmental cysts, which are derived from abnormally situated ectodermal tissue. Epidermoid cysts of the floor of the mouth represent <0.01% of all oral cysts. So far, only a few cases have been reported.
CASE REPORT: Hereby, we present a case of a giant sublingual epidermoid cyst, which was completely asymptomatic upon presentation. However, due to its large size, it pushed the epiglottis posteriorly and created difficulty during intubation. The patient developed respiratory distress after its surgical excision and extubation, requiring tracheostomy post operatively. The patient recovered well and a successful weaning of tracheostomy was performed, giving the patient a healthy life.
CONCLUSION: Epidermoid cyst is a rare differential diagnosis of sublingual swelling that should be kept in mind for large asymptomatic swellings in this region. The only symptom it can cause might be respiratory distress due to its large size. This can happen not only pre-operatively but also post-operatively and the surgeon should be ready for immediate tracheostomy.

PMID: 27602342 [PubMed]

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Intraparotid Neurofibroma of the Facial Nerve: A Case Report.

Intraparotid Neurofibroma of the Facial Nerve: A Case Report.

Iran J Otorhinolaryngol. 2016 Jul;28(87):287-90

Authors: Nofal AA, El-Anwar MW

Abstract
INTRODUCTION: Intraparotid neurofibromas of the facial nerve are extremely rare and mostly associated with neurofibromatosis type 1 (NF1).
CASE REPORT: This is a case of a healthy 40-year-old man, which underwent surgery for a preoperatively diagnosed benign parotid gland lesion. After identification of the facial nerve main trunk, a single large mass (6 x 3 cm) incorporating the upper nerve division was observed. The nerve portion involved in the mass could not be dissected and was inevitably sacrificed with immediate neuroraphy of the upper division of the facial nerve with 6/0 prolene. The final histopathology revealed the presence of a neurofibroma. Complete left side facial nerve paralysis was observed immediately postoperatively but the function of the lower half was returned within 4 months and the upper half was returned after 1 year. Currently, after 3 years of follow up, there are no signs of recurrence and normal facial nerve function is observed.
CONCLUSION: Neurofibroma should be considered as the diagnosis in a patient demonstrating a parotid mass. In cases where it is diagnosed intraoperatively, excision of part of the nerve with the mass will be inevitable though it can be successfully repaired by end to end anastomosis.

PMID: 27602341 [PubMed]

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Sclerosing Mucoepidermoid Carcinoma of the Parotid Gland.

Sclerosing Mucoepidermoid Carcinoma of the Parotid Gland.

Iran J Otorhinolaryngol. 2016 Jul;28(87):281-5

Authors: Bidari-Zerehpoosh F, Naghibzadeh B, Jamali E, Jamali M, Mafi A, Bahrami-Motlagh H

Abstract
INTRODUCTION: Mucoepidermoid carcinoma represents one of the most common malignant salivary gland tumors. However, the sclerosing morphologic variant is extremely rare with only 23 reported cases in the English-language literature since it was discovered in 1987.
CASE REPORT: Herein, we describe another case that was diagnosed in a 25-year-old woman presenting with a posterior auricular mass, as well as a review of the literature, which demonstrates that this is an extremely rare malignancy with no strict protocol for treatment.
CONCLUSION: Pathologists must be aware of recognizing low grade sclerosing mucoepidermoid carcinoma which has metastatic potential and is frequently misdiagnosed as a benign lesion.

PMID: 27602340 [PubMed]

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Asthma in Rhinosinusitis: A Survey from Iran.

Asthma in Rhinosinusitis: A Survey from Iran.

Iran J Otorhinolaryngol. 2016 Jul;28(87):275-80

Authors: Bakhshaee M, Majidi MR, Gharavi V, Alavizadeh FS, Movahed R, Asnaashari P, Asnaashari AM

Abstract
INTRODUCTION: The coexistence of asthma and chronic rhinosinusitis (CRS) is more common than expected given their individual prevalence in the general population and may affect patient's quality of life. The aim of this study was to evaluate the prevalence of asthma in chronic rhinosinusitis in Mashhad, Northeast Iran.
MATERIALS AND METHODS: This study was performed in two university hospital from November 2012 for 12 months. In total, 153 patients with chronic rhinosinusitis were enrolled and referred to a particular pulmonologist for asthma evaluation.
RESULTS: The mean age of participants was 40.54±13.11 years, and 41.8% were male. In total, 63.4% of patients had the polypoid form of CRS. The proportion of patients in this study with asthma was 41.8%, compared with a general asthma prevalence in this region of 13.5%.
CONCLUSION: There is a high prevalence of asthma among patients with CRS, but it often remains undiagnosed. Asthma in CRS patients should be diagnosed and treated in order to improve patient's quality of life. We recommend an evaluation of the lower airways in all of these patients as well as further studies in this field.

PMID: 27602339 [PubMed]

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Analysis of Epstein Barr Virus Encoded RNA Expression in Nasopharyngeal Carcinoma in North-Eastern India: A Chromogenic in Situ Hybridization Based Study.

Analysis of Epstein Barr Virus Encoded RNA Expression in Nasopharyngeal Carcinoma in North-Eastern India: A Chromogenic in Situ Hybridization Based Study.

Iran J Otorhinolaryngol. 2016 Jul;28(87):267-74

Authors: Saikia A, Raphael V, Shunyu NB, Khonglah Y, Mishra J, Jitani AK, Medhi J

Abstract
INTRODUCTION: Nasopharyngeal carcinoma (NPC) is a common cancer in the North-East region of India. Though the role of environmental contributors of NPC in the North-Eastern part of India is firmly established, EBV as an etiological agent in the region remains unexplored.
MATERIAL AND METHODS: Fifty-one patients, who presented at the department of ENT, NEIGRIHMS and were confirmed as NPC upon histopathological examination, were included in the study. Chromogenic in-situ hybridization (CISH) was used for the evaluation of EBER (Epstein Barr Virus Encoded RNA). Presence of nuclear signals was taken as positive for EBER expression. EBER status was correlated with various clinicopathological parameters like age, sex, dietary habits, histological types of NPC, and ethnicity of the patients.
RESULTS: The age range of the study group was 25 to 70 years with a mean age of 44.64 years and a male:female ratio of 3:2. Non-keratinizing undifferentiated type of NPC was the most common histological type. EBV was positive in 59% (30/51) of our cases. It showed a statistically significant correlation with the Naga community (P=0.01), with consumption of smoked food (P=0.02), and cigarette smoking (P=0.02). There was no correlation of EBV with age, sex, lymph node metastasis, stage, and histology.
CONCLUSION: Our result indicates that EBV may be an additional risk factor in the pathogenesis of NPC in this region of India. So apart from lifestyle modification, a future study for a screening test for EBV viral load even in asymptomatic patients may be considered, for determination of disease susceptibility, early diagnosis, and proper management.

PMID: 27602338 [PubMed]

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HLA-Cw Allele Frequency in Definite Meniere's Disease Compared to Probable Meniere's Disease and Healthy Controls in an Iranian Sample.

HLA-Cw Allele Frequency in Definite Meniere's Disease Compared to Probable Meniere's Disease and Healthy Controls in an Iranian Sample.

Iran J Otorhinolaryngol. 2016 Jul;28(87):262-6

Authors: Dabiri S, Ghadimi F, Firouzifar M, Yazdani N, Mohammad-Amoli M, Vakili V, Mahvi Z

Abstract
INTRODUCTION: Several lines of evidence support the contribution of autoimmune mechanisms in the pathogenesis of Meniere's disease. The aim of this study was determining the association between HLA-Cw Alleles in patients with definite Meniere's disease and patients with probable Meniere's disease and a control group.
MATERIALS AND METHODS: HLA-Cw genotyping was performed in 23 patients with definite Meniere's disease, 24 with probable Meniere's disease, and 91 healthy normal subjects, using sequence specific primers polymerase chain reaction technique. The statistical analysis was performed using stata 8 software.
RESULTS: There was a significant association between HLA-Cw*04 and HLA-Cw*16 in both definite and probable Meniere's disease compared to normal healthy controls. We observed a significant difference in HLA-Cw*12 frequencies between patients with definite Meniere's disease compared to patients with probable Meniere's disease (P=0.04). The frequency of HLA-Cw*18 is significantly higher in healthy controls (P=0.002).
CONCLUSION: Our findings support the rule of HLA-Cw Alleles in both definite and probable Meniere's disease. In addition, differences in HLA-Cw*12 frequency in definite and probable Meniere's disease in our study's population might indicate distinct immune and inflammatory mechanisms involved in each condition.

PMID: 27602337 [PubMed]

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Facial Nerve Monitoring During Parotidectomy:A Two-Center Retrospective Study.

Facial Nerve Monitoring During Parotidectomy:A Two-Center Retrospective Study.

Iran J Otorhinolaryngol. 2016 Jul;28(87):255-60

Authors: Régloix SB, Grinholtz-Haddad J, Maurin O, Genestier L, Lisan Q, Pons Y

Abstract
INTRODUCTION: We present a retrospective two-center study series and discussion of the current literature to assess the benefits of facial nerve monitoring during parotidectomy.
MATERIALS AND METHODS: From 2007 to 2012, 128 parotidectomies were performed in 125 patients. Of these, 47 procedures were performed without facial nerve monitoring (group 1) and 81 with facial nerve monitoring (group 2). The primary endpoint was the House-Brackmann classification at 1 month and 6 months. Facial palsy was determined when the House-Brackmann grade was 3 or higher.
RESULTS: In group 1, 15 facial palsies were noted; 8 were transient and 7 were definitive. In group 2, 19 facial palsies were noted; 12 were transient and 7 were definitive. At both one and six months after parotidectomy, the rate of facial palsy in reoperation cases was significantly higher in group 1 than in group 2.
CONCLUSION: Facial nerve monitoring is a simple, effective adjunct method that is available to surgeons to assist with the functional preservation of the facial nerve during parotid surgery. Although it does not improve the facial prognosis in first-line surgery, it does improve the facial prognosis in reoperations.

PMID: 27602336 [PubMed]

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Effects of Steroids and Curcumin on Prevention of Laryngeal Stenosis Secondary to Trauma.

Effects of Steroids and Curcumin on Prevention of Laryngeal Stenosis Secondary to Trauma.

Iran J Otorhinolaryngol. 2016 Jul;28(87):249-54

Authors: Iravani K, Babaie Z, Ashraf MJ, Tanideh N

Abstract
INTRODUCTION: The aim of this study was to compare the preventive effects of corticosteroids and curcumin on subglottic stenosis in an animal model.
MATERIALS AND METHODS: Twenty-one male German Shepherd dogs were used for this study. After standardized trauma to the subglottic area, the dogs were divided into three groups. Group A received curcumin (450 mg/ day) for 15 days; Group B received beclomethasone (2 puffs/day, 50 µg/dose) for 15 days; Group C received saline spray only. At 6 weeks after the injury, the larynx specimens were examined histopathologically to assess epithelialization, inflammation, and fibrosis.
RESULTS: Complete epithelial covering of the steroid-treated group was significantly less than that of the control group. Despite inflammation and fibrosis, there was no significant difference between the steroid and control groups. In the curcumin-treated group, there was no significant difference between the groups.
CONCLUSION: Topically applied steroid decreases epithelialization after induced subglottic injury. It is recommended that further studies be conducted in order to investigate the effects of the two drugs on airway stenosis prevention.

PMID: 27602335 [PubMed]

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CenoDerm vs. Fascia lata for the Prevention of Dorsal Nasal Irregularities in Rhinoplasty.

CenoDerm vs. Fascia lata for the Prevention of Dorsal Nasal Irregularities in Rhinoplasty.

Iran J Otorhinolaryngol. 2016 Jul;28(87):241-8

Authors: Mohebbi A, Hamidian R, Poosti SB, Hosseini SS

Abstract
INTRODUCTION: Dorsal nasal irregularity is a complication of rhinoplasty surgery, mostly seen in patients with thin skin. Acellular dermis (CenoDerm) and homologous fascia lata covering the nasal bone cartilage structure have been used to achieve a smooth surface. In this study, we aimed to investigate clinical outcomes using these two materials.
MATERIALS AND METHODS: After a standard rhinoplasty procedure, a layer of the acellular dermis or homologous fascia lata was placed in the pocket of the dorsum. Patients were evaluated for clinical outcomes at 3, 6, and 12 months after the procedure.
RESULTS: Forty-two of 68 patients completed the follow-up period. Patient satisfaction was higher in the homologous fascia lata group. Similarly, nasal dorsum inspection and palpation results were better in the homologous fascia lata group compared with the CenoDerm group but was significant in palpation (P=0.00). There was no complete absorption in the homologous fascia lata group 6 months after surgery (P= 0.04 vs. CenoDerm) but no significant difference was observed at 12 months.
CONCLUSION: Homologous fascia lata is better than acellular dermis in preventing dorsal nasal irregularity after rhinoplasty in thin-skinned patients.

PMID: 27602334 [PubMed]

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Surgical treatment of sporadic vestibular schwannoma in a series of 1006 patients.

Surgical treatment of sporadic vestibular schwannoma in a series of 1006 patients.

Acta Otorhinolaryngol Ital. 2016 Sep 6;

Authors: Zhang Z, Nguyen Y, De Seta D, Russo FY, Rey A, Kalamarides M, Sterkers O, Bernardeschi D

Abstract
The management of sporadic vestibular schwannoma (VS) has evolved in the last decades. The aim of this study was to analyse the evolution in surgical outcomes of VSs operated by a neurotological team between 1990 and 2006 by different approaches. A monocentric retrospective review of medical charts of 1006 patients was performed. In order to assess eventual changes and progress, the 17-years period was divided in three periods, each one comprehending 268 VS (1990-1996), 299 VS (1997-2001), and 439 VS (2002-2006). Mean follow-up was 5.9 ± 2.4 years. Overall, complete VS removal was achieved in 99.4% of cases. Mortality rate was 0.3%, meningitis and CSF leaks were observed in 1.2 % and 9 % of the cases, respectively. CSF leakage decreased from 11.6% to 7.1% between the first and last period (p < 0.01) as well as revision surgery from 3.4 % to 0.9 % (p < 0.05). Facial nerve was anatomically preserved in 97.7% of cases. At one year, a good facial nerve function was observed in 85.1% of patients (grade I and II of House-Brackmann grading scale), which ranged between the first and last period from 78.4% to 87.6% (p <0.05). At one year, hearing preservation was obtained in 61.6% of patients, which increased from the first period to the last one from 50.9% to 69.0% (p < 0.05) (class A+B+C from the AAO-HNS classification). Useful hearing (class A+B) was observed in 33.5% of cases overall, with 21.8% and 42% in the first and last period, respectively (p < 0.01). Surgical outcomes of sporadic vestibular schwannoma have improved concerning facial nerve function outcomes, hearing preservation and cerebrospinal fluid (CSF) leaks, mainly due to the neuro-otological team's experience. Functional results after complete microsurgical removal of large VS depend on experience gained on small VS removal.

PMID: 27600105 [PubMed - as supplied by publisher]

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3D curved multiplanar cone beam CT reconstruction for intracochlear position assessment of straight electrodes array. A temporal bone and clinical study.

3D curved multiplanar cone beam CT reconstruction for intracochlear position assessment of straight electrodes array. A temporal bone and clinical study.

Acta Otorhinolaryngol Ital. 2016 Sep 6;

Authors: De Seta D, Mancini P, Russo FY, Torres R, Mosnier I, Bensimon JL, De Seta E, Heymann D, Sterkers O, Bernardeschi D, Nguyen Y

Abstract
A retrospective review of post-op cone beam CT (CBCT) of 8 adult patients and 14 fresh temporal bones that underwent cochlear implantation with straight flexible electrodes array was performed to determine if the position of a long and flexible electrodes array within the cochlear scalae could be reliably assessed with CBCT. An oto-radiologist and two otologists examined the images and assessed the electrodes position. The temporal bone specimens underwent histological analysis for confirm the exact position. The position of the electrodes was rated as scala tympani, scala vestibule, or intermediate position for the electrodes at 180°, 360° and for the apical electrode. In the patient group, for the electrodes at 180° all observers agreed for scala tympani position except for 1 evaluation, while a discrepancy in 3 patients both for the 360° and for the apical electrode assessment were found. In five temporal bones the evaluations were in discrepancy for the 180° electrode, while at 360° a disagreement between raters on the scalar positioning was seen in six temporal bones. A higher discrepancy between was found in assessment of the scalar position of the apical electrode (average pairwise agreement 45.4%, Fleiss k = 0.13). A good concordance was found between the histological results and the consensus between raters for the electrodes in the basal turn, while low agreement (Cohen's k 0.31, pairwise agreement 50%) was found in the identification of the apical electrode position confirming the difficulty to correct identify the electrode position in the second cochlear turn in temporal bones. In conclusion, CBCT is a reliable radiologic exam to correctly evaluate the position of a lateral wall flexible array in implanted patients using the proposed imaging reconstruction method, while some artefacts impede exact evaluation of the position of the apical electrode in temporal bone and other radiological techniques should be preferred in ex vivo studies.

PMID: 27600104 [PubMed - as supplied by publisher]

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3D curved multiplanar cone beam CT reconstruction for intracochlear position assessment of straight electrodes array. A temporal bone and clinical study.

3D curved multiplanar cone beam CT reconstruction for intracochlear position assessment of straight electrodes array. A temporal bone and clinical study.

Acta Otorhinolaryngol Ital. 2016 Sep 6;

Authors: De Seta D, Mancini P, Russo FY, Torres R, Mosnier I, Bensimon JL, De Seta E, Heymann D, Sterkers O, Bernardeschi D, Nguyen Y

PMID: 27600104 [PubMed - as supplied by publisher]

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[Nasal secretion and postnasal drip syndrome].

[Nasal secretion and postnasal drip syndrome].

MMW Fortschr Med. 2016 Sep;158(15):67-72

Authors: Klimek L

PMID: 27596199 [PubMed - in process]

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Effects of Steroids and Curcumin on Prevention of Laryngeal Stenosis Secondary to Trauma.

Effects of Steroids and Curcumin on Prevention of Laryngeal Stenosis Secondary to Trauma.

Iran J Otorhinolaryngol. 2016 Jul;28(87):249-54

Authors: Iravani K, Babaie Z, Ashraf MJ, Tanideh N

PMID: 27602335 [PubMed]

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Control of the glottal configuration in ex vivo human models: quantitative anatomy for clinical and experimental practices.

Control of the glottal configuration in ex vivo human models: quantitative anatomy for clinical and experimental practices.

Surg Radiol Anat. 2016 Sep 6;

Authors: Lagier A, Guenoun D, Legou T, Espesser R, Giovanni A, Champsaur P

Abstract
INTRODUCTION: The objective of this paper was to identify the determining factors of the glottal prephonatory configuration from the point of view of the resulting muscular actions (i.e., arytenoids adduction, membranous vocal fold adduction, and tension).
MATERIALS AND METHODS: 21 human non-embalmed excised larynges (12 females and 9 males) were studied. Experiment A (11 larynges) studied four conditions of adduction of the vocal folds and arytenoids. Experiment B (10 larynges) studied the effect of cricothyroid approximation on the vocal fold length and the cricothyroid angle.
RESULTS: Experiment A: The mean glottal area significantly decreased from 41.2 mm(2) mean with no adduction, to 10.2 mm(2) mean with arytenoid adduction, to 9.2 mm(2) with membranous vocal fold adduction, and down to 1.1 mm(2) with the combination of arytenoid and membranous adduction. The effect of the task was statistically significant. Experiment B: The length of vocal folds increased from 13.61 mm median to 14.48 mm median, and the cricothyroid angle decreased of 10.05 median along with cricothyroid approximation.
DISCUSSION: The results of experiment A emphasize the sub-division of adductor intrinsic muscles in arytenoids adductors (i.e., LCA and IA), and membranous vocal fold adductor (i.e., TA). The results of experiment B quantify the effect of cricothyroid approximation on the vocal folds length. The implications of these results can be useful in both clinical practice and experimental studies.

PMID: 27600801 [PubMed - as supplied by publisher]

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Submucosal bulge in the hypopharynx causing dysphagia.

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Submucosal bulge in the hypopharynx causing dysphagia.

Dysphagia. 2014 Oct;29(5):629-31

Authors: Agarwal J, Galati L, Pinheiro-Neto CD

PMID: 25205220 [PubMed - indexed for MEDLINE]

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Chin tuck for prevention of aspiration: effectiveness and appropriate posture.

Chin tuck for prevention of aspiration: effectiveness and appropriate posture.

Dysphagia. 2014 Oct;29(5):603-9

Authors: Ra JY, Hyun JK, Ko KR, Lee SJ

Abstract
Chin tuck has been has been widely used to prevent aspiration in the patients with dysphagia. This study was performed to investigate the effectiveness and the degree of optimal neck flexion of chin tuck. Ninety-seven patients who showed aspiration in the videofluoroscopic swallow study (VFSS). Participants were grouped into the effective (patients who showed effect with chin tuck) and ineffective group (those who did not show effect with chin tuck). VFSS was performed in neutral and chin tuck position and findings were compared between the groups. Severity of aspiration was assessed by the point penetration-aspiration scale. Duration of dysphagic symptoms, history of tracheostomy, and other possible contributing factors were also compared. Neck flexion angle was measured to find appropriate posture in which aspiration was prevented with chin tuck. Aspiration was reduced or eliminated in only 19 patients (19.6 %) with chin tuck. Oral transit time, pharyngeal delayed time and pharyngeal transit time were significantly shortened in both groups (p < 0.05), but the difference between the groups was not significant. Female sex and absence of residue in pyriform sinus favored the effect of chin tuck (p < 0.05). At least 17.5° of neck flexion was required to achieve an effect with chin tuck. The effectiveness of chin tuck was less than anticipated. Patients without residue in pyriform sinus were more likely to benefit from chin tuck. Sufficient neck flexion was important in chin tuck to prevent aspiration.

PMID: 25012700 [PubMed - indexed for MEDLINE]

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Automated acoustic analysis in detection of spontaneous swallows in Parkinson's disease.

Automated acoustic analysis in detection of spontaneous swallows in Parkinson's disease.

Dysphagia. 2014 Oct;29(5):572-7

Authors: Golabbakhsh M, Rajaei A, Derakhshan M, Sadri S, Taheri M, Adibi P

Abstract
Acoustic monitoring of swallow frequency has become important as the frequency of spontaneous swallowing can be an index for dysphagia and related complications. In addition, it can be employed as an objective quantification of ingestive behavior. Commonly, swallowing complications are manually detected using videofluoroscopy recordings, which require expensive equipment and exposure to radiation. In this study, a noninvasive automated technique is proposed that uses breath and swallowing recordings obtained via a microphone located over the laryngopharynx. Nonlinear diffusion filters were used in which a scale-space decomposition of recorded sound at different levels extract swallows from breath sounds and artifacts. This technique was compared to manual detection of swallows using acoustic signals on a sample of 34 subjects with Parkinson's disease. A speech language pathologist identified five subjects who showed aspiration during the videofluoroscopic swallowing study. The proposed automated method identified swallows with a sensitivity of 86.67 %, a specificity of 77.50 %, and an accuracy of 82.35 %. These results indicate the validity of automated acoustic recognition of swallowing as a fast and efficient approach to objectively estimate spontaneous swallow frequency.

PMID: 24958599 [PubMed - indexed for MEDLINE]

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Overexpression of IL-4 in the thyroid of transgenic mice upregulates the expression of Duox1 and the anion transporter pendrin.

Overexpression of IL-4 in the thyroid of transgenic mice upregulates the expression of Duox1 and the anion transporter pendrin.

Thyroid. 2016 Sep 6;

Authors: Eskalli Z, Achouri Y, Hahn S, Many MC, Craps J, Refetoff S, Liao XH, Dumont JE, Van Sande J, Corvilain B, Miot F, De Deken X

Abstract
BACKGROUND: The dual oxidases (Duox) are thyroid-functional markers involved in H2O2-generation, which is essential for thyroid hormone synthesis. During inflammation, cytokines upregulate DUOX gene expression in the airway and the intestine, suggesting a role for these proteins in innate immunity. We previously demonstrated that interleukin-4 (IL-4) upregulates DUOX gene expression in thyrocytes. Although the role of IL-4 in autoimmune thyroid diseases (AITD) has been studied extensively, the effects of IL-4 on thyroid physiology remain largely unknown. Therefore, we generated a new animal model to study the impact of IL-4 on thyroid function.
METHODS: Transgenic (Thyr-IL-4) mice with thyroid-targeted expression of murine IL-4 were generated. Transgene expression was verified at the mRNA and protein level in thyroid tissues and primary cultures. The phenotype of the Thyr-IL-4 animals was characterized by measuring serum T4 and TSH levels and performing thyroid morphometric analysis, immunohistochemistry, whole transcriptome sequencing, quantitative RT-PCR, and ex vivo thyroid function assays.
RESULTS: Thyrocytes from two Thyr-IL-4 mouse lines (#30 and #52) expressed IL-4, which was secreted into the extracellular space. Although ten month-old transgenic animals had T4 and TSH serum levels in the normal range, they had altered thyroid follicular structure with enlarged follicles composed of elongated thyrocytes containing numerous endocytic vesicles. These follicles were positive for T4 staining the colloid indicating their capacity to produce thyroid hormones. RNA profiling of Thyr-IL-4 thyroid samples revealed modulation of multiple genes involved in inflammation, while no major leukocyte infiltration could be detected. Upregulated expression of Duox1, Duoxa1, and the pendrin anion exchanger gene (Slc26a4) was detected. In contrast, the iodide symporter gene Slc5a5 was markedly downregulated resulting in impaired iodide uptake and reduced thyroid hormone levels in transgenic thyroid tissue. H2O2 production was increased in Thyr-IL-4 thyroid tissue compared to wild type animals, but no significant oxidative stress could be detected.
CONCLUSIONS: This is the first study to show that ectopic expression of IL-4 in thyroid tissue upregulates Duox1/Duoxa1 and Slc26a4 expression in the thyroid. The present data demonstrate that IL-4 could affect thyroid morphology and function, mainly by downregulating Slc5a5 expression, while maintaining a normal euthyroid phenotype.

PMID: 27599561 [PubMed - as supplied by publisher]

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Thyroid Stimulating Hormone Levels are Associated with Cardiometabolic Risk Factors in Euthyroid Adolescents.

Thyroid Stimulating Hormone Levels are Associated with Cardiometabolic Risk Factors in Euthyroid Adolescents.

Thyroid. 2016 Sep 6;

Authors: Le TN, Celi F, Wickham EP

Abstract
BACKGROUND: Increased TSH levels and free T3 to free T4 (fT3:fT4) ratios, even within the euthyroid range, have been associated with cardiometabolic risk factors in adults but are less characterized in youth. We sought to determine relations between TSH, thyroid hormones, and cardiometabolic risk factors in euthyroid adolescents.
METHODS: Data were extracted from the United States NHANES (National Health and Nutrition Examination Survey, 2007-2010) for univariate and multivariate analyses of TSH, thyroid hormones, body mass index (BMI), blood pressure, lipids, and glucose metabolism. Subjects aged 12-18 years, with normal TSH and anti-TPO-antibody levels, without history of thyroid disease, diabetes, or treatment of hypertension/dyslipidemia (n=1,167) were included. TSH and thyroid hormones were assessed for impact on BMI Z-score, systolic and diastolic blood pressure (SBP, DBP), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein B (ApoB), and triglycerides, and glucose metabolism.
RESULTS: Univariate analyses revealed positive linear relations between TSH and SBP, TC, fasting and 2-hour glucose, and HOMA-IR (homeostasis model assessment of insulin resistance). The fT3:fT4 ratio negatively correlated with HDL-C but positively with BMI Z-score, SBP, triglycerides, fasting and 2-hour glucose, fasting insulin, and HOMA-IR. In multivariate analyses controlling for age, sex, race, and BMI Z-score, relations between TSH and both TC and fasting glucose remained significant, and the fT3:fT4 ratio was positively associated with fasting glucose and HOMA-IR.
CONCLUSIONS: In an unselected population of euthyroid U.S. adolescents, TSH and thyroid hormones correlate with multiple cardiometabolic risk factors, with age- and sex-independent effects on cholesterol and glucose metabolism.

PMID: 27599541 [PubMed - as supplied by publisher]

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Juvenile nasopharyngeal angiofibroma.

Juvenile nasopharyngeal angiofibroma.

J Oral Maxillofac Pathol. 2016 May-Aug;20(2):330

Authors: Makhasana JA, Kulkarni MA, Vaze S, Shroff AS

Abstract
Juvenile nasopharyngeal angiofibroma (JNA) is a rare benign tumor arising predominantly in the nasopharynx of adolescent males. It is an aggressive neoplasm and shows a propensity for destructive local spread often extending to the base of the skull and into the cranium. Clinically, however, it is obscure with painless, progressive unilateral nasal obstruction being the common presenting symptom with or without epistaxis and rhinorrhea. Diagnosis of JNA is made by complete history, clinical examination, radiography, nasal endoscopy and by using specialized imaging techniques such as arteriography, computer tomography and magnetic resonance imaging. Histopathology reveals a fibrocellular stroma with spindle cells and haphazard arrangement of collagen interspersed with an irregular vascular pattern. A case report of JNA with rare intra-oral manifestation in a 17-year-old male patient is presented in the article. JNA being an aggressive tumor may recur posttreatment. Thus, early diagnosis, accurate staging, and adequate treatment are essential in the management of this lesion.

PMID: 27601836 [PubMed]

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Submandibular intubation as an alternative for intra-operative airway management in maxillofacial fractures - our institutional experience.

Submandibular intubation as an alternative for intra-operative airway management in maxillofacial fractures - our institutional experience.

Indian J Anaesth. 2016 Aug;60(8):573-7

Authors: Banerjee PK, Jain A, Behera B

Abstract
BACKGROUND AND AIMS: Airway management in anaesthesia for maxillofacial surgical procedures is tricky at times when the nasal/oral routes are contraindicated or are impossible. Tracheostomy as an alternative inherits its own complications. We present a case series of the submandibular route for tracheal intubation as an alternative.
METHODS: The procedure was performed in ten selected adult patients with maxillofacial/mandibular fractures associated with a fracture of skull base or nasal bone. All of them were medically stable with no need of intensive care or mechanical ventilation in post-operative period.
RESULTS: Submandibular intubation in all ten patients of panfacial fractures allowed uninterrupted surgical techniques with a secured airway. All patients were reverted to oro-tracheal tube at the end of surgery as immediate maxillomandibular fixation was not necessary. The patients were extubated after recovery from anaesthesia before they left the operating theatre. One patient in the post-operative period had a superficial infection of incision site that responded well to local treatment. No other complications were encountered in the intra-operative or post-operative period.
CONCLUSION: In complex maxillofacial injuries, when oral or nasal intubation hampers surgeon's field of view, submandibular intubation offers an effective alternative to short-term tracheostomy along with small risk potential. There is a need to emphasise its regular application in such cases so that technique can be mastered by both surgeons and anaesthesiologist.

PMID: 27601740 [PubMed]

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Intra-operative electrooculographic monitoring to prevent post-operative extraocular motor nerve dysfunction during skull base surgeries.

Intra-operative electrooculographic monitoring to prevent post-operative extraocular motor nerve dysfunction during skull base surgeries.

Indian J Anaesth. 2016 Aug;60(8):560-5

Authors: Sheshadri V, Bharadwaj S, Chandramouli BA

Abstract
BACKGROUND AND AIMS: Intra-operative identification and preservation of extraocular motor nerves is one of the main goals of surgeries for skull base tumours and this is done by monitoring the extraocular movement (EOM). Intra-operative electromyographic monitoring has been reported, but it is a complex and skilful process. Electrooculography (EOG) is a simple and reliable technique for monitoring EOMs. We aimed to assess the utility of EOG monitoring in preventing extraocular motor nerve dysfunction during skull base surgeries.
METHODS: In this retrospective cohort study, intra-operative EOG recordings were obtained using disposable needle electrodes placed on the periorbital skin and the polarity of the waves noted for interpretation. Triggered as well as continuous EOG responses were recorded after monopolar electrode stimulation of cranial nerve (CN) during tumour removal which helped the surgeon with careful dissection and avoiding potential nerve injuries.
RESULTS: Of the 11 cases monitored, oculomotor and abducent nerves were identified in all cases, but the trochlear nerve could not be definitively identified. Six patients had no pre- or post-operative extraocular motor nerve dysfunction. The other five patients had pre-existing deficits before surgery, which recovered completely in two, significantly in one, and did not improve in two patients at 3-6 months follow-up.
CONCLUSIONS: EOG was found to be a simple and reliable method of monitoring extraocular motor nerves (CNs III and VI) intraoperatively.

PMID: 27601738 [PubMed]

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Unfavorable Results After Free Tissue Transfer to Head and Neck: Lessons Based on Experience from the University of Toronto.

Unfavorable Results After Free Tissue Transfer to Head and Neck: Lessons Based on Experience from the University of Toronto.

Clin Plast Surg. 2016 Oct;43(4):639-51

Authors: Kuuskeri M, O'Neill AC, Hofer SO

Abstract
The purpose of the current article is to provide an overview of the functional and aesthetic unfavorable results of head and neck reconstruction, and provide suggestions on how to address these issues. Understanding the consequences of an unsuccessful reconstruction provides the foundation for proper planning and personalized approach to reconstruction of lost structures.

PMID: 27601389 [PubMed - in process]

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Postoperative cerebrospinal fluid leak after microvascular reconstruction of craniofacial defects with orbital exenteration.

Postoperative cerebrospinal fluid leak after microvascular reconstruction of craniofacial defects with orbital exenteration.

Laryngoscope. 2016 Sep 7;

Authors: Gill KS, Hsu D, Tassone P, Pluta J, Nyquist G, Krein H, Bilyk J, Murchison AP, Iloreta A, Evans JJ, Heffelfinger RN, Curry JM

Abstract
OBJECTIVES: To assess risk factors for cerebrospinal fluid (CSF) leak and complications after microvascular reconstruction of cranio-orbitofacial resection with orbital exenteration (CFOE).
STUDY DESIGN: Retrospective case series.
METHODS: Seventy consecutive patients at a tertiary hospital underwent 76 procedures with microvascular reconstruction of CFOE defects. Patients were stratified by extent of skull base exposure and presence or absence of dural resection. Patients with exposure of the orbital apex and roof alone were classified as minimal skull base exposure (MS) (n = 32). Those with skull base exposure beyond the orbital apex and roof were classified as significant skull base exposure (SS) (n = 38) and were subdivided into those with dural exposure (SSe) (n = 15) and those with dural resection (SSr) (n = 23). The main outcome measure was incidence of postoperative CSF leak according to univariate and multivariate analysis of risk factors, including previous radiation, surgery, and location of defect.
RESULTS: Intraoperative leaks occurred in five and four patients in the MS and SSe groups, respectively, with no postoperative leaks. In the SSr group, five patients developed a postoperative CSF leak and three required operative management. Multivariate analysis revealed middle fossa exposure to be the only significant predictor of CSF leak (P = 0.03). The overall complication rate was 31.6%. Major complications were greater in the SS group compared to the MS group (P = 0.05).
CONCLUSION: In this series, middle fossa resection increased the risk of postoperative CSF leak after microvascular reconstruction of CFOE defects, and complication rates were greater with more complex defects.
LEVEL OF EVIDENCE: 4. Laryngoscope, 2016.

PMID: 27601262 [PubMed - as supplied by publisher]

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Sinus opacification in the intensive care unit patient.

Sinus opacification in the intensive care unit patient.

Laryngoscope. 2016 Sep 7;

Authors: Huyett P, Lee S, Ferguson BJ, Wang EW

Abstract
OBJECTIVES/HYPOTHESIS: The significance of sinus opacification in intensive care unit (ICU) patients remains uncertain. Our objectives were to determine the baseline incidence and risk factors associated with the development of radiographic sinus abnormalities in the ICU population.
METHODS: A retrospective study of head computed tomography scan or magnetic resonance imaging from April 2013 through April 2014 of 612 neurologic ICU patients at the University of Pittsburgh Medical Center Presbyterian Hospital, Pittsburgh, Pennsylvania, was performed. Images were scored by the Lund-Mackay system (LMS). Exclusion criteria included prior sinus or skull base surgery, history of sinonasal malignancy, facial fractures, ICU admission less than 3 days, or inadequate imaging.
RESULTS: At the time of admission, 40.7% of patients had a LMS greater than zero (mean 2.2). Worsening sinus opacification occurred in 42.6% of patients (mean highest LMS 4.6) during ICU admission. There was a peak between days 8 and 10, during which 65% of scans exhibited worsening opacification compared to baseline. On multivariate analysis, risk factors associated with increased sinus opacification (higher LMS) included the presence of an endotracheal tube (odds ration [OR] 3.28, P < .001) or nasogastric tube (OR 3.34, P < .001) and increased length of stay (OR 2.50, P < .001). Age greater than 60 was found to be protective for the development of worsening sinus opacification (OR 0.57, P = .007).
CONCLUSION: Using serial imaging and comparison control groups, this study finds that there is a high baseline incidence of sinus opacification in the ICU population. Prolonged length of stay, younger age, and presence of nasogastric or endotracheal tubes all corresponded to worsening LMS.
LEVEL OF EVIDENCE: 4. Laryngoscope, 2016.

PMID: 27601202 [PubMed - as supplied by publisher]

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Surgical treatment of sporadic vestibular schwannoma in a series of 1006 patients.

Surgical treatment of sporadic vestibular schwannoma in a series of 1006 patients.

Acta Otorhinolaryngol Ital. 2016 Sep 6;

Authors: Zhang Z, Nguyen Y, De Seta D, Russo FY, Rey A, Kalamarides M, Sterkers O, Bernardeschi D

PMID: 27600105 [PubMed - as supplied by publisher]

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Treatment of the recanalization of maxillary and mandibular arteriovenous malformations in children.

Treatment of the recanalization of maxillary and mandibular arteriovenous malformations in children.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Jun 29;

Authors: Huang Z, Zhang D, Chen Y, Wang Y, Chen W, Huang Z

Abstract
OBJECTIVE: This study reviewed our experience in treating the recanalization of maxillary and mandibular arteriovenous malformations in children.
STUDY DESIGN: Four patients with maxillary or mandibular arteriovenous malformations (AVMs) were included in this study. All the patients had undergone multidisciplinary treatment of AVM at least 26 months before our review, including superselective intra-arterial embolization combined with bone wax packing. Computed tomographic angiography and digital subtraction angiography were performed to confirm the presence of recanalization. Superselective intra-arterial embolization combined with bone wax packing and tooth extractions were performed in the patients with recanalization.
RESULTS: After confirmation of the recanalization of AVM by digital subtraction angiography, the patients were treated with superselective intra-arterial embolization combined with bone wax packing and tooth extractions (if necessary). All the patients were followed up for 5 to 14 months, with an average of 9.5 months. The outcome for all patients was good, and no patient complained of pulsatile sensation or hemorrhage after treatment.
CONCLUSIONS: In the treatment for recanalization of maxillary and mandibular AVMs, reapplication of the superselective intra-arterial embolization, combined with bone wax packing, remains necessary.

PMID: 27601351 [PubMed - as supplied by publisher]

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AAOM Clinical Practice Statement: Management of Patients on Warfarin Therapy.

AAOM Clinical Practice Statement: Subject: Management of Patients on Warfarin Therapy.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Jun 29;

Authors:

PMID: 27601350 [PubMed - as supplied by publisher]

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Clinical, microbiologic and radiologic assessment of soft and hard tissues surrounding zygomatic implants: a retrospective study.

Clinical, microbiologic and radiologic assessment of soft and hard tissues surrounding zygomatic implants: a retrospective study.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Jun 29;

Authors: Lombardo G, D'Agostino A, Trevisiol L, Romanelli MG, Mascellaro A, Gomez-Lira M, Pardo A, Favero V, Nocini PF

Abstract
OBJECTIVES: To assess the clinical, microbiologic, and radiologic status of soft and hard tissues surrounding zygomatic implants.
STUDY DESIGN: Patients who had at least two zygomatic implants were eligible for the study. Their soft tissues were analyzed, and microbial samples were collected. Cone beam computed tomography (CBCT) and orthopantomography were used to measure bone levels. The patients were also asked to complete a Visual Analogue Scale (VAS) questionnaire assessing their satisfaction.
RESULTS: A total of 65 zygomatic implants placed in 20 patients were assessed. As one zygomatic implant was lost, the cumulative survival rate was 98.5%. All the prostheses were successful. Peri-implant soft tissues were generally in a healthy condition. The patients with a history of periodontitis had worse mean peri-implant clinical parameters and showed more bacterial colonization with respect to their nonperiodontal counterparts. The implant recipients had low levels of crestal and zygomatic bone loss and high VAS scores indicating their general satisfaction.
CONCLUSIONS: Although zygomatic implants were confirmed to be a reliable treatment option, patients with a history of periodontitis were, nevertheless, found to have special needs, such as frequent dental hygiene sessions.

PMID: 27601349 [PubMed - as supplied by publisher]

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Regional and gender differences in laryngeal cancer mortality: trends and predictions until 2030 in Brazil.

Regional and gender differences in laryngeal cancer mortality: trends and predictions until 2030 in Brazil.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Jun 29;

Authors: Dantas de Oliveira NP, Barbosa IR, Vieria Paulino JN, de Camargo Cancela M, Bezerra de Souza DL

Abstract
OBJECTIVE: Analysis of laryngeal cancer mortality trends in Brazil and its geographic regions for the period 1996-2010 and calculation of mortality predictions for the period 2011-2030.
STUDY DESIGN: An epidemiologic, ecologic, demographic-based study, which utilized information from the Mortality Information System on all cancer-related deaths in Brazil, is presented here. Mortality trends were analyzed by Joinpoint regression, and Nordpred was utilized for the calculation of predictions.
RESULTS: When comparing the last observed period and the last predicted period for men, an increase of 10,588 deaths is expected, representing an increase of 69%. For women, the expected increase in the number of deaths will be 2217, representing an increase of 104%. Laryngeal cancer mortality rates will increase in the North and Northeast regions for men and in the Northeast and Southeast regions for women.
CONCLUSIONS: Despite the current high mortality for laryngeal cancer, rates will continue to increase until 2030 in Brazil.

PMID: 27601348 [PubMed - as supplied by publisher]

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Effect of length, diameter, intraoral location on implant stability.

Effect of length, diameter, intraoral location on implant stability.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Jun 29;

Authors: Shiffler K, Lee D, Rowan M, Aghaloo T, Pi-Anfruns J, Moy PK

Abstract
OBJECTIVES: To quantitatively compare stability of dental implants with varying lengths, diameters, and intraoral locations.
STUDY DESIGN: Retrospectively, 200 consecutive NobelReplace Tapered Groovy implants of varying lengths and diameters were evaluated via implant stability quotient readings at placement (T1) and follow-up (T2). Data were analyzed by analysis of variance and simple linear regression tests.
RESULTS: Intraoral location was statistically significant at T1 and T2. Although implant diameter was not statistically significant, implant length resulted in T1 (P = .08) and T2 (P = .09), which may have a clinically relevant effect on implant stability. An overall implant survival rate of 98% was achieved. Gender and age did not seem to affect implant stability quotient values at placement, follow-up, or implant survival.
CONCLUSIONS: Intraoral location is an important factor in implant stability, with implants placed in the mandible being more stable than implants placed in the maxilla both at T1 and T2. Length may have a clinically relevant effect on implant stability.

PMID: 27601347 [PubMed - as supplied by publisher]

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Postoperative cerebrospinal fluid leak after microvascular reconstruction of craniofacial defects with orbital exenteration.

Postoperative cerebrospinal fluid leak after microvascular reconstruction of craniofacial defects with orbital exenteration.

Laryngoscope. 2016 Sep 7;

Authors: Gill KS, Hsu D, Tassone P, Pluta J, Nyquist G, Krein H, Bilyk J, Murchison AP, Iloreta A, Evans JJ, Heffelfinger RN, Curry JM

PMID: 27601262 [PubMed - as supplied by publisher]

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Experiences of Parents Caring for Infants with Rare Scalp Mass as Identified through a Disease-Specific Blog.

Experiences of Parents Caring for Infants with Rare Scalp Mass as Identified through a Disease-Specific Blog.

J Am Board Fam Med. 2015 Nov-Dec;28(6):750-8

Authors: Worthen M, Leonard TH, Blair TR, Gupta N

Abstract
BACKGROUND: Delayed subaponeurotic fluid collection (DSFC) is a self-limited disorder of unknown etiology characterized by a benign, fluid-filled mass in the subaponeurotic layer of an infant's scalp. While a few case series describe DSFC, the experiences of families whose infants develop this condition have not previously been reported.
METHODS: We used a disease-specific blog to evaluate the experiences of 69 families affected by DSFC. We identified self-reported clinical features of DSFC and qualitatively analyzed the families' experiences with obtaining a diagnosis and care for their infants.
RESULTS: Infants presented in several clinical settings, and multiple diagnostic procedures were administered, including ultrasound (46%), computed tomography (30%), and head radiography (22%). Qualitative themes emerged: lack of provider awareness of DSFC, concern about potentially harmful diagnostic procedures, suspicion of child abuse, and the importance of the website in providing support to families.
CONCLUSIONS: Though DSFC can be diagnosed clinically and its natural history is benign, its presence can be emotionally draining for parents. Physicians should be aware of this clinical entity to rapidly allay parental distress and avoid unnecessary procedures. Disease-specific blogs can help providers learn about rare diseases, contain useful clinical information for research, and can benefit patient care by providing social support for families.

PMID: 26546650 [PubMed - indexed for MEDLINE]

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Patient-Reported Measures of Hearing Loss and Tinnitus in Pediatric Cancer and Hematopoietic Stem Cell Transplantation: A Systematic Review.

Patient-Reported Measures of Hearing Loss and Tinnitus in Pediatric Cancer and Hematopoietic Stem Cell Transplantation: A Systematic Review.

J Speech Lang Hear Res. 2016 Sep 7;:1-6

Authors: Stark D, Rosenberg AR, Johnston D, Knight K, Caperon L, Uleryk E, Frazier AL, Sung L

Abstract
Purpose: We identified studies that described use of any patient-reported outcome scale for hearing loss or tinnitus among children and adolescents and young adults (AYAs) with cancer or hematopoietic stem cell transplantation (HSCT) recipients.
Method: In this systematic review, we performed electronic searches of OvidSP MEDLINE, EMBASE, and PsycINFO to August 2015. We included studies if they used any patient-reported scale of hearing loss or tinnitus among children and AYAs with cancer or HSCT recipients. Only English language publications were included. Two reviewers identified studies and abstracted data.
Results: There were 953 studies screened; 6 met eligibility criteria. All studies administered hearing patient-reported outcomes only once, after therapy completion. None of the studies described the psychometric properties of the hearing-specific component. Three instruments (among 6 studies) were used: Health Utilities Index (Barr et al., 2000; Fu et al., 2006; Kennedy et al., 2014), Hearing Measurement Scales (Einar-Jon et al., 2011; Einarsson et al., 2011), and the Tinnitus Questionnaire for Auditory Brainstem Implant (Soussi & Otto, 1994). All had limitations, precluding routine use for hearing assessment in this population.
Conclusions: We identified few studies that included hearing patient-reported measures for children and AYA cancer and HSCT patients. None are ideal to take forward into future studies. Future work should focus on the creation of a new psychometrically sound instrument for hearing outcomes in this population.

PMID: 27603148 [PubMed - as supplied by publisher]

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Confirmatory factor analysis of Clinical Outcomes in Routine Evaluation (CORE-OM) used as a measure of emotional distress in people with tinnitus.

Confirmatory factor analysis of Clinical Outcomes in Routine Evaluation (CORE-OM) used as a measure of emotional distress in people with tinnitus.

Health Qual Life Outcomes. 2016;14(1):124

Authors: Handscomb L, Hall DA, Hoare DJ, Shorter GW

Abstract
BACKGROUND: People with troublesome tinnitus often experience emotional distress. Therefore a psychometrically sound instrument which can evaluate levels of distress and change over time is necessary to understand this experience. Clinical Outcomes in Routine Evaluation (CORE-OM) is a measure of emotional distress which has been widely used in mental health research. Although originally designed as a 4-factor questionnaire, factor analyses have not supported this structure and a number of alternative factor structures have been proposed in different samples. The aims of this study were to test the factor structure of the CORE-OM using a large representative tinnitus sample and to use it to investigate levels of emotional distress amongst people with a range of tinnitus experience.
METHODS: The CORE-OM was completed by 342 people experiencing tinnitus who self-rated their tinnitus on a 5-point scale from 'not a problem' to 'a very big problem'. Confirmatory factor analysis was used to test all ten factor models which have been previously derived across a range of population samples. Model fit was assessed using fit criterion and theoretical considerations. Mean scores on the full questionnaire and its subscales were compared between tinnitus problem categories using one-way ANOVA.
RESULTS: The best fitting model included 33 of the 34 original items and was divided into three factors: negatively worded items, positively worded items and risk. The full questionnaire and each factor were found to have good internal consistency and factor loadings were high. There was a statistically significant difference in total CORE-OM scores across the five tinnitus problem categories. However there was no significant difference between those who rated their tinnitus 'not a problem', and 'a small problem' or 'a moderate problem.'
CONCLUSION: This study found a 3-factor structure for the CORE-OM to be a good fit for a tinnitus population. It also found evidence of a relationship between emotional distress as measured by CORE-OM and perception of tinnitus as a problem. Its use in tinnitus clinics is to be recommended, particularly when emotional distress is a target of therapy.

PMID: 27600656 [PubMed - in process]

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Autoimmune sensorineural hearing loss as presenting manifestation of paediatric Behçet disease responding to adalimumab: a case report.

Autoimmune sensorineural hearing loss as presenting manifestation of paediatric Behçet disease responding to adalimumab: a case report.

Ital J Pediatr. 2016;42(1):81

Authors: Marsili M, Marzetti V, Lucantoni M, Lapergola G, Gattorno M, Chiarelli F, Breda L

Abstract
BACKGROUND: Autoimmune sensorineural hearing loss, also known as autoimmune inner ear disease (AIED) is a rare clinical entity characterized by progressive and bilateral sensorineural hearing loss often accompanied by vestibular symptoms. Diagnosis is essential as a consistent number of patients show a positive response to steroids alone or in association with other immunosuppressive drugs. AIED is defined as primary when the disease is limited to the ear, whereas in up to a third of cases it is associated to other systemic autoimmune diseases such as Behçet disease (BD). BD is a rare multisystem vasculitis characterized by recurrent oral and genital aphtosis, uveitis, skin lesions, neurological and vascular manifestations. Clinical presentation is variable thus making the diagnosis difficult in many instances. The choice of therapy is also limited by the scarceness of high-quality therapy studies.
CASE PRESENTATION: We present a 15-year-old-boy with six months of history of fever, dizziness, tinnitus and ataxia. He had a final diagnosis of AIED associated to BD and was successfully treated with the anti-tumor necrosis factor (TNF)-α adalimumab.
CONCLUSIONS: This case report points out to the diagnostic and therapeutic challenges of BD especially when unusual symptoms are the prominent manifestations of the disease. It also suggests that adalimumab is a good therapeutic option in children with BD and audiovestibular symptoms.

PMID: 27600159 [PubMed - in process]

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[Head and neck intensity-modulated radiation therapy: Normal tissues dose constraints. Pharyngeal constrictor muscles and larynx].

[Head and neck intensity-modulated radiation therapy: Normal tissues dose constraints. Pharyngeal constrictor muscles and larynx].

Cancer Radiother. 2016 Sep 2;

Authors: Graff P, Woisard V, Racadot S, Thariat J, Pointreau Y

Abstract
Radio-induced pharyngolaryngeal chronic disorders may challenge the quality of life of head and neck cancer long survivors. Many anatomic structures have been identified as potentially impaired by irradiation and responsible for laryngeal edema, dysphonia and dysphagia. Some dose constraints might be plausible such as keeping the mean dose to the pharyngeal constrictor muscles under 50 to 55Gy, the mean dose to the supra-glottic larynx under 40 to 45Gy and, if feasible, the mean dose to the glottic larynx under 20Gy. A reduction of the dose delivered to the muscles of the floor of the mouth and the cervical esophagus would be beneficial as well. Nevertheless, the publications available do not provide an extensive enough level of proof. One should consider limiting as low as possible the dose delivered to these structures without compromising the quality of irradiation of the target tumor volumes.

PMID: 27599684 [PubMed - as supplied by publisher]

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Dizziness and neck pain: a correct diagnosis is required before consulting a physiotherapist.

Dizziness and neck pain: a correct diagnosis is required before consulting a physiotherapist.

Acta Neurol Belg. 2016 Sep 6;

Authors: van Leeuwen RB, van der Zaag-Loonen H

Abstract
Patients with dizziness often present with concurrent neck complaints. Although there is no evidence that physiotherapy treatment of the neck reduces dizziness, many patients have been treated by a physiotherapist before they visit our tertiary dizziness centre. 1. How often do dizziness and neck complaints co-occur? and 2. how many patients have been treated by a physiotherapist for their neck complaints with a view to reduce the dizziness complaints? In a prospective observational study, the following data were collected: age, gender, neck complaints, and whether or not the dizziness had been treated by physiotherapy. From 455 non-consecutive patients with dizziness, 192 (42 %) patients had concurrent neck complaints in addition to dizziness. Within this group, 87 (45 %) had been treated with physiotherapy to reduce the dizziness. In 81 patients (94 %) who had been treated with physiotherapy, the doctors of the dizziness centre discovered a cause of the dizziness that could be treated medically. Neck complaints and dizziness often coincide. Treatment of the neck complaints with physiotherapy is frequently used. However, the causes of the dizziness are often vestibular (non-cervical) for which medical treatment is available. A correct diagnosis is required before consulting a physiotherapist.

PMID: 27600993 [PubMed - as supplied by publisher]

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Sinking flap syndrome with abdominal pain: an atypical presentation.

Sinking flap syndrome with abdominal pain: an atypical presentation.

BMJ Case Rep. 2016;2016

Authors: Beuchat I, Michel P, Maeder P, Diserens K

Abstract
UNLABELLED: A 53-year-old man developed significant mass effect secondary to an ischaemic stroke and was treated with decompressive craniectomy. During the first few days postsurgery he developed orthostatic vertigo with nausea. After a month, with increasing mobilisation and rehabilitation, he started reporting of severe abdominal pain. No aetiology could be found despite extensive local work up and the symptoms were resistant to any symptomatic treatment. Within days postcranioplasty there was a complete resolution of all the symptoms.
CONCLUSION: the sinking flap syndrome can cause abdominal pain and orthostatic vertigo.

PMID: 27599806 [PubMed - in process]

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Dorsal penile nerve block with ropivacaine versus intravenous tramadol for the prevention of catheter-related bladder discomfort: study protocol for a randomized controlled trial.

Dorsal penile nerve block with ropivacaine versus intravenous tramadol for the prevention of catheter-related bladder discomfort: study protocol for a randomized controlled trial.

Trials. 2015;16:596

Authors: Li JY, Liao R

Abstract
BACKGROUND: Catheter-related bladder discomfort (CRBD) is common in male patients under general anesthesia, and it may cause patient agitation and exacerbated postoperative pain. In this study, we will enroll male patients undergoing elective surgery with urinary catheterization after anesthetic induction and compare the efficacy of a dorsal penile nerve block (DPNB) and intravenous tramadol for the prevention of CRBD.
METHODS/DESIGN: This trial is a prospective, open-label, randomized controlled trial that will test the superiority of a dorsal penile nerve block with 0.33% ropivacaine to the use of intravenous tramadol 1.5 mg/kg for CRBD prevention. A total of 60 male patients undergoing elective surgery with urinary catheterization after anesthetic induction will be randomized to receive either DPNB with 0.33% ropivacaine (DPNB group) or intravenous tramadol 1.5 mg/kg (TRAM group) after the completion of surgery but before extubation. The primary outcome is the incidence and severity of CRBD. Secondary outcomes include Visual Analog Score (VAS) for postoperative pain, number of patients requiring sulfentanil after operation, acceptance of an indwelling urinary catheter after extraction of the catheter, and postoperative side effects, which include postoperative nausea/vomiting (PONV), vertigo, sedation, drowsiness, and dry mouth.
DISCUSSION: For CRBD prevention, this trial is planned to test the superiority of a dorsal penile nerve block with 0.33% ropivacaine to the use of intravenous tramadol 1.5 mg/kg. The results will provide new insight into the mechanism of CRBD and new clinical practice for the prevention of CRBD.
TRIAL REGISTRATION: The registration number is NCT01721031, which was assigned by the National Institutes of Health Clinical Trials Registry (ClinicalTrials.gov) on 27 October 27.

PMID: 26715519 [PubMed - indexed for MEDLINE]

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Concurrent Acoustic Activation of the Medial Olivocochlear System Modifies the After-Effects of Intense Low-Frequency Sound on the Human Inner Ear.

Concurrent Acoustic Activation of the Medial Olivocochlear System Modifies the After-Effects of Intense Low-Frequency Sound on the Human Inner Ear.

J Assoc Res Otolaryngol. 2015 Dec;16(6):713-25

Authors: Kugler K, Wiegrebe L, Gürkov R, Krause E, Drexl M

Abstract
>Human hearing is rather insensitive for very low frequencies (i.e. below 100 Hz). Despite this insensitivity, low-frequency sound can cause oscillating changes of cochlear gain in inner ear regions processing even much higher frequencies. These alterations outlast the duration of the low-frequency stimulation by several minutes, for which the term 'bounce phenomenon' has been coined. Previously, we have shown that the bounce can be traced by monitoring frequency and level changes of spontaneous otoacoustic emissions (SOAEs) over time. It has been suggested elsewhere that large receptor potentials elicited by low-frequency stimulation produce a net Ca(2+) influx and associated gain decrease in outer hair cells. The bounce presumably reflects an underdamped, homeostatic readjustment of increased Ca(2+) concentrations and related gain changes after low-frequency sound offset. Here, we test this hypothesis by activating the medial olivocochlear efferent system during presentation of the bounce-evoking low-frequency (LF) sound. The efferent system is known to modulate outer hair cell Ca(2+) concentrations and receptor potentials, and therefore, it should modulate the characteristics of the bounce phenomenon. We show that simultaneous presentation of contralateral broadband noise (100 Hz-8 kHz, 65 and 70 dB SPL, 90 s, activating the efferent system) and ipsilateral low-frequency sound (30 Hz, 120 dB SPL, 90 s, inducing the bounce) affects the characteristics of bouncing SOAEs recorded after low-frequency sound offset. Specifically, the decay time constant of the SOAE level changes is shorter, and the transient SOAE suppression is less pronounced. Moreover, the number of new, transient SOAEs as they are seen during the bounce, are reduced. Taken together, activation of the medial olivocochlear system during induction of the bounce phenomenon with low-frequency sound results in changed characteristics of the bounce phenomenon. Thus, our data provide experimental support for the hypothesis that outer hair cell calcium homeostasis is the source of the bounce phenomenon.

PMID: 26264256 [PubMed - indexed for MEDLINE]

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[Relevance of HPV infections in head and neck cancers : Highlights of the 2016 ASCO Annual Meeting].

[Relevance of HPV infections in head and neck cancers : Highlights of the 2016 ASCO Annual Meeting].

HNO. 2016 Sep 6;

Authors: Hoffmann M

Abstract
The papers on human papillomavirus (HPV) infections in head and neck carcinomas presented during the ASCO Meeting in 2016 investigated factors influencing the survival of patients with known HPV status. Interestingly, women suffering from oropharyngeal carcinomas show better survival than men do. This is believed to be the consequence of differences in the immune system of male and female patients. Another interesting finding is that the HPV status in cases of locoregional recurrence of oropharyngeal carcinomas represents a positive predictive marker for patient survival. Other papers presented at the meeting compared methods used to reliably determine HPV-driven carcinomas. Of particular interest is the development of a new in situ hybridization method to determine the viral mRNA of the oncogenes E6 and E7. The results presented appear promising with regard to their accuracy in detecting HPV-driven carcinomas. Another set of papers investigated, partly in retrospective settings, interventional studies in which the HPV status of the patients was taken into account. It is noteworthy that the high doses of cisplatin that were tested in comparison with weekly administered cisplatin or the treatment with cetuximab instead of cisplatin showed positive effects in some survival calculations but were accompanied by higher toxicity. Overall the papers presented demonstrate the necessity for further epidemiologic, methodological, interventional, and in particular prospective studies.

PMID: 27601039 [PubMed - as supplied by publisher]

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[Expert assessment of hearing aid fitting].

[Expert assessment of hearing aid fitting].

HNO. 2016 Sep 6;

Authors: Michel O

PMID: 27601038 [PubMed - as supplied by publisher]

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[Early and one-stage posterior-anterior surgery for fresh and severe lower cervical spine fracture and dislocation].

[Early and one-stage posterior-anterior surgery for fresh and severe lower cervical spine fracture and dislocation].

Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2016 Aug;41(8):838-45

Authors: Duan C, Hu J, Wang X, Wu J

Abstract
OBJECTIVE: To explore the clinical value of early and one-stage posterior laminectomy decompression, fracture reconstruction and lateral mess screw fixation combined with anterior cervical corpectomy or discectomy for the treatment of fresh and severe lower cervical spine fracture and dislocation. 
METHODS: A total of 156 consecutive cases of severe fracture and dislocation of lower cervical spine were reviewed from January 2008 to January 2015. Skull traction was installed when the patients were enrolled in the hospital, so the operation was performed as early as possible. Firstly, the posterior procedure was applied to the patients prone on a frame. A standard posterior laminectomy, fixation and fusion were performed with lateral mass screws and rods. The cervical spine reconstruction was achieved by laminecomy, partially facetectomy, leverage and distraction. The technique of rotating rod was applied to recover the sequence of the cervical and keep or increase the zygopophysis and lordosis of the cervical on the sagittal plane. After the skull traction removed, a standard anterior approach to the cervical spine was initiated as the second stage of the procedure. Anterior cervical corpectomy or discectomy, spinal cord decompression, antograft and cervical spine auto-locking plate fixation were carried out. The stability, the fusion rate of the injured segments and spinal cord decompression were observed on the regular postoperative X-ray film and CT scan. The function of the spinal cord was evaluated by American Spinal Injury Association (ASIA) classification. 
RESULTS: A total of 137 cases were followed-up, 19 failed to follow-up and 8 of them were due to death. The follow-up time was from 9.0 months to 35.0 months (mean: 13.7 months). All patients got completely reduction of the cervical spine. The injured segments were stable. There was no patient of bone graft no-fusion. The cervical intervertebral height and lordosis were reconstructed and maintained and all grafts were fused at the end of follow-up period. There was no complication related to internal fixation breakage, loosening or displacement. There was also no neurovascular and esophagus complications during the operation. Twelve patients complained neck pain at the final follow-up. There were 12 cases of wound infection and 12 cases of neck inflammatory. They were healed after anti-inflammatory therapy. There were 13 cases of cerebrospinal fluid leakage, and they were healed after the symptomatic treatment. The neuro-function of most patients was improved, and ASIA classification was improved by 1 to 2 grade. 
CONCLUSION: Early and one-stage posterior-anterior decompression and reconstruction for the patients with fresh and severe lower cervical spine fracture and dislocation can achieve good reduction and cervical alignment of cervical spine. The injured segments can gain postoperative immediate stability. It also gives a completely decompression, which is benefit to the patients for nursing, functional exercise, and the functional recovery of the spinal cord.

PMID: 27600012 [PubMed - in process]

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Botulinum toxin injection in laryngeal dyspnea.

Botulinum toxin injection in laryngeal dyspnea.

Eur Arch Otorhinolaryngol. 2016 Sep 6;

Authors: Woisard V, Liu X, Bes MC, Simonetta-Moreau M

Abstract
Data, regarding the use of botulinum toxin (BT-A) in laryngeal dyspnea, are scarce, coming from some cases reports in the literature, including Vocal fold paralysis, laryngeal dystonia, vocal cord dysfunction also called paradoxical motion of the vocal fold (PMVF), and post-neuroleptic laryngeal dyskinesia. There is no consensus regarding the muscles and the doses to inject. The aim of this study is to present a retrospective review of patients treated in our ENT Department by BT-A injection in this indication. This study is a retrospective study describing patients who underwent an injection of botulinum toxin for laryngeal dyspnea in the ENT Department from 2005 to 2015 years. The inclusion criteria were a dyspnea associated with a laryngeal dysfunction, confirmed by flexible fiberoptic nasopharyngolaryngoscopy. Information concerning the causes of the dyspnea, the botulinum toxin BT-A injections procedure, post-injection follow-up, and respiratory outcome were collected for all patients included. In the group of 13 patients included, the main cause identified as principal factor linked with the short breath was: a bilateral VF paralysis (Patel et al., Otolaryngol Head Neck Surg 130:686-689, 7), laryngeal dystonia (Balkissoon and Kenn, Semin Respir Crit Care Med 33:595-605, 2), Anxiety syndrome associated with unilateral vocal fold paralysis or asthma (Marcinow et al., Laryngoscope 124:1425-1430, 3), and an isolated asthma (Zwirner et al., Eur Arch Otorhinolaryngol 254:242-245, 1). Nine out of the thirteen patients were improved by the injections. A BT-A-induced stable benefit for four patients led them to stop the injections in the follow-up. Good outcome was observed in five other patients (main cause: bilateral VP paralysis), allowing a progressive lengthening of the delay between BT-A injections. Four patients did not report a positive risk/benefit ratio after BT-A injections; two of them (with bilateral VF paralysis), because of respiratory side effects and lack of benefit without the side effects for the two others. This failure of effect was not related with BT-A doses injected. This study provides support for using BT-A injections as a symptomatic treatment of periodic laryngeal dyspnea, regardless of the etiologic context. From our data, we suggest that a small starting dose (of around 4 U BT-A Botox(®)) could be enough for a first injection to obtain a good benefit. The target muscle should be determined by the EMG analysis.

PMID: 27600559 [PubMed - as supplied by publisher]

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Letter to the Editor: Concerning "Xenograft Model for Therapeutic Drug Testing in Recurrent Respiratory Papillomatosis".

Letter to the Editor: Concerning "Xenograft Model for Therapeutic Drug Testing in Recurrent Respiratory Papillomatosis".

Ann Otol Rhinol Laryngol. 2016 Sep 5;

Authors: Branski RC, Dion GR, Best S

PMID: 27599839 [PubMed - as supplied by publisher]

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Validation of the Distress Thermometer and Problem List in Patients with Recurrent Respiratory Papillomatosis.

Validation of the Distress Thermometer and Problem List in Patients with Recurrent Respiratory Papillomatosis.

Otolaryngol Head Neck Surg. 2016 Sep 6;

Authors: San Giorgi MR, Aaltonen LM, Rihkanen H, Tjon Pian Gi RE, van der Laan BF, Hoekstra-Weebers JE, Dikkers FG

Abstract
OBJECTIVE: There is no specific clinical tool for physicians to detect psychosocial and physical distress or health care need in patients with recurrent respiratory papillomatosis (RRP). The main aim of this study is to validate the RRP-adapted Distress Thermometer and Problem List (DT&PL).
STUDY DESIGN: Prospective cross-sectional questionnaire research.
SETTING: Academic tertiary care medical centers in Groningen, Netherlands, and Helsinki, Finland.
METHODS AND SUBJECTS: Ninety-one juvenile- and adult-onset RRP patients participated from the departments of otorhinolaryngology-head and neck surgery of the University Medical Center Groningen, Netherlands, and Helsinki University Hospital, Finland. The Hospital Anxiety and Depression Scale was used as the gold standard.
RESULTS: A DT cutoff score ≥4 gave the best sensitivity and specificity. Thirty-one percent of patients had significant distress according to the DT cutoff. Significantly more patients with a score above than under the cutoff had a referral wish. The PL appeared to be reliable. Patients' opinions on the DT&PL were largely favorable.
CONCLUSION: The Dutch and Finnish versions of the DT&PL are valid, reliable screening tools for distress in RRP patients.

PMID: 27600632 [PubMed - as supplied by publisher]

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Perioperative Deep Vein Thrombosis Risk Stratification: A Comparative Analysis of Free and Pedicled Flap Patients.

Perioperative Deep Vein Thrombosis Risk Stratification: A Comparative Analysis of Free and Pedicled Flap Patients.

Otolaryngol Head Neck Surg. 2016 Sep 6;

Authors: Sinha S, Puram SV, Sethi RK, Goyal N, Emerick KS, Lin D, Durand ML, Deschler DG

Abstract
Patients with head and neck cancer who undergo reconstructive surgery are at risk for deep venous thrombosis (DVT), but the risk profile for patients undergoing major flap reconstruction is highly variable. Herein, we report our findings from a retrospective analysis of head and neck cancer patients (n = 517) who underwent free (n = 384) or pedicled (n = 133) flap reconstructive operations at a major tertiary care center from 2011 to 2014. DVTs developed perioperatively in 9 (1.7%) patients. Compared with pedicled flap patients, free flap patients had a longer mean operative time (421.4 ± 4.4 vs 332.7 ± 10.7 min, P < .0001), but the DVT incidence did not differ significantly between free and pedicled flap patients (1.6% vs 2.2%, respectively, P = .28). These data suggest that perioperative DVT risk in head and neck oncology patients may be largely similar regardless of the reconstructive strategy pursued.

PMID: 27600631 [PubMed - as supplied by publisher]

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Novel Dissection Station for Endolaryngeal Microsurgery and Laser Surgery: Development and Dissection Course Experience.

Novel Dissection Station for Endolaryngeal Microsurgery and Laser Surgery: Development and Dissection Course Experience.

Otolaryngol Head Neck Surg. 2016 Sep 6;

Authors: Mattioli F, Presutti L, Caversaccio M, Bonali M, Anschuetz L

Abstract
OBJECTIVE: We aimed to develop and validate an ex vivo dissection station for endolaryngeal surgery suitable for different kinds of laryngeal specimen and any type of operating technique (CO2 laser, cold instruments by endoscopic or microscopic techniques).
STUDY DESIGN: Experimental construction and validation of a highly specialized dissection station.
SETTING: Laboratory and international dissection course.
METHODS: We designed a lightweight dissection station made of polycarbonate resin approved for use with a CO2 laser. The cylindrical box hosts an articulated laryngeal support. The laryngoscope is positioned on an articulated arm, which is fixed on the construction's footplate. Validation of the larynx box was performed during an international dissection course on laryngeal surgery held in January 2016.
RESULTS: We assessed the suitability of our novel dissection station among specialized laryngologists with a mean experience of 14 years. Feedback from the participants was very positive, with a mean general impression of 9.5 (out of 10 points) and a recommendation score of 9.6 for further use. Its utility in transforming the taught surgical steps into daily practice has been highly recognized, with a score of 9.5.
CONCLUSION: The lightweight and transparent larynx box is suitable for any kind of laryngeal specimen, and any surgical intervention can be taught at reasonable cost. It is safe and suitable for use with CO2 lasers. Validation among experienced surgeons revealed its suitability in the teaching of endolaryngeal microsurgery and laser surgery.

PMID: 27600630 [PubMed - as supplied by publisher]

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Primary Caregiver Perception of Pain Control following Pediatric Adenotonsillectomy: A Cross-Sectional Survey.

Primary Caregiver Perception of Pain Control following Pediatric Adenotonsillectomy: A Cross-Sectional Survey.

Otolaryngol Head Neck Surg. 2016 Sep 6;

Authors: Sowder JC, Gale CM, Henrichsen JL, Veale K, Liljestrand KB, Ostlund BC, Sherwood A, Smith A, Olsen GH, Ott M, Meier JD

Abstract
OBJECTIVES: To (1) review pain medications prescribed following pediatric adenotonsillectomy (T&A), (2) identify pain medications reported to be helpful, and (3) compare parent-reported outcomes among various combinations of pain medications.
STUDY DESIGN: Case series with planned data collection.
SETTING: Multihospital network.
SUBJECTS AND METHODS: The primary caregivers of children aged 1 to 18 years who underwent isolated T&A from June to December 2014 were contacted 14 to 21 days after surgery. Data collected included pain medications prescribed, medications most helpful in controlling pain, and duration that pain medication was required. Parents rated their children's pain on postoperative days 2, 3, 7, and 14 and reported the time to resumption of normal diet/activity, as well as any hospital return visits.
RESULTS: The study cohort included 672 subjects of 1444 potential participants (46% response rate). The mean age of the patients was 7.9 ± 3.6 years. Narcotics were prescribed in 71.9%, and 70.4% were told to use ibuprofen. Children who took ibuprofen alone were significantly younger (P < .001). Pain was significantly less on postoperative days 2 and 3 in the ibuprofen-only group as compared with the groups taking narcotics only (P < .001) and ibuprofen with narcotics (P = .002). Those taking ibuprofen alone returned to normal activity (P < .001) and diet (P = .026) sooner than those taking ibuprofen with narcotics. No difference was seen in pain control on subgroup analysis comparing oxycodone and hydrocodone.
CONCLUSIONS: For pediatric T&A, significant variation exists in the management of postoperative pain. Parents of children given ibuprofen reported less pain than those given narcotics with and without ibuprofen. Further studies are needed to identify the optimal pain regimen for children after T&A.

PMID: 27600629 [PubMed - as supplied by publisher]

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Evaluation of the in vitro push-out bond strengths of different post luting systems after artificial aging.

Evaluation of the in vitro push-out bond strengths of different post luting systems after artificial aging.

Minerva Stomatol. 2016 Sep 7;

Authors: Marigo L, D'Arcangelo C, De Angelis F, Cordaro M, Vadini M, Lajolo C

Abstract
BACKGROUND: Purpose of this study was to evaluate the push-out bond strengths of four commercially available adhesive luting systems (two self-adhesive and two etch-and-rinse systems) after mechanical aging.
METHODS: Forty single-rooted anterior teeth were divided into four groups according to the luting cement system used: G1= Cement-One; G2= One-Q-adhesive Bond + Axia Core Dual; G3 = SmartCem 2; and G4 XP Bond + Core X flow. Anatomical Post were cemented in G1 and G2, and D.T. Light-Post Illusion were cemented in G3 and G4. All samples were subjected to masticatory stress simulation consisting of 300000 cycles applied with a computer-controlled chewing simulator. Push-out bond strength values (MPa) were calculated at cervical, middle, and apical each level, and the total bond strengths were calculated as the averages of the three levels. Statistical analysis was performed with data analysis software and significance was set at p<0.05.
RESULTS: Statistically significant differences in total bond strength were detected between the cements (G4=3.28 vs. G1=2.77 vs. G2=2.36 vs. G3=1.13 MPa; p<0.05). Specifically, G1 exhibited a lower bond strength in the apical zone, G3 exhibited a higher strength in this zone, and G2 and G4 exhibited more homogeneous bonding strengths across the different anatomical zones.
CONCLUSION: After artificial aging, etch-and-rinse luting systems exhibited more homogeneous bond strengths; nevertheless Cement-One exhibited a total bond strength second only to Core X Flow.

PMID: 27604042 [PubMed - as supplied by publisher]

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Αρχειοθήκη ιστολογίου

Πέμπτη 8 Σεπτεμβρίου 2016