OtoRhinoLaryngology News

Παρασκευή 11 Αυγούστου 2017

Upper neck papillary thyroid cancer (UPTC): A new proposed term for the composite of thyroglossal duct cyst-associated papillary thyroid cancer, pyramidal lobe papillary thyroid cancer, and Delphian node papillary thyroid cancer metastasis.

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Upper neck papillary thyroid cancer (UPTC): A new proposed term for the composite of thyroglossal duct cyst-associated papillary thyroid cancer, pyramidal lobe papillary thyroid cancer, and Delphian node papillary thyroid cancer metastasis.

Laryngoscope. 2016 Jul;126(7):1709-14

Authors: Zizic M, Faquin W, Stephen AE, Kamani D, Nehme R, Slough CM, Randolph GW

Abstract
OBJECTIVES/HYPOTHESIS: Thyroglossal duct cyst (TGDC) is a common congenital anomaly, but TGDC carcinoma is rare. Thyroglossal duct cyst carcinoma management is controversial, especially that of the orthotopic thyroid gland. We aim to provide an insight into the pathologic basis of this management controversy through the review of 28 TGDC cancer cases, thus far the largest such series to our knowledge.
STUDY DESIGN: Retrospective.
METHODS: Twenty-eight cases recorded as TGDC cancer in the hospital database were reviewed; their initial clinical diagnosis from medical chart review (DX1) and final pathological review diagnosis (DX2) through pathology slides review by our pathologist (blinded to DX1) were compared. The thyroid gland management and pathology were evaluated.
RESULTS: In the 28 TGDC carcinoma (hospital-recorded diagnosis) patients, DX1 and DX2 were respectively reported as 53% and 14% TGDC carcinoma, 11% and 29% as pyramidal lobe primary, and 4% and 25% as metastatic Delphian node. Thirty-two percent of cases were in the indeterminate category, in both DX1 and DX2, but included different patients. Thyroidectomy was performed in 54% of the cases, papillary thyroid cancer (PTC) was reported in 37% of these thyroid glands. Concurrent thyroid gland malignancy was reported in all Delphian node and pyramidal lobe PTC patients.
CONCLUSION: The diagnosis of TGDC cancer comprises a heterogeneous group that includes true TGDC cancer, pyramidal lobe primary, Delphian node metastasis, and indeterminate cases. We propose a new terminology of upper neck papillary thyroid carcinoma (UPTC) to denote this heterogeneous group and recommend a rational algorithm for management. Correct pathologic subcategory and thyroid ultrasonography are essential for optimal management of thyroid gland in UPTC cases.
LEVEL OF EVIDENCE: 4. Laryngoscope, 126:1709-1714, 2016.

PMID: 26691539 [PubMed - indexed for MEDLINE]

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Analysis of laryngoscopic features in patients with unilateral vocal fold paresis.

Analysis of laryngoscopic features in patients with unilateral vocal fold paresis.

Laryngoscope. 2016 Aug;126(8):1831-6

Authors: Woo P, Parasher AK, Isseroff T, Richards A, Sivak M

Abstract
OBJECTIVES/HYPOTHESIS: The diagnosis of paresis in patients with vocal fold motion impairment remains a challenge. More than 27 clinical parameters have been cited that may signify paresis. We hypothesize that some features are more significant than others.
STUDY DESIGN: Prospective case series.
METHODS: Two laryngologists rated laryngoscopy findings in 19 patients suspected of paresis. The diagnosis was confirmed with laryngeal electromyography. A standard set of 27 ratings was used for each examination that included movement, laryngeal configuration, and stroboscopy signs. A Fisher exact test was completed for each measure. A kappa coefficient was calculated for effectiveness in predicting the laterality of paresis.
RESULTS: Left-sided vocal fold paresis (n = 13) was significantly associated with ipsilateral axis deviation, thinner vocal fold, bowing, reduced movement, reduced kinesis, and phase lag (P < .05). Right-sided vocal fold paresis (n = 6) was significantly associated with ipsilateral shorter vocal fold, axis deviation, reduced movement, and reduced kinesis (P < .05). Using these key parameters, the senior author was accurately able to diagnose the side of paresis in 89.5% of cases for a kappa coefficient of 0.78.
CONCLUSIONS: Of the multiple features on laryngoscopy, glottic configuration, ipsilateral thin vocal fold, vocal fold bowing, reduced movement, reduced kinesis, and phase lag were more likely to be associated with vocal fold paresis.
LEVEL OF EVIDENCE: 4 Laryngoscope, 126:1831-1836, 2016.

PMID: 26651146 [PubMed - indexed for MEDLINE]

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Early glottic cancer involving the anterior commissure treated by transoral laser cordectomy.

Early glottic cancer involving the anterior commissure treated by transoral laser cordectomy.

Laryngoscope. 2016 Aug;126(8):1817-22

Authors: Hoffmann C, Cornu N, Hans S, Sadoughi B, Badoual C, Brasnu D

Abstract
OBJECTIVES/HYPOTHESIS: Anterior commissure involvement is considered to be a risk factor for poorer outcomes after transoral laser cordectomy (TLC) for early glottic cancer. The objective of this study was to determine the outcomes and relevance of the tumor-node-metastasis (TNM) classification in a large series of patients with early glottic cancer involving the anterior commissure treated by TLC.
METHODS: The clinical and surgical parameters, as well as follow-up results, of the patients treated consecutively for early-stage glottic squamous cell carcinoma involving the anterior commissure (Tis, T1a, T1b, and T2) by transoral CO2 laser cordectomy in an urban academic medical center from January 2001 to March 2013 were analyzed retrospectively. The main outcomes measures were: 5-year disease free survival (DFS), ultimate local control with laser alone, laryngeal preservation, overall-survival (OS) rates, and disease-specific survival (DSS) rates (Kaplan-Meier).
RESULTS: Ninety-six patients treated from January 2001 to March 2013 were included. The 5-year DFS and ultimate local control with laser alone rates were 61.7% and 74.4%, respectively. The laryngeal preservation rate was 93.4%; and the OS and DSS rates were 79.2% and 91.5%, respectively. Postoperative T classification (pT) status was not found to be a significant predictor of recurrences, but was predictive of more severe recurrences requiring other treatments than laser.
CONCLUSION: TLC is an effective treatment for early stage glottic cancer involving the anterior commissure. The TNM classification is a relevant prognosis factor for severe recurrences.
LEVEL OF EVIDENCE: 4. Laryngoscope, 126:1817-1822, 2016.

PMID: 26597482 [PubMed - indexed for MEDLINE]

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Can videostroboscopy predict early glottic cancer? A systematic review and meta-analysis.

Can videostroboscopy predict early glottic cancer? A systematic review and meta-analysis.

Laryngoscope. 2016 Sep;126(9):2079-84

Authors: Mehlum CS, Rosenberg T, Groentved AM, Dyrvig AK, Godballe C

Abstract
OBJECTIVE: Correct assessment of patients with a glottic lesion is crucial for ensuring proper treatment in cases of cancer or premalignancy and for avoiding unnecessary surgery. For years, videostroboscopy (VS) has been the gold standard for assessing such lesions, but diagnostic difficulties have been described. We aim to estimate the diagnostic accuracy of VS in differentiating early glottic cancer from noninvasive lesions by conducting a systematic review and meta-analysis of published studies.
DATA SOURCES: PubMed and Embase databases were searched without restrictions on publication date.
REVIEW METHODS: A systematic review and subsequent meta-analysis were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. We systematically searched the literature for publications on stroboscopic diagnosis of cancer or premalignant lesions on the vocal cords. All retrieved studies were reviewed and qualitatively assessed. The pooled sensitivity and specificity of VS were calculated, and bubble and summary receiver operating characteristics plots were created.
RESULTS: A meta-analysis was conducted on five studies with a total of 307 patients. The sensitivities of VS within the single studies ranged from 86% to 100% and specificities ranged from 7% to 93%. The meta-analysis showed that the sensitivity of the combined results was 0.96 (95% confidence interval [CI]: 0.89-0.98), and the specificity was 0.65 (95% CI: 0.21-0.93).
CONCLUSION: VS is able to identify almost all patients with cancer, but only approximately two-thirds of patients with noninvasive lesions are correctly identified as not having cancer. Further research concerning assessment of patients with vocal cord lesions is needed.
LEVEL OF EVIDENCE: NA Laryngoscope, 126:2079-2084, 2016.

PMID: 26524997 [PubMed - indexed for MEDLINE]

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Increased number of volatile organic compounds over malignant glottic lesions.

Increased number of volatile organic compounds over malignant glottic lesions.

Laryngoscope. 2016 Jul;126(7):1606-11

Authors: Shoffel-Havakuk H, Frumin I, Lahav Y, Haviv L, Sobel N, Halperin D

Abstract
OBJECTIVES/HYPOTHESIS: Electronic noses can identify diseases, including head and neck squamous cell carcinoma (SCC) by the fingerprint of volatile organic compounds (VOCs) in exhaled air. However, whether these VOCs originated from the malignant lesion itself remains unclear. The objective was to test for the presence and properties of VOCs directly over the vocal folds in malignant and benign lesions, as a potential tool for noninvasive screening.
STUDY DESIGN: Prospective observational case control study.
METHODS: Samples of mucus directly covering vocal fold lesions were analyzed using gas chromatography mass spectrometry for detection of VOCs, and evaluation of the properties and quantity of VOCs in the samples. Additionally, samples of oropharyngeal mucus were analyzed to exclude VOCs found also in the vicinity of the lesion. Benign and malignant lesion groups were compared using a nonparametric (Mann-Whitney) test.
RESULTS: We studied 14 patients, six with SCC and eight with benign pathology. We found an increased number of discrete VOC types in patients with SCC both above the lesion (SCC = 4.333 ± 2.5, benign = 0.875 ± 0.6; Z=3, P < .001) and directly above the lesion with exclusion of its vicinity (SCC = 3.167 ± 1.9, benign = 0.5 ± 0.5; Z = 2.8, P < .003). VOCs detected in SCCs but not in benign samples included the straight-chain fatty acids: butyric acid, pentanoic acid, hexanoic acid, and heptanoic acid.
CONCLUSIONS: Compared with benign vocal fold lesions, the environment of vocal folds in SCC is enriched with VOCs. These preliminary findings highlight a unique pattern that may contribute to the development of a future minimally invasive technology for screening vocal fold lesions for malignancy.
LEVEL OF EVIDENCE: NA Laryngoscope, 126:1606-1611, 2016.

PMID: 26490745 [PubMed - indexed for MEDLINE]

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Selecting an acoustic correlate for automated measurement of American English rhotic production in children.

Selecting an acoustic correlate for automated measurement of American English rhotic production in children.

Int J Speech Lang Pathol. 2017 Aug 10;:1-9

Authors: Campbell H, Harel D, Hitchcock E, McAllister Byun T

Abstract
PURPOSE: A current need in the field of speech-language pathology is the development of reliable and efficient techniques to evaluate accuracy of speech targets over the course of treatment. As acoustic measurement techniques improve, it should become possible to use automated scoring in lieu of ratings from a trained clinician in some contexts. This study asks which acoustic measures correspond most closely with expert ratings of children's productions of American English /ɹ/ in an effort to develop an automated scoring algorithm for use in treatment targeting rhotics.
METHOD: A series of ordinal mixed-effects regression models were fit over a large sample of children's productions of words containing /ɹ/ that had previously been rated by three trained clinicians. Akaike/Bayesian Information Criteria were used to select the best-fitting model.
RESULT: Controlling for age, sex, and allophonic contextual differences, the measure that accounted for the most variance in speech rating was F3-F2 distance normalised relative to a sample of age- and sex-matched speakers.
CONCLUSION: We recommend this acoustic measure for use in future automated scoring of children's production of American English rhotics. We also suggest that computer-based treatment with automated scoring should facilitate increases in treatment dosage by improving options for home practice.

PMID: 28795872 [PubMed - as supplied by publisher]

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18F-FDG PET/CT may exclude malignancy in sonographically suspicious and scintigraphically hypofunctional thyroid nodules and reduce unnecessary thyroid surgeries.

18F-FDG PET/CT may exclude malignancy in sonographically suspicious and scintigraphically hypofunctional thyroid nodules and reduce unnecessary thyroid surgeries.

Thyroid. 2017 Aug 10;:

Authors: Ruhlmann M, Ruhlmann J, Görges R, Herrmann K, Antoch G, Keller HW, Ruhlmann V

Abstract
BACKGROUND: The aim of this study was to evaluate whether [18F]-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) is useful in the further characterization of sonographically suspicious and scintigraphically hypofunctional thyroid nodules.
METHODS: 65 patients with a sonographically suspicious thyroid nodules that were hypofunctional on 99m-Tc-pertechnetate scintigraphy (diameter > 1 cm) were retrospectively analyzed. All patients underwent evaluation with FDG-PET/CT. Thyroid nodules were sonographically categorized by TIRADS criteria. FDG uptake in the thyroid nodules was visually compared with the remainder of the thyroid tissue and categorized as pathological or non-pathological. In cases of pathologically increased uptake, maximum standardized uptake value (SUVmax) of the suspicious nodule and the perinodular thyroid tissue were determined. Depending on the results of the FDG-PET/CT, patients underwent thyroid surgery (pathological FDG uptake) or follow-up examinations (non-pathological FDG uptake). The endpoints for comparison with the FDG uptake were either histological results or sonographic follow-up examinations of at least 5 years.
RESULTS: In 18/65 (28%) patients PET/CT showed visually pathological FDG uptake in the suspicious thyroid nodules (SUVmax 7.1 ± 4.6). 3/18 (17%) of these nodules were sonographically categorized as TIRADS 4a, 11/18 (61%) nodules as TIRADS 4b, 3/18 (17%) nodules as TIRADS 4c and 1/18 (6%) nodule as TIRADS 5. The other nodules without pathological FDG uptake were categorized as TIRADS 4a in 24/47 (51%) patients, as TIRADS 4b in 18/47 (38%), and as TIRADS 4c in 5/47 (11%) patients. 23 patients (18 FDG positive, 5 FDG negative) underwent surgery. The other patients underwent follow-up examinations with stability on observation over at least 5 years as a surrogate endpoint. Taking into consideration, that FDG-PET/CT was rated as true negative in 42/47 patients with stability on sonographic follow-up, sensitivity, specificity, PPV and NPV of FDG-PET/CT in detecting malignancy in the suspicious thyroid nodules was 100%, 87%, 61% and 100%, respectively.
CONCLUSION: FDG-PET/CT allows stratification of patients with sonographically suspicious and scintigraphically hypofunctional thyroid nodules with a PPV of 61% and NPV of 100%. The absence of visually pathological FDG uptake in suspicious thyroid nodules may be useful for avoiding unnecessary thyroid surgery.

PMID: 28793848 [PubMed - as supplied by publisher]

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Editorial: The Complex and Instructive Relationship between OSA and Nocturnal Cardiovascular Death

Publication date: Available online 11 August 2017
Source:Sleep Medicine
Author(s): C.Anwar A. Chahal, Akil A. Sherif, Virend K. Somers

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Measurement is always better than self-report - is it that easy?

Publication date: Available online 10 August 2017
Source:Sleep Medicine
Author(s): Bernd Kowall, Andreas Stang

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Oral pemphigus vulgaris: Liquid-based cytological findings and pitfalls

Pemphigus vulgaris (PV) is a chronic autoimmune bullous disease characterized by the formation of suprabasal cleavage and acantholysis. As this disease almost always affects the oral mucosa, conventional cytological smears of oral lesions can be used for the initial diagnosis of PV. We report two cases of PV that were initially diagnosed based on cytological smears of an oral sample. As atypical squamous cells were present even in the liquid-based cytological (LBC) smears of the oral lesion in these two cases, this ultimately led to the misinterpretation of squamous cell carcinoma. These findings demonstrate that cytological mimicry of oral PV can occur in malignant cases when there is an absence of appropriate clinical information.

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The combined application of urinary liquid-based cytology with fluorescence in situ hybridization and p16/Ki-67 dual immunostaining is valuable for improving the early diagnosis of upper tract urothelial carcinomas

Abstract

Objectives

To evaluate the diagnostic values of urine liquid-based cytology (LBC), fluorescence in situ hybridization (FISH), and p16/Ki-67 dual immunostaining in the detection of upper tract urothelial carcinomas (UTUCs).

Methods

Sixty-one patients with UTUCs were retrospectively analyzed. All patients were diagnosed both by urine cytology and by FISH, and histologically confirmed as UTUCs. Thirty-two patients had been stained with p16/Ki-67 dual labeling.

Results

The sensitivities for low-grade UTUCs (LGUTUCs) and high-grade UTUCs (HGUTUCs) were 33.3% and 67.4% by LBC, 60% and 69.6% by FISH, and 12.5% and 66.7% by p16/Ki-67 dual labeling, respectively.

Conclusions

Our results indicated that LBC was more suitable to identify HGUTUCs, FISH was highly valuable for predicting LGUTUCs, and p16/Ki-67 dual labeling was useful for distinguishing HGUTUCs from LGUTUCs. The combined application of these methods may improve the sensitivity or accuracy in the detection or diagnosis of UTUCs.

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Lateral Cortical Thickening and Bone Heterogeneity of the Subtrochanteric Femur Measured With Quantitative CT as Indicators for Early Detection of Atypical Femoral Fractures in Long-Term Bisphosphonate Users.

Lateral Cortical Thickening and Bone Heterogeneity of the Subtrochanteric Femur Measured With Quantitative CT as Indicators for Early Detection of Atypical Femoral Fractures in Long-Term Bisphosphonate Users.

AJR Am J Roentgenol. 2017 Aug 10;:1-7

Authors: Lee SH, Lee YH, Suh JS

Abstract
OBJECTIVE: The objective of our study was to compare subtrochanteric femur bone mineral density (BMD) and bone quality of long-term bisphosphonate (BP) users who sustained an atypical femoral fracture (AFF) with BP users who did not sustain a femoral fracture and BP-naïve patients with no history of femoral fracture using quantitative CT (QCT).
MATERIALS AND METHODS: Fourteen female BP users with an AFF (mean age, 72.6 years; mean duration of BP use, 6.2 years; mean body mass index, 21.9) who had undergone QCT before fracture events were sex-, age-, BP use duration-, and body mass index-matched to 14 BP users who did not sustain a fracture and 14 BP-naïve patients. The lateral cortical thickness index (CTI) and the mean BMD (BMDmean) and SD of the BMD (BMDSD) within the lateral cortex and within the entire cross-sectional area of the subtrochanteric femur were measured on axial QCT. Femoral neck-shaft angles were measured on the QCT scout image. Parameters were analyzed using the Kruskal-Wallis test.
RESULTS: Lateral CTIs were greater in the BP users with an AFF (median, 0.28) than in the BP users without a femoral fracture (median, 0.21) (p = 0.038) and the BP-naïve group (median, 0.21) (p = 0.009). The lateral cortex BMDSD was significantly higher in the BP users with an AFF (median, 59.59 mg/cm(3)) than the BP users without a femoral fracture (median, 39.27 mg/cm(3); p = 0.049) and the BP-naïve group (median, 31.02 mg/cm(3); p = 0.037). There was no significant difference among groups in lateral cortex BMDmean, BMDmean and BMDSD of the entire cross-sectional area, and femoral neck-shaft angle.
CONCLUSION: Long-term BP users with a subsequent AFF had a thicker lateral cortex and higher lateral cortex BMDSD at the subtrochanteric area before the fracture on QCT than BP users who did not sustain a femoral fracture and BP-naïve patients.

PMID: 28796551 [PubMed - as supplied by publisher]

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Rhabdomyosarcoma of the breast: Report of a rare malignancy.

Rhabdomyosarcoma of the breast: Report of a rare malignancy.

Cancer Biol Ther. 2017 Aug 10;:0

Authors: Yuan Y, Hou J, Pan Y

Abstract
Rhabdomyosarcoma (RMS) is an uncommon type of soft-tissue malignancy which mainly influences children. RMS rarely occurs in breast and little of the clinical behavior and treatment strategies were reported. Here, we describe a case of adult female patient with breast RMS. A 34-years-old Chinese woman visited to our hospital complaining palpable mass in her left breast. Seven months ago, the patient was diagnosed as lymphocytic mastitis and received surgical excision in the left breast. Five months later, she noticed a palpable mass again in the left breast. Ultrasonography suspected a malignant lesion and a diagnosis of RMS was made after segmental mastectomy and immunohistochemical staining. Therapy consisted of mastectomy and following neoadjuvant chemotherapy. The patient has remained disease free 30 months post-operatively. We should consider RMS when we see a breast mass. Tissue biopsy and immunohistochemical staining are recommended for diagnosis of RMS in young women. Oncologists should take immediate and active treatment on RMS.

PMID: 28795902 [PubMed - as supplied by publisher]

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Proton therapy for head and neck cancer: expanding the therapeutic window.

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Proton therapy for head and neck cancer: expanding the therapeutic window.

Lancet Oncol. 2017 May;18(5):e254-e265

Authors: Leeman JE, Romesser PB, Zhou Y, McBride S, Riaz N, Sherman E, Cohen MA, Cahlon O, Lee N

Abstract
Use of proton beam therapy has expanded, with the number of proton centres rapidly increasing not only in the USA but also worldwide. The physical characteristics of the proton beam offer important advantages versus widely used photon techniques in terms of radiation precision. In head and neck cancer in particular, proton beam therapy is uniquely suited for the complex anatomy of tumours and sensitive surrounding organs. De-intensification and personalisation of treatment to limit toxicity are of renewed importance in the context of human papilloma virus-associated disease, in which young patients will be cured but bear the consequences of adverse effects for decades. Comparisons of radiation dose distributions between photon and proton techniques suggest considerable benefit in terms of toxicity sparing, but this has only recently been confirmed by substantial clinical data. In this Review, we attempt to define the role of this method in the contemporary multidisciplinary management of various types of head and neck cancer.

PMID: 28456587 [PubMed - indexed for MEDLINE]

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Benign paroxysmal positional vertigo commonly occurs following repair of superior canal dehiscence.

Benign paroxysmal positional vertigo commonly occurs following repair of superior canal dehiscence.

Laryngoscope. 2016 Sep;126(9):2092-7

Authors: Barber SR, Cheng YS, Owoc M, Lin BM, Remenschneider AK, Kozin ED, Lee DJ

Abstract
OBJECTIVES/HYPOTHESIS: Repair of superior canal dehiscence (SCD) often results in the resolution of preoperative auditory and vestibular symptoms; however, many patients experience dizziness in the postoperative period. Postoperative dizziness may be the result of new-onset benign paroxysmal positional vertigo (BPPV). This study aims to investigate the prevalence of BPPV before and following SCD repair.
STUDY DESIGN: Retrospective chart review at a tertiary care center.
METHODS: Electronic medical records were reviewed for patients with a diagnosis of SCD syndrome (SCDS) between January 2002 and May 2015. Collected information included demographic data, incidence of BPPV diagnosed by Dix-Hallpike maneuver before and following surgery, operative technique, repair material, and the duration of time to BPPV onset.
RESULTS: A total of 180 patients with a diagnosis of SCDS were identified: 84 patients underwent surgery (operated subjects) and 96 were observed (nonoperated, control group). In operated subjects, 20 of 84 (23.8%) developed BPPV following SCD repair versus 6.2% of nonoperated (P < 0.005). Benign paroxysmal positional vertigo lateralized to the operated side in all but one subject whose laterality was unknown (P < 0.0001). There were no associations of BPPV with surgical approach (P = 0.50) or repair material (P = 0.33). The majority of subjects (58%) were diagnosed with BPPV within 3 months of surgery.
CONCLUSION: New-onset BPPV occurs commonly after SCD repair and may be the result of mobilized otoliths from inner ear pressure changes. Although the exact etiology of post-SCD repair BPPV remains unknown, postoperative dizziness is important to discuss with patients during preoperative counseling.
LEVEL OF EVIDENCE: 4. Laryngoscope, 126:2092-2097, 2016.

PMID: 26666775 [PubMed - indexed for MEDLINE]

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Reduced disease-specific survival following a diagnosis of multiple primary cutaneous malignant melanomas – a nationwide, population-based study

Abstract

Outcome data comparing patients with multiple primary invasive cutaneous malignant melanomas (MPMs) to single primary invasive cutaneous malignant melanoma (SPM) show conflicting results. We have analyzed differences in disease-specific survival between these patients in a nationwide population-based setting. From the Swedish Melanoma Register, 27,235 patients were identified with a first invasive cutaneous malignant melanoma (CMM) between 1990 and 2007, followed-up through 2013. Of these, 700 patients developed MPMs. Cox proportional hazard regression was used for adjusted cause-specific hazard ratios (HRs). An interval of ≤5 years between CMM diagnoses was significantly correlated to a decreased CMM-specific survival in Stage I-II MPM- vs. SPM-patients (HR 1.32; 95% CI 1.04-1.67; P = 0.02). MPM-patients with longer time interval between diagnoses experienced similar risk of CMM-death as SPM-patients. The risk of CMM-death increased by almost 50% above the expected outcome according to stage of the index CMM by the diagnosis of a second CMM (HR 1.48; 95% CI 1.19-1.85; P < 0.001). MPM vs. SPM-patients had a worse outcome (HR 1.38; 95% CI 1.05 - 1.83; P = 0.001). This emphasizes the importance of prevention efforts in SPM-patients to decrease the risk of subsequent CMMs and has implications for more vigilant follow-up in MPM-patients. This article is protected by copyright. All rights reserved.

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Absence of cardiotoxicity with prolonged treatment and large accumulating doses of pegylated liposomal doxorubicin

Abstract

Background

Pegylated liposomal doxorubicin (PLD) is used as a second-line therapy for gynecologic cancers, with a better short-term toxicity profile compared to doxorubicin or other anthracyclines.

Methods

We screened 14 patients with recurrent gynecologic cancers, who underwent prolonged treatment with large cumulative doses of PLD for overt or subtle signs of cardiotoxicity (CTX) using standard and advanced echocardiography techniques [3D volumetric method for left ventricular ejection fraction (LVEF) and left ventricular/right ventricular global longitudinal strain]. Half the patients had previous echocardiographic studies available for comparison.

Results

The average PLD treatment duration was 23.6 ± 10.8 months (range 13–57), accumulating dose of 1387 ± 483 mg (range 780–2538 mg). The study group had a normal LVEF both by 2D-echo (60 ± 5%, range 50–67) and 3D echo (58 ± 5%, range 46–63). Two patients (14%) were found to have minimally reduced ejection fraction by 2D and 3D echo (50%/46% and 51%/49%, respectively) that did not meet the current definition of CTX. For the seven patients who had consecutive echocardiography studies, the average LVEF remained stable between studies (59 ± 7, 60 ± 9 and 58 ± 10.5% for the latest study, previous, p < 0.79, and most remote study p < 0.9); No change was found in average left ventricular/right ventricular global longitudinal strain as well: −20.8 ± 4.6% at the latest study and −19.3 ± 2.6% for the previous (p < 0.51).

Conclusion

No prevalent or incident cases of cardiotoxicity were found despite prolonged treatment with large cumulative doses of PLD, adding to previous reports on shorter treatment duration.

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News and Announcements.

News and Announcements.

Otolaryngol Head Neck Surg. 1991 Jun;104(6):900-902

Authors:

PMID: 28791906 [PubMed]

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Book Review: Tinnltus Pathophysiology and Management Tinnltus Pathophysiology and Management edited by Kitahara Masaaki . 121 pages with illustrations. Igaku-Shoin , Tokyo , 1988 . $39.50 .

Book Review: Tinnltus Pathophysiology and Management Tinnltus Pathophysiology and Management edited by Kitahara Masaaki . 121 pages with illustrations. Igaku-Shoin , Tokyo , 1988 . $39.50 .

Otolaryngol Head Neck Surg. 1991 Jun;104(6):899

Authors: Eisele DW, Norton SJ

PMID: 28791905 [PubMed]

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Book Review: Sicher and DuBruil's Oral Anatomy Sicher and DuBruil's Oral Anatomy by DuBrul E. Lloyd . 356 pages with illustrations. Ishiyaku EuroAmerica, Inc. , St. Louis , 1988 . $42.50 .

Book Review: Sicher and DuBruil's Oral Anatomy Sicher and DuBruil's Oral Anatomy by DuBrul E. Lloyd . 356 pages with illustrations. Ishiyaku EuroAmerica, Inc. , St. Louis , 1988 . $42.50 .

Otolaryngol Head Neck Surg. 1991 Jun;104(6):898

Authors: Eisele DW

PMID: 28791904 [PubMed]

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Book Review: Rhinoplasty: Problems and Controversies Rhinoplasty: Problems and Controversies edited by Rees T.D. Baker D.C. , and Tabbal N. . 434 pages. C.V. Mosby Co. , St. Louis , 1988 . $80.00 .

Book Review: Rhinoplasty: Problems and Controversies Rhinoplasty: Problems and Controversies edited by Rees T.D. Baker D.C. , and Tabbal N. . 434 pages. C.V. Mosby Co. , St. Louis , 1988 . $80.00 .

Otolaryngol Head Neck Surg. 1991 Jun;104(6):898

Authors: Eisele DW, Papel ID

PMID: 28791903 [PubMed]

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Book Review: Headache Headache by Raskin Neil Hugh , MD. 396 pages. 2nd ed . Churchill Livingstone, Inc. , New York , 1988 . $49.00.

Book Review: Headache Headache by Raskin Neil Hugh , MD. 396 pages. 2nd ed . Churchill Livingstone, Inc. , New York , 1988 . $49.00.

Otolaryngol Head Neck Surg. 1991 Jun;104(6):895-896

Authors: Eisele DW, Pratt LW

PMID: 28791902 [PubMed]

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Book Review: Physiology of the Ear Physiology of the Ear edited by John A.E. and Santos-Sacchi J. . 518 pages. Raven Press , New York , 1988 . $99.00 .

Book Review: Physiology of the Ear Physiology of the Ear edited by John A.E. and Santos-Sacchi J. . 518 pages. Raven Press , New York , 1988 . $99.00 .

Otolaryngol Head Neck Surg. 1991 Jun;104(6):897-898

Authors: Eisele DW, Neal GD

PMID: 28791900 [PubMed]

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Book Review: Microsurgery of fie Skull Base Microsurgery of fie Skull Base by Fisch UGO , and Mattox Douglas . 670 pages with illustrations. Georg Thieme Verlag, Stuttgart , 1988 . $168.00 .

Book Review: Microsurgery of fie Skull Base Microsurgery of fie Skull Base by Fisch UGO , and Mattox Douglas . 670 pages with illustrations. Georg Thieme Verlag, Stuttgart , 1988 . $168.00 .

Otolaryngol Head Neck Surg. 1991 Jun;104(6):897

Authors: Eisele DW, Willis R

PMID: 28791899 [PubMed]

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Book Review: MCQs in Otolaryngology and Head and Neck Surgery MCQs in Otolaryngology and Head and Neck Surgery by Lancer Jack M. and Jones Andrew S. . 162 pages. Butterworth, London , 1988 . $29.95 .

Book Review: MCQs in Otolaryngology and Head and Neck Surgery MCQs in Otolaryngology and Head and Neck Surgery by Lancer Jack M. and Jones Andrew S. . 162 pages. Butterworth, London , 1988 . $29.95 .

Otolaryngol Head Neck Surg. 1991 Jun;104(6):896

Authors: Eisele DW, Eisele DW

PMID: 28791898 [PubMed]

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Book Review: Hearing-impaired Children: A Guide for Concerned Parents and Professionals Hearing-impaired Children: A Guide for Concerned Parents and Professionals by Bevan Richard C. . 188 pages. Thomas Charles C. , Springfield, Ill., 1988 . $32.75 .

Book Review: Hearing-impaired Children: A Guide for Concerned Parents and Professionals Hearing-impaired Children: A Guide for Concerned Parents and Professionals by Bevan Richard C. . 188 pages. Thomas Charles C. , Springfield, Ill., 1988 . $32.75 .

Otolaryngol Head Neck Surg. 1991 Jun;104(6):896

Authors: Eisele DW, Catlin FI

PMID: 28791897 [PubMed]

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Selecting an acoustic correlate for automated measurement of American English rhotic production in children

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Butterfly Cartilage Tympanoplasty Long-term Results: Excellent Treatment Method in Small and Medium Sized Perforations.

Butterfly Cartilage Tympanoplasty Long-term Results: Excellent Treatment Method in Small and Medium Sized Perforations.

Clin Exp Otorhinolaryngol. 2017 Aug 12;:

Authors: Kaya I, Benzer M, Uslu M, Bilgen C, Kirazli T

Abstract
Objectives: The aim of this study was to evaluate and report the long-term results of the butterfly cartilage tympanoplasty. Short-term and long-term hearing outcomes were compared according to age and perforation location as well.
Methods: Ninety-three patients who were diagnosed with noncomplicated chronic otitis media and underwent microscopic transcanal butterfly cartilage tympanoplasty due to anterior, posterior, and central tympanic membrane perforation were included. Age, gender, follow-up time, pre- and postoperative pure tone audiometry thresholds (both air and bone conduction), pre- and postoperative air-bone gaps (ABGs), if any residual perforation was noted.
Results: At the end of the follow-up period, successful closure occurred 88 in 93 patients and success rate is 94.6%. In all patients, including those with residual perforations, the mean preoperative bone conduction threshold was 15.9 dB (range, 5 to 50 dB) among all groups whereas mean air conduction threshold was 36.4±15.1 dB (range, 10 to 90 dB) preoperatively and 28.8±14.3 dB in 6th month follow-up and 24.9±14.1 dB 24th month follow-up. Preoperative mean ABG was 22.1±7.1 dB (range, 5 to 40 dB) whereas 13.3±5.9 dB 6 months after surgery and 11.9±5.5 dB 24 months after surgery. There was a significant difference between pre- and postoperative ABG in both 6th and 24th month follow-up (P6mo-24mo<0.05). Furthermore, preoperative mean air conduction differed significantly from postoperative 6th and 24th month follow-up mean air conduction thresholds (P<0.05).
Conclusion: We suggested that butterfly cartilage tympanoplasty can be safely performed in small, moderate, and even large perforations, as the hearing outcomes and successful closure rate are similar to those of other surgical methods. Moreover, it can be performed under local anaesthesia and it has low complication rates.

PMID: 28797141 [PubMed - as supplied by publisher]

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Polycyclic aromatic hydrocarbons and trace elements bounded to airborne PM10 in the harbor of Volos, Greece: Implications for the impact of harbor activities

Publication date: October 2017
Source:Atmospheric Environment, Volume 167
Author(s): E. Manoli, A. Chelioti-Chatzidimitriou, K. Karageorgou, A. Kouras, D. Voutsa, C. Samara, I. Kampanos
Harbors are often characterized by high levels of air pollutants that are emitted from ship traffic and other harbor activities. In the present study, the concentrations of Polycyclic Aromatic Hydrocarbons (PAHs) and trace elements (As, Cd, Ni, Pb, Cr, Mn, Zn, and Fe) bounded to the inhalable particulate matter PM10 were studied in the harbor of Volos, central Greece, during a 2-year period (2014–2015). Seasonal and daily variations were investigated. Moreover, total carcinogenic and mutagenic activities of PAHs were calculated. The effect of major wind sectors (sea, city, industrial, harbor) was estimated to assess the potential contribution of ship traffic and harbor activities, such as scrap metal handling operations. Results showed that the harbor sector (calm winds ≤ 0.5 m s⁻¹) was associated with the highest concentrations of PM10. The harbor sector was also associated with relatively increased levels of trace elements (As, Fe, Cr, Mn, Ni), however the effect of this sector was lower than the corresponding effect of the industrial wind sector. The sea sector showed only a slight increase in B[a]Py and Σ12PAHs, whereas the highest increasing effect for PAHs and traffic-related elements, such as Pb and Zn, was evidenced for the city sector.

Graphical abstract

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A comparative study on the therapeutic effect of TRPV1, TRPA1, and TRPM8 agonists on swallowing dysfunction associated with aging and neurological diseases

Abstract

Background

Oropharyngeal sensory impairment is a potential target to treat swallowing dysfunction in patients with oropharyngeal dysphagia (OD).

Aim

To assess the therapeutic effect of stimulating oropharyngeal sensory afferents with TRPV1, TRPA1, or TRPM8 agonists vs increasing bolus viscosity in older and neurologic patients with OD by comparing four studies of similar experimental design.

Methods

Swallow function of 142 older patients with impaired safety of swallow at nectar ([50-350] mPa·s) viscosity was evaluated with videofluoroscopy (VFS) while treated with TRPV1 (150 μmol/L), TRPV1/A1 (150 μmol/L and 1 mmol/L), or TRPM8 (1 mmol/L or 10 mmol/L) agonists or modified starch (MS) at spoon thick viscosity (>1750 mPa·s).

Results

TRPV1 stimulation with capsaicinoids reduced penetrations by 50%, pharyngeal residue by 80%, and LVC time by 24.38% and increased bolus velocity by 36.51%. TRPV1/A1 stimulation with piperine reduced penetrations by 56.32%, LVC time by 25.55% and increased bolus velocity by 23.63%. TRPM8 stimulation with menthol 1 mmol/L reduced penetrations by 37.5% while 10 mmol/L reduced LVC time by 18.44%. Thickeners reduced penetrations by 77.11%, but increased pharyngeal residue by 19.89%, delayed LVC by 41.73%, and reduced bolus velocity by 13.44%.

Conclusion

Natural capsaicinoids have a stronger therapeutic effect on VFS signs and swallow response by stimulating TRPV1 than TRPV1/A1 or TRPM8 agonists. While TRP stimulants increased bolus velocity and reduced swallow response times, thickeners reduced bolus velocity and further delayed the swallow response. This study sets the bases to develop new pharmacologic strategies for older patients with OD, moving away from compensation toward the recovery of swallow function.

Oropharyngeal sensory stimulation is a therapeutic strategy for swallowing dysfunction in oropharyngeal dysphagia (OD). We compared the therapeutic effect of three pharmacological agonists forTRPV1 (capsaicinoids), TRPA1 (piperine), and TRPM8 (menthol) with that of thickeners in older patients with OD. TRPV1 stimulation had the strongest therapeutic effect on swallow dysfunction in OD. Pharmacological stimulants and thickeners elicit their therapeutic effects through opposite mechanisms in the biomechanics of swallow response. Pharmacological sensory stimulants are promising treatments to improve swallowing function in OD.

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Outcomes with a Posterior Reduced Dental Arch: A Randomized Controlled Trial

Abstract

Objective

To compare function, patient satisfaction and quality of life of patients with a posterior reduced mandibular arch with those who had all missing teeth replaced with removable partial dentures.

Methods

Patients with at least 3 and not more than 6 posterior occluding pairs of teeth were enrolled sequentially and randomized into one of two treatment groups: a denture and no denture group. A research assistant allocated interventions; concealment was ensured using opaque-sealed envelopes. Analysis of data was performed in stages, adding samples of 10 incrementally, and stopping when the relevant statistical tests indicated a clear conclusion as judged by the power set at 80% or above. Study outcomes included patient satisfaction, function and survival of remaining teeth at 3 and 12 months post-intervention, using a visual analogue scale and the Oral Impacts on Daily Performance) Statistical analysis was performed by the 'intention-to-treat' principle.

Results

Age range of included patients was 23-55 years (mean=42.3; SD=9.2), with 78% being females. Most patients (70%) belonged to the low- or no-income group. Nine patients left the study, for different reasons. Primary outcomes for the denture group: 10% of the patients were not satisfied and 20% were unhappy with their function; for the no-denture group: 85% of the patients (with 15% having left the study) were satisfied with both their function and their non-denture status.

Conclusion

Patients with posterior reduced mandibular dental arches reported greater perceived satisfaction, function and quality of life compared to those who had received a cobalt-chrome clasp-retained partial removable prosthesis.

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Orthodontics: A number of points

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Everything you need in vibrant colours

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Primary dental care: Heresy, dam it!

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Minimum intervention children's dentistry – the starting point for a lifetime of oral health

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Dental history: Wartime dentists

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Catch a glimpse of the future

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Occupational health: Accessing services

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Preserving the life of your unit

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Risk management: An upstream approach

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Increased levels of dissolved titanium are associated with peri-implantitis – a cross-sectional study

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Alternative sugars: Xylitol

Elaine Gardner, British Dietetic Association (BDA) Spokesperson, presents part 1 in our brand new series of columns on sugar and sugar alternatives.

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A guide to building 'MI' oral healthcare practice

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Call for change to child-focused terminology

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Prolonged breastfeeding can cause caries

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A toothbrush which looks as smart as it performs

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BDJ Team now accepts manuscript submissions

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Safe cabinetry

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Microbes and Host Response: A relationship in health and disease

The human body hosts billions of microorganisms. According to one estimate, the ratio of bacterial cells to human cells is 10:1. There are an enormous diversity and specificity based on where the species live and how they interact with each other as well as the host. While bacterial species define how the host lives and adapts to its environment, host-associated factors also determine the microbiome and its components.

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Beyond Ultrasound Guidance for Regional Anesthesiology.

Despite its popularity, ultrasound (US)-guided regional anesthesiology is associated with significant limitations. The latter can be attributed to either the US machine (ie, decreased ability to insonate deep neural structures, as well as the thoracic spine) or the operator. Shortcomings associated with the operator can be explained by errors in perception (ie, ambiguous criteria for needle/catheter tip-to-nerve proximity and subparaneural local anesthetic injection) or interpretation. Perhaps the greatest confusion afflicting US-guided regional anesthesiology originates from an intellectual misconception pertaining to its application. Increasingly, authors are using US to identify interfascial planes where local anesthetic can be injected thereby "discovering" new truncal blocks. Often these novel blocks suffer from a lack of proper randomized, comparative validation. Fortunately, solutions have been proposed to remedy many shortcomings associated with US guidance. The inability of US to reliably insonate deep neural structures can be circumvented with adjunctive neurostimulation. Fluoroscopy and waveform analysis have been proven to increase the success rate of thoracic epidural blocks. For continuous nerve blocks, combined US-neurostimulation may provide an objective end point (ie, an evoked motor response) for neural proximity and subparaneural positioning of the catheter tip. Finally, the solution to the plethora of nonvalidated US-guided blocks is both elegant and simple. New nerve blocks should answer a specific clinical need, and their first descriptions should take the form of an adequately powered, observer-blinded, randomized comparison against the established standard of care or, at the very least, a large case series (eg, a Brief Technical Report). Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.

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Abstracts

Eur Thyroid J 2017;6(suppl 1):23-118

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Scientific Programme

Eur Thyroid J 2017;6(suppl 1):1-22

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Title Page / Table of Contents / Scientific and Organizing Committees

Eur Thyroid J 2017;6(suppl 1):I-VI

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Industry-Sponsored Satellite Symposia

Eur Thyroid J 2017;6(suppl 1):119-127

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General Information

Eur Thyroid J 2017;6(suppl 1):128-134

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The role of vitamin D in hepatic metastases from colorectal cancer

Abstract

Colorectal cancer (CRC) represents a significant health burden worldwide, comprising approximately 10% of annual cancer cases globally. Hepatic metastases are the most common site of CRC metastasis, and are the leading cause of death in CRC patients. There is strong epidemiologic evidence for an inverse association between vitamin D status and risk of CRC; however, the role of vitamin D in the natural history of liver metastases has not yet been investigated. Several researchers have proposed hallmarks of metastases; crucially, metastases can be blocked by interrupting just one rate-limiting step. Vitamin D status has been implicated in each proposed hallmark of metastasis. The aim of this review is to examine the potential role for vitamin D in reducing the development of hepatic metastases from CRC and outline the candidate mechanisms by which vitamin D may mediate these effects. The results of ongoing randomised intervention trials are eagerly awaited to determine whether addressing vitamin D insufficiency in CRC patients could reduce the occurrence of liver metastases, and the consequent morbidity and mortality.

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Data-driven classification of patients with primary progressive aphasia

Publication date: November 2017
Source:Brain and Language, Volume 174
Author(s): Paul Hoffman, Seyed Ahmad Sajjadi, Karalyn Patterson, Peter J. Nestor
Current diagnostic criteria classify primary progressive aphasia into three variants–semantic (sv), nonfluent (nfv) and logopenic (lv) PPA–though the adequacy of this scheme is debated. This study took a data-driven approach, applying k-means clustering to data from 43 PPA patients. The algorithm grouped patients based on similarities in language, semantic and non-linguistic cognitive scores. The optimum solution consisted of three groups. One group, almost exclusively those diagnosed as svPPA, displayed a selective semantic impairment. A second cluster, with impairments to speech production, repetition and syntactic processing, contained a majority of patients with nfvPPA but also some lvPPA patients. The final group exhibited more severe deficits to speech, repetition and syntax as well as semantic and other cognitive deficits. These results suggest that, amongst cases of non-semantic PPA, differentiation mainly reflects overall degree of language/cognitive impairment. The observed patterns were scarcely affected by inclusion/exclusion of non-linguistic cognitive scores.

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The role of vitamin D in hepatic metastases from colorectal cancer

Abstract

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Ocular surface lubricants.

Purpose of review: The purpose of this article is to provide an overview of the ocular lubricants currently available, consider the components of the various formulations and highlight the status of preservative use in the treatment of anterior ocular surface diseases. Recent findings: The primary components of ocular surface lubrication have been, in the past, based on various cellulose formulations that increase hydration. Advances in lubrication have come from areas of the human body requiring lubrication such as the skeletal joints as well as examining the use of natural components of the tear fluid. These have resulted in novel modifications of existing tear components, for example, thiolated carboxymethyl hyaluronic acid which creates crosslinking to mechanically increase retention time for ocular surface hydration. Other proteoglycans such as lubricin, having one of the lowest coefficients of friction in nature, to a lipopolysaccharide derivative of tamarind seed, may provide a unique delivery system for lubricants and medications. Summary: The present state of ocular surface lubrication is slowly advancing from the routine use of cellulose-based solutions and gels to more advanced replacement with natural tear components. The advances that are occurring on other lubricating surfaces of the musculoskeletal system are also providing some insights into potential use on the ocular surface. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Hymenoptera-induced anaphylaxis: is it a mast cell driven hematological disorder?.

Purpose of review: Hymenoptera-induced allergy (HVA) is a common cause of anaphylaxis and may be fatal. It is associated with systemic mastocytosis in about 7% of adult patients. Systemic mastocytosis is a proliferative disorder of hematopoietic mast cell progenitors. There is recent data on the association between systemic mastocytosis and HVA. Recent findings: Hymenoptera venoms are the most common immunoglobulin E-mediated elicitors of anaphylaxis in patients with mastocytosis. Some patients with systemic mastocytosis do not have cutaneous involvement and have only been identified because of HVA. These patients do have distinct demographic, clinical, and laboratory features as compared with patients with mastocytosis with skin lesions. They show a male predominance, more severe (cardiovascular) as compared to skin symptoms, lower baseline serum tryptase, less bone marrow mast cell aggregates, and KIT mutations restricted to mast cell lineage. Summary: Although hymenoptera-induced anaphylaxis is not primarily a mast cell-driven hematological disorder, the latter is present in a significant proportion of patients and has to be excluded by basal serum tryptase determination, skin inspection as well as exclusion of systemic mastocytosis by D816V mutation analysis in peripheral blood and/or bone marrow examination in selected patients. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Climate changes and Hymenoptera venom allergy: are there some connections?.

Purpose of review: This review aims to update the world status of the main allergenic stinging Hymenoptera. Recent findings: In this review, we consider the problems that social Hymenoptera (bees, wasps and ants) could represent in the nearest future for human health in different parts of the world. Summary: Distribution and consistency of allergenic species including venomous insects are interested by accelerated dynamics caused by climate changes and globalization. Owing to the expansion of ranges of native species and colonization of invasive ones, even in the uncertainty of present available models, new challenges presented by stinging Hymenoptera should be expected in the future. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Eosinophilic Oesophagitis in Children: Disease Modulation by Topical Steroids

Abstract

Purpose of review

Eosinophilic oesophagitis (EoE) is a chronic inflammatory disease, and effective treatment for paediatric EoE is still evolving. There is no consensual standard therapy for adults or children, as evolving concepts still need to be properly validated and there has been continuous update from published trials. This paper summarizes the current knowledge about inflammatory background and corticosteroid therapy in paediatric eosinophilic oesophagitis.

Recent findings

There are some effective therapies in EoE treatment, and currently, the use of PPI may be considered as the first-line treatment, as a sub-group of EoE patients can be responsive to them. However, a considerable proportion of patients will not respond both clinically and histologically or will recur. Various dietary options and topical steroids are valid alternatives.

Basic research has shown that corticosteroids downregulate inflammation and prevent remodelling, reducing the long-term complication rate, mainly related to stenosis.

Corticosteroids are effective and safe especially if delivered in a viscous solution (budesonide, fluticasone). New formulations may be available soon thereby sparing the need for home-made manipulations. Clinical remission and the possibility to maintain treatment for long periods without serious side-effects make this option attractive in paediatric patients that have the prospect of long-term disease.

Summary

Corticosteroids are effective as induction and maintenance therapy and can be used safely in long-term therapy in childhood, leading to sustained remission.

Active research will provide further evidence to consolidate outcome and length of treatment.

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Prognostic Utility of Fatty Acid-Binding Protein 4 in Patients with Type 2 Diabetes and Acute Ischemic Stroke

Abstract

The role of fatty acid-binding proteins (FABPs) in atherosclerosis has been investigated. The aim of this study was to verify the hypothesis that higher levels of serum fatty acid-binding protein 4 (FABP4) could be a prognostic factor in Chinese patients with type 2 diabetes (T2DM) and acute ischemic stroke (AIS). From September 2015 to August 2016, consecutive first-ever AIS patients combined with T2DM were included in this study. FABP4, NIH stroke scale (NIHSS), and conventional risk factors were evaluated to determine their value to predict functional outcomes within 3 months. Multivariate analyses were performed using logistic regression models. We measured FABP4 in 329 patients. The median age of patients included in this study was 63 (IQR, 56–72) years and 45.9% were women. FABP4 serum levels were obtained at a median of 8.5 h (IQR, 4.0–14.0 h) after the stroke onset with a median value of 21.4 ng/ml (IQR, 15.6–28.2 ng/ml). In multivariable models, FABP4 remained an independent stroke severity predictor with an adjusted OR of 1.05 (95% CI, 1.02–1.09). In multivariate models comparing the third (odd ratio (OR), 2.25; 95% confidence interval (CI), 1.59–3.54) and fourth quartiles (OR, 3.75; 95% CI, 2.48–5.03) against the first quartile of the FABP4, levels of FABP4 were associated with poor functional outcome. At 3 months, 38 patients (11.6%; 95%CI, 8.1–15.0%) had died. The mortality distribution across the FABP4 quartiles ranged between 3.7% (first quartile) and 20.7% (fourth quartile). Elevation of FABP4 is associated with an increased risk of death and poor functional outcome events in patients with type 2 diabetes and acute ischemic stroke and is independent of other established clinical risk predictors and biomarkers.

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An aggressive and fatal craniofacial group A Streptococcus infection resulting from a minimally displaced orbital floor fracture

Publication date: Available online 10 August 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): R.M. Uhrich, M. Sherban, C. Valdez
While sharp, penetrating trauma is often associated with group A Streptococcus (GAS) infections and subsequent necrotizing fasciitis (NF) and streptococcal toxic shock syndrome (STSS), there are scant reports in the oral and maxillofacial surgery literature regarding blunt, non-penetrating trauma in association with these conditions. With a clinical course that initially appears relatively benign following blunt trauma, NF can progress swiftly through the fascial planes and may quickly become life-threatening if the oral and maxillofacial surgeon fails to recognize some of the critical pathognomonic signs. The case of a 64-year-old female who suffered a ground-level mechanical fall with a minimally displaced lateral orbital wall fracture is reported here. This seemingly benign, non-penetrating injury subsequently developed into rapidly progressive, fatal NF and STSS. This case is used to highlight the necessity for early detection of NF and STSS prior to rapid clinical decline, as these scenarios, particularly bilateral peri-orbital NF with resulting mortality, have been reported infrequently following blunt, craniofacial trauma in the literature related to this specialty.

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Two-stage reconstruction of the severely deficient alveolar ridge: bone graft followed by alveolar distraction osteogenesis

Publication date: Available online 10 August 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): A. Rachmiel, O. Emodi, D. Aizenbud, D. Rachmiel, D. Shilo
Distraction osteogenesis for the augmentation of severe alveolar bone deficiency has gained popularity during the past two decades. In cases where the vertical bone height is not sufficient to create a stable transport segment, performing alveolar distraction osteogenesis (ADO) is not possible. In these severe cases, a two-stage treatment protocol is suggested: onlay bone grafting followed by ADO. An iliac crest onlay bone graft followed by ADO was performed in 13 patients: seven in the mandible and six in the maxilla. Following ADO, endosseous implants and prosthetic restorations were placed. In all cases, the onlay bone graft resulted in inadequate height for implant placement, but allowed ADO to be performed. ADO was performed to a mean total vertical augmentation of 13.7mm. Fifty-two endosseous implants were placed. During a mean follow-up of 4.85 years, two implants failed, both during the first 6 months; the survival rate was 96.15%. In severe cases lacking the required bone for ADO, using an onlay bone graft as a first stage treatment increases the bone height thus allowing ADO to be performed. This article describes a safe and stable two-stage treatment modality for severely atrophic cases, resulting in sufficient bone for implant placement and correction of the inter-maxillary vertical relationship.

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Vertical platysma myocutaneous flap reconstruction for oral defects using three different incision designs: experience with 68 cases

Publication date: Available online 10 August 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): L. Huang, X. Gao, T. Su, C.-H. Jiang, X.-C. Jian
This study evaluated the effects of three different incision designs for the vertical platysma myocutaneous flap (VPMF): apron, MacFee, and T-shaped. This flap was used for the reconstruction of intraoral defects following cancer ablation in selected patients. Sixty-eight cases of VPMF reconstruction were assessed: the apron incision was used in 28, MacFee incision in 22, and T-shaped incision in 18. With regard to postoperative outcomes, there were 26 cases of flap survival and two of partial necrosis with the apron incision; 20 of survival and two of partial necrosis with the MacFee incision; 15 of survival and three of partial necrosis with the T-shaped incision. Success rates were 92.9%, 90.9% and 83.3%, respectively, for VPMF with the apron, MacFee, and T-shaped incisions. A wound healing disturbance in the neck was seen in three cases of VPMF with the apron incision and one case with the MacFee incision. The MacFee incision had the best aesthetic effect, and the postoperative neck scar was more obvious for the T-shaped incision. It is recommended that VPMF with the MacFee or apron incision be used for the reconstruction of larger buccal mucosa and floor of the mouth defects, while VPMF with the T-shaped incision should be used for smaller intraoral defects, especially tongue defects of the lateral surface.

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Neuromuscular Monitoring in the Perioperative Period.

Neuromuscular monitoring devices were introduced into clinical practice in the 1970s. Qualitative neuromuscular monitors, or peripheral nerve stimulators, provide an electrical stimulus to a motor nerve and the response of corresponding muscle subjectively evaluated. A standard peripheral nerve stimulator provides several patterns of nerve stimulation, including train-of-four (TOF), double-burst, tetanic, and post-tetanic count. Qualitative (and quantitative) monitors are needed to determine onset of neuromuscular blockade, maintain the required depth of muscle relaxation during the surgical procedure, and assess an appropriate dose of reversal agent. However, absence of fade measured with a peripheral nerve stimulator does not exclude residual neuromuscular block; TOF ratios as low as 0.4-0.6 may be present when fade is no longer observed. In addition, the risk of incomplete neuromuscular recovery may be influenced by monitoring site. The adductor pollicis is more sensitive to the effects of neuromuscular blocking agents (compared to the muscles surrounding the eye), and monitoring at this site may more accurately reflect recovery of pharyngeal muscles (the last muscles to recover from the effects of neuromuscular blocking agents, in which dysfunction may persist even at a TOF ratio of 1.0). Quantitative monitors are devices that measure and quantify the degree of muscle weakness and display the results numerically. Several different technologies have been developed, including mechanomyography, electromyography, acceleromyography, kineograph, and phonomyography. Lower doses of anticholinesterases may be used to effectively reverse neuromuscular blockade at TOF ratios of 0.4-0.6; quantitative monitoring is required to determine that this level of neuromuscular recovery has occurred. As clinical tests of muscle strength, peripheral nerve stimulators are unable to determine whether full recovery of neuromuscular function is present at the end of the surgical procedure. The use of quantitative monitors is essential in excluding clinically important muscle weakness (TOF ratios

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Prolongation of Apnea Time in Obese Patients-Concerns With Rate of Rise of CO2.

No abstract available

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The Coagulation Profile of End-Stage Liver Disease and Considerations for Intraoperative Management.

The coagulopathy of end-stage liver disease results from a complex derangement in both anticoagulant and procoagulant processes. With even minor insults, cirrhotic patients experience either inappropriate bleeding or clotting, or even both simultaneously. The various phases of liver transplantation along with fluid and blood product administration may contribute to additional disturbances in coagulation. Thus, anesthetic management of patients undergoing liver transplantation to improve hemostasis and avoid inappropriate thrombosis in the perioperative environment can be challenging. To add to this challenge, traditional laboratory tests of coagulation are difficult to interpret in patients with end-stage liver disease. Viscoelastic coagulation tests such as thromboelastography (Haemonetics Corporation, Braintree, MA) and rotational thromboelastometry (TEM International, Munich, Germany) have helped to reduce transfusion of allogeneic blood products, especially fresh frozen plasma, but have also lead to the increased use of fibrinogen-containing products. In general, advancements in surgical techniques and anesthetic management have led to significant reduction in blood transfusion requirements during liver transplantation. Targeted transfusion protocols and pharmacologic prevention of fibrinolysis may further aid in the management of the complex coagulopathy of end-stage liver disease. (C) 2017 International Anesthesia Research Society

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The Perioperative Surgical Home: A New Role for the Acute Pain Service.

No abstract available

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Differential Roles of the Right and Left Toe Perfusion Index in Predicting the Incidence of Postspinal Hypotension During Cesarean Delivery.

BACKGROUND: Aortocaval compression by the gravid uterus, low baseline vasomotor tone, and spinal anesthesia-related sympathetic blockade contribute to spinal anesthesia-induced hypotension during cesarean delivery. The finger perfusion index (PI) can predict spinal hypotension by reflecting baseline vasomotor tone, but cannot directly reflect aortocaval compression by the gravid uterus. This study aimed to examine whether baseline toe PIs predict the incidence of maternal hypotension and reflect aortocaval compression by the gravid uterus during cesarean delivery under spinal anesthesia. METHODS: One hundred parturients undergoing elective cesarean delivery were enrolled. The relationship between baseline toe PI and the incidence of hypotension following induction of spinal anesthesia was quantified using area under the receiver operator curves, and results compared for the right and left toe PIs. RESULTS: The area under the receiver operator curves for left and right toe baseline PIs were 0.81 (95% confidence interval, 0.71-0.88) and 0.76 (95% confidence interval, 0.66-0.84), respectively. Following induction of spinal anesthesia, the toe PIs did not change in parturients with hypotension, but increased significantly among those who did not develop hypotension. CONCLUSIONS: Our study demonstrated that baseline toe PIs were inversely associated with the incidence of postspinal hypotension during cesarean delivery. Continuous monitoring of toe PIs during induction of spinal anesthesia might help to predict the development of postspinal hypotension and reflect the aortocaval compression by the gravid uterus. (C) 2017 International Anesthesia Research Society

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Reducing Mortality in the Perioperative Period: 2nd ed.

No abstract available

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The First Reported Case of Primary Intestinal-type Adenocarcinoma of the Middle Ear and Review of the Literature.

Objective: Adenocarcinoma of the middle ear is a rare entity that must be distinguished from other adenomatous tumors of the temporal bone. We present the first patient of an intestinal-type adenocarcinoma originating from the middle ear. Patients: A 58-year-old woman presented with an 8-year history of left otorrhea. Her middle ear effusions were quite thick and gummy. She underwent eight sets of pressure-equalization tubes within 3 years. In 2011, her physical examination identified a middle ear mass, and she underwent mastoidectomy. A middle ear adenoma was resected. She underwent an additional three mastoidectomies for recurrence, with pathology from the 4th mastoidectomy revealing a diagnosis of adenocarcinoma. Imaging, at that time, showed an extensive temporal bone and Eustachian tube tumor. Interventions: She underwent a left subtotal temporal bone resection, parotidectomy, infratemporal fossa resection, dural resection, and microvascular free flap reconstruction followed by postoperative proton beam radiotherapy. Main Outcome Measures: The final pathology report revealed intestinal-type adenocarcinoma. Results: Treatment was successful and the patient remains disease free 4 years later. Conclusion: This is the first report of an intestinal-type adenocarcinoma of the middle ear and temporal bone. This patient also illustrates the difficulty of accurate histologic diagnosis of adenomatous tumors of the middle ear. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Surgery With or Without Postoperative Radiation Therapy for Early-stage External Auditory Canal Squamous Cell Carcinoma: A Meta-analysis.

Objective: External auditory canal squamous cell carcinoma (EACSCC) is a rare disease with no standard treatment supported by high-level evidence. The aim of this study was to investigate EACSCC prognoses according to treatment modality and thus determine the optimal intervention for early-stage disease. Data Sources: PubMed, Scopus, and Ichushi-Web searches of the English and Japanese-language literature published between January 1, 2006 and December 31, 2016 were performed using the key words "external auditory canal cancer" and "temporal bone cancer." Study Selection: Articles related to EACSCC that include the 5-year overall survival rate or individual patient data for histological types, follow-up periods, and final outcomes were enrolled. Data Extraction: Sex, age, Moody's modified Pittsburgh stage, type of treatment modality, type of operation, follow-up period, and 5-year survival rates were extracted. Data Synthesis: Twenty articles were used for the aggregate meta-analysis using a random-effects model, and 18 articles that reported 99 patients with early-stage EACSCC were used for the individual patient data meta-analysis. Conclusion: The 5-year overall survival rate of early-stage EACSCC was 77%. Postoperative radiation therapy (PORT) was performed in 45% of stage I patients and 68% of stage II patients. Survival analysis of all patients showed no differences between the surgery-only and PORT groups; however, PORT exhibited a better prognosis than surgery alone among patients with stage I disease (p = 0.003, log-rank test). This result indicated that PORT can be the standard therapy for stages I and II EACSCC. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Audiometric Outcomes Following Endoscopic Ossicular Chain Reconstruction.

Objective: To evaluate the audiometric outcomes following endoscopic ossicular chain reconstruction (OCR). Study Design: Retrospective case series. Setting: Two tertiary referral centers. Patients: Sixty two ears with ossicular discontinuity. Intervention(s): Endoscopic and microscopic OCR in patients with ossicular discontinuity. Main Outcome Measures: Bone and air pure-tone averages (PTA), air-bone gap (ABG), and word recognition scores (WRS). Results: Sixty two ears were included for analysis. Patients that underwent ossiculoplasty were subdivided based on prosthesis type (total ossicular replacement prosthesis [TORP] and partial ossicular replacement prosthesis [PORP], primary and staged ossiculoplasties, and surgical approach [microscopic and total endoscopic]). Forty two ears required PORP reconstructions, while 20 ears required TORP reconstructions. The microscope was used to reconstruct the ossicular chain in 31 cases, while an exclusive endoscopic approach was used in the remaining 31 patients. Controlling for the prosthesis, there were no significant postoperative differences in bone PTA, air PTA, and ABG between primary and staged ossiculoplasties, or surgical approach. Conclusions: Controlling for the type of prosthesis, there were no significant differences in hearing outcomes with respect to staged ossicular chain reconstruction or whether the endoscope or microscope was used for visualization. Thus, in this series, endoscopic OCR yields similar audiometric outcomes when compared with microscopic OCR. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Sensitivity and Specificity of Clinical and Laboratory Otolith Function Tests.

Objective: To evaluate clinic based and laboratory tests of otolith function for their sensitivity and specificity in demarcating unilateral compensated complete vestibular deficit from normal. Study Design: Prospective cross-sectional study. Setting: Tertiary care hospital vestibular physiology laboratory. Subjects: Control group-30 healthy adults, 20-45 years age; Case group-15 subjects post vestibular shwannoma excision or post-labyrinthectomy with compensated unilateral complete audio-vestibular loss. Intervention: Otolith function evaluation by precise clinical testing (head tilt test-HTT; subjective visual vertical-SVV) and laboratory testing (headroll-eye counterroll-HR-ECR; vesibular evoked myogenic potentials-cVEMP). Main Outcome Measure: Sensitivity and specificity of clinical and laboratory tests in differentiating case and control subjects. Results: Measurable test results were universally obtained with clinical otolith tests (SVV; HTT) but not with laboratory tests. The HR-ECR test did not indicate any definitive wave forms in 10% controls and 26% cases. cVEMP responses were absent in 10% controls. HTT test with normative cutoff at 2 degrees deviations from vertical noted as 93.33% sensitive and 100% specific. SVV test with normative cutoff at 1.3 degrees noted as 100% sensitive and 100% specific. Laboratory tests demonstrated poorer specificities owing primarily to significant unresponsiveness in normal controls. Conclusions: Clinical otolith function tests, if conducted with precision, demonstrate greater ability than laboratory testing in discriminating normal controls from cases with unilateral complete compensated vestibular dysfunction. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Hearing Preservation During Cochlear Implantation and Electroacoustic Stimulation in Patients With SLC26A4 Mutations.

Background and Objectives: Patients with SCL26A4 mutations presenting with Mondini deformity and enlarged vestibular aqueduct (EVA) tend to have comparable residual hearing. Although cochlear implantation (CI) produces good results in this group, deterioration of residual hearing can be an adverse event after surgery due to accompanying cochlear malformation and perilymph leakage during cochleostomy. The purpose of this study was to investigate if CI in patients with SCL26A4 mutations via the round window (RW) approach could achieve preservation of residual hearing, and to evaluate their speech reception with electroacoustic stimulation (EAS). Subjects and Methods: This is a retrospective chart review of eight patients with bilateral EVA, who were bi-allelic patients with SCL26A4 mutations. CI was performed in all patients by a single surgeon using the RW approach. Audiological results were compared before and after implantation. Results: Additional hearing loss after CI was less than 10 dBHL in five out of eight patients. Average hearing deterioration after CI was 8.75 dB (range, 0-26). Six out of eight patients used EAS mode after CI. The acoustic stimulation frequency ranged from 271 to 438 Hz. Patients showed better speech recognition in quiet and in noise using EAS mode compared with electrical stimulation alone. Conclusions: Preservation of residual hearing could be achieved after CI in patients with the SLC26A4 mutation via the RW approach. For successful preservation of residual hearing, application of newly-developed soft electrode and meticulous surgical is necessary. Our study showed that patients with the SLC26A4 mutation can be good candidates for EAS surgery. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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The Effect of Citalopram Versus a Placebo on Central Auditory Processing in the Elderly.

Objective: Evaluate the effects of therapy with citalopram on the central auditory processing in the elderly measured by central auditory tests. Study Design: Prospective, randomized, double-blind, placebo-controlled study. Setting: Tertiary referral center. Patients: Thirty-nine patients older than 60 years with normal hearing thresholds or symmetrical sensorineural hearing loss up to 70 dBHL, word-recognition score equal to or better than 70%, and diagnosed with central auditory processing disorders completed the study. They underwent the mini-mental state examination, as a way to screen those with the possibility of dementia; they also underwent the Beck depression inventory, for screening individuals with depression. Intervention: Citalopram 20 mg/d or placebo for 6 months. Main Outcome Measure: The central auditory tests were applied to the selection of individuals with auditory processing disorders and repeated after 6 months' treatment. The tests were sound localization, speech in noise, dichotic digits test, pitch pattern sequence, duration pattern test, and gaps-in-noise. Results: Comparisons of central auditory tests pre- and posttreatment in groups showed: sound localization (p = 0.022), pitch pattern sequence humming (p = 0.110), pitch pattern sequence nomination (p = 0.355), duration pattern test humming (p = 0.801), duration pattern test nomination (p = 0.614), and gaps-in-noise (p = 0.230). Dichotic tests in right and left ears respectively: speech in noise (p = 0.949; p = 0.722), dichotic digits test (p = 0.943; p = 0.513). Conclusion: There was no clinical effect with the use of citalopram in central auditory processing tests of the subjects. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Anatomical Relationship of the Middle Cranial Fossa Dura to Surface Landmarks of the Temporal Bone.

Hypothesis: The suprameatal crest and temporal line provides a reliable landmark to the middle fossa dura. Background: Surface anatomy of the temporal bone is used to guide mastoid surgery, but studies investigating these landmarks are limited. The aim of this study was to examine the anatomical relationship of the middle fossa dura to the temporal line. Methods: Thirty-two fresh hemicephalic temporal bones were prepared by drawing four lines along the mastoid including the suprameatal crest and temporal line (line 2), one line 5 mm superior to line 2 (line 1), and one 5 mm inferior to line 2 (line 3), and at Reid's base line (line 4). Four points were marked along these lines anterior to posterior 3 mm apart. A 1 mm bur was used to drill perpendicular to these points to examine the relationship to the middle fossa dura. Results: The dura was found inferior to line 2 in 6.3% at point 1, 6.3% at point 2, 9.4% at point 3, and 18.8% at point 4. The dura in line 1 was found inferior to point 1 in 52.1%, point 2 in 46.9%, point 3 in 56.3%, and point 4 in 62.5%. Only one specimen (3.1%) had dura lying inferior to line 3. No specimens were inferior line 4 at any point. Conclusion: The dura of the middle fossa lies superior the temporal line in >80% of specimens and at least 5 mm superior in nearly half. This indicates the temporal line or a line slightly inferior to this is reliably inferior the middle fossa dura. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Jacobson's Nerve Schwannoma Presenting as a Middle Ear Mass Causing Pulsatile Tinnitus: A Case Report.

No abstract available

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Comparing Outcomes Following Salvage Microsurgery in Vestibular Schwannoma Patients Failing Gamma-knife Radiosurgery or Microsurgery.

Objective: The increasing use of primary gamma-knife radiosurgery (GKS) for the treatment of vestibular schwannoma (VS) has led to a concomitant increase in the number of patients requiring salvage surgery for GKS failure. When patients underwent GKS as the primary treatment, it is known that dissecting tumor from adjacent nerves during salvage surgery is more difficult. In this report, we share our clinical experience with such patients and analyze the clinical findings of patients with tumor regrowth/recurrence. Study Design: Retrospective chart review. Setting: Tertiary center. Patients: Nine patients who underwent salvage surgery for VS regrowth/recurrence after GKS or microsurgery were enrolled. Main Outcome Measures: Symptom progression, radiological changes, intraoperative findings, and surgical outcomes were evaluated and compared. Results: Six patients with previous GKS and three with previous microsurgery underwent salvage microsurgery. The most obvious symptom of tumor regrowth was aggravation of hearing loss. Salvage surgery in all patients was limited to subtotal or near-total resection via a translabyrinthine/transotic approach. Severe adhesion, thickening, and fibrosis were more prominent findings in the GKS than in the previous microsurgery group. Dissection of the tumor from the facial nerve was more difficult in the GKS than in the microsurgery patients. Despite anatomical preservation of the facial nerve in all the six patients, three in the GKS group, but none in the revision microsurgery group, had worsening of facial nerve function. Conclusion: Salvage microsurgery of VS after failed GKS is more difficult than revision microsurgery, and the facial nerve outcomes are relatively poor. Therefore, the primary method of VS treatment should be carefully chosen. Additional imaging studies are recommended in patients with a sudden change in hearing loss who underwent GKS. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Oral Administration of Clinical Stage Drug Candidate SENS-401 Effectively Reduces Cisplatin-induced Hearing Loss in Rats.

Hypothesis: SENS-401, an oral clinical-stage drug, may reduce cisplatin-induced hearing loss and cochlear damage in an in vivo model. Background: Cisplatin is commonly associated with hearing loss, causing significant learning and behavioral difficulties in the pediatric cancer population, and for which there are currently no clinical solutions. SENS-401 has previously been shown to improve acoustic trauma-induced hearing loss in vivo. Methods: The effect of SENS-401 (R-azasetron besylate) on cisplatin IC50 values was evaluated in a panel of cisplatin-sensitive cell lines (NIH:OVCAR-3, SK-N-AS, NCI-H460, FaDu). Auditory brainstem response and distortion product otoacoustic emission tests were performed in a rat model of cisplatin-induced hearing-loss (8 mg/kg, day 1) at baseline, and after 14 days of SENS-401 (6.6, 13.2, 26.4 mg/kg/d). Cochlear outer hair cells were counted after immunolabeling for myosin-VIIa. Results: Cisplatin cytotoxicity was not impacted by the addition of SENS-401 (up to 10 [mu]M) in any of the cell types evaluated. In vivo, all SENS-401 doses significantly improved auditory brainstem response threshold shift (up to 30 dB) and distortion product otoacoustic emission amplitude loss (up to 19 dB) over placebo. Body weight and survival were not significantly different between rats receiving placebo and those receiving 26.4 mg/kg SENS-401. Significantly more surviving outer hair cells were present after SENS-401 treatment compared with placebo (p

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Duration of Eligibility Prior to Cochlear Implantation: Have We Made Any Progress?.

Objective: The objective is to determine if eligibility (as defined as the duration of severe to profound hearing loss before cochlear implantation [CI]) has changed over the 30 years since Food and Drug Administration approval. Data Sources: English-language, peer-reviewed articles, theses, and trial data available through PubMed and Cochrane Library databases up until and including May 31, 2016. Study Selection: One thousand six unique articles were identified. Prospective studies that reported duration of severe/profound hearing loss before CI in adult patients were included. Retrospective studies, reviews, meta-analyses, articles reporting pediatric or mixed data, hybrid/electroacoustic CI, and articles from centers outside the United States were excluded. Seventy-one studies met inclusion criteria and were included for analysis. Data Extraction: Contributing authors independently reviewed included studies for data validity and applicability. Data Synthesis: Metaregression was used to assess the relationship between the year of publication and duration of hearing loss. To account for a possible age effect, a second model was estimated including mean age at the time of study as a covariate. Conclusion: A positive association between study year and the duration of hearing loss before implantation was found showing a 0.28-year increase in the duration of hearing loss for every increasing study year. Contrary to conventional assumption, duration of eligibility for CI appears to be increasing. Though the reasons for this are not clear, current strategies to increase both awareness and access to CI seem to be falling short. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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The Seasonal Variation of Benign Paroxysmal Positional Vertigo.

Objective: Benign paroxysmal positional vertigo (BPPV) is characterized by recurrent episodes of positional vertigo due to dislodged otoconia debris within the semicircular canals. Many studies have proposed a correlation between Vitamin-D deficiency and recurrent BPPV. In the UK, serum Vitamin-D falls during the winter, reaching its lowest level in May and it is highest level in September. We hypothesize that if there is a relationship between BPPV and Vitamin-D levels, one would expect to see a seasonal variation in the incidence of BPPV among UK residents. Methods: A retrospective review of clinic letters and general practitioner referrals for patients presenting to a University Otolaryngology department over a 4-year period. Patients were divided into two groups: those presenting during the months associated with low serum Vitamin-D levels, and those presenting during the months associated with high serum Vitamin-D levels. Results: Three hundred thirty-nine patients were identified with posterior canal BPPV as a consequence of having had a positive Dix-Hallpike maneuver recorded in the clinical notes between October 2012 and October 2016. A Wilcoxon rank-sum test demonstrated there to be a statistically significant difference between the low serum Vitamin-D group and the high serum Vitamin-D group (p = 0.0367). Conclusion: The results confirm that there is a seasonal variation in the incidence of BPPV. This study is important as it adds to the mounting literature suggesting an association between serum Vitamin-D levels and BPPV. Second, it suggests a therapeutic strategy to improve outcomes in affected patients. Third, it adds significance to the hypothesized role of calcium metabolism for the development of inner ear disease. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Patulous Eustachian Tube Dysfunction: Patient Demographics and Comorbidities.

Objective: The objective is to describe a large cohort of patients presenting with patulous Eustachian tube (pET) dysfunction. Study Design: Retrospective patient series. Setting: Tertiary referral center. Patients: All outpatient visits (2004-2016) that were assigned ICD9 code (381.7-Patulous Eustachian tube) were screened. Only patients with observed tympanic membrane movements during ipsilateral nasal breathing or acoustic reflex decay testing demonstrating transmitted nasal breathing were included (n = 190, n = 239 ears). Main Outcome Measures: Demographics and nasopharyngoscopy/otomicroscopy findings by comorbidities. Results: The majority (54%) was female and mean age of symptom onset was 38.0 (SD 20.0) years. Common symptoms included voice autophony (93%), breath autophony (92%), aural fullness (57%), pulsatile tinnitus (17%), and crackling or rumbling sounds (14%). Symptoms increased in frequency and duration with time (65%), were exacerbated with exercise (27%), and improved with placing the head in a dependent position (65%), sniffing (28%), upper respiratory infection (8%), and ipsilateral internal jugular vein compression (12%). In 52% pET was bilateral. Common comorbidities include environmental allergy (49%), weight loss (35%), laryngopharyngeal reflux (33%), anxiety (31%), autoimmunity (13%), and neuromuscular disease (8%). Allergy and anxiety patients were younger and more likely to have tonic contraction of the tensor veli palatini on exam (p

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Intracanalicular Vestibular Schwannomas: Initial Clinical Manifestation, Imaging Classification, and Risk Stratification for Management Proposal.

Introduction: There is no consensus about the use of observation as a therapeutic modality for intracanalicular vestibular schwannoma (ICVS). The objective of this study was to describe tumor evolution, its correlation with initial size, stage of vestibular schwannoma, clinical presentation and to propose a risk classification for tumor growth with a therapeutic decision algorithm. Methods: Fifty-three patients with ICVS were followed prospectively from 2010 to 2015. The mean follow-up was 32 months. Patients underwent clinical examination, audiogram, magnetic resonance imaging at 6, 12, and then 12 months intervals within the first 5 years of initial diagnosis. We analyzed the patient's clinical course, audiologic changes, initial tumor location, and correlation of different parameters with ICVS growth. Results: Fourteen patients (26%) deteriorated their hearing level and 17 patients (27%) showed tumor growth during the follow-up period. Growth was noted during the first year of observation in 13 patients (76.5%). Considering initial presentation: tumor size, intracanalicular staging, and hearing level, patients with larger vestibular schwannoma, extension to the fundus regardless of tumor size, higher initial pure-tone average, and speech recognition test showed a significantly higher rate of tumor growth. ICVS evolution was not correlated with hearing deterioration with time. Discussion: We should consider observation a therapeutic modality. We valid the intrameatal staging as prognostic factor and propose a stratification of patients into low, moderate, or high risk for potential tumor growth to guide the initial management of ICVS. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Πέμπτη 10 Αυγούστου 2017

The Utility of Immunohistochemistry in Mycobacterial Infection: A Proposal for Multimodality Testing.

Mycobacterium species are slow growing bacteria that cause significant morbidity and mortality worldwide. Because of the relative rarity of mycobacterial infections, potential for detection of nonpathogenic environmental contaminants, and substantial costs associated with molecular diagnostics, effective screening methods are needed to identify samples most suitable for molecular testing. While anatomic pathology specimens can be utilized to identify characteristic histologic inflammatory patterns and to directly visualize mycobacteria through histochemical (acid fast bacilli [AFB]) stains, the utility of immunohistochemistry (IHC) in this setting is unknown. A cohort of 121 cases previously referred for mycobacterial sequencing, including 12 Mycobacterium tuberculosis (MTB), 42 nontuberculosis mycobacteria (NTM), and 67 cases negative for mycobacteria by polymerase chain reaction (PCR), were stained with an antimycobacteria antibody, and the results were compared with histology, AFB stains, PCR, and cultures. IHC was positive in 50% MTB, 81% NTM, and 49% of cases negative for mycobacteria by sequencing, with excellent (>90%) concordance with AFB stains. Organisms were identifiable by IHC using a 10x objective in the majority of cases. Negative PCR with positive IHC was attributed to paucity of organisms in 30/33 cases, and positive PCR with negative IHC was most often associated with MTB. IHC is highly sensitive for NTM but has a lower sensitivity for MTB, suggesting that cases with a high clinical and histologic suspicion for MTB should be sent for PCR even when AFB and IHC are negative. Incorporation of IHC into a screening algorithm for molecular testing has the potential for significant savings of cost and time. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Genomic Analysis of Pigmented Epithelioid Melanocytomas Reveals Recurrent Alterations in PRKAR1A, and PRKCA Genes.

Pigmented epithelioid melanocytoma (PEM) is a rare cutaneous melanocytic tumor first described as epithelioid blue nevus in patients with the Carney Complex (CC). PEM was among the first established examples of an intermediate class of melanocytic tumors, including atypical Spitz tumors, with frequent metastasis to lymph nodes but only rare extranodal spread. Sporadic and CC-associated PEM are essentially histologically indistinguishable. A subset of PEM shows loss of cytoplasmic expression of the protein kinase A regulatory subunit alpha (PRKAR1A), a tumor suppressor gene mutated in 70% of families with CC. However, molecular studies of such tumors have been limited. Therefore, we used next-generation sequencing to assess 480 cancer-related genes and performed PrkaR1[alpha] immunohistochemistry on 13 cases morphologically consistent with PEM. Six cases demonstrated loss of PrkaR1[alpha] expression by immunohistochemistry. Three cases were "combined" PEM arising in association with a common nevus. These lesions harbored PRKAR1A genetic alterations in addition to BRAF mutations. Three "pure" PEM, not associated with a common nevus, showed no evidence of PRKAR1A genetic alterations despite loss of PrkaR1[alpha] expression. Two of these PEM demonstrated MAP2K1 in frame deletions. PrkaR1[alpha] protein expression was preserved in 7 cases. Two of these lesions revealed fusions of the gene encoding the protein kinase C alpha isoform (PRKCA) to 2 distinct partners (ATP2B4-PRKCA and RNF13-PRKCA). Two lesions may represent misdiagnosed "blue nevus with epithelioid features" as they demonstrated GNAQ hotspot mutations. A conceivable explanation, but one we do not favor is that rare PEM are caused by GNAQ mutations. No genetic aberrations were detected in 3 lesions. None of our 13 cases demonstrated TERT alterations or significant chromosomal copy number changes. These results further validate the concept of PEM as a distinctive intermediate/borderline melanocytic tumor, and also illustrate its molecular heterogeneity. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Αρχειοθήκη ιστολογίου

Παρασκευή 11 Αυγούστου 2017

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Πέμπτη 10 Αυγούστου 2017