OtoRhinoLaryngology News

Τρίτη 3 Οκτωβρίου 2017

Left ventricular diastolic dysfunction in women with nonobstructive ischemic heart disease: insights from magnetic resonance imaging and spectroscopy

Ischemic heart disease, in the absence of obstructive coronary artery disease, is prevalent in women and constitutes a major risk factor for developing major adverse cardiovascular events, including myocardial infarction, stroke, and heart failure. For decades, diagnosis was considered benign and often minimized; however, it is now known that this etiology carries much risk and is a significant burden to the health care system. This review summarizes the current state of knowledge on nonobstructive ischemic heart disease (NOIHD), the association between NOIHD and left ventricular diastolic dysfunction, potential links between NOIHD and the development of heart failure with preserved ejection fraction (HFpEF), and therapeutic options and knowledge gaps for patients living with NOIHD.

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Modulation of taste processing by temperature

Taste stimuli have a temperature that can stimulate thermosensitive neural machinery in the mouth during gustatory experience. Although taste and oral temperature are sometimes discussed as different oral sensory modalities, there is a body of literature that demonstrates temperature is an important component and modulator of the intensity of gustatory neural and perceptual responses. Available data indicate that the influence of temperature on taste, herein referred to as "thermogustation," can vary across taste qualities, can also vary among stimuli presumed to share a common taste quality, and is conditioned on taste stimulus concentration, with neuronal and psychophysical data revealing larger modulatory effects of temperature on gustatory responding to weakened taste solutions compared with concentrated. What is more, thermogustation is evidenced to involve interplay between mouth and stimulus temperature. Given these and other dependencies, identifying principles by which thermal input affects gustatory information flow in the nervous system may be important for ultimately unravelling the organization of neural circuits for taste and defining their involvement with multisensory processing related to flavor. Yet thermal effects are relatively understudied in gustatory neuroscience. Major gaps in our understanding of the mechanisms and consequences of thermogustation include delineating supporting receptors, the potential involvement of oral thermal and somatosensory trigeminal neurons in thermogustatory interactions, and the broader operational roles of temperature in gustatory processing. This review will discuss these and other issues in the context of the literature relevant to understanding thermogustation.

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Chronic hypoxia alters maternal uterine and fetal hemodynamics in the full-term pregnant guinea pig

Placental hypoxia is associated with maternal hypertension, placental insufficiency, and fetal growth restriction. In the pregnant guinea pig, prenatal hypoxia during early gestation inhibits cytotrophoblast invasion of spiral arteries, increases maternal blood pressure, and induces fetal growth restriction. In this study the impact of chronic maternal hypoxia on fetal heart structure was evaluated using four-dimensional echocardiography with spatiotemporal image correlation and tomographic ultrasound, and uterine and umbilical artery resistance/pulsatility indexes and fetal heart function were evaluated using pulsed-wave Doppler ultrasound. Pregnant guinea pigs were exposed to normoxia (n = 7) or hypoxia (10.5% O₂, n = 9) at 28–30 days gestation, which was maintained until full term (65 days). At full term, fetal heart structure and outflow tracts were evaluated in the four-chamber view. Fetal heart diastolic function was assessed by E wave-to-A wave diastolic filling ratios (E/A ratios) of both ventricles and systolic function by the myocardial performance index (or Tie) of left ventricles of normoxic (n = 21) and hypoxic (n = 17) fetuses. There were no structural abnormalities in fetal hearts. However, hypoxia induced asymmetric fetal growth restriction and increased the placental/fetal weight compared with normoxic controls. Hypoxia increased Doppler resistance and pulsatility indexes in the uterine, but not umbilical, arteries, had no effect on the Tie index, and increased the E/A ratio in left, but not right, ventricles. Thus, prolonged hypoxia, starting at midgestation, increases uterine artery resistance and generates fetal growth restriction at full term. Furthermore, the enhanced cardiac diastolic filling with no changes in systolic function or umbilical artery resistance suggests that the fetal guinea pig systemic circulation undergoes a compensated, adaptive response to prolonged hypoxia exposure.

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Chronic hindbrain administration of oxytocin is sufficient to elicit weight loss in diet-induced obese rats

Oxytocin (OT) administration elicits weight loss in diet-induced obese (DIO) rodents, nonhuman primates, and humans by reducing energy intake and increasing energy expenditure. Although the neurocircuitry underlying these effects remains uncertain, OT neurons in the paraventricular nucleus are positioned to control both energy intake and sympathetic nervous system outflow to interscapular brown adipose tissue (BAT) through projections to the hindbrain nucleus of the solitary tract and spinal cord. The current work was undertaken to examine whether central OT increases BAT thermogenesis, whether this effect involves hindbrain OT receptors (OTRs), and whether such effects are associated with sustained weight loss following chronic administration. To assess OT-elicited changes in BAT thermogenesis, we measured the effects of intracerebroventricular administration of OT on interscapular BAT temperature in rats and mice. Because fourth ventricular (4V) infusion targets hindbrain OTRs, whereas third ventricular (3V) administration targets both forebrain and hindbrain OTRs, we compared responses to OT following chronic 3V infusion in DIO rats and mice and chronic 4V infusion in DIO rats. We report that chronic 4V infusion of OT into two distinct rat models recapitulates the effects of 3V OT to ameliorate DIO by reducing fat mass. While reduced food intake contributes to this effect, our finding that 4V OT also increases BAT thermogenesis suggests that increased energy expenditure may contribute as well. Collectively, these findings support the hypothesis that, in DIO rats, OT action in the hindbrain evokes sustained weight loss by reducing energy intake and increasing BAT thermogenesis.

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Fluorescence quenching by metal centered porphyrins and poryphyrin enzymes

Fluorescence spectroscopy and microscopy have been used extensively to monitor biomolecules, especially reactive oxygen species (ROS) and, more recently, reactive sulfide (RSS) species. Nearly all fluorophores are either excited by or emit light between 450 and 550 nm, which is similar to the absorbance of heme proteins and metal-centered porphyrins. Here we examined the effects of catalase (Cat), reduced and oxidized hemoglobin (Hb and metHb), albumin (alb), manganese (III) tetrakis (4-benzoic acid) porphyrin chloride (MnTBAP), iron protoporphyrin IX (hemin), and copper protoporphyrin IX (CuPPIX) on the fluorescence properties of fluorescein. We also examined the effects of catalase and MnTBAP on fluorophores for ROS (dichlorofluorescein, DCF), polysulfides (3',6'-di(O-thiosalicyl)fluorescein, SSP4), and H₂S (7-azido-4-methylcoumarin, AzMC) previously activated by H₂O₂, a mixed polysulfide (H₂S_n, n = 1–7) and H₂S, respectively. All except albumin concentration dependently inhibited fluorophore fluorescence and absorbed light between 450 and 550 nm, suggesting that the inhibitory effect was physical not catalytic. Catalase inhibition of fluorescein fluorescence was unaffected by sodium azide, dithiothreitol, diamide, tris(2-carboxyethyl)phosphine (TCEP), or iodoacetate, supporting a physical inhibitory mechanism. Catalase and TBAP augmented, then inhibited DCF fluorescence, but only inhibited SSP4 and AzMC fluorescence indicative of a substrate-specific catalytic oxidation of DCF and nonspecific fluorescence inhibition of all three fluorophores. These results suggest caution must be exercised when using any fluorescent tracers in the vicinity of metal-centered porphyrins.

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Pituitary adenylate cyclase-activating polypeptide drives cardiorespiratory responses to heat stress in neonatal mice

The neuropeptide pituitary adenylate cyclase-activating polypeptide (PACAP) has emerged as a principal and rate-limiting regulator of physiological stress responses in adult rodents and has been implicated in sudden infant death syndrome (SIDS). Recent studies show that PACAP plays a role in neonatal cardiorespiratory responses to hypoxia, hypercapnia, and hypothermia, but not hyperthermia, which is often associated with SIDS. Here we tested the hypothesis that, consistent with a role in SIDS, PACAP is involved in regulating the neonatal cardiorespiratory responses to severe heat. To address this, we used head-out plethysmography and surface ECG electrodes to study the cardiorespiratory physiology of conscious neonatal PACAP-null and wild-type mice at ambient temperatures of 32°C (baseline) and 40°C (heat stress). We also assessed body surface temperature as an indicator of cutaneous heat loss. Our results show that wild-type neonatal mice respond to heat stress by increasing ventilation (P = 0.007) and associated expired CO₂ (P = 0.041), heart rate (P < 0.001), and cutaneous heat loss (P < 0.001). In PACAP-null neonates, this heat response is impaired, as indicated by a decrease in ventilation (P = 0.04) and associated expired CO₂ (P = 0.006) and a blunted increase in heart rate (P = 0.001) and cutaneous heat loss (P = 0.0002). In addition, heart rate variability at baseline was lower in PACAP-null neonates than wild-type controls (P < 0.01). These results suggest that, during heat stress, PACAP is important for neonatal cardiorespiratory responses that help regulate body temperature. Abnormal PACAP regulation could, therefore, contribute to neonatal disorders in which the autonomic response to stress is impaired, such as SIDS.

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Polymorphous Low Grade Adenocarcinoma of the Parotid in a Teenager.

Polymorphous Low Grade Adenocarcinoma of the Parotid in a Teenager.

Iran J Otorhinolaryngol. 2017 Sep;29(94):299-302

Authors: Khosla D, Verma S, Gupta N, Punia RS, Kaur G, Pandey AK, Dimri K

Abstract
INTRODUCTION: Polymorphous low grade adenocarcinoma (PLGA) is a rare salivary gland neoplasm with an indolent course. It occurs primarily in the minor salivary glands but can rarely occur in the major salivary glands. It usually occurs in the fifth to seventh decades of life with female preponderance.
CASE REPORT: A 16-year-old male presented with recurrent painless swelling in the right preauricular region and with a history of surgical intervention at the same site in the past. His histopathology report was suggestive of pleomorphic adenoma. The swelling recurred after one year of excision and a superficial parotidectomy was performed. The detailed histopathological examination was suggestive of Polymorphous low grade adenocarcinoma. In view of close margins, the patient was given adjuvant radiotherapy. Thirty-three months post-surgery, he is alive and disease-free. We describe a rare case of PLGA of the parotid gland in a teenager with its clinical characteristics, histopathological features, and treatment.
CONCLUSION: The occurrence of PLGA in the parotid gland is rare with only a few cases reported in literature. The diagnosis of PLGA is challenging due to morphological diversity.

PMID: 28955679 [PubMed]

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Axillary Lymph Node Metastasis in Medullary Thyroid Carcinoma: A Case Report.

Axillary Lymph Node Metastasis in Medullary Thyroid Carcinoma: A Case Report.

Iran J Otorhinolaryngol. 2017 Sep;29(94):295-297

Authors: Rasihashemi SZ, Azhough R, Ramouz A

Abstract
INTRODUCTION: Medullary thyroid cancer (MTC) is an uncommon neoplasm originating from parafollicular C cells. Distant metastasis in MTC, such as axillary node involvement, is extremely rare.
CASE REPORT: The present study describes a known case of MTC with axillary lymph node metastasis in a 31-year-old woman. In 2010, she underwent total thyroidectomy and right-sided modified radical neck dissection. In May 2015, she was referred with a 3-month history of a mass in the left axilla. Fine needle aspiration cytology (FNAC) confirmed MTC in the axillary nodes. Left axillary lymph node dissection was performed and postoperative histopathology revealed metastatic medullary thyroid carcinoma in prepared specimens.
CONCLUSION: MTC with axillary lymph node metastasis is a rare condition which has been reported in previous studies to impair patient prognosis. However, in the current case, the patient had no other MTC-related complications subsequent to final lymphadenectomy.

PMID: 28955678 [PubMed]

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Acute Lymphoblastic Leukemia Following Nasopharyngeal Carcinoma: Report of an Unusual Case.

Acute Lymphoblastic Leukemia Following Nasopharyngeal Carcinoma: Report of an Unusual Case.

Iran J Otorhinolaryngol. 2017 Sep;29(94):291-294

Authors: Farhangi H, Silanian Toosi M, Alamdaran SA, Bagheri S

Abstract
INTRODUCTION: Nasopharyngeal carcinoma (NPC) is a rare malignancy in children. Nasal obstruction, otitis media with effusion, pain in the ear, hearing problems, and unusual neck mass are among the signs and symptoms of this malignancy.
CASE REPORT: We report the case of a 13-year-old girl with NPC who later developed acute lymphoblastic leukemia (ALL) through the course of her disease. To our knowledge, this is the first report of ALL following childhood nasopharyngeal carcinoma in the English-language literature.
CONCLUSION: Reports of secondary malignancies at the site of radiotherapy for NPC exist, but this is the first report of ALL following NPC.

PMID: 28955677 [PubMed]

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A Rare Cause of Intranasal Mass: Bilateral Ectopic Nasal Teeth.

A Rare Cause of Intranasal Mass: Bilateral Ectopic Nasal Teeth.

Iran J Otorhinolaryngol. 2017 Sep;29(94):287-289

Authors: Koçak HE, Özdamar K, Bilgi B, Acıpayam H

Abstract
INTRODUCTION: Ectopic teeth occur in a wide variety of sites, including the maxillary sinus, mandibular condyle, coronoid process, orbital, and nasal cavities. Reported symptoms and signs associated with nasal teeth include facial pain, external nasal deformities, foul-smelling rhinorrhea, recurrent epistaxis, and oronasal fistula. Ectopic teeth occurring bilaterally in the nasal cavity is very very rare.
CASE REPORT: A bilateral intranasal ectopic teeth case, which is asymptomatic on the right side and symptomatic on the left side, is presented. The tooth on left side was extracted endoscopically. There were no complications.
CONCLUSION: Extraction of an intranasal tooth under endoscopic guidance is an adequate treatment. If the ectopic intranasal tooth is asymptomatic, clinicians should follow with clinical examination and radiological imaging.

PMID: 28955676 [PubMed]

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Pesticide Exposure and Head and Neck Cancers: A Case-Control Study in an Agricultural Region.

Pesticide Exposure and Head and Neck Cancers: A Case-Control Study in an Agricultural Region.

Iran J Otorhinolaryngol. 2017 Sep;29(94):275-285

Authors: Amizadeh M, Safari-Kamalabadi M, Askari-Saryazdi G, Amizadeh M, Reihani-Kermani H

Abstract
INTRODUCTION: Causes of head and neck cancers (HNCs) are multifactorial, and few studies have investigated the association between chemical exposure and HNCs. The objective of this study was to investigate associations between HNCs, agricultural occupations, and pesticide exposure. The potential for the accumulation of pesticides in the adipose tissue of patients was also investigated.
MATERIALS AND METHODS: A structured questionnaire was used to collect information on demographics, occupation, and exposure to pesticides in a hospital-based case-control study. Pesticide residue in the adipose tissue of the neck in both cases and controls was also monitored via gas chromatography-mass spectroscopy.
RESULTS: Thirty-one HNC cases were included in this study as well as 32 gender-, age-, and smoking-matched controls. An agricultural occupation was associated with HNC (odds ratio [OR], 3.26; 95% confidence interval [CI], 1.13-9.43) after controlling for age, sex, and smoking. Pesticide exposure was associated with total HNC cases (OR, 7.45; 95% CI, 1.78-3.07) and larynx cancer (OR, 9.33; 95% CI, 1.65-52.68). A dose-response pattern was observed for HNC cases (P=0.06) and larynx cancer (P=0.01). In tracing the pesticide residue, five chlorinated pesticides, namely dichlorodiphenyltrichloroethane (DDT), dichlorodipheny-ldichloroethane (DDD), dichlorodiphenyldichloroethylene (DDE), dieldrin, and lindane, were identified in the adipose tissue. Chlorinated pesticide detection was significantly associated with HNC (OR, 3.91; 95% CI 0.9-0.16.9).
CONCLUSION: HNCs were found to be associated with pesticide exposure after controlling for confounders. A high education level was identified as a modifying factor decreasing the risk of HNCs. Further studies with larger number of subjects are recommended to assess these relationships in greater detail.

PMID: 28955675 [PubMed]

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Vestibulo-Ocular Reflex Abnormalities in Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo: A Pilot Study.

Vestibulo-Ocular Reflex Abnormalities in Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo: A Pilot Study.

Iran J Otorhinolaryngol. 2017 Sep;29(94):269-274

Authors: Fallahnezhad T, Adel Ghahraman M, Farahani S, Hoseinabadi R, Jalaie S

Abstract
INTRODUCTION: Benign paroxysmal positional vertigo (BPPV), involving the semicircular canals, is one of the most common diseases of the inner ear. The video head impulse test (vHIT) is a new test that examines the function of the canals. This study aimed to investigate the vestibulo-ocular reflex (VOR) gain, gain asymmetry and saccades after stimulating all six canals in patients definitively diagnosed with posterior semicircular canal BPPV (PSC-BPPV).
MATERIALS AND METHODS: Twenty-nine unilateral PSC-BPPV patients with normal oculographic and caloric results were enrolled in this study. vHIT was performed on six canals, and VOR gain, gain asymmetry and saccades were measured.
RESULTS: Sixteen (55.17%) patients had abnormal posterior canal VOR gains in the ipsilesional ear. VOR gains in both horizontal canals were within normal limits. Superior canal VOR gains were mostly lower than normal and were not correlated to PSC abnormalities (P>0.05). No corrective saccades could be observed.
CONCLUSION: VOR gain in the direction of the posterior semicircular canal may be reduced in PSC-BPPV patients. Evaluation of PSC-VOR parameters could be beneficial, although superior canal measurements should be interpreted with caution.

PMID: 28955674 [PubMed]

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Therapeutic effect of Intra-Tympanic Dexamethasone-Hyaluronic Acid Combination in Sudden Sensorineural Hearing Loss.

Therapeutic effect of Intra-Tympanic Dexamethasone-Hyaluronic Acid Combination in Sudden Sensorineural Hearing Loss.

Iran J Otorhinolaryngol. 2017 Sep;29(94):255-260

Authors: Rogha M, Kalkoo A

Abstract
INTRODUCTION: Hearing loss is fairly a common disorder which is usually treated with corticosteroids via systemic administration and/or intra-tympanic injection. This study aimed to compare the effectiveness of intra-tympanic injections of dexamethasone with its combination with hyaluronic acid in patients with sudden sensorineural hearing loss.
MATERIALS AND METHODS: In this clinical trial, 40 patients were randomly assigned to two groups; in the first group, 20 patients received 2.4 mg intra-tympanic dexamethasone, while in the second group patients received injections of 2.4 mg of dexamethasone plus 2 mg of hyaluronic acid in combination. Patients in both groups were injected every other day to a total of three injections. The hearing status of patients was evaluated by pure tone audiometry (bone conduction threshold) before and 2 weeks after the intervention.
RESULTS: Assessment of hearing threshold before and after treatment in the two groups showed a significant difference between hearing thresholds at frequencies of 4,000 to 8,000 Hz (P<0.001). The difference at other frequencies was not meaningful; however, in general, we found a better therapeutic effect in patients who received the combination of dexamethasone and hyaluronic acid.
CONCLUSION: A combination of dexamethasone and hyaluronic acid in patients with sudden sensorineural hearing loss may be more effective than dexamethasone alone. Because hyaluronic acid lacks certain side effects, and also makes it possible to reduce the steroid dose, we recommend the use of this combination in the treatment of patients with sudden sensorineural hearing loss.

PMID: 28955673 [PubMed]

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Treatment of Advanced Carcinoma of the Larynx and Hypopharynx with Laser Followed by External Radiotherapy.

Treatment of Advanced Carcinoma of the Larynx and Hypopharynx with Laser Followed by External Radiotherapy.

Iran J Otorhinolaryngol. 2017 Sep;29(94):247-253

Authors: Varghese L, Mathew J, John S, Job A

Abstract
INTRODUCTION: Radical laryngeal surgeries for extensive laryngeal and hypopharyngeal tumors often require a permanent tracheostomy, which has an immense impact on the quality of life of patients. A minimally invasive technique such as transoral laser microresection (TLM) followed by radiotherapy can preserve the functions of the voice and swallowing. The aim of this study is to evaluate the role of laser debulking in the treatment of carcinoma of the larynx and hypopharynx, to evaluate the response of the tumor to subsequent radiotherapy, and also to assess the usefulness of laser in avoiding tracheostomy and functional preservation of the voice and swallowing.
MATERIALS AND METHODS: This prospective cohort study included patients with carcinoma of the larynx and hypopharynx unwilling to have definitive surgery and those medically unfit for radical surgery. The clinical profile of patients at presentation, tumor status following laser debulking, immediately after radiotherapy (RT), 6 weeks post RT, 3 months post RT, and at the end of study; short term complications associated with laser surgery; and usefulness of laser in avoiding tracheostomy and in functional preservation of the voice were evaluated.
RESULTS: There were 18 (90%) male patients and 2 (10%) female patients. Age ranged from 24 to 78 years with a mean age of 55. Hoarseness of voice was the most frequent presenting complaint (90%) followed by progressive dysphagia (45%), odynophagia (40%), otalgia (40%), and dyspnoea (25%). 11 (55%) patients had T3 tumors, while 6 (30%) were T2, and 3 (15%) were T4 lesions. 65% of patients were free of lymph node metastasis at presentation. 2 (10%) had N1 and 5 (25%) had N2 nodes. At presentation 10 (50%) patients had Stage III disease and 6 (30%) had stage IV disease. 13 patients (65%) had moderately differentiated squamous cell carcinoma. None of the risk factors and co-morbid illnesses showed any statistically significant difference among the tumor sites. Apart from the 2 (10%) patients who had residual disease, 2 (10%) patients developed a recurrent tumor in the course of their follow up. None had neck recurrence. Two patients underwent tracheostomy, before laser surgery, for compromised airway and both had recurrence of their tumor and continued to be on tracheostomy.
CONCLUSION: Laser debulking followed by radiotherapy is a viable alternative in the management of malignancies of the larynx and hypopharynx for those who refuse radical surgery and for those patients in whom radical open surgery is impractical due to physiological reasons such as advanced age and poor pulmonary reserve.

PMID: 28955672 [PubMed]

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Is Decline Rate of Intact Parathyroid Hormone Level a Reliable Criterion for Early Discharge of Patients after Total Thyroidectomy?

Is Decline Rate of Intact Parathyroid Hormone Level a Reliable Criterion for Early Discharge of Patients after Total Thyroidectomy?

Iran J Otorhinolaryngol. 2017 Sep;29(94):239-246

Authors: Kolahdouzan M, Shahabi Shahmiri S, Hashemi SM, Keleidari B, Nazem M, Mohammadi Mofrad R

Abstract
INTRODUCTION: Parathyroid dysfunction leading to symptomatic hypocalcemia is not uncommon following a total thyroidectomy and is often associated with significant patient morbidity and a prolonged hospital stay. The current study aimed at evaluating the comparative predictive role of serum calcium and intact parathyroid hormone (iPTH) for post-thyroidectomy hypocalcemia.
MATERIALS AND METHODS: This prospective study was performed in 83 consecutive patients undergoing total thyroidectomy. Laboratory data such as serum calcium, vitamin D level, serum iPTH and serum phosphorus levels before surgery, postoperative calcium, and PTH levels measured after 1 and 6 hours and on the first postoperative day (1POD) were recorded.
RESULTS: Among the 83 patients, the mean (SD) age was 45.87 (12.57) years (range, 21-72 years); 70 (84.3%) patients were female. Final pathology was benign for 47 (56.6%) patients and malignant for 36 (43.4%) patients. In total, lymph node dissections were performed in 19 subjects (22.9%). On histological examination of the specimens, the parathyroid gland was found to have been removed inadvertently in 13 (15.7%) cases. In total, 35 (40.9%) patients developed hypocalcemia after thyroidectomy; receiver operating characteristic (ROC) analysis showed that a cut-off value of 15.39 pg/ml for iPTH, with a decline rate of 73% 1 hour after thyroidectomy is a significant predictor of hypocalcemia (area under the curve [AUC], 0.878; 95% confidence interval [CI], 0.79-0.96, P<0.0001) compared with calcium <8 mg/dl (2 mmol/L) with AUC=0.639; 95% CI, 0.51-0.76); P=0.067).
CONCLUSION: The current study showed that the decline rate in iPTH is a more reliable factor for hypocalcemia after total thyroidectomy than serum calcium. Patients with a decline rate <73% in iPTH could be discharged at 1POD without supplementation.

PMID: 28955671 [PubMed]

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"Ear Nose Throat J"[jour]; +17 new citations

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Abnormal Cervical Vestibular-Evoked Myogenic Potentials Predict Evolution of Isolated Recurrent Vertigo into Meniere's Disease.

Abnormal Cervical Vestibular-Evoked Myogenic Potentials Predict Evolution of Isolated Recurrent Vertigo into Meniere's Disease.

Front Neurol. 2017;8:463

Authors: Lee SU, Kim HJ, Choi JY, Koo JW, Kim JS

Abstract
INTRODUCTION: Vestibular-evoked myogenic potentials (VEMPs) can be abnormal in patients with idiopathic recurrent spontaneous vertigo. We aimed to determine whether abnormal cervical vestibular-evoked myogenic potentials (cVEMPs) can predict evolution of isolated recurrent vertigo into Meniere's disease (MD).
METHODS: We had followed up 146 patients with isolated recurrent vertigo and an evaluation of cVEMPs for 0-142 months [median = 6, interquartile range (IQR) = 0-29] at the Dizziness Clinic of Seoul National University Bundang Hospital from June 2003 to May 2014. We defined the variables associated with a progression into MD and calculated cumulative progression rates.
RESULTS: Among the 94 patients with recurrent vertigo and abnormal cVEMPs, 18 (18/94, 19%) showed an evolution into MD while only 2 of the 50 (4%) patients with normal cVEMPs evolved into MD during the follow-up (p = 0.01). The interval between onset of vertigo and development of cochlear symptoms ranged from 1 month to 13.6 years (median = 3 years, IQR = 0.5-4.5 years). Overall, pure tone audiometry (PTA) threshold at 0.25 kHz [hazard ratio (HR) = 1.1, 95% confidence interval (CI) = 1.0-1.2] and abnormalities of cVEMPs (HR = 5.6, 95% CI = 1.3-25.5) were found to be significantly associated with a later conversion into MD. The cumulative progression rate was 12% (95% CI = 5-18) at 1 year, 18% (8-26) at 2 years, and 22% (11-32) at 3 years.
CONCLUSION: Abnormal cVEMPs may be an indicator for evolution of isolated recurrent vertigo into MD. Patients with isolated recurrent vertigo may be better managed conforming to MD when cVEMPs are abnormal.

PMID: 28928714 [PubMed]

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Otolith Dysfunction in Persons With Both Diabetes and Benign Paroxysmal Positional Vertigo.

http:--pt.wkhealth.com-pt-pt-core-templa

Otolith Dysfunction in Persons With Both Diabetes and Benign Paroxysmal Positional Vertigo.

Otol Neurotol. 2017 Mar;38(3):379-385

Authors: DʼSilva LJ, Staecker H, Lin J, Maddux C, Ferraro J, Dai H, Kluding PM

Abstract
OBJECTIVE: Vestibular dysfunction is a well-recognized complication of type 2 diabetes (DM) that may contribute to increased fall risk. The prevalence of benign paroxysmal positional vertigo (BPPV) is higher in people with DM. The impact of DM on the otolith organs of the vestibular system in people with BPPV is unknown. The purpose of this study was to analyze otolith function using vestibular-evoked myogenic potential (VEMP) tests in people with DM and concurrent BPPV (BPPV + DM), and to examine the relationships between VEMP variables and diabetes-related variables.
STUDY DESIGN: Prospective, cross-sectional study.
SETTING: Tertiary academic medical center.
SUBJECTS AND METHODS: Participants 40 to 65 years were recruited in four groups: controls (n = 20), people with DM (n = 19), BPPV (n = 18), and BPPV + DM (n = 14). Saccule and utricle function were examined using cervical VEMP (cVEMP) and ocular VEMP (oVEMP), respectively. Diabetes-related variables such as HbA1c, duration of diabetes, and presence of sensory impairment due to diabetes were collected.
RESULTS: The frequency of abnormal cVEMP responses was higher in the DM (p = 0.005), BPPV (p = 0.003), and BPPV + DM (p <0.001) groups compared with controls. In the participants with diabetes, higher HbA1c levels were correlated with prolonged P1 (p = 0.03) and N1 latencies (p = 0.03). The frequency of abnormal oVEMP responses was not different between groups (p = 0.2).
CONCLUSION: Although BPPV and DM may independently affect utricle and saccule function, they do not seem to have a distinct cumulative effect.

PMID: 27930443 [PubMed - indexed for MEDLINE]

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Detection of Saccular Endolymphatic Hydrops in Ménière's Disease Using a Modified Glycerol cVEMP Test in Combination With the Tuning Property Test.

Detection of Saccular Endolymphatic Hydrops in Ménière's Disease Using a Modified Glycerol cVEMP Test in Combination With the Tuning Property Test.

Otol Neurotol. 2016 Sep;37(8):1131-6

Authors: Murofushi T, Komiyama S, Suizu R

Abstract
OBJECTIVE: To determine the optimal method for detecting saccular endolymphatic hydrops (EH) in patients with Ménière's disease (MD) using a glycerol cervical vestibular evoked myogenic potential (cVEMP) test in combination with a tuning property test.
STUDY DESIGN: Prospective patients series.
SETTING: Tertiary referral center.
PATIENTS: Twenty-three subjects (age: 36-77 years) were enrolled in this study. Seventeen subjects were diagnosed with definite MD. Six subjects were diagnosed with possible MD.
INTERVENTION: Diagnostic.
MAIN OUTCOME MEASURE: The corrected amplitudes of p13-n23 (cVEMP) were measured before and after the administration of 10% glycerol (500 ml, 2 h, intravenously). A tuning property index and the p13-n23 amplitude improvement ratio were calculated.
RESULTS: The positivity rate (PR) during the tuning property test was 55% (definite MD-affected ears), 35% (definite MD-unaffected ears), and 25% (possible MD ears). The PR during the glycerol cVEMP amplitude test was 60, 8, and 0%, respectively. The use of modified criteria for the glycerol cVEMP test in combination with the tuning property test resulted in the PR increasing to 75, 57, and 25%, respectively. The pre-glycerol stage results obtained using the tuning property test almost (except in two ears) completely agreed with the glycerol cVEMP test results by the modified criteria.
CONCLUSION: The tuning property test is an easy and useful way of detecting saccular EH. However, the glycerol cVEMP test is required in patients that do not respond to either 500 or 1000 Hz short tone bursts (STB).

PMID: 27525625 [PubMed - indexed for MEDLINE]

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Secondary Endolymphatic Hydrops After Acoustic Trauma.

Secondary Endolymphatic Hydrops After Acoustic Trauma.

Otol Neurotol. 2016 Jun;37(5):428-33

Authors: Chen YJ, Young YH

Abstract
OBJECTIVE: This study applied an inner ear test battery in patients with secondary hydrops after acoustic trauma to assess the inner ear deficits.
STUDY DESIGN: Retrospective study.
SETTING: University hospital.
METHODS: Twenty patients with secondary hydrops after acoustic trauma were assigned to Group A. The interval between noise exposure and the testing time varied from 1 month to 3 years (median 3 months). Another 20 patients without progressive hearing loss for at least 3 years after acoustic trauma were assigned to Group B. There were no significant differences between the two groups in terms of age, sex, laterality, and noise source. Before treatment, all patients received audiometry, and caloric, ocular vestibular-evoked myogenic potential (VEMP), and cervical VEMP (cVEMP) tests.
RESULTS: Percentages of abnormal mean hearing level (MHL), cVEMP test, oVEMP test, and caloric test were 75%, 75%, 61%, and 43% in Group A, and 35%, 57%, 61%, and 39% in Group B, respectively. Both groups exhibited a significantly declining sequence in inner ear function. Comparison of the abnormalities in the inner ear test battery between Groups A and B revealed a significant difference in percentages of abnormal MHL, but not in those of abnormal cVEMP, oVEMP, and caloric tests.
CONCLUSION: Secondary hydrops after acoustic trauma occurs mainly on the cochlear part, but less on the vestibular part probably because previous acoustic trauma, i.e., firearms have severely damaged the vestibular partition.

PMID: 27093028 [PubMed - indexed for MEDLINE]

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[Loudness optimized registration of compound action potential in cochlear implant recipients].

[Loudness optimized registration of compound action potential in cochlear implant recipients].

Laryngorhinootologie. 2017 Sep 22;:

Authors: Berger K, Hocke T, Hessel H

Abstract
Background Postoperative measurements of compound action potentials are not always possible due to the insufficient acceptance of the CI-recipients. This study investigated the impact of different parameters on the acceptance of the measurements. Methods Compound action potentials of 16 CI recipients were measured with different pulse-widths. Recipients performed a loudness rating at the potential thresholds with the different sequences. Results Compound action potentials obtained with higher pulse-widths were rated softer than those obtained with smaller pulse-widths. Conclusions Compound action potentials measured with higher pulse-widths generate a gap between loudest acceptable presentation level and potential threshold. This gap contributes to a higher acceptance of postoperative measurements.

PMID: 28938498 [PubMed - as supplied by publisher]

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[Hearing rehabilitation with cochlear implants and cognitive abilities].

[Hearing rehabilitation with cochlear implants and cognitive abilities].

HNO. 2017 Sep 25;:

Authors: Knopke S, Olze H

Abstract
The relevance of assessing cognitive functioning is increasing against the background of the continuing demographic changes. Up to a few years ago the focus was on the effects of cochlear implantation in children born deaf in comparison to healthy individuals. Currently, the question arises whether hearing rehabilitation in the elderly, e.g. by postlingual cochlear implantation, has a protective effect on cognitive functioning and therefore on the risk of onset of dementia. This review describes the association of cognitive functioning with hearing disorders and cochlear implantation. Historical aspects of intelligence testing are illustrated. Knowledge on cognitive aspects in elderly persons with hearing disorders and cochlear implants is rare in the currently available literature. Initial findings indicate a positive correlation between hearing improvement and cognitive functioning. Further studies are urgently required in order to elucidate appropriate guidelines for the treatment of patients with cognitive deficits and hearing impairment.

PMID: 28948301 [PubMed - as supplied by publisher]

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[Preoperative determination of nerve of origin in patients with vestibular schwannoma. German version].

[Preoperative determination of nerve of origin in patients with vestibular schwannoma. German version].

HNO. 2017 Sep 25;:

Authors: Rahne T, Plößl S, Plontke SK, Strauss C

Abstract
BACKGROUND: Vestibular schwannoma (VS) is a benign tumor that develops in the internal auditory canal and the cerebellopontine angle, potentially diminishing hearing or balance. Most VS tumors arise from one of two vestibular branches: the superior or inferior vestibular nerve. Determining the specific nerve of origin could improve patient management in terms of preoperative counseling, treatment selection, and surgical decision-making and planning. The aim of this study was to introduce a novel scoring system that was designed to determine the nerve of origin.
METHODS: The nerve of origin was predicted based on video head impulse assessments of all semicircular channels, together with cervical/ocular vestibular-evoked myogenic potential tests. The acquired data were entered into a scoring system developed to allocate the tumor origin. Finally, the nerve of origin was definitively determined intraoperatively.
RESULTS: The novel scoring system was applied to 5 consecutive patients undergoing surgical VS treatment. In one case, no determination was possible. In all other cases, the preoperatively predicted tumor origin was the same as the origin determined during surgery.
CONCLUSION: The scoring system predicts the nerve of origin and will be evaluated in a larger prospective cohort study of VS patients in the near future.

PMID: 28948300 [PubMed - as supplied by publisher]

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[Intraoperative parathyroid hormone measurement is the best predictor of postoperative symptomatic hypocalcemia].

[Intraoperative parathyroid hormone measurement is the best predictor of postoperative symptomatic hypocalcemia].

HNO. 2017 Sep 25;:

Authors: Bähler S, Müller W, Linder T, Frotzler A, Fischli S, Aqtashi B, Elmas F, Nader A

Abstract
BACKGROUND: The goal of this study is to evaluate risk factors for transient postoperative hypocalcemia (HC) and to define cutoff values for perioperative parathyroid hormone (PTH) and calcium parameters (Ca) to reduce the morbidity of symptomatic HC.
MATERIALS AND METHODS: At our tertiary referral hospital (Luzerner Kantonsspital, Switzerland), a total of 353 patients underwent total thyroidectomy between 2006 and 2013 and were analyzed retrospectively in terms of HC risk. The serum values of calcium and PTH were measured at strictly defined time intervals, and patients' symptoms and the necessity of treatments were determined from patients' charts.
RESULTS: The prevalence of transient postoperative HC was 43%; however, only 10% of patients were symptomatic. Significant risk factors for serum and symptomatic HC were calcium values (pre-, intra-, 4 h and 1 d postoperative), PTH values (intraoperative, 4 h and 1 d postoperative), and PTH decline. Interestingly, preoperative PTH values, patient age, weight of the thyroid gland, diagnosis, and sex were not significant risk factors. In the ROC analysis ('receiver operating characteristics'), calcium measurement 4 h postoperatively showed the best predictive ability for detecting serum HC, whereas intraoperative PTH measurements were predictive for symptomatic HC.
CONCLUSION: Calcium and PTH values as well as PTH decline are significant risk factors for postoperative HC. Preoperatively, only calcium measurement is prognostically significant. Intraoperative PTH measurement is the most reasonable and sensitive factor for early recognition of temporary postoperative HC in the clinical setting.

PMID: 28948297 [PubMed - as supplied by publisher]

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The nasal cycle 122 years on - are we any wiser?

The nasal cycle 122 years on - are we any wiser?

J Laryngol Otol. 2017 Oct;131(10):845

Authors: Fishman J, Youngs R, Fisher E, Hussain M

PMID: 28967353 [PubMed - in process]

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Impact of pre-operative body mass index in head and neck cancer patients undergoing microvascular reconstruction.

Impact of pre-operative body mass index in head and neck cancer patients undergoing microvascular reconstruction.

J Laryngol Otol. 2017 Oct 02;:1-5

Authors: Hyun DJ, Joo YH, Kim MS

Abstract
OBJECTIVES: To analyse the relationship of pre-operative body mass index with surgical complications and oncological outcomes in patients undergoing microvascular reconstruction for head and neck squamous cell cancer.
METHOD: A retrospective review was conducted of 259 patients who underwent microvascular free flap reconstruction after head and neck ablative surgery.
RESULTS: Mean body mass index was 22.48 kg/m2. There were no correlations between body mass index and: flap failure (p = 0.739), flap ischaemia (p = 0.644), pharyngocutaneous fistula (p = 0.141) or wound infection (p = 0.224). The five-year disease-specific survival rate was 63 per cent. On univariate analysis, the five-year disease-specific survival rate was significantly correlated with pre-operative body mass index, based on Kaplan-Meier survival curves (p = 0.028). The five-year disease-specific survival rates in underweight, normal weight, overweight and obese groups were 47 per cent, 55 per cent, 65 per cent and 80 per cent, respectively.
CONCLUSION: Pre-operative body mass index was a useful predictor for recurrence and survival in patients who underwent microvascular reconstruction for head and neck squamous cell cancer.

PMID: 28967346 [PubMed - as supplied by publisher]

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Bullous Exudative Retinal Detachment after Retinal Pattern Scan Laser Photocoagulation in Diabetic Retinopathy

Laser retinal photocoagulation is the gold standard treatment for diabetic retinopathy. We describe 3 cases in which bullous exudative retinal detachment (ERD) developed after pattern scan laser photocoagulation (PASCAL) in diabetic retinopathy. ERD spontaneously resolved in all 3 cases with various visual courses. This case series highlights 2 key points: first, ERD can occur regardless of gender, age, glycemic control, or vitreous status and despite a moderate number of laser shots, even with PASCAL; second, ERD in nonvitrectomized eyes may cause irreversible visual loss, even if the ERD resolves within 1 month.
Case Rep Ophthalmol 2017;8:475–481

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Recurrent Diabetic Macular Edema: What to Do

Diabetic macular edema (DME) is a leading cause of blindness in the working population. Herein, we report the case of a patient with recurrent DME for about 6 years, uncontrolled by several medical and surgical treatments, that was successfully treated with a single sustained-release fluocinolone acetonide intravitreal implant in her right eye. The affected eye had presented a visual acuity of 2/10 and a central macular thickness of 488 µm prior to the injection. After treatment with the fluocinolone acetonide intravitreal implant, the patient's right eye presented an improvement in best corrected visual acuity to 6/10 and a reduction of central macular thickness to 198 µm. These functional and anatomical results were continuous and sustained during a follow-up period of more than 12 months, and with an acceptable and manageable safety profile. These results show that fluocinolone acetonide intravitreal implantation is an effective treatment option in DME and should be considered in the DME treatment pathway.
Case Rep Ophthalmol 2017;8:465–474

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Foot and ankle reconstruction with vertically designed deep inferior epigastric perforator flap

Introduction

The deep inferior epigastric perforator (DIEP) flap is one of the most commonly utilized flaps of reconstructive surgery. Although the horizontal flap design is the most commonly used, this flap can be vertically designed to avoid drawbacks such as excessive tissue dissection, relatively reduced flap perfusion, and scarification of the contralateral flap opportunity. The aim of this report is to present our case series for foot and ankle reconstruction with vertical designed DIEP flap.

Patients and methods

The free vertically designed DIEP flaps (VDIEP) were used in eight patients (7 male, 1 female) whose age is in a range of 20–66 years for soft tissue reconstructions in the ankle and foot region over a five-year period. The range of defects' size was from 8 × 5 cm to 15 × 7 cm and the causes were electrical burn, trauma and diabetic foot infections.

Results

Flap dimensions varied from 10 × 6 cm to 17 × 9 cm. All the flaps had two or more perforators, and all flaps survived completely. There were no early or late complications. We followed up the patients for 10 months in average. We observed no functional problems, especially in main motions of foot and ankle like eversion, inversion, flexion or extension except one patient. Donor site scars were acceptable in all patients.

Conclusions

The VDIEP flap may be an option for selected lower extremity soft tissue reconstructions, and it may be an alternative to classically designed abdominal flaps.

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Systematic review of lymphovenous anastomosis (LVA) for the treatment of lymphedema

Introduction

Lymphedema is a chronic condition caused by the obstruction or impairment of lymphatic fluid transport resulting in irreversible skin fibrosis. Besides conservative therapy, surgical techniques for lymphedema including liposuction, lymphatico-lymphatic bypass, lymphovenous anastomosis (LVA), and vascularized lymph node transfer (VLNT) are options with increasing popularity in the recent past. In our review, we investigated the efficacy of LVA for the treatment of lymphedema. Both objective and subjective outcomes of surgical treatment were evaluated.

Methods

Studies were identified through systematic review in PubMed database up to September 2016. Only original Articles which exclusively performed LVA for lymphedema treatment were included. Our primary endpoint was the objective of a subjective postoperative lymphedema reduction.

Results

A total of 293 titles were identified, out of which 18 studies including 939 patients were deemed eligible. The studies included in this review describe significant variations in surgical techniques, number of anastomoses and supplementary interventions. All studies reported objective reductions in circumference measurements. Subjective symptom relief was found in 50-100% of the patients as well as a reduction in the number of cellulitis episodes in all investigated cases.

Conclusion

Although the studies included in this review showed great heterogeneity, LVA surgery revealed both objective and subjective improvements in most patients.

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Lymphatic mapping of the upper limb with lymphedema before lymphatic supermicrosurgery by mirroring of the healthy limb

Introduction

Supermicrosurgical lymphatic-venous anastomosis (LVA) can improve limbs lymphedema. We describe a technique that we employ for preoperative lymphatic mapping of the upper limb (UL), when indocyanine green (ICG) lymphography shows only dermal backflow (DB) and no lymphatic vessel is detectable.

Patients and methods

Sixteen patients undergoing LVA for unilateral UL lymphedema, showing "stardust" or "diffuse" DB pattern, were included. Demographic, clinical data, and limbs measurements were recorded. LymQoL arm questionnaire was administered. Mean age of patients was 58.8 ± 13.1 years. Fifteen were females and 1 male. Lymphatic anatomy of the healthy limb was investigated by ICG lymphography and reported on the affected limb by a four steps technique: marking the main lymphatic pathway on the healthy limb, measuring of the distances at seven levels between the pathway and a line joining fixed landmarks, reporting these measurements on the affected limb with a correction proportional to the degree of swelling, marking skin incisions at the intersection of this pathway with venules, individuated by near infrared light system. Results were analyzed by postoperative questionnaire and changes of limb measurements.

Results

For every limb, we could find 3 ± 0.73 incision sites each containing at least one lymphatic vessel suitable for anastomosis. In every patient, we could perform 3.38 ± 0.62 anastomoses. Mean follow-up was 12.13 ± 2.73 months. After surgery, mean preoperative QoL score increased from 5.5 to 7.9 (P < .001), and mean difference between the mean circumferences of the affected and healthy limbs decreased from 4.3 ± 1.3 to 2.5 ± 1.3 cm, showing improvement of swelling after surgery (P < .01).

Conclusion

This technique allowed to preoperatively map UL lymphatics even if diffuse DB was present.

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Comparing the thoracodorsal and internal mammary vessels as recipients for microsurgical autologous breast reconstruction: A systematic review and meta-analysis

Background

Our aim was to determine whether the thoracodorsal (Td) vessels have comparable clinical outcomes to the internal mammary (IM) vessels as recipients for autologous free tissue transfer for breast reconstruction.

Methods

Systematic searches of MEDLINE, EMBASE, CENTRAL, and World of Science from inception to June 2016 were performed by two independent reviewers. Studies that included adult females undergoing autologous free tissue transfer for breast reconstruction were selected. The two comparison groups were the use of IM or Td as recipient vessels. Our primary outcome was rate of flap survival. We assessed the methodologic quality of included studies using the JADAD and MINOR scales.

Results

A total of 1897 patients underwent 2644 free abdominal flap tissue transfer in the 10 articles that were included in our analysis. There was one randomized controlled study (Jadad score 2/5) and 9 nonrandomized controlled studies (MINORS scores 11–19/24). There was no difference between the uses of either vessel in terms of flap loss (1.18; 95% CI 0.71–1.95). Complication rate among the IM vessels ranged from 5 to 12%, compared with 3.4–12% among Td vessels. Hematoma and seroma rates were variable. Fat necrosis was higher with Td vessels in two studies. Performing Td vessels anastomosis was associated with shorter operative time and higher risk of encountering unusable vessel.

Conclusion

Both recipient vessels are safe, reliable and demonstrate equivocal results in the absence of contraindications. Utilizing either as a first-line vessel is reasonable, depending on surgeons' preference or certain clinical scenarios.

Question

Therapeutic, Level of evidence: III

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Tear drop-free anterolateral thigh flap, a versatile design for lower limb reconstruction after trauma

Abstract

Background

In lower limb reconstruction the cosmetic outcome is influenced by the contouring of the flap at the recipient site as well as by the donor site closure. It is also important to minimise compression of the flap pedicle. We discuss the outcomes of a versatile ALT flap design that allows freedom in skin paddle tailoring without elongating the scar, reduction of the tension over the pedicle and improved cosmetic results of both donor and recipient sites.

Methods

Between January 2009 and October 2015, 27 patients underwent reconstruction using tear drop ALTs. The age ranged between 20 and 89 years. Seventeen were elective procedures and 10 were urgent. The locations of the defects were: knee (1 case), achilles tendon (2 cases), os calcis (1 case), lateral malleolus (1 case), fibula (3 cases), tibia (6 cases), tibia/fibula (5 cases), and ankle (8 cases). The sizes of the defects ranged from 4 × 3 cm to 9 × 7 cm.

Results

The size of the flap ranged from 6 × 4 cm to 11 × 7 cm. One venous congestion and a wound dehiscence occurred, no flap loss. Two defatting procedures were performed. The mean follow-up was 16.44 months. Final outcomes showed good functional and cosmetic results in both the donor and recipient sites.

Conclusions

The tear drop ALT is a useful tool in lower limb reconstruction allowing to improve skin paddle tailoring without elongating the donor site scar. It allows minimal tension over the pedicle while optimizing the contour of both the donor and recipient sites.

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Issue Information

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Suprafascial dissection of the pedicled groin flap: A safe and practical approach to flap harvest

Abstract

Background

The groin flap has been relied upon for more than 4 decades and is well suited for reconstruction of the mutilated hand. Classic groin flap harvest is subfascial and includes the superficial circumflex iliac artery (SCIA). SCIA perforator flaps have shown that one perforator is sufficient to supply a large flap without breaching fascia. Accordingly, we routinely preserve the fascia and rely wholly on the superficial branch of the SCIA, sparing the deep branch. We aim to investigate the safety of suprafascial flap elevation and encourage a paradigm shift in reconstruction with groin flap transfer.

Methods

Between 2008 and 2013, 77 hand injuries were treated with pedicled groin flap transfers. According to surgeons' preference, 49 flaps were elevated with conventional technique ("subfascial") and 28 were harvested with suprafascial approach ("fascia sparing"). Demographic data including flap size, operative time, and outcome were reviewed in both approaches and compared.

Results

Suprafascial flaps were taken as large as 32 × 12 cm² and subfascial flaps large as 30 × 10 cm² (p = 0.08). Operative time was 268.2 ± 104.7 minutes in the suprafascial group and 227.4 ± 89.0 in the subfascial group (p = 0.14). One suprafascial flap (3.6%) had partial necrosis compared to four subfascial flaps (8.2%) (p = 0.65). All patients were followed for a minimum of six months. All the wounds finally healed without further flap reconstruction, and all the patients were back to the normal life with activities.

Conclusion

Suprafascial dissection is safe and does not adversely influence outcomes. Thinner flaps are expected to facilitate flap insetting and reduce revisionary debulking surgery.

Level of Evidence

III (Therapeutic)

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Modified fusion lymphoplasty for approximation of diameter and distance between two lymphatic vessels and a larger recipient vein

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Comments on “Dorsal approach for vascular repairs in distal finger replantations”

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Gracilis flap with supply from the superficial femoral artery

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Descriptive Cadaveric Study Comparing the Accuracy of Ultrasound versus Fluoroscopic Guidance for First Sacral Transforaminal Injections

Ultrasound is rarely used for guiding lumbosacral epidural steroid injections due to its technical limitations. For example, sonographic imaging lacks the ability to confirm epidural spread and identify vascular uptake. The perceived risk that these limitations pose to human subjects has precluded any large scale clinical trials to date.

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Feedback Facility-assisted Balance Training in a Patient with Multiple System Atrophy: A Case Report

Multiple system atrophy is a rare neurodegenerative disease with poor prognosis. Furthermore, there are no pharmacology or notable rehabilitation strategies available to prevent the worsening of the disease. This case report assessed the outcome of feedback facility-assisted balance training in combination with physical therapy in a 61-year-old man. The patient participated in 30 training sessions over six weeks for 30 minutes each that involved balance training. His static and dynamic balance abilities were improved on the Berg Balance Scale, Trunk Impairment Scale, Functional Independence Measure, and Functional Reach.

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Perception of Employment by the Veterans Participating in the National Veterans Wheelchair Games: A Survey Study

Employment in those with disability is an important rehabilitation goal along with achieving some measure of functional independence and at the same time one of the most difficult goals to achieve. The number of people with disabilities participating in adaptive sports has been steadily rising over the years. A few studies have looked at the relationship between physical fitness and employment status in those with disability, but there have been no studies that focused on the results of organized adaptive sports events affecting employment outcome.

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A Systematic Review of Exercise Systematic Reviews in the Cancer Literature (2005-2017)

Evidence supports the benefits of exercise for patients with cancer; however, specific guidance for clinical decision making regarding exercise timing, frequency, duration, and intensity is lacking. Efforts are needed to optimize clinical recommendations for exercise in the cancer population.

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Editorial Board

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Integrating Rehabilitation Into the Cancer Care Continuum

There has never been a more urgent need to integrate rehabilitation into the oncology care continuum. A cancer diagnosis is one of the most common, disabling and costly diagnoses affecting people living in the United States (US) and other developed countries. Projections indicate that nearly 40% of those born today will develop cancer in their lifetime [1]. Due to many advances in oncology-directed treatments, the overall 5-year survival rate has steadily increased and is currently hovering around 67% [1].

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A Guide to Inpatient Cancer Rehabilitation: Focusing on Patient Selection and Evidence-Based Outcomes

Cancer inpatients commonly suffer from impairments that can prohibit safe discharge home from the acute care inpatient medical service and thus require transfer to a postacute inpatient rehabilitation facility. It has been demonstrated in multiple studies that cancer rehabilitation inpatients are able to make statistically significant functional improvements and at a similar pace as their noncancer counterparts. Medical fragility and reimbursement regulations are concerns that affect acceptance and triage of cancer rehabilitation inpatients.

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Effects of Voice Therapy on Laryngeal Motor Units During Phonation in Chronic Superior Laryngeal Nerve Paresis Dysphonia.

Effects of Voice Therapy on Laryngeal Motor Units During Phonation in Chronic Superior Laryngeal Nerve Paresis Dysphonia.

J Voice. 2017 Sep 26;:

Authors: Kaneko M, Hitomi T, Takekawa T, Tsuji T, Kishimoto Y, Hirano S

Abstract
OBJECTIVES: Injury to the superior laryngeal nerve can result in dysphonia, and in particular, loss of vocal range. It can be an especially difficult problem to address with either voice therapy or surgical intervention. Some clinicians and scientists suggest that combining vocal exercises with adjunctive neuromuscular electrical stimulation may enhance the positive effects of voice therapy for superior laryngeal nerve paresis (SLNP). However, the effects of voice therapy without neuromuscular electrical stimulation are unknown. The purpose of this retrospective study was to demonstrate the clinical effectiveness of voice therapy for rehabilitating chronic SLNP dysphonia in two subjects, using interspike interval (ISI) variability of laryngeal motor units by laryngeal electromyography (LEMG).
METHODS: Both patients underwent LEMG and were diagnosed with having 70% recruitment of the cricothyroid muscle, and 70% recruitment of the cricothyroid and thyroarytenoid muscles, respectively. Both patients received voice therapy for 3 months. Grade, roughness, breathiness, asthenia, and strain (GRBAS) scale, stroboscopic examination, aerodynamic assessment, acoustic analysis, and Voice Handicap Index-10 were performed before and after voice therapy. Mean ISI variability during steady phonation was also assessed.
RESULTS: After voice therapy, both patients showed improvement in vocal assessments by acoustic, aerodynamic, GRBAS, and Voice Handicap Index-10 analysis. LEMG indicated shortened ISIs in both cases.
CONCLUSIONS: This study suggests that voice therapy for chronic SLNP dysphonia can be useful for improving SLNP and voice quality.

PMID: 28967588 [PubMed - as supplied by publisher]

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Chondroblastoma of extra-craniofacial bones: Clinicopathological analyses of 103 cases

We elucidated clinicopathological characteristics of chondroblastoma (CB) in Japan, and reliable clinicopathologic parameters predicting local recurrence and/or metastasis. Clinicopathological profiles of 103 CB (80 male, 23 female) in extra-craniofacial bones were retrieved. Numerical scoring of nine pathological and five radiological features was statistically analyzed to determine prognostic significance. Age ranged 8–61 years (average 19.6 years). Frequently involved sites were femur, tibia, calcaneus, patella and humerus. Radiologically, tumors were 2–80 mm (average 31.1 mm) in size. Marginal sclerosis and calcification were common. Histologically, pink cartilage, mitoses, and chicken-wire calcification were often seen. Within a follow-up period [2–260 months (average 53.5 months)], the local recurrence rate was 15.5%. No patient had metastasis. Recurrence was most frequently observed at the femur. By log-rank analysis, only cyst formation in images was significant for predicting recurrence free survival (RFS). By Cox hazard analysis with representative clinico-radiological and pathological features, only age (≥16 years) and cyst formation were significant predictors for RFS. Pathological features were not significant in both uni- and multivariate analyses.

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Clinicopathological features of neuroblastic tumors with opsoclonus-myoclonus-ataxia syndrome: Follicular structure predicts a better neurological outcome

Neuroblastic tumors (NT) with opsoclonus-myoclonus syndrome (OMS) display characteristic histological features, such as lymphocytic infiltration with lymphoid follicles, indicating an underlying immune response. We retrospectively assessed NT patients from 2001 to 2016. Five cases of NT with OMS and 76 cases of NT without OMS were histopathologically reviewed in this study. The grade of lymphocytic infiltration was evaluated. The number of follicles was counted and the presence or absence of lymphoid follicles was recorded for each case. We also confirmed the presence or absence of follicular dendritic cells (FDCs). We investigated the relationship between the histopathological and clinical findings of NT with OMS. Lymphocytic infiltration was observed in all cases; however, the precise follicular structure was occasionally unclear. Patients with clear follicular structures displayed germinal centers including tingible body macrophages and FDCs. All patients without neurological sequelae demonstrated a clear follicular structure with a FDC meshwork pattern. The interval between OMS onset and the detection and initial treatment of NT was typically longer in patients with neurological sequelae compared to those without neurological sequelae. Early detection and treatment of NT with OMS at the phase of a clear follicular formation with multiple FDC may provide favorable neurological outcomes.

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Update on Quinolone Allergy: A Complementary Note

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Primary suction thrombectomy for acute ischemic stroke: a meta-analysis of the current literature

Publication date: Available online 3 October 2017
Source:Clinical Neurology and Neurosurgery
Author(s): Jin Pyeong Jeon, Sung-Eun Kim, Chul Ho Kim
ObjectivesWe conducted a meta-analysis to assess the angiographic and clinical outcomes for ischemic stroke patients treated with primary suction thrombectomy and to compare the procedural outcomes based on the treatment strategies (primary suction vs. stent retriever thrombectomy).Patients andMethodsWe conducted a systemic literature review through an online data base from January 2004 through December 2016. The primary outcomes were rate of successful recanalization on final angiogram and good outcome three months after stroke onset. We used a fixed-effect model in cases with heterogeneity < 50%.ResultsFifteen articles were included. Primary suction thrombectomy achieved a successful recanalization rate of 85.2% (95% confidence interval [CI]: 79.9%–89.3%), a good clinical outcome rate of 52.7% (95% CI: 49.3%–56.2%) after the three-month follow-up, a mortality rate of 13.0% (95% CI: 8.9%–18.5%) and a symptomatic intracranial hemorrhage rate of 6.2% (95% CI: 4.8%–8.0%). The rates of recanalization (odds ratio [OR], 1.064; 95% CI: 0.202–5.608; p=0.571) and good outcomes (OR, 0.920; 95% CI: 0.570–1.486; p=0.735) did not differ significantly between primary suction thrombectomy and stent retriever thrombectomy.ConclusionPrimary suction thrombectomy produced higher recanalization and good clinical outcome rates than did stent retriever thrombectomy. Larger-scale studies are necessary that consider factors such as occlusion site, stroke severity, and concomitant use of endovascular devices.

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Maxillary zygomatic hexagonal implant system (MZH system) for severe resorption: a new technique

Abstract

Introduction

The biomechanical demands of the severely resorbed maxilla have prompted the search for alternative points of anchorage for zygomatic implants that allows stabilizing a prosthesis in young patients (30 years old or more) for restitution of function and form. The purpose of this study is to describe the protocol of zygomatic hexagonal implants in patients with severe maxillary bone resorption.

Materials and methods

Ten patients with severe maxillary resorption were treated with hexagonal implants system, they were evaluated at the preoperative and the postoperative periods for a minimal of 24 months, and the evaluation was clinical and trough conventional radiographs and CT scans. Six implants according to prosthetic prior planning were placed in each patient. Anteroposterior severely resorbed maxilla was evidence. Patients were rehabilitated with immediate provisional prosthesis. Ten days after surgery, definitive prosthesis metal structures were designed and adapted.

Results

Force distribution and load concentration were balanced; adjustment of the metal bar was passive. Correction of skeletal relationship was evident. No fatigue in the later additions in controls was observable. No complications were found in the immediate postoperative period and late (6–24 months), no patients dropped out from the study, and all were followed up to 24 months.

Conclusions

The zygomatic hexagonal implants' protocol guarantees barrier function, biomechanical stability, load distribution, and preventing fatigue bone/implant interface, which allows distributing of the forces through the pillars, anterior masticatory load reduction, and correcting the skeletal class III type which occurs in patients with severe resorption.

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Word-initial rhotics in Slovenian 4-year-olds with typical versus protracted phonological development.

Word-initial rhotics in Slovenian 4-year-olds with typical versus protracted phonological development.

Clin Linguist Phon. 2017 Oct 02;:1-21

Authors: Ozbič M, Kogovšek D, Stemberger JP, Bernhardt BM, Muznik M, Novšak Brce J

Abstract
This paper describes word-initial (WI) rhotic cluster development in Slovenian 4-year-olds. Data for /l/ and WI singleton /r/ serve as comparisons. Participants were 19 children with typical development (TD) and 13 with more protracted phonological development (PPD). A single-word list included 15 WI /r/-clusters, 9 /l/-clusters and 3 singleton /r/s and /l/s each. Results showed significantly higher match (accuracy) levels for rhotics in the TD group. Among rhotic clusters, TD children showed highest match levels for labial clusters, and the PPD group, for /dr/. Match levels did not differ significantly between singletons and clusters or targets in stressed versus unstressed syllables. Substitutions were more frequent than deletions, and children with PPD had more frequent and varied mismatch patterns; for the PPD group, [l] was the most frequent substitution for /r/ and for the TD group, other rhotics. The study provides additional criterion reference data on Slovenian phonological development.

PMID: 28968145 [PubMed - as supplied by publisher]

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Word-initial rhotic clusters in typically developing children: European Portuguese.

Word-initial rhotic clusters in typically developing children: European Portuguese.

Clin Linguist Phon. 2017 Oct 02;:1-22

Authors: Ramalho AM, Freitas MJ

Abstract
Rhotic clusters are complex structures segmentally and prosodically and are frequently one of the last structures acquired by Portuguese-speaking children. This paper describes cross-sectional data for word-initial (WI) rhotic tap clusters in typically developing 3-4- and 5-year-olds in Portugal. Additional information is provided on WI /l/ as a singleton and in clusters. A native speaker audio-recorded and transcribed single words in a story-telling task. Results for WI rhotic clusters show an age effect consistent with previous research on European Portuguese. Singleton /l/ was in advance of /l/-clusters as expected, but the tap clusters were in advance of the /l/-clusters, possibly reflecting the velarized characteristics of the lateral. The prosodic variables word stress and word length were relevant for the WI rhotic clusters: shorter words and stressed syllables showed higher accuracy. Finally, mismatches ('errors') mainly reflected negative structural constraints (deletion of C2 and epenthesis) rather than segmental constraints (substitutions).

PMID: 28968136 [PubMed - as supplied by publisher]

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The use of CT-scan in foreign body aspiration in children: A 6 years' experience

Publication date: November 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 102
Author(s): Vincent Pitiot, Margaux Grall, Dominique Ploin, Eric Truy, Sonia Ayari Khalfallah
IntroductionA foreign body aspiration is a risky situation, common in pediatric emergency. The "gold standard" to rule out a foreign body or proceed to its extraction, is rigid bronchoscopy (RB) under general anesthesia. However, RB is an intrusive exam with possible complications. Depending on authors, RB in emergency is a procedure at risk of complications in 4–17% of cases. Advances in radiology allow CT-scanners of fast acquisition and high definition, which could be used as an alternative to RB.Materials and methodsThis is a retrospective analysis of 6 years from May 2010 to May 2016, in a tertiary referral center. All children that presented a foreign body aspiration suspicion and had a cervical-thoracic CT with multiplanar reconstruction were analyzed.Results200 children were included. The average age was 30 months. 132 were considered normal and 68 pathological. Among the 68 RB performed for pathological scanner, a foreign body was found in 59 cases, and we had 9 cases of false positives. Among the 132 considered normal, 27 have had a RB despite this, due to persistent symptoms, all were negative; 105 were discharged home without endoscopy with monitoring instructions. 1 child was reviewed three months later for asthma, without second choking event reported. A new CT-scan found a foreign body that was removed by RB. Due to the nature of the foreign body it is very unlikely to link it to the first choking event, but retrospectively we cannot be certain. Considering this case as the only false negative, the negative predictive value (NPV) of CT was 99.2% and positive predictive value (PPV) of 83.8%.ConclusionThe use of CT -scan with multiplanar reconstruction in suspected foreign body aspiration is a reliable alternative to endoscopy under general anesthesia, especially in asymptomatic patients, avoiding too many negative endoscopies.

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Multiple primary squamous cell carcinomas of the lower lip and tongue arising in discoid lupus erythematosus: a case report.

Multiple primary squamous cell carcinomas of the lower lip and tongue arising in discoid lupus erythematosus: a case report.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Aug 30;:

Authors: Arvanitidou IE, Nikitakis NG, Georgaki M, Papadogeorgakis N, Tzioufas A, Sklavounou A

Abstract
Squamous cell carcinoma (SCC) developing in lesions of discoid lupus erythematosus (DLE) is rare, most frequently arising on sun-exposed skin and very rarely affecting the lips. A review of the English language literature revealed only 21 published cases of labial SCC in patients with DLE. Here, an unusual case of a patient with DLE who developed 3 primary SCCs of the oral and perioral region is presented. A 40-year-old female with a 24-year history of DLE with peri- and intraoral involvement initially developed SCC of the vermillion border of the right lower lip; the lesion was surgically removed and did not recur within 6 months. In spite of strong recommendation for regular follow-up, the patient failed to keep her appointments but returned 7 years later. No signs of recurrence of the original lower lip cancer were noticed, but a new SCC of the left lateral border of the tongue with cervical lymph node metastasis was diagnosed; despite aggressive combined treatment, locoregional recurrence and distant metastatic disease developed within a few months; in addition, a new primary SCC of the vermillion border of the left lower lip developed. This rare case and a thorough review of the pertinent literature underscore the possibility of development of even multiple intraoral and perioral SCCs in the context of longstanding DLE, which necessitates close long term follow-up for early diagnosis and management.

PMID: 28967499 [PubMed - as supplied by publisher]

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Erratum to "Efficacy of intralesional betamethasone for erosive oral lichen planus and evaluation of recurrence: a randomized, controlled trial [Oral Surg Oral Med Oral Pathol Oral Radiol 2013;116:584-590].

Erratum to "Efficacy of intralesional betamethasone for erosive oral lichen planus and evaluation of recurrence: a randomized, controlled trial [Oral Surg Oral Med Oral Pathol Oral Radiol 2013;116:584-590].

Oral Surg Oral Med Oral Pathol Oral Radiol. 2014 May;117(5):655

Authors: Liu C, Xie B, Yang Y, Lin D, Wang C, Lin M, Ge L, Zhou H

PMID: 28964380 [PubMed]

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Cancer survival in people with aids: A population-based study from São Paulo, Brazil

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Survival from tumours of the central nervous system in Danish children: Is survival related to family circumstances?

Abstract

Little is known about social inequalities in childhood cancer survival. We investigated the impact of family circumstances on survival from paediatric central nervous system (CNS) tumours in a nationwide, register-based cohort of Danish children.

All children born between 1973 and 2006 and diagnosed with a CNS tumour before the age of 20 years (N=1,261) were followed until 10 years from diagnosis. Using Cox proportional hazards models, the impact of various family characteristics on overall survival was estimated.

Hazard ratios (HR) for all CNS tumours combined did not show strong associations between survival and any family characteristic. Analyses by CNS tumour subtypes showed reduced survival for children with glioma when living outside of Copenhagen (HR 1.55; CI 1.03; 2.35). For embryonal CNS tumours, the number of full siblings was associated with worse survival (HR for having 3+ siblings 3.60; CI 1.52; 8.53) and a trend of better survival was observed for children with parents of younger age at child's diagnosis and poorer survival of children with parents of older age.

Despite free and uniform access to health care services, some family circumstances appear to affect survival from specific CNS tumour types in Danish children. Further research is warranted to gain a more comprehensive understanding of the impact of family factors on childhood cancer survival in other populations and to elaborate underlying mechanisms and pathways of those survival inequalities observed.

While access to uniform health care and standardized treatments is free in Denmark, Danish children with cancer may not benefit equally from the health system. Whether social inequalities account for these differences is uncertain. Here, associations between family circumstances and survival of pediatric tumors of the central nervous system were analyzed for a cohort of Danish children born between 1973 and 2006. The findings show that certain family circumstances, including number of siblings, place of residence, and parent age at time of diagnosis, are associated with survival. Targeted interventions may be needed to further improve survival rates and reduce inequities. This article is protected by copyright. All rights reserved.

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Highlights from the Current Issue: October 2017.

Highlights from the Current Issue: October 2017.

Otolaryngol Head Neck Surg. 2017 Oct;157(4):541-542

Authors: Krouse JH

PMID: 28967341 [PubMed - in process]

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S-1 as an option for second-line treatment of NSCLC. Is the “East Side Story” applicable in the West?

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SELECT-2: a Phase II, double-blind, randomised, placebo-controlled study to assess the efficacy of selumetinib plus docetaxel as a second-line treatment for patients with advanced or metastatic non-small cell lung cancer

Abstract

Background

Combination of selumetinib plus docetaxel provided clinical benefit in a previous Phase II trial for patients with KRAS-mutant advanced non-small cell lung cancer (NSCLC). The Phase II SELECT-2 trial investigated safety and efficacy of selumetinib plus docetaxel for patients with advanced or metastatic NSCLC.

Patients and methods

Patients who had disease progression after first-line anti-cancer therapy were randomised (2:2:1) to selumetinib 75 mg BID plus docetaxel 60 mg/m² or 75 mg/m² (SEL+DOC 60; SEL+DOC 75), or placebo plus docetaxel 75 mg/m² (PBO+DOC 75). Patients were initially enrolled independently of KRAS mutation status, but the protocol was amended to include only patients with centrally confirmed KRAS wild-type NSCLC. Primary endpoint was progression-free survival (PFS; RECIST 1.1); statistical analyses compared each selumetinib group with PBO+DOC 75 for KRAS wild-type and overall (KRAS mutant or wild-type) populations.

Results

212 patients were randomised; 69% were KRAS wild-type. There were no statistically significant improvements in PFS or overall survival (OS) for overall or KRAS wild-type populations in either selumetinib group compared with PBO+DOC 75. Overall population median PFS for SEL+DOC 60, SEL+DOC 75 compared with PBO+DOC 75 was 3.0, 4.2 and 4.3 months, HRs: 1.12 (90% CI: 0.8, 1.61) and 0.92 (90% CI: 0.65, 1.31), respectively. In the overall population, a higher objective response rate (ORR; investigator assessed) was observed for SEL+DOC 75 (33%) compared with PBO+DOC 75 (14%); odds ratio: 3.26 (90% CI: 1.47, 7.95). Overall the tolerability profile of SEL+DOC was consistent with historical data, without new or unexpected safety concerns identified.

Conclusion

The primary endpoint (PFS) was not met. The higher ORR with SEL+DOC 75 did not translating into prolonged PFS for the overall or KRAS wild-type patient populations. No clinical benefit was observed with SEL+DOC in KRAS wild-type patients compared with docetaxel alone. No unexpected safety concerns were reported.Trial identifier: clinicaltrials.gov NCT01750281

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Inflammatory gastrointestinal diseases associated with PD-1 Blockade Antibodies

Abstract

Background

Immune check-point blockade agents have shown clinical activity in cancer patients but are associated with immune-related adverse events that could limit their development. The aim of this study was to describe the gastrointestinal immune-related adverse events (GI-irAE) in patients with cancer treated with anti-PD-1.

Methods

this is a retrospective study of consecutive adult patients who had a suspected GI-irAE due to anti-PD-1 antibodies between 2013 and 2016. Patients were recruited through a pharmacovigilance registry. Patients' data were reviewed by a multidisciplinary committee that included gastroenterologists, oncologists and a pathologist. Quantitative variables are described by median (range), qualitative variable by frequency (percentage).

Results

Forty-five patients were addressed to a Gastroenterology unit for a suspected GI-IrAE. Twenty patients had a confirmed GI-irAE related to anti-PD-1, which occurred 4.2 months (0.2; 22.1) after the initiation of anti-PD-1. GI-IrAE incidence rate under anti-PD-1 treatment was estimated to be 1.5%. Among patients with GI-IrAE, main symptoms were diarrhea (n=16, 84%), abdominal pain (n=13, 68%), nausea and vomiting (n=11, 55%), intestinal obstruction (n=1, 5%), and hematochezia (n=2, 10%). No patient had colectomy. Four distinct categories of GI-irAE were observed: acute colitis (n=8, 40%), microscopic colitis (n=7, 35%), upper gastrointestinal tract inflammation (n=4, 20%) and pseudo-obstruction (n=1, 5%). Response rates to corticosteroids were 87.5% (7/8) in acute colitis, 57% (4/7) in microscopic colitis and 75% (3/4) in upper gastrointestinal tract inflammation. Median time to resolution was 36 days (6-172) in acute colitis, and 98 days (42-226) in microscopic colitis.

Conclusion

This study suggests that GI-irAE are different and less frequent with anti PD-1 than with anti CTLA-4.

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LEF-1: Diagnostic utility in distinguishing basaloid neoplasms of the salivary gland

Background

Lymphoid enhancer binding factor 1 (LEF-1) has recently been reported as a potential immunohistochemical (IHC) marker for basal cell adenoma (BCA) and other salivary gland tumors, which may contribute to an increased accuracy in differentiating basaloid salivary gland neoplasms. We evaluated the utility of LEF-1 in fine needle aspiration (FNA) and resection specimens to distinguish pleomorphic adenoma (PA), BCA, basal cell adenocarcinoma (BCAC), and adenoid cystic carcinoma (ACC) as well as in non-neoplastic salivary gland (NNSG).

Methods

Cases including 66 PA (35 FNA, 31 resections), 12 BCA (5 FNA, 7 resections), 42 ACC (11 FNA, 31 resections), 1 BCAC FNA, and 10 NNSG (5 FNA, 5 resections) were obtained and stained for LEF-1.

Results

On cell block (CB), 51% of PA and 60% of BCA were LEF-1 positive while 91% of ACC were LEF-1 negative. Among resections, there was a higher percentage of LEF-1 positive PA (84%) and BCA (86%), and a higher percentage of LEF-1 negative ACC (97%). LEF-1 staining had a low to moderate sensitivity for detecting benign basaloid neoplasms on FNA CB and resection specimens (52.5% and 84%, respectively), but a higher specificity (92% and 97% respectively), and positive predictive value (95% and 97% respectively).

Conclusion

When comparing benign (PA and BCA) and the most common malignant basaloid salivary gland tumor (ACC), positive LEF-1 favors a benign neoplasm. Additional studies with LEF-1, specifically including other rare basaloid salivary gland neoplasms are needed to further clarify the role of LEF-1 in diagnosing these lesions on FNA.

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Checklist for a complete chronic urticaria medical history: an easy tool

Existing guidelines do not offer a quick, efficient alternative to the patient's recollection of relevant clinical features during anamnesis and physical examination for chronic urticaria (CU). This study aime...

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Immunological classification of renal cell carcinoma patients based on phenotypic analysis of immune check-point molecules

Abstract

Objectives

To clarify comprehensive immunological signature patterns of tumour tissue-infiltrating lymphocytes in patients with renal cell carcinoma and show its clinical significance.

Materials and methods

We investigated the surface marker expressions of tumour tissue-infiltrating lymphocytes quantitatively and classified them based on their functional populations. We extracted 109 sets of tumour tissue-infiltrating lymphocytes from 80 patients who underwent surgical resection of renal cell carcinoma, of which 44 tumour tissue-infiltrating lymphocytes were multiply extracted from 15 patients. Each tumour tissue-infiltrating lymphocyte was characterised on the basis of functional T-cell populations using ten surface marker expressions measured by flow cytometry.

Results

All sets of the tumour tissue-infiltrating lymphocytes were classified into three groups, which correlated significantly with Fuhrman grade (OR 0.253, 95% CI 0.094–0.678, P = 0.006). Importantly, both overall metastasis-free survival (HR 0.449, 95% CI 0.243–0.832, P = 0.011) and recurrence-free survival (HR 0.475, 95% CI 0.238–0.948, P = 0.035) of the patients with the higher marker expressions were significantly inferior to those of the patients with the lower marker expressions by multivariate analysis. Six specific genes for this classification identified by microarray analysis verified our results using the TCGA KIRC data set. In addition, we discovered the presence of intra-tumoural diversity in the classification of 3 (20%) of the 15 patients.

Conclusions

This study showed that the presence of classable diversity in the immunological signature of tumour tissue-infiltrating lymphocytes correlated with prognosis and tumour aggressiveness that was observed even within individual tumours in some patients with renal cell carcinoma.

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Immunological classification of renal cell carcinoma patients based on phenotypic analysis of immune check-point molecules

Abstract

Objectives

To clarify comprehensive immunological signature patterns of tumour tissue-infiltrating lymphocytes in patients with renal cell carcinoma and show its clinical significance.

Materials and methods

Results

Conclusions

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Treatment of gastric eosinophilia by epicutaneous immunotherapy in piglets sensitized to peanuts

Abstract

Background

Eosinophilic Gastrointestinal Disorders (EGIDs) are hypersensitivity disorders frequently triggered by food allergy and manifested by mucosal eosinophilic infiltration at any level of the gastro-intestinal tract. This study established a model of gastric eosinophilia in peanut-sensitized piglets to evaluate the efficacy of epicutaneous immunotherapy (EPIT) for its treatment.

Methods

Experiments were carried out in piglets first sensitized by 3 intra-peritoneal injections of peanut protein extract (PPE) with adjuvant, and then given PPE orally for 10 days, a sequence leading to gastric eosinophilia assessed by endoscopy. For 3 months, 8 piglets received active EPIT, using Viaskin^® loaded with PPE, applied daily on the ear, while 8 received placebo EPIT (Placebo). Piglets were exposed to a second 10-day period of PPE orally. Lesions were scored by endoscopy on the last day of PPE exposure. After sacrifice, all parts of the digestive tract were analysed by a pathologist unaware of the piglets' status. IgE response was measured and mechanistic parameters were analyzed in the spleen.

Results

After sensitization, a significant increase of total IgE was observed in sensitized compared to naive animals (61.1±13.3 vs 27.8±6 ng/mL, p<0.01). Following oral intake of PPE, sensitized piglets developed moderate gastritis compared to naive piglets (1.5 vs 1.0, median score). After 3 months of immunotherapy, median IgE was significantly reduced in EPIT vs placebo piglets (61.4±16.3 vs 105.9±25.6 ng/mL, p<0.01). Active EPIT significantly reduced gastric mucosal lesions induced by PPE oral intake (macroscopic score 0 [0-2] vs 2 [1-3], p<0.01, respectively active vs placebo) and gastric mucosa eosinophils counts (239 eosinophils/mm² [59-645] vs 2554 eosinophils/mm² [462-8057], p<0.01, respectively active vs placebo). GATA-3, IL-5 and eotaxin mRNA expression decreased significantly after EPIT (p<0.05).

Conclusions

This study describes a large animal model of gastric eosinophil in peanut-sensitized piglets. Utilizing this model, we demonstrated the efficacy of EPIT in treating peanut-induced EGIDs.

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Immunological classification of renal cell carcinoma patients based on phenotypic analysis of immune check-point molecules

Abstract

Objectives

To clarify comprehensive immunological signature patterns of tumour tissue-infiltrating lymphocytes in patients with renal cell carcinoma and show its clinical significance.

Αρχειοθήκη ιστολογίου

Τρίτη 3 Οκτωβρίου 2017

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