Laser irradiation promotes the proliferation of mouse pre-osteoblast cell line MC3T3-E1 through hedgehog signaling pathway

Abstract

Low-level laser could promote osteoblast proliferation, and it has been applied in clinical practice to promote wound healing and tissue regeneration. However, the mechanism related to laser irradiation remains unclear. This study aimed to investigate the effects of low-level laser irradiation on the cell proliferation and the expressions of hedgehog signaling molecules Indian hedgehog (Ihh), Ptch, and Gli in vitro. In our present study, the MTT method was used to evaluate the effect on cell proliferation of laser irradiation on MC3T3-E1 cells. And cell cycle was examined by flow cytometry. Gene and protein expressions of hedgehog signaling molecules, including Ihh, Ptch, Smoothened (Smo), and Gli, were examined by qRT-PCR and western blot analysis. The results showed that laser irradiation at dosage of 3.75 J/cm² enhances the proliferation of MC3T3-E1 cells compared with control groups (p = 0.00). Moreover, laser irradiation (3.75 J/cm²) increased the cell amount at S phase (p = 0.00). In addition, the expressions of Ihh, Ptch, Smo, and Gli were significantly increased compared to the control during laser irradiation (3.75 J/cm²)-induced MC3T3-E1 osteoblast proliferation. After adding the hedgehog signaling inhibitor CY (cyclopamine), cell proliferation and Ihh, Ptch, Smo, and Gli expressions were inhibited (p = 0.00), and the cell amount at S phase was reduced compared with combination groups (p = 0.00). These results indicated that laser irradiation promotes proliferation of MC3T3-E1 cells through hedgehog signaling pathway. Our findings provide insights into the mechanistic link between laser irradiation-induced osteogenesis and hedgehog signaling pathway.

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PHASES Score for the Management of Intracranial Aneurysm [Original Contributions]

Background and Purpose—The aim of this study is to assess whether the PHASES score allows to (1) match decisions taken by multidisciplinary team whether to observe or intervene, (2) classify patients being diagnosed with a ruptured versus unruptured intracranial aneurysm (UIA), and (3) discriminate patients at low risk of rupture from the population of patients diagnosed with intracranial aneurysm.Methods—Population-based prospective and consecutive data were collected between 2006 and 2014. Patients (n=841) were stratified into 4 groups: stable UIA; growing observed UIA; immediately treated UIA; and aneurysmal subarachnoid hemorrhage (aSAH). All patients initially observed were pooled in a follow-up UIA group; patients from growing observed UIA, immediately treated UIA, and aSAH were pooled in a high risk of rupture group. Results are expressed as median [quartile 1, quartile 3].Results—PHASES scores of immediately treated UIA patients were significantly higher than follow-up UIA group (5 [3, 7] versus 2 [1, 4]). Patients diagnosed with UIA and PHASES score of >3 were more likely to be treated, and the score ≤3 was predictive for observation (areas under these curves=0.74). Odds of being diagnosed with an aSAH were associated with PHASES score of >3 (UIA, 4 [2, 6]; aSAH, 5 [4, 8]; areas under these curves=0.66). Scores of stable UIA patients were significantly lower than high risk of rupture group (2 [1, 4] versus 5 [4, 7]; stable UIA outcome prediction by PHASES score of ≤3: areas under these curves=0.76).Conclusions—There is a progression of PHASES score between stable UIA, growing observed UIA, immediately treated UIA, and aSAH groups. PHASES score of ≤3 is associated with a low but not negligible likelihood of aneurysm rupture, and specificity of the classifier is low.

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Early Prediction of Delayed Ischemia and Functional Outcome in Acute Subarachnoid Hemorrhage [Original Contributions]

Background and Purpose—Diffusion tensor imaging (DTI) parameters are markers of cerebral lesion in some diseases. In patients with acute subarachnoid hemorrhage (SAH), we investigated whether DTI parameters measured at <72 hours might be associated with delayed cerebral ischemia (DCI) and with poor functional outcome at 3 months (modified Rankin Scale score ≥3).Methods—DTI was performed in a prospective cohort of 60 patients with nontraumatic SAH at <72 hours. Association of fractional anisotropy and apparent diffusion coefficient values at <72 hours with the occurrence of DCI and outcome at 3 months was evaluated with logistic regression models, adjusting for known predictors of prognosis.Results—At <72 hours after SAH, fractional anisotropy values at the cerebellum were associated with DCI occurrence (78% less odds of DCI for each 0.1 increase in fractional anisotropy; P=0.019). Early apparent diffusion coefficient values were not associated with DCI. After adjusting for confounding variables, an increase of 10 U in apparent diffusion coefficient at the frontal centrum semiovale corresponded to 15% increased odds of poor outcome (P=0.061).Conclusions—DTI parameters at <72 hours post-SAH are independently associated with the occurrence of DCI and functional outcome. These preliminary results suggest the role of DTI parameters as surrogate markers of prognosis in nontraumatic SAH.

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Musikalische Fähigkeiten bei Kindern mit auditiver Verarbeitungs- und Wahrnehmungsstörung

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-113038

Hintergrund In der klinischen Praxis wurden bei Kindern mit auditiven Verarbeitungs- und Wahrnehmungsstörungen (AVWS) Schwierigkeiten bei der Lösung musikalischer Aufgaben beobachtet. Musikalität bei AVWS ist bisher wenig erforscht. Material und Methoden 15 AVWS-Patienten im Alter zwischen 6 und 11 Jahren wurden mit der Messung musikalischer Fähigkeiten (MMF) untersucht und mit 15 Kontrollprobanden verglichen. Ergebnisse AVWS-Patienten zeigen statistisch signifikante Defizite in den Aufgaben zur Tonhöhendifferenzierung, Reproduktion von Rhythmen und Melodien. Zusammenhänge zwischen sprachlichen und musikalischen Leistungen bei AVWS-Patienten wurden nachgewiesen. Schlussfolgerungen Musikalische Fähigkeiten sollten in der AVWS-Diagnostik mehr Beachtung finden. Positive Transfereffekte musikalischen Trainings auf die Sprachentwicklung und allgemeine kognitive Fähigkeiten wurden in zahlreichen Studien nachgewiesen. Bei Vorliegen musikalischer Defizite sollte musikalische Förderung als Therapiemethode bei AVWS diskutiert werden.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Das endoskopische Browlift mittels Endotine Forehead Device bei Fazialisparese

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-113040

Hintergrund: Die Augenpartie ist sowohl in funktioneller Hinsicht als auch für die Expression von Emotionen von zentraler Bedeutung. Eine chronische Fazialisparese mit Lähmung des Stirnastes kann zu einer Brauenptosis mit Einschränkungen des Gesichtsfeldes und einer deutlichen Asymmetrie des Gesichts führen. Das endoskopische Browlift mit resorbierbarem Endotine Forehead Device stellt ein attraktives Konzept zur Korrektur der Brauenptosis und Symmetrisierung der Stirn-/Brauenregion dar. Material und Methoden Das endoskopische Augenbrauen- und Stirnlift unter Anwendung des Endotine Forehead Devices wurde in unserer Klinik bisher an 9 Patienten mit Fazialisparese durchgeführt. Das intraoperative Handling, Komplikationen und das postoperative Ergebnis wurden analysiert. Die Symmetrisierung der Augenbrauen wurde durch die FACEgram-Software erfasst. Zur postoperativen Abfrage der Patientenzufriedenheit wurde nach durchschnittlich 10 Monaten der Glasgow Benefit Inventory Fragebogen eingesetzt. Ergebnisse Mit Hilfe des endoskopischen Stirnlifts mit dem Endotine Forehead Device gelang eine minimal-invasive, komplikationsarme Symmetrisierung der Stirn- und Augenbrauenregion. Operationsbedingte Morbiditäten wurden nicht kaum beobachtet. Folgende Komplikationen wurden beobachtet: Eine Patientin erlitt eine Rezidivptosis bei postoperativem Hämatom. Eine weitere empfand die Palpabilität des Device als störend. Die Patienten berichteten über eine postoperative Steigerung der Lebensqualität, d.er durchschnittliche Punktwert im Glasgow Benefit Inventory nach der Operation lag bei + 29,2 (SD 13,6). Schlussfolgerungen Das endoskopische Brow- und Stirnlift mit dem Endotine Forehead Device stellt eine erfolgreiche, komplikationsarme Therapieoption bei Brauenptosis in Folge einer Fazialisparese dar.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Hereditäre Innenohrdysplasie mit Betroffenheit von aufeinanderfolgenden Generationen einer Familie

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-113039

Georg Thieme Verlag KG Stuttgart · New York

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Progrediente Verschlechterung des Sprachverstehens nach Cochlea-Implantation

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-113041

Georg Thieme Verlag KG Stuttgart · New York

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Das endoskopische Browlift mittels Endotine Forehead Device bei Fazialisparese

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-113040

Hintergrund: Die Augenpartie ist sowohl in funktioneller Hinsicht als auch für die Expression von Emotionen von zentraler Bedeutung. Eine chronische Fazialisparese mit Lähmung des Stirnastes kann zu einer Brauenptosis mit Einschränkungen des Gesichtsfeldes und einer deutlichen Asymmetrie des Gesichts führen. Das endoskopische Browlift mit resorbierbarem Endotine Forehead Device stellt ein attraktives Konzept zur Korrektur der Brauenptosis und Symmetrisierung der Stirn-/Brauenregion dar. Material und Methoden Das endoskopische Augenbrauen- und Stirnlift unter Anwendung des Endotine Forehead Devices wurde in unserer Klinik bisher an 9 Patienten mit Fazialisparese durchgeführt. Das intraoperative Handling, Komplikationen und das postoperative Ergebnis wurden analysiert. Die Symmetrisierung der Augenbrauen wurde durch die FACEgram-Software erfasst. Zur postoperativen Abfrage der Patientenzufriedenheit wurde nach durchschnittlich 10 Monaten der Glasgow Benefit Inventory Fragebogen eingesetzt. Ergebnisse Mit Hilfe des endoskopischen Stirnlifts mit dem Endotine Forehead Device gelang eine minimal-invasive, komplikationsarme Symmetrisierung der Stirn- und Augenbrauenregion. Operationsbedingte Morbiditäten wurden nicht kaum beobachtet. Folgende Komplikationen wurden beobachtet: Eine Patientin erlitt eine Rezidivptosis bei postoperativem Hämatom. Eine weitere empfand die Palpabilität des Device als störend. Die Patienten berichteten über eine postoperative Steigerung der Lebensqualität, d.er durchschnittliche Punktwert im Glasgow Benefit Inventory nach der Operation lag bei + 29,2 (SD 13,6). Schlussfolgerungen Das endoskopische Brow- und Stirnlift mit dem Endotine Forehead Device stellt eine erfolgreiche, komplikationsarme Therapieoption bei Brauenptosis in Folge einer Fazialisparese dar.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Hereditäre Innenohrdysplasie mit Betroffenheit von aufeinanderfolgenden Generationen einer Familie

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-113039

Georg Thieme Verlag KG Stuttgart · New York

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Musikalische Fähigkeiten bei Kindern mit auditiver Verarbeitungs- und Wahrnehmungsstörung

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-113038

Hintergrund In der klinischen Praxis wurden bei Kindern mit auditiven Verarbeitungs- und Wahrnehmungsstörungen (AVWS) Schwierigkeiten bei der Lösung musikalischer Aufgaben beobachtet. Musikalität bei AVWS ist bisher wenig erforscht. Material und Methoden 15 AVWS-Patienten im Alter zwischen 6 und 11 Jahren wurden mit der Messung musikalischer Fähigkeiten (MMF) untersucht und mit 15 Kontrollprobanden verglichen. Ergebnisse AVWS-Patienten zeigen statistisch signifikante Defizite in den Aufgaben zur Tonhöhendifferenzierung, Reproduktion von Rhythmen und Melodien. Zusammenhänge zwischen sprachlichen und musikalischen Leistungen bei AVWS-Patienten wurden nachgewiesen. Schlussfolgerungen Musikalische Fähigkeiten sollten in der AVWS-Diagnostik mehr Beachtung finden. Positive Transfereffekte musikalischen Trainings auf die Sprachentwicklung und allgemeine kognitive Fähigkeiten wurden in zahlreichen Studien nachgewiesen. Bei Vorliegen musikalischer Defizite sollte musikalische Förderung als Therapiemethode bei AVWS diskutiert werden.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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

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Progrediente Verschlechterung des Sprachverstehens nach Cochlea-Implantation

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-113041

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

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Three-Dimensional Anthropometric Evaluation of Facial Morphology.

Objectives: The objectives of this study were to evaluate sexual dimorphism for facial features within Colombian and Mexican-American populations and to compare the facial morphology by sex between these 2 populations. Materials and Methods: Three-dimensional facial images were acquired by using the portable 3dMDface system, which captured 223 subjects from 2 population groups of Colombians (n = 131) and Mexican-Americans (n = 92). Each population was categorized into male and female groups for evaluation. All subjects in the groups were aged between 18 and 30 years and had no apparent facial anomalies. A total of 21 anthropometric landmarks were identified on the 3-dimensional faces of each subject. The independent t test was used to analyze each data set obtained within each subgroup. Results: The Colombian males showed significantly greater width of the outercanthal width, eye fissure length, and orbitale than the Colombian females. The Colombian females had significantly smaller lip and mouth measurements for all distances except upper vermillion height than Colombian males. The Mexican-American females had significantly smaller measurements with regard to the nose than Mexican-American males. Meanwhile, the heights of the face, the upper face, the lower face, and the mandible were all significantly less in the Mexican-American females. The intercanthal and outercanthal widths were significantly greater in the Mexican-American males and females. Meanwhile, the orbitale distance of Mexican-American sexes was significantly smaller than those of the Colombian males and females. The Mexican-American group had significantly larger nose width and length of alare than the Colombian group regarding both sexes. With respect to the nasal tip protrusion and nose height, they were significantly smaller in the Colombian females than in the Mexican-American females. The face width was significantly greater in the Colombian males and females. Conclusions: Sexual dimorphism for facial features was presented in both the Colombian and Mexican-American populations. In addition, there were significant differences in facial morphology between these 2 populations. (C) 2017 by Mutaz B. Habal, MD.

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Variations in Current Procedural Terminology Coding for Craniofacial Surgery: a Need for Review and Change.

Background: A survey was utilized to study the coding practices of surgeons performing craniofacial procedures, in order to determine whether coding for these procedures might be standardized or expanded. Methods: An online survey was designed with 6 sample cases to cover a variety of procedures encountered in the field of craniofacial surgery which was sent to members of 3 professional organizations centered around the practice of craniofacial/maxillofacial surgery. Surgeons were asked to read the vignettes and choose from a series of multiple-choice responses to code the cases, or write in their own response. Codes were based on the American Medical Association current procedural terminology listings. Responses were compiled and tabulated. Results: One hundred twenty-eight people initiated the survey. The largest common coding responses for each vignette were selected by 45.2% of respondents for the case describing placement of an internal mandibular distractor; 45.3% for the case of scaphocephaly remodeling; 67.1% for a case of cranioplasty for trigonocephaly; 47.2% for hypertelorism repair with periorbital osteotomies; 60% for LeFort III advancement with external distractors; and 53.6% for the case describing the removal of an internal mandibular distractor. Between 4 and 12 codes were identified for possible use in each clinical scenario. Conclusion: There appears to be wide variability among those who routinely perform craniofacial surgery as to the appropriate ways to code these procedures. We hope to bring this to the attention of coding committees for further discussion to hopefully bring about more accurate and descriptive codes for craniofacial surgical procedures. (C) 2017 by Mutaz B. Habal, MD.

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Aesthetic Lateral Canthoplasty: a Gray Line Split Approach.

Background: Many women in Asian countries chase larger and brighter eyes, but to most Asian people only double eye plasty and epicanthoplasty is not enough. As a result, aesthetic lateral canthoplasty, another procedure to lengthen the palpebral fissure, is becoming more and more popular. However, the current procedure of aesthetic lateral canthoplasty has many potential complications, restricting the wide application of this procedure. Methods: Here, the authors developed a minimally invasive method through gray line split and canthopexy to achieve lateral canthoplasty. Eighty-seven patients from February 2013 to January 2016 were included and had the procedure. The lengthen of the palpebral fissure was measured and photographs were also taken before the surgery and in the follow-up periods. Besides, the complications related to this procedure were also investigated. Results: The authors have performed aesthetic lateral canthoplasty in 87 patients, almost all of the follow-up patients have satisfactory results with a lengthen of palpebral fissure ranging from 2.3 to 4.2 mm. Through the long-term follow-up the authors found the lengthen of the palpebral fissure is stable. No serious complications like lacrimal system fistula or hypertrophic scars emerged except 1 patient with conjunctival exposure. Conclusions: Through this gray line split method, the authors can acquire larger and brighter eyes without serious complications. The authors think that this is a good method and worthy of promotion. (C) 2017 by Mutaz B. Habal, MD.

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Change in Posterior Pharyngeal Space After Counterclockwise Rotational Orthognathic Surgery for Class II Dentofacial Deformity Diagnosed With Obstructive Sleep Apnea Based on Cephalometric Analysis.

Although maxillomandibular advancement (MMA) is an orthognathic surgical procedure used to manage obstructive sleep apnea (OSA) in individuals who are noncompliant with continuous positive airway pressure therapy, simple MMA encounters problems in terms of aesthetic outcomes in Asian populations with preexisting dentoalveolar protrusion. Our current prospective investigation describes changes in posterior pharyngeal space and aesthetic outcomes after counterclockwise rotational orthognathic surgery, which is known to be quite difficult in terms of the maintenance of the skeletal stability in skeletal class II patients with OSA. This prospective study investigated the surgical outcome of patients who suffered from OSA following counterclockwise rotational orthognathic surgery. The patients were skeletal class II patients who underwent orthognathic surgery between March 2013 and December 2014. Cephalometric posterior airway analysis and a questionnaire for facial perception were used to assess pharyngeal airway and patient perception of facial appearance. A total of 14 patients were included. Satisfactory results were achieved without complications in all OSA patients. The airway parameters for anteroposterior length significantly increased. Thirteen patients answered a questionnaire on their facial appearance, and the visual analog scale averaged 7.31 points, indicating a favorable facial appearance. Counterclockwise rotational orthognathic surgery without maxilla advancement for the correction of OSA can effectively increase the posterior pharyngeal space, with favorable aesthetic results. With thoughtful application, this novel approach may be an alternative to standard approaches for the correction of OSA using orthognathic surgery. (C) 2017 by Mutaz B. Habal, MD.

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Speech Perceptions and Health-Related Quality of Life Among Children With Cleft Lip and Palate.

Background: The association between perception of speech and health-related quality of life (HRQOL) among patients with cleft palate is not well understood. The purpose of this study was to determine: the agreement between patient and parent perception of speech, the correlation between patient/parent speech perception and objective analysis by a speech-language pathologist (SLP), and the relationship between objective speech analysis and HRQOL among children with cleft lip with or without palate (CLCP). Methods: The authors surveyed 108 CLCP patients who received treatment at a large tertiary medical center from 2013 to 2014. Patients and parents were queried regarding their difficulty with speech, and an SLP performed perceptual speech analysis with each patient. Patient-reported survey instruments were used to assess anxiety, depression, anger, peer relationships, stigma, and overall psychosocial health. The authors assessed the agreement between patients and SLP analysis as well as association between speech and HRQOL. Results: Patient and parent-reported speech quality demonstrated moderate agreement regarding the quality of the child's speech (r = 0.46-0.64). Parent and patient speech perception was not well associated with SLP analysis (V = 0.06-0.30). Patient speech perception was correlated with depression (P = 0.03), while SLP analysis was correlated with anger (P = 0.03, P = 0.004), depression (P = 0.007), and difficulty with peer relationships (P = 0.02). Conclusions: Patients and parents have different perceptions of the quality of the child's speech, and their ratings differ from SLP perceptual speech analysis. Both patient speech perception and SLP analysis are correlated with important aspects of quality of life, and should be considered when evaluating children with CLCP. (C) 2017 by Mutaz B. Habal, MD.

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Review of "Mastery of Care-Toward Communitarian Regulation" by Pronovost P and Higgins RS in Ann Surg 265: 271-272, 2017.

No abstract available

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The Effect of Anterior Palatoplasty Plus Modified Expansion Sphincter Pharyngoplasty on Voice Performance in Obstructive Sleep Apnea Syndrome.

Objective: We aimed to investigate the effect of anterior palatoplasty (AP) plus modified expansion sphincter pharyngoplasty (MESP) on voice performance in patients with obstructive sleep apnea syndrome (OSAS). Methods: Fourteen OSAS patients who had AP + MESP procedure were included in the study. Voice performances of the patients were analyzed with acoustic voice analysis before surgery, and 6 months after surgery. Results: Preoperative and postoperative F0, jitter percentage, and shimmer percentage were compared. Mean preoperative F0 was 129.85 Hz, and mean postoperative F0 was 138.07 Hz, with a significant difference in between (P = 0.017). Mean preoperative jitter percentage was 0.65, and mean shimmer percentage was 0.88, while those values were 0.67 and 0.84, respectively, in the postoperative period. The differences were not statistically significant (P = 0.801 and 0.652). Conclusion: The AP + MESP procedure performed for OSAS results in improvement of F0 in the long term; however, there were no differences in jitter percentage and shimmer percentage. (C) 2017 by Mutaz B. Habal, MD.

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Double Vision After Minimally Invasive Orbital Decompression.

Introduction: New onset Diplopia following orbital decompression in thyroid eye disease patients is estimated to occur in up to 30% to 40% of decompression patients, mostly related to deep lateral and medial wall decompressions. Methods: A retrospective chart review of all minimally invasive (fat and minimal bone orbital decompression performed at the UCLA Stein Eye Institute between 2005 and 2015. Inclusion criteria were thyroid eye disease patients older than 18 years undergoing fat only orbital decompression with no previous muscle surgery. Results: The chart review revealed only 5 patients with new onset diplopia after this surgery. The cases are discussed and a possible mechanism for the diplopia is proposed. Discussion: Double vision following minimally invasive orbital decompression is rare and the mechanisms are poorly understood. (C) 2017 by Mutaz B. Habal, MD.

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Mozart Ear Deformity: a Rare Diagnosis in the Ear Reconstruction Clinic.

Mozart ear is a rare auricular deformity; clinically the auricle is characterized by the bulging appearance of the anterosuperior portion of the auricle due to fusion of the crura of the antihelix, an inversion in the normal form of the cavum conchae resulting in its convexity and a slit-like narrowing of the orifice of the external auditory meatus. A retrospective review of clinical and photographic records of patients attended at the ear reconstruction clinic of our hospital between June of 2010 and May 2016 was performed; out of 576 consecutive patients only 3 fulfilled the inclusion criteria, with a prevalence of 0.5%. The authors present these patients. Surgical interventions mainly focus on the correction of the convex concha; however, the procedure should be tailored to the severity of the deformity and the wishes of the patient. (C) 2017 by Mutaz B. Habal, MD.

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Lower Eyelid Reconstruction After Ablation of Skin Malignancies: How Far Can We Get in a Single-Stage Procedure?.

: Reconstruction of full-thickness lower eyelid defects tends to be a devastating procedure, especially when big amount of tissue has to be removed because of oncological reasons. The applied techniques are mostly difficult to execute and multistaged, often require extensive dissection, and result in scarring and facial disfigurement. The aim of the present study is to demonstrate the authors' experience in single-staged reconstructions of full-thickness defects of the lower eyelid with local tissue only. Material and Methods: A retrospective analysis was conducted identifying patients with postexcisional defects after skin cancer occurring in the lower eyelid, reconstructed in 1 stage. Appropriate demographic, pathological, preoperative, and postoperative clinical data and photo documentation were collected and analyzed. Results: After excluding patients with partial thickness defects (n=5), a total of 13 patients with lower eyelid full-thickness defects were studied, including 9 women and 4 men with mean age 66.5 years (age range 53-79 years). The most common malignancy was basal cell carcinoma (n = 11). In one of the patients 2 synchronous neoplasms were excised simultaneously from the same lower eyelid. The reconstruction was successfully performed in 1 stage in all the patients by recruiting the same eyelid tissue and/or temporal tissue. No additional surgery was needed at a minimal follow-up of 9 months. Conclusion: Local tissue flaps have proven to be a reliable option for a single-stage reconstruction of large full-thickness defects. Tenzel flap technique seems to be a reliable option for repair of defects as large as 60% of the total eyelid length. (C) 2017 by Mutaz B. Habal, MD.

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Demarcative Necrosis Along Previous Laceration Line After Filler Injection.

In recent years, fillers have been widely used for soft tissue augmentation. Although they are generally considered to be safe, many complications have been reported to date. Nose and nasolabial fold augmentations with fillers can lead to an implementation of nasal skin necrosis, possibly caused by intravascular embolism and/or extravascular compression. Herein, we present a case of a successfully treated patient who experienced skin necrosis after an injection of dermal fillers into the nasolabial fold. Interestingly, we discovered that the patient had experienced a laceration 8 years ago around the area in which the filler was injected. (C) 2017 by Mutaz B. Habal, MD.

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Displacement of a Broken Dental Injection Needle Into the Perivertebral Space.

Dental injection needle breakage is an uncommon problem in dental practice. Displacement of the broken fragment into anatomical spaces is, on the other hand, a serious complication that occurs most commonly during inferior alveolar nerve blocks as a result of material wear, incorrect application of the anesthesia technique, or sudden movement of the patient during injection. Further complications such as infection, trismus, and nerve paralysis may exacerbate the condition and, if not treated adequately, life-threatening conditions may develop over time as the fragment dislodges deeper in soft tissues. Clinical symptoms of the patient, as well as the findings gathered from detailed physical examination and radiographic evaluation, are important factors to consider before performing an exploratory surgery. Removal of a broken needle may be troublesome due to its proximity to vital anatomic structures. Multislice computed tomography is a reliable imaging modality that provides accurate information to pinpoint the exact location of the needle fragment. This report describes a case of needle breakage occurred during inferior alveolar nerve block which was performed to extract a third molar tooth and the migration of the broken fragment from the right mandibular ramus area into the perivertebral space, with special emphasis on the surgical retrieval technique with multiplanar computed tomography imaging guidance. (C) 2017 by Mutaz B. Habal, MD.

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Review of "Surgical Education and Health Care Reform, Defining the Role and Value of Trainees in an Evolving Medical Landscape" by Fayanju OM, Aggarwal R, Baucom RB, Ferrone CR, Massaro D, Terhune KP in Ann Surg 265: 459-460, 2017.

No abstract available

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Morphometric Analysis of the Posterior Cranial Fossa in Syndromic and Nonsyndromic Craniosynostosis.

Posterior cranial fossa (PCF) anatomy can be abnormal in craniosynostosis, and hindbrain herniation may occur. This study analyzed PCF anatomy in single suture and complex craniosynostosis. Children with craniosynostosis and age-matched controls were identified. Cephalic index (CI) for cranial vault and PCF as well as tentorial (TA) and occipital angles (OA) were measured on preoperative imaging. Children with syndromic (N = 6), bicoronal (N = 4), sagittal (N = 12), and metopic synostosis (N = 4) as well as controls (N = 10) were enrolled. Mean CI for cranial vault was 0.89, 0.93, 0.65, 0.74, and 0.78, respectively. Corresponding CI for PCF was 0.81, 0.93, 0.62, 0.74, and 0.78. Mean TA and OA were 45.4[degrees] and 96.6[degrees] in syndromic, 39.7[degrees] and 87.0[degrees] in bicoronal, 34.0 and 75.0[degrees] in sagittal, 39.7[degrees] and 87.0[degrees] in metopic synostosis, and 42.9[degrees] and 88.3[degrees] in controls. While CI, TA, and OA in metopic synostosis were similar to controls, abnormalities were found in syndromic, bicoronal, and sagittal synostosis. Syndromic and bicoronal craniosynostosis patients had a higher CI for both cranial vault and PFC as well as larger TA and OA, indicating a brachycephalic skull with steep tentorium and narrow PCF. In sagittal synostosis, CI for cranial vault and PCF were lower and TA and OA smaller, reflecting scaphocephalic deformity also at PCF, with a flat tentorium. This study provides basic PCF morphometry in craniofacial conditions. (C) 2017 by Mutaz B. Habal, MD.

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Nasal Septal Deformity in Relation to the Mode of Delivery.

Objective: The aim of this study was to find the relation between mode of delivery and the types of septal deviation. Materials and Methods: Records of patients treated for a deviated nasal septum from March 2003 to October 2015 were reviewed. Those with previous facial trauma were excluded. Information retrieved included basic demographic data, mode of delivery, sibling birthing order, type and date of surgery, and postoperational outcomes. Results: A total of 130 records were recovered. According to Guyuron's classification of nasal septal deviation, we found that type 5 was the most common type for patients delivered normally, whereas type 2 was the most common type for those who were delivered by cesarean section. Conclusion: Mode of delivery may be related to a certain type of deviation. However, studies with larger samples are required to support the finding in our study. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2tzgm9Z

Open Craniosynostosis Surgery: Effect of Early Intraoperative Blood Transfusion on Postoperative Course.

Correction of craniosynostosis can result in blood loss when the patient already has physiologic anemia. The aim of this study was to determine whether patients benefit from early blood transfusion and whether the timing of blood transfusion affects metabolic disturbances and the postoperative course. In this retrospective review, 71 patients who underwent open calvarial vault remodeling for correction of craniosynostosis were separated into 2 groups according to whether they received blood transfusions early (within the first 30 minutes of surgery) or later (after the first 30 minutes of surgery). Patients were further separated into nonsyndromic and syndromic cohorts. Tracked variables included hemoglobin, hematocrit, arterial blood gas values, lactate level, length of stay, estimated blood loss, and amount of blood transfused in the operating room, amount transfused postoperatively, and total amount transfused. Among all patients, the early transfusion group had a higher hemoglobin nadir overall and received less postoperative blood. Within the nonsyndromic cohort, the early transfusion group had a higher estimated blood loss and received more transfused blood. In the syndromic cohort, the early transfusion group had a hemoglobin nadir that was significantly higher than in the late transfusion group and a lower estimated blood loss, shorter pediatric intensive care unit stay, and less postoperative blood transfused. Syndromic patients also received significantly more blood overall. For syndromic patients undergoing open calvarial vault remodeling, transfusion within the first 30 minutes of surgery should be considered. (C) 2017 by Mutaz B. Habal, MD.

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Post-Surgical Relapse in Metopic Synostosis and Limitations of the Interfrontal Angle as an Outcome Measure.

Background: The interfrontal angle (IFA) has been utilized as a surrogate for morphologic assessment of the anterior cranial region in metopic synostosis with success in characterizing presenting severity. Its utility as an outcome measure has not been assessed similarly. In this study, we aimed to determine whether meaningful information relative to shape, and relapse in particular, could be assessed using the IFA. Methods: Patients with operatively treated isolated metopic synostosis were identified and included based on the availability of "previously obtained" low-dose computerized tomography (CT) scans at (1) preoperative and 2 postoperative (2) postoperative day-3 and (3) 1 year time points. Relapse was calculated as the percentage of the operatively induced change in IFA that was retained after the first postoperative year. Results: After exclusionary criteria, 19 patients were identified. The mean IFA values at the 3 time points were 119.3[degrees] (+/-9.8), 139.6[degrees] (+/-6.3), and 135.3[degrees] (+/-7.1), chronologically. Of the 19 patients, 14 (73.7%) experienced relapse, with this subgroup averaging 62.4% retention of their surgical change after 1 year. Increased preoperative severity and delayed age at surgical intervention were concurrently associated with an increased occurrence of relapse (P = 0.011). Another model utilizes preoperative IFA to predict the change in IFA that would accompany surgery on a case-by-case basis (P

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Surgical Outcomes of Endonasal Conjunctivodacryocystorhinostomy According to Jones Tube Location.

Purpose: The aim of this study was to compare surgical outcomes and complications of endonasal conjunctivodacryocystorhinostomy (CDCR) according to Jones tube location. Methods: Patients who underwent endonasal CDCR owing to proximal obstruction of the lacrimal drainage system between 2009 and 2016 were retrospectively reviewed. Patients were divided into 2 groups according to the location of the proximal end of the Jones tube. The canthal-based group included patients in which the proximal end of the Jones tube was located in the medial canthal angle, and the fornix-based group included patients in which the proximal end of the Jones tube was located in the inferomedial conjunctival fornix. Success rates were evaluated at 3 months and 6 months after surgery. Causes of failure, incidence of tube migration, and incidence of canthal deformity were also evaluated. Results: The success rate at 3 months postoperative was 95% in the canthal-based group and 78.6% in the fornix-based group (P = 0.283). Success rates at 6 months postoperative were 85% in the canthal-based group and 71.4% in the fornix-based group, respectively (P = 0.410). The main cause of failure was granuloma in the canthal-based group (2/20) and medial migration in the fornix-based group (3/14). Medial canthal deformity occurred in 12 of 20 cases in the canthal-based group, but none occurred in the fornix-based group. Conclusion: The canthal-based group had a lower migration rate and slightly better surgical success rate than the fornix based group, but canthal deformity was more prevalent. (C) 2017 by Mutaz B. Habal, MD.

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Our Surgical Past: An Aid to Understanding the Present and a Guide to the Future.

No abstract available

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Reconstruction of a Marjolin Ulcer Defect of the Scalp Invading Brain and Causing Brain Abscess Formation Using Free Latissimus Dorsi Flap.

Marjolin ulcers are known as aggressive malignant tumors that mostly arise over chronic wounds and cutaneous scars. Brain abscess is a serious medical condition that requires surgical drainage along with antibiotic treatment. Here, we report a case with a Marjolin ulcer located over the right parietal bone with intracranial abscess formation along with tumor invasion into brain parenchyma. This patient was a 64-year-old man and had a 4 x 4 cm open wound on his scalp from which a purulent discharge was coming. This wound required surgical excision with security margins, resection of bone, evacuation of the cystic cavity, and excision of the walls of the cystic cavity, which were invaded by the tumor. Duraplasty and reconstruction of the defect with a free lattisimus dorsi flap are performed. To the best of our knowledge, the case reported here is unique because of the formation of brain abscess in the background of a long-lasting Marjolin ulcer invading brain parenchyma. It must be remembered that on the background of cutaneous scars located over the scalp, a Marjolin ulcer may develop, and if left untreated, tumor cells may invade even the brain parenchyma. Long-term asymptomatic brain infections may also accompany the given scenario, and complicate differential diagnosis. (C) 2017 by Mutaz B. Habal, MD.

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Das endoskopische Browlift mittels Endotine Forehead Device bei Fazialisparese

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-113040

Hintergrund: Die Augenpartie ist sowohl in funktioneller Hinsicht als auch für die Expression von Emotionen von zentraler Bedeutung. Eine chronische Fazialisparese mit Lähmung des Stirnastes kann zu einer Brauenptosis mit Einschränkungen des Gesichtsfeldes und einer deutlichen Asymmetrie des Gesichts führen. Das endoskopische Browlift mit resorbierbarem Endotine Forehead Device stellt ein attraktives Konzept zur Korrektur der Brauenptosis und Symmetrisierung der Stirn-/Brauenregion dar. Material und Methoden Das endoskopische Augenbrauen- und Stirnlift unter Anwendung des Endotine Forehead Devices wurde in unserer Klinik bisher an 9 Patienten mit Fazialisparese durchgeführt. Das intraoperative Handling, Komplikationen und das postoperative Ergebnis wurden analysiert. Die Symmetrisierung der Augenbrauen wurde durch die FACEgram-Software erfasst. Zur postoperativen Abfrage der Patientenzufriedenheit wurde nach durchschnittlich 10 Monaten der Glasgow Benefit Inventory Fragebogen eingesetzt. Ergebnisse Mit Hilfe des endoskopischen Stirnlifts mit dem Endotine Forehead Device gelang eine minimal-invasive, komplikationsarme Symmetrisierung der Stirn- und Augenbrauenregion. Operationsbedingte Morbiditäten wurden nicht kaum beobachtet. Folgende Komplikationen wurden beobachtet: Eine Patientin erlitt eine Rezidivptosis bei postoperativem Hämatom. Eine weitere empfand die Palpabilität des Device als störend. Die Patienten berichteten über eine postoperative Steigerung der Lebensqualität, d.er durchschnittliche Punktwert im Glasgow Benefit Inventory nach der Operation lag bei + 29,2 (SD 13,6). Schlussfolgerungen Das endoskopische Brow- und Stirnlift mit dem Endotine Forehead Device stellt eine erfolgreiche, komplikationsarme Therapieoption bei Brauenptosis in Folge einer Fazialisparese dar.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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

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Hereditäre Innenohrdysplasie mit Betroffenheit von aufeinanderfolgenden Generationen einer Familie

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-113039

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

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Musikalische Fähigkeiten bei Kindern mit auditiver Verarbeitungs- und Wahrnehmungsstörung

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-113038

Hintergrund In der klinischen Praxis wurden bei Kindern mit auditiven Verarbeitungs- und Wahrnehmungsstörungen (AVWS) Schwierigkeiten bei der Lösung musikalischer Aufgaben beobachtet. Musikalität bei AVWS ist bisher wenig erforscht. Material und Methoden 15 AVWS-Patienten im Alter zwischen 6 und 11 Jahren wurden mit der Messung musikalischer Fähigkeiten (MMF) untersucht und mit 15 Kontrollprobanden verglichen. Ergebnisse AVWS-Patienten zeigen statistisch signifikante Defizite in den Aufgaben zur Tonhöhendifferenzierung, Reproduktion von Rhythmen und Melodien. Zusammenhänge zwischen sprachlichen und musikalischen Leistungen bei AVWS-Patienten wurden nachgewiesen. Schlussfolgerungen Musikalische Fähigkeiten sollten in der AVWS-Diagnostik mehr Beachtung finden. Positive Transfereffekte musikalischen Trainings auf die Sprachentwicklung und allgemeine kognitive Fähigkeiten wurden in zahlreichen Studien nachgewiesen. Bei Vorliegen musikalischer Defizite sollte musikalische Förderung als Therapiemethode bei AVWS diskutiert werden.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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

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Progrediente Verschlechterung des Sprachverstehens nach Cochlea-Implantation

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-113041

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

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Incidence of Hepatitis B Viral Reactivation After Kidney Transplantation With Low-dose Rituximab Administration.

Background: In hematological malignancy patients intended to receive rituximab, hepatitis B virus (HBV) serology screening, viral reactivation monitoring, are recommended. However, the effect of single-dose rituximab (RIT) on HBV reactivation in kidney transplant patients with previous HBV infection is still unclear. Methods: In this retrospective cohort study consisting of 1294 kidney transplant patients, we identified 76 patients showing preoperative hepatitis B surface antigen-negative, hepatitis B core antibody-positive, and HBV-DNA negative results. A rituximab dose of 200mg/body was administered to 48 patients, 46 of whom did not receive prophylaxis (RIT+ group). Twenty-eight patients received neither rituximab nor prophylaxis (RIT- group). We monitored HBV-DNA by polymerase chain reaction every 1-3 months, and HBV reactivation was defined as detectable HBV-DNA. Results: HBV reactivation was found in 1 patient in the RIT+ group (2.2%) and 1 patient in the RIT- group (3.6%) at 6 weeks and 5.5 years posttransplant, respectively, but spontaneously cleared. Both patients showed positive hepatitis B surface antibody (anti-HBs) preoperatively. HBV reactivation was not found in 6 patients lacking anti-HBs preoperatively. Conclusions: Low-dose RIT administration in kidney transplant patients without prophylaxis is associated with low incidence of HBV reactivation. However, the comparisons amongst standard-dose RIT, low-dose RIT, and controls with high quality study design is necessary. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Aggregating Marginal Gains in Posttransplant CMV Risk Stratification.

No abstract available

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The use of Ex Vivo Generated Regulatory T Cell Preparations in a Canine Lung Allograft Model.

No abstract available

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Non-HLA Antibodies Impact on C4d staining, Stellate Cell Activation and Fibrosis in Liver Allografts.

Background: Recent data has shown an increased risk for rejection, fibrosis progression, and death in liver transplant (LT) recipients with preformed or de novo HLA donor-specific alloantibodies (DSA). However, the role of non-HLA autoantibodies and the interaction between HLA DSA and non-HLA autoantibodies remains uncharacterized. Methods: We analyzed 1269 primary LT recipients from 1/2000-4/2009 with known HLA DSA status for Angiotensin II Type-1 Receptor and Endothelin-1 Type A receptor autoantibodies(anti-AT1R-Abs and anti-ETAR-Abs respectively) pre-LT and year-1 post-LT. Results: Preformed non-HLA autoantibodies alone did not impact outcomes. In multivariable modeling, the combination of preformed non-HLA autoantibodies and HLA-DSA were associated with an increased risk for death [Hazard Ratio (HR)=1.66; p=0.02] especially if the HLA DSA was of the IgG3 subclass (HR=2.28; p=0.01). A single de novo non-HLA autoantibody was associated with an increased risk for TCMR or AMR rejection(68% vs. 41%, p=0.01) and fibrosis progression (HR=1.84; p=0.02). Biopsies with de novo non-HLA autoantibodies revealed a new sinusoidal C4d staining pattern when compared to HLA DSA(71% vs. 3%; p

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Relevance of chromosomal band 11q13 in oral carcinogenesis: An update of current knowledge

Publication date: September 2017
Source:Oral Oncology, Volume 72
Author(s): Pablo Ramos-García, Isabel Ruiz-Ávila, José Antonio Gil-Montoya, Ángela Ayén, Lucía González-Ruiz, Francisco José Navarro-Triviño, Miguel Ángel González-Moles
An important event in oral carcinogenesis is the amplification of chromosomal band 11q13, in which numerous oncogenes and some tumor-suppressor genes are localized and frequently co-amplified during the malignant transformation of oral epithelium. The objectives of this study were to review published data on the involvement of 11q13 amplification in oral cancer, to provide an update on novel concepts and terminology related to gene amplification, and to explore the composition of the 11q13 amplicon in OSCC, including its most relevant amplicon cores and potential drivers. We report on the critical oncogenes and tumor-suppressor genes in 11q13 that may play a major role in oral cancer, focusing on their functions, on the characteristics acquired by their amplification, and on their clinicopathological implications. Finally, we discuss the possible usefulness of the 11q13 region as a therapeutic target in oral cancer.



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Letter to Editors: Detection of endolymphatic hydrops using traditional MR imaging sequences

Publication date: Available online 30 June 2017
Source:American Journal of Otolaryngology
Author(s): Shinji Naganawa, Michihiko Sone




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Letter to the editor

Publication date: Available online 30 June 2017
Source:American Journal of Otolaryngology
Author(s): Satvinder Singh Bakshi




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Letter to the editor

Publication date: Available online 30 June 2017
Source:American Journal of Otolaryngology
Author(s): Satvinder Singh Bakshi




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Letter to Editors: Detection of endolymphatic hydrops using traditional MR imaging sequences

Publication date: Available online 30 June 2017
Source:American Journal of Otolaryngology
Author(s): Shinji Naganawa, Michihiko Sone




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Letter to Editors: Detection of endolymphatic hydrops using traditional MR imaging sequences

Publication date: Available online 30 June 2017
Source:American Journal of Otolaryngology
Author(s): Shinji Naganawa, Michihiko Sone




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Letter to the editor

Publication date: Available online 30 June 2017
Source:American Journal of Otolaryngology
Author(s): Satvinder Singh Bakshi




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Separation, Aspiration, and Fat Equalization: SAFE Liposuction Concepts for Comprehensive Body Contouring

No abstract available

http://ift.tt/2utw038

Evidence-Based Medicine: Mandible Fractures

Learning Objectives: After reading this article, the participant should be able to: 1. Explain the epidemiology of mandible fractures. 2. Discuss preoperative evaluation of the patient with a mandible fracture. 3. Compare the various modalities of fracture fixation. 4. Identify common complications after fracture repair. Summary: In this Maintenance of Certification/Continuing Medical Education article, the reader is provided with a review of the epidemiology, preoperative evaluation, perioperative management, and surgical outcomes of mandible fractures. The objective of this series is to present a review of the literature so that the practicing physician can remain up-to-date on key evidence-based guidelines to enhance management and improve outcomes. The physician can also seek further in-depth study of the topic through the references provided.

http://ift.tt/2utrOQZ

Discussion: Vertical Midface Lifting with Periorbital Anchoring in the Management of Lower Eyelid Retraction: A 10-Year Clinical Retrospective Study

No abstract available

http://ift.tt/2srTVi5

Evidence-Based Medicine: Alloplastic Breast Reconstruction

Learning Objectives: After studying this article, the participant should be able to: 1. Understand the different advances that have resulted in improved outcomes in implant-based reconstruction. 2. Gain knowledge about specific techniques that have evolved rapidly in recent years and how to implement these. 3. Gain an understanding of controversies associated with alloplastic reconstruction. 4. Recognize undesirable outcomes in implant-based breast reconstruction and understand strategies for correction. Summary: There have been multiple advances in implant-based breast reconstruction. Many of these have resulted in improvements in patient outcomes and care. Understanding new techniques and technologies ensures competence in providing care for the alloplastic breast reconstruction patient. This article was prepared to accompany practice-based assessment with ongoing surgical education for the Maintenance of Certification for the American Board of Plastic Surgery. It is structured to outline the care of the patient with the postmastectomy breast deformity.

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Medial Row Perforators Are Associated with Higher Rates of Fat Necrosis in Bilateral DIEP Flap Breast Reconstruction

Background: The purpose of this study was to evaluate perfusion-related complications in bilateral deep inferior epigastric perforator (DIEP) flap breast reconstruction based on perforator selection. Methods: A retrospective review of a prospectively maintained database was performed on all patients undergoing bilateral DIEP flap reconstruction at a single institution between 2004 and 2014. The hemiflaps were separated into three cohorts based on perforator location: lateral row only, medial row only, and medial plus lateral rows. Postoperative flap-related complications were compared and analyzed. Results: There were 728 total hemiflaps: 263 (36.1 percent) based on the lateral row, 225 (30.9 percent) based on the medial row, and 240 (33.0 percent) based on both the medial and lateral rows. The groups were well matched by perforator number and flap weight. Fat necrosis occurrence was significantly higher in flaps based solely on the medial row versus lateral row perforators (24.5 percent versus 8.2 percent; p

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Cohort Study to Assess the Impact of Breast Implants on Breastfeeding

No abstract available

http://ift.tt/2utvZMC

Predictors, Classification, and Management of Umbilical Complications in DIEP Flap Breast Reconstruction

Background: In recent years, the deep inferior epigastric perforator (DIEP) flap has become the workhorse flap for autologous breast reconstruction. Despite increased reports on DIEP flaps, umbilical complications have not been previously studied. The aesthetics of the umbilicus dictates the beauty of the abdomen, and it is critical for plastic surgeons to minimize the scarring of the umbilicus. In this study, we retrospectively reviewed patients who underwent DIEP flaps to determine the predictors of umbilical complications, and created a classification system of these wounds. Methods: Retrospective review of 323 patients who underwent DIEP flap surgery from 2009 to 2016 was performed. Umbilical stalk heights, widths of fascial diastasis, and abdominal wall thicknesses were measured from computed tomographic scans. Data regarding demographic and patient characteristics were collected. Results: Of the 323 patients, there were 58 patients that had umbilical complications (18 percent). These patients had statistically higher body mass indexes, heavier flaps, and thicker abdominal walls (p

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Two-Stage Implant-Based Breast Reconstruction: An Evolution of the Conceptual and Technical Approach over a Two-Decade Period

No abstract available

http://ift.tt/2utzGlI

Tumor-to-Nipple Distance as a Predictor of Nipple Involvement: Expanding the Inclusion Criteria for Nipple-Sparing Mastectomy

Background: A tumor-to-nipple distance of greater than 2 cm has traditionally been considered a criterion for nipple-sparing mastectomy. This study evaluates whether magnetic resonance imaging and sonographic measurements of tumor-to-nipple distance accurately reflect the risk of nipple involvement by disease. Methods: All nipple-sparing mastectomy cases with implant-based reconstruction performed by the senior author between July 2006 and December 2014 were retrospectively reviewed. Therapeutic cases with preoperative magnetic resonance imaging or sonography were included. Results: One hundred ninety-five cases were included. Preoperative imaging consisted of sonography (n = 169), magnetic resonance imaging (n = 152), or both (n = 126). With sonography, nipple involvement did not differ between nipple-sparing mastectomy candidates and noncandidates using a tumor-to-nipple distance cutoff of 2 cm (10.7 percent versus 10.6 percent; p = 0.988) or 1 cm (9.3 percent versus 15.0 percent; p = 0.307). With magnetic resonance imaging, nipple involvement did not differ between candidates and noncandidates using a cutoff of 2 cm (11.6 percent versus 12.5 percent; p = 0.881) or 1 cm (11.4 percent versus 13.8 percent; p = 0.718). When sonography and magnetic resonance imaging findings were both available and concordant, nipple involvement still did not differ between candidates and noncandidates using a cutoff of 2 cm (8.8 percent versus 11.8 percent; p = 0.711) or 1 cm (7.6 percent versus 14.3 percent; p = 0.535). Conclusion: A tumor-to-nipple distance as small as 1 cm, as measured by sonography or magnetic resonance imaging, should not be considered a contraindication to nipple-sparing mastectomy. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

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ASPS/PSF Sponsored Symposia and Workshops

No abstract available

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A Novel Noncontact Diffuse Correlation Spectroscopy Device for Assessing Blood Flow in Mastectomy Skin Flaps: A Prospective Study in Patients Undergoing Prosthesis-Based Reconstruction

Summary: A new advanced technology, noncontact diffuse correlation spectroscopy, has been recently developed for the measurement of tissue blood flow through analyzing the motions of red blood cells in deep tissues. This technology is portable, inexpensive, and noninvasive, and can measure up to 1.5-cm tissue depth. In this prospective study, the authors aimed to explore the use of this novel device in the prediction of mastectomy skin flap necrosis. The noncontact diffuse correlation spectroscopy device was used to measure mastectomy skin flap flow in patients undergoing mastectomy and immediate implant-based breast reconstruction before and immediately after mastectomy, and after placement of the prosthesis. Patients were tracked for the development of complications, including skin necrosis and the need for further surgery. Nineteen patients were enrolled in the study. Four patients (21 percent) developed skin necrosis, one of which required additional surgery. The difference in relative blood flow levels immediately after mastectomy in patients with or without necrosis was statistically significant, with values of 0.27 ± 0.11 and 0.66 ± 0.22, respectively (p = 0.0005). Relative blood flow measurements immediately after mastectomy show a significant high accuracy in prediction of skin flap necrosis, with an area under the receiver operating characteristic curve of 0.95 (95 percent confidence interval, 0.81 to 1). The noncontact diffuse correlation spectroscopy device is a promising tool that provides objective information regarding mastectomy skin flap viability intraoperatively, allowing surgeons early identification of those compromised and ischemic flaps with the hope of potentially salvaging them. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, IV.

http://ift.tt/2ss37mr

Evidence-Based Medicine: Management of Metacarpal Fractures

Learning Objectives: After reading this article, the participant should be able to: 1. Understand metacarpal anatomy and its role in fracture pathology. 2. Determine when surgical intervention is needed for metacarpal fractures. 3. Understand the various treatment options for surgical fixation of metacarpal fractures. 4. Describe the role for external fixation in managing difficult metacarpal fractures. Background: Metacarpal fractures are common injuries that plastic surgeons should be able to evaluate and treat. The goal of this review is to highlight current evidence for managing metacarpal fractures. This Continuing Medical Education article consists of a literature review, illustrations, videos, and an online Continuing Medical Education examination. Methods: The authors reviewed the scientific literature from 2000 to 2015 regarding treatment of metacarpal fractures. Cadaver models were used for instructional videography demonstrating common surgical techniques. Multiple-choice questions were created to review pertinent topics. A discussion and references are provided. Results: Numerous treatment options have been described for metacarpal fractures, including splinting, percutaneous fixation, open reduction with internal fixation, and external fixation. All modalities are acceptable strategies for treating metacarpal fractures. The ultimate goal is to maximize hand function with minimal morbidity. Conclusions: A thorough understanding of treatment modalities is helpful in evaluating and managing metacarpal fractures. Although the current literature supports a wide array of treatment strategies, high-level evidence to guide fracture management remains lacking.

http://ift.tt/2tvB8GJ

Vertical Midface Lifting with Periorbital Anchoring in the Management of Lower Eyelid Retraction: A 10-Year Clinical Retrospective Study

Background: Lower eyelid retraction can be the unfortunate result of aesthetic surgery, trauma, disease, or the aging processes. The purpose of this article is to assess whether midface lifting based on purely vertical repositioning constitutes an effective procedure for its correction. Methods: A retrospective study was carried out on 199 patients (311 eyelids) operated on between January of 2004 and January of 2014. The various causes of eyelid retraction in this population included cosmetic blepharoplasty (56.8 percent), involutional ectropion (23.1 percent), tumor resection (9.5 percent), facial nerve paralysis (8.5 percent), and trauma and related surgery (2 percent). The study was restricted exclusively to cases of moderate and severe lower eyelid retraction addressed by means of midface lifting. The mean follow-up time was 16.8 months. All of the patients were subjected to midface lifting with strengthening of the lateral canthus. A spacer graft was also used in 37.7 percent of the cases. Results: One hundred ninety-five patients (97.9 percent) displayed objective improvement of the eyelid retraction and a marked degree of improvement both in aesthetic terms and as regards the functional disorders reported. Only four patients (2 percent) presented complications such as needing another operation. Conclusion: Midface lifting based on purely vertical repositioning makes it possible to recruit a considerable amount of "new" skin at the lower eyelid, thus ensuring a decrease in vertical distraction and correct recovery of the height of the external lamellar plane. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

http://ift.tt/2srWP6z

Reconstructive Plastic Surgery of the Head and Neck: Current Techniques and Flap Atlas

No abstract available

http://ift.tt/2tvEJEI

Botulinum Toxin for Neck Rejuvenation: Assessing Efficacy and Redefining Patient Selection

Background: The "Nefertiti lift" consists of injecting the platysmal bands and the inferior border of the mandible with botulinum toxin. No clinical trial has evaluated its effect on the different lower face and neck aging components, and little is known about the clinical characteristics that predict treatment success. Methods: Patients were injected with abobotulinumtoxinA along the inferior border of the mandible and into the platysmal bands. Using standardized preinjection and postinjection photographs, the jowls, marionette lines, oral commissures, neck volume, and platysmal bands at maximal contraction and at rest were assessed with validated photonumeric scales. In addition, the overall appearance of the lower face and neck was evaluated by the Investigators and Subjects Global Aesthetic Improvement Score. Pain and patient satisfaction rates were also evaluated. Results: Thirty patients were injected with a mean dose of 124.9 U of abobotulinumtoxinA per patient. Platysmal bands at rest and with maximal tension reached a statistically significant improvement. The other components showed a tendency for improvement but did not reach statistical significance; 93.3 percent of investigators and patients rated the overall results as improved, and 96.6 percent of patients were satisfied with their results. When comparing the patients who improved the most to all the other patients, they had lower preinjection region-specific scores. Conclusions: The Nefertiti lift can be used on its own or in conjunction with other rejuvenating procedures. It is particularly helpful in younger patients with platysma muscle hyperactivity and retained skin elasticity. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

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Reply: Effects of Negative-Pressure Wound Therapy on Primary Closed Defects after Superficial Circumflex Iliac Artery Perforator Flap Harvest: Randomized Controlled Study

No abstract available

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Discussion: Botulinum Toxin for Neck Rejuvenation: Assessing Efficacy and Redefining Patient Selection

No abstract available

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Discussion: The Efficacy of Perforator Flaps in the Treatment of Chronic Osteomyelitis

No abstract available

http://ift.tt/2utsV2W

Assessment of the Efficacy of Cryolipolysis on Saddlebags: A Prospective Study of 53 Patients

Background: Cryolipolysis is a noninvasive subcutaneous fat removal technique. Its efficacy has been demonstrated on various fatty areas but not yet on saddlebags. The main objective of this study was to demonstrate the efficacy, patient tolerance, and safety of cryolipolysis on the saddlebags. Methods: This prospective study enrolled 53 patients with saddlebags. Patients with a history of liposuction or other surgical procedure on the saddlebag area and those on diet pills were excluded. The primary endpoint was a decrease in fat thickness at 3 and 6 months, as assessed by thigh circumference measurement and by ultrasound evaluation of subcutaneous fat. Pain associated with cryolipolysis was assessed using a visual analogue scale. Body mass index at the different time points and adverse events were recorded. All patients completed a satisfaction questionnaire at the end of the study. Results: At 6 months, there was a mean decrease of 5.63 cm in thigh circumference; the mean decrease in fat layer thickness measured by ultrasound was 1.31 cm. The satisfaction questionnaire showed that 93.75 percent of patients were satisfied with the results. The mean visual analogue scale score was 1.66 of 10 after the session. Reversible skin changes such as postprocedure postinflammatory hyperpigmentation were observed in 8.33 percent of patients. Conclusions: Cryolipolysis is an effective technique for reducing saddlebag fat and is well tolerated by patients. A substantial risk of skin lesions, including postinflammatory hyperpigmentation that resolved after a few months, was observed. Cryolipolysis is a good alternative to liposuction in women with moderate, well-localized saddlebags. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

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Evidence-Based Medicine: Current Evidence in the Diagnosis and Management of Carpal Tunnel Syndrome

Learning Objectives: After studying this article, the participant should be able to: 1. Create a safe and effective plan for management of carpal tunnel syndrome. 2. Support his or her rationale for the use of diagnostic tests. 3. Discuss elements of management that have been controversial, including anesthesia, the use of a tourniquet, postoperative pain control, and cost of care. Summary: This is the fourth MOC-PS CME article on carpal tunnel syndrome. Each of the prior three has had a slightly different focus, and the reader is invited to review all to generate a comprehensive view of the management of this common, and often controversial, topic. The operative goal—to release the transverse carpal ligament—is straightforward: diagnosis, cause, and technique have generated more vibrant discussions.

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Allergic contact dermatitis in preservatives: current standing and future options

Purpose of review: Preservatives are well known skin sensitizers and represent one of the main causes of contact allergy. The purpose of this article is to review the current state of contact sensitization induced by preservatives and point future alternatives for products' preservation. Recent findings: Isothiazolinones currently are the most common preservatives responsible of contact allergy in Europe and in the United States, and although some regulatory interventions have been taken place, the current contact allergy outbreak is not yet under control. Despite the ban of methyldibromo glutaronitrile from cosmetics in Europe, sensitized patients are still diagnosed, suggesting other nonregulated sources of exposure. Sensitization rates to formaldehyde and formaldehyde-releasers are lower in Europe in comparison with the United States due to stricter regulations regarding their use. Prevalence of contact allergy to parabens has remained stable over the last decades, whereas iodopropynyl butylcarbamate is an emerging allergen with an increasing prevalence. Future alternatives for products' preservation look for a broad antimicrobial spectrum, but with a better safety profile (in terms of sensitization) than the currently available compounds. Summary: Given the high rates of sensitization reported over the last years, timely regulatory actions are urgently required for some preservatives that currently represent a concern for public health.

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Reactions to cytostatic agents in children

Purpose of review: The current review will focus on drug hypersensitivity reactions to chemotherapy specifically to those drugs most used in children. We know that potentially all chemotherapeutic agents can cause infusion reactions, generally defined as adverse drug reactions. Of these, some are Type A, defined as expected and described in the characteristics of the drug and others, and Type B, defined as unexpected reactions which cannot be explained by the known toxicity profile of the drug. When an unexpected reaction occurs, drugs we can refer as hypersensitivity reactions (HSRs). Some of these (HSRs) are allergic reactions as they have an underlying immunologic mechanism. In general, the cytotoxic agents most commonly associated with HSRs are the platinum salts derivatives, taxanes, pegylated liposomal doxorubicin, L-asparaginase, procarbazine, etoposide, bleomycin, and cytarabin. Recent findings: HSRs may also occur in children with cancer, during the treatment with chemotherapeutic drugs. The most used drugs of this group in children to cause HSRs are: carboplatin, L-asparaginase, and methothrexate. The aim of this review is to summarize the incidence and the clinical features of HSRs occurring with these drugs in children. Summary: The aim of this review is to summarize the incidence and the clinical features of HSRs occurring with these drugs in children. The current review will focus on the most involved drugs in children, the type of reactions, the mechanisms involved, and the best way to manage them.

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Seasonal Allergic Rhinitis: A focused systematic review and practice parameter update

Purpose of review: The review compares and contrasts seven major United States and international allergic rhinitis guidelines from 2008 to 2017. Recent findings: Despite many treatment options for allergic rhinitis, patients often report lack of therapeutic control and a reduced quality of life. Guidelines intended to improve allergic rhinitis care have been evolving into evidence based, systematic reviews, with less reliance on consensus of expert opinion characteristic of more traditional guidelines. The first Grading of Recommendations Assessment, Development, and Evaluation-based guideline developed in the United States for seasonal allergic rhinitis was first published in 2017. Summary: When critically analyzing the allergic rhinitis guidelines that use the rigorous Grading of Recommendations Assessment, Development, and Evaluation methodology, different groups of expert authors, using the same reference articles, will, at times, reach different conclusions regarding the quality of the evidence and the strength of the recommendation. Factors potentially contributing to these divergent determinations include: lack of objective primary outcome measures in allergic rhinitis, poorly defined Minimal Clinically Important Difference, failure to include all interested parties in guideline development, for example, patients, and subjectivity inherent in the expert panel.

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Editorial introductions

No abstract available

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Molecular aspects of allergens in atopic dermatitis

Purpose of review: Molecular allergology uses pure, mainly recombinant and structurally defined allergen molecules and allergen-derived epitopes to study mechanisms of IgE-associated allergy, to diagnose, and even predict the development of allergic manifestations and to treat and prevent IgE-associated allergies. Atopic dermatitis, a chronic inflammatory skin disease is almost always associated with IgE sensitization to allergens. However, also non-IgE-mediated pathomechanisms seem to be operative in atopic dermatitis and it is often difficult to identify the disease-causing allergens. Here we review recent work showing the usefulness of molecular allergology to study mechanisms of atopic dermatitis, for diagnosis and eventually for treatment and prevention of atopic dermatitis. Recent findings: IgE sensitization to airborne, food-derived, microbial allergens, and autoallergens has been found to be associated with atopic dermatitis. Using defined allergen molecules and non-IgE-reactive allergen derivatives, evidence could be provided for the existence of IgE- and non-IgE-mediated mechanisms of inflammation in atopic dermatitis. Furthermore, effects of epicutaneous allergen administration on systemic allergen-specific immune responses have been studied. Multi-allergen tests containing micro-arrayed allergen molecules have been shown to be useful for the identification of culprit allergens in atopic dermatitis and may improve the management of atopic dermatitis by allergen-specific immunotherapy, allergen avoidance, and IgE-targeting therapies in a personalized medicine approach. Summary: Molecular allergology allows for dissection of the pathomechanisms of atopic dermatitis, provides new forms of allergy diagnosis for identification of disease-causing allergens, and opens the door to new forms of management by allergen-specific and T cells-targeting or IgE-targeting interventions in a personalized medicine approach.

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Drug allergy/hypersensitivity in adults and children

No abstract available

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Allergen immunotherapy for the treatment of respiratory allergies in the elderly

Purpose of review: Respiratory allergies, including asthma and allergic rhinitis can also occur in the elderly. Allergen immunotherapy for allergic diseases is the only disease-modifying treatment for patients with allergies available thus far. Here, we review current evidence supporting the use of allergen immunotherapy in the elderly and discuss its efficacy and utility for the treatment of respiratory allergic diseases in this setting. Recent findings: Subcutaneous and/or sublingual immunotherapy are effective therapeutic options in not only young but also older patients. Allergen immunotherapy reduces medication and symptom scores in the elderly and can thus be safely prescribed in this population. Summary: Elderly individuals with proven, clinically relevant immunoglobulin E sensitization to inhalant allergens may benefit from allergen immunotherapy for respiratory allergic diseases. Older patients without contraindications should therefore be considered for treatment, with the additional benefit of reduced medication and symptom scores.

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Hypersensitivity reactions to gadolinium-based contrast agents

Purpose of review: Gadolinium-based contrast agents (GBCAs) have been utilized since the late 1980s to enhance the diagnostic value of MRI studies. They are known to have excellent safety profile and serious adverse reactions are uncommon despite widespread global use. However, immediate hypersensitivity reactions are well described in the literature, with urticaria the most common manifestation. Anaphylaxis can occur, though fatality is extremely rare. This review explores the incidence of GBCA-related hypersensitivity reactions and highlights potential risk factors. Recent findings: Emerging evidence suggests that immediate hypersensitivity reactions to GBCAs can be IgE-mediated. Skin testing may be informative in confirmation of causality and revealing cross-reactivity patterns. Summary: GBCA hypersensitivity is infrequent but can be serious. Familiarity with management of acute hypersensitivity reactions may be lifesaving. Appropriate use of diagnostic testing can be used to guide future management of patients who have suffered from such reactions.

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Aspirin challenge and desensitization: how, when and why

Purpose of review: To investigate the current approach to aspirin challenge (drug provocation) and/or desensitization in patients with histories of hypersensitivity reactions to it, particularly in those with cardiovascular diseases. Recent findings: The literature indicates that patients with coronary artery disease (CAD), including those with an acute coronary syndrome, may safely undergo low-dose aspirin challenge and/or desensitization. Recently, flowcharts regarding challenge/desensitization procedures with aspirin in patients with CAD and histories of aspirin hypersensitivity reactions have become available. Aspirin desensitization and continuous aspirin therapy constitute an effective option in patients with nonsteroidal anti-inflammatory drug-exacerbated respiratory diseases (NERD) who have suboptimally controlled asthma or rhinosinusitis, or require multiple revision polypectomies. Summary: The use of aspirin has proven to reduce morbidity and mortality associated with CAD. There is a general consensus on aspirin's effectiveness in secondary prevention of CAD. Therefore, aspirin desensitization is necessary in patients with CAD and histories of hypersensitivity reactions to it. The effectiveness of aspirin desensitization and continuous therapy in patients with NERD has been shown in numerous studies. However, shared selection criteria of candidates for aspirin challenge/desensitization procedures, and simple and homogeneous protocols are necessary. Moreover, preventive safety measures are still needed in order to reduce the potential risks of these procedures.

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Alternative treatments for chronic spontaneous urticaria beyond the guideline algorithm

Purpose of review: The international EAACI/GA2LEN/EDF/WAO guideline suggests a stepwise approach for the therapeutic management of chronic spontaneous urticaria (CSU), outlined in an algorithm. The aim of this article is to summarize and review the evidence available on alternative treatment options for CSU outside of this algorithm. Recent findings: Although CSU is a common disease, there are a limited number of high-quality studies, and only antihistamines and omalizumab are licensed for its treatment. Most studies regarding alternative therapies for CSU show methodological limitations and a high risk of bias. For many therapies, only case reports and uncontrolled studies exist. Recent publications on alternative treatments for chronic urticaria/CSU include reports on the use of adalimumab, rituximab, vitamin D, probiotics, histaglobulin, injection of autologous whole blood or serum, and phototherapy. Summary: Numerous treatments beyond the guideline algorithm have been evaluated in patients with refractory CSU. The global level of evidence to support their efficacy in CSU is low or very low. Further research is needed to assess the efficacy and safety of alternative therapies of CSU to manage adequately those patients who do not respond to the treatments included in the algorithm.

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Skin allergy

No abstract available

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Pharmacotherapy of mast cell disorders

Purpose of review: Mast cell disorders (MCDs) comprise mastocytosis and disorders referred to as mast cell activation syndrome and are caused by abnormal accumulation and/or activation of mast cells in tissues. Clinical signs and symptoms are protean; therefore, finding suitable treatment options for individual patients entails a challenge for clinicians. The purpose of this manuscript is to review the literature on the available therapeutic interventions in patients with MCD. Recent findings: Pharmacotherapy is mainly directed against the effects of mast cells and their mediators. The current recommendations are exclusively based on expert opinions due to the lack of controlled clinical trials. The targeted therapies aiming at blocking mutant KIT variants and/or downstream signaling pathways are currently being developed and may be considered in severely affected, therapy-refractory patients. Summary: There is currently no method for predicting the best available approach to control symptoms in individual patients with MCD. Therefore, a stepwise, individual-based approach in pharmacotherapy options appears to be most successful strategy and is recommended in all patients. The core component of the treatment in most patients is to control symptoms caused by mast cell mediator release, whereas cytoreductive therapies are mainly reserved for patients with advanced/aggressive systemic mastocytosis.

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Atopic dermatitis phenotypes and the need for personalized medicine

Purpose of review: To describe recent developments in therapies which target the molecular mechanisms in atopic dermatitis. Recent findings: Current advances in the understanding of the molecular basis of atopic dermatitis are leading to the stratification of different atopic dermatitis phenotypes. New therapies offer the option to target-specific molecules involved in the pathophysiology of atopic dermatitis. Current new therapies under investigation aim to modulate specific inflammatory pathways associated with distinctive atopic dermatitis phenotypes, which would potentially translate into the development of personalized, targeted-specific treatments of atopic dermatitis. Summary: Despite the unmet need for well tolerated, effective, and personalized treatment of atopic dermatitis, the current standard treatments of atopic dermatitis do not focus on the individual pathogenesis of the disease. The development of targeted, phenotype-specific therapies has the potential to open a new promising era of individualized treatment of atopic dermatitis.

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Phonemdiskrimination und Lese-Rechtschreibleistung unter logopädischer Therapie

Sprache Stimme Gehör
DOI: 10.1055/s-0042-114842

Hintergrund Die Effekte von logopädischen Therapien zu auditiven Verarbeitungsstörungen (AVS) und Lese-Rechtschreibstörung (LRS) sind umstritten. Es wurde untersucht, wie sich die Phonemdiskrimination und die Lese-Rechtschreibleistung unter Sprachtherapie und Training der auditiven Diskrimination mit Graphembezug verbesserte. Methodik Von 124 Kindern (MW 8,6 Jahre) wurden Testwerte zur Phonemdiskrimination (HLAD), Rechtschreibung (DRT/HSP) und zum Lesen (ELFE) über ein lineares Regressionsmodell berechnet. Als Einflussfaktoren wurden vorangegangene Sprachentwicklungsstörungen, auditives Kurzzeitgedächtnis (ZFG), IQ, Konzentrationsauffälligkeit, familiäre Prädisposition und das Geschlecht aufgenommen. Ergebnisse Die Kinder, die zu Beginn in den standardisierten Tests unter Prozentrang ≤ 25 lagen, verbesserten ihre Leistungen signifikant. Dennoch blieb der mittlere Prozentrang nach mindestens 40 Therapieeinheiten weiterhin im pädagogisch auffälligen Bereich (PR ≤ 25). Das Geschlecht und ZFG hatten einen signifikanten Einfluss. Diskussion Die Ergebnisse zeigen einerseits, dass eine signifikante Verbesserung nach mindestens 40 Therapieeinheiten nachweisbar ist, machen aber auch die Grenzen der Veränderbarkeit deutlich: Über das untere Leistungsviertel kommen die Kinder nicht hinaus. Dies hat entscheidende Folgen für die Beratung der Eltern, Kinder und Therapeuten.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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

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Cholesteatoma as a complication of Langerhans Cell Histiocytosis of the temporal bone: A nationwide cross-sectional analysis

Publication date: September 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 100
Author(s): Jonathan C. Simmonds, Mark Vecchiotti
ObjectiveTo determine if patients with Langerhans Cell Histiocytosis (LCH) of the temporal bone have a higher risk of developing cholesteatoma.MethodsReview of literature and cross-sectional weighted analysis of patients under 19 with a diagnosis of LCH from the National Inpatient Sample (NIS) and Kids' Inpatient Database (KID) from 2000 to 2013. ICD-9 codes and demographics were analyzed; pairwise comparisons and multivariate analyses were performed.ResultsOnly seven cases of cholesteatoma after the treatment for LCH of the temporal bone have been documented in the literature. No significant association between cholesteatoma and LCH was seen (OR 0.747 [0.149–3.751]). Patients with LCH did have a higher incidence of chronic otitis media, chronic otitis externa, chronic sinusitis, hearing loss, and otitis media with effusion.ConclusionOur results show that patients with Langerhans Cell Histiocytosis do not appear to have a higher risk of developing cholesteatoma. However they are more likely to be diagnosed with chronic otitis externa which should be differentiated from cholesteatoma or recurrence of LCH.



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Pediatric head and neck bone sarcomas: An analysis of 204 cases

Publication date: September 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 100
Author(s): Jacob S. Brady, Sei Y. Chung, Emily Marchiano, Jean Anderson Eloy, Soly Baredes, Richard Chan Woo Park
ObjectivesTo analyze the demographics, survival, and treatment efficacy of pediatric sarcomas of the facial skeleton and skull.MethodsRetrospective study of cases from the US National Cancer Institute's Surveillance, Epidemiology, and End Results database. Pediatric patients between the ages of 0 and 18 diagnosed with a malignant sarcoma of either the mandible or the bones of skull, face, and associated joints from 1973 to 2013 were studied.ResultsIn total, 204 patients were included in the analysis. The average age at diagnosis was 11.39 (±5.15) years with a male-to-female ratio of 1.4:1. Whites were the most commonly affected race (76.0%). Malignant mandible sarcomas accounted for 29.9% of the cohort (n = 61). The most common pathology was osteosarcoma, which accounted for 43.6% of the cohort (n = 89). Among patients with known histologic grade (n = 95), 26.0% were AJCC stage III or IV. Overall, 5-year disease-specific survival (DSS) was 80.6%. When stratified by treatment modality, 5-year DSS was 86.0% for surgery alone, 67.9% for radiation alone, and 75.3% for surgery with adjuvant radiotherapy (p = 0.041).ConclusionsOsteosarcoma, Ewing's sarcoma, and chondrosarcoma are the most common subtypes of pediatric head and neck bone sarcoma. Such sarcomas more commonly affect whites and males during pubertal ages. Disease-specific survival is not affected by primary site. Surgery alone is the mainstay of treatment, and demonstrates higher 5-year disease-specific survival compared to radiotherapy alone. Adjuvant radiotherapy does not seem to increase survival, but further investigation is warranted.



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Pathophysiology of esophageal impairment due to button battery ingestion

Publication date: September 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 100
Author(s): Johannes Völker, Christine Völker, Philipp Schendzielorz, Sebastian P. Schraven, Andreas Radeloff, Robert Mlynski, Rudolf Hagen, Kristen Rak
BackgroundThe increased use of button batteries with high energy densities in devices of daily life presents a high risk of injury, especially for toddlers and young children. If an accidental ingestion of a button battery occurs, this foreign body can become caught in the constrictions of the esophagus and cause serious damage to the adjacent tissue layers. The consequences can be ulcerations, perforations with fistula formation and damage to the surrounding anatomical structures. In order to gain a better understanding of the pathophysiology after ingestion, we carried out systematic studies on fresh preparations of porcine esophagi.MethodsThe lithium button battery type CR2032, used most frequently in daily life, was exposed in preparations of porcine esophagi and incubated under the addition of artificial saliva at 37 °C. A total of eight esophagi were analysed by different methods. Measurements of the pH value around the battery electrodes and histological studies of the tissue damage were carried out after 0.5–24 h exposure time. In addition, macroscopic time-lapse images were recorded. Measurements of the battery voltage and the course of the electric current supplemented the experiments.FindingsThe investigations showed that the batteries caused an electrolysis reaction in the moist environment. The positive electrode formed an acidic and the negative electrode a basic medium. Consequently, a coagulation necrosis at the positive pole, and a deep colliquation necrosis at the minus pole occurred. After an exposure time of 12 h, tissue damage caused by the lye corrosion was observed on the side of the negative electrode up to the lamina muscularis. The corrosion progressed up to the final exposure time of 24 h, but the batteries still had sufficient residual voltage, such that further advancing damage would be expected.ConclusionsButton battery ingestion in humans poses an acute life-threatening danger and immediate endoscopic removal of the foreign body is essential. After only 2 h exposure time, significant damage to the tissue could be detected, which progressed continuously to complete esophageal perforation. The primary prevention of battery ingestion is therefore of particular importance.



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Paediatric injection medialisation laryngoplasty: Recent Great Ormond Street Hospital experience

Publication date: September 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 100
Author(s): K.A. Stephenson, L. Cavalli, A. Lambert, J. Fleming, E. Lawes, S. Gupta, C.G. Jephson, L.A. Cochrane
IntroductionUnilateral vocal fold paresis may significantly impair the vocal quality and laryngeal competence of a child. Relatively little literature relates to injection medialisation laryngoplasty (IML) in children and previous reports have involved small numbers of heterogenous cases.MethodsA retrospective review was conducted of paediatric patients managed by our multidisciplinary specialist voice clinic undergoing IML for unilateral vocal fold paresis. Cases of bilateral paresis, those characterised by vocal fold fixation, and patients without formal pre and post-operative voice evaluation were excluded.ResultsEighteen IML procedures were performed in 12 children eligible for inclusion between 2005 and 2015. The average age at time of procedure was 12 years (range 9–15 years). Autologous fat was used in 5 procedures, succeeded by calcium hydroxylapatite (Radiesse^® Voice) from 2011 (n = 13). A significant improvement in median GRBAS score components was observed after calcium hydroxylapatite injection in terms of grade (p = 0.008), breathiness (p = 0.002) and aesthenia (p = 0.016). A pre- and post-procedural Voice Handicap Index was self-completed by 6 patients receiving calcium hydroxylapatite injection; the median change in score was an improvement of 19 points (interquartile range 36.5).ConclusionWe describe the outcomes of a comparatively large paediatric series and have found IML using calcium hydroxylapatite to be a reliable technique associated with improved subjective outcome measures. Management of UVCP in the child is a challenge with particular investigative and interventional considerations. Further study supported by high quality subjective and, where possible, objective outcome measures, is required to better inform patient selection, timing of intervention and choice of injection material.



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Disparities in access to pediatric hearing health care.

Purpose of review: There are significant disparities in care facing children with hearing loss. The objective of this review is to assess the current disparities in pediatric hearing healthcare delivery, describe the barriers of efficient and effective pediatric hearing health care, and explore the innovations to improve pediatric hearing healthcare delivery. Recent findings: Children with hearing loss from certain geographic regions or ethnic background are significantly delayed in diagnosis and treatment. Multiple patient characteristics (presentation of hearing loss), parental factors (insurance status, socioeconomic status, educational status, and travel distance to providers), and provider barriers (specialist shortage and primary care provider challenges) prevent the delivery of timely hearing health care. Advances, such as improved screening programs and the expansion of care through remote services, may help to ameliorate these disparities. Summary: Timely identification and treatment of pediatric hearing loss is critical to prevent lifelong language complications. Children from vulnerable populations, such as rural residents, face significant disparities in care. Careful assessment of these barriers and implementation of culturally acceptable interventions are paramount to maximize communication outcomes of children with hearing loss. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Cholesteatoma as a complication of Langerhans Cell Histiocytosis of the temporal bone: A nationwide cross-sectional analysis

Publication date: September 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 100
Author(s): Jonathan C. Simmonds, Mark Vecchiotti
ObjectiveTo determine if patients with Langerhans Cell Histiocytosis (LCH) of the temporal bone have a higher risk of developing cholesteatoma.MethodsReview of literature and cross-sectional weighted analysis of patients under 19 with a diagnosis of LCH from the National Inpatient Sample (NIS) and Kids' Inpatient Database (KID) from 2000 to 2013. ICD-9 codes and demographics were analyzed; pairwise comparisons and multivariate analyses were performed.ResultsOnly seven cases of cholesteatoma after the treatment for LCH of the temporal bone have been documented in the literature. No significant association between cholesteatoma and LCH was seen (OR 0.747 [0.149–3.751]). Patients with LCH did have a higher incidence of chronic otitis media, chronic otitis externa, chronic sinusitis, hearing loss, and otitis media with effusion.ConclusionOur results show that patients with Langerhans Cell Histiocytosis do not appear to have a higher risk of developing cholesteatoma. However they are more likely to be diagnosed with chronic otitis externa which should be differentiated from cholesteatoma or recurrence of LCH.



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