Which methods may help reduce the likelihood of edema and ecchymosis after rhinoplasty?
Plastic and Reconstructive Surgery
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Τρίτη 31 Μαΐου 2016
Decreasing Postop Edema and Ecchymosis After Rhinoplasty
Office-Based Ultrasound-Guided FNA with Molecular Testing for Thyroid Nodules
Objective
Ultrasound-guided fine-needle aspiration (FNA) biopsy is the primary method of evaluating thyroid nodules. Up to one-third of FNA results are reported to be of "indeterminate" cytology, which carries a 25% malignancy risk. Most of these patients are referred for diagnostic surgery, which results in many unnecessary interventions. We implemented an FNA protocol combining expert thyroid cytopathology and molecular testing of indeterminate lesion in our community practice. This study is a report of the outcomes from this protocol as compared with historical data in the same setting over a similar period.
Study DesignCase series with planned data collections and retrospective chart reviews.
SettingA large community-based practice with multiple satellite offices.
Subjects and MethodsA total of 264 thyroid nodules (196 patients) were evaluated under the new protocol from January to December 2014, and data were collected in a prospective manner. Historical data for a similar period (2012), obtained by chart review, included 164 nodules (134 patients) biopsied in a hospital setting by a number of radiologists, with cytologic interpretations completed by community-based pathologists. Statistical analyses included 2 and Fischer's exact tests.
ResultsBased on the new protocol, the rate of indeterminate lesion diagnosis was reduced from 24% to 10% (P = .006) and the rate of diagnostic surgery from 24% to 6% (P < .001). Of the patients who underwent diagnostic surgery, 58% had evidence of malignancy, as compared with 12% in our previous experience (P = .04).
ConclusionExpert cytopathologic analysis combined with molecular testing of indeterminate FNA samples significantly reduced unnecessary operations.
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Cloning and Expression of L1 Protein Human Papillomavirus Type 31 Isolated from Iranian Patients in Escherichia coli
Monoclonal Antibodies in Immunodiagnosis and Immunotherapy , Vol. 0, No. 0.
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Clinical and molecular heterogeneity of head and neck spindle cell and sclerosing rhabdomyosarcoma
Spindle cell and sclerosing rhabdomyosarcoma (sRMS/scRMS) accounting for 5–10% of all RMS, were recently reclassified as a stand-alone pathologic entity in the latest WHO classification of soft tissue tumors [1]. Spindle cell RMS was first described by the German–Italian Cooperative Sarcoma Study on the basis of its distinct clinicopathologic features and favorable outcome, resulting in separation from the more common embryonal RMS (ERMS) [2]. Sclerosing RMS was first defined by Mentzel and Katenkamp as a 'sclerosing pseudovascular RMS in adults' [3].
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Lidocaine Tinnitus
In the United States, up to 35 percent of adults will experience an episode of tinnitus. Although most cases of tinnitus are temporary, chronic tinnitus can be incapacitating, making it difficult for you to function and hear the sounds that you want to hear. If you suffer from worsening volume of tinnitus, lidocaine tinnitus may be a solution for you.
Who Qualifies for Lidocaine Tinnitus?
Lidocaine is a way to treat chronic tinnitus that has been worsening over a period of 4 to 8 weeks or longer. Lidocaine would not be used to treat temporary tinnitus. About 8 percent of people have chronic tinnitus and would be under consideration for treatment with lidocaine. Your doctor may evaluate your symptoms and perform some tests such as an EKG to check for abnormal heart rhythms and a hearing exam to check for worsening hearing loss to make sure that you are healthy enough to receive lidocaine tinnitus.
How Lidocaine for Tinnitus Works
Lidocaine for tinnitus is administered intravenously. The medication is added to a saline solution in an intravenous solution bag and delivered to you through a vein. The medication takes 30 to 60 minutes to get into your body. Once the lidocaine is absorbed into your body, it works to numb the nerve endings in your auditory system. When the nerve endings are less stimulated, you will experience a lessening of the volume of your tinnitus. The lidocaine may also reduce hyperactivity of the nerves within your ears. Your normal sense of hearing will not be diminished due to the lidocaine. Some doctors will treat you with a single IV of lidocaine every couple of months to prevent your symptoms from worsening. Other doctors will give you IV lidocaine once per day for a few consecutive days to eliminate tinnitus symptoms.
Benefits of Lidocaine for Tinnitus
There are many benefits to using lidocaine for incapacitating tinnitus symptoms. Lidocaine is generally regarded as safe and has been widely used in dentistry and medicine to provide local anesthesia for minor procedures such as dental fillings or stitches. There is a minimal amount of pain when getting lidocaine for tinnitus. The only pain you are likely to experience is when the IV line is placed. The lidocaine treatment should last for several months, providing you with a long duration of relief from your tinnitus symptoms. Most people experience no side effects from lidocaine injections.
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Speech Perception in Classroom Acoustics by Children With Cochlear Implants and With Typical Hearing
Purpose
This study measured speech perception ability in children with cochlear implants and children with typical hearing when listening across ranges of reverberation times (RTs) and speech-to-noise ratios. Method
Participants listened in classroom RTs of 0.3, 0.6, and 0.9 s combined with a 21-dB range of speech-to-noise ratios. Subsets also listened in a low-reverberant audiological sound booth. Performance measures using the Bamford-Kowal-Bench Speech-in-Noise Test (Etymotic Research, Inc., 2005) were 50% correct word recognition across these acoustic conditions, with supplementary analyses of percent correct. Results
Reduction in RT from 0.9 to 0.6 s benefited both groups of children. A further reduction in RT to 0.3 s provided additional benefit to the children with cochlear implants, with no further benefit or harm to those with typical hearing. Scores in the sound booth were significantly higher for the participants with implants than in the classroom. Conclusions
These results support the acoustic standards of 0.6 s RT for children with typical hearing and 0.3 s RT for children with auditory issues in learning spaces (≤283 m3) as specified in standards S12.60-2010/Part 1 of the American National Standards Institute /Acoustical Society of America (2010). In addition, speech perception testing in a low-reverberant booth overestimated classroom listening ability in children with cochlear implants.from #ENT via xlomafota13 on Inoreader http://ift.tt/1P2vmxp
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Enucleation with or without adjuvant therapy versus marsupialization with or without secondary enucleation in the treatment of keratocystic odontogenic tumors: a systematic review and meta-analysis
The purpose of this study was to compare the recurrence rate (RR) of keratocystic odontogenic tumors (KOTs) in patients who underwent enucleation with or without adjuvant therapy, to patients who underwent decompression with or without residual cystectomy. An extensive search of major databases through PubMed, EMBASE, and Cochrane CENTRAL was conducted to identify all relevant articles published without date and language restrictions from inception to December 2015. Relevant articles were selected based on the following specific inclusion criteria.
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The bony cartilaginous unit: the missing graft in septorhinoplasty
To achieve the desired nasoseptal refinements in septorhinoplasty, sufficient septal cartilage is needed. There are many cases in which septal cartilage is insufficient, especially in revision surgery. To obtain an optimal outcome, a bony cartilaginous unit is proposed as a versatile graft for various parts of the nose. This bony cartilaginous unit is extracted using the open septorhinoplasty approach in which the bilateral septal flaps are elevated over the entire cartilaginous and bony part; however, the cartilaginous septum and posterior bony part are not separated and are removed as an integrated unit.
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Piezoelectric surgery and navigation: a safe approach for complex cases of Eagle syndrome
Eagle syndrome was first described by Eagle in 1937. It is associated with an elongated styloid process and/or calcification of the stylohyoid ligament, mainly resulting in pain in the orofacial region. The treatment of Eagle syndrome includes conservative treatment with physical therapy supported by medication, or surgical removal of the styloid process. Two different surgical approaches are described in the literature: the transoral and transcervical approaches. Both have their limitations and specific intraoperative risks.
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Can the American College of Surgeons NSQIP Surgical Risk Calculator identify patients at risk of complications following microsurgical breast reconstruction?
The American College of Surgeons National Surgery Quality Improvement Program (ACS NSQIP) Surgical Risk Calculator is an open access online tool that estimates the risk of adverse post-operative events for a wide range of surgical procedures. This study evaluates the predictive value of the ACS NSQIP calculator in patients undergoing microvascular breast reconstruction.
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Pedicled Lower Extremity Fillet Flap for Coverage of Massive Pelvic Wounds
Fillet flaps are traditionally harvested from nonsalvagable extremities to reconstruct complex soft tissue defects. This method results in minimal donor site morbidity, and can be effective in reconstructing large pelvic wounds requiring significant soft tissue coverage.Here, we present their application in three young patients with extensive pelvic wounds secondary to trauma and its sequelae. In each case, neurologic injury limited limb function, and fillet flaps were used to fill soft tissue defects and pad bony prominences.
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Cost-savings in outpatient versus inpatient reduction mammaplasty
Reduction mammaplasties are increasingly performed as outpatient procedures. Cost savings are assumed, but published data on the subject are scarce. Our aim was to retrospectively determine the possible cost savings achieved by performing reduction mammaplasties as outpatient procedures.
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Facial aesthetic outcome analysis in unilateral cleft lip and palate surgery using web-based extended panel assessment
The reproducible measurement of aesthetic outcomes after cleft lip and palate (CLP) surgery remains elusive and there is no internationally recognised system. The aim of this pilot study was to better understand how humans rate post-operative aesthetic outcome after UCLP repair using a novel web-based rating platform with an extended panel of surgeon-raters.
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Cortical functional correlates of responsiveness to short-lasting preventive intervention with ketogenic diet in migraine: a multimodal evoked potentials study
Here, we aim to identify cortical electrofunctional correlates of responsiveness to short-lasting preventiveintervention with ketogenic diet (KD) in migraine.
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Lipopolysaccharide-Induced CD300b Receptor Binding to Toll-like Receptor 4 Alters Signaling to Drive Cytokine Responses that Enhance Septic Shock
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Store-Operated Ca Entry in Follicular T Cells Controls Humoral Immune Responses and Autoimmunity
Germinal center reactions are tightly regulated by follicular helper (Tfh) and regulatory (Tfr) T cells. Feske and colleagues demonstrate that both Tfh and Tfr cells critically depend on store-operated calcium entry (SOCE) to prevent autoimmunity and promote anti-viral immune responses.
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The use of a modified abbé island flap to reconstruct primary lip defects of over 80 %
Abstract
Background
Lip reconstruction for defects greater than 80 % present a challenge in maintaining acceptable oral function and good aesthetic results. Abbé flaps offer an excellent reconstructive option but are limited to defects under 65 %.
Methods
We describe a two-stage "modified Abbé island flap" technique whereby a full-thickness myocutaneous flap is combined with a modified Karapandzic flap, allowing for reconstruction of total and near total lip defects.
Results
Six patients underwent successful two-stage lower and upper lip reconstruction with this technique. Oral competence and satisfactory aesthetic outcomes were achieved in all six cases. There were no complications. Although microstomia was noted to a certain extent, we argue this impact to be less than the morbidity of a free flap that lacks sphincteric function.
Conclusion
The "Modified Abbé Island Flap" can be used to reconstruct near-total lip defects using locally innervated, well-vascularized tissues that recreate the oral sphincter and restore oral competence. The combination of the conventional Abbé flap with a modified Karapandzic flap provides reliable results and significantly reduces operating time.
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Time-domain comparisons of power law attenuation in causal and noncausal time-fractional wave equations
The attenuation of ultrasound propagating in human tissue follows a power law with respect to frequency that is modeled by several different causal and noncausal fractional partial differential equations. To demonstrate some of the similarities and differences that are observed in three related time-fractional partial differential equations, time-domain Green's functions are calculated numerically for the power law wave equation, the Szabo wave equation, and for the Caputo wave equation. These Green's functions are evaluated for water with a power law exponent of y = 2, breast with a power law exponent of y = 1.5, and liver with a power law exponent of y = 1.139. Simulation results show that the noncausal features of the numerically calculated time-domain response are only evident very close to the source and that these causal and noncausal time-domain Green's functions converge to the same result away from the source. When noncausal time-domain Green's functions are convolved with a short pulse, no evidence of noncausal behavior remains in the time-domain, which suggests that these causal and noncausal time-fractional models are equally effective for these numerical calculations.
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Acoustic scattering from phononic crystals with complex geometry
This work introduces a formalism for computing external acoustic scattering from phononic crystals (PCs) with arbitrary exterior shape using a Bloch wave expansion technique coupled with the Helmholtz-Kirchhoff integral (HKI). Similar to a Kirchhoff approximation, a geometrically complex PC's surface is broken into a set of facets in which the scattering from each facet is calculated as if it was a semi-infinite plane interface in the short wavelength limit. When excited by incident radiation, these facets introduce wave modes into the interior of the PC. Incorporation of these modes in the HKI, summed over all facets, then determines the externally scattered acoustic field. In particular, for frequencies in a complete bandgap (the usual operating frequency regime of many PC-based devices and the requisite operating regime of the presented theory), no need exists to solve for internal reflections from oppositely facing edges and, thus, the total scattered field can be computed without the need to consider internal multiple scattering. Several numerical examples are provided to verify the presented approach. Both harmonic and transient results are considered for spherical and bean-shaped PCs, each containing over 100 000 inclusions. This facet formalism is validated by comparison to an existing self-consistent scattering technique.
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In-air hearing of a diving duck: A comparison of psychoacoustic and auditory brainstem response thresholds
Auditory sensitivity was measured in a species of diving duck that is not often kept in captivity, the lesser scaup. Behavioral (psychoacoustics) and electrophysiological [the auditory brainstem response (ABR)] methods were used to measure in-air auditory sensitivity, and the resulting audiograms were compared. Both approaches yielded audiograms with similar U-shapes and regions of greatest sensitivity (2000−3000 Hz). However, ABR thresholds were higher than psychoacoustic thresholds at all frequencies. This difference was least at the highest frequency tested using both methods (5700 Hz) and greatest at 1000 Hz, where the ABR threshold was 26.8 dB higher than the behavioral measure of threshold. This difference is commonly reported in studies involving many different species. These results highlight the usefulness of each method, depending on the testing conditions and availability of the animals.
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Paediatric Cochlear Implantation in Patients with Waardenburg Syndrome
Objective: To analyse the benefit of cochlear implantation in young deaf children with Waardenburg syndrome (WS) compared to a reference group of young deaf children without additional disabilities. Method: A retrospective study was conducted on children with WS who underwent cochlear implantation at the age of 2 years or younger. The post-operative results for speech perception (phonetically balanced standard Dutch consonant-vocal-consonant word lists) and language comprehension (the Reynell Developmental Language Scales, RDLS), expressed as a language quotient (LQ), were compared between the WS group and the reference group by using multiple linear regression analysis. Results: A total of 14 children were diagnosed with WS, and 6 of them had additional disabilities. The WS children were implanted at a mean age of 1.6 years and the 48 children of the reference group at a mean age of 1.3 years. The WS children had a mean phoneme score of 80% and a mean LQ of 0.74 at 3 years post-implantation, and these results were comparable to those of the reference group. Only the factor additional disabilities had a significant negative influence on auditory perception and language comprehension. Conclusions: Children with WS performed similarly to the reference group in the present study, and these outcomes are in line with the previous literature. Although good counselling about additional disabilities concomitant to the syndrome is relevant, cochlear implantation is a good rehabilitation method for children with WS.
Audiol Neurotol 2016;21:187-194
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Audiol Neurotol 2016;21:187-194
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Exploring Methods to Measure the Prevalence of Ménière's Disease in the US Clinformatics™ Database, 2010-2012
Recent studies on the epidemiology of the inner-ear disorder Ménière's disease (MD) use disparate methods for sample selection, case identification and length of observation. Prevalence estimates vary geographically from 17 to 513 cases per 100,000 people. We explored the impact of case detection strategies and observation periods in estimating the prevalence of MD in the USA, using data from a large insurance claims database. Using case detection strategies of ≥1, ≥2 and ≥3 ICD-9 claim codes for MD within a 1-year period, the 2012 prevalence estimates were 66, 27 and 14 cases per 100,000 people, respectively. For ≥1, ≥2 and ≥3 insurance claims within a 3-year observation period, the prevalence estimates were 200, 104 and 66 cases per 100,000 people, respectively. Estimates based on a single claim are likely to overestimate prevalence; this conclusion is aligned with the American Academy of Otolaryngology-Head and Neck Foundation criteria requiring ≥2 definitive episodes for a definite diagnosis, and it has implications for future epidemiologic research. We believe estimates for ≥2 claims may be a more conservative estimate of the prevalence of MD, and multiyear estimates may be needed to allow for adequate follow-up time.
Audiol Neurotol 2016;21:172-177
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The effect of the leukotriene antagonist pranlukast on pediatric acute otitis media
Publication date: August 2016
Source:International Journal of Pediatric Otorhinolaryngology, Volume 87
Author(s): Yoshihisa Nakamura, Yuki Hamajima, Motohiko Suzuki, Shinichi Esaki, Makoto Yokota, Masanori Oshika, Ippei Takagi, Keiko Yasui, Naoya Miyamoto, Kazuko Sugiyama, Meiho Nakayama, Shingo Murakami
ObjectiveConventional treatment for acute otitis media mainly targets bacteria with antibiotics, neglecting to control for mediators of inflammation. Mediators of inflammation, such as leukotrienes, have been identified in patients with acute otitis media (AOM) or subsequent secretory otitis media (SOM). They can cause functional eustachian tube dysfunction or increase mucous in the middle ear, causing persistent SOM following AOM. The objective of the present study was to evaluate whether or not administration of pranlukast, a widely used leukotriene C4, D4, and E4 antagonist, together with antibiotics could inhibit the progression to SOM.MethodsChildren with AOM, who were from two to 12 years old, were randomly divided into two groups as follows: a control group in which 50 patients received antibiotic-based conventional treatment according to guidelines for treating AOM proposed by the Japan Otological Society (version 2006); and a pranlukast group, in which 52 patients were administered pranlukast for up to 28 days as well as given conventional treatment. Cases were regarded as persistent SOM when a tympanogram was type B or C2 four weeks after treatment was initiated.ResultsTwo patients in the pranlukast group and 3 patients in the control group were excluded because they relapsed AOM within 28 days after initial treatment. Therefore, the analysis included 50 and 47 subjects in the pranlukast and control groups, respectively. The percentage of patients diagnosed with persistent SOM (22.0%) was significantly smaller in the pranlukast group compared with the control group (44.7%) (p = 0.018, chi-squared test).ConclusionThe results indicate that combined treatment of AOM with antibiotics and a leukotriene antagonist to control inflammation is useful for preventing progression to persistent SOM.
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Shared decision-making in pediatric otolaryngology: Parent, physician and observational perspectives
Publication date: August 2016
Source:International Journal of Pediatric Otorhinolaryngology, Volume 87
Author(s): Paul Hong, Erin Maguire, Ayala Y. Gorodzinsky, Janet A. Curran, Krista Ritchie, Jill Chorney
ObjectiveTo describe physician and parent behavior during pediatric otolaryngology surgical consultations, and to assess whether perceptions of shared decision-making and observed behavior are related.MethodsParents of 126 children less than 6-years of age who underwent consultation for adeontonsillectomy or tympanostomy tube insertion were prospectively enrolled. Parents completed the Shared Decision-Making Questionnaire-Patient version (SDM-Q-9), while surgeons completed the Shared Decision-Making Questionnaire-Physician version (SDM-Q-Doc) after the consultation. Visits were video-recorded and analyzed using the Roter Interaction Analysis System to quantify physician and parent involvement during the consultation.ResultsPerceptions of shared decision-making between parents (SDM-Q-9) and physicians (SDM-Q-Doc) were significantly positively correlated (p = 0.03). However, there was no correlation between parents' perceptions of shared decision-making and observations of physician and parent behavior/involvement (proportion of physician socioemotional talk, task-focused talk, or proportion of parent talk). Surgeons' perceptions of shared decision-making were correlated with physician task-focused talk and proportion of parent talk.ConclusionsParents and physicians had similar perceptions of the degree of shared decision-making to be taking place during pediatric otolaryngology consultations. However, there was variability in the degree to which parents participated, and parent perceptions of shared decision-making were not correlated with actual observed involvement.
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Editorial Board
Publication date: July 2016
Source:International Journal of Pediatric Otorhinolaryngology, Volume 86
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Development of a vestibular schwannoma xenograft zebrafish model for in vivo antitumor drug screening
Objectives/Hypothesis
The development of a simple, reliable, and cost-effective animal model greatly facilitates disease treatment. We aimed to establish a rapid, simple, and reproducible live zebrafish vestibular schwannoma xenograft model for antitumor drug screening.
Methods
We optimized each of the following conditions for tumor cell xenografts in zebrafish larvae: larval stage, incubation temperature, and injected cell number. We used NF2-/-mouse Schwann (SC4) cells and generated mCherry fluorescent protein-expressing cells prior to injection into zebrafish larvae. SC4 cells were counted using a fluorescence microscope, suspended in 10% fetal bovine serum, and injected into the center of the yolk sac using a microinjection system. The injected embryos were transferred to E3 medium (for zebrafish embryos), and subsequent tumor formation was observed by fluorescence microscopy over a 5-day period. To validate our model, xenografted embryos were transferred into 6-well plates (5 embryos per well) and treated with everolimus, a known antitumor drug.
Results
mCherry fluorescent protein-expressing SC4 cells were successfully grafted into the yolk sacs of zebrafish embryos without any immunosuppressant treatment. At 2 days postinjection, the xenografted cells had grown into tumor masses. The optimal speed of tumor formation depended on the larval stage (30 hpf), incubation temperature (31°C), and injected cell number (200 cells). In preliminary tests, everolimus treatment yielded a > 20% reduction in the number of SC4 cells in the yolk.
Conclusion
Our in vivo model has the potential to greatly facilitate vestibular schwannoma treatment because of its speed, simplicity, reproducibility, and amenability to live imaging.
Level of Evidence
N/A. Laryngoscope, 2016
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Safety of transoral surgery for oropharyngeal malignancies: An analysis of the ACS NSQIP
Objectives/Hypothesis
Minimally invasive transoral surgical approaches for the resection of oropharyngeal tumors offer unique opportunities to achieve oncologically sound results while reducing treatment-related morbidity. The objective of this study is to characterize the mortality and complication rates of transoral oncologic resections in a large, prospective, de-identified national dataset from multiple hospitals.
Study Design
Retrospective, multi-institutional cohort study of 305 patients.
Methods
The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) datasets were accessed and examined for adult patients who underwent transoral surgical resection of oropharyngeal cancers during the years 2010 through 2013. Patient demographics, postoperative complications, and 30-day mortality were evaluated.
Results
A total of 305 patients in the 2010 to 2013 ACS NSQIP datasets met study criteria. For the 18 postoperative complications that we assessed, 24 of 305 patients developed 37 complications, representing a complication rate of 7.9%. Among all patients, the 30-day mortality rate was 0.7%, representing two patient deaths. The presence of preoperative dyspnea, hypertension requiring medication, and an American Society of Anesthesiologists classification of 3 or 4 were significantly associated with extended hospital length of stay (LOS) (> 4 days). On multivariate analysis, hypertension was the only factor that was marginally significant with a longer LOS (odds ratio = 1.74, P = 0.057).
Conclusion
Transoral resection of properly selected oropharyngeal tumors is safe, with low 30-day morbidity and mortality. A greater understanding of the risk factors for complications following transoral surgery may improve patient selection and safety.
Level of Evidence
4. Laryngoscope, 2016
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Vocal fold motion outcome based on excellent prognosis with laryngeal electromyography
Objectives/Hypothesis
As laryngeal electromyography (LEMG) becomes more refined, accurate predictions of vocal fold motion recovery are possible. Focus has been on outcomes for patients with poor prognosis for vocal fold motion recovery. Limited information is available regarding the expected rate of purposeful vocal fold motion recovery when there is good to normal motor recruitment, no signs of denervation, and no signs of synkinetic activity with LEMG, termed excellent prognosis. The objective of this study is to determine the rate of vocal fold motion recovery with excellent prognosis findings on LEMG after acute recurrent laryngeal nerve injury.
Study Design
Retrospective review.
Methods
Patients undergoing a standardized LEMG protocol, consisting of qualitative (evaluation of motor recruitment, motor unit configuration, detection of fibrillations, presence of synkinesis) and quantitative (turns analysis) measurements were evaluated for purposeful vocal-fold motion recovery, calculated after at least 6 months since onset of injury.
Results
Twenty-three patients who underwent LEMG for acute vocal fold paralysis met the inclusion criteria of excellent prognosis. Eighteen patients (78.3%) recovered vocal fold motion, as determined by flexible laryngoscopy.
Conclusion
Nearly 80% of patients determined to have excellent prognosis for vocal fold motion recovery experienced return of vocal fold motion. This information will help clinicians not only counsel their patients on expectations but will also help guide treatment.
Level of Evidence
4. Laryngoscope, 2016
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Liver disease in patients undergoing head and neck surgery: Incidence and risk for postoperative complications
Objectives/Hypothesis
Head and neck cancer patients have multiple risk factors for liver disease. However, little is known about the incidence of liver disease or the safety of surgery in these patients.
Study Design
We conducted a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program from 2005 to 2013.
Methods
We identified patients undergoing head and neck surgery and excluded them if preoperative laboratory data were missing. Patients were classified as having liver disease if their preoperative aspartate aminotransferase-to-platelet ratio index was ≥ 0.7, and as having advanced liver disease if their Model for End-Stage Liver Disease-Sodium score was ≥ 10. We compared the rate of postoperative complications using multivariable logistic regression.
Results
Among 19,138 eligible patients, the incidence of any degree of liver disease was 6.8% for aerodigestive tract surgery and 3.3% for controls. The 30-day mortality rate after major head and neck surgery, which included composite resection; free tissue transfer; and total laryngectomy with advanced, mild, and no liver disease, was 14.6%, 3.0%, and 0.9%, respectively (P < 0.001). For nonmajor surgery, the mortality rate was 3.0%, 0.3%, and 0.3%, respectively (P < 0.001). On multivariable analysis, patients with advanced liver disease experienced a six-fold higher rate of 30-day mortality (odds ratio 6.1; 95% confidence interval, 2.9–12.8).
Conclusion
There is a high risk to detect liver disease in patients undergoing head and neck surgery of the aerodigestive tract. Those with advanced liver disease are at high risk for perioperative mortality, and this risk should be judiciously considered in medical/surgical decision making and postoperative care.
Level of Evidence
2c. Laryngoscope, 2016
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Graftless sinus augmentation with simultaneous dental implant placement: clinical results and biological perspectives
Publication date: Available online 31 May 2016
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): M. Falah, D.-S. Sohn, S. Srouji
After a sinus lifting procedure, the compartment around the implants under the sinus mucosal lining in the sinus floor is filled with a blood clot from surrounding bleeding. The aim of this study was to evaluate the feasibility of bone formation following graftless sinus lifting with the simultaneous placement of dental implants. Thirty graftless sinus lifting procedures were performed and 72 dental implants placed in 18 consecutive patients, using the lateral window approach. Clinical and radiological follow-up was conducted throughout the 6-month healing period. Biopsies of 30 cases were collected at 6 months post-treatment: 15 biopsies were taken from the newly formed bone near the basal floor and 15 from the newly formed bone near the elevated membrane. New bone consolidation in the maxillary sinus was apparent radiologically and histologically at 6 months after sinus augmentation, providing an average 6.14±1.34mm of bone-gain. Based on histological analysis and histomorphometric data, the consolidated bone in the augmented sinus comprised 56.7±11.9% to 59.9±13.4% vital bone tissue. Out of the 72 implants placed, only four failed, indicating a 94% overall implant survival rate. Based on this case series, blood clot can be considered autologous osteogenic graft material, to which osteoprogenitors can migrate, differentiate, and regenerate bone.
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Palatal injection for removal of maxillary teeth: is it required? A systematic review
Publication date: Available online 30 May 2016
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): E.K. Badenoch-Jones, T. Lincoln
There is a growing body of work examining whether a palatal injection is necessary for the extraction of maxillary teeth with contemporary local anaesthetics. The available literature was reviewed systematically by conducting a search of the PubMed, EMBASE, and Cochrane CENTRAL databases for trials examining outcomes of maxillary tooth extraction where buccal injection of local anaesthetic only was used for one or more test groups. The selected studies were reviewed for study type, sample size, quality, participant characteristics and methodology, outcome variables, and findings. Fifteen studies met the inclusion criteria. Six of the studies were randomized controlled trials. Four studies were controlled clinical trials that did not report randomization. Five were clinical trials that were not controlled and examined outcomes of one or more test groups. The pain of local anaesthetic injection(s) in the test group (buccal injection only) versus control group (buccal and palatal injection), number of cases requiring supplemental buccal or palatal injection in cases of unsuccessful local anaesthesia, and pain during the procedure were designated as primary outcomes. Pain on probing of the mucosa was designated as a secondary outcome. All nine controlled studies that assessed pain during the procedure found no statistically significant difference between the test and control groups.
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Modified tragus edge approach for mid-level or low condylar fractures
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): Z. Li, W. Zhoa, C. Liu, J. Liu
The aim of this study was to evaluate and report a modified tragus edge approach (MTEA) for surgical access to mid-level or low condylar fractures. The MTEA was used on 45 patients (59 sides). All of the patients were reviewed for scarring, parotid fistula, facial nerve function, occlusion, deviation, and limitation of mouth opening (MO). Forty-one patients (64 sides) with middle or low level condylar fractures who underwent surgery by retromandibular approach during the same period were selected for comparison. In the MTEA group, scars were not obvious and there was no parotid fistula. The occlusion of four cases (8.9%) was not ideal, but returned to normal after 2 weeks of intermaxillary traction. Temporary facial nerve damage was present on two sides (3.4%). MO was not deviated in any patient, but was limited in the first 2 weeks after operation in three cases (6.7%). The risks of facial nerve dysfunction and parotid fistula were much higher in the retromandibular approach group than in the MTEA group, while the risks of malocclusion and limitation of MO were similar. MTEA is safe and has good aesthetic outcomes. MTEA represents an appropriate surgical access to mid-level and low condylar fractures.
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Tinnitus: Evaluation of Intratympanic Injection of Combined Lidocaine and Corticosteroids
Background: Tinnitus is an annoying problem and until now there is no consensus on its treatment. Aims: In this prospective study, we evaluated the effectiveness of intratympanic lidocaine and dexamethasone (ITLD) injections for the management of subjective idiopathic tinnitus (SIT). Methods: Forty patients with SIT attended the Department of Otorhinolaryngology, Tanta University Hospital, Egypt, between May 2013 and May 2014. The patients were categorized into two groups: group A included 20 patients treated with ITLD injection, and group B included 20 patients treated with intratympanic saline injection as a control. Intratympanic injections were performed four times within 4 weeks in a double-blind manner. At the end of the treatment program, we analyzed the improvement and worsening rates of tinnitus using the following parameters: tinnitus questionnaires, Tinnitus Handicap Index (THI), and loudness matching test. Results: The effectiveness rates of the ITLD group reported in the tinnitus questionnaires, the THI and the loudness matching test were 74.3% in all tests, compared to 26.7, 40.0 and 26.7%, respectively, in the saline group. There was a statistically significant difference between the groups within 2 months after injection. To analyze the therapeutic effect of ITLD on tinnitus of 6 months duration, the improvement rates reported in the tinnitus questionnaires, the THI and the loudness matching test were 78.5% in all tests in the ITLD group, compared to 40.0, 40.0 and 30.0%, respectively, in the saline group. Conclusion: There were statistically significant differences between both groups. ITLD seems to be effective for idiopathic tinnitus.
ORL 2016;78:159-166
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ORL 2016;78:159-166
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Enucleation with or without adjuvant therapy versus marsupialization with or without secondary enucleation in the treatment of keratocystic odontogenic tumors: a systematic review and meta-analysis
Publication date: Available online 31 May 2016
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Essam Ahmed Al-Moraissi, M. Anthony Pogrel, Edward Ellis
The purpose of this study was to compare the recurrence rate (RR) of keratocystic odontogenic tumors (KOTs) in patients who underwent enucleation with or without adjuvant therapy, to patients who underwent decompression with or without residual cystectomy. An extensive search of major databases through PubMed, EMBASE, and Cochrane CENTRAL was conducted to identify all relevant articles published without date and language restrictions from inception to December 2015. Relevant articles were selected based on the following specific inclusion criteria. A weighted RR and odds ratio (OR) using a random with 95% confidence interval (CI) were performed. Meta-regression analysis was conducted to further identify the influence of the duration of follow-up periods on the overall OR. A total of 1182 KOT patients enrolled in 14 studies were included in this analysis. There was a significant advantage for the enucleation ± adjuvant therapy group in preventing recurrence for patients with KOTs (OR, 0.541 mm; 95% CI, 0.302 to 0.875 mm; p = 0.001). The overall pooled weighted RR for enucleation ± adjuvant therapy and decompression ± secondary cystectomy were 18.2% and 27.1%, respectively. The meta-regression analysis showed that duration of follow-up time did not significantly influence the OR of KOT recurrence (Q = 0.506, p = 0.646). In conclusion, initial cystectomy ± adjuvant therapy were associated with fewer recurrences than decompression ± secondary cystectomy.
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Enucleation with or without adjuvant therapy versus marsupialization with or without secondary enucleation in the treatment of keratocystic odontogenic tumors: a systematic review and meta-analysis
Publication date: Available online 31 May 2016
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Essam Ahmed Al-Moraissi, M. Anthony Pogrel, Edward Ellis
The purpose of this study was to compare the recurrence rate (RR) of keratocystic odontogenic tumors (KOTs) in patients who underwent enucleation with or without adjuvant therapy, to patients who underwent decompression with or without residual cystectomy. An extensive search of major databases through PubMed, EMBASE, and Cochrane CENTRAL was conducted to identify all relevant articles published without date and language restrictions from inception to December 2015. Relevant articles were selected based on the following specific inclusion criteria. A weighted RR and odds ratio (OR) using a random with 95% confidence interval (CI) were performed. Meta-regression analysis was conducted to further identify the influence of the duration of follow-up periods on the overall OR. A total of 1182 KOT patients enrolled in 14 studies were included in this analysis. There was a significant advantage for the enucleation ± adjuvant therapy group in preventing recurrence for patients with KOTs (OR, 0.541 mm; 95% CI, 0.302 to 0.875 mm; p = 0.001). The overall pooled weighted RR for enucleation ± adjuvant therapy and decompression ± secondary cystectomy were 18.2% and 27.1%, respectively. The meta-regression analysis showed that duration of follow-up time did not significantly influence the OR of KOT recurrence (Q = 0.506, p = 0.646). In conclusion, initial cystectomy ± adjuvant therapy were associated with fewer recurrences than decompression ± secondary cystectomy.
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FOXP3+ CD4 T-cell maturity and responses to microbial stimulation alter with age and associate with early life gut colonization
Publication date: Available online 30 May 2016
Source:Journal of Allergy and Clinical Immunology
Author(s): Sophia Björkander, Maria A. Johansson, Lena Hell, Gintare Lasaviciute, Caroline Nilsson, Ulrika Holmlund, Eva Sverremark-Ekström
Teaser
Peripheral CD4+FOXP3+ T-cells from children are immature and less responsive to S. aureus. Early gut colonization with S. aureus and lactobacilli associates with the functional phenotype of FOXP3+ cells, implying involvement of microbes in immune-maturation.from #ENT via xlomafota13 on Inoreader http://ift.tt/1spaZFF
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FOXP3+ CD4 T-cell maturity and responses to microbial stimulation alter with age and associate with early life gut colonization
Publication date: Available online 30 May 2016
Source:Journal of Allergy and Clinical Immunology
Author(s): Sophia Björkander, Maria A. Johansson, Lena Hell, Gintare Lasaviciute, Caroline Nilsson, Ulrika Holmlund, Eva Sverremark-Ekström
Teaser
Peripheral CD4+FOXP3+ T-cells from children are immature and less responsive to S. aureus. Early gut colonization with S. aureus and lactobacilli associates with the functional phenotype of FOXP3+ cells, implying involvement of microbes in immune-maturation.from #ENT via xlomafota13 on Inoreader http://ift.tt/1spaZFF
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Comparison of the incidence of osteoradionecrosis with conventional radiotherapy and intensity-modulated radiotherapy
Abstract
Background
Modern techniques of radiotherapy are supposed to decrease the incidence of osteoradionecrosis of the mandible (ORNM). The purpose of this study was to compare the incidence of ORNM after intensity-modulated radiotherapy (IMRT) in comparison to conventional 3D conformal radiotherapy techniques (conventional RT).
Methods
We conducted a retrospective study of consecutive unselected patients treated in a single institution between 2002 and 2012. To minimize confounding effects, only patients with oropharyngeal carcinoma without surgery of the primary site were included.
Results
The cohorts included 145 patients in the conventional RT group and 89 patients in the IMRT group. Total incidence rate of ORNM was similar for both groups with rates of 11% versus 10% (n = 16 for conventional RT and n = 9 for IMRT; p = 1.0). Subanalysis revealed more ORNM in T4 classified lesions with IMRT (p = .007). Analysis of different risk factors showed no statistically significant difference between ORNM and no-ORNM patients.
Conclusion
We found no reduction in ORNM with IMRT. © 2016 Wiley Periodicals, Inc. Head Neck, 2016
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Δευτέρα 30 Μαΐου 2016
Der operative Honorararzt im Krankenhaus vor dem Aus?
Zusammenfassung
Die Kooperation zwischen niedergelassenem Chirurgen und Krankenhaus im Bereich der plastischen Chirurgie birgt für alle Beteiligten Vorteile. Der Beitrag widmet sich den rechtlichen Rahmenbedingungen für den niedergelassenen Arzt und skizziert die gegenwärtig bestehenden Diskussionen um eine Einbindung als „Honorararzt" anhand von aktuellen Entwicklungen in der Rechtsprechung. Insbesondere die Abgrenzung einer freiberuflichen Tätigkeit von einer abhängigen Beschäftigung kann im Einzelfall schwierig sein. Neben den Problemen mit der Sozialversicherungspflicht ergeben sich aufgrund der jüngsten Entwicklungen zur Etablierung eines Gesetzes zur Bekämpfung der Korruption im Gesundheitswesen zudem Fragen im Hinblick auf die Zuweisung von Patienten gegen Entgelt. Abschließend werden im Nachgang zur sog. Honorararzt-Entscheidung des Bundesgerichtshofs die bestehenden Möglichkeiten zur Liquidation privatärztlicher Leistungen bzw. von Wahlleistungsentgelten durch Honorarärzte oder angestellte Ärzte im Krankenhaus erörtert.
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Phenotype of a Belgian Family With 6p25 Deletion Syndrome
Background:
The 6p25 deletion syndrome is one of the many syndromes with both hearing impairment as well as vision impairment. However, the audiometric characteristics and radiological findings of patients with 6p25 deletions are only scarcely described in literature. This study focused on characterizing the audiometric and radiological features of a Belgian family with a chromosome 6p25 deletion.
Objective:To evaluate the hearing impairment, audiometric testing and radiological examination of the temporal bones in 3 family members with a 3.4 Mb deletion in chromosome band 6p25.
Results:All 3 family members demonstrated slowly progressive sensorineural or mixed hearing impairment. Radiologic examination revealed thickened and sclerotic stapes in all patients and a minor internal partition type II of the cochlea in 2 patients.
Conclusion:There is a significant phenotypic variability within and among families with the 6p25 deletion syndrome. A thorough genotype-phenotype correlation is difficult because of the small number of affected patients and the limited clinical data available. More clinical data of families with 6p25 deletions need to be published in order to create a reliable and precise phenotypic characterization. However, our findings can facilitate counseling of hearing impairment caused by 6p25 deletions.
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Middle Cranial Fossa Dehiscence as an Incidental Finding on CT
Objectives:
This retrospective chart review demonstrates that the prevalence of middle cranial fossa (MCF) dehiscence on computed tomography (CT) scans increases with age.
Methods:High-resolution temporal bone CT scans, which had been obtained for any otologic complaint, were reviewed independent of all clinical history. Scans showing soft tissue, fluid, trauma, or previous operations were excluded. The CTs from 183 patients (296 ears) were reviewed, blinded for age and body mass index (BMI). The MCF floor was divided into 7 regions and systematically inspected. Ages and BMIs of the patients were subsequently extracted from the medical record.
Results:Logistic regression analysis confirmed increasing MCF dehiscence with age (P < .05, odds ratio [OR] = 1.07, R = .584). Over all ages (range, 1-88 years; average, 38.5), 32% of MCF floors were dehiscent at any 1 site. For age 60 and over, 55% were dehiscent. The most common sites of MCF dehisence were directly above the malleus head and above the additus ad antrum (35% and 28%, respectively). Superior canal dehiscence (SCD) was seen in 7% of all patients and only in the context of MCF dehiscence. The prevalence of MCF dehiscence increased with age when patients were analyzed by BMI <25, BMI = 25-30, and BMI >30 (P < .003, P < .04, P = .03).
Conclusion:The increase of middle cranial fossa dehiscence with respect to age is statistically significant. Over all ages, approximately 32% of ears show dehiscence. Over 60 years, approximately 55% show dehiscence. The odds of having dehiscence double with a 10-year difference in age. The most common sites along the MCF floor are in the epitympanum over the malleus head and the additus ad antrum. There was a statistically significant increase in MCF dehiscence with age when patients with equivalent BMIs are compared.
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Der operative Honorararzt im Krankenhaus vor dem Aus?
Zusammenfassung
Die Kooperation zwischen niedergelassenem Chirurgen und Krankenhaus im Bereich der plastischen Chirurgie birgt für alle Beteiligten Vorteile. Der Beitrag widmet sich den rechtlichen Rahmenbedingungen für den niedergelassenen Arzt und skizziert die gegenwärtig bestehenden Diskussionen um eine Einbindung als „Honorararzt" anhand von aktuellen Entwicklungen in der Rechtsprechung. Insbesondere die Abgrenzung einer freiberuflichen Tätigkeit von einer abhängigen Beschäftigung kann im Einzelfall schwierig sein. Neben den Problemen mit der Sozialversicherungspflicht ergeben sich aufgrund der jüngsten Entwicklungen zur Etablierung eines Gesetzes zur Bekämpfung der Korruption im Gesundheitswesen zudem Fragen im Hinblick auf die Zuweisung von Patienten gegen Entgelt. Abschließend werden im Nachgang zur sog. Honorararzt-Entscheidung des Bundesgerichtshofs die bestehenden Möglichkeiten zur Liquidation privatärztlicher Leistungen bzw. von Wahlleistungsentgelten durch Honorarärzte oder angestellte Ärzte im Krankenhaus erörtert.
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Phenotype of a Belgian Family With 6p25 Deletion Syndrome
Background:
The 6p25 deletion syndrome is one of the many syndromes with both hearing impairment as well as vision impairment. However, the audiometric characteristics and radiological findings of patients with 6p25 deletions are only scarcely described in literature. This study focused on characterizing the audiometric and radiological features of a Belgian family with a chromosome 6p25 deletion.
Objective:To evaluate the hearing impairment, audiometric testing and radiological examination of the temporal bones in 3 family members with a 3.4 Mb deletion in chromosome band 6p25.
Results:All 3 family members demonstrated slowly progressive sensorineural or mixed hearing impairment. Radiologic examination revealed thickened and sclerotic stapes in all patients and a minor internal partition type II of the cochlea in 2 patients.
Conclusion:There is a significant phenotypic variability within and among families with the 6p25 deletion syndrome. A thorough genotype-phenotype correlation is difficult because of the small number of affected patients and the limited clinical data available. More clinical data of families with 6p25 deletions need to be published in order to create a reliable and precise phenotypic characterization. However, our findings can facilitate counseling of hearing impairment caused by 6p25 deletions.
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Middle Cranial Fossa Dehiscence as an Incidental Finding on CT
Objectives:
This retrospective chart review demonstrates that the prevalence of middle cranial fossa (MCF) dehiscence on computed tomography (CT) scans increases with age.
Methods:High-resolution temporal bone CT scans, which had been obtained for any otologic complaint, were reviewed independent of all clinical history. Scans showing soft tissue, fluid, trauma, or previous operations were excluded. The CTs from 183 patients (296 ears) were reviewed, blinded for age and body mass index (BMI). The MCF floor was divided into 7 regions and systematically inspected. Ages and BMIs of the patients were subsequently extracted from the medical record.
Results:Logistic regression analysis confirmed increasing MCF dehiscence with age (P < .05, odds ratio [OR] = 1.07, R = .584). Over all ages (range, 1-88 years; average, 38.5), 32% of MCF floors were dehiscent at any 1 site. For age 60 and over, 55% were dehiscent. The most common sites of MCF dehisence were directly above the malleus head and above the additus ad antrum (35% and 28%, respectively). Superior canal dehiscence (SCD) was seen in 7% of all patients and only in the context of MCF dehiscence. The prevalence of MCF dehiscence increased with age when patients were analyzed by BMI <25, BMI = 25-30, and BMI >30 (P < .003, P < .04, P = .03).
Conclusion:The increase of middle cranial fossa dehiscence with respect to age is statistically significant. Over all ages, approximately 32% of ears show dehiscence. Over 60 years, approximately 55% show dehiscence. The odds of having dehiscence double with a 10-year difference in age. The most common sites along the MCF floor are in the epitympanum over the malleus head and the additus ad antrum. There was a statistically significant increase in MCF dehiscence with age when patients with equivalent BMIs are compared.
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Response to pneumococcal polysaccharide vaccine in children with asthma, and children with recurrent respiratory infections, and healthy children
Publication date: Available online 30 May 2016
Source:Allergologia et Immunopathologia
Author(s): A. Quezada, L. Maggi, X. Norambuena, J. Inostroza, F. Quevedo
BackgroundTo analyse specific immune response to the 23-valent pneumococcal polysaccharide vaccine by measuring pneumococcal antibodies in children with asthma and with respiratory recurrent infection (RRI) as compared to healthy children.MethodsThe study included 60 children, divided into three groups: 20 with asthma, 20 with RRI, and 20 healthy controls. Post-vaccination specific IgG antibodies against 10 pneumococcal serotypes (S1, S3, S4, S5, S6B, S9V, S14, S18C, S19F, and S23F) contained in the 23-valent pneumococcal polysaccharide vaccine (PPV) were measured. A specific IgG concentration ≥1.3μg/mL was considered a protective response to the vaccine. For statistical analysis, levels of specific IgG antibodies against each of the 10 pneumococcal serotypes were compared across the three groups of children using the x2 test.ResultsAll of the children showed antipneumococcal antibody levels >1.3μg/mL for over 70% of the serotypes, considered within the normal range of response. Average IgG antibody levels and percentages of children protected were statistically comparable among the three groups studied.ConclusionThe asthmatic children without RRI had pneumococcal antibody levels and percentages of serotype-specific protection to PPV comparable to those of healthy children. Asthmatic children with recurrent infections should be evaluated for specific antibody deficiency (SAD). Because asthma patients are at high risk for invasive pneumococcal infections, it would be worthwhile to explore systematic administration of PPV in children over the age of two years who have not received a pneumococcal conjugate vaccine, considering the positive response to PPV reported here.
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Association of interleukin-2 and interferon-γ single nucleotide polymorphisms with Juvenile systemic lupus erythematosus
Publication date: Available online 30 May 2016
Source:Allergologia et Immunopathologia
Author(s): S. Harsini, V. Ziaee, F. Tahghighi, M. Mahmoudi, A. Rezaei, S. Soltani, M. Sadr, M.H. Moradinejad, Y. Aghighi, N. Rezaei
PurposeJuvenile systemic lupus erythematosus (JSLE) is a severe and chronic autoimmune disease of unknown origin. Inflammatory cytokines can play a pivotal role in the pathogenesis of JSLE, while their secretion is under genetic control. The current investigation was performed to analyse the associations of particular single nucleotide polymorphisms (SNPs) of interleukin-2 (IL-2) and interferon-gamma (IFN-γ) genes in a case control study.Materials and methodsThe allele, genotype and haplotype frequencies of the polymorphic IL-2 (G/T at −330, rs2069762, and G/T at +166, rs2069763) and IFN-γ (A/T at +874, rs2430561) genes were estimated in 59 patients with JSLE by contrast with 140 healthy controls using polymerase chain reaction with sequence-specific primers method.ResultsResults of the analysed data revealed a negative allelic association for JSLE in IL-2 −330/T (P=0.02), as well as a positive allelic association for IL-2 −330/G (P=0.02). IL-2 GG genotype (−330) in the patient group was also significantly overrepresented (P<0.001), while IL-2 GT genotype (−330) was notably decreased in the patients with JSLE (P<0.001). Additionally, the frequency of IL-2 (−330, +166) GT haplotype was significantly higher in the patient group (P<0.001).ConclusionIL-2 cytokine gene polymorphisms could affect individual susceptibility to JSLE and can take on the role of possible genetic markers for vulnerability to JSLE.
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Effects of zinc supplementation in the prevention of respiratory tract infections and diarrheal disease in Colombian children: A 12-month randomised controlled trial
Publication date: Available online 30 May 2016
Source:Allergologia et Immunopathologia
Author(s): N.S. Martinez-Estevez, A.N. Alvarez-Guevara, C.E. Rodriguez-Martinez
BackgroundAmong the preventive strategies for lowering the incidence of upper respiratory tract infections (URTI) and acute diarrhoea episodes, two of the most common diseases in children, zinc supplementation has received special interest. However, there is a need for additional studies that determine the preventive effects of different doses of zinc on URTI and diarrhoeal disease episodes in children.MethodsIn a randomised, triple-blind clinical trial, we evaluated the efficacy of 12 months of daily zinc supplementation in the incidence of URTI and acute diarrhoea in a population of healthy children aged between 6 and 12 months living in Bogota, Colombia. The outcomes analysed were incidence of URTI, acute diarrhoeal disease episodes, and side effects of the interventions.ResultsBetween 2010 and 2013, a total of 355 children underwent randomisation, with 174 assigned to the zinc supplementation group and 181 to the control group. In the multivariate analyses, having been randomised to the non-supplemented control group (IRR 1.73, 95% CI 1.52–1.97, p<0.001), and nursery attendance (IRR 1.41, 95% CI 1.07–1.87, p=0.016) were independently linked to the number of URTI. Likewise, having been randomised to the non-supplemented group (IRR 1.43, 95% CI 1.20–1.71, p<0.001), and lower socioeconomic status (IRR 1.86, 95% CI 1.11–3.13, p=0.018) were independently associated to the number of diarrhoeal disease episodes.ConclusionsDaily supplementation of 5mg of zinc during 12 months significantly decreased the incidence of URTI and diarrhoeal disease episodes in a healthy population of children aged between 6 and 12 months.
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Association between two polymorphisms of histamine-metabolising enzymes and the severity of allergic rhinitis in a group of Mexican children
Publication date: Available online 30 May 2016
Source:Allergologia et Immunopathologia
Author(s): R. Meza-Velázquez, F. López-Márquez, S. Espinosa-Padilla, M. Rivera-Guillen, N. Gutíerrez-Díaz, L. Pérez-Armendáriz, M. Rosales-González
BackgroundIt has been suggested that polymorphisms of histamine metabolising enzymes can be a risk factor for developing histamine-involving diseases. The aim of the present study is to research the possible association between two functional single nucleotide polymorphisms (SNPs): C314T in the Histamine-N-Methyl Transferase gene and C2029G in the Diamine Oxidase gene, with the severity of allergic rhinitis and the number of allergic diseases, in a group of allergic Mexican children.MethodsWe studied 154 unrelated allergic children. SNPs were analysed by RT-PCR. The total serum IgE was measured by chemiluminescence and the serum histamine by ELISA. We used logistic regression analysis to determine OR.ResultsPatients carrying the mutant allele for any SNP had more risk to develop higher rhinitis severity or a bigger number of allergic diseases. Haplotype analysis revealed that this effect is synergistic. In patients carrying one or two mutant alleles, serum histamine levels were higher than those of patients carrying only wild alleles. Serum IgE levels were not associated with the presence of mutant alleles.ConclusionThe presence of these SNPs in patients with allergic rhinitis can lead to higher serum histamine, therefore to a higher risk of developing more severe symptoms or more associated allergic diseases, even if the serum IgE remains low.
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Mould and grass pollen allergy as risk factors for childhood asthma in Zaragoza, Spain
Publication date: Available online 30 May 2016
Source:Allergologia et Immunopathologia
Author(s): N. Segura, J. Fraj, J.L. Cubero, M.T. Sobrevía, A. Lezaun, L. Ferrer, A. Sebastián, C. Colás
ObjectiveExamine the prevalence of asthma and associated predictive factors in a group of 468 students.Patients and methodsA descriptive, cross-sectional observational study in a randomly selected population of 468 children aged 10–12, in the city of Zaragoza. We used the ISAAC questionnaire on asthma completed by children under supervision of the investigators. We assessed the genetic risk (family history of asthma) and environmental risks. The risk for atopy was assessed by the presence of positive skin prick tests.Results25.3% of the children had symptoms consistent with asthma in the city of Zaragoza. Among them 33.1% reported a history of asthma in close relatives (OR=1.78, p<0.001). The history of hospitalisations for lower respiratory tract illness was strongly associated with the presence of asthma (OR=6.72, p<0.0001). Positive skin tests to Alternaria (OR=2.00, p<0.0001) and grass pollen (OR=1.76, p<0.001) were predictors of asthma. 63.6% of asthmatic children had presented clinical rhinitis in the previous 12 months, compared with 32% of non-asthmatics, and this difference was statistically significant (OR=3.89, p<0.0001). 47% of asthmatics presented with or previously had eczema, whereas only 26.9% of non-asthmatics presented with or previously had these types of lesions (p<0.0001).ConclusionThe following are predictors of asthma: History of hospital admissions for lower respiratory tract illness, presence of rhinitis and/or eczema, positive prick test for certain aeroallergens, especially Alternaria and grass pollen, and family history of asthma.
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Response to pneumococcal polysaccharide vaccine in children with asthma, and children with recurrent respiratory infections, and healthy children
Publication date: Available online 30 May 2016
Source:Allergologia et Immunopathologia
Author(s): A. Quezada, L. Maggi, X. Norambuena, J. Inostroza, F. Quevedo
BackgroundTo analyse specific immune response to the 23-valent pneumococcal polysaccharide vaccine by measuring pneumococcal antibodies in children with asthma and with respiratory recurrent infection (RRI) as compared to healthy children.MethodsThe study included 60 children, divided into three groups: 20 with asthma, 20 with RRI, and 20 healthy controls. Post-vaccination specific IgG antibodies against 10 pneumococcal serotypes (S1, S3, S4, S5, S6B, S9V, S14, S18C, S19F, and S23F) contained in the 23-valent pneumococcal polysaccharide vaccine (PPV) were measured. A specific IgG concentration ≥1.3μg/mL was considered a protective response to the vaccine. For statistical analysis, levels of specific IgG antibodies against each of the 10 pneumococcal serotypes were compared across the three groups of children using the x2 test.ResultsAll of the children showed antipneumococcal antibody levels >1.3μg/mL for over 70% of the serotypes, considered within the normal range of response. Average IgG antibody levels and percentages of children protected were statistically comparable among the three groups studied.ConclusionThe asthmatic children without RRI had pneumococcal antibody levels and percentages of serotype-specific protection to PPV comparable to those of healthy children. Asthmatic children with recurrent infections should be evaluated for specific antibody deficiency (SAD). Because asthma patients are at high risk for invasive pneumococcal infections, it would be worthwhile to explore systematic administration of PPV in children over the age of two years who have not received a pneumococcal conjugate vaccine, considering the positive response to PPV reported here.
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Association of interleukin-2 and interferon-γ single nucleotide polymorphisms with Juvenile systemic lupus erythematosus
Publication date: Available online 30 May 2016
Source:Allergologia et Immunopathologia
Author(s): S. Harsini, V. Ziaee, F. Tahghighi, M. Mahmoudi, A. Rezaei, S. Soltani, M. Sadr, M.H. Moradinejad, Y. Aghighi, N. Rezaei
PurposeJuvenile systemic lupus erythematosus (JSLE) is a severe and chronic autoimmune disease of unknown origin. Inflammatory cytokines can play a pivotal role in the pathogenesis of JSLE, while their secretion is under genetic control. The current investigation was performed to analyse the associations of particular single nucleotide polymorphisms (SNPs) of interleukin-2 (IL-2) and interferon-gamma (IFN-γ) genes in a case control study.Materials and methodsThe allele, genotype and haplotype frequencies of the polymorphic IL-2 (G/T at −330, rs2069762, and G/T at +166, rs2069763) and IFN-γ (A/T at +874, rs2430561) genes were estimated in 59 patients with JSLE by contrast with 140 healthy controls using polymerase chain reaction with sequence-specific primers method.ResultsResults of the analysed data revealed a negative allelic association for JSLE in IL-2 −330/T (P=0.02), as well as a positive allelic association for IL-2 −330/G (P=0.02). IL-2 GG genotype (−330) in the patient group was also significantly overrepresented (P<0.001), while IL-2 GT genotype (−330) was notably decreased in the patients with JSLE (P<0.001). Additionally, the frequency of IL-2 (−330, +166) GT haplotype was significantly higher in the patient group (P<0.001).ConclusionIL-2 cytokine gene polymorphisms could affect individual susceptibility to JSLE and can take on the role of possible genetic markers for vulnerability to JSLE.
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Effects of zinc supplementation in the prevention of respiratory tract infections and diarrheal disease in Colombian children: A 12-month randomised controlled trial
Publication date: Available online 30 May 2016
Source:Allergologia et Immunopathologia
Author(s): N.S. Martinez-Estevez, A.N. Alvarez-Guevara, C.E. Rodriguez-Martinez
BackgroundAmong the preventive strategies for lowering the incidence of upper respiratory tract infections (URTI) and acute diarrhoea episodes, two of the most common diseases in children, zinc supplementation has received special interest. However, there is a need for additional studies that determine the preventive effects of different doses of zinc on URTI and diarrhoeal disease episodes in children.MethodsIn a randomised, triple-blind clinical trial, we evaluated the efficacy of 12 months of daily zinc supplementation in the incidence of URTI and acute diarrhoea in a population of healthy children aged between 6 and 12 months living in Bogota, Colombia. The outcomes analysed were incidence of URTI, acute diarrhoeal disease episodes, and side effects of the interventions.ResultsBetween 2010 and 2013, a total of 355 children underwent randomisation, with 174 assigned to the zinc supplementation group and 181 to the control group. In the multivariate analyses, having been randomised to the non-supplemented control group (IRR 1.73, 95% CI 1.52–1.97, p<0.001), and nursery attendance (IRR 1.41, 95% CI 1.07–1.87, p=0.016) were independently linked to the number of URTI. Likewise, having been randomised to the non-supplemented group (IRR 1.43, 95% CI 1.20–1.71, p<0.001), and lower socioeconomic status (IRR 1.86, 95% CI 1.11–3.13, p=0.018) were independently associated to the number of diarrhoeal disease episodes.ConclusionsDaily supplementation of 5mg of zinc during 12 months significantly decreased the incidence of URTI and diarrhoeal disease episodes in a healthy population of children aged between 6 and 12 months.
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Association between two polymorphisms of histamine-metabolising enzymes and the severity of allergic rhinitis in a group of Mexican children
Publication date: Available online 30 May 2016
Source:Allergologia et Immunopathologia
Author(s): R. Meza-Velázquez, F. López-Márquez, S. Espinosa-Padilla, M. Rivera-Guillen, N. Gutíerrez-Díaz, L. Pérez-Armendáriz, M. Rosales-González
BackgroundIt has been suggested that polymorphisms of histamine metabolising enzymes can be a risk factor for developing histamine-involving diseases. The aim of the present study is to research the possible association between two functional single nucleotide polymorphisms (SNPs): C314T in the Histamine-N-Methyl Transferase gene and C2029G in the Diamine Oxidase gene, with the severity of allergic rhinitis and the number of allergic diseases, in a group of allergic Mexican children.MethodsWe studied 154 unrelated allergic children. SNPs were analysed by RT-PCR. The total serum IgE was measured by chemiluminescence and the serum histamine by ELISA. We used logistic regression analysis to determine OR.ResultsPatients carrying the mutant allele for any SNP had more risk to develop higher rhinitis severity or a bigger number of allergic diseases. Haplotype analysis revealed that this effect is synergistic. In patients carrying one or two mutant alleles, serum histamine levels were higher than those of patients carrying only wild alleles. Serum IgE levels were not associated with the presence of mutant alleles.ConclusionThe presence of these SNPs in patients with allergic rhinitis can lead to higher serum histamine, therefore to a higher risk of developing more severe symptoms or more associated allergic diseases, even if the serum IgE remains low.
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Mould and grass pollen allergy as risk factors for childhood asthma in Zaragoza, Spain
Publication date: Available online 30 May 2016
Source:Allergologia et Immunopathologia
Author(s): N. Segura, J. Fraj, J.L. Cubero, M.T. Sobrevía, A. Lezaun, L. Ferrer, A. Sebastián, C. Colás
ObjectiveExamine the prevalence of asthma and associated predictive factors in a group of 468 students.Patients and methodsA descriptive, cross-sectional observational study in a randomly selected population of 468 children aged 10–12, in the city of Zaragoza. We used the ISAAC questionnaire on asthma completed by children under supervision of the investigators. We assessed the genetic risk (family history of asthma) and environmental risks. The risk for atopy was assessed by the presence of positive skin prick tests.Results25.3% of the children had symptoms consistent with asthma in the city of Zaragoza. Among them 33.1% reported a history of asthma in close relatives (OR=1.78, p<0.001). The history of hospitalisations for lower respiratory tract illness was strongly associated with the presence of asthma (OR=6.72, p<0.0001). Positive skin tests to Alternaria (OR=2.00, p<0.0001) and grass pollen (OR=1.76, p<0.001) were predictors of asthma. 63.6% of asthmatic children had presented clinical rhinitis in the previous 12 months, compared with 32% of non-asthmatics, and this difference was statistically significant (OR=3.89, p<0.0001). 47% of asthmatics presented with or previously had eczema, whereas only 26.9% of non-asthmatics presented with or previously had these types of lesions (p<0.0001).ConclusionThe following are predictors of asthma: History of hospital admissions for lower respiratory tract illness, presence of rhinitis and/or eczema, positive prick test for certain aeroallergens, especially Alternaria and grass pollen, and family history of asthma.
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Larynxreflexe und larynxassoziierte Reflexe
Zusammenfassung
Der laryngeale Adduktionsreflex sowie der pharyngoglottale Schlussreflex schützen die Trachea bzw. die tiefen Atemwege vor dem Eindringen von Fremdmaterial. Der laryngeale Exspirationsreflex und der Hustenreflex dienen dazu, bereits in den Kehlkopf eingedrungenes Fremdmaterial wieder kranialwärts zu expedieren. Weitere larynxassoziierte Reflexe bzw. reflexhafte Funktionen sind der Inspirationsreflex, der Schnüffelreflex und der Schluckreflex. In der Klinik hat es sich bei Patienten mit Dysphagie bisher bewährt, den laryngealen Adduktionsreflex orientierend mit Luftimpulsen zu testen. Mit einem Wasserschlucktest kann der Hustenreflex überprüft werden. Der Schnüffelreflex sollte für die Überprüfung der Abduktionsfähigkeit der Stimmlippen genutzt werden. Es wäre wünschenswert, zukünftig diese lebenswichtigen Schutzmechanismen gezielter und genauer zu überprüfen und insbesondere hinsichtlich der prädiktiven Validität zu evaluieren.
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Konkremente und iatrogene Fremdkörper der ableitenden Tränenwege
Zusammenfassung
Hintergrund
Konkremente (Dakryolithen oder Fremdkörper) der ableitenden Tränenwege (TNW) führen zu chronischen Entzündungen und/oder rezidivierenden TNW-Stenosen. Dakryolithen selbst können aber auch durch chronische Entzündungen verursacht werden.
Ziel der Arbeit
Anhand typischer Verläufe werden die klinischen Zeichen, die Lokalisationen und die chirurgischen Möglichkeiten zur Entfernung der Konkremente aus den TNW aufgezeigt.
Methoden
Eine retrospektive Analyse von 1451 TNW-Operationen von 1131 Patienten wurde durchgeführt. Repräsentativ wurden 14 TNW von 11 Patienten retrospektiv in Hinblick auf aktuelle Beschwerden, Voroperationen sowie chirurgische Eingriffe ausgewertet. Zu 3 Patienten liegen histologische Befunde der entfernten Dakryolithen vor. Durch eine genaue Fotodokumentation werden die operativen Vorgehensweisen geschildert.
Ergebnisse
Bei 220 TNW-Operationen (15,2 %) wurden Dakryolithen nachgewiesen, bei 12 (0,8 %) iatrogenes Fremdkörpermaterial.
Bei allen ausgewählten Patienten lag eine schmerzhafte chronische Entzündung der TNW vor, entweder im Bereich des Tränensacks oder der Tränenkanälchen. Bei 10 Patienten wurde der Eingriff allein oder in Kombination mit einem transkanalikulären Endoskopiesystem durchgeführt. Bei 4 Patienten wurde allein durch einen externen Zugang (transkutan/transkonjunktival) operiert. Bezogen auf die gesamte Studienpopulation wurden bei 16,9 % (n = 91) der Dakryozystorhinostomien, bei 14,6 % (n = 77) der Dakryoendoskopien und bei 35,6 % (n = 52) der Kanalikulotomien Dakryolithen gefunden.
Schlussfolgerung
Konkremente der TNW stellen eine wichtige Differenzialdiagnose bei der Behandlung von Tränenabflussstörungen dar. Verschiedene chirurgische Zugangswege sollten zur Therapie vorgehalten und beherrscht werden. Anamnestisch liegen häufig stattgehabte Eingriffe im Bereich der TNW vor.
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Anatomie und Physiologie der ableitenden Tränenwege
Zusammenfassung
Erkrankungen der ableitenden Tränenwege spielen nicht nur für Augenärzte und interventionell tätige Radiologen eine Rolle, sondern auch für HNO-Ärzte, welche die ableitenden Tränenwege endonasal konservativ oder chirurgisch therapieren. Der vorliegende Beitrag gibt, basierend auf dem heutigen Kenntnisstand unter Berücksichtigung eigener Forschungsergebnisse der letzten Jahre sowie klinischer Gesichtspunkte, einen Überblick über das Grundwissen der Tränenwegsanatomie und -physiologie. Dabei fließen funktionelle Aspekte zum Tränentransport sowie embryologische und pathophysiologische Aspekte mit ein.
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Free abdominal fat transfer (FAT) for partial and total parotidectomy defect reconstruction
Objectives/Hypothesis
A variety of techniques have been proposed for reconstruction of the parotidectomy defect. We reviewed our experience with free abdominal fat transfer (FAT) graft reconstruction of parotidectomy defects for benign and malignant disease.
Methods
The medical records of patients who underwent parotidectomy for benign or malignant disease from 2007 to 2015 were retrospectively reviewed.
Results
One hundred and five patients underwent 108 parotidectomies with FAT reconstruction, with bilateral parotidectomy performed in three patients. The majority of patients had benign pathology (71%) and tumors < 3 cm (57%). Prior surgery had been performed in 13 cases (12%) and prior radiation had been performed in three (3%). Superficial parotidectomy was performed in 62 patients (57%) and concurrent elective neck dissection was performed in eight (7%). A facelift incision was utilized in 59 patients (55%). Postoperative radiation was used in 21 patients (19%). Abdominal donor site complications occurred in 11 patients (10%), consisting of hematoma in eight patients (7%) and seroma in three (3%). Parotidectomy wound dehiscence occurred in six cases (6%); all responded to conservative management. There was no association between age, tumor size, comorbidity, smoking status, extent of surgery, incision, or prior radiation on the development of wound complications. Fat transfer graft debulking was required in three patients with persistent overcorrection beyond 6 months postoperatively. No patient demonstrated undercorrection or further FAT resorption beyond 6 months.
Conclusion
Fat transfer reconstruction of the parotidectomy defect is safe and achieves a consistent and predictable long-term cosmetic result.
Level of Evidence
4. Laryngoscope, 2016
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Establishing a danger zone: An anatomic study of the lingual artery in base of tongue surgery
Objectives/Hypothesis
To contrast the changes in measurement of the hypoglossal/lingual artery neurovascular bundle (HLNVB) to constant surface landmarks in the base of tongue (BOT) during surgically simulated retraction versus resting anatomic position, and to identify a safe zone for BOT robotic surgery to avoid injury to the HLNVB.
Study Design
Human cadaver study.
Methods
Five fresh-frozen head and neck complexes were obtained, and seven HLNVBs were dissected. A microcaliper was used to measure the distance from the HLNVB to constant surface landmarks in resting and surgically simulated positions using a Feyh-Kastenbauer retractor.
Results
Measurements from foramen cecum to palatoglossus muscle (P < 0.042) was significantly different when comparing anatomical to surgically simulated positions. Importantly, the location of the lingual artery in reference to the surface landmarks measured was dramatically altered with tongue retraction. With retraction, the branches of the dorsal lingual artery were not encountered posterior to a horizontal line between midway circumvallate papilla (mCVP).
Conclusion
Measurements of the HLNVB to surface landmarks in the BOT differs significantly between resting and a surgically simulated tongue position. The dorsal branch of the lingual artery seems more superficial in the BOT than previously described. A safe zone may exist posterior to an imaginary horizontal line between mCVP; however, further studies are needed to confirm this.
Level of Evidence
N/A. Laryngoscope, 2016
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Comparison between 4-MV and 6-MV radiotherapy in T1N0 glottic cancer
Objectives/Hypothesis
The purpose of this study was to report the outcomes of a retrospective consecutive cohort study of patients with T1N0M0 glottic carcinoma treated with 4-MV or 6-MV radiotherapy.
Study Design
Retrospective case–control study.
Methods
This was a retrospective review of all patients with T1N0M0 glottic carcinoma treated with radiotherapy between January 2000 and December 2012 in the Department of Radiation Oncology at National Cancer Center Singapore. A total of 124 patients were included. Clinical endpoints of interest were: local control (LC), overall survival (OS), and disease-specific survival (DSS). Other prognostic factors for LC were also analyzed: age, gender, smoking status, T substage, dose fraction, field size, anterior commissure involvement, total dose, and overall treatment time.
Results
Six-megavolt photon radiotherapy was used in 73 patients and 4-MV photon radiotherapy in 51 patients. Median follow-up was 4.9 years. The 5-year LC and OS were as follows: 4 MV, 91.6% and 83.4%; 6 MV, 88.8% and 82.8%; and the 5-year LC, OS, and DSS for all patients were 90.4%, 83.3%, and 98.3%. There was no significant difference in LR and OS between 4-MV and 6-MV radiotherapy (P = .92, P = .16, respectively). In the univariate analysis of LC, none of the prognostic factors was statistically significant. Twenty patients (23%) developed second primary cancers, the majority in the lungs.
Conclusions
Six-megavolt photon radiotherapy yields comparable results to 4-MV photons. Bolus and computed tomographic simulation are useful to ensure adequate dose coverage of target volume. Follow-up postradiotherapy should incorporate chest imaging, smoking cessation advice, and thyroid function test.
Level of Evidence
4 Laryngoscope, 2016
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Impact of chronic obstructive pulmonary disease on patients undergoing laryngectomy for laryngeal cancer
Objectives/Hypothesis
Although chronic obstructive pulmonary disease (COPD) is a common comorbidity in patients undergoing laryngeal cancer surgery, the impact of this comorbidity in this setting is not well established. In this analysis, we used the Nationwide Inpatient Sample (NIS) to elucidate the impact of COPD on outcomes after laryngectomy for laryngeal cancer.
Methods
The NIS was queried for patients admitted from 1998 to 2010 with laryngeal cancer who underwent total or partial laryngectomy. Patient demographics, type of admission, length of stay, hospital charges, and concomitant diagnoses were analyzed.
Results
Our inclusion criteria yielded a cohort of 40,441 patients: 3,051 with COPD and 37,390 without. On average, COPD was associated with an additional $12,500 (P < 0.001) in hospital charges and an additional 1.4 days (P < 0.001) of hospital stay. There was no significant difference in incidence of in-hospital mortality between the COPD and non-COPD groups after total laryngectomy (1.1% in COPD vs. 1.0% in non-COPD; P = 0.776); however, there was an increased incidence of in-hospital mortality in the COPD group compared to the non-COPD group after partial laryngectomy (3.4% in COPD vs. 0.4% in non-COPD; P < 0.001). Multivariate adjusted logistic regression revealed that COPD was associated with greater odds of pulmonary complications after both partial laryngectomy (odds ratio [OR] = 3.198; P < 0.001) and total laryngectomy (OR = 1.575; P < 0.001).
Conclusion
Chronic obstructive pulmonary disease appears to be associated with greater hospital charges, length of stay, and postoperative pulmonary complications in patients undergoing laryngectomy for laryngeal cancer. Chronic obstructive pulmonary disease after partial, but not total, laryngectomy appears to be associated with increased risk of in-hospital mortality.
Level of Evidence
2C. Laryngoscope, 2016
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Pediatric sialoblastoma: Evaluation and management
Publication date: August 2016
Source:International Journal of Pediatric Otorhinolaryngology, Volume 87
Author(s): Alexandria L. Irace, Eelam A. Adil, Natasha M. Archer, Victoria M. Silvera, Antonio Perez-Atayde, Reza Rahbar
ObjectivesSialoblastoma is a rare congenital salivary gland tumor of epithelial origin. The objectives of this study are to review the literature regarding clinical presentation of sialoblastoma, evaluate the effectiveness of various treatment methods, and present guidelines for evaluation and management in the pediatric population.Data sources:Case presentation and literature review.Review methodsA comprehensive search was conducted to identify cases of pediatric sialoblastoma in the English-language literature. The presentation, evaluation, and management of reported cases were analyzed. We also report an invasive and recurrent case in a pediatric patient to highlight the aggressive nature of these lesions.ResultsSixty-two cases of pediatric sialoblastoma were reviewed. The age at initial presentation ranged from before birth to 15 years. The parotid gland was the most common location (n = 47). Surgical excision was the primary treatment in all patients. Nine patients developed metastatic disease of the lung, lymph nodes, or bone. Almost a third of patients had recurrence and over two thirds of patients were tumor-free for at least 1 year following their last treatment intervention.ConclusionPrompt and complete surgical excision should be recommended to prevent local and systemic recurrence of pediatric sialoblastoma. Chemotherapy has also shown promise in several cases, and clinical genomics may shed light on more therapy options. Patients should be closely followed for at least 12 months following diagnosis, or longer depending on the histopathological staging of the tumor.
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Free abdominal fat transfer (FAT) for partial and total parotidectomy defect reconstruction
Objectives/Hypothesis
A variety of techniques have been proposed for reconstruction of the parotidectomy defect. We reviewed our experience with free abdominal fat transfer (FAT) graft reconstruction of parotidectomy defects for benign and malignant disease.
Methods
The medical records of patients who underwent parotidectomy for benign or malignant disease from 2007 to 2015 were retrospectively reviewed.
Results
One hundred and five patients underwent 108 parotidectomies with FAT reconstruction, with bilateral parotidectomy performed in three patients. The majority of patients had benign pathology (71%) and tumors < 3 cm (57%). Prior surgery had been performed in 13 cases (12%) and prior radiation had been performed in three (3%). Superficial parotidectomy was performed in 62 patients (57%) and concurrent elective neck dissection was performed in eight (7%). A facelift incision was utilized in 59 patients (55%). Postoperative radiation was used in 21 patients (19%). Abdominal donor site complications occurred in 11 patients (10%), consisting of hematoma in eight patients (7%) and seroma in three (3%). Parotidectomy wound dehiscence occurred in six cases (6%); all responded to conservative management. There was no association between age, tumor size, comorbidity, smoking status, extent of surgery, incision, or prior radiation on the development of wound complications. Fat transfer graft debulking was required in three patients with persistent overcorrection beyond 6 months postoperatively. No patient demonstrated undercorrection or further FAT resorption beyond 6 months.
Conclusion
Fat transfer reconstruction of the parotidectomy defect is safe and achieves a consistent and predictable long-term cosmetic result.
Level of Evidence
4. Laryngoscope, 2016
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Establishing a danger zone: An anatomic study of the lingual artery in base of tongue surgery
Objectives/Hypothesis
To contrast the changes in measurement of the hypoglossal/lingual artery neurovascular bundle (HLNVB) to constant surface landmarks in the base of tongue (BOT) during surgically simulated retraction versus resting anatomic position, and to identify a safe zone for BOT robotic surgery to avoid injury to the HLNVB.
Study Design
Human cadaver study.
Methods
Five fresh-frozen head and neck complexes were obtained, and seven HLNVBs were dissected. A microcaliper was used to measure the distance from the HLNVB to constant surface landmarks in resting and surgically simulated positions using a Feyh-Kastenbauer retractor.
Results
Measurements from foramen cecum to palatoglossus muscle (P < 0.042) was significantly different when comparing anatomical to surgically simulated positions. Importantly, the location of the lingual artery in reference to the surface landmarks measured was dramatically altered with tongue retraction. With retraction, the branches of the dorsal lingual artery were not encountered posterior to a horizontal line between midway circumvallate papilla (mCVP).
Conclusion
Measurements of the HLNVB to surface landmarks in the BOT differs significantly between resting and a surgically simulated tongue position. The dorsal branch of the lingual artery seems more superficial in the BOT than previously described. A safe zone may exist posterior to an imaginary horizontal line between mCVP; however, further studies are needed to confirm this.
Level of Evidence
N/A. Laryngoscope, 2016
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Comparison between 4-MV and 6-MV radiotherapy in T1N0 glottic cancer
Objectives/Hypothesis
The purpose of this study was to report the outcomes of a retrospective consecutive cohort study of patients with T1N0M0 glottic carcinoma treated with 4-MV or 6-MV radiotherapy.
Study Design
Retrospective case–control study.
Methods
This was a retrospective review of all patients with T1N0M0 glottic carcinoma treated with radiotherapy between January 2000 and December 2012 in the Department of Radiation Oncology at National Cancer Center Singapore. A total of 124 patients were included. Clinical endpoints of interest were: local control (LC), overall survival (OS), and disease-specific survival (DSS). Other prognostic factors for LC were also analyzed: age, gender, smoking status, T substage, dose fraction, field size, anterior commissure involvement, total dose, and overall treatment time.
Results
Six-megavolt photon radiotherapy was used in 73 patients and 4-MV photon radiotherapy in 51 patients. Median follow-up was 4.9 years. The 5-year LC and OS were as follows: 4 MV, 91.6% and 83.4%; 6 MV, 88.8% and 82.8%; and the 5-year LC, OS, and DSS for all patients were 90.4%, 83.3%, and 98.3%. There was no significant difference in LR and OS between 4-MV and 6-MV radiotherapy (P = .92, P = .16, respectively). In the univariate analysis of LC, none of the prognostic factors was statistically significant. Twenty patients (23%) developed second primary cancers, the majority in the lungs.
Conclusions
Six-megavolt photon radiotherapy yields comparable results to 4-MV photons. Bolus and computed tomographic simulation are useful to ensure adequate dose coverage of target volume. Follow-up postradiotherapy should incorporate chest imaging, smoking cessation advice, and thyroid function test.
Level of Evidence
4 Laryngoscope, 2016
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Impact of chronic obstructive pulmonary disease on patients undergoing laryngectomy for laryngeal cancer
Objectives/Hypothesis
Although chronic obstructive pulmonary disease (COPD) is a common comorbidity in patients undergoing laryngeal cancer surgery, the impact of this comorbidity in this setting is not well established. In this analysis, we used the Nationwide Inpatient Sample (NIS) to elucidate the impact of COPD on outcomes after laryngectomy for laryngeal cancer.
Methods
The NIS was queried for patients admitted from 1998 to 2010 with laryngeal cancer who underwent total or partial laryngectomy. Patient demographics, type of admission, length of stay, hospital charges, and concomitant diagnoses were analyzed.
Results
Our inclusion criteria yielded a cohort of 40,441 patients: 3,051 with COPD and 37,390 without. On average, COPD was associated with an additional $12,500 (P < 0.001) in hospital charges and an additional 1.4 days (P < 0.001) of hospital stay. There was no significant difference in incidence of in-hospital mortality between the COPD and non-COPD groups after total laryngectomy (1.1% in COPD vs. 1.0% in non-COPD; P = 0.776); however, there was an increased incidence of in-hospital mortality in the COPD group compared to the non-COPD group after partial laryngectomy (3.4% in COPD vs. 0.4% in non-COPD; P < 0.001). Multivariate adjusted logistic regression revealed that COPD was associated with greater odds of pulmonary complications after both partial laryngectomy (odds ratio [OR] = 3.198; P < 0.001) and total laryngectomy (OR = 1.575; P < 0.001).
Conclusion
Chronic obstructive pulmonary disease appears to be associated with greater hospital charges, length of stay, and postoperative pulmonary complications in patients undergoing laryngectomy for laryngeal cancer. Chronic obstructive pulmonary disease after partial, but not total, laryngectomy appears to be associated with increased risk of in-hospital mortality.
Level of Evidence
2C. Laryngoscope, 2016
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