OtoRhinoLaryngology by Alexandros G.Sfakianakis: Ιουνίου 2016

Πέμπτη 30 Ιουνίου 2016

Transeptal suturing - a cost-efficient alternative for nasal packing in septal surgery

ABSTRACT INTRODUCTION: Nasal packing is routinely used in septal surgery to prevent postoperative bleeding. OBJECTIVE: To demonstrate the possibility of transeptal suture as a safe and effective way to avoid nasal packing and to improve efficiency. METHODS: This is a prospective, descriptive, inferential cost study comprising 92 patients. Two randomized groups of patients were analyzed, one with nasal packing and the other with transeptal suture. RESULTS: In the group of transeptal suture no patient experienced postoperative bleeding, and a statistically significant reduction of pain and headache was demonstrated. At the same time, we improved efficiency by saving on material costs. CONCLUSIONS: Transeptal suture is an effective and safe alternative to classic nasal packing in septal surgery. Moreover, it improves the efficiency of the intervention by saving costs.

Resumo Introdução: O tamponamento nasal é usado rotineiramente na cirurgia septal para evitar sangramentos no pós-operatório. Objetivo: Demonstrar a possibilidade de se realizar uma sutura transeptal como alternativa eficaz e segura ao tamponamento nasal, com melhora na eficiência da intervenção. Método: Este é um estudo prospectivo, descritivo e de custo inferencial, compreendendo 92 pacientes. Dois grupos aleatórios foram estudados: um com tamponamento nasal e o outro com sutura transeptal. Resultado: No grupo de sutura transeptal, nenhum paciente experimentou sangramento no pós-operatório, tendo sido estatisticamente demonstrada uma significante redução de cefaléia e dor. Ao mesmo tempo, houve melhora na eficiência da intervenção, com economia no custo de material. Conclusões: A sutura transeptal é uma alternativa eficaz e segura ao tamponamento nasal clássico. Além do mais, melhora a eficiência da intervenção, economizando no custo de material.

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Facial trauma among victims of terrestrial transport accidents

ABSTRACT INTRODUCTION: In developing countries, terrestrial transport accidents - TTA, especially those involving automobiles and motorcycles - are a major cause of facial trauma, surpassing urban violence. OBJECTIVE: This cross-sectional census study attempted to determine facial trauma occurrence with terrestrial transport accidents etiology, involving cars, motorcycles, or accidents with pedestrians in the northeastern region of Brazil, and examine victims' socio-demographic characteristics. METHODS: Morbidity data from forensic service reports of victims who sought care from January to December 2012 were analyzed. RESULTS: Altogether, 2379 reports were evaluated, of which 673 were related to terrestrial transport accidents and 103 involved facial trauma. Three previously trained and calibrated researchers collected data using a specific form. Facial trauma occurrence rate was 15.3% (n = 103). The most affected age group was 20-29 years (48.3%), and more men than women were affected (2.81:1). Motorcycles were involved in the majority of accidents resulting in facial trauma (66.3%). CONCLUSION: The occurrence of facial trauma in terrestrial transport accident victims tends to affect a greater proportion of young and male subjects, and the most prevalent accidents involve motorcycles.

Resumo Introdução: Nos países em desenvolvimento, os acidentes de transporte terrestre (ATTs) são uma das principais causas de trauma facial, superando os casos de violência urbana, especialmente aqueles envolvendo automóveis e motocicletas. Objetivo: O objetivo deste estudo transversal censitário foi determinar a ocorrência de traumas faciais com etiologia de acidente de transporte terrestre (ATT): automóveis, motocicletas ou atropelamentos, em uma cidade do Nordeste do Brasil. Método: Foram analisados os dados de morbidade em laudos de um serviço forense de vítimas que procuraram o serviço de janeiro a dezembro de 2010. Resultados: Ao todo, foram avaliados 2.379 laudos; 673 eram referentes a ATTs, e 103 apresentaram traumas faciais. A coleta de dados foi realizada por três pesquisadores previamente treinados e calibrados, sendo elaborado um formulário específico para coleta das informações contidas nos laudos. Destes, 15,3% (n = 103) sofreram trauma facial. A faixa etária predominante para os eventos de trauma facial foi de 20-29 anos (48,3%), acometendo mais homens do que mulheres (2,81:1). A motocicleta foi o principal tipo de veículo com envolvimento de vítimas (66,3%). Conclusões: A ocorrência de traumas faciais em vítimas de acidente de transporte terrestreten de a afetar, em maior proporção, indivíduos homens e jovens, com maior prevalência para os acidentes envolvendo motocicletas.

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Transcanal endoscopic myringoplasty: a case series in a university center

ABSTRACT INTRODUCTION: Transcanal myringoplasty has the advantages of demanding lower operative time and minimal external incisions. It can be performed using the microscopic or endoscopic approach. In the last decade, the use of endoscopes in ear surgery has increased significantly. This technique may allow "around the corner" visualization of small recesses, through narrow spaces, without the aid of canalplasty in unfavorable ear canals. OBJECTIVE: To describe a case series of transcanal endoscopic myringoplasty performed in a university service. The characteristics, advantages, and disadvantages of this technique are also discussed. METHODS: A case series study, based on the chart review of patients submitted to transcanal endoscopic myringoplasty in the period from January of 2012 to October of 2014. RESULTS: Data from 22 patients were analyzed. Tympanic perforation closure three months after surgery was observed in 86.4% of all patients. There was statistically significant improvement in pure tone average thresholds after surgery (p < 0.001). CONCLUSION: Transcanal endoscopic myringoplasty is a feasible, safe, and effective procedure; it can be an alternative to microscopic surgery.

Resumo Introdução: A miringoplastia realizada por via transcanal possui como vantagens a maior rapidez do procedimento e menor incisão externa, podendo ser realizada com auxílio de microscópio ou endoscópio. Na última década tem sido observado um aumento do uso de endoscópios na cirurgia otológica. Essa técnica pode permitir melhor visibilização de espaços encobertos e estreitos, sem necessidade canaloplastia em meatos desfavoráveis. Objetivo: Descrever uma série de casos de miringoplastia endoscópica transcanal, em um serviço universitário, discutindo suas particularidades, vantagens e desvantagens. Método: Estudo de série de casos, baseado na revisão de prontuários dos pacientes submetidos a miringoplastia com uso exclusivo de endoscópio rígido, no período de Janeiro de 2012 a Outubro de 2014. Resultados: Foram analisados os dados de 22 pacientes. Na otoscopia pós-operatória, foi observado fechamento da perfuração timpânica em 86,4% dos pacientes, após 3 meses da intervenção. Para a amostra estudada, foi observada melhora funcional estatisticamente significante da média dos limiares tonais (PTA) após a cirurgia (p < 0,001). Conclusão: A miringoplastia endoscópica transcanal é um procedimento seguro, factível e efetivo, podendo ser realizado como alternativa à cirurgia microscópica.

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Speech nasality and nasometry in cleft lip and palate

ABSTRACT INTRODUCTION: Perceptual evaluation is considered the gold standard to evaluate speech nasality. Several procedures are used to collect and analyze perceptual data, which makes it susceptible to errors. Therefore, there has been an increasing desire to find methods that can improve the assessment. OBJECTIVE: To describe and compare the results of speech nasality obtained by assessments of live speech, the Test of Hypernasality (THYPER), assessments of audio recorded speech, and nasometry. METHODS: A retrospective study consisting of 331 patients with operated unilateral cleft lip and palate. Speech nasality was assessed by four methods of assessment: live perceptual judgement, THYPER, audio-recorded speech sample judgement by multiple judges, and nasometry. All data were collected from medical records of patients, with the exception of the speech sample recording assessment, which was carried out by multiple judges. RESULTS: The results showed that the highest percentages of absence of hypernasality were obtained from judgements performed live and from the THYPER, with equal results between them (79%). Lower percentages were obtained from the recordings by judges (66%) and from nasometry (57%). CONCLUSION: The best results among the four speech nasality evaluation methods were obtained for the ones performed live (live nasality judgement by a speech pathologist and THYPER).

Resumo Introdução: A avaliação perceptiva é considerada padrão-ouro para avaliar a nasalidade de fala. Vários procedimentos são utilizados para coletar e analisar os dados percebidos, o que a torna suscetível a erros. Por isso, há uma preocupação crescente na procura de métodos que possam aperfeiçoá-la. Objetivo: Descrever e comparar os resultados da nasalidade de fala obtidos por meio de julgamento ao vivo, Teste de Hipernasalidade (THIPER), julgamento de gravações por juízes e nasometria. Método: Estudo retrospectivo de 331 pacientes com fissura labiopalatina unilateral operada. Foi realizada a análise dos resultados do julgamento da nasalidade ao vivo e por meio de gravações por juízes, do THIPER e da nasometria. Os dados foram coletados do prontuário dos pacientes, com exceção do julgamento das gravações das amostras de fala, que foi realizado por juízes múltiplos. Resultados: Foram obtidas porcentagens mais altas de ausência de hipernasalidade no julgamento ao vivo e no THIPER, com resultados iguais entre ambas (79%). Porcentagens menores de ausência de hipernasalidade foram obtidas no julgamento das gravações por juízes (66%) e para a nasometria (57%). Conclusão: Os melhores resultados entre as quatro modalidades de avaliação da nasalidade de fala foram obtidos para as realizadas ao vivo (julgamento por um fonoaudiólogo e THIPER).

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Speech recognition in individuals with sensorineural hearing loss

ABSTRACT INTRODUCTION: Hearing loss can negatively influence the communication performance of individuals, who should be evaluated with suitable material and in situations of listening close to those found in everyday life. OBJECTIVE: To analyze and compare the performance of patients with mild-to-moderate sensorineural hearing loss in speech recognition tests carried out in silence and with noise, according to the variables ear (right and left) and type of stimulus presentation. METHODS: The study included 19 right-handed individuals with mild-to-moderate symmetrical bilateral sensorineural hearing loss, submitted to the speech recognition test with words in different modalities and speech test with white noise and pictures. RESULTS: There was no significant difference between right and left ears in any of the tests. The mean number of correct responses in the speech recognition test with pictures, live voice, and recorded monosyllables was 97.1%, 85.9%, and 76.1%, respectively, whereas after the introduction of noise, the performance decreased to 72.6% accuracy. CONCLUSIONS: The best performances in the Speech Recognition Percentage Index were obtained using monosyllabic stimuli, represented by pictures presented in silence, with no significant differences between the right and left ears. After the introduction of competitive noise, there was a decrease in individuals' performance.

Resumo Introdução: A perda auditiva pode influenciar negativamente o desempenho comunicativo e estes indivíduos devem ser avaliados com material adequado e em situações de escuta próximas às observadas no cotidiano. Objetivo: Analisar e comparar o desempenho de indivíduos com perda auditiva neurossensorial de grau leve a moderado em testes de reconhecimento de fala apresentados no silêncio e no ruído segundo as variáveis orelha e tipos de apresentação do estímulo. Método: Participaram do estudo 19 indivíduos destros com perda auditiva neurossensorial bilateral simétrica de grau leve a moderado, submetidos ao teste de reconhecimento de fala com palavras em diferentes modalidades e ao teste de fala com ruído branco com figuras. Resultados: Não houve diferença significante entre as orelhas direita e esquerda para nenhum dos testes realizados. A média de acertos no teste de reconhecimento de fala com figuras, viva voz e monossílabos gravados foi 97,1%; 85,9% e 76,1%, respectivamente, e 72,6% de acertos no teste com ruído. Conclusões: O melhor desempenho no Índice Percentual de Reconhecimento de Fala foi obtido utilizando como estímulos monossílabos representados por figuras apresentados no silêncio, sem diferenças significantes entre as orelhas direita e esquerda. Com a introdução do ruído competitivo, houve descréscimo no desempenho dos indivíduos.

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Diagnosis of temporomandibular joint disorders: indication of imaging exams

ABSTRACT INTRODUCTION: Knowledge of the different imaging tests and their appropriate indications is crucial to establish the diagnosis of temporomandibular disorders, especially in patients with overlapping signs and symptoms. OBJECTIVE: To present and assess the main diagnostic imaging tests for temporomandibular disorders and rationally discuss their indication criteria, advantages, and disadvantages. METHODS: Literature review in the Web of Knowledge, PubMed and SciELO databases, as well as manual search for relevant publications in reference lists of the selected articles. RESULTS: Computed tomography and magnetic resonance imaging were considered the gold standard assessments for the temporomandibular joint to evaluate hard and soft tissues, respectively. Each diagnostic method exhibited distinct sensitivity and specificity for the different subtypes of joint dysfunction. CONCLUSION: Selecting an evaluation examination based on its accuracy, safety, and clinical relevance is a rational decision that can help lead to an accurate diagnosis and an optimum treatment plan.

Resumo Introdução: O conhecimento dos distintos exames de imagem e sua correta indicação é fundamental para elaboração do diagnóstico das disfunções temporomandibulares, principalmente em pacientes com grande sobreposição de sinais e sintomas. Objetivo: Apresentar e avaliar os principais exames de diagnóstico por imagem das disfunções temporomandibulares, além de discutir racionalmente os seus critérios de indicação, vantagens e desvantagens. Método: Revisão da literatura nas bases de dados Web of Knowledge, PubMed e SciELO, além de busca manual por publicações relevantes nas listas de referências dos artigos selecionados. Resultado: Os exames de tomografia computadorizada e ressonância magnética foram considerados ''padrão-ouro'' para a avaliação dos tecidos duros e moles, respectivamente, da articulação temporomandibular. Cada método de diagnóstico pesquisado apresentou sensibilidade e especificidade distintas para os diferentes subtipos de disfunção da articulação. Conclusão: Considera-se como racional a indicação fundamentada na acurácia, segurança e relevância clínica do exame a ser solicitado, o que implica na adequada determinação do diagnóstico e do plano de tratamento.

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Intratympanic corticosteroid for sudden hearing loss: does it really work?

ABSTRACT INTRODUCTION: Sudden deafness is characterized by an abrupt hearing loss of at least 30 dB in three sequential frequencies in the standard pure tone audiogram over three days or less. Treatment is based on its etiology, and oral corticosteroids are widely used. Intratympanic corticosteroids are included as primary or secondary treatment when there is no improvement with the use of oral corticosteroids. OBJECTIVE: To determine the effectiveness of therapy with intratympanic steroids in sudden deafness. METHODS: A systematic review was performed of publications on the topic in the databases of PubMed/MEDLINE, with the keywords: sudden deafness, sudden hearing loss, and corticosteroids. RESULTS: Thirty scientific studies were analyzed. As to the objectives of the study analyzed, 76.7% sought to evaluate the use of intratympanic therapy salvage after failure to conventional treatment, and intratympanic therapy was used as the primary treatment 23.3% of the studies. CONCLUSION: Intratympanic corticosteroid therapy is prescribed primarily when there is failure of conventional therapy and when it is limited to use systemic corticosteroids, such as the diabetic patient.

Resumo Introdução: A surdez súbita é caracterizada por uma perda abrupta da audição de pelo menos 30 dB em três frequências sequenciadas no audiograma tonal de rotina ao longo de três dias, oumenos. O tratamento é fundamentado em sua etiologia e corticosteroides orais são amplamenteutilizados. A terapia com corticosteroide intratimpânico foi incluída como tratamento primárioou secundário nos casos em que não houve melhora com o uso de corticosteroides orais. Objetivo: Determinar a eficácia da terapia intratimpânica com esteroides em casos de surdez súbita. Método: Foi realizada uma revisão sistemática das publicações sobre o tópico no banco dedados Pubmed/Medline, com as palavras-chave: surdez súbita, perda súbita da audição e corticosteroides. Resultados: Foram analisados 30 estudos científicos. Com relação aos objetivos dos estudos analisados, 76,7% procuravam avaliar o uso da terapia intratimpânica em seguida ao insucesso com o tratamento convencional; a terapia intratimpânica foi empregada como tratamento primário em 23,3% dos estudos. Conclusão: A terapia com corticosteroide intratimpânico é prescrita primariamente nos casos de insucesso com a terapia convencional e quando há limitação para o uso de corticosteroides sistêmicos, como ocorre com o paciente diabético.

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Pulsatile tinnitus related to progestin from intrauterine device

Solitary circumscribed neuroma of the larynx

Innate immunity against hepatitis C virus

Yongfen Xu | Jin Zhong

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Schmerzhafte Nasenatmungsbehinderung

Laryngo-Rhino-Otol 2016; 95: e1-e1
DOI: 10.1055/s-0042-109896

Article in Thieme eJournals:
Table of contents | Full text

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Schmerzhafte Nasenatmungsbehinderung

Laryngo-Rhino-Otol 2016; 95: e1-e1
DOI: 10.1055/s-0042-109896

Article in Thieme eJournals:
Table of contents | Full text

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Surgical Management of Myringosclerosis over an Entire Perforated Tympanic Membrane by Simple Underlay Myringoplasty

The aim of our study is to demonstrate the surgical management of myringosclerosis over a perforated whole tympanic membrane using simple underlay myringoplasty. Simple underlay myringoplasty with fibrin glue was performed in 11 ears with myringosclerosis over the entire tympanic membrane. The patients were one male and ten females and their mean age was 61.8 years (range, 40–73 yr). Surgical success was defined as an intact tympanic membrane 12 months after surgery. Closure of the perforation was successful in 10 (91%) of the 11 patients. Failure of the graft occurred in one patient who then underwent a revision procedure using her stored fascia in the outpatient clinic with a successful outcome. The overall success rate was 100%. Although this study included a small number of cases, removal of myringosclerosis at the edge of a perforation is a beneficial technique for simple underlay myringoplasty in terms of the success rate and postoperative hearing threshold, especially when myringosclerosis extends over the entire tympanic membrane.

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Surgical Management of Myringosclerosis over an Entire Perforated Tympanic Membrane by Simple Underlay Myringoplasty

Unilateral complex syngnathia of the maxilla, mandible, and zygomatic complex in a newborn baby

Syngnathia is a rare congenital fusion of the hard and soft tissues of the jaw. Early intervention after birth is essential because without it the baby cannot feed, and facial growth and function will be severely affected.1

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Successful revision of involved margins under frozen section control

Involved margins in resections of oral cancer are common, and examination of frozen sections is a valuable aid for later revision to improve survival. We reported results on patients with pT1 and pT2 oral cancers having involved margins on initial resection treated from January 2010 to December 2011 with a follow up of 12 to 24 months.1

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Unilateral complex syngnathia of the maxilla, mandible, and zygomatic complex in a newborn baby

Successful revision of involved margins under frozen section control

A Two-Year Randomized Trial of Interventions to Decrease Stress Hormone Vasopressin Production in Patients with Meniere’s Disease—A Pilot Study

by Tadashi Kitahara, Hidehiko Okamoto, Munehisa Fukushima, Masaharu Sakagami, Taeko Ito, Akinori Yamashita, Ichiro Ota, Toshiaki Yamanaka

Meniere's disease, a common inner ear condition, has an incidence of 15–50 per 100,000. Because mental/physical stress and subsequent increase in the stress hormone vasopressin supposedly trigger Meniere's disease, we set a pilot study to seek new therapeutic interventions, namely management of vasopressin secretion, to treat this disease. We enrolled 297 definite Meniere's patients from 2010 to 2012 in a randomized-controlled and open-label trial, assigning Group-I (control) traditional oral medication, Group-II abundant water intake, Group-III tympanic ventilation tubes and Group-IV sleeping in darkness. Two hundred sixty-three patients completed the planned 2-year-follow-up, which included assessment of vertigo, hearing, plasma vasopressin concentrations and changes in stress/psychological factors. At 2 years, vertigo was completely controlled in 54.3% of patients in Group-I, 81.4% in Group-II, 84.1% in Group-III, and 80.0% in Group-IV (statistically I Trial Registration: ClinicalTrials.gov NCT01099046

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A Two-Year Randomized Trial of Interventions to Decrease Stress Hormone Vasopressin Production in Patients with Meniere’s Disease—A Pilot Study

by Tadashi Kitahara, Hidehiko Okamoto, Munehisa Fukushima, Masaharu Sakagami, Taeko Ito, Akinori Yamashita, Ichiro Ota, Toshiaki Yamanaka

Narrow-Bladed “Endo” Sagittal Split Osteotomy Retractor

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0036-1584889

A modification of the Obwegeser sagittal split retractor is presented. It is slender while still protecting the soft tissues and is particularly suitable for endoscopically assisted surgery.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

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Sudden death after major head and neck cancer surgery due to undetected arrhythmogenic right ventricle cardiomyopathy (ARVC)

Abstract

Background

Oral squamous cell carcinoma is the sixth most frequent malignancy in Austria. The incidence of arrhythmogenic right ventricle dysplasia (ARVC), an important cause of sudden cardiac death, is estimated at 1:5000 to 1:1000.

Case report

We present a case of a 75-year-old woman who underwent major oncologic surgery for T4aN0M0 maxillary squamous cell carcinoma and reconstruction with a scapular-latissimus dorsi microvascular flap. The patient died suddenly during her postoperative care. Autopsy revealed pericardiac tamponade due to rupture of the right ventricular wall. Histologic examination showed ARVC in a sample taken directly from the ruptured area. Cause of death was secondary arrhythmia originating from the ARVC. The arrhythmia had led to rupture of the right ventricular wall and sudden cardiac death.

Discussion

As per our current knowledge, no cases of maxillary cancer and ARVC as co-morbidities have been reported in the literature. The patient had been given anti-arrhythmia treatment for previously detected atrial fibrillation, which could have been why the arrhythmia was not apparent on the electrocardiogram. Thus, although the appropriate preoperative diagnostics were performed according to current oncologic and anesthesiology guidelines, the potentially lethal cardiac condition of the patient could not be detected.

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Narrow-Bladed “Endo” Sagittal Split Osteotomy Retractor

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0036-1584889

A modification of the Obwegeser sagittal split retractor is presented. It is slender while still protecting the soft tissues and is particularly suitable for endoscopically assisted surgery.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

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Sudden death after major head and neck cancer surgery due to undetected arrhythmogenic right ventricle cardiomyopathy (ARVC)

Abstract

Background

Case report

Discussion

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Are intra-articular injections of hyaluronic acid effective for the treatment of temporomandibular disorders? A systematic review

This systematic review aimed to investigate whether intra-articular injections of hyaluronic acid (HA) are better than other drugs used in temporomandibular joint arthrocentesis, for the improvement of temporomandibular disorder (TMD) symptoms. Two independent reviewers performed an electronic search of the MEDLINE and Web of Science databases for relevant studies published in English up to March 2016. The key words used included a combination of 'hyaluronic acid', 'viscosupplementation', 'intra-articular injections', 'corticosteroids', or 'non steroidal anti inflammatory agents' with 'temporomandibular disorder'.

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The effect of a platelet-rich fibrin conduit on neurosensory recovery following inferior alveolar nerve lateralization: a preliminary clinical study

This retrospective study aimed to assess the recovery of neurosensory dysfunction following modified inferior alveolar nerve (IAN) lateralization surgery compared to the conventional approach. Data from two groups of patients who underwent IAN lateralization in 2014 were included in this study. In one group, platelet-rich fibrin was placed over the IAN and this was protected with a collagen membrane conduit; the other group underwent the conventional IAN lateralization procedure. Implants were placed immediately.

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Severe adverse skin reaction and desensitization to sorafenib

Sorafenib is a multikinase inhibitor that targets various receptor tyrosine kinases and RAF kinases (serine/threonine kinases) associated with tumor growth. The most common adverse reactions (≥20%) for sorafenib are diarrhea, fatigue, infection, alopecia, hand-foot skin reaction, rash, weight loss, decreased appetite, nausea, gastrointestinal and abdominal pains, hypertension, and hemorrhage. Severe skin reactions may require dose reduction or even discontinuation of the therapy.1 We report a case of a patient in whom continuation of sorafenib treatment was required despite suspected sorafenib-induced fever and generalized urticaria.

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Objective measurement of frequency and pattern of nocturnal cough in children with asthma exacerbation

Although a number of patients with asthma report experiencing persistent cough during sleep, it has not yet been objectively investigated.

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Food allergy education program at an elementary school

Food allergy (FA) is common among elementary school children, with a reported 19.7% experiencing FA-related symptoms.1 Adverse reactions to foods occur frequently even though schools have preventive measures against FA reactions.2 A past survey revealed that students in elementary school did not fully understand FA.1 Notably, even though older, many teenagers with FA did not inform their friends about their FA-related condition.3 It has been previously reported that bullying related to FA is a serious issue in schools.

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Are intra-articular injections of hyaluronic acid effective for the treatment of temporomandibular disorders? A systematic review

The effect of a platelet-rich fibrin conduit on neurosensory recovery following inferior alveolar nerve lateralization: a preliminary clinical study

Severe adverse skin reaction and desensitization to sorafenib

Objective measurement of frequency and pattern of nocturnal cough in children with asthma exacerbation

Food allergy education program at an elementary school

Comparison of the amount of bioaccessible fumonisin B 1 and B 2 in maize and rice inoculated with Fusarium verticillioides (MRC 826) and determined by in vitro digestion—preliminary results

Abstract

In this study the occurrence of hidden fumonisin B₁ (FB₁) and fumonisin B₂ (FB₂) was analysed, on two cereal substrates (maize and rice), inoculated with Fusarium verticillioides (MRC 826), in order to determine the ratio of hidden FB₁ and FB₂. Two parallel methods were applied: an in vitro human digestion sample pre-treatment and the routine extraction procedure, in both cases with subsequent LC-MS analysis. It was found that all samples showed higher concentration of total fumonisin B₁ after digestion, as compared to that of free fumonisin analysed only after extraction. The percentage of the hidden form by maize was 18.8 % (±2.4) for FB₁ and 36.8 % (±3.8) for FB₂, while for rice it was 32.3 % (±11.3) and 58.0 (±6.8), respectively, expressed as the proportion to total fumonisin B₁, for the total dataset. Significant differences were found in the FB₁ and FB₂ concentration measured after the different digestion phases (saliva, gastric and duodenal) in case of both matrixes. The results are useful for human risk assessment, since both humans and animals may be exposed to markedly higher toxin load, as determined merely by conventional analytical methods.

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Riechstörungen

Zusammenfassung

Riechstörungen sind häufig, insbesondere im Alter. Ätiologisch unterscheidet man daneben sinunasale und nichtsinunasale Ursachen. Als wichtiges Frühsymptom bei neurodegenerativen Erkrankungen sind Dysov. a. in der Diagnostik von M. Parkinson und M. Alzheimer von Bedeutung. Neben HNO-ärztlicher Abklärung und der Testung mittels Riechstiften gewinnen auch qualitativ hochwertige Schnittbildverfahren wie z. B. die MRT weiter an Bedeutung für die Prognose und die Therapieentscheidung. Im Kindesalter müssen u. a. ein verkürztes Aufmerksamkeitsintervall und eine eingeschränkte Auswahl an bekannten olfaktorischen Reizen Berücksichtigung finden. Riechtraining, antiphlogistische und chirurgische Maßnahmen sind – je nach Ätiologie – therapeutisch erfolgversprechend. Bei intrakraniellen Ursachen von Riechstörungen ist die Kenntnis und schonende Behandlung der anatomischen Strukturen des olfaktorischen Signalwegs durch den Neurochirurgen wichtig für die Langzeitprognose.

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Erratum zu: Multizentrische Studie zur Hörsturztherapie

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Erratum zu: Ballondilatation der Tuba auditiva bei Mittelohroperationen

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Unilateral complex syngnathia of the maxilla, mandible, and zygomatic complex in a newborn baby

Publication date: Available online 30 June 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Abdullah Özel, Gamze Şenol Güven, Emrah Dilaver, Sina Uçkan

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Skeletal stability after sagittal split ramus osteotomy with physiological positioning in patients with skeletal mandibular prognathism and facial asymmetry

Publication date: Available online 29 June 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Seigo Ohba, Noriko Nakao, Takako Kawasaki, Kei-ichiro Miura, Tokutaro Minamizato, Yoshiyuki Koga, Noriaki Yoshida, Izumi Asahina
The correction of deformities of the jaw in patients with facial asymmetry is challenging because of the high rate of relapse, which may partly be caused by skeletal interference and inappropriate seating of the condylar head. We evaluated outcomes in 30 patients who were treated by short lingual osteotomy with physiological positioning. Nine had facial symmetry (absolute displacement of the menton<2mm), 14 had minor asymmetry (displacement of >2 to <4mm), and 7 severe asymmetry (displacement of >4mm). The postoperative position of the menton (Me) was stable in each group, but deviated by 3.56mm in those with severe asymmetry. This deviation remained immediately after operation and after more than one year in this group, which implies that the Me was not on the mandibular midline. The lateral swing of both sides of the proximal segment did not change immediately after operation in any group. Although short lingual osteotomy with physiological positioning can result in skeletal stability, it is important to assess the association between the dental arch and the mandible using computed tomography to ensure a good outcome in patients with a skeletal class III deformity and facial asymmetry.

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Successful revision of involved margins under frozen section control

Publication date: Available online 30 June 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): S. Gokavarapu, N. Parvataneni, S. Nusrath, R. Chander, L.M. Chandrasekhara Rao S.

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Initial Stop Voicing in Bilingual Children With Cochlear Implants and Their Typically Developing Peers With Normal Hearing

Purpose

This study focuses on stop voicing differentiation in bilingual children with normal hearing (NH) and their bilingual peers with hearing loss who use cochlear implants (CIs).

Method

Twenty-two bilingual children participated in our study (11 with NH, M age = 5;1 [years;months], and 11 with CIs, M hearing age = 5;1). The groups were matched on hearing age and a range of demographic variables. Single-word picture elicitation was used with word-initial singleton stop consonants. Repeated measures analyses of variance with three within-subject factors (language, stop voicing, and stop place of articulation) and one between-subjects factor (NH vs. CI user) were conducted with voice onset time and percentage of prevoiced stops as dependent variables.

Results

Main effects were statistically significant for language, stop voicing, and stop place of articulation on both voice onset time and prevoicing. There were no significant main effects for NH versus CI groups. Both children with NH and with CIs differentiated stop voicing in their languages and by stop place of articulation. Stop voicing differentiation was commensurate across the groups of children with NH versus CIs.

Conclusions

Stop voicing differentiation is accomplished in a similar fashion by bilingual children with NH and CIs, and both groups differentiate stop voicing in a language-specific fashion.

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DTC Stem Cell Marketing Common in US in 'Cowboy Culture'

Study authors found a virtual 'cowboy culture' of unregulated, direct-to-consumer marketing of questionable treatments.
Medscape Medical News

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Sequence conservation predicts T cell reactivity against ragweed allergens

Abstract

Background

Ragweed is a major cause of seasonal allergy, affecting millions of people worldwide. Several allergens have been defined based on IgE reactivity, but their relative immunogenicity in terms of T cell responses has not been studied.

Objective

We comprehensively characterized T cell responses from atopic, ragweed-allergic subjects to Amb a 1, Amb a 3, Amb a 4, Amb a 5, Amb a 6, Amb a 8, Amb a 9, Amb a 10, Amb a 11, and Amb p 5, and examined their correlation with serological reactivity and sequence conservation in other allergens.

Methods

Peripheral blood mononuclear cells (PBMCs) from donors positive for IgE toward ragweed extracts after in vitro expansion for secretion of IL-5 (a representative Th2 cytokine) and IFNγ (Th1) in response to a panel of overlapping peptides spanning the above listed allergens.

Results

Three previously identified dominant T cell epitopes (Amb a 1 176-191, 200-215, and 344-359) were confirmed and three novel dominant epitopes (Amb a 1 280-295, 304-319, and 320-335) were identified. Amb a 1, the dominant IgE allergen, was also the dominant T cell allergen, but dominance patterns for T cell and IgE responses for the other ragweed allergens did not correlate. Dominance for T cell responses correlated with conservation of ragweed epitopes with sequences of other well-known allergens.

Conclusion and clinical relevance

These results provide the first assessment of the hierarchy of T cell reactivity in ragweed allergens, which is distinct from that observed for IgE reactivity and influenced by T cell epitope sequence conservation. The results suggest that ragweed allergens associated with lesser IgE reactivity and significant T cell reactivity may be targeted for T cell immunotherapy, and further support the development of immunotherapies against epitopes conserved across species to generate broad reactivity against many common allergens.

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Minimal Hearing Loss: From a Failure-Based Approach to Evidence-Based Practice

Purpose

A representative sample of the literature on minimal hearing loss (MHL) was reviewed to provide evidence of challenges faced by children with MHL and to establish the need for evidence-based options for early intervention.

Method

Research articles published from 1950 to 2013 were searched in the Medline database using the keywords minimal hearing loss, unilateral hearing loss, and mild hearing loss. References cited in retrieved articles were also reviewed.

Results

In total, 69 articles contained relevant information about pediatric outcomes and/or intervention for unilateral hearing loss, 50 for mild hearing loss, and 6 for high-frequency hearing loss. Six challenges associated with MHL emerged, and 6 interventions were indicated. Evidence indicates that although some individuals may appear to have no observable speech-language or academic difficulties, others experience considerable difficulties. It also indicates that even though children with MHL may appear to catch up in some areas, difficulties in select domains continue into adulthood.

Conclusions

Evidence indicates significant risks associated with untreated MHL. Evidence also demonstrates the need for early intervention and identifies several appropriate intervention strategies; however, no single protocol is appropriate for all children. Therefore, families should be educated about the impact of MHL and about available interventions so that informed decisions can be made.

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Recombinant chicken interferon-alpha inhibits the replication of exogenous avian leukosis virus (ALV) in DF-1 cells

Publication date: August 2016
Source:Molecular Immunology, Volume 76
Author(s): Manman Dai, Siyu Wu, Min Feng, Saixiang Feng, Chao Sun, Dayong Bai, Mingzhu Gu, Ming Liao, Weisheng Cao
Chickeninterferon alpha (ChIFNα) belongs to type I IFNs that are important antiviral cytokines. We investigated whether ChIFNα plays a role in avian leukosis virus (ALV) infections of chickens. Firstly, we explored the immune response to ALV in vivo by measuring cytokine expression profiles in the spleens and bursas of chickens during the late stages of ALV-J infection. The results indicated that ALV-J infection could induce a mixed Th1/Th2 cytokine response by elevating levels of both interleukin-2 (IL-2) and IL-10. In contrast, tumor necrosis factor alpha (TNF-α) levels decreased in the spleen while interferon beta (IFNβ) and Toll-like receptor 7 (TLR7) expression levels in the bursa increased significantly. This indicated that ALV-J stimulates a Type I IFN response. Next, we found that different ALV subgroups or strains up-regulated chicken IFN regulatory factor 3 (ChIRF-3) promoter activity, suggesting that ALV infection could trigger Type I IFNs pathway in vitro. Accordingly, we further investigated ChIFNα antiviral effects on ALV replication in DF-1 cells by successfully expressing recombinant ChIFNα in Escherichia coli (E. coli) strain BL21. The specific activity of the purified rChIFNα protein was determined to be 4×10⁷U/mL. When added at 4000U/mL, the recombinant protein restrained ALV replication as measured by decreases in viral protein p27 levels and mRNA expression. This new reagent may be useful for prophylactic and therapeutic drug design.

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Augmenting College Students' Study of Speech-Language Pathology Using Computer-Based Mini Quiz Games

Purpose

This study examined whether undergraduate college students' immediate recall and longer-term retention of introductory voice disorder concepts improved by using mini quiz games (MQGs; interactive knowledge tests in game format) compared with (a) traditional study alone, (b) MQGs and traditional study together, or (c) a no-study control condition.

Method

Ninety-three college students participated in proctored sessions in which they were given a pretest, viewed an online lecture on introductory voice disorder concepts, and then engaged in either no intervention or interventions including traditional study, MQG play, or both MQG play and traditional study, followed by an immediate recall posttest and longer-term retention follow-up test.

Results

Analyses suggested that the effects of all interventions (traditional study, MQG play, and the combination of the 2) were equivalent and resulted in significantly greater improvements from pretest to immediate recall posttest performance than the control condition. In contrast, MQGs and MQGs with traditional study, but not traditional study alone, showed better results for long-term retention than no study.

Conclusion

Results provide preliminary support for the idea that there may be multiple effective learning modes, beyond traditional study, that enhance recall and retention of knowledge foundational to speech-language pathology clinical training and practice.

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Comparison of the amount of bioaccessible fumonisin B 1 and B 2 in maize and rice inoculated with Fusarium verticillioides (MRC 826) and determined by in vitro digestion—preliminary results

Abstract

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Riechstörungen

Zusammenfassung

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Erratum zu: Multizentrische Studie zur Hörsturztherapie

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Τετάρτη 29 Ιουνίου 2016

Long-term and 'patient-reported' outcomes of total esophagogastric dissociation versus laparoscopic fundoplication for gastroesophageal reflux disease in the severely neurodisabled child.

http:--linkinghub.elsevier.com-ihub-imag

Long-term and 'patient-reported' outcomes of total esophagogastric dissociation versus laparoscopic fundoplication for gastroesophageal reflux disease in the severely neurodisabled child.

J Pediatr Surg. 2015 Nov;50(11):1828-32

Authors: Lansdale N, McNiff M, Morecroft J, Kauffmann L, Morabito A

Abstract
AIM: Fundoplication has high failure rates in neurodisability: esophagogastric dissociation (TOGD) has been proposed as an alternative. This study aimed to compare the long-term and 'patient-reported' outcomes of TOGD and laparoscopic fundoplication (LapFundo).
METHODS: Matched cohort comparison comprises (i) retrospective analysis from a prospective database and (ii) carer questionnaire survey of symptoms and quality of life (CP-QoL-Child). Children were included if they had severe neurodisability (Gross Motor Function Classification System five) and spasticity.
RESULTS: Groups were similar in terms of previous surgery and comorbidities. The TOGD group was younger (22 vs. 31.5months, p=0.038) with more females (18/23 vs. 11/24, p=0.036). TOGD was more likely to require intensive care: operative time, length of stay and time to full feeds were all longer (p<0.0001). Median follow-up was 6.3 and 5.8years. Rates of complications were comparable. Symptom recurrence (5/24 vs. 1/23, p=0.34) and use of acid-reducing medication (13/24 vs. 4/23, p=0.035) were higher for LapFundo. Carer-reported symptoms and QoL were similar.
CONCLUSIONS: TOGD had similar efficacy to LapFundo (with suggestion of lower failure), with comparable morbidity and carer-reported outcomes. However, TOGD was more 'invasive,' requiring longer periods of rehabilitation. Families should be offered both procedures as part of comprehensive preoperative counseling.

PMID: 26210817 [PubMed - indexed for MEDLINE]

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Significant pressure differences between solid-state and water-perfused systems in lower esophageal sphincter measurement.

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Significant pressure differences between solid-state and water-perfused systems in lower esophageal sphincter measurement.

Surg Endosc. 2015 Dec;29(12):3565-9

Authors: Gehwolf P, Hinder RA, DeVault KR, Edlinger M, Wykypiel HF, Klingler PJ

Abstract
OBJECTIVE: High-resolution manometry of the esophagus has gained worldwide acceptance, using different solid-state catheters. Thus, normal values for lower esophageal sphincter (LES) resting pressure in suspected gastroesophageal reflux disease patients have been established using water-perfused manometry. These standard values are commonly applied using also solid-state techniques, although they have never been compared before. The aim of the study was to compare LES measurements obtained with water-perfused manometry with a solid-state technique.
METHODS: Thirty healthy subjects were studied twice on the same day: Technique 1: Station pull through using a water-perfused catheter with ports arranged at 0°, 90°, 180° and 270° which were averaged to give a mean LES pressure. Technique 2: Solid-state circumferential probe with a single station pull through. Data were collected using the same computer system and program. The LES pressures were randomly and blindly analyzed.
RESULTS: Twenty-seven subjects out of 30 were analyzed. Using the solid-state system, the mean LES pressure was higher (15.0 vs. 23.3 mmHg, p = 0.003) and 19 of 27 (70%) individual measurements were higher. Two subjects had a hypertensive LES by solid state (58.6 resp. 47.5 mmHg), while their pressures were normal with water-perfused manometry (21.0 resp. 23.4 mmHg). The distal esophageal pressures (mean of pressure at 3 and 8 cm above LES) were the same with the two techniques.
CONCLUSION: In normal control subjects, LES measurement using circumferential solid-state transducers yields higher pressures than standard water-perfused manometry. Which system yields the "true" resting pressure of the physiologic LES remains to be determined.

PMID: 25701063 [PubMed - indexed for MEDLINE]

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Reflux control is important in the management of Barrett's Esophagus: results from a retrospective 1,830 patient cohort.

Reflux control is important in the management of Barrett's Esophagus: results from a retrospective 1,830 patient cohort.

Surg Endosc. 2015 Dec;29(12):3528-34

Authors: Brown CS, Lapin B, Wang C, Goldstein JL, Linn JG, Denham W, Haggerty SP, Talamonti MS, Howington JA, Carbray J, Ujiki MB

Abstract
BACKGROUND: It is unknown whether acid/reflux control prevents progression in Barrett's esophagus. In this study, we investigate whether medical or surgical control of reflux is associated with a decreased risk of progression to dysplasia/esophageal adenocarcinoma.
METHODS: We retrospectively collected and analyzed data from a cohort of Barrett's esophagus patients participating in this single-center study comprised of all patients diagnosed with Barrett's esophagus at NorthShore University Health System hospitals and clinics over a 10-year period. Patients were followed in order to identify those progressing from Barrett's esophagus to low-grade dysplasia, high-grade dysplasia, and esophageal adenocarcinoma. We collected information from the patient's electronic medical records regarding demographic, endoscopic findings, histological findings, smoking/alcohol history, medication use including proton-pump inhibitors, and history of bariatric and antireflux surgery. Risk-adjusted modeling was performed using multivariable logistic regression.
RESULTS: This study included 1,830 total Barrett's esophagus patients, 102 of which had their Barrett's esophagus progress to low-grade dysplasia, high-grade dysplasia, or esophageal adenocarcinoma (confirmed by biopsy) with an annual incidence rate of 1.1%. Mean follow-up period was 5.51 years (10,083 patient-years). Compared to the group that did not progress, the group that progressed was older (69.3 ± 13.7 vs. 63.9 ± 13.4 years. p < 0.001) and likely to be male (75 vs. 61%, p < 0.01). In the multivariable analysis, patients who had a history of antireflux surgery (n = 44) or proton-pump inhibitor use without surgery (n = 1,641) were found to progress at significantly lower rates than patients who did not have antireflux surgery or were not taking PPI's (OR 0.18, 95% CI 0.09-0.36).
CONCLUSIONS: Reflux control was associated with decreased risk of progression to low-grade dysplasia, high-grade dysplasia, or esophageal adenocarcinoma. These results support the use of reflux control strategies such as proton-pump inhibitor therapy or surgery in patients with non-dysplastic Barrett's esophagus for the prevention of progression to dysplasia/adenocarcinoma.

PMID: 25676204 [PubMed - indexed for MEDLINE]

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Comparison of Long-term Differences in Dysphagia: Cervical Arthroplasty and Anterior Cervical Fusion.

Comparison of Long-term Differences in Dysphagia: Cervical Arthroplasty and Anterior Cervical Fusion.

Clin Spine Surg. 2016 Jun 27;

Authors: Smucker JD, Bassuener SR, Sasso RC, Riew KD

Abstract
STUDY DESIGN: Retrospective cohort study.
OBJECTIVE: This study investigates the incidence of long-term dysphagia in cervical disc arthroplasty, and anterior cervical discectomy and fusion (ACDF) patients.
SUMMARY OF BACKGROUND DATA: No long-term comparison of dysphagia between cervical arthroplasty and fusion patients has been published. Widely variable short-term postsurgical dysphagia rates have been reported.
MATERIALS AND METHODS: Cohorts for this study are patients with single-level cervical degenerative disc disease previously enrolled in a randomized clinical trial comparing cervical arthroplasty and ACDF. Subjective modified Bazaz Dysphagia Severity questionnaires were distributed to each patient at a minimum of 5 years postoperative for the long-term assessment. Dysphagia severity data were pooled to compare the rate of patients with dysphagia (grade>1) to asymptomatic (grade=1).
RESULTS: In the arthroplasty cohort, 15 of 22 (68%) patients completed long-term swallowing questionnaires with no reports of dysphagia. Eighteen of 25 (72%) ACDF patients completed questionnaires, with 5 of 18 (28%) reporting dysphagia. This is a statistically significant difference (P=0.042) favoring lower rates of long-term dysphagia after cervical arthroplasty at an average interval of 7 years postoperative (range, 5.5-8.5 y). No significant difference between rates of self-reported short-term dysphagia was noted with 12% (3/25) and 9% (2/22) in the ACDF and arthroplasty groups, respectively (P=0.56). All short-term dysphagia cases in the arthroplasty cohort reported complete resolution of symptoms within 12 months postoperative. In the ACDF cohort, persistent symptoms at 7 years were noted in all responding patients. Three ACDF patients reported new late-onset, which was not noted in the arthroplasty cohort.
CONCLUSIONS: To date, these findings represent the longest reported follow-up interval comparing rates of dysphagia between randomized cohorts of cervical arthroplasty and fusion patients. Our study suggests that cervical arthroplasty is less likely than ACDF to cause sustained long-term or late-presenting dysphagia.

PMID: 27352373 [PubMed - as supplied by publisher]

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Clinical and Radiographic Outcomes in Patients Undergoing Single-level Anterior Cervical Arthrodesis: A Prospective Trial Comparing Allograft to a Reduced Dose of rhBMP-2.

Clinical and Radiographic Outcomes in Patients Undergoing Single-level Anterior Cervical Arthrodesis: A Prospective Trial Comparing Allograft to a Reduced Dose of rhBMP-2.

Clin Spine Surg. 2016 Jun 27;

Authors: Burkus JK, Dryer RF, Arnold PM, Foley KT

Abstract
STUDY DESIGN: A prospective study with historical controls.
OBJECTIVES: To evaluate and compare the safety and effectiveness of recombinant human bone morphogenetic protein-2 (rhBMP-2) with allograft for anterior cervical discectomy and fusion (ACDF) in patients with symptomatic single-level cervical degenerative disk disease.
SUMMARY OF BACKGROUND DATA: rhBMP-2 is an osteoinductive protein that has been shown to induce fusion when used as an implant with a suitable carrier in spine surgery. However, some previous studies have shown rhBMP-2 use to be associated with a higher complication rate.
METHODS: Investigational patients (224) with single-level cervical degenerative disk disease underwent ACDF with rhBMP-2 at a dose of 0.6 or 1.05 mg and were compared with historical control patients (486) treated with allograft spacer and cervical plate.
RESULTS: At 24 months, improvement was significantly greater in the investigational group (37.1 points) than in the control group for Neck Disability Index (P=0.002) and arm pain (P=0.031). The overall neurological success rate was higher in the investigational group (P<0.001). Neck pain and general health status (SF-36 PCS and MCS) were similar. Fusion rate in the investigational group was higher than in the control group (99.4% vs. 87.2%, P=0.002).Cumulative adverse event rates at 24 months were similar; however, higher rates of dysphagia (P=0.001), local swelling (P=0.024), oropharyngeal pain (P=0.013), neck pain (P=0.019), and foraminal stenosis (P=0.002) were observed in the investigational group. Heterotopic ossification was also higher in the investigational group.
CONCLUSIONS: At doses of 0.6 or 1.05 mg in a PEEK interbody cage, rhBMP-2 was effective in inducing fusion and improving Neck Disability Index and arm pain in single-level ACDF patients; however, higher rates of certain adverse events were observed in the investigational group.
LEVEL OF EVIDENCE: Level 2.

PMID: 27352370 [PubMed - as supplied by publisher]

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Propensity-matched Analysis of Outcomes and Hospital Charges for Anterior Versus Posterior Cervical Fusion for Cervical Spondylotic Myelopathy.

Propensity-matched Analysis of Outcomes and Hospital Charges for Anterior Versus Posterior Cervical Fusion for Cervical Spondylotic Myelopathy.

Clin Spine Surg. 2016 Jun 27;

Authors: Tanenbaum JE, Lubelski D, Rosenbaum BP, Benzel EC, Mroz TE

Abstract
STUDY DESIGN: Retrospective analysis of data from the Nationwide Inpatient Sample, a nationally representative, all-payer database of inpatient diagnoses and procedures in the United States.
OBJECTIVE: The objective of this study is to compare anterior cervical fusion (ACF) to posterior cervical fusion (PCF) in the treatment of cervical spondylotic myelopathy (CSM).
SUMMARY OF BACKGROUND DATA: Previous studies used retrospective single-institution level data to quantify outcomes for CSM patients fusion. It is unclear whether ACF or PCF is superior with regards to charges or outcomes for the treatment of CSM.
MATERIALS AND METHODS: We used Nationwide Inpatient Sample data to compare ACF to PCF in the management of CSM. All patients 18 years or older with a diagnosis of CSM between 1998 and 2011 were included. ACF patients were matched to PCF patients using propensity scores based on patient characteristics (number of levels fused, spine alignment, comorbidities), hospital characteristics, and patient demographics. Multivariable regression was used to measure the effect of treatment assignment on in-hospital charges, length of hospital stay, in-hospital mortality, discharge disposition, and dysphagia diagnosis.
RESULTS: From 1998 to 2011, we identified 109,728 hospitalizations with a CSM diagnosis. Of these patients, 45,629 (41.6%) underwent ACF and 14,439 (13.2%) underwent PCF. The PCF cohort incurred an average of $41,683 more in-hospital charges (P<0.001, inflation adjusted to 2011 dollars) and remained in hospital an average of 2.4 days longer (P<0.001) than the ACF cohort. The ACF cohort was just as likely to die in the hospital [odds ratio 0.91; 95% confidence interval (CI), 0.68-1.2], 3.0 times more likely to be discharged to home or self-care (95% CI, 2.9-3.2), and 2.5 times more likely to experience dysphagia (95% CI, 2.0-3.1) than the PCF cohort.
CONCLUSIONS: In treating CSM, ACF led to lower hospital charges, shorter hospital stays, and an increased likelihood of being discharged to home relative to PCF.

PMID: 27352367 [PubMed - as supplied by publisher]

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Evaluation of the effectiveness of esomeprazole treatment strategies in the management of patients with gastroesophageal reflux disease symptoms: a meta-analysis.

Evaluation of the effectiveness of esomeprazole treatment strategies in the management of patients with gastroesophageal reflux disease symptoms: a meta-analysis.

Pharmazie. 2016 May;71(5):285-91

Authors: Mei J, Yu Y, Ma J, Yu X

Abstract
Here we aimed to evaluate the effectiveness of esomeprazole treatment strategies comparing with other proton pump inhibitors (PPI) in clinical practice for six months in the management of patients with symptomatic gastroesophageal reflux disease (GERD). An extensive search of the literature focusing on PPI therapeutic evaluation was performed up to December 2014. Risk ratio (RR) with its corresponding 95% confidence intervals (CIs) in each study was chosen as the effect size. Cochrane's Q statistic and I2 test were both conducted to evaluate heterogeneity across individual studies. Meta-regression was conducted to explore the source of heterogeneity and sensitive analysis was performed to assess the risk bias for the meta-analysis. Totally, eleven trials with high quality enrolled in the meta-analysis. Esomeprazole therapy (20 mg daily) had lower relapse rates than other drugs during six months maintenance treatment (RR = 0.67; 95% CI: 0.55-0.83). Heartburn (RR = 0.72; 95% CI: 0.57-0.92) and epigastric pain (RR = 0.82, 95% Cl: 0.70-0.96) were less likely to happen after esomeprazole treatment, and no significant advantage was found on acid regurgitation and dysphagia. Moreover, lower risk for serious adverse events was observed after esomeprazole therapy (RR = 1.40, 95% CI: 1.04-1.88). Blind method or difference controlled drugs did not influence heterogeneity across studies. Moreover, the conclusion on acid regurgitation, abdominal pain and dysphagia might be unstable. In GERD patients, esomeprazole 20 mg daily is more effective than other PPIs regarding relapse rates, symptoms of epigastric pain and heartburn, and serious adverse events.

PMID: 27348974 [PubMed - in process]

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Low-Dose Tricyclics for Esophageal Hypersensitivity: Is it all Placebo Effect?

Low-Dose Tricyclics for Esophageal Hypersensitivity: Is it all Placebo Effect?

Am J Gastroenterol. 2016 Feb;111(2):225-7

Authors: Keefer L, Kahrilas PJ

Abstract
Limsrivilai et al. report on a randomized control trial (RCT) testing the efficacy of imipramine for treating esophageal hypersensitivity and functional heartburn, the first RCT to test this therapy in this indication. Among 43 functional heartburn and esophageal hypersensitivity patients randomized to treatment with 25 mg qhs imipramine and 40 randomized to matched placebo, the response rates, judged by a 50% reduction in gastroesophageal reflux disease symptoms, were 37.2% and 37.5%, respectively, with no observed difference between patients with hypersensitivity and those with functional heartburn. On the positive side, imipramine treatment was associated with improvement in quality of life as assessed by total SF-36 score. Although negative at first glance, there are several important lessons from this study: (i) low-dose tricyclic is sufficient in these patients; (ii) proton pump inhibitors can (and should) be discontinued when they are ineffective; and (iii) distinguishing between functional heartburn and esophageal hypersensitivity is of unclear clinical relevance.

PMID: 26882945 [PubMed - indexed for MEDLINE]

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pH monitoring of gastro-oesophageal reflux before and after laparoscopic sleeve gastrectomy.

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pH monitoring of gastro-oesophageal reflux before and after laparoscopic sleeve gastrectomy.

Br J Surg. 2016 Mar;103(4):399-406

Authors: Thereaux J, Barsamian C, Bretault M, Dusaussoy H, Lamarque D, Bouillot JL, Czernichow S, Carette C

Abstract
BACKGROUND: Gastro-oesophageal reflux disease (GORD) is a common obesity-related co-morbidity that is assessed objectively by 24-h pH monitoring. Some concerns have been raised regarding the risk of de novo GORD or exacerbation of pre-existing GORD after laparoscopic sleeve gastrectomy. Here, 24-h pH monitoring was used to assess the influence of laparoscopic sleeve gastrectomy on postoperative GORD in obese patients with or without preoperative GORD.
METHODS: From July 2012 to September 2014, all patients scheduled for laparoscopic sleeve gastrectomy were invited to participate in a prospective follow-up. Patients who underwent preoperative 24-h pH monitoring were asked to repeat the examination 6 months after operation. GORD was defined as an oesophageal pH < 4 for at least 4·2 per cent of the total time recorded.
RESULTS: Of 89 patients, 76 had preoperative pH monitoring for GORD evaluation and 50 had postoperative reassessment. Patients without (group 1, 29 patients) or with (group 2, 21 patients) preoperative GORD were similar regarding age, sex ratio and body mass index. In group 1, the median (i.q.r.) total time at pH < 4 was significantly higher after surgery than before: 5·6 (2·5-9·5) versus 1·6 (0·7-2·9) per cent (P < 0·001). Twenty of the 29 patients experienced de novo GORD as determined by 24-h pH monitoring (P < 0·001). In group 2, total time at pH < 4 after surgery was no different from the preoperative value: 5·9 (3·9-10·7) versus 7·7 (5·2-10·3) per cent (P = 0·296).
CONCLUSION: Laparoscopic sleeve gastrectomy was associated with de novo GORD in over two-thirds of patients, but did not seem to exacerbate existing GORD.

PMID: 26806096 [PubMed - indexed for MEDLINE]

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Proton pump inhibitor-responsive oesophageal eosinophilia: an entity challenging current diagnostic criteria for eosinophilic oesophagitis.

Proton pump inhibitor-responsive oesophageal eosinophilia: an entity challenging current diagnostic criteria for eosinophilic oesophagitis.

Gut. 2016 Mar;65(3):524-31

Authors: Molina-Infante J, Bredenoord AJ, Cheng E, Dellon ES, Furuta GT, Gupta SK, Hirano I, Katzka DA, Moawad FJ, Rothenberg ME, Schoepfer A, Spechler SJ, Wen T, Straumann A, Lucendo AJ, PPI-REE Task Force of the European Society of Eosinophilic Oesophagitis (EUREOS)

Abstract
Consensus diagnostic recommendations to distinguish GORD from eosinophilic oesophagitis (EoE) by response to a trial of proton pump inhibitors (PPIs) unexpectedly uncovered an entity called 'PPI-responsive oesophageal eosinophilia' (PPI-REE). PPI-REE refers to patients with clinical and histological features of EoE that remit with PPI treatment. Recent and evolving evidence, mostly from adults, shows that patients with PPI-REE and patients with EoE at baseline are clinically, endoscopically and histologically indistinguishable and have a significant overlap in terms of features of Th2 immune-mediated inflammation and gene expression. Furthermore, PPI therapy restores oesophageal mucosal integrity, reduces Th2 inflammation and reverses the abnormal gene expression signature in patients with PPI-REE, similar to the effects of topical steroids in patients with EoE. Additionally, recent series have reported that patients with EoE responsive to diet/topical steroids may also achieve remission on PPI therapy. This mounting evidence supports the concept that PPI-REE represents a continuum of the same immunological mechanisms that underlie EoE. Accordingly, it seems counterintuitive to differentiate PPI-REE from EoE based on a differential response to PPI therapy when their phenotypic, molecular, mechanistic and therapeutic features cannot be reliably distinguished. For patients with symptoms and histological features of EoE, it is reasonable to consider PPI therapy not as a diagnostic test, but as a therapeutic agent. Due to its safety profile, ease of administration and high response rates (up to 50%), PPI can be considered a first-line treatment before diet and topical steroids. The reasons why some patients with EoE respond to PPI, while others do not, remain to be elucidated.

PMID: 26685124 [PubMed - indexed for MEDLINE]

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An unusual cause of odynophagia.

An unusual cause of odynophagia.

Gut. 2016 Mar;65(3):399, 534

Authors: Moreman C, Budihal S, Ubhi S, de Caestecker J, Richards CJ

PMID: 26423111 [PubMed - indexed for MEDLINE]

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Esophago-Cardial-Gastric Tunneling Peritoneoscopy: In Vivo Dog Survival Study.

Esophago-Cardial-Gastric Tunneling Peritoneoscopy: In Vivo Dog Survival Study.

J Laparoendosc Adv Surg Tech A. 2015 Nov;25(11):920-5

Authors: Liu BR, Song JT, Kong LJ, Ma X, Liu JY, Cui GX

Abstract
BACKGROUND: Diagnostic peritoneoscopy is typically performed by using a rigid laparoscope. Inspired by gastric submucosal tunneling for peritoneal natural orifice transluminal endoscopic surgery access and peroral endoscopic myotomy for the treatment of achalasia, we developed a novel esophago-cardial-gastric tunneling (ECGT) peritoneoscopy technique with a flexible endoscope. This study aims to evaluate its feasibility and safety.
MATERIALS AND METHODS: The study comprised 10 Beagle dogs. A longitudinal mucosal incision was made on the esophageal wall, and a submucosal tunnel was created through the cardia into the stomach. An incision was made in the muscular layer of the stomach, and then the endoscope was advanced into the peritoneal cavity. Peritoneoscopy with the flexible endoscope was performed. After intraperitoneal exploration, the esophageal mucosal entry was closed with endoclips. All dogs resumed food intake 12 hours after the procedures. Diets, behavior, and body temperature of all of the dogs were observed. Endoscopic examinations were performed 4 weeks after the procedure, and then the animals were sacrificed for necropsy.
RESULTS: The ECGT peritoneoscopy was successfully done in all dogs. Diets, behavior, and body temperature were normal in all dogs. The entry of the esophagus was healed well in 9 dogs; the mucosa of the entry was torn in 1 dog, but the submucosal tunnel was healed well at the cardia. Necropsy showed complete closure of the gastric serosal exit, and no intraperitoneal abscess was found. Histopathological examinations showed submucosal tunnels healed well.
CONCLUSIONS: The ECGT peritoneoscopy is feasible and safe for peritoneal exploration. It should be a good choice for the clinical application of diagnostic peritoneoscopy.

PMID: 26402572 [PubMed - indexed for MEDLINE]

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Peripheral and central control of swallowing initiation in healthy humans.

Peripheral and central control of swallowing initiation in healthy humans.

Physiol Behav. 2015 Nov 1;151:404-11

Authors: Aida S, Takeishi R, Magara J, Watanabe M, Ito K, Nakamura Y, Tsujimura T, Hayashi H, Inoue M

Abstract
We investigated (1) how peripheral inputs might assist central inputs in the control of voluntary evoked swallowing, (2) inter-individual variation in involuntary and voluntary swallowing initiation, and (3) whether natural chewing behavior affects the initiation of involuntary swallowing in healthy humans. Eleven participants completed a repetitive saliva swallowing test (RSST), chewing test (CHEW), and rest period (REST). In RSST, participants repetitively swallowed as quickly as possible. In CHEW, subjects chewed gum freely. We delivered pharyngeal electrical stimulation (PEStim) to the laryngopharynx and compared the number of swallows that occurred with and without PEStim. PEStim significantly increased the number of voluntary evoked swallows in RSST, as well as the number of swallows in CHEW and REST trials, although this facilitatory effect was larger in REST trials. We found a positive correlation between the number of swallows at RSST without PEStim and that at REST with PEStim within individuals. Additionally, we found a significant positive correlation between the number of swallows at RSST with PEStim and the sum of that at RSST without PEStim and at REST with PES. Based on the current results, we suggest that (1) peripheral inputs within a certain range appear to facilitate the central inputs that control voluntary swallowing, (2) inter-individual variations in swallowing initiation may arise from differences in the excitability of the common neural network in the lower brainstem, and (3) during chewing, food reduction in the oral cavity is prioritized, such that the neural network associated with chewing may regulate swallowing initiation.

PMID: 26253217 [PubMed - indexed for MEDLINE]

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Long-term and 'patient-reported' outcomes of total esophagogastric dissociation versus laparoscopic fundoplication for gastroesophageal reflux disease in the severely neurodisabled child.

Long-term and 'patient-reported' outcomes of total esophagogastric dissociation versus laparoscopic fundoplication for gastroesophageal reflux disease in the severely neurodisabled child.

J Pediatr Surg. 2015 Nov;50(11):1828-32

Authors: Lansdale N, McNiff M, Morecroft J, Kauffmann L, Morabito A

PMID: 26210817 [PubMed - indexed for MEDLINE]

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Significant pressure differences between solid-state and water-perfused systems in lower esophageal sphincter measurement.

Significant pressure differences between solid-state and water-perfused systems in lower esophageal sphincter measurement.

Surg Endosc. 2015 Dec;29(12):3565-9

Authors: Gehwolf P, Hinder RA, DeVault KR, Edlinger M, Wykypiel HF, Klingler PJ

PMID: 25701063 [PubMed - indexed for MEDLINE]

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Reflux control is important in the management of Barrett's Esophagus: results from a retrospective 1,830 patient cohort.

Reflux control is important in the management of Barrett's Esophagus: results from a retrospective 1,830 patient cohort.

Surg Endosc. 2015 Dec;29(12):3528-34

Authors: Brown CS, Lapin B, Wang C, Goldstein JL, Linn JG, Denham W, Haggerty SP, Talamonti MS, Howington JA, Carbray J, Ujiki MB

PMID: 25676204 [PubMed - indexed for MEDLINE]

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Paraneoplastic pemphigus as a presentation of acute myeloid leukemia: Early diagnosis and remission.

Paraneoplastic pemphigus as a presentation of acute myeloid leukemia: Early diagnosis and remission.

Hematol Oncol Stem Cell Ther. 2016 Jun 23;

Authors: Siddiqui S, Bilal M, Otaibi Z, Bilimoria F, Patel N, Rossetti J

Abstract
Skin lesions are frequently encountered in clinical practice which can be a presentation of systemic diseases not excluding an occult malignancy. Commonly reported paraneoplastic dermatologic manifestations include acanthosis nigricans, dermatomyositis, erythroderma, hypertrophic osteoarthropathy, Sweet syndrome, and paraneoplastic pemphigus (PNP). PNP is a rare autoimmune mucocutaneous disease characterized by severe stomatitis, polymorphic skin eruptions, and associated underlying neoplasms most commonly non-Hodgkin's lymphoma, chronic lymphocytic leukemia, and Castleman disease. PNP is characterized on histopathology as dyskeratotic epithelial cells with acantholysis with a typical immunofluorescence staining pattern of direct and/or indirect staining of intercellular, basement membrane, and dermoepidermal junction with immunoglobulin-G and C3. PNP has been described to have poor prognosis with a mortality range of 75-90% and a mean survival of less than 1year. We describe a previously unreported case of PNP associated with acute myeloid leukemia (AML) where the patient presented with a nonhealing ulcer and hemorrhagic crusting on the face that did not respond to antimicrobials and steroids. Investigations revealed leukocytosis with peripherally circulating blasts. Skin biopsy revealed an evolving PNP and bone marrow biopsy confirmed evidence of AML. The patient underwent induction, consolidation, and then successful allogenic bone marrow transplantation with complete remission. The skin lesion, which was initially refractory to treatments, surprisingly resolved within 7days of starting induction chemotherapy. In this case, the skin lesion was a key factor in early diagnosis and instituting treatment for the underlying AML. Early intervention gave our patient a better outcome with an ongoing survival of 18months since diagnosis, maintaining complete remission.

PMID: 27352260 [PubMed - as supplied by publisher]

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