Ottogi America, Inc. Issues Allergy Alert on Undeclared Egg in Product

Ottogi America, Inc. of Gardena, California announced today it is recalling 1lb 5.16ounce of Jin Ramen Mild 5pk. (Best Before Aug. 19th 2019) and Jin Ramen Spicy 5pk. (Best Before Aug. 20th 2019) due to undeclared egg as an ingredient on the packages. People who have an allergy or severe sensitivity to eggs run the risk of serious or life-threatening allergic reaction if they consume these products. (Source: Food and Drug Administration)

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Holidays a Challenge for Those With Allergies

SATURDAY, Nov. 24, 2018 -- The holidays can be a particularly difficult time for people with food allergies. But one health expert suggests that these folks can still enjoy festive gatherings, as long as they take certain precautions. About 5... (Source: Drugs.com - Daily MedNews)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2KzE9fS

Ottogi America, Inc. Issues Allergy Alert on Undeclared Egg in Product

Ottogi America, Inc. of Gardena, California announced today it is recalling 1lb 5.16ounce of Jin Ramen Mild 5pk. (Best Before Aug. 19th 2019) and Jin Ramen Spicy 5pk. (Best Before Aug. 20th 2019) due to undeclared egg as an ingredient on the packages. People who have an allergy or severe sensitivity to eggs run the risk of serious or life-threatening allergic reaction if they consume these products. (Source: Food and Drug Administration)

MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2BvCzc4

Holidays a Challenge for Those With Allergies

SATURDAY, Nov. 24, 2018 -- The holidays can be a particularly difficult time for people with food allergies. But one health expert suggests that these folks can still enjoy festive gatherings, as long as they take certain precautions. About 5... (Source: Drugs.com - Daily MedNews)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2KzE9fS

Ottogi America, Inc. Issues Allergy Alert on Undeclared Egg in Product

Ottogi America, Inc. of Gardena, California announced today it is recalling 1lb 5.16ounce of Jin Ramen Mild 5pk. (Best Before Aug. 19th 2019) and Jin Ramen Spicy 5pk. (Best Before Aug. 20th 2019) due to undeclared egg as an ingredient on the packages. People who have an allergy or severe sensitivity to eggs run the risk of serious or life-threatening allergic reaction if they consume these products. (Source: Food and Drug Administration)

MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2BvCzc4

Holidays a Challenge for Those With Allergies

SATURDAY, Nov. 24, 2018 -- The holidays can be a particularly difficult time for people with food allergies. But one health expert suggests that these folks can still enjoy festive gatherings, as long as they take certain precautions. About 5... (Source: Drugs.com - Daily MedNews)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2KzE9fS

Ottogi America, Inc. Issues Allergy Alert on Undeclared Egg in Product

Ottogi America, Inc. of Gardena, California announced today it is recalling 1lb 5.16ounce of Jin Ramen Mild 5pk. (Best Before Aug. 19th 2019) and Jin Ramen Spicy 5pk. (Best Before Aug. 20th 2019) due to undeclared egg as an ingredient on the packages. People who have an allergy or severe sensitivity to eggs run the risk of serious or life-threatening allergic reaction if they consume these products. (Source: Food and Drug Administration)

MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2BvCzc4

Holidays a Challenge for Those With Allergies

SATURDAY, Nov. 24, 2018 -- The holidays can be a particularly difficult time for people with food allergies. But one health expert suggests that these folks can still enjoy festive gatherings, as long as they take certain precautions. About 5... (Source: Drugs.com - Daily MedNews)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2KzE9fS

Evaluation of serum and salivary interferon-gamma levels in oral lichen planus patients: A systematic review and meta-analysis of case-control studies

Cytokines have regulatory and leading roles in immunopathogenesis of OLP. Herein, the present meta-analysis evaluates the serum and salivary interferon-gamma (IFN-γ) levels in the OLP patients compared with the controls as well as the correlation of this cytokine with the progression of OLP.

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Evaluation of serum and salivary interferon-gamma levels in oral lichen planus patients: A systematic review and meta-analysis of case-control studies

Cytokines have regulatory and leading roles in immunopathogenesis of OLP. Herein, the present meta-analysis evaluates the serum and salivary interferon-gamma (IFN-γ) levels in the OLP patients compared with the controls as well as the correlation of this cytokine with the progression of OLP.

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Title: Commentary – Novel technique of filler injection in the temple area using the vein detection device, Vein Probe࣪

Injectable soft tissue fillers were the 2nd most common minimally invasive cosmetic procedure with approximately 2.7 million performed in the United States in 2017.1 This minimally invasive procedure is performed by a myriad of practitioners with a widely divergent medical training background ranging from plastic surgeons, otolaryngologists, ophthalmologists, obstetricians, internists, dentists and nurses. The complications related to soft tissue fillers are well described in the literature.2,3,4,5 Given the frequency with which this procedure is performed and the varying medical training of the performing practitioners, efforts to improve the safety of this procedure should be encouraged and embraced.

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Title: Commentary – Novel technique of filler injection in the temple area using the vein detection device, Vein Probe࣪

Injectable soft tissue fillers were the 2nd most common minimally invasive cosmetic procedure with approximately 2.7 million performed in the United States in 2017.1 This minimally invasive procedure is performed by a myriad of practitioners with a widely divergent medical training background ranging from plastic surgeons, otolaryngologists, ophthalmologists, obstetricians, internists, dentists and nurses. The complications related to soft tissue fillers are well described in the literature.2,3,4,5 Given the frequency with which this procedure is performed and the varying medical training of the performing practitioners, efforts to improve the safety of this procedure should be encouraged and embraced.

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Nationwide analysis of unplanned 30‐day readmissions after transsphenoidal pituitary surgery

Background

Transsphenoidal pituitary surgery has evolved into a safe procedure with shorter hospitalizations, yet unplanned readmissions remain a quality measure for which there is a paucity of data. We sought to examine rates, timing, etiologic factors, and costs surrounding readmission after transsphenoidal pituitary surgery.

Methods

The Nationwide Readmissions Database (NRD) was queried for patients who underwent transsphenoidal pituitary between January 2013 and November 2013. Patient, procedure, admission, and hospital‐level characteristics were compared for patients with and without unplanned 30‐day readmission. Multivariate logistic regression was used to identify readmission predictors. A total of 8546 patients were included in this retrospective study.

Results

A total of 8546 patients with a median age of 54 years and female predominance were identified, with 742 patients experiencing at least 1 unplanned readmission within 30 days of index admission. Hypertension, hypothyroidism, diabetes, and obesity were common comorbidities among readmitted patients. Readmission was most frequently because of nervous system complications, followed by neurohypophyseal or electrolyte disorders, cerebrospinal fluid leak, hemorrhage, and meningitis. Median length and cost of stay of index admission was greater in the readmission group (p < 0.001). Fluid and electrolyte disorders as well as neurologic disease (most commonly epilepsy or convulsions) present on initial admission were predictive of length of initial stay and readmission (p < 0.001). Median readmission cost was $7723 and was expected to occur within 7 days.

Conclusion

Approximately 8.7% of patients undergoing transsphenoidal pituitary surgery experience an unplanned readmission within 30 days of discharge. Risk factors identified should be considered to reduce preventable readmissions and identify medically complex patients.

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Effect of elderly status on postoperative complications in patients with sinonasal cancer

Background

Elderly patients with multiple comorbidities may be at higher risk of postoperative complications. With an increasingly aging population, more data assessing for predisposing factors are needed in this at‐risk group. In this study, we analyzed the effect of elderly status on relative comorbidities and complications of sinonasal cancer (SNC) patients receiving surgery.

Methods

A retrospective database analysis was performed using cases from the Nationwide Inpatient Sample (NIS) from 2003 to 2012. Patients with a diagnosis of malignant neoplasm of the nasal cavity or paranasal sinuses, who received surgery for sinonasal malignancy, including neck dissections, were selected. Demographics of interest included age, sex, race, type of admission, mean length of stay, and median hospital charges. Elderly and nonelderly patients were compared for differences in rates of acute medical complications, acute surgical complications, and relevant procedures during hospitalization.

Results

Of the 920 cases identified in the NIS, 382 (41.5%) were elderly (≥65 years). Cases of SNC were more frequently seen in males than females (p < 0.001). Elderly patients had significantly higher comorbidity rates compared with nonelderly patients, which included congestive heart failure, hypertension, diabetes, chronic pulmonary disease, and chronic renal failure (p < 0.001 for all). Elderly patients more frequently had postoperative cardiac complications (6.0% vs 0.5%, p < 0.001), but this finding was not statistically significant on multivariate analysis when controlling for race, sex, and comorbidities.

Conclusion

Elderly status is not an independent factor for postoperative complications in patients undergoing surgery for sinonasal malignancy.

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Nationwide analysis of unplanned 30‐day readmissions after transsphenoidal pituitary surgery

Background

Transsphenoidal pituitary surgery has evolved into a safe procedure with shorter hospitalizations, yet unplanned readmissions remain a quality measure for which there is a paucity of data. We sought to examine rates, timing, etiologic factors, and costs surrounding readmission after transsphenoidal pituitary surgery.

Methods

The Nationwide Readmissions Database (NRD) was queried for patients who underwent transsphenoidal pituitary between January 2013 and November 2013. Patient, procedure, admission, and hospital‐level characteristics were compared for patients with and without unplanned 30‐day readmission. Multivariate logistic regression was used to identify readmission predictors. A total of 8546 patients were included in this retrospective study.

Results

A total of 8546 patients with a median age of 54 years and female predominance were identified, with 742 patients experiencing at least 1 unplanned readmission within 30 days of index admission. Hypertension, hypothyroidism, diabetes, and obesity were common comorbidities among readmitted patients. Readmission was most frequently because of nervous system complications, followed by neurohypophyseal or electrolyte disorders, cerebrospinal fluid leak, hemorrhage, and meningitis. Median length and cost of stay of index admission was greater in the readmission group (p < 0.001). Fluid and electrolyte disorders as well as neurologic disease (most commonly epilepsy or convulsions) present on initial admission were predictive of length of initial stay and readmission (p < 0.001). Median readmission cost was $7723 and was expected to occur within 7 days.

Conclusion

Approximately 8.7% of patients undergoing transsphenoidal pituitary surgery experience an unplanned readmission within 30 days of discharge. Risk factors identified should be considered to reduce preventable readmissions and identify medically complex patients.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2PSC44j

Effect of elderly status on postoperative complications in patients with sinonasal cancer

Background

Elderly patients with multiple comorbidities may be at higher risk of postoperative complications. With an increasingly aging population, more data assessing for predisposing factors are needed in this at‐risk group. In this study, we analyzed the effect of elderly status on relative comorbidities and complications of sinonasal cancer (SNC) patients receiving surgery.

Methods

A retrospective database analysis was performed using cases from the Nationwide Inpatient Sample (NIS) from 2003 to 2012. Patients with a diagnosis of malignant neoplasm of the nasal cavity or paranasal sinuses, who received surgery for sinonasal malignancy, including neck dissections, were selected. Demographics of interest included age, sex, race, type of admission, mean length of stay, and median hospital charges. Elderly and nonelderly patients were compared for differences in rates of acute medical complications, acute surgical complications, and relevant procedures during hospitalization.

Results

Of the 920 cases identified in the NIS, 382 (41.5%) were elderly (≥65 years). Cases of SNC were more frequently seen in males than females (p < 0.001). Elderly patients had significantly higher comorbidity rates compared with nonelderly patients, which included congestive heart failure, hypertension, diabetes, chronic pulmonary disease, and chronic renal failure (p < 0.001 for all). Elderly patients more frequently had postoperative cardiac complications (6.0% vs 0.5%, p < 0.001), but this finding was not statistically significant on multivariate analysis when controlling for race, sex, and comorbidities.

Conclusion

Elderly status is not an independent factor for postoperative complications in patients undergoing surgery for sinonasal malignancy.

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Effect of margin design on fracture load of zirconia crowns

Zirconia‐based restorations are showing an increase as the clinicians' preferred choice at posterior sites because of the strength and esthetic properties of such restorations. However, all‐ceramic restorations fracture at higher rates than do metal‐based restorations. Margin design is one of several factors that can affect the fracture strength of all‐ceramic restorations. The aim of this study was to assess the effect of preparation and crown margin design on fracture resistance. Four groups of bilayer zirconia crowns (with 10 crowns in each group) were produced by hard‐ or soft‐machining technique, with the following four different margin designs: chamfer preparation (control); slice preparation; slice preparation with an additional cervical collar of 0.7 mm thickness; and reduced occlusal thickness (to 0.4 mm) on slice preparation with an additional cervical collar of 0.7 mm thickness. Additionally, 10 hard‐machined crowns with slice preparation were veneered and glazed with feldspathic porcelain. In total, 90 crowns were loaded centrally in the occlusal fossa until fracture. The load at fracture was higher than clinically relevant mastication loads for all preparation and margin designs. The crowns on a chamfer preparation fractured at higher loads compared with crowns on a slice preparation. An additional cervical collar increased load at fracture for hard‐machined crowns.

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Proteomic analysis of dentin–enamel junction and adjacent protein‐containing enamel matrix layer of healthy human molar teeth

The dentin–enamel junction (DEJ) is the border where two different mineralized structures – enamel and dentin – meet. The protein‐rich DEJ, together with the inner enamel region of mature teeth, is known to exhibit higher fracture toughness and crack growth resistance than bulk phase enamel. However, an explanation for this behavior has been hampered by the lack of compositional information for the DEJ and the adjacent enamel organic matrix (EOM). We studied proteomes of the DEJ and EOM of healthy human molars and compared them with dentin and enamel proteomes from the same teeth. These tissues were cut out of tooth sections by laser capture microdissection, proteins were extracted and cleaved by trypsin, then processed by liquid chromatography coupled to tandem mass spectrometry to analyze the proteome profiles of these tissues. This study identified 46 proteins in DEJ and EOM. The proteins identified have a variety of functions, including calcium ion‐binding, formation of extracellular matrix, formation of cytoskeleton, cytoskeletal protein binding, cell adhesion, and transport. Collagens were identified as the most dominant proteins. Tissue‐specific proteins, such as ameloblastin and amelogenin, were also detected. Our findings reveal new insight into proteomics of DEJ and EOM, highly mineralized tissues that are obviously difficult to analyze.

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Interaction between interferon regulatory factor 6 and glycine receptor beta shows a protective effect on developing nonsyndromic cleft lip with or without cleft palate in the Han Chinese population

Single‐nucleotide polymorphisms (SNPs) in protein‐coding regions of genes which were previously reported to be associated with nonsyndromic cleft lip, with or without palate involvement (NSCL/P), were investigated. Twelve candidate loci [platelet‐derived growth factor C (PDGFC), platelet‐derived growth factor subunit A (PDGFA), platelet‐derived growth factor receptor alpha (PDGFRA), glycine receptor alpha 2 (GLRA2), glycine receptor beta (GLRB), ATP binding cassette subfamily A member 4 (ABCA4), MAF bZIP transcription factor B (MAFB), interferon regulatory factor 6 (IRF6), CCDC26 long non‐coding RNA (CCDC26), paired box 7 (PAX7), ventral anterior homeobox 1 (VAX1), and netrin 1 (NTN1)] covering 1.5 Mbp were sequenced in 136 NSCL/P patients and 54 healthy controls. Twenty‐five genomic variants identified were further validated in another 400 NSCL/P and 200 controls. Two SNPs in IRF6 showed a protective effect against the development of NSCL/P (rs12405750, OR = 0.54, 95% CI: 0.41–0.69; and rs2235371, OR = 0.55, 95% CI: 0.43–0.71). The missense variant, rs2235371, alters the conserved amino acid valine to isoleucine at codon 274 (V274I). We observed that SNPs at IRF6 (rs2235371 and rs12405750) and GLRB (rs73856838 and rs72685584) show consistent interaction effects. The association between the missense SNP rs2235371 in gene IRF6 and NSCL/P suggests that this SNP may play an important role as a risk factor for NSCL/P in the Han Chinese populations. The marginal signal near 4q31 detected in previous genome‐wide association studies might be caused by an interaction between the IRF6 and GLRB genes. This interaction needs to be further validated by experimentation in follow‐up studies.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2r2e8wD

Effect of margin design on fracture load of zirconia crowns

Zirconia‐based restorations are showing an increase as the clinicians' preferred choice at posterior sites because of the strength and esthetic properties of such restorations. However, all‐ceramic restorations fracture at higher rates than do metal‐based restorations. Margin design is one of several factors that can affect the fracture strength of all‐ceramic restorations. The aim of this study was to assess the effect of preparation and crown margin design on fracture resistance. Four groups of bilayer zirconia crowns (with 10 crowns in each group) were produced by hard‐ or soft‐machining technique, with the following four different margin designs: chamfer preparation (control); slice preparation; slice preparation with an additional cervical collar of 0.7 mm thickness; and reduced occlusal thickness (to 0.4 mm) on slice preparation with an additional cervical collar of 0.7 mm thickness. Additionally, 10 hard‐machined crowns with slice preparation were veneered and glazed with feldspathic porcelain. In total, 90 crowns were loaded centrally in the occlusal fossa until fracture. The load at fracture was higher than clinically relevant mastication loads for all preparation and margin designs. The crowns on a chamfer preparation fractured at higher loads compared with crowns on a slice preparation. An additional cervical collar increased load at fracture for hard‐machined crowns.

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Medialization laryngoplasty/arytenoid adduction: U.S. outcomes, discharge status, and utilization trends

Objectives/Hypothesis

To evaluate trends, outcomes, and healthcare utilization following medialization laryngoplasty (ML) with or without arytenoid adduction (AA) over 10 years.

Study Design

Retrospective observational study.

Methods

Using OptumLabs Data Warehouse, trends, outcomes, and healthcare utilization from 2006 to 2015 were examined with a focus on discharge type (same day or not). Predictors of postoperative emergency department (ED) use and hospitalization were determined by multivariable logistic regression.

Results

Overall rate of ML was 1.09 per 100 thousand enrollees per year. Of these, 7.8% ML were combined with an AA. Outpatient same‐day discharge represented 62.0% (1,142 of 1,843) of total patients, steadily increasing over the 10‐year period (P < 0.01). There was a 5.9% revision ML rate and 1.0% rate of tracheotomy within 1 day of ML. A total of 5.6% visited an ED, and 5.4% were admitted to a hospital following initial discharge within 30 days. Same‐day discharge was found to be a predictor of hospitalization within 30 days after ML (odds ratio [OR] 1.74, P = 0.0452), along with Elixhauser comorbidity index of 4 + (OR 5.74, P = 0.0001). Pulmonary embolism, pulmonary hypertension, and weight loss were top predictors of ED visit or hospitalization.

Conclusion

To our knowledge, this is the first search evaluating national claims data for ML with or without AA. Overall rate of ML is low, and same‐day discharge has become more common over a 10‐year period, with an associated higher 30‐day hospital admission risk. Correct patient selection criteria for disposition status cannot be fully determined based on current data, but a high Elixhauser comorbidity index clearly carries increased risk for hospitalization after initial discharge.

Level of Evidence

4. Laryngoscope, 2018

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Proteomic analysis of dentin–enamel junction and adjacent protein‐containing enamel matrix layer of healthy human molar teeth

The dentin–enamel junction (DEJ) is the border where two different mineralized structures – enamel and dentin – meet. The protein‐rich DEJ, together with the inner enamel region of mature teeth, is known to exhibit higher fracture toughness and crack growth resistance than bulk phase enamel. However, an explanation for this behavior has been hampered by the lack of compositional information for the DEJ and the adjacent enamel organic matrix (EOM). We studied proteomes of the DEJ and EOM of healthy human molars and compared them with dentin and enamel proteomes from the same teeth. These tissues were cut out of tooth sections by laser capture microdissection, proteins were extracted and cleaved by trypsin, then processed by liquid chromatography coupled to tandem mass spectrometry to analyze the proteome profiles of these tissues. This study identified 46 proteins in DEJ and EOM. The proteins identified have a variety of functions, including calcium ion‐binding, formation of extracellular matrix, formation of cytoskeleton, cytoskeletal protein binding, cell adhesion, and transport. Collagens were identified as the most dominant proteins. Tissue‐specific proteins, such as ameloblastin and amelogenin, were also detected. Our findings reveal new insight into proteomics of DEJ and EOM, highly mineralized tissues that are obviously difficult to analyze.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2FCIjog

Interaction between interferon regulatory factor 6 and glycine receptor beta shows a protective effect on developing nonsyndromic cleft lip with or without cleft palate in the Han Chinese population

Single‐nucleotide polymorphisms (SNPs) in protein‐coding regions of genes which were previously reported to be associated with nonsyndromic cleft lip, with or without palate involvement (NSCL/P), were investigated. Twelve candidate loci [platelet‐derived growth factor C (PDGFC), platelet‐derived growth factor subunit A (PDGFA), platelet‐derived growth factor receptor alpha (PDGFRA), glycine receptor alpha 2 (GLRA2), glycine receptor beta (GLRB), ATP binding cassette subfamily A member 4 (ABCA4), MAF bZIP transcription factor B (MAFB), interferon regulatory factor 6 (IRF6), CCDC26 long non‐coding RNA (CCDC26), paired box 7 (PAX7), ventral anterior homeobox 1 (VAX1), and netrin 1 (NTN1)] covering 1.5 Mbp were sequenced in 136 NSCL/P patients and 54 healthy controls. Twenty‐five genomic variants identified were further validated in another 400 NSCL/P and 200 controls. Two SNPs in IRF6 showed a protective effect against the development of NSCL/P (rs12405750, OR = 0.54, 95% CI: 0.41–0.69; and rs2235371, OR = 0.55, 95% CI: 0.43–0.71). The missense variant, rs2235371, alters the conserved amino acid valine to isoleucine at codon 274 (V274I). We observed that SNPs at IRF6 (rs2235371 and rs12405750) and GLRB (rs73856838 and rs72685584) show consistent interaction effects. The association between the missense SNP rs2235371 in gene IRF6 and NSCL/P suggests that this SNP may play an important role as a risk factor for NSCL/P in the Han Chinese populations. The marginal signal near 4q31 detected in previous genome‐wide association studies might be caused by an interaction between the IRF6 and GLRB genes. This interaction needs to be further validated by experimentation in follow‐up studies.

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The effects of cryotherapy on vocal fold healing in a rabbit model

Objectives/Hypothesis

Cryotherapy has been shown to be a scarless treatment modality for dermal lesions; however, there are limited data addressing the effect of cryotherapy on vocal fold tissue. The aim of this study was to clarify the effectiveness of cryotherapy for prevention of postsurgical vocal fold scarring.

Study Design

Prospective animal study in rabbits.

Methods

The lamina propria of 20 rabbit vocal folds was bilaterally stripped, followed by randomized unilateral cryotherapy. Five larynges were harvested for real‐time polymerase chain reaction (RT‐PCR) analysis at 1 day, 3 days, and 7 days postinjury. The remaining five were harvested for histologic analysis at 3 months. Images of the healing phase were recorded by laryngoscopy. Analyses of RT‐PCR for cyclooxygenase (COX)‐2, interleukin (IL)‐6, collagen I, collagen III, matrix metallopeptidase 1 (MMP1), transforming growth factor β (TGFβ1), α smooth muscle actin (α‐SMA), and hyaluronan synthase 1 (HAS1) were completed. Histological samples were completed for collagen and hyaluronic acid analysis.

Results

RT‐PCR results revealed that higher expressions of HAS1 and MMP1 and lower expressions of COX‐2, IL‐6, collagen I, collagen III, TGFβ1, and α‐SMA were observed, and histological examination showed significantly increased hyaluronic acid, decreased deposition, and more organized configuration of collagen in injury with the cryotherapy cohort compared with the injury cohort.

Conclusions

Cryotherapy can inhibit the inflammatory reaction and simulate a fetal healing environment in extracellular matrix synthesis to regenerate vocal fold tissue with less fibrosis. Histological results showed that cryotherapy achieves a mature healing result with less scar, which tends to return to normal. In summary, the findings of this study suggest that administration of cryotherapy at the time of injury has the potential to minimize vocal fold scarring.

Level of Evidence

NA Laryngoscope, 2018

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Acute inflammatory response to contrast agent aspiration and its mechanisms in the rat lung

Objectives/Hypothesis

Contrast agent (CA) aspiration is an established complication of upper gastrointestinal and videofluoroscopic swallow studies. The underlying molecular biological mechanisms of acute response to CA aspiration in the respiratory organs remain unclear. The aims of this study were to elucidate the histological and biological influences of three kinds of CAs on the lung and to clarify the differences in acute responses.

Study Design

Animal model.

Methods

Eight‐week‐old male Sprague Dawley rats were divided into five groups (n = 6 in each group). Three groups underwent tracheal instillation of one of three different CAs: barium (Ba) sulfate, nonionic contrast agents (NICAs), and ionic contrast agents (ICAs). A control group was instilled with saline and a sham group was instilled with air. All animals were euthanized on day 2 after treatment and histological and gene analysis was performed.

Results

No animal died after CA or control/sham aspiration. Ba caused severe histopathologic changes and more prominent inflammatory cell infiltration in the lungs compared with the two other iodinated contrast agents. Increases in expressions of inflammatory cytokines (tumor necrosis factor [Tnf], interleukin‐1β [Il1b], and interferon‐γ [Ifng]) were observed in Ba aspiration rats, and upregulation of Il1b was seen in ICA aspiration rats. NICA did not cause obvious histologic changes or expressions of inflammatory cytokines and fibrosis‐related genes in the lungs.

Conclusions

Ba caused significantly more acute lung inflammation in a rodent model than did ioinic and nonionic iodinated CAs. Nonionic contrast did not cause any discernible inflammatory response in the lungs, suggesting that it may be the safest contrast for videofluoroscopic swallow studies.

Level of Evidence

NA

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Physician impact on the patient and family experience in a pediatric otolaryngology practice

Objective

On the Press Ganey (PG) survey, the item "likelihood of recommending practice" is a proxy for patient satisfaction because only the most satisfied patients will recommend a practice to friends and family. The objective of this study is to determine which other items on the PG survey best correlate with "likelihood of recommending practice" as a measure of patient satisfaction in pediatric otolaryngology.

Study Design

Retrospective analysis of a survey database.

Methods

The PG survey, consisting of 24 questions scaled from 1 to 5 representing (1) very poor, (2) poor, (3) fair, (4) good, and (5) very good, was sent to 28 different pediatric otolaryngology practices. Using the Pearson correlation coefficient, the statistical relationship of each PG survey question was analyzed in its association to the PG question "likelihood of recommending practice." Factors with a correlation coefficient greater than 0.65 were considered significant.

Results

Ten of 24 questions on the PG survey correlated with a top "likelihood of recommending practice" score. Eight of these 10 items were from the Care Provider category and were related to the physician–patient/family interaction.

Conclusion

Patient satisfaction surveys are utilized as a quality metric of the patient and family experience. These scores serve as one of several measures that affect reimbursement. The results demonstrate that most of the factors correlated with "likelihood of recommending practice" are provider‐based. In conclusion, the physician–patient interaction strongly influences the potential for a practice to earn top box scores on the PG item "likelihood of recommending practice" and thereby achieve the highest patient satisfaction.

Level of Evidence

NA. Laryngoscope, 2018

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Solving periprosthetic leakage with a novel prosthetic device

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Validation of a septoplasty deformity grading system for the evaluation of nasal obstruction

Objectives/Hypothesis

We developed and validated a septal deformity grading (SDG) system that accounts for anatomic location and grading of deformity severity.

Study Design

Retrospective cohort study.

Methods

Subjects were patients with nasal obstruction presenting to University of California, Irvine Medical Center. Subjects were given pre‐ and postoperative Nasal Obstruction Symptom Evaluation (NOSE) questionnaires and were evaluated by a facial plastic surgeon using our septal deformity grading (SDG) system. Validity and reliability analyses were conducted on the SDG results. Statistical analyses were conducted on SDG and NOSE data to assess and compare instruments, and to validate the SDG instrument using the NOSE instrument.

Results

One hundred thirty‐five patients met inclusion criteria. Cronbach's α was ≥ 0.7 for SDG and pre‐ and postoperative NOSE scores. There was a significant difference in pre‐ and postoperative NOSE scores (Z score = −7.21, P < .001). Correlations between postoperative NOSE and SDG scores were significant (P = .014), and convergent construct validity was achieved. There was a significant difference in SDG scores between primary versus revision operations (P < .001), history versus no history of nasal trauma, and nasal/septal surgery (P = .025, P = .003, respectively). The odds of having a revision operation were 2.3 times higher for high SDG scores (P < .001), of having a history of nasal trauma were 1.33 times higher for high SDG scores (P = .014), and of having a history of nasal/septal surgery were 2.9 times higher for low SDG scores.

Conclusions

Our SDG system addresses the challenge of providing objective anatomic information on the severity of nasal septal deformities, and may be valuable when used in conjunction with subjective data gathered from the NOSE questionnaire.

Level of Evidence

4 Laryngoscope, 2018

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Analysis of patient factors associated with 30‐day mortality after tracheostomy

Objective

Mortality has been reported to be 22% to 45% in patients with a tracheostomy. To better counsel patients and families, we aimed to determine the effect of body mass index (BMI), socioeconomic status (SES), and the 17 conditions of the Charlson comorbidity index (CCI) on 30‐day survival posttracheostomy.

Methods

This retrospective cohort study identified adult patients enrolled from our institution in the Global Tracheostomy Collaborative database from March 2014 to June 2015. Data collected included age, BMI, residential zip code, and comorbidities. Cox proportionate univariate and multivariate analyses were used to measure the impact of BMI, SES, and CCI variables with 30‐day posttracheostomy survival. We used geocoding as a surrogate for patients' SES. We used Deyo's modification of the CCI, which utilized International Classification of Diseases, 9th Revision, codes to identify comorbidities.

Results

Of 326 tracheostomies identified, the 30‐day mortality rate was 15.6%. No significant differences were noted in BMI or in any of the SES categories between survivors and nonsurvivors. CCI was significantly higher in the 30‐day mortality group. Congestive heart failure (hazard ratio [HR] = 2.39), severe liver disease (HR = 3.15), and peripheral vascular disease (HR = 2.62) were found to significantly impact 30‐day survival.

Conclusion

Higher CCI and specifically severe liver disease, congestive heart failure, and peripheral vascular disease were associated with increased 30‐day mortality posttracheostomy. No association was found between BMI or SES and 30‐day survival. This study identified three comorbidities that independently affect mortality in tracheostomy patients, which should be discussed with patients and families before tracheostomy.

Level of Evidence

3. Laryngoscope, 2018

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Do steroids improve recovery in vestibular neuritis?

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2PVPQmP

Should the Contralateral Tonsil Be Removed in Cases of HPV‐Positive Squamous Cell Carcinoma of the Tonsil?

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2R68Pro

Second primary lung malignancy following head and neck squamous cell carcinoma

Objectives/Hypothesis

Analyze the characteristics of second primary lung malignancies (SPLMs) following an index head and neck squamous cell carcinoma (HNSCC).

Study Design

Retrospective cohort study.

Methods

The Surveillance, Epidemiology and End Results database was queried for all cases of HNSCC between 1973 and 2014 (N = 101,856). This population was compared to a standard population to assess relative risk for lung cancer, calculated as the standardized incidence ratio (SIR). Patients who developed SPLMs were extracted (N = 8,116) and compared to all other cases of lung cancer (N = 1,160,853) to assess histopathological differences. SPLM subpopulations divided by head and neck primary site were compared for lung cancer histology and time interval between cancer diagnoses.

Results

Overall, 8.0% of HNSCC patients developed SPLMs (SIR = 4.22, P < .001), diagnosed an average of 6.7 years later. Patients with HNSCC of the supraglottis and hypopharynx were at the highest risk relative to a standard population, with SIRs of 8.10 and 6.34, respectively. When comparing SPLMs to all other lung cancers, there was no difference in the distribution of lung lobe affected, but SPLMs were significantly more likely to be of squamous cell carcinoma histology (42.0% vs. 21.0%, P < .001). Among head and neck subsites, lung cancers following larynx tumors had a significantly higher proportion of small cell histology, and those following oropharyngeal or hypopharyngeal tumors had significantly higher proportions of squamous cell histology.

Conclusions

Patients who undergo curative treatment of HNSCC are at high risk for developing SPLMs. Subsite‐specific differences may help elucidate the degree of risk attributable to smoking, genetic susceptibility, human papillomavirus infection, or metastasis masquerading as an SPLM.

Level of Evidence

4 Laryngoscope, 2018

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2PTAkaY

Levator claviculae muscle: Anatomic variation found during neck dissection

The levator claviculae muscle is a variant of the anatomy of the posterior triangle of the neck. It is reported in 2% to 3% of all humans. All previous articles described this muscle as an incidental finding during cadaveric or radiological examinations. We report here, for the first time, a case discovering this muscle variation intraoperatively during a modified radical neck dissection. The muscle was identified on the left side, originating from the transverse processes of the upper cervical vertebrae (C2‐C3), attached to the upper aspect of the middle part of the clavicle. This muscle was innervated by the supraclavicular nerve, coming from the third and fourth rami of the cervical spinal nerves. Blood supply to the muscle could not be identified clearly during the surgical procedure. Surgeons and radiologists should be aware of the presence of this rare variant muscle so as not to misinterpret the anatomy. Laryngoscope, 2018

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Feasibility of shotgun metagenomics to assess microbial ecology of pediatric tracheostomy tubes

Objective

Biofilm formation on medical devices such as tracheostomy tubes (TTs) is a serious problem. The clinical impact of biofilms on the airway is still unclear. Biofilms may play a role in granulation tissue development, recurrent airway infections, and failure of laryngotracheal reconstructions. The microbial ecology on TTs has yet to be elucidated. The purpose of this study was to determine the feasibility of shotgun metagenomics to assess the biodistribution of microorganisms on TTs.

Methods

Four TTs were collected from pediatric patients (1.4–10.2 years) with (n = 2) and without (n = 2) granulation tissue formation. Duration of TT placement prior to retrieval from patients ranged from 5 to 365 days. DNA extraction was performed using the MO BIO UltraClean Microbial Isolation (Mo Bio Laboratories, Carlsbad, CA). Library generation using Nextera XT adapters (Illumina Inc., San Diego, CA) and metagenomic shotgun sequencing was performed using the Illumina NextSeq500 (Illumina Inc, San Diego, CA). Salinibacter ruber, a species not found in mammalian microbiome communities, was used as a DNA standard and represented 0.7% to 5.7% of the microbiome, ensuring good quality and abundance of sample DNA.

Results

Metagenomic shotgun sequencing was successful for all patients. In TTs associated with granuloma, Fusobacterium nucleatum, Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae were predominant, most of which are considered pathogens. From TTs without granulomas, Neisseria mucosa, Neisseria sicca, Acinetobacter baumannii, and Haemophilus parainfluenzae were identified, primarily consistent with respiratory microbiome.

Conclusion

This study reveals that metagenomic shotgun sequencing of biofilms formed on pediatric TTs is feasible with an apparent difference in microbiome for patients with granulation tissue. Further studies are necessary to elucidate the pathogenesis of microbial ecology and its role in airway disease in patients with TTs.

Level of Evidence

2c. Laryngoscope, 2018

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The Impact of a Stepwise Approach to Primary Tumor Detection in Squamous Cell Carcinoma of the Neck With Unknown Primary

Objectives/Hypothesis

To examine the cumulative effect of diagnostic steps for primary tumor identification in patients with head and neck squamous cell carcinoma of unknown primary (HNSCCUP), including lingual tonsillectomy, and the impact of primary tumor identification on subsequent treatment.

Study Design

Retrospective analysis.

Methods

We reviewed the records of 110 patients diagnosed with HNSCCUP between 2003 and 2015. Results of diagnostic imaging (fluorodeoxyglucose‐positron emission tomography/computed tomography [FDG‐PET/CT]), tumor detection with direct laryngoscopy with biopsies, palatine tonsillectomy, and transoral robotic surgery (TORS) lingual tonsillectomy were recorded. Associations between demographic and treatment variables with overall survival (OS) and progression‐free survival (PFS) were modeled with Cox proportional hazards models.

Results

FDG‐PET/CT was suspicious for a primary site in 23/77 (30%) patients. Direct laryngoscopy identified a primary tumor in 34/110 patients (31%). Forty‐seven patients underwent palatine tonsillectomy, which identified 17 primaries (36%), yielding a cumulative primary tumor identification of 51/110 (46%). Fourteen patients underwent TORS lingual tonsillectomy, which identified eight primaries (57%), resulting in a cumulative identification of 59/110 (53%). The detection rate increased from 28/63 (44%) to 31/47 (66%) after the addition of TORS lingual tonsillectomy to our institutional approach. Detection rates varied by HPV status. Primary tumor identification altered subsequent radiation planning, as patients with an identified primary tumor received radiation to a smaller volume of tissue than did those without an identified primary tumor. However, there was no significant association between primary tumor identification and OS or PFS.

Conclusions

A stepwise approach to primary tumor identification identifies a primary tumor in a majority of patients.

Level of Evidence

4 Laryngoscope, 2018

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Olfactory function in mild cognitive impairment and Alzheimer's disease: A meta‐analysis

Objective

Olfactory function is altered in mild cognitive impairment (MCI) and Alzheimer's disease (AD); therefore, it may serve as a useful tool for the early detection of MCI before its advancement to AD. The aim of this meta‐analysis was to investigate olfactory deficits in patients with MCI and AD.

Study Design

Literature search.

Methods

A search was conducted of the electronic databases PubMed, Embase, and Web of Science from their inception until 2017. We included original articles with adequate data on the identification, threshold, and/or discrimination of olfactory function in MCI or AD. The standard mean difference and 95% confidence interval (CI) were calculated. The studies were weighted according to inverse variance estimates. The effect sizes were categorized as small [Cohen's d = 0.2], medium (d = 0.5), or large (d ≥ 0.8) based on these methods. Subgroup analyses were performed based on mean age and sex differences between the groups.

Results

Twelve articles (reporting 21 effects) examining 563 patients with MCI and 788 patients with AD, were included in the meta‐analysis. Compared to MCI, AD had moderate to large heterogeneous effects on olfactory function (Cohen's d = 0.64, 95% CI: 0.50, 0.78). Olfactory identification tests demonstrated larger effects (d = 0.71, 95% CI: 0.51, 0.91) than did tests of other olfactory domains.

Conclusions

Meta‐analysis results revealed that olfactory identification was more profoundly impaired in patients with AD than in those with MCI. These findings suggest that a simple test of odor identification is valuable in differentiating individuals at a risk of AD.

Level of Evidence

NA Laryngoscope, 2018

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Over–under versus medial tympanoplasty: Comparison of benefit, success, and hearing results

Objectives/Hypothesis

A hybrid variation of a tympanoplasty technique, termed over–under tympanoplasty (OUT), was evaluated to demonstrate the long‐term outcomes and complications compared to medial tympanoplasty.

Study Design

Retrospective review.

Methods

Patients who underwent a tympanoplasty between 2010 and 2015 were included. Primary outcome measures included graft healing at 18 months, change in air‐bone gap (ABG), and change in high‐frequency hearing at 8 kHz. The Shapiro‐Wilk test, Student t test, and nonparametric Mann‐Whitney test were used to compare results. Univariate logistic regression analysis was used to identify potential predictors of surgical success.

Results

One hundred eleven patients were included; 84 underwent the over–under technique and 27 underwent medial tympanoplasty. At the 18‐month follow‐up, 100% of patients in the medial tympanoplasty group had closure of the TM perforation compared to 84% (71/84) in the over–under group. In the over–under group, 12% of patients developed small or pinpoint perforations, and 4% developed larger, recurrent perforations. Mean improvement in ABG was similar between the two groups (11.6 dB for the medial group vs. 11.9 dB for the over–under group, P < .001). No hearing loss was noted in either group. No lateralization of the graft or anterior blunting was noted.

Conclusions

In this series, the OUT technique had a high success rate with TM perforations, including anterior, near total, and total perforations. Hearing loss from dissection on the malleus was not found. This approach blends the advantages and minimizes the disadvantages of the classic techniques and is well suited for all types of tympanic membrane perforations.

Level of Evidence

3b Laryngoscope, 2018

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Novel approach using transoral robotic surgery for resection of cervical spine chordoma

Chordomas are rare, infiltrative neoplasms of notochordal origin that present along the spinal canal; en bloc surgical resection is paramount to successful treatment. Limited visualization and complex anatomy are major challenges to resection of upper cervical spine chordomas and often require invasive surgery. A 27‐year‐old male presented with an incidentally discovered chordoma of the midline second cervical vertebra of the spine. To obtain en bloc resection of the lesion while both overcoming limitations due to access and without introducing morbidity from traditional anterior approaches, we elected using transoral robotic surgery for resection. Due to complete resection, the patient remains disease‐free and was spared adjuvant radiation. Laryngoscope, 2018

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Airway anomalies in patients with craniosynostosis

Objectives

1) Characterize the spectrum of airway anomalies in patients with craniosynostosis, and 2) identify clinical characteristics of these patients that may be associated with the development of airway anomalies.

Methods

This study is a retrospective case series assessing the type and frequency of airway anomalies in all patients with craniosynostosis seen at a tertiary‐care children's hospital between 2000 and 2016. Cohort analyses were then performed to identify differences in airway anomalies dependent on syndromic associations, multisutural fusion, and location of suture fusion. Clinical characteristics examined included demographics and additional neurologic and craniofacial abnormalities.

Results

Four hundred and ninety‐six patients with craniosynostosis (83.5% white, 64.5% male; 33.9% sagittal, 28.8% metopic, 11.5% coronal, 1.2% lambdoid, and 24.6% multisutural) were included. Notable airway anomalies included the following: 13.3% adenotonsillar hypertrophy, 8.9% laryngomalacia, 7.3% tracheomalacia, 7.1% subglottic stenosis, 4.0% bronchomalacia, 3.8% laryngeal cleft, and 1.2% vocal fold paresis. Multisutural craniosynostosis patients (n = 122) were more likely to have obstructive sleep apnea (P = 0.005), adenotonsillar hypertrophy (P = 0.014), tracheomalacia (P = 0.011), subglottic stenosis (P < 0.001), and epiglottic/base of tongue collapse (P = 0.003) and require tracheostomy (P = 0.001) and mechanical ventilation (P = 0.017) compared with single suture craniosynostosis. Syndromic craniosynostosis patients (n = 33) were more likely to have obstructive sleep apnea (P < 0.001), laryngomalacia (P = 0.047), and subglottic stenosis (P = 0.009) compared with nonsyndromic patients.

Conclusion

Airway anomalies are prevalent in patients with craniosynostosis; patients with multisutural or syndromic types have an increased risk of developing certain abnormalities. There should be a lower threshold for referral for airway evaluation in these populations.

Level of Evidence

4. Laryngoscope, 2018

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The effects of cryotherapy on vocal fold healing in a rabbit model

Objectives/Hypothesis

Cryotherapy has been shown to be a scarless treatment modality for dermal lesions; however, there are limited data addressing the effect of cryotherapy on vocal fold tissue. The aim of this study was to clarify the effectiveness of cryotherapy for prevention of postsurgical vocal fold scarring.

Study Design

Prospective animal study in rabbits.

Methods

The lamina propria of 20 rabbit vocal folds was bilaterally stripped, followed by randomized unilateral cryotherapy. Five larynges were harvested for real‐time polymerase chain reaction (RT‐PCR) analysis at 1 day, 3 days, and 7 days postinjury. The remaining five were harvested for histologic analysis at 3 months. Images of the healing phase were recorded by laryngoscopy. Analyses of RT‐PCR for cyclooxygenase (COX)‐2, interleukin (IL)‐6, collagen I, collagen III, matrix metallopeptidase 1 (MMP1), transforming growth factor β (TGFβ1), α smooth muscle actin (α‐SMA), and hyaluronan synthase 1 (HAS1) were completed. Histological samples were completed for collagen and hyaluronic acid analysis.

Results

RT‐PCR results revealed that higher expressions of HAS1 and MMP1 and lower expressions of COX‐2, IL‐6, collagen I, collagen III, TGFβ1, and α‐SMA were observed, and histological examination showed significantly increased hyaluronic acid, decreased deposition, and more organized configuration of collagen in injury with the cryotherapy cohort compared with the injury cohort.

Conclusions

Cryotherapy can inhibit the inflammatory reaction and simulate a fetal healing environment in extracellular matrix synthesis to regenerate vocal fold tissue with less fibrosis. Histological results showed that cryotherapy achieves a mature healing result with less scar, which tends to return to normal. In summary, the findings of this study suggest that administration of cryotherapy at the time of injury has the potential to minimize vocal fold scarring.

Level of Evidence

NA Laryngoscope, 2018

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Acute inflammatory response to contrast agent aspiration and its mechanisms in the rat lung

Objectives/Hypothesis

Contrast agent (CA) aspiration is an established complication of upper gastrointestinal and videofluoroscopic swallow studies. The underlying molecular biological mechanisms of acute response to CA aspiration in the respiratory organs remain unclear. The aims of this study were to elucidate the histological and biological influences of three kinds of CAs on the lung and to clarify the differences in acute responses.

Study Design

Animal model.

Methods

Eight‐week‐old male Sprague Dawley rats were divided into five groups (n = 6 in each group). Three groups underwent tracheal instillation of one of three different CAs: barium (Ba) sulfate, nonionic contrast agents (NICAs), and ionic contrast agents (ICAs). A control group was instilled with saline and a sham group was instilled with air. All animals were euthanized on day 2 after treatment and histological and gene analysis was performed.

Results

No animal died after CA or control/sham aspiration. Ba caused severe histopathologic changes and more prominent inflammatory cell infiltration in the lungs compared with the two other iodinated contrast agents. Increases in expressions of inflammatory cytokines (tumor necrosis factor [Tnf], interleukin‐1β [Il1b], and interferon‐γ [Ifng]) were observed in Ba aspiration rats, and upregulation of Il1b was seen in ICA aspiration rats. NICA did not cause obvious histologic changes or expressions of inflammatory cytokines and fibrosis‐related genes in the lungs.

Conclusions

Ba caused significantly more acute lung inflammation in a rodent model than did ioinic and nonionic iodinated CAs. Nonionic contrast did not cause any discernible inflammatory response in the lungs, suggesting that it may be the safest contrast for videofluoroscopic swallow studies.

Level of Evidence

NA

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Physician impact on the patient and family experience in a pediatric otolaryngology practice

Objective

On the Press Ganey (PG) survey, the item "likelihood of recommending practice" is a proxy for patient satisfaction because only the most satisfied patients will recommend a practice to friends and family. The objective of this study is to determine which other items on the PG survey best correlate with "likelihood of recommending practice" as a measure of patient satisfaction in pediatric otolaryngology.

Study Design

Retrospective analysis of a survey database.

Methods

The PG survey, consisting of 24 questions scaled from 1 to 5 representing (1) very poor, (2) poor, (3) fair, (4) good, and (5) very good, was sent to 28 different pediatric otolaryngology practices. Using the Pearson correlation coefficient, the statistical relationship of each PG survey question was analyzed in its association to the PG question "likelihood of recommending practice." Factors with a correlation coefficient greater than 0.65 were considered significant.

Results

Ten of 24 questions on the PG survey correlated with a top "likelihood of recommending practice" score. Eight of these 10 items were from the Care Provider category and were related to the physician–patient/family interaction.

Conclusion

Patient satisfaction surveys are utilized as a quality metric of the patient and family experience. These scores serve as one of several measures that affect reimbursement. The results demonstrate that most of the factors correlated with "likelihood of recommending practice" are provider‐based. In conclusion, the physician–patient interaction strongly influences the potential for a practice to earn top box scores on the PG item "likelihood of recommending practice" and thereby achieve the highest patient satisfaction.

Level of Evidence

NA. Laryngoscope, 2018

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Solving periprosthetic leakage with a novel prosthetic device

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Validation of a septoplasty deformity grading system for the evaluation of nasal obstruction

Objectives/Hypothesis

We developed and validated a septal deformity grading (SDG) system that accounts for anatomic location and grading of deformity severity.

Study Design

Retrospective cohort study.

Methods

Subjects were patients with nasal obstruction presenting to University of California, Irvine Medical Center. Subjects were given pre‐ and postoperative Nasal Obstruction Symptom Evaluation (NOSE) questionnaires and were evaluated by a facial plastic surgeon using our septal deformity grading (SDG) system. Validity and reliability analyses were conducted on the SDG results. Statistical analyses were conducted on SDG and NOSE data to assess and compare instruments, and to validate the SDG instrument using the NOSE instrument.

Results

One hundred thirty‐five patients met inclusion criteria. Cronbach's α was ≥ 0.7 for SDG and pre‐ and postoperative NOSE scores. There was a significant difference in pre‐ and postoperative NOSE scores (Z score = −7.21, P < .001). Correlations between postoperative NOSE and SDG scores were significant (P = .014), and convergent construct validity was achieved. There was a significant difference in SDG scores between primary versus revision operations (P < .001), history versus no history of nasal trauma, and nasal/septal surgery (P = .025, P = .003, respectively). The odds of having a revision operation were 2.3 times higher for high SDG scores (P < .001), of having a history of nasal trauma were 1.33 times higher for high SDG scores (P = .014), and of having a history of nasal/septal surgery were 2.9 times higher for low SDG scores.

Conclusions

Our SDG system addresses the challenge of providing objective anatomic information on the severity of nasal septal deformities, and may be valuable when used in conjunction with subjective data gathered from the NOSE questionnaire.

Level of Evidence

4 Laryngoscope, 2018

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Medialization laryngoplasty/arytenoid adduction: U.S. outcomes, discharge status, and utilization trends

Objectives/Hypothesis

To evaluate trends, outcomes, and healthcare utilization following medialization laryngoplasty (ML) with or without arytenoid adduction (AA) over 10 years.

Study Design

Retrospective observational study.

Methods

Using OptumLabs Data Warehouse, trends, outcomes, and healthcare utilization from 2006 to 2015 were examined with a focus on discharge type (same day or not). Predictors of postoperative emergency department (ED) use and hospitalization were determined by multivariable logistic regression.

Results

Overall rate of ML was 1.09 per 100 thousand enrollees per year. Of these, 7.8% ML were combined with an AA. Outpatient same‐day discharge represented 62.0% (1,142 of 1,843) of total patients, steadily increasing over the 10‐year period (P < 0.01). There was a 5.9% revision ML rate and 1.0% rate of tracheotomy within 1 day of ML. A total of 5.6% visited an ED, and 5.4% were admitted to a hospital following initial discharge within 30 days. Same‐day discharge was found to be a predictor of hospitalization within 30 days after ML (odds ratio [OR] 1.74, P = 0.0452), along with Elixhauser comorbidity index of 4 + (OR 5.74, P = 0.0001). Pulmonary embolism, pulmonary hypertension, and weight loss were top predictors of ED visit or hospitalization.

Conclusion

To our knowledge, this is the first search evaluating national claims data for ML with or without AA. Overall rate of ML is low, and same‐day discharge has become more common over a 10‐year period, with an associated higher 30‐day hospital admission risk. Correct patient selection criteria for disposition status cannot be fully determined based on current data, but a high Elixhauser comorbidity index clearly carries increased risk for hospitalization after initial discharge.

Level of Evidence

4. Laryngoscope, 2018

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Analysis of patient factors associated with 30‐day mortality after tracheostomy

Objective

Mortality has been reported to be 22% to 45% in patients with a tracheostomy. To better counsel patients and families, we aimed to determine the effect of body mass index (BMI), socioeconomic status (SES), and the 17 conditions of the Charlson comorbidity index (CCI) on 30‐day survival posttracheostomy.

Methods

This retrospective cohort study identified adult patients enrolled from our institution in the Global Tracheostomy Collaborative database from March 2014 to June 2015. Data collected included age, BMI, residential zip code, and comorbidities. Cox proportionate univariate and multivariate analyses were used to measure the impact of BMI, SES, and CCI variables with 30‐day posttracheostomy survival. We used geocoding as a surrogate for patients' SES. We used Deyo's modification of the CCI, which utilized International Classification of Diseases, 9th Revision, codes to identify comorbidities.

Results

Of 326 tracheostomies identified, the 30‐day mortality rate was 15.6%. No significant differences were noted in BMI or in any of the SES categories between survivors and nonsurvivors. CCI was significantly higher in the 30‐day mortality group. Congestive heart failure (hazard ratio [HR] = 2.39), severe liver disease (HR = 3.15), and peripheral vascular disease (HR = 2.62) were found to significantly impact 30‐day survival.

Conclusion

Higher CCI and specifically severe liver disease, congestive heart failure, and peripheral vascular disease were associated with increased 30‐day mortality posttracheostomy. No association was found between BMI or SES and 30‐day survival. This study identified three comorbidities that independently affect mortality in tracheostomy patients, which should be discussed with patients and families before tracheostomy.

Level of Evidence

3. Laryngoscope, 2018

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Do steroids improve recovery in vestibular neuritis?

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2PVPQmP

Should the Contralateral Tonsil Be Removed in Cases of HPV‐Positive Squamous Cell Carcinoma of the Tonsil?

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2R68Pro

Second primary lung malignancy following head and neck squamous cell carcinoma

Objectives/Hypothesis

Analyze the characteristics of second primary lung malignancies (SPLMs) following an index head and neck squamous cell carcinoma (HNSCC).

Study Design

Retrospective cohort study.

Methods

The Surveillance, Epidemiology and End Results database was queried for all cases of HNSCC between 1973 and 2014 (N = 101,856). This population was compared to a standard population to assess relative risk for lung cancer, calculated as the standardized incidence ratio (SIR). Patients who developed SPLMs were extracted (N = 8,116) and compared to all other cases of lung cancer (N = 1,160,853) to assess histopathological differences. SPLM subpopulations divided by head and neck primary site were compared for lung cancer histology and time interval between cancer diagnoses.

Results

Overall, 8.0% of HNSCC patients developed SPLMs (SIR = 4.22, P < .001), diagnosed an average of 6.7 years later. Patients with HNSCC of the supraglottis and hypopharynx were at the highest risk relative to a standard population, with SIRs of 8.10 and 6.34, respectively. When comparing SPLMs to all other lung cancers, there was no difference in the distribution of lung lobe affected, but SPLMs were significantly more likely to be of squamous cell carcinoma histology (42.0% vs. 21.0%, P < .001). Among head and neck subsites, lung cancers following larynx tumors had a significantly higher proportion of small cell histology, and those following oropharyngeal or hypopharyngeal tumors had significantly higher proportions of squamous cell histology.

Conclusions

Patients who undergo curative treatment of HNSCC are at high risk for developing SPLMs. Subsite‐specific differences may help elucidate the degree of risk attributable to smoking, genetic susceptibility, human papillomavirus infection, or metastasis masquerading as an SPLM.

Level of Evidence

4 Laryngoscope, 2018

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2PTAkaY

Levator claviculae muscle: Anatomic variation found during neck dissection

The levator claviculae muscle is a variant of the anatomy of the posterior triangle of the neck. It is reported in 2% to 3% of all humans. All previous articles described this muscle as an incidental finding during cadaveric or radiological examinations. We report here, for the first time, a case discovering this muscle variation intraoperatively during a modified radical neck dissection. The muscle was identified on the left side, originating from the transverse processes of the upper cervical vertebrae (C2‐C3), attached to the upper aspect of the middle part of the clavicle. This muscle was innervated by the supraclavicular nerve, coming from the third and fourth rami of the cervical spinal nerves. Blood supply to the muscle could not be identified clearly during the surgical procedure. Surgeons and radiologists should be aware of the presence of this rare variant muscle so as not to misinterpret the anatomy. Laryngoscope, 2018

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2RbTCVE

Feasibility of shotgun metagenomics to assess microbial ecology of pediatric tracheostomy tubes

Objective

Biofilm formation on medical devices such as tracheostomy tubes (TTs) is a serious problem. The clinical impact of biofilms on the airway is still unclear. Biofilms may play a role in granulation tissue development, recurrent airway infections, and failure of laryngotracheal reconstructions. The microbial ecology on TTs has yet to be elucidated. The purpose of this study was to determine the feasibility of shotgun metagenomics to assess the biodistribution of microorganisms on TTs.

Methods

Four TTs were collected from pediatric patients (1.4–10.2 years) with (n = 2) and without (n = 2) granulation tissue formation. Duration of TT placement prior to retrieval from patients ranged from 5 to 365 days. DNA extraction was performed using the MO BIO UltraClean Microbial Isolation (Mo Bio Laboratories, Carlsbad, CA). Library generation using Nextera XT adapters (Illumina Inc., San Diego, CA) and metagenomic shotgun sequencing was performed using the Illumina NextSeq500 (Illumina Inc, San Diego, CA). Salinibacter ruber, a species not found in mammalian microbiome communities, was used as a DNA standard and represented 0.7% to 5.7% of the microbiome, ensuring good quality and abundance of sample DNA.

Results

Metagenomic shotgun sequencing was successful for all patients. In TTs associated with granuloma, Fusobacterium nucleatum, Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae were predominant, most of which are considered pathogens. From TTs without granulomas, Neisseria mucosa, Neisseria sicca, Acinetobacter baumannii, and Haemophilus parainfluenzae were identified, primarily consistent with respiratory microbiome.

Conclusion

This study reveals that metagenomic shotgun sequencing of biofilms formed on pediatric TTs is feasible with an apparent difference in microbiome for patients with granulation tissue. Further studies are necessary to elucidate the pathogenesis of microbial ecology and its role in airway disease in patients with TTs.

Level of Evidence

2c. Laryngoscope, 2018

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The Impact of a Stepwise Approach to Primary Tumor Detection in Squamous Cell Carcinoma of the Neck With Unknown Primary

Objectives/Hypothesis

To examine the cumulative effect of diagnostic steps for primary tumor identification in patients with head and neck squamous cell carcinoma of unknown primary (HNSCCUP), including lingual tonsillectomy, and the impact of primary tumor identification on subsequent treatment.

Study Design

Retrospective analysis.

Methods

We reviewed the records of 110 patients diagnosed with HNSCCUP between 2003 and 2015. Results of diagnostic imaging (fluorodeoxyglucose‐positron emission tomography/computed tomography [FDG‐PET/CT]), tumor detection with direct laryngoscopy with biopsies, palatine tonsillectomy, and transoral robotic surgery (TORS) lingual tonsillectomy were recorded. Associations between demographic and treatment variables with overall survival (OS) and progression‐free survival (PFS) were modeled with Cox proportional hazards models.

Results

FDG‐PET/CT was suspicious for a primary site in 23/77 (30%) patients. Direct laryngoscopy identified a primary tumor in 34/110 patients (31%). Forty‐seven patients underwent palatine tonsillectomy, which identified 17 primaries (36%), yielding a cumulative primary tumor identification of 51/110 (46%). Fourteen patients underwent TORS lingual tonsillectomy, which identified eight primaries (57%), resulting in a cumulative identification of 59/110 (53%). The detection rate increased from 28/63 (44%) to 31/47 (66%) after the addition of TORS lingual tonsillectomy to our institutional approach. Detection rates varied by HPV status. Primary tumor identification altered subsequent radiation planning, as patients with an identified primary tumor received radiation to a smaller volume of tissue than did those without an identified primary tumor. However, there was no significant association between primary tumor identification and OS or PFS.

Conclusions

A stepwise approach to primary tumor identification identifies a primary tumor in a majority of patients.

Level of Evidence

4 Laryngoscope, 2018

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Olfactory function in mild cognitive impairment and Alzheimer's disease: A meta‐analysis

Objective

Olfactory function is altered in mild cognitive impairment (MCI) and Alzheimer's disease (AD); therefore, it may serve as a useful tool for the early detection of MCI before its advancement to AD. The aim of this meta‐analysis was to investigate olfactory deficits in patients with MCI and AD.

Study Design

Literature search.

Methods

A search was conducted of the electronic databases PubMed, Embase, and Web of Science from their inception until 2017. We included original articles with adequate data on the identification, threshold, and/or discrimination of olfactory function in MCI or AD. The standard mean difference and 95% confidence interval (CI) were calculated. The studies were weighted according to inverse variance estimates. The effect sizes were categorized as small [Cohen's d = 0.2], medium (d = 0.5), or large (d ≥ 0.8) based on these methods. Subgroup analyses were performed based on mean age and sex differences between the groups.

Results

Twelve articles (reporting 21 effects) examining 563 patients with MCI and 788 patients with AD, were included in the meta‐analysis. Compared to MCI, AD had moderate to large heterogeneous effects on olfactory function (Cohen's d = 0.64, 95% CI: 0.50, 0.78). Olfactory identification tests demonstrated larger effects (d = 0.71, 95% CI: 0.51, 0.91) than did tests of other olfactory domains.

Conclusions

Meta‐analysis results revealed that olfactory identification was more profoundly impaired in patients with AD than in those with MCI. These findings suggest that a simple test of odor identification is valuable in differentiating individuals at a risk of AD.

Level of Evidence

NA Laryngoscope, 2018

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Over–under versus medial tympanoplasty: Comparison of benefit, success, and hearing results

Objectives/Hypothesis

A hybrid variation of a tympanoplasty technique, termed over–under tympanoplasty (OUT), was evaluated to demonstrate the long‐term outcomes and complications compared to medial tympanoplasty.

Study Design

Retrospective review.

Methods

Patients who underwent a tympanoplasty between 2010 and 2015 were included. Primary outcome measures included graft healing at 18 months, change in air‐bone gap (ABG), and change in high‐frequency hearing at 8 kHz. The Shapiro‐Wilk test, Student t test, and nonparametric Mann‐Whitney test were used to compare results. Univariate logistic regression analysis was used to identify potential predictors of surgical success.

Results

One hundred eleven patients were included; 84 underwent the over–under technique and 27 underwent medial tympanoplasty. At the 18‐month follow‐up, 100% of patients in the medial tympanoplasty group had closure of the TM perforation compared to 84% (71/84) in the over–under group. In the over–under group, 12% of patients developed small or pinpoint perforations, and 4% developed larger, recurrent perforations. Mean improvement in ABG was similar between the two groups (11.6 dB for the medial group vs. 11.9 dB for the over–under group, P < .001). No hearing loss was noted in either group. No lateralization of the graft or anterior blunting was noted.

Conclusions

In this series, the OUT technique had a high success rate with TM perforations, including anterior, near total, and total perforations. Hearing loss from dissection on the malleus was not found. This approach blends the advantages and minimizes the disadvantages of the classic techniques and is well suited for all types of tympanic membrane perforations.

Level of Evidence

3b Laryngoscope, 2018

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Novel approach using transoral robotic surgery for resection of cervical spine chordoma

Chordomas are rare, infiltrative neoplasms of notochordal origin that present along the spinal canal; en bloc surgical resection is paramount to successful treatment. Limited visualization and complex anatomy are major challenges to resection of upper cervical spine chordomas and often require invasive surgery. A 27‐year‐old male presented with an incidentally discovered chordoma of the midline second cervical vertebra of the spine. To obtain en bloc resection of the lesion while both overcoming limitations due to access and without introducing morbidity from traditional anterior approaches, we elected using transoral robotic surgery for resection. Due to complete resection, the patient remains disease‐free and was spared adjuvant radiation. Laryngoscope, 2018

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Airway anomalies in patients with craniosynostosis

Objectives

1) Characterize the spectrum of airway anomalies in patients with craniosynostosis, and 2) identify clinical characteristics of these patients that may be associated with the development of airway anomalies.

Methods

This study is a retrospective case series assessing the type and frequency of airway anomalies in all patients with craniosynostosis seen at a tertiary‐care children's hospital between 2000 and 2016. Cohort analyses were then performed to identify differences in airway anomalies dependent on syndromic associations, multisutural fusion, and location of suture fusion. Clinical characteristics examined included demographics and additional neurologic and craniofacial abnormalities.

Results

Four hundred and ninety‐six patients with craniosynostosis (83.5% white, 64.5% male; 33.9% sagittal, 28.8% metopic, 11.5% coronal, 1.2% lambdoid, and 24.6% multisutural) were included. Notable airway anomalies included the following: 13.3% adenotonsillar hypertrophy, 8.9% laryngomalacia, 7.3% tracheomalacia, 7.1% subglottic stenosis, 4.0% bronchomalacia, 3.8% laryngeal cleft, and 1.2% vocal fold paresis. Multisutural craniosynostosis patients (n = 122) were more likely to have obstructive sleep apnea (P = 0.005), adenotonsillar hypertrophy (P = 0.014), tracheomalacia (P = 0.011), subglottic stenosis (P < 0.001), and epiglottic/base of tongue collapse (P = 0.003) and require tracheostomy (P = 0.001) and mechanical ventilation (P = 0.017) compared with single suture craniosynostosis. Syndromic craniosynostosis patients (n = 33) were more likely to have obstructive sleep apnea (P < 0.001), laryngomalacia (P = 0.047), and subglottic stenosis (P = 0.009) compared with nonsyndromic patients.

Conclusion

Airway anomalies are prevalent in patients with craniosynostosis; patients with multisutural or syndromic types have an increased risk of developing certain abnormalities. There should be a lower threshold for referral for airway evaluation in these populations.

Level of Evidence

4. Laryngoscope, 2018

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Progression of hearing loss in neurofibromatosis type 2 according to genetic severity

Objectives/Hypothesis

This study set out to describe the progression of hearing loss in patients with neurofibromatosis type 2 (NF2), treated in a quaternary multidisciplinary clinic. It also aimed to compare hearing loss across patients grouped according to a known genetic severity score to explore its utility for prognostication.

Study Design

Retrospective cohort study.

Methods

We conducted a study of 147 patients with confirmed NF2 diagnosis for a mean observational period of 10 years. Pure‐tone average (PTA), optimum discriminations scores (ODS), and genotype data were collected. Patients were classified according to hearing class (American Academy of Otolaryngology), their candidacy for auditory implantation (UK National NF2 consensus) and grouped by genetic severity as: 1 = tissue mosaic, 2A = mild classic, 2B = moderate classic, and 3 = severe. Survival analysis investigated the effect of genetic severity on the age of loss of serviceable hearing.

Results

Genetic severity was a significant predictor of hearing outcomes such as ODS, hearing classification, and maximum annual PTA deterioration. Although the overall median age of loss of serviceable hearing was 78 years, there was significant variation according to the genetic severity; the median for severe patients was 32 years compared to a median of 80 for tissue mosaic patients.

Conclusions

This is the first description of long‐term hearing outcomes in a clinical setting across a large heterogeneous cohort of patients with NF2. The results highlight the potential importance and benefit of considering the genetic severity score of patients when undertaking treatment decisions, as well as planning future natural history studies.

Level of Evidence

2c Laryngoscope, 2018

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Using word clouds to Re‐envision letters of recommendation for residency applicants

Objectives/Hypothesis

To develop a "word cloud"–based visual letter of recommendation (VLOR) and to evaluate its efficiency in discerning applicant quality compared to narrative letters of recommendation (NLORs).

Study Design

Cross‐sectional cohort study.

Methods

NLORs for 48 otolaryngology residency applicants interviewed from the 2016 application cycle were identified and mined for descriptive terms to generate a word cloud, referred to as a VLOR. Eight individuals reviewed and rated a total of 187 blinded NLORs and 48 VLORs on a four‐point scale (negative to exceptional). Median VLOR and NLOR scores and the time to review for each candidate were compared using the Wilcoxon signed rank test.

Results

It took significantly more time to review the NLORs in comparison to the VLORs (67 seconds, interquartile range [IQR]: 41–98 seconds vs. 17 seconds, IQR: 11–26 seconds, P < .001). There was no significant difference between median scores for VLORs and NLORs (P = .136). Review time and score correlated positively for VLORs and was statistically significant (ρ = 0.459, P = .001), indicating that more time spent reviewing equates to higher scores. The same relationship appeared with NLORs, but was not statistically significant (ρ = 0.276, P = .058).

Conclusions

VLORs are a novel and efficient additive tool for screening candidates for otolaryngology residency interview slots. Their scores do not significantly vary from NLOR scores and are significantly faster to evaluate.

Level of Evidence

2b Laryngoscope, 2018

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Titanium dental implants with different collar design and surface modifications: a systematic review on survival rates and marginal bone levels

Abstract

Aim

To compare clinical and radiographic outcomes of dental implants with different neck characteristics.

Methods

A protocol‐oriented search aimed at the question: "In patients subjected to tooth replacement with screw‐type dental implants does the modification of the implant neck macro or micro‐geometry contribute to the improvement of survival rates and maintenance of the peri‐implant marginal bone levels?" Primary outcomes were survival and marginal bone level (MBL) changes evaluated on randomized controlled trials with >10 participants and follow‐up >1 year. Risk of bias was evaluated using the Cochrane Collaboration's tool. The review follows the PRISMA statement.

Results

Forty‐three studies compared: 1. One‐ versus two‐piece implants (N=7); 2. Two‐piece implants with different neck characteristics (machined and rough collars, microthreads, LASER microtexturing) (N=21); 3. Two‐piece implants with macrogeometry modifications (tapering, back‐tapering and scalloping) (N=6). One‐ and two‐piece implants showed similar survival (RR= 0.45, 95% CI: [0.12, 1.66], p=0.23) and MBL changes (WMD=0.09mm, 95% CI: [‐0.27, 0.45], p=0.64) at 1‐year post‐loading. Machined collar implants have higher risk of early failure than rough collar implants (RR= 3.96, 95% CI: [1.12, 13.93], p=0.03) and 0.43mm higher bone resorption (95% CI: [0.0, 0.86], p=0.05). Microthreads (WMD= 0.07mm, 95% CI: [‐0.01, 0.15], p=0.10) and LASER microtexturing (WMD=0.15mm, 95% CI: [‐0.35, 0.65], p=0.56) do not reduce bone resorption. Scalloped implants have 1.26mm higher resorption (95% CI: [0.72, 2.00], p<0.001).

Conclusions

One‐ and two‐piece implants have similar survival and MBL changes. Rough collar implants have lower MBL changes than machined collar implants. Additional modifications to rough collars are irrelevant.

This article is protected by copyright. All rights reserved.

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Disseminated Trichosporonosis with Atypical Histology Findings in a Patient with Acute Lymphocytic Leukemia

We report a case of disseminated Trichosporon asahii in a patient on systemic anti‐fungal therapy who presented with multiple cutaneous nodules suggestive of fungal infection. Histologic features resembled neutrophilic eccrine hidradenitis but staining with periodic acid‐Schiff and Gomori methenamine silver confirmed the clinical diagnosis. This case highlights the importance of maintaining suspicion for trichosporonosis and contextualizing histologic findings within the underlying clinical picture.

This article is protected by copyright. All rights reserved.

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Disseminated Trichosporonosis with Atypical Histology Findings in a Patient with Acute Lymphocytic Leukemia

We report a case of disseminated Trichosporon asahii in a patient on systemic anti‐fungal therapy who presented with multiple cutaneous nodules suggestive of fungal infection. Histologic features resembled neutrophilic eccrine hidradenitis but staining with periodic acid‐Schiff and Gomori methenamine silver confirmed the clinical diagnosis. This case highlights the importance of maintaining suspicion for trichosporonosis and contextualizing histologic findings within the underlying clinical picture.

This article is protected by copyright. All rights reserved.

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Student and foundation doctor perspectives on promoting entry to ENT specialist training

Abstract

In recent years, there has been a decline in the number of applications per ST3 post for ENT. The majority of medical students and foundation doctors have a limited exposure to ENT during undergraduate medical training. This is a common issue in smaller surgical specialties, and is acknowledged as one factor deterring students from surgical careers.

This article is protected by copyright. All rights reserved.

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Student and foundation doctor perspectives on promoting entry to ENT specialist training

Abstract

In recent years, there has been a decline in the number of applications per ST3 post for ENT. The majority of medical students and foundation doctors have a limited exposure to ENT during undergraduate medical training. This is a common issue in smaller surgical specialties, and is acknowledged as one factor deterring students from surgical careers.

This article is protected by copyright. All rights reserved.

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T1ρ and T2 mapping for the determination of articular cartilage denaturalization with osteonecrosis of the femoral head: A prospective controlled trial

Background

In the future, biochemical MRI might provide a valuable noninvasive quantitative analysis of the biochemical composition of cartilage in osteonecrosis of the femoral head (ONFH).

Purpose

To investigate the diagnostic performance of T₁ρ and T₂ mapping in cartilage denaturalization with ONFH and to determine the correlation between T₁ρ and T₂ mapping and the Association Research Circulation Osseous (ARCO) stage.

Study Type

Prospective.

Subjects

Forty‐seven patients with ONFH (stage I to III according to the ARCO criteria) and 24 volunteers (control group) were recruited for the prospective study.

Sequence

Conventional MRI, multiple echo recalled gradient echo (MERGE), and T₁ρ and T₂ mapping sequences.

Assessment

Pseudocolor images and MERGE images were combined in the AW4.5 workstation. The region of interest (ROI) of the hip cartilage was 4–6 mm². The sagittal T₁ρ and T₂ mapping values were calculated by the two first authors.

Statistical Tests

One‐way analysis of variance (ANOVA), LSD t‐tests, Pearson correlation analysis, and receiver operator characteristic (ROC) curves. The significance level was set at P < 0.05.

Results

The T₁ρ and T₂ mapping values of the ONFH group were significantly higher than the values of the control group (P = 0.000). Regarding the assessment of the severity of ARCO staging, both T₁ρ (r = 0.66, P = 0.004) and T₂ mapping (r = 0.501, P = 0.002) were positively associated with disease severity. The T₁ρ values were positively correlated with the T₂ mapping values (r = 0.381, P = 0.000). The areas under the curve (AUC) for the T₁ρ and T₂ mapping values were 0.822 and 0.791, respectively. The diagnostic sensitivity and specificity were 72.34% and 70.83% for T₁ρ mapping and 72.34% and 58.33%, respectively, for T₂ mapping.

Data Conclusion

Both T₁ρ and T₂ mapping performed well in diagnosing the cartilage denaturalization in ARCO stage I‐III ONFH patients. T₁ρ mapping had a higher diagnostic sensitivity and specificity than T₂ mapping.

Level of Evidence: 2

Technical Efficacy: Stage 2

J. Magn. Reson. Imaging 2018.

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T1ρ and T2 mapping for the determination of articular cartilage denaturalization with osteonecrosis of the femoral head: A prospective controlled trial

Background

In the future, biochemical MRI might provide a valuable noninvasive quantitative analysis of the biochemical composition of cartilage in osteonecrosis of the femoral head (ONFH).

Purpose

To investigate the diagnostic performance of T₁ρ and T₂ mapping in cartilage denaturalization with ONFH and to determine the correlation between T₁ρ and T₂ mapping and the Association Research Circulation Osseous (ARCO) stage.

Study Type

Prospective.

Subjects

Forty‐seven patients with ONFH (stage I to III according to the ARCO criteria) and 24 volunteers (control group) were recruited for the prospective study.

Sequence

Conventional MRI, multiple echo recalled gradient echo (MERGE), and T₁ρ and T₂ mapping sequences.

Assessment

Pseudocolor images and MERGE images were combined in the AW4.5 workstation. The region of interest (ROI) of the hip cartilage was 4–6 mm². The sagittal T₁ρ and T₂ mapping values were calculated by the two first authors.

Statistical Tests

One‐way analysis of variance (ANOVA), LSD t‐tests, Pearson correlation analysis, and receiver operator characteristic (ROC) curves. The significance level was set at P < 0.05.

Results

The T₁ρ and T₂ mapping values of the ONFH group were significantly higher than the values of the control group (P = 0.000). Regarding the assessment of the severity of ARCO staging, both T₁ρ (r = 0.66, P = 0.004) and T₂ mapping (r = 0.501, P = 0.002) were positively associated with disease severity. The T₁ρ values were positively correlated with the T₂ mapping values (r = 0.381, P = 0.000). The areas under the curve (AUC) for the T₁ρ and T₂ mapping values were 0.822 and 0.791, respectively. The diagnostic sensitivity and specificity were 72.34% and 70.83% for T₁ρ mapping and 72.34% and 58.33%, respectively, for T₂ mapping.

Data Conclusion

Both T₁ρ and T₂ mapping performed well in diagnosing the cartilage denaturalization in ARCO stage I‐III ONFH patients. T₁ρ mapping had a higher diagnostic sensitivity and specificity than T₂ mapping.

Level of Evidence: 2

Technical Efficacy: Stage 2

J. Magn. Reson. Imaging 2018.

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Two cases of occupational allergic contact dermatitis caused by abacavir

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Sensitivity to imidazoles/nitroimidazoles in subjects sensitized to methylchloroisothiazolinone/methylisothiazolinone: A simple coincidence?

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Phytophotodermatitis related to Peucedanumpaniculatum Loisel , a case report

Phytophotodermatitis is a skin reaction due to ultraviolet light exposure after previous contact with a photosensitising plant compound such as furocoumarins. Phytophotodermatitis are often described with lime (1), fig leaves (2) or celery (3). We report the case of a 60‐years‐old man who developed phytophotodermatitis after encountering Peucedanum paniculatum Loisel during a walk in Corsica, France.

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Fixed drug eruption caused by fulvestrant confirmed by skin tests: First case

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Patch testing with alkyl glucosides: concomitant reactions are common but not ubiquitous

Background

Alkyl glucosides are a family of mild surfactants that are increasingly used in a wide range of cosmetics and household products. Contact allergy to alkyl glucosides may be more frequent than previously suspected, especially in atopic patients.

Objectives

To investigate the frequency of contact allergy to alkyl glucosides and to identify concomitant reactivity.

Patients/Methods

We retrospectively reviewed all cases of suspected allergic contact dermatitis (ACD) in which patients were either patch tested with a cosmetic series that includes five alkyl glucosides (decyl glucoside, lauryl glucoside, coco glucoside, cetearyl glucoside, caprylyl/capryl glucoside) or a specific alkyl glucoside series from November 2013 to April 2017 in two UK centres.

Results

A total of 5775 patients were patch tested across the two centres. Twenty‐nine (1.04%) of the 2796 patients tested to the cosmetic/alkyl glucoside series had a positive patch test reaction to at least one of the alkyl glucosides. Twenty three (79.3%) were sensitised to multiple alkyl glucosides; 21 patients (72.4%) were female. The mean age was 43.5 years. Twelve patients (41.4%) had a background of atopic dermatitis.

Conclusions

The prevalence of alkyl glucoside‐induced ACD is relatively high and there are frequent concomitant reactions between different alkyl glucosides. We recommend the inclusion of alkyl glucosides in all cosmetic series.

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Cobalt content of a convenience sample of leather shoes and gloves in Denmark

Chromium is a well‐known allergen in leather products, however, cobalt has not historically been associated with leather exposure. Cobalt allergic contact dermatitis (ACD) from leather in furniture upholstery has been reported in Denmark,^1,2 and leather furniture samples obtained in the United States also were found to contain cobalt.³ However, no clear cases of cobalt ACD from leather gloves or shoes have been reported. In this study we examined cobalt content in a convenience sample of shoes and gloves.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2zrbTrv

Two cases of occupational allergic contact dermatitis caused by abacavir

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2P1dwRk

Sensitivity to imidazoles/nitroimidazoles in subjects sensitized to methylchloroisothiazolinone/methylisothiazolinone: A simple coincidence?

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2zqXQCa

Phytophotodermatitis related to Peucedanumpaniculatum Loisel , a case report

Phytophotodermatitis is a skin reaction due to ultraviolet light exposure after previous contact with a photosensitising plant compound such as furocoumarins. Phytophotodermatitis are often described with lime (1), fig leaves (2) or celery (3). We report the case of a 60‐years‐old man who developed phytophotodermatitis after encountering Peucedanum paniculatum Loisel during a walk in Corsica, France.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2P1k1ns

Fixed drug eruption caused by fulvestrant confirmed by skin tests: First case

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2zmIAWU

Patch testing with alkyl glucosides: concomitant reactions are common but not ubiquitous

Background

Alkyl glucosides are a family of mild surfactants that are increasingly used in a wide range of cosmetics and household products. Contact allergy to alkyl glucosides may be more frequent than previously suspected, especially in atopic patients.

Objectives

To investigate the frequency of contact allergy to alkyl glucosides and to identify concomitant reactivity.

Patients/Methods

We retrospectively reviewed all cases of suspected allergic contact dermatitis (ACD) in which patients were either patch tested with a cosmetic series that includes five alkyl glucosides (decyl glucoside, lauryl glucoside, coco glucoside, cetearyl glucoside, caprylyl/capryl glucoside) or a specific alkyl glucoside series from November 2013 to April 2017 in two UK centres.

Results

A total of 5775 patients were patch tested across the two centres. Twenty‐nine (1.04%) of the 2796 patients tested to the cosmetic/alkyl glucoside series had a positive patch test reaction to at least one of the alkyl glucosides. Twenty three (79.3%) were sensitised to multiple alkyl glucosides; 21 patients (72.4%) were female. The mean age was 43.5 years. Twelve patients (41.4%) had a background of atopic dermatitis.

Conclusions

The prevalence of alkyl glucoside‐induced ACD is relatively high and there are frequent concomitant reactions between different alkyl glucosides. We recommend the inclusion of alkyl glucosides in all cosmetic series.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2P1QERK

Cobalt content of a convenience sample of leather shoes and gloves in Denmark

Chromium is a well‐known allergen in leather products, however, cobalt has not historically been associated with leather exposure. Cobalt allergic contact dermatitis (ACD) from leather in furniture upholstery has been reported in Denmark,^1,2 and leather furniture samples obtained in the United States also were found to contain cobalt.³ However, no clear cases of cobalt ACD from leather gloves or shoes have been reported. In this study we examined cobalt content in a convenience sample of shoes and gloves.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2zrbTrv