Current Microbiological Trends of Chronic Suppurative Otitis Media in a Tertiary Care Centre, Mysuru, India

Abstract

The aim of the study was to re- evaluate the current bacteriological profile of chronic suppurative otitis media and to know their antibiotic sensitivity pattern to commonly used antibiotics. To provide a guideline for empirical antibiotic therapy when culture facilities are not available. Observational study. Patients who presented to Ear, Nose and Throat department with chronic or recurrent ear discharge and on clinical examination found to have actively discharging ears were selected. Patients who did not receive antimicrobial therapy (topical or systemic) for the last 7 days were included. Out of the 106 ear swabs processed, bacterial growth was found in 100 samples (94.33%), while 6 samples (5.66%) showed no growth. The results revealed Pseudomonas aeruginosa as the most isolated bacteria (49%), followed by Staphylococcus aureus (18%). Antibiotic susceptibility—Pseudomonas aeruginosa was sensitive to Cefoperazone–Sulbactam (96%), Imipenem (82%), Piperacillin–Tazobactam (82%), Amikacin in 82% and Gentamicin (76%). It was found that Pseudomonas was sensitive to Ciprofloxacin in only 57% of the cases. Staphylococcus aureus isolates were sensitive to Vancomycin in 90%, Gentamicin in 81%, Clindamycin in 72%, and Erythromycin in 45%. It was found that 100% of the isolates were resistant to Ciprofloxacin. Our findings highlight the importance of continuous and periodic evaluation of microbiological pattern and antibiotic sensitivity of isolates in chronic suppurative otitis media patients to decrease the potential risk of complications by early institution of appropriate treatment.

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Current Microbiological Trends of Chronic Suppurative Otitis Media in a Tertiary Care Centre, Mysuru, India

Abstract

The aim of the study was to re- evaluate the current bacteriological profile of chronic suppurative otitis media and to know their antibiotic sensitivity pattern to commonly used antibiotics. To provide a guideline for empirical antibiotic therapy when culture facilities are not available. Observational study. Patients who presented to Ear, Nose and Throat department with chronic or recurrent ear discharge and on clinical examination found to have actively discharging ears were selected. Patients who did not receive antimicrobial therapy (topical or systemic) for the last 7 days were included. Out of the 106 ear swabs processed, bacterial growth was found in 100 samples (94.33%), while 6 samples (5.66%) showed no growth. The results revealed Pseudomonas aeruginosa as the most isolated bacteria (49%), followed by Staphylococcus aureus (18%). Antibiotic susceptibility—Pseudomonas aeruginosa was sensitive to Cefoperazone–Sulbactam (96%), Imipenem (82%), Piperacillin–Tazobactam (82%), Amikacin in 82% and Gentamicin (76%). It was found that Pseudomonas was sensitive to Ciprofloxacin in only 57% of the cases. Staphylococcus aureus isolates were sensitive to Vancomycin in 90%, Gentamicin in 81%, Clindamycin in 72%, and Erythromycin in 45%. It was found that 100% of the isolates were resistant to Ciprofloxacin. Our findings highlight the importance of continuous and periodic evaluation of microbiological pattern and antibiotic sensitivity of isolates in chronic suppurative otitis media patients to decrease the potential risk of complications by early institution of appropriate treatment.

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Toward Automatic Detection of Radiation-Induced Cerebral Microbleeds Using a 3D Deep Residual Network

Abstract

Cerebral microbleeds, which are small focal hemorrhages in the brain that are prevalent in many diseases, are gaining increasing attention due to their potential as surrogate markers of disease burden, clinical outcomes, and delayed effects of therapy. Manual detection is laborious and automatic detection and labeling of these lesions is challenging using traditional algorithms. Inspired by recent successes of deep convolutional neural networks in computer vision, we developed a 3D deep residual network that can distinguish true microbleeds from false positive mimics of a previously developed technique based on traditional algorithms. A dataset of 73 patients with radiation-induced cerebral microbleeds scanned at 7 T with susceptibility-weighted imaging was used to train and evaluate our model. With the resulting network, we maintained 95% of the true microbleeds in 12 test patients and the average number of false positives was reduced by 89%, achieving a detection precision of 71.9%, higher than existing published methods. The likelihood score predicted by the network was also evaluated by comparing to a neuroradiologist's rating, and good correlation was observed.

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Toward Automatic Detection of Radiation-Induced Cerebral Microbleeds Using a 3D Deep Residual Network

Abstract

Cerebral microbleeds, which are small focal hemorrhages in the brain that are prevalent in many diseases, are gaining increasing attention due to their potential as surrogate markers of disease burden, clinical outcomes, and delayed effects of therapy. Manual detection is laborious and automatic detection and labeling of these lesions is challenging using traditional algorithms. Inspired by recent successes of deep convolutional neural networks in computer vision, we developed a 3D deep residual network that can distinguish true microbleeds from false positive mimics of a previously developed technique based on traditional algorithms. A dataset of 73 patients with radiation-induced cerebral microbleeds scanned at 7 T with susceptibility-weighted imaging was used to train and evaluate our model. With the resulting network, we maintained 95% of the true microbleeds in 12 test patients and the average number of false positives was reduced by 89%, achieving a detection precision of 71.9%, higher than existing published methods. The likelihood score predicted by the network was also evaluated by comparing to a neuroradiologist's rating, and good correlation was observed.

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Effect of continuous positive airway pressure on endothelin-1 in patients with obstructive sleep apnea: a meta-analysis

Abstract

Purpose

Obstructive sleep apnea (OSA) is related to endothelin-1 (ET-1). Continuous positive airway pressure (CPAP) is an effective therapy for OSA. However, the effectiveness of CPAP on ET-1 levels in patients with OSA yielded contradictory results. We conducted a meta-analysis to assess the effect of CPAP on ET-1 levels in OSA.

Methods

The Embase, and Cochrane Library and PubMed were searched before March, 2018. The overall effects were measured by the standardized mean difference (SMD) with a 95% confidence interval (CI). Ten studies were included and the meta-analysis was conducted using Stata 14.0.

Results

10 studies involving 375 patients were included in the meta-analysis. The result showed that there was a significant reduction in ET-1 levels in OSA patients before and after CPAP therapy (SMD = − 0.74, 95% CI = − 1.30 to − 0.17, z = 2.56, p = 0.01). Further, subgroup analysis demonstrated that Apnea–Hypopnea Index (AHI), CPAP therapy duration, and sample size also affected CPAP therapy.

Conclusions

Our meta-analysis indicated that CPAP treatment among OSA patients was significantly was related to a decrease in ET-1 levels. Further prospective long-term studies with a larger number of patients are needed to evaluate and clarify this issue.

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Effect of continuous positive airway pressure on endothelin-1 in patients with obstructive sleep apnea: a meta-analysis

Abstract

Purpose

Obstructive sleep apnea (OSA) is related to endothelin-1 (ET-1). Continuous positive airway pressure (CPAP) is an effective therapy for OSA. However, the effectiveness of CPAP on ET-1 levels in patients with OSA yielded contradictory results. We conducted a meta-analysis to assess the effect of CPAP on ET-1 levels in OSA.

Methods

The Embase, and Cochrane Library and PubMed were searched before March, 2018. The overall effects were measured by the standardized mean difference (SMD) with a 95% confidence interval (CI). Ten studies were included and the meta-analysis was conducted using Stata 14.0.

Results

10 studies involving 375 patients were included in the meta-analysis. The result showed that there was a significant reduction in ET-1 levels in OSA patients before and after CPAP therapy (SMD = − 0.74, 95% CI = − 1.30 to − 0.17, z = 2.56, p = 0.01). Further, subgroup analysis demonstrated that Apnea–Hypopnea Index (AHI), CPAP therapy duration, and sample size also affected CPAP therapy.

Conclusions

Our meta-analysis indicated that CPAP treatment among OSA patients was significantly was related to a decrease in ET-1 levels. Further prospective long-term studies with a larger number of patients are needed to evaluate and clarify this issue.

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Clinical Thyroidology®High-Impact Articles

FREE ACCESS through December 11, 2018.
Read Now:

Vemurafenib Restores Radioiodine Uptake in Some Metastatic Thyroid Cancers
Jerome M. Hershman  

Randomized, Controlled Trials Show That Treatment of Subclinical Hypothyroidism Does Not Improve Quality of Life, Cognition, Blood Pressure, or BMI
Tim I.M. Korevaar 

Symptoms Strongly Drive the Consideration of Alternative Thyroid Hormone–Replacement Options in Patients with Hypothyroidism
Angela M. Leung 

Which Factors Predict the Outcome of Ablative Radioactive Iodine Treatment of Hyperthyroid Graves' Disease?
Jacques Orgiazzi 

 

The post Clinical Thyroidology^®High-Impact Articles appeared first on American Thyroid Association.

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Clinical Thyroidology®High-Impact Articles

FREE ACCESS through December 11, 2018.
Read Now:

Vemurafenib Restores Radioiodine Uptake in Some Metastatic Thyroid Cancers
Jerome M. Hershman  

Randomized, Controlled Trials Show That Treatment of Subclinical Hypothyroidism Does Not Improve Quality of Life, Cognition, Blood Pressure, or BMI
Tim I.M. Korevaar 

Symptoms Strongly Drive the Consideration of Alternative Thyroid Hormone–Replacement Options in Patients with Hypothyroidism
Angela M. Leung 

Which Factors Predict the Outcome of Ablative Radioactive Iodine Treatment of Hyperthyroid Graves' Disease?
Jacques Orgiazzi 

 

The post Clinical Thyroidology^®High-Impact Articles appeared first on American Thyroid Association.

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Temporal bone trauma effects on auditory anatomical structures in mastoid obliteration

Abstract

Purpose

The risk of temporal bone fractures in head trauma is not negligible, as injuries also depend on the resistance and integrity of head structures. The capacity of mastoid cells to absorb part of the impact kinetic energy of the temporal bone is diminished after open cavity mastoidectomy, even if the surgical procedure is followed by mastoid obliteration. The aim of our study was to evaluate the severity of lesions in auditory anatomical structures after a lateral impact on cadaveric temporal bones in which open cavity mastoidectomy followed by mastoid obliteration was performed, compared to cadaveric temporal bones with preserved mastoids.

Methods

The study was carried out on 20 cadaveric temporal bones, which were randomly assigned to two groups. In the study group, open cavity mastoidectomy followed by mastoid obliteration with heterologous materials was performed. All temporal bones were impacted laterally under the same conditions. Temporal bone fractures were evaluated by CT scan.

Results

External auditory canal fractures were six times more seen in the study group. Tympanic bone fractures were present in 80% of the samples in the study group and 10% in the control group (p = .005). Middle ear fractures were found in 70% of the samples in the study group and 10% in the control group (p = .02). Otic capsule violating fractures of the temporal bone were present only in the study group.

Conclusions

Mastoid obliteration with heterologous materials after open cavity mastoidectomy increases the risk of fracture, with the involvement of auditory anatomical structures.

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Temporal bone trauma effects on auditory anatomical structures in mastoid obliteration

Abstract

Purpose

The risk of temporal bone fractures in head trauma is not negligible, as injuries also depend on the resistance and integrity of head structures. The capacity of mastoid cells to absorb part of the impact kinetic energy of the temporal bone is diminished after open cavity mastoidectomy, even if the surgical procedure is followed by mastoid obliteration. The aim of our study was to evaluate the severity of lesions in auditory anatomical structures after a lateral impact on cadaveric temporal bones in which open cavity mastoidectomy followed by mastoid obliteration was performed, compared to cadaveric temporal bones with preserved mastoids.

Methods

The study was carried out on 20 cadaveric temporal bones, which were randomly assigned to two groups. In the study group, open cavity mastoidectomy followed by mastoid obliteration with heterologous materials was performed. All temporal bones were impacted laterally under the same conditions. Temporal bone fractures were evaluated by CT scan.

Results

External auditory canal fractures were six times more seen in the study group. Tympanic bone fractures were present in 80% of the samples in the study group and 10% in the control group (p = .005). Middle ear fractures were found in 70% of the samples in the study group and 10% in the control group (p = .02). Otic capsule violating fractures of the temporal bone were present only in the study group.

Conclusions

Mastoid obliteration with heterologous materials after open cavity mastoidectomy increases the risk of fracture, with the involvement of auditory anatomical structures.

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Chemically modified peanut extract shows increased safety while maintaining immunogenicity

Abstract

Background

Peanuts are most responsible for food‐induced anaphylaxis in adults in developed countries. An effective and safe immunotherapy is urgently needed. The aim of this study was to investigate the immunogenicity, allergenicity and immunotherapeutic efficacy of a well characterized chemically modified peanut extract (MPE) adsorbed to Al(OH)₃.

Methods

Peanut extract (PE) was modified by reduction and alkylation. Using sera of peanut allergic patients, competitive IgE‐binding assays and mediator release assays were performed. The immunogenicity of MPE was evaluated by measuring activation of human PE‐specific T‐cell lines and the induction of PE‐specific IgG in mice. The safety and efficacy of MPE adsorbed to Al(OH)₃ was tested in two mouse models by measuring allergic manifestations upon peanut challenge in peanut allergic mice.

Results

Compared to PE, the IgE‐binding and capacity to induce allergic symptoms of MPE was lower in all patients. PE and MPE displayed similar immunogenicity in vivo and in vitro. In mice sensitized to PE, the threshold for anaphylaxis (drop in BT) upon subcutaneous challenge with PE was 0.01 mg, while at 0.3 mg MPE no allergic reaction occurred. Anaphylaxis was not observed when PE and MPE were fully adsorbed to Al(OH)₃. Both PE and MPE + Al(OH)₃ showed to be efficacious in a model for immunotherapy.

Conclusion

In our studies an Al(OH)₃ adsorbed MPE showed reduced allergenicity compared to unmodified PE, while the efficacy of immunotherapy is maintained. The preclinical data presented in this study supports further development of modified peanut allergens for IT.

This article is protected by copyright. All rights reserved.

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Much ado about Biologicals:Highlights of the Master Class on Biologicals, Prague, 2018

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Chemically modified peanut extract shows increased safety while maintaining immunogenicity

Abstract

Background

Peanuts are most responsible for food‐induced anaphylaxis in adults in developed countries. An effective and safe immunotherapy is urgently needed. The aim of this study was to investigate the immunogenicity, allergenicity and immunotherapeutic efficacy of a well characterized chemically modified peanut extract (MPE) adsorbed to Al(OH)₃.

Methods

Peanut extract (PE) was modified by reduction and alkylation. Using sera of peanut allergic patients, competitive IgE‐binding assays and mediator release assays were performed. The immunogenicity of MPE was evaluated by measuring activation of human PE‐specific T‐cell lines and the induction of PE‐specific IgG in mice. The safety and efficacy of MPE adsorbed to Al(OH)₃ was tested in two mouse models by measuring allergic manifestations upon peanut challenge in peanut allergic mice.

Results

Compared to PE, the IgE‐binding and capacity to induce allergic symptoms of MPE was lower in all patients. PE and MPE displayed similar immunogenicity in vivo and in vitro. In mice sensitized to PE, the threshold for anaphylaxis (drop in BT) upon subcutaneous challenge with PE was 0.01 mg, while at 0.3 mg MPE no allergic reaction occurred. Anaphylaxis was not observed when PE and MPE were fully adsorbed to Al(OH)₃. Both PE and MPE + Al(OH)₃ showed to be efficacious in a model for immunotherapy.

Conclusion

In our studies an Al(OH)₃ adsorbed MPE showed reduced allergenicity compared to unmodified PE, while the efficacy of immunotherapy is maintained. The preclinical data presented in this study supports further development of modified peanut allergens for IT.

This article is protected by copyright. All rights reserved.

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Much ado about Biologicals:Highlights of the Master Class on Biologicals, Prague, 2018

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The rhinologist's role in the management of rathke's cleft cysts

Purpose of review To review the recent literature regarding the growing role of rhinologists and otolaryngologists with neurosurgeons in the joint multidisciplinary team approach for managing patients with Rathke's cleft cysts (RCC). Recent findings The transnasal endoscopic approach to the skull base has become relatively mainstream for surgical treatment of RCCs. Suprasellar lesions, especially those that are purely suprasellar, are associated with higher recurrence rates, though an extended approach may improve dissection and access and therefore aid in lesion removal. Endoscopic cyst drainage is a well tolerated and effective way to treat RCC, and often avoids the postoperative endocrinopathies associated with complete cyst wall removal. Novel techniques have been described for maintaining tract patency, including the use of stents and flaps, in order to prevent cyst stenosis and reaccumulation. A frontier in skull base surgery is in applications for pediatric patients, and managing RCCs in this population surgically appears to be associated with positive outcomes overall. Summary Team-based endoscopic skull base surgery has spurred advances in our understanding of skull base disease, including RCCs. Optimal outcomes are most apparent when the experience and technique of both the endoscopist and neurosurgeon have developed jointly over time. Correspondence to Edward C. Kuan, MD, MBA, Department of Otolaryngology-Head & Neck Surgery, University of California, Irvine Medical Center, 101 The City Dr S, Bldg 56, Ste 500, Orange, CA 92868, USA.. Tel: +1 714 456 5753; fax: +1 714 456 5747; e-mail: eckuan@uci.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Review and update on extracorporeal septoplasty

Purpose of review To examine the recent literature on extracorporeal septoplasty. Recent findings The literature suggests that extracorporeal septoplasty is an effective approach for both functional and cosmetic treatment of moderate to severe deformities of the caudal and dorsal septum. The procedure can be performed via an endonasal or external approach based on the nature of the deformity and the experience of the surgeon, although recent literature highlights various advantages of an external approach. The use of polydioxanone foil as a scaffold for septal reconstruction is widely accepted, and can enhance the technical performance of this technique. Although reported complication rates are low, tip deprojection and rotation have been observed in cases where extracorporeal septoplasty is performed without simultaneous rhinoplasty. Summary Extracorporeal septoplasty is a useful technique in the armamentarium of surgeons addressing deviations of the dorsal and caudal septum. Correspondence to Daniel G. Becker, Penn Medicine – Becker ENT, LLC 570 Egg Harbor Road, Suite B2, Sewell, NJ 08080, USA. Tel: +1 856 589 6673; fax: +1 856 589 3343; e-mail: dbecker@beckerent.com Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Histopathologic analysis in the diagnosis and management of chronic rhinosinusitis

Purpose of review New research in the pathogenesis of chronic rhinosinusitis has shed light on an emerging classification system based on endotypes, which help to explain the individualized mechanism of disease in patients suffering from chronic rhinosinusitis with and without nasal polyps. The purpose of this review is to advocate the use of structured histopathologic analysis in the diagnosis and management of patients affected by chronic rhinosinusitis with and without polyps. Recent findings Numerous studies have demonstrated the role of inflammation in chronic rhinosinusitis and the ensuing histopatholgic changes. Few studies have implemented structured histopathologic analysis to guide diagnosis and treatment. Individualized therapy including biotherapeutics and comprehensive surgery has shown to improve outcomes in patients with refractory disease. Summary Structured histopathologic analysis can provide helpful information on the endotype of chronic rhinosinusitis. Routine use in clinical practice should be standardized especially in cases of chronic rhinosinusitis refractory to medical therapy and/or surgery. Correspondence to Dr Bobby A. Tajudeen, MD, Co-Director, Rush Sinus Program, Rush University Medical Center, 1611W. Harrison St., Suite 550, Chicago, IL 60612, USA. Tel: +312 942 9174; fax: +312 942 6653; e-mail: bobby_tajudeen@rush.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Management of sphenoid lateral recess encephalocoeles

Purpose of review Sphenoid sinus lateral recess encephalocoeles (SSLRE) are rare occurrences and pose unique challenges due to limited surgical access for endoscopic endonasal repair and also the lack of consensus on optimal perioperative managements specifically in the spontaneous cases, which are also believed to be a variant of idiopathic intracranial hypertension (IIH). Endoscopic endonasal approaches have largely replaced the transcranial route and the techniques are continuously being refined to reduce the neurovascular morbidity and improve outcome. Recent findings Transpetrygoid is the most utilized approach with modifications suggested to limit bone removal, exposure and preservation of the neurovascular structures as dictated by the extent of the lateral recess. As more experience is gained, extended transphenoidal techniques were also successfully used for access. Lateral transorbital is a new approach to the lateral recess investigated in cadavers. IIH treatment is still controversial in the setting of SSLRE, but it appears rationale to evaluate, monitor and treat if necessary. Summary SSLRE management should be tailored to the specific anatomical variances and cause. Modifications of techniques have been described giving different options to access the lateral recess. Successful repair for spontaneous SSLRE may require treatment of IIH if present, but the long-term outcome is still unclear. Correspondence to Narayanan Prepageran, MBBS, MS, FRCS, Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia. Tel: +60 379 492062; e-mail: prepageran@yahoo.com Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Indications and endonasal treatment of petrous apex cholesterol granulomas

Purpose of review Lesions of the petrous apex of the temporal bone can be challenging to access and approaches laterally through the mastoid as well as medially through an endonasal approach are utilized to access this region while preserving function of adjacent structures. Cholesterol granulomas of the petrous apex requiring surgery are marsupialized to prevent expansion of the inflamed cyst and relieve associated clinical symptoms. The endonasal approach to the petrous apex has in the past been limited to lesions medial to the internal carotid artery. Recent findings Endoscopic approaches have been developed to expand the range of petrous apex lesions that are accessible endonasally. These endonasal corridors include a nasopharyngeal/transclival corridor, lateralization of the internal carotid artery to create an expanded medial window, a pterygopalatine infrapetrosal approach, and a contralateral maxillary approach, which allow improved access to the inferior and lateral petrous apex. Nasoseptal flaps may reduce the risk of postoperative stenosis of the drainage tract. Summary Endoscopic endonasal approaches can be used safely to address both medial and lateral/inferior petrous apex lesions. Morbidity of these procedures is low and use of a nasoseptal flap may limit restenosis of the drainage pathway. Correspondence to Michael A. Kohanski, MD, PhD, Division of Rhinology, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Medical Center, 5th Floor Ravdin Building, 3400 Spruce Street, Philadelphia, PA 19104, USA. Tel: +1 215 614 0491; e-mail: Michael.Kohanski@uphs.upenn.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Current indications for balloon sinuplasty

Purpose of review The purpose of the review is to evaluate the current indications and contraindications for balloon sinuplasty and review the clinical trials performed in this area. Recent findings The indications for balloon sinus dilatation are somewhat similar to those for endoscopic sinus surgery. Balloon sinus ostial dilation (BSD) has been found to be most effective in the treatment of recurrent acute sinusitis (RARS) and chronic rhinosinusitis without nasal polyposis (CRSsNP) that has been refractory to medical therapy. Multiple randomized clinical trials have demonstrated the efficacy of BSD in improving quality-of-life outcomes in patients with limited CRSsNP in both the clinic and operating room settings. However, because BSD merely dilates blocked sinusal ostia without removing tissue, it is typically restricted to addressing disorder involving the frontal, sphenoid, and maxillary sinuses. Individuals who have significant disease of the ethmoid sinus may have BSD adjunctively with endoscopic sinus surgery. BSD is unsuitable as a primary treatment modality in pansinus polyposis, widespread fungal sinusitis, connective tissue disorders at an advanced stage, or potential malignancy. A recent expert clinical consensus statement also concluded that BSD is not appropriate for treatment of patients with headache that do not meet the diagnostic criteria for CRS or RARS or patients who do not have both positive findings of sinus disease on computed tomography and sinonasal symptoms. Summary Balloon sinuplasty is an option in the treatment of sinusitis that has failed appropriate medical therapy. Evidence is best for limited disease in patients with CRSsNP affecting the frontal, sphenoid, and maxillary sinuses. Because BSD can be performed in the office setting, it can be a viable therapeutic alternative in patients with comorbidities who are unable to tolerate general anesthesia. Correspondence to Cemal Cingi, MD, Professor, Department of Otolaryngology, Head and Neck Surgery, University of Eskisehir Osmangazi, 26020 Eskisehir, Turkey. Tel: +90 532 2676616; e-mail: ccingi@gmail.com Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Contemporary management of juvenile angiofibroma

Purpose of review To illustrate the latest developments and trends in the management of juvenile angiofibroma. Recent findings Endoscopic surgery is currently the primary management strategy for juvenile angiofibroma. Recent reports on the use of multiportal approaches have contributed to further extend its indications. Studies from different countries suggest that the lesion can display variable growth rates not only in relation to patient age. The same concept applies to residual lesions. For this reason, retreatment of persistent juvenile angiofibromas is indicated when serial imaging clearly shows that the lesion is growing. When redo surgery is potentially associated with high morbidity for the critical relationships of the lesion with adjacent structures, stereotactic or intensity-modulated radiation therapy can be an alternative. Early use of MRI in the postoperative course is a highly effective way to detect residual lesions. Summary Contemporary management of juvenile angiofibroma should primarily rely on endoscopic surgery to obtain radical tumor resection. Recent evidence on the behavior of residual postoperative juvenile angiofibroma and the development of conformal RT techniques have helped to clarify the role of watchful waiting and radiotherapy (RT) as alternatives to aggressive procedures in cases with critical extension of the lesion. Although radical excision is the primary therapeutic objective, the benign nature of juvenile angiofibroma and the reported tendency of small residual lesions to remain stable or involute, especially in postpubertal patients, should always be kept in mind to avoid unnecessary morbidity. Video abstract In the video, two of the authors describe the content of the review and present the main topics discussed in the article. https://ift.tt/2zCohVk. Correspondence to Giacomo Bertazzoni, MD, Unit of Otorhinolaryngology, University of Brescia, ASST Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy. Tel: +39 030 3995322; e-mail: ilbertaz@gmail.com Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (https://ift.tt/2JRSqmn). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Oncologic management of sinonasal undifferentiated carcinoma

Purpose of review This article reviews the latest treatment paradigms in sinonasal undifferentiated carcinoma (SNUC). Recent findings The aggressive biology and associated advanced presentation of SNUC make successful treatment a challenge shared across medical specialties. Still, studies reporting outcomes in SNUC indicate that an aggressive treatment strategy consisting of surgery, radiation and chemotherapy offers the best chance of prolonged survival. Summary Successful treatment of SNUC requires highly specialized care at tertiary cancer treatment facilities. A better understanding of the biology of the disease coupled with increasing outcome reporting will lead to optimized treatment regimens. Correspondence to Zara M. Patel, MD, Assistant Professor, Director of Endoscopic Skull Base Surgery, Rhinology - Sinus and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 801 Welch, Stanford, CA 94305, USA. Tel: +1 650 723 5651; e-mail: zmpatel@stanford.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Endotypes of chronic rhinosinusitis

Purpose of review In contrast to the phenotypic classification of chronic rhinosinusitis (CRS), endotyping categorizes disease variants based on their underlying pathophysiologic mechanisms. Defining CRS endotypes may provide information on the risk for disease progression, recurrence and comorbid conditions, as well as identify suitable therapeutic targets. With the emergence of biologics, endotyping may enable personalized pharmacotherapy for recalcitrant CRS. The purpose of this review is to briefly summarize the pathophysiology and endotypes of CRS, and highlight the biologics that target mediators of CRS. Recent findings CRS is due to dysregulated immunologic responses to external stimuli, which induces inflammatory mediators. The linkage between innate lymphoid cells, adaptive CD4+ T helper and CD8 + cytotoxic T cells has led to proposed endotypes that are based around immune response deviation into type 1, type 2 and type 3 responses. Cluster analysis has attempted to define endotypes, accounting for clinical characteristics, molecular and cellular biomarkers, and treatment response. Biologics targeting epithelial-derived cytokines and immunoglobulin E, as well as mediators of type 1, type 2 and type 3 inflammation, are being investigated in CRS. Summary Although there have been significant advances made in the understanding of the pathomechanisms of CRS, there currently remains a lack of full characterization of CRS endotypes. Correspondence to Yvonne Chan, MD, FRCSC, MSc, HBSc, Division Head, Division of Rhinology, Department of Otolaryngology – Head and Neck Surgery, University of Toronto, Trillium Health Partners, 102-101 Queensway West, Mississauga, ON L5B 2P7, USA. Tel: +1 905 277 4312; e-mail: y.chan@utoronto.ca Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Open-neck organ preservation surgery for hypopharyngeal cancer: indications, techniques, limits, and outcomes

Purpose of review To appraise the practice and role of open-neck organ preserving surgery for hypopharyngeal squamous cell carcinoma and to update the current indications, techniques, limits, and outcomes. Recent findings The role of primary surgery for hypopharyngeal carcinoma has shifted over the past two decades to primary nonsurgical management with the use of induction or concurrent chemoradiotherapy. The preferred and most suitable tumours for open-neck surgery are the small-volume T stage diseases, with small to medium-volume neck metastases, however such patients are exceedingly rare. Nonetheless, more advanced tumours with cartilage invasion, vocal cord paralysis, or located at piriform apex and postcricoid area, previously unsuitable for open-neck organ preserving surgery, can now be excised and repaired, minimizing morbidity and improving quality of patients' life. Much of this surgical progress has been developed by innovative surgeons using free tissue transfer, accurate placement surgery, reconstruction of a neoglottis, and perfecting the pharyngoesophageal anastomosis. Current practice of open-neck organ preserving surgery for hypopharyngeal carcinoma has been mainly reported in Asia: Korea, Taiwan, Japan, and China. Summary There are some patients who are deemed unsuitable and/or unwilling for current treatment by nonsurgical approaches, and open-neck organ preserving laryngopharyngeal surgery may be a more suitable alternative than selecting a 'lesser or modified' chemo or bioradiotherapy regimen, resulting in a prolonged quantity and quality of life. Correspondence to Professor Patrick J. Bradley, MBA, FRCS, MD, 10 Chartwell Grove, Mapperley Plains, Nottingham NG3 5RD, UK. Tel: +44 115 9201611; e-mail: pjbradley@zoo.co.uk Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Salivaomics in oral cancer

Purpose of review The goal of cancer screening is to detect tumor at an early stage, and early cancer detection is the hallmark of successful treatment. In addition to traditional tissue biopsy-based diagnostics, more reliable, inexpensive, and noninvasive methods are required for early diagnosis of cancer. In this review, we highlight some of the recent advancements in the field of salivary diagnostics in oral cancer. Recent findings 'Salivaomics' is a broad collection of technologies used to explore different types of molecules contained in saliva. Although many protein and mRNA salivary biomarkers have been identified that can detect oral squamous cell carcinoma (OSCC), none have so far been validated for current clinical use. As the heterogeneity in carcinogenesis and multifactorial cause for OSCC, the most reliable results are gathered with the use of multiple biomarker candidates to improve accuracy and sensitivity of the test used. This further requires sensitive technology to detect salivary biomarkers in low quantities. Summary Large scale studies that incorporate proteomic, transcriptomic, and additional 'omics,' need to be initiated to bring technology to clinical point-of-care applications. Correspondence to Katri Aro, MD, PhD, Department of Otorhinolaryngology – Head and Neck Surgery, Helsinki University Hospital, PO Box 263, FI-00029 HUS, Helsinki, Finland. Tel: +358 50 4272000; e-mail: katri.aro@hus.fi Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Oncologic management of sinonasal undifferentiated carcinoma

Purpose of review This article reviews the latest treatment paradigms in sinonasal undifferentiated carcinoma (SNUC). Recent findings The aggressive biology and associated advanced presentation of SNUC make successful treatment a challenge shared across medical specialties. Still, studies reporting outcomes in SNUC indicate that an aggressive treatment strategy consisting of surgery, radiation and chemotherapy offers the best chance of prolonged survival. Summary Successful treatment of SNUC requires highly specialized care at tertiary cancer treatment facilities. A better understanding of the biology of the disease coupled with increasing outcome reporting will lead to optimized treatment regimens. Correspondence to Zara M. Patel, MD, Assistant Professor, Director of Endoscopic Skull Base Surgery, Rhinology - Sinus and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 801 Welch, Stanford, CA 94305, USA. Tel: +1 650 723 5651; e-mail: zmpatel@stanford.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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The rhinologist's role in the management of rathke's cleft cysts

Purpose of review To review the recent literature regarding the growing role of rhinologists and otolaryngologists with neurosurgeons in the joint multidisciplinary team approach for managing patients with Rathke's cleft cysts (RCC). Recent findings The transnasal endoscopic approach to the skull base has become relatively mainstream for surgical treatment of RCCs. Suprasellar lesions, especially those that are purely suprasellar, are associated with higher recurrence rates, though an extended approach may improve dissection and access and therefore aid in lesion removal. Endoscopic cyst drainage is a well tolerated and effective way to treat RCC, and often avoids the postoperative endocrinopathies associated with complete cyst wall removal. Novel techniques have been described for maintaining tract patency, including the use of stents and flaps, in order to prevent cyst stenosis and reaccumulation. A frontier in skull base surgery is in applications for pediatric patients, and managing RCCs in this population surgically appears to be associated with positive outcomes overall. Summary Team-based endoscopic skull base surgery has spurred advances in our understanding of skull base disease, including RCCs. Optimal outcomes are most apparent when the experience and technique of both the endoscopist and neurosurgeon have developed jointly over time. Correspondence to Edward C. Kuan, MD, MBA, Department of Otolaryngology-Head & Neck Surgery, University of California, Irvine Medical Center, 101 The City Dr S, Bldg 56, Ste 500, Orange, CA 92868, USA.. Tel: +1 714 456 5753; fax: +1 714 456 5747; e-mail: eckuan@uci.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Review and update on extracorporeal septoplasty

Purpose of review To examine the recent literature on extracorporeal septoplasty. Recent findings The literature suggests that extracorporeal septoplasty is an effective approach for both functional and cosmetic treatment of moderate to severe deformities of the caudal and dorsal septum. The procedure can be performed via an endonasal or external approach based on the nature of the deformity and the experience of the surgeon, although recent literature highlights various advantages of an external approach. The use of polydioxanone foil as a scaffold for septal reconstruction is widely accepted, and can enhance the technical performance of this technique. Although reported complication rates are low, tip deprojection and rotation have been observed in cases where extracorporeal septoplasty is performed without simultaneous rhinoplasty. Summary Extracorporeal septoplasty is a useful technique in the armamentarium of surgeons addressing deviations of the dorsal and caudal septum. Correspondence to Daniel G. Becker, Penn Medicine – Becker ENT, LLC 570 Egg Harbor Road, Suite B2, Sewell, NJ 08080, USA. Tel: +1 856 589 6673; fax: +1 856 589 3343; e-mail: dbecker@beckerent.com Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Histopathologic analysis in the diagnosis and management of chronic rhinosinusitis

Purpose of review New research in the pathogenesis of chronic rhinosinusitis has shed light on an emerging classification system based on endotypes, which help to explain the individualized mechanism of disease in patients suffering from chronic rhinosinusitis with and without nasal polyps. The purpose of this review is to advocate the use of structured histopathologic analysis in the diagnosis and management of patients affected by chronic rhinosinusitis with and without polyps. Recent findings Numerous studies have demonstrated the role of inflammation in chronic rhinosinusitis and the ensuing histopatholgic changes. Few studies have implemented structured histopathologic analysis to guide diagnosis and treatment. Individualized therapy including biotherapeutics and comprehensive surgery has shown to improve outcomes in patients with refractory disease. Summary Structured histopathologic analysis can provide helpful information on the endotype of chronic rhinosinusitis. Routine use in clinical practice should be standardized especially in cases of chronic rhinosinusitis refractory to medical therapy and/or surgery. Correspondence to Dr Bobby A. Tajudeen, MD, Co-Director, Rush Sinus Program, Rush University Medical Center, 1611W. Harrison St., Suite 550, Chicago, IL 60612, USA. Tel: +312 942 9174; fax: +312 942 6653; e-mail: bobby_tajudeen@rush.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Management of sphenoid lateral recess encephalocoeles

Purpose of review Sphenoid sinus lateral recess encephalocoeles (SSLRE) are rare occurrences and pose unique challenges due to limited surgical access for endoscopic endonasal repair and also the lack of consensus on optimal perioperative managements specifically in the spontaneous cases, which are also believed to be a variant of idiopathic intracranial hypertension (IIH). Endoscopic endonasal approaches have largely replaced the transcranial route and the techniques are continuously being refined to reduce the neurovascular morbidity and improve outcome. Recent findings Transpetrygoid is the most utilized approach with modifications suggested to limit bone removal, exposure and preservation of the neurovascular structures as dictated by the extent of the lateral recess. As more experience is gained, extended transphenoidal techniques were also successfully used for access. Lateral transorbital is a new approach to the lateral recess investigated in cadavers. IIH treatment is still controversial in the setting of SSLRE, but it appears rationale to evaluate, monitor and treat if necessary. Summary SSLRE management should be tailored to the specific anatomical variances and cause. Modifications of techniques have been described giving different options to access the lateral recess. Successful repair for spontaneous SSLRE may require treatment of IIH if present, but the long-term outcome is still unclear. Correspondence to Narayanan Prepageran, MBBS, MS, FRCS, Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia. Tel: +60 379 492062; e-mail: prepageran@yahoo.com Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Indications and endonasal treatment of petrous apex cholesterol granulomas

Purpose of review Lesions of the petrous apex of the temporal bone can be challenging to access and approaches laterally through the mastoid as well as medially through an endonasal approach are utilized to access this region while preserving function of adjacent structures. Cholesterol granulomas of the petrous apex requiring surgery are marsupialized to prevent expansion of the inflamed cyst and relieve associated clinical symptoms. The endonasal approach to the petrous apex has in the past been limited to lesions medial to the internal carotid artery. Recent findings Endoscopic approaches have been developed to expand the range of petrous apex lesions that are accessible endonasally. These endonasal corridors include a nasopharyngeal/transclival corridor, lateralization of the internal carotid artery to create an expanded medial window, a pterygopalatine infrapetrosal approach, and a contralateral maxillary approach, which allow improved access to the inferior and lateral petrous apex. Nasoseptal flaps may reduce the risk of postoperative stenosis of the drainage tract. Summary Endoscopic endonasal approaches can be used safely to address both medial and lateral/inferior petrous apex lesions. Morbidity of these procedures is low and use of a nasoseptal flap may limit restenosis of the drainage pathway. Correspondence to Michael A. Kohanski, MD, PhD, Division of Rhinology, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Medical Center, 5th Floor Ravdin Building, 3400 Spruce Street, Philadelphia, PA 19104, USA. Tel: +1 215 614 0491; e-mail: Michael.Kohanski@uphs.upenn.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Current indications for balloon sinuplasty

Purpose of review The purpose of the review is to evaluate the current indications and contraindications for balloon sinuplasty and review the clinical trials performed in this area. Recent findings The indications for balloon sinus dilatation are somewhat similar to those for endoscopic sinus surgery. Balloon sinus ostial dilation (BSD) has been found to be most effective in the treatment of recurrent acute sinusitis (RARS) and chronic rhinosinusitis without nasal polyposis (CRSsNP) that has been refractory to medical therapy. Multiple randomized clinical trials have demonstrated the efficacy of BSD in improving quality-of-life outcomes in patients with limited CRSsNP in both the clinic and operating room settings. However, because BSD merely dilates blocked sinusal ostia without removing tissue, it is typically restricted to addressing disorder involving the frontal, sphenoid, and maxillary sinuses. Individuals who have significant disease of the ethmoid sinus may have BSD adjunctively with endoscopic sinus surgery. BSD is unsuitable as a primary treatment modality in pansinus polyposis, widespread fungal sinusitis, connective tissue disorders at an advanced stage, or potential malignancy. A recent expert clinical consensus statement also concluded that BSD is not appropriate for treatment of patients with headache that do not meet the diagnostic criteria for CRS or RARS or patients who do not have both positive findings of sinus disease on computed tomography and sinonasal symptoms. Summary Balloon sinuplasty is an option in the treatment of sinusitis that has failed appropriate medical therapy. Evidence is best for limited disease in patients with CRSsNP affecting the frontal, sphenoid, and maxillary sinuses. Because BSD can be performed in the office setting, it can be a viable therapeutic alternative in patients with comorbidities who are unable to tolerate general anesthesia. Correspondence to Cemal Cingi, MD, Professor, Department of Otolaryngology, Head and Neck Surgery, University of Eskisehir Osmangazi, 26020 Eskisehir, Turkey. Tel: +90 532 2676616; e-mail: ccingi@gmail.com Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Contemporary management of juvenile angiofibroma

Purpose of review To illustrate the latest developments and trends in the management of juvenile angiofibroma. Recent findings Endoscopic surgery is currently the primary management strategy for juvenile angiofibroma. Recent reports on the use of multiportal approaches have contributed to further extend its indications. Studies from different countries suggest that the lesion can display variable growth rates not only in relation to patient age. The same concept applies to residual lesions. For this reason, retreatment of persistent juvenile angiofibromas is indicated when serial imaging clearly shows that the lesion is growing. When redo surgery is potentially associated with high morbidity for the critical relationships of the lesion with adjacent structures, stereotactic or intensity-modulated radiation therapy can be an alternative. Early use of MRI in the postoperative course is a highly effective way to detect residual lesions. Summary Contemporary management of juvenile angiofibroma should primarily rely on endoscopic surgery to obtain radical tumor resection. Recent evidence on the behavior of residual postoperative juvenile angiofibroma and the development of conformal RT techniques have helped to clarify the role of watchful waiting and radiotherapy (RT) as alternatives to aggressive procedures in cases with critical extension of the lesion. Although radical excision is the primary therapeutic objective, the benign nature of juvenile angiofibroma and the reported tendency of small residual lesions to remain stable or involute, especially in postpubertal patients, should always be kept in mind to avoid unnecessary morbidity. Video abstract In the video, two of the authors describe the content of the review and present the main topics discussed in the article. https://ift.tt/2zCohVk. Correspondence to Giacomo Bertazzoni, MD, Unit of Otorhinolaryngology, University of Brescia, ASST Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy. Tel: +39 030 3995322; e-mail: ilbertaz@gmail.com Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (https://ift.tt/2JRSqmn). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Endotypes of chronic rhinosinusitis

Purpose of review In contrast to the phenotypic classification of chronic rhinosinusitis (CRS), endotyping categorizes disease variants based on their underlying pathophysiologic mechanisms. Defining CRS endotypes may provide information on the risk for disease progression, recurrence and comorbid conditions, as well as identify suitable therapeutic targets. With the emergence of biologics, endotyping may enable personalized pharmacotherapy for recalcitrant CRS. The purpose of this review is to briefly summarize the pathophysiology and endotypes of CRS, and highlight the biologics that target mediators of CRS. Recent findings CRS is due to dysregulated immunologic responses to external stimuli, which induces inflammatory mediators. The linkage between innate lymphoid cells, adaptive CD4+ T helper and CD8 + cytotoxic T cells has led to proposed endotypes that are based around immune response deviation into type 1, type 2 and type 3 responses. Cluster analysis has attempted to define endotypes, accounting for clinical characteristics, molecular and cellular biomarkers, and treatment response. Biologics targeting epithelial-derived cytokines and immunoglobulin E, as well as mediators of type 1, type 2 and type 3 inflammation, are being investigated in CRS. Summary Although there have been significant advances made in the understanding of the pathomechanisms of CRS, there currently remains a lack of full characterization of CRS endotypes. Correspondence to Yvonne Chan, MD, FRCSC, MSc, HBSc, Division Head, Division of Rhinology, Department of Otolaryngology – Head and Neck Surgery, University of Toronto, Trillium Health Partners, 102-101 Queensway West, Mississauga, ON L5B 2P7, USA. Tel: +1 905 277 4312; e-mail: y.chan@utoronto.ca Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Open-neck organ preservation surgery for hypopharyngeal cancer: indications, techniques, limits, and outcomes

Purpose of review To appraise the practice and role of open-neck organ preserving surgery for hypopharyngeal squamous cell carcinoma and to update the current indications, techniques, limits, and outcomes. Recent findings The role of primary surgery for hypopharyngeal carcinoma has shifted over the past two decades to primary nonsurgical management with the use of induction or concurrent chemoradiotherapy. The preferred and most suitable tumours for open-neck surgery are the small-volume T stage diseases, with small to medium-volume neck metastases, however such patients are exceedingly rare. Nonetheless, more advanced tumours with cartilage invasion, vocal cord paralysis, or located at piriform apex and postcricoid area, previously unsuitable for open-neck organ preserving surgery, can now be excised and repaired, minimizing morbidity and improving quality of patients' life. Much of this surgical progress has been developed by innovative surgeons using free tissue transfer, accurate placement surgery, reconstruction of a neoglottis, and perfecting the pharyngoesophageal anastomosis. Current practice of open-neck organ preserving surgery for hypopharyngeal carcinoma has been mainly reported in Asia: Korea, Taiwan, Japan, and China. Summary There are some patients who are deemed unsuitable and/or unwilling for current treatment by nonsurgical approaches, and open-neck organ preserving laryngopharyngeal surgery may be a more suitable alternative than selecting a 'lesser or modified' chemo or bioradiotherapy regimen, resulting in a prolonged quantity and quality of life. Correspondence to Professor Patrick J. Bradley, MBA, FRCS, MD, 10 Chartwell Grove, Mapperley Plains, Nottingham NG3 5RD, UK. Tel: +44 115 9201611; e-mail: pjbradley@zoo.co.uk Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Salivaomics in oral cancer

Purpose of review The goal of cancer screening is to detect tumor at an early stage, and early cancer detection is the hallmark of successful treatment. In addition to traditional tissue biopsy-based diagnostics, more reliable, inexpensive, and noninvasive methods are required for early diagnosis of cancer. In this review, we highlight some of the recent advancements in the field of salivary diagnostics in oral cancer. Recent findings 'Salivaomics' is a broad collection of technologies used to explore different types of molecules contained in saliva. Although many protein and mRNA salivary biomarkers have been identified that can detect oral squamous cell carcinoma (OSCC), none have so far been validated for current clinical use. As the heterogeneity in carcinogenesis and multifactorial cause for OSCC, the most reliable results are gathered with the use of multiple biomarker candidates to improve accuracy and sensitivity of the test used. This further requires sensitive technology to detect salivary biomarkers in low quantities. Summary Large scale studies that incorporate proteomic, transcriptomic, and additional 'omics,' need to be initiated to bring technology to clinical point-of-care applications. Correspondence to Katri Aro, MD, PhD, Department of Otorhinolaryngology – Head and Neck Surgery, Helsinki University Hospital, PO Box 263, FI-00029 HUS, Helsinki, Finland. Tel: +358 50 4272000; e-mail: katri.aro@hus.fi Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Impact of a digital health intervention on asthma resource utilization

Abstract

Digital health interventions have been associated with reduced rescue inhaler use and improved controller medication adherence. This quality improvement project assessed the benefit of these interventions on asthma-related healthcare utilizations, including hospitalizations, emergency department (ED) utilization and outpatient visits. The intervention consisted of electronic medication monitors (EMMs) that tracked rescue and controller inhaler medication use, and a digital health platform that presented medication use information and asthma control status to patients and providers. In 224 study patients, the number of asthma-related ED visits and combined ED and hospitalization events 365 days pre- to 365 days post-enrollment to the intervention significantly decreased from 11.6 to 5.4 visits (p < 0.05) and 13.4 to 5.8 events (p < 0.05) per 100 patient-years, respectively. This digital health intervention was successfully incorporated into routine clinical practice and was associated with lower rates of asthma-related hospitalizations and ED visits.

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Allergen-specific IgE and IgG4 patterns among patients with different allergic diseases

Abstract

Background

In addition to allergen-specific IgE (sIgE), allergen-specific IgG4 (sIgG4) antibodies are also involved in the immune response resulting from an allergen exposure. The aim of our study was to analyze sIgE and sIgG4 patterns in the most common allergic disorders: bronchial asthma, upper airway disorders and atopic dermatitis.

Methods

In this study a screening analysis of blood serum samples from 673 patients aged from 6 months to 17 years with different allergic entities was performed on microarrays. sIgE and sIgG4 levels to the most common allergens were estimated.

Results

sIgE response to most pollen allergens is more strongly associated with respiratory diseases than with atopic dermatitis, while sIgE responses to cat and dog dander are more strongly associated with bronchial asthma than with atopic dermatitis and upper airway disorders such as rhinosinusitis and allergic rhinitis. A lower prevalence of sIgG4 to pollen allergens in cases of atopic dermatitis is observed compared with that in cases of asthma and upper airway disorders. Analyzing all the allergic disorders, one can see that sIgG4 response to inhalant allergens is strongly associated with sensitization to the corresponding allergen.

Conclusion

Allergen-specific IgE and IgG4 patterns that are relevant to concrete allergic diseases differ by sIgE and sIgG4 prevalences to defined allergens.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2Uam1xe

Impact of a digital health intervention on asthma resource utilization

Abstract

Digital health interventions have been associated with reduced rescue inhaler use and improved controller medication adherence. This quality improvement project assessed the benefit of these interventions on asthma-related healthcare utilizations, including hospitalizations, emergency department (ED) utilization and outpatient visits. The intervention consisted of electronic medication monitors (EMMs) that tracked rescue and controller inhaler medication use, and a digital health platform that presented medication use information and asthma control status to patients and providers. In 224 study patients, the number of asthma-related ED visits and combined ED and hospitalization events 365 days pre- to 365 days post-enrollment to the intervention significantly decreased from 11.6 to 5.4 visits (p < 0.05) and 13.4 to 5.8 events (p < 0.05) per 100 patient-years, respectively. This digital health intervention was successfully incorporated into routine clinical practice and was associated with lower rates of asthma-related hospitalizations and ED visits.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2AMg40V

Allergen-specific IgE and IgG4 patterns among patients with different allergic diseases

Abstract

Background

In addition to allergen-specific IgE (sIgE), allergen-specific IgG4 (sIgG4) antibodies are also involved in the immune response resulting from an allergen exposure. The aim of our study was to analyze sIgE and sIgG4 patterns in the most common allergic disorders: bronchial asthma, upper airway disorders and atopic dermatitis.

Methods

In this study a screening analysis of blood serum samples from 673 patients aged from 6 months to 17 years with different allergic entities was performed on microarrays. sIgE and sIgG4 levels to the most common allergens were estimated.

Results

sIgE response to most pollen allergens is more strongly associated with respiratory diseases than with atopic dermatitis, while sIgE responses to cat and dog dander are more strongly associated with bronchial asthma than with atopic dermatitis and upper airway disorders such as rhinosinusitis and allergic rhinitis. A lower prevalence of sIgG4 to pollen allergens in cases of atopic dermatitis is observed compared with that in cases of asthma and upper airway disorders. Analyzing all the allergic disorders, one can see that sIgG4 response to inhalant allergens is strongly associated with sensitization to the corresponding allergen.

Conclusion

Allergen-specific IgE and IgG4 patterns that are relevant to concrete allergic diseases differ by sIgE and sIgG4 prevalences to defined allergens.

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Clinical Thyroidology®High-Impact Articles

FREE ACCESS through December 11, 2018.
Read Now:

Vemurafenib Restores Radioiodine Uptake in Some Metastatic Thyroid Cancers
Jerome M. Hershman  

Randomized, Controlled Trials Show That Treatment of Subclinical Hypothyroidism Does Not Improve Quality of Life, Cognition, Blood Pressure, or BMI
Tim I.M. Korevaar 

Symptoms Strongly Drive the Consideration of Alternative Thyroid Hormone–Replacement Options in Patients with Hypothyroidism
Angela M. Leung 

Which Factors Predict the Outcome of Ablative Radioactive Iodine Treatment of Hyperthyroid Graves' Disease?
Jacques Orgiazzi 

 

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VideoEndocrinology™ High-Impact Videos

VideoEndocrinology™
The Official Journal of: American Thyroid Association

FREE ACCESS through December 14, 2018.
Watch now:

Transoral Endoscopic Thyroidectomy Vestibular Approach: Technical Tips and Tricks
Gustavo G. Fernandez Ranvier, Patrick Neshiwat, William B. Inabnet III

Central Neck Dissection: The Five Key Steps
Nathaniel J. Walsh, Asif M. Talukder, David J. Terris 

Transoral and Submental Thyroidectomy
Yufei Chen, Kathryn H. Chomsky-Higgins, Iheoma Nwaogu, Carolyn D. Seib, Jessica E. Gosnell, Wen T. Shen, Quan-Yang Duh, Insoo Suh 

3D Anatomic Adrenal Modeling Aids Preoperative Planning in Cortical-Sparing Adrenalectomy
Janeil M. Mitchell, Michael J. Magnetta, Kelly L. McCoy, Sally E. Carty, Linwah Yip

The post VideoEndocrinology™ High-Impact Videos appeared first on American Thyroid Association.

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Clinical Thyroidology®High-Impact Articles

FREE ACCESS through December 11, 2018.
Read Now:

Vemurafenib Restores Radioiodine Uptake in Some Metastatic Thyroid Cancers
Jerome M. Hershman  

Randomized, Controlled Trials Show That Treatment of Subclinical Hypothyroidism Does Not Improve Quality of Life, Cognition, Blood Pressure, or BMI
Tim I.M. Korevaar 

Symptoms Strongly Drive the Consideration of Alternative Thyroid Hormone–Replacement Options in Patients with Hypothyroidism
Angela M. Leung 

Which Factors Predict the Outcome of Ablative Radioactive Iodine Treatment of Hyperthyroid Graves' Disease?
Jacques Orgiazzi 

 

The post Clinical Thyroidology^®High-Impact Articles appeared first on American Thyroid Association.

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VideoEndocrinology™ High-Impact Videos

VideoEndocrinology™
The Official Journal of: American Thyroid Association

FREE ACCESS through December 14, 2018.
Watch now:

Transoral Endoscopic Thyroidectomy Vestibular Approach: Technical Tips and Tricks
Gustavo G. Fernandez Ranvier, Patrick Neshiwat, William B. Inabnet III

Central Neck Dissection: The Five Key Steps
Nathaniel J. Walsh, Asif M. Talukder, David J. Terris 

Transoral and Submental Thyroidectomy
Yufei Chen, Kathryn H. Chomsky-Higgins, Iheoma Nwaogu, Carolyn D. Seib, Jessica E. Gosnell, Wen T. Shen, Quan-Yang Duh, Insoo Suh 

3D Anatomic Adrenal Modeling Aids Preoperative Planning in Cortical-Sparing Adrenalectomy
Janeil M. Mitchell, Michael J. Magnetta, Kelly L. McCoy, Sally E. Carty, Linwah Yip

The post VideoEndocrinology™ High-Impact Videos appeared first on American Thyroid Association.

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VideoEndocrinology™ High-Impact Videos

VideoEndocrinology™
The Official Journal of: American Thyroid Association

FREE ACCESS through December 14, 2018.
Watch now:

Transoral Endoscopic Thyroidectomy Vestibular Approach: Technical Tips and Tricks
Gustavo G. Fernandez Ranvier, Patrick Neshiwat, William B. Inabnet III

Central Neck Dissection: The Five Key Steps
Nathaniel J. Walsh, Asif M. Talukder, David J. Terris 

Transoral and Submental Thyroidectomy
Yufei Chen, Kathryn H. Chomsky-Higgins, Iheoma Nwaogu, Carolyn D. Seib, Jessica E. Gosnell, Wen T. Shen, Quan-Yang Duh, Insoo Suh 

3D Anatomic Adrenal Modeling Aids Preoperative Planning in Cortical-Sparing Adrenalectomy
Janeil M. Mitchell, Michael J. Magnetta, Kelly L. McCoy, Sally E. Carty, Linwah Yip

The post VideoEndocrinology™ High-Impact Videos appeared first on American Thyroid Association.

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VideoEndocrinology™ High-Impact Videos

VideoEndocrinology™
The Official Journal of: American Thyroid Association

FREE ACCESS through December 14, 2018.
Watch now:

Transoral Endoscopic Thyroidectomy Vestibular Approach: Technical Tips and Tricks
Gustavo G. Fernandez Ranvier, Patrick Neshiwat, William B. Inabnet III

Central Neck Dissection: The Five Key Steps
Nathaniel J. Walsh, Asif M. Talukder, David J. Terris 

Transoral and Submental Thyroidectomy
Yufei Chen, Kathryn H. Chomsky-Higgins, Iheoma Nwaogu, Carolyn D. Seib, Jessica E. Gosnell, Wen T. Shen, Quan-Yang Duh, Insoo Suh 

3D Anatomic Adrenal Modeling Aids Preoperative Planning in Cortical-Sparing Adrenalectomy
Janeil M. Mitchell, Michael J. Magnetta, Kelly L. McCoy, Sally E. Carty, Linwah Yip

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Working memory training involves learning new skills

We present a new framework characterizing training-induced changes in WM as the acquisition of novel cognitive routines akin to learning a new skill. Predictions were tested in three studies analyzing the transfer between WM tasks following WM training. Study 1 reports a meta-analysis establishing substantial transfer when trained and untrained tasks shared either a serial recall, complex span or backward span paradigm. Transfer was weaker for serial recall of verbal than visuo-spatial material, suggesting that this paradigm is served by an existing verbal STM system and does not require a new routine. Re-analysis of published WM training data in Study 2 showed that transfer was restricted to tasks sharing properties proposed to require new routines. In a re-analysis of data from four stud...

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[Impairments of language and communication in schizophrenia].

In conclusion, more well-controlled speech-language therapy studies are required in order to improve participation and communication-related quality of life in schizophrenia. PMID: 30488088 [PubMed - as supplied by publisher] (Source: Der Nervenarzt)

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Collaborative design of accessible information with people with aphasia

. (Source: Aphasiology)

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Towards an asset-based approach to promoting and sustaining well-being for people with aphasia and their families: an international exploratory study

. (Source: Aphasiology)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2KMKx3e

Working memory training involves learning new skills

We present a new framework characterizing training-induced changes in WM as the acquisition of novel cognitive routines akin to learning a new skill. Predictions were tested in three studies analyzing the transfer between WM tasks following WM training. Study 1 reports a meta-analysis establishing substantial transfer when trained and untrained tasks shared either a serial recall, complex span or backward span paradigm. Transfer was weaker for serial recall of verbal than visuo-spatial material, suggesting that this paradigm is served by an existing verbal STM system and does not require a new routine. Re-analysis of published WM training data in Study 2 showed that transfer was restricted to tasks sharing properties proposed to require new routines. In a re-analysis of data from four stud...

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[Impairments of language and communication in schizophrenia].

In conclusion, more well-controlled speech-language therapy studies are required in order to improve participation and communication-related quality of life in schizophrenia. PMID: 30488088 [PubMed - as supplied by publisher] (Source: Der Nervenarzt)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2KO9w6p

Collaborative design of accessible information with people with aphasia

. (Source: Aphasiology)

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

Towards an asset-based approach to promoting and sustaining well-being for people with aphasia and their families: an international exploratory study

. (Source: Aphasiology)

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Examination of the enhanced recovery guidelines in thoracic surgery

Purpose of review Enhanced Recovery After Thoracic Surgery (ERATS) has gained momentum over the past few years, although the evidence base and expert recommendations lag behind other specialties. This review will present and examine key points from the first guidelines for enhanced recovery after lung surgery, released in 2018, jointly sponsored by the European Society of Thoracic Surgeons and the Enhanced Recovery After Surgery Society. Recent findings The recently released guidelines present core components of enhanced recovery as they pertain to lung resection surgery. Although evidence is still sparse in some areas, the guidelines summarize the available literature and incorporate levels of recommendation based upon the strength of available data as well as expert consensus. As of yet, the relative contribution of individual ERATS components to improvement in outcomes is unclear, but overall compliance does seem to be linked to positive results. Since the creation of the guidelines, additional literature related to ERATS has been released, and it will be incorporated and discussed into our review. Summary The creation of guidelines for enhanced recovery after lung resection will provide the thoracic anesthesiologist a framework upon which to build a comprehensive perioperative anesthetic plan. Correspondence to Emily G. Teeter, MD, FASE, Department of Anesthesiology, University of North Carolina at Chapel Hill, N2198 UNC Hospitals, CB #7010, Chapel Hill, NC 27599-7010, USA. Tel: 1 (919) 966 5136; E-mail: Emily_Teeter@med.unc.edu Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Neuromonitoring in the elderly

Purpose of review To summarize recent recommendations on intraoperative electroencephalogram (EEG) neuromonitoring in the elderly aimed at the prevention of postoperative delirium and long-term neurocognitive decline. We discuss recent perioperative EEG investigations relating to aging and cognitive dysfunction, and their implications on intraoperative EEG neuromonitoring in elderly patients. Recent findings The incidence of postoperative delirium in elderly can be reduced by monitoring depth of anesthesia, using an index number (0–100) derived from processed frontal EEG readings. The recently published European Society of Anaesthesiology guideline on postoperative delirium in elderly now recommends guiding general anesthesia with such indices (Level A). However, intraoperative EEG signatures are heavily influenced by age, cognitive function, and choice of anesthetic agents. Detailed spectral EEG analysis and research on EEG-based functional connectivity provide new insights into the pathophysiology of neuronal excitability, which is seen in elderly patients with postoperative delirium. Summary Anesthesiologists should become acquainted with intraoperative EEG signatures and their relation to age, anesthetic agents, and the risk of postoperative cognitive complications. A working knowledge would allow an optimized and individualized provision of general anesthesia for the elderly. Correspondence to Claudia Spies, Department of Anesthesiology and Operative Intensive Care Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany. Tel: +49 30 450 651 001; e-mail: claudia.spies@charite.de Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Incremental value of noncerebral somatic tissue oxygenation monitoring for patients undergoing surgery

Purpose of the review There is increasing interest in the use of noncerebral somatic tissue oxygen saturation (SstO2) monitoring on the basis of near-infrared spectroscopy in patients undergoing surgery or residing in intensive care unit. The relevant question is whether SstO2 monitoring can improve the quality of care. In this article, we reviewed the clinical application of SstO2 monitoring in acute care, focusing on its use in patients undergoing surgery. Recent findings Multiple small cohort studies conducted on pediatric patients reported close associations of SstO2 measurements over different regions such as the splanchnic and renal tissue beds with systemic oxygenation, transfusion, hemodynamic indices, morbidity, and mortality. Conversely, there is paucity of literature on SstO2 monitoring in adult patients. The limited number of reports suggests that SstO2 levels over bulk muscles such as the thenar eminence, forearm, and lower leg during surgery are correlated with postoperative outcomes including postoperative nausea and vomiting and the length of hospital stay in adult patients undergoing surgery. The only pilot, randomized interventional study based on 50 patients undergoing surgery did not find a difference in outcomes on the basis of the use of SstO2 monitoring. Summary Somatic tissue oxygenation may represent an essential aspect of human physiology in acute care, and it is likely outcome-relevant based on observational cohort studies. Future research should examine whether SstO2-guided care can further improve patient outcomes using randomized controlled trials. Correspondence to Lingzhong Meng, MD, Professor and Division Chief, Department of Anesthesiology, Yale University School of Medicine, 333 Cedar Street, TMP 3, PO Box 208051, New Haven, CT 06520, USA. Tel: +1 203 785 2802; e-mail: lingzhong.meng@yale.edu Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Extravascular lung water monitoring for thoracic and lung transplant surgeries

Purpose of review Excessive accumulation of extravascular lung water (EVLW) resulting in pulmonary edema is the most feared complication following thoracic surgery and lung transplant. ICUs have long relied on chest radiography to monitor pulmonary status postoperatively but the increasing recognition of the limitations of bedside plain films has fueled development of newer technologies, which offer earlier detection, quantitative assessments, and can aide in preoperative screening of surgical candidates. In this review, we focus on the emergence of transpulmonary thermodilution (TPTD) and lung ultrasound with a focus on the clinical integration of these modalities into current intraoperative and critical care practices. Recent findings Recent studies demonstrate transpulmonary thermodilution and lung ultrasound provide greater sensitivity and earlier detection of lung water accumulation and are useful to guide clinical management. Assessments from these techniques have predictive value of postoperative outcome. Further, EVLW assessment shows promise as a preoperative screening tool in lung transplant patients. Summary Monitoring EVLW in the perioperative period offers clinicians a powerful tool to guide fluid therapy and manage pulmonary edema. Both TPTD and lung ultrasound have unique attributes in the care of thoracic surgery and lung transplant patients. Correspondence to Sherif Assaad, MD, Department of Anesthesiology, Yale University School of Medicine, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA. Tel: +1 203 932 5711; fax: +1 203 937 4803; e-mail: sherif.assaad@yale.ed Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Spinal cord perfusion protection for thoraco-abdominal aortic aneurysm surgery

Purpose of Review Spinal cord ischemia (SCI) is a devastating complication after open or endovascular aortic repair for thoracoabdominal aortic disease. The underlying pathogenesis is not fully understood but appears multifactorial. Multiple spinal cord protection strategies and monitoring techniques are currently utilized with variable results seen. The purpose of this review is to summarize important and recent findings related to cause, monitoring and impact of multiple spinal cord protection strategies. Recent Findings Recent data suggests collateral blood flow as the major determinant of spinal cord perfusion instead of individual intercostal vessels, potential role of transcutaneous near-infrared spectroscopy for monitoring of spinal cord perfusion and positive impact of implementing multimodal spinal cord protection strategies on reducing the risk of SCI. Summary SCI leading to paraplegia is a multifactorial complication that remains a major concern in complex aortic surgeries. Although there are no sufficient data to document the efficacy of spinal cord protection techniques individually, their effect on lowering the risk of SCI is most evident when used concomitantly using a multimodal approach that encompasses the perioperative and early postoperative period. Correspondence to Lovkesh Arora, MD, 200 Hawkins drive, 6JCP, Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City, IA 52242-1079, USA. Tel: +1 319 384 6079; e-mail: Lovkesh-arora@uiowa.edu Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Prehabilitation is better than cure

Purpose of review With a continuously growing number of older patients undergoing major surgical procedures, reliable parameters practicable in perioperative routine revealing those patients at risk are urgently needed. Recently, the concept of 'prehabilitation' with its key elements exercise, nutrition and psychological stress reduction especially in frail patients is attracting increasing attention. Recent findings Literature search revealed a huge amount of publications in particular within the last 12 months. Although a single definition of both frailty and prehabilitation is still to be made, various players in the perioperative setting obviously are becoming increasingly convinced about a possible benefit of the program – referring to different components and measures performed. Although physiologically advantages seem obvious, there is hardly any reliable data on clinical outcomes resulting from properly performed studies. This applies especially to octogenarians; thus those at risk for adverse events the concept originally addresses. Summary Identifying high-risk patients at the earliest possible stage and increasing their physiological reserve prior to surgery is a promising approach that seems to result in remarkable improvements for older patients. However, further studies on effectiveness in a highly heterogeneous population and agreement on a common concept are mandatory before a final judgement can be given. Correspondence to Simone Gurlit, MD, Department of Anesthesiology and operative Intensive Care, St. Franziskus-Hospital Muenster, Hohenzollernring 70, 48145 Muenster, Germany. Tel: +49 251 935 3936; fax: +49 251 935 4077; e-mails: simonegurlit@aol.com, simone.gurlit@sfh-muenster.de Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Biomarkers and postoperative cognitive function: could it be that easy?

Purpose of review Neurocognitive dysfunction after surgery is highly relevant in the elderly. The multifactorial manner of this syndrome has made it hard to define an ideal biomarker to predict individual risk and assess diagnosis and severity of delirium [postoperative delirium (POD)] and subsequent postoperative cognitive decline (POCD). This review summarizes recent literature on blood biomarkers for POD/POCD. Recent findings Markers for delirium have been searched for in the cerebrospinal fluid to examine the pathologic cascade. However, cerebrospinal fluid cannot be easily obtained in the perioperative setting. Thus, attention shifts toward prediction markers from patients' blood to determine the individual risk. In this regard, three major groups of peripheral blood markers could be distinguished: first, global, but unspecific markers associated with POD/POCD; second, specific and established markers related to neurocognitive function; and third, upcoming or newly described markers with less evidence. Solely neuron-specific enolase is an adequate biomarker based on recent literature. Summary Single markers for postoperative cognitive impairment cannot predict POD/POCD in geriatric patients. However, a wisely arranged battery of promising biomarkers might achieve a satisfying sensitivity and specificity for the preoperative assessment of subsequent cognitive decline. Adequately powered studies to prove this hypothesis are required. Correspondence to Simon T. Schaefer, Department of Anaesthesiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany. Tel: +49 89 440 013 181 142; fax: +49 89 440 078 886; e-mail: simon.schaefer@med.uni-muenchen.de Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (https://ift.tt/1qR4umk). Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Delayed recovery following thoracic surgery: persistent issues and potential interventions

Purpose of review Lung and esophageal surgery remain a curative option for resectable cancers. However, despite advances in surgical and anesthesia practices, the inclusion of patients with comorbidities that would have previously not been offered curative resection presents additional concerns and challenges. Recent findings Perioperative complication rates remain high and prolonged and/or painful recovery are common. Further, many patients face a permanent decline in their functional status, which negatively affects their quality of life. Examination of the variables associated with high complications following thoracic surgery reveals patient, physician, and institutional factors in the forefront. Anesthesiologist training, Enhanced Recovery After Surgery protocols, and preparations to minimize "failure to rescue" when a complication does arise are key strategies to address adverse outcomes. Summary Delayed and complicated recovery after thoracic noncardiac surgery persist in current practice. This review analyzes the diverse factors that can impact complications and quality of life after lung surgery and the interventions that can help decrease length of stay and improve return to baseline conditions. Correspondence to Alessia Pedoto, MD FASA, Department of Anesthesiology and Critical Care Medicine, 1275 York Ave. Room M301, New York, NY 10065, USA. Tel: +1 212 639 6840; e-mail: pedotoa@mskcc.org Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Examination of the enhanced recovery guidelines in thoracic surgery

Purpose of review Enhanced Recovery After Thoracic Surgery (ERATS) has gained momentum over the past few years, although the evidence base and expert recommendations lag behind other specialties. This review will present and examine key points from the first guidelines for enhanced recovery after lung surgery, released in 2018, jointly sponsored by the European Society of Thoracic Surgeons and the Enhanced Recovery After Surgery Society. Recent findings The recently released guidelines present core components of enhanced recovery as they pertain to lung resection surgery. Although evidence is still sparse in some areas, the guidelines summarize the available literature and incorporate levels of recommendation based upon the strength of available data as well as expert consensus. As of yet, the relative contribution of individual ERATS components to improvement in outcomes is unclear, but overall compliance does seem to be linked to positive results. Since the creation of the guidelines, additional literature related to ERATS has been released, and it will be incorporated and discussed into our review. Summary The creation of guidelines for enhanced recovery after lung resection will provide the thoracic anesthesiologist a framework upon which to build a comprehensive perioperative anesthetic plan. Correspondence to Emily G. Teeter, MD, FASE, Department of Anesthesiology, University of North Carolina at Chapel Hill, N2198 UNC Hospitals, CB #7010, Chapel Hill, NC 27599-7010, USA. Tel: 1 (919) 966 5136; E-mail: Emily_Teeter@med.unc.edu Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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

Neuromonitoring in the elderly

Purpose of review To summarize recent recommendations on intraoperative electroencephalogram (EEG) neuromonitoring in the elderly aimed at the prevention of postoperative delirium and long-term neurocognitive decline. We discuss recent perioperative EEG investigations relating to aging and cognitive dysfunction, and their implications on intraoperative EEG neuromonitoring in elderly patients. Recent findings The incidence of postoperative delirium in elderly can be reduced by monitoring depth of anesthesia, using an index number (0–100) derived from processed frontal EEG readings. The recently published European Society of Anaesthesiology guideline on postoperative delirium in elderly now recommends guiding general anesthesia with such indices (Level A). However, intraoperative EEG signatures are heavily influenced by age, cognitive function, and choice of anesthetic agents. Detailed spectral EEG analysis and research on EEG-based functional connectivity provide new insights into the pathophysiology of neuronal excitability, which is seen in elderly patients with postoperative delirium. Summary Anesthesiologists should become acquainted with intraoperative EEG signatures and their relation to age, anesthetic agents, and the risk of postoperative cognitive complications. A working knowledge would allow an optimized and individualized provision of general anesthesia for the elderly. Correspondence to Claudia Spies, Department of Anesthesiology and Operative Intensive Care Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany. Tel: +49 30 450 651 001; e-mail: claudia.spies@charite.de Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2Q5uTWF

Incremental value of noncerebral somatic tissue oxygenation monitoring for patients undergoing surgery

Purpose of the review There is increasing interest in the use of noncerebral somatic tissue oxygen saturation (SstO2) monitoring on the basis of near-infrared spectroscopy in patients undergoing surgery or residing in intensive care unit. The relevant question is whether SstO2 monitoring can improve the quality of care. In this article, we reviewed the clinical application of SstO2 monitoring in acute care, focusing on its use in patients undergoing surgery. Recent findings Multiple small cohort studies conducted on pediatric patients reported close associations of SstO2 measurements over different regions such as the splanchnic and renal tissue beds with systemic oxygenation, transfusion, hemodynamic indices, morbidity, and mortality. Conversely, there is paucity of literature on SstO2 monitoring in adult patients. The limited number of reports suggests that SstO2 levels over bulk muscles such as the thenar eminence, forearm, and lower leg during surgery are correlated with postoperative outcomes including postoperative nausea and vomiting and the length of hospital stay in adult patients undergoing surgery. The only pilot, randomized interventional study based on 50 patients undergoing surgery did not find a difference in outcomes on the basis of the use of SstO2 monitoring. Summary Somatic tissue oxygenation may represent an essential aspect of human physiology in acute care, and it is likely outcome-relevant based on observational cohort studies. Future research should examine whether SstO2-guided care can further improve patient outcomes using randomized controlled trials. Correspondence to Lingzhong Meng, MD, Professor and Division Chief, Department of Anesthesiology, Yale University School of Medicine, 333 Cedar Street, TMP 3, PO Box 208051, New Haven, CT 06520, USA. Tel: +1 203 785 2802; e-mail: lingzhong.meng@yale.edu Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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