We showed recently that ethyl-2-amino-pyrrole-3-carboxylates (EAPCs) exhibit potent antiproliferative activities against a broad spectrum of soft tissue sarcoma and gastrointestinal stromal tumor (GIST) cell lines in vitro. The molecular mechanism of action was owing to inhibition of tubulin polymerization and induction of a robust G2/M cell-cycle arrest, leading to the accumulation of tumor cells in the M-phase and induction of apoptosis. Given that more than 50% of the patients with GISTs develop resistance to imatinib (IM) over the 2 years of IM-based therapy, we examined whether EAPCs exhibit activity against IM-resistant GISTs in vitro and in vivo. A real-time antiproliferation assay illustrated the potent antiproliferative activities of EAPCs against IM-sensitive and IM-resistant GISTs. This was in agreement with the colony formation assay, which revealed potent antiproliferative activities of EAPCs against IM-resistant GISTs, being much stronger when compared with IM and doxorubicin, a topoisomerase II inhibitor. Next, we tested the efficacy of EAPCs in the xenograft model of GISTs, exhibiting secondary IM resistance owing to RTK switch (loss of c-KIT/gain of FGFR2α). A total of 30 5- to 8-week-old female nu/nu mice were subcutaneously inoculated into the flank areas with IM-resistant GIST-T1-R cells (100 μl of 1×107 GIST T-1R cells/ml suspension, in Dulbecco's PBS). Mice were randomized as control (untreated), IM (50 mg/kg), EAPC-20 (10 mg/kg) or EAPC-24 (10 mg/kg) and were treated orally for 10 days. IM has a minor inhibitory effect on tumor size, thus revealing GIST resistance to IM. In contrast, both of EAPCs effectively reduced the tumor size. This was associated with an increased intratumoral apoptosis as detected by immunohistochemical staining for cleaved caspase-3 on day 5 of the treatment. Furthermore, both EAPCs significantly reduced the proliferative activity of tumor cells in the central zones of tumors as measured by positivity for Ki-67 staining. More importantly, in EAPC-24-treated GISTs, the histological response was mainly characterized by the induction of necrosis, whereas EAPC-20 induced the signs of intratumoral fibrosis and myxoid degeneration. Collectively, our data suggest that EAPC-20 and EAPC-24 are the perspective antitumor agents that exhibit antiproliferative and cytotoxic activity against GISTs exhibiting secondary resistance to IM. Correspondence to Sergei Boichuk, Dr Sci, PhD, MD, Department of Pathology, Kazan State Medical University, Kazan 420012, Russia Tel: +7 917 397 8093; fax: +8 843 236 0652; e-mail: boichuksergei@mail.ru Received September 3, 2018 Accepted January 8, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2UhbhMT
Σάββατο 26 Ιανουαρίου 2019
Upregulation of sine oculis homeobox homolog 3 is associated with proliferation, invasion, migration, as well as poor prognosis of esophageal cancer
Esophageal cancer (EC) is a common cancer worldwide. Sine oculis homeobox homolog (SIX3) is a human transcription factor that regulates the progression of vertebrate eye and fetal forebrain. However, studies on the function of SIX3 in human tumorigenesis remain rare. In this study, we aim to evaluate the role and the significance of SIX3 in EC. The TCGA database and clinical samples were used to assess the expression of SIX3 in EC patients. The Kaplan–Meier method and Cox's proportional hazards model were performed to analyze the correlations between SIX3 expression and EC clinical outcomes. The expressions of SIX3 in EC cells were measured by quantitative reverse transcription PCR analysis. The cell proliferation was detected using cell counting kit-8 and colony formation assay. The migration and invasion capacity of EC cells were evaluated using wound healing and Transwell methods. Western blot assay was used to measure the alterations in some important protein expression levels in the PI3K/Akt signaling pathway. We found that SIX3 was highly expressed in the EC tissues and cells. In addition, high expression of SIX3 was related to poor survival. The knockdown of SIX3 significantly inhibited the proliferation, migration, and invasion of ECA109 cells. A similar pattern was also found in the proliferation and migration of SKGT-4 cell line. The expression levels of some key proteins in the PI3K/Akt signaling pathway were obviously decreased after cells were transfected with si-SIX3, possibly resulting in PI3K/AKT signaling inactivation. In addition, E-cadherin and N-cadherin showed some change. Collectively, the results shed light on a potentially promoting role of SIX3 in human EC. Thus, SIX3 might be considered a novel prognostic biomarker and therapeutic target for EC patients. Correspondence to Jie Du, MS, Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, No. 185, Ju Qian Street, Changzhou, Jiangsu 213003, China Tel: +86 135 0664 7690; e-mail: jiedu1976@163.com Received September 27, 2018 Received in revised form December 17, 2018 Accepted January 3, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FIH3PN
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FIH3PN
Cytotoxic constituents from Penicillium concentricum, an endophytic fungus from Trichocolea tomentella
In our continuing effort to identify bioactive secondary metabolites from natural sources, the antiproliferative activity of 23 compounds, previously isolated from Penicillium concentricum, was assessed using the sulforhodamine B assay. The cytotoxic effect was determined against HeLa cervical, HT-29 colon, MDA-MB-321 breast, PC-3, and DU-145 prostate cancer cell lines. Compounds were also tested in the mitochondrial transmembrane potential (MTP) and nuclear factor kappa B (NF-κB) target-based assays. The results showed that 2-bromogentisyl alcohol (2) and 3-hydroxy-benzenemethanol (8) exhibited the highest cytotoxic activity against different cancer cell lines. Epoxydon (14) showed selectivity against DU-145 prostate cancer cells [inhibitory concentration 50 (IC50)=1.2 μmol/l]. Compounds 2, 8, 14, 18, 21 also induced damage of MTP (IC50=0.1, 0.2, 7.0, 9.6, and 1.8 μmol/l, respectively). In the NF-κB assay, only compound 8 exhibited potent inhibition (IC50=0.3 μmol/l). Compounds 2 and 14 showed cytotoxic activity and induction of damage in mitochondrial membrane potential while compound 8 inhibited NF-κB and MTP damage. Additionally, compound 14 with selectivity against DU-145 prostate cancer cells induced cell cycle arrested in G2/M phase. Thus, compounds 2, 8, and 14 could be useful leads in the development of new anticancer agents from natural sources. Correspondence to Esperanza Carcache de Blanco, PhD, Department of Pharmacy, The Ohio State University, Lloyd M. Parks Hall 500 W. 12th Avenue, Columbus, OH 43210, USA Tel: +1 614 247 7815; fax: +1 614 292 1335; e-mail: carcache-de-blan.1@osu.edu Received November 16, 2018 Received in revised form December 26, 2018 Accepted January 16, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DAUkHJ
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DAUkHJ
Ethyl-2-amino-pyrrole-3-carboxylates are active against imatinib-resistant gastrointestinal stromal tumors in vitro and in vivo
We showed recently that ethyl-2-amino-pyrrole-3-carboxylates (EAPCs) exhibit potent antiproliferative activities against a broad spectrum of soft tissue sarcoma and gastrointestinal stromal tumor (GIST) cell lines in vitro. The molecular mechanism of action was owing to inhibition of tubulin polymerization and induction of a robust G2/M cell-cycle arrest, leading to the accumulation of tumor cells in the M-phase and induction of apoptosis. Given that more than 50% of the patients with GISTs develop resistance to imatinib (IM) over the 2 years of IM-based therapy, we examined whether EAPCs exhibit activity against IM-resistant GISTs in vitro and in vivo. A real-time antiproliferation assay illustrated the potent antiproliferative activities of EAPCs against IM-sensitive and IM-resistant GISTs. This was in agreement with the colony formation assay, which revealed potent antiproliferative activities of EAPCs against IM-resistant GISTs, being much stronger when compared with IM and doxorubicin, a topoisomerase II inhibitor. Next, we tested the efficacy of EAPCs in the xenograft model of GISTs, exhibiting secondary IM resistance owing to RTK switch (loss of c-KIT/gain of FGFR2α). A total of 30 5- to 8-week-old female nu/nu mice were subcutaneously inoculated into the flank areas with IM-resistant GIST-T1-R cells (100 μl of 1×107 GIST T-1R cells/ml suspension, in Dulbecco's PBS). Mice were randomized as control (untreated), IM (50 mg/kg), EAPC-20 (10 mg/kg) or EAPC-24 (10 mg/kg) and were treated orally for 10 days. IM has a minor inhibitory effect on tumor size, thus revealing GIST resistance to IM. In contrast, both of EAPCs effectively reduced the tumor size. This was associated with an increased intratumoral apoptosis as detected by immunohistochemical staining for cleaved caspase-3 on day 5 of the treatment. Furthermore, both EAPCs significantly reduced the proliferative activity of tumor cells in the central zones of tumors as measured by positivity for Ki-67 staining. More importantly, in EAPC-24-treated GISTs, the histological response was mainly characterized by the induction of necrosis, whereas EAPC-20 induced the signs of intratumoral fibrosis and myxoid degeneration. Collectively, our data suggest that EAPC-20 and EAPC-24 are the perspective antitumor agents that exhibit antiproliferative and cytotoxic activity against GISTs exhibiting secondary resistance to IM. Correspondence to Sergei Boichuk, Dr Sci, PhD, MD, Department of Pathology, Kazan State Medical University, Kazan 420012, Russia Tel: +7 917 397 8093; fax: +8 843 236 0652; e-mail: boichuksergei@mail.ru Received September 3, 2018 Accepted January 8, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2UhbhMT
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2UhbhMT
Upregulation of sine oculis homeobox homolog 3 is associated with proliferation, invasion, migration, as well as poor prognosis of esophageal cancer
Esophageal cancer (EC) is a common cancer worldwide. Sine oculis homeobox homolog (SIX3) is a human transcription factor that regulates the progression of vertebrate eye and fetal forebrain. However, studies on the function of SIX3 in human tumorigenesis remain rare. In this study, we aim to evaluate the role and the significance of SIX3 in EC. The TCGA database and clinical samples were used to assess the expression of SIX3 in EC patients. The Kaplan–Meier method and Cox's proportional hazards model were performed to analyze the correlations between SIX3 expression and EC clinical outcomes. The expressions of SIX3 in EC cells were measured by quantitative reverse transcription PCR analysis. The cell proliferation was detected using cell counting kit-8 and colony formation assay. The migration and invasion capacity of EC cells were evaluated using wound healing and Transwell methods. Western blot assay was used to measure the alterations in some important protein expression levels in the PI3K/Akt signaling pathway. We found that SIX3 was highly expressed in the EC tissues and cells. In addition, high expression of SIX3 was related to poor survival. The knockdown of SIX3 significantly inhibited the proliferation, migration, and invasion of ECA109 cells. A similar pattern was also found in the proliferation and migration of SKGT-4 cell line. The expression levels of some key proteins in the PI3K/Akt signaling pathway were obviously decreased after cells were transfected with si-SIX3, possibly resulting in PI3K/AKT signaling inactivation. In addition, E-cadherin and N-cadherin showed some change. Collectively, the results shed light on a potentially promoting role of SIX3 in human EC. Thus, SIX3 might be considered a novel prognostic biomarker and therapeutic target for EC patients. Correspondence to Jie Du, MS, Department of Cardiothoracic Surgery, The Third Affiliated Hospital of Soochow University, No. 185, Ju Qian Street, Changzhou, Jiangsu 213003, China Tel: +86 135 0664 7690; e-mail: jiedu1976@163.com Received September 27, 2018 Received in revised form December 17, 2018 Accepted January 3, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FIH3PN
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FIH3PN
Cytotoxic constituents from Penicillium concentricum, an endophytic fungus from Trichocolea tomentella
In our continuing effort to identify bioactive secondary metabolites from natural sources, the antiproliferative activity of 23 compounds, previously isolated from Penicillium concentricum, was assessed using the sulforhodamine B assay. The cytotoxic effect was determined against HeLa cervical, HT-29 colon, MDA-MB-321 breast, PC-3, and DU-145 prostate cancer cell lines. Compounds were also tested in the mitochondrial transmembrane potential (MTP) and nuclear factor kappa B (NF-κB) target-based assays. The results showed that 2-bromogentisyl alcohol (2) and 3-hydroxy-benzenemethanol (8) exhibited the highest cytotoxic activity against different cancer cell lines. Epoxydon (14) showed selectivity against DU-145 prostate cancer cells [inhibitory concentration 50 (IC50)=1.2 μmol/l]. Compounds 2, 8, 14, 18, 21 also induced damage of MTP (IC50=0.1, 0.2, 7.0, 9.6, and 1.8 μmol/l, respectively). In the NF-κB assay, only compound 8 exhibited potent inhibition (IC50=0.3 μmol/l). Compounds 2 and 14 showed cytotoxic activity and induction of damage in mitochondrial membrane potential while compound 8 inhibited NF-κB and MTP damage. Additionally, compound 14 with selectivity against DU-145 prostate cancer cells induced cell cycle arrested in G2/M phase. Thus, compounds 2, 8, and 14 could be useful leads in the development of new anticancer agents from natural sources. Correspondence to Esperanza Carcache de Blanco, PhD, Department of Pharmacy, The Ohio State University, Lloyd M. Parks Hall 500 W. 12th Avenue, Columbus, OH 43210, USA Tel: +1 614 247 7815; fax: +1 614 292 1335; e-mail: carcache-de-blan.1@osu.edu Received November 16, 2018 Received in revised form December 26, 2018 Accepted January 16, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DAUkHJ
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DAUkHJ
VideoEndocrinology™ New Open Access Video
Parapharyngeal Dissection for Papillary Thyroid Cancer
Justin Tran, Mark Zafereo
The post VideoEndocrinology™ New Open Access Video appeared first on American Thyroid Association.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2T4XFEg
Quality of CT Imaging of Periocular Metallic Foreign Bodies Using Artifact Reduction Software
Purpose: CT is the standard of care for assessment of ocular and orbital trauma; however, artifacts from metallic foreign bodies can limit the utility of CT. The authors hypothesize that implementation of metal artifact reduction techniques can improve image quality and diagnostic confidence for a diverse group of interpreters. Methods: A case series of ten subjects with retained periocular metallic foreign bodies imaged with CT were identified retrospectively from a large urban trauma center. Postacquisition images were processed with an iterative-based metal streak artifact reduction software. The severity of the metal streak artifact was assessed by clinicians including radiologists (4), ophthalmologists (4), and oculoplastic specialists (3) using a numeric scale to grade images on seven clinically relevant criteria. Each image was also analyzed to measure the size of the artifact and degree of streaking. Results: Overall confidence in diagnosis and severity of metallic streak was improved with metallic artifact reduction (p
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FQPkkK
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FQPkkK
Frictional Keratosis, Contact Keratosis and Smokeless Tobacco Keratosis: Features of Reactive White Lesions of the Oral Mucosa
Abstract
White lesions of the oral cavity are quite common and can have a variety of etiologies, both benign and malignant. Although the vast majority of publications focus on leukoplakia and other potentially malignant lesions, most oral lesions that appear white are benign. This review will focus exclusively on reactive white oral lesions. Included in the discussion are frictional keratoses, irritant contact stomatitis, and smokeless tobacco keratoses. Leukoedema and hereditary genodermatoses that may enter in the clinical differential diagnoses of frictional keratoses including white sponge nevus and hereditary benign intraepithelial dyskeratosis will be reviewed. Many products can result in contact stomatitis. Dentrifice-related stomatitis, contact reactions to amalgam and cinnamon can cause keratotic lesions. Each of these lesions have microscopic findings that can assist in patient management.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2U9yVL4
Lichenoid Characteristics in Premalignant Verrucous Lesions and Verrucous Carcinoma of the Oral Cavity
Abstract
Verrucous hyperkeratosis (VH), verrucous carcinoma (VC) and the relentless, truly pre-malignant variant proliferative verrucous leukoplakia often exhibit lichenoid histologic features that may create a diagnostic dilemma for pathologists. This study aims to evaluate and categorize the frequency and the histopathologic patterns of lichenoid features seen in these lesions. Following IRB approval, cases of VH and VC from 1994 to 2014 were retrieved from the archives of UF Oral Pathology Biopsy Service. A panel of 4 board-certified oral and maxillofacial pathologists reviewed and scored the presence or absence of 5 lichenoid features: band-like infiltrate (BLI), saw tooth rete ridges (STRR), interface stomatitis (IS), civatte bodies (CB), and basement membrane degeneration (BMD). Cases not fulfilling the stringent selection criteria were excluded. A total of 70 cases of VH and 56 cases of VC were included. Approximately 25% of both VH and VC cases exhibited 3 or more lichenoid features. By Chi square testing, BLI (p = 0.000), IS (p = 0.005), and CB (p = 0.026) were significantly more common in VC than VH. Gingival lesions had significantly less frequent BLI (p = 0.004) and IS (p = 0.024) versus other sites. However, STRR was significantly more common in VH than VC (p = 0.000) in the gingiva. (p = 0.002). Statistical analysis revealed that the only significant valid association was the increased presence of band-like infiltrate in VC over VH (p = 0.001). Lichenoid features are common in both VH and VC and may represent a nonspecific inflammatory response to the dysplasia or malignancy rather than concomitant lichenoid disease. This could lead to significant under diagnoses of these premalignant or potentially malignant lesions by pathologists.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2U87q4B
Black and Brown: Non-neoplastic Pigmentation of the Oral Mucosa
Abstract
Black and brown pigmentation of the oral mucosa can occur due to a multitude of non-neoplastic causes. Endogenous or exogenous pigments may be responsible for oral discoloration which can range from innocuous to life-threatening in nature. Physiologic, reactive, and idiopathic melanin production seen in smoker's melanosis, drug-related discolorations, melanotic macule, melanoacanthoma and systemic diseases are presented. Exogenous sources of pigmentation such as amalgam tattoo and black hairy tongue are also discussed. Determining the significance of mucosal pigmented lesions may represent a diagnostic challenge for clinicians. Biopsy is indicated whenever the source of pigmentation cannot be definitively identified based on the clinical presentation.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DsEw9V
Pre-auricular Sinus with Post-auricular Extension: An Uncommon Variant
Abstract
Pre-auricular sinus usually presents in front of the auricle without any diagnostic dilemma. But confusion arises when it presents with post-auricular swelling, abscess or discharging sinus. Here we describe series of pre-auricular sinus with post-auricular extension, a "variant type" of pre-auricular sinus and their management. A prospective study was done in the department of ENT in a tertiary care hospital of West Bengal from April 2015 to March 2018. After control of infection and proper pre-operative investigations patients, sinus was excised using bi-directional approach. The sinus tract along with a thin rim of conchal cartilage and pre and post-auricular cuff of skin was excised in toto. Among 76 cases of pre-auricular sinus, seven had "variant type". There were five males and two females in the variant group. Five patients were in the first decade of life and two patients were in the second decade of life. Four patients presented with post-auricular scar, two patients presented with post-auricular discharging sinus and one patient presented with post-auricular abscess. Wound healing was perfectly normal in all patients. None had recurrence till 1 year follow up. Pre-auricular sinus may present as "variant type" with post-auricular abscess or discharging sinus. So when a patient presents with post-auricular abscess or discharging sinus, pre-auricular region and pinna should be examined carefully. This helps to avoid unnecessary investigations and interventions which only complicate future management of these patients.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FNGsw8
Kimura’s Disease: A Diagnostic and Therapeutic Challenge
Abstract
Kimura's disease, also known as Eosinophilic Granuloma, is a rare chronic condition seen mainly in Oriental population. It presents with subcutaneous nodules, lymphadenopathy, salivary gland hypertrophy with peripheral eosinophilia and raised serum IgE levels; rarely renal involvement may also be present. Its etiology mainly remains unknown. We present a case series of two patients. Our first case is a middle aged female which presented with a parotid swelling, mimicking a parotid neoplasm. Further investigations revealed associated intra-parotid and cervical lymphadenopathy. An excisional biopsy in the form of Superficial Parotidectomy with lymph node excision was done. Histopathological examination of the excised specimen revealed it to be a case of Kimura's disease. Our second case, a young adult, presented with a gradually increasing post-auricular swelling. Preliminary investigations in this case pointed towards Kimura's disease. Excision biopsy of the lesion was done. Histopathological studies confirmed the diagnosis for the same. Both the patients are under our regular follow up and remain disease-free at a follow up of 1 year and 8 months respectively.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2HqWP3e
An Immunohistochemical Study of HIF-1 Alpha in Oral Epithelial Dysplasia and Oral Squamous Cell Carcinoma
Abstract
To evaluate and compare the expression of HIF-1 Alpha (HIF-1α) in oral epithelial dysplasia (OED) and various grades of Oral squamous cell carcinoma (OSCC). 30 cases each of OEDand OSCC were stained with HIF-1α antibody. Quantification of HIF-1α positive cellswas carried out and the data was statistically analysed. The mean % HIF-1α labeling index (HIF-1α LI) increased significantly from mild OED (32.11%), moderate OED (55.07%), to severe OED (64.58%). There was a statistically significant increase in the expression of HIF-1α as grades of OED increased. The mean HIF-1α LI % in well differentiated OSCC was 46.3%, Moderately differentiated OSCC—76.31% and Poorly differentiated OSCC—89.9%. The mean HIF-1α LI was found to increase with increasing grades of OSCC which was statistically significant (P < 0.05). Further a comparison of mean HIF-1α LI in OED with different histologic grades of OSCC by Independent samples t test was performed. We found statistically significant difference between OED and moderately differentiated OSCC and OED and poorly differentiated OSCC (P = 0.000). Progressive increase in expression of HIF-1α was noted from OED to OSCC. It can be postulated that epithelial dysplastic lesions with increased HIF-1α expression are at greater risk of malignant transformation, suggesting that the expression of HIF-1α is an early event in oral carcinogenesis.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2S4Uq2r
To Be Cautious or Not: Tension Pneumothorax After First Tracheostomy Tube Exchange
Abstract
Tracheostomy tube change is a relatively common procedure once a tracheo-cutaneous tract matures. Regular tracheostomy tube changes prevent the formation of granulation tissue and reduce bacterial colonization (Yaremchuk and Yaremchuk in Laryngoscope 113(1):1–10, 2003). However, serious complications such as subcutaneous emphysema, loss of airway and mediastinitis, can occur if the tube exchange is performed inappropriately. We present a rare association of tension pneumothorax following a tracheostomy tube exchange in a 50-year-old patient who underwent tracheotomy 3 days back. The patient was successfully managed conservatively with chest tube and supportive care.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RWz3R1
Evaluation of Quality of Life and Pattern of Improvement of Bronchial Asthma in Chronic Rhinosinusitis Patients Treated by Functional Endoscopic Sinus Surgery
Abstract
Chronic inflammatory disorders of the upper airways are extremely prevalent and have a major impact on public health. Sinusitis and bronchial asthma are closely interrelated diseases and sinusitis is known to influence bronchial asthma in its severity and chronicity. Causal relationships have been proposed but not yet proved. The relationship between sinusitis and asthma is academically interesting and has important diagnostic and therapeutic implications. The present study is designed to evaluate the efficacy of functional endoscopic sinus surgery done as treatment for chronic rhinosinusitis on bronchial asthma patients, in terms of quality of life and pattern of improvement. Objectives of the study were to determine whether bronchial asthma and quality of life improved after functional endoscopic sinus surgery. This was an open labelled randomised control trial, done at ENT Department of Medical College, Thiruvananthapuram. Those in Group A underwent functional endoscopic sinus surgery and group B patients were given only medicines as per standard protocol. All of them received asthma treatment depending on asthma attacks and severity and followed up at specific intervals. Quality of life status and pattern of improvement of bronchial asthma among these patients were evaluated. Patients of chronic rhinosinusitis treated by functional endoscopic sinus surgery showed significant improvement in the mean asthma symptom score, asthma medication use score, pulmonary function test results, and quality of life assessment scores. Functional endoscopic sinus surgery could be considered early in the natural course of chronic rhinosinusitis with concomitant bronchial asthma.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FHHo58
Leiomyosarcoma of Mandible: A Diagnostic Dilemma; Case Report and Review of Literature
Abstract
Leiomyosarcoma and its pleomorphic variant are rare entities in the head and neck region. Since they usually present as slow growing, discrete firm, and non-ulcerated painless mass, they seem to be deceptively benign and are thus misdiagnosed. Histopathological and immunohistochemical studies are the ways of getting a definitive diagnosis. Till date surgery has been the primary treatment but effectiveness of radiotherapy/chemotherapy is still questionable. Here, we describe a case of leiomyosarcoma in mandible along with discussion about the ways of diagnosis, its differentiation with its pleomorphic variant and their managements.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2CxPUQ7
Teaching Ear Examination Skill to Undergraduate Students Using Check List
Abstract
For examination of ear, proper illumination is a pre requisite. Diseases related to ear may lead to altered sense of hearing and may affect normal balance system. If students are taught to examine ear using a check list, they may perform better. To teach ear examination to undergraduate students using a check list. Total 50 undergraduate students of M.B.B.S. attending E.N.T. clinic in Chirayu Medical College and Hospital were included in the study. They were given enrolment no. 1 to 50 and were divided into two groups. Group 1, enroll. no. 1 to 25 and group 2, enroll. no. 26 to 50. Group 1 was taught using check list and the Group 2 was taught without use of checklist. Both the groups were evaluated using check list. The group B students were again taught, using check list and were again evaluated using check list. Use of check list showed that there was statistically significant improvement in learning by students using check list in group 1 students compared to group 2 students who were taught without use of check list. The group 2 students also had improvement on evaluation, after they were taught using check list. Study suggests that use of check list for ear examination skill to undergraduate students has significant role and students learn better than when taught without use of checklist. Inclusion of checklist for teaching ear examination to undergraduate students may be considered.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FLzHKp
The Role of MIF on Eosinophil Biology and Eosinophilic Inflammation
Abstract
Macrophage migration inhibitory factor (MIF) is an inflammatory cytokine that participates in innate and adaptive immune responses. MIF contributes to the resistance against infection agents, but also to the cellular and tissue damage in infectious, autoimmune, and allergic diseases. In the past years, several studies demonstrated a critical role for MIF in the pathogenesis of type-2-mediated inflammation, including allergy and helminth infection. Atopic patients have increased MIF amounts in affected tissues, mainly produced by immune cells such as macrophages, Th2 cells, and eosinophils. Increased MIF mRNA and protein are found in activated Th2 cells, while eosinophils stock pre-formed MIF protein and secrete high amounts of MIF upon stimulation. In mouse models of allergic asthma, the lack of MIF causes an almost complete abrogation of the cardinal signs of the disease including mucus secretion, eosinophilic inflammation, and airway hyper-responsiveness. Additionally, blocking the expression of MIF in animal models leads to significant reduction of pathological signs of eosinophilic inflammation such as rhinitis, atopic dermatitis, eosinophilic esophagitis and helminth infection. A number of studies indicate that MIF is important in the effector phase of type-2 immune responses, while its contribution to Th2 differentiation and IgE production is not consensual. MIF has been found to intervene in different aspects of eosinophil physiology including differentiation, survival, activation, and migration. CD4+ T cells and eosinophils express CD74 and CXCR4, receptors able to signal upon MIF binding. Blockage of these receptors with neutralizing antibodies or small molecule antagonists also succeeds in reducing the signals of inflammation in experimental allergic models. Together, these studies demonstrate an important contribution of MIF on eosinophil biology and in the pathogenesis of allergic diseases and helminth infection.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2G4jG2C
Inner-City Asthma in Children
Abstract
Asthma in inner-city children is often severe and difficult to control. Residence in poor and urban areas confers increased asthma morbidity even after adjusting for ethnicity, age, and gender. Higher exposure to household pests, such as cockroaches and mice, pollutants and tobacco smoke exposure, poverty, material hardship, poor-quality housing, differences in health care quality, medication compliance, and heath care access also contribute to increased asthma morbidity in this population. Since 1991, the National Institutes of Allergy and Infectious Diseases established research networks: the National Cooperative Inner-City Asthma Study (NCICAS), the Inner-City Asthma Study (ICAS), and the Inner-City Asthma Consortium (ICAC), to improve care for this at risk population. The most striking finding of the NCICAS is the link between asthma morbidity and the high incidence of allergen sensitization and exposure, particularly cockroach. The follow-up ICAS confirmed that reductions in household cockroach and dust mite were associated with reduction in the inner-city asthma morbidity. The ICAC studies have identified that omalizumab lowered fall inner-city asthma exacerbation rate; however, the relationship between inner-city asthma vs immune system dysfunction, respiratory tract infections, prenatal environment, and inner-city environment is still being investigated. Although challenging, certain interventions for inner-city asthma children have shown promising results. These interventions include family-based interventions such as partnering families with asthma-trained social workers, providing guidelines driven asthma care as well as assured access to controller medication, home-based interventions aim at elimination of indoor allergens and tobacco smoke exposure, school-based asthma programs, and computer/web-based asthma programs.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2G4jYXg
Revascularization of Free Skin Grafts Overlying Modified Hughes Tarsoconjunctival Flaps Monitored Using Laser-Based Techniques
Purpose: It has recently been shown that the flap pedicle does not supply blood to a tarsoconjunctival graft in the modified Hughes procedure in patients. This raises questions concerning the rate of revascularization of the free skin graft commonly used to reconstruct the anterior lamella. The aim of this study was, thus, to monitor the course of revascularization in free skin grafts overlying modified Hughes tarsoconjunctival flaps, using laser-based techniques. Methods: Free skin grafts from the upper eyelid or upper arm in 9 patients were used to cover a tarsoconjunctival flap according to the modified Hughes procedure. Blood perfusion was monitored using laser speckle contrast imaging, and vascular reactivity was studied with laser Doppler velocimetry after heating the tissue to 44°C. Measurements were made at the time of surgery (baseline) and at 1, 3, 8, and 16 weeks postoperatively. Results: The gradual increase in perfusion of the free skin grafts during the healing process indicates revascularization. A slight increase in perfusion was seen already after 1 week. Perfusion reached 50% of the baseline after 3 weeks, and complete restoration of perfusion was seen after 8 weeks. The vascular function monitored with heat-induced hyperemia increased in a similar fashion. Conclusions: Full-thickness skin grafts revascularize within 3 to 8 weeks, despite overlying a tarsoconjunctival flap, which has recently been reported to be avascular. This provides further evidence that it should be possible to repair large eyelid defects using free full-thickness eyelid grafts. Accepted for publication October 23, 2018. Supported by the Swedish Government Grant for Clinical Research, the European Union's Horizon 2020 programme for Research and Innovation, Skåne University Hospital Research Grants, Skåne County Council Research Grants, Crown Princess Margaret's Foundation, the Foundation for the Visually Impaired in the County of Malmöhus, The Nordmark Foundation for Eye Diseases at Skåne University Hospital, the Diabetes Society of South-West Skåne, and the Swedish Eye Foundation. The authors have no financial or conflicts of interest to disclose. Address correspondence and reprint requests to Malin Malmsjö, M.D., Ph.D., Skånes University Hospital, 2nd Floor, Kioskgatan 1, SE-221 85 Lund, Sweden. E-mail malin.malmsjo@med.lu.se © 2019 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2CwHg4k
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2CwHg4k
Quality of CT Imaging of Periocular Metallic Foreign Bodies Using Artifact Reduction Software
Purpose: CT is the standard of care for assessment of ocular and orbital trauma; however, artifacts from metallic foreign bodies can limit the utility of CT. The authors hypothesize that implementation of metal artifact reduction techniques can improve image quality and diagnostic confidence for a diverse group of interpreters. Methods: A case series of ten subjects with retained periocular metallic foreign bodies imaged with CT were identified retrospectively from a large urban trauma center. Postacquisition images were processed with an iterative-based metal streak artifact reduction software. The severity of the metal streak artifact was assessed by clinicians including radiologists (4), ophthalmologists (4), and oculoplastic specialists (3) using a numeric scale to grade images on seven clinically relevant criteria. Each image was also analyzed to measure the size of the artifact and degree of streaking. Results: Overall confidence in diagnosis and severity of metallic streak was improved with metallic artifact reduction (p
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FQPkkK
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FQPkkK
Frictional Keratosis, Contact Keratosis and Smokeless Tobacco Keratosis: Features of Reactive White Lesions of the Oral Mucosa
Abstract
White lesions of the oral cavity are quite common and can have a variety of etiologies, both benign and malignant. Although the vast majority of publications focus on leukoplakia and other potentially malignant lesions, most oral lesions that appear white are benign. This review will focus exclusively on reactive white oral lesions. Included in the discussion are frictional keratoses, irritant contact stomatitis, and smokeless tobacco keratoses. Leukoedema and hereditary genodermatoses that may enter in the clinical differential diagnoses of frictional keratoses including white sponge nevus and hereditary benign intraepithelial dyskeratosis will be reviewed. Many products can result in contact stomatitis. Dentrifice-related stomatitis, contact reactions to amalgam and cinnamon can cause keratotic lesions. Each of these lesions have microscopic findings that can assist in patient management.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2U9yVL4
Lichenoid Characteristics in Premalignant Verrucous Lesions and Verrucous Carcinoma of the Oral Cavity
Abstract
Verrucous hyperkeratosis (VH), verrucous carcinoma (VC) and the relentless, truly pre-malignant variant proliferative verrucous leukoplakia often exhibit lichenoid histologic features that may create a diagnostic dilemma for pathologists. This study aims to evaluate and categorize the frequency and the histopathologic patterns of lichenoid features seen in these lesions. Following IRB approval, cases of VH and VC from 1994 to 2014 were retrieved from the archives of UF Oral Pathology Biopsy Service. A panel of 4 board-certified oral and maxillofacial pathologists reviewed and scored the presence or absence of 5 lichenoid features: band-like infiltrate (BLI), saw tooth rete ridges (STRR), interface stomatitis (IS), civatte bodies (CB), and basement membrane degeneration (BMD). Cases not fulfilling the stringent selection criteria were excluded. A total of 70 cases of VH and 56 cases of VC were included. Approximately 25% of both VH and VC cases exhibited 3 or more lichenoid features. By Chi square testing, BLI (p = 0.000), IS (p = 0.005), and CB (p = 0.026) were significantly more common in VC than VH. Gingival lesions had significantly less frequent BLI (p = 0.004) and IS (p = 0.024) versus other sites. However, STRR was significantly more common in VH than VC (p = 0.000) in the gingiva. (p = 0.002). Statistical analysis revealed that the only significant valid association was the increased presence of band-like infiltrate in VC over VH (p = 0.001). Lichenoid features are common in both VH and VC and may represent a nonspecific inflammatory response to the dysplasia or malignancy rather than concomitant lichenoid disease. This could lead to significant under diagnoses of these premalignant or potentially malignant lesions by pathologists.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2U87q4B
Black and Brown: Non-neoplastic Pigmentation of the Oral Mucosa
Abstract
Black and brown pigmentation of the oral mucosa can occur due to a multitude of non-neoplastic causes. Endogenous or exogenous pigments may be responsible for oral discoloration which can range from innocuous to life-threatening in nature. Physiologic, reactive, and idiopathic melanin production seen in smoker's melanosis, drug-related discolorations, melanotic macule, melanoacanthoma and systemic diseases are presented. Exogenous sources of pigmentation such as amalgam tattoo and black hairy tongue are also discussed. Determining the significance of mucosal pigmented lesions may represent a diagnostic challenge for clinicians. Biopsy is indicated whenever the source of pigmentation cannot be definitively identified based on the clinical presentation.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DsEw9V
Pre-auricular Sinus with Post-auricular Extension: An Uncommon Variant
Abstract
Pre-auricular sinus usually presents in front of the auricle without any diagnostic dilemma. But confusion arises when it presents with post-auricular swelling, abscess or discharging sinus. Here we describe series of pre-auricular sinus with post-auricular extension, a "variant type" of pre-auricular sinus and their management. A prospective study was done in the department of ENT in a tertiary care hospital of West Bengal from April 2015 to March 2018. After control of infection and proper pre-operative investigations patients, sinus was excised using bi-directional approach. The sinus tract along with a thin rim of conchal cartilage and pre and post-auricular cuff of skin was excised in toto. Among 76 cases of pre-auricular sinus, seven had "variant type". There were five males and two females in the variant group. Five patients were in the first decade of life and two patients were in the second decade of life. Four patients presented with post-auricular scar, two patients presented with post-auricular discharging sinus and one patient presented with post-auricular abscess. Wound healing was perfectly normal in all patients. None had recurrence till 1 year follow up. Pre-auricular sinus may present as "variant type" with post-auricular abscess or discharging sinus. So when a patient presents with post-auricular abscess or discharging sinus, pre-auricular region and pinna should be examined carefully. This helps to avoid unnecessary investigations and interventions which only complicate future management of these patients.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FNGsw8
Comparison of Functional Organ Preservation by Concomitant Boost Radiotherapy Versus Concurrent Chemoradiation in Locally Advanced Carcinoma of Larynx or Hypopharynx: A Prospective Randomized Study
Abstract
Functional organ preservation is a major challenge in management of advanced laryngeal and hypopharyngeal carcinoma. Although ideal approach is a subject of much debate, radiotherapy with or without chemotherapy is most commonly used modality. This randomized study was conducted to compare functional organ preservation by chemoradiation (CRT) versus concomitant boost radiotherapy (CBRT). A total of 40 patients with advanced (stage III/stage IVa) laryngeal and hypopharyngeal cancer were randomized to receive either CRT (n = 20) to a dose of 66 Gy in 33 fractions over 6.5 weeks with concurrent cisplatin (100 mg/m2 on days 1, 22 and 43) or CBRT (n = 20) to a dose of 67.5 Gy in 40 fractions over 5 weeks. Patients were assessed for organ preservation rate, toxicities, voice and swallowing functions utilizing Voice Related Quality of Life (VRQOL) and MD Anderson Dysphagia Inventory (MDADI) scores, respectively, for minimum follow up of 6 months. Organ preservation rate (intact disease free larynx) at 6 months post treatment was observed in 100% in CRT arm and 95% in CBRT arm. There was no significant difference in mucositis and dermatitis in two arms (p = 0.82 and 0.78, respectively). Dysphagia was observed more in CRT arm (n = 12 vs n = 6). Late toxicities grade 3 xerostomia, grade 2 dysguesia, were seen significantly more in CRT arm. There was no statistical difference between the two arms in terms of VRQOL (p = 0.55) and MDADI scores (p = 0.13). In CRT arm 13 patients complete response and in CBRT arm 12 patients had complete response. Accelerated fractionation with concomitant boost schedule is as effective as CRT in anatomical and functional preservation of larynx. The toxicities, voice and dysphagia related quality of life is comparable.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2G0xBXs
Randomised Comparison of Safety Profile and Short Term Response of Itraconazole, Voriconazole and Amphotericin B in the Management of Chronic Invasive Fungal Rhinosinusitis
Abstract
Chronic invasive fungal rhino sinusitis (CIFS) is a well described clinical entity characterized by mucosal and sub mucosal infiltration of mycotic organisms and angio-centric extension into orbital and intracranial structures. Itraconazole, Voriconazole and Amphotericin B are commonly used for CIFS. In the present study we have evaluated short term clinical response of these drugs. Thirty diagnosed patients of CIFS who presented to us from January 2011 to December 2015 were divided into three groups randomly. Group A, B and C received Itraconazole, Voriconazole and Amphotericin respectively. Visual Analogue scale (VAS), Lund Mackay (LM) radiological scores and Kupferberg's nasal endoscopic grades were seen and compared in all patients before treatment, after primary surgical debridement and biopsy and after post biopsy antifungal drug treatment. We assessed the serum drug levels using HPLC assay at 4 and 8 weeks of therapy and correlated them for efficacy and safety. All the groups had significant improvement after treatment compared to beginning of study. Inter group comparison showed that mean LM, NE and VAS scores were significantly better in Voriconazole group compared to Itraconazole and amphotericin B therapy. The reduction of these objective parameters with treatment was also significantly high in Voriconazole group compared to the other two groups. Voriconazole has shown to be the most effective treatment modality for chronic invasive fungal sinusitis compared to other commonly used drugs such as Itraconazole and Amphotericin B.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DwAJsk
An Immunohistochemical Study of HIF-1 Alpha in Oral Epithelial Dysplasia and Oral Squamous Cell Carcinoma
Abstract
To evaluate and compare the expression of HIF-1 Alpha (HIF-1α) in oral epithelial dysplasia (OED) and various grades of Oral squamous cell carcinoma (OSCC). 30 cases each of OEDand OSCC were stained with HIF-1α antibody. Quantification of HIF-1α positive cellswas carried out and the data was statistically analysed. The mean % HIF-1α labeling index (HIF-1α LI) increased significantly from mild OED (32.11%), moderate OED (55.07%), to severe OED (64.58%). There was a statistically significant increase in the expression of HIF-1α as grades of OED increased. The mean HIF-1α LI % in well differentiated OSCC was 46.3%, Moderately differentiated OSCC—76.31% and Poorly differentiated OSCC—89.9%. The mean HIF-1α LI was found to increase with increasing grades of OSCC which was statistically significant (P < 0.05). Further a comparison of mean HIF-1α LI in OED with different histologic grades of OSCC by Independent samples t test was performed. We found statistically significant difference between OED and moderately differentiated OSCC and OED and poorly differentiated OSCC (P = 0.000). Progressive increase in expression of HIF-1α was noted from OED to OSCC. It can be postulated that epithelial dysplastic lesions with increased HIF-1α expression are at greater risk of malignant transformation, suggesting that the expression of HIF-1α is an early event in oral carcinogenesis.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2S4Uq2r
To Be Cautious or Not: Tension Pneumothorax After First Tracheostomy Tube Exchange
Abstract
Tracheostomy tube change is a relatively common procedure once a tracheo-cutaneous tract matures. Regular tracheostomy tube changes prevent the formation of granulation tissue and reduce bacterial colonization (Yaremchuk and Yaremchuk in Laryngoscope 113(1):1–10, 2003). However, serious complications such as subcutaneous emphysema, loss of airway and mediastinitis, can occur if the tube exchange is performed inappropriately. We present a rare association of tension pneumothorax following a tracheostomy tube exchange in a 50-year-old patient who underwent tracheotomy 3 days back. The patient was successfully managed conservatively with chest tube and supportive care.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RWz3R1
Leiomyosarcoma of Mandible: A Diagnostic Dilemma; Case Report and Review of Literature
Abstract
Leiomyosarcoma and its pleomorphic variant are rare entities in the head and neck region. Since they usually present as slow growing, discrete firm, and non-ulcerated painless mass, they seem to be deceptively benign and are thus misdiagnosed. Histopathological and immunohistochemical studies are the ways of getting a definitive diagnosis. Till date surgery has been the primary treatment but effectiveness of radiotherapy/chemotherapy is still questionable. Here, we describe a case of leiomyosarcoma in mandible along with discussion about the ways of diagnosis, its differentiation with its pleomorphic variant and their managements.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2CxPUQ7
Complications of Paediatric Cochlear Implantation in the Population of Uttarakhand
Abstract
Cochlear implants surgery is now routinely done at this center. Complications which have been experienced in cochlear implant surgery at our center are discussed, as a detailed knowledge about the complications and their early anticipation can save an expensive device and most importantly patients morbidity. To discuss the complications of the paediatric cochlear implantation in the population of Uttarakhand. The total of 60 patients were included in this study (age group 1–5 years) who had undergone the cochlear implantation surgery between Sept. 2015 and Sept. 2016. These patients were regularly monitored and followed up for 1 year. All the surgeries were performed by same team of surgeons. Rate of minor complications is 8.33% (reversible facial nerve paresis, injury to chorda tympani nerve, local skin reaction, perilymph gussher) and major complications is 5% (implant rejection and flap necrosis). The various complications should be closely monitored by the surgeon so that these can be avoided.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RDtXd5
Suitable Alternative for Human Cadaver Temporal Bone Dissection: Comparative Micro Ear Anatomy of Cattle, Pig and Sheep with Human
Abstract
The study was undertaken to compare the micro ear anatomy of three commonly available animal models which are expected to have similar anatomy to human and to find out suitable model among them as an alternative for human cadaver temporal bone dissection. This is an observational study of comparison of micro ear anatomy of the three animal models with human. Decapitated heads of cattle, pig and sheep were collected from slaughter houses, soft tissues along with brain were removed and preserved in commercially available formalin preservative. CT scan was taken for the three specimens and 3D reconstructions were done. Each specimen was subjected to micro dissection and the anatomical features were studied and compared with human. Among the three animal models sheep is found to be an ideal model for a beginner because of ease of exposure of bone, very thin cortical bone, and no cellularity, good exposure of all the middle ear structures and similar interrelations of middle ear structures with human. Pig may not be an ideal model because of abundant fatty soft tissues, thick periosteum very narrow space occupied by the middle ear, difficulty in accessing cellularity small fragile ossicular chain and overhanging facial nerve.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FMC6ES
A Study on Deep Neck Space Infections
Abstract
Deep neck space infections (DNSI) are serious diseases that involve several spaces in the neck. These are commonly seen in low socioeconomic group with poor oral hygiene, and nutritional disorders. These are bacterial infections originating from the upper aerodigestive tract. The incidence of this disease was relatively high before the advent of antibiotics. Treatment of DNSI includes antibiotic therapy, airway management and surgical intervention. Management of DNSI is traditionally based on prompt surgical drainage of the abscess followed by antibiotics or nonsurgical treatment using appropriate antibiotics in the case of cellulitis. This study was conducted to investigate the age and gender, clinical symptoms, site involved, etiology, co-morbidities, bacteriology, complications and outcomes in the patients of DNSI. A prospective study of deep neck space infections was conducted during the period July 2017 to July 2018 on the patients who attended the outpatient department and were admitted as inpatient in Safdarjung hospital, New Delhi. 40 Cases with DNSI all ages and both genders were included in the study. Patients who didn't require surgical intervention to drain pus were excluded. All parameters including age, gender, co-morbidities, presentation, site, bacteriology, complications, and investigations were studied. Due to advent of antibiotics, deep neck space infections are in decreasing trend. The common age group found to be affected is in 2nd and 3rd decade in our study. Out of all deep neck space infections, submandibular space infections were common (37.5%) followed by peritonsillar infections (12.5%). Infection of deep neck space remains fairly common and challenging disease for clinicians. Prompt recognition and treatment of DNSI are essential for an improved prognosis. Odontogenic and tonsillopharyngitis are the commonest cause. Key elements for improved results are the prompt recognition and early intervention. Special attention is required to high-risk groups such as diabetics, the elderly and patients with underlying systemic diseases as the condition may progress to life-threatening complications.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FFiwLh
Teaching Ear Examination Skill to Undergraduate Students Using Check List
Abstract
For examination of ear, proper illumination is a pre requisite. Diseases related to ear may lead to altered sense of hearing and may affect normal balance system. If students are taught to examine ear using a check list, they may perform better. To teach ear examination to undergraduate students using a check list. Total 50 undergraduate students of M.B.B.S. attending E.N.T. clinic in Chirayu Medical College and Hospital were included in the study. They were given enrolment no. 1 to 50 and were divided into two groups. Group 1, enroll. no. 1 to 25 and group 2, enroll. no. 26 to 50. Group 1 was taught using check list and the Group 2 was taught without use of checklist. Both the groups were evaluated using check list. The group B students were again taught, using check list and were again evaluated using check list. Use of check list showed that there was statistically significant improvement in learning by students using check list in group 1 students compared to group 2 students who were taught without use of check list. The group 2 students also had improvement on evaluation, after they were taught using check list. Study suggests that use of check list for ear examination skill to undergraduate students has significant role and students learn better than when taught without use of checklist. Inclusion of checklist for teaching ear examination to undergraduate students may be considered.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FLzHKp
Speckle Tracking Analysis of Left Ventricular Systolic Function Following Traumatic Brain Injury: A Pilot Prospective Observational Cohort Study
Background: Systolic dysfunction and reduction in left ventricular ejection fraction (LVEF) has been documented after traumatic brain injury (TBI). Speckle tracking is an emerging technology for myocardial strain assessment which has been utilized to identify subclinical myocardial dysfunction, and is most commonly reported as global longitudinal strain (GLS). We examined myocardial strain and regional strain patterns following moderate-severe TBI. Materials and Methods: We conducted a prospective cohort study of moderate-severe TBI patients (Glasgow Coma Scale≤12) and age/sex-matched controls. Transthoracic echocardiography was performed within the first day and 1 week following TBI. Myocardial function was assessed using both GLS and LVEF, and impaired systolic function was defined as GLS >−16% or LVEF ≤50%. Regional strain patterns and individual strain trajectories were examined. Results: Thirty subjects were included, 15 patients with TBI and 15 age/sex-matched controls. Among patients with adequate echocardiographic windows, systolic dysfunction was observed in 2 (17%) patients using LVEF and 5 (38%) patients using GLS within the first day after TBI. Mean GLS was impaired in patients with TBI compared with controls (−16.4±3.8% vs. −20.7±1.8%, P=0.001). Regional myocardial examination revealed impaired strain primarily in the basal and mid-ventricular segments. There was no improvement in GLS from day 1 to day 7 (P=0.81). Conclusions: Myocardial strain abnormalities are common and persist for at least 1 week following moderate-severe TBI. Speckle tracking may be useful for the early diagnosis and monitoring of systolic dysfunction following TBI. Supported by NIH L30 NS084420. The authors have no conflicts of interest to disclose. Address correspondence to: Vijay Krishnamoorthy, MD, PhD, Department of Anesthesiology, Duke University, 2301 Erwin Road, Durham, NC 27710 (e-mail: vijay.krishnamoorthy@duke.edu). Received August 24, 2018 Accepted December 9, 2018 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2AZTtP0
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2AZTtP0
Infratentorial immature teratoma of congenital origin can be associated with a 20-year survival outcome: a case report and review of literature
Congenital intracranial tumors are very rare and account for less than 2% of all childhood brain tumors. Teratomas constitute about one third to one half of these, predominantly located midline in the supraten...
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DCv5oG
Helicopter air ambulance services
Purpose of review Helicopter air ambulances are an integral component of modern trauma care, and are able to transport patients to facilities with greater capabilities, extract injured patients from hostile terrain, and speed transport to a trauma center. Recent findings HAA transport does not reduce the total time required to transport a patient, but it does reduce the time that the patient is between healthcare facilities. Factors that have been suggested to improve outcomes for trauma patients include the availability of advanced interventions, skilled personnel, speed, and trauma center access. Despite their potential benefits to the patient, HAA operations carry significant risks. HAA operations are among the most dangerous professions for both pilot and crew with a mortality rate greater than commercial fishing, loggers, and steelworkers. The US Federal Aviation Administration (FAA) has identified that the four most common causes of HAA accidents as inadvertent flight into instrument meteorological conditions, loss of control, controlled flight into terrain, and night conditions. Summary HAA operations are well tolerated and can improve patient care, but additional research is needed to improve our understanding of HAA operations and their effect on outcomes. Correspondence to Keith J. Ruskin, MD, FAsMA, FRAeS, Professor of Anesthesia and Critical Care and Biological Sciences Collegiate Division, Department of Anesthesia and Critical Care, University of Chicago, 5841 S. Maryland Avenue MC4028, Chicago, IL 60637, USA. Tel: +1 773 834 2369; e-mail: ruskin@uchicago.edu Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2AZuSKg
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2AZuSKg
Resuscitative endovascular balloon occlusion of the aorta: an option for noncompressible torso hemorrhage?
Purpose of review Hemorrhage is the major cause of early death in severely injured patients. In civilian emergency medical services, the majority of life-threatening bleedings are found in noncompressible body regions (e.g. abdomen and pelvis). Resuscitative endovascular balloon occlusion of the aorta (REBOA) has therefore been discussed in recent years as a possible lifesaving procedure and numerous studies, meta-analyses and guidelines have been published. In this review, the data situation of REBOA in the management of bleeding trauma patients is discussed and practical implementation is depicted. Recent findings The typical indication for REBOA is a traumatic life-threatening hemorrhage below the diaphragm in patients unresponsive or only transiently responsive to the usual conservative therapeutic measures. REBOA appears to be a safe and effective procedure to reduce blood loss and stabilize the patient's hemodynamic status. However, surgical hemostasis has to be achieved within 30–60 min after occlusion of the aorta. Data on clear advantages of REBOA over resuscitative thoracostomy are inconclusive. Summary REBOA could play an important role in the management of the severely bleeding patient in the future. Together with transfusion and therapy of coagulation disorders, REBOA may be an additional tool in the anesthetist's hands for trauma management in interprofessional care concepts. Correspondence to Dr Jürgen Knapp, Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland. Tel: +41 31 632 04 96; e-mail: juergen.knapp@insel.ch Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2ATxj0P
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2ATxj0P
Speckle Tracking Analysis of Left Ventricular Systolic Function Following Traumatic Brain Injury: A Pilot Prospective Observational Cohort Study
Background: Systolic dysfunction and reduction in left ventricular ejection fraction (LVEF) has been documented after traumatic brain injury (TBI). Speckle tracking is an emerging technology for myocardial strain assessment which has been utilized to identify subclinical myocardial dysfunction, and is most commonly reported as global longitudinal strain (GLS). We examined myocardial strain and regional strain patterns following moderate-severe TBI. Materials and Methods: We conducted a prospective cohort study of moderate-severe TBI patients (Glasgow Coma Scale≤12) and age/sex-matched controls. Transthoracic echocardiography was performed within the first day and 1 week following TBI. Myocardial function was assessed using both GLS and LVEF, and impaired systolic function was defined as GLS >−16% or LVEF ≤50%. Regional strain patterns and individual strain trajectories were examined. Results: Thirty subjects were included, 15 patients with TBI and 15 age/sex-matched controls. Among patients with adequate echocardiographic windows, systolic dysfunction was observed in 2 (17%) patients using LVEF and 5 (38%) patients using GLS within the first day after TBI. Mean GLS was impaired in patients with TBI compared with controls (−16.4±3.8% vs. −20.7±1.8%, P=0.001). Regional myocardial examination revealed impaired strain primarily in the basal and mid-ventricular segments. There was no improvement in GLS from day 1 to day 7 (P=0.81). Conclusions: Myocardial strain abnormalities are common and persist for at least 1 week following moderate-severe TBI. Speckle tracking may be useful for the early diagnosis and monitoring of systolic dysfunction following TBI. Supported by NIH L30 NS084420. The authors have no conflicts of interest to disclose. Address correspondence to: Vijay Krishnamoorthy, MD, PhD, Department of Anesthesiology, Duke University, 2301 Erwin Road, Durham, NC 27710 (e-mail: vijay.krishnamoorthy@duke.edu). Received August 24, 2018 Accepted December 9, 2018 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2AZTtP0
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2AZTtP0
Thyroid Hormone Receptor Alpha Mutations Lead to Epithelial Defects in the Adult Intestine in a Mouse Model of Resistance to Thyroid Hormone
Thyroid, Ahead of Print.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2HAhYZ7
Neural Switch Asymmetry in Feature-Based Auditory Attention Tasks
Abstract
Active listening involves dynamically switching attention between competing talkers and is essential to following conversations in everyday environments. Previous investigations in human listeners have examined the neural mechanisms that support switching auditory attention within the acoustic featural cues of pitch and auditory space. Here, we explored the cortical circuitry underlying endogenous switching of auditory attention between pitch and spatial cues necessary to discern target from masker words. Because these tasks are of unequal difficulty, we expected an asymmetry in behavioral switch costs for hard-to-easy versus easy-to-hard switches, mirroring prior evidence from vision-based cognitive task-switching paradigms. We investigated the neural correlates of this behavioral switch asymmetry and associated cognitive control operations in the present auditory paradigm. Behaviorally, we observed no switch-cost asymmetry, i.e., no performance difference for switching from the more difficult attend-pitch to the easier attend-space condition (P→S) versus switching from easy-to-hard (S→P). However, left lateral prefrontal cortex activity, correlated with improved performance, was observed during a silent gap period when listeners switched attention from P→S, relative to switching within pitch cues. No such differential activity was seen for the analogous easy-to-hard switch. We hypothesize that this neural switch asymmetry reflects proactive cognitive control mechanisms that successfully reconfigured neurally-specified task parameters and resolved competition from other such "task sets," thereby obviating the expected behavioral switch-cost asymmetry. The neural switch activity observed was generally consistent with that seen in cognitive paradigms, suggesting that established cognitive models of attention switching may be productively applied to better understand similar processes in audition.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2R90hiL
Trends, Determinants, and Associations of Treated Hypothyroidism in the United Kingdom, 2005–2014
Thyroid, Ahead of Print.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2S8kwSc
Intensivist staffing and outcome in the ICU: daytime, nighttime, 24/7?
Purpose of review Many hospitals, particularly large academic centers, have begun to provide 24-h in-house intensive care attending coverage. Proposed advantages for this model include improved patient care, greater provider, nursing and patient satisfaction, better communication, and greater cost-effectiveness. This review will evaluate current evidence with respect to 24/7 coverage, including patient outcomes, cost-effectiveness, and impact on training/education. Recent findings Evidence surrounding 24-h intensivist staffing has been mixed. Although a subset of studies suggest a possible benefit to 24-h intensivist coverage, recent prospective studies have shown no difference in major patient outcomes, including mortality and ICU length of stay between patients in ICUs with and those without 24-h intensivist coverage. Summary Although some studies cite increased caregiver and patient satisfaction, outcome studies find no consistent effect on patient-centered outcomes such as mortality or length of stay. Downsides to in-house nighttime attending staffing include physician burnout, adverse effects on physician health, decreased trainee autonomy, and effects on trainee specialty choices because of undesirable lifestyle considerations. Tele-ICU and other novel approaches may allow for attending supervision without physical presence. Correspondence to Avery Tung, MD, 5841 S Maryland Ave MC 4028, Chicago, IL 60637, USA. Tel: +1 (773) 834 7937; E-mail: atung@dacc.uchicago.edu Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2T6WGnd
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2T6WGnd
Burn injury and blood transfusion
Purpose of review Blood transfusion is ubiquitous in major burn injury. The present article describes recent research findings directly impacting blood transfusion strategies in major burn injury both in the operating room and the ICU. Recent findings Transfusion strategies have been the focus of recent burn investigations. First, a randomized prospective trial encompassing both the ICU and operating room reported that a restrictive red blood cell transfusion threshold (7 g/dl) had equivalent outcomes to a traditional threshold (10 g/dl) for burns more than 20% in terms of mortality, infection, length of stay, duration of mechanical ventilation, and wound healing despite receiving significantly fewer transfusions. The second burn transfusion advance addresses coagulation. Although burn patients initially have elevated fibrinogen, thrombocytopenia and other coagulation disorders develop during excision. Blood product repletion should be based on measurements such as thromboelastography in addition to traditional tests. Finally, a recent randomized trial suggests that fresh-frozen plasma and platelets during burn excision more than 20% may decrease transfusion requirements. Summary A restrictive transfusion practice during burn excision and grafting is well tolerated and effective in reducing the number of transfusions without increasing complications. Repletion of coagulation products should focus on measured deficits of platelets, fibrinogen, and factors. Correspondence to Tina L. Palmieri, 2425 Stockton Blvd, Suite 718, Sacramento, CA 95817, USA. Tel: +1-916-453-2050; fax: +1-916-453-2373; e-mail: tlpalmieri@ucdavis.edu Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2T7QATz
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2T7QATz
The use of new procoagulants in blunt and penetrating trauma
Purpose of review Uncontrolled bleeding in trauma secondary to a combination of surgical bleeding and trauma-induced complex coagulopathy is a leading cause of death. Prothrombin complex concentrates (PCCs), recombinant activated factor seven (rFVIIa) and recombinant human prothrombin act as procoagulants by increasing thrombin generation and fibrinogen concentrate aids stable clot formation. This review summarizes current evidence for procoagulant use in the management of bleeding in trauma, and data and evidence gaps for routine clinical use. Recent findings Retrospective and prospective studies of PCCs (±fibrinogen concentrate) have demonstrated a decreased time to correction of trauma coagulopathy and decreased red cell transfusion with no obvious effect on mortality or thromboembolic outcomes. PCCs in a porcine model of dilutional coagulopathy demonstrated a sustained increase in thrombin generation, unlike recombinant human prothrombin which showed a transient increase and has been studied only in animals. In other retrospective studies, there is a suggestion that lower doses of PCCs may be effective in the setting of acquired coagulopathy. Summary There is increasing evidence that early correction of coagulopathy has survival benefits, and the use of procoagulants as first-line therapy has the potential benefit of rapid access and timely treatment. This requires confirmation in prospective studies. Correspondence to Pratima Chowdary, Consultant Haematologist, KD Haemophilia and Thrombosis Centre, Royal Free London NHS Foundation Trust, London, UK;. e-mails: p.chowdary@nhs.net, p.chowdary@ucl.ac.uk Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2TagE0q
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2TagE0q
Reconstructive Ladder for Transoral Resections of Oropharyngeal Cancers
Abstract
Purpose of Review
Transoral robotic surgery (TORS) now offers extended reach and capability to the head and neck oncologic surgeon, but in doing so, provides a reconstructive dilemma. The objective of this manuscript is to discuss the most recent advances and options available after resection with TORS.
Recent Findings
The latest research provides a common framework for surgeons to classify the type of oropharyngeal defect. A variety of reconstructive options described include secondary intent, modifications to existing local and regional flaps, and advances utilizing robotic assistance in free flap reconstruction.
Summary
There exists a multitude of reconstructive options with appropriate considerations for a stepwise approach based on patient-specific factors, surgeon capability, and the extent of the oropharyngeal defect. Just as robotic resection extends the capability in extirpation, it is now being used to refine free flap inset in the appropriate case.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2G0G0tU
Future Meetings
Thyroid, Volume 29, Issue 1, Page 157-158, January 2019.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2HAhPF3
Correction to: Diagnostic Performance of Ultrasound-Based Risk-Stratification Systems for Thyroid Nodules: Comparison of the 2015 American Thyroid Association Guidelines with the 2016 Korean Thyroid Association/Korean Society of Thyroid Radiology and 2017 American College of Radiology Guidelines by Ha EJ, Na DG, Moon W-J, Lee YH, and Choi N. Thyroid 2018;28:1532–1537. DOI: 10.1089/thy.2018.0094
Thyroid, Volume 29, Issue 1, Page 159-159, January 2019.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2S8o2Mh
Unfavorable Socioeconomic Factors Underlie High Rates of Hospitalization for Complicated Thyrotoxicosis in Some Regions of the United States
Thyroid, Volume 29, Issue 1, Page 27-35, January 2019.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2HAhMZT
Expression, Localization, and Regulation of the Sodium Bicarbonate Cotransporter NBCe1 in the Thyroid
Thyroid, Ahead of Print.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2HAhLVP
Reconstructive Ladder for Transoral Resections of Oropharyngeal Cancers
Abstract
Purpose of Review
Transoral robotic surgery (TORS) now offers extended reach and capability to the head and neck oncologic surgeon, but in doing so, provides a reconstructive dilemma. The objective of this manuscript is to discuss the most recent advances and options available after resection with TORS.
Recent Findings
The latest research provides a common framework for surgeons to classify the type of oropharyngeal defect. A variety of reconstructive options described include secondary intent, modifications to existing local and regional flaps, and advances utilizing robotic assistance in free flap reconstruction.
Summary
There exists a multitude of reconstructive options with appropriate considerations for a stepwise approach based on patient-specific factors, surgeon capability, and the extent of the oropharyngeal defect. Just as robotic resection extends the capability in extirpation, it is now being used to refine free flap inset in the appropriate case.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2G0G0tU
3D-printed breast phantom for multi-purpose and multi-modality imaging
Background: Breast imaging technology plays an important role in breast cancer planning and treatment. Recently, three-dimensional (3D) printing technology has become a trending issue in phantom constructions for medical applications, with its advantages of being customizable and cost-efficient. However, there is no current practice in the field of multi-purpose breast phantom for quality control (QC) in multi-modalities imaging. The purpose of this study was to fabricate a multi-purpose breast phantom with tissue-equivalent materials via a 3D printing technique for QC in multi-modalities imaging. Methods: We used polyvinyl chloride (PVC) based materials and a 3D printing technique to construct a breast phantom. The phantom incorporates structures imaged in the female breast such as microcalcifications, fiber lesions, and tumors with different sizes. Moreover, the phantom was used to assess the sensitivity of lesion detection, depth resolution, and detectability thresholds with different imaging modalities. Phantom tissue equivalent properties were determined using computed tomography (CT) attenuation [Hounsfield unit (HU)] and magnetic resonance imaging (MRI) relaxation times. Results: The 3D-printed breast phantom had an average background value of 36.2 HU, which is close to that of glandular breast tissue (40 HU). T1 and T2 relaxation times had an average relaxation time of 206.81±17.50 and 20.22±5.74 ms, respectively. Mammographic imaging had improved detection of microcalcification compared with ultrasound and MRI with multiple sequences [T1WI, T2WI and short inversion time inversion recovery (STIR)]. Soft-tissue lesion detection and cylindrical tumor contrast were superior with mammography and MRI compared to ultrasound. Hemispherical tumor detection was similar regardless of the imaging modality used. Conclusions: We developed a multi-purpose breast phantom using a 3D printing technique and determined its value for multi-modal breast imaging studies.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Um2bPc
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Um2bPc
Quantitative and qualitative comparison of low- and high-cost 3D-printed heart models
Current visualization techniques of complex congenital heart disease (CHD) are unable to provide comprehensive visualization of the anomalous cardiac anatomy as the medical datasets can essentially only be viewed from a flat, two-dimensional (2D) screen. Three-dimensional (3D) printing has therefore been used to replicate patient-specific hearts in 3D views based on medical imaging datasets. This technique has been shown to have a positive impact on the preoperative planning of corrective surgery, patient-doctor communication, and the learning experience of medical students. However, 3D printing is often costly, and this impedes the routine application of this technology in clinical practice. This technical note aims to investigate whether reducing 3D printing costs can have any impact on the clinical value of the 3D-printed heart models. Low-cost and a high-cost 3D-printed models based on a selected case of CHD were generated with materials of differing cost. Quantitative assessment of dimensional accuracy of the cardiac anatomy and pathology was compared between the 3D-printed models and the original cardiac computed tomography (CT) images with excellent correlation (r=0.99). Qualitative evaluation of model usefulness showed no difference between the two models in medical applications.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DBSfLy
Insights into 3D printing in medical applications
Three-dimensional (3D) printing has been increasingly used in the medical field with reported applications showing great value in assisting clinical decision-making and improving patient care (1-10). Patient-specific 3D printed models derived from medical imaging datasets, mainly from computed tomography (CT) and magnetic resonance imaging (MRI) are shown to play an important role in pre-surgical planning and simulation of complex surgical procedures, medical education and patient-doctor communication (1-14).
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2UgR0XO
Virtual museum of congenital heart defects: digitization and establishment of a database for cardiac specimens
Education and training of morphology for medical students, and professionals specializing in pediatric cardiology and surgery has traditionally been based on hands-on encounter with congenitally malformed cardiac specimens. Large international archives are no longer widely available due to stricter data protection rules, a reduced number of autopsies, attrition rate of existing specimens, and most importantly due to a higher survival rate of patients. Our Cardiac Archive houses about 400 cardiac specimens with congenital heart disease. The collection spans almost 60 years and thus goes back to pre-surgical era. Unfortunately, attrition rate due to desiccation has led to an increased natural decay in recent years. The present multi-institutional project focuses on saving the collection by digitization. Specimens are scanned by high-resolution micro-CT/MRI. Virtual 3D-models are segmented and a comprehensive database is built. We now report an initial feasibility study with six test specimens that provided promising results, however, adequate presentation of the intracardiac anatomy, including septa and cardiac valves requires further refinements. Computer assisted design methods are necessary to overcome consequences of pathological examination, shrinkage and/or distortion of the specimens. For a next step, we anticipate an expandable web-based virtual museum with interactive reference and training tools. Web access for professional third parties will be provided by registration/subscription. In a future phase, segmental wall motion data could be added to virtual models. 3D-printed models may replace actual specimens and serve as hands-on surgical training to elucidate complex morphologies, promote surgical emulation, and extract more accurate procedural knowledge based on such a collection.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DBSczm
Thyroid Hormone Receptor Alpha Mutations Lead to Epithelial Defects in the Adult Intestine in a Mouse Model of Resistance to Thyroid Hormone
Thyroid, Ahead of Print.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2UlE17m
Trends, Determinants, and Associations of Treated Hypothyroidism in the United Kingdom, 2005–2014
Thyroid, Ahead of Print.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DBmClB
Radioiodine Uptake and Thyroglobulin-Guided Radioiodine Remnant Ablation in Patients with Differentiated Thyroid Cancer: A Prospective, Randomized, Open-Label, Controlled Trial
Thyroid, Volume 29, Issue 1, Page 101-110, January 2019.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Ul6WIr
Leslie J. De Groot (September 20, 1928–October 3, 2018)
Thyroid, Volume 29, Issue 1, Page 1-6, January 2019.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DAITzM
Correction to: Diagnostic Performance of Ultrasound-Based Risk-Stratification Systems for Thyroid Nodules: Comparison of the 2015 American Thyroid Association Guidelines with the 2016 Korean Thyroid Association/Korean Society of Thyroid Radiology and 2017 American College of Radiology Guidelines by Ha EJ, Na DG, Moon W-J, Lee YH, and Choi N. Thyroid 2018;28:1532–1537. DOI: 10.1089/thy.2018.0094
Thyroid, Volume 29, Issue 1, Page 159-159, January 2019.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DBS0QE
Association Between Diethylhexyl Phthalate Exposure and Thyroid Function: A Meta-Analysis
Thyroid, Ahead of Print.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DADFEm
Expression, Localization, and Regulation of the Sodium Bicarbonate Cotransporter NBCe1 in the Thyroid
Thyroid, Ahead of Print.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2UmIczP
3D-printed breast phantom for multi-purpose and multi-modality imaging
Background: Breast imaging technology plays an important role in breast cancer planning and treatment. Recently, three-dimensional (3D) printing technology has become a trending issue in phantom constructions for medical applications, with its advantages of being customizable and cost-efficient. However, there is no current practice in the field of multi-purpose breast phantom for quality control (QC) in multi-modalities imaging. The purpose of this study was to fabricate a multi-purpose breast phantom with tissue-equivalent materials via a 3D printing technique for QC in multi-modalities imaging. Methods: We used polyvinyl chloride (PVC) based materials and a 3D printing technique to construct a breast phantom. The phantom incorporates structures imaged in the female breast such as microcalcifications, fiber lesions, and tumors with different sizes. Moreover, the phantom was used to assess the sensitivity of lesion detection, depth resolution, and detectability thresholds with different imaging modalities. Phantom tissue equivalent properties were determined using computed tomography (CT) attenuation [Hounsfield unit (HU)] and magnetic resonance imaging (MRI) relaxation times. Results: The 3D-printed breast phantom had an average background value of 36.2 HU, which is close to that of glandular breast tissue (40 HU). T1 and T2 relaxation times had an average relaxation time of 206.81±17.50 and 20.22±5.74 ms, respectively. Mammographic imaging had improved detection of microcalcification compared with ultrasound and MRI with multiple sequences [T1WI, T2WI and short inversion time inversion recovery (STIR)]. Soft-tissue lesion detection and cylindrical tumor contrast were superior with mammography and MRI compared to ultrasound. Hemispherical tumor detection was similar regardless of the imaging modality used. Conclusions: We developed a multi-purpose breast phantom using a 3D printing technique and determined its value for multi-modal breast imaging studies.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Um2bPc
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Um2bPc
Quantitative and qualitative comparison of low- and high-cost 3D-printed heart models
Current visualization techniques of complex congenital heart disease (CHD) are unable to provide comprehensive visualization of the anomalous cardiac anatomy as the medical datasets can essentially only be viewed from a flat, two-dimensional (2D) screen. Three-dimensional (3D) printing has therefore been used to replicate patient-specific hearts in 3D views based on medical imaging datasets. This technique has been shown to have a positive impact on the preoperative planning of corrective surgery, patient-doctor communication, and the learning experience of medical students. However, 3D printing is often costly, and this impedes the routine application of this technology in clinical practice. This technical note aims to investigate whether reducing 3D printing costs can have any impact on the clinical value of the 3D-printed heart models. Low-cost and a high-cost 3D-printed models based on a selected case of CHD were generated with materials of differing cost. Quantitative assessment of dimensional accuracy of the cardiac anatomy and pathology was compared between the 3D-printed models and the original cardiac computed tomography (CT) images with excellent correlation (r=0.99). Qualitative evaluation of model usefulness showed no difference between the two models in medical applications.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DBSfLy
Insights into 3D printing in medical applications
Three-dimensional (3D) printing has been increasingly used in the medical field with reported applications showing great value in assisting clinical decision-making and improving patient care (1-10). Patient-specific 3D printed models derived from medical imaging datasets, mainly from computed tomography (CT) and magnetic resonance imaging (MRI) are shown to play an important role in pre-surgical planning and simulation of complex surgical procedures, medical education and patient-doctor communication (1-14).
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2UgR0XO
Virtual museum of congenital heart defects: digitization and establishment of a database for cardiac specimens
Education and training of morphology for medical students, and professionals specializing in pediatric cardiology and surgery has traditionally been based on hands-on encounter with congenitally malformed cardiac specimens. Large international archives are no longer widely available due to stricter data protection rules, a reduced number of autopsies, attrition rate of existing specimens, and most importantly due to a higher survival rate of patients. Our Cardiac Archive houses about 400 cardiac specimens with congenital heart disease. The collection spans almost 60 years and thus goes back to pre-surgical era. Unfortunately, attrition rate due to desiccation has led to an increased natural decay in recent years. The present multi-institutional project focuses on saving the collection by digitization. Specimens are scanned by high-resolution micro-CT/MRI. Virtual 3D-models are segmented and a comprehensive database is built. We now report an initial feasibility study with six test specimens that provided promising results, however, adequate presentation of the intracardiac anatomy, including septa and cardiac valves requires further refinements. Computer assisted design methods are necessary to overcome consequences of pathological examination, shrinkage and/or distortion of the specimens. For a next step, we anticipate an expandable web-based virtual museum with interactive reference and training tools. Web access for professional third parties will be provided by registration/subscription. In a future phase, segmental wall motion data could be added to virtual models. 3D-printed models may replace actual specimens and serve as hands-on surgical training to elucidate complex morphologies, promote surgical emulation, and extract more accurate procedural knowledge based on such a collection.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DBSczm
Thyroid Hormone Receptor Alpha Mutations Lead to Epithelial Defects in the Adult Intestine in a Mouse Model of Resistance to Thyroid Hormone
Thyroid, Ahead of Print.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2UlE17m
Trends, Determinants, and Associations of Treated Hypothyroidism in the United Kingdom, 2005–2014
Thyroid, Ahead of Print.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DBmClB
Radioiodine Uptake and Thyroglobulin-Guided Radioiodine Remnant Ablation in Patients with Differentiated Thyroid Cancer: A Prospective, Randomized, Open-Label, Controlled Trial
Thyroid, Volume 29, Issue 1, Page 101-110, January 2019.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Ul6WIr
Leslie J. De Groot (September 20, 1928–October 3, 2018)
Thyroid, Volume 29, Issue 1, Page 1-6, January 2019.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DAITzM
Future Meetings
Thyroid, Volume 29, Issue 1, Page 157-158, January 2019.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2UkdcjP
Correction to: Diagnostic Performance of Ultrasound-Based Risk-Stratification Systems for Thyroid Nodules: Comparison of the 2015 American Thyroid Association Guidelines with the 2016 Korean Thyroid Association/Korean Society of Thyroid Radiology and 2017 American College of Radiology Guidelines by Ha EJ, Na DG, Moon W-J, Lee YH, and Choi N. Thyroid 2018;28:1532–1537. DOI: 10.1089/thy.2018.0094
Thyroid, Volume 29, Issue 1, Page 159-159, January 2019.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DBS0QE
Unfavorable Socioeconomic Factors Underlie High Rates of Hospitalization for Complicated Thyrotoxicosis in Some Regions of the United States
Thyroid, Volume 29, Issue 1, Page 27-35, January 2019.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Uj8XFm
Association Between Diethylhexyl Phthalate Exposure and Thyroid Function: A Meta-Analysis
Thyroid, Ahead of Print.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DADFEm
Expression, Localization, and Regulation of the Sodium Bicarbonate Cotransporter NBCe1 in the Thyroid
Thyroid, Ahead of Print.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2UmIczP
Factor associated with alcohol use among Lahu and Akha hill tribe youths, northern Thailand
Alcohol use impacts several dimensions, including physical health, mental health, families, and social interactions. This study aimed to estimate the prevalence and to determine the factors associated with alc...
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2sOMjsM
Epistaxis audit revisited.
| Related Articles |
Epistaxis audit revisited.
J Laryngol Otol. 2018 Dec;132(12):1045
Authors: Fishman J, Fisher E, Hussain M
PMID: 30674370 [PubMed - in process]
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RfefiV
Cluster of differentiation 8 T-cell population in the laryngeal mucosa of smokers with laryngeal cancer.
| Related Articles |
Cluster of differentiation 8 T-cell population in the laryngeal mucosa of smokers with laryngeal cancer.
J Laryngol Otol. 2018 Dec;132(12):1134-1137
Authors: Elwany S, Radi S, Khalil H, Talaat I, Belasy K
Abstract
OBJECTIVE: To study the cluster of differentiation 8 population in the laryngeal mucosa of patients with laryngeal carcinoma. To our knowledge this is the first paper to address this issue.
METHODS: The study group included 40 patients with known laryngeal cancer who were scheduled for laryngectomy. The control groups included 10 smokers and 10 non-smokers who were scheduled for microlaryngeal surgery. Specimens from the three groups were processed for histopathological and histochemical evaluation.
RESULTS: In patients without cancer of the larynx, the number of cluster of differentiation 8 lymphocytes was greater in smokers than non-smokers. The number of cluster of differentiation 8 lymphocytes was greatest in smokers with laryngeal cancer, and the difference between this group and the two control groups was statistically significant.
CONCLUSION: The study showed that smoking increased the number of cluster of differentiation 8 T-lymphocytes in the laryngeal mucosa. The increase was greatest in patients who had developed laryngeal cancer.
PMID: 30674369 [PubMed - in process]
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2sJ64lj
Efficacy of fluoroscopy-guided endoscopic cricopharyngeal myotomy.
| Related Articles |
Efficacy of fluoroscopy-guided endoscopic cricopharyngeal myotomy.
J Laryngol Otol. 2018 Dec;132(12):1128-1133
Authors: Fujiwara K, Kawamoto K, Taira K, Fukuhara T, Koyama S, Kataoka H, Kitano H, Takeuchi H
Abstract
BACKGROUND: In endoscopic cricopharyngeal myotomy, surgeons sometimes have concerns about performing an adequate incision with only a narrow intra-cavital view from one direction. In order to overcome these issues, fluoroscopic radiography was used during endoscopic cricopharyngeal myotomy.
METHODS: Peri-operative fluoroscopic radiography was utilised to check the position of the diverticuloscope, and to confirm the extent of the incision during surgery. A balloon catheter was used to determine whether the cricopharyngeal muscle was sufficiently resected. Blood loss, peri-operative complications, and functional oral swallowing scale and penetration aspiration scale scores were evaluated.
RESULTS: In 12 out of 15 patients, intra-operative fluoroscopic radiography showed the diverticuloscope positioned in the post-cricoid area, and the cricopharyngeal muscle was raised and the surgery completed without adverse effect. Swallowing functions improved following surgery.
CONCLUSION: Intra-operative fluoroscopy might improve endoscopic cricopharyngeal myotomy by allowing surgeons to confirm the extent of resection, and by reducing peri-operative morbidity and complication rates.
PMID: 30674368 [PubMed - in process]
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2WhYnAg
Cost-effectiveness of Coblation compared with cold steel tonsillectomies in the UK.
| Related Articles |
Cost-effectiveness of Coblation compared with cold steel tonsillectomies in the UK.
J Laryngol Otol. 2018 Dec;132(12):1119-1127
Authors: Guest JF, Rana K, Hopkins C
Abstract
OBJECTIVE: This study aimed to estimate the cost-effectiveness of Coblation compared with cold steel tonsillectomy in adult and paediatric patients in the UK.
METHOD: Decision analysis was undertaken by combining published clinical outcomes with resource utilisation estimates derived from a panel of clinicians.
RESULTS: Using a cold steel procedure instead of Coblation is expected to generate an incremental cost of more than £2000 for each additional avoided haemorrhage, and the probability of cold steel being cost-effective was approximately 0.50. Therefore, the cost-effectiveness of the two techniques was comparable. When the published clinical outcomes were replaced with clinicians' estimates of current practice, Coblation was found to improve outcome for less cost, and the probability of Coblation being cost-effective was at least 0.70.
CONCLUSION: A best-case scenario suggests Coblation affords the National Health Service a cost-effective intervention for tonsillectomy in adult and paediatric patients compared with cold steel procedures. A worst-case scenario suggests Coblation affords the National Health Service an equivalent cost-effective intervention for adult and paediatric patients.
PMID: 30674367 [PubMed - in process]
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RbwhTv
The Gopen-Yang Superior Semicircular Canal Dehiscence Questionnaire: development and validation of a clinical questionnaire to assess subjective symptoms in patients undergoing surgical repair of superior semicircular canal dehiscence.
| Related Articles |
The Gopen-Yang Superior Semicircular Canal Dehiscence Questionnaire: development and validation of a clinical questionnaire to assess subjective symptoms in patients undergoing surgical repair of superior semicircular canal dehiscence.
J Laryngol Otol. 2018 Dec;132(12):1110-1118
Authors: Voth BL, Sheppard JP, Barnette NE, Ong V, Nguyen T, Jacky Chen CH, Duong C, Arsenault JJ, Lagman C, Gopen Q, Yang I
Abstract
OBJECTIVE: To characterise subjective symptoms in patients undergoing surgical repair of superior semicircular canal dehiscence.
METHODS: Questionnaires assessing symptom severity and impact on function and quality of life were administered to patients before superior semicircular canal dehiscence surgery, between June 2011 and March 2016. Questionnaire sections included general quality of life, internal amplified sounds, dizziness and tinnitus, with scores of 0-100 points.
RESULTS: Twenty-three patients completed the questionnaire before surgery. Section scores (mean±standard deviation) were: 38.2 ± 25.2 for general quality of life, 52.5 ± 23.9 for internal amplified sounds, 35.1 ± 28.8 for dizziness, 33.3 ± 30.7 for tinnitus, and 39.8 ± 22.2 for the composite score. Cronbach's α statistic averaged 0.93 (range, 0.84-0.97) across section scores, and 0.83 for the composite score.
CONCLUSION: The Gopen-Yang Superior Semicircular Canal Dehiscence Questionnaire provides a holistic, patient-centred characterisation of superior semicircular canal dehiscence symptoms. Internal consistency analysis validated the questionnaire and provided a quantitative framework for further optimisation in the clinical setting.
PMID: 30674366 [PubMed - in process]
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2WhYhbS
Εγγραφή σε:
Αναρτήσεις (Atom)