Malignant peripheral nerve sheath tumor (MPNST) arising from angiosarcoma: a rare case report

ConclusionsDivergent differentiation of an angiosarcoma to a neurosarcoma supports the theory that cells of the neural crest capable of differentiating both to neuroectoderm and to mesenchyme give origin to these tumors. (Source: Oral and Maxillofacial Surgery)

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Malignant peripheral nerve sheath tumor (MPNST) arising from angiosarcoma: a rare case report

ConclusionsDivergent differentiation of an angiosarcoma to a neurosarcoma supports the theory that cells of the neural crest capable of differentiating both to neuroectoderm and to mesenchyme give origin to these tumors. (Source: Oral and Maxillofacial Surgery)

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ALLERGY MAXIMUM STRENGTH (Urtica Dioica, Althaea Officinalis Root, Inula Helenium Root, Angelica Archangelica Root, Pine Needle Oil (Pinus Sylvestris), Sodium Chloride, And Silicon Dioxide) Solution/ Drops [Forces Of Nature]

Updated Date: Feb 1, 2019 EST (Source: DailyMed Drug Label Updates)

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ALLERGY MIX LOS ANGELES (Local Remedy Los Angeles) Liquid [ASN]

Updated Date: Feb 1, 2019 EST (Source: DailyMed Drug Label Updates)

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ALLERGY MAXIMUM STRENGTH (Urtica Dioica, Althaea Officinalis Root, Inula Helenium Root, Angelica Archangelica Root, Pine Needle Oil (Pinus Sylvestris), Sodium Chloride, And Silicon Dioxide) Solution/ Drops [Forces Of Nature]

Updated Date: Feb 1, 2019 EST (Source: DailyMed Drug Label Updates)

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Primary Prevention of Food Allergy

Abstract

Purpose of Review

The goal of this review is to present an updated summary of the various approaches to prevent childhood food allergies and report recent advances in potential prevention trials for food allergy.

Recent Findings

Several approaches related to maternal dietary supplementation as well as infant GI-based supplementation have been tried and are the subject of ongoing clinical investigation.

Summary

The prevalence of food allergy appears to be increasing but several, varied approaches to prevention are being actively pursued such that an effective strategy may not be too far in the future.

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Optimization of the Surgical Field in Endoscopic Sinus Surgery: an Evidence-Based Approach

Abstract

Purpose of Review

The advent of endoscopic sinus surgery (ESS) has enabled the development of minimally invasive surgical procedures in Rhinology. However, proficiency with ESS techniques can still be hampered by poorly controlled bleeding limiting visibility of the surgical field (VSF). This can lead to increased operating time and, more importantly, increased risk of major and minor complications. To optimize the VSF and mitigate the risk of complications, many strategies have been explored.

Recent Findings

This is a narrative review of the relative risks and benefits of pre- and intra-operative interventions aimed at optimizing intraoperative conditions during ESS. The value of these interventions is determined based on their impact on intraoperative blood loss, time of surgery, and the VSF, and weighed against their adverse event profile.

Summary

This review provides a comprehensive overview of the evidence relating to the safety and efficacy of interventions used to improve intraoperative conditions during ESS.

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Primary Prevention of Food Allergy

Abstract

Purpose of Review

The goal of this review is to present an updated summary of the various approaches to prevent childhood food allergies and report recent advances in potential prevention trials for food allergy.

Recent Findings

Several approaches related to maternal dietary supplementation as well as infant GI-based supplementation have been tried and are the subject of ongoing clinical investigation.

Summary

The prevalence of food allergy appears to be increasing but several, varied approaches to prevention are being actively pursued such that an effective strategy may not be too far in the future.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Ts4Jv0

Optimization of the Surgical Field in Endoscopic Sinus Surgery: an Evidence-Based Approach

Abstract

Purpose of Review

The advent of endoscopic sinus surgery (ESS) has enabled the development of minimally invasive surgical procedures in Rhinology. However, proficiency with ESS techniques can still be hampered by poorly controlled bleeding limiting visibility of the surgical field (VSF). This can lead to increased operating time and, more importantly, increased risk of major and minor complications. To optimize the VSF and mitigate the risk of complications, many strategies have been explored.

Recent Findings

This is a narrative review of the relative risks and benefits of pre- and intra-operative interventions aimed at optimizing intraoperative conditions during ESS. The value of these interventions is determined based on their impact on intraoperative blood loss, time of surgery, and the VSF, and weighed against their adverse event profile.

Summary

This review provides a comprehensive overview of the evidence relating to the safety and efficacy of interventions used to improve intraoperative conditions during ESS.

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Feasibility of hearing preservation for residual hearing with longer cochlear implant electrodes.

CONCLUSION: It is possible to achieve hearing preservation in the lower frequency by the use of longer electrodes. This study underscores the importance of atraumatic surgery, even for patients with only limited residual hearing, and longer electrodes should be adopted for EAS. PMID: 30702034 [PubMed - as supplied by publisher] (Source: Acta Oto-Laryngologica)

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Feasibility of hearing preservation for residual hearing with longer cochlear implant electrodes.

CONCLUSION: It is possible to achieve hearing preservation in the lower frequency by the use of longer electrodes. This study underscores the importance of atraumatic surgery, even for patients with only limited residual hearing, and longer electrodes should be adopted for EAS. PMID: 30702034 [PubMed - as supplied by publisher] (Source: Acta Oto-Laryngologica)

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Role of Metformin in the Treatment of Patients with Thyroid Nodules and Insulin Resistance: A Systematic Review and Meta-Analysis

Thyroid, Ahead of Print.


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Asthma and Allergy Mobile Apps in 2018

Abstract

Purpose of Review

This paper offers a comprehensive review of interactive mobile allergy and asthma smartphone applications available within the USA in 2018, with an emphasis on interactive asthma apps.

Recent Findings

Primary care and specialty clinicians interested in introducing digital health apps into their practices will soon have more choices, for Apple® and major electronic medical record software companies are investing heavily in the mobile medical marketplace, guaranteeing personal health information and access to care will always be immediately available in one's digital hand.

Summary

Interactive mobile asthma applications are valuable assets for patients and caregivers alike, for they offer immediate communications between patients and those responsible for providing for their needs.

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Role of Metformin in the Treatment of Patients with Thyroid Nodules and Insulin Resistance: A Systematic Review and Meta-Analysis

Thyroid, Ahead of Print.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SltZpk

Asthma and Allergy Mobile Apps in 2018

Abstract

Purpose of Review

This paper offers a comprehensive review of interactive mobile allergy and asthma smartphone applications available within the USA in 2018, with an emphasis on interactive asthma apps.

Recent Findings

Primary care and specialty clinicians interested in introducing digital health apps into their practices will soon have more choices, for Apple® and major electronic medical record software companies are investing heavily in the mobile medical marketplace, guaranteeing personal health information and access to care will always be immediately available in one's digital hand.

Summary

Interactive mobile asthma applications are valuable assets for patients and caregivers alike, for they offer immediate communications between patients and those responsible for providing for their needs.

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Intrathyroidal ectopic thymus tissue: a diagnostic challenge

Abstract

Objectives

The prevalence of thyroid nodules in pediatric population is 0.2–2%, which is lower than adults. However, the probability of the nodule to be malignant is higher than adults (20–73%). Differential diagnosis of thyroid lesions in children includes intrathyroidal ectopic thymus tissue (ITT). ITT can present as a thyroid nodule, and be confused with malignancy with its hyperechoic pattern; this might cause unnecessary fine-needle aspiration biopsies and/or surgical interventions. In the current study, we mainly aim to define both US and color Doppler ultrasonography (CDUS) characteristics of ITT. We also aim to describe the most sensitive and most specific diagnostic parameters of ITT.

Methods

We have evaluated US examination reports of 56 children for whom differential diagnosis included ITT between February 2015 and August 2018. We have recorded sonographic characteristics of the lesions, CDUS data, and thyroid hormone levels.

Results

Study population consists of 56 patients (22 ITT, 34 other diagnoses). Median age of the population is 10 years. Age, sex, laboratory results, and follow-up change in lesion diameters do not show any significant difference between ITT and other diagnosis groups. Typical US appearance, fusiform lesion shape, and isovascular CDUS characteristics are higher in ITT group. The median value of the lesion's highest diameter is smaller in ITT group. The most valuable criteria to predict ITT presence were the fusiform shape and the longest diameter of the lesion.

Conclusions

Fusiform shape and a maximum diameter of ≤ 9 mm are the most selective criteria to predict ITT diagnosis.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2S3e6EH

Intrathyroidal ectopic thymus tissue: a diagnostic challenge

Abstract

Objectives

The prevalence of thyroid nodules in pediatric population is 0.2–2%, which is lower than adults. However, the probability of the nodule to be malignant is higher than adults (20–73%). Differential diagnosis of thyroid lesions in children includes intrathyroidal ectopic thymus tissue (ITT). ITT can present as a thyroid nodule, and be confused with malignancy with its hyperechoic pattern; this might cause unnecessary fine-needle aspiration biopsies and/or surgical interventions. In the current study, we mainly aim to define both US and color Doppler ultrasonography (CDUS) characteristics of ITT. We also aim to describe the most sensitive and most specific diagnostic parameters of ITT.

Methods

We have evaluated US examination reports of 56 children for whom differential diagnosis included ITT between February 2015 and August 2018. We have recorded sonographic characteristics of the lesions, CDUS data, and thyroid hormone levels.

Results

Study population consists of 56 patients (22 ITT, 34 other diagnoses). Median age of the population is 10 years. Age, sex, laboratory results, and follow-up change in lesion diameters do not show any significant difference between ITT and other diagnosis groups. Typical US appearance, fusiform lesion shape, and isovascular CDUS characteristics are higher in ITT group. The median value of the lesion's highest diameter is smaller in ITT group. The most valuable criteria to predict ITT presence were the fusiform shape and the longest diameter of the lesion.

Conclusions

Fusiform shape and a maximum diameter of ≤ 9 mm are the most selective criteria to predict ITT diagnosis.

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Macroscopic and radiographic aspects of orthodontic movement associated with corticotomy: animal study

Abstract

Introduction

To quantify the rate of tooth movement in two corticotomy protocols in an experimental model in rats through macroscopic and radiographic analysis.

Methods

The animals were divided into three groups: orthodontic movement (CO), orthodontic movement plus corticotomy surgery (G2), and orthodontic movement and corticotomy surgery with decorticalization (G3).The euthanasia occurred in 7 and 14 days. The data were statistically analyzed (p < 0.05).

Results

The CO presented lower distance between the mesial surface of the first molar and the distal surface of the third molar when compared to the G2 (6.96 ± 0.24, p = 0.009) and G3 (6.93 ± 0.18, p = 0.016) in the macroscopic analysis. In the 7 days, there was no statistically significant radiographic difference between the three groups: CO(0.94 ± 0.21 mm²), G2(1.05 ± 0,27 mm²), and G3(1.08 ± 0.27 mm²).There was a statistically significant difference between CO (0.87 ± 0.12 mm²), G2 (1.00 ± 0.12 mm²), and G3 (1.11 ± 0.14 mm²) at 14 days. There was a statistically significant linear difference between the groups in all periods.

Conclusion

Tooth movement and the region of interest were influenced by corticotomy, regardless of the surgical technique in the 14 days.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2S0rYj3

Macroscopic and radiographic aspects of orthodontic movement associated with corticotomy: animal study

Abstract

Introduction

To quantify the rate of tooth movement in two corticotomy protocols in an experimental model in rats through macroscopic and radiographic analysis.

Methods

The animals were divided into three groups: orthodontic movement (CO), orthodontic movement plus corticotomy surgery (G2), and orthodontic movement and corticotomy surgery with decorticalization (G3).The euthanasia occurred in 7 and 14 days. The data were statistically analyzed (p < 0.05).

Results

The CO presented lower distance between the mesial surface of the first molar and the distal surface of the third molar when compared to the G2 (6.96 ± 0.24, p = 0.009) and G3 (6.93 ± 0.18, p = 0.016) in the macroscopic analysis. In the 7 days, there was no statistically significant radiographic difference between the three groups: CO(0.94 ± 0.21 mm²), G2(1.05 ± 0,27 mm²), and G3(1.08 ± 0.27 mm²).There was a statistically significant difference between CO (0.87 ± 0.12 mm²), G2 (1.00 ± 0.12 mm²), and G3 (1.11 ± 0.14 mm²) at 14 days. There was a statistically significant linear difference between the groups in all periods.

Conclusion

Tooth movement and the region of interest were influenced by corticotomy, regardless of the surgical technique in the 14 days.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2S0rYj3

Role of Metformin in the Treatment of Patients with Thyroid Nodules and Insulin Resistance: A Systematic Review and Meta-Analysis

Thyroid, Ahead of Print.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GjVbyj

Role of Metformin in the Treatment of Patients with Thyroid Nodules and Insulin Resistance: A Systematic Review and Meta-Analysis

Thyroid, Ahead of Print.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SltZpk

Role of Metformin in the Treatment of Patients with Thyroid Nodules and Insulin Resistance: A Systematic Review and Meta-Analysis

Thyroid, Ahead of Print.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GjVbyj

Role of Metformin in the Treatment of Patients with Thyroid Nodules and Insulin Resistance: A Systematic Review and Meta-Analysis

Thyroid, Ahead of Print.


from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SltZpk

Gadolinium retention in gliomas and adjacent normal brain tissue: association with tumor contrast enhancement and linear/macrocyclic agents

Abstract

Purpose

To quantitate gadolinium deposits in gliomas and adjacent normal brain specimens, and to evaluate their association with tumor contrast enhancement and the type of gadolinium-based contrast agent (GBCA) used.

Methods

A total of 69 patients with primary glioma who underwent contrast-enhanced magnetic resonance imaging (MRI) prior to surgery were included in this retrospective study. Gadolinium was measured from histologically viable tumor, normal brain, and necrosis within the sample, when available, using inductively coupled plasma mass spectrometry (ICP-MS). Tumor contrast enhancement was categorized as none, minimal, or noticeable. Differences in gadolinium deposits by contrast enhancement and GBCA type were assessed.

Results

Seven patients received linear GBCA and 62 macrocyclic, respectively. At the time of surgery, gadolinium deposits were detected in 39 out of 69 (57%) tumor samples, 8 out of 13 (62%) normal brain, and 12 out of 14 (86%) necrotic specimens. Gadolinium was detected in both enhancing and non-enhancing tumors, but was greatest in gliomas with noticeable enhancement (p = 0.02). Administration of linear agents gadodiamide and gadopentetate dimeglumine resulted in significantly higher tumor gadolinium relative to macrocyclic gadoterate meglumine (p < 0.01 and p < 0.05, respectively). Normal brain and necrosis also showed higher gadolinium after exposure to linear gadodiamide (both p < 0.05). In multivariate regression, GBCA type (linear/macrocyclic) was the most powerful predictor of tumor gadolinium retention (p < 0.001).

Conclusion

Gadolinium can be detected in both enhancing and non-enhancing gliomas, neighboring normal brain, and necrosis. Gadolinium retention is higher after exposure to linear GBCAs compared with the macrocyclic gadoterate meglumine.

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Gadolinium retention in gliomas and adjacent normal brain tissue: association with tumor contrast enhancement and linear/macrocyclic agents

Abstract

Purpose

To quantitate gadolinium deposits in gliomas and adjacent normal brain specimens, and to evaluate their association with tumor contrast enhancement and the type of gadolinium-based contrast agent (GBCA) used.

Methods

A total of 69 patients with primary glioma who underwent contrast-enhanced magnetic resonance imaging (MRI) prior to surgery were included in this retrospective study. Gadolinium was measured from histologically viable tumor, normal brain, and necrosis within the sample, when available, using inductively coupled plasma mass spectrometry (ICP-MS). Tumor contrast enhancement was categorized as none, minimal, or noticeable. Differences in gadolinium deposits by contrast enhancement and GBCA type were assessed.

Results

Seven patients received linear GBCA and 62 macrocyclic, respectively. At the time of surgery, gadolinium deposits were detected in 39 out of 69 (57%) tumor samples, 8 out of 13 (62%) normal brain, and 12 out of 14 (86%) necrotic specimens. Gadolinium was detected in both enhancing and non-enhancing tumors, but was greatest in gliomas with noticeable enhancement (p = 0.02). Administration of linear agents gadodiamide and gadopentetate dimeglumine resulted in significantly higher tumor gadolinium relative to macrocyclic gadoterate meglumine (p < 0.01 and p < 0.05, respectively). Normal brain and necrosis also showed higher gadolinium after exposure to linear gadodiamide (both p < 0.05). In multivariate regression, GBCA type (linear/macrocyclic) was the most powerful predictor of tumor gadolinium retention (p < 0.001).

Conclusion

Gadolinium can be detected in both enhancing and non-enhancing gliomas, neighboring normal brain, and necrosis. Gadolinium retention is higher after exposure to linear GBCAs compared with the macrocyclic gadoterate meglumine.

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Impact of type of tooth on outcome of non-surgical root canal treatment

Abstract

Objectives

We assessed the impact of type of tooth on the outcome of root canal treatment (RCT) according to factors potentially weakening the prognosis such as preoperative apical periodontitis (AP) and treatment modality (primary or secondary RCT).

Materials and methods

We scrutinized patient documents including pre- and postoperative radiographs of 640 permanent teeth receiving non-surgical RCT at Helsinki University Clinic in 2008–2011. Of teeth, 44% were molars, 32% premolars, and 24% anterior teeth. Patients' mean age was 51.5 years; 51% were male. AP was present in 60.5% of teeth preoperatively. We used the periapical index (PAI) to assess the radiographs and defined radiographically "healthy" and "healing" cases as successful. Statistical evaluation included chi-squared tests, Fisher's exact tests, t tests, and logistic regression modeling.

Results

The overall success rate (SR) was 84.1%; 88.3% for primary and 75.5% for secondary RCT (p < 0.001). The SRs for anterior teeth, premolars and molars were 85.6%, 88.8%, and 79.7%, respectively. Teeth with and without AP had SRs of 77.3% and 94.5%, respectively (p < 0.001). The RCTs were more likely to succeed in anterior teeth and premolars than in molars (OR 1.7; 95% CI 1.1–2.7) and in females than in males (OR 1.9; 95% CI 1.2–3.1).

Conclusions

Apart from existing AP and retreatment scenario, also, the type of tooth and gender had a significant influence on the outcome of RCT in this study.

Clinical relevance

The prognosis of RCT varies by type of tooth; special attention should be given to RCT of molar teeth.

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January 2019 Briefing - Allergy

Here are what the editors at HealthDay consider to be the most important developments in Allergy for January 2019. This roundup includes the latest research news from journal articles, as well as the FDA approvals and regulatory changes that are the... (Source: Drugs.com - Pharma News)

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Impact of type of tooth on outcome of non-surgical root canal treatment

Abstract

Objectives

We assessed the impact of type of tooth on the outcome of root canal treatment (RCT) according to factors potentially weakening the prognosis such as preoperative apical periodontitis (AP) and treatment modality (primary or secondary RCT).

Materials and methods

We scrutinized patient documents including pre- and postoperative radiographs of 640 permanent teeth receiving non-surgical RCT at Helsinki University Clinic in 2008–2011. Of teeth, 44% were molars, 32% premolars, and 24% anterior teeth. Patients' mean age was 51.5 years; 51% were male. AP was present in 60.5% of teeth preoperatively. We used the periapical index (PAI) to assess the radiographs and defined radiographically "healthy" and "healing" cases as successful. Statistical evaluation included chi-squared tests, Fisher's exact tests, t tests, and logistic regression modeling.

Results

The overall success rate (SR) was 84.1%; 88.3% for primary and 75.5% for secondary RCT (p < 0.001). The SRs for anterior teeth, premolars and molars were 85.6%, 88.8%, and 79.7%, respectively. Teeth with and without AP had SRs of 77.3% and 94.5%, respectively (p < 0.001). The RCTs were more likely to succeed in anterior teeth and premolars than in molars (OR 1.7; 95% CI 1.1–2.7) and in females than in males (OR 1.9; 95% CI 1.2–3.1).

Conclusions

Apart from existing AP and retreatment scenario, also, the type of tooth and gender had a significant influence on the outcome of RCT in this study.

Clinical relevance

The prognosis of RCT varies by type of tooth; special attention should be given to RCT of molar teeth.

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Crunching the data: New liver cancer subtypes revealed immunologically

(Tokyo Medical and Dental University) Tokyo Medical and Dental University (TMDU) researchers used substantial datasets on liver cancer patients to develop a new classification of hepatocellular carcinoma (HCC) into three distinct subgroups with different genetic, immunological, and clinical features. The findings of HCC subtypes related to metabolic disease, immunosuppression, or mitogenic/stem-cell-like tumors should aid the development of more targeted treatment and promote the fight against this devastating disease. (Source: EurekAlert! - Biology)

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January 2019 Briefing - Allergy

Here are what the editors at HealthDay consider to be the most important developments in Allergy for January 2019. This roundup includes the latest research news from journal articles, as well as the FDA approvals and regulatory changes that are the... (Source: Drugs.com - Pharma News)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2TxdB2B

Macroscopic and radiographic aspects of orthodontic movement associated with corticotomy: animal study

Abstract

Introduction

To quantify the rate of tooth movement in two corticotomy protocols in an experimental model in rats through macroscopic and radiographic analysis.

Methods

The animals were divided into three groups: orthodontic movement (CO), orthodontic movement plus corticotomy surgery (G2), and orthodontic movement and corticotomy surgery with decorticalization (G3).The euthanasia occurred in 7 and 14 days. The data were statistically analyzed (p < 0.05).

Results

The CO presented lower distance between the mesial surface of the first molar and the distal surface of the third molar when compared to the G2 (6.96 ± 0.24, p = 0.009) and G3 (6.93 ± 0.18, p = 0.016) in the macroscopic analysis. In the 7 days, there was no statistically significant radiographic difference between the three groups: CO(0.94 ± 0.21 mm²), G2(1.05 ± 0,27 mm²), and G3(1.08 ± 0.27 mm²).There was a statistically significant difference between CO (0.87 ± 0.12 mm²), G2 (1.00 ± 0.12 mm²), and G3 (1.11 ± 0.14 mm²) at 14 days. There was a statistically significant linear difference between the groups in all periods.

Conclusion

Tooth movement and the region of interest were influenced by corticotomy, regardless of the surgical technique in the 14 days.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2S0rYj3

Macroscopic and radiographic aspects of orthodontic movement associated with corticotomy: animal study

Abstract

Introduction

To quantify the rate of tooth movement in two corticotomy protocols in an experimental model in rats through macroscopic and radiographic analysis.

Methods

The animals were divided into three groups: orthodontic movement (CO), orthodontic movement plus corticotomy surgery (G2), and orthodontic movement and corticotomy surgery with decorticalization (G3).The euthanasia occurred in 7 and 14 days. The data were statistically analyzed (p < 0.05).

Results

The CO presented lower distance between the mesial surface of the first molar and the distal surface of the third molar when compared to the G2 (6.96 ± 0.24, p = 0.009) and G3 (6.93 ± 0.18, p = 0.016) in the macroscopic analysis. In the 7 days, there was no statistically significant radiographic difference between the three groups: CO(0.94 ± 0.21 mm²), G2(1.05 ± 0,27 mm²), and G3(1.08 ± 0.27 mm²).There was a statistically significant difference between CO (0.87 ± 0.12 mm²), G2 (1.00 ± 0.12 mm²), and G3 (1.11 ± 0.14 mm²) at 14 days. There was a statistically significant linear difference between the groups in all periods.

Conclusion

Tooth movement and the region of interest were influenced by corticotomy, regardless of the surgical technique in the 14 days.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2S0rYj3

Analyse und Management von postoperativen Schmerzen nach Sialendoskopie

Laryngo-Rhino-Otol
DOI: 10.1055/a-0834-6147

Hintergrund Die Sialendoskopie ist ein minimal-invasives Verfahren zur Diagnostik und Therapie von Erkrankungen des Speicheldrüsengangsystems. Sie kann in ITN und in LA durchgeführt werden. Vor diesem Hintergrund ist die postoperative Schmerzsituation interessant, über deren Ausmaß aktuell jedoch wenig bekannt ist. Daher wurden in dieser Studie die postoperativen Schmerzen nach Sialendoskopie in LA und ihr Schmerzmanagement in einer quantitativen Untersuchung erfasst und analysiert. Material und Methoden Es wurden 103 Patienten in die retrospektive Studie eingeschlossen, bei denen im Zeitraum von 2013 bis 2015 eine Sialendoskopie der Glandula parotis oder der Glandula submanibularis in Lokalanästhesie durchgeführt wurde. Analysiert wurden die postoperativen Schmerzen in Ruhe und bei Belastung am Operationstag, sowie am ersten und zweiten postoperativen Tag. Die Schmerzen wurden anhand einer numerischen Rating Skala (NRS 0–10) erfasst, welche im Rahmen des QUIPS-Projektes (Qualitätsverbesserung in der postoperativen Schmerztherapie) verwendet wird. Ergebnisse Am Operationstag betrug der Schmerz in Ruhe 0,9 ± 1,9 und bei Belastung 0,7 ± 1,4. Am ersten postoperativen Tag wurden Schmerzen von 1,2 ± 1,8 in Ruhe und 0,9 ± 1,9 bei Belastung festgestellt. Am zweiten postoperativen Tag zeigte sich eine Reduktion der Schmerzen auf 0,75 ± 1,6 in Ruhe und 0,73 ± 1,5 bei Belastung. Insgesamt wurden Metamizol (Novalgin®) und Ibuprofen als häufigste postoperative Analgetika eingesetzt. Am Operationstag erhielten 37,9 % der Patienten Schmerzmittel, am ersten postoperativen Tag 26,2 % der Patienten und am zweiten postoperativen Tag 12,6 % der Patienten. Schlussfolgerung Sialendoskopien der Glandula submandibularis und parotis sind mit moderaten postoperativen Schmerzen verbunden, welche sich gut mit Nicht-Opioiden behandeln lassen.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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

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Analyse und Management von postoperativen Schmerzen nach Sialendoskopie

Laryngo-Rhino-Otol
DOI: 10.1055/a-0834-6147

Hintergrund Die Sialendoskopie ist ein minimal-invasives Verfahren zur Diagnostik und Therapie von Erkrankungen des Speicheldrüsengangsystems. Sie kann in ITN und in LA durchgeführt werden. Vor diesem Hintergrund ist die postoperative Schmerzsituation interessant, über deren Ausmaß aktuell jedoch wenig bekannt ist. Daher wurden in dieser Studie die postoperativen Schmerzen nach Sialendoskopie in LA und ihr Schmerzmanagement in einer quantitativen Untersuchung erfasst und analysiert. Material und Methoden Es wurden 103 Patienten in die retrospektive Studie eingeschlossen, bei denen im Zeitraum von 2013 bis 2015 eine Sialendoskopie der Glandula parotis oder der Glandula submanibularis in Lokalanästhesie durchgeführt wurde. Analysiert wurden die postoperativen Schmerzen in Ruhe und bei Belastung am Operationstag, sowie am ersten und zweiten postoperativen Tag. Die Schmerzen wurden anhand einer numerischen Rating Skala (NRS 0–10) erfasst, welche im Rahmen des QUIPS-Projektes (Qualitätsverbesserung in der postoperativen Schmerztherapie) verwendet wird. Ergebnisse Am Operationstag betrug der Schmerz in Ruhe 0,9 ± 1,9 und bei Belastung 0,7 ± 1,4. Am ersten postoperativen Tag wurden Schmerzen von 1,2 ± 1,8 in Ruhe und 0,9 ± 1,9 bei Belastung festgestellt. Am zweiten postoperativen Tag zeigte sich eine Reduktion der Schmerzen auf 0,75 ± 1,6 in Ruhe und 0,73 ± 1,5 bei Belastung. Insgesamt wurden Metamizol (Novalgin®) und Ibuprofen als häufigste postoperative Analgetika eingesetzt. Am Operationstag erhielten 37,9 % der Patienten Schmerzmittel, am ersten postoperativen Tag 26,2 % der Patienten und am zweiten postoperativen Tag 12,6 % der Patienten. Schlussfolgerung Sialendoskopien der Glandula submandibularis und parotis sind mit moderaten postoperativen Schmerzen verbunden, welche sich gut mit Nicht-Opioiden behandeln lassen.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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

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from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DONtdR

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from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2S52qRI

[PERSPECTIVES] Cochlear Frequency Tuning and Otoacoustic Emissions

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from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2UCUZ1d

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from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2HKZl4H

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from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RxINwC

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Inhibition of Histone Methyltransferase G9a Attenuates Noise-Induced Cochlear Synaptopathy and Hearing Loss

ABSTRACT

Posttranslational modification of histones alters their interaction with DNA and nuclear proteins, influencing gene expression and cell fate. In this study, we investigated the effect of G9a (KMT1C, EHMT2), a major histone lysine methyltransferase encoded by the human EHMT2 gene and responsible for histone H3 lysine 9 dimethylation (H3K9me2) on noise-induced permanent hearing loss (NIHL) in adult CBA/J mice. The conditions of noise exposure used in this study led to losses of cochlear synapses and outer hair cells (OHCs) and permanent auditory threshold shifts. Inhibition of G9a with its specific inhibitor BIX 01294 or with siRNA significantly attenuated these pathological features. Treatment with BIX 01294 also prevented the noise-induced decrease of KCNQ4 immunolabeling in OHCs. Additionally, G9a was increased in cochlear cells, including both outer and inner sensory hair cells, some spiral ganglion neurons (SGNs), and marginal cells, 1 h after the completion of the noise exposure. Also subsequent to noise exposure, immunoreactivity for H3K9me2 appeared in some nuclei of OHCs following a high-to-low frequency gradient with more labeled OHCs in the 45-kHz than the 32-kHz region, as well as in the marginal cells and in some SGNs of the basal turn. These findings suggest that epigenetic modifications of H3K9me2 are involved in NIHL and that pharmacological targeting of G9a may offer a strategy for protection against cochlear synaptopathy and NIHL.

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Inhibition of Histone Methyltransferase G9a Attenuates Noise-Induced Cochlear Synaptopathy and Hearing Loss

ABSTRACT

Posttranslational modification of histones alters their interaction with DNA and nuclear proteins, influencing gene expression and cell fate. In this study, we investigated the effect of G9a (KMT1C, EHMT2), a major histone lysine methyltransferase encoded by the human EHMT2 gene and responsible for histone H3 lysine 9 dimethylation (H3K9me2) on noise-induced permanent hearing loss (NIHL) in adult CBA/J mice. The conditions of noise exposure used in this study led to losses of cochlear synapses and outer hair cells (OHCs) and permanent auditory threshold shifts. Inhibition of G9a with its specific inhibitor BIX 01294 or with siRNA significantly attenuated these pathological features. Treatment with BIX 01294 also prevented the noise-induced decrease of KCNQ4 immunolabeling in OHCs. Additionally, G9a was increased in cochlear cells, including both outer and inner sensory hair cells, some spiral ganglion neurons (SGNs), and marginal cells, 1 h after the completion of the noise exposure. Also subsequent to noise exposure, immunoreactivity for H3K9me2 appeared in some nuclei of OHCs following a high-to-low frequency gradient with more labeled OHCs in the 45-kHz than the 32-kHz region, as well as in the marginal cells and in some SGNs of the basal turn. These findings suggest that epigenetic modifications of H3K9me2 are involved in NIHL and that pharmacological targeting of G9a may offer a strategy for protection against cochlear synaptopathy and NIHL.

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Is lymph node ratio a prognostic factor for patients with oral squamous cell carcinoma?

Lymph node ratio (LNR), defined as the ratio of positive resected lymph nodes (LNs) to the total number of resected LNs, predicts survival for some solid tumors. We investigated the value of LNR in the prognosis and postsurgical management of oral squamous cell carcinoma (OSCC).

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Is lymph node ratio a prognostic factor for patients with oral squamous cell carcinoma?

Lymph node ratio (LNR), defined as the ratio of positive resected lymph nodes (LNs) to the total number of resected LNs, predicts survival for some solid tumors. We investigated the value of LNR in the prognosis and postsurgical management of oral squamous cell carcinoma (OSCC).

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Inhibition of Histone Methyltransferase G9a Attenuates Noise-Induced Cochlear Synaptopathy and Hearing Loss

ABSTRACT

Posttranslational modification of histones alters their interaction with DNA and nuclear proteins, influencing gene expression and cell fate. In this study, we investigated the effect of G9a (KMT1C, EHMT2), a major histone lysine methyltransferase encoded by the human EHMT2 gene and responsible for histone H3 lysine 9 dimethylation (H3K9me2) on noise-induced permanent hearing loss (NIHL) in adult CBA/J mice. The conditions of noise exposure used in this study led to losses of cochlear synapses and outer hair cells (OHCs) and permanent auditory threshold shifts. Inhibition of G9a with its specific inhibitor BIX 01294 or with siRNA significantly attenuated these pathological features. Treatment with BIX 01294 also prevented the noise-induced decrease of KCNQ4 immunolabeling in OHCs. Additionally, G9a was increased in cochlear cells, including both outer and inner sensory hair cells, some spiral ganglion neurons (SGNs), and marginal cells, 1 h after the completion of the noise exposure. Also subsequent to noise exposure, immunoreactivity for H3K9me2 appeared in some nuclei of OHCs following a high-to-low frequency gradient with more labeled OHCs in the 45-kHz than the 32-kHz region, as well as in the marginal cells and in some SGNs of the basal turn. These findings suggest that epigenetic modifications of H3K9me2 are involved in NIHL and that pharmacological targeting of G9a may offer a strategy for protection against cochlear synaptopathy and NIHL.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2WAxcRi

Inhibition of Histone Methyltransferase G9a Attenuates Noise-Induced Cochlear Synaptopathy and Hearing Loss

ABSTRACT

Posttranslational modification of histones alters their interaction with DNA and nuclear proteins, influencing gene expression and cell fate. In this study, we investigated the effect of G9a (KMT1C, EHMT2), a major histone lysine methyltransferase encoded by the human EHMT2 gene and responsible for histone H3 lysine 9 dimethylation (H3K9me2) on noise-induced permanent hearing loss (NIHL) in adult CBA/J mice. The conditions of noise exposure used in this study led to losses of cochlear synapses and outer hair cells (OHCs) and permanent auditory threshold shifts. Inhibition of G9a with its specific inhibitor BIX 01294 or with siRNA significantly attenuated these pathological features. Treatment with BIX 01294 also prevented the noise-induced decrease of KCNQ4 immunolabeling in OHCs. Additionally, G9a was increased in cochlear cells, including both outer and inner sensory hair cells, some spiral ganglion neurons (SGNs), and marginal cells, 1 h after the completion of the noise exposure. Also subsequent to noise exposure, immunoreactivity for H3K9me2 appeared in some nuclei of OHCs following a high-to-low frequency gradient with more labeled OHCs in the 45-kHz than the 32-kHz region, as well as in the marginal cells and in some SGNs of the basal turn. These findings suggest that epigenetic modifications of H3K9me2 are involved in NIHL and that pharmacological targeting of G9a may offer a strategy for protection against cochlear synaptopathy and NIHL.

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Impact of Collateral Filling Delay on the Development of Subacute Complications After Acute Ischemic Stroke

Abstract

Purpose

Leptomeningeal collaterals play a pivotal role in acute ischemic stroke. While most collateral scores rely on subjective visual analysis, an objective quantification is possible using dynamic computed tomography (CT) angiography (dynCTA). The aim was to determine the value of collateral filling delay (CFD) as assessed by dynCTA for predicting subacute stroke complications.

Methods

All subjects with isolated prebifurcation middle cerebral artery M1 occlusions were selected from an initial cohort of 2635 patients who underwent multiparametric CT for suspected stroke. The CFD was defined as the difference in time to peak enhancement between M2 segments of both hemispheres. Logistic regression analysis of CFD for space-occupying infarction (≥5 mm shift of brain tissue over the midline), parenchymal hematoma, and hemorrhagic transformation on follow-up imaging was performed.

Results

In this study 78 patients (47 female, median age 74 years) were included. The median CFD was 6.31 s (interquartile range [IQR] 4.00–8.64). The CFD values were correlated with qualitative collateral scores (p < 0.05). Higher CFD was associated with the development of space-occupying infarction in univariable (odds ratio, OR = 1.28; p = 0.002) and multivariable regression analysis (OR = 1.48; p = 0.004). The CFD had no association with parenchymal hematoma or hemorrhagic transformation (p > 0.05).

Conclusion

A high CFD may serve as reproducible measure for collateralization and indicate development of increased risk of space-occupying infarction.

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Impact of Collateral Filling Delay on the Development of Subacute Complications After Acute Ischemic Stroke

Abstract

Purpose

Leptomeningeal collaterals play a pivotal role in acute ischemic stroke. While most collateral scores rely on subjective visual analysis, an objective quantification is possible using dynamic computed tomography (CT) angiography (dynCTA). The aim was to determine the value of collateral filling delay (CFD) as assessed by dynCTA for predicting subacute stroke complications.

Methods

All subjects with isolated prebifurcation middle cerebral artery M1 occlusions were selected from an initial cohort of 2635 patients who underwent multiparametric CT for suspected stroke. The CFD was defined as the difference in time to peak enhancement between M2 segments of both hemispheres. Logistic regression analysis of CFD for space-occupying infarction (≥5 mm shift of brain tissue over the midline), parenchymal hematoma, and hemorrhagic transformation on follow-up imaging was performed.

Results

In this study 78 patients (47 female, median age 74 years) were included. The median CFD was 6.31 s (interquartile range [IQR] 4.00–8.64). The CFD values were correlated with qualitative collateral scores (p < 0.05). Higher CFD was associated with the development of space-occupying infarction in univariable (odds ratio, OR = 1.28; p = 0.002) and multivariable regression analysis (OR = 1.48; p = 0.004). The CFD had no association with parenchymal hematoma or hemorrhagic transformation (p > 0.05).

Conclusion

A high CFD may serve as reproducible measure for collateralization and indicate development of increased risk of space-occupying infarction.

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Patient management algorithm combining processed electroencephalographic monitoring with cerebral and somatic near-infrared spectroscopy: a case series

Abstract

Purpose

Cerebral oximetry is a monitoring tool used in the perioperative care of cardiac surgery patients to ensure adequate cerebral perfusion and oxygenation. When combined with somatic oximetry, the differential diagnosis of cerebral desaturation can be better identified and managed more specifically, as somatic oximetry serves as a global or localized perfusion monitor (depending on its regional position). The use of processed electroencephalography (pEEG) in cardiac surgery could further guide the management of desaturation episodes, as reductions in pEEG activity without a change in the anesthetic agent level indicate potential cerebral ischemia. Continuous integration of multiple monitoring modalities are thus desirable to assess organ perfusion and organ function.

Clinical features

Four clinical cases are presented in which the combination of pEEG and cerebro-somatic oximetry assisted with understanding the mechanism of cerebral desaturation encountered during cardiac surgery.

Conclusion

Integrating combinations of different monitoring modalities such as cerebral and somatic oximetry with pEEG can help the diagnosis and treatment of organ malperfusion and related dysfunction.

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Patient management algorithm combining processed electroencephalographic monitoring with cerebral and somatic near-infrared spectroscopy: a case series

Abstract

Purpose

Cerebral oximetry is a monitoring tool used in the perioperative care of cardiac surgery patients to ensure adequate cerebral perfusion and oxygenation. When combined with somatic oximetry, the differential diagnosis of cerebral desaturation can be better identified and managed more specifically, as somatic oximetry serves as a global or localized perfusion monitor (depending on its regional position). The use of processed electroencephalography (pEEG) in cardiac surgery could further guide the management of desaturation episodes, as reductions in pEEG activity without a change in the anesthetic agent level indicate potential cerebral ischemia. Continuous integration of multiple monitoring modalities are thus desirable to assess organ perfusion and organ function.

Clinical features

Four clinical cases are presented in which the combination of pEEG and cerebro-somatic oximetry assisted with understanding the mechanism of cerebral desaturation encountered during cardiac surgery.

Conclusion

Integrating combinations of different monitoring modalities such as cerebral and somatic oximetry with pEEG can help the diagnosis and treatment of organ malperfusion and related dysfunction.

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Mitteilungen des Berufsverbandes der Deutschen Radiologen

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Akutes Abdomen

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Mitteilungen des Berufsverbandes der Deutschen Radiologen

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Akutes Abdomen

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Validation and Reliability of the French Version of the Sydney Swallow Questionnaire

In conclusion, the SSQ-f is a valid and reliable instrument to measure and detect oropharyngeal dysphagia in French-speaking subjects and can be used in a clinical setting. (Source: Dysphagia)

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Validation and Reliability of the French Version of the Sydney Swallow Questionnaire

In conclusion, the SSQ-f is a valid and reliable instrument to measure and detect oropharyngeal dysphagia in French-speaking subjects and can be used in a clinical setting. (Source: Dysphagia)

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Intraoperative verification of resection margins of maxillary malignancies by cone-beam computed tomography

Publication date: Available online 31 January 2019

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): O. Ivashchenko, B. Pouw, J.K. de Witt, E. Koudounarakis, J. Nijkamp, R.L.P. van Veen, T.J.M. Ruers, B.M. Karakullukcu

Abstract

Resection of maxillary cancer often results in incomplete excision because of the tumour's proximity to important structures such as the orbit. To deal with this problem we prospectively investigated the feasibility of intraoperative imaging during maxillectomy to verify the planned resection margins. In total, six patients diagnosed with maxillary cancer listed for maxillectomy were included, irrespective of the histological type of tumour. Before resection, an accurate intended resection volume was delineated on diagnostic images. At the end of the operation we took a cone-beam computed tomographic (CT) scan of the treated maxilla, after which the accuracy of the resection was quantitatively evaluated by comparing the preoperative resection plan and the images acquired intraoperatively, based on the anatomy. Further resection was then done if necessary and quantitatively evaluated with a second cone-beam CT scan. Postoperatively we compared the results of the scan with those of the histological examination. Of the six, two resections were reported pathologically as less than radical, each of which was detected by intraoperative CT and resulted in extensions of the original resections. The mean (SD) distance between the planned and the actual resection was 1.49 (2.78) mm. This suggests that intraoperative cone-beam CT imaging is a promising way to make an adequate intraoperative assessment of planned surgical margins of maxillary tumours. This allows for intraoperative resection margins to be improved, possibly leading to a better prognosis for the patient.

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Neurosensory issues after lateralisation of the inferior alveolar nerve and simultaneous placement of osseointegrated implants

Publication date: Available online 31 January 2019

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): J.M. Castellano-Navarro, J.J. Castellano-Reyes, M. Hirdina-Castilla, A. Suárez-Soto, S. Bocanegra-Pérez, M. Vicente-Barrero

Abstract

Our aim was to evaluate neurosensory symptoms after lateralisation of the inferior alveolar nerve (IAN). We studied a retrospective case series with one-year follow up that included 139 procedures in 123 patients. After the IAN had been located it was deflected from the mandibular body and the implant placed. Sensitivity was mapped 24 hours, one month, six months, and one year after the intervention by gently pressing the skin and lips with the tip of a probe. A total of 337 implants were placed in 123 patients aged between 44 and 68 years.

There were 33 men and 90 women and they all recovered. The IAN was mobilised by one of two procedures, one that involves the nerve directly (transposition) and one that does not (lateralisation). During lateralisation the nerve is deflected laterally through a mandibular osteotomy, while the mental nerve and mental foramen are not manipulated. The resulting hypoaesthetic area was drawn on a graph to assess its extension. Although different techniques are available for placing implants in atrophic jaws, mobilisation of the IAN is indicated in certain cases in which other techniques are not feasible or have a high risk of complications.

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Intraoperative verification of resection margins of maxillary malignancies by cone-beam computed tomography

Publication date: Available online 31 January 2019

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): O. Ivashchenko, B. Pouw, J.K. de Witt, E. Koudounarakis, J. Nijkamp, R.L.P. van Veen, T.J.M. Ruers, B.M. Karakullukcu

Abstract

Resection of maxillary cancer often results in incomplete excision because of the tumour's proximity to important structures such as the orbit. To deal with this problem we prospectively investigated the feasibility of intraoperative imaging during maxillectomy to verify the planned resection margins. In total, six patients diagnosed with maxillary cancer listed for maxillectomy were included, irrespective of the histological type of tumour. Before resection, an accurate intended resection volume was delineated on diagnostic images. At the end of the operation we took a cone-beam computed tomographic (CT) scan of the treated maxilla, after which the accuracy of the resection was quantitatively evaluated by comparing the preoperative resection plan and the images acquired intraoperatively, based on the anatomy. Further resection was then done if necessary and quantitatively evaluated with a second cone-beam CT scan. Postoperatively we compared the results of the scan with those of the histological examination. Of the six, two resections were reported pathologically as less than radical, each of which was detected by intraoperative CT and resulted in extensions of the original resections. The mean (SD) distance between the planned and the actual resection was 1.49 (2.78) mm. This suggests that intraoperative cone-beam CT imaging is a promising way to make an adequate intraoperative assessment of planned surgical margins of maxillary tumours. This allows for intraoperative resection margins to be improved, possibly leading to a better prognosis for the patient.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2BfeIg9

Neurosensory issues after lateralisation of the inferior alveolar nerve and simultaneous placement of osseointegrated implants

Publication date: Available online 31 January 2019

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): J.M. Castellano-Navarro, J.J. Castellano-Reyes, M. Hirdina-Castilla, A. Suárez-Soto, S. Bocanegra-Pérez, M. Vicente-Barrero

Abstract

Our aim was to evaluate neurosensory symptoms after lateralisation of the inferior alveolar nerve (IAN). We studied a retrospective case series with one-year follow up that included 139 procedures in 123 patients. After the IAN had been located it was deflected from the mandibular body and the implant placed. Sensitivity was mapped 24 hours, one month, six months, and one year after the intervention by gently pressing the skin and lips with the tip of a probe. A total of 337 implants were placed in 123 patients aged between 44 and 68 years.

There were 33 men and 90 women and they all recovered. The IAN was mobilised by one of two procedures, one that involves the nerve directly (transposition) and one that does not (lateralisation). During lateralisation the nerve is deflected laterally through a mandibular osteotomy, while the mental nerve and mental foramen are not manipulated. The resulting hypoaesthetic area was drawn on a graph to assess its extension. Although different techniques are available for placing implants in atrophic jaws, mobilisation of the IAN is indicated in certain cases in which other techniques are not feasible or have a high risk of complications.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2TsvAam

Deep Learning for Segmentation of 49 Selected Bones in CT Scans: First Step in Automated PET/CT-based 3D Quantification of Skeletal Metastases

Publication date: Available online 1 February 2019

Source: European Journal of Radiology

Author(s): Sarah Lindgren Belal, May Sadik, Reza Kaboteh, Olof Enqvist, Johannes Ulén, Mads H. Poulsen, Jane Simonsen, Poul F. Hoilund-Carlsen, Lars Edenbrandt, Elin Trägårdh

Abstract

Purpose

The aim of this study was to develop a deep learning-based method for segmentation of bones in CT scans and test its accuracy compared to manual delineation, as a first step in the creation of an automated PET/CT-based method for quantifying skeletal tumour burden.

Methods

Convolutional neural networks (CNNs) were trained to segment 49 bones using manual segmentations from 100 CT scans. After training, the CNN-based segmentation method was tested on 46 patients with prostate cancer, who had undergone ¹⁸F-choline-PET/CT and ¹⁸F-NaF PET/CT less than three weeks apart. Bone volumes were calculated from the segmentations. The network's performance was compared with manual segmentations of five bones made by an experienced physician. Accuracy of the spatial overlap between automated CNN-based and manual segmentations of these five bones was assessed using the Sørensen-Dice index (SDI). Reproducibility was evaluated applying the Bland-Altman method.

Results

The median (SD) volumes of the five selected bones were by CNN and manual segmentation: Th7 41 (3.8) and 36 (5.1), L3 76 (13) and 75 (9.2), sacrum 284 (40) and 283 (26), 7^th rib 33 (3.9) and 31 (4.8), sternum 80 (11) and 72 (9.2), respectively. Median SDIs were 0.86 (Th7), 0.85 (L3), 0.88 (sacrum), 0.84 (7^th rib) and 0.83 (sternum). The intraobserver volume difference was less with CNN-based than manual approach: Th7 2% and 14%, L3 7% and 8%, sacrum 1% and 3%, 7^th rib 1% and 6%, sternum 3% and 5%, respectively. The average volume difference measured as ratio volume difference/mean volume between the two CNN-based segmentations was 5-6% for the vertebral column and ribs and ≤3% for other bones.

Conclusion

The new deep learning-based method for automated segmentation of bones in CT scans provided highly accurate bone volumes in a fast and automated way and, thus, appears to be a valuable first step in the development of a clinical useful processing procedure providing reliable skeletal segmentation as a key part of quantification of skeletal metastases.

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Hepatic capsular retraction: an updated MR imaging review

Publication date: Available online 31 January 2019

Source: European Journal of Radiology

Author(s): Catherine E.P. Panick, Ryan D. Ward, Christopher Coppa, Peter S. Liu

Abstract

Hepatic capsular retraction is a morphologic descriptor that refers to invagination or focal flattening of the typical smooth contour of the liver capsule. It is an uncommon finding that, when combined with other imaging features and clinical context, can help to refine the differential diagnosis in patients with liver lesions. Although this descriptor has historically been used in reference to a small subset of benign and malignant lesions, the differential has since been expanded with the discovery of new entities causing capsular retraction as well as with novel and increased use of liver-directed treatment techniques. Additionally, modern imaging techniques now allow for improved detection and characterization of capsular retraction. In this review, we discuss these common and uncommon causes of capsular retraction, with an emphasis on findings from body MRI.

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Time-resolved quantitative evaluation of diaphragmatic motion during forced breathing in a health screening cohort in a standing position: Dynamic chest phrenicography

Publication date: Available online 31 January 2019

Source: European Journal of Radiology

Author(s): Tomoyuki Hida, Yoshitake Yamada, Masako Ueyama, Tetsuro Araki, Mizuki Nishino, Atsuko Kurosaki, Masahiro Jinzaki, Hiroshi Honda, Hiroto Hatabu, Shoji Kudoh

Abstract

Objective

To assess diaphragmatic motion during forced breathing in a health screening center cohort by time-resolved quantitative analysis using dynamic chest radiography and demonstrate the characteristics and associations with demographics and pulmonary function of participants.

Materials and methods

This prospective study includes 174 volunteers (99 males; median 57, range 36-93 years old) that underwent dynamic chest radiography with a flat panel detector system during forced breathing in a standing position. We automatically tracked and recorded the positions of the top of the diaphragms and the excursions on images of each participant and calculated peak motion speeds based on the data. We investigated the associations with demographics and pulmonary function statistically.

Results

The average excursions of the diaphragms during forced breathing were 49.1 ± 17.0 mm (right; mean ± standard deviation) and 52.1 ± 15.9 mm (left). The peak motion speeds were 26.7 ± 10.0 mm/s (right) and 32.2 ± 12.4 mm/s (left) in the inspiratory phase and 22.1 ± 12.7 mm/s (right) and 24.3 ± 10.3 mm/s (left) in the expiratory phase. Excursions and peak motion speeds of the left diaphragm were significantly greater than the right. Higher body mass index (BMI) and vital capacity (VC) were associated with greater excursions and faster peak motion speeds of the diaphragms.

Conclusions

Time-resolved quantitative analysis of the diaphragms with dynamic chest radiography demonstrated the characteristics of diaphragmatic motion during forced breathing in a health screening cohort. Higher BMI and VC were associated with excursions and peak motion speeds of the diaphragms.

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Does patellar alignment or trochlear morphology predict worsening of patellofemoral disease within the first 5 years after anterior cruciate ligament reconstruction?

Publication date: Available online 31 January 2019

Source: European Journal of Radiology

Author(s): Erin M Macri, Brooke E Patterson, Kay M Crossley, Josh J Stefanik, Ali Guermazi, Evelina Blomqwist, Karim M Khan, Tim S Whitehead, Hayden G Morris, Adam G Culvenor

Abstract

Purpose

We described patellofemoral alignment and trochlear morphology at one and five years after anterior cruciate ligament reconstruction (ACLR), and evaluated the associations between alignment and trochlear morphology (at one year) and worsening patellofemoral osteoarthritis (OA) features by five years. We also evaluated the associations between alignment and morphology to self-reported pain and function (Knee injury and Osteoarthritis Outcome Score, KOOS) at five years.

Materials and methods

In this longitudinal observational study, we followed 73 participants (mean age 29[9] years, 40% women) from one- to five-years after ACLR. Using MRI, we measured alignment and morphology, and scored cartilage and bone marrow lesions at both time points. We used mixed effects and linear regression models to achieve our stated aims.

Results

Greater lateral patella displacement increased risk of cartilage worsening (Odds Ratio [95% CI]: 1.09 [1.01, 1.16]); while less lateral tilt (0.91 [0.83, 0.99]) and greater trochlear angle (0.88 [0.77, 1.00]) were protective. Greater medial trochlear inclination increased risk of bone marrow lesion worsening (1.12 [1.04, 1.19]); while greater trochlear angle was protective (0.80 [0.67, 0.96]). Greater lateral displacement was associated with worse self-reported KOOS sport and recreation scores (β [95% CI]: -11.0 [-20.9, -1.2]) and quality of life scores (-10.5 [-20.4, -0.7]).

Conclusions

Lateral displacement, lateral tilt, and morphology at 1 year post-ACLR altered the risk of worsening patellofemoral OA features four years later. Lateral displacement was the only measure associated with worse self-reported symptoms at five years. These findings may lead to novel treatment strategies for secondary prevention after ACLR.

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MR features based on LI-RADS identify cytokeratin 19 status of hepatocellular carcinomas

Publication date: Available online 31 January 2019

Source: European Journal of Radiology

Author(s): Xin-Xing Hu, Wen-Tao Wang, Li Yang, Zhao-Xia Yang, He-Yue Liang, Ying Ding, Yuan Ji, Meng-Su Zeng, Sheng-Xiang Rao

Abstract

Objective

To retrospectively evaluate the value of MR features based on Liver Imaging Reporting and Data System (LI-RADS ver.2017) for identifying the status of cytokeratin (CK) 19 expression of HCC before surgery.

Methods

A total of 201 patients with 207 HCCs who underwent MR imaging were reviewed retrospectively. MR features based on LI-RADS ver.2017 as well as clinical data were compared between CK19-positive (n = 51) and CK19-negative (n = 156) HCCs groups. Potential predictive parameters were identified by univariate and multivariate logistic regression analysis and diagnostic odds ratios (ORs) were recorded.

Results

MR features including targetoid appearance (p = 0.001) was more frequently observed while non-peripheral "washout" (p < 0.0001) and non-rim arterial phase hyper-enhancement (p < 0.0001) were found less frequently in CK19-positive HCCs compared to CK19-negative HCCs. At multivariate analysis, serum alphafetoprotein (AFP)>20 ng/ml (OR = 5.9) and targetoid appearance (OR = 4.2) and non-peripheral "washout" (OR = 0.2) were significant independent predictors of CK19-positive HCCs.

Conclusion

Targetoid appearance and absence non-peripheral "washout" combined with elevated AFP were useful for differentiating CK19-positive HCCs from CK19-negative HCC.

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Medical-grade polycaprolactone scaffolds made by melt electrospinning writing for oral bone regeneration – a pilot study in vitro

Abstract

Background

The spectrum of indications for the use of membranes and scaffolds in the field of oral and maxillofacial surgery includes, amongst others, guided bone regeneration (GBR). Currently available membrane systems face certain disadvantages such as difficult clinical handling, inconsistent degradation, undirected cell growth and a lack of stability that often complicate their application. Therefore, new membranes which can overcome these issues are of great interest in this field.

Methods

In this pilot study, we investigated polycaprolactone (PCL) scaffolds intended to enhance oral wound healing by means of melt electrospinning writing (MEW), which allowed for three-dimensional (3D) printing of micron scale fibers and very exact fiber placement. A singular set of box-shaped scaffolds of different sizes consisting of medical-grade PCL was examined and the scaffolds' morphology was evaluated via scanning electron microscopy (SEM). Each prototype sample with box sizes of 225 μm, 300 μm, 375 μm, 450 μm and 500 μm was assessed for cytotoxicity and cell growth by seeding each scaffold with human osteoblast-like cell line MG63.

Results

All scaffolds demonstrated good cytocompatibility according to cell viability, protein concentration, and cell number. SEM analysis revealed an exact fiber placement of the MEW scaffolds and the growth of viable MG63 cells on them. For the examined box-shaped scaffolds with pore sizes between 225 μm and 500 μm, a preferred box size for initial osteoblast attachment could not be found.

Conclusions

These well-defined 3D scaffolds consisting of medical-grade materials optimized for cell attachment and cell growth hold the key to a promising new approach in GBR in oral and maxillofacial surgery.

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Deep Learning for Segmentation of 49 Selected Bones in CT Scans: First Step in Automated PET/CT-based 3D Quantification of Skeletal Metastases

Publication date: Available online 1 February 2019

Source: European Journal of Radiology

Author(s): Sarah Lindgren Belal, May Sadik, Reza Kaboteh, Olof Enqvist, Johannes Ulén, Mads H. Poulsen, Jane Simonsen, Poul F. Hoilund-Carlsen, Lars Edenbrandt, Elin Trägårdh

Abstract

Purpose

The aim of this study was to develop a deep learning-based method for segmentation of bones in CT scans and test its accuracy compared to manual delineation, as a first step in the creation of an automated PET/CT-based method for quantifying skeletal tumour burden.

Methods

Convolutional neural networks (CNNs) were trained to segment 49 bones using manual segmentations from 100 CT scans. After training, the CNN-based segmentation method was tested on 46 patients with prostate cancer, who had undergone ¹⁸F-choline-PET/CT and ¹⁸F-NaF PET/CT less than three weeks apart. Bone volumes were calculated from the segmentations. The network's performance was compared with manual segmentations of five bones made by an experienced physician. Accuracy of the spatial overlap between automated CNN-based and manual segmentations of these five bones was assessed using the Sørensen-Dice index (SDI). Reproducibility was evaluated applying the Bland-Altman method.

Results

The median (SD) volumes of the five selected bones were by CNN and manual segmentation: Th7 41 (3.8) and 36 (5.1), L3 76 (13) and 75 (9.2), sacrum 284 (40) and 283 (26), 7^th rib 33 (3.9) and 31 (4.8), sternum 80 (11) and 72 (9.2), respectively. Median SDIs were 0.86 (Th7), 0.85 (L3), 0.88 (sacrum), 0.84 (7^th rib) and 0.83 (sternum). The intraobserver volume difference was less with CNN-based than manual approach: Th7 2% and 14%, L3 7% and 8%, sacrum 1% and 3%, 7^th rib 1% and 6%, sternum 3% and 5%, respectively. The average volume difference measured as ratio volume difference/mean volume between the two CNN-based segmentations was 5-6% for the vertebral column and ribs and ≤3% for other bones.

Conclusion

The new deep learning-based method for automated segmentation of bones in CT scans provided highly accurate bone volumes in a fast and automated way and, thus, appears to be a valuable first step in the development of a clinical useful processing procedure providing reliable skeletal segmentation as a key part of quantification of skeletal metastases.

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Hepatic capsular retraction: an updated MR imaging review

Publication date: Available online 31 January 2019

Source: European Journal of Radiology

Author(s): Catherine E.P. Panick, Ryan D. Ward, Christopher Coppa, Peter S. Liu

Abstract

Hepatic capsular retraction is a morphologic descriptor that refers to invagination or focal flattening of the typical smooth contour of the liver capsule. It is an uncommon finding that, when combined with other imaging features and clinical context, can help to refine the differential diagnosis in patients with liver lesions. Although this descriptor has historically been used in reference to a small subset of benign and malignant lesions, the differential has since been expanded with the discovery of new entities causing capsular retraction as well as with novel and increased use of liver-directed treatment techniques. Additionally, modern imaging techniques now allow for improved detection and characterization of capsular retraction. In this review, we discuss these common and uncommon causes of capsular retraction, with an emphasis on findings from body MRI.

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Time-resolved quantitative evaluation of diaphragmatic motion during forced breathing in a health screening cohort in a standing position: Dynamic chest phrenicography

Publication date: Available online 31 January 2019

Source: European Journal of Radiology

Author(s): Tomoyuki Hida, Yoshitake Yamada, Masako Ueyama, Tetsuro Araki, Mizuki Nishino, Atsuko Kurosaki, Masahiro Jinzaki, Hiroshi Honda, Hiroto Hatabu, Shoji Kudoh

Abstract

Objective

To assess diaphragmatic motion during forced breathing in a health screening center cohort by time-resolved quantitative analysis using dynamic chest radiography and demonstrate the characteristics and associations with demographics and pulmonary function of participants.

Materials and methods

This prospective study includes 174 volunteers (99 males; median 57, range 36-93 years old) that underwent dynamic chest radiography with a flat panel detector system during forced breathing in a standing position. We automatically tracked and recorded the positions of the top of the diaphragms and the excursions on images of each participant and calculated peak motion speeds based on the data. We investigated the associations with demographics and pulmonary function statistically.

Results

The average excursions of the diaphragms during forced breathing were 49.1 ± 17.0 mm (right; mean ± standard deviation) and 52.1 ± 15.9 mm (left). The peak motion speeds were 26.7 ± 10.0 mm/s (right) and 32.2 ± 12.4 mm/s (left) in the inspiratory phase and 22.1 ± 12.7 mm/s (right) and 24.3 ± 10.3 mm/s (left) in the expiratory phase. Excursions and peak motion speeds of the left diaphragm were significantly greater than the right. Higher body mass index (BMI) and vital capacity (VC) were associated with greater excursions and faster peak motion speeds of the diaphragms.

Conclusions

Time-resolved quantitative analysis of the diaphragms with dynamic chest radiography demonstrated the characteristics of diaphragmatic motion during forced breathing in a health screening cohort. Higher BMI and VC were associated with excursions and peak motion speeds of the diaphragms.

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