MONDAY, Jan. 7, 2019 -- Nearly 11 percent of U.S. adults are estimated to be food-allergic, but 19 percent believe they have a food allergy, according to a study published online Jan. 4 in JAMA Network Open. Ruchi S. Gupta, M.D., M.P.H., from the... (Source: Drugs.com - Pharma News)
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Δευτέρα 7 Ιανουαρίου 2019
About 11 Percent of U.S. Adults Have Food Allergy
About 11 Percent of U.S. Adults Have Food Allergy
MONDAY, Jan. 7, 2019 -- Nearly 11 percent of U.S. adults are estimated to be food-allergic, but 19 percent believe they have a food allergy, according to a study published online Jan. 4 in JAMA Network Open. Ruchi S. Gupta, M.D., M.P.H., from the... (Source: Drugs.com - Pharma News)
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Multidisciplinary Management of Collegiate Sports-Related Concussions
Conclusion Management of the complex sequelae of sports-related concussion for the varsity collegiate athlete necessitates implementation of a multidisciplinary, collaborative approach. Speech-language pathologists' training in the assessment and treatment of brain injury provides the team with an objective perspective in the evaluation and postinjury management of the injured student athlete. While our understanding of concussions has improved greatly over the past two decades, researchers and clinicians on the front lines of care recognize that continued voids exist in our knowledge, with the need to continually explore new methods to identify and manage the complex immediate and potentially long-term ramifications of concussion. [...] Thieme Medical Publishers 333 Seventh Avenue, New ...
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The Role of Speech-Language Pathology in an Interdisciplinary Care Model for Persistent Symptomatology of Mild Traumatic Brain Injury
Semin Speech Lang 2019; 40: 065-078 DOI: 10.1055/s-0038-1676452The Marcus Institute for Brain Health (MIBH) provides interdisciplinary care for adults struggling with persistent effects of mild traumatic brain injury and accompanying changes in behavioral health, with specific emphases on Veterans and retired elite athletes. The cognitive, physical, and behavioral symptoms associated with mild traumatic brain injury are interrelated, with neurobiopsychosocial modeling encompassing the factors related to recovery from a traumatic brain injury. The diffuse impacts of chronic concussive injuries require multiple clinical providers to address the breadth of symptoms, facilitating both interdisciplinary and transdisciplinary care models. By implementing integrated practice units, patients recei...
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Multidisciplinary Management of Collegiate Sports-Related Concussions
Conclusion Management of the complex sequelae of sports-related concussion for the varsity collegiate athlete necessitates implementation of a multidisciplinary, collaborative approach. Speech-language pathologists' training in the assessment and treatment of brain injury provides the team with an objective perspective in the evaluation and postinjury management of the injured student athlete. While our understanding of concussions has improved greatly over the past two decades, researchers and clinicians on the front lines of care recognize that continued voids exist in our knowledge, with the need to continually explore new methods to identify and manage the complex immediate and potentially long-term ramifications of concussion. [...] Thieme Medical Publishers 333 Seventh Avenue, New ...
MedWorm Message: If you are looking to buy something in the January Sales please visit TheJanuarySales.com for a directory of all the best sales in the UK. Any income gained via affiliate links keeps MedWorm running.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Tyzq12
The Role of Speech-Language Pathology in an Interdisciplinary Care Model for Persistent Symptomatology of Mild Traumatic Brain Injury
Semin Speech Lang 2019; 40: 065-078 DOI: 10.1055/s-0038-1676452The Marcus Institute for Brain Health (MIBH) provides interdisciplinary care for adults struggling with persistent effects of mild traumatic brain injury and accompanying changes in behavioral health, with specific emphases on Veterans and retired elite athletes. The cognitive, physical, and behavioral symptoms associated with mild traumatic brain injury are interrelated, with neurobiopsychosocial modeling encompassing the factors related to recovery from a traumatic brain injury. The diffuse impacts of chronic concussive injuries require multiple clinical providers to address the breadth of symptoms, facilitating both interdisciplinary and transdisciplinary care models. By implementing integrated practice units, patients recei...
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Cowboy Aphasia Camp Helps Campers Talk and Student Clinicians Learn
For seven years—soon to be eight—during the heat of the Oklahoma summer, graduate students in the Department of Communication Sciences and Disorders at Oklahoma State University have teamed up with people who have aphasia for a week of activities designed to get everyone talking. Plans for last year's camp started in the usual way, and then, through a twist of good fortune, two speech-language pathologists from Perth, Australia, crossed 13 time zones to join the event. OSU's Cowboy Aphasia Camp will never be the same. (Named for the school's mascot–the OSU Cowboys.) Historically, funds for our camp are raised primarily through an awareness walk, Heels for Words, which takes place each spring. (This year's fundraiser is scheduled for April 27 and camp takes place in ea...
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Cowboy Aphasia Camp Helps Campers Talk and Student Clinicians Learn
For seven years—soon to be eight—during the heat of the Oklahoma summer, graduate students in the Department of Communication Sciences and Disorders at Oklahoma State University have teamed up with people who have aphasia for a week of activities designed to get everyone talking. Plans for last year's camp started in the usual way, and then, through a twist of good fortune, two speech-language pathologists from Perth, Australia, crossed 13 time zones to join the event. OSU's Cowboy Aphasia Camp will never be the same. (Named for the school's mascot–the OSU Cowboys.) Historically, funds for our camp are raised primarily through an awareness walk, Heels for Words, which takes place each spring. (This year's fundraiser is scheduled for April 27 and camp takes place in ea...
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Cowboy Aphasia Camp Helps Campers Talk and Student Clinicians Learn
For seven years—soon to be eight—during the heat of the Oklahoma summer, graduate students in the Department of Communication Sciences and Disorders at Oklahoma State University have teamed up with people who have aphasia for a week of activities designed to get everyone talking. Plans for last year's camp started in the usual way, and then, through a twist of good fortune, two speech-language pathologists from Perth, Australia, crossed 13 time zones to join the event. OSU's Cowboy Aphasia Camp will never be the same. (Named for the school's mascot–the OSU Cowboys.) Historically, funds for our camp are raised primarily through an awareness walk, Heels for Words, which takes place each spring. (This year's fundraiser is scheduled for April 27 and camp takes place in ea...
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Impact of Ga-68-PSMA PET/CT on management in prostate cancer patients with very early biochemical recurrence after radical prostatectomy
Abstract
Purpose
With the availability of ultra-sensitive PSA assays, early biochemical relapse (eBCR) of prostate cancer is increasingly being detected at values much lower than the conventional threshold of 0.2 ng/ml. Accurate localisation of disease in this setting may allow treatment modification and improved outcomes, especially in patients with pelvis-confined or extra-pelvic oligometastasis (defined as up to three pelvic nodal or distant sites). We aimed to measure the detection rate of [68]Ga-PSMA-HBNED-CC (PSMA)-PET/CT and its influence on patient management in eBCR of prostate cancer following radical prostatectomy (RP).
Methods
We retrospectively identified 28 patients who underwent PSMA-PET/CT for post-RP eBCR (PSA < 0.5 ng/ml) at our tertiary care cancer centre. Two nuclear medicine physicians independently recorded the sites of PSMA-PET/CT positivity. Multidisciplinary meeting records were accessed to determine changes in management decisions following PSMA-PET/CT scans.
Results
The mean age of patients was 65.6 years (range: 50–76.2 years); median PSA was 0.22 ng/ml (interquartile range: 0.15 ng/ml to 0.34 ng/ml). Thirteen patients (46.4%) had received radiotherapy in the past. PSMA-PET/CT was positive in 17 patients (60.7%). Only one patient had polymetastasis (> 3 sites); the remainder either had prostatectomy bed recurrence (n = 2), pelvic oligometastasis (n = 10), or extra-pelvic oligometastasis (n = 4). PSMA-PET/CT resulted in management change in 12 patients (42.8%), involving stereotactic body radiotherapy (n = 6), salvage radiotherapy (n = 4), and systemic treatment (n = 2).
Conclusions
Our findings show that PSMA-PET/CT has a high detection rate in the eBCR setting following RP, with a large proportion of patients found to have fewer than three lesions. PSMA-PET/CT may be of value in patients with early PSA failure, and impact on the choice of potentially curative salvage treatments.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2M0N22Q
Cowboy Aphasia Camp Helps Campers Talk and Student Clinicians Learn
For seven years—soon to be eight—during the heat of the Oklahoma summer, graduate students in the Department of Communication Sciences and Disorders at Oklahoma State University have teamed up with people who have aphasia for a week of activities designed to get everyone talking. Plans for last year's camp started in the usual way, and then, through a twist of good fortune, two speech-language pathologists from Perth, Australia, crossed 13 time zones to join the event. OSU's Cowboy Aphasia Camp will never be the same. (Named for the school's mascot–the OSU Cowboys.) Historically, funds for our camp are raised primarily through an awareness walk, Heels for Words, which takes place each spring. (This year's fundraiser is scheduled for April 27 and camp takes place in ea...
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Vw6Zmp
Impact of Ga-68-PSMA PET/CT on management in prostate cancer patients with very early biochemical recurrence after radical prostatectomy
Abstract
Purpose
With the availability of ultra-sensitive PSA assays, early biochemical relapse (eBCR) of prostate cancer is increasingly being detected at values much lower than the conventional threshold of 0.2 ng/ml. Accurate localisation of disease in this setting may allow treatment modification and improved outcomes, especially in patients with pelvis-confined or extra-pelvic oligometastasis (defined as up to three pelvic nodal or distant sites). We aimed to measure the detection rate of [68]Ga-PSMA-HBNED-CC (PSMA)-PET/CT and its influence on patient management in eBCR of prostate cancer following radical prostatectomy (RP).
Methods
We retrospectively identified 28 patients who underwent PSMA-PET/CT for post-RP eBCR (PSA < 0.5 ng/ml) at our tertiary care cancer centre. Two nuclear medicine physicians independently recorded the sites of PSMA-PET/CT positivity. Multidisciplinary meeting records were accessed to determine changes in management decisions following PSMA-PET/CT scans.
Results
The mean age of patients was 65.6 years (range: 50–76.2 years); median PSA was 0.22 ng/ml (interquartile range: 0.15 ng/ml to 0.34 ng/ml). Thirteen patients (46.4%) had received radiotherapy in the past. PSMA-PET/CT was positive in 17 patients (60.7%). Only one patient had polymetastasis (> 3 sites); the remainder either had prostatectomy bed recurrence (n = 2), pelvic oligometastasis (n = 10), or extra-pelvic oligometastasis (n = 4). PSMA-PET/CT resulted in management change in 12 patients (42.8%), involving stereotactic body radiotherapy (n = 6), salvage radiotherapy (n = 4), and systemic treatment (n = 2).
Conclusions
Our findings show that PSMA-PET/CT has a high detection rate in the eBCR setting following RP, with a large proportion of patients found to have fewer than three lesions. PSMA-PET/CT may be of value in patients with early PSA failure, and impact on the choice of potentially curative salvage treatments.
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Surgical Management of Nasal Dermoid Lesions
Nasal dermoids are the most common congenital midline nasal lesions. They often present as a midline pit or nasal mass and arise from incomplete or failed regression of the dural diverticulum during embryogenesis. Management requires complete resection of the tract and an appropriate surgical approach is based on location, extent, and presence/degree of intracranial extension. Classically requiring an open craniotomy for resection, newer strategies employ a minimally disruptive approach to fully excise the lesion and the tract to prevent recurrence. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
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Introduction
Pediatric skull base pathology, though uncommon, is a unique challenge. While not common, for each patient and their family, it is a frightening diagnosis that is often difficult to understand. Even for many surgeons, these are rarely seen. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
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The endoscopic endonasal approach for pediatric craniopharyngiomas
Craniopharyngiomas are rare but challenging tumors of the ventral skull base affecting primarily pediatric patients. In select cases, the endoscopic endonasal approach represents an appropriate surgical option when tumor resection is favored. However, nuances of the pediatric nasal corridor must be carefully considered to optimize both tumor resection and skull base reconstruction. Here we review pertinent developmental details, options for creation of an optimal endonasal corridor, principles of tumor resection, and techniques for reconstruction. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
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Surgical Management of Juvenile Nasopharyngeal Angiofibroma
Juvenile Nasopharyngeal Angiofibromas (JNA) are benign yet aggressive anterior skull base tumors that occur almost exclusively in male adolescents. Diagnosis is typically made through radiographic findings and clinical characteristics; biopsy is not recommended due to the vascular nature of the disease. As with most tumors, there is a spectrum of tumor extent and invasion. In JNAs one of the most important components of extent is the vascular supply. Once the vascular supply is identified, a systematic approach to resection can be planned. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
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Special Considerations for Nasoseptal Flap Use in Children
The introduction of the vascularized pedicled nasoseptal flap has revolutionized endoscopic skull base surgery, providing a highly versatile option to repair even the most complex skull base defects. Though demonstrated with outstanding results in adult patients, there islimited experience in the pediatric population. Early investigation found that there are limitations in utilization of the nasoseptal flap in children due to craniofacial restrictions. More recently, these concerns have been mitigated, and nasoseptal flaps are reliably used in reconstructing even the largest skull base defects in the youngest patients. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
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Open Anterior Skull Base Surgery in the Pediatric Population: Anatomy, Approaches and Considerations
The objectives of this paper are to synthesize the existing literature on open approaches to the anterior skull base in children. First, we review the developmental anatomy of the anterior skull base. Next, we describe the most commonly used open approaches to the ASB and other adjunctive procedures. Lastly, we review the reconstructive options and comment important pediatric-specific considerations. Our review reports the variety of open approaches to access the anterior skull base in children. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2LYstDQ
Pediatric Skull Base Surgery: Encephaloceles and Cerebrospinal Fluid Leaks
In recent years, endoscopic endonasal approaches (EEAs) to the pediatric skull base have become an increasingly popular method for treatment of a variety of malignant and benign lesions. These approaches have largely evolved from experience in adult patients and can be an excellent alternative to open procedures in carefully selected patients. Pediatric encephaloceles can be addressed via open craniotomy, transpalatal, and endoscopic endonasal methods. The surgical approach should be dictated by the anatomy of the patient as well as the size and location of the encephalocele in question. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2sgihxG
Locoregional Flaps in Pediatric Anterior Skull Base Surgery
Management of skull base defects involves the separation of the cranial cavity from the nasal cavity in order to prevent cerebrospinal fluid leak, pneumocephalus, and intracranial infection. The size and location of the defect as well as donor tissue available will determine the type of reconstruction. Reconstruction options include free tissue grafts, locoregional flaps and microvascular free flaps. In children, the size of potential flaps must be considered as well as the length of the pedicle, as often these differ in children. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2LXyYqO
Surgical Management of Nasal Dermoid Lesions
Nasal dermoids are the most common congenital midline nasal lesions. They often present as a midline pit or nasal mass and arise from incomplete or failed regression of the dural diverticulum during embryogenesis. Management requires complete resection of the tract and an appropriate surgical approach is based on location, extent, and presence/degree of intracranial extension. Classically requiring an open craniotomy for resection, newer strategies employ a minimally disruptive approach to fully excise the lesion and the tract to prevent recurrence. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2sdxeAF
Introduction
Pediatric skull base pathology, though uncommon, is a unique challenge. While not common, for each patient and their family, it is a frightening diagnosis that is often difficult to understand. Even for many surgeons, these are rarely seen. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2LVvWmJ
Surgical Management of Juvenile Nasopharyngeal Angiofibroma
Juvenile Nasopharyngeal Angiofibromas (JNA) are benign yet aggressive anterior skull base tumors that occur almost exclusively in male adolescents. Diagnosis is typically made through radiographic findings and clinical characteristics; biopsy is not recommended due to the vascular nature of the disease. As with most tumors, there is a spectrum of tumor extent and invasion. In JNAs one of the most important components of extent is the vascular supply. Once the vascular supply is identified, a systematic approach to resection can be planned. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2LX9ny5
Special Considerations for Nasoseptal Flap Use in Children
The introduction of the vascularized pedicled nasoseptal flap has revolutionized endoscopic skull base surgery, providing a highly versatile option to repair even the most complex skull base defects. Though demonstrated with outstanding results in adult patients, there islimited experience in the pediatric population. Early investigation found that there are limitations in utilization of the nasoseptal flap in children due to craniofacial restrictions. More recently, these concerns have been mitigated, and nasoseptal flaps are reliably used in reconstructing even the largest skull base defects in the youngest patients. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2sf0siv
Open Anterior Skull Base Surgery in the Pediatric Population: Anatomy, Approaches and Considerations
The objectives of this paper are to synthesize the existing literature on open approaches to the anterior skull base in children. First, we review the developmental anatomy of the anterior skull base. Next, we describe the most commonly used open approaches to the ASB and other adjunctive procedures. Lastly, we review the reconstructive options and comment important pediatric-specific considerations. Our review reports the variety of open approaches to access the anterior skull base in children. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2LYstDQ
Pediatric Skull Base Surgery: Encephaloceles and Cerebrospinal Fluid Leaks
In recent years, endoscopic endonasal approaches (EEAs) to the pediatric skull base have become an increasingly popular method for treatment of a variety of malignant and benign lesions. These approaches have largely evolved from experience in adult patients and can be an excellent alternative to open procedures in carefully selected patients. Pediatric encephaloceles can be addressed via open craniotomy, transpalatal, and endoscopic endonasal methods. The surgical approach should be dictated by the anatomy of the patient as well as the size and location of the encephalocele in question. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2sgihxG
Locoregional Flaps in Pediatric Anterior Skull Base Surgery
Management of skull base defects involves the separation of the cranial cavity from the nasal cavity in order to prevent cerebrospinal fluid leak, pneumocephalus, and intracranial infection. The size and location of the defect as well as donor tissue available will determine the type of reconstruction. Reconstruction options include free tissue grafts, locoregional flaps and microvascular free flaps. In children, the size of potential flaps must be considered as well as the length of the pedicle, as often these differ in children. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2LXyYqO
European Perspective on 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: Proceedings of an Interactive International Symposium
Thyroid, Ahead of Print.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2VAXXob
European Perspective on 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: Proceedings of an Interactive International Symposium
Thyroid, Ahead of Print.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2C9KvyH
European Perspective on 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: Proceedings of an Interactive International Symposium
Thyroid, Ahead of Print.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2VAXXob
European Perspective on 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: Proceedings of an Interactive International Symposium
Thyroid, Ahead of Print.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2VAXXob
European Perspective on 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: Proceedings of an Interactive International Symposium
Thyroid, Ahead of Print.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2VAXXob
Obligatory role of endoplasmic reticulum in brain FDG uptake
Abstract
Purpose
The endoplasmic reticulum (ER) contains hexose-6P-dehydrogenase (H6PD). This enzyme competes with glucose-6P-phosphatase for processing a variety of phosphorylated hexoses including 2DG-6P. The present study aimed to verify whether this ER glucose-processing machinery contributes to brain FDG uptake.
Methods
Effect of the H6PD inhibitor metformin on brain 18F-FDG accumulation was studied, in vivo, by microPET imaging. These data were complemented with the in vitro estimation of the lumped constant (LC). Finally, reticular accumulation of the fluorescent 2DG analogue 2-[N-(7-nitrobenz-2-oxa-1,3-diazol-4-yl)amino]-2-deoxyglucose (2NBDG) and its response to metformin was studied by confocal microscopy in cultured neurons and astrocytes.
Results
Metformin halved brain 18F-FDG accumulation without altering whole body tracer clearance. Ex vivo, this same response faced the doubling of both glucose consumption and lactate release. The consequent fall in LC was not explained by any change in expression or activity of its theoretical determinants (GLUTs, hexokinases, glucose-6P-phosphatase), while it agreed with the drug-induced inhibition of H6PD function. In vitro, 2NBDG accumulation selectively involved the ER lumen and correlated with H6PD activity being higher in neurons than in astrocytes, despite a lower glucose consumption.
Conclusions
The activity of the reticular enzyme H6PD profoundly contributes to brain 18F-FDG uptake. These data challenge the current dogma linking 2DG/FDG uptake to the glycolytic rate and introduce a new model to explain the link between 18-FDG uptake and neuronal activity.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2CWpo4q
Obligatory role of endoplasmic reticulum in brain FDG uptake
Abstract
Purpose
The endoplasmic reticulum (ER) contains hexose-6P-dehydrogenase (H6PD). This enzyme competes with glucose-6P-phosphatase for processing a variety of phosphorylated hexoses including 2DG-6P. The present study aimed to verify whether this ER glucose-processing machinery contributes to brain FDG uptake.
Methods
Effect of the H6PD inhibitor metformin on brain 18F-FDG accumulation was studied, in vivo, by microPET imaging. These data were complemented with the in vitro estimation of the lumped constant (LC). Finally, reticular accumulation of the fluorescent 2DG analogue 2-[N-(7-nitrobenz-2-oxa-1,3-diazol-4-yl)amino]-2-deoxyglucose (2NBDG) and its response to metformin was studied by confocal microscopy in cultured neurons and astrocytes.
Results
Metformin halved brain 18F-FDG accumulation without altering whole body tracer clearance. Ex vivo, this same response faced the doubling of both glucose consumption and lactate release. The consequent fall in LC was not explained by any change in expression or activity of its theoretical determinants (GLUTs, hexokinases, glucose-6P-phosphatase), while it agreed with the drug-induced inhibition of H6PD function. In vitro, 2NBDG accumulation selectively involved the ER lumen and correlated with H6PD activity being higher in neurons than in astrocytes, despite a lower glucose consumption.
Conclusions
The activity of the reticular enzyme H6PD profoundly contributes to brain 18F-FDG uptake. These data challenge the current dogma linking 2DG/FDG uptake to the glycolytic rate and introduce a new model to explain the link between 18-FDG uptake and neuronal activity.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2CWpo4q
Food Allergy: Not Just a Kids' Problem
(MedPage Today) -- Affects more than 26 million U.S. adults -- but half of those who think they have allergies are undiagnosed (Source: MedPage Today Allergy)
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Tivic Health ’s OTC sinus pain device wins FDA nod
(Image courtesy of Tivic Health) Tivic Health Systems said that its ClearUP device for allergy-induced sinus pain has received 510(k) clearance from FDA. ClearUP is an over-the-counter device that provides consumers with a simple, non-invasive and drug-free option to relieve sinus pain caused by various environmental allergies such as dust, mold, pollens and pet dander, according to the San Francisco-based company. Get the full story on our sister site, Medical Design & Outsourcing. The post Tivic Health's OTC sinus pain device wins FDA nod appeared first on MassDevice. (Source: Mass Device)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2CbdJxg
Food Allergy: Not Just a Kids' Problem
(MedPage Today) -- Affects more than 26 million U.S. adults -- but half of those who think they have allergies are undiagnosed (Source: MedPage Today Allergy)
MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Re5DOp
Tivic Health ’s OTC sinus pain device wins FDA nod
(Image courtesy of Tivic Health) Tivic Health Systems said that its ClearUP device for allergy-induced sinus pain has received 510(k) clearance from FDA. ClearUP is an over-the-counter device that provides consumers with a simple, non-invasive and drug-free option to relieve sinus pain caused by various environmental allergies such as dust, mold, pollens and pet dander, according to the San Francisco-based company. Get the full story on our sister site, Medical Design & Outsourcing. The post Tivic Health's OTC sinus pain device wins FDA nod appeared first on MassDevice. (Source: Mass Device)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2CbdJxg
Food Allergy: Not Just a Kids' Problem
(MedPage Today) -- Affects more than 26 million U.S. adults -- but half of those who think they have allergies are undiagnosed (Source: MedPage Today Allergy)
MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Re5DOp
Tivic Health ’s OTC sinus pain device wins FDA nod
(Image courtesy of Tivic Health) Tivic Health Systems said that its ClearUP device for allergy-induced sinus pain has received 510(k) clearance from FDA. ClearUP is an over-the-counter device that provides consumers with a simple, non-invasive and drug-free option to relieve sinus pain caused by various environmental allergies such as dust, mold, pollens and pet dander, according to the San Francisco-based company. Get the full story on our sister site, Medical Design & Outsourcing. The post Tivic Health's OTC sinus pain device wins FDA nod appeared first on MassDevice. (Source: Mass Device)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2CbdJxg
Food Allergy: Not Just a Kids' Problem
(MedPage Today) -- Affects more than 26 million U.S. adults -- but half of those who think they have allergies are undiagnosed (Source: MedPage Today Allergy)
MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Re5DOp
Tivic Health ’s OTC sinus pain device wins FDA nod
(Image courtesy of Tivic Health) Tivic Health Systems said that its ClearUP device for allergy-induced sinus pain has received 510(k) clearance from FDA. ClearUP is an over-the-counter device that provides consumers with a simple, non-invasive and drug-free option to relieve sinus pain caused by various environmental allergies such as dust, mold, pollens and pet dander, according to the San Francisco-based company. Get the full story on our sister site, Medical Design & Outsourcing. The post Tivic Health's OTC sinus pain device wins FDA nod appeared first on MassDevice. (Source: Mass Device)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2CbdJxg
Updates in management of acute invasive fungal rhinosinusitis
Purpose of review Acute invasive fungal rhinosinusitis (AIFRS) is a rare and often fatal disease, that remains incompletely understood. Case series and literature reviews constitute most of the literature on AIFRS, and act as the standards by which we treat these extremely complex patients. This review discusses management of AIFRS, with focuses on optimal diagnostic and therapeutic strategies. Recent findings Mortality rates remain high, around 50% overall, though some recent studies have shown higher survival rates with early diagnosis and complete surgical resection. Some recent publications on AIFRS have focused on the utility of frozen section analysis both to diagnose and potentially guide the completeness of endoscopic surgical debridement. It was also recently shown that complete endoscopic resection of disease leads to higher survival than when disease was incompletely resected. Additionally, a new antifungal agent was recently approved by the FDA, which has a more favorable pharmacologic and side effect profile, though more studies are necessary to determine its utility. Summary Early diagnosis requires identification of sinusitis symptoms in immunocompromised patients, followed by intranasal biopsy and frozen section analysis. Early surgical debridement and antifungal therapy then remain the cornerstones of AIFRS management. Video abstract See Video, Supplemental Digital Content 1, http://bit.ly/2BKeblx.from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2sdTr1i
Endotypes of chronic rhinosinusitis
Purpose of review In contrast to the phenotypic classification of chronic rhinosinusitis (CRS), endotyping categorizes disease variants based on their underlying pathophysiologic mechanisms. Defining CRS endotypes may provide information on the risk for disease progression, recurrence and comorbid conditions, as well as identify suitable therapeutic targets. With the emergence of biologics, endotyping may enable personalized pharmacotherapy for recalcitrant CRS. The purpose of this review is to briefly summarize the pathophysiology and endotypes of CRS, and highlight the biologics that target mediators of CRS. Recent findings CRS is due to dysregulated immunologic responses to external stimuli, which induces inflammatory mediators. The linkage between innate lymphoid cells, adaptive CD4+ T helper and CD8 + cytotoxic T cells has led to proposed endotypes that are based around immune response deviation into type 1, type 2 and type 3 responses. Cluster analysis has attempted to define endotypes, accounting for clinical characteristics, molecular and cellular biomarkers, and treatment response. Biologics targeting epithelial-derived cytokines and immunoglobulin E, as well as mediators of type 1, type 2 and type 3 inflammation, are being investigated in CRS. Summary Although there have been significant advances made in the understanding of the pathomechanisms of CRS, there currently remains a lack of full characterization of CRS endotypes.from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2sg77Ji
Endotypes of chronic rhinosinusitis
Purpose of review In contrast to the phenotypic classification of chronic rhinosinusitis (CRS), endotyping categorizes disease variants based on their underlying pathophysiologic mechanisms. Defining CRS endotypes may provide information on the risk for disease progression, recurrence and comorbid conditions, as well as identify suitable therapeutic targets. With the emergence of biologics, endotyping may enable personalized pharmacotherapy for recalcitrant CRS. The purpose of this review is to briefly summarize the pathophysiology and endotypes of CRS, and highlight the biologics that target mediators of CRS. Recent findings CRS is due to dysregulated immunologic responses to external stimuli, which induces inflammatory mediators. The linkage between innate lymphoid cells, adaptive CD4+ T helper and CD8 + cytotoxic T cells has led to proposed endotypes that are based around immune response deviation into type 1, type 2 and type 3 responses. Cluster analysis has attempted to define endotypes, accounting for clinical characteristics, molecular and cellular biomarkers, and treatment response. Biologics targeting epithelial-derived cytokines and immunoglobulin E, as well as mediators of type 1, type 2 and type 3 inflammation, are being investigated in CRS. Summary Although there have been significant advances made in the understanding of the pathomechanisms of CRS, there currently remains a lack of full characterization of CRS endotypes.from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2sg77Ji
Management of sphenoid lateral recess encephalocoeles
Purpose of review Sphenoid sinus lateral recess encephalocoeles (SSLRE) are rare occurrences and pose unique challenges due to limited surgical access for endoscopic endonasal repair and also the lack of consensus on optimal perioperative managements specifically in the spontaneous cases, which are also believed to be a variant of idiopathic intracranial hypertension (IIH). Endoscopic endonasal approaches have largely replaced the transcranial route and the techniques are continuously being refined to reduce the neurovascular morbidity and improve outcome. Recent findings Transpetrygoid is the most utilized approach with modifications suggested to limit bone removal, exposure and preservation of the neurovascular structures as dictated by the extent of the lateral recess. As more experience is gained, extended transphenoidal techniques were also successfully used for access. Lateral transorbital is a new approach to the lateral recess investigated in cadavers. IIH treatment is still controversial in the setting of SSLRE, but it appears rationale to evaluate, monitor and treat if necessary. Summary SSLRE management should be tailored to the specific anatomical variances and cause. Modifications of techniques have been described giving different options to access the lateral recess. Successful repair for spontaneous SSLRE may require treatment of IIH if present, but the long-term outcome is still unclear.from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2M1aKvO
Indications and endonasal treatment of petrous apex cholesterol granulomas
Purpose of review Lesions of the petrous apex of the temporal bone can be challenging to access and approaches laterally through the mastoid as well as medially through an endonasal approach are utilized to access this region while preserving function of adjacent structures. Cholesterol granulomas of the petrous apex requiring surgery are marsupialized to prevent expansion of the inflamed cyst and relieve associated clinical symptoms. The endonasal approach to the petrous apex has in the past been limited to lesions medial to the internal carotid artery. Recent findings Endoscopic approaches have been developed to expand the range of petrous apex lesions that are accessible endonasally. These endonasal corridors include a nasopharyngeal/transclival corridor, lateralization of the internal carotid artery to create an expanded medial window, a pterygopalatine infrapetrosal approach, and a contralateral maxillary approach, which allow improved access to the inferior and lateral petrous apex. Nasoseptal flaps may reduce the risk of postoperative stenosis of the drainage tract. Summary Endoscopic endonasal approaches can be used safely to address both medial and lateral/inferior petrous apex lesions. Morbidity of these procedures is low and use of a nasoseptal flap may limit restenosis of the drainage pathway.from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2LUZroI
Phakomatous Choristoma of the Orbit With Involvement of the Inferior Oblique Muscle
The authors report a case of phakomatous choristoma presenting as an orbital tumor with involvement of the inferior oblique muscle. This is the only known case of this rare tumor directly invading and incorporating the inferior oblique. This tumor should be included in the differential of eyelid tumors and orbital tumors in infants. Finally, the authors review the histopathological and embryological characteristics of this lenticular tumor.from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RhRKPx
Aesthetic Abstracts
Orbital Expansion in Cranial Vault After Minimally Invasive Extradural Transorbital Decompression for Thyroid Orbitopathy
Purpose: To test the hypothesis that the orbit expands in the cranial vault after wide dural exposure after minimally invasive extradural transorbital decompression for thyroid eye disease. Methods: A cross-sectional cohort study of 36 patients (60 orbits). Preoperative and postoperative (6 months) orbital CT following extradural transorbital decompression was analyzed. Primary outcome measure was the percentage area of the cranial vault occupied by orbital and brain tissue in a predefined window before and after surgery. Secondary outcome measures were displacement of the anteriormost aspect of the temporal lobe, reduction in clinical proptosis, change in clinical activity score, and change in diplopia. Results: The mean percentage of the selected area of the cranial vault preoperatively was 0% orbital and 44% ± 15% brain tissue, compared with 70% ± 16% orbital and 28% ± 14% brain tissue postoperatively (pfrom #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2C3JZ5c
Massive Orbital Extension of a Congenital Dacryocystocele in a 9 Month Old
No abstract availablefrom #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2ReKLH8
Triamcinolone for the Treatment of Graves Ophthalmopathy Tested With Short Tau Inversion Recovery Magnetic Resonance
Purpose: To evaluate if parabulbar triamcinolone reduces orbital swelling in patients with Graves ophthalmopathy. Methods: This is a prospective study of a series of patients with active and moderate Graves ophthalmopathy. Short tau inversion recovery magnetic resonance was used to evaluate the intensity of the extraocular rectus muscles and orbital fat, before and after the treatment with parabulbar triamcinolone. Results: The signal intensity ratio of the sum of the OD rectus muscles was 3.67 before treatment (95% CI, 3.26–4.09) and 2.83 after treatment (95% CI, 2.63–3.03) (pfrom #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2C5PLU4
Preseptal Upper Eyelid Lipoma
Superficial subcutaneous lipomas are benign, slow-growing neoplasms comprised mature adipose cells that may be surrounded by a fibrous tissue capsule. While found commonly on the body, simple lipomas are rarely described in the eyelids. Reports of two eyelid lipomas in the literature describe the anatomy to be posterior to the orbital septum. The presenting authors report the case of a simple lipoma of the eyelid found fully in the preseptal plane. Lipomas can occur anterior to the orbital septum and should be considered in the differential when presented with a painless, slow-growing eyelid mass in adults.from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Rd97B5
Anatomic Variations of the Infraorbital Foramen in Caucasian Versus African American Skulls
Purpose: The infraorbital foramen (IOF) represents a highly conserved structure but demonstrates morphologic variability. The purpose of this study is to describe the IOF location, size, and supernumerary foramina in an African American population and compare it with a Caucasian population. Methods: Sixty African American and 60 Caucasian skulls from the Hamann-Todd collection of the Cleveland Museum of Natural History were studied. The primary outcome was the number of accessory IOF and measurements of the location, size, shape, and direction of each foramen. Pearson chi-square, t tests, Fisher exact test, and Wilcoxon rank sum tests were used to analyze the data. Results: The African American population had a smaller vertical IOF diameter (mean = 2.81 mm) compared with the Caucasian population (mean = 3.08 mm) on the right side (pfrom #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2C9AMsb
Diversity in the American Society of Ophthalmic Plastic and Reconstructive Surgery
Purpose: To assess the epidemiology of women and underrepresented minorities (URMs; Hispanic, African American, and Native American) in the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS). Methods: An observational retrospective study of living ASOPRS members was identified through the ASOPRS member directory, search engine-driven informatics, and direct communication. Members were profiled for gender, race, geographic location, and academic rank (or not). The percentage of women and URMs in the society over time was also assessed. Results: The authors identified 617 living ASOPRS members as of June 2017. Of these, 109 (17.7%) were female and 58 (9.4%) were URMs. Surgeons completed fellowships from 1961 (male) or 1973 (female) until 2015. Women members significantly increased from 7 (4.9% of the total) before 1986 to 24 (30.4%) between 2011 and 2015 (last 5 years). URMs significantly increased over time, with 0 female and 5 (3.4%) male minorities before 1985 to 5 (6.3%) females and 13 (16.5%) males within the last 5 years (pfrom #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2C5lyEn
Role of Retrobulbar Hyaluronidase in Filler-Associated Blindness: Evaluation of Fundus Perfusion and Electroretinogram Readings in an Animal Model
Purpose: Hyaluronic acid gel filler-associated blindness is an uncommon but devastating complication. Hyaluronidase can potentially dissolve intravascular filler and improve perfusion; however, its role in filler-associated blindness has yet to be determined. The purpose of this study is to determine the effect of retrobulbar hyaluronidase on hyaluronic acid gel-induced ophthalmic artery occlusion in a rabbit model. Methods: New Zealand red rabbits were used to simulate hyaluronic acid gel filler-associated vascular occlusive blindness. Ophthalmic artery occlusion and subsequent ischemia were confirmed by both retinal fundus photography and electroretinogram changes. Retrobulbar hyaluronidase 1,000 IU was injected 30 minutes after occlusion. Fundus photography and electroretinogram changes were recorded at 30, 60, 90, and 120 after administration of retrobulbar hyaluronidase. Results: A total of 6 rabbits were used, for a total of 12 eyes. Four eyes were used as controls. Of the 8 experimental eyes, 2 eyes had recorded partial occlusion and 6 eyes had fully occluded ophthalmic arteries by angiographic evaluation. One of the partially occluded eyes demonstrated some improvement in perfusion 60 minutes after injection of retrobulbar hyaluronidase; however, electroretinogram readings remained flat over the 120-minute period of observation. Six eyes with completely occluded ophthalmic arteries showed no improvement in retinal perfusion with corresponding flat electroretinogram readings at 120 minutes following retrobulbar hyaluronidase injection. Conclusions: In this rabbit model, 1,000 IU of retrobulbar hyaluronidase administered 30 minutes after occlusion failed to reverse obstruction or restore function following hyaluronic acid gel occlusion of the ophthalmic artery.from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2C9HNsQ
Change in Eyelid Carcinoma T Category With Use of the 8th Versus 7th Edition of the American Joint Committee on Cancer: Cancer Staging Manual
Purpose: To evaluate the frequency and nature of changes in T category when eyelid carcinomas are staged using the criteria in the 8th edition instead of the 7th edition of the American Joint Committee on Cancer staging manual. Methods: Following Institutional Review Board approval, a retrospective review was conducted for all consecutive patients with the diagnosis of eyelid carcinoma treated by the senior author from January 2012 through December 2016. After a review of the clinical and pathologic data, each patient's disease was staged using both the 7th-edition and 8th-edition American Joint Committee on Cancer criteria for eyelid carcinomas. Changes in T categories between the 2 staging systems were examined. Results: The review initially identified 167 patients with the diagnosis of eyelid carcinoma. Four patients were excluded because of incomplete or unclear data. The remaining 163 patients included 78 men and 85 women aged 21 to 97 years (median, 68 years). Eighty-two patients had basal cell carcinoma; 35, squamous cell carcinoma; 32, sebaceous carcinoma; 6, mucinous eccrine carcinoma; 3, Merkel cell carcinoma; 3, adenocarcinomas; and 2, adnexal carcinoma. The most common T category according to the 7th-edition criteria was T2a; the most common T category according to the 8th-edition criteria was T1b. Of the 163 patients, 64 (39%) had a lower T category with the 8th-edition than with the 7th-edition criteria, 59 (36%) had a higher T category, and 40 (25%) had the same T category. Conclusions: Application of the 8th-edition American Joint Committee on Cancer criteria for eyelid carcinoma changed the T category in 75% of patients. In general, the new 8th-edition American Joint Committee on Cancer tumor, node, metastasis (TNM) designations allow for a more objective and consistent designation of the T category.from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2C6u7Pj
Systemic Diffuse Large B-Cell Lymphoma Presenting as Bilateral Orbital Vasculopathy
The authors report a case of a 58-year-old man with bilateral proptosis and signs of orbital inflammation without any associated systemic findings. MRI showed diffuse orbital infiltration. An intraconal orbital biopsy revealed polyclonal lymphoplasmacytic infiltration and non-necrotizing lymphoid small-vessel vasculopathy. The orbital symptoms resolved following a 2-week course of oral prednisone. Three months later, the patient experienced abdominal pain and weight loss. Ultrasonographic investigation showed hepatosplenomegaly, a retroperitoneal mass, and inguinal lymphadenopathy. A lymph node biopsy revealed a diffuse large B-cell lymphoma. The patient underwent chemotherapy but died 6 months later with metastatic disease. This case suggests that diffuse orbital inflammation with nonspecific vasculitis may be an early paraneoplastic finding associated with diffuse large B-cell lymphoma.from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RhIMla
Cultures of Proximal and Distal Segments of Silicone Tubes After Dacryocystorhinostomy
Purpose: To compare the results of cultures of the proximal and distal segments of silicone tubes after dacryocystorhinostomy. Methods: The medical records of patients undergoing a dacryocystorhinostomy and silicone intubation were reviewed. The inclusion criteria were cultures of both distal and proximal stent segments after removal, dye testing, evaluation of the tear meniscus, and notation of the presence or absence of discharge before and after removal. The exclusion criteria included the use of systemic or topical antibiotics within 1 month before tube removal. Results: Forty-six lacrimal systems in 40 patients were included, with 6 patients having bilateral dacryocystorhinostomies. There were no cases of dacryocystitis at the time of or after tube removal. Four (9%) of the dacryocystorhinostomies failed. Forty-one (89%) of the distal tube segments had positive cultures. The distal tube cultures grew 17 (36%) gram-positive bacteria, 21 (45%) gram-negative bacteria, 7 (15%) skin flora, and 2 (4%) fungi (6 distal segments had mixed cultures). Thirteen (28%) of the proximal tube segments had positive cultures. The proximal tube cultures were 5 (38%) gram-negative bacteria, 4 (31%) gram-positive bacteria, 3 (23%) skin flora, and 1 (8%) acid-fast bacteria. Four (31%) of the proximal tubes with positive cultures grew the same organism as the distal tube segment. Nine (69%) of the proximal tubes with positive cultures grew different organisms than the distal segment. Forty-two (91%) of all the proximal tube cultures were either negative or grew different organisms than the distal segment cultures. Conclusions: The proximal segment of a silicone tube after a dacryocystorhinostomy may be a "privileged" area. There is usually a lack of growth or the growth of different organisms than those present on the distal tube segments. This may be explained by the protective nature of the tear film. The findings may also help to explain the low incidence of dacryocystitis in spite of the growth of virulent organisms on the distal tube segment after a dacryocystorhinostomy.from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2C4BiHS
Nasolacrimal Duct Obstruction Following Hyaluronic Acid Rejuvenation of the Tear Trough
Although generally safe, hyaluronic acid rejuvenation of periorbital tissue has been reported to cause minor and major adverse events. The authors document a case of nasolacrimal duct obstruction due to hyaluronic acid rejuvenation of the tear trough. Nasolacrimal duct obstruction immediately resolved following irrigation of hyaluronidase into the affected lacrimal system. To the authors' knowledge, this is the first reported case of nasolacrimal duct obstruction due to filler injection.from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Rc45Va
Nasolacrimal Sac Diverticulum: A Case Series and Literature Review
Purpose: To describe the demographics, presentation, treatment, and outcome in 10 cases of lacrimal sac diverticulum and to review the literature on this topic, and to determine the incidence of diverticula from a series of dacryocystograms. Methods: Data were collected for all consecutive patients with lacrimal sac diverticulum seen between 2003 and 2015, including patient demographics, clinical presentation, imaging findings, treatment, and follow-up. A systematic literature review was performed for cases of lacrimal sac diverticulum. A retrospective review of 400 consecutive dacryocystograms was performed to determine the incidence of lacrimal sac diverticulum. Results: Ten cases (9 patients) of lacrimal sac diverticulum are described, and a further 36 cases were discovered through a literature review. Epiphora, swelling, and dacryocystitis and/or diverticulitis were the most common presenting complaints. When all 46 cases are combined, lacrimal patency was demonstrated in 50% of cases. Dacryocystography diagnosed only 57% of patients with diverticulum, not helped by the addition of ultrasound or CT. The incidence of diverticulum was 3.2% on review of 400 consecutive dacryocystograms (1.6% per lacrimal system). Surgical management with dacryocystorhinostomy and/or diverticulum excision was effective in all 34 operated cases at resolving symptoms in the case series and literature review. Conclusions: Lacrimal sac diverticula present with epiphora, medial canthal swelling, dacryocystitis, and/or diverticulitis. Dacryocystography, despite being the most sensitive radiologic test, is only 59% sensitive, and adjunctive CT and ultrasound have limited use. Surgical management is recommended because conservative management often fails. Dacryocystorhinostomy, diverticulum excision, or a combination thereof appears to be equivalent in achieving resolution of symptoms.from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2C6w8er
Necrotic Herpes Simplex Virus Infection of the Nose and Orbit
This is the first reported case of necrotizing nasal and sinus herpes infection with orbital involvement. A 94-year-old male with a past medical history of hypertension, congestive heart failure, and chronic kidney disease presented with necrotic nasal cellulitis and a red left eye with blurry vision. Onset was 2 weeks prior with an upper lip fever blister. He was admitted to medicine and started on antimicrobials. Maxillofacial computed tomography scan revealed pansinusitis with involvement of bilateral medial orbital walls. Initial nasal biopsy was negative. Repeat biopsy was positive for herpes simplex virus 1. His nose was debrided with full-thickness skin grafting. While there are reports of necrotizing herpes simplex, none were to the extent of our patient nor raised suspicion for invasive fungal sinusitis. Differentiating is important as this patient made a full recovery in comparison to patients with mucormycosis where mortality is often as high as 80%.from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RbvZRn
Extraocular Muscle Enlargement and Thyroid Eye Disease-like Orbital Inflammation Associated with Immune Checkpoint Inhibitor Therapy in Cancer Patients
Purpose: To describe thyroid eye disease (TED)-like orbital inflammatory syndrome in 3 cancer patients treated with immune checkpoint inhibitors. Methods: All consecutive patients treated by the senior author who were receiving immune checkpoint inhibitors and developed TED-like orbital inflammation were included. Results: Three cancer patients treated with immune checkpoint inhibitors developed orbital inflammation. The first patient was treated with a combination of a cytotoxic T-lymphocyte antigen-4 inhibitor and a programmed cell death protein 1 inhibitor and developed TED-like orbital inflammation with normal thyroid function and antibody levels. The second patient had a previous diagnosis of Graves disease without TED, and developed TED soon after initiating treatment with a programmed cell death protein 1 inhibitor. The third patient developed acute hyperthyroidism with symptomatic TED following treatment with an investigational cytotoxic T-lymphocyte antigen-4 inhibitor agent. All 3 patients were managed with either systemic steroids or observation, with resolution of their symptoms and without the need to halt immune checkpoint inhibitor treatment for their cancer. Discussion and Conclusions: TED-like orbital inflammation may occur as a side effect of immune checkpoint inhibitor therapy with anti–cytotoxic T-lymphocyte antigen-4 or anti-PD-1 inhibitors. To the best of their knowledge, this is the first reported case of TED as a result of programmed cell death protein 1 inhibitor monotherapy. All 3 patients were treated with systemic steroids and responded quickly while continuing treatment with immune checkpoint inhibitors for their cancer. With increasing use of this class of drugs, clinicians should be familiar with the clinical manifestations and treatments for this adverse reaction.from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2C7xntX
Ophthalmic Eosinophilic Granulomatosis With Polyangiitis (Churg–Strauss Syndrome): A Systematic Review of the Literature
Purpose: To review and summarize the clinical features, presentations, diagnostic modalities, and management of ophthalmic manifestations of eosinophilic granulomatosis with polyangiitis (EGPA, formerly Churg–Strauss Syndrome). Methods: A systematic PubMed search of all English articles on EGPA with ophthalmic involvement was performed. Emphasis was placed on English-language articles, but any article with an abstract translated into English was also included. Only those cases that satisfied the American Rheumatology criteria (1990) for diagnosis were included. Data examined included epidemiology, pathogenesis, presentations, diagnostic modalities, and management. Results: There was a wide range in ophthalmic manifestations of EGPA. In order of most frequent presentation to least frequent, these include central retinal artery or vein occlusion, ischemic optic neuropathy, conjunctival nodules, orbital myositis, proptosis, dacryoadenitis, retinal vasculitis/infarcts/edema, cranial nerve palsy, and amaurosis. The 46 qualifying cases were divided into the categories of ischemic vasculitis versus idiopathic orbital inflammation due to prognostic significance. Ischemic vasculitis cases tended to be older patients (p = 0.03), unilateral (p = 0.006), require immunosuppressive therapy beyond steroids (p = 0.015), and were less likely to show improvement on therapy (p = 0.0003). Conclusions: Prompt diagnosis of EGPA by the ophthalmologist can decrease patient morbidity and mortality. This requires knowledge of likely ophthalmic EGPA presentations, as well as recommended workups and treatment.from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2CbaLsC
Aesthetic Abstracts
Orbital Expansion in Cranial Vault After Minimally Invasive Extradural Transorbital Decompression for Thyroid Orbitopathy
Purpose: To test the hypothesis that the orbit expands in the cranial vault after wide dural exposure after minimally invasive extradural transorbital decompression for thyroid eye disease. Methods: A cross-sectional cohort study of 36 patients (60 orbits). Preoperative and postoperative (6 months) orbital CT following extradural transorbital decompression was analyzed. Primary outcome measure was the percentage area of the cranial vault occupied by orbital and brain tissue in a predefined window before and after surgery. Secondary outcome measures were displacement of the anteriormost aspect of the temporal lobe, reduction in clinical proptosis, change in clinical activity score, and change in diplopia. Results: The mean percentage of the selected area of the cranial vault preoperatively was 0% orbital and 44% ± 15% brain tissue, compared with 70% ± 16% orbital and 28% ± 14% brain tissue postoperatively (pfrom #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2C3JZ5c
Massive Orbital Extension of a Congenital Dacryocystocele in a 9 Month Old
No abstract availablefrom #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2ReKLH8
Triamcinolone for the Treatment of Graves Ophthalmopathy Tested With Short Tau Inversion Recovery Magnetic Resonance
Purpose: To evaluate if parabulbar triamcinolone reduces orbital swelling in patients with Graves ophthalmopathy. Methods: This is a prospective study of a series of patients with active and moderate Graves ophthalmopathy. Short tau inversion recovery magnetic resonance was used to evaluate the intensity of the extraocular rectus muscles and orbital fat, before and after the treatment with parabulbar triamcinolone. Results: The signal intensity ratio of the sum of the OD rectus muscles was 3.67 before treatment (95% CI, 3.26–4.09) and 2.83 after treatment (95% CI, 2.63–3.03) (pfrom #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2C5PLU4
Anatomic Variations of the Infraorbital Foramen in Caucasian Versus African American Skulls
Purpose: The infraorbital foramen (IOF) represents a highly conserved structure but demonstrates morphologic variability. The purpose of this study is to describe the IOF location, size, and supernumerary foramina in an African American population and compare it with a Caucasian population. Methods: Sixty African American and 60 Caucasian skulls from the Hamann-Todd collection of the Cleveland Museum of Natural History were studied. The primary outcome was the number of accessory IOF and measurements of the location, size, shape, and direction of each foramen. Pearson chi-square, t tests, Fisher exact test, and Wilcoxon rank sum tests were used to analyze the data. Results: The African American population had a smaller vertical IOF diameter (mean = 2.81 mm) compared with the Caucasian population (mean = 3.08 mm) on the right side (pfrom #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2C9AMsb
Complete Excision of a Simple Dacryops Using Fibrin Sealant and Trypan Blue Mixture
A 69-year-old woman presented to the oculofacial plastic service with a painless superotemporal subconjunctival mass in the OS. Over the past year, the lesion had been progressively enlarging, resulting in horizontal diplopia with lateral gaze. Visual acuity was within normal limits with no evidence of optic neuropathy. On examination, the lesion was tense, transilluminated, and was clinically consistent with a simple dacryops. Complete excision of the lesion was planned under local anesthesia with monitored care. To facilitate complete removal of the lesion, fibrinogen and a mixture of thrombin and trypan blue were injected to fill the cyst cavity. This blue-stained fibrin clot allowed for easy visualization of the border and ensured complete excision without collateral damage to surrounding normal tissue. Simple dacryops is often difficult to remove completely with its capsule intact and this technique allows for clear delineation of the cyst and preservation of epithelial integrity for complete and efficient removal.from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RekecJ
Systemic Diffuse Large B-Cell Lymphoma Presenting as Bilateral Orbital Vasculopathy
The authors report a case of a 58-year-old man with bilateral proptosis and signs of orbital inflammation without any associated systemic findings. MRI showed diffuse orbital infiltration. An intraconal orbital biopsy revealed polyclonal lymphoplasmacytic infiltration and non-necrotizing lymphoid small-vessel vasculopathy. The orbital symptoms resolved following a 2-week course of oral prednisone. Three months later, the patient experienced abdominal pain and weight loss. Ultrasonographic investigation showed hepatosplenomegaly, a retroperitoneal mass, and inguinal lymphadenopathy. A lymph node biopsy revealed a diffuse large B-cell lymphoma. The patient underwent chemotherapy but died 6 months later with metastatic disease. This case suggests that diffuse orbital inflammation with nonspecific vasculitis may be an early paraneoplastic finding associated with diffuse large B-cell lymphoma.from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RhIMla
Diversity in the American Society of Ophthalmic Plastic and Reconstructive Surgery
Purpose: To assess the epidemiology of women and underrepresented minorities (URMs; Hispanic, African American, and Native American) in the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS). Methods: An observational retrospective study of living ASOPRS members was identified through the ASOPRS member directory, search engine-driven informatics, and direct communication. Members were profiled for gender, race, geographic location, and academic rank (or not). The percentage of women and URMs in the society over time was also assessed. Results: The authors identified 617 living ASOPRS members as of June 2017. Of these, 109 (17.7%) were female and 58 (9.4%) were URMs. Surgeons completed fellowships from 1961 (male) or 1973 (female) until 2015. Women members significantly increased from 7 (4.9% of the total) before 1986 to 24 (30.4%) between 2011 and 2015 (last 5 years). URMs significantly increased over time, with 0 female and 5 (3.4%) male minorities before 1985 to 5 (6.3%) females and 13 (16.5%) males within the last 5 years (pfrom #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2C5lyEn
Role of Retrobulbar Hyaluronidase in Filler-Associated Blindness: Evaluation of Fundus Perfusion and Electroretinogram Readings in an Animal Model
Purpose: Hyaluronic acid gel filler-associated blindness is an uncommon but devastating complication. Hyaluronidase can potentially dissolve intravascular filler and improve perfusion; however, its role in filler-associated blindness has yet to be determined. The purpose of this study is to determine the effect of retrobulbar hyaluronidase on hyaluronic acid gel-induced ophthalmic artery occlusion in a rabbit model. Methods: New Zealand red rabbits were used to simulate hyaluronic acid gel filler-associated vascular occlusive blindness. Ophthalmic artery occlusion and subsequent ischemia were confirmed by both retinal fundus photography and electroretinogram changes. Retrobulbar hyaluronidase 1,000 IU was injected 30 minutes after occlusion. Fundus photography and electroretinogram changes were recorded at 30, 60, 90, and 120 after administration of retrobulbar hyaluronidase. Results: A total of 6 rabbits were used, for a total of 12 eyes. Four eyes were used as controls. Of the 8 experimental eyes, 2 eyes had recorded partial occlusion and 6 eyes had fully occluded ophthalmic arteries by angiographic evaluation. One of the partially occluded eyes demonstrated some improvement in perfusion 60 minutes after injection of retrobulbar hyaluronidase; however, electroretinogram readings remained flat over the 120-minute period of observation. Six eyes with completely occluded ophthalmic arteries showed no improvement in retinal perfusion with corresponding flat electroretinogram readings at 120 minutes following retrobulbar hyaluronidase injection. Conclusions: In this rabbit model, 1,000 IU of retrobulbar hyaluronidase administered 30 minutes after occlusion failed to reverse obstruction or restore function following hyaluronic acid gel occlusion of the ophthalmic artery.from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2C9HNsQ
Re: “Orbicularis Retaining Ligament Release in Lower Blepharoplasty: Assessing Efficacy and Complications”
No abstract availablefrom #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Re3guZ
Erratum
Change in Eyelid Carcinoma T Category With Use of the 8th Versus 7th Edition of the American Joint Committee on Cancer: Cancer Staging Manual
Purpose: To evaluate the frequency and nature of changes in T category when eyelid carcinomas are staged using the criteria in the 8th edition instead of the 7th edition of the American Joint Committee on Cancer staging manual. Methods: Following Institutional Review Board approval, a retrospective review was conducted for all consecutive patients with the diagnosis of eyelid carcinoma treated by the senior author from January 2012 through December 2016. After a review of the clinical and pathologic data, each patient's disease was staged using both the 7th-edition and 8th-edition American Joint Committee on Cancer criteria for eyelid carcinomas. Changes in T categories between the 2 staging systems were examined. Results: The review initially identified 167 patients with the diagnosis of eyelid carcinoma. Four patients were excluded because of incomplete or unclear data. The remaining 163 patients included 78 men and 85 women aged 21 to 97 years (median, 68 years). Eighty-two patients had basal cell carcinoma; 35, squamous cell carcinoma; 32, sebaceous carcinoma; 6, mucinous eccrine carcinoma; 3, Merkel cell carcinoma; 3, adenocarcinomas; and 2, adnexal carcinoma. The most common T category according to the 7th-edition criteria was T2a; the most common T category according to the 8th-edition criteria was T1b. Of the 163 patients, 64 (39%) had a lower T category with the 8th-edition than with the 7th-edition criteria, 59 (36%) had a higher T category, and 40 (25%) had the same T category. Conclusions: Application of the 8th-edition American Joint Committee on Cancer criteria for eyelid carcinoma changed the T category in 75% of patients. In general, the new 8th-edition American Joint Committee on Cancer tumor, node, metastasis (TNM) designations allow for a more objective and consistent designation of the T category.from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2C6u7Pj
Cultures of Proximal and Distal Segments of Silicone Tubes After Dacryocystorhinostomy
Purpose: To compare the results of cultures of the proximal and distal segments of silicone tubes after dacryocystorhinostomy. Methods: The medical records of patients undergoing a dacryocystorhinostomy and silicone intubation were reviewed. The inclusion criteria were cultures of both distal and proximal stent segments after removal, dye testing, evaluation of the tear meniscus, and notation of the presence or absence of discharge before and after removal. The exclusion criteria included the use of systemic or topical antibiotics within 1 month before tube removal. Results: Forty-six lacrimal systems in 40 patients were included, with 6 patients having bilateral dacryocystorhinostomies. There were no cases of dacryocystitis at the time of or after tube removal. Four (9%) of the dacryocystorhinostomies failed. Forty-one (89%) of the distal tube segments had positive cultures. The distal tube cultures grew 17 (36%) gram-positive bacteria, 21 (45%) gram-negative bacteria, 7 (15%) skin flora, and 2 (4%) fungi (6 distal segments had mixed cultures). Thirteen (28%) of the proximal tube segments had positive cultures. The proximal tube cultures were 5 (38%) gram-negative bacteria, 4 (31%) gram-positive bacteria, 3 (23%) skin flora, and 1 (8%) acid-fast bacteria. Four (31%) of the proximal tubes with positive cultures grew the same organism as the distal tube segment. Nine (69%) of the proximal tubes with positive cultures grew different organisms than the distal segment. Forty-two (91%) of all the proximal tube cultures were either negative or grew different organisms than the distal segment cultures. Conclusions: The proximal segment of a silicone tube after a dacryocystorhinostomy may be a "privileged" area. There is usually a lack of growth or the growth of different organisms than those present on the distal tube segments. This may be explained by the protective nature of the tear film. The findings may also help to explain the low incidence of dacryocystitis in spite of the growth of virulent organisms on the distal tube segment after a dacryocystorhinostomy.from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2C4BiHS
Nasolacrimal Duct Obstruction Following Hyaluronic Acid Rejuvenation of the Tear Trough
Although generally safe, hyaluronic acid rejuvenation of periorbital tissue has been reported to cause minor and major adverse events. The authors document a case of nasolacrimal duct obstruction due to hyaluronic acid rejuvenation of the tear trough. Nasolacrimal duct obstruction immediately resolved following irrigation of hyaluronidase into the affected lacrimal system. To the authors' knowledge, this is the first reported case of nasolacrimal duct obstruction due to filler injection.from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Rc45Va
Nasolacrimal Sac Diverticulum: A Case Series and Literature Review
Purpose: To describe the demographics, presentation, treatment, and outcome in 10 cases of lacrimal sac diverticulum and to review the literature on this topic, and to determine the incidence of diverticula from a series of dacryocystograms. Methods: Data were collected for all consecutive patients with lacrimal sac diverticulum seen between 2003 and 2015, including patient demographics, clinical presentation, imaging findings, treatment, and follow-up. A systematic literature review was performed for cases of lacrimal sac diverticulum. A retrospective review of 400 consecutive dacryocystograms was performed to determine the incidence of lacrimal sac diverticulum. Results: Ten cases (9 patients) of lacrimal sac diverticulum are described, and a further 36 cases were discovered through a literature review. Epiphora, swelling, and dacryocystitis and/or diverticulitis were the most common presenting complaints. When all 46 cases are combined, lacrimal patency was demonstrated in 50% of cases. Dacryocystography diagnosed only 57% of patients with diverticulum, not helped by the addition of ultrasound or CT. The incidence of diverticulum was 3.2% on review of 400 consecutive dacryocystograms (1.6% per lacrimal system). Surgical management with dacryocystorhinostomy and/or diverticulum excision was effective in all 34 operated cases at resolving symptoms in the case series and literature review. Conclusions: Lacrimal sac diverticula present with epiphora, medial canthal swelling, dacryocystitis, and/or diverticulitis. Dacryocystography, despite being the most sensitive radiologic test, is only 59% sensitive, and adjunctive CT and ultrasound have limited use. Surgical management is recommended because conservative management often fails. Dacryocystorhinostomy, diverticulum excision, or a combination thereof appears to be equivalent in achieving resolution of symptoms.from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2C6w8er
Necrotic Herpes Simplex Virus Infection of the Nose and Orbit
This is the first reported case of necrotizing nasal and sinus herpes infection with orbital involvement. A 94-year-old male with a past medical history of hypertension, congestive heart failure, and chronic kidney disease presented with necrotic nasal cellulitis and a red left eye with blurry vision. Onset was 2 weeks prior with an upper lip fever blister. He was admitted to medicine and started on antimicrobials. Maxillofacial computed tomography scan revealed pansinusitis with involvement of bilateral medial orbital walls. Initial nasal biopsy was negative. Repeat biopsy was positive for herpes simplex virus 1. His nose was debrided with full-thickness skin grafting. While there are reports of necrotizing herpes simplex, none were to the extent of our patient nor raised suspicion for invasive fungal sinusitis. Differentiating is important as this patient made a full recovery in comparison to patients with mucormycosis where mortality is often as high as 80%.from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RbvZRn
Extraocular Muscle Enlargement and Thyroid Eye Disease-like Orbital Inflammation Associated with Immune Checkpoint Inhibitor Therapy in Cancer Patients
Purpose: To describe thyroid eye disease (TED)-like orbital inflammatory syndrome in 3 cancer patients treated with immune checkpoint inhibitors. Methods: All consecutive patients treated by the senior author who were receiving immune checkpoint inhibitors and developed TED-like orbital inflammation were included. Results: Three cancer patients treated with immune checkpoint inhibitors developed orbital inflammation. The first patient was treated with a combination of a cytotoxic T-lymphocyte antigen-4 inhibitor and a programmed cell death protein 1 inhibitor and developed TED-like orbital inflammation with normal thyroid function and antibody levels. The second patient had a previous diagnosis of Graves disease without TED, and developed TED soon after initiating treatment with a programmed cell death protein 1 inhibitor. The third patient developed acute hyperthyroidism with symptomatic TED following treatment with an investigational cytotoxic T-lymphocyte antigen-4 inhibitor agent. All 3 patients were managed with either systemic steroids or observation, with resolution of their symptoms and without the need to halt immune checkpoint inhibitor treatment for their cancer. Discussion and Conclusions: TED-like orbital inflammation may occur as a side effect of immune checkpoint inhibitor therapy with anti–cytotoxic T-lymphocyte antigen-4 or anti-PD-1 inhibitors. To the best of their knowledge, this is the first reported case of TED as a result of programmed cell death protein 1 inhibitor monotherapy. All 3 patients were treated with systemic steroids and responded quickly while continuing treatment with immune checkpoint inhibitors for their cancer. With increasing use of this class of drugs, clinicians should be familiar with the clinical manifestations and treatments for this adverse reaction.from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2C7xntX
Surgical Management of Nasal Dermoid Lesions
Nasal dermoids are the most common congenital midline nasal lesions. They often present as a midline pit or nasal mass and arise from incomplete or failed regression of the dural diverticulum during embryogenesis. Management requires complete resection of the tract and an appropriate surgical approach is based on location, extent, and presence/degree of intracranial extension. Classically requiring an open craniotomy for resection, newer strategies employ a minimally disruptive approach to fully excise the lesion and the tract to prevent recurrence.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2AA60st
Surgical Management of Nasal Dermoid Lesions
Nasal dermoids are the most common congenital midline nasal lesions. They often present as a midline pit or nasal mass and arise from incomplete or failed regression of the dural diverticulum during embryogenesis. Management requires complete resection of the tract and an appropriate surgical approach is based on location, extent, and presence/degree of intracranial extension. Classically requiring an open craniotomy for resection, newer strategies employ a minimally disruptive approach to fully excise the lesion and the tract to prevent recurrence.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2AA60st
Supraclavicular Flap as a Salvage Procedure in Reconstruction of Head and Neck Complex Defects
The supraclavicular island flap (SCIF) is an interesting therapeutic option in head and neck reconstruction. Since popularized by Pallua in the late 90's, several clinical series have been published showing its versatility and usefulness. However, only a few studies have focused on factors associated with complications from SCIF use. In this study, we analyzed the factors contributing to SCIF unreliability. We performed a retrospective review of the data of 87 patients undergoing SCIF reconstruction between 2008 and 2015.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2H09kCX
Improving measurement 1: Harnessing the PROMise of outcome measures
Patient reported outcome measures (PROMs) are completed by patients to capture one or more aspects of their health and wellbeing, typically taking the form of standardised and validated questionnaires.1 They are broadly divided into generic PROMs and site, disease or condition-specific.2 Their psychometric robustness is of paramount importance, the methods of which and how to assess for this are described in detail in this journal and elsewhere.2,3 The number of PROMs available and their profile amongst clinicians is rising, such as with the recent Royal College of Surgeons advice for the routine collection of PROMs for all those undergoing cosmetic surgery as part of their Cosmetic Surgery Standards.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RzWyil
Nail size and appearance following nail fusion plasty of thumb duplication.
To evaluate nail appearance after nail fusion plasty to treat thumb duplication.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2H2kMhg
“Fibrin Tissue Sealant and Minor Skin Grafts in Burn Surgery: a Systematic Review and Meta-Analysis.”
The indications for use of fibrin glue in skin grafting burn patients remains understudied. The purpose of this study is to review the efficacy of fibrin tissue sealant in skin graft adherence, establish guidelines for use of fibrin tissue sealant, and review the cost effectiveness of fibrin glue.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RBRQRl
Bio-Alcamid complications; a 10 year review
This article is a follow up to "Early and late complications of polyalkimide gel (Bio-Alcamid)".1 It is a summary of late complications that have developed in patients treated with Bio-Alcamid for HIV lipoatrophy following extended follow up of 10 years.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2H0n1l4
Does non-activated platelet-rich plasma (PRP) enhance fat graft outcome? An in vivo assessment with 3D CT-scan
The adjunction of autologous platelet-rich plasma (PRP) is emerging as a promising approach to enhance the long-term survival of fat grafting, but there are still insufficient data on its efficacy. The aim of this in vivo study was to assess the effect of the addition of non-activated PRP on fat graft outcome.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RI4DSt
“The Use of Indocyanine Green Angiography in Postmastectomy Reconstruction: Do Outcomes Improve Over Time?”
Indocyanine green angiography (ICGA) reduces ischemic complications by assessing mastectomy flap perfusion intraoperatively. However, outcomes of ICGA can be surgeon-dependent due to its relative novelty. We aimed to determine whether patient outcomes improved with the adoption of ICGA over time.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RBRFp9
Autologous breast reconstruction surgery outcomes in patients with autoimmune connective tissue disease
Autologous breast reconstruction following mastectomy remains an integral component in the management of these patients. Those with pre-existing medical conditions require special consideration, such as patients with autoimmune connective tissue diseases (CTDs). Autoimmune CTDs include a group of disorders with a wide spectrum of clinical manifestations that may adversely affect surgical outcomes.1 Due to these factors, surgeons may be reluctant to perform autologous breast reconstructions in these patients, particularly using free tissue transfer.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GVQqwO
Supraclavicular Flap as a Salvage Procedure in Reconstruction of Head and Neck Complex Defects
The supraclavicular island flap (SCIF) is an interesting therapeutic option in head and neck reconstruction. Since popularized by Pallua in the late 90's, several clinical series have been published showing its versatility and usefulness. However, only a few studies have focused on factors associated with complications from SCIF use. In this study, we analyzed the factors contributing to SCIF unreliability. We performed a retrospective review of the data of 87 patients undergoing SCIF reconstruction between 2008 and 2015.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2H09kCX
Improving measurement 1: Harnessing the PROMise of outcome measures
Patient reported outcome measures (PROMs) are completed by patients to capture one or more aspects of their health and wellbeing, typically taking the form of standardised and validated questionnaires.1 They are broadly divided into generic PROMs and site, disease or condition-specific.2 Their psychometric robustness is of paramount importance, the methods of which and how to assess for this are described in detail in this journal and elsewhere.2,3 The number of PROMs available and their profile amongst clinicians is rising, such as with the recent Royal College of Surgeons advice for the routine collection of PROMs for all those undergoing cosmetic surgery as part of their Cosmetic Surgery Standards.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RzWyil
Nail size and appearance following nail fusion plasty of thumb duplication.
To evaluate nail appearance after nail fusion plasty to treat thumb duplication.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2H2kMhg
“Fibrin Tissue Sealant and Minor Skin Grafts in Burn Surgery: a Systematic Review and Meta-Analysis.”
The indications for use of fibrin glue in skin grafting burn patients remains understudied. The purpose of this study is to review the efficacy of fibrin tissue sealant in skin graft adherence, establish guidelines for use of fibrin tissue sealant, and review the cost effectiveness of fibrin glue.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RBRQRl
Bio-Alcamid complications; a 10 year review
This article is a follow up to "Early and late complications of polyalkimide gel (Bio-Alcamid)".1 It is a summary of late complications that have developed in patients treated with Bio-Alcamid for HIV lipoatrophy following extended follow up of 10 years.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2H0n1l4
Does non-activated platelet-rich plasma (PRP) enhance fat graft outcome? An in vivo assessment with 3D CT-scan
The adjunction of autologous platelet-rich plasma (PRP) is emerging as a promising approach to enhance the long-term survival of fat grafting, but there are still insufficient data on its efficacy. The aim of this in vivo study was to assess the effect of the addition of non-activated PRP on fat graft outcome.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RI4DSt
“A Cadaveric Analysis of the Bloody Supply to Rectus Femoris”
Rectus femoris is a versatile muscle frequently used as a pedicled flap in reconstructive surgery. The anatomy and blood supply of rectus femoris needs to be clearly understood in order to safely preserve its reconstructive and functional capabilities. Classical anatomical description states that the proximal pedicle insertion into rectus femoris is 10– 15cm from the anterior superior iliac spine (ASIS). The aim of this study was to dissect and identify the pedicular blood supply to rectus femoris and further map its morphology relative to the ASIS.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GVQxbI
“The Use of Indocyanine Green Angiography in Postmastectomy Reconstruction: Do Outcomes Improve Over Time?”
Indocyanine green angiography (ICGA) reduces ischemic complications by assessing mastectomy flap perfusion intraoperatively. However, outcomes of ICGA can be surgeon-dependent due to its relative novelty. We aimed to determine whether patient outcomes improved with the adoption of ICGA over time.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RBRFp9
Autologous breast reconstruction surgery outcomes in patients with autoimmune connective tissue disease
Autologous breast reconstruction following mastectomy remains an integral component in the management of these patients. Those with pre-existing medical conditions require special consideration, such as patients with autoimmune connective tissue diseases (CTDs). Autoimmune CTDs include a group of disorders with a wide spectrum of clinical manifestations that may adversely affect surgical outcomes.1 Due to these factors, surgeons may be reluctant to perform autologous breast reconstructions in these patients, particularly using free tissue transfer.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GVQqwO
Tauopathy in veterans with long-term posttraumatic stress disorder and traumatic brain injury
Abstract
Purpose
Traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) have emerged as independent risk factors for an earlier onset of Alzheimer's disease (AD), although the pathophysiology underlying this risk is unclear. Postmortem studies have revealed extensive cerebral accumulation of tau following multiple and single TBI incidents. We hypothesized that a history of TBI and/or PTSD may induce an AD-like pattern of tau accumulation in the brain of nondemented war veterans.
Methods
Vietnam War veterans (mean age 71.4 years) with a history of war-related TBI and/or PTSD underwent [18F]AV145 PET as part of the US Department of Defense Alzheimer's Disease Neuroimaging Initiative. Subjects were classified into the following four groups: healthy controls (n = 21), TBI (n = 10), PTSD (n = 32), and TBI+PTSD (n = 17). [18F]AV1451 reference tissue-normalized standardized uptake value (SUVr) maps, scaled to the cerebellar grey matter, were tested for differences in tau accumulation between groups using voxel-wise and region of interest approaches, and the SUVr results were correlated with neuropsychological test scores.
Results
Compared to healthy controls, all groups showed widespread tau accumulation in neocortical regions overlapping with typical and atypical patterns of AD-like tau distribution. The TBI group showed higher tau accumulation than the other clinical groups. The extent of tauopathy was positively correlated with the neuropsychological deficit scores in the TBI+PTSD and PTSD groups.
Conclusion
A history of TBI and/or PTSD may manifest in neurocognitive deficits in association with increased tau deposition in the brain of nondemented war veterans decades after their trauma. Further investigation is required to establish the burden of increased risk of dementia imparted by earlier TBI and/or PTSD.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2C5m7yg
Tauopathy in veterans with long-term posttraumatic stress disorder and traumatic brain injury
Abstract
Purpose
Traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) have emerged as independent risk factors for an earlier onset of Alzheimer's disease (AD), although the pathophysiology underlying this risk is unclear. Postmortem studies have revealed extensive cerebral accumulation of tau following multiple and single TBI incidents. We hypothesized that a history of TBI and/or PTSD may induce an AD-like pattern of tau accumulation in the brain of nondemented war veterans.
Methods
Vietnam War veterans (mean age 71.4 years) with a history of war-related TBI and/or PTSD underwent [18F]AV145 PET as part of the US Department of Defense Alzheimer's Disease Neuroimaging Initiative. Subjects were classified into the following four groups: healthy controls (n = 21), TBI (n = 10), PTSD (n = 32), and TBI+PTSD (n = 17). [18F]AV1451 reference tissue-normalized standardized uptake value (SUVr) maps, scaled to the cerebellar grey matter, were tested for differences in tau accumulation between groups using voxel-wise and region of interest approaches, and the SUVr results were correlated with neuropsychological test scores.
Results
Compared to healthy controls, all groups showed widespread tau accumulation in neocortical regions overlapping with typical and atypical patterns of AD-like tau distribution. The TBI group showed higher tau accumulation than the other clinical groups. The extent of tauopathy was positively correlated with the neuropsychological deficit scores in the TBI+PTSD and PTSD groups.
Conclusion
A history of TBI and/or PTSD may manifest in neurocognitive deficits in association with increased tau deposition in the brain of nondemented war veterans decades after their trauma. Further investigation is required to establish the burden of increased risk of dementia imparted by earlier TBI and/or PTSD.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2C5m7yg
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