Multi-Compartment Mesenchymal Tissue Segmentation in Pelvic MRI Examinations of Women: Anthropomorphic and Clinical Correlations

Publication date: Available online 3 January 2019

Source: European Journal of Radiology

Author(s): Raamis Khwaja, Riham Dessouky, Michael Heffler, Yin Xi, Ian J. Neeland, Avneesh Chhabra

Abstract

Aim

To investigate the reliability of multicompartmental volumetric mesenchymal segmentations on MRI and their correlations with anthropomorphic and clinical parameters.

Materials and methods

A consecutive series of middle-age (35-50 year old) female volunteers with variable body mass index (BMI) and MRI scans performed as a part of the Dallas Heart Study were included. A semi-automatic segmentation tool was used to partition different mesenchymal tissues- fat, muscle, and bone on MRI of pelvis. Total volumes of each compartment were calculated and compared between overweight/obese (BMI> = 25 kg/m²) and non-obese (BMI < 25 kg/m²) groups, and with physical performance measurements, i.e. mean activity counts per minute (MVPA) and cardiorespiratory fitness (CRF) estimated by submaximal treadmill test (TT). Kruskal Wallis, Mann-Whitney U test, intraclass correlation coefficient (ICC) and Spearman correlations were used. P value <0.05 was considered statistically significant.

Results

There were statistically significant positive correlations between fat volume and BMI (p < 0.0001), muscle volume and height (p = 0.03), and bone volume and height (p < 0.0001). Significant inverse correlations were found between bone volume and BMI (p = 0.002). Fair to good interobserver reliability was seen with muscle and fat volumes (ICC = 0.43-0.64) and excellent reliability was seen with bone volumes (ICC = 0.78-0.79). Statistically significant inverse correlations were found between MVPA and age (p = 0.01), and TT with BMI and weight (p = 0.01, 0.03).

Conclusion

Multi-compartment mesenchymal tissue volume quantification on pelvic MRI is reliable in females. Inverse correlation of bone volume with BMI has potential implications for future risk of fracture.

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Corrigendum to “Correct knowledge of medical cannabis legal status in one's own state: Differences between adolescents and adults in the United States, 2004-2013” Addictive Behaviors 88 (2019) 23–28

Publication date: Available online 3 January 2019

Source: Addictive Behaviors

Author(s): Pia M. Mauro, Julian Santaella-Tenorio, Alexander S. Perlmutter, Deborah S. Hasin, Christine M. Mauro, Silvia S. Martins

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Youth perception of harm and addictiveness of tobacco products: Findings from the Population Assessment of Tobacco and Health Study (Wave 1)

Publication date: Available online 3 January 2019

Source: Addictive Behaviors

Author(s): David R. Strong, Karen Messer, Martha White, Yuyan Shi, Madison Noble, David B. Portnoy, Alexander Persoskie, Annette R. Kaufman, Kelvin Choi, Charles Carusi, Maansi Bansal-Travers, Andrew Hyland, John Pierce

Abstract

Purpose

We provide a US national assessment of youth perceptions of the harm and addictiveness of six separate tobacco products, identifying a continuum of perceived harm associated with a range of products in relation to patterns of current use, former use, and susceptibility to use tobacco products.

Methods

We evaluated youth respondents (N = 13,651) ages 12–17 from Wave 1 (2013–2014) of the Population Assessment of Tobacco and Health (PATH) Study. Analyses (2015–2016) focused on refining measures of perceived harm for each product and delineating youth characteristics (demographic, tobacco use status) associated with beliefs about the harmfulness and addictiveness of tobacco products.

Results

Cigars, hookah and e-cigarettes were each perceived as having significantly lower harm (p's < 0.05) than smokeless products, with the lowest ratings of harmfulness and addictiveness observed for hookah and e-cigarettes (p's < 0.001). Incrementally lower levels of harm and addictiveness perceptions were observed among youth at increasing risk for tobacco use (p's < 0.05).

Conclusions

Among U.S. youth, lower perceptions of harm and addictiveness of tobacco products were associated with susceptibility to use tobacco and patterns of tobacco product use. Future longitudinal assessments from the PATH Study can provide key information on youth development of perceptions of harm and addictiveness and influences on patterns of tobacco use.

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Travel time to provider is associated with advanced stage at diagnosis among low income head and neck squamous cell carcinoma patients in North Carolina

Publication date: February 2019

Source: Oral Oncology, Volume 89

Author(s): Douglas R. Farquhar, Maheer M. Masood, Nicholas R. Lenze, Philip McDaniel, Angela Mazul, Siddharth Sheth, Adam M. Zanation, Trevor G. Hackman, Mark Weissler, Jose P. Zevallos, Andrew F. Olshan

Abstract

Objective

There is considerable variation in the travel required for a patient with head and neck squamous cell carcinoma (HNSCC) to receive a diagnosis. The impact of this travel on the late diagnosis of cancer remains unexamined, even though presenting stage is the strongest predictor of mortality. Our aim is to determine whether travel time affects HNSCC stage at diagnosis independently of other risk factors, and whether this association is affected by socioeconomic status.

Materials and methods

Cases were obtained from the CHANCE database, a population-based case-control study in North Carolina (n = 808). The mean age was 59.6 and 72% were male. Stage at diagnosis was categorized as early (T1-T2) or advanced (T3-T4) T stage and the presence or absence of nodal metastasis. Multivariate logistic regression models were used to estimate odds ratios for stage-at-diagnosis based on travel time, after adjustment for variables including demographics, income, insurance status, alcohol, and tobacco use.

Results

The adjusted odds ratio (OR) of advanced T-stage at diagnosis was 1.97 for each hour driven (95% CI 1.36–2.87). There was no association with nodal metastases. There was a significant interaction between travel time and income (p = 0.026) with a pattern of higher ORs for increased distance among lower income (<$20,000) patients compared to the ORs for higher income (>$20,000) patients.

Discussion

Travel time was an independent contributor to advanced T stage at diagnosis among low income patients. This suggests travel burden may be a barrier to early diagnosis of HNSCC for impoverished patients.

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Travel time to provider is associated with advanced stage at diagnosis among low income head and neck squamous cell carcinoma patients in North Carolina

Publication date: February 2019

Source: Oral Oncology, Volume 89

Author(s): Douglas R. Farquhar, Maheer M. Masood, Nicholas R. Lenze, Philip McDaniel, Angela Mazul, Siddharth Sheth, Adam M. Zanation, Trevor G. Hackman, Mark Weissler, Jose P. Zevallos, Andrew F. Olshan

Abstract

Objective

There is considerable variation in the travel required for a patient with head and neck squamous cell carcinoma (HNSCC) to receive a diagnosis. The impact of this travel on the late diagnosis of cancer remains unexamined, even though presenting stage is the strongest predictor of mortality. Our aim is to determine whether travel time affects HNSCC stage at diagnosis independently of other risk factors, and whether this association is affected by socioeconomic status.

Materials and methods

Cases were obtained from the CHANCE database, a population-based case-control study in North Carolina (n = 808). The mean age was 59.6 and 72% were male. Stage at diagnosis was categorized as early (T1-T2) or advanced (T3-T4) T stage and the presence or absence of nodal metastasis. Multivariate logistic regression models were used to estimate odds ratios for stage-at-diagnosis based on travel time, after adjustment for variables including demographics, income, insurance status, alcohol, and tobacco use.

Results

The adjusted odds ratio (OR) of advanced T-stage at diagnosis was 1.97 for each hour driven (95% CI 1.36–2.87). There was no association with nodal metastases. There was a significant interaction between travel time and income (p = 0.026) with a pattern of higher ORs for increased distance among lower income (<$20,000) patients compared to the ORs for higher income (>$20,000) patients.

Discussion

Travel time was an independent contributor to advanced T stage at diagnosis among low income patients. This suggests travel burden may be a barrier to early diagnosis of HNSCC for impoverished patients.

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Planning Wellness in 2019

Publication date: Available online 3 January 2019

Source: Current Problems in Diagnostic Radiology

Author(s): David Fessell

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Primary osteosarcoma of the breast: Pathophysiology and Imaging Review

Publication date: Available online 3 January 2019

Source: Current Problems in Diagnostic Radiology

Author(s): Bilal Mujtaba, Sameh M. Nassar, Rizwan Aslam, Naveen Garg, John E. Madewell, Ahmed Taher, Abdelrahman k Hanafy, Gary Whitman

Abstract

Extraskeletal osteosarcoma (ESOS) are rare malignant mesenchymal neoplasms of soft tissues representing around 1% of all soft tissue. The exact mechanism of tumorigenesis of primary breast osteosarcoma still unclear. However, most of the cases develop without a recognized aetiologic factor. Primary osteosarcoma of the breast is often initially misdiagnosed as breast fibroadenoma. Different imaging modalities and pathology play important role in differentiating breast osteosarcoma from other benign and malignant lesions of the breast resulting in dramatic change in the management.

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PRIMARY INTRA-ABDOMINAL EWING'S SARCOMA IN ADULTS: A MULTIMODALITY IMAGING SPECTRUM

Publication date: Available online 2 January 2019

Source: Current Problems in Diagnostic Radiology

Author(s): Shakunthala Revannagowda, Kiran Gangadhar, Gensuke Akaike, Manjiri Dighe

ABSTRACT

Ewing sarcoma (ES) and peripheral primitive neuroectodermal tumor (PNET) are part of a spectrum of neoplastic diseases known as the ES family of tumors (EFT), which also includes extraosseous ES (EES), PNET, malignant small-cell tumor of the thoracopulmonary region (Askin's tumor), and atypical ES. Although imaging features of these tumors have been previously described, extensive discussion about intra-abdominal manifestations are scarce in the literature. We present an imaging spectrum of these tumors in the abdomen and pelvis with particular attention to multimodality approach for staging and restaging.

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Performance of an Interactive Upper Extremity Peripheral Nerve Training Module Among Medical Students, Radiology Residents and Fellows: A Multi-Institutional Study

Publication date: Available online 2 January 2019

Source: Current Problems in Diagnostic Radiology

Author(s): Adam Daniel Singer, Yara Younan, Vandad Saadat, Monica Umpierrez, Vita Kesner, Nicholas Boulis, Felix Gonzalez, Ty K. Subhawong

Abstract

Background and Purpose

Chronic pain is a common problem and imaging is becoming increasingly utilized in the characterization of peripheral neuropathy although this topic is not emphasized during medical training. We hypothesized that an electronic module and nerve atlas would be effective in improving comprehension among trainees.

Materials and Methods

In this IRB approved study, a training module was created that included a side-by-side comparison of normal upper extremity nerves on MRI and US, with embedded questions and cases, followed by a brief hands-on US scanning session. Thirty volunteers with variable training were enrolled in one institution while fourteen volunteers were enrolled in another. Pre- and post-test scores were collected and compared.

Results

There was a response rate of 100% at both institutions. At the first institution, subjects were divided into two groups: group 1 (16 medical students) and group 2 (14 residents/fellows). There was a baseline deficit of knowledge among both groups, with a mean pre-test score of 37.5% and 47.5% for group 1 and group 2 respectively (p=0.017). After module completion, both groups improved with a mean post-test score of 67.2% for group 1 and 76.1% for group 2. At the second institution, there was similar improvement even if the scanning session was not done.

Conclusions

Use of an electronic module helps trainees to become more familiar with peripheral nerve imaging, regardless of level of training. Use of the module, even in the absence of hands on US scanning, results in an improved understanding of this topic.

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Planning Wellness in 2019

Publication date: Available online 3 January 2019

Source: Current Problems in Diagnostic Radiology

Author(s): David Fessell

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Primary osteosarcoma of the breast: Pathophysiology and Imaging Review

Publication date: Available online 3 January 2019

Source: Current Problems in Diagnostic Radiology

Author(s): Bilal Mujtaba, Sameh M. Nassar, Rizwan Aslam, Naveen Garg, John E. Madewell, Ahmed Taher, Abdelrahman k Hanafy, Gary Whitman

Abstract

Extraskeletal osteosarcoma (ESOS) are rare malignant mesenchymal neoplasms of soft tissues representing around 1% of all soft tissue. The exact mechanism of tumorigenesis of primary breast osteosarcoma still unclear. However, most of the cases develop without a recognized aetiologic factor. Primary osteosarcoma of the breast is often initially misdiagnosed as breast fibroadenoma. Different imaging modalities and pathology play important role in differentiating breast osteosarcoma from other benign and malignant lesions of the breast resulting in dramatic change in the management.

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PRIMARY INTRA-ABDOMINAL EWING'S SARCOMA IN ADULTS: A MULTIMODALITY IMAGING SPECTRUM

Publication date: Available online 2 January 2019

Source: Current Problems in Diagnostic Radiology

Author(s): Shakunthala Revannagowda, Kiran Gangadhar, Gensuke Akaike, Manjiri Dighe

ABSTRACT

Ewing sarcoma (ES) and peripheral primitive neuroectodermal tumor (PNET) are part of a spectrum of neoplastic diseases known as the ES family of tumors (EFT), which also includes extraosseous ES (EES), PNET, malignant small-cell tumor of the thoracopulmonary region (Askin's tumor), and atypical ES. Although imaging features of these tumors have been previously described, extensive discussion about intra-abdominal manifestations are scarce in the literature. We present an imaging spectrum of these tumors in the abdomen and pelvis with particular attention to multimodality approach for staging and restaging.

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Performance of an Interactive Upper Extremity Peripheral Nerve Training Module Among Medical Students, Radiology Residents and Fellows: A Multi-Institutional Study

Publication date: Available online 2 January 2019

Source: Current Problems in Diagnostic Radiology

Author(s): Adam Daniel Singer, Yara Younan, Vandad Saadat, Monica Umpierrez, Vita Kesner, Nicholas Boulis, Felix Gonzalez, Ty K. Subhawong

Abstract

Background and Purpose

Chronic pain is a common problem and imaging is becoming increasingly utilized in the characterization of peripheral neuropathy although this topic is not emphasized during medical training. We hypothesized that an electronic module and nerve atlas would be effective in improving comprehension among trainees.

Materials and Methods

In this IRB approved study, a training module was created that included a side-by-side comparison of normal upper extremity nerves on MRI and US, with embedded questions and cases, followed by a brief hands-on US scanning session. Thirty volunteers with variable training were enrolled in one institution while fourteen volunteers were enrolled in another. Pre- and post-test scores were collected and compared.

Results

There was a response rate of 100% at both institutions. At the first institution, subjects were divided into two groups: group 1 (16 medical students) and group 2 (14 residents/fellows). There was a baseline deficit of knowledge among both groups, with a mean pre-test score of 37.5% and 47.5% for group 1 and group 2 respectively (p=0.017). After module completion, both groups improved with a mean post-test score of 67.2% for group 1 and 76.1% for group 2. At the second institution, there was similar improvement even if the scanning session was not done.

Conclusions

Use of an electronic module helps trainees to become more familiar with peripheral nerve imaging, regardless of level of training. Use of the module, even in the absence of hands on US scanning, results in an improved understanding of this topic.

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Effectiveness of a comprehensive oral management protocol for the prevention of severe oral mucositis in patients receiving radiotherapy with or without chemotherapy for oral cancer: a multicentre, phase II, randomized controlled trial

Publication date: Available online 2 January 2019

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): Y. Kawashita, Y. Koyama, H. Kurita, M. Otsuru, Y. Ota, M. Okura, A. Horie, H. Sekiya, M. Umeda

Abstract

The aim of this phase II, multicentre, randomized controlled trial was to evaluate the effectiveness of a comprehensive oral management protocol for the prevention of severe oral mucositis in patients with oral cancer receiving radiotherapy alone or chemoradiotherapy. In total, 124 patients with oral cancer were enrolled from five institutions. Of these, 37 patients undergoing radiotherapy were randomly divided into an intervention group (n = 18) and a control group (n = 19). The remaining 87 patients, who were undergoing chemoradiotherapy, were also randomized into an intervention group (n = 42) and a control group (n = 45). During radiotherapy, patients in the control group received only oral care, while those in the intervention group additionally received spacers to cover the entire dentition, pilocarpine hydrochloride, and topical dexamethasone ointment for oral mucositis. The primary endpoint was the incidence of severe oral mucositis. The intervention was significantly associated with a decreased incidence of severe oral mucositis in patients receiving radiotherapy alone (P = 0.046), but not in those receiving chemoradiotherapy (P = 0.815). These findings suggest that an oral management protocol can prevent severe oral mucositis in patients with oral cancer undergoing radiotherapy without concurrent chemotherapy.

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Effectiveness of a comprehensive oral management protocol for the prevention of severe oral mucositis in patients receiving radiotherapy with or without chemotherapy for oral cancer: a multicentre, phase II, randomized controlled trial

Publication date: Available online 2 January 2019

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): Y. Kawashita, Y. Koyama, H. Kurita, M. Otsuru, Y. Ota, M. Okura, A. Horie, H. Sekiya, M. Umeda

Abstract

The aim of this phase II, multicentre, randomized controlled trial was to evaluate the effectiveness of a comprehensive oral management protocol for the prevention of severe oral mucositis in patients with oral cancer receiving radiotherapy alone or chemoradiotherapy. In total, 124 patients with oral cancer were enrolled from five institutions. Of these, 37 patients undergoing radiotherapy were randomly divided into an intervention group (n = 18) and a control group (n = 19). The remaining 87 patients, who were undergoing chemoradiotherapy, were also randomized into an intervention group (n = 42) and a control group (n = 45). During radiotherapy, patients in the control group received only oral care, while those in the intervention group additionally received spacers to cover the entire dentition, pilocarpine hydrochloride, and topical dexamethasone ointment for oral mucositis. The primary endpoint was the incidence of severe oral mucositis. The intervention was significantly associated with a decreased incidence of severe oral mucositis in patients receiving radiotherapy alone (P = 0.046), but not in those receiving chemoradiotherapy (P = 0.815). These findings suggest that an oral management protocol can prevent severe oral mucositis in patients with oral cancer undergoing radiotherapy without concurrent chemotherapy.

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A Multi-site Cross-Sectional Survey Exploring Medical Undergraduate Knowledge of Oral and Maxillofacial Surgery

Abstract

Purpose

To evaluate medical student exposure to OMFS and knowledge of which clinical cases are appropriate to refer to the OMFS surgeon and the academic requirements to pursue a career in OMFS.

Methods

The investigators designed and distributed a cross-sectional survey to a cohort of current UK medical students. The primary outcome was medical student knowledge of the role of the OMFS, which was measured by their ability to correctly identify which cases were appropriate to refer to OMFS. Secondary outcomes included: identifying the proportion of students exposed to OMFS and the nature of this exposure; identifying student knowledge of the requirements to commence OMFS speciality training; and comparing knowledge of OMFS in those exposed to OMFS at medical school and those not exposed. The investigators hypothesised that undergraduates exposed to OMFS would have a greater understanding of the role of the OMFS and the requirements to pursue this speciality.

Results

Of the 299 participants included in this study, 77.4% (230) had no exposure to OMFS at medical school. Overall, the students exposed to OMFS at medical school performed superiorly (mdn = 13) to the OMFS-naïve students (mdn = 13), z-score = 2.185, p = 0.03, in correctly identifying cases to refer to an OMFS surgeon. They also were more likely to correctly identify the requirement of core surgical training (CST) (p = 0.04, χ² = 4.182) and membership of the Royal College of Surgeons (p = 0.02, χ² = 9.879) as needed to begin OMFS speciality training.

Conclusion

Exposure to OMFS is still limited within the medical undergraduate curriculum, and this is reflected in poor knowledge of OMFS. An increase in the amount of contact with OMFS at an undergraduate level would not only help create greater interest in OMFS as a career but would help doctors of all specialities when exposed to OMFS.

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A Multi-site Cross-Sectional Survey Exploring Medical Undergraduate Knowledge of Oral and Maxillofacial Surgery

Abstract

Purpose

To evaluate medical student exposure to OMFS and knowledge of which clinical cases are appropriate to refer to the OMFS surgeon and the academic requirements to pursue a career in OMFS.

Methods

The investigators designed and distributed a cross-sectional survey to a cohort of current UK medical students. The primary outcome was medical student knowledge of the role of the OMFS, which was measured by their ability to correctly identify which cases were appropriate to refer to OMFS. Secondary outcomes included: identifying the proportion of students exposed to OMFS and the nature of this exposure; identifying student knowledge of the requirements to commence OMFS speciality training; and comparing knowledge of OMFS in those exposed to OMFS at medical school and those not exposed. The investigators hypothesised that undergraduates exposed to OMFS would have a greater understanding of the role of the OMFS and the requirements to pursue this speciality.

Results

Of the 299 participants included in this study, 77.4% (230) had no exposure to OMFS at medical school. Overall, the students exposed to OMFS at medical school performed superiorly (mdn = 13) to the OMFS-naïve students (mdn = 13), z-score = 2.185, p = 0.03, in correctly identifying cases to refer to an OMFS surgeon. They also were more likely to correctly identify the requirement of core surgical training (CST) (p = 0.04, χ² = 4.182) and membership of the Royal College of Surgeons (p = 0.02, χ² = 9.879) as needed to begin OMFS speciality training.

Conclusion

Exposure to OMFS is still limited within the medical undergraduate curriculum, and this is reflected in poor knowledge of OMFS. An increase in the amount of contact with OMFS at an undergraduate level would not only help create greater interest in OMFS as a career but would help doctors of all specialities when exposed to OMFS.

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Building and repairing the stereocilia cytoskeleton in mammalian auditory hair cells

Publication date: Available online 2 January 2019

Source: Hearing Research

Author(s): A. Catalina Vélez-Ortega, Gregory I. Frolenkov

Abstract

Despite all recent achievements in identification of the molecules that are essential for the structure and mechanosensory function of stereocilia bundles in the auditory hair cells of mammalian species, we still have only a rudimentary understanding of the mechanisms of stereocilia formation, maintenance, and repair. Important molecular differences distinguishing mammalian auditory hair cells from hair cells of other types and species have been recently revealed. In addition, we are beginning to solve the puzzle of the apparent life-long stability of the stereocilia bundles in these cells. New data link the stability of the cytoskeleton in the mammalian auditory stereocilia with the normal activity of mechanotransduction channels. These data suggest new ideas on how a terminally-differentiated non-regenerating hair cell in the mammalian cochlea may repair and tune its stereocilia bundle throughout the life span of the organism.

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Differential growth of craniofacial and tibial bones to sympathetic hyperactivity-related hypertension in rats

Publication date: Available online 3 January 2019

Source: Archives of Oral Biology

Author(s): Yuta Uchikawa, Jun Hosomichi, Jun-ichi Suzuki, Hiroyuki Yamaguchi, Yuji Ishida, Kasumi Hatano, Risa Usumi-Fujita, Yasuhiro Shimizu, Sawa Kaneko, Shunsuke Uesugi, Takashi Ono

Abstract

Objective

To evaluate the effect of sympathetic nervous system hyperactivity on craniofacial skeletal growth in growing spontaneously hypertensive rats (SHRs).

Design

Craniofacial skeletal growth was compared between male SHR and Wistar―Kyoto rats (WKR) using linear measurements on lateral and transverse cephalometric radiographs at the age of 12 weeks. Tibia length was measured as an index of whole body growth. Body weight　and blood pressure were measured from 3 to 12 weeks of age. Bone microstructure in the mandibular condyle and tibia between the two groups was compared at the age of 12 weeks using microcomputed tomography.

Results

The SHRs had a significantly lower body weight than WKRs from 7 weeks of age, and tibial length was significantly smaller in the SHRs than in the WKR at 12 weeks of age. In all SHRs, blood pressure was significantly higher than in WKRs from 3 to 12 weeks of age. Cephalometric analyses revealed decreased measurements of the neurocranium, viscerocranium, and mandible in SHRs, and mandibular growth was most negatively affected in this group. Lastly, in SHRs, microcomputed tomography analyses revealed decreased bone mineral density and bone volume/tissue volume in the mandibular condyle but not in the tibia.

Conclusion

In growing SHRs, hypertension related to the hyperactivity of the sympathetic nervous system reduced craniofacial skeletal growth more than the growth of the tibia.

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Building and repairing the stereocilia cytoskeleton in mammalian auditory hair cells

Publication date: Available online 2 January 2019

Source: Hearing Research

Author(s): A. Catalina Vélez-Ortega, Gregory I. Frolenkov

Abstract

Despite all recent achievements in identification of the molecules that are essential for the structure and mechanosensory function of stereocilia bundles in the auditory hair cells of mammalian species, we still have only a rudimentary understanding of the mechanisms of stereocilia formation, maintenance, and repair. Important molecular differences distinguishing mammalian auditory hair cells from hair cells of other types and species have been recently revealed. In addition, we are beginning to solve the puzzle of the apparent life-long stability of the stereocilia bundles in these cells. New data link the stability of the cytoskeleton in the mammalian auditory stereocilia with the normal activity of mechanotransduction channels. These data suggest new ideas on how a terminally-differentiated non-regenerating hair cell in the mammalian cochlea may repair and tune its stereocilia bundle throughout the life span of the organism.

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Differential growth of craniofacial and tibial bones to sympathetic hyperactivity-related hypertension in rats

Publication date: Available online 3 January 2019

Source: Archives of Oral Biology

Author(s): Yuta Uchikawa, Jun Hosomichi, Jun-ichi Suzuki, Hiroyuki Yamaguchi, Yuji Ishida, Kasumi Hatano, Risa Usumi-Fujita, Yasuhiro Shimizu, Sawa Kaneko, Shunsuke Uesugi, Takashi Ono

Abstract

Objective

To evaluate the effect of sympathetic nervous system hyperactivity on craniofacial skeletal growth in growing spontaneously hypertensive rats (SHRs).

Design

Craniofacial skeletal growth was compared between male SHR and Wistar―Kyoto rats (WKR) using linear measurements on lateral and transverse cephalometric radiographs at the age of 12 weeks. Tibia length was measured as an index of whole body growth. Body weight　and blood pressure were measured from 3 to 12 weeks of age. Bone microstructure in the mandibular condyle and tibia between the two groups was compared at the age of 12 weeks using microcomputed tomography.

Results

The SHRs had a significantly lower body weight than WKRs from 7 weeks of age, and tibial length was significantly smaller in the SHRs than in the WKR at 12 weeks of age. In all SHRs, blood pressure was significantly higher than in WKRs from 3 to 12 weeks of age. Cephalometric analyses revealed decreased measurements of the neurocranium, viscerocranium, and mandible in SHRs, and mandibular growth was most negatively affected in this group. Lastly, in SHRs, microcomputed tomography analyses revealed decreased bone mineral density and bone volume/tissue volume in the mandibular condyle but not in the tibia.

Conclusion

In growing SHRs, hypertension related to the hyperactivity of the sympathetic nervous system reduced craniofacial skeletal growth more than the growth of the tibia.

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Atopy in chronic rhinosinusitis: impact on quality of life outcomes

Background

Chronic rhinosinusitis (CRS), in particular with nasal polyps (CRSwNP), has been linked with skewed T‐helper 2 and immunoglobulin E (IgE)‐mediated allergic responses. The role of atopy in CRS, however, remains unclear. Correlations between immunological allergic markers and patient‐reported outcomes measures (PROMs) were investigated.

Methods

A cross‐sectional study of adult patients with CRS undergoing endoscopic sinus surgery was conducted. Immunological allergic markers included automated immunoassay testing for serum‐specific IgE to common allergens (house dust mite, grass, mold, animal epithelia) and total IgE. PROMs were assessed using the 22‐item Sino‐Nasal Outcome Test (SNOT‐22). Patients were defined as atopic based on either a positive specific IgE or elevated total IgE (>160 kU/L).

Results

A total of 446 patients (45.7% female, age 49.05 ± 14.96 years) were recruited, of which 42.8% had asthma, 51.6% had CRSwNP, and 63.0% had eosinophilic CRS. Positive allergen sensitization was detected in 52.9% patients. Total IgE levels were elevated in 28.0% with mean IgE level of 161 ± 269 kU/L. Atopy was associated with younger age at the time of surgery, CRSwNP, asthma, and eosinophilic CRS (eCRS). Atopy was also associated with increased severity in nasal symptom score (13.1 ± 6.4 vs 11.9 ± 6.0, p = 0.04), as well as worse scores in the loss of smell/taste (χ²(1) = 5.97, p = 0.02) and need to blow nose (χ²(1) = 4.26, p = 0.04) questions in the CRS population. In the CRSwNP population, there was no significant association between atopy and PROMs.

Conclusion

Comorbid atopy in CRS is associated with additional symptom burden, reflected mainly within the nasal symptom quality of life markers. Atopy assessment in CRS is important to ensure appropriate and successful treatment of the disease.

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Atopy in chronic rhinosinusitis: impact on quality of life outcomes

Background

Chronic rhinosinusitis (CRS), in particular with nasal polyps (CRSwNP), has been linked with skewed T‐helper 2 and immunoglobulin E (IgE)‐mediated allergic responses. The role of atopy in CRS, however, remains unclear. Correlations between immunological allergic markers and patient‐reported outcomes measures (PROMs) were investigated.

Methods

A cross‐sectional study of adult patients with CRS undergoing endoscopic sinus surgery was conducted. Immunological allergic markers included automated immunoassay testing for serum‐specific IgE to common allergens (house dust mite, grass, mold, animal epithelia) and total IgE. PROMs were assessed using the 22‐item Sino‐Nasal Outcome Test (SNOT‐22). Patients were defined as atopic based on either a positive specific IgE or elevated total IgE (>160 kU/L).

Results

A total of 446 patients (45.7% female, age 49.05 ± 14.96 years) were recruited, of which 42.8% had asthma, 51.6% had CRSwNP, and 63.0% had eosinophilic CRS. Positive allergen sensitization was detected in 52.9% patients. Total IgE levels were elevated in 28.0% with mean IgE level of 161 ± 269 kU/L. Atopy was associated with younger age at the time of surgery, CRSwNP, asthma, and eosinophilic CRS (eCRS). Atopy was also associated with increased severity in nasal symptom score (13.1 ± 6.4 vs 11.9 ± 6.0, p = 0.04), as well as worse scores in the loss of smell/taste (χ²(1) = 5.97, p = 0.02) and need to blow nose (χ²(1) = 4.26, p = 0.04) questions in the CRS population. In the CRSwNP population, there was no significant association between atopy and PROMs.

Conclusion

Comorbid atopy in CRS is associated with additional symptom burden, reflected mainly within the nasal symptom quality of life markers. Atopy assessment in CRS is important to ensure appropriate and successful treatment of the disease.

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Clinical presentation and characteristics of lymphoma in the head and neck region

Abstract

Background

The study analyses clinical characteristics of histologically defined head and neck (H&N) lymphoma to raise the awareness of ENT specialists to the leading symptoms.

Method

From 2003 to 2011, all patients with histologically defined H&N lymphoma from our clinic were evaluated.

Results

This study identified 221 patients with H&N lymphoma comprising 193 non-Hodgkin lymphomas (NHL) and 28 Hodgkin lymphomas (HL). Among NHL there were 77 indolent (iNHL), 110 aggressive (aNHL), six highly aggressive NHL and further 28 HL. Patients with highly aggressive NHL and HL were significantly younger (p < 0.0001). Corresponding to the leading symptoms, we found nodal and extranodal involvement. NHL demonstrated manifestation in neck lymph nodes, tonsils, major salivary glands, sinonasal-system and hypopharynx/larynx. HL showed exclusive manifestation in lymph nodes of the neck and the tonsils (p < 0.0001). The mean time from first symptoms to diagnosis ranged from 1.5 ± 0.7 months in highly aggressive lymphoma to 7.5 ± 11.5 months in iNHL.

Conclusions

The variable clinical presentation of lymphoma is a challenge for the ENT specialist. Fast diagnosis is crucial for rapid treatment, especially in highly aggressive NHL like the Burkitt-lymphoma and HL. A standardized medical history, clinical examination and imaging evaluations paired with patient's signs, symptoms and demographic knowledge might indicate lymphoma. Biopsies in the H&N region should always be immediately performed in suspicious findings.

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Intratonsillar Abscess: A Not-So-Rare Clinical Entity

Publication date: Available online 3 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Jonathan P. Giurintano, Sarah Kortebein, Merry Sebelik, Jerome Thompson, Jennifer McLevy-Bazzanella

Abstract

Objective

To report the prevalence of intratonsillar abscess in the pediatric population at our institution and demonstrate that intratonsillar abscess is a more commonly encountered diagnosis than previously reported.

Methods

A retrospective chart review was performed that included patients presenting to our pediatric tertiary referral academic emergency department from January 1, 2014 to December 31, 2014 diagnosed with intratonsillar abscess on computed tomography.

Results

In the year 2014, 22 children were diagnosed with intratonsillar abscess by radiological criteria. The majority of patients (82%) required no surgical intervention and were successfully treated with antibiotics and supportive measures. All patients recovered from the infection uneventfully, and there were no treatment complications recorded.

Conclusion

Even in recent literature, intratonsillar abscess is described as a rare entity, with few cases reported. In our experience, CT imaging demonstrating the presence of intratonsillar abscess is more common than previously described. Regardless of treatment method, in our experience children with intratonsillar abscess do well clinically.

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Cochlear Implantation for Single-Sided Deafness in Children and Adolescents

Publication date: Available online 2 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Daniel M. Zeitler, Douglas P. Sladen, Melissa D. DeJong, Jennifer H. Torres, Michael F. Dorman, Matthew L. Carlson

Abstract

Objective

To evaluate audiometric outcomes in pediatric and adolescent patients with single-sided deafness (SSD) undergoing cochlear implantation.

Methods

A retrospective cohort design at two tertiary level academic cochlear implant centers. The subjects included nine children ages 1.5 to 15 years-old with single-sided deafness (SSD) who had undergone cochlear implantation in the affected ear. Objective outcome measures included were speech reception testing in quiet and noise, bimodal speech reception threshold testing in noise, tinnitus suppression, and device usage.

Results

Nine pediatric and adolescent patients with SSD were implanted between 2011-2016. The median age at implantation was 8.9 years (range, 1.5-15.1) and the children had a median duration of deafness 2.9 years (range, 0.8-9.5). There was variability in testing measures due to patient age. Median pre-operative aided word recognition scores on the affected side were <30% regardless of the testing paradigm used. Six patients had pre-operative word testing (4 CNC, median score 25%; 2 MLNT, 8% and 17%). Four patients had pre-operative sentence testing (3 AzBio, median score 44%; 1 HINT-C, 57%). Median post-implantation follow-up interval was 12.3 months (range, 3-27.6 months). Six subjects had post-operative word recognition testing (CNC median, 70%; MLNT 50%, 92%) with a median improvement of 45.5 percentage points. Five subjects had post-operative sentence testing (AzBio, median 82%; HINT, median 76%), with a median improvement of 40.5 percentage points. Eight patients are full time users of their device. Tinnitus and bimodal speech reception thresholds in noise were improved.

Conclusion

Pediatric subjects with SSD benefit substantially from cochlear implantation. Objective speech outcome measures are improved in both quiet and noise, and bimodal speech reception thresholds in noise are greatly improved. There is a low rate of device non-use.

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Vestibular and Oculomotor Function in Children with CP: Descriptive Study

Publication date: Available online 2 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): A. Almutairi, G. Cochrane, J.B. Christy

Objective

We aimed to describe vestibular/oculomotor function of 7-12-year-old children with CP, Gross Motor Function Classification System (GMFCS) levels (I-III), in comparison to an age-matched control group to understand the effect of the vestibular system on activities and participation of children with CP.

Methods

Vestibular, oculomotor and balance function were tested in children with CP. Central and peripheral vestibular function was examined using an enclosed rotary chair and infrared video goggles (100Hz) that measured eye movements. Oculomotor tests included smooth pursuit and optokinetic nystagmus (OKN). Vestibulo-Ocular Reflex (VOR) tests, done in complete darkness, included step rotation (STEP), sinusoidal harmonic acceleration (SHA) test, VOR cancellation and enhancement, and subjective visual vertical and horizontal (SVV/SVH). The integrity of the saccule was tested with the Cervical Vestibular Evoked Myogenic Potential. If able, the participants' balance abilities were examined using the Sensory Organization Test (SOT) to determine ability to maintain standing balance during six conditions that challenged the visual, somatosensory and vestibular systems. Independent t-tests and Mann-Whitney U tests were used to compare results between groups.

Results

Forty-one children with CP (mean age=9.44 years, SD= 1.66; 23F/18M; Gross Motor Function Classification System levels: I (n=19), II (n=7), III (n=15) and thirty-three typically developing (TD) children (mean age=10.16 years, SD= 1.6; 13F/20M) were recruited from the Birmingham, AL community. There was no significant difference between children with CP and TD children in saccular function (i.e. C-VEMP test), and peripheral vestibular end organ (i.e. SHA test and STEP test), VOR enhancement, or OKN gain. Velocity gain for horizontal smooth pursuit was significantly worse in children with CP (p=0.009), compared to TD children. Poor mediation of central vestibular function were that evident with significantly higher VOR cancellation gain in children with CP (p<0.0001), compared to TD children and significantly higher SVV variance (p=0.002), SVH mean (p=0.001), and SVH variance (p<0.0001) in children with CP compared to TD children. Compromised balance abilities in children with CP was evident with significantly lower composite scores (p<0.0001), vestibular ratio (p<0.0001), and visual ratio (p=0.021). The somatosensory ratio (p=0.798) of children with CP was similar to children with TD.

Conclusions

Although peripheral vestibular function was intact, children with CP had difficulty coupling eye and head movement (VOR cancellation), using the vestibular system for postural control (SOT), demonstrated poor perception of upright (SVV/SVH), and had difficulty following a slow moving target (smooth pursuit eye movement). These results implicate a central vestibular and oculomotor function impairment the severity of which corresponded with severity of the level of CP.

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A Multi-site Cross-Sectional Survey Exploring Medical Undergraduate Knowledge of Oral and Maxillofacial Surgery

Abstract

Purpose

To evaluate medical student exposure to OMFS and knowledge of which clinical cases are appropriate to refer to the OMFS surgeon and the academic requirements to pursue a career in OMFS.

Methods

The investigators designed and distributed a cross-sectional survey to a cohort of current UK medical students. The primary outcome was medical student knowledge of the role of the OMFS, which was measured by their ability to correctly identify which cases were appropriate to refer to OMFS. Secondary outcomes included: identifying the proportion of students exposed to OMFS and the nature of this exposure; identifying student knowledge of the requirements to commence OMFS speciality training; and comparing knowledge of OMFS in those exposed to OMFS at medical school and those not exposed. The investigators hypothesised that undergraduates exposed to OMFS would have a greater understanding of the role of the OMFS and the requirements to pursue this speciality.

Results

Of the 299 participants included in this study, 77.4% (230) had no exposure to OMFS at medical school. Overall, the students exposed to OMFS at medical school performed superiorly (mdn = 13) to the OMFS-naïve students (mdn = 13), z-score = 2.185, p = 0.03, in correctly identifying cases to refer to an OMFS surgeon. They also were more likely to correctly identify the requirement of core surgical training (CST) (p = 0.04, χ² = 4.182) and membership of the Royal College of Surgeons (p = 0.02, χ² = 9.879) as needed to begin OMFS speciality training.

Conclusion

Exposure to OMFS is still limited within the medical undergraduate curriculum, and this is reflected in poor knowledge of OMFS. An increase in the amount of contact with OMFS at an undergraduate level would not only help create greater interest in OMFS as a career but would help doctors of all specialities when exposed to OMFS.

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Intratonsillar Abscess: A Not-So-Rare Clinical Entity

Publication date: Available online 3 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Jonathan P. Giurintano, Sarah Kortebein, Merry Sebelik, Jerome Thompson, Jennifer McLevy-Bazzanella

Abstract

Objective

To report the prevalence of intratonsillar abscess in the pediatric population at our institution and demonstrate that intratonsillar abscess is a more commonly encountered diagnosis than previously reported.

Methods

A retrospective chart review was performed that included patients presenting to our pediatric tertiary referral academic emergency department from January 1, 2014 to December 31, 2014 diagnosed with intratonsillar abscess on computed tomography.

Results

In the year 2014, 22 children were diagnosed with intratonsillar abscess by radiological criteria. The majority of patients (82%) required no surgical intervention and were successfully treated with antibiotics and supportive measures. All patients recovered from the infection uneventfully, and there were no treatment complications recorded.

Conclusion

Even in recent literature, intratonsillar abscess is described as a rare entity, with few cases reported. In our experience, CT imaging demonstrating the presence of intratonsillar abscess is more common than previously described. Regardless of treatment method, in our experience children with intratonsillar abscess do well clinically.

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Cochlear Implantation for Single-Sided Deafness in Children and Adolescents

Publication date: Available online 2 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Daniel M. Zeitler, Douglas P. Sladen, Melissa D. DeJong, Jennifer H. Torres, Michael F. Dorman, Matthew L. Carlson

Abstract

Objective

To evaluate audiometric outcomes in pediatric and adolescent patients with single-sided deafness (SSD) undergoing cochlear implantation.

Methods

A retrospective cohort design at two tertiary level academic cochlear implant centers. The subjects included nine children ages 1.5 to 15 years-old with single-sided deafness (SSD) who had undergone cochlear implantation in the affected ear. Objective outcome measures included were speech reception testing in quiet and noise, bimodal speech reception threshold testing in noise, tinnitus suppression, and device usage.

Results

Nine pediatric and adolescent patients with SSD were implanted between 2011-2016. The median age at implantation was 8.9 years (range, 1.5-15.1) and the children had a median duration of deafness 2.9 years (range, 0.8-9.5). There was variability in testing measures due to patient age. Median pre-operative aided word recognition scores on the affected side were <30% regardless of the testing paradigm used. Six patients had pre-operative word testing (4 CNC, median score 25%; 2 MLNT, 8% and 17%). Four patients had pre-operative sentence testing (3 AzBio, median score 44%; 1 HINT-C, 57%). Median post-implantation follow-up interval was 12.3 months (range, 3-27.6 months). Six subjects had post-operative word recognition testing (CNC median, 70%; MLNT 50%, 92%) with a median improvement of 45.5 percentage points. Five subjects had post-operative sentence testing (AzBio, median 82%; HINT, median 76%), with a median improvement of 40.5 percentage points. Eight patients are full time users of their device. Tinnitus and bimodal speech reception thresholds in noise were improved.

Conclusion

Pediatric subjects with SSD benefit substantially from cochlear implantation. Objective speech outcome measures are improved in both quiet and noise, and bimodal speech reception thresholds in noise are greatly improved. There is a low rate of device non-use.

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A Multi-site Cross-Sectional Survey Exploring Medical Undergraduate Knowledge of Oral and Maxillofacial Surgery

Abstract

Purpose

To evaluate medical student exposure to OMFS and knowledge of which clinical cases are appropriate to refer to the OMFS surgeon and the academic requirements to pursue a career in OMFS.

Methods

The investigators designed and distributed a cross-sectional survey to a cohort of current UK medical students. The primary outcome was medical student knowledge of the role of the OMFS, which was measured by their ability to correctly identify which cases were appropriate to refer to OMFS. Secondary outcomes included: identifying the proportion of students exposed to OMFS and the nature of this exposure; identifying student knowledge of the requirements to commence OMFS speciality training; and comparing knowledge of OMFS in those exposed to OMFS at medical school and those not exposed. The investigators hypothesised that undergraduates exposed to OMFS would have a greater understanding of the role of the OMFS and the requirements to pursue this speciality.

Results

Of the 299 participants included in this study, 77.4% (230) had no exposure to OMFS at medical school. Overall, the students exposed to OMFS at medical school performed superiorly (mdn = 13) to the OMFS-naïve students (mdn = 13), z-score = 2.185, p = 0.03, in correctly identifying cases to refer to an OMFS surgeon. They also were more likely to correctly identify the requirement of core surgical training (CST) (p = 0.04, χ² = 4.182) and membership of the Royal College of Surgeons (p = 0.02, χ² = 9.879) as needed to begin OMFS speciality training.

Conclusion

Exposure to OMFS is still limited within the medical undergraduate curriculum, and this is reflected in poor knowledge of OMFS. An increase in the amount of contact with OMFS at an undergraduate level would not only help create greater interest in OMFS as a career but would help doctors of all specialities when exposed to OMFS.

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Exploring Disease Immunogenicity and the Immunological Effects of Hypomethylating Agents in Acute Myeloid Leukemia

Condition:   Acute Myeloid Leukemia Intervention:   Genetic: Immunogenic profile Sponsor:   Istituto Scientifico Romagnolo per lo Studio e la cura dei Tumori Not yet recruiting (Source: ClinicalTrials.gov)

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Intestinal Microbiota on Allergy, Growth and Development

Condition:   Pregnancy Intervention:   Sponsor:   Chinese University of Hong Kong Recruiting (Source: ClinicalTrials.gov)

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Multiple Drug Hypersensitivity Syndrome

Condition:   Drug Allergy Intervention:   Sponsor:   University Hospital, Montpellier Not yet recruiting (Source: ClinicalTrials.gov)

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Dose, Safety, Tolerability, and Immunogenicity of an HIV-1 Vaccine, VRC-HIVRGP096-00-VP, With Alum in Healthy Adults < TAB >

Condition:   Human Immunodeficiency Virus (HIV) Intervention:   Biological: VRC-HIVRGP096-00-VP Sponsor:   National Institute of Allergy and Infectious Diseases (NIAID) Recruiting (Source: ClinicalTrials.gov)

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Therapeutic Drug Monitoring of Tocilizumab in Rheumatoid Arthritis

Conditions:   Rheumatoid Arthritis;   Tocilizumab Intervention:   Drug: Tocilizumab Sponsors:   Tel-Aviv Sourasky Medical Center;   Amsterdam Rheumatology and Immunology Center Recruiting (Source: ClinicalTrials.gov)

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Identification of Allergic Asthmatics Reactive to Felis Catus (Cat Hair) Allergen Inhalation

Condition:   Asthma Atopic Intervention:   Biological: Felis Catus Sponsors:   University of North Carolina, Chapel Hill;   National Heart, Lung, and Blood Institute (NHLBI) Not yet recruiting (Source: ClinicalTrials.gov)

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Exploring Disease Immunogenicity and the Immunological Effects of Hypomethylating Agents in Acute Myeloid Leukemia

Condition:   Acute Myeloid Leukemia Intervention:   Genetic: Immunogenic profile Sponsor:   Istituto Scientifico Romagnolo per lo Studio e la cura dei Tumori Not yet recruiting (Source: ClinicalTrials.gov)

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.

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Intestinal Microbiota on Allergy, Growth and Development

Condition:   Pregnancy Intervention:   Sponsor:   Chinese University of Hong Kong Recruiting (Source: ClinicalTrials.gov)

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Multiple Drug Hypersensitivity Syndrome

Condition:   Drug Allergy Intervention:   Sponsor:   University Hospital, Montpellier Not yet recruiting (Source: ClinicalTrials.gov)

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Dose, Safety, Tolerability, and Immunogenicity of an HIV-1 Vaccine, VRC-HIVRGP096-00-VP, With Alum in Healthy Adults < TAB >

Condition:   Human Immunodeficiency Virus (HIV) Intervention:   Biological: VRC-HIVRGP096-00-VP Sponsor:   National Institute of Allergy and Infectious Diseases (NIAID) Recruiting (Source: ClinicalTrials.gov)

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Therapeutic Drug Monitoring of Tocilizumab in Rheumatoid Arthritis

Conditions:   Rheumatoid Arthritis;   Tocilizumab Intervention:   Drug: Tocilizumab Sponsors:   Tel-Aviv Sourasky Medical Center;   Amsterdam Rheumatology and Immunology Center Recruiting (Source: ClinicalTrials.gov)

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Identification of Allergic Asthmatics Reactive to Felis Catus (Cat Hair) Allergen Inhalation

Condition:   Asthma Atopic Intervention:   Biological: Felis Catus Sponsors:   University of North Carolina, Chapel Hill;   National Heart, Lung, and Blood Institute (NHLBI) Not yet recruiting (Source: ClinicalTrials.gov)

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The effect of frontal sinus pneumatization on anatomic variants of paranasal sinuses

Abstract

Purpose

The aim of this study is to determine the effect of frontal sinus pneumatization on various variations of paranasal sinuses on maxillofacial CT.

Materials and methods

A total number of 120 patients (62 females, 58 males) were included in this study. Patients were divided into three groups regarding their frontal sinus pneumatization extent on paranasal sinus CT as Type 1 pneumatization (aplasia and hypoplasia), Type 2 pneumatization (medium) and Type 3 pneumatization (hyperplasia). The prevalence of various variations on paranasal sinus CT like pneumatization of upper and middle concha, presence of agger nasi, Haller and Onodi cell, maxillary sinus and sphenoid sinus hypoplasia, pneumatization of anterior clinoid process, pterygoid process and greater wing of sphenoid sinus, dehiscence and protrusion of internal carotid artery and optic nerve and vidian canal types were ascertained and compared within each group.

Results

The prevalence of upper and middle concha pneumatization, Haller cell, pneumatization of anterior clinoid process, pterygoid process and greater wing of sphenoid and internal carotid artery dehiscence and protrusion was higher in Type 3 group compared with other groups.

Conclusion

Excessive pneumatization of frontal sinus has various effects on paranasal sinus variations at maxillofacial CT. Surgeons dealing with endoscopic sinus surgery, maxillofacial and skull base surgery must be vigilant of association between certain variations when analyzing CT scan preoperatively for avoiding complications.

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A new approach to vocal cord leukoplakia and evaluation of proton pump ınhibitor treatment

Abstract

Purpose

Our aim is identify a new approach to vocal cord leukoplakia treatment and detect to efficiency of proton pump inhibitors.

Study design

Prospective, nonrandomized experimental clinical trial.

Methods

A 'First Assessment Scale' was prepared. This scale included the lesion's and the patient's characteristics. Using this scale, 24 patients included to the study. 20 mg rabeprazole twice daily was applied to all patients. At the end of 3rd month, a 'Second Assessment Scale' was used and two groups created. In group 1, 19 patients were accepted to responsive for the therapy and received the same therapy. The group 2 was included five patients that accepted unresponsive to treatment and directed to surgery. All patients received the same treatment additionally 3 months. At the end of 6th month, the Reflux Symptom Index (RSI), the Reflux Finding Score (RFS) and the Red–Green–Blue (RGB) values evaluated and comparisons were made.

Results

The RSI and RFS values were significantly decreased in all patients. The Red values were significantly decreased with treatment in group 1, but the Green and Blue values were not. In group 2, the RGB values were not showed the significant differences. In conclusion, seven patients (29,2%) showed complete lesion regression, 12 patients (50%) showed partial lesion regression and five patients (20,8%) showed no response to treatment.

Conclusions

The proton pump inhibitor treatment may be beneficial for the selected patients. The scales that we prepared were useful for lesion assesment.

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Clinical pattern of fungal balls in the paranasal sinuses: our experience with 70 patients

Abstract

Purpose

Many physicians recommend endoscopic sinus surgery (ESS) even when an asymptomatic paranasal sinus (PNS) fungal ball is detected incidentally. The aim of this study was to investigate the natural behavior of PNS fungal balls via sinus imaging techniques.

Methods

A follow-up study of 74 pathologically confirmed fungus balls was conducted in 70 patients who underwent multiple head and neck computed tomography (CT) scans or magnetic resonance imaging (MRI). We investigated the changes in symptoms and lesion size, as well as any new occurrences.

Results

Of the 74 fungus balls detected in 70 patients, we observed the renewed formation of a fungal ball in 21 patients, which was not present on initial imaging conducted over a period of 2–162 months. The fungal ball was already present in 53 patients on the initial screening, and the longest follow-up was 197 months (range 1–197 months). Of these 53 lesions, 29 lesions showed an increase in size (29/53, 54.7%), whereas 12 lesions were not associated with any clinical symptoms (12/53, 22.6%). In the 21 newly formed fungal balls, further development was observed in 10 lesions, with 4 lesions showing an increase in size. Thus, size increment occurred in 33 of the 57 fungus balls.

Conclusions

The fungal balls can exist without local tissue invasion for up to 17 years and new formation of the fungal balls was observed even within 2 months, especially when accompanied by initial clinical symptoms of sinusitis.

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A prospective, non-randomized evaluation of a novel low energy radiofrequency treatment for nasal obstruction and snoring

Abstract

Background

Weak or inward-bent cartilage of the nasal sidewall at the level of the internal nasal valve (INV) can produce narrowness or collapse of the nasal valve. This is a common cause of impaired nasal breathing during daily activities and there is also an established connection between nasal obstruction and snoring. The condition is often difficult to treat, although even a small enlargement of the lumen at the nasal valve can lead to a significant improvement in the ease of nasal breathing.

Methods

The primary objective of this prospective study was to evaluate the safety and efficacy of the Vivaer system for the treatment of narrowed nasal valves and to measure changes in the symptoms of nasal obstruction and snoring. The Vivaer system uses low energy radiofrequency to remodel the nasal sidewall in order to improve airflow.

Results

The study involved 31 patients presenting from 1st September 2017 to 1st May 2018 with symptoms of nasal obstruction and snoring. In all patients, an improvement was observed in nasal breathing measured by NOSE score, sleep quality by SOS questionnaire and quality of life as measured by EQ-5D and SNOT-22.

Conclusion

Vivaer intranasal remodeling can provide a durable and well-tolerated non-invasive treatment for those patients who are suffering congestion due to narrowness or collapse of the INV.

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The effect of frontal sinus pneumatization on anatomic variants of paranasal sinuses

Abstract

Purpose

The aim of this study is to determine the effect of frontal sinus pneumatization on various variations of paranasal sinuses on maxillofacial CT.

Materials and methods

A total number of 120 patients (62 females, 58 males) were included in this study. Patients were divided into three groups regarding their frontal sinus pneumatization extent on paranasal sinus CT as Type 1 pneumatization (aplasia and hypoplasia), Type 2 pneumatization (medium) and Type 3 pneumatization (hyperplasia). The prevalence of various variations on paranasal sinus CT like pneumatization of upper and middle concha, presence of agger nasi, Haller and Onodi cell, maxillary sinus and sphenoid sinus hypoplasia, pneumatization of anterior clinoid process, pterygoid process and greater wing of sphenoid sinus, dehiscence and protrusion of internal carotid artery and optic nerve and vidian canal types were ascertained and compared within each group.

Results

The prevalence of upper and middle concha pneumatization, Haller cell, pneumatization of anterior clinoid process, pterygoid process and greater wing of sphenoid and internal carotid artery dehiscence and protrusion was higher in Type 3 group compared with other groups.

Conclusion

Excessive pneumatization of frontal sinus has various effects on paranasal sinus variations at maxillofacial CT. Surgeons dealing with endoscopic sinus surgery, maxillofacial and skull base surgery must be vigilant of association between certain variations when analyzing CT scan preoperatively for avoiding complications.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2R7Z3sY

A new approach to vocal cord leukoplakia and evaluation of proton pump ınhibitor treatment

Abstract

Purpose

Our aim is identify a new approach to vocal cord leukoplakia treatment and detect to efficiency of proton pump inhibitors.

Study design

Prospective, nonrandomized experimental clinical trial.

Methods

A 'First Assessment Scale' was prepared. This scale included the lesion's and the patient's characteristics. Using this scale, 24 patients included to the study. 20 mg rabeprazole twice daily was applied to all patients. At the end of 3rd month, a 'Second Assessment Scale' was used and two groups created. In group 1, 19 patients were accepted to responsive for the therapy and received the same therapy. The group 2 was included five patients that accepted unresponsive to treatment and directed to surgery. All patients received the same treatment additionally 3 months. At the end of 6th month, the Reflux Symptom Index (RSI), the Reflux Finding Score (RFS) and the Red–Green–Blue (RGB) values evaluated and comparisons were made.

Results

The RSI and RFS values were significantly decreased in all patients. The Red values were significantly decreased with treatment in group 1, but the Green and Blue values were not. In group 2, the RGB values were not showed the significant differences. In conclusion, seven patients (29,2%) showed complete lesion regression, 12 patients (50%) showed partial lesion regression and five patients (20,8%) showed no response to treatment.

Conclusions

The proton pump inhibitor treatment may be beneficial for the selected patients. The scales that we prepared were useful for lesion assesment.

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Clinical pattern of fungal balls in the paranasal sinuses: our experience with 70 patients

Abstract

Purpose

Many physicians recommend endoscopic sinus surgery (ESS) even when an asymptomatic paranasal sinus (PNS) fungal ball is detected incidentally. The aim of this study was to investigate the natural behavior of PNS fungal balls via sinus imaging techniques.

Methods

A follow-up study of 74 pathologically confirmed fungus balls was conducted in 70 patients who underwent multiple head and neck computed tomography (CT) scans or magnetic resonance imaging (MRI). We investigated the changes in symptoms and lesion size, as well as any new occurrences.

Results

Of the 74 fungus balls detected in 70 patients, we observed the renewed formation of a fungal ball in 21 patients, which was not present on initial imaging conducted over a period of 2–162 months. The fungal ball was already present in 53 patients on the initial screening, and the longest follow-up was 197 months (range 1–197 months). Of these 53 lesions, 29 lesions showed an increase in size (29/53, 54.7%), whereas 12 lesions were not associated with any clinical symptoms (12/53, 22.6%). In the 21 newly formed fungal balls, further development was observed in 10 lesions, with 4 lesions showing an increase in size. Thus, size increment occurred in 33 of the 57 fungus balls.

Conclusions

The fungal balls can exist without local tissue invasion for up to 17 years and new formation of the fungal balls was observed even within 2 months, especially when accompanied by initial clinical symptoms of sinusitis.

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A prospective, non-randomized evaluation of a novel low energy radiofrequency treatment for nasal obstruction and snoring

Abstract

Background

Weak or inward-bent cartilage of the nasal sidewall at the level of the internal nasal valve (INV) can produce narrowness or collapse of the nasal valve. This is a common cause of impaired nasal breathing during daily activities and there is also an established connection between nasal obstruction and snoring. The condition is often difficult to treat, although even a small enlargement of the lumen at the nasal valve can lead to a significant improvement in the ease of nasal breathing.

Methods

The primary objective of this prospective study was to evaluate the safety and efficacy of the Vivaer system for the treatment of narrowed nasal valves and to measure changes in the symptoms of nasal obstruction and snoring. The Vivaer system uses low energy radiofrequency to remodel the nasal sidewall in order to improve airflow.

Results

The study involved 31 patients presenting from 1st September 2017 to 1st May 2018 with symptoms of nasal obstruction and snoring. In all patients, an improvement was observed in nasal breathing measured by NOSE score, sleep quality by SOS questionnaire and quality of life as measured by EQ-5D and SNOT-22.

Conclusion

Vivaer intranasal remodeling can provide a durable and well-tolerated non-invasive treatment for those patients who are suffering congestion due to narrowness or collapse of the INV.

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Les suites de la reconstruction mammaire immédiate : comparaison de cinq techniques chirurgicales

Publication date: Available online 2 January 2019

Source: Annales de Chirurgie Plastique Esthétique

Author(s): A. Durry, A. Baratte, C. Mathelin, C. Bruant-Rodier, F. Bodin

Résumé

Introduction

Cette étude analyse les suites postopératoires des différentes techniques de reconstructions mammaires immédiates : DIEP, gracilis, grand dorsal autologue, prothèse d'expansion et prothèse définitive.

Matériel et méthodes

Toutes les patientes opérées d'une RMI entre 2012 et 2017 au CHU de Strasbourg ont été incluses dans cette étude rétrospective. Les principaux paramètres recueillis étaient le temps de cicatrisation, les complications, reprises et échecs. Ces données ont été comparées entre les cinq techniques de reconstructions à la recherche de différences significatives. Ces techniques chirurgicales ont été regroupées en deux groupes : les lambeaux libres et les prothèses. Les données de ces deux groupes ont été comparées également.

Résultats

Cent quatre-vingt-treize patientes ont été prises en charge entre 2012 et 2017. Parmi celles-ci, 44 ont bénéficié d'une reconstruction bilatérale (23 %). Les complications précoces et peu graves étaient moins fréquentes dans le groupe prothèses que dans le groupe lambeaux libres : 8,6 % vs 33,3 % (p < 0,01) pour les RMI unilatérales et 10,9 % vs 38,9 % (p < 0,01) pour les bilatérales. Aucun échec n'était reporté dans le groupe lambeau libre contre 6,2 % pour les prothèses définitives et 3,6 % pour les prothèses d'expansion. La cicatrisation était plus longue dans le groupe lambeaux libres que dans le groupe prothèses : 5,6 semaines vs 4,2 semaines (p < 0,01).

Conclusion

La RMI par lambeau libre est associée à un risque plus important de complications précoces et peu graves à type de trouble de la cicatrisation, qui prolongent la durée des soins locaux. En revanche, le taux d'échec n'est pas supérieur avec les lambeaux libres.

Summary

Introduction

This study analyzes postoperative course of different immediate breast reconstruction techniques: deep inferior epigastric perforator flap (DIEP), gracilis, latissimus dorsi flap, expander implants and definitive implants.

Methods

All women operated on IBR between 2012 and 2017 in the CHU Strasbourg were included in this retrospective study. The main data collected were healing time, complications, surgical revisions and failure rates. These data were compared between the five IBR techniques to find a significant difference. Two groups were distinguished according to the surgical techniques: free flaps and implants. Data of those groups were compared too.

Results

One hundred and ninety three patients have had a breast surgical treatment between 2012 and 2017. Among them, 44 had a bilateral IBR (23%). Early and unserious complications, were less frequent in the implants group than in the free flaps group: 8.6% vs. 33.3% (P < 0.01) for unilateral reconstructions and 10.9% vs. 38.9% (P < 0.01) for bilateral reconstructions. No surgical failures were found in the free flaps group versus 6.2% for definitive implants and 3.6% for expander implants. Healing time was longer for the free flaps group than for the prothesis group: 5.6 weeks vs. 4.2 weeks, (P < 0.01).

Conclusion

IBR with free flaps is associated with a higher risk for early and unserious complications as healing disorders, which extend the dressings time. However the failure rate is not higher with free flaps.

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Les suites de la reconstruction mammaire immédiate : comparaison de cinq techniques chirurgicales

Publication date: Available online 2 January 2019

Source: Annales de Chirurgie Plastique Esthétique

Author(s): A. Durry, A. Baratte, C. Mathelin, C. Bruant-Rodier, F. Bodin

Résumé

Introduction

Cette étude analyse les suites postopératoires des différentes techniques de reconstructions mammaires immédiates : DIEP, gracilis, grand dorsal autologue, prothèse d'expansion et prothèse définitive.

Matériel et méthodes

Toutes les patientes opérées d'une RMI entre 2012 et 2017 au CHU de Strasbourg ont été incluses dans cette étude rétrospective. Les principaux paramètres recueillis étaient le temps de cicatrisation, les complications, reprises et échecs. Ces données ont été comparées entre les cinq techniques de reconstructions à la recherche de différences significatives. Ces techniques chirurgicales ont été regroupées en deux groupes : les lambeaux libres et les prothèses. Les données de ces deux groupes ont été comparées également.

Résultats

Cent quatre-vingt-treize patientes ont été prises en charge entre 2012 et 2017. Parmi celles-ci, 44 ont bénéficié d'une reconstruction bilatérale (23 %). Les complications précoces et peu graves étaient moins fréquentes dans le groupe prothèses que dans le groupe lambeaux libres : 8,6 % vs 33,3 % (p < 0,01) pour les RMI unilatérales et 10,9 % vs 38,9 % (p < 0,01) pour les bilatérales. Aucun échec n'était reporté dans le groupe lambeau libre contre 6,2 % pour les prothèses définitives et 3,6 % pour les prothèses d'expansion. La cicatrisation était plus longue dans le groupe lambeaux libres que dans le groupe prothèses : 5,6 semaines vs 4,2 semaines (p < 0,01).

Conclusion

La RMI par lambeau libre est associée à un risque plus important de complications précoces et peu graves à type de trouble de la cicatrisation, qui prolongent la durée des soins locaux. En revanche, le taux d'échec n'est pas supérieur avec les lambeaux libres.

Summary

Introduction

This study analyzes postoperative course of different immediate breast reconstruction techniques: deep inferior epigastric perforator flap (DIEP), gracilis, latissimus dorsi flap, expander implants and definitive implants.

Methods

All women operated on IBR between 2012 and 2017 in the CHU Strasbourg were included in this retrospective study. The main data collected were healing time, complications, surgical revisions and failure rates. These data were compared between the five IBR techniques to find a significant difference. Two groups were distinguished according to the surgical techniques: free flaps and implants. Data of those groups were compared too.

Results

One hundred and ninety three patients have had a breast surgical treatment between 2012 and 2017. Among them, 44 had a bilateral IBR (23%). Early and unserious complications, were less frequent in the implants group than in the free flaps group: 8.6% vs. 33.3% (P < 0.01) for unilateral reconstructions and 10.9% vs. 38.9% (P < 0.01) for bilateral reconstructions. No surgical failures were found in the free flaps group versus 6.2% for definitive implants and 3.6% for expander implants. Healing time was longer for the free flaps group than for the prothesis group: 5.6 weeks vs. 4.2 weeks, (P < 0.01).

Conclusion

IBR with free flaps is associated with a higher risk for early and unserious complications as healing disorders, which extend the dressings time. However the failure rate is not higher with free flaps.

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Female undergraduate dental students may present higher depressive symptoms: a systematic review

Abstract

Depressive disorder is a prevalent mental disorder that may be manifested by dysphoric mood and loss of interest or pleasure in daily activities (de Zwart, Jeronimus, & de Jonge, 2018). Episodes of depression may be triggered by mild chronic stress (Mahar, Bambico, Mechawar, & Nobrega, 2014). Higher workload, emotional burden, and demand for technical skills may be examples of stressors that are increased in dental students (Alzahem, Van der Molen, & De Boer, 2013). Therefore, it is not surprising that dental students may experience elevated rates of depression when compared with the general population.

This article is protected by copyright. All rights reserved.

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Female undergraduate dental students may present higher depressive symptoms: a systematic review

Abstract

Depressive disorder is a prevalent mental disorder that may be manifested by dysphoric mood and loss of interest or pleasure in daily activities (de Zwart, Jeronimus, & de Jonge, 2018). Episodes of depression may be triggered by mild chronic stress (Mahar, Bambico, Mechawar, & Nobrega, 2014). Higher workload, emotional burden, and demand for technical skills may be examples of stressors that are increased in dental students (Alzahem, Van der Molen, & De Boer, 2013). Therefore, it is not surprising that dental students may experience elevated rates of depression when compared with the general population.

This article is protected by copyright. All rights reserved.

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Clinical evaluation of two dark blood methods of late gadolinium quantification of ischemic scar

Background

Late gadolinium enhancement (LGE) imaging was validated for diagnosis and quantification of myocardial infarction (MI). Despite good contrast between scar and normal myocardium, contrast between blood pool and myocardial scar can be limited. Dark blood LGE sequences attempt to overcome this issue.

Purpose

To evaluate T₁ rho (T₁ρ)‐prepared dark blood sequence and compare to blood nulled (BN) phase sensitive inversion recovery (PSIR) and standard myocardium nulled (MN) PSIR for detection and quantification of scar.

Study Type

Prospective.

Population

Thirty patients with prior MI.

Field Strength/Sequence

Patients underwent identical 1.5 T MRI protocols. Following routine LGE imaging, a slice with scar, remote myocardium, and blood pool was selected. PSIR LGE was repeated with inversion time set to MN, to BN, and T₁ρ FIDDLE (flow‐independent dark‐blood delayed enhancement) in random order.

Assessment

Three observers. Qualitative assessment of confidence scores in scar detection and degree of transmurality. Quantitative assessment of myocardial scar mass (grams), and contrast‐to‐noise ratio (CNR) measurements between scar, blood pool, and myocardium.

Statistical Tests

Repeated‐measures analysis of variance (ANOVA) with Bonferroni correction, coefficient of variation, and the Cohen κ statistic.

Results

CNR_scar‐blood was significantly increased for both BN (27.1 ± 10.4) and T₁ρ (30.2 ± 15.1) compared with MN (15.3 ± 8.4 P < 0.001 for both sequences). There was no significant difference in CNR_scar‐myo between BN (55.9 ± 17.3) and MN (51.1 ± 17.8 P = 0.512); both had significantly higher CNR_scar‐myo compared with the T₁ρ (42.6 ± 16.9 P = 0.007 and P = 0.014, respectively). No significant difference in scar size between LGE methods: MN (2.28 ± 1.58 g) BN (2.16 ± 1.57 g) and T₁ρ (2.29 ± 2.5 g). Confidence scores were significantly higher for BN (3.87 ± 0.346) compared with MN (3.1 ± 0.76 P < 0.001) and T₁ρ (3.20 ± 0.71 P < 0.001).

Data Conclusion

PSIR with inversion time (TI) set for blood nulling and the T₁ρ LGE sequence demonstrated significantly higher scar to blood CNR compared with routine MN. PSIR with TI set for blood nulling demonstrated significantly higher reader confidence scores compared with routine MN and T₁ρ LGE, suggesting routine adoption of a BN PSIR approach might be appropriate for LGE imaging.

Level of Evidence: 2

Technical Efficacy: Stage 2

J. Magn. Reson. Imaging 2018.

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Clinical evaluation of two dark blood methods of late gadolinium quantification of ischemic scar

Background

Late gadolinium enhancement (LGE) imaging was validated for diagnosis and quantification of myocardial infarction (MI). Despite good contrast between scar and normal myocardium, contrast between blood pool and myocardial scar can be limited. Dark blood LGE sequences attempt to overcome this issue.

Purpose

To evaluate T₁ rho (T₁ρ)‐prepared dark blood sequence and compare to blood nulled (BN) phase sensitive inversion recovery (PSIR) and standard myocardium nulled (MN) PSIR for detection and quantification of scar.

Study Type

Prospective.

Population

Thirty patients with prior MI.

Field Strength/Sequence

Patients underwent identical 1.5 T MRI protocols. Following routine LGE imaging, a slice with scar, remote myocardium, and blood pool was selected. PSIR LGE was repeated with inversion time set to MN, to BN, and T₁ρ FIDDLE (flow‐independent dark‐blood delayed enhancement) in random order.

Assessment

Three observers. Qualitative assessment of confidence scores in scar detection and degree of transmurality. Quantitative assessment of myocardial scar mass (grams), and contrast‐to‐noise ratio (CNR) measurements between scar, blood pool, and myocardium.

Statistical Tests

Repeated‐measures analysis of variance (ANOVA) with Bonferroni correction, coefficient of variation, and the Cohen κ statistic.

Results

CNR_scar‐blood was significantly increased for both BN (27.1 ± 10.4) and T₁ρ (30.2 ± 15.1) compared with MN (15.3 ± 8.4 P < 0.001 for both sequences). There was no significant difference in CNR_scar‐myo between BN (55.9 ± 17.3) and MN (51.1 ± 17.8 P = 0.512); both had significantly higher CNR_scar‐myo compared with the T₁ρ (42.6 ± 16.9 P = 0.007 and P = 0.014, respectively). No significant difference in scar size between LGE methods: MN (2.28 ± 1.58 g) BN (2.16 ± 1.57 g) and T₁ρ (2.29 ± 2.5 g). Confidence scores were significantly higher for BN (3.87 ± 0.346) compared with MN (3.1 ± 0.76 P < 0.001) and T₁ρ (3.20 ± 0.71 P < 0.001).

Data Conclusion

PSIR with inversion time (TI) set for blood nulling and the T₁ρ LGE sequence demonstrated significantly higher scar to blood CNR compared with routine MN. PSIR with TI set for blood nulling demonstrated significantly higher reader confidence scores compared with routine MN and T₁ρ LGE, suggesting routine adoption of a BN PSIR approach might be appropriate for LGE imaging.

Level of Evidence: 2

Technical Efficacy: Stage 2

J. Magn. Reson. Imaging 2018.

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Head and neck microsurgical reconstruction using the superficial temporal vein for antegrade and retrograde drainage: A clinical case series

Abstract

Background

In head and neck microsurgical reconstruction, previous surgery and past radiation exposure to the neck may adversely affect recipient vessel access in the neck. The superficial temporal vessels can be used to overcome these challenges. The purpose of this article is to demonstrate the viability of using the superficial temporal vein (STV) for a double venous anastomosis, for antegrade and retrograde drainage, in head and neck microvascular free flap transfers.

Methods

An 11-year retrospective chart review was performed of clinical cases of head and neck reconstruction by free tissue transfer, in which the recipient vessels used were the superficial temporal artery (STA) and vein, with the latter providing for dual antegrade and retrograde drainage.

Results

The case series comprised of six patients who underwent free flap reconstruction of craniofacial defects following resection of malignant tumours in five, and due to noma in one. Compromising factors were scarring, radiotherapy, previous surgery and the recipient superficial temporal vein being less than 1 mm in diameter above the parotid. The recipient vessels used were the superficial temporal artery and veins in all cases.

Conclusions

The use of the superficial temporal blood supply for a single arterial supply and a dual antegrade and retrograde venous drainage is a reliable technique for free flaps to the upper two thirds of the head. A double venous anastomosis adds to its dependability.

Level of Evidence: Level IV, therapeutic study.

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Treatment of vaginal relaxation syndrome with an Erbium:YAG laser 360° scanning scope via automatic dual mode technique

Abstract

Background

Vaginal relaxation syndrome (VRS) is a common phenomenon affecting women and their partners which may lead to decreased sexual satisfaction. Recently, the use of 2940-nm Erbium:YAG laser (Er:YAG) has been extended to cosmetic gynecology to treat VRS. This study evaluated the efficacy of this non-surgical laser procedure.

Methods

From October 2014 till January 2017, 39 females with vaginal relaxation syndrome (VRS) were treated with the 2940-nm Er:YAG. Their ages ranged from 27 to 47. Those 39 patients received one to four treatment sessions at 2–3-week intervals. The sessions were performed with a 360° scope via automatic dual step technique. The first step consisted of three passes of multiple pulses ranging from 1.7 to 2.2 J per pulse. The second step consisted of two passes of long-pulsed wave of 3.7 J and a pulse width of 1 s. The improvement in sexual satisfaction was assessed subjectively by patients' questionnaire.

Results

Improvement in sexual satisfaction was reported by 78% of the patients. A few minor side effects were reported such as vaginal ecchymosis and mild burning sensation.

Conclusions

In patients suffering from VRS, the use of automatic dual pass technique Er:YAG is a convenient non-surgical method to obtain reasonable tightening of vaginal wall and improve sexual satisfaction.

Level of Evidence: Level IV, case series study.

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Head and neck microsurgical reconstruction using the superficial temporal vein for antegrade and retrograde drainage: A clinical case series

Abstract

Background

In head and neck microsurgical reconstruction, previous surgery and past radiation exposure to the neck may adversely affect recipient vessel access in the neck. The superficial temporal vessels can be used to overcome these challenges. The purpose of this article is to demonstrate the viability of using the superficial temporal vein (STV) for a double venous anastomosis, for antegrade and retrograde drainage, in head and neck microvascular free flap transfers.

Methods

An 11-year retrospective chart review was performed of clinical cases of head and neck reconstruction by free tissue transfer, in which the recipient vessels used were the superficial temporal artery (STA) and vein, with the latter providing for dual antegrade and retrograde drainage.

Results

The case series comprised of six patients who underwent free flap reconstruction of craniofacial defects following resection of malignant tumours in five, and due to noma in one. Compromising factors were scarring, radiotherapy, previous surgery and the recipient superficial temporal vein being less than 1 mm in diameter above the parotid. The recipient vessels used were the superficial temporal artery and veins in all cases.

Conclusions

The use of the superficial temporal blood supply for a single arterial supply and a dual antegrade and retrograde venous drainage is a reliable technique for free flaps to the upper two thirds of the head. A double venous anastomosis adds to its dependability.

Level of Evidence: Level IV, therapeutic study.

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Treatment of vaginal relaxation syndrome with an Erbium:YAG laser 360° scanning scope via automatic dual mode technique

Abstract

Background

Vaginal relaxation syndrome (VRS) is a common phenomenon affecting women and their partners which may lead to decreased sexual satisfaction. Recently, the use of 2940-nm Erbium:YAG laser (Er:YAG) has been extended to cosmetic gynecology to treat VRS. This study evaluated the efficacy of this non-surgical laser procedure.

Methods

From October 2014 till January 2017, 39 females with vaginal relaxation syndrome (VRS) were treated with the 2940-nm Er:YAG. Their ages ranged from 27 to 47. Those 39 patients received one to four treatment sessions at 2–3-week intervals. The sessions were performed with a 360° scope via automatic dual step technique. The first step consisted of three passes of multiple pulses ranging from 1.7 to 2.2 J per pulse. The second step consisted of two passes of long-pulsed wave of 3.7 J and a pulse width of 1 s. The improvement in sexual satisfaction was assessed subjectively by patients' questionnaire.

Results

Improvement in sexual satisfaction was reported by 78% of the patients. A few minor side effects were reported such as vaginal ecchymosis and mild burning sensation.

Conclusions

In patients suffering from VRS, the use of automatic dual pass technique Er:YAG is a convenient non-surgical method to obtain reasonable tightening of vaginal wall and improve sexual satisfaction.

Level of Evidence: Level IV, case series study.

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Treatment of vaginal relaxation syndrome with an Erbium:YAG laser 360° scanning scope via automatic dual mode technique

Abstract

Background

Vaginal relaxation syndrome (VRS) is a common phenomenon affecting women and their partners which may lead to decreased sexual satisfaction. Recently, the use of 2940-nm Erbium:YAG laser (Er:YAG) has been extended to cosmetic gynecology to treat VRS. This study evaluated the efficacy of this non-surgical laser procedure.

Methods

From October 2014 till January 2017, 39 females with vaginal relaxation syndrome (VRS) were treated with the 2940-nm Er:YAG. Their ages ranged from 27 to 47. Those 39 patients received one to four treatment sessions at 2–3-week intervals. The sessions were performed with a 360° scope via automatic dual step technique. The first step consisted of three passes of multiple pulses ranging from 1.7 to 2.2 J per pulse. The second step consisted of two passes of long-pulsed wave of 3.7 J and a pulse width of 1 s. The improvement in sexual satisfaction was assessed subjectively by patients' questionnaire.

Results

Improvement in sexual satisfaction was reported by 78% of the patients. A few minor side effects were reported such as vaginal ecchymosis and mild burning sensation.

Conclusions

In patients suffering from VRS, the use of automatic dual pass technique Er:YAG is a convenient non-surgical method to obtain reasonable tightening of vaginal wall and improve sexual satisfaction.

Level of Evidence: Level IV, case series study.

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Treatment of vaginal relaxation syndrome with an Erbium:YAG laser 360° scanning scope via automatic dual mode technique

Abstract

Background

Vaginal relaxation syndrome (VRS) is a common phenomenon affecting women and their partners which may lead to decreased sexual satisfaction. Recently, the use of 2940-nm Erbium:YAG laser (Er:YAG) has been extended to cosmetic gynecology to treat VRS. This study evaluated the efficacy of this non-surgical laser procedure.

Methods

From October 2014 till January 2017, 39 females with vaginal relaxation syndrome (VRS) were treated with the 2940-nm Er:YAG. Their ages ranged from 27 to 47. Those 39 patients received one to four treatment sessions at 2–3-week intervals. The sessions were performed with a 360° scope via automatic dual step technique. The first step consisted of three passes of multiple pulses ranging from 1.7 to 2.2 J per pulse. The second step consisted of two passes of long-pulsed wave of 3.7 J and a pulse width of 1 s. The improvement in sexual satisfaction was assessed subjectively by patients' questionnaire.

Results

Improvement in sexual satisfaction was reported by 78% of the patients. A few minor side effects were reported such as vaginal ecchymosis and mild burning sensation.

Conclusions

In patients suffering from VRS, the use of automatic dual pass technique Er:YAG is a convenient non-surgical method to obtain reasonable tightening of vaginal wall and improve sexual satisfaction.

Level of Evidence: Level IV, case series study.

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Depth of invasion alone as a prognostic factor in low‐risk early‐stage oral cavity carcinoma

Objectives

To evaluate the significance of increasing depth of invasion (DOI) as the sole risk factor for recurrence in patients with low‐risk early‐stage oral cavity squamous cell carcinoma (OCSCC).

Methods

We retrospectively reviewed 560 patients with OCSCC treated at our institution between 2003 and 2013. Patients were included if they had low‐risk early‐stage OCSCC treated with surgical resection ± neck dissection and no adjuvant therapy. Low risk was defined as absence of positive or close margins, lymphovascular invasion, perineural invasion, and positive lymph nodes. Patients with tumor (T)3‐T4 disease were excluded. Pathology specimens were independently re‐reviewed by two board‐certified pathologists to confirm proper measurement of DOI. Kaplan‐Meier and Cox proportional hazards regression analyses were performed to identify factors predictive for recurrence as well as progression‐free survival (PFS) and overall survival (OS).

Results

A total of 126 patients with low‐risk early‐stage T1‐2N0 OCSCC were included. Median follow‐up time was 42.5 months and median DOI was 4 mm. There was no significant difference in incidence of local (P = 0.95), regional (P = 0.81), or distant recurrence (P = 0.96) among patients with DOI < 4 mm versus ≥4 mm. On multivariable analysis, DOI was significant for both PFS (P = 0.03) and OS (P = 0.002).

Conclusion

In this study, we show that in the absence of other high‐risk pathologic features, DOI ≥ 4 mm does not portend for increased incidence of local, regional, or distant relapse in patients treated with surgery alone; however, increasing DOI is a marker for worse PFS and OS in patients with low‐risk, early‐stage OCSCC.

Level of Evidence

4. Laryngoscope, 2019

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Mandibular muscle attachments in genial advancement surgery for obstructive sleep apnea

Objectives/Hypothesis

Genioglossus advancement is performed in select patients with obstructive sleep apnea. Surgical techniques attempt to capture the genial tubercle of the mandible; however, measurements of the genioglossus, geniohyoid, and digastric muscles are poorly delineated. This investigation is the largest anatomic study exploring the muscles of genial advancement surgery and the first to quantitatively characterize muscular attachments relative to the tubercle, providing new insights from an anatomic perspective on optimizing muscular advancement.

Study Design

Cadaveric study.

Methods

Fifty‐three fresh cadaveric mandibles underwent dissection of the genial tubercle and genioglossus, geniohyoid, and digastric muscles.

Results

Genial tubercle, geniohyoid, and genioglossus mean height was 7.78 mm, 5.15 mm, and 6.11 mm, respectively. On average, the geniohyoid began 4.88 mm and ended 10.03 mm from the inferior border of the mandible; the genioglossus 11.91 mm and 18.01 mm, similarly. Intermuscular distance, if present, was 2.67 mm; the muscles overlapped in 28% of cadavers. The combined vertical height of the muscles at their mandibular attachment was 13.94 mm, significantly differing from the height of the genial tubercle. The left and right lateral insertion of the digastric muscles was 19.34 mm and 19.31 mm, respectively, from midline.

Conclusions

The variable range of muscle attachments suggests that genioglossal and geniohyoid attachments extend beyond the genial tubercle and may not originate concentrically from the tubercle, but overlap and lie in very close proximity. Mandibular anterior muscle attachments require anatomic accuracy and an effective operative evaluation of advancement before reproducible, clinically effective osteotomies can be recommended.

Level of Evidence

NA Laryngoscope, 2019

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