A re‐introduction of environmental mite allergen control strategies for asthma treatment and the debate on their effectiveness

Abstract

Asthma affects three hundred million people worldwide. The effectiveness of house dust mite allergen control for asthma treatment is debatable. One aspect that has been little discussed in existing meta‐analyses is the possible role of environmental strategies. Here, we re‐introduce the previously defined strategies for mite allergen control and discuss their importance to the debate on clinical effectiveness. The strategy of concurrent bedroom interventions is related to the combined use of a priori defined interventions, while the strategy of exposure‐based control relates to the treatment of relevant textiles after assessing exposure. The air purification strategy aims to purify the human breathing zone of airborne allergens. In Western European patient practice, the use of these strategies differs. A post hoc study of the dominant Cochrane review by Gøtzsche and Johansen (Cochrane Database of Systematic Reviews, 2008, Art. No: CD001187) appears to indicate that a majority of the underlying trials reported on the strategy of concurrent bedroom interventions, which were mainly executed in a minimal manner. Some trials have reported on the air purification strategy and may potentially alter the debate on effectiveness. No trial has reported on the strategy of exposure‐based control. We therefore hypothesize that the absence of evidence for the effectiveness of mite allergen control for asthma treatment applies to the strategy of concurrent bedroom interventions. The evidence‐based effectiveness of the exposure‐based control strategy appears to be undetermined. The results of our post hoc re‐analysis urge that future meta‐analyses of mite allergen control should a priori define the environmental strategy under study. Future trials of mite allergen control are warranted to test the exposure‐based strategy as well as the sparsely tested strategy of air purification.

This article is protected by copyright. All rights reserved.

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“Sinus Headache”: Diagnosis and Dilemma?? An Analytical and Prospective Study

AbstractTo evaluate the type, location, severity of headache and their relation to various nasal and sinus related pathological conditions. All the patients presenting with acute and chronic sinus and nasal infections along with headache were included in the study. The diagnostic confirmation was done with clinical along with radiological and endoscopic evaluation. Various parameters categorized accordingly. Chronic rhinosinusitis/chronic recurrent rhinosinusitis are the most common nasal condition seen in oto-rhino-laryngology OPD which has enormous economic burden and significant morbidity on general population. The headache is the commonest associated symptom which is needed to be given attention. The location, variation, pattern of the headache can guide us towards the correct diagnosi...

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Spontaneous Resolution of Fourth Branchial Fistula Following Thyroid Surgery: Case Report

We present a case of a 43-year-old man with accidental finding of asymptomatic fourth pouch cyst and fistula following follicular thyroid cancer surgery. The day after the surgery, suction bottle was filled with little white crumbs and the wound started to suppurate. Barium swallow revealed the presence of a fistulous canal that arose from the left pyriform sinus. Meanwhile, the pathologist confirmed the presence of a lateral neck cyst within this thyroid lobe. The patient was operated on but fistulous canal was not visualized. In the meantime, wound discharge ceased spontaneously. At 1-year follow up, the patient was still well and free from any symptoms. These anomalies may manifest not only in childhood but may stay asymptomatic for a long time. It seems that the fistula can resolve spo...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2T3hCeN

“Sinus Headache”: Diagnosis and Dilemma?? An Analytical and Prospective Study

AbstractTo evaluate the type, location, severity of headache and their relation to various nasal and sinus related pathological conditions. All the patients presenting with acute and chronic sinus and nasal infections along with headache were included in the study. The diagnostic confirmation was done with clinical along with radiological and endoscopic evaluation. Various parameters categorized accordingly. Chronic rhinosinusitis/chronic recurrent rhinosinusitis are the most common nasal condition seen in oto-rhino-laryngology OPD which has enormous economic burden and significant morbidity on general population. The headache is the commonest associated symptom which is needed to be given attention. The location, variation, pattern of the headache can guide us towards the correct diagnosi...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2ATC4rc

Spontaneous Resolution of Fourth Branchial Fistula Following Thyroid Surgery: Case Report

We present a case of a 43-year-old man with accidental finding of asymptomatic fourth pouch cyst and fistula following follicular thyroid cancer surgery. The day after the surgery, suction bottle was filled with little white crumbs and the wound started to suppurate. Barium swallow revealed the presence of a fistulous canal that arose from the left pyriform sinus. Meanwhile, the pathologist confirmed the presence of a lateral neck cyst within this thyroid lobe. The patient was operated on but fistulous canal was not visualized. In the meantime, wound discharge ceased spontaneously. At 1-year follow up, the patient was still well and free from any symptoms. These anomalies may manifest not only in childhood but may stay asymptomatic for a long time. It seems that the fistula can resolve spo...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2T3hCeN

Regulation of water‐soluble glucan synthesis by the Streptococcus mutans dexA gene effects biofilm aggregation and cariogenic pathogenicity

Abstract

The cariogenic pathogen Streptococcus mutans (S. mutans) effectively utilizes dietary sucrose for the synthesis of exopolysaccharides (EPS), which act as a scaffold for its biofilm and thus contribute to its cariogenic pathogenicity. Dextranase (Dex), which is a type of glucanase, participates in the degradation of water‐soluble glucan; however, the structural features of the exopolysaccharides regulated by the dexA gene have received limited attention. Our recent studies reported novel protocols to fractionate and analyzed the structural characteristics of glucans from S. mutans biofilms. In this study, we identify the role of the S. mutans dexA gene in dextran‐dependent aggregation in biofilm formation. Our results show that deletion of dexA (SmudexA) results in increased transcription of exopolysaccharide synthesis‐related genes, including gtfB, gtfD, and ftf. Interestingly, we reveal that inactivating the dexA gene may lead to elevated water‐soluble glucan (WSG) synthesis in S. mutans, which results in dysregulated cariogenicity in vivo. Furthermore, structural analysis provides new insights regarding the lack of mannose monosaccharides, especially in the water‐soluble glucan synthesis of the SmudexA mutants. The biofilm phenotypes that are associated with the reduced glucose monosaccharide composition in both WSG and water‐insoluble glucan (WIG) shift the dental biofilm to reduce the cariogenic incidence of the SmudexA mutants. Taken together, these data reveal that exopolysaccharide synthesis fine‐tuning by the dexA gene results in a densely packed EPS matrix that may impede the glucose metabolism of WSG, thereby leading to the lack of an energy source for the bacteria. These results highlight dexA targeting as a potentially effective tool in dental caries management.

This article is protected by copyright. All rights reserved.

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

Regulation of water‐soluble glucan synthesis by the Streptococcus mutans dexA gene effects biofilm aggregation and cariogenic pathogenicity

Abstract

The cariogenic pathogen Streptococcus mutans (S. mutans) effectively utilizes dietary sucrose for the synthesis of exopolysaccharides (EPS), which act as a scaffold for its biofilm and thus contribute to its cariogenic pathogenicity. Dextranase (Dex), which is a type of glucanase, participates in the degradation of water‐soluble glucan; however, the structural features of the exopolysaccharides regulated by the dexA gene have received limited attention. Our recent studies reported novel protocols to fractionate and analyzed the structural characteristics of glucans from S. mutans biofilms. In this study, we identify the role of the S. mutans dexA gene in dextran‐dependent aggregation in biofilm formation. Our results show that deletion of dexA (SmudexA) results in increased transcription of exopolysaccharide synthesis‐related genes, including gtfB, gtfD, and ftf. Interestingly, we reveal that inactivating the dexA gene may lead to elevated water‐soluble glucan (WSG) synthesis in S. mutans, which results in dysregulated cariogenicity in vivo. Furthermore, structural analysis provides new insights regarding the lack of mannose monosaccharides, especially in the water‐soluble glucan synthesis of the SmudexA mutants. The biofilm phenotypes that are associated with the reduced glucose monosaccharide composition in both WSG and water‐insoluble glucan (WIG) shift the dental biofilm to reduce the cariogenic incidence of the SmudexA mutants. Taken together, these data reveal that exopolysaccharide synthesis fine‐tuning by the dexA gene results in a densely packed EPS matrix that may impede the glucose metabolism of WSG, thereby leading to the lack of an energy source for the bacteria. These results highlight dexA targeting as a potentially effective tool in dental caries management.

This article is protected by copyright. All rights reserved.

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

A critical analysis of the prognostic performance of the 8th edition American Joint Committee on Cancer staging for metastatic cutaneous squamous cell carcinoma of the head and neck

Abstract

Background

The 8th edition AJCC staging of cutaneous squamous cell carcinoma of the head and neck (cSCCHN) incorporated extranodal extension (ENE) for the first time. This study compared the prognostic performance of the 7th and 8th edition staging for cSCCHN with nodal metastases.

Methods

Retrospective analysis of 96 patients with metastatic cSCCHN, comparing the ability of staging systems to predict disease‐specific and overall survival (OS) using the proportion of variation explained and Harrell's C‐index.

Results

In AJCC8, the N classification was upstaged in 77% of patients due to the presence of ENE and 88% of patients were classified as TNM stage IV. AJCC8 was inferior to AJCC7 in predicting disease‐specific survival for both N and TNM stages, and OS by TNM stage.

Conclusions

The majority of patients with metastatic cSCCHN have ENE and are classified as TNM stage IV based on the 8th edition staging, resulting in poor prognostic performance.

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Impact of tumor‐associated macrophages and BRAFV600E mutation on clinical outcomes in patients with various thyroid cancers

Abstract

Background

Tumor‐associated macrophages (TAMs) play a role in thyroid cancer tumor progression and metastasis. This study aimed to investigate the association of TAM density and cluster of differentiation 68 (CD68) expression with thyroid tumors as a prognostic marker and the relationship of these factors with BRAF^V600E mutations.

Methods

This study included 275 thyroid specimen tissues, including benign and malignant lesions. We compared the clinicopathological features according to thyroid tumor types and evaluated the presence of CD68 expression and BRAF^V600E mutations.

Results

CD68 positive expression increased with aggressiveness of thyroid tumor histologic grades (P < 0.001). In patients with poorly differentiated thyroid cancer (PDTC) and anaplastic thyroid cancer (ATC), CD68 positivity was associated with aggressive adverse clinical outcomes such as extrathyroidal extension, cervical lymph node metastases, and distant metastases (P < 0.05).

Conclusions

CD68 positivity was more frequent in advanced and aggressive thyroid cancer types such as PDTC/ATC.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2MizKi5

Bilateral vs ipsilateral adjuvant radiotherapy in patients with cancer of unknown primary of the head and neck: An analysis of the clinical outcome and radiation‐induced side effects

Abstract

Background

The purpose of this study was to analyze and compare ipsilateral and bilateral adjuvant radiotherapy in patients with cancer of unknown primary (CUP) of the head and neck.

Methods

Overall survival, recurrence‐free survival, and radiation‐induced side effects were assessed in 76 patients with CUP who underwent ipsilateral (n = 29) or bilateral (n = 47) radiotherapy.

Results

At a median follow‐up of 41 months, the 5‐year overall survival and recurrence‐free rate were 67.9% and 71.5%, respectively. No statistically significant difference between ipsilateral and bilateral radiotherapy could be found regarding 5‐year overall survival, recurrence‐free survival, occurrence of a primary tumor, and distant metastasis. The analysis of radiation‐induced acute side effects showed a significant benefit of ipsilateral radiotherapy.

Conclusion

As the main parameters of the study regarding the outcome and radiation‐induced side effects showed no advantages of bilateral radiotherapy, the strategy of ipsilateral radiotherapy can be recommended for the adjuvant treatment of CUP patients.

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

Issue Information

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

Cover Image

The cover image, by David H. Yeh et al., is based on the Original Article Shouldering the load of mandible reconstruction: 81 cases of oromandibular reconstruction with the scapular tip free flap, DOI: 10.1002/hed.25342.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2sAB0UJ

A critical analysis of the prognostic performance of the 8th edition American Joint Committee on Cancer staging for metastatic cutaneous squamous cell carcinoma of the head and neck

Abstract

Background

The 8th edition AJCC staging of cutaneous squamous cell carcinoma of the head and neck (cSCCHN) incorporated extranodal extension (ENE) for the first time. This study compared the prognostic performance of the 7th and 8th edition staging for cSCCHN with nodal metastases.

Methods

Retrospective analysis of 96 patients with metastatic cSCCHN, comparing the ability of staging systems to predict disease‐specific and overall survival (OS) using the proportion of variation explained and Harrell's C‐index.

Results

In AJCC8, the N classification was upstaged in 77% of patients due to the presence of ENE and 88% of patients were classified as TNM stage IV. AJCC8 was inferior to AJCC7 in predicting disease‐specific survival for both N and TNM stages, and OS by TNM stage.

Conclusions

The majority of patients with metastatic cSCCHN have ENE and are classified as TNM stage IV based on the 8th edition staging, resulting in poor prognostic performance.

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

Impact of tumor‐associated macrophages and BRAFV600E mutation on clinical outcomes in patients with various thyroid cancers

Abstract

Background

Tumor‐associated macrophages (TAMs) play a role in thyroid cancer tumor progression and metastasis. This study aimed to investigate the association of TAM density and cluster of differentiation 68 (CD68) expression with thyroid tumors as a prognostic marker and the relationship of these factors with BRAF^V600E mutations.

Methods

This study included 275 thyroid specimen tissues, including benign and malignant lesions. We compared the clinicopathological features according to thyroid tumor types and evaluated the presence of CD68 expression and BRAF^V600E mutations.

Results

CD68 positive expression increased with aggressiveness of thyroid tumor histologic grades (P < 0.001). In patients with poorly differentiated thyroid cancer (PDTC) and anaplastic thyroid cancer (ATC), CD68 positivity was associated with aggressive adverse clinical outcomes such as extrathyroidal extension, cervical lymph node metastases, and distant metastases (P < 0.05).

Conclusions

CD68 positivity was more frequent in advanced and aggressive thyroid cancer types such as PDTC/ATC.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2MizKi5

Bilateral vs ipsilateral adjuvant radiotherapy in patients with cancer of unknown primary of the head and neck: An analysis of the clinical outcome and radiation‐induced side effects

Abstract

Background

The purpose of this study was to analyze and compare ipsilateral and bilateral adjuvant radiotherapy in patients with cancer of unknown primary (CUP) of the head and neck.

Methods

Overall survival, recurrence‐free survival, and radiation‐induced side effects were assessed in 76 patients with CUP who underwent ipsilateral (n = 29) or bilateral (n = 47) radiotherapy.

Results

At a median follow‐up of 41 months, the 5‐year overall survival and recurrence‐free rate were 67.9% and 71.5%, respectively. No statistically significant difference between ipsilateral and bilateral radiotherapy could be found regarding 5‐year overall survival, recurrence‐free survival, occurrence of a primary tumor, and distant metastasis. The analysis of radiation‐induced acute side effects showed a significant benefit of ipsilateral radiotherapy.

Conclusion

As the main parameters of the study regarding the outcome and radiation‐induced side effects showed no advantages of bilateral radiotherapy, the strategy of ipsilateral radiotherapy can be recommended for the adjuvant treatment of CUP patients.

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

Issue Information

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

Cover Image

The cover image, by David H. Yeh et al., is based on the Original Article Shouldering the load of mandible reconstruction: 81 cases of oromandibular reconstruction with the scapular tip free flap, DOI: 10.1002/hed.25342.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2sAB0UJ

Competence of final year otolaryngology residents with the bedside head impulse test

The bedside head impulse test (bHIT) is a clinical method of assessing the vestibulo-ocular reflex (VOR). It is a critical component of the bedside assessment of dizzy patients, and can help differentiate acut...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2sAfW0A

Competence of final year otolaryngology residents with the bedside head impulse test

The bedside head impulse test (bHIT) is a clinical method of assessing the vestibulo-ocular reflex (VOR). It is a critical component of the bedside assessment of dizzy patients, and can help differentiate acut...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2sAfW0A

CNPAS: A Differential to Choanal Atresia

Abstract

A case of 7 day old male child, born at 36 weeks, presented with feeding difficulties, hypothermia and failure to thrive. After clinical examination to rule out any gross congenital anomalies, CT scan was done which was suggestive of pyriform aperture stenosis. It was surgically dilated and stented successfully.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Mjur1U

Reconstruction of Orbital Suprastructure Maxillectomy Defects by Temporalis Myofascial Flap

Abstract

Oncological surgery being radical is often mutilating in form and function especially in the maxillary/orbit region reconstruction of maxillo-orbit defects are challenging due to the complex three dimensional anatomy. Free flaps are de-rigueur but a technical resource with constraints. The temporalis myofascial flap (TMFF) is a locally available, safe and reliable flap which can be used for the reconstruction of various orbital and supramaxillary facial defects. To study the use of the temporalis myofascial flap in the reconstruction of various orbital and supramaxillary facial defects. Temporalis myofascial flap was harvested and successfully used in reconstruction of three patients who had undergone orbital exenteration with or without suprastructural maxillectomy. There was no morbidity related to flap loss. Temporalis flap (TMFF) can be considered as a first line reconstructive option for limited resection of upper maxilla with palatal preservation. Its proximity to the oral cavity, palate and mid third face and the technical ease makes the TMFF valuable for reconstruction. The techniques and outcomes of TMFF are discussed.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2sz246Z

CNPAS: A Differential to Choanal Atresia

Abstract

A case of 7 day old male child, born at 36 weeks, presented with feeding difficulties, hypothermia and failure to thrive. After clinical examination to rule out any gross congenital anomalies, CT scan was done which was suggestive of pyriform aperture stenosis. It was surgically dilated and stented successfully.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Mjur1U

Reconstruction of Orbital Suprastructure Maxillectomy Defects by Temporalis Myofascial Flap

Abstract

Oncological surgery being radical is often mutilating in form and function especially in the maxillary/orbit region reconstruction of maxillo-orbit defects are challenging due to the complex three dimensional anatomy. Free flaps are de-rigueur but a technical resource with constraints. The temporalis myofascial flap (TMFF) is a locally available, safe and reliable flap which can be used for the reconstruction of various orbital and supramaxillary facial defects. To study the use of the temporalis myofascial flap in the reconstruction of various orbital and supramaxillary facial defects. Temporalis myofascial flap was harvested and successfully used in reconstruction of three patients who had undergone orbital exenteration with or without suprastructural maxillectomy. There was no morbidity related to flap loss. Temporalis flap (TMFF) can be considered as a first line reconstructive option for limited resection of upper maxilla with palatal preservation. Its proximity to the oral cavity, palate and mid third face and the technical ease makes the TMFF valuable for reconstruction. The techniques and outcomes of TMFF are discussed.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2sz246Z

Factors associated with exacerbations among adults with asthma according to electronic health record data

Asthma is a chronic inflammatory lung disease that affects 18.7 million U.S. adults. Electronic health records (EHRs) are a unique source of information that can be leveraged to understand factors associated w...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2VZ5UUp

Factors associated with exacerbations among adults with asthma according to electronic health record data

Asthma is a chronic inflammatory lung disease that affects 18.7 million U.S. adults. Electronic health records (EHRs) are a unique source of information that can be leveraged to understand factors associated w...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2VZ5UUp

Reconstructive surgery for mycetoma: a case series

Abstract

Background

Mycetoma is an under recognised but significant disease endemic in various countries and associated with high morbidity. Treatment is a combination of antimicrobial therapy, with surgery often reserved for refractory or delayed cases where functional sequelae are often ignored. This case series aimed to provide preliminary evidence for the role of reconstructive surgery in treating mycetoma.

Methods

Twenty-six cases of eumycetoma suitable for reconstruction post-excision were identified between 2013 and 2016 in three centres in Sudan. The choice of reconstruction was based on consensus of the treating team, and relevant end-points noted including patient satisfaction, mobility and complication rate.

Results

Mycetoma lesions affected primarily the limbs (n = 23), with three cases involving the gluteal region. A range of reconstructive options was used including skin grafting (n = 14), local flaps (n = 5) and regional flaps (n = 4). Three cases were closed primarily. No complications were noted, and disease recurrence was not found in any of the patients. Subjective interviewing revealed adequate patient satisfaction with cosmesis, and all patients reached a post-operative mobility status at least equivalent to their pre-morbid state.

Conclusions

This study demonstrates the feasibility of reconstructive surgery in selective patients with mycetoma as part of their treatment protocol.

Level of Evidence: Level IV, therapeutic study.

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Treatment gap, help-seeking, stigma and magnitude of alcohol use disorder in rural Ethiopia

Although alcohol use disorders contribute a high proportion of population disease burden, the treatment gap is large, especially in low- and middle-income countries. To narrow this gap, contextually relevant e...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2MiNF7Y

Reconstructive surgery for mycetoma: a case series

Abstract

Background

Mycetoma is an under recognised but significant disease endemic in various countries and associated with high morbidity. Treatment is a combination of antimicrobial therapy, with surgery often reserved for refractory or delayed cases where functional sequelae are often ignored. This case series aimed to provide preliminary evidence for the role of reconstructive surgery in treating mycetoma.

Methods

Twenty-six cases of eumycetoma suitable for reconstruction post-excision were identified between 2013 and 2016 in three centres in Sudan. The choice of reconstruction was based on consensus of the treating team, and relevant end-points noted including patient satisfaction, mobility and complication rate.

Results

Mycetoma lesions affected primarily the limbs (n = 23), with three cases involving the gluteal region. A range of reconstructive options was used including skin grafting (n = 14), local flaps (n = 5) and regional flaps (n = 4). Three cases were closed primarily. No complications were noted, and disease recurrence was not found in any of the patients. Subjective interviewing revealed adequate patient satisfaction with cosmesis, and all patients reached a post-operative mobility status at least equivalent to their pre-morbid state.

Conclusions

This study demonstrates the feasibility of reconstructive surgery in selective patients with mycetoma as part of their treatment protocol.

Level of Evidence: Level IV, therapeutic study.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Crv4BS

Treatment gap, help-seeking, stigma and magnitude of alcohol use disorder in rural Ethiopia

Although alcohol use disorders contribute a high proportion of population disease burden, the treatment gap is large, especially in low- and middle-income countries. To narrow this gap, contextually relevant e...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2MiNF7Y

Exploring the Use of ECochG Testing During Electrode Insertion in Cochlear Implant Surgery

Conditions:   Cochlear Implants;   Hearing Preservation Intervention:   Procedure: Electrocochlography Sponsors:   Cambridge University Hospitals NHS Foundation Trust;   University of Cambridge Recruiting (Source: ClinicalTrials.gov)

MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.

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

Clinical Study of Minimally Invasive Ponto Surgical Technique (MIPS) - Design Iteration

Conditions:   Bone Conduction Deafness;   Unilateral Deafness;   Middle Ear Deafness;   Mixed Hearing Loss Intervention:   Device: Minimally Invasive Ponto Surgery Sponsor:   Oticon Medical Recruiting (Source: ClinicalTrials.gov)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Mqpjt7

Reconstructive surgery for mycetoma: a case series

Abstract

Background

Mycetoma is an under recognised but significant disease endemic in various countries and associated with high morbidity. Treatment is a combination of antimicrobial therapy, with surgery often reserved for refractory or delayed cases where functional sequelae are often ignored. This case series aimed to provide preliminary evidence for the role of reconstructive surgery in treating mycetoma.

Methods

Twenty-six cases of eumycetoma suitable for reconstruction post-excision were identified between 2013 and 2016 in three centres in Sudan. The choice of reconstruction was based on consensus of the treating team, and relevant end-points noted including patient satisfaction, mobility and complication rate.

Results

Mycetoma lesions affected primarily the limbs (n = 23), with three cases involving the gluteal region. A range of reconstructive options was used including skin grafting (n = 14), local flaps (n = 5) and regional flaps (n = 4). Three cases were closed primarily. No complications were noted, and disease recurrence was not found in any of the patients. Subjective interviewing revealed adequate patient satisfaction with cosmesis, and all patients reached a post-operative mobility status at least equivalent to their pre-morbid state.

Conclusions

This study demonstrates the feasibility of reconstructive surgery in selective patients with mycetoma as part of their treatment protocol.

Level of Evidence: Level IV, therapeutic study.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Crv4BS

Exploring the Use of ECochG Testing During Electrode Insertion in Cochlear Implant Surgery

Conditions:   Cochlear Implants;   Hearing Preservation Intervention:   Procedure: Electrocochlography Sponsors:   Cambridge University Hospitals NHS Foundation Trust;   University of Cambridge Recruiting (Source: ClinicalTrials.gov)

MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.

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

Clinical Study of Minimally Invasive Ponto Surgical Technique (MIPS) - Design Iteration

Conditions:   Bone Conduction Deafness;   Unilateral Deafness;   Middle Ear Deafness;   Mixed Hearing Loss Intervention:   Device: Minimally Invasive Ponto Surgery Sponsor:   Oticon Medical Recruiting (Source: ClinicalTrials.gov)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Mqpjt7

Reconstructive surgery for mycetoma: a case series

Abstract

Background

Mycetoma is an under recognised but significant disease endemic in various countries and associated with high morbidity. Treatment is a combination of antimicrobial therapy, with surgery often reserved for refractory or delayed cases where functional sequelae are often ignored. This case series aimed to provide preliminary evidence for the role of reconstructive surgery in treating mycetoma.

Methods

Twenty-six cases of eumycetoma suitable for reconstruction post-excision were identified between 2013 and 2016 in three centres in Sudan. The choice of reconstruction was based on consensus of the treating team, and relevant end-points noted including patient satisfaction, mobility and complication rate.

Results

Mycetoma lesions affected primarily the limbs (n = 23), with three cases involving the gluteal region. A range of reconstructive options was used including skin grafting (n = 14), local flaps (n = 5) and regional flaps (n = 4). Three cases were closed primarily. No complications were noted, and disease recurrence was not found in any of the patients. Subjective interviewing revealed adequate patient satisfaction with cosmesis, and all patients reached a post-operative mobility status at least equivalent to their pre-morbid state.

Conclusions

This study demonstrates the feasibility of reconstructive surgery in selective patients with mycetoma as part of their treatment protocol.

Level of Evidence: Level IV, therapeutic study.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Crv4BS

Ethnobotany of Mexican and northern Central American cycads (Zamiaceae)

This study documents cycad-human relationships in Mexico, Belize, Guatemala, El Salvador, and Honduras over the last 6000 years. The impetus was acute need for a better understanding of previously undocumented...

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

Phytogeographical and sociolinguistical patterns of the diversity, distribution, and uses of wild mushrooms in Côte d’Ivoire, West Africa

Many fungal species in tropical Africa are useful, with high added value, and play essential roles in the structure and dynamic of ecosystems. However, the diversity, distribution, and uses by local population...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2AS21Yi

Ethnobotany of Mexican and northern Central American cycads (Zamiaceae)

This study documents cycad-human relationships in Mexico, Belize, Guatemala, El Salvador, and Honduras over the last 6000 years. The impetus was acute need for a better understanding of previously undocumented...

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

Phytogeographical and sociolinguistical patterns of the diversity, distribution, and uses of wild mushrooms in Côte d’Ivoire, West Africa

Many fungal species in tropical Africa are useful, with high added value, and play essential roles in the structure and dynamic of ecosystems. However, the diversity, distribution, and uses by local population...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2AS21Yi

An automatic restoration framework based on GPU-accelerated collateral filtering in brain MR images

Abstract

Background

Image restoration is one of the fundamental and essential tasks within image processing. In medical imaging, developing an effective algorithm that can automatically remove random noise in brain magnetic resonance (MR) images is challenging. The collateral filter has been shown a more powerful algorithm than many existing methods. However, the computation of the collateral filter is more time-consuming and the selection of the filter parameters is also laborious. This paper proposes an automatic noise removal system based on the accelerated collateral filter for brain MR images.

Methods

To solve these problems, we first accelerated the collateral filter with parallel computing using the graphics processing unit (GPU) architecture. We adopted the compute unified device architecture (CUDA), an application programming interface for the GPU by NVIDIA, to hasten the computation. Subsequently, the optimal filter parameters were selected and the automation was achieved by artificial neural networks. Specifically, an artificial neural network system associated with image feature analysis was adopted to establish the automatic image restoration framework. The best feature combination was selected by the paired t-test and the sequential forward floating selection (SFFS) methods.

Results

Experimental results indicated that not only did the proposed automatic image restoration algorithm perform dramatically faster than the traditional collateral filter, but it also effectively removed the noise in a wide variety of brain MR images. A speed up gain of 34 was attained to process an MR image, which completed within 0.1 s. Representative illustrations of brain tumor images demonstrated the capability of identifying lesion boundaries, which outperformed many existing methods.

Conclusions

We believe that our accelerated and automated restoration framework is promising for achieving robust filtering in many brain MR image restoration applications.

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Mayo Clinic Minute: What happens to your body when you're allergic to food?

What happens to your body when you have an allergic reaction to food? Dr. Avni Joshi, a Mayo Clinic pediatric allergist and immunologist, asks, "How does food allergy happen is the first question?" Watch: The Mayo Clinic Minute https://youtu.be/o9mj7BgR-fY Journalists: Broadcast-quality video pkg (0:59) is in the downloads?at the end of the post. Please 'Courtesy: [...] (Source: News from Mayo Clinic)

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An automatic restoration framework based on GPU-accelerated collateral filtering in brain MR images

Abstract

Background

Image restoration is one of the fundamental and essential tasks within image processing. In medical imaging, developing an effective algorithm that can automatically remove random noise in brain magnetic resonance (MR) images is challenging. The collateral filter has been shown a more powerful algorithm than many existing methods. However, the computation of the collateral filter is more time-consuming and the selection of the filter parameters is also laborious. This paper proposes an automatic noise removal system based on the accelerated collateral filter for brain MR images.

Methods

To solve these problems, we first accelerated the collateral filter with parallel computing using the graphics processing unit (GPU) architecture. We adopted the compute unified device architecture (CUDA), an application programming interface for the GPU by NVIDIA, to hasten the computation. Subsequently, the optimal filter parameters were selected and the automation was achieved by artificial neural networks. Specifically, an artificial neural network system associated with image feature analysis was adopted to establish the automatic image restoration framework. The best feature combination was selected by the paired t-test and the sequential forward floating selection (SFFS) methods.

Results

Experimental results indicated that not only did the proposed automatic image restoration algorithm perform dramatically faster than the traditional collateral filter, but it also effectively removed the noise in a wide variety of brain MR images. A speed up gain of 34 was attained to process an MR image, which completed within 0.1 s. Representative illustrations of brain tumor images demonstrated the capability of identifying lesion boundaries, which outperformed many existing methods.

Conclusions

We believe that our accelerated and automated restoration framework is promising for achieving robust filtering in many brain MR image restoration applications.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2U0Yeim

Mayo Clinic Minute: What happens to your body when you're allergic to food?

What happens to your body when you have an allergic reaction to food? Dr. Avni Joshi, a Mayo Clinic pediatric allergist and immunologist, asks, "How does food allergy happen is the first question?" Watch: The Mayo Clinic Minute https://youtu.be/o9mj7BgR-fY Journalists: Broadcast-quality video pkg (0:59) is in the downloads?at the end of the post. Please 'Courtesy: [...] (Source: News from Mayo Clinic)

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Mayo Clinic Minute: What happens to your body when you're allergic to food?

What happens to your body when you have an allergic reaction to food? Dr. Avni Joshi, a Mayo Clinic pediatric allergist and immunologist, asks, "How does food allergy happen is the first question?" Watch: The Mayo Clinic Minute https://youtu.be/o9mj7BgR-fY Journalists: Broadcast-quality video pkg (0:59) is in the downloads?at the end of the post. Please 'Courtesy: [...] (Source: News from Mayo Clinic)

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Mayo Clinic Minute: What happens to your body when you're allergic to food?

What happens to your body when you have an allergic reaction to food? Dr. Avni Joshi, a Mayo Clinic pediatric allergist and immunologist, asks, "How does food allergy happen is the first question?" Watch: The Mayo Clinic Minute https://youtu.be/o9mj7BgR-fY Journalists: Broadcast-quality video pkg (0:59) is in the downloads?at the end of the post. Please 'Courtesy: [...] (Source: News from Mayo Clinic)

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Associations between combined overweight and obesity, lifestyle behavioural risk and quality of life among Australian regional school children: baseline findings of the Goulburn Valley health behaviours monitoring study

Health related quality of life is a multi-dimensional construct of particular interest in determining the consequences of illness and disease. This study aimed to determine the relationships between overweight...

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The impact of an exercise program on quality of life in older breast cancer survivors undergoing aromatase inhibitor therapy: a randomized controlled trial

This study evaluated the impact of an exercise program on quality of life in older breast cancer survivors undergoing aromatase inhibitor therapy.

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Associations between combined overweight and obesity, lifestyle behavioural risk and quality of life among Australian regional school children: baseline findings of the Goulburn Valley health behaviours monitoring study

Health related quality of life is a multi-dimensional construct of particular interest in determining the consequences of illness and disease. This study aimed to determine the relationships between overweight...

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The impact of an exercise program on quality of life in older breast cancer survivors undergoing aromatase inhibitor therapy: a randomized controlled trial

This study evaluated the impact of an exercise program on quality of life in older breast cancer survivors undergoing aromatase inhibitor therapy.

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Ottogi America, Inc. Issues Allergy Alert on Undeclared Egg in Products

Ottogi America, Inc. announced today it is recalling below 21 items due to a possibility of containing egg ingredient undeclared on the packages. People who have an allergy or severe sensitivity to eggs run the risk of serious or life-threatening allergic reaction of they consume these products. (Source: Food and Drug Administration)

MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.

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Misdiagnosis of Penicillin Allergy Common Misdiagnosis of Penicillin Allergy Common

Most patients who report having a penicillin allergy are not really allergic to the antibiotic, and they may be missing out on the best treatment for their condition as a result, according to a report in JAMA January 15.Reuters Health Information (Source: Medscape Medical News Headlines)

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Ottogi America, Inc. Issues Allergy Alert on Undeclared Egg in Products

Ottogi America, Inc. announced today it is recalling below 21 items due to a possibility of containing egg ingredient undeclared on the packages. People who have an allergy or severe sensitivity to eggs run the risk of serious or life-threatening allergic reaction of they consume these products. (Source: Food and Drug Administration)

MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.

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Misdiagnosis of Penicillin Allergy Common Misdiagnosis of Penicillin Allergy Common

Most patients who report having a penicillin allergy are not really allergic to the antibiotic, and they may be missing out on the best treatment for their condition as a result, according to a report in JAMA January 15.Reuters Health Information (Source: Medscape Medical News Headlines)

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Misdiagnosis of Penicillin Allergy Common Misdiagnosis of Penicillin Allergy Common

Most patients who report having a penicillin allergy are not really allergic to the antibiotic, and they may be missing out on the best treatment for their condition as a result, according to a report in JAMA January 15.Reuters Health Information (Source: Medscape Medical News Headlines)

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Radiation-induced papillary thyroid cancer: is it a distinct clinical entity?

Purpose of review To present the current status of knowledge regarding radiation-induced papillary thyroid cancer (RIPTC), defining its epidemiologic, pathologic, and clinical characteristics, with ensuing possible therapeutic and prognostic consequences. Recent findings Cumulative evidence shows that RIPTC resembles sporadic papillary thyroid cancer (PTC) of comparable age, both in terms of clinical-pathological features and prognosis. Therefore, more aggressive treatment does not seem to be required when managing RIPTC as its prognosis is comparable to that of never-irradiated patients. Summary Radiation exposure in childhood is a well-documented risk factor for development of PTC. Therefore, increased exposure to medical or environmental radiation may be in part responsible, along with increased screening, of the recent burgeoning incidence of PTC. A specific morphological and molecular portrait of RIPTC is unlikely to exist. The more aggressive histologic and clinical features initially reported in radiation-induced cases are consistent with the expectations in nonradiation-related PTC of a comparable age. Aggressive histology, nodal, and distant metastases correlate with early age at onset rather than with radiation exposure. Although relapses are frequent in children, long-term cancer-specific mortality is approximately 1%, lower than that observed for adults and comparable between irradiated and nonirradiated cohorts. RIPTC does not require more aggressive surgery or more adjuvant treatments, as prognosis is as good as that of sporadic PTC when matched for stage and treatment received. Correspondence to Lorenzo Bresciani, MD, Department of Otorhinolaryngology, Maxillofacial, and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, 20133 Milan, Italy. Tel: +390223902793; fax: +390223902760; e-mail: lorenzo.bresciani@istitutotumori.mi.it Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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Misdiagnosis of Penicillin Allergy Common Misdiagnosis of Penicillin Allergy Common

Most patients who report having a penicillin allergy are not really allergic to the antibiotic, and they may be missing out on the best treatment for their condition as a result, according to a report in JAMA January 15.Reuters Health Information (Source: Medscape Medical News Headlines)

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Management of the marginal mandibular nerve during and after neck dissection

Purpose of review Marginal mandibular nerve palsy (MMNP) is often an understated complication after neck dissection. This article reviews literature regarding anatomic landmarks that help define marginal mandibular nerve (MMN) during neck dissection, oncologic safety of surgical maneuvers, implications of MMNP, and reconstructive options. Recent findings A thorough knowledge of anatomy of the nerve can aid in its preservation. Course, branching pattern and communications of MMN are extremely variable. The Hayes Martin method classically described to preserve the nerve may not be oncologically safe in patients with prefacial nodal involvement. MMNP significantly affects quality of life after neck dissection. Cause, timing, and degree of neural damage play an important role in determining diagnostic and therapeutic options to correct the deformity resulting from MMNP. Owing to treatment-related factors, functionality of local structures may be compromised, which limits available reconstructive options for the surgeon. This should favor a shift of management option toward more conservative procedures in patients treated for head and neck cancer. Summary When oncologically safe, the MMN must always be preserved. The patient perceived deformity resulting from MMNP is significantly higher than clinician-detected rate. In select patients who are affected by significant smile asymmetry, multiple dynamic and static corrective procedures can be offered. Correspondence to Deepak Balasubramanian, MCh, Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India 682041. Tel: +91 8089089887; e-mail: dr.deepak.b@gmail.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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A nomogram for predicting bowel obstruction in preoperative colorectal cancer patients with clinical characteristics

Bowel obstruction (BO) is a complication that commonly affects patients with colorectal cancer (CRC). BO causes severe outcomes, and its treatment leads to a dilemma for many surgeons. Moreover, the factors co...

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Interferon-α versus interleukin-2 in Chinese patients with malignant melanoma: a randomized, controlled, trial

The US Food and Drug Association has approved interferon-α (IFN-α) and interleukin-2 (IL-2) as adjuvant therapy in malignant melanoma. The objective of the study was to compare efficacy and safety of subcutaneous interferon-α with continuous intravenous IL-2 in Chinese patients with malignant melanoma. A total of 250 patients with unresectable malignant melanoma were subjected to randomized in 1 : 1 ratio. Patients received subcutaneous 9×106 IU/m2 IFN-α (IFN-α group, n=125) or continuous intravenous 9×106 IU/m2 IL-2 (IL-2 group, n=125) at every 21 days for 4 months. The response, progression-free survival, overall survival, adverse effects, and cost were evaluated by experts in the field. IL-2 and IFN-α were effective in improvement of malignant melanoma after 4 months of intervention. IL-2 was effective in improving brain metastasis. Patients of the IL-2 group had a higher overall survival (P

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Interferon-α versus interleukin-2 in Chinese patients with malignant melanoma: a randomized, controlled, trial

The US Food and Drug Association has approved interferon-α (IFN-α) and interleukin-2 (IL-2) as adjuvant therapy in malignant melanoma. The objective of the study was to compare efficacy and safety of subcutaneous interferon-α with continuous intravenous IL-2 in Chinese patients with malignant melanoma. A total of 250 patients with unresectable malignant melanoma were subjected to randomized in 1 : 1 ratio. Patients received subcutaneous 9×106 IU/m2 IFN-α (IFN-α group, n=125) or continuous intravenous 9×106 IU/m2 IL-2 (IL-2 group, n=125) at every 21 days for 4 months. The response, progression-free survival, overall survival, adverse effects, and cost were evaluated by experts in the field. IL-2 and IFN-α were effective in improvement of malignant melanoma after 4 months of intervention. IL-2 was effective in improving brain metastasis. Patients of the IL-2 group had a higher overall survival (P

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Correlation between systemic inflammatory response and quality of life in patients with chronic rhinosinusitis

Background

Local sinonasal inflammation resulting from altered T‐cell immune signaling is a contributor to the pathogenesis of chronic rhinosinusitis (CRS). CRS patients experience negative impacts on quality of life (QOL) and suffer from comorbidities linked to systemic inflammation. However, systemic inflammatory profiling to evaluate the association between systemic inflammation and QOL in CRS has not been performed. Our objectives were to compare local and systemic inflammatory gene expression in patients with CRS to determine if systemic markers of inflammation associate with disease severity and disease‐specific QOL.

Methods

A prospective observational study was conducted comparing 16 patients with CRS to 10 controls. Inflammatory gene expression in the anterior ethmoid tissues and peripheral blood of patients was measured using multiplex gene expression analysis and correlated to disease severity (computed tomography and nasal endoscopy) and disease‐specific QOL (22‐item Sino‐Nasal Outcome Test [SNOT‐22] and Rhinosinusitis Disability Index) using linear regression analyses.

Results

Patients with CRS showed significant increases in the expression of ctla4 and jak1 in sinonasal tissue and blood (p < 0.05), whereas the gene expression of hla‐dqa1, hla‐dqb1, and dusp4 was significantly decreased in patients with CRS compared to controls (p < 0.05). Soluble and local ctla4 and jak1 showed a significant positive correlation with clinical markers of disease severity and disease‐specific QOL (p < 0.05).

Conclusion

Local and systemic gene expression involved in T‐cell immune signaling was found to be significantly altered in the blood and sinonasal tissues of patients with CRS compared to controls and significantly correlated to disease severity and QOL in patients with CRS.

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Herbal dry extract BNO 1011 improves clinical and mucociliary parameters in a rabbit model of chronic rhinosinusitis

Background

Enhancing chloride (Cl^–) secretion in sinus epithelia represents a novel therapeutic approach to chronic rhinosinusitis (CRS). Herbal dry extract BNO 1011 enhances mucociliary clearance (MCC) via upregulation of Cl^– secretion in sinonasal cultures in vitro and murine epithelium in vivo. The objective of this study is to evaluate whether the BNO 1011 improves MCC and clinical parameters in a rabbit model of CRS.

Methods

After the development of CRS in 30 New Zealand white rabbits, animals were randomly assigned to receive oral placebo (n = 10), BNO 1011 (low dose [LD], 25 mg/kg/daily) (n = 10), or BNO1011 (high dose [HD], 125 mg/kg/daily) (n = 10) for 4 weeks. Outcomes included sinus opacification (Kerschner's rabbit sinus CT grade), maxillary epithelial Cl⁻ secretion (sinus potential difference [PD] assay), airway surface liquid (ASL) depth using micro‐optical coherence tomography (μOCT), and submucosal gland density (SMD) on histopathology. Outcome parameters were analyzed by 2 blinded investigators.

Results

BNO 1011 significantly cleared sinus opacification (HD = 1.21 ± 0.63, LD = 1.26 ± 0.37,) compared to placebo (4.02 ± 0.92) (p = 0.009). BNO 1011 resulted in markedly greater mean sinus PD polarization (HD = –12.23 ± 1.4 mV, LD = –12.0 ± 3.0 mV) when compared to rabbits treated with placebo (–4.1 ± 1.1 mV) (p = 0.03). ASL depth was significantly improved when treated with HD (4.08 ± 0.06 μm) and LD (4.05 ± 0.06 μm) compared to placebo (3.5 ± 0.05 μm) (post hoc analysis, p < 0.0001). Histologically, epithelial thickness (HD = 10.0 ± 0.7 μm; LD = 13.7 ± 0.9 μm; placebo = 21.1 ± 2.3 μm; p < 0.005), subepithelial thickness (HD = 63.1 ± 6.6 μm; LD = 103.2 ± 6.7 μm; placebo = 113.3 ± 6.0 μm; p < 0.001), and SMD (HD = 22.2 ± 2.9%; LD = 31.8 ± 1.1%; placebo = 43.8 ± 1.7%; p < 0.0001) were noticeably better with the HD.

Conclusion

Herbal dry extract BNO 1011 improves radiographic, histologic, and MCC parameters in a rabbit model of CRS.

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Outcomes and imaging findings of respiratory epithelial adenomatoid hamartoma: a systematic review

Background

Respiratory epithelial adenomatoid hamartoma (REAH) is a recently classified histopathologic diagnosis often identified incidentally following endoscopic sinus surgery (ESS) for presumed chronic rhinosinusitis. Limited data exist defining preoperative imaging features and surgical outcomes. The purpose of this study is to examine characteristic imaging findings of REAH and postoperative olfactory and recurrence outcomes.

Methods

A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) guidelines on articles published from 1995 to present. PubMed, EMBASE, and Ovid MEDLINE databases were queried for studies pertinent to imaging findings of REAH and surgical outcomes. Quality of articles was assessed using the Methodological Index for Non‐Randomized Studies (MINORS).

Results

A total of 294 articles were identified, with 15 meeting inclusion criteria. Seven articles assessed both imaging findings and surgical outcomes. Three articles focused exclusively on imaging, whereas 5 examined surgical outcomes. Olfactory cleft (OC) widening greater than 10 mm on computed tomography (CT) was characteristic of REAH. A total of 441 patients with REAH were included; 221 patients (50.1%) had concurrent nasal polyposis, whereas 154 patients (34.9%) had isolated REAH. Surgical intervention ranged from simple excision to complete ESS. Sixty‐five percent (65%) of patients reported improved olfaction; 4.1% of patients recurred with follow‐up ranging from 4 months to 5 years.

Conclusion

A widened OC may suggest the presence of REAH. This disease process has been identified in patients with nasal polyposis or encountered as an isolated lesion. Targeted surgery may result in improved olfaction and a low likelihood of recurrence, though long‐term prospective studies are necessary.

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Deadly amoeba infections from nasal and sinus irrigation: how should we discuss with our patients?

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Long‐term olfaction outcomes in transnasal endoscopic skull‐base surgery: a prospective cohort study comparing electrocautery and cold knife upper septal limb incision techniques

Background

Olfactory nerve fibers are at risk of injury during transnasal endoscopic skull‐base approaches. Olfactory outcomes for various techniques have not been thoroughly investigated. This study aims to report long‐term olfactory outcomes when a cold knife upper septal limb incision technique is used compared to monopolar cautery.

Methods

A prospective cohort study was performed at a tertiary referral center. Adult patients undergoing endoscopic approaches with septal incisions were randomized to cold knife or monopolar cautery groups. Patient demographics, clinical history, surgical data, and outcomes were collected. Preoperative, 3‐month, and 12‐month postoperative scores on the University of Pennsylvania Smell Inventory Test (UPSIT) and 22‐item Sino‐Nasal Outcome Test (SNOT‐22) were measured. Fisher's exact tests were performed for categorical variables and t tests were performed for continuous variables.

Results

Twenty‐two (22) patients (10 cold knife, 12 cautery) were enrolled between March 2016 and August 2017. The average age ± standard deviation was 50.2 ± 14.0 years (p = 0.59), 54% (p = 0.69) were female, and the primary pathology was pituitary adenoma (73%, p = 1.00). Preoperative, 3‐month, and 12‐month postoperative UPSIT scores were similar between the cold knife and cautery groups (32.8 vs 32.4, p = 0.80; 33.1 vs 33.0, p = 0.96; 33.6 vs 33.3, p = 0.84). On the "sense of smell/taste" question of the SNOT‐22, there was also no difference at all time points (p > 0.22).

Conclusion

There was no significant change in patient UPSIT scores 1 year after transnasal skull‐base approaches, and no short‐term or long‐term differences between cold knife and cautery upper septal limb incision techniques. Our study supports an individualized approach based on surgeon preference.

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Correlation between systemic inflammatory response and quality of life in patients with chronic rhinosinusitis

Background

Local sinonasal inflammation resulting from altered T‐cell immune signaling is a contributor to the pathogenesis of chronic rhinosinusitis (CRS). CRS patients experience negative impacts on quality of life (QOL) and suffer from comorbidities linked to systemic inflammation. However, systemic inflammatory profiling to evaluate the association between systemic inflammation and QOL in CRS has not been performed. Our objectives were to compare local and systemic inflammatory gene expression in patients with CRS to determine if systemic markers of inflammation associate with disease severity and disease‐specific QOL.

Methods

A prospective observational study was conducted comparing 16 patients with CRS to 10 controls. Inflammatory gene expression in the anterior ethmoid tissues and peripheral blood of patients was measured using multiplex gene expression analysis and correlated to disease severity (computed tomography and nasal endoscopy) and disease‐specific QOL (22‐item Sino‐Nasal Outcome Test [SNOT‐22] and Rhinosinusitis Disability Index) using linear regression analyses.

Results

Patients with CRS showed significant increases in the expression of ctla4 and jak1 in sinonasal tissue and blood (p < 0.05), whereas the gene expression of hla‐dqa1, hla‐dqb1, and dusp4 was significantly decreased in patients with CRS compared to controls (p < 0.05). Soluble and local ctla4 and jak1 showed a significant positive correlation with clinical markers of disease severity and disease‐specific QOL (p < 0.05).

Conclusion

Local and systemic gene expression involved in T‐cell immune signaling was found to be significantly altered in the blood and sinonasal tissues of patients with CRS compared to controls and significantly correlated to disease severity and QOL in patients with CRS.

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

Herbal dry extract BNO 1011 improves clinical and mucociliary parameters in a rabbit model of chronic rhinosinusitis

Background

Enhancing chloride (Cl^–) secretion in sinus epithelia represents a novel therapeutic approach to chronic rhinosinusitis (CRS). Herbal dry extract BNO 1011 enhances mucociliary clearance (MCC) via upregulation of Cl^– secretion in sinonasal cultures in vitro and murine epithelium in vivo. The objective of this study is to evaluate whether the BNO 1011 improves MCC and clinical parameters in a rabbit model of CRS.

Methods

After the development of CRS in 30 New Zealand white rabbits, animals were randomly assigned to receive oral placebo (n = 10), BNO 1011 (low dose [LD], 25 mg/kg/daily) (n = 10), or BNO1011 (high dose [HD], 125 mg/kg/daily) (n = 10) for 4 weeks. Outcomes included sinus opacification (Kerschner's rabbit sinus CT grade), maxillary epithelial Cl⁻ secretion (sinus potential difference [PD] assay), airway surface liquid (ASL) depth using micro‐optical coherence tomography (μOCT), and submucosal gland density (SMD) on histopathology. Outcome parameters were analyzed by 2 blinded investigators.

Results

BNO 1011 significantly cleared sinus opacification (HD = 1.21 ± 0.63, LD = 1.26 ± 0.37,) compared to placebo (4.02 ± 0.92) (p = 0.009). BNO 1011 resulted in markedly greater mean sinus PD polarization (HD = –12.23 ± 1.4 mV, LD = –12.0 ± 3.0 mV) when compared to rabbits treated with placebo (–4.1 ± 1.1 mV) (p = 0.03). ASL depth was significantly improved when treated with HD (4.08 ± 0.06 μm) and LD (4.05 ± 0.06 μm) compared to placebo (3.5 ± 0.05 μm) (post hoc analysis, p < 0.0001). Histologically, epithelial thickness (HD = 10.0 ± 0.7 μm; LD = 13.7 ± 0.9 μm; placebo = 21.1 ± 2.3 μm; p < 0.005), subepithelial thickness (HD = 63.1 ± 6.6 μm; LD = 103.2 ± 6.7 μm; placebo = 113.3 ± 6.0 μm; p < 0.001), and SMD (HD = 22.2 ± 2.9%; LD = 31.8 ± 1.1%; placebo = 43.8 ± 1.7%; p < 0.0001) were noticeably better with the HD.

Conclusion

Herbal dry extract BNO 1011 improves radiographic, histologic, and MCC parameters in a rabbit model of CRS.

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Deadly amoeba infections from nasal and sinus irrigation: how should we discuss with our patients?

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European Society of Neuroradiology (ESNR)

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Aortic dilatation associates with flow displacement and increased circumferential wall shear stress in patients without aortic stenosis: A prospective clinical study

Background

The relationship between blood flow characteristics and ascending aortic (AA) dilatation has not been studied in patients with a tricuspid aortic valve (TAV) without aortic stenosis.

Purpose

To evaluate whether 4D flow characteristics determined in MRI are related to AA dilatation by comparing dilated AA and nondilated AA subjects with TAV.

Study Type

Prospective.

Population

Twenty patients with dilated AA and 20 age‐matched patients with nondilated AA.

Field Strength/Sequence

1.5T/4D flow, 2D flow, and anatomic images.

Assessment

Altogether, 16 different 4D flow parameters were assessed in 10 planes in the thoracic aorta. Intra‐ and interobserver reproducibility were analyzed.

Statistical Tests

Independent t‐test for normally distributed and the Mann–Whitney test for skewed distributed parameters were used. A paired‐samples t‐test was used to compare 2D and 4D flow parameters. Intraclass correlation coefficient (ICC) was used in intra‐ and interobserver reproducibility analysis.

Results

Aortic flow was displaced from the centerline of the aorta in the proximal and tubular planes. Flow displacement (FD) was greatest in the proximal plane of AA and was higher in dilated AA (4.5%, range 3.0–5.8%) than in nondilated AA (2.0%, 1.0–3.0%, P < 0.001). Total wall shear stress (WSS) values were 1.3 ± 0.4 times higher on the displaced side than on the opposite side of the aorta (P < 0.01). The circumferential WSS (WSS_C) ratio to total WSS was greater in dilated AA, being 0.48 ± 0.11 vs. 0.32 ± 0.09 in the inner curvature of the proximal AA (P < 0.001) and 0.37 ± 0.11 vs. 0.26 ± 0.07 in the whole aortic ring in the distal AA (P < 0.001). Depending on 4D flow parameters, reproducibility varied from excellent (ICC = 0.923) to very low (ICC = 0.204).

Data Conclusion

The present study demonstrates that 4D flow measurements help to visualize the pathological flow patterns related to aortic dilatation. Flow displacement and an increased WSSc/WSS ratio are significantly associated with AA dilatation.

Level of Evidence: 2

Technical Efficacy: Stage 2

J. Magn. Reson. Imaging 2019.

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Multiparameter diffusion‐weighted imaging for characterizing pathological patterns in lupus nephritis patients: A preliminary study

Background

Microstructural changes of lupus nephritis (LN) kidney such as inflammatory cell infiltration or fibrosis could influence water molecular movement or diffusion, which indicates that diffusion‐weighted imaging (DWI) may become a valuable tool in evaluation of this disease.

Purpose

To explore whether multiparameter diffusion‐weighted imaging (mDWI) could contribute to characterize pathological patterns in LN patients.

Study Type

Retrospective.

Population

Twenty‐two patients with LN.

Field Strength/Sequence

Multi‐b value DWI was performed with a 3.0 T scanner.

Assessment

Apparent diffusion coefficient (ADC)_m, perfusion‐related diffusion coefficient (D_f), molecular diffusion coefficient (D_s), perfusion fraction (f), ADC_s, α, ADC_k, and mean kurtosis (MK) were calculated by monoexponential, biexponential, stretched‐exponential, and kurtosis models fits, respectively.

Statistical Tests

Independent sample t‐test, Pearson analysis and receiver operating characteristic (ROC).

Results

In the whole group, the activity index (AI) correlated significantly with alpha values in the medulla (rho = –0.54, P = 0.03). The chronicity index (CI) correlated significantly with D_s values in the medulla (rho = –0.61, P = 0.02). No significant association was found between any other diffusion parameter and histologic grade with all P > 0.05. For differentiating proliferative LN (Class III or IV) from Class V, the area under the ROC curve (AUC) of alpha in the medulla was 0.833 (P = 0.023).

Data Conclusion

mDWI might be used for the characterization of pathological patterns in LN patients.

Level of Evidence: 3

Technical Efficacy Stage: 2

J. Magn. Reson. Imaging 2019.

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Propofol TCI Reductions Do Not Attenuate Significant Falls in Cardiac Output Associated With Anesthesia Induction and Knee-Chest Positioning in Spinal Surgery

Background: Induction of anesthesia and the knee-chest position are associated with hemodynamic changes that may impact patient outcomes. The aim of this study was to assess whether planned reductions in target-controlled infusion propofol concentrations attenuate the hemodynamic changes associated with anesthesia induction and knee-chest position. Materilas and Methods: A total of 20 patients scheduled for elective lumbar spinal surgery in the knee-chest position were included. In addition to standard anesthesia monitoring, bispectral index and noninvasive cardiac output (CO) monitoring were undertaken. The study was carried out in 2 parts. In phase 1, target-controlled infusion propofol anesthesia was adjusted to maintain BIS 40 to 60. In phase 2, there were 2 planned reductions in propofol target concentration: (1) immediately after loss of consciousness—reduction calculated using a predefined formula, and (2) before positioning—reduction equal to the average percentage decrease in CO after knee-chest position in phase 1. Changes from baseline in CO and other hemodynamic variables following induction of anesthesia and knee-chest positioning were compared. Results: Induction of anesthesia led to decreases of 25.6% and 19.8% in CO from baseline in phases 1 and 2, respectively (P

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Journal Club

No abstract available

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Cognitive Prehabilitation: Supercharged Mind or Wishful Thinking?

No abstract available

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The need for short MRI examinations: A musculoskeletal perspective

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Aortic dilatation associates with flow displacement and increased circumferential wall shear stress in patients without aortic stenosis: A prospective clinical study

Background

The relationship between blood flow characteristics and ascending aortic (AA) dilatation has not been studied in patients with a tricuspid aortic valve (TAV) without aortic stenosis.

Purpose

To evaluate whether 4D flow characteristics determined in MRI are related to AA dilatation by comparing dilated AA and nondilated AA subjects with TAV.

Study Type

Prospective.

Population

Twenty patients with dilated AA and 20 age‐matched patients with nondilated AA.

Field Strength/Sequence

1.5T/4D flow, 2D flow, and anatomic images.

Assessment

Altogether, 16 different 4D flow parameters were assessed in 10 planes in the thoracic aorta. Intra‐ and interobserver reproducibility were analyzed.

Statistical Tests

Independent t‐test for normally distributed and the Mann–Whitney test for skewed distributed parameters were used. A paired‐samples t‐test was used to compare 2D and 4D flow parameters. Intraclass correlation coefficient (ICC) was used in intra‐ and interobserver reproducibility analysis.

Results

Aortic flow was displaced from the centerline of the aorta in the proximal and tubular planes. Flow displacement (FD) was greatest in the proximal plane of AA and was higher in dilated AA (4.5%, range 3.0–5.8%) than in nondilated AA (2.0%, 1.0–3.0%, P < 0.001). Total wall shear stress (WSS) values were 1.3 ± 0.4 times higher on the displaced side than on the opposite side of the aorta (P < 0.01). The circumferential WSS (WSS_C) ratio to total WSS was greater in dilated AA, being 0.48 ± 0.11 vs. 0.32 ± 0.09 in the inner curvature of the proximal AA (P < 0.001) and 0.37 ± 0.11 vs. 0.26 ± 0.07 in the whole aortic ring in the distal AA (P < 0.001). Depending on 4D flow parameters, reproducibility varied from excellent (ICC = 0.923) to very low (ICC = 0.204).

Data Conclusion

The present study demonstrates that 4D flow measurements help to visualize the pathological flow patterns related to aortic dilatation. Flow displacement and an increased WSSc/WSS ratio are significantly associated with AA dilatation.

Level of Evidence: 2

Technical Efficacy: Stage 2

J. Magn. Reson. Imaging 2019.

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Multiparameter diffusion‐weighted imaging for characterizing pathological patterns in lupus nephritis patients: A preliminary study

Background

Microstructural changes of lupus nephritis (LN) kidney such as inflammatory cell infiltration or fibrosis could influence water molecular movement or diffusion, which indicates that diffusion‐weighted imaging (DWI) may become a valuable tool in evaluation of this disease.

Purpose

To explore whether multiparameter diffusion‐weighted imaging (mDWI) could contribute to characterize pathological patterns in LN patients.

Study Type

Retrospective.

Population

Twenty‐two patients with LN.

Field Strength/Sequence

Multi‐b value DWI was performed with a 3.0 T scanner.

Assessment

Apparent diffusion coefficient (ADC)_m, perfusion‐related diffusion coefficient (D_f), molecular diffusion coefficient (D_s), perfusion fraction (f), ADC_s, α, ADC_k, and mean kurtosis (MK) were calculated by monoexponential, biexponential, stretched‐exponential, and kurtosis models fits, respectively.

Statistical Tests

Independent sample t‐test, Pearson analysis and receiver operating characteristic (ROC).

Results

In the whole group, the activity index (AI) correlated significantly with alpha values in the medulla (rho = –0.54, P = 0.03). The chronicity index (CI) correlated significantly with D_s values in the medulla (rho = –0.61, P = 0.02). No significant association was found between any other diffusion parameter and histologic grade with all P > 0.05. For differentiating proliferative LN (Class III or IV) from Class V, the area under the ROC curve (AUC) of alpha in the medulla was 0.833 (P = 0.023).

Data Conclusion

mDWI might be used for the characterization of pathological patterns in LN patients.

Level of Evidence: 3

Technical Efficacy Stage: 2

J. Magn. Reson. Imaging 2019.

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Contrast‐enhanced MRI for breast cancer screening

Multiple studies in the first decade of the 21^st century have established contrast‐enhanced breast MRI as a screening modality for women with a hereditary or familial increased risk for the development of breast cancer. In recent studies, in women with various risk profiles, the sensitivity ranges between 81% and 100%, which is approximately twice as high as the sensitivity of mammography. The specificity increases in follow‐up rounds to around 97%, with positive predictive values for biopsy in the same range as for mammography. MRI preferentially detects the more aggressive/invasive types of breast cancer, but has a higher sensitivity than mammography for any type of cancer. This performance implies that in women screened with breast MRI, all other examinations must be regarded as supplemental. Mammography may yield ~5% additional cancers, mostly ductal carcinoma in situ, while slightly decreasing specificity and increasing the costs. Ultrasound has no supplemental value when MRI is used. Evidence is mounting that in other groups of women the performance of MRI is likewise superior to more conventional screening techniques. Particularly in women with a personal history of breast cancer, the gain seems to be high, but also in women with a biopsy history of lobular carcinoma in situ and even women at average risk, similar results are reported. Initial outcome studies show that breast MRI detects cancer earlier, which induces a stage‐shift increasing the survival benefit of screening. Cost‐effectiveness is still an issue, particularly for women at lower risk. Since costs of the MRI scan itself are a driving factor, efforts to reduce these costs are essential. The use of abbreviated MRI protocols may enable more widespread use of breast MRI for screening.

Level of Evidence: 1

Technical Efficacy: Stage 5

J. Magn. Reson. Imaging 2019.

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Propofol TCI Reductions Do Not Attenuate Significant Falls in Cardiac Output Associated With Anesthesia Induction and Knee-Chest Positioning in Spinal Surgery

Background: Induction of anesthesia and the knee-chest position are associated with hemodynamic changes that may impact patient outcomes. The aim of this study was to assess whether planned reductions in target-controlled infusion propofol concentrations attenuate the hemodynamic changes associated with anesthesia induction and knee-chest position. Materilas and Methods: A total of 20 patients scheduled for elective lumbar spinal surgery in the knee-chest position were included. In addition to standard anesthesia monitoring, bispectral index and noninvasive cardiac output (CO) monitoring were undertaken. The study was carried out in 2 parts. In phase 1, target-controlled infusion propofol anesthesia was adjusted to maintain BIS 40 to 60. In phase 2, there were 2 planned reductions in propofol target concentration: (1) immediately after loss of consciousness—reduction calculated using a predefined formula, and (2) before positioning—reduction equal to the average percentage decrease in CO after knee-chest position in phase 1. Changes from baseline in CO and other hemodynamic variables following induction of anesthesia and knee-chest positioning were compared. Results: Induction of anesthesia led to decreases of 25.6% and 19.8% in CO from baseline in phases 1 and 2, respectively (P

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Journal Club

No abstract available

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Cognitive Prehabilitation: Supercharged Mind or Wishful Thinking?

No abstract available

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Comparison of pre-oxygenation using spontaneous breathing through face mask and high-flow nasal oxygen: A prospective randomised crossover controlled study in healthy volunteers

BACKGROUND High-flow nasal oxygen (HFNO) therapy has been proposed for pre-oxygenation before intubation, but the end-tidal fraction of oxygen (ETO2) obtained remains unknown. OBJECTIVE(S) To compare the ETO2 following a 3 min pre-oxygenation with HFNO and face mask. SETTING Operating room in a primary university hospital. DESIGN A prospective, randomised crossover study. PARTICIPANTS Fifty healthy volunteers. INTERVENTIONS Participants were randomly pre-oxygenated through spontaneous breathing 100% oxygen in a face mask and with HFNO (mouth closed, heated and humidified gas flow at 60 l min–1). In the face mask group, the ETO2 was measured continuously. In the HFNO group, the nasal cannula was quickly exchanged with a face mask while the subject held their breath at end inspiration and the ETO2 was measured after a deep expiration. The protocol ended when ETO2 reached 90% or otherwise at 6 min. MAIN OUTCOME MEASURES The primary endpoint was the ETO2 after 3 min of pre-oxygenation. Secondary endpoints were the proportion of participants with an ETO2 at least 90% and the time until the ETO2 at least 90%. RESULTS The ETO2 after 3 min of pre-oxygenation was 89 (2) % and 77 (12) % in the face mask and HFNO groups [difference 12% (95% confidence interval, 95% CI: 8 to 15]; P 

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Central venous-to-arterial PCO2 difference, arteriovenous oxygen content and outcome after adult cardiac surgery with cardiopulmonary bypass: A prospective observational study

BACKGROUND Rapid identification and treatment of tissue hypoxia reaching anaerobiosis (dysoxia) may reduce organ failure and the occurrence of major postoperative complications (MPC) after cardiac surgery. The predictive ability of PCO2-based dysoxia biomarkers, central venous-to-arterial PCO2 difference (ΔPCO2) and ΔPCO2 to arteriovenous oxygen content difference ratio, is poorly studied in this setting. OBJECTIVES We evaluated the ability of PCO2-based tissue dysoxia biomarkers, blood lactate concentration and central venous oxygen saturation measured 2 h after admission to the ICU as predictors of MPC. DESIGN A prospective, observational cohort study. SETTING Single-centre, academic hospital cardiovascular ICU. PATIENTS We included adult patients undergoing cardiac surgery with cardiopulmonary bypass and measured dysoxia biomarkers at ICU admission, and after 2, 6 and 24 h. MAIN OUTCOME MEASURES The primary endpoint was MPC, a composite of cardiac and noncardiac MPC evaluated in the 48 h following surgery. After univariate analysis of MPC covariates including dysoxia biomarkers measured at 2 h, multivariate logistic regression analyses were performed to identify the association of these biomarkers with MPC for confounders. Areas under the receiver operating characteristic curves were determined for biomarkers which remained independently associated with MPC. RESULTS MPC occurred in 56.5% of the 308 patients analysed. ΔPCO2, blood lactate concentration and central venous oxygen saturation measured at 2 h, but not ΔPCO2 to arteriovenous oxygen content difference ratio, were significantly associated with MPC. However, only ΔPCO2 was independently associated with MPC after multivariate analysis. The areas under the receiver operating characteristic curves of ΔPCO2 measured at 2 h for MPC prediction was 0.64 (95% CI 0.57 to 0.70, P 

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Programmed intermittent bolus infusion versus continuous infusion of 0.2% levobupivacaine after ultrasound-guided thoracic paravertebral block for video-assisted thoracoscopic surgery: A randomised controlled trial

BACKGROUND The analgesic benefits of programmed intermittent bolus infusion for thoracic paravertebral block remain unknown. OBJECTIVE The aim of this study was to compare the analgesia from intermittent bolus infusion with that of a continuous infusion after thoracic paravertebral block. DESIGN A randomised controlled study. SETTING A single centre between December 2016 and November 2017. Seventy patients scheduled for video-assisted thoracoscopic surgery were included in the study. INTERVENTION(S) Patients were randomly assigned to receive 0.2% levobupivacaine via continuous infusion (5 ml h−1, continuous group) or programmed intermittent bolus infusion (15 ml every 3 h, bolus group) after an initial 15-ml bolus injection of 0.2% levobupivacaine. MAIN OUTCOME MEASURES The main outcome was the amount of rescue fentanyl (per kg of body weight) consumed within 24 h after surgery. Secondary outcomes were postoperative pain scores, plasma levobupivacaine concentrations and the number of dermatomes anaesthetised. RESULTS There was no significant difference between the continuous and bolus groups in the postoperative consumption of fentanyl (median [interquartile range] 5.5 [4 to 9.5] μg kg−1 versus 6 [3.5 to 9] μg kg−1 respectively, P = 0.45) and postoperative pain scores within 24 h. At 20 h after initiating the infusions, there was no statistically significant difference between the two groups in terms of the plasma levobupivacaine concentration. The number of dermatomes anaesthetised to pinprick and cold testing was significantly greater in the bolus group. CONCLUSION Our findings suggest that postoperative pain and opioid usage are similar with either programmed intermittent bolus infusion or continuous infusion after thoracic paravertebral block. Programmed intermittent bolus infusion provides a wider sensory blockade and could benefit patients requiring a wider extent of anaesthesia. TRIAL REGISTRATION UMIN Clinical Trials Registry (UMIN-CTR; URL: http://umin.ac.jp/ctr/, ID: UMIN000023378). Correspondence to Dr. Yasuko Taketa, Department of Anesthesiology and Critical Care, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama-City, Ehime 790-0024, Japan. E-mail: suko1231@yahoo.co.jp © 2019 European Society of Anaesthesiology

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Pre-operative ultrasonographic evaluation of inferior vena cava collapsibility index and caval aorta index as new predictors for hypotension after induction of spinal anaesthesia: A prospective observational study

BACKGROUND Hypotension after spinal anaesthesia is a common side effect that may be harmful. Patients' susceptibility to intra-operative hypotension can be affected by many pre-operative factors. OBJECTIVES The current study aimed to evaluate the efficacy of both pre-operative inferior vena cava collapsibility index (IVCCI) and inferior vena cava to aorta diameter (IVC : Ao) index for predicting postspinal anaesthesia hypotension (PSAH). DESIGN Prospective observational blinded study. SETTING Operating room from June 2017 to February 2018. PATIENTS One hundred adult patients of both sexes, American Society of Anesthesiologists' physical status 1 or 2 scheduled for elective surgery under spinal anaesthesia were included in this study. INTERVENTIONS Patients received spinal anaesthesia performed at the level of L3 to 4 or L4 to 5 intervertebral space with the patient in the sitting position then placed in the supine position immediately after neuraxial block and kept supine throughout the study period (30 min). IVCCI and IVC : Ao index were assessed pre-operatively. Baseline noninvasive blood pressure was recorded before administration of spinal anaesthesia then every minute after spinal blockade for 30 min. MAIN OUTCOME MEASURES The primary outcome was to evaluate the predictive values of both IVCCI and IVC : Ao index for detecting PSAH and the secondary outcomes were to compare the predictive values of both IVCCI and IVC : Ao index and to detect other clinical predictors for PSAH using logistic regression analysis. RESULTS Forty-five patients developed PSAH (45%). IVCCI was significantly higher in patients who developed PSAH than in patients who did not, while IVC : Ao index was significantly lower in patients who developed PSAH than in patients who did not. Hypotension after induction of spinal anaesthesia was defined as an absolute value of SBP less than 90 mmHg, a decrease in SBP more than 30% of the baseline value or an absolute value of arterial blood pressure less than 60 mmHg. Logistic regression analysis revealed that IVCCI and IVC : Ao index were good predictors of the occurrence of PSAH. Receiver operating characteristic curve analysis showed that IVC : Ao index had a sensitivity of 96%, a specificity of 88%, and an accuracy of 95% to predict PSAH at a cut-off point less than 1.2. IVCCI had a sensitivity of 84%, a specificity of 77%, and an accuracy of 84% to predict PSAH at a cut-off point more than 44.7%. CONCLUSION Pre-operative IVCCI and IVC : Ao index are good predictors of the occurrence of PSAH. However, IVC : Ao index is a more powerful predictor than IVCCI. TRIAL REGISTRATION This study evaluate accuracy of two diagnostic methods for the occurrence of postspinal anaesthesia hypotension, so not a clinical trial as no intervention is present and no outcome of intervention is measured. Correspondence to Dr Eman Ramadan Salama, MD, Anaesthesia and Surgical ICU, Tanta University Hospital, Tanta, Egypt Tel: +20 1277886405; fax: +20 402231671; e-mail: dr.ers1975@yahoo.com © 2019 European Society of Anaesthesiology

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Comparison of pre-oxygenation using spontaneous breathing through face mask and high-flow nasal oxygen: A prospective randomised crossover controlled study in healthy volunteers

BACKGROUND High-flow nasal oxygen (HFNO) therapy has been proposed for pre-oxygenation before intubation, but the end-tidal fraction of oxygen (ETO2) obtained remains unknown. OBJECTIVE(S) To compare the ETO2 following a 3 min pre-oxygenation with HFNO and face mask. SETTING Operating room in a primary university hospital. DESIGN A prospective, randomised crossover study. PARTICIPANTS Fifty healthy volunteers. INTERVENTIONS Participants were randomly pre-oxygenated through spontaneous breathing 100% oxygen in a face mask and with HFNO (mouth closed, heated and humidified gas flow at 60 l min–1). In the face mask group, the ETO2 was measured continuously. In the HFNO group, the nasal cannula was quickly exchanged with a face mask while the subject held their breath at end inspiration and the ETO2 was measured after a deep expiration. The protocol ended when ETO2 reached 90% or otherwise at 6 min. MAIN OUTCOME MEASURES The primary endpoint was the ETO2 after 3 min of pre-oxygenation. Secondary endpoints were the proportion of participants with an ETO2 at least 90% and the time until the ETO2 at least 90%. RESULTS The ETO2 after 3 min of pre-oxygenation was 89 (2) % and 77 (12) % in the face mask and HFNO groups [difference 12% (95% confidence interval, 95% CI: 8 to 15]; P 

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Central venous-to-arterial PCO2 difference, arteriovenous oxygen content and outcome after adult cardiac surgery with cardiopulmonary bypass: A prospective observational study

BACKGROUND Rapid identification and treatment of tissue hypoxia reaching anaerobiosis (dysoxia) may reduce organ failure and the occurrence of major postoperative complications (MPC) after cardiac surgery. The predictive ability of PCO2-based dysoxia biomarkers, central venous-to-arterial PCO2 difference (ΔPCO2) and ΔPCO2 to arteriovenous oxygen content difference ratio, is poorly studied in this setting. OBJECTIVES We evaluated the ability of PCO2-based tissue dysoxia biomarkers, blood lactate concentration and central venous oxygen saturation measured 2 h after admission to the ICU as predictors of MPC. DESIGN A prospective, observational cohort study. SETTING Single-centre, academic hospital cardiovascular ICU. PATIENTS We included adult patients undergoing cardiac surgery with cardiopulmonary bypass and measured dysoxia biomarkers at ICU admission, and after 2, 6 and 24 h. MAIN OUTCOME MEASURES The primary endpoint was MPC, a composite of cardiac and noncardiac MPC evaluated in the 48 h following surgery. After univariate analysis of MPC covariates including dysoxia biomarkers measured at 2 h, multivariate logistic regression analyses were performed to identify the association of these biomarkers with MPC for confounders. Areas under the receiver operating characteristic curves were determined for biomarkers which remained independently associated with MPC. RESULTS MPC occurred in 56.5% of the 308 patients analysed. ΔPCO2, blood lactate concentration and central venous oxygen saturation measured at 2 h, but not ΔPCO2 to arteriovenous oxygen content difference ratio, were significantly associated with MPC. However, only ΔPCO2 was independently associated with MPC after multivariate analysis. The areas under the receiver operating characteristic curves of ΔPCO2 measured at 2 h for MPC prediction was 0.64 (95% CI 0.57 to 0.70, P 

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Programmed intermittent bolus infusion versus continuous infusion of 0.2% levobupivacaine after ultrasound-guided thoracic paravertebral block for video-assisted thoracoscopic surgery: A randomised controlled trial

BACKGROUND The analgesic benefits of programmed intermittent bolus infusion for thoracic paravertebral block remain unknown. OBJECTIVE The aim of this study was to compare the analgesia from intermittent bolus infusion with that of a continuous infusion after thoracic paravertebral block. DESIGN A randomised controlled study. SETTING A single centre between December 2016 and November 2017. Seventy patients scheduled for video-assisted thoracoscopic surgery were included in the study. INTERVENTION(S) Patients were randomly assigned to receive 0.2% levobupivacaine via continuous infusion (5 ml h−1, continuous group) or programmed intermittent bolus infusion (15 ml every 3 h, bolus group) after an initial 15-ml bolus injection of 0.2% levobupivacaine. MAIN OUTCOME MEASURES The main outcome was the amount of rescue fentanyl (per kg of body weight) consumed within 24 h after surgery. Secondary outcomes were postoperative pain scores, plasma levobupivacaine concentrations and the number of dermatomes anaesthetised. RESULTS There was no significant difference between the continuous and bolus groups in the postoperative consumption of fentanyl (median [interquartile range] 5.5 [4 to 9.5] μg kg−1 versus 6 [3.5 to 9] μg kg−1 respectively, P = 0.45) and postoperative pain scores within 24 h. At 20 h after initiating the infusions, there was no statistically significant difference between the two groups in terms of the plasma levobupivacaine concentration. The number of dermatomes anaesthetised to pinprick and cold testing was significantly greater in the bolus group. CONCLUSION Our findings suggest that postoperative pain and opioid usage are similar with either programmed intermittent bolus infusion or continuous infusion after thoracic paravertebral block. Programmed intermittent bolus infusion provides a wider sensory blockade and could benefit patients requiring a wider extent of anaesthesia. TRIAL REGISTRATION UMIN Clinical Trials Registry (UMIN-CTR; URL: http://umin.ac.jp/ctr/, ID: UMIN000023378). Correspondence to Dr. Yasuko Taketa, Department of Anesthesiology and Critical Care, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama-City, Ehime 790-0024, Japan. E-mail: suko1231@yahoo.co.jp © 2019 European Society of Anaesthesiology

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Pre-operative ultrasonographic evaluation of inferior vena cava collapsibility index and caval aorta index as new predictors for hypotension after induction of spinal anaesthesia: A prospective observational study

BACKGROUND Hypotension after spinal anaesthesia is a common side effect that may be harmful. Patients' susceptibility to intra-operative hypotension can be affected by many pre-operative factors. OBJECTIVES The current study aimed to evaluate the efficacy of both pre-operative inferior vena cava collapsibility index (IVCCI) and inferior vena cava to aorta diameter (IVC : Ao) index for predicting postspinal anaesthesia hypotension (PSAH). DESIGN Prospective observational blinded study. SETTING Operating room from June 2017 to February 2018. PATIENTS One hundred adult patients of both sexes, American Society of Anesthesiologists' physical status 1 or 2 scheduled for elective surgery under spinal anaesthesia were included in this study. INTERVENTIONS Patients received spinal anaesthesia performed at the level of L3 to 4 or L4 to 5 intervertebral space with the patient in the sitting position then placed in the supine position immediately after neuraxial block and kept supine throughout the study period (30 min). IVCCI and IVC : Ao index were assessed pre-operatively. Baseline noninvasive blood pressure was recorded before administration of spinal anaesthesia then every minute after spinal blockade for 30 min. MAIN OUTCOME MEASURES The primary outcome was to evaluate the predictive values of both IVCCI and IVC : Ao index for detecting PSAH and the secondary outcomes were to compare the predictive values of both IVCCI and IVC : Ao index and to detect other clinical predictors for PSAH using logistic regression analysis. RESULTS Forty-five patients developed PSAH (45%). IVCCI was significantly higher in patients who developed PSAH than in patients who did not, while IVC : Ao index was significantly lower in patients who developed PSAH than in patients who did not. Hypotension after induction of spinal anaesthesia was defined as an absolute value of SBP less than 90 mmHg, a decrease in SBP more than 30% of the baseline value or an absolute value of arterial blood pressure less than 60 mmHg. Logistic regression analysis revealed that IVCCI and IVC : Ao index were good predictors of the occurrence of PSAH. Receiver operating characteristic curve analysis showed that IVC : Ao index had a sensitivity of 96%, a specificity of 88%, and an accuracy of 95% to predict PSAH at a cut-off point less than 1.2. IVCCI had a sensitivity of 84%, a specificity of 77%, and an accuracy of 84% to predict PSAH at a cut-off point more than 44.7%. CONCLUSION Pre-operative IVCCI and IVC : Ao index are good predictors of the occurrence of PSAH. However, IVC : Ao index is a more powerful predictor than IVCCI. TRIAL REGISTRATION This study evaluate accuracy of two diagnostic methods for the occurrence of postspinal anaesthesia hypotension, so not a clinical trial as no intervention is present and no outcome of intervention is measured. Correspondence to Dr Eman Ramadan Salama, MD, Anaesthesia and Surgical ICU, Tanta University Hospital, Tanta, Egypt Tel: +20 1277886405; fax: +20 402231671; e-mail: dr.ers1975@yahoo.com © 2019 European Society of Anaesthesiology

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Spontaneous Resolution of Fourth Branchial Fistula Following Thyroid Surgery: Case Report

Abstract

Fourth branchial pouch anomalies represent one of the rarest types of all branchial apparatus anomalies. They appear in the first lifedecade in a form of recurrent left-sided neck masses which demands surgical treatment. Accidental finding, appearance later in life and spontaneous resolving are really rare. We present a case of a 43-year-old man with accidental finding of asymptomatic fourth pouch cyst and fistula following follicular thyroid cancer surgery. The day after the surgery, suction bottle was filled with little white crumbs and the wound started to suppurate. Barium swallow revealed the presence of a fistulous canal that arose from the left pyriform sinus. Meanwhile, the pathologist confirmed the presence of a lateral neck cyst within this thyroid lobe. The patient was operated on but fistulous canal was not visualized. In the meantime, wound discharge ceased spontaneously. At 1-year follow up, the patient was still well and free from any symptoms. These anomalies may manifest not only in childhood but may stay asymptomatic for a long time. It seems that the fistula can resolve spontaneously and that conservative approach is an alternative to multiple surgical procedures.

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Spontaneous Resolution of Fourth Branchial Fistula Following Thyroid Surgery: Case Report

Abstract

Fourth branchial pouch anomalies represent one of the rarest types of all branchial apparatus anomalies. They appear in the first lifedecade in a form of recurrent left-sided neck masses which demands surgical treatment. Accidental finding, appearance later in life and spontaneous resolving are really rare. We present a case of a 43-year-old man with accidental finding of asymptomatic fourth pouch cyst and fistula following follicular thyroid cancer surgery. The day after the surgery, suction bottle was filled with little white crumbs and the wound started to suppurate. Barium swallow revealed the presence of a fistulous canal that arose from the left pyriform sinus. Meanwhile, the pathologist confirmed the presence of a lateral neck cyst within this thyroid lobe. The patient was operated on but fistulous canal was not visualized. In the meantime, wound discharge ceased spontaneously. At 1-year follow up, the patient was still well and free from any symptoms. These anomalies may manifest not only in childhood but may stay asymptomatic for a long time. It seems that the fistula can resolve spontaneously and that conservative approach is an alternative to multiple surgical procedures.

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Multiple Papules on an Elderly Man: Challenge

No abstract available

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Multiple Papules on an Elderly Man: Challenge

No abstract available

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