Association of geographic tongue and fissured tongue with ABO blood group among adult psoriasis patients – A novel study from a tertiary care hospital in Saudi Arabia

Publication date: Available online 7 February 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Nabeeh A. Al Qahtani, Angeline Deepthi, Nada Mohammed Alhussain, BashayerAyesh Mohammed Al Shahrani, Hamza Alshehri, Amal Alhefzi, Betsy Joseph

Abstract

Objective

We aimed to determine if there was any association between geographic tongue and fissured tongue with ABO blood group among adult psoriasis patients in Saudi Arabia.

Materials and method

This hospital-based cross-sectional study included 100 consecutive new adult patients diagnosed with psoriasis and 100 case-matched participants in the control group (non-psoriatic). Socio-demographic and dermatologic parameters, intraoral lesions (geographic tongue (GT) and fissured tongue (FT)) along with ABO blood grouping and immunoglobulins (Ig)) were recorded which was evaluated using the Chi-square test or Fisher's exact test.

Results

74% of patients had an early age of onset, and 48% of them reported this disease in their parents.76% in generalized psoriasis had plaque type while 78% in the localized type had pustular type lesions. 70% of psoriatic patients had O positive blood group. 63% of tongue lesions seen in these patients were GT, and it was most prominent in O positive (64.28%) and O negative (62.50%) blood groups. GT was prevalent among in females (75.6%).

Conclusion

This study demonstrates a positive association of both GT and FT in this population of adult patients with psoriasis compared to a case-matched control population without psoriasis.

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Prescription of Potentially Inappropriate Medications in Geriatric Patients: Data from a Single Dental Institution

Publication date: Available online 8 February 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Arwa Farag, Jessaca York, Matthew Finkelman, Bhavik Desai

ABSTRACT

Objectives

The Beers Criteria and the Screening Tool of Older Persons' Potentially Inappropriate Prescriptions(STOPP) are consensus-driven lists of potentially inappropriate medications(PIMs) in geriatric patients. The Primary objective was to determine the frequency of PIMs prescribed to geriatrics at Tufts University School of Dental Medicine(TUSDM). The secondary aim was to determine the American Society of Anesthesiologists (ASA) status of these patients and suggest that Beers/STOPP guidelines should be implied with consideration to the patient's ASA status.

Methods

Beers/STOPP criteria were studied and PIMs thus identified. A retrospective electronic chart review of patients at TUSDM aged 65+ was performed for calendar years 2013,2014 and 2015. Search queries were generated for ASA status, along with PIM's prescribed.

Results

Out of 15569 geriatrics, over half of patients between 65-74 years were classified as ASA-I. Over a 3-year-period, 895(5.75%) and 840(5.4%) received new prescriptions for opioids or NSAIDs, respectively. New prescriptions for muscle relaxants, benzodiazepines and tricyclic antidepressants were given to 65(0.42%),44(0.28%) and 38(0.24%) patients, respectively.

Conclusion

PIMs are prescribed at low percentages to geriatric patients. However, prescription of opioids, benzodiazepines and NSAIDs across undergraduate/postgraduate clinics is not uncommon. The majority of TUSDM geriatric patients fall within the category of ASAI-II. ASA classification must be taken into consideration when PIMs are prescribed to geriatrics rather than relying solely on chronological age.

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CLINICO-RADIOLOGICAL FOLLOW UP OF CHERUBISM WITH AGGRESSIVE CHARACTERISTICS: A SERIES OF 3 CASES

Publication date: Available online 7 February 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Dr. Sunita Gupta, Dr. Khushboo Singh, Dr. Anju Garg, Dr. P.S. Bhandari, Dr. Shyam Kishor Sah, Dr. Ernst Reichenberger, Dr. Seema Kapoor, Dr. Shyama Jain, Dr. Nirupama Trehanpati

ABSTRACT

Background

Cherubism is a rare autosomal dominant disorder characterized by degradation of bone that is replaced by fibrous tissue containing multinucleated giant cells. It clinically manifests as bilateral mandibular and maxillary enlargement. The recent World Health Organization (WHO) classification of 2017 now lists cherubism as one of the giant cell lesions of the jaws, distinct from fibro-osseous disorders.

Materials and Methods

We discuss three cases of familial cherubism having aggressive characteristics with clinico-radiologic evaluation of the lesions for 12 years, 18 years, and 1.5 years, respectively. Follow-up was observational without active intervention. Clinical analysis of the lesions for increase or decrease in size and association with functional impairments was correlated with periodic conventional and advanced imaging. All three cases are currently on a follow-up examination schedule.

Conclusion

The outcome in two cases with long term follow-up has been excellent without intervention, although one case had extensive involvement of the jaws as well as unusual involvement of the mandibular condyle and orbit. Another unique finding was the development of a secondary giant cell lesion involving the palate in the affected mother of patient 3, who had had cherubic lesions in childhood.

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Plasmacytoid cells in salivary pleomorphic adenoma. An alternative interpretation of their immunohistochemical characteristics highlights function and capability for epithelial-mesenchymal transition

Publication date: Available online 7 February 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Ioannis G. Koutlas, Michelle Dolan, Mark W. Lingen, Prokopios P. Argyris

Abstract

Objectives

Plasmacytoid cells (PLCs) in salivary pleomorphic adenoma (SPA) are regarded as modified neoplastic myoepithelia and define plasmacytoid myoepithelioma (pMYO). However, histochemically, immunohistochemically and ultrastructurally, PLCs fail to demonstrate frank myogenous properties. Epithelial-mesenchymal transition (EMT) may explain the phenotypes in SPA. Our aim was to evaluate 1) PLCs with accepted or purported myoepithelial and EMT-related markers; and 2) pMYOs for PLAG1 aberrations by FISH.

Study Design

Eight SPAs with or without PLC-predominance and 3 pMYOs were immunohistochemically studied.

Results

PLCs in SPA and pMYO exhibited strong, scattered to diffuse positivity for K7, rare K14 positivity and were mostly negative for α-SMA, h-caldesmon, and p63/p40. S100 staining was strong and diffuse, while calponin was variable. DOG1 was negative. PLCs in pMYO and PLC-rich-SPA exhibited selective or diffuse, WT-1 and D2-40 immunoreactivity. EMT markers SNAIL/SLUG exhibited strong and variable immunoreactivity in PLCs, in contrast to weak or absent e-cadherin expression. SOX10 was diffusely and strongly positive. PLAG1 rearrangement was present in 1 pMYO.

Conclusions

1) PLCs mostly fail to express myoepithelial markers; 2) PLCs are neoplastic cells adapting to micro-environmental changes and capable of EMT; 3) Tumors composed solely of PLCs are apparently SPAs depleted of a ductal component.

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Association of geographic tongue and fissured tongue with ABO blood group among adult psoriasis patients – A novel study from a tertiary care hospital in Saudi Arabia

Publication date: Available online 7 February 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Nabeeh A. Al Qahtani, Angeline Deepthi, Nada Mohammed Alhussain, BashayerAyesh Mohammed Al Shahrani, Hamza Alshehri, Amal Alhefzi, Betsy Joseph

Abstract

Objective

We aimed to determine if there was any association between geographic tongue and fissured tongue with ABO blood group among adult psoriasis patients in Saudi Arabia.

Materials and method

This hospital-based cross-sectional study included 100 consecutive new adult patients diagnosed with psoriasis and 100 case-matched participants in the control group (non-psoriatic). Socio-demographic and dermatologic parameters, intraoral lesions (geographic tongue (GT) and fissured tongue (FT)) along with ABO blood grouping and immunoglobulins (Ig)) were recorded which was evaluated using the Chi-square test or Fisher's exact test.

Results

74% of patients had an early age of onset, and 48% of them reported this disease in their parents.76% in generalized psoriasis had plaque type while 78% in the localized type had pustular type lesions. 70% of psoriatic patients had O positive blood group. 63% of tongue lesions seen in these patients were GT, and it was most prominent in O positive (64.28%) and O negative (62.50%) blood groups. GT was prevalent among in females (75.6%).

Conclusion

This study demonstrates a positive association of both GT and FT in this population of adult patients with psoriasis compared to a case-matched control population without psoriasis.

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Atopic Dermatitis: Collegium Internationale Allergologicum (CIA) Update 2019

Atopic dermatitis (AD) is a chronic inflammatory skin disease presenting with recurrent eczematous lesions and intense pruritus. It is common and affects both children and adults, often beginning in infancy. Due to the unpredictable disease course, its visible skin lesions, itching and scratching followed by sleeplessness, other associated atopic diseases, and behavioral and psychiatric disorders, AD is an immense burden for patients and caregivers. AD is determined by a genetic predisposition characterized by an impaired skin barrier and a T-helper-2-predominant inflammation. Restoration of the skin barrier is the main approach for treating and preventing AD. In order to cope with acute flares, usually topical corticosteroids (TCS) are applied, while topical calcineurin inhibitors (TCI) a...

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Transient Receptor Potential Ankyrin 1 Enhances Ovalbumin-Induced Acute Allergic Inflammation in Murine Models

Conclusion: These results introduce a novel concept that TRPA1 mediates early events in allergic inflammation, but does not seem to affect allergic sensitization, and could therefore be a novel drug target to treat conditions associated with allergic inflammation.Int Arch Allergy Immunol (Source: International Archives of Allergy and Immunology)

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CLINICO-RADIOLOGICAL FOLLOW UP OF CHERUBISM WITH AGGRESSIVE CHARACTERISTICS: A SERIES OF 3 CASES

Publication date: Available online 7 February 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Dr. Sunita Gupta, Dr. Khushboo Singh, Dr. Anju Garg, Dr. P.S. Bhandari, Dr. Shyam Kishor Sah, Dr. Ernst Reichenberger, Dr. Seema Kapoor, Dr. Shyama Jain, Dr. Nirupama Trehanpati

ABSTRACT

Background

Cherubism is a rare autosomal dominant disorder characterized by degradation of bone that is replaced by fibrous tissue containing multinucleated giant cells. It clinically manifests as bilateral mandibular and maxillary enlargement. The recent World Health Organization (WHO) classification of 2017 now lists cherubism as one of the giant cell lesions of the jaws, distinct from fibro-osseous disorders.

Materials and Methods

We discuss three cases of familial cherubism having aggressive characteristics with clinico-radiologic evaluation of the lesions for 12 years, 18 years, and 1.5 years, respectively. Follow-up was observational without active intervention. Clinical analysis of the lesions for increase or decrease in size and association with functional impairments was correlated with periodic conventional and advanced imaging. All three cases are currently on a follow-up examination schedule.

Conclusion

The outcome in two cases with long term follow-up has been excellent without intervention, although one case had extensive involvement of the jaws as well as unusual involvement of the mandibular condyle and orbit. Another unique finding was the development of a secondary giant cell lesion involving the palate in the affected mother of patient 3, who had had cherubic lesions in childhood.

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Hypothyroidism in the older population

Abstract

Background

Both overt hypothyroidism as well as minor elevations of serum thyrotropin (TSH) levels associated with thyroid hormones within their respective reference ranges (termed subclinical hypothyroidism) are relatively common in older individuals. There is growing evidence that treatment of subclinical hypothyroidism may not be beneficial, particularly in an older person. These findings are relevant at a time when treatment with thyroid hormones is increasing and more than 10–15% of people aged over 80 years are prescribed levothyroxine replacement therapy.

Main body

The prevalence of hypothyroidism increases with age. However, the reference range for TSH also rises with age, as the population distribution of TSH concentration progressively rises with age. Furthermore, there is evidence to suggest that minor TSH elevations are not associated with important outcomes such as impaired quality of life, symptoms, cognition, cardiovascular events and mortality in older individuals. There is also evidence that treatment of mild subclinical hypothyroidism may not benefit quality of life and/or symptoms in older people. It is unknown whether treatment targets should be reset depending on the age of the patient. It is likely that some older patients with non-specific symptoms and incidental mild subclinical hypothyroidism may be treated with thyroid hormones and could potentially be harmed as a result. This article reviews the current literature pertaining to hypothyroidism with a special emphasis on the older individual and assesses the risk/benefit impact of contemporary management on outcomes in this age group.

Conclusions

Current evidence suggests that threshold for treating mild subclinical hypothyroidism in older people should be high. It is reasonable to aim for a higher TSH target in treated older hypothyroid patients as their thyroid hormone requirements may be lower. In addition, age-appropriate TSH reference ranges should be considered in the diagnostic pathway of identifying individuals at risk of developing hypothyroidism. Appropriately designed and powered randomised controlled trials are required to confirm risk/benefit of treatment of subclinical hypothyroidism in older people. Until the results of such RCTs are available to guide clinical management international guidelines should be followed that advocate a conservative policy in the management of mild subclinical hypothyroidism in older individuals.

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

Atopic Dermatitis: Collegium Internationale Allergologicum (CIA) Update 2019

Atopic dermatitis (AD) is a chronic inflammatory skin disease presenting with recurrent eczematous lesions and intense pruritus. It is common and affects both children and adults, often beginning in infancy. Due to the unpredictable disease course, its visible skin lesions, itching and scratching followed by sleeplessness, other associated atopic diseases, and behavioral and psychiatric disorders, AD is an immense burden for patients and caregivers. AD is determined by a genetic predisposition characterized by an impaired skin barrier and a T-helper-2-predominant inflammation. Restoration of the skin barrier is the main approach for treating and preventing AD. In order to cope with acute flares, usually topical corticosteroids (TCS) are applied, while topical calcineurin inhibitors (TCI) a...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2I0Br5q

Transient Receptor Potential Ankyrin 1 Enhances Ovalbumin-Induced Acute Allergic Inflammation in Murine Models

Conclusion: These results introduce a novel concept that TRPA1 mediates early events in allergic inflammation, but does not seem to affect allergic sensitization, and could therefore be a novel drug target to treat conditions associated with allergic inflammation.Int Arch Allergy Immunol (Source: International Archives of Allergy and Immunology)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Ggp5EC

Hypothyroidism in the older population

Abstract

Background

Both overt hypothyroidism as well as minor elevations of serum thyrotropin (TSH) levels associated with thyroid hormones within their respective reference ranges (termed subclinical hypothyroidism) are relatively common in older individuals. There is growing evidence that treatment of subclinical hypothyroidism may not be beneficial, particularly in an older person. These findings are relevant at a time when treatment with thyroid hormones is increasing and more than 10–15% of people aged over 80 years are prescribed levothyroxine replacement therapy.

Main body

The prevalence of hypothyroidism increases with age. However, the reference range for TSH also rises with age, as the population distribution of TSH concentration progressively rises with age. Furthermore, there is evidence to suggest that minor TSH elevations are not associated with important outcomes such as impaired quality of life, symptoms, cognition, cardiovascular events and mortality in older individuals. There is also evidence that treatment of mild subclinical hypothyroidism may not benefit quality of life and/or symptoms in older people. It is unknown whether treatment targets should be reset depending on the age of the patient. It is likely that some older patients with non-specific symptoms and incidental mild subclinical hypothyroidism may be treated with thyroid hormones and could potentially be harmed as a result. This article reviews the current literature pertaining to hypothyroidism with a special emphasis on the older individual and assesses the risk/benefit impact of contemporary management on outcomes in this age group.

Conclusions

Current evidence suggests that threshold for treating mild subclinical hypothyroidism in older people should be high. It is reasonable to aim for a higher TSH target in treated older hypothyroid patients as their thyroid hormone requirements may be lower. In addition, age-appropriate TSH reference ranges should be considered in the diagnostic pathway of identifying individuals at risk of developing hypothyroidism. Appropriately designed and powered randomised controlled trials are required to confirm risk/benefit of treatment of subclinical hypothyroidism in older people. Until the results of such RCTs are available to guide clinical management international guidelines should be followed that advocate a conservative policy in the management of mild subclinical hypothyroidism in older individuals.

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Discrepancies in Interpretation of the Minor Salivary Gland Biopsy in the Diagnosis of Sjögren syndrome

Publication date: Available online 8 February 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Sarah Wicheta, Troy Van der Groen, William C. Faquin, Meredith August

Purpose

Although the minor salivary gland biopsy(MSGB) is a major criterion for diagnosis of Sjögren syndrome(SS), multiple studies have outlined difficulties in standardization.1, 2 The purpose of this study was to answer the following question: In all patients referred for MSGB, did strict application of focus scoring criteria alter the sensitivity of and predictive value of the MSGB in the diagnosis of SS when compared to the initial interpretation?

Materials and Methods

We designed a cross-sectional study of patients referred to the Massachusetts General Hospital Department of OMS over a 5-year period for MSGB. The primary predictor variable was the MSGB focus score. The primary outcome variable was the SS diagnosis. The newly established SS diagnosis status results were then compared to the initial SS diagnoses. Sensitivity, specificity and positive and negative predictive values were calculated. Other relevant variables of interest, such as size of glandular tissue harvested and associated signs and symptoms, were also described.

The primary predictor variable was the MSGB focus score the primary outcome variable was the SS diagnosis (positive or negative).

Results

Seventy-three patients met inclusion criteria. The mean age was 48.5 years (range, 19-71yrs) and 64 were female (87.6%). Our previous study utilizing initial pathology reports yielded 80.0% sensitivity, 87.5% specificity, PPV=57.1% and NPV= 95.5%. The current review of the MSGB using strict focus scoring guidelines yielded: 95.4% sensitivity, 76.4% specificity, PPV=63.6% and NPV=97.5%.

Conclusion

The MSGB is an important major criterion in establishing a diagnosis of SS. Application of strict focus scoring guidelines when reviewing the MSGB yielded a sensitivity far greater than initially reported in this group. Difficulties with interpretation are discussed. Future studies will focus on improvement of interpretation and immunohistochemical aids in diagnosis.

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A simple technique to repair a residual oronasal fistula in bilateral cleft lip and palate patients

Publication date: Available online 8 February 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Bruce R. Nicol, Noel Ye Naung, Joseph E. Van Sickels

Purpose

An anterior palatal oronasal fistula in a bilateral cleft lip and palate is a challenging clinical dilemma. The purpose of this paper is to present a two-stage technique to repair the fistula in consistent fashion. The technique was developed to avoid more complicated procedures that had greater morbidity to be used on larger oronasal defects that could not be treated in a single procedure.

Methods

This is a retrospective study performed over fifteen years using this technique in a private practice setting. From 2002 to 2017, fifteen 7 to 12-years-old patients (11 male and 4 female) were treated. When they were seen in a multispecialty clinic with an anterior residual fistulae impression were obtained. They were then scheduled for a first stage closing of the fistulae. Data was retrospective analyzed. The two-stage procedure started with closing the central portion of the fistulae as the first stage. During a second stage 6 months later, the residual nasoalveolar cleft would be closed and grafted in a standard fashion. The first stage involves posteriorly reflecting a full thickness mucoperiosteal flap and inserting into the palatal soft tissue and stabilizing the segment with a splint for three weeks. The premaxillary segment was left denuded.

Results

Fourteen out of fifteen patients (93%) had the central portion of the oronasal fistulae successfully closed. One patient had a partial breakdown when the splint was prematurely removed in 2 weeks. The patient underwent successful closure by the same procedure at a later date. All patient had a successful second stage grafting of their nasoalveolar clefts.

Conclusion

An alternative technique was presented to treat the clinically challenging oronasal fistulae. This two-stage closure of a palatal fistula is simple, allows consistent closure of the soft tissue defects, and avoids complex alternative procedures with significant surgical morbidities.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2UNV8Pb

Discrepancies in Interpretation of the Minor Salivary Gland Biopsy in the Diagnosis of Sjögren syndrome

Publication date: Available online 8 February 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Sarah Wicheta, Troy Van der Groen, William C. Faquin, Meredith August

Purpose

Although the minor salivary gland biopsy(MSGB) is a major criterion for diagnosis of Sjögren syndrome(SS), multiple studies have outlined difficulties in standardization.1, 2 The purpose of this study was to answer the following question: In all patients referred for MSGB, did strict application of focus scoring criteria alter the sensitivity of and predictive value of the MSGB in the diagnosis of SS when compared to the initial interpretation?

Materials and Methods

We designed a cross-sectional study of patients referred to the Massachusetts General Hospital Department of OMS over a 5-year period for MSGB. The primary predictor variable was the MSGB focus score. The primary outcome variable was the SS diagnosis. The newly established SS diagnosis status results were then compared to the initial SS diagnoses. Sensitivity, specificity and positive and negative predictive values were calculated. Other relevant variables of interest, such as size of glandular tissue harvested and associated signs and symptoms, were also described.

The primary predictor variable was the MSGB focus score the primary outcome variable was the SS diagnosis (positive or negative).

Results

Seventy-three patients met inclusion criteria. The mean age was 48.5 years (range, 19-71yrs) and 64 were female (87.6%). Our previous study utilizing initial pathology reports yielded 80.0% sensitivity, 87.5% specificity, PPV=57.1% and NPV= 95.5%. The current review of the MSGB using strict focus scoring guidelines yielded: 95.4% sensitivity, 76.4% specificity, PPV=63.6% and NPV=97.5%.

Conclusion

The MSGB is an important major criterion in establishing a diagnosis of SS. Application of strict focus scoring guidelines when reviewing the MSGB yielded a sensitivity far greater than initially reported in this group. Difficulties with interpretation are discussed. Future studies will focus on improvement of interpretation and immunohistochemical aids in diagnosis.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2tcxz7d

A simple technique to repair a residual oronasal fistula in bilateral cleft lip and palate patients

Publication date: Available online 8 February 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Bruce R. Nicol, Noel Ye Naung, Joseph E. Van Sickels

Purpose

An anterior palatal oronasal fistula in a bilateral cleft lip and palate is a challenging clinical dilemma. The purpose of this paper is to present a two-stage technique to repair the fistula in consistent fashion. The technique was developed to avoid more complicated procedures that had greater morbidity to be used on larger oronasal defects that could not be treated in a single procedure.

Methods

This is a retrospective study performed over fifteen years using this technique in a private practice setting. From 2002 to 2017, fifteen 7 to 12-years-old patients (11 male and 4 female) were treated. When they were seen in a multispecialty clinic with an anterior residual fistulae impression were obtained. They were then scheduled for a first stage closing of the fistulae. Data was retrospective analyzed. The two-stage procedure started with closing the central portion of the fistulae as the first stage. During a second stage 6 months later, the residual nasoalveolar cleft would be closed and grafted in a standard fashion. The first stage involves posteriorly reflecting a full thickness mucoperiosteal flap and inserting into the palatal soft tissue and stabilizing the segment with a splint for three weeks. The premaxillary segment was left denuded.

Results

Fourteen out of fifteen patients (93%) had the central portion of the oronasal fistulae successfully closed. One patient had a partial breakdown when the splint was prematurely removed in 2 weeks. The patient underwent successful closure by the same procedure at a later date. All patient had a successful second stage grafting of their nasoalveolar clefts.

Conclusion

An alternative technique was presented to treat the clinically challenging oronasal fistulae. This two-stage closure of a palatal fistula is simple, allows consistent closure of the soft tissue defects, and avoids complex alternative procedures with significant surgical morbidities.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2UNV8Pb

Mélanome muqueux des fosses nasales avec extension cutanée mimant un lentigo malin cutané d’extension muqueuse

Publication date: Available online 8 February 2019

Source: Annales de Chirurgie Plastique Esthétique

Author(s): A. Houette, A. Depeyre, S. Mansard, C. Chevenet, I. Barthelemy, N. Pham Dang

Résumé

Le mélanome muqueux est une tumeur maligne rare développée aux dépens des mélanocytes. Nous rapportons le cas d'un patient présentant un mélanome muqueux des fosses nasales dont le diagnostic clinique et anatomopathologique initial était lentigo malin avec extension muqueuse. Devant l'évolution trop rapide de la lésion par rapport au diagnostic évoqué, de nouvelles biopsies (ayant notamment mis en évidence une mutation de C-Kit) ont permis de réorienter le diagnostic vers un mélanome muqueux à extension cutanée. L'exérèse chirurgicale large avec reconstruction par lambeau libre anté-brachial et étai costal a permis de contrôler localement la pathologie. À un an postopératoire, une évolution ganglionnaire parapharyngée non accessible à la chirurgie a été traitée par radiothérapie stéréotaxique. Près de 5 ans après le diagnostic, le patient est considéré en rémission clinique et radiologique. Le suivi clinique par nasofibroscopie se rajoute au suivi habituel des patients pris en charge pour un mélanome muqueux quel que soit le degré d'envahissement. Le lentigo malin à extension muqueuse est une entité rare qui ne doit être évoquée qu'en seconde intention une fois le diagnostic de mélanome muqueux écarté avec certitude.

Summary

Mucosal melanoma is a rare malignant disease developed from melanocyte. We report the case of a patient with nasal cavity mucosal melanoma with a primary clinical and histological diagnosis of malignant lentigo with mucosal spreading. The presence of a c-Kit mutation, in a second lecture and the evolving nature of the lesion, reorientated the diagnosis of malignant lentigo to mucosal melanoma with skin extension. Extensive surgical resection and foramen free flap with costal graft reconstruction may have a local control of the disease. Yet, after one year, a regional evolution involving a parapharyngeal node was treated by stereotaxic radiotherapy. After 5 years, the patient was considered in clinical and radiological remission. Malignant lentigo with mucosal extension is a very rare situation, this diagnoses must be evoqued after setting mucosal melanoma diagnosis.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2E0MGXt

Hypothyroidism in the older population

Both overt hypothyroidism as well as minor elevations of serum thyrotropin (TSH) levels associated with thyroid hormones within their respective reference ranges (termed subclinical hypothyroidism) are relativ...

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

Mélanome muqueux des fosses nasales avec extension cutanée mimant un lentigo malin cutané d’extension muqueuse

Publication date: Available online 8 February 2019

Source: Annales de Chirurgie Plastique Esthétique

Author(s): A. Houette, A. Depeyre, S. Mansard, C. Chevenet, I. Barthelemy, N. Pham Dang

Résumé

Le mélanome muqueux est une tumeur maligne rare développée aux dépens des mélanocytes. Nous rapportons le cas d'un patient présentant un mélanome muqueux des fosses nasales dont le diagnostic clinique et anatomopathologique initial était lentigo malin avec extension muqueuse. Devant l'évolution trop rapide de la lésion par rapport au diagnostic évoqué, de nouvelles biopsies (ayant notamment mis en évidence une mutation de C-Kit) ont permis de réorienter le diagnostic vers un mélanome muqueux à extension cutanée. L'exérèse chirurgicale large avec reconstruction par lambeau libre anté-brachial et étai costal a permis de contrôler localement la pathologie. À un an postopératoire, une évolution ganglionnaire parapharyngée non accessible à la chirurgie a été traitée par radiothérapie stéréotaxique. Près de 5 ans après le diagnostic, le patient est considéré en rémission clinique et radiologique. Le suivi clinique par nasofibroscopie se rajoute au suivi habituel des patients pris en charge pour un mélanome muqueux quel que soit le degré d'envahissement. Le lentigo malin à extension muqueuse est une entité rare qui ne doit être évoquée qu'en seconde intention une fois le diagnostic de mélanome muqueux écarté avec certitude.

Summary

Mucosal melanoma is a rare malignant disease developed from melanocyte. We report the case of a patient with nasal cavity mucosal melanoma with a primary clinical and histological diagnosis of malignant lentigo with mucosal spreading. The presence of a c-Kit mutation, in a second lecture and the evolving nature of the lesion, reorientated the diagnosis of malignant lentigo to mucosal melanoma with skin extension. Extensive surgical resection and foramen free flap with costal graft reconstruction may have a local control of the disease. Yet, after one year, a regional evolution involving a parapharyngeal node was treated by stereotaxic radiotherapy. After 5 years, the patient was considered in clinical and radiological remission. Malignant lentigo with mucosal extension is a very rare situation, this diagnoses must be evoqued after setting mucosal melanoma diagnosis.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2E0MGXt

Hypothyroidism in the older population

Both overt hypothyroidism as well as minor elevations of serum thyrotropin (TSH) levels associated with thyroid hormones within their respective reference ranges (termed subclinical hypothyroidism) are relativ...

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

Dermatology Advocacy Groups May Not Disclose Conflicts Dermatology Advocacy Groups May Not Disclose Conflicts

Many patient advocacy groups focused on skin conditions receive funding from companies that sell dermatology treatments, and a new study suggests these nonprofits don't always disclose their ties to industry.Reuters Health Information (Source: Medscape Allergy Headlines)

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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Retrieval of inhaled foreign bodies in laryngectomised patients: Novel technique using a flexible nasendoscope under local anaesthetic

Abstract

Laryngectomised patients are at inherent risk of inhalation of foreign bodies, which can be an emergency airway situation.

A retrofitted flexible nasendoscope can be a safe, effective and a more familiar instrument for otolaryngologists, especially when the procedure needs to be undertaken out of hours.

Conducting the procedure with nebulised local anaesthetic and sedation is favourable in patients with high burden of comorbid disease and makes the procedure well tolerated.

This article is protected by copyright. All rights reserved.

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

Proposal of a New Clinical Method for removal of Button Batteries and other Ferrous Material from the External Auditory Ear Canal and Nasal Cavity using a Fine Magnet Probe

Abstract

Battery foreign bodies in the external auditory canal or nasal cavity are an ENT emergency, and require immediate removal.

The purposely‐designed fine magnet probe as described in this paper, allows safe and prompt removal of a ferrous foreign body from the ear canal with minimal trauma.

Widespread use of a fine magnet probe is proposed in ENT clinics and in the acute situation, for removal of ferrous foreign bodies. This method is quick, safe, well tolerated and cost efficient.

This article is protected by copyright. All rights reserved.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GvV5Uv

The clinical value of 4‐hour delayed‐enhanced 3D‐FLAIR MR images in sudden hearing loss

Abstract

Objective

The aim of this study was to investigate the clinical significance of 4‐hour delayed‐enhanced 3.0 Tesla (3T) 3D‐fluid attenuated inversion recovery (FLAIR) MR imaging in sudden sensorineural hearing loss (SSNHL).

Study Design

Case series with comparisons.

Setting

Tertiary referral centre.

Participants

Eighty‐seven idiopathic SSNHL patients were enrolled between January 2015 and December 2016 and received high dose steroid therapy and intratympanic steroid injections as salvage treatment.

Intervention

Pre‐contrast, 10‐minute and 4‐hour delayed‐enhanced 3D‐FLAIR MR images were obtained using double‐dose IV gadolinium.

Main outcome measures

The results of treatment were evaluated according to Siegel's criteria 3 months after the start of treatment. Where possible lesion‐side laterality of the inner ear was identified based on the MR images, the associations between MR findings and other clinical parameters were analyzed, and the relationships between hearing recovery and MR image findings were assessed.

Results

Lesion‐side laterality was identified on MRI in 52 (59.7%), 18 (20.1%) and 8(9.2%) patients, based on 4‐hour delayed, 10‐minute delayed, and pre‐contrast images, respectively. The hearing recovery rate was significantly lower in the patients with lesion‐side laterality on 4‐hour delayed images (p < .001). In a multivariate analysis, lesion‐side laterality on 4‐hour delayed images was associated with poor prognosis (OR=5.6) after adjusting other prognostic factors including initial hearing level, lesion‐side laterality on 10‐min delayed images and presence of vertigo. In addition, as the extent of enhancement in the inner ear increased the probability of hearing recover decreased (p=.001).

Conclusions

Contrast enhancement of inner ear structures can be seen on 4‐hour delayed‐enhanced 3T 3D‐FLAIR MR images in idiopathic sudden sensorineural hearing loss. Asymmetric lesion‐side enhancement of the inner ear may be associated with a poor prognosis.

This article is protected by copyright. All rights reserved.

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Our Experience With Home Self‐Assessment of Speech Recognition in the Care Pathway of 10 Newly‐Implanted Adult Cochlear Implant Users

Abstract

The number of CI users has grown rapidly, resulting in an increased workload for CI centres and a need for new and innovative ways to provide healthcare to users of a CI.

A telehealth application was developed with a functionality to self‐administer speech recognition tests at home, which was evaluated in 10 newly‐implanted patients.

Speech recognition in quiet and in noise improved steadily during the first few weeks of rehabilitation, after which it stabilized.

The home tests provided a good alternative to testing in the clinic for newly‐implanted patients who were able and willing to perform part of their CI care from home, and felt confident in using the technology required.

Frequently administered speech recognition self‐tests provide fine‐grained progress details which enable clinicians to monitor their CI user's speech recognition ability over time without the need for users of a CI to visit the clinic.

This article is protected by copyright. All rights reserved.

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

Soft palate bi‐pedicle flaps: a modification of VY repair of cleft soft palate

Abstract

Palatal fistula and velopharyngeal insufficiency are the commonest complications of cleft palate surgery.

For patients with cleft soft palate, beside hard palate VY push back flaps, two soft palate bi‐pedicle flaps were made on each sides of the posterior palate to dissect and push soft palate back and medial closing the VP valve.

In operated 26 children, sutures were tensionless and palatal integrity could be achieved in all patients without reported postoperative bleeding, fistula, infection, suture release, or granulation.

Postoperative nasoendoscopy registered grade 4 VP closure in all with restoration of normal speech (0 grade of nasality) at 6 months postoperatively.

The newly designed bi‐pedicle soft palate flaps with the VY repair of the cleft palate helps to avoid palatal fistula, elongate the soft palate and achieve proper VP closure.

This article is protected by copyright. All rights reserved.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DZ2Z6Z

Multidisciplinary oral rehabilitation of an adolescent suffering from juvenile Gorlin-Goltz syndrome – a case report

Abstract

Background

The Gorlin-Goltz syndrome is an autosomal dominant disorder characterized by keratocystic odontogenic tumors in the jaws, multiple basal cell carcinomas and skeletal abnormities. Frequently, the manifestation of the syndrome occurs in the adolescent years.

Case presentation

An 11-year-old boy was referred to our clinic due to the persistence of the lower deciduous molars. The further diagnosis revealed bilateral keratocystic odontogenic tumors in the region of teeth 33 and 45 representing a symptom of a Gorlin-Goltz syndrome. This case of the oral rehabilitation of an adolescent with bilateral keratocystic odontogenic tumors shows the approach of a multidisciplinary treatment concept including the following elements: Enucleation and bone defect augmentation using a prefabricated bone graft; distraction osteogenesis to extend the graft-block vertically after cessation of growth; accompanying orthodontic treatment, guided implant placement and prosthetic rehabilitation. Six months after implant insertion, a new keratocystic odontogenic tumor in the basal part of the left sinus maxillaris had to be removed combined with the closure of the oroantral fistula. During the follow-up period of 18 months in semi-annual intervals, the patient showed no sign of pathology.

Conclusion

In the presented case could be shown that distraction osteogenesis of prefabricated bone blocks is possible. With a multidisciplinary approach in a long-term treatment a sufficient oral rehabilitation of the patient suffering from extended keratocystic odontogenic tumors was possible.

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

Dermatology Advocacy Groups May Not Disclose Conflicts Dermatology Advocacy Groups May Not Disclose Conflicts

Many patient advocacy groups focused on skin conditions receive funding from companies that sell dermatology treatments, and a new study suggests these nonprofits don't always disclose their ties to industry.Reuters Health Information (Source: Medscape Allergy Headlines)

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/2DmRJ2P

Retrieval of inhaled foreign bodies in laryngectomised patients: Novel technique using a flexible nasendoscope under local anaesthetic

Abstract

Laryngectomised patients are at inherent risk of inhalation of foreign bodies, which can be an emergency airway situation.

A retrofitted flexible nasendoscope can be a safe, effective and a more familiar instrument for otolaryngologists, especially when the procedure needs to be undertaken out of hours.

Conducting the procedure with nebulised local anaesthetic and sedation is favourable in patients with high burden of comorbid disease and makes the procedure well tolerated.

This article is protected by copyright. All rights reserved.

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

Proposal of a New Clinical Method for removal of Button Batteries and other Ferrous Material from the External Auditory Ear Canal and Nasal Cavity using a Fine Magnet Probe

Abstract

Battery foreign bodies in the external auditory canal or nasal cavity are an ENT emergency, and require immediate removal.

The purposely‐designed fine magnet probe as described in this paper, allows safe and prompt removal of a ferrous foreign body from the ear canal with minimal trauma.

Widespread use of a fine magnet probe is proposed in ENT clinics and in the acute situation, for removal of ferrous foreign bodies. This method is quick, safe, well tolerated and cost efficient.

This article is protected by copyright. All rights reserved.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GvV5Uv

The clinical value of 4‐hour delayed‐enhanced 3D‐FLAIR MR images in sudden hearing loss

Abstract

Objective

The aim of this study was to investigate the clinical significance of 4‐hour delayed‐enhanced 3.0 Tesla (3T) 3D‐fluid attenuated inversion recovery (FLAIR) MR imaging in sudden sensorineural hearing loss (SSNHL).

Study Design

Case series with comparisons.

Setting

Tertiary referral centre.

Participants

Eighty‐seven idiopathic SSNHL patients were enrolled between January 2015 and December 2016 and received high dose steroid therapy and intratympanic steroid injections as salvage treatment.

Intervention

Pre‐contrast, 10‐minute and 4‐hour delayed‐enhanced 3D‐FLAIR MR images were obtained using double‐dose IV gadolinium.

Main outcome measures

The results of treatment were evaluated according to Siegel's criteria 3 months after the start of treatment. Where possible lesion‐side laterality of the inner ear was identified based on the MR images, the associations between MR findings and other clinical parameters were analyzed, and the relationships between hearing recovery and MR image findings were assessed.

Results

Lesion‐side laterality was identified on MRI in 52 (59.7%), 18 (20.1%) and 8(9.2%) patients, based on 4‐hour delayed, 10‐minute delayed, and pre‐contrast images, respectively. The hearing recovery rate was significantly lower in the patients with lesion‐side laterality on 4‐hour delayed images (p < .001). In a multivariate analysis, lesion‐side laterality on 4‐hour delayed images was associated with poor prognosis (OR=5.6) after adjusting other prognostic factors including initial hearing level, lesion‐side laterality on 10‐min delayed images and presence of vertigo. In addition, as the extent of enhancement in the inner ear increased the probability of hearing recover decreased (p=.001).

Conclusions

Contrast enhancement of inner ear structures can be seen on 4‐hour delayed‐enhanced 3T 3D‐FLAIR MR images in idiopathic sudden sensorineural hearing loss. Asymmetric lesion‐side enhancement of the inner ear may be associated with a poor prognosis.

This article is protected by copyright. All rights reserved.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DYs0zt

Our Experience With Home Self‐Assessment of Speech Recognition in the Care Pathway of 10 Newly‐Implanted Adult Cochlear Implant Users

Abstract

The number of CI users has grown rapidly, resulting in an increased workload for CI centres and a need for new and innovative ways to provide healthcare to users of a CI.

A telehealth application was developed with a functionality to self‐administer speech recognition tests at home, which was evaluated in 10 newly‐implanted patients.

Speech recognition in quiet and in noise improved steadily during the first few weeks of rehabilitation, after which it stabilized.

The home tests provided a good alternative to testing in the clinic for newly‐implanted patients who were able and willing to perform part of their CI care from home, and felt confident in using the technology required.

Frequently administered speech recognition self‐tests provide fine‐grained progress details which enable clinicians to monitor their CI user's speech recognition ability over time without the need for users of a CI to visit the clinic.

This article is protected by copyright. All rights reserved.

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

Soft palate bi‐pedicle flaps: a modification of VY repair of cleft soft palate

Abstract

Palatal fistula and velopharyngeal insufficiency are the commonest complications of cleft palate surgery.

For patients with cleft soft palate, beside hard palate VY push back flaps, two soft palate bi‐pedicle flaps were made on each sides of the posterior palate to dissect and push soft palate back and medial closing the VP valve.

In operated 26 children, sutures were tensionless and palatal integrity could be achieved in all patients without reported postoperative bleeding, fistula, infection, suture release, or granulation.

Postoperative nasoendoscopy registered grade 4 VP closure in all with restoration of normal speech (0 grade of nasality) at 6 months postoperatively.

The newly designed bi‐pedicle soft palate flaps with the VY repair of the cleft palate helps to avoid palatal fistula, elongate the soft palate and achieve proper VP closure.

This article is protected by copyright. All rights reserved.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DZ2Z6Z

Multidisciplinary oral rehabilitation of an adolescent suffering from juvenile Gorlin-Goltz syndrome – a case report

Abstract

Background

The Gorlin-Goltz syndrome is an autosomal dominant disorder characterized by keratocystic odontogenic tumors in the jaws, multiple basal cell carcinomas and skeletal abnormities. Frequently, the manifestation of the syndrome occurs in the adolescent years.

Case presentation

An 11-year-old boy was referred to our clinic due to the persistence of the lower deciduous molars. The further diagnosis revealed bilateral keratocystic odontogenic tumors in the region of teeth 33 and 45 representing a symptom of a Gorlin-Goltz syndrome. This case of the oral rehabilitation of an adolescent with bilateral keratocystic odontogenic tumors shows the approach of a multidisciplinary treatment concept including the following elements: Enucleation and bone defect augmentation using a prefabricated bone graft; distraction osteogenesis to extend the graft-block vertically after cessation of growth; accompanying orthodontic treatment, guided implant placement and prosthetic rehabilitation. Six months after implant insertion, a new keratocystic odontogenic tumor in the basal part of the left sinus maxillaris had to be removed combined with the closure of the oroantral fistula. During the follow-up period of 18 months in semi-annual intervals, the patient showed no sign of pathology.

Conclusion

In the presented case could be shown that distraction osteogenesis of prefabricated bone blocks is possible. With a multidisciplinary approach in a long-term treatment a sufficient oral rehabilitation of the patient suffering from extended keratocystic odontogenic tumors was possible.

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

Eosinophil Peroxidase, GATA3 and T-bet as Tissue Biomarkers in Chronic Rhinosinusitis

Publication date: Available online 8 February 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Devyani Lal, Benjamin L. Wright, Kelly P. Shim, Matthew A. Zarka, James J. Lee, Yu-Hui Chang, Sergei I. Ochkur, Rohit Divekar, Alfred D. Doyle, Elizabeth A. Jacobsen, Hirohito Kita, Matthew A. Rank

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

Histamine-driven responses are sustained via a bioactive metabolite

Publication date: Available online 8 February 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Tania E. Velez, Adam J. Byrne, Joshua B. Wechsler, Rebecca A. Krier-Burris, Kathryn E. Hulse, Paul J. Bryce

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2tc535q

Relationship Between Otorhinologic Trauma and Attention Deficit Hyperactivity Disorder Symptoms In Children

Publication date: Available online 8 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Ali Karayağmurlu, İsmail Aytaç, Secaattin Gülşen

Abstract

Objevtives

Otorhinologic trauma is an important condition at the ear, nose and throat (ENT) outpatient clinic in children. Attention deficit hyperactivity disorder (ADHD) has been identified as a potential risk factor that may contribute to the incidence of traumatic injuries. The aim of the study was to investigate whether there is an association between otorhinologic trauma and ADHD symptoms in children.

Methods

A prospective study was conducted between September 2017 and March 2018. Fifty-six pediatric patients admitted to the Ear Nose and Throat (ENT) outpatient clinic of a research and training hospital aged between 4 and 18 years were included. The control group consisted of 56 age- and gender-similar children without otorhinologic trauma. Conner's parent Rating Scale (CPRS) was used to evaluate the ADHD symptoms.

Results

The children with otorhinologic trauma had significantly higher mean scores in all subscales, including inattentiveness, hyperactivity, oppositional defiant disorder (ODD) (p < 0.05). Furthermore, analysis of the study group showed that the hyperactivity score in the subgroup with a history of repetitive injuries were significantly higher than those of the subgroup without a history of repetitive injuries (p < 0.05).

Conclusions

These findings suggest that patients admitted to the ENT outpatient clinic for otorhinologic trauma had a higher number of ADHD and ODD symptoms than those who did not have otorhinologic trauma. Psychiatric evaluation for ADHD and ODD should be considered for patients admitted to clinics with similar injuries, especially those who have a history of repetitive injuries.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SA3Rat

Eosinophil Peroxidase, GATA3 and T-bet as Tissue Biomarkers in Chronic Rhinosinusitis

Publication date: Available online 8 February 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Devyani Lal, Benjamin L. Wright, Kelly P. Shim, Matthew A. Zarka, James J. Lee, Yu-Hui Chang, Sergei I. Ochkur, Rohit Divekar, Alfred D. Doyle, Elizabeth A. Jacobsen, Hirohito Kita, Matthew A. Rank

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

Histamine-driven responses are sustained via a bioactive metabolite

Publication date: Available online 8 February 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Tania E. Velez, Adam J. Byrne, Joshua B. Wechsler, Rebecca A. Krier-Burris, Kathryn E. Hulse, Paul J. Bryce

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2tc535q

Relationship Between Otorhinologic Trauma and Attention Deficit Hyperactivity Disorder Symptoms In Children

Publication date: Available online 8 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Ali Karayağmurlu, İsmail Aytaç, Secaattin Gülşen

Abstract

Objevtives

Otorhinologic trauma is an important condition at the ear, nose and throat (ENT) outpatient clinic in children. Attention deficit hyperactivity disorder (ADHD) has been identified as a potential risk factor that may contribute to the incidence of traumatic injuries. The aim of the study was to investigate whether there is an association between otorhinologic trauma and ADHD symptoms in children.

Methods

A prospective study was conducted between September 2017 and March 2018. Fifty-six pediatric patients admitted to the Ear Nose and Throat (ENT) outpatient clinic of a research and training hospital aged between 4 and 18 years were included. The control group consisted of 56 age- and gender-similar children without otorhinologic trauma. Conner's parent Rating Scale (CPRS) was used to evaluate the ADHD symptoms.

Results

The children with otorhinologic trauma had significantly higher mean scores in all subscales, including inattentiveness, hyperactivity, oppositional defiant disorder (ODD) (p < 0.05). Furthermore, analysis of the study group showed that the hyperactivity score in the subgroup with a history of repetitive injuries were significantly higher than those of the subgroup without a history of repetitive injuries (p < 0.05).

Conclusions

These findings suggest that patients admitted to the ENT outpatient clinic for otorhinologic trauma had a higher number of ADHD and ODD symptoms than those who did not have otorhinologic trauma. Psychiatric evaluation for ADHD and ODD should be considered for patients admitted to clinics with similar injuries, especially those who have a history of repetitive injuries.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SA3Rat

Dermatology Advocacy Groups May Not Disclose Conflicts Dermatology Advocacy Groups May Not Disclose Conflicts

Many patient advocacy groups focused on skin conditions receive funding from companies that sell dermatology treatments, and a new study suggests these nonprofits don't always disclose their ties to industry.Reuters Health Information (Source: Medscape Allergy Headlines)

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/2DmRJ2P

Dermatology Advocacy Groups May Not Disclose Conflicts Dermatology Advocacy Groups May Not Disclose Conflicts

Many patient advocacy groups focused on skin conditions receive funding from companies that sell dermatology treatments, and a new study suggests these nonprofits don't always disclose their ties to industry.Reuters Health Information (Source: Medscape Allergy Headlines)

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/2DmRJ2P

In‐Office Injection Pharyngoplasty for Velopharyngeal Insufficiency After Oropharyngeal Cancer Treatment

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2BsEz4f

Histoanatomical structures of laryngeal atresia: Functional considerations

Objective

To study the histoanatomical structure of laryngeal atresia with a focus on the laryngeal functional components in order to evaluate the functional prognosis of laryngeal atresia repair.

Methods

Twenty‐one consecutives cases of laryngeal atresia were diagnosed at our institution between 2009 and 2016. Morphological analysis by macroscopic exam during autopsy was performed in 19 cases. Histological study of the larynx included hematoxylin and eosin staining and protein S100 immunostaining. Our analysis focused on the vocal folds, structures of the lamina propria, cricoarytenoid joints, muscles, and innervation. For each case, associated malformations were classified into two groups: severe and moderate.

Results

Antenatal diagnosis was suspected because of congenital high airway obstruction syndrome in nine cases (37%).

Associated malformations were present in 19 cases (90%), including severe malformations in 12 cases (57%). Atresia involved the cricoid in all cases, with a residual lumen in only one case and the glottis in 18 cases. Separation between the cricoid and arytenoid cartilages was observed in all cases. Fusion of the vocal process of the arytenoids in the midline was present in 13 cases.

According to the gestational age, posterior maculae flavae (MF) were present in 17 of 19 cases, with abnormal structure and median fusion in 13 cases. Anterior MF were present in nine of 18 cases, with fusion on the midline in five cases.

Intrinsic abductors and adductors muscles were identifiable in all cases, with fusion of thyroarytenoids muscles in the midline in 18 cases. Both recurrent laryngeal nerves were observed in all cases.

Conclusion

Laryngeal atresia is generally associated with other malformations, with a high risk of fatal outcomes. We observed that the functional structures of the glottic plane were present in most cases, with the exception of MF, which were frequently abnormal.

Level of Evidence

4. Laryngoscope, 2019

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In‐Office Injection Pharyngoplasty for Velopharyngeal Insufficiency After Oropharyngeal Cancer Treatment

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2BsEz4f

LICHENOID FOLLICULITIS OF THE SCALP IN FOUR PATIENTS WITH ICHTHYOSIFORM SKIN DISORDERS AND CICATRICIAL ALOPECIA

Ichthyosis is a heterogeneous group of inherited skin disorders characterized by a defect of keratinization. Patients diagnosed with lamellar ichthyosis (LI) and some ichthyosiform syndromes, such as the Conradi–Hünermann‐Happle syndrome (CHHS), usually present with hair loss. Even though only few dermatologic complaints carry as many emotional overtones as hair loss, there is extremely little data available in the literature regarding scalp histopathologic features on ichthyosis. A better understanding of scalp changes in such context may result in new therapeutic strategies that in turn would enhance patients' self‐steem and quality of life. The aim of this paper is to describe the scalp histopathologic findings of four young patients with cicatricial alopecia: three diagnosed as having LI and the fourth with CHHS.

This article is protected by copyright. All rights reserved.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2E0zFx2

Plamacytoid dendritic cells in granulomatous variant of mycosis fungoides.

Introduction

Granulomatous mycosis fungoides (MF) is a rare variant in which granulomas are associated with other typical signs of MF. Its prognosis is worse than that of classical MF. Plasmacytoid dendritic cells (PDC) are a subset of Interferon (IFN) producing dendritic cells that link the innate and the adaptative immune responses. They have also been related to tolerance to certain tumors such as melanoma.

Materials and methods

In this paper, we examined for the presence of CD123+ PDC in six cases of granulomatous MF from our archives.

Results

We found clusters of 10 or more positive cells in three of six cases of granulomatous MF (two women and a man, in their 6^th and 7^th decade). Although in two of these three cases the granulomatous response was extensive, in the other, it only represented 10% of the infiltrate of the biopsy. In all three cases, the granulomas were epithelioid, sarcoidal type.

Conclusions

CD123+ PDC can be identified in granulomatous MF. The pathogenic and prognostic role of this finding requires further clarification.

This article is protected by copyright. All rights reserved.

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

Sweet syndrome with pseudocarcinomatous hyperplasia: A case report and review of the literature

Abstract:

Pseudocarcinomatous (pseudoepitheliomatous) hyperplasia represents reactive epidermal change mimicking squamous cell carcinoma (SCC), owing to a variety of inflammatory and neoplastic phenomena, including deep fungal infections, CD30‐positive lymphomas, and others. We report a case of Sweet syndrome (SS) arising in a patient with acute myelogenous leukemia, with persistent orolabial involvement which mimicked SCC both clinically and microscopically, but resolved entirely with adequate corticosteroid treatment. Clinicians should be aware that neutrophilic dermatoses such as SS and pyoderma gangrenosum may rarely exhibit pseudocarcinomatous epidermal changes similar to those seen in soft tissue infections and other inflammatory dermatoses.

This article is protected by copyright. All rights reserved.

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

LICHENOID FOLLICULITIS OF THE SCALP IN FOUR PATIENTS WITH ICHTHYOSIFORM SKIN DISORDERS AND CICATRICIAL ALOPECIA

Ichthyosis is a heterogeneous group of inherited skin disorders characterized by a defect of keratinization. Patients diagnosed with lamellar ichthyosis (LI) and some ichthyosiform syndromes, such as the Conradi–Hünermann‐Happle syndrome (CHHS), usually present with hair loss. Even though only few dermatologic complaints carry as many emotional overtones as hair loss, there is extremely little data available in the literature regarding scalp histopathologic features on ichthyosis. A better understanding of scalp changes in such context may result in new therapeutic strategies that in turn would enhance patients' self‐steem and quality of life. The aim of this paper is to describe the scalp histopathologic findings of four young patients with cicatricial alopecia: three diagnosed as having LI and the fourth with CHHS.

This article is protected by copyright. All rights reserved.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2E0zFx2

A rare pitfall in the molecular interpretation of BRAF V600E status in melanoma in the setting of BRAF V600E‐mutated chronic lymphocytic leukemia/small lymphocytic lymphoma

BRAF mutation status is a critical predictive and prognostic biomarker in guiding management of unresectable and metastatic melanoma.¹ We recently observed a case of BRAF V600E‐mutated chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) intermixed with BRAF V600E wild‐type melanoma reported to harbor BRAF V600E mutation on molecular testing. Our observation underscores the importance of appropriate tumor selection for molecular studies and knowledge of mutational status of co‐existing tumors.

This article is protected by copyright. All rights reserved.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GtcD3A

Plamacytoid dendritic cells in granulomatous variant of mycosis fungoides.

Introduction

Granulomatous mycosis fungoides (MF) is a rare variant in which granulomas are associated with other typical signs of MF. Its prognosis is worse than that of classical MF. Plasmacytoid dendritic cells (PDC) are a subset of Interferon (IFN) producing dendritic cells that link the innate and the adaptative immune responses. They have also been related to tolerance to certain tumors such as melanoma.

Materials and methods

In this paper, we examined for the presence of CD123+ PDC in six cases of granulomatous MF from our archives.

Results

We found clusters of 10 or more positive cells in three of six cases of granulomatous MF (two women and a man, in their 6^th and 7^th decade). Although in two of these three cases the granulomatous response was extensive, in the other, it only represented 10% of the infiltrate of the biopsy. In all three cases, the granulomas were epithelioid, sarcoidal type.

Conclusions

CD123+ PDC can be identified in granulomatous MF. The pathogenic and prognostic role of this finding requires further clarification.

This article is protected by copyright. All rights reserved.

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

Sweet syndrome with pseudocarcinomatous hyperplasia: A case report and review of the literature

Abstract:

Pseudocarcinomatous (pseudoepitheliomatous) hyperplasia represents reactive epidermal change mimicking squamous cell carcinoma (SCC), owing to a variety of inflammatory and neoplastic phenomena, including deep fungal infections, CD30‐positive lymphomas, and others. We report a case of Sweet syndrome (SS) arising in a patient with acute myelogenous leukemia, with persistent orolabial involvement which mimicked SCC both clinically and microscopically, but resolved entirely with adequate corticosteroid treatment. Clinicians should be aware that neutrophilic dermatoses such as SS and pyoderma gangrenosum may rarely exhibit pseudocarcinomatous epidermal changes similar to those seen in soft tissue infections and other inflammatory dermatoses.

This article is protected by copyright. All rights reserved.

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

Hemispheric asymmetries in cortical gray matter microstructure identified by neurite orientation dispersion and density imaging

Publication date: 1 April 2019

Source: NeuroImage, Volume 189

Author(s): Judith Schmitz, Christoph Fraenz, Caroline Schlüter, Patrick Friedrich, Rex E. Jung, Onur Güntürkün, Erhan Genç, Sebastian Ocklenburg

Abstract

Histological studies have reported microstructural hemispheric asymmetries in several cortical areas of the human brain, but reliable in vivo assessment methods have been lacking so far. Here, we used neurite orientation dispersion and density imaging (NODDI) to examine microstructural asymmetries in in vivo and determine if findings are in accordance with what has been reported in histological studies. We examined intra-neurite volume fraction (INVF), neurite orientation dispersion (ODI), and isotropic volume fraction (ISO) asymmetries in two independent samples of healthy adults (n = 269 and n = 251). Over both samples, we found greater left-hemispheric INVF in early auditory, inferior parietal and temporal-parietal-occipital areas. In contrast, we found greater right-hemispheric INVF in the fusiform and inferior temporal gyrus, reflecting what has been reported in histological studies. ODI was asymmetric towards the left hemisphere in frontal areas and towards the right hemisphere in early auditory areas. ISO showed less pronounced asymmetries. There were hardly any effects of sex or handedness on microstructural asymmetry as determined by NODDI. Taken together, these findings suggest substantial microstructural asymmetries in gray matter, making NODDI a promising marker for future genetic and behavioral studies on laterality.

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The inner fluctuations of the brain in presymptomatic Frontotemporal Dementia: The chronnectome fingerprint

Publication date: 1 April 2019

Source: NeuroImage, Volume 189

Author(s): Enrico Premi, Vince D. Calhoun, Matteo Diano, Stefano Gazzina, Maura Cosseddu, Antonella Alberici, Silvana Archetti, Donata Paternicò, Roberto Gasparotti, John van Swieten, Daniela Galimberti, Raquel Sanchez-Valle, Robert Laforce, Fermin Moreno, Matthis Synofzik, Caroline Graff, Mario Masellis, Maria Carmela Tartaglia, James Rowe, Rik Vandenberghe

Abstract

Frontotemporal Dementia (FTD) is preceded by a long period of subtle brain changes, occurring in the absence of overt cognitive symptoms, that need to be still fully characterized. Dynamic network analysis based on resting-state magnetic resonance imaging (rs-fMRI) is a potentially powerful tool for the study of preclinical FTD.

In the present study, we employed a "chronnectome" approach (recurring, time-varying patterns of connectivity) to evaluate measures of dynamic connectivity in 472 at-risk FTD subjects from the Genetic Frontotemporal dementia research Initiative (GENFI) cohort.

We considered 249 subjects with FTD-related pathogenetic mutations and 223 mutation non-carriers (HC). Dynamic connectivity was evaluated using independent component analysis and sliding-time window correlation to rs-fMRI data, and meta-state measures of global brain flexibility were extracted.

Results show that presymptomatic FTD exhibits diminished dynamic fluidity, visiting less meta-states, shifting less often across them, and travelling through a narrowed meta-state distance, as compared to HC. Dynamic connectivity changes characterize preclinical FTD, arguing for the desynchronization of the inner fluctuations of the brain. These changes antedate clinical symptoms, and might represent an early signature of FTD to be used as a biomarker in clinical trials.

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The individual functional connectome is unique and stable over months to years

Publication date: 1 April 2019

Source: NeuroImage, Volume 189

Author(s): Corey Horien, Xilin Shen, Dustin Scheinost, R. Todd Constable

Abstract

Functional connectomes computed from fMRI provide a means to characterize individual differences in the patterns of BOLD synchronization across regions of the entire brain. Using four resting-state fMRI datasets with a wide range of ages, we show that individual differences of the functional connectome are stable across 3 months to 1–2 years (and even detectable at above-chance levels across 3 years). Medial frontal and frontoparietal networks appear to be both unique and stable, resulting in high ID rates, as did a combination of these two networks. We conduct analyses demonstrating that these results are not driven by head motion. We also show that edges contributing the most to a successful ID tend to connect nodes in the frontal and parietal cortices, while edges contributing the least tend to connect cross-hemispheric homologs. Our results demonstrate that the functional connectome is stable across years and that high ID rates are not an idiosyncratic aspect of a specific dataset, but rather reflect stable individual differences in the functional connectivity of the brain.

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Hemispheric asymmetries in cortical gray matter microstructure identified by neurite orientation dispersion and density imaging

Publication date: 1 April 2019

Source: NeuroImage, Volume 189

Author(s): Judith Schmitz, Christoph Fraenz, Caroline Schlüter, Patrick Friedrich, Rex E. Jung, Onur Güntürkün, Erhan Genç, Sebastian Ocklenburg

Abstract

Histological studies have reported microstructural hemispheric asymmetries in several cortical areas of the human brain, but reliable in vivo assessment methods have been lacking so far. Here, we used neurite orientation dispersion and density imaging (NODDI) to examine microstructural asymmetries in in vivo and determine if findings are in accordance with what has been reported in histological studies. We examined intra-neurite volume fraction (INVF), neurite orientation dispersion (ODI), and isotropic volume fraction (ISO) asymmetries in two independent samples of healthy adults (n = 269 and n = 251). Over both samples, we found greater left-hemispheric INVF in early auditory, inferior parietal and temporal-parietal-occipital areas. In contrast, we found greater right-hemispheric INVF in the fusiform and inferior temporal gyrus, reflecting what has been reported in histological studies. ODI was asymmetric towards the left hemisphere in frontal areas and towards the right hemisphere in early auditory areas. ISO showed less pronounced asymmetries. There were hardly any effects of sex or handedness on microstructural asymmetry as determined by NODDI. Taken together, these findings suggest substantial microstructural asymmetries in gray matter, making NODDI a promising marker for future genetic and behavioral studies on laterality.

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The inner fluctuations of the brain in presymptomatic Frontotemporal Dementia: The chronnectome fingerprint

Publication date: 1 April 2019

Source: NeuroImage, Volume 189

Author(s): Enrico Premi, Vince D. Calhoun, Matteo Diano, Stefano Gazzina, Maura Cosseddu, Antonella Alberici, Silvana Archetti, Donata Paternicò, Roberto Gasparotti, John van Swieten, Daniela Galimberti, Raquel Sanchez-Valle, Robert Laforce, Fermin Moreno, Matthis Synofzik, Caroline Graff, Mario Masellis, Maria Carmela Tartaglia, James Rowe, Rik Vandenberghe

Abstract

Frontotemporal Dementia (FTD) is preceded by a long period of subtle brain changes, occurring in the absence of overt cognitive symptoms, that need to be still fully characterized. Dynamic network analysis based on resting-state magnetic resonance imaging (rs-fMRI) is a potentially powerful tool for the study of preclinical FTD.

In the present study, we employed a "chronnectome" approach (recurring, time-varying patterns of connectivity) to evaluate measures of dynamic connectivity in 472 at-risk FTD subjects from the Genetic Frontotemporal dementia research Initiative (GENFI) cohort.

We considered 249 subjects with FTD-related pathogenetic mutations and 223 mutation non-carriers (HC). Dynamic connectivity was evaluated using independent component analysis and sliding-time window correlation to rs-fMRI data, and meta-state measures of global brain flexibility were extracted.

Results show that presymptomatic FTD exhibits diminished dynamic fluidity, visiting less meta-states, shifting less often across them, and travelling through a narrowed meta-state distance, as compared to HC. Dynamic connectivity changes characterize preclinical FTD, arguing for the desynchronization of the inner fluctuations of the brain. These changes antedate clinical symptoms, and might represent an early signature of FTD to be used as a biomarker in clinical trials.

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The individual functional connectome is unique and stable over months to years

Publication date: 1 April 2019

Source: NeuroImage, Volume 189

Author(s): Corey Horien, Xilin Shen, Dustin Scheinost, R. Todd Constable

Abstract

Functional connectomes computed from fMRI provide a means to characterize individual differences in the patterns of BOLD synchronization across regions of the entire brain. Using four resting-state fMRI datasets with a wide range of ages, we show that individual differences of the functional connectome are stable across 3 months to 1–2 years (and even detectable at above-chance levels across 3 years). Medial frontal and frontoparietal networks appear to be both unique and stable, resulting in high ID rates, as did a combination of these two networks. We conduct analyses demonstrating that these results are not driven by head motion. We also show that edges contributing the most to a successful ID tend to connect nodes in the frontal and parietal cortices, while edges contributing the least tend to connect cross-hemispheric homologs. Our results demonstrate that the functional connectome is stable across years and that high ID rates are not an idiosyncratic aspect of a specific dataset, but rather reflect stable individual differences in the functional connectivity of the brain.

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Highly‐accelerated volumetric brain examination using optimized wave‐CAIPI encoding

Background

Rapid volumetric imaging protocols could better utilize limited scanner resources.

Purpose

To develop and validate an optimized 6‐minute high‐resolution volumetric brain MRI examination using Wave‐CAIPI encoding.

Study Type

Prospective.

Population/Subjects

Ten healthy subjects and 20 patients with a variety of intracranial pathologies.

Field Strength/Sequence

At 3 T, MPRAGE, T₂‐weighted SPACE, SPACE FLAIR, and SWI were acquired at 9‐fold acceleration using Wave‐CAIPI and for comparison at 2–4‐fold acceleration using conventional GRAPPA.

Assessment

Extensive simulations were performed to optimize the Wave‐CAIPI protocol and minimize both g‐factor noise amplification and potential T₁/T₂ blurring artifacts. Moreover, refinements in the autocalibrated reconstruction of Wave‐CAIPI were developed to ensure high‐quality reconstructions in the presence of gradient imperfections. In a randomized and blinded fashion, three neuroradiologists assessed the diagnostic quality of the optimized 6‐minute Wave‐CAIPI exam and compared it to the roughly 3× slower GRAPPA accelerated protocol using both an individual and head‐to‐head analysis.

Statistical Test

A noninferiority test was used to test whether the diagnostic quality of Wave‐CAIPI was noninferior to the GRAPPA acquisition, with a 15% noninferiority margin.

Results

Among all sequences, Wave‐CAIPI achieved negligible g‐factor noise amplification (g_avg ≤ 1.04) and burring artifacts from T₁/T₂ relaxation. Improvements of our autocalibration approach for gradient imperfections enabled increased robustness to gradient mixing imperfections in tilted‐field of view (FOV) prescriptions as well as variations in gradient and analog‐to‐digital converter (ADC) sampling rates. In the clinical evaluation, Wave‐CAIPI achieved similar mean scores when compared with GRAPPA (MPRAGE: Ø_W = 4.03, Ø_G = 3.97; T₂w SPACE: Ø_W = 4.00, Ø_G = 4.00; SPACE FLAIR: Ø_W = 3.97, Ø_G = 3.97; SWI: Ø_W = 3.93, Ø_G = 3.83) and was statistically noninferior (N = 30, P < 0.05 for all sequences).

Data Conclusion

The proposed volumetric brain exam retained comparable image quality when compared with the much longer conventional protocol.

Level of Evidence: 2

Technical Efficacy: Stage 1

J. MAGN. RESON. IMAGING 2019.

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Highly‐accelerated volumetric brain examination using optimized wave‐CAIPI encoding

Background

Rapid volumetric imaging protocols could better utilize limited scanner resources.

Purpose

To develop and validate an optimized 6‐minute high‐resolution volumetric brain MRI examination using Wave‐CAIPI encoding.

Study Type

Prospective.

Population/Subjects

Ten healthy subjects and 20 patients with a variety of intracranial pathologies.

Field Strength/Sequence

At 3 T, MPRAGE, T₂‐weighted SPACE, SPACE FLAIR, and SWI were acquired at 9‐fold acceleration using Wave‐CAIPI and for comparison at 2–4‐fold acceleration using conventional GRAPPA.

Assessment

Extensive simulations were performed to optimize the Wave‐CAIPI protocol and minimize both g‐factor noise amplification and potential T₁/T₂ blurring artifacts. Moreover, refinements in the autocalibrated reconstruction of Wave‐CAIPI were developed to ensure high‐quality reconstructions in the presence of gradient imperfections. In a randomized and blinded fashion, three neuroradiologists assessed the diagnostic quality of the optimized 6‐minute Wave‐CAIPI exam and compared it to the roughly 3× slower GRAPPA accelerated protocol using both an individual and head‐to‐head analysis.

Statistical Test

A noninferiority test was used to test whether the diagnostic quality of Wave‐CAIPI was noninferior to the GRAPPA acquisition, with a 15% noninferiority margin.

Results

Among all sequences, Wave‐CAIPI achieved negligible g‐factor noise amplification (g_avg ≤ 1.04) and burring artifacts from T₁/T₂ relaxation. Improvements of our autocalibration approach for gradient imperfections enabled increased robustness to gradient mixing imperfections in tilted‐field of view (FOV) prescriptions as well as variations in gradient and analog‐to‐digital converter (ADC) sampling rates. In the clinical evaluation, Wave‐CAIPI achieved similar mean scores when compared with GRAPPA (MPRAGE: Ø_W = 4.03, Ø_G = 3.97; T₂w SPACE: Ø_W = 4.00, Ø_G = 4.00; SPACE FLAIR: Ø_W = 3.97, Ø_G = 3.97; SWI: Ø_W = 3.93, Ø_G = 3.83) and was statistically noninferior (N = 30, P < 0.05 for all sequences).

Data Conclusion

The proposed volumetric brain exam retained comparable image quality when compared with the much longer conventional protocol.

Level of Evidence: 2

Technical Efficacy: Stage 1

J. MAGN. RESON. IMAGING 2019.

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Clinical and immunological differences between asymptomatic HDM‐sensitized and HDM‐allergic rhinitis patients

Abstract

Background

Confirmation of the clinical relevance of sensitisation is important for the diagnosis of allergic rhinitis.

Objective

To investigate the usefulness of an in vitro basophil activation test and component‐resolved diagnosis in distinguishing between symptomatic allergic rhinitis patients and asymptomatic sensitization to house dust mites (HDMs).

Methods

Thirty‐six subjects with a positive skin prick test (SPT) for HDM were divided into a symptomatic (n=17) and an asymptomatic (n=19) group on the basis of their clinical history and a nasal provocation test. A basophil CD63 response to in vitro stimulation with Dermatophagoides pteronyssinus whole allergen extract and the IgE reactivity profiles for Der p 1, 2, 4, 5, 7, 10, 11, 14, 15, 18, 21, 23 were evaluated. Serum IgE and IgG specific to D. pteronyssinus whole allergen extract and total IgE were measured.

Results

There were no statistically significant differences in the levels of IgE (IgE levels were higher in symptomatic patients with P=0.055) and IgG specific to D. pteronyssinus and total IgE. Symptomatic patients showed a lower threshold for in vitro basophil activation (3.33 ng/mL versus 33.3 ng/mL), a higher area under the curve (AUC) of basophil activation (171 vs. 127) (P=0.017), a higher response to positive control with anti‐FcεRI stimulation (97% vs. 79%) (P<0.001), a recognition of more HDM allergens (4 vs. 2), and more frequent sensitization to rDer p 7 (P=0.016) and rDer p 23 compared to asymptomatic subjects (P=0.018). There was a positive correlation (r=0.63; P<0.001) between the number of recognised allergens and the AUC of basophil activation.

Conclusion and clinical relevance

In the subjects studied the differences in the basophil response to D. pteronyssinus allergen extract, number of recognized HDM allergens and reactivity to rDer p 7 and rDer p 23 distinguish symptomatic from asymptomatic HDM sensitisation better than SPT or allergen extract specific IgE. Information regarding the clinical relevance of sensitization is important for the prescription of allergen‐specific immunotherapy.

This article is protected by copyright. All rights reserved.

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Clinical and immunological differences between asymptomatic HDM‐sensitized and HDM‐allergic rhinitis patients

Abstract

Background

Confirmation of the clinical relevance of sensitisation is important for the diagnosis of allergic rhinitis.

Objective

To investigate the usefulness of an in vitro basophil activation test and component‐resolved diagnosis in distinguishing between symptomatic allergic rhinitis patients and asymptomatic sensitization to house dust mites (HDMs).

Methods

Thirty‐six subjects with a positive skin prick test (SPT) for HDM were divided into a symptomatic (n=17) and an asymptomatic (n=19) group on the basis of their clinical history and a nasal provocation test. A basophil CD63 response to in vitro stimulation with Dermatophagoides pteronyssinus whole allergen extract and the IgE reactivity profiles for Der p 1, 2, 4, 5, 7, 10, 11, 14, 15, 18, 21, 23 were evaluated. Serum IgE and IgG specific to D. pteronyssinus whole allergen extract and total IgE were measured.

Results

There were no statistically significant differences in the levels of IgE (IgE levels were higher in symptomatic patients with P=0.055) and IgG specific to D. pteronyssinus and total IgE. Symptomatic patients showed a lower threshold for in vitro basophil activation (3.33 ng/mL versus 33.3 ng/mL), a higher area under the curve (AUC) of basophil activation (171 vs. 127) (P=0.017), a higher response to positive control with anti‐FcεRI stimulation (97% vs. 79%) (P<0.001), a recognition of more HDM allergens (4 vs. 2), and more frequent sensitization to rDer p 7 (P=0.016) and rDer p 23 compared to asymptomatic subjects (P=0.018). There was a positive correlation (r=0.63; P<0.001) between the number of recognised allergens and the AUC of basophil activation.

Conclusion and clinical relevance

In the subjects studied the differences in the basophil response to D. pteronyssinus allergen extract, number of recognized HDM allergens and reactivity to rDer p 7 and rDer p 23 distinguish symptomatic from asymptomatic HDM sensitisation better than SPT or allergen extract specific IgE. Information regarding the clinical relevance of sensitization is important for the prescription of allergen‐specific immunotherapy.

This article is protected by copyright. All rights reserved.

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Adamantinoma-Like Ewing Sarcoma of the Thyroid: A Case Report and Review of the Literature

Abstract

Currently considered a variant of Ewing sarcoma, adamantinoma-like Ewing sarcoma is a rare malignancy that shows classic Ewing sarcoma-associated gene fusions but also epithelial differentiation. Here we present the 6th reported case of adamantinoma-like Ewing sarcoma involving the thyroid gland. Sections of the thyroid tumor from a 20-year old woman showed sheets, lobules and trabeculae of primitive, uniform, small round blue cells that diffusely expressed pankeratin, p40 and CD99. Fluorescent in situ hybridization revealed an EWSR1 gene rearrangement and an EWSR1-FLI1 fusion was detected by RT-PCR. Neck lymph nodes were not involved, and the patient was treated with a Ewing sarcoma chemotherapy protocol and radiation and is disease free 7 months after surgery. The unusual histology and immunohistochemical profile of adamantinoma-like Ewing sarcoma makes diagnosis and classification very challenging. We also present a literature review of adamantinoma-like Ewing sarcoma involving the thyroid.

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Adamantinoma-Like Ewing Sarcoma of the Thyroid: A Case Report and Review of the Literature

Abstract

Currently considered a variant of Ewing sarcoma, adamantinoma-like Ewing sarcoma is a rare malignancy that shows classic Ewing sarcoma-associated gene fusions but also epithelial differentiation. Here we present the 6th reported case of adamantinoma-like Ewing sarcoma involving the thyroid gland. Sections of the thyroid tumor from a 20-year old woman showed sheets, lobules and trabeculae of primitive, uniform, small round blue cells that diffusely expressed pankeratin, p40 and CD99. Fluorescent in situ hybridization revealed an EWSR1 gene rearrangement and an EWSR1-FLI1 fusion was detected by RT-PCR. Neck lymph nodes were not involved, and the patient was treated with a Ewing sarcoma chemotherapy protocol and radiation and is disease free 7 months after surgery. The unusual histology and immunohistochemical profile of adamantinoma-like Ewing sarcoma makes diagnosis and classification very challenging. We also present a literature review of adamantinoma-like Ewing sarcoma involving the thyroid.

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American Hearing Research Foundation awards 10 grants in FY19

Elmhurst, Illinois – February 7, 2019 – The American Hearing Research Foundation (AHRF) announced that in January 2019, it awarded ten grants to investigators who are exploring hearing and balance disorders of the inner ear.  AHRF awarded over $250,000 in grant monies in 2019.

 

AHRF President Alan Micco, MD, commented, "We were excited by the novel ideas in the proposals. It was difficult to choose. We funded scientists who are pursuing new ideas, and projects whose results could have the greatest impact on how we understand and treat hearing and balance losses."

 

Seven grants of $20,000 to $50,000 were awarded, plus three grants of approximately $1,000 each for otolaryngology residents.  Recipients will explore diverse topics, including ways to deliver hearing-protective drugs to those receiving cancer treatments, gene therapy approaches for inherited hearing loss, sound processing problems associated with autism, and how noise exposure causes changes in a specific region of the brain.

 

One of the AHRF grants was issued in partnership with the American Cochlear Implant (ACI) Alliance. The two organizations co-sponsored a one-time grant of $25,000 for a planning study that will evaluate the lifetime cost and burden of severe to profound hearing loss. One of the project's three principal investigators, Alexandria Quittner, PhD (Nicklaus Children's Research Institute), explains, "If deafness exists before a child acquires speech and language (typically age 3), the lifetime costs to society exceed $1 million per child, according to the Mohr (2000) study. The goal of this multi-disciplinary project is to replicate this study, and extend it by following children with cochlear implants for 13 to 15 years."

 

In 2019, three otolaryngology residents received a Bernard & Lottie Drazin Resident Grant. AHRF offers this grant program to encourage individuals who might pursue a career in hearing and balance research. Each year AHRF offers up to five $1,000 awards to otolaryngology residents at specific institutions. Residents in their third year of otolaryngology programs are required to conduct basic science or clinical research projects.

 

The 2019 grant recipients, academic institutions, and research projects are:

 

American Cochlear Implant Alliance/AHRF Partner Grant ($25,000)

• Alexandra L. Quittner, PhD; Ivette Cejas, PhD; Laurie Eisenberg, PhD; Nicklaus Children's Research Institute, FL; Reductions in Societal Costs and Burden for those with Severe to Profound Hearing Loss: Impact of Pediatric Cochlear Implantation

 

AHRF Regular Grants ($20,000 to $50,000)

• Charles Askew, PhD; Chengwen Li, MD, PhD; University of North Carolina at Chapel Hill; Development of Adeno-Associated Vectors for Genetic Treatment of Inherited Hearing Loss
• Christopher G. Clinard, PhD; Erin G. Piker, AuD, PhD; James Madison University, VA; A more sensitive measure of age-related changes in the vestibular system: Vestibular evoked myogenic potentials (VEMPs) elicited by amplitude-modulated tones
• Larry Hoffman, PhD; Ashley Kita, MD; Johnny Saldate, PhD; Geffen School of Medicine at UCLA; Designing a drug-eluting scaffold for ototherapeutics
• Tessa-Jonne F. Ropp, PhD; University of North Carolina at Chapel Hill; Exploring Deficits in the Auditory Cortex Associated with Autism
• Marina Augusto Silveira, PhD; University of Michigan; Neuropeptide Y as a Neuro-modulator of Noise-Induced Hyper-excitability in the Inferior Colliculus
• Xiaodong Tan, PhD; Northwestern University, IL; Protective Effect of Honokiol in Noise-Induced Hearing Loss

 

Bernard & Lottie Drazin Memorial Grants for Otolaryngology Residents ($1,000)

• Erin R. Cohen, MD; University of Miami Miller School of Medicine; Radiation Toxicity and Biology in Merlin-Deficient and Normal Schwann Cells in Vitro
• Nathan R. Lindquist, MD; Baylor College of Medicine, TX; "Evaluation of cognitive function in hearing loss patients utilizing the BrainCheck computerized assessment tool
• Elise Lippmann, MD; University of Illinois at Chicago; Validating the use of a non-linguistic test across a broad clinical population

 

 

About AHRF

AHRF is a nonprofit organization that has been making new discoveries possible for more than 60 years by funding novel research to better understand and overcome hearing and balance disorders of the inner ear. Since 2010, the organization has funded 76 projects with more than $1.6 million in research grants.

For more information on AHRF, visit www.American-Hearing.org. Donations for research funding can be made online.

Follow AHRF on Twitter.  Like AHRF on Facebook. Sign up for newsletter updates on the AHRF homepage.

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Winter 2019 Newsletter

View Winter 2019 Newsletter

The post Winter 2019 Newsletter appeared first on American Hearing Research Foundation.

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Computer Algorithms in Assessment of Obstructive Sleep Apnoea Syndrome and Its Application in Estimating Prevalence of Sleep Related Disorders in Population

Abstract

The incorporation of telemedicine and artificial intelligence for early screening and assessment of severity of life-style disorders has a great potential for better assessment in a busy outpatient clinic and thereby curtail down the related morbidities. A computer based algorithm based upon standardized questionnaire (from established assessment tools) is designed to assess the risk of obstructive sleep apnoea syndrome (OSAS). In addition the incorporation of basic screening questions of anamnesis help in suggesting a probable diagnosis of sleep related disorder as well. The overall data at our center has been analyzed to establish the existing pattern of sleep related disorders. Of 850 healthy subjects screened, prevalence of snoring was 20.47% while OSAS was seen in 4.20% (N = 25) in males and 2.64% (N = 8) in females. The parasomnia was most prevalent (14.71%), followed by insomnia (10.24%), periodic leg movement (6.59%), bruxism (1.65%) and narcolepsy (0.59%). Hypertension, laryngopharyngeal reflux and obesity were the common co-morbidities in OSAS while family history of hypertension and diabetes were common in snorers. A significant association with OSA was seen with diabetes mellitus, neck circumference and nasal obstruction, while, obesity and apnoeic episodes were more significantly associated with OSA than snorers. Increased waist to hip ratio was appreciated in both the OSAS and snorers. The algorithm based online assessment is likely to diagnose the occult clinical cases as well as assess the risk of OSAS. In routine outpatient clinic, a clinician may better assess the patient morbidity with a comprehensive availability of symptoms and moreover enhance the post-treatment compliance. In addition a smartphone based computerized assessment for general population may be designed for other lifestyle disorders as well.

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Papillary Thyroid Carcinoma with Cervical Lymph Node Metastasis Arising from Lingual Thyroid

Abstract

Although lingual thyroid is the most common site for ectopic thyroid gland but carcinomas originating from lingual thyroid are extremely rare, accounting only for 1% of all ectopic thyroids. Here we represent a young female with a bleeding mass at the base of her tongue and review the diagnostic approach towards papillary thyroid carcinoma of lingual thyroid. The surgical treatment and follow up are discussed. A combination of radiological studies and histological evaluation should be deployed to investigate suspicious lingual thyroids. The perspective of diagnostic and therapeutic approaches for carcinomas of lingual thyroid is the same as orthotopic thyroid tissue.

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