The Joint Tip Graft: A Joint Support for Rim, Facet and Infratip Lobule in Rhinoplasty

Abstract

Background

The authors of this study have developed a novel graft called the 'The Joint Tip Graft' which adds support to the lateral crus, camouflages the tip grafts, supports the facet and adds volume to the nasal tip as a single graft. The aim of this study was to define and introduce the tripod graft.

Methods

Thirty patients who underwent primary rhinoplasty at a tertiary academic center were included. Patients were randomly assigned into two groups according to the grafts used: group 1: Joint tip graft was additionally used, and group 2: Joint tip graft was not used. All patients were photographed by a photographer who is familiar with medical photography. Preoperative and postoperative sixth month photographs were taken for analysis. The brightest point of the infratip lobule and the darkest point of the facets were selected and analyzed with computer software. The luminance ratio of facet to infratip lobule was calculated to overcome light and head position differences.

Results

Mean infratip luminance scores were 112.20 ± 5.72 and 109.73 ± 7.13 in groups 1 and 2, respectively (p > 0.05). Mean facet luminance scores were 101.33 ± 4.91 and 89.27 ± 5.11 in groups 1 and 2, respectively (p < 0.05). Facet/infratip luminance ratios were calculated for each group. Mean facet/infratip luminance ratios were 0.90 ± 0.01 and 0.82 ± 0.16 for groups 1 and 2, respectively (p < 0.05).

Conclusions

The joint tip graft is a novel graft that is easy to harvest and apply. It spans both of the alar cartilages, supports the facet area and creates a smooth gradual light shadow transition. Additionally, it acts as a camouflage over the tip grafts.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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Trauma on a Recently Augmented Breast as a Trigger for Mondor’s Disease

Abstract

Mondor's disease is the eponym used to describe a self-limited phlebitis or thrombophlebitis of the superficial veins localized mainly on the thoracoabdominal area of the human body. Its clinical manifestation includes painful superficial cords causing skin retraction. This medical condition could be idiopathic, iatrogenic or a manifestation of underlying pathology such as breast cancer and seems to be more common than has been previously thought. The vast majority of the clinical studies and case reports to date focus on Mondor's disease as a disorder which is more or less directly related to a previous surgical intervention. In this case report, the author discusses the possible role of breast surgery as a predisposing factor only and the trauma on the operated breast as a trigger for onset and earlier manifestation of Mondor's disease. A special emphasis is put on the importance of trauma prevention in breast augmentation surgery, especially when maneuvers like postoperative massages are considered.

Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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Camouflage of the Nasal Dorsum in Thin-Skinned Patients with Diced Cartilage Combined with a New Cross-Linked Hyaluronan (NCH) Gel and Blood: A New Method

Abstract

Introduction

Nasal dorsum irregularities after rhinoplasty are still one of the most common complaints among both surgeons and patients. In this study, we used a new cross-linked hyaluronan (NCH) gel and blood mixture as the stabilisation scaffold. Diced cartilage combined with the NCH gel and blood mixture was used for nasal dorsum camouflage.

Patients and Methods

Fifty-two thin-skinned patients (29 females and 23 males) underwent primary rhinoplasty including nasal dorsum enhancement with diced cartilage combined with the NCH gel and blood mixture. The cartilage tissue was diced into small pieces; then, 1 cc NCH gel and blood were added into diced cartilage. The mixture was delivered onto the nasal dorsum via dorsal retractor.

Results

After 1 year of follow-up, there were no irregularities in the nasal dorsum area observed, nor any displacement or absorbance of the camouflage material. No complications occurred.

Conclusion

The use of diced cartilage combined with the NCH gel and blood is an effective, simple and safe method for nasal dorsum camouflage in thin-skinned patients in rhinoplasty. The NCH gel within the mixed graft also reduces adhesions at the osteotomy lines.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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The Joint Tip Graft: A Joint Support for Rim, Facet and Infratip Lobule in Rhinoplasty

Abstract

Background

The authors of this study have developed a novel graft called the 'The Joint Tip Graft' which adds support to the lateral crus, camouflages the tip grafts, supports the facet and adds volume to the nasal tip as a single graft. The aim of this study was to define and introduce the tripod graft.

Methods

Thirty patients who underwent primary rhinoplasty at a tertiary academic center were included. Patients were randomly assigned into two groups according to the grafts used: group 1: Joint tip graft was additionally used, and group 2: Joint tip graft was not used. All patients were photographed by a photographer who is familiar with medical photography. Preoperative and postoperative sixth month photographs were taken for analysis. The brightest point of the infratip lobule and the darkest point of the facets were selected and analyzed with computer software. The luminance ratio of facet to infratip lobule was calculated to overcome light and head position differences.

Results

Mean infratip luminance scores were 112.20 ± 5.72 and 109.73 ± 7.13 in groups 1 and 2, respectively (p > 0.05). Mean facet luminance scores were 101.33 ± 4.91 and 89.27 ± 5.11 in groups 1 and 2, respectively (p < 0.05). Facet/infratip luminance ratios were calculated for each group. Mean facet/infratip luminance ratios were 0.90 ± 0.01 and 0.82 ± 0.16 for groups 1 and 2, respectively (p < 0.05).

Conclusions

The joint tip graft is a novel graft that is easy to harvest and apply. It spans both of the alar cartilages, supports the facet area and creates a smooth gradual light shadow transition. Additionally, it acts as a camouflage over the tip grafts.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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Amalgamation of Central Lymph Node Dissection in Papillary Thyroid Carcinoma: Study from South Indian Population

AbstractThe aim of this study was to evaluate the correlation between central lymph node (CLN) metastasis and Clinicopathological characteristics of papillary thyroid cancer (PTC). In addition, we investigated the incidence and risk factors for ipsilateral and contra lateral CLN metastasis in unilateral PTC and the appropriate surgical extent for CLN dissection. A prospective study of 143 patients with unilateral PTC who underwent total thyroidectomy and prophylactic bilateral CLN dissection was conducted. Of 143 patients, 58 had CLN metastases. The rate of CLN metastasis was considerably higher in cases of maximal tumor size>  1 cm (P <  0.0001; OR 5.81). Ipsilateral CLN metastasis was detected in 41% of cases of unilateral PTC, and contra lateral CLN metastases was found in ...

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Deaf woman claims she will become a MILLIONAIRE by teaching sign language from her home

Katie Redstar, 34, is set to teach sign language to huge corporate companies. The entrepreneur from Leeds has also signed a book deal. (Source: the Mail online | Health)

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Amalgamation of Central Lymph Node Dissection in Papillary Thyroid Carcinoma: Study from South Indian Population

AbstractThe aim of this study was to evaluate the correlation between central lymph node (CLN) metastasis and Clinicopathological characteristics of papillary thyroid cancer (PTC). In addition, we investigated the incidence and risk factors for ipsilateral and contra lateral CLN metastasis in unilateral PTC and the appropriate surgical extent for CLN dissection. A prospective study of 143 patients with unilateral PTC who underwent total thyroidectomy and prophylactic bilateral CLN dissection was conducted. Of 143 patients, 58 had CLN metastases. The rate of CLN metastasis was considerably higher in cases of maximal tumor size>  1 cm (P <  0.0001; OR 5.81). Ipsilateral CLN metastasis was detected in 41% of cases of unilateral PTC, and contra lateral CLN metastases was found in ...

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Deaf woman claims she will become a MILLIONAIRE by teaching sign language from her home

Katie Redstar, 34, is set to teach sign language to huge corporate companies. The entrepreneur from Leeds has also signed a book deal. (Source: the Mail online | Health)

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Assessment of Oxidative Stress in Patients with Sudden Hearing Loss: A Non-randomized Prospective Clinical Study

Abstract

The etiology of sudden hearing loss (SHL) has not been fully elucidated. Previous studies claimed that different etiological factors may play a role in the pathogenesis of SHL. The aim of the present study is to investigate the presence of oxidative stress (OS) in SHL cases using thiol-disulfide balance. In addition, total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI) and lipid hydroperoxide levels (LOOH) were investigated. A total of 30 cases (15 female, 15 male, mean age 48.9 ± 8.1 years, age range: 36–68 years) were included in the study. Thiol and disulfide amounts, thiol/disulfide ratios, TOS, TAS, OSI and LOOH scores of the case group and control group were compared. Native thiol (SH) and total thiol (SH + SH) values were significantly lower in the SHL group than in the control group (p = 0.028 and p = 0.044, respectively). The LOOH value, TOS value and OSI value were significantly higher in the SHL group than in the control group (all p values < 0.05). The TAS value was significantly lower in the SHL group than in the control group (p = 0.0001). The present study has presented that the thiol-disulfide balance was impaired in SHL cases. OS may play a role in the development of SHL.

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Assessment of Oxidative Stress in Patients with Sudden Hearing Loss: A Non-randomized Prospective Clinical Study

Abstract

The etiology of sudden hearing loss (SHL) has not been fully elucidated. Previous studies claimed that different etiological factors may play a role in the pathogenesis of SHL. The aim of the present study is to investigate the presence of oxidative stress (OS) in SHL cases using thiol-disulfide balance. In addition, total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI) and lipid hydroperoxide levels (LOOH) were investigated. A total of 30 cases (15 female, 15 male, mean age 48.9 ± 8.1 years, age range: 36–68 years) were included in the study. Thiol and disulfide amounts, thiol/disulfide ratios, TOS, TAS, OSI and LOOH scores of the case group and control group were compared. Native thiol (SH) and total thiol (SH + SH) values were significantly lower in the SHL group than in the control group (p = 0.028 and p = 0.044, respectively). The LOOH value, TOS value and OSI value were significantly higher in the SHL group than in the control group (all p values < 0.05). The TAS value was significantly lower in the SHL group than in the control group (p = 0.0001). The present study has presented that the thiol-disulfide balance was impaired in SHL cases. OS may play a role in the development of SHL.

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Experimental Human Infection With Neisseria Gonorrhoeae

Condition:   Gonococcal Infection Interventions:   Drug: Cefixime;   Drug: Ceftriaxone;   Drug: Ciprofloxacin;   Biological: Neisseria gonorrhoeae strain FA1090 A26;   Biological: Neisseria gonorrhoeae strain FA7537 Sponsor:   National Institute of Allergy and Infectious Diseases (NIAID) Recruiting (Source: ClinicalTrials.gov)

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Impact of MEditerranean Diet, Inflammation and Microbiome After an Acute Coronary Syndrome

Condition:   Acute Coronary Syndrome Interventions:   Other: Microbiota analysis;   Other: Immunological analysis;   Other: Proteome analysis;   Other: Metabolome analysis;   Other: Clinical evaluation;   Other: Diet evaluation;   Other: MedDiet Sponsors:   Consorcio Centro de Investigación Biomédica en Red, M.P.;   Hospital General Universitario Gregorio Marañon;   Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana;   University of Navarra;   Institut National de la Santé Et de la Recher che Médicale, France;   Tel Aviv University;   Göteborg University Not yet recruiting (Source: ClinicalTrials.gov)

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Effect of Migalastat on Cardiac Involvement in Fabry Disease

Conditions:   Fabry Disease;   Heart Diseases Intervention:   Diagnostic Test: Cardiological evaluation Sponsors:   Ospedale San Donato;   Amicus Therapeutics;   Institute of Biomedicine and Molecular Immunology - CNR Recruiting (Source: ClinicalTrials.gov)

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Study in Cat-Allergic Patients With Asthma to Evaluate the Efficacy of a Single Dose of REGN1908-1909 to Reduce Bronchoconstriction Upon Cat Allergen Challenge

Conditions:   Cat Allergy;   Mild Asthma Interventions:   Drug: REGN1908-1909;   Drug: Placebo Sponsor:   Regeneron Pharmaceuticals Not yet recruiting (Source: ClinicalTrials.gov)

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Combining TLR9 Agonist With bNAbs for Reservoir Reduction and Immunological Control of HIV

Condition:   HIV-1-infection Interventions:   Drug: Saline;   Drug: Lefitolimod;   Drug: 3BNC117 and 10-1074 Sponsors:   University of Aarhus;   Aalborg Universitetshospital;   Odense University Hospital;   Rigshospitalet, Denmark;   Hvidovre University Hospital;   The Peter Doherty Institute for Infection and Immunity;   University of Utah Not yet recruiting (Source: ClinicalTrials.gov)

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Combination Therapy With VRC-HIVMAB060-00-AB (VRC01) and 10-1074 in HIV-Infected Individuals Undergoing Sequential Treatment Interruptions

Condition:   HIV Interventions:   Biological: VRC-HIVMAB060-00-AB (VRC01);   Biological: 10-1074;   Biological: Normal Saline Placebo Sponsor:   National Institute of Allergy and Infectious Diseases (NIAID) Recruiting (Source: ClinicalTrials.gov)

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The Influence of ANS-6637 on Midazolam Pharmacokinetics in Healthy Volunteers

Condition:   Opioid Addiction Interventions:   Drug: MDZ;   Drug: ANS-6637 Sponsors:   National Institutes of Health Clinical Center (CC);   National Institute of Allergy and Infectious Diseases (NIAID) Recruiting (Source: ClinicalTrials.gov)

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Experimental Human Infection With Neisseria Gonorrhoeae

Condition:   Gonococcal Infection Interventions:   Drug: Cefixime;   Drug: Ceftriaxone;   Drug: Ciprofloxacin;   Biological: Neisseria gonorrhoeae strain FA1090 A26;   Biological: Neisseria gonorrhoeae strain FA7537 Sponsor:   National Institute of Allergy and Infectious Diseases (NIAID) Recruiting (Source: ClinicalTrials.gov)

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Impact of MEditerranean Diet, Inflammation and Microbiome After an Acute Coronary Syndrome

Condition:   Acute Coronary Syndrome Interventions:   Other: Microbiota analysis;   Other: Immunological analysis;   Other: Proteome analysis;   Other: Metabolome analysis;   Other: Clinical evaluation;   Other: Diet evaluation;   Other: MedDiet Sponsors:   Consorcio Centro de Investigación Biomédica en Red, M.P.;   Hospital General Universitario Gregorio Marañon;   Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana;   University of Navarra;   Institut National de la Santé Et de la Recher che Médicale, France;   Tel Aviv University;   Göteborg University Not yet recruiting (Source: ClinicalTrials.gov)

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Effect of Migalastat on Cardiac Involvement in Fabry Disease

Conditions:   Fabry Disease;   Heart Diseases Intervention:   Diagnostic Test: Cardiological evaluation Sponsors:   Ospedale San Donato;   Amicus Therapeutics;   Institute of Biomedicine and Molecular Immunology - CNR Recruiting (Source: ClinicalTrials.gov)

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

Study in Cat-Allergic Patients With Asthma to Evaluate the Efficacy of a Single Dose of REGN1908-1909 to Reduce Bronchoconstriction Upon Cat Allergen Challenge

Conditions:   Cat Allergy;   Mild Asthma Interventions:   Drug: REGN1908-1909;   Drug: Placebo Sponsor:   Regeneron Pharmaceuticals Not yet recruiting (Source: ClinicalTrials.gov)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2tvzHa2

Combining TLR9 Agonist With bNAbs for Reservoir Reduction and Immunological Control of HIV

Condition:   HIV-1-infection Interventions:   Drug: Saline;   Drug: Lefitolimod;   Drug: 3BNC117 and 10-1074 Sponsors:   University of Aarhus;   Aalborg Universitetshospital;   Odense University Hospital;   Rigshospitalet, Denmark;   Hvidovre University Hospital;   The Peter Doherty Institute for Infection and Immunity;   University of Utah Not yet recruiting (Source: ClinicalTrials.gov)

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Combination Therapy With VRC-HIVMAB060-00-AB (VRC01) and 10-1074 in HIV-Infected Individuals Undergoing Sequential Treatment Interruptions

Condition:   HIV Interventions:   Biological: VRC-HIVMAB060-00-AB (VRC01);   Biological: 10-1074;   Biological: Normal Saline Placebo Sponsor:   National Institute of Allergy and Infectious Diseases (NIAID) Recruiting (Source: ClinicalTrials.gov)

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The Influence of ANS-6637 on Midazolam Pharmacokinetics in Healthy Volunteers

Condition:   Opioid Addiction Interventions:   Drug: MDZ;   Drug: ANS-6637 Sponsors:   National Institutes of Health Clinical Center (CC);   National Institute of Allergy and Infectious Diseases (NIAID) Recruiting (Source: ClinicalTrials.gov)

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Auditory Gaydar: Perception of Sexual Orientation Based on Female Voice.

Authors: Sulpizio S, Fasoli F, Antonio R, Eyssel F, Paladino MP, Diehl C Abstract We investigated auditory gaydar (i.e., the ability to recognize sexual orientation) in female speakers, addressing three related issues: whether auditory gaydar is (1) accurate, (2) language-dependent (i.e., occurs only in some languages, but not in others), and (3) ingroup-specific (i.e., occurs only when listeners judge speakers of their own language, but not when they judge foreign language speakers). In three experiments, we asked Italian, Portuguese, and German participants (total N = 466) to listen to voices of Italian, Portuguese, and German women, and to rate their sexual orientation. Our results showed that auditory gaydar was not accurate; listeners were not able to identify speakers' sexual...

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Age Estimation in Foreign-accented Speech by Native and Non-native Speakers.

This study investigates the effect of speaker first language and the role played by such speaker characteristics as fundamental frequency and speech rate. In this study English and Japanese first language speakers listened to English- and Japanese-accented English speech and estimated the speaker's age. We find the highest correlation between real and estimated speaker age for English listeners listening to English speakers, followed by Japanese listeners listening to both English and Japanese speakers, with English listeners listening to Japanese speakers coming last. We find that Japanese speakers are estimated to be younger than the English speakers by English listeners, and that both groups of listeners estimate male speakers and speakers with a lower mean fundamental frequency to be o...

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Rhythmic Abilities Correlate with L2 Prosody Imitation Abilities in Typologically Different Languages.

Authors: Cason N, Marmursztejn M, D'Imperio M, Schön D Abstract While many studies have demonstrated the relationship between musical rhythm and speech prosody, this has been rarely addressed in the context of second language (L2) acquisition. Here, we investigated whether musical rhythmic skills and the production of L2 speech prosody are predictive of one another. We tested both musical and linguistic rhythmic competences of 23 native French speakers of L2 English. Participants completed perception and production music and language tests. In the prosody production test, sentences containing trisyllabic words with either a prominence on the first or on the second syllable were heard and had to be reproduced. Participants were less accurate in reproducing penultimate accent placem...

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Auditory Gaydar: Perception of Sexual Orientation Based on Female Voice.

Authors: Sulpizio S, Fasoli F, Antonio R, Eyssel F, Paladino MP, Diehl C Abstract We investigated auditory gaydar (i.e., the ability to recognize sexual orientation) in female speakers, addressing three related issues: whether auditory gaydar is (1) accurate, (2) language-dependent (i.e., occurs only in some languages, but not in others), and (3) ingroup-specific (i.e., occurs only when listeners judge speakers of their own language, but not when they judge foreign language speakers). In three experiments, we asked Italian, Portuguese, and German participants (total N = 466) to listen to voices of Italian, Portuguese, and German women, and to rate their sexual orientation. Our results showed that auditory gaydar was not accurate; listeners were not able to identify speakers' sexual...

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

Age Estimation in Foreign-accented Speech by Native and Non-native Speakers.

This study investigates the effect of speaker first language and the role played by such speaker characteristics as fundamental frequency and speech rate. In this study English and Japanese first language speakers listened to English- and Japanese-accented English speech and estimated the speaker's age. We find the highest correlation between real and estimated speaker age for English listeners listening to English speakers, followed by Japanese listeners listening to both English and Japanese speakers, with English listeners listening to Japanese speakers coming last. We find that Japanese speakers are estimated to be younger than the English speakers by English listeners, and that both groups of listeners estimate male speakers and speakers with a lower mean fundamental frequency to be o...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2BEtKw8

Rhythmic Abilities Correlate with L2 Prosody Imitation Abilities in Typologically Different Languages.

Authors: Cason N, Marmursztejn M, D'Imperio M, Schön D Abstract While many studies have demonstrated the relationship between musical rhythm and speech prosody, this has been rarely addressed in the context of second language (L2) acquisition. Here, we investigated whether musical rhythmic skills and the production of L2 speech prosody are predictive of one another. We tested both musical and linguistic rhythmic competences of 23 native French speakers of L2 English. Participants completed perception and production music and language tests. In the prosody production test, sentences containing trisyllabic words with either a prominence on the first or on the second syllable were heard and had to be reproduced. Participants were less accurate in reproducing penultimate accent placem...

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Use these five essential oils to stop allergies dead in their tracks

(Natural News) Today, allergies have become a widespread and growing health problem across the globe. While we often associate allergies to the changing seasons, they are not just restricted to the increase of pollen in the air. Allergies can be the result of both genetic and environmental triggers. Environmental allergens include pollen, dust, mold, latex,... (Source: NaturalNews.com)

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Use these five essential oils to stop allergies dead in their tracks

(Natural News) Today, allergies have become a widespread and growing health problem across the globe. While we often associate allergies to the changing seasons, they are not just restricted to the increase of pollen in the air. Allergies can be the result of both genetic and environmental triggers. Environmental allergens include pollen, dust, mold, latex,... (Source: NaturalNews.com)

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Use these five essential oils to stop allergies dead in their tracks

(Natural News) Today, allergies have become a widespread and growing health problem across the globe. While we often associate allergies to the changing seasons, they are not just restricted to the increase of pollen in the air. Allergies can be the result of both genetic and environmental triggers. Environmental allergens include pollen, dust, mold, latex,... (Source: NaturalNews.com)

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

Use these five essential oils to stop allergies dead in their tracks

(Natural News) Today, allergies have become a widespread and growing health problem across the globe. While we often associate allergies to the changing seasons, they are not just restricted to the increase of pollen in the air. Allergies can be the result of both genetic and environmental triggers. Environmental allergens include pollen, dust, mold, latex,... (Source: NaturalNews.com)

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

Risk Factors for Restenosis After Stenting or Angioplasty of Vertebral Artery Origin

Abstract

Background and Purpose

Endovascular treatment represents a well-established therapeutic option in patients with vertebral artery origin (VAO) stenosis. Our aim was to determine which factors affect short- and long-term restenosis rates after endovascular VAO therapy.

Methods

We conducted a single center analysis of 52 patients (36 men; age 64 ± 9.54 years) who underwent 55 endovascular procedures (27 balloon-assisted angioplasty [BAA], 28 stent-assisted angioplasty [SAA]) between 2005–2015. We collected data on patients clinical characteristics, medication and post-interventional follow-up visits.

Results

Overall, 15 of 55 vessels (27%) showed ≥70% restenosis at 1 year (short-term follow-up) and 18 after a mean follow-up of 52.9 ± 31.8 months (long-term). BMI ≥ 25 kg/m² was associated with ≥70% restenosis in short-term (P = 0.014) and long-term (P = 0.003) follow-up. Other risk factors, namely, hypertension, ischemic heart disease, smoking, diabetes mellitus, hypercholesterolemia, atrial fibrillation, CRP (>5 mg/l) or pre-treatment antiplatelet administration, statin intake and platelet count, were not associated with restenosis risk in the entire cohort or in patients in the BAA group (all P > 0.05). BMI (P = 0.003) and ischemic heart disease (P = 0.041) were, in turn, associated with restenosis risk in the long-term follow-up in the SAA group. Patients undergoing BAA developed less frequently (P = 0.032) restenosis (18%) during long-term follow-up as compared to patients treated by stenting (46%).

Conclusion

BMI ≥ 25 kg/m² increases the odds for ≥70% restenosis of VAO while ischemic heart disease represents an additional risk factor in stented patients. Further studies are required to established therapeutic strategies lowering the restenosis rates in overweight individuals after VAO therapy, especially ones undergoing stenting.

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Risk Factors for Restenosis After Stenting or Angioplasty of Vertebral Artery Origin

Abstract

Background and Purpose

Endovascular treatment represents a well-established therapeutic option in patients with vertebral artery origin (VAO) stenosis. Our aim was to determine which factors affect short- and long-term restenosis rates after endovascular VAO therapy.

Methods

We conducted a single center analysis of 52 patients (36 men; age 64 ± 9.54 years) who underwent 55 endovascular procedures (27 balloon-assisted angioplasty [BAA], 28 stent-assisted angioplasty [SAA]) between 2005–2015. We collected data on patients clinical characteristics, medication and post-interventional follow-up visits.

Results

Overall, 15 of 55 vessels (27%) showed ≥70% restenosis at 1 year (short-term follow-up) and 18 after a mean follow-up of 52.9 ± 31.8 months (long-term). BMI ≥ 25 kg/m² was associated with ≥70% restenosis in short-term (P = 0.014) and long-term (P = 0.003) follow-up. Other risk factors, namely, hypertension, ischemic heart disease, smoking, diabetes mellitus, hypercholesterolemia, atrial fibrillation, CRP (>5 mg/l) or pre-treatment antiplatelet administration, statin intake and platelet count, were not associated with restenosis risk in the entire cohort or in patients in the BAA group (all P > 0.05). BMI (P = 0.003) and ischemic heart disease (P = 0.041) were, in turn, associated with restenosis risk in the long-term follow-up in the SAA group. Patients undergoing BAA developed less frequently (P = 0.032) restenosis (18%) during long-term follow-up as compared to patients treated by stenting (46%).

Conclusion

BMI ≥ 25 kg/m² increases the odds for ≥70% restenosis of VAO while ischemic heart disease represents an additional risk factor in stented patients. Further studies are required to established therapeutic strategies lowering the restenosis rates in overweight individuals after VAO therapy, especially ones undergoing stenting.

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Clinicians’ perceptions for indicating and contra-indicating integrated treatment for SUD and comorbid PTSD, a vignette study

Posttraumatic Stress Disorder (PTSD) is more common in patients with Substance Use Disorder (SUD) than in the general population. Although international guidelines recommend integrated treatment clinicians are...

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Higher doses of naloxone are needed in the synthetic opiod era

There has been a dramatic increase of deaths due to illicit fentanyl. We examined the pharmacology of fentanyl and reviewed data on the number of repeat doses of naloxone used to treat fentanyl overdoses. Mult...

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Clinicians’ perceptions for indicating and contra-indicating integrated treatment for SUD and comorbid PTSD, a vignette study

Posttraumatic Stress Disorder (PTSD) is more common in patients with Substance Use Disorder (SUD) than in the general population. Although international guidelines recommend integrated treatment clinicians are...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2twthr6

Higher doses of naloxone are needed in the synthetic opiod era

There has been a dramatic increase of deaths due to illicit fentanyl. We examined the pharmacology of fentanyl and reviewed data on the number of repeat doses of naloxone used to treat fentanyl overdoses. Mult...

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Stapes Prosthesis Length: One Size Fits All?

Conclusion: The individual measurement led to a zero rate of the vestibulum positions of stapes prosthesis pistons with a low insertion depth/vestibular depth ratio.Audiol Neurotol 2019;24:1 –7 (Source: Audiology and Neurotology)

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from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2T1MrUd

Stapes Prosthesis Length: One Size Fits All?

Conclusion: The individual measurement led to a zero rate of the vestibulum positions of stapes prosthesis pistons with a low insertion depth/vestibular depth ratio.Audiol Neurotol 2019;24:1 –7 (Source: Audiology and Neurotology)

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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VOR adaptation training and retention in a patient with profound bilateral vestibular hypofunction

A novel training method known as incremental VOR adaptation (IVA) can improve the vestibulo‐ocular reflex (VOR) gain for both active and passive head rotation by coupling active head rotations with a laser‐projected target that moves in the opposite direction of the head at a fraction of the head velocity. A 51‐year‐old male with bilateral vestibular hypofunction participated in a research protocol using a portable IVA device for 645 days. Passive VOR gains improved 179% to 600%; standing posture and gait also improved. Motor learning within the vestibular system using the IVA method is possible after severe vestibular pathology. Laryngoscope, 2019

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VOR adaptation training and retention in a patient with profound bilateral vestibular hypofunction

A novel training method known as incremental VOR adaptation (IVA) can improve the vestibulo‐ocular reflex (VOR) gain for both active and passive head rotation by coupling active head rotations with a laser‐projected target that moves in the opposite direction of the head at a fraction of the head velocity. A 51‐year‐old male with bilateral vestibular hypofunction participated in a research protocol using a portable IVA device for 645 days. Passive VOR gains improved 179% to 600%; standing posture and gait also improved. Motor learning within the vestibular system using the IVA method is possible after severe vestibular pathology. Laryngoscope, 2019

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Intraoperative electron beam radiotherapy for locoregionally persistent or recurrent head and neck cancer

Abstract

Background

To report our institutional experience with intraoperative radiotherapy for persistent or recurrent head and neck cancer.

Methods

Sixty‐one patients were treated with salvage surgery and intraoperative radiation therapy (IORT). Fifty‐eight patients (95%) had previously received external beam radiotherapy (EBRT) as a component of their definitive therapy. Forty‐four patients (72%) had squamous cell carcinoma (SCC). Surgical margins were positive in 28 patients (46%). IORT was prescribed to a median dose of 12.5 Gy (range, 10‐17.5). Twenty‐three patients (38%) received a course of postoperative EBRT (median 45 Gy). Clinical outcomes were retrospectively reviewed and univariate analysis was performed using log‐rank tests to correlate clinical outcomes with histology, surgical margin, and adjuvant therapy.

Results

Median follow‐up among surviving patients was 15.9 months. Median progression‐free survival (PFS) and overall survival (OS) were 9.8 and 19.1 months, respectively. One‐ and 2‐year rates of locoregional control (LRC) were 59% and 35%, respectively. One‐ and 2‐year rates of PFS were 39% and 19%, respectively. One‐ and 2‐year rates of OS were 62% and 42%, respectively. Overall survival was better for non‐SCC histology (P = .03). For SCC patients, negative surgical margin showed a trend toward improved PFS (P = .09) and OS (P = .06). There was one grade‐5 toxicity due to carotid rupture.

Conclusions

IORT has shown effective LRC and OS with an acceptably low rate of severe toxicity at our institution. OS was significantly better for non‐SCC histology. For SCC patients, there is a trend toward improved PFS and OS associated with negative surgical margins.

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Hypopharyngeal cancer treatment: Does initial surgery confer survival benefit?

Abstract

Background

Organ preservation protocols have increasingly been applied for the treatment of head and neck cancers, including hypopharyngeal squamous cell carcinoma (HSCC). We sought to evaluate whether patients treated with primary surgery followed by adjuvant therapy had survival benefit over patients treated with initial nonsurgical modalities.

Methods

We retrospectively reviewed patients with new diagnosis of HSCC at the University of Pittsburgh (1994‐2014) treated with either primary total laryngectomy with pharyngectomy or organ preservation.

Results

One hundred thirty‐seven patients were identified. Surgical cases were more likely to be of advanced T stage. Initial surgery was more likely to be performed in the earlier years of the cohort. After adjusting for this imbalance using a propensity score, primary surgery was associated with improved survival compared with nonoperative therapy (P = 0.02).

Conclusions

Due to its survival advantage, primary surgery followed by adjuvant treatment should be considered as a viable treatment of HSCC.

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Staging soft tissue sarcoma of the head and neck: Evaluation of the AJCC 8th edition revised T classifications

Abstract

Background

The American Joint Committee on Cancer (AJCC) has proposed new T classifications for head and neck sarcomas in the 8th edition of the AJCC Cancer Staging Manual, but these classifications have not been evaluated for prognostic utility in tumor staging.

Methods

The predictive ability of revised AJCC T classifications was evaluated by nonlinear multivariable regression using records from the Surveillance, Epidemiology, and End Results database (N = 2756). A proposed staging algorithm was developed using a subset of records and compared to the AJCC 7th edition using a separate validation dataset.

Results

Categorization of tumor size using revised AJCC 8th edition T classifications accurately reflected the predictive information of this intrinsically continuous variable. A proposed staging system based on revised AJCC T classifications showed significant improvement in clinical performance compared to the previous AJCC 7th edition staging system.

Conclusions

Stratifying risk of sarcoma‐specific death by categorization of tumor size is informative for head and neck sarcoma. A staging algorithm based on revised AJCC 8th edition T classifications is validated and proposed for further evaluation in staging sarcomas of the head and neck.

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Radiotherapy for benign head and neck paragangliomas

Abstract

Purpose

To update our experience treating benign head‐and‐neck paragangliomas (PGs) with radiotherapy (RT).

Methods

A total of 149 patients with 176 PGs received curative‐intent RT; 126 received RT to 1 PG and 23 to 2 or more PGs. The most common dose fractionation schedule was 45 Gy/25 once‐daily fractions/5 weeks which was used to treat 147 PGs (83.5%) in 123 patients (82.6%). Patients were followed with physical examination and CT/MRI. The median follow‐up for all patients was 10.6 years (range, 0.2‐50.4 years); the median follow‐up for surviving patients was 11.1 years (range, 0.2‐50.4).

Results

The 5‐year, 10‐year, and 15‐year outcomes were: local control, 99%, 96%, and 95%; distant metastasis‐free survival, 99%, 99%, and 99%; cause‐specific survival, 98%, 98%, and 98%; and overall survival, 90%, 75%, and 64%, respectively. No patient developed a moderate or severe complication, or a radiation‐induced second tumor or malignant transformation of the benign PG.

Conclusion

RT is an effective treatment for head‐and‐neck PGs with a low risk of complications.

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Intraoperative electron beam radiotherapy for locoregionally persistent or recurrent head and neck cancer

Abstract

Background

To report our institutional experience with intraoperative radiotherapy for persistent or recurrent head and neck cancer.

Methods

Sixty‐one patients were treated with salvage surgery and intraoperative radiation therapy (IORT). Fifty‐eight patients (95%) had previously received external beam radiotherapy (EBRT) as a component of their definitive therapy. Forty‐four patients (72%) had squamous cell carcinoma (SCC). Surgical margins were positive in 28 patients (46%). IORT was prescribed to a median dose of 12.5 Gy (range, 10‐17.5). Twenty‐three patients (38%) received a course of postoperative EBRT (median 45 Gy). Clinical outcomes were retrospectively reviewed and univariate analysis was performed using log‐rank tests to correlate clinical outcomes with histology, surgical margin, and adjuvant therapy.

Results

Median follow‐up among surviving patients was 15.9 months. Median progression‐free survival (PFS) and overall survival (OS) were 9.8 and 19.1 months, respectively. One‐ and 2‐year rates of locoregional control (LRC) were 59% and 35%, respectively. One‐ and 2‐year rates of PFS were 39% and 19%, respectively. One‐ and 2‐year rates of OS were 62% and 42%, respectively. Overall survival was better for non‐SCC histology (P = .03). For SCC patients, negative surgical margin showed a trend toward improved PFS (P = .09) and OS (P = .06). There was one grade‐5 toxicity due to carotid rupture.

Conclusions

IORT has shown effective LRC and OS with an acceptably low rate of severe toxicity at our institution. OS was significantly better for non‐SCC histology. For SCC patients, there is a trend toward improved PFS and OS associated with negative surgical margins.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2V4LtnF

Hypopharyngeal cancer treatment: Does initial surgery confer survival benefit?

Abstract

Background

Organ preservation protocols have increasingly been applied for the treatment of head and neck cancers, including hypopharyngeal squamous cell carcinoma (HSCC). We sought to evaluate whether patients treated with primary surgery followed by adjuvant therapy had survival benefit over patients treated with initial nonsurgical modalities.

Methods

We retrospectively reviewed patients with new diagnosis of HSCC at the University of Pittsburgh (1994‐2014) treated with either primary total laryngectomy with pharyngectomy or organ preservation.

Results

One hundred thirty‐seven patients were identified. Surgical cases were more likely to be of advanced T stage. Initial surgery was more likely to be performed in the earlier years of the cohort. After adjusting for this imbalance using a propensity score, primary surgery was associated with improved survival compared with nonoperative therapy (P = 0.02).

Conclusions

Due to its survival advantage, primary surgery followed by adjuvant treatment should be considered as a viable treatment of HSCC.

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

Staging soft tissue sarcoma of the head and neck: Evaluation of the AJCC 8th edition revised T classifications

Abstract

Background

The American Joint Committee on Cancer (AJCC) has proposed new T classifications for head and neck sarcomas in the 8th edition of the AJCC Cancer Staging Manual, but these classifications have not been evaluated for prognostic utility in tumor staging.

Methods

The predictive ability of revised AJCC T classifications was evaluated by nonlinear multivariable regression using records from the Surveillance, Epidemiology, and End Results database (N = 2756). A proposed staging algorithm was developed using a subset of records and compared to the AJCC 7th edition using a separate validation dataset.

Results

Categorization of tumor size using revised AJCC 8th edition T classifications accurately reflected the predictive information of this intrinsically continuous variable. A proposed staging system based on revised AJCC T classifications showed significant improvement in clinical performance compared to the previous AJCC 7th edition staging system.

Conclusions

Stratifying risk of sarcoma‐specific death by categorization of tumor size is informative for head and neck sarcoma. A staging algorithm based on revised AJCC 8th edition T classifications is validated and proposed for further evaluation in staging sarcomas of the head and neck.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2V5sRUr

Radiotherapy for benign head and neck paragangliomas

Abstract

Purpose

To update our experience treating benign head‐and‐neck paragangliomas (PGs) with radiotherapy (RT).

Methods

A total of 149 patients with 176 PGs received curative‐intent RT; 126 received RT to 1 PG and 23 to 2 or more PGs. The most common dose fractionation schedule was 45 Gy/25 once‐daily fractions/5 weeks which was used to treat 147 PGs (83.5%) in 123 patients (82.6%). Patients were followed with physical examination and CT/MRI. The median follow‐up for all patients was 10.6 years (range, 0.2‐50.4 years); the median follow‐up for surviving patients was 11.1 years (range, 0.2‐50.4).

Results

The 5‐year, 10‐year, and 15‐year outcomes were: local control, 99%, 96%, and 95%; distant metastasis‐free survival, 99%, 99%, and 99%; cause‐specific survival, 98%, 98%, and 98%; and overall survival, 90%, 75%, and 64%, respectively. No patient developed a moderate or severe complication, or a radiation‐induced second tumor or malignant transformation of the benign PG.

Conclusion

RT is an effective treatment for head‐and‐neck PGs with a low risk of complications.

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Uniform combined reconstruction of multichannel 7T knee MRI receive coil data without the use of a reference scan

Background

MR image intensity nonuniformity is often observed at 7T. Reference scans from the body coil used for uniformity correction at lower field strengths are typically not available at 7T.

Purpose

To evaluate the efficacy of a novel algorithm, Uniform Combined Reconstruction (UNICORN), to correct receive coil‐induced nonuniformity in musculoskeletal 7T MRI without the use of a reference scan.

Study Type

Retrospective image analysis study.

Subjects

MRI data of 20 subjects was retrospectively processed offline.

Field Strength/Sequence: Knees of 20 subjects were imaged at 7T with a single‐channel transmit, 28‐channel phased‐array receive knee coil. A turbo‐spin‐echo sequence was used to acquire 33 series of images.

Assessment

Three fellowship‐trained musculoskeletal radiologists with cumulative experience of 42 years reviewed the images. The uniformity, contrast, signal‐to‐noise ratio (SNR), and overall image quality were evaluated for images with no postprocessing, images processed with N4 bias field correction algorithm, and the UNICORN algorithm.

Statistical Tests

Intraclass correlation coefficient (ICC) was used for measuring the interrater reliability. ICC and 95% confidence intervals (CIs) were calculated using the R statistical package employing a two‐way mixed‐effects model based on a mean rating (k = 3) for absolute agreement. The Wilcoxon signed‐rank test with continuity correction was used for analyzing the overall image quality scores.

Results

UNICORN was preferred among the three methods evaluated for uniformity in 97.9% of the pooled ratings, with excellent interrater agreement (ICC of 0.98, CI 0.97–0.99). UNICORN was also rated better than N4 for contrast and equivalent to N4 in SNR with ICCs of 0.80 (CI 0.72–0.86) and 0.67 (CI 0.54–0.77), respectively. The overall image quality scores for UNICORN were significantly higher than N4 (P < 6 × 10^‐13), with good to excellent interrater agreement (ICC 0.90, CI 0.86–0.93).

Data Conclusion

Without the use of a reference scan, UNICORN provides better image uniformity, contrast, and overall image quality at 7T compared with the N4 bias field‐correction algorithm.

Level of Evidence: 4

Technical Efficacy: Stage 1

J. Magn. Reson. Imaging 2019.

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Building blocks for thoracic MRI: Challenges, sequences, and protocol design

Thoracic MRI presents important and unique challenges. Decreased proton density in the lung in combination with respiratory and cardiac motion can degrade image quality and render poorly executed sequences uninterpretable. Despite these challenges, thoracic MRI has an important clinical role, both as a problem‐solving tool and in an increasing array of clinical indications. Advances in scanner and sequence design have also helped to drive this development, presenting the radiologist with improved techniques for thoracic MRI. Given this evolving landscape, radiologists must be familiar with what thoracic MR has to offer. The first step in developing an effective thoracic MRI practice requires the creation of efficient and malleable protocols that can answer clinical questions. To do this, radiologists must have a working knowledge of the MR sequences that are used in the thorax, many of which have been adapted from use elsewhere in the body. These sequences can be broadly divided into three categories: traditional/anatomic, functional, and cine based. Traditional/anatomic sequences allow for the depiction of anatomy and pathologic processes with the ability for characterization of signal intensity and contrast enhancement. Functional sequences, including diffusion‐weighted imaging, and high temporal resolution dynamic contrast enhancement, allow for the noninvasive measurement of tissue‐specific parameters. Cine‐based sequences can depict the motion of structures in the thorax, either with retrospective ECG gating or in real time. The purpose of this article is to review these categories, the building block sequences that comprise them, and identify basic questions that should be considered in thoracic MRI protocol design.

Level of Evidence: 5

Technical Efficacy Stage: 3

J. Magn. Reson. Imaging 2019.

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Application of neurite orientation dispersion and density imaging to characterize brain microstructural abnormalities in type‐2 diabetics with mild cognitive impairment

Background

Diffusion‐tensor‐imaging (DTI) is sensitive in detecting white matter changes in type‐2 diabetes mellitus (T2DM). However, DTI indices can be affected by either neurite density or spatial variation. A novel diffusion MRI technique, termed neurite orientation dispersion and density imaging (NODDI), can provide distinct indices of fiber density and dispersion.

Purpose

To characterize brain microstructural alterations in T2DM patients with mild cognitive impairment (MCI) using the NODDI model.

Study Type

Cross‐sectional.

Subjects

Twenty T2DM patients with (DM‐MCI group), 18 age‐ and gender‐matched T2DM patients with normal cognition (DM‐NC group), and 28 euglycemic healthy controls (HC).

Field Strength/Sequence

3T/NODDI.

Assessment

Diffusion data were analyzed using tract‐based‐spatial‐statistics (TBSS) analysis in white matter and voxel‐based analysis in both white and gray matter. NODDI indices, including intracellular volume fraction (Vic) and orientation dispersion index (ODI), were estimated from multiple regions and compared among these groups.

Statistical Tests

Differences between groups were compared by Student's t‐test, Pearson chi‐square test, or analysis of variance when appropriate. Correlation analyses were performed to investigate the relationship between NODDI variables and clinical measurements.

Results

Whole‐brain TBSS revealed that 2.29% and 2.02% of the white matter regions exhibited decreased fractional anisotropy and Vic, respectively, between the DM‐NC and HC, while considerably larger white matter areas showed decreased fractional anisotropy (38.38%) and Vic (34.64%) between the DM‐MCI and HC (Student's t‐test, P < 0.05). However, the angular variation of neurites, characterized by ODI, exhibited very little (0.1%, P < 0.05) or no difference (P > 0.05) between either the DM‐MCI or DM‐NC groups and HC. Decreased Vic values in the genu of the corpus callosum (R = 0.580, 0.551 and 0.586, P < 0.01) and thalamus (R = 0.570, 0.616, and 0.595, P < 0.05) correlated with glycosylated hemoglobin A1c level, disease duration, and neuropsychological scores, respectively.

Data Conclusion

T2DM patients with cognitive decline had reduced Vic, which indicated decreased density of axons and dendrites. NODDI might be able to help probe microstructural changes in white and gray matter and provide information on diabetic encephalopathy, including those with cognitive impairment.

Level of Evidence: 1

Technical Efficacy: Stage 2

J. Magn. Reson. Imaging 2019.

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Uniform combined reconstruction of multichannel 7T knee MRI receive coil data without the use of a reference scan

Background

MR image intensity nonuniformity is often observed at 7T. Reference scans from the body coil used for uniformity correction at lower field strengths are typically not available at 7T.

Purpose

To evaluate the efficacy of a novel algorithm, Uniform Combined Reconstruction (UNICORN), to correct receive coil‐induced nonuniformity in musculoskeletal 7T MRI without the use of a reference scan.

Study Type

Retrospective image analysis study.

Subjects

MRI data of 20 subjects was retrospectively processed offline.

Field Strength/Sequence: Knees of 20 subjects were imaged at 7T with a single‐channel transmit, 28‐channel phased‐array receive knee coil. A turbo‐spin‐echo sequence was used to acquire 33 series of images.

Assessment

Three fellowship‐trained musculoskeletal radiologists with cumulative experience of 42 years reviewed the images. The uniformity, contrast, signal‐to‐noise ratio (SNR), and overall image quality were evaluated for images with no postprocessing, images processed with N4 bias field correction algorithm, and the UNICORN algorithm.

Statistical Tests

Intraclass correlation coefficient (ICC) was used for measuring the interrater reliability. ICC and 95% confidence intervals (CIs) were calculated using the R statistical package employing a two‐way mixed‐effects model based on a mean rating (k = 3) for absolute agreement. The Wilcoxon signed‐rank test with continuity correction was used for analyzing the overall image quality scores.

Results

UNICORN was preferred among the three methods evaluated for uniformity in 97.9% of the pooled ratings, with excellent interrater agreement (ICC of 0.98, CI 0.97–0.99). UNICORN was also rated better than N4 for contrast and equivalent to N4 in SNR with ICCs of 0.80 (CI 0.72–0.86) and 0.67 (CI 0.54–0.77), respectively. The overall image quality scores for UNICORN were significantly higher than N4 (P < 6 × 10^‐13), with good to excellent interrater agreement (ICC 0.90, CI 0.86–0.93).

Data Conclusion

Without the use of a reference scan, UNICORN provides better image uniformity, contrast, and overall image quality at 7T compared with the N4 bias field‐correction algorithm.

Level of Evidence: 4

Technical Efficacy: Stage 1

J. Magn. Reson. Imaging 2019.

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

Building blocks for thoracic MRI: Challenges, sequences, and protocol design

Thoracic MRI presents important and unique challenges. Decreased proton density in the lung in combination with respiratory and cardiac motion can degrade image quality and render poorly executed sequences uninterpretable. Despite these challenges, thoracic MRI has an important clinical role, both as a problem‐solving tool and in an increasing array of clinical indications. Advances in scanner and sequence design have also helped to drive this development, presenting the radiologist with improved techniques for thoracic MRI. Given this evolving landscape, radiologists must be familiar with what thoracic MR has to offer. The first step in developing an effective thoracic MRI practice requires the creation of efficient and malleable protocols that can answer clinical questions. To do this, radiologists must have a working knowledge of the MR sequences that are used in the thorax, many of which have been adapted from use elsewhere in the body. These sequences can be broadly divided into three categories: traditional/anatomic, functional, and cine based. Traditional/anatomic sequences allow for the depiction of anatomy and pathologic processes with the ability for characterization of signal intensity and contrast enhancement. Functional sequences, including diffusion‐weighted imaging, and high temporal resolution dynamic contrast enhancement, allow for the noninvasive measurement of tissue‐specific parameters. Cine‐based sequences can depict the motion of structures in the thorax, either with retrospective ECG gating or in real time. The purpose of this article is to review these categories, the building block sequences that comprise them, and identify basic questions that should be considered in thoracic MRI protocol design.

Level of Evidence: 5

Technical Efficacy Stage: 3

J. Magn. Reson. Imaging 2019.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Sdc0Ny

Application of neurite orientation dispersion and density imaging to characterize brain microstructural abnormalities in type‐2 diabetics with mild cognitive impairment

Background

Diffusion‐tensor‐imaging (DTI) is sensitive in detecting white matter changes in type‐2 diabetes mellitus (T2DM). However, DTI indices can be affected by either neurite density or spatial variation. A novel diffusion MRI technique, termed neurite orientation dispersion and density imaging (NODDI), can provide distinct indices of fiber density and dispersion.

Purpose

To characterize brain microstructural alterations in T2DM patients with mild cognitive impairment (MCI) using the NODDI model.

Study Type

Cross‐sectional.

Subjects

Twenty T2DM patients with (DM‐MCI group), 18 age‐ and gender‐matched T2DM patients with normal cognition (DM‐NC group), and 28 euglycemic healthy controls (HC).

Field Strength/Sequence

3T/NODDI.

Assessment

Diffusion data were analyzed using tract‐based‐spatial‐statistics (TBSS) analysis in white matter and voxel‐based analysis in both white and gray matter. NODDI indices, including intracellular volume fraction (Vic) and orientation dispersion index (ODI), were estimated from multiple regions and compared among these groups.

Statistical Tests

Differences between groups were compared by Student's t‐test, Pearson chi‐square test, or analysis of variance when appropriate. Correlation analyses were performed to investigate the relationship between NODDI variables and clinical measurements.

Results

Whole‐brain TBSS revealed that 2.29% and 2.02% of the white matter regions exhibited decreased fractional anisotropy and Vic, respectively, between the DM‐NC and HC, while considerably larger white matter areas showed decreased fractional anisotropy (38.38%) and Vic (34.64%) between the DM‐MCI and HC (Student's t‐test, P < 0.05). However, the angular variation of neurites, characterized by ODI, exhibited very little (0.1%, P < 0.05) or no difference (P > 0.05) between either the DM‐MCI or DM‐NC groups and HC. Decreased Vic values in the genu of the corpus callosum (R = 0.580, 0.551 and 0.586, P < 0.01) and thalamus (R = 0.570, 0.616, and 0.595, P < 0.05) correlated with glycosylated hemoglobin A1c level, disease duration, and neuropsychological scores, respectively.

Data Conclusion

T2DM patients with cognitive decline had reduced Vic, which indicated decreased density of axons and dendrites. NODDI might be able to help probe microstructural changes in white and gray matter and provide information on diabetic encephalopathy, including those with cognitive impairment.

Level of Evidence: 1

Technical Efficacy: Stage 2

J. Magn. Reson. Imaging 2019.

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The use of smartphones in radiographic diagnosis: accuracy on the detection of marginal gaps

Abstract

Objective

To compare the accuracy of computer monitor and smartphone screen for radiographic diagnosis of marginal gap.

Materials and methods

Forty teeth with mesial-occlusal-distal inlays (each tooth with a perfect fit and a 0.4-mm marginal gap restoration) were imaged with a phosphor plate system. Original digital radiographs were exported and analyzed with two different methods: computer monitor and smartphone screen; for the last method, images were shared with WhatsApp. Three examiners assessed all radiographs (n = 160) for the presence of marginal gap by using a dichotomous scale (yes/no). Diagnostic performance of each examiner and viewing method was evaluated by means of sensitivity (Se), specificity (Sp), and overall accuracy (Ac). Difference between the frequencies of gap detection of each method was analyzed using the McNemar test. Intra- and inter-examiner agreements were calculated using kappa statistics.

Results

Intra- and inter-examiner agreements were ≥ 0.80 for both methods. Similar diagnostic performance was found for computer monitor (Se = 0.87–1; Sp = 0.8–0.97; Ac = 0.84–0.99) and smartphone (Se = 0.77–1; Sp = 0.87–1; Ac = 0.88–0.95) viewing methods. No statistically significant differences in the frequency of gap detection were observed between the methods (P > 0.05).

Conclusion

Diagnostic accuracy of smartphone screens was similar to that of computer monitor for marginal gap detection.

Clinical relevance

Smartphones are becoming a common daily tool. In this sense, it might be an important new aid in Dentistry, including radiographic evaluation, which could benefit patients and dentists.

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

The use of smartphones in radiographic diagnosis: accuracy on the detection of marginal gaps

Abstract

Objective

To compare the accuracy of computer monitor and smartphone screen for radiographic diagnosis of marginal gap.

Materials and methods

Forty teeth with mesial-occlusal-distal inlays (each tooth with a perfect fit and a 0.4-mm marginal gap restoration) were imaged with a phosphor plate system. Original digital radiographs were exported and analyzed with two different methods: computer monitor and smartphone screen; for the last method, images were shared with WhatsApp. Three examiners assessed all radiographs (n = 160) for the presence of marginal gap by using a dichotomous scale (yes/no). Diagnostic performance of each examiner and viewing method was evaluated by means of sensitivity (Se), specificity (Sp), and overall accuracy (Ac). Difference between the frequencies of gap detection of each method was analyzed using the McNemar test. Intra- and inter-examiner agreements were calculated using kappa statistics.

Results

Intra- and inter-examiner agreements were ≥ 0.80 for both methods. Similar diagnostic performance was found for computer monitor (Se = 0.87–1; Sp = 0.8–0.97; Ac = 0.84–0.99) and smartphone (Se = 0.77–1; Sp = 0.87–1; Ac = 0.88–0.95) viewing methods. No statistically significant differences in the frequency of gap detection were observed between the methods (P > 0.05).

Conclusion

Diagnostic accuracy of smartphone screens was similar to that of computer monitor for marginal gap detection.

Clinical relevance

Smartphones are becoming a common daily tool. In this sense, it might be an important new aid in Dentistry, including radiographic evaluation, which could benefit patients and dentists.

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

Woman gets new tongue made from her arm after cancer battle

Source: www.mirror.co.uk Author: Laura Elvin A woman who lost her tongue while fighting cancer has had a new one made from […]

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

Woman gets new tongue made from her arm after cancer battle

Source: www.mirror.co.uk Author: Laura Elvin A woman who lost her tongue while fighting cancer has had a new one made from […]

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

Fine needle aspiration cytology and intraoperative frozen section in parotid gland tumor surgery: A retrospective multicenter analysis of 417 cases

Abstract

Salivary gland tumors represent a group of heterogeneous lesions with distinct biological behavior and complex clinicopathological characteristics. In 70% of the cases the parotid gland is affected and in about 80% the tumor is benign.¹

In general, an accurate diagnosis of parotid tumors consists of a triple assessment, comprising clinical examination, imaging and histological or cytological analysis.

This article is protected by copyright. All rights reserved.

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Changing the culture is a marathon not a sprint

Abstract

Integrated knowledge translation (IKT) is built upon the premise that involving knowledge users as partners in the research process will result in science that is more relevant to the public and therefore will have greater impact. Drawing on our experiences with a large and multifaceted IKT food allergy research program we highlight the disjuncture between the goals of IKT and the nature of basic science research, most notably the long timelines before research is ready for translation. Our partner consultations concluded that IKT success should be measured in a different way. That is, it should not be about informing an immediate gap in the translation of food allergy findings but about building relationships between our partners, greater awareness, understanding and knowledge about the nature of science and IKT, and ultimately helping to create better policy and science down the road. It is the recognition that it behooves us as scientists to be able to answer those "why" questions. We call for other researchers to consider the success of IKT beyond the short term timelines of any one research project but instead as an avenue to build partnerships, innovate thinking about research questions and to maximize choice and minimize risk for individuals in Canada and beyond affected by food allergy.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Ip5ALI

Immediate hypersensitivity to polyethylene glycols in unrelated products: when standardization in the nomenclature of the components of drugs, cosmetics, and food becomes necessary

Abstract

Background

Polyethylene glycols (PEGs) and their derivatives are non-ionic polymers of ethylene oxide commercially available with numerous synonyms, such as macrogol, oxyethylene polymer, and laureth-9. Although these polymers are usually safe, mild to life-threatening immediate-type hypersensitivity reactions have been reported. Nevertheless, awareness about their allergic potential is minimal due to the non-standardization of their nomenclature.

Case presentation

We present the case of a 29-years-old woman who developed several local and systemic type I hypersensitivity reactions including a severe anaphylactic reaction to different pharmacologic and cosmetic products whose excipients included PEG. Prick tests and basophil activation tests were performed to several pharmacological and cosmetic products, but only those containing PEGs and their derivatives were positive. The patient was diagnosed with immediate hypersensitivity IgE-mediated to PEGs and its derivatives.

Conclusions

Standardization of the terminology used to describe the presence of PEGs in products would help patients to identify them clearly and unequivocally and thus avoid the development of hypersensitivity reactions. It is also recommended studying PEG allergy in reactions to products containing PEGs, once allergy to the active ingredients has been excluded and in reactions to multiple unrelated drugs.

Clinical study protocol number PI2018/29 (registered on 24 September 2018)

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

Fine needle aspiration cytology and intraoperative frozen section in parotid gland tumor surgery: A retrospective multicenter analysis of 417 cases

Abstract

Salivary gland tumors represent a group of heterogeneous lesions with distinct biological behavior and complex clinicopathological characteristics. In 70% of the cases the parotid gland is affected and in about 80% the tumor is benign.¹

In general, an accurate diagnosis of parotid tumors consists of a triple assessment, comprising clinical examination, imaging and histological or cytological analysis.

This article is protected by copyright. All rights reserved.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DS9kQx

Changing the culture is a marathon not a sprint

Abstract

Integrated knowledge translation (IKT) is built upon the premise that involving knowledge users as partners in the research process will result in science that is more relevant to the public and therefore will have greater impact. Drawing on our experiences with a large and multifaceted IKT food allergy research program we highlight the disjuncture between the goals of IKT and the nature of basic science research, most notably the long timelines before research is ready for translation. Our partner consultations concluded that IKT success should be measured in a different way. That is, it should not be about informing an immediate gap in the translation of food allergy findings but about building relationships between our partners, greater awareness, understanding and knowledge about the nature of science and IKT, and ultimately helping to create better policy and science down the road. It is the recognition that it behooves us as scientists to be able to answer those "why" questions. We call for other researchers to consider the success of IKT beyond the short term timelines of any one research project but instead as an avenue to build partnerships, innovate thinking about research questions and to maximize choice and minimize risk for individuals in Canada and beyond affected by food allergy.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Ip5ALI

Immediate hypersensitivity to polyethylene glycols in unrelated products: when standardization in the nomenclature of the components of drugs, cosmetics, and food becomes necessary

Abstract

Background

Polyethylene glycols (PEGs) and their derivatives are non-ionic polymers of ethylene oxide commercially available with numerous synonyms, such as macrogol, oxyethylene polymer, and laureth-9. Although these polymers are usually safe, mild to life-threatening immediate-type hypersensitivity reactions have been reported. Nevertheless, awareness about their allergic potential is minimal due to the non-standardization of their nomenclature.

Case presentation

We present the case of a 29-years-old woman who developed several local and systemic type I hypersensitivity reactions including a severe anaphylactic reaction to different pharmacologic and cosmetic products whose excipients included PEG. Prick tests and basophil activation tests were performed to several pharmacological and cosmetic products, but only those containing PEGs and their derivatives were positive. The patient was diagnosed with immediate hypersensitivity IgE-mediated to PEGs and its derivatives.

Conclusions

Standardization of the terminology used to describe the presence of PEGs in products would help patients to identify them clearly and unequivocally and thus avoid the development of hypersensitivity reactions. It is also recommended studying PEG allergy in reactions to products containing PEGs, once allergy to the active ingredients has been excluded and in reactions to multiple unrelated drugs.

Clinical study protocol number PI2018/29 (registered on 24 September 2018)

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

Identity blues: the ethnobotany of the indigo dyeing by Landian Yao (Iu Mien) in Yunnan, Southwest China

Indigo-dyed textiles have been central to the cultural identity of Landian Yao (literally "blue clothes Yao") people in Southwest China for centuries, driving a significant local market for naturally dyed indi...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2V8PEil

Floristic composition and utilization of ethnomedicinal plant species in home gardens of the Eastern Himalaya

Home gardens are popular micro land-use system and are socioeconomically linked with people for their livelihood. In the foothill region of Eastern Himalaya, very less documentations are available on species r...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2tuTW7L

Identity blues: the ethnobotany of the indigo dyeing by Landian Yao (Iu Mien) in Yunnan, Southwest China

Indigo-dyed textiles have been central to the cultural identity of Landian Yao (literally "blue clothes Yao") people in Southwest China for centuries, driving a significant local market for naturally dyed indi...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2V8PEil

Floristic composition and utilization of ethnomedicinal plant species in home gardens of the Eastern Himalaya

Home gardens are popular micro land-use system and are socioeconomically linked with people for their livelihood. In the foothill region of Eastern Himalaya, very less documentations are available on species r...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2tuTW7L

Molecules, Vol. 24, Pages 749: Structure Characterization and Otoprotective Effects of a New Endophytic Exopolysaccharide from Saffron

This study could provide new insights for studies on the pharmacological mechanisms of endophytic exopolysaccharides from saffron as otoprotective agents (Source: Molecules)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2V30oyE

Molecules, Vol. 24, Pages 749: Structure Characterization and Otoprotective Effects of a New Endophytic Exopolysaccharide from Saffron

This study could provide new insights for studies on the pharmacological mechanisms of endophytic exopolysaccharides from saffron as otoprotective agents (Source: Molecules)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2V30oyE

$8 million surgery center in Albany gets state approval

A project by three health care organizations to open an $8.4 million outpatient surgery center has secured a key state approval. The Everett Road Surgery Center received contingent approval from the state's Public Health and Health Planning Council meeting on Thursday. OrthoNY, Albany ENT& Allergy Services PC, and St. Peter's Hospital would own the surgery center. The building where the surgery center would be located is already under construction at 123 Everett Road. Albany ENT is moving its… (Source: bizjournals.com Health Care News Headlines)

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$8 million surgery center in Albany gets state approval

A project by three health care organizations to open an $8.4 million outpatient surgery center has secured a key state approval. The Everett Road Surgery Center received contingent approval from the state's Public Health and Health Planning Council meeting on Thursday. OrthoNY, Albany ENT& Allergy Services PC, and St. Peter's Hospital would own the surgery center. The building where the surgery center would be located is already under construction at 123 Everett Road. Albany ENT is moving its… (Source: bizjournals.com Health Care News Headlines)

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

$8 million surgery center in Albany gets state approval

A project by three health care organizations to open an $8.4 million outpatient surgery center has secured a key state approval. The Everett Road Surgery Center received contingent approval from the state's Public Health and Health Planning Council meeting on Thursday. OrthoNY, Albany ENT& Allergy Services PC, and St. Peter's Hospital would own the surgery center. The building where the surgery center would be located is already under construction at 123 Everett Road. Albany ENT is moving its… (Source: bizjournals.com Health Care News 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/2EhlhjX

$8 million surgery center in Albany gets state approval

A project by three health care organizations to open an $8.4 million outpatient surgery center has secured a key state approval. The Everett Road Surgery Center received contingent approval from the state's Public Health and Health Planning Council meeting on Thursday. OrthoNY, Albany ENT& Allergy Services PC, and St. Peter's Hospital would own the surgery center. The building where the surgery center would be located is already under construction at 123 Everett Road. Albany ENT is moving its… (Source: bizjournals.com Health Care News Headlines)

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Competing photochemical reactions of bis-naphthols and their photoinduced antiproliferative activity

Photochem. Photobiol. Sci., 2019, Accepted Manuscript
DOI: 10.1039/C8PP00532J, Paper

Matija Sambol, Katja Ester, Stephan Landgraf, Branka Mihaljevic, Mario Cindric, M Kralj, Nikola Basarić
Photophysical properties and photochemical reactivity for a series of bis-naphthols 4a-4e and bis-anthrols 5a and 5e were investigated by preparative irradiations in CH3OH, fluorescence spectroscopy and laser flash photolysis (LFP)....
The content of this RSS Feed (c) The Royal Society of Chemistry

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://rsc.li/2T4QFdR

Competing photochemical reactions of bis-naphthols and their photoinduced antiproliferative activity

Photochem. Photobiol. Sci., 2019, Accepted Manuscript
DOI: 10.1039/C8PP00532J, Paper

Matija Sambol, Katja Ester, Stephan Landgraf, Branka Mihaljevic, Mario Cindric, M Kralj, Nikola Basarić
Photophysical properties and photochemical reactivity for a series of bis-naphthols 4a-4e and bis-anthrols 5a and 5e were investigated by preparative irradiations in CH3OH, fluorescence spectroscopy and laser flash photolysis (LFP)....
The content of this RSS Feed (c) The Royal Society of Chemistry

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://rsc.li/2T4QFdR

Woman gets new tongue made from her arm after cancer battle

Source: www.mirror.co.uk Author: Laura Elvin A woman who lost her tongue while fighting cancer has had a new one made from […]

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

Woman gets new tongue made from her arm after cancer battle

Source: www.mirror.co.uk Author: Laura Elvin A woman who lost her tongue while fighting cancer has had a new one made from […]

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

Fehlen des linken Leberlappens

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Nd0xwI

Fehlen des linken Leberlappens

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Amalgamation of Central Lymph Node Dissection in Papillary Thyroid Carcinoma: Study from South Indian Population

Abstract

The aim of this study was to evaluate the correlation between central lymph node (CLN) metastasis and Clinicopathological characteristics of papillary thyroid cancer (PTC). In addition, we investigated the incidence and risk factors for ipsilateral and contra lateral CLN metastasis in unilateral PTC and the appropriate surgical extent for CLN dissection. A prospective study of 143 patients with unilateral PTC who underwent total thyroidectomy and prophylactic bilateral CLN dissection was conducted. Of 143 patients, 58 had CLN metastases. The rate of CLN metastasis was considerably higher in cases of maximal tumor size > 1 cm (P < 0.0001; OR 5.81). Ipsilateral CLN metastasis was detected in 41% of cases of unilateral PTC, and contra lateral CLN metastases was found in 14% of cases where as bilateral CLN metastases in 8% of cases. The rate of contra lateral CLN metastasis was considerably higher in cases of PTC with a large tumor size (≥ 1 cm) (P = 0.0003; OR = 0.144) and with ipsilateral CLN metastasis (P = 0.0002; OR 0.12). Tumor size > 1 cm was independent risk factors for CLN metastasis. Maximal tumor size > 1 cm and presence of ipsilateral CLN macro metastasis were independent risk factors for contra lateral CLN metastasis. Therefore, both ipsilateral and contra lateral CLN dissections should be considered for unilateral PTC with a maximal tumor size > 1 cm or presence of ipsilateral CLN macro metastasis.

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

Amalgamation of Central Lymph Node Dissection in Papillary Thyroid Carcinoma: Study from South Indian Population

Abstract

The aim of this study was to evaluate the correlation between central lymph node (CLN) metastasis and Clinicopathological characteristics of papillary thyroid cancer (PTC). In addition, we investigated the incidence and risk factors for ipsilateral and contra lateral CLN metastasis in unilateral PTC and the appropriate surgical extent for CLN dissection. A prospective study of 143 patients with unilateral PTC who underwent total thyroidectomy and prophylactic bilateral CLN dissection was conducted. Of 143 patients, 58 had CLN metastases. The rate of CLN metastasis was considerably higher in cases of maximal tumor size > 1 cm (P < 0.0001; OR 5.81). Ipsilateral CLN metastasis was detected in 41% of cases of unilateral PTC, and contra lateral CLN metastases was found in 14% of cases where as bilateral CLN metastases in 8% of cases. The rate of contra lateral CLN metastasis was considerably higher in cases of PTC with a large tumor size (≥ 1 cm) (P = 0.0003; OR = 0.144) and with ipsilateral CLN metastasis (P = 0.0002; OR 0.12). Tumor size > 1 cm was independent risk factors for CLN metastasis. Maximal tumor size > 1 cm and presence of ipsilateral CLN macro metastasis were independent risk factors for contra lateral CLN metastasis. Therefore, both ipsilateral and contra lateral CLN dissections should be considered for unilateral PTC with a maximal tumor size > 1 cm or presence of ipsilateral CLN macro metastasis.

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

Study to Assess Safety and Ability to Induce Immune Responses of HIV-1 Vaccines M3 and M4 Given Alone or in Combination in HIV-infected Adults

Condition:   HIV-1 Infection Interventions:   Biological: MVA.tHIVconsv3;   Biological: MVA.tHIVconsv4;   Other: Placebo Sponsors:   University of North Carolina, Chapel Hill;   National Institute of Allergy and Infectious Diseases (NIAID) Recruiting (Source: ClinicalTrials.gov)

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from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2EjwD7o

Study to Assess Safety and Ability to Induce Immune Responses of HIV-1 Vaccines M3 and M4 Given Alone or in Combination in HIV-infected Adults

Condition:   HIV-1 Infection Interventions:   Biological: MVA.tHIVconsv3;   Biological: MVA.tHIVconsv4;   Other: Placebo Sponsors:   University of North Carolina, Chapel Hill;   National Institute of Allergy and Infectious Diseases (NIAID) Recruiting (Source: ClinicalTrials.gov)

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Investigation of Human Papillomavirus (HPV) and Epstein-Barr Virus (EBV) in antrochoanal polyps

Publication date: Available online 19 February 2019

Source: American Journal of Otolaryngology

Author(s): Esra Yılmaz, Necat Alatas, Fahrı Ucar, Tulın Cora, Kurtulus Buruk, Yasar Unlu

Abstract

Objectives/hypotheses

This study aimed to investigate the presence of HPV (HPV types 11 and 16) and EBV in antrochoanal polyps and to contribute to the current literature in this regard.

Study design

A case-control study.

Methods

A total of 100 patients (including 43 patients undergoing surgery for antrochoanal polyp, 27 patients undergoing surgery for nasal polyp, and 30 patients undergoing surgery for hypertrophic inferior turbinate) were included in this study. DNA was isolated from formalin-fixed, paraffin-embedded samples with the aid of the Bioneer's AccuPrep Genomic DNA Extraction Kit. In the obtained genomic DNAs, while the detection of HPV DNA was performed using the nested-PCR method, the detection of HPV types 11/16 and EBV DNA was performed using the RT-PCR method.

Results

The mean age of the patients with antrochoanal polyp was 26.7 ± 15.4 years (range 7–70). There were 20 (46.5%) women and 23 (53.5%) men in the antrochoanal polyp group. HPV DNA was positively detected using the nested-PCR method in 14 (32.6%) of the patients with antrochoanal polyp and in 3 (11.1%) of the patients with nasal polyp. HPV DNA was not detected in the hypertrophic inferior turbinate group (control group). There was a statistically significant difference between all groups in terms of HPV DNA positivity. In the antrochoanal polyp group, 2 patients had HPV 11 positivity and 12 patients had HPV 16 positivity. In the nasal polyp group, 1 patient had HPV 11 positivity and 2 patients had HPV 16 positivity. EBV DNA was positively detected in 16 (37.2%) of the patients with antrochoanal polyp, in 11 (40.7%) of the patients with nasal polyp and in 8 (26.7%) of the patients with hypertrophic inferior turbinate, respectively. There was no statistically significant difference between the groups in terms of EBV DNA positivity.

Conclusions

This study demonstrates that there is a need for further studies investigating the presence of viruses in antrochoanal polyps.

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United States-based global otolaryngology surgery: A call to more horizontal sustainable efforts

Publication date: Available online 19 February 2019

Source: American Journal of Otolaryngology

Author(s): Brian M. Lin, Mark A. Varvares, Gregory W. Randolph, David A. Shaye

Abstract

Objective

To examine global surgery involvement among general members of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) and characterize international otolaryngology surgical interventions.

Methods

Data on global surgery involvement were derived from responses provided by voluntary online survey respondent members of the AAO-HNS, obtained in October 2017. These data were compared against World Bank metrics of national health expenditure and surgical specialists per capita as benchmarks for need.

Results

There were 362 responses (response rate of 3.7%). A large proportion of respondents reported being involved in global surgery (61.3%). Locations where respondents worked included: South America (13.3%), Central America (17.7%), Caribbean (10.2%), Europe (4.1%), Africa (16.3%), Asia (16.6%), the Middle East (4.1%), and Oceania (3.6%). A greater proportion of respondents reported traveling to locations that have lower health care expenditure per capita and lower mean number of surgical specialists per 100,000 people, according to data from the World Bank. The primary purpose of trips was most commonly surgical mission (60.3%), followed by education (37.8%), and research (1.9%).

Conclusion

Members of the AAO-HNS are active in global surgery efforts around the world. Collaboration among members of the AAO-HNS may serve to improve long-term sustainability of these efforts.

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Reconstruction of a subtotal septorhinectomy defect with a chimeric paramedian-pericranial forehead flap

Publication date: Available online 19 February 2019

Source: American Journal of Otolaryngology

Author(s): Lucas Harrison, Michelle Sieffert, Sangati Kadakia, Sameep Kadakia, Ron Michael Johnson, Yadranko Ducic

Abstract

The nose is a complex structure important for aesthetic appearance, social interaction, and respiration. Full thickness nasal defects with resection of the septum pose a significant challenge to the reconstructive surgeon due to the lack of local tissues to replace the nasal lining and significant risk of nasal collapse owing to the paucity of rigid infrastructure. The purpose of this paper is to present a unique case of nasal reconstruction utilizing a bilaminar paramedian forehead flap (combined pericranial flap and forehead flap) with embedded cantilever rib graft in a patient who underwent resection for an intranasal malignancy involving the septum and soft tissue envelope. This case serves to demonstrate the great utility in using chimeric flaps based on a single pedicle given the low patient morbidity, predictable results, and rapid recovery period.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2BGjF1A

Perioperative interdisciplinary approach for reduction of opioid use in pediatric tonsillectomy: Protocol using dexmedetomidine and bupivicaine as adjunct agents

Publication date: Available online 18 February 2019

Source: American Journal of Otolaryngology

Author(s): Austin DeHart, Jessica Potter, Justin Anderson, Iolanda Russo-Menna, Jong Hyung Lee, Derek A. Chapman, Kelley M. Dodson

Abstract

Importance

Pediatric tonsillectomy is a common procedure now being performed most often for patients with obstructive sleep apnea, which has been associated with increased sensitivity to the respiratory side effects of opioid medications. This study investigates a strategy to decrease the use of opiate medications in a particularly vulnerable population.

Objective

Describe an interdisciplinary approach between Otolaryngologists and Anesthesiologists to decrease opiate use in tonsillectomy patients. Demonstrate safety of this protocol. Evaluate the effect of the protocol on intraoperative need for opiate medications and inhaled anesthetic use. Perform cost analysis of the protocol.

Design

Retrospective case-control study with cost analysis.

Setting

Tertiary Care Hospital.

Participants

Pediatric patients undergoing tonsillectomy at a tertiary care hospital.

Interventions

Preoperative and intraoperative dexmedetomidine with local bupivacaine injection into the tonsillar fossa.

Measures

Intraoperative need for sevoflurane, opiate, and propofol. Post-operative pain scores, and utilization of post-operative opiate, acetaminophen, and ibuprofen pain medications. Post-operative adverse events. Cost analysis of protocol.

Results

This protocol led to a decrease in intraoperative opiate use by 49.6%, a decrease in intraoperative sevofluorane use by 18%, and a lower reported maximum post-operative pain score without any increase in adverse events. The protocol added a small increase in medication cost of $4.07 to each procedure.

Conclusion

The use of dexmedetomidine and local anesthetic in pediatric tonsillectomy is a safe and effective protocol that allows for the reduction of opiate use and improved post-operative pain control.

Key points

Question: Can the combination of dexmedetomidine and infiltration of local anesthetic reduce overall opioid use for peediatric patients undergoing tonsillectomy?

Findings: In this case-control study, use of dexmedetomidine and local anesthetic injected into the tonsillar fossa led to a decrease in intraoperative opiate use by 49.6%, a decrease in intraoperative sevofluorane use by 18%, and a lower reported maximum pain score without an increase in adverse events.

Meaning: Use of dexmedetomidine and local anesthetic as anesthetic adjuncts may help reduce need for intraoperative opiates and decrease the use of volatile anesthetic agents in pediatric tonsillectomy patients, which are undesirable medications in the pediatric population for their respective respiratory depression and potentially neurotoxic side effects.

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Behavioral analysis of HPV+ oropharyngeal cancer: Do you know your patients?

Publication date: Available online 18 February 2019

Source: American Journal of Otolaryngology

Author(s): Annika Meyer, Daniel A. Alicea, Rocco M. Ferrandino, Brett A. Miles

Abstract

Objective

Evaluate the epidemiologic makeup of a population of HPV+ OPSCC patients treated at one institution over approximately a decade.

Study design

Prospective survey study of HPV+ OPSCC treated between 2007 and 2016.

Setting

Mount Sinai Health System

Subjects and methods

Patients aged 18+ who underwent treatment for HPV+ OPSCC. 223 patients were asked to complete a health survey including substance use and sexual history in order to specifically characterize the social behaviors of patients with HPV + OPSCC.

Results

Eighty-two patients responded, 70 male (85.4%) and 12 female (14.6%). While half of patients were nonsmokers, 18.3% had a smoking history of <15 pack years, and 32.9% had a 15+ pack-year smoking history. Nearly 25% reported significant drinking history (3+ drinks/day). Males had an average of 18 lifetime sexual partners, and females had 7 partners. Eight patients reported >100 sexual partners.

Conclusions

HPV+ OPSCC was more prevalent in white males with a high number of lifetime sexual partners, as expected. Careful evaluation revealed other findings of significance that are not generally associated with this population. Half of our patients had significant historical tobacco and alcohol consumption. One quarter of patients had a history of another malignancy. These findings highlight the importance of taking a comprehensive history when determining appropriate treatment or designing future de-escalation trials in HPV+ OPSCC.

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Purely intracranial vagal schwannoma: A case report of a rare lesion

Publication date: Available online 18 February 2019

Source: American Journal of Otolaryngology

Author(s): Zachary G. Schwam, Vivian Z. Kaul, R. Shrivastava, George B. Wanna

Abstract

We present a rare intracranial vagal schwannoma along with its preoperative, intraoperative, and postoperative course.

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

Tinnitus in the side with better hearing

Publication date: Available online 18 February 2019

Source: American Journal of Otolaryngology

Author(s): Ho Yun Lee, Su Jin Kim, Dong Sik Chang, Sun Ae Shin

Abstract

Objectives

We aimed to confirm the characteristics of patients with tinnitus in the better-hearing side.

Materials and methods

Among the 778 patients who visited the tinnitus clinic complaining of unilateral tinnitus at a local university hospital between March 2014 and December 2017, we recruited 62 patients who showed tinnitus in the better-hearing side on pure-tone audiometry. The mean hearing threshold was calculated using the arithmetic mean of the pure tone thresholds at 1, 2, 3, and 4 kHz. In addition, patients' medical history, tinnitus questionnaires, and other audiologic test results were thoroughly analyzed together for diagnosis.

Results

Fluctuating hearing loss without vertigo or Ménière's disease were the most common etiologies (n = 16, 25.8%), followed by high-frequency hearing loss (n = 13, 21.0%), sudden idiopathic hearing loss (n = 6, 9.7%), and presbycusis (n = 6, 9.7%). Somatosensory tinnitus was also observed in seven patients. Neck pain was associated with tinnitus in five patients (8.1%), and two other patients (3.2%) experienced temporomandibular disorder in the same side as the tinnitus.

Conclusion

Tinnitus was associated with deterioration of hearing even when it occurred in the better-hearing side. Among the possible etiologies, fluctuating hearing loss in the tinnitus side was the most common audiologic finding. Assessment of hearing level at each frequency was more effective in detecting high-frequency hearing loss rather than the use of the mean hearing level. In addition, somatosensory tinnitus should not be ignored.

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