Surgical site infections after parotidectomy: management and benefits of an antibiotic prophylaxis protocol.

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Surgical site infections after parotidectomy: management and benefits of an antibiotic prophylaxis protocol.

Acta Otorhinolaryngol Ital. 2018 Dec 29;:

Authors: Meccariello G, Montevecchi F, D'Agostino G, Zeccardo E, Al-Raswashdeh MFH, De Vito A, Vicini C

Abstract
The use of perioperative prophylactic antibiotics in uncontaminated head and neck surgery is still controversial. The aim of this study was to assess the efficacy of an institutional antibiotic prophylactic protocol in preventing surgical site infection after parotidectomy. The medical charts of 448 patients who underwent parotidectomy were reviewed. Patients were divided in two groups according the use of perioperative administration of intravenous cefazolin or post-operative week course of antibiotics. Surgical site infection was registered in 29 (6.5%) cases, 16 (5.7%) within the group before the application of protocol and 13 (7.9%) within the antibiotic prophylaxis protocol group. The univariate and multivariate logistic regression analyses showed that predictors for surgical site infection were the amount of drain output ≥ 50 ml in the first post-operative 24 hours (OR: 4.86; 1.59-14.82 95% CI; p < 0.01) and history of a previous parotid acute infection (OR: 13.83; 5.31-36 95% CI; p < 0.01). The majority of post-surgical infections (82%) were treated with intravenous antibiotic therapy. The remnants were treated surgically. Perioperative antibiotic treatment is recommended for patients undergoing parotid gland surgery and intravenous antibiotics during the post-operative course are highly suggested in case of history of previous acute parotid infection and drain output ≥ 50 ml in first 24 hours.

PMID: 30632521 [PubMed - as supplied by publisher]

http://bit.ly/2RnDUuS

Oculorespiratory Reflex During Repair of an Orbital Fracture.

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Oculorespiratory Reflex During Repair of an Orbital Fracture.

JAMA Otolaryngol Head Neck Surg. 2019 Feb 07;:

Authors: Dang RP, Bhatt NK, Rizzi CJ, Chi JJ

PMID: 30730542 [PubMed - as supplied by publisher]

http://bit.ly/2GuWz14

Assessment of Application-Driven Postoperative Care in the Pediatric Tonsillectomy Population: A Survey-Based Pilot Study.

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Assessment of Application-Driven Postoperative Care in the Pediatric Tonsillectomy Population: A Survey-Based Pilot Study.

JAMA Otolaryngol Head Neck Surg. 2019 Feb 07;:

Authors: Ali SA, Kovatch KJ, Hwang C, Bohm LA, Zopf DA, Thorne MC

PMID: 30730540 [PubMed - as supplied by publisher]

http://bit.ly/2RRV9A2

Association of Chronic Rhinosinusitis With Depression and Anxiety in a Nationwide Insurance Population.

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Association of Chronic Rhinosinusitis With Depression and Anxiety in a Nationwide Insurance Population.

JAMA Otolaryngol Head Neck Surg. 2019 Feb 07;:

Authors: Kim JY, Ko I, Kim MS, Yu MS, Cho BJ, Kim DK

Abstract
Importance: Chronic rhinosinusitis (CRS) is associated with a decreased quality of life, affecting physical and emotional aspects of daily function, the latter of which could manifest as depression and anxiety.
Objective: To evaluate the risk of depression and anxiety in CRS, depending on the CRS phenotype (CRS without nasal polyps [CRSsNP] and CRS with nasal polyps [CRSwNP]).
Design, Setting, and Participants: This retrospective nationwide cohort study used population-based insurance data (consisting of data from approximately 1 million patients). The study population included 16 224 patients with CRS and 32 448 individuals without CRS, with propensity score matching between groups according to sociodemographic factors and enrollment year. Data were collected from January 1, 2002, through December 31, 2013, and analyzed from July 1 through November 15, 2018.
Main Outcomes and Measures: Survival analysis, the log-rank test, and Cox proportional hazards regression models were used to calculate the incidence, survival rate, and hazard ratio (HR) of depression and anxiety for each group.
Results: Among the 48 672 individuals included in the study population (58.8% female), the overall incidence of depression during the 11-year follow-up was 1.51-fold higher in the CRS group than in the non-CRS group (24.2 vs 16.0 per 1000 person-years; adjusted HR, 1.54; 95% CI, 1.48-1.61). The incidence of anxiety was also higher in the CRS group than in the comparison group (42.2 vs 27.8 per 1000 person-years; adjusted HR, 1.57; 95% CI, 1.52-1.62). Moreover, the adjusted HRs of developing depression (CRSsNP, 1.61 [95% CI, 1.54-1.69]; CRSwNP, 1.41 [95% CI, 1.32-1.50]) and anxiety (CRSsNP, 1.63 [95% CI, 1.57-1.69]; CRSwNP, 1.45 [95% CI, 1.38-1.52]) were greater in patients with CRSsNP than in those with CRSwNP.
Conclusions and Relevance: This observational study suggests that CRS is associated with an increased incidence of depression and anxiety. Specifically, findings from this study found that patients without nasal polyps showed a higher risk of developing depression and anxiety than those with nasal polyps.

PMID: 30730537 [PubMed - as supplied by publisher]

http://bit.ly/2E1DBxB

Enlarging Right-Sided Tongue Mass in an Adult Male.

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Enlarging Right-Sided Tongue Mass in an Adult Male.

JAMA Otolaryngol Head Neck Surg. 2019 Feb 07;:

Authors: Strauss SB, Bello J, Shifteh K

PMID: 30730535 [PubMed - as supplied by publisher]

http://bit.ly/2RRXydT

The Centers for Medicare & Medicaid Services' Overhaul of Office-Visit Payments-What's the Bottom Line for Otolaryngology?

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The Centers for Medicare & Medicaid Services' Overhaul of Office-Visit Payments-What's the Bottom Line for Otolaryngology?

JAMA Otolaryngol Head Neck Surg. 2019 Feb 07;:

Authors: Rathi VK, Varvares MA, Naunheim MR

PMID: 30730534 [PubMed - as supplied by publisher]

http://bit.ly/2GxG0lc

Does Chronic Rhinosinusitis Lead to Psychiatric Disease?

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Does Chronic Rhinosinusitis Lead to Psychiatric Disease?

JAMA Otolaryngol Head Neck Surg. 2019 Feb 07;:

Authors: McCoul ED

PMID: 30730532 [PubMed - as supplied by publisher]

http://bit.ly/2RTCiV8

„Für eine Welt ohne Allergien“

So weit, wie das ambitionierte Motto des 13. Deutschen Allergiekongresses erahnen lassen könnte, ist es leider noch lange nicht. Doch wie man diesem bislang noch weit entfernten Ziel ein Stück näher kommen könnte, wurde Ende September in Dresden diskutiert. Behandelte Themen waren unter anderem Defizite in der Anapylaxietherapie und gezielte Exposition versus Allergenvermeidung.

http://bit.ly/2MYdTwO

Gezielte Exposition versus Allergenmeidung

http://bit.ly/2SE9Gn9

Planung von langer Hand lohnt sich

Für die meisten niedergelassenen Ärzte ist der Verkauf ihrer Praxis am Berufsende ein wichtiger Baustein der eigenen Altersvorsorge. Ein Plan, der angesichts schwindender Zahlen junger Mediziner immer seltener aufgeht. Tatsächlich treibt viele Ärzte die Sorge um, wie sie ihren Ruhestand finanzieren sollen, so ein aktuelles Umfrageergebnis.

http://bit.ly/2MVqvEO

Schlechte Bewertungen im Internet: dulden oder löschen lassen?

Arztbewertungsportale im Internet erfreuen sich zunehmender Beliebtheit. Leider äußern sich dort aber vor allem unzufriedene Patienten. Vernichtende Kritik wirkt im Internet jedoch als Blickfang: Schon einige wenige solcher Bewertungen können die Leistung eines Arztes in ein völlig falsches Licht rücken. Ein Blick auf die rechtlichen Hintergründe zum Umgang mit solchen Bewertungen.

http://bit.ly/2SDTyC3

Allergologie unter Druck

http://bit.ly/2MZvftk

Vorsicht bei erhöhtem sIgE gegen Nahrungsmittel

Die orale Nahrungsmittelprovokation gehört zu den Standardmethoden in der Diagnostik der Nahrungsmittelallergie. Bei erhöhtem Anaphylaxierisiko sollte aber besser auf den Test verzichtet werden. Wer ist besonders gefährdet?

http://bit.ly/2SE9BzR

So sicher ist die intranasale Glukokortikoidtherapie

Auch wenn die intranasale Glukokorikoidtherapie als sicher gilt, befürchten manche systemische Nebenwirkungen, wie sie von einer oralen Anwendung bekannt sind. Bisher gab es keine Metaanalysen, mit deren Hilfe dies geklärt werden konnte. HNO-Ärzte aus den USA konnten diese Lücke nun schließen.

http://bit.ly/2N2f7r2

Weitergabe von Daten und Datenübertragung — nur mit Einwilligung?

Durch die Datenschutzgrundverordnung (DSGVO) ist in der Ärzteschaft Verunsicherung darüber entstanden, unter welchen Voraussetzungen Patientendaten an Dritte weitergegeben werden dürfen. Es besteht oftmals die Sorge, für jede Weitergabe von Patientendaten eine schriftliche Einwilligung des Patienten zu benötigen und so im Papierwust zu ersticken. Im Fokus steht dabei die Weitergabe von Daten an weiter- oder nachbehandelnde Ärzte, an Labore sowie an Abrechnungsgesellschaften. Doch auch außerhalb des Praxisalltags ist der Thematik Beachtung zu schenken.

http://bit.ly/2SE9xjB

Defizite in der Anaphylaxietherapie

http://bit.ly/2MXEtpH

Praxisöffnungszeiten — neuer Liebling der Populisten

http://bit.ly/2SE9tjR

Lesenswerte Therapiebegleitung für Tumorpatienten

http://bit.ly/2MYTZBJ

Spezifische Immuntherapie: Warnung vor unbedachter Anwendung

http://bit.ly/2SE9oN5

Akupunktur bei allergischen Erkrankungen — wann ist sie sinnvoll?

http://bit.ly/2MVqv7M

Neue EAACI-Definition der Pollensaison ist klinisch relevant

2017 hat die European Academy of Allergy and Clinical Immunology die Definition für die Birken- und Gräserpollenflugsaison neu festgelegt. Eine Studie überprüfte die Korrelation der Definition anhand von Pollenzählungen mit der klinischen Symptomatik.

http://bit.ly/2SDTdiL

Korrekt abrechnen bei Patienten aus dem Ausland

Die Abrechnung bei Patienten aus dem Ausland ist nicht ganz einfach, weil je nach Herkunftsland andere Regeln gelten. Die KBV hat ihre entsprechende Checkliste zum 1. Oktober aktualisiert, um Ärzten einen Leitfaden an die Hand zu geben.

http://bit.ly/2MYdRVI

Vom Kykladenidol zur Medici-Nase

Die Nase als zentrale Struktur innerhalb des Gesichtes kann das ästhetische Erscheinungsbild einer Person entscheiden, im positiven, wie im negativen Sinne. Nicht umsonst spielt die ästhetische Nasenchirurgie in den letzten Jahrzehnten eine zunehmend bedeutsame Rolle. Aber auch in der bildenden Kunst haben sich Maler und Bildhauer der Nase über die Jahrtausende immer wieder besonders intensiv gewidmet. Mit dieser ersten Folge beginnen wir eine Serie zur Rolle der Nase in der Kunst.

http://bit.ly/2SGnZaR

Inhaltsverzeichnis

http://bit.ly/2N2f66s

Die Aufklärung im forensischen Alltag

Die Beweislast für die ordnungsgemäße Aufklärung eines Patienten obliegt dem Arzt und ist mitunter schwierig zu erfüllen. Hilfreich ist daher die sogenannte „ständige Aufklärungsübung".

http://bit.ly/2DtFKQX

Genügt der Erlös der Praxisagabe als Altersvorsoge?

http://bit.ly/2SmkYx5

Eosinophile Ösophagitis durch sublinguale Immunisierung

Die eosinophile Ösophagitis (EoE) ist eine progressive, immunvermittelte, chronisch-entzündliche Erkrankung der Speiseröhre mit zunehmender Prävalenz, deren Ätiologie und Pathomechanismen nicht abschließend geklärt sind. Hier stellen wir den Fall einer EoE vor, die als Nebenwirkung einer sublingualen Immunisierung (SLIT) aufgetreten ist.

http://bit.ly/2DuSdUy

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

Abstract

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

http://bit.ly/2E0qHzS

A Guide to Yellow Oral Mucosal Entities: Etiology and Pathology

Abstract

When faced with an uncertain clinical pathosis in the oral cavity, identifying the color of the mucosal lesion helps to narrow down a differential diagnosis. Although less common than red and white lesions, yellow lesions encompass a small group of distinct mucosal pathologic entities. Adipose tissue, lymphoid tissue, and sebaceous glands are naturally occurring yellow constituents of the oral cavity and become apparent with associated developmental or neoplastic lesions. Reactive and inflammatory lesions can create a yellow hue due to purulence, necrosis, and calcification. Some systemic diseases are known to deposit yellow bi-products such as amyloid or bilirubin into the oral mucosa of an affected person, and while not always yellow, unusual entities like verruciform xanthoma and granular cell tumor fall under the umbrella of yellow lesions given their occasional propensity to demonstration the color. This chapter aims to explore the unique group that is yellow lesions presenting in the oral mucosa.

http://bit.ly/2TfsKp2

Ulcerated Lesions of the Oral Mucosa: Clinical and Histologic Review

Abstract

Ulcerated lesions of the oral cavity have many underlying etiologic factors, most commonly infection, immune related, traumatic, or neoplastic. A detailed patient history is critical in assessing ulcerative oral lesions and should include a complete medical and medication history; whether an inciting or triggering trauma, condition, or medication can be identified; the length of time the lesion has been present; the frequency of episodes in recurrent cases; the presence or absence of pain; and the growth of the lesion over time. For multiple or recurrent lesions the presence or history of ulcers on the skin, genital areas, or eyes should be evaluated along with any accompanying systemic symptoms such as fever, arthritis, or other signs of underlying systemic disease. Biopsy may be indicated in many ulcerative lesions of the oral cavity although some are more suitable for clinical diagnosis. Neoplastic ulcerated lesions are notorious in the oral cavity for their ability to mimic benign ulcerative lesions, highlighting the essential nature of biopsy to establish a diagnosis in cases that are not clinically identifiable or do not respond as expected to treatment. Adjunctive tests may be required for final diagnosis of some ulcerated lesions especially autoimmune lesions. Laboratory tests or evaluation to rule out systemic disease may be also required for recurrent or severe ulcerations especially when accompanied by other symptoms. This discussion will describe the clinical and histopathologic characteristics of a variety of ulcerated lesions found in the oral cavity.

http://bit.ly/2FZue3A

Erythematous and Vascular Oral Mucosal Lesions: A Clinicopathologic Review of Red Entities

Abstract

Erythematous lesions of the oral mucosa are common and can reflect a variety of conditions, ranging from benign reactive or immunologically-mediated disorders to malignant disease. Together with vascular abnormalities, which can vary from reddish to bluish-purple in color, the differential diagnosis for erythematous oral mucosal change is quite diverse. This review focuses on salient clinical features and histopathologic findings of selected conditions which clinically present as red or vascular-like oral mucosal alterations, including oral vascular malformations and neoplasms, pyogenic granuloma, localized juvenile spongiotic gingival hyperplasia, denture stomatitis, benign migratory glossitis (geographic tongue), orofacial granulomatosis, granulomatosis with polyangiitis (Wegener granulomatosis), megaloblastic anemia, and erythroplakia. Recognition of the characteristic clinical features of these conditions, in conjunction with thorough patient history, will allow clinicians to narrow the differential diagnosis and guide appropriate clinical decision making, including the need for tissue biopsy, in order to complete the diagnostic process and initiate optimal patient care.

http://bit.ly/2G7qUmo

Non-HPV Papillary Lesions of the Oral Mucosa: Clinical and Histopathologic Features of Reactive and Neoplastic Conditions

Abstract

Excluding human papillomavirus (HPV)-driven conditions, oral papillary lesions consist of a variety of reactive and neoplastic conditions and, on occasion, can herald internal malignancy or be part of a syndrome. The objectives of this paper are to review the clinical and histopathological features of the most commonly encountered non-HPV papillary conditions of the oral mucosa. These include normal anatomic structures (retrocuspid papillae, lingual tonsils), reactive lesions (hairy tongue, inflammatory papillary hyperplasia), neoplastic lesions (giant cell fibroma), lesions of unknown pathogenesis (verruciform xanthoma, spongiotic gingival hyperplasia) and others associated with syndromes (for instance Cowden syndrome) or representing paraneoplastic conditions (malignant acanthosis nigricans). Common questions regarding differential diagnosis, management, and diagnostic pitfalls are addressed, stressing the importance of clinico-pathologic correlation and collaboration.

http://bit.ly/2FUqLDk

A Rainbow of Colors and Spectrum of Textures: An Approach to Oral Mucosal Entities

http://bit.ly/2FZ9zNl

Candidiasis: Red and White Manifestations in the Oral Cavity

Abstract

Candidiasis is a very common malady in the head neck region. This review will concentrate on intraoral, pharyngeal and perioral manifestations and treatment. A history of the origins associated with candidiasis will be introduced. In addition, oral conditions associated with candidiasis will be mentioned and considered. The various forms of oral and maxillofacial candidiasis will be reviewed to include pseudomembranous, acute, chronic, median rhomboid glossitis, perioral dermatitis, and angular cheilitis. At the end of this review the clinician will be better able to diagnose and especially treat candidal overgrowth of the oral facial region. Of particular interest to the clinician are the various treatment modalities with appropriate considerations for side effects.

http://bit.ly/2G7qMmO

Black and Brown Oro-facial Mucocutaneous Neoplasms

Abstract

Black and brown-colored mucocutaneous lesions present a differential diagnostic challenge, with malignant melanoma being the primary clinical concern. The vast majority of pigmented lesions in the head and neck region are the result of benign, reactive factors such as post-inflammatory melanosis. However, it is not uncommon to discover a range of muco-cutaneous black and brown neoplasms in the oro-facial area. The majority of black/brown pigmented neoplasms are melanocytic in origin; these are neoplasms of neural crest derivation. Melanocytic nevi are a diverse group of benign neoplasms that are the result of specific oncogenic mutations. They are common on cutaneous surfaces but can manifest in mucosal sites. Currently, nevi are classified based on clinical and histological criteria. The most common cutaneous and oral mucosal nevus is the acquired melanocytic nevus; nevi do not pose an increased risk for the development of malignant melanoma. Emerging information on specific genetic differences supports the notion of biologically distinct nevi. This article will review the classic clinical and microscopic features of nevi commonly found in the head and neck region, and discuss emerging concepts in nevus pathogenesis and taxonomy. Melanoma is a malignant melanocytic neoplasm and is a result of cumulative genetic deregulation. The etiology of malignant melanoma (MM) is multifactorial and includes underlying genetic susceptibility, UV radiation, skin-type, and race. The majority of MM occurs on cutaneous surfaces and less commonly on mucosal and extra-cutaneous visceral organs. Regardless of location, MM exhibits clinical-pathological features that relate to horizontal or vertical tumor spread. Cutaneous and mucosal MM typically present as asymmetrical, irregularly bordered, large (> 0.5 cm), heterogeneous brown-black lesions with foci of erythema, atrophy or ulceration. As with melanocytic nevi, advances in melanomagenesis research have revealed primary oncogenic BRAF and NRAS mutations associated with cutaneous MM. Unlike their cutaneous counterparts, mucosal melanomas exhibit primary oncogenic alterations in c-KIT and other genes. This article will discuss the role of specific primary oncogenic and secondary/tertiary genetic defects in differential clinical presentation, anatomic distribution, future classification changes, and targeted therapy of melanoma. The clinical and microscopic features of mucosal melanomas and a summary of management guidelines will be discussed. Additionally, this article will cover the salient features of melanocytic neuroectodermal tumor of infancy, a neoplastic entity that can involve the oro-facial region, and the clinical-pathological features of selected, commonly occurring pigmented ectodermally-derived neoplasms that are often part of the clinical differential diagnosis of black–brown pigmented lesions.

http://bit.ly/2G6YR6q

Lumps and Bumps of the Gingiva: A Pathological Miscellany

Abstract

Lesions of the gingivae are amongst the commonest lesions seen in patients and the vast majority are reactive hyperplasias, related to a number of chronic irritant stimuli. However, there are a number of entities that have a predilection for the gingivae, which are much less common in other parts of the oral cavity. The purpose of this paper is to discuss the clinical and histological differential diagnoses when presented with a lump on the gingivae, including the approach to diagnosis and diagnostic pitfalls.

http://bit.ly/2FWagql

HPV-Related Papillary Lesions of the Oral Mucosa: A Review

Abstract

Human papillomaviruses (HPVs) are causative of a group of clinically papillary lesions. The HPV-related lesions of the oral cavity include squamous papilloma, condyloma acuminatum, verruca vulgaris, and multifocal epithelial hyperplasia. Benign entities, such as verruciform xanthoma or giant cell fibroma, as well as malignancies, such as papillary squamous cell carcinoma and verrucous carcinoma, may be considered in the clinical and/or histologic differential diagnoses of these lesions. Mechanisms of infection, epidemiology, clinical presentations, histologic features, and differential diagnoses of the HPV-related oral pathologies are discussed. Current concepts of viral transmission, especially as pertaining to lesions in pediatric patients, and the impacts of HPV vaccination are reviewed.

http://bit.ly/2FYoPtE

Tongue Lumps and Bumps: Histopathological Dilemmas and Clues for Diagnosis

Abstract

Exophytic lesions of the tongue encompass a diverse spectrum of entities. These are most commonly reactive, arising in response to local trauma but can also be neoplastic of epithelial, mesenchymal or miscellaneous origin. In most cases, the microscopic examination is likely to provide a straightforward diagnosis. However, some cases can still raise microscopic diagnostic dilemmas, such as conditions that mimic malignancies, benign tumors with overlapping features and anecdotal lesions. A series of "lumps and bumps" of the tongue are presented together with suggested clues that can assist in reaching a correct diagnosis, emphasizing the importance of the clinico-pathological correlations.

http://bit.ly/2G7qH2u

Frictional Keratosis, Contact Keratosis and Smokeless Tobacco Keratosis: Features of Reactive White Lesions of the Oral Mucosa

Abstract

White lesions of the oral cavity are quite common and can have a variety of etiologies, both benign and malignant. Although the vast majority of publications focus on leukoplakia and other potentially malignant lesions, most oral lesions that appear white are benign. This review will focus exclusively on reactive white oral lesions. Included in the discussion are frictional keratoses, irritant contact stomatitis, and smokeless tobacco keratoses. Leukoedema and hereditary genodermatoses that may enter in the clinical differential diagnoses of frictional keratoses including white sponge nevus and hereditary benign intraepithelial dyskeratosis will be reviewed. Many products can result in contact stomatitis. Dentrifice-related stomatitis, contact reactions to amalgam and cinnamon can cause keratotic lesions. Each of these lesions have microscopic findings that can assist in patient management.

http://bit.ly/2U9yVL4

Lichenoid Characteristics in Premalignant Verrucous Lesions and Verrucous Carcinoma of the Oral Cavity

Abstract

Verrucous hyperkeratosis (VH), verrucous carcinoma (VC) and the relentless, truly pre-malignant variant proliferative verrucous leukoplakia often exhibit lichenoid histologic features that may create a diagnostic dilemma for pathologists. This study aims to evaluate and categorize the frequency and the histopathologic patterns of lichenoid features seen in these lesions. Following IRB approval, cases of VH and VC from 1994 to 2014 were retrieved from the archives of UF Oral Pathology Biopsy Service. A panel of 4 board-certified oral and maxillofacial pathologists reviewed and scored the presence or absence of 5 lichenoid features: band-like infiltrate (BLI), saw tooth rete ridges (STRR), interface stomatitis (IS), civatte bodies (CB), and basement membrane degeneration (BMD). Cases not fulfilling the stringent selection criteria were excluded. A total of 70 cases of VH and 56 cases of VC were included. Approximately 25% of both VH and VC cases exhibited 3 or more lichenoid features. By Chi square testing, BLI (p = 0.000), IS (p = 0.005), and CB (p = 0.026) were significantly more common in VC than VH. Gingival lesions had significantly less frequent BLI (p = 0.004) and IS (p = 0.024) versus other sites. However, STRR was significantly more common in VH than VC (p = 0.000) in the gingiva. (p = 0.002). Statistical analysis revealed that the only significant valid association was the increased presence of band-like infiltrate in VC over VH (p = 0.001). Lichenoid features are common in both VH and VC and may represent a nonspecific inflammatory response to the dysplasia or malignancy rather than concomitant lichenoid disease. This could lead to significant under diagnoses of these premalignant or potentially malignant lesions by pathologists.

http://bit.ly/2U87q4B

Black and Brown: Non-neoplastic Pigmentation of the Oral Mucosa

Abstract

Black and brown pigmentation of the oral mucosa can occur due to a multitude of non-neoplastic causes. Endogenous or exogenous pigments may be responsible for oral discoloration which can range from innocuous to life-threatening in nature. Physiologic, reactive, and idiopathic melanin production seen in smoker's melanosis, drug-related discolorations, melanotic macule, melanoacanthoma and systemic diseases are presented. Exogenous sources of pigmentation such as amalgam tattoo and black hairy tongue are also discussed. Determining the significance of mucosal pigmented lesions may represent a diagnostic challenge for clinicians. Biopsy is indicated whenever the source of pigmentation cannot be definitively identified based on the clinical presentation.

http://bit.ly/2DsEw9V

Role of epithelial–mesenchymal transition factors in the histogenesis of uterine carcinomas

Abstract

Several subtypes of high-grade endometrial carcinomas (ECs) contain an undifferentiated component of non-epithelial morphology, including undifferentiated and dedifferentiated carcinomas and carcinosarcomas (CSs). The mechanism by which an EC undergoes dedifferentiation has been the subject of much debate. The epithelial–mesenchymal transition (EMT) is one of the mechanisms implicated in the transdifferentiation of high-grade carcinomas. To improve our understanding of the role of EMT in these tumors, we studied a series of 89 carcinomas including 14 undifferentiated/dedifferentiated endometrial carcinomas (UECs/DECs), 49 CSs (21 endometrial, 29 tubo-ovarian and peritoneal), 17 endometrioid carcinomas (grade 1–3), and 9 high-grade serous carcinomas of the uterus, using a panel of antibodies targeting known epithelial markers (Pan-Keratin AE1/AE3 and E-cadherin), mesenchymal markers (N-cadherin), EMT transcription factors (TFs) (ZEB1, ZEB2, TWIST1), PAX8, estrogen receptors (ER), progesterone receptors (PR), and the p53 protein. At least one of the three EMT markers (more frequently ZEB1) was positive in the sarcomatous component of 98% (n = 48/49) of CSs and 98% (n = 13/14) of the undifferentiated component of UEC/DEC. In addition, 86% of sarcomatous areas of CSs and 79% of the undifferentiated component of UEC/DEC expressed all three EMT-TFs. The expression of these markers was associated with the loss of or reduction in epithelial markers (Pan-keratin, E-cadherin), PAX8, and hormone receptors. In contrast, none of the endometrioid and serous endometrial carcinomas expressed ZEB1, while 6% and 36% of endometrioid and 11% and 25% of serous carcinomas focally expressed ZEB2 and TWIST1, respectively. Although morphologically different, EMT appears to be implicated in the dedifferentiation in both CSs and UEC/DEC. Indeed, we speculate that the occurrence of EMT in a well differentiated endometrioid carcinoma may consecutively lead to a dedifferentiated and undifferentiated carcinoma, while in a type II carcinoma, it may result in a CS.

http://bit.ly/2TFboSv

Acknowledgement to reviewers 2018

http://bit.ly/2BwYA9P

Comprehensive analysis of PD-L1 expression, HER2 amplification, ALK/EML4 fusion, and mismatch repair deficiency as putative predictive and prognostic factors in ovarian carcinoma

Abstract

Most ovarian carcinomas (OC) are characterized by poor prognosis, particularly the most frequent type high-grade serous carcinoma. Besides PARP inhibitors, target-based therapeutic strategies are not well established. We asked the question which other therapeutic targets could be of potential value and, therefore, analyzed a large cohort of OC for several predictive factors. Two hundred eighty-eight (288) cases of OC including the major histological types were analyzed by immunohistochemistry for PD-L1HER2, ALK, and the mismatch repair (MMR) proteins MLH1, PMS2, MSH2, and MSH6. HER2 amplification and ALK/EML4 fusion were assessed by fluorescence in situ hybridization. The most frequent finding was PD-L1 expression ≥ 1% in 19.5% of the cases, which correlated with a significantly better overall survival in multivariate analysis (p < 0.001). HER2 amplification was detected in 11 cases (4%), all high-grade serous carcinomas. Amplification of HER2 did not correlate with patients' survival. ALK/EML4 fusion was found in two cases (0.74%): one high-grade serous and one endometrioid carcinoma. MMR deficiency was only present in one case of stage IV high-grade serous carcinoma. Subsets of high-grade serous carcinomas show PD-L1 expression and HER2 amplification, respectively, and, therefore, could qualify for immune checkpoint inhibitor therapy or anti HER2 therapy. PD-L1 is also of prognostic impact. ALK/EML4 fusion is very rare in OC and not a putative therapeutic target.

http://bit.ly/2TFbklJ

Compact buds with biphasic differentiation and calcitonin-expressing neuroendocrine cells—previously unrecognized structures of thyroglossal duct unveiled by immunohistochemistry

Abstract

Immunophenotype of thyroglossal duct (TGD) cysts, including lining epithelium and thyroid remnants, is scarcely addressed in the literature. There is indirect evidence that C cells may be derived from progenitor cells of the midline thyroid primordium. This is supported by the recent concept of the endodermal origin of lateral thyroid anlagen and several case reports. We aimed to search for neuroendocrine cells in TGD cysts and to characterize immunophenotype of the thyroid follicles and epithelial lining of TGD. Out of 98 TGD cysts, 70% contained both cyst-lining epithelium and thyroid follicles, whereas 30% possessed only cyst-lining epithelium. Specimens eligible for immunohistochemistry (n = 61) were stained for thyroid-specific and neuroendocrine markers. Thyroid remnants were positive for thyroid transcription factor 1 (TTF-1) and other thyroid tissue-specific markers and negative for calcitonin. TGD epithelium showed strong p63 positivity. We found that respiratory epithelium in 9.8% of TGDs contained neuroendocrine cells positive for calcitonin, chromogranin A, and synaptophysin but negative for carcinoembryonic antigen. In 44.2% of the cases, we detected compact buds, microscopic structures appearing as nests of epithelial cells with a biphasic population of basal (p63+) and central (TTF-1+) cells. Thyroid remnants in TGD expressed full spectrum of thyroid-specific markers and contained no C cells. Instead, calcitonin-expressing neuroendocrine cells were found among the respiratory epithelium of TGD. These cells can be a potential source of neuroendocrine tumors mimicking medullary carcinoma in median anlage derivatives. We also discovered precursor compact buds with dual immunophenotype and proposed a concept of their morphogenesis.

http://bit.ly/2BtAEnQ

A mismatch repair-deficient and HPV-negative anorectal squamous cell carcinoma

Abstract

Invasive primary squamous cell carcinomas involving the anorectal region are challenging to manage. Microsatellite instability has been shown to impact clinical courses and outcomes of patients affected by many types of carcinomas. To the best of our knowledge, there are no reports on microsatellite instability in anorectal squamous cell carcinomas. Here, we report a HPV-negative anorectal squamous cell carcinoma which, despite cisplatin-based chemoradiation therapy, showed progression. Interestingly, after identification of its mismatch repair-deficiency (MLH1/PMS2-absent, MSH2/MSH6-intact), pembrolizumab-based immunotherapy was initiated, leading to a marked clinical response. This unique case illustrates that microsatellite instability testing and immunotherapy targeting immune checkpoint blockade should be considered for managing anorectal squamous cell carcinomas that fail conventional chemoradiation therapies or when patients are non-surgical candidates. This report provides the first evidence of microsatellite instability in anorectal squamous cell carcinomas and supports the role for microsatellite instability testing in this cancer type to optimize patient management.

http://bit.ly/2TBF8zI

National multicentric evaluation of quality of pathology reports for rectal cancer in France in 2016

Abstract

The quality of pathologic assessment of rectal cancer specimens is crucial for treatment efficiency and survival. The Royal College of Pathologists (RCP) recommends evaluating the quality of the pathology report in routine practice using three quality indicators (QIs): the number of lymph nodes (LNs) analyzed (≥ 12), the rate of venous invasion (VI ≥ 30%), and peritoneal involvement (pT4a ≥ 10%). In this study, we evaluated the three QIs of the French national pathology reports and compared them with British guidelines and assessed the influence of neoadjuvant radiochemotherapy on QIs. From January 1 to December 31, 2016, all pathology reports for rectal adenocarcinoma were collected from French departments. Neoadjuvant radiochemotherapy included long-course radiotherapy with concomitant 5-FU-based chemotherapy. A total of 983 rectal cancer pathology reports were evaluated. A median of 15 LNs were analyzed and 81% of centers had ≥ 12 LNs. The rate of VI was 30% and 41% of centers had ≥ 30% VI. The rate of pT4a was 4% and 18% of centers reported ≥ 10% pT4a. None of the centers reached the threshold for the three QIs. All three QIs were lower after radiochemotherapy compared to surgery alone. In conclusion, in French routine practice, the values of two of the three QIs (LNs analyzed and VI) were globally in line with RCP guidelines. However, the rate of pT4a was very low, particularly after radiochemotherapy, suggesting its low value in rectal cancer.

http://bit.ly/2BvCsfU

European follow-up of incorrect biomarker results for colorectal cancer demonstrates the importance of quality improvement projects

Abstract

Biomarker analysis for colorectal cancer has been shown to be reliable in Europe with 97% of samples tested by EQA participants to be correctly classified. This study focuses on errors during the annual EQA assessment. The aim was to explore the causes and actions related to the observed errors and to provide feedback and assess any improvement between 2016 and 2017. An electronic survey was sent to all laboratories with minimum one genotyping error or technical failure on ten tumor samples. A workshop was organized based on 2016 survey responses. Improvement of performance in 2017 was assessed for returning participants (n = 76), survey respondents (n = 13) and workshop participants (n = 4). Survey respondents and workshop participants improved in terms of (maximum) analysis score, successful participation, and genotyping errors compared to all returning participants. In 2016, mostly pre- and post-analytical errors (both 25%) were observed caused by unsuitability of the tumor tissue for molecular analysis. In 2017, most errors were due to analytical problems (50.0%) caused by methodological problems. The most common actions taken (n = 58) were protocol revisions (34.5%) and staff training (15.5%). In 24.1% of issues identified no action was performed. Corrective actions were linked to an improved performance, especially if performed by the pathologist. Although biomarker testing has improved over time, error occurrence at different phases stresses the need for quality improvement throughout the test process. Participation to quality improvement projects and a close collaboration with the pathologist can have a positive influence on performance.

http://bit.ly/2THIUrd

Analysis of the prognostic relevance of sex-steroid hormonal receptor mRNA expression in muscle-invasive urothelial carcinoma of the urinary bladder

Abstract

Muscle-invasive urothelial carcinoma of the urinary bladder (UCB) often recurs following radical cystectomy (RC). An altered expression of sex-steroid hormone receptors has been associated with oncological outcomes of UCB and may represent therapeutic targets. Here the expression of different hormone receptors was measured on mRNA levels in patients treated by RC and associated with outcomes. Androgen receptor (AR), estrogen receptor 1 (ESR1), and progesterone receptor (PGR) mRNA expression was assessed by quantitative reverse transcription polymerase chain reaction (RT-qPCR) in RC samples of 87 patients with a median age of 66 (39–88) years. Univariate and multivariate analyses were performed to test associations with pathological and clinical characteristics as well as recurrence-free (RFS) and disease-specific survival (DSS). AR mRNA expression was lower in comparison with ESR1 and PGR expression (p < 0.0001). In univariate analysis, high expression levels of AR were associated with reduced RFS (HR 2.8, p = 0.015) and DSS (HR 2.8, p = 0.010). High AR mRNA expression and a positive lymph node status were independent predictors for reduced RFS (HR 2.5, p = 0.0049) and DSS (HR 3.4, p = 0.009). In patients with low AR mRNA expression, an increased ESR1 and PGR mRNA expression were associated with reduced RFS and DSS. High expression levels of AR are significantly associated with adverse outcome in patients with muscle-invasive UCB following RC. ESR1 and PGR expression status can further stratify patients with low AR expression into subgroups with significantly reduced RFS and DSS. Therapeutic targeting of AR may influence outcomes in patients with UCB.

http://bit.ly/2BrNO4P

Acute Epstein–Barr virus-positive cytotoxic T cell lymphoid hyperplasia in the upper aerodigestive tract, mimicking extranodal natural killer/T cell lymphoma, nasal type

Abstract

To describe the clinicopathological features of nine patients with acute Epstein–Barr virus (EBV)-positive cytotoxic T cell lymphoid hyperplasia (EBV+TLH) in the upper aerodigestive tract, in which initial findings led to a preliminary misdiagnosis of extranodal NK/T cell lymphoma, nasal type (ENKTL). A series of nine cases of EBV+TLH in one Chinese institution over a 9-year interval was retrospectively analyzed. Median age was 16 years (range 5–29 years) with a M:F ratio of 5:4. All patients were previously healthy with an acute onset period of < 1 month. Six patients (66%) presented with masses or polypoid protrusions in the upper aerodigestive tract. Nasopharyngeal symptoms, cervical lymphadenopathy, and fever were found in 89%, 78%, and 56% of patients, respectively. In seven cases, morphology mainly showed small-sized irregular cells and in two cases medium-to-large cells. In all cases, the cells diffusely expressed cytoplasmic CD3 and at least one marker for cytotoxic granules, but were negative for CD56. CD5 expression was detected in eight cases (8/9, 89%). In all cases, double staining for CD3 and EBER indicated that most T cells were infected with EBV. T cell receptor gene rearrangement was performed in five cases and all showed polyclonal results. All patients achieved complete remission within 1 month after diagnosis without any chemoradiotherapy and were followed up 19–124 months without recurrent disease. EBV+TLH in the upper aerodigestive tract is occasionally observed in China. The histopathologic features of EBV+TLH can mimic ENKTL. EBV+TLH should be taken into consideration as a potential diagnosis when the disease duration is short, spontaneous remission is achieved without intervention, and when histology shows infiltration with EBV-infected T lymphocytes.

http://bit.ly/2TNSE3a

Cerebrovascular pathology in cerebral amyloid angiopathy presenting as intracerebral haemorrhage

Abstract

Cerebral amyloid angiopathy (CAA) is the second most common cause of non-traumatic intracerebral haemorrhage (ICH) accounting for 12–15% of lobar haemorrhages in the elderly. Definitive diagnosis of CAA requires histological evaluation. We aimed to evaluate the spectrum of cerebrovascular changes in CAA-related ICH. Between 2011 and 2015, biopsy-confirmed cases of CAA were retrieved and clinical, radiological and pathological features were reviewed. The spectrum of vascular alterations was evaluated and amyloid deposition was graded in accordance with the Greenberg and Vonsattel scale. Seven cases of sporadic CAA [5 males and 2 females] were diagnosed, none of whom were suspected to have CAA pre-operatively. Six presented with large intracerebral haematoma (ICH) requiring neurosurgical intervention (age range: 56–70 years) and one had episodic headache and multiple microhaemorrhages requiring a diagnostic brain biopsy (45 years). In the presence of large ICH, vascular amyloid deposits were of moderate to severe grade (grade 4 in 4, grades 2 and 3 in 1 case each) with predominant involvement of medium (200–500 μm) to large (> 500 μm) leptomeningeal vessels. Fibrinoid necrosis was noted in four. Two were hypertensive and on antiplatelet agents. β-Amyloid plaques were detected in two, one of whom had symptomatic dementia. MRI performed in 3 of 6 cases with ICH did not reveal any microhaemorrhages. Amyloid deposits in small (50–200 μm) to medium (200–500 μm) calibre intracortical vessels produced parenchymal microhemorrhages. Histopathological examination of ICH is essential for diagnosing CAA. The vascular calibre rather than grade of amyloid deposits dictates size of the bleed. Presence of co-morbidities such as antiplatelet agents may predispose to haemorrhage.

http://bit.ly/2BpeNxB

Targeted sequencing with a customized panel to assess histological typing in endometrial carcinoma

Abstract

The two most frequent types of endometrial cancer (EC) are endometrioid (EEC) and serous carcinomas (SC). Differential diagnosis between them is not always easy. A subset of endometrial cancers shows misleading microscopical features, which cause problems in differential diagnosis, and may be a good scenario for next-generation sequencing. Previous studies have assessed the usefulness of targeted sequencing with panels of generic cancer-associated genes in EC histological typing. Based on the analysis of TCGA (The Cancer Genome Atlas), EEC and SC have different mutational profiles. In this proof of principle study, we have performed targeted sequencing analysis with a customized panel, based on the TCGA mutational profile of EEC and SC, in a series of 24 tumors (16 EEC and 8 SC). Our panel comprised coding and non-coding sequences of the following genes: ABCC9, ARID1A, ARID5B, ATR, BCOR, CCND1, CDH19, CHD4, COL11A1, CSDE1, CSMD3, CTCF, CTNNB1, EP300, ERBB2, FBXW7, FGFR2, FOXA2, KLLN, KMT2B, KRAS, MAP3K4, MKI67, NRAS, PGAP3, PIK3CA, PIK3R1, PPP2R1A, PRPF18, PTEN, RPL22, SCARNA11, SIN3A, SMARCA4, SPOP, TAF1, TP53, TSPYL2, USP36, and WRAP53. Targeted sequencing validation by Sanger sequencing and immunohistochemistry was performed in a group of genes. POLE mutation status was assessed by Sanger sequencing. The most mutated genes were PTEN (93.7%), ARID1A (68.7%), PIK3CA (50%), and KMT2B (43.7%) for EEC, and TP53 (87.5%), PIK3CA (50%), and PPP2R1A (25%) for SC. Our panel allowed correct classification of all tumors in the two categories (EEC, SC). Coexistence of mutations in PTEN, ARID1A, and KMT2B was diagnostic of EEC. On the other hand, absence of PTEN, ARID1A, and KMT2B mutations in the presence of TP53 mutation was diagnostic of SC. This proof of concept study demonstrates the suitability of targeted sequencing with a customized endometrial cancer gene panel as an additional tool for confirming histological typing.

http://bit.ly/2TFZWpV

In this issue

http://bit.ly/2BpeKlp

Validation of the pathological prognostic staging system proposed in the revised eighth edition of the AJCC staging manual in different molecular subtypes of breast cancer

Abstract

The authors investigated the clinical utility of the revised prognostic staging system proposed in the eighth edition of the American Joint Committee on Cancer (AJCC) staging manual in breast cancer (BC) patients. We retrospectively reviewed the data of 714 BC patients that received surgical treatment and standard adjuvant therapy from January 2005 to December 2007. All patients were restaged for anatomic TNM stage and pathological prognostic (PP) stage as defined in the revised eighth edition of the AJCC manual. Compared with anatomic stage, PP stage was different from anatomic stage in 325 (45.5%) patients, 254 were down-staged and 71 were upstaged. There were significant differences in overall survival (OS) and disease-free survival (DFS) according to different anatomic stages or PP stages (all, p < 0.001). In anatomic stage I patients, OS was significantly different between PP stages IA and IB (p < 0.001), but no significant difference was observed between anatomic stages IA and IB (p = 0.413). PP stages exhibited significant OS differences in anatomic stage IIB (p = 0.011), but survival differences according to PP stages were not observed in anatomic stage IIA, IIIA, or IIIC. PP stages were found to have prognostic value with respect to OS and DFS for luminal (p < 0.001 and p < 0.001), HER2-positive (p = 0.001 and p = 0.013), and triple-negative (p = 0.008 and p = 0.03) subtypes. The prognostic staging system proposed in the eighth edition of the AJCC more accurately predicts the clinical outcomes of BC patients than the traditional anatomic staging system.

http://bit.ly/2TGeyFP

Evaluation of tumor-infiltrating lymphocytes in osteosarcomas of the jaws: a multicenter study

Abstract

The aim of the present study was to investigate the profile of tumor-infiltrating lymphocytes (TIL) in osteosarcomas of the jaws (OSJ). A total of 21 OSJ samples were analyzed in a retrospective and cross-sectional multicenter study. Immunohistochemistry was performed to determine the recognition of TIL such as CD4⁺, CD8⁺, granzyme B⁺ (GrB), programmed cell death protein⁺ (PD-1), and cytotoxic T lymphocyte-associated antigen 4⁺ (CTLA-4) in intratumoral and peripheral (stromal) regions. Positivity was determined based on the percentage and density of TIL⁺ per square millimeter [1 = absent (< 25 cells/mm²), 2 = low (25 to 130 cells/mm²), and 3 = high (> 130 cells/mm²)]. The association of TIL density with clinicopathologic data was determined by the Mann-Whitney test (p < 0.05). OSJ were positive for CD8⁺ cells in 45% (n = 9) of cases, for CD4⁺ cells in 30% (n = 6) of cases, and for CTLA-4⁺ in 4.8% (n = 1) of cases, with a score of 2 (low TIL) in all cases. All cases were negative for GrB and PD-1 (score 1). No association was observed between immune infiltrate and clinicopathologic findings. OSJ showed a microenvironment with low TIL, including failure of effectiveness of the antitumor immune response (absence of GrB⁺ cells), and few cells exhibited immunotherapeutic targets, such as CTLA-4 and PD-1.

http://bit.ly/2BqxIs4

Exploring the Introduction of European Dogs to North America Through Shoulder Height

Abstract

The introduction of domesticated species to new environments has been used to identify colonization events in the archaeological record, but rarely provides the opportunity to investigate colonists' selection of particular breeds or stock. This analysis employs morphometrics, the measurement of skeletal landmarks, supported by historic documentation to explore the intersection between colonists' breed preferences and species translocation. In doing so, this analysis provides insight into the differential effects of human selective breeding on domestic dog's (Canis familiaris) physical characteristics in Native American and European societies. Historic sources suggest that European colonists selectively imported large dog breeds capable of defending settlements and livestock, acting as war dogs, and aiding hunters. Colonists' dogs are reputed to have been significantly larger than Native American dogs. This study compares standardized measurements taken on bones to estimate shoulder height. We find that dog populations in England and North America spanning the period 0‐1800 AD exhibit an almost identical average stature; however, the range of shoulder height variation in European dogs is far greater than seen in eastern Native American dog populations. Dogs in colonial American contexts are statistically larger than both Native American and European dog populations, supporting documentary accounts that colonists selectively imported breeds from the largest available in Europe.

http://bit.ly/2tdl4rR

Changes in indigenous population structure in colonial Mexico City and Morelos

Abstract

The Spanish conquest and colonization of Mexico had disastrous effects on indigenous people. Disease, coupled with drastic changes in the economic, political, and religious structures, led to an enormous depopulation event throughout the colony of New Spain. What remains unclear in historic and archaeological accounts of Spanish colonization in Mexico is the effects of these changes on indigenous population structure and variation. In this study, we use biological distance and population structure analyses of two Mexico City church ossuary samples from the 16^th to 17^th centuries, as well as a sample of burials from a convent in nearby Morelos, to investigate these relationships at the center of the Spanish colony in Central Mexico. Colonial samples are compared with a large dataset of pre‐contact samples from Central Mexico and the surrounding regions, to evaluate changes in population structures. We compare colonial and pre‐contact samples using biological distance analysis and a population structure program commonly applied in genetic analyses and modified for phenotypic data. Our results show that the colonial Mexico City samples are more biologically similar to the pre‐contact samples from Veracruz, Toluca Valley, and West Mexico than to other pre‐contact samples from the Valley of Mexico. The sample from Yecapixtla in Morelos is also most similar to the Veracruz, Toluca Valley, and West Mexico samples, but is also somewhat similar to the pre‐contact sample from Morelos and the nearby Oaxaca Valley. Generally, biological similarities among colonial samples and pre‐contact samples do not correlate with geographic proximity or population size, but coincide with cultural changes. Our study provides bioarchaeological evidence of some degree of population replacement, resulting from either forced migration from surrounding areas for labor, or through indigenous alliances with the Spanish conquerors. Our results also show concordance between traditional biodistance analysis, and non‐traditional analyses employed in population genetics studies.

http://bit.ly/2UKEEaK

Victims of a 17th century massacre in Central Europe: perimortem trauma of castle defenders

Abstract

Interments of massacre victims typically differ from normal funerary practices. Bodies are commonly not orderly buried, but are thrown into a single grave‐pit and exhibit multiple perimortem traumatic injuries. Although perimortem skeletal trauma constitutes the most direct and unambiguous evidence for violence and warfare in the past, analysis should take contextual information into account. The aim of our research is to examine the skeletal evidence of interpersonal violence in the remains of defenders of a castle in Gołańcz, Poland, who were killed in AD 1656 during the Polish‐Swedish War. This event is well documented in the historical sources, thereby providing the detailed socio‐cultural context.

Standard anthropological methods were used to estimate age‐at‐death and biological sex. Macroscopic morphological features developed by forensic anthropologists were applied to distinguish between antemortem, perimortem and postmortem trauma. Descriptive and metric attributes were analyzed for each injury.

Of the 25 skeletons recovered from a mass grave, 22 displayed evidence of perimortem trauma. In total, 90 injuries were found, mainly consisting of sharp‐force trauma. These included 79 injuries to the skull, two injuries to the teeth and nine injuries to the postcranial skeleton. Multiple traumatic lesions were found in 15 individuals (68.1%). The most prevalent were sharp‐force trauma (21 individuals, 95.5%), followed by blunt‐force trauma (two individuals, 9.1%.), with high‐velocity projectile wounds being least common (one individual, 4.5%). Two individuals had their teeth broken off in the perimortem period.

Our study revealed that the inhabitants of Gołańcz were subjected to an extreme level of interpersonal violence, as evidenced by the location, pattern, and distribution of the observed traumatic injuries. From archaeological and historical data, it is known that the event took place during the Swedish invasion into Poland. Our data demonstrate that violence was inflicted not only upon men, but also upon women and children. These findings are in contrast to written accounts, which maintain that the Swedish army spared women and children during the attack, and as such show bias inherent to culture‐related sources of information.

http://bit.ly/2tcvrfw

Acts of life: Assessing entheseal change as an indicator of social differentiation in post‐medieval Aalst (Belgium)

Abstract

Lower levels of physical activity are often linked to higher socio‐economic status (SES) in past societies. As an activity marker, changes at muscle attachment sites known as entheseal changes (EC) have been used with varying efficacy. This study investigates this proposed link between EC as a physical activity marker and socio‐economic status within one well‐defined temporo‐geographic context. EC data from 16 entheses in three skeletal collections from the post‐medieval town of Aalst, Belgium, were evaluated using the Coimbra method. The skeletal assemblages represent distinct socio‐economic groups, evidenced by historical and dietary isotope data. The Louis D'haeseleerstraat sample represents lower class individuals (n=46), the Hopmarkt sample middle class individuals (n=110), and the Saint Martin's church (n=13) higher class individuals. EC data are tested for correlation to status, age, and sex. EC patterns did not differ significantly between the SES groups at any entheses except the M. iliopsoas and common extensor, where the higher class showed more EC. Within the populations, at the Hopmarkt sexual differences were only observed in the Achilles tendon attachment, whereas at the Louis D'haeseleerstraat sexual differences were present in the M. triceps brachii, M. brachioradialis, and quadriceps entheses. Only some entheses showed a significant correlation with age, and these were inconsistent between populations. EC are not a reliable indicator of socio‐economic status in post‐medieval Aalst. This could suggest that the hypothesis that the wealthy were less physically active oversimplifies the lives of people in the past. It could also suggest that EC is not a suitable proxy for physical activity, or that it cannot be used without in‐depth knowledge of the types of activities performed by various socio‐economic groups in addition to consideration of all other etiological factors. This study illustrates the caution necessary when using EC as a proxy for social status in past societies.

http://bit.ly/2USDBWl

BONE TOOLS OF LATE HOLOCENE HUNTER‐GATHERER‐FISHERS OF NORTH‐CENTRAL CHILE: CASE STUDY OF THE PUNTA TEATINOS ASSEMBLAGE

Abstract

During the Late Holocene, important changes can be identified in the social dynamics of hunter‐gatherer populations in different regions of the southern Andes. These transformations are associated with processes of demographic growth, territoriality, increased social complexity, technological innovations, and intensified exploitation of the environment. One of the technological transformations associated with these processes is the popularization of bone instruments. In this study, we discuss the functions of bone tools made by Late Holocene coastal hunters‐gatherers of North‐Central Chile, by carrying out a morphological characterization and identifying use‐wear patterns on their surfaces. Our results show that bone technology was used for hunting, fishing, and gathering activities, from flint working to processing vegetal fibres and hide. A reduce number of artefacts had an ornamental use as well. These results suggest a varied and intensive exploitation of the surrounding space by coastal groups, where bones of land animals constituted an important part of the raw materials used in bone industry. Also, we argue that some bone artefacts were elements structuring social relations, as they participated in flows of information and social networks. We conclude by arguing that the popularization of bone industry reflects the dynamics of social complexity, as well as how bone was integrated as a productive, economic, and social resource in the process of coastal hunters and gatherers who inhabited the area.

http://bit.ly/2tiEcVf

An Execution in Medieval Sicily: CT scan analysis and 3D reconstruction of an ancient forensic context.

Abstract

The bioarchaeological and forensic approach is increasingly applied in the study of funerary contexts in archeology. Here, we present a case of an atypical medieval burial recently discovered in Piazza Armerina (Sicily) in which the integrated use of traditional bioarchaeological and forensic anthropology methods was crucial. The skeleton was lying in a prone position and was characterized by a peculiar injury pattern. We recorded six clear stab wound marks on the posterior surface of the sternum. The use of CT scan and 3D modelling techniques has made it possible to obtain a reliable reconstruction of the cause and modality of death, pointing to the execution of the individual. The importance of this case study is twofold. First, the injury pattern recorded currently constitutes a unicum in the bioarchaeological record. Second, it represents the first well‐documented case of an atypical burial in Sicily.

http://bit.ly/2US3buj

Black woodpecker (Dryocopus martius L.) in the archaeozoological context of the Savvatiev Pustyn', a medieval rural Russian monastery

Abstract

Here we report a discovery of a bone of the black woodpecker (Dryocopus martius L.) in medieval layers of the rural Savvatiev Monastery (Tver Region, Russia). Deposited in the wooden house, presumably refectory, sub‐floor woodpecker's remains could be associated with an activity of the cat. A complex of bones, associated with the find, characterizes the place as a monastery.

http://bit.ly/2E20roR

Analysis of pathology and activity‐related changes to the patellae of individuals from Tell Abraq

Abstract

The examination of comingled ossuary collections creates unique analytical issues as bones are rarely articulated, requiring that the skeletal elements be examined on an individual basis. A result is that the estimation of crucial demographic information like age at death and sex becomes problematic and attempts to ascertain this information involve a high degree of error. Bearing these issues in mind, however, the focus of this project is to identify and interpret signs of osteoarthritis, osteochondritis dissecans, and osteochondral fracturing, as well as to score for the presence and degree of musculoskeletal markers, on patellae from the ossuary at Tell Abraq. A secondary goal of this project was to utilize the patellae to elicit both estimations of minimum number of individuals and the ratio of sex within the population.

Preliminary results indicate a high prevalence of osteoarthritis, osteochondritis dissecans, and enchondral fracture that was not correlated to estimated sex. This lack of correlation may be due to several factors, including difficulty in sex estimation based on metric analysis of a single element, a skewed sex distribution, or an actual lack of correlation. Regardless of the difficulties of estimating sex in a comingled collection, it seems clear that both men and women were exposed to conditions that fostered the development of osteoarthritis and that trauma to the knee was a common occurrence for those ultimately interred in the ossuary.

http://bit.ly/2GBc6wr

Leukemia in Ancient Egypt: earliest case and state‐of‐the‐art, techniques for diagnosing generalized osteolytic lesions

Abstract

Malignant bone tumors are uncommon among archaeological skeletal remains, and the general skeletal involvement is even less frequent. Multiple myelomas along with metastases are the most common conditions in paleopathology, whereas malignant myeloproliferative diseases have only been described in a handful of cases.

We present a probable case of acute lymphocytic leukemia in a skeleton of an individual from Ancient Egypt, dated to the end of the First Intermediate Period and the beginning of the Middle Kingdom (c 2160‐2000 BC). The excavation of the Temple of Millions of Years of Thutmosis III located in el‐Assasif (Luxor, Upper Egypt), recovered a total of 41 complete individual from an associated grave‐Necropolis placed close to the north enclosure wall. The individual, a 16 to 21 year‐old male, showed a severe disease affecting all the skeleton with, predominantly, osteolytic lesions and areas of new bone formation. Gross examination under magnification and X‐ray in field were performed.

We review the paleopathological literature to compare the cases previously reported of malignant disease. The morphology and distribution of the lesions of the individual are discussed to make an adequate differential diagnosis in the individual. Several criteria suggest that the disease was most likely acute lymphocytic leukemia: the individual died before the age of 21, the patterns of the bone lesions as well as its distribution below the elbow and knee joints, the presence of a gap in the coronal suture and the mandible involvement.

If this is the case, it would be the oldest case of leukemia described in Ancient Egypt, and could help to understand the evolution patterns of cancer in the history.

http://bit.ly/2E1tglk

A prehistoric case of developmental defects of the spine in a young adult female from the Atacama Desert

Abstract

We report the case of a female individual from an archaeological site from the Late Intermediate Period (ca. 1000‐1400 AD) of the Azapa Valley in the far north of Chile. The spine presents several pathologies, including a triple hemivertebrae involving T7, T8 and T10 and the fusion of axis‐C3. We consider that these bone anomalies could be related to Klippel‐Feil syndrome.

http://bit.ly/2GzUVLC

CANINE SEX ESTIMATION AND SEXUAL DIMORPHISM IN THE COLLECTION OF IDENTIFIED SKELETONS OF THE UNIVERSITY OF COIMBRA, WITH AN APPLICATION IN A ROMAN CEMETERY FROM FARO, PORTUGAL

Abstract

Sexual estimation of human remains is an aspect of great importance for the characterization of demographic profiles in bioarcheology and to identify individuals in forensic cases. The aims of this paper are threefold: to generate population‐specific formulae for sex estimation based on permanent canine metrics, to evaluate the dental sexual dimorphism and to develop a Bayesian approach in a sample of 115 individuals from the documented human sample housed in the University of Coimbra (Portugal). Discriminant functions and logistic regression equations were developed and posterior probabilities were calculated. Formulae offered high percentages of correct sex assignation (77.42‐86.54% for the discriminant functions and 81.63‐85.18% for the logistic regression), while posterior probabilities ranged between 0.71 and 0.85. The procedures were then applied in an archaeological sample of 32 individuals from the Roman (I‐III century AC) cemetery of Ossonoba Romana (Faro, Portugal) in order to test the relevance of their use in this geographical‐related sample. The results of correct estimation are higher than 75% for three formulae and four combinations of variables in the Bayesian approach. Although phenotypic variation may be a factor influencing the sex estimations, canine odontometrics are powerful tools when previously tested, and can increase the amount of data obtained for paleodemographic and forensic purposes. In this case, some of the methods developed for the modern sample can be used in archaeological samples and in spatial and temporal‐related skeletal collections.

http://bit.ly/2E1hMy2

Bone retouchers from the Middle Palaeolithic site of El Salt, Stratigraphic Unit Xa (Alicante, Spain): First data and comparison with the Middle to Upper Pleistocene European record

Abstract

Middle Palaeolithic sites frequently present bones with a double function, linked to subsistence and technology, which are generally referred to as "retouchers" or "bone retouchers." These have been identified in several European sites from the Middle Pleistocene to Holocene, but different explanations of their origin and functionality have been cited. Although bone retouchers were made using various animal parts, they were usually produced from diaphyseal fragments of medium to large hoofed mammals. We present a small assemblage of six bone retouchers recovered from Stratigraphic Unit Xa (52.3 ± 4.6 ka), in the Middle Palaeolithic site of El Salt (Alicante, Spain), and compare our data with previous studies from several sites in south‐western France, northern Italy, and north‐eastern Spain. These tools were generated using diaphyseal fragments from red deer, horses, and other large mammals previously exploited by humans for meat and marrow. Our findings add to the existing knowledge on the behaviour and faunal resource management of the last Neanderthal groups on the western Iberian Peninsula before they disappeared from the region around 45–40 ka.

http://bit.ly/2Gzlcty

Examining adjuvant radiation dose in head and neck squamous cell carcinoma

Abstract

Background

Compare adjuvant radiation dose trends and outcomes in head and neck squamous cell carcinoma (HNSCC).

Methods

Nonmetastatic HNSCCs treated between 2004 and 2014 with primary site surgery, lymph node dissection, and adjuvant radiation were identified in the National Cancer Database. Standard dose radiation (SD‐RT) was defined as an equivalent dose in 2 Gy (EQD2) ≥56.64 and ≤60 Gy and high‐dose radiation (HD‐RT) as an EQD2 >60 and <70 Gy.

Results

HD‐RT was given to 46% of the 15 836 HNSCC patients managed with adjuvant radiation. When adjusted for poor prognostic factors, HD‐RT was associated with increased mortality (HR1.09; 95%CI 1.02‐1.16). In nonoropharynx or human papillomavirus‐negative oropharynx primary that had positive margins, ≥5 positive lymph nodes, and/or extranodal extension, HD‐RT was still not associated with improved survival (HR 1.01, 95% CI 0.91‐1.12).

Conclusions

There was no survival benefit from postoperative dose escalation above EQD2 60 Gy even in a high‐risk cohort.

http://bit.ly/2SFecSq

Dynamic changes in chemosensitivity immune predictors in patients with hypopharyngeal cancer treated with induction chemotherapy

Abstract

Background

There are currently no data predicting chemosensitivity of induction chemotherapy (ICT) for hypopharyngeal squamous cell carcinomas (SCC).

Methods

Associations between immune cells and overall response (OR) to ICT and changes in immune cells during ICT were observed in 40 patients with hypopharyngeal SCC undergoing ICT.

Results

CD4⁺ and CD8⁺ T‐cell and regulatory T‐cell (Treg) frequencies reached diagnostic accuracy for OR to ICT. OR rate was significantly higher in CD4⁺‐high T cell, CD8⁺‐high T cell, and low Treg groups. A transient reduction in Tregs and increases in Tregs in the non‐OR and OR groups were observed during the course of ICT. Conversely, increases in CD8⁺ T cells and reductions in CD8⁺ T cells in the non‐OR and OR groups were observed.

Conclusion

High CD4⁺ T‐cell, high CD8⁺ T‐cell, and low Treg frequencies can be predictors for high efficacy of ICT in patients with hypopharyngeal SCC.

http://bit.ly/2MXh1sF

Postoperative radiation performed at the same surgical facility associated with improved overall survival in oral cavity squamous cell carcinoma

Abstract

Background

The purpose of this analysis is to evaluate whether postoperative radiotherapy (PORT) at the same facility as surgery portends to better survival outcomes compared to PORT given at a different facility.

Methods

Patients underwent upfront surgery at the National Cancer Database reporting facility followed by PORT. PORT was coded as performed at either the same facility or at a different facility as surgery.

Results

A total of 10 832 patients were selected. Five‐year overall survival (OS) was higher in patients undergoing PORT at the same facility: 52.5% vs 48.4% (P < 0.001). PORT performed at the same facility was associated with improved OS under multivariate (HR, 0.92; P = 0.01) and propensity score matched (hazard ratio, 0.90; P = 0.004) analyses.

Conclusions

OS was better among patients with head and neck cancer who received PORT at the same facility as surgery.

http://bit.ly/2SFe8Ca

The role of age in treatment‐related adverse events in patients with head and neck cancer: A systematic review

Abstract

Head and neck squamous cell carcinoma (HNSCC) is often diagnosed in advanced stage and therefore requires aggressive, multimodal treatment. Elderly patients are often excluded from standard therapy regimens purely based on age. This clinical review aims to collect all published data in the literature on treatment modality selection in elderly patients and on age‐related adverse events following treatment of HNSCC. We performed a literature search for articles on the treatment of HNSCC in elderly patients. Most of the articles were retrospective studies with the consequent limitations. It can be concluded that age is not an absolute contraindication for intensive treatment and comorbidity is an important predictor of outcome, but not the only one. Despite the existence of multiple tools for pretreatment evaluation, there are not consistent data on their use.

http://bit.ly/2MXgVBj

Outcomes and cost implications of microvascular reconstructions of the head and neck

Abstract

Background

Critical review of current head and neck reconstructive practices as related to free flap donor sites and their impact on clinical outcomes and cost.

Methods

Retrospective multicenter review of free tissue transfer reconstruction of head and neck defects (n = 1315). Variables reviewed: defect, indication, T classification, operative duration, and complications. A convenience sample was selected for analysis of overall (operative and inpatient admission) charges per hospitalization (n = 400).

Results

Mean charges of hospitalization by donor tissue: radial forearm free flap (RFFF) $127 636 (n = 183), osteocutaneous RFFF (OCRFFF) $125 456 (n = 70), anterior lateral thigh $133 781 (n = 54), fibula $140 747 (n = 42), latissimus $208 890 (n = 24), rectus $169 637 (n = 18), scapula $128 712 (n = 4), and ulna $110 716 (n = 5; P = .16). Mean operative times for malignant lesions stratified by T classification: 6.9 hours (±25 minutes) for T1, 7.0 hours (±16 minutes) for T2, 7.3 hours (±17 minutes) for T3, and 7.8 hours (±11 minutes) for T4 (P < .0001). Complications correlated with differences in mean charges: minor surgical ($123 720), medical ($216 387), and major surgical ($169 821; P < .001). Operations for advanced malignant lesions had higher mean charges: T1 lesions ($106 506) compared to T2/T3 lesions ($133 080; P = .03) and T4 lesions ($142 183; P = .02). On multivariate analysis, the length of stay, operative duration, and type a postoperative complication were factors affecting overall charges for the hospitalization (P < .018).

Conclusion

Conclusion: The RFFF and OCRFFF had the lowest complication rates, length of hospitalization, duration of operation, and mean charges of hospitalization. Advanced stage malignant disease correlated with increased hospitalization length, operative time, and complication rates resulting in higher hospitalization charges.

http://bit.ly/2SAbAW3

Robotic cochlear implantation: feasibility of a multiport approach in an ex vivo model

Abstract

Purpose

A recent clinical trial has shown the feasibility of robotic cochlear implantation. The electrode was inserted through the robotically drilled tunnel and an additional access through the external auditory canal was created to provide for means of visualization and manipulation. To obviate the need for this additional access, the utilization of multiple robotically drilled tunnels targeting the round window has been proposed. The objective of this study was to assess the feasibility of electrode insertion through a robotic multiport approach.

Methods

In four ex vivo human head specimens (left side), four trajectories through the facial recess (2x) and the retrofacial and suprameatal region were planned and robotically drilled. Optimal three-port configurations were determined for each specimen by analyzing combinations of three of the four trajectories, where the three trajectories were used for the electrode, endoscopic visualization and manipulative assistance. Finally, electrode insertions were conducted through the optimal configurations.

Results

The electrodes could successfully be inserted, and the procedure sufficiently visualized through the facial recess drill tunnels in all specimens. Effective manipulative assistance for sealing the round window could be provided through the retrofacial tunnel.

Conclusions

Electrode insertion through a robotic three-port approach is feasible. Drill tunnels through the facial recess for the electrode and endoscope allow for optimized insertion angles and sufficient visualization. Through a retrofacial tunnel effective manipulation for sealing is possible.

http://bit.ly/2UJvyee

Does procalcitonin have a role in the pathogenesis of nasal polyp?

Abstract

Purpose

The aim of this study is to investigate serum and tissue procalcitonin (PCT) levels in patients with nasal polyps.

Methods

The study was designed to be prospectively controlled and included 26 patients chronic rhinosinusitis with nasal polyp (CRSwNP) endoscopically diagnosed and as a control group 25 chronic rhinosinusitis without nasal polyp (CRSsNP). NP specimens, nasal mucosal tissue and venous blood samples of both groups were collected and PCT levels determined by Elisa method. The results were compared statistically.

Results

Serum PCT values were 1319.5 pg/mL in the NP group and 818.8 pg/mL in the control group. The difference between the groups was statistically significant (p = 0.0001). In the NP group, the average PCT value of the polyp tissue was 1521.5 pg/gr, while the mean PCT value of the control group in the nasal mucosa was 414.6 pg/gr. There was a statistically significant difference between the groups (p = 0.0001). The tissue cut-off value of PCT 750 was significant [area under curve 0.940 (0.863–1.00)]. Serum PCT 950 cut-off value was significant [area under curve 0.860 (0.748–0.972)] activity (CI: 95%).

Conclusions

This is the first study of its kind to objectively examine PCT in the polyp and serum of CRSwNP patients. PCT may serve as a diagnostic biomarker in nasal polyps.

http://bit.ly/2MUziXA

Cervical Haematoma Secondary to Spontaneous Bleeding of Parathyroid Adenoma

Publication date: January–February 2019

Source: Acta Otorrinolaringologica (English Edition), Volume 70, Issue 1

Author(s): Alberto Martínez-Martínez, Jade García-Espinosa

http://bit.ly/2WUb3h4

Macrostomia: The defining feature of the oculo-auriculo-vertebral spectrum

Publication date: January–February 2019

Source: Acta Otorrinolaringologica (English Edition), Volume 70, Issue 1

Author(s): Mainak Dutta, Indranil Chatterjee

http://bit.ly/2RMTSdq

Digestive Migration and Spontaneous Expulsion of a Montgomery Salivary Derivation Tube

Publication date: January–February 2019

Source: Acta Otorrinolaringologica (English Edition), Volume 70, Issue 1

Author(s): Pablo Torrico Román

http://bit.ly/2WT1qil

Guideline on Cochlear Implants

Publication date: January–February 2019

Source: Acta Otorrinolaringologica (English Edition), Volume 70, Issue 1

Author(s): Manuel Manrique, Ángel Ramos, Carlos de Paula Vernetta, Elisa Gil-Carcedo, Luis Lassaletta, Isabel Sanchez-Cuadrado, Juan Manuel Espinosa, Ángel Batuecas, Carlos Cenjor, María José Lavilla, Faustino Núñez, Laura Cavalle, Alicia Huarte

Abstract

Introduction

In the last decade numerous hospitals have started to work with patients who are candidates for a cochlear implant (CI) and there have been numerous and relevant advances in the treatment of sensorineural hearing loss that extended the indications for cochlear implants.

Objectives

To provide a guideline on cochlear implants to specialists in otorhinolaryngology, other medical specialities, health authorities and society in general.

Methods

The Scientific Committees of Otology, Otoneurology and Audiology from the Spanish Society of Otolaryngology and Head and Neck Surgery (SEORL-CCC), in a coordinated and agreed way, performed a review of the current state of CI based on the existing regulations and in the scientific publications referenced in the bibliography of the document drafted.

Results

The clinical guideline on cochlear implants provides information on: (a) definition and description of Cochlear Implant; (b) indications for cochlear implants; (c) organisational requirements for a cochlear implant programme.

Conclusions

A clinical guideline on cochlear implants has been developed by a Committee of Experts of the SEORL-CCC, to help and guide all the health professionals involved in this field of CI in decision-making to treathearing impairment.

Resumen

Introducción

En la última década son numerosos los hospitales que han iniciado su actividad en pacientes candidatos a un implante coclear (IC), y se han producido numerosos y relevantes avances para el tratamiento de la hipoacusia neurosensorial que han desembocado en una ampliación de las indicaciones de los IC.

Objetivos

Ofrecer a los especialistas de otorrinolaringología, de otras especialidades médicas, autoridades sanitarias y a la sociedad en general una guía clínica sobre implantes cocleares.

Métodos

Las comisiones científicas de otología, otoneurología y audiología de la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC), de manera coordinada y consensuada, han llevado a cabo una revisión del estado actual de los IC basándose en las reglamentaciones existentes y en las publicaciones científicas que se referencian en la bibliografía del documento elaborado.

Resultados

La guía clínica sobre implantes cocleares aporta información sobre: a) definición y descripción sobre IC; b) indicaciones de los IC; y c) requisitos organizativos para un programa de IC.

Conclusiones

Se ha elaborado por un comité de expertos de la SEORL-CCC una Guía clínica sobre implantes cocleares que aporta coordenadas de actuación para todos aquellos agentes de la sanidad en la toma de decisiones en el ámbito de los IC como forma de tratamiento de la discapacidad auditiva.

http://bit.ly/2RMTOKI

Diagnosis and Treatment of Otitis Media With Effusion: CODEPEH Recommendations

Publication date: January–February 2019

Source: Acta Otorrinolaringologica (English Edition), Volume 70, Issue 1

Author(s): Faustino Núñez-Batalla, Carmen Jáudenes-Casaubón, Jose Miguel Sequí-Canet, Ana Vivanco-Allende, Jose Zubicaray-Ugarteche

Abstract

The incidence and the prevalence rates of otitis media with effusion (OME) are high. However, there is evidence that only a minority of professionals follow the recommendations provided in clinical practice guidelines. For the purpose of improving diagnosis and treatment of OME in children to prevent and/or reduce its impact on children's development, the Commission for the Early Detection of Deafness (CODEPEH) has deeply reviewed the scientific literature on this field and has drafted a document of recommendations for a correct clinical reaction to of OME, including diagnosis and medical and surgical treatment methodology. Among others, medication, in particular antibiotics and corticoids, should not be prescribed and 3 months of watchful waiting should be the first adopted measure. If OME persists, an ENT doctor should assess the possibility of surgical treatment. The impact of OME in cases of children with a comorbidity is higher, so it requires immediate reaction, without watchful waiting.

Resumen

La incidencia y prevalencia de la otitis media secretora infantil (OMS) son elevadas, sin embargo, existen evidencias de que solo una minoría de profesionales sigue las recomendaciones de las guías para su manejo clínico. Con objeto de mejorar el diagnóstico y el tratamiento de la OMS, para prevenir y/o reducir sus consecuencias sobre el desarrollo del niño, la Comisión para la Detección Precoz de la Hipoacusia (CODEPEH) ha realizado una amplia revisión de la literatura científica sobre la materia y ha elaborado un documento de recomendaciones para una correcta actitud clínica ante la OMS, abordando métodos diagnósticos y tratamiento médico y quirúrgico. Entre otros, no usar ninguna medicación, especialmente corticoides y antibióticos, siendo la espera vigilada la primera medida a tomar durante 3 meses. Si persiste la OMS, el otorrinolaringólogo valorará el tratamiento quirúrgico. En niños que presentan comorbilidades de diversa entidad, el impacto de la OMS es superior por lo que hay que actuar de forma inmediata, sin espera vigilada.

http://bit.ly/2WUIgbR

Congenital Aural Atresia prevalence in the Argentinian population

Publication date: January–February 2019

Source: Acta Otorrinolaringologica (English Edition), Volume 70, Issue 1

Author(s): Mario Emilio Zernotti, Carlos A. Curet, Susana Cortasa, Mario Chiaraviglio, Maria Fernanda Di Gregorio

Abstract

Introduction

Congenital Aural Atresia (CAA) or microtia is a malformation that results in esthetic and functional problems. There is little information on prevalence, considering that Latin American is the most affected region in the world.

Objective

To determine the prevalence of microtia, considering the different ethnical structure of the population.

Methods

A retrospective analysis was performed of the clinical reports of newborn infants (public hospitals) in three different regions.

Results

The incidence of CAA in Argentina was 1 case per 7500 new births (i.e. 1.3/10,000). Marked differences were found per geographical area. The means were calculated per year by bilateral parametric estimation, according to the ethnical origins of the population. In the Caucasoid area: 02.47/10,000 (±1.2), in the Mestizo area: 03.99/10,000 (±0.0) and finally in the Amerindian area: 20.93/10,000 (±0.1).

Conclusion

This study shows different incidences according to the demographic features of the population from 1.90/10,000 to 20.9/10,000. This data indicates that CAA is associated with a genetic problem (ethnic differences).

Resumen

Introducción

La atresia aural congénita (AAC) o microtia es una malformación que produce problemas funcionales y estéticos. Existe falta de información de prevalencia en Argentina, teniendo en cuenta además que Latinoamérica es la región más afectada del mundo.

Objetivo

Determinar la prevalencia de microtia, teniendo en cuenta la estructura étnica de la población según las regiones.

Métodos

Análisis retrospectivo de historias clínicas en hospitales públicos de recién nacidos en diferentes zonas del país.

Resultados

La prevalencia de atresia en Argentina fue de uno de cada 7.500 recién nacidos (1,3/10.000). Se encontraron marcadas diferencias de acuerdo al área geográfica. En el área caucásica: 2,47/10.000 (± 1,2), en el área mestiza: 3,99/10.000 (± 0) y en el área amerindia: 20,93/10.000 (± 0,1).

Conclusión

El estudio muestra una diferente incidencia con arreglo a las características demográficas de la población, de entre 1,90/10.000 y 20,9/10.000. Estos datos permitirían asociar la atresia con problemas genéticos (origen étnico).

http://bit.ly/2RRd9dN

Multi-disciplinary clinical protocol for the diagnosis of bulbar amyotrophic lateral sclerosis

Publication date: January–February 2019

Source: Acta Otorrinolaringologica (English Edition), Volume 70, Issue 1

Author(s): Rita Chiaramonte, Carmela Di Luciano, Ignazio Chiaramonte, Agostino Serra, Marco Bonfiglio

Abstract

Introduction and objectives

The objective of this study was to examine the role of different specialists in the diagnosis of amyotrophic lateral sclerosis (ALS), to understand changes in verbal expression and phonation, respiratory dynamics and swallowing that occurred rapidly over a short period of time.

Materials and methods

22 patients with bulbar ALS were submitted for voice assessment, ENT evaluation, Multi-Dimensional Voice Program (MDVP), spectrogram, electroglottography, fiberoptic endoscopic evaluation of swallowing.

Results

In the early stage of the disease, the oral tract and velopharyngeal port were involved. Three months after the initial symptoms, most of the patients presented hoarseness, breathy voice, dysarthria, pitch modulation problems and difficulties in pronunciation of explosive, velar and lingual consonants. Values of MDVP were altered. Spectrogram showed an additional formant, due to nasal resonance. Electroglottography showed periodic oscillation of the vocal folds only during short vocal cycle. Swallowing was characterized by weakness and incoordination of oro-pharyngeal muscles with penetration or aspiration.

Conclusions

A specific multidisciplinary clinical protocol was designed to report vocal parameters and swallowing disorders that changed more quickly in bulbar ALS patients. Furthermore, the patients were stratified according to involvement of pharyngeal structures, and severity index.

Resumen

Introducción y objetivos

El objetivo de este estudio fue examinar la función de los diferentes especialistas en el diagnóstico de la esclerosis lateral amiotrófica (ELA), para comprender quèc) cambios se produjeron en cuanto a expresión verbal, dinámica fonatoria y respiratoria, y deglución, en un breve periodo de tiempo.

Materiales y mèc)todos

Se sometió a 22 pacientes con ELA bulbar a evaluación de la voz, examen ORL, programa de voz multi-dimensional (MDVP), espectrograma, electroglotografía y evaluación de la deglución mediante endoscopía de fibra óptica.

Resultados

En la etapa temprana de la enfermedad, el tracto oral y el cierre velofaríngeo se vieron comprometidos. Transcurridos 3 meses de los síntomas iniciales, la mayoría de los pacientes presentó ronquera, voz entrecortada, disartria, problemas de modulación de la afinación y dificultades de pronunciación de las consonantes oclusivas, velares y linguales. Los valores del MDVP se vieron alterados. El espectrograma reflejó un formante adicional, debido a la resonancia nasal. La electroglotografía mostró una oscilación periódica de las cuerdas vocales únicamente durante el ciclo vocal corto. La deglución se vio caracterizada por debilidad y descoordinación de los músculos orofaríngeos, con penetración o aspiración.

Conclusiones

Se diseñó un protocolo clínico multidisciplinar específico para reportar los parámetros vocales y los trastornos deglutorios que experimentan un cambio más rápido en los pacientes con ELA bulbar. Además, se estratificaron los pacientes con arreglo al compromiso de las estructuras faríngeas y el índice de gravedad.

http://bit.ly/2WVlIYu

Predictive Value of EGFR-PI3K-pAKT-mTOR-pS6 Pathway in Sinonasal Squamous Cell Carcinomas

Publication date: January–February 2019

Source: Acta Otorrinolaringologica (English Edition), Volume 70, Issue 1

Author(s): María Gabriela Muñoz-Cordero, Fernando López, Cristina García-Inclán, Alejandro López-Hernández, Sira Potes-Ares, Laura Fernández-Vañes, José Luis Llorente, Mario Hermsen

Abstract

Background and objectives

We have previously indicated that EGFR has a role in carcinogenesis in a subgroup of sinonasal squamous cell carcinomas (SNSCC). In addition, EGFR activates 2 of the most important intracellular signalling pathways: PI3K/pAKT/mTOR/pS6 and MAP pathway kinases. The objective of this study was to evaluate the involvement of the EGFR/PI3K/pAKT/mTOR/pS6 pathway and its relationship with clinical–pathological parameters and follow-up of sinonasal squamous cell carcinoma.

Material and methods

The immunohistochemical expression of different components of the PI3K/AKT/mTOR/pS6 pathway and its relationship with various clinical-pathological parameters was studied in a series of 54 patients with SNSCC.

Results

Loss of PTEN expression was observed in 33/54 cases (61%) and pAKT, mTOR and pS6 pre-expression was observed in 19/54 cases (35%), 8/54 cases (15%), and 47/54 cases (87%), respectively. Loss of PTEN expression was related to intracranial invasion and development of regional metastases (P=.005). Overexpression of pS6 was associated with a decrease in survival (P=.008), presence of local recurrences (P=.055), and worsening of overall prognosis (P=.007). No significant relationships were observed between pAKT and mTOR expression and the clinicopathological parameters studied.

Conclusions

Alterations in the expression of EGFR/PI3K/pAKT/mTOR/pS6 pathway components are common in a subgroup of SNSCC. This study reveals that the absence of pS6 overexpression is associated with better clinical outcomes. Therefore, pS6 expression could be considered as an unfavourable prognostic marker.

Resumen

Antecedentes y objetivos

En estudios previos hemos indicado que EGFR tiene un papel en la carcinogénesis en un subgrupo de carcinomas epidermoides nasosinusales (CENS). Además, EGFR activa a 2 de las más importantes vías de señalización intracelular como son la PI3K/pAKT/mTOR/pS6 y la vía MAP-cinasas. El objetivo de este estudio fue evaluar la participación de la ruta de EGFR/PI3K/pAKT/mTOR/pS6 y su relación con parámetros clínico-patológicos y de seguimiento de los CENS.

Material y métodos

La expresión proteica de PTEN, pAKT, mTOR y pS6 fue analizada mediante inmunohistoquímica en 54 CENS. Los resultados fueron relacionados con diversos parámetros clínico-patológicos y la supervivencia.

Resultados

La pérdida de expresión de PTEN se observó en 33/54 casos (61%) y la sobreexpresión de pAKT, mTOR y pS6 se observó en 19/54 casos (35%), 8/54 casos (15%) y 47/54 casos (87%), respectivamente. La pérdida de expresión de PTEN se relacionó con la invasión intracraneal y el desarrollo de metástasis regionales (p = 0,005). La ausencia de sobreexpresión de pS6 se relacionó con una supervivencia específica (p = 0,008) y global (p = 0,007) más favorables y la ausencia de recidivas locales (p = 0,055). No se observaron relaciones significativas entre la expresión de pAKT y mTOR y los parámetros clínico-patológicos estudiados.

Conclusiones

Las alteraciones en la expresión de los componentes de la vía EGFR/PI3K/pAKT/mTOR/pS6 son frecuentes en un subgrupo de CENS. Este estudio revela que la ausencia de sobreexpresión de pS6 se relaciona con mejores resultados clínicos, por lo que la expresión pS6 podría considerarse como un marcador pronóstico.

http://bit.ly/2Sr0rrq

Infectious complications in head and neck surgery: Porto Oncology Centre retrospective analysis

Publication date: January–February 2019

Source: Acta Otorrinolaringologica (English Edition), Volume 70, Issue 1

Author(s): Miguel Sá Breda, Joaquim Castro Silva, Eurico Monteiro

Abstract

Objective

To analyze the impact of infectious complications and microbiology in the postoperative period after major oncologic neck surgeries.

Methods

A retrospective study conducted in an oncology center, including all the consecutive patients who developed infectious complications after major neck cancer surgery, from October 2012 to May 2016 (44 months). Among other data, we collected TNM stage, ASA score, body mass index, comorbidities and habits, pre and postoperative hemoglobin levels, albumin serum levels, pre-surgical treatments, length of inpatient stay, isolated microbiological agents and the recorded complications and mortality rate.

Results

In the studied period, 761 major neck surgeries were performed. Of these, 96 patients had complications (12.6%). Pharyngocutaneous fistula (PCF) was the most frequent complication (56%) and nosocomial pneumonia was the most common systemic complication (23%). Pseudomonas aeruginosa was the principal microorganism of the 26 species isolated (15%). 12 deaths were registered. Using multiple linear regression we concluded that flap/cutaneous necrosis and PCF were complications with statistical significance that prolonged inpatient stay. The same complications had significant relative risk for more than 30 days of hospitalization.

Conclusion

The postoperative period is critical for the successful treatment of head and neck oncology patients. PCF and flap/cutaneous necrosis were the principal complications which worsened the outcomes during this critical period. The early recognition and treatment of these complications is crucial.

Resumen

Objetivo

Analizar el impacto de las complicaciones infecciosas en el período posoperatorio de las cirugías oncológicas mayores de cabeza y cuello, y estudio de los agentes microbianos implicados.

Métodos

Estudio retrospectivo realizado en un instituto oncológico, en pacientes que desarrollaron complicaciones infecciosas después de la cirugía oncológica mayor de cuello, entre octubre de 2012 y mayo de 2016 (44 meses). Entre otros se recogieron el estadio TNM, la puntuación ASA, el índice de masa corporal, las comorbilidades, los hábitos tóxicos, los niveles de hemoglobina pre y postoperatoria, los niveles séricos de albúmina, los tratamientos previos a la cirugía, la duración de la hospitalización y los microorganismos aislados, así como las complicaciones sufridas y la tasa de mortalidad.

Resultados

En este período se realizaron 761 cirugías cervicales mayores. De estas, 96 pacientes presentaron complicaciones (12,6%). Las que con mayor frecuencia se registraron fueron la fístula faringocutánea (FFC) (56%) y la neumonía nosocomial (23%). Fueron aislados 26 tipos de microorganismos, siendo la Pseudomonas aeruginosa la más frecuente (15%). Se registraron 12 fallecimientos. Tras el estudio estadístico con regresión lineal múltiple, se detecta que la necrosis cutánea o del colgajo y la FFC fueron las complicaciones con un mayor impacto estadístico en la estancia hospitalaria. Asimismo, fueron los factores que más influyeron en las hospitalizaciones de 30 días o más.

Conclusión

Una buena evolución durante el período postoperatorio es fundamental para obtener éxito en el tratamiento de los pacientes oncológicos de cabeza y cuello. La FFC y la necrosis de colgajo o cutánea constituyeron las principales complicaciones con un mayor impacto en los resultados obtenidos. La detección precoz de estas complicaciones, así como su tratamiento, son cruciales.

http://bit.ly/2DomK6F

Clinical Experience With Patients With Spasmodic Dysphonia and Primary Meige Syndrome

Publication date: January–February 2019

Source: Acta Otorrinolaringologica (English Edition), Volume 70, Issue 1

Author(s): María Fernanda Pedrero-Escalas, Isabel García-López, Susana Santiago-Pérez, Francisco Vivancos, Javier Gavilán

Abstract

Introduction

Meige syndrome (MS) is part of the group of segmental cranial dystonias, which affect more than two cranial muscle groups. Specifically, blepharospasm is associated with another cranial dystonia (oromandibular, cervical or laryngeal). The aim of this paper was to report our experience in patients with spasmodic dysphonia (SD) associated with primary MS.

Material and methods

A retrospective study involving 8 patients between May 2010 and June 2015. Variables recorded were: age, sex, associated dystonia, electromyographic pattern in laryngeal muscles and treatment given. Outcomes after treatment were assessed using GRBAS(i) scale and VHI-30 questionnaire, always provided by the same examiner.

Results

Fifty-six patients with MS were treated in the Neurology Department. Eight patients of 56 were diagnosed with SD (prevalence of 14%). All of our patients had adductor SD. The median age was 71 years. All the patients were treated with intralaryngeal botulinum toxin under electromyographic control. Clinically relevant improvements were found after treatment on both the GRBAS(i) scale and the VHI-30 questionnaire.

Conclusion

In the study of SD, we should always rule out an association with MS. From the point of view of otorhinolaryngology, the joint use of the GRBAS(i) scale and the VHI-30 questionnaire are useful, reliable and efficient methods for assessing progress and response to treatment. Laryngeal infiltration under electromyographic control with botulinum toxin is the therapeutic alternative that provides better results. The management of SD associated with MS does not differ from isolated SD.

Resumen

Introducción

El síndrome de Meige (SM) es considerado una distonía craneal segmentaria que afecta a dos o más músculos craneales. Específicamente, asocia blefaroespasmo a otra distonía craneal (oromandibular, cervical o laríngea). El objetivo de este artículo es presentar nuestra experiencia clínica en pacientes con disfonía espasmódica (DE) asociada a SM primario.

Material y métodos

Estudio retrospectivo realizado entre mayo de 2010 y junio de 2015. Incluyó 8 pacientes. Las variables recogidas fueron: sexo, edad, distonías asociadas, electromiografía laríngea y tratamiento. Los resultados clínicos objetivados fueron realizados, siempre por el mismo investigador, con la escala GRBAS(i) y el cuestionario VHI-30.

Resultados

Cincuenta y seis pacientes fueron tratados de SM por el servicio de Neurología. Ocho pacientes asociaron DE (prevalencia 14%). El 100% de nuestros pacientes tenían DE aductora. La mediana de edad para la aparición de DE fue de 71 años. Todos los pacientes fueron tratados con infiltración intralaríngea de toxina botulínica bajo control electromiográfico. Se objetivó mejoría clínica tanto en la escala GRBAS(i) como en los cuestionarios VHI-30.

Conclusión

En el estudio de la DE siempre debe tenerse presente su posible asociación con el SM. Desde el punto de vista otorrinolaringológico, el uso conjunto de la escala GRBAS(i) y los cuestionarios VHI-30 es útil, fiable y eficiente como método para evaluar evolución y respuesta a tratamiento. La infiltración laríngea de toxina botulínica bajo control electromiográfico es la alternativa terapéutica que provee mejores resultados clínicos. El manejo de la DE asociada al SM no difiere del de la DE aislada.

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