Chemoimmunotherapy for Triple-Negative Breast Cancer

Chemoimmunotherapy for Triple-Negative Breast Cancer.Preview
https://www.ncbi.nlm.nih.gov/pubmed/30575878
JAMA Slomski A

Dec 21st, 2018 - Chemoimmunotherapy for Triple-Negative Breast Cancer.|2018|Slomski A,|

Advances in risk assessment and prophylaxis for central nervous system relapse in diffu... Preview
https://www.ncbi.nlm.nih.gov/pubmed/30573511
Haematologica Qualls D, Abramson JS

Dec 20th, 2018 - Central nervous sytem recurrence of diffuse large B-cell lymphoma is an uncommon but devastating event, making identification of patients at high risk for relapse within the central nervous system essential for clinicians. Modern risk stratification includes both clinical and biologic features. A validated clinical risk model employing the 5 traditional international prognostic index risk facto...

First-Line Ibrutinib Confirmed for CLL. Preview
https://www.ncbi.nlm.nih.gov/pubmed/30530733
Cancer Discovery;

Dec 12th, 2018 - Ibrutinib should be a standard of care for many patients with chronic lymphocytic leukemia, according to results from two phase III trials. The BTK inhibitor, given alone or in combination with rituximab, improved clinical outcomes-including progression-free survival-when compared with chemoimmunotherapy regimens.

Targeted Therapies in CLL: Monotherapy Versus Combination Approaches. Preview
https://www.ncbi.nlm.nih.gov/pubmed/30535947
Current Hematologic Malignancy Reports; Khan M, Siddiqi T

Dec 12th, 2018 - While chemoimmunotherapy has improved outcomes in chronic lymphocytic leukemia (CLL), it is not curative, has significant relapse rates, and is not always well tolerated. Recently, novel targeted therapies have been developed to increase response rates and reduce toxicity, especially in high-risk disease. Current goals of CLL therapies are to produce deep and durable, especially minimal ...

Management of unfit elderly patients with chronic lymphocytic leukemia. Preview
https://www.ncbi.nlm.nih.gov/pubmed/30527922
European Journal of Internal Medicine; Eichhorst B, Hallek M et. al.

Dec 12th, 2018 - Chronic lymphocytic leukemia (CLL) is a disease characterized by an increasing incidence with age reaching 35/100,000 in patients over 85 years. Elderly CLL patients carry several challenges, which have to be considered particularly in advanced stages including a higher risk of infections and individual differences in comorbidities and geriatric syndromes. Although no specific tool for geriatri...

Ibrutinib-rituximab 'new standard of care' in younger CLL patients
https://www.mdedge.com/hematologynews/nhlhub/article/190863/cll/ibrutinib-rituximab-new-standard-care-younger-cll-patients
Neil Osterweil

Dec 11th, 2018 - SAN DIEGO – The combination of ibrutinib and rituximab was associated with a two-thirds reduction in chronic lymphocytic leukemia (CLL) progression, compared with standard chemoimmunotherapy in patients younger than 70 years old, interim results of a phase 3 randomized trial showed. Among 529 patients with previously untreated, symptomatic CLL randomly assigned to ibrutinib-rituximab (IR.

Novel therapies for relapsed/refractory aggressive lymphomas.Preview
https://www.ncbi.nlm.nih.gov/pubmed/30504294
Hematology. American Society of Hematology. Education Program; Cohen JB

Dec 7th, 2018 - Most patients with aggressive non-Hodgkin lymphoma will be cured with initial chemoimmunotherapy; however, most patients with relapsed disease will not be cured and will die as a result of their disease. In these cases, continued treatment with conventional chemotherapy is typically not of benefit and can contribute to significant toxicities and decreased quality of life for patients. Fo...

Where to start? Upfront therapy for follicular lymphoma in 2018.Preview
https://www.ncbi.nlm.nih.gov/pubmed/30504308
Hematology. American Society of Hematology. Education Program; Leonard JP, Nastoupil LJ et. al.

Dec 7th, 2018 - The initial approach to the management of follicular lymphoma (FL) is challenging for patients and physicians. Most FL patients present with minimal symptoms; given the lack of a survival benefit to early treatment in this population, a period of observation without therapy is often appropriate. Once there is disease progression beyond low-tumor-burden criteria or symptoms prompting interventio...

Selecting Frontline Therapy for CLL in 2018. Preview
https://www.ncbi.nlm.nih.gov/pubmed/30504317
Hematology. American Society of Hematology. Education Program; Jain N

Dec 7th, 2018 - The treatment landscape of chronic lymphocytic leukemia (CLL) has changed dramatically in the last few years. The role of chemoimmunotherapy has declined significantly for patients with CLL. Fludarabine, cyclophosphamide, rituximab chemotherapy remains the standard frontline therapy for young fit patients with CLL, especially if IGHV mutated. For older adults, ibrutinib has been shown to...

Relapsed CLL: sequencing, combinations, and novel agents.Preview
https://www.ncbi.nlm.nih.gov/pubmed/30504318
Hematology. American Society of Hematology. Education Program; Brown JR

Dec 7th, 2018 - Although the therapy of chronic lymphocytic leukemia (CLL) has changed rapidly over the last 5 years, the key considerations in selecting a therapy for a previously treated patient with CLL continue to include the nature of the prior therapy and the duration of prior remission to that therapy, the prognostic features of the disease, and the health and comorbidities of the patient in question. F...

Ibrutinib Regimens versus Chemoimmunotherapy in Older Patients with Untreated CLL. Preview
https://www.ncbi.nlm.nih.gov/pubmed/30501481
The New England Journal of Medicine; Woyach JA, Ruppert AS et. al.

Dec 7th, 2018 - Ibrutinib has been approved by the Food and Drug Administration for the treatment of patients with untreated chronic lymphocytic leukemia (CLL) since 2016 but has not been compared with chemoimmunotherapy. We conducted a phase 3 trial to evaluate the efficacy of ibrutinib, either alone or in combination with rituximab, relative to chemoimmunotherapy. Patients 65 years of age or ol...

Older CLL Patients See Better PFS With Ibrutinib
https://www.mdedge.com/fedprac/avaho/article/190538/leukemia-myelodysplasia-transplantation/older-cll-patients-see-better

Dec 6th, 2018 - SAN DIEGO – In the phase 3 Alliance A041202 trial of older patients with previously untreated chronic lymphocytic leukemia (CLL), ibrutinib showed superior progression-free survival (PFS). Results of the trial were reported by Jennifer A.

For Older Patients With CLL, Ibrutinib Beats StandardChemoimmunotherapy
https://www.ashclinicalnews.org/on-location/older-patients-cll-ibrutinib-beats-standard-chemoimmunotherapy/

Dec 4th, 2018 - Results from a randomized phase III study indicate that the Bruton tyrosine kinase (BTK) inhibitor ibrutinib was superior to standard-of-care chemoimmunotherapy for older patients with chronic lymphocytic leukemia (CLL). Lead author Jennifer A. Woyach, MD, from The Ohio State University Comprehensive Cancer Center in Columbus, presented the findings of the Alliance North American Intergr...

Double-Hit Gene Expression Signature Defines a Distinct Subgroup of Germinal Center B-C... Preview
https://www.ncbi.nlm.nih.gov/pubmed/30523716
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology;Ennishi D, Jiang A et. al.

Dec 3rd, 2018 - High-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements (HGBL-DH/TH) has a poor outcome after standard chemoimmunotherapy. We sought to understand the biologic underpinnings of HGBL-DH/TH with BCL2 rearrangements (HGBL-DH/TH- BCL2) and diffuse large B-cell lymphoma (DLBCL) morphology through examination of gene expression. We analyzed RNA sequencing data from 157 de novo ...

Waldenstrom Macroglobulinemia Clinical Practice Guidelines (2018)
https://www.medscape.com/viewarticle/905623

Nov 30th, 2018 - The guidelines on the diagnosis, treatment, and follow-up of Waldenstrom macroglobulinemia were released on October 1, 2018, by the European Society for Medical Oncology (ESMO).[1] Diagnosis Waldenstrom macroglobulinemia (WM) is diagnosed based on histopathologic confirmation of bone marrow (BM) infiltration by monoclonal lymphoplasmacytic cells and serum monoclonal immunoglobulin M (IgM), conf...

Chemo-Free Regimen Feasible for Indolent Lymphoma
https://www.medpagetoday.com/hematologyoncology/lymphoma/76531

Nov 26th, 2018 - More than a third of patients with symptomatic indolent lymphoma required no chemotherapy during more than 10 years of follow-up after initial treatment with rituximab (Rituxan), data from two randomized Scandinavian studies showed. Three-fourths of the patients remained alive at the end of follow-up, including 38% of patients with follicular lymphoma never treated with chemotherapy. The random...

Evaluation of subcutaneous rituximab administration on Canadian systemic therapy suites. Preview
https://www.ncbi.nlm.nih.gov/pubmed/30464679
Current Oncology (Toronto, Ont.); Stewart DA, Boudreault JS et. al.

Nov 23rd, 2018 - Non-Hodgkin lymphoma (nhl) is the most common hematologic malignancy. Diffuse large B-cell lymphoma (dlbcl) and follicular lymphoma (fl) constitute 55% of new nhl cases and are initially treated with rituximab-based chemoimmunotherapy. Relative to intravenous (IV) rituximab, a subcutaneous (sc) formulation approved in 2016 has comparable pharmacokinetics, efficacy, and safety, and a grea...

What's Hot at This Year's ASH Meeting?
https://www.medscape.com/viewarticle/905521

Nov 23rd, 2018 - The premier event in hematology is celebrating its diamond anniversary. This will be the 60th annual meeting of the American Society of Hematology (ASH). It will be returning to the city of San Diego, California, and will run from November 30 to December 4. More than 25,000 attendees from 155 countries are expected, and more than 4800 abstracts will be presented, Aaron Gerds, MD, chair of ASH's...

ASH 2018 coming attractions look at the big picture
https://www.mdedge.com/jcomjournal/article/189383/aggressive-lymphomas/ash-2018-coming-attractions-look-big-picture/page/0/1

Nov 21st, 2018 - Among these star attractions are results of a phase 3, randomized study of daratumumab (Darzalex) plus lenalidomide and dexamethasone versus lenalidomide-dexamethasone alone for patients with newly diagnosed multiple myeloma who are ineligible for transplant. The investigators found that adding daratumumab reduced the risk of disease progression or death by close to 50%, supporting the combinat.

Outcome of patients aged 80 years or older treated for chronic lymphocytic leukaemia. Preview
https://www.ncbi.nlm.nih.gov/pubmed/30460980
British Journal of Haematology; Al-Sawaf O, Bahlo J et. al.

Nov 21st, 2018 - Clinical management of chronic lymphocytic leukaemia (CLL) in patients aged ≥80 years is based on limited evidence due to the lack of published information. Therefore, we analysed CLL patients aged ≥80 years using data from seven phase III clinical trials of the German CLL Study Group. Among 3552 participants, 152 were ≥80 years old at initiation of first-line study treatment. Median age was 82...

Thyroid nodules in children and teenagers

Pediatr Rev. 
Consultation with the specialist: thyroid nodules.
Osipoff JN1, Wilson TA.
Author information
1
Division of Pediatric Endocrinology, Department of Pediatrics, Stony Brook Children's Hospital, State University of New York, Stony Brook, NY, USA.
Abstract
Based on strong research evidence, thyroid nodules in children and teenagers are more likely to be malignant than in adults. Based on strong research evidence, a history of ionizing radiation to the head or neck is an independent risk factor for the development of thyroid malignancies. There is strong research evidence, including a recent meta-analysis, supporting the use of fine-needle aspiration biopsy in the evaluation of all pediatric and adolescent patients presenting with a thyroid nodule. The surgical management and postoperative care of pediatric and adolescent patients who have well-differentiated thyroid carcinomas remains controversial, because the rarity of the disease limits the ability to conduct randomized, prospective research studies. Numerous studies have demonstrated that, despite presenting with more advanced disease, pediatric and adolescent patients with thyroid carcinoma have a higher survival rate than adults. The American Thyroid Association has issued strong evidence-based recommendations for the management of medullary thyroid carcinoma, including RET mutation testing and early prophylactic total thyroidectomy in children with high-risk mutations.

PMID: 22301033 DOI: 10.1542/pir.33-2-75
https://www.ncbi.nlm.nih.gov/pubmed/22301033

Ravulizumab for treatment of paroxysmal nocturnal hemoglobinuria

FDA approves ravulizumab for treatment of paroxysmal nocturnal hemoglobinuria
https://www.mdedge.com/internalmedicine/article/191740/anemia/fda-approves-ravulizumab-treatment-paroxysmal-nocturnal
Lucas Franki, Internal Medicine News

Dec 21st, 2018 - The Food and Drug Administration has approved ravulizumab(Ultomiris) injection for the treatment of adult patients with paroxysmal nocturnal hemoglobinuria (PNH). Wikimedia Commons/FitzColinGerald/Creative Commons License "The approval of Ultomiris will change the way that patients with PNH are treated.

Ravulizumab (ALXN1210) in patients with paroxysmal nocturnal hemoglobinuria: res... Preview
https://www.ncbi.nlm.nih.gov/pubmed/30171081
Blood Advances; Röth A, Rottinghaus ST et. al.

Sep 2nd, 2018 - Ravulizumab (ALXN1210), a humanized monoclonal antibody to complement component C5, was engineered from eculizumab to have a substantially longer terminal half-life, permitting longer dosing intervals for paroxysmal nocturnal hemoglobinuria (PNH) treatment. Two phase 1b/2 multicenter open-label studies evaluated efficacy and safety of multiple doses and regimens of ravulizumab in ...

Drug is convenient alternative for PNH, doc says
https://www.mdedge.com/content/drug-convenient-alternative-pnh-doc-says
Jen Smith

Jun 22nd, 2018 - Photo from EHA Session at the 23rd Congress of the European Hematology Association (EHA) STOCKHOLM—Results of a phase 3 study suggest the long-acting C5 complement inhibitor ravulizumab produces similar results as eculizumab in patients with paroxysmal nocturnal hemoglobinuria (PNH). Treatment with ravulizumab every 8 weeks proved noninferior to treatment with eculizumab every 2 w.

New Drug for PHN Taken Only Once Every 8 Weeks
https://www.medscape.com/viewarticle/898793

Jul 2nd, 2018 - STOCKHOLM, Sweden — A new drug under development for the treatment of paroxysmal nocturnal hemoglobinuria (PNH),  ravulizumab (ALXN1210, Alexion Pharmaceuticals), has shown noninferiority compared with eculizumab (Soliris, Alexion Pharmaceuticals), currently the only therapy approved for the syndrome. But it achieved similar outcomes while being administered by intravenous (IV) infusion ...

FDA OKs New Options for Two Rare Blood Diseases
https://www.medpagetoday.com/hematologyoncology/hematology/77084

Dec 21st, 2018 - WASHINGTON -- The FDA announced new approvals for two rare and life-threatening blood diseases on Friday, as blastic plasmacytoid dendritic cell neoplasm (BPDCN) gets its first approved agent and paroxysmal nocturnal hemoglobinuria (PNH) gets a new drug that drastically cuts the frequency of treatments. BPDCN Gets First Approved Drug The FDA approved the infusion therapy tagraxofusp (Elzonris) ...

Elzonris (tagraxofusp-erzs) for blastic plasmacytoid dendritic cell neoplasm (BPDCN)

FDA approves Elzonris for blastic plasmacytoid dendritic cell neoplasm
https://www.mdedge.com/hematologynews/article/191723/rare-diseases/fda-approves-elzonris-blastic-plasmacytoid-dendritic
Laura Nikolaides, Hematology News

Dec 21st, 2018 - The Food and Drug Administration has approved tagraxofusp-erzs (Elzonris) infusion for the treatment of blastic plasmacytoid dendritic cell neoplasm (BPDCN) in adults and pediatric patients, 2 years of age and older. Approval was based on efficacy in two cohorts of patients in a single-arm clinical trial.

Drug under priority review for BPDCN
https://www.mdedge.com/content/drug-under-priority-review-bpdcn
HT Staff

Aug 15th, 2018 - Photo by Bill Branson Vials of drug The US Food and Drug Administration(FDA) has accepted for priority review the biologics license application seeking approval for tagraxofusp (Elzonris, SL-401) to treat blastic plasmacytoid dendritic cell neoplasm (BPDCN). The FDA expects to make a decision on this application by February 21, 2019.

FDA OKs New Options for Two Rare Blood Diseases
https://www.medpagetoday.com/hematologyoncology/hematology/77084

Dec 21st, 2018 - WASHINGTON -- The FDA announced new approvals for two rare and life-threatening blood diseases on Friday, as blastic plasmacytoid dendritic cell neoplasm (BPDCN) gets its first approved agent and paroxysmal nocturnal hemoglobinuria (PNH) gets a new drug that drastically cuts the frequency of treatments. BPDCN Gets First Approved Drug The FDA approved the infusion therapy tagraxofusp (Elzonri...

Lysyl Oxidase Is a Key Player in BRAF/MAPK Pathway-Driven Thyroid Cancer Aggressiveness

Thyroid, Ahead of Print.


http://bit.ly/2CD5Hyu

A Novel Thyroid Hormone Receptor Beta Mutation (G357R) in a Family with Resistance to Thyroid Hormone Beta: Extending the Borders of the “Hot” Region in the THRB Gene

Thyroid, Ahead of Print.


http://bit.ly/2TiQecu

Free Flap Head and Neck Reconstruction with an Emphasis on Postoperative Care

Facial plast Surg 2018; 34: 597-604
DOI: 10.1055/s-0038-1676076

Microsurgical free tissue transfer represents the mainstay of care in both ablative locoregional management and the simultaneous reconstruction of a defect. Advances in microsurgical techniques have helped balance the restoration of both form and function—decreasing the significant morbidity once associated with large ablative, traumatic, or congenital defects—while providing immediate reconstruction enabling early aesthetic and functional rehabilitation. There are a multitude of perioperative measures and considerations that aim to maximize the success of free tissue transfer. These include nutritional support, tight glycemic control, acknowledgment of psychological and psychiatric factors, intraoperative surgical technique, and close postoperative monitoring of the patients' hemodynamic physiology. While the success rates of free tissue transfer in experienced hands are comparable to alternative options, the consequences of flap failure are catastrophic—with the potential for significant patient morbidity, prolonged hospital stay (and associated increased financial implications), and increasingly limited options for further reconstruction. Success is entirely dependent on a continuous arterial inflow and venous outflow until neovascularization occurs. Flap failure is multifactorial and represents a dynamic process from the potentially reversible failing flap to the necrotic irreversibly failed flap—necessitating debridement, prolonged wound care, and ultimately decisions concerned with future reconstruction. The overriding goal of free flap monitoring is therefore the detection of microvascular complications prior to permanent injury occurring—identifying and intervening within that critical period between the failing flap and the failed flap—maximizing the potential for salvage. With continued technique refinement, microvascular free flap reconstruction offers patients the chance for both reliable functional and aesthetic restoration in the face of significant ablative defects. The caveat to this optimism is the requirement for considered perioperative care and the optimization of those factors that may offer the difference between success and failure.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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A Giant Cutaneous Horn on the Cheek

Facial plast Surg 2018; 34: 663-664
DOI: 10.1055/s-0038-1675635

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
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http://bit.ly/2Sw9aod

Postoperative Care in Aesthetic Rhinoplasty Patients

Facial plast Surg 2018; 34: 553-560
DOI: 10.1055/s-0038-1676379

After rhinoplasty, during the first 24 hours, the patients should be closely monitored for pain and discomfort, nausea and vomiting, and cool compresses must be applied regularly to decrease edema and ecchymosis. In the early postoperative period of the first month, the sutures, cast, and splints are usually removed during the first week. Then the patient is followed-up at 1, 3, 6, and 12-month intervals routinely to observe healing. In the meantime, any kind of intranasal and extranasal complications should be noted. The outcome measures such as ROE, NOSE, or SCHNOS should be used 3 to 6 months after surgery. If the patient is closely followed-up, then any unwanted complication or dissatisfaction can be solved after 6 to 12 months.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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http://bit.ly/2AmlL63

Postoperative Care in Facial Implants

Facial plast Surg 2018; 34: 612-623
DOI: 10.1055/s-0038-1676463

Facial augmentation is a growing field, secondary to the appreciation of the changes seen in the facial skeleton with aging and the growing acceptance/popularity of facial fat grafting and facial fillers. In addition, it plays a significant role in patients with congenital facial deficiencies as well as those interested in facial feminization/masculinization surgery. Several facial implants are discussed in this article including classic facial implants such as malar, submalar, chin, and prejowl implants as well as newer facial implants such as mandible, temporal, forehead, and skull implants. Special care is given to the postoperative care of these implants. Custom-made implants with three-dimensional computed tomography reconstruction are also discussed
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
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http://bit.ly/2SlLcM9

Face and Neck Lift—Postoperative Care

Facial plast Surg 2018; 34: 561-569
DOI: 10.1055/s-0038-1676380

Primary aim of the article is a discussion of the postoperative care after face and neck lift. A brief history of face and neck lift along with different techniques are described. Importance of preoperative assessment is stressed.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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http://bit.ly/2AlbTJX

General Precautions and Safety Aspects of Facial Laser Treatment

Facial plast Surg 2018; 34: 588-596
DOI: 10.1055/s-0038-1676284

The current overview of laser radiation therapy options and the legal aspects of the head and neck region provides insight into the available laser hardware, discusses the indications and treatment options and risks, as well as the necessary precautions to be taken when operating a laser device. Further handling recommendations and requirements for the laser devices are drawn and the question of transferring tasks to nonmedical personnel is discussed. The reader should get an idea about the benefits and risks of using lasers in treating patients and be able to set the precise indication on the background of possibilities, adverse effects, and legal aspects.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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http://bit.ly/2Sw95AV

Postoperative Care of the Facial Plastic Surgery Patient—Forehead and Blepharoplasty

Facial plast Surg 2018; 34: 570-578
DOI: 10.1055/s-0038-1676354

In any kind of surgery, postoperative care is essential for a good result, but especially when the matter at stake is facial plastic surgery. Despite having performed a perfect surgery, with the least amount of damage to the soft tissues and osteocartilaginous structures, minimal bleeding, and in terms of the surgical time, without adequate postoperative care our results can be affected considerably in the short and long run. Therefore, we must have very clear guidelines regarding postoperative care and the duties of our patients, which should be emphasized during the informed consent of the intervention. It is also essential to comment on the warning signs of postoperative complications, which need to be detected and treated in time to achieve the expected post-surgery results. Before being discharged from the hospital, the patient again receives the postoperative instructions, as well as receiving a paper copy to avoid any possible misunderstandings. In this article, we will detail the postoperative care and complications of brow lift and upper and lower blepharoplasty.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Postoperative Management of Cleft Lip and Palate Surgery

Facial plast Surg 2018; 34: 605-611
DOI: 10.1055/s-0038-1676381

Cleft lip and palatal clefts are one of the most common birth defects with a global incidence of 1 in 700 live births. The majority of these orofacial clefts are nonsyndromic. However, a general screening for syndromes and other organ anomalies should always be performed as their association with orofacial clefts cannot be overlooked. With the recent progress in the knowledge of cleft repair, the procedures to correct cleft lip and palate though complex, have been simplified to allow improvisation in outcome and to achieve even better finesse of surgical result. The procedural complications and the pursuit of having near perfect esthetics and functionality, make this deformity a recipient of multiple procedures. This ensures that the patient is under the care of the treating surgeon for long term and allows the surgeon to follow-up on the result, not only to provide care but also to intercept any deviation in the desired outcome. Postoperative care of cleft lip and palate surgery is largely underdiscussed and a set of fixed guidelines will help the treating surgeon to provide the most comprehensive care to the cleft patients. The authors review the practices followed at their hospitals—a high volume cleft and craniofacial care center, a tertiary care multispeciality teaching hospital, and a community teaching and training hospital. The commonly followed practices with suitable evidence in postoperative care of these patients are enlisted here.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Perioperative Care Considerations and Management of Complications Involving Surgical and Technology Procedures

Facial plast Surg 2018; 34: 579-587
DOI: 10.1055/s-0038-1676119

Technology impacts the lives of everyone nowadays and has had perhaps a greater impact on the lives of facial plastic surgeons and the patients they seek to help with both surgery and procedures. This article will discuss modern technology's impact on intervening in the aging process including technology used for facial and skin rejuvenation and reconstruction concentrating on the techniques and care to minimize complications as well as dealing with complication from the treatments.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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The Evidence for Adjunctive Facelift Procedures

Facial plast Surg 2018; 34: 624-630
DOI: 10.1055/s-0038-1675750

Facelift surgery is a popular treatment but exhibits high variation among practitioners in terms of both core technique and adjunctive measures. This review identified significant evidence addressing the role of pre-infiltration, drains, fat grafting, fibrin tissue adhesives, hilotherapy, and other miscellaneous adjuncts. Based on the authors' assessment of the current literature, there is reasonable supportive evidence for pre-infiltration, fat grafting and laser skin resurfacing, which appear to be safe and effective in appropriately selected patients. Drain use is not mandatory but may confer some benefit. Conversely the evidence for the use of fibrin tissue adhesives and hilotherapy is not compelling.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

http://bit.ly/2Sw8YW1

Postoperative Care in Facial Plastic Surgery

Facial plast Surg 2018; 34: 551-552
DOI: 10.1055/s-0038-1676526

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Full text

http://bit.ly/2Ame0Nu

Clinical Thyroidology®High-Impact Articles

FREE ACCESS through January 11, 2019
Read Now:

Levothyroxine Replacement for Primary Hypothyroidism Can Be Given Between Meals with Similar Effectiveness at Various Times of the Day
Charles H. Emerson  

Most "Recurrences" of Thyroid Cancer Represent Persistent Rather Than Recurrent Disease
Martin Biermann, Katrin Brauckhoff 

Surgery for Hyperthyroidism Lowers Cardiovascular Mortality Compared with Radioactive Iodine
Andrew J. Day, Michael W. Yeh, Masha J. Livhits 

No Benefit of Levothyroxine Among Pregnant Hypothyroid and/or Hypothyroxinemic Women on Offspring IQ at Age 9 years
Angela M. Leung 

Current ATA Thyroid Cancer Guidelines Are Poor Predictors of the Extent of Thyroidectomy
Tracy S. Wang

Using the American College of Radiology Thyroid Imaging Reporting and Data System Will Decrease the Number of Thyroid Nodule Biopsies While Improving Diagnostic Accuracy
Stephanie A. Fish 

Levothyroxine Treatment Does Not Reduce Risk for Premature Delivery Among TPO-Negative Pregnant Women with a TSH of 2.5 to 10.0 mIU/L
Elizabeth N. Pearce 

Methimazole Has a Dose-Dependent Association With Congenital Malformations, but Switching to PTU in the First Trimester Seems Too Late
Tim I.M. Korevaar

The post Clinical Thyroidology^®High-Impact Articles appeared first on American Thyroid Association.

http://bit.ly/2AiF948

Rhinolith: Examining the clinical, radiological and surgical features of 23 cases

Rhinolith is a hard nasal mass formed in time by the mineral salts around an endogenous or exogenous-originating nidus. Rhinolith, which is seen rarely, has been reported in the literature as case reports. In this study, we are presenting the demographic and clinical features together with accompanying sinonasal pathologies of 23 rhinolith cases.

http://bit.ly/2EWwbxn

A submucosal tumor at the base of the tongue

Publication date: Available online 27 December 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): A. Ko, C.L. Hyun, G.C. Lim

http://bit.ly/2CDFkIU

Acta Medica International

http://www.actamedicainternational.com/currentissue.asp?sabs=n

Simulation in anaesthesia Sanjeev Kumar Jain, Rohit Kumar Varshney Acta Medica International 2018 5(2):53-54

Features of acid–base balance of bone marrow Lyudmila P Nikolaeva Acta Medica International 2018 5(2):55-57 Context: Bone marrow (BM) pH has rarely been measured, and the long BM has barely been studied at all because intravital obtaining of the long BM is impossible due to the extreme strength of the long bone tissue. Aims: The study aimed to investigate the acid–base balance of the BM and to compare the acid–base properties of long BM and flat BM. Subjects and Methods: Forty flat BM samples were extracted by sternal puncture. Forty long BM samples were extracted from the femora in patients who had to have a limb amputated. A blood gas and acid–base status analyzer were used to determine pH. Results: Flat BM pH is similar to blood p; the long BM pH is acidic and ranges from 6.7 to 6.9. Hematopoietic stem cells occur in both acidic and slightly alkaline environments. The blood gas and acid–base status analyzer used in this study are suitable for determining the acid–base properties of BM. Conclusions: The acid–base status appears to be an important factor of stem cell differentiation. This paper can be of interest to biotechnologists and researchers who investigate possibilities to influence the differentiation and properties of the stem cells.

Incidence of atrial fibrillation after cardiac surgery and its pharmacological management Persis Ann George, Anila Varkey, Adithya Nandan, Uday Venkat Mateti, Mundayat Gopalakrishnan, Rovin Mathew Theempalangad Acta Medica International 2018 5(2):58-62 Aim: Postoperative atrial fibrillation (POAF) is one of the most commonly occurring complications after cardiac surgery. The study aims to determine the incidence of POAF and to analyze its pharmacological management in patients scheduled for cardiac surgery. Methodology: A prospective observational study was carried out for 6 months (October 2016 to March 2017) in cardiothoracic surgery. Drug therapy details by medication chart review and clinical review in patients who underwent coronary artery bypass graft, mitral valve replacement (MVR), and aortic valve replacement was carried out and analyzed for the incidence of POAF. The statistical analysis was performed using SPSS. Results: A total of 83 patients were recruited for this study. The POAF incidence was 18.07% with the highest incidence on the 2nd postoperative day. The mean age of patients with POAF was 49.40 ± 12.77 years. Rheumatic heart disease and alcohol were identified as the predisposing factors of POAF. The incidence of POAF was the highest following MVR (80%) than other cardiac surgeries. Patients who developed POAF had a longer length of hospitalization (median 9 vs. 7 days). Amiodarone, metoprolol, verapamil, atorvastatin, clopidogrel, and aspirin were the most frequently prescribed drugs for the management of POAF. Administration of metoprolol, nebivolol, atorvastatin, bisoprolol, metoprolol + atorvastatin + aspirin, and other combinations before cardiac surgery reduced the risk of developing POAF. Conclusion: The overall incidence of POAF was 18.07%. Amiodarone (13.3%), metoprolol (40%), verapamil (66.7%), aspirin (26.7%), clopidogrel (13.3%), and atorvastatin (20%) were found to be safe and effective in the treatment of POAF patients.

Caregivers' awareness and perception of cardiopulmonary resuscitation: Our experience Ibrahim Aliyu, Abdulsalam Mohammed, Zainab F Ibrahim Acta Medica International 2018 5(2):63-68 Introduction: Adverse health-related events such as cardiac arrest can occur at any location: it is broadly classified as out-of-hospital or in-hospital cardiac arrest. The location of cardiac arrest however affects outcome; the actions of caregivers and bystanders may influence the outcome of witnessed out-of-hospital cardiac arrest; therefore, their knowledge of cardiopulmonary resuscitation (CPR) is relevant. Materials and Methods: This was a questionnaire-based cross-sectional study conducted at the Paediatric Outpatient Clinic and Paediatric Specialty Clinic of Aminu Kano Teaching Hospital. Results: There were 120 (33.3%) males and 240 (66.7%) females, with a male-to-female ratio of 1:2. Only 57 (15.8%) respondents were aware of CPR. However, 69 (19.2%) respondents were aware of chest compression. One hundred and twenty-nine (35.8%) respondents reported that they could perform mouth-to-mouth resuscitation on their own children; however, 66 (18.3%) respondents reported willingness to perform mouth-to-mouth resuscitation on another person's child if the need arose. Only 15 (4.2%) respondents had training on CPR. Six (40%) respondents were trained at school. However, caregivers in the chronic illness subgroup were more willing to perform mouth-to-mouth resuscitation. Caregivers of children with acute illnesses would use palm kernel oil to treat convulsion; however, those of the chronic illness group would mostly use herbs to treat convulsion; this observation was statistically significant (Fisher's exact test = 32.457, P = 0.00). Conclusion: There was poor awareness of CPR among respondents; furthermore, there was lack of willingness to perform CPR by most respondents on children.

A comparative analysis of the baska mask versus I-gel for general anesthesia in surgical patients undergoing laparoscopic cholecystectomy Usha Kumari Chaudhary, Som Raj Mahajan, Monika Mahajan, Charu Sharma, Mukesh Sharma Acta Medica International 2018 5(2):69-73 Background and Aims: Baska mask is a newly introduced membranous cuffed supraglottic device whereas I-gel is made up of thermoplastic elastomer, both suitably designed from the anatomical perspective of the airway. Settings and Design: We conducted randomized controlled comparative trial of the Baska mask versus I-gel in a patient undergoing laparoscopic cholecystectomy. Subjects and Methods: A total of 100 adult patients in the age group of 20–70 years undergoing elective laparoscopic cholecystectomy were randomly divided into two groups as follows: (1) Baska mask group and (2) I-gel group. The primary outcome was to compare oropharyngeal leak pressure (OLP) of Baska mask and I-gel groups. The secondary outcome was the ease of insertion and removal, number of attempts, insertion time, leak fraction, and laryngopharyngeal morbidity. Statistical Analysis Used: Demographic details were compared using the Chi-square and t-tests. Student's t-test for independent variables was used to compare means of data obtained. Results: Mean OLP was significantly higher in Baska mask group than I-gel group at insertion (29.54 ± 1.41 cm H2O vs. 23.16 ± 3.07 cm H2O, P = 0.02) and 30 min after insertion (33.54 ± 1.16 cm H2O vs. 25.97 ± 2.25 cm H2O, P = 0.001). Insertion time was 12.33 ± 2.61 s with Baska mask and 11.31 ± 1.84 s with I-gel (P = 0.02). Insertion was very easy in 58% of patients in Baska mask and 76% of patients in I-gel (P = 0.03). The leak fraction of Baska mask was significantly less than I-gel (3.56 ± 3.6 vs. 7.16 ± 2.45, P = 0.01). Laryngopharyngeal morbidity was comparable in the two groups. Conclusion: Baska mask is more effective in providing greater OLP compared to I-gel without any increase in laryngopharyngeal morbidity.

Chromosomal aberrations in multiple myeloma: A study on Indian population Angel Beula P. Royal, Syeda Sabiha S. Lubna, P Beaulah Angel, Vijaya V Mysorekar, TS Sundareshan Acta Medica International 2018 5(2):74-78 Aims: The aim of this study was to evaluate the complexity of the chromosomal abnormalities in multiple myeloma (MM) cases and to correlate the findings with the previous reported cases. Materials and Methods: Bone marrow samples were obtained from patients with MM and sent for cytogenetic study. The patient's details were logged and the cytogenetic test was performed. The karyotypes were analyzed and interpreted as per the standard guidelines. Results: Of the compiled data of cases from 2013 to 2016, 34 patients were diagnosed with MM. About 15% were below the age of 50, maximum patients were between ages of 61 and 70 years (50%). There were 25 male and 9 female. Twenty-one cases had normal karyotypes and few cases showed structural rearrangements and numerical abnormalities. Conclusions: From the data compiled, only a total of 34 cases were positive for MM, indicating that the disease is quite rare in our population. It has been previously reported that the disease usually occurs in people over the age of 50 years, however, in this study, 5 (15%) were below the age of 50 indicating that MM can affect the age group below 50 years as well. The numerical, structural abnormalities and few clonal abnormalities observed in our study added a few more to the previously reported abnormalities. However, the interesting finding of our study was a case with a combination of clones of hypodiploidy, hyperdiploidy, hypotetraploidy, and hypertetraploidy which was in contrary to the reported literatures, which were only one type of ploidy were observed. Thus, the heterogeneity and complexity of the chromosomal abnormalities in MM and the challenge in staging the disease have been proven in our study.

Prevalence of exclusive breastfeeding and knowledge related to breastfeeding among mothers attending immunization center and well-baby clinic Shuvendu Roy, Ashish K Simalti, Bindu T Nair Acta Medica International 2018 5(2):79-83 Background: The World Health Organization defines exclusive breastfeeding (EBF) as giving baby only breast milk for the first 6 months without adding any additional drink including water or food. We undertook this study with an objective to assess the prevalence of breastfeeding among mothers in North Indian setting. Aims: The aims of this study were to assess the prevalence of EBF among mothers attending a well-baby clinic and to look for variable significantly impacting probability of breastfeeding and assessing the challenges faced and existing knowledge regarding breastfeeding. Materials and Methods: This was a questionnaire-based one-point survey to assess the prevalence of EBF. The questionnaire was based on the review of literature and included parameters considered significant by various studies. Mother's knowledge regarding breastfeeding was assessed by another questionnaire. Results: A total of 970 mothers were approached who visited immunization center and well-baby clinic during the study. After taking out those who were unwilling and did not meet the criteria, we had 634 mothers who participated in our study. They were divided into two groups based on whether they exclusive breastfed their babies for 6 months or not. Comparison of both these groups revealed breastfeeding counseling to be the most important variable. Statistical Analysis Used: It is a cross-sectional type of study with a questionnaire-based one-point survey. The minimum sample size required was calculated using Daniel's formula: n = z2pq/d. Consequent sampling was done. Chi-square test for independence was done to assess the association between both the groups for all the parameters recorded. Conclusions: All mothers were aware that breast milk is beneficial for their baby; however, the biggest problem was anxiety regarding the adequacy of their breast milk. There is also need for a widespread campaign related to harm done by prelacteals and substitutes of breast milk including cow milk.

Treatment of patients suffering from exercise-induced asthma: Prevention of exercise-induced bronchial spasm – Literature review Leonid Oleksijovych Bezrukov, Olena Kostiantynivna Koloskova, Lorina Alimivna Ivanova, Tetiana Mykhailivna Bilous, Olena Grygorivna Grygola, Yuliia Igorivna Voitkevich Acta Medica International 2018 5(2):84-89 Exercise-induced bronchial asthma (EIBA) or exercise-induced bronchial spasm is all terms that describe the phenomenon of transient obstruction of the bronchi after intensive physical stress. This article presents the recommendations about the rational administration of pharmacological and nonpharmacological methods of treatment of EIBA that in the majority of cases enables to provide considerable control over the disease without limitation of the physical activity of patients.

Penile entrapment: A case where innovation is the need of the hour Gajanan Shripad Bhat Acta Medica International 2018 5(2):90-91 Penile entrapment is a rare and unique condition requiring urgent decompression to preserve the organ function and prevent complications. There is no universal method that is applicable to all cases as there are hardly any guidelines. Management of a 35-year-old male who presented to our emergency room with a metal ring around his penis has been described here. The case report highlights the need to devise one's own method to decompress the entrapped penis based on the available technology and manpower on hand in a given situation.

The effectiveness of continuous venovenous hemodiafiltration in phenobarbital intoxication Yasemin Çoban, Dinçer Yildizdas, Özden Özgür Horoz, Nagehan Aslan, Didar Arslan Acta Medica International 2018 5(2):92-94 Phenobarbital continues to be widely used in childhood epilepsy. Incorrect drug prescription can sometimes lead to intoxication, particularly in young children. A 40-month-old female infant presented to our emergency department due to failure to awaken. The patient was assessed in terms of etiology of coma, and her history revealed that she had been given a 100 mg phenobarbital pill instead of 15 mg. Her blood phenobarbital level was high (>80 mg/dl). At physical examination, her Glasgow coma score was 6, the pupils were isochoric, pupillary light reflex was bilateral positive, deep tendon reflexes were absent, respiration was superficial, and pulmonary bilateral diffuse secretory rales were present, and the patient was intubated. Continuous venovenous hemodiafiltration (CVVHDF) was performed due to prolonged coma, intubation, and potentially fatal phenobarbital level. Blood phenobarbital levels at 4 and 12 h improved to >80 and 33.4 mg/dl, and the patient was extubated at 14 h. CVVHDF was effective in intoxication despite long-acting barbiturate phenobarbital not binding to protein. We think that this is a useful method capable of use in phenobarbital intoxications.

Pediatric Respirology and Critical Care Medicine

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Outcomes and prediction Rina Triasih Pediatric Respirology and Critical Care Medicine 2018 2(4):57-57

Obstructive sleep-disordered breathing in children: Impact on the developing brain Lisa M Walter, Rosemary S C Horne Pediatric Respirology and Critical Care Medicine 2018 2(4):58-64 Obstructive sleep-disordered breathing (SDB) affects up to 11% of children and forms a continuum of severity ranging from primary snoring to obstructive sleep apnea. Children with SDB exhibit significant neurocognitive and cardiovascular dysfunction, which is associated with repetitive hypoxia and sleep fragmentation that characterize the condition. We reviewed the recent literature pertaining to the effect of SDB on the brain in children. These include studies that utilized near-infrared spectroscopy to determine cerebral oxygenation and structural and functional magnetic resonance imaging (MRI) of the brain. Studies have identified that the effect of SDB on cerebral oxygenation in children is minimal and not clinically significant. There are conflicting reports on the association between the measures of cerebral oxygenation and peripheral arterial oxygen saturation (SpO2), and further research needs to be conducted to elucidate the relationship between peripheral SpO2, cerebral oxygenation, and SDB in children. MRI studies have reported significant structural and functional changes to the brains of children with SDB, in brain regions associated with neurocognition, behavior, and autonomic function. These include reduced white and gray matter and structural changes to a multitude of brain areas including, but not limited to, the hippocampus, cortex, amygdala, insula, thalamus, cerebellum, and basal ganglia. These studies utilize a variety of MRI techniques to address different research questions, but contribute to the gradually developing picture of the adverse effects of SDB on the brain in children.

Validation of a modified pediatric risk of mortality III model in a pediatric intensive care unit in Thailand Kanokpan Ruangnapa, Sittikiat Sucheewakul, Tippawan Liabsuetrakul, Edward McNeil, Kantara Lim, Wanaporn Anantaseree Pediatric Respirology and Critical Care Medicine 2018 2(4):65-72 Objective: The objective of this study is to compare the performance of a modified Pediatric Risk of Mortality (PRISM) III model with the original PRISM III in prediction of mortality risk in a Thailand pediatric intensive care unit (PICU). Subjects and Methods: Children aged 1 month to 18 years who stayed in the PICU for more than 8 h during November 2013 to December 2016 were included in the study. Results: The medical records of 1175 PICU patients were included in the analysis. The patients were randomly split into two equal groups: a development (n = 588) and a validation (n = 587) sample. A modified PRISM III model was derived from the original PRISM III by omitting arterial blood gas parameters and adding selected clinical variables. The model was developed using a multiple logistic regression model on the development sample and assessed using the area under the curve (AUC) obtained from a receiver operating characteristic curve. The modified PRISM III scores were significantly higher in nonsurvivors (median = 9, interquartile range [IQR] = 4 − 13) compared to survivors (median = 2, IQR = 0 − 5). The modified PRISM III model had similar discriminative performances compared to the original PRISM III in predicting 2-day mortality (AUC: 0.874 vs. 0.873), 7-day mortality (AUC: 0.851 vs. 0.851) and overall mortality (AUC: 0.845 vs. 0.956). The modified PRISM III model was calibrated in the validation sample, and the standardized mortality ratios (SMRs) were similar. Conclusions: The performance of a modified PRISM III model in predicting mortality risk was comparable to the original PRISM III. Both had similar discriminative performance and SMR for overall mortality prediction in a PICU.

Pulmonary function abnormalities in Nigerian children with sickle cell anaemia: Prevalence, pattern and predictive factors Bankole Peter Kuti, Samuel Ademola Adegoke Pediatric Respirology and Critical Care Medicine 2018 2(4):73-79 Background: Advances in care of children with sickle cell anaemia (SCA) have increased their chances of survival to adolescence and adulthood though this is often associated with multi-organ system pathologies including lung dysfunctions. This study aimed to determine the prevalence, pattern and factors associated with pulmonary function abnormalities in Nigerian children with SCA. Methods: Pulmonary functions of 104 children with SCA in steady state and 104 age- and sex-matched haemoglobin AA controls aged 6 to 16 years at the Wesley Guild Hospital, Ilesa Nigeria, were assessed using Spirolab III (Medical International Research, Italy) spirometer following standard protocol. Socio-demographic characteristics, nutritional status and pulmonary function parameters of these children were compared, and the predictive factors of pulmonary function abnormalities in SCA children were determined using binary logistic regression. Results: SCA children had lower lung volumes and capacities and higher prevalence of pulmonary function abnormalities compared to controls, and a restrictive ventilatory pattern (22.1%) was the most predominant form. Adolescent age, previous acute chest syndrome (ACS), repeated painful crises and multiple hospitalisations in the previous year were significantly associated with pulmonary function abnormalities (P < 0.05). Only adolescent age group (odds ratio [OR] = 3.738; 95% confidence interval [CI] = 1.480–9.440; P = 0.005) and previous ACS (OR = 8.500; 95% CI = 2.044–12.959; P = 0.044) independently predicted pulmonary function impairments among the SCA children. Conclusion: SCA predisposes children to pulmonary dysfunction, particularly during adolescent years and in those with ACS, multiple crises and hospitalisations. Routine pulmonary function assessment in these children will facilitate early recognition and prompt management.

Swallowing-related quality of life after free flap surgery due to cancer of the head and neck

Abstract

Purpose

Treatment of head and neck cancers (HNC) often leads to impairment in speech and swallowing functions. This study evaluated swallowing problems and the impact of complications on swallowing-related QOL after free flap surgery for HNC.

Methods

Swallowing-related QOL was assessed using MDADI and SWAL questionnaires.

Results

Of 45 assessed patients, 25 (45.5%) had at least one postoperative complication. Patients reported less than < 86 points in 8/9 SWAL-QOL domains. The SWAL-QL total score or MDADI composite scores were not related to surgical complications. Those with medical complications had lower scores in SWAL-QOL domains of mental health (82.8 (21.8) vs 65.5 (24.2), p = 0.024) and sleep (77.6 (23.0) vs 52.3 (24.3), p = 0.003).

Conclusions

In conclusion, swallowing related QOL is significantly impaired after 2 years of the tumor resection and free flap reconstruction for cancer of the head and neck, when using the cut-off value of 86 points in SWAL-QOL assessment tool. Surgical complications did not have an impact on swallowing-related QOL but medical complications were related to impairment in general QOL-related domains.

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Ultrasonography guided fine needle aspiration cytology in patients with laryngo-hypopharyngeal lesions

Publication date: Available online 28 December 2018

Source: Brazilian Journal of Otorhinolaryngology

Author(s): Lakshminarasimman Parasuraman, Chirom Amit Singh, Suresh C. Sharma, Alok Thakar

Abstract

Introduction

Laryngeal lesions are usually evaluated by microlaryngoscopy/direct laryngoscopy under anaesthesia for disease mapping and tissue diagnosis. However patients with anticipated airway compromise due to laryngeal mass may require either a protective tracheotomy or emergency tracheotomy to secure the airway. To minimise risk of unplanned tracheotomy and expedite the diagnosis we performed ultrasound-guided transcutaneous fine needle aspiration cytology.

Objective

To evaluate the feasibility and performance of ultrasound-guided transcutaneous fine needle aspiration cytology of suspicious/recurrent laryngo-hypopharyngeal masses.

Methods

Fine needle aspiration cytology was performed under ultrasound guidance. Twenty- four patients were recruited, of which 17 had a pure laryngeal lesion; 6 patients had laryngo-pharyngeal, and one patient had a base tongue lesion with supra-glottis extension.

Results

Out of 24 patients, 21 had positive cytology for squamous cell carcinoma, 2 patients had non-diagnostic cytology (atypical cells) and the other had inadequate tissue for definitive diagnosis. Patients with negative and inconclusive cytology underwent direct laryngoscopy biopsy, which was positive for squamous malignancy. All patients tolerated the procedure well and no adverse events were noted.

Conclusion

Although direct laryngoscopy remains the standard of care in evaluation of laryngo-hypopharyngeal lesions, this pilot study has shown that ultrasound-guided transcutaneous fine needle aspiration cytology was feasible as an out-patient procedure, employing safe and sensitive technique enabling rapid diagnosis and avoiding the need for direct laryngoscopy under GA for tissue diagnosis.

Resumo

Introdução

As lesões laríngeas são geralmente avaliadas por microlaringoscopia/laringoscopia direta sob anestesia para mapeamento da doença e diagnóstico tecidual. No entanto, em pacientes com comprometimento prévio das vias aéreas devido à lesão laríngea, pode ser necessária uma traqueostomia protetora ou traqueostomia de emergência para assegurar as vias aéreas. Para minimizar o risco de uma traqueostomia não planejada e agilizar o diagnóstico, realizamos punção aspirativa por agulha fina guiada por ultrassonografia transcutânea.

Objetivo

Avaliar a viabilidade e desempenho da punção aspirativa por agulha fina guiada por ultrassonografia transcutânea em lesões laríngeo-hipofaríngeas suspeitas/recorrentes.

Método

A punção aspirativa por agulha fina foi realizada, sob orientação ultrassonográfica. Foram recrutados 24 pacientes, sendo 17 pacientes com lesão laríngea apenas, 6 pacientes com lesão laríngeo-faríngea, e um paciente com lesão na base da língua com extensão supraglótica.

Resultados

Dos 24 pacientes, 21 apresentaram citologia positiva para carcinoma espinocelular, 2 pacientes apresentaram citologia não diagnóstica (células atípicas) e o outro apresentou tecido inadequado para o diagnóstico definitivo. Os pacientes com citologia negativa e inconclusiva foram submetidos à biópsia através de laringoscopia direta, que foi positiva para lesão maligna espinocelular. Todos os pacientes toleraram bem o procedimento e nenhum evento adverso foi observado.

Conclusão

Embora a laringoscopia direta continue sendo o padrão de cuidado na avaliação das lesões laríngeo-hipofaríngeas, este estudo piloto demonstrou que a punção aspirativa por agulha fina guiada por ultrassonografia transcutânea é uma técnica viável, ambulatorial, segura e sensível, permitindo rápido diagnóstico e evitando a necessidade de laringoscopia direta sob anestesia geral para diagnóstico tecidual.

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The investigation of semantic memory deficit in chronic tinnitus: a behavioral report

Publication date: Available online 28 December 2018

Source: Brazilian Journal of Otorhinolaryngology

Author(s): Maryam Karimi Boroujeni, Saeid Mahmoudian, Farnoush Jarollahi

Abstract

Introduction

Tinnitus is a central auditory disorder in which different processing systems are involved as a network. One of these networks is memory. Previous studies have demonstrated some deficits in various types of memory in chronic tinnitus.

Objectives

The main purpose of the present study was to investigate the semantic memory, which is not yet investigated in the tinnitus population.

Methods

In this case–control study, 15 subjects with chronic tinnitus and 16 matched healthy controls were included. 40 semantically related and 40 semantically unrelated word pairs were presented to the participants in a counter-balanced fashion. They were asked to make decision about their semantic relatedness. Then the participants' reaction times and the accuracy of responses were calculated.

Results

Mean of reaction times were significantly longer in the tinnitus group (M = 1034 ms, SD = 0.31) compared to the control group (Mean = 1016 ms, SD = 0.13), p < 0.05. However, no significant difference was found for the mean percentage of correct responses between the two groups.

Conclusion

The current study provided behavioral evidence that chronic tinnitus can affect the semantic memory. Such behavioral outcomes may provide new insights into more research activities in the field of electrophysiology and neuroimaging in the tinnitus population.

Resumo

Introdução

O zumbido é um distúrbio auditivo central, no qual diferentes sistemas de processamento estão envolvidos como em uma rede. Uma dessas redes é a memória. Estudos anteriores demonstraram alguns déficits em vários tipos de memória no zumbido crônico.

Objetivos

O objetivo principal do presente estudo foi investigar a memória semântica, que ainda não foi investigada na população com zumbido.

Método

Neste estudo de caso-controle, 15 indivíduos com zumbido crônico e 16 controles saudáveis pareados foram incluídos. 40 pares de palavras semanticamente relacionados e 40 semanticamente não relacionados foram apresentados aos participantes de forma contrabalançada. Eles foram instruídos a tomar decisões sobre sua relação semântica. Em seguida, os tempos de reação dos participantes e a precisão das respostas foram calculados.

Resultados

A média dos tempos de reação foi significativamente maior no grupo com zumbido (M = 1034 ms, DP = 0,31) em comparação ao grupo controle (média = 1016 ms, DP = 0,13), p < 0,05. Entretanto, nenhuma diferença significante foi encontrada para a porcentagem média de respostas corretas entre os dois grupos.

Conclusão

O presente estudo forneceu evidências comportamentais de que o zumbido crônico pode afetar a memória semântica. Tais resultados comportamentais podem levar a novas percepções em mais atividades de pesquisa no campo da eletrofisiologia e neuroimagem na população com zumbido.

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A Population-Based Survival Analysis of Pediatric Tonsillar Malignancies and Review of a Rare Case

Publication date: Available online 28 December 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Tyler A. Janz, Ramamoorthy Nagasubramanian, Julie L. Wei

Abstract

Objective

To examine the survival of pediatric tonsillar cancer patients and review a rare case of pediatric tonsillar cancer.

Methods

Pediatric patients in the Surveillance, Epidemiology, and End Results (SEER) database were included from 1973-2014 based on a diagnosis of tonsillar malignancy using the ICD O-3 tonsil primary site codes of: C09.0, C09.1, C09.8, and C09.9. Patients were included from birth-18 years. Survival analysis was performed using Kaplan-Meier analysis. Additionally, a case of pediatric natural killer (NK) cell tonsillar lymphoma diagnosed and treated at the Nemours Children's hospital in Orlando, Florida is presented.

Results

One hundred forty-one cases of tonsil cancer were identified. The mean age at diagnosis was 9.9 years (SD: 5.1, range: 0.0-18.0). Ninety five (67.4%) patients were male and 116 (82.3%) had unilateral malignancies. Burkitt lymphoma (32.6%) followed by diffuse large B-cell lymphoma (DLBCL) (27.0%) were the two most common histological types of tonsillar cancers. 79.4% of patients received chemotherapy and 81.6% received surgery as a part of their care. The 5-year disease-specific survival rate was >90% for patient cohorts diagnosed from 1984-1993, 1994-2003, and 2004-2014 as compared to 64% for patients diagnosed from 1973-1983 (p=.01).

Conclusions

Survival rates for pediatric patients with tonsillar cancer are excellent. Pediatric primary tonsil cancer occurred most commonly in adolescent males and usually presents as a unilateral mass. Lymphoma remains the predominant histological type of cancer. Most patients are likely to receive surgery and chemotherapy.

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Is otitis media with effusion associated with oxidative stress? Evaluation of thiol/disulfide homeostasis

Publication date: Available online 27 December 2018

Source: American Journal of Otolaryngology

Author(s): Eda Şimşek, Cemile Koca Bicer, Muhammed Recai Mazlumoğlu, Soner Sertan Kara, Ozcan Erel, Ayşe Çarlıoğlu

Abstract

Background

We evaluated the relationship between otitis media with effusion and thiol/disulfide homeostasis using a novel marker of oxidative stress.

Methods

The study group consisted of 30 patients (mean age 8.33 ± 3.30 years) with bilateral otitis media with effusion admitted to our hospital. The control group consisted of 35 (mean age 7.40 ± 3.97 years) age-, sex-, and body mass index-matched healthy subjects. Thiol/disulfide homeostasis was measured using a newly developed method.

Results

Native and total thiol levels were lower in the study than the control group (native thiols 421.37 ± 72 μmol/L vs. 464.46 ± 46.42 μmol/L, p < 0.05; total thiols 468.42 ± 77.89 μmol/L vs. 501.32 ± 50.30 μmol/L, respectively). Disulfide levels and the disulfide/native thiol and disulfide/total thiol ratios were higher in the study group (disulfides 23.56 ± 4.68 μmol/L vs. 18.43 ± 4.94 μmol/L; disulfide/native thiol ratio 5.65 ± 1.05 vs. 3.97 ± 1.03%; disulfide/total thiol ratio 5.06 ± 0.83 vs. 3.66 ± 0.88%, respectively).

Conclusion

Oxidative stress may be the major cause of the increase in oxidized thiols in patients with bilateral otitis media with effusion, however, this relationship requires further investigation.

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Long-term oncological and functional outcomes of induction chemotherapy followed by (chemo)radiotherapy vs definitive chemoradiotherapy vs surgery-based therapy in locally advanced stage III/IV hypopharyngeal cancer: Multicenter review of 266 cases

Publication date: February 2019

Source: Oral Oncology, Volume 89

Author(s): Eun-Jae Chung, Woo-Jin Jeong, Young Ho Jung, Seong Keun Kwon, Tack-Kyun Kwon, Soon-Hyun Ahn, Myung-Whun Sung, Bhumsuk Keam, Dae-Seog Heo, Jin Ho Kim, Hong-Gyun Wu, Keun-Wook Lee, Keun-Yong Eom, Young-Soo Rho

Abstract

Objective: The aim of this study was to evaluate the treatment outcomes for stage III/IV locally advanced hypopharyngeal squamous cell carcinoma (SCC), comparing induction chemotherapy followed by (chemo)radiotherapy (ICT), definitive chemoradiotherapy (CRT) and surgery-based therapy (SRT). Subjects and Methods: Two hundred sixty-six patients with stage III/IV locally advanced hypopharyngeal squamous cell carcinoma (SCC) who underwent ICT (n = 74), CRT (n = 53) or SRT (n = 139) from 1997 through 2014 at the Seoul National University Hospital (n = 127) and the Hallym University Medical Center (n = 139) were enrolled in the study. All surgical procedures in the SRT group were performed by a single surgeon to eliminate surgeon bias. Results: The 5-year disease-free survival (DFS) and overall survival (OS) of all patients (n = 266) were 59.4% and 44%, respectively. The 5-year DFS rates after salvage treatment were 52.7% for ICT, 52.8% for CRT and 65.5% for SRT (p = 0.194). The OS rates were 44.6% for ICT, 39.6% for CRT and 45.3% for SRT group (p = 0.106). The salvage rates were 12.5% for ICT, 15.6% for CRT and 3.8% for SRT group. The final laryngeal preservation rate was significantly lower in the SRT group (44.6%) than in the ICT (71.6%) or CRT (71.7%) groups. All major postoperative complications were significantly higher in the salvage surgery group. Conclusion: Treatment outcomes in the ICT and CRT groups were comparable to that of the SRT group for stage III/IV hypopharyngeal SCC. However, the relatively low chance of cure and high risk of complications should be taken into account when considering salvage surgery.

http://bit.ly/2V8hbkG

Wideband tympanometry and absorbance measurements in otosclerotic ears

Objectives

This study aimed to assess absorbance using a thorough analysis of individual points of its plot in ears with intraoperatively confirmed otosclerosis. To the best of our knowledge, until recently no analyses have been performed that concerned the shape of an absorbance plot and a detailed analysis of its individual points. This study is the first to undertake such an issue.

Methods

A total of 77 otosclerotic ears were included in the study. Pure tone audiometry, low frequency tympanometry, and wide band tympanometry including absorbance were performed preoperatively. The average patients' age in the group was 43.49 years (standard deviation = 10.44). Individual points of absorbance plot were thoroughly analyzed. Parameters were analyzed, such as resonance frequency; number of peaks; maximum absorbance (Height); and plot Width at the following Heights: 1/3, 1/2, and 2/3 (Width1/3, Width1/2, Width2/3, respectively), as well as associated absorbance parameters and frequencies.

Results

Data analysis revealed five different types of absorbance plots. Numerous statistically significant differences regarding the parameters of individual points of the plots were found among the distinguished types.

Conclusions

There are five types of absorbance plots in otosclerotic ears: type I, characterized by two distinct peaks, closely resembling normal ear absorbance plot; type II with a single distinct peak reaching high values of absorbance; type III with reduced absorbance for frequencies <2000 Hz; type IV with reduced absorbance for all frequencies; and type V with reduced absorbance for frequencies >2000 Hz. Absorbance measurements may play an important role in the diagnostics of otosclerosis; however, further research is necessary in this area.

Levels of Evidence

4. Laryngoscope, 2018

http://bit.ly/2Aj64wy

Prolonged antibiotic administration for surgical site infection in pediatric laryngotracheal surgery

Objectives/Hypothesis

Incidence of surgical site infection (SSI) after laryngotracheal (LT) surgery is relatively high, especially in children.

Study Design

Retrospective and prospective cohort study.

Methods

Clinical records of children who underwent open LT surgery at the Istituto Giannina Gaslini Children's Hospital from January 2008 to August 2017 were reviewed for development of SSI. Standard antibiotic prophylaxis was administered until February 2015. In March 2015, an antibiotic treatment tailored on pathogens isolated from surveillance cultures and prolonged until extubation was introduced. Incidence and risk factors for SSI before and after the new protocol implementation were analyzed by means of univariate and multivariable analyses.

Results

A total of 57 procedures were analyzed. SSI incidence was 36% in patients receiving standard prophylaxis and 4% in those treated with the new strategy (P = .004), with an absolute benefit increase of 32% (95% confidence interval: 11%–52%), in absence of any difference in clinical conditions between the two groups.

Conclusions

The new management protocol had a highly favorable impact on the development of an SSI.

Level of Evidence

2b Laryngoscope, 2018

http://bit.ly/2SqERyT

Drug‐Induced Sleep Endoscopy and Surgical Outcomes: A Multicenter Cohort Study

Objective

To evaluate the association between findings of blinded reviews of preoperative drug‐induced sleep endoscopy (DISE) examinations using the VOTE Classification and obstructive sleep apnea (OSA) surgical outcomes in a large multicenter, international cohort.

Methods

Retrospective, multi‐center cohort study of adults without tonsillar hypertrophy who underwent pharyngeal surgery for OSA. The study included only participants without enlarged tonsils. Four independent reviewers performed blinded review of preoperative DISE videos using the VOTE Classification system and scoring of a primary structure contributing to airway obstruction. DISE findings were examined for an association with surgical outcomes with univariate analyses and multiple regression.

Results

Two hundred seventy‐five study participants were included from 14 centers. Mean age was 51.4 ± 11.8 years, and body mass index was 30.1 ± 5.2 kg/m². There was moderate interrater reliability (kappa = 0.40–0.60) for DISE findings. Oropharyngeal lateral wall‐related obstruction was associated with poorer surgical outcomes (adjusted odds ratio (AOR) 0.51; 95% CI 0.27, 0.93). Complete tongue‐related obstruction was associated with a lower odds of surgical response in moderate to severe OSA (AOR 0.52; 95% CI 0.28, 0.98), with findings that were similar but not statistically significant in other analyses. Surgical outcomes were not clearly associated with the degree and configuration of velum‐related obstruction or the degree of epiglottis‐related obstruction. Surgical response was associated with tonsil size and body mass index (inversely).

Conclusion

DISE findings concerning the oropharyngeal lateral walls and tongue may be the most important findings of this evaluation technique.

Level of Evidence

2b Laryngoscope, 2018

http://bit.ly/2AjdOid

Middle‐ear dexamethasone delivery via ultrasound microbubbles attenuates noise‐induced hearing loss

Objectives/Hypothesis

In this study, we expanded our previous investigation by testing the efficiency of trans–round window membrane dexamethasone (DEX) delivery mediated by ultrasound (US)‐aided microbubbles (MBs) and its preventive effects regarding noise exposure in animal models.

Study Design

Live animal model.

Methods

Forty‐two pigmented male guinea pigs were divided into the following three groups: an US‐MBs (USM) group, in which the tympanic bulla was filled with DEX and MBs and exposed to US; a round window soaking (RWS) group, without the US irradiation; and a control group. The above‐mentioned manipulations were performed 2 hours prior to white noise exposure. The cochlear damage, including auditory threshold shifts, hair cell loss, and expression of cochlear HMGB1, was evaluated.

Results

The enhanced DEX delivery efficiency of the USM group was approximately 2.4× to 11.2× greater than that of the RWS group. After the noise exposure, the RWS group showed significant cochlear protection compared with the control group, and more significant and dominant protective effects were demonstrated in the USM group.

Conclusions

The application of US‐MBs provides a safe and more effective approach than spontaneous diffusion, which is commonly used in clinical practice; thus, this technique holds potential for future inner‐ear drug delivery.

Level of Evidence

NA Laryngoscope, 2018

http://bit.ly/2SuLTmB

Laryngeal Botulinum Toxin Injection for Vocal Tremor: Utility of Concurrent Strap Muscle Injection

Objectives/Hypothesis

Vocal tremor is a neurologic disorder that can be treated with laryngeal botulinum toxin injections (LBTX). We sought to describe our experience with thyroarytenoid and concurrent strap muscle injection.

Study Design

Retrospective chart review.

Methods

A chart review was performed of all patients with a primary diagnosis of vocal tremor treated with LBTX from 2012 through 2017.

Results

Twenty‐one patients were included (mean age 69 years, 100% female). Thirteen patients (62%) had a minor component of spasmodic dysphonia in addition to their tremor. Fourteen patients had vertical and horizontal components to their tremor, and two had horizontal tremor alone. The remaining five patients did not have clear characterization of their tremor. A total of 49 injections were reviewed (25 thyroarytenoid [TA], 24 thyroarytenoid and strap muscle [TA+S]), and patients reported subjective voice benefit with 48 (96%) of these (92% TA, 100% TA+S). When available, the postprocedural change from baseline Voice Handicap Index‐10 and Consensus Auditory Perceptual Evaluation of Voice scores were calculated (mean overall: −1.9, −7.8; TA: −2.7, −3.5; TA+S: −1.4, −10.3, respectively). Subjective patient improvement ratings (scale 0%–100%) were obtained for 46 injections, with a mean of 70% improvement per injection. Of patients with both horizontal and vertical tremor, outcomes were improved with TA+S injection versus TA alone (mean improvement 74% vs. 35%, P < .005).

Conclusions

There is utility in the characterization of vertical and horizontal components of vocal tremor. Patients with both appear to have increased benefit with injection of strap muscles in addition to thyroarytenoid muscles.

Level of Evidence

4. Laryngoscope, 2018

http://bit.ly/2AjiKDu

Short telomere length in peripheral blood leukocytes in head and neck cancer: Findings in a Brazilian cohort

Abstract

Background

Telomeres are specialized DNA structures that are critical to maintain cell homeostasis and to avoid genomic instability. Epidemiological studies have examined the association between leukocyte telomere length (LTL) and risk of cancers, but the findings remain conflicting.

Methods

Mean LTL was measured by quantitative PCR in 97 patients with head and neck cancer (HNC) and 262 healthy controls. The association between LTL and patients' clinical status, such as smoke, alcoholism, and overall survival, were also evaluated.

Results

The age‐adjusted LTL was significantly shorter in patients with HNC in comparison to healthy controls (P = .0003). Patients with shortest LTL had an increased risk to develop HNC (P < 0.0001). No significant correlation was observed between LTL and patients' clinical features and personal habits.

Conclusions

Our data support the hypothesis that LTL is a risk factor for HNC. The use of LTL as a biomarker can help physicians to identify high‐risk individuals for HNC.

http://bit.ly/2GKzWrd

Human papilloma virus‐associated squamous cell carcinoma of the larynx in an 18‐year‐old woman

Abstract

Background

Human papilloma virus (HPV)‐associated malignancies are considered to be sexually transmitted diseases.

Methods

We report a HPV‐positive larynx cancer in an 18‐year‐old female clarinet player, despite vaccination with the quadrivalent HPV‐6‐11‐16‐18‐vaccine Gardasil (Merck Sharp & Dohme Corp., West Point, Pennsylvania). The patient showed no evidence of genito‐oral infection but showed some evidence for oral‐oral HPV transmission through the sharing of saliva‐infested clarinet mouthpieces. A right vocal cord lesion of benign appearance was removed via free margin resection.

Results

Histopathology revealed a microinvasive squamous cell carcinoma inside a zone of high‐grade dysplasia that was positive for HPV‐45. No tumor recurrence was observed during a 4‐year follow‐up evaluation.

Conclusion

Benign lesion appearance and quadrivalent HPV vaccine status do not exclude HPV‐associated malignancies. In our patient, the Gardasil vaccine did not provide crossover protection against HPV 45 infection. HPV‐associated disease may not necessarily be transmitted via sexual practice patterns alone.

http://bit.ly/2Ri5o4q