As has been well recognized, methotrexate (MTX) leads to a state of immunosuppression and can provide a basis for the development of lymphoproliferative disorders (LPDs). MTX-associated LPDs can affect nodal sites as well as extranodal sites, though the manifestation of an LPD in the form of multiple pulmonary nodules is rare. Here, we report two cases of MTX-associated LPD with multiple bilateral pulmonary nodules, which was a finding suggestive of lung cancer, and bilateral cervical lymphadenopathy.
http://bit.ly/2E0Eq9X
Παρασκευή 8 Φεβρουαρίου 2019
Methotrexate-associated lymphoproliferative disorder with multiple pulmonary nodules and bilateral cervical lymphadenopathy
The Rationale for Endoscopic Inferior Meatal Antrostomy
ORL 2019;81:41–47
http://bit.ly/2BqjSGf
Real-time PCR HPV genotyping in fine needle aspirations of metastatic head and neck squamous cell carcinoma: Exposing the limitations of conventional p16 immunostaining
Publication date: March 2019
Source: Oral Oncology, Volume 90
Author(s): F. El-Salem, M. Mansour, M. Gitman, B.A. Miles, M.R. Posner, R.L. Bakst, E.M. Genden, W.H. Westra
Abstract
Background
Given the propensity for HPV-positive head and neck squamous cell carcinoma (HPV-HNSCC) to metastasize to cervical lymph nodes, fine needle aspiration (FNA) plays an important diagnostic role in their initial detection. Indeed, there is now an unwavering commitment to HPV testing of FNAs even in the absence of clear methodologic guidelines and threshold criteria. A particular difficulty pertains to the interpretation of p16 staining.
Design
Data was collected for 210 patients with suspected regionally metastatic HNSCC that had undergone FNA as part of standard clinical care. Initial HPV screening was performed on cell blocks with real-time PCR using primers targeting L1 of high-risk HPV types. Additional genotyping was performed on HPV-positive cases. The results were compared to p16 staining and subsequent excisions when available.
Results
Of the 207 samples with sufficient DNA, 175 (85%) were HPV positive. HPV-16 was the most commonly detected genotype (90%). Of the HPV-positive cases, the primary site was the oropharynx (n = 154, 88.0%), supraglottic larynx (n = 2, 1.1%), nasal cavity (n = 1, 0.6%), hypopharynx (n = 1, 0.6%) or unknown (n = 17, 9.7%). On comparison with 31 paired surgical excisions, HPV status was concordant in all cases (100% correlation). Of 142 HPV-positive cases with matching p16 stains, p16 staining was reported as positive (n = 85, 60%), focal (n = 27, 19%), negative (n = 24, 17%) or non-contributory (n = 6, 4%); and only 33% reached the standard threshold limit (i.e. 70%) for HPV positivity.
Conclusion
For patients with metastatic HNSCC, real-time PCR of FNAs reliably reflects HPV status, and is superior to conventional p16 immunostaining.
http://bit.ly/2BoK4RC
Oesophagectomy and Chest Wall and Respiratory Function
Conditions: Esophageal Cancer; Esophagectomy; Respiratory Function Loss
Interventions: Other: 3D motion capture system; Other: Incentive spirometry; Other: Questionnaires
Sponsor: Imperial College London
Not yet recruiting
http://bit.ly/2MWSXpV
Interventions: Other: 3D motion capture system; Other: Incentive spirometry; Other: Questionnaires
Sponsor: Imperial College London
Not yet recruiting
http://bit.ly/2MWSXpV
The Bacterial Composition of the Stomach in Reflux Disease
Conditions: GORD; Oesophageal Cancer; Oesophageal Reflux; Gastric Cancer; Gastro Esophageal Reflux; Oesophageal Carcinoma; Barrett Esophagus; Esophagitis
Intervention: Diagnostic Test: No intervention but patients are undergoing an upper GI endoscopy and biopsies for clinical purposes
Sponsor: Imperial College London
Recruiting
http://bit.ly/2SCb5KR
Intervention: Diagnostic Test: No intervention but patients are undergoing an upper GI endoscopy and biopsies for clinical purposes
Sponsor: Imperial College London
Recruiting
http://bit.ly/2SCb5KR
Endocytosis of CF in marginal cells of stria vascularis regulated by ROCK and MLCK signaling cascade, but not G-proteins
Publication date: Available online 8 February 2019
Source: Auris Nasus Larynx
Author(s): Akinobu Kakigi, Teruhiko Okada, Taizo Takeda, Natsumi Uehara, Ken-ichi Nibu
Abstract
Objective The endocytosis of cationized feritin (CF) via a clathrin-mediated pathway is regulated by a signaling network. Marginal cells showed the active endocytosis of CF via a clathrin-mediated pathway. The internalization of receptors through this clathrin-mediated pathway is an important regulatory event in signal transduction. Numerous kinases are involved in endocytosis, and each endocytic route is subjected to high-order regulation by cellular signaling mechanisms. In this study, we investigated whether ROCK and MLCK signaling cascades and G-proteins regulate the endocytosis of CF in marginal cells of the stria vascularis.
Methods CF was infused into the cochlear duct with pertussis toxin (PTX),Clostridium botulinum C3 toxin (BTX), guanosine(g-thio)-triphosphate (GTP-γS), ML-7, Y-27632. Endocytic activity was measured at 30 min after the start of infusion under an electron microscope.
Results In marginal cells, CF was internalized via a clathrin-mediated pathway that depends on F-actin and microtubules (MT). Its processes were controlled by myosin light chain kinase (MLCK) and Rho-associated kinase (ROCK), but not affected by G-protein-coupled receptor (GPCR) or the RhoA signaling cascade.
Conclusion Our previous study showed that the main endocytotic pathway of microperoxidase (MPO) did not depend on the Rho/ROCK molecular switch or actin/myosin motor system, but was mainly regulated by the RhoA signaling cascade. The present study results indicate that these signaling cascades regulating CF internalization completely differ from the cascades for MPO internalization.
http://bit.ly/2GfRiva
Methotrexate-associated lymphoproliferative disorder with multiple pulmonary nodules and bilateral cervical lymphadenopathy
Publication date: Available online 8 February 2019
Source: Auris Nasus Larynx
Author(s): Seiichiro Makihara, Shin Kariya, Mai Noujima-Harada, Nobuya Ohara, Tomoyuki Naito, Junya Matsumoto, Yohei Noda, Mitsuhiro Okano, Tadashi Yoshino, Kazunori Nishizaki
Abstract
As has been well recognized, methotrexate (MTX) leads to a state of immunosuppression and can provide a basis for the development of lymphoproliferative disorders (LPDs). MTX-associated LPDs can affect nodal sites as well as extranodal sites, though the manifestation of an LPD in the form of multiple pulmonary nodules is rare. Here, we report two cases of MTX-associated LPD with multiple bilateral pulmonary nodules, which was a finding suggestive of lung cancer, and bilateral cervical lymphadenopathy. After withdrawal of MTX, the multiple bilateral pulmonary nodules and bilateral cervical lymphadenopathy disappeared without chemotherapy in both cases. From these results, patients with pulmonary nodules and cervical lymphadenopathy should be examined for head and neck malignant tumors. Also, physicians should carefully check the administration of MTX. In patients with an MTX-associated LPD, we need to make an early diagnosis and consider discontinuing the administration of MTX as soon as possible.
http://bit.ly/2HYRC39
Retrieval of inhaled foreign bodies in laryngectomised patients: Novel technique using a flexible nasendoscope under local anaesthetic
Abstract
Laryngectomised patients are at inherent risk of inhalation of foreign bodies, which can be an emergency airway situation.
A retrofitted flexible nasendoscope can be a safe, effective and a more familiar instrument for otolaryngologists, especially when the procedure needs to be undertaken out of hours.
Conducting the procedure with nebulised local anaesthetic and sedation is favourable in patients with high burden of comorbid disease and makes the procedure well tolerated.
This article is protected by copyright. All rights reserved.
http://bit.ly/2DYYMjU
Proposal of a New Clinical Method for removal of Button Batteries and other Ferrous Material from the External Auditory Ear Canal and Nasal Cavity using a Fine Magnet Probe
Abstract
Battery foreign bodies in the external auditory canal or nasal cavity are an ENT emergency, and require immediate removal.
The purposely‐designed fine magnet probe as described in this paper, allows safe and prompt removal of a ferrous foreign body from the ear canal with minimal trauma.
Widespread use of a fine magnet probe is proposed in ENT clinics and in the acute situation, for removal of ferrous foreign bodies. This method is quick, safe, well tolerated and cost efficient.
This article is protected by copyright. All rights reserved.
http://bit.ly/2GvV5Uv
The clinical value of 4‐hour delayed‐enhanced 3D‐FLAIR MR images in sudden hearing loss
Abstract
Objective
The aim of this study was to investigate the clinical significance of 4‐hour delayed‐enhanced 3.0 Tesla (3T) 3D‐fluid attenuated inversion recovery (FLAIR) MR imaging in sudden sensorineural hearing loss (SSNHL).
Study Design
Case series with comparisons.
Setting
Tertiary referral centre.
Participants
Eighty‐seven idiopathic SSNHL patients were enrolled between January 2015 and December 2016 and received high dose steroid therapy and intratympanic steroid injections as salvage treatment.
Intervention
Pre‐contrast, 10‐minute and 4‐hour delayed‐enhanced 3D‐FLAIR MR images were obtained using double‐dose IV gadolinium.
Main outcome measures
The results of treatment were evaluated according to Siegel's criteria 3 months after the start of treatment. Where possible lesion‐side laterality of the inner ear was identified based on the MR images, the associations between MR findings and other clinical parameters were analyzed, and the relationships between hearing recovery and MR image findings were assessed.
Results
Lesion‐side laterality was identified on MRI in 52 (59.7%), 18 (20.1%) and 8(9.2%) patients, based on 4‐hour delayed, 10‐minute delayed, and pre‐contrast images, respectively. The hearing recovery rate was significantly lower in the patients with lesion‐side laterality on 4‐hour delayed images (p < .001). In a multivariate analysis, lesion‐side laterality on 4‐hour delayed images was associated with poor prognosis (OR=5.6) after adjusting other prognostic factors including initial hearing level, lesion‐side laterality on 10‐min delayed images and presence of vertigo. In addition, as the extent of enhancement in the inner ear increased the probability of hearing recover decreased (p=.001).
Conclusions
Contrast enhancement of inner ear structures can be seen on 4‐hour delayed‐enhanced 3T 3D‐FLAIR MR images in idiopathic sudden sensorineural hearing loss. Asymmetric lesion‐side enhancement of the inner ear may be associated with a poor prognosis.
This article is protected by copyright. All rights reserved.
http://bit.ly/2DYs0zt
Our Experience With Home Self‐Assessment of Speech Recognition in the Care Pathway of 10 Newly‐Implanted Adult Cochlear Implant Users
Abstract
The number of CI users has grown rapidly, resulting in an increased workload for CI centres and a need for new and innovative ways to provide healthcare to users of a CI.
A telehealth application was developed with a functionality to self‐administer speech recognition tests at home, which was evaluated in 10 newly‐implanted patients.
Speech recognition in quiet and in noise improved steadily during the first few weeks of rehabilitation, after which it stabilized.
The home tests provided a good alternative to testing in the clinic for newly‐implanted patients who were able and willing to perform part of their CI care from home, and felt confident in using the technology required.
Frequently administered speech recognition self‐tests provide fine‐grained progress details which enable clinicians to monitor their CI user's speech recognition ability over time without the need for users of a CI to visit the clinic.
This article is protected by copyright. All rights reserved.
http://bit.ly/2GAWmtc
Soft palate bi‐pedicle flaps: a modification of VY repair of cleft soft palate
Abstract
Palatal fistula and velopharyngeal insufficiency are the commonest complications of cleft palate surgery.
For patients with cleft soft palate, beside hard palate VY push back flaps, two soft palate bi‐pedicle flaps were made on each sides of the posterior palate to dissect and push soft palate back and medial closing the VP valve.
In operated 26 children, sutures were tensionless and palatal integrity could be achieved in all patients without reported postoperative bleeding, fistula, infection, suture release, or granulation.
Postoperative nasoendoscopy registered grade 4 VP closure in all with restoration of normal speech (0 grade of nasality) at 6 months postoperatively.
The newly designed bi‐pedicle soft palate flaps with the VY repair of the cleft palate helps to avoid palatal fistula, elongate the soft palate and achieve proper VP closure.
This article is protected by copyright. All rights reserved.
http://bit.ly/2DZ2Z6Z
Relationship Between Otorhinologic Trauma and Attention Deficit Hyperactivity Disorder Symptoms In Children
Publication date: Available online 8 February 2019
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Ali Karayağmurlu, İsmail Aytaç, Secaattin Gülşen
Abstract
Objevtives
Otorhinologic trauma is an important condition at the ear, nose and throat (ENT) outpatient clinic in children. Attention deficit hyperactivity disorder (ADHD) has been identified as a potential risk factor that may contribute to the incidence of traumatic injuries. The aim of the study was to investigate whether there is an association between otorhinologic trauma and ADHD symptoms in children.
Methods
A prospective study was conducted between September 2017 and March 2018. Fifty-six pediatric patients admitted to the Ear Nose and Throat (ENT) outpatient clinic of a research and training hospital aged between 4 and 18 years were included. The control group consisted of 56 age- and gender-similar children without otorhinologic trauma. Conner's parent Rating Scale (CPRS) was used to evaluate the ADHD symptoms.
Results
The children with otorhinologic trauma had significantly higher mean scores in all subscales, including inattentiveness, hyperactivity, oppositional defiant disorder (ODD) (p < 0.05). Furthermore, analysis of the study group showed that the hyperactivity score in the subgroup with a history of repetitive injuries were significantly higher than those of the subgroup without a history of repetitive injuries (p < 0.05).
Conclusions
These findings suggest that patients admitted to the ENT outpatient clinic for otorhinologic trauma had a higher number of ADHD and ODD symptoms than those who did not have otorhinologic trauma. Psychiatric evaluation for ADHD and ODD should be considered for patients admitted to clinics with similar injuries, especially those who have a history of repetitive injuries.
http://bit.ly/2SA3Rat
Histoanatomical structures of laryngeal atresia: Functional considerations
Objective
To study the histoanatomical structure of laryngeal atresia with a focus on the laryngeal functional components in order to evaluate the functional prognosis of laryngeal atresia repair.
Methods
Twenty‐one consecutives cases of laryngeal atresia were diagnosed at our institution between 2009 and 2016. Morphological analysis by macroscopic exam during autopsy was performed in 19 cases. Histological study of the larynx included hematoxylin and eosin staining and protein S100 immunostaining. Our analysis focused on the vocal folds, structures of the lamina propria, cricoarytenoid joints, muscles, and innervation. For each case, associated malformations were classified into two groups: severe and moderate.
Results
Antenatal diagnosis was suspected because of congenital high airway obstruction syndrome in nine cases (37%).
Associated malformations were present in 19 cases (90%), including severe malformations in 12 cases (57%). Atresia involved the cricoid in all cases, with a residual lumen in only one case and the glottis in 18 cases. Separation between the cricoid and arytenoid cartilages was observed in all cases. Fusion of the vocal process of the arytenoids in the midline was present in 13 cases.
According to the gestational age, posterior maculae flavae (MF) were present in 17 of 19 cases, with abnormal structure and median fusion in 13 cases. Anterior MF were present in nine of 18 cases, with fusion on the midline in five cases.
Intrinsic abductors and adductors muscles were identifiable in all cases, with fusion of thyroarytenoids muscles in the midline in 18 cases. Both recurrent laryngeal nerves were observed in all cases.
Conclusion
Laryngeal atresia is generally associated with other malformations, with a high risk of fatal outcomes. We observed that the functional structures of the glottic plane were present in most cases, with the exception of MF, which were frequently abnormal.
Level of Evidence
4. Laryngoscope, 2019
http://bit.ly/2TEw8K2
Multidisciplinary oral rehabilitation of an adolescent suffering from juvenile Gorlin-Goltz syndrome – a case report
Abstract
Background
The Gorlin-Goltz syndrome is an autosomal dominant disorder characterized by keratocystic odontogenic tumors in the jaws, multiple basal cell carcinomas and skeletal abnormities. Frequently, the manifestation of the syndrome occurs in the adolescent years.
Case presentation
An 11-year-old boy was referred to our clinic due to the persistence of the lower deciduous molars. The further diagnosis revealed bilateral keratocystic odontogenic tumors in the region of teeth 33 and 45 representing a symptom of a Gorlin-Goltz syndrome. This case of the oral rehabilitation of an adolescent with bilateral keratocystic odontogenic tumors shows the approach of a multidisciplinary treatment concept including the following elements: Enucleation and bone defect augmentation using a prefabricated bone graft; distraction osteogenesis to extend the graft-block vertically after cessation of growth; accompanying orthodontic treatment, guided implant placement and prosthetic rehabilitation. Six months after implant insertion, a new keratocystic odontogenic tumor in the basal part of the left sinus maxillaris had to be removed combined with the closure of the oroantral fistula. During the follow-up period of 18 months in semi-annual intervals, the patient showed no sign of pathology.
Conclusion
In the presented case could be shown that distraction osteogenesis of prefabricated bone blocks is possible. With a multidisciplinary approach in a long-term treatment a sufficient oral rehabilitation of the patient suffering from extended keratocystic odontogenic tumors was possible.
http://bit.ly/2SmVfEH
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
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
Πέμπτη 7 Φεβρουαρίου 2019
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A Case of Diprosopus Tetraophthalmos: Ocular Findings and Surgical Treatment of Exposure KeratopathyDiprosopus is a rare variation of conjoined twinning. In this report, ophthalmic findings in an infant with diprosopus tetraophthalmos are p...
