Τρίτη 4 Μαΐου 2021

Cholesterol Granuloma of the Sphenoid Sinus: An Insidious Entity

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Abstract

Pathology of sphenoid sinus is uncommon and may pose a diagnostic challenge in view of its vague symptoms together with its relatively inaccessible location at the skull base. Radiological imaging is of utmost importance in diagnosis. We present an insidious case of a sphenoid sinus cholesterol granuloma.

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Expression of VAChT and 5-HT in Ulcerative colitis dendritic cells

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Via histochem

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Acta Histochem. 2021 Apr 30;123(4):151715. doi: 10.1016/j.acthis.2021.151715. Online ahead of print.

ABSTRACT

Ulcerative colitis is a chronic inflammatory condition of the gastrointestinal tract that can affect people of worldwide. In contrast with Crohn's disease, that can relate the entire thickness of the bowel wall, the inflammation of ulcerative colitis is limited to the colonic mucosa. Immune cells including activated T cells, plasma cells, mast cells, macrophages, and dendritic cells (DCs) trigger the inflammation. Furthermore, dendritic cells are antigen presenting cells involved in maintaining intestinal immune homeostasis. It has been described an increment of number in DCs colonic mucosa of patients with ulcerative colitis. The immune cells such as antigen-presenting cells can act as autocrine or paracrine modulators. Recent studies showed that dendritic cells synthetized and released classical neurotransmitters as glutamate, dopamine, acetylcholine, and serotonin. Paraformaldehyde-fixed intestinal tissues, obtained from the stricture sites of ten patients with ulcerative colitis were analyzed by immunostaining for Langerin/CD207, serotonin and vesicular acetylcholine transporter. As controls, unaffected (normal) portions of five patients were also investigated. Aim of this study was to characterize for the first time the human gut dendritic cells of ulcerative colitis patients, with Langerin/CD207 that is a c-type lectin expressed by differ ent types of DCs and to colocalize in the same cells the expression of serotonin and vesicular acetylcholine transporter, showing the link between dendritic cells, gut enterochromaffin cells or autonomic nerves in immune activation and generation of intestinal inflammation.

PMID:33940317 | DOI:10.1016/j.acthis.2021.151715

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Septal Extension Graft in Increasing Nasal Tip Projection

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Abstract

To study the use of septal extension graft for increasing nasal tip projection in cases of an under-projected nasal tip and to evaluate post-operative aesthetic and functional outcomes associated with it. 28 patients of underprojected tip underwent rhinoplasty with use of Direct caudal type of Septal extension graft with a minimum follow up of 12 months, operated between January 2018 to January 2020. ROE questionnaire and photographic evaluation were used for the assessment of post-operative functional and aesthetic outcomes. Significant improvement was seen in both aesthetic and functional outcomes with a mean ROE questionnaire score of 30.5 pre-operatively to 79.5 post-operatively. Pre-operative and post-operative photographic evaluation showed significant improvement in aesthetic outcome. None of the patients reported any postoperative complication. Septal extension graft can be used in patients with nasal tip deformity, Binder's syndrome, caudal septal disl ocation, drooping tip,/ retracted columella and short nose with good post-operative aesthetic and functional outcomes and hence is an important technique for grafting. Owing to its rigid fixation with nasal septum, anterior nasal spine and lower alar cartilage, long term results for the control of nasal tip projection and rotation are remarkable.

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Title-Optical Forceps: The Real Boon for Surgeon, Residents and Patients with Foreign Body Aspiration

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Abstract

Management of aspirated foreign bodies in children becomes very challenging in absence of most appropriate instruments. Rigid bronchoscopy has evolved in the long course of history. The advent of Hopkins rod telescope and optical forceps has enhanced the efficacy as well as the safety of removing tracheobronchial foreign bodies. Total 36 children of age less than 16 year with confirmed diagnosis of airway F.B. were included in the study. Two types of forceps were used: (1)Optical forceps combined with Hopkins rod lens telescope[n = 25] (2)Standard forceps [n = 11]. Most common age group was 1–5 year [n = 26] with male preponderance [n = 20]. Most common site was right bronchus in 13 cases (RMB-11, RBI-1, RLLB-1) followed by Left main bronchus in 11 cases, trachea in 10 cases, bilateral bronchus and sub-glottis each in 1 case. Vegetative F.B. were found in majority of cases [n = 26]. Mean grasping attempt, Mean bronchoscopic inserti on and Mean time taken from insertion of forceps to removal of F.B. were less in optical forceps as compared to standard forceps with significant p-value. Optical forceps have advantage of high resolution & magnified view of airway, spring action in handle and better tactile sensation. These helps in correctly identifying the type, size and site of tracheobronchial foreign body. Precise grasping attempts with optical forceps reduces the chances of complications. Optical forceps have given the new dimension to the Rigid Bronchoscopy and proved to be the real boon for surgeons, residents and patients with F.B. aspiration.

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Novel dopamine receptor 3 antagonists inhibit the growth of primary and temozolomide resistant glioblastoma cells

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by Sarah E. Williford, Catherine J. Libby, Adetokunbo Ayokanmbi, Arphaxad Otamias, Juan J. Gordillo, Emily R. Gordon, Sara J. Cooper, Matthew Redmann, Yanjie Li, Corinne Griguer, Jianhua Zhang, Marek Napierala, Subramaniam Ananthan, Anita B. Hjelmeland

Treatment for the lethal primary adult brain tumor glioblastoma (GBM) includes the chemotherapy temozolomide (TMZ), but TMZ resistance is common and correlates with promoter methylation of the DNA repair enzyme O-6-methylguanine-DNA methyltransferase (MGMT). To improve treatment of GBMs, including those resistant to TMZ, we explored the potential of targeting dopamine receptor signaling. We found that dopamine receptor 3 (DRD3) is expressed in GBM and is also a previously unexplored target for therapy. We identified novel antagonists of DRD3 that decreased the growth of GBM xenograft-derived neurosphere cultures with minimal toxicity against human astrocytes and/or induced pluripotent stem cell-derived neurons. Among a set of DRD3 antagonists, we identified two compounds, SRI-21979 and SRI-30052, that were brain penetrant and displayed a favorable therapeutic window analysis of The Cancer Genome Atlas data demonstrated that higher levels of DRD3 (but not DRD2 or DRD4) were associated with worse prognosis in primary, MGMT unmethylated tumors. These data suggested that DRD3 antagonists may remain efficacious in TMZ-resistant GBMs. Indeed, SRI-21979, but not haloperidol, significantly reduced the growth of TMZ-resistant GBM cells. Together our data suggest that DRD3 antagonist-based therapies may provide a novel therapeutic option for the treatment of GBM.
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Smell impairment in patients with chronic rhinosinusitis: a real-life study

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Eur Arch Otorhinolaryngol. 2021 May 3. doi: 10.1007/s00405-021-06848-9. Online ahead of print.

ABSTRACT

OBJECTIVE: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a frequently occurring condition involving type 2 inflammation. It has a global prevalence of approximately 4% and has a major effect on the quality of life of those affected by it. CRSwNP is a complex condition for otorhinolaryngologists to manage, since its precise pathogenic basis has not been established, treatment is challenging and the condition often recurs. It is common to find abnormalities in smelling in those with CRSwNP.

MATERIALS AND METHODS: This cross-sectional study enrolled patients suffering from CRS. Three groups were compared: 1812 patients with CRS, 571 with CRSwNP, and 120 with CRSwNP treated by FESS. The Sniffin' Sticks® olfactory test was used to measure olfactory function in all patients.

RESULTS: Olfactory dysfunction was a common symptom in patients with CRS, ranging in frequency from 56 to 74%. In patients with CRSwNP, impairment of sense of smell affected 64% of subjects (42% with anosmia, 10% with hyposmia, and 12% with cacosmia). After surgery, there was a significant improvement in the ability to smell normally.

CONCLUSION: The present study confirms that impairment of smell is a common symptom in patients with chronic rhinosinusitis, mainly in subjects with nasal polyps. FESS reduces the prevalence of olfactory dysfunction.

PMID:33942122 | DOI:10.1007/s00405-021-06848-9

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Tumor‑host interface in oral squamous cell carcinoma: Impact on nodal metastasis and prognosis

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Eur Arch Otorhinolaryngol. 2021 May 4. doi: 10.1007/s00405-021-06853-y. Online ahead of print.

NO ABSTRACT

PMID:33944991 | DOI:10.1007/s00405-021-06853-y

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Postoperative treatment following paranasal sinus surgery

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Via hno

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HNO. 2021 May 3. doi: 10.1007/s00106-021-01057-6. Online ahead of print.

ABSTRACT

Postoperative care is a crucial aspect for the success of paranasal sinus interventions. Basic procedures include saline nasal wash, which should be started on the first postoperative day, topical steroids, and antibiotics in cases of infection. Medical treatment involves aspiration of secretion in the inferior meatus during the first week. Removal of scabs in the surgical field should be carri ed out under endoscopic control beginning at the second week. Intervals are scheduled individually. Occlusion of the nose for the time of epithelium regeneration provides a moist space in the ethmoid, which improves wound healing.

PMID:33942126 | DOI:10.1007/s00106-021-01057-6

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Unclear chronic vertigo syndromes-experiences with an interdisciplinary inpatient diagnostic concept

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HNO. 2021 May 4. doi: 10.1007/s00106-021-01059-4. Online ahead of print.

ABSTRACT

Dizziness is a common leading symptom. Especially patients with chronic vertigo syndromes experience a significant impairment in quality of life up to a limitation of their ability to work in the case of employed persons. The consequences are financial and capacitive burdens on the health system due to frequently multiple examinations and sick leave up to occupational invalidity of the affected patient. In 150 patients with chronic vertigo syndromes and an unclear outpatient diagnosis, at least one diagnosis that justified the complaint was made in over 90% of cases on the basis of a structured interdisciplinary inpatient diagnostic concept. Chronic vertigo syndromes are often multifactorial. Psychosomatic (accompanying) diagnoses were found in more than half of the patients. Targeted therapy can only be recommended after establishing a specific diagnosis. This justifies an interdisciplinary inpatient diagnostic concept for persistently unclear cases.

PMID:33944963 | DOI:10.1007 /s00106-021-01059-4

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Allogenes und autologes Material führt bei Mastoidhöhlenobliteration zu vergleichbaren Rezidivraten

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Laryngorhinootologie
DOI: 10.1055/a-1432-3123

Einleitung Bei symptomatischen Mastoidhöhlen nach Ohroperationen besteht die Therapie der Wahl in der chirurgischen Verkleinerung. Hierbei stehen verschiedene Methoden und Materialien zur Obliteration zur Verfügung. Allogenes Material ist leicht verfügbar, kann jedoch zu Wundinfektionen aufgrund von Abstoßungsreaktionen, Granulationen und Entzündungsreaktionen führen, weshalb autologes Material aufgrund seiner guten Biokompatibilität häufig bevorzugt wird. Ziel dieser Studie war es, die Langzeitergebnisse von Patienten nach Mastoidhöhlenobliteration mit allogenem und autologem Material im Hinblick auf das Auftreten von Rezidivcholesteatomen, die Anzahl der Revisionsoperationen und den Einfluss der Operation auf die Lebensqualität zu vergleichen.Methoden Patienten, die sich einer Mastoidhöhlenobliteration mit dem allogenen Material Hydroxylapatit-Matrix (HMM) unterzogen, wurden retrospektiv in die Studie eingeschlossen. In einem prospektiven Studienteil wurden Patienten eingeschlossen, welche sich einer Mastoidhöhlenobliteration mit autologem Rekonstruktionsmaterial (AutoM) unterzogen. Bei allen Patienten wurde neben einer ausführlichen Aktenanalyse eine Reintonaudiometrie durchgeführt und bei der postoperativen Untersuchung das Zürcher Mittelohrinventar (Zurich Chronic Middle Ear Inventory (ZCMEI-21)) zur Erhebung der gesundheitsbezogenen, krankheitsspezifischen Lebensqualität ausgefüllt.Ergebnisse Insgesamt wurden 22 Patienten mit einem durchschnittlichen Alter von 56,9 Jahren (SD 18,7 Jahre) und HMM (mittleres Nachuntersuchungsintervall: 88,3 Monate; SD 21,9 Monate) sowie 25 Patienten mit einem Durchschnittsalter von 52,4 Jahren (SD 13,7 Jahre) und AutoM (mittleres Nachuntersuchungsintervall: 13,5 Monate; SD 9,5 Monate) in die Studie eingeschlossen. Die audiologische Revisionsfreiheit lag nach einem Jahr für HMM bei 100% und für AutoM bei 85%. Die Rezidivfreihe it lag nach einem Jahr für HMM bei 95% und für AutoM bei 100%. Die Gruppen unterschieden sich weder hinsichtlich des postoperativen Hörergebnisses noch der postoperativen Lebensqualität.Diskussion Die Obliteration von Mastoidhöhlen ist eine chirurgische Herausforderung. Es zeigte sich kein relevanter Unterschied zwischen den verwendeten Materialien im Hinblick auf die Rezidivrate, das Hören und die Lebensqualität über den für beide Gruppen beobachteten Zeitraum von 13,5 Monaten. Die oft fehlende subjektive Symptomatik zusammen mit der hohen Rate an Rezidivcholesteatomen und Revisionsindikationen unterstreicht die Notwendigkeit einer regelmäßigen klinischen Nachsorge inklusive der Ohrmikroskopie bei chronischen Mittelohrerkrankungen und lässt regelmäßige Nachuntersuchungen dringend empfehlen.
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Georg Thieme Verlag KG R� �digerstraße 14, 70469 Stuttgart, Germany

Article in Thieme eJournals:
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Prevention of cerebrospinal fluid leak after vestibular schwannoma surgery: a case-series focus on mastoid air cells' partition

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Eur Arch Otorhinolaryngol. 2021 May 3. doi: 10.1007/s00405-021-06850-1. Online ahead of print.

ABSTRACT

BACKGROUND: Petrous bone pneumatization may be related to cerebrospinal fluid (CSF) leak secondary to vestibular schwannoma surgery.

OBJECTIVE: To assess the association between petrous bone pneumatization and CSF leak in vestibular schwannoma surgery.

METHODS: A retrospective study included 222 consecutive vestibular schwannoma patients treated via a retrosigmoid or translabyrinthine approach in a 17-year period in one University Hospital. Association of CSF leak and petrous bone pneumatization, as seen on CT scans, was assessed on ANOVA and Student's t or Chi-squared test in case of non-parametric distribution.

RESULTS: One hundred and 75 resections were performed on a retrosigmoid approach and 47 on a translabyrinthine approach. Mean age was 53.6 ± 12.9 years. Mean follow-up was 5 years 6 months. Twenty-six patients (1 1.7%) showed CSF leak and 8 (3.6%) meningitis. Approach (p = 0.800), gender (p = 0.904), age (p = 0.234), body-mass index (p = 0.462), tumor stage (p = 0.681) and history of schwannoma surgery (p = 0.192) did not increase the risk of CSF leak. This risk was unrelated to mastoid pneumatization (p = 0.266). There was a highly significant correlation between internal acousticus meatus (IAM) posterior wall pneumatization and CSF leak after retrosigmoid surgery (p = 0.008). Eustachian tube packing in the translabyrinthine approach did not decrease risk of CSF leak (p = 0.571).

CONCLUSION: Degree of petrous bone pneumatization was not significantly related to risk of CSF leak, but pneumatization of the posterior IAM wall increased this risk in retrosigmoid surgery. Eustachian tube packing in the translabyrinthine approach is not sufficient to prevent postoperative CSF leak. Both approaches had similar rates of CSF leaks, around 12%.

PMID:33942123 | DOI:10.1007/s00405-021-06850-1

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