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Hopkins ME, Li LQ, Yeo JJ, Hathorn I. Using simulation as a platform to prepare for ear, nose and throat emergencies in the coronavirus disease 2019 era and beyond. J Laryngol Otol 2024; 138:466-471. [PMID: 38073419 DOI: 10.1017/s0022215123001597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND Following limited clinical exposure during the coronavirus disease 2019 pandemic, a simulation-based platform aimed at providing a unique and safe learning tool was established. The aim was to improve the skills, knowledge and confidence of new ENT doctors. METHOD The course was developed through 5 iterations over 28 months, moving from a half-day session to 2 full-day courses with more scenarios. Participant, faculty and local simulation team feedback drove course development. High-fidelity scenarios were provided, ranging from epistaxis to stridor, using technology including SimMan3 G mannequin, mask-Ed™ and nasendoscopy simulators. RESULTS Participant feedback consistently demonstrated that the knowledge and skills acquired enhanced preparedness for working in ENT, with impact being sustained in clinical practice. CONCLUSION Preparing healthcare professionals adequately is essential to enhancing patient safety. This simulation course has been effective in supporting new doctors in ENT and has subsequently been rolled out at a national level.
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Affiliation(s)
- Michael E Hopkins
- Department of ENT, NHS Lothian, St John's Hospital at Howden, Livingston, Scotland, UK
| | - Lucy Q Li
- Department of ENT, NHS Greater Glasgow and Clyde, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | - Justin Jy Yeo
- Department of ENT, The Dudley Group NHS Foundation Trust, Russell Halls Hospital, Dudley, UK
| | - Iain Hathorn
- Department of ENT, NHS Lothian, St John's Hospital at Howden, Livingston, Scotland, UK
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2
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Liu J, Xu W, Jin Z, Deng X. Does Increasing the Bend Angle of a Stylet to 90° Increase the Nasotracheal Intubation Success Rate? J Oral Maxillofac Surg 2024; 82:152-158. [PMID: 37926429 DOI: 10.1016/j.joms.2023.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 10/05/2023] [Accepted: 10/09/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Video-stylet-guided nasotracheal intubation (NTI) is an effective technique for airway management. However, the impact of the bend angle on the success rate of intubation remains unclear. PURPOSE Does increasing the bend angle of a stylet to 90° increase NTI success rate?. STUDY DESIGN, SETTING, SAMPLE This prospective randomized controlled trial was conducted in the operating room of a population-based hospital. Adult patients requiring NTI were recruited. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE The primary predictor variable is the choice of stylet bend angle (90° vs 70° bend) in NTI. MAIN OUTCOME VARIABLE(S) The primary outcome variables were success rates of NTI, defined as the proportion of successful intubation cases to total cases. COVARIATES Demographics, intubation time, the distance from the thyroid prominence to the nostril, additional maneuvers applied during intubation, and cases of epistaxis were recorded. ANALYSES The student's t-test was used to compare continuous variables between groups. Ordinal data (intubation attempts, head extension, and epistaxis) were analyzed using the Wilcoxon rank-sum test. As appropriate, frequency (external pharyngeal pressure) was analyzed using the χ2 test or Fisher's exact test. A P value of <.05 was considered statistically significant. RESULTS Of the 103 subjects assessed for eligibility, 98 were enrolled in the study. The mean age (27.0 ± 6.9 years vs 27.0 ± 4.1 years, P = .972) and sex differences (male/female: 9/40 vs 7/42, P = .136) were comparable between groups. The overall success rate in the 70° group was significantly lower than that in the 90° group (91.8 vs 100%, P < .001). The intubation time in the 70° group was significantly longer than that in the 90° group (43.2 ± 15.8 s vs 33.7 ± 7.3 s, P < .001). CONCLUSIONS AND RELEVANCE A 90° bend angle of the stylet significantly improves the likelihood of successful NTI.
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Affiliation(s)
- Juhui Liu
- Attending, Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenli Xu
- Attending, Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zibin Jin
- Attending, Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoming Deng
- Professor, Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Engel ER, Wusik K, Bright P, Vadivelu S, Taylor JM, Hammill A. Prevalence and Predictors of Hereditary Hemorrhagic Telangiectasia and Capillary-Malformation Arteriovenous Malformation Syndrome Among Children with Neurovascular Malformations. J Pediatr 2024; 264:113761. [PMID: 37797790 DOI: 10.1016/j.jpeds.2023.113761] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE To investigate the prevalence and predictors of hereditary hemorrhagic telangiectasia (HHT) and capillary-malformation arteriovenous malformation (CM-AVM) syndrome among children with no prior personal or family history of these diseases who presented with an arteriovenous shunt lesion. STUDY DESIGN A retrospective chart review was completed on patients aged 0 through 21 years with arteriovenous shunt lesions evaluated at our Cerebrovascular Center. Diagnosis of definite or suspected HHT or CM-AVM was based on clinical features and genetic testing. Associations between final diagnosis and type and number of lesions, epistaxis, telangiectasias, CM, and pulmonary AVMs were assessed. RESULTS Eighty-nine patients were included. Thirteen (14.6%) had definite HHT, 11 (12.4%) suspected HHT, and 4 (4.5%) definite CM-AVM. Having ≥2 episodes of epistaxis/year and ≥ 2 sites with telangiectasias were each associated with definite HHT (P < .001). Having ≥ 2 CM was associated with definite CM-AVM (P < .001). Pulmonary AVM was associated with increased odds of having definite HHT (OR = 6.3, 95% CI: 1.2-33.4). Multiple lesions (OR = 24.5, 95% CI: 4.5-134.8) and arteriovenous fistulas (OR = 6.2, 95% CI: 1.9-20.3) each increased the likelihood of having definite HHT or CM-AVM. Genetic testing was positive in 31% of patients tested. CONCLUSIONS We recommend that children with neurovascular shunt lesions be offered genetic testing and undergo further evaluation for HHT and CM-AVM. Awareness and early diagnosis of these conditions is a critical step toward improving long-term outcomes and preventing disease-associated complications.
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Affiliation(s)
- Elissa R Engel
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
| | - Katie Wusik
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Philip Bright
- University of Kentucky College of Medicine, Northern Kentucky Campus, Highland Heights, KY
| | - Sudhakar Vadivelu
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - J Michael Taylor
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Adrienne Hammill
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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4
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Li P, Gao C, Wei Y, Zhao X, Sun D, Lin L, Yang Y, Shao Q, Lv H. A novel frameshift mutation of the endoglin(ENG) gene causes hereditary hemorrhagic telangiectasia in a Chinese family. Eur Arch Otorhinolaryngol 2024; 281:237-243. [PMID: 37603052 DOI: 10.1007/s00405-023-08186-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 08/09/2023] [Indexed: 08/22/2023]
Abstract
PURPOSE Hereditary hemorrhagic telangiectasia (HHT) is a dominantly inherited disorder that involves epistaxis, mucocutaneous telangiectases, and visceral arteriovenous malformations (AVMs). This study aims to investigate the genetic causes in a Chinese family with HHT. METHODS HHT was confirmed according to Curaçao's diagnostic criteria. Three patients diagnosed with HHT and healthy members were recruited. Whole-exome sequencing (WES) and sanger sequencing were performed to define the patient's genetically pathogenic factor. RESULTS The proband presented with recurrent epistaxis, hepatopulmonary arteriovenous malformation, and adenocarcinoma. A novel frameshift mutation (c.1376_1377delAC, p.H459Lfs*41) of the ENG gene was revealed in affected individuals by WES. There was no report of this variant and predicted to be highly damaging by causing truncation of the ENG protein. CONCLUSION We report a novel variant in the ENG gene in Chinese that extends the mutational and phenotypic spectra of the ENG gene, and also demonstrates the feasibility of WES in the application of genetic diagnosis of HHT.
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Affiliation(s)
- Peng Li
- School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Chunhai Gao
- Department of Laboratory Medicine, Linyi People's Hospital, Linyi, China
- Key Laboratory for Laboratory Medicine of Linyi City, Linyi People's Hospital, Linyi, China
| | - Yuda Wei
- Department of Laboratory Medicine, Linyi People's Hospital, Linyi, China
- Key Laboratory for Laboratory Medicine of Linyi City, Linyi People's Hospital, Linyi, China
| | - Xiangyu Zhao
- Department of Laboratory Medicine, Linyi People's Hospital, Linyi, China.
- Key Laboratory for Laboratory Medicine of Linyi City, Linyi People's Hospital, Linyi, China.
| | - Dezhong Sun
- Department of Otorhinolaryngology, Linyi People's Hospital, Linyi, China
| | - Liqiang Lin
- Department of Otorhinolaryngology, Linyi People's Hospital, Linyi, China
| | - Yangyang Yang
- Department of Otorhinolaryngology, Linyi People's Hospital, Linyi, China
| | - Qiang Shao
- Department of Otorhinolaryngology, Linyi People's Hospital, Linyi, China
| | - Huaiqing Lv
- Department of Otorhinolaryngology, Linyi People's Hospital, Linyi, China.
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Shovlin CL, Patel D, Bielowka A, Ledermann JA, Modarresi A, Bernabeu-Herrero ME, Aldred MA, Alsafi A. MEK 1 inhibition and bleeding in hereditary haemorrhagic telangiectasia. Br J Haematol 2024; 204:361-365. [PMID: 37872650 DOI: 10.1111/bjh.19167] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 10/25/2023]
Affiliation(s)
- Claire L Shovlin
- National Heart and Lung Institute, Imperial College London, London, UK
- NIHR Imperial Biomedical Research Centre, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Dilip Patel
- National Heart and Lung Institute, Imperial College London, London, UK
- NIHR Imperial Biomedical Research Centre, London, UK
| | - Adrianna Bielowka
- National Heart and Lung Institute, Imperial College London, London, UK
- NIHR Imperial Biomedical Research Centre, London, UK
| | | | - Atieh Modarresi
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Maria E Bernabeu-Herrero
- National Heart and Lung Institute, Imperial College London, London, UK
- NIHR Imperial Biomedical Research Centre, London, UK
| | | | - Ali Alsafi
- Imperial College Healthcare NHS Trust, London, UK
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Newman M, Nguyen TBV, McHugh T, Reddy K, Sommer DD. Early-onset juvenile nasopharyngeal angiofibroma (JNA): a systematic review. J Otolaryngol Head Neck Surg 2023; 52:85. [PMID: 38115030 PMCID: PMC10731762 DOI: 10.1186/s40463-023-00687-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Juvenile Nasopharyngeal Angiofibroma (JNA) is a fibrovascular tumor of the nasopharynx that classically presents in adolescent males. The reported mean age of onset is between 13 and 22 years old [1-6]. Significant androgen stimulation is hypothesized to explain the strong predisposition for JNA to present in young adolescent males. However, considerable variability in age at diagnosis exists with rare involvement of very young patients incongruent with typical male pubertal growth patterns. OBJECTIVE The purpose of this systematic review is to identify cases of early-onset JNA (EOJNA), (defined as age < 10 years) in the literature and to examine the disease characteristics and treatments used in this patient group. A case of a 7 year old boy with EOJNA at our institution is also described and presented. METHODS We searched Embase, Cochrane database and MEDLINE from 1996 to February 2021 for studies that reported cases of EOJNA. Relevant clinico-demographic data, disease severity and treatment outcomes were recorded and analyzed using descriptive statistics. We compared our findings with reported means for JNA in all ages. RESULTS We identified 29 studies containing a total of 34 cases of EOJNA. The vast majority (31/34) of patients were males and the mean age of diagnosis was 8.15 years old. The most common presenting symptoms were nasal obstruction (65.2%) and epistaxis (60.9%). Patients were most commonly Radkowski stage II (39.4%) and III (39.4%). Primary treatment modalities included open surgery (66.7%), endoscopic surgery (24.2%), and radiotherapy (9.1%). Recurrence was evident in 30%. Radkowski stage and type of treatment did not differ significantly within the EOJNA group (p = 0.440 and p = 0.659, respectively). CONCLUSION This systematic review suggests that rare cases of EOJNA have distinct disease characteristics. Patients in this cohort appeared to have more advanced disease and higher recurrence rates when compared with reported averages. We hope that this review prompts increased clinical awareness of this potentially more aggressive subtype of JNA. As more cases of EOJNA are reported, a more powered statistical analysis of this cohort would be feasible.
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Affiliation(s)
- Matthew Newman
- Otolaryngology-Head and Neck Surgery Division, Department of Surgery, McMaster University Medical Centre, 3V1 Clinic, 1200 Main St. West, Hamilton, ON, L8N 3Z5, Canada
| | - Thomas Boi Vu Nguyen
- Otolaryngology-Head and Neck Surgery Division, Department of Surgery, McMaster University Medical Centre, 3V1 Clinic, 1200 Main St. West, Hamilton, ON, L8N 3Z5, Canada.
| | - Tobial McHugh
- Otolaryngology-Head and Neck Surgery Division, Department of Surgery, McMaster University Medical Centre, 3V1 Clinic, 1200 Main St. West, Hamilton, ON, L8N 3Z5, Canada
| | - Kesava Reddy
- Neurological Surgery Division, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Doron Dov Sommer
- Otolaryngology-Head and Neck Surgery Division, Department of Surgery, McMaster University Medical Centre, 3V1 Clinic, 1200 Main St. West, Hamilton, ON, L8N 3Z5, Canada
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7
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Costantini C, Fati F, Pani E, Beretta F, Bisoffi S, Mazzero G, Negri E, Revetria C, Sadri HR, Ciardini E. Two-balloon epistaxis catheter to ensure vaginal patency in a complex case of vaginoplasty for vaginal agenesis: a case report. Pediatr Med Chir 2023; 45. [PMID: 38010316 DOI: 10.4081/pmc.2023.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 09/05/2023] [Indexed: 11/29/2023] Open
Abstract
Congenital vaginal atresia is a rare anomaly of the female genital tract. Many vaginoplasty procedures have been described, but the postoperative risk of vaginal stenosis remains a challenge. We report a case of isolated distal vaginal agenesis in a patient with neurological impairment where the use of an "alternative" dilator was needed. An 11-year-old girl with Down syndrome was admitted to the Emergency Department complaining of pelvic pain. The clinical evaluation showed a hard and painful pelvic mass associated with an imperforate hymen. Abdominal ultrasound and pelvic MRI were suggestive for hematometrocolpos and absence of the lower third segment of the vagina. Vaginoscopy confirmed the diagnosis of congenital vaginal agenesis. The patient then underwent a laparoscopic-assisted vaginoplasty. Considering the difficult management of the postoperative period, an epistaxis catheter was used as a vaginal stent and dilator. The use of an epistaxis catheter to provide adequate vaginal patency after vaginoplasty can be an alternative solution especially in those cases where calibrations with dilators are difficult or not tolerated.
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Affiliation(s)
- Chiara Costantini
- Santa Chiara Hospital, Department of Pediatric Surgery, Trento; University of Padua, Department of Women and Child Health, Padua.
| | - Federica Fati
- Santa Chiara Hospital, Department of Pediatric Surgery, Trento; University of Padua, Department of Women and Child Health, Padua.
| | - Elisa Pani
- Santa Chiara Hospital, Department of Pediatric Surgery, Trento.
| | - Fabio Beretta
- Santa Chiara Hospital, Department of Pediatric Surgery, Trento.
| | - Silvia Bisoffi
- Santa Chiara Hospital, Department of Pediatric Surgery, Trento; University of Padua, Department of Women and Child Health, Padua.
| | - Giosuè Mazzero
- Santa Chiara Hospital, Department of Pediatric Surgery, Trento.
| | - Elisa Negri
- Santa Chiara Hospital, Department of Pediatric Surgery, Trento, Italy..
| | - Clara Revetria
- Santa Chiara Hospital, Department of Pediatric Surgery, Trento.
| | - Hamid R Sadri
- Santa Chiara Hospital, Department of Pediatric Surgery, Trento.
| | - Enrico Ciardini
- Santa Chiara Hospital, Department of Pediatric Surgery, Trento.
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Lyster AL, Biørn SH, Kjeldsen AD, Nielsen C, Lange B, Fialla AD, Vinholt PJ. The bleeding diathesis in patients with hereditary haemorrhagic telangiectasia is not due to impaired platelet function. Orphanet J Rare Dis 2023; 18:354. [PMID: 37964294 PMCID: PMC10648329 DOI: 10.1186/s13023-023-02968-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/06/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Patients with the rare disease; Hereditary haemorrhagic telangiectasia (HHT) often bleed from telangiectatic lesions in mucosal surfaces. Studies suggest that impaired platelet function may also play a role in their bleeding tendency. The aim of the present study was to investigate whether HHT-patients with epistaxis have impaired platelet function. METHOD We conducted a case-control study based on a sample size calculation and included 22 HHT-patients (inclusion criteria: epistaxis severity score ≥ 4, no intake of medicine affecting platelet function the last 5 days, HHT-type 1 or 2, age ≥ 18 years) and 20 controls. We assessed the platelet function with standard haemostasis parameters, flow cytometry (platelet function and micro aggregation), rotational thromboelastometry and Platelet Function Analyzer 200. RESULTS We found no significant difference in mean platelet volume and immature platelet fraction and no difference in platelet activation as measured by exposure of CD62P, CD63P and PAC1 binding. Nor did we find a significant difference in platelet aggregation response in HHT-patients compared with the control group for all agonists (thrombin receptor activating peptide, adenosine diphosphate and collagen-related peptide). The PFA-200 analysis was without difference between the two groups and thromboelastometry showed no impairment of global haemostasis. CONCLUSION Reduced platelet function is unlikely to contribute to the frequent and long bleeding episodes that HHT-patients suffer from. We propose that further studies should focus on whether patients with HHT have hypercoagulability.
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Affiliation(s)
- Anne Lørup Lyster
- Department of Clinical Biochemistry, Odense University Hospital, Winsløws Vej 4, 5000, Odense C, Denmark.
- Department of Clinical Research, University of Southern Denmark (SDU), Campusvej 55, 5230, Odense M, Denmark.
- Department of Gastroenterology, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark.
- Department of Oto-Rhino-Laryngology, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark.
- OPEN, Patient Data Explorative Network, J.B. Winsløws Vej 9A, Third Floor, 5000, Odense C, Denmark.
| | - Signe Hedengran Biørn
- Department of Clinical Biochemistry, Odense University Hospital, Winsløws Vej 4, 5000, Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark (SDU), Campusvej 55, 5230, Odense M, Denmark
| | - Anette Drøhse Kjeldsen
- Department of Clinical Research, University of Southern Denmark (SDU), Campusvej 55, 5230, Odense M, Denmark
- Department of Oto-Rhino-Laryngology, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark
- Member of VASCERN (The European Reference Network of Rare Multisystemic Vascular Diseases, Paris), The HHT-Centre at Odense University Hospital, 5000 Odense C, Denmark
| | - Christian Nielsen
- Department of Clinical Immunology, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark
| | - Bibi Lange
- Department of Oto-Rhino-Laryngology, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark
| | - Annette Dam Fialla
- Department of Clinical Research, University of Southern Denmark (SDU), Campusvej 55, 5230, Odense M, Denmark
- Department of Gastroenterology, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark
- Member of VASCERN (The European Reference Network of Rare Multisystemic Vascular Diseases, Paris), The HHT-Centre at Odense University Hospital, 5000 Odense C, Denmark
| | - Pernille Just Vinholt
- Department of Clinical Biochemistry, Odense University Hospital, Winsløws Vej 4, 5000, Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark (SDU), Campusvej 55, 5230, Odense M, Denmark
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Munhall CC, Shah S, Nguyen SA, Meyer TA, Schlosser RJ, White DR. Otolaryngologic Presentations to Emergency Departments During the COVID-19 Pandemic: A Systematic Review and Meta-Analysis. Ann Otol Rhinol Laryngol 2023; 132:1467-1476. [PMID: 37016555 PMCID: PMC10076161 DOI: 10.1177/00034894231165575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
OBJECTIVES To perform a systematic review of otolaryngologic presentation rates to emergency department settings before and after lockdown due to the COVID-19 pandemic. SOURCES PubMed, Scopus, and CINAHL. METHODS A systematic search was conducted following PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses) for studies describing otolaryngologic presentations to emergency department and rapid access clinic settings both in the before-lockdown and after-lockdown periods. The start of after-lockdown period varied based on initiation of lockdown, ranging from March 1st to June 1st of 2020 across general emergency department studies. RESULTS A total of 14 studies were included in this review. About 10 were general emergency departments, 3 were specifically pediatric emergency departments, and 1 study focused on the geriatric population (>65 years). A total of 13 790 patients were included, with 9446 in the before-lockdown period (68.5%) and 4344 in the after-lockdown period (31.5%). Meta-analysis of proportions for otolaryngologic presentations across general emergency departments was performed. Comparison of weighted proportions found significant differences between before-lockdown and after-lockdown presentation rates for infectious etiologies, tonsillitis specifically, foreign bodies, non-infectious airway issues, and epistaxis among these studies. CONCLUSIONS The increased proportions of various non-infectious presentations (eg, epistaxis, foreign bodies, and airway issues) following lockdown might be associated with proportional decreases in infectious pathologies, given decreased social contact to prevent SARS-CoV-2 transmission. Overall, it is important for otolaryngologists to recognize what presentations might more commonly be seen and require evaluation and potential intervention in light of a global pandemic.
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Affiliation(s)
- Christopher C. Munhall
- Department of Otolaryngology – Head and
Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Sunny Shah
- Department of Otolaryngology – Head and
Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Shaun A. Nguyen
- Department of Otolaryngology – Head and
Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Ted A. Meyer
- Department of Otolaryngology – Head and
Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Rodney J. Schlosser
- Department of Otolaryngology – Head and
Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - David R. White
- Department of Otolaryngology – Head and
Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
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Liu S, Yu Q, Guo R, Chen K, Xia J, Guo Z, He L, Wu Q, Liu L, Li Y, Zhang B, Lu L, Sheng X, Zhu J, Zhao L, Qi H, Liu K, Yin L. A Biodegradable, Adhesive, and Stretchable Hydrogel and Potential Applications for Allergic Rhinitis and Epistaxis. Adv Healthc Mater 2023; 12:e2302059. [PMID: 37610041 DOI: 10.1002/adhm.202302059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/07/2023] [Indexed: 08/24/2023]
Abstract
Bioadhesive hydrogels have attracted considerable attention as innovative materials in medical interventions and human-machine interface engineering. Despite significant advances in their application, it remains critical to develop adhesive hydrogels that meet the requirements for biocompatibility, biodegradability, long-term strong adhesion, and efficient drug delivery vehicles in moist conditions. A biocompatible, biodegradable, soft, and stretchable hydrogel made from a combination of a biopolymer (unmodified natural gelatin) and stretchable biodegradable poly(ethylene glycol) diacrylate is proposed to achieve durable and tough adhesion and explore its use for convenient and effective intranasal hemostasis and drug administration. Desirable hemostasis efficacy and enhanced therapeutic outcomes for allergic rhinitis are accomplished. Biodegradation enables the spontaneous removal of materials without causing secondary damage and minimizes medical waste. Preliminary trials on human subjects provide an essential foundation for practical applications. This work elucidates material strategies for biodegradable adhesive hydrogels, which are critical to achieving robust material interfaces and advanced drug delivery platforms for novel clinical treatments.
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Affiliation(s)
- Shengnan Liu
- School of Materials Science and Engineering, The Key Laboratory of Advanced Materials of Ministry of Education, State Key Laboratory of New Ceramics and Fine Processing, Center for Flexible Electronics Technology, Tsinghua University, Beijing, 100084, P. R. China
| | - Qianru Yu
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Rui Guo
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Kuntao Chen
- School of Materials Science and Engineering, The Key Laboratory of Advanced Materials of Ministry of Education, State Key Laboratory of New Ceramics and Fine Processing, Center for Flexible Electronics Technology, Tsinghua University, Beijing, 100084, P. R. China
| | - Jiao Xia
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Zhenhu Guo
- School of Materials Science and Engineering, The Key Laboratory of Advanced Materials of Ministry of Education, State Key Laboratory of New Ceramics and Fine Processing, Center for Flexible Electronics Technology, Tsinghua University, Beijing, 100084, P. R. China
| | - Lu He
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Qian Wu
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Lan Liu
- Animal Science and Technology College, Beijing University of Agriculture, Beijing, 102206, China
- State Key Laboratory of Biochemical Engineering, Institute of Process Engineering, Chinese Academy of Sciences, Beijing, 100190, China
| | - Yunxuan Li
- School of Materials Science and Engineering, The Key Laboratory of Advanced Materials of Ministry of Education, State Key Laboratory of New Ceramics and Fine Processing, Center for Flexible Electronics Technology, Tsinghua University, Beijing, 100084, P. R. China
| | - Bozhen Zhang
- School of Materials Science and Engineering, The Key Laboratory of Advanced Materials of Ministry of Education, State Key Laboratory of New Ceramics and Fine Processing, Center for Flexible Electronics Technology, Tsinghua University, Beijing, 100084, P. R. China
| | - Lin Lu
- Animal Science and Technology College, Beijing University of Agriculture, Beijing, 102206, China
| | - Xing Sheng
- Department of Electronic Engineering, Beijing National Research Center for Information Science and Technology, Institute for Precision Medicine, Center for Flexible Electronics Technology, and IDG/McGovern Institute for Brain Research, Tsinghua University, Beijing, 100084, China
| | - Jiahua Zhu
- State Key Laboratory of Biochemical Engineering, Institute of Process Engineering, Chinese Academy of Sciences, Beijing, 100190, China
| | - Lingyun Zhao
- School of Materials Science and Engineering, The Key Laboratory of Advanced Materials of Ministry of Education, State Key Laboratory of New Ceramics and Fine Processing, Center for Flexible Electronics Technology, Tsinghua University, Beijing, 100084, P. R. China
| | - Hui Qi
- Laboratory of Musculoskeletal Regenerative Medicine, Beijing Institute of Traumatology and Orthopaedics, Beijing, 100035, China
| | - Ke Liu
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
- Beijing Clinical Research Institute, Beijing, 100050, China
| | - Lan Yin
- School of Materials Science and Engineering, The Key Laboratory of Advanced Materials of Ministry of Education, State Key Laboratory of New Ceramics and Fine Processing, Center for Flexible Electronics Technology, Tsinghua University, Beijing, 100084, P. R. China
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11
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Webster KE, Mulvaney CA, Galbraith K, Rana M, Marom T, Daniel M, Venekamp RP, Schilder AG, MacKeith S. Autoinflation for otitis media with effusion (OME) in children. Cochrane Database Syst Rev 2023; 9:CD015253. [PMID: 37750500 PMCID: PMC10521168 DOI: 10.1002/14651858.cd015253.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
BACKGROUND Otitis media with effusion (OME) is an accumulation of fluid in the middle ear cavity, common amongst young children. The fluid may cause hearing loss. When persistent, it may lead to behavioural problems and a delay in expressive language skills. Management of OME includes watchful waiting, medical, surgical and mechanical treatment. Autoinflation is a self-administered technique, which aims to ventilate the middle ear and encourage middle ear fluid clearance by providing a positive pressure of air in the nose and nasopharynx (using a nasal balloon or other handheld device). This positive pressure (sometimes combined with simultaneous swallow) encourages opening of the Eustachian tube and may help ventilate the middle ear. OBJECTIVES To assess the efficacy (benefits and harms) of autoinflation for the treatment of otitis media with effusion in children. SEARCH METHODS The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 20 January 2023. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-randomised trials in children aged 6 months to 12 years with unilateral or bilateral OME. We included studies that compared autoinflation with either watchful waiting (no treatment), non-surgical treatment or ventilation tubes. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were determined following a multi-stakeholder prioritisation exercise and were: 1) hearing, 2) OME-specific quality of life and 3) pain and distress. Secondary outcomes were: 1) persistence of OME, 2) other adverse effects (including eardrum perforation), 3) compliance or adherence to treatment, 4) receptive language skills, 5) speech development, 6) cognitive development, 7) psychosocial skills, 8) listening skills, 9) generic health-related quality of life, 10) parental stress, 11) vestibular function and 12) episodes of acute otitis media. We used GRADE to assess the certainty of evidence for each outcome. Although we included all measures of hearing assessment, the proportion of children who returned to normal hearing was our preferred method to assess hearing, due to challenges in interpreting the results of mean hearing thresholds. MAIN RESULTS We identified 11 completed studies that met our inclusion criteria (1036 participants). The majority of studies included children aged between 3 and 11 years. Most were carried out in Europe or North America, and they were conducted in both hospital and community settings. All compared autoinflation (using a variety of different methods and devices) to no treatment. Most studies required children to carry out autoinflation two to three times per day, for between 2 and 12 weeks. The outcomes were predominantly assessed just after the treatment phase had been completed. Here we report the effects at the longest follow-up for our main outcome measures. Return to normal hearing The evidence was very uncertain regarding the effect of autoinflation on the return to normal hearing. The longest duration of follow-up was 11 weeks. At this time point, the risk ratio was 2.67 in favour of autoinflation (95% confidence interval (CI) 1.73 to 4.12; 85% versus 32%; number needed to treat to benefit (NNTB) 2; 1 study, 94 participants), but the certainty of the evidence was very low. Disease-specific quality of life Autoinflation may result in a moderate improvement in quality of life (related to otitis media) after short-term follow-up. One study assessed quality of life using the Otitis Media Questionnaire-14 (OMQ-14) at three months of follow-up. Results were reported as the number of standard deviations above or below zero difference, with a range from -3 (better) to +3 (worse). The mean difference was -0.42 lower (better) for those who received autoinflation (95% CI -0.62 to -0.22; 1 study, 247 participants; low-certainty evidence; the authors report a change of 0.3 as clinically meaningful). Pain and distress caused by the procedure Autoinflation may result in an increased risk of ear pain, but the evidence was very uncertain. One study assessed this outcome, and identified a risk ratio of 3.50 for otalgia in those who received autoinflation, although the overall occurrence of pain was low (95% CI 0.74 to 16.59; 4.4% versus 1.3%; number needed to treat to harm (NNTH) 32; 1 study, 320 participants; very low-certainty evidence). Persistence of OME The evidence suggests that autoinflation may slightly reduce the persistence of OME at three months. Four studies were included, and the risk ratio for persistence of OME was 0.88 for those receiving autoinflation (95% CI 0.80 to 0.97; 4 studies, 483 participants; absolute reduction of 89 people per 1000 with persistent OME; NNTB 12; low-certainty evidence). AUTHORS' CONCLUSIONS All the evidence we identified was of low or very low certainty, meaning that we have little confidence in the estimated effects. However, the data suggest that autoinflation may have a beneficial effect on OME-specific quality of life and persistence of OME in the short term, but the effect is uncertain for return to normal hearing and adverse effects. The potential benefits should be weighed against the inconvenience of regularly carrying out autoinflation, and the possible risk of ear pain.
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Affiliation(s)
- Katie E Webster
- Cochrane ENT, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Caroline A Mulvaney
- Cochrane ENT, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Kevin Galbraith
- Cochrane ENT, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Mridul Rana
- ENT Department, Frimley Health NHS Foundation Trust, Slough, UK
| | - Tal Marom
- Department of Otolaryngology - Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ben Gurion University Faculty of Health Sciences, Ashdod, Israel
| | - Mat Daniel
- Nottingham Children's Hospital, Nottingham, UK
| | - Roderick P Venekamp
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Anne Gm Schilder
- evidENT, Ear Institute, University College London, London, UK
- NIHR UCLH Biomedical Research Centre, University College London, London, UK
| | - Samuel MacKeith
- ENT Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Lee-Fowler T, Clark-Price S, Lascola K. Detection of canine obstructive nasal disease using infrared thermography: A pilot study. PLoS One 2023; 18:e0291440. [PMID: 37699012 PMCID: PMC10497125 DOI: 10.1371/journal.pone.0291440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/28/2023] [Indexed: 09/14/2023] Open
Abstract
Infrared thermography detects variations in heat signature and is utilized in other species to non-invasively identify respiratory disease. This study aimed to determine if infrared thermography could be used to detect nasal disease in dogs. Eight dogs presenting for nasal disease (ND group) and ten healthy control dogs (C group) were enrolled. Dorsal and rostral images of the nose were acquired using a Fluke TiX580 60Hz thermal imaging camera. Images were analyzed using the accompanying software. Regions of interest were defined over the right and left nasal passages to determine the maximum (max), average (avg), and minimum (min) temperatures. Temperatures were compared between ND and C groups, and correlation to disease state (ND or C) was evaluated. Temperature differences and imaging patterns were subjectively compared with diagnosis based on computed tomography (CT) and histopathology. The ND group consisted of 5 spayed females and 3 neutered males. Clinical sings included unilateral epistaxis (n = 4); bilateral serous discharge and sneezing (n = 1); bilateral mucopurulent discharge, epistaxis, and sneezing (n = 1); unilateral mucoid discharge, epistaxis and sneezing (n = 1); and sneezing and unilateral epistaxis (n = 1). Temperatures were significantly different between ND and C groups on dorsal (max p = <0.001, avg p = 0.001, min p = <0.001) and rostral (max p = <0.001, avg p = <0.001, min p = 0.005) images. Temperature positively correlated to disease status (ND vs C group) in both dorsal and rostral images. Subjective analysis of images allowed correct identification of abnormal or normal 27/36 times. Obstructive nasal disease results in a local temperature increase in the affected nasal passage that can be non-invasively detected by infrared thermography.
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Affiliation(s)
- Tekla Lee-Fowler
- Department of Clinical Sciences, Auburn University, Auburn, AL, United States of America
| | - Stuart Clark-Price
- Department of Clinical Sciences, Auburn University, Auburn, AL, United States of America
| | - Kara Lascola
- Department of Clinical Sciences, Auburn University, Auburn, AL, United States of America
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13
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Mao ST, Li B, Wang D, Liu SS, Su SF, Wei LL, Chai FY, Liu Y, Liu YF. [Non-muscle myosin heavy chain 9 gene-related disorders with thrombocytopenia: report of two pedigrees and literature review]. Zhonghua Er Ke Za Zhi 2023; 61:833-838. [PMID: 37650166 DOI: 10.3760/cma.j.cn112140-20230329-00220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Objective: To summarize the clinical characteristics and gene variants of 2 pedigrees of non-muscle myosin heavy chain 9 related diseases (MYH9-RD) in children. Methods: The basic information, clinical features, gene variants and laboratory tests of MYH9-RD patients from 2 pedigrees confirmed in the First Affiliated Hospital of Zhengzhou University in November 2021 and July 2022 were analyzed retrospectively. "Non-muscle myosin heavy chain 9 related disease" "MYH9" and "children" were used as key words to search at Pubmed database, CNKI and Wanfang database up to February 2023. The MYH9-RD gene variant spectrum and clinical data were analyzed and summarized. Results: Proband 1 (male, 11 years old) sought medical attention due to epistaxis, the eldest sister and second sister of proband 1 only showed excessive menstrual bleeding, the skin and mucous membrane of the their mother were prone to ecchymosis after bumping, the uncle of proband 1 had kidney damage, and the maternal grandmother and maternal great-grandmother of proband 1 had a history of cataracts. There were 7 cases of phenotypic abnormalities in this pedigree. High-throughput sequencing showed that the proband 1 MYH9 gene had c.279C>G (p.N93K) missense variant, and family verification analysis showed that the variant was inherited from the mother. A total of 4 patients including proband 1 and family members were diagnosed with MYH9-RD. The proband 2 (female, 1 year old) sought medical attention duo to fever and cough, and the father's physical examination revealed thrombocytopenia. There were 2 cases of phenotypic abnormalities in this pedigree. High-throughput sequencing showed that there was a c.4270G>A (p.D1424N) missense variant in the proband 2 MYH9 gene, and family verification analysis showed that the variant was inherited from the father. A total of 2 patients including proband 2 and his father were diagnosed with MYH9-RD. A total of 99 articles were retrieved, including 32 domestic literatures and 67 foreign literatures. The MYH9-RD cases totaled 149 pedigrees and 197 sporadic patients, including 2 pedigrees in our study. There were 101 cases with complete clinical data, including 62 sporadic cases and 39 pedigrees. There were 56 males and 45 females, with an average age of 6.9 years old. The main clinical manifestations were thrombocytopenia, skin ecchymosis, and epistaxis. Most patients didn't receive special treatment after diagnosis. Six English literatures related to MYH9-RD caused by c.279C>G mutation in MYH9 gene were retrieved. Italy reported the highest number of cases (3 cases). Twelve literatures related to MYH9-RD caused by c.4270G>A mutation in MYH9 gene were retrieved. China reported the highest number of cases (9 cases). Conclusions: The clinical manifestations of patients in the MYH9-RD pedigrees varied greatly. MYH9 gene c.279C>G and c.4270G>A mutations are the cause of MYH9-RD.
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Affiliation(s)
- S T Mao
- Department of Hematology and Oncology, Children's Hospital, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - B Li
- Department of Hematology and Oncology, Children's Hospital, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - D Wang
- Department of Hematology and Oncology, Children's Hospital, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - S S Liu
- Department of Hematology and Oncology, Children's Hospital, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - S F Su
- Department of Hematology and Oncology, Children's Hospital, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - L L Wei
- Department of Hematology and Oncology, Children's Hospital, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - F Y Chai
- Department of Hematology and Oncology, Children's Hospital, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Y Liu
- Department of Hematology and Oncology, Children's Hospital, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Y F Liu
- Department of Hematology and Oncology, Children's Hospital, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
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14
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Orabi NA, Behnke J, Reyes C, Ramadan HH, Makary CA. Effect of absorbable nasal packing saturated with ciprofloxacin and dexamethasone following endoscopic sinus surgery: A prospective cohort study. Int Forum Allergy Rhinol 2023; 13:1801-1804. [PMID: 36413477 DOI: 10.1002/alr.23114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/17/2022] [Accepted: 11/18/2022] [Indexed: 08/24/2023]
Affiliation(s)
- Norman A Orabi
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, WV
| | - John Behnke
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, WV
| | - Camilo Reyes
- Department of Otolaryngology, Medical College of, Georgia at Augusta University, Augusta, GA
| | - Hassan H Ramadan
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, WV
| | - Chadi A Makary
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, WV
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15
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Ge P, Han C, Reyila A, Liu D, Hong W, Liu J, Zhang J, Han X, Li X, Huang M, Fan S, Kaierdebieke A, Wu X, Huang X, Guo W, Liu S, Bian Y. Risk of antiangiogenic adverse events in metastatic colorectal cancer patients receiving aflibercept in combination with chemotherapy: A meta-analysis. Medicine (Baltimore) 2023; 102:e34793. [PMID: 37657052 PMCID: PMC10476758 DOI: 10.1097/md.0000000000034793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/26/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Aflibercept has been approved for the treatment of metastatic colorectal cancer for more than a decade, but its antiangiogenesis adverse effect profile during treatment remains unclear. This study is conducted to systematically review the risk of antiangiogenic adverse events in patients with metastatic colorectal cancer receiving aflibercept plus chemotherapy. METHODS We searched databases, including PubMed, Embase and the Cochrane Library up to September 9, 2021. Relevant randomized controlled trials (RCTs) and single-arm studies were included in the review. Statistical analyses were performed using R to calculate the summary incidence rate of antiangiogenic-related adverse events, odds ratios and 95% CIs. Heterogeneity among the included studies was assessed by subgroup analysis. Publication bias analysis and sensitivity analysis were performed to confirm the reliability of the results. RESULTS A total of 2889 patients from 10 studies met the inclusion criteria. The quality of the included studies was evaluated as qualified for further quantitative synthesis. In part of single-arm studies, the occurrence rates were 44.2% (95%CI, 39.7-48.7%) for hypertension, 31.3% (95% CI, 19.3-43.3%) for proteinuria, 27.3% (95%CI, 21.2-33.4%) for epistaxis, 22.5% (95%CI, 7.8-37.3%) for hemorrhage events, 8.0% (95%CI, 2.0-14 .0%) for venous thromboembolic event in all grades and 22.6% (95%CI, 19.1-26.2%) for grade III/IV hypertension, 7.4% (95%CI, 6.2-8.5%) for grade III/IV proteinuria. In part of RCT, compared to its counterpart, aflibercept containing arm was associated with the increased incidence rate in hypertension (OR:6.30, 95%CI: 3.49-11.36), proteinuria (OR:4.12, 95%CI: 1.25-13.61), epistaxis (OR:3.71, 95%CI: 2.84-4.85), III/IV hypertension (OR:7.20, 95%CI: 5.23-9.92), III/IV proteinuria (OR:5.13, 95%CI: 3.13-8.41). The funnel plot, Begg test and Egger test were carried out on the primary endpoints, III/IV hypertension rate and III/IV proteinuria rate, the result of which detected no obvious publication bias. No significant difference was observed in subgroup analysis in the primary endpoint between the subgroups stratified by treatment line (firstline or non-firstline), chemotherapy regime (FOLFIRI or others) and study design (RCTs or single-arm trials). CONCLUSION The available evidence suggests that using aflibercept is associated with an increased risk of antiangiogenic adverse events compared with controls. Further studies are needed to investigate this association. In the appropriate clinical scenario, the use of aflibercept in its approved indications remains justified. However, the results of this study should be interpreted with caution, as some of the evidence comes from single-arm clinical trials.
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Affiliation(s)
- Pu Ge
- Institute of Chinese Medical Sciences, University of Macau, Macau, China
- State Key Laboratory of Quality Research in Chinese Medicine, University of Macau, Macau, China
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macau, China
| | - Chunyan Han
- School of Political Science and Public Administration, Shandong University, Qingdao, China
| | | | - Diyue Liu
- International School of Public Health and One Health, Hainan Medical University, Haikou, China
| | - Wenying Hong
- Faculty of Health Sciences, University of Macau, Macau, China
| | - Jiaxin Liu
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Jinzi Zhang
- School of Humanities and Social Sciences, Harbin Medical University, Harbin, China
| | - Xiao Han
- The Fifth Affiliated Hospital of Sun Yat-sat University, Zhuhai, China
| | - Xialei Li
- School of Pharmaceutical Sciences, Shandong University, Jinan, China
| | - Mengjie Huang
- School of Public Health, Shandong University, Jinan, China
| | - Siyuan Fan
- Department of Preventive Medicine, Yanjing Medical College, Capital Medical University, Beijing, China
| | | | - Xiaoyu Wu
- School of Pharmaceutical Sciences, Shandong University, Jinan, China
| | - Xiaolu Huang
- Clinically Third Series, China Medical University, Shenyang, China
| | - Weirui Guo
- School of Clinical Medicine of Jining Medicine University, Jining, China
| | - Siyu Liu
- Stomatology College of Shandong University, Jinan, China
| | - Ying Bian
- Institute of Chinese Medical Sciences, University of Macau, Macau, China
- State Key Laboratory of Quality Research in Chinese Medicine, University of Macau, Macau, China
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macau, China
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16
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Pham HK, Nguyen T, Tran TT, Thai TT. A comparison of effectiveness between Posisep and Merocel nasal packing after endoscopic sinus surgery: Findings from a randomized, double-blinded, controlled trial. Medicine (Baltimore) 2023; 102:e34782. [PMID: 37565850 PMCID: PMC10419511 DOI: 10.1097/md.0000000000034782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 07/26/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND The effectiveness of nonabsorbable and biodegradable nasal packing is still controversial, and the choice of nasal packing type can alter the outcome of endoscopic sinus surgery. This study compared the effectiveness of Posisep and Merocel as nasal packing materials with regard to hemostasis, adhesion, wound healing, patient's satisfaction and health-related quality of life after endoscopic sinus surgery (ESS). METHODS A prospective, randomized, double-blinded, controlled trial was conducted in patients with chronic rhinosinusitis refractory undergoing symmetrical bilateral ESS. At the completion of surgery, a nasal packing (either Merocel or Posisep) was randomly chosen and placed into the middle meatus of each nasal cavity. All patients were scheduled for follow-up visits at 24 hours, 5 days, 3 weeks, and 5 weeks days after surgery. Health-related quality of life was measured using the Sino-Nasal Outcome Test (SNOT-22). The overall inflammatory burden of chronic rhinosinusitis was measured by the Lund-Mackay postoperative endoscopic score (LMES). RESULTS Among 62 patients included in data analysis (n = 31 for each group), the mean age was 42.4 years and 54.8% were females. Patients with Posisep after ESS had more improvement and better symptoms measured through SNOT-22 and LMES at 24 hours, 5 days, and 3 weeks than those with Merocel after ESS. While some aspects measured by LMES such as discharge and scarring were still better until 5 weeks after surgery, all symptoms measured by SNOT-22 were similar between the 2 groups 5 weeks after surgery. CONCLUSION Posisep containing chitosan provided patients with a better quality of life throughout the early recovery period compared with Merocel. Although more studies are needed, our findings support the use of Posisep after ESS.
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Affiliation(s)
- Huu Kien Pham
- Department of Otolaryngology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Department of Otolaryngology - Head and Neck Surgery, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Trong Nguyen
- International SOS, Center Point Tower at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tai Thanh Tran
- Department of Otolaryngology - Head and Neck Surgery, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Truc Thanh Thai
- Department of Medical Statistics and Informatics, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
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Kumskova M, Flora GD, Staber J, Lentz SR, Chauhan AK. Characterization of bleeding symptoms in Ehlers-Danlos syndrome. J Thromb Haemost 2023; 21:1824-1830. [PMID: 37179130 DOI: 10.1016/j.jtha.2023.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 03/22/2023] [Accepted: 04/04/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Easy bruising is included as a major or minor criterion for the classification of multiple types of Ehlers-Danlos syndrome (EDS). Despite a longstanding recognition of the association between EDS and bleeding, we still lack a definitive understanding of the frequency, severity, and types of bleeding complications in patients with EDS. OBJECTIVES To evaluate hemorrhagic symptoms using the International Society of Thrombosis and Haemostasis bleeding assessment tool (ISTH-BAT) in a cohort of patients with defined types of EDS. METHODS We utilized the ISTH-BAT to characterize hemorrhagic symptoms and their severity in a cohort of 52 patients with classical, classical-like, hypermobile, or vascular EDS and a matched group of 52 healthy control subjects. RESULTS The mean ISTH-BAT score was 0.1 for healthy subjects and 9.1 for patients with EDS (p < .0001). An abnormal ISTH-BAT score was observed in 32 of 52 (62%) patients with EDS and 0 of 52 healthy controls (p < .0001). The most frequent bleeding symptoms were bruising, muscle hematomas, menorrhagia, epistaxis, bleeding from the oral cavity, and bleeding after tooth extraction. Menorrhagia that was life-threatening or required surgery was reported in 7 of 52 (14%) patients with EDS. CONCLUSION Patients with multiple types of EDS exhibit a wide range of bleeding symptoms ranging from mild to life-threatening episodes.
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Affiliation(s)
- Mariia Kumskova
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA.
| | - Gagan D Flora
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Janice Staber
- Stead Family Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA
| | - Steven R Lentz
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Anil K Chauhan
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA. https://twitter.com/chauhanlab
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Mohamad SA, Badwi AM, Elrehany M, Ali S, Helmy AM. Cholecalciferol-load films for the treatment of nasal burns caused by cauterization of the hypertrophied inferior turbinate: formulation, in vivo study, and clinical assessment. Drug Deliv Transl Res 2023; 13:1102-1115. [PMID: 36509965 DOI: 10.1007/s13346-022-01275-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2022] [Indexed: 12/15/2022]
Abstract
Nasal turbinate hypertrophy is among the most common nasal obstruction disorders, affecting the patient's quality of life significantly. Endoscopic submucosal diathermy is a prevalent cauterization procedure for treating turbinate hypertrophy. Regrettably, the nasal burn associated with diathermy typically heals slowly causing facial pain and nasal bleeding and possibly resulting in synechiae formation. In the current study, we have developed, for the first time, a polymeric film loaded with cholecalciferol for local treatment of nasal burns. The casting method was used to prepare films of different compositions of polymers such as chitosan, polyvinyl alcohol (PVA), Carbopol 971p (CP971p), and hydroxypropyl methylcellulose (HPMC) as well as a plasticizer. Several characterizations were performed for the cholecalciferol-loaded films (e.g. weight, thickness, content uniformity, surface pH, folding endurance, disintegration time, and in vitro release) to select the optimal formulation. The optimal formulation (F4) displayed compatibility between the used polymers and the drug. In vivo animal study was carried out to assess the healing efficacy of the formulated cholecalciferol-loaded film. The rabbits treated with the cholecalciferol-loaded film demonstrated significantly higher mRNA expression of the growth factor TGF-β and significantly lower mRNA expression of the proinflammatory cytokine TNF-α and IL-1β compared to the plain film treated group and the untreated control group. A randomized, single-blinded, parallel, controlled clinical trial was conducted on 20 patients scheduled to undergo endoscopic submucous diathermy. The results of the clinical study demonstrated significant reductions in facial pain and nasal bleeding scores for the nostrils treated with cholecalciferol-loaded films in comparison to the nostrils treated with plain films. Furthermore, the endoscopic examination showed good healing for 95% of the cholecalciferol-loaded film-treated nostrils. In conclusion, the optimized film can be considered an opportune approach for enhancing the healing rate of nasal burns and thus reducing the downsides of the diathermy procedure.
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Affiliation(s)
- Soad A Mohamad
- Department of Pharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, Deraya University, Minya, Egypt
| | - Ahmed M Badwi
- Department of Otorhinolaryngology, Faculty of Medicine, Minya University, Minya, Egypt
| | - Mahmoud Elrehany
- Department of Biochemistry, Faculty of Pharmacy, Deraya University, Minya, Egypt
| | - Sherif Ali
- Department of Biochemistry, Faculty of Pharmacy, New Valley University, New Valley, Egypt
| | - Abdelrahman M Helmy
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Deraya University, Minya, Egypt.
- Pharmaceutical Engineering and 3D Printing (PharmE3D) Lab, Division of Molecular Pharmaceutics and Drug Delivery, College of Pharmacy, The University of Texas at Austin, Austin, TX, 78712, USA.
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19
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Hu H, Hu X, Hu G, Li D, Cai J. Diagnosis and management of extramedullary plasmacytoma in nasal cavity: Clinical experience and literature review. Medicine (Baltimore) 2023; 102:e32647. [PMID: 36637932 PMCID: PMC9839280 DOI: 10.1097/md.0000000000032647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Nasal extramedullary plasmacytoma (EMP) is a rare plasma cell tumor that occurs in the soft tissue of the nasal cavity, and its imaging characteristics are still unclear. The purpose of this study was to investigate the clinical features, imaging findings, treatment, survival analysis, and prognosis of nasal EMP, and to provide a systematic review of the patients we treated and the published literature. A 45-year-old female patient who presented with epistaxis with nasal obstruction was recommended for magnetic resonance imaging to assess the nature of the lesion. On magnetic resonance imaging, abnormal signal shadow can be seen in the right nasal cavity. Diffusion weighted imaging showed signal of the lesion was significantly limited, presenting high signal, with a low apparent dispersion coefficient, and the lesion was significantly enhanced on contrast-enhanced scan. Combined with the clinical manifestations of the patient, who was initially considered to have a hemangioma. She underwent endoscopic nasal surgery under general anesthesia to remove the mass, and the final pathology confirmed it was EMP. However, the final pathology confirmed EMP. Five months later, the patient came to our hospital for follow-up and underwent fluorine-18-fluorodeoxyglucose/positron emission tomography/computed tomography scan, which showed no recurrence of the lesion and no transformation of multiple myeloma. The nasal EMP imaging findings were mostly soft tissue masses with uniform density or signal, which were significantly enhanced by enhancement scan, high signal on diffusion weighted imaging and low signal on apparent dispersion coefficient. Immunohistochemical staining for CD38, CD138, and CD79a was positive in most of the cases evaluated, while CD20 and CD10 were negative. The absence of dilated features, infiltrative features and the presence of significant contrast enhancement may be relatively specific imaging findings of nasal EMP. The prognosis of nasal EMP is good, and recurrence, metastasis, and transformation into multiple myeloma are rare. Because the lesions are sensitive to radiotherapy, surgical resection combined with radiotherapy is a more effective treatment.
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Affiliation(s)
- Hongyu Hu
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xianwen Hu
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Guomei Hu
- Department of Pathology, The First People’s Hospital of Zunyi City, The Third Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Dandan Li
- Department of Obstetrics, Zunyi Hospital of Traditional Chinese Medicine, Zunyi, China
| | - Jiong Cai
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- * Correspondence: Jiong Cai, Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Zunyi 563003, China (e-mail: )
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20
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Smirnov FY, Korneva YS, Shenderov SV, Sveklov DA. [Micotic aneurysm of the internal carotid artery in a patient with sarcoidosis as a cause of ischemic stroke and profuse epitaxis]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:90-94. [PMID: 37682101 DOI: 10.17116/jnevro202312308290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
The article describes the following case: a 63-year-old patient with sarcoidosis, who was on long-term therapy with metipred, developed profuse epistaxis, and upon admission to the hospital, clinical manifestation of stroke. Computer tomography (CT) of the brain at admission revealed destruction of the posterior wall of the sphenoid bone and an area of increased density in the projection of the left optic nerve regarded as a neoplasm of the sphenoid sinus or inflammatory changes. CT angiography revealed the occlusion of the left internal carotid artery (LICA) from the C1 segment throughout. At the time of thrombus extraction, the patient developed profuse bleeding from the nasal cavity. According to staged angiography, the antegrade blood flow through the LICA to the sphenoid segment was restored; against the background of profuse bleeding, the flow of contrast from the LICA into the sphenoid sinus and further into the nasopharynx is visualized; in the projection of the sphenoid sinus, a formation was revealed that required differentiation between a giant aneurysm, an arteriovenous fistula, and a neoplasm of the sphenoid sinus. Destructive embolization of the LICA at the level of the petrosal segment was performed for vital indications, the bleeding was stopped, but the patient died due to acute posthemorrhagic anemia. An autopsy revealed a mycotic aneurysm of the LICA, the rupture of the wall of which caused nasal bleeding, which was spontaneously stopped due to the formation of an extended thrombus, which, in turn, became the cause of stroke.
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Affiliation(s)
| | - Yu S Korneva
- City Hospital No. 26, St. Petersburg, Russia
- Mechnikov North-Western State Medical University, St Petersburg, Russia
- Smolensk State Medical University, Smolensk, Russia
| | | | - D A Sveklov
- City Hospital No. 26, St. Petersburg, Russia
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21
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J B, Patel NK, Kumar N, Singh J, Kumar K. Clinical Dilemma, Bernard Soulier Syndrome versus Immune Thrombocytopenic Purpura: A Case Report. Cardiovasc Hematol Disord Drug Targets 2023; 23:72-75. [PMID: 37114784 DOI: 10.2174/1871529x23666230419095422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/06/2023] [Accepted: 03/10/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Bernard Soulier Syndrome (BSS) is a rare autosomal recessive disorder due to deficiency or dysfunction of the glycoprotein GPIb-V-IX complex on the platelet surface. It is also known as hemorrhagiparous thrombocytic dystrophy or congenital hemorrhagiparous thrombocytic dystrophy. The patient usually presents with severe and prolonged bleeding along with characteristics of giant blood platelets and low platelet counts. Manifestations of BSS include epistaxis, gum bleeding, purpuric rashes, menorrhagia, rarely melena, and hematemesis. On the other hand, immune thrombocytopenic purpura (ITP) is an acquired autoimmune disorder in which there is accelerated platelet destruction and reduced platelet production. Isolated thrombocytopenia without fever, lymphadenopathy, and organomegaly usually lead to the diagnosis of immune thrombocytopenia. CASE PRESENTATION A 20 years old female presented with complaints of recurrent episodes of epistaxis since childhood and menorrhagia during menarche. She was misdiagnosed as ITP elsewhere. Later, based on thorough clinical examination and investigation, the diagnosis was confirmed as BSS. CONCLUSION BSS should always be taken in the differential diagnosis of ITP, especially when persistent, refractory, and treated unsuccessfully with steroids or splenectomy.
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Affiliation(s)
- Bhavya J
- Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Nitish Kumar Patel
- Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Nilesh Kumar
- Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Jitendra Singh
- Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Kailash Kumar
- Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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22
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Abera EG, Tukeni KN, Didu GH, Chala TK, Yilma D, Gudina EK. Epistaxis and thrombocytopenia as major presentations of louse borne relapsing fever: Hospital-based study. PLoS One 2022; 17:e0279721. [PMID: 36584095 PMCID: PMC9803200 DOI: 10.1371/journal.pone.0279721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/13/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Louse-borne relapsing fever (LBRF) remains a cause of sporadic illness and occasional outbreaks in Ethiopia and other east African countries in overcrowded and unhygienic settings. In this article, we present clinical profiles and treatment outcome of patients treated as confirmed or probable cases of LBRF at Jimma Medical Center (JMC) in southwest Ethiopia. METHODS Patients treated as confirmed or probable cases of LBRF at JMC during a period of May-July 2022 were prospectively followed during their course of hospital stay. All patients were evaluated with blood film for hemoparasites, complete blood count, and liver enzymes on hospital presentation. They were followed with daily clinical evaluation during their hospital stay. RESULT Thirty-six patients were treated as cases of LBRF. All patients except one were from Jimma Main Prison in Jimma Town, Ethiopia. All the patients were male with mean age of 28.7 years (SD = 12.7). The diagnosis of LBRF was confirmed by detection of B. recurrentis in blood film of 14 (38.9%) of the patients; the rest were treated as presumptive case of LBRF. Fever, reported by all patients, and an acute onset epistaxis, 30 (83.3%), were the major reasons for healthcare visits. Twenty-two (61.1%) patients were having thrombocytopenia with a platelet count < 150,000/μL; nine (25%) of which had severe forms (<50,000/μL). All patients were treated with oral doxycycline and discharged with improvement after a mean length of hospital stay of 4.25 days (SD = 0.77), range 2-6 days. Public health emergency was activated within two days of the first cases and helped in delousing all the cases and their contacts. CONCLUSION LBRF remains a public health problem in Ethiopia in settings with poor personal hygiene. Patients with LBRF may present with severe thrombocytopenia and life-threatening bleeding. Early detection and treatment initiation prevents outbreak propagation and improves treatment outcome.
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Affiliation(s)
- Eyob Girma Abera
- Department of Public Health, Jimma University, Jimma, Oromia, Ethiopia
- Clinical Trial Unit, Jimma University, Jimma, Oromia, Ethiopia
- * E-mail:
| | | | | | - Temesgen Kabeta Chala
- Department of Health Policy and Management, Jimma University, Jimma, Oromia, Ethiopia
| | - Daniel Yilma
- Clinical Trial Unit, Jimma University, Jimma, Oromia, Ethiopia
- Department of Internal Medicine, Jimma University, Jimma, Oromia, Ethiopia
| | - Esayas Kebede Gudina
- Clinical Trial Unit, Jimma University, Jimma, Oromia, Ethiopia
- Department of Internal Medicine, Jimma University, Jimma, Oromia, Ethiopia
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23
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Al-Samkari H. Doxycycline for bleeding in hereditary hemorrhagic telangiectasia: When low-hanging fruit meets inconvenient data. J Thromb Haemost 2022; 20:1067-1069. [PMID: 35445574 DOI: 10.1111/jth.15675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 02/10/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Hanny Al-Samkari
- Division of Hematology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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24
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Brighouse JR, Shepherd K, Santos R, Shivamurthy V. Sinister sinusitis. Arch Dis Child Educ Pract Ed 2022; 107:113-115. [PMID: 32933929 DOI: 10.1136/archdischild-2020-319887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 07/22/2020] [Indexed: 11/04/2022]
Abstract
Two previously well Caucasian teenage girls with no significant travel or family history were admitted with sinusitis refractory to treatment with antibiotics. Both had progressive symptoms despite broad-spectrum antibiotics and developed involvement of other systems, ultimately requiring admission to the paediatric intensive care unit (PICU). They were subsequently diagnosed with the same condition and made an excellent recovery.The first girl, 14 years old, originally presented to her general practitioner with a sore throat, nasal congestion, and fever. Despite multiple courses of antibiotics over the following month she presented again multiple times with progressive symptoms including epistaxis, widespread myalgia and arthralgia, difficulty in breathing, haemoptysis, fatigue, and weight loss. Examination on admission found minimal discharge from her right tympanic membrane, ulcerated inferior turbinates with dried blood and yellow mucus in both nasal cavities, swollen tonsils without exudate, and an isolated aphthous ulcer on the tip of her tongue. She had small bilateral cervical lymph nodes. Examination of the cardiovascular system was unremarkable but on respiratory examination there was reduced air entry on the right side. Her abdomen was generally tender but soft with no organomegaly. A week into her admission she developed an oxygen requirement and increased work of breathing requiring intubation and ventilation.The second girl, 13 years old, presented to her local hospital with a 1-day history of epistaxis, right ear pain, and pain and swelling to the right periorbital tissues. Again, despite multiple courses of antibiotics, she had persistent symptoms and subsequently developed fever, fatigue, haemoptysis, and had a syncopal episode. She was admitted to her local district general hospital and, despite initial treatment, deteriorated over the following 2 weeks with persistent fever, new oxygen requirement, deteriorating renal function, and anaemia. She was transferred to a tertiary centre for respiratory support which escalated from Optiflow, through continuous then biphasic positive airway pressure, intubation and ventilation, and ultimately VV-ECMO.The investigations for both patients prior to admission to PICU at our centre are shown in table 1.
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Affiliation(s)
| | - Kathryn Shepherd
- Paediatric Rheumatology, Evelina London Children's Hospital, London, UK
| | - Rui Santos
- Department of Paediatric Radiology, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
| | - Vinay Shivamurthy
- Paediatric Rheumatology, Evelina London Children's Hospital, London, UK
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25
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Stihl C, Haubner F. [ Epistaxis: Osler's disease as an important differential diagnosis]. MMW Fortschr Med 2022; 164:44-45. [PMID: 35274264 DOI: 10.1007/s15006-022-0774-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Clemens Stihl
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, LMU Klinikum München, Marchioninistraße 15, 81377, München, Germany.
| | - Frank Haubner
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, LMU Klinikum München, Marchioninistraße 15, 81377, München, Germany
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26
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Wang YJ, Ren YY, Tang CY, Li XT, Liu JF. [Clinical characteristics analysis of two cases of nosebleed with acute cerebral hemorrhage]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2021; 56:1336-1337. [PMID: 34963223 DOI: 10.3760/cma.j.cn115330-20210304-00108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Y J Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Y Y Ren
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - C Y Tang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - X T Li
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - J F Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
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27
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胡 健, 王 剑, 许 敏, 来 育, 薛 涛, 陈 福, 查 定, 陈 晓. [Hereditary hemorrhagic telangiectasia: 8 case report and lirerature review]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2021; 35:1031-1034. [PMID: 34886610 PMCID: PMC10128373 DOI: 10.13201/j.issn.2096-7993.2021.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Indexed: 04/30/2023]
Affiliation(s)
- 健 胡
- 空军军医大学西京医院耳鼻咽喉头颈外科(西安,710032)
| | - 剑 王
- 空军军医大学西京医院耳鼻咽喉头颈外科(西安,710032)
| | - 敏 许
- 空军军医大学西京医院耳鼻咽喉头颈外科(西安,710032)
| | - 育斌 来
- 空军军医大学西京医院耳鼻咽喉头颈外科(西安,710032)
| | - 涛 薛
- 空军军医大学西京医院耳鼻咽喉头颈外科(西安,710032)
| | - 福权 陈
- 空军军医大学西京医院耳鼻咽喉头颈外科(西安,710032)
| | - 定军 查
- 空军军医大学西京医院耳鼻咽喉头颈外科(西安,710032)
| | - 晓栋 陈
- 空军军医大学西京医院耳鼻咽喉头颈外科(西安,710032)
- 陈晓栋,
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28
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Abstract
PURPOSE Woodruff's plexus is a vascular network located on the posterior lateral wall of the inferior meatus of the nasal cavity and it is generally considered to be responsible for posterior epistaxis. Despite being initially identified in 1949 as a venous plexus, discrepancies exist within literature regarding this anatomical structure, particularly its arterial or venous nature and its association with posterior epistaxis. This systematic review aims to collate information pertaining to Woodruff's plexus and evaluate our current understanding of this vascular area. METHODS The systematic review was performed using published data in PubMed, Google Scholar, Scopus, EBSCO and Web of Science platforms using keywords such as 'Woodruff', 'posterior' and 'plexus'. Articles referring to Woodruff's plexus were collected and analysed by independent reviewers. RESULTS The search revealed 154 papers, out of which only 40 were included in the review. Out of this number only two papers were anatomical dissection studies, both of which identify the plexus as venous in nature. Seventeen studies describe the plexus as venous by citing these two papers. The remainder of the articles (23) consider Woodruff's plexus as arterial with variability in the reported arteries that supply it. CONCLUSION Woodruff's original description of a venous plexus is supported by modern anatomical studies. There are a multitude of reports that Woodruff's plexus is arterial in nature, despite the absence of existing anatomical studies to support this notion. This misconception has likely arisen due to clinical associations in relation to posterior epistaxis.
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Affiliation(s)
- Cezar Octavian Morosanu
- Human Anatomy Resource Centre (HARC), University of Liverpool, Sherrington Building, Ashton Street, Liverpool, L69 3GE, UK.
| | - Craig Humphreys
- Human Anatomy Resource Centre (HARC), University of Liverpool, Sherrington Building, Ashton Street, Liverpool, L69 3GE, UK
| | - Stephanie Egerton
- Human Anatomy Resource Centre (HARC), University of Liverpool, Sherrington Building, Ashton Street, Liverpool, L69 3GE, UK
| | - Claire M Tierney
- Human Anatomy Resource Centre (HARC), University of Liverpool, Sherrington Building, Ashton Street, Liverpool, L69 3GE, UK
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29
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Markussen DL, Hagen JE, Tvedt A, Steihaug OM. Epistaxis after testing for COVID-19. Tidsskr Nor Laegeforen 2021; 141:21-0114. [PMID: 33950662 DOI: 10.4045/tidsskr.21.0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Testing for airway microbes has increased during the current COVID-19 pandemic. This case report demonstrates that testing can lead to complications. CASE PRESENTATION A man in his seventies was transferred to our hospital for coronary angiography. On admission he underwent testing with nasopharyngeal swab for COVID-19. He started bleeding profusely from the nostril insertion site. The haemorrhage was controlled by bilateral anterior and posterior balloon tamponade, the coronary angiography was postponed, he was given a transfusion of packed red blood cells and had to spend a total of nine days in hospital. INTERPRETATION The World Health Organization recommends screening of all patients for COVID-19 upon admission to hospital. The risk of every procedure must be carefully considered in relation to the benefits, especially when large numbers of patients are affected. For our patient, the likelihood of COVID-19 infection was low, and the risk of complications was high.
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30
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Garry S, Wauchope J, Ryan ÉJ, Heffernan C. Response to Alsaif A et al. The addition of silver nitrate cautery to antiseptic nasal cream for patients with epistaxis: A systematic review and meta-analysis. Int J Pediatr Otorhinolaryngol 2021; 141:110569. [PMID: 33349452 DOI: 10.1016/j.ijporl.2020.110569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/14/2020] [Indexed: 11/20/2022]
Affiliation(s)
- S Garry
- Department of Otorhinolaryngology, Children's Hospital Ireland at Temple Street, Dublin 1, Ireland; Department of Surgery, Royal College of Surgeons in Ireland, Dublin 1, Ireland.
| | - J Wauchope
- Department of Otorhinolaryngology, Children's Hospital Ireland at Temple Street, Dublin 1, Ireland; Department of Surgery, Royal College of Surgeons in Ireland, Dublin 1, Ireland
| | - É J Ryan
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin 1, Ireland
| | - C Heffernan
- Department of Otorhinolaryngology, Children's Hospital Ireland at Temple Street, Dublin 1, Ireland; Department of Surgery, Royal College of Surgeons in Ireland, Dublin 1, Ireland
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31
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Abstract
ABSTRACT Acute hemorrhagic edema of infancy is a rare leukocytoclastic vasculitis that affects infants and children aged 4 to 24 months. We report a case of a 5-month-old girl with purpuric lesions with associated hemorrhagic lacrimation and epistaxis.
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Affiliation(s)
| | - Carolina Vega
- Department of Pediatrics, University of Connecticut School of Medicine
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32
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Juniat V, Rose GE, Timlin H, Wagh VJ, Abou-Rayyah Y, Uddin J, Verity DH. Day-Case Admission for External Dacryocystorhinostomy in Preschool Children. Ophthalmic Plast Reconstr Surg 2021; 37:65-66. [PMID: 32379172 DOI: 10.1097/iop.0000000000001694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Epistaxis during or after dacryocystorhinostomy may present a risk of circulatory compromise, particularly in young children. In view of this concern, we reviewed the outcome and complications of external dacryocystorhinostomy in preschool children, aged less than 4½ years. DESIGN Retrospective noncomparative series. PATIENTS AND METHODS A case-note review for a series of preschool children undergoing external dacryocystorhinostomy as a day-case admission at Moorfields Eye Hospital between 1992 and 2018; all surgery was consultant-led. Details were taken of the type of surgery, any intraoperative or postoperative complications (surgical or anesthetic), any unplanned admissions after surgery, and the functional outcome. To assess the veracity of the medical records, the parents for a sample of 67 children were contacted to check whether there had been any unrecorded events or concerns. OUTCOME MEASURES Anesthetic or surgical complications, unplanned admissions, and postoperative events. RESULTS One-hundred and eighty-seven children (117 boys; 63%) underwent 228 external dacryocystorhinostomies during 201 admissions, the average admission age being 36.8 months (median, 37.5; range, 5.5-53.5 months). Forty-one children (20%) underwent bilateral dacryocystorhinostomy: the 27 having simultaneous bilateral surgery dacryocystorhinostomy were operated at a mean age of 38.2 months (median, 37.5; range, 15.5-53.5 months), this being significantly different from the average age at first operation in 14 children undergoing sequential admission for bilateral dacryocystorhinostomy (mean, 24.9 months; median, 27.0; range, 5.5-42.5) (p = 0.0023). No adverse anesthetic events were recorded, 2 children (2 dacryocystorhinostomies) required temporary nasal packing at the end of surgery for epistaxis, and one further child was admitted for overnight observation because of persistent mild epistaxis after bilateral dacryocystorhinostomy. Three children (3 dacryocystorhinostomies) had a mild, self-limiting secondary epistaxis, and there were no unplanned emergency admissions. The telephone survey did not reveal any disparity in the medical records. CONCLUSION With experienced surgeons and anesthetists in a suitable specialist hospital, external dacryocystorhinostomy in preschool children would appear to be a safe and effective procedure, with few and minor complications. Although facilities for overnight observation should be available, the surgery can typically be planned as a day-case admission, and simultaneous bilateral surgery is also possible in this age-group.
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Affiliation(s)
- Valerie Juniat
- Adnexal Service, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
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Canpolat DG, Orbay Yasli S. Does a Nasal Airway Facilitate Nasotracheal Intubation or Not? A Prospective, Randomized, and Controlled Study. J Oral Maxillofac Surg 2020; 79:89.e1-89.e9. [PMID: 32961126 DOI: 10.1016/j.joms.2020.08.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/24/2020] [Accepted: 08/24/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Nasotracheal intubation (NTI) is generally preferred for maxillofacial surgery to provide a more suitable and wide surgery area for the surgeons. The purpose of the study was to evaluate whether using a nasal airway just before the NTI may facilitate NTI or not. METHODS This prospective, randomized, and controlled study was performed on patients who were admitted to our hospital for maxillofacial surgery. In group 1, a nasal airway was used just before the NTI during mask ventilation, and patients in the group were ventilated without nasal airway. Airway group was the primary predictor of the study. The NTI duration was the primary outcome variable, and the number of attempts was the secondary outcome variable. Difficulty of ventilation and complications were the other variables that were recorded. RESULTS A total of 70 patients were included in the study and divided into 2 groups. There was no statistically significant relationship between the duration of NTI and other variables, but the significance value for sternomental distance, ventilation difficulty, and epistaxis was P < .10. The NTI duration (the primary outcome variable) and the number of attempts (the secondary outcome variable) are statistically lower in the nasal airway group (group 1) than the control group (group 2). Ventilation difficulty was significantly higher in group 2 when compared with group 1 (P = .04). The model and regression coefficients for both variables are statistically significant in terms of duration of NTI and number of attempt values that they were lower in nasal airway group than the control group. There were no statistically significant differences between the groups in terms of complications (P < .05). CONCLUSIONS The present study has shown that inserting a nasal airway into the nostril just before the NTI may facilitate the intubation process by preparing the nasal passage.
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Affiliation(s)
- Dilek Günay Canpolat
- Associate Professor in Anesthesiology, Department of Oral and Maxillofacial Surgery, Erciyes University, Kayseri, Turkey.
| | - Seher Orbay Yasli
- Assistant Professor in Anesthesiology, Department of Oral and Maxillofacial Surgery, Erciyes University, Kayseri, Turkey
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Dupuis-Girod S. Intravenous Bevacizumab in Hereditary Hemorrhagic Telangiectasia: A Role That Is Still to Be Defined. Mayo Clin Proc 2020; 95:1565-1566. [PMID: 32753127 DOI: 10.1016/j.mayocp.2020.06.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/24/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Sophie Dupuis-Girod
- Hôpital Femme-Mère-Enfants, Service de Génétique et Centre de Référence National pour la maladie de Rendu-Osler, Bron, France.
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Minarik L, Vargova K, Dusilkova N, Kulvait V, Jonasova A, Kodet O, Stopka T. Hereditary Haemorrhagic Telangiectasia (HHT) Marked by ACVRL1C1120T Variant Displays Hypopigmented Naevi and Frequent Bleeding Episodes if CYP2C9 Co-Mutated: Clinical Notes & Rationale of Patient Registry. Folia Biol (Praha) 2020; 66:1-6. [PMID: 32512653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Hereditary haemorrhagic telangiectasia (HHT) exhibits considerable phenotypic heterogeneity. Therefore, precise mutation screening and evaluation of patient risk must be determined in every HHT family. We present an HHT-2 case with an initial life-threatening bleeding episode that led to identification of a relatively large HHT family. Exome sequencing of the family members determined HHT-associated ACVRL1C1120T variant resulting in Arg374Trp substitution at the Ser/Thr-kinase domain region. The affected members display typical epistaxis symptomatology from early childhood resulting in sideropoenia. In addition, the HHT patients also displayed dermatology findings such as facial teleangiectasias and trunk/limb white spots representing post-inflammatory hypopigmentation. Interestingly, co-segregating with modifying cytochrome P450 (CYP2C) variant in the HHT patients led to NSAID intolerance marked by increased frequency of bleeding episodes. No arterial-venous malformation of the visceral organs and brain or association with cancer were observed. The heterogeneity of clinical presentation and the role of other variants support the need of regular patient monitoring and development of a nation-wide patient registry.
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Affiliation(s)
- L Minarik
- Biocev, First Faculty of Medicine, Charles University, Vestec, Czech Republic
| | - K Vargova
- Institute of Pathological Physiology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - N Dusilkova
- Biocev, First Faculty of Medicine, Charles University, Vestec, Czech Republic
- Institute of Pathological Physiology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - V Kulvait
- Biocev, First Faculty of Medicine, Charles University, Vestec, Czech Republic
| | - A Jonasova
- First Department of Medicine, Department of Haematology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - O Kodet
- Department of Dermatology and Venereology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - T Stopka
- Biocev, First Faculty of Medicine, Charles University, Vestec, Czech Republic
- First Department of Medicine, Department of Haematology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
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Rebella G, Basso L, Federici M, Castaldi A. Recurrent Epistaxis of Unknown Origin: the Role of Imaging. Acta Neurol Taiwan 2019; 28(4):126-130. [PMID: 32026456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
We report two cases of patients who presented to the Emergency Room (ER) with a history of recurrent epistaxis. Conservative treatment was provided to both patients and the most common causes of bleeding were excluded. Patients underwent radiological examinations that revealed the presence of an Intracavernous Carotid Artery Aneurysm (ICAA) extending into the sphenoid sinus through the erosion of postero-lateral bony wall. Aneurysms rupture caused massive nasal bleeding. The purpose of our case report is to illustrate as a very common symptom like epistaxis, in a small number of cases can be underestimated: rare and severe causes of nasal bleeding, as ICAA, should therefore always be considered in the differential diagnosis.
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Affiliation(s)
- Giacomo Rebella
- Department of Health Sciences (DISSAL), University of Genoa, Via Pastore 1, 16132 Genova, Italy
| | - Luca Basso
- Department of Health Sciences (DISSAL), University of Genoa, Via Pastore 1, 16132 Genova, Italy
| | - Margherita Federici
- Department of Ente Ospedaliero Ospedali Galliera, Department of Diagnostic and Interventional Neuroradiology
| | - Antonio Castaldi
- Department of Ente Ospedaliero Ospedali Galliera, Department of Diagnostic and Interventional Neuroradiology
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Decaix T, Grognet A, Cudennec T, Pépin M. [Not Available]. Soins Gerontol 2019; 24:43-44. [PMID: 31806179 DOI: 10.1016/j.sger.2019.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Théodore Decaix
- Service de gériatrie, hôpitaux universitaires Paris-Île-de-France-Ouest, site Ambroise-Paré, (AP-HP), 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - Alix Grognet
- Service de gériatrie, hôpitaux universitaires Paris-Île-de-France-Ouest, site Ambroise-Paré, (AP-HP), 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - Tristan Cudennec
- Service de gériatrie, hôpitaux universitaires Paris-Île-de-France-Ouest, site Ambroise-Paré, (AP-HP), 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - Marion Pépin
- Service de gériatrie, hôpitaux universitaires Paris-Île-de-France-Ouest, site Ambroise-Paré, (AP-HP), 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France.
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Al-Samkari H. Systemic Bevacizumab for Hereditary Hemorrhagic Telangiectasia: Considerations from Observational Studies. Otolaryngol Head Neck Surg 2019; 160:368. [PMID: 30798765 DOI: 10.1177/0194599818813521] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Yavorkovsky LL. Case 28-2018: A Man with Epistaxis, Pain and Erythema of the Forearm, and Pancytopenia. N Engl J Med 2018; 379:2381-2382. [PMID: 30575470 DOI: 10.1056/nejmc1813964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Griffith S, Archbold R, Schell S. Correlating regional emergency epistaxis visits with internet search activity. Am J Otolaryngol 2018; 39:685-687. [PMID: 30078510 DOI: 10.1016/j.amjoto.2018.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/13/2018] [Accepted: 07/17/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate the correlation between internet search activity and epistaxis-related Emergency Department visits. MATERIALS AND METHODS Data from Google Trends were obtained (www.google.com/trends) for the search term "nosebleed" in Erie County, Pennsylvania during a five-year period. All epistaxis-related CPT code events were obtained from one hospital in this county during the same period. Google total counts were cross tabulated with the following month's ED visits. Graphical analysis and correlation were used to assess the relationship between ED visits and search engine activity. RESULTS A strong positive correlation was observed between epistaxis-related ED visits and search engine activity for the term "nosebleed" (r = 0.655). CONCLUSION Search engine activities for the term "nosebleed" correlates strongly with epistaxis-related ED visits. This study demonstrates the usefulness of utilizing Google Trends search data to assess regional disease burdens, which may provide a means for epidemiological study that is quicker than conventional methods.
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Affiliation(s)
- Shane Griffith
- Department of Otolaryngology, University of Pittsburgh Medical Center Hamot, 201 State St, Erie, PA 16550, USA.
| | - Robert Archbold
- Lake Erie College of Osteopathic Medicine, 1858 W Grandview Blvd, Erie, PA 16509, USA.
| | - Stephen Schell
- Department of Otolaryngology, University of Pittsburgh Medical Center Hamot, 201 State St, Erie, PA 16550, USA
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Mondorf W. Manifestation of a Congenital Disorder. Dtsch Arztebl Int 2018; 115:250. [PMID: 29716692 PMCID: PMC5938550 DOI: 10.3238/arztebl.2018.0250a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Wolfgang Mondorf
- *Praxis und Labor zur Diagnostik und Therapie von Blutgerinnungsstörungen Frankfurt am Main
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Gossage JR. The Current Role of Bevacizumab in the Treatment of Hereditary Hemorrhagic Telangiectasia-Related Bleeding. Mayo Clin Proc 2018; 93:130-132. [PMID: 29395348 DOI: 10.1016/j.mayocp.2017.12.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 12/21/2017] [Indexed: 11/20/2022]
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Muszalska J, Zatoński T. [Inverted papilloma of the nasal cavity - a case report]. Pol Merkur Lekarski 2017; 42:87-89. [PMID: 28258684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Inverted papilloma is a rare, benign sinonasal tumor. Its etiology is the most likely related to HPV infection. Inverted papilloma originates from the ciliated respiratory epithelium, typically from the lateral nasal wall. The tumor is characterized by endophytic growth inwards the stroma with adjacent tissues destruction. The clinical symptoms are non-specific, such as: unilateral obstruction of the nasal duct, rhinorrhoea, epistaxis and anosmia. The treatment consists in a complete surgical excision of the tumor. Inverted papilloma has a tendency to recurrence with incomplete resection and a potential to malignant transformation to squamous cell carcinoma. This manuscript presents a case of a young woman who suffered from recurrent epistaxis from ulceration of the mucous of the anterior part of the nasal septum. The patient in the interview had indicated the symptoms since six months and unsuccessful treatment with cetirizine. The woman was qualified to a surgical removal of the lesion with a transnasal approach. The histopahtological examination of the sample revealed Papilloma inversum. One-year follow up did not disclose the recurrence of the tumor.
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Affiliation(s)
- Jadwiga Muszalska
- Clinical Department of Otolaryngology, 4th Military Clinical Hospital with Outpatients Unit in Wroclaw, Poland
| | - Tomasz Zatoński
- Chair and Department of Otolaryngology, Head and Neck Surgery, Medical University of Wroclaw, Poland
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Dupuis-Girod S, Ambrun A, Decullier E, Fargeton AE, Roux A, Bréant V, Colombet B, Rivière S, Cartier C, Lacombe P, Chinet T, Blivet S, Blondel JH, Gilbert-Dussardier B, Dufour X, Michel J, Harle JR, Dessi P, Faure F. Effect of Bevacizumab Nasal Spray on Epistaxis Duration in Hereditary Hemorrhagic Telangectasia: A Randomized Clinical Trial. JAMA 2016; 316:934-42. [PMID: 27599328 DOI: 10.1001/jama.2016.11387] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Epistaxis is the most frequent and disabling manifestation of hereditary hemorrhagic telangiectasia (HHT). The efficacy of intravenous bevacizumab (an anti-vascular endothelial growth factor monoclonal antibody) for epistaxis has been shown. However, the efficacy of intranasal bevacizumab has yet to be evaluated. OBJECTIVE To evaluate the efficacy of 3 different doses of bevacizumab administered as a nasal spray in a repeated manner for the duration of nosebleeds in patients with HHT. DESIGN, SETTING, AND PARTICIPANTS Randomized, multicenter, placebo-controlled, phase 2/3 clinical trial with dose selection at an intermediate analysis and prespecified stopping rules (nonbinding stopping for futility). Patients aged 18 years or older with a diagnosis of HHT were recruited from 5 French centers from April 2014 to January 2015 with a 6-month follow-up after the end of treatment. Participants had a history of self-reported nosebleeds with a monthly duration of more than 20 minutes in at least the 3 months prior to inclusion corroborated by epistaxis grids completed during the same preinclusion period. INTERVENTIONS Eighty consecutive HHT patients were randomized and treated in the phase 2 study, with 4 parallel groups in a 1:1:1:1 ratio. One group received placebo (n = 21); the other 3 received bevacizumab nasal spray. Each bevacizumab group received a different dose of the drug (25 mg [n = 20], 50 mg [n = 20], or 75 mg [n = 19] per treatment) in 3 doses 14 days apart for a total treatment duration of 4 weeks, resulting in a total dose of 75 mg, 150 mg, and 225 mg in each treatment group. MAIN OUTCOMES AND MEASURES Mean monthly epistaxis duration for 3 consecutive months immediately after the end of the treatment. RESULTS Of the 80 patients who were randomized (mean age, 60.47 [SD, 10.61] years; 37 women [46.25%]), 75 completed the study. Mean monthly epistaxis duration measured at 3 months was not significantly different in the 59 patients receiving bevacizumab in comparison with the placebo group (P = .57) or between the bevacizumab groups. The mean monthly epistaxis duration was 259.2 minutes (95% CI, 82.1-436.3 minutes) in the 25-mg group, 244.0 minutes (95% CI, 81.8-406.2 minutes) in the 50-mg group, 215.0 minutes (95% CI, 102.8-327.2 minutes) in the 75-mg group, and 200.4 minutes (95% CI, 109.3-291.5 minutes) in the placebo group. Toxicity was low and no severe adverse events were reported. This study was terminated prior to phase 3 for treatment futility after interim analysis on the recommendations of an independent data monitoring committee. CONCLUSIONS AND RELEVANCE In patients with HHT, a bevacizumab nasal spray treatment of 3 administrations at 14-day intervals with doses of 25 mg, 50 mg, or 75 mg per spray, compared with a placebo, did not reduce monthly epistaxis duration in the 3 consecutive months immediately after the end of treatment. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02106520.
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Affiliation(s)
- Sophie Dupuis-Girod
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfants, Service de Génétique et centre de référence sur la maladie de Rendu-Osler, Bron, France2Université de Lyon, Faculté de médecine, Université Lyon 1, Lyon, France
| | - Alexis Ambrun
- Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service d'ORL, Lyon, France
| | - Evelyne Decullier
- Hospices Civils de Lyon, pôle IMER, Lyon, France5Université Lyon 1, Lyon, France
| | - Anne-Emmanuelle Fargeton
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfants, Service de Génétique et centre de référence sur la maladie de Rendu-Osler, Bron, France2Université de Lyon, Faculté de médecine, Université Lyon 1, Lyon, France
| | - Adeline Roux
- Hospices Civils de Lyon, pôle IMER, Lyon, France
| | - Valentine Bréant
- Hospices Civils de Lyon, Pharmacie, Hôpital Louis Pradel, Bron, France
| | - Bettina Colombet
- Hospices Civils de Lyon, Pharmacie, Hôpital Louis Pradel, Bron, France
| | - Sophie Rivière
- Service de Médecine Interne A, Centre Hospitalier Universitaire, Montpellier, France
| | - César Cartier
- Service d'ORL, Centre Hospitalier Universitaire, Montpellier, France
| | - Pascal Lacombe
- Hôpital Ambroise Paré, Service de Radiologie, Assistance Publique-Hôpitaux de Paris, Université Paris Ile-de-France Ouest, Boulogne, France
| | - Thierry Chinet
- Hôpital Ambroise Paré, Service de Pneumologie, Assistance Publique-Hôpitaux de Paris, Université Paris Ile-de-France Ouest, Boulogne, France
| | - Sandra Blivet
- Hôpital Ambroise Paré, Service de Pneumologie, Assistance Publique-Hôpitaux de Paris, Université Paris Ile-de-France Ouest, Boulogne, France
| | - Jean-Hugues Blondel
- Hôpital Ambroise Paré, Service d'ORL, Assistance Publique-Hôpitaux de Paris, Université Paris Ile-de-France Ouest, Boulogne, France
| | | | | | - Justin Michel
- Hôpital de la conception, CHU de Marseille, Service de médecine interne, Marseille, France
| | - Jean-Robert Harle
- Hôpital de la conception, CHU de Marseille, Service de médecine interne, Marseille, France
| | - Patrick Dessi
- Hôpital la Timone, CHU de Marseille, Service d'ORL, Marseille, France
| | - Frédéric Faure
- Hospices Civils de Lyon, Hôpital E. Herriot, Service d'ORL, Lyon, France
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Wang Y, Wang Y, Ma Y, Pu X. [The role of Th9, Th17 and Treg cells on pathogenesis of nasal polyps]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2016; 30:277-281. [PMID: 27373033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To investigate the expression levels of Th9, Th17 and Treg cells in peripheral blood of patients with chronic rhinosinusitis with nasal polyps (CRSwNP), and explore the role of Th9, Th17 and Treg cells in the progression of CRSwNP. METHOD Forty-six cases with CRSwNP served as an experimental group, while 22 cases with simple nasal bleeding or nasal septum deviation served as a control group. The peripheral blood of patients in both groups was collected and analyzed. (1) Using flow cytometry (FCM) to detect the expression rates of Th9, Th17 and Treg cells in peripheral blood. (2) Using qRT-PCR to detect the expression of relevant transcription factor of Th9, Th17 and Treg cells (IL-9mRNA, PU. 1, IRF-4, RoRc, and Foxp3). (3) Using SPSS16.0 to analyse the differentiations and the revelance among these three cells. RESULT (1) The expression rates of Th9 and Th17 cells in patients with CRSwNP (1.29% ± 0.18%, 4.03% ± 0.69%) was higher than the control group (0.45% ± 0.14%, 1.35% ± 0.26%). But the expression rates of Treg cells in the experimental group (2.98% ± 0.13%) was significantly lower than the control group (5.44% ± 0.57%). The differences were statistically significant (P < 0.05). (2) The expression of revelant transcription factor (IL-9mRNA, PU.1, IRF-4, RoRc) in NP group was also higher than the control group. The expression of Foxp3 in the control group was higher than NP, the differences both were statistically significant (P < 0.05). (3) The difference between Th9 and Th17 in patients with NP was not significant (P > 0.05), and the negative correlation was found between Th17 and Treg (r = -0.549, P < 0.05). CONCLUSION The high expression level of Th9 and Th17 cells might promote the development of NP, whereas the low expression level of Treg cells might further aggravate the occurrence of NP. The main function of the imbalance of Th17/Treg cells may be immune regulation in the pathogenesis of nasal polys.
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Li J, Bian D, Wang J. [Pleomorphic adenoma of the nasal septum: a case report]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2016; 30:76-77. [PMID: 27197465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We report a rare case of pleomorphic adenoma arising from the nasal septum. A 37-year-old woman presented with a 1-year-history of right-sided occasional epistaxis. Computed tomographic scans revealed an oval mass in the right nasal cavity. The tumor was removed endoscopically with endonasal approach. The microscopic finding showed numbers of myoepithelial cells and duct-like structures consisting of loose myxoid stroma. This lesion had histological characteristics of a pleomorphic adenoma, and this was confirmed by immunohistochemical expression of cytokeratin, S-100 protein and SMA. Her post-operative course was uneventful, and she is currently free from the disease 1.5 years after surgery.
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Lu S, Zhang L, Li J. [Research progress on the management of no packing after septoplasty]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2016; 30:80-83. [PMID: 27197467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Packing the nose after septoplasty is common practice. The use of postoperative packing has been proposed to reduce the dead space between the subperichondrial flaps and minimize postoperative complications such as hemorrhage, septal hematoma, and formation of synechiae. Additionally, postoperative packing is thought to stabilize the remaining cartilaginous septum and minimize persistence or recurrence of septal deviation. Despite these theoretic advantages, evidence to support the use of postoperative packing is lacking. Additionally, nasal packing is not an innocuous procedure. The use of nasal packing actually cause these complications such as postop- erative pain, mucosal injury, bleeding, worsening of breathing due to sleep disorders, and postoperative infections. Routine use of anterior nasal packing after septoplasty should be challenged for not presenting proven benefit. As alternatives to traditional packing, septal suturing, septal stapler and fibrin glue have been used recently. The purpose of this article is to summarize the progress of traditional packing to no packing after septoplasty.
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