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Αλέξανδρος Γ. Σφακιανάκης

Thursday, January 21, 2021

Die dentogene Sinusitis

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Laryngorhinootologie
DOI: 10.1055/a-1339-1606

In den letzten Jahren wird eine steigende Anzahl odontogener Entzündungen der Kieferhöhle beobachtet. Voraussetzung für eine bakterielle Infektion der Kieferhöhle ist die Perforation der Schneider'schen Membran. Pathogenetisch ist die ostiomeatale Einheit durch die vom Kieferhöhlenboden aufsteigende Infektion erst sekundär involviert. Wichtig sind neben der Anamnese bildgebende Verfahren, wobei der hochauflösenden CT und der DVT wegen der 3-dimensionalen Auflösung eine besondere Aufgabe zukommt. Eine zahnärztliche Röntgenaufnahme oder eine zahnärztliche Untersuchung zur Diagnostik ist in vielen Fällen nicht ausreichend. Aufgrund der Anatomie sind vor allem die Molaren al s Auslöser einer dentogenen Sinusitis anzusehen. Das Keimspektrum ist polymikrobiell mit einer Dominanz von Anaerobiern. Therapeutisch favorisieren wir die 1-zeitige Operation mit Sanierung des zugrunde liegenden Prozesses und funktioneller Nebenhöhlenchirurgie. Auch in der Implantologie kann die funktionelle Nebenhöhlenchirurgie einen wesentlichen Beitrag zur Sanierung entzündlicher Komplikationen leisten.
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Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Article in Thieme eJournals:
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GREB1L, CRELD2 and ITGA10 expression in the human developmental and postnatal kidneys: an immunohistochemical study.

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GREB1L, CRELD2 and ITGA10 expression in the human developmental and postnatal kidneys: an immunohistochemical study.

Acta Histochem. 2021 Jan 15;123(2):151679

Authors: Lasić V, Kosović I, Jurić M, Racetin A, Čurčić J, Šolić I, Lozić M, Filipović N, Šoljić V, Martinović V, Saraga-Babić M, Vukojević K

Abstract
BACKGROUND: Aim of our study is to provide an insight into the genetic expression landscape of GREB1L, ITGA10 and CRELD2 which are important in human genitourinary tract development which might help elucidate the critical stages for the onset of kidney anomalies.
METHODS: Morphological parameters were analyzed using immunohistochemistry on human foetal (13-38 w) and postnatal (1.5 and 7.5y) human kidney samples.
RESULTS: GREB1L marker had a strong intensity and the highest rate in proximal tubules (PTC) of 1.5 years' kidney (90.25%). In the distal tubules (DCT) there were statistically significant differences in 13 w, 15 w, 16 w, 21 w, 38 w and 7.5y regarding 1.5y (Kruskal-Wallis test, p < 0.001). There was significantly more GREB1L in the glomeruli at 21 w and 38 w in regard to all other stages (Kruskal-Wallis test, p < 0.01). ITGA10 staining intensity was strongest in PCT with the highest rate in 13 w (92.75%), while the lowest rate was found in glomeruli and DCT (Kruskal-Wallis test, p < 0.001). CRELD2 had the strongest staining intensity in PCT with the highest rate in 13 w and 1.5y (92.25%) and lowest in the glomeruli of 7.5 years (24.3 %). In DCT there were statistically significant differences in CRELD2 positive cells in 13 w, 15 w, 16 w, 21 w, 38 w and 7.5y regarding 1.5y (Kruskal-Wallis test, p < 0.01). ITGA10 and CRELD 2 co-localised in the postnatal period in DCT.
CONCLUSION: High kidney expressions of GREB1L, ITGA10 and CRELD2 even in the postnatal period implicate their importance not only for the onset of CAKUT in the case of their mutation but also for maintenance of kidney homeostasis.

PMID: 33460985 [PubMed - as supplied by publisher]

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Methotrexate on the hippocampus, cerebellum, liver, and kidneys

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Evaluation of the effect of methotrexate on the hippocampus, cerebellum, liver, and kidneys of adult male albino rat: Histopathological, immunohistochemical and biochemical studies.

Acta Histochem. 2021 Jan 16;123(2):151682

Authors: Ahmed ZSO, Hussein S, Ghandour RA, Azouz AA, El-Sakhawy MA

Abstract
Methotrexate (MTX) has been used for treatment of autoimmune diseases, inflammatory disorders as rheumatic arthritis, and different types of cancers. However, it has shown adverse effects on vital organs. The current study was conducted to investigate the toxic effect of MTX on the hippocampus, cerebellum, liver and kidneys of adult male albino rats. MTX was injected weekly at 5 mg/kg body weight via I/P injection for 6 weeks. At the end of the experiment, histopathological, immunohistochemical and biochemical evaluation were performed on the hippocampus, cerebellum, liver, and kidney tissues of the sacrificed rats. We observed that methotrexate induced neural tissue damage in the hippocampus and cerebellum, degeneration of hepatocytes, congestion of the central vein and blood sinusoids of the liver, distortion in the renal corpuscles and necrosis of the renal tubule. Immunohistochemical findings revealed strong positive expression of Caspase-3, PCNA and GFAP. Biochemical stu dies revealed significant elevation in the serum levels of AST and ALT, in addition to high serum concentrations of creatinine and urea. Also, MTX injection increased MDA, while it decreased GSH, SOD and AChE levels. We conclude the ability of MTX to induce oxidative stress that results into apoptosis and tissue injury, leading to neurotoxicity, hepatotoxicity, and nephrotoxicity.

PMID: 33465564 [PubMed - as supplied by publisher]

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Anatomo-sonographic identification of the longissimus capitis and splenius cervicis muscles: principles for possible application to ultrasound-guided botulinum toxin injections in cervical dystonia.

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Anatomo-sonographic identification of the longissimus capitis and splenius cervicis muscles: principles for possible application to ultrasound-guided botulinum toxin injections in cervical dystonia.

Surg Radiol Anat. 2021 Jan 18;:

Authors: Brumpt E, Aubry S, Vuillier F, Tatu L

Abstract
OBJECTIVE: The main objective of this study was to define and verify anatomo-sonographic landmarks for ultrasound-guided injection of botulinum toxin into the longissimus capitis (LC) and splenius cervicis (SC) muscles.
METHODS AND RESULTS: After a preliminary work of anatomical description of the LC and SC muscles, we identified these muscles on two cadavers and then on a healthy volunteer using ultrasound and magnetic resonance imaging (MRI) to establish a radio-anatomical correlation. We defined an anatomo-sonographic landmark for the injection of each of these muscles. The correct positioning of vascular glue into the LC muscle and a metal clip into the SC muscle of a fresh cadaver as verified by dissection confirmed the utility of the selected landmarks.
DISCUSSION: For the LC muscle, the intramuscular tendon of the cranial part of the muscle appears to be a reliable anatomical landmark. The ultrasound-guided injection can be performed within the cranial portion of the muscle, between the intra-muscular tendon and insertion into the mastoid process at dens of the axis level. For the SC muscle, the surface topographic landmarks of the spinous processes of the C4-C5 vertebrae and the muscle body of the levator scapulae muscle seem to be reliable landmarks. From these, the ultrasound-guided injection can be carried out laterally by transfixing the body of the levator scapulae.
CONCLUSION: The study defined two cervical anatomo-sonographic landmarks for injecting the LC and SC muscles.

PMID: 33459837 [PubMed - as supplied by publisher]

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The infragluteal fold: An appraisal by MRI combined with an anatomic study.

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The infragluteal fold: An appraisal by MRI combined with an anatomic study.

Surg Radiol Anat. 2021 Jan 18;:

Authors: Stivala A, di Summa PG, Bernard C, Moris V, See LA, Loffroy R, Zwetyenga N, Cheynel N, Guillier D

Abstract
PURPOSE: The gluteal region is a key element of beauty balance and sexual appearance. However, there is no clear anatomical description of the infragluteal fold, nor any classification exists allowing standardizing treatment of this area in case of jeopardisation. The purpose of this study was to perform an anatomical description of the infragluteal fold (IGF) matching radiological and anatomical findings in describing specifically raise of the fibrous component at the bone level.
METHODS: Six volunteers (three males and three females) underwent an MRI scan (Siemens Aera® 1.5 T) of the pelvic region. T1 Vibe Morpho T2, Sag Space 3D, and Millimetric slices were performed in order to obtain a more detailed selection of the gluteal landmark. Trabecular connective tissue of the region was analyzed using Horos® ROI (region of interest) segmentation function. Four fresh cadavers (two males, two females, accounting for 8 hemipelvis) were dissected in order to compare the radiological findings.
RESULTS: The infragluteal fold is a connectival fibrous band extending from the ramus of the ischium (but not involving the ischial tuberosity, for a length of 21 mm ± 2 and 21 mm ± 3), the apex of the sacrum (for a length of 13 ± 2 and 11 mm ± 2), and the coccyx (for a length of 19 mm ± 2 and 20 mm ± 2, all measures referring to volunteers and cadavers, respectively) reaching superficially the dermis of the medial one-third of the cutaneous fold. No significant difference was found between volunteer and cadaver group in MRI measurement of bony origins, or between MRI and cadaveric dissection measurements.
CONCLUSION: Knowledge of this structure will define novel surgical techniques in infragluteal fold restoration.

PMID: 33462737 [PubMed - as supplied by publisher]

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Shoulder scaption is dependent on the behavior of the different partitions of the infraspinatus muscle.

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Shoulder scaption is dependent on the behavior of the different partitions of the infraspinatus muscle.

Surg Radiol Anat. 2021 Jan 19;:

Authors: Hoshikawa K, Yuri T, Giambini H, Kiyoshige Y

Abstract
PURPOSE: The purpose of this study was to investigate if the three partitions (superior, middle, and inferior partitions) of the infraspinatus muscle previously described in anatomical studies will present different behavior during scapular plane abduction (scaption) as described using shear-wave elastography, especially during initial range of motion.
METHODS: Eight volunteers held their arm against gravity 15° intervals from 30° to 150° in scaption. Shear-wave elastography was implemented at each position to measure shear modulus at rest and during muscle contraction, as a surrogate for muscle stiffness, of each partition. Muscle activity was defined as the difference in stiffness values between the resting positions and those during muscle contraction (ΔE = stiffness at contraction-stiffness at rest).
RESULTS: The activity value for the middle partition was 25.1 ± 10.8 kPa at 30° and increased up to 105° (52.2 ± 10.8 kPa), with a subsequent decrease at larger angle positions (p < .001). The superior partition showed a flatter and constant behavior with smaller activity values except at higher angles (p < .001). Peak activity values for the superior partition were observed at 135° (23.0 ± 12.0 kPa). Increase activity for inferior partition began at 60° and showed a peak at 135° (p < .001; 32.9 ± 13.8 kPa).
CONCLUSION: Stiffness measured using shear-wave elastography in each partition of the infraspinatus muscle demonstrated different behavior between these partitions during scaption. The middle partition generated force throughout scaption, while the superior and inferior partitions exerted force at end range.

PMID: 33464394 [PubMed - as supplied by publisher]

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Knowledge, Attitudes, Beliefs, and Treatment Burden Related to the Use of Levothyroxine in Hypothyroid Pregnant Women in the United States

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Abstract
Background: The use of prescribed medications during pregnancy is a challenge and an underestimated source of treatment burden. Levothyroxine (LT4) for the treatment of overt and subclinical hypothyroidism is extensively prescribed during pregnancy. To this end, we aimed to explore the patients' perceived benefits and risks, knowledge, beliefs, attitudes, and related burden of LT4 therapy during pregnancy.

Methods: In this cross-sectional study, we surveyed pregnant women who were treated with LT4 during pregnancy from January 1, 2019, to December 31, 2019, in a tertiary academic medical center of the United States. The anonymous online survey included questions to gather demographic data and multiple-choice questions regarding the benefits and risks, knowledge, beliefs, attitudes, and burden related to LT4 use during pregnancy.

Results: Sixty-four pregnant women (mean age 31.5 years) completed the study survey (response rate: 96%): 62% were diagnosed with hypothyroidism more than 12 months before pregnancy, 16% less than or about 12 months before pregnancy, and 22% during pregnancy. We found that one-third of pregnant women using LT4 had a feeling of uneasiness/anxiety due to their hypothyroidism diagnosis. About half of the respondents (45%) reported that they did not receive an explanation by their clinician regarding the maternal/fetal risks of uncontrolled hypothyroidism or the benefits of adequate control. Finally, two in three patients expressed various concerns of LT4-related treatment burden.

Conclusions: Our findings support the need for increased effective communication and tailored counseling to address fears, anxiety, and uncertainties about the benefits and risks of LT4 use in pregnancy. For patients with clear benefits from LT4 treatment in pregnancy, it could help to overcome their concerns, promote adherence, and decrease adverse maternal/fetal outcomes. For patients with no clear benefits established, clinicians need to be aware of LT4-related treatment burden in pregnancy and implement patient-centered approaches in their clinical practices.

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Thyroid, Ahead of Print.
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Papillary Thyroid Carcinoma with High-Grade Features Versus Poorly Differentiated Thyroid Carcinoma: An Analysis of Clinicopathologic and Molecular Features and Outcome

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Abstract
Background: Similar to poorly differentiated thyroid carcinoma (PDTC), papillary thyroid carcinoma with high-grade features (PTC HGF) demonstrates increased mitotic activity and/or necrosis; however, PTC HGF is excluded from the World Health Organization (WHO) definition of PDTC based on maintained nuclear features of PTC.

Methods: Consecutive tumors that met criteria for PTC HGF, defined as tumors with maintained nuclear features of PTC and mitoses numbering 5 or more per 10 contiguous high-power fields and/or tumor necrosis, and PDTC (defined as per the WHO criteria) were identified. Clinicopathologic characteristics, follow-up data, and targeted next-generation sequencing results were compared between groups.

Results: There were 15 PTC HGF and 47 PDTC. PTC HGF was associated with a higher rate of pT4 disease (53% vs. 13%, p = 0.0027) and lymph node metastases (73% vs. 38%, p = 0.049). The disease-specific survival was worse for patients with PTC HGF compared with those with PDTC using Kaplan–Meier estimation (p < 0.001) and was worse in subgroup analysis evaluating patients with widely invasive PDTC (i.e., those with a similar rate of pT4 disease) and PTC HGF (p = 0.040). PTC HGF had a higher BRAFV600E mutation rate (42% vs. 3%; p = 0.003), a trend toward more gene fusions (25% vs. 3%; p = 0.052), and a higher rate of relative gain of 1q (67% vs. 15%; p = 0.002) than PDTC.

Conclusions: Our results demonstrate that PTC HGF are important to recognize based on their aggressive behavior. The molecular differences between PTC HGF and PDTC suggest that PTC HGF should be considered a distinct group from PDTC.

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Thyroid, Ahead of Print.
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Middle Ear Carcinoid Tumor With External Auditory Canal Extension

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Middle Ear Carcinoid Tumor With External Auditory Canal Extension: A Case Report.

Ear Nose Throat J. 2021 Jan 20;:145561321989145

Authors: Tsetsos N, Poutoglidis A, Sotiroudi S, Baliaka A, Vlachtsis K

PMID: 33470831 [PubMed - as supplied by publisher]

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Chronic Sphenoiditis With Deep Neck Space Extension

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Chronic Sphenoiditis With Deep Neck Space Extension: Case Report With Review of the Literature and Postulated Mechanisms for Extracranial Extension.

Ear Nose Throat J. 2021 Jan 20;:145561321989453

Authors: Levinson J, Rossi IR, Kuan EC, Tajudeen BA

Abstract
Isolated primary sphenoid sinusitis is a rare occurrence, estimated to make up less than 3% of sinus infections. The posterior anatomic location of the sphenoid makes treatment challenging when it becomes infected. Complications involving intracranial extension to surrounding structures often result in cranial nerve deficits due to their proximity. A single case of chronic sphenoiditis with direct extracranial extension into the prevertebral space is reported with a discussion on clinical presentation, diagnosis, and management. A 46-year-old female patient with diffuse headaches radiating into the neck and throat was evaluated in the office. Computed tomography demonstrated sphenoiditis with direct extension into the prevertebral space. Imaging revealed a purported route of direct extension through the clinoid and directly into the clivus to form an abscess in the longus colli muscle. The patient underwent endoscopic surgical management including drainage of the prevertebral abscess and has since made a full recovery. This is the first reported case of direct extension of sphenoiditis into the prevertebral space. The findings highlight the importance of aggressive treatment of chronic sphenoid infections to prevent detrimental complications. Computed tomography imaging proved an advantageous imaging modality to demonstrate bony erosion and sinus tracts from the skull base to the deep neck space.

PMID: 33470832 [PubMed - as supplied by publisher]

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Eustachian Tube Dysfunction in Children With Adenoid Hypertrophy: The Role of Adenoidectomy for Improving Ear Ventilation.

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Eustachian Tube Dysfunction in Children With Adenoid Hypertrophy: The Role of Adenoidectomy for Improving Ear Ventilation.

Ear Nose Throat J. 2021 Jan 20;:145561321989455

Authors: Manno A, Iannella G, Savastano V, Vittori T, Bertin S, Pasquariello B, Pace A, Rossetti V, Magliulo G

Abstract
INTRODUCTION: To our knowledge, few papers have addressed preoperative evaluation of the impact of adenoid hypertrophy (AH) on the pathogenesis of eustachian tube dysfunction (ETD) in children with otitis media with effusion (OME).
AIM: The aim of this study was 2-fold: first, to evaluate ETD using tubomanometry and Eustachian Tube Score 7 (ETS-7), in a group of children having AH; second, to assess the clinical impact of adenoidectomy on the ETD of these patients.
METHODS: Fifty patients, aged 4 to 15 years, underwent adenoidectomy based on various parameters: size of the adenoids causing canal obstruction (grades 1-4), the presence of OME, and recurrent episodes of rhinosinusitis. The function of the eustachian tube was evaluated using ETS-7 before and after surgical treatment. The patients were followed up for 6 months.
RESULTS: Forty children presented ETD. Of these, 36 had a grade 4 AH. The preoperative mean value for ETS-7 was 6.62. The mean postoperative ETS-7 score showed a value of 9.60 with a statistical difference compared to the preoperative value (P = .0015).
CONCLUSIONS: Adenoid hypertrophy has a high impact on the frequency of ETD. In the patients observed in the present study, the ETS-7 score appeared to be a valid tool for assessing ETD both preoperatively and postoperatively. Adenoidectomy seemed to be effective in improving ETD as well as middle ear ventilation.

PMID: 33470833 [PubMed - as supplied by publisher]

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