Blog Archive

Αλέξανδρος Γ. Σφακιανάκης

Thursday, May 20, 2021

IgG4-Related Disease and the Salivary Glands

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IgG4-related disease is a rare, immune-mediated, systemic disease that is characterized by soft tissue lymphocyte infiltration and resultant fibrosis. The salivary glands are among the most commonly affected organs. Patients present with subacute submandibular and/or parotid swelling and sialadenitis. Diagnosis incorporates clinical, serologic, radiologic, and pathologic findings. Most cases respond quickly to systemic glucocorticoids. IgG4-related disease mimics many infectious, inflammatory, and neoplastic diseases. Therefore, IgG4-related disease is frequently misdiagnosed. A knowledge of the pathophysiology, diagnosis, and management of IgG4-related disease is important for providers who treat salivary gland diseases.
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Extent and Indications for Elective and Therapeutic Neck Dissection for Salivary Carcinoma

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Although salivary gland malignancies account for only a small percentage of all head and neck cancers, the incidence is increasing. Furthermore, there is a wide variety of histologic subtypes which must be taken into account in the context of their location. Each is associated with a different rate of regional metastasis and overall survival. This article examines the incidence of salivary gland malignancies and provides evidence for the indications for and extent of elective or therapeutic neck dissection based on location, pathologic type, and histopathologic characteristics.
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Observation Rather than Surgery for Benign Parotid Tumors

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Surgery is the preferred treatment of benign parotid lesions, but it carries a risk of complications. Therefore, the approach toward the surgery of these lesions should seek to avoid complications. There are no guidelines or recommendations for when not to operate. Integration of comorbidities and other factors shift the scales from surgery toward observation in a small subset of patients presenting with parotid tumors. When observation is chosen, the patient should be followed frequently and cautiously, and the surgeon should be prepared to change strategy to surgical excision if in doubt.
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Practical Salivary Ultrasound Imaging Tips and Pearls

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Ultrasound imaging is a valuable and effective clinical tool for salivary gland disorder evaluation and management. Pathologies including salivary duct stenosis, sialolithiasis, neoplasms, and autoimmune disorders have characteristic sonographic features. Maneuvers such as bimanual palpation and oral administration of sialagogues during the ultrasound examination can enhance examination findings. Ultrasound guidance is useful for targeting needle biopsies of neoplasms, ensuring appropriate intraparenchymal gland injections, and augmenting salivary duct instrumentation and intraoperative management.
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Olig2 knockdown alleviates hypoxic-ischemic brain damage in newborn rats

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Histol Histopathol. 2021 May 20:18344. doi: 10.14670/HH-18-344. Online ahead of print.

ABSTRACT

OBJECTIVES: Neuronal damage is an important pathological mechanism in neonatal hypoxic-ischemic brain damage (HIBD). We found in our previous studies that oligodendrocyte transcription factor 2 (Olig2) downregulation was able to increase cell survival in the brain. However, the specific mechanism has yet to be clarified.

METHODS: Sprague-Dawley rats aged 3 d were randomly divided into three groups: the normal control group, the Olig2-RNAi group, and the RNAi-negative control group. The normal control group received no treatment, the Olig2-RNAi group received the Olig2 RNAi adenovirus, and the RNAi-negative control group was given the control adenovirus after the completion of the HIBD model. Infarct lesions and their volumes were observed by triphenyltetrazolium chloride (TTC) staining 3 d after the completion of the adenovirus local i njection. The condition of the tissue was characterized by hematoxylin-eosin staining 7 d after the model was established, and cell viability was determined by azure methylene blue staining. Subcellular damage was analyzed by transmission electron microscopy. Rotarod analysis was performed to detect moving behavior ability and an MWM assay was conducted to evaluate the memory.

RESULTS: TTC staining showed a smaller brain injury area in the Olig2-RNAi group than in the RNAi-negative control group. Hematoxylin-eosin staining indicated the presence of severe cell injury in the hippocampal region after HIBD, which improved after Olig2 knockdown. Azure methylene blue staining and electron microscopy results suggested that the cells improved after Olig2 knockdown. The rats stayed longer on the rotating rod, and their latency in the water maze test was gradually shortened relative to that of the rats in the Olig2-RNAi negative control group.

CONCLUSION: Olig2 knockdown can prom ote the repair of hypoxic-ischemic brain damage in newborn rats.

PMID:34013967 | DOI:10.14670/HH-18-344

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The displacement technique: a simple method for clearing maxillary sinus stubborn mucus

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Eur Arch Otorhinolaryngol. 2021 May 20. doi: 10.1007/s00405-021-06874-7. Online ahead of print.

ABSTRACT

BACKGROUND: Clearing thick secretions from the hidden crevices of the maxillary sinus can be challenging and can increase operative time during endoscopic sinus surgery.

METHODS: We demonstrate the Displacement Technique as a user-friendly technique to address thick secretions within the maxillary sinus barring no orbital floor dehiscence. First, a wide maxillary antrostomy is performed. Then, a surgical pledget is placed in the maxillary sinus to displace the inspissated content into the nasal cavity using a curved suction. This process is repeated as necessary.

CONCLUSION: The displacement technique is a simple and inexpensive method for addressing stubborn secretions.

PMID:34014361 | DOI:10.1007/s00405-021-06874-7

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Wednesday, May 19, 2021

Following historical ‘tracks’ of hair follicle miniaturisation in patterned hair loss: Are elastin bodies the forgotten aetiology?

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Abstract

Pattern Hair Loss (PHL) is a chronic regressive condition of the scalp, where follicular miniaturisation and decreased scalp hair coverage occurs in affected areas. In all PHL cases there is a measurable progressive shortening of the terminal hair growth duration, along with reduced linear growth rates. In both genders, PHL initially shows an increase in short telogen hairs ≤30mm in length, reflecting a cycle completion of under six months in affected terminal hair follicles. To understand the miniaturisation process, we re-examine the dynamics of miniaturisation and ask the question, 'why do miniaturised hair follicles resist treatment?' In the light of recent developments in relation to hair regeneration, we looked back in the older literature for helpful clues 'lost to time' and reprise a 1978 Hermann Pinkus observation of an array of elastin deposits beneath the dermal papilla following subsequent anagen/telogen transitions in male balding, originally described by Ar ao and Perkins who concluded that these changes provide a "morphologic marker of the entire biologic process in the balding scalp". Thus, we have reviewed the role of the elastin-like bodies in hair pathology and we propose that alterations in elastin architecture may contribute to the failure of vellus-like hair reverting back to their terminal status and may indicate a new area for therapeutic intervention.

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