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Thursday, June 6, 2019

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,


Cardiac MRI   Free-breathing Cardiorespiratory Synchronized Cine MRI for Assessment of Left and...
Cardiac MRI Free-breathing Cardiorespiratory Synchronized Cine MRI for Assessment of Left and Right Ventricular Volume and Function in Sedated Children and Adolescents with Impaired Breath-holding Capacity A free-breathing cardiorespiratory synchronized cine sequence acquires the complete cardiac cycle with adequate spatial, contrast, and temporal resolutions for evaluating ventricular morphology, volume, and function with image quality equivalent to that of the standard of reference breath-hold...
Αλέξανδρος Γ. Σφακιανάκης
2m
Repair of oroantral fistula via modified endoscopic medial maxillectomy with free nasal mucoperichondrial-osteal...
Repair of oroantral fistula via modified endoscopic medial maxillectomy with free nasal mucoperichondrial-osteal graftJiao Xia, Youxiang Ma, Hao Tian & Ruxiang ZhangReceived 06 Feb 2019, Accepted 28 Apr 2019, Published online: 20 May 2019Download citation  https://doi.org/10.1080/00016489.2019.1614221  Select Language▼Translator disclaimerAbstractBackground: Many techniques have been proposed to close an oroantral fistula (OAF), with most of them involving transoral repairs with oral soft tissue...
Αλέξανδρος Γ. Σφακιανάκης
15h
Comparison of anterior and posterior tympanomeatal flap elevations in endoscopic transcanal tympanoplasty...
Comparison of anterior and posterior tympanomeatal flap elevations in endoscopic transcanal tympanoplastyArin Ozturk ORCID Icon, Murat Benzer ORCID Icon, Isa Kaya ORCID Icon, Sercan Gode ORCID Icon, Cem Bilgen ORCID Icon & Tayfun Kirazli ORCID IconReceived 25 Mar 2019, Accepted 21 Apr 2019, Published online: 20 May 2019Download citation  https://doi.org/10.1080/00016489.2019.1612533  Select Language▼Translator disclaimerAbstractBackground: There is not an ideal tympanomeatal flap incision type...
Αλέξανδρος Γ. Σφακιανάκης
15h
Caloric tests in clinical practice in benign paroxysmal positional vertigo Jingtao Bi ORCID Icon, Bo...
Caloric tests in clinical practice in benign paroxysmal positional vertigoJingtao Bi ORCID Icon, Bo Liu, Yi Zhang, Jinping Duan & Qian ZhouReceived 09 Feb 2019, Accepted 28 Apr 2019, Published online: 17 May 2019Download citation  https://doi.org/10.1080/00016489.2019.1614220  Select Language▼Translator disclaimerAbstractBackground: The value of caloric tests in benign paroxysmal positional vertigo (BPPV) patients is unclear.Objectives: To analyze the features and clinical significance of caloric...
Αλέξανδρος Γ. Σφακιανάκης
15h
Application of multiplanar reconstruction of spiral CT in the diagnosis and treatment of enlarged vestibular...
Application of multiplanar reconstruction of spiral CT in the diagnosis and treatment of enlarged vestibular aqueductsBo Gao, Yi Jiang, Shasha Huang, Qiang Wang, Xue Gao, Jianming Cai &  show allReceived 28 Jan 2019, Accepted 21 Apr 2019, Published online: 24 May 2019Download citation  https://doi.org/10.1080/00016489.2019.1612534  Select Language▼Translator disclaimerAbstractBackground: Multiplanar reconstruction (MPR) of High Resolution Computed Tomography (HRCT) makes it possible to achieve...
Αλέξανδρος Γ. Σφακιανάκης
15h
association between local recurrence and surgical margins in vertical partial laryngectomy for T1 glottic...
association between local recurrence and surgical margins in vertical partial laryngectomy for T1 glottic squamous cell carcinomaYue Yang, Jian Zhou, Min Chen, Yi Fang, Lei Tao, Peijie He,  show allReceived 17 Dec 2018, Accepted 28 Apr 2019, Published online: 24 May 2019Download citation  https://doi.org/10.1080/00016489.2019.1614664  Select Language▼Translator disclaimerAbstractBackground: The effect of surgical margins on local recurrence in T1 glottic squamous cell carcinoma (GSCC) is unclear.Objectives:...
Αλέξανδρος Γ. Σφακιανάκης
15h
Effect of perinatal biotin deficiency on auditory pathway of the Wistar-Albino rats Nevreste Didem Sonbay...
Effect of perinatal biotin deficiency on auditory pathway of the Wistar-Albino ratsNevreste Didem Sonbay Yılmaz, Özer Erdem Gür, Nuray Ensari, Erdogan Bulut, Ozlem Tugce Kaya, Serap Sırvancı,  show allReceived 26 Jan 2019, Accepted 28 Apr 2019, Published online: 24 May 2019Download citation  https://doi.org/10.1080/00016489.2019.1614665  Select Language▼Translator disclaimerAbstractAim: Severe biotin deficiency associated with biotinidase enzyme deficiency in newborns is seen as severe neurological...
Αλέξανδρος Γ. Σφακιανάκης
15h
Clinical analysis of surgical treatment for head and neck lymphatic malformations in children: a series...
Clinical analysis of surgical treatment for head and neck lymphatic malformations in children: a series of 128 casesShengcai Wang, Jiangnan Du, Yuanhu Liu, Jie Zhang, Wentong Ge, Yamei Zhang,  show allReceived 12 Jan 2019, Accepted 03 May 2019, Published online: 06 Jun 2019Download citation  Select Language▼Translator disclaimerAbstractBackground: Lymphatic malformations (LMs) are caused due to abnormal lymphatic development, and mainly occur in neonates or young children. At present, the role of...
Αλέξανδρος Γ. Σφακιανάκης
15h
Microbiome and skin biology Purpose of review The skin is home to a diverse milieu of bacteria, fungi,...
Microbiome and skin biologyPurpose of review The skin is home to a diverse milieu of bacteria, fungi, viruses, bacteriophages, and archaeal communities. The application of culture-independent approaches has revolutionized the characterization of the skin microbiome and have revealed a previously underappreciated phylogenetic and functional granularity of skin-associated microbes in both health and disease states. Recent findings The physiology of a given skin-niche drives the site-specific differences...
Αλέξανδρος Γ. Σφακιανάκης
15h
New phenotypes in hypersensitivity reactions to nonsteroidal anti-inflammatory drugs Purpose of review...
New phenotypes in hypersensitivity reactions to nonsteroidal anti-inflammatory drugsPurpose of review Nonsteroidal anti-inflammatory drug (NSAID) is one of the most frequently prescribed medications in the medical field, and hypersensitivity to NSAID is a common adverse drug reaction encountered. However, NSAID hypersensitivity presents a variety of symptoms caused by diverse pharmacological and immunological mechanisms. Recent findings Owing to the heterogeneity of the disease, a new concept for...
Αλέξανδρος Γ. Σφακιανάκης
15h
Cutaneous drug hypersensitivity: developments and controversies Purpose of review Cutaneous drug hypersensitivity...
Cutaneous drug hypersensitivity: developments and controversiesPurpose of review Cutaneous drug hypersensitivity reactions (CDHRs) are a complicated area with multiple clinical manifestations and differential diagnoses, requiring differentiated diagnostic measurements and optimized therapeutic management. Recent findings Disseminated CDHRs to classical drugs can be classified by a simple algorithm, whereas chemotherapeuticals or biopharmaceuticals may show drug-specific and atypical clinical presentations....
Αλέξανδρος Γ. Σφακιανάκης
15h
Treatable traits in chronic rhinosinusitis with nasal polyps Purpose of review Chronic rhinosinusitis...
Treatable traits in chronic rhinosinusitis with nasal polypsPurpose of review Chronic rhinosinusitis with nasal polyps (CRSwNP) is a complex inflammatory sinonasal disease that deserves a multidisciplinary precision medicine approach. In a precision medicine model, a more pragmatic approach taking in consideration disease features that are potentially treatable should be considered. Recent findings Several treatable traits in CRSwNP can be identified: from disease-related ones, to extra-ENT features,...
Αλέξανδρος Γ. Σφακιανάκης
15h
Role of T cells in non-immediate drug allergy reactions Purpose of review Nonimmediate drug hypersensitivity...
Role of T cells in non-immediate drug allergy reactionsPurpose of review Nonimmediate drug hypersensitivity reactions (NI-DHR) constitute the most complex group of drug allergy, with many drugs involved. Both parent drugs and their reactive metabolites can be implicated. Although with some drugs the number of metabolites is limited, with others it is quite extensive and many still remain to be identified. The diagnostic approaches are insufficient for the diagnosis and realistic approaches that reproduce...
Αλέξανδρος Γ. Σφακιανάκης
15h
Neurotrophic factors and nerve growth factor in ocular allergy Purpose of review During allergic reaction,...
Neurotrophic factors and nerve growth factor in ocular allergyPurpose of review During allergic reaction, nervous and immune systems mutually interact through release of mediators, including neurotrophic factors and nerve growth factor (NGF). These mediators modulate allergic reaction through binding their receptors expressed by immune and structural cells and by stimulating neuropeptide release by nerves. The role of neuropeptides and NGF has been demonstrated in allergic asthma and rhinitis, and,...
Αλέξανδρος Γ. Σφακιανάκης
15h
Dupilumab after the 2017 approval for the treatment of atopic dermatitis: what's new and what's next?...
Dupilumab after the 2017 approval for the treatment of atopic dermatitis: what's new and what's next?Purpose of review The IL-4/13 antagonist dupilumab was approved in 2017 as the first biologic for atopic dermatitis. Here, we comprehensively review compelling new data regarding dupilumab published following the approval. Recent findings Daily clinical practice reports of dupilumab in atopic dermatitis are favorable and in line with the registration trials. Dupilumab does not appear to negatively...
Αλέξανδρος Γ. Σφακιανάκης
15h
Common and different roles of IL-4 and IL-13 in skin allergy and clinical implications Purpose of review...
Common and different roles of IL-4 and IL-13 in skin allergy and clinical implicationsPurpose of review This review summarizes the mode of action of IL-4 and IL-13 in skin allergy, upcoming therapeutics and depicts key outcomes of the latest clinical trials. Recent findings Atopic dermatitis is considered to be one of the most common inflammatory skin disease in industrialized countries. Accompanied by strong pruritus, atopic dermatitis has a significant impact on quality of life in severely affected...
Αλέξανδρος Γ. Σφακιανάκης
15h
Multi-Compartment Profiling of Bacterial and Host Metabolites Identifies Intestinal Dysbiosis and Its...
Multi-Compartment Profiling of Bacterial and Host Metabolites Identifies Intestinal Dysbiosis and Its Functional Consequences in the Critically Ill ChildWijeyesekera, Anisha, PhD1; Wagner, Josef, PhD2; De Goffau, Marcus, PhD1; Thurston, Sarah, MSc3; Rodrigues Sabino, Adilson, PhD4; Zaher, Sara, MSc3; White, Deborah, RN3; Ridout, Jenna, RN5; Peters, Mark J., FRCPCH, PhD6,7; Ramnarayan, Padmanabhan, FRCPCH, MD6,8; Branco, Ricardo G., FRCPCH, PhD5; Torok, M. Estee, FRCPCH, PhD3,5; Valla, Frederic, MD9;...
Αλέξανδρος Γ. Σφακιανάκης
15h
Second generation antihistamines: an update Sánchez-Borges, Mario; Ansotegui, Ignacio J. Role of the ocular surface microbiome in allergic disease Cavuoto, Kara M.; Stradiotto, Allison C.; Galor, Anat Biological treatments for severe asthma Assaf, Sara M.; Hanania, Nicola A. Biologics and anaphylaxis Sala-Cunill, Anna; Luengo, Olga; Cardona, Victoria Topical tacrolimus for allergic eye diseases Erdinest, Nir; Ben-Eli, Hadas; Solomon, Abraham
Common and different roles of IL-4 and IL-13 in skin allergy and clinical implicationsPurpose of review This review summarizes the mode of action of IL-4 and IL-13 in skin allergy, upcoming therapeutics and depicts key outcomes of the latest clinical trials. Recent findings Atopic dermatitis is considered to be one of the most common inflammatory skin disease in industrialized countries. Accompanied by strong pruritus, atopic dermatitis has a significant impact on quality of life in severely affected...
Αλέξανδρος Γ. Σφακιανάκης
15h
Sex disparities in salivary malignancies: Does female sex impact oncological outcome? Publication date:...
Sex disparities in salivary malignancies: Does female sex impact oncological outcome?Publication date: July 2019Source: Oral Oncology, Volume 94Author(s): Ximena Mimica, Marlena McGill, Ashley Hay, Daniella Karassawa Zanoni, Jatin P. Shah, Richard J. Wong, Alan L. Ho, Marc A. Cohen, Snehal G. Patel, Ian GanlyAbstractObjectivePrevious population-based studies in salivary gland carcinomas have described a relationship between female sex and superior oncological outcome.Patients and methodsOur institutional...
Αλέξανδρος Γ. Σφακιανάκης
15h
Surrogates of immunologic cell death (ICD) and chemoradiotherapy outcomes in head and neck squamous...
Surrogates of immunologic cell death (ICD) and chemoradiotherapy outcomes in head and neck squamous cell carcinoma (HNSCC)Publication date: July 2019Source: Oral Oncology, Volume 94Author(s): Panagiota Economopoulou, George Koutsodontis, Areti Strati, Efthymios Kirodimos, Evangelos Giotakis, Pavlos Maragoudakis, Constantine Prikas, Nikolaos Papadimitriou, Christos Perisanidis, Eleni Gagari, Ioannis Kotsantis, Elena Vagia, Maria Anastasiou, Maria Gkotzamanidou, George Kavourakis, Evi Lianidou, Amanda...
Αλέξανδρος Γ. Σφακιανάκης
15h
Prospective clinical trial to evaluate safety and feasibility of using a single port flexible robotic...
Prospective clinical trial to evaluate safety and feasibility of using a single port flexible robotic system for transoral head and neck surgeryPublication date: July 2019Source: Oral Oncology, Volume 94Author(s): Jason Y.K. Chan, Raymond K. Tsang, F. Christopher Holsinger, Michael C.F. Tong, Cherrie W.K. Ng, Philip W.Y. Chiu, Simon S.M. Ng, Eddy W.Y. WongAbstractIntroductionThe aim of this study was to determine the clinical safety and feasibility of a novel single-port flexible robot for Transoral...
Αλέξανδρος Γ. Σφακιανάκης
15h
Multifocality of papillary thyroid carcinoma as a risk factor for disease recurrence Publication date:...
Multifocality of papillary thyroid carcinoma as a risk factor for disease recurrencePublication date: July 2019Source: Oral Oncology, Volume 94Author(s): Woo Ri Choi, Jong-Lyel Roh, Gyungyup Gong, Kyung-Ja Cho, Seung-Ho Choi, Soon Yuhl Nam, Sang Yoon KimAbstractObjectivesTumor multifocality or bilaterality is associated with increased risk of papillary thyroid carcinoma (PTC) recurrence. However, its prognostic value in clinical outcomes remains controversial. This study aimed to evaluate the association...
Αλέξανδρος Γ. Σφακιανάκης
15h
Does increasing the incidence of extracapsular dissection for benign tumors of the parotid correlate...
Does increasing the incidence of extracapsular dissection for benign tumors of the parotid correlate with an increased need for revision surgery?Publication date: July 2019Source: Oral Oncology, Volume 94Author(s): Konstantinos Mantsopoulos, Sarina K. Mueller, Miguel Goncalves, Mirco Schapher, Michael Koch, Heinrich IroAbstractObjectivesThe aim of this study was to investigate the hypothesis of whether extracapsular dissection (ED) of the parotid gland increases the need for revision surgery for...
Αλέξανδρος Γ. Σφακιανάκης
15h
A three-gene expression signature associated with positive surgical margins in tongue squamous cell...
A three-gene expression signature associated with positive surgical margins in tongue squamous cell carcinomas: Predicting surgical resectability from tumour biology?Publication date: July 2019Source: Oral Oncology, Volume 94Author(s): Zuzana Saidak, Caroline Pascual, Jebrane Bouaoud, Louise Galmiche, Florian Clatot, Stéphanie Dakpé, Cyril Page, Antoine GalmicheAbstractObjectivesAchieving complete tumour resection is one of the main goals of surgery for head and neck squamous cell carcinoma (HNSCC)...
Αλέξανδρος Γ. Σφακιανάκης
15h
Priorities of human papillomavirus-associated oropharyngeal cancer patients at diagnosis and after...
Priorities of human papillomavirus-associated oropharyngeal cancer patients at diagnosis and after treatmentPublication date: August 2019Source: Oral Oncology, Volume 95Author(s): Melina J. Windon, Carole Fakhry, Farhoud Faraji, Tanya Troy, Christine G. Gourin, Ana P. Kiess, Wayne Koch, David W. Eisele, Gypsyamber D'SouzaAbstractIntroductionLittle is known regarding how human papillomavirus-positive oropharyngeal cancer (HPV-OPC) patient goals change with treatment. This study evaluates whether patient...
Αλέξανδρος Γ. Σφακιανάκης
15h
Oral mucositis in head and neck cancer: Evidence-based management and review of clinical trial data...
Oral mucositis in head and neck cancer: Evidence-based management and review of clinical trial dataPublication date: August 2019Source: Oral Oncology, Volume 95Author(s): Adriana Blakaj, Marcelo Bonomi, Mauricio E. Gamez, Dukagjin M. BlakajAbstractOral Mucositis (OM) continues to be an oncologic challenge in the context of antineoplastic therapy for head and neck cancer (HNC) treatment. It is a dose-limiting toxicity of chemotherapy and radiation treatment and negatively impacts quality of life and...
Αλέξανδρος Γ. Σφακιανάκης
15h
Intracellular calprotectin (S100A8/A9) controls epithelial differentiation and caspase-mediated cleavage...
Intracellular calprotectin (S100A8/A9) controls epithelial differentiation and caspase-mediated cleavage of EGFR in head and neck squamous cell carcinomaPublication date: August 2019Source: Oral Oncology, Volume 95Author(s): Prokopios P. Argyris, Zachary Slama, Chris Malz, Ioannis G. Koutlas, Betty Pakzad, Ketan Patel, Deepak Kademani, Ali Khammanivong, Mark C. HerzbergAbstractObjectivesCalprotectin (S100A8/A9) appears to function as a tumor suppressor in head and neck squamous cell carcinoma (HNSCC)...
Αλέξανδρος Γ. Σφακιανάκης
15h
Oral Oncology
Second primary cancers in patients with oral cavity cancer included in the Korea Central Cancer RegistryPublication date: August 2019Source: Oral Oncology, Volume 95Author(s): Seung-Ki Min, Sung Weon Choi, Jiwon Lim, Joo Yong Park, Kyu-Won Jung, Young-Joo WonAbstractObjectivesThe improved survival of patients with oral cavity cancer (OCC) has generated interest in factors affecting survivorship, particularly among second primary cancer (SPC) patients. This study aimed to assess the incidence, patterns,...
Αλέξανδρος Γ. Σφακιανάκης
15h
Second primary cancers in patients with oral cavity cancer
included in the Korea Central Cancer RegistryPublication date: August 2019Source: Oral Oncology, Volume 95Author(s): Seung-Ki Min, Sung Weon Choi, Jiwon Lim, Joo Yong Park, Kyu-Won Jung, Young-Joo WonAbstractObjectivesThe improved survival of patients with oral cavity cancer (OCC) has generated interest in factors affecting survivorship, particularly among second primary cancer (SPC) patients. This study aimed to assess the incidence, patterns, and risk factors for SPC after OCC treatment in the...
Αλέξανδρος Γ. Σφακιανάκης
15h
Ischemic Preconditioning Maintains Performance on Two 5-km Time Trials in Hypoxia da Mota, Gustavo R.1,2;...
Ischemic Preconditioning Maintains Performance on Two 5-km Time Trials in Hypoxiada Mota, Gustavo R.1,2; Willis, Sarah J.2; dos Santos, Nelson Sobral2; Borrani, Fabio2; Billaut, François3; Millet, Grégoire P.2Medicine & Science in Sports & Exercise: May 31, 2019 - Volume Publish Ahead of Print - Issue - pdoi: 10.1249/MSS.0000000000002049Original Investigation: PDF OnlyBUYPAPAbstractAuthor InformationArticle MetricsPurpose The ergogenic effect of ischemic preconditioning (IPC) on endurance...
Αλέξανδρος Γ. Σφακιανάκης
15h
Dual-Task Walking Capacity Mediates Tai Ji Impact on Physical and Cognitive Function Li, Fuzhong1; Harmer,...
Dual-Task Walking Capacity Mediates Tai Ji Impact on Physical and Cognitive FunctionLi, Fuzhong1; Harmer, Peter2; Chou, Li-Shan3Medicine & Science in Sports & Exercise: May 31, 2019 - Volume Publish Ahead of Print - Issue - pdoi: 10.1249/MSS.0000000000002051Original Investigation: PDF OnlyBUYPAPAbstractAuthor InformationArticle MetricsPurpose Emerging evidence indicates exercise training improves mobility and cognition and reduces falls in older adults, but underlying mechanisms are not well...
Αλέξανδρος Γ. Σφακιανάκης
15h
Ultrasound Does Not Detect Acute Changes in Glycogen in Vastus Lateralis of Man Routledge, Harry E1;...
Ultrasound Does Not Detect Acute Changes in Glycogen in Vastus Lateralis of ManRoutledge, Harry E1; Bradley, Warren J1; Shepherd, Sam O1; Cocks, Matthew1; Erskine, Robert M1,2; Close, Graeme L1; Morton, James P1Medicine & Science in Sports & Exercise: May 31, 2019 - Volume Publish Ahead of Print - Issue - pdoi: 10.1249/MSS.0000000000002052Original Investigation: PDF OnlyBUYPAPAbstractAuthor InformationArticle MetricsPurpose To examine the validity of ultrasound (via cloud based software that...
Αλέξανδρος Γ. Σφακιανάκης
15h
Postural instability according to virtual reality program Hwibin Im, Tae-Hun Kim, Seung-Hwan Bang, Jung...
Postural instability according to virtual reality programHwibin Im, Tae-Hun Kim, Seung-Hwan Bang, Jung Kyu Lee, Jae-Jun Song ORCID Icon & Sung-Won ChaeReceived 25 Mar 2019, Accepted 28 Apr 2019, Published online: 30 May 2019Download citation  https://doi.org/10.1080/00016489.2019.1614223  Select Language▼Translator disclaimerAbstractBackground: The popularity of virtual reality (VR) grew rapidly. Short guidelines with a lack of emphasis on safe use appears prior to usage. It is necessary for...
Αλέξανδρος Γ. Σφακιανάκης
15h
Endolymphatic hydrops induced by different mechanisms responds differentially to spironolactone: a rationale...
Endolymphatic hydrops induced by different mechanisms responds differentially to spironolactone: a rationale for understanding the diversity of treatment responses in hydropic inner ear diseaseEva Degerman, René In 't Zandt, Annki Pålbrink & Måns MagnussonReceived 10 Feb 2019, Accepted 03 May 2019, Published online: 30 May 2019Download citation  https://doi.org/10.1080/00016489.2019.1616819  AbstractBackground: The exact pathophysiological mechanism(s) underlying endolymphatic hydrops (EH) remain...
Αλέξανδρος Γ. Σφακιανάκης
15h
Comprehensive comparison of MR image quality between intratympanic and intravenous gadolinium injection...
Comprehensive comparison of MR image quality between intratympanic and intravenous gadolinium injection using 3D real IR sequencesYang Li, Yan Sha, Feng Wang, Ping Lu, Xilan Liu, Yaru Sheng,  show allReceived 25 Oct 2018, Accepted 30 Dec 2018, Published online: 25 May 2019Download citation  https://doi.org/10.1080/00016489.2019.1600719  Select Language▼Translator disclaimerAbstractBackground: Intratympanic and intravenous gadolinium administration is used to visualise endolymphatic hydrops.Aims/objectives:...
Αλέξανδρος Γ. Σφακιανάκης
15h
Orbital cavernous haemangioma; profile and outcome of 76 patients managed surgically Pedro Clarós ORCID...
Orbital cavernous haemangioma; profile and outcome of 76 patients managed surgicallyPedro Clarós ORCID Icon, Emmanuel Choffor-Nchinda ORCID Icon, Marta Lopez-Fortuny, Andres Claros ORCID Icon & Salvador QuintanaReceived 10 Mar 2019, Accepted 21 Apr 2019, Published online: 01 Jun 2019Download citation  https://doi.org/10.1080/00016489.2019.1618913  Select Language▼Translator disclaimerAbstractBackground: Orbital cavernous haemangioma (OCH) is one of the most common primary orbital tumours in...
Αλέξανδρος Γ. Σφακιανάκης
15h
An investigation of life quality of patients after two different acoustic neuroma resections Fei Ning,...
An investigation of life quality of patients after two different acoustic neuroma resectionsFei Ning, Haiwei Zuo, Lei Guo, Changling Jiao, Xiaoping Xu, Bingbing Kong &  show allPages 547-551 | Received 09 Jan 2019, Accepted 04 Apr 2019, Published online: 03 May 2019Download citation  https://doi.org/10.1080/00016489.2019.1606437  Select Language▼Translator disclaimerAbstractBackground: Patients may suffer postoperative facial nerve injury, hearing loss, or other postoperative complications after...
Αλέξανδρος Γ. Σφακιανάκης
15h
Empyema thoracis in children: A 5-year experience in a Tertiary Care Institute Kartik Chandra Mandal,...
Empyema thoracis in children: A 5-year experience in a Tertiary Care InstituteKartik Chandra Mandal, Gobinda Mandal, Pankaj Halder, Dipanwita Mitra, Bidyut Debnath, Mala BhattacharyaJournal of Indian Association of Pediatric Surgeons 2019 24(3):197-202Objective: Empyema thoracis (ET) in children is a disease of significant morbidity and mortality. In the event of failure to resolute following intercostal chest tube drainage (ICD), thoracotomy decortication (TDC) remains the treatment of choice. We...
Αλέξανδρος Γ. Σφακιανάκης
15h
Testicular volume in a cohort of prepubertal Indian children Rohith Srinivas, Reju Joseph Thomas, Tunny...
Testicular volume in a cohort of prepubertal Indian childrenRohith Srinivas, Reju Joseph Thomas, Tunny Sebastian, Jujju Jacob KurianJournal of Indian Association of Pediatric Surgeons 2019 24(3):192-196Context: There are orchidometer-based testicular volume nomograms for Indian children; however, accurate and reliable values measured by ultrasound are lacking. Aims: The aim of this study was to (1) measure the testicular volumes of boys from birth to 8 years and generate reference values and (2)...
Αλέξανδρος Γ. Σφακιανάκης
15h
Early cholangitis after portoenterostomy in children with biliary atresia Priya Ramachandran, Mohamed...
Early cholangitis after portoenterostomy in children with biliary atresiaPriya Ramachandran, Mohamed Safwan, Muthukrishnan Saravana Balaji, Ashitha K Unny, Anis Akhtarkhavari, Vidya Tamizhvanan, Mohamed RelaJournal of Indian Association of Pediatric Surgeons 2019 24(3):185-188Aims and Objectives: Biliary atresia (BA) is a cholangiodestructive disease of the biliary tree. The first line of treatment is a Kasai portoenterostomy (PE) following which patients may develop cholangitis. We studied the effect...
Αλέξανδρος Γ. Σφακιανάκης
16h
Analysis of risk factors of pancreatic injury during elective laparoscopic splenectomy in children...
Analysis of risk factors of pancreatic injury during elective laparoscopic splenectomy in childrenMohammad Gharieb Khirallah, Fouad Hesham Salama, Mohammad Ahmad Arafa, Nagi Ebrahim Eldessoki, Mohammad ElshanshoryJournal of Indian Association of Pediatric Surgeons 2019 24(3):180-184Introduction: Laparoscopic splenectomy (LS) became the standard choice for splenectomy in children with benign hematological disease. There are few reports about pancreatic injury during LS. The purpose of this study is...
Αλέξανδρος Γ. Σφακιανάκης
16h
Analysis of prognostic factors in congenital diaphragmatic hernia in neonates Jenisha Chaudhary, B...
Analysis of prognostic factors in congenital diaphragmatic hernia in neonatesJenisha Chaudhary, B Shivprasad, V Lakshmi, R Shanmughsundaram, G Nandhini, P BalamourouganeJournal of Indian Association of Pediatric Surgeons 2019 24(3):176-179Aim: The aim is to study the demographic characteristics of neonates with congenital diaphragmatic hernia (CDH) and to analyze the prognostic factors determining mortality. Settings and Design: A retrospective cohort of CDH admitted at a tertiary level hospital...
Αλέξανδρος Γ. Σφακιανάκης
16h
Oral propranolol in infantile hemangiomas: Analysis of factors that affect the outcome Arun Mohanan...
Oral propranolol in infantile hemangiomas: Analysis of factors that affect the outcomeArun Mohanan Ainipully, Sarath Kumar Narayanan, Arun Preeth Vazhiyodan, Prathap SomnathJournal of Indian Association of Pediatric Surgeons 2019 24(3):170-175Aim: The primary treatment for the subset of infantile hemangiomas (IHs) which develops complication is pharmacological intervention, and propranolol has become a popular choice. Here, we evaluated the efficacy and safety of propranolol in a clinical cohort...
Αλέξανδρος Γ. Σφακιανάκης
16h
ambiguous genitaliaKashish Khanna, Shilpa Sharma, Devendra K Gupta Journal of Indian Association of...
ambiguous genitaliaKashish Khanna, Shilpa Sharma, Devendra K GuptaJournal of Indian Association of Pediatric Surgeons 2019 24(3):162-169Disorders of sex development (DSD) are a sensitive and stressful condition for the family as well as the treating physician to deal with. The main issue in managing such cases is sex assignment. The decision is influenced by the cultural background, the sex of rearing, clinical features, the biochemical parameters including hormonal studies, the imaging reports,...
Αλέξανδρος Γ. Σφακιανάκης
16h
Pediatric Surgery
ObituarySachchidananda DasJournal of Indian Association of Pediatric Surgeons 2019 24(3):157-157Avoiding litigation in clinical practiceParthapratim GuptaJournal of Indian Association of Pediatric Surgeons 2019 24(3):158-161A clinical approach to diagnosis of ambiguous genitaliaKashish Khanna, Shilpa Sharma, Devendra K GuptaJournal of Indian Association of Pediatric Surgeons 2019 24(3):162-169Disorders of sex development (DSD) are a sensitive and stressful condition for the family as well as the...
Αλέξανδρος Γ. Σφακιανάκης
16h
Πότε αξίζει να κάνετε υπομονή;, Αποφάσεις Γενικής Συνέλευσης..
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Αλέξανδρος Γ. Σφακιανάκης
17h
Comparison of 99mTc-Sestamibi Molecular Breast Imaging and Breast MRI in Patients With Invasive Breast...
Comparison of 99mTc-Sestamibi Molecular Breast Imaging and Breast MRI in Patients With Invasive Breast Cancer Receiving Neoadjuvant ChemotherapyKatie N. Hunt1, Amy Lynn Conners1, Matthew P. Goetz2, Michael K. O'Connor1 ... Show allShare Share+ Affiliations:Citation: American Journal of Roentgenology: 1-12. 10.2214/AJR.18.20628AbstractFull TextReferencesPDFPDF PlusAdd to FavoritesPermissionsDownload CitationABSTRACT :OBJECTIVE. The purpose of this study is to prospectively compare the size of invasive...
Αλέξανδρος Γ. Σφακιανάκης
20h
Peripheral Thyroid Nodule Calcifications on Sonography: Evaluation of Malignant Potential Harshawn S....
Peripheral Thyroid Nodule Calcifications on Sonography: Evaluation of Malignant PotentialHarshawn S. Malhi1, Erik Velez1, Brittany Kazmierski1, Mittul Gulati1 ... Show allShare Share+ Affiliation:Citation: American Journal of Roentgenology: 1-4. 10.2214/AJR.18.20799AbstractFull TextReferencesPDFPDF PlusAdd to FavoritesPermissionsDownload CitationABSTRACT :OBJECTIVE. The purpose of this study is to assess the association of thyroid cancer with sonographic features of peripheral calcifications.MATERIALS...
Αλέξανδρος Γ. Σφακιανάκης
20h
Comparison of Whole-Body DWI and 18F-FDG PET/CT for Detecting Intramedullary and Extramedullary Lesions...
Comparison of Whole-Body DWI and 18F-FDG PET/CT for Detecting Intramedullary and Extramedullary Lesions in Multiple MyelomaJianpu Chen1, Chongjiao Li1, Yueli Tian1, Qing Xiao1 ... Show allShare Share+ Affiliations:Citation: American Journal of Roentgenology: 1-9. 10.2214/AJR.18.20989AbstractFull TextReferencesPDFPDF PlusSupplementalAdd to FavoritesPermissionsDownload CitationABSTRACT :OBJECTIVE. The purpose of this study was to compare the ability of whole-body (WB) DWI and 18F-FDG PET/CT in detecting...
Αλέξανδρος Γ. Σφακιανάκης
20h
Gallium-68–Labeled Prostate-Specific Membrane Antigen–11 PET/CT of Prostate and Nonprostate Cancers...
Gallium-68–Labeled Prostate-Specific Membrane Antigen–11 PET/CT of Prostate and Nonprostate CancersSaabry Osmany1,2, Sumbul Zaheer3,4, Twyla B. Bartel5, Mickaila Johnston6 ... Show allShare Share+ Affiliations:Citation: American Journal of Roentgenology: 1-14. 10.2214/AJR.19.21084AbstractFull TextReferencesPDFPDF PlusAdd to FavoritesPermissionsDownload CitationABSTRACT :OBJECTIVE. The purpose of this study is to provide a concise summary of the current experience with 68Ga-labeled prostate-specific...
Αλέξανδρος Γ. Σφακιανάκης
20h
Artificial Intelligence in Musculoskeletal Imaging: Current Status and Future Directions Soterios Gyftopoulos1,2,...
Artificial Intelligence in Musculoskeletal Imaging: Current Status and Future DirectionsSoterios Gyftopoulos1,2, Dana Lin1, Florian Knoll1, Ankur M. Doshi1 ... Show allShare Share+ Affiliations:Citation: American Journal of Roentgenology: 1-8. 10.2214/AJR.19.21117AbstractFull TextReferencesPDFPDF PlusAdd to FavoritesPermissionsDownload CitationABSTRACT :OBJECTIVE. The objective of this article is to show how artificial intelligence (AI) has impacted different components of the imaging value chain...
Αλέξανδρος Γ. Σφακιανάκης
20h
Intraoperative Percutaneous Microcoil Localization of Small Peripheral Pulmonary Nodules Using Cone-Beam...
Intraoperative Percutaneous Microcoil Localization of Small Peripheral Pulmonary Nodules Using Cone-Beam CT in a Hybrid Operating RoomJason K. Lempel1 and Daniel P. Raymond2Share Share+ Affiliations:Citation: American Journal of Roentgenology: 1-4. 10.2214/AJR.19.21175AbstractFull TextReferencesPDFPDF PlusAdd to FavoritesPermissionsDownload CitationABSTRACT :OBJECTIVE. Thoracoscopic surgical resection of small peripheral pulmonary nodules can be challenging, and often preoperative localization techniques...
Αλέξανδρος Γ. Σφακιανάκης
20h
Sleeve Lobectomy for Non–Small Cell Lung Cancers: Predictive CT Features for Resectability and Outcome...
Sleeve Lobectomy for Non–Small Cell Lung Cancers: Predictive CT Features for Resectability and Outcome AnalysisJong Hyuk Lee1,2, Soon Ho Yoon1, Young Tae Kim3, Chang Hyun Kang3 ... Show allShare Share+ Affiliations:Citation: American Journal of Roentgenology: 1-10. 10.2214/AJR.19.21258AbstractFull TextReferencesPDFPDF PlusAdd to FavoritesPermissionsDownload CitationABSTRACT :OBJECTIVE. The purpose of this study was to investigate the CT features predictive of resectability in sleeve lobectomy (SL)...
Αλέξανδρος Γ. Σφακιανάκης
20h
VIDEO: Preoperative CT Angiography for Scapula Osteocutaneous Free Flap Reconstructions Bilal Mujtaba1,...
VIDEO: Preoperative CT Angiography for Scapula Osteocutaneous Free Flap ReconstructionsBilal Mujtaba1, Liang Gu1,2, Rene D. Largo3, Behrang Amini1 ... Show allShare Share+ Affiliations:Citation: American Journal of Roentgenology: W1-W2. 10.2214/AJR.19.21266AbstractFull TextReferencesPDFPDF PlusSupplementalAdd to FavoritesPermissionsDownload CitationABSTRACT :OBJECTIVE. The objective of this video article is to discuss the use of the scapular osteocutaneous free flap in reconstructive procedures....
Αλέξανδρος Γ. Σφακιανάκης
20h
Comparison of Radiography and Histopathologic Analysis in the Evaluation of Hip Arthritis Julia Crim1,...
Comparison of Radiography and Histopathologic Analysis in the Evaluation of Hip ArthritisJulia Crim1, Alexander Oserowsky2, Lester J. Layfield3 and Robert L. Schmidt4Share Share+ Affiliations:Citation: American Journal of Roentgenology: 1-7. 10.2214/AJR.19.21277AbstractFull TextReferencesPDFPDF PlusAdd to FavoritesPermissionsDownload CitationABSTRACT :OBJECTIVE. The purpose of this study was to establish the correlation of radiography findings with findings of gross and microscopic histopathologic...
Αλέξανδρος Γ. Σφακιανάκης
20h
Speed Versus Interpretation Accuracy: Current Thoughts and Literature Review Lawrence R. Muroff1,2,...
Speed Versus Interpretation Accuracy: Current Thoughts and Literature ReviewLawrence R. Muroff1,2, and Leonard Berlin3,4,5Share Share+ Affiliations:Citation: American Journal of Roentgenology: 1-3. 10.2214/AJR.19.21290AbstractFull TextReferencesPDFPDF PlusAdd to FavoritesPermissionsDownload CitationABSTRACT :OBJECTIVE. Whether there is a precise relationship between reading speed and diagnostic accuracy has been an elusive and much debated issue. We discuss the literature and include practical considerations...
Αλέξανδρος Γ. Σφακιανάκης
20h
The Value of Low-Dose Dynamic Myocardial Perfusion CT for Accurate Evaluation of Microvascular Obstruction...
The Value of Low-Dose Dynamic Myocardial Perfusion CT for Accurate Evaluation of Microvascular Obstruction in Patients With Acute Myocardial InfarctionMengmeng Yu1, Xiuyu Chen2, Xu Dai1, Jingwei Pan3 ... Show allShare Share+ Affiliations:Citation: American Journal of Roentgenology: 1-9. 10.2214/AJR.19.21305AbstractFull TextReferencesPDFPDF PlusAdd to FavoritesPermissionsDownload CitationABSTRACT :OBJECTIVE. The purpose of this study was to investigate the diagnostic performance of quantitative parameters...
Αλέξανδρος Γ. Σφακιανάκης
20h
Limb salvage using microvascular reconstructions for secondary regional vascular insufficiency in the...
Limb salvage using microvascular reconstructions for secondary regional vascular insufficiency in the neuro ischemic diabetic foot; is it making impact?Thalaivirithan Margabandu Balakrishnan, Illayakumar Pramasivam, Krishnakumar Thirunavukarasu, Jaganmohan Janardhanan, Sritharan NarayananIndian Journal of Vascular and Endovascular Surgery 2019 6(2):65-73Introduction: Secondary regional vascular insufficiency (RVI) is a pathophysiological state that occurs most commonly following the successfully...
Αλέξανδρος Γ. Σφακιανάκης
20h
Preoperative factors predicting the outcomes of arteriovenous fistula surgery Vedamurthy Reddy Pogula,...
Preoperative factors predicting the outcomes of arteriovenous fistula surgeryVedamurthy Reddy Pogula, Mallikarjuna Reddy Nalubolu, Ranadheer Byram, Harikrishna Maddiboina, Sudeep Bodduluri, AP Pavan, P Banuteja Reddy, Jayaraju JuturuIndian Journal of Vascular and Endovascular Surgery 2019 6(2):74-78Purpose: The aim is to study the preoperative factors predicting the outcome of arteriovenous fistulas (AVF) in chronic kidney disease (CKD) patients. Successful AVF formation is vital to the success of...
Αλέξανδρος Γ. Σφακιανάκης
20h
Ulnar basilic arterio venous fistula: An useful alternative access for hemodialysis Sekar Natarajan...
Ulnar basilic arterio venous fistula: An useful alternative access for hemodialysisSekar NatarajanIndian Journal of Vascular and Endovascular Surgery 2019 6(2):79-81Objective: Native arteriovenous fistula done at the distal most site has been promoted as the vascular access of choice. Radiocephalic fistula at wrist or snuffbox is widely used but ulnar basilic fistula is seldom performed. The aim of this study is to analyse the usefulness of ulnar basilic fistula as a hemodialysis access. Method:...
Αλέξανδρος Γ. Σφακιανάκης
20h
Ultrasound-assisted angioplasty for failing arteriovenous access Shahzad Sarosh Bulsara, Vinit Paliwal,...
Ultrasound-assisted angioplasty for failing arteriovenous accessShahzad Sarosh Bulsara, Vinit Paliwal, Govind Prasad, NR Manjubharath, Ashutosh Aher, Ashish Airen, Tapish Sahu, Virender Sheorain, Tarun Grover, Rajiv ParakhIndian Journal of Vascular and Endovascular Surgery 2019 6(2):82-88Introduction: Arteriovenous (AV) access maturity and patency is critical for patients on hemodialysis. Maintaining a functioning AV access for these patients is of paramount importance. Salvage of failing AV accesses...
Αλέξανδρος Γ. Σφακιανάκης
20h
Vascular access related complications with ipsilateral upper limb oedema in hemodialysis RD Nagaraj,...
Vascular access related complications with ipsilateral upper limb oedema in hemodialysisRD Nagaraj, Sarala Settipalli, P Sandeep, AY Lakshmi, V SivakumarIndian Journal of Vascular and Endovascular Surgery 2019 6(2):89-98Background: Central vein-related obstruction is a growing problem in maintenance hemodialysis (MHD). Prior to central vein temporary access, failure to implement "fistula first policy" is an important contributor for this problem. It interferes with the outcomes in dialysis adding...
Αλέξανδρος Γ. Σφακιανάκης
20h
Role of brachial artery ligation as an emergency procedure in bleeding arteriovenous access AR Chandrashekhar,...
Role of brachial artery ligation as an emergency procedure in bleeding arteriovenous accessAR Chandrashekhar, Luv Luthra, Sanjay C Desai, B Rajendra PrasadIndian Journal of Vascular and Endovascular Surgery 2019 6(2):99-101Introduction: Bleeding from a ruptured or infected arteriovenous (AV) access is a life-threatening situation leading to increased mortality in chronic kidney disease (CKD) patients. All these patients need emergent and expeditious management. The procedures described for bleeding...
Αλέξανδρος Γ. Σφακιανάκης
20h
Pseudoaneurysm of peripheral arteries: Our experience in a community-based hospital Lokesh Shekher...
Pseudoaneurysm of peripheral arteries: Our experience in a community-based hospitalLokesh Shekher Jaiswal, Narendra Pandit, Jagat Narayan Prasad, Shailesh AdhikaryIndian Journal of Vascular and Endovascular Surgery 2019 6(2):102-106Introduction: Pseudoaneurysms are false aneurysm where disruption in the arterial wall forms a localized pulsatile hematoma connecting the artery. The common causes are intravenous drug abuse (IVDA), iatrogenic (vascular interventions and surgery), trauma, and infections....
Αλέξανδρος Γ. Σφακιανάκης
20

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480

Second generation antihistamines: an update Sánchez-Borges, Mario; Ansotegui, Ignacio J. Role of the ocular surface microbiome in allergic disease Cavuoto, Kara M.; Stradiotto, Allison C.; Galor, Anat Biological treatments for severe asthma Assaf, Sara M.; Hanania, Nicola A. Biologics and anaphylaxis Sala-Cunill, Anna; Luengo, Olga; Cardona, Victoria Topical tacrolimus for allergic eye diseases Erdinest, Nir; Ben-Eli, Hadas; Solomon, Abraham

Common and different roles of IL-4 and IL-13 in skin allergy and clinical implications
Purpose of review This review summarizes the mode of action of IL-4 and IL-13 in skin allergy, upcoming therapeutics and depicts key outcomes of the latest clinical trials. Recent findings Atopic dermatitis is considered to be one of the most common inflammatory skin disease in industrialized countries. Accompanied by strong pruritus, atopic dermatitis has a significant impact on quality of life in severely affected individuals. Aside from unspecific immunosuppressant medications, therapeutics targeting the key cytokines IL-4 and IL-13 and their downstream mediators are under development or have been approved just recently with outstanding potential. Summary The recent development of several biologics and small compounds has the potential to revolutionize the treatment of atopic dermatitis, and applying this set of state-of-the-art drugs will provide a unique chance to gain insights into this skin disorder, patient subgroups, and key inflammatory mediators. Correspondence to Jana Zeitvogel, Division of Immunodermatology and Allergy Research, Department of Dermatology, Allergy and Venereology, Hannover Medical School, Hannover, Germany. Tel: +49 511 532 5074; e-mail. Zeitvogel.jana@mh-hannover.de Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Drug hypersensitivity in HIV infection
Purpose of review Immune-mediated adverse drug reactions (IM-ADRs) are many times more common in HIV-infected patients. Usual offending drugs include antiretroviral and antiinfectives, but the burden of specific drug IM-ADRs is population-specific; changing as new and fixed dose combinations enter the market, and drug-resistance patterns demand. This review considers recent literature on epidemiology, mechanisms, clinical management and prevention of IM-ADRs amongst persons living with HIV/AIDS. Recent findings Epidemiological studies continue to describe high rates of delayed hypersensitivity to known offenders, as well as similar reactions in preexposure prophylaxis. IM-ADRs to oral and injectable integrase strand transfer inhibitors are reported with expanding use. The clinical spectrum and management of IM-ADRs occurring in HIV-infected populations is similar to uninfected; with exceptions such as a recently described severe delayed efavirenz DILI with high mortality. Furthermore, the context can be unique, such as the lower than expected mortality in a Stevens–Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) cohort from a HIV/TB high burden setting. Programmatic data showing the near complete elimination of Abacavir drug hypersensitivity syndrome following implementation of HLA-B57:01 screening is a stellar example of how prevention is possible with mechanistic insight. Summary IM-ADRs remain a challenge in persons living with HIV. The complexities posed by polypharmacy, overlapping drug toxicities, drug interactions, overlap of IM-ADRs with other diseases, limited alternative drugs, and vulnerable patients with advanced immunosuppression with high mortality, necessitate increased use of drug provocation testing, treat-through and desensitization strategies. There is an urgent need for improved diagnostics and predictive biomarkers for prevention, or to guide treat-through, rechallenge and desensitization approaches. Correspondence to Professor Jonny Peter, Division of Allergy and Clinical Immunology, H52 Old Main Building, Groote Schuur Hospital, Observatory, 7925 Cape Town, South Africa. E-mail: Jonny.Peter@uct.ac.za Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Highlights in allergic contact dermatitis 2018/2019
Purpose of review The purpose was to highlight recent findings especially concerning new and old allergens, trends, diagnosis and causes of contact allergy. Recent findings Nickel is still the most frequent cause of contact allergy in women and piercings remain an important risk factor. Countries with a long history of regulation of contact allergens have the lowest level of contact allergy to nickel and chromium in Europe. Among the most frequent causes of fragrance contact allergy is terpenes, which are oxidized such as limonene, linalool and in some countries: geraniol. Methylisothiazolinone is still causing considerable problems due to hidden exposures. Acrylates are emerging allergens and 2-hydroxyethyl methacrylate has been included in the 2019 update of the baseline series, as many new cases are seen due to long-lasting nail polish based on acrylates and glue (isobornyl acrylate) in insulin pumps. More than 10 new allergens have been described, which need to be considered in diagnosing contact allergy. Summary Allergic contact dermatitis is a frequent problem, it also constitutes a challenge to diagnose due to many potential contact allergens. The main culprit allergens remain the same, new significant causes are found especially within acrylates. Correspondence to Jeanne D. Johansen, DMSc, Professor, Consultant, Department of Dermatology and Allergy, National Allergy Research Centre, Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark. Tel: +45 38677301; e-mail: Jeanne.duus.johansen@regionh.dk Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Dupilumab after the 2017 approval for the treatment of atopic dermatitis: what's new and what's next?
Purpose of review The IL-4/13 antagonist dupilumab was approved in 2017 as the first biologic for atopic dermatitis. Here, we comprehensively review compelling new data regarding dupilumab published following the approval. Recent findings Daily clinical practice reports of dupilumab in atopic dermatitis are favorable and in line with the registration trials. Dupilumab does not appear to negatively affect pharmacokinetics of CYP450-metabolized drugs nor vaccination responses. Type 2 inflammation biomarkers in skin and serum are reduced following dupilumab treatment. Dupilumab increases the risk for conjunctivitis, especially with higher baseline atopic dermatitis severity and a history of conjunctivitis, but the underlying mechanisms are unknown. Favorable effects of dupilumab have been reported in treatment-recalcitrant hand eczema and prurigo nodularis cases; for allergic contact dermatitis and alopecia areata, there are conflicting responses to dupilumab, possible stemming from pathophysiological heterogeneity. Summary Daily practice data support the continued use of dupilumab for atopic dermatitis. The only safety signal is an increased risk for conjunctivitis; mechanistic studies into dupilumab-associated conjunctivitis should lead to risk mitigation strategies. Prospective, controlled evaluations are needed for dupilumab in hand eczema and prurigo nodularis. A precision medicine-driven drug-development approach is essential to assess dupilumab for diseases with heterogeneous pathophysiologies, such as alopecia areata and allergic contact dermatitis. Correspondence to Deepak M.W. Balak, MD, PhD, MSc, National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. Tel: +31 88 75 739 37; e-mail: d.m.w.balak@umcutrecht.nl Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Neurotrophic factors and nerve growth factor in ocular allergy
Purpose of review During allergic reaction, nervous and immune systems mutually interact through release of mediators, including neurotrophic factors and nerve growth factor (NGF). These mediators modulate allergic reaction through binding their receptors expressed by immune and structural cells and by stimulating neuropeptide release by nerves. The role of neuropeptides and NGF has been demonstrated in allergic asthma and rhinitis, and, to a lesser extent, in allergic conjunctivitis. The aim of this review are to elucidate the evidence of the role of NGF and neuropeptides in the pathogenesis of allergic conjunctivitis. Recent findings NGF modulates allergic reaction by stimulating release of cytokines, inflammatory mediators and neuropeptides by immune and structural cells and nerve endings at the site of inflammation. Evidence showed that local and systemic NGF levels increase in patients with allergic conjunctivitis, including allergic rhinoconjuncivitis, vernal keratoconjunctivitis and atopic keratoconjunctivitis. We recently described an increase of conjunctival p75NTR expression in patients with allergic rhinoconjuncivitis, and an increase of tear levels of NGF after conjunctival provocation test with allergen. Summary NGF modulates ocular allergic reaction. Increasing understanding of the role of neuropeptides in allergic conjunctivitis may pave the way to the development of novel therapeutic approaches and improvement of patients' management. Correspondence to Professor Alessandro Lambiase, Department of Sense Organs, University Sapienza of Rome, Vilae del Policlinico, 155, 00161 Rome, Italy. Tel: +39 064 997 5357; e-mail: alessandro.lambiase@uniroma1.it Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Role of T cells in non-immediate drug allergy reactions
Purpose of review Nonimmediate drug hypersensitivity reactions (NI-DHR) constitute the most complex group of drug allergy, with many drugs involved. Both parent drugs and their reactive metabolites can be implicated. Although with some drugs the number of metabolites is limited, with others it is quite extensive and many still remain to be identified. The diagnostic approaches are insufficient for the diagnosis and realistic approaches that reproduce the pathological response are lacking. Recent findings A wider view has now been considered, with the inclusion of several mechanisms that may contribute to drug hypersensitivity reactions (DHR): the classical hapten hypothesis, the danger signal and the pharmacological interaction. Monitoring the acute response provides relevant information about the mechanisms involved, with the identification of a large number of genes that can be over-expressed or under-expressed in the acute phase of the response. Assessment of risk of developing reactions can be verified by HLA associations. Summary Further knowledge of these NI-DHR, including molecular genetics and transcriptomic analysis, has enabled a better understanding and management of these reactions. Correspondence to E. Gómez, Roche Pharma Research and Early Development, Pharmaceutical Sciences, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Brunngasse, 40. 4153. Reinach. BL., Switzerland. Tel: +41 76 321 40 37; e-mail: enriquegomezalcaide@gmail.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Treatable traits in chronic rhinosinusitis with nasal polyps
Purpose of review Chronic rhinosinusitis with nasal polyps (CRSwNP) is a complex inflammatory sinonasal disease that deserves a multidisciplinary precision medicine approach. In a precision medicine model, a more pragmatic approach taking in consideration disease features that are potentially treatable should be considered. Recent findings Several treatable traits in CRSwNP can be identified: from disease-related ones, to extra-ENT features, to behavioral and environmental factors. This review article summarizes primarily the recent findings of CRSwNP-related treatable traits and how they can be modified by given treatments. Summary The advent of biological agents acting directly to the endotype underlying CRSwNP pushes the scientific community to integrate clinical, surgical and immunological evaluations for each single patient; this naturally leads to the identification of specific treatable traits that can serve as possible outcomes for any single biological. Correspondence to Enrico Heffler, Personalized Medicine, Asthma and Allergy, Humanitas University, Via Rita Levi Montalcini 4; 20089 - Pieve Emanuele, Milan, Italy. Tel: +39 0282247013; e-mail: heffler.enrico@gmail.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Cutaneous drug hypersensitivity: developments and controversies
Purpose of review Cutaneous drug hypersensitivity reactions (CDHRs) are a complicated area with multiple clinical manifestations and differential diagnoses, requiring differentiated diagnostic measurements and optimized therapeutic management. Recent findings Disseminated CDHRs to classical drugs can be classified by a simple algorithm, whereas chemotherapeuticals or biopharmaceuticals may show drug-specific and atypical clinical presentations. Controversies in drug hypersensitivity diagnosis exist about the benefit and accuracy of in-vitro tests. Although skin tests are the best means of detecting sensitization to drugs, methods have not been sufficiently standardized. The necessity for skin tests before performing drug provocation test (DPT) and of prolonged DPTs is discussed in selected patients. If a suspicion has been documented, β-lactam allergy should be excluded. The standard allergy diagnosis is done by an allergist. In case of urgent need because of an infection and low risk according to history, faster delabeling pathways have been developed. There is weak evidence that patients with mastocytosis may have a slightly increased risk of developing immediate-type drug hypersensitivity; however, if considerations are taken, drugs do not have to be withheld for this patient group. There is particular need for improved diagnostic measurements in patients with drug-induced severe cutaneous adverse reactions (SCARs), both identifying the offending drug and detecting individuals at risk. Further challenges encompass appropriate treatments during the acute as well as chronic phase of SCARs. Summary Recent literature has contributed to our understanding of clinical manifestations and existing controversies and future needs in this area. Correspondence to Knut Brockow, Department of Dermatology and Allergology Biederstein, School of Medicine, Technical University Munich, Biedersteiner Str. 29, 80802 München, Germany. Tel:+ 0049 89 4140 3182; fax+: 0049 89 4140 3127; e-mail: knut.brockow@tum.de Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

New phenotypes in hypersensitivity reactions to nonsteroidal anti-inflammatory drugs
Purpose of review Nonsteroidal anti-inflammatory drug (NSAID) is one of the most frequently prescribed medications in the medical field, and hypersensitivity to NSAID is a common adverse drug reaction encountered. However, NSAID hypersensitivity presents a variety of symptoms caused by diverse pharmacological and immunological mechanisms. Recent findings Owing to the heterogeneity of the disease, a new concept for the classification of NSAID hypersensitivity has recently been proposed to diagnose and manage NSAID hypersensitivity for personalized treatment. Acute and delayed reactions were distinguished in this classification, and identification of symptoms and speculation of putative mechanisms help physicians make the right diagnosis. NSAID-exacerbated respiratory disease is a noticeable phenotype of NSAID hypersensitivity that involves upper airway comorbidities (chronic rhinosinusitis with nasal polyps) as well as asthmatic features. The cutaneous phenotypes of NSAID hypersensitivity occur, and cross-reactivity with other types of NSAID should be considered in establishing a proper diagnosis. Hypersensitivity to a single NSAID can present urticaria/angioedema and anaphylaxis, in which an IgE-mediated immune response is suggested to be a prime mechanism. Management of NSAID hypersensitivity reactions includes avoidance, pharmacological treatment following standard guidelines, and aspirin desensitization. Summary The classification, diagnosis, and management of NSAID hypersensitivity should be individually reached by identifying its phenotype. Correspondence to Hae-Sim Park, Department of Allergy and Clinical Immunology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon 16499, Korea. Tel: +82 31 219 5150; fax: +82 31 219 5154; e-mail: hspark@ajou.ac.kr Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Microbiome and skin biology
Purpose of review The skin is home to a diverse milieu of bacteria, fungi, viruses, bacteriophages, and archaeal communities. The application of culture-independent approaches has revolutionized the characterization of the skin microbiome and have revealed a previously underappreciated phylogenetic and functional granularity of skin-associated microbes in both health and disease states. Recent findings The physiology of a given skin-niche drives the site-specific differences in bacterial phyla composition of healthy skin. Changes in the skin microbiome have consistently been associated with atopic dermatitis. In particular, Staphylococcus aureus overgrowth with concomitant decline in Staphylococcus epidermidis is a general feature associated with atopic dermatitis and is not restricted to eczematous lesions. Changes in fungal species are now also being described. Changes in the composition and metabolic activity of the gut microbiota are associated with skin health. Summary We are now beginning to appreciate the intimate and intricate interactions between microbes and skin health. Multiple studies are currently focused on the manipulation of the skin or gut microbiome to explore their therapeutic potential in the prevention and treatment of skin inflammation. Correspondence to Liam O'Mahony, Office 450, 4th Floor Food Science and Technology Building, University College Cork, Cork, Ireland. Tel.: +353 21 4901316;. e-mail: liam.omahony@ucc.ie Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.


Sánchez-Borges, Mario; Ansotegui, Ignacio J.
Cavuoto, Kara M.; Stradiotto, Allison C.; Galor, Anat
Assaf, Sara M.; Hanania, Nicola A.
Sala-Cunill, Anna; Luengo, Olga; Cardona, Victoria
Erdinest, Nir; Ben-Eli, Hadas; Solomon, Abraham

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480

Oral Oncology

Second primary cancers in patients with oral cavity cancer included in the Korea Central Cancer Registry

Publication date: August 2019

Source: Oral Oncology, Volume 95

Author(s): Seung-Ki Min, Sung Weon Choi, Jiwon Lim, Joo Yong Park, Kyu-Won Jung, Young-Joo Won

Abstract
Objectives

The improved survival of patients with oral cavity cancer (OCC) has generated interest in factors affecting survivorship, particularly among second primary cancer (SPC) patients. This study aimed to assess the incidence, patterns, and risk factors for SPC after OCC treatment in the Korean population.

Materials and methods

Data from 15,261 patients with OCC (ICD-O: C01–C06) identified between 1993 and 2014 were extracted from the Korean Central Cancer Registry. The standardized incidence ratio (SIR) for SPC after index OCC was calculated, and Poisson regression analysis was performed to evaluate the risk factors for SPC among survivors.

Results

The overall SIR for SPC among OCC survivors was 1.47 (95% confidence interval [CI] 1.39–1.56). SIR differed by sex (male: 1.51 vs. female: 1.37), age at diagnosis (<45 years: 2.47 vs. 45–64 years: 1.68 vs. ≥ 65 years: 1.10), index OCC subsite (floor of mouth: 1.95 vs. gum: 1.30), follow-up duration (6–23 months: 1.64 vs. 24–59 months: 1.51 vs. 60–119 months: 1.48 vs. ≥ 120 months: 1.24), histological OCC type (salivary gland malignancy: 1.77 vs. squamous cell carcinoma: 1.44 vs. others: 1.47), and radiation history (any: 1.94 vs. no radiation: 1.37). The risk factors for SPC development among OCC survivors included younger age at diagnosis and history of radiation therapy.

Conclusion

OCC survivors have significantly increased risks of SPCs, exhibiting distinctive site distributions and chronological patterns. These patients would benefit from an SPC surveillance protocol.



Intracellular calprotectin (S100A8/A9) controls epithelial differentiation and caspase-mediated cleavage of EGFR in head and neck squamous cell carcinoma

Publication date: August 2019

Source: Oral Oncology, Volume 95

Author(s): Prokopios P. Argyris, Zachary Slama, Chris Malz, Ioannis G. Koutlas, Betty Pakzad, Ketan Patel, Deepak Kademani, Ali Khammanivong, Mark C. Herzberg

Abstract
Objectives

Calprotectin (S100A8/A9) appears to function as a tumor suppressor in head and neck squamous cell carcinoma (HNSCC) and expression in the carcinoma cells and patient survival rates are directly related. We seek to characterize the suppressive role of calprotectin in HNSCC.

Aims

(1) Investigate changes in S100A8/A9 expression as oral carcinogenesis progresses and (2) determine whether intracellular calprotectin can regulate epidermal growth factor receptor (EGFR), a negative prognostic factor, in HNSCC.

Materials and methods

Using immunohistochemistry (IHC), S100A8/A9 was analyzed in HNSCC specimens (N = 46), including well-differentiated (WD, N = 19), moderately-differentiated (MD, N = 14), poorly-differentiated (PD, N = 5) and non-keratinizing/basaloid (NK/BAS, N = 8), and premalignant epithelial dysplasias (PED, N = 16). Similarly, EGFR was analyzed in HNSCCs (N = 21). To determine whether calprotectin and EGFR expression are mechanistically linked, TR146 HNSCC cells that are S100A8/A9-expressing or silenced (shRNA) were compared for EGFR levels and caspase-3/7 activity using western blotting and immunofluorescence microscopy.

Results

In normal oral mucosal epithelium, S100A8/A9 stained strongly in the cytoplasm and nucleus of suprabasal cells; basal cells were consistently S100A8/A9 negative. In PED and HNSCC, S100A8/A9 expression was lower than in adjacent normal epithelial tissues (NAT) and declined progressively in WD, MD, PD and NK/BAS HNSCCs. S100A8/A9 and EGFR levels appeared inversely related, which was simulated in vitro when S100A8/A9 was silenced in TR146 cells. Silencing S100A8/A9 significantly reduced caspase-3/7 activity, whereas EGFR levels increased.

Conclusions

In HNSCC, S100A8/A9 is directly associated with cellular differentiation and appears to promote caspase-3/7-mediated cleavage of EGFR, which could explain why patients with S100A8/A9-high tumors survive longer.



Oral mucositis in head and neck cancer: Evidence-based management and review of clinical trial data

Publication date: August 2019

Source: Oral Oncology, Volume 95

Author(s): Adriana Blakaj, Marcelo Bonomi, Mauricio E. Gamez, Dukagjin M. Blakaj

Abstract

Oral Mucositis (OM) continues to be an oncologic challenge in the context of antineoplastic therapy for head and neck cancer (HNC) treatment. It is a dose-limiting toxicity of chemotherapy and radiation treatment and negatively impacts quality of life and cancer treatment efficacy. Significant effort in the field of OM has been made to help alleviate its symptoms and its subsequent clinical and economic impact. Despite these advances, the treatment of oral mucositis remains difficult and focuses on palliative measures. There are, however, many promising new biological targets currently undergoing investigation to ameliorate or help prevent the toxicity of OM in HNC. Some of these targets undergoing investigation in phase 2 and 3 clinical trials are further highlighted along with the pathobiology of OM, clinical course, prevention, and management measures.



Priorities of human papillomavirus-associated oropharyngeal cancer patients at diagnosis and after treatment

Publication date: August 2019

Source: Oral Oncology, Volume 95

Author(s): Melina J. Windon, Carole Fakhry, Farhoud Faraji, Tanya Troy, Christine G. Gourin, Ana P. Kiess, Wayne Koch, David W. Eisele, Gypsyamber D'Souza

Abstract
Introduction

Little is known regarding how human papillomavirus-positive oropharyngeal cancer (HPV-OPC) patient goals change with treatment. This study evaluates whether patient ranking of non-oncologic priorities relative to cure and survival shift after treatment as compared to priorities at diagnosis.

Materials and Methods

This is a prospective study of HPV-OPC patient survey responses at diagnosis and after treatment. The relative importance of 12 treatment-related priorities was ranked on an ordinal scale (1 as highest). Median rank (MR) was compared using Wilcoxon matched-pairs signed-rank tests. Prevalence of high concern for 11 treatment-related issues was compared using paired t-test. The effect of patient characteristics on change in priority rank and concern was evaluated using linear regression.

Results

Among 37 patients, patient priorities were generally unchanged after treatment compared with at diagnosis, with cure and survival persistently ranked top priority. Having a moist mouth uniquely rose in importance after treatment. Patient characteristics largely did not affect change in priority rank. Concerns decreased after treatment, except concern regarding recurrence.

Discussion

Treatment-related priorities are largely similar at diagnosis and after treatment regardless of patient characteristics. The treatment experience does not result in a shift of priorities from cure and survival to non-oncologic domains over cure and survival. The rise in importance of moist mouth implies that xerostomia may have been underappreciated as a sequelae of treatment. A decrease in most treatment-related concerns is encouraging, whereas the persistence of specific areas of concern may inform patient counseling.



A three-gene expression signature associated with positive surgical margins in tongue squamous cell carcinomas: Predicting surgical resectability from tumour biology?

Publication date: July 2019

Source: Oral Oncology, Volume 94

Author(s): Zuzana Saidak, Caroline Pascual, Jebrane Bouaoud, Louise Galmiche, Florian Clatot, Stéphanie Dakpé, Cyril Page, Antoine Galmiche

Abstract
Objectives

Achieving complete tumour resection is one of the main goals of surgery for head and neck squamous cell carcinoma (HNSCC) tumours. Whether biological characteristics of tumours contribute to the surgical resectability and the presence of positive surgical margins (SM) after resection of HNSCC is unclear. We aimed to address this issue.

Materials and methods

We used data from The Cancer Genome Atlas (TCGA) to relate the SM status of 356 HNSCC tumours covering five major primary locations (tongue, larynx, tonsils, floor of mouth and buccal mucosa) with data from multiple omics approaches (transcriptomic, genomic and proteomic analyses).

Results

We identified three differentially expressed genes whose expression was significantly associated with the presence of positive SM in tongue tumours (n = 144). The three genes (CCDC66, ZRANB2 and VCPKMT) displayed significantly higher mRNA levels in tongue tumours with positive SM compared to tumours with negative SM. The corresponding gene expression signature identified tongue tumours with a positive SM with high sensitivity and specificity (85% and 76%, respectively, Area Under the Curve (AUC) = 0.84). Tongue tumours with this signature were characterised by a high grade, elevated proliferation levels and a tumour stroma with fewer fibroblasts and endothelial cells.

Conclusion

Positive SM were found to be strikingly associated with tumour biology in tongue tumours. These findings offer interesting perspectives for biomarker identification and precision surgery in these tumours.



Does increasing the incidence of extracapsular dissection for benign tumors of the parotid correlate with an increased need for revision surgery?

Publication date: July 2019

Source: Oral Oncology, Volume 94

Author(s): Konstantinos Mantsopoulos, Sarina K. Mueller, Miguel Goncalves, Mirco Schapher, Michael Koch, Heinrich Iro

Abstract
Objectives

The aim of this study was to investigate the hypothesis of whether extracapsular dissection (ED) of the parotid gland increases the need for revision surgery for benign tumours in comparison to traditional surgical modalities. A further aim of this study was to evaluate and compare the functional outcome of revision procedures after primary ED with other modalities involving the parotid gland in our department.

Materials and methods

All patients who underwent revision parotid surgery after a primary surgical procedure at a tertiary care hospital (University of Erlangen-Nürnberg) between 2000 and 2016 were included in our study. Data concerning the indication for revision surgery as well as the functional postsurgical outcome were obtained.

Results

2465 cases formed our study sample. In total, revision surgery was necessary in 30/2465 cases (1.2%). 1532 patients underwent primary ED, with 17 cases requiring revision (1.1%), whereas 933 cases were managed by means of other facial nerve dissecting surgical modalities, with the indication for revision surgery in 13 cases (1.4%). Our analysis did not reveal a statistically significantly higher need for revision surgery or a higher rate of facial nerve palsies after revision surgery in the group of patients after primary ED.

Conclusion

The argument in favour of a greater need for revision surgery after primary parenchyma-sparing modalities was not sustained from our data. Due to the low revision rate and the acceptable functional results after revision surgery, we believe that extracapsular dissection is justified in cases where a benign lesion is suspected preoperatively.



Multifocality of papillary thyroid carcinoma as a risk factor for disease recurrence

Publication date: July 2019

Source: Oral Oncology, Volume 94

Author(s): Woo Ri Choi, Jong-Lyel Roh, Gyungyup Gong, Kyung-Ja Cho, Seung-Ho Choi, Soon Yuhl Nam, Sang Yoon Kim

Abstract
Objectives

Tumor multifocality or bilaterality is associated with increased risk of papillary thyroid carcinoma (PTC) recurrence. However, its prognostic value in clinical outcomes remains controversial. This study aimed to evaluate the association of multifocality or bilaterality with recurrence and survival after total thyroidectomy.

Methods

This was a retrospective study of 2390 consecutive patients with pathologically confirmed PTC who underwent total thyroidectomy. Multifocality and bilaterality were decided based on the final pathology results, that is, if there were two or more tumor foci and bilateral location, respectively. Primary outcomes were recurrence-free survival (RFS). Cox proportional hazards regression analyses were used to assess the associations of multifocality, bilaterality, and other clinicopathological factors with RFS.

Results

Multifocal and bilateral PTC were found in 892 (37.3%) and 593 (24.8%) patients, respectively. Multivariate analyses showed that multifocality, lymphovascular invasion, N category, and number of positive lymph node (>5) were significant independent variables predictive of RFS (all P < 0.05). Multifocality was associated with adjusted hazard ratios for RFS of 1.93 (95% confidence interval = 1.33–2.80; P = 0.001). In a subset analysis, the prognostic value of multifocality was found to be significant in those patients with PTC > 1 cm, but not in papillary thyroid microcarcinoma.

Conclusions

Tumor multifocality is an independent risk factor of PTC recurrence after total thyroidectomy. This indicate a more progressive state of disease, being included in risk stratification.



Prospective clinical trial to evaluate safety and feasibility of using a single port flexible robotic system for transoral head and neck surgery

Publication date: July 2019

Source: Oral Oncology, Volume 94

Author(s): Jason Y.K. Chan, Raymond K. Tsang, F. Christopher Holsinger, Michael C.F. Tong, Cherrie W.K. Ng, Philip W.Y. Chiu, Simon S.M. Ng, Eddy W.Y. Wong

Abstract
Introduction

The aim of this study was to determine the clinical safety and feasibility of a novel single-port flexible robot for Transoral Robotic Surgery (TORS).

Materials and methods

This was a prospective phase II / IDEAL stage 2 clinical trial of both benign and malignant lesions of the head and neck. The primary endpoint included conversion rates and perioperative complications within 30 days following surgery. The study was registered on www.ClinicalTrials.gov (NCT03010813). The Fisher's exact test and Mann-Whitney U test were used to compare categorical, and non-parametric data for the trial. A p value <0.05 was considered to be statistically significant. Statistical analysis was performed with SPSS 20.0 (IBM Corp., Armonk, New York)

Results

Twenty-one patients safely underwent TORS with the da Vinci SP (Intuitive Surgical Inc., Sunnyvale, CA) demonstrating the feasibility of access to the nasopharynx, oropharynx, larynx and hypopharynx. There were no conversions of the robotic surgical system. There were no serious adverse events or adverse events related to the use of the robot at 30-day follow-up for all patients.

Conclusions

In a prospective Phase II clinical trial, a novel single-port flexible robotic system appears safe and feasible to use for transoral endoscopic head and neck surgery to access the nasopharynx, oropharynx, larynx and hypopharynx.



Surrogates of immunologic cell death (ICD) and chemoradiotherapy outcomes in head and neck squamous cell carcinoma (HNSCC)

Publication date: July 2019

Source: Oral Oncology, Volume 94

Author(s): Panagiota Economopoulou, George Koutsodontis, Areti Strati, Efthymios Kirodimos, Evangelos Giotakis, Pavlos Maragoudakis, Constantine Prikas, Nikolaos Papadimitriou, Christos Perisanidis, Eleni Gagari, Ioannis Kotsantis, Elena Vagia, Maria Anastasiou, Maria Gkotzamanidou, George Kavourakis, Evi Lianidou, Amanda Psyrri

Abstract
Objectives

Chemoradiation can induce immunogenic (ICD) or tolerogenic cell death. ICD relies on the generation of damage-associated molecular patterns which can stimulate toll-like receptors (TLRs). We sought to determine whether we can predict responses to chemoradiation by measuring surrogate biomarkers of ICD in a cohort of patients with locally advanced (LA) head and neck squamous cell carcinoma (HNSCC).

Materials and Methods

In a cohort of 113 LA HNSCC pts we evaluated expression of TLR4, TLR7 and TLR9 in the EpCAM + circulating tumor cell (CTC) fraction at baseline and after cisplatin chemoradiation. We also quantified changes in chemokines CXCL10, CXCL16 and IL-2R in the serum.

Results

Seventy three patients had evaluable specimens. Among cases with biomarker assessment at baseline and post treatment, 36.8% had an increase in CXCL10 levels (p = 0.022), 73.7% had an increase in CXCL16 levels (p = 0.002) and 63.8% had an increase in IL2Ra levels (p = 0.032) with treatment. 52.0% of evaluable cases at baseline and post-treatment had an increase in TLR4 levels (p = 0.996), 42.9% had an increase in TLR7 levels (p = 0.042) and 27.7% had increase in TLR9 levels (p = 0.011) with treatment. CXCL10 levels at baseline were significantly associated with PFS and OS (p = 0.010 and p = 0.032, respectively).

Conclusions

Our results suggest that chemoradiation leads to quantifiable effects in surrogate markers of ICD. These effects may inform trials combining chemoradiation with immune checkpoint inhibitors. In addition, CXCL10 has prognostic effect in pts treated with chemoradiation.



Sex disparities in salivary malignancies: Does female sex impact oncological outcome?

Publication date: July 2019

Source: Oral Oncology, Volume 94

Author(s): Ximena Mimica, Marlena McGill, Ashley Hay, Daniella Karassawa Zanoni, Jatin P. Shah, Richard J. Wong, Alan L. Ho, Marc A. Cohen, Snehal G. Patel, Ian Ganly

Abstract
Objective

Previous population-based studies in salivary gland carcinomas have described a relationship between female sex and superior oncological outcome.

Patients and methods

Our institutional database of 884 surgically treated patients with salivary gland malignancies from 1985 to 2015 was analyzed for the impact of sex on oncological outcomes. Histologies were classified in three risk groups, low, intermediate and high. Survival outcomes were determined using the Kaplan-Meier method. Hazard ratios for male sex were determined using the Cox proportional hazards model.

Results

Eight hundred sixty-seven patients were identified; median age was 59 years, and 51% had a minor salivary gland malignancy. Female patients were younger (58 versus 60 years; p = 0.040) and had a lower incidence of high-risk histologies (25% versus 40%, p < 0.001) and T3-T4 tumors compared to men (23% versus 31%, p < 0.001). With a median follow-up of 57 months, female patients had a superior 5-year disease-specific survival (DSS) (90% versus 79%; p < 0.001). The unadjusted hazard ratio showed male patients had a 2.15-fold increased risk of death (HR 2.15; 95% CI, 1.50–3.06, p < 0.001). After adjusting for Charlson comorbidity index, tobacco use, histological risk group, and overall pathological stage, males still had a statistically significant increased risk of death (HR 1.48; 95% CI 1.05–2.17; p = 0.047). Subgroup analysis showed DSS for females was significantly better in the high-risk histological group (5-year 68% versus 49%, p = 0.007).

Conclusion

Our study shows that sex has an impact on cancer-specific survival and that female sex favors improved survival.



Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480

Pediatric Surgery

Obituary
Sachchidananda Das

Journal of Indian Association of Pediatric Surgeons 2019 24(3):157-157



Avoiding litigation in clinical practice
Parthapratim Gupta

Journal of Indian Association of Pediatric Surgeons 2019 24(3):158-161



A clinical approach to diagnosis of ambiguous genitalia
Kashish Khanna, Shilpa Sharma, Devendra K Gupta

Journal of Indian Association of Pediatric Surgeons 2019 24(3):162-169

Disorders of sex development (DSD) are a sensitive and stressful condition for the family as well as the treating physician to deal with. The main issue in managing such cases is sex assignment. The decision is influenced by the cultural background, the sex of rearing, clinical features, the biochemical parameters including hormonal studies, the imaging reports, parental preference, fertility potential, and the assessment of mental make-up of the child when possible. In third world countries, there is diagnostic dilemma as most children with DSD present late and a detailed-lengthy work-up often delay their definitive treatment. In this article, the authors try to identify the important clinical features in children presenting with various types of DSD, which may aid in making a quick provisional clinical diagnosis and expediting the diagnostic work-up. The data have been gathered from 38 years of experience of the senior author while managing about 1200 cases of DSD in the pediatric intersex clinic at the tertiary care level institute. 


Oral propranolol in infantile hemangiomas: Analysis of factors that affect the outcome
Arun Mohanan Ainipully, Sarath Kumar Narayanan, Arun Preeth Vazhiyodan, Prathap Somnath

Journal of Indian Association of Pediatric Surgeons 2019 24(3):170-175

Aim: The primary treatment for the subset of infantile hemangiomas (IHs) which develops complication is pharmacological intervention, and propranolol has become a popular choice. Here, we evaluated the efficacy and safety of propranolol in a clinical cohort of IHs and analyzed clinical characteristics associated with a good outcome. Materials and Methods: We retrospectively reviewed a total of 52 IHs patients, between ages 1 and 48 months (median age: 7.5 months), who were treated with oral propranolol, with dose ranging from 2 to 3 mg/kg/day. Efficacy was evaluated using mean percentage reduction, visual analog scale (VAS), and parental satisfaction levels at week 2 and months 1, 2, 6, and 12. The adverse effects were noted and responses after 6 months were graded. Statistical analyses of the outcome were also performed for the responses with regard to age at propranolol initiation, site of lesion, and mean duration of treatment. Results: A therapeutic response with at least 50&#37; mean percentage reduction in size was noted in 84.6&#37; at the end of 6 months. VAS score and parental satisfaction levels correlated well with mean percentage reduction (63.7 &#177; 15.6) at 6 months. Patients aged &#60;6 months and those with cephalic lesions exhibited a greater therapeutic response rate with shorter overall mean duration of the treatment. Conclusions: Oral propranolol at 2&#8211;3 mg/kg/day dosing has shown to be effective and safe for IHs in pediatric age group. Intervention in the early proliferative phase, with especially, the cephalic lesions result in better resolution rates with shorter duration of overall treatment. 


Analysis of prognostic factors in congenital diaphragmatic hernia in neonates
Jenisha Chaudhary, B Shivprasad, V Lakshmi, R Shanmughsundaram, G Nandhini, P Balamourougane

Journal of Indian Association of Pediatric Surgeons 2019 24(3):176-179

Aim: The aim is to study the demographic characteristics of neonates with congenital diaphragmatic hernia (CDH) and to analyze the prognostic factors determining mortality. Settings and Design: A retrospective cohort of CDH admitted at a tertiary level hospital during January 2005&#8211;December 2017. Materials and Methods: All cases of CDH admitted to our tertiary care neonatal intensive care unit before undergoing surgery were included in the study. Babies admitted after surgery and those with eventration of the diaphragm were excluded from the study. Results: Thirty cases (66.66&#37; males, 53.33&#37; inborn, and 63.3&#37; &#62;37 weeks) formed the study cohort. Mean birth weight was 2762 &#177; 579.67 g and mean gestational age was 37.12 &#177; 1.76 weeks. About 56.66&#37; of the cases were detected antenatally. The survival rate was 60&#37;. Predictors of poor survival included herniation of the liver or stomach (P &#60; 0.05), low Apgar score at 5 min (&#60;5), presence of moderate-to-severe persistent pulmonary hypertension of the newborn (PPHN) (P &#60; 0.001), presence of shock (P &#60; 0.003), low partial pressure of oxygen, high alveolar&#8211;arterial oxygen gradient, and high oxygenation index during first 24 h. Conclusions: Majority of the neonates with CDH at our center were &#62;37 weeks and survival was 60&#37;. The predictors of adverse outcome were low Apgar score, presence of moderate-to-severe PPHN, need for higher ventilatory settings, and shock. Antenatal detection of diaphragmatic hernia did not impact survival rates. 


Analysis of risk factors of pancreatic injury during elective laparoscopic splenectomy in children
Mohammad Gharieb Khirallah, Fouad Hesham Salama, Mohammad Ahmad Arafa, Nagi Ebrahim Eldessoki, Mohammad Elshanshory

Journal of Indian Association of Pediatric Surgeons 2019 24(3):180-184

Introduction: Laparoscopic splenectomy (LS) became the standard choice for splenectomy in children with benign hematological disease. There are few reports about pancreatic injury during LS. The purpose of this study is to spot on factors increasing the risk of pancreatic injury during LS in children. Patients and Methods: A total of 140 children had LS for benign causes. Children were categorized into A and B groups. LigaSure&#8482; was used to control pedicle in Group A, while endoscopic staplers were used in Group B. Preoperative levels of amylase, lipase, and lactate dehydrogenase (LDH) were obtained. The mean of pancreatic enzymes and LDH values was calculated on the 3 postoperative successive days. Results: A total of 71 boys and 69 girls had LS. The mean splenic size was 13.50 cm in Group A and 12.51 cm in Group B. The mean operative time in Group A was 41.91 min and in Group B was 56.36 min. The mean level of amylase was 42.99 IU/ml in Group A and 75.70 IU/ml in Group B (P &#61; 0.001). The mean level of lipase was 37 IU/ml in Group A and 76.66 IU/ml in Group B (P &#61; 0.001). Conclusion: Pancreatic injury during LS is a rare complication usually presented on biochemical level. We believe that it is a hemostatic-dependent complication rather than splenic size or nature of disease. 


Early cholangitis after portoenterostomy in children with biliary atresia
Priya Ramachandran, Mohamed Safwan, Muthukrishnan Saravana Balaji, Ashitha K Unny, Anis Akhtarkhavari, Vidya Tamizhvanan, Mohamed Rela

Journal of Indian Association of Pediatric Surgeons 2019 24(3):185-188

Aims and Objectives: Biliary atresia (BA) is a cholangiodestructive disease of the biliary tree. The first line of treatment is a Kasai portoenterostomy (PE) following which patients may develop cholangitis. We studied the effect of early cholangitis on the outcome of PE, namely jaundice clearance and early native liver survival (NLS). Methods: We reviewed the data of all children who developed cholangitis after PE from our prospectively maintained database of children with BA. The standardized treatment of all children in the database is described. The frequency and nature of these episodes were characterized, and the outcome of PE and NLS 1 year after PE was calculated. Results: Of 62 children who underwent PE in our institutions, 27 developed cholangitis. All episodes of cholangitis occurred within 14 months of PE. Of 25 children who cleared jaundice in the overall series, 19 had cholangitis. The incidence of cholangitis was significantly higher in children who cleared jaundice. Nine children who had cholangitis are alive with native livers for more than 1 year after PE. Twelve children had intractable cholangitis. Three of these children are alive with native liver 1 year after PE. Conclusion: In our series, cholangitis occurred in most children who cleared jaundice. Furthermore, the 1-year NLS of children who developed cholangitis was 33&#37;. 


Umbilicoplasty in neonates with a new technique: Results of 20-year follow-up
Sanjay Suryaji Prabhu Khope, Neena Vishwajeet Phaldesai

Journal of Indian Association of Pediatric Surgeons 2019 24(3):189-191

Context: An aesthetically acceptable umbilicus is an important component of the body and absent or dysmorphia may lead to psychological discomfort. Therefore reconstruction of neoumbilicus attains importance in abdominal surgical planning. This innovative surgical creation of umbilicus was planned during the initial surgery of umbilical defects to achieve these goals with minimal scarring. Materials and Methods: Our technique was applied to all 26 cases: primary omphalocele repair (n &#61; 5), abdominal wall reconstructions after conservative management of large omphaloceles (n &#61; 17), large umbilical hernias (n &#61; 3), and one case of patent vitelointestinal duct with redundant skin. All patients were followed up yearly for the aesthetic appearance and clinical photographs were recorded. Results: Technique applied to all 26 patients had excellent cosmesis and long term follow up was very encouraging. Conclusions: All patients had successful abdominal wall closure. Most of the patients had minimal scar of the large hernia repair and the umbilicus was normal looking and well accepted cosmetically. 


Testicular volume in a cohort of prepubertal Indian children
Rohith Srinivas, Reju Joseph Thomas, Tunny Sebastian, Jujju Jacob Kurian

Journal of Indian Association of Pediatric Surgeons 2019 24(3):192-196

Context: There are orchidometer-based testicular volume nomograms for Indian children; however, accurate and reliable values measured by ultrasound are lacking. Aims: The aim of this study was to (1) measure the testicular volumes of boys from birth to 8 years and generate reference values and (2) to identify factors if any that may influence variation in testicular volumes. Settings and Design: This was a prospective observational study conducted on 320 children in the Department of Pediatric Surgery, Christian Medical College, Vellore, India. Subjects and Methods: A total of 320 boys without any genital abnormalities were studied. The testes were scanned using a linear transducer, and the length, width, and depth of each testis were recorded. Testicular volume was calculated using Lambert&#39;s equation &#8211; length &#215; width &#215; depth &#215; 0.71. Statistical Analysis Used: Mean testicular volumes and standard deviation for every year of age were calculated. The centile values for testicular volume were computed using R software. Results: Age-specific nomogram of each testis was created separately. Interobserver variability of the measurement was shown to be up to 0.3 ml. No difference was demonstrated in the testicular volumes between the right and left testis. No correlation was found between body weight and body mass index with testicular volume. From the data on differences in size between the two sides, a volume differential index of 27&#37; corresponds to the 95th centile. Conclusions: Reference values have been created for testicular volumes in prepubertal Indian children that could be used to assess the effects of disease and surgical interventions in this age group. 


Empyema thoracis in children: A 5-year experience in a Tertiary Care Institute
Kartik Chandra Mandal, Gobinda Mandal, Pankaj Halder, Dipanwita Mitra, Bidyut Debnath, Mala Bhattacharya

Journal of Indian Association of Pediatric Surgeons 2019 24(3):197-202

Objective: Empyema thoracis (ET) in children is a disease of significant morbidity and mortality. In the event of failure to resolute following intercostal chest tube drainage (ICD), thoracotomy decortication (TDC) remains the treatment of choice. We have reviewed the outcome of management of 96 cases of ET with the intent to establish the scope of ICD as primary form of the management. Materials and Methods: This is a retrospective study of 96 patients of ET who were managed in pediatric surgery department over a period of 5 years (April 2013 &#8211; March 2018). Ninety-six patients at a single center met inclusion criteria for having ET and underwent ICD. We excluded the cases where video-assisted thoracoscopic surgery was provided as primary treatment. The patients were categorized into complicated and uncomplicated groups. Those with pyopneumothorax, encysted empyema, multiloculated empyema, and bilateral ET were assigned as complicated group. There were two treatment groups: (I) those responded with ICD alone (II) those with ICD followed by TDC. Results: All 96 cases received ICD as primary management. There were 54 uncomplicated cases and 42 complicated cases. Out of 42 complicated cases, 26 patients recovered with ICD alone and 16 patients needed TDC. A total of 80 (83.33&#37;) patients (54 uncomplicated &#177; 26 complicated) recovered with ICD alone. Significant complications were encountered in follow-up of patients who underwent delayed thoracotomy in the form of overriding of the ribs (n &#61; 3) and postoperative air leak (n &#61; 4). There was no mortality in our series. Conclusion: Early initiation of management of ET with intercostal tube drainage is simple, safe, effective even in complicated cases, and has less complications. Thoracotomy with decortication should be reserved for ICD failure cases. 


Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480

Vascular and Endovascular Surgery

Wither "clinical evaluation"
Kalkunte R Suresh

Indian Journal of Vascular and Endovascular Surgery 2019 6(2):61-62



Paradigm shift in mentoring
Edwin Stephen

Indian Journal of Vascular and Endovascular Surgery 2019 6(2):63-64



Limb salvage using microvascular reconstructions for secondary regional vascular insufficiency in the neuro ischemic diabetic foot; is it making impact?
Thalaivirithan Margabandu Balakrishnan, Illayakumar Pramasivam, Krishnakumar Thirunavukarasu, Jaganmohan Janardhanan, Sritharan Narayanan

Indian Journal of Vascular and Endovascular Surgery 2019 6(2):65-73

Introduction: Secondary regional vascular insufficiency (RVI) is a pathophysiological state that occurs most commonly following the successfully involved perforosome-directed distal revascularization (IPDDR). This IPDDR renders bounding pulse in the vicinity of diabetic foot ulcer, which shows no signs of early granulation (the sign of healing potential) for variable time. This is the main cause for delaying the definitive reconstruction in the successfully revascularized diabetic foot. Aim: The aim of this study is to evaluate the effectiveness of microvascular and nonmicrovascular reconstructions (NMVRs) in the treatment of secondary RVI of the neuroischemic diabetic foot following successful IPDDR. Endpoints assessed in this study were as follows: (1) Time taken to render a stable and shoe able foot or foot residuum following successful revascularization of the neuroischemic diabetic foot. (2) Time interval between IPDDR and definitive reconstruction in both groups. (3) Rate of complications including recurrence of foot ulcers and failures of reconstruction in each group. Patients and Methods: From 2014 to 2017, 128 neuroischemic diabetic foot patients (a multicenter study) after successful IPDDR for their critical limb ischemia subsequently underwent various types of reconstructions. All had a variable period of secondary RVI following successful revascularization. A retrospective study was conducted by dividing them into two groups &#8211; MVR group with 69 patients and NMVR group with 59 patients. The interval between the IPDDR and definitive reconstructions in each group was called the &#8220;latent period.&#8221; All were followed up for an average period of 30 months. The standard postoperative care and offloading techniques were followed in both groups. Results: The average time taken for obtaining shoeable and stable foot or its residuum in the MVR group was 55.5 days and NMVR group was 76.5 days. By statistical analysis, the MVR group had lesser latency period (P &#61; 0.042), lesser ulcer recurrences (P &#61; 0.044), and lesser flap and reconstruction failures leading to amputation (P &#61; 0.0345). Conclusion: The MVR by bringing tissue from above or at the level of hip area produces sound and early healing of secondary RVI with higher limb salvage rate following the successful revascularization of neuroischemic diabetic foot. 


Preoperative factors predicting the outcomes of arteriovenous fistula surgery
Vedamurthy Reddy Pogula, Mallikarjuna Reddy Nalubolu, Ranadheer Byram, Harikrishna Maddiboina, Sudeep Bodduluri, AP Pavan, P Banuteja Reddy, Jayaraju Juturu

Indian Journal of Vascular and Endovascular Surgery 2019 6(2):74-78

Purpose: The aim is to study the preoperative factors predicting the outcome of arteriovenous fistulas (AVF) in chronic kidney disease (CKD) patients. Successful AVF formation is vital to the success of hemodialysis treatment. The factors leading to failure of AVF maturation are still ill defined and there is a limited ability to predict surgical vascular outcomes. In part, this is due to the heterogeneity of end-stage renal disease populations. Methods: A prospective observational study was under taken on CKD patients requiring vascular access surgery for a period of 2 years were from November 2015 to October 2017. Informed consent was obtained. Demographic, clinical factors, comorbidities including age, gender, site, laterality, smoking, diabetes, hypertension, coronary artery disease and peripheral vascular disease, vessel caliber, type of anastomosis, flow across vein, and anastomosis were noted. The patient&#39;s vessel status recorded preoperatively by a Doppler ultrasound. Postoperative assessment of AVF was performed with Doppler 4 weeks after surgery. Data were analyzed to assess the risk factors predicting AVF outcomes. Results: A total of 330 cases of AV fistula were enrolled in the study. Of these 330 cases, they were categorized and evaluated separately according to the site of fistula creation. 180 underwent radio-cephalic fistulas, 100 brachio-cephalic and 50 had brachio-basilic fistulas. All the fistulas were separately categorized and evaluated for the factors predicting their outcome. Conclusions: In this study, the outflow vein diameter, arterial diameter and flow rate in the vein and across the anastomosis were the predominant factor determining the success of the proximal and distal arm fistulas. 


Ulnar basilic arterio venous fistula: An useful alternative access for hemodialysis
Sekar Natarajan

Indian Journal of Vascular and Endovascular Surgery 2019 6(2):79-81

Objective: Native arteriovenous fistula done at the distal most site has been promoted as the vascular access of choice. Radiocephalic fistula at wrist or snuffbox is widely used but ulnar basilic fistula is seldom performed. The aim of this study is to analyse the usefulness of ulnar basilic fistula as a hemodialysis access. Method: Retrospective analysis of 52 ulnar basilic fistula done in 51 patients over 20 years (2007-2017) with a follow up of one year was done. Results: Fifty two ulnar basilic fistulae were established in 51 patients. Three patients developed early thrombosis and in one of them another ulnar fistula could be established in the same limb. Three others thrombosed within the next 4 months. Six fistulas failed to mature and could not be used for dialysis. Fortyone out of 52 remained patent at the end of one year (78.8 &#37;).There was no distal ischaemia in any of them. Majority of the failures occurred in women. Conclusion: Ulnar basilic fistula is an useful alternative when radiocephalic fistula is not possible or has already failed. It has high long term patency, has minimal complications and has the advantage of retaining the proximal sites for fistula in case of failure. 


Ultrasound-assisted angioplasty for failing arteriovenous access
Shahzad Sarosh Bulsara, Vinit Paliwal, Govind Prasad, NR Manjubharath, Ashutosh Aher, Ashish Airen, Tapish Sahu, Virender Sheorain, Tarun Grover, Rajiv Parakh

Indian Journal of Vascular and Endovascular Surgery 2019 6(2):82-88

Introduction: Arteriovenous (AV) access maturity and patency is critical for patients on hemodialysis. Maintaining a functioning AV access for these patients is of paramount importance. Salvage of failing AV accesses has been traditionally done mainly with angiographic techniques requiring significant amounts of contrast agent and radiation exposure. Ultrasound-guided angioplasty has been described, but its utility needs to be further studied. Methods: Group 1: 42 patients undergoing ultrasound-assisted angioplasty (UAA) for AV access salvage were assessed prospectively for 9 months (October 2016 to June 2017). Group 2: Retrospective data of 47 patients who underwent angioplasty for failing AV access without ultrasound assistance, over 9 months was collected (January to September 2016). This group was matched with Group 1 in terms of age, sex, type of AV access, and cause of AV access dysfunction. Results: There was a statistically significant decrease in the average number of angiographic runs (2.5 vs. 7.9) and fluoroscopy time in minutes (3.8 vs. 13.1) recorded during UAA (P &#60; 0.01). The average quantity of contrast agent used in milliliters (17.6 vs. 49.8) was also significantly less when ultrasound assistance was used (P &#60; 0.01). Conclusion: UAA for failing AV access reduces the radiation exposure and the amount of contrast agent used in these patients who require multiple of these sessions and need dialysis to get the contrast agent out of their circulation. This technique is feasible and reliable; hence should be used more frequently and effectively. Our model of UAA for AV access salvage allows all cases including complex cases to be performed with the added advantage of reduced radiation exposure and contrast agent; serving as a boon to these already distressed patients. Immediate complication management and adjunctive open procedures also become possible because of the hybrid operating room setup with fluoroscopy facility. 


Vascular access related complications with ipsilateral upper limb oedema in hemodialysis
RD Nagaraj, Sarala Settipalli, P Sandeep, AY Lakshmi, V Sivakumar

Indian Journal of Vascular and Endovascular Surgery 2019 6(2):89-98

Background: Central vein-related obstruction is a growing problem in maintenance hemodialysis (MHD). Prior to central vein temporary access, failure to implement &#8220;fistula first policy&#8221; is an important contributor for this problem. It interferes with the outcomes in dialysis adding to mechanical vascular perturbations, resulting in limb, facial, and chest wall edema. Keeping them in view, we undertook this study on MHD patients, presented with central vein-related vascular access problems and ipsilateral upper limb edema, with the aim to investigate the vascular anatomical obstructive lesions causing the clinical syndrome and their management. Materials and Methods: This cross-sectional study included 25 patients of end-stage renal disease on MHD who manifested with vascular access dysfunction, presented with ipsilateral upper limb edema, and were the study subjects. All patients were evaluated with thorough clinical, laboratory, and computed tomographic (CT) angiography (CTAngio) studies to address the issues. Results: All patients had ipsilateral upper limb edema and 36&#37; of them had in addition facial edema. Fifty percent had difficult cannulation with raising venous pressure during HD sessions and difficulty in securing hemostasis at the end of dialysis. CTAngio revealed central vein stenosis in 48&#37;, peripheral stenosis in 20&#37;, and combined central and peripheral stenosis in 32&#37; patients. Cephalic arch involvement was noted in 16&#37; patients. Depending on the patients preference, dialysis switched over to peritoneal dialysis in 24&#37;, new vascular access was created in 20&#37;, and balloon angioplasty in 16&#37; during management. Conclusions: This study describes the central venous-related problems in MHD patients. We reiterate the importance of three early warning signs: high venous pressure, difficulty to achieve hemostasis at the end of dialysis, and ipsilateral limb, face, chest wall edema as the presage signs to suspect and exclude the underlying central vein obstructions. A continuum of management is discussed. 


Role of brachial artery ligation as an emergency procedure in bleeding arteriovenous access
AR Chandrashekhar, Luv Luthra, Sanjay C Desai, B Rajendra Prasad

Indian Journal of Vascular and Endovascular Surgery 2019 6(2):99-101

Introduction: Bleeding from a ruptured or infected arteriovenous (AV) access is a life-threatening situation leading to increased mortality in chronic kidney disease (CKD) patients. All these patients need emergent and expeditious management. The procedures described for bleeding complications in AV access are associated with high morbidity and mortality. In some cases, there is a need for a major surgery or bypass. Aim: The aim was to evaluate the safety and efficacy of brachial artery ligation (BAL) in bleeding AV access. Materials and Methods: This was a single-center retrospective analysis of 106 patients who underwent BAL for bleeding AV access (AV graft [AVG]/brachiocephalic [BC] AV fistula [AVF]) from January 2007 to 2017. Results: During this study period, BAL was done in a total of 106 patients, out of which 51 patients underwent AVG explantation with BA ligation and 55 with ligation in BC fistulas. There were 73 males and 33 females with a mean age of 45 years (11&#8211;90). The primary etiology was hypertension (66&#37;), diabetes (23.58&#37;), and other causes (10.3&#37;). Twenty patients presented with acute bleeding due to graft erosion and 31 patients had purulent discharge from puncture site with sepsis. Infection was involving anastomosis in all patients. Out of 55 patients who underwent AVF, 5 patients had infection at puncture site 3&#8211;4 cm near the anastomosis. Fifty patients had infected pseudoaneurysms at the anastomotic site that developed within 1 week of the creation of fistula. All patients were evaluated and assessed for signs of ischemia in the postoperative period till the time of discharge. Conclusion: BAL is a safe alternative in patients with access site bleeding as it reduces not only the operative time but also the morbidity and mortality associated with CKD patients. Ligation of the brachial artery at the elbow can be used as a primary approach in complicated vascular access. 


Pseudoaneurysm of peripheral arteries: Our experience in a community-based hospital
Lokesh Shekher Jaiswal, Narendra Pandit, Jagat Narayan Prasad, Shailesh Adhikary

Indian Journal of Vascular and Endovascular Surgery 2019 6(2):102-106

Introduction: Pseudoaneurysms are false aneurysm where disruption in the arterial wall forms a localized pulsatile hematoma connecting the artery. The common causes are intravenous drug abuse (IVDA), iatrogenic (vascular interventions and surgery), trauma, and infections. Aims: The aim of this study was to analyze the etiology, management, and outcome of patients with pseudoaneurysms of peripheral arteries. Materials and Methods: This is a retrospective analysis of prospectively maintained database of 32 patients with peripheral artery pseudoaneurysms over 45 months at a community-based hospital of Eastern Nepal. Results: The most common site involved was femoral artery (56.3&#37;) followed by brachial (15.6&#37;), radial (6.3&#37;), anterior tibial (6.3&#37;), and others (15.5&#37;). The common etiologies were iatrogenic (46.9&#37;), IVDA (31.3&#37;), trauma (18.7&#37;), and infection (3.1&#37;). Operative intervention was performed in 29 (90.6&#37;) patients as follows: ligation of artery and debridement (46.9&#37;), primary repair (28.1&#37;), and venous graft bypass (15.6&#37;). Three patients (9.4&#37;) with noninfected iatrogenic pseudoaneurysms of &#60;3 cm were managed conservatively. Infected pseudoaneurysms were seen in 14 (43.7&#37;) patients. Staphylococcus aureus was the most common isolate in the culture. There was no reoperation, amputation, or any in-hospital mortality. At follow-up, one patient developed leg claudication pain following a femoral artery ligation and one of the five patients developed a graft thrombosis after an autologous reversed saphenous vein bypass graft without any sequelae. Conclusion: Although repair with distal revascularization is an ideal approach, debridement and simple ligation of pseudoaneurysms is a safer alternative especially in IV drug abusers. 


Risk assessment of varicose veins among the traffic police of Kathmandu Metropolitan City, Nepal
Robin Man Karmacharya, Laxmi Prajapati, Sangeeta Rai

Indian Journal of Vascular and Endovascular Surgery 2019 6(2):107-109

Introduction: Varicose veins are swollen, tortuous, and sometimes painful veins that are filled with an abnormal collection of blood. Varicose veins are known to be common among professionals such as teachers, traffic police, nurses, shopkeepers, and bus conductors, who have to stand for a long time daily. Other risk factors include age, obesity, pregnancy, smoking, and family history. If left untreated, it can lead to several complications such as ulcers, bleeding, and thromboembolism. Objective: The objective was to assess the risk of varicose veins among traffic police officers of Kathmandu Metropolitan City. Methods: An analytical cross-sectional study was conducted. Data were collected by interview technique and observation method which consisted of self-constructed semi-structured questionnaire for sociodemographic data, descriptive rating scales for symptoms, and observational checklist for signs of varicose veins. Nonprobability convenient sampling technique was used. Results: Out of 200 respondents, 24 (12&#37;) were at risk of varicose veins, out of which 22 were male and the rest were female. Conclusion: The results of the study suggest that overall risk of varicose vein is 12&#37;, with males accounting for 12.3&#37; and females for 9.5&#37;. In the study, the risk of varicose veins is statistically significantly associated with the family history of varicose vein and smoking. 


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