Monday, February 8, 2021

Long‐term therapy with botulinum toxin in facial synkinesis

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Abstract

Objectives

Treatment with botulinum toxin A (BoNT) is the therapy of choice for many patients with facial synkinesis. Repeated injections relieve hypertonicity and hyperkinesis of reinnervated mimic muscles. Aim of the study was to prove if the injection regime and dosage of BoNT change during long‐time therapy.

Design

Retrospective analysis of patients' data, who were treated for synkinesis with BoNT from 1998 to 2018.

Setting

Tertiary referral facial nerve center

Participants

Injection pattern of BoNT was based on clinical symptoms, observations of the specialist and on previous treatment pattern. Onabotulinumtoxin (OnaBoNT), Incobotulinumtoxin (IncoBoNT) and Abobotulinumtoxin (AboBoNT) were available for treatment. Patients consulted our department for following treatment as soon as the symptoms re‐occurred.

Main outcome measures

Change in dosage and injection pattern, the time intervals between treatments over the entire therapy period.

Results

73 patients were repeatedly injected. The median number of treatments was 18, the median treatment interval was 3.0 months. During the initial treatment, orbicularis oculi and the mentalis muscles were the most frequently injected muscles (94%). During repeated treatment, the number of injected muscles increased significantly (p < 0.0001), whereas the dose per muscle remained stable. The initial dose was 24 U (95%‐CI 22‐27 U) for OnaBoNT and IncoBoNT; 69 U for AboBoNT (95%‐CI 44‐94 U). We observed a significant increase in dosage for OnaBoNT and IncoBoNT (p < 0.0001) during the long‐term therapy. The time intervals between treatments were stable for all three BoNT preparations (p > 0.05).

Conclusions

We observed significant change in treatment dose and injection pattern of BoNT in patients with facial synkinesis. These results provide an orientation in dose finding and injection regimen of BoNT in the long‐term course of therapy.

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Can an in vitro hair drug model be developed using dermal papilla cells alone?

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Abstract

The search for hair growth drugs is hindered by the lack of in vitro models which adequately mimic the native hair follicle[1]. The in vitro organotypic model accurately reproduces hair drug responses from the hair shaft elongation of cultured hair follicles; however, these can only be maintained for 2 weeks, posing a challenge to obtain sufficient samples for comprehensive and continuous studies[2].

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Substantial alterations of the intestinal microbiota in psoriasis patients

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Abstract

Psoriasis is an immune‐mediated inflammatory skin condition. Accumulating evidence suggest that there is an intimate relationship between intestinal dysbiosis and psoriasis. In order to evaluate the specificity of intestinal microflora in patients with psoriasis and to investigate the link between psoriasis and gut microbiota, this study collected stool samples from 20 patients with moderate to severe chronic plaque psoriasis and 20 healthy controls. Methodological details are provided in the online supplementary material.

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Pneumosinus Dilatans: A Myriad of Symptomology

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Abstract

Pneumosinus dilatans is an abnormal expansion of the air-filled paranasal sinuses. Usually found incidentally on radiology, it does rarely present in the form of cosmetic, neurological, ocular or rhinological pathologies. We report a case of a young male with complaints of bilateral gradual vision loss, diagnosed as pneumosinus dilatans with optic nerve atrophy. He underwent bilateral optic nerve decompression. A review of all cases of pneumosinus dilatans, reported over the last 100 years in English literature is presented.

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Effects of diurnal changes on temporal processing in morning-type and evening-type individuals with normal hearing.

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Effects of diurnal changes on temporal processing in morning-type and evening-type individuals with normal hearing.

Eur Arch Otorhinolaryngol. 2021 Feb 02;:

Authors: Prakash P, Jayan A, Prabhu P

Abstract
OBJECTIVE: The present study aims at determining the influence of diurnal changes in duration discrimination and temporal resolution in the morning- and evening-type individuals with normal hearing sensitivity.
METHOD: Sixty individuals with normal hearing were divided into morning, evening and intermediate types using the Morningness-Eveningness Questionnaire. Tests for Duration discrimination, Gap detection, and Temporal modulation transfer function were carried out in all the participants during morning and evening. The performance of subjects of all the three groups during both morning and evening was analyzed.
RESULTS: Results revealed a diurnal effect on morning and evening type individuals' performance where morning type exhibited better performance when tested during morning and evening individuals when tested during the evening. At the same time, there were no significant diurnal effects seen in the intermediate type.
CONCLUSIONS: The poor cognitive performance and lack of inhibitory control at the time of the off-peak hours possibly result in the poor scores. Furthermore, the diurnal effects on objective audiological tests in morning and evening type individuals should be studied. The influence of diurnal changes could be considered an extraneous variable in future research on psychoacoustic tests in younger adults.

PMID: 33532900 [PubMed - as supplied by publisher]

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Surgical anatomy of the transcanal infracochlear approach.

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Surgical anatomy of the transcanal infracochlear approach.

Eur Arch Otorhinolaryngol. 2021 Feb 03;:

Authors: Cömert E, Cömert A

Abstract
PURPOSE: The objective of this study is to describe the detailed surgical anatomy of the infracochlear approach to prevent complications and to compare the postauricular transcanal microscopic and endoscopic approaches to reach the petrous apex.
METHODS: Cadaver heads were dissected using a binocular surgical microscope, endoscopes, and an electric drill. The dimensions of the access field that could be reached and manipulated with surgical instruments and straight drill via postauricular transcanal microscopic and endoscopic approaches were evaluated.
RESULTS: Both postauricular microscopic and transcanal endoscopic approaches were considered to be inapplicable in cases with a tympanic cavity located jugular bulb closer than 3 mm to the cochlea. This relationship was seen in 3 (9%) sides of the cadavers. In 4 specimens (12%), a cochlear aqueduct with an open lumen was detected. Both postauricular microscopic and transcanal endoscopic approaches reached a nearly identic dissection area. Detailed anatomy of the approach and measurements about the topography of the third portion of the facial nerve from the tympanic cavity were presented.
CONCLUSION: Both traditional microscopic postauricular and endoscopic transcanal approaches provided comparable access areas to the inferior petrous apex with wide exposure, and radiologic measurements were compatible. A tympanic cavity located jugular bulb in close relation with cochlea was the only instance that restricted the applicability of this technique.

PMID: 33532901 [PubMed - as supplied by publisher]

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Patients with comorbid rheumatoid arthritis are predisposed to peritonsillar abscess: real-world evidence.

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Patients with comorbid rheumatoid arthritis are predisposed to peritonsillar abscess: real-world evidence.

Eur Arch Otorhinolaryngol. 2021 Feb 03;:

Authors: Ding MC, Tsai MS, Yang YH, Liu CY, Tsai YT, Hsu CM, Wu CY, Chang PJ, Lin KM, Chang GH

Abstract
PURPOSE: The peritonsillar abscess (PTA)-rheumatoid arthritis (RA) association remains unclear. Here, the effects of RA on PTA incidence and prognosis are elucidated.
METHODS: We compared PTA incidence and prognosis of 30,706 RFCIP-registered patients with RA (RA cohort) with matched individuals without RA from another database of 1 million randomly selected people representing Taiwan's population (non-RA cohort).
RESULTS: The RA cohort had significantly higher PTA incidence [incidence rate ratio (IRR) (95% CI) 1.73 (1.10-2.71), P = 0.017) and cumulative incidence (P = 0.016, Kaplan-Meier curves). Cox regression analyses demonstrated RA cohort to have an estimated 1.72-fold increased PTA risk (95% CI 1.09-2.69, P = 0.019). PTA was more likely within the first 5 years of RA diagnosis (for < 1, 1-5, and ≥ 5 postdiagnosis years, IRRs: 2.67, 2.31, and 1.10, respectively, and P = 0.063, 0.021, and 0.794, respectively; average onset duration: 4.3 ± 3.3 years after RA diagnosis). PTA increased length of hospital stay significantly and risk of complication with deep neck infection nonsignificantly [6.5 ± 4.5 vs 4.6 ± 2.8 days (P = 0.045) and 18.52% vs 7.81% (P = 0.155), respectively]. Moreover, RA-cohort patients not receiving RA therapy exhibited 5.06-fold higher PTA risk than those receiving RA-related therapy (95% CI 1.75-14 .62, P = 0.003).
CONCLUSIONS: In patients with RA, PTA incidence is the highest within 5 years of RA diagnosis, and RA therapy is essential for reducing PTA risk.
LEVEL OF EVIDENCE: 4.

PMID: 33533941 [PubMed - as supplied by publisher]

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Resistant Temporal Lobe Epilepsy: Initial Steps into a Bigger Epilepsy Surgery Program.

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Resistant Temporal Lobe Epilepsy: Initial Steps into a Bigger Epilepsy Surgery Program.

J Neurosci Rural Pract. 2021 Jan;12(1):193-196

Authors: Mehrotra A, Singh S, Kanjilal S, Attri G, Rangari K, Paliwal VK, Mani V, Verma PK, Maurya VP, Sardhara J, Bhaisora KS, Das KK, Srivastava AK, Jaiswal AK, Behari S

Abstract
Background  Among the patients of drug-resistant epilepsy, a subset which has focal impaired seizures localizes to the temporal lobe region (TLE). A majority of these cases are surgically amenable with anterior-medial temporal lobe resection or "lesionectomy." Objective  In India, there is scarcity of "specialized centers" providing "comprehensive epilepsy care" and this dearth is further worse in populous states. In this article, we share our single center, observational, and retrospective experience of TLE in background of limited resources and utmost requirement. Methodology  Our study is a retrospective analysis medically refractory epilepsy patients (2016-2019). Patients with medically refractory epilepsy were selected based upon our noninvasive protocol (clinical semiology, interictal scalp electroencephalography (EEG), long-term video EEG monitoring data, and magnetic resonance injury [MRI]). The follow-up was noted from the last out-patient visit record or throu gh telephonic conversation (International League Against Epilepsy score). Results  Of 23 cases of TLE ( n = 7, mesial temporal sclerosis; n = 16 temporal lobe like cavernomas, tumors, or arterio-venous malformations). Single photon emission computed tomography/positron emission tomography (SPECT/PET) was performed in five cases (three cases of ictal/interictal SPECT and two cases of PET scan) where there was discordance between EEG/clinical and MRI. The median follow-up was of 19 months with 18 cases being seizure free. Five cases were fully off the antiepileptic drug (AEDs) while in 15 cases, the AEDs dosages or the number were reduced. Average number of AEDs reduced from 2.9 in preoperative period to 1.2 postoperatively. Two cases had quadrantanopia and one case of cerebrospinal fluid leak. Conclusion  A multidisciplinary and holistic approach is required for best patient care. The results of our initial surgical experience are encouraging.

PMID: 33531782 [PubMed]

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New European Approvals: Brexucabtagene autoleucel for refractory mantle cell lymphoma after Bruton tyrosine kinase (BTK) inhibitor

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[New European Approvals: Brexucabtagene autoleucel for refractory mantle cell lymphoma after Bruton tyrosine kinase (BTK) inhibitor].

Bull Cancer. 2021 Jan 30;:

Authors: Rousseau A, Thieblemont C

PMID: 33531153 [PubMed - as supplied by publisher]

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New AMM: Nivolumab for advanced oesophageal squamous cell carcinomia after first line of chemotherapy

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[New AMM: Nivolumab for advanced oesophageal squamous cell carcinomia after first line of chemotherapy].

Bull Cancer. 2021 Jan 30;:

Authors: Reich M, Coutzac C

PMID: 33531154 [PubMed - as supplied by publisher]

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The Natural History of Parapharyngeal Solitary Fibrous Tumor/Hemangiopericytoma: A Case Report.

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The Natural History of Parapharyngeal Solitary Fibrous Tumor/Hemangiopericytoma: A Case Report.

Ear Nose Throat J. 2021 Feb 02;:145561321991338

Authors: Xu M, Chen M, Hua H, Yin J, Yan S

Abstract
Solitary fibrous tumor/hemangiopericytoma (SFT/HPC) is extremely rare, and most of them are immediately treated for radical resection. However, the information concerning its natural history remains unclear. In this report, we presented a patient with parapharyngeal SFT/HPC, who was not immediately treated with surgical resection at first diagnosis. After approximately 3 years, the tumor volume doubling time (TVDT) and specific growth rate (SGR) could be measured through 3 serial magnetic resonance imagings. The TVDTs in the early and late pretreatment stages were 350 and 180 days, respectively, while the SGRs were 0.002 and 0.003, respectively. The growth rate of this disease entity is generally slow and may accelerate in the disease process.

PMID: 33530739 [PubMed - as supplied by publisher]

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Modified Negative Pressure Enclosure During Tracheostomy in Patients With COVID-19.

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Modified Negative Pressure Enclosure During Tracheostomy in Patients With COVID-19.

Ear Nose Throat J. 2021 Feb 02;:145561321991319

Authors: Levy DA, Boey HP, Leff PD

Abstract
COVID-19 also known as severe acute respiratory syndrome coronavirus 2 is the result of a highly transmissible coronavirus which can result in severe infection of the respiratory tract. The global pandemic which began in early 2020 has created a number of challenges for the medical community to contain the rate of transmission, especially to health care workers. A minority of the infected population will progress toward severe respiratory distress ultimately requiring mechanical ventilator assistance. Although preliminary data suggest a poor prognosis for those requiring ventilation support, there is a subgroup who will eventually be weaned off. As the pandemic evolves, this cohort of infected, chronically intubated and ventilated individuals will become more prevalent and may require tracheostomy to aid in recovery. Unfortunately, tracheostomy is an aerosol-generating procedure which poses high risks to all members within the operating room, as described by previous authors. There is an urgent need to explore and develop methods to maximize the safety of tracheostomy and other aerosol-generating procedures in order to reduce intraoperative transmission. In the present article, we present a modified technique for negative pressure enclosure in patients with COVID-19 who underwent tracheostomy.

PMID: 33530740 [PubMed - as supplied by publisher]

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