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1.
Otolaryngol Head Neck Surg ; 158(5): 854-859, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29460670

RESUMO

Objectives To evaluate national trends in opioid prescribing patterns by otolaryngologists for postoperative pain control after common otolaryngologic procedures. Study Design Cross-sectional; survey. Subjects and Methods A survey to determine opioid prescribing patterns for the treatment of postoperative pain following common otolaryngologic procedures was distributed to all members of the American Academy of Otolaryngology-Head and Neck Surgery. Results The most common pain medication prescribed for adults postoperatively was hydrocodone-acetaminophen (73%), followed by oxycodone-acetaminophen (39%). The most common pain medication prescribed postoperatively for children was acetaminophen (67%), followed by nonsteroidal anti-inflammatory drugs (65%). Overall, there was a wide variation in quantity of opioids prescribed for each surgery, ranging from 0 to more than 60 doses. Mean opioid prescriptions were greatest for tonsillectomy (37 tablets) and least for direct laryngoscopy (5.3 tablets). Conclusion This study identifies nationwide variations in opioid prescribing patterns among otolaryngologists. While otolaryngology is a relatively small specialty, we still have an obligation to work with all physicians to help combat the current opioid epidemic. By evaluating nationwide postoperative pain regimens, we are moving closer toward understanding how to reduce the opioid burden.


Assuntos
Analgésicos Opioides/uso terapêutico , Otolaringologia , Padrões de Prática Médica , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Otorrinolaringológicos/efeitos adversos , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Estados Unidos
2.
Int J Pediatr Otorhinolaryngol ; 104: 178-181, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29287862

RESUMO

INTRODUCTION: There has been a growing shift towards endoscopic management of laryngeal procedures in pediatric otolaryngology. There still appears to be a shortage of pediatric otolaryngology programs and children's hospitals worldwide where physicians can learn and practice these skills. Laryngeal simulation models have the potential to be part of the educational training of physicians who lack exposure to relatively uncommon pediatric otolaryngologic pathology. OBJECTIVES: The objective of this study was to assess the utility of pediatric laryngeal models to teach laryngeal pathology to physicians at an international meeting. METHODS: Pediatric laryngeal models were assessed by participants at an international pediatric otolaryngology meeting. Participants provided demographic information and previous experience with pediatric airways. Participants then performed simulated surgery on these models and evaluated them using both a previously validated Tissue Likeness Scale and a pre-simulation to post-simulation confidence scale. RESULTS: Participants reported significant subjective improvement in confidence level after use of the simulation models (p < 0.05). Participants reported realistic representations of human anatomy and pathology. The models' tissue mechanics were adequate to practice operative technique including the ability to incise, suture, and suspend models. CONCLUSION: The pediatric laryngeal models demonstrate high quality anatomy, which is easy manipulated with surgical instruments. These models allow both trainees and surgeons to practice time-sensitive airway surgeries in a safe and controlled environment.


Assuntos
Laringe/cirurgia , Manequins , Otolaringologia/educação , Pediatria/educação , Criança , Competência Clínica , Humanos
4.
Bone ; 90: 127-32, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27297606

RESUMO

Osteogenesis Imperfecta (OI) comprises a group of genetic skeletal fragility disorders. The mildest form of OI, Osteogenesis Imperfecta type I, is frequently caused by haploinsufficiency mutations in COL1A1, the gene encoding the α1(I) chain of type 1 collagen. Children with OI type I have a 95-fold higher fracture rate compared to unaffected children. Therapies for OI type I in the pediatric population are limited to anti-catabolic agents. In adults with osteoporosis, anabolic therapies that enhance Wnt signaling in bone improve bone mass, and ongoing clinical trials are determining if these therapies also reduce fracture risk. We performed a proof-of-principle experiment in mice to determine whether enhancing Wnt signaling in bone could benefit children with OI type I. We crossed a mouse model of OI type I (Col1a1(+/Mov13)) with a high bone mass (HBM) mouse (Lrp5(+/p.A214V)) that has increased bone strength from enhanced Wnt signaling. Offspring that inherited the OI and HBM alleles had higher bone mass and strength than mice that inherited the OI allele alone. However, OI+HBM and OI mice still had bones with lower ductility compared to wild-type mice. We conclude that enhancing Wnt signaling does not make OI bone normal, but does improve bone properties that could reduce fracture risk. Therefore, agents that enhance Wnt signaling are likely to benefit children and adults with OI type 1.


Assuntos
Osso e Ossos/patologia , Osso e Ossos/fisiopatologia , Colágeno Tipo I/metabolismo , Osteogênese Imperfeita/patologia , Osteogênese Imperfeita/fisiopatologia , Via de Sinalização Wnt , Alelos , Animais , Fenômenos Biomecânicos , Densidade Óssea , Matriz Óssea/patologia , Osso e Ossos/diagnóstico por imagem , Osso e Ossos/metabolismo , Calcificação Fisiológica , Osso Esponjoso/diagnóstico por imagem , Osso Esponjoso/patologia , Osso Esponjoso/fisiopatologia , Colágeno Tipo I/genética , Cadeia alfa 1 do Colágeno Tipo I , Osso Cortical/diagnóstico por imagem , Osso Cortical/patologia , Osso Cortical/fisiopatologia , Modelos Animais de Doenças , Feminino , Fêmur/diagnóstico por imagem , Fêmur/patologia , Fêmur/fisiopatologia , Proteína-5 Relacionada a Receptor de Lipoproteína de Baixa Densidade/metabolismo , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Vértebras Lombares/fisiopatologia , Masculino , Camundongos Endogâmicos C57BL , Tamanho do Órgão , Microtomografia por Raio-X
5.
J Bone Miner Res ; 29(10): 2297-306, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24677211

RESUMO

The cell surface receptor low-density lipoprotein receptor-related protein 5 (LRP5) is a key regulator of bone mass and bone strength. Heterozygous missense mutations in LRP5 cause autosomal dominant high bone mass (HBM) in humans by reducing binding to LRP5 by endogenous inhibitors, such as sclerostin (SOST). Mice heterozygous for a knockin allele (Lrp5(p.A214V) ) that is orthologous to a human HBM-causing mutation have increased bone mass and strength. Osteogenesis imperfecta (OI) is a skeletal fragility disorder predominantly caused by mutations that affect type I collagen. We tested whether the LRP5 pathway can be used to improve bone properties in animal models of OI. First, we mated Lrp5(+/p.A214V) mice to Col1a2(+/p.G610C) mice, which model human type IV OI. We found that Col1a2(+/p.G610C) ;Lrp5(+/p.A214V) offspring had significantly increased bone mass and strength compared to Col1a2(+/p.G610C) ;Lrp5(+/+) littermates. The improved bone properties were not a result of altered mRNA expression of type I collagen or its chaperones, nor were they due to changes in mutant type I collagen secretion. Second, we treated Col1a2(+/p.G610C) mice with a monoclonal antibody that inhibits sclerostin activity (Scl-Ab). We found that antibody-treated mice had significantly increased bone mass and strength compared to vehicle-treated littermates. These findings indicate increasing bone formation, even without altering bone collagen composition, may benefit patients with OI.


Assuntos
Osso e Ossos/patologia , Proteína-5 Relacionada a Receptor de Lipoproteína de Baixa Densidade/metabolismo , Osteogênese Imperfeita/metabolismo , Osteogênese Imperfeita/patologia , Transdução de Sinais , Proteínas Adaptadoras de Transdução de Sinal , Alelos , Animais , Colágeno/metabolismo , Modelos Animais de Doenças , Feminino , Glicoproteínas/antagonistas & inibidores , Glicoproteínas/metabolismo , Humanos , Peptídeos e Proteínas de Sinalização Intercelular , Masculino , Camundongos , Mutação/genética , Osteogênese
6.
A A Case Rep ; 3(9): 123-5, 2014 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-25611864

RESUMO

We describe a patient who developed a hypopharyngeal mass (in the setting of a cervical osteophyte) while taking clopidogrel and aspirin for coronary artery disease. He had a 2-month history of progressive dysphagia and hoarseness. Physical examination and computed tomography scan revealed a soft tissue retropharyngeal mass of unclear etiology yet with a stable airway. He was admitted to the intensive care unit for a 48-hour clopidogrel washout followed by surgery. A hematoma and cervical osteophyte were removed with scant bleeding. This case report emphasizes the need to consider the medication history of a patient when assessing the cause of an otherwise unexpected finding.

7.
Plast Reconstr Surg ; 129(2): 228e-233e, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22286438

RESUMO

BACKGROUND: Obesity, determined by body mass index, is known to be associated with surgical complications. This study was performed to evaluate a correlation between body mass index and postoperative complications in reduction mammaplasty. METHODS: The authors performed a retrospective analysis of consecutive reduction mammaplasties performed at the Brigham and Women's Hospital by eight surgeons between 1995 and 2007. Data regarding demographics, comorbidities, body mass index, reduction specimen weight, reduction technique, and complications were collected. Univariate and multivariate analyses were used to assess the association between body mass index and complication rates. Multivariate logistic regression analysis was used to determine the threshold body mass index value at which differential complication rates were maximal. RESULTS: A total of 675 bilateral reduction mammaplasties were analyzed; 75 complications (11 percent) were observed, including hematoma, infection, necrosis, and reoperation. Mean body mass index was 31.0 ± 6.2. A significant association was noted between body mass index and complication rate on the basis of both univariate (p = 0.036) and multivariate (p = 0.037) analyses. Trend analysis of body mass index as a categorical variable relative to complication rate was also statistically significant (p = 0.01). A cutoff point was suggested whereby patients with a body mass index of more than 35.6 experienced a significantly higher complication rate than did patients below this threshold (odds ratio = 2.002; p = 0.004). CONCLUSIONS: Body mass index is significantly associated with increased complications following reduction mammaplasty. An index value greater than 35.6 is associated with a twofold-higher risk of complications. Patients with a body mass index of 36 or above should be cautioned regarding a potential increased risk of complications. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, IV.


Assuntos
Índice de Massa Corporal , Mamoplastia/efeitos adversos , Adolescente , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Prognóstico , Estudos Retrospectivos , Adulto Jovem
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