Sialendoscopy plus laser lithotripsy in sialolithiasis of the submandibular gland in 64 patients: A simple and safe procedure

ObjectiveTo demonstrate the safety and efficiency of holmium laser-assisted lithotripsy during sialendoscopy of the submandibular gland using a retrospective, interventional consecutive case series.MethodsWe performed 374 sialendoscopies between 2008 and 2015 and evaluated all patients regarding clinical symptoms, clinical findings, therapy and outcome. We performed 109 procedures of holmium laser-assisted lithotripsy in 64 patients whose sialoliths measured 5 mm or more in diameter. In addition to retrospective case note reviews, we performed telephone interviews of all patients in January 2017.ResultsWe performed 374 consecutive submandibular gland sialendoscopy procedures in 276 patients between 2008 to 2015. Sialolithiasis had either previously been diagnosed, or symptoms highly suggestive of sialolithiasis of the submandibular gland presented in 197 patients.Holmium laser-assisted Laser lithotripsy was performed in 109 cases (64.9%). Smaller mobile concrement was removed directly either by forceps or wire basket, or following marsupialisation of the submandibular duct. This was the case in 88 patients (29.1%). Three patients (0.8%) required surgical removal of the submandibular gland due to early abscess. The majority of patients (n = 374 procedures; 90.1%) remained symptom-free after two or more years following intervention. In the remaining procedures (n = 37 procedures; 9.9%), patients reported discreet postprandial problems but did not seek medical attention. In total, we managed to preserve the submandibular gland and avoid open surgery in 99% of patients through endoscopic management of submandibular concrement and duct stenosis.ConclusionHolmium laser-assisted lithotripsy is a simple, safe, and effective procedure for treating patients with sialolithiasis of the submandibular gland. Removal of the gland is rarely required, and removing the gland without prior sialendoscopy is no longer recommended. It should be offered to all patients with submandibular gland sialolithiasis, or such patients should be referred to the appropriate centre for sialendoscopy before submandibulectomy is considered.     

Cardiomyopathies and Genetic Testing in Heart Failure: Role in Defining Phenotype-Targeted Approaches and Management

Cardiomyopathies represent an important cause of heart failure, often affecting young individuals, and have important implications for relatives. Genetic testing for cardiomyopathies is an established care pathway in contemporary cardiology practice. The primary cardiomyopathies where genetic testing is indicated are hypertrophic, dilated, arrhythmogenic, and restrictive cardiomyopathies, with left ventricular noncompaction as a variant phenotype. Early identification and initiation of therapies in patients with inherited cardiomyopathies allow for targeting asymptomatic and presymptomatic patients in stages A and B of the American College of Cardiology/American Heart Association classification of heart failure. The current approach for genetic testing uses gene panel–based testing with the ability to extend to whole-exome and whole-genome sequencing in rare instances. The central components of genetic testing include defining the genetic basis of the diagnosis, providing prognostic information, and the ability to screen and risk-stratify relatives. Genetic testing for cardiomyopathies should be coordinated by a multidisciplinary team including adult and pediatric cardiologists, genetic counsellors, and geneticists, with access to expertise in cardiac imaging and electrophysiology. A pragmatic approach for addressing genetic variants of uncertain significance is important. In this review, we highlight the indications for genetic testing in the various cardiomyopathies, the value of early diagnosis and treatment, family screening, and the care process involved in genetic counselling and testing.     

Effects of levamisole in Sézary syndrome. Apparent acceleration of disease.

2 patients with Sézary syndrome were treated with levamisole. Both patients had clinical and hematological evidence of acceleration of their disease and ultimately died, although 1 patient had improvement in skin test reactivity. We suggest that levamisole be used with caution, if at all, in patients with T-lymphocyte malignancies.     

Die Thymektomie und ihr Erscheinungsbild

Zusammenfassung Nach einer kurzen Erörterung der Fehler, die unserer Ansicht nach bisher bei der Thymektomie gemacht wurden und die für den Mißerfolg dieses Eingriffes bisher verantwortlich sind, wird eine Methode zur Thymektomie bei jungen Meerschweinchen beschrieben. Beim Meerschweinchen wird das Bild des Thymusfalls eingehend studiert, es besteht in Wachstumsstillstand bzw. Wachstumshemmung, Tonusverlust der Muskulatur, Muskelatrophie und Tod. Der Thymus ist nach unseren Versuchen lebensnotwendig. Die thymektomierten Tiere zeigen schwere histologische Veränderungen in Schilddrüse, Nebennieren, Pankreas und Keimdrüsen. Es werden Belege für sämtliche Befunde mitgeteilt. Besonders stark verändert ist bei den thymektomierten Tieren das Herz. Die Befunde am Herzen sind derartig, daß man annehmen kann, daß der Tod des thymektomierten Tieres die Folge einer degenerativen Herzveränderung und Herzdilatation ist. Im Gegensatz zu älteren Befunden werden keinerlei Störungen des Kalkhaushaltes gesehen. Es werden Therapieversuche bei thymektomierten Tieren mit Ausfallserscheinungen beschrieben, die ergeben, daß das aus dem Thymus von Kälbern gewonnene Lipoid in der Lage ist, den Wachstumsstillstand bei den thymektomierten Tieren schnell und sicher zu beheben.Wir danken dem Herrn Oberpräsidenten und Gauleiter von Schleswig-Holstein Hinrich Lohse für Mittel, die uns die Durchführung dieser Arbeit ermöglichten, und der Forschungsgemeinschaft der deutschen Wissenschaft sowie dem Reichsforschungsrat für die Erteilung eines Forschungsstipendiums. Auch der Freiburger wissenschaftlichen Gesellschaft haben wir an dieser Stelle für die Überlassung von Forschungsmitteln zur Anschaffung von Versuchstieren unseren Dank abzustatten.     

Über die Abhängigkeit der Carotinresorption aus dem Darm von der Zugeführten Fettart

Ohne Zusammenfassung