Unusual case of spontaneous discharge of pus (infected cyst) through the dorsum of the tongue

Neck swellings are often a result of infections that spread from the teeth. This case highlights an unusual presentation of spontaneous pustular discharge from the anterior dorsum of the tongue.     

Implementing partnership-driven clinical federated electronic health record data sharing networks

ObjectiveBuilding federated data sharing architectures requires supporting a range of data owners, effective and validated semantic alignment between data resources, and consistent focus on end-users. Establishing these resources requires development methodologies that support internal validation of data extraction and translation processes, sustaining meaningful partnerships, and delivering clear and measurable system utility. We describe findings from two federated data sharing case examples that detail critical factors, shared outcomes, and production environment results.MethodsTwo federated data sharing pilot architectures developed to support network-based research associated with the University of Washington’s Institute of Translational Health Sciences provided the basis for the findings. A spiral model for implementation and evaluation was used to structure iterations of development and support knowledge share between the two network development teams, which cross collaborated to support and manage common stages.ResultsWe found that using a spiral model of software development and multiple cycles of iteration was effective in achieving early network design goals. Both networks required time and resource intensive efforts to establish a trusted environment to create the data sharing architectures. Both networks were challenged by the need for adaptive use cases to define and test utility.ConclusionAn iterative cyclical model of development provided a process for developing trust with data partners and refining the design, and supported measureable success in the development of new federated data sharing architectures.     

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??Objective??To select the best predictor of swallowing functions by exploring the correlation between the swallowing function and tongue mobility and tongue pressure of the patients with tongue defects after oral cancer surgery or oropharyngeal cancer surgery. Methods??From July 2017 to March 2018??in Hospital of Stomatology??Sun Yat-sen University??thirty-six cases of patients with tongue defects after oral cancer surgery or oropharyngeal cancer surgery were collected during return visits in the outpatient clinics of our hospital. The swallowing functions were graded by their water swallowing test??WST??results. The tongue mobility scores were evaluated by using the lingual range of motion??LROM??method??while the tongue pressure was measured by using the Iowa oral performance instrument??IOPI??. Spearman rank correlation analysis was applied to calculate the rank correlation coefficient??rs?? between the tongue mobility scores or tongue pressure and WST results??and the corresponding P value. Results??The rs value between WST results and tongue mobility scores or tongue pressure was -0.575 and -0.613 respectively??P??0.05??. The rs value of tongue pressure was larger than that of tongue mobility scores. Conclusion??Both the tongue mobility scores and tongue pressure have a great impact on the swallowing functions of patients with tongue defects after oral cancer surgery or oropharyngeal cancer surgery??and tongue pressure is the best predictor.     

Use of the double-paddle anterolateral thigh flap for locally advanced tongue carcinoma requiring second site reconstruction

BackgroundAdvanced oral tongue carcinoma can present with extension beyond the oral cavity. Operative defects after resection may involve multiple anatomical sites and significantly impact speech and swallowing. Dependence on long-term enteral feeding is not uncommon for these patients. The anterolateral thigh (ALT) flap is one of the most reliable and flexible flaps used in the reconstruction of total and subtotal tongue defects. The double-paddle flap modification may be a more suitable option for complex oral tongue defects after advanced tumor ablation.MethodsCase series of 31 patients with oral tongue squamous cell carcinoma that were classified as stage IV. The age of patients ranged from 32 to 63 years. We designed the double-paddle ALT flaps to reconstruct the two-site surgical defects (tongue defect and pharynx or neck skin defect). Postoperative viability of the flap was checked by clinical observation. The last examination was performed at 3-months after the completion of adjuvant chemoradiotherapy. The functional capacity of our patients was evaluated by three physicians (Head and Neck Surgeon, Radiation Oncologist, and Physiatrist) using a Speech Intelligibility Score and the Functional Oral Intake Scale.ResultsA total of 31 patients with surgical defects after total or subtotal tongue resection for cancer underwent double-paddle ALT flaps for reconstruction from March 2018 to December 2019. The dimension of flaps from 8 × 12 cm to 10 × 18 cm were divided into double-paddle from 8 × 5 cm to 10 × 10 cm. There was one case of pedicle thrombosis, one case of postoperative bleeding, three cases of neck infection, and six cases of salivary fistula. Our patients were seen in follow up from 6 to 36 months, with median follow-up of 23.5 months. The survival rate of ALT flap was 100%. All of our patients achieved an oral diet by 9 months after surgery. The mean score speech intelligibility was 2.74 ± 0.68 (4-point ordinal scale). The 2-year disease-free survival rate was 61.3%.ConclusionsThe double-paddle ALT flap is a reliable flap suitable for oral defects involving multiple subsites after ablative procedures. The majority of patients demonstrated acceptable functional rehabilitation.Clinical question/ level of evidenceTherapeutic, IV.     

Prevalencia e incidencia de sobrepeso y obesidad en 2,5 millones de niños y adolescentes en España

Introduction and objectivesChildhood obesity trends are plateauing in Spain, but limited information is available about how they differ by region. This study assessed childhood and adolescent the prevalence and incidence of overweight and obesity from 2005 to 2017 across 8 Spanish regions.MethodsThis longitudinal study used height and weight measurements from 2.5 million children aged 2 to 17 years to calculate overweight and obesity, according to the World Health Organization (WHO) guidelines. Data were obtained from The Base de datos para la Investigación Farmacoepidemiológica en Atención Primaria, and the Information System for Research in Primary Care. Prevalence and incidence rates and trends from 2005 to 2017 were calculated and stratified by age, sex, and region.ResultsThe overall obesity prevalence increased in boys and girls from age 2 (0.8%; 95%CI, 0.8-0.9 in both sexes) until peaking at age 7 in girls (17.3%; 95%CI, 17.1-17.5) and age 9 in boys (24.1%; 95%CI 23.9-24.3). The highest and lowest obesity prevalences were observed in Murcia and Navarre. Overall obesity prevalence trends decreased from 2005 to 2017 in all age-sex groups and in most regions. Highest obesity incidence rates were found in children aged 6 to 7 years, (4.5 [4.5-4.5] and 3.5 [3.5-3.5] new obesity cases per 100 person-years in boys and girls, respectively). Boys had higher prevalence and incidence rates than girls across all regions. Overweight/obesity prevalence and incidence rates and their trends were consistently higher than the obesity results, although a similar pattern was observed across sex and age.ConclusionsOverweight and obesity prevalence slightly decreased in Spain from 2005 to 2017, but regional, sex, and age differences persisted. Because incidence peaked around the age of 6 years, it may be important to begin health promotion programs at an early age.