Vitiligo and tumoral melanosis: signs of metastasis in a patient with melanoma

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Presence of the Merkel cell polyomavirus in Merkel cell carcinoma combined with squamous cell carcinoma in a patient with chronic arsenism

Summary

We present a case of Merkel cell carcinoma (MCC) coincident with squamous cell carcinoma (SCC) on the breast of a woman with chronic arsenism. This case demonstrates the distinct association of chronic arsenism with two different primary cutaneous carcinomas. Merkel cell polyomavirus (MCPyV) was identified in the lesional skin of the MCC but not in that of the SCC, suggesting there are different interactions of MCPyV in the pathogenesis of SCC and MCC related to arsenic. Physicians need to be vigilant in the occurrence of both SCC and MCC in patients with chronic arsenism. To our knowledge, this is the first study to show the presence of MCPyV in the MCC but not the SCC portion of an arsenic-induced tumour.

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ATA members elected to Endocrine Society Council 2017

Congratulations to ATA Members Susan J. Mandel, MD, MPH and Anthony Hollenberg, MD  who were elected to serve as Officers and Council for the Endocrine Society . Read More….

The post ATA members elected to Endocrine Society Council 2017 appeared first on American Thyroid Association.

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Stability of suxamethonium in pharmaceutical solution for injection by validated stability-indicating chromatographic method

To assess the stability of pharmaceutical suxamethonium (succinylcholine) solution for injection by validated stability-indicating chromatographic method in vials stored at room temperature.

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Agenesia nasal y otras malformaciones faciales: reporte de un caso de anomalía congénita y revisión de literatura

Publication date: Available online 22 October 2016
Source:Acta Otorrinolaringológica Española
Author(s): María del Carmen Navas-Aparicio, Cinthya Mora-Mesén




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Hypoparathyroidism following thyroidectomy: Predictive factors

Publication date: Available online 21 October 2016
Source:Acta Otorrinolaringológica Española
Author(s): Cristiana Coimbra, Francisco Monteiro, Pedro Oliveira, Leandro Ribeiro, Mário Giesteira de Almeida, Artur Condé
ObjectiveTo evaluate the incidence and predictive factors for transient and permanent hypocalcemia and hypoparathyroidism following thyroidectomy.MethodWe studied all the 162 patients that underwent thyroid surgery in the ENT department of the Centro Hospitalar Vila Nova Gaia/Espinho from January 2005 to December 2014. We reviewed pre-operative, 6h and 12h after surgery ionized calcium and PTH levels. All patients were reviewed and evaluated according to the following criteria: gender, age, thyroid function, histologic diagnosis of the specimen, surgery extension and presence or absence of hypoparathyroidism.ResultsThere were 31 (19.1%) cases of transient hypoparathyroidism and 8 (5%) of permanent hypoparathyroidism. No significant difference was found for transient hypoparathyroidism when patients were analyzed by gender. However, all cases of permanent hypoparathyroidism were observed in female individuals.Comparing hemithyroidectomy with all other surgical procedures, we found that extension of surgery was a great predictor of transient (p=0.0001) and permanent (p=0.001) hypoparathyroidism.Diagnosis of malignancy was a strong predictor of transient hypoparathyroidism (p=0.002). It was also associated with permanent hypoparathyroidism, although differences did not reach statistical significance (p=0.096).ConclusionExtension of surgery (total thyroidectomy) and diagnosis of malignancy are predictors of transient and permanent hypoparathyroidism.



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Diente ectópico intranasal

Publication date: Available online 21 October 2016
Source:Acta Otorrinolaringológica Española
Author(s): Paula Cruz Toro, Ignacio Clemente, Iván Domènech




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Bone Anchored Hearing Aid (BAHA) in children: Experience of a tertiary referral centre in Portugal

Publication date: Available online 21 October 2016
Source:Acta Otorrinolaringológica Española
Author(s): Francisco Rosa, Ana Silva, Cláudia Reis, Miguel Coutinho, Jorge Oliveira, Cecília Almeida e Sousa
ObjectivesThe aim of this study is to describe the experience of a tertiary referral centre in Portugal, of the placement of BAHA in children.MethodsThe authors performed a retrospective analysis of all children for whom hearing rehabilitation with BAHA was indicated at a central hospital, between January 2003 and December 2014.Results53 children were included. The most common indications for placement of BAHA were external and middle ear malformations (n=34, 64%) and chronic otitis media with difficult to control otorrhea (n=9, 17%). The average age for BAHA placement was 10.66±3.44 years. The average audiometric gain was 31.5±7.20dB compared to baseline values, with average hearing threshold with BAHA of 19.6±5.79dB. The most frequent postoperative complications were related to the skin (n=15, 28%). There were no major complications.ConclusionsThis study concludes that BAHA is an effective and safe method of hearing rehabilitation in children.



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Spontaneous laryngeal abscess causing dysphagia

Publication date: Available online 21 October 2016
Source:Acta Otorrinolaringológica Española
Author(s): Nurdoğan Ata, İrfan Fırat Özcan




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Evaluación de la obstrucción nasal mediante rinomanometría y escalas subjetivas y medición del éxito terapéutico médico y quirúrgico

Publication date: Available online 23 October 2016
Source:Acta Otorrinolaringológica Española
Author(s): Hugo Lara-Sánchez, Candelas Álvarez Nuño, Elisa Gil-Carcedo Sañudo, Agustín Mayo Iscar, Luis Ángel Vallejo Valdezate
Introducción y objetivosEstudio prospectivo de pacientes con obstruccción nasal (ON) a fin de cuantificar el éxito terapéutico mediante una rinomanometría anterior activa (RAA), la escala de Evaluación de los Síntomas de Obstrucción Nasal (NOSE) y la Escala Visual Análoga (EVA), y determinar la correlación que existe entre las pruebas.MétodosRealizamos RAA y valoración subjetiva mediante las escalas NOSE y EVA a pacientes con ON antes y después del tratamiento médico (corticoides tópicos) o quirúrgico (septoplastia, turbinoplastia o septoturbinoplastia). Comparamos y analizamos los resultados de las puntuaciones obtenidas en ambas escalas subjetivas (NOSE y VAS) con las mediciones en la RAA.ResultadosUn total de 102 pacientes cumplieron los criterios de selección. Los resultados muestran que la mejoría de la ON, tras tratamiento quirúrgico, es evaluada más positivamente si la herramienta de medición es la RAA. Por el contrario, el tratamiento médico mejora el flujo nasal medido con la RAA, pero sin significación estadística (p=0,1363). Medimos la correlación entre RAA, escalas NOSE y EVA y hallamos solo una correlación positiva entre las escalas NOSE y EVA (r=0,83327).ConclusionesLos pacientes quirúrgicamente tratados por ON presentan mejores resultados cuando estos se evalúan mediante RAA o con escalas subjetivas. No existe una correlación significativa entre RAA y las escalas NOSE y EVA; esto se considera debido a que la RAA y las escalas subjetivas son complementarias y miden diferentes aspectos de ON. La RAA y las escalas subjetivas son instrumentos útiles para emplearlos de forma conjunta en el seguimiento de pacientes con ON.IntroductionProspective study of patients with nasal obstruction (NO) in order to measure therapeutic success by anterior active rhinomanometry (AAR), Nasal Obstruction Symptom Evaluation (NOSE) scale and Visual Analogue Scale (VAS) and to establish the correlation between these tests.MethodsPatients with NO, on whom we performed an AAR, NOSE and VAS scales at baseline and after medical treatment (topical nasal steroid) or surgery (septoplasty, turbinoplasty or septoplasty and turbinoplasty). The nasal flow obtained by the AAR and the score of both subjective scales (NOSE and VAS) were compared and analyzed.ResultsA total of 102 patients were included in the study. Surgical treatment resulted in statistically significant differences with the AAR and the subjective scales. While in patients with medical treatment there was an increase in the AAR nasal flow but without statistical significance (P=.1363). The correlation between the AAR, the NOSE and VAS scales was measured finding a strong correlation between the NOSE and VAS scales only (r=.83327).ConclusionsThe patients with NO treated surgically have better results when these are evaluated by AAR or with subjective scales. There is no significant correlation between AAR, NOSE and VAS scales, this is considered to be because the AAR and subjective scales are complementary and measure different aspects of NO. The AAR and subjective scales are useful tools to be used together for the follow up of patients with NO.



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Evaluación de la historia familiar de hipoacusia permanente en la infancia como factor de riesgo en el cribado universal

Publication date: Available online 21 October 2016
Source:Acta Otorrinolaringológica Española
Author(s): Mercedes Valido Quintana, Ángeles Oviedo Santos, Silvia Borkoski Barreiro, Alfredo Santana Rodríguez, Ángel Ramos Macías
Introducción y objetivoEl 60% de las hipoacusias prelinguales tienen un origen genético. Entre los factores de riesgo se encuentra el antecedente familiar de hipoacusia permanente en la infancia. El objetivo del estudio es conocer la relación entre este factor de riesgo y la hipoacusia, evaluándose características clínico-epidemiológicas y si existe variación genética no sindrómica relacionada.Material y métodoEstudio retrospectivo, transversal, descriptivo y observacional de los recién nacidos entre enero de 2007 y diciembre de 2010 con factor de riesgo de antecedente familiar de hipoacusia mediante otoemisiones acústicas provocadas transitorias y potenciales evocados auditivos de tronco cerebral.ResultadosNacieron 26.717 niños. Ochocientos cincuenta y siete (3,2%) tenían antecedente familiar. Cincuenta y siete (0,21%) no pasan segundas otoemisiones. Un 29,1% (n=16) tenían otro antecedente de riesgo añadido. Un 17,8% (n=9) tenían factor de riesgo no clásico. Ningún factor de riesgo tenía relación con la hipoacusia, excepto la cardiopatía. Según potenciales, el 76,4% tenían normoaudición y el 23,6%, hipoacusia. La media de familiares hipoacúsicos es de 1,25. En test genéticos el 82,86% son homocigosis normal, el 11,43% heterocigosis para mutación 35delG del gen de la Conexina 26, el 2,86% heterocigosis R143W del mismo gen y el 2,86% homocigosis mutante 35delG. No se encuentra relación entre hipoacusia y tener un alelo mutado.ConclusionesEl porcentaje de niños con antecedente familiar diagnosticado de hipoacusia es superior a lo esperado en la población general. Es necesaria la actualización del perfil genético para esclarecer la relación encontrada entre hipoacusia con cardiopatía, el número de familiares afectos y la baja prevalencia en las mutaciones analizadas.Introduction and objectiveSixty percent of prelingual hearing loss is of genetic origin. A family history of permanent childhood hearing loss is a risk factor. The objective of the study is to determine the relationship between this risk factor and hearing loss. We have evaluated clinical and epidemiological characteristics and related nonsyndromic genetic variation.Material and methodThis was a retrospective, descriptive and observational study of newborns between January 2007 and December 2010 with family history as risk factor for hearing loss using transient evoked otoacoustic emissions and auditory brainstem response.ResultsA total of 26,717 children were born. Eight hundred and fifty-seven (3.2%) had family history. Fifty-seven(0.21%) failed to pass the second test. A percentage of 29.1 (n=16) had another risk factor, and 17.8% (n=9) had no classical risk factor. No risk factor was related to the hearing loss except heart disease. Seventy-six point four percent had normal hearing and 23.6% hearing loss. The mean of family members with hearing loss was 1.25. On genetic testing, 82.86% of homozygotes was normal, 11.43% heterozygosity in Connexin 26 gene (35delG), 2.86% R143W heterozygosity in the same gene and 2.86% mutant homozygotes (35delG). We found no relationship between hearing loss and mutated allele.ConclusionsThe percentage of children with a family history and hearing loss is higher than expected in the general population. The genetic profile requires updating to clarify the relationship between hearing loss and heart disease, family history and the low prevalence in the mutations analyzed.



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¿Es la vía aérea nasal el principal medio de transmisión para la tuberculosis faríngea?

Publication date: Available online 21 October 2016
Source:Acta Otorrinolaringológica Española
Author(s): Esteban Vergara-de la Rosa, José Galvez-Olortegui, Tomas Galvez-Olortegui, Luis Concepcion-Urteaga




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A Huge Cystic Retroperitoneal Lymphangioma Presenting with Back Pain

Retroperitoneal lymphangioma is a rare location and type of benign abdominal tumors. The clinical presentation of this rare disease is nonspecific, ranging from abdominal distention to sepsis. Here we present a 73-year-old female patient with 3-month history of back pain. USG and CT revealed a huge cystic mass which was surgically excised and appeared to be lymphangioma on histopathology.

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A Child with Severe Malaria Presenting with Acute Surgical Abdomen (Duodenal Perforation)

Plasmodium falciparum, the commonest cause of severe malaria in children, is an important cause of mortality in developing nations like Nepal. Duodenal perforation in a case of complicated malaria, although a rare entity, can occur in children. Early diagnosis, proper medical treatment, and early surgical repair can be a lifesaving measure in such cases. Here, we report a case of a 5-year-old male child with falciparum malaria complicated by a duodenal perforation that was successively managed with appropriate antimalarial drugs and early surgical repair.

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A Dog Is a Doctor’s Best Friend: The Use of a Service Dog as a Perioperative Assistant

Service dogs are beneficial in providing assistance to people with multiple types of disabilities and medical disorders including visual impairment, physical disabilities, seizure disorders, diabetes, and mental illness. Some service animals have been trained as a screening tool for cancer. We review a case involving a 6-year-old female with a history of mast cell mediator release and immediate hypersensitivity due to the urticaria pigmentosa variant of cutaneous mastocytosis who underwent a cystourethroscopy. Her service dog, JJ, who would alert to mast cell mediator release, was used throughout the perioperative course as a means of anxiolysis and comfort and to monitor for mast cell mediator release. This case presents an example of a service dog used in a family-care model in the field of anesthesiology and provides a unique example of using a service dog as an additional monitor to alert the care team for impending mast cell mediator release.

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Management of rhinomaxillary mucormycosis with Posaconazole in immunocompetent patients

Publication date: Available online 20 October 2016
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Sachin Rai, Shikha Yadav, Dinesh Kumar, Vijay Kumar, Vidya Rattan
Mucormycosis is an opportunistic, uncommon and serious systemic fungal infection mostly presenting in immunocompromised patients. The combination of surgical debridement, parenteral therapy with Amphotericin B and management of the underlying systemic disease is the standard treatment modality for mucormycosis. The drawback of this regime is the need for long hospitalization due to the serious side effects of Amphotericin B requiring regular monitoring. Oral Posaconazole is one of the newer antifungals that have shown promising results. This paper highlights a case series of rhinomaxillary mucormycosis in immunocompetent patients diagnosed and managed successfully with surgical debridement and oral Posaconazole administration on out-patient basis.



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Morphometric analysis of prognathic and non-prognathic mandibles in relation to BSSO sites using CBCT

Publication date: Available online 19 October 2016
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Tengku Aszraf Tengku Shaeran, Ramizu Shaari, Shafulizan Abdul Rahman, Mohammad Khursheed Alam, Alauddin Muhamad Husin
BackgroundBilateral sagittal split osteotomy (BSSO) is the most versatile procedure and adopted by many surgeons to relocate the mandible in patients having mandibular prognathism (MP). Injury to the inferior alveolar nerve (IAN) and unfavorable splits are two surgical complications of BSSO which are associated with mandibular morphology. Uses of cone beam computed tomography (CBCT) in providing 3-D images has gained a wider acceptance in surgical field nowadays. Its advantages are including reduced cost, lesser radiation dose and smaller physical footprint comparing to the conventional computed tomography.PurposeThis study aims to identify the differences in morphology of prognathic and non-prognathic mandible at BSSO sites using cone beam computed tomography images.MethodsThis retrospective study involved 51 CBCT images of patients having mandibular prognathism and without mandibular prognathism. The latter group made up from patients with Class I skeletal pattern. Samples were taken using purposive sampling method from two clinical centers.ResultPrognathic mandible has higher lingula level, superiorly and buccally placed inferior alveolar nerve canal at distal second molar, thinner mediolateral width of ramus at anterior and posterior part and thinner anteroposterior width of the ramus.ConclusionMorphology of mandible in patients with mandibular prognathism (MP) was significantly different from patients without mandibular prognathism (WMP) for most of the parameters. The high risk parameters may be highlighted to the patients using cone beam computed tomography images.



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Changes in the salivary oxidative status in individuals with temporomandibular disorders and pain

Publication date: Available online 18 October 2016
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Claudyane de Almeida, José Miguel Amenábar
Temporomandibular joint disorders are quite common among the general public. Free radicals may play a role in the pathogenesis of joint diseases, and the oxidative stress is an important aspect in the mechanism of TMDs. The use of new biotechnologies has enabled the use of saliva as a diagnostic method. This is the first paper that aims to investigate changes in the oxidative status, through saliva analysis, in individuals who suffer from temporomandibular disorder and pain. Sixty individuals, 54 women and 06 men, aged between 10 and 60, participated in this research. The questionnaire 'Research Diagnostic Criteria for Temporomandibular Disorders' (RDC/TMD) was filled out in order to determine the presence and the type of TMD, and the Visual Analogue Scale (VAS) was conducted in order to measure the pain perception caused by TMD. In addition, the total oxidant status (TOS), and the total antioxidant capacity (TAC) were measured, and the oxidative stress index (OSI) was calculated. The t-test and the Pearson Correlation Test were used with the significance level of p<0.05. The TAC in individuals with TMD and pain was significantly reduced (p<0.001). There was no difference regarding the levels of TOS (p=0.765) between both groups. As a result, the OSI was significantly higher in the group TMD and pain (p=0.011). There was no correlation between VAS, TAC, and TOS values. Within the limits of this study, oxidative changes seem to influence the pathogenesis of pain in TMDs.



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Trismus in oral cancer patients undergoing surgery and radiotherapy

Publication date: Available online 22 October 2016
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Padmanidhi Agarwal, H.R. Shiva Kumar, Kirthi Kumar Rai
ObjectiveThe aim of this study was to determine the incidence of trismus before and after surgery and subsequent radiotherapy for patients of oral cancer and to determine the risk factors for the same.Methods30 patients diagnosed with oral cancer were included. Maximum mouth opening was measured for each patient as the inter incisal distance and was measured on 4 occasions – preoperatively at the time of diagnosis, post-operatively at discharge from the hospital, post-radiotherapy and at 6 months follow-up. The site of cancer, staging and grading of the malignancy, the surgical treatment performed, method of reconstruction, details of radiotherapy and compliance to physiotherapy were recorded, to evaluate the risk factors for developing trismus.ResultsTrismus was observed in 53.3% patients at the time of diagnosis which increased significantly post-surgery (86.7%) and post-radiotherapy (85.7%) and gradually decreased (65.4%) at 6 months. The use of flaps for reconstruction, delay in radiotherapy post-surgery and non-compliance of patients to physiotherapy were the risk factors for developing trismus, showing statistical significance (p<0.05).ConclusionTrismus is a significant complication of oral malignancies or its surgical and radiotherapy treatment, or both. Consideration must be given to its early diagnosis, to help in timely intervention and planning of preventive strategies.



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