Tumor enucleation specimens of small renal tumors more frequently have a positive surgical margin than partial nephrectomy specimens, but this is not associated with local tumor recurrence

Abstract

Approaches to nephron-sparing surgeries (NSS) of renal lesions include partial nephrectomy (PN) and tumor enucleation (TE). Our objective was to examine the pathology of the pseudocapsule and status of the surgical margin in small renal masses treated by NSS and to correlate these findings with the surgical and oncological outcomes. All consecutive renal TE and PN specimens obtained during the period between January 2012 and December 2014, of which clinical follow-up was available, were included in this study. Pathologic features and clinical data were reviewed and analyzed. A total of 117 NSS specimens (59 EN, 58 PN) were reviewed. Clear cell renal cell carcinomas and paraganglioma had the thickest pseudocapsules (0.36 mm), while angiomyolipomas did not form a well-defined pseudocapsule. Other tumors were intermediate in their characteristics. The positive margin rate for TE and PN was 17.2 and 0 %, respectively. Compared to PN, TE involved a significantly shorter procedure time, less blood loss, and fewer post-operative complications. None of the patients from either group was found to have a local recurrence after follow-up imaging. Although positive surgical margins were more frequently seen in TE specimens, local tumor recurrence was comparable to PN. Thus, TE is a reasonable choice for pT1 renal tumors, especially for those without a prominent infiltrative growth pattern.

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Scleroderma and dentistry: Two case reports

Scleroderma is a chronic connective tissue disorder with unknown etiology. It is characterized by excessive deposition of extracellular matrix in the connective tissues causing vascular disturbances which can ...

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Epithelioid sarcoma with multiple lesions on the left arm: a case report

Epithelioid sarcoma is a rare, high-grade malignant tumor of the soft tissue. The incidence of local recurrence, regional lymph node involvement, and distant metastases is high. Epithelioid sarcoma is most oft...

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Course of disease in multifocal choroiditis lacking sufficient immunosuppression: a case report

Multifocal choroiditis with panuveitis is a rare disease. The educational merit of this case presentation results from the good documentation and the impressive ocular fundus pictures.

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Anti-N-methyl-D-aspartate receptor encephalitis with an imaging-invisible ovarian teratoma: a case report

Anti-N-methyl-D-aspartate receptor encephalitis is a recently discovered disease entity of paraneoplastic limbic encephalitis. It largely affects young women and is often associated with an ovarian teratoma. I...

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Application-Based Hearing Screening in the Elderly Population

Objectives:

The effects of age-related hearing loss are severe. Early detection is essential for maximum benefit. However, most hearing-impaired adults delay obtaining treatment. Diagnostic hearing testing at an appropriate facility is impractical, and new methods for screening audiometry aim to provide easy access for patients and reliable outcomes. The purpose of this study was to examine the accuracy of application-based hearing screening in an elderly population.

Methods:

The uHear application was downloaded to an iPad. Application-based hearing screening was performed in a non-soundproofed quiet room, and subsequently all participants underwent full diagnostic audiometry in a soundproof booth.

Results:

Sixty patients were recruited and completed both tests. Significant differences were observed between the hearing results obtained with the application and the standard audiogram at all frequencies and in both ears. Following subtraction of a constant factor of 25 dB from the application-based results in order to compensate for ambient noise, no significant differences in pure tone average were found between the 2 methods.

Conclusions:

The uHear application is inaccurate in assessing hearing thresholds for screening in the elderly. However, when site-specifically corrected, the uHear application may be used as a screening tool for hearing loss in an elderly population.

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Impact of a Multidisciplinary Round Visit for the Management of Dysphagia Utilizing a Wi-Fi-Based Wireless Flexible Endoscopic Evaluation of Swallowing

Objectives:

The management of dysphagia requires a multidisciplinary approach, especially in large-scale hospitals. We introduce a novel protocol using a Wi-Fi–based flexible endoscopic evaluation of swallowing (FEES) system and aim to verify its effectiveness in evaluation and rehabilitation of inpatients with dysphagia.

Method:

We conducted novel Wi-Fi–based FEES at the bedside using 3 iPads as monitors and recorders. Functional outcomes of swallowing in 2 different hospitals for acute care with conventional wired or wireless FEES were compared retrospectively.

Results:

Using the wireless system, we could visit more patients in a short period of time. Furthermore, a large multidisciplinary team was able to be present at the bedside, which made it easy to hold discussions and rapidly devise appropriate rehabilitation strategies. Aspiration pneumonia recurred in a few cases following our intervention with wireless FEES. Functional oral intake score was significantly increased following the intervention. Moreover, the number of deaths during hospitalization using wireless FEES evaluation was lower than those observed using the conventional system.

Conclusion:

Wi-Fi–based wireless FEES system, the first of its kind, allowed our multidisciplinary team to easily and effectively assess inpatients with dysphagia by facilitating simple examinations and intensive transprofessional discussions for patient rehabilitation.

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The Utility of the MAUDE Database for Osseointegrated Auditory Implants

Objective:

To determine the utility of Manufacturer and User Friendly Device Experience (MAUDE) database in studying osseointegrated auditory implant (OAI)–related complications.

Methods:

The MAUDE database was searched for all reports involving OAIs (ie, Baha, Ponto, Sophono). Complications were classified into 1 or more of 6 categories—implant, abutment, processor, skin, surgery, and other. Subcategories were generated to prevent overgeneralization. Other variables recorded included date of report, number of complications per report, manufacturer, and time from complication to report.

Results:

Over the study period, there were 269 complications listed from 238 reports divided into the following categories: implant related (n = 145), abutment related (n = 16), processor related (n = 13), skin and soft tissue related (n = 79), surgery related (n = 11), and other (n = 5). No demographic data were available. There were no discernible trends from the data, and when compared to published literature, MAUDE data appear to under- or misrepresent complications.

Conclusion:

The MAUDE database is limited in its design and given fairly disparate reporting quality may not be ideally suited for quantifying risks of OAIs. These findings suggest the necessity for a substantially improved central registry for otologic implants and highlight the need for further research to investigate the root causes of their associated complication

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Measurements of chlorhexidine, p-chloroaniline, and p-chloronitrobenzene in saliva after mouth wash before and after operation with 0.2% chlorhexidine digluconate in maxillofacial surgery: a randomised controlled trial

Chlorhexidine gluconate is used to prevent the accumulation of dental plaque and gingivitis, infection of the surgical site, and ventilator-associated pneumonia in maxillofacial surgery, but it is not clear whether the metabolites of chlorhexidine are detectable in the patient's saliva at clinically relevant concentrations. Forty-three patients who had orofacial operations were randomised to use a 0.2% chlorhexidine gluconate (n=23), or an octenidine-based, chlorhexidine-free (n=20), mouthwash once preoperatively and three times daily for five postoperative days.

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Effect of curcumin on nasal symptoms and airflow in patients with perennial allergic rhinitis

Allergic rhinitis (AR) is a common disorder that can significantly affect patient quality of life. Previous studies have found that curcumin had anti-inflammatory and antioxidant effects and clinical benefits in cancer and asthma.

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Sugammadex

Neuromuscular blocking agents (NMBAs) and antibiotics are the most common triggers of intraoperative anaphylaxis. Sugammadex, a modified γ-cyclodextrin, rapidly reverses aminosteroid NMBAs (rocuronium and vecuronium) and acts 3 to 8 times faster than neostigmine.1 It has a good safety profile and has been licensed in more than 70 countries. However, the US Food and Drug Administration (FDA) approved it only recently in December 2015.2 Anaphylaxis to this drug occurs rarely, estimated at 29 per 1,000,000 population, usually at the end of anesthesia when sugammadex is used for NMBA reversal.

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Is the association between exhaled nitric oxide and asthma symptoms altered by body weight in rural adolescents?

Some studies have found that increased levels of exhaled nitric oxide (eNO) correspond to more frequent asthma symptoms.1,2 However, recent studies in adult and adolescent patients have suggested that obese or overweight individuals with asthma have decreased eNO levels compared with their normal weight counterparts.3,4 If this decreased eNO hypothesis in obesity is correct, then the association between eNO and asthma symptoms is likely to vary by body mass index (BMI; calculated as the weight in kilograms divided by square of height in meters).

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Interactive effects between obesity and atopy on inflammation

Obesity-associated asthma is usually characterized by neutrophilic or noneosinophilic airway inflammation.1,2 However, previous studies have found that some obese individuals with asthma have increased IgE levels and are atopic.3 It seems that asthma with overlap phenotype of atopy and obesity may have more complex characteristics. This cross-sectional study was conducted to investigate inflammatory features with clinical characteristics that are related to obesity and atopy.

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Volumenaugmentation bei HIV-assoziierter Lipoatrophie einer 17-Jährigen

Zusammenfassung

Die ästhetischen Folgen fazialer Lipoatrophien führen bei HIV-Infizierten häufig zu ernsten psychischen Belastungen, die die Compliance in Bezug auf antiretrovirale Therapien gefährden können. Wir beschreiben eine HIV-infizierte Patientin mit ausgeprägten Hohlwangen, die während eines 6‑jährigen Behandlungsverlaufs unter mehrfachen Anwendungen von Belotero® – einem monophasischen polydensifizierten (CPM) Hyaluronan-Filler – ein fast altersgerechtes Aussehen erreichte. Intensität und Häufigkeit von Nebenwirkungen waren vernachlässigbar klein.

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A comparison of King Vision video laryngoscopy and direct laryngoscopy as performed by residents: a randomized controlled trial

For more than 40 years, direct laryngoscopy (DL) has been used to assure the airway during endotracheal intubation. The King Vision video laryngoscope is one of the latest devices introduced for endotracheal intubation. We hypothesize that, relative to direct laryngoscopy, it improves the intubation success rate with fewer intubation attempts and no difference in intubation time or complications.

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Atropine and glycopyrrolate do not support bacterial growth—safety and economic considerations

Evaluation of bacterial growth in atropine and glycopyrrolate.

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Obstetric team simulation program challenges

To describe the challenges associated with the development and assessment of an obstetric emergency team simulation program.

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Table of Contents

Publication date: November 2016
Source:Annals of Allergy, Asthma & Immunology, Volume 117, Issue 5





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Racial/ethnic and socioeconomic differences in self-reported food allergy among food-sensitized children in National Health and Nutrition Examination Survey III

Publication date: November 2016
Source:Annals of Allergy, Asthma & Immunology, Volume 117, Issue 5
Author(s): Emily C. McGowan, Elizabeth C. Matsui, Roger Peng, Päivi M. Salo, Darryl C. Zeldin, Corinne A. Keet




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Instructions for Authors

Publication date: November 2016
Source:Annals of Allergy, Asthma & Immunology, Volume 117, Issue 5





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Editorial Board

Publication date: November 2016
Source:Annals of Allergy, Asthma & Immunology, Volume 117, Issue 5





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Allergic contact conjunctivitis and cross-reaction between phenylephrine and epinephrine due to phenylephrine eye drops

Publication date: November 2016
Source:Annals of Allergy, Asthma & Immunology, Volume 117, Issue 5
Author(s): Diego Gutiérrez Fernández, Raquel de la Varga Martínez, Eva María Lasa Luaces, Antonio Foncubierta Fernández, José Antonio Andrés García, Fermín Medina Varo




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Updating knowledge about food allergy: critical needs for the practicing clinician

Publication date: November 2016
Source:Annals of Allergy, Asthma & Immunology, Volume 117, Issue 5
Author(s): Amal H. Assa'ad, Sami Bahna




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Non–IgE-mediated food allergy syndromes

Publication date: November 2016
Source:Annals of Allergy, Asthma & Immunology, Volume 117, Issue 5
Author(s): Melanie A. Ruffner, Jonathan M. Spergel




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Information for Readers

Publication date: November 2016
Source:Annals of Allergy, Asthma & Immunology, Volume 117, Issue 5





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The platelet-activating factor pathway in food allergy and anaphylaxis

Publication date: November 2016
Source:Annals of Allergy, Asthma & Immunology, Volume 117, Issue 5
Author(s): Peter Vadas




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Not every seafood “allergy” is allergy!

Publication date: November 2016
Source:Annals of Allergy, Asthma & Immunology, Volume 117, Issue 5
Author(s): Sami L. Bahna




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What is new in food allergy diagnostics? A practice-based approach

Publication date: November 2016
Source:Annals of Allergy, Asthma & Immunology, Volume 117, Issue 5
Author(s): Stephanie Logsdon, Amal Assa'ad




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Rye-dependent exercise-induced anaphylaxis

Publication date: November 2016
Source:Annals of Allergy, Asthma & Immunology, Volume 117, Issue 5
Author(s): Jesús Miguel García-Menaya, Gian Marco Chiarella, Concepción Cordobés-Durán, Alba Catherine Mahecha, Pedro Bobadilla-González




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The custom clearance of pro- and prebiotics in allergy prevention

Publication date: November 2016
Source:Annals of Allergy, Asthma & Immunology, Volume 117, Issue 5
Author(s): Alessandro Fiocchi, Vincenzo Fierro, Fabiola La Marra, Lamia Antanios Dahdah




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Food allergies in the elderly

Publication date: November 2016
Source:Annals of Allergy, Asthma & Immunology, Volume 117, Issue 5
Author(s): Erika Jensen-Jarolim, Sebastian A.F. Jensen




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The latest on food allergy immunotherapy

Publication date: November 2016
Source:Annals of Allergy, Asthma & Immunology, Volume 117, Issue 5
Author(s): Jeffrey M. Chambliss, A. Wesley Burks




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Aspiration-induced pulmonary syndromes

Publication date: November 2016
Source:Annals of Allergy, Asthma & Immunology, Volume 117, Issue 5
Author(s): Kena Shah, Juan Guarderas, Guha Krishnaswamy




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The clinical relevance of filaggrin mutations

Publication date: November 2016
Source:Annals of Allergy, Asthma & Immunology, Volume 117, Issue 5
Author(s): Mark W. Tenn, Anne K. Ellis




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Parental decision making associated with pediatric emergency department use for asthma

Publication date: November 2016
Source:Annals of Allergy, Asthma & Immunology, Volume 117, Issue 5
Author(s): Shawna S. Mudd, C. Jean Ogborn, Mary Elizabeth Bollinger, Tricia Morphew, Joan Kub, Cassie Lewis-Land, Melissa H. Bellin, Arlene Butz
BackgroundDisadvantaged minority children are disproportionately affected by asthma. This group is also known to frequently use the emergency department (ED) for asthma care. Understanding decisions for use of the ED is important to prevent high cost.ObjectiveTo examine caregiver factors associated with the decision to use the ED for asthma care in inner-city children with asthma.MethodsOne hundred fifty participants in a randomized clinical trial testing the effectiveness of a home-based asthma intervention were enrolled, and questionnaires were administered to caregivers during the child's ED asthma visit. Sociodemographics, health characteristic data, and caregiver interview data were examined to ascertain factors that affected caregiver decision making to use the ED for asthma care. A cluster analysis was performed to correlate caregiver reasons for the decision to use the ED for asthma care.ResultsThree clusters emerged for decision making: urgency, preference for the use of the ED, and access to care issues. The perception of urgency was the most common reason reported by caregivers (91%) followed by reporting a preference for the ED for care (37%) and reporting access to care issues (31%). Access to care was primarily attributable to the inability to get a same-day appointment with their primary care practitioner (24%).ConclusionThe caregiver factors involved in the decision to use the ED can provide a basis for further intervention and investigation. Such factors include caregiver asthma home management, improvement in relationships with primary care practitioners, and access to care-related issues.



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Tolerance to nonsteroidal anti-inflammatory drugs and alcohol after omalizumab treatment in a patient with chronic urticaria

Publication date: November 2016
Source:Annals of Allergy, Asthma & Immunology, Volume 117, Issue 5
Author(s): Kristen M. Walters, Andrew A. White




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Contribution of Leptosphaeria species ascospores to autumn asthma in areas of oilseed rape production

Publication date: November 2016
Source:Annals of Allergy, Asthma & Immunology, Volume 117, Issue 5
Author(s): Malgorzata Jedryczka, Magdalena Sadyś, Miroslaw Gilski, Agnieszka Grinn-Gofron, Joanna Kaczmarek, Agnieszka Strzelczak, Roy Kennedy
BackgroundAn increase in the number of hospital admissions from September to November in the northern hemisphere has been frequently reported. At this time, some species of fungal genus Leptosphaeria produce numerous ascospores, which are easily airborne. However, we lack knowledge about whether Leptosphaeria produces allergenic proteins.ObjectiveTo evaluate the potential of Leptosphaeria ascospores to contribute to autumn asthma.MethodsDetailed bioinformatic analysis of proteins produced by Leptosphaeria maculans available in databases was performed and the data compared with allergens found in other airborne fungi. The concentrations of Leptosphaeria ascospores detected at 2 sites were compared to these obtained in other environments worldwide.ResultsWe found that Leptosphaeria species produce proteins with a high identity to commonly known aeroallergens of several well-characterized molds. The level of amino acid identity significantly exceeded the allergen identity thresholds recommended by the Food and Agricultural Organization/World Health Organization (35%), which indicates allergenic properties of L maculans and ensures the same properties in the other Leptosphaeria species.ConclusionHigh concentrations of Leptosphaeria species ascospores in the autumn and postulated allergenicity of their proteins strongly suggest that this genus contributes to worldwide reported autumn asthma. The finding opens the question of allergenicity of the other never studied fungal species present in aeroplankton.



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Offene oder roboterassistierte Operation zur Therapie des Prostatakarzinoms

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The use of illuminance as a guide to effective light delivery during daylight PDT in the UK

Abstract

Background

Daylight PDT (dPDT) is an effective and nearly painless treatment for field-change actinic keratosis. Measuring the protoprophyrin-IX (PpIX)-weighted exposure dose can give an indication of when conditions are most viable for effective dPDT. It would be advantageous for practitioners if more detailed information of exposure dose and appropriate treatment conditions were available. Where sophisticated measurement equipment is unavailable, simpler and more cost-effective methods of dose measurement are desirable.

Objectives

To devise a model whereby illuminance data can be converted into PpIX-weighted exposure dose, and to use this model to estimate appropriate times for dPDT across the UK and Ireland.

Methods

Spectral irradiance data were analysed to obtain a conversion model for illuminance to PpIX-weighted dose. This model was applied to historic illuminance data from nine sites to obtain PpIX-weighted dose across the UK and Ireland. Temperature data and an analysis of conservatory-based dPDT were also considered.

Results

A distribution of the expected PpIX-weighted dose across the nine locations is presented; however, the temperature data showed that it could be too cold for dPDT even when there is sufficient light exposure. Conservatory-based dPDT could extend the times in the year for possible treatment.

Conclusions

This proposed conversion model provides a means of using an illuminance reading to calculate the PpIX-weighted exposure dose. Dosimetry of dPDT may be carried out simply and at low cost using the presented method, however the results presented may be used as a guide for those considering dPDT, without the need to conduct measurements themselves.

This article is protected by copyright. All rights reserved.

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Allergy in Severe Asthma

Abstract

It is well recognized that atopic sensitisation is an important risk factor for asthma, both in adults and in children. However, the role of allergy in severe asthma is still under debate. The term "Severe Asthma" encompasses a highly heterogeneous group of patients who require treatment on steps 4–5 of GINA guidelines to prevent their asthma from becoming "uncontrolled", or whose disease remains "uncontrolled" despite this therapy. Epidemiological studies on emergency room visits and hospital admissions for asthma suggest the important role of allergy in asthma exacerbations. In addition, allergic asthma in childhood is often associated with severe asthma in adulthood. A strong association exists between asthma exacerbations and respiratory viral infections, and interaction between viruses and allergy further increases the risk of asthma exacerbations. Furthermore, fungal allergy has been shown to play an important role in severe asthma. Other contributing factors include smoking, pollution and work-related exposures. The "Allergy and Asthma Severity" EAACI Task Force examined the current evidence and produced this position document on the role of allergy in severe asthma.

This article is protected by copyright. All rights reserved.

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Alpha-gal is a possible target of IgE-mediated reactivity to antivenom

Abstract

Background

Antivenoms are mammalian immunoglobulins with the ability to neutralize snake venom components and to mitigate the progression of toxic effects. Immediate hypersensitivity to antivenoms often occurs during the first administration of these heterologous antibodies. A comparable clinical situation occurred after introduction of cetuximab, a chimeric mouse-human antibody, for cancer treatment. The carbohydrate epitope galactose-alpha-1,3-galactose, located on the Fab region of cetuximab, was identified as the target responsible for IgE reactivity.

Objective

To investigate whether serum IgE antibodies directed to the α-gal epitope are associated with hypersensitivity to equine antivenoms.

Methods

Antivenoms were screened for α-gal epitopes via immunoblot and in comparison to cetuximab and pork kidney by IgE reactivity assays. Basophil activation tests were used to investigate reactivity to antivenoms in samples from 20 patients with specific IgE antibodies to α-gal and 10 controls. Additional IgE detection, IgE inhibition, ImmunoCAP inhibition and skin prick tests were performed using samples from selected patients.

Results

Both antivenoms and cetuximab induced positive skin prick test results in patients with sIgE to α-gal. Alpha-gal epitopes were detected by immunoblotting on antivenoms. Measurements of IgE reactivity and ImmunoCAP inhibition indicated that the antivenoms contained lower α-gal contents than cetuximab. Deglycosylation assays and IgE inhibition tests confirmed that IgE-mediated reactivity to antivenom is associated with α-gal. Antivenoms, pork kidney and cetuximab activated basophils from patients with IgE to α-gal.

Conclusion

Alpha-gal is a potential target of IgE-mediated reactivity to equine antivenom and a possible cause of the high incidence of hypersensitivity reactions during the first application of equine antivenom.

This article is protected by copyright. All rights reserved.

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MicroRNA-203 inhibits tumor growth and metastasis through PDPN

Abstract

Objective

MicroRNAs play an important role in regulating hypopharyngeal cancer development. miR-203 has been previously shown to possess anti-tumor capabilities in many cancers, but not in hypopharyngeal cancer.

Design

Using human normal and hypopharyngeal cancer specimens, we explored the expression levels of miR-203 in the two groups, and further correlated them with different stages of cancer and lymph node metastasis.

Setting and Participants

Applying human pharynx FaDu cancer cells and lentiviral transduction technique, we investigated the effects of miR-203 on cancer cell viability, migration and invasion. Moreover, we studied the novel relationship between miR-203 and podoplanin (PDPN) in hypopharyngeal cancer.

Results

The downregulated levels of miR-203 in human hypopharyngeal cancer tissues were associated with advanced cancer stages and lymph node metastasis. High levels of miR-203 inhibited cell viability, migration and invasion of hypopharyngeal cancer cells. Further studies suggested miR-203 directly targeted and inhibited PDPN expression. PDPN Silencing suppresses hypopharyngeal cancer cell abilities. In addition, PDPN overexpression was able to reverse miR-203 inhibitory effects on cell viability, migration and invasion.

Conclusion

PDPN acts as an oncogene to promote hypopharyngeal cancer cell viability, migration and invasion. miR-203 directly targets PDPN to suppress its expression, thus exerting inhibitory effects on cancer metastasis.

This article is protected by copyright. All rights reserved.

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Differences in patterns of survival in metastatic adenoid cystic carcinoma of the head and neck

Abstract

Background

We examined the assumption in conventional teaching about metastatic adenoid cystic carcinoma (ACC) being an indolent type of disease.

Methods

A single center analysis of 105 cases of ACC was performed. Radiographs were reviewed and tumor response to chemotherapy was measured. Distant disease-free survival (DDFS) and time to death since distant metastases diagnosis were analyzed.

Results

Forty-two percent of the patients were diagnosed with distant metastases. DDFS showed significant negative associations with advanced T classification, N+ classification, solid type tumor, and positive surgical margins. Distant metastases (91%) developed in the first 5 years after presentation. Median distant metastatic survival was 13.8 months. The most frequent organ sited was the lung. Solid type ACC showed a preponderance for multiorgan metastases (17/28; 61%). Distant metastases seemed not to occur in case of clear surgical margins. Solid type ACC had a significant poorer survival after development of distant metastases.

Conclusion

Metastatic ACC is not always an indolent disease. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

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Primary aortoduodenal fistula: a rare entity with lethal effects

Primary aortoduodenal fistula (ADF) is a rare but morbid diagnosis. Here, we present the case of a patient with a primary ADF that resulted in mortality. Despite multiple attempts at radiographic and endoscopic diagnosis, the fistula did not declare itself until the patient exsanguinated. Given the morbidity associated with ADF and the imperfection of associated diagnostic studies, a high index of suspicion is required to make a timely diagnosis.

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Lung lobar collapse as the first manifestation of pulmonary epithelioid haemangioendothelioma diagnosed with fibreoptic bronchoscopy

Pulmonary epithelioid haemangioendothelioma (PEH) is a rare tumour of endothelial origin that usually occurs in the lung and liver. It usually presents as bilateral multiple nodular lesions. We report a middle-aged woman with a unique presentation of PEH with lung lobar collapse. The diagnosis was made with fibreoptic bronchoscopy rather than video-assisted thoracoscopy. Clinicians and pathologists should be aware of rare conditions that can present as lung lobar collapse.

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Piperacillin-induced mild haemolytic anaemia in a 44-year-old patient with cystic fibrosis

Piperacillin–tazobactam is an antipseudomonal antibiotic frequently used in patients with cystic fibrosis (CF) to treat pulmonary exacerbations. Drug-induced immune haemolytic anaemia is a rare complication during treatment with piperacillin. So far, piperacillin-induced immune haemolytic anaemia (PIHA) is regarded as an acute and severe haemolytic anaemia resulting into life-threatening events. Here we report on a patient with mild PIHA, which did not result in any clinical symptoms or necessity for treatment. To the best of our knowledge, this is the first case report of PIHA without an acute severe haemolytic anaemia. Further research is needed to clarify if this case is a solitary clinical manifestation of PIHA or if mild clinical courses of PIHA might be under-reported. Cases of PIHA have been largely reported in patients with CF. This unequal distribution maybe due to the frequent administration of piperacillin for pulmonary exacerbation in patients with CF or due to CF-related cofactors of yet unknown aetiology.

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Self-disembowelment during delirium tremens: why early diagnosis is vital

Delirium tremens is a serious yet treatable complication of alcohol withdrawal. Timely diagnosis is critical as there are well-established treatment regimens that provide symptomatic relief within hours to days. We report the case of a 34-year-old man with an undisclosed history of alcohol dependency. He presented with paranoid beliefs and was transferred to a psychiatric inpatient unit with suspected schizophrenia. Classic features of delirium tremens such as sympathetic overdrive and visual hallucinations were not salient features of his presentation. Within 24 hours of admission, he sustained major self-inflicted abdominal stab wounds and extracted a metre of small bowel as a result of command hallucinations. The possibility of delirium tremens was raised by the receiving trauma team and he responded rapidly to benzodiazepines. Emergency jejunal reanastomosis was successful. This case highlights the fact that delirium tremens may present atypically and that associated command hallucinations can confer grave risks.

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Hoarse voice: a rare presentation of tuberculosis lymphadenitis

A man aged 37 years from Indian descent presented to an inner city London hospital with hoarseness of voice, fatigue, night sweats and a 2 kg weight loss. Laryngoscopy demonstrated a left vocal fold palsy. Extensive investigations were undertaken with disseminated malignancy being primarily investigated. CT/MRI scanning showed non-specific necrotic mediastinal lymph nodes. Tuberculin skin testing, cytology and PCR were eventually undergone. Tests yielded results consistent with tuberculosis (TB) infection and the patient was started on standard TB treatment protocol, with excellent results. TB infection can result in multiple atypical presentations of disease, including hoarseness of voice secondary to vocal cord paralysis. This is a rare but important presentation for community clinician's to consider, especially in populations where TB is epidemiologically thought to be prevalent.

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The needs and experiences of skin cancer patients: a qualitative systematic review with meta-synthesis

Abstract

Background

Skin cancer incidence is increasing worldwide. This is an update of a previous review published in 2010 that identified only two studies and found that the needs and experiences of individuals with skin cancer were under-researched.

Objectives

To undertake a qualitative systematic review of the needs and experiences of people with a diagnosis of skin cancer.

Methods

As an update of a previous review, the following databases were searched from 2010 to 30/11/15: CINAHL PsycINFO, MEDLINE and EMBASE. The methodological quality of the studies was assessed using the Joanna Briggs Institute (JBI) Qualitative Assessment Review Instrument (QARI). The qualitative research findings were synthesised using a pragmatic meta-aggregative approach.

Results

Fourteen studies (16 papers) were included. Only three studies included keratinocyte carcinoma patients. 15 categories were identified and these resulted in four overarching synthesised findings (SFs) from diagnosis (SF1) through treatment (SF2) and follow up (SF3), and then a fourth SF (SF4) that addressed patients' satisfaction with their care and their relationship with health professionals.

Conclusions

Despite the fact that keratinocyte carcinoma and melanoma patients can have very different prognosis, they also share similar needs and concerns especially around the time of diagnosis and follow up/surveillance for new lesions. Health professionals working with skin cancer patients need to understand their psychosocial concerns, and their information needs in order to design services appropriately. Future studies need to consider keratinocyte carcinoma patients as well as melanoma patients.

This article is protected by copyright. All rights reserved.

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Recurring Facial Erythema in an Infant

Causes of facial rashes and erythema in infants are many but rarely only happen during feeding times which are commonly and sometimes wrongly attributed to food allergy. There is a rare condition called Auriculotemporal nerve syndrome that is characterized by recurrent episodes of gustatory facial flushing and sweating along the cutaneous distribution of Auriculotemporal nerve: the so-called Frey syndrome. This condition is most frequently observed in adults usually after parotid surgery. It is rare in children and is mostly attributed to forceps assisted delivery. It can also be misinterpreted as food allergy. Here we report a case of an infant with Frey syndrome without any history of perinatal trauma, which was considered initially as food allergy and highlights the importance of distinguishing it from food allergy.

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Erratum

In the article entitled "Chronic granulomatous disease as an SOS call for multicenter cooperative effort to prevent infections: A meta-analysis of the treatments" (Ann Allergy Asthma Immunol 2016;117:285-289), the third author's name was incorrectly listed as Annamaria Zicari. The author's correct name is Anna Maria Zicari.

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The platelet-activating factor pathway in food allergy and anaphylaxis

The synchronous release of multiple chemical mediators and their combined effects on target organs are responsible for the disruption of homeostasis seen in anaphylaxis. The exocytosis and release of these mediators collectively contribute to the multisystem manifestations of anaphylaxis, but clearly the actions of certain mediators appear to be more prominent and contribute disproportionately to severe and fatal outcomes.

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Tolerance to nonsteroidal anti-inflammatory drugs and alcohol after omalizumab treatment in a patient with chronic urticaria

Nonsteroidal anti-inflammatory drugs (NSAIDs) are some of the most commonly used drugs in the world, and it is estimated that more than 20 million people in the United States use an NSAID on a regular basis.1 Given our aging population and increases in the treatment of various inflammatory conditions and cardiovascular disease, the use of NSAIDs is increasing significantly in clinical practice. Not surprisingly, the number of adverse reactions from NSAID ingestion have paralleled this increase in use.

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The custom clearance of pro- and prebiotics in allergy prevention

Although allergy was considered a "white elephant" in the previous century,1 it currently affects large strata of the population, not only in the industrialized world but also with an increasing incidence in emerging countries. After the increase in respiratory allergy from 1960 through 1990, there has been a remarkable increase in food allergy, which has reached epidemic proportions.2 Australian data have indicated that more than 10% of 1-year-old infants in the 2010s have challenge-proved immunoglobulin A-mediated food allergy to one of the common allergenic foods of infancy, with sensitization reported at 8.9% for peanut, 16.5% for egg white, and 5.6% for cow's milk.

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Updating knowledge about food allergy: critical needs for the practicing clinician

Food allergy has become a major part of the practice of allergy and immunology, necessitating that the allergist/immunologist remain current on the most cutting edge knowledge in patient management and research. We also need to be equipped to answer the "million dollar questions," such as why food allergies are on the rise, and can food allergies be treated. Allergy/Immunology clinicians need to separate the "haves" from the "have nots" – that is, defining the patients who have food allergies, from those who think they have food allergies, but in reality they do not.

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What is new in food allergy diagnostics? A practice-based approach

The literature is replete with reviews listing diagnostic methods for food allergy and their utility. However, for the practicing allergist/immunologist, the diagnosis, or the dediagnosis, of food allergy starts with the patient presentation. Unlike other disorders, for which a patient presents, a history is obtained, and tests are performed to elucidate the disorder, in food allergy, the sequence of events is often reversed. The ubiquitous availability and indiscriminate ordering of food specific serum IgEs, the prior recommendations of late introductions of allergenic foods in the diet of infants, and the avoidance of allergenic foods in the diets of siblings and families of persons with food allergy may have contributed to this situation.

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Editorial Board

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The latest on food allergy immunotherapy

Food allergies are becoming increasingly common and have a significant effect on patients and families. In 2007 the estimated prevalence of food allergies among school-aged children was approximately 3.9%, an 18% increase since 1997, with other studies estimating up to 8% of children affected (and 5% of adults).1,2 However, exposures and symptoms may occur well before children enter school. When egg allergy was specifically looked at, the cumulative prevalence was estimated at 2.6% by 2.5 years old.

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Information for Readers

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Aspiration-induced pulmonary syndromes

Aspiration of foreign material into the lungs is not uncommon and has been described even in healthy individuals.1 However, in many clinical pulmonary syndromes, aspiration as an important triggering event remains unsuspected and undiagnosed. The purpose of this review is to present the various facets of aspiration-related lung disease and discuss the diagnosis and management of these conditions. Aspiration-related pulmonary and airway disease can result in a plethora of conditions.

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Analysis of 10 Environmental Allergen Components of the American Cockroach in Taiwan

Cockroaches are important sources of indoor airborne allergens. The American cockroach (Periplaneta americana) is the second leading inhalant allergen causing allergic airway diseases in Taiwan. We previously reported a difference in pathogenicity of different allergen components from American cockroaches.

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Issue Information - Editorial Board

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Announcement

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Forthcoming Events

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Issue Information - TOC

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Acquired anhidrosis in a case of autoimmune autonomic ganglionopathy

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Case of lichen planus induced by sitagliptin phosphate hydrate

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Limited incremental effect of inflammatory bowel disease on risk of comorbidities in patients with psoriasis

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Potential inhibition of development of rapidly progressive interstitial lung disease by prompt and sufficient immunosuppressive treatment in patients with anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis

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Revised guideline for the diagnosis and treatment of acquired idiopathic generalized anhidrosis in Japan

Abstract

Acquired idiopathic generalized anhidrosis (AIGA) is characterized by an acquired impairment in total body sweating despite exposure to heat or exercise. Severe cases may result in heatstroke. Most cases of AIGA have been reported in Asia, especially in Japan. However, there is limited information on the epidemiology of this condition, and no diagnostic criteria or appropriate treatment options have been established. This guideline was developed to fill this gap. It contains information on the etiology, diagnosis, evaluation of disease severity and evidence-based recommendations for the treatment of AIGA. Appropriate treatment according to disease severity may relieve the clinical manifestations and emotional distress experienced by patients with AIGA.

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Livedoid vasculopathy and popliteal artery occlusion in a patient with protein S deficiency

Abstract

Livedoid vasculopathy (LV) is a chronic disease with recurrent reticularis and ulcers, mainly affecting the feet and lower legs. The pathogenesis of LV has not been yet thoroughly understood, but thrombosis is thought to play a major role because fibrin deposition within both the wall and lumen of affected vessels is pathologically detected. A 68-year-old woman first presented to our hospital in 2004 with a 6-year history of a reticular rash and ulceration on the lower legs. Screening tests for vasculitis and collagen disease were mostly normal, leading to diagnosis of LV. After failed treatment with steroid and aspirin, she was started on warfarin, to which she had a favorable response. However, she had to be admitted to the hospital because complication of swelling and infection in her left lower leg in 2004 + 10. Contrast-enhanced computed tomography showed thrombosis in the left popliteal artery. Screening tests for thrombotic tendency revealed that protein S activity was low (27%) although total protein S antigen was within normal range (73%). Analysis of protein S-alpha gene revealed 155 Lys>Glu mutation in exon VI, which was reported in 1994 and named as protein S Tokushima. Thus, we conclude that protein S deficiency could contribute to LV.

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Simultaneous onset of sporotrichosis in mother and daughter

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Case of autosomal recessive woolly hair/hypotrichosis with atopic dermatitis

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Impact of adalimumab treatment on cardiovascular risk biomarkers in psoriasis: Results of a pilot study

Abstract

Psoriasis is a chronic systemic immune-mediated inflammatory dermatosis associated with several comorbidities. Psoriasis patients are at increased risk of developing cardiovascular diseases (CVD), namely, coronary heart disease, stroke or peripheral vascular disease, and psoriasis seems to be an independent cardiovascular risk factor. Antipsoriatic systemic therapy, especially anti-tumor necrosis factor (TNF)-α, seems to exert a beneficial effect on these comorbidities. The purpose of this study was: (i) to measure the level of cardiovascular serum markers in psoriasis patients in comparison with healthy volunteers; and (ii) to compare the serum level of the same markers in patients before and 3 months after adalimumab therapy. We investigated six biomarkers connected to CVD: C-reactive protein (measured high sensitively, hsCRP), oxidized low-density lipoproteins (oxLDL), oxLDL/β-glycoprotein I complex (oxLDL/β2GPI), vascular endothelial adhesion molecule 1 (VCAM-1), E-selectin and interleukin (IL)-22. These biomarkers were measured in 21 patients with moderate/severe psoriasis before and after treatment with adalimumab and in healthy volunteers. hsCRP (P < 0.05), oxLDL-β2GPI complex (P < 0.05), E-selectin (P < 0.001) and IL-22 (P < 0.001) were significantly increased in comparison with healthy controls, whereas oxLDL and VCAM-1 were also higher in psoriasis patients but the difference did not reach statistical significance. A decrease of E-selectin (P < 0.001) and IL-22 (P < 0.001) was observed after 3 months of adalimumab therapy. Inhibition of TNF-α seems to not only improve psoriasis but also decreases serum cardiovascular biomarkers. E-selectin and IL-22 could serve for monitoring of the efficacy of antipsoriatic systemic therapy on cardiovascular risk.

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Minimally Invasive Treatment of Mirizzi Syndrome, a Rare Cause of Cholestasis in Childhood

Mirizzi syndrome is the compressive blockage of the cystic or choledochal duct caused by a biliary stone occupying the cystic canal or Hartmann's pouch. This occurrence is rare and, in English literature, three cases defined in children have been observed. In order to draw attention to this rare occurrence, we preferred a 14-year-old male patient with Mirizzi syndrome. In this case, ERCP was performed preoperatively and the diagnosis was carried out with the help of clear visualisation and identification of the tissue structures as well as the stent placed in bile duct; so we protected the patient from the possible iatrogenic injury occurring during surgery.

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The geographic distribution of the otolaryngology workforce in the United States

Objectives

To describe the deployment of otolaryngologists and evaluate factors associated with the geographic distribution of otolaryngologists in the United States.

Study Design

Cross-sectional study.

Methods

The otolaryngology physician supply was defined as the number of otolaryngologists per 100,000 in the hospital referral region (HRR). The otolaryngology physician supply was derived from the American Medical Association Masterfile or from the Medicare Enrollment and Provider Utilization Files. Multiple linear regression tested the association of population, physician, and hospital factors on the supply of Medicare-enrolled otolaryngologists/HRR.

Results

Two methods of measuring the otolaryngology workforce were moderately correlated across hospital referral regions (Pearson coefficient 0.513, P = .0001); regardless, the supply of otolaryngology providers varies greatly over different geographic regions. Otolaryngologists concentrate in regions with many other physicians, particularly specialist physicians. The otolaryngology supply also increases with regional population income and education levels. Using AMA-derived data, there was no association between the supply of otolaryngologists and staffed acute-care hospital beds and the presence of an otolaryngology residency-training program. In contrast, the supply of otolaryngology providers enrolled in Medicare independently increases for each HRR by 0.8 per 100,000 for each unit increase in supply of hospital beds (P < .0001) and by 0.49 per 100,000 in regions with an otolaryngology residency-training program (P = .006), accounting for all other factors.

Conclusion

Irrespective of methodology, the supply of otolaryngologists varies widely across geographic regions in the United States. For Medicare beneficiaries, regional hospital factors—including the presence of an otolaryngology residency program—may improve access to otolaryngology services.

Level of Evidence

N/A. Laryngoscope, 2016

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High-sensitivity FEES with NBI-illumination

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Characteristics of tinnitus in adolescents and association with psychoemotional factors

Objectives/Hypothesis

The characteristics and underlying mechanisms of tinnitus remain more elusive in the pediatric population than in adults. We investigated the prevalence of tinnitus, its characteristics, and associated factors, with a focus on psychoemotional problems in adolescents.

Study Design

Cross-sectional study

Methods

In total, 962 adolescents were surveyed for tinnitus and possibly related otologic and socioeconomic factors. The participants completed a visual analog scale (VAS) pertaining to various aspects of tinnitus, as well as the Tinnitus Handicap Inventory, Children's Depression Inventory (CDI), State Anxiety Inventory for Children, Trait Anxiety Inventory for Children (TAIC), Internet Addiction Test, Conners' Abbreviated Parent Rating Scale, and a learning disability score. Characteristics of tinnitus were analyzed, and psychoemotional and other factors were compared between tinnitus and nontinnitus groups.

Results

Approximately one-third of subjects reported experiencing tinnitus. A family history of tinnitus, subjective hearing loss, dizziness, and CDI and TAIC abnormalities were significantly associated with tinnitus. In the tinnitus-always group, tinnitus showed significant relationships with subjective hearing loss, bilateral tinnitus, and VAS, CDI, and TAIC scores.

Conclusions

The results suggest that about one-third of adolescents experience tinnitus, which may be related to psychoemotional factors. In particular, anxiety and depression may be important factors to consider in managing tinnitus in adolescents. Further study of tinnitus in adolescents, including efforts toward diagnosis and management, is needed to determine whether there is a causal relationship with anxiety and depression, and the extent to which adverse outcomes may be associated with these psychoemotional factors.

Level of Evidence

4 Laryngoscope, 2016

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Cellular source and proinflammatory roles of high-mobility group box 1 in surgically injured rat vocal folds

Objectives/Hypothesis

High-mobility group box 1 (HMGB1) is a chromatin-binding protein located in the cell nucleus. Following injury, immunocompetent cells secrete HMGB1 to the extracellular milieu under the stimulation of proinflammatory cytokines. Extracellular HMGB1 acts a danger signal that instigates the innate immunity and tissue repair. We previously reported HMGB1 in the vocal fold extracellular compartment between day 3 and day 7 following surgical injury. In this study, we further investigated the cell source of HMGB1 and the relationship of proinflammatory cytokine expression and HMGB1 translocation in wounded vocal folds.

Study Design

Prospective animal study.

Methods

Bilateral vocal fold injury was performed on 122 Sprague-Dawley rats. An additional 18 rats served as uninjured controls. Animals were sacrificed at multiple time points up to 4 weeks after surgery. Immunohistochemical costaining was performed to identify the cell source of HMGB1. Cell markers ED1, fibroblast-specific protein 1 (FSP1), and alpha smooth muscle actin (α-SMA) were used to identify macrophages, fibroblasts, and myofibroblasts, respectively. Enzyme-linked immunosorbent assays were performed to measure cytokine levels of interleukin-1beta (IL-1β) and tumor necrosis factor-alpha (TNF-α) in vocal fold tissue.

Results

Costaining of HMGB1 was strong with ED1 and FSP1 but was minimal with α-SMA in injured vocal folds. Compared to uninjured controls, IL-1β and TNF-α expression increased significantly the first 2 days after injury.

Conclusions

Macrophages and fibroblasts were a major cell source of vocal fold HMGB1. Translocation of HMGB1 may be an active response to the early accumulation of IL-1β and TNF-α in the wounded vocal folds.

Level of Evidence

NA Laryngoscope, 2016

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Triological Society Best Practice: Is esophagoscopy necessary during panendoscopy?

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Table of contents

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Masthead

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The importance of recognizing a cervical origin of the right subclavian artery

Cervical origin of the right subclavian artery is rare and is associated with DiGeorge syndrome. During total thyroidectomy and right lateral neck dissection for metastatic thyroid cancer in a 26-year-old female, the right subclavian artery was found to be cervical in origin. This was identifiable on preoperative computerized tomography. Screening for DiGeorge syndrome and other cardiovascular abnormalities in this patient was negative. However, all reported cases of this right subclavian artery anomaly tested positive for DiGeorge syndrome. Cervical origin of the right subclavian artery may present in the absence of DiGeorge syndrome. Laryngoscope, 126:2497–2499, 2016

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Antibiotic prescription for acute rhinosinusitis: Emergency departments versus primary care providers

Objectives/Hypothesis

We have previously identified patient characteristics associated with emergency department (ED) rather than primary-care provider (PCP) presentation for uncomplicated acute rhinosinusitis (ARS). Here we investigate potential disparities in prescription of antibiotics for patients presenting to a PCP versus ED for uncomplicated ARS.

Study Design

Cross-sectional study of the 2005 to 2010 National Ambulatory Medical Care Surveys and National Hospital Ambulatory Medical Care Surveys.

Methods

A total of 37,975,715 patient presentations for uncomplicated ARS to PCPs and EDs. The primary outcome measure was prescription of an oral antibiotic, which was tested for association with clinical setting (PCP vs. ED) and clinical, demographic, and socioeconomic patient characteristics.

Results

Among adult ARS presentations, 57.0% received an antibiotic prescription from a PCP versus 59.1% in the ED. Pediatric patients also were commonly prescribed antibiotics by PCPs (52.9%) and EDs (51.4%). Compared to PCPs, EDs were not associated with antibiotic prescription for adults (odds ratio [OR] = 1.09, 95% confidence interval [CI]: 0.79–1.50, P = 0.613) or children (OR = 0.94, 95% CI: 0.51–1.72, P = 0.840). Among PCP visits, antibiotic prescription was more likely in the Northeast United States (OR = 2.90, 95% CI: .31–6.38, P = 0.009). No other demographic, clinical, or socioeconomic patient characteristics, including insurance status, were associated with antibiotic prescription by PCPs or EDs.

Conclusion

More than half of ARS patients presenting to PCPs and EDs are prescribed antibiotics. There was no differential antibiotic prescription for ED versus PCP presentation. ARS patients in the Northeast were more likely to receive antibiotics from PCPs, whereas no such variation was seen for EDs. Interventions targeting PCPs, especially in the Northeast, may reduce excessive antibiotic utilization.

Level of Evidence

4. Laryngoscope, 126:2439–2444, 2016

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Management of a nonhealing forehead wound with a novel frontalis-pericranial flap and a full-thickness skin graft

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Complication rates of open surgical versus percutaneous tracheostomy in critically ill patients

Background

In the setting of critical care, the most common indications for tracheostomy include: prolonged intubation, to facilitate weaning from mechanical ventilation, and for pulmonary toileting. In this setting, tracheostomy can be performed either via open surgical or percutaneous technique. Advantages for percutaneous dilatational tracheostomy (PDT) include: simplicity, smaller incision, less tissue trauma, lower incidence of wound infection, lower incidence of peristomal bleeding, decreased morbidity from patient transfer, and cost-effectiveness. Despite many studies comparing surgical tracheostomy (ST) versus PDT, there remains no consensus on which of these techniques minimizes complications in critically ill patients.

Purpose

To provide an updated meta-analysis to answer the following question: Is there a difference in complication rates between ST and PDT in the setting of critically ill patients? Our secondary outcome of interest was to examine the difference in procedure time in the ST versus PDT groups.

Methods

We conducted a literature search using the following databases: Ovid MEDLINE, Embase, Google Scholar, and Cochrane Database of Systematic Reviews. Studies from 1985 until October 2014 published in French or English languages in peer-reviewed journals were included.

Results

With regard to rates of mortality, intraoperative hemorrhage, and postoperative hemorrhage, there was no statistically significant difference between the two techniques. Evaluation of infections rates and operative time, however, revealed a statistically significant difference, favoring PDT over ST.

Conclusion

In critically ill patients, PDT appears to be a safe and efficient alternative to open ST.

Level of Evidence

NA Laryngoscope, 126:2459–2467, 2016

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Effect of a Pre-Treatment Educational Video in Improving Patient Satisfaction with 5-Fluorouracil Treatment for Actinic Keratoses: A Randomized Controlled Trial

Abstract

Introduction

Patient treatment satisfaction and adherence may be affected by the initial understanding of outcomes in the treatment of actinic keratoses with 5-fluorouracil 5% cream (5-FU). Pre-treatment educational videos may optimize this understanding. The objective of this study was to determine whether prospective patient viewing of an educational video delineating treatment effects and expectations improves patient satisfaction and treatment completion rates for the treatment of actinic keratoses with 5-FU.

Methods

Forty-four participants were recruited to the UC Davis Dermatology outpatient clinic. Each participant was randomized to the video (group A) or control group (group B), and topical 5-FU cream treatment was conducted for 2 weeks in both groups.

Results

A follow-up questionnaire was performed to assess patient satisfaction and adherence to the treatment regimen. The results of these questions were analyzed using the Mann-Whitney test. One item on the questionnaire asked the patient to rate their overall level of satisfaction on a score of 0–100. The results of this question were analyzed using the unpaired t test. The results of the statistical analysis show no significant difference between the patient group that viewed the video and the patient group that did not view the video.

Conclusions

We speculate that this study may establish a foundation for subsequent studies that may affect the broader medical community and promote development of educational videos.

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