Comparison of the alendronate and irradiation with a light-emitting diode (LED) on murine osteoclastogenesis

Abstract

Photomodulation therapy (PBMT) using light-emitting diode (LED) has been proposed as an alternative to conventional osteoporosis therapies. Our aim was to determine the effect of irradiation with a light-emitting diode on receptor activator of NF-κB ligand (RANKL)-mediated differentiation of mouse bone marrow macrophages into osteoclasts and compare it to alendronate treatment. The cells were irradiated with LED at 635±10 nm, 9-cm spot size, 5 mW/cm², and 18 J for 60 min/day in a CO₂ incubator. The differentiation of irradiated and untreated RANKL-stimulated bone marrow macrophages into osteoclasts was evaluated by tartrate-resistant acid phosphatase (TRAP) staining and by molecular methods. These included assessing messenger RNA (mRNA) expression of osteoclastic markers such as TRAP, c-Fos, Atp6v0d2, DC-STAMP, NFATc1, cathepsin K, MMP9 and OSCAR; phosphorylation of various MAPKs, including extracellular signal-regulated kinase ERK1/2, P38, and JNK; NF-κB translocation; and resorption pit formation. Results were compared to those obtained with sodium alendronate. Production of reactive oxygen species was measured by a 2',7'-dihydrodichlorofluorescein diacetate assay. LED irradiation and alendronate inhibited mRNA expression of osteoclast-related genes, such as TRAP, c-Fos, and NFATc1, and reduced the osteoclast activity of RANKL-stimulated bone marrow macrophages. LED irradiation, but not alendronate, also inhibited the production of reactive oxygen species (ROS); phosphorylation of ERK, P38, and IκB; and NF-κB translocation. These findings suggest that LED irradiation downregulates osteoclastogenesis by ROS production; this effect could lead to reduced bone loss and may offer a new therapeutic tool for managing osteoporosis.

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The Therapeutic Effect of Patient-Specific Implants in Cranioplasty

Patient specific implants have been used for the reconstruction of large skull bone defects. Several therapeutic effects have been suggested in current literature but were never objectified. The aim of the current study was to evaluate the change in quality of life, pain, aesthetics, and the surgical and medical outcomes after reconstruction of large skull bone defects with titanium or polyetheretherketone (PEEK) implants.

http://ift.tt/2fFQouH

Clinical audit and national survey on the assessment of collateral circulation before radial forearm free flap harvest

Controversy exists regarding the use of Duplex Ultrasound (DUS) in addition to the Modified Allen's Test (MAT) for the assessment of collateral circulation prior to elevation of the Radial Forearm Free Flap (RFFF). A survey amongst members of BAOMS Head & Neck Oncology Subspecialty Interest Group and a completed local audit was undertaken to assess the need for DUS. Data for the initial audit was collected retrospectively between 2010 – 2013. Both MAT and DUS was performed routinely during this period.

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Erratum to: Debates in allergy medicine: specific immunotherapy efficiency in children with atopic dermatitis

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Consenso español para el tratamiento de los tumores nasosinusales

Publication date: Available online 1 November 2016
Source:Acta Otorrinolaringológica Española
Author(s): Fernando López, Juan José Grau, José Antonio Medina, Isam Alobid
Los tumores nasosinusales son neoplasias poco frecuentes. Su epidemiología, histopatología y características clínicas son diferentes a las del resto de neoplasias malignas de cabeza y cuello. El diagnóstico y tratamiento de estos tumores plantea diversos desafíos debido a su escasa incidencia, su diversidad histológica, la producción de sintomatología inespecífica en los estadios precoces y por tener un pronóstico variable en función de su histología, lugar de origen y estadificación. Su localización centrofacial y la proximidad de estructuras como la órbita y la base del cráneo hacen que su tratamiento sea difícil y complejo, conllevando una elevada morbimortalidad. La cirugía seguida de radioterapia es el tratamiento de elección en la mayor parte de los casos. Para conseguir unos buenos resultados se requiere de equipos multidisciplinares altamente especializados. En este artículo se expone un protocolo de consenso para el tratamiento de los tumores nasosinusales realizado por la Sociedad Española de Otorrinolaringología en colaboración con la Sociedad Española de Oncología Médica y la Sociedad Española de Oncología Radioterápica.Sinonasal tumors are rare neoplasms with distinctive clinical, aetiological and pathological features. The diagnosis and treatment of these tumours is challenging because of their low incidence, histological diversity and production of non-specific symptoms in the early stages. They have a variable prognosis depending on their histology, origin and staging. Their location, close to neurocritical structures, which are of special relevance to surgery and postoperative treatment, makes their treatment difficult and complex, leading to high morbidity and mortality. Surgery followed by radiotherapy is the mainstay of treatment. To provide the best possible care, patients with sinonasal cancer should be treated in clinical referral centres specializing in skull-base pathologies. Such centres should include a multidisciplinary team led by otolaryngologist surgeons. This article outlines a consensus protocol for the management of these tumours devised by the Spanish Society of Otolaryngology in collaboration with the Spanish Society of Medical Oncology and the Spanish Society for Radiation Oncology.



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Is there a role for regenerative medicine in chronic rhinosinusitis with nasal polyps?

Publication date: Available online 2 November 2016
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Fabiana C.P. Valera, Leandra M. Endam, Badr Ibrahim, Emmanuelle Brochiero, Martin Y. Desrosiers




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Frequency of inadequate neuromuscular blockade during general anesthesia

We used electronic health record data to define frequency of inadequate intraoperative neuromuscular blockade (NMB).

http://ift.tt/2fg2YOD

The effect of play distraction on anxiety before premedication administration: a randomized trial

The majority of children scheduled to undergo surgery experience substantial anxiety in the preoperative holding area before induction of anesthesia. Pharmacological interventions aimed at reducing perioperative anxiety are paradoxically a source of stress for children themselves. Midazolam is frequently used as premedication, and the formula of this drug in Turkey is bitter. We aimed to assess the role of distraction in the form of playing with play dough (Play-Doh) on reducing premedication anxiety in children.

http://ift.tt/2eWau2D

An effective compromise between cost and referral rate: A sequential hearing screening protocol using TEOAEs and AABRs for healthy newborns

Publication date: December 2016
Source:International Journal of Pediatric Otorhinolaryngology, Volume 91
Author(s): Yingying Shang, Wenyang Hao, Zhiqiang Gao, Chunxiao Xu, Ying Ru, Daofeng Ni
ObjectiveThis study evaluated the efficacy of a sequential hearing screening protocol using transient evoked otoacoustic emission (TEOAE) and automated auditory brainstem response (AABR) tests in healthy newborns.DesignA TEOAE screening was performed during the first 48–72 h of life. If the infants failed, an AABR test was performed at the same time, and they were referred for a TEOAE rescreening at six weeks old. The results of screening Protocol 1 (only TEOAE) were compared with those of screening Protocol 2 (sequential TEOAE + AABR screenings for the first screening and TEOAE for the rescreening).Study sampleA total of 1062 healthy newborns were enrolled in this research.ResultsFor Protocol 1, the first screening and rescreening referral rates were 11.1% and 2.2%, respectively. In contrast, for Protocol 2, the referral rates were significant lower at 3.8% and 0.9%, respectively. Using the two protocols, six infants were diagnosed with hearing loss (0.57%).ConclusionsAdding simultaneous AABR tests for infants who fail TEOAE testing at the first screening stage can significantly reduce referral rates without increasing misdiagnosis rates. Although this sequential screening process involves slightly more time and has a higher cost than TEOAE alone, its greater accuracy compensates for this difference.



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Development of the maxillary sinus in infants and children

Publication date: December 2016
Source:International Journal of Pediatric Otorhinolaryngology, Volume 91
Author(s): Bharat Bhushan, Karen Rychlik, James W. Schroeder
ObjectiveTo examine the age related volume change of the maxillary sinus in children by measuring the change of the height, weight, and depth using computed tomography (CT).MethodsChildren <18 years of age who underwent a CT Scan of the sinuses for reasons other than sinus related issues were included in the study.Results139 patients were included (68 females and 71 Males) and the mean age of the patients was 9.6 ± 5.4 years. The cohort was divided into three groups based on their ages – Age <6 years (n = 45), age between 6 and 12 years (n = 44) and age > 12 years (n = 50). Patients in each age group demonstrated an increase in their Maxillary sinus height (p<0.001). Patients < 6years of age and between 6 and 12 years of age had a significant increase in their maxillary sinus width and depth (p < 0.001). The maxillary sinus width, depth and volume did not increase significantly after the age of 12 years in these patients.ConclusionWe demonstrated periods of significant size increase of the maxillary sinuses as determined by different dimensions in children at various ages. The height of the maxillary sinus has steady growth from birth to at least the age of 18 years. The width and depth increase up to 12 years of age.



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BRAF/MEK and PD-1 Inhibition Tied to Better Overall Survival in Advanced Melanoma

BRAF/MEK and PD-1 inhibition significantly improves overall survival compared with other treatments for patients with advanced BRAF-mutated melanoma, Canada-based researchers say.
Reuters Health Information

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Abametapir Kills Lice and Eggs in Phase 3 Trials

An experimental treatment kills head lice after only one application and, unlike currently available treatments, also kills their eggs, according to new research.
Medscape Medical News

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Epistaxis grading in Osler's disease: comparison of comprehensive scores with detailed bleeding diaries

Background

Use of reliable grading scores to measure epistaxis severity in hereditary hemorrhagic telangiectasia (HHT) is essential in clinical routine and for scientific purposes. For practical reasons, visual analog scale (VAS) scoring and the Epistaxis Severity Score (ESS) are widely used. VAS scores are purely subjective, and a potential shortcoming of the ESS is that it is based on self-reported anamnestic bleeding data. The aim of this study was to validate the level of correlation between VAS scores, the ESS, and actual bleeding events, based on detailed epistaxis diaries of patients.

Methods

Records from daily epistaxis diaries maintained by 16 HHT patients over 112 consecutive days were compared with the monthly ESS and daily VAS scores in the corresponding time period. The Spearman rank correlation coefficient, analysis of variance models, and multiple R² measures were used for statistical analysis.

Results

Although the ESS and VAS scores generally showed a high degree of correlation with actual bleeding events, mild events were underrepresented in both scores.

Conclusions

Our results highlight the usefulness of the ESS as a standard epistaxis score in cohorts with moderate to severe degrees of epistaxis. The use of detailed epistaxis diaries should be considered when monitoring patients and cohorts with mild forms of HHT.

http://ift.tt/2eoLf8o

Effect of posture and extracranial contamination on results of cerebral oximetry by near-infrared spectroscopy

Abstract

Background

Near-infrared spectroscopy (NIRS)-based cerebral oximetry is a noninvasive technology used to estimate regional cerebral oxygen saturation (rSO₂). Extracranial blood flow is known to substantially affect rSO₂ values measured by most clinically available devices. Several studies have also reported that the Trendelenburg position and upright position have a larger effect on rSO₂ measurements than the supine position. Therefore, we investigated the effect of these two positions (the Trendelenburg position versus the upright position) and extracranial contamination on rSO₂ measurements obtained using two commercially available devices and one prototype device.

Methods

Twelve healthy volunteers were enrolled in the study. They each had three cerebral oximetry devices applied to their forehead (FORE-SIGHT ELITE™, CAS Medical Systems Inc., Branford, CT, USA; INVOS 5100c™, Medtronic, Minneapolis, MN, USA; and NIRO-TRS, Hamamatsu Photonics, Hamamatsu, Japan). A circumferential pneumatic head cuff was positioned proximal to the NIRS cerebral oximetry sensors. We measured rSO₂, heart rate (HR), and blood pressure (BP) in six conditions (supine, Trendelenburg and upright positions, with and without scalp ischemia induced by head cuff inflation) every 5 min with each oximetry device. Total hemoglobin (tHb), which is associated with cerebral blood volume (CBV) as measured by positron emission tomography, was measured using the NIRO-TRS device to determine extracranial blood volume in each position.

Results

Measurements of rSO₂ with all the devices were affected by extracranial contamination. The percentage of extracranial contamination was highest with INVOS 5100c™ in the upright position (INVOS, 21.3%; FORE-SIGHT, 14.3%; NIRO-TRS, 3.6%). Measurements of rSO₂ obtained in the upright position were significantly lower than those obtained in the supine position, using INVOS-5100c™ and FORE-SIGHT ELITE™ (71 vs. 74% and 67 vs. 72%, respectively), but not using NIRO-TRS (62 vs. 64%). A significant decrease in tHb was observed after head cuff inflation in the supine and Trendelenburg positions (supine, 0.132–0.123 μmol/l; Trendelenburg, 0.133–0.125 μmol/l).

Conclusions

Except when using NIRO-TRS, measurements of rSO₂ in the forehead are significantly lower when measured in the upright position than in the supine position. All devices in this study were affected by extracranial contamination.

http://ift.tt/2eoKKuT

Impact of non-surgical periodontal therapy on saliva and serum levels of markers of oxidative stress

Abstract

Objective

The purpose of this study was to determine the effect of non-surgical periodontal treatment on markers of oxidative stress in saliva and serum in patients with chronic periodontitis.

Materials and methods

In total, 25 patients, who were diagnosed with generalized chronic periodontitis (11 females and 14 males), and 26 systemically and periodontally healthy individuals (15 females and 11 males) were included. The plaque index (PI), gingival index (GI), probing pocket depth (PPD), attachment loss (AL), gingival recession (GR), and bleeding on probing (BOP) were recorded at baseline and 6 weeks later. Malondialdehyde (MDA), 8-hydroxydeoxyguanosine (8-OHdG), and 4-hydroxy-2-nonenal (4-HNE) were assessed in saliva and serum samples before and after the non-surgical treatment by enzyme-linked immune sorbent assay (ELISA).

Results

In the group with chronic periodontitis, all clinical parameters were significantly higher compared to the control group at baseline (p < 0.001). Periodontal treatment reduced plaque, gingival inflammation, and pocket depth significantly (p < 0.001). At baseline, salivary 8-OHdG was significantly higher in chronic periodontitis (p < 0.001) and reduced significantly subsequent to the periodontal treatment (p < 0.001). Salivary MDA and serum 4-HNE were significantly higher in the patients with periodontitis compared to the control group (p < 0.001). Periodontal treatment did not significantly change the levels of 4-HNE and salivary MDA (p = 0.503, p = 0.093).

Conclusions

Salivary 8-OHdG and MDA may be associated with local impact of periodontal disease, while 4-HNE may be associated with systemic impact of chronic periodontitis.

Clinical relevance

Clinical intervention in periodontitis may be beneficial for periodontitis patients' systemic oxidative stress control, and using lipidic agents for the use of anti-inflammatory/pro-resolving processes for blocking the actions of arachidonic acid cascade can enable some late therapeutic strategies in order to lead oxidative stress-induced inflammation.

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Role of CD8+ T Cells in the Selection of HIV-1 Immune Escape Mutations

Viral Immunology , Vol. 0, No. 0.


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Usefulness of MRI-CBCT Image Registration to Evaluate Temporomandibular Joint Internal Derangement by Novice Examiners

Publication date: Available online 2 November 2016
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Mohammed A.Q. Al-Saleh, Noura Alsufyani., Hollis Lai., Manuel Lagravere., Jacob L. Jaremko, Paul W. Major
PurposeTo assess whether novice examiners can more reliably determine temporomandibular joint (TMJ) disc derangements using fused magnetic resonance and coned-beam computed tomography (MRI-CBCT) images compared to MRI alone.MethodsThirty dental students with minimal exposure to TMJ imaging received a 30-minute calibration session explaining TMJ diagnostic imaging and normal anatomy of the TMJ internal derangement. The students evaluated the disc positions of 16 TMJs in two sets of images (MRI-alone and MRI-CBCT images) randomly and independently. The disc positions evaluated by two experienced radiologists were used for comparison.ResultsThe internal consistency among all students improved from an unacceptable consistency (α = 0.40) with MRI alone to a good consistency (α = 0.84) with MRI-CBCT images. The agreement between students and the radiologists improved from a poor agreement with MRI alone (k mean=0.07±0.12) to a moderate agreement with MRI-CBCT images (k mean=0.55±0.25). This improvement in the agreement was significant (p<0.001).ConclusionsFusing MRI and CBCT images to visualize the TMJs in a single display significantly improved the examiners' reliability and accuracy of assessment of disc positions. The improvement of the novice readers in assessing the disc positions highlights the potential use of MRI-CBCT image fusion as an educational tool.



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Destructive soft tissue mass in the maxilla/maxillary sinus

Publication date: Available online 2 November 2016
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Emily Lanzel, Sergei I. Syrbu, John W. Hellstein, Kyle M. Stein, Sean Welander, Saulo L. Sousa Melo




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N-RAS expression in patients with salivary adenoid cystic carcinoma: association with clinicopathological features and prognosis

Publication date: Available online 2 November 2016
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Jiuling Yue, Xiaonan Liu, Shanshan Zhuo, Wenchao Zhang
ObjectiveThe aim of this study was to investigate N-RAS expression in patients with salivary adenoid cystic carcinoma (SACC) and to analyze its association with clinicopathological features and prognosis.Study DesignWe determined N-RAS expression in SACC tumors via immunohistochemistry and evaluated the association between N-RAS expression and clinicopathological variables. The disease-free survival curves were plotted using the Kaplan-Meier method. The parameters of prognostic significance found by univariate analysis were tested by a multivariate Cox regression model.ResultsN-RAS expression was detected in 61 of 72 (84.7%) SACC tumor samples. In univariate analyses, N-RAS expression was associated with clinical stage, tumor size, adjacent tissue invasion and distant metastasis. N-RAS expression was associated with disease-free survival in univariate analysis, however in multivariate analysis N-RAS was not an independent prognostic indicator, but clinical stage (0.04) and histological subtype (0.02) were statistically significant.ConclusionOur data suggests that N-RAS was overexpressed in SACC tissues, but not an independent prognostic indicator of disease-free survival. Only clinical stage and histological subtype were prognostic indicators of disease-free survival.



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Death Related to Dental Treatment: A Systematic Review

Publication date: Available online 2 November 2016
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): N.G. Reuter, P.M. Westgate, M. Ingram, C.S. Miller
ObjectiveTo identify factors associated with death in relation to dental care.MethodsA systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. PubMed, Dental and Oral Sciences Source, Web of Science and the Cochrane database were searched, and references of all retrieved articles were analyzed. Studies were included if death occurred within 90 days of the dental appointment, and the patient's age, procedure and information regarding cause or time of death were provided. Factors associated with death were assessed by multivariate analyses and logistic regression.ResultsFifty-six publications, consisting of retrospective studies and case reports/series, which reported 148 fatalities, were analyzed. On average, 2.6 deaths were reported per year. The leading cause of deaths was anesthesia-sedation-medication-related complications (n=70). Other causes were cardiovascular events (n=31), infection (n=19), airway-respiratory complications (n=18), bleeding (n=5), and other (n=5). Age (p<0.0001), disease severity (P<0.02), disease stability (P<0.006), dental provider characteristics (p<0.05), level of consciousness/sedation (P<0.02), and drug effects (p<0.03) were significantly associated with death.ConclusionReports of death are rare, however specific risk factors associated with dentistry were identified. A better understanding of these factors is important for the development of guidelines that help prevent fatalities in dentistry.Statement of Clinical RelevanceOver the past 56 years, fatalities have been reported in the literature about thrice a year in association with the provision of dental care. Distinct patient, provider and procedural factors (i.e., anesthesia-sedation) are significantly associated with these adverse events.



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Assessment Of Zygomatic Bone Using Cone Beam Computed Tomography In A Turkish Population (Research Article)

Publication date: Available online 2 November 2016
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Kıvanç Kamburoğlu, Burcu Kirşan, Buket Acar, Candan Semra Paksoy
ObjectiveTo provide linear and volumetric measurements of zygomatic bone using CBCT images.Study DesignCBCT images were assessed in 198 patients. Posterior and anterior zygomatic bone widths (M1 and M2), zygomatic bone projection (M3), zygomatic bone height (M4), combined zygomatic arch diameter (M5), maximum cortical thickness (M6), gray value obtained from maximum cortical thickness region (M7), minimum cortical thickness (M8), and gray value obtained from minimum cortical thickness region (M9) were measured. Volume and surface area measurements of the zygomatic bone were also conducted. Sex, age and side were all recorded for each patient. General Linear Model (ANOVA) was performed (p<0.05).ResultsAge (p<0.001) and gender (p=0.001) significantly affected M1. Gender significantly affected M3 (p=0.003) and M4 (p=0.000) with higher values for men. Gender (p=0.000) and age (p=0.000) significantly affected M5 variation. Only age had a significant effect on M6 variation with an increase with age (p<0.015). Only gender had a significant effect on M7 (p=0.005), M8 (p=0.000) and M9 (p=0.004) with higher values for men. All of the factors significantly affected zygomatic bone volume variation [gender (p=0.000), age (p=0.000) and side (p<0.004)].ConclusionA detailed examination of the zygomatic bone region can be performed with CBCT images.



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Symptomatic enlarged fabella

Description

A male patient aged 20 years presented to our outpatient department reporting of a 2-year history of right knee discomfort associated with snapping episodes, especially when moving from a seated to a standing position. His medical history was unremarkable and there was no history of trauma. The oblique radiograph of the knee revealed a large ossified structure at the posterolateral corner (figure 1). Routine blood tests, erythrocyte sedimentation rate and C reactive protein were within normal limits. MRI of the knee showed the large ossified structure within the lateral head of the gastrocnemius, while the rest of the examination was normal (figure 2). The tendon of the lateral head of the gastrocnemius attached to its posterior aspect and the anterior surface articulated with the lateral femoral condyle. Based on the location and anatomical characteristics, the structure was identified as a fabella and its large...

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Large schwannoma of the sciatic nerve

Description

A 40-year-old woman was referred with an 8-month history of fullness of the right posterior thigh. This was associated with pain, primarily on sitting and occasional radicular pain down the ipsilateral leg. On examination a mobile, firm lump was identified that was tender to palpate and which also elicited a shooting pain down the leg on examination. MRI demonstrated a well-defined multiloculated mass 9 cmsx6 cms which appeared to arise from the sciatic nerve, raising suspicion for a schwannoma (figure 1). A biopsy confirmed the diagnosis of schwannoma. Surgical excision was undertaken, carefully dissecting the lesion from the sciatic nerve (figure 2). The patient had an uneventful postoperative recovery without neurovascular deficits.

Figure 1

A coronal (A) and axial (B) T1-weighted MRI of a well-defined multiloculated mass 9 cmsx6 cms arising from the sciatic nerve.

Figure 2

Schwannoma lesion excised en...

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Abdominal tuberculosis: an old disease surprising young doctors

Tuberculosis remains a worldwide public health concern. Atypical extrapulmonary presentations may delay the diagnosis and treatment. We present the case of an adult woman admitted to the emergency department with bowel obstruction. The putative intraoperative diagnostic hypothesis was ovarian cancer with peritoneal dissemination. Histopathological analysis showed a chronic granulomatous inflammatory disease with acid-fast bacilli. The patient was started on an alternative parenteral antituberculosis drug combination until oral feeding was available. Currently, 5 months after surgery, she is asymptomatic. Abdominal tuberculosis is the most frequent extrapulmonary site with a wide range of clinical presentations. Emergency laparotomy may be necessary in patients who present with acute abdomen. Bowel obstruction due to adhesions and strictures is not infrequent. However, tuberculous abdominal cocoon presentation as in our patient is rare. Treatment with parenteral alternative drug regimens for tuberculosis is mandatory until the oral route is available.

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Asymptomatic free-floating vitreous cyst masquerading as cysticercosis

A male patient aged 37 years, referred with the diagnosis of right eye intravitreal cysticercosis, was diagnosed as asymptomatic free-floating vitreous cyst after thorough evaluation. The patient was kept under observation, since baseline visual acuity was unaffected. No change was noted over the period of 6 months.

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Miliary tuberculosis in an immunocompetent male with a fatal outcome

A man aged 33 years, born in Nepal, but resident in the UK for 7 years presented to the emergency department with a 4-day history of general malaise, fever (temperature 38.6°C) and a non-productive cough. His medical history was unremarkable and no high-risk behaviour was identified. Clinical examination confirmed decreased air entry bilaterally with bibasal crackles. He was tachycardic, with a heart rate of 120 bpm. Further investigation with a 12-lead ECG confirmed supraventricular tachycardia (SVT) which was terminated with vagal manoeuvres. His chest radiograph demonstrated left basal consolidation. His white cell count was 11x10⁹/L and his C reactive protein was 43.2 mg/L. His blood cultures revealed no growth. He was diagnosed with community-acquired pneumonia and started treatment with amoxicillin and clarithromycin. 3 days post admission, he was intubated for 24 hours in the Department of Intensive Care Medicine. Further episodes of SVT were observed and an ECHO showed a severely dilated and impaired left ventricle. Further chest radiographs illustrated diffuse consolidation with evidence of pulmonary oedema. HIV serology was negative. He developed transaminitis and thrombocytopenia. An ultrasound scan of his liver showed no obvious liver pathology. He remained tachypnoeic and due to worsening pulmonary oedema and extensive consolidation, he was readmitted to the intensive care unit. A CT abdomen with contrast showed an unusual pattern of lymphadenopathy with disproportionately enlarged coeliac axis nodes (5x7x5 cm) and minor para-aortic adenopathy, suspicious for lymphoma. On inserting his central venous catheter in his right internal jugular vein, pus was inadvertently aspirated from his right neck. Acid alcohol fast bacilli (AAFFB) were isolated from the pus and was subsequently identified as Mycobacterium tuberculosis. He started treatment with antitubercular medication rifater: a combination of rifampicin 720 mg od, isoniazid 300 mg po od and pyrazinamide 1750 mg. In addition, he received ethambutol 1000 mg po od and pyridoxine 5 mg. He developed worsening metabolic acidosis, pH 7.19, loss of respiratory compensation and pancytopenia. Right heart strain was evident on his Focused Intensive Care Echo. He developed an increased oxygen requirement and respiratory distress on the ventilator. An erect chest radiograph showed bilateral pneumothoraces and bronchopleural fistulae. A chest drain was inserted. Following discussion with the Cardiothoracic Surgeons, pleurodesis was not deemed possible. He developed inotropic-dependent shock with worsening lung compliance. As a result of his deteriorating ventilation, acidosis and hyperkalaemia, he started treatment with continuous veno-venous haemofiltration. With a diagnosis of miliary tuberculosis and SVT causing cardiogenic pulmonary oedema, this man sadly died with his family at his bedside 10 weeks following initial hospital presentation.

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Prenatal sonographic diagnosis of Beckwith-Wiedemann syndrome in a fetus with omphalocoele

Description

A 28 years old primigravida was referred to Department of Obstetrics and Gynaecology, King George's Medical University, as 35 weeks pregnancy with polyhydramnious with suspected fetal omphalocoele. The defect was diagnosed at 24 weeks at some external centre and the patient was counselled regarding continuation of pregnancy with postnatal surgical repair of malformation after delivery. The diagnosis of Beckwith-Wiedemann syndrome (BWS) was missed at that time.

Phenotypic presentation of BWS has several variations and low occurrence of multiple abnormalities simultaneously limits the sonograhic detection rate. The genotypic detection is feasible only if the molecular defect is known.

We are submitting images of this fetus which shows a fetus with large abdominal wall defect covered by a wall containing only bowel loops and not the liver (figure 1). Along with it the fetus also shows bilateral enlarged kidneys with a suspicious cystic lesion on upper pole of right kidney...

http://ift.tt/2fELhe9

Delayed diagnosis of a foreign body in the tongue

Description

A 70 year-old man presented with 1-month history of progressive pain in the tongue after eating fish. The patient stated that he had sought medical care back then, but since no foreign body was found he was discharged with paracetamol. Physical examination revealed a mass located in the middle third of the right edge of the tongue with 1.5 cm of diameter, with mild inflammatory signs.

Contrast-enhanced CT scan of the pharynx revealed the presence of an abscess embedded in the tongue surrounding a radio-opaque foreign body (figure 1). A fish bone was removed surgically by making a 1 cm incision over the mass on the right side of the tongue under general anaesthesia (figure 2). Therapy was complemented with ceftriaxone, clindamycin and methylprednisolone. On 3-month follow-up, the patient had a fully healed tongue with complete regression of the mass and with no neuromuscular sequelae.

...

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Atypical lymphocytic lobular panniculitis: an overlap condition with features of subcutaneous panniculitis-like T-cell lymphoma and lupus profundus

Description

A woman aged 45 years presented for evaluation of skin lesions. She reported an 8–9-year history of occasionally tender, waxing-and-waning skin nodules refractory to dapsone, prednisone and methotrexate. Examination revealed multiple indurated subcutaneous nodules distributed on the upper extremities, with scattered patches of lipoatrophy in areas of nodule regression (figure 1). Her medical history was unremarkable; CBC and CMP were within normal limits, with no history of radiotherapy or evidence of internal organ involvement. She had a positive ANA titre (1:160, speckled), but negative anti-dsDNA, anti-Smith, anti-Ro and anti-La antibodies.

Figure 1

Multiple erythematous subcutaneous nodules distributed over the patient's right arm.

Differential diagnosis included erythema nodosum (EN), erythema induratum of Bazin (EIB), lupus profundus (LP) and cutaneous lymphoma.

Initial wedge biopsy in 2008 disclosed a predominantly lobular panniculitic process with some septal involvement (figure 2A). Broad zones of...

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Active Surveillance of Papillary Thyroid Microcarcinoma

Condition:   Thyroid Cancer, Papillary
Intervention:  
Sponsor:   Dong Jun Lim
Recruiting - verified October 2016

http://ift.tt/2eUT6Ls

A Comparative Study of Ultrasound Versus CT Measurement of Tongue and Oral Cavity Size

Condition:   Ultrasound Airway Imaging in Determining the Oral Cavity and Tongue Size
Intervention:   Other: Ultrasound scan
Sponsor:   University Health Network, Toronto
Recruiting - verified October 2016

http://ift.tt/2fejIpz

Study To Compare Avelumab In Combination With Standard of Care Chemoradiotherapy (SoC CRT) Versus SoC CRT for Definitive Treatment In Patients With Locally Advanced Squamous Cell Carcinoma Of The Head And Neck (JAVELIN HEAD AND NECK 100)

Condition:   Squamous Cell Carcinoma of the Head and Neck
Interventions:   Drug: Avelumab;   Other: Chemoradiation
Sponsor:   Pfizer
Not yet recruiting - verified October 2016

http://ift.tt/2eUO15U

A Safety Study of SGN-2FF for Patients With Advanced Solid Tumors

Conditions:   Non-small Cell Lung Cancer;   Renal Cell Cancer;   Breast Cancer;   Bladder Cancer;   Head and Neck Cancer;   Colorectal Cancer
Intervention:   Drug: SGN-2FF
Sponsor:   Seattle Genetics, Inc.
Not yet recruiting - verified October 2016

http://ift.tt/2femyLd

18F-FDG-PET Guided Dose-Painting With Intensity Modulated Radiotherapy in Oropharyngeal Tumours

Condition:   Oropharyngeal Cancer
Intervention:   Radiation: FDG-PET guided radiation dose escalation
Sponsors:   Guy's and St Thomas' NHS Foundation Trust;   Velindre NHS Trust
Recruiting - verified October 2016

http://ift.tt/2eUW6Yu

PET/MR in Radiotherapy for Head and Neck Cancer Pilot

Condition:   Head and Neck Cancer
Intervention:   Other: Imaging
Sponsor:   Guy's and St Thomas' NHS Foundation Trust
Recruiting - verified October 2016

http://ift.tt/2felerw

Panorama

http://ift.tt/2fcQXJc

Robotic Assisted Laparoscopic Prostatectomy Performed after Previous Suprapubic Prostatectomy

Operative management of prostate cancer in a patient who has undergone previous open suprapubic simple prostatectomy poses a unique surgical challenge. Herein, we describe a case of intermediate risk prostate cancer in a man who had undergone simple prostatectomy ten years prior to presentation. The patient was found to have Gleason 7 prostate cancer on MRI fusion biopsy of the prostate for elevated PSA and underwent an uncomplicated robot assisted laparoscopic radical prostatectomy.

http://ift.tt/2fdTUtE

Pediatric Isolated Sinonasal Schwannoma: A New Case Report and Literature Review

Schwannomas of the paranasal sinus are uncommon. Less than 4% of schwannomas involve the nasal cavity and paranasal sinuses, even less in the pediatric age group. A case of schwannoma arising in maxillary sinus in a 2.5-year-old Chinese boy is reported. The basis for discussion of this case is the exceptional rarity of sinonasal schwannoma in pediatric patients.

http://ift.tt/2eUA9bS

Increased frequency of the PTPN22W* variant in primary Sjogren's Syndrome: Association with low type I IFN scores

Publication date: Available online 1 November 2016
Source:Clinical Immunology
Author(s): Nikolaos I. Vlachogiannis, Adrianos Nezos, Athanasios G. Tzioufas, Michael Koutsilieris, Haralampos M. Moutsopoulos, Clio P. Mavragani
Recent data suggest the association of the autoimmune gene variant PTPN22W* with dampened type I Interferon (IFN) responses, seen in a subset of primary Sjogren's Syndrome (pSS) patients. We sought to explore the potential contribution of PTPN22W* in this setting. PTPN22W* was identified in DNA samples derived from 352 pSS patients and 482 healthy controls (HC). Type I IFN score was determined in available peripheral blood cDNA of 164 pSS patients by Real-Time PCR. Increased prevalence of the PTPN22W* variant was detected in pSS patients compared to HC [9.7% vs 5.0%, p-value: 0.02]. Of interest, only the low but not the high type I IFN pSS subgroup displayed higher PTPN22W* rates compared to HC (12.2% vs 5.0%, p-value: 0.03). PTPN22W* risk variant increases susceptibility for pSS, particularly the low type I IFN subset implying the presence of distinct genetic backgrounds among low and high type I IFN autoimmune subgroups.



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The relationship between biomarkers of fungal allergy and lung damage in asthma

Abstract

Background

Immunological biomarkers are key to the diagnosis of allergic bronchopulmonary aspergillosis (ABPA) and fungal sensitisation, but how these relate to clinically relevant outcomes is unclear.

Objectives

To assess how fungal immunological biomarkers are related to fixed airflow obstruction and radiological abnormalities in moderate to severe asthma.

Methods

Cross-sectional study of 431 asthmatics. Inflammatory biomarkers, lung function and an IgE fungal panel to colonising filamentous fungi, yeasts and fungal aeroallergens were measured. CT scans were scored for the presence of radiological abnormalities. Factor analysis informed the variables used in a k-means cluster analysis. Fixed airflow obstruction and radiological abnormalities were then mapped to these immunological variables in the cluster analysis.

Results

329 (76.3%) subjects were sensitised to ≥1 fungi. Sensitisation to A. fumigatus and/or P.chrysogenum was associated with a lower post-bronchodilator FEV₁ compared to those not sensitised to fungi ((73.0 (95%CI 70.2-76)vs 82.8 (95%CI 78.5-87.2) % predicted, p<0.001), independent of atopic status (p=0.005)), and an increased frequency of bronchiectasis (54.5%, p<0.001), tree-in-bud (18.7%, p<0.001) and collapse/consolidation (37.5%, p=0.002). Cluster analysis identified three clusters: (i) hypereosinophilic (n=71, 16.5%), (ii) high immunological biomarker load and high frequency of radiological abnormalities (n=34, 7.9%), (iii) low levels of fungal immunological biomarkers (n=326, 75.6%).

Conclusions

IgE sensitisation to thermotolerant filamentous fungi, in particular A. fumigatus but not total IgE, is associated with fixed airflow obstruction and a number of radiological abnormalities in moderate to severe asthma. All patients with IgE sensitisation to A. fumigatus are at risk of lung damage irrespective of whether they meet the criteria for ABPA.

This article is protected by copyright. All rights reserved.

http://ift.tt/2enyta7

Treatment of chemically-induced oral ulcer using adipose-derived mesenchymal stem cell sheet

Abstract

Background

This study investigated the effects of mesenchymal stem cell (MSC) sheet transplantation on healing of chemically-induced oral ulceration in a rabbit animal model.

Methods

Oral mucosal ulcers were induced by topical application of filter paper soaked with 70% acetic acid to the anterior gingiva and buccal mucosa of 12 New Zealand white rabbits. The animals were randomly assigned to 2 groups: with (treatment group, n=6) or without (control group, n=6) cell sheets applied to ulcers. Gross findings were sequentially evaluated, and histologic examination was performed on day 7.

Results

Based on gross inspection, ulceration resolved before day 5 in the treatment group; however, in the control group, healing was incomplete on day 7. In the treatment group, the total area of the ulcer decreased significantly from day 2 to day 5 (p<0.001) and from day 5 to day 7 (p=0.020), whereas the area decreased significantly from day 5 to day 7 in the control group (p<0.001). Histologic and immunofluorescence examination revealed, full-thickness mucosa healing and complete basal cell coverage in the treatment group; in contrast, only partial healing was observed on day 7 in the control group.

Conclusions

Cell sheet technology using MSC can be an alternative treatment for oral ulcerations in that it can decrease healing time without invasive properties.

This article is protected by copyright. All rights reserved.

http://ift.tt/2fcxeJX

Identification of Phenotypic Clusters of Non-steroidal Anti-inflammatory Drugs Exacerbated Respiratory Disease

Abstract

Background

Clinical presentation of non-steroidal anti-inflammatory drugs exacerbated respiratory disease (NERD) is found to be heterogeneous. This study classified phenotypic clusters to determine NERD subtypes.

Methods

We performed 2-step cluster analysis using urticaria, chronic rhinosinusitis (CRS), and atopy, in a NERD cohort comprising 302 patients. Asthma exacerbation was defined as receiving at least 1 burst of intravenous steroid treatment and/or at least 2 bursts of oral steroid use (≥ 45 mg/3days) per year. The possession rate of anti-asthmatic medications was estimated during the follow-up period.

Results

There were 4 subtypes; subtype 1 (NERD with CRS / atopy and no urticaria), subtype 2 (NERD with CRS and no urticaria / atopy), subtype 3 (NERD without CRS / urticaria), and subtype 4 (NERD with urticaria). Significant differences were found between the 4 subtypes in the female proportion, baseline FEV1%, serum total IgE level, and sputum/peripheral eosinophil count. A higher frequency of asthma exacerbations was noted in subtype 1 compared to subtype 3. The possession rates of medium to high dose ICS/LABA showed significant differences among the 4 subtypes. Metabolomic analysis showed that the 4 subtypes of NERD had a higher serum LTE4 level than those with aspirin-tolerant asthma. The patients with subtypes 1 and 3 had a higher urine LTE4 level than those with subtype 2.

Conclusion

We found 4 distinct subtypes with different clinical/biochemical findings and asthma exacerbations in a NERD cohort. These findings suggest that stratified strategies by applying subtype classification may help achieve better outcomes in the management of NERD.

This article is protected by copyright. All rights reserved.

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Cutaneous acute graft-versus-host disease with isomorphic disposition over striae distensae in a 12-year-old girl

http://ift.tt/2ezoHiU

Reduced expression of the ATP2A2 gene in vemurafenib-induced keratoacanthoma-like papules in a melanoma patient

http://ift.tt/2edlapp

Toxic epidermal necrolysis induced by thalidomide and dexamethasone treatment for multiple myeloma

http://ift.tt/2f0vuCO

Eruptive syringomas: unresponsiveness to oral isotretinoin

http://ift.tt/2faH01e

Dysmorphic Facial Features and Other Clinical Characteristics in Two Patients with PEX1 Gene Mutations

Peroxisomal disorders are a group of genetically heterogeneous metabolic diseases related to dysfunction of peroxisomes. Dysmorphic features, neurological abnormalities, and hepatic dysfunction can be presenting signs of peroxisomal disorders. Here we presented dysmorphic facial features and other clinical characteristics in two patients with PEX1 gene mutation. Follow-up periods were 3.5 years and 1 year in the patients. Case was one-year-old girl that presented with neurodevelopmental delay, hepatomegaly, bilateral hearing loss, and visual problems. Ophthalmologic examination suggested septooptic dysplasia. Cranial magnetic resonance imaging (MRI) showed nonspecific gliosis at subcortical and periventricular deep white matter. Case was 2.5-year-old girl referred for investigation of global developmental delay and elevated liver enzymes. Ophthalmologic examination findings were consistent with bilateral nystagmus and retinitis pigmentosa. Cranial MRI was normal. Dysmorphic facial features including broad nasal root, low set ears, downward slanting eyes, downward slanting eyebrows, and epichantal folds were common findings in two patients. Molecular genetic analysis indicated homozygous novel IVS1-2A>G mutation in Case and homozygous p.G843D (c.2528G>A) mutation in Case in the PEX1 gene. Clinical findings and developmental prognosis vary in PEX1 gene mutation. Kabuki-like phenotype associated with liver pathology may indicate Zellweger spectrum disorders (ZSD).

http://ift.tt/2ecUuVL

European consensus-based (S2k) Guideline on the Management of Herpes Zoster – guided by the European Dermatology Forum (EDF) in cooperation with the European Academy of Dermatology and Venereology (EADV), Part 1: Diagnosis

Abstract

Herpes zoster (HZ, shingles) is a frequent medical condition which may severely impact the quality of life of affected patients. Different therapeutic approaches to treat acute HZ are available. The aim of this European project was the elaboration of a consensus-based guideline on the management of patients who present with HZ, considering different patient populations and different localizations. This interdisciplinary guideline aims at an improvement of the outcomes of the acute HZ management concerning disease duration, acute pain and quality of life of the affected patients and at a reduction of the incidence of postherpetic neuralgia and other complications. The guideline development followed a structured and predefined process, considering the quality criteria for guidelines development as suggested by the AGREE II instrument. The steering group was responsible for the planning and the organization of the guideline development process (Division of Evidence based Medicine, dEBM). The expert panel was nominated by virtue of clinical expertise and/or scientific experience and included experts from the fields of dermatology, virology/infectiology, ophthalmology, otolaryngology, neurology and anaesthesiology. Recommendations for clinical practice were formally consented during the consensus conference, explicitly considering different relevant aspects. The guideline was approved by the commissioning societies after an extensive internal and external review process. In this first part of the guideline, diagnostic means have been evaluated. The expert panel formally consented recommendations for the management of patients with (suspected) HZ, referring to the assessment of HZ patients, considering various specific clinical situations. Users of the guideline must carefully check whether the recommendations are appropriate for the context of intended application. In the setting of an international guideline, it is generally important to consider different national approaches and legal circumstances with regard to the regulatory approval, availability and reimbursement of diagnostic and therapeutic interventions.

http://ift.tt/2e1upha

What's new in atopic eczema? An analysis of systematic reviews published in 2014. Part 1. Epidemiology, risk factors and outcomes

Summary

This review summarizes key findings from nine systematic reviews on atopic eczema (AE) published or first indexed in 2014. It focuses on epidemiology, disease processes and methodological issues. There is reasonable evidence to conclude that high birth weight (> 4000 g) is a risk factor for the development of AE. A lower socioeconomic position is associated with lower prevalence of AE. The effect of exposure to traffic-related air pollution in childhood on the development of AE is uncertain. CD14 polymorphisms do not appear to have an effect in AE. There may be a role for interleukin-18 in AE development. Patients with AE are at decreased risk of brain tumours, but at increased risk of developing attention deficit hyperactivity disorder. Evidence supports the view that normal-appearing skin in AE is in fact structurally abnormal. Lower success rates at inducing remission in AE are associated with increased risk of relapse during long-term follow-up. The Eczema Area Severity Index (EASI) has been agreed as the preferred core instrument to measure clinical signs in future research. There remains a lack of consensus on the definition of an AE flare.

http://ift.tt/2ez61Qs

Systematic review of compound action potentials as predictors for cochlear implant performance

Objectives/Hypothesis

The variability in speech perception between cochlear implant users is thought to result from the degeneration of the auditory nerve. Degeneration of the auditory nerve, histologically assessed, correlates with electrophysiologically acquired measures, such as electrically evoked compound action potentials (eCAPs) in experimental animals. To predict degeneration of the auditory nerve in humans, where histology is impossible, this paper reviews the correlation between speech perception and eCAP recordings in cochlear implant patients.

Data Sources

PubMed and Embase.

Review Methods

We performed a systematic search for articles containing the following major themes: cochlear implants, evoked potentials, and speech perception. Two investigators independently conducted title-abstract screening, full-text screening, and critical appraisal. Data were extracted from the remaining articles.

Results

Twenty-five of 1,429 identified articles described a correlation between speech perception and eCAP attributes. Due to study heterogeneity, a meta-analysis was not feasible, and studies were descriptively analyzed. Several studies investigating presence of the eCAP, recovery time constant, slope of the amplitude growth function, and spatial selectivity showed significant correlations with speech perception. In contrast, neural adaptation, eCAP threshold, and change with varying interphase gap did not significantly correlate with speech perception in any of the identified studies.

Conclusions

Significant correlations between speech perception and parameters obtained through eCAP recordings have been documented in literature; however, reporting was ambiguous. There is insufficient evidence for eCAPs as a predictive factor for speech perception. More research is needed to further investigate this relation. Laryngoscope, 2016

http://ift.tt/2e1lFYo