Scaffold-free cartilage tissue engineering with a small population of human nasoseptal chondrocytes

Objective

Cartilage tissue engineering is a promising approach to provide suitable materials for nasal reconstruction; however, it typically requires large numbers of cells. We have previously shown that a small number of chondrocytes cultivated within a continuous flow bioreactor can elicit substantial tissue growth, but translation to human chondrocytes is not trivial. Here, we aimed to demonstrate the application of the bioreactor to generate large-sized tissues from a small population of primary human nasoseptal chondrocytes.

Study Design

Experimental study.

Methods

Chondrocytes were cultured in the bioreactor using different medium compositions, with varying amounts of serum and with or without growth factors. Resulting engineered tissues were analyzed for physical properties, biochemical composition, tissue microstructure, and protein localization.

Results

Bioreactor-cultivated constructs grown with serum and growth factors (basic fibroblast growth factor and transforming growth factor beta 2) had greater thickness, as well as DNA and glycosaminoglycan (GAG) contents, compared to low serum and no growth factor controls. These constructs also showed the most intense proteoglycan and collagen II staining.

Conclusion

The combination of bioreactor conditions, serum, and growth factors allowed the generation of large, thick scaffold-free human cartilaginous tissues that resembled the native nasoseptal cartilage. There also may be implications for patient selection in future clinical applications of these engineered tissues because their GAG content decreased with donor age.

Level of Evidence

NA. Laryngoscope, 2016

http://ift.tt/2fbApjW

Quality of life of patients with recurrent respiratory papillomatosis

Objectives/Hypothesis

Recurrent respiratory papillomatosis (RRP) is a disease with a high disease burden. Few studies have assessed quality of life (QoL) of RRP patients. This study compares QoL of these patients with controls. Associations between QoL and sociodemographic and illness-related factors are examined, as is uptake of psychosocial care and speech therapy.

Study Design

Prospective cross-sectional questionnaire research.

Methods

Ninety-one RRP patients (response = 67%) from two university hospitals in the Netherlands and Finland completed the following patient reported outcome measures: (HADS), 15-dimensional health-related quality-of-life scale (15D), Voice Handicap Index (VHI) and the RAND 36-item health-related quality-of-life survey instrument (RAND-36) assessing health-related QoL and voice handicap, and they provided sociodemographic, illness-related, and allied healthcare use. Descriptive analyses, χ² tests, t tests, analysis of variance tests, and Pearson correlations were computed to describe the study population and to examine differences between groups.

Results

RRP patients had significantly higher mean scores on depression, health-related QoL (15D) and on voice problems (VHI), and significantly lower mean scores on anxiety than controls. Dutch patients had more pain and a decreased general health perception (RAND-36) than controls. Dutch patients and older patients were more depressed, women were more anxious, older patients had lower health-related QoL, and smoking was significantly associated with voice handicap. Patients who had received psychosocial care had significantly higher HADS-depression mean scores than patients who did not receive psychosocial care.

Conclusions

Having RRP has significant effect on voice-related QoL and depression, but has no negative effect on anxiety and health-related QoL. Risk factors for decreased functioning are different than previously hypothesized by many authors. Prevention should be aimed at these risk factors.

Level of Evidence

4. Laryngoscope, 2016

http://ift.tt/2eAptQM

Electrophysiological identification of nonrecurrent laryngeal nerves

Objectives/Hypothesis

The nonrecurrent laryngeal nerve (NRLN) is a common anatomic variation of the right recurrent laryngeal nerve (RLN), which has been associated with an increased risk of injury during thyroid and parathyroid surgery. We suggest that early successful identification using intraoperative nerve monitoring (IONM) and preservation of this variant will help the surgeon to avoid injury to this nerve. Our objective was to examine the electrophysiological parameters of the NRLN and the efficacy of IONM for successful identification of the NRLN.

Study Design

Retrospective database analysis.

Methods

This is a retrospective study of a prospectively collected database of all patients who underwent thyroid and parathyroid surgeries by a single surgeon at a tertiary care center over 3 years (n = 481). Patients' demographic data and operative reports, including the IONM reports, were reviewed. Average stimulation thresholds with resulting amplitudes and latencies were compared. Preoperative and postoperative laryngoscopy were performed in all cases.

Results

We identified 15 NRLNs (2.2%) in a total 682 laryngeal nerves. No left-sided NRLNs were observed. The average right vagus latency in the NRLN group was shorter than that of the RLN group (2.40 ms ± 0.49 ms vs. 3.43 ms ± 1.03 ms; P < .001). No statistically significant difference was observed between the initial amplitudes of the right vagus nerves in the two groups (713.67 μV ± 208.71 μV vs. 816.22 μV ± 470.45 μV; P = .14). All NRLN cases exhibited normal functioning of vocal cords on postoperative laryngoscopy.

Conclusions

IONM is highly effective in the identification of the NRLN. Right vagus nerve latency in the NRLN group was found to be significantly shorter than in the RLN group. Early identification of the NRLN allowed cautious preservation of the NRLN, resulting in excellent postoperative outcomes. The rate of NRLN identification may be improved by routine use of IONM.

Level of Evidence

4 Laryngoscope, 2016

http://ift.tt/2fbAnbO

Intratympanic dexamethasone in sudden sensorineural hearing loss: A systematic review and meta-analysis

Objective

Systemic dexamethasone has demonstrated conclusive benefits in reversing sudden sensorineural hearing loss (SSNHL) despite considerable number of potential side effects. In contrast, the intratympanic route of steroid administration averts several possible complications. This study aims to examine the literature to delineate the efficacy and side effect of intratympanic dexamethasone (ITD) injection for the treatment of SSNHL.

Data Source

Cochrane, Embase, and MEDLINE electronic databases from January 1950 to August 2014, with an update performed on November 10, 2014.

Review Methods

Systematic review and meta-analysis of randomized controlled clinical trials (RCCTs), using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram and guidelines. Quality assessment was performed using The Cochrane Collaboration Tool for Assessing Risk of Bias.

Results

Eight RCCTs on SSNHL were included Three of the eight studies had high risk of bias. Substantial heterogeneity was found. The meta-analysis failed to detect statistically significant difference between ITD and alternative treatment (odds ratio = 0.39, 95% credible intervals = 0.11–1.27). The side-effects profile was favorable for ITD. No serious adverse events were recorded.

Conclusion

There is no sufficient scientific evidence to support a difference between ITD and alternative therapy for SSNHL. We recommend larger RCCTs to determine the effectiveness of ITD compared to oral steroid therapy. We encourage a shift in study design selection toward noninferiority or superiority studies. Avoiding systemic corticotherapy, especially in vulnerable populations, should be the rationale for future research in the field.

Laryngoscope, 2016

http://ift.tt/2eAq44U

Propionibacterium skull base osteomyelitis complicated by internal carotid artery pseudoaneurysm

The microbiology of skull base osteomyelitis (SBO) is evolving. We present here the first case of SBO caused by Propionibacterium acnes leading to the development of a pseudoaneurysm of the internal carotid artery. Otolaryngologists should recognize this pathogen as a potential cause of invasive temporal bone infection to optimize prompt diagnosis and treatment.

Laryngoscope, 2016

http://ift.tt/2fbCso4

Accuracy of endoscopic and videofluoroscopic evaluations of swallowing for oropharyngeal dysphagia

Objectives

A systematic review and meta-analysis of the literature was conducted to compare the accuracy with which flexible endoscopic evaluation of swallowing (FEES) and videofluoroscopic swallowing study (VFSS) assessed oropharyngeal dysphagia in adults.

Data Sources

PubMed, Embase, and the Latin American and Caribbean Health Sciences Literature (LILACS) database.

Methods

A review of published studies was conducted in parallel by two groups of researchers. We evaluated the methodological quality, homogeneity, threshold effect, and publication bias. The results are presented as originally published, then with each test compared against the other as a reference and both compared against a composite reference standard, and then pooled using a random effects model. Software use consisted of Meta-DiSc and SPSS.

Results

The search yielded 5,697 articles. Fifty-two articles were reviewed in full text, and six articles were included in the meta-analysis. FEES showed greater sensitivity than VFSS for aspiration (0.88 vs. 0.77; P = .03), penetration (0.97 vs. 0.83; P = .0002), and laryngopharyngeal residues (0.97 vs. 0.80; P < .0001). Sensitivity to detect pharyngeal premature spillage was similar for both tests (VFSS: 0.80; FEES: 0.69; P = .28). The specificities of both tests were similar (range, 0.93–0.98). In the sensitivity analysis there were statistically significant differences between the tests regarding residues but only marginally significant differences regarding aspiration and penetration.

Conclusions

FEES had a slight advantage over VFSS to detect aspiration, penetration, and residues. Prospective studies comparing both tests against an appropriate reference standard are needed to define which test has greater accuracy.

Level of Evidence

2aLaryngoscope, 2016

http://ift.tt/2fRG2ns

Hearing loss associated with enlarged vestibular aqueduct and zero or one mutant allele of SLC26A4

Objectives/Hypothesis

To characterize the severity and natural history of hearing loss, and the prevalence of having a cochlear implant in a maturing cohort of individuals with enlarged vestibular aqueduct (EVA) and zero or one mutant allele of SLC26A4.

Study Design

Prospective cohort study of subjects ascertained between 1998 and 2015 at the National Institutes of Health Clinical Center.

Methods

Study subjects were 127 individuals (median age, 8 years; range, 0–59 years) with EVA in at least one ear.

Results

Ears with EVA and zero or one mutant allele of SLC26A4 had mean 0.5/1/2/4-kHz pure-tone averages of 62.6 and 52.9 dB HL, respectively, in contrast to EVA ears with two mutant alleles of SLC26A4 (88.1 dB HL; P < .01). This association was independent of age, sex, or side of EVA (P < .001). Natural history of hearing loss was not associated with number of mutant alleles (P = .94). The prevalence of having a cochlear implant was nine (12%) of 76, two (13%) of 15, and 12 (38%) of 32 subjects with zero, one, and two mutant alleles, respectively (P = .00833). This association was not independent (P = .534) but reflected underlying correlations with age at time of first audiogram (P = .003) or severity of hearing loss (P = .000).

Conclusions

Ears with EVA and zero or one mutant allele of SLC26A4 have less severe hearing loss, no difference in prevalence of fluctuation, and a lower prevalence of cochlear implantation in comparison to ears with two mutant alleles of SLC26A4.

Level of Evidence

NA Laryngoscope, 2016

http://ift.tt/2eZHE12

Are neuromodulating medications effective for the treatment of chronic neurogenic cough?

http://ift.tt/2fREkT6

Long-Term Outcomes of Patients with Papillary Thyroid Cancer Undergoing Remnant Ablation with 30 Millicurie Radioiodine: Patient Cohort Definition Makes No Sense

Thyroid , Vol. 0, No. 0.


http://ift.tt/2fRvhlg

Significance of Size of Persistent/Recurrent Central Nodal Disease on Surgical Morbidity and Response to Therapy in Reoperative Neck Dissection for Papillary Thyroid Carcinoma

Thyroid , Vol. 0, No. 0.


http://ift.tt/2fAOok3

Accuracy of three-dimensional soft tissue prediction for Le Fort I osteotomy using Dolphin 3D software: a pilot study

Publication date: Available online 14 November 2016
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): C.M. Resnick, R.R. Dang, S.J. Glick, B.L. Padwa
Three-dimensional (3D) soft tissue prediction is replacing two-dimensional analysis in planning for orthognathic surgery. The accuracy of different computational models to predict soft tissue changes in 3D, however, is unclear. A retrospective pilot study was implemented to assess the accuracy of Dolphin 3D software in making these predictions. Seven patients who had a single-segment Le Fort I osteotomy and had preoperative (T0) and >6-month postoperative (T1) cone beam computed tomography (CBCT) scans and 3D photographs were included. The actual skeletal change was determined by subtracting the T0 from the T1 CBCT. 3D photographs were overlaid onto the T0 CBCT and virtual skeletal movements equivalent to the achieved repositioning were applied using Dolphin 3D planner. A 3D soft tissue prediction (TP) was generated and differences between the TP and T1 images (error) were measured at 14 points and at the nasolabial angle. A mean linear prediction error of 2.91±2.16mm was found. The mean error at the nasolabial angle was 8.1±5.6°. In conclusion, the ability to accurately predict 3D soft tissue changes after Le Fort I osteotomy using Dolphin 3D software is limited.



http://ift.tt/2gc1tE3

Evaluation of benign paroxysmal positional vertigo following Le Fort I osteotomy

Publication date: Available online 14 November 2016
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): K. Deniz, S.S. Akdeniz, A.Ö. Koç, S. Uçkan, L.N. Ozluoğlu
The Le Fort I osteotomy is widely used to correct dentofacial deformities. Benign paroxysmal positional vertigo (BPPV) is a common vestibular end organ disorder characterized by short, often recurrent episodes of vertigo. Head trauma is one of the known causes of BPPV. During pterygoid osteotomy, the surgical trauma induced by percussion with the surgical mallet and osteotomes can displace otoliths into the semicircular canal, resulting in BPPV. The aim of this study was to evaluate the potential risk of occurrence of BPPV in individuals undergoing Le Fort I osteotomy. Twenty-three patients were included in this study. The Dix–Hallpike manoeuvre, positional tests using electronystagmography, and vestibular evoked myogenic potential (VEMP) tests were performed 1 week before surgery (T0), 1 week after surgery (T1), and 1 month after surgery (T2). The results were compared statistically. BPPV was observed in three patients. Eleven patients had nystagmus at the T1 evaluation and seven at the T2 evaluation. The difference between the T0 and T1 time points was statistically significant (P=0.001). BPPV is a possible complication of Le Fort I osteotomy. Surgeons should be aware of this complication, and the diagnosis of BPPV should be considered in patients who have undergone Le Fort I osteotomy.



http://ift.tt/2eV0Auk

Survival of Brånemark System Mk III implants and analysis of risk factors associated with implant failure

Publication date: Available online 14 November 2016
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): T. Hasegawa, S. Kawabata, D. Takeda, E. Iwata, I. Saito, S. Arimoto, A. Kimoto, M. Akashi, H. Suzuki, T. Komori
The purpose of this study was to retrospectively investigate the outcomes of Brånemark System Mk III TiUnite/Groovy implants placed in patients at Kobe University Hospital. Various risk factors for implant failure, including mechanical coupling, were investigated by univariate and multivariate analysis. The predictive variables investigated included age, sex, smoking habit, general health, history of radiation therapy, application of a dentomaxillary prosthesis, type of prosthesis, use of alveolar bone augmentation, site of implant insertion, mechanical coupling between implants, and the length and diameter of the implants. Of the 907 implants investigated, only 23 were unsuccessful; the overall survival rate was 96.7%. Increased age, radiation therapy, application of a removable prosthesis or dentomaxillary prosthesis, lack of mechanical coupling between implants, and shorter implants (≤8.5mm) were significant risk factors for implant failure according to univariate analysis (P<0.05). Multivariate analysis identified a significant association (P<0.05) between dental implant failure and a lack of mechanical coupling between implants (odds ratio 6.88) and shorter implants (≤8.5mm) (odds ratio 3.43). The findings of this study demonstrated multivariate relationships between various risk factors and dental implant failure.



http://ift.tt/2gc4JiA

In vivo tissue engineered bone versus autologous bone: stability and structure

Publication date: Available online 14 November 2016
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): R.M. Zimmerer, P. Jehn, H. Kokemüller, R. Abedian, M. Lalk, F. Tavassol, N.-C. Gellrich, S. Spalthoff
This pilot study investigated the biomechanical properties of prefabricated, vascularized bioartificial bone grafts, which may provide an alternative bone source for the restoration of segmental osseous defects. Vascularized bioartificial bone grafts comprise an artificial customized scaffold made of beta-tricalcium phosphate. Bone formation along the prefabricated scaffold is induced by autogenous cancellous bone. Vascularization of the bone graft is provided by the host's vascular system. Within 6 months, a mammalian bioreactor (sheep were used in the present study) creates heterotopic vascularized bioartificial bone grafts of a predetermined anatomical shape, which can be harvested for reconstructing osseous defects. The bioartificial bone grafts in this study contained up to 25% bone tissue, as shown by histomorphometric analysis and computed tomography. Moreover, unconfined compression tests revealed that the constructs had mechanical characteristics similar to those of ovine cancellous bone. Therefore, this method could be applied to generate vascularized prefabricated bone substitutes for critical-size defects.



http://ift.tt/2eV34sJ

Comparison of auto-fluorescence and tetracycline fluorescence for guided bone surgery of medication-related osteonecrosis of the jaw: a randomized controlled feasibility study

Publication date: Available online 14 November 2016
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): O. Ristow, S. Otto, C. Geiß, V. Kehl, M. Berger, M. Troeltzsch, S. Koerdt, B. Hohlweg-Majert, C. Freudlsperger, C. Pautke
Recent studies have indicated that bone shows auto-fluorescence under an appropriate fluorescence lamp. The aim of this preliminary study was to compare the success rates of the established tetracycline fluorescence-guided bone surgery with auto-fluorescence-guided bone surgery in the treatment of medication-related osteonecrosis of the jaw (MRONJ). Forty patients suffering from MRONJ were referred for surgical treatment and were divided randomly into two groups: auto-fluorescence (n=20) or tetracycline fluorescence (n=20) guided bone surgery. The primary endpoint was treatment success, defined as the absence of exposed bone at 8 weeks after surgery. Secondary outcomes assessed were mucosal integrity, signs of infection, pain, and loss of sensitivity; these were evaluated descriptively at 10 days, 8 weeks, 6 months, and 1 year after surgery. At 8 weeks postoperative, 18/20 patients (90%) in the auto-fluorescence group and 17/20 patients (85%) in the tetracycline fluorescence group showed mucosal integrity (P>0.05). At the last follow-up, 94% in the auto-fluorescence group and 89% in the tetracycline fluorescence group presented complete mucosal coverage with no exposed bone, infection, or pain (P>0.05). There was no significant difference between the two techniques for any of the secondary outcomes (P>0.05). The results of this preliminary study show that auto-fluorescence-guided bone surgery has comparable success rates to the established tetracycline fluorescence-guided bone surgery.



http://ift.tt/2gc46G3

Tumor Multifocality Is a Candidate to Influence Management When Unsuspected Sporadic Medullary Thyroid Carcinoma Is Discovered after Unilateral Thyroidectomy

Clinical Thyroidology Nov 2016, Vol. 28, No. 11: 343-345.


http://ift.tt/2eZnFPV

Does Normal TSH Mean Euthyroidism in L-T4 Treatment?

Clinical Thyroidology Nov 2016, Vol. 28, No. 11: 325-328.


http://ift.tt/2fRqBvA

How Much Does Prolonged Incomplete Treatment of Hyperthyroidism Contribute to the Long-Term Risk of Cardiovascular Events?

Clinical Thyroidology Nov 2016, Vol. 28, No. 11: 329-331.


http://ift.tt/2eZp4G1

Estrogen Status Is Not Associated With Increased Thyroid Cancer Risk among Postmenopausal U.S. Women

Clinical Thyroidology Nov 2016, Vol. 28, No. 11: 349-351.


http://ift.tt/2fRvN2p

Higher Free T4 Levels Are Associated with an Increased Risk of Any Solid Cancer

Clinical Thyroidology Nov 2016, Vol. 28, No. 11: 332-333.


http://ift.tt/2eZnELR

Subclinical Hyperthyroidism, but not Subclinical Hypothyroidism, Is Associated with Increased Dementia Risk

Clinical Thyroidology Nov 2016, Vol. 28, No. 11: 340-342.


http://ift.tt/2fRsSqL

Combined Determination of Serum HCG and FT4 Can Predict Risk For Preeclampsia

Clinical Thyroidology Nov 2016, Vol. 28, No. 11: 334-336.


http://ift.tt/2eZrPaF

Delaying Radioactive Iodine Ablation for up to One Year Does Not Increase Recurrence for Patients with Differentiated Thyroid Cancer

Clinical Thyroidology Nov 2016, Vol. 28, No. 11: 346-348.


http://ift.tt/2fRpprR

Fine Particle Air Pollution May Alter Newborn Thyroid Function

Clinical Thyroidology Nov 2016, Vol. 28, No. 11: 337-339.


http://ift.tt/2eZt2yB

Preoperative FNA Cytology May Diagnose Noninvasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features

Clinical Thyroidology Nov 2016, Vol. 28, No. 11: 352-354.


http://ift.tt/2fRnkMC

Abréviations

Publication date: November 2016
Source:Annales de Dermatologie et de Vénéréologie, Volume 143, Issue 11





http://ift.tt/2eV6kEB

Editorial board

Publication date: November 2016
Source:Annales de Dermatologie et de Vénéréologie, Volume 143, Issue 11





http://ift.tt/2gc5S9O

Calendrier

Publication date: November 2016
Source:Annales de Dermatologie et de Vénéréologie, Volume 143, Issue 11





http://ift.tt/2eV6Gei

Author Guidelines

http://ift.tt/2eZo0lz

Acknowledgements to reviewers

http://ift.tt/2fRuAs1

Salvage Transoral Videolaryngoscopic Surgery for radiorecurrent hypopharyngeal and supraglottic cancer

To evaluate the feasibility of Transoral Videolaryngoscopic Surgery (TOVS) for radiorecurrent supraglottic and hypopharyngeal cancer, and to compare survival and complications between primary and radiorecurrent cases.

http://ift.tt/2fArGbN

IL-15 signaling in NK cell cancer immunotherapy

Jai Rautela | Nicholas D Huntington

http://ift.tt/2eZ3bHa

Alternative inflammasome activation enables IL-1ß release from living cells

Moritz M Gaidt | Veit Hornung

http://ift.tt/2fR8NRn

Early innate immune responses to bacterial LPS

Charles V Rosadini | Jonathan C Kagan

http://ift.tt/2fR7YIa

Severe Infliximab-Induced Alopecia and Scalp Psoriasis in a Woman with Crohn’s Disease: Dramatic Improvement after Drug Discontinuation and Treatment with Adjuvant Systemic and Topical Therapies

Abstract

Scalp psoriasis with alopecia is a rare cutaneous reaction to tumor necrosis factor alpha antagonists. This reaction often reverses with discontinuation of the offending drug and initiation of topical treatments; however, irreversible hair loss may occur if a scarring alopecia develops. We describe a woman with Crohn's disease who developed scalp psoriasis and alopecia secondary to infliximab. She had a remarkable recovery after discontinuation of infliximab and treatment with oral minocycline and topical therapy: mineral oil under occlusion, betamethasone lotion, and sequential coal tar, salicylic acid, and ketoconazole shampoos each day. The patient's alopecia completely resolved within 4 months of initiating this treatment regimen. In summary, early diagnosis of alopecia secondary to tumor necrosis factor alpha antagonist therapy is crucial in preventing diffuse alopecia and scalp psoriasis. In addition to discontinuing the offending agent, initiating aggressive adjuvant treatment with an oral antibiotic, topical therapies, or both, should be considered to reverse tumor necrosis factor alpha antagonist-induced alopecia and/or scalp psoriasis.

http://ift.tt/2gbIhpI

Association of eosinophilic esophagitis and food pollen allergy syndrome

Eosinophilic esophagitis (EoE), an inflammatory condition of the esophagus, is an important cause of dysphagia. The fibroinflammatory response, if not addressed, may result in advanced disease.1 Initially thought to be rare, the incidence of EoE is increasing, currently ranging from 1.3 to 9.5 per 100,000 in various series.1,2 Despite the increased incidence, the pathophysiology of this disease is not well understood.3 EoE is associated with a high sensitization rate to both foods and aeroallergens,4 although the role sensitization plays is not completely clear.

http://ift.tt/2fRbGS5

Improvement of psychiatric symptoms in youth following resolution of sinusitis

Publication date: January 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 92
Author(s): Talia Mahony, Douglas Sidell, Hayley Gans, Kayla Brown, Bahare Farhadian, Melissa Gustafson, Janell Sherr, Margo Thienemann, Jennifer Frankovich
IntroductionAccumulating evidence supports a role for inflammation in psychiatric illness, and the onset or exacerbation of psychiatric symptoms may follow non-CNS infections. Here, we provide the first detailed description of obsessive-compulsive and related psychiatric symptoms arising concurrently with sinusitis.MethodsWe reviewed the charts of 150 consecutive patients evaluated in our Pediatric Acute-onset Neuropsychiatric Syndromes clinic for documented sinusitis as defined by the American Academy of Pediatrics guidelines. Sinusitis treatments, sinonasal imaging, and neuropsychiatric symptoms before, during, and after sinusitis onset were noted. Patients were included in the final review if they had a clear diagnosis of isolated sinusitis (without concurrent illness and/or immunodeficiency), and were evaluated during an episode of sinusitis.Results10/150 (6.6%) patients had isolated sinusitis at the time of their neuropsychiatric deterioration. Eight patients received antibiotics to treat sinusitis, three of whom also received sinus surgery. Neuropsychiatric symptoms improved in all eight patients concurrent with resolution of sinusitis per parent report and clinician assessment. One patient did not follow through with recommended sinus surgery or antibiotics and her psychiatric symptoms persisted. One patient was lost to follow-up.ConclusionsImprovement of psychiatric symptoms correlated with resolution of sinus disease in this retrospective study. Identification, treatment, and resolution of underlying infections, including sinusitis, may have the potential to change the trajectory of some neuropsychiatric illnesses. Randomized clinical trials are needed.



http://ift.tt/2fTN4JR

Prescribing practices for systemic agents in the treatment of severe pediatric atopic dermatitis in the US and Canada: The PeDRA TREAT survey

There is a paucity of literature to direct physicians in the prescribing of immunomodulators for patients with severe atopic dermatitis (AD).

http://ift.tt/2eUwmaL

Zur Verabschiedung von Prof. Dr. Dr. H.-G. Bull

http://ift.tt/2gbj8vo

Ärztliche Werbung im Bereich der „Schönheitschirurgie“

Zusammenfassung

Das Recht gewährt Ärzten immer mehr Freiheit bei der Durchführung von Werbemaßnahmen. Trotzdem ist insbesondere auf dem Gebiet der sog. Schönheitschirurgie Vorsicht geboten. Der Werbebegriff ist weit gefasst. Praktisch ist jeder ärztliche Internetauftritt Werbung. Das Heilmittelwerbegesetz (HWG) soll die in der Regel medizinisch wenig fachkundigen Werbeadressaten vor Fehlentscheidungen durch unangemessene Beeinflussung schützen. Häufiger verletzt ärztliche Werbung Regelungen des Gesetzes gegen den unlauteren Wettbewerb (UWG), das Konkurrenten oder Wettbewerbsverbänden Abmahnungen, einstweilige Verfügungen oder Urteile zur Beseitigung und/oder künftigen Unterlassung unlauterer Handlungen ermöglicht. Schließlich ist Ärzten berufswidrige, also insbesondere anpreisende, irreführende oder vergleichende Werbung untersagt.

http://ift.tt/2gbn27O

The 300 most cited articles published in periodontology

Abstract

Objectives

It is important to evaluate the characteristics of the most cited articles in any specialty. The number of citations may be a proxy for clinical and research activity. The objectives of the present methodological study were (1) to report the characteristics of the 300 most cited articles in periodontology and (2) to explore the association of these characteristics with the number of citations.

Methods

We searched in the Web of Science database for the 300 most cited articles published in periodontology on June 15, 2015. We described characteristics of the articles such as type of study, type of scientific journal, topic reported, year of publication, affiliation of the first author of the article, and impact factor. Linear regression analysis was used to investigate associations of these variables with the number of citations.

Results

The search retrieved approximately 155,356 publications; out of the studies that met the eligibility criteria, the 300 most cited were included for analysis. Comprising more than 50 % of the included articles, basic biology and the detection of bacteria were the most prevalent topics. Narrative reviews were the most frequent type of article (27 % of the sample). Regression analysis demonstrated that some characteristics, for example "narrative reviews," are more prone to be cited than others.

Conclusion

We conclude that scientific evolution in periodontology has been based more on narrative reviews than on reproducible systematic reviews.

Clinical relevance

Future research is encouraged to elucidate the extent to which scientific progress is improved through systematic compared with narrative reviews.

http://ift.tt/2fSly1p

C-shaped canals—prevalence and root canal configuration by cone beam computed tomography evaluation in first and second mandibular molars—a cross-sectional study

Abstract

Objectives

C-shaped root canal configuration is an unusual root canal morphology and one of the most often anatomical variations in root canal systems of second mandibular molars. The purpose of this study was to assess the prevalence, symmetry and configuration of C-shaped canals in first and second mandibular molars in an Israeli population using cone beam computed tomography (CBCT).

Materials and methods

One thousand twenty Israel patients' CBCT scans were screened and evaluated. First and second mandibular molars with C-shaped canals were identified. Prevalence configuration along the root and symmetry were analyzed, and new radicular groove classification was proposed.

Results

Total of 1465 mandibular second molars and 1229 mandibular first molars were evaluated. The overall prevalence of C-shaped canals in first and second mandibular molars was 0.16 and 4.6%, respectively. No significant difference was found by gender or side of occurrence. The unilateral prevalence of C-shaped canals in mandibular second molars was 55%. C-shaped canal configuration changed along the root in 63% of the cases.

Conclusions

The prevalence of C-shaped canals in first and second mandibular molars in the Israeli population is low in comparison to other subpopulations. Clinicians should be aware of the possible asymmetry, different configuration along the root, and the location of danger zone of this anatomic variation during clinical work.

Clinical relevance

CBCT is an efficient three dimensional radiographic examination for evaluation of C-shape root canal configuration. CBCT may help the clinicians during clinical work for considering appropriate cleaning, shaping, and obturation technique according to the characteristic of C-shape root canal configuration.

http://ift.tt/2fzPoot

Th9 cells in the pathogenesis of EAE and multiple sclerosis

Abstract

Interleukin (IL)-9 producing CD4⁺ T helper cells (Th9) are the newest addition to the T helper cell subsets. IL-9 binds to a heterodimeric receptor consisting of the IL-9 receptor (IL-9R) and a common γ chain also presents in IL-2, IL-4, IL-7, and IL-15 receptor complexes. In addition to Th9 cells, Th17 cells secrete smaller amounts of IL-9. Many functional and regulatory roles associated with Th9 cells are currently not fully understood. IL-9 is a pleiotropic cytokine that affects the activity of multiple cell types in the immune compartment as well as in the central nervous system (CNS). Initially implicated in type 2 inflammation, IL-9 has been recently shown to be a key player in regulating autoimmune responses in experimental autoimmune encephalomyelitis (EAE), an animal model of multiple sclerosis (MS). Here, we review the current understanding of the role of Th9/IL-9 signaling in EAE and MS. We summarize the source and regulation of Th9 cells in vivo, the influence of IL-9 signaling on peripheral and CNS-resident cells in EAE, and the association between IL-9 and MS disease activity.

http://ift.tt/2frSPjo

Salvage Transoral Videolaryngoscopic Surgery for radiorecurrent hypopharyngeal and supraglottic cancer

Publication date: Available online 14 November 2016
Source:Auris Nasus Larynx
Author(s): Masayuki Tomifuji, Koji Araki, Taku Yamashita, Akihiro Shiotani
ObjectiveTo evaluate the feasibility of Transoral Videolaryngoscopic Surgery (TOVS) for radiorecurrent supraglottic and hypopharyngeal cancer, and to compare survival and complications between primary and radiorecurrent cases.MethodsTwelve cases of salvage TOVS for radiorecurrent cancer and 53 cases of TOVS as an initial treatment (primary cases) were evaluated. Days to resume soft diet, Functional Outcomes of Swallowing Scale (FOSS), postoperative complications, epithelization days and survival outcomes were assessed by retrospective chart review.ResultsFOSS score was significantly worse in salvage cases compared with primary cases. Bleeding and airway compromise was slightly greater in salvage cases than in primary cases; however, this was not statistically significant. Wound healing was significantly delayed in salvage cases compared with primary cases (P<0.001). In primary cases, wounds were re-epithelized within 60 days in 83% of patients and within 90 days in almost all patients, while in salvage cases 42% of patients required more than 90 days for wound healing. In salvage cases, the 5-year overall survival, disease specific survival rate, local control rate, and laryngeal preservation rate was 85.7%, 85.7%, 62.5%, and 78.0%, respectively, and 85.7%, 98.0%, 91.3%, and 97.8%, respectively, for primary cases. Local control rate was significantly better in primary cases than in salvage cases.ConclusionSalvage TOVS was feasible in highly selected cases. After serial transoral surgery, the final laryngeal preservation rate was satisfactory. Swallowing function in salvage cases tended to be worse than in primary cases, and a significantly longer time was required for wound healing.



http://ift.tt/2eYeGhL

Ganglioneuroma of the pancreas in a 4-year-old girl

Ganglioneuroma (GN) is the uncommon, benign representative of the peripheral neuroblastic tumours (PNTs), which arise from primitive sympathetic ganglion cells. PNTs comprise one of the most common groups of neoplastic diseases in infants and children, but its occurrence in the pancreas is rare. We report a 4-year-old girl with GN of the pancreas requiring pancreaticoduodenectomy as a definitive therapy and with a great outcome, and we review the published literature.

http://ift.tt/2fQ97jj

Hereditary angioedema (HAE): a cause for recurrent abdominal pain

A 44-year-old Hispanic woman presented to the emergency room with a 2-day history of sudden onset of severe cramping left lower quadrant abdominal pain associated with ~20 episodes diarrhoea. Abdominal CT scan exhibited bowel wall oedema and acute extensive colitis. On the basis of the preliminary diagnosis of acute abdomen, the patient was admitted under the surgical team and treated for acute colitis. Since her family history was significant for hereditary angioedema (HAE), complement studies were performed which revealed low complement C4 levels and abnormally low values of C1q esterase inhibitor. Thus, the diagnosis of HAE type I was established. This case report summarises that the symptoms of HAE are often non-specific, hence making the underlying cause difficult to diagnose.

http://ift.tt/2eXVFfv

Pericardiectomy as a diagnostic and therapeutic procedure

A 70-year-old man presented with recent onset, predominantly right-sided heart failure. Echocardiogram demonstrated features of hypertensive heart disease and was suggestive of, but non-diagnostic for, constrictive pericarditis (CP). CT demonstrated mild pericardial thickening. Right heart catheterisation showed elevation and equalisation of diastolic pressures in all cardiac chambers with early rapid filling, minimal ventricular interdependence, and no dissociation of intrathoracic and intracardiac pressures. While several features pointed towards CP, the minimal ventricular interdependence and no dissociation of intrathoracic and intracardiac pressures suggested other pathology. Diagnostic pericardiectomy was performed, after which the central venous pressure decreased from 22 to 12 mm Hg. Pathology revealed pericardial fibrosis. The patient experienced sustained resolution of his heart failure. A potential explanation for lack of CP criteria was the presence of hypertensive heart disease. CP needs to be considered when approaching patients with heart failure as diagnostic evaluation can be multifaceted and treatment curative.

http://ift.tt/2fQ8HZX

Medial rectus muscle cysticercosis: an assessment using ultrasonography and CT

Description

A 9-year-old boy presented with the history of progressive pain, watering and abduction limitation for 1-week duration. Medical history revealed two episodes of recurrent congestion on the nasal side and watering 2 and 4 week's prior. On examination visual acuity was 20/200 improving to 20/40 with refraction and 20/20 in right and left eye, respectively; extraocular motility was severely restricted in abduction and elevation with minimal restriction in depression and adduction (figure 1). Fundus examination showed localised choroidal mount on the nasal retina without any intraocular cyst. Ultrasonography of the orbit revealed a large cyst in the medial rectus muscle with peripheral high amplitude spike echo (figure 2A). Subsequent CT imaging of the head and neck showed a well-defined large cyst in medial rectus indenting the globe with a peripheral high amplitude dot, without any intracranial foci (figure 2B). Both the ultrasonography...

http://ift.tt/2eXXMQF

Multimodality imaging in Bertolottis syndrome: an important cause of low back pain in young adults

Description

A 30-year-old woman presented to the orthopaedics outpatient department with low back pain (LBP) for 4 weeks, not relieved on medications. She had no known comorbidities. On examination, there was movement restriction of the lower spine and focal right posterior lumbar tenderness. Blood routines showed raised acute inflammatory markers. Imaging work-up included a routine frontal radiograph of the lumbar spine which showed a lumbosacral transition vertebra with enlarged right transverse process (figure 1). Sacroilliac joints appeared normal. Plain MRI of the lumbar spine was performed which revealed lumbosacral transitional vertebra (LSTV) with enlarged transverse process articulating with the sacral ala bilaterally forming diarthroidal joint (Castellvi type IIb) and the subchondral bone of this joint showed T2 short inversion recovery hyperintense signals and hypointense signals on T1-weighted images, which was suggestive of marrow oedema. The intervening cartilage was also hyperintense. There were no signal abnormalities on...

http://ift.tt/2fQ7fXE

Cyr61/CCN1 is involved in the pathogenesis of psoriasis vulgaris via promoting IL-8 production by keratinocytes in a JNK/NF-κB pathway

Publication date: Available online 14 November 2016
Source:Clinical Immunology
Author(s): Pinru Wu, Gang Ma, Xianjin Zhu, Ting Gu, Jie Zhang, Yue Sun, Hui Xu, Rongfen Huo, Beiqing Wang, Baihua Shen, Xiangdong Chen, Ningli Li
PurposeInterleukin-8 (IL-8) is an important factor in the pathogenesis of psoriasis vulgaris, which is characterized by proliferation of keratinocytes, neutrophil infiltration and angiogenesis. Cysteine-rich 61 (Cyr61/CCN1), a secreted extracellular matrix protein, is a novel proinflammatory factor. Whether Cyr61 is involved in the development of psoriasis vulgaris via IL-8 production remains unknown. In this study we explore the role of Cyr61 in IL-8 expression regulation in vivo and in vitro.MethodsSkin samples from normal donors and psoriasis vulgaris patients were examined the profile of Cyr61 and IL-8 using immunohistochemistry, real-time PCR and Western blotting. HaCaT cells were treated with Cyr61 and IL-8 expression was analyzed by real-time PCR and ELISA. Signal transduction pathways in Cyr61-induced IL-8 production were investigated by real-time PCR, western blotting, luciferase reporter assay or chromatin immunoprecipitation (ChIP) assay. IMQ-induced psoriasis-like mice were treated with anti-Cyr61monoclonal antibodies (mAb), or IgG1 as a control.ResultsWe found that Cyr61 was abundant in the epidermis of patients with psoriasis vulgaris and positively correlated with the pathogenesis of skin lesions. Cyr61 induced IL-8 production by keratinocytes in a dose dependent manner. This IL-8 synthesis occurred in an IL-1β- and TNF-α- independent mode via PI3K, AKT and JNK activation, with binding of enhanced AP-1, C/EBPβ and NF-κB to sites located in the IL-8 promoter region. Treatment with anti-Cyr61 mAb led to reduction of MIP-2 level, decreased neutrophil infiltration, and attenuated inflammation in vivo.ConclusionsOur results not only reveal a novel mechanism illustrating the role of Cyr61 in epidermis pathogenesis but also suggest that therapies targeting Cyr61 may represent a novel strategy in the treatment of psoriasis vulgaris.



http://ift.tt/2f9bYUg

Congenital anosmia: Our experience of eleven patients with aplasia or hypoplasia of the olfactory tract

Abstract

Anosmia is present in approximately 1% of the population and can have a significant impact on quality of life ¹. In contrast to acquired anosmia, congenital anosmia is a relatively rare condition characterized by a complete lack of olfactory perception and the aplasia or hypoplasia of the olfactory bulb. Kallmann syndrome (congenital hypogonadotropic hypogonadism and anosmia) is the best known condition assoicated with congenital anosmia ^2,3. Kallmann Syndrome has a prevalence of around 1 in 8000, and is five times more common in men than women ^2,3.

This article is protected by copyright. All rights reserved.

http://ift.tt/2f90X5o

CME examination

http://ift.tt/2eXss4b

Answers to CME examination

http://ift.tt/2fPCLVI

Answers to CME examination

http://ift.tt/2eXmujS

Intraoperative retention sutures to facilitate closure

Large defects with limited adjacent tissue laxity and defects in high-tension areas, such as the back and scalp, can be challenging to repair.

http://ift.tt/2fPCe66

Multiple plaques, slack skin, and ulcers

A 37-year-old man presented with a 12-year history of infiltrative plaques, skin laxity, and ulcers on his body. The physical examination revealed multiple infiltrative plaques, circumscribed red patches on his trunk and extremities, and several ulcers on his arms and lower back. There was a painful 20 cm × 25 cm ulcer on his left popliteal fossa with a necrotic base and a violaceous border. Loose skin masses involved his axillae and buttocks (Fig 1). Histopathology of the abdomen revealed a deep dermal infiltrate of atypical lymphocytes, scattered multinucleated giant cells, and a loss of elastic fibers.

http://ift.tt/2eXo5GE

Whose practice is this anyway? To conform or not to conform

This case raises two separate but related dilemmas: the ethical dilemma of a physician prioritizing profit over beneficence, and the issue of a physician having a fundamental disagreement with his employer over patient care. The latter is increasingly common and relevant in a health care system trending toward larger organizations in which hospitals and multispecialty groups pressure physicians to increase volume and revenue. In an ideal situation, a physician and employer enjoy a symbiotic and harmonious relationship with only minor disagreements that are easily resolved.

http://ift.tt/2fPHt5W

Dermoscopic findings in hyperkeratosis lenticularis perstans

A 46-year-old man presented with asymptomatic lesions on the back of his hands and feet of 20 years' duration. Family history revealed that his father presented long-standing similar lesions. On physical examination, brown, rounded hyperkeratotic plaques were noted (Fig 1).

http://ift.tt/2eXq2Tg

Reply to: “The relationship between lymphocytic thrombophilic arteritis and cutaneous polyarteritis nodosa”

To the Editor: We read with interest the comments by Kelly and Tancharoen1 regarding our article published in the December 2015 issue of the Journal of the American Academy of Dermatology.2 They were concerned about the methodology of the study and the conclusions made regarding the relationship between macular lymphocytic arteritis/lymphocytic thrombophilic arteritis (MLA/LTA) and cutaneous polyarteritis nodosa (cPAN).

http://ift.tt/2fPEudP

Asymptomatic solitary nodule of the forehead

A 46-year-old white woman presented with a 6-month history of an asymptomatic 12 mm × 5 mm pinkish-red solitary nodule on her forehead (Fig 1, A). Dermoscopically, the lesion showed a background variable from orange to pinkish-red, with telangiectasia with a crown arrangement characterized by in-focus arborizing vessels that did not cross the center of the lesion (Fig 1, B). The general clinical examination was negative. Excision of the lesion was performed, and the cell population was S-100+ and CD1a– (Fig 1, C and D).

http://ift.tt/2eXq25I

Segmental stiff skin syndrome (SSS): Two additional cases with a positive response to mycophenolate mofetil and physical therapy

To the Editor: Recently, Myers et al1 described a distinct subtype of the stiff skin syndrome (SSS) characterized by a segmental distribution, delayed onset, and reduced morbidity. Reviewing their cohort of 4 patients and an additional 48 cases from the literature, the authors reported that segmental SSS comprises up to one third of all SSS cases. Histopathologic assessments from their patients revealed thickened and horizontally oriented collagen and adipocyte entrapment without inflammation, features that typify the widespread form and are useful to differentiate the disorder from diagnostic mimickers with linear and segmental patterns, such as morphea and connective tissue nevi.

http://ift.tt/2fPE1rL

Sudden edematous exudative erythema in a waterfall pattern

A 48-year-old man presented to the emergency department because of a sudden, widespread, painful skin rash that started 18 hours after a bath. With no remarkable personal medical history, he was referred to the Department of Dermatology for a suspected thermal burn. The patient stated that he had taken a shower with an infusion of fig leaves followed by sun exposure, which was intended to be a purifying treatment. The physical examination revealed erythematous and edematous lesions with some areas of blistering and exudation located exclusively in sun-exposed areas.

http://ift.tt/2eXmvV6

Changes in sex and racial diversity in academic dermatology faculty over 20 years

In the field of medicine, increased sex and racial diversity leads to improved health care access for the underserved, and better patient outcomes in this subset of patients.1 We previously showed that while sex diversity in dermatology residents has increased significantly over the past 2 decades, racial diversity has not changed significantly.2 Here, we present a 20-year analysis of changes in sex and race diversity among academic dermatology faculty.

http://ift.tt/2fPHpmA

Collision tumors: A diagnostic challenge

A pigmented lesion was located on the back of a 40-year-old woman with family history of melanoma and multiple nevi. The lesion was small in size, and clinically symmetric (Fig 1).

http://ift.tt/2gaa0Y7

Clinical simulators of cysts

To the Editor: Cutaneous cysts are commonly encountered in clinical practice, yet dermatologists' ability to successfully identify these cysts is largely unknown due to paucity of studies on the subject. Reports of malignancies misdiagnosed as cysts highlight the importance of correct recognition of cysts by clinicians.1-3

http://ift.tt/2eXoitb

Tinea nigra: A diagnostic pitfall

A 13-year-old girl presented with a pigmented lesion on her left palm with a quadrangular shape measuring 2 × 2 cm (Fig 1). The lesion, which appeared 2 years before, after a trip to a Greek island, was interpreted as melanocytic by other dermatologists.

http://ift.tt/2fN9DQ6

Teledermatology as a tool to improve access to care for medically underserved populations: A retrospective descriptive study

To the Editor: With more than 16 million newly insured individuals since the implementation of the Affordable Care Act, dermatologists are challenged to improve access to care. Teledermatology is rapidly emerging as one solution and has been shown to provide high diagnostic accuracy and reproducibility.1-3 Although traditionally there has been limited literature on teledermatology in safety-net health systems, a recent prospective study of 196 teleconsults4 in an underserved outpatient setting found that the system improved care through dermatologist-recommended management modifications.

http://ift.tt/2g7pAo0

Rethinking screening for thyroid autoimmunity in vitiligo

See related letters on pages e231 and e233

http://ift.tt/2eSY3kk

Reply to: “Comment on ‘Review of patient registries in dermatology’”

To the Editor: We thank Zweegers et al for suggesting additional helpful, important registries. The psoriasis registries they described provide important complements to randomized control trial (RCT) data. Registries provide information about real-world effectiveness, about how well drugs work over the course of long-term, chronic diseases, and perhaps most importantly, about drug safety, as clinical trials tend not to be large enough or long enough to fully elucidate rare risks. A limitation of patient registries is that patients are generally not randomized to different treatment groups, making it essential to address potential biases in treatment assignment when making comparisons between different treatment groups.

http://ift.tt/2fN8yYt

A chronic poorly healing wound on the right lateral trunk

An 82-year-old man with a history of hypertension and coronary artery disease presented with a 6-month history of a chronic poor healing wound. He had undergone coronary artery intervention three times within the past 2 years, with development of painful erythema on the right lateral trunk immediately after the third procedure. In the following months, ulcers developed within and showed no tendency to heal. The physical examination revealed a 7 cm × 8 cm hyperpigmented indurated patch with overlying ulcers and telangiectasia on the right lateral trunk (Fig 1).

http://ift.tt/2g7u3XN

Appearance of lentigines in psoriasis patients treated with apremilast

To the Editor: The development of lentigines in areas previously affected by psoriasis plaques is a rare event mainly reported after phototherapy. Several cases of lentigines appearing in resolving psoriatic plaques during or after treatment with anti-tumor necrosis factor (TNF) or anti-interleukin (IL)-12/IL-23 drugs have been reported but they remain anecdotal.1-3 Apremilast is a phosphodiesterase 4 (PDE4) inhibitor that was approved by the US Food and Drug Administration (FDA) in 2014 and by the European Medical Agency in 2015 for the treatment of psoriasis and psoriatic arthritis.

http://ift.tt/2fN8uId

Erlotinib Hydrochloride in Reducing Duodenal Polyp Burden in Patients With Familial Adenomatous Polyposis at Risk of Developing Colon Cancer

Conditions:   Attenuated Familial Adenomatous Polyposis;   Familial Adenomatous Polyposis
Interventions:   Drug: Erlotinib Hydrochloride;   Other: Laboratory Biomarker Analysis
Sponsor:   National Cancer Institute (NCI)
Not yet recruiting - verified November 2016

http://ift.tt/2f8LOkB

Durvalumab, an Anti-PD-L1 Antibody, and Chemoradiation Before Surgery for Esophageal Cancer

Conditions:   Esophageal Adenocarcinoma;   Gastroesophageal Junction Adenocarcinoma
Interventions:   Biological: durvalumab;   Drug: carboplatin AUC 2/paclitaxel;   Radiation: External beam radiation;   Procedure: esophagogastrectomy
Sponsors:   Memorial Sloan Kettering Cancer Center;   AstraZeneca
Recruiting - verified November 2016

http://ift.tt/2extqWn

Exercise Prior to Oesophagectomy

Conditions:   Postoperative Complications (Cardiopulmonary);   Oesophageal Adenocarcinoma
Interventions:   Behavioral: Pre-operative Exercise Programme (my-PEP);   Behavioral: Home Exercise Programme (HEP)
Sponsor:   University of East Anglia
Recruiting - verified November 2016

http://ift.tt/2f8KbDB

Phase III Study of Vinflunine Plus Methotrexate Versus Methotrexate Alone in Patients With Head and Neck Cancer

Condition:   Recurrent or Metastatic Head and Neck Carcinoma
Interventions:   Drug: vinflunine;   Drug: Methotrexate
Sponsor:   Pierre Fabre Medicament
Recruiting - verified November 2016

http://ift.tt/2exrc9m

Phase II Study of Radiation Therapy and Vismodegib for Advanced Head/Neck Basal Cell Carcinoma

Conditions:   Locally Advanced Basal Cell Carcinoma;   Skin Cancer;   Cutaneous Malignancy
Interventions:   Drug: Vismodegib;   Radiation: Radiation therapy
Sponsors:   Sue Yom;   Genentech, Inc.
Recruiting - verified November 2016

http://ift.tt/2f8KTRm

The Buried Bumper Syndrome: External Bumper Extraction after Radial Mini Incisions and Replacement through an Adjacent Tract

Although considered as a safe method to provide long-term nutritional support, percutaneous endoscopic gastrostomy (PEG) may be complicated by a buried bumper syndrome (BBS), a life-threatening condition. Removal of the PEG tube with its buried bumper and reinsertion of a new PEG tube is often necessary. Since its description in 1988, less than 50 cases of BBS managed by external extraction of the buried bumper have been reported. We report a case of buried bumper that was removed by external traction without the need for endoscopic or laparoscopic treatment but with the need of two radial millimeter skin incisions after abdominal CT study and finally immediate PEG replacement but through an adjacent site.

http://ift.tt/2fRCUJZ

Three cases of herpetic folliculitis causes by varicella-zoster virus: Immunohistochemical analysis

http://ift.tt/2fyhHnq

Bromoderma in a pituitary adenoma patient treated with bromocriptine

http://ift.tt/2fQSzv3

Case of sarcoidosis with seasonal cutaneous ulceration

http://ift.tt/2fymwwW

Pigmented extramammary Paget's disease: Pitfalls of diagnosis

http://ift.tt/2fQVtQD

Septic arthritis caused by Mycobacterium marinum infection

http://ift.tt/2fylOzT

One-year safety and efficacy study of bilastine treatment in Japanese patients with chronic spontaneous urticaria or pruritus associated with skin diseases

Abstract

A number of second-generation non-sedating antihistamines are used in clinical practices over the world. However, long-term safety and efficacy have not been proved high level evidence based medicine. We have performed an open-label, multicenter, phase III study to evaluate the long-term safety and efficacy of bilastine, a novel non-sedating H₁-antihistamine for patients with chronic spontaneous urticaria (CSU) or pruritus associated with skin diseases (trial registration no. JapicCTI-142528). Patients aged 18–74 years were treated with bilastine 20 mg once daily for up to 52 weeks. Safety and tolerability were assessed on the basis of adverse events (AE), bilastine-related AE, laboratory tests and vital signs. Efficacy was assessed based on rash score, itch score, overall improvement and quality of life. One hundred and ninety-eight patients enrolled, 122 of whom (61.6%) completed the 52-week treatment period. AE were reported in 64.5% and bilastine-related AE in 2.5% of patients throughout the 52-week treatment period. All AE were mild to moderate in severity. AE associated with the nervous system occurred in 10 patients (5.1%) including seven patients (3.6%) with headache. Somnolence reported in two of these patients (1.0%) was related to bilastine. All efficacy variables improved during treatment with bilastine. In conclusion, long-term treatment with bilastine 20 mg once daily for 52 weeks is safe and well tolerated in Japanese patients with CSU or pruritus associated with skin diseases. Bilastine improved disease symptoms of both conditions early in treatment, and the efficacy was maintained throughout the treatment.

http://ift.tt/2fQSk3e

Case of infantile digital fibromatosis: Observation of its dermoscopic features

http://ift.tt/2fyleSu

Hemorrhagic Lacrimation and Epistaxis in Acute Hemorrhagic Edema of Infancy

Acute hemorrhagic edema of infancy is an uncommon benign cutaneous vasculitis. Despite its worrisome presentation, it carries good prognosis with rarely reported systemic involvement. Management of these cases has been an area of debate with majority of physicians adopting conservative modalities. We report a case that presented with classic triad of rash, low grade fever, and peripheral edema along with two rarely reported manifestations in literature: hemorrhagic lacrimation and epistaxis.

http://ift.tt/2fP8sOQ

A Rare Tumor in the Cervical Sympathetic Trunk: Ganglioneuroblastoma

Ganglioneuroblastoma is a rare tumor with moderate malignancy, which is composed of mature ganglion cells and seen in sympathetic ganglia and adrenal medulla. The diagnosis is possible after cytological and immunohistochemical studies following a needle biopsy or surgical excision. There is no consensus regarding the need for chemo- or radiotherapy after surgery. In this case report, clinical behavior and diagnosis and treatment of the rare tumor cervical ganglioneuroblastoma were discussed.

http://ift.tt/2fR9StI

Combined Acute Haemolytic and Secondary Angle Closure Glaucoma following Spontaneous Intraocular Haemorrhages in a Patient on Warfarin

Background: To report the first described case of combined haemolytic and acute angle closure glaucoma secondary to spontaneous intraocular haemorrhages in a patient on excessive anticoagulation. To the best of our knowledge, this is the first case reported in the literature presenting with raised intraocular pressure due to both mechanisms. Case Description: A 90-year-old woman presented with acute pain and reduction in vision in the left eye. Her intraocular pressure (IOP) was 55 mm Hg. There were red tinted blood cells in the anterior chamber giving it a reddish hue. The patient was known to have advanced wet macular degeneration. She was taking oral warfarin for atrial fibrillation. Her international normalised ratio (INR) was 7.7. B-scan ultrasound of posterior segment showed vitreous and suprachoroidal haemorrhages. An ultrabiomicroscopic examination confirmed open angles. A diagnosis of haemolytic glaucoma secondary to intraocular haemorrhages was made. The IOP was controlled medically. Warfarin was withdrawn and oral vitamin K therapy was initiated leading to a rapid INR reduction. Three days later, her anterior chamber became progressively shallower causing a secondary acute angle closure which was managed medically. After 2 months, the left IOP was well-controlled without any medications and the eye was not inflamed. Her vision in that eye remained perception of light. Conclusion: Patients with suprachoroidal haemorrhages should be closely monitored as they might subsequently develop acute angle closure despite an initially open angle and well-controlled INR and IOP. Excessive anticoagulation needs to be prevented to minimise the risk of sight-threatening complications.
Case Rep Ophthalmol 2016;7:233–238

http://ift.tt/2fQAkWA