Publication date: Available online 23 December 2016
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Jennifer F. Ha, Ayesha Ahmad, Marci M. Lesperance
IntroductionThe advent of chromosome microarray analysis (CMA) for evaluation of patients with multiple congenital anomalies has made it possible to define chromosomal imbalances with greater precision and resolutions significantly smaller than possible by standard G-banded chromosome analysis. We describe two patients with novel chromosomal anomalies involving chromosome 22q13, a locus also associated with Phelan-McDermid syndrome (PMS).ObjectiveWe aim to characterize the novel phenotypic and genotypic findings of two patients with 22q13 microdeletions, distinct from PMS, comparing and contrasting with features of PMS.ResultsCase 1 is a 4-year-old boy with global developmental delay, esotropia, moderate aortic root dilation, genu valgum, and in-toeing gait. MRI brain for evaluation of neonatal hypotonia revealed a left cerebellopontine angle arachnoid cyst. He referred on newborn hearing screening, and diagnostic auditory brainstem response (ABR) showed left profound retrocochlear hearing loss. Surgical intervention for the arachnoid cyst was deferred, with spontaneous resolution at age two years without hearing recovery. CMA revealed a novel, de novo 5.1 Mb microdeletion of 22q13.31q13.33 not involving SHANK3, a gene typically deleted in PMS. Case 2 is a 6-year-old girl with some features also seen in patients with PMS but also several atypical features. She has a complex chromosomal rearrangement including a 5.3 Mb 22q13 microdeletion (not including SHANK3) and de novo 2.1 Mb gain of 22q11.ConclusionAs diagnostic sensitivity improves, smaller chromosomal imbalances will be detectable related to milder or different phenotypes. We present two patients with novel deletions of chromosome 22q13 associated with multiple congenital anomalies and features distinct from PMS.
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Παρασκευή 23 Δεκεμβρίου 2016
Clinical characterization of novel chromosome 22q13 microdeletions
Vitamin D3 derivatives, alone or in combination with glucocorticoids, suppress streptococcal pyrogenic enterotoxin A-stimulated proliferation of peripheral blood mononuclear cells in patients with psoriasis
Abstract
Bacterial colonization on skin or tonsil may influence the clinical response of patients with psoriasis to immunosuppressive drugs. However, few studies have investigated the effects of bacterial superantigens on therapy in these patients. Recently, combination therapy with topical glucocorticoids (GC) and vitamin D3 (VD3) appears to be more effective than GC or VD3 monotherapy for psoriasis. We evaluated the suppressive effects of betamethasone butyrate propionate (BBP), three VD3 derivatives (calcipotriol, maxacalcitol and tacalcitol), cyclosporin and BBP plus VD3, on concanavalin A (ConA)- or streptococcal pyrogenic enterotoxin A (SPEA)-stimulated proliferation of peripheral blood mononuclear cells (PBMC) obtained from 35 psoriasis patients. Drug concentrations effecting 50% inhibition concentration of ConA- or SPEA-stimulated PBMC proliferation were estimated. Cytokine levels of tumor necrosis factor-α, γ-interferon, interleukin-1b, -2, -4, -5, -6, -8 -10 and -12p70 in PBMC culture supernatants were measured with bead-array procedures. Suppression of PBMC proliferation by BBP was significantly lower when PBMC were stimulated by SPEA than when stimulated by ConA. In contrast, the suppressive effects of calcipotriol and tacalcitol increased significantly when PBMC were stimulated by SPEA than when stimulated by ConA. The suppressive effect of BBP on SPEA-stimulated PBMC proliferation was improved significantly by adding 1–1000 ng/mL calcipotriol, compared with BBP alone. Cytokine levels in PBMC culture supernatants were not significantly different between ConA- and SPEA-stimulated PBMC. Calcipotriol and BBP in combination markedly suppressed SPEA-stimulated PBMC proliferation. SPEA produced by colonization of hemolytic streptococci may reduce the efficacy of BBP but not VD3 derivatives in the treatment of psoriasis.
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Incidence of serum antibody titers against varicella zoster virus in Japanese patients with herpes zoster
Abstract
Herpes zoster is an internal reactivation of varicella zoster virus following establishment of latent infection in the dorsal root ganglia during primary infection, which presents as chickenpox. Therefore, serologically, herpes zoster patients already have anti-varicella zoster virus immunoglobulin G at the onset of disease. Hence, positive serum antibody does not confirm the diagnosis of herpes zoster. We retrospectively investigated the incidence of varicella zoster virus-specific complement fixation in 865 zoster patients at initial presentation to a dermatology clinic. As a result, 66% of patients showed negative complement fixation, with patient numbers decreasing as titer increased. Paired complement fixation tests conducted within a short period showed a marked elevation in titer, and complement fixation titer gradually decreased after a year. Furthermore, incidence showed no correlation with patient age. These observations indicate that the complement fixation titer at first visit is mainly influenced by the duration from onset to presentation at clinic. Our findings indicate that a positive complement fixation result by single-point testing confirms at least recent onset of herpes zoster, while paired tests can confirm disease when primary tests are negative.
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Short-term effect of scalpel debridement of plantar callosities versus treatment with salicylic acid patches: The EMEDESCA randomized controlled trial
Abstract
This study compares scalpel debridement versus salicylic acid patches in the treatment of plantar callosities. A randomized clinical trial (ACTRN12614000591651) was performed with 62 patients, divided into two intervention groups. Group A received treatment with salicylic acid patches (Callívoro Marthand®) and group B underwent scalpel debridement of plantar callosities. Pain was measured on a visual analog scale, and foot pain and disability were evaluated using the Manchester Foot Pain Disability Index (MFPDI) questionnaire (Spanish version). Significant differences were observed in pain measured immediately after treatment (P < 0.001) and at 15 days and 6 weeks after treatment. For some components, the MFPDI questionnaire revealed significantly better outcomes by scalpel debridement at 15 days after treatment. The scalpel debridement of plantar callosities relieves pain more effectively than salicylic acid patches, and patients achieve greater functionality in the initial weeks after debridement.
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Dynamic Risk Stratification for Predicting Recurrence in Patients with Differentiated Thyroid Cancer Treated Without Radioactive Iodine Remnant Ablation Therapy
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Superior canal dehiscence with tegmen defect revealed by otoscopy: Video clip demonstration of pulsatile tympanic membrane
Publication date: Available online 23 December 2016
Source:Auris Nasus Larynx
Author(s): Andrea Castellucci, Cristina Brandolini, Gianluca Piras, Ignacio Javier Fernandez, Davide Giordano, Carmine Pernice, Giovanni Carlo Modugno, Antonio Pirodda, Gian Gaetano Ferri
Superior canal dehiscence is a pathologic condition of the otic capsule acting as aberrant window of the inner ear. It results in reduction of inner ear impedance and in abnormal exposure of the labyrinthine neuroepithelium to the action of the surrounding structures. The sum of these phenomena leads to the onset of typical cochleo-vestibular symptoms and signs. Among them, pulsatile tinnitus has been attributed to a direct transmission of intracranial vascular activities to labyrinthine fluids. We present the first video-otoscopic documentation of spontaneous pulse-synchronous movements of the tympanic membrane in two patients with superior canal dehiscence. Pulsating eardrum may represent an additional sign of third-mobile window lesion.
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Dermoscopic features of squamous cell carcinoma on the lips
Summary
Background
Dermoscopy of cutaneous squamous cell carcinoma (SCC) has already been described. However little is known on the dermoscopic features of lip SCC.
Objectives
to describe the clinic and dermoscopic criteria of lip SCC,
Methods
Clinical and dermoscopic images of lip SCC were retrospectively evaluated for the presence of specific dermoscopic criteria. Cases were collected from Skin Cancer Unit of Reggio Emilia, Italy, Dermatology Unit Second University of Naples, Italy, and First Department of Dermatology of Aristotle University of Thessaloniki, Greece.
Results
We collected 22 lip SCC; the majority were located on the lower lip (90.9%); more than 2/3 of the total series were flat (68.2%). The clinical images revealed that white-yellowish and red colours were almost equally presented and usually combined together. The predominant clinical aspect that characterized lip SCC was the presence of ulceration (90.9%). Dermoscopically, we noticed polymorphous unfocused small size vessels located both peripheral or throughout the lesions. Scales and white structures were observed in all lesions.
Conclusions
The presence of ulceration, scales, polymorphous vessels and white structures are the main dermoscopic features of lip SCC.
This article is protected by copyright. All rights reserved.
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Randomized controlled trial comparing 35% trichloroacetic acid peel and 5-aminolevulinic acid photodynamic therapy for the treatment of multiple actinic keratosis
Summary
Background
Photodynamic therapy (PDT) and chemical peels with trichloroacetic acid (TCA) can be applied to larger skin areas and thus are suitable treatment options for patients with multiple actinic keratosis (AK). Despite its long use TCA has, however, only been investigated rarely in this indication.
Objectives
This randomized, observer-blinded, intrapatient comparison study sought to investigate the efficacy and safety of 35% TCA versus 20% aminolevulinic acid PDT (ALA PDT) in patients with extensive field cancerisation and multiple AK in the face or on the scalp.
Methods
28 patients with at least 5 AK in two comparable anatomical areas on the head were treated with 35% TCA and ALA PDT randomly assigned to each area. Therapeutic efficacy, adverse events and cosmetic outcome were assessed by a blinded investigator at 1, 3, 6 and 12 months after treatment.
Results
After 12-months follow up TCA and ALA PDT reduced the total lesion count, the primary outcome, by 31,9% and 58,0%, respectively (p=0,006). Complete clearance of preexisting AK were 48,8% for TCA and 73,7% for ALA PDT (p=0,011). Treatment failure (Number of AK greater than 50% of the baseline count) was observed in 7 patients (25%) after TCA and in 2 patients (7,1%) after PDT treatment. Treatment-related pain was significantly higher for ALA PDT (VAS 7,5±2,3 vs TCA: 5,1±2,6; p=0,04) whereas scarring (n=6, 21,4%) was only seen in TCA treated patients.
Conclusions
ALA PDT provided better clinical results than TCA in the treatment of patients with extensive field cancerisation and multiple AK.
This article is protected by copyright. All rights reserved.
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A comparison study of clinician-rated atopic dermatitis outcome measures for intermediate to dark skin patients
Abstract
Background
Atopic dermatitis (AD) assessment is more difficult in patients with skin of colour (SOC). We sought to compare the reliability of commonly used outcome measures for assessing AD in SOC patients and evaluated a novel greyscale in this population.
Method
Twenty-five AD patients each attended a one-day scoring exercise based in either Sydney or Melbourne, Australia. Each patient was scored by the same five physicians using the Eczema Area Severity Index (EASI), objective-Scoring Atopic Dermatitis score (oSCORAD), Investigator's Global Assessment (IGA) and a novel greyscale. Patients also completed the Patient-Oriented Eczema Measure (POEM) and quality of life measures. A mexameter was used for measuring baseline melanin indices. Ten random patients were re-scored to test intra-rater reliability.
Results
We included 11 light skinned patients (melanin index ≤200) and 14 SOC patients (melanin index >200) in the cohort. The inter-rater ICCs were: EASI 0.827 (95% CI 0.658-0.941) for light skin and 0.774 (95% CI 0.598-0.906) for SOC; oSCORAD 0.680 (95% CI 0.441-0.880) for light skin and 0.736 (95%CI 0.544-0.889) for SOC; IGA 0.803 (95%CI 0.618-0.932) for light skin and 0.696 (95%CI 0.490-0.868) for SOC; the greyscale had an ICC of 0.776 (95%CI: 0.601-0.907) when replacing the EASI's erythema scale for SOC patients. All scores showed excellent intra-rater reliability for all skin types. Erythema component analysis showed that erythema did not contribute to variability.
Conclusions
EASI showed excellent reliability for patients of all skin colours, and is recommended as the optimal core measure for patients with all skin colours.
This article is protected by copyright. All rights reserved.
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Treatment Patterns and Outcomes among Adults Admitted to Hospital in the United Kingdom (UK) due to Plaque or Erythrodermic Psoriasis
Abstract
The National Institute for Health and Care Excellence (NICE) identified treatment of moderate-to-severe psoriasis as an area for research.1-2 No recent studies have assessed treatment patterns and outcomes among patients hospitalised for psoriasis in the UK.3-5
This study evaluated clinician- and patient-reported outcomes, treatment patterns, and hospital length of stay (LOS) in patients admitted to hospital for plaque or erythrodermic psoriasis, and enrolled 61 eligible patients across 9 UK hospital sites from 15 November 2013 to 2 June 2014.
This article is protected by copyright. All rights reserved.
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Painful skin lesions and squamous cell carcinoma predict overall mortality risk in organ transplant recipients: A cohort study
Abstract
Background
Organ transplant recipients have a highly increased risk of cutaneous squamous cell carcinomas. Sensation of pain in cutaneous tumours is a powerful patient-reported warning signal for invasive cutaneous squamous cell carcinomas in organ transplant recipients.
Objectives
The impact of painful compared to painless skin lesions and cutaneous squamous cell carcinoma (SCC) compared to other skin lesions on the overall mortality risk in organ transplant recipients (OTR) was investigated.
Methods
We followed 410 OTR from 10 different centres across Europe and North America during the period between 2008 and 2015. These patients had been enrolled in an earlier study to define clinically meaningful patient-reported warning signals predicting the presence of SCC and had been included if they had a lesion requiring histological diagnosis. Cumulative incidences of overall mortality were calculated using Kaplan-Meier survival analysis and risk factors were analysed with Cox proportional hazard analysis.
Results
There was an increased overall mortality risk in OTR who reported painful compared to painless skin lesions with a hazard ratio adjusted for age, sex, and other relevant factors of 1.6 (95% CI 0.97-2.7). There was also an increased overall mortality risk in OTR diagnosed with SCC compared to other skin lesions with an adjusted hazard ratio of 1.7 (95% CI 1.0-2.8). Mortality due to internal malignancies and systemic infections appeared to prevail in OTR with SCC.
Conclusions
We suggest that OTR have an increased overall mortality risk if they develop painful skin lesions or are diagnosed with cutaneous SCC.
This article is protected by copyright. All rights reserved.
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Development of a Multidimensional Assessment Tool for Uremic Pruritus in Dialysis Patients (UP-Dial)
Abstract
Background
Dialysis patients with uremic pruritus (UP) have a significantly impaired quality of life. To assess the therapeutic effect of UP treatments, a well-validated comprehensive and multidimensional instrument needed to be established.
Objectives
To develop and validate a multidimensional scale assessing the UP in dialysis patients: Uremic Pruritus in Dialysis Patients (UP-Dial).
Methods
The development and validation of the UP-Dial instrument was conducted in four phases: (1) item generation, (2) development of pilot questionnaire, (3) refinement of questionnaire with patient recruitment, and (4) psychometric validation. Participants completed the UP-Dial, the visual analogue scale (VAS) of UP, the Dermatology Life Quality Index (DLQI), the Kidney Disease Quality of Life-36 (KDQOL-36), the Pittsburgh Sleep Quality Index (PSQI), and the Beck Depression Inventory (BDI) during May 15, 2012 to November 30, 2015.
Results
The 27-item pilot UP-Dial was generated with 168 participants completing the pilot scale. After factor analysis was performed, the final 14-item UP-Dial encompassed the structure of three domains: signs and symptoms, psychosocial, and sleep. Face and content validity were satisfied through the item generation process and review of experts. The psychometric analysis demonstrated that the UP-Dial had good convergent validity and discriminant validity. The UP-Dial was significantly correlated (Spearman rank, [95% CI]) with the VAS-UP (0.76 [0.69 to 0.83]), DLQI (0.78 [0.71 to 0.85]), KDQOL-36 (-0.86 [-0.91 to -0.81]), PSQI (0.85 [0.80 to 0.89]), and BDI (0.70 [0.61 to 0.79]). The UP-Dial revealed excellent internal consistency (Cronbach's α 0.90 [0.87 to 0.92]) and reproducibility (intraclass correlation 0.95 [0.90 to 0.98]).
Conclusions
The UP-Dial is valid and reliable for assessing UP among dialysis patients. Future research should increase the cross-cultural adaptation and translation of the scale to other languages.
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Hyperspectral imaging in detecting dermal invasion in lentigo maligna melanoma
Abstract
Invasive lentigo maligna melanoma (LMM) and its in situ precursor lentigo maligna (LM) are the most common melanoma types on the head and neck areas 1. Clinically unsuspected invasion is revealed histologically in 5-52% of LMs 2. Thus, correct early diagnoses are crucial for determining accurate resection margins and the discussion of sentinel lymph node examination 3.
Hyperspectral imaging is based on the detection of spectral differences reflecting a tissue's biological properties and can be used for detecting skin malignancies 4,5.
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Biopsy correlation of surface area vs single axis measurements on CT scan of lymph nodes in patients with erythrodermic mycosis fungoides and Sezary syndrome
Abstract
Sezary syndrome (SS) presents with erythroderma, leukaemic blood involvement and frequent lymphadenopathy whilst 15% of mycosis fungoides (MF) patients present with erythroderma1. Staging of patients with erythrodermic (e)MF/SS includes IIIA, IIIB, IVA or IVB dependant on blood, lymph node (LN) or visceral involvement2.
In MF/SS; an abnormal LN is either firm, irregular, clustered, or fixed on examination or ≥15mm on imaging. Excisional biopsy is indicated of the largest, most suspicious node 2 −4.
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Methodological aspects of assessing hand eczema. Comparison of two tools and three different categories of evaluators
Abstract
Hand eczema is a common and persistent disease 1 with a poor prognosis1-3. There is no accepted definition of hand eczema severity. However, the extent of hand eczema has been shown to be an important prognostic factor 1. Agner et al. applied HECSI (Hand Eczema Severity Index) as a measure of severity4. HECSI combines evaluation of the extent and the morphology of hand eczema. Meding et al. have evaluated the extent of hand eczema using HEES (Hand Eczema Extent Score)
This article is protected by copyright. All rights reserved.
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ATR gene mutations in HPV negative oropharyngeal cancer
Oropharyngeal cancer is increasing in incidence and has now become the commonest sub-site of cancer in the head and neck region [1]. It is unusual as these cancers tend to occur in younger patients, non-smokers and majority are associated with Human Papilloma Virus (HPV) infection. The prognosis of patients with HPV-associated oropharyngeal cancer tends to be significantly better in terms of survival outcome as compared to patients with HPV-negative oropharyngeal cancer [2]. However, the molecular mechanisms causing distinct treatment response are largely unknown.
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Superior canal dehiscence with tegmen defect revealed by otoscopy: Video clip demonstration of pulsatile tympanic membrane
Superior canal dehiscence is a pathologic condition of the otic capsule acting as aberrant window of the inner ear. It results in reduction of inner ear impedance and in abnormal exposure of the labyrinthine neuroepithelium to the action of the surrounding structures. The sum of these phenomena leads to the onset of typical cochleo-vestibular symptoms and signs. Among them, pulsatile tinnitus has been attributed to a direct transmission of intracranial vascular activities to labyrinthine fluids.
http://ift.tt/2i3EefQ
Epidemiology and Risk Factors of Maxillofacial Injuries in Brazil, a 5-year Retrospective Study
Abstract
Aim
The etiology and epidemiology of maxillofacial injuries varies widely in different regions of the world due to socioeconomic status, cultural aspects in addition to road traffic and drug consumption. The aim of this study is to determine major causes and epidemiological characteristics of maxillofacial trauma in a 5-year period.
Materials and methods
Reports of corporal trauma (n = 25,632) from 2007 to 2011 in the Department of Forensic Medicine were analyzed as to the presence of maxillofacial injuries. Data were submitted to Chi square test and to multivariate Poisson regression.
Results
3262 reports referred maxillofacial trauma. The majority were men (55.8%), single (68.9%), most of them white (75.7%). The average age was 28.9 years (SD = 8.42), and victims with age between 16 and 30 years old were the most affected (48.0%). Women comprised 44% of total sample, 67.8% (971) were single, 76% (1.076) white and 46% (691) aged between 16 and 30 years old. Middle third injuries were associated after adjustment with females (PR 1.05; 95% CI 1.01–1.11), non-white subjects (PR 1.06; 95% CI 1.01–1.12) and physical aggression (PR 1.07; 95% CI 1.02–1.13). Injuries in the oral region was more prevalent in men (PR 1.24; 95% CI 1.09–1.41), in those aged between 16 and 30 (PR 1.97; 95% CI 1.48–2.61) and in subjects with injuries caused by traffic accident (PR 1.21; 95% CI 1.02–1.44). The presence of injuries in the lower third of face remained associated in the final model only with traffic accident (PR 1.75; 95% CI 1.43–2.15).
Conclusion
Health care practitioners must recognize vulnerable population and most prevalent sites of lesion to identify cases of violence.
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Acute renal dysfunction caused by nonsucrose intravenous immunoglobulin in common variable immunodeficiency
Replacement intravenous immunoglobulin G (IVIG) is approved by the US Food and Drug Administration (FDA) for primary and secondary immune deficiency and is also used as an immunomodulatory agent for autoimmune and inflammatory disorders.1 Although IVIG is well tolerated, renal dysfunction occurs infrequently, most often in older patients with preexisting renal disease receiving a sucrose-containing IVIG product administered at a high dose as an immunomodulatory agent for hematologic or neurologic disease.
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Molecular approaches for the analysis of airborne pollen
Pollen monitoring is a common and vital tool in the field of allergy, creating awareness in pollen sensitive individuals. Traditionally, pollen monitoring has been based on conventional microscopic counting techniques that are labor intensive and limited in the identification to the genus or family level. Molecular techniques provide an alternative approach that is less labor intensive and enable identification of any species by its genetic fingerprint.
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Prolonged EVLP Using OCS Lung: Cellular and Acellular Perfusates.
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Kidney Transplant with Low Levels of DSA or Low Positive B-Flow Crossmatch: An Underappreciated Option for Highly-Sensitized Transplant Candidates.
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Safety and Efficacy of Treatment of Hepatitis C in Kidney Transplant Recipients with Directly Acting Antiviral Agents.
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Treatment of Acute Antibody-Mediated Renal Allograft Rejection with Cyclophosphamide.
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Do salivary bypass tubes lower the incidence of pharyngocutaneous fistula following total laryngectomy? A retrospective analysis of predictive factors using multivariate analysis
Abstract
Salivary bypass tubes (SBT) are increasingly used to prevent pharyngocutaneous fistula (PCF) following laryngectomy and pharyngolaryngectomy. There is minimal evidence as to their efficacy and literature is limited. The aim of the study was to determine if SBT prevent PCF. The study was a multicentre retrospective case control series (level of evidence 3b). Patients who underwent laryngectomy or pharyngolaryngectomy for cancer or following cancer treatment between 2011 and 2014 were included in the study. The primary outcome was development of a PCF. Other variables recorded were age, sex, prior radiotherapy or chemoradiotherapy, prior tracheostomy, type of procedure, concurrent neck dissection, use of flap reconstruction, use of prophylactic antibiotics, the suture material used for the anastomosis, tumour T stage, histological margins, day one post-operative haemoglobin and whether a salivary bypass tube was used. Univariate and multivariate analysis were performed. A total of 199 patients were included and 24 received salivary bypass tubes. Fistula rates were 8.3% in the SBT group (2/24) and 24.6% in the control group (43/175). This was not statistically significant on univariate (p value 0.115) or multivariate analysis (p value 0.076). In addition, no other co-variables were found to be significant. No group has proven a benefit of salivary bypass tubes on multivariate analysis. The study was limited by a small case group, variations in tube duration and subjects given a tube may have been identified as high risk of fistula. Further prospective studies are warranted prior to recommendation of salivary bypass tubes following laryngectomy.
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Perioperative and Anesthetic Considerations for Neurosurgical Laser Interstitial Thermal Therapy Ablations.
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Craniomaxillofacial Fibrous Dysplasia: Conservative Treatment and Maxillary Osteotomy Using the Schuchardt-Kufner Technique
Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0036-1597584
Fibrous dysplasia (FD) is a disturbance of the mesenchymal tissue that accounts for 2.5% of all bone tumors and more than 7% of nonmalignant bone tumors. In the craniomaxillofacial region, FD affects the calvaria, skull base, zygoma, and jaws, the prevalent site being the maxilla (50% of cases). Therapy for craniomaxillofacial FD is surgical. The goals of surgery are to prevent functional disorders and restore facial symmetry, volume, and contour. In this article, we present a case of a young female patient affected by right orbital-zygomatic-maxillary FD. She had developed facial asymmetry and malocclusion that were corrected using the Schuchardt-Kufner osteotomy technique.
[...]
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Article in Thieme eJournals:
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Imaging in Juvenile Nasopharyngeal Angiofibroma: Clinical Significance of Ramharan and Chopstick Sign
Abstract
Imaging plays an important role in the diagnosis, staging and prognosis of JNA. Certain radiological changes as seen on CECT were observed to be consistent in our case series. This study analysed preoperative and postoperative CECT of large series of JNA patients to evaluate the sites and pattern of spread of tumor. We evaluated the clinical significance of pterygoid wedge in preoperative and postoperative imaging and thus elucidating two new radiological signs. Retrospective analysis of the pre operative and post operative imaging data of 242 patients with JNA. The findings in the scan were clinically correlated with the endoscopic intraoperative findings. Preoperative evaluation of the pterygoid wedge revealed widening on the involved side in 99.1% of our cases which is 1.8 times greater compared to the uninvolved side. The possibility of residual/recurrent tumor was found to be significantly higher in those where the pterygoid wedge was not removed by drilling (p < 0.001) Drilling of the pterygoid wedge intra operatively, reduced the rate of residual/recurrence from 31.9 to 3.07%. Widening of the pterygoid wedge seen in the preoperative CECT, referred as RAM HARAN sign occurs in JNA. It has a significant diagnostic value as a radiological sign in JNA. Drilling of the pterygoid wedge intraoperatively reduces the rate of recurrence of JNA. Appearance of the two pterygoid plates on postoperative CECT, as two parallel lines, referred as Chopstick sign, has a remarkable prognostic value as a radiological sign in JNA.
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Asthma–chronic obstructive pulmonary disease overlap syndrome: a controversial concept
Purpose of review: To illustrate the scant evidence and the shortcomings of the concept of 'asthma-COPD overlap syndrome' (ACOS) in terms of clinical utility. Recent findings: Asthma and chronic obstructive pulmonary disease (COPD) are considered as two distinct and heterogeneous diseases. For many years, physicians have been aware that asthma and COPD can coexist in some patients. Recently, the term ACOS has been applied when a person has clinical features of both asthma and COPD. However, the lack of an accurate diagnosis has led to inconsistent data regarding reported prevalence, prognosis and therapeutics. Even today, it has not been possible to establish a phenotypic characterization of ACOS, although it is part of the overall complexity and heterogeneity of COPDs. No high quality data exist on which to base treatment recommendations for ACOS. Consequently, in clinical practice, treatment is extrapolated from the available evidence on asthma and COPD. Summary: The current concept of ACOS seems clinically irrelevant because it has no influence on the prognosis and treatment of these patients. The authors concluded that the term ACOS should be avoided in the case of patients with features of both asthma and COPD.http://ift.tt/2ip4LB1
Dendritic cell subset expression in severe chronic rhinosinusitis with nasal polyps
Purpose of review: Two main pillars are implicated in nasal polyposis development: a severe imbalance in immunomodulation and a mechanical dysfunction because of an abnormal remodeling process. Dendritic cells play a crucial role in the link between innate and adaptive immune response and orchestrating the T-cell response and are implicated in the severe inflammatory process found in nasal polypoid tissue. This review summarizes the existent knowledge about dendritic cells in nasal polyposis. Recent findings: Dendritic cells are found increased in nasal polyposis, regardless of subset. Of interest, plasmacytoid dendritic cells are decreased in patients with a more severe Th2 profile, suggesting an important role of the cytokines milieu in their functional response or that plasmacytoid dendritic cell could act mitigating the inflamed process found in polypoid tissue. Summary: Understanding the dendritic cell subset expression in different environments, as well as the effect of these subsets on T-cell differentiation will greatly improve the development of new therapies in nasal polyposis.http://ift.tt/2ip7Roz
Natural killer cells in asthma
Purpose of review: This review article discusses current knowledge on natural killer (NK) cells in asthma. Recent findings: It is now well accepted that NK cell activities go beyond cancer immune surveillance and antiviral defense. Recent reports indicate that NK cells are activated in response to allergens in vivo. NK cells promote allergic sensitization, type-2 immune response, development of eosinophilic inflammation, and airway hyperresponsiveness. NK cells are activated by respiratory syncytial virus and other respiratory viruses. When infection occurs in the setting of active allergic inflammation, NK cells augment its magnitude and contribute to asthma exacerbations. Proasthma activities of NK cells can be programmed during embryogenesis through maternal exposure to environmental pollutants. Prenatally programmed NK cells produce type-2 and type-3 cytokines and mediate asthma predisposition. NK cells can also act as asthma antagonists. NK cells contribute to the resolution of inflammation through suppression of antigen-specific CD4+ T cells and type-3 immunity. When viral infection occurs in naïve mice prior to allergic sensitization, NK cells antagonize type-2 immunity and prevent development of asthma. Summary: NK cells are nonredundant participants of allergic inflammation. The environmental context determines whether NK cells act as protagonists or antagonists.http://ift.tt/2ip6w0Z
Medical therapy, refractory chronic rhinosinusitis, and productivity costs
Purpose of review: The purpose of this review is to address the most recent advances in the medical therapy for chronic rhinosinusitis (CRS), define recalcitrant and refractory CRS, and discuss the productivity costs associated with CRS. Recent findings: Recent studies evaluating anti-IL-4 receptor α antibodies and calcium channel blockers have demonstrated promising early results during management of CRS. Recent appropriateness criteria have been developed to assist clinicians with defining which patients have 'refractory' CRS and may be considered candidates for endoscopic sinus surgery. Productivity costs appear to be associated with disease severity and can be reduced with appropriate interventions. Summary: Topical corticosteroid therapy and high volume saline irrigation continue to be the cornerstone to medical therapy, whereas use of systemic corticosteroids and antibiotics depends on CRS phenotype and presence of acute exacerbation. More research is needed before routine use of novel immunomodulatory therapies such as anti-IL5, anti-IgE, anti-IL4, and calcium channel blockers. Clinicians should apply an appropriate definition for refractory CRS when discussing role of sinus surgery. Assessing the degree of work productivity impairment can assist in treatment decision-making and may help predict treatment outcomes.http://ift.tt/2ipaAhF
The current overuse and misuse of meta-analyses on sublingual immunotherapy: the case of grass pollen allergy
Purpose of review: Meta-analysis provides the highest level of evidence-based efficacy of a medical treatment or intervention. Allergen immunotherapy in its two forms of subcutaneous immunotherapy and sublingual immunotherapy (SLIT) is an effective treatment of respiratory allergy as shown by meta-analyses, but in recent years there has been an overflow of meta-analyses on SLIT, with contrasting results that may generate confusion among physicians. Recent findings: It can be observed that flaws are often present in meta-analyses including: incorrect selection of trials, inappropriate use of evaluation parameters for the analysis, and unsuitable analyses. For instance, it is clear that a meta-analysis of several small studies does not predict the results of a single large study that remains the gold standard to assess the efficacy and safety of a treatment. To assess the interest of the matter, we calculated the number of citations of meta-analyses on SLIT efficacy in the 10 years after the first publication in 2005 and detected a continuous decrease in citations. Summary: Today, the appropriateness of a meta-analysis should be carefully evaluated, taking into account that a meta-analysis uses a statistical approach to combine the results from multiple small studies to increase power, to improve estimates of the size of the effect, and/or to resolve uncertainty when reports disagree. Editors and reviewers of medical journals should consider that to judge a meta-analysis requires a high level of expertise that is obvious in reviewers belonging to the Cochrane organization.http://ift.tt/2ipe3Nb
Near-fatal asthma: a heterogeneous clinical entity
Purpose of review: The aims of the present review were to describe the heterogeneous nature of near-fatal asthma (NFA) and to summarize the distinctive phenotypes identified in this subtype of asthma. Recent findings: Clinical, physiological, and histological studies have shown a large number of triggers, pathological mechanisms, and risk factors associated with NFA. Based on the demographic and clinical characteristics of the patients, the circumstances surrounding the asthma exacerbation and some distinctive features of the disease, several clinical profiles of asthma patients with NFA have been described. Recent data show new associations between some gene expression patterns and fatal asthma, as well as with some biological markers related to inflammatory or immunologic mechanisms in the airways. Also, the use of statistical methods, such as cluster analysis, allowed identifying and confirming different phenotypes of life-threatening asthma patients. Summary: NFA is a heterogeneous clinical entity, in which different patients' clinical profiles may coexist [e.g. rapid-onset NFA, NFA in patients with dyspnea hypoperception or sensitized to certain pneumoallergens (Alternaria alternata, soybean), NFA related to the menstrual cycle, brittle asthma]. Knowledge of these phenotypes as well as adequate and specific management strategies can reduce morbidity and mortality in patients suffering from NFA.http://ift.tt/2ipbo6c
Targeting IL-25 as a novel therapy in chronic rhinosinusitis with nasal polyps
Purpose of review: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous inflammatory disorder with a poorly understood pathophysiology. Recent findings show that epithelial-derived cytokines, including thymic stromal lymphopoietin, IL-33, and IL-25, can exacerbate Th2 immune responses, ultimately leading to recalcitrant chronic rhinosinusitis and nasal polyps. Although IL-25 is increased in CRSwNP, the targeting of IL-25 as a therapeutic strategy remains largely unexplored. In this review, we outline the many recent advances in our understanding of the association between IL-25 and CRSwNP. Recent findings: Recently, we demonstrated that IL-25, produced primarily by sinonasal epithelial cells and infiltrating mast cells, plays an important role in the pathogenesis of CRSwNP in Asian patients. Furthermore, IL-25 and IL-25R are elevated in nasal polyps. This cytokine has roles in the pathogenesis of CRSwNP via modulating group 2 innate lymphoid cells (ILC2s). Similarly, ILC2 enrichment has been reported in CRSwNP patients, and a positive correlation has been shown between ILC2s and CRSwNP. Clinical trials blocking thymic stromal lymphopoietin and IL-33 pathways are ongoing using monoclonal antibodies, AMG157 and AMG282, against CRSwNP, respectively. Summary: Studies on the role played by IL-25 in the pathogenesis of CRSwNP are accumulating and suggest the possibility of a novel therapeutic strategy for treating CRSwNP.http://ift.tt/2ip8M8h
IgE and eosinophils as therapeutic targets in asthma
Purpose of review: Asthma is a chronic inflammatory disorder characterized by reversible airflow obstruction, which is being more widely recognized as a broad-spectrum disease that encompasses multiple patient characteristics and pathophysiologic mechanisms. Suboptimal asthma control leads to increasing burden of healthcare costs and loss of productivity to society. Biologic therapies targeted at IgE and eosinophils can be used in poorly controlled allergic and eosinophilic asthma, respectively. The purpose of this review is to analyze the advancements in currently available biologic therapies targeted at IgE and eosinophils in asthma and to identify how these therapies may impact overall healthcare costs. Recent findings: Omalizumab is an anti-IgE antibody that is approved for use of poorly controlled moderate-to-severe asthma. Many studies have confirmed that omalizumab not only improves quality of life and symptom scores, but also decreases urgent care and emergency department visits and hospitalizations. Dupilumab is a biologic agent targeted at TH2 cytokines, but indirectly impacts IgE and is an important biologic agent for atopic disease. Mepolizumab, reslizumab, and benralizumab target IL-5, a key cytokine for eosinophils. For patients with poorly controlled eosinophilic asthma, these biologic agents improve asthma symptoms, reduce exacerbations, and reduce emergency visits and hospitalizations. Summary: Poorly controlled severe asthma affects a small portion of patients with asthma in the United States and yet it accounts for large portion of healthcare utilization. Biological therapies in poorly controlled severe persistent asthma have been identified to reduce healthcare utilization, including emergency visits and hospitalizations. Biologic agents have a clear beneficial role in the management of severe asthma, and further evaluations should be continued in identifying optimal patient characteristics for the various agents and overall benefit toward healthcare utilization and cost.http://ift.tt/2ipbnPG
Rhinitis: adherence to treatment and new technologies
Purpose of review: Nonadherence to treatment is a major issue in approximately 50% of patients suffering from chronic diseases. The availability of new technologies could represent a possible way to improve patients' engagement and adherence in a real-life setting. Research and technology tools made available or in process of being made available to patients with allergic diseases and their physicians could potentially improve the management of these disease in daily life by improving adherence. In this review, we sought to outline many of the recent advances in these technological approaches. Recent findings: Short Message Service (SMS) reminder, social networks, wearable devices, mobile applications (Apps), monitoring systems of inhaled device use, often presented as 'serious game' are changing the way of approaching to chronic disease, such as rhinitis, management. Summary: Studies of the role played by various technologies in improving adherence to treatment in rhinitis are still limited as compared with other diseases such as asthma, but the results are encouraging. Further studies in this area may lead to the discovery of novel management approaches that is easy to be integrated in patients' daily life.http://ift.tt/2ip54LN
Allergen immunotherapy: an updated review of safety
Purpose of review: Allergen immunotherapy is the only modality that can modify the immune response upon exposure to aeroallergens and venom allergens. This review will update the allergist on recent studies evaluating safety of sublingual and subcutaneous allergen immunotherapy. Recent findings: Multiple clinical trials and retrospective studies have been published evaluating overall safety of these therapies. The risk of systemic reactions with subcutaneous immunotherapy remains quite low, but near-fatal and fatal anaphylaxis does occur, requiring physicians to be aware of potential risks for such events. Sublingual immunotherapy has a high incidence of local site application reactions, but severe anaphylactic events are very uncommon. Summary: Subcutaneous immunotherapy and sublingual immunotherapy are beneficial in treating allergic rhinitis and venom hypersensitivity but should be administered only by physicians familiar with potential risk factors and able to manage treatment-related local and systemic allergic reactions.http://ift.tt/2hRL1sD
Fragen 878 für die Facharztprüfung
Laryngo-Rhino-Otol 2016; 95: 878-878
DOI: 10.1055/s-0042-118104
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
http://ift.tt/2im3IFX
Therapie von Polyposis nasi – Sicherheit und Wirksamkeit von Steroidinjektionen in Polypen
Laryngo-Rhino-Otol 2016; 95: 824-825
DOI: 10.1055/s-0042-115533
Berichte über Erblindungen führen zu Debatten bezüglich der Sicherheit von Steroidinjektionen in Polypen. Obwohl viele Studien die Wirksamkeit und Sicherheit der Steroidinjektionen verifizierten, existieren keine Studien zum Vergleich der Wirksamkeit und den Nebeneffekten von Steroidinjektionen in Polypen mit einer oralen Steroidbehandlung. Laryngosscope 2016; 126: 1730–1735
[...]
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
http://ift.tt/2haJFVM
Antikorruptionsgesetz tritt in Kraft
Laryngo-Rhino-Otol 2016; 95: 853-854
DOI: 10.1055/s-0042-108313
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
http://ift.tt/2im0NwK
Behandlung von Otosklerose – Dioden-Laser-Stapedotomie vs. konventionelle Stapedotomie
Laryngo-Rhino-Otol 2016; 95: 826-827
DOI: 10.1055/s-0042-115532
Die Vorteile einer Laser-Operation liegen im Ausbleiben von Blutungen, einer hohen Präzision und einer geringeren Schädigung des Innenohrs und der Gehörknöchelchenkette. In einer doppelt-blinden, randomisierten klinischen Studie untersuchten die Autoren die Wirksamkeit der Dioden-Laser-Stapedotomie verglichen zur konventionellen manuellen Stapedotomie bei Otosklerose. Otolaryngology – Head and Neck Surgery 2016; 154: 1099–1105
[...]
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
http://ift.tt/2haHYHZ
Kommentar der Schriftleitung
Laryngo-Rhino-Otol 2016; 95: 821-821
DOI: 10.1055/s-0042-118095
Liebe Leserinnen und Leser Video-Editorial www.thieme.de/lro Liebe Leserinnen und Leser,„Referiert und diskutiert" beendet das Jahr mit 2 prospektiven klinischen Studien. Steroidinjektion in Nasenpolypen bei chronischer Sinusitis im Vergleich zur oralen Steroidtherapie ist das erste Thema und dann Dioden-Laser-Stapedotomie im Vergleich zur konventionellen Stapedotomie bei Otosklerose. Beides sind gute Beispiele wie wichtige Fragestellungen zu vermeintlichen Routinebehandlungen in der HNO-Heilkunde ein ganz neues Evidenzniveau erreichen können.
[...]
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
http://ift.tt/2imcAve
Rhinosinusitis with Nasal Polyposis
Laryngo-Rhino-Otol 2016; 95: 836-836
DOI: 10.1055/s-0042-115888
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
http://ift.tt/2haLYs0
Grundlagen der Ohrchirurgie
Laryngo-Rhino-Otol 2016; 95: 855-877
DOI: 10.1055/s-0042-118098
Der vorliegende Facharztwissen-Beitrag zum Thema „Grundlagen der Ohrchirurgie" gibt einen kurz gefassten Überblick über aktuelle Indikationen, die notwendige Diagnostik sowie die operationstechnischen Prinzipien häufiger otologischer Krankheitsbilder. Neben der plastisch-rekonstruktiven Chirurgie der Ohrmuschel werden die Prinzipien der Chirurgie des äußeren Gehörgangs, der sanierenden Mittelohrchirurgie sowie die Tumorchirurgie des Felsenbeins thematisiert. Zusätzlich werden Aspekte der operativen Hörrehabilitation (mit Ausnahme der implantierbaren Hörsysteme) unter der Berücksichtigung aktueller Studienergebnisse dargestellt.
[...]
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | CME online | Full text
http://ift.tt/2ilWFwL
Rezension Medikamentöse Therapie in der HNO-Heilkunde
Laryngo-Rhino-Otol 2016; 95: 852-852
DOI: 10.1055/s-0042-115246
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
http://ift.tt/2im0LF8
Schädelbasischirurgie
Laryngo-Rhino-Otol 2016; 95: 879-883
DOI: 10.1055/s-0042-118108
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
http://ift.tt/2haNI4u
The effect of head rotation on efficiency of face mask ventilation in anaesthetised apnoeic adults: A prospective, randomised, crossover study.
http://ift.tt/2ilT3Li
Novel needle guide reduces time to perform ultrasound-guided femoral nerve catheter placement: A randomised controlled trial.
http://ift.tt/2hatNTj
The Importance of Innate Immunity in Acne [Free article]
Cutaneous Involvement in the Deep Mycoses: A Literature Review. Part I—Subcutaneous Mycoses [Free article]
Cutaneous involvement in the Deep Mycoses: A Review. Part II—Systemic Mycoses [Free article]
Kidney Disease and Psoriasis. A New Comorbidity? [Free article]
Reflectance Confocal Microscopy in Lentigo Maligna [Free article]
Frontal Fibrosing Alopecia in Men: Presentations in 12 Cases and a Review of the Literature [Free article]
Disseminated Superficial Actinic Porokeratosis [Free article]
Preliminary Experience With Transdermal Oxybutynin Patches for Hyperhidrosis [Free article]
A Slow-Growing Tumor on the Forehead [Free article]
Reticulate Hyperpigmentation of the Flexures [Free article]
Intraoperative Care During Eyelid Surgery [Free article]
Melanocytic Lesion with a Globular Pattern Showing Changes During Short-term Follow-up [Free article]
Lichen Nitidus Arising on Vitiligo: A New Variant of the Isotopic Coresponse [Free article]
Linear Multiple Epithelioid Hemangioma Associated With a Quiescent Vascular Malformation [Free article]
Milroy Disease or Primary Congenital Lymphedema Associated With Invasive Squamous Cell Carcinoma [Free article]
Systemic Absorption of Topical Tacrolimus in Metastatic Crohn Disease With Skin Ulcers [Free article]
Quinacrine: A Treatment Option That Should Not Be Overlooked [Free article]
Concomitant Pyoderma Gangrenosum and Erythema Nodosum in a Patient With Ulcerative Colitis [Free article]
Non-AIDS Kaposi sarcoma in the external ear [Free article]
Patient with disseminated tuberculosis and rare perianal involvement [Free article]
The evolution of hierarchical triple star-systems
Field stars are frequently formed in pairs, and many of these binaries are part of triples or even higher-order systems. Even though, the principles of single stellar evolution and binary evolution, have been accepted for a long time, the long-term evolution of stellar triples is poorly understood. The presence of a third star in an orbit around a binary system can significantly alter the evolution of those stars and the binary system. The rich dynamical behaviour in three-body systems can give rise to Lidov-Kozai cycles, in which the eccentricity of the inner orbit and the inclination between the inner and outer orbit vary periodically. In turn, this can lead to an enhancement of tidal effects (tidal friction), gravitational-wave emission and stellar interactions such as mass transfer and collisions. The lack of a self-consistent treatment of triple evolution, including both three-body dynamics as well as stellar evolution, hinders the systematic study and general understanding of the long-term evolution of triple systems. In this paper, we aim to address some of these hiatus, by discussing the dominant physical processes of hierarchical triple evolution, and presenting heuristic recipes for these processes. To improve our understanding on hierarchical stellar triples, these descriptions are implemented in a public source code TrES, which combines three-body dynamics (based on the secular approach) with stellar evolution and their mutual influences. Note that modelling through a phase of stable mass transfer in an eccentric orbit is currently not implemented in TrES, but can be implemented with the appropriate methodology at a later stage.
http://ift.tt/2inlQLl
Infinity of subharmonics for Duffing equations with convex and oscillatory nonlinearities
The existence of infinity of subharmonics for Duffing equations with convex and oscillatory nonlinearities is shown. This result is a corollary of two theorems. These theorems, one for a weak sub-quadratic potential and another for a geometric case, roughly speaking, are complementary. The approach of this paper is based on the phase-plane analysis for the time map and using the Poincaré-Birkhoff twist theorem.
http://ift.tt/2intK7E
An Expansile Mass of the Sphenoid Sinus or Petrous Apex.
| Related Articles |
An Expansile Mass of the Sphenoid Sinus or Petrous Apex.
JAMA Otolaryngol Head Neck Surg. 2016 Dec 22;:
Authors: Pou JD, Marino MJ, Aslam R
PMID: 28006058 [PubMed - as supplied by publisher]
http://ift.tt/2ioyTfG
Cetuximab and Radiotherapy in Laryngeal Preservanion.
| Related Articles |
Cetuximab and Radiotherapy in Laryngeal Preservanion.
JAMA Otolaryngol Head Neck Surg. 2016 Dec 22;:
Authors: D'Ascanio L, Ricci G, Piazza F
PMID: 28006053 [PubMed - as supplied by publisher]
http://ift.tt/2i0KJNX
Cetuximab and Radiotherapy in Laryngeal Preservanion-Reply.
| Related Articles |
Cetuximab and Radiotherapy in Laryngeal Preservanion-Reply.
JAMA Otolaryngol Head Neck Surg. 2016 Dec 22;:
Authors: Bonner JA, Chin S, Spencer S
PMID: 28006051 [PubMed - as supplied by publisher]
http://ift.tt/2i0OCTa
Health Care Resource Use in Patients With and Without 22q11.2 Deletion Syndrome Undergoing Sphincter Pharyngoplasty for Velopharyngeal Insufficiency.
| Related Articles |
Health Care Resource Use in Patients With and Without 22q11.2 Deletion Syndrome Undergoing Sphincter Pharyngoplasty for Velopharyngeal Insufficiency.
JAMA Otolaryngol Head Neck Surg. 2016 Dec 22;:
Authors: Wright DT, Nguyen SA, Teufel RJ, White DR
Abstract
Importance: The use of health care resources in patients with velopharyngeal insufficiency undergoing sphincter pharyngoplasty is unknown.
Objectives: To examine the use of health care resources by patients with velopharyngeal insufficiency who have undergone sphincter pharyngoplasty and investigate whether patients with 22q11.2 deletion syndrome (22qDS) had a longer length of stay, increased cost of admission, and higher number of complications.
Design, Setting, and Participants: Using data from the Kids' Inpatient Database for January 1 to December 31, 2012, we retrospectively analyzed all patients undergoing pharyngoplasty for velopharyngeal insufficiency. In addition, patients were analyzed according to whether or not they had 22qDS. Data were analyzed from January 1 to December 31, 2012.
Main Outcomes and Measures: Total cost of admission, length of stay, number of procedures, and number of complications.
Results: There were 687 patients: 90 with 22qDS (mean [SD] age, 6.4 [2.7] years; 43 males and 47 females) and 597 without 22qDS (mean [SD] age, 7.5 [4.1] years; 326 males and 271 females). In both groups, patients were predominantly white, had private insurance, were treated in a children's hospital, and were from either the West or Midwest. The median length of stay (2.0 [interquartile range (IQR), 1.0-3.9] vs 1.0 [IQR, 1.0-2.0] days; 95% CI, 1.0-2.0) and total cost of admission ($9269.24 [IQR, $6800.65-$13 189.25] vs $6936.95 [IQR, $5036.71-$9054.98]; 95% CI, $6791.83-$7542.47) were higher for the group with 22qDS than those without 22qDS, while there was no significant difference in the number of procedures performed. In addition, the median number of diagnoses (5.0 [IQR, 3.0-9.0] vs 3.0 [IQR, 2.0-5.0]; 95% CI, 3.0-4.0) and number of chronic conditions (3.0 [IQR, 2.0-5.0] vs 2.0 [IQR, 1.0-2.0]; 95% CI, 2.0-2.0) were higher for the group with 22qDS than those without 22qDS. Furthermore, results of a multiple regression model showed that 22qDS was positively associated with both length of stay (B = 0.92; 95% CI, 0.59-1.24) and total cost (B = $3458.78; 95% CI, $2051.09-$4866.46).
Conclusions and Relevance: This study demonstrates that patients with 22qDS undergoing sphincter pharyngoplasty for velopharyngeal insufficiency have more complex medical conditions and require more health care resources than patients without 22qDS.
PMID: 28006043 [PubMed - as supplied by publisher]
http://ift.tt/2iorUDF
Efficacy and Safety of Ciprofloxacin Plus Fluocinolone in Otitis Media With Tympanostomy Tubes in Pediatric Patients: A Randomized Clinical Trial.
| Related Articles |
Efficacy and Safety of Ciprofloxacin Plus Fluocinolone in Otitis Media With Tympanostomy Tubes in Pediatric Patients: A Randomized Clinical Trial.
JAMA Otolaryngol Head Neck Surg. 2016 Dec 22;:
Authors: Spektor Z, Pumarola F, Ismail K, Lanier B, Hussain I, Ansley J, Butehorn HF, Esterhuizen K, Byers J, Douglis F, Lansford B, Hernández FJ
Abstract
Importance: Acute otitis media with tympanostomy tubes (AOMT) in children commonly presents with otorrhea and negatively affects their daily activities.
Objective: To evaluate the efficacy and safety of topical ciprofloxacin, 0.3%, plus fluocinolone acetonide, 0.025%, otic solution relative to ciprofloxacin, 0.3%, otic solution alone and fluocinolone acetonide, 0.025%, otic solution alone in the treatment of AOMT in children.
Design, Setting, and Participants: Two twin multicenter, randomized, double-blind clinical trials with identical designs were conducted from June 24, 2011, through June 23, 2014, at ear, nose, and throat pediatric practices, general practices, hospitals, and clinical research centers. The study population comprised 662 children (331 in each trial) with AOMT in at least 1 ear who presented with moderate or severe purulent otorrhea for 3 weeks or less. Data analyses were performed on an intention-to-treat basis.
Interventions: Patients were randomly assigned to receive ciprofloxacin plus fluocinolone, ciprofloxacin alone, or fluocinolone alone twice daily for 7 days and were evaluated on days 1 (baseline), 3 to 5 (undergoing therapy), 8 to 10 (end of therapy), and 18 to 22 (test of cure).
Main Outcomes and Measures: The primary efficacy measure was time to cessation of otorrhea. The principal secondary end point was sustained microbiological cure, defined as eradication or presumed eradication at end-of-therapy and test-of-cure visits.
Results: A total of 662 children participating in the 2 studies were randomized to receive ciprofloxacin plus fluocinolone (n = 223), ciprofloxacin alone (n = 221), or fluocinolone alone (n = 218). The median age was 2.5 years (range, 0.6-12.7 years). The median time to cessation of otorrhea was 4.23 days (95% CI, 3.65-4.95 days) in patients receiving ciprofloxacin plus fluocinolone compared with 6.95 days (95% CI, 5.66-8.20 days) in those receiving ciprofloxacin and not estimable findings in those receiving fluocinolone alone (P < .001). The clinical cure rate at the test-of-cure visit was 80.6% in the ciprofloxacin plus fluocinolone group, 67.4% in the ciprofloxacin group (difference, 13.2%; 95% CI, 5.0%-21.4%; P = .002), and 47.6% in the fluocinolone group (difference, 33.0%; 95% CI, 24.0%-42.0%; P < .001). The sustained microbiological cure rate was 79.7% in the ciprofloxacin plus fluocinolone group vs 67.7% in the ciprofloxacin group (difference, 12.0%; 95% CI, 0.8%-23.0%; P = .04) and 37.6% in the fluocinolone group (difference, 42.1%; 95% CI, 29.3%-54.8%; P < .001). Only 7 (3.1%) of the patients receiving ciprofloxacin plus fluocinolone, 8 (3.6%) of the patients receiving ciprofloxacin, and 10 (4.7%) of the patients receiving fluocinolone presented with adverse events related to study medication.
Conclusions and Relevance: The combination of ciprofloxacin plus fluocinolone is more effective than treatment with ciprofloxacin or fluocinolone alone for AOMT, and it is safe and well tolerated in children.
Trial Registration: clinicaltrials.gov Identifiers: NCT01395966 and NCT01404611.
PMID: 28006041 [PubMed - as supplied by publisher]
http://ift.tt/2hajz5s
Imaging in Juvenile Nasopharyngeal Angiofibroma: Clinical Significance of Ramharan and Chopstick Sign
Abstract
Imaging plays an important role in the diagnosis, staging and prognosis of JNA. Certain radiological changes as seen on CECT were observed to be consistent in our case series. This study analysed preoperative and postoperative CECT of large series of JNA patients to evaluate the sites and pattern of spread of tumor. We evaluated the clinical significance of pterygoid wedge in preoperative and postoperative imaging and thus elucidating two new radiological signs. Retrospective analysis of the pre operative and post operative imaging data of 242 patients with JNA. The findings in the scan were clinically correlated with the endoscopic intraoperative findings. Preoperative evaluation of the pterygoid wedge revealed widening on the involved side in 99.1% of our cases which is 1.8 times greater compared to the uninvolved side. The possibility of residual/recurrent tumor was found to be significantly higher in those where the pterygoid wedge was not removed by drilling (p < 0.001) Drilling of the pterygoid wedge intra operatively, reduced the rate of residual/recurrence from 31.9 to 3.07%. Widening of the pterygoid wedge seen in the preoperative CECT, referred as RAM HARAN sign occurs in JNA. It has a significant diagnostic value as a radiological sign in JNA. Drilling of the pterygoid wedge intraoperatively reduces the rate of recurrence of JNA. Appearance of the two pterygoid plates on postoperative CECT, as two parallel lines, referred as Chopstick sign, has a remarkable prognostic value as a radiological sign in JNA.
http://ift.tt/2hfTBkb
Massive bilateral mandibular metastasis from papillary thyroid carcinoma
Publication date: Available online 22 December 2016
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Siti Asmat Md Arepen, Irfan Mohamad
Papillary thyroid carcinoma (PTC) comprises almost eighty percent of differentiated thyroid malignancy. It affects female more than male in the age range between 40–50years old. It usually metastasizes to ipsilateral regional lymph nodes of neck and rarely have distant metastasis. Common route of dissemination of tumour is through lymphatic system. We reported a rare case of bilateral mandibular metastasis from incomplete resection of follicular variant of PTC.
http://ift.tt/2hR1Jbp
The kinase inhibitors R406 and GS-9973 impair T cell functions and macrophage-mediated anti-tumor activity of rituximab in chronic lymphocytic leukemia patients
Abstract
Small molecules targeting kinases involved in B cell receptor signaling are showing encouraging clinical activity in chronic lymphocytic leukemia (CLL) patients. Fostamatinib (R406) and entospletinib (GS-9973) are ATP-competitive inhibitors designed to target spleen tyrosine kinase (Syk) that have shown clinical activity with acceptable toxicity in trials with CLL patients. Preclinical studies with these inhibitors in CLL have focused on their effect in patient-derived leukemic B cells. In this work we show that clinically relevant doses of R406 and GS-9973 impaired the activation and proliferation of T cells from CLL patients. This effect could not be ascribed to Syk-inhibition given that we show that T cells from CLL patients do not express Syk protein. Interestingly, ζ-chain-associated protein kinase (ZAP)-70 phosphorylation was diminished by both inhibitors upon TCR stimulation on T cells. In addition, we found that both agents reduced macrophage-mediated phagocytosis of rituximab-coated CLL cells. Overall, these results suggest that in CLL patients treated with R406 or GS-9973 T cell functions, as well as macrophage-mediated anti-tumor activity of rituximab, might be impaired. The potential consequences for CLL-treated patients are discussed.
http://ift.tt/2hgEUgB
Delivery of foreign cytotoxic T lymphocyte epitopes to tumor tissues for effective antitumor immunotherapy against pre-established solid tumors in mice
Abstract
Cytotoxic T lymphocyte (CTL) can have remarkable abilities to kill tumor cells. However, the establishment of successful CTL-based anticancer therapy has met with many challenges. Within tumor cells, there exist subpopulations with low or no expression of the targeted antigen (termed as antigen-loss variants). In addition, tumor cells can downregulate the levels of major histocompatibility complex class I (MHC-I) molecules on cell surface due to immune pressure. As a result, some tumor cells can escape the immune pressure bestowed by CTLs, resulting in treatment failure. To address these difficulties, a new approach is developed to deliver foreign high-affinity CTL epitopes to tumor tissues utilizing pH-responsive "smart" microparticles (MPs). These MPs could encapsulate CTL peptide epitope, release the peptide under acidic condition encountered in tumor tissues and enhance CTL activation. Mice bearing pre-established tumor as "antigen-loss variant" solid tumor models were administered intratumorally with MPs containing the CTL peptide, which showed 100% survival following the treatment. In contrast, all control mice died from tumor. Significant protection from tumor-induced death was also observed with systemic administration of CTL peptide-MPs. The therapeutic efficacy can be attributed to enhanced delivery of the epitope to tumor tissues, presentation of the epitope by tumor cells as well as tumor stromal cells and/or generation of epitope-specific CTLs by the peptide-containing MPs. These findings offer a promising new direction for treating established solid tumor using CTL therapy.
http://ift.tt/2i0Gtho
A survey of facilitators and barriers to recruitment to the MAGNETIC trial
Background: Recruitment to randomised controlled trials with children is challenging. It is imperative to understand the factors that boost or hinder recruitment of children to clinical trials. We conducted a survey of facilitators and barriers to recruitment to the MAGNETIC trial, using a previously developed web-based tool. Methods: MAGNETIC is a multicentre randomised trial of nebulised magnesium in acute severe asthma, recruiting 508 children from 30 UK sites. Recruiters were asked to grade a list of factors from –3 to +3 depending on whether the factor was perceived as a strong, intermediate or weak barrier (–3 to –1) or facilitator (+1 to + 3), and using (0) if it was thought to be not applicable. Free text responses were invited on strategies applied to counter the identified barriers. Results: The commonly identified facilitators were motivation and experience of study teams, effective communication and coordination between teams at site and between sites and the Clinical Trials Unit, the presence of designated research nurses, good trial management, clinical trial publicity, simple inclusion criteria, effective communication with parents and presentation of trial information in a simple and clear manner. The commonly identified barriers were heavy clinical workload, shift patterns of work, Good Clinical Practice (GCP) training, inadequate number of trained staff, time and setting of consent seeking, non-availability of research staff out of hours and parents' concerns about their child taking an experimental medicine. Having a designated research nurse, arranging GCP training and trial-related training sessions for staff were the most commonly reported interventions. Conclusions: This study highlights important generic and trial-specific facilitators and barriers to recruitment to a paediatric trial in the acute setting and provides information on the recruitment strategies or interventions that were applied to overcome these barriers. This information can be very useful in informing the design and conduct of future clinical trials with children, particularly in the acute or emergency setting.Trial registrationISRCTN, ISRCTN81456894. Registered on 15 November 2007.
http://ift.tt/2inLz6i
Citalopram-induced dyskinesia of the tongue: a video presentation
We describe a 51-year-old man with sudden onset involuntary movements of the tongue 2 weeks after initiation of citalopram. The movements were continuous and isolated to the tongue. Speech was minimally dysarthric. Further examination revealed no abnormalities. Citalopram was continued and spontaneous improvement was noticed in the following weeks. There was complete recovery 5 weeks after symptoms had started. We argue that the involuntary tongue movements were a side effect of citalopram. Furthermore, our patient used concomitant citalopram and methylphenidate, a combination which potentially elicits side effects. We include a video of the tongue movements in this patient.
http://ift.tt/2hk93x7
Malaria epidemiological research in the Republic of Congo
Background: Reliable and comprehensive information on the burden of malaria is critical for guiding national and international efforts in malaria control. The purpose of this review is to provide an overview of published data and available information on malaria resulting from field studies/investigations conducted in the Republic of Congo (RoC) from 1992 to 2015, as baseline for assisting public health authorities and researchers to define future research priorities as well as interventions. Methods: This review considers data from peer-reviewed articles and information from the National Malaria Control Programme reports, based on field investigations or samples collected from 1992 to 2015. Peer-reviewed papers were searched throughout online bibliographic databases PubMed, HINARI and Google Scholar using the following terms: "malaria", "Congo", "Brazzaville", "prevalence", "antimalarial", "efficacy", "falciparum", "genetic", "diversity". Original articles and reviews were included and selection of relevant papers was made. Results: Twenty-eight published articles were included in this review and two additional records from the National Malaria Control Programme were also considered. The majority of studies were conducted in Brazzaville and Pointe-Noire. Conclusion: The present systematic review reveals that number of studies have been conducted in the RoC with regard to malaria. However, their results cannot formally be generalized at the country level. This suggests a need for implementing regular multisite investigations and surveys that may be representative of the country, calling for the support and lead of the Ministry of Health.
http://ift.tt/2iktPNj
Minimally invasive (sinus tarsi) approach for calcaneal fractures
Background: According to the anatomic characteristics of the calcaneus and the sinus tarsi approach, we designed a combined plate. The goal of this study was to retrospectively assess the functional outcomes and complications of treatment with our self-designed plate. Methods: From March 2014 to October 2015, 18 patients with closed calcaneal fractures (14 Sanders type II and 4 type III) were treated with our combined locking plate through a minimally invasive sinus tarsi approach. All patients underwent both clinical and radiological evaluations. Results: The follow-up duration for all patients ranged from 6 to 13.5 months. The radiographs demonstrated significant corrections of the calcaneal width, length, height, Böhler angle, and Gissane angle from preoperatively to 3 months postoperatively and the last follow-up. However, there were no significant differences in the variables between 3 months postoperatively and the last follow-up. The mean Maryland foot score was 88.1 ± 8.8, in which excellent outcomes were achieved in 11 patients, good in 4, and fair in 3 (excellent and good rate, 83.3% (15 of 18)). No statistical significances in the mean Maryland foot score (88.1 ± 8.8 vs 87.8 ± 10.1, p = 0.9), and the excellent and good rate (85.7 vs 75.0%, p = 1.0) was found between type II and type III fractures. No complications were observed in all fractured feet. Conclusion: Treatment with our self-designed combined plate through a sinus tarsi approach may be safe and effective for type II and type III calcaneal fractures.
http://ift.tt/2h9k7Zh
Salmon roe (ikura)–induced anaphylaxis in a child
Source:Annals of Allergy, Asthma & Immunology
Author(s): Jasmit Minhas, John A. Saryan, Diana S. Balekian
http://ift.tt/2ikS0ex
Malaria epidemiological research in the Republic of Congo
Background: Reliable and comprehensive information on the burden of malaria is critical for guiding national and international efforts in malaria control. The purpose of this review is to provide an overview of published data and available information on malaria resulting from field studies/investigations conducted in the Republic of Congo (RoC) from 1992 to 2015, as baseline for assisting public health authorities and researchers to define future research priorities as well as interventions. Methods: This review considers data from peer-reviewed articles and information from the National Malaria Control Programme reports, based on field investigations or samples collected from 1992 to 2015. Peer-reviewed papers were searched throughout online bibliographic databases PubMed, HINARI and Google Scholar using the following terms: "malaria", "Congo", "Brazzaville", "prevalence", "antimalarial", "efficacy", "falciparum", "genetic", "diversity". Original articles and reviews were included and selection of relevant papers was made. Results: Twenty-eight published articles were included in this review and two additional records from the National Malaria Control Programme were also considered. The majority of studies were conducted in Brazzaville and Pointe-Noire. Conclusion: The present systematic review reveals that number of studies have been conducted in the RoC with regard to malaria. However, their results cannot formally be generalized at the country level. This suggests a need for implementing regular multisite investigations and surveys that may be representative of the country, calling for the support and lead of the Ministry of Health.
http://ift.tt/2iktPNj
Minimally invasive (sinus tarsi) approach for calcaneal fractures
Background: According to the anatomic characteristics of the calcaneus and the sinus tarsi approach, we designed a combined plate. The goal of this study was to retrospectively assess the functional outcomes and complications of treatment with our self-designed plate. Methods: From March 2014 to October 2015, 18 patients with closed calcaneal fractures (14 Sanders type II and 4 type III) were treated with our combined locking plate through a minimally invasive sinus tarsi approach. All patients underwent both clinical and radiological evaluations. Results: The follow-up duration for all patients ranged from 6 to 13.5 months. The radiographs demonstrated significant corrections of the calcaneal width, length, height, Böhler angle, and Gissane angle from preoperatively to 3 months postoperatively and the last follow-up. However, there were no significant differences in the variables between 3 months postoperatively and the last follow-up. The mean Maryland foot score was 88.1 ± 8.8, in which excellent outcomes were achieved in 11 patients, good in 4, and fair in 3 (excellent and good rate, 83.3% (15 of 18)). No statistical significances in the mean Maryland foot score (88.1 ± 8.8 vs 87.8 ± 10.1, p = 0.9), and the excellent and good rate (85.7 vs 75.0%, p = 1.0) was found between type II and type III fractures. No complications were observed in all fractured feet. Conclusion: Treatment with our self-designed combined plate through a sinus tarsi approach may be safe and effective for type II and type III calcaneal fractures.
http://ift.tt/2h9k7Zh
A survey of facilitators and barriers to recruitment to the MAGNETIC trial
Background: Recruitment to randomised controlled trials with children is challenging. It is imperative to understand the factors that boost or hinder recruitment of children to clinical trials. We conducted a survey of facilitators and barriers to recruitment to the MAGNETIC trial, using a previously developed web-based tool. Methods: MAGNETIC is a multicentre randomised trial of nebulised magnesium in acute severe asthma, recruiting 508 children from 30 UK sites. Recruiters were asked to grade a list of factors from –3 to +3 depending on whether the factor was perceived as a strong, intermediate or weak barrier (–3 to –1) or facilitator (+1 to + 3), and using (0) if it was thought to be not applicable. Free text responses were invited on strategies applied to counter the identified barriers. Results: The commonly identified facilitators were motivation and experience of study teams, effective communication and coordination between teams at site and between sites and the Clinical Trials Unit, the presence of designated research nurses, good trial management, clinical trial publicity, simple inclusion criteria, effective communication with parents and presentation of trial information in a simple and clear manner. The commonly identified barriers were heavy clinical workload, shift patterns of work, Good Clinical Practice (GCP) training, inadequate number of trained staff, time and setting of consent seeking, non-availability of research staff out of hours and parents' concerns about their child taking an experimental medicine. Having a designated research nurse, arranging GCP training and trial-related training sessions for staff were the most commonly reported interventions. Conclusions: This study highlights important generic and trial-specific facilitators and barriers to recruitment to a paediatric trial in the acute setting and provides information on the recruitment strategies or interventions that were applied to overcome these barriers. This information can be very useful in informing the design and conduct of future clinical trials with children, particularly in the acute or emergency setting.Trial registrationISRCTN, ISRCTN81456894. Registered on 15 November 2007.
http://ift.tt/2inLz6i
Sex differences in activation of lung-related type 2 innate lymphoid cells in experimental asthma
Source:Annals of Allergy, Asthma & Immunology
Author(s): Kristi J. Warren, Jenea M. Sweeter, Jacqueline A. Pavlik, Amy J. Nelson, Jane M. Devasure, John D. Dickinson, Joseph H. Sisson, Todd A. Wyatt, Jill A. Poole
http://ift.tt/2h9InKz
Malaria epidemiological research in the Republic of Congo
Background: Reliable and comprehensive information on the burden of malaria is critical for guiding national and international efforts in malaria control. The purpose of this review is to provide an overview of published data and available information on malaria resulting from field studies/investigations conducted in the Republic of Congo (RoC) from 1992 to 2015, as baseline for assisting public health authorities and researchers to define future research priorities as well as interventions. Methods: This review considers data from peer-reviewed articles and information from the National Malaria Control Programme reports, based on field investigations or samples collected from 1992 to 2015. Peer-reviewed papers were searched throughout online bibliographic databases PubMed, HINARI and Google Scholar using the following terms: "malaria", "Congo", "Brazzaville", "prevalence", "antimalarial", "efficacy", "falciparum", "genetic", "diversity". Original articles and reviews were included and selection of relevant papers was made. Results: Twenty-eight published articles were included in this review and two additional records from the National Malaria Control Programme were also considered. The majority of studies were conducted in Brazzaville and Pointe-Noire. Conclusion: The present systematic review reveals that number of studies have been conducted in the RoC with regard to malaria. However, their results cannot formally be generalized at the country level. This suggests a need for implementing regular multisite investigations and surveys that may be representative of the country, calling for the support and lead of the Ministry of Health.
http://ift.tt/2iktPNj
Minimally invasive (sinus tarsi) approach for calcaneal fractures
Background: According to the anatomic characteristics of the calcaneus and the sinus tarsi approach, we designed a combined plate. The goal of this study was to retrospectively assess the functional outcomes and complications of treatment with our self-designed plate. Methods: From March 2014 to October 2015, 18 patients with closed calcaneal fractures (14 Sanders type II and 4 type III) were treated with our combined locking plate through a minimally invasive sinus tarsi approach. All patients underwent both clinical and radiological evaluations. Results: The follow-up duration for all patients ranged from 6 to 13.5 months. The radiographs demonstrated significant corrections of the calcaneal width, length, height, Böhler angle, and Gissane angle from preoperatively to 3 months postoperatively and the last follow-up. However, there were no significant differences in the variables between 3 months postoperatively and the last follow-up. The mean Maryland foot score was 88.1 ± 8.8, in which excellent outcomes were achieved in 11 patients, good in 4, and fair in 3 (excellent and good rate, 83.3% (15 of 18)). No statistical significances in the mean Maryland foot score (88.1 ± 8.8 vs 87.8 ± 10.1, p = 0.9), and the excellent and good rate (85.7 vs 75.0%, p = 1.0) was found between type II and type III fractures. No complications were observed in all fractured feet. Conclusion: Treatment with our self-designed combined plate through a sinus tarsi approach may be safe and effective for type II and type III calcaneal fractures.
http://ift.tt/2h9k7Zh