Klippel-Feil syndrome (KFS) is associated with numerous craniofacial abnormalities but rarely with skull base tumor formation. We report an unusual and dramatic case of a symptomatic, mature skull base teratoma in an adult patient with KFS, with extension through the basisphenoid to obstruct the nasopharynx. This benign lesion was associated with midline palatal and cerebral defects, most notably pituitary and vertebrobasilar arteriolar duplications. A multidisciplinary workup and a complete endoscopic, transnasal surgical approach between otolaryngology and neurosurgery were undertaken. Out of concern for vascular control of the fibrofatty dense tumor stalk at the skull base and need for complete teratoma resection, we successfully employed a tissue resection tool with combined ultrasonic and bipolar diathermy to the tumor pedicle at the sphenoid/clivus junction. No CSF leak or major hemorrhage was noted using this endonasal approach, and no concerning postoperative sequelae were encountered. The patient continues to do well now 3 years after tumor extirpation, with resolution of all preoperative symptoms and absence of teratoma recurrence. KFS, teratoma biology, endocrine gland duplication, and the complex considerations required for successfully addressing this type of advanced skull base pathology are all reviewed herein.
http://ift.tt/2j7IBYf
Τρίτη 3 Ιανουαρίου 2017
Endoscopic Resection of Skull Base Teratoma in Klippel-Feil Syndrome through Use of Combined Ultrasonic and Bipolar Diathermy Platforms
Transoral submandibulotomy for deep hilar submandibular gland sialolithiasis
Objectives/Hypothesis
To assess the long-term results after transoral submandibulotomy for stones located in the deep hilar and intraparenchymal submandibular region.
Study Design
Retrospective cohort analysis.
Methods
Retrospective evaluation including all patients treated with transoral submandibulotomy for sialolithiasis at a tertiary referral center.
Results
Complete stone removal at the first transoral surgical treatment was achieved in 185 of 234 patients (79.1%). One hundred seventy-five of the 234 patients were followed up for a mean of 31.2 ( ± 20.5) months. During the follow-up period, 140 of the 175 patients (80.0%) became symptom free after one operation. In patients with residual symptoms, no further treatment was needed in 12 patients (6.9%) due to the mildness of the symptoms; 23 patients (13.1%) received further therapy, which was successful in 15 cases. Submandibulectomy only had to be performed in 3.4% of the patients with follow-up (6/175). In a questionnaire survey, 91.4% of the patients stated that they would be prepared to have the same operation again.
Conclusions
These findings show that transoral removal of submandibular sialoliths located in the deep hilum or adjacent intraglandular parenchyma is an effective treatment that can be assisted by additional measures. The techniques described show high success rates, good long-term results, low complication rates, and they avoided the need for submandibulectomy in >95% of cases.
Level of Evidence
4. Laryngoscope, 2017
http://ift.tt/2hPUX7g
Normal fluoroscopic appearance status post-successful endoscopic Zenker diverticulotomy
Objective
Endoscopic Zenker diverticulotomy (EZD) is a primary treatment for Zenker diverticulum (ZD). During EZD, the diverticulum is not excised, and interpretation of postoperative videofluoroscopic swallow study (VFSS) is challenging. The purpose of this investigation was to describe normal VFSS findings status post-successful EZD.
Methods
The charts of all patients with ZD treated at our center between October 01, 2011, and May 30, 2014, were abstracted. Outcome measures included recidivistic diverticulum size, Eating Assessment Tool-10 (EAT-10), penetration aspiration scale, pharyngeal constriction ratio (PCR), and pharyngoesophageal segment (PES) opening.
Results
Twenty patients met inclusion criteria. The mean age was 70.5 (± 13) years. Seventy percent of the patients were male. Mean EAT-10 decreased 72.1% from 17.9 (± 8.2) to 5 (± 6.9) (P < 0.0001), and diverticulum size decreased 50.9% from 1.96 cm (± 0.68) to 0.96 cm (± 0.57) (P < 0.001). The PCR improved 33.6% from 0.17 (± 0.13) to 0.11 (± 0.11) (P < 0.001). Mean PES opening increased 61.6% from 0.53 cm (± 0.3544) to 0.86 cm (± 0.29) in lateral view and increased 40.0% from 1.00 cm (± 0.54) to 1.39 cm (± 0.46) in anteroposterior view (P < 0.001).
Conclusion
VFSS following successful EZD demonstrates an approximate 50% reduction in diverticulum size and significant improvement in PCR and PES opening. These data provide a framework for the expected fluoroscopic outcomes of successful diverticulotomy.
Level of Evidence
4. Laryngoscope, 2017
http://ift.tt/2iO7lRX
Complete necrosis of hepatocellular carcinoma after preoperative portal vein embolization: a case report
Hepatocellular carcinoma has a poor prognosis; few patients can undergo surgical curative treatment according to Barcelona Clinic Liver Cancer guidelines. Progress in surgical techniques has led to operations ...
http://ift.tt/2j3ePQp
Prepancreatic postduodenal portal vein: a case report and review of the literature
Prepancreatic postduodenal portal vein is extremely rare, with only 13 cases reported in the literature.
http://ift.tt/2iGWko9
A stab wound to the axilla illustrating the importance of brachial plexus anatomy in an emergency context: a case report
Although open injuries involving the brachial plexus are relatively uncommon, they can lead to permanent disability and even be life threatening if accompanied by vascular damage. We present a case report of a...
http://ift.tt/2j3fMbv
Double localization of a non-anastomotic pseudoaneurysm after an axillofemoral bypass: a case report and review of the literature
A traumatic non-anastomotic pseudoaneurysm is a rare complication of an axillofemoral bypass graft. Fewer than 20 cases have been reported in the literature. Our case is unusual in that we report a double loca...
http://ift.tt/2iGWsEa
Hyperbaric oxygen therapy for a refractory skin ulcer after radical mastectomy and radiation therapy: a case report
Radiation therapy is performed as an adjuvant therapy when indicated following surgical resection of malignant tumors. However, radiation exposure induces acute or chronic dermatitis, depending on the radiatio...
http://ift.tt/2j37P5V
Amplified music exposure carries risks to hearing
Source:International Journal of Pediatric Otorhinolaryngology, Volume 93
Author(s): Valéria Gomes da Silva, Carlos Augusto Costa Pires de Oliveira, Pedro Luíz Tauil, Isabella Monteiro de Castro Silva, André Luiz Lopes Sampaio
ObjectiveTo investigate the association between changes in the outer hair cells and exposure to amplified music in a group of high-school students.Materials and methodsIn this retrospective, case-control study, 86 subjects underwent audiometry, immittance audiometry, and distortion-product otoacoustic emission tests. The subjects were questioned about their listening habits and divided into 2 groups: exposed and unexposed.ResultsMost of the subjects had reduced function in their outer hair cells, mainly beginning at 8 kHz. Among 60 subjects—30 cases and 30 controls—75% were considered exposed and 25% unexposed. The exposed subjects were 9.33 times more likely to have altered outer hair cells than the unexposed subjects were.ConclusionExposure to amplified music is associated with reduced function in the hair cells.
http://ift.tt/2iO48la
The path to cancer, and back: Immune modulation during hepatitis C virus infection, progression to fibrosis and cancer, and unexpected roles of new antivirals.
http://ift.tt/2iO5qgj
Targeted complement inhibition protects vascularized composite allografts from acute graft injury and prolongs graft survival when combined with subtherapeutic cyclosporine A therapy.
http://ift.tt/2hPSYjn
Synthesis and activity of the salicylic acid ester of bakuchiol in psoriasis-surrogate keratinocytes and skin substitutes
Summary
Background
Topical retinoids are effective in retarding skin ageing and restoring homeostasis in skin conditions such as psoriasis. However their adverse effects (AEs), which include irritation (retinoid dermatitis), photosensitivity and teratogenicity, limit their use and patient compliance. Development of retinoid analogues with minimal AEs would allow a broader and more compliant use.
Aim
To synthesise a novel molecule, bakuchiol salicylate (bakusylan), with a modulatory gene expression profile similar to retinoids, using as reference three prescription retinoids: tretinoin, tazarotene and adapalene.
Methods
We hypothesized that because bakuchiol salicylate has a structure entirely different from existing retinoids, there would be at least a partial uncoupling of AEs from the skin-normalizing activity of this retinoid. This hypothesis was tested at the transcriptional level in psoriatic cytokine-treated cultures of keratinocytes and organotypic skin substitutes, using DNA microarrays and custom PCR arrays.
Results
Evaluation of the gene expression profile of bakuchiol salicylate revealed elimination of several components of the retinoid-like proinflammatory response and teratogenic signature, without a substantial loss of normalizing potential. A possible mechanism of action, consisting of keratinocyte desensitization to psoriatic cytokine signalling through inhibition of the signal transducer and regulator of transcription (STAT)1/3/interferon inflammatory signal transduction axis was also identified.
Conclusion
Bipartite materials obtained by merging two skin-active entities with specific, complementary bioactivities, such as bakuchiol and salicylic acid, may yield a new class of functional retinoids.
http://ift.tt/2hR8867
Morphoea with prominent plasma cell endoneuritis
Summary
Morphoea (localized scleroderma) is a cutaneous inflammatory condition characterized by the development of indurated and discoloured plaques. The histological features of morphoea typically include a superficial and deep perivascular and periadnexal chronic inflammatory infiltrate associated with variable degrees of dermal and/or subcutaneous sclerosis. The infiltrate is typically composed of lymphocytes, macrophages and conspicuous plasma cells. The early stages of morphoea may have a very prominent inflammatory infiltrate associated with subtle sclerosis. In addition, the inflammatory infiltrate may show a perineural and rarely intraneural distribution. We report two cases of morphoea that histologically showed plasma cell endoneuritis associated with subtle dermal sclerosis. These two cases highlight the potential for diagnostic confusion with infectious and inflammatory diseases, particularly leprosy and lupus.
http://ift.tt/2iC1QWE
Use of nicotinamide in dermatology
Summary
Nicotinamide (niacinamide) is the water-soluble, amide form of vitamin B3. We review the evidence underlying the use of nicotinamide for various dermatological indications, including nonmelanoma cancer prophylaxis, blistering disorders, acne vulgaris and cosmetic indications, and speculate upon its future role in dermatological practice.
http://ift.tt/2hQWp7C
Use of optical coherence tomography for the diagnosis of preclinical lesions of circumscribed palmar hypokeratosis
Summary
Circumscribed hypokeratosis of palms and soles is a rare dermatosis, usually affecting women. Diagnosis is mainly based on the clinical characteristics, including the clinical appearance and anatomical site of the skin lesions and on the demographic features of the affected patients, usually middle-aged to elderly women. Skin biopsy may be performed to confirm clinical diagnosis. Optical coherence tomography (OCT) is a technique that has been undergone substantial development in dermatology in recent years, and its use in clinical practice has been growing progressively. Several dermatological conditions have been studied with this tool, but to our knowledge, it has not been used to investigate this form of hypokeratosis. We report a case of circumscribed palmar hypokeratosis for which diagnosis was confirmed by OCT, which was performed as the patient was reluctant to undergo skin biopsy because of its invasiveness. We highlight the potential use of OCT in obtaining a virtual skin biopsy to confirm clinical diagnosis and identify preclinical skin lesions amenable to early treatment.
http://ift.tt/2iC0knw
Innate immunity in cutaneous melanoma
Summary
The skin immune system is composed of a vast network of immune cells, including lymphocytes, macrophages, neutrophils, dendritic cells and Langerhans cells, which not only are involved in inflammatory responses but also contribute to homeostatic function and may participate in the various steps of carcinogenesis. Many studies support the notion that innate immunity has a key role in the development, growth and prognosis of cutaneous malignant melanoma (MM), through the release of pro- and/or anti-inflammatory cytokines and tumour growth factors. The tumour environment in a major subset of cutaneous MM shows evidence of a T cell-infiltrated phenotype, but there is less known about the presence and the phenotype of other immune system cells. Response to immunotherapy is largely correlated with the presence of T cells in the tumour microenvironment, while the regulation exerted by stromal components such as macrophages and mast cells has been less investigated. In the current report, we review the recent literature, focusing our attention on the role of macrophages, dendritic cells, mast cells and natural killer cells in orchestrating MM progression, to better understand tumour immunobiology. The identification of new therapeutic targets and the application of approaches aimed at modulating crosstalk between immune and tumour cells, could have a crucial impact on immunotherapy and result in better clinical outcome. We hope this review will be helpful in cutaneous MM research.
http://ift.tt/2iBXEqc
EACMFS Prizes and Awards
The Council of EACMFS wishes to ensure that all members of the Association are aware of the current awards and prizes that are available. These are designed to provide educational support and also to allow the opportunity for trainees and those who have recently achieved specialist status to visit units outside their own departments.
http://ift.tt/2iyowJp
Predictors of extracapsular extension in HPV-associated oropharyngeal cancer treated surgically
Source:Oral Oncology, Volume 65
Author(s): Mathew Geltzeiler, Daniel Clayburgh, John Gleysteen, Neil D. Gross, Bronwyn Hamilton, Peter Andersen, Daniel Brickman
ObjectivesExtracapsular extension (ECE) in cervical metastatic lymph nodes remains an indication for adding chemotherapy for patients with oropharyngeal squamous cell carcinoma (OPSCC). The aim of this study is to identify specific imaging characteristics on computed tomography (CT) scan that are predictive of ECE in order to better risk stratify patients preoperatively.Materials and methodsA single cohort study was performed using a prospectively collected database of patients with HPV-related OPSCC who underwent transoral robotic surgery with cervical lymphadenectomy. CT scans were assessed for the presence of multiple imaging characteristics, including lymph node size, number of nodes positive, cystic appearance, and border irregularity. Univariable and multivariable analyses were performed to analyze each variable's predictability of pathologic ECE.Results100 patients underwent TORS with cervical lymphadenectomy for OPSCC from 2010 to 2015. Ninety-one percent (21/23) of patients with 3 or more radiologically suspicious nodes were found to have pathologic ECE, which was a significantly greater proportion than patients with fewer suspicious nodes (p<0.001). CT scans with 3 or more radiologically suspicious nodes displayed a sensitivity and specificity of 55% and 94%, respectively with a positive predictive value (PPV) of 91% for ECE. Irregular borders and age were also correlated with ECE on multivariable analysis.Conclusion and relevanceThe presence of 3 or more radiologically suspicious lymph nodes on CT scan has a 91% PPV for any histologic evidence of ECE. The absolute number of radiographically suspicious lymph node metastases may be a useful method for risk-stratifying patients for the presence of ECE.
http://ift.tt/2iGuicG
A three-lncRNA signature derived from the Atlas of ncRNA in cancer (TANRIC) database predicts the survival of patients with head and neck squamous cell carcinoma
Source:Oral Oncology, Volume 65
Author(s): Wei Cao, Jian-nan Liu, Zeqi Liu, Xu Wang, Ze-Guang Han, Tong Ji, Wan-tao Chen, Xin Zou
ObjectiveLong non-coding RNAs (lncRNAs) have important biological functions and can be used as prognostic biomarkers in cancer. To identify a lncRNA prognostic signature for head and neck squamous cell carcinoma (HNSCC).MethodWe analysed RNA-seq data derived from the TANRIC database to identify a lncRNA prognostic signature model using the orthogonal partial least squares discrimination analysis (OPLS-DA) and 1.5-fold expression change criterion methods. The prognosis prediction model based on the lncRNA signatures and clinical parameters were evaluated using the 5-fold cross validation method.ResultsA total of 84 out of 3199 lncRNAs were significantly associated with the survival of patients with HNSCC (log-rank test P<0.01). Using the OPLS-DA and 1.5-fold change selection criterion, 5 lncRNAs (KTN1-AS1, LINC00460, GUSBP11, LINC00923 and RP5-894A10.6) were further selected. The prediction power of each combination of the 5 lncRNAs was evaluated through the receiver operating characteristic (ROC) curve and a three-lncRNA panel (KTN1-AS1, LINC00460 and RP5-894A10.6) achieved the highest prognostic prediction power (AUC 0.68, 95% CI 0.60–0.76, P<0.0001) in the cohort. The patients were categorized into high- and low-risk groups based on their three-lncRNA profiles. Patients with high-risk scores had worse overall survival than those with low risk scores in the cohort (log-rank test P=0.0003). Multivariable Cox regression analyses showed that the lncRNA signature and tumour grade were independent prognostic factors for patients with HNSCC.ConclusionsOur findings showed that the three-lncRNA signature might be a novel biomarker for the accurate prognosis prediction of patients with HNSCC.
http://ift.tt/2j2SrGH
Case of coeliac disease presenting in the psychiatry ward
Albino J Oliveira-Maia, Isabel Andrade, J Bernardo Barahona-Correa<br />Dec 21, 2016; 2016:201621682-201621682<br />case-report
http://ift.tt/2iNLkmo
Vertical muscle transposition with silicone band belting in VI nerve palsy
Ricardo Dourado Leite, Cristina Freitas, Sandra Guimaraes<br />Dec 14, 2016; 2016:201621672-201621672<br />case-report
http://ift.tt/2hPHEUa
Congenital dacryocystocele
Amar Pujari<br />Dec 9, 2016; 2016:201621802-201621802<br />case-report
http://ift.tt/2iNJWQB
Muscle mania: the quest for the perfect body
Maira Hameed, Ajay Sahu, Maria B Johnson<br />Dec 1, 2016; 2016:201621720-201621720<br />case-report
http://ift.tt/2hPJ6FX
Comfrey herbal remedy causing second-degree heart block: do not be outfoxed by digitalis
Mathew Kurian Vithayathil, Matthew Edwards<br />Dec 1, 2016; 2016:201621699-201621699<br />case-report
http://ift.tt/2iNLPws
When plenty is too much: water intoxication in a patient with a simple urinary tract infection
Laura Christine Lee, Maryann Noronha<br />Nov 1, 2016; 2016:201621688-201621688<br />case-report
http://ift.tt/2hPAHlU
Recurrent osteomyelitis of the mandible in osteopetrosis: a common complication of an uncommon disease
Anjali Saigal, Maragathavalli Gopal, Neeta Mohanty, Satya Ranjan Misra<br />Jun 8, 2015; 2015:201420897-201420897<br />case-report
http://ift.tt/2iNUlvI
TAZ Induction Directs Differentiation of Thyroid Follicular Cells from Human Embryonic Stem Cells
Thyroid , Vol. 0, No. 0.
http://ift.tt/2hPHdsT
If the Metabolic Winter Is Coming, When Will It Be Summer?
Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.
http://ift.tt/2hQHOcd
Ectopic Molar Removal from the Ramus/Condyle Unit: A Minimally Invasive Approach
Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0036-1594275
Ectopic molars within the mandibular ramus/condyle unit, although rare, present a unique challenge to the surgeon. Multiple approaches have been described in the literature for their removal. A review of the English literature on the subject of mandibular ectopic molars and their epidemiology, etiology, indications for removal, and surgical techniques was completed. In addition, a case report is presented of an ectopic mandibular molar in the mid-ramus region which was removed via a minimally invasive, intraoral, technique combining the use of endoscopy and piezoelectric surgery. The authors advocate this technique as it offers the following advantages: avoidance of injury to branches of the facial nerve, unaesthetic scars, and sialocele formation; maximization of surgical field visualization with limited dissection; ability for safe sectioning of the tooth with minimal risks to adjacent structures; and precise bone removal, reducing the risk of iatrogenic or postoperative mandible fracture.
[...]
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Article in Thieme eJournals:
Table of contents | Abstract | Full text
http://ift.tt/2ixsFNQ
Three-Dimensional Printing: Custom-Made Implants for Craniomaxillofacial Reconstructive Surgery
Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0036-1594277
Craniomaxillofacial reconstructive surgery is a challenging field. First it aims to restore primary functions and second to preserve craniofacial anatomical features like symmetry and harmony. Three-dimensional (3D) printed biomodels have been widely adopted in medical fields by providing tactile feedback and a superior appreciation of visuospatial relationship between anatomical structures. Craniomaxillofacial reconstructive surgery was one of the first areas to implement 3D printing technology in their practice. Biomodeling has been used in craniofacial reconstruction of traumatic injuries, congenital disorders, tumor removal, iatrogenic injuries (e.g., decompressive craniectomies), orthognathic surgery, and implantology. 3D printing has proven to improve and enable an optimization of preoperative planning, develop intraoperative guidance tools, reduce operative time, and significantly improve the biofunctional and the aesthetic outcome. This technology has also shown great potential in enriching the teaching of medical students and surgical residents. The aim of this review is to present the current status of 3D printing technology and its practical and innovative applications, specifically in craniomaxillofacial reconstructive surgery, illustrated with two clinical cases where the 3D printing technology was successfully used.
[...]
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Article in Thieme eJournals:
Table of contents | Abstract | Full text
http://ift.tt/2ixoYrB
Role of Interleukin-17A on the Chemotactic Responses to CCL7 in a Murine Allergic Rhinitis Model
by Yu-Lian Zhang, Doo Hee Han, Dong-Young Kim, Chul Hee Lee, Chae-Seo Rhee
BackgroundThe proinflammatory cytokine interleukin (IL)-17A is associated with eosinophil infiltration into the nasal mucosa in a mouse model of ovalbumin-induced allergic rhinitis. Chemotaxis of eosinophils is mediated primarily through C-C chemokine receptor type 3 (CCR3). However, the mechanism underlying the IL-17A-mediated enhancement of eosinophil recruitment via chemoattractants/chemokines remains unknown.
ObjectivesIn this study, we assessed the contribution of IL-17A to eosinophil-related inflammation via the CCL7/CCR3 pathway in experimental allergic rhinitis.
MethodsIL-17A knockout (KO) and wild-type (WT) BALB/c mice were injected intraperitoneally and challenged intranasally with OVA to induce allergic rhinitis. Various parameters of the allergic response were evaluated, and mRNA and protein levels of CCL7 and CCR3 in nasal tissue and serum were compared between the two groups. The chemotactic response to CCL7 with or without IL-17A in bone marrow-derived eosinophils (bmEos) from BALB/c mice was measured.
ResultsIn the allergic rhinitis model, IL-17A deficiency significantly decreased nasal symptoms, serum IgE levels, and eosinophil recruitment to the nasal mucosa. CCL7 and CCR3 mRNA and protein levels were decreased in the nasal mucosa of IL-17A KO mice compared with the WT mice. BmEos showed a significantly increased chemotactic response to -low concentration of CCL7 in the presence of IL-17A compared with its absence.
ConclusionThe suppression of nasal inflammation due of IL-17A deficiency in allergic rhinitis is partly responsible for the regulation of CCL7 secretion and eosinophil infiltration, which may be regulated via the CCL7/CCR3 pathway.
http://ift.tt/2j1h9Yb
Geschichte der Deutsch-Japanischen Dermatologischen Gesellschaft
Zusammenfassung
Zwischen der Deutschen und Japanischen Dermatologie bestehen traditionell starke Beziehungen. Diese Tatsache bewog Prof. Hornstein und Prof. Nishiyama, gemeinsame Tagungen von Dermatologen beider Länder zu organisieren. Das erste Treffen der Deutsch-Japanischen Dermatologischen Gesellschaft wurde in Erlangen im Anschluss an den 16. Weltkongress der Dermatologie im Jahr 1967 ausgerichtet. Seitdem wurden alternierend Tagungen in Deutschland und Japan abgehalten. Diese Tagungen wurden erfolgreich von Professoren beider Länder organisiert. In diesem Beitrag werden Erinnerungsfotos der gemeinsamen Tagungen präsentiert.
http://ift.tt/2iNlz5E
Selective induction of IL-1β after a brief isoflurane anesthetic in children undergoing MRI examination
Abstract
Purpose
To determine if isoflurane anesthesia without surgery causes systemic inflammation in children. Inflammation is targeted as responsible for the development of many neurologic pathologies. The effect will be evaluated by measuring serum cytokine levels before and after isoflurane anesthesia. The possible neurotoxic effect of anesthetic agents is a concern in pediatric anesthesia. Questions remain as to the true effects of anesthesia alone on systemic inflammation. The current study assesses systemic inflammatory response to general anesthesia in children not exposed to surgical stress.
Methods
Twenty-five patients, aged 6 months to 11 years undergoing MRI scanning were recruited. Patients with ASA Physical Status Classification >II, known neurologic disease, prematurity, recent infection, or current treatment with anti-inflammatory medications were excluded. Each patient received a sevoflurane induction, peripheral intravenous catheterization, and laryngeal mask airway placement. Isoflurane was titrated to ensure adequate depth of anesthesia. Two peripheral blood samples were obtained: one immediately after placement of the PIV and one upon arrival to the post-anesthesia care unit. Serum cytokine levels were compared between pre- and post-isoflurane time points using paired t tests.
Results
For all patients, interleukin-1β increased after isoflurane when compared to pre-isoflurane samples (pre = 25.97 ± 9.01, post = 38.53 ± 16.56, p = 0.0002). Serum levels of IL-6 (pre = 2.28 ± 2.27, post = 2.04 ± 2.15, p = 0.146) and tumor necrosis factor-α (pre = 94.26 ± 18.07, post = 85.84 ± 12.12, p = 0.057) were not significantly changed. Interleukin-10 and vascular endothelial growth factor were undetectable in pre- and post-isoflurane samples at a minimum detection threshold of 6.6 and 10 pg/ml, respectively.
Conclusions
A brief (approximately 60 min) exposure to isoflurane general anesthesia, without induced surgical stress, significantly increased serum IL-1β, a selective activation marker of systemic inflammation (IL-1β pathway).
http://ift.tt/2iwXTof
Swallowing action immediately before intravenous fentanyl at induction of anesthesia prevents fentanyl-induced coughing: a randomized controlled study
Abstract
Purpose
Fentanyl is a strong µ-opioid analgesic which attenuates the stimulation of surgical invasion and tracheal intubation. However, intravenous fentanyl often induces coughing [fentanyl-induced coughing (FIC)] during induction of anesthesia. We found that the swallowing action, when requested at induction of anesthesia, attenuated FIC. In the current study, we investigated the relationship between the occurrence of FIC and the swallowing action.
Methods
The study included American Society of Anesthesiologists physical status I or II patients, aged 20–64 years, who were undergoing elective surgery. They were divided into two groups—one group was urged to perform the swallowing action immediately before intravenous fentanyl (S group), and the other group performed no swallowing action (non-S group). The patients first received intravenous fentanyl and were observed for 90 s. Each patient's background, dose of fentanyl and occurrence of coughing were investigated from their records and a motion picture recording. The incidence of FIC was evaluated by chi-squared test, and severity was tested by Wilcoxon rank-sum test. P < 0.05 was considered statistically significant.
Results
The incidence of FIC in the S group and non-S group was 14.0 and 40.4%, respectively. The risk of FIC was reduced in the S group by 75%; risk ratio (95% confidence interval) was 0.35 (0.20, 0.60). The number of coughs in the S group were less than in the non-S group (P < 0.001).
Conclusion
The swallowing action immediately before intravenous fentanyl may be a simple and clinically feasible method for preventing FIC effectively.
Clinical trial number: UMIN000012086 (http://ift.tt/2ix8Fel).
http://ift.tt/2hNkhWy
Fear-avoidance beliefs are independently associated with the prevalence of chronic pain in Japanese workers
Abstract
Purpose
Pain is a global public health problem with implications for both personal and social heath. Fear-avoidance beliefs (FABs) have been demonstrated to negatively impact and prolong pain in many Western countries, but little is known about the association between FABs and chronic pain (CP) in Asian countries, including Japan. We examined the relationship between FABs and CP in Japanese white-collar workers, a growing population with a high prevalence of CP.
Methods
Questionnaires and company records were used to gather data from 433 Japanese white-collar workers. Data were related to experience of pain, participant sociodemographic/health/lifestyle characteristics, fear-avoidance beliefs [Tampa Scale for Kinesiophobia (TSK)], work-related psychosocial factors (Brief Job Stress Questionnaire), and depressive illness [Psychological Distress Scale (K6)]. Analysis of covariance and multilevel logistic regression modeling were used to analyze associations between the data while controlling for factors known to influence CP prevalence.
Results
Prevalence rate of CP was 11.1% (48 of 433 persons). Adjusted odds ratios for participants with CP significantly increased in participants with high TSK scores, even after adjusting for factors known to influence CP prevalence.
Conclusion
We found a significant association between high TSK scores and CP in Japanese white-collar workers when controlling for other known factors that influence CP such as work-related psychosocial characteristics and depressive conditions. This finding suggests that FABs are independently associated with prevalence of CP.
http://ift.tt/2ix643P
Semi-quantitative analysis of salivary gland scintigraphy in Sjögren’s syndrome diagnosis: a first-line tool
Abstract
Objective
The aim of this study was the assessment of semi-quantified salivary gland dynamic scintigraphy (SGdS) parameters independently and in an integrated way in order to predict primary Sjögren's syndrome (pSS).
Materials and methods
Forty-six consecutive patients (41 females; age 61 ± 11 years) with sicca syndrome were studied by SGdS after injection of 200 MBq of pertechnetate. In sixteen patients, pSS was diagnosed, according to American-European Consensus Group criteria (AECGc).
Semi-quantitative parameters (uptake (UP) and excretion fraction (EF)) were obtained for each gland. ROC curves were used to determine the best cut-off value. The area under the curve (AUC) was used to estimate the accuracy of each semi-quantitative analysis.
To assess the correlation between scintigraphic results and disease severity, semi-quantitative parameters were plotted versus Sjögren's syndrome disease activity index (ESSDAI). A nomogram was built to perform an integrated evaluation of all the scintigraphic semi-quantitative data.
Results
Both UP and EF of salivary glands were significantly lower in pSS patients compared to those in non-pSS (p < 0.001). ROC curve showed significantly large AUC for both the parameters (p < 0.05).
Parotid UP and submandibular EF, assessed by univariated and multivariate logistic regression, showed a significant and independent correlation with pSS diagnosis (p value <0.05). No correlation was found between SGdS semi-quantitative parameters and ESSDAI. The proposed nomogram accuracy was 87%.
Conclusion
SGdS is an accurate and reproducible tool for the diagnosis of pSS. ESSDAI was not shown to be correlated with SGdS data.
Clinical relevance
SGdS should be the first-line imaging technique in patients with suspected pSS.
http://ift.tt/2ixaCHI
Role of Interleukin-17A on the Chemotactic Responses to CCL7 in a Murine Allergic Rhinitis Model
by Yu-Lian Zhang, Doo Hee Han, Dong-Young Kim, Chul Hee Lee, Chae-Seo Rhee
BackgroundThe proinflammatory cytokine interleukin (IL)-17A is associated with eosinophil infiltration into the nasal mucosa in a mouse model of ovalbumin-induced allergic rhinitis. Chemotaxis of eosinophils is mediated primarily through C-C chemokine receptor type 3 (CCR3). However, the mechanism underlying the IL-17A-mediated enhancement of eosinophil recruitment via chemoattractants/chemokines remains unknown.
ObjectivesIn this study, we assessed the contribution of IL-17A to eosinophil-related inflammation via the CCL7/CCR3 pathway in experimental allergic rhinitis.
MethodsIL-17A knockout (KO) and wild-type (WT) BALB/c mice were injected intraperitoneally and challenged intranasally with OVA to induce allergic rhinitis. Various parameters of the allergic response were evaluated, and mRNA and protein levels of CCL7 and CCR3 in nasal tissue and serum were compared between the two groups. The chemotactic response to CCL7 with or without IL-17A in bone marrow-derived eosinophils (bmEos) from BALB/c mice was measured.
ResultsIn the allergic rhinitis model, IL-17A deficiency significantly decreased nasal symptoms, serum IgE levels, and eosinophil recruitment to the nasal mucosa. CCL7 and CCR3 mRNA and protein levels were decreased in the nasal mucosa of IL-17A KO mice compared with the WT mice. BmEos showed a significantly increased chemotactic response to -low concentration of CCL7 in the presence of IL-17A compared with its absence.
ConclusionThe suppression of nasal inflammation due of IL-17A deficiency in allergic rhinitis is partly responsible for the regulation of CCL7 secretion and eosinophil infiltration, which may be regulated via the CCL7/CCR3 pathway.
http://ift.tt/2j1h9Yb
Brainstem infarct after Le Fort I osteotomy: A morbid complication
With the evolution of advanced surgical skills, the Le Fort I osteotomy is commonly used to correct maxillofacial deformities, and the complications are well described, the most serious and life-threatening of which involve operative injury to the nerves and vital blood vessels.1–3 Iatrogenic injury to blood vessels may lead to massive blood loss and result in ischaemia of vital structures of the brain. We would like to report a brainstem stroke, a rare, unpreventable complication encountered during such a procedure.
http://ift.tt/2iFOyLj
Inhaled corticosteroid dose response in asthma
Inhaled corticosteroid (ICS) titration in asthma is primarily based on symptoms and pulmonary function. ICSs may not be increased on this basis despite residual airway inflammation.
http://ift.tt/2j6gkkH
Massive blood loss in elective spinal and orthopedic surgery: Retrospective review of intraoperative transfusion strategy
To evaluate the perioperative dynamics of hematologic changes and transfusion ratio in patients undergoing a major spinal surgery accompanied with massive bleeding defined as blood loss >5 liters.
http://ift.tt/2hNuJ0j
Gentamicin Applied to the Oval Window Suppresses Vestibular Function in Guinea Pigs
Abstract
Intratympanic gentamicin therapy is widely used clinically to treat the debilitating symptoms of Ménière's disease. Cochleotoxicity is an undesirable potential side effect of the treatment and the risk of hearing loss increases proportionately with gentamicin concentration in the cochlea. It has recently been shown that gentamicin is readily absorbed through the oval window in guinea pigs. The present study uses quantitative functional measures of vestibular and cochlea function to investigate the efficacy of treating the vestibule by applying a small volume of gentamicin onto the stapes footplate in guinea pigs. Vestibular and cochlea function were assessed by recording short latency vestibular evoked potentials in response to linear head acceleration and changes in hearing threshold, respectively, 1 and 2 weeks following treatment. Histopathology was analyzed in the crista ampullaris of the posterior semi-circular canal and utricular macula in the vestibule, and in the basal and second turns of the cochlea. In animals receiving gentamicin on the stapes footplate, vestibular responses were significantly suppressed by 72.7 % 2 weeks after treatment with no significant loss of hearing. This suggests that the vestibule can be treated directly by applying gentamicin onto the stapes footplate.
http://ift.tt/2hOftF2
Case reports: Should we do away with them?
There has been a gradual decline in the number of case reports published in leading medical journals in recent years. Since case reports are not highly cited they have an adverse effect on the journal impact factor. On the other hand sharing new experiences, challenges, or discoveries with colleagues is essential for medical community. Should case reports be eliminated from the journals or published only in journals devoted to case reports?
http://ift.tt/2iwUS7i
Deleting the HCN1 Subunit of Hyperpolarization-Activated Ion Channels in Mice Impairs Acoustic Startle Reflexes, Gap Detection, and Spatial Localization
Abstract
It has been proposed that the high temporal and spatial acuities of human listeners and animals tested in the hearing laboratory depend in part on the short time constants of auditory neurons that are able to preserve or sharpen the information conveyed in the timing of firing of auditory nerve fibers. We tested this hypothesis in a series of in vivo experiments, based on previous in vitro experiments showing that neuronal time constants are raised in brainstem slices when HCN1 channels are blocked or in slices obtained from Hcn1 −/− null mutant mice. We compared Hcn1 −/− and Hcn1 +/+ mice on auditory brainstem responses (ABRs) and behavioral measures. Those measures included temporal integration for acoustic startle responses (ASRs), ASR depression by noise offset, and ASR inhibition by gaps in noise and by shifts of a noise source along the azimuth as measures of temporal and spatial acuity. Hcn1 −/− mice had less sensitive ABR thresholds at 32 and 48 kHz. Their wavelet P1b was delayed, and wave 2 was absent in the 16 kHz/90 SPL waveform, indicating that groups of neurons early in the auditory pathways were delayed and fired asynchronously. Baseline ASR levels were lower in Hcn1 −/− mice, temporal integration was delayed, time constants for ASR depression by noise offset were higher, and their sensitivity to brief gaps and spatial acuity was diminished. HCN1 channels are also present in vestibular, cutaneous, digestive, and cardiac neurons that variously may contribute to the deficits in spatial acuity and possibly in ASR levels.
http://ift.tt/2iM1axS
The effect of second-stage pushing and body mass index on postdural puncture headache
To explore how pushing during labor and body mass index affect the development of postdural puncture headache in parturients who experienced dural puncture with Tuohy needles.
http://ift.tt/2hNoeuf
Intraoperative aberrant bispectral index values due to facial nerve monitoring
Bispectral index is an accepted depth of anaesthesia monitor for guiding intraoperative hypnotic agent administration. Frontalis EMG displayed on BIS monitor may increase due to twitching of frontalis muscle. EMG increases are also known to cause artefactual increases in BIS values. We report a case of artefactual increase of EMG and subsequently BIS values, due to electrical artefact from cranial nerve stimulator being used to identify the facial nerve. An explanation of the effect of stimulator signal on BIS EMG and BIS values has been provided.
http://ift.tt/2iwYRB7
Effects of the concurrent use of a reduced dose of propofol with divided supplemental remifentanil and moderate hyperventilation on duration and morphology of electroconvulsive therapy-induced electroencephalographic seizure activity: A randomized controlled trial
The clinical adequacy of electroconvulsive therapy (ECT) depends on not only seizure duration but also seizure amplitude and postictal suppression. The objective of this study was to evaluate the effects of combination of a reduced dose of propofol and moderate hyperventilation on seizure duration and electrical stimulus requirement for adequate ictal amplitude and postictal suppression.
http://ift.tt/2hNjhBL
Dexmedetomidine decreases the required amount of bupivacaine for ultrasound-guided transversus abdominis plane block in pediatrics patients: a randomized study
The effect of dexmedetomidine on the potency of bupivacaine for transversus abdominis plane (TAP) block in pediatric patients has not been investigated.
http://ift.tt/2ix0COK
Effects of pneumoperitoneum on severe hypernatremia in an adult patient who underwent laparoscopic surgery of hydatid cysts
We describe the first case of severe hypernatremia associated to laparoscopic surgery for hydatid cyst in an adult patient after the use of hypertonic saline solution with complete resolution. Severe hypernatremia is an unusual fact at the immediate postoperative period but may have fatal consequences for the patient and need immediate action. The patient reached a serum sodium concentration of 179 mmol/L without adverse effects after 6 days of treatment. Laparoscopy could play a crucial role in Na+ absorption due to high intraabdominal pressure caused by the pneumoperitoneum and its limitations to avoid peritoneal absorption of hypertonic saline solution.
http://ift.tt/2hNuQIU
Assessment of treatment response in patients with laryngopharyngeal reflux
Abstract
To evaluate treatment response in patients with laryngopharyngeal reflux (LPR). A prospective study of 100 patients with voice disorders was conducted. Patients were evaluated using reflux symptom index (RSI) and reflux finding score (RFS) by 70° rigid laryngoscope. Patients with RFS score of 7 or more were diagnosed of having LPR and were started with anti-reflux therapy for a period of 6 months. Patients were assessed at regular intervals using RSI and RFS. The prevalence of LPR in patients with voice disorders was found to be 25%. The mean RSI score improved gradually and significantly over a period of 6 months from 11.84 at presentation to 2.04 after 6 months of treatment (p value <0.001). The mean value of RFS improved from 7.92 at entry to 1.52 after 6 months of treatment (p value <0.001). However, it was found that the improvement was not significant at end of first month of treatment, and improvement in RSI and RFS scores was found only after 2 months of treatment. RSI and RFS improve significantly after treatment for 6 months with PPI like Omeprazole. But the improvement starts from the 2nd month from the onset of treatment. Treatment of LPR for at least 6 months may be indicated to attain a full resolution of physical findings.
http://ift.tt/2i7EGGD
Primary transoral robotic surgery with concurrent neck dissection for early stage oropharyngeal squamous cell carcinoma implemented at a Danish head and neck cancer center: a phase II trial on feasibility and tumour margin status
Abstract
There is an increasing incidence of oropharyngeal squamous cell carcinoma (OPSCC) in the western world due to human papillomavirus (HPV). According to the Danish Head and Neck Cancer Group guidelines, the current recommended treatment of patients with OPSCC in Denmark is primary radiation therapy (RT) with or without concomitant chemotherapy. This is the first study in Scandinavia from a head and neck cancer centre that aims to demonstrate the feasibility of performing primary transoral robotic surgery (TORS) and concurrent neck dissection for patients with early stage OPSCC. Between September 2014 and January 2016, 30 consecutive patients with clinical T1–T2, N0–N1 OPSCC underwent primary TORS and concurrent neck dissection. The patients were offered postoperative adjuvant therapy according to pathological risk parameters: pT >2, T-site margin <2 mm, pN >1 or extracapsular extension (ECE). Concomitant chemotherapy was offered to patients with the presence of ECE or involved margins. Twenty-nine patients had negative margins on T-site after primary resection. Only one patient had a close margin of 1 mm. Unilateral neck dissection was performed in 21 patients while nine patients underwent bilateral neck dissection. Due to an upstaging following surgery, 13 patients were referred to adjuvant therapy. Four of these patients received RT and two patients received concomitant chemo-radiation (CCR) therapy. Seven patients declined the recommended adjuvant therapy one of whom later developed an N-site recurrence and received salvage surgery with postoperative RT. In summary, 43% of the patients were referred to adjuvant therapy following primary surgery which was mainly due to N-site stage migration and ECE. Primary TORS and concurrent neck dissection is a safe and feasible procedure that may be an alternative to primary RT and CCR in a selected group of patients with early stage OPSCC.
http://ift.tt/2hOQgur
Assessment of treatment response in patients with laryngopharyngeal reflux
Abstract
To evaluate treatment response in patients with laryngopharyngeal reflux (LPR). A prospective study of 100 patients with voice disorders was conducted. Patients were evaluated using reflux symptom index (RSI) and reflux finding score (RFS) by 70° rigid laryngoscope. Patients with RFS score of 7 or more were diagnosed of having LPR and were started with anti-reflux therapy for a period of 6 months. Patients were assessed at regular intervals using RSI and RFS. The prevalence of LPR in patients with voice disorders was found to be 25%. The mean RSI score improved gradually and significantly over a period of 6 months from 11.84 at presentation to 2.04 after 6 months of treatment (p value <0.001). The mean value of RFS improved from 7.92 at entry to 1.52 after 6 months of treatment (p value <0.001). However, it was found that the improvement was not significant at end of first month of treatment, and improvement in RSI and RFS scores was found only after 2 months of treatment. RSI and RFS improve significantly after treatment for 6 months with PPI like Omeprazole. But the improvement starts from the 2nd month from the onset of treatment. Treatment of LPR for at least 6 months may be indicated to attain a full resolution of physical findings.
http://ift.tt/2i7EGGD
Alterations in Evoked Otoacoustic Emissions by the Use of Meglumine Antimoniate in American Tegumentary Leishmaniasis Patients
by Débora Cristina de Oliveira Bezerra, Renata Oliveira de Barcelos, Ellen Carvalho de Castro, Claudia Cristina Jardim Duarte, Raquel de Vasconcellos Carvalhaes Oliveira, Tania Salgado de Sousa Torraca, Maria Helena de Araújo-Melo, Frederico Pereira Bom Braga, Benivaldo Ramos Ferreira Terceiro, Lúcia Regina do Nascimento Brahim Paes, Armando de Oliveira Schubach, Cláudia Maria Valete-Rosalino
IntroductionTegumentary Leishmaniasis (TL) is a neglected, non-contagious, infectious disease, caused by different protozoa species of the Leishmania genus that affects skin and mucous membranes. Meglumine Antimoniate (MA), the first drug of choice for TL treatment in Brazil, has already been associated with cochlear toxicity, which is defined as damages of the cochlea caused by exposure to chemical substances, resulting in reversible or irreversible hearing loss. Auditory monitoring for cochlear toxicity aims at the early detection of auditory disorders, enabling, when possible, hearing to be preserved or an early auditory rehabilitation. Although otoacoustic emissions (OAEs) are used in this monitoring, there is no consensus on the criteria that define cochlear toxicity by this examination. The objective of this study was to describe the characteristics of the OAEs in cochlear toxicity monitoring in TL patients using MA.
MethodsProspective and longitudinal study of auditory monitoring of 35 patients with parasitological diagnosis of TL, with liminal tonal audiometry, high frequency audiometry, immitanciometry, distortion product evoked otoacoustic emissions (DPEOAEs) and transient evoked otoacoustic emissions (TEOAEs) before treatment, at the end of treatment, one month after the end of treatment and two months after the end of treatment.
Results80% male, with median age of 44 years (IIQ: 22–59). In the pre-treatment evaluation: 11.4% complained of hearing loss and 20% of tinnitus, 48.6% presented auditory alterations in liminal tonal audiometry (LTA, 65.2% in high frequency audiometry (HFA), 26.6% in DPEOAE and 51.4% in TEOAE. No association was verified between genre and alterations in the EOAE examinations. We observed that patients that presented disorders in DPEOAE examinations were 17 years older than those without alterations and that patients that showed disorders in TEOAEO examinations were 34 years older than those without disorders. The presence of alterations in DPEOAE and TEOAE before beginning treatment was associated with each other and with the presence of alterations in LTA and HFA, and only DPEOAE was associated with hearing loss. We observed a significantly higher number of alterations of DPEOAE at the end of treatment than during pre-treatment and values of the ratio signal/noise significantly smaller at the end of treatment than during pre-treatment in the frequencies of 2 kHz (difference of 1.7dB; p = 0.016) and 4 kHz (difference of 2.45dB; p = 0.016) in DPEOAE and in the range 1.75/2.5 kHz in TEOAE (difference of 2.9dB; p = 0.039).
ConclusionThe ototoxic signals observed in our study using EOAE indicated that both, DPEOAE and TEOAE are adequate and sensitive techniques for clinical monitoring of ototoxicity by MA. Their application is very simple, and their results help the physician to take the most adequate steps for each patient, thus avoiding permanent hearing damage.
http://ift.tt/2iAr5ZF
Happy New Year from the ATA
The post Happy New Year from the ATA appeared first on American Thyroid Association.
http://ift.tt/2i6R7Tn
A Review of the Evidence for Melanoma in Nine Inca Mummies
Abstract
An often cited statement in the medical literature is that nine Inca mummies (c.400 BC) had skin and osseous lesions from melanoma. However, a review of the incidence of melanoma in modern populations, the incidence of non-melanoma skin cancer in modern Peru, the pattern and type of osseous lesions exhibited by these individuals, and the age of at least one of them indicate the data are inconsistent with a diagnosis of melanoma.
http://ift.tt/2i7dUye
Gentamicin Applied to the Oval Window Suppresses Vestibular Function in Guinea Pigs
Abstract
Intratympanic gentamicin therapy is widely used clinically to treat the debilitating symptoms of Ménière's disease. Cochleotoxicity is an undesirable potential side effect of the treatment and the risk of hearing loss increases proportionately with gentamicin concentration in the cochlea. It has recently been shown that gentamicin is readily absorbed through the oval window in guinea pigs. The present study uses quantitative functional measures of vestibular and cochlea function to investigate the efficacy of treating the vestibule by applying a small volume of gentamicin onto the stapes footplate in guinea pigs. Vestibular and cochlea function were assessed by recording short latency vestibular evoked potentials in response to linear head acceleration and changes in hearing threshold, respectively, 1 and 2 weeks following treatment. Histopathology was analyzed in the crista ampullaris of the posterior semi-circular canal and utricular macula in the vestibule, and in the basal and second turns of the cochlea. In animals receiving gentamicin on the stapes footplate, vestibular responses were significantly suppressed by 72.7 % 2 weeks after treatment with no significant loss of hearing. This suggests that the vestibule can be treated directly by applying gentamicin onto the stapes footplate.
http://ift.tt/2hOftF2
Deleting the HCN1 Subunit of Hyperpolarization-Activated Ion Channels in Mice Impairs Acoustic Startle Reflexes, Gap Detection, and Spatial Localization
Abstract
It has been proposed that the high temporal and spatial acuities of human listeners and animals tested in the hearing laboratory depend in part on the short time constants of auditory neurons that are able to preserve or sharpen the information conveyed in the timing of firing of auditory nerve fibers. We tested this hypothesis in a series of in vivo experiments, based on previous in vitro experiments showing that neuronal time constants are raised in brainstem slices when HCN1 channels are blocked or in slices obtained from Hcn1 −/− null mutant mice. We compared Hcn1 −/− and Hcn1 +/+ mice on auditory brainstem responses (ABRs) and behavioral measures. Those measures included temporal integration for acoustic startle responses (ASRs), ASR depression by noise offset, and ASR inhibition by gaps in noise and by shifts of a noise source along the azimuth as measures of temporal and spatial acuity. Hcn1 −/− mice had less sensitive ABR thresholds at 32 and 48 kHz. Their wavelet P1b was delayed, and wave 2 was absent in the 16 kHz/90 SPL waveform, indicating that groups of neurons early in the auditory pathways were delayed and fired asynchronously. Baseline ASR levels were lower in Hcn1 −/− mice, temporal integration was delayed, time constants for ASR depression by noise offset were higher, and their sensitivity to brief gaps and spatial acuity was diminished. HCN1 channels are also present in vestibular, cutaneous, digestive, and cardiac neurons that variously may contribute to the deficits in spatial acuity and possibly in ASR levels.
http://ift.tt/2iM1axS
Oral health improvements in Switzerland over 20 years
While the time trends in oral health are favourable, differences still persist in dental status and in prosthetic dental restorations (PDR) between population subgroups. This study aimed to identify changes in oral health in Switzerland over two decades and to describe their relationship to sociodemographic factors in 2012. Swiss Health Surveys were conducted in 1992, 2002, and 2012. The mean number of missing teeth and the prevalence of PDR were calculated at each time point. Logistic regression analysis was performed to assess associations between the prevalence of PDR and sociodemographic factors. The mean number of missing teeth decreased from five in 1992 to three in 2012. Dental status – as indicated by the number of teeth present – improved across all sociodemographic groups, with the greatest improvements being found in obese participants and in participants with the lowest incomes and educational levels. The prevalence of implant-based restorations increased from 3.2% in 2002 to 9.8% in 2012, and the shift from fixed to removable restorations occurred in the age group being 10 years older. The overall prevalence of PDR decreased in middle-aged people. In conclusion, over the two decades of the study, the oral health of the Swiss population substantially improved. Although sociodemographic differences persisted, they decreased considerably in terms of the number of missing teeth and percentage of the population with a functional dentition.
http://ift.tt/2iz4sVt
Thymoma-associated multi-organ autoimmunity: two cases and a review of the literature
Thymoma-associated multi-organ autoimmunity (TAMA) is defined as a disease of the liver, intestine, and skin, which histopathologically resembles graft-versus-host disease (GVHD).1,2 Several sporadic cases imply that cutaneous manifestations of TAMA are associated with a poor prognosis.2-5 However, it is difficult to examine the association because of the rarity of the disease. Herein we describe two cases of TAMA with cutaneous lesions and fatal courses, and review the literature with a focus on the prognosis.
This article is protected by copyright. All rights reserved.
http://ift.tt/2iv2ck3
Cytokine profile after oral food challenge in infants with food protein-induced enterocolitis syndrome
Publication date: Available online 2 January 2017
Source:Allergology International
Author(s): Mitsuaki Kimura, Yasunori Ito, Masaki Shimomura, Hideaki Morishita, Takaaki Meguro, Yuichi Adachi, Shiro Seto
BackgroundAlthough food protein-induced enterocolitis syndrome (FPIES) is supposed to be caused by inflammation, the role of cytokines has not yet been clarified.MethodsTo elucidate the role of cytokines in the development of symptoms and abnormal laboratory findings at an oral food challenge (OFC), changes in serum cytokine levels were analyzed for 6 OFCs in 4 patients with FPIES. The result of OFC was judged positive if any gastrointestinal (GI) symptoms (vomiting, diarrhea, or bloody stool) were induced.ResultsAmong 11 cytokines profiled, serum levels of interleukin (IL)-2, IL-5, and IL-8 were clearly increased in all 4 positive OFCs in which elevations of the serum level of C-reactive protein (CRP) and peripheral blood neutrophilia were also seen. The level of serum IL-10 also rose in 2 positive OFCs. Remarkable increases in the serum level of interferon-gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α), IL-6, and IL-12 were observed in a positive OFC where the serum level of CRP rose markedly (6.75 mg/dL). The serum levels of IL-5 were also elevated in 2 negative OFCs. No apparent specific correlations were found between cytokines and GI symptoms.ConclusionsThese results suggest that IL-2 and IL-8 are involved in the antigen-specific immune responses in most patients with FPIES. Further studies are needed to elucidate the significance of these cytokine in the pathogenesis of FPIES.
http://ift.tt/2i5OqB7
Atopic dermatitis: immune deviation, barrier dysfunction, IgE autoreactivity and new therapies
Publication date: Available online 2 January 2017
Source:Allergology International
Author(s): Masutaka Furue, Takahito Chiba, Gaku Tsuji, Dugarmaa Ulzii, Makiko Kido-Nakahara, Takeshi Nakahara, Takafumi Kadono
Atopic dermatitis (AD) is a chronic or chronically relapsing, eczematous, severely pruritic skin disorder mostly associated with IgE elevation and skin barrier dysfunction due to decreased filaggrin expression. The lesional skin of AD exhibits Th2- and Th22-deviated immune reactions that are progressive during disease chronicity. Th2 and Th22 cytokines further deteriorate the skin barrier by inhibiting filaggrin expression. Some IgEs are reactive to self-antigens. The IgE autoreactivity may precipitate the chronicity of AD. Upon activation of the ORAI1 calcium channel, atopic epidermis releases large amounts of thymic stromal lymphopoietin (TSLP), which initiates the Th2 and Th22 immune response. Th2-derived interleukin-31 and TSLP induce an itch sensation. Taken together, TSLP/Th2/Th22 pathway is a promising target for developing new therapeutics for AD. Enhancing filaggrin expression using ligands for the aryl hydrocarbon receptor may also be an adjunctive measure to restore the disrupted barrier function specifically for AD.
http://ift.tt/2j48Ajh
Pre-emptive analgesic effect of lornoxicam in mandibular third molar surgery: a prospective, randomized, double-blind clinical trial
The aim of this study was to establish whether the pre-emptive use of lornoxicam (16mg) in third molar surgery ensures successful postoperative analgesia and reduces rescue analgesic intake when compared to postoperative application, and in comparison with placebo. Ninety patients were split randomly into three groups: group A received lornoxicam 60min before surgery and placebo 60min after surgery; group B received placebo 60min before surgery and lornoxicam 60min after surgery; group C received placebo 60min before surgery and placebo 60min after surgery.
http://ift.tt/2iuKdKi
Anti-Tumor Necrosis Factor α-induced Lupus Erythematosus Panniculitis
Abstract
Anti-tumor necrosis factor alpha (TNFα) therapies are used with success in many chronic inflammatory diseases. A wide range of adverse events has been reported in patients receiving these agents1, including lichenoid eruptions, lupus-like syndrome1, 2 and psoriasiform eruptions3. Lupus erythematosus panniculitis (LEP) is a rare variant of cutaneous lupus erythematosus (CLE), which occurs approximately in 1%-3% of CLE. Here we report a case of a patient with rheumatoid arthritis (RA) treated with anti-TNFα that developed skin lesions clinically and pathologically compatible with LEP.
This article is protected by copyright. All rights reserved.
http://ift.tt/2iyJ6HO
Skin ultrasound features of Merkel-cell carcinoma
Abstract
Merkel-cell carcinoma (MCC) is an uncommon, highly aggressive skin tumor with a low but growing incidence1. MCC usually shows a non-specific clinical presentation. Diagnostic confirmation by histopathological and immunohistochemical evaluation are required2.
The role of ultrasound is becoming increasingly important in the diagnosis of numerous skin cancers due to its ability to recognize different sonographic patterns and accurately delimit the real tumour dimensions3.
This article is protected by copyright. All rights reserved.
http://ift.tt/2hNxtxL
PD-L1 expression and survival among melanoma patients treated with standard immunotherapy or chemotherapy
Abstract
The association between programmed death ligand 1 (PD-L1) expression and survival among melanoma patients treated with chemotherapy is unclear.1-5 We retrospectively characterized PD-L1 levels in patients with melanoma treated at Aarhus University Hospital in Denmark (2001-2012) using a prototype immunohistochemistry assay (QualTek Molecular Laboratories, Goleta, California, USA) and investigated the association between PD-L1 and overall survival (OS) in patients who received chemotherapy or immunotherapy (interleukin-2, interferon, ipilimumab). None of the patients received pembrolizumab or nivolumab.
This article is protected by copyright. All rights reserved.
http://ift.tt/2hLlvlc
Mutational spectrum of EDA and EDAR genes in a cohort of Mexican mestizo patients with hypohidrotic ectodermal dysplasia
Abstract
Hypohidrotic ectodermal dysplasia (HED) has a prevalence of 1:5,000-10,000 newborns and it is characterized by hypotrichosis and abnormalities in teeth and sweat glands.1 Most patients have an X-linked (XLHED) pattern of inheritance due to mutations in EDA which encodes for ectodysplasin. In addition, three HED-associated autosomal genes are known: EDAR which encodes for an ectodysplasin receptor; EDARADD corresponding to a cytoplasmic adaptor molecule and WNT10A which encodes for a signaling molecule of the WNT/β-catenin pathway.1-4
This article is protected by copyright. All rights reserved
http://ift.tt/2iuxQOJ
Increased non-melanoma skin cancer risk in young patients with inflammatory bowel disease on immunomodulatory therapy: a retrospective single centre cohort study
Abstract
Background
Recent studies report an increased risk of non-melanoma skin cancer (NMSC) in immunosuppressed patients with inflammatory bowel disease (IBD). Concurrently, paediatric IBD incidence is rising, with more patients now exposed to immunomodulators from a younger age.
Objectives
To investigate NMSC incidence and to examine the risk associated with immunomodulators in the development of NMSC in patients with IBD.
Methods
This was a retrospective single centre cohort study. Patients with IBD attending a tertiary adult hospital from 1994 - 2013 were included. Skin cancer incidence was compared with population data from the National Cancer Registry of Ireland (NCRI) to calculate standardised incidence ratios (SIR). Logistic regression was utilised for risk factor analysis.
Results
2053 patients with IBD were studied. The SIR for NMSC in IBD patients taking immunomodulators overall was 1.8 (95% CI 1.0-2.7) with age specific rates significantly elevated across certain age categories. Exposure to thiopurines (OR: 5.26, 95% CI 2.15 – 12.93, p <0.001) and in particular thiopurines and/or tumour necrosis factor alpha (TNFα) inhibitors (OR: 6.45, 95% CI 2.69 – 15.95, p <0.001) was significantly associated with NMSC. The majority (82%) of those exposed to a TNFα inhibitor also had thiopurine exposure.
Conclusions
Compliance with skin cancer preventative measures should be highlighted to all patients with IBD. There should be a low threshold for dermatology referral for immunosuppressed patients, particularly those with a history of exposure to dual immunomodulators from a young age.
This article is protected by copyright. All rights reserved.
http://ift.tt/2iuGFrM
Public primary and secondary skin cancer prevention, perceptions and knowledge: An international cross-sectional survey
Abstract
Background
The incidence of melanoma and non-melanoma skin cancer is continuing to increase worldwide, with sun exposure serving as the primary external etiologic force in its development. Despite noticeable public health efforts, there continue to be gaps in public awareness and primary and secondary prevention mechanisms. This survey study sought to investigate preventative behaviors regarding sun exposure and skin cancer detection at an international scale.
Methods
A questionnaire was submitted, both online and by telephone, to a representative sample (based on official demographic statistics on gender, age and region) of people aged from 15 to 65 originating from 23 countries. Questions dealt with demographics, sun exposure and protection, risk knowledge, self-examination, medical advice seeking. Data were then gathered and analyzed at different levels.
Results
19,569 respondents were recruited. Overall, sunscreen and sunglasses were the most used measures for sun protection. There were however difference between countries and geographical areas. Some high-risk countries in terms of sun exposure (according to their location to Equator) exhibited higher rates of primary preventative behaviors, in particular Australia, Chile and Greece. There were also discrepancies between countries regarding secondary prevention through self-examination and medical advice seeking. Young people, men, individuals belonging to a lower socioeconomic class or having a lower education level were all least likely to know or follow primary and secondary preventive measures.
Conclusion
We found imperfections and geographical inequality both regarding primary and secondary prevention of skin cancer. Our study provides insights that could help to target populations more effectively through information campaigns embedded into the global needed endeavor aiming to reduce mid- and long-term development of skin cancer.
This article is protected by copyright. All rights reserved.
http://ift.tt/2hLdOLS
Pre-emptive analgesic effect of lornoxicam in mandibular third molar surgery: a prospective, randomized, double-blind clinical trial
Publication date: Available online 2 January 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): I.M. Mojsa, J. Stypulkowska, P. Novak, K. Lipczynski, K. Szczeklik, M. Zaleska
The aim of this study was to establish whether the pre-emptive use of lornoxicam (16mg) in third molar surgery ensures successful postoperative analgesia and reduces rescue analgesic intake when compared to postoperative application, and in comparison with placebo. Ninety patients were split randomly into three groups: group A received lornoxicam 60min before surgery and placebo 60min after surgery; group B received placebo 60min before surgery and lornoxicam 60min after surgery; group C received placebo 60min before surgery and placebo 60min after surgery. Postoperative pain was recorded on a visual analogue scale and on a numerical rating scale at 1, 2, 4, 6, 8, 12, and 24h after surgery. The patients recorded total dose of paracetamol intake during the 24h after the procedure. The efficacy of postoperative analgesia was greater in lornoxicam groups when compared to the placebo group; there was no difference between the two lornoxicam groups (A and B). Patients in group C took their first rescue analgesic dose earlier after surgery than patients in the two lornoxicam groups. The average dose of paracetamol taken in group C was 1000mg, while it was500 mg in the lornoxicam groups.
http://ift.tt/2iDPa4l
Bilateral Half-Head Comparison of 1% Anthralin Ointment in Children with Alopecia Areata
Abstract
Background/Objectives
Alopecia areata (AA) is one of the most difficult skin diseases to manage well. In children, anthralin is commonly used for the treatment of AA. Available research consists of a limited number of uncontrolled trials that assessed the effectiveness of anthralin in promoting hair growth in patients with AA. The objective of this study was to validate the clinical effectiveness of short-contact anthralin 1% ointment in children with AA.
Methods
Thirty children with chronic, severe, treatment-refractory, extensive AA were treated with 1% anthralin ointment. One side of the scalp was treated with anthralin for 12 months and the other side was left untreated. Outcomes were evaluated according to the Severity of Alopecia Tool (SALT) score.
Results
The mean time to first response in terms of new hair growth was 3 months and the mean time to maximal response was 9 months. In the first 12-month period, 10 patients (33.4%) achieved complete response to treatment and 11 patients (36.6%) had a partial response. Of the 11 patients with partial response at the end of the first year, 6 achieved a complete response before the end of the study. Total SALT scores for the entire scalp decreased from the end of the first year to the end of the 2-year period. No serious adverse events were observed.
Conclusion
Anthralin 1% is an effective therapy for AA and should be continued at least 9 months. At 9 months of topical anthralin therapy, the patients with at least a 50% reduction in their pretreatment SALT scores should continue the same treatment for at least 1 year. Anthralin is safe in children with chronic, severe, treatment-refractory, extensive AA.
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