Lateral skull base surgery in a pediatric population: A 25-year experience in a referral skull base center

Publication date: Available online 14 January 2017
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Golda Grinblat, Sampath Chandra Prasad, Andrea Fulcheri, Melissa Laus, Alessandra Russo, Mario Sanna
ObjectiveTo analyze the pathology and surgical outcomes of lateral skull base (LSB) procedures in a pediatric population.Study DesignRetrospective case review in a referral skull base center.MethodsCharts of pediatric patients who underwent defined LSB procedures from 1983 to 2015 for various pathologies were evaluated at our center. A systematic review of literature was performed and our results were compared with the literature.Results63 patients presented with 65 diseased ears. The mean age was 13 years. 29 (44.6%) presented with hearing loss and 28 (44.4%) and chronic otorrhea. The most common pathology was petrous bone cholesteatoma (27, 42.5%) followed by vestibular schwannoma (10, 15.8%). Subtotal petrosectomy (24, 35.8%) was the most common surgical procedure followed by, transotic (18, 26.8%). The facial nerve function was preserved in 45 (67.1%) and the hearing in 28 (41.7%) cases respectively. No major complications, including mortality was encountered in our series.ConclusionIn rare and extensive pathologies involving the skull base in a pediatric population, the surgeon is posed with the dilemma of trying to achieve facial and hearing preservation while dealing with total tumor clearance. Mastery over LSB procedures can ensure complete disease clearance with optimal functional outcomes.Level of evidence2b.



http://ift.tt/2iVACty

A simple method to control the distal tip of nasotracheal tube using the surgical suture

With great interest, we read the recent article by Hung et al. [1] describing a novel method to control the distal tip of nasotracheal tube. In clinical practice, we had used this technique to achieve the successful nasotracheal intubation [2]. We completely agree with the authors that this method may be used as a back-up technique if the cuff inflation technique fails for controlling the tube tip location during nasotracheal intubation. However, one of main concerns on this method is possible injury of the nasal mucosa by removing the surgical suture along the tube placed in the nasal passage immediately after intubation.

http://ift.tt/2jx3EQR

Evaluating LMA-ProSeal insertion techniques: A call for methodological clarification

In the recent article by Ishio et al. [1] evaluating the insertion efficacy of the LMA-ProSeal by novice doctors with or without a 90° bend created by an intubating stylet in anesthetized patients, they demonstrate that a 90° bend re-figuration facilitates LMA-ProSeal insertion, as shown by a higher successful insertion rate, a higher sealing pressure, and a lower subjective difficulty of insertion. To rightly compare effect of insertion techniques on performance of the studied device in a randomized controlled trial, however, standardization of equipment and rational design of study are crucial.

http://ift.tt/2jlR61b

Acute Truncal Lymphedema Secondary to Axillary Metastatic Melanoma Presenting Like Cellulitis

There are reported cases of diphencyprone used in treating cutaneous metastases of melanoma. Here, we report a patient with previous primary melanoma on his left back treated with surgical excision and lymphadenectomy, followed by radiotherapy for the recurrent tumor on the primary site. Despite radiotherapy and treatment with dabrafenib and trametinib, in-transit metastases have developed and topical diphencyprone was applied to these metastases. Six weeks later, the patient developed fever and a spreading erythematous tender indurated plaque covering the left side of the body including axillae, back, and flank, clinically suggestive of cellulitis. Systemic antibiotic therapy did not improve the condition and a biopsy showed sparse lymphocytic infiltrate. With the diagnosis of possible acute lymphedema, a CT scan was requested that showed significant axillary lymph node metastasis. The fever was considered secondary to dabrafenib and trametinib therapy. This case highlights that, in patients with lymphadenectomy, atypical forms of lymphedema on the body may appear. Truncal lymphedema is an infrequent event.

http://ift.tt/2jSaq75

Actin isoform expression patterns in adult extracardiac and cardiac rhabdomyomas indicate a different cell of origin

Abstract

Rhabdomyomas are rare striated muscle-type tumors arising in the heart or in soft tissues. Using a monoclonal antibody specific for the cardiac isoform of α-actin (α-cardiac actin, α-CAA), differential expression patterns in striated muscle tissues were reported previously. The purpose of the present study was to determine whether the α-actin isoform specificity is maintained in rhabdomyomas according to their origin, comparing extracardiac to cardiac rhabdomyomas. We immunohistochemically investigated adult extracardiac (pharyngeal) rhabdomyomas (n = 4) and cardiac rhabdomyomas (n = 7) employing isoform-specific monoclonal antibodies. The extracardiac rhabdomyomas revealed only a few scattered α-CAA-positive tumor cells (antibody cAc1-20.42) while the cardiac rhabdomyomas exhibited abundant expression of α-CAA, indicating a close relatedness to cardiac muscle fibers. The α-skeletal actin (α-SKA) specific monoclonal antibody (3B3) produced the reverse results. General sarcomeric antibodies (HHF35 and Alpha Sr-1) displayed strong positivity in all rhabdomyomas studied. Alpha-smooth muscle actin (α-SMA) was negative or heterogeneously positive in extracardiac and cardiac rhabdomyomas. Our results suggest that despite similar morphology, the intrinsic differential alpha-actin isoform specificity of mature skeletal vs. cardiac muscle is maintained in extracardiac and cardiac rhabdomyomas. Thus, adult extracardiac rhabdomyomas differentiate towards mature skeletal muscle although they may exhibit centrally placed nuclei like cardiac muscle cells, while cardiac rhabdomyomas reflect true cardiac muscle differentiation. Our findings appear to indicate a different biological nature of cardiac and extracardiac rhabdomyomas, probably related to a different cell of origin. To our knowledge, this is the first report suggesting a derivation of extracardiac and cardiac rhabdomyomas from skeletal and cardiac muscle cells, respectively.

http://ift.tt/2ipouok

Ultrasensitive detection of oncogenic human papillomavirus in oropharyngeal tissue swabs

Abstract

Background

The incidence of oropharyngeal squamous cell carcinoma (OPSCC) caused by oncogenic human papillomavirus (HPV) is rising worldwide. HPV-OPSCC is commonly diagnosed by RT-qPCR of HPV E6 and E7 oncoproteins or by p16 immunohistochemistry (IHC). Droplet digital PCR (ddPCR) has been recently reported as an ultra-sensitive and highly precise method of nucleic acid quantification for biomarker analysis. To validate the use of a minimally invasive assay for detection of oncogenic HPV based on oropharyngeal swabs using ddPCR. Secondary objectives were to compare the accuracy of ddPCR swabs to fresh tissue p16 IHC and RT-qPCR, and to compare the cost of ddPCR with p16 IHC.

Methods

We prospectively included patients with p16⁺ oral cavity/oropharyngeal cancer (OC/OPSCC), and two control groups: p16⁻ OC/OPSCC patients, and healthy controls undergoing tonsillectomy. All underwent an oropharyngeal swab with ddPCR for quantitative detection of E6 and E7 mRNA. Surgical specimens had p16 IHC performed. Agreement between ddPCR and p16 IHC was determined for patients with p16 positive and negative OC/OPSCC as well as for healthy control patients. The sensitivity and specificity of ddPCR of oropharyngeal swabs were calculated against p16 IHC for OPSCC.

Results

122 patients were included: 36 patients with p16⁺OPSCC, 16 patients with p16⁻OPSCC, 4 patients with p16⁺OCSCC, 41 patients with p16⁻OCSCC, and 25 healthy controls. The sensitivity and specificity of ddPCR of oropharyngeal swabs against p16 IHC were 92 and 98% respectively, using 20–50 times less RNA than that required for conventional RT-qPCR. Overall agreement between ddPCR of tissue swabs and p16 of tumor tissue was high at ĸ = 0.826 [0.662-0.989].

Conclusion

Oropharyngeal swabs analyzed by ddPCR is a quantitative, rapid, and effective method for minimally invasive oncogenic HPV detection. This assay represents the most sensitive and accurate mode of HPV detection in OPSCC without a tissue biopsy in the available literature.

http://ift.tt/2jl4zq3

When the cows come home: occupational tinea barbae in a cattle farmer

Publication date: Available online 13 January 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): S. Al-Ali, R. Elledge, A. Ilchyshyn, P. Stockton




http://ift.tt/2jKcgCT

A rare complication of middle ear cholesteatoma – Pseudoaneurysm of petrous internal carotid artery

Publication date: Available online 13 January 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): L.Y. Lim, I. Mohamad, J.H. Lau, I.P. Tang
ObjectivesTo report a rare complication of middle ear cholesteatoma resulting pseudoaneurysm of petrous internal carotid artery (ICA).Case reportA 39year old lady presented with sudden profuse bleeding from the right ear. Previously, she had been having bilateral intermittent foul smelling ear discharge for a year. Otoscope finding was insignificant as only blood seen. Computed tomography of temporal bone and magnetic resonance imaging of brain suggested locally aggressive cholesteatoma. Right ICA angiography showed pseudoaneurysm of petrous part of ICA. She underwent coil embolisation followed by bilateral modified radical mastoidectomy a month later. She recovered well after surgery and remained symptoms free.ConclusionsPseudoaneurysm of petrous ICA as a complication of middle ear cholesteatoma is extremely rare. Spontaneous profuse bleeding maybe the only clinical presentation. Radiological imaging is important to diagnose and assist in treatment. Endovascular technique may be required, followed by surgical treatment for infection control



http://ift.tt/2jkF5co

Influence of enamel/dentin thickness on the toxic and esthetic effects of experimental in-office bleaching protocols

Abstract

Objectives

This paper aims to assess the whitening effectiveness and toxicity of tooth-bleaching protocols applied to enamel/dentin disks simulating mandibular incisors (ICs) and premolars (PMs).

Materials and methods

A 10% hydrogen peroxide (H₂O₂) gel was applied for 3 × 15, 1 × 15, or 1 × 5 min to enamel/dentin disks simulating mandibular ICs and PMs, and the trans-enamel and trans-dentinal diffusion products were applied to human dental pulp cells (1 h). Professional therapy (35% H₂O₂—3 × 15 min) was used as positive control, and non-bleached samples were used as negative control. Cell viability and morphology, oxidative stress generation, and odontoblastic marker expression were assessed. The H₂O₂ diffusion and enamel color change (ΔE) were also analyzed.

Results

The 10% H₂O₂ gel induced significant cell viability reduction only when applied 3 × 15 min, with the intensity of oxidative stress and down-regulation of odontoblastic markers being higher in the IC group. The other experimental bleaching protocols caused slight alterations regarding the cell parameters evaluated, with intensity being related to enamel/dentin thickness. These effects were also correlated with higher H₂O₂ diffusion in the IC group. ΔE values similar as positive control were found for the 10% 3 × 15 and 1 × 15 protocols on IC group, after 4 and 6 sessions.

Conclusion

Application of a 10% H₂O₂ bleaching gel for 15 or 45 min to thin dental substrate significantly minimizes cell toxicity in comparison with highly concentrated gels associated with similar esthetic outcomes by increasing the number of bleaching sessions.

Clinical relevance

Bleaching gels with 10% H₂O₂ applied in small teeth for short periods may be an interesting alternative to obtain whitening effectiveness without causing toxicity to pulp cells, which may be able to reduce the tooth hypersensitivity claimed by patients.

http://ift.tt/2ixiBUs

Repeated applications of photodynamic therapy on Candida glabrata biofilms formed in acrylic resin polymerized

Abstract

Previous studies have been suggested that photodynamic therapy (PDT) can be used as an adjuvant treatment for denture stomatitis. In this study, we evaluated the effects of multiple sessions of PDT on Candida glabrata biofilms in specimens of polymerized acrylic resin formed after 5 days. Subsequently, four applications of PDT were performed on biofilms in 24-h intervals (days 6–9). Also, we evaluated two types of PDT, including application of laser and methylene blue or light-emitting diode (LED) and erythrosine. The control groups were treated with physiological solution. The effects of PDT on biofilm were evaluated after the first and fourth application of PDT. The biofilm analysis was performed by counting the colony-forming units. The results showed that between the days 6 and 9, the biofilms not treated by PDT had an increase of 5.53 to 6.05 log (p = 0.0271). Regarding the treatments, after one application of PDT, the biofilms decreased from 5.53 to 0.89 log. When it was done four applications, the microbial reduction ranged from 6.05 log to 0.11 log. We observed that one application of PDT with laser or LED caused a reduction of 3.36 and 4.64 compared to the control groups, respectively (p = 0.1708). When it was done four applications of PDT, the reductions achieved were 1.57 for laser and 5.94 for LED (p = 0.0001). It was concluded that repeated applications of PDT on C. glabrata biofilms showed higher antimicrobial activity compared to single application. PDT mediated by LED and erythrosine was more efficient than the PDT mediated by laser and methylene blue.

http://ift.tt/2jimmhN

Dynamic optical absorption characteristics of blood after slow and fast heating

Abstract

Laser treatment is the most effective therapy in dermatology for vascular skin disorders, such as port-wine stains (PWS). Changes in heat-induced absorbance in blood must be determined for accurate numerical simulation and implementation of multi-pulse laser therapy for treatment of PWS. Thermally induced absorbance changes in hemoglobin in blood were compared in vitro between slow water bath heating and fast heating irradiated by using sub-millisecond Nd:YAG laser. Blood composition at different temperatures was calculated by comparing blood absorption spectra with those of pure HbO₂, Hb, and metHb at room temperature. Blood absorbance to heat energy were categorized into three stages distinguished by metHb and coagulation points, which are the validity and security thresholds of the optimized therapy, respectively. Rapid laser heating can distinctively enhance blood absorbance by photochemically induced strong instability compared with slow heating at a constant temperature. Slow heating facilitates metHb point at 70 °C and coagulation point at 75 °C as the temperature of the water bath increases. However, the temperature at which metHb or coagulation point shifts to higher than 10 °C when pulses and fluence in laser irradiation change. Laser fluence less than 20 J/cm² and more than 50 J/cm² is unsuitable for laser treatment because of its low probability to coagulate vascular hyperplasia and high probability to damage normal tissues adjacent to target lesions, respectively. Few bubbles formed after mediate fluence is beneficial to minimize adverse side-effects. Considering blood absorbance, temperature evolution, and bubble formation, we recommend 30–40 J/cm² and 2–4 Hz frequency as the optimal laser parameters in sub-millisecond Nd:YAG laser.

http://ift.tt/2jt2BRY

Review of Diagnostic Challenges in Occupational Asthma

Abstract

Purpose of review

Occupational asthma (OA) is one of the most frequent occupational diseases and its diagnosis is often difficult. This review summarizes its current diagnostic challenges.

Recent findings

OA is associated with significant health and socio-economic burden. It is underdiagnosed and physicians need to adopt a stepwise approach to confirm the diagnosis. Although early removal from exposure to the offending agent is associated with a better prognosis, physicians should try to confirm the diagnosis of work-related asthma before taking a worker off work. A proper occupational and medical history is very important but is not enough to make the diagnosis of OA. Objective evidence of work-related asthma is required and this represents a serious challenge to most physicians. Measurement of non-specific bronchial responsiveness (NSBR) and spirometry may confirm the diagnosis of asthma but do not confirm the diagnosis of OA. Serial monitoring of peak expiratory flows (PEF), NSBR, and airway inflammation at and off work may confirm the diagnosis of OA but are often difficult to perform. Confirming sensitization by skin prick tests or specific IgE may help to support the diagnosis of OA. Specific inhalation challenges (SIC) in the lab or at work are considered the reference standard but are of limited access. Medical surveillance programs along with primary prevention (reducing exposure) may help to reduce the burden of OA, but the ideal program has yet to be defined.

Summary

The diagnostic workup of OA remains a challenge and needs a rigorous stepwise evaluation.

http://ift.tt/2iTYg9Q

OX40: Structure and function – What questions remain?

Publication date: March 2017
Source:Molecular Immunology, Volume 83
Author(s): Jane Willoughby, Jordana Griffiths, Ivo Tews, Mark S. Cragg
OX40 is a type 1 transmembrane glycoprotein, reported nearly 30 years ago as a cell surface antigen expressed on activated T cells. Since its discovery, it has been validated as a bone fide costimulatory molecule for T cells and member of the TNF receptor family. However, many questions still remain relating to its function on different T cell sub-sets and with recent interest in its utility as a target for antibody-mediated immunotherapy, there is a growing need to gain a better understanding of its biology.Here, we review the expression pattern of OX40 and its ligand, discuss the structure of the receptor:ligand interaction, the downstream signalling it can elicit, its function on different T cell subsets and how antibodies might engage with it to provide effective immunotherapy.



http://ift.tt/2jjb253

Enhancement of NK cell-mediated lysis of non-small lung cancer cells by nPKC activator, ingenol 3,20 dibenzoate

Publication date: March 2017
Source:Molecular Immunology, Volume 83
Author(s): Chenyuan Gong, Chao Yao, Zihang Xu, Zhongya Ni, Xiaowen Zhu, Lixin Wang, Xuewei Yan, Wuxiong Zhou, Shiguo Zhu
The IFN-γ production is crucial for NK cell-mediated lysis of cancer cells. Thus increasing the IFN-γ production by NK cells may be an ideal strategy to improve their tumoricidal effect. Since the focus on new drug development has shifted towards natural products, limited information is out there about natural products that enhance the IFN-γ production by NK cells. In this study, through a high-throughput screening, we have identified a natural product ingenol 3,20 dibenzoate (IDB), an activator of tumor suppressor protein kinase C (PKC) isozymes, could increase the IFN-γ production and degranulation by NK cells, especially when NK cells were stimulated by non-small lung cancer (NSCLC) cells. IDB also significantly enhanced the NK cell-mediated lysis of NSCLC cells. Furthermore, PKC inhibitor, sotrastaurin abrogated IDB-induced IFN-γ production, degranulation and cytotoxicity, but did not affect IFN-γ production by NK cells without IDB treatment and NSCLC cell stimulation. The IFN-γ neutralization reversed the IDB-induced enhancement of NK cell mediated killing. In conclusion, our study indicated that IDB enhanced NK cell-mediated lysis of NSCLC cells is dependent on specific PKC mediated IFN-γ production and degranulation. Thus, IDB may have a promising application in clinic for NK cell-based cancer immunotherapy.

Graphical abstract

http://ift.tt/2jJCFRg

Anti-inflammatory effects of ononin on lipopolysaccharide-stimulated RAW 264.7 cells

Publication date: March 2017
Source:Molecular Immunology, Volume 83
Author(s): Lin Dong, Lei Yin, Yuanbin Zhang, Xueyan Fu, Jincai Lu
Increasing evidence has shown that ononin, a major isoflavone, has anti-inflammatory effects on lipopolysaccharide (LPS)-induced inflammation. However, the molecular mechanisms underlying the anti-inflammatory effects of ononin are still unclear. In the present study, we investigated these effects and the underlying mechanisms of ononin on LPS-induced inflammatory responses. Mouse RAW 264.7 cells were treated with 1μg/mL LPS and 5, 25, 50, 100 or 150μM ononin for 18h. Cell viability was assessed using MTT assays, and the production of nitric oxide (NO), prostaglandin E2 (PGE2) and the pro-inflammatory cytokines TNF-α, IL-1β and IL-6 in cultures was examined by Griess and ELISA analyses. qRT-PCR was performed to detect the mRNA expression of inducible nitric oxide synthase (iNOS) and cyclooxygenase (COX-2). Mitogen-activated protein kinases (MAPKs) and nuclear transcription factor Kappa-B (NF-κB) signalling pathway-related proteins were assessed by western blot assays. The results showed that cell viability was not significantly affected by up to 100μM ononin. The production of NO, PGE2 and the pro-inflammatory cytokines TNF-α, IL-1β and IL-6 in the cultures, the mRNA expression of two major inflammatory mediators, COX-2 and iNOS, and the expression of phosphorylated IκB-α, ERK, JNK, and p38 MAPKs proteins in LPS-treated cells were significantly increased. These changes could be reversed by treatment with ononin in a concentration-dependent manner (P<0.05). The results suggest that ononin has anti-inflammatory effects on LPS-induced inflammatory responses by inhibiting the NF-κB and MAPK pathways and may be a potential treatment for inflammation.

Graphical abstract

http://ift.tt/2jJyx3Y

Evaluation of lip pulling method efficacy for direct laryngoscopy: A prospective crossover clinical pilot trial

A lip pulling method is usually used to prevent lip or tooth injuries [1]. We previously suggested that this method may provide a better laryngoscopy [2]. We hypothesized that lip pulling could also improve laryngoscopy, since the lips sometimes impede sufficient laryngoscopy with the Macintosh laryngoscope (McL). To test our hypothesis, we conducted a prospective randomized crossover study to compare laryngoscopy with or without lip pulling. The primary outcome was the efficiency of laryngoscopy (Fig.

http://ift.tt/2jJxZed

Comparing direct and indirect laryngoscopy: Study design is crucial

In a randomized, controlled clinical trial by Kurnaz and Sarıtaş [1]. comparing intubation performance of the Truview PCD™ and Macintosh laryngoscopes and their effects on intubation hemodynamic responses in geriatric patients, they show that compared to Macintosh laryngoscope, Truview PCD™ laryngoscope (TPL) does not provide significant hemodynamic response sparing or a shorten intubation time. Besides the limitations described in the discussion, there are the several issues in this study that need to be clarified.

http://ift.tt/2jj8rbu

Reply to the correspondence in relation to the article “Randomized study of post-cesarean analgesia with intrathecal morphine alone or combined with clonidine”

Firstly I would like to thank the opportunity to respond Dr. Bhakta.

http://ift.tt/2jJx7GH

Anaesthetic management of a patient with Michels syndrome

Michels Syndrome, which was first defined in 1978, is an uncommon syndrome seen with craniosynostosis, blepharophimosis, ptosis, epicanthus inversus, cleft lip/palate, abnormal supra umbilical abdominal wall defect and mental deficit, hearing loss, spina bifida occulta, abnormalities in the kidneys, bladder and genital system [1].

http://ift.tt/2jj24Fd

Lip injury associated with i-gel placement during general anesthesia

Although the i-gel® (i-gel: Intersurgical, U.K.) supraglottic airway device is useful for airway management during general anesthesia [1,2], there are reports of nerve and tongue injuries associated with i-gel use [3,4]. Here, we report a case of lip injury associated with i-gel use during general anesthesia.

http://ift.tt/2jJxZLf

Dose ranging effects of pregabalin on pain in patients undergoing laparoscopic hysterectomy: A randomized, double blinded, placebo controlled, clinical trial

The study aimed to investigate the preemptive analgesia efficacy of different concentrations (75, 150 and 300mg) of preemptive pregabalin for the postoperative pain management after laparoscopic hysterectomy.

http://ift.tt/2jj4Ee1

Use of local anesthetic a key tenet in multimodal analgesia to modulate chronic post-mastectomy pain

Steyaert et al. performed a cross-sectional survey of women undergoing mastectomy with axillary lymph node dissection to determine risk factors, including anesthetic and analgesic regimen, for the development of chronic post-mastectomy pain [1]. They found that of the many anesthetic and analgesic variables studied, only the use of halogenated agents was associated with a decreased incidence of chronic pain. We appreciate the diligence of this investigation into how our anesthetic care can affect our patients, particularly given the frequent incidence of chronic post-mastectomy pain in this population.

http://ift.tt/2jJybdL

When the cows come home: occupational tinea barbae in a cattle farmer

We recently treated a man with an unusual facial infection who had been admitted under the maxillofacial team. He was 29 years old, otherwise healthy, and presented with pyrexia and a severe, spreading, facial folliculitis, which had worsened over two weeks. He had initially been treated for suspected folliculitis with amoxicillin orally, but to no effect.

http://ift.tt/2jvoT5A

Investigating the role of the newly described OSCC amoeboid phenotype in metastasis and chemoresistance of oral cancer

Cellular plasticity, as seen in epithelial-to-mesenchymal transition (EMT), may be partly responsible for metastasis and therapeutic failure. In addition to the epithelial and mesenchymal cells, we describe another oral squamous cell carcinoma (OSCC) stem phenotype, seen thus far only in aggressive tumours such as melanomas and sarcomas. This is the amoeboid cell, whose distinct properties we describe in OSCC for the first time.

http://ift.tt/2iosEwM

Component columella augmentation in cleft nose rhinoplasty: a preliminary study

The purpose of this study was to evaluate the outcome of a component columella augmentation technique in cleft nose rhinoplasty. This prospective study included rhinoplasty procedures in bilateral cleft nose patients treated by component columella augmentation technique. After surgery, all patients were followed up daily for the first week, and then at 1 month and 6 months postoperative. The following four parameters were assessed: nasal tip projection, infratip lobule length, infratip lobule-to-base distance, and columella–labial angle.

http://ift.tt/2jvl8ND

Omalizumab-associated eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)

Omalizumab is a humanized anti-IgE antibody that has been recommended for the management of persistent asthma associated with high serum IgE levels.1 Several cases have been reported in the literature that suggest its association with eosinophilic granulomatosis with polyangiitis (EGPA), which was previously called Churg-Strauss syndrome (CSS). EGPA is a rare necrotizing systemic vasculitis of medium and small blood vessels characterized by asthma, eosinophilia, and eosinophilic or granulomatous tissue inflammation.

http://ift.tt/2iTUDAV

Mealtime behavior among parents and their young children with food allergy

Food allergies are increasingly prevalent in the pediatric population. Balancing allergen avoidance with the promotion of healthy eating behaviors can be challenging for families.

http://ift.tt/2jj14kf

Review of Diagnostic Challenges in Occupational Asthma

Abstract

Purpose of review

Occupational asthma (OA) is one of the most frequent occupational diseases and its diagnosis is often difficult. This review summarizes its current diagnostic challenges.

Recent findings

OA is associated with significant health and socio-economic burden. It is underdiagnosed and physicians need to adopt a stepwise approach to confirm the diagnosis. Although early removal from exposure to the offending agent is associated with a better prognosis, physicians should try to confirm the diagnosis of work-related asthma before taking a worker off work. A proper occupational and medical history is very important but is not enough to make the diagnosis of OA. Objective evidence of work-related asthma is required and this represents a serious challenge to most physicians. Measurement of non-specific bronchial responsiveness (NSBR) and spirometry may confirm the diagnosis of asthma but do not confirm the diagnosis of OA. Serial monitoring of peak expiratory flows (PEF), NSBR, and airway inflammation at and off work may confirm the diagnosis of OA but are often difficult to perform. Confirming sensitization by skin prick tests or specific IgE may help to support the diagnosis of OA. Specific inhalation challenges (SIC) in the lab or at work are considered the reference standard but are of limited access. Medical surveillance programs along with primary prevention (reducing exposure) may help to reduce the burden of OA, but the ideal program has yet to be defined.

Summary

The diagnostic workup of OA remains a challenge and needs a rigorous stepwise evaluation.

http://ift.tt/2iTYg9Q

Vitiligo-like lesions occurring in patients receiving anti-programmed cell death–1 therapies are clinically and biologically distinct from vitiligo

The use of anti-programmed cell death (PD)-1 therapies in metastatic tumors is associated with cutaneous side effects including vitiligo-like lesions.

http://ift.tt/2jJonQM

Airtraq® videolaryngoscope for assessing vocal cord mobility at the end of thyroidectomy

Voice impairment due to recurrent laryngeal nerve (RLN) palsy is one of the common and serious complications caused by thyroid surgery and a leading reason for medicolegal litigation. RLN palsy rates depend not only on the type of thyroid disease and the extent of resection but also on the surgeon's training. Routine RLN recognition is considered the gold standard of care for the prevention of nerve injury during thyroid surgery [1]; however, despite meticulous anatomical identification, the reported incidence of RLN palsy ranges from 0 to 12% [2,3].

http://ift.tt/2jiRr5f

Intraoperative anaphylaxis, cardiac arrest and hypertrophic cardiomyopathy: Implications for Kounis syndrome

Anaphylactic reactions occurring during general anesthesia constitute the most severe and frequent forms of drug-induced hypersensitivity reactions. Although bronchospasm, cutaneous and mucus signs and symptoms are easily recognized, signs and symptoms that mainly involve the cardiovascular system constitute diagnostic and therapeutic problems. In the very interesting report published recently [1], a 75-year-old woman, hypertensive, smoker and allergic to penicillin and cephalosporin with vancomycin spacer placement, developed twice hypotensive cardiac arrest with pulseless electrical activity during preoperative general anesthesia for left total hip re-implantation.

http://ift.tt/2jvfPhj

Postoperative foreign language syndrome

Foreign language syndrome (FLS), a substitution of native language (first language, L1) with person's later learned language (second language, L2) may rarely occur after serious injury to the brain which renders victims unconscious. There have been few reported cases of the FLS since it was first reported in the 1940s. The most famous case was a Norwegian woman, hit by shrapnel (World War II), who subsequently developed a German accent. Other cases include two British woman, one developed a Chinese accent following a migraine, and another had a stroke and gained a French accent (Foreign accent syndrome).(http://ift.tt/1QrW1FS).

http://ift.tt/2jk29aZ

NEIL1 is a candidate gene associated with common variable immunodeficiency in a patient with a chromosome 15q24 deletion

Publication date: Available online 14 January 2017
Source:Clinical Immunology
Author(s): Rosa Romano, Apostolos Zaravinos, Kyriaki Liadaki, Rozina Caridha, Johanna Lundin, Göran Carlsson, Jacek Winiarski, Qiang Pan-Hammarström, Lennart Hammarström
We report the first patient with an interstitial deletion of chromosome 15q24.1-q24.3 associated with common variable immunodeficiency (CVID). The 18-year old female patient's clinical and immunological phenotype was compared with 8 additional previously published patients with chr15q24 deletions. A CGH analysis estimated the deletion to be 3.767Mb in size (chr15: 74,410,916–78,178,418) and the result was confirmed using qRT-PCR. We defined an immune-related commonly deleted region (ICDR) within the chromosomal band 15q24.2, deleted in all four patients with different forms of antibody deficiencies. Mutations in the 14 genes within this ICDR were not identified in the remaining allele in our patient by WES and gene expression analyses showed haploinsufficiency of all the genes. Among these genes, we consider Nei Like DNA Glycosylase 1 (NEIL1) as a likely candidate gene due to its crucial role in B-cell activation and terminal differentiation.



http://ift.tt/2jv6iXt

Hypoxia Inducible Factor-1α Inhibition Modulates Airway Hyperresponsiveness and Nitric Oxide Levels in a BALB/c Mouse Model of Asthma

Publication date: Available online 14 January 2017
Source:Clinical Immunology
Author(s): Carola Dewitz, Elisa McEachern, Stephanie Shin, Kathryn Akong, Dale G. Nagle, David H. Broide, Praveen Akuthota, Laura E. Crotty Alexander
Hypoxia inducible factor (HIF)-1α is a master regulator of inflammation and is upregulated in alveolar macrophages and lung parenchyma in asthma. HIF-1α regulates select pathways in allergic inflammation, and thus may drive particular asthma phenotypes. This work examines the role of pharmacologic HIF-1α inhibition in allergic inflammatory airway disease (AIAD) pathogenesis in BALB/c mice, which develop an airway hyperresponsiveness (AHR) asthma phenotype. Systemic treatment with HIF-1α antagonist YC-1 suppressed the increase in HIF-1α expression seen in control AIAD mice. Treatment with YC-1 also decreased AHR, blood eosinophilia, and allergic inflammatory gene expression: IL-5, IL-13, myeloperoxidase and iNOS. AIAD mice had elevated BAL levels of NO, and treatment with YC-1 eliminated this response. However, YC-1 did not decrease BAL, lung or bone marrow eosinophilia. We conclude that HIF-1α inhibition in different genetic backgrounds, and thus different AIAD phenotypes, decreases airway resistance and markers of inflammation in a background specific manner.Capsule SummaryAsthma is a common disease that can be difficult to control with current therapeutics. We describe how pharmacologic targeting of a specific transcription factor, HIF-1α, suppresses asthmatic airway reactivity and inflammation.

Graphical abstract

http://ift.tt/2jjVVbg

Clinical characteristics associated with days to discharge among patients admitted with a primary diagnosis of lower limb cellulitis

Clinicians have limited ability to classify risk of prolonged hospitalization among patients with lower limb cellulitis.

http://ift.tt/2jPSPwK

Internet-based skin cancer screening using clinical images alone or in conjunction with dermoscopic images: A randomized teledermoscopy trial

Teledermoscopy involves the use of dermoscopic images for remote consultation and decision-making in skin cancer screening.

http://ift.tt/2iTxlLi

Complete deltoid resection in early childhood without muscle transfer results in normal shoulder function at long-term follow-up: a case report

Musculoskeletal tumors involving the deltoid muscle and necessitating its complete resection are rare. The function after complete deltoid resection is reported to be limited, and several authors consider musc...

http://ift.tt/2jPNBkt

Glucagon-like peptide-1 analogues - an efficient therapeutic option for the severe insulin resistance of lipodystrophic syndromes: two case reports

Lipodystrophic syndromes are uncommon medical conditions which are normally associated with metabolic disorders, such as diabetes mellitus, dyslipidemia, and fatty liver disease. These complications are genera...

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Component columella augmentation in cleft nose rhinoplasty: a preliminary study

Publication date: Available online 13 January 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): B. Bohluli, P. Varedi, M. Sezavar, S. Pakzad, S.C. Bagheri
The purpose of this study was to evaluate the outcome of a component columella augmentation technique in cleft nose rhinoplasty. This prospective study included rhinoplasty procedures in bilateral cleft nose patients treated by component columella augmentation technique. After surgery, all patients were followed up daily for the first week, and then at 1 month and 6 months postoperative. The following four parameters were assessed: nasal tip projection, infratip lobule length, infratip lobule-to-base distance, and columella–labial angle. Thirteen rhinoplasty patients were included. Tip projection was increased (5.6±3.5mm) in all cases postoperatively (P<0.05); the increase was seen mostly in the lobule-to-base length (4.5±0.4mm), with a minimal change in lobule length (1.1±3.6mm). Preoperative and postoperative lobule lengths were not statistically different (P>0.05). With this technique, it is not necessary to involve the upper and lower lips. Therefore, the non-aesthetic vertical scars and tissue distortion that may occur with local flaps are easily avoided. Compared to composite augmentation, each part of the deformity (cartilage and skin) is precisely and separately restored with this technique.



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Cortical bone thickness of the mandibular canal and implications for bilateral sagittal split osteotomy: a cadaveric study

Preoperative delineation of the mandibular canal and surrounding cortical bone thickness is mandatory prior to bilateral sagittal split osteotomy (BSSO). The cortical bone thickness of 101 cadaveric mandibles was measured to define the mandibular canal. The mandibles were cut at the anterior ramus, at the third, second, and first molar, and at the premolar. The cortical bone thickness was measured between the mandibular canal and inferior border, buccal cortex, and lingual cortex at each cutting point.

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Three-dimensional finite element model to predict patterns of pterygomaxillary dysjunction during Le Fort I osteotomy

The aim of this study was to determine whether non-linear three-dimensional finite element analysis (3D-FEA) can be applied to simulate pterygomaxillary dysjunction during Le Fort I osteotomy (LFI) not involving a curved osteotome (LFI-non-COSep), and to predict potential changes in the fracture pattern associated with extending the cutting line. Computed tomography (CT) image data (100 snapshots) after LFI were converted to 3D-CT images. 3D-FEA models were built using preoperative CT matrix data and used to simulate pterygomaxillary dysjunction.

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Desensitization to acetazolamide in a patient with previous antimicrobial sulfonamide allergy

Acetazolamide is a carbonic anhydrase inhibitor that is frequently used in the management of idiopathic intracranial hypertension. Acetazolamide is a sulfonamide agent; specifically, it is a nonsulfonylarylamine, which lacks the amine moiety found at the N4 position that is seen in sulfa antibiotics.1 Sulfonamide antibiotics contain a substituted ring at the N1 position that is thought to be the driving factor in immediate hypersensitivity reactions.2 Although sulfa allergies are commonly reported, there is no evidence to suggest cross-reactivity between sulfonamide antibiotics and sulfonamide nonantibiotics.

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Analysis of primary treatment and prognosis of spontaneous urticaria

Publication date: Available online 13 January 2017
Source:Allergology International
Author(s): Toshihiko Tanaka, Makiko Hiragun, Michihiro Hide, Takaaki Hiragun
BackgroundThe prognosis of spontaneous urticaria in association with early treatment remains unclear. In this study, we retrospectively studied the prognosis of acute spontaneous urticaria in relation to age and treatments in a local clinic of dermatology.MethodsOut of 5000 patients who visited an office dermatology clinic, clinical records of patients with spontaneous urticaria were extracted. Their prognosis and the relation to age and treatments were analyzed by the Kaplan–Meier method and generalized Wilcoxon test.ResultsAmong 386 patients diagnosed with spontaneous urticaria, 284 patients (73.6%) began treatments within a week after the onset. Their non-remission rates after one week, four weeks and one year from the onset were 26.8%, 15.0% and 6.7%, respectively. The non-remission rates of patients who were 20-years-old or younger by one year after the onset of urticaria, were significantly lower than those of patients older than 20-years-old. No apparent relationship between remission rates and sex or the use of steroids was detected. However, the non-remission rates of urticaria treated with a standard dose of antihistamine were lower than that treated with additional medications.ConclusionsMost patients who began treatments within one week from the onset remitted quickly. However approximately 7% of them continued to suffer from symptoms for more than a year. Such prolongation tended to be seen among patients who required other medications in addition to a standard dose of antihistamine.



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Drug eruption caused by esomeprazole: A case report and mini-review

Publication date: Available online 13 January 2017
Source:Allergology International
Author(s): Maiko Taura, Jun Asai, Yusuke Wakabayashi, Koji Masuda, Norito Katoh




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Mealtime behavior among parents and their young children with food allergy

Publication date: Available online 13 January 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Linda Jones Herbert, Priya Mehta, Hemant Sharma
BackgroundFood allergies are increasingly prevalent in the pediatric population. Balancing allergen avoidance with the promotion of healthy eating behaviors can be challenging for families.ObjectiveTo characterize mealtime behaviors among parents of young children with food allergy.MethodsSeventy-four parents of young children with food allergies (≤7 years of age) completed measures of mealtime behavior, perceptions of food allergy risk and severity, pediatric parenting stress, and food allergy–related quality of life. Mealtime behavior reports were compared with published data regarding typically developing children, young children with type 1 diabetes, and children with diagnosed feeding disorders (with or without related medical factors).ResultsParents of young children with food allergies reported frequent mealtime concerns. Specifically, they reported significantly more mealtime behavioral concerns than typically developing peers, comparable mealtime behavioral concerns to young children with type 1 diabetes, and significantly fewer mealtime behavioral concerns than children with diagnosed feeding disorders. Parental mealtime concerns were positively correlated with other parent perceptions of food allergy, such as risk of allergen exposure, illness-related parenting stress, and food allergy–related quality of life.ConclusionYoung children with food allergy and their parents are more likely to exhibit mealtime behavioral concerns than typically developing peers and their parents. Future research should investigate the effect of food allergies and maladaptive mealtime behaviors on children's nutrition to provide clinical guidelines for parents who may benefit from psychosocial and/or nutritional support.



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Omalizumab-associated eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)

Publication date: Available online 13 January 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Salik Nazir, Niranjan Tachamo, Shoaib Bilal Fareedy, Muhammad Sohail Khan, Saroj Lohani




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Hemotherapy algorithm for the management of trauma-induced coagulopathy: the German and European perspective.

Purpose of review: This review presents a synopsis of best current knowledge with reference to the updated German and European guidelines and recommendations on the management of severe trauma hemorrhage and trauma-induced coagulopathy as well as a viscoelastic-based treatment algorithm based upon international expert consensus to trigger the administration of hemostatic agents and blood products. Recent findings: Uncontrolled hemorrhage and trauma-induced coagulopathy are the major causes for preventable death after trauma and early detection and aggressive management have been associated with improved outcomes. However, best practice to treat this newly defined entity is still under debate. In the acute phase, the clinical management usually follows the 'Damage Control Resuscitation' concept, which advocates the empiric administration of blood products in predefined and fixed ratios. As an alternative, several European but also a few US trauma centers have instituted the concept of 'Goal-directed Coagulation Therapy' based upon results obtained from early point-of-care viscoelastic testing. Summary: Current guidelines urge for the implementation of evidence-based local protocols and algorithms including clinical quality and safety management systems together with parameters to assess key measures of bleeding control and outcome. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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