Head and Neck Medicine by Alexandros G.Sfakianakis: 01/17/17

Τρίτη 17 Ιανουαρίου 2017

Development of actinobacterial resources for functional cosmetics

Summary

Background

Actinobacteria usually produce different functional compounds for various applications.

Objective

The aim of this research was to develop actinobacterial resources through the isolation and identification of soil bacteria with antibacterial and enzyme inhibitory activities for cosmetics application.

Methods

Soil bacteria were isolated and tested for antibacterial activity against Propionibacterium acnes and Staphylococcus epidermidis using the spotting method. Isolates exhibiting antibacterial activities were assayed for tyrosinase inhibition, elastase inhibition, and free radical scavenging activity.

Results

Twelve actinobacterial strains were found to inhibit the growth of P. acnes and S. epidermidis. Among them, ten were from the genus Streptomyces and the other two were from the genera Actinokineospora and Calidifontibacter, and potentially represented novel species. For tyrosinase inhibition activities, when compared with arbutin (IC₅₀=47.84±0.36 μg mL⁻¹), strain T65 had similar activity with an IC₅₀ value of 49.05±3.29 μg mL⁻¹. For elastase inhibition, strains T65, T811, and R311 had similar activities with IC₅₀ values of 10.78±1.88 μg mL⁻¹, 10.19±0.82 μg mL⁻¹, and 10.19±2.1 μg mL⁻¹, respectively, which had similar inhibitory activity to the IC₅₀ value of the standard oleanolic acid (8.94±1.38 μg mL⁻¹). For DPPH radical scavenging activities, two strains, R311 and T327, with IC₅₀ values of 6.11±1.17 μg mL⁻¹ and 5.25±0.93 μg mL⁻¹, respectively, had slightly lower activities than ascorbic acid (IC₅₀=4.08±0.03 μg mL⁻¹).

Conclusion

Among twelve strains of actinobacteria, the most effective strains were selected for the inhibition of both P. acnes and S. epidermidis as well as for enzyme activities. Actinobacterial strains isolated in this study could be used to produce active metabolites for cosmetics applications.

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Keratosis Obturans: A Disease of the Tropics?

Abstract

Keratosis obturans appears to be an obscure and relatively uncommon entity, even in literature search of journals and reference texts, so much so that there is not even any prevalence or incidence statistics available. However, the condition did not appear to be as uncommon based on our clinical observations. We have managed to obtain 64 patients representing 67 ears with keratosis obturans in our study period of about 18 months with a pattern of occurrence during this period. Humid weather seemed to play a role in the frequency of its appearance during certain period in our observation. There also appears to be a correlation between the severity of symptoms (predominantly pain and hearing loss) and the presenting appearance of the condition, i.e., presence or absence of granulation tissue, as well as that the degree of difficulty in exenteration of the keratosis obturans (matrix and content) depending on the expansion of the bony canal. Our figures showed the majority of the patients are females and young individuals, the majority of them occur unilaterally. The condition also appear to stop short of involving the tympanic membrane with only the bony canal being expanded with the surrounding oedema creating an apparent "canal stenosis".

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Outcomes of Newborn Hearing Screening Program: A Hospital Based Study

Abstract

Hearing loss is hidden disability and second most common congenital pathology. Prevention, early identification and early intervention of hearing loss can prevent further disability in development of speech, language, cognition and other developmental domains. The prevalence of congenital hearing loss has been estimated to be 1.2–5.7 per thousand in neonates. In these contexts, the aim of study was to determine outcomes of neonates hearing screening program in Hospital. It is a clinical cross-sectional study which was conducted in tertiary care centre from 8th July, 2015 to 31th May, 2016. Total no of 2254 cases were screened. Details case history including high risk register, Pediatric Audiometry, Otoacoustic Emission tests were performed followed brainstem evoked response audiometry. The Prevalence of hearing loss among high risk babies confirmation by BERA was 8.8% per 1000 babies and 16 cases were recommended for Cochlear Implant. The screening protocol with objective test i.e. Distortion Product Otoacoustic Emission and confirmation by Brainstem Evoked Response Audiometry is very useful tool in early identification of congenital hearing loss in neonates. Hence, the results of this study will be used to initiate universal newborn hearing screening in other hospitals. Moreover, this study highlights the relevance of neonatal hearing screening in other states of India and country where this screening is not performed routinely in all hospitals and creating awareness to identify neonatal risk factors associated with hearing loss and understand the importance of early identification and early intervention and among health care professionals.

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Role of Topical Medication in Prevention of Post-extubation Subglottic Stenosis

Abstract

Iatrogenic laryngotracheal injury is the most serious complication of endotracheal intubation since this method of establishing airway was first described by Eugene Bouchut in 1858. Even today, subglottic stenosis is the most dreaded complication of intubation. This animal study is focused on the host tissue response to intubation induced injury resulting in subglottic stenosis and methods to prevent this complication. To assess the role of topically applied Mitomycin-C and Triamcinolone Acetonide in wound healing process following post-extubation subglottic injury. Prospective Randomized block, single-blinded, experimental study. Forty New-Zealand white rabbits where block randomized and allocated into 4 groups based on the type of topical medication that was applied post-extubation. Further these groups where subdivided into 3 subgroups based on the time of sacrifice (4, 6 and 12 weeks) to study the histopathological changes that occurred in a temporal sequence at the subglottis. It was observed that the rabbits in the control group and those that received Mitomycin-C only had more respiratory distress compared to those treated with Triamcinolone Acetonide. Statistically significant histopathological changes were observed in all the 4 groups. Mitomycin-C applied topically did not alter the wound healing process following post-extubation injury in the subglottis. Triamcinolone Acetonide significantly altered wound healing in the subglottis and prevented occurrence of respiratory distress.

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Modeling Responses in the Superior Paraolivary Nucleus: Implications for Forward Masking in the Inferior Colliculus

Abstract

A phenomenological model of the responses of neurons in the superior paraolivary nucleus (SPON) of the rodent is presented in this study. Pure tones at the characteristic frequency (CF) and broadband noise stimuli evoke offset-type responses in these neurons. SPON neurons also phase-lock to the envelope of sinusoidally amplitude-modulated (SAM) stimuli for a range of modulation frequencies. Model SPON neuron received inhibitory input that was relayed by the ipsilateral medial nucleus of the trapezoid body from the contralateral model ventral cochlear nucleus neuron. The SPON model response was simulated by detecting the slope of its inhibitory postsynaptic potential. Responses of the proposed model to pure tones at CF and broadband noise were offset-type independent of the duration of the input stimulus. SPON model responses were also synchronized to the envelope of SAM stimuli with precise timing for a range of modulation frequencies. Modulation transfer functions (MTFs) obtained from the model response to SAM stimuli resemble the physiological MTFs. The output of the proposed SPON model provides an input for models of physiological responses at higher levels of the ascending auditory pathway and can also be utilized to infer possible mechanisms underlying gap detection and duration encoding as well as forward masking at the level of the auditory midbrain.

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Tumid lupus: An unexpected diagnosis for the otolaryngologist

Tumid lupus is an uncommon variant of lupus erythematosus. Patients present with subcutaneous lesions. Ophthalmic literature reports disease manifestation as orbital inflammation. Autoimmune serology is often negative. Without a high index of suspicion, the diagnosis is easily overlooked delaying treatment. Tumid lupus is not significantly discussed in the Otolaryngologic literature. Here we present a Case Report of a male who initially presented to Ophthalmology with unilateral orbital complaint of eyelid puffiness.

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Modeling Responses in the Superior Paraolivary Nucleus: Implications for Forward Masking in the Inferior Colliculus

Abstract

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Update on Aspirin-Exacerbated Respiratory Disease

Abstract

Aspirin-exacerbated respiratory disease (AERD) is an acquired disease characterized by chronic eosinophilic airway inflammation with underlying dysregulation of arachidonic acid metabolism. The purpose of this paper is to review the latest developments in our understanding of the underlying pathophysiology including the role of eosinophils, mast cells, innate lymphoid cells (ILC₂), and platelets. Clinical features such as respiratory reactions induced by alcohol, aggressive nasal polyposis, and anosmia will allow for earlier recognition of these patients in clinical practice. The current state of the art management of AERD will be addressed including the ongoing central role for aspirin desensitization and high-dose aspirin therapy.

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Evaluation of the postoperative cognitive dysfunction in elderly patients with general anesthesia

OBJECTIVE: The present study is aimed to study the neuron-specific enolase (NSE) and S100b proteins in the evaluation of postoperative cognitive dysfunction in elderly patients with general anesthesia.

PATIENTS AND METHODS: A total of 142 aged patients, who were treated with transurethral resection of the prostate (TURP) surgery under general anesthesia with propofol from June 2014 to December 2015, were randomly divided into two groups. The experiment group was given scopolamine butylbromide by intramuscular injection before the operation, while the control group had no preoperative intramuscular injection. The propofol was used for maintenance during the operation. The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scales were adopted for testing the patients on preoperative day 1, postoperative day 2 and postoperative day 9. After the surgery, there were 4 cases of postoperative cognitive dysfunction (POCD) patients in experiment group, while 21 cases of POCD patients in control group. While the 142 healthy adult volunteers, who were admitted to physical examination center of our hospital in the corresponding period, were selected as healthy controls. The expression levels of S100b and NSE of patients, as well as healthy controls, were detected by ELISA.

RESULTS: In POCD patients, serum S100b and NSE levels were evidently higher than those of patients without POCD and healthy control group (p<0.05). S100b and NSE levels of POCD patients in experiment group were significantly lower than those of control group (p<0.05). Serum S100b and NSE levels are higher, the longer duration of POCD is, as the correlation coefficient rs=-0.1342, -1.6644, p<0.05.

CONCLUSIONS: The expression levels of S100b protein and plasma NSE in the serum of POCD patients increased, which indicated the severity of the disease. The preoperative intramuscular injection of scopolamine butylbromide has important clinical significance for the prevention of POCD.

L'articolo Evaluation of the postoperative cognitive dysfunction in elderly patients with general anesthesia sembra essere il primo su European Review.

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Minimally-invasive middle fossa craniotomy approach with endoscopic repair of superior canal dehiscence

Publication date: Available online 17 January 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Elliott D. Kozin, Daniel J. Lee
Superior canal dehiscence (SCD) is a bony defect of the superior semicircular canal (SSC). SCD syndrome (SCDS) occurs when vestibular or auditory dysfunction accompanies SCD. While not all SCD patients are symptomatic, surgical repair is an option in patients with incapacitating symptoms and unresponsive to conservative treatment. Traditionally, repair of SCDS when involving the arcuate eminence can be achieved utilizing a middle fossa craniotomy (MFC) approach. However, approximately 30% of SCD cases have a medial arcuate eminence defect along a downsloping tegmen, making the defect difficult to visualize with the binocular microscope without a large craniotomy, extensive temporal lobe retraction and drilling of the skull base. As complete visualization of an arcuate eminence defect is essential for successful repair, we describe an operative approach to visualize the SCD that combines a small MFC and rigid angled endoscopy. The wide-field view and superior transillumination with skull base endoscopy can be achieved with a minimal access skin incision, small bony window, less dural dissection, reduced brain retraction, resulting in unequivocal identification of the entire arcuate eminence defect.

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Keratosis Obturans: A Disease of the Tropics?

Abstract

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Outcomes of Newborn Hearing Screening Program: A Hospital Based Study

Abstract

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Role of Topical Medication in Prevention of Post-extubation Subglottic Stenosis

Abstract

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Re: Minimal invasive treatment using patient-specific template for mandibular fractures in children: “Wing- splint” by CAD/CAM technology

We appreciate Hegab's comments about our recent paper and agree with him in some parts.1 We understand the concern that the orthodontic implants installed in the alveolar bone of children may be loosened when intermaxillary fixation is put in place, because the bone is not rigid in a child's mandible at the time of permanent tooth eruption. The "wing-splint" of our paper was an effort to overcome this.2

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Epstein-Barr-virus-related mucocutaneous ulceration that mimics oral squamous cell carcinoma: the importance of recognising this new condition

We report a case and present a literature search of the relatively newly reported condition of Epstein Barr Virus (EBV)-related mucocutaneous ulceration. EBV-related mucocutaneous ulcers clinically present as oral squamous cell carcinoma (OSCC) in immunocompromised elderly patients but usually resolve by stopping or modifying the medication.As the two conditions can present in a similar way, and the management of each is totally different, this case highlights the importance of recognising this condition at an early stage.

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Anatomic Considerations for Sinonasal and Ventral Skull Base Malignancy

Malignancies of the sinonasal region and ventral skull base include a varied group of uncommon tumors that are a challenge to treat. These malignancies, with few exceptions, often present late because of their insidious growth and bland symptomatology. As with malignancies of other sites, the primary goal in surgical management is complete resection with negative margins. This presents a unique surgical challenge in that these lesions lie within a region of densely populated anatomic real estate. This fact reinforces the importance of complete preoperative work-up and a sound anatomic understanding. This article discusses key anatomic regions and their importance from an endonasal perspective.

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The Role of Radiation Therapy in the Management of Sinonasal and Ventral Skull Base Malignancies

Sinonasal and ventral skull base malignancies are rare tumors that arise in a complex anatomic location juxtaposed with critically important normal tissues. The standard treatment paradigm for most histologies has been surgery followed by postoperative radiation therapy. Because of their propensity to present at an advanced stage and the presence of nearby critical structures, patients are at risk for severe radiation-induced long-term toxicity. Recent advances in radiotherapy technique have improved the therapeutic ratio between tumor control and normal tissue toxicity. This article reviews issues pertinent to the use of radiotherapy in the management of these tumors.

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Update HNO

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Dank an die Gutachter 2016

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Endonasal septal perforation repair using posterior and inferiorly based mucosal rotation flaps

Publication date: Available online 16 January 2017
Source:American Journal of Otolaryngology
Author(s): Steven Dayton, Nipun Chhabra, Steven Houser
ImportanceRepair of nasal septal perforations is challenging regardless of surgical technique due to their location and the health of surrounding tissue. There is currently no surgical procedure which is completely effective in the treatment of anteriorly located perforations.ObjectiveTo report a novel method of closing anterior septal perforations using an inferiorly based mucosal rotation flap and an acellular dermal interposition graft, as well as expand upon a previous series.DesignThe study includes patients who underwent surgical repair for septal perforations by the senior author between 2003 and 2015.SettingThe study took place at MetroHealth Medical Center in Cleveland, Ohio.ParticipantsThirty-nine patients (15 male) with septal perforations of various size and etiology underwent endonasal repair using rotation flaps. The average age of patients was 42-years old (range 10–67years).Intervention for clinical trials or exposure for observational studiesFive patients had perforations such that we used inferiorly based flaps, while 35 cases utilized posteriorly based flaps. Acellular dermis was used in addition to a unilateral rotation flap.Main outcomes and measuresThe primary outcome desired was a complete closure of the septal perforation. The success, or lack thereof, was monitored after healing from surgery.ResultsThirty-seven of the forty surgical procedures demonstrated complete closure of the perforation, a 92.5% success rate. Perforations were separated based upon size. Small perforations (<1cm) had a 93.3% success rate, medium (1–2cm) 88.9%, and all seven large perforations (>2cm) were closed successfully. In addition, all five of the inferiorly based procedures resulted in complete closure of the perforation. Of the failed repairs, one required revision surgery to repair a recurring perforation, while the other two were asymptomatic following the procedure.Conclusions and relevanceEndonasal repair using inferiorly based mucosal rotation flaps coupled with an acellular dermal interposition graft is a valid technique for the repair of septal perforations. Posterior rotation flaps are preferred due to major septal blood supply from branches of the sphenopalatine artery, but inferiorly based flaps are also viable options for repair for perforations located in the anterior septum.

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Recurrent Uveal Effusion after Laser Iridotomy

A 59-year-old woman was seen by an ophthalmologist for blurred vision, ocular pain, headache, and nausea. She was diagnosed with acute primary angle closure (APAC) and successfully treated with medications. Using ultrasound biomicroscopy (UBM), engorged episcleral vein was observed and small uveal effusion was diagnosed after laser peripheral iridotomy (LPI). The uveal effusion disappeared and was again diagnosed by UBM together with anterior segment inflammation with ocular pain. Iritis caused by LPI after APAC might be a cause of uveal effusion in this specific case.
Case Rep Ophthalmol 2017;8:26–30

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Update on Aspirin-Exacerbated Respiratory Disease

Abstract

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Pneumatosis coli causing pneumoperitoneum

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<span class="paragraphSection"><div class="boxTitle">Abstract</div>This is a case of a 54-year-old gentleman who presented to an outside hospital emergency department with lower abdominal pain. Computed tomography imaging showed a small amount of intraperitoneal free air and cystic pneumatosis coli. He was admitted, managed conservatively with intravenous antibiotics, and then discharged home after his symptoms improved. Elective laparoscopic sigmoid colectomy was subsequently performed with intraoperative findings of partial sigmoid volvulus and extensive pneumatosis coli of the sigmoid colon. Pneumoperitoneum was determined to be from ruptured intramural cysts. The etiology of pneumatosis coli was likely from chronic sigmoid volvulus.</span>

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Saphenous vein patch for correction of anomalous origin of the right coronary artery from the left main coronary artery

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<span class="paragraphSection"><div class="boxTitle">Abstract</div>Anomalous origin of the coronary arteries is a rare congenital heart defect that may lead to disturbed life style, myocardial infarction and sudden death. This report describes a young lady with the right coronary artery arising from the left main coronary artery, which was confirmed by coronary angiography and corrected surgically using saphenous vein patch.</span>

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A rare presentation of an acute appendicitis

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<span class="paragraphSection"><div class="boxTitle">Abstract</div>Paraumbilical hernia sac usually contains omentum, bowel loop and rarely appendicular epiploicae, metastatic deposits and vermiform appendix. Presentation of acute appendicitis in a paraumbilical hernia is rare and limited to few case reports in the literature. Herein, we would like to report a case of a successfully treated acute appendicitis presenting in a paraumbilical hernia in an 84-year-old lady with 6-month follow-up.</span>

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Lipopolysaccharide-induced suppression of periodontal ligament cell proliferation and apoptosis are strengthened under high glucose conditions

Publication date: Available online 17 January 2017
Source:Archives of Oral Biology
Author(s): Jianxin Liu, Shulan Chen, Weiwei Ren, Jianing Liu, Pishan Yang, Zhenggang Chen, Qiang Zhang, Fang Yang
The present study aimed to investigate the effect of lipopolysaccharide (LPS) on the proliferation and apoptosis of human periodontal ligament (hPDL) cells under normal glucose or high glucose conditions. Primary cultures of hPDL cells were prepared from extracted premolars of patients. The cells were incubated with 0, 1, or 10μg/mL LPS under normal glucose (5.5mmol/L) or high glucose (25mmol/L) conditions for 24h or 48h. Cell proliferation was detected using a CCK-8 assay, and cell apoptosis was measured by Hoechst 33258 staining and Annexin V-fluorescein isothiocyanate (FITC)/propidium iodide (PI) double staining. BCL2 and BAX mRNA and protein levels were measured by real-time polymerase chain reaction and western blotting, respectively. LPS (10μg/mL) induced significant inhibition of cell proliferation and cell apoptosis, and a significant decrease in the BCL2/BAX ratio in the cells cultured with 5.5mmol/L glucose. These effects of LPS were increased significantly in cells treated with 25mmol/L glucose. Analysis of variance of the factorial design revealed that high glucose and LPS had a significant interaction for cell apoptosis, but not for cell proliferation. High glucose augmented LPS-induced hPDL cell apoptosis and cell proliferation inhibition. LPS and high glucose might interact to induce cell apoptosis.

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Lipopolysaccharide-induced suppression of periodontal ligament cell proliferation and apoptosis are strengthened under high glucose conditions

Differences in RANTES and IL-6 levels among chronic rhinosinusitis patients with predominant gram-negative and gram-positive infection

Vascular mapping of the retroauricular skin – proposal for a posterior superior surgical incision for transcutaneous bone-conduction hearing implants

Atypical presentation of Bezold's and Citelli's abscesses, with recollection following an incomplete postoperative course of antibiotics

Bezold's and Citelli's abscesses are rare complications of otitis media. We present a case of a 44-year-old Eastern European man, with a history of recurrent otitis media, who was admitted to hospital with mastoiditis and initially treated with antibiotics. Despite clinical improvement, a CT scan showed mastoiditis with Bezold's and Citelli's abscesses. The patient underwent a myringotomy and grommet insertion, in addition to a cortical mastoidectomy and curettage of the neck abscesses. After a good recovery, he was discharged home. However, likely due to the language barrier, he did not complete a course of antibiotics as prescribed, and the abscess re-collected, necessitating a re-admission and re-operation. This report illustrates the importance of considering rare features of a common disease in the differential, and of communication in ensuring compliance.

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Not so patchy story of attempted suicide...leading to 24 hours of deep sleep and survival!

Here, we present a somewhat unusual suicide attempt where, despite an unbelievable overdose with transdermal fentanyl patches, the patient survived. The patient—a woman aged 70 years, who has suffered from chronic back pain despite starting transdermal fentanyl patches in 2007. The unconventional method of attempted suicide was based on online research into deaths from fentanyl patch toxicity. She had gradually accumulated 100 µg fentanyl patches from repeat prescriptions, applying 14 patches with fatal intent, alongside 2 45 mg mirtazapine tablets, and concurrent therapeutic doses of tramadol and morphine sulfate oral solution. However, after 24 hours, she awoke from a deep sleep to the sound of the telephone ringing, somewhat amazed her drastic efforts had failed. During admission to Great Western hospital, she was seen by liaison psychiatry and subsequently transferred to the care of the pain management team, to which she had already been referred.

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Disseminated adenovirus infection causing severe ARDS

A previously healthy young man with a rare genetic condition presented with severe acute respiratory distress syndrome secondary to pneumonia with septic shock. He did not improve with conventional therapy for his known causal organism thus prompting further workup. He was found to be profoundly immunosuppressed raising our suspicion for atypical organisms. A bronchoalveolar lavage sample was positive via PCR for adenovirus which we suspect exacerbated a pre-existing bacterial pneumonia and led to a severe and non-responsive respiratory failure. His serum adenovirus load was markedly elevated. Treatment was started once the diagnosis of disseminated adenovirus infection was made; however, at that time patient was suffering from refractory hypoxaemia, respiratory acidosis, right heart failure and septic shock. Despite maximal supportive measures our patient ultimately expired over the course of 6 days.

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Ingestion of cylindrical batteries and its management

In contrast to the ingestion of coin batteries, the ingestion of cylindrical batteries is an uncommon medical presentation. Owing to their larger size, cylindrical battery ingestion can lead to serious complications including intestinal haemorrhage, bowel obstruction, bowel perforation, peritonitis and even death. We discuss the case of a 17-year-old girl who presented after swallowing three cylindrical batteries. Her medical history included depression and previous battery ingestion that required surgical removal. During this presentation however, these ingested batteries were removed endoscopically at oesophagogastroduodenoscopy and ileocolonoscopy. The patient was subsequently discharged without complication. This paper discusses the complications and management of cylindrical battery ingestion.

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Disseminated melioidosis in the head and neck

A 35-year-old man was admitted to an intensive care unit with unilateral facial swelling and septic shock after multiple presentations to the emergency department with non-specific unilateral pain over the parotid area. A CT scan of his neck showed diffuse right-sided facial soft tissue infection, mastoid effusion and temporal lobe cerebritis. The upper lobes of his lungs had cannonball lesions that were suggestive of septic lung metastases. Blood cultures and ear canal swabs were positive for Burkholderia pseudomallei. The temporal lobe cerebritis eventually developed into an abscess, necessitating a cortical mastoidectomy, craniectomy and temporal lobectomy. After the surgical interventions, antibiotic therapy was continued for a further 6 months. The patient remained well and had no signs of recurrence up to 7 months after the initial presentation.

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Haemodialysis in acute paracetamol poisoning

A woman aged 23 years presented late with clinical and biochemical features of a life-threatening paracetamol (acetaminophen) overdose. Despite instigating N-acetylcysteine treatment, due to evidence of mitochondrial dysfunction together with an exceedingly high paracetamol level, the decision was made to dialyse the patient acutely to remove the parent drug. This was highly effective, and with on-going supportive care, the patient made a full recovery without the need for transplantation. This case highlights the role of extracorporeal therapy as a treatment option in selected cases of paracetamol overdose, consistent with the international guidelines.

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Supra and infratentorial ectopic schwannoma mimicking a meningioma

We report the case of a supra and infratentorial ectopic schwannoma, mimicking a meningioma, that was surgically resected on a 75-year-old man, with a history of progressive visual loss and headaches. MRI was in favour of an occipital, cystic, tentorial-based meningioma extending to the posterior fossa, with signs of intratumoral haemorrhage. This is a unique case because of the rare type of lesion, in a very atypical location, completely unexpected by the preoperative imaging analysis, and to the best of our knowledge it is the oldest patient reported in the literature with this kind of tumour.

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Feinmodellierung und diskrete Augmentation des Nasenrückens mittels „free diced cartilage“

Zusammenfassung

Hintergrund

Insbesondere die Modellierung des Nasenrückens im Rahmen von Rhinoseptumplastiken stellt eine Herausforderung für den Operateur dar. Bei unsachgemäßer Handhabung drohen Unregelmäßigkeiten des Nasenrückens, die eine Hauptursache für Revisionsoperationen darstellen.

Zielsetzung

Es erfolgt die Vermittlung der Technik zur Feinmodellierung und diskreten Augmentation des Nasenrückens mittels „free diced cartilage" (fDC).

Schlussfolgerung

Die Verwendung von fDC zur Feinmodellierung und diskreten Augmentation des Nasenrückens erlaubt sichere und zuverlässig reproduzierbare Ergebnisse bei niedriger Spenderarealmorbidität und hoher Kosteneffektivität.

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Psychologische Aspekte von Tattoo & Co

Zusammenfassung

Von ärztlicher Seite aus wird vorwiegend auf medizinische Risiken von Tätowierungen, Piercings und anderen Formen der Body-Modification hingewiesen. Abgesehen von medizinisch sinnvollen Tattoos, etwa einer auftätowierten Brustwarze nach Mammakarzinom, können gerade junge Menschen in ihrer Persönlichkeitsentwicklung von Körperschmuck profitieren. Beispiele sind das subjektive Gefühl gestiegener Attraktivität, Stolz auf die „Mutprobe" durch das Ertragen der Schmerzen und bessere Integration in die Gruppe der Gleichaltrigen. Bei Borderline-Patienten kann es sogar zum Rückgang selbstverletzender Verhaltensweisen kommen. Nicht selten verarbeiten Menschen traumatische Lebensereignisse, z. B. den Tod einer nahestehenden Person, durch ein Tattoo. Obwohl heute in Deutschland rund 8 Mio. Menschen tätowiert sind, zeigen aktuelle Studien, dass es weiterhin Vorurteile gibt. Die Entscheidung für ein tätowiertes Bild ist nicht zufällig, sondern spiegelt den Charakter des Trägers wider. Ein Mensch, der sich mit Tattoos wie z. B. Blumengirlanden schmückt, ist tatsächlich meist friedfertiger. Jemand, dessen Oberarm ein „Skull" ziert, muss aber nicht aggressiver sein; der Totenschädel kann ihn auch an die Begrenztheit des Lebens mahnen.

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Die Macht des Wortes

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Efficacy and safety of mepolizumab in Japanese patients with severe eosinophilic asthma

Publication date: Available online 16 January 2017
Source:Allergology International
Author(s): Terufumi Shimoda, Hiroshi Odajima, Arisa Okamasa, Minako Kawase, Masaki Komatsubara, Bhabita Mayer, Steven Yancey, Hector Ortega
BackgroundThe MENSA trial assessed the efficacy and safety of mepolizumab in patients with severe eosinophilic asthma. This report describes the efficacy and safety of mepolizumab in Japanese patients from MENSA.MethodsA post hoc analysis of the Japanese subgroup from the randomized, double-blind, placebo-controlled, double-dummy, Phase III MENSA trial (NCT01691521). Patients ≥12 years with severe eosinophilic asthma received mepolizumab 75 mg intravenously (IV), 100 mg subcutaneously (SC), or placebo, every 4 weeks for 32 weeks. The primary endpoint was the annualized rate of exacerbations. Secondary and other endpoints included annualized rate of exacerbations requiring emergency department (ED) visit/hospitalization, morning peak expiratory flow (PEF), St George's Respiratory Questionnaire (SGRQ) score and eosinophil counts. Adverse events (AEs) were monitored.ResultsIn the Japanese subgroup (N = 50), the rate of clinically significant exacerbations was reduced by 90% (rate ratio [RR]: 0.10; 95% confidence interval [CI]: 0.02–0.57; P = 0.010) with mepolizumab IV and 62% (RR: 0.38; 95% CI: 0.12–1.18; P = 0.094) with mepolizumab SC, versus placebo. No exacerbations requiring ED visit/hospitalization were reported with mepolizumab IV; exacerbations were reduced by 73% (RR: 0.27; 95% CI: 0.06–1.29; P = 0.102) with mepolizumab SC versus placebo. Compared with placebo, mepolizumab IV and SC numerically increased morning PEF from baseline by 40 L/min and 13 L/min, improved quality of life by greater than the minimal clinically important difference (SGRQ: 9.5 [P = 0.083] and 7.9 [P = 0.171] points) and reduced eosinophil counts. AE incidence was similar between treatments. Results were broadly consistent with the overall population.ConclusionsMepolizumab was efficacious and well tolerated in Japanese patients with severe eosinophilic asthma, producing similar responses to the overall MENSA population.

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Leukocytoclastic vasculitis with eosinophilic infiltration associated with thalidomide therapy for multiple myeloma: A case report

Publication date: Available online 16 January 2017
Source:Allergology International
Author(s): Susumu Ichiyama, Yoko Funasaka, Hiroko Yamashita, Hideto Tamura, Koiti Inokuchi, Hidehisa Saeki

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Use of 3D-CT airway analysis software to assess a patient with severe persistent bronchial asthma treated with bronchial thermoplasty

Publication date: Available online 16 January 2017
Source:Allergology International
Author(s): Satoru Ishii, Motoyasu Iikura, Masayuki Hojo, Haruhito Sugiyama

http://ift.tt/2iDaJgZ

Medication Overuse in Chronic Pain

Abstract

Purpose of Review

Chronic pain is usually managed by various pharmacotherapies after exhausting the conservative modalities such as over-the-counter choices. The goal of this review is to investigate current state of opioids and non-opioid medication overuse that includes NSAIDs, skeletal muscle relaxants, antidepressants, membrane stabilization agents, and benzodiazepine. How to minimize medication overuse and achieve better outcome in chronic pain management?

Recent Findings

Although antidepressants and membrane stabilization agents contribute to the crucial components for neuromodulation, opioids were frequently designated as a rescue remedy in chronic pain since adjunct analgesics usually do not provide instantaneous relief. The updated CDC guideline for prescribing opioids has gained widespread attention via media exposure. Both patients and prescribers are alerted to respond to the opioid epidemic and numerous complications. However, there has been overuse of non-opioid adjunct analgesics that caused significant adverse effects in addition to concurrent opioid consumption. It is a common practice to extrapolate the WHO three-step analgesic ladder for cancer pain to apply in non-cancer pain that emphasizes solely on pharmacologic therapy which may result in overuse and escalation of opioids in non-cancer pain. There has been promising progress in non-pharmacologic therapies such as biofeedback, complementary, and alternative medicine to facilitate pain control instead of dependency on pharmacologic therapies.

Summary

This review article presents the current state of medication overuse in chronic pain and proposes precaution to balance the risk and benefit ratio. It may serve as a premier for future study on clinical pathway for comprehensive chronic pain management and reduce medication overuse.

http://ift.tt/2j4URow

In silico prediction of Leishmania major-specific CD8+ epitopes

http://ift.tt/2iJz9ZE

Skin microbiome and acne vulgaris: staphylococcus, a new actor in acne

Abstract

Propionibacterium acnes (P. acnes), the sebaceous gland and follicular keratinocytes are considered the three actors involved in the development of acne.

This exploratory study investigated the characteristics of the skin microbiota in subjects with acne and determined microbiota changes after 28 days of application of erythromycin 4% or a dermocosmetic.

Skin Microbiota were collected under axenic conditions from comedones, papulo-pustular lesions and nonlesional skin areas from subjects with mild to moderate acne according to the GEA Grading using swabs. Samples were characterised using a high-throughput sequencing approach that targets a portion of the bacterial 16S rRNA gene.

Results

Overall, microbiota samples from 26 subjects showed an overabundance of Proteobacteria and Firmicutes and an underrepresentation of Actinobacteria. Staphylococci were more abundant on the surface of comedones, papules and pustules (p=0.004 and p=0.003 respectively) than on nonlesional skin. Their proportions increased significantly with acne severity (p<0.05 between GEA-2 and GEA-3). Propionibacteria represented less than 2% of the bacteria on the skin surface.

At Day 28, only the number of Actinobacteria had decreased with erythromycin while the dermocosmetic decreased also the number of Staphylococci. A significant reduction (p<0.05) from Day 0 of comedones, papules and pustules with no significant difference between the products was observed.

Conclusion

The bacterial diversity on all sampling areas was similar.

The dermocosmetic decreased the number of Actinobacteria and Staphylococcus spp. after 28 days. Staphylococcus remained the predominant genus of the superficial skin microbiota. No significant reduction of Staphylococcus spp. was observed with the topical antibiotic.

http://ift.tt/2iD31Ut

The parathyroid hormone family member TIP39 interacts with sarco/endoplasmic reticulum Ca2+- ATPase activity by influencing calcium homeostasis

Abstract

Darier disease (DD) is a genetic skin disease that is associated with mutations in the ATP2A2 gene encoding the type 2 sarco/endoplasmic reticulum Ca²⁺-ATPase (SERCA2). Mutations of this gene result in alterations of calcium homeostasis, abnormal epidermal adhesion and dyskeratosis. Silencing of ATP2A2 in monolayer cell culture of keratinocytes reduces desmoplakin expression at the borders of cells and impacts cell adhesion. Here, we report establishment of a three-dimensional (3D) epidermal model of DD, and use this model to evaluate peptide therapy with tuberoinfundibular peptide of 39 residues (TIP39) to normalize calcium transport. Gene silencing of ATP2A2 in keratinocytes grown in a 3D model resulted in dyskeratosis, partial parakeratosis and suprabasal clefts that resembled the histological changes seen in skin biopsies from patients with DD. TIP39, a peptide recently identified as a regulator of keratinocyte calcium transport,, was then applied to this ATP2A2 silenced 3D epidermal model. In normal keratinocytes, TIP39 increased [Ca²⁺]_i through the inositol trisphosphate (IP3) receptor pathway and stimulated differentiation. In monolayer ATP2A2-silenced keratinocytes, although TIP39 increased cytosolic calcium from the endoplasmic reticulum (ER), the response was incomplete compared with its control. TIP39 was observed to reduce intercellular clefts of the gene silenced epidermal model but did not significantly upregulate keratinocyte differentiation genes such as keratin10 and filaggrin. These findings indicate that TIP39 is a modulator of ER calcium signaling and may be used as a potential strategy for improving aspects of DD.

http://ift.tt/2iJzv2g

Collapse of human scalp microbiome network in dandruff and seborrheic dermatitis

http://ift.tt/2iD6L8q

Ultraviolet B irradiation increases keratin 1 and keratin 10 expression in HaCaT keratinocytes via TRPV1 activation and ERK phosphorylation

http://ift.tt/2iJvPhc

Divergence of cAMP signaling pathways mediating augmented nucleotide excision repair and pigment induction in melanocytes

Abstract

Loss-of-function melanocortin 1 receptor (MC1R) polymorphisms are common in UV-sensitive fair-skinned individuals and are associated with blunted cAMP second messenger signaling and higher lifetime risk of melanoma because of diminished ability of melanocytes to cope with UV damage. cAMP signaling positions melanocytes to resist UV injury by up-regulating synthesis of UV-blocking eumelanin pigment and by enhancing the repair of UV-induced DNA damage. cAMP enhances melanocyte nucleotide excision repair (NER), the genome maintenance pathway responsible for the removal of mutagenic UV photolesions, through cAMP-activated protein kinase (protein kinase A)-mediated phosphorylation of the ataxia telangiectasia mutated and Rad3 related (ATR) protein on the S435 residue. We investigated the interdependence of cAMP-mediated melanin upregulation and cAMP-enhanced DNA repair in primary human melanocytes and a melanoma cell line. We observed that the ATR-dependent molecular pathway linking cAMP signaling to the NER pathway is independent of MITF activation. Similarly, cAMP-mediated up-regulation of pigment synthesis is independent of ATR, suggesting that the key molecular events driving MC1R-mediated enhancement of genome maintenance (e.g. PKA-mediated phosphorylation of ATR) and MC1R-induced pigment induction (e.g. MITF activation) are distinct.

http://ift.tt/2iJxQdm

Biomaterials: A potential pathway to healing chronic wounds?

Abstract

Chronic dermal wounds are a devastating problem that disproportionally affect individuals with conditions such as diabetes, paralysis, or simply old age. These wounds are extremely challenging to treat due to a heterogeneous combination of causative factors, creating a substantial burden on healthcare systems worldwide. Despite their large impact, there is currently a startling lack of options for effectively treating the underlying biological changes that occur within the wounds. Biomaterials possess an enticing ability to provide new comprehensive approaches to healing these devastating wounds; advanced wound dressings are now being developed that enable the ability to coordinate temporal delivery of multiple therapeutics, protect sensitive biologics from degradation, and provide supportive matrices that encourage the growth of tissue. This positions biomaterials as a potential 'conductor' of wound repair, allowing them to simultaneously address numerous barriers to healing, and in turn providing a promising pathway to innovative new technologies for driving successful healing.

http://ift.tt/2iD486z

Loss of FAS/FASL signaling does not reduce apoptosis in Sharpin null mice

Abstract

Mice with mutations in SHANK-associated RH domain interactor (Sharpin) develop a hypereosinophilic auto-inflammatory disease known as chronic proliferative dermatitis. Affected mice have increased apoptosis in the keratinocytes of the skin, esophagus, and forestomach driven by extrinsic TNF receptor mediated apoptotic signaling pathways. FAS receptor signaling is an extrinsic apoptotic signaling mechanism frequently involved in inflammatory skin diseases. Compound mutations in Sharpin and Fas or Fasl were created to determine if these death domain proteins influenced the cutaneous phenotype in Sharpin null mice. Both Sharpin/Fas and Sharpin/Fasl compound mutant mice developed an auto-inflammatory phenotype similar to that seen in Sharpin null mice indicating that initiation of apoptosis by FAS signaling is likely not involved in the pathogenesis of this disease.

http://ift.tt/2iJzqeY

IGF1R signaling acts on the anagen to catagen transition in the hair cycle

Abstract

Insulin like growth factor 1 (IGF1) is important for skin development and homeostasis. However, overexpression and inactivation studies have produced variable findings regarding its role in hair follicle (HF) biology. Here, we studied a conditional and inducible knockout of the IGF1 receptor (IGF1R) in keratin 15-expressing bulge cells. Deletion of IGF1R after the development of the skin appendages in K15-IGF1R^KO mice showed no abnormalities in epidermal homeostasis. Numbers of bulge cells were lower in K15-IGF1R^KO mice than in controls, without consequences on wound healing, at least in young mice. K15-IGF1R^KO HFs entered anagen phase earlier than controls and showed a delay in the anagen/catagen switch. The expression of BMP-4 mRNA was inhibited in HFs from K15-IGF1R^KO. MED1 transcription was impaired in the epidermis of K15-IGF1R^KO mice. These findings suggest that IGF1R controls the hair cycle, partly through BMP-4 activation.

http://ift.tt/2iDfcjP

Genetic defects in PI3Kδ affect B-cell differentiation and maturation leading to hypogammaglobulineamia and recurrent infections

Publication date: Available online 17 January 2017
Source:Clinical Immunology
Author(s): Marjolein Wentink, Virgil Dalm, Arjan C. Lankester, Pauline A. van Schouwenburg, Liesbeth Schölvinck, Tomas Kalina, Radana Zachova, Anna Sediva, Annechien Lambeck, Ingrid Pico-Knijnenburg, Jacques J.M. van Dongen, Malgorzata Pac, Ewa Bernatowska, Martin van Hagen, Gertjan Driessen, Mirjam van der Burg
BackgroundMutations in PIK3CD and PIK3R1 cause activated PI3K-δ syndrome (APDS) by dysregulation of the PI3K-AKT pathway.MethodsWe studied precursor and peripheral B-cell differentiation and apoptosis via flowcytometry. Furthermore, we performed AKT-phosphorylation assays and somatic hypermutations (SHM) and class switch recombination (CSR) analysis.ResultsWe identified 13 patients of whom 3 had new mutations in PIK3CD or PIK3R1. Patients had low total B-cell numbers with increased frequencies of transitional B cells and plasmablasts, while the precursor B-cell compartment in bone marrow was relatively normal. Basal AKT phosphorylation was increased in lymphocytes from APDS patients and natural effector B cells where most affected. PI3K mutations resulted in altered SHM and CSR and increased apoptosis.ConclusionsThe B-cell compartment in APDS patients is affected by the mutations in PI3K. There is reduced differentiation beyond the transitional stage, increased AKT phosphorylation and increased apoptosis. This B-cell phenotype contributes to the clinical phenotype.

http://ift.tt/2iJxzqJ

Neuroendocrinology of mast cells: Challenges and Controversies

Abstract

Mast cells (MC) are hemopoietically-derived tissue immune cells that are ubiquitous in the body, including neuroendocrine organs such as the hypothalamus, pineal, pituitary, ovaries, pancreas and uterus where their action is not well understood. Mast cells have historically been associated with allergies because of their rich content of histamine and tryptase, but more recently with regulation of immunity and inflammation due their synthesis and release of numerous cytokines and chemokines. Mast cells are located perivascularly and express numerous receptors for diverse ligands such as allergens, pathogens, neurotransmitters, neuropeptides and hormones including acetylcholine, calcitonin gene-related peptide (CGRP), corticosteroids, corticotropin-releasing hormone (CRH), β-endorphin, epinephrine, 17β-estradiol, gonadotrophins, hemokinin-A (HKA), leptin, melatonin, neurotensin (NT), parathyroid hormone (PTH), substance P (SP) and vasoactive instestinal peptide (VIP). Moreover, MC can synthesize and release most of their neurohormonal triggers, including adrenocorticotropin hormone (ACTH), CRH, endorphins, HKA, leptin, melatonin, NT, SP and VIP. Animal experiments have shown that diencephalic MC increase in number during courting in doves, while stimulation of brain and nasal MC leads to activation of the hypothalamic-pituitary-adrenal (HPA) axis. Recent evidence indicates that MC reactivity exhibits diurnal variations and it is interesting that melatonin appears to regulate MC secretion. However, the way MC change their phenotype or secrete specific molecules selectively at different pathophysiological settings still remains unknown. Mast cells developed over 500 million years ago and may have served as the original prototype neuroimmunoendocrine cell and then evolved into a master regulator of such interactions, especially since most of the known diseases involve neuroinflammation that worsens with stress.

http://ift.tt/2iJz6wW

UVA-1 exposure in vivo leads to an IL-6 surge within the skin

http://ift.tt/2iD4cDa

Niacinamide leave-on formulation provide long-lasting protection against bacteria in vivo

http://ift.tt/2iJCqrP

Granzyme A potentiates chemokine production in IL-17 stimulated keratinocytes

http://ift.tt/2iJCMip

Body regions have an impact on the collagen/elastin index of the skin measured by non-invasive in vivo vertical two photon microscopy

http://ift.tt/2iD6VfG

A Study to Investigate Biomarker Effects of Pre-Surgical Treatment With DNA Damage Repair (DDR) Agents in Patients With Head and Neck Squamous Cell Carcinoma (HNSCC)

Condition: Head and Neck Squamous Cell Carcinoma
Interventions: Drug: AZD6738; Drug: Olaparib
Sponsor: AstraZeneca
Not yet recruiting - verified January 2017

http://ift.tt/2jsp1G1

Trial of Nivolumab as a Novel Neoadjuvant Pre-Surgical Therapy for Locally Advanced Oral Cavity Cancer

Condition: Oral Cavity SCC
Intervention: Drug: Nivolumab
Sponsors: David Neskey; Bristol-Myers Squibb
Not yet recruiting - verified January 2017

http://ift.tt/2jUJb82

Transmeatal tympanoplasty of subtotal and anterior perforations; a single-institution experience including 94 patients

Abstract

Transmeatal myringoplasty is suitable for all cases of eardrum perforations.

Results are 90% closure rate; comparable to other published series of retroauricular techniques.

Operation can be completed in 15-20 minute, meaning cost-effective use of surgical resources.

Far less patient discomfort and lower morbidity compared to a retroauricular approach.

Tragal perichondrium is found to be a suitable and reliable graft material.

http://ift.tt/2jsjejr

Clonidine is effective for the treatment of primary idiopathic hyperhidrosis and hot flushes: a case report

While primary hyperhidrosis can be seen in men, accompanying hot flushes is rarely seen in men. Primary hyperhidrosis is thought to be related to overactivity of the sympathetic nervous system while hot flushe...

http://ift.tt/2jFK1X8

A single intervention for cockroach control reduces cockroach exposure and asthma morbidity in children

Publication date: Available online 17 January 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Felicia A. Rabito, John C. Carlson, Hua He, Derek Werthmann, Coby Schal
BackgroundExposure to cockroaches is an important asthma trigger, particularly for children with asthma living in inner cities. Integrated pest management is the recommended approach to cockroach abatement; however, it is costly and difficult to implement. The impact of reducing cockroach exposure on asthma outcomes is not known.ObjectiveWe sought to test the use of a single intervention, insecticidal bait, to reduce cockroach exposure in the home of children with asthma in New Orleans and to examine the impact of cockroach reduction on asthma outcomes.MethodsOne hundred two children aged 5 to 17 years with moderate to severe asthma were enrolled in a 12-month randomized controlled trial testing the use of insecticidal bait on cockroach counts and asthma morbidity. Homes were visited 6 times and asthma symptoms were assessed every 2 months.ResultsAfter adjustment, intervention homes had significantly fewer cockroaches than did control homes (mean change in cockroaches trapped, 13.14; 95% CI, 6.88-19.39; P < .01). Children in control homes had more asthma symptoms and unscheduled health care utilization in the previous 2 weeks (1.82, 95% CI, 0.14-3.50, P = .03; 1.17, 95% CI, 0.11-2.24, P = .03, respectively) and a higher proportion of children with FEV1 of less than 80% predicted (odds ratio, 5.74; 95% CI, 1.60-20.57; P = .01) compared with children living in intervention homes.ConclusionsPrevious research has demonstrated improvement in asthma health outcomes using multifaceted interventions. The strategic placement of insecticidal bait, which is inexpensive, has low toxicity, and is widely available, resulted in sustained cockroach elimination over 12 months and was associated with improved asthma outcomes. This single intervention may be an alternative to multifaceted interventions currently recommended to improve asthma morbidity.

http://ift.tt/2j4NIov

Profound Loss of Esophageal Tissue Differentiation in Eosinophilic Esophagitis

Publication date: Available online 17 January 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): M. Rochman, J. Travers, C.E. Miracle, M.C. Bedard, T. Wen, N.P. Azouz, J.M. Caldwell, K. Kc, J.D. Sherrill, B.P. Davis, J.K. Rymer, K.M. Kaufman, M.E. Rothenberg
BackgroundA key question in the allergy field is to understand how tissue specific disease is manifested. Eosinophilic esophagitis (EoE) is an emerging tissue specific allergic disease whose pathogenesis remains unclear.ObjectiveHerein, we tested the hypothesis that a defect in tissue specific esophageal genes is an integral part of EoE pathogenesis.MethodsWe interrogated the pattern of expression of esophagus-specific signature genes derived from the Human Protein Atlas in the EoE transcriptome and in EPC2 esophageal epithelial cells. Western blot and immunofluorescence were used for evaluating expression of esophageal proteins in control and active EoE biopsies. Whole-exome sequencing (WES) was performed to identify mutations in esophagus-specific genes.ResultsWe found that ∼39% of the esophagus-specific transcripts were altered in EoE, with ∼90% being downregulated. The majority of transcriptional changes observed in esophagus-specific genes were reproduced in vitro in esophageal epithelial cells differentiated in the presence of IL-13. Functional enrichment analysis revealed keratinization and differentiation as the most affected biological processes, and identified IL-1 cytokines and serine peptidase inhibitors (SERPINs) as the most dysregulated esophagus-specific protein families in EoE. Accordingly, EoE biopsies evidenced a profound loss of tissue differentiation, decreased expression of keratin 4 and cornulin and elevated expression of keratin 5 and 14. Whole-exome sequencing of 33 unrelated EoE cases revealed 39 rare mutations in 18 esophagus-specific differentially expressed genes.ConclusionsA tissue-centered analysis has revealed a profound loss of esophageal tissue differentiation as an integral and specific part of the pathophysiology of EoE, and implicated protease- and IL-1−related activities as putative central pathways in disease pathogenesis.

Teaser

There is a profound impairment of esophageal tissue differentiation including a loss of tissue identity genes in eosinophilic esophagitis, providing potential value for predictive medicine, diagnostics and treatment of this emerging disease.

http://ift.tt/2jsilrp

Docetaxel Retinopathy: A Case Report

Background: To report the use of En-face optical coherence tomography (OCT) in a patient treated with docetaxel and tamoxifen for breast cancer for the detection of macular edema (ME) without evidence of leakage on fluorescein angiography (FA). Case Presentation: A 52-year-old woman treated for breast cancer presented with bilateral visual loss for 2 months. FA showed no significant leakage while spectral-domain OCT scans of both eyes showed foveolar and parafoveolar cystic spaces in a moderately thickened macula. En-face OCT segmented at the inner retina showed the petaloid arrangement of cystic cavities, comparable to a cystoid ME. Conclusions: The combined use of tamoxifen could have potentiated the toxic effect of docetaxel on the macula. En-face OCT images may reveal a petaloid aspect of the macula due to cysts in the inner retina segmentation, when FA shows no leakage.
Case Rep Ophthalmol 2017;8:21–25

http://ift.tt/2iJ0b3s

Issue Information

http://ift.tt/2jse72Y

Complications associated with the treatment of fractures of the dentate portion of the mandible in paediatric patients: a systematic review

Publication date: Available online 16 January 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): A.N. Bobrowski, M.A. Torriani, C.L. Sonego, P.H. deA. Carvalho, L.K. Post, O.L. Chagas Júnior
This study aimed to answer the following question: What is the best treatment option for fractures of the dentate portion of the mandible in paediatric patients when considering the occurrence of postoperative complications? A systematic literature review was done using the PubMed, Scopus, and Cochrane Library databases, and 1186 articles on the topic were found. Twelve of these articles were included in the final review after the full texts had been read. A sample of 178 paediatric patients was obtained. In the six cases in which treatment was surgery with titanium plate fixation, there were no postoperative complications, whereas in the 141 cases in which treatment was surgery with biodegradable plates, there were 12 postoperative complications, and in the 31 cases in which treatment was non-surgical, there were three postoperative complications. A connection between the best treatment and the number of postoperative complications in fractures of the dentate portion of the mandible in paediatric patients could not be established; however, the occurrence of postoperative complications was low for both surgical and non-surgical treatments.

http://ift.tt/2ix4wZ5

Differences in RANTES and IL-6 levels among chronic rhinosinusitis patients with predominant gram-negative and gram-positive infection

Abstract

Background

Bacteria are suspected players in the pathogenesis of chronic rhinosinusitis (CRS), yet their exact role is not understood. We investigated the effect of planktonic and biofilm of staphylococcus aureus (SA) and Pseudomonas aeruginosa (PA) on the mucosa of CRS patients with gram-positive and gram-negative infections by measuring the levels of IL-6 and RANTES, a chemokine with activity on eosinophils and T lymphocytes.

Methods

Ethmoid mucosa of six CRS patients with gram-positive bacteria on culture and five with gram-negative bacteria were compared to ethmoid mucosa of 8 control patients. The tissue explants were stimulated with SA and PA extracts in planktonic and biofilm form for 6 hours, then RANTES levels were measured by ELISA.

Results

Compared to the control group, CRS patients with gram-negative predominance demonstrated a significantly higher level of RANTES expression in response to all forms of bacterial stimuli (P-value <0.05). Patients with gram-positive predominance showed a higher level of RANTES compere to control group, however, this difference was not significant (P-value >0.05).

Conclusions

The mucosa of CRS patients with gram-negative infections has a heightened innate immune response compared to controls and patients with gram-positive infections. It is possible that this response leads to the pathological eosinophilic inflammation seen in CRS.

http://ift.tt/2jFe1SS

Vascular mapping of the retroauricular skin – proposal for a posterior superior surgical incision for transcutaneous bone-conduction hearing implants

Abstract

Background

Passive transcutaneous osseointegrated hearing implant systems have become increasingly popular more recently. The area over the implant is vulnerable due to vibration and pressure from the externally worn sound processor. Good perfusion and neural integrity has the potential to reduce complications. The authors' objective was to determine the ideal surgical exposure to maintain perfusion and neural integrity and decrease surgical time as a result of reduced bleeding.

Methods

The vascular anatomy of the temporal-parietal soft tissue was examined in a total of 50 subjects. Imaging diagnostics included magnetic resonance angiography in 12 and Doppler ultrasound in 25 healthy subjects to reveal the arterial network. Cadaver dissection of 13 subjects formed the control group. The prevalence of the arteries were statistically analyzed with sector analysis in the surgically relevant area.

Results

The main arterial branches of this region could be well identified with each method. Statistical analysis showed that the arterial pattern was similar in all subjects. The prevalence of major arteries is low in the upper posterior area though large in proximity to the auricle region.

Conclusions

Diverse methods indicate the advantages of a posterior superior incision because the major arteries and nerves are at less risk of damage and best preserved. Although injury to these structures is rare, when it occurs, the distal flow is compromised and the peri-implant area is left intact. Hand-held Doppler is efficient and cost-effective in finding the best position for incision, if necessary, in subjects with a history of surgical stress to the retroauricular skin.

Trial registration

This was a non-interventional study.

http://ift.tt/2iIlC4r

Erratum

Publication date: Available online 16 January 2017
Source:Annals of Allergy, Asthma & Immunology

http://ift.tt/2jFgjkS

Short-term and long-term follow-up of pulmonary function in patients with COPD after total laryngectomy: A prospective study

Objective

There exists no standardized method for examining lung function in laryngectomized patients.

Study Design and Methods

We established a base plate adapter (BPA) system for patients after laryngectomy. In 10 patients with chronic obstructive pulmonary disease (COPD), we evaluated pulmonary function before laryngectomy, as well as 2 weeks and 3 months after laryngectomy.

Results

The BPA system was well tolerated and delivered reliable results comparable to measurements with a mouthpiece. The parameters forced expiratory volume in one second (FEV₁), forced vital capacity (FVC), and mean forced expiratory flow between 25% and 75% of forced vital capacity (MFEF_25–75) changed in the early postoperative examinations (2 weeks postoperative), whereas MFEF_25–75, FEF₇₅, peak expiratory flow (PEF), and peak inspiratory flow (PIF)) showed differences from baseline in long-term follow-up (3 months postoperative).

Conclusion

We provide a practicable method of lung function testing in laryngectomized patients with COPD that is essential to tailor inhalation therapy despite tracheotomy. Lung function measurements of laryngectomized patients with COPD should be performed under stable clinical conditions a few weeks after surgery. Guidelines of COPD might be complemented considering the subgroup of laryngectomized patients.

Level of Evidence

4. Laryngoscope, 2016

http://ift.tt/2iCcCuk

Current and future management of the young child with early onset wheezing.

Purpose of review: In this review, we discuss current thinking in relation to available guidelines for the care of preschool-aged children with recurrent wheezing, while highlighting the gaps in our knowledge and discussing changes that could occur over the next 5 years. Recent findings: The Asthma Predictive Index as well as allergen-specific IgE, peripheral eosinophil count and exhaled nitric oxide are perhaps underutilized sources of information that can assist in predicting progression to asthma and response to therapies. Inhaled corticosteroids and leukotriene receptor antagonists decrease impairment and exacerbation frequency in wheezing children but are not disease modifying. Macrolides may be useful during acute wheezing episodes for preventing progression to more severe symptoms. Monoclonal antibodies targeting IgE and TH2 cytokines have been successful in trials of adults and older children with asthma, but trials in younger children are needed. Summary: Establishing the phenotype and endotype of young wheezing children can be useful for prognostication of future asthma risk as well as for selection of the most appropriate treatment. Primary asthma prevention strategies are needed during the critical developmental window in early life prior to the onset of irrecoverable loss of lung function. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2jT6uyW

Trauma and transfusion.

No abstract available

http://ift.tt/2jTAOK5

Multimodal individualized concept of hemodynamic monitoring.

Purpose of review: To discuss the pathophysiological rationale of advanced hemodynamic monitoring in the critically ill and also to highlight the importance of a multimodal, individualized approach. Recent findings: There are several clinical studies and animal experiments evaluating, which hemodynamic endpoint should be the best target during fluid management. Recent systematic reviews and meta-analyses also investigated the effects of advanced hemodynamic endpoints targeted hemodynamic management on outcome mainly in high-risk surgical patients. Although most of these studies report positive results, this knowledge does not seem to affect our everyday practice. According to large international surveys, most physicians still rely on inappropriate indices. One of the reasons could be that target values applied in these studies can be misleading in the individual patient. Therefore, we describe the concept of an individualized approach, in which normalizing the components of oxygen delivery are put in the context of the patients' individual response by evaluating components of oxygen consumption, and organ perfusion. Summary: Advanced hemodynamic monitoring-based management provides a number of benefits, which could be better tailored for the patients' actual needs by putting this into a multimodal, individualized approach. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2jrl0Bn

Passage of an Anterior Odontoid Screw through Gastrointestinal Tract

Purpose. Anterior screw fixation has become a popular surgical treatment method for instable odontoid fractures. Screw loosening and migration are a rare, severe complication following anterior odontoid fixation, which can lead to esophagus perforation and requires revision operation. Methods. We report a case of screw loosening and migration after anterior odontoid fixation, which perforated the esophagus and was excreted without complications in a 78-year-old male patient. Results. A ventral dislocated anterior screw perforated through the esophagus after eight years after implantation and was excreted through the gastrointestinal (GI) tract. At a 6-month follow-up after the event the patient was asymptomatic. Conclusion. Extrusion via the GI tract is not safe enough to be considered as a treatment option for loosened screws. Some improvements could be implemented to prevent such an incident. Furthermore, this case is a fine example that recent preoperative imaging is mandatory before revision surgery for screw loosening.

http://ift.tt/2iwxYyi

Simultaneous Left Ventricular and Deep Vein Thrombi Caused by Protein C Deficiency

Protein C deficiency is a risk of venous thrombosis because of poor fibrinolytic activity. It remains controversial whether protein C deficiency causes arterial thrombosis. A 21-year-old woman was referred with a chief complaint of right leg pain and numbness. Contrast-enhanced computed tomography revealed a low-density mass in the left ventricle (LV), splenic infarction, and peripheral arterial obstructions in her right leg. Thrombosis extending from the renal vein to the inferior vena cava was also detected. Electrocardiography revealed ST depression in leads II, III, and aVF. Transthoracic echocardiography revealed hypokinesis of the apex and interventricular septum and a hypoechoic mass in the LV (26 × 20 mm). She was diagnosed with acute arterial obstruction caused by the LV thrombus, which might have resulted from previous myocardial infarction. Protein C activation turned out to be low (41%) 5 days after admission. The anticoagulant therapy was switched from heparin to rivaroxaban 16 days after admission. The LV thrombus disappeared 24 days after initial treatment, and she has had no thrombotic episodes for 2.8 years under rivaroxaban therapy. Thrombophilia should be investigated for cases of simultaneous left ventricular and deep venous thrombi. Rivaroxaban can be effective in prevention of further thrombotic events.

http://ift.tt/2j3xhJb

Opening Injection Pressure Is Higher in Intraneural Compared With Perineural Injections During Simulated Nerve Blocks of the Lower Limb in Fresh Human Cadavers.

Background and Objectives: Needle-induced nerve trauma and intraneural injection can lead to neurologic injury during peripheral nerve blocks. In this study, we assessed the utility of opening injection pressure (OIP), time to OIP, and rate of rise to OIP in detecting needle-nerve contact and intraneural injection. Methods: Five common ultrasound-guided blocks of the femoral, saphenous, subgluteal sciatic, tibial, and common peroneal nerves were simulated in 10 fresh cadavers. Opening injection pressure was defined as peak psi in the 60-second interval during which the injection is initiated. Pressure-time curves were constructed separately for intraneural and perineural injections for each of the 5 nerves studied. Results: Opening injection pressure was higher for intraneural than for perineural injections (P

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Internal Jugular and Subclavian Vein Thrombosis in a Case of Ovarian Cancer

Central venous catheter insertion and cancer represent some of the important predisposing factors for deep venous thrombosis (DVT). DVT usually develops in the lower extremities, and venous thrombosis of the upper extremities is uncommon. Early diagnosis and treatment of deep venous thrombosis are of importance, because it is a precursor of complications such as pulmonary embolism and postthrombotic syndrome. A 47-year-old woman visited our department with painful swelling on the left side of her neck. Initial examination revealed swelling of the region extending from the left neck to the shoulder without any redness of the overlying skin. Laboratory tests showed a white blood cell count of 5,800/mm3 and an elevated serum C-reactive protein of 4.51 mg/dL. Computed tomography (CT) of the neck revealed a vascular filling defect in the left internal jugular vein to left subclavian vein region, with the venous lumina completely occluded with dense soft tissue. On the basis of the findings, we made the diagnosis of thrombosis of the left internal jugular and left subclavian veins. The patient was begun on treatment with oral rivaroxaban, but the left shoulder pain worsened. She was then admitted to the hospital and treated by balloon thrombectomy and thrombolytic therapy, which led to improvement of the left subclavian venous occlusion. Histopathologic examination of the removed thrombus revealed adenocarcinoma cells, indicating hematogenous dissemination of malignant cells.

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“Hidden scar” submandibular gland excision using an endoscope-assisted hairline approach

Publication date: February 2017
Source:Oral Oncology, Volume 65
Author(s): Seung Hoon Woo, Jung Je Park, MinSu Kwon, Jin Pyeong Kim
ObjectivesEndoscope-assisted surgery is becoming the standard and most frequently preferred technique in a number of surgical disciplines because of its advantages of leaving a minimal or concealed postoperative scar compared with the conventional approaches. However, such operations are not yet standard in submandibular gland (SMG) surgery due to the anatomic complexity of this region.Materials and methodsWe conducted a prospective comparative analysis of the clinical outcome of patients who underwent SMG resection using the hairline approach versus the conventional transcervical approach. We evaluated the feasibility of the procedure by comparing the operation (operation time, hospital stay) and patient (drainage, complications) variable and the cosmetic satisfaction of the patients in each group.ResultsTwenty patients underwent the hairline approach and 20 underwent the conventional transcervical approach. Among the operation factors, only the operation time in the hairline approach group was longer than in the conventional group (P<0.003); we observed no other significant differences in the overall operation and patient factors between the two groups. Cosmetic satisfaction evaluated with a graded scale showed much better results in the hairline approach group (P<0.001).ConclusionSMG excision using endoscope assisted hairline incision is a feasible method for treating SMG disease with excellent cosmetic results.

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Streptococcus gordonii —a rare cause of prosthetic joint infection in a total hip replacement

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<span class="paragraphSection"><div class="boxTitle">Abstract</div>A 69-year-old female with a history of bilateral total hip replacements presented with rigors, fever and sudden onset left groin pain. A pelvic X-ray showed well-fixed implants. Blood results revealed a leucocytosis (white cell count 22.3 × 10<sup>9</sup> l<sup>–1</sup>) and elevated C-reactive protein (211 mg/l). Ultrasound-guided aspiration of her left hip grew <span style="font-style:italic;">Streptococcus gordonii</span>. No source infection could be identified apart from a new chronic sinus infection in a left upper incisor. Following a discussion with the patient a 6-week course of intravenous ceftriaxone was started and was successful in normalizing her inflammatory markers. She was placed on long-term suppressive amoxicillin following this. Her suppressive antibiotic therapy was complicated by the development of a clostridium difficile infection and her antibiotics were changed to doxycycline. At 1-year follow-up, she was asymptomatic with no further episodes of groin pain or fever.</span>

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Rotator cuff impingement associated with Type III acromial morphology in a young athlete—a case for early imaging

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<span class="paragraphSection"><div class="boxTitle">Abstract</div>Down-sloped or hooked acromion morphologies may cause bony encroachment on the soft tissues of the subacromial space, predisposing to shoulder impingement syndrome. Of the latter, a hooked or Type III acromion (T3A) has also been linked to rotator cuff (RC) pathology. However, as bony acromial impingement is typically thought to occur over the age of 40, its occurrence in younger shoulder athletes presenting with shoulder pain, impingement and RC pathology may be overlooked. This case serves to illustrate the occurrence of T3A in a younger shoulder athlete, and the importance of early imaging in achieving diagnostic accuracy. Appropriate surgical referrals are patients with subacromial impingement syndrome refractory to 3–6 months of appropriate conservative treatment. Surgery may be particularly beneficial in patients with a T3A.</span>

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Synchronous single-port access laparoscopic right hemicolectomy and laparoscopic-assisted vaginal hysterectomy with bilateral salpingo-oophorectomy

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<span class="paragraphSection"><div class="boxTitle">Abstract</div>Laparoscopic surgery through a single incision is gaining popularity with different stakeholders. The advantages of improved cosmetics, decreased postoperative pain and blood loss continue to attract patients from different surgical fields. Multidisciplinary approach to different surgical entities through a single incision has just been introduced. We report the first case of a synchronous single-port access (SPA) laparoscopic right hemicolectomy and laparoscopic-assisted vaginal hysterectomy with bilateral salpingo-oophorectomy through a single incision above the umbilicus in a 48-year-old female with ascending colon mass and uterine mass with good postoperative outcomes. SPA laparoscopic surgery is feasible for multidisciplinary approach in resectable tumors.</span>

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Αρχειοθήκη ιστολογίου

Τρίτη 17 Ιανουαρίου 2017

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