Childhood asthma is a risk factor for the development of chronic obstructive pulmonary disease.

Purpose of review: This review will catalog the many recent longitudinal studies that have investigated the relationship between asthma and lung function, or the persistence and trajectories of lung function deficits. Recent findings: Recent work has reported on 50-year follow-ups of some prominent population cohorts. A history of asthma confers a 10-30-fold risk of chronic obstructive pulmonary disease. Individuals reaching a reduced maximum growth of forced expiratory volume in 1 s in early adulthood are at risk for early or more severe chronic obstructive pulmonary disease (COPD). Summary: Taken together, there is a wealth of overlapping cohort studies of lung function, asthma and COPD. These show that asthma is associated with reduced lung function, which may start in infancy or prenatally, persists through childhood and adulthood and predisposes for early or more severe COPD. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2kqY7uI

Incorporating technology to advance asthma controller adherence.

Purpose of review: Technological innovations, including text messaging, smart phone applications, and electronic monitoring devices, aimed at improving asthma controller adherence are being rapidly introduced both into clinical care and directly marketed to patients. This review analyzes recent clinical trials implementing these interventions, with a focus on their benefits and shortcomings. Recent findings: Poor medication adherence continues to exert significant morbidity on patients with asthma. Objective, real-time measures to monitor adherence can overcome the limitations of prior methods, including self-report and prescription refills. Technological advances, especially those incorporating reminder systems, have demonstrated improved controller adherence. The increased adherence in these trials has not translated into consistent clinical improvement, including reducing hospitalizations, emergency department visits, and asthma exacerbations, possibly secondary to study design and poor inhalation technique. Summary: Novel monitoring and reminder technology can augment patient medication adherence and provide clues to management before escalating therapy. Further studies are needed to investigate the overarching clinical impact of this technology, especially as it grows into routine clinical practice. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2j3h1f6

Asthma guidelines: the Global Initiative for Asthma in relation to national guidelines.

Purpose of review: To compare and contrast national asthma guidelines with the Global Initiative for Asthma (GINA) strategy for asthma management and prevention. Recent findings: The common goal of GINA and national asthma guidelines is to improve asthma care using the best evidence available from published data. This evidence-based approach has evolved from an initial perspective of expert opinion but with that evolution has not always considered the breadth of asthma phenotypes. GINA and national guidelines differ in a number of ways. GINA reviews available data and updates the core document and recommendations based on the latest data on a yearly basis to offer local, regional and national guidelines materials needed for knowledge mobilization. It remains the purview of those organizations to structure and implement those locally appropriate guidelines. Summary: Both GINA and national guidelines have furthered asthma care to narrow the care gap from what is known to how asthma care is delivered, hopefully in a more directed, personalized manner. As well, both GINA and national guidelines have helped to shape the direction of research for the future benefit of children and their families. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2kr2QwO

Management of preschool recurrent wheezing and asthma: a phenotype-based approach.

Purpose of review: The purpose of this review is to summarize the recent evidence on the management of preschool children with wheezing and asthma, and to propose a phenotype-based approach to the management of these children. Recent findings: Recent studies have begun to identify populations of preschool children that are likely to benefit from inhaled corticosteroids (ICS) therapy and defined ICS regimens: daily ICS in preschool children with persistent asthma, and pre-emptive high-dose intermittent ICS among preschool children with intermittent disease reduce the risk of exacerbation. In addition, among preschool children with mild persistent asthma, the presence of aeroallergen sensitivity and/or blood eosinophil counts of 300/[mu]L or greater are predictors of good response to daily ICS therapy. Other studies identified intermittent azithromycin as a therapy to prevent, and potentially to treat, acute exacerbations. The uncertainty of the role of oral corticosteroids (OCS) as a therapy for acute exacerbations continues, as a recent meta-analysis showed that OCS did not prevent hospitalizations or urgent visits, and did not reduce the need for additional courses of OCS. Whereas previous epidemiologic studies suggested acetaminophen may increase risk of exacerbations, a clinical trial clearly demonstrated acetaminophen use, compared to ibuprofen use,does not increase exacerbation risk among preschool children with mild-persistent asthma. Summary: Recent studies have shown potential for phenotypic-driven therapies for the management of preschool children with asthma. Targeting airway bacteria has emerged as a promising therapeutic approach, but its effect on antibiotic resistance still needs to be investigated. Finally, more studies are required to evaluate if oral corticosteroids provide any benefits for acute episodic wheeze. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2j3dHRi

Chylopericardium with symptoms of tamponade on the grounds of extensive neck vein thrombosis

<span class="paragraphSection"><div class="boxTitle">Abstract</div>Chylopericardium is a recognized complication of thoracic trauma, surgery or malignancy. Idiopathic or primary presentations, however, are rarely encountered in clinical practice. The severity of its presentation varies from the complete absence of symptoms to cardiac tamponade. We present the case of a 23-year-old woman with chylopericardium and extensive neck vein thrombosis that was managed surgically with a pericardial window.</span>

http://ift.tt/2jokKlT

Occult fracture of the lesser tuberosity in a 9-year-old female swimmer

<span class="paragraphSection"><div class="boxTitle">Abstract</div>The adolescent avulsion of the lesser tuberosity of the humerus has historically been considered as very rare. The youngest patient reported in the literature is 11 years old. We report a case of a 9-year-old girl who suffered a subscapularis tendon tear with an occult avulsion of the lesser tuberosity. Late repair restored function. Despite that late repair in this present case resulted in excellent outcome, we strongly recommend the additional axillary lateral view of the plain radiographs, as well as proper physical examination to facilitate early diagnosis.</span>

http://ift.tt/2jvGSIU

Post-operative avascular necrosis of the maxilla: a rare complication following orthognathic surgery

<span class="paragraphSection"><div class="boxTitle">Abstract</div>We present a patient with sickle cell trait who suffered avascular necrosis of the maxilla as a complication of maxillary osteotomy. Understanding the blood supply of the maxilla and how possible patient related, anaesthetic and operative factors affect it, is important in understanding how the vascularity of the maxilla can become compromised in a surgical procedure. The perioperative parameters were analysed to identify any prognostic elements. Avascular necrosis of the maxilla is a rare complication of orthognathic surgery with few cases reported in the literature. There are identifiable risk factors that can influence the blood supply of the maxilla. Careful preoperative assessment is required to exclude patient factors that have the potential to affect tissue vascularity. This in conjunction with sound anaesthetic and surgical technique should all minimize the risk of avascular necrosis. Even so it is still possible for this rare complication to occur.</span>

http://ift.tt/2jolvM1

Price variation in the most commonly prescribed ear drops in Southern California

Objectives/Hypothesis

To evaluate the variability and discrepancies among the most commonly prescribed ear drops sold at pharmacies in southern California.

Study Design

Prospective study evaluating 11 commonly used ear drops to treat otologic disorders.

Methods

Randomly selected drug stores in three major counties in Southern California (Los Angeles, Orange, and San Diego) were included. Mean, range, minimum, and maximum prices for each drug were calculated and analyzed. The median income of pharmacy ZIP code was also cross-referenced.

Results

Data were collected from 108 pharmacies. The mean prices are noted for each of the individual drugs: Cortisporin (brand) 10 mL, $82.70; neomycin, polymyxin B sulfates, and hydrocortisone (Cortisporin–generic) 10 mL, $34.70; ofloxacin (generic) 10 mL, $99.95; sulfacetamide (generic) 15 mL, $40.18; Ciprodex (brand) 7.5 mL, $194.44; Cipro HC (brand) 10 mL, $233.32; Vosol (brand) 15 mL, $120.75; acetic acid (Vosol–generic) 10 mL, $116.55; VosolHC (brand) 10 mL, $204.14; acetic acid/aluminum acetate (Domeboro–generic) 60 mL, $22.91; and Tobradex (brand) 5 mL, $166.47.

Conclusions

There is significant variability among the prices of ear drops across Southern Californian pharmacies, which can be a financial burden to patients paying out of pocket or with high deductibles. A state-mandated, publically accessible report of drug prices may help decrease variability and cost by promoting competition among pharmacies. Price negotiations by governmental payers may assist in reducing prices. In the treatment of otologic disorders, clinicians can help reduce costs for patients by prescribing generic ear drop medications and cheaper alternatives when clinically appropriate.

Level of Evidence

4. Laryngoscope, 2017

http://ift.tt/2kh70rM

Childhood asthma is a risk factor for the development of chronic obstructive pulmonary disease.

Purpose of review: This review will catalog the many recent longitudinal studies that have investigated the relationship between asthma and lung function, or the persistence and trajectories of lung function deficits. Recent findings: Recent work has reported on 50-year follow-ups of some prominent population cohorts. A history of asthma confers a 10-30-fold risk of chronic obstructive pulmonary disease. Individuals reaching a reduced maximum growth of forced expiratory volume in 1 s in early adulthood are at risk for early or more severe chronic obstructive pulmonary disease (COPD). Summary: Taken together, there is a wealth of overlapping cohort studies of lung function, asthma and COPD. These show that asthma is associated with reduced lung function, which may start in infancy or prenatally, persists through childhood and adulthood and predisposes for early or more severe COPD. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2kqY7uI

Incorporating technology to advance asthma controller adherence.

Purpose of review: Technological innovations, including text messaging, smart phone applications, and electronic monitoring devices, aimed at improving asthma controller adherence are being rapidly introduced both into clinical care and directly marketed to patients. This review analyzes recent clinical trials implementing these interventions, with a focus on their benefits and shortcomings. Recent findings: Poor medication adherence continues to exert significant morbidity on patients with asthma. Objective, real-time measures to monitor adherence can overcome the limitations of prior methods, including self-report and prescription refills. Technological advances, especially those incorporating reminder systems, have demonstrated improved controller adherence. The increased adherence in these trials has not translated into consistent clinical improvement, including reducing hospitalizations, emergency department visits, and asthma exacerbations, possibly secondary to study design and poor inhalation technique. Summary: Novel monitoring and reminder technology can augment patient medication adherence and provide clues to management before escalating therapy. Further studies are needed to investigate the overarching clinical impact of this technology, especially as it grows into routine clinical practice. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2j3h1f6

Asthma guidelines: the Global Initiative for Asthma in relation to national guidelines.

Purpose of review: To compare and contrast national asthma guidelines with the Global Initiative for Asthma (GINA) strategy for asthma management and prevention. Recent findings: The common goal of GINA and national asthma guidelines is to improve asthma care using the best evidence available from published data. This evidence-based approach has evolved from an initial perspective of expert opinion but with that evolution has not always considered the breadth of asthma phenotypes. GINA and national guidelines differ in a number of ways. GINA reviews available data and updates the core document and recommendations based on the latest data on a yearly basis to offer local, regional and national guidelines materials needed for knowledge mobilization. It remains the purview of those organizations to structure and implement those locally appropriate guidelines. Summary: Both GINA and national guidelines have furthered asthma care to narrow the care gap from what is known to how asthma care is delivered, hopefully in a more directed, personalized manner. As well, both GINA and national guidelines have helped to shape the direction of research for the future benefit of children and their families. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2kr2QwO

Management of preschool recurrent wheezing and asthma: a phenotype-based approach.

Purpose of review: The purpose of this review is to summarize the recent evidence on the management of preschool children with wheezing and asthma, and to propose a phenotype-based approach to the management of these children. Recent findings: Recent studies have begun to identify populations of preschool children that are likely to benefit from inhaled corticosteroids (ICS) therapy and defined ICS regimens: daily ICS in preschool children with persistent asthma, and pre-emptive high-dose intermittent ICS among preschool children with intermittent disease reduce the risk of exacerbation. In addition, among preschool children with mild persistent asthma, the presence of aeroallergen sensitivity and/or blood eosinophil counts of 300/[mu]L or greater are predictors of good response to daily ICS therapy. Other studies identified intermittent azithromycin as a therapy to prevent, and potentially to treat, acute exacerbations. The uncertainty of the role of oral corticosteroids (OCS) as a therapy for acute exacerbations continues, as a recent meta-analysis showed that OCS did not prevent hospitalizations or urgent visits, and did not reduce the need for additional courses of OCS. Whereas previous epidemiologic studies suggested acetaminophen may increase risk of exacerbations, a clinical trial clearly demonstrated acetaminophen use, compared to ibuprofen use,does not increase exacerbation risk among preschool children with mild-persistent asthma. Summary: Recent studies have shown potential for phenotypic-driven therapies for the management of preschool children with asthma. Targeting airway bacteria has emerged as a promising therapeutic approach, but its effect on antibiotic resistance still needs to be investigated. Finally, more studies are required to evaluate if oral corticosteroids provide any benefits for acute episodic wheeze. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2j3dHRi

French updated recommendations in Stage I to III melanoma treatment and management

Abstract

As knowledge continues to develop, regular updates are necessary concerning recommendations for practice. The recommendations for the management of melanoma stages I to III were drawn up in 2005. At the request of the Société Française de Dermatologie, they have now been updated using the methodology for recommendations proposed by the Haute Autorité de Santé in France. In practice, the principal recommendations are as follows: for staging, it is recommended that the 7th edition of AJCC be used. The maximum excision margins have been reduced to 2 cm. Regarding adjuvant therapy, the place of interferon has been reduced and no validated emerging medication has yet been identified. Radiotherapy may be considered for patients in Stage III at high risk of relapse. The sentinel lymph node technique remains an option. Initial examination includes routine ultrasound as of Stage II, with other examinations being optional in stages IIC and III. A shorter strict follow-up period (3 years) is recommended for patients, but with greater emphasis on imaging.

http://ift.tt/2k1hpur

Thymic origins of T cell receptor alloreactivity.

MHC restriction is a unique feature of T cell antigen recognition. Mature T cells respond to antigenic nonself peptides bound to self-MHC molecules, but a sizeable fraction of peripheral T cells can also respond to nonself peptide-MHC (pMHC) complexes in the context of transplantation. MHC specificity of the T cell receptor repertoire is shaped during thymic development. Two hypotheses have been proposed to explain MHC specificity of T cells. It has been suggested that MHC specificity is an intrinsic feature of TCR structure, mediated by the germline-encoded regions of the TCR sequence. In support of this model, an estimated 15-30% of preselection TCR repertoire is estimated to be MHC-specific. Moreover, structural studies have shown some degree of conserved binding topology for TCR-peptide MHC complexes. However, there is also evidence that MHC restriction can be imposed on the TCR repertoire during thymic development, and it has been proposed that the interaction of the Lck kinase with CD4 or CD8 coreceptors is critical for generation of MHC specificity. This review will discuss recent work on assessment of the preselection of TCR repertoire, molecular evidence for the germline encoded TCR bias for MHC and for the coreceptor sequestration model in the context of alloreactivity and transplantation. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2k1gOJ7

Impact of Antibodies that React with Liver Tissue and Donor-specific anti-HLA Antibodies in Pediatric Idiopathic Posttransplantation Hepatitis.

Background: The cause of late graft dysfunction has not been elucidated. Although an antibody-mediated reaction is suspected as a potential mechanism, the target antigens have not been clarified. Methods: To clarify the etiology of idiopathic posttransplantation hepatitis (IPTH), we simultaneously examined the presence of antibodies that react with liver tissue (ARLT) by means of indirect immunofluorescence staining, as well as the presence of donor-specific anti-human leukocyte antigen antibodies (HLA-DSA). A subanalysis of the IPTH group was also performed. Within the IPTH group, the correlation between ARLT titer and clinical data were analyzed. Results: In the sera of patients with IPTH (30 patients), ARLT were found at a significantly higher frequency than in patients without IPTH (42 patients; p

http://ift.tt/2jcqJHi

Broad spectrum antibiotic enrofloxacin modulates contact sensitivity through gut microbiota in a murine model

Publication date: Available online 24 January 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Anna Strzępa, Monika Majewska-Szczepanik, Francis M. Lobo, Li Wen, Marian Szczepanik
BackgroundMedical advances in the field of infection therapy has led to an increasing use of antibiotics, which, apart from eliminating pathogens, also partially eliminate naturally existing commensal bacteria. It has become increasingly clear that less exposure to microbiota early in life may contribute to the observed rise in "immune-mediated" diseases including autoimmunity and allergy.ObjectiveWe sought to test whether the change of gut microbiota with the broad spectrum antibiotic enrofloxacin will modulate contact sensitivity (CS) in mice.MethodsNatural gut microbiota were modified by oral treatment with enrofloxacin prior to sensitization with TNP-Cl followed by CS testing. Finally, adoptive cell transfers were performed to characterize the regulatory cells that are induced by microbiota modification.ResultsOral treatment with enrofloxacin suppresses CS and production of anti-TNP IgG1 antibodies. Adoptive transfer experiments show that antibiotic administration favors induction of regulatory cells that suppress CS. Flow cytometry and adoptive transfer of purified cells show that antibiotic-induced suppression of CS is mediated by TCRαβ⁺CD4⁺CD25⁺FoxP3⁺ Treg, CD19⁺B220⁺CD5⁺IL-10⁺, IL-10⁺ Tr1, and IL-10⁺TCRγδ⁺ cells. Treatment with the antibiotic induces dysbiosis characterised by increased proportion of Clostridium coccoides (cluster XIVa), Clostridium coccoides – E. rectale (cluster XIVab), Bacteroidetes and Bifidobacterium spp., but decreased segmented filamentous bacteria. Transfer of antibiotic-modified gut microbiota inhibits CS, but this response can be restored through oral transfer of control gut bacteria to antibiotic-treated animals.ConclusionOral treatment with a broad spectrum antibiotic modifies gut microbiota composition and promotes anti-inflammatory response, suggesting that manipulation of gut microbiota can be a powerful tool to modulate the course of CS.

Teaser

Antibiotic-induced dysbiosis, characterized by increased levels of Bacteroidetes, Bifidobacterium spp., Clostridium cluster XIVa and XIVab, but decreased proportions of segmented filamentous bacteria, effectively inhibits contact sensitivity by inducing a variety of regulatory cells.


http://ift.tt/2j2XjjG

Traumatologie der Nase

Zusammenfassung

Die Nase als prominentestes Element des Gesichtes wird überdurchschnittlich oft traumatisiert. Eine exakte Beurteilung einer traumatisierten Nase, eine angemessene Diagnostik und die Entscheidung zu einer adäquaten Frühbehandlung tragen dazu bei, bleibende Formstörungen zu verhindern. Die gesamte Palette der bekannten Techniken der Rhinoplastik ermöglicht weitreichende Korrekturmaßnahmen. In die Planung intensiver Korrekturmaßnahmen sollten technische Varianten wie mehrfache Osteotomien und die Abtragung überschüssiger Knochensequester oder Narben einbezogen werden. Außerdem ist die Auswahl eines geeigneten Materials zur Auffüllung von Defekten wichtig.

http://ift.tt/2kpWkKr

Pleomorphic Adenoma (Mixed Tumor) of Dorsum of Nose: A Rare Tumor at a Rare Site

http://ift.tt/2jncClL

A Rare Case of Locally Advanced Recurrent Neuroendocrine Tumour of Neck Salvaged by a Radical Surgical Approach

Abstract

Neuroendocrine tumours of head and neck are rare neoplasms and even more rare are those of cutaneous adenoid cystic carcinoma with neuroendocrine differentiation. Virtually every known variant of neoplasia with neuroendocrine differentiation can arise in complex structures of head and neck (Mills in Endocr Pathol 7(4):329–343. doi:10.1007/BF02739841) [1]. Such tumours are usually non functional, locally aggressive and may spread to lymph nodes or lungs. They are diagnosed by histopathology, immunohistochemistry and radionuclide imaging. When these tumours involve the carotid artery, they pose challenges in the surgical management.

http://ift.tt/2jubavB

Evolving healthcare delivery paradigms and the optimization of 'value' in anesthesiology.

Purpose of review: Healthcare worldwide is evolving to yield enhanced care provided at a lowered cost. Patient-centric paradigms that hasten surgical recovery and strengthen collaboration amongst medical professionals are gaining impetus. This review will discuss the changing healthcare landscape and outline its implications on anesthesiology practice. Recent findings: Anesthesiologists must be nimble and versatile as they adapt to healthcare redesign. An increased responsibility for patient outcomes should be embraced by extending the breadth and depth of clinical practice throughout the surgical care continuum. The perioperative surgical home and enhanced recovery after surgery provide paradigms to further integrate expanding clinical opportunities and improved patient outcomes. Investment is needed in perioperative medical education and research efforts to best position anesthesiologists for success both now and in the future. Summary: Exemplifying opportunities to demonstrate value-added care, the scope of anesthesiology education and clinical practice should diversify to further integrate perioperative care of surgical patients. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2k0tBLG

Quality organization and risk in anaesthesia: the French perspective.

Purpose of review: Ensuring the quality and safety of anaesthesia in the face of budgetary restrictions and changing demographics is challenging. In France, the environment is regulated by the legislation, and it is often necessary to find solutions that seize opportunities to break with the traditional organization. Recent findings: Postoperative mortality remains excessively high. The move towards ambulatory care is being adequately integrated into all the stages of patient management in the context of a single therapeutic plan that is mutually agreed upon by all caregivers. The French National Health Authority, which provides certification for healthcare establishments, encourages this 'seamless' approach between private practice and the hospital setting, based on teamwork and interdisciplinary consultation. By daring to break with traditional organizational structures, and by taking account of human factors and staged strategies, it is possible to deliver appropriate care, with a level of quality and safety that meets users' demands. Summary: The management of a patient undergoing surgery with anaesthesia is a seamless spectrum from the patient's home to the hospital and back to home. Decision-making must be multidisciplinary. Increased use of ambulatory care, breaks with traditional organizational structures, and efforts to reduce postoperative mortality represents opportunities to improve overall system performance. Demographic and economic constraints are potential threats to be identified. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2kg1VQq

Assessment of competence: developing trends and ethical considerations.

Purpose of review: This review explores new concepts in competency assessment in anesthesiology, the associated ethical challenges, and directions for new research. Recent findings: Many new tools for the assessment of competence are currently in development to address changes in medical education curricula. The assessment of competence currently focuses on technical skills, nontechnical skills, and the interaction of both through the use of simulation, with increasing emphasis on validity and reliability testing. Summary: The search for objective measures of competence is well underway. Current methods require substantial investment of resources, and further research into more efficient and financially feasible tools of assessment is needed. As these assessments become more common in use, the ethical challenges raised by defining competency in high-stakes clinical practice situations will need to be addressed. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2k0Bq44

Update on low-dose corticosteroids.

Purpose of review: Low-dose hydrocortisone is recommended in patients with septic shock unresponsive to fluid and vasopressor therapy. Recent research added new data for patients with septic shock and other target groups such as patients with severe sepsis, acute respiratory distress syndrome (ARDS), community-acquired pneumonia, and burns. The objective of this review is to summarize and comment recent findings on low-dose corticosteroids (LDC) in critically ill patients. Recent findings: In the last 2 years, a series of clinical trials and retrospective analyses investigated LDC therapy in critically ill patients with severe systemic inflammation of various origins. Improvement in morbidity has been demonstrated in ARDS and community-acquired pneumonia. Retrospective propensity-score analyses also suggest that LDC administered in severe septic shock or in septic shock due to community-acquired pneumonia or intestinal perforation may improve survival. Summary: Low-dose hydrocortisone or a corresponding low-dose corticosteroid therapy may improve morbidity in specific target groups of critically ill patients. Beneficial effects on mortality remain to be demonstrated in large-scale randomized controlled trials. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2kg4rG6

Might Trauma Be a Triggering Factor for Craniofacial Fibrous Dysplasia?.

Fibrous dysplasia (FD) is a rare, benign disease of unclear etiology where normal bone is replaced with abnormal fibrous and weak osseous tissue. Any bone of the skeleton might be involved but skull is one of the most commonly affected sites. Fibrous dysplasia is known to be caused by a genetic mutation leading to inappropriate proliferation and differentiation of osteoblastic cells. However; it is not known whether any triggering factor exists which might contribute to this genetic mutation. The authors postulated that trauma might be a triggering factor for this disease. Trauma, as a triggering factor, has not been reported to be clearly linked to FD in the literature so far. Through this perspective; the authors report a patient of fronto-orbital fibrous dysplasia developing 6 years after a fronto-orbital skull fracture, at the same localization of the fracture line. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2juGcU5

Endoscopic-Assisted Removal of a Rare Mucocele Complicating From Alloplastic Medial Orbital Fracture Reconstruction.

Orbital wall fracture reconstruction is usually recommended to prevent subsequent functional and esthetic complications. Mucocele development following such injuries or its management is recognized but rare sequelae. When they occur, they represent a diagnostic and management dilemma. The authors described a patient with orbital and ethmoidal mucocele. A 62-year-old female patient presented with progressive left exophthalmos 1 year following titanium mesh reconstruction of a medial orbital wall fracture. Computed tomography and magnetic resonance imaging demonstrated an encysted lesion encasing the mesh plate in the left orbit and extending into the ethmoidal sinus. The patient is treated surgically through endoscopic-assisted approach with complete removal of the lesion and lacrimal duct stenting. The patient improved immediately after surgery. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2jnBgCC

A Rare Complication of Infraorbital Nerve Hyperesthesia in Surgically Repaired Orbital Fracture Patients.

Injury to the peripheral sensory branches of the trigeminal nerve can follow a wide variety of craniofacial injuries. Many patients with facial fractures complain about the symptom of numbness to the distribution of injured nerve, which is indicative of hypoesthesia. Hyperesthesia involving the infraorbital nerve is rare in comparison to hypoesthesia secondary to facial trauma. The authors report on 2 patients with infraorbital nerve hyperesthesia in surgically repaired orbital fracture patients. Surgical decompression of the infraorbital nerve led to rapid resolution of hyperesthesia. To the best of our knowledge, these were rare cases of patients who presented with persistent hyperesthesia. Clinician should perform early surgical decompression of the infraorbital nerve in patient with persistent hyperesthesia of the infraorbital nerve. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2juKr1H

Giant Orf on the Nose.

Orf is a zoonotic infectious disease caused by parapoxvirus. Orf lesions are typically seen on the hand, but they have rarely been reported on the nose. Herein, the authors report a rare patient of an orf lesion on the nose of a 52-year-old man after the Muslim celebration of the feast of the sacrifice. The lesion spontaneously recovered 8 weeks after the initial appearance and showed no evidence of recurrence after 1 year of follow-up. Orf virus infections may occur more often after the celebration of the feast of the sacrifice in Muslim countries. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2jnCvSm

A Rare Concha Variation: Coronal Cleft.

Nasal turbinates are embryologically derived from a series of outgrowths from the foetal lateral nasal wall. These outgrowths form a series of ridges, referred to as "ethmoturbinals" and have several vital functions. Several different turbinate variations have been reported so far. The authors presented 3 patients of coronal clefted concha who were diagnosed with magnetic resonance imaging. Computed tomography scans and nasal endoscopic examinations are also performed subsequently. These patients are the first coronal clefted concha cases in the literature and also the first radiological study defining concha cleft. This shows paucity of data documenting variations in the lateral nasal wall. Understanding the anatomy and the anatomic variations of the nasal cavity and nasal turbinates is critical to guide the procedure due to its close proximity to vital structures such as orbita and skull base, especially for functional endoscopic sinus surgery that is a widely used technique nowadays. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2juIvqb

Novel Treatment Planning of Hemimandibular Hyperplasia by the Use of Three-Dimensional Computer-Aided-Design and Computer-Aided-Manufacturing Technologies.

Rationale and Aim: Hemimandibular hyperplasia is characterized by an obvious overgrowth in the size of the mandible on one side, which can extend up to the midline causing facial asymmetry. Surgical resection of the overgrowth depends heavily on the skill and experience of the surgeon. This report describes a novel methodology of applying three-dimensional computer-aided-design and computer-aided-manufacturing principles in improving the outcome of surgery in 2 mandibular hyperplasia patients. Methodology: Both patients had their cone beam computer tomography (CBCT) scan performed. CMF Pro Plan software (v. 2.1) was used to process the scan data into virtual 3-dimensional models of the maxilla and mandible. Head tilt was adjusted manually by following horizontal reference. Facial asymmetry secondary to mandibular hypertrophy was obvious on frontal and lateral views. Simulation functions were followed including mirror imaging of the unaffected mandibular side into the hyperplastic side and position was optimized by translation and orientation functions. Reconstruction of virtual symmetry was assessed and checked by running 3-dimensional measurements. Then, subtraction functions were used to create a 3-dimensional template defining the outline of the lower mandibular osteotomy needed. Precision of mandibular teeth was enhanced by amalgamating the CBCT scan with e-cast scan of the patient lower teeth. 3-Matic software (v. 10.0) was used in designing cutting guide(s) that define the amount of overgrowth to be resected. The top section of the guide was resting on the teeth hence ensuring stability and accuracy while positioning it. The guide design was exported as an .stl file and printed using in-house 3-dimensional printer in biocompatible resin. Conclusion: Three-dimensional technologies of both softwares (CMF Pro Plan and 3-Matic) are accurate and reliable methods in the diagnosis, treatment planning, and designing of cutting guides that optimize surgical correction of hemimandibular hyperplasia at timely and cost-effect manner. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2jnEOF4

Postoperative Three-Dimensional Evaluation of Mandibular Contouring Surgery Using Computer-Assisted Simulation Planning and a Three-Dimensional-Printed Surgical Guide.

Mandibular contouring surgery was performed using computer-assisted simulation planning (CASP) and 3-dimensional printed surgical guide. The outcome of the surgery was evaluated by overlapping preoperative image. The patient underwent mandibular contouring surgery according to CASP for his residual facial asymmetry of the mandibular angle and mental area. The overall facial aesthetic of the patient was improved. In the overlapping image, the left mandibular border area was slightly overcorrected. However, the other portion was operated as planned. The overcorrection was due to the improper adaptation of the surgical guide adjacent to the mental foramen. In conclusion, usage of CASP and a surgical guide could reduce operation time and increase the accuracy of the operation. However, the design of the stent should be improved around the mental foramen to avoid nerve damage and improper adaptation. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2juDXAa

Ameloblastoma in a Patient With Williams Syndrome and Use of Fibular Flap.

No abstract available

http://ift.tt/2jnCHBi

Cephalometric Analysis of Modifications of the Mandible Due to Reduction Mandibuloplasty in Patients With Prominent Mandibular Angle.

Cephalometry has been used to measure hard and soft facial tissues as well as to conduct the ostectomy to determine the characteristics of the prominent mandibular angles (PMA). The changes produced on the mandibles by reduction mandibuloplasty are not known. The objective of the present study was to identify by cephalometric analysis the anatomical changes of the mandibles that occur in patients with PMA after reduction mandibuloplasty. Forty-two patients with PMA were submitted to cephalometric analysis before, 1 week and 6 months after surgery to evaluate the changes of the mandibles produced by reduction mandibuloplasty. Cephalometry was standardized to obtain descriptive measurements of the dimensions of the mandibles. The modifications of the mandibles due to reduction mandibuloplasty showed a significant change obtained by cephalometry. At 1 week after surgery, the average distance between the gonions decreased 17.70 +/- 8.46 mm, the average length of the mandibular ramus reduced 5.84 +/- 3.26 mm, the average mandibular body length increased 4.61 +/- 2.74 mm, the average gonial angle increased 14.78 +/- 6.65[degrees], the average mandibular plane angle increased 10.29 +/- 3.82[degrees]. At 6 months postoperatively, the first 3 linear measurements increased 3.68 +/- 2.91, 1.66 +/- 2.51, and 2.10 +/- 2.37 mm respectively; however, the last 2 angular measurements reduced 2.86 +/- 3.02[degrees] and 1.77 +/- 2.62[degrees] respectively. The results demonstrated that reduction mandibuloplasty can modificate mandibular contouring three-dimensionally. The data of 6 months postoperatively compare to those of the beauty people reported in the literature, there were statistically differences between the linear measurements, but no statistically differences between the angular measurements. Despite bone regeneration result in linear or angular measurements change, postoperative angular shape was predominantly maintained, and the preoperative angular prominence did not recur. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2juBaqr

The Study of Calcium, Phosphonium, Magnesium, and Ferrum Concentration in Serum of Patients With Primary Trigeminal Neuralgia.

Objective: To measure the concentration of 4 essential elements (Ca, P, Mg, Fe) in serum of patients with primary trigeminal neuralgia. And evaluate the role of the 4 elements in serum on the pathogenesis of trigeminal neuralgia (TN), and the relevance of etiology. Methods: From June 2013 to June 2014, a number of 80 patients with primary trigeminal neuralgia were collected. We present a retrospective review of the concentration of 4 essential elements with those of control group of 80 patients without TN. The concentrations of 4 elements were measured with Olympus AU 400 automatic biochemistry analyzer. Results: In primary TN patients, the concentration of Ca, P, Mg in serum is lower than the control group obviously (P

http://ift.tt/2jnCHkM

Antronasal Polyp Extending to Orbital Fossa.

Sinonasal infections and nasal polyps can be taken as 2 components of a disease. Polyps due to chronic inflammations of nasal cavity and sinuses are not rare. They may present with various clinical signs and symptoms, while the secondary complications may cause serious problems. They are most commonly treated medically, although surgery is the therapy of choice in some conditions. The complications can be listed as mucocele formation, orbital inflammation, intracranial extension by erosion of the boney structures. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2juAUIi

Microvascular Tissue Transfers for Midfacial and Anterior Cranial Base Reconstruction.

Reconstruction of a midfacial defect can represent a difficult challenge for the plastic surgeon. Although many midfacial deformities have traumatic or congenital origins, the vast majority of head and neck defects occur after resection of malignant head and neck neoplasms. Autogenous reconstruction is now routinely performed for larger, complex defects resulting from surgical resection or trauma. In this study, the authors present 27 patients with midfacial defects reconstructed with free flaps. Twenty-two of the defects were created by surgical ablation of cancer (maxillectomy) and the others were traumatic. The maxillectomy defects were classified into 4 according to the classification proposed by Cordeiro. Eighteen of the patients were male and 9 were female. Twenty-nine free flaps were performed. Six different types of flaps including radial forearm flap, vertical rectus abdominis (VRAM) flap, anterolateral thigh (ALT) flap, tensor fasciae latae (TFL) flap, fibula osteocutaneous flap, and iliac osteocutaneous flap were accomplished. Types I and II defects were reconstructed with radial forearm flap. Type III defects were reconstructed with VRAM and ALT. Type IV defects were reconstructed with VRAM and TFL. Two patients underwent a second flap reconstruction due to recurrent disease (9.1%). Average patient age was 53.1 years. Free-flap survival was 100%. Free tissue transfer is the method of choice in midfacial reconstruction. Following a reconstructive algorithm is useful in the decision-making process for patient evaluation and treatment. Every reconstructive microsurgeon might have different experiences with different flaps. Therefore, the algorithm for flap choices is not universal among surgeons. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2jnIBlX

Microtia and Social Media: Patient Versus Physician Perspective of Quality of Information.

Introduction: Previous research demonstrates that patients seek high-quality information on the World Wide Web, especially in rare conditions such as microtia. Social media has overtaken other sources of patient information but quality remains untested. This study quantifies the quality of information for patients with Microtia on social media compared with nonsocial media websites and compares physician and patient scoring on quality using the DISCERN tool. Methods: In phase 1, quality of the top 100 websites featuring information "Microtia" was ranked according to quality score and position on Google showing the position of social media websites among other nonsocial media websites. Phase 2 involved independent scoring of websites on microtia compared with a patient group with microtia to test whether physicians score differently to patients with t test comparison. Results: Social media websites account for 2% of the scored websites with health providers linking to social media. Social media websites were among the highest ranked on Google. No correlation was found between the quality of information and Google rank. Social media scored higher than nonsocial media websites regarding quality of information on microtia. No significant difference existed between physician and patient quality of information scores on social media and nonsocial media websites (p 1.033). Conclusion: Physicians and patients objectively score microtia websites alike. Social media websites have higher use despite being few in number compared with nonsocial media websites. Physicians providing links to social media on information websites on rare conditions such as microtia are engaging in current information-seeking trends. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2juF5E1

Comparison of Two Screw-Retained Free Gingival Grafting Techniques.

Free gingival graft is a predictable technique for increasing the amount of attached gingiva and root coverage; however, its use is limited for cosmetic reasons. To overcome this issue, this study sought to compare 2 free gingival graft techniques that use oral screws to attach grafts. Free gingival graft was performed on teeth 44 to 46 using the traditional technique, while on the opposite side, on teeth 34 to 36, partly epithelialized free gingival grafts were performed. The partly epithelialized free gingival grafts were found to provide better cosmetic results relative to the completely epithelialized free gingival graft, and the use of stabilizing screws was found to be simple and effective. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2jnFZ7p

Clinical Observation of Treatment of Chronic Subdural Hematoma With Novel Double Needle Minimally Invasive Aspiration Technology.

Objective: The aim of the present study was to explore the clinical effects, including the prevention of complications, of the treatment of chronic subdural hematoma with double needle aspiration. Methods: The clinical data of 31 patients with chronic subdural hematoma treated by double YL-1 needle double skull drilling and 31 controls treated by traditional drilling and drainage were analyzed retrospectively. Results: In the YL-1 needle group, only 1 patient was with hematoma recurrence, 1 patient was with intracranial pneumocephalus, and the remaining patients who were followed up for 3 months achieved a clinical cure. In the traditional drilling and drainage group, 13 patients were with hematoma recurrence within 3 months after the operation and 7 patients were with postoperative intracranial pneumocephalus. Conclusions: The method of double YL-1 needle is better than the traditional drilling and drainage method for the treatment of chronic subdural hematoma because it reduces the postoperative recurrence rate and complications. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2juDU7s

A Review of "Role of Surgeons in the Changing Sociocultural, Political, and Environmental Climate" by Frilling A in Ann Surg 264: 691-695, 2016.

No abstract available

http://ift.tt/2jnENku

Two- and Three-Dimensional Transesophageal Echocardiography for Two Separate Primary Cardiac Lymphomas in the Right Heart.

No abstract available

http://ift.tt/2kg4Jgf

Atopische Dermatitis per Pricktest diagnostizieren?

Milde Formen der atopischen Dermatitis lassen sich nicht immer leicht von anderen Hauterkrankungen abgrenzen. Auf der Suche nach einer möglichen diagnostischen Hilfe haben Deutsche Allergologen nun die Juckbohne untersucht.

http://ift.tt/2kpkHZ4

Ulcus cruris oft von neuropathischem Schmerz begleitet

Unabhängig von der Ursache des Geschwürs leidet die Mehrzahl der Patienten mit einem Ulcus cruris an neuropathischen Schmerzen.

http://ift.tt/2kfJ3Rk

Giftige Stoffe beim Haare-Lasern

Wenn Haare unterm Laserstrahl verdampfen, riecht das nicht nur schlecht, es entstehen auch toxische Substanzen: Die Werte für Kohlenmonoxid und Blausäure-Vorstufen in der Atemluft werden teilweise um das 300-Fache überschritten.

http://ift.tt/2kpiX1Q

Videosprechstunde darf persönlichen Kontakt nicht ersetzen

Die Videosprechstunde ist auf dem Weg in die Regelversorgung. Jetzt wurden technische Anforderungen veröffentlicht, ab Juli 2017 soll es eine eigene EBM-Ziffer geben. Alles andere als unmissverständlich sind jedoch die berufsrechtlichen Rahmenbedingungen.

http://ift.tt/2kfI5Vj

Gürtelrose ist unter Statintherapie häufiger

Bereits aus früheren Studien geht hervor, dass bei Patienten mit einer Statintherapie die Wahrscheinlichkeit für die Entwicklung eines Herpes zoster leicht erhöht ist. Unklar war bisher, ob dies dosisabhängig ist. Dieser Zusammenhang wurde nun überprüft.

http://ift.tt/2kpu4aO

Dein Gesicht: mein Gesicht!

Viele Figuren in Märchen und Sagen nehmen im Handumdrehen das Aussehen anderer Wesen an. In modernen Erzählungen ist diese Wandlungsfähigkeit der Wissenschaft vorbehalten: Im 1997 erschienen Film „Face/Off" erzählt Regisseur John Woo die Geschichte zweier Erzfeinde, die mittels Transplantation ihre Gesichter – und damit ihre Identitäten – tauschen.

http://ift.tt/2kfOqAi

Hautkrebsscreening ohne Nutzen?

Acht Jahre nach der Einführung des nationalen Hautkrebsscreenings in Deutschland lässt sich immer noch keine verlässliche Aussage über dessen Nutzen treffen. Ein Team der Uni Dresden hat nun Kassendaten ausgewertet, um mehr über Teilnahmeraten, entdeckte Krebsfälle und den Effekt auf die Krankheitsprognose zu erfahren.

http://ift.tt/2kpqr4J

Neue Melanomdiagnostik-Verfahren mit Vorsicht zu gebrauchen

Zwei in jüngster Zeit in die dermatologische Melanomdiagnostik eingeführte Verfahren sind in einer US-amerikanischen Studie miteinander verglichen worden. Völlig überzeugen konnte keines der beiden.

http://ift.tt/2kfKSht

Inhaltsverzeichnis

http://ift.tt/2kfHlje

Verdächtiges Ulkus an der Ferse

http://ift.tt/2kpaGLg

Nävusassoziierte Melanome weniger aggressiv

Melanome, die sich de novo entwickeln, sind offenbar mit einer kürzeren Überlebenszeit assoziiert als Formen, die aus melanozytären Nävi entstehen. Das lässt die Befundauswertung zweier großer US-Kohorten vermuten.

http://ift.tt/2kfCeQ0

Wissen Sie, was ein Kerion ist?

http://ift.tt/2kpobdT

„Atrophodermia vermiculata“

http://ift.tt/2kfAC8K

Mängel in der Praxisorganisation nerven Patienten

Wenn Patienten einem Arzt die Treue kündigen, liegt die Ursache oft in vermeintlichen Kleinigkeiten, die aber doch gehörig nerven können, wenn sie sich wiederholen. Schuld sind oft Fehler und Unzulänglichkeiten in der Praxisorganisation.

http://ift.tt/2kpu2zI

Hinter dem Exanthem steckt ein brasilianisches Virus

http://ift.tt/2kfM9oz

Neue Therapieoption bei atopischer Dermatitis

Die topische Behandlung von atopischer Dermatitis basiert seit Jahren auf Kortikosteroiden, Calcineurin-Inhibitoren oder systemischen Immunsuppressiva. Der Januskinase-Inhibitor Tofacitinib könnte laut einer kanadischen Studie eine neue Behandlungsoption sein.

http://ift.tt/2kppoSk

Praxischefs ziehen Lehren aus Online-Bewertungen

Patientenkritik an der Praxis auf Online-Portalen lassen Praxischefs meist nicht kalt. Mehr als die Hälfte hat bereits reagiert, um die Prozesse in ihrem Versorgungsalltag zu optimieren.

http://ift.tt/2kfAAh8

Ungewöhnliche Vertiefungen in der Gesichtshaut

http://ift.tt/2kpaDPA

Aktinische Keratose: mit Photolyase neuen Läsionen besser vorbeugen

Nach photodynamischer Therapie werden Patienten mit aktinischer Keratose angehalten, das Hautareal mit Sonnencreme vor weiteren UV-Schäden zu schützen. Dabei wäre eine Photolyase-haltige Sonnencreme unter Umständen wirkungsvoller.

http://ift.tt/2kfEg2k

„Fragen Sie Ihre Patienten nach psychischen Problemen!“

http://ift.tt/2kpu1vE

Pleomorphic Adenoma (Mixed Tumor) of Dorsum of Nose: A Rare Tumor at a Rare Site

http://ift.tt/2jncClL

A Rare Case of Locally Advanced Recurrent Neuroendocrine Tumour of Neck Salvaged by a Radical Surgical Approach

Abstract

Neuroendocrine tumours of head and neck are rare neoplasms and even more rare are those of cutaneous adenoid cystic carcinoma with neuroendocrine differentiation. Virtually every known variant of neoplasia with neuroendocrine differentiation can arise in complex structures of head and neck (Mills in Endocr Pathol 7(4):329–343. doi:10.1007/BF02739841) [1]. Such tumours are usually non functional, locally aggressive and may spread to lymph nodes or lungs. They are diagnosed by histopathology, immunohistochemistry and radionuclide imaging. When these tumours involve the carotid artery, they pose challenges in the surgical management.

http://ift.tt/2jubavB

Japanese workers with long leisure time have deteriorated periodontal condition: A cross-sectional study

Publication date: Available online 23 January 2017
Source:Journal of Oral Biosciences
Author(s): Norio Aoyama, Jun-ichi Suzuki, Hiroki Sato, Asuka Yoshida, Yuka Shiheido, Yuichi Izumi
ObjectivesThe relationship between length of leisure time and periodontal condition is unknown. The aim of this cross-sectional study was to clarify the association between leisure time and periodontal states.MethodsThis study was conducted on a cross-sectional sample of male (n=68) and female (n=30) Japanese healthy workers aged between 22 and 75 years. Periodontal states, including probing pocket depth, attachment level, bleeding on probing and serum antibody level for periodontal bacteria, and self-reported work conditions were assessed.ResultsSubjects with long leisure times on a weekday showed increased probing pocket depth and attachment loss compared to subjects with shorter free times. The serum antibody level of a major periodontal pathogen, Porphyromonas gingivalis, was higher in the long leisure group than in the short time group.ConclusionsSubjects with long leisure time showed aggregated periodontal condition consistent with increased serum antibody against periodontal bacteria compared to subjects with short free time.



http://ift.tt/2jWETQP

Premotoneuronal inputs to early developing trigeminal motoneurons

Publication date: Available online 24 January 2017
Source:Journal of Oral Biosciences
Author(s): Keishi Matsuda, Shiro Nakamura, Mutsumi Nonaka, Ayako Mochizuki, Kiyomi Nakayama, Takehiko Iijima, Atsuro Yokoyama, Makoto Funahashi, Tomio Inoue
ObjectivesWe previously reported that masseter motoneurons (MMNs) and digastric motoneurons (DMNs) in postnatal day (P) 1–5 rats receive convergent inputs from the lateral (l-) and medial (m-) supratrigeminal regions (SupV), intertrigeminal region (IntV), and dorsal region of the principal sensory trigeminal nucleus (PrV). The l-SupV sends burst inputs predominantly to the MMNs. We compared the synaptic inputs to P9–12 rat MMNs and DMNs with those found in the previous study involving P1–5 rats.MethodsWe performed whole-cell recordings and laser photolysis of caged glutamate in the MMNs and DMNs of P9–12 rats.ResultsSimilar to P1–5 rats, the photostimulation of multiple regions within the l-SupV, m-SupV, IntV, and dorsal PrV, induced postsynaptic currents (PSCs) in both P9–12 MMNs and DMNs. Photostimulation induced predominantly low-frequency PSCs in both P9–12 motoneurons, whereas l-SupV photostimulation predominantly induced burst PSCs in P1–5 rats. However, when the caged glutamate concentration was doubled, l-SupV photostimulation evoked burst PSCs in all P9–12 MMNs. Furthermore, l-SupV and m-SupV photostimulation evoked burst or low-frequency PSCs at significantly higher rates in the MMNs compared to in the DMNs.ConclusionsThese results suggested that, similar to P1–5 motoneurons, both P9–12 motoneurons received convergent inputs from the SupV, IntV, and PrV; however, the input–output gains of some of the premotor neurons decreased. These synaptic input changes may contribute to the proper development of chewing.



http://ift.tt/2k0nFCA

Mängel in der Praxisorganisation nerven Patienten

Wenn Patienten einem Arzt die Treue kündigen, liegt die Ursache oft in vermeintlichen Kleinigkeiten, die aber doch gehörig nerven können, wenn sie sich wiederholen. Schuld sind oft Fehler und Unzulänglichkeiten in der Praxisorganisation.

http://ift.tt/2kpu2zI

Hinter dem Exanthem steckt ein brasilianisches Virus

http://ift.tt/2kfM9oz

Neue Therapieoption bei atopischer Dermatitis

Die topische Behandlung von atopischer Dermatitis basiert seit Jahren auf Kortikosteroiden, Calcineurin-Inhibitoren oder systemischen Immunsuppressiva. Der Januskinase-Inhibitor Tofacitinib könnte laut einer kanadischen Studie eine neue Behandlungsoption sein.

http://ift.tt/2kppoSk

Praxischefs ziehen Lehren aus Online-Bewertungen

Patientenkritik an der Praxis auf Online-Portalen lassen Praxischefs meist nicht kalt. Mehr als die Hälfte hat bereits reagiert, um die Prozesse in ihrem Versorgungsalltag zu optimieren.

http://ift.tt/2kfAAh8

Ungewöhnliche Vertiefungen in der Gesichtshaut

http://ift.tt/2kpaDPA

Aktinische Keratose: mit Photolyase neuen Läsionen besser vorbeugen

Nach photodynamischer Therapie werden Patienten mit aktinischer Keratose angehalten, das Hautareal mit Sonnencreme vor weiteren UV-Schäden zu schützen. Dabei wäre eine Photolyase-haltige Sonnencreme unter Umständen wirkungsvoller.

http://ift.tt/2kfEg2k

„Fragen Sie Ihre Patienten nach psychischen Problemen!“

http://ift.tt/2kpu1vE

A randomized controlled clinical and histopathological trial comparing excisional biopsies of oral fibrous hyperplasias using CO 2 and Er:YAG laser

Abstract

This study was conducted in order to compare clinical and histopathological outcomes for excisional biopsies when using pulsed CO₂ laser versus Er:YAG laser. Patients (n = 32) with a fibrous hyperplasia in the buccal mucosa were randomly allocated to the CO₂ (140 Hz, 400 μs, 33 mJ) or the Er:YAG laser (35 Hz, 297 μs, 200 mJ) group. The duration of excision, intraoperative bleeding and methods to stop the bleeding, postoperative pain (VAS; ranging 0–100), the use of analgesics, and the width of the thermal damage zone (μm) were recorded and compared between the two groups. The median duration of the intervention was 209 s, and there was no significant difference between the two methods. Intraoperative bleeding occurred in 100% of the excisions with Er:YAG and 56% with CO₂ laser (p = 0.007). The median thermal damage zone was 74.9 μm for CO₂ and 34.0 μm for Er:YAG laser (p < 0.0001). The median VAS score on the evening after surgery was 5 for the CO₂ laser and 3 for the Er:YAG group. To excise oral soft tissue lesions, CO₂ and Er:YAG lasers are both valuable tools with a short time of intervention and postoperative low pain. More bleeding occurs with the Er:YAG than CO₂ laser, but the lower thermal effect of Er:YAG laser seems advantageous for histopathological evaluation.

http://ift.tt/2kqaI1A

Hepatitis C Virus and Interferon-Free Antiviral Therapeutics Revolution: Implications for Pakistan

Viral Immunology , Vol. 0, No. 0.


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Development of a Time and Cost Benefit Antibody Binding Test-Based Method for Determination of Rabies Vaccine Potency

Viral Immunology , Vol. 0, No. 0.


http://ift.tt/2koXSEG

Update on dermoscopy of Spitz/Reed naevi and management guidelines by the International Dermoscopy Society

Abstract

Spitzoid lesions represent a challenging and controversial group of tumours, in terms of clinical recognition, biologic behavior and management strategies. Although Spitz naevi are considered benign tumours, their clinical and dermoscopic morphologic overlap with spitzoid melanoma renders the management of spitzoid lesions particularly difficult. The controversy deepens because of the existence of tumours that cannot be safely histopathologically diagnosed as naevi or melanomas (atypical Spitz tumours). The dual objective of the present study was to provide an updated classification on dermoscopy of Spitz naevi, and management recommendations of spitzoid looking lesions based on a consensus among experts in the field. After a detailed search of the literature for eligible studies, a data synthesis was performed from 15 studies on dermoscopy of Spitz naevi. Dermoscopically, Spitz naevi are typified by 3 main patterns: starburst pattern (50.6%), a pattern of regularly distributed dotted vessels (19.3%) and globular pattern with reticular depigmentation (17.0%). A consensus-based algorithm for the management of spitzoid lesions is proposed. According to it, dermoscopically asymmetric lesions with spitzoid features (both flat/raised and nodular) should be excised to rule out melanoma. Dermoscopically symmetric spitzoid nodules should also be excised or closely monitored, irrespectively of the age, to rule out atypical Spitz tumours. Dermoscopically symmetric flat spitzoid lesions should be managed according to the age of the patient. Finally, the histopathologic diagnosis of atypical Spitz tumour should warrant wide excision but not a sentinel lymph node biopsy.

This article is protected by copyright. All rights reserved.

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Electrochemotherapy in the treatment of metastatic malignant melanoma: A prospective cohort study by InspECT

Abstract

Background

Electrochemotherapy (ECT) is an effective local treatment for cutaneous metastasis. Treatment involves the administration of chemotherapeutic drugs followed by delivery of electrical pulses to the tumour. The aim of this study was to investigate the effectiveness of ECT in cutaneous metastases of melanoma and to identify factors which affect (beneficially or adversely) the outcome.

Methods

13 cancer centres in the International Network for Sharing Practices on Electrochemotherapy (INSPECT) consecutively and prospectively uploaded data to a common database. ECT consisted of intratumoural or intravenous injection of bleomycin, followed by application of electric pulses under local or general anaesthesia.

Results

151 patients with metastatic melanoma were identified from the database, 114 of which had follow-up data of 60 days or more. 80 of these patients (73%) experienced an overall response (complete response + partial response = OR). 394 lesions were treated, of which 306 (77%) revealed an OR, 229 a complete response (58%). In multivariate analysis, factors positively associated with overall response were coverage of deep margins, absence of visceral metastases, presence of lymphoedema, treatment of non-irradiated areas were factors significantly influencing treatment efficacy. Factors significant associated to a complete response to ECT treatment were: coverage of deep margins, previous irradiation of treated area, and tumour size (<3 cm). One-year overall survival in this cohort of patients was 67% (C.I. 95%: 57%-77%), whilst melanoma specific survival was 74% (C.I. 95%: 64%-84%). No serious adverse events were reported, and the treatment was in general very well tolerated.

Conclusion

ECT is a highly effective local treatment for melanoma metastases in the skin, with no severe adverse effects. In the presence of certain clinical factors, ECT may be considered for local tumour control as an alternative to established local treatments, or as an adjunct to systemic treatments.

This article is protected by copyright. All rights reserved.

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Nicotinamide reduces COX-2 expression in HaCaT keratinocytes after ultraviolet B irradiation

Abstract

In their interesting research letter, Chen et al. (2016 Apr 8. doi: 10.1111/bjd.14662)¹ described the protective effects of oral nicotinamide (NCT) for chemoprevention of non-melanoma skin cancers (NMSCs) in renal transplant recipients. We totally agree that NCT can represent a new opportunity

for NMSC chemoprevention basing on its capability to preserve cellular energy reserve for ATP-dependent DNA repair as well as UV-induced immunosuppression.² Moreover, we hypothesize that one of the mechanisms through which NCT may act is by modulating the expression of cyclooxygenase (COX)-2, the rate-limiting enzyme in prostaglandin (PG) generation.

This article is protected by copyright. All rights reserved.

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Purification and immunochemical characterization of Pla l 2, the profilin from Plantago lanceolata

Publication date: March 2017
Source:Molecular Immunology, Volume 83
Author(s): Raquel Moya, Virginia Rubio, Juan Mª. Beitia, Jerónimo Carnés, M. Angeles López-Matas
Profilins are small actin-binding proteins found in eukaryotes and involved in cell development, cytokinesis, membrane trafficking, and cell motility. From an allergenic point of view, profilins are panallergens usually involved in allergic polysensitization, although they are generally recognized as minor allergens.The objectives of this study were to identify and characterize the profilin from Plantago lanceolata pollen and to investigate the cross-reactivity between profilins from different pollen allergenic sources.Profilins from P. lancelolata (Pla l 2) and palm tree pollen (Pho d 2) were purified by affinity chromatography, deeply characterized and identified by mass spectrometry. Pla l 2 allergenicity was confirmed by immunoblot with serum samples from a patient population sensitized to profilin. Immunoblot inhibition was performed to study IgG reactivity between different pollen profilins. IgE cross-reactivity was demonstrated by ImmunoCAP inhibition.Pla l 2 is the second P. lanceolata allergen included in the IUIS Allergen Nomenclature database. Four peptides from purified Pla l 2 were identified with percentages of homology with other pollen profilins between 73 and 86%. Eighty-six percent (21/24) of the patient population recognized Pla l 2. The allergenic relatedness between Pla l 2, Pho d 2 and six pollen profilins was confirmed, and IgE cross-reactivity of Pla l 2 with rBet v 2 and rPhl p 12 was demonstrated.Pla l 2 is the profilin from P. lanceolata. The demonstrated allergenicity of this protein and its cross-reactivity with other pollen profilins support its use in profilin diagnostic assays.



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Inflammasomes in the lung

Publication date: Available online 24 January 2017
Source:Molecular Immunology
Author(s): James W. Pinkerton, Richard Y. Kim, Avril A.B. Robertson, Jeremy A. Hirota, Lisa G. Wood, Darryl A. Knight, Matthew A. Cooper, Luke A.J. O'Neill, Jay C. Horvat, Philip M. Hansbro
Innate immune responses act as first line defences upon exposure to potentially noxious stimuli. The innate immune system has evolved numerous intracellular and extracellular receptors that undertake surveillance for potentially damaging particulates. Inflammasomes are intracellular innate immune multiprotein complexes that form and are activated following interaction with these stimuli. Inflammasome activation leads to the cleavage of pro-IL-1β and release of the pro-inflammatory cytokine, IL-1β, which initiates acute phase pro-inflammatory responses, and other responses are also involved (IL-18, pyroptosis). However, excessive activation of inflammasomes can result in chronic inflammation, which has been implicated in a range of chronic inflammatory diseases. The airways are constantly exposed to a wide variety of stimuli. Inflammasome activation and downstream responses clears these stimuli. However, excessive activation may drive the pathogenesis of chronic respiratory diseases such as severe asthma and chronic obstructive pulmonary disease. Thus, there is currently intense interest in the role of inflammasomes in chronic inflammatory lung diseases and in their potential for therapeutic targeting. Here we review the known associations between inflammasome-mediated responses and the development and exacerbation of chronic lung diseases.



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USPSTF Recommendation for Obstructive Sleep Apnea Screening in Adults

The US Preventive Services Task Force (USPSTF) was created in 1984 as an independent, volunteer panel of national experts in prevention and evidence-based medicine. It works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services such as screenings, counseling services, and preventive medications. Any USPSTF recommendation on a clinical service is based on a review of existing peer-reviewed medical evidence, and the clinical service is then assigned a grade of A through D, where A recommends for and D against the service, or an "I statement" when evidence is insufficient or of too poor quality to assess the balance of benefits and harms. USPSTF recommendations do not consider the costs of a preventive service.

http://ift.tt/2jZwUTp

Programmed Death-Ligand 1 Expression in Papillary Thyroid Cancer and Its Correlation with Clinicopathologic Factors and Recurrence

Thyroid , Vol. 0, No. 0.


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The Second Antithyroid Drug Treatment Is Effective in Relapsed Graves' Disease Patients: A Median 11-Year Follow-Up Study

Thyroid , Vol. 0, No. 0.


http://ift.tt/2jtvXPC

Twenty-year follow-up using a postal survey of childhood vitiligo treated with narrowband ultraviolet-B phototherapy

Vitiligo is a depigmenting skin disorder with an estimated prevalence of 1%.¹ Childhood-onset vitiligo occurs in approximately a third of all cases.² Early-onset childhood vitiligo tends to be a more extensive and progressive type of vitiligo.³ Narrowband ultraviolet-B (NB-UVB) phototherapy is an effective treatment option in active vitiligo and leads to >75% repigmentation in 14-75% of childhood cases.^4,5 Unfortunately, no evidence is available whether this repigmentation is long-lasting. To date, no data are available on the long-term efficacy and safety of NB-UVB in childhood vitiligo.

This article is protected by copyright. All rights reserved.

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Siramesine causes preferential apoptosis of mast cells in skin biopsies from psoriatic lesions

Summary

Background

Skin mast cells are implicated as detrimental effector cells in various inflammatory skin diseases such as contact eczema, atopic dermatitis and psoriasis. Selective reduction of cutaneous mast cells, e.g. by inducing targeted apoptosis, might prove a rational and efficient therapeutic strategy in dermatoses negatively influenced by mast cells.

Objectives

The objective of the present study was to evaluate whether a lysosomotropic agent such as siramesine can cause apoptosis of mast cells present in psoriatic lesions.

Methods

Punch biopsies were obtained from lesional and uninvolved skin in 25 patients with chronic plaque psoriasis. After incubation with siramesine, the number of tryptase-positive mast cells, and their expression of IL-6 and IL-17 was analyzed. Skin biopsies were digested to allow flow cytometry analysis of the drug's effect on cutaneous fibroblasts and keratinocytes.

Results

Siramesine caused a profound reduction in the total number of mast cells in both lesional and uninvolved psoriatic skin biopsies without affecting the gross morphology of the tissue. The drug reduced the density of IL-6- and IL-17-positive mast cells, and showed antiproliferative effects on epidermal keratinocytes but had no apparent cytotoxic effect on keratinocytes or dermal fibroblasts.

Conclusions

Considering the pathophysiology of psoriasis, the effects of siramesine on cutaneous mast cells may prove favourable from the therapeutic aspect. The results encourage further studies to assess the usefulness of siramesine and other lysosomotropic agents in the treatment of cutaneous mastocytoses and inflammatory skin diseases aggravated by dermal mast cells.

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Antipruritic effect of pretreatment with 8% topical capsaicin on histamine- and cowhage-evoked itch in healthy volunteers – a randomized placebo-blinded proof-of-concept trial

Abstract

Background

Chronic itch is difficult to treat and associated with significantly decreased life quality. Topical low-concentration capsaicin (0.006-0.05%) has previously been investigated and applied in therapy of itch but contradictory evidence exits regarding its efficacy.

Objectives

This placebo-controlled, double-blinded study investigated the effect of 8% topical capsaicin applied for 1 and 24 hours on evoked itch, neurogenic inflammation and itch-associated dysesthesia.

Methods

Sixteen healthy volunteers (22±0.5 years, 9F) were treated with capsaicin for 1h and 24hrs, and vehicle for 24hrs on each volar forearm. After capsaicin/vehicle application, histamine (1%, administered prick test lancets) and cowhage (40-45 spicules) were applied in pretreated areas. Evoked itch and pain intensities were recorded for 10 minutes using a visual analog scale (0-10 cm), while Sensitivity To Touch-evoked Itch (STTI) was evaluated using von Frey filaments before/after itch provocations (as a measure of punctuate hyperknesis). Neurogenic inflammation was assessed using perfusion-imaging.

Results

In the vehicle-pretreated areas peak itch responses to histamine and cowhage were 4.67±0.58 and 5.15±0.71, respectively. Capsaicin-pretreatment reduced peak itch responses to both histamine and cowhage, after 24-hour pretreatment to 1.41±0.58 (p=0.003) and 0.81±0.18, (p<0.001), respectively. 1-hour capsaicin-pretreatment only reduced cowhage-induced itch (p=0.023). Furthermore, 24-hours capsaicin-pretreatment abolished punctuate hyperknesis and lowered histamine-induced neurogenic inflammation but did not affect wheal reactions.

Conclusions

Twenty-four hours of topical 8% capsaicin-pretreatment reduced histaminergic and non-histaminergic itch by ≈75%, while only significant reduction was achieved for non-histaminergic itch in a standard 1-hour treatment. Further investigations are needed to elucidate the clinical potential of high-concentration capsaicin as an antipruritic.

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The influence of gender and atopy in the relationship between obesity and asthma in childhood

Publication date: Available online 24 January 2017
Source:Allergologia et Immunopathologia
Author(s): N. Alvarez Zallo, I. Aguinaga-Ontoso, I. Alvarez-Alvarez, F. Guillén-Grima, C. Azcona San Julian
BackgroundThe objective of the study was to examine the relationship between asthma and overweight–obesity in Spanish children and adolescents and to determine whether this relationship was affected by gender and atopy.MethodsThe study involves 8607 Spanish children and adolescents from the International Study of Asthma and Allergies in Childhood phase III. Unconditional logistic regression was used to obtain adjusted odds ratios (OR) and 95% confidence intervals (95% CI) for the association between asthma symptoms and overweight–obesity in the two groups. Afterwards, it was stratified by sex and rhinoconjunctivitis.ResultsThe prevalence of overweight and obesity in 6–7-year-old children was 18.6% and 5.2% respectively and in 13–14 year-old teenagers was 11.4% and 1.1% respectively. Only the obese children, not the overweight children, of the 6–7 year old group had a higher risk of any asthma symptoms (wheezing ever: OR 1.68 [1.15–2.47], asthma ever: OR 2.29 [1.43–3.68], current asthma 2.56 [1.54–4.28], severe asthma 3.18 [1.50–6.73], exercise-induced asthma 2.71 [1.45–5.05]). The obese girls had an increased risk of suffering any asthma symptoms (wheezing ever: OR 1.73 [1.05–2.91], asthma ever: OR 3.12 [1.67–5.82], current asthma 3.20 [1.65–6.19], severe asthma 4.83[1.94–12.04], exercise-induced asthma 3.68 [1.67–8.08]). The obese children without rhinoconjunctivitis had a higher risk of asthma symptoms.ConclusionsObesity and asthma symptoms were associated in 6–7 year-old children but not in 13–14 year-old teenagers. The association was stronger in non-atopic children and obese girls.



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Healthcare Usage after Uvulopalatopharyngoplasty – Impact of Analgesic Regimen

Publication date: Available online 23 January 2017
Source:American Journal of Otolaryngology
Author(s): William S. Tierney, Gabriel Gabarain, Alan H. Kominsky
Outcome Objectives1) Analyze differences in healthcare usage between subjects receiving different perioperative analgesic medications after uvulopalatopharyngoplasty (UPPP) surgery. 2) Comment on the impact of perioperative analgesic medication on length of hospital stay and complications after UPPP.MethodsA retrospective cohort study of 120 UPPPs conducted by a single surgeon in the past 5 years was conducted. Subjects were grouped based on perioperative pain medication regimen into three groups; narcotics alone (n=83), narcotics with gabapentin (n=27), or narcotics with ketorolac trimethamine (n=10). The primary outcome variable was total number of clinic/emergency room and/or telephone encounters related to post-UPPP pain. Secondary outcomes included length of post-operative hospital stay, number of telephone and/or clinical encounters in which the patient complained specifically of pain or requested a refill for analgesics, and post-operative complications.ResultsNo significant difference was found between the three analgesic regimens in post-operative hospital stay length (p=0.28, median stay 23.5hrs), number of clinic or telephone encounters related to pain(p=0.26, mean value 0.71 encounters), or post-operative complication rate (p=0.82, 5.9% complication rate).ConclusionThis study shows no significant difference in post-operative healthcare usage between patients with peri-operative analgesic regimens including narcotics alone, gabapentin with narcotics, or ketorolac with narcotics. Post-operative complication rate and length of stay did not differ between groups. These data suggest that these three medication regimens have similar impact on post-operative course for UPPP patients. Therefore, the most affordable or simplest options have equivalent effects on post-operative healthcare usage.



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Paradoxical Vocal Fold Motion (PVFM) in Pediatric Otolaryngology

Publication date: Available online 24 January 2017
Source:American Journal of Otolaryngology
Author(s): Blake Smith, Claudio Milstein, Bryan Rolfes, Samantha Anne
IntroductionParadoxical vocal fold motion (PVFM) is a condition in which the vocal cords exhibit inappropriate inspiratory adduction, and it has been poorly studied in the pediatric population.MethodsPediatric patients diagnosed with PVCM by a pediatric otolaryngologist and doctor of speech pathology from 2008 to 2012 were reviewed. Patients in whom another cause for their respiratory disturbance was eventually identified were excluded. Patient demographics, characteristics, treatment, and outcomes were reviewed. Study was approved by Institutional Review Board at our institutionResultsThirty patients met criteria for inclusion, one with chiari malformation was excluded. 17/29 (59%) were female. Body mass index numbers (BMI) ranged from 16 to 25 with mean of 21. 9/29 (31%) competed at the highest level of a sport; only 3/29 (10%) did not participate in athletics. Average age of onset was 12.0years; average diagnosis delay was 1.3years. Mean follow up was 2.3years. 24/29 (83%) were previously treated for asthma. 23/29(79%) were previously treated for reflux. 25/29(86%) completed at least one session of respiratory and laryngeal control therapy with overall average of 2.2 sessions completed. All patients who attended a second therapy session were recorded as having improvement in symptoms.ConclusionsPediatric patients with PVFM often participate in high levels of organized sports and the frequency of concurrent asthma and reflux symptoms in this population supports the theory that laryngeal hypersensitivity contributes to the pathophysiology of PVFM. These patients were not found to have any associated psychiatric diagnoses. Pediatric patients with PVFM have an excellent prognosis when treated with speech therapy and for comorbid conditions as indicated.



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Two Cases of Proliferative Diabetic Retinopathy with Marked Sheathing of the Retinal Arteries following Vitrectomy

Purpose: The aim of this paper was to report 2 patients (3 eyes) with proliferative diabetic retinopathy (PDR) who showed marked sheathing of the retinal arterioles that was ultimately attributed to calcification following vitrectomy. Cases: Case 1 involved a 65-year-old female with PDR who underwent bilateral vitrectomy for traction retinal detachment. Postoperatively, bilateral retinal redetachment (reRD) was observed. Sheathing of the retinal arterioles was observed at the same time, yet was not apparent preoperatively. Case 2 involved a 71-year-old female with PDR who underwent vitrectomy for vitreous hemorrhage. Postoperatively, reRD was observed, and fundus findings showed sheathing of the retinal arterioles. In both patients, silicone oil tamponade and retinopexy were performed at reoperation, but sheathing of the retinal arterioles persisted postoperatively. Fluorescein fundus angiography showed that retinal blood flow was maintained, and no vessel leakage occurred. In addition, no sheathing of the retinal veins was observed. Optical coherence tomography (OCT) showed a higher intensity for retinal arterioles with sheathing than for normal retinal arterioles. Conclusion: Vessel sheathing in our 2 patients (3 eyes) differed from the sheathing seen in vasculitis. Based on the hyperintensity on OCT, this sheathing may have been due to retinal artery calcification induced by hypoxia and inflammation associated with reRD.
Case Rep Ophthalmol 2017;8:40–48

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Ataxia-telangiectasia: Immunodeficiency and survival

Publication date: Available online 24 January 2017
Source:Clinical Immunology
Author(s): Nienke J.H. van Os, Anne F.M. Jansen, Marcel van Deuren, Asgeir Haraldsson, Nieke T.M. van Driel, Amos Etzioni, Michiel van der Flier, Charlotte A. Haaxma, Tomohiro Morio, Amit Rawat, Michiel H.D. Schoenaker, Annarosa Soresina, Alexander M.R. Taylor, Bart P.C. van de Warrenburg, Corry M.R. Weemaes, Nel Roeleveld, Michèl A.A.P. Willemsen
Ataxia-telangiectasia (AT) is a neurodegenerative disorder characterized by ataxia, telangiectasia, and immunodeficiency. An increased risk of malignancies and respiratory diseases dramatically reduce life expectancy. To better counsel families, develop individual follow-up programs, and select patients for therapeutic trials, more knowledge is needed on factors influencing survival. This retrospective cohort study of 61 AT patients shows that classical AT patients had a shorter survival than variant patients (HR 5.9, 95%CI 2.0–17.7), especially once a malignancy was diagnosed (HR 2.5, 95%CI 1.1–5.5, compared to classical AT patients without malignancy). Patients with the hyper IgM phenotype with hypogammaglobulinemia (AT-HIGM) and patients with an IgG2 deficiency showed decreased survival compared to patients with normal IgG (HR 9.2, 95%CI 3.2–26.5) and patients with normal IgG2 levels (HR 7.8, 95%CI 1.7–36.2), respectively. If high risk treatment trials will become available for AT, those patients with factors indicating the poorest prognosis might be considered for inclusion first.



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Panorama Dermatologische Praxis

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Bactericidal antibiotics promote oxidative damage and programmed cell death in sinonasal epithelial cells

Background

Antibiotics are widely and heavily used in the treatment of chronic sinusitis. Bactericidal antibiotics can stimulate reactive oxygen species (ROS) formation, a proinflammatory response, and cell death in cultured human sinonasal epithelial cells (SNECs). Sulforaphane (SFN) is a potent stimulator of the antioxidant nuclear factor erythroid 2-related factor 2 (Nrf-2) system and a suppressor of inflammation. In this study we utilized SFN to further explore the relationship between levofloxacin treatment, ROS formation, and the cell death response.

Methods

SNECs were collected from patients during endoscopic sinus surgery and grown in culture at the air-liquid interface. Differentiated SNECs were stimulated with levofloxacin with or without SFN pretreatment. ROS were quantified. Apoptosis markers of caspase-3 activity and DNA fragmentation were quantified.

Results

Cultured SNECs treated with levofloxacin resulted in a significant increase in activity of the proapoptotic caspase-3 protease (5.9-fold, p = 0.01). The increase in activity was suppressed by pretreatment with SFN (1.9-fold). ROS levels increased with levofloxacin treatment (range, 1.2-fold to 1.8-fold), but were not significantly suppressed by pretreatment with SFN (range, 1.0-fold to 1.3-fold).

Conclusion

In this study, we demonstrate that treatment of cultured SNECs with levofloxacin leads to an increase in caspase-3 activity. SFN pretreatment suppresses the increased apoptotic response possibly through its antioxidant stimulating properties. Our results suggest that levofloxacin treatment stimulates a potent proapoptotic possibly through an ROS-dependent mechanism. Future studies will explore if this antibiotic-induced response is harmful to recovery of function in those with sinusitis.

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Painful purpura associated with exposure to levamisole-adulterated cocaine

Description

A 56-year-old man presented with a 2-day history of a painful rash. Examination revealed necrotic retiform purpura over the trunk and extremities (figure 1). Laboratory testing was notable for leucopenia (3.2 cells/µL) and positive peripheral antineutrophil cytoplasmic antibody (p-ANCA) with antimyeloperoxidase specificity (3.5 U, normal <0.4 U). Skin biopsy showed microvascular thrombosis and fibrinoid necrosis. On questioning, the patient endorsed regular cocaine use.

Figure 1

Necrotic retiform purpura over the trunk and extremities.

The patient was diagnosed with levamisole-induced vasculitis. He was discharged after workup but was readmitted a week later with wound superinfection requiring antibiotic therapy, surgical debridement and skin grafting. He recovered well postoperatively with complete resolution of his wounds at 2-month follow-up.

Levamisole is a veterinary antihelminthic previously used as an immunomodulator and cancer adjuvant prior to its withdrawal in 1999 from US markets due to toxicity. In the early...

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Successful treatment of tumour-induced osteomalacia after resection of an oral peripheral ossifying fibroma

Tumour-induced osteomalacia is a paraneoplastic syndrome wherein bone is affected by a hormone from a tumour that causes renal phosphate wasting and hypophosphataemia. Here, we present the case of a 31-year-old man who has been suffering from generalised bone pains and a spine deformity that led to loss of height. Pertinent findings are low serum phosphorus, low vitamin D and decreased bone mineral density. These findings led to a diagnosis of osteomalacia. However, the finding of an oral mass raised some questions as to what role it plays in the patient's disease. It was suspected that the oral mass (fibroma) was producing a hormone that led to renal phosphate wasting, hypophosphataemia and then osteomalacia. This hypothesis was proven after surgical removal of the mass led to normalisation of the metabolic derangements and eventually led to a resolution of the bone pains.

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Lymphoma presenting as a toothache: a wolf in sheep's clothing

Although rare in the oral cavity, oral non-Hodgkin lymphoma frequently mimics odontogenic and other oral pathologies. The purpose of this report is to discuss the diagnostic difficulty in a case of a 75-year-old man with diffuse large B-cell lymphoma presenting initially as a toothache.

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Atraumatic splenic rupture secondary to Epstein-Barr virus infection

We present a case report of atraumatic splenic rupture secondary to Epstein-Barr virus (EBV) infection. A woman aged 36 years presented to a London teaching hospital's Accident and Emergency department with severe abdominal pain following a 6-day history of diarrhoea and vomiting, which had been under review by her GP. A CT scan demonstrated free intraperitoneal fluid and abnormal appearance of her spleen. Blood tests demonstrated EBV infection with positive serology and leucocytosis. She underwent a laparoscopic washout, which confirmed a subcapsular splenic haematoma that was initially managed conservatively. However, she subsequently re-presented with increasing pain and required an elective splenectomy. This case demonstrates the risk of splenic rupture following EBV infection, even in the absence of trauma, and highlights the importance of prompt diagnosis and appropriate counselling in patients with infectious mononucleosis.

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Neurotological findings after electrical injury at the workplace

Objectives/Hypothesis

Neurotological findings secondary to electrical injuries have rarely been reported in the world literature. We attempt to characterize the neurotological findings following electrical injury and to determine the role head injury and loss of consciousness play in this population's clinical presentation.

Study Design

Retrospective cohort study.

Methods

A database containing 3,438 patients with work-related injuries was scanned for individuals who sustained and survived electrical injuries at work. Detailed analysis of the frequencies of presenting features and test results was performed. A comparative analysis was made between the subsets of patients with and without loss of consciousness and/or head injury.

Results

A cohort of 42 patients was identified. All patients had multiple symptoms. Dizziness was a significant complaint in all workers with electrical injuries. Other common complaints included tinnitus and imbalance. Characterization of these symptoms is provided in detail according to statistical frequency. In this cohort, 25 workers had a concomitant head injury and 17 workers had an associated loss of consciousness. There was no statistically significant difference when clinical presentation, examination, and balance testing results were compared between the subsets.

Conclusions

Frequency and characterization of symptoms following electrical injury are provided. Dizziness is the most common presenting neurotological feature. Loss of consciousness and/or associated head injury do not affect the clinical presentation in this particular population.

Level of Evidence

2b. Laryngoscope, 2017

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Adjuncts to local anaesthetics in tonsillectomy: a systematic review and meta-analysis

Abstract

The infiltration of local anaesthetic agents has been shown to reduce post-tonsillectomy pain. A number of recent studies have shown that the addition of agents such as clonidine and dexamethasone improve the efficacy of nerve blocks and spinal anaesthesia. The aim of this review was to determine whether additives to local anaesthetic agents improve post-tonsillectomy outcomes. Four major databases were systematically searched for all relevant studies published up to August 2016. All study designs with a control group receiving local anaesthetic infiltration and an intervention receiving the same infiltration with an added agent were included in this review. These studies were then assessed for level of evidence and risk of bias. The data were then analysed both qualitatively and where appropriate by meta-analysis. We reviewed 11 randomised controlled trial (RCTs) that included 854 patients. Due to inconsistencies in the methods used to report outcomes, both quantitative and qualitative comparisons were required to analyse the extracted data. Overall, we found that dexamethasone, magnesium, pethidine and tramadol reduce post-operative pain and analgesia use, with dexamethasone in particular significantly reducing post-operative nausea and vomiting and magnesium infiltration significantly reducing the incidence of laryngospasm. This systematic review of RCTs provides strong evidence that the use of dexamethasone and magnesium as additives to local anaesthetics reduces post-tonsillectomy pain and analgesia requirement. There is limited evidence that pethidine and tramadol have a similar effect on pain and analgesia requirement. The studies in this pooled analysis are sufficiently strong to make a level one recommendation that the addition of magnesium to local anaesthetics reduces the incidence of laryngospasm, a potentially lethal post-operative complication.

Review level of evidence: 1.

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Biomarkers and Functional Imaging in Predicting Response of Esophageal Cancer

Condition:   Esophageal Cancer
Interventions:   Other: Biomarkers Testing;   Other: Functional Imaging analysis
Sponsor:   Fourth Military Medical University
Recruiting - verified January 2017

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The maturation state of the auditory nerve and brainstem in rats exposed to lead acetate and supplemented with ferrous sulfate

Publication date: Available online 23 January 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Fernanda Zucki, Thais C. Morata, Josilene L. Duarte, Maria Cecília F. Ferreira, Manoel H. Salgado, Kátia F. Alvarenga
IntroductionThe literature has reported the association between lead and auditory effects, based on clinical and experimental studies. However, there is no consensus regarding the effects of lead in the auditory system, or its correlation with the concentration of the metal in the blood.ObjectiveTo investigate the maturation state of the auditory system, specifically the auditory nerve and brainstem, in rats exposed to lead acetate and supplemented with ferrous sulfate.Methods30 weanling male rats (Rattus norvegicus, Wistar) were distributed into six groups of five animals each and exposed to one of two concentrations of lead acetate (100 or 400mg/L) and supplemented with ferrous sulfate (20mg/kg). The maturation state of the auditory nerve and brainstem was analyzed using Brainstem Auditory Evoked Potential before and after lead exposure. The concentration of lead in blood and brainstem was analyzed using Inductively Coupled Plasma-Mass Spectrometry.ResultsWe verified that the concentration of Pb in blood and in brainstem presented a high correlation (r=0.951; p<0.0001). Both concentrations of lead acetate affected the maturation state of the auditory system, being the maturation slower in the regions corresponding to portion of the auditory nerve (wave I) and cochlear nuclei (wave II). The ferrous sulfate supplementation reduced significantly the concentration of lead in blood and brainstem for the group exposed to the lowest concentration of lead (100mg/L), but not for the group exposed to the higher concentration (400mg/L).ConclusionThis study indicate that the lead acetate can have a deleterious effects on the maturation of the auditory nerve and brainstem (cochlear nucleus region), as detected by the Brainstem Auditory Evoked Potentials, and the ferrous sulphate can partially amend this effect.



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Primary Ameloblastoma of the Temporal Bone

Publication date: Available online 24 January 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Andro Košec, Jakov Ajduk, Mihael Ries, Robert Trotić
Ameloblastoma is a locally aggressive tumor derived from odontogenic epithelium. Although benign, its clinical behavior may often times exhibit malignant characteristics. It is marked by slow and persistent growth with infiltration of adjacent tissues. Almost 70% occur in the mandible in patients over 30 years of age. Recurrence of ameloblastoma due to inadequate treatment is frequent. Due to its slow growth, recurrences may present decades after primary surgery. A primary ameloblastoma in an area outside of the mandible, maxilla and infratemporal fossa regions has not been described in detail to date, with only one possible case mentioned in literature. The authors present a case of primary temporal bone ameloblastoma in a 17-year-old male patient. The tumor originated in the left mastoid, infiltrating the lateral semicircular canal, facial nerve and cochlea, adhering to the sigmoid sinus and posterior cranial fossa dura. Although invasion of multiple structures in the infratemporal fossa and the temporal bone leads to variable disease presentation, this case is unique when considering that the first symptom of disease was unilateral recurring sensorineural sudden hearing loss. Surgery required transection of the facial nerve. Histopathology confirmed primary temporal bone ameloblastoma. The difficulties in achieving wide surgical margins, diagnostics and further management are also addressed.



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Sinonasal quality of life outcomes following laser treatment of epistaxis related to hereditary hemorrhagic telangiectasia

Abstract

Hereditary hemorrhagic telangiectasia (HHT) is an inherited vascular disorder which manifests as recurrent, episodic, and potentially debilitating epistaxis. In this study, we aim to (1) characterize baseline sinonasal symptoms for HHT patients and to (2) analyze changes in sinonasal symptoms before and after laser surgical treatment for HHT. We performed a retrospective chart review of sinonasal outcome test-22 (SNOT-22) scores before and after one or more laser surgical treatments for HHT-related epistaxis between January 1, 2010 and December 1, 2015 at a tertiary academic medical center with an HHT Foundation-approved Center of Excellence. Preoperative and all subsequent postoperative SNOT-22 scores (short-term, <45 days and long-term, ≥45 days) were compared. Twenty consecutive HHT patients underwent 51 laser surgeries for recurrent epistaxis. Mean preoperative, short-term postoperative, and long-term postoperative SNOT-22 scores were 34.6 ± 5.4, 33.9 ± 5.5, and 18.8 ± 4.6, respectively. When analyzing subcategory scores, there was a significant improvement in the rhinologic domain from short-term to long-term postoperatively (13.5 vs. 7.3; p = 0.004), in the non-rhinologic otolaryngic domain from short-term to long-term postoperatively (2.8 vs. 1.7; p = 0.014), and in the psychological domain from preoperative and short-term postoperative to long-term postoperatively (12.2 and 10.0 vs. 6.0; p = 0.015 and 0.01, respectively). Following laser surgery for HHT-related epistaxis, patients' rhinologic symptoms worsened on the short run postoperatively but improved over time. The main benefit of laser treatment appears to be long-term improvement in psychological factors. This study once again underscores the important role of the otolaryngologist in managing sinonasal manifestations of HHT.

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Nail apparatus melanoma thickness is associated with side and age

Abstract

Nail apparatus melanoma (NAM) is a rare variant of cutaneous melanoma that arises in the nail unit and typically appears as melanonychia in its early stage.¹ Since the factors associated with the progression of NAM are not fully understood, 102 cases of NAM were analysed to identify clinical factors associated with Breslow's thickness.

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Cross-sectional evaluation of acute adverse reactions during UVA1 phototherapy

Abstract

Phototherapy with ultraviolet A-1 (UVA1) can induce durable remissions in sclerosing disorders such as morphea¹. Optimal UVA1 dosing remains an area of research^2-4. Acute adverse reactions to UVA1 include erythema, pruritus and polymorphic light eruption (PMLE)⁵. The acute adverse reaction rate during UVA1 phototherapy has been reported to be as high as 15%, half of which was attributable to erythema⁶. However, other articles report minimal acute UVA1 toxicity⁷. Our objectives were to report on the chronology of acute adverse reactions and to identify associated factors.

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Cathepsin K modulates invasion, migration, and adhesion of oral squamous cell carcinomas in vitro

Abstract

Objective

Cathepsin K was initially discovered as an osteoclast-specific cysteine proteinase, but the enzyme is also expressed in various cancers including oral squamous cell carcinomas. The present study aimed to clarify the function of cathepsin K in oral squamous cell carcinomas.

Materials and methods

Expression levels of cathepsin K were examined in six types of cell carcinomas. Carcinomas overexpressing cathepsin K were constructed. Effects of cathepsin K overexpression and treatment with odanacatib, a specific cathepsin K inhibitor, on cell invasion, migration, and adhesion were analysed.

Results

Different levels of cathepsin K was expressed in carcinomas. Cathepsin K was predominantly localized in lysosomes. Cathepsin K overexpression impaired the proliferation of carcinomas. Invasion analysis showed that cathepsin K overexpression enhanced invasion and migration of carcinomas, whereas inhibition of cathepsin K by odanacatib caused the opposite effects in carcinomas. Cathepsin K overexpression also increased cell adhesion and slightly increased surface expression of the adhesion receptor CD29/integrin β₁.

Conclusions

The enhanced invasion of carcinomas resulting from cathepsin K overexpression is probably due to the increased cell migration and adhesion. Thus, cathepsin K is implicated not only in protein degradation but also in invasion, migration, and adhesion of oral squamous cell carcinomas.

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