Cowden syndrome (CS) is a rare dominantly inherited multisystem disorder, characterized by an extraordinary malignant potential. In 80% of cases, the human tumor suppressor gene phosphatase and tensin homolog (PTEN) is mutated. We present a case of a 17-year-old boy with genetically confirmed CS and Graves' disease (GD). At the age of 15, he presented with intention tremor, palpitations, and marked anxiety. On examination, he had macrocephaly, coarse facies, slight prognathism, facial trichilemmomas, abdominal keratoses, leg hemangioma, and a diffusely enlarged thyroid gland. He started antithyroid drug (ATD) therapy with methimazole and, after a 2-year treatment period without achieving a remission status, a total thyroidectomy was performed. Diagnosis and management of CS should be multidisciplinary. Thyroid disease is frequent, but its management has yet to be fully defined. The authors present a case report of a pediatric patient with CS and GD and discuss treatment options.
http://ift.tt/2kMsiRw
Δευτέρα 30 Ιανουαρίου 2017
A Pediatric Case of Cowden Syndrome with Graves’ Disease
Osteopathic Manipulative Treatment Limits Chronic Constipation in a Child with Pitt-Hopkins Syndrome
Pitt-Hopkins Syndrome (PTHS) is a rare genetic disorder caused by insufficient expression of the TCF4 gene. Children with PTHS typically present with gastrointestinal disorders and early severe chronic constipation is frequently found (75%). Here we describe the case of a PTHS male 10-year-old patient with chronic constipation in whom Osteopathic Manipulative Treatment (OMT) resulted in improved bowel functions, as assessed by the diary, the QPGS-Form A Section C questionnaire, and the Paediatric Bristol Stool Form Scale. The authors suggested that OMT may be a valid tool to improve the defecation frequency and reduce enema administration in PTHS patients.
http://ift.tt/2joUoBX
Meretoja’s Syndrome: Lattice Corneal Dystrophy, Gelsolin Type
Lattice corneal dystrophy gelsolin type was first described in 1969 by Jouko Meretoja, a Finnish ophthalmologist. It is caused by an autosomal dominant mutation in gelsolin gene resulting in unstable protein fragments and amyloid deposition in various organs. The age of onset is usually after the third decade of life and typical diagnostic triad includes progressive bilateral facial paralysis, loose skin, and lattice corneal dystrophy. We report a case of a 53-year-old female patient referred to our Department of Ophthalmology by severe dry eye and incomplete eyelid closure. She had severe bilateral facial paresis, significant orbicularis, and perioral sagging as well as hypoesthesia of extremities and was diagnosed with Meretoja's syndrome at the age of 50, confirmed by the presence of gelsolin mutation. At our observation she had bilateral diminished tear film break-up time and Schirmer test, diffuse keratitis, corneal opacification, and neovascularization in the left eye. She was treated with preservative-free lubricants and topical cyclosporine, associated with nocturnal complete occlusion of both eyes, and underwent placement of lacrimal punctal plugs. Ocular symptoms are the first to appear and our role as ophthalmologists is essential for the diagnosis, treatment, and monitoring of ocular alterations in these patients.
http://ift.tt/2kOztom
A Giant Lumbar Pseudomeningocele in a Patient with Neurofibromatosis Type 1: A Case Report
This is a rare case of giant lumbar pseudomeningocele with intra-abdominal extension in patient with neurofibromatosis type 1 (NF1). The patient's clinical course is retrospectively reviewed. A 34-year-old female affected by NF1 was referred to our institution for persistent low back pain and MRI diagnosis of pseudomeningocele located at L3 level with paravertebral extension. From the first surgical procedure by a posterior approach until the relapse of the pseudomeningocele documented by MRI, the patient underwent two subsequent posterior surgical procedures to repair the dural sac defect with fat graft and fibrin glue. One month after the third operation, the abdominal MRI showed a giant intra-abdominal pseudomeningocele causing compression of visceral structures. The patient was asymptomatic. The pseudomeningocele was treated with an anterior abdominal approach and the use of the acellular dermal matrix (ADM) sutured directly on the dural defect on the anterolateral wall of the spinal canal. After six months of follow-up the MRI showed no relapse of the pseudomeningocele. Our case highlights the possible use of ADM as an effective and safe alternative to the traditional fat graft to repair challenging and large dural defects.
http://ift.tt/2kOMMVs
Can an Educational Intervention Improve Iodine Nutrition Status in Pregnant Women? A Randomized Controlled Trial
Thyroid , Vol. 0, No. 0.
http://ift.tt/2jO7oQa
Reduction of Radiation Dosage in Visualization of Paranasal Sinuses in Daily Routine
Background. Preoperative imaging of the nose and paranasal sinus is standard in otorhinolaryngology. Previous studies on phantoms demonstrated the potential for dose reduction of cone beam computed tomography (CBCT) by varying the application parameters. Methodology. Based on previous studies, the standard protocol of paranasal sinus imaging by CBCT was altered. One hundred and fifty examinations using the old protocol (01/2010–01/2011, high dosage) and 150 examinations using the new protocol (09/2012–09/2013, low dosage) were evaluated and compared for the visibility of 17 anatomical structures, the Lund-Mackay Score, and technical parameters. Results. Alteration of the protocol resulted in a significant reduction in dosage (6.64 mGy versus 2.88 mGy). Both groups showed the same amount of pathology (Lund-Mackay Score: versus ; ). There was a significant better visibility of the anatomical structures (all visible = 1, nothing visible = 4) (results: 1.25 versus 1.17; ) in the low-dosage group. Conclusion. Despite a significant reduction in the applied dosage, reliable visualization of the bony anatomy of the anterior skull base is possible by CBCT. This demonstrates the need for the discussion of the required clinical imaging quality.
http://ift.tt/2kJrysT
Associations Between Adiposity and Metabolic Syndrome Over Time: The Healthy Twin Study
Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.
http://ift.tt/2jxnUAM
Ustekinumab for the treatment of acrodermatitis continua of Hallopeau refractory to anti-TNF agents
Abstract
Acrodermatitis continua of Hallopeau (ACH) is a variant of pustular psoriasis that is often very difficult to treat. Almost all anti-psoriatic agents have been used in the treatment of ACH. Ustekinumab, a fully human monoclonal antibody of the IgG1 class, is directed to the shared p40 subunit of cytokines IL-12 and IL-23. Herein, we present our experience of ustekinumab use in a 50-year-old man who was resistant to anti-tumor necrosis factor-α agents. Though initial therapy with ustekinumab achieved a sustained response in our patient, after a seven months of interruption, retreatment resulted in a slower and poorer response than the initial regimen. Both responses of our patient reflects: (i) the recalcitrant chronic nature of ACH in some patients, (ii) the value of ustekinumab in ACH treatment, (iii) the fact that, as with other biologics, a loss of response may also occur with ustekinumab when the treatment is interrupted. All these data provides evidence for the fact that the course of ACH is unpredictable and possibly indicate that concerning current biologics used in the treatment of ACH, we have still failed to hit the target we aimed for.
http://ift.tt/2klxURX
Exhaled nitric oxide or FEF25%–75% Balancing diagnostic value with efficacy despite evidentiary uncertainty
We appreciate the comments1,2 on our recent publication investigating the value of exhaled nitric oxide (FeNO) in predicting the outcome of a methacholine challenge (MCH) in adults with respiratory symptoms presenting to a tertiary care center.3 Despite our hypothesis not being confirmed, the performance profile of FeNO (inexpensive, point of care, information predicting treatment response) makes this testing modality attractive compared with MCH testing (more expensive, logistically more cumbersome, helpful primarily when the result is negative).
http://ift.tt/2klsu9u
Control measures in asthma: one size likely does not fit all
Despite great advances in our understanding and treatment of asthma, significant morbidity and mortality persist. Recent statistics have reported 1.8 million emergency department visits and 3,651 deaths from asthma in the United States.1,2 Although the greatest lability occurs in those with severe asthma, a recent study from the United Kingdom found that only 39% of patients who died of asthma were previously labeled as having severe asthma.3 All these findings speak to the need for better measurements of asthma control.
http://ift.tt/2kaYVVH
Stevens-Johnson syndrome and toxic epidermal necrolysis
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN or Lyell disease) are rare diseases that cause acute destruction of the epithelium of the skin and mucous membrane by a violent immune response. SJS, TEN, and SJS-TEN overlap are considered variants in a spectrum of disease severity. SJS involves epidermal detachment of less than 10% of total body surface area, TEN involves epidermal detachment of more than 30% of total body surface area, and SJS-TEN overlap involves epidermal detachment of 10% to 29% of total body surface area.
http://ift.tt/2klnP7Q
Guidelines for the prevention of peanut allergy in the United States
Allergists-immunologists are frequently consulted for specific recommendations regarding when to introduce solid foods to infants at risks for food allergy. While they had been given evidence from the literature for the lack of benefit from a delay in the introduction of allergenic foods, there was no evidence for lack of harm, let alone a benefit, for their early introduction. Results from the prospective randomized clinical trial that evaluated the preventive role of early introduction of peanut in the diet of infants at risk for peanut allergy (known as the Learning Early About Peanut Allergy [LEAP] study)1 have recently been published.
http://ift.tt/2klCmAb
Environmental control measures for the management of atopy
With the increasing prevalence of allergic airway disease in recent years, efforts have focused on the importance of environmental control measures to decrease morbidity and improve quality of life in the allergic population. Once allergy and asthma have been established, allergen abatement is an important aspect of managing the atopic population. We review current evidence of the role of environmental control and abatement measures for common allergens including furry animals, rodents, cockroach, dust mite, and mold.
http://ift.tt/2kJs7Dp
Book Review
Climate change is the defining challenge of our century, and this book considers its effects on aeroallergens and allergic diseases. These effects range from the geographic distribution of allergenic species of plants and molds to the allergenicity of the pollen grains and spores themselves. Also addressed are increased aeroallergen production, lengthening of allergy seasons, and interactions with air pollution. The remaining sections describe the effects on allergic disease incidence and clinical presentations.
http://ift.tt/2klkqpf
Asthma Yardstick
Current asthma guidelines recommend a control-based approach to management that involves assessment of impairment and risk followed by implementation of treatment strategies individualized according to the patient's needs and preferences. The fact that many patients still experience severe symptoms that negatively affect quality of life suggests that asthma control remains an objective to be achieved. Tools are available to help patients (and families) manage the day-to-day and short-term variability in asthma symptoms; however, when and how to implement a sustained step-up in therapy is less clear.
http://ift.tt/2klmVZ2
Exhaled nitric oxide's ability to predict methacholine challenge
I read with interest the article "Evaluation of Exhaled Nitric Oxide's Ability to Predict Methacholine Challenge in Adults With Nonobstructive Spirometry" by Nickels and Lim, recently published on Annals of Allergy, Asthma, and Immunology.1 Their study, which was retrospectively conducted and selected patients who performed fractional exhaled nitric oxide (FeNO) and methacholine bronchial challenge within 2 weeks of each other, found that FeNO had a nonbrilliant ability to predict the outcome of a methacholine challenge, despite patients with positive methacholine challenge result having signficantly higher levels of FeNO.
http://ift.tt/2kly3oD
Fractional exhaled nitric oxide, methacholine, or forced expiratory flow between 25% and 75%
Nickels and Lim1 retrospectively evaluated 774 adults who underwent methacholine challenge and fractional exhaled nitric oxide (FeNO) measurement. They reported that approximately 16% of tested individuals had positive methacholine challenge results (ie, bronchial hyperreactivity [BHR]) and that FeNO values were higher in those with BHR. A receiver operating characteristic curve revealed an area under the curve of 0.57, suggesting a poor association between FeNO and methacholine outcomes. Therefore, the authors concluded that in corticosteroid-naive pulmonary patients with normal forced expiratory volume in 1 second values, FeNO poorly predicts the outcome of a methacholine challenge.
http://ift.tt/2kloXbn
Breathing parameters associated to two different external nasal dilator strips in endurance athletes
The aim of the study was to investigate and compare the effects of two different external nasal dilator strips (ENDS) on nasal respiratory flow, maximal oxygen uptake (VO2max), nasal VO2max, time to exhaustion and subjective nasal obstruction in adult triathletes participating in exhaustive, controlled physical exercise tests.
http://ift.tt/2jPuweP
Evaluation of bone resorption in fibula and deep circumflex iliac artery flaps following dental implantation: A three-year follow-up study
Long-term results of dental implant treatment in fibula free and deep circumflex iliac artery (DCIA) free flaps are scarce. The purpose of this study was to assess and compare peri-implant bone resorption of vascularized bone flaps treated with dental implants. A total of 28 patients, 14 fibula and 14 DCIA flaps, respectively, underwent reconstruction of the lower and upper jaw by the use of vascularized bone flaps and were treated with dental implants. Peri-implant bone resorption was measured using digital panographs up to 3 years.
http://ift.tt/2klrthA
The development of dendritic cell vaccine-based immunotherapies for glioblastoma
Abstract
In this review, we focus on the biologic advantages of dendritic cell-based vaccinations as a therapeutic strategy for cancer as well as preclinical and emerging clinical data associated with such approaches for glioblastoma patients.
http://ift.tt/2kNtJuU
Evidence for a role of eosinophils in blister formation in bullous pemphigoid
Abstract
Background
Bullous pemphigoid (BP) is an autoimmune bullous disease of the skin characterized by subepidermal blister formation due to tissue-bound and circulating autoantibodies to the hemidesmosomal antigens BP180 and BP230. Although eosinophils and their toxic mediators are found abundantly in BP lesions, their role in blister formation has remained unclear.
Objective
To investigate the role of eosinophils in the pathogenesis of BP with a specific focus on blister formation and to define conditions inducing dermal-epidermal separation (DES).
Methods
In an ex vivo human model of BP, normal human skin cryosections were incubated with purified human peripheral blood eosinophils with or without activation in the presence or absence of BP autoantibodies, brefeldin A, diphenyleneiodonium (DPI), DNase, or blocking F(ab')2 fragments to CD16, CD18, CD32 and CD64. DES was assessed by light microscopy studies and quantified using Fiji software.
Results
Following activation with IL-5 and in the presence of BP autoantibodies, eosinophils induced separation along the dermal-epidermal junction of ex vivo skin. DES was significantly reduced by blocking any of the following: Fcγ receptor binding (p=0.048), eosinophil adhesion (p=0.046), reactive oxygen species (ROS) production (p=0.002), degranulation (p<0.0001), or eosinophil extracellular trap (EET) formation (p=0.048).
Conclusions
Our results provide evidence that IL-5-activated eosinophils directly contribute to BP blister formation in the presence of BP autoantibodies. DES by IL-5-activated eosinophils depends on adhesion and Fcγ receptor activation, requires elevated ROS production and degranulation, and involves EET formation. Thus, targeting eosinophils may be a promising therapeutic approach for BP.
This article is protected by copyright. All rights reserved.
http://ift.tt/2kkUrym
Adult Atopic Dermatitis with Comorbid Atopic Disease is Associated with Increased Risk of Infections: A Population-Based Cross-Sectional Study
Abstract
Introduction
Atopic dermatitis (AD) is related to other atopic diseases asthma and allergic rhinitis. It is known that those with asthma or allergic rhinitis have impaired immune responses that may predispose them to infections. This study sought to determine whether adult AD is associated with systemic infections, and whether association is strengthened in those with AD plus another atopic disease.
Methods
This cross-sectional study obtained information from adults in the 2010 and the 2012 National Health Interview Survey (NHIS). The primary exposure was history of AD without or with an additional atopic disease, asthma or allergic rhinitis. Self-reported systemic infections were the primary outcomes. Survey logistic regression was performed and adjusted odds ratios (aOR) reported.
Results
AD in NHIS 2010 was associated with increased risk of sinusitis [aOR (95% CIs): 1.65 (1.42, 1.91), P < 0.001], head or chest cold [1.31 (1.12, 1.52), P < 0.001], and gastrointestinal illness [2.39 (1.97, 2.89), P < 0.001], and in NHIS 2012, pneumonia/influenza [1.73 (1.54, 1.95), P < 0.001], strep throat/tonsillitis [1.72 (1.54, 1.92), P < 0.001], sinusitis [1.77 (1.54, 2.02), P < 0.001], head or chest cold [1.49 (1.33, 1.67), P < 0.001], and infectious disease [2.66 (2.20, 3.21), P < 0.001]. An increase in atopic disease mirrored an increase in number of infectious outcomes and was statistically significant in the combined dataset (P < 0.001).
Conclusion
The associations between AD and AD plus another atopic disease with systemic infections suggest that an underlying immune defect may be contributing to microbial susceptibility. Further studies are warranted to understand the burden of infectious disease in this population.
http://ift.tt/2kkmu0j
Low-dose carperitide (α-human A-type natriuretic peptide) alleviates hemoglobin concentration decrease during prolonged oral surgery: a randomized controlled study
Abstract
Purpose
Surgical injury stimulates the renin–angiotensin–aldosterone system (RAAS) and causes antidiuresis, leading to postoperative oliguria. Carperitide (α-human A-type natriuretic peptide) is a cardiac peptide hormone secreted from the atrium. This peptide hormone enhances diuresis by suppressing the RAAS. In our experience, carperitide alleviates decreased hemoglobin (Hb) concentration during elective surgery. In the current study, we investigated the relationship between low-dose carperitide (0.01 µg/kg/min) and Hb concentration during oral surgery.
Methods
Patients (ASA-PS: I–II, 40–80 years old) undergoing oral maxillofacial surgery (duration of operation >8 h) were enrolled in this study. Patients were divided into two groups: the carperitide group received carperitide at 0.01 µg/kg/min and the control group received normal saline. Body fluid water [including total body water (TBW), extracellular water (ECW), and intracellular water (ICW)], urine volume, and chemical parameters such as Hb concentration, PaO2, and serum electrolytes were evaluated every 2 h.
Results
In the carperitide group (n = 15), Hb decreased from 12.6 ± 1.1 to 10.8 ± 1.5 g/dl, while it decreased from 12.6 ± 1.4 to 9.5 ± 1.3 g/dl in the control group (n = 15) (p < 0.05). Urine volume (2557.3 ± 983.5 mL) in the carperitide group was significantly more than it was in the control group (1108.8 ± 586.4 mL; p < 0.001). There were no significant differences in clinical characteristics, body fluid water, PaO2, and serum electrolytes between the two groups. In addition, there were no perioperative clinical respiratory and hemodynamic complications in the groups.
Conclusion
The Hb concentration in the group administered low-dose carperitide at 0.01 µg/kg/min remained higher than that in the control group during surgery. Administration of low-dose carperitide may therefore reduce the risk of blood transfusion during surgery.
http://ift.tt/2jMMrVY
Pyomyositis Is Not Only a Tropical Pathology: A Case Series
Primary pyomyositis has been thought to be endemic to tropical countries, and in fact often called "tropical pyomyositis", but this case series demonstrates that's not always the case.
Journal of Medical Case Reports
http://ift.tt/2kzkePW
Can You Have Your Cake and Eat It Too? The Sunlight D-lema
Can the negative health consequences of sun exposure be balanced with the benefits of sunlight as an important source of vitamin D and other beneficial photochemical processes?
The British Journal of Dermatology
http://ift.tt/2jzIwcj
Low-skill flexible bronchoscopic intubation – Overcoming common pitfalls
To the Editor,
http://ift.tt/2kLHEpa
Clinical experiences of the continuous quadratus lumborum block via paramedian sagittal oblique approach
To the Editor:
http://ift.tt/2kNtLCV
Continuous serratus plane block in a patient with multiple rib fractures
A 63-year-old man with a medical history of obesity (BMI 32), complicated by chronic obstructive pulmonary disease, diabetes, and hypertension was admitted to the emergency department (ED) following a car accident. While in the ED, the patient was fully collaborative (GSC 15), hemodynamically stable, and visibly suffering from chest pain. Self-reported pain intensity originating mainly from the right side of the thorax was 9–10, as measured on the numeric rating scale (NRS).
http://ift.tt/2kLMgMd
A simple method to control the distal tip of nasotracheal tube using the surgical suture - A reply
We thank Yang et al. for their letter in response to our article "A novel method to control the distal tip of nasotracheal tube" [1]. Nasotracheal intubation is an established airway management technique in patients undergoing oral and maxilla-facial surgery. The most frequent complication of nasotracheal intubation is nasal mucosal trauma and the incidence of mild to severe epistaxis is reportedly to be about 35.3% when using a conventional tracheal tube (Rusch endotracheal tube) [2]. Yang et al.
http://ift.tt/2kNwRa0
Adapting the Toyota production model to teach systems-based practice to anesthesiology fellows
What does the Accreditation Council for Graduate Medical Education (ACGME) core competency in systems-based practice (SBP) mean for anesthesiologists? The broad ACGME definition of SBP is "an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value." They further refined the definition into 6 resident expectations known as milestones [1], and subsequent education expert consensus has provided additional operational definitions [2,3].
http://ift.tt/2kIeyUH
Esophageal Doppler monitoring with the Ambu® AuraGain™ laryngeal mask airway
To the Editor,
http://ift.tt/2jMFiVw
Social Distancing of College Students Toward Individuals Who Experienced Sexual Violence
Violence and Gender , Vol. 0, No. 0.
http://ift.tt/2kI3XJh
Pars plana vitrectomy with 360° versus localized laser retinopexy in the management of retinal detachment with undetected breaks intraoperatively: a retrospective, comparative, interventional study
Abstract
The purpose of this study is to compare the efficacy of intraoperative 360° and localized laser retinopexy in 23-gauge pars plana vitrectomy (PPV) for rhegmatogenous retinal detachments (RRD) with undetected retinal breaks intraoperatively. This is a retrospective, comparative, interventional study. Medical records of 48 consecutive eyes with RRD of intraoperative undetected retinal breaks were reviewed. Nineteen patients (group I) received 360° laser retinopexy in PPV, while the remaining 29 patients (group II) underwent localized laser retinopexy. In group I, a triple row of confluent medium-white laser burns were placed posterior to the ora serrata. Anatomical and visual outcomes of the two groups were compared. The mean follow-up period was 13.46 ± 3.02 months. No significant difference was identified in baseline characteristics. A single-operation reattachment rate of 89.47% was achieved in group I, which was significantly higher than that of group II (55.17%, p = 0.01), and this trend was not weakened after adjustment for the confounding factor (odds ratio 0.15, p = 0.03). Moreover, greater improvement of postoperative best-corrected visual acuity was observed in group I. Significant complications sufficient to require further operation included proliferative vitreoretinopathy in 2 (4.17%) eyes and epiretinal membrane in 4 (8.33%) eyes. Three hundred sixty-degree laser retinopexy was associated with better anatomic and visual outcomes in RRD patients with unseen breaks intraoperatively, when compared with localized laser retinopexy in PPV.
http://ift.tt/2jM35F2
Photobiostimulation reverses allodynia and peripheral nerve damage in streptozotocin-induced type 1 diabetes
Abstract
For better evaluation of the efficacy of low-level laser therapy in treating painful diabetic neuropathy and in protecting nerve fiber damage, we conducted a study with type 1 diabetic rats induced by streptozotocin. It is well known that diabetic peripheral neuropathy is the leading cause of pain in those individuals who suffer from diabetes. Despite the efficacy of insulin in controlling glucose level in blood, there is no effective treatment to prevent or reverse neuropathic damage for total pain relief.Male Wistar rats were divided into saline, vehicle, and treatment groups. A single intraperitoneal (i.p.) injection of streptozotocin (STZ) (85 mg/kg) was administered for the induction of diabetes. The von Frey filaments were used to assess nociceptive thresholds (allodynia). Behavioral measurements were accessed 14, 28, 48, and 56 days after STZ administration. Rats were irradiated with GaAs Laser (Gallium Arsenide, Laserpulse, Ibramed Brazil) emitting a wavelength of 904 nm, an output power of 45 mWpk, beam spot size at target 0.13 cm2, a frequency of 9500 Hz, a pulse time 60 ns, and an energy density of 6,23 J/cm2.The application of four sessions of low-level laser therapy was sufficient to reverse allodynia and protect peripheral nerve damage in diabetic rats.The results of this study indicate that low-level laser therapy is feasible to treat painful diabetic condition in rats using this protocol. Although its efficacy in reversing painful stimuli and protecting nerve fibers from damage was demonstrated, this treatment protocol must be further evaluated in biochemical levels to confirm its biological effects.
http://ift.tt/2jOCtAS
Current Melanoma Epidemic Caused by Old Medical Beliefs
Medscape Medical News
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Is Atopic Dermatitis Really Mom's Fault?
A recent study suggests that maternal stress may be one factor in pediatric atopic dermatitis. Is this information helpful for providers? For mothers? Dr Gary Stadtmauer weighs in.
Medscape Allergy & Immunology
http://ift.tt/2ktKziT
Secular Trend of Metabolic Syndrome and Its Components in a Cohort of Iranian Adults from 2001 to 2013
Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.
http://ift.tt/2jOxVKO
MRI of diffuse large B-cell non-Hodgkin’s lymphoma of the head and neck: comparison of Waldeyer’s ring and sinonasal lymphoma
Abstract
To document the magnetic resonance imaging (MRI) features of diffuse large B-cell lymphoma (DLBCL) in Waldeyer's ring (WR) and the sinonasal (SN) region, and to identify any differences between lymphatic and extra-lymphatic DLBCLs, and predictors of disease beyond the neck. Primary, nodal, and multifocal sites on head and neck MRI were compared between 31 WR and 15 SN DLBCL, and between 27 patients with disease confined to the head and neck and 16 patients with disease beyond the neck, using logistic regression. Compared to SN, WR DLBCLs had significantly smaller primary tumour volumes (p = 0.009), less deep invasion (p = 0.001), and more nodal disease (p = 0.016). Tumour site (WR vs. SN) was an independent predictor of deep invasion (p = 0.007). Nodal and multifocal diseases were predictors of disease beyond the neck (p = 0.027 and 0.011, respectively). Lymphatic WR DLBCLs were less locally aggressive but had greater propensity to nodal spread than extra-lymphatic SN DLBCLs. Nodal and multifocal diseases predicted disease beyond the neck.
http://ift.tt/2jnnQIy
Clinical features and surgical treatment for Chinese juvenile onset current respiratory papillomatosis (JORRP)
Abstract
Juvenile onset current respiratory papillomatosis (JORRP), which is the commonest benign laryngeal disease in children, has not been well investigated. This study aimed at further evaluating the clinical features and surgery for such children with JORRP. Patients diagnosed as JORRP in our department from January 2011 to June 2014 were enrolled, and the demographic and clinical data were collected. All the patients were followed up after surgery, and the recurrences were recorded. A total of 124 patients were included and categorized into low recurrence (<4/year, n = 97) and high recurrence (≥4/year, n = 27) groups based on the recurrence at diagnosis, respectively. The demographic characteristics were comparable in two groups. There were more patients in high recurrence group who had dyspnea II–III, abnormal chest X-ray findings and severe illness, and needed electrocardiscope monitoring (P < 0.05). Patients who had dyspnea II (P = 0.008) and severe illness (P = 0.002) needed electrocardiscope monitoring (P = 0.014) in high recurrence group were more prone to have recurrence after surgery. Multivariate logistic regression analysis proved that high recurrence at diagnosis was an independent risk factor for recurrence after surgery in JORRP [95 %CI OR 17.342 (1.266, 237.608), P = 0.033]. The recurrence at diagnosis could be used as a prognostic factor for JORRP after surgery, which could help to improve the therapeutic efficacy in such children.
http://ift.tt/2k9NsWv
The comparison of edema and ecchymosis after piezoelectric and conventional osteotomy in rhinoplasty
Abstract
The basic aim of our study is to compare the results of the conventional and piezoelectric osteotomy in rhinoplasty by complete subperiosteal degloving of nasal bone to minimize soft-tissue injury. The study was designed as a prospective, double-blind, randomized, and controlled study. Setting is a tertiary referral hospital in Turkey. Ninety patients who underwent primary open rhinoplasty with osteotomy, performed by either the conventional instruments or the piezoelectric device. The complete subperiosteal degloving of the entire nasal bone was done up to the nasal maxillary sulcus, medial canthus, and nasion in all patients, independent of the type of osteotomy device used. Patients subsequently underwent median-oblique and lateral osteotomy, either with an ultrasonic device or a conventional 2-mm guarded, straight osteotome. The postoperative edema and ecchymosis were evaluated by another surgeon who was blinded to the osteotomy procedure on postoperative days 2 and 7. The edema scores were significantly increased on the second day compared with the seventh day in both groups 1 and 2. However, there was no significant difference between groups. The ecchymosis scores were slightly higher in postoperative day 2, compared with day 7, in both groups 1 and 2, but statistically not significant. This study showed that the main reason edema and ecchymosis are seen post-rhinoplasty is related to soft-tissue injury during osteotomy.
http://ift.tt/2k9DHYh
A comparison of low versus high radioiodine administered activity in patients with low-risk differentiated thyroid cancer
Abstract
Post-surgical therapeutic management of differentiated thyroid cancer (DTC) is still a controversial subject. Indeed, there is no consensus on the dose of 131I to be administered, although the current trend towards therapy easing through mini-cures for patients with good prognosis. To confirm the non-inferiority in terms of effectiveness of an ablative mini-cure from 1.11 to 1.85 GBq, over a cure of 3.7 GBq, in patients with DTC operated for low and very low risk. We retrospectively studied 157 patients with very low and low risk DTC, followed in the Nuclear Medicine Department of the Salah Azaiez Institute between 2002 and 2012. These patients had a complementary radioiodine therapy with either low dose (group A) or high dose (group B) with an evaluation at 6 months post treatment and in long-term. The study took place at a referral center. The average age was 42.8 ± 13.7 years with a female predominance (86.7 %). The DTC papillary represented the most common etiology (95 %) with a predominance of pure papillary (68 %) on the follicular variant (27 %). The first cure evaluation did not show statistically significant difference between the two approaches in terms of therapeutic ablative efficiency (p = 0.13). The overall success rate was 77 % (121/157), with 83 % (54/65) in group A and 72.8 % (67/92) in group B. The likelihood of having a remission from the first cure was 1.83 times greater for patients treated with low doses (OR = 1.83, 95 % CI 0.23–1.29). At the end of follow, we have noted one case of refractory disease. The male gender (adjusted OR = 2.71, 95 % CI 0.51–4.23, p = 0.03), and the baseline Tg ≥ 10 (ng/ml) (adjusted OR = 3.48, 95 % CI 1.25–9.67, p = 0.01) were significantly independent predictors of successful first cure ablation. The results provide that mini-dose protocol is not less effective for ablation of the thyroid remnant than 3.7 GBq activity.
http://ift.tt/2jnmX2y
Cervical lymph node metastases of squamous cell carcinoma of unknown origin: the diagnostic value of FDG PET/CT and clinical outcome
Abstract
FDG PET/CT is perceived as a valuable diagnostic tool in addition to the standard diagnostic workup for patients with isolated neck lymph nodes of squamous cell carcinoma of unknown primary (SCCUP). For patients with SCCUP intended for primary radiotherapy, we hypothesize that the previously reported FDG PET/CT detection rates are too high. From 2008 to 2015, 30 SCCUP patients were examined with FDG PET/CT. The objective of the FDG PET/CT examination was twofold: (1) improve the radiotherapy target definition, and (2) identify the primary cancer. Before the FDG PET/CT, the patients had been through a standard workup consisting of CT of the neck and chest, examination with flexible endoscopy with patient awake, panendoscopy and examination under general anesthesia, tonsillectomy and sometimes blind sampling biopsies, and MRI (floor of the mouth). All FDG PET/CTs were performed applying a flat table, head support and fixation mask as part of the radiotherapy treatment planning. Diagnostic CT with contrast was an integrated part of the PET/CT examination. Only 1/30 patients (cancer of the vallecula) had their primary cancer detected by FDG PET/CT. In addition, a non-biopsied patient with high uptake in the ipsilateral palatine tonsil was included, giving a detection rate of ≤7 % (95 % CI 2–21 %). In this retrospective study, we found that the FDG PET/CT detection rate of the primary for SCCUP patients is lower than previously reported. It is questionable whether FDG PET/CT is necessary for these patients when improved, advanced workup is available.
http://ift.tt/2k9Iadr
Delayed diagnosis of sinonasal lymphoma due to bilateral manifestation
Abstract
The objective of this study is to analyze the presenting symptoms, the time to correct diagnosis and outcome of a European patient cohort with sinonasal lymphoma focusing on unilateral vs. bilateral sinonasal involvement. In a retrospective setting in a European tertiary referral center, eleven patients (9 males, 2 females) with sinonasal lymphoma diagnosed between 2002 and 2015 were identified and divided into a unilateral and bilateral group according to their CT finding. Clinical findings on first presentation, the presence of B symptoms, the radiologic findings, overall survival and disease-specific survival were assessed. 55 % of the patients suffered from bilateral manifestation, which was associated with a delayed diagnosis (10 vs. 1.5 months, p < 0.05). B symptoms (67 vs. 0 %) and death of disease (50 vs. 0 %) were observed only in the bilateral group. Nasal NK/T-cell lymphoma was the most frequent diagnosis, followed by diffuse large B-cell lymphoma. Bilateral mucosal manifestation with B symptoms was shown to be common within the rare entity of sinonasal lymphomas and patients with bilateral sinonasal manifestation are at risk for a delayed diagnosis with worse outcome.
http://ift.tt/2jnvIcU
Vascular endothelial growth factor levels in patients with obstructive sleep apnea: a meta-analysis
Abstract
Published articles regarding the blood levels of vascular endothelial growth factor (VEGF) in obstructive sleep apnea (OSA) patients are contradictory. The objective of this study was to explore whether VEGF levels is high or not in OSA subjects via quantitatively statistical analysis. The electronic databases of Pubmed, Web of Science, EMBASE were systematic searched. The VEGF levels and clinical characteristics of participants between OSA group and control group were extracted for analysis. Weighted mean difference (WMD) or standard mean difference (SMD) with 95 % confidence interval (CI) was calculated by fixed effects or random effects model. Appropriate statistical software was employed for data synthesis. Totaling 15 articles with 697 participants were included in this study. Pooled meta-analysis showed that blood VEGF concentrations were significantly higher in OSA patients than in control subjects (SMD 1.89, 95 % CI 0.92–2.87, p = 0.000). Subgroup analysis demonstrated that when compared with control group, OSA patients with age ≥50 years (SMD 2.54, 95 % CI 1.28–3.80, p = 0.000), apnea hypopnea index ≥30 events/h (SMD 2.47, 95 % CI 1.20–3.73, p = 0.000) had higher VEGF levels. Compared with control subjects, OSA patients had an elevated VEGF in serum (SMD 3.55, 95 % CI 1.82–5.28, p = 0.000) rather than in plasma. High blood VEGF concentrations were observed in OSA patients, particularly in the older and more serious patients.
http://ift.tt/2k9MTMe
Effect of budesonide and azelastine on histamine signaling regulation in human nasal epithelial cells
Abstract
Both glucocorticoids and H1-antihistamines are widely used on patients with airway diseases. However, their direct effects on airway epithelial cells are not fully explored. Therefore, we use the primary culture of human nasal epithelial cells (HNEpC) to delineate in vitro mucosal responses to above two drugs. HNEpC cells were cultured with/without budesonide and azelastine. The growth rate at each group was recorded and measured as population double time (PDT). The histamine1-receptor (H1R), muscarinic1-receptor (M1R) and M3R were measured using immunocytochemistry and western blotting after 7-days treatment. Then, we used histamine and methacholine to stimulate the mucus secretion from HNEpC and observed the MUC5AC expression in culture supernatants. Concentration-dependent treatment-induced inhibition of HNEpC growth rate was observed. Cells incubated with azelastine proliferated significantly slower than that with budesonide and the combined use of those drugs led to significant PDT prolong. The immunocytochemistry showed the H1R, M1R and M3R were obviously located in the cell membrane without apparent difference after treatment. However, western blotting showed that budesonide can significantly up-regulate the H1R, M1R and M3R level while azelastine had opposite effects. Histamine and methacholine stimulated MUC5AC secretion was greater in cells treated with budesonide but was lesser in those treated with azelastine, as compared to controls. Our data suggest that both budesonide and azelastine can significantly inhibit HNEpC proliferation, and therefore, be helpful in against airway remodeling. Long-term use of budesonide might amplify histamine signaling and result in airway hyperreactivity to stimulants by enhancing H1R, M1R and M3R expression while azelastine can oppose this effect. Therefore, combined use of those two drugs in patients with chronic inflammatory airway diseases may be an ideal option.
http://ift.tt/2jnxomO
Palato-maxillary reconstruction by the angular branch-based tip of scapula free flap
Abstract
The angular branch (AB)-based tip of scapula free flap is a valuable reconstructive option in palato-maxillary defects needing significant structural support. We herein retrospectively evaluate our surgical series with special focus on functional outcomes and postoperative morbidity. Ninety-seven consecutive palatomaxillary oncologic resections were performed at our institution between August 2008 and November 2015. The analysis focused on those reconstructed by an AB-based tip of scapula free flap (N = 18; 19 %). A prospective assessment of donor site morbidity was performed by the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire in 12 (67 %) patients. Among patients reconstructed by an AB-based tip of scapula free flap, 13 (72 %) had a Class II and 5 (28 %) a Class III defect according to Okay classification. Flap success rate was 94 %, with one failure requiring an anterolateral thigh flap. Eight (44 %) patients experienced recipient site complications, while donor site problems occurred in two only (11 %). Eleven (61 %) subjects were able to maintain a normal and 7 (39 %) a soft-to-firm diet. The mean DASH score was 10.5. Our results confirm that the AB-based tip of scapula free flap is a reliable choice in palatomaxillary reconstruction, with both satisfactory functional outcomes and negligible donor site morbidity.
http://ift.tt/2jnAnMj
Additional non-sentinel lymph node metastases in early oral cancer patients with positive sentinel lymph nodes
Abstract
To determine risk factors for additional non-sentinel lymph node metastases in neck dissection specimens of patients with early stage oral cancer and a positive sentinel lymph node biopsy (SLNB). A retrospective analysis of 36 previously untreated SLNB positive patients in our institution and investigation of currently available literature of positive SLNB patients in early stage oral cancer was done. Degree of metastatic involvement [classified as isolated tumor cells (ITC), micro- and macrometastasis] of the sentinel lymph node (SLN), the status of other SLNs, and additional non-SLN metastases in neck dissection specimens were analyzed. Of 27 studies, comprising 511 patients with positive SLNs, the pooled prevalence of non-SLN metastasis in patients with positive SLNs was 31 %. Non-SLN metastases were detected (available from 9 studies) in 13, 20, and 40 % of patients with ITC, micro-, and macrometastasis in the SLN, respectively. The probability of non-SLN metastasis seems to be higher in the case of more than one positive SLN (29 vs. 24 %), the absence of negative SLNs (40 vs. 19 %), and a positive SLN ratio of more than 50 % (38 vs. 19 %). Additional non-SLN metastases were found in 31 % of neck dissections following positive SLNB. The presence of multiple positive SLNs, the absence of negative SLNs, and a positive SLN ratio of more than 50 % may be predictive factors for non-SLN metastases. Classification of SLNs into ITC, micro-, and macrometastasis in the future SLNB studies is important to answer the question if treatment of the neck is always needed after positive SLNB.
http://ift.tt/2jnvHWo
Using preoperative unsupervised cluster analysis of chronic rhinosinusitis to inform patient decision and endoscopic sinus surgery outcome
Abstract
The purpose of this study is to use unsupervised cluster methodology to identify phenotype and mucosal eosinophilia endotype subgroups of patients with medical refractory chronic rhinosinusitis (CRS), and evaluate the difference in quality of life (QOL) outcomes after endoscopic sinus surgery (ESS) between these clusters for better surgical case selection. A prospective cohort study included 131 patients with medical refractory CRS who elected ESS. The Sino-Nasal Outcome Test (SNOT-22) was used to evaluate QOL before and 12 months after surgery. Unsupervised two-step clustering method was performed. One hundred and thirteen subjects were retained in this study: 46 patients with CRS without nasal polyps and 67 patients with nasal polyps. Nasal polyps, gender, mucosal eosinophilia profile, and prior sinus surgery were the most discriminating factors in the generated clusters. Three clusters were identified. A significant clinical improvement was observed in all clusters 12 months after surgery with a reduction of SNOT-22 scores. There was a significant difference in QOL outcomes between clusters; cluster 1 had the worst QOL improvement after FESS in comparison with the other clusters 2 and 3. All patients in cluster 1 presented CRSwNP with the highest mucosal eosinophilia endotype. Clustering method is able to classify CRS phenotypes and endotypes with different associated surgical outcomes.
http://ift.tt/2k9GBw8
The use of narrow band imaging for the detection of benign lesions of the larynx
Abstract
In the cases of uncertainty, even if the patient has no complaints about his voice quality, sometimes, benign vocal fold mass lesions are removed to exclude malignancy with the risk of resultant dysphonia. Narrow Band Imaging (NBI) enables a specific visualization of vessel structures in the superficial tissue. Benign lesions of the larynx are frequently characterized by abnormal vessel configuration or an absence of vessels in the area of the lesion. It was hypothesized that, in the primary diagnosis of patients with these benign lesions, the combination of white light and NBI endoscopy enables a better detection compared with white light endoscopy alone. Twenty-nine patients (eight patients with a cyst on a vocal fold, eight with a polyp, seven with a Reinke´s edema, two with a leukoplakia, one with a carcinoma, one with a granuloma, and two without any pathologic finding) were examined with normal white light and NBI endoscopy. 87 video sequences (29 white, 29 NBI, and 29 white/NBI) were generated and randomized and presented to 20 otolaryngologists who rated the videos in terms of the suspected diagnosis. Results were compared with the histopathologic findings of microlaryngoscopy. The probability of detecting benign lesions of the vocal folds was higher using NBI in combination with white light endoscopy compared with white light endoscopy alone. For vocal fold cysts, this difference was statistically significant. NBI endoscopy in combination with normal white light endoscopy improves the detection rate of benign lesions of the larynx, especially of vocal fold cysts.
http://ift.tt/2jnpPww
Otologic and audiologic findings in 22q11.2 deletion syndrome
Abstract
Hearing loss is frequently present in the 22q11.2 deletion syndrome. Our aim was to describe the audiologic and otologic features of patients with 22q11.2 deletion syndrome. We conducted a retrospective cohort study in a single tertiary referral center. We reviewed medical files of all patients with 22q11.2 deletion syndrome who visited an otolaryngologist, plastic surgeon or speech therapist, for audiologic or otologic features. Hearing loss was defined as a pure tone average (of 0.5, 1, 2, and 4 kHz) of >20 decibel hearing level. Audiograms were available for 102 of 199 included patients, out of which 163 ears were measured in the required frquencies (0.5–4 kHz). Median age at time of most recent audiogram was 7 years (range 3–29 years). In 62 out of 163 ears (38%), hearing loss was present. Most ears had conductive hearing loss (n = 58) and 4 ears had mixed hearing loss. The severity of hearing loss was most frequently mild (pure tone average of ≤40 decibel hearing level). In 22.5% of ears, otitis media with effusion was observed at time of most recent audiogram. Age was not related to mean air conduction hearing thresholds or to otitis media with effusion (p = 0.43 and p = 0.11, respectively). In conclusion, hearing loss and otitis media are frequently present in patients with 22q11.2 deletion syndrome. Moreover, our results suggest that children with 22q11.2 deletion syndrome remain susceptible for otitis media as they age.
http://ift.tt/2k9Klhe
Anatomical approach to surgery for intrathoracic goiter
Abstract
The anatomical approach to the intrathoracic goiter (ITG) was used to understand its etiology and to rationalize surgical technique of thyroidectomy. For a retrospective chart review, we selected cases of multinodular goiter with totally ITGs (n = 69; M 29, F 40), while 916 cases with cervical goiter were used for comparison. The topography of the thyroid gland was assessed against the tracheal rings and against the vertebrae. The regional anatomy of the thoracic inlet was assessed by its bony margins and the relations of structures traversing the area. Average tracheal-diameter-to-thoracic-inlet ratio was calculated. The ITG group consisted of 52 cases of retrosternal goiter (75.4 %), nine cases of retrotracheal goiter (13 %), and eight cases of retroesophageal goiter (11.6 %). In all but one analyzed cases, the goiters were removed via cervical incision. Mean weight of goiters was 183 g. The area of thoracic inlet in the cases of ITG had no difference in comparison with the cases of cervical goiter (F/M p = 0.11/0.15), but the tracheal-diameter-to-thoracic-inlet ratio was significantly smaller (F/M p = 0.06/0.04). In the ITG cases, the position of the upper edge of the isthmus of the thyroid was about 1.5 tracheal rings lower than in healthy individuals (p = 0.03). The area of the thoracic inlet, the neck size, and the anteroposterior diameter of the inlet do not affect the development of the ITG. The smaller tracheal-diameter-to-thoracic-inlet ratio and the lower position of the thyroid gland are the main indicators for the development of the ITG.
http://ift.tt/2jnyq2m
Cortical and subcortical processing of short duration speech stimuli in trained rock musicians: a pilot study
Abstract
Most trained musicians are actively involved in rigorous practice from several years to achieve a high level of proficiency. Therefore, musicians are best group to research changes or modification in brain structures and functions across several information processing systems. This study aimed to investigate cortical and subcortical processing of short duration speech stimuli in trained rock musicians and non-musicians. Two groups of participant (experimental and control groups) in the age range of 18–25 years were selected for the study. Experimental group includes 15 rock musicians who had minimum professional training of 5 years of rock music, and each member had to be a regular performer of rock music for at least 15 h a week. Further age-matched 15 participants who were not having any formal training of any music served as non-musicians, in the control group. The speech-evoked ABR (S-ABR) and speech-evoked ALLR (S-LLR) with short duration speech 'synthetic /da/' was elicited in both groups. Different measures were analyzed for S-ABR and S-LLR. For S-ABR, MANOVA revealed significant main effect of groups on latencies of wave V, wave A, and amplitude of wave V/A slope. Similarly, Kruskal–Wallis test showed significantly higher F 0 amplitude in rock musicians compared with non-musicians. For S-LLR, MANOVA showed statistically significant differences observed for latencies of wave P2 and N2 and amplitude measures of P2–N2 amplitude. This study indicated better neural processing of short duration speech stimuli at subcortical as well as cortical level among rock musicians when compared with non-musicians.
http://ift.tt/2k9GwIQ
Functional outcome after one-stage flap reconstruction of the hypopharynx following tumor ablation
Abstract
The main objective of this study was to evaluate functional outcome in terms of food passage of the three different reconstruction techniques that are currently most often used for hypopharyngeal reconstruction in our institution. A retrospective observational database research was conducted of all patients that underwent hypopharyngeal reconstruction for carcinoma of the hypopharynx or larynx from 1992 until 2014 in the University Medical Center Groningen. The following techniques were most commonly used and therefore analyzed: the pedicled pectoralis major flap, the radial forearm free flap and the anterolateral thigh free flap. Our primary outcome food passage was measured after 1 year and classified in gastric tube fed, fluids, semisolid or solid. Complications were registered according to the Clavien Dindo classification in five different grades. Comorbidity was scored using the Adult Comorbidity Evaluation Index. 58 patients were included. 51 patients survived one year follow up, 25 % returned to a solid diet, 40 % returned to a semi-solid diet and 20 % remained feeding tube dependent. Overall flap success rate was 88 and 35 % developed a pharyngocutaneous fistula. Multivariable ordinal regression showed that reconstruction with free flaps, a near-circumferential surgical defect, a higher body mass index and no comorbidity showed significantly better functional outcomes in the food passage. For recipient site complications, both free flaps and a shorter surgery time resulted in less severe complications. This study shows that the use of free flaps is superior to the use of the pectoralis major flap, and that it should therefore be reserved as a second choice.
http://ift.tt/2jnq1M5
Bone anchored hearing implants without skin thinning: the Gruppo Otologico surgical and audiological experience
Abstract
To investigate the surgical and audiological outcomes of an installation of a bone-anchored hearing system (BAHS) procedure without tissue reduction using Ponto implants and abutments. Retrospective consecutive case series. Forty-nine patients, 18 years or older and eligible for treatment with a bone-anchored hearing system with tissue preservation surgery, were included in the study. Following a systematic scheme for medical outcomes, we collected the data regarding surgical intervention, quality of life (GBI), skin and soft tissue reactions (Holgers grading system), pain and numbness (VAS). Hearing performance (aided thresholds and speech recognition in noise) was recorded in 20 patients. No implants were lost, skin, and soft tissue reactions were mild in 96 % of the all visits. Quality of life (GBI) generally improved in the aided condition compared to prior to implantation. Audiologically, 100 % of the 20 patients examined showed improvement of speech reception and sound field thresholds comparing aided to unaided. An average improvement of 33 dB on PTA was recorded. The study, presenting data on a large population, treated with tissue preservation and modern titanium implants, shows that this treatment is a viable solution that results in fewer complications, high degree of predictability and good audiological results.
http://ift.tt/2k9NqxR
Efficacy of Oral Moisturizing Jelly on Oral Health and Nutrition in Post-radiotherapy Head and Neck Cancer Patients
Interventions: Dietary Supplement: Oral moisturizing jelly; Other: Artificial saliva
Sponsors: Dental Innovation Foundation Under Royal Patronage; Mahidol University; Srinakharinwirot University; Ministry of Health, Thailand
Not yet recruiting - verified January 2017
http://ift.tt/2kjrBOx
The Safety and Efficacy Test of Nutri-PEITC Jelly in Head and Neck Cancer Patients
Interventions: Dietary Supplement: Nutri-jelly with PEITC; Dietary Supplement: Nutri-jelly
Sponsors: Dental Innovation Foundation Under Royal Patronage; Mahidol University; Srinakharinwirot University; Ministry of Health, Thailand
Recruiting - verified January 2017
http://ift.tt/2kGeiFq
Physiotherapy After Anterior Cervical Spine Surgery
Interventions: Other: Prescribed Physical Activity; Other: Exercises with Internet support
Sponsor: Linkoeping University
Not yet recruiting - verified January 2017
http://ift.tt/2kjtZVC
Bilateral thigh methicillin-resistant Staphylococcus aureus necrotising fasciitis in a man with newly diagnosed Human Immunodeficiency Virus (HIV)
Methicillin-resistant Staphylococcus aureus (MRSA) necrotising fasciitis (NF) is rare and constitutes a medical and surgical emergency. We report a case of a 53-year-old man with type-2 diabetes mellitus and newly diagnosed HIV infection who presented with 1 week of progressively worsening bilateral sharp thigh pain. On presentation, he was febrile, tachycardic and had bilateral thigh erythema and mild tenderness without open wounds. He had leucocytosis, lactic acidosis and acute kidney injury. Urgent incision and drainage (I&D) was performed for suspected NF. Blood cultures and I&D were positive for MRSA. Biopsy of bilateral thighs showed NF. He was treated with wound washout and 6 weeks of intravenous antibiotics. After undergoing skin graft for wounds, he was discharged to physical rehabilitation. Here we report severe sepsis from bilateral thigh MRSA NF in a patient with newly diagnosed HIV.
http://ift.tt/2jNCLYU
Mycobacterium chelonae hand infection after steroid injection in a patient with rheumatoid arthritis receiving long-term linezolid therapy
A 66-year-old multimorbid man with rheumatoid arthritis developed an infection after a steroid injection in the hand. Mycobacterium chelonae was cultured 1-month after presentation. In the mean time, his third finger had been amputated. Further treatment was based on preliminary susceptibility testing and the American Thoracic Society guidelines. No regression of the infection was observed before the addition of linezolid (600 mgx1/day) to a combination antimicrobial therapy also consisting of clarithromycin (500 mgx2/day) and moxifloxacin (400 mgx1/day), even though two methods of susceptibility testing, the E-test and broth microdilution, had shown susceptibility to other antimicrobial drugs. The healing was complete 12 months after presentation. There were no serious side effects observed with the use of linezolid in reduced dosage of 600 mgx1/day for a duration of 9 months.
http://ift.tt/2jKYnr2
Lhermitte-Duclos disease associated to Cowden syndrome: de novo diagnosis and management of these extremely rare syndromes in a patient
A 36-year-old woman, with history of cutaneous papilomatosis and thyroid carcinoma presented with headache, transitory visual blurring and nausea. Funduscopy showed papilloedema. MRI showed a tumour of the right cerebellar hemisphere with a striated, tigroid pattern, typical of Lhermitte-Duclos disease (LDD). Significant clinical and perimetric improvements were noted after surgery and the follow-up did not reveal recurrences of the tumour. LDD is an extremely rare differential diagnosis of posterior fossa tumours. LDD and the history of thyroid carcinoma permitted us to diagnose Cowden syndrome (CS). We present a clinical case that supports the possibility of performing a preoperative diagnosis of LDD based on MRI features. We review the diagnosis and management of LDD and CS. This report highlights the importance of excluding CS after LDD diagnosis, of monitoring the optic nerve postoperatively using optical coherence tomography and of prompt treatment that can potentially prevent visual function loss.
http://ift.tt/2jNMuhx
Cerebral venous thrombosis as the first presentation of classical homocystinuria in an adult patient
A 30-year-old woman presented with severe headache, dysarthria and right hemiparesis. She was treated for suspected viral encephalopathy and recovered over the following weeks although the headaches persisted. Two months later she was treated in-hospital for pulmonary embolism. The following year she was readmitted for increased frequency of headaches and was given a diagnosis of migraine. A subsequent MRI head scan was suggestive of longstanding venous sinus infarcts and neuroradiology review concluded that encephalitis had been the incorrect initial diagnosis. Subsequent investigations for an underlying cause of the two episodes of venous thrombosis revealed a total homocysteine level of >350 μmol/L (<15 μmol/L). An underlying diagnosis of homocystinuria secondary to cystathionine β-synthase deficiency was made although this metabolic condition is normally recognised in childhood. Treatment with pyridoxine and betaine normalised her homocysteine levels and she has had no further thrombotic event since.
http://ift.tt/2jKXbUM
Idiosyncratic drug reactions and membranous glomerulopathy
An infant boy with steroid-resistant nephrotic syndrome (idiopathic membranous glomerulonephropathy) achieved remission with ciclosporin but developed eosinophilia and high IgE levels (max 19 000 iU/mL). Conversion to tacrolimus resulted in chronic diarrhoea (eosinophilic gastroenteritis), muscle weakness, polyserositis and failure-to-thrive. In contrast, a trial without tacrolimus resulted in a ciclosporin-responsive relapse, therapy-resistant focal seizures with generalised spikes, worsening muscle weakness and diarrhoea. The patient was weaned off of ciclosporin and completely normalised. In vitro testing demonstrated decreased viability of the patient's cells when incubated with calcineurin inhibitors (ciclosporin, 70%; tacrolimus, 80% compared to control cells), supporting their role in this adverse drug reaction.
http://ift.tt/2jNMKxj
Rare presentation of Brodie's abscess in the acromion process and the value of the penumbra sign
A 17-year-old male patient presented with a swelling on his right shoulder 1 week after a fall. MRI revealed a superficial fluid collection of the acromion and trapezius muscle, with slight enhancement of the wall. The swelling burst open spontaneously after failed conservative therapy and was treated with surgical drainage and antibiotics. Tissue cultures showed a Staphylococcus aureus. 1 year later, he presented with local red discolouration and a recurrent painful swelling that fluctuated at palpation. Radiographs showed a lytic lesion of the acromion process. MRI showed a sinus in the lytic cavity and a penumbra sign, which helped to identify this extremely rare occurrence of Brodie's abscess in the acromion process that was breaking through to the subcutaneous fat. The abscess was treated successfully with surgical drainage and intravenous antibiotics. In retrospect, the first MRI showed a small cortical indentation, with slight oedema of the acromion process.
http://ift.tt/2jKUK4E
Subcorneal pustular dermatosis and episcleritis associated with poorly controlled ulcerative colitis
A man aged 56 years with a history of ulcerative colitis (UC) status postsubtotal colectomy was hospitalised with fevers, dry cough, eye redness and a new bloody, mucoid rectal discharge. 2 months prior to admission, the dermatologist had started him on dapsone for subcorneal pustular dermatosis but did not recognise that he had recently self-discontinued mesalamine enemas, inducing a flare of his UC. After a thorough inpatient evaluation, including flexible sigmoidoscopy, active UC involving the rectal stump was determined to be driving his dermatological and ophthalmological findings. By reinstituting mesalamine enemas, control of his UC was achieved and the extraintestinal manifestations of his inflammatory bowel disease (IBD) resolved. This case illustrates the importance of careful history taking and of early recognition of extraintestinal manifestations of IBD in order to appropriately target treatment and prevent unnecessary morbidity.
http://ift.tt/2jNNd2B
Complications of dysgerminoma: meeting the health needs of patients in conflict zones
A symptom of prolonged conflict is the destruction of infrastructure and healthcare systems. While the need for acute trauma services is obvious in conflict zones, patients with chronic diseases also require care. This report describes the clinical course of a young teenage girl with a large mid pelvic tumour originating from the left ovary and reaching the umbilicus. She presented with acute abdominal pain and underwent surgery in a healthcare facility within a conflict zone. She was then transferred to a neighbouring country for continuing care. The tumour is malignant. After further surgery, she required chemotherapy and will need ongoing surveillance. She has since returned to her home country. It is doubtful that she will be able to access all the care she needs. We describe her healthcare needs and discuss the disastrous effects of conflict on meeting the health needs of civilian populations in war zones.
http://ift.tt/2jKX2AA
Wunderlich's syndrome as a manifestation of polyarteritis nodosa
Wunderlich syndrome is a rare clinical entity characterised by spontaneous renal haemorrhage that can be life-threatening and requires emergency attention. The most frequent aetiologies are renal tumours and vascular diseases. The authors report a case of a patient admitted with hypovolaemic shock due to a retroperitoneal haematoma in the context of polyarteritis nodosa (PAN). Prognosis of untreated PAN is very poor with 13% 5-year survival rate. Therefore, early recognition of disease and proper treatment with immunosuppressors will prevent catastrophic complications and improves survival.
http://ift.tt/2jNMJtf
Paralysis that easily reverses: a case of thyrotoxic periodic paralysis
Thyrotoxic periodic paralysis is a potentially life-threatening condition associated with recurrent episodes of muscle weakness and hypokalaemia due to hyperthyroidism. Diagnosis is often delayed or misdiagnosed due to its rarity in the western world and subtle features of hyperthyroidism on initial presentation. Here we present the case of a 25-year-old man who presented to the emergency department (ED) with sudden onset weakness of bilateral upper and lower extremities. His labs revealed hypokalaemia with elevated T4 and suppressed thyroid-stimulating hormone and he was diagnosed with thyrotoxic periodic paralysis. He was treated with potassium repletion, atenolol and methimazole with complete reversal of his paralysis within the next day. Unfortunately, he failed to keep the follow-up appointment after discharge, ran out of his methimazole and landed up in the ED again.
http://ift.tt/2jKWnz0
Blood, brain and binocular vision
A man aged 51 years presented with sudden onset, horizontal, binocular, double vision and right facial weakness. Ocular motility examination demonstrated a right horizontal gaze palsy pattern in keeping with a one-and-a-half syndrome. Since this was associated with a concomitant, ipsilateral, lower motor neuron (LMN) facial (VIIth) cranial nerve palsy, he had acquired an eight-and-a-half syndrome. Diffusion-weighted MRI confirmed a small infarcted area in the pons of the brainstem which correlated with anatomical location of the horizontal gaze centre and VIIth cranial nerve fasciculus. As a result of this presentation, further investigations uncovered a hitherto undiagnosed blood dyscrasia—namely polycythaemia vera. Regular venesection was started which resulted in complete resolution of his ocular motility dysfunction and an improvement of his LMN facial nerve palsy.
http://ift.tt/2jNU3EV
Volumetric evaluation of pharyngeal segments in obstructive sleep apnea patients
Publication date: Available online 30 January 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Marcos Marques Rodrigues, Valfrido Antonio Pereira Filho, Mário Francisco Real Gabrielli, Talles Fernando Medeiros de Oliveira, Júlio Américo Pereira Batatinha, Luis Augusto Passeri
IntroductionObstructive sleep apnea occurs by recurrent collapse of the upper airway during sleep, resulting in total (apnea) or partial (hypopnea) reduction of the airflow and has intimate relation with changes in the upper airway. Cone Beam CT allows the analysis of the upper airway and its volume by three-dimensional reconstruction.ObjectiveTo evaluate a possible correlation between the volume of the upper airway and the severity of the obstructive sleep apnea.MethodsA retrospective study was performed reviewing polysomnographic data and Cone Beam CT records of 29 patients (13 males and 16 females). The correlation between the volume of the nasopharynx, the oropharynx and the total superior pharynx with the AHI was assessed by Pearson's rank correlation coefficient.ResultsThe obstructive sleep apnea severity division was: ten patients had severe, 7 had moderate, 6 had mild and 6 of them were healthy. The correlation between the nasopharynx, the oropharynx and the total superior pharynx volumes and the Apnea-Hypopnea-Index was respectively: −0.415 (p=0.025), 0.186 (p=0.334) and −0329 (p=0.089). The Spearman's rank controlled by the Body Mass Index, the age and the gender was: −0.206 (p=0.304), −0.155 (p=0.439) and 0.242 (p=0.284).ConclusionThere is no correlation between the volume of the airway and the obstructive sleep apnea, assessed by Apnea-Hypopnea-Index and controlled by the Body Mass Index, the age and the gender. The volume of the upper airways as an isolated parameter did not correlate to the severity of the obstructive sleep apnea syndrome, and should be evaluated together with other factors.
http://ift.tt/2kjAOqq
Medication-associated gastrointestinal tract injury
Abstract
Medication-associated gastrointestinal (GI) tract injury has been known for centuries for some medications. The more recently introduced biologicals are a class of drugs that constantly increases, and as such, the spectrum of GI tract side effects is steadily growing. This review covers not only long-known GI tract side effects of drugs but also those more recently described. A comprehensive but concise list of medications used in daily practice and associated with GI tract injury is presented.
http://ift.tt/2jKMPUF
Neonatal Liver Failure and Congenital Cirrhosis due to Gestational Alloimmune Liver Disease: A Case Report and Literature Review
Neonatal liver failure (NLF) is a major cause of neonatal morbidity and mortality, presenting as acute liver failure and/or congenital cirrhosis. Many affected patients show antenatal signs of fetal injury. There are several causes of NLF and early diagnosis is mandatory to elucidate the etiology and determine a specific treatment or the best management strategy. Gestational alloimmune liver disease associated with neonatal hemochromatosis (GALD-NH) is a rare but potentially treatable cause of NLF. It should be considered in any neonate with fetal signs of disease and postnatal signs of liver failure with no other identifiable causes. GALD-NH is often diagnosed late and patients are therefore referred late to specialized centers, delaying treatment. This case highlights the consequences of late diagnosis and treatment of GALD-NH and emphasizes the importance of a high grade of suspicion of this disease in order to refer the patient to a specialized center soon enough to perform the appropriate treatment.
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DNA ploidy and cell cycle protein expression in oral squamous cell carcinomas with and without lymph node metastases
Abstract
Background
Oral squamous cell carcinoma (OSCC) is the most frequently occurring malignant tumour in the oral cavity. OSCC arises because of multiple genetic alterations. Cell cycle aberrations and aneuploidy are reportedly among the main characteristics of cancer cells and are associated with aggressive growth and poor prognosis.
Methods
The study sample included 47 non-metastasised (NM) and 39 metastasised (M) primary OSCC, with matched positive cervical lymph nodes (LN) and 17 normal oral mucosa (NOM) samples. Tissue microarrays (TMAs) were prepared with a minimum of three cores from each case. TMA sections were cut and immunostained with MCM2, Ki-67, geminin and cyclin D1 antibodies. DNA image analysis was performed on the whole tissue section before TMAs were created.
Results
The results revealed that there were no differences in cell cycle protein expression in different areas of the tumours or between the metastatic and non-metastatic carcinomas. None of the cell cycle proteins showed significant differences between the lymph node metastasis and the primary OSCC, except for Ki-67. Geminin/Ki-67 ratio showed significant difference between metastatic and non-metastatic tumours. Aneuploidy was detected in all (100%) cases of OSCC. Similarly, all lymph node samples (39 cases) were aneuploid.
Conclusion
The results suggest that although there was dysregulation of cell cycle regulatory proteins, only Ki-67 and the MCM2/Ki-67 and geminin/Ki-67 ratios may have prognostic significance in oral cancer. DNA ploidy alone was not specific and may not be a good tool to evaluate prognosis or metastatic progression in oral cavity carcinomas.
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Fahreignung onkologischer Patienten
Zusammenfassung
Die Fahreignung im Straßenverkehr kann durch onkologische Erkrankungen und deren Therapien beeinträchtigt sein. Ihre medizinische Beurteilung und die daraus abzuleitende Aufklärung des Patienten sind für jeden behandelnden Arzt verpflichtend (Sicherheitsaufklärung). So unterschiedlich und komplex sich onkologische Erkrankungen und deren Therapien darstellen, so vielschichtig gestaltet sich auch die Beurteilung der fahreignungsrelevanten Faktoren. Das Spektrum reicht von tumorbedingten Einschränkungen aufgrund zerebraler Metastasen über chemotherapieassoziierte Nebenwirkungen, wie Polyneuropathie, Sehstörungen oder sog. Chemobrain, und strahlentherapiebedingte Folgen bis hin zu Einschränkungen durch eine medikamentöse Schmerztherapie. Im vorliegenden Beitrag werden die wesentlichen Aspekte der Fahreignungsbeurteilung bei onkologischen Patienten erläutert und praktische Tipps mit Hinweisen auf Checklisten und Vorlagen gegeben.
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Haplotype-based gene–gene interaction of bone morphogenetic protein 4 and interferon regulatory factor 6 in the etiology of non-syndromic cleft lip with or without cleft palate in a Chilean population
Non-syndromic cleft lip with or without cleft palate (NSCL/P) is the most common craniofacial birth defect in humans, the etiology of which can be dependent on the interactions of multiple genes. We previously reported haplotype associations for polymorphic variants of interferon regulatory factor 6 (IRF6), msh homeobox 1 (MSX1), bone morphogenetic protein 4 (BMP4), and transforming growth factor beta 3 (TGFB3) in Chile. Here, we analyzed the haplotype-based gene–gene interaction for markers of these genes and NSCL/P risk in the Chilean population. We genotyped 15 single nucleoptide polymorphisms (SNPs) in 152 Chilean patients and 164 controls. Linkage disequilibrium (LD) blocks were determined using the Haploview software, and phase reconstruction was performed by the Phase program. Haplotype-based interactions were evaluated using the multifactor dimensionality reduction (MDR) method. We detected two LD blocks composed of two SNPs from BMP4 (Block 1) and three SNPs from IRF6 (Block 2). Although MDR showed no statistical significance for the global interaction model involving these blocks, we found four combinations conferring a statistically significantly increased NSCL/P risk (Block 1–Block 2): T-T/T-G C-G-T/G-A-T; T-T/T-G C-G-C/C-G-C; T-T/T-G G-A-T/G-A-T; and T-T/C-G G-A-T/G-A-T. These findings may reflect the presence of a genomic region containing potential causal variants interacting in the etiology of NSCL/P and may contribute to disentangling the complex etiology of this birth defect.
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Efficacy and safety of topical calcipotriol in management of alopecia areata: A pilot study
Abstract
Reports have highlighted serum vitamin D deficiency and reduced 1,25-dihydroxyvitamin D(3) receptors(VDR) expression on hair follicles of alopecia areata(AA) patients. Very few studies have demonstrated efficacy of topical calcipotriol (vitamin D analogue) in AA. We intended to study the efficacy of calcipotriol lotion 0.005% in AA and correlate its outcome with serum vitamin D levels. We conducted a prospective study, in which 22 patients with AA were treated with calcipotriol lotion 0.005% twice daily for 3 months. Clinico-epidemiological parameters including severity of AA and SALT score were calculated at baseline and at 12 weeks. Hair regrowth was assessed monthly at 4, 8, 12 weeks. Serum vitamin D levels were measured at baseline. After 12 weeks of treatment, hair regrowth was observed in 13 (59.1%) patients. Mean period for onset of disease stabilization and hair regrowth was 4 weeks and 4.21± 2.13 weeks, respectively. Among these 13 patients, SALT50 and SALT100 was observed in 6(46.2%) and 2(9%) patients, respectively. Response to treatment was better in patients with lower vitamin D levels (p < .009). Topical calcipotriol can be an alternative treatment in AA and it could prove to be more useful in patients who are vitamin D deficient.
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Tranexamic acid in treatment of melasma: A comprehensive review of clinical studies
Abstract
Melasma is a human melanogenesis dysfunction that results in localized, chronic acquired hyperpigmentation of the skin. It has a significant impact on appearance, causing psychosocial and emotional distress, and reducing the quality of life of the affected patients. Tranexamic acid (TA) is a plasmin inhibitor used to prevent abnormal fibrinolysis to reduce blood loss and exerts its effect by reversibly blocking lysine binding sites on plasminogen molecules, thus inhibiting plasminogen activator (PA) from converting plasminogen to plasmin. As plasminogen also exists in human epidermal basal cells and cultured human keratinocyte are known to produce PA, there is basic rationale that TA will affect keratinocyte function and interaction. A thorough literature review indicates that while TA is used through various route of administration including oral, topical, and intradermal injection and as adjutant therapy with laser to treat melasma, its efficacy is not established adequately. Further studies are needed to clarify the role of TA in treatment of melasma.
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Use of topical sirolimus in the management of multiple familial trichoepitheliomas
Abstract
The management of trichoepitheliomas is challenging, especially in children. This challenge is exemplified in patients with multiple trichoepitheliomas who present with progression of lesion count and size despite treatment with current strategies, including CO2 laser and surgery. We present the novel use of topical 1% sirolimus cream in two siblings with multiple facial trichoepitheliomas; one was treated with a combination of CO2 laser ablation and topical sirolimus, and the other was treated with topical sirolimus alone. Both siblings had a reduction in the growth of new lesions with no reported side effects. This is the first report demonstrating that topical sirolimus, either in combination with CO2 laser or alone, can be a promising treatment for trichoepitheliomas.
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