Study of efficacy of esthetic High-Intensity Focused Ultrasound system on Iranian skin for reducing the laxity and wrinkles of aging

Summary

Background

Ultrasound is a mechanical wave that transmitted in a straight line and it can be focused at frequencies of 1-7 MHz with a high degree of precision. An important aspect of HIFU is that damaging focal point is located several millimeters below the surface of the skin and tissue above and below the focal point remains unaffected. Due to absorption of this energy, temperature of tissue rises to more than 60°C and this stimulates the cells for collagen production and tissue rejuvenation.

Objective

To evaluate the clinical efficacy and safety of High-Intensity Focused Ultrasound on Skin Laxity and wrinkles.

Material and Method

The study involved 22 women aged 35-62 with skin type II-IV. HIFU device with three transducers was employed. Various focal depths with different energies were used in accordance with skin thickness. Improvement for seven regions of face and whole face were evaluated by two dermatologists and patients 3 months after treatment.

Results

All of the patients completed the study. Three months after treatment, there was a highly statistical improvement in skin laxity for all of the patients. Also, the average percentage of improvement by doctor's opinion and patients was 58% and 60%, respectively.

Conclusion

The experimental data obtained from dermatologists and patients showed that HIFU appears to be a safe and effective modality for skin laxity treatment.

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The efficacy study of the combination of tripeptide-10-citrulline and acetyl hexapeptide-3. A prospective, randomized controlled study

Summary

Background

Bioactive peptides have beneficial effects on the skin.

Objective

We investigated to evaluate the effect of acetyl hexapeptide-3 and tripeptide-10 citrulline and the possible synergism between these two peptides.

Methods

Twenty-four healthy volunteers were randomized to receive combination of acetyl hexapeptide-3 with tripeptide-10 citrulline (Group G1), tripeptide-10 citrulline (Group, G2), acetyl hexapeptide-3 (Group G3), or neither peptide (Group G4) for 60 days. Skin properties evaluated included skin microtopography, parameters cR2 and cR3, and transepidermal water loss (TEWL) using a skin visioscan and a tewameter, respectively.

Results

After 20 days, the measurements between G1 and G2 groups (cR2 P=.045, cR3 P=.044), G2 and G3 groups (cR2 P=.017, cR3 P=.017), G3 and G4 groups (CR2 P=.022), and G2 and G4 groups (cR3 P=.028) from baseline were significant. After 60 days, measurements between groups G1 and G3 (cR2 P=.016, cR3 P=.025), groups G2 and G3 (cR2 P=.044, cR3= P=.044), and groups G1 and G4 (cR2 P=.025) were significant. After 20 days, changes in TEWL between groups G1 and G3 (P=.03), groups G2 and G3 (P=.045), and groups G3 and G4 (P=.025) were significant. After 40 days, changes between groups G2 and G3 (P=.028) and groups G3 and G4 (P=.01) from baseline were significant.

Conclusion

Our results confirm the antiwrinkle activity of acetyl hexapeptide-3. A significant decrease in TEWL with acetyl hexapeptide-3 treatment is observed. We provided clinical evidence for the antiwrinkle efficacy of tripeptide-10 citrulline and possibly TEWL. The underlying mechanism by which these two peptides can act synergistically was not clear in this study.

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Chemotherapy-induced alopecia management: Clinical experience and practical advice

Summary

Background

Chemotherapy-induced alopecia (CIA) is probably one of the most shocking aspects for oncological patients and underestimated by physicians. Among hair loss risk factors, there are treatment-related aspects such as drug dose, administration regimen, and exposure to X-rays, but also patient-related characteristics. To the best of our knowledge, no guidelines are available about CIA management.

Aims and methods

With this study, based on literature background and our clinical experience, we would like to propose a list of actions in order to estimate the risk of hair loss before starting chemotherapy and to manage this condition before, during, and after drug administration and to create a sort of practical guide for dermatologists and oncologists.

Results and conclusion

There is an urgent need for prospective studies to clarify the mechanistic basis of alopecia associated with these drugs and consequently to design evidence-based management strategies.

http://ift.tt/2kYT0Cs

Duplication Anomalies of the Internal Auditory Canal: Varied Spectrum

Abstract

Duplication anomalies of the internal auditory canal are rare, with only twenty-one cases reported in literature. These range from incomplete partition and complete partition to true duplication. We present three cases showing this entire spectrum of duplication abnormalities and discuss the role of imaging in the preoperative work up of such patients planned for cochlear implant.

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Coercive Control, Physical Violence, and Masculinity

Violence and Gender , Vol. 0, No. 0.


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An evaluation of craniofacial growth pattern in North Indian children

Publication date: Available online 1 February 2017
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Vivek Mehta, R.K. Pandey
ObjectiveThe aim of this study was to assess craniofacial growth pattern in children with generalized decreased skeletal age and compare it with the children having normal skeletal age.Materials and methodsLateral cephalograms and hand wrist radiographs of 40 patients (age group 3–14 years) were taken and skeletal age assessment was done with hand wrist radiographs according to Greulich and Pyle, based on which two groups were made, Group A – Control group (normal skeletal age) and Group B – study group (decreased skeletal age). Group A had a sample size of 21 and Group B, a sample size of 19. These were further divided into subgroups according to age: subgroup (a) – 3 to 6 years, subgroup (b) – 7 to 11 years and subgroup (c) – 12 to 14 years. The skeletal and dental patterns were analyzed with Down's Cephalometric analysis. Student "t" test was used to verify comparisons in all the subgroups of patients of Group A and Group B.ResultsThe facial angle and Cant of occlusal plane exhibited maximum difference between the two groups which indicated that mandibular growth was affected more than other bones in diseased child patients.ConclusionThe present study led to the conclusion that craniofacial growth was retarded in children with generalized decreased skeletal age in comparison to healthy child patients.



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Primary Thyroid Carcinoma with Low-Risk Histology and Distant Metastases: Clinicopathologic and Molecular Characteristics

Thyroid , Vol. 0, No. 0.


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Effects of Adequate Iodine Supply on the Incidence of Iodine-Induced Thyroid Disorders in Slovenia

Thyroid , Vol. 0, No. 0.


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Acknowledgment of Reviewers

Thyroid Feb 2017, Vol. 27, No. 2: 302-305.


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Shigenobu Nagataki (January 18, 1932–November 12, 2016)

Thyroid Feb 2017, Vol. 27, No. 2: 135-136.


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Future Meetings

Thyroid Feb 2017, Vol. 27, No. 2: 306-307.


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New application of three-dimensional printing biomaterial in nasal reconstruction

Objectives

Polycaprolactone (PCL) is an U.S. Food and Drug Administration-approved synthetic biodegradable polymer and is easily fabricated into three-dimensional (3D) structures. In this study, the 3D-printed PCL implant for nasal augmentation was further evaluated for its suitability for nasal surgeries such as septoplasty and rhinoplasty.

Methods

Ten New Zealand White rabbits were included and divided into study and sham groups (7 and 3, respectively). A lateral incision was made on the nasal dorsum and a pocket formed in the subperichondrial plane between the upper lateral cartilage and nasal septum. Polycaprolactone was fabricated based on 3D printing technology into a 0.8 × 0.8-cm rectangular shape for use as a nasal implant. The material was inserted as a septal extension graft and sutured with alar cartilage for nasal reshaping. The implants were harvested 4, 8, and 12 weeks after implantation and evaluated by gross morphological assessment and histological examination.

Results

The initial shape of the implant was unchanged in all cases, and no definitive postoperative complications were seen over the 3-month period. Gross morphological evaluation confirmed that implants remained in their initial location without migration or extrusion. Histologic evaluations showed that the implant architectures were maintained with excellent fibrovascular ingrowth and minimal inflammatory reactions.

Conclusion

Polycaprolactone can be used for nasal reconstruction such as nasal augmentation. Polycaprolactone is easy to work with and will avoid the increased operative time and morbidity associated with autograft harvesting. Therefore, PCL implants designed by 3D printing can serve as clinically biocompatible materials in craniofacial reconstruction in the future.

Level of Evidence

NA. Laryngoscope, 2017

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Adjuvant radiotherapy is not supported in patients with verrucous carcinoma of the oral cavity

Objective

To analyze the impact of adjuvant radiation therapy (RT) on overall survival (OS) and disease-specific survival (DSS) in patients with verrucous carcinoma (VC) as compared to squamous cell carcinoma (SCC) of the oral cavity.

Study Design

Cross-sectional population analysis.

Methods

Cases of nonmetastatic VC/SCC of the oral cavity were extracted from the Surveillance, Epidemiology, and End Results (SEER) database (1988–2013). Kaplan-Meier survivals, stratified according to T stage, were compared between VC and SCC for treatment with or without adjuvant RT.

Results

A total of 18,819 VC/SCC cases were identified. There were 581 (3.1%) VC (mean age 69.6 years, 48.9% female) versus 18,238 (97.0%) SCC (mean age, 65.3, 37.1% female) patients. Verrucous carcinoma patients receiving surgery alone (N = 539) demonstrated a trend toward improved OS versus VC patients receiving surgery and RT (N = 40) (117.0 vs. 71.4 months, respectively, P = 0.119). There was a statistically significant improvement in DSS in VC patients receiving surgery alone (217.2 vs. 110.9 months, P = 0.05). Verrucous carcinoma patients treated with adjuvant RT demonstrated a trend toward a worse OS (71.4 vs. 93.0 months, P = 0.992) and DSS (110.9 vs. 162.3 months, P = 0.275) compared to SCC treated with adjuvant RT, suggesting a different biology and radiosensitivity between VC and SCC.

Conclusion

Verrucous carcinoma treated with adjuvant RT had a worse OS and DSS compared to both VC treated with surgery alone and SCC treated with surgery and adjuvant RT. Consideration should be given to surgical re-section rather than adjuvant RT in patients with positive margins or local recurrence.

Level of Evidence

2C. Laryngoscope, 2017

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Validation of a new snoring detection device based on a hysteresis extraction algorithm

Publication date: Available online 1 February 2017
Source:Auris Nasus Larynx
Author(s): Hirotaka Hara, Masakazu Tsutsumi, Syunsuke Tarumoto, Toshikazu Shiga, Hiroshi Yamashita
ObjectiveThis paper aims to introduce and validate our newly developed snoring detection device to automatically identify the incidence and amplitude of snores using the hysteresis extraction method.MethodsThirty patients (16 males and 14 females) with a history of snoring were included in this study. Each patient underwent a conventional polysomnography (PSG). Natural overnight snoring was recorded from each subject using our original snore detection device and an integrated circuit (IC) recorder while the patient slept during PSG. A new algorithm based on hysteresis extraction was used to detect snores and qualify the level of each event at 30-s intervals (one epoch). The automated and subjective assessment concordance was evaluated by comparing a total of 27,295 epochs, and sensitivity, specificity, and accuracy were calculated.ResultsStudy population analysis revealed a mean rate of snore time against the total sleep time of 14.1±7.9%. Further, validation of the automatic snore detection revealed the following: sensitivity, 71.2%; specificity, 93.1%; positive predictive value, 77.7%; negative predictive value, 94.6%; and accuracy, 90.7%.ConclusionsThis study revealed the efficacy of our newly developed snoring detection device and indicated that it may serve as a useful method in further snoring analysis via objective medical assessment. However, the sample size of 30 subjects was relatively small; therefore, further research is needed to evaluate this device.



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Facial nerve paralysis associated with temporal bone masses

Publication date: Available online 1 February 2017
Source:Auris Nasus Larynx
Author(s): Hironobu Nishijima, Kenji Kondo, Ryoji Kagoya, Hitoshi Iwamura, Kazuo Yasuhara, Tatsuya Yamasoba
ObjectiveTo investigate the clinical and electrophysiological features of facial nerve paralysis (FNP) due to benign temporal bone masses (TBMs) and elucidate its differences as compared with Bell's palsy.MethodsFNP assessed by the House–Brackmann (HB) grading system and by electroneurography (ENoG) were compared retrospectively.ResultsWe reviewed 914 patient records and identified 31 patients with FNP due to benign TBMs. Moderate FNP (HB Grades II–IV) was dominant for facial nerve schwannoma (FNS) (n=15), whereas severe FNP (Grades V and VI) was dominant for cholesteatomas (n=8) and hemangiomas (n=3). The average ENoG value was 19.8% for FNS, 15.6% for cholesteatoma, and 0% for hemangioma. Analysis of the correlation between HB grade and ENoG value for FNP due to TBMs and Bell's palsy revealed that given the same ENoG value, the corresponding HB grade was better for FNS, followed by cholesteatoma, and worst in Bell's palsy.ConclusionsFacial nerve damage caused by benign TBMs could depend on the underlying pathology. Facial movement and ENoG values did not correlate when comparing TBMs and Bell's palsy. When the HB grade is found to be unexpectedly better than the ENoG value, TBMs should be included in the differential diagnosis.



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Vemurafenib-induced toxic epidermal necrolysis: is it an emerging side effect of the drug?

Abstract

Vemurafenib, a selective inhibitor of the BRAF-kinase used in treatment of metastatic melanoma alone or in combinations,¹ is known to cause various adverse skin reactions such as maculopapular rash, photosensitivity and hyperkeratotic lesions, affecting more than 90% of patients.^1-2 Severe adverse reactions were observed in less than 1% of the patients in clinical trials.³ However, the increasing number of reported cases of vemurafenib-induced toxic epidermal necrolysis (TEN), a life-threatening severe cutaneous adverse reaction, is striking. ^4-8 We herein present another patient with vemurafenib-induced TEN.

This article is protected by copyright. All rights reserved.

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Diagnostic Agreement and Interobserver Concordance with Teledermoscopy Referrals

Abstract

Background

Malignant melanoma and non-melanoma skin cancers are among the fastest increasing malignancies in many countries. With the help of new tools, such as teledermoscopy referrals between Primary Health Care and Dermatology clinics, the management of these patients could be made more efficient.

Objective

To evaluate the diagnostic agreement and interobserver concordance achieved when assessing referrals sent through a mobile teledermoscopic referral system as compared to referrals sent via the current paper-based system without images.

Methods

The referral information from 80 teledermoscopy referrals and 77 paper referrals were evaluated by six Swedish dermatologists. They were asked to answer questions about the probable diagnosis, the priority, and a management decision.

Results

Teledermoscopy generally resulted in higher diagnostic agreement, better triaging and more malignant tumours being booked directly to surgery. The largest difference between the referral methods was seen for invasive melanomas. Referrals for benign lesions were significantly more often correctly resent to Primary Health Care with teledermoscopy. However, referrals for cases of melanoma in situ were also incorrectly resent 5 times. The interobserver concordance was moderate with both methods.

Conclusion

By adding clinical and dermoscopic images to referrals, the triage process for both benign and dangerous skin tumours can be improved. With teledermoscopy, patients with melanoma especially can receive treatment more swiftly.

This article is protected by copyright. All rights reserved.

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Use of Topical Glucocorticoids: a Population-Based Cohort Study

Abstract

Background

Little is known about the prescriptions of topical glucocorticoids in the general population.

Objectives

To report an overall picture of topical glucocorticoid prescriptions in France.

Methods

This study used the Echantillon Généraliste de Bénéficiaires (EGB) database, a 1/97^th random sampling of the French population covered by the main national healthcare insurance system (approximately 90% of the whole population). All patients prescribed topical glucocorticoids over a 5-year period (January 1, 2011 to December 31, 2015) were identified using a specific codes list for topical glucocorticoids.

Results

Over the 5-year study period, 662,531 individuals were recorded for at least one day in the EGB. Among them, 220,345 (33.3%) were prescribed at least once topical glucocorticoid. The prevalence of topical glucocorticoid prescription increased regularly from 2011 (11.7%) to 2015 (12.5%). A total of 922,026 tubes of topical glucocorticoids were dispensed, mainly high potency glucocorticoids, and were mainly prescribed by general practitioners (73.1%). A total of 1,713 (0.8%) patients were prescribed at least 24 tubes over a calendar year. These patients were more frequently men (p<0.001) and older (p<0.001) than the overall population of patients prescribed topical glucocorticoids. The 124,844 tubes prescribed to these patients had stronger potency than those prescribed to the overall population (p<0.001) and were mostly prescribed by general practitioners (68.1%). The reasons for prescription were available for only 371 patients (21.7%) and were mainly psoriasis, auto-immune bullous dermatoses and eczema.

Conclusion

About 12% of the French general population is prescribed topical glucocorticoids at least once each year. Most prescriptions are issued by general practitioners, dermatologists being the prescribers in less than one quarter of cases.

This article is protected by copyright. All rights reserved.

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A Case of Eosinophilic Fasciitis Associated with Pyoderma Gangrenosum

Abstract

Eosinophilic fasciitis (EF) is a rare, systemic inflammatory disease that is characterized by symmetrical swelling and scleroderma-like indurations of the distal extremities and trunk, often accompanied by pain and eosinophilia. Rarely, muscle degeneration may occur. Histologically, EF is marked by thickened, fibrotic fascia and fascial inflammation with lymphocytes and eosinophils.^1,2 Herein, we present a previously unreported case of concurrent pyoderma gangrenosum (PG) and biopsy-proven EF successfully treated with rituximab.

This article is protected by copyright. All rights reserved.

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Effect of nebulized budesonide on decreasing the recurrence of allergic fungal rhinosinusitis

To evaluate the clinical efficacy and the effects on decreasing the recurrence of AFRS (allergic fungal rhinosinusitis) of a budesonide inhalation suspension delivered via transnasal nebulization to patients following endoscopic sinus surgery.

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Relations of Facial Nerve With Retromandibular Vein in Human Fetuses.

The relationship of facial nerve (FN) and its branches with the retromandibular vein (RMV) has been described in adults, whereas there is no data in the literature regarding this relationship in fetuses. The study was conducted to evaluate the anatomic relationships of these structures on 61 hemi-faces of fetuses with a mean age of 26.5 +/- 4.9 weeks with no visible facial abnormalities. The FN trunk was identified at its emergence at the stylomastoid foramen. It was traced till its ramification within the parotid gland. In 46 sides, FN trunk ramified before crossing RMV and ran lateral to it, while in 8 sides FN trunk ramified on the lateral aspect of the RMV. In 3 sides, FN trunk ramified after crossing the RMV at its medial aspect. In only 1 side, FN trunk trifurcated as superior, middle, and inferior divisions and RMV lied anterior to FN trunk, lateral to superior division, medial to middle and inferior divisions. In 2 sides, FN trunk bifurcated as superior and inferior divisions. Retromandibular vein was located anterior to FN trunk, medial to superior division, lateral to inferior division in both of them. In 1 side, RMV ran medial to almost all branches, except the cervical branch of FN. Variability in the relationship of FN and RMV in fetuses as presented in this study is thought to be crucial in surgical procedures particularly in early childhood. (C) 2017 by Mutaz B. Habal, MD.

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Characteristics of Pediatric Cheek Mass.

Purpose: Patients with cheek mass are often referred to our medical center's department of plastic surgery. Most patients with deep cheek mass have the characteristic of a slowly growing, painless mass. We reviewed the lesion's pathology of this complex anatomic area in the pediatric population, focusing on differential diagnosis and the recent surgical strategies. Methods: We retrospectively reviewed 56 patients visiting our department from 2009 to 2016. Data analysis included the patients' lesion characteristics, clinical presentation, presumptive diagnosis, results of preoperative investigations, pathological diagnosis, and treatment details. Results: Patient age ranged from 1 day to 19 years (mean 7.81 years). The most common presentation was an asymptomatic, slowly enlarging mass. Preoperative diagnoses were made after clinical examination, and then the imaging study was performed. Surgical intervention was performed in 31 patients. The most common histopathological types were vascular anomalies. The next order of prevalence, from most prevalent to least, was lipomatosis, neurofibroma, and teratoma cases. Conclusion: As for our patients, various histopathological types of pediatric cheek mass were presented. Being suspicious of a rare disease and having a prudent diagnostic skill were important for a successful diagnosis. The primary treatment of these lesions is surgical excision with a meticulous surgical approach. In our patients, the prognosis of such treatment was good. This study provides a differential diagnosis of cheek mass in the pediatric population and signifies that the prevalence and types of cheek mass in pediatrics are different from those of the adult population. (C) 2017 by Mutaz B. Habal, MD.

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Anatomical Study of the Infraorbital Nerve and Surrounding Structures for the Surgery of Orbital Floor Fractures.

The infraorbital nerve (ION) can easily be damaged by orbital trauma and periorbital surgical manipulations, due to its abutment to the orbital floor. Anatomic variability of the ION and surrounding structures has infrequently been documented. The aim of this study is to give precise anatomical knowledge about the ION with surrounding structures, to avoid iatrogenic injury of the ION during periorbital procedures. Forty orbits of 40 skull subjects (20 males and 20 females) were studied to analyze structures around the ION. The authors located the ION, infraorbital canal/groove (IOC/G), and infraorbital foramen (IOF), using several reference points. The various distances were also measured between those structures, and statistically analyzed. The authors compared the left and right sides, and analyzed the differences between both sexes. The IOF was also investigated regarding the shape and presence of the accessory IOF. Three different types of orbital floor osseous anatomy were made based on macroscopic analysis. Type 1 shows no groove, and the ION enters the canal covered by the roof (5 patients, 12.5%). Type 2 revealed a pseudocanal, which has a very thin, almost transparent roof (26 patients, 65.0%). Type 3 consists of the ION traveling in a true groove, before entering an IOC (9 patients, 22.5%). IOG/C complexes took the upward lateral course, until exiting via the IOF. The mean +/- SD length of the IOC was 12.86 +/- 3.79 mm, and of the IOG was 16.15 +/- 2.88 mm. The calculated combined mean length of the IOC/G complex was found to be 29.01 +/- 3.17 mm. An accessory IOF was found in 35% of the skulls (50% in male and 20% in female skulls), with a higher frequency on the left side in both male and female skulls. These results can increase the authors' knowledge of the anatomic variability of the infraorbital region, and help facial plastic surgeons during their surgical manipulations prevent any possible iatrogenic injury of the ION. (C) 2017 by Mutaz B. Habal, MD.

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Is Surgical Navigation Useful During Closed Reduction of Nasal Bone Fractures?.

Objective: To report the case of a 42-year-old woman with a nasal bone fracture that was easily treated using a surgical navigation system. Methods: In this clinical report, the authors suggest that intraoperative surgical navigation systems are useful diagnostically and for localizing sites of nasal bone fractures exactly. Results: The patient underwent successful closed reduction of the nasal bone fracture. Conclusions: Surgical navigation is a useful tool for identifying nasal bone fracture locations and for guiding closed reduction. Surgical navigation is recommended when nasal bone fractures are complicated or not well reduced using the ordinary method. (C) 2017 by Mutaz B. Habal, MD.

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Is Presence of Vascular Loop in Magnetic Resonance Imaging Always Related to Tinnitus?.

Introduction: One of the most common otological complaints is tinnitus in adults. When there is a complaint of unilateral tinnitus and retrocochlear pathology is suspected, imaging methods are applied. However, the imaging findings obtained may not always be compatible with the severity and localization of the tinnitus. Aim: The aim of the present study was to determine whether or not there was a significant correlation between the findings on magnetic resonance imaging (MRI) and the presence and severity of tinnitus in patients with the complaint of unilateral tinnitus. Method: The study included 44 patients with no loss of hearing who presented with the complaint of unilateral tinnitus. The relationship between tinnitus severity and vascular loop presence was investigated. Results: Various types of vascular loop were determined in 14 patients. No statistically significant relationship was determined between the presence of vascular loop and the Tinnitus Handicap Inventory scores. Conclusion: The results of this study showed no significant difference in respect of the presence of vascular loop on the MRI findings of symptomatic and healthy ears. The presence of vascular loop on MRI is not always a pathological event and should be considered only as an examination finding that could be an anatomic variation. (C) 2017 by Mutaz B. Habal, MD.

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Open Reduction in Pediatric Condylar Fracture.

Facial fractures in children are rare. Lack of pneumatization, fat pockets, mixed dentition, contribute to the elasticity and bone stability. When mandibular fractures occur in children, most often involve the condyle by indirect trauma. Such fractures are the center of discussion on the form of treatment if this should be performed conservatively, or held the reduction and fixation of the fracture with surgical exposure of the fragments. In condylar fractures in children, in most patients, the proposed treatment is closed reduction. Treatment with open reduction and fixation has its specific indications. In this case, the authors report a patient cycling accident victim, with cut-contusion injury in ment with limited mouth opening and left condylar fracture with medial rotation. The treatment was the reduction and fixation of fragments by open process. (C) 2017 by Mutaz B. Habal, MD.

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Reconstruction of Extensive Orbital Exenteration Defects Using an Anterolateral Thigh/Vastus Lateralis Chimeric Flap.

Neglected malignant tumors within the orbital region can invade the eyeball, extraocular muscles, and bone substance surrounding the eye. Such patients require orbital exenteration, which may involve extraocular skeletal structures (even exposing paranasal sinuses), resulting in 3-dimensional defects requiring reconstruction. This study presents our experience with anterolateral thigh vastus lateralis (ALT/VL) chimeric free flaps for the reconstruction of extensive orbital exenteration defects involving various paranasal sinuses. Between 2012 and 2016, 4 patients with extensive 3-dimensional orbital defects with sinus involvement were treated using the ALT/VL chimeric flap. The ALT component (117-170 cm2) was used to resurface the cutaneous defect while the VL component (105-243 cm3) was used to obliterate the cavitary defect. The flaps were all based on the common descending pedicle, and branches to separate components were individually dissected. Recipient vessels were in the neck region, to which the donor pedicles were passed through a tunnel for anastomosis. All cavitary and surface defects were simultaneously reconstructed via the ALT/VL chimeric flap. Within an average of 17 months, no complications associated with flap surgery were observed. One patient received postoperative adjuvant radiotherapy with no complications. With its separate components supplied by a common vascular pedicle, the ALT/VL chimeric free flap allows the surgeon to conveniently reconstruct separate spatial and volumetric defects resulting from extensive orbital exenteration. (C) 2017 by Mutaz B. Habal, MD.

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Combined Endoscopic and Trans Palpebral Orbital Reconstruction for Silent Sinus Syndrome.

Silent Sinus Syndrome is defined as a painless spontaneous and progressive enophthalmos and hypoglobus with maxillary sinus hypoplasia and orbital floor resorption. It is caused by maxillary sinus atelectasis in a setting of ipsilateral chronic maxillary sinus hypoventilation. The syndrome was first described in 1964 by Montgomery, but the term "Silent Sinus Syndrome" was not coined until 1994 by Soparkar. The aetiology is still controversial: some authors postulate a basal hypoplastic sinus, other suggest an acquired process due to an obstruction of the ostium in the medium meatus. Silent Sinus Syndrome presents in the third to fifth decades of life, very rarely in childhood with no gender predilection and it is usually a unilateral disorder. The symptoms are not shown to be related to chronic sinuses disease. The clinical signs are: enophthalmos, hypoglobus, upper lid retraction secondary to dystopia of the globe, sinking of the eye and orbital asymmetry, deepened upper lid sulcus, disappearance of the palpebral fold line, lagophthalmos, vertical diplopia, malar depression, and facial asymmetry. Extraocular muscle function is generally preserved and usually there is no visual impairment. The diagnosis is confirmed by computed tomography scan of the orbits and paranasal sinuses. The treatment consists of orbital reconstruction and functional rehabilitation of the maxillary sinuses. (C) 2017 by Mutaz B. Habal, MD.

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Survey of Ocular Prosthetics Rehabilitation in the United Kingdom, Part 1: Anophthalmic Patients' Aetiology, Opinions, and Attitudes.

Purpose: Ocular prostheses are constructed to aid cosmetic, functional, and psychological rehabilitation of anophthalmic patients. Part-1 of this study aimed to evaluate anophthalmic patients' opinions, attitudes, and experience about aspects related to their postfit ocular prostheses. Methods: One hundred sixty questionnaires were delivered to anophthalmic patients inquiring about different information such as age, gender, occupation, eye-loss cause, prosthesis type, prosthesis-wearing frequency, prosthesis-cleaning frequency, and problems encountered. A total of 126 questionnaires were returned (response rate was 78.8%). Data was analyzed using SPSS software (P 0.05). Conclusions: Trauma is the most common cause of anophthalmic patients in the North-West of England. Anophthalmic patients are likely to experience problems with their prosthetic eye if they have lost their natural eye due to disease; it is their first prosthesis; or if they clean it once every 6 months. (C) 2017 by Mutaz B. Habal, MD.

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Endoscopic Endonasal Transsphenoidal Approach From the Otolaryngologist Point of View.

Objective: In February 2009, the authors' center formed a team of neurosurgeons, otolaryngologists, endocrinologists, and radiologists to perform pituitary surgery using the endoscopic endonasal transsphenoidal approach (EETSA). This paper reviews the authors' experience with the technique, pathological outcomes, hormone profiles, and postoperative complications. Methods: Between February 2009 and December 2015, 535 patients underwent the EETSA with 2-nostrils/4-hands surgery. All of the patients had preoperative neurophthalmological and endocrinological assessments and neuroimaging. Patients were followed for at least 6 months with otolaryngological evaluations. Results: The most common pathology treated was pituitary adenomas, with 390 (72.9%) patients. Of these, 287 (73.6%) were nonfunctioning adenomas. As the surgical method, the conventional 2-nostrils/4-hands technique was performed in 77 patients (14.4%), a right conventional nasoseptal flap and left modified nasoseptal rescue flap technique was used in 135 patients (25.2%), and bilateral modified nasoseptal rescue flaps were used in 323 patients (60.4%). Postoperative complications occurred in 46 patients (8.6%). The most common complications were vascular injury or hematoma (10 patients, 1.9%), and the most common postoperative sinonasal complaints were hyposmia or anosmia. Olfactory function was significantly decreased according to the Connecticut Chemosensory Clinical Research Center test (P

http://ift.tt/2jXysdm

A Surgical Technique for Management of the Metopic Suture in Syndromic Craniosynostosis.

Objectives: The objective is to describe a new surgical procedure developed in the San Jose Pediatric University Hospital for the management of syndromic synostosis of the metopic suture in a patient clinically diagnosed with Saethre-Chotzen syndrome. Methods: The diagnosis of Saethre-Chotzen syndrome, bilateral coronal sutures, and metopic suture synostoses was made through photographic, anthropometric, exophthalmometric, and computed tomography analysis. The keel-like frontal bone deformity was corrected following resection using a fusiform osteotomy, remodelling was obtained by milling the edges, and the bony fragments were repositioned and fixed on the posterior wall of the frontal bone. Additionally, a fronto-orbital advancement with a self-stabilizing bar was performed. Results: The 1-year postoperative results showed improvement in the position of the fronto-orbital bar, adequate cranial expansion, satisfactory correction of the upper facial third alteration, and correction of the keel-like deformity. Conclusions: The surgical approach has not previously been described in the literature and offers an alternative management for syndromic craniosyntostosis of the metopic suture, avoiding skull irregularities. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2ku0osk

An Economic Analysis of Bromocriptine Versus Trans-Sphenoidal Surgery for the Treatment of Prolactinoma.

Prolactinomas account for ~40% of all pituitary adenomas and are important causes of infertility and gonadal dysfunction. In general, most prolactinomas are treated medically with dopaminergic agonists, while surgery is reserved for patients intolerant or nonresponsive to these medications. The aim of this study was to carry out a comparative analysis of the cost-effectiveness of medical therapy with bromocriptine and surgical therapy with trans-sphenoidal surgery. A Markov model was developed based on retrospective data from 126 patients with prolactinoma treated in our hospital between October 2008 and May 2009, and from data published previously. For patients with microadenoma, the cost of medical treatment was estimated to be [yen]20,555, while the cost of surgery was calculated to be [yen]22,527. For patients with macroadenoma, the cost of therapy with bromocriptine was [yen]31,461 in males and [yen]27,178 in females, while the cost of surgery was [yen]42,357 in males and [yen]44,094 in females. Sensitivity analyses (carried our using variations in patient age, bromocriptine therapeutic dose, bromocriptine maintenance dose, and the success rate of bromocriptine withdrawal) indicated that our model showed good stability, although our results were most heavily influenced by variations in the bromocriptine maintenance dose. It is concluded that, from an economic viewpoint, medical therapy with bromocriptine should be the first-line treatment option for patients with prolactinoma, irrespective of whether this is a microadenoma or macroadenoma. (C) 2017 by Mutaz B. Habal, MD.

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Efficacy and Safety of Willis Covered Stent for Treatment of Internal Carotid Artery Aneurysms.

Objective: The purpose of this study was to evaluate the clinical and short-term outcome of patients who underwent covered stent treatment for internal carotid artery aneurysms. Methods: Twelve cases patients with internal carotid artery aneurysms were treated with Willis covered stents during the period from December 2010 to January 2016. The guiding catheter was placed as high as possible to facilitate the delivery of the covered stent system. Results: Covered stent placement was successful in 11 of 12 case patients (91.6%), embolization was successful in 11 of 12 patients (91.6%), the treatment in 1 patient of 12 cavernous aneurysms patients was performed covered stents +ONYX + plastic coil embolization, and the other was used Willis covered stents. The results indicated that only 1 of 12 patients underwent postoperative massive cerebral infarction, but was successfully rescued. The angiographic following-up of patients using covered stent suggested that 12 cases patients were complete occlusion and the parent artery patency. Clinical follow-up results also demonstrated that clinical neurologic symptoms fully recovered in 11 of 12 cases patients, another case improved and were not aggravated in any patient before discharge and had aggravated symptoms. Conclusion: Willis covered stents are effective for treatment of internal carotid artery aneurysms with good safety and short-term outcomes. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2kubSfC

The Rapid Development of Squamous Cell Carcinoma on the Nasal Dorsum of a Patient Receiving Immunosuppressive Therapy.

The risk of cancer is significantly increased in patients undergoing renal transplant surgery than in the general population. In particular, skin cancer is the most commonly occurring cancer in these patients. A 34-year-old man underwent living renal transplantation for focal segmental glomerulosclerosis. After 18 months, he developed a lesion on the nasal dorsum, approximately 1 cm in size, and the lesion rapidly expanded to cover the entire dorsum. Owing to its rapid expansion, the lesion was suspected to be a malignant tumor and wide excision was planned. We removed the lesion with a 6-mm margin. Squamous cell carcinoma was diagnosed through intraoperative rapid pathological examination. The nasal bone and septum were invaded by the tumor and, as a result, the entire external nose was removed. The patient's nose was subsequently reconstructed using a free forearm flap for lining, iliac bone graft for the nasal frame, and a scalping forehead flap for skin coverage. Selective target radiotherapy was administered at the closest margin around the lesion, and the dosage of immunosuppressants was reduced. At >2 years postoperatively, the patient showed good cosmetic results with no relapse or metastasis of the tumor. We report the unusual case of a young man who developed a rapidly progressing squamous cell carcinoma on his nasal dorsum after 18 months of immunosuppression. Squamous cell carcinoma in organ transplant recipients may be more aggressive and may progress differently than in regular patients. Therefore, special attention is required for patients who take immunosuppressive drugs after renal transplant surgery. (C) 2017 by Mutaz B. Habal, MD.

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A Rare Case of Malignant Fibrous Histiocytoma (Undifferentiated High-Grade Pleomorphic Sarcoma) of Malar Region.

Malignant fibrous histiocytoma is a sarcoma with rare occurrence in the oral and maxillofacial region; surgery is the most reliable treatment. Inadequate resection of the sarcoma on the oral and maxillofacial region is associated with a high incidence of local recurrence and a poor prognosis. Only few patients of malignant fibrous histiocytoma of the malar region have been previously reported in the literature. The authors report a new patient of malignant fibrous histiocytoma on the right malar region that treated a complete tumor surgical excision without lymph node dissection. Examination of the resected specimen revealed that the tumor was completely removed. (C) 2017 by Mutaz B. Habal, MD.

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Inappropriate Management After Accidental Displacement of Upper Third Molar to the Infratemporal Fossa May Disrupt Its Subsequent Removal.

No abstract available

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Real Opportunity for the Present and a Forward Step for the Future of Bone Tissue Engineering.

No abstract available

http://ift.tt/2jXtCwO

Methotrexate Induces Apoptosis in Organ-Cultured Nasal Polyps Via the Fas Pathway.

Objective: Methotrexate (MTX) is very effective when used to treat chronic inflammatory diseases, and also induces apoptosis in nasal polyps (NPs). Increasing evidence suggests that Fas-Fas ligand (FasL) interactions activate multiple pathways involved in the regulation of immune and inflammatory cell functions. The aim of the present study was to identify pathways activated by Fas signaling when NPs were treated with MTX. Methods: Nasal polyps tissues were cultured using an air-liquid interface organ culture method. Cultures were maintained in the absence or presence of MTX (10 or 100 [mu]M) for 24 hours. The authors used the reverse transcription-polymerase chain reaction method and Western blotting to identify pathways activated by Fas when NPs were treated with MTX. Results: The Fas mRNA expression ratio was unchanged upon MTX treatment, but the FasL mRNA expression ratio was significantly higher in MTX-treated than nontreated polyps. In addition, the expression levels of the Fas and FasL proteins were significantly higher in polyps treated with both 10 and 100 [mu]M MTX compared with nontreated polyps. Conclusions: Methotrexate induces apoptosis in NPs via the Fas pathway. Future studies should explore the topical use of MTX for NP control. Methotrexate may be a useful alternative steroid-sparing agent for the treatment of NPs. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2ku8WzM

Using the Endoscopic Transconjunctival and Transcaruncular Approach to Repair Combined Orbital Floor and Medial Wall Blowout Fractures.

Purpose: To demonstrate the effectiveness of the endoscopic transcaruncular and transconjunctival approach in the repair of combined medial and inferior orbital wall fractures. Methods: A retrospective chart review was conducted on 160 patients with combined medial and inferior orbital wall fractures. All patients underwent surgery via an endoscopic transcaruncular and transconjunctival approach without lateral canthotomy, performed by a single surgeon. Porous polyethylene sheets (1.0 mm in thickness) were implanted to cover the orbital defects. The minimal postoperative follow-up period was 6 months. The authors evaluated enophthalmos, diplopia, and ocular motility pre and postoperatively and report surgical complications. Results: A total of 160 patients were included, comprising 121 men and 39 women. The mean patient age was 33.9 +/- 14.1 years, and the mean postoperative follow-up period was 12 months. The average enophthalmos was 3.20 mm preoperatively, and the mean improvement at 6 months after surgery was 2.82 mm. One patient suffered a canalicular laceration after surgery, and another retrobulbar hemorrhage; however, both of these complications resolved with appropriate management. Otherwise, there were no significant surgical complications including newly developed diplopia, decreased visual acuity, or cerebrospinal fluid leakage. Conclusions: The endoscopic transcaruncular and transconjunctival approach is a useful and promising technique to repair combined medial and inferior orbital wall fractures. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2jXyrGk

Cervicofacial Primary Cutaneous Actinomycosis: Surgical Treatment for Complete Remission of the Disease.

Actinomycosis, an infectious bacterial disease caused by Actinomyces species, is very rare and is characterized by contiguous spreading, subacute to chronic granulomatous inflammation and the formation of multiple abscesses and sinus tracts that may discharge sulfur granules. Actinomycosis that presents on the skin without endogenous origin is called primary cutaneous actinomycosis, and the occurrence and treatment of primary cutaneous actinomycosis is rarely reported. This report describes the treatment of primary cervicofacial actinomycosis with a literature review, and emphasizes the importance of surgical option for complete remission of the disease. (C) 2017 by Mutaz B. Habal, MD.

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Overview of Sinonasal and Ventral Skull Base Malignancy Management

Significant technological advances have fostered a movement toward minimally invasive surgical interventions for the management of ventral skull base malignancies. The care of patients with these lesions ideally involves an interdisciplinary skull base team that includes otolaryngologists, neurologic surgeons, radiation oncologists, and medical oncologists. This overview describes considerations essential for diagnosis, prognosis, and preoperative evaluation. Furthermore, surgical nuances, strategies for skull base reconstruction, and nonsurgical options are briefly discussed. Our hope is that this overview may be useful as an up-to-date description of the challenging clinical scenarios associated with these lesions.

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The Making of a Skull Base Team and the Value of Multidisciplinary Approach in the Management of Sinonasal and Ventral Skull Base Malignancies

The management of sinonasal and ventral skull base malignancies is best performed by a team. Although the composition of the team may vary, it is important to have multidisciplinary representation. There are multiple obstacles, both individual and institutional, that must be overcome to develop a highly functioning team. Adequate training is an important part of team-building and can be fostered with surgical telementoring. A quality improvement program should be incorporated into the activities of a skull base team.

http://ift.tt/2k0CCnm

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

In most cases of advanced sinonasal and ventral skull base cancer, a multimodal treatment approach provides the best chance for improved outcomes. Depending on the tumor type and extent of disease, systemic chemotherapy has been shown to play an important role in neoadjuvant, concomitant, and adjuvant settings. The lack of randomized trials continues to limit its indications. Further high-quality studies are needed to understand ideal chemotherapeutic regimens and their role and sequential timing in sinonasal and ventral skull base cancer.

http://ift.tt/2jXr9m3

Survival, Morbidity, and Quality-of-Life Outcomes for Sinonasal and Ventral Skull Base Malignancies

Sinonasal and ventral skull base malignancies are a rare, heterogeneous group of cancers. Although prognosis usually depends on many factors, long-term survival rates remain low despite recent advances. Population-based databases are powerful resources for studying survival outcomes. However, institutional retrospective chart-review studies have been able to provide more insight on recurrence patterns, morbidity, and quality-of-life metrics, as well as more details of the treatment information that may affect outcomes. This article discusses general considerations for understanding reported outcome data, summarizes the overall outcomes and their determinants, and provides histology-specific outcomes reported in the literature.

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Validation of a new snoring detection device based on a hysteresis extraction algorithm

This paper aims to introduce and validate our newly developed snoring detection device to automatically identify the incidence and amplitude of snores using the hysteresis extraction method.

http://ift.tt/2kj7LB7

Facial nerve paralysis associated with temporal bone masses

To investigate the clinical and electrophysiological features of facial nerve paralysis (FNP) due to benign temporal bone masses (TBMs) and elucidate its differences as compared with Bell's palsy.

http://ift.tt/2kTsrm2

The suppressive effects of landiolol administration on the occurrence of postoperative atrial fibrillation and tachycardia, and plasma IL-6 elevation in patients undergoing esophageal surgery: A randomized controlled clinical trial

To determine whether perioperative landiolol administration suppresses postoperative atrial fibrillation (AF) and the plasma cytokines elevation in patients undergoing esophageal cancer surgery.

http://ift.tt/2kUAMmd

Efficacy of oral diclofenac with or without codeine for pain control after invasive bilateral third molar extractions

Postoperative pain and inflammation after oral surgery is mostly managed using non-steroidal anti-inflammatory drugs (NSAIDs). However, opioids combined with NSAIDs may improve pain management in patients, especially after traumatic oral surgery. Few studies have compared NSAIDs with and without opioid use after oral and maxillofacial surgery. This randomized, double-blind, cross-over study compared the clinical efficacy of either diclofenac (50mg) and codeine (50mg) or diclofenac alone (50mg) for the management of postoperative pain after invasive third molar surgery.

http://ift.tt/2kiZGvT

Temporomandibular total joint prosthesis infections: a ten-year retrospective analysis

A retrospective review of 178 total temporomandibular joint replacements (TJR) performed on 106 patients at the University of Alabama at Birmingham during the years 2000–2010 was completed. Data regarding sex, past medical history, prosthesis manufacturer, microbiology, antibiotic therapy, and the need for additional procedures were obtained from the medical records of patients who developed a prosthetic joint infection following TJR. Of the 106 patients, 95 (89.6%) were female and 11 (10.4%) were male.

http://ift.tt/2kTnutG

Epidemiology of Otitis Media with Spontaneous Perforation of the Tympanic Membrane in Young Children and Association with Bacterial Nasopharyngeal Carriage, Recurrences and Pneumococcal Vaccination in Catalonia, Spain - The Prospective HERMES Study

by Robert Cilveti, Montserrat Olmo, Josefa Pérez-Jove, Juan-José Picazo, Josep-Lluis Arimany, Emiliano Mora, Tomás M. Pérez-Porcuna, Ignacio Aguilar, Aurora Alonso, Francesc Molina, María del Amo, Cristina Mendez, on behalf of the HERMES Study Group

The Epidemiology of otitis media with spontaneous perforation of the tympanic membrane and associated nasopharyngeal carriage of bacterial otopathogens was analysed in a county in Catalonia (Spain) with pneumococcal conjugate vaccines (PCVs) not included in the immunization programme at study time. A prospective, multicentre study was performed in 10 primary care centres and 2 hospitals (June 2011-June 2014), including all otherwise healthy children ≥2 months ≤8 years with otitis media presenting spontaneous tympanic perforation within 48h. Up to 521 otitis episodes in 487 children were included, showing by culture/PCR in middle ear fluid (MEF): Haemophilus influenzae [24.2%], both Streptococcus pneumoniae and H. influenzae [24.0%], S. pneumoniae [15.9%], Streptococcus pyogenes [13.6%], and Staphylococcus aureus [6.7%]. Culture-negative/PCR-positive otitis accounted for 31.3% (S. pneumoniae), 30.2% (H. influenzae) and 89.6% (mixed S. pneumoniae/H. influenzae infections). Overall, incidence decreased over the 3-year study period, with significant decreases in otitis by S. pneumoniae and by H. influenzae, but no decreases for mixed S. pneumoniae/H. influenzae infections. Concordance between species in nasopharynx and MEF was found in 58.3% of cases, with maximal rates for S. pyogenes (71.8%), and with identical pneumococcal serotype in 40.5% of cases. Most patients (66.6%) had past episodes. PCV13 serotypes were significantly more frequent in first episodes, in otitis by S. pneumoniae as single agent, and among MEF than nasopharyngeal isolates. All non-PCV13 serotypes separately accounted for

http://ift.tt/2jYTQRZ

THE UTILITY OF CARDIOPULMONARY EXERCISE TESTING FOR THE PREDICTION OF OUTCOMES IN AMBULATORY CHILDREN WITH DILATED CARDIOMYOPATHY.

No abstract available

http://ift.tt/2kiHYc1

Cyclooxygenase in Cancer Prevention and Treatments for Actinic Keratosis

Abstract

Non-steroidal anti-inflammatory drugs (NSAIDs) are a chemically diverse class of drugs that target the cyclooxygenase (COX) pathway and have anti-inflammatory, analgesic, and antipyretic properties. Elevated expression of COX-2 has been associated with tumor progression in skin cancer through multiple mechanisms. We present evidence for a chemoprotective effect of NSAIDs and discuss potential mechanisms of action of COX-2 in cancer. We also discuss the challenges associated with the treatment of actinic keratosis and the factors that should be taken into consideration when selecting a treatment regimen. A range of treatments are reviewed, with an emphasis on combination therapies.

http://ift.tt/2k0et0i

9th Skin Academy Symposium: Building Bridges in Dermatology Chair’s Introduction

Abstract

An introduction to the proceedings sharing an overview of presentations given as part of the 9th Skin Academy Symposium, held in Barcelona, Spain, April 9–10, 2016. The Skin Academy is an international and interdisciplinary dermatology initiative created to contribute to the growth in scientific knowledge of those dealing with skin diseases. This year's meeting aimed to 'build bridges' between the latest research and everyday clinical practice, providing dermatologists with important updates on some of the most common skin diseases, as well as current 'hot' topics.

http://ift.tt/2kUhXj1

Acne and Rosacea

Abstract

Acne, one of the most common skin diseases, affects approximately 85% of the adolescent population, and occurs most prominently at skin sites with a high density of sebaceous glands such as the face, back, and chest. Although often considered a disease of teenagers, acne is occurring at an increasingly early age. Rosacea is a chronic facial inflammatory dermatosis characterized by flushing (or transient facial erythema), persistent central facial erythema, inflammatory papules/pustules, and telangiectasia. Both acne and rosacea have a multifactorial pathology that is incompletely understood. Increased sebum production, keratinocyte hyper-proliferation, inflammation, and altered bacterial colonization with Propionibacterium acnes are considered to be the underlying disease mechanisms in acne, while the multifactorial pathology of rosacea is thought to involve both vasoactive and neurocutaneous mechanisms. Several advances have taken place in the past decade in the research field of acne and rosacea, encompassing pathogenesis and epidemiology, as well as the development of new therapeutic interventions. In this article, we provide an overview of current perspectives on the pathogenesis and treatment of acne and rosacea, including a summary of findings from recent landmark pathophysiology studies considered to have important implications for future clinical practice. The advancement of our knowledge of the different pathways and regulatory mechanisms underlying acne and rosacea is thought to lead to further advances in the therapeutic pipeline for both conditions, ultimately providing a greater array of treatments to address gaps in current management practices.

http://ift.tt/2k0hfSV

The Potential Psychological Impact of Skin Conditions

Abstract

Skin conditions such as psoriasis, eczema, and skin cancer often have a substantial psychologic and social impact on our patients. Some of these patients limit their life because they feel self-conscious about their symptoms. Sometimes, greater life satisfaction comes from accepting that perhaps some symptoms will remain or recur, even in an individual who responds well to treatment. This acceptance involves acknowledging the existence of symptoms, thereby allowing the patient to pursue a meaningful life that is not overly limited by their potential presence. This is not only liberating for the patient but also for the medical professional, who can sometimes feel pressured by patients' unrealistic expectations to achieve symptom reductions that are not possible. We discuss how to talk with patients about their expectations regarding treatment and whether relief of symptoms is a necessary component to living a better life. Helping patients to find the right words to explain their visible symptoms to others can sometimes help them feel less self-conscious in public settings and thereby more comfortable going out into the world to pursue a meaningful life.

http://ift.tt/2kUpiiL

Psoriasis and Atopic Dermatitis

Abstract

Psoriasis and atopic dermatitis are common, chronic inflammatory skin diseases. We discuss several aspects of these disorders, including: risk factors; incidence and prevalence; the complex disease burden; and the comorbidities that increase the clinical significance of each disorder. We also focus on treatment management strategies and outline why individualized, patient-centered treatment regimens should be part of the care plans for patients with either psoriasis or atopic dermatitis. Finally, we conclude that, while our theoretical knowledge of the optimum care plans for these patients is increasingly sophisticated, this understanding is, unfortunately, not always reflected in daily clinical practice.

http://ift.tt/2k0dygi

Skin Cancer: Epidemiology, Disease Burden, Pathophysiology, Diagnosis, and Therapeutic Approaches

Abstract

Skin cancer, including both melanoma and non-melanoma, is the most common type of malignancy in the Caucasian population. Firstly, we review the evidence for the observed increase in the incidence of skin cancer over recent decades, and investigate whether this is a true increase or an artefact of greater screening and over-diagnosis. Prevention strategies are also discussed. Secondly, we discuss the complexities and challenges encountered when diagnosing and developing treatment strategies for skin cancer. Key case studies are presented that highlight the practic challenges of choosing the most appropriate treatment for patients with skin cancer. Thirdly, we consider the potential risks and benefits of increased sun exposure. However, this is discussed in terms of the possibility that the avoidance of sun exposure in order to reduce the risk of skin cancer may be less important than the reduction in all-cause mortality as a result of the potential benefits of increased exposure to the sun. Finally, we consider common questions on human papillomavirus infection.

http://ift.tt/2kUiBgN

Einfluss des Schluckvolumens auf die Pharynxdynamik, evaluiert mit dünnen Hochauflösungsmanometriesonden

Laryngo-Rhino-Otol
DOI: 10.1055/s-0042-118231

Das Bolusvolumen hat einen modulierenden Einfluss auf die Schluckdynamik, allerdings sind bisher gewonnene Ergebnisse bezüglich der Adaptation der Pharynxfunktion uneinheitlich. Das Ziel war es deshalb, schluckvolumenbedingte Veränderungen von Druck- und Zeitparametern im Pharynx und oberen Ösophagussphinkter (oÖS) mit der Hochauflösungsmanometrie (HRM) umfassend zu untersuchen. Um die normale Schluckphysiologie zu evaluieren, wurden besonders dünne HRM-Sonden eingesetzt, von denen nur eine geringe Beeinflussung der untersuchten Strukturen zu erwarten war.10 gesunde Probanden führten während einer HRM-Untersuchung jeweils 10 Schluckversuche mit 2 ml und 10 ml Wasser in aufrechter Position durch. Druck- und Zeitparameter für die Velopharynx- und Zungengrundregion sowie den oÖS wurden bestimmt und die Ergebnisse für die beiden Bolusvolumina statistisch auf Unterschiede untersucht.Bei größeren Schluckvolumina waren ein längerer Verschluss des Velopharynx und eine längere Öffnung des oÖS feststellbar. Veränderungen der Druckparameter waren nicht nachweisbar.Das Bolusvolumen hatte einen Einfluss auf die Zeitparameter der pharyngealen Phase, sodass zeitliche Anpassungen der automatisierten Schluckdynamik nachgewiesen werden konnten. In anderen Studien gezeigte Änderungen pharyngealer Druckparameter konnten nicht bestätigt werden. Sie sind möglicherweise durch HRM-Sonden mit großem Durchmesser bedingt, die selbst einen Einfluss auf die Kontraktionseigenschaften der Pharynxstrukturen nehmen können. Unter diagnostischen Gesichtspunkten sollten HRM-Untersuchungen immer mit unterschiedlichen Bolusvolumina durchgeführt werden, um den Schluckvorgang vollständig zu untersuchen.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

http://ift.tt/2jXhfAR

Patient blood management and perioperative anaemia

<span class="paragraphSection"><div class="boxedTextSection">Key points<ul><li class="bullet">Perioperative anaemia and allogenic blood transfusion are independent risk factors for poor postoperative outcomes: morbidity and mortality.</li><li class="bullet">Approximately one-third of patients are found to be anaemic on pre-assessment.</li><li class="bullet">Patient Blood Management (PBM) is a clinical concept with the goal of avoiding unnecessary blood transfusions to improve patient outcomes and safety.</li><li class="bullet">PBM involves early detection and treatment of preoperative anaemia, minimization of perioperative blood loss and improving tolerance to anaemia in the postoperative setting.</li><li class="bullet">Iron deficiency can be absolute or functional and requires iron supplementation to improve body reserves and utilization.</li><li class="bullet">PBM is a multimodal, multidisciplinary strategy requiring surgical and medical speciality input.</li></ul></div>Perioperative anaemia is an independent risk factor for increased length of hospital and intensive care stay, postoperative complications, and increased mortality.<a href="#mkw061-B1" class="reflinks">¹</a> It is a strong predictor for perioperative blood transfusion requirements. In general, approximately one-third of patients are found to be anaemic at pre-assessment. Perioperative anaemia and allogenic blood transfusion are both, preventable surgical risks. Administration of blood in the perioperative setting is a risk factor which contributes to poor outcomes.<a href="#mkw061-B1" class="reflinks">¹</a> Patient Blood Management (PBM) is a clinical concept, which when implemented, has the primary goal of avoiding unnecessary blood transfusions and improving patient outcome and safety. This article summarizes PBM and the strategies involved in identifying and managing perioperative anaemia and blood transfusion.</span>

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Corrigendum

<span class="paragraphSection"><strong>Principles of total intravenous anaesthesia: practical aspects of using total intravenous anaesthesia <span style="font-style:italic;">BJA Education</span>, 2016, 16(8): <strong><a href="article.aspx?volume=&page=">276–280<span></span></a></strong>, DOI 10.1093/bjaed/mkv074</strong> </span>

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Hypothalamic–pituitary–adrenal function during health, major surgery, and critical illness

<span class="paragraphSection">1A011A022C012C04</span>

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Mitral valve and mitral valve disease

<span class="paragraphSection">1A012A033G00</span>

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Pain management programmes

<span class="paragraphSection">2E033E00</span>

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Disaster management in a low-resource setting: the role of anaesthetists in international emergency medical teams

<span class="paragraphSection">1I022A072A123A103I00</span>

http://ift.tt/2ks0cuk

Anaesthesia for liver transplantation

<span class="paragraphSection">2A033A04</span>

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Training Groups

Publication date: February 2017
Source:British Journal of Oral and Maxillofacial Surgery, Volume 55, Issue 2





http://ift.tt/2ktRQ54

Editorial Board

Publication date: February 2017
Source:British Journal of Oral and Maxillofacial Surgery, Volume 55, Issue 2





http://ift.tt/2ktO9wc

A successfully treated case of cardiac arrest after Caesarean section complicated by pheochromocytoma crisis and amniotic fluid embolism

Abstract

Both pheochromocytoma and amniotic fluid embolism (AFE) are important causes of maternal mortality. We present a case of a 29-year-old woman who developed cardiac arrest after Caesarean section, complicated by both pheochromocytoma crisis and AFE. After resuscitation, the patient developed multiple organ dysfunction, rhabdomyolysis and disseminated intravascular coagulation (DIC). After institution of multidisciplinary interventions (including the use of an intra-aortic balloon pump, extracorporeal membrane oxygenation, continuous hemodiafiltration, and neuroprotective therapeutic hypothermia) the patient made a full recovery without any apparent neurological deficit.

http://ift.tt/2jEFmU8

Isoflurane decreases proliferation and differentiation, but none of the effects persist in human embryonic stem cell-derived neural progenitor cells

Abstract

Purpose

Volatile anesthetics are a potential risk for cognitive impairment in the developing brain. Isoflurane causes cell death, reduces neurogenesis, and changes neuronal differentiation. In this study, the effects of a single isoflurane exposure on the developing human brain were evaluated using human embryonic stem cell (hESC)-derived neural progenitor cells (NPCs).

Methods

Multipotent NPCs were derived from hESCs and randomly exposed to either 5 vol% isoflurane (4 h) or no isoflurane (control group). The cells were fixed after 1, 3, 5, and 7 days to evaluate differentiation using the ratio of β-III tubulin to nestin. Neuronal cell survival and proliferation were assessed using the WST-1 and bromodeoxyuridine (BrdU) cell proliferation assays, respectively. To evaluate the mechanism of isoflurane neurotoxicity, we added TAT-Pep5, a p75 neurotrophic receptor (p75^NTR) inhibitor, to each of the groups.

Results

Isoflurane had minimal or no effect on the cell survival of NPCs in vitro. Proliferation, assessed on the basis of BrdU incorporation, was inhibited in the isoflurane group on days 3 (p = 0.033) and 5 (p = 0.001). The ratios of β-III tubulin to nestin in the isoflurane group on days 1 and 3 were significantly lower (p = 0.004 and p = 0.029, respectively) than those in the control group. Anti-proliferative and differentiation-reducing effect did not persist. TAT-Pep5 pretreatment significantly blocked the isoflurane-mediated decrease in the β-III tubulin to nestin ratio (p = 0.012) on day 1.

Conclusion

Exposing NPCs to isoflurane hampered proliferation and differentiation but not neuronal survival. Isoflurane may be a powerful neuronal modulator during the early developmental period, partly mediated by activation of p75^NTR.

http://ift.tt/2ksba2T

In reply: Assessing interaction between dexmedetomidine and propofol

http://ift.tt/2jEMVKm

AI as Good as Docs for Diagnosing Skin Cancers From Photo

Artificial intelligence, in the form of a new deep-learning algorithm, aided by advances in computer science and large datasets, can classify skin lesions as malignant or benign.
Medscape Medical News

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Comparing lightwand-guided intubation techniques

http://ift.tt/2ks6UQY

Anesthesiology residency combined with an MBA degree

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A suspected case of rocuronium–sugammadex complex-induced anaphylactic shock after cesarean section

Abstract

An anaphylactic reaction during a cesarean section occurs rarely, and rocuronium is thought to be one of the common agents causing perioperative anaphylaxis. Here we report an anaphylactic shock after cesarean section that is suggested to be induced by the rocuronium–sugammadex complex. A 36-year-old primigravida underwent an elective cesarean section under general anesthesia due to placenta previa. While the operation was completed uneventfully, she developed anaphylactic shock following sugammadex administration. She was successfully managed with rapid treatments. Serum tryptase level was significantly elevated. Although sugammadex was first suspected to be the causative agent, the result of intradermal skin tests with sugammadex were negative. Surprisingly, a subsequent intradermal test with undiluted rocuronium caused the patient to fall into a state of shock. Furthermore, a later skin-prick test with pre-mixed rocuronium–sugammadex complex also revealed a strong positive reaction, and a test with only rocuronium showed negative. We finally concluded that the rocuronium–sugammadex complex is the causative agent in this case. To the best of our knowledge, this is the first report suggesting anaphylaxis caused by the rocuronium–sugammadex complex. This case highlights the importance of appropriate examinations to determinate the pathogenesis of anaphylaxis in order to establish risk reduction strategies.

http://ift.tt/2ksdkiZ

Supraglottic jet oxygenation and ventilation saved a patient with ‘cannot intubate and cannot ventilate’ emergency difficult airway

Abstract

The emergency difficult airway with the 'cannot intubate and cannot ventilate' (CICV) situation contributes to a high percentage of anesthesia- and emergency medicine-related morbidity and mortality. A new technique of supraglottic jet oxygenation and ventilation (SJOV) via the nasal approach was successfully used in an emergency to save a patient with a CICV difficult airway from a catastrophic outcome.

http://ift.tt/2jENaVK

Is ‘Group and Save’ Blood Request Routinely Required for Nasopharyngeal Biopsy?

Abstract

Objectives To establish our current practice of 'group and save' blood for nasopharyngeal tumour biopsy (NB), and to determine the rate of blood transfusions among patients who underwent NB under general anaesthesia. Methods A retrospective chart review of all patients who underwent biopsy of NB in our tertiary institution between January 2006 and December 2015 was undertaken. Those with Juvenile nasopharyngeal angiofibroma were excluded. Data retrieved included patients' characteristics such as age/sex, anaemia, primary tumour extension, and histology. Outcome measures included rate of 'group and save blood' requests, intra-operative blood loss, blood transfusion rates. Comparison was made between those that were requested to group and save blood prior to surgery (group 'A') and the group 'B' that were not so requested. Results We analysed eligible 103 cases (71 males and 32 females) out of 121 nasopharyngeal biopsies over the study period. 'Group and save' blood was undertaken in 47.6% (49/103) of our patients. Only 12.2% of the requested blood was transfused. Among evaluated patient characteristics, only oropharyngeal tumour extension differ between the study groups (P = 0.025). Overall, 14% had significant intra-operative blood loss (>500 ml), while 9.7% were transfused. The rates of blood loss and transfusion were not significantly different between the study groups (P = 0.22 and 0.09 respectively). Significant factors that influenced transfusion were pre-operative anaemia and oropharyngeal tumour extension. Conclusion There was high rate of arbitrary request for 'group and save blood' prior to NB in our institution over the last decade, which seems largely unnecessary. We recommend it be undertaken only in the presence anaemia and extensive oropharyngeal tumour extension.

http://ift.tt/2krn3FR

The effect of pre-operative topical anaesthetic cream on the ablative width and coagulative depth of ablative fractional resurfacing laser

Abstract

Topical anaesthetic cream (TAC) is commonly used as a pre-treatment of ablative fractional resurfacing (AFR) laser. Most of anaesthetic cream contains distilled water as major component. Therefore, pre-operative TAC may interfere the photothermal reaction in the skin treated with fractional carbon-dioxide (FCO₂) laser and fractional erbium-doped yttrium aluminium garnet (FEr:YAG) laser. The objective of the study was to compare the ablative width (AW) and coagulative depth (CD) of AFR laser with and without pre-treatment with TAC. Four Thai females who underwent abdominoplasty were included in the study. The excised skin of each subject was divided into four areas. TAC (eutectic mixture of local anaesthesia; EMLA) with 1-h occlusion was applied only on the first and second areas. The first and third areas were treated with FCO₂ at 15 mj and 5% density. The second and fourth areas were treated with FEr:YAG at 28 J/cm² and 5% density. Six biopsied specimens were obtained from each area. A total of 96 specimens (24 specimens from each area) were collected from four patients and examined randomly by two dermatopathologists. The ablative width and coagulative depth from each specimen were determined. In FCO₂-treated specimens, the mean AW of the specimens that were pre-treated with TAC and control was 174.86 ± 24.57 and 188.52 ± 41.32 μm. The mean CD of the specimens that were pre-treated with TAC and control was 594.96 ± 111.72 and 520.03 ± 147.40 μm. There were no significant differences in AW and CD between both groups (p = 0.53 and p = 0.15). In FEr:YAG-treated specimens, the mean AW of the specimens that were pre-treated with TAC and control was 381.11 ± 48.02 and 423.65 ± 60.16 μm. The mean CD of the specimens that were pre-treated with TAC and control was 86.03 ± 29.44 and 71.59 ± 18.99 μm. There were no significant differences in AW and CD between both groups (p = 0.16 and p = 0.24). The pre-treatment with TAC provided no statistically difference from the control group on AW and CD of both FCO₂ and FEr:YAG laser irradiation. However, there was a tendency to have narrower AW and deeper CD of the areas that were pre-treated with TAC when comparing to that of the control.

http://ift.tt/2jXVmno

A review of the mechanism of action of lasers and photodynamic therapy for onychomycosis

Abstract

Onychomycosis is one of the most common diseases in the field of dermatology. It refers to the fungal infection of the nail plate or nail bed with high incidence in the general population. The available treatment options for onychomycosis have limited use due to side effects, drug interactions, and contraindications, which necessitates the application of an alternative treatment for onychomycosis. In the recent years, lasers and photodynamic therapy (PDT) have been recognized as alternative treatment options. Most of the previous studies have found them to be safe and effective treatment modalities in this indication; however, the results varied greatly and the in vitro and in vivo outcomes are contradictory. In the present review, studies related to the mechanism of action of lasers and PDT for the treatment of onychomycosis will be discussed, with a focus on to find explanation to the contradictory results.

http://ift.tt/2kS7Jjr

Application of reflectance confocal microscopy to evaluate skin damage after irradiation with an yttrium-scandium-gallium-garnet (YSGG) laser

Abstract

The objective of this study was to observe the characteristics of the skin after irradiation with a 2790-nm yttrium-scandium-gallium-garnet (YSGG) laser using reflectance confocal microscopy (RCM). A 2790-nm YSGG laser was used to irradiate fresh foreskin (four doses, at spot density 3) in vitro. The characteristics of microscopic ablative columns (MAC), thermal coagulation zone (TCZ), and microscopic treatment zones (MTZ) were observed immediately after irradiation using digital microscope and RCM. The characteristics of MAC, TCZ, and MTZ with variations in pulse energy were comparatively analyzed. After irradiation, MAC, TCZ, and MTZ characteristics and undamaged skin between MTZs can be observed by RCM. The depth and width of MTZ obviously increased with the increase in pulse energy. At 80, 120, and 160 mJ/microbeam (MB), the MTZ actual area and proportion were about two times that of the theoretical value and three times at 200 mJ/MB. With increases in depth, the single MAC gradually decreased in a fingertip-shaped model, with TCZ slowly increasing, and MTZ slightly decreasing in a columnar shape. RCM was able to determine the characteristics of thermal injury on the skin after the 2790-nm YSGG laser irradiation with different pulse energies. Pulse energy higher than 200 mJ/MB may have much larger thermal injury and side effect. RCM could be used in the clinic in future.

http://ift.tt/2jXO6ry

Laser and LED phototherapy on midpalatal suture after rapid maxilla expansion: Raman and histological analysis

Abstract

The aim of this study was to analyze the effect of laser or LED phototherapy on the acceleration of bone formation at the midpalatal suture after rapid maxilla expansion. Forty-five rats were divided into groups at 7 days (control, expansion, expansion and laser irradiation, and expansion and LED irradiation) and into 14 days (expansion, expansion and laser in the 1st week, expansion and LED in the 1st week, expansion and laser in the 1st and 2nd weeks, expansion and LED in the 1st and 2nd weeks). Laser/LED irradiation occurred every 48 h. Expansion was accomplished with a spatula and maintained with a triple helicoid of 0.020-in stainless steel orthodontic wire. A diode laser (λ780 nm, 70 mW, spot of 0.04 cm², t = 257 s, SAEF of 18 J/cm²) or a LED (λ850 ± 10 nm, 150 ± 10 mW, spot of 0.5 cm², t = 120 s, SAEF of 18 J/cm²) was applied in one point in the midpalatal suture immediately behind the upper incisors. Raman spectroscopy and histological analyses of the suture region were carried and data was submitted to statistical analyses (p ≤ 0.05). Raman spectrum analysis demonstrated that irradiation increases hydroxyapatite in the midpalatal suture after expansion. In the histological analysis of various inflammation, there was a higher production of collagen and osteoblastic activity and less osteoclastic activity. The results showed that LED irradiation associated to rapid maxillary expansion improves bone repair and could be an alternative to the use of laser in accelerating bone formation in the midpalatal suture.

http://ift.tt/2kSe0LI

Low-level laser therapy as an adjunct to conventional therapy in the treatment of diabetic foot ulcers

Abstract

Foot ulcers are serious complications of diabetes mellitus (DM) and are known to be resistant to conventional treatment. This study was conducted to evaluate the efficacy of low-level laser therapy (LLLT) for the treatment of diabetic foot ulcers in a tertiary care centre (Department of Surgery, Mahatma Gandhi Memorial Medical College and Maharaja Yashwantrao Hospital, A.B. Road, Indore). A total of 30 patients with type 2 DM having Meggitt-Wagner grade I foot ulcers of more than 6 weeks duration with negative culture were studied. Patients were randomized into two groups of 15 each. Patients in study group received LLLT (660 ± 20 nm, 3 J/cm²) along with conventional therapy and those in control group were treated with conventional therapy alone. The primary outcome measure was the absolute and relative wound size reduction at 2 weeks compared to the baseline parameter. Percentage ulcer area reduction was 37 ± 9% in the LLLT group and 15 ± 5.4% in the control group (p < 0.001). For ∼75% of wounds of the treatment group, wound area reduction of 30–50% was observed. In contrast, for the control group, ∼80% of wounds showed a wound area reduction of <20% on day 15. Further, the wounds with initial wound area 1000–2000 mm² seems to have better final outcome than the groups with larger areas. The treated groups showed higher amount of granulation than the control group. The results suggest that LLLT is beneficial as an adjunct to conventional therapy in the treatment of diabetic foot ulcers.

http://ift.tt/2jXRNgS

Severe toxicity induced by accumulation of active sunitinib metabolite in a Japanese patient with renal cell carcinoma: a case report

Sunitinib is a multi-targeted tyrosine kinase inhibitor that is approved for treatment of renal cell carcinoma as an oral anticancer drug. Therapeutic drug monitoring of total sunitinib (sunitinib and N-desethyl ...

http://ift.tt/2jYI2iC

Safe and successful birth following pelvic radiotherapy for rectal mucosa-associated lymphoid tissue lymphoma: a case report

Mucosa-associated lymphoid tissue lymphomas can occur in various parts of the body, and half of mucosa-associated lymphoid tissue lymphomas occur in the gastrointestinal tract. Gastric mucosa-associated lympho...

http://ift.tt/2jW4Htx

A Novel Modified Tracheo-Esophageal Voice Prosthesis for Total Laryngectomy Patients

Conditions:   Laryngeal Cancer;   Hypopharynx Cancer
Intervention:   Device: Modified Trans-Esophageal Prosthesis
Sponsor:   HealthCare Global Enterprise Ltd.
Recruiting - verified January 2017

http://ift.tt/2krKm2z

Effect of a Combination of Local Steroid Injection With Oral Steroid Administration for the Prevention on Esophageal Stricture After Endoscopic Submucosal Dissection for Early Esophageal Neoplasm

Condition:   Esophageal Stricture
Interventions:   Drug: combination of local steroid injection（triamcinolone ）with oral steroid administration（prednisone）;   Drug: oral steroid administration（prednisone）
Sponsor:   Shanghai Zhongshan Hospital
Not yet recruiting - verified January 2017

http://ift.tt/2jE6lPE

A Trial of Intratumoral Injections of SD-101 in Combination With Pembrolizumab in Patients With Metastatic Melanoma or Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma

Conditions:   Metastatic Melanoma;   Head Neck Cancer
Interventions:   Drug: SD-101;   Biological: Pembrolizumab;   Drug: SD-101;   Biological: Pembrolizumab
Sponsors:   Dynavax Technologies Corporation;   Merck Sharp & Dohme Corp.
Recruiting - verified January 2017

http://ift.tt/2kWtMo7

Akutes vestibuläres Syndrom nach Kleinhirninfarkt

Zusammenfassung

Berichtet wird über eine Patientin mit wiederholten Drehschwindelattacken und einem Unsicherheitsgefühl über Wochen, eine ausführliche neurootologische und radiologische Diagnostik erfolgten. Pathologische Ergebnisse beinhalteten initial einen benignen paroxysmalen Lagerungsschwindel („benign paroxysmal positional vertigo", BPPV) rechts, einen persistierenden horizontalen Spontannystagmus (SPN) nach links und einen pathologischen Bedside- und Video-Kopfimpulstest („video-head impulse test", HIT) links. Der SPN nach links und der pathologische HIT links ließen eine zentrale Genese vermuten, sodass eine Magnetresonanztomographie des Kopfs (cMRT) veranlasst wurde, die einen Kleinhirninfarkt im Versorgungsgebiet des medialen Asts der A. cerebelli inferior posterior („posterior inferior cerebellar artery", mPICA) links zeigte.

http://ift.tt/2jYxoZb

Beziehung zwischen Funktionsendoskopie und Impedanz-pH-Metrie

Zusammenfassung

Die klassischen gastroenterologischen diagnostischen Werkzeuge stellen sich zunehmend als unzureichend für die schwierige kausale Zuordnung extraösophagealer Symptome zu einer vermuteten pathologischen Refluxaktivität dar. Einige neue methodische Ansätze, wie die funktionelle Endoskopie („videopanendoscopy", VPE), werden als hilfreich propagiert. Allerdings fehlen bisher noch Daten, die den Nutzen dieser Untersuchung objektiv belegen. In einer Pilotstudie wurde eine gute Korrelation des Reflux-Symptom-Index zu den Befunden der Endoskopie dokumentiert. Die Impedanz-pH-Metrie gilt aktuell als „Goldstandard" der Diagnostik der ösophagealen Refluxkrankheit. Ergänzend wurde jetzt die Beziehung funktionsendoskopischer Befunde zu den Ergebnissen der Impedanz-pH-Metrie bei Patienten mit extraösophagealen Symptomen untersucht. Dabei stellte sich heraus, dass pathologische Befunde der VPE mit den Ergebnissen der Impedanz-pH-Metrie in Bezug auf die Parameter „Refluxanzahl", „Fraktionszeit" und „DeMeester-Score" gut korrelieren.

http://ift.tt/2jW0oON

Submandibulärer Tumor

http://ift.tt/2jYzI2q

Sun Protection Factor Communication of Sunscreen Effectiveness

This study used a web-based experiment to evaluated whether dermatology experts are able to adequately assess improvements in sunscreen effectiveness.

http://ift.tt/2jwEiX7

Incorrect Author Affiliation and Error in Abstract Results and Findings of Key Points

In the Original Investigation titled "Incidence of and Risk Factors for Skin Cancer in Organ Transplant Recipients in the United States," published online January 11, 2017, the institutional affiliation for Mr Allen F. Shih was incorrect; he is affiliated with Yale New Haven Hospital. There was also an error in the abstract Results, as well as the Findings of the Key Points. The incidence ratio for posttransplant skin cancer overall was corrected to 1437 per 100 000 person-years, and the specific subtype rates for squamous cell carcinoma, malignant melanoma, and Merkel cell carcinoma were corrected to 812, 75, and 2 per 100 000 person-years, respectively. This article has been corrected online.

http://ift.tt/2kSOKFs

Comparison of Physical Pretreatment Regimens to Enhance Protoporphyrin IX Uptake

This randomized clinical trial compares the relative potential of different physical pretreatments to enhance protoporphyrin IX fluorescence among participants with normal skin before photodynamic therapy.

http://ift.tt/2jwGy0k

Transparent Reporting of Demographic Characteristics of Study Participants

By 2060, the US Census Bureau projections indicate that the United States will no longer have a single majority population; rather, the nation will be composed of a "plurality" of races and ethnic groups. In the early 1990s, congressional legislation set forth guidelines to include women and encourage the inclusion of members of racial and ethnic minority groups in federally sponsored human participant research. While substantial gains have been made regarding the participation of women in clinical research, the number of minorities appears to be lagging. Compliance with congressional mandates as well as valid analysis of differences between sexes or races/ethnicities requires an accurate system of inclusion data tracking.

http://ift.tt/2kSBIYw

Petechiae, Purpura, and Hemorrhagic Vesicles

A man presented with encephalopathy, recent falls, leukocytosis, nausea, and arthralgias, and progressing cutaneous eruption, scattered petechiae and hemorrhagic vesicles on the hands and feet, and palpable purpura were noted across the extremities. What is your diagnosis?

http://ift.tt/2jwEkhH

Trends in Geographic Distribution and Density of US Dermatologists

This study examines the geographic distribution and density of dermatologists in the United States using data from the American Academy of Dermatology database.

http://ift.tt/2kSJBwO

Adalimumab is a safe option for psoriasis patients with concomitant hepatitis B or C infection: a multicentre cohort study of 37 patients and review of the literature

Abstract

Background

Little data is available about the safety of TNF-α inhibitors in patients with HCV and HBV infection. In particular, data concerning the use of adalimumab in patients with psoriasis and concomitant viral hepatitis are lacking and little is known about the drug's real safety in this context.

Objective

to assess the long-term safety of adalimumab in a group of 17 consecutive psoriatic patients affected by chronic HBV infection and 20 consecutive psoriatic patients affected by chronic HCV infection.

Methods

Thirty-seven consecutive patients with psoriasis and concomitant HBV or HCV infection being treated with adalimumab at four Italian referral centres (Modena, Padova, Verona, Turin) were assessed before the treatment and at the end of follow-up. Viral load and radiological studies (echography, Fibroscan) were also carried out in some of the patients.

Results

The patients responded well to treatment and did not show any HBV or HCV reactivation in a mean follow-up period of 27 and 40 months, respectively. The fibrosis score in 8 HCV patients showed a slight reduction: pre-treatment mean value 5.83, post-treatment mean value 5.65.

Conclusion

The use of adalimumab seems to be safe in patients with severe psoriasis and HBV or HCV infection. Nevertheless, large-scale prospective studies will be able to provide vital information on the impact of anti-TNF treatment on hepatic function in patients with psoriasis and concomitant chronic HCV or HBV infection and appropriate monitoring scheduling.

This article is protected by copyright. All rights reserved.

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Perioperative Hyperalgesia and Associated Clinical Factors

Abstract

Purpose of Review

Pain has an important evolutionary role because it serves as an essential warning device to damaging stimuli. The perioperative setting is a unique environment where clinicians must accurately diagnose and address the source of pain. Modern-day perioperative pain control continues to be unsatisfactory. Nearly half of all surgical patients have moderate to severe pain postoperatively, and 24% experience inadequate pain relief. Furthermore, over half of the patients develop chronic pain after thoracotomies, mastectomies, and limb amputation surgeries. Hyperalgesia in the perioperative setting is an important and under-recognized source of morbidity during the perioperative course.

Recent Findings

Key sources of perioperative hyperalgesia include nociceptive-induced pain with surgical trauma, opioid-induced hyperalgesia, and inadequate control of pain in the preoperative setting. Research also hints that inhaled anesthetics may also play a role in the development of perioperative hyperalgesia. Despite new evidence, hyperalgesia remains difficult to diagnose and treat.

Summary

In our manuscript, we aim to help clinicians develop strategies to define, understand, diagnose, and treat perioperative hyperalgesia. Common mechanisms of perioperative hyperalgesia are delineated in an organized fashion with clinicians as the target audience.

http://ift.tt/2kqX4ie

SCAMPs for Multimodal Post-Operative Analgesia: A Concept to Standardize and Individualize Care

Abstract

Purpose of Review

We discuss the challenges and strategies in delivering post-operative pain relief that is both standardized and individualized as appropriate. Post-operative pain remains under-treated and is frequently complicated by side effects. Guidelines for multimodal analgesia report varying strengths of evidence. Additionally, there are particular evidence gaps in establishing how individual and population subgroups responses vary, due to pharmacogenetic, metabolic, and psychological variation.

Recent Findings

In cases where evidence is scarce or low quality, Standardized Clinical Assessment and Management Plans (SCAMPs) are an innovative method for healthcare practitioners to integrate available evidence resources and avoid unplanned variations in the quality of care delivered. Implementation of SCAMPs can be facilitated by the sheer volume of relevant information for drug prescribing and monitoring, drug-drug interactions, laboratory tests of organ function, drug metabolism and excretion data, electronic medical record data, and individual pharmacogenetic profile data.

Summary

Standardization of care using algorithms or computer-assisted prescribing is emerging as a useful tool to raise compliance where guidance does exist. Individualizing care may require computational analysis of vast quantities of individual and population data to support or lead clinician decision-making. Such technology is used widely across diverse fields ranging from meteorology and commerce to agriculture and gene sequencing, but there are particular applications and challenges within medicine. To maximize benefit and reduce harm from post-operative analgesia, standardization and individualization, such as SCAMPs must be balanced and employed as appropriate.

http://ift.tt/2jDfc42

Effects of targeted therapies on the bone in arthritides

Publication date: Available online 31 January 2017
Source:Autoimmunity Reviews
Author(s): Ágnes Szentpétery, Ágnes Horváth, Katalin Gulyás, Zsófia Pethö, Harjit Pal Bhattoa, Sándor Szántó, Gabriella Szücs, Oliver FitzGerald, Georg Schett, Zoltán Szekanecz
Inflammatory arthritides, such as rheumatoid arthritis (RA) and spondyloarthritides (SpA) have been associated with both localized bone resorption and/or formation, and generalized osteoporosis. Systemic inflammation may be the major driver for bone loss in arthritis. In RA and peripheral SpA the RANK-RANKL-OPG network is involved in bone resorption, while in axial SpA the Wnt-β-catenin axis and its inhibitors (DKK-1, sclerostin) are the most relevant. Targeted therapies including biologics and small molecule tyrosine kinase inhibitors may interfere with inflammatory bone metabolism. Most of these compounds are able to slow down radiographic progression and osteoporosis in arthritides. In very early cases of non-radiological SpA, there may be a window of opportunity allowing to prevent syndesmophyte formation. The inability of targeted therapies to increase the production of DKK-1 and sclerostin may explain the lack of efficacy of TNF inhibitors to halt syndesmophyte formation in SpA. Further clinical trials are needed to better understand the bone effects of targeted therapies.



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Demyelinating syndrome in SLE encompasses different subtypes: Do we need new classification criteria? Pooled results from systematic literature review and monocentric cohort analysis

Publication date: Available online 31 January 2017
Source:Autoimmunity Reviews
Author(s): Matteo Piga, Elisabetta Chessa, Maria Teresa Peltz, Alberto Floris, Alessandro Mathieu, Alberto Cauli
ObjectiveTo describe features of demyelinating syndrome (DS) in systemic lupus erythematosus (SLE).MethodsA systematic review using a combination of Mesh terms in PubMed and a retrospective analysis of 343 adult patients with SLE were carried out to identify patients with DS. Retrieved cases were classified as affected with DS according to 1999 ACR nomenclature and attributed to SLE by applying the 2015 algorithm. DS defined according to the clinical but not temporal 1999 ACR criteria was classified as clinically isolated syndrome (CIS).ResultsEstimated prevalence of DS (including CIS) in the SLE cohort was 1.3% and incidence rate was 1.5 cases per 1000 patient-years. Overall, 100 cases from literature review and 4 from SLE cohort were identified and are presented as a whole: 49 (47.1%) were classified as neuromyelitis optica spectrum disorders (NMOSD), 29 (27.9%) as CIS, 14 (13.5%) as NMO, 7 (6.7%) as DS prominently involving the brainstem and 5 (4.8%) as DS prominently involving the brain. DS was the SLE onset manifestation in 41 (39.4%) patients. Longitudinally extensive transverse myelitis was the most frequent manifestations being present in 73 (70.2%) patients (37 NMOSD, 21 CIS, 14 NMO, 1 DSB). Methylprednisolone pulses (79.8%) and cyclophosphamide (55.8%), but also plasma-exchange (16.3%) and rituximab (7.6%) in relapsing-refractory cases, were mostly prescribed. Complete recovery rate ranged between 62% in CIS to 7% in NMO.ConclusionDS in SLE is rare (1%) and encompasses different subtypes including CIS. Timely diagnosis and early treatment are recommended to minimize complications.



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The endothelial nitric oxide synthase (eNOS) polymorphism in otitis media with effusion (OME)

Publication date: February 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 134, Issue 1
Author(s): M. Ates, C. Cevik, R. Dokuyucu, O. Berber, S. Colak, M. Izmirli
ObjectivesOtitis media with effusion (OME) is the most common disease after viral infections of upper respiratory tract (URTI) in children. Studies indicate the important role of nitric oxide (NO) in the etiology of hearing loss. However, there is no study that focuses on the role of nitric oxide synthase (eNOS) polymorphisms in the cases with OME. The aim of the present study is to evaluate the eNOS polymorphisms in the pediatric patients with OME.Materials and methodsEighty-nine patients who are diagnosed with otitis media with effusion and 85 healthy subjects who are compatible in terms of age and gender were included in the study. All patients in the study were subjected to complete ear, nose, throat (ENT) and audiological examinations. DNA analysis was performed with polymerase chain reaction (PCR) technique from the blood samples. The PCR product was cut by restriction fragment length polymorphism (RFLP) with BanII enzyme and checked by agarose gel electrophoresis.ResultsAs a result of genetic analysis, there is no significant difference between patients and the controls in terms of eNOS Glu298Asp polymorphism (G/G, G/T, T/T). When these groups were compared in terms of allele distributions, a significant relationship was found between the patients and the controls (P=0.037).ConclusionTo the best of our knowledge, G allele was identified as predisposing to the development of OME and this is the first report indicates the correlation between the eNOS G894T polymorphism and OME in Turkey.



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Editorial Board

Publication date: February 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 134, Issue 1





http://ift.tt/2kRnM48

Intraorbital foreign body: A rifle bullet removed 20 years after the accident

Publication date: February 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 134, Issue 1
Author(s): P. Clarós, J.V.F. Fokouo, A. Clarós
IntroductionTrauma of the orbit and eyeball is common, but intraorbital bullet is a relatively rare event.Clinical casesThe authors report the management of a patient with chorioretinitis sclopetaria secondary to a gunshot wound twenty years previously.DiscussionThe clinical, diagnostic and therapeutic aspects of this unusual case of intraorbital foreign body are discussed.



http://ift.tt/2kgYkls

Thanks to reviewers

Publication date: February 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 134, Issue 1





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Dose adjustment of biologic therapies for psoriasis in dermatological practice: a retrospective study

Abstract

Introduction

Despite the large routine use of biologic drugs in psoriasis treatment, the majority of studies do not take into consideration dose-adjustment practice in "real life" dermatological setting.

In routine clinical practice the disease management may include a large number of conditions requiring non-standard dosage regimens, including dose-escalation, dose-reduction and/or off-label treatment interruption.

Objective

The ONDA (Outcome of non-standard dosing regimen in Psoriasis and Psoriatic Arthritis) study aim was to retrospectively analyse dose-adjustment strategies among biologic therapies for psoriasis in dermatological practice during a 3-year period.

Results

This retrospective, observational, multicentre study was carried out in 350 patients (68% male, 32% female) affected by plaque-type psoriasis (Pso) with a coexistence of psoriatic arthritis in 164 patients (46.9%). At baseline mean PASI score was 14.9 (SD 7.2). Dose-adjustment was demonstrated to be a common practice with 70/350 patients (20%) who needed a dose-variation during the treatment time, in particular a dose-increase in 20/70 patients (28.6%) and a dose-reduction in 50/70 patients (71.4%). Dose-increase was due to inefficacy on Pso parameters in 60% of cases and to inefficacy of PsA parameters in 40% of cases, while dose-reduction (or temporary off-label treatment interruption) was due to prolonged remission in 54% of cases, other reason in 18% of cases, patient choice or request in 14% of cases, occurrence of concomitant event in 12% of cases.

Conclusion

Dose-adjustment is a common clinical practice, consisting of frequent dose-reduction when a disease prolonged remission is obtained or dose-increase to improve efficacy on Pso and PsA disease parameters.

This article is protected by copyright. All rights reserved.

http://ift.tt/2kRvn2T