Head and Neck Medicine by Alexandros G.Sfakianakis: 02/08/17

Τετάρτη 8 Φεβρουαρίου 2017

Enhanced high-energy protocol using a fractional bipolar radiofrequency device combined with bipolar radiofrequency and infrared light for improving facial skin appearance and wrinkles

Summary

Background

Fractional bipolar radiofrequency treatment and treatment with bipolar radiofrequency combined with infrared light have been shown in previous trials to safely and effectively improve the appearance of facial wrinkles.

Aims

To evaluate a high-energy protocol with combined bipolar radiofrequency and infrared light energies for improvement in photoaged facial skin.

Patients/Methods

Seventy-two patients presenting with mild to moderate facial wrinkles underwent a single full-face treatment (n=54) or two treatments (n=18) at 6-week intervals. Independent blinded assessment and investigator assessment were performed, using the Fitzpatrick Wrinkle and Elastosis Scale (0-9) and the Global Aesthetic Improvement scale. Patients also completed a self-assessment questionnaire concerning satisfaction with the treatment.

Results

All patients achieved some degree of improvement in their wrinkles and skin appearance, following a single treatment or two treatments with the enhanced-energy protocol. Blinded evaluation demonstrated 71% and 70% of the patients showing improvement of one unit or greater on the Fitzpatrick Scale, at the 12-week and 24-week follow-ups post-treatment, respectively. Similar results were reported by investigators. Under the Global Aesthetic Improvement Scale, investigators observed 87%, 91% and 81% of patients showing improvement at the 6-, 12-, and 24-week post-treatment end, respectively. Patients tolerated the treatments well and were satisfied with the clinical results.

Conclusion

The enhanced-energy treatment protocol, with fractional bipolar radiofrequency treatment and treatment with bipolar radiofrequency combined with infrared light applications, yields significant improvement of skin texture, wrinkling, and overall appearance following a single treatment. The results appear gradually over time and are maintained for at least 6 months' post-treatment.

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Cutaneous manifestations in treated Whipple's disease

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Presence of antibodies against Legionella pneumophila in patients with pemphigus vulgaris

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Sebaceous carcinoma in solid organ transplant recipients

Abstract

Background

Though a rare tumor, sebaceous carcinoma is relatively well-described in immunocompetent patients, in whom it often occurs in a periorbital distribution where it has an overall poor prognosis with a high metastasis rate. The effect of transplant-related immunosuppression on the development of sebaceous carcinoma and its outcomes has not been characterized.

Methods

We collected 9 cases from a single institution of patients developing sebaceous carcinoma after solid organ transplantation. We analyzed clinicopathologic features.

Results

We estimate the prevalence of sebaceous carcinoma post-solid organ transplantation to be 0.09%. The mean age at diagnosis was 66.1 years (std 7.0 years). The mean time between transplantation and sebaceous carcinoma diagnosis was 7.1 years (std 5.1 years). All tumors occurred in extra-ocular distribution. Two patients likely had Muir-Torre syndrome, of whom 1 died from metastatic sebaceous carcinoma. No other patients developed metastatic disease or had disease-related death. Mohs micrographic surgery and wide local excision were equally effective and there were no recurrences with either procedure.

Conclusions

Our study found that sebaceous carcinoma in solid organ transplant recipients occurs in in an extraorbital distribution with only 1 patient developing metastatic disease. Both Mohs micrographic surgery and wide local excision are acceptable treatment modalities for sebaceous carcinoma in transplant recipients.

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Thyrotropin receptor gene expression in the association between chronic spontaneous urticaria and Hashimoto's thyroiditis

Abstract

Background

Chronic spontaneous urticaria (CSU) may be associated with autoimmune thyroid diseases, and the Autologous Serum Skin Test (ASST) is an autoreactivity marker. The thyrotropin (TSH) and TSH receptor (TSHR) could play a role in the pathogenesis of CSU. The aim of this study was to evaluate ASST positivity and TSHR gene expression in healthy skin and ASST wheals in euthyroid women with CSU, with (14 patients) and without (15 patients) Hashimoto's thyroiditis (HT).

Methods

ASST was performed and TSHR gene expression studied in wheals induced by ASST and in healthy skin.

Results

ASST presented greater positivity (86% × 40%) and larger diameter (10.8 × 9.6 mm) in the HT group (P < 0.05). TSHR gene expression was higher in the ASST area and healthy skin of HT group (P < 0.01). Positive correlation of antibodies levels with ASST wheal measurements and TSHR gene expression was seen.

Conclusions

Women with CSU and HT presented greater positivity and larger measurements for ASST and higher TSHR expression in the skin, suggesting association between CSU, thyroid autoimmunity, and TSHR.

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Erratum

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Issue Information - TOC

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Systematic review of laser therapy in xanthelasma palpebrarum

Abstract

Xanthelasma palpebrarum is a benign periorbital xanthoma with substantial cosmetic and psychosocial burden for patients. Treatment modalities should be considered based on efficacy as well as cosmetic outcome. Laser modalities in the treatment of xanthelasma palpebrarum have not been comprehensively reviewed and discussed. Accordingly, this study seeks to systematically and critically review the available literature discussing laser treatment of xanthelasma palpebrarum. PubMed was systematically reviewed for reports on laser therapy in the treatment of xanthelasma palpebrarum. A total of 21 studies were included in this review discussing laser treatment of xanthelasma palpebrarum. Laser types included carbon dioxide, yttrium aluminum garnet, pulsed dye, argon, and a 1450 nm diode laser. The carbon dioxide laser was the most commonly reported modality followed by yttrium aluminum garnet laser. All of the laser modalities offered moderate to excellent clearance rates with minimal side effect profiles. Further large scale studies comparing different laser modalities are required to determine the best laser modality. However, laser modalities as a whole offer a treatment option for xanthelasma palpebrarum, that is, cosmetically excellent with a reasonable side-effect profile.

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Modifications of body surface: piercings, tattoos, and scarification

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Opening new horizons in regenerative dermatology using platelet-based autologous therapies

Abstract

Biological therapeutic therapies are gaining the attention of scientists and medical doctors. Accumulating evidence suggests that blood-derived autologous therapies are safe and effective treatments for skin repair and wound healing. The fibrin network formed after plasmatic activation and the autologous growth factors released when platelets degranulate constitute a real biological medicine that has been shown to promote cell recruitment, stimulate new blood vessel formation, reduce inflammation as well as protect from local infections. This perspective highlights recent basic and clinical results published on blood-derived autologous therapies in the field of regenerative dermatology and discusses potential challenges and future prospects.

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Stimulation of Thyroid Function by Human Chorionic Gonadotropin During Pregnancy: A Risk Factor for Thyroid Disease and a Mechanism for Known Risk Factors

Thyroid , Vol. 0, No. 0.

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Consanguinity and the Risk of Hashimoto's Thyroiditis

Thyroid , Vol. 0, No. 0.

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Vitamin K Deficiency Presenting in an Infant with an Anterior Mediastinal Mass: A Case Report and Review of the Literature

We report a case of a 1-month-old infant with spontaneous thymic hemorrhage secondary to severe vitamin K deficiency. He was brought to medical attention due to scrotal bruising and during evaluation was noted to be tachypneic and hypoxemic. Chest X-ray revealed an enlarged cardiothymic silhouette, and a follow-up echocardiogram revealed a mass in the anterior mediastinum. Routine laboratory work-up revealed severe coagulopathy. Further questioning revealed the patient had not received prophylactic vitamin K at birth. The coagulopathy resolved with administration of vitamin K, and a biopsy confirmed the anterior mediastinal mass was due to spontaneous thymic hemorrhage.

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Synovial Sarcoma of the Larynx: Report of a Case and Review of Literature

Sarcomas account for less than 1% of malignant neoplasms arising in the head and neck in adults. Laryngeal synovial sarcoma is an extremely rare form of laryngeal malignancy with less than 20 cases reported in the literature. We report the case of a 48-year-old man with synovial sarcoma of the larynx. He underwent excision of the tumor followed by radiation. He is alive in remission at 36 months. The literature on synovial sarcoma of the larynx is reviewed.

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A systematic review and meta-analysis of pre-clinical studies assessing the effect of nicotine on osseointegration

Nicotine has been associated with vasoconstriction and an impaired cellular healing response. It is therefore likely that nicotine jeopardizes osseointegration. This systematic review and meta-analysis was performed to assess pre-clinical studies on the effect of nicotine on implant osseointegration. Databases were searched up to and including March 2016 for animal/non-human studies using the following Keywords: bone to implant contact; implant; nicotine; osseointegration; bone healing; and new bone formation.

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Surgical removal of keratocystic odontogenic tumours via a Le Fort I osteotomy approach: a retrospective study of the recurrence rate

The keratocystic odontogenic tumour (KCOT) is one of the most aggressive odontogenic cysts and has a high recurrence rate. The treatment of these tumours is the subject of debate. A KCOT in the posterior maxilla with sinus involvement is rare. Few reports have been published in the literature. The purpose of this study was to evaluate the recurrence rate after surgical removal of maxillary KCOTs via a Le Fort I osteotomy. A search was performed to identify patients with a follow-up time of at least 5 years.

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The relationship between neurofibromatosis type 1, juvenile xanthogranuloma, and malignancy: A retrospective case-control study

Neurofibromatosis type 1 (NF-1) predisposes individuals to the development of benign and malignant tumors. The association of NF-1, juvenile xanthogranuloma (JXG), and juvenile myelomonocytic leukemia has been described in the literature. It is unclear whether JXG alone constitute a risk factor for leukemia or other malignancies in children with NF-1.

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Understanding the cost of dermatologic care: A survey study of dermatology providers, residents, and patients

The American Academy of Dermatology recommends dermatologists understand the costs of dermatologic care.

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Prevalence of Skin Sensitization to Pollen of Date Palm in Marrakesh, Morocco

Background. Date palm's pollen has been identified as a source of allergy; the rate of sensitization of this pollen is between 6 and 29%. Objective. To determine the prevalence of sensitization to date palm in Marrakesh and to identify the clinical profile. Patients and Methods. This study is based on a questionnaire and the prick test on 7 allergens, in population aged 5 years and above with clinical symptoms suggesting allergic diseases, from November 2012 to February 2013 in Marrakech. Results. We included 468 patients (women: 79.5%). The prick tests were considered interpretable in 467 cases. The prevalence of skin sensitization to pollen of date palm was 6.6%. The 31 cases of sensitization to date palm involved 7 men and 24 women with an average age of 37.5 years. Cutaneous monosensitization to date palm's pollen was observed in 2 cases. Asthma, rhinitis, and conjunctivitis were recorded, respectively, in 48.4%, 93.5%, and 67.7%. Conclusion. Skin sensitization to pollen of date palm does not seem unusual among allergic patients in Marrakech and is comparable to that found in Casablanca (7%), Barcelona (6.6%), and Cartagena (6.1%).

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Histone deacetylase 7 silencing induces apoptosis and autophagy in salivary mucoepidermoid carcinoma cells

Abstract

Background

The overexpression of histone deacetylases (HDACs) has been observed in many cancers and inhibition of specific HDACs has emerged as a new target for cancer therapy. We found that HDAC7 expression was selectively reduced by HDAC inhibitor apicidin in salivary mucoepidermoid carcinoma (MEC) cells. Here, we show that HDAC7 suppression has a potent anti-tumor effect in MEC cells.

Methods

HDAC7 was knocked down using HDAC7 siRNAs and cell proliferation was quantified. Cell cycle progression, apoptosis, and autophagy were measured by flow cytometry and immunoblotting.

Results

HDAC7 siRNAs inhibited cell proliferation and c-Myc expression, increased p27 expression caused G2/M phase cell cycle arrest in both YD-15 and Mc3 cells. HDAC7 silencing increased the sub-G1 population, Annexin V positive apoptotic cells and cleaved caspase3 levels. HDAC7 silencing induced an increase in autophagic markers, number of acidic vesicular organelles, and LC3B II levels, and decrease in p62 levels. HDAC7 siRNAs reduced the activation of ERK. HDAC7 knockdown resulted in grow inhibition through G2/M phase cell cycle arrest and induced both apoptosis and autophagy in MEC cells.

Conclusions

This study indicates that inhibition of HDAC7 might become a novel and effective therapeutic approach for treating to MEC.

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Incidence of lip malignancies in Germany – data from 9 population-based cancer registries

Abstract

Background

The objective of this study was to analyse the incidence of lip malignancies in Germany.

Methods

Data from population-based cancer registries covering a population of 39 million inhabitants from 14 federal states were pooled. Lip malignancies were classified according to the International Classification of Diseases (ICD-10). Age-standardised incidence rates and annual percentage changes in the incidence trends of lip cancer (C00), melanoma of the lip (C43.0), and non-melanoma skin cancer of the lip (C44.0) were calculated.

Results

Lip cancer (C00) incidence rate was 0.57/0.15 per 100,000 (men/women) in 2003 and 0.52/0.18 in 2012. In women, the change was statistically significant.

Melanoma lip cancer (C43.0) incidence rates both in men and women were 0.02 in 2003 and 0.01 in 2012. Incidence rates of non-melanoma skin cancer of the lip (C44.0) significantly increased from 1.6 in 2003 to 2.1 in 2012 in men and from 1.5 in 2003 to 2.4 in 2012 in women.

In lip cancer (C00), the vast majority (98% in men / 93% in women) were squamous cell carcinomas and 2% / 7% were basal-cell carcinoma. In men, 56% of non-melanoma skin cancers (C44.0) were squamous cell carcinoma, whereas these were only 27% in women.

Conclusions

The incidences of non-melanoma skin cancer of the lip increased over time in Germany in both sexes. Lip cancer incidence increased in women, while it stayed stable in men. Melanoma of the lip did not change in incidence. The distribution of histology in non-melanoma skin cancer of the lip differed by sex.

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Zum Tode von Claus Walter – Pionier der plastischen Gesichtschirurgie

Laryngo-Rhino-Otol 2017; 96: 8-9
DOI: 10.1055/s-0042-122401

Georg Thieme Verlag KG Stuttgart · New York

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Prognosefaktoren für Langzeit-Tracheostoma nach Chemoradiatio

Laryngo-Rhino-Otol 2017; 96: 4-5
DOI: 10.1055/s-0042-113593

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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BAHA-Implantation: Weniger Hautkomplikationen durch lineare Inzision statt Flap

Laryngo-Rhino-Otol 2017; 96: 6-7
DOI: 10.1055/s-0042-121779

Georg Thieme Verlag KG Stuttgart · New York

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A Tribute to Tony Bull Surgeon, Teacher, Leader, Gentleman (1934 – 2016)

Laryngo-Rhino-Otol 2017; 96: 10-10
DOI: 10.1055/s-0042-122402

Georg Thieme Verlag KG Stuttgart · New York

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Einfluss des Überlappungsbereichs zwischen akustischer und elektrischer Stimulation

Laryngo-Rhino-Otol
DOI: 10.1055/s-0042-117639

Patienten mit residualem Tieftonhörvermögen sowie Hochtonsteilabfall mit an Taubheit grenzendem Hörvermögen bei mittleren und hohen Frequenzen werden durch Cochlea-Implantate mit elektrisch-akustischer Stimulation (EAS, „hybride" Stimulation) versorgt. Im Grenzbereich zwischen elektrischer und akustischer Stimulation kann es zu einer Überlagerung der beiden Reizformen kommen. Die Überlagerung wird bestimmt durch die Einführtiefe der Reizelektrode und der oberen Grenze des akustisch stimulierbaren Bereichs, sowie der Festlegung der Übertragungsbereiche (akustisch/elektrisch) durch den CI-Sprachprozessor. Die Studie untersuchte den Einfluss der Variation des elektrisch-akustischen Überlagerungsbereichs auf das Sprachverstehen im Störgeräusch, wobei die Breite der „Übertragungslücke" zwischen den beiden verschiedenen Reizmodalitäten durch 2 unterschiedliche Verfahren variiert wurde. Die an 9 erfahrenen Nutzern des MED-EL Duet 2 Prozessors ermittelten Ergebnisse zeigen, dass der elektrisch-akustische Übertragungsbereich und mit ihm die Trennfrequenz zwischen Akustik-Teil und CI individuell angepasst werden sollten. Weitere Studien müssen zeigen, ob allgemeingültige Aussagen zur Auswirkung der Überlagerung zwischen elektrischer und akustischer Stimulation möglich sind, wobei eine Vergrößerung des Probandenkollektivs sowie eine längere Eingewöhnungszeit vor Durchführung der Hörtests notwendig erscheinen.
[...]

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Influence of gender of the teaching staff on students’ acceptance of a virtual implant planning course

Acceptance of new technology is influenced by a number of situational and social factors. So far, only limited data are available on the influence of the teaching staff's gender on the acceptance of virtual dental implant planning by students. This study aimed at assessing the influence of the teaching staff's gender on the acceptance of a virtual implant planning course by male and female undergraduate dental students and their general attitude toward implantology.Two groups of third-year dental students (group 1, 9 males, 22 females; group 2, 12 males, 20 females) attended a virtual dental implant planning course.

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Thyroid High-Impact Articles

FREE ACCESS through February 20, 2017.
Read now:

Latest Impact Factor: 3.784
The Official Journal of: American Thyroid Association

Anti-Thyrotropin Autoantibodies in Patients with Macro-Thyrotropin and Long-Term Changes in Macro-Thyrotropin and Serum Thyrotropin Levels
Naoki Hattori, Takashi Ishihara, Naoki Matsuoka, Takanori Saito, Akira Shimatsu

No Effect of the Thr92Ala Polymorphism of Deiodinase-2 on Thyroid Hormone Parameters, Health-Related Quality of Life, and Cognitive Functioning in a Large Population-Based Cohort Study
Hanneke J.C.M. Wouters, Hannah C.M. van Loon, Melanie M. van der Klauw, Martin F. Elderson, Sandra N. Slagter, Anneke Muller Kobold, Ido P. Kema, Thera P. Links, Jana V. van Vliet-Ostaptchouk, Bruce H.R. Wolffenbuttel

Practical Performance of the 2015 American Thyroid Association Guidelines for Predicting Tumor Recurrence in Patients with Papillary Thyroid Cancer in South Korea
Seul Gi Lee, Woo Kyung Lee, Hye Sun Lee, Jieun Moon, Cho Rok Lee, Sang Wook Kang, Jong Ju Jeong, Kee-Hyun Nam, Woong Youn Chung, Young Suk Jo, Jandee Lee

Fusion Oncogenes Are the Main Genetic Events Found in Sporadic Papillary Thyroid Carcinomas from Children
Maria Isabel C. Vieira Cordioli, Lais Moraes, André U. Bastos, Paloma Besson, Maria Teresa de Seixas Alves, Rosana Delcelo, Osmar Monte, Carlos Longui, Adriano Namo Cury, Janete M. Cerutti

Single Point Mutations in Pediatric Differentiated Thyroid Cancer
Ali S. Alzahrani, Avaniyapuram Kannan Murugan, Ebtesam Qasem, Meshael Alswailem, Hindi Al-Hindi, Yufei Shi

Distribution of RET Mutations in Multiple Endocrine Neoplasia 2 in Denmark 1994-2014: A Nationwide Study
Jes Sloth Mathiesen, Jens Peter Kroustrup, Peter Vestergaard, Kirstine Stochholm, Per Løgstrup Poulsen, Åse Krogh Rasmussen, Ulla Feldt-Rasmussen, Mette Gaustadnes, Torben Falck Ørntoft, Thomas van Overeem Hansen, Finn Cilius Nielsen, Kim Brixen, Christian Godballe, Anja Lisbeth Frederiksen

The post Thyroid High-Impact Articles appeared first on American Thyroid Association.

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Is cricoid pressure effective in patients with achalasia?

Rapid sequence induction/intubation (RSII) is commonly used to anesthetize patients with achalasia but the effective cricoid pressure (CP) needed to occlude the esophageal entrance has not been established and its effectiveness has been questioned, since the dilated esophagus is wider than the cricoid cartilage. We document the effectiveness of CP using contrast imaging in a 34-year-old, 70kg symptomatic achalasia patient who consented for a contrast imaging study of the pharynx. The esophagus was emptied of 800ml of semi-liquid non-digested food.

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Can we reduce anesthesia exposure? Neonatal brain MRI: Swaddling vs. sedation, a national survey

Neonatal magnetic resonance imaging (MRI) is a diagnostic modality that requires minimal motion to acquire quality images. Sedation or even general anesthesia may be necessary to achieve acceptable scans. There is a growing body of literature, especially in animal studies, that links neurotoxicity with anesthetic exposure to the developing brain. There is no study outlining strategies used by neonatal intensive care units (NICU) to achieve quality MRI images with limited exposure to medications identified as possibly harmful to the developing brain.

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Do Nasal Surgeries Affect Mucociliary Clearance?

Abstract

The study was conducted to assess the impact of different nasal surgeries on the nasal mucociliary clearance mechanism. Mucociliary function of the nasal mucosa of patients who were undergoing various nasal surgeries was assessed by the Saccharin test by placing 5 mg saccharin granule on the anterior end of the inferior turbinate 1 day prior to the surgery. The time required for the test subject to experience a sweet taste was measured in minutes. Post-operatively the test was repeated 6 weeks after the surgery and the test times were compared. A total of 60 patients were part of this study. Of the 60 cases, 19 cases had undergone only septoplasty, 13 cases had undergone only functional endoscopic sinus surgery (FESS), 25 cases had undergone septoplasty with FESS, 2 cases underwent septoplasty with bilateral partial inferior turbinectomy (PIT) and one case was submucous resection (SMR). Significant improvement in nasal mucociliary clearance was observed in all the patients after the procedures. Out of the 19 cases of septoplasty, 57.9 % showed improvement on the right side and 47.4 % on the left side. Out of the 13 cases of FESS, 61.5 % showed improvement on the right side and 69.2 % on the left side. Out of the 25 cases of FESS with septoplasty, 76.0 % showed improvement on both sides. The case of SMR did not show improvement. The 2 cases of septoplasty with PIT showed improvement. Statistically, highly significant improvement of test time was seen postoperatively as compared to pre-operatively. Among the surgical procedures, FESS with septoplasty showed better improvement as compared to the other procedures. Based on the study, we can conclude that nasal surgeries done for correction of septal deviation and rhino sinusitis significantly improves nasal mucociliary clearance mechanism thereby improving the physiological functions of the upper airway.

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Thyroglossal Duct Cysts: A Clinicosurgical Experience

Abstract

Thyroglossal cyst is the most common congenital neck mass and occurs in 7% of the population. They occur due to failure of thyroglossal duct to involute and atrophy thyroglossal duct cysts often occur in pediatric patients. Majority of them are found infrahyoid region. The purpose of the present study is to report our 5 year clinical experience of thyroglossal cysts in terms of clinical features and surgical findings with special emphasis on naked eye extend of patent thyroglossal duct when present. To the best of our knowledge this is first clinical study which has reported the extend of thyroglossal duct on naked eye. This prospective observational study was done in the Postgraduate Department of ENT, Head and Neck surgery of Government medical college, Srinagar for a period of five years from January 2011 to January 2016. Thirty patients of histopathologically confirmed thyroglossal cysts were enrolled in the study. Patients were initially diagnosed on the basis of clinical history, examination and USG findings suggestive of cyst. Clinical data and surgical data in terms of size and location of cyst, presence or absence of thyroglossal duct etc. was analyzed and formulated in tables for patients who had histopathologically confirmed cyst. Mean age was 10 years. Majority (73.3%) were less than 15 years of age. Males were 22 in number (73.3%) while females compromised 26.7% of population. Ninety percent of patients presented with neck swelling. Erythema/redness over swelling was seen in 13.3% of patients. Majority (83.3%) of cysts were subhyoid in location. Thyroglossal ducts were seen to be patent for different lengths and areas. Majority of patients (80%) had tract arising from cyst and disappearing at superior border of hyoid body while three patients (10%) had patent thyroglossal duct from cyst to vallecular mucosa. A complete patent thyroglossal duct was seen in one patient (3.3%) from cyst to base of tongue. Complete Absent tract was seen in two patients (6.7%). Majority (70%) of cysts were having size between 1.6 and 3 cm. Intraoperative 10% of cyst got ruptured. Thyroglossal cysts are most commonly seen in pediatric males. Most of them present with visible midline neck swelling. In few cases cyst can rupture after repeated infections leading to sinus formation. Most of them are subhyoid in location. These cysts are usually of size 1.5–3 cm. Complete patent thyroglossal duct from cyst to tongue musculature is rarely seen while most of the times, a patent duct just disappears at the superior border of body of hyoid. None of our cysts had malignant features.

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Cut Throat Injury: Our Experience in Rural Set-Up

Abstract

Cut throat injuries are one of the emergency conditions managed by ENT specialists. If not treated in time, they may lead to death. Prevention of these complications depends on immediate resuscitation by securing the airway by tracheostomy or intubation, prompt control of hemorrhage and blood replacement. The present study was conducted to study the sociodemographic profile of patients of cut throat injury, motives behind cut throat injury, site and depth of the injury, treatment given at our hospital and outcome. A prospective study was done in the department of ENT in a tertiary care hospital of rural West Bengal between January 2014 and December 2015. Patients who were brought dead and minor neck injury were excluded from the study. Endotracheal intubation where possible, or emergency tracheostomy was done below the level of injury. Ryle's tube was inserted where necessary. Injured structures were repaired in layers. Among 22 patients there were 18 male and 4 female. The peak age of incidence was in the 4th decade of life. Suicidal cut throat injury was the most common mode of injury. Most of the injuries were in the zone II (72.73%). Three patients died due to severe haemorrhage and/or aspiration. Decannulation was possible in 9 out of 12 patients. Cut throat injuries have become a major cause of morbidity and mortality in our society. Patients with injury of larynx or upper trachea need preliminary tracheostomy. Post-operative endoscopy identifies nerve injuries and stenosis problems.

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Update on Potential Therapies for IgE-Mediated Food Allergy

Abstract

Purpose of Review

Food allergy is common, affecting up to 8% of children in the USA. Currently, therapy is limited to avoidance of the implicated allergen and availability of self-injectable epinephrine. However, several new approaches to food allergy are under investigation. This article reviews the published data on these new approaches.

Recent Findings

Oral immunotherapy, in which allergic subjects are exposed to increasing amounts of antigen, can be accomplished in the majority of allergic individuals. However, this approach is not a cure as most patients will react after cessation of regular intake. In addition, there is a high rate of side effects. Other approaches include epicutaneous immunotherapy, therapy with anti-IgE medications, and use of Chinese herbs.

Summary

Several novel approaches on food allergy are under study. At the current time, these approaches show promise for preventing severe reactions to accidental exposures. However, there is little evidence that current approaches will represent a true cure for food allergy.

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Update on Potential Therapies for IgE-Mediated Food Allergy

Abstract

Purpose of Review

Recent Findings

Summary

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Lipoprotein(a) in nephrological patients

Abstract

In contrast to existing EAS/ESC guidelines on the management of lipid disorders, current recommendations from nephrological societies are very conservative and restrictive with respect to any escalation of lipid lowering/statin therapy. Furthermore, lipoprotein(a) (Lp(a)) – an established cardiovascular risk factor – has not even been mentioned. While a number of retrospective and prospective studies suggested that Lp(a) has relevant predictive value and might have – at least in stage-3 chronic kidney disease (CKD) – the same negative effects if draged along in non-CKD patients, there is no guidance on diagnostic or therapeutic procedures. The persistent lack of recognition automatically leads to therapeutic nihilism, which might pose a number of relatively young patients to a significantly increased risk for adverse cardiovascular events. Further evaluation of Lp(a) in CKD is very important to provide appropriate treatment to patients with high Lp(a) levels, even in the presence of CKD.

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Assessment of the success rates of type 1 cartilage tympanoplasty in pediatric and adult patients

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Transcriptionally Active High-Risk Human Papillomavirus is Not a Common Etiologic Agent in the Malignant Transformation of Inverted Schneiderian Papillomas

Abstract

The role of human papillomavirus (HPV) as an etiologic and transformational agent in inverted Schneiderian papilloma (ISP) is unclear. Indeed, reported detection rates of HPV in ISPs range from 0 to 100%. The true incidence has been confounded by a tendency to conflate high- and low-risk HPV types and by the inability to discern biologically relevant from irrelevant HPV infections. The recent development of RNA in situ hybridization for high-risk HPV E6/E7 mRNA now allows the direct visualization of transcriptionally active high-risk HPV in ISP, providing an opportunity to more definitively assess its role in the development and progression of ISPs. We performed p16 immunohistochemistry and high-risk HPV RNA in situ hybridization on 30 benign ISPs, 7 ISPs with dysplasia, 16 ISPs with carcinomatous transformation, and 7 non-keratinizing squamous cell carcinomas (SCCs) with inverted growth that were unassociated with ISP. Transcriptionally active HPV was not detected in any of the 52 ISPs including those that had undergone carcinomatous transformation, but it was detected in two of seven (29%) non-keratinizing SCCs that showed inverted growth. There was a strong correlation between high-risk HPV RNA in situ hybridization and p16 immunohistochemistry (97%; p < 0.01). These results indicate that transcriptionally active high-risk HPV does not play a common role in either the development of ISP or in its transformation into carcinoma.

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Springer-Preis für Dermatologie 2017

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Topical Rapamycin for Facial Angiofibromas in a Child with Tuberous Sclerosis Complex (TSC): A Case Report and Long-Term Follow-up

Abstract

Tuberous sclerosis complex (TSC) is a genetic multisystem disorder with prominent skin involvement including facial angiofibromas that often appear in early childhood. Here we report the case of a 12-year-old girl with widespread disfiguring facial angiofibromas that were successfully treated with topical rapamycin, a mTOR inhibitor. A sustained remission of skin lesions was documented in detail over a 3-year follow-up. This case highlights the fact that topical rapamycin is a useful option in treating TSC-associated skin lesions. Especially in medically complex patients topical treatment may lessen the need for surgical interventions, reducing the risks of surgery, its adverse effects and permanent scarring. However, there is no standard dose or formulation at present. Topical rapamycin appears safe, but long-term maintenance therapy is necessary to prevent facial lesions from regrowth.

http://ift.tt/2kIzrPJ

Salivary levels of interleukin-8 and growth factors are modulated in patients with geographic tongue

Abstract

Objectives

The aim of the study was to determine the levels of salivary epidermal growth factor (EGF) and vascular endothelial growth factor (VEGF) as well as interleukin-8 (IL-8) in patients with geographic tongue (GT), as compared to control subjects.

Methodology

An enzyme-linked immunosorbent assay (ELISA) was used to measure the levels of IL-8, EGF, and VEGF in whole saliva samples collected from 34 patients with GT and 38 control subjects. The patients and controls were grouped and matched according to age, gender, and the presence of systemic diseases, which are factors that may influence the levels of salivary biomarkers.

Results

All patients with GT displayed significantly higher levels of IL-8 than the controls (P<0.001). The young female patients also showed reduced levels of EGF (P<0.05) and VEGF (P<0.05), as compared to the young male patients where no such differences were observed. Interestingly, high levels of IL-8 (P<0.001) and VEGF (P<0.05) were detected in the patients with GT who also suffered from hypertension.

Conclusion

We consider IL-8 an inflammatory mediator, which contributes to the acute inflammatory response found in GT. EGF and VEGF also seem to be involved in the pathophysiology of GT.

http://ift.tt/2knaPeF

Transcriptionally Active High-Risk Human Papillomavirus is Not a Common Etiologic Agent in the Malignant Transformation of Inverted Schneiderian Papillomas

Abstract

http://ift.tt/2kTVyoP

Prediction of clinical peanut allergy status among children in Hamilton, Ontario using chart review data collected during 2012–2015

Peanut sensitization does not necessarily indicate clinical peanut allergy, and uncertainty as to whether or not there is true peanut allergy can lead to increased anxiety and decreased quality of life for pat...

http://ift.tt/2ksDzov

Prevalence of allergen sensitization in 1000 adults in Saskatchewan

The prevalence of sensitization varies geographically based on multiple environmental factors including humidity. The aim of this study was to determine the prevalence of atopy in symptomatic adults. More impo...

http://ift.tt/2kIERKQ

Primum non nocere—first do no harm. And then feed peanut

The Addendum Guidelines for the Prevention of Peanut Allergy in the United States—Report of the NIAID-Sponsored Expert Panel were developed to build on previous food allergy guidelines after several key studies d...

http://ift.tt/2kTNHHs

Day-time variation of serum periostin in asthmatic adults treated with ICS/LABA and adults without asthma

We aimed to determine the effect of sampling time during the day on serum periostin levels in adult participants with and without asthma.

http://ift.tt/2kTL60d

Large hepatocellular carcinoma in a non-cirrhotic liver with peritoneal and omental metastasis in a healthy man: a case report

Liver cancer is the second leading cause of cancer death in men worldwide. Hepatocellular carcinoma usually develops in the setting of cirrhosis or chronic inflammation. Major risk factors for developing hepat...

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JAMA Dermatology Peer Reviewers in 2016

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Unusual Presentation of Poppers Dermatitis

This case report describes an unusual presentation of poppers (alkyl nitrites) dermatitis.

http://ift.tt/2h8yzSh

February 2017 Issue Highlights

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Errors in Figure and Caption

In the article titled "Symptomatic Congenital Hemangioma and Congenital Hemangiomatosis Associated With a Somatic Activating Mutation in GNA11," published online July 20, 2016, and also in the September 2016 issue of JAMA Dermatology, Figure 3B contained an alignment error, and the caption for Figure 3B incorrectly reported the number of nonreference exome sequencing reads. A Letter of explanation has been published, and the original article has been corrected online.

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A Skin Cancer Prevention Campaign

This Viewpoint describes a skin cancer prevention advertising campaign using messages on sugar packets in Portugal.

http://ift.tt/2ll6aOv

JAMA Dermatology —The Year in Review, 2016

In 2016, JAMA Dermatology's reach increased with an ever-broadening digital presence. The total number of views of our content was 3.2 million, which represents a 20% increase over 2015. One driver of our digital presence is the Patient Pages, which are published quarterly under the capable direction of Dr Misha Rosenbach. The graphic artists of The JAMA Network work with the authors to represent diseases in a compelling manner that cannot be caught by a camera. Each piece is heavily curated to achieve the goal of "telling the story" with easily understood graphics and language. The Patient Pages are offered free to convey information to people who have these diseases. The number of downloads per month provides a measure of the magnitude of the response to the Patient Pages. For example, the page on Raynaud phenomenon by Milam et al was downloaded 7229 times in a single month.

http://ift.tt/2lrHm3V

Insufficient Evidence of Cimetidine Benefit in Protoporphyria—Reply

In Reply We would like to thank Drs Langendonk and Wilson for their insightful comments that highlight the challenges of diagnosis and treatment of erythropoietic protoporphyria (EPP). We agree that data from the 3 cases may not be generalized until larger-scale rigorous clinical trials can be conducted. Nevertheless, the dramatic and rapid clinical improvements our patients experienced cannot be ignored. The overwhelming positive responses from the international EPP community have led us to believe that cimetidine has the potential to be a safe and effective addition to the management of EPP and warrants further study.

http://ift.tt/2ll7T6s

Patient-Acquired Photographs for Managing Postoperative Concerns

This quality improvement study assesses the utility of patient-directed photography for triaging and managing concerns that occur after dermatologic surgery.

http://ift.tt/2gpDOif

Tracing the Medicinal Acceptance of Aloe Vera

For many, a weekend of fun in the sun without the protection of sunscreen means heavy application of Aloe vera in the following few days. This leads to the question of when it was first discovered that A vera could be used to soothe skin damage, and the potential uses of this natural remedy. The use of A vera in clinical medicine cannot be understated; reported applications of this plant include seborrheic dermatitis, cystic acne, asthma, gonorrhea, and even the common cold.

http://ift.tt/2ll9x85

Spectrum of Diversity in Dermatology

The US Census Bureau projections show that by 2060, the non-Hispanic white population will no longer be the majority population in the United States and will be less than 44% with majority-minority crossover occurring around 2044. There will no longer be one population majority but instead a plurality of racial and ethnic groups. The underrepresentation of minorities in clinical research has been recognized for many years and resulted in national efforts to increase their participation. Lack of diversity in research participants impacts our ability to generalize results because studies may fail to detect relevant findings in specific groups owing to the effects of their unique mix of environmental, physiological, and cultural factors. The National Institutes of Health, the primary source of federal research funding in the United States, enforces a federal law that requires inclusion of women and minorities in all clinical research studies as appropriate for the scientific goals of proposed work. It is important that the scientific community recognize that diversity among research participants is not simply a government requirement but instead a scientific and ethical obligation needed to achieve equality and eliminate health disparities.

http://ift.tt/2j5uWwW

Dermatologists Must Take an Active Role in the Diagnosis of Cellulitis

Misdiagnosis of cellulitis presents dermatologists with both a responsibility to intervene medically as well as an opportunity to correct misperceptions about the scope of our dermatological clinical practice. Cellulitis is a common cutaneous disease in the United States, with an estimated prevalence of 14.5 million cases per year. Concern for cellulitis leads to about 2.8 million emergency department (ED) visits per year. But as Weng and colleagues demonstrate in this issue of JAMA Dermatology, cellulitis is widely misdiagnosed at a significant and unnecessary cost to our patients and health care system. Heath care costs in the United States are high and rising, and cellulitis misdiagnosis contributes to this larger problem. Weng and colleagues show that anywhere between $250 and $515 million are misspent in this way. In EDs and the inpatient setting, the treatment of cellulitis mimickers as true cellulitis leads to delayed diagnoses, complications, increased costs, and morbidity. We applaud the authors' efforts to quantify this common, expensive, and harmful practice gap, as well as senior author Dr Kroshinsky's continued efforts in this arena.

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Effectively Disclosing Skin Biopsy Specimen Test Results

This study attempts to determine the method by which patients prefer to be notified of skin biopsy results from follow-up appointments.

http://ift.tt/2h8yzBL

Costs and Consequences of Misdiagnosed Lower Extremity Cellulitis

This cross-sectional study examines the rate of misdiagnosed lower extremity cellulitis in patients admitted to the hospital from the emergency department and projects national estimates of associated health care costs.

http://ift.tt/2flgL8E

Severe Oral Ulcers Associated With Nivolumab Treatment

This case report describes a patient with severe oral ulcers associated with nivolumab treatment.

http://ift.tt/2gJ56SG

Cost-effectiveness of Skin Cancer Screening

This Markov model and budget effect analysis examines the cost-effectiveness of total-body skin examination and lesion-directed screening and assesses their budget effect and the influence on skin cancer epidemiological findings.

http://ift.tt/2h0CtfK

Error in Abstract Results

In the Original Investigation titled "Reexamining the Threshold for Reexcision of Histologically Transected Dysplastic Nevi," published online August 17, 2016, and also in the December 2016 print issue of JAMA Dermatology, there was an error in a percentage in the abstract Results. The sentence should read as follows: "Six of 304 (2.0%) observed DN subsequently developed melanoma at the same site, compared with 1 of 170 (0.6%) that were reexcised (P = .43)." This article has been corrected online.

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Ex Vivo Dermoscopy With Derm Dotting

This retrospective study evaluates the clinicopathological characteristics and usefulness of ex vivo dermoscopy with derm dotting for histopathologic diagnosis of skin tumors.

http://ift.tt/2hwP1Qp

The Evolution of Burn Therapy—Then and Now

The earliest known record of burn treatment is in the ancient Egyptian Ebers Papyrus (dated 1500 bc), which contains descriptions of applications of mud, excrement, oil, plant extracts, frogs boiled in oil, or fermenting goat dung. The Greeks and Romans used dressings impregnated with rendered pig fat, resin, and bitumen (Hippocrates, fourth century BC). Galen (ad 129-199) was known for being the first person to use cold water to treat burns. His treatments for most wounds included wine, vinegar, and water compresses. Today, studies have shown that cooling treatment decreases wound depth, reduces time for wound reepithelialization and requirement for grafting and scar management.

http://ift.tt/2k3BQrs

Epidermal Nerve Fiber Quantification in Erythromelalgia

This cohort study examines whether erythromelalgia is associated with a structural loss of small fibers using the epidermal nerve fiber density technique and compares this with functional studies of small nerve fibers.

http://ift.tt/2gpyf3c

Stevens-Johnson Syndrome—A Look Back

Stevens-Johnson syndrome (SJS) was first described in 1922 by the pediatricians A. M. Stevens and F. C. Johnson, who reported 2 cases of New York City children with a febrile, mucocutaneous eruption of a presumed infectious etiology (Figure). The 2 boys were from different neighborhoods, and there was no evidence of contact with one another. However, their clinical courses, including high fever, purulent eye and mouth discharge, and seasonal presentation, raised suspicion of an infectious cause. Apart from blindness (total in 1 child, partial in the other) both children made full recoveries with only supportive care received at Bellevue Hospital. Both boys were initially misdiagnosed as having hemorrhagic measles or "black measles" until Stevens and Johnson astutely recognized that the clinical morphologic characteristics and associated symptoms were quite unique and likely constituted a new entity.

http://ift.tt/2k3CGnZ

Is there a role for craniofacial surgery in the treatment of extensive or recurrent head and neck tumors involving cranial bases?

Publication date: Available online 8 February 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Chunyue Ma, Jun Li, Yi Shen, Yiqun Wu, Runjie Shi, Jian Sun
PurposeExtensive or recurrent head and neck tumors involving the cranial base are extremely difficult to treat on a surgical perspective. The purposes of this study are to estimate and identify factors associated with overall survival after traditional craniofacial resection of these cases, and to discuss the specific indications and treatment outcomes.MethodsFrom January 2005 to December 2014, a retrospective cohort study was performed with the analysis of the patients diagnosed with extensive or recurrent head and neck tumors extending to the skull base. The clinical records were reviewed for predictor variables regarding demographics, prior treatment status, pathologic characteristics, tumor sites and sizes, skull base bone or brain parenchyma invasions, reconstructive approaches, surgical margins and adjuvant therapies. The outcome variable was overall survival. Overall survival was estimated using Kaplan Meier methods and risk factors were identified using Cox modeling.ResultsThe cohort was composed of 119 subjects with a mean age of 44.53 years old and 67 (56.30%) were male. Through-and-through resection of the skull base bones (dural exposure) was performed in one hundred patients (84.03%). The overall complication rate for the entire group was 42.86% and the perioperative mortality was 2.52% (n=3). The mean follow-up period reached 43.88 months. Of these patients (n=116), 39 experienced local recurrences. After multivariate analysis, surgical margin (P=0.001), pathological classification (P=0.016), extent of skull base involvement (P=0.001) were found to be independent factors affecting overall survival.ConclusionCraniofacial surgery for extensive or recurrent skull base lesions is feasible on well-selected patients.

http://ift.tt/2kn78FN

The Role of Rifampin in Leprosy

This Viewpoint considers the role of rifampin in the substantial decline in the prevalence of leprosy.

http://ift.tt/2k3qYtz

A Growing Mass in the Nostril

A man in his 30s presented with a 1-cm growing mass in the right nostril that was nontender, exophytic, and verrucous. The lesion bled with minimal trauma but did not obstruct his breathing. What is your diagnosis?

http://ift.tt/2kmMQMn

Statistical Concerns on Vismodegib for Basal Cell Carcinoma Meta-Analysis—Reply

In Reply Regarding our article "Hedgehog Pathway Inhibitor Therapy for Locally Advanced and Metastatic Basal Cell Carcinoma: A Systematic Review and Pooled Analysis of Interventional Studies," Dr Lima draws attention to our pooled analysis methodology and applies a methodology for meta-analysis, thereby identifying a difference in confidence intervals while noting a small difference in mean values. He appropriately illustrates that it is very important for both authors and readers to understand the complex approaches in these types of studies.

http://ift.tt/2k3ibrC

Samuel L. Moschella, MD—An Exceptional Leader

One of the coauthors of the accompanying article, Dr Moschella, "Sam," was involved in the historical, clinical, and therapeutic aspects of turning the tide of the leprosy. Sam has devoted his professional life to teaching, and has earned the endless gratitude of countless residents, students and patients. Gone are the days when he would bound up 6 flights at the old Lahey Clinic building, or when he would play hockey with the priests on the Boston College rink. But, on his 90th birthday, he led the discussion at the Atlantic Dermatological Conference in Boston. Brilliantly!

http://ift.tt/2kmQfuM

Microbiopsy Biomarker Profiling in a Melanoma Resembling a Pigmented BCC

This case report describes microbiopsy biomarker profiling in a superficial melanoma that resembled a pigmented basal cell carcinoma.

http://ift.tt/2k3oAmw

Statistical Concerns on Vismodegib for Basal Cell Carcinoma Meta-Analysis

To the Editor The recent meta-analysis published by Jacobsen and colleagues in JAMA Dermatology amalgamated all available evidence pertaining the role of vismodegib for locally advanced and metastatic basal cell carcinoma. Well-conducted meta-analyses can provide more accurate estimates of response and safety and investigate further the reasons for clinical discrepancies across studies.

http://ift.tt/2kmRief

Association of Human Papillomavirus Vaccine With Keratinocyte Carcinomas

This report describes the reduction in skin cancers in 2 patients after the administration of the quadrivalent human papillomavirus vaccine.

http://ift.tt/2k3kniy

Efficiency of Ugly Duckling Sign in Melanoma Detection

This experimental study assesses the agreement of dermatologists on identification of the ugly duckling sign and estimates the contribution of intrapatient comparative analysis to the diagnosis of melanoma.

http://ift.tt/2kn5Muv

Parathyroid Cancer Versus Atypical Parathyroid Neoplasm; Investigating Their Clinical Characteristics and Biological Behavior

Conditions: Parathyroid Carcinoma; Parathyroid Neoplasm
Intervention: Other: Chart Review
Sponsor: M.D. Anderson Cancer Center
Recruiting - verified February 2017

http://ift.tt/2loDik5

Radiotherapy Related Skin Toxicity: Mepitel® vs. Standard Care in Patients With Locally Advanced Head-and-Neck Cancer

Condition: Head and Neck Neoplasms
Interventions: Other: Mepitel® Film; Other: Standard Care
Sponsor: University of Schleswig-Holstein
Not yet recruiting - verified February 2017

http://ift.tt/2kTvg62

February IFAR editorial

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Masthead - Editorial Board And Table of Contents

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Cognitive impairment and depressive symptoms coexisting in an elderly man

We report a case of a man aged 67 years presenting with recent depressive symptoms and paranoid ideations in addition to 1-year cognitive impairment. He has vascular risk factors and family history of memory loss. An episode of depression 2 decades ago resolved spontaneously but was followed by occupational decline. On mental state examination, he denied having depressed mood, hallucinations or delusions, but there were prominent word-finding difficulties and impaired attention and concentration.

http://ift.tt/2kmkt12

A complicated multisystem flare of systemic lupus erythematosus during pregnancy

We report a case of systemic lupus erythematosus (SLE) in a young woman who became pregnant amid a severe flare. She continued to have active disease in the face of aggressive treatments complicated by several side effects of immunosuppressive drugs including recurrent sepsis and gestational diabetes. Her fetus was at risk for congenital heart block during the second and third trimesters. Despite an extremely guarded prognosis, she delivered a healthy baby girl. This case highlights the complexities of SLE management during pregnancy. We discuss the therapeutic options available in pregnancy, and highlight the importance of cross-specialty multidisciplinary care in these women.

http://ift.tt/2k3f9U3

Disseminated intravascular coagulation-like reaction following rituximab infusion

Rituximab generally is a well-tolerated medication used in a variety of haematological and autoimmune conditions. The safety profile of the medication has been reviewed in the literature. Infusion reactions due to cytokine release are the most common side effects. With the increased use of rituximab, there is an increase incidence of cytopenias, most commonly thrombocytopenia and leucopenia. Coagulopathy is quite rare, reported previously in four cases in the literature. We highlighted the clinical course of a 39-year-old patient with precursor B-cell acute lymphoblastic leukaemia who was started on rituximab infusion. The patient developed a cytokine-release syndrome with haemodynamic instability, followed by rapid-onset cytopenias and disseminated intravascular coagulation abnormalities characterised by coagulopathy with fibrinolysis and mucocutaneous bleeding. The report is followed by a review of the literature. It is important to recognise rituximab-induced coagulopathy early as part of the differential diagnosis of thrombocytopenia and disseminated intravascular coagulation following rituximab administration.

http://ift.tt/2kmAmEx

Minor traumatic retroclival epidural haematoma in an adult

Description

A man aged 64 years was transferred to the emergency department because of a witnessed syncopal event. It occurred after standing up and he hit the back of his head against the ground. On arrival, the result of his neurological examinations was normal. Brain CT revealed a hyperdense mass lesion. It extended from the posterior aspect of the dens to the upper clival region (figure 1). Blood tests, including coagulation, had no abnormal findings. Dynamic MRI, magnetic resonance angiography and digital subtraction angiography revealed no meningeal tumours, aneurysms, traumatic arterial dissections, and visible fractures or dislocations in the skull base or craniocervical region.

Figure 1

Brain CT of the present patient showing gradual decrease in the retroclival epidural haematoma: CT taken initially (A), 2 hours later (B) and 8 days after the accident (C).

He was admitted for close neurological monitoring. On...

http://ift.tt/2k3bWEf

Case of Strongyloides hyperinfection syndrome

Description

A woman aged 36 years with untreated AIDS presented with symptoms of abdominal pain, increasing dyspnoea with haemoptysis and weight loss. Prior to arrival in the USA, she lived in the Democratic Republic of Congo. She was afebrile, and had bilateral expiratory wheezing on examination. T-helper CD4 cell count was 106 (9%) and HIV PCR quantification was 1 146 362 copies/mL. A CT scan revealed bilateral ground glass opacities, diffuse small bowel wall thickening and mild hepatosplenomegaly. A bronchoscopy with bronchoalveolar lavage (BAL) showed 11 nucleated cells/μL noted (11% neutrophils, 4% lymphocytes, 77% mononuclear cells and 8% eosinophils). BAL microscopy noted live Strongyloides larvae (video 1 and figure 1). Cytopathology studies were also notable for the presence of Strongyloides stercoralis larvae (figure 2). Blood cultures grew Klebsiella pneumoniae. This clinical amalgamation of enteritis, Gram-negative rod bacteraemia and pulmonary invasion of filariform larvae is classic...

http://ift.tt/2kmi0DW

Homonymous hemianopia in the primary antiphospholipid syndrome

A woman aged 26 years was referred by her GP to the eye casualty department with sudden-onset left homonymous hemianopia and right-sided headache. Full ophthalmic examination was normal with the exception of a left homonymous hemianopia confirmed with automated perimetry. Urgent CT imaging revealed a non-haemorrhagic cerebral infarct in the right parieto-occipital region. Subsequent blood tests confirmed a diagnosis of antiphospholipid syndrome with positivity in IgG anticardiolipin antibody, IgG anti-β2-GP1 antibody and the Lupus anticoagulant screen. MRI revealed extensive congenital abnormality at the Circle of Willis, affecting the right half of circulation. The unique dual pathologies may explain her predisposition to right-sided cerebral infarctions. This case highlights a rare but potentially fatal cause of visual disturbance in a young patient, and the importance of the multidisciplinary team approach in diagnosis and management.

http://ift.tt/2k34ecX

Cultivated limbal epithelial transplantation and penetrating keratoplasty postchemical injury: a 14-year follow-up

An 11-year-old girl presented to our tertiary eye care centre with a 9-month-old history of lime injury in the left eye in 1999 with vision of counting fingers close to the face. She initially underwent superficial keratectomy with amniotic membrane graft in 1999. Subsequently, cultivated limbal epithelial transplantation was performed in 2001 which improved her vision to 20/400. Following development of pannus and symblepharon in the left eye, she underwent pannus resection and conjunctival limbal autograft in 2002 and, a month later, optical penetrating keratoplasty (PK) following which her vision improved to 20/125. She was under regular follow-up, underwent exotropia correction and subsequent levator palpebrae superioris resection for ptosis and was maintaining good vision. On her last follow-up 14 years after PK in 2016, her vision in the left eye was 20/40 with lipid keratopathy and her right eye showed no signs of focal limbal stem cell deficiency.

http://ift.tt/2kmqDhI

Study of Distracted Bone in Maxilla: A Comparative Analysis

Abstract

Introduction

Anterior maxillary distraction is one of the accepted modalities to treat hypoplastic maxilla. The study was undertaken to assess the maturation of the bone formed, which is measured by analyzing the amount of mineralization of the bone.

Materials and Methods

For the study 29 patients were chosen, who were divided into three groups. First group consist of patients who had undergone distraction osteogenesis. Second group has cleft patients and third group is the control group. A bone biopsy using trephine drill is obtained from the subjects. This sample is subjected to Fourier transform infrared spectroscopy (FTIR).

Results

From the results a mineral to matrix ratio is obtained which is then compared between the three groups. There is a statistically significant difference between the mineralization of the three groups. The distracted bone shows the lowest mineralization while mineralization of the cleft bone is also less than the normal bone.

Conclusion

The study conclusively establishes that the distracted bone is not as mineralized as the normal bone. Although functionally the distracted bone is as good as the native bone and grafted bone as proved by the success rate of the implants placed. The study also highlights the use of FTIR for assessing the bone quality.

http://ift.tt/2k2Rm6W

Insulin effect on hearing recovery in idiopathic sudden sensorineural hearing loss: retrospective study of 145 patients

Abstract

1.We compared the hearing results of idiopathic sudden sensorineural hearing loss (ISSNHL) in normoglycemic patients versus those with pre-diabetes and diabetes mellitus (DM), including demographics and the impact of insulin administration.

2.The success rate for return of hearing in patients with DM was very high (80.0%) contrary to very low success rate for patients with pre-diabetes (38.2%).

3.High SD and MAGE in DM group could be explained by the effect of insulin and steroid treatment.

4.We believe the best explanation for the salutary impact of administration of insulin on hearing return was through reversal of ischemia

5.Intensive glucose management with insulin during steroid treatment in patients with ISSNHL and hyperglycemia beneficial to hearing recovery.

http://ift.tt/2km6jNs

Do Nasal Surgeries Affect Mucociliary Clearance?

Abstract

http://ift.tt/2klPOkc

Thyroglossal Duct Cysts: A Clinicosurgical Experience

Abstract

http://ift.tt/2k2qUKp

Cut Throat Injury: Our Experience in Rural Set-Up

Abstract

http://ift.tt/2klX3J7

Validation of published nomograms and accordingly individualized induction chemotherapy in nasopharyngeal carcinoma

Publication date: April 2017
Source:Oral Oncology, Volume 67
Author(s): Pu-Yun OuYang, Lu-Ning Zhang, Yao Xiao, Xiao-Wen Lan, Xiao-Min Zhang, Jun Ma, Fang-Yun Xie
ObjectivesWe have attempted to validate two published nomograms in nasopharyngeal carcinoma (NPC) and individualize induction chemotherapy (IC) accordingly.Materials and methodsFrom 2007 to 2011, 920 patients were included in the study. The validity of the nomograms was assessed by Harrell's concordance index (C-index), areas under the curve (AUC), and calibration curves. Disease-free survival (DFS) and overall survival (OS) by IC were evaluated in and out of risk stratified patients with and without propensity score matching analysis.ResultsCompared with the 7th edition of the Union for International Cancer Control (UICC) staging system, Tang's nomogram better discriminated DFS (C-index 0.629 versus 0.569, P=0.002; AUC 0.635 versus 0.576, P=0.018), whereas Yang's nomogram had no advantage in predicting OS (C-index 0.648 versus 0.606, P=0.184; AUC 0.643 versus 0.604, P=0.157). Calibration curves indicated good agreement between predicted and observed DFS or OS probability. Without risk stratification, patients achieved no benefit from IC in DFS (P⩾0.101) or OS (P⩾0.370). However, among 580 high-risk patients stratified by Tang's nomogram, IC improved five-year DFS from 68.8 to 74.8% (P=0.072), and OS from 82.6 to 87.9% (P=0.065), and the improvement of DFS and OS increased to 9.3% (P=0.019) and 7.3% (P=0.036), respectively, in 426 propensity-matched patients.ConclusionsTang's nomogram helps to stratify stage III-IVa-b NPC, and IC is beneficial to high-risk patients in clinical practice.

http://ift.tt/2k2wHuH

Re-irradiation for recurrent and second primary cancers of the head and neck

Publication date: April 2017
Source:Oral Oncology, Volume 67
Author(s): Maria A. Velez, Darlene Veruttipong, Pin-Chieh Wang, Robert Chin, Philip Beron, Elliot Abemayor, Maie St. John, Allen M. Chen
PurposeTo evaluate a single-institutional experience with the use of re-irradiation for recurrent and new primary cancers of the head and neck.MethodsThe medical charts of 80 consecutive patients who underwent re-irradiation for local-regionally recurrent or second primary head and neck cancer between November 1998 and December 2015 were analyzed. Multivariate analysis was performed using Cox proportional hazard and logistic regression to determine predictors of clinical outcomes.ResultsSeventy-six of the 80 patients were evaluable. The median age was 57.5 (range 26.6–84.9); Intensity-modulated radiotherapy (IMRT) was used in 71 (93.4%) patients with a median dose of 60Gy. Thirty-one patients (40.8%) underwent salvage surgery before re-irradiation and 47 (61.8%) received concurrent systemic therapy. The median time interval between radiation courses was 25.3months (range 2–322months). The 2-year estimates of overall survival, progression free survival, locoregional control, and distant control were 51.0%, 31.3%, 36.8% and 68.3%, respectively. Patients who underwent salvage surgery prior to re-irradiation had significantly improved locoregional control, progression free survival, and overall survival (p<0.05, for all). On multivariate analysis, gross tumor volume (GTV) at re-irradiation and interval between radiation courses were associated with improved overall survival. Severe (grade⩾3) late complications were observed in 25 patients (32.8%).ConclusionsRe-irradiation for recurrent or second primary head and neck cancer is feasible and effective in select patients with head and neck cancer. The high observed rate of treatment-related morbidity highlights the continue challenges that accompany this approach.

http://ift.tt/2kNmpTO

Shared genetic variants suggest common pathways in allergy and autoimmune diseases

Publication date: Available online 8 February 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Eskil Kreiner, Johannes Waage, Marie Standl, Susanne Brix, Tune H. Pers, Alexessander Couto Alves, Nicole M. Warrington, Carla MT. Tiesler, Elaine Fuertes, Lude Franke, Joel N. Hirschhorn, Alan James, Angela Simpson, Joyce Y. Tung, Gerard H. Koppelman, Dirkje S. Postma, Craig E. Pennell, Marjo-Riitta Jarvelin, Adnan Custovic, Nicholas Timpson, Manuel A. Ferreira, David P. Strachan, John Henderson, David Hinds, Hans Bisgaard, Klaus Bønnelykke
BackgroundThe relationship between allergy and autoimmune disorders is complex and poorly understood.ObjectiveTo investigate commonalities in genetic loci and pathways between allergy and autoimmune diseases to elucidate shared disease mechanisms.MethodsWe meta-analyzed two GWAS on self-reported allergy and sensitization comprising a total of 62,330 individuals. These results were used to calculate enrichment for SNPs previously associated with autoimmune diseases. Furthermore, we probed for enrichment within genetic pathways and of transcription factor binding sites, and characterized commonalities in the variant burden on tissue-specific regulatory sites by calculating the enrichment of allergy SNPs falling in gene regulatory regions in various cells using Encode Roadmap DHS data, and compared the allergy data with all known diseases.ResultsAmong 290 loci previously associated with 16 autoimmune diseases, we found a significant enrichment of loci also associated with allergy (p=1.4e-17) encompassing 29 loci at a false discovery rate<0.05. Such enrichment seemed to be a general characteristic for all autoimmune diseases. Among the common loci, 48% had the same direction of effect for allergy and autoimmune diseases. Additionally, we observed an enrichment of allergy SNPs falling within immune pathways and regions of chromatin accessible in immune cells that was also represented in autoimmune diseases, but not in other diseases.ConclusionWe identified shared susceptibility loci and commonalities in pathways between allergy and autoimmune diseases, suggesting shared diseases mechanisms. Further studies of these shared genetic mechanisms might help understanding the complex relationship between these diseases, including the parallel increase in disease prevalence.

Teaser

We identified shared susceptibility loci and commonalities in pathways between allergy and autoimmune diseases. Further studies of these loci and related mechanisms might help understanding the complex relationship between allergy and autoimmunity.

http://ift.tt/2kqu3m9

Congenital absence of sternum in an infant

Description

A female baby aged 6 months, born to non-consanguineous parents presented with anterior chest wall deformity since birth. On examination, an absent palpable sternum along with paradoxical respiratory movements with visible cardiac contractions and vasculature were seen beneath a thin layer of skin which led to the diagnosis of congenital absence of the sternum (figure 1 and video 1). The rest of the examination was found to be normal with no other obvious congenital anomalies. CT scan of the thorax showed mild shift of the mediastinum towards the right side with the pericardium abutting the anterior chest wall and absence of ectopiacardis. There was no other associated underlying malformation.

Figure 1

The absent sternum along with visible cardiac contractions and vasculature were seen beneath a thin layer of skin.

Video 1

The absent sternum along with visible cardiac...

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A Pediatric Case With Takotsubo Cardiomyopathy and Neurogenic Pulmonary Edema Due to an Epidural Hemorrhage.

No abstract available

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Journal Club.

No abstract available

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Yet Another Absolute Indication for Rapid Sequence Intubation.

No abstract available

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Perioperative Management of Adult Patients With External Ventricular and Lumbar Drains: Guidelines From the Society for Neuroscience in Anesthesiology and Critical Care.

External ventricular drains and lumbar drains are commonly used to divert cerebrospinal fluid and to measure cerebrospinal fluid pressure. Although commonly encountered in the perioperative setting and critical for the care of neurosurgical patients, there are no guidelines regarding their management in the perioperative period. To address this gap in the literature, The Society for Neuroscience in Anesthesiology & Critical Care tasked an expert group to generate evidence-based guidelines. The document generated targets clinicians involved in perioperative care of patients with indwelling external ventricular and lumbar drains. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved

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Reconstruction of Large Orbital Posterior Floor Wall Fracture Considering Orbital Floor Slope Using Endoscope.

Purpose: Reconstruction of a large orbital fracture extending to the posterior wall of the maxillary sinus is difficult and challenging. In this study, the authors present transconjunctival or transcaruncular approach using endoscopy and layered porous polyethylene barrier sheets to manage large orbital floor wall fracture. Methods: A retrospective review of all patients who underwent reconstruction of large orbital floor wall fractures between June 2009 and July 2015 was conducted. Patient demographics, degree of enophthalmos, ocular motility and diplopia test results, and surgical complications were reviewed. Results: This study included 53 eyes of 53 patients. The mean time from trauma to surgery was 34.1 days (range, 1-360 days). The average postoperative follow-up period was 6.1 months (range, 3-14 months). The degrees of enophthalmos preoperatively, and 1 week, 1 month, and 3 months postoperatively were -1.98 mm (range, -1.5 to -3 mm), 0.13 mm (range, -1.0 to +1.5 mm), -0.09 mm (range, -2.0 to +1.5 mm), and -0.43 mm (range, -2.0 to +1.0 mm), respectively. The mean improvement in enophthalmos at 3 months postoperation was 1.55 mm (P

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The Possible Role of Endoscopy in Diagnosis of Benign Tumors of the Nasal Cavity.

Background: Benign tumors of the nasal cavity represent a large variety of different histopathological entities. Although advances in nasal endoscopy over the past couple of decades have made it possible to detect the vast majority of these lesions, accurate diagnosis and proper management can be delayed since they are misdiagnosed as inflammatory paranasal sinus disease or simple epistaxis. Objectives: The aims of the present study are to determine the relative incidence of benign tumor of the nasal cavity and to provide typical endoscopic features of common tumors. This information can potentially improve clinicians' comprehension of benign tumors of the nasal cavity and be helpful in making provisional diagnosis. Results: The present study included 32 patients (25 males, 7 females) with benign tumor of the nasal cavity, which was pathologically confirmed. The most common symptom was nasal obstruction (12/37.5%), followed by recurrent epistaxis (7/21.9%). The most common involving site was anterior nasal septum (17/53.1%), followed by nasal vestibule (7/18.8%) and inferior turbinate (4/12.5%). The most common pathology was squamous papilloma (12/37.5%), followed by lobular capillary hemangioma (7/21.9%). The provisional diagnosis was easily made by nasal endoscopy in 19 (59.4%) patients with typical endoscopic features, especially squamous papilloma, lobular capillary hemangioma, and verruca vulgaris. Conclusions: Clinicians should keep in mind that benign tumors of the nasal cavity are included in the differential diagnosis of unilateral nonspecific nasal symptoms such as nasal obstruction and epistaxis. Also, clinicians should be familiar with the endoscopic findings of various benign tumors and perform the diagnostic approaches with the provisional diagnosis on the basis of those findings. (C) 2017 by Mutaz B. Habal, MD.

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Endoscopy-Assisted Transoral Versus Endoscopy-Assisted Transcervical Minimal Incision Plus Mandibular Osteotomy Approach in Resection of Large Parapharyngeal Space Tumors.

Background: Resection of the parapharyngeal space is often challenging. This study aims to evaluate the outcome of the endoscopy-assisted transoral approach for resection of the parapharyngeal space tumors compared with the endoscopy-assisted transcervical approach. Methods: Twenty-three consecutive patients (15 males, 8 females) who underwent resection of large parapharyngeal space tumors via endoscopy-assisted transoral (ETO) approach or endoscopy-assisted transcervical minimal incision plus osteotomy of the vertical ramus outside the mandibular foramen (ETC + MO) approach were analyzed retrospectively. Results: The tumors in ETO group are benign; there are 2 patients with adenoid cystic carcinoma and 1 patient with recurrent pleomorphic adenoma in ETC + MO group. All of the tumors were removed completely and without rupture. No major complications developed in any patient. Temporary facial paresis occurred in 1 patient in the ETC + MO group, which resolved spontaneously within 8 weeks. The cosmetic effects of all patients in ETO groups and 10 patients in ETC + MO groups were excellent. Patients were followed up for 7 to 26 months, no recurrence was encountered. Conclusion: ETO and ETC + MO approach in resection of large parapharyngeal space tumors are feasible and safe technique that achieve excellent aesthetic and functional results. Endoscopy-assisted transoral approach can shorten hospitalized time and avoid the risk of marginal mandibular nerve injury and ETC + MO approach may be used in malignant or recurrent parapharyngeal space tumors. (C) 2017 by Mutaz B. Habal, MD.

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Review of "Rational vs. Intuitive Judgment in Surgical Decision Making" by Morris AM in Ann Surg 264: 887-888, 2016.

No abstract available

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Review of "Infrared Thermal Imaging Has the Potential to Reduce Unnecessary Surgery and Delays to Necessary Surgery in Burn Patients" by Singer AJ, Relan P, Beto L, Jones-Kolinski L, Sandoval S, Clark RAF in J Burn Care Res 37: 350-355, 2016.

No abstract available

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Long-Term Outcome of Microautologous Fat Transplantation to Correct Temporal Depression.

Objective: Sunken temporal fossa appears oftentimes in Asians and resembles bad fortune that people wish to change. Numerous techniques and materials have been applied clinically for augmenting the sunken temporal fossa with variable results. The microautologous fat transplantation (MAFT) technique proposed by Lin et al in 2006 has demonstrated favorable results in facial rejuvenation. In the present study, the authors applied the MAFT technique with an innovative instrument in sunken temporal fossa and reported its results. Methods: Microautologous fat transplantation was performed on 208 patients during the 4-year period starting in January 2010. Fat was harvested by liposuction, processed and refined by centrifugation at 1200 g for 3 minutes. Then purified fat was microtransplanted to the temporal fossa with the assistance of an instrument, MAFT-Gun. The patients were followed up regularly and photographs were taken for comparison. Results: On average, the MAFT procedure took 48 minutes to complete. The average delivered fat was 6.8 +/- 0.2 mL/6.5 +/- 0.3 mL for the right/left side. The average follow-up period was 18 months. No complication including skin necrosis, vascular compromise, nodulation, fibrosis, and asymmetry was noted. The patient-rated satisfaction 5-point Likert scale demonstrated that 81.3% of all patients had favorable results (38.5% very satisfied and 42.8% satisfied). Conclusions: The concept and technique of MAFT along with the micro- and precise controlling instrument enabled surgeons to perform fat grafting accurately and consistently. In comparison with other strategies for volume restoration, the MAFT procedure demonstrated the patients' high satisfaction with the long-term results. Therefore, the potential of MAFT as an alternative strategy in sunken temporal fossa in Asians was emphasized. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://ift.tt/OBJ4xP (C) 2017 by Mutaz B. Habal, MD.

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Endoscopic Transnasal Transpterygoid Excision of an Infratemporal Dermoid Cyst.

Objective: Intracranial dermoid cysts are rare, slow-growing masses of sellar, parasellar regions, and posterior cranial fossa. The symptomatology of these cysts depends on the localization and presence of rupture. The preoperative diagnosis of these cysts by imagining techniques is distinctive as they have characteristic appearances. Patient: Endoscopic transnasal transpterygoid approach to infratemporal fossa for an extradural dermoid cyst of a 24 year-old woman is presented in this clinical report. Headache, dizziness, and retro orbital pain were her main complaints and diagnostic imagining studies designated an intracranial dermoid cyst preoperatively. The cyst was excised uneventfully with no recurrence 6 months after the operation. Conclusion: Surgery of intracranial lesions neighboring critical vital neurovascular structures can be challenging to the surgeon. Alternative minimal invasive approaches should always be considered for averting life-threatening complications. (C) 2017 by Mutaz B. Habal, MD.

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Αρχειοθήκη ιστολογίου

Τετάρτη 8 Φεβρουαρίου 2017

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