Τετάρτη 15 Φεβρουαρίου 2017
Regression of cutaneous xerosis with emollient treatment in sub-Saharan African patients
Abstract
Emollients have proven effective in improving cutaneous xerosis in various populations; however, no clinical data are available for African patients. The observational study "Xerafrica" was conducted by dermatologists in seven sub-Saharan countries to assess the evolution of xerosis after an 8-week treatment with an emollient. Patients were children above 3 years or adults. Secondary objectives were to assess pruritus, improvement in symptoms, quality of life, satisfaction, and tolerance. An analysis of 185 patients was made. After 8 weeks of emollient treatment, the relative reduction of the "Scaling Roughness Redness Cracks" (SRRC) score was −83.9% and −80.4% in children and adults, respectively. The effect was significantly stronger when topical steroids were co-prescribed with the emollient and in patients with co-dermatosis. To a lesser extent, the effect of emollient was also observed at week 4. Similarly, pruritus and quality of life strongly improved during follow-up. Skin lesions improved in almost all patients, with a high level of satisfaction noted by both dermatologists and patients. The "Xerafrica" study addressed, for the first time, the treatment of xerosis by emollients in an African population. In this specific context, the emollient markedly reduced xerosis as soon as 4 weeks and resolved it almost totally by 8 weeks. The study confirms, under real-life conditions, the efficacy and tolerability of an emollient in improving xerosis.
http://ift.tt/2lNBMw7
Hematemesis as Initial Presentation in a 10-Week-Old Infant with Eosinophilic Gastroenteritis
Eosinophilic gastroenteritis is a rare condition characterized by eosinophilic inflammation in the gastrointestinal tract resulting in a variety of gastrointestinal symptoms. There is currently a dearth of information on this topic in the pediatric literature, as very few cases have been reported. In this report, we present a case of eosinophilic gastroenteritis in a 10-week-old patient with initial presenting symptom of hematemesis. To our knowledge, this is the youngest case reported in the literature and is unique in its initial presentation.
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Vedolizumab treatment for immune checkpoint inhibitor-induced enterocolitis
Abstract
Immune checkpoint inhibitors (ICPI), such as ipilimumab [anti-cytotoxic T-lymphocyte antigen-4 (CTLA-4) antibody] and nivolumab or pembrolizumab [anti-programmed cell death protein-1 (PD-1) antibodies], improve survival in several cancer types. Since inhibition of CTLA-4 or PD-1 leads to non-selective activation of the immune system, immune-related adverse events (irAEs) are frequent. Enterocolitis is a common irAE, currently managed with corticosteroids and, if necessary, anti-tumor necrosis factor-α therapy. Such a regimen carries a risk of serious side-effects including infections, and may potentially imply impaired antitumor effects. Vedolizumab is an anti-integrin α4β7 antibody with gut-specific immunosuppressive effects, approved for Crohn's disease and ulcerative colitis. We report a case series of seven patients with metastatic melanoma or lung cancer, treated with vedolizumab off-label for ipilimumab- or nivolumab-induced enterocolitis, from June 2014 through October 2016. Clinical, laboratory, endoscopic, and histologic data were analyzed. Patients initially received corticosteroids but were steroid-dependent and/or partially refractory. One patient was administered infliximab but was refractory. The median time from onset of enterocolitis to start of vedolizumab therapy was 79 days. Following vedolizumab therapy, all patients but one experienced steroid-free enterocolitis remission, with normalized fecal calprotectin. This was achieved after a median of 56 days from vedolizumab start, without any vedolizumab-related side-effects noted. The patient in whom vedolizumab was not successful, due to active ulcerative colitis, received vedolizumab prophylactically. This is the first case series to suggest that vedolizumab is an effective and well-tolerated therapeutic for steroid-dependent or partially refractory ICPI-induced enterocolitis. A larger prospective study to evaluate vedolizumab in this indication is warranted.
http://ift.tt/2ljHHbZ
Non-impacted third molars affect the periodontal status of adjacent teeth: a cross-sectional study
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Zhi-Bang Li, Hong-Lei Qu, Li-Na Zhou, Bei-Min Tian, Li-Na Gao, Fa-Ming Chen
PurposeMost previous studies of the effect of third molars (M3s) on the health of adjacent second molars (A-M2s) have focused on impacted third molars (I-M3s). The purpose of this study was to investigate whether non-impacted third molars (N-M3s) may affect the periodontal status of A-M2s.Patients and MethodsIn this cross-sectional study, subjects (≥ 18 years) who had at least one quadrant with intact first and second molars anda non-impacted or absent M3 were enrolled in this study. The periodontal measures of M2 (6 sites) in the examined quadrants included the gingival index (GI), plaque index (PLI), probing pocket depth (PPD), clinical attachment level (CAL), gingival recession (GR) and bleeding on probing (BOP). The mean GI, PLI, PPD, CAL, BOP proportion and the proportion with at least one site with PPD ≥ 5 mm were compared usingthe T-test or chi-square test. The association of PPD5+ (%) or BOP (%) with the presence of N-M3s was assessed using a two-level logistic regression model (quadrant-based analysis).ResultsA total of 135 subjects (43.7% male, 40.6±11.5 years) were enrolled in this study. Subjects who had at least one quadrant with 3 intact molars and an N-M3 were enrolled in Group A (105 patients), while subjects who had at least one quadrant with intact first and second molars without an M3 were enrolled in Group B (30 patients). The periodontal parameters, i.e., GI, PLI, PPD, CAL, BOP and PPD5+, were significantly greater in Group A. When other factors associated with periodontal disease were controlled, N-M3s were associated with the PPD5+ (odds ratio, 6.7) and BOP (odds ratio, 4.0) of the A-M2s. Other factors positively associated with A-M2 PPD5+ were location on the mandible, age greater than 35 years and smoking.ConclusionsThe presence of N-M3s is a potential risk factor for the development of periodontitis in A-M2s.
http://ift.tt/2llNBZu
Sun-protective behaviors in patients with cutaneous hyperpigmentation: A cross-sectional study
Disorders of hyperpigmentation are seen commonly in clinical practice. Despite numerous studies investigating sun-protective habits among healthy persons, little is known about these behaviors within patient populations with hyperpigmentation disorders.
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The Vitiligo Working Group recommendations for narrowband ultraviolet B light phototherapy treatment of vitiligo
Treatment of vitiligo with narrowband ultraviolet B light (NBUVB) is an important component of the current standard of care. However, there are no consistent guidelines regarding the dosing and administration of NBUVB in vitiligo, reflected by varied treatment practices around the world.
http://ift.tt/2krMLvd
Neues zu Früherkennung und Screening
Das Hautkrebsscreening ist seit seiner Einführung in der Diskussion und auch weiterhin Gegenstand von Untersuchungen. So kamen auch im vergangenen Jahr Gegner und Fürsprecher zu Wort, zudem gibt es neue Kosten-Nutzen-Bewertungen, alternative Screeningmethoden und Ansätze, die Eigenuntersuchung zu verbessern.
http://ift.tt/2lSqrXL
Weiterhin ungebremster Zuwachs der Neuinfektionsrate
Ist die Zunahme der Syphilisinfektionen einer gefährlichen Sorglosigkeit geschuldet oder einer Rückkehr zur Normalität? Aktuelle Publikationen gehen von ersterem aus. Die Neuinfektionen sollten trotz neu erprobter Therapieregime und einer möglichen Therapieintensivierung leitliniengerecht behandelt werden.
http://ift.tt/2lS4ZSX
Rund um die Psoriasis
Psoriasispatienten leiden in den seltensten Fällen allein an ihrer Grunderkrankung. Betroffene sind sowohl für somatische als auch psychische Komorbidität anfällig. Durch die Beachtung psychischer Begleiterkrankungen und deren Behandlung durch die entsprechenden Fachkollegen könnten Haut, Gelenke und Psyche gleichermaßen positiv beeinflusst werden.
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Atopische Dermatitis: Was ist in der Pipeline?
In den letzten Jahren wurden mehrere neue Systemtherapien für die Psoriasis zugelassen. Bei der atopischen Dermatitis – einer anderen dermatologischen Volkskrankheit – nehmen Neuentwicklungen auch an Fahrt auf. Zahlreiche Angriffspunkte werden untersucht, darunter der Histamin-4-Rezeptor und diverse Interleukinrezeptoren. Auch zur Immunadsorption und zur Stammzelltherapie gibt es aktuelle Studiendaten.
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Besondere Lokalisationen
Pigmentierte Läsionen präsentieren sich in besonderen Lokalisationen wie zum Beispiel der Mukosa oft untypisch. Ob in solchen Fällen die Auflichtmikroskopie zur Diagnosesicherung überhaupt dienlich ist, war lange strittig, zumal es ob der Seltenheit von Schleimhautmelanomen nur wenig valides Datenmaterial gab. Erst in den letzten Jahren wurden neue, wichtige Erkenntnisse gewonnen.
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Neues zu In-vitro-Diagnostik, Autoinjektoren und Kounis-Syndrom
Warum funktioniert die SIT mit Bienengift schlechter als bei Wespengift? Was ist die ideale Nadellänge für einen Adrenalinautoinjektor? Wie stellt man sicher, dass man ein Kounis-Syndrom nicht übersieht? Diese und weitere Fragen wurden im Rahmen des aktuellen Derma Updates diskutiert.
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Malignomrisiko erfordert enges Monitoring
Zusammenfassung
Die Therapieoptionen der zur Gruppe der inflammatorischen Myopathien zählenden Dermatomyositis sind nach wie vor nicht zufriedenstellend. Dafür wurde in den letzten Jahren die Diagnostik verfeinert: Unter anderem ermöglichen neue Biomarker eine Verlaufsüberwachung oder eine Zuordnung zu Erkrankungsgruppen. Weiterhin bleibt aufgrund der Tumorassoziation eine engmaschige Überwachung notwendig.
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Clinical markers of asthma and IgE assessed in parents before conception predicts asthma and hay fever in the offspring
Abstract
Background
Mice models suggest epigenetic inheritance induced by parental allergic disease activity. However, we know little of how parental disease activity before conception influences offspring's asthma and allergy in humans.
Objective
We aimed to assess the associations of parental asthma severity, bronchial hyperresponsiveness (BHR), and total and specific IgEs, measured before conception vs after birth, with offspring asthma and hay fever.
Methods
The study included 4293 participants (mean age 34, 47% men) from the European Community Respiratory Health Survey (ECRHS) with information on asthma symptom severity, BHR, total and specific IgEs from 1991-1993, and data on 9100 offspring born 1972-2012. Adjusted relative risk ratios (aRRR) for associations of parental clinical outcome with offspring allergic disease were estimated with multinomial logistic regressions.
Results
Offspring asthma with hay fever was more strongly associated with parental BHR and specific IgE measured before conception than after birth (BHR: aRRR=2.96 [95% CI: 1.92, 4.57] and 1.40[1.03, 1.91], respectively; specific IgEs: 3.08[2.13, 4.45] and 1.83[1.45, 2.31], respectively). This was confirmed in a sensitivity analysis of a subgroup of offspring aged 11-22 years with information on parental disease activity both before and after birth.
Conclusion & Clinical Relevance
Parental BHR and specific IgE were associated with offspring asthma and hay fever, with the strongest associations observed with before conception as compared to after birth of the child. If the hypothesis is confirmed in other studies, parental disease activity assessed before conception may prove useful for identifying children at risk for developing asthma with hay fever.
This article is protected by copyright. All rights reserved.
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Buccal Films as a Dressing for the Treatment of Aphthous Lesions
Abstract
Background
Buccal flexible films in the form of solid, thin, mucoadhesive patches can be used as dressings separating aphthous lesions from the environment of the oral cavity, which can in turn shorten the treatment period and reduce the pain perception.
Methods
The clinical study was performed on 36 volunteers suffering from aphthous lesions. The first group was treated using standard means - by application of an oral gel containing cholin salicylas (Mundisal) on the aphthous lesion. The second group was treated with the same preparation, however, the lesion was covered with a mucoadhesive film following the application of the gel. The criteria for statistical evaluation were the size of lesions in relation to the length of the treatment and the subjective perception of the treatment results.
Results And Conclusions
The application of buccal films covering aphthous lesions during the treatment significantly increased the rate of healing when compared with the standard methods of treatment. While the pain improvement was statistically significant as soon as Day 3 in the experimental group, it was only apparent on Day 5 in the control group, and the number of successfully treated patients (pain perception improving to VAS 2 or less) was at all time points higher in the experimental group than in the control group. The results imply that the use of buccal films for treatment of aphthous lesions is very promising and can lead to a significant reduction of the duration of patients' discomfort.
This article is protected by copyright. All rights reserved.
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Low prevalence of human papillomavirus in head and neck squamous cell carcinoma in the northwest region of the Philippines
by Pia Marie Albano, Dana Holzinger, Christianne Salvador, Jose Orosa III, Sheryl Racelis, Modesty Leaño, Danilo Sanchez Jr, Lara Mae Angeles, Gordana Halec, Markus Schmitt, John Donnie Ramos, Michael Pawlita
BackgroundGeographic heterogeneity of human papillomavirus (HPV) involvement in head and neck squamous cell carcinoma (HNSCC) has been observed over the last few years. This trend has not been evaluated in the Philippines. Hence, this study aims to provide for the first time a data on the prevalence of HPV in HNSCC in the northwestern region of the Philippines.
MethodsTwo hundred one (201) biopsy samples (179 formalin fixed paraffin embedded and 22 fresh frozen) from 163 Filipino HNSCC cases (oral cavity = 88; larynx = 60; oropharynx = 15) diagnosed between 2003 to 2013 were initially included in this study. HPV DNA was detected by two methods: (1) BSGP5+/6+-PCR/ multiplex human papillomavirus genotyping and (2) TaqMan probes-based real-time qPCR. Presence of HPV type-specific transcripts were also analyzed by reverse transcription-PCR with subsequent hybridization to oligonucleotide probes coupled to Luminex beads. Co-amplification of the β-globin and ubiquitin C genes served as internal positive controls for DNA and RNA analyses, respectively.
Results and conclusionsOf the 163, 82 (50.3%) cases had at least one tissue sample that was valid for molecular analysis. Only two of the DNA valid cases (2.4%) were HPV DNA-positive (HPV11 and HPV33). All HPV mRNA assays rendered negative results except for HPV11 transcripts. Results of this study may indicate that there is probably very low prevalence of HPV-associated HNSCC among Filipino adults living in a rural region of the Philippines. This study could serve as a benchmark for designing follow-up studies that would assess possible changes in trends of HNSCC among Filipinos in different ethnic regions of the country, especially urban areas in which the population is expected to adapt Western style sexual behavior. A prospective sampling of fresh frozen tissue is also highly recommended to ensure better molecular analyses.
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R248G cystic fibrosis transmembrane conductance regulator mutation in three siblings presenting with recurrent acute pancreatitis and reproductive issues: a case series
Mutational combinations of the cystic fibrosis transmembrane conductance regulator, CFTR, gene have different phenotypic manifestations at the molecular level with varying clinical consequences for individuals po...
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O 6 -Benzylguanine-Potentiated Topical Carmustine for Mycosis Fungoides
This phase 1-2 trial evaluates the use of combination therapy with O6-benzylguanine and carmustine to determine the maximum tolerated dose in patients with stage IA or stage IIA cutaneous T-cell lymphoma, mycosis fungoides type.
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Noninsulated Microneedle Fractional Radiofrequency for Radiation Dermatitis
This case report describes the treatment of chronic radiation dermatitis with noninsulated microneedle fractional radiofrequency.
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Photodynamic Therapy With and Without Ablative Fractional Laser
This randomized clinical trial examines the efficacy of 1 session of ablative fractional laser-primed photodynamic therapy compared with 2 sessions of conventional methyl aminolevulinate photodynamic therapy for the treatment of microinvasive squamous cell carcinoma.
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NOT RECLUSE
This Viewpoint suggests a mnemonic device to avoid false diagnoses of brown recluse spider bites.
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Crusted Papules and Pustules on the Leg After a Trout Fishing Trip
A woman in her 20s presented with aerythematous, crusted, edematous plaques and pustules with weeping of yellow exudate on her left leg 3 days after returning from a trout fishing trip in a freshwater lake. What is your diagnosis?
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Bilateral Sinonasal Extramedulary Plasmacytoma treated with radiotherapy and a Medial Maxillectomy with a Denker's procedure
Source:American Journal of Otolaryngology
Author(s): Samuel N. Helman, Peter Filip, Codrin Iacob, Patrick Colley
http://ift.tt/2kyl0wc
Nasal juvenile angiofibroma: Current perspectives with emphasis on management
ABSTRACT
Juvenile angiofibroma is an uncommon, benign, locally aggressive vascular tumor. It is found almost exclusively in young men. Common presenting symptoms include nasal obstruction and epistaxis. More advanced tumors may present with facial swelling and visual or neurological disturbances. The evaluation of patients with juvenile angiofibroma relies on diagnostic imaging. Preoperative biopsy is not recommended. The mainstay of treatment is resection combined with preoperative embolization. Endoscopic surgery is the approach of choice in early stages, whereas, in advanced stages, open or endoscopic approaches are feasible in expert hands. Postoperative radiotherapy (RT) or stereotactic radiosurgery seem valuable in long-term control of juvenile angiofibroma, particularly those that extend to anatomically critical areas unsuitable for complete resection. Chemotherapy and hormone therapy are ineffective. The purpose of the present review was to update current aspects of knowledge related to this rare and challenging disease. © 2017 Wiley Periodicals, Inc. Head Neck, 2017
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Prognostic markers in metastatic cutaneous squamous cell carcinoma of the head and neck
ABSTRACT
Background
The minority of head and neck cutaneous squamous cell carcinomas (SCC) metastasize to regional lymph nodes. The purpose of this study was to describe the clinical outcomes and prognostic factors for patients with node-positive head and neck cutaneous SCC who underwent lymphadenectomy.
Methods
We conducted a retrospective single center study using the Kaplan–Meier method for the investigation of the overall survival (OS) and locoregional control rates. The Cox proportional hazards model was evaluated to identify prognostic factors.
Results
The median number of positive lymph nodes from 149 lymphadenectomies was 2 in the neck and 1 in the parotid gland. The 5-year OS and locoregional control rates were 50% and 77%, respectively. OS was worse among older patients (hazard ratio [HR], 1.04; p = .015), immunosuppressed patients (HR, 2.06; p = .034), and patients with a high total lymph node ratio (calculated from the number of positive lymph nodes divided by the total number of nodes; multivariate analysis [MVA]; HR, 1.13; p = .019).
Conclusion
Low total lymph node ratio is associated with improved outcomes in node-positive head and neck cutaneous SCC. © 2017 Wiley Periodicals, Inc. Head Neck, 2017
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Utility approach to decision-making in extended T1 and limited T2 glottic carcinoma
ABSTRACT
Background
It is still undecided if endoscopic laser surgery or radiotherapy is the preferable treatment in extended T1 and limited T2 glottic tumors. Health utilities assessed from patients can aid in decision-making.
Methods
Patients treated for extended T1 or limited T2 glottic carcinoma by laser surgery (n = 12) or radiotherapy (n = 14) assigned health utilities using a visual analog scale (VAS), time tradeoff (TTO) technique and scored their voice handicap using the Voice Handicap Index (VHI).
Results
VAS and TTO scores were slightly lower for the laser group compared to the radiotherapy group, however, not significantly so. The VHI showed a correlation with the VAS score, which was very low in both groups and can be considered (near) normal.
Conclusion
Patients show no clear preference for the outcomes of laser surgery or radiotherapy from a quality of life (QOL) or voice handicap point of view. These data can now be incorporated into decision-making models. © 2017 Wiley Periodicals, Inc. Head Neck, 2017
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Biologische Therapien in der Otologie
Zusammenfassung
Mehrere Millionen Menschen weltweit leiden an Hörverlust. Derzeitige Therapien für Patienten mit hochgradigem Hörverlust beschränken sich auf die Versorgung mit einem Cochleaimplantat. Sofern der Hörnerv intakt ist, profitieren die behandelten Personen enorm, und ein Sprachverstehen ist wieder möglich. Allerdings gibt es nach wie vor Einschränkungen, die aus technologischer Sicht nicht angegangen werden. Neuartige Ansätze, basierend auf Zelltransplantation und Gentherapie, entwickeln sich rapide, zumindest im experimentellen Sektor. Klinische Translationsansätze indes sind, verglichen mit der Fülle an Grundlagenforschung auf diesem Gebiet, eher rudimentär. Die vorliegende Übersichtsarbeit konzentriert sich daher zum einen auf translationsfähige Ansätze und die zu überkommenden Hindernisse bei der Translation, zum anderen auf erste klinische Ansätze biologischer Therapien bei hochgradiger Schwerhörigkeit, insbesondere in Verbindung mit einer Cochleaimplantation.
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Opsoclonus
Description
An Iranian boy aged 15 years presented with a few day's history of abnormal gait and sudden repetitive jerky limbs' movements. The past histories were unremarkable. He was fully conscious. Examination revealed ataxia of stance and gait and generalised myoclonic jerks. Ocular examination revealed opsoclonus (video 1). Routine blood tests and brain MRI with gadolinium were normal. The boy's father stated that he intends to go back to Iran and manage his son there. In Iran, brain MRI, chest/abdomenopelvic CT scans, paraneoplastic autoantibodies panel and CSF analysis were unremarkable. The boy was diagnosed with idiopathic opsoclonus; partially improved on intravenous immunoglobulin.
Video 1
The patient was asked to look forward. Note the repetitive, involuntary, high-amplitude, chaotic and multidirectional conjugate eye movements; these represent opsoclonus (dancing eyes; saccadomania). Opsoclonus is present during fixation, pursuit movements and convergence. In addition, it persists during sleep or eyelid...
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Granulocytic sarcoma: a rare cause of sciatica
We describe a case report of a man aged 56 years with a 4-month history of right-sided sciatica-type pain with subclinical disc prolapse evident on MRI. Worsening pain together with the appearance of a tender mass in his right buttock prompted further imaging, which demonstrated an infiltrative mass engulfing the lumbosacral plexus. This was later shown to be a granulocytic sarcoma on biopsy. Intervertebral disc herniation can be an incidental finding and is not always the cause of sciatica.
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Clinical management of electrical burns in the developing world: a case of electrical burn injury left untreated leading to amputation
We discuss the case of a 26-year-old male patient from Northern Samar, the Philippines who was left without essential health services after the amputation of all four limbs following a high voltage (20 000 volts) injury in Metro Manila in 2011. Local health services in the developing world are faced with enormous challenges in providing first-line care for burn patients. The cost of maintaining a burn unit, finding suitable qualified staff, and appropriate referral mechanisms are only some of the challenges faced. Once a patient is discharged from hospital they face more obstacles in obtaining artificial limbs, physiotherapy and access to mental health services. Disability pensions are non-existent thus patients place a considerable lifelong burden on their families.
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Hyperactive delirium following administration of intra-articular corticosteroid
Intra-articular administration of corticosteroids is a commonly used treatment for osteoarthritis as well as other inflammatory disorders of the joints. It is well known that delirium and psychosis can arise following the administration of oral corticosteroids but there are few documented cases of the development of acute hyperactive delirium with psychosis following intra-articular administration. We describe a case of an 82-year-old female patient with moderate dementia who developed a delirium with psychosis which responded well to a first-generation antipsychotic.
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Glioblastoma with primitive neuronal pattern in a girl aged 3 months: a rare diagnosis at an unusual age
A girl aged 3 months presented with multiple seizures within 12 hours and was noted to have a palpable swelling over the right temporal region. MRI of the brain revealed a large right frontotemporal tumour, suggestive of supratentorial primitive neuroectodermal tumour. She underwent a stealth-guided craniotomy and debulking of the tumour. Histopathology and immunochemistry of the specimen, however, indicated a high-grade tumour with glioblastoma and neuroblastic components. She underwent adjuvant chemotherapy following the surgery and is well at 7-month follow-up. This case underscores the importance of considering the rare entity of glioblastoma with primitive neuronal pattern as a differential diagnosis in a young child.
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Migrated Hem-o-Lok clips in the ureter: a rare cause of recurrent urinary tract infection
Erosion of surgical materials into the adjacent organs following surgical procedures is a rare complication. Migrations of these surgical materials into the urinary tract like pelvicalyceal system, ureter and bladder have been reported following various urological procedures. We present a case of migrated Hem-o-Lok clips into the ureter following a laparoscopic partial nephrectomy for angiomyolipoma of the left kidney presented with recurrent urinary tract infection. The case was managed with ureteroscopic removal of clips. The patient is asymptomatic on last follow-up.
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Longitudinal melanonychia on multiple nails induced by hydroxyurea
Description
A Caucasian woman aged 67 years presented to our outpatient clinic with an 18 months history of asymptomatic continuously progressing longitudinal brown bands on her toenails. There was no history of trauma or friction to her toenails. She was ineffectively treated with oral terbinafine for 3 months due to suspected onychomycosis. Since 3 years, she received treatment for polycythaemia vera with hydroxyurea in varying doses ranging from 500 to 1500 mg daily. Her polycythaemia vera was adequately regulated. She experienced no other side effects. Her medical history was otherwise unremarkable. Family history was negative for longitudinal melanonychia and melanoma.
Physical examination showed multiple longitudinal brown-pigmented bands on eight toenails with subungual hyperkeratosis. Pseudo-Hutchinson's sign was present as the pigmentations extended proximally beneath the translucent cuticles, but the cuticles and nail folds were not affected (figures 1 and 2A). Her fingernails were normal. No other mucocutaneous pigmentations were...
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Correction: Delayed diagnosis of a cerebrovascular accident associated with anabolic steroid use
Cooper I, Reeve N, Doherty W (2011). Delayed diagnosis of a cerebrovascular accident associated with anabolic steroid use. BMJ Case Reports 2011; doi:10.1136/bcr.02.2011.3857.
This case reports incorrectly makes reference to anabolic-adrenergic steroids throughout the article. This should be corrected to anabolic-androgenic steroids.
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Organ-specific biomarkers in lupus
Source:Autoimmunity Reviews
Author(s): Haijing Wu, Jinrong Zeng, Ming Zhao, Qianjin Lu
Systemic lupus erythematosus (SLE) is a complex and highly heterogeneous disease, which affects multiple organs, including joints, skin, kidneys, heart, hematopoietic system, and nerve system. While the etiopathogenesis of SLE still remains unclear, genetic susceptibilities and aberrant epigenetic modifications are believed to be involved. For precision therapy, it is necessary to assess accurately and objectively organ involvements and disease activity, which is difficult by current clinical laboratory tests. Biomarkers, which are a biologic, genetic, epigenetic or a chemical characteristic and conveniently detectable, serve as measures of disease diagnosis, activity, prognosis, and manifestation prediction, thereby providing instruction for individualized therapy. In addition, biomarkers differ according to different manifestations, since the disease activity index and treatments vary significantly. For example, unlike other non-renal SLE, lupus nephritis requires significant immunosuppressive drugs. Over the past decades, the research on biomarkers in lupus has been strengthened and numerous promising biomarkers have been identified at levels of genomics, transcriptomics and proteomics. In this review, we summarize the conventional and novel biomarkers in the tissue-specific manner, and discuss their roles in specific organ diagnosis, future manifestation prediction, disease activity assessment and their correlation with histology results. By doing so, it aims to shed a light on individualized treatment.
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Neonatal Lupus: Follow-up in infants with anti-SSA/Ro antibodies and review of the literature
Source:Autoimmunity Reviews
Author(s): Antonio Alberto Zuppa, Riccardo Riccardi, Simonetta Frezza, Francesca Gallini, Rita Maria Paola Luciano, Giovanni Alighieri, Costantino Romagnoli, Sara De Carolis
Neonatal Lupus Syndrome (NLS) is a distinct clinical entity caused by transplacental passage of maternal anti-SSA/Ro antibodies (Ab). Mothers may have systemic lupus erythematosus, Sjögren syndrome, or other connective tissue disease, or may be completely healthy at the time of giving birth. NLS includes several clinical manifestations: complete congenital heart block (CCHB) and cutaneous lupus are the most common, while hepatobiliary disease, hematological manifestations and central nervous system involvement may occur.Data from literature on the incidence of the different clinical manifestations of NLS are difficult to compare because they come mostly from retrospective studies or prospective studies, but up to date no systematic follow-up was carried out. We performed a large prospective single-center study with a systematic clinical and instrumental follow-up until 9months of life, in order to evaluate the incidence and the clinical impact of NLS features.From 2004 to 2014 all infants born in our center to mothers with anti-SSA/Ro Ab were enrolled in a specific diagnostic and follow-up (FU) program.At birth, 50 infants born to mothers with anti-SSA/Ro Ab were found positive for anti-SSA/Ro Ab. Infants were tested for anti SSA/Ro Ab at 3months of life, if positive they were re-tested at 6 and 9months. At 9months anti-SSA/Ro Ab were positive in 10% of children. In two cases (4%) a CCHB was identified during pregnancy and required pacemaker implantation at birth. In 10% of cases a transient ECG alterations was found during follow-up. Hematological NLS features (anemia, neutropenia, thrombocytopenia) were found at birth and during FU in several patients, in all cases without clinical manifestations and in most cases with complete normalization at 9months. Mild and transient elevation of aminotransferases between 3 and 6months of life were found in 56% and 40% of patient, respectively; non-specific ultrasound cerebral anomalies in absence of clinical neurological signs were found at birth in 9 patients (18%), subsequently normalized.Prenatal maternal screening is of primary importance in order to early detect CCHB, which requires maternal treatment and pacemaker implantation at birth. Infants born to mothers with anti-SSA/Ro Ab should be monitored for all NLS features at birth. However, during the first months of life, these infants seem to develop only mild, transient and self-limited clinical manifestations, which in most cases are completely solved at 9months of life. This consideration, together with the evidence that only 10% of infants had anti-SSA/Ro Ab persistent in blood at 9months, suggests that follow-up of these children can be performed until 6–9months of life with good clinical safety. Moreover, a clinical and laboratory monitoring at 3months of life, when the highest incidence of hematological features and liver tests alterations are observed, is strongly recommended. In the future, it would be clarified if a follow-up until adulthood would be indicated in cases with persistent anti SSA/Ro or in all infants born to mother with anti SSA/Ro.
http://ift.tt/2lKRoAK
IBD immunopathogenesis: A comprehensive review of inflammatory molecules
Source:Autoimmunity Reviews
Author(s): Jae Hyon Park, Laurent Peyrin-Biroulet, Michael Eisenhut, Jae Il Shin
Inflammatory molecules play a crucial role in the pathogenesis of inflammatory bowel disease (IBD) such as ulcerative colitis and Crohn's disease, both of which are chronic inflammatory conditions of the gastrointestinal tract. Abnormal expressions of pro-and anti-inflammatory molecules have been described to cause an imbalance to the gut innate and adaptive immunity, and recently a large portion of research in IBD has been geared towards identifying novel molecules that may be used as potential therapeutic targets. Understanding of these inflammatory molecules has suggested that although ulcerative colitis and Crohn's disease share many common clinical symptoms and signs, they are in fact two separate clinical entities characterized by different immunopathogenesis. In this review, we comprehensively discuss the roles of numerous inflammatory molecules including but not limited to cytokines, chemokines, inflammasomes, microRNAs and neuropeptides and their expression status in ulcerative colitis and Crohn's disease in relation to their effects on the overall intestinal inflammatory process.
http://ift.tt/2lPsCML
Multiple sclerosis in the real world: A systematic review of fingolimod as a case study
Publication date: Available online 15 February 2017
Source:Autoimmunity Reviews
Author(s): Tjalf Ziemssen, Jennie Medin, C. Anne-Marie Couto, Catherine R. Mitchell
IntroductionThe aim of our study was to systematically review the growing body of published literature reporting on one specific multiple sclerosis (MS) treatment, fingolimod, in the real world to assess its effectiveness in patients with MS, evaluate methodologies used to investigate MS in clinical practice, and describe the evidence gaps for MS as exemplified by fingolimod.MethodsWe conducted a PRISMA-compliant systematic review of the literature (cut-off date: 4 March 2016). Published papers reporting real-world data for fingolimod with regard to clinical outcomes, persistence, adherence, healthcare costs, healthcare resource use, treatment patterns, and patient-reported outcomes that met all the eligibility criteria were included for data extraction and quality assessment.Results and discussionBased on 34 included studies, this analysis found that fingolimod treatment improved outcomes compared to the period before treatment initiation and was more effective than interferons or glatiramer acetate. However, among studies comparing fingolimod with natalizumab, overall trends were inconsistent: some reported natalizumab to be more effective than fingolimod and others reported similar effectiveness for natalizumab and fingolimod. These studies illustrate the challenges of investigating MS in the real world, including the subjectivity in evaluating some clinical outcomes and the heterogeneity of methodologies used and patient populations investigated, which limit comparisons across studies. Gaps in available real-world evidence for MS are also highlighted, including those relating to patient-reported outcomes, combined clinical outcomes (to measure overall treatment effectiveness), and healthcare costs/resource use.ConclusionsThe included studies provide good evidence of the real-world effectiveness of fingolimod and highlight the diversity of methodologies used to assess treatment benefit in clinical practice. Future studies could address the evidence gaps found in the literature and the challenges associated with researching MS when designing real-world studies, assessing data, and comparing evidence across studies.
http://ift.tt/2lKWKMu
Towards developing criteria for scleroderma renal crisis: A scoping review
Source:Autoimmunity Reviews
Author(s): Sabrina Hoa, Edward P. Stern, Christopher P. Denton, Marie Hudson
ObjectiveThe absence of a gold standard for scleroderma renal crisis (SRC) has hindered our understanding of this problem. The objective of this scoping review was to identify the criteria used to define SRC in order to guide the development of a consensus definition for SRC.MethodsWe conducted a search in three databases: Medline, Embase and non-Ovid Pubmed. Papers were eligible for inclusion if they were full-length articles in English whose main topic was SRC or scleroderma renal disease. Two reviewers independently screened eligible papers for final study selection. Data was extracted using a customized form. A web-based survey of members of the Scleroderma Clinical Trials Consortium was used to identify unpublished definitions of SRC.ResultsWe identified 415 papers that met inclusion criteria. Forty original definitions of SRC were identified from 36 studies, 9 reviews and 2 editorials. There was significant heterogeneity in definitions. As a rule, though, in addition to new-onset hypertension and acute kidney injury, other common items used to define SRC included hypertensive encephalopathy and seizures, microangiopathic hemolytic anemia and characteristic changes on kidney biopsy. The web-based survey identified unpublished definitions of SRC that were largely consistent with the results of the published literature.ConclusionSRC was defined in a minority of studies and criteria were heterogeneous. A consensus definition of SRC is urgently needed to standardize data collection on SRC and further our understanding of this serious problem.
http://ift.tt/2lPlzmZ
The farming environment protects mice from allergen-induced skin contact hypersensitivity
Abstract
Background
Being born and raised in a farm provides a long-lasting protection for allergies. The microbial environment provided by farm animals is crucial to induce this protective effect, although underlying immune mechanisms remain elusive.
Objective
To establish a mouse model of global exposure to the farming environment and to study immunologic changes linked to protection of allergy.
Methods
Mice colonies were bred in parallel in a farm cowshed and the University animal facility (AF). Mice from both locations were subjected to a skin contact allergy model. Peripheral blood cells and cell cytokine production were assessed in both populations. In addition, the gut microbiome at various ages was characterized.
Results
Mice born in the farm were less prone to develop allergy than mice bred in the AF. Mice transfers between the AF and the farm showed a better protection when mice were moved to the farm early in life. As compared to AF-bred mice, farm mice displayed early immune activation with higher CD4+ T cell population, in particular CD4+CD25+FoxP3- (activated cells). The cytokine profile of mice from the farm was skewed towards an IL-17, and IL-22 secreting cell profile accompanied by increased IL-10 secretion. These differences were mostly seen within a specific age window between birth and 8 weeks of age. Microbiome analysis showed differences between 4 and 20-weeks old mice and between farm and AF mice with an increased number of Murine mastadenovirus B in young farm mice exclusively.
Conclusion
The farming environment provides a strong, allergy protective IL-22 stimulus and generates activated CD4+ T cells. Exposure to the farm environment early in their life may also provide a better protection for contact skin allergy. Whether a viral trigger might decisively influence protection for allergies remains to be determined.
This article is protected by copyright. All rights reserved.
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Serum carotenoid and tocopherol concentrations and risk of asthma in childhood: a nested case-control study
Abstract
Background
The antioxidant hypothesis regarding the risk of asthma in childhood has resulted in inconsistent findings. Some data indicate that the role of antioxidants in childhood asthma risk may have a critical time window of effect, but only a well-designed longitudinal cohort study can clarify this hypothesis.
Objective
To study the longitudinal associations between serum carotenoid and tocopherol concentrations during the first 4 years of life and asthma risk by the age of 5 years.
Methods
Based on a case-control design nested within a Finnish birth cohort, 146 asthma cases were matched to 270 controls on birth time, sex, genetic-risk, and birth place. Non-fasting blood samples were collected at the ages of 1, 1.5, 2, 3, and 4 years and serum carotenoids and tocopherols were analyzed. Parents reported the presence and age at start of persistent doctor-diagnosed asthma in the child at the age of 5 years. Data analyses were conducted using generalized estimating equations.
Results
We did not find strong associations between serum carotenoids and tocopherols and the risk of asthma based on age-specific and longitudinal analyses. Both lower and higher quarters of α-carotene and γ-tocopherol increase the risk of asthma.
Conclusions
The current findings do not support the suggestion that the increased prevalence of asthma may be a consequence of decreased intake of antioxidant nutrients. Moreover, we did not confirm any critical time window of impact of antioxidants on asthma risk. Replication of these findings in similar longitudinal settings will strengthen this evidence base.
This article is protected by copyright. All rights reserved.
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Value of Geriatric Screening to Predict Postoperative Morbidity for Head and Neck Cancer
Condition: Head and Neck
Intervention:
Sponsor: AZ Sint-Jan AV
Recruiting - verified February 2017
http://ift.tt/2l8bIsp
Intervention:
Sponsor: AZ Sint-Jan AV
Recruiting - verified February 2017
http://ift.tt/2l8bIsp
CBT-501 Study for Select Advanced or Relapsed/Recurrent Solid Tumors
Conditions: Solid Tumor; Advanced Cancer; ColoRectal Cancer; Endometrial Cancer; Gastric Cancer; Hepatocellular Cancer; Nonsmall Cell Lung Cancer; Mesothelioma; Ovarian Cancer; Renal Cancer; Nasopharyngeal Cancer; Esophageal Cancer; Gastroesophageal Junction Adenocarcinoma
Intervention: Drug: Genolimzumab injection
Sponsors: CBT Pharmaceuticals, Inc.; Novotech (Australia) Pty Limited
Not yet recruiting - verified February 2017
http://ift.tt/2lhqu2R
Intervention: Drug: Genolimzumab injection
Sponsors: CBT Pharmaceuticals, Inc.; Novotech (Australia) Pty Limited
Not yet recruiting - verified February 2017
http://ift.tt/2lhqu2R
Massive internal jugular vein tumor thrombus derived from squamous cell carcinoma of the head and neck: two case reports
Abstract
Purpose
Tumor thrombosis of the internal jugular vein (IJV) is an extremely rare disease, and the reported cases have been exclusively associated with differentiated thyroid cancer. In the present study, we describe two cases of IJV tumor thrombosis originated from squamous cell carcinoma (SCC), which is the first case report.
Methods
Case 1 was a 67-year-old man diagnosed with advanced supraglottic SCC with a massive tumor thrombus in the IJV. He was treated with bio-radiotherapy followed by radical surgery. Case 2 was a 65-year-old woman who underwent radical surgery for SCC of thyroid with tumor thrombosis in the IJV.
Results
These cases rapidly developed local recurrences and distant metastases and died within 10 months after surgery.
Conclusions
IJV tumor thrombosis originated from SCC apparently reflects extremely aggressive state of the tumor. Recognition and precaution to this condition is essential for the development of a clinically effective treatment strategy.
http://ift.tt/2kJU4dH
Evaluation of the oropharynx in class I and II skeletal patterns by CBCT
Abstract
Purpose
This study aimed to evaluate the dimensions of the oropharynx and its shape in the minimum cross-sectional area, in individuals with Class I and Class II skeletal patterns, using three-dimensional CBCT images.
Methods
Forty-two cone-beam computed tomography images of grown individuals were evaluated. The images were divided according to the patient's skeletal patterns. The dimensions of the oropharyngeal airway space were determined using the Dolphin Imaging software.
Results
The volume and the minimum cross-sectional area were greater in patients with a Class I skeletal pattern, with a median difference of 5379 mm3 and 86.8 mm2, respectively. The anteroposterior and lateral diameters in the minimum cross-sectional area were also higher in Class I individuals (2.3 and 6.0 mm, respectively), but the ratio between them was not different.
Conclusions
The volume and the minimum cross-sectional area of the oropharynx, as well as the anteroposterior and lateral diameters, are lower in individuals with a class II skeletal pattern than in individuals with a class I skeletal pattern. There was no difference in the shape of the oropharynx in healthy individuals with different skeletal patterns.
http://ift.tt/2ghZGtE
Maxillary sinus mucocele: predisposing factors, clinical presentations, and treatment
Abstract
Purpose
Maxillary sinus mucocele (MSM) is uncommon lesion and has many presenting features. The aim of this study was to detect the possible predisposing factors, clinical characteristics, and to assess the efficacy of trans-nasal endoscopic treatment of this lesion.
Methods
This retrospective multicenter study was conducted on 36 patients with MSM, the diagnosis of the disease was based on computed tomographic criteria. The patients' history, presenting features, and surgical management were reviewed. All patients were followed up postoperatively for at least 3 years.
Results
Chronic sinusitis, previous surgery, allergic rhinitis, and nasal trauma may be implicated as predisposing factors for the disease. However, in some patients (56%) the cause may remain uncertain. MSM may present with unilateral cheek pain, heaviness, swelling, numbness, hemifacial pain, nasal obstruction, nasal discharge, and/or proptosis. All patients were treated with trans-nasal endoscopic marsupialization through the middle meatus, patients with large MSM showed bulged medial maxillary wall, and they needed to empty the fluid through inferior antrostomy to facilitate introduction of the instruments to the middle meatus. All patients reported resolution of their symptoms, and none required revision surgery through the follow-up period.
Conclusions
MSM has several predisposing factors such as chronic sinusitis, previous surgery, allergic rhinitis and nasal trauma. However, some patients have no identifiable cause. The disease can present with a variety of symptoms which are usually related to their expansion and subsequent pressure on the surrounding structures. Trans-nasal endoscopic approach is an effective and safe method for treatment of the lesion.
http://ift.tt/2lKKQ50
Custom-made mouth prop for TMJ arthrocentesis: a technical note
Abstract
Introduction
TMJ arthrocentesis involves lavage of the upper joint space which forces the disc apart from the fossa and washes away the inflammatory components of the joint. To increase the joint space during arthrocentesis, the patient is usually asked to open the mouth and deviate it to the opposite side so as to distract the condyle from the glenoid fossa thereby increasing joint space.
Method
The authors describe a simple and rapid technique of preparing a custom-made mouth prop to hold the mandible in eccentric position during arthrocentesis.
Findings
The custom-made mouth prop is an effective tool to help relax the patient in an eccentric position during the duration of arthrocentesis procedure.
http://ift.tt/2ggrL7m
Factors associated to post-operative nausea and vomiting following oral and maxillofacial surgery: a prospective study
Abstract
Aim
This study aims to address and assess possible factors associated with nausea and vomiting (NV) following oral and maxillofacial surgery.
Material and methods
A prospective study was carried out in the period from December 2013 to January 2016 targeting all attended cases in that period. For statistical analysis, Pearson chi-square and Fisher tests were used to verify association and ANOVA and Student's t tests to test for significant difference, p was defined as ≤0.05. The sample group consisted of 207 patients with an average age of 33.56 years (±13.23), and 70.5% of subjects were male.
Results
Calculations based on the predictive model showed that a female patient with prior history of nausea and vomiting who used opioids and had intra-oral surgical access would have a 96% chance of experiencing a nausea and vomiting episode.
Other factors like age, being overweight, anesthesia, surgery duration, and duration of hospital stay also contribute so that these aspects must be paid careful attention prior to surgery to ensure a suitably orientated treatment that will avoid disturbances caused by post-operative nausea and vomiting.
Conclusion
The occurrence of post-operative nausea and vomiting after oral and maxillofacial surgery was found to be more higher incidence associated to female patients who used opioids, who had a prior history of NV, whose surgery involved intra-oral access, who were in the second or third decades of their lives, who have above average weight, and who have long anesthesia when undergoing surgery, resulting in a long hospital stays.
http://ift.tt/2gL5Fa3
The effect of Tonsillectomy on the Morbidity from recurrent Tonsillitis
Abstract
Background
Tonsillitis is a common condition with an incidence in UK general practice of 37 per 1000 population a year1. Recurrent tonsillitis results in significant morbidity and impacts on individuals' quality of life. This study assesses the morbidity and quality of life of adults with recurrent tonsillitis, and the impact of surgical intervention on their health state.
Objectives
1.To describe disease specific and global quality of life for adults with recurrent tonsillitis six months after tonsillectomy, using two instruments: the Health Impact of Throat Problems (HITP) and EuroQol-visual analogue scale (EQ-VAS) questionnaire.
2.To assess the overall health benefit from tonsillectomy as an intervention using the Glasgow Benefit Inventory (GBI).
3.To assess potential predictors of tonsillectomy benefit.
Design
A prospective, observational cohort audit of patients who have fulfilled Scottish Intercollegiate Guideline Network (SIGN) criteria for tonsillectomy2.
Setting
Secondary care, teaching hospital.
Participants
Seventy patients (57 female), median age 20 years (range 13-41).
Results
Median pre-operative HITP was 47 (range 15-67), compared to 4 (0-72), (p< 0.001) 6 months following surgery. Median HITP difference was 39.5 (range -20 to 75). There was no significant change in global Quality of Life. Median overall 6 months GBI was 39 (-3-100). Patients had an average of 27 episodes of tonsillitis over a period of seven years before "achieving" tonsillectomy, significantly higher than the SIGN guidelines of three or more episodes over three years.
Conclusions
Recurrent tonsillitis causes a poor disease specific quality of life. Patients experienced a median of three episodes per year for seven years before tonsillectomy. Following tonsillectomy, patients had a significant improvement in their disease specific quality of life. Baseline HITP significantly improved after tonsillectomy. The results imply patients with recurrent acute tonsillitis may be experiencing undue delay
This article is protected by copyright. All rights reserved.
http://ift.tt/2lQuS5n
Coblation® Intracapsular Tonsillectomy (Tonsillotomy) in Children: A Prospective Study of 500 Consecutive Cases with Long Term Follow Up
Abstract
Objectives
Intracapsular tonsillectomy (tonsillotomy) has been used internationally, mainly in the management of obstructive sleep apnoea, rather than recurrent tonsillitis, with little published data evaluating its use for this latter indication. We present long-term prospective data from 500 paediatric cases undergoing Coblation® intracapsular tonsillectomy, for both obstructive and infective indications.
Design
Prospective case series, March 2013-January 2016, all with completed follow up.
Setting
Tertiary paediatric otolaryngological practice.
Participants
500 consecutive patients (6 months to 18 years, mean 5.1 years) undergoing Coblation® intracapsular tonsillectomy (with or without adenoidectomy), for obstructive and/ or infective indications, almost exclusively under the care of the senior author (DJT).
Main outcome measures
Validated parent-reported T-14 tonsil symptom questionnaires were used in all cases pre- and post-operatively, including in the long term. Parents also recorded duration of analgesia, time to return to school, any complications and whether they would recommend the procedure.
Results
With a mean follow up 7.4 months, symptom control has been excellent (mean total T-14 score (/70) 31.01 preoperatively, 2.68 post-operatively, p<0.0000001), with similar trends for obstructive and infective domains. Two small secondary haemorrhages required readmission and observation only (0.4%), otherwise no complications, delayed discharges or readmissions occurred. 12/500 (2.4%) have since undergone revision tonsil surgery, 10 for obstructive and 2 for infective symptoms, the majority in very young children, with revision adenoidectomy at the same time. More than 99% of parents would recommend the surgery.
Conclusions
Our experience of this technique has been very positive, with excellent control of both obstructive and infective symptoms, and exceptionally low rates of complications. Further work will be required to allow conclusive demonstration of its advantages over extracapsular tonsillectomy.
This article is protected by copyright. All rights reserved.
http://ift.tt/2lKHD5t
Defining an inflamed tumor immunophenotype in recurrent, metastatic squamous cell carcinoma of the head and neck
Source:Oral Oncology, Volume 67
Author(s): Glenn J. Hanna, Hongye Liu, Robert E. Jones, Alyssa F. Bacay, Patrick H. Lizotte, Elena V. Ivanova, Mark A. Bittinger, Megan E. Cavanaugh, Amanda J. Rode, Jonathan D. Schoenfeld, Nicole G. Chau, Robert I. Haddad, Jochen H. Lorch, Kwok-Kin Wong, Ravindra Uppaluri, Peter S. Hammerman
ObjectivesImmune checkpoint inhibitors have demonstrated clinical benefit in recurrent, metastatic (R/M) squamous cell carcinoma of the head and neck (SSCHN), but lacking are biomarkers that predict response. We sought to define an inflamed tumor immunophenotype in this R/M SCCHN population and correlate immune metrics with clinical parameters and survival.MethodsTumor samples were prospectively acquired from 34 patients to perform multiparametric flow cytometry and multidimensional clustering analysis integrated with next-generation sequencing data, clinical parameters and outcomes.ResultsWe identified an inflamed subgroup of tumors with prominent CD8+ T cell infiltrates and high PD-1/TIM3 co-expression independent of clinical variables, with improved survival compared with a non-inflamed subgroup (median overall survival 84.0 vs. 13.0months, p=0.004). The non-inflamed subgroup demonstrated low CD8+ T cells, low PD-1/TIM3 co-expression, and higher Tregs. Overall non-synonymous mutational burden did not correlate with response to PD-1 blockade in a subset of patients.ConclusionR/M SCCHN patients with an inflamed tumor immunophenotype demonstrate improved survival. Further prospective studies are needed to validate these findings and explore the use of immunophenotype to guide patient selection for immunotherapeutic approaches.
http://ift.tt/2kpBRGm
Candidate apoptotic and DNA repair gene approach confirms involvement of ERCC1, ERCC5, TP53 and MDM2 in radiation-induced toxicity in head and neck cancer
Source:Oral Oncology, Volume 67
Author(s): D. Borchiellini, M.C. Etienne-Grimaldi, R.J. Bensadoun, K. Benezery, O. Dassonville, G. Poissonnet, L. Llorca, N. Ebran, P. Formento, Y. Château, J. Thariat, G. Milano
IntroductionSingle nucleotide polymorphisms (SNPs) of DNA repair and apoptosis genes have been associated with outcome in head and neck squamous cell carcinoma (HNSCC) patients receiving radiotherapy (RT). Our goal was to conduct a candidate gene study in HNSCC patients receiving RT or chemoRT.Methods122 non-resectable HNSCC patients undergoing RT (N=38) or chemoRT (N=84) between 1992 and 2006 were retrospectively analyzed. ERCC1 Lys259Thr (rs735482), ERCC2 Lys751Gln (rs13181), ERCC5 His46His C>T (rs1047768), XRCC1 Arg399Gln (rs25487), TP53 Arg72Pro (rs1042522) and MDM2 309T>G (rs2279744) were analyzed on tumor DNA. SNP profile was considered to assess RT-related toxicity.ResultsAll 120 evaluable patients experienced RT-related toxicity at any time. Among them, 83% had G3-4 acute side-effects during RT, mainly dysphagia, mucositis, epithelitis and/or xerostomia (DMEX). 28/105 patients (27%) had early G3-4 toxicity up to 3months after the end of RT. 29/96 patients (30%) had G3-4 late toxicity thereafter. The presence of G allele of MDM2 or Thr allele of ERCC1 was associated with a significantly higher risk of acute and/or early DMEX toxicity. The MDM2 309GG genotype was linked to a higher risk of acute G3-4 dermatitis. The ERCC5 TT genotype was associated with more frequent G3-4 late cervical skin fibrosis or xerostomia. Pro allele of TP53 72 was associated with a higher risk of G3-4 osteoradionecrosis.ConclusionRelevant SNPs in DNA repair (ERCC1 and ERCC5) and apoptosis (MDM2 and TP53) genes might influence the severity of radiation-related side-effects in HNSCC patients. Prospective clinical SNP-based validation studies are needed on these bases.
http://ift.tt/2kJB1QC
JAMA Otolaryngology-Head & Neck Surgery-The Year in Review, 2016.
JAMA Otolaryngology-Head & Neck Surgery-The Year in Review, 2016.
JAMA Otolaryngol Head Neck Surg. 2017 Feb 09;:
Authors: Piccirillo JF
PMID: 28196221 [PubMed - as supplied by publisher]
http://ift.tt/2lOLQlA
JAMA Otolaryngology-Head & Neck Surgery Peer Reviewers in 2016.
JAMA Otolaryngology-Head & Neck Surgery Peer Reviewers in 2016.
JAMA Otolaryngol Head Neck Surg. 2017 Feb 09;:e170051
Authors:
PMID: 28196202 [PubMed - as supplied by publisher]
http://ift.tt/2lgJUER
Assessment of Surgical Learning Curves in Transoral Robotic Surgery for Squamous Cell Carcinoma of the Oropharynx.
Assessment of Surgical Learning Curves in Transoral Robotic Surgery for Squamous Cell Carcinoma of the Oropharynx.
JAMA Otolaryngol Head Neck Surg. 2017 Feb 09;:
Authors: Albergotti WG, Gooding WE, Kubik MW, Geltzeiler M, Kim S, Duvvuri U, Ferris RL
Abstract
Importance: Transoral robotic surgery (TORS) is increasingly employed as a treatment option for squamous cell carcinoma of the oropharynx (OPSCC). Measures of surgical learning curves are needed particularly as clinical trials using this technology continue to evolve.
Objective: To assess learning curves for the oncologic TORS surgeon and to identify the number of cases needed to identify the learning phase.
Design, Setting, and Participants: A retrospective review of all patients who underwent TORS for OPSCC at the University of Pittsburgh Medical Center between March 2010 and March 2016. Cases were excluded for involvement of a subsite outside of the oropharynx, for nonmalignant abnormality or nonsquamous histology, unknown primary, no tumor in the main specimen, free flap reconstruction, and for an inability to define margin status.
Exposures: Transoral robotic surgery for OPSCC.
Main Outcomes and Measures: Primary learning measures defined by the authors include the initial and final margin status and time to resection of main surgical specimen. A cumulative sum learning curve was developed for each surgeon for each of the study variables. The inflection point of each surgeon's curve was considered to be the point signaling the completion of the learning phase.
Results: There were 382 transoral robotic procedures identified. Of 382 cases, 160 met our inclusion criteria: 68 for surgeon A, 37 for surgeon B, and 55 for surgeon C. Of the 160 included patients, 125 were men and 35 were women. The mean (SD) age of participants was 59.4 (9.5) years. Mean (SD) time to resection including robot set-up was 79 (36) minutes. The inflection points for the final margin status learning curves were 27 cases (surgeon A) and 25 cases (surgeon C). There was no inflection point for surgeon B for final margin status. Inflection points for mean time to resection were: 39 cases (surgeon A), 30 cases (surgeon B), and 27 cases (surgeon C).
Conclusions and Relevance: Using metrics of positive margin rate and time to resection of the main surgical specimen, the learning curve for TORS for OPSCC is surgeon-specific. Inflection points for most learning curves peak between 20 and 30 cases.
PMID: 28196200 [PubMed - as supplied by publisher]
http://ift.tt/2lOBDW9
Association of Otolaryngology Resident Duty Hour Restrictions With Procedure-Specific Outcomes in Head and Neck Endocrine Surgery.
Association of Otolaryngology Resident Duty Hour Restrictions With Procedure-Specific Outcomes in Head and Neck Endocrine Surgery.
JAMA Otolaryngol Head Neck Surg. 2017 Feb 09;:
Authors: Smith A, Braden L, Wan J, Sebelik M
Abstract
Importance: Graduate medical education has undergone a transformation from traditional long work hours to a restricted plan to allow adequate rest for residents. The initial goal of this restriction is to improve patient outcomes.
Objective: To determine whether duty hour restrictions had any impact on surgery-specific outcomes by analyzing complications following thyroid and parathyroid procedures performed before and after duty hour reform.
Design, Setting, and Participants: Retrospective cross-sectional analysis of the National Inpatient Sample (NIS).The NIS was queried for procedure codes associated with thyroid and parathyroid procedures for the years 2000 to 2002 and 2006 to 2008. Hospitals were divided based on teaching status into 3 groups: nonteaching hospitals (NTHs), teaching hospitals without otolaryngology programs (THs), and teaching hospitals with otolaryngology programs (THs-OTO).
Main Outcomes and Measures: Procedure-specific complication rates, length of stay, and mortality rates were collected. SAS statistical software (version 9.4) was used for analysis with adjustment using Charlson comorbidity index.
Results: Total numbers of head and neck endocrine procedures were 34 685 and 39 770 (a 14.7% increase), for 2000 to 2002 and 2006 to 2008, respectively. THs-OTO contributed a greater share of procedures in 2006 to 2008 (from 18% to 25%). With the earlier period serving as the reference, length of stay remained constant (2.1 days); however, total hospital charges increased (from $12 978 to $23 708; P < .001). Rates of postoperative hematoma (odds ratio [OR], 1.21; 95% CI, 1.06-1.38), hypoparathyroidism (OR, 1.27; 95% CI, 1.06-1.52), and unintentional vessel lacerations (OR, 1.36; 95% CI, 1.02-1.83) increased overall with NTHs (OR, 1.26; 95% CI, 1.04-1.52), THs (OR, 1.65; 95% CI, 1.15-2.37), and THs-OTO (OR, 1.98; 95% CI, 1.09-3.61) accounting for these differences, respectively. Overall mortality decreased (OR, 0.66; 95% CI, 0.47-0.94) following a decrease in the TH-OTO mortality rate (OR, 0.34; 95% CI, 0.12-0.93).
Conclusions and Relevance: While recurrent laryngeal nerve injury, hematoma formation, and hypoparathyroidism did not change, length of stay and mortality improved within THs-OTO following head and neck endocrine procedures after implementation of duty hour regulations. This finding refutes the concern that duty hour restrictions result in poorer overall outcomes. Less time available to develop technical competence may play a factor in some outcomes in lieu of recurrent laryngeal nerve injury increasing within THs and accidental injury to vessels, organs, or nerves and hypocalcemia increasing within THs-OTO. Furthermore, head and neck endocrine cases increased at THs with otolaryngology programs.
PMID: 28196195 [PubMed - as supplied by publisher]
http://ift.tt/2kS1oGt
Sirolimus for Vincristine-Resistant Kasabach–Merritt Phenomenon: Report of Eight Patients
Abstract
Background
The use of sirolimus for patients with multidrug-resistant Kasabach–Merritt phenomenon (KMP) has been reported in recent years. We present the experience of a single center in treating vincristine-resistant KMP using sirolimus alone.
Methods
Children with vincristine-resistant KMP who were treated with oral sirolimus alone were eligible for inclusion in the study. We evaluated responses according to graded response criteria and acute toxicities according to the National Cancer Institute Common Toxicity Criteria.
Results
Between March 2012 and October 2014, eight patients underwent sirolimus treatment. The response rate of hematologic parameters was 100% (8/8). Three tumors shrank enough to allow excision. The tumors were resected after hematologic parameters normalized. Of the five patients with unresectable vascular lesions, three had complete response, and two had partial response of their tumors at the completion of long-term (39.7 ± 24.4 wks) sirolimus treatment. Grade 3 or 4 adverse events were not documented during treatment or follow-up. No recurrence or progression of the disease was observed during follow-up.
Conclusion
In this small case series, we found sirolimus to be highly effective, with minimal side effects, for vincristine-resistant KMP. A larger study to compare sirolimus and vincristine for KMP is warranted.
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Simulation-Guided Navigation for Vector Control in Pediatric Mandibular Distraction Osteogenesis
Publication date: Available online 14 February 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Giovanni Badiali, Fabrizio Cutolo, Andrea Roncari, Claudio Marchetti, Alberto Bianchi
AimNavigation technology has given surgeons the capacity to know precisely where their instruments are during surgery, and simulation-guided navigation is a surgical method which is based on the use of navigation technology linked to 3D virtual surgery simulation. The aim of the present study was to evaluate the absolute accuracy of simulation-guided navigation as an aid to reproduce the planned position of the distraction device vector in pediatric mandibular distraction osteogenesis.Materials and methodsWe retrospectively evaluated seven patients affected by unilateral (3 pts.) or bilateral (4 pts.) mandibular hypoplasia and treated with this method between 2012 and 2014 at the Maxillofacial Surgery Unit of the University of Bologna, Italy. All patients were enrolled for mandibular distraction using internal unidirectional devices (11 distraction devices implanted overall). Patients were studied through a complete three-dimensional workflow, which led to obtaining a virtual reconstruction of the facial bones and the simulation of the distraction device positioning using a specific experimental software. The surgical planning was loaded on the navigation system and the distraction device was placed following the virtual plan, which is displayed on the navigation system as a guide and tracked with the navigation instruments.ResultsWe analyzed the outcome comparing the recorded three-dimensional coordinates of the achieved distractor position and the three-dimensional coordinates of the planned distractor position. Among the eleven placed distractors, we found a mean angular error of 3.74° ± 3.30° on the axial axis (yaw) and of 6.27° ± 5.32° on the sagittal axis (pitch), while median angular errors are 3.72° on the axial axis (yaw) and 4.08° on the sagittal axis (pitch).ConclusionOur preliminary experience seems to support that simulation-guided navigation for vector control in mandibular distraction osteogenesis could be a useful procedure for reproducing the virtually planned outcome. Nevertheless, our results cannot be considered completely satisfactory. There is a lot of room to improve accuracy and errors seem to depend mainly on the soft tissues interference during distractor placement.
Graphical abstract
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Ultrapulse carbon dioxide laser treatment for bilateral facial nevus comedonicus: A case report
Abstract
Nevus comedonicus (NC), a rare skin ailment with an aggregation of dilated follicular orifices filled with keratinous material, is difficult to treat. Several drugs have been assessed for the treatment of NC, but with limited success. Surgery requires much experience and the recurrence rate is high. Various types of laser have been tried, with promising outcomes. A 54-year-old male patient with bilateral facial NC was admitted on July 8, 2014. A coin-sized area was first treated successfully with ultrapulse CO2 laser. The remaining lesions were treated during three subsequent sessions at 2-week intervals. There were no complications. There was no recurrence after 2 years. This case suggests that ultrapulse CO2 laser could efficiently alleviate NC. Ultrapulse CO2 laser treatment should be further studied for its application in the treatment of NC.
http://ift.tt/2kwh8eY
Effectiveness and safety of antihistamines up to fourfold or higher in treatment of chronic spontaneous urticaria
Treatment with second-generation antihistamines is recommended in patients with chronic spontaneous urticaria (CSU). Some patients remain unresponsive even after up-dosing up to fourfold. Many third line treat...
http://ift.tt/2lik9Uj
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