Assessing asthma in the otolaryngologist's office.

Purpose of review: To familiarize otolaryngologists and other practitioners with basic diagnosis and treatment of asthma in adults and children based on current literature. Recent findings: Increased fractional excretion of nitrous oxide and sputum eosinophils have been identified in asthmatic patients being evaluated for chronic cough and appear to be more sensitive in diagnosis than traditional spirometry. Both sublingual and subcutaneous immunotherapy modalities are effective in decreasing symptoms and medication use in patients with allergic rhinitis and allergic asthma. Summary: Undiagnosed comorbid asthma is prevalent among patients with chronic rhinosinusitis and allergic rhinitis and control of all diseases processes greatly improves quality of life. Office spirometry is a helpful tool in the evaluation and management of asthma. Otolaryngologists should be able to recognize undiagnosed or poorly controlled asthma, initiate and improve medical therapy, and treat rhinosinusitis to improve asthma control. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Biologics for asthma and allergy.

Purpose of review: The development of monoclonal antibody-based biologics targeted at inhibition of the Th2 cytokines interleukin-4, interleukin-5 and interleukin-13 represent potentially effective treatments for asthma and allergic diseases. This short review is based on English-language original articles in PubMed or MedLine that reported significant clinical findings on the evidence demonstrating the effectiveness or otherwise of the targeting of interleukin-4, interleukin-5 or interleukin-13 in asthma or allergic disease. Recent findings: Asthma exhibits marked heterogeneity both clinically and at the molecular phenotypic level requiring specifically targeted treatments to block the key pathways of the disease. It is becoming apparent that significant clinical effects with anticytokine-based biologic therapies are more likely in carefully selected patient populations that take asthma phenotypes into account. Biologics aimed at interleukin-4/13, interleukin-5 or immunoglobulin E are potentially effective treatments for patients with difficult to treat allergic disease. The development of reproducible and straightforward discriminatory biomarkers may aid identification of those patients most likely to benefit from treatment with these expensive interventions. Summary: Overall these biologics-based therapies are effective treatments for difficult to treat asthma and allergic disease with a safety profile comparable with placebo in the majority of published studies. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Integration of high-risk human papillomavirus into cellular cancer-related genes in head and neck cancer cell lines

ABSTRACT

Background

Human papillomavirus (HPV)-positive oropharyngeal cancer is generally associated with excellent response to therapy, but some HPV-positive tumors progress despite aggressive therapy. The purpose of this study was to evaluate viral oncogene expression and viral integration sites in HPV16- and HPV18-positive squamous cell carcinoma lines.

Methods

E6/E7 alternate transcripts were assessed by reverse transcriptase-polymerase chain reaction (RT-PCR). Detection of integrated papillomavirus sequences (DIPS-PCR) and sequencing identified viral insertion sites and affected host genes. Cellular gene expression was assessed across viral integration sites.

Results

All HPV-positive cell lines expressed alternate HPVE6/E7 splicing indicative of active viral oncogenesis. HPV integration occurred within cancer-related genes TP63, DCC, JAK1, TERT, ATR, ETV6, PGR, PTPRN2, and TMEM237 in 8 head and neck squamous cell carcinoma (HNSCC) lines but UM-SCC-105 and UM-GCC-1 had only intergenic integration.

Conclusion

HPV integration into cancer-related genes occurred in 7 of 9 HPV-positive cell lines and of these 6 were from tumors that progressed. HPV integration into cancer-related genes may be a secondary carcinogenic driver in HPV-driven tumors. © 2017 Wiley Periodicals, Inc. Head Neck, 2017

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Positron emission tomography-CT prediction of occult nodal metastasis in recurrent laryngeal cancer

ABSTRACT

Background

The purpose of this study was to evaluate the predictive value of positron emission tomography (PET)-CT in identifying occult nodal metastasis in clinically and radiographically N0 patients with recurrent laryngeal cancer undergoing salvage laryngectomy.

Methods

Retrospective review of 46 clinically and radiographically N0 patients with recurrent laryngeal cancer who underwent a PET-CT examination before salvage laryngectomy with neck dissection from January 1, 2002, to December 31, 2014, was performed.

Results

Two patients (16.7%) had true-positive PET-CT results, whereas 10 patients (83.3%) had false-negative scans, 1 patient (2.9%) had a false-positive result and 33 patients (97.1%) had a true-negative PET-CT. The sensitivity of PET-CT was 16.7% (95% confidence interval [CI], 3.5% to 46.0%) with a specificity of 97.1% (95% CI, 83.8% to 99.9%), positive predictive value (PPV) of 66.7% (95% CI, 20.2% to 94.4%), and negative predictive value (NPV) of 76.7% (95% CI, 62.1% to 87.0%).

Conclusion

PET-CT has poor sensitivity and NPV making PET-CT an imperfect predictor of nodal disease in recurrent laryngeal cancer. © 2017 Wiley Periodicals, Inc. Head Neck, 2017

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Treatment-related determinants of survival in early-stage (T1–2N0M0) oral cavity cancer: A population-based study

ABSTRACT

Background

National guidelines support both surgical and radiotherapy (RT) as initial treatment options for early-stage oral cavity squamous cell carcinoma (SCC). There remains limited data evaluating the survival outcomes of RT and the current practice patterns for these lesions.

Methods

We conducted a retrospective review of 8274 patients in the Surveillance, Epidemiology, and End Results (SEER) database from 1988 to 2008 with T1 to T2N0M0 oral cavity SCC. Primary outcomes were 5-year overall survival (OS) and disease-specific survival (DSS).

Results

Surgical therapy had significantly improved OS (140 months; p < .001) and DSS (217 months; p < .001) compared to surgery with adjuvant RT (104 and 163 months, respectively) and definitive RT (68 and 136 months, respectively). The use of radiation alone was associated with an increased T classification, hard palate, retromolar trigone primary site lesions, and advanced patient age.

Conclusion

Primary radiation without surgery continues to be used in a subset of early-stage oral cavity SCCs, in which it is associated with decreased OS and DSS. © 2017 Wiley Periodicals, Inc. Head Neck, 2017

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Treatment delays in oral cavity squamous cell carcinoma and association with survival

Abstract

Background

Treatment durations and factors associated with delays for oral cavity squamous cell carcinoma (SCC) have previously been described but are not fully understood. Impact of delays on overall survival (OS) remains unclear.

Methods

The National Cancer Data Base (NCDB) was used to analyze 4868 patients with oral cavity SCC from 1998 to 2011. Diagnosis-to-surgery, surgery-to-radiotherapy (RT)_start, RT duration, total treatment package (surgery-to-RT_end), and diagnosis-to-RT_end were evaluated. Associations between delays and various factors were analyzed using binary logistic regression. Associations with OS were analyzed using the Cox proportional hazards model.

Results

Medians for diagnosis-to-surgery, surgery-to-RT_start, RT duration, total treatment package, and diagnosis-to-RT_end were 30, 50, 49, 101, and 136 days, respectively. Age ≥60 years, uninsured or Medicaid insurance, comorbidity, late pT, and treatment at an academic/research institution were associated with diagnosis-to-surgery delays. Only delays in RT duration were significantly associated with decreased OS (hazard ratio [HR] = 1.21; p = .02).

Conclusion

Numerous factors are associated with treatment delays. RT duration is significantly associated with OS. © 2017 Wiley Periodicals, Inc. Head Neck, 2017

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Correlating the depth of invasion at specific anatomic locations with the risk for regional metastatic disease to lymph nodes in the neck for oral squamous cell carcinoma

ABSTRACT

Background

The purpose of this study was to investigate the critical primary tumor depth of invasion in oral squamous cell carcinoma that would lead to a 20% or greater risk of nodal metastasis.

Methods

An institutional review board approved retrospective review of our head and neck database was performed from 2009 to 2014 and the data were statistically analyzed.

Results

Two hundred eighty-six patients with a diagnosis of oral squamous cell carcinoma who met our inclusion criteria underwent primary excision and neck dissection. For a depth of invasion of 1 mm or less, there were no patients with a positive node. From 1.1 mm to 2 mm of depth of invasion, there was 1 of 11 patients (9%) who had at least 1 positive node. At 2.1 mm to 3 mm, 5 of 25 patients (20%) had at least 1 positive node.

Conclusion

Depth of invasion and the location of the tumor are 2 important variables to consider when making treatment recommendations to patients with clinical N0 disease. © 2017 Wiley Periodicals, Inc. Head Neck, 2017

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Laryngoscopy during swimming: A novel diagnostic technique to characterize swimming- induced laryngeal obstruction

Exercise-induced laryngeal obstruction (EILO) is a key differential diagnosis for respiratory symptoms in athletes and is particularly prevalent in aquatic athletes. A definitive diagnosis of EILO is dependent on laryngoscopy, performed continuously, while an athlete engages in the sport that precipitates their symptoms. This report provides the first description of the feasibility of performing continuous laryngoscopy during exercise in a swimming environment. The report describes the methodology and safety of the use of continuous laryngoscopy while swimming. Laryngoscope, 2017

http://ift.tt/2mhsqt9

Cerebrospinal Fluid Fistula for the Craniofacial Surgeon: A Review and Management Paradigm.

Craniofacial surgeons perform operations that involve exposure of the dura. Typical procedures include cranial vault remodeling (CVR), fronto-orbital advancement (FOA), Le Fort III, monobloc, bipartition advancement, or distraction. Cerebrospinal fluid (CSF) fistulas remain one of the most common complications encountered, occurring in up to 30% of patients. Cerebrospinal fluid fistulas can be encountered intraoperatively, acutely, or in the late postoperative period. Traditional management has been well described in the neurosurgical literature. While several studies of complications exist, there is a relative lack of adequate information for craniofacial surgeons. The authors review current literature and provide 3 patients to illustrate our management paradigm. The authors review 30 years of experience at our institution and the pertinent literature. The mean rate of CSF fistula was 11.2%; rates were lowest for FOA/CVR, 5.5%. Patients with fistulas persisting after 2 days of conservative therapy or whom were symptomatic prompted placement of a lumbar subarachnoid catheter. Failure of the leak to resolve with CSF diversion prompted exploration and therapy which could include a patch, pericranial flap, and/or endonasal repair with septal flaps. Three patients are used to illustrate the paradigm, all of which have had no recurrence thus far. Cerebrospinal fluid fistula remains one of most common complications craniofacial surgeons encounter. Although neurosurgeons are often part of the clinical team, the craniofacial surgeon should be familiar with all aspects of treatment. Prompt diagnosis and appropriate knowledgeable management may avoid morbidity and mortality. (C) 2017 by Mutaz B. Habal, MD.

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Microsurgical Replantation of Total Avulsed Scalp: Extending the Limits.

Background: Avulsion of the scalp is a rare but severe trauma and challenging to the reconstructive surgeon. It poses not only physical concussion but also significant persisting psychological distress to the patients. Methods: Medical records from 5 patients who suffered scalp avulsion were reviewed retrospectively. The following data and methods were assessed: age, number of vessels repaired, method of replantation, vein grafts required, blood transfusion, ischemia time, total operating time, and percentage of scalp survival. Results: In 4 patients, the replantation was performed at the anatomic site. Two arteries and 2 veins were anastomosed in 2 patients; a single artery and a single vein were anastomosed in 2 patients. The middle temporal vein was chosen for anastomosis as a recipient vessel in 2 patients. In the fifth patient with simultaneous cervical fracture that makes primarily replantation technically not possible, the scalp was implanted ectopically in the forearm for the purpose of secondary replantation at the anatomic site. After a mean follow-up of 22.6 months (range 13-29 months), 4 of 5 patients exhibited successful survival of the replanted scalp. Conclusions: The success of scalp replantation is determined by a comprehensive management of the trauma and well-trained microsurgical technique. The middle temporal vein can be used as a reliable alternative recipient vessel for microvascular anastomosis when replanting the avulsed scalp. In patients in whom primary replantation is not possible, temporary ectopic implantation of the avulsed scalp and anatomic replantation at a second stage is considerable. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2lPiVAb

Early Surgical Correction of the Nasal Deformity in Laurin-Sandrow Syndrome.

Laurin-Sandrow syndrome (LSS) is a rare autosomal disorder characterized by polysyndactyly of the hands and feet in a mirror fashion, absence of the radius and tibia with duplicated ulna and fibula, and nasal anomalies. Nasal defects are varied, and range from hypoplastic nasal skeleton to redundant nasal tissue, along with abnormalities of nasal subunits. Only 14 patients of LSS have been described in the literature. The authors present a unique case of a newborn with LSS and anterior nasal stenosis, resulting in respiratory failure. Early surgical intervention to relieve the bony and soft tissue overgrowth of the anterior nasal vault was required to allow for successful extubation. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2mvnk8i

Editorial Lp(a) – the underestimated cardiovascular risk factor

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Orbital apex syndrome as a complication of herpes zoster ophthalmicus

Orbital apex syndrome is a rare neuro-ophthalmic manifestation of herpes zoster virus infection. We report one such case with favourable outcome in an immunocompetent patient. A 60-year-old woman presented with rash in the dermatome of the left ophthalmic nerve (V1), followed by sudden loss of vision with complete left-sided external and internal ophthalmoplegia. MRI of brain and orbits with contrast revealed optic perineuritis and myositis without intracranial involvement confirming the diagnosis of orbital apex syndrome. Functional visual recovery was achieved after a course of intravenous and oral steroids under antiviral cover over a follow-up period of 3 months.

http://ift.tt/2lTRIgl

Lattice-like paraproteinemic keratopathy (PPK) of monoclonal gammopathy of undetermined significance (MGUS)

Description

A male patient aged 71 years presented with a history of progressive visual loss in the past 3 years. Ophthalmological evaluation showed a best-corrected visual acuity of 20/200 bilaterally and the presence of bilateral linear lattice-like corneal opacities similar to lattice dystrophy (LD) and dense nuclear cataracts at slit lamp examination (figure 1). There was no family history of ocular diseases. Serum protein electrophoresis included in the systemic investigation showed a band in the -globulin fraction (figure 2). Nephelometry detected an increased level of light chains—75.6 mg/dL (normal: 3.3–19.4 mg/dL) and a normal level of light chains—14.4 mg/dL (normal: 5.7–26.3 mg/dL) and an increased / ratio of 5.25 (normal: 0.26–1.65). Immunoelectrophoresis also confirmed the IgG- gammopathy. Myelogram showed 2% of plasma cells. No lytic bone lesions were present on plain X-ray. No mutations were found on transforming growth factor β-induced gene (TGFBI) nor on gelsolin gene...

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Rare association of congenital penile urethrocutaneous fistula with Y-type urethral duplication

A 24-year-old man presented with symptoms of difficulty in passage of urine, mixed with gas and stool from penoscrotal junction since birth. He had a history of surgery (posterior sagittal anorectoplasty) for imperforate anus in first week of his life. On physical examination, external meatus was adequate with small 5x5 mm fistulous opening noted at penoscrotal junction with normal anal tone and opening. On evaluation with retrograde urethrography, voiding cystourethrogram, cystoscopy and barium enema, he was found to have penile urethrocutaneous fistula of 0.5x0.5 cm with Y-type incomplete urethral duplication. Urethroanal fistula (Y-type urethral duplication) was of small size (<5 mm), so closed primarily through perineal route with interposition of ischiorectal fat. Penile urethrocutaneous fistula (4 mm) too was closed primarily and covered with tunica vaginalis flap in single sitting. It has been 6 months since surgery and the patient is fully continent and voiding well with no urinary or faecal leak.

http://ift.tt/2lTWSbR

Hypercalcaemia caused by active pulmonary tuberculosis in an elderly person without fever or pulmonary symptoms

Many diseases can cause hypercalcaemia, including primary hyperparathyroidism, cancer, drugs and granulomatous diseases. A nursing home resident aged 81 years was admitted because of altered mental status. The patient did not have fever, cough, sputum or night sweat. Hypercalcaemia was identified as a cause of the consciousness disturbance. Chest radiograph showed no acute process. Laboratory workups revealed elevated serum levels of 1,25-(OH)2 vitamin D₃ and positive T-spot test. Microscopic examination of the suctioned sputum identified acid-fast bacilli, which was confirmed as Mycobactrium tuberculsosis. Tuberculosis should be considered as the important cause of hypercalcaemia since early diagnosis and treatment is recommended for preventing its outbreak among people with close contacts with patients.

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Over 10 years MRI observation of a patient with neuronal intranuclear inclusion disease

We present a sporadic neuronal intranuclear inclusion disease (NIID) patient with neuropathy followed by cognitive dysfunction along with brain MRIs findings of leucoencephalopathy. Her cognitive impairment gradually progressed along with abnormal intensity lesions in diffusion-weighted images. This pathological and clinical deterioration resemble pathological process in prion diseases.

http://ift.tt/2lTEOP3

Emergency cricothyroidotomy following tracheobronchial stenting

A man aged 51 years was referred for tracheobronchial stenting after a poorly differentiated oesophageal carcinoma had progressed to cause stridor. Bronchoscopy revealed a left vocal cord palsy and tumour infiltration into the trachea. A tracheobronchial stent was placed, and after distal migration was endoscopically resited. Returning from theatre, the patient developed severe upper airway obstruction that progressed to cause CO₂ narcosis and loss of consciousness. A rapid sequence induction was initiated, and a Glidescope revealed bilateral vocal cord palsy with severe oedema causing an inability to pass a tube or stylet. Tracheostomy was attempted above the suprasternal notch but was obstructed by the stent. Oxygen saturations dropped steadily, reaching as low as 38%. Emergency cricothyroidotomy was performed, compliant with DAS guidelines, that proved successful. The stent was removed, which was blocked with blood and secretions, and tracheostomy was placed 2 days later. The patient made a full neurological recovery.

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Subretinal abscess

Description

A 32-year-old man with a history of intravenous drug use was admitted to the hospital for evaluation of intermittent fever and chills over the course of several weeks. On examination, the temperature was 39.0°C and pulse rate 110 bpm. A grade 2/6 holosystolic murmur was appreciated at the left lower sternal border. Transthoracic echocardiography with agitated saline contrast demonstrated an echodensity on the septal leaflet of the tricuspid valve associated with mild tricuspid regurgitation and a right-to-left shunt. Blood cultures grew methicillin-resistant Staphylococcus aureus. On the third day of hospitalisation, mild conjunctival erythema of the right eye was observed, which was associated with discomfort and a subjective decrease in vision. Visual fields on confrontation revealed a large inferior scotoma. Bedside indirect ophthalmoscopy established the presence of a yellow, elevated subretinal mass ~10 times the diameter of the optic disc, adjacent to the superior-temporal vascular arcade, with associated intraretinal...

http://ift.tt/2lTSyJR

Could kinesiology taping help mitigate pain, breathlessness and abdominal-related symptoms in cancer?

We present the case of a woman who was an amateur athlete diagnosed with primary breast cancer, and 10 years later with terminal metastatic cancer. This case report was prepared posthumously in co-operation with her next of kin (husband). The patient first presented to a sports physiotherapist (AR) for her pain-management and to help maintain physical fitness so that she could continue with sports and an active lifestyle. The patient continued with physiotherapy for several months to enable her to be active. However, when her health deteriorated significantly due to advancing cancer, the treatment was modified and aimed at improving the patient's general well-being. The physiotherapist applied kinesiology tape over the patient's lower rib cage, diaphragm and abdomen in an attempt to manage pain, breathlessness and abdominal bloating. The patient reported alleviation of pain, breathlessness, abdominal discomfort and nausea, accompanied by improvements in eating, drinking, energy levels and physical function.

http://ift.tt/2lFJ1Uh

Self-esteem as an important factor in quality of life and depressive symptoms in anosmia: A pilot study

Abstract

Objectives

Previous research has reported a negative impact of olfactory dysfunction on quality of life and depressive symptoms. As self-esteem was identified as a contributing factor to depression, the present study aimed to investigate quality of life (QoL), depressive symptoms, and self-esteem in patients with smell loss.

Design

Prospective controlled study.

Setting

Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, in cooperation with the Department of Ear, Nose and Throat Diseases, Medical University of Vienna, Austria.

Participants

Twenty-two anosmic patients (12 female, 10 male) and 25 healthy controls (15 female, 10 male) participated in this study.

Main outcome measures

Olfactory performance was assessed using the Sniffin' Sticks battery. In addition, psychological questionnaires that covered the topics quality of life (WHOQOL-BREF), depressive symptoms (BDI-II), and self-esteem (MSWS) were conducted.

Results

The results of this study revealed a decrease in quality of life and reduced body-related self-esteem in anosmic patients. Furthermore, quality of life and self-esteem were correlated with depressive symptoms.

Conclusion

As self-esteem, quality of life, and depressive symptoms in anosmia interact with each other, we suggest that self-esteem should be considered in the medical history, in order to provide a personalized intervention, adapted to the patient's needs.

This article is protected by copyright. All rights reserved.

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Influence of surface roughness on silicone rubber voice prostheses on in vitro biofilm formation and clinical lifetime in laryngectomized patients

Abstract

Objectives

Evaluation of the influence of a smooth surface moulding technique of silicone rubber indwelling voice prostheses on in vitro biofilm formation and analysis of the clinical in situ lifetime.

Design

Biofilm formation on smooth and Groningen ultra-low resistance (URL) prostheses was studied in an artificial throat model. The clinical lifetime of smooth voice prostheses were compared to the previous lifetime of URL by counting the number of replacements in a consecutive 6 months period in the same patient. Participants: Eleven laryngectomized patients in follow up who required frequent replacement of their voice prostheses.

Settings

Tertiary University Medical Center.

Results

Use of a smoother mould and less viscous silicone rubber yielded a decrease in surface roughness from 46 nm to 8 nm, and was accompanied by a 40% reduction in the prevalence of bacteria and yeast in in vitro formed biofilms. Clinically, the lifetime was significantly (p < 0.005) increased by a factor of 2.1.

Conclusions

This combined in vitro and clinical study suggests that the choice of material and in particular its surface finishing, may be determining factors with respect to the clinical lifetime of silicone rubber implants and devices failing due to biofilm formation.

This article is protected by copyright. All rights reserved.

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Generation and Characterization of Inhibitory Antibodies Specific to Guinea Pig CXCR1 and CXCR2

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy , Vol. 0, No. 0.


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Monoclonal Antibody TfR Monoclonal Antibody

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy Feb 2017, Vol. 36, No. 1: 35-35.


http://ift.tt/2l9W4v4

Antiglycopeptide Mouse Monoclonal Antibody LpMab-21 Exerts Antitumor Activity Against Human Podoplanin Through Antibody-Dependent Cellular Cytotoxicity and Complement-Dependent Cytotoxicity

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy Feb 2017, Vol. 36, No. 1: 20-24.


http://ift.tt/2lFcmzK

Monoclonal Antibody 4E3-2F7 Antimouse Dermokine-β/α

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy Feb 2017, Vol. 36, No. 1: 36-36.


http://ift.tt/2lFshfz

Three-Dimensional Image Fusion of FDG-PET/CT and Contrast-Enhanced CT for Computer-Assisted Planning of Maxillectomy of Recurrent Maxillary Squamous Cell Carcinoma and Defects Reconstruction

Publication date: Available online 24 February 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Yao Yu, Wen-Bo Zhang, Xiao-Jing Liu, Chuan-Bin Guo, Guang-Yan Yu, Xin Peng
PurposeTo describe a new technology assisted by three-dimensional image fusion of ¹⁸F-fluorodeoxyglucose-positron emission tomography/computed tomography (¹⁸FDG-PET/CT) and contrast-enhanced CT (CECT) for computer planning of a maxillectomy of recurrent maxillary squamous cell carcinoma and defects reconstruction.MethodsTreatment of recurrent maxillary squamous cell carcinoma usually includes tumor resection and free flap reconstruction. ¹⁸FDG-PET/CT provided images of regions of abnormal glucose uptake and thus demonstrated metabolic tumor volume to guide tumor resection CECT data were used to create three-dimensional (3D) reconstructed images of vessels, to demonstrate the vascular diameters and locations, so that the most suitable vein and artery could be selected during anastomosis of the free flap. The data of preoperative maxillofacial CECT scans and ¹⁸FDG-PET/CT were imported into the navigation system (iPlan 3.0; Brainlab, Feldkirchen, Germany). Three-dimensional image fusion between FDG-PET/CT and CECT was accomplished using the Brainlab software according to the position of the two skulls simulated respectively in the CECT and PET/CT. After verification of the image fusion accuracy, the 3D reconstruction images of the metabolic tumor, vessels, and other critical structures could be visualized within the same coordinate system. These sagittal, coronal, axial, and 3D reconstruction images were used to determine the virtual osteotomy sites and reconstruction plan, which was provided to the surgeon and used for surgical navigation.ResultThe average shift of the 3D image fusion between FDG-PET/CT and CECT was <1 mm. This technique, by clearly demonstrating the metabolic tumor volume and the most suitable vessels for anastomosis, facilitated resection and reconstruction of recurrent maxillary squamous cell carcinoma.ConclusionsWe used 3D image fusion of FDG-PET/CT and CECT to successfully accomplish resection and reconstruction of recurrent maxillary squamous cell carcinoma. This method has the potential to improve the clinical outcomes of this challenging procedure.



http://ift.tt/2muVYPX

Osteofibrous Dysplasia Versus Ossifying Fibroma: Semantic Confusion

Publication date: Available online 24 February 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Fumio Ide, Kentaro Kikuchi, Kaoru Kusama




http://ift.tt/2muXgdt

Computed tomography based three dimensional finite element analyses of various types of plates placed for virtually reduced unilateral condylar fracture of the mandible of the patient

Publication date: Available online 24 February 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Kazuhiro Murakami, Kazuhiko Yamamoto, Tsutomu Sugiura, Satoshi Horita, Yumiko Matsusue, Tadaaki Kirita
PurposeTo evaluate stresses in various types of plates placed for virtually reduced unilateral condylar fracture of the mandible using computed tomography (CT)-based three-dimensional finite element (FE) models of the patient to select the optimal plate system.Materials and methodsA CT-based FE model of the mandible of a patient with unilateral condylar fracture was constructed. The fracture was virtually reduced and fixed with one and two straight titanium plate(s), two straight poly-L-lactic acid (PLLA) plates, and 4-hole (box), 5-hole (strut), and 7-hole (lambda) condylar plates. Stresses developing in these plates were analyzed by applying 478.1 N of bite force at the first molar of the contralateral side of the mandible.ResultThe magnitudes of tensile stress were within the tensile strength in all types of plates. However, the magnitudes of compressive stress in one straight titanium plate and two straight PLLA plates were beyond the compressive strength. The tensile and compressive stresses of the 5-hole (strut) plate were the smallest among the three types of condylar plates.ConclusionFixation by two straight titanium plates or any types of condylar plates was biomechanically indicated for the condylar fracture of this patient. Among these plates, the 5-hole (strut) plate was considered optimal. FE analysis is useful in selecting the optimal fixation method in the individual patient.



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What's in a Name? Actions Speak Louder Than Words

Publication date: Available online 24 February 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Roger A. Meyer




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Surge of Surgeons—Really?

Publication date: Available online 24 February 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Stewart K. Lazow




http://ift.tt/2lF6Kp6

Summary of mutations underlying autosomal recessive congenital ichthyoses (ARCI) in Arabs with four novel mutations in ARCI-related genes from the United Arab Emirates

Abstract

Background

Clinical and molecular heterogeneity is a prominent characteristic of congenital ichthyoses, with the involvement of numerous causative loci. Mutations in these loci feature in autosomal recessive congenital ichthyoses (ARCIs) quite variably, with certain genes/mutations being more frequently uncovered in particular populations.

Methods

In this study, we used whole exome sequencing as well as direct Sanger sequencing to uncover four novel mutations in ARCI-related genes, which were found in families from the United Arab Emirates. In silico tools such as CADD and SIFT Indel were used to predict the functional consequences of these mutations.

Results

The here-presented mutations occurred in three genes (ALOX12B, TGM1, ABCA12), and these are a mixture of missense and indel variants with damaging functional consequences on their encoded proteins.

Conclusions

This study presents an overview of the mutations that were found in ARCI-related genes in Arabs and discusses molecular and clinical details pertaining to the above-mentioned Emirati cases and their novel mutations with special emphasis on the resulting protein changes.

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Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features Accounts for More Than Half of “Carcinomas” Harboring RAS Mutations

Thyroid , Vol. 0, No. 0.


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Outcome of Large Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features

Thyroid , Vol. 0, No. 0.


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Role of laminin 332 in lymph node metastasis of papillary thyroid carcinoma

Publication date: Available online 24 February 2017
Source:Auris Nasus Larynx
Author(s): Kyoung Ho Oh, June Choi, Jeong-Soo Woo, Seung Kuk Baek, Kwang Yoon Jung, Min Ji Koh, Young-Sik Kim, Soon Young Kwon
ObjectiveThe invasiveness of papillary thyroid carcinoma (PTC), including the occurrence of cervical lymph node metastasis, is the main determining factors contributing to recurrence and poor prognosis. Laminin 332 is a glycoprotein involved in cell migration and cancer cell invasion into surrounding tissues and is therefore related to poor prognosis in many cancers. Here, we investigated the expression and role of laminin 332 in PTC and examine the possibility that laminin 332 could be involved in the invasiveness of PTC.MethodsLaminin 332 expression was determined by immunohistochemical staining in all 40 patients. The correlations between laminin 332 expression and clinical factors were investigated. We examined the expression of the laminin 332 γ2 chain using reverse transcription polymerase chain reaction and western blotting in PTC cells and determined the relationship between the expression of laminin 332 and the invasiveness of these cell lines using cell invasion assays.ResultsLaminin 332 was expressed specifically within tumor tissue. The frequency of laminin 332 γ2 chain expression was significantly correlated with cervical lymph node metastasis (​p=0.003). Invasiveness increased as the expression of laminin 332 γ2 increased in the tested PTC cell lines.ConclusionLaminin 332 expression may be a useful marker for predicting lymph node metastasis in papillary thyroid carcinoma, and could increase the ability of cancer cells to invade, which would influence the prognosis of patients with PTC.



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The effects of unilateral cochlear ablation on the expression of vesicular glutamate transporter 1 in the lower auditory pathway of neonatal rats

Publication date: Available online 24 February 2017
Source:Auris Nasus Larynx
Author(s): Hiroki Hasegawa, Miyako Hatano, Hisashi Sugimoto, Makoto Ito, Hiroshi Kawasaki, Tomokazu Yoshizaki
ObjectivesUnilateral cochlear damage has profound effects on the central auditory pathways in the brain.MethodsWe examined the effects of unilateral cochlear ablation on VGLUT1 expression in the cochlear nucleus (CN) and the superior olivary complex (SOC) in neonatal rats.ResultsVGLUT1 expression in the CN subdivisions (the AVCN, the PVCN and the DCN-deep layers) and the SOC (the MnTB, the LSO and the MSO) ipsilateral to the ablated side was significantly suppressed by unilateral cochlear ablation. Interestingly, VGLUT1 expression in the PVCN and the DCN-deep layers contralateral to the ablated side was also reduced.ConclusionOur findings indicate that unilateral cochlear ablation affects VGLUT1 expression in the central auditory pathways not only ipsilateral but also contralateral to the ablated side.



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Chikungunya Infection: a Global Public Health Menace

Abstract

Chikungunya virus (CHIKV) has been involved in epidemics in African and Asian subcontinents and, of late, has transcended to affect the Americas. Aedes aegypti and Aedes albopictus are the major vectors for CHIKV infection, which results in dissemination of virus to various vital organs. Entry of virus into these tissues causes infiltration of innate immune cells, monocytes, macrophages, neutrophils, natural killer cells, and adaptive immune cells. Macrophages bearing the replicating virus, in turn, secrete pro-inflammatory cytokines IL-1β, TNF-α, and IL-17. Together, this pro-inflammatory milieu induces osteoclastogenesis, bone loss, and erosion. CHIKV is characterized by fever, headache, myalgia, rash, and symmetric polyarthritis, which is generally self-limiting. In a subset of cases, however, musculoskeletal symptoms may persist for up to 3–5 years. Viral culture and isolation from blood cells of infected patients are the gold standards for diagnosis of CHIKV. In routine practice, however, assays for anti-CHIKV IgM antibodies are used for diagnosis, as elevated levels in blood of infected patients are noted from 10 days following infection for up to 3–6 months. Early diagnosis of CHIKV is possible by nucleic acid detection techniques. Treatment of acute CHIKV is mainly symptomatic, with analgesics, non-steroidal anti-inflammatory agents (NSAIDs), and low-dose steroids. No vaccines or anti-viral medicines have been approved for clinical therapy in CHIKV as yet. Hydroxychloroquine and methotrexate have been used in chronic CHIKV infection with variable success.

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Impact of control of blood glucose level during treatment of sudden deafness in diabetics: relationship with prognosis

Abstract

The objective of this study is to investigate the impact of control of blood glucose level during treatment of sudden deafness. A retrospective study was performed involving 197 patients from January, 2011 to September, 2015. All patients were administrated prednisolone (Pharmaprednisolone tab^®, 5 mg/T; KoreaPharma) p.o under the following regimen: 60 mg/day for 4 days, 40 mg/day for 2 days, 30 mg/day for 1 day, 20 mg/day for 1 day, and 10 mg/day for 2 days. During treatment, pure tone audiometry and blood glucose level were investigated for each patient and the results were statistically analyzed. Mean hearing improvement was 19.2 dB for the non-diabetes group and 24.8 dB for the diabetes group. The greater improvement for diabetics was not statistically significant (p = 0.146). Hearing improvement was 25.1 dB for subjects with mean blood glucose <200 mg/dl and 24.6 dB for subjects with mean blood glucose >200 mg/dl; the difference was not statistically significant (p = 0.267). Mean blood glucose level was 200.8 mg/dl for subjects with hearing improvement >20 dB and 181.8 mg/dl for subjects with hearing improvement <20 dB; the difference was not statistically significant (p = 0.286). Control of blood glucose level during treatment of sudden deafness does not have a direct effect on prognosis.

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Inlay butterfly cartilage tympanoplasty in dry central perforated chronic otitis media

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Minimally invasive medial maxillectomy and the position of nasolacrimal duct: the CT study

Abstract

Several minimally invasive modifications of endoscopic medial maxillectomy have been proposed recently, with the least traumatic techniques utilizing the lacrimal recess as a route to enter the sinus. The aim of the study was to analyze the anatomy of medial maxillary wall in the region of nasolacrimal canal and, thus, to determine the capability of performing minimally invasive approach to the maxillary sinus leading through the lacrimal recess. The course of nasolacrimal canal and the distance between the anterior maxillary wall and the nasolacrimal canal (the width of lacrimal recess) were evaluated in 125 randomly selected computed tomography (CT) head examinations. The proportion of cases with unfavorable anatomical conditions (lacrimal recess too narrow to accept a 4 mm optic) to perform minimally invasive middle maxillectomy was assessed. The width of lacrimal recess, measured at the level of the inferior turbinate attachment, varied between 0 and 15.2 mm and was related to slanted course of nasolacrimal canal. The more perpendicular the axis of the canal to the nasal flor, the narrower the lacrimal recess. In about 16% of cases, lacrimal recess width was less than 4 mm and in 14.4% it was missing. The endoscopic approach to maxillary sinus leading through lacrimal recess is possible in about 70% of patients. In the remaining group of patients when the lacrimal recess is too narrow, this type of approach may be difficult to perform without damaging the piriform aperture rim or bony framework of nasolacrimal duct, or it may be impracticable when lacrimal recess is missing.

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Clinical benefits of polyurethane nasal packing in endoscopic sinus surgery

Abstract

The benefits of nasal packing after endoscopic sinus surgery (ESS) are still debated in the literature. Our aims were to evaluate the efficacy, and the clinical effects of a totally degradable nasal dressing used after ESS. Thirty patients with chronic rhinosinusitis with nasal polyps were enrolled in a prospective, randomized, double-blind, controlled study. Every patient underwent ESS and a polyurethane nasal dressing was used in one nasal fossa and the contralateral fossa was left unpacked. The extent of mucosal edema, crust formation, bleeding tendency, presence of synechiae, amount of nasal discharge, and the patency of the ostiomeatal complex (OMC) was evaluated during nasal endoscopy on the first, fourth, and twelfth postoperative weeks. All clinical findings were statistically analyzed. Endoscopy showed a significant improvement in the patency of the OMC on the side with resorbable material at 4 weeks after surgery. Follow-up at week 12 showed that in addition to the OMC patency scores, synechia formation and nasal discharge were also significantly improved in the packed fossa. Polyurethane packing is an effective alternative for nasal packing following functional endoscopic sinus surgery.

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The status of the middle turbinate and the risk of sinusitis after endoscopic transnasal sphenoidotomy

Abstract

The objectives of this study are to evaluate the occurrence of postoperative middle turbinate lateralization and the relationship between this lateralization and the risk of iatrogenic sinusitis after endoscopic transnasal sphenoidotomy procedure. Patients who undergone endoscopic transnasal sphenoidotomy and came under the surveillance of our otorhinolaryngology department between the January of 2010 and the December of 2015 were retrospectively scanned. Among them, the patients who were evaluated with paranasal sinus computed tomography (CT) postoperatively were included in the study. The amount of middle turbinate lateralization in each patient was evaluated by comparing their routine preoperative CT image with the postoperative CT image. The air-fluid levels or soft tissue opacifications in the sinuses or obstruction of the ostiomeatal complex were accepted as the evidence of sinusitis on the images. The patients were asked questions regarding their symptoms of sinusitis on a phone interview for the statistical evaluation of their preoperative and postoperative Visual Analog Scale scores of complaints of sinusitis. The difference between preoperative and postoperative measurements was found to be statistically significant (p < 0.001, 95% CI). The middle turbinate position was lateralized in 31 patients (81.6%), medialized in four patients (10.5%), and remained unchanged in three patients (7.9%). Overall, the sinus opacification and mucosal thickening rates did not change significantly which suggested the operation did not pose patients at increased risk of sinusitis. Mean VAS scores of complaints of sinusitis did not change significantly except for sensation of facial pressure, which showed a minor but statistically significant decrease (p < 0.001). This study revealed the lateralization of the middle turbinate after transnasal sphenoidotomy. However, it seemed that this lateralization did not create a predisposing factor for the development of acute and chronic sinusitis.

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Long-term results of a modified expansion sphincter pharyngoplasty for sleep-disordered breathing

Abstract

Our aim was to evaluate the long-term objective and subjective results of a modified expansion sphincter pharyngoplasty (ESP) technique in patients with sleep-disordered breathing. Single center prospective study of 35 patients underwent an ESP as a primary surgical treatment between June 2012 and September 2015 at the hospital AZ Sint-Jan Bruges-Ostend. Patients were divided into non-OSAS and OSAS (AHI >5). Primary outcome parameters were the Epworth Sleeping Scale (ESS, reduction and score less then 10) and the Visual Analogue Score of snoring (VAS, assessed by partner) evaluated at 3 months and 1 year. In addition, the OSAS group underwent a polysomnography after 6 months to calculate the Apneu-Hypopneu Index (AHI) change. Secondary outcome parameters were possible complications and morbidity rate. The overall Epworth Sleepiness Scale showed a steady total reduction of, respectively, 42 and 48% at the two timepoints. All patients had a post-operative score of less than ten points. The Visual Analogue Score improved in 92% of the patients; of these, the snoring was reduced in 86% and disappeared in 6%. In the OSAS group, we noticed a reduction in AHI of more than 50 in 53% of the patients. A considerable reduction was found in the severe OSAS group, where we found a mean pre-operative average AHI of 41.3/h that was reduced 6 months after the operation to 17.4/h. There were no severe complications or increased morbidity rate observed. This first long-term study shows that the modified ESP seems to be a safe and promising technique in palatal surgery for patients with sleep-disordered breathing. Surgical effectiveness is sustained after 1 year, both in OSAS as in snoring pathology. The technique seems as approachable for the basic ENT surgeon as the uvulopalatopharynoplasty.

http://ift.tt/2mgKYte

Acoustic analysis of snoring sounds recorded with a smartphone according to obstruction site in OSAS patients

Abstract

Snoring is a sign of increased upper airway resistance and is the most common symptom suggestive of obstructive sleep apnea. Acoustic analysis of snoring sounds is a non-invasive diagnostic technique and may provide a screening test that can determine the location of obstruction sites. We recorded snoring sounds according to obstruction level, measured by DISE, using a smartphone and focused on the analysis of formant frequencies. The study group comprised 32 male patients (mean age 42.9 years). The spectrogram pattern, intensity (dB), fundamental frequencies (F ₀), and formant frequencies (F ₁, F ₂, and F ₃) of the snoring sounds were analyzed for each subject. On spectrographic analysis, retropalatal level obstruction tended to produce sharp and regular peaks, while retrolingual level obstruction tended to show peaks with a gradual onset and decay. On formant frequency analysis, F ₁ (retropalatal level vs. retrolingual level: 488.1 ± 125.8 vs. 634.7 ± 196.6 Hz) and F ₂ (retropalatal level vs. retrolingual level: 1267.3 ± 306.6 vs. 1723.7 ± 550.0 Hz) of retrolingual level obstructions showed significantly higher values than retropalatal level obstruction (p < 0.05). This suggests that the upper airway is more severely obstructed with retrolingual level obstruction and that there is a greater change in tongue position. Acoustic analysis of snoring is a non-invasive diagnostic technique that can be easily applied at a relatively low cost. The analysis of formant frequencies will be a useful screening test for the prediction of occlusion sites. Moreover, smartphone can be effective for recording snoring sounds.

http://ift.tt/2muAPWb

The comparison of the quality of life and intranasal edema between the patients with or without nasal packing after septoplasty

Abstract

Septoplasty is one of the most common operations performed in otolaryngology and anterior nasal packing is done routinely to prevent postoperative bleeding, septal hematoma or nasal synechia. Currently, transseptal sutures have gained a broader application area, not only for preventing the complications such as septal hematoma and bleeding but also closing any accidental tears of septal mucosa and providing additional support for the cartilage pieces retained in septoplasty. We evaluated the quality of life of the patients in early postoperative period (in the first postoperative week), intranasal edema with endoscopic examination and the intranasal changes with acoustic rhinometry. We performed a prospective and randomized study with patients undergoing septoplasty without inferior turbinectomy. As packing material, there were two groups: in group A, gauze in a glove finger and in group B, Doyle splint were used, and in the additional group C, only transseptal suture with 4/0 vicryl among the cartilaginous septum was performed. The patients were invited to control examinations on the postoperative 2nd, 4th and 7th days to evaluate the scores from 1 to 5 on the questionnaire for the pain, nasal fullness, sneezing, epiphora, difficulty in swallowing and sleep disturbances. The patients were also administered an endoscopic nasal examination for the purpose of detecting the intranasal edema, and acoustic rhinometry was performed during the control examinations to detect the intranasal changes. Total occluding packing was found to cause much more frequent and higher scores of epiphora, sneezing, difficulty in swallowing, but mainly, the pain compared to in silicone packing with airway and transseptal suture only. Although the silicone packing with airway was found to be much more comfortable, it also led to sneezing and epiphora. The patients without nasal packing had more comfortable period especially in the early postoperative days (the first 4 days). However, 1 week after surgery, groups with and without nasal packing were found to be equalized on behalf of the objective and subjective parameters. As any complication was not observed due to not using nasal packing, it is thought that nasal packing usage following septoplasty is not a necessity.

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Validation study of WatchPat 200 for diagnosis of OSA in an Asian cohort

Abstract

To validate a wrist-worn portable device (WatchPat 200) to diagnose OSA in an Asian cohort. To evaluate its cost-effectiveness. Twenty patients with suspected OSA were recruited and had simultaneous polysomnography (PSG) and WatchPAT assessments concurrently within the hospital's sleep laboratory. The study population consisted of 18 male and 2 female patients, whose mean age was 39 (±16) years, mean BMI was 27.2 (±5.5) kg/m², mean Epworth Sleepiness score was 8.55 (±4.8). The correlation between the AHI was assessed using Spearman's correlation coefficient and agreement was tested via the Bland Altman plot. Sensitivities and specificities were then applied to the various AHI groups. Spearman's coefficient was 0.94, which suggested that a very strong correlation between the AHI recorded by the WatchPat and the PSG. Bland–Altman plot showed good agreement with the AHI mean difference of about 4.23 with a slight tendency to overscore the AHI at the mild range of OSA and underscore the range at the severe end of OSA. The WatchPat showed 100% sensitivity when compared to PSG for mild OSA and is thus a good screening test for the undiagnosed general population. Furthermore, it also showed 100% specificity when compared to PSG for severe OSA suggesting that it is a good diagnostic test for people with a high suspicion of OSA. This facilitates a timelier diagnosis and a more economical approach with potential cost savings of up to $900 per patient.

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Re: Comparison of local and general anaesthesia for arthrocentesis of the temporomandibular joint

Publication date: Available online 24 February 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): A. Ramasamy, B. Madhan




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Comparison of non-invasive radiographic measurements of soft tissue in the interdental space: a cadaver study

Publication date: Available online 24 February 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Kristian Kniha, Stephan Christian Möhlhenrich, Florian Peters, Tsanko Yovev, Manuel Räsch, Andreas Prescher, Frank Hölzle, Ali Modabber
When we use implants the aesthetic appearance of the patient is dependent to a large extent on identification of factors that influence the presence of interdental papillae. The aim of this study was to compare the accuracy of different non-invasive measurements to indicate the top of the interdental papilla on dental radiographs. The sample comprised six fresh, partly edentulous cadavers. The distance from the level of the interproximal bone next to the tip of the papilla was measured (n=330) on standard radiographic images. Five different mixtures of radiopaque markers that had been used to highlight the top of the papilla in recently published studies were analysed. All measurements were compared with the bone probing length, which was evaluated clinically. The mixture of zinc oxide, eugenol cement, and tungsten powder (mean (SD) 0.14 (0.17)mm) deviated least from the control value. The deviation was significant (p<0.01) between the zinc oxide, eugenol cement, and tungsten powder mixture and each of the other individual combinations. The most accurate non-invasive radiographic method of measuring the interproximal length of the papilla relative to the alveolar bone crest was therefore the mixture of zinc oxide, eugenol cement, and tungsten powder.



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Development of a database to record orofacial manifestations in patients with rare diseases: a status report from the ROMSE (recording of orofacial manifestations in people with rare diseases) database

Publication date: Available online 24 February 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): M. Hanisch, L. Hanisch, K. Benz, J. Kleinheinz, J. Jackowski
The aim of this working group was to establish a ROMSE (recording of orofacial manifestations in people with rare diseases) database to provide clinicians, patients, and their families with better information about these diseases. In 2011, we began to search the databases Orphanet, OMIM^® (Online Mendelian Inheritance in Man^®), and PubMed, for rare diseases with orofacial symptoms, and since 2013, the collected information has been incorporated into a web-based, freely accessible database. To date, 471 rare diseases with orofacial signs have been listed on ROMSE, and 10 main categories with 99 subcategories of signs such as different types of dental anomalies, changes in the oral mucosa, dysgnathia, and orofacial clefts, have been defined. The database provides a platform for general clinicians, orthodontists, and oral and maxillofacial surgeons to work on the best treatments.



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Mast cell sarcoma of the sternum, clonally related to an antecedent germ cell tumor with a novel D579del KIT mutation

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EWSR1 rearrangement is a frequent event in papillary thyroid carcinoma and in carcinoma of the thyroid with Ewing family tumor elements (CEFTE)

Abstract

Carcinomas of the thyroid with Ewing family tumor element (CEFTEs) are small-cell thyroid tumors with epithelial differentiation that disclose p63 expression and EWSR1-FLI1 rearrangement, carry a favorable prognosis and may co-exist with papillary thyroid carcinoma (PTC) foci. Two histogenetic hypotheses have been advanced regarding the origin of CEFTEs: arising in PTCs or in solid cell nests (SCN). A total of 3 CEFTEs, 54 PTCs, and 10 SCNs were reviewed, and fluorescence in situ hybridization (FISH) technique was performed in all cases to search for the presence of EWSR1 rearrangements. The three CEFTEs disclosed the EWSR1-FLI1 rearrangement both in the small cell and in the PTC component. Out of the 54 PTC cases, 28 (51.9%) were positive, 20 (37.0%) were negative, and 6 (11.1%) were inconclusive for EWSR1 rearrangement; in two of the positive PTC cases, the EWSR1-FLI1 rearrangement was detected. Classic PTC disclosed more often the EWSR1 rearrangement than other PTC variants (p = 0.031). PTCs with EWSR1 rearrangement disclosed a lower percentage of nuclei with EWSR1 polysomy than those without EWSR1 rearrangement (p = 0.001). Out of the 10 SCNs, 7 (70.0%) were negative and 3 (30.0%) were inconclusive for the EWSR1 rearrangement. Monosomic nuclei were more frequent (mean of 44.3%) in SCNs than in PTCs (p < 0.001). The presence of the EWSR1-FLI1 rearrangement in PTC component of all studied CEFTEs and the existence of the EWSR1 rearrangement in some PTCs favor the origin of CEFTE from PTC. The high frequency of EWSR1 rearrangements in PTC may represent a new diagnostic marker of these tumors.

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Congenital melanocytic nevi in young children: Histopathologic features and clinical outcomes

Although only large congenital melanocytic nevi (CMN) are associated with a significantly high risk for malignant transformation, CMN of all sizes are prone to changes in clinical appearance in early childhood and thus are often biopsied or excised. While CMNs typically exhibit benign behavior, atypical histopathologic findings might be common and may prompt additional unnecessary procedures.

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Mnenomic to Cut False Diagnoses of Recluse Spider Bites

A simple mnemonic can help avoid false diagnosis of recluse spider bites, which has been mistaken for up to 40 other medical conditions, according to three U.S. researchers.
Reuters Health Information

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Comparison of non-invasive radiographic measurements of soft tissue in the interdental space: a cadaver study

When we use implants the aesthetic appearance of the patient is dependent to a large extent on identification of factors that influence the presence of interdental papillae. The aim of this study was to compare the accuracy of different non-invasive measurements to indicate the top of the interdental papilla on dental radiographs. The sample comprised six fresh, partly edentulous cadavers. The distance from the level of the interproximal bone next to the tip of the papilla was measured (n=330) on standard radiographic images.

http://ift.tt/2lE8Nts

Prophylactic use of fibrin sealant (ARTISS™) for facilitating safe transition to drain-free thyroid surgery: a single-centre case series review of 109 procedures

Despite a lack of evidence to support drain insertion in thyroid surgery, drain placement, to prevent rapidly expanding haematoma which occurs in around 1% of cases, remains common ^1,2,3. Throughout surgery there has been a drive towards reducing postoperative length of hospital admission. For day-case thyroidectomy to become a widely adopted clinical reality, the use of drains requires abandonment, but beyond this, the cause for surgeons' reticence to practise drain-free surgery, namely haematoma risk, needs to be addressed. This paper describes a study conducted to examine the efficacy of ARTISS^™, a commercially available thrombin-dilute fibrin sealant, in thyroid surgery to permit safe transition to drain-free surgery.

This article is protected by copyright. All rights reserved.

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Sensitivity of tumor surface brushings to detect human papilloma virus DNA in head and neck cancer

Publication date: April 2017
Source:Oral Oncology, Volume 67
Author(s): Barbara Kofler, Wegene Borena, Claudia Manzl, Jozsef Dudas, Anne-Sophie Wegscheider, Pidder Jansen-Dürr, Volker Schartinger, Herbert Riechelmann
ObjectiveHuman papilloma virus (HPV) induced head and neck squamous cell carcinoma (HNSCC) represents a distinct tumor subset. We questioned how accurately a brushing from the tumor surface detects HPV in patients with HNSCC.Materials and methodsBrushings from the tumor surface were compared with HPV DNA isolation from formalin-fixed and paraffin-embedded (FFPE) tumor biopsies, which served as the reference standard. In both matrices, HPV DNA was detected using a commercially available test kit. In addition, p16 was assessed in tumor biopsies by immunohistochemistry (IHC). The tumors were considered p16 positive if 70% or more of cancer cells expressed p16.Results93 patients with HNSCC were included. Sensitivity and specificity of the brush test were 83% (95%CI: 67–92%) and 85% (95%CI: 72–93%). Results of p16 IHC were concordant with FFPE samples DNA determinations in 73/93 patients. In 53 patients (57%) the tumor was located in the oropharynx and in 40 patients (43%) the tumor was located in the non-oropharynx region. Sensitivity and specificity of the brush test in patients with oropharyngeal cancer was higher with 86% (95%CI: 70–95%) and 89% (95%CI: 65–99%).ConclusionSuperficial brushes from the tumor surface may be used to identify HPV positive HNSCC.



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The role of perineural invasion in treatment decisions for oral cancer patients: A review of the literature

The role of perineural invasion (PNI) in the management of patients with oral squamous cell carcinoma (OSSC) is still controversial, and there is no consensus regarding the most appropriate therapeutic approach. The purpose of this study is to review the findings in the literature describing OSCC as a neurotropic malignancy, with the aim of correlating perineural invasion with treatment decisions and disease prognosis.

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Mutually Exclusive Expression Pattern of Keratin Markers for Differentiation and Proliferation in Circumscribed Palmar Hypokeratosis

Abstract

Circumscribed palmar or plantar hypokeratosis (CPH), has been regarded as a benign clonal epidermal differentiation or a keratinization disorder. CPH is characterized by a well-demarcated annular depressed erythematous lesion on the thenar or hypothenar eminences of the palms and sole, and its distinctive histopathological features are an abrupt decrease in the thickness of the corneal layer and hypogranulosis in the affected lesion. Herein, we present a case of CPH and also demonstrate mutually exclusive expression pattern of keratin markers for differentiation and proliferation between the affected and unaffected epidermis.

This article is protected by copyright. All rights reserved.

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Diminished Protein-Bound ω-Hydroxylated Ceramides In The Skin Of Ichthyosis Patients With 12r-Lox Or Elox-3 Deficiency

Abstract

Autosomal recessive congenital ichthyoses (ARCI) are a group of hereditary skin disorders. The disease phenotype is associated with an impaired epidermal barrier leading to increased transepidermal water loss, temperature instability and hypernatremic dehydration in infancy. ARCI are known to be caused by mutations in at least nine different genes which encode proteins involved in the formation of the epidermal barrier.

This article is protected by copyright. All rights reserved.

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Cross-Sectional Comparisons of Patient-Reported Disease Control, Disease Severity, and Symptom Frequency in Children with Atopic Dermatitis

Abstract

Atopic dermatitis (AD) is a chronic inflammatory disease of the skin that commonly affects children. Research in AD has utilized an increasing variety of scoring measures to monitor disease, and this lack of standardization has been cited as an obstacle to evidence-based decision making. The Harmonizing Outcome Measures for Eczema (HOME) initiative aims to establish consensus on a core set of outcome measures for AD and currently recommends the Patient-Oriented Eczema Measure (POEM) for recording patient-reported outcomes.

This article is protected by copyright. All rights reserved.

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Increased frequency of multiple sclerosis among bullous pemphigoid patients. A population-based cohort study on comorbidities anchored around the diagnosis of bullous pemphigoid

Abstract

Background

Bullous pemphigoid (BP) is a disease of the elderly, and may be associated to neurological, cardiovascular diseases and diabetes. Mortality rates strongly exceed that of the background population.

Objectives

We aimed to investigate the frequency of comorbidities and their temporal relation to BP.

Methods

A register-based matched cohort study on all Danish patients with a hospital-based diagnosis of BP (n = 3,281). Main outcomes were MS, Parkinson's disease (PD), Alzheimer's disease (AD), stroke (ST), diabetes (DM I and II), malignancies (MAL), ischaemic heart disease (IHD) and hypertension (HYP) and eventually death.

Results

At baseline, BP patients had an increased prevalence of MS, odds ratio (OR)_MS 9.7 (95% confidence interval (CI) 6.0-15.6), OR_PD 4.2 (95% CI 3.1-5.8), OR_AD 2.6 (95% CI 1.8-3.5) and OR_ST 2.7 (95% CI 2.4-2.9). Furthermore, MAL, cardiovascular disease and DM were overrepresented among BP patients, OR_DMI 3.1 (95% CI 2.5-3.8), OR_DMII 2.3 (95% CI 2.0-2.6), OR_MAL 1.3 (95% CI 1.1-1.4), OR_IHD 1.7 (95% CI 1.5-1.8) and OR_HYP 2.0 (95% CI 1.8-2.2). During follow-up, the risk of MS was significantly higher among BP patients, HR_MS 9.4 (95% CI 4.9-18.0), even if events during the first year after diagnosis of BP were excluded HR_MS-1 5.1 (95% CI 2.3-11.3). BP patients had an average increased mortality rate of 2.04 (95% CI 1.96-2.13).

Conclusions

We discovered a significantly increased frequency of MS among BP patients. At the time of diagnosis, BP patients had an excessive number of comorbidities and an increased mortality rate over the years to follow.

This article is protected by copyright. All rights reserved.

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Inflammation Following Invasive Procedures for Warthin's Tumour: A Retrospective Case Series

Abstract

Objective

To determine the risk of inflammation associated with fine-needle aspiration during evaluation of Warthin's tumour.

Design

Retrospective case series.

Setting

Tertiary medical center.

Participants

All patients who underwent fine-needle aspiration followed by parotidectomy between1992-2009 for the diagnosis/evaluation of a parotid gland tumour.

Main outcome measure

Rate of fine-needle-aspiration-related parotitis in patients with Warthin's tumour or other parotid pathologies.

Results

A total of 593 parotidectomies were performed in 553 patients during the study period, 96 (16.2%) for Warthin's tumour (study group) and 497 for other parotid-related pathologies (control group). Parotid gland inflammation following fine-needle aspiration was observed in 16 cases in the study group (16.7%) and 8 (1.6%) in the control group (P <0.001). On multivariate regression analysis, parotitis following fine-needle aspiration was more common in patients with Warthin's tumor than other parotid-related pathologies even after adjustment for possible confounders (P<0.007). Signs of inflammation were noted during surgery in 6 cases in the study group (6.3%) and none in the control group (P <0.001); respective rates of postoperative inflammation (wound infection) were 1.04% and 3.3% (P=NS). Management of parotitis consisted of hospitalization and systemic antibiotic therapy.

Conclusions

Warthin's tumour is associated with a tenfold higher risk of inflammation compared to other parotid tumours following invasive procedures. Clinicians should be alert to this complication in order to initiate proper treatment and patients must be properly counseled.

This article is protected by copyright. All rights reserved.

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Kutane Lyme-Borreliose

Zusammenfassung

Die Serologie, also die Bestimmung von IgM- und IgG-Antikörpern gegen Borrelia burgdorferi sensu lato im Serum, ist die am häufigsten verwendete Labormethode zur Diagnose kutaner Manifestationen der Lyme-Borreliose. Dafür wird in einem ersten Schritt ein sensitiver ELISA verwendet. Ein positives oder grenzwertiges ELISA-Resultat muss in einem zweiten Schritt mit einem spezifischen Immunoblot bestätigt werden. Damit hat die Serologie eine Sensitivität von 80–95 %. Die Diagnose eines typischen Erythema migrans wird klinisch gestellt. Die Serologie kommt nur bei atypischen Erythemata migrantia zur Anwendung. Dagegen ist die Serologie in der Diagnostik des Borrelienlymphozytoms oder der Acrodermatitis chronica atrophicans eine obligatorische Komponente. Eine positive Serologie kann auch nach erfolgreicher Therapie persistieren und ist keine Indikation für eine prolongierte antibiotische Therapie, wenn keine Symptome einer Lyme-Borreliose vorliegen.

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Cisto dentígeno e de retenção

Cisto dentígeno e de retenção 

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Chikungunya Infection: a Global Public Health Menace

Abstract

Chikungunya virus (CHIKV) has been involved in epidemics in African and Asian subcontinents and, of late, has transcended to affect the Americas. Aedes aegypti and Aedes albopictus are the major vectors for CHIKV infection, which results in dissemination of virus to various vital organs. Entry of virus into these tissues causes infiltration of innate immune cells, monocytes, macrophages, neutrophils, natural killer cells, and adaptive immune cells. Macrophages bearing the replicating virus, in turn, secrete pro-inflammatory cytokines IL-1β, TNF-α, and IL-17. Together, this pro-inflammatory milieu induces osteoclastogenesis, bone loss, and erosion. CHIKV is characterized by fever, headache, myalgia, rash, and symmetric polyarthritis, which is generally self-limiting. In a subset of cases, however, musculoskeletal symptoms may persist for up to 3–5 years. Viral culture and isolation from blood cells of infected patients are the gold standards for diagnosis of CHIKV. In routine practice, however, assays for anti-CHIKV IgM antibodies are used for diagnosis, as elevated levels in blood of infected patients are noted from 10 days following infection for up to 3–6 months. Early diagnosis of CHIKV is possible by nucleic acid detection techniques. Treatment of acute CHIKV is mainly symptomatic, with analgesics, non-steroidal anti-inflammatory agents (NSAIDs), and low-dose steroids. No vaccines or anti-viral medicines have been approved for clinical therapy in CHIKV as yet. Hydroxychloroquine and methotrexate have been used in chronic CHIKV infection with variable success.

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Long-term effects of pulsed high-intensity laser therapy in the treatment of post-burn pruritus: a double-blind, placebo-controlled, randomized study

Abstract

We assessed the long-term effects of pulsed high-intensity laser therapy (HILT) in post-burn pruritus treatment. A total of 49 adult burn patients with mean age of 31.53 ± 10.14 years participated, with 24 patients randomly assigned to the active laser group (ALG) and 25 in the placebo laser group (PLG). The ALG received HILT three times per week for 6 weeks, while the PLG received placebo HILT. Both groups received 10-mg cetirizine tablets twice daily and 10 mg at bedtime. All patients were advised to massage their burn scars with coconut oil for 5 min four times daily. The outcomes measured were the itch severity scale (ISS), impairment of pruritus-related quality of life (QoL), pain level by the visual analog scale (VAS), hand grip strength by handheld dynamometer, and daily cetirizine intake. Repeated-measures ANOVA was used to compare the baseline and post-treatment measurements and after 12 weeks of follow-up. Statistical significance was set at P < 0.05. ISS decreased significantly in the ALG after 6 weeks of treatment and after 12 weeks of follow-up compared with the PLG. The QoL results showed a significant improvement in the ALG compared with the PLG, which continued after 12 weeks. VAS results significantly decrease, hand grip strength significantly improved, and cetirizine intake significantly decreased post-treatment in the ALG relative to the PLG. HILT combined with cetirizine seems more effective in patients with post-burn pruritus than a placebo laser procedure with cetirizine.

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A precision medicine approach to a patient with unresolved pain following orthopedic surgery: a case report

Precision medicine is a promising technology in patient care that combines genetic analysis with clinical data, such as health, behavioral, functional, environment, and lifestyle information. Here we present t...

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Current status in diagnosis of atopic dermatitis in China

Abstract

In China, eczema and atopic dermatitis (AD) have been traditionally considered as 2 distinct entities. Eczema typically referred to the milder phenotypes or to phenotypes with atypical morphology and distribution of lesions and many dermatologists have ever recognized that the "eczema" diagnosed clinically by them is actually milder phenotypes or phenotypes with atypical morphology and distribution of lesions of AD. Moreover, AD, contact dermatitis, diaper dermatitis, perioral dermatitis, halo dermatitis, pompholyx, seborrheic dermatitis, etc. are not included in category of "eczema" in Chinese textbook of dermatology².

This article is protected by copyright. All rights reserved.

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Allergenome characterization of the mosquito Aedes aegypti

Abstract

Background

Saliva and muscle derived mosquito allergens have been purified and characterized. However, the complete set of allergens remains to be elucidated. In this study, we identified and characterized IgE-binding proteins from the mosquito species A. aegypti.

Methods

Serum was obtained from 15 allergic individuals with asthma and/or rhinitis and sensitized to mosquito. IgE-binding was determined by ELISA. Total proteins from freeze dried bodies of A. aegypti were extracted and IgE reactive proteins were identified by 2D-gel electrophoresis, followed by Western blot with pooled or individual sera. IgE-reactive spots were further characterized by mass spectrometry.

Results

Twenty five IgE-reactive spots were identified, corresponding to 10 different proteins, some of which appeared as different variants or isoforms. Heat shock cognate 70 (HSC-70) and Tropomyosin showed IgE reactivity with 60% of the sera, Lysosomal aspartic protease and "AAEL006070-PA" (Uniprot: Q177P3) with 40% and the other proteins with less than 33.3% of the sera. Different variants, or isoforms of Tropomyosin, Arginine or Creatine kinase, Glyceraldehyde-3-phosphate dehydrogenase (GPDH), Calcium-binding protein and Phosphoglycerate mutase were also identified. The mixture of three allergens (Aed a 6, Aed a 8 and Aed a 10) seems to identify more than 80% of A. aegypti sensitized individuals, indicating that these allergens should be considered when designing of improved mosquito allergy diagnostic tools.

Conclusions

The newly identified allergens may play a role in the pathophysiology of mosquito allergy in the Tropics, and some of them might be important arthropod-related proteins involved in cross-reactivity between A. aegypti and other allergenic arthropods.

This article is protected by copyright. All rights reserved.

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Skin prick tests and specific IgE in 10 year old children: agreement and association with allergic diseases

Abstract

Background

Accurate assessment of atopic sensitization is pivotal to clinical practice and research. Skin prick test (SPT) and specific IgE (sIgE) are often used interchangeably. Some studies have suggested a disagreement between these two methods, and little is known about their association with allergic diseases. The aims of our study were to evaluate agreement between SPT and sIgE, and to compare their association with allergic diseases in 10-year old children.

Methods

SPT, sIgE measurements and assessment of allergic diseases were performed in children aged 10 years old in the Protection against Allergy: STUdy of Rural Environment (PASTURE) cohort. The agreement between SPT and sIgE was assessed by Cohen's kappa coefficient with different cutoff values.

Results

SPTs and sIgE were performed in 529 children. The highest agreement (κ=0.44) was found with a cutoff value of 3 and 5 mm for SPT, and 3.5 IU/mL for sIgE. The AUC obtained with SPT were not significantly different from those obtained with sIgE. For asthma and hay fever, SPT (cutoff value at 3 mm) had a significantly higher specificity (p<0.0001) than sIgE (cutoff value at 0.35 IU/mL) and the specificity was not different between both tests (p=0.1088).

Conclusion

SPT and sIgE display moderate agreement, but have a similar AUC for allergic diseases. At the cutoff value of 3 mm for SPT and 0.35 IU/mL for sIgE, SPT has a higher specificity for asthma and hay fever than sIgE without difference for sensitivity.

This article is protected by copyright. All rights reserved.

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Apremilast : attention aux idées et comportements suicidaires

Publication date: Available online 24 February 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): J.-L. Schmutz




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Malformations lymphatiques kystiques superficielles

Publication date: Available online 24 February 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): R. Gabeff, G. Lorette, D. Herbreteau, A. le Touze, D. Goga, A. Maruani




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IRF9 as a negative regulator involved in TRIF-mediated NF-κB pathway in a teleost fish, Miichthys miiuy

Publication date: May 2017
Source:Molecular Immunology, Volume 85
Author(s): Xueyan Zhao, Qing Chu, Junxia Cui, Ruixuan Huo, Tianjun Xu
Proinflammatory cytokines and type I IFNs were produced by TLR signaling and these responses are crucial for host defensive responses against pathogens. In order to avoid harmful and inappropriate inflammatory responses, there are multiple mechanisms to negatively regulate TLR signaling. In this paper, we have firstly studied IRF9 functions as a negative regulator involved in TRIF-mediated NF-κB pathway. Moreover, we found inhibitory effect of IRF9 primary depends on DBD domain. Interestingly, we also demonstrated that else mutants of IRF9, except for IRF9-ΔDBD, have different inhibitory effects upon TRIF-mediated NF-κB pathway. This study provides a novel evidence about the negatively regulation of innate immune signaling pathway in teleost fish. In addition, this finding provides new insights into the regulatory mechanism in mammals.



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Hyperfixation intense d’une kératose séborrhéique en TEP-TDM

Publication date: Available online 24 February 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): C. Merklen-Djafri, P. Truntzer, S. Hassler, B. Cribier
IntroductionLa tomographie à émission de positons (TEP) est un examen basé sur la fixation d'un traceur radioactif par des cellules hypermétaboliques. Il est principalement utilisé couplé à la tomodensitométrie (TEP-TDM) dans le bilan d'extension des cancers, du fait d'une grande sensibilité et d'une grande spécificité pour la détection des métastases. Toutefois, des tumeurs bénignes peuvent avoir une hyperfixation inhabituelle, dont des tumeurs cutanées. Nous rapportons un cas très exceptionnel de kératose séborrhéique à l'origine d'une hyperfixation pathologique.ObservationUn patient de 55 ans atteint d'un carcinome épidermoïde de l'œsophage nous a été adressé en raison de la découverte d'un foyer d'hyperfixation en TEP-TDM, correspondant à une lésion cutanée pigmentée. Il n'y avait aucune autre hyperfixation suspecte. Cette lésion a été excisée et l'examen histologique a montré qu'il s'agissait d'une kératose séborrhéique. L'aspect histologique était celui d'une kératose séborrhéique classique, sans activité mitotique remarquable.DiscussionLa TEP-TDM est reconnue comme un examen permettant le diagnostic de malignité. De rares cas d'hyperfixation par des tumeurs cutanées bénignes ont cependant été décrits : histiocytofibromes, pilomatricomes ou condylomes. L'hyperfixation par une kératose séborrhéique n'a été qu'exceptionnellement rapportée.ConclusionCe cas très inhabituel d'hyperfixation d'une kératose séborrhéique en TEP-TDM confirme que l'activité hypermétabolique détectée par cet examen n'est pas synonyme de malignité. Une confrontation avec la clinique et les données histologiques est indispensable. Les raisons de l'activité métabolique accrue au sein de ces tumeurs bénignes ne sont pas connues.BackgroundPositron emission tomography (PET) is an examination based upon the uptake of a radioactive tracer by hypermetabolic cells. It is primarily used in tandem with tomodensitometry (PET-TDM) for cancer staging because of its high sensitivity and specificity for the detection of metastases. However, unusually high uptake may occur with benign tumours, including skin tumours. Herein, we report an extremely rare case of pathological uptake levels resulting from seborrhoeic keratosis.Patients and methodsA 55-year-old male patient with oesophageal squamous-cell carcinoma was referred to us following the discovery of an area of high marker uptake following PET-TDM and corresponding to a pigmented skin lesion. No other areas of suspect high uptake were seen. The lesion was surgically excised and histological examination indicated seborrhoeic keratosis. The histological appearance was that of standard seborrhoeic keratosis without any notable mitotic activity.DiscussionPET-TDM is an examination that enables diagnosis of malignancy. However, rare cases have been described of increased marker uptake by benign cutaneous tumours such as histiocytofibroma, pilomatricoma and condyloma. To date, there have only been only very few cases of increased uptake due to seborrhoeic keratosis.ConclusionThis extremely unusual case of increased glucose uptake in PET-TDM due to seborrhoeic keratosis confirms that the hypermetabolic activity detected by this examination is not necessarily synonymous with malignancy and that confirmation by clinical and histological findings is essential. The reasons for increased metabolic activity within such benign tumours are not known.



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Pustulose exanthématique aiguë généralisée induite par le phloroglucinol (Spasfon®)

Publication date: Available online 24 February 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): N. Brahimi, E. Maubec, T. Petit, B. Crickx, V. Descamps
IntroductionLa pustulose exanthématique aiguë généralisée (PEAG) est une toxidermie sévère réalisant une éruption maculo-pustuleuse fébrile d'apparition brutale. Nous rapportons une première observation de PEAG secondaire à la prise de phloroglucinol (Spasfon^®).ObservationUne femme de 27 ans, enceinte, développait un tableau de pustulose exanthématique fébrile trois jours après la prise phloroglucinol et de paracétamol (Perfalgan^®) par voie parentérale en traitement d'une colique néphrétique. Elle n'avait aucun antécédent de psoriasis. Le bilan biologique montrait une hyperleucocytose à polynucléaires neutrophiles. Les prélèvements cytobactériologiques des pustules étaient négatifs. La biopsie cutanée trouvait une vasculite leucocytoclasique à polynucléaires neutrophiles. La réintroduction du phloroglucinol après l'accouchement induisait la reproduction du même tableau clinique au bout de quelques heures. Le diagnostic de PEAG secondaire au phloroglucinol était retenu, avec un score d'imputabilité intrinsèque I4 (S3 C3) selon les critères de Begaud et al. L'évolution était favorable après interruption du médicament.DiscussionIl s'agit à notre connaissance du premier cas de PEAG pour lequel l'imputabilité du phloroglucinol est confirmée par un test de réintroduction positif.BackgroundAcute generalized exanthematous pustulosis (AGEP) is a severe drug eruption. We report herein the first case of AGEP induced by phloroglucinol (Spasfon^®).Patients and methodsA 27-year-old pregnant woman developed a febrile exanthematous pustulosis eruption three days after treatment with intravenous phloroglucinol and paracetamol for nephritic colic. She had no previous history of psoriasis. The laboratory workup showed hyperleukocytosis with neutrophilia. A cytobacteriological sample of the pustules was negative. Skin biopsy revealed marked neutrophilic and leukocytoclastic vasculitis. Reintroduction of phloroglucinol after delivery resulted in the same clinical symptoms within a few hours of intake. A diagnosis of phloroglucinol-induced AGEP was made on the basis of intrinsic imputability of I4 (S3 C3) using the imputability criteria of Begaud et al. The outcome was favorable after withdrawal of the drug.DiscussionTo the best of our knowledge, this is the first case of phloroglucinol-induced AGEP confirmed by reintroduction of the drug.



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Cutaneous basidiobolomycosis: Seven cases in southern Benin

Publication date: Available online 24 February 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): F. Atadokpédé, J. Gnossikè, H. Adégbidi, B. Dégboé, Y. Sissinto-Savi de Tovè, A. Adéyé, C. Koudoukpo, A. Chauty, D. Chabasse, J.-P. Saint-André, M.-T. Dieng, M.-C. Koeppel, H.-G. Yedomon, F. do-Ango-Padonou
BackgroundCutaneous basidiobolomycosis is the most common form of entomophthoramycosis. Herein we report seven cases of cutaneous basidiobolomycosis.Patients and methodsA retrospective observational study was conducted at the Buruli ulcer treatment centre in Pobè and at the national teaching hospital in Cotonou from 2010 to 2015.ResultsSeven cases of cutaneous basidiobolomycosis were diagnosed. The mean patient age was 9.53 years. There were 4 female and 3 male patients, all from southeast Benin. Clinically, the disease presented in all cases as a hard, well-defined, subcutaneous plaque with little inflammation, and which could easily be lifted from the deep structures but remained attached to the surface structures. The overlying skin was hyperpigmented. Plaques were localized to the buttocks or thighs. All patients had inflammatory anaemia with an accelerated erythrocyte sedimentation rate (30 to 70mm over the first hour), and a low haemoglobin count (8.7 to 11.4g/dL). Blood hypereosinophilia (650 to 3784elements/mm³) was present in six of the seven subjects. Histopathology (performed for 5 of the 7 subjects) showed granulomatous lesions with foreign-body giant cells, and inflammatory cells, with occasional eosinophils surrounding fungal hyphae (Splendore-Hoeppli phenomenon). Mycological analysis revealed Basidiobolus ranarum in three cases. The patients were treated with ketoconazole (5/7) and itraconazole (2/7), with good outcomes after 10 to 24 weeks of therapy.DiscussionCutaneous basidiobolomycosis is uncommon in southern Benin, with only seven cases being diagnosed over 6 years. The diagnosis of cutaneous basidiobolomycosis is a challenge in the field in Benin due to the non-specific clinical presentation, the lack of technical resources, and the existence of numerous differential diagnoses.ConclusionCutaneous basidiobolomycosis is an uncommon fungal infection in southern Benin chiefly affecting children.



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Kyste trichilemmal proliférant : une présentation inhabituelle

Publication date: Available online 24 February 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): A. Viarnaud, K. Alhazmi, G. Constant, S. Gaudron, G. Hirsch, M. Janier, R. Ochisor, B. Hillion




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Dermatoses et surinfection herpétique : étude rétrospective de 34 cas

Publication date: Available online 24 February 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): V. Seta, F. Fichel, J.-F. Méritet, S. Bouam, N. Franck, M.-F. Avril, N. Dupin
IntroductionLa surinfection herpétique (SH) est une complication classique mais peu étudiée des dermatoses.ObjectifIdentifier les dermatoses compliquées de SH et préciser les caractéristiques des SH chez des patients hospitalisés dans un service de dermatologie.MéthodesÉtude descriptive, rétrospective entre 2008 et 2014, monocentrique, ayant inclus les cas de SH définis par une PCR HSV positive prélevée sur un site non classique de récurrence herpétique, dans un contexte de dermatose sous-jacente active. Une fiche était remplie pour chaque cas avec les données d'anamnèse, clinico-biologiques, thérapeutiques et évolutives.RésultatsTrente-quatre cas de SH correspondant à 30 sujets ont été inclus. L'âge moyen au diagnostic était de 63,3±24,2 ans. Les dermatoses sous-jacentes étaient 7 pemphigus, 6 pemphigoïdes bulleuses, 3 pemphigoïdes des muqueuses, 3 dermatites atopiques (DA), 1 maladie de Darier et 14 autres dermatoses. Les patients se présentaient avec des lésions cutanées (94 %) ou muqueuses (62 %), majoritairement érosives (79 %), vésiculeuses (27 %) ou bulleuses (41 %), volontiers douloureuses (56 %) ou prurigineuses (29 %). Au diagnostic, 41 % avaient une immunothérapie systémique et 24 % une corticothérapie locale. La PCR était positive à HSV1 dans 20 cas, HSV2 dans 4 cas et indéterminée dans 10 cas. Il existait une lymphopénie dans 59 % des cas. La majorité des patients ont reçu un traitement pour la SH. Neuf ont fait au moins une récidive.ConclusionEn plus du pemphigus et de la DA, notre étude a permis d'identifier d'autres dermatoses compliquées de SH. Ces résultats nécessitent d'être précisés par un travail plus systématique et prospectif.BackgroundAlthough varicelliform Kaposi eruption is a well-known complication of dermatoses, it has not been widely investigated.AimTo investigate features of dermatoses and herpes superinfection in patients hospitalized in a dermatology department.Patients and methodsWe performed a single-centre, retrospective study between 2008 and 2014 that included cases of Kaposi varicelliform eruptions defined by positive PCR of an unconventional site of herpetic recurrence in a setting of active dermatitis. A record was compiled of each case giving details of the history, clinical and laboratory findings, therapeutic data and outcome.ResultsThirty-four cases of Kaposi varicelliform eruptions in 30 subjects were studied. Mean age at diagnosis was 63.3±24.2 years. The underlying dermatoses were as follows: 7 pemphigus, 6 bullous pemphigoid, 3 cicatricial pemphigoid, 3 atopic dermatitis, 1 Darier disease, and 14 other dermatoses. Patients presented with skin (94.1 %) or mucous membrane lesions (62 %), mostly erosive (79 %), vesicular (27 %) or bullous (41 %), often painful (56 %) or pruritic (29 %). At diagnosis, 41.2 % were undergoing systemic immunotherapy and 24 % were on topical corticosteroids. PCR was positive for HSV1 in 20 cases and for HSV2 in 4 cases, and indeterminate in 10 cases. Lymphocytopenia was seen in 59 % of cases. The majority of patients received treatment. Nine patients experienced at least one relapse.ConclusionOur study confirms the over-representation not only of the expected dermatoses (pemphigus and atopic dermatitis), but also of others such as pemphigoid and acute dermatoses; these results should be investigated in a more systematic prospective study.



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Amicrobial pustulosis of the folds: Where have we gone 25years after its original description?

Publication date: Available online 24 February 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): C. Schissler, C. Velter, D. Lipsker
BackgroundTwenty-five years ago at the Journées Dermatologiques de Paris, Prof. Béatrice Crickx described a new association, "antimicrobial pustulosis and systemic lupus erythematosus", a condition now known as amicrobial pustulosis of the folds (APF). The aim of this study is to analyse the clinical and laboratory characteristics of APF and to outline the gradual advancement of knowledge regarding this disease.Materials and methodsBased on a case of APF seen in our department, we carried out a review of the literature since 1991 by searching the Medline database for scientific articles using the following keywords: "Amicrobial Pustulosis" or "Pustular Dermatosis" and "Folds".ResultsWe collated 63 cases of APF. In total, 90% involved women and the mean age was 30 years. Cutaneous lesions consisted of pustules in an erythematous setting, frequently erosive and affecting the skinfolds, anogenital region, scalp, external auditory meatus and umbilicus. Histological examination revealed spongiform subcorneal pustulosis associated with mixed inflammatory infiltrate in the dermis.DiscussionAPF belongs to the spectrum of neutrophilic dermatoses. Its complex physiopathology involves an auto-inflammatory mechanism. It is associated with a variety of autoimmune diseases, in most cases systemic lupus erythematosus. Diagnosis of the condition is difficult and is based on histological correlation and negative microbiological culture. The most effective treatment is still systemic corticosteroids, although new therapeutic alternatives are emerging such as anakinra and anti-TNF-alpha drugs.



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Place de l’immunophénotypage sanguin et de l’étude de la clonalité dans la prise en charge des lymphomes T cutanés

Publication date: Available online 24 February 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): C. Bouthemy, A. Beldi-Ferchiou, N. Ortonne, M.-H. Delfau-Larue, S. Ingen-Housz-Oro, V. Molinier-Frenkel




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Tumeur musculaire lisse atypique dermique

Publication date: Available online 24 February 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): C. Attencourt, D. Thuillier, F. Lombart, T. Petit
IntroductionNous rapportons un cas de tumeur musculaire lisse atypique dermique.ObservationUn patient de 58 ans présentait un nodule blanc-rosé du torse, indolore, apparu deux ans plus tôt. À l'examen histologique, il s'agissait d'une prolifération tumorale intradermique composée de cellules musculaires lisses avec quelques atypies. Il était compté jusqu'à cinq mitoses dans les champs les plus mitotiques. Le diagnostic proposé était celui de tumeur musculaire lisse atypique dermique.DiscussionLa tumeur musculaire lisse atypique dermique s'inscrit dans un spectre lésionnel allant du léiomyome cutané au léiomyosarcome. Le pronostic est essentiellement représenté par le risque de récidive locale. Le terme de tumeur musculaire lisse atypique dermique n'est pas actuellement admis par l'Organisation mondiale de la santé (OMS) mais proposé comme alternative à celui de sarcome, dont l'impact psychologique et social n'est pas négligeable.BackgroundWe report herein a case of atypical intradermal smooth-muscle neoplasm.Patient and methodsA 58-year-old man presented with a painless pinkish-white chest nodule ongoing for two years. Histopathology revealed a proliferation of intradermal smooth-muscle cells. Some atypia and 5 mitoses were seen in the most mitotic fields. The histopathologist suggested a diagnosis of "atypical intradermal smooth-muscle neoplasm".DiscussionAtypical intradermal smooth-muscle neoplasm is part of a spectrum extending from skin leiomyoma to leiomyosarcoma. The prognosis consists chiefly in risk of local recurrence. The terminology is not currently accepted by WHO but nevertheless offers an alternative to inappropriate diagnosis of sarcoma, which carries psychological and social impact.



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Le jeu du déodorant, challenge diagnostique en dermatologie pédiatrique

Publication date: Available online 24 February 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): N. Soysal, E. Bourrat




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Localisations cutanées d’un lymphome lymphoblastique T

Publication date: Available online 24 February 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): C. Nascimbeni, S. Chantepie, C. Brugiere, F. Comoz, V. Salaun, L. Verneuil
IntroductionLe lymphome lymphoblastique (LBL) est un lymphome non hodgkinien (LNH) rare. Les localisations cutanées des LBL concernent moins de 20 % des patients.ObservationNous rapportons le cas d'un homme de 66 ans sans antécédent pathologique notable qui présentait une lésion tumorale du cuir chevelu d'extension progressive, plusieurs macules et nodules violacés du tronc ainsi qu'une adénopathie spinale unique. La tomodensitométrie (TDM) thoraco-abdomino-pelvienne, réalisée en raison d'une insuffisance rénale aiguë, montrait une importante infiltration tissulaire rétropéritonéale. Les biopsies cutanées et le bilan d'extension concluaient à un LBL-T associant des lésions cutanées, osseuses et ganglionnaires rétropéritonéales, sans masse médiastinale. Après deux mois de traitement par CHOP (quatre cycles), les lésions cutanées et la masse tumorale abdominale avaient régressé, et la fonction rénale était revenue à la normale.DiscussionTreize cas de LBL avec atteinte cutanée ont été rapportés ; la plupart des patients étaient jeunes (moins de 30 ans) et présentaient des lésions cutanées multiples (nodules ou tumeurs) associées à de nombreuses adénopathies périphériques, un envahissement de la moelle osseuse et souvent une masse médiastinale. La présentation clinique du LBL-T dans notre cas est originale en raison des localisations cutanées associées à un syndrome tumoral abdominal, sans infiltration médiastinale, avec une adénopathie périphérique unique, chez un sujet âgé.BackgroundLymphoblastic lymphoma (LBL) is a rare form of non-Hodgkin's lymphoma (NHL). Cutaneous LBL is seen in less than 20% of patients.Patients and methodsHerein, we report the case of a 66-year-old male patient without any previous disease history of note and who was presenting a gradually spreading tumoral lesion of the scalp, several purplish macules and nodules on the trunk, and a single spinal adenopathy. A thoracic-abdominal-pelvic CT scan performed for acute renal failure, revealed extensive infiltration of retroperitoneal tissue. Skin biopsies and staging tests indicated LBL-T with associated cutaneous, bone and lymph node retroperitoneal lesions with no mediastinal mass. After two months of treatment with CHOP (four courses), the cutaneous lesions and abdominal tumoral mass had regressed and renal function had returned to normal.DiscussionThere have been 13 reported cases of LBL with cutaneous involvement; most of these patients were young (under 30 years) and presented multiple cutaneous lesions (nodules or tumors) associated with numerous peripheral adenopathies, invasion of the bone marrow, and in many cases, a mediastinal mass. The clinical presentation of LBL-T in our case is novel on account of the cutaneous sites, associated with abdominal tumoral syndrome, without mediastinal infiltration, and with a single peripheral adenopathy, in an elderly subject.



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