The Lymphatic Anatomy of the Lower Eyelid and Conjunctiva and Correlation with Postoperative Chemosis and Edema

The lower eyelid and conjunctiva are drained by interconnecting superficial and deep lymphatic systems of the face. The superficial system is vulnerable to damage in incisions and dissection in the infraorbital area. The deep system is vulnerable to damage in dissection around the orbicularis retaining ligament and the zygomaticocutaneous ligaments. The authors suggest that concurrent damage to both the superficial and deep lymphatic systems, especially laterally, may be responsible for postoperative chemosis and edema.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Abstracts

http://ift.tt/2lYDOXD

Influence of third molars in mandibular fractures. Part 2: mandibular condyle—a meta-analysis

The aim of this systematic review was to investigate the influence of the presence and position of mandibular third molars in mandibular condyle fractures. An electronic search was conducted in PubMed, Scopus, Web of Science, Cochrane Library, and VHL, through January 2016. The eligibility criteria included observational studies. The search strategy resulted in 704 articles. Following the selection process, 13 studies were included in the systematic review and 11 in the meta-analysis. In terms of the risk of bias analysis, six studies presented ≤6 stars in the Newcastle–Ottawa scale assessment.

http://ift.tt/2lusPmU

Papilla and alveolar crest levels in immediate versus delayed single-tooth zirconia implants

The aim of this study was to determine the correlation between the papilla deficit and the distance between the bone crest at the neighbouring tooth and the contact point of the clinical crown (distance 4) for immediate and delayed zirconia implants. This prospective observational study included 78 patients with 82 implants investigated at the 1-year follow-up. Patients received single-unit zirconia implants (Straumann PURE Ceramic Implant with ZLA surface) that were placed using either the delayed (group A) or immediate (group B) protocol after tooth extraction.

http://ift.tt/2mbpGMT

Impact of caries and dental fluorosis on oral health-related quality of life: a cross-sectional study in schoolchildren receiving water naturally fluoridated at above-optimal levels

Abstract

Purpose

The purpose of this study was to evaluate the impact of caries and fluorosis on oral health-related quality of life (OHRQoL) among schoolchildren living in areas with high concentrations of fluoride in water.

Methods

Five hundred and twenty-four schoolchildren (8–12 year olds) residing in rural communities in central Mexico were examined for oral hygiene, caries (International Caries Detection and Assessment System, ICDAS II), and fluorosis (Thylstrup and Fejerskov Index, TFI). OHRQoL was evaluated with the Child Perceptions Questionnaire for two age groups (CPQ_8–10 and CPQ_11–14). Generalized structural equation models were constructed for data analysis.

Results

Overall prevalence of caries was 88.5% and fluorosis 46.9%. In the group of 8–10 year olds, 48% of the children had advanced carious lesions in primary or permanent teeth (ICDAS ≥4), 22.6% had moderate/severe fluorosis, and 59.9% of children had an impact on OHRQoL. Schoolchildren with ICDAS ≥4 were more likely [OR = 1.75, (95% CI 1.34–2.28)] to suffer a negative impact on OHRQoL. In the group of 11–12 year olds, 19.9% of children had advanced carious lesions and 23.2% showed moderate/severe fluorosis; 67.3% of children reported had an impact on OHRQoL. Children 11–12 year olds with fluorosis (TFI ≥4) [OR = 2.39 (95% CI 2.12–2.69)], caries (ICDAS ≥4) [OR = 2.18 (95% CI 2.13–2.24)], and low brushing frequency [OR = 2.04 (95% CI 1.21–3.44)] were more likely to have deterioration on OHRQoL.

Conclusion

A negative impact on OHRQoL was observed in children with caries and fluorosis.

Clinical relevance

Deterioration on OHRQoL found in children as a sequel of caries and fluorosis should be considered when designing health policies leading to prevention and effective health promotion programs and incorporated to clinical guidelines for timely dental treatment.

http://ift.tt/2lYCEvc

Evaluation of the risk of infection associated with subcutaneous allergen immunotherapy

Questions have recently been raised by regulatory bodies in the United States regarding a potential risk of infections related to subcutaneous allergen immunotherapy (SCIT) injections. In response to a fungal meningitis outbreak from contaminated, compounded injectable medications, the US Food and Drug Administration endorsed the US Pharmacopeia's Pharmaceutical Compounding—Sterility Preparations guidelines as the standard for pharmaceutical compounding in 2013.1 An exemption was granted to allergen extracts as long as they addressed specific procedures that were feasible in an office setting.

http://ift.tt/2mHFdlz

Idiopathic avascular necrosis associated with humoral deficiency

The prevalence of avascular necrosis (AVN) of the femoral head is unknown, but estimates indicate that the incidence is between 10,000 and 20,000 new cases a year, with a smaller fraction of those being idiopathic.1 Idiopathic AVN has been associated with a variety of autoimmune conditions, including systemic lupus erythematosus and antiphospholipid syndrome.2 It has also been associated with infections and immunodeficiencies, such as human immunodeficiency virus (HIV).3 It has never been described in association with a functional humoral deficiency.

http://ift.tt/2mgzupp

Consensus statement for the treatment of infantile haemangiomas with propranolol

Abstract

Although most infantile haemangiomas do not require treatment due to a natural history of spontaneous involution, some require early intervention. The Australasian Vascular Anomalies Network and the Australasian Paediatric Dermatology Network have developed a consensus statement for the treatment of infantile haemangiomas with oral propranolol. Infants with haemangiomas that are life threatening, at risk of ulceration, or at risk of causing a significant functional impairment, psychological impact or physical deformity should be treated early with oral propranolol. Oral propranolol is safe and effective and in most healthy infants oral propranolol can be started in an outpatient setting.

http://ift.tt/2lVXg9i

Burden of human scabies in sub-Saharan African prisons: Evidence from the west region of Cameroon

Abstract

Background/Objectives

There is little data on the profile and magnitude of scabies in sub-Saharan African prisons. The present study aimed to assess the prevalence and determinants of scabies in prisons of the west region of Cameroon.

Methods

We conducted a cross-sectional study from March to August 2014, and consecutively recruited volunteer detainees of three randomly selected prisons in the West Region of Cameroon. The diagnosis was based on clinical findings after assessment by two experienced and well-trained dermatologists.

Results

We enrolled 755 prisoners, 17 (2%) of whom were women. Their mean age was 32 ± 12 years. There were 242 cases (32%) of scabies, with significantly more cases in the most crowded prison (P < 0.0001). Men were significantly more affected than women (P = 0.004) and the prevalence of scabies significantly decreased when the level of education increased (P < 0.0001). In addition to a low level of education (adjusted odds ratio (aOR) 1.90; P < 0.0001), sharing clothes/bedding (aOR 2.72; P < 0.0001) and the number of detainees per cell > 10 (aOR 1.89; P = 0.002), but not age, duration of incarceration, number of baths/week and washing/week, were independent drivers of scabies occurrence.

Conclusion

Almost one-third of prisoners suffered from scabies in our prisons. A low educational level, the sharing of clothes/bedding and number of detainees/cell > 10 were independent determinants of the disease. Urgent measures must be undertaken to reduce the burden of scabies in our prisons.

http://ift.tt/2lVSp7P

Suction blistering the lesional skin of vitiligo patients reveals useful biomarkers of disease activity

Vitiligo is an autoimmune disease of the skin with limited treatment options; there is an urgent need to identify and validate biomarkers of disease activity to support vitiligo clinical studies.

http://ift.tt/2mNd5N2

Macrophage and osteoclast polarization in bisphosphonate associated necrosis and osteoradionecrosis

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a complication of antiresorptive therapy with nitrogen-containing bisphosphonates (BP). With various suggestions as to pathogenesis, the etiology of BRONJ is not sufficiently understood. Osteoclasts and their precursors, that is, macrophages, are the main target cells of BP. BP can repolarize regeneration- and healing-associated M2 macrophages towards the tissue destructive M1-type. The current study aims to elucidate differences in macrophage and osteoclast polarization in BRONJ, osteoradionecrosis (ORN) and healthy control specimens.

http://ift.tt/2mgmWOA

A Wandering Abdominal Mass in a Neonate: An Enteric Duplication Cyst Mimicking an Ovarian Cyst

Enteric duplication cysts are rare congenital anomalies that are prenatally diagnosed through antenatal ultrasonography (US). In female patients, however, attention must be paid since these formations might be confused with ovarian cysts. Herein, we present a case of a low birth weight female infant with an enteric duplication cyst. A cystic lesion was detected in the right abdomen of the fetus on antenatal US and magnetic resonance imaging (MRI). Serial US and MRI examinations performed after birth showed a single cyst that wandered from side to side in the abdomen; the initial diagnosis was thought to be an ovarian cyst. During laparotomy, however, it was found to be an enteric duplication cyst with volvulus. To our knowledge, there has been no report of an enteric duplication cyst presenting as a wandering abdominal mass. Our experience indicates that early intervention is necessary for patients who have a wandering abdominal mass to avoid complications and urgent surgery, whether it is an ovarian cyst or an enteric duplication cyst.

http://ift.tt/2mvqQE2

In Situ Splitting of a Rib Bone Graft for Reconstruction of Orbital Floor and Medial Wall

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0036-1597915

In situ splitting of rib bone graft was conducted in 22 patients for the repair of orbital fracture with no other complicating fractures. A bone graft was harvested from the sixth or seventh rib in the right side. The repair of the orbital floor and medial wall was successful in all the cases. Ten patients had bone grafting to the orbital floor, eight had it done onto medial wall, and 4 onto both floor and wall after reduction. The mean length of in situ rib bone graft was 40.9 mm (range, 20–70 mm), the mean width of these was 14.9 mm (range, 8–20 mm). The bone grafting was done by one leaf for 15 cases and two leafs for 7 cases in size of defects. The technique of in situ splitting of a rib bone graft for the repair of the orbital floor and medial wall is a simple and safe procedure, easily taking out the in situ splitting of a rib, and less pain in donor site. It has proved to be an optimal choice in craniofacial reconstruction, especially the defects of orbital floor and medial wall.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

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Liver radiofrequency ablation as emergency treatment for a ruptured hepatocellular carcinoma: a case report

Hemoperitoneum is a possible complication of hepatocellular carcinoma that may require emergency surgery as an alternative to radiological locoregional therapies.

http://ift.tt/2ltJLdd

Aflatoxins, discolouration and insect damage in dried cowpea and pigeon pea in Malawi and the effectiveness of flotation/washing operation in eliminating the aflatoxins

Abstract

Aflatoxin contamination and biodeterioration were examined in 302 samples of dry cowpeas and pigeon peas that were randomly purchased from 9 districts of the Southern Region of Malawi during July and November 2015. Further, the impact of flotation/washing on aflatoxin levels on the pulses was elucidated. Aflatoxin analyses involved immunoaffinity column (IAC) clean-up and HPLC quantification with fluorescence detection (FLD) while legume biodeterioration assessments were done by visual inspection. Aflatoxins were frequently detected in cowpea (24%, max., 66 μg/kg) and pigeon pea (22%, max., 80 μg/kg) samples that were collected in the month of July. Lower aflatoxin incidence of 15% in cowpeas (max., 470 μg/kg) and 14% in pigeon peas (max., 377 μg/kg) was recorded in the November collection. Overall, aflatoxin levels were significantly higher in the pulses that were collected in November. However, there were no significant differences in the total aflatoxin (aflatoxin B₁ (AFB₁) + AFB₂ + AFG₁ + AFG₂) levels between the two types of pulses. Remarkably, in 76.2% of the aflatoxin positive cowpea and in 41.7% of the aflatoxin positive pigeon pea samples, aflatoxin G₁ concentration exceeded aflatoxin B_1. Insect damage percentage averaged at 18.1 ± 18.2% (mean ± SD) in the cowpeas and 16.1 ± 19.4% in pigeon peas. Mean discolouration percentage (number of pulses) of the cowpeas and pigeon peas was found to be at 6.7 ± 4.9 and 8.7 ± 6.2%, respectively. Washing and discarding the buoyant fraction was highly efficient in reducing aflatoxin levels; only 5.2 ± 11.1% of the initial aflatoxin level was found in the cleaned samples. In conclusion, cowpeas and pigeon peas sold on the local market in Malawi may constitute a hazard especially if floatation/washing step is skipped.

http://ift.tt/2maFn6Q

Psychische Verfassung und psychosoziale Versorgungssituation von Überlebenden von kleinzelligem Lungenkrebs

Zusammenfassung

Hintergrund

Über die psychische Verfassung und psychosoziale Versorgungssituation von Überlebenden mit kleinzelligem Lungenkrebs (SCLC) ist wenig bekannt.

Methode

Vom Februar 2015 bis September 2016 befragten die Autoren SCLC-Patienten in Behandlung und in Nachsorge, welche nach der Diagnose mindestens 1 Jahr überlebt hatten, mittels des Gesundheitsfragebogens für Patienten (PHQ-4) nach ihrer psychischen Belastung. Die Inanspruchnahme von psychosozialen Versorgungsangeboten wurde mit Hilfe selbst entwickelter Fragen erhoben.

Ergebnisse

Von 86 angeschriebenen Personen nahmen 60 an der Befragung teil (Teilnahmequote 70 %). Bei 26 % bestand der Verdacht auf eine depressive Störung, bei 26 % der Verdacht auf eine Angststörung. Insgesamt bestand bei 36 % der Verdacht auf eine behandlungsbedürftige psychische Belastung. Den psychoonkologischen Dienst im Krankenhaus hatten 17 % genutzt. 80 % derjenigen, welchen in der Rehabilitationsklinik Einzelgespräche angeboten worden waren, hatten diese genutzt. Ambulante Angebote hatten 35 % in Anspruch genommen. Insgesamt hatten 63 % der Befragten psychosoziale Angebote genutzt.

Schlussfolgerung

Die psychische Belastung von SCLC-Überlebenden ist hoch. Die Mehrheit der Befragten hat psychosoziale Angebote in Anspruch genommen.

http://ift.tt/2lVow7I

Association between promoter methylation of DAPK gene and HNSCC: A meta-analysis

by Fucheng Cai, Xiyue Xiao, Xun Niu, Yi Zhong

Background

The death-associated protein kinase (DAPK) is a tumor suppressor gene, which is a mediator of cell death of INF-γ–induced apoptosis. Aberrant methylation of DAPK promoter has been reported in patients with head and neck squamous cell carcinoma (HNSCC). However, the results of these studies are inconsistent. Hence, the present study aimed to evaluate the association between the promoter methylation of DAPK gene and HNSCC.

Methods

Relevant studies were systematically searched in PubMed, Web of Science, Ovid, and Embase. The association between DAPK promoter methylation and HNSCC was assessed by odds ratio (ORs) and 95% confidence intervals (CI). To evaluate the potential sources of heterogeneity, we conducted the meta-regression analysis and subgroup analysis.

Results

Eighteen studies were finally included in the meta-analysis. The frequency of DAPK promoter methylation in patients with HNSCC was 4.09-fold higher than the non-cancerous controls (OR = 3.96, 95%CI = 2.26–6.95). A significant association between DAPK promoter methylation and HNSCC was found among the Asian region and the Non-Asia region (Asian region, OR = 4.43, 95% CI = 2.29–8.58; Non-Asia region, OR = 3.39, 95% CI = 1.18–9.78). In the control source, the significant association between DAPK promoter methylation and HNSCC was seen among the autologous group and the heterogeneous group (autologous group, OR = 2.71, 95% CI = 1.49–4.93; heterogeneous group, OR = 9.50, 95% CI = 2.98–30.27). DAPK promoter methylation was significantly correlated with alcohol status (OR = 1.85, 95% CI = 1.07–3.21).

Conclusion

The results of this meta-analysis suggested that aberrant methylation of DAPK promoter was associated with HNSCC.

http://ift.tt/2lXevoL

Norepinephrine Intermittent Intravenous Boluses to Prevent Hypotension During Spinal Anesthesia for Cesarean Delivery: A Sequential Allocation Dose-Finding Study.

BACKGROUND: The use of phenylephrine as the first-line agent for prevention and treatment of maternal hypotension during cesarean delivery (CD) may reduce cardiac output, posing a theoretical risk to mother and fetus. Norepinephrine has been suggested as a potential alternative, because its [beta]-adrenergic effects might result in greater heart rate and cardiac output than phenylephrine. The use of norepinephrine to prevent and treat hypotension during CD is new, and its use as a bolus has not been fully determined in this context. The purpose of this study was to determine the effective norepinephrine dose, when given as intermittent intravenous (IV) boluses, to prevent postspinal hypotension in 90% of women undergoing elective CD (ED90). METHODS: This was a prospective, double-blind sequential allocation dose-finding study, using the biased coin up-and-down design. Forty-term pregnant women undergoing elective CD under spinal anesthesia received a set intermittent norepinephrine bolus of either 3, 4, 5, 6, 7, or 8 [micro]g every time their systolic blood pressure (SBP) fell to below 100% of baseline. The primary outcome was the success of the norepinephrine regimen to maintain SBP at or above 80% of baseline, from induction of spinal anesthesia to delivery of the fetus. Secondary outcomes included nausea, vomiting, hypertension (SBP > 120% of baseline), bradycardia (

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The PBX1 lupus susceptibility gene regulates CD44 expression

Publication date: May 2017
Source:Molecular Immunology, Volume 85
Author(s): Yuxin Niu, Mayami Sengupta, Anton A. Titov, Seung-Chul Choi, Laurence Morel
PBX1-d is novel splice isoform of pre-B-cell leukemia homeobox 1 (PBX1) that lacks its DNA-binding and Hox-binding domains, and functions as a dominant negative. We have shown that PBX1-d expression in CD4⁺ T cells is associated with systemic lupus erythematosus (SLE) in a mouse model as well as in human subjects. More specifically, PBX1-d expression leads to the production of autoreactive activated CD4+ T cells, a reduced frequency and function of Foxp3+ regulatory T (Treg) cells and an expansion of follicular helper T (Tfh) cells. Very little is known about the function of PBX1 in T cells, except that it directly regulates the expression of miRNAs associated with Treg and Tfh homeostasis. In the present study, we show that PBX1 directly regulated the expression of CD44, a marker of T cell activation. Two PBX1 binding sites in the promoter directly regulated CD44 expression, with PBX1-d driving a higher expression than the normal isoform PBX1-b. In addition, mutations in each of the two binding sites had different effects of PBX1-b and PBX1-d. Finally, we showed that an enhanced recruitment of co-factor MEIS by PBX1-d over PBX1-b, while there was no difference for co-factor PREP1 recruitment. Therefore, this study demonstrates that the lupus-associated PBX1-d isoform directly transactivates CD44, a marker of CD44 activation and memory, and that it has different DNA binding and co-factor recruitment relative to the normal isoform. Taken together, these results confirm that PBX1 directly regulates genes related to T cell activation and shows that the lupus-associated isoform PBX1-d has unique molecular functions.



http://ift.tt/2mFYweW

Association between promoter methylation of DAPK gene and HNSCC: A meta-analysis

by Fucheng Cai, Xiyue Xiao, Xun Niu, Yi Zhong

Background

The death-associated protein kinase (DAPK) is a tumor suppressor gene, which is a mediator of cell death of INF-γ–induced apoptosis. Aberrant methylation of DAPK promoter has been reported in patients with head and neck squamous cell carcinoma (HNSCC). However, the results of these studies are inconsistent. Hence, the present study aimed to evaluate the association between the promoter methylation of DAPK gene and HNSCC.

Methods

Relevant studies were systematically searched in PubMed, Web of Science, Ovid, and Embase. The association between DAPK promoter methylation and HNSCC was assessed by odds ratio (ORs) and 95% confidence intervals (CI). To evaluate the potential sources of heterogeneity, we conducted the meta-regression analysis and subgroup analysis.

Results

Eighteen studies were finally included in the meta-analysis. The frequency of DAPK promoter methylation in patients with HNSCC was 4.09-fold higher than the non-cancerous controls (OR = 3.96, 95%CI = 2.26–6.95). A significant association between DAPK promoter methylation and HNSCC was found among the Asian region and the Non-Asia region (Asian region, OR = 4.43, 95% CI = 2.29–8.58; Non-Asia region, OR = 3.39, 95% CI = 1.18–9.78). In the control source, the significant association between DAPK promoter methylation and HNSCC was seen among the autologous group and the heterogeneous group (autologous group, OR = 2.71, 95% CI = 1.49–4.93; heterogeneous group, OR = 9.50, 95% CI = 2.98–30.27). DAPK promoter methylation was significantly correlated with alcohol status (OR = 1.85, 95% CI = 1.07–3.21).

Conclusion

The results of this meta-analysis suggested that aberrant methylation of DAPK promoter was associated with HNSCC.

http://ift.tt/2lXevoL

Tumor-to-tumor metastases: papillary thyroid carcinoma into a clear cell renal cell carcinoma

Abstract

Background

Thyroid metastases to distant sites are uncommon incidents, most often metastasizing to the lungs and bones. Rates of metastasis to the kidney are particularly low, ranging from 2.8–3.8% for papillary and 6–20% for follicular variants of well-differentiated thyroid cancers (WDTCs). In rare instances, tumor-to-tumor metastasis between two true primary neoplasms can occurs. This medical phenomenon has previously occurred as a clear cell renal cell carcinoma (CCRCC) spreading to a WDTC. To our knowledge, this is the first report of a tumor-to-tumor metastasis of a thyroid cancer metastasizing to a primary renal neoplasm.

Case presentation

A 72 year old male presented to the urology clinic with complaints of flank pain. Computed tomography (CT) imaging of the abdomen and pelvis revealed a 5.7 cm solid enhancing mass from the lateral aspect of the right kidney, suspicious for renal cell carcinoma (RCC). The patient subsequently underwent a right laparoscopic radical nephrectomy, and immunohistochemical staining of the 5.5 cm lesion revealed a positive RCC marker to establish a diagnosis of a pT1b ISUP Grade 2 CCRCC. The tumor contained a 3 mm focus of a lesion staining positive for TTF1 and Thyroglobulin, and negative for RCC marker. This finding established a diagnosis of a tumor-to-tumor metastasis of PTC to CCRCC. Subsequent ultrasound and CT of the head and neck revealed a heterogeneously hypodense 3.3 cm mass in the right thyroid lobe, prompting a total thyroidectomy and level VI neck dissection. Pathology revealed a classic variant multifocal PTC and two ipsilateral lymph nodes positive for metastatic PTC. Ultimately, the thyroid specimen was positive for lymphatic vascular invasion, extrathyroidal extension with invasion of the tracheal cartilage, staging as T4aN1aM1. On follow up examination the patient was recovering well, without signs of dysphagia or dysphonia, and showed bilateral mobile vocal cords on laryngoscope examination.

Conclusions

Tumor-to-tumor metastasis between the thyroid and kidney is an extremely rare occurrence, reports of RCC metastases from a WDTC has not yet been reported in the literature. Corroboration of diagnostic imaging findings with immunohistochemistry staining can consolidate a diagnosis of thyroid neoplasm tumor-to-tumor metastasis to a RCC, thereby prompting surgical excision.

http://ift.tt/2mLAgqU

Mechanisms of efficacy in cancer immunotherapy: 14th Annual Meeting of the Association for Cancer Immunotherapy (CIMT), Mainz, Germany, May 10–12, 2016

http://ift.tt/2lzDnly

BRAF V600E Mutation in Involuting Nevus in a Patient Treated With Vemurafenib

This case report describes a BRAF V600E mutation in involuting nevus in a patient treated with vemurafenib.

http://ift.tt/2lcSTaO

Variation in the Cost of Managing Actinic Keratosis

This retrospective cohort study evaluates geographic variation in health care cost for management of actinic keratosis and the association with patient-related and health-related factors.

http://ift.tt/2mLtJfI

Surgical Smoke Risks and Safety Practices During Electrosurgery

This study assessed clinician awareness of surgical smoke risks and current safety practices during active electrosurgery among dermatology residents.

http://ift.tt/2ld0ypM

Helping Patients Decide on Treatment Options for Actinic Keratosis

The senior author (D.J.E.) saw the patient one time over 20 years ago, but remembers the visit vividly. A short, dapper, articulate 90-year-old retired executive, the man related an appointment he had with another dermatologist in the Southern state he wintered in. The doctor entered the examination room, cryotherapy spray bottle in hand, and with little preamble, liberally administered the sacrament of liquid nitrogen; then turned to leave. "Wait, I have some questions," the patient said. "Sir," the dermatologist replied, "I'm a very busy man. Make another appointment." The patient held his right thumb and index finger a centimeter apart in front of him and said, "He made me feel this small." At a loss for words, Dr Elpern teared up.

http://ift.tt/2mLlMHv

Global Skin Disease Morbidity and Mortality

This study measures the burden of skin diseases worldwide.

http://ift.tt/2lcT7Pq

Enhanced Removal of Phenol With Lidocaine vs Alcohol

This in vitro study examines intraoperative irrigation of the nail bed, comparing the effect of 3 aqueous solutions for the neutralization of phenol.

http://ift.tt/2mLr85O

An Overwhelming Desire to Be Blind: Similarities and Differences between Body Integrity Identity Disorder and the Wish for Blindness

Background: The urge to be permanently blind is an extremely rare mental health disturbance. The underlying cause of this desire has not been determined yet, and it is uncertain whether the wish for blindness is a condition that can be included in the context of body integrity identity disorder, a condition where people feel an overwhelming need to be disabled, in many cases by amputation of a limb or through paralysis. Objective: The aim of this study is to test the hypothesis that people with a desire for blindness suffer from a greater degree of visual stress in daily activities than people in a healthy visual control group. Method: We created a Likert scale questionnaire to measure visual stress, covering a wide range of everyday situations. The wish for blindness is extremely rare and worldwide only 5 people with an urge to be blind were found to participate in the study (4 female, 1 male). In addition, a control group of 35 (28 female, 7 male) visually healthy people was investigated. Questions addressing issues that may be experienced by participants with a desire to be blind were integrated into the questionnaire. Results: The hypothesis that people with a desire for blindness suffer from a significantly higher visual overload in activities of daily living than visually healthy subjects was confirmed; the significance of visual stress between these groups was p #x3c; 0.01. In addition, an interview with the 5 affected participants supported the causal role of visual overload. Conclusions: The desire for blindness seems to originate from visual overload caused by either ophthalmologic or organic brain disturbances. In addition, psychological reasons such as certain personal character traits may play an active role in developing, maintaining, and reinforcing one's desire to be blind.
Case Rep Ophthalmol 2017;8:124–136

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Conjunctival Chemosis Caused by Exposure of the Lacrimal Caruncle: A Case Report

An 84-year-old woman presented with a 3-month history of conjunctival chemosis in the left eye. At the first examination, the chemosis neighbored the lacrimal caruncle and was localized in the inferomedial region of the conjunctiva. During eyelid closure, only the left lacrimal caruncle was exposed. One month later, the chemosis further extended to the inferolateral region. We debulked the lacrimal caruncle to prevent the exposure of the caruncle. One month after the surgery, conjunctival chemosis had resolved completely. At the postoperative 6-month follow-up, the patient showed no recurrence of chemosis.
Case Rep Ophthalmol 2017;8:120–123

http://ift.tt/2m8QYDo

Alopécie frontale fibrosante : étude prospective de 20 cas

Publication date: Available online 1 March 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): S. Elloudi, S. Gallouj, M. Meziane, F.-Z. Mernissi, M. Rimani
IntroductionL'alopécie frontale fibrosante (AFF) est une variante de lichen plan pilaire touchant volontiers la femme ménopausée. Nous rapportons une série de vingt observations d'AFF et en décrivons les caractéristiques épidémiologiques, cliniques, dermatoscopiques et évolutives sous traitement.Patients et méthodesIl s'agit d'une étude prospective qui a inclus, sur une durée de 16 mois, tous les malades atteints d'AFF ayant consulté au service de dermatologie du CHU Hassan II de Fès.RésultatsTous les patients étaient de sexe féminin ; leur âge moyen était de 46 ans et 65 % d'entre elles n'étaient pas ménopausées. L'examen dermatoscopique objectivait des signes spécifiques de la maladie. La biopsie cutanée, orientée par la dermatoscopie, confirmait dans tous les cas le diagnostic de lichen plan pilaire dans sa variante AFF. Des affections dysimmunitaires et autres étaient notées chez la moitié des patientes. Des traitements variés étaient instaurés : dermocorticoïdes, tacrolimus en pommade, minoxidil topique à 2 %, hydroxychloroquine, finastéride oral…ConclusionL'AFF est de plus en plus décrite chez des femmes avant la ménopause. La dermatoscopie facilite le diagnostic, oriente la biopsie, évalue l'efficacité du traitement et estime le pronostic.BackgroundFrontal fibrosing alopecia (FFA) is a variant of lichen planopilaris predominantly affecting postmenopausal women. We report a series of 20 cases of FFA and describe the epidemiological, clinical, dermoscopic features and progress under treatment.Patients and methodsThis was a prospective study conducted over a period of 16 months in patients seen at the dermatology department of the Hassan II University in Fez, Morocco.ResultsMean patient age was 46 years. Patients were premenopausal in 65% of cases. Dermoscopic examination revealed specific signs of the disease. Skin biopsy guided by dermoscopy confirmed the diagnosis of lichen planus pilaris in its FFA variant in all cases. Immune dysfunctions and other disorders were noted in half of the cases. Various treatments had been initiated, including topical corticosteroids, tacrolimus ointment, minoxidil 2%, hydroxychloroquine, and oral finasteride. The results were satisfactory with a decline within one year.ConclusionFFA is increasingly widely described in premenopausal women. Dermoscopy may be used to facilitate diagnosis, guide biopsy, evaluate treatment efficacy and establish a prognosis.



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Gastric malignancy presenting as a neck swelling to the otorhinolaryngologists: a case of internal jugular venous thrombosis

A woman aged 69 years presented with a 2-week history of left-sided neck swelling, dysphagia and night sweats. CT revealed an internal jugular venous thrombosis, multiple pulmonary emboli and gastric thickening. Endoscopy found a haemorrhagic fundal polypoidal tumour; biopsies diagnosed a gastric adenocarcinoma, Lauren's intestinal type. She was managed with radiotherapy and low molecular weight heparin.

http://ift.tt/2mtCjnn

Non-epileptic attack disorder: the importance of diagnosis and treatment

A 50-year-old woman was taken to hospital by emergency ambulance during her first seizure. She was admitted to hospital, treated with intravenous diazepam, diagnosed with epilepsy and started on antiepileptic drug (AED) therapy. This was ineffective so she was referred to a tertiary centre where she underwent video EEG and was diagnosed with non-epileptic attack disorder. Her experience of the diagnosis was positive; it allowed her to understand what was happening to her and to understand the link between her seizures, adverse childhood experiences and the death of her mother. She stopped taking AEDs and she was referred to a psychologist which led to a significant improvement in her functioning and quality of life. We present this case as a good example of the benefits of accurate diagnosis, clear explanation and access to specialist care.

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Bilateral incudomalleolar dislocations: an unusual cause of deafness

Description

A 57-year-old woman was seen in an outpatient neurosurgery clinic after reporting daily headaches, a 'whooshing and squelching' sound in her head and reduced hearing in her left ear. Three months' prior she required admission following serious head trauma. Imaging at that time revealed multiple skull fractures with extra-axial haemorrhages. Follow-up thin section CT of the petrous temporal bones (figure 1) demonstrated bilateral incudomalleolar dislocations. Ossicular chain disruption can be easily overlooked and thorough assessment of the middle ear should be performed on follow-up imaging, particularly considering persistent patient symptoms.

Figure 1

Cropped images of the left and right inner ear ossicles from an axial thin section CT scan through the petrous temporal bones demonstrating bilateral incudomalleolar dislocations (only left side labelled). i, incus; m, malleus; Orange arrow head, incudomalleolar dislocation; Red arrow, fracture line through left mastoid bone.

At...

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A rash and a rare cause of unilateral diaphragmatic paralysis

A 61-year-old man who was an ex-heavy smoker presented to our ambulatory care centre with a 4-week history of dyspnoea on mild exertion. 2 weeks prior to his symptoms, he had developed right-sided cervical herpes zoster for which he was prescribed oral acyclovir by his general practitioner. On examination, a rash over the right C4–5 dermatomes was noted and dullness on percussion of the right mid and lower zones with markedly reduced air entry. His chest radiograph showed a raised right hemi-diaphragm with associated right middle and lower lobe collapse. Further investigation with CT and bronchoscopy did not identify a cause and showed no evidence of underlying malignancy or endobronchial obstruction. An ultrasound 'sniff test' was performed to confirm diaphragmatic paralysis. We present a rare case of cervical herpes-induced diaphragmatic paralysis, and summarise our approach and the current understanding of this interesting condition.

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Unusual Morel-Lavallee lesion of the knee region in an elderly patient

The Morel-Lavallee lesion (MLL) of the knee region has been described in the Orthopaedic literature, and all of those were fit and healthy young participants sustaining sports-related trauma to the knee. We describe a case of an elderly woman, on aspirin and prophylactic clexane, who sustained a low-energy injury to the right knee and developed an MLL of the knee region. A delayed recognition, led to the persistence of the MLL as a diffuse haematoma, which subsequently became colonised with methicillin-resistant Staphylococcus aureus. We discuss the management of a case and highlight the importance of early identification and management of MLL of the knee region. Further evidence needs to be collected about MLL lesions in elderly, frail patients who are anticoagulated, and have increased risk of falls. This cohort of patients is more vulnerable to bleeding and infection than a fit, young adult population.

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Macular hole closure following spontaneous release of vitreomacular traction

We describe the temporal changes observed with spectral-domain optical coherence tomography (SD-OCT) in the left eye of a 65-year-old man who developed a stage 1 macular hole secondary to vitreomacular traction (VMT). After 1 month, VMT had resolved spontaneously with a complete posterior vitreous detachment. Following VMT resolution, macular hole demonstrated progressive improvement and outer retinal disruption recovered spontaneously. This report highlights the importance of observation before any intervention for cases of stage 1 macular hole associated with VMT.

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Case of polyostotic primary bone lymphoma successfully treated with immunochemotherapy and consolidation radiotherapy

A 47-year-old woman presented with symptoms of sharp pain over the left anterior thigh with radiation from the groin to the knee. She subsequently developed numbness in that region and reduced motor strength in extensors of the left knee. Plain radiography of the spine and knee was normal. An MRI of the spine revealed an irregular extramedullary mass with intradural and extradural components, extending from the L3 to L5 vertebrae. She underwent a laminectomy and posterior spinal decompression based on a working diagnosis of nerve sheath tumour. Histopathology revealed a primary bone lymphoma. A positron emission tomography CT (PET-CT) performed as part of the staging workup revealed fluorodeoxyglucose avid lesions in the spine and left femur. She received immunochemotherapy (Rituximab-Cyclophosphamide, Hydroxydaunorubicin, Oncovin and Prednisone) for eight cycles with an interim PET-CT revealing complete response. Subsequently, she received consolidation radiotherapy, 36 Gy in 20 fractions over 4 weeks to both lesions. She is now disease-free on follow-up for the past 1 year.

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Takotsubo cardiomyopathy secondary to spontaneous right-sided pneumothorax

Takotsubo cardiomyopathy (TCM) is a unique type of cardiomyopathy characterised by left ventricular systolic dysfunction in association with stressful conditions. Patients with this condition usually present with chest pain and dyspnoea, and the presentation can mimic acute coronary syndrome. We present a case of a woman aged 58 years who presented with progressive dyspnoea and cough. Her initial evaluation was suggestive of acute myocardial infarction with elevated serum troponin T and ST segment elevation. Her chest radiograph showed a large right-sided pneumothorax, which was treated with chest tube insertion. Coronary angiography and echocardiogram did not show any evidence of obstructive coronary artery disease but did show a large area of akinesis consistent with TCM. The patient was managed medically with supportive care. Her pneumothorax resolved, and her follow-up echocardiogram also showed improvement. The association between pneumothorax and TCM is rare, and only four other cases have been reported so far in the English literature.

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The bumper technique for advancing a large profile microcatheter

Operators commonly encounter difficulty maneuvering a microcatheter beyond the distal lip of wide neck aneurysms and aneurysms in challenging locations. Few techniques have been described to guide operators in these particular situations. In this case report of a 56-year-old woman with a 16 mm ophthalmic artery aneurysm, the microcatheter continually snagged the distal aneurysm lip, preventing delivery of a flow diverter into the distal parent vessel. In troubleshooting this obstacle, a second microguidewire was introduced alongside the microcatheter and was used to cover the distal lip of the aneurysm to prevent further snagging. The second guidewire successfully deflected the microcatheter into the distal vessel, a technique that we have aptly dubbed the 'bumper technique'.

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Caterpillar hair in the eye

Description

A 12-year-old boy presented with a 5-day history of foreign body sensation, redness, pain and photophobia in the left eye (LE). The patient gave a history of playing in fields 5 days before his symptoms. He had used topical antibiotics and artificial tears without relief. At presentation, the visual acuity was 20/20 in both eyes. On slit-lamp examination, linear fine foreign bodies (caterpillar-hair) were seen buried in the superficial and deep corneal stroma. The ends of some hair were seen penetrating through the cornea into the anterior chamber (AC) (figure 1, arrow). There were 2+ cells and 1+ flare in the AC, and cells in the vitreous of LE. The left optic disc and macula were normal. Preretinal small vitreous exudates were noted in LE (figure 2, arrow). On anterior segment optical coherence tomography of the cornea, intrastromal hair could be documented (

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DNA methylation pattern of apoptosis-related genes in ameloblastoma

Abstract

Objectives

DNA methylation is an important mechanism of gene control expression, and it has been poorly addressed in odontogenic tumours. On this basis, we aimed to assess the methylation pattern of 22 apoptosis-related genes in solid ameloblastomas

Materials and Methods

Ameloblastoma fresh samples (n=10) and dental follicles (n=8) were included in the study. The percentage fraction of methylated and unmethylated DNA promoter of 22 apoptosis-related genes was determined by using enzymatic restriction digestion and quantitative real-time PCR (qPCR) array. The relative expressions of the genes that showed the most discrepant methylation profile between tumours and controls were analysed by reverse-transcription quantitative PCR (RT-qPCR).

Results

Lower methylation percentages of TNFRSF25 (47.2%) and BCL2L11 (33.2%) were observed in ameloblastomas compared to dental follicles (79.3% and 59.5%, respectively). The RT-qPCR analysis showed increased expression of BCL2L11 in ameloblastomas compared to dental follicles, in agreement with the methylation analysis results, while there was no difference between the expression levels of TNFRSF25 between both groups

Conclusions

On the basis of our results, the transcription of the apoptosis-related gene BCL2L11 is possibly regulated by promoter DNA methylation in ameloblastoma. The biological significance of this finding in ameloblastoma pathobiology remains to be clarified.

This article is protected by copyright. All rights reserved.

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Iron overload induces apoptosis of murine preosteoblast cells via ROS and inhibition of AKT pathway

Abstract

Objective

This study investigates the inhibitory effect of iron overload on MC3T3-E1 cells and its molecular mechanism.

Methods

MC3T3-E1 cells were grown under different concentrations of FAC (ferric ammonium citrate), the WST-8 assay was used to investigate the proliferation of cells following FAC with or without deferasirox. DCFH-DA fluorescence probe was applied to detect the cellular reactive oxygen species (ROS) level. The apoptotic cells were analyzed with Annexin V-FITC/PI and the Hoechst 33258 nuclear staining assay. The JC-1 staining assay was applied to observe the change in the mitochondrial transmembrane potential. The expression levels of caspase-3, PARP, Bcl-2 family proteins and AKT kinase were detected with the western blot assay.

Results

Iron overload had a cytotoxic effect on MC3T3-E1 cells in a dosage-dependent way and resulted in increasing level of intracellular ROS. Iron overload induced apoptosis in MC3T3-E1 cells via a caspase-dependent mechanism that is accompanied by mitochondria dysfunction and decreased expression of anti-apoptotic proteins. The expression levels of cleaved-caspase-3 and cleaved-PARP were upregulated, while the expression levels of caspase-9, caspase-7, caspase-3 and PARP were downregulated. Phosphorylation of AKT kinase decreased.

Conclusion

Iron overload can generate ROS in cells, inhibit AKT kinase and its downstream proteins activity and subsequently initiate apoptotic events.

This article is protected by copyright. All rights reserved.

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Neoadjuvant chemotherapy in geriatric head and neck cancers

ABSTRACT

Background

The purpose of this study was to present our findings on the treatment completion rates and outcomes in geriatric patients with head and neck cancer treated with neoadjuvant chemotherapy followed by definitive therapy.

Methods

Geriatric patients with locally advanced head and neck cancer who received neoadjuvant chemotherapy were selected for this analysis. Overall survival (OS) and progression-free survival (PFS) were estimated.

Results

Forty-six of 49 patients completed neoadjuvant chemotherapy (93.9%). The compliance to local treatment was 73.3% and the median OS was 49.9 months (95% confidence interval [CI] = 22.0–77.8 months) in patients who received neoadjuvant chemotherapy for organ preservation (n = 15). In patients receiving neoadjuvant chemotherapy for technically unresectable disease, the corresponding figures were 82.06% and 9.0 months (95% CI = 5.9–12.1 months), respectively.

Conclusion

Individualized neoadjuvant chemotherapy protocols in geriatric patients have high compliance rates to treatment and the median OS in geriatric patients treated for organ preservation is similar to that of young patients. © 2017 Wiley Periodicals, Inc. Head Neck, 2017

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Image Gallery: Hypopharynx carcinoma overlapped by cervicofacial actinomycosis

A 36-year-old man, a smoker, with impaired dental status, presented with a 1-year history of a tumour-like formation on the neck (a, b). The lesion had begun simultaneously with complains of a recurrent pharyngitis.

This article is protected by copyright. All rights reserved.

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Field Elective Volume De-Intensification for Oropharyngeal and Laryngeal Squamous Cell Carcinoma

Conditions:   Head and Neck Cancer;   Carcinoma, Squamous Cell;   Neoplasms, Oral;   Neoplasms, Pharyngeal
Interventions:   Radiation: Intensity Modulated Radiation Therapy;   Drug: chemotherapy
Sponsor:   University of Texas Southwestern Medical Center
Recruiting - verified February 2017

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Gastric Duplication: A Rare Cause of Recurrent Vomiting

Vomiting is a physical finding that can occur at any age but presents the greatest challenge when it is recurrent in a child. The etiology is varied (Sieunarine and Manmohansingh, 1989; Suzuki, 1982), and recurrent vomiting can be a symptom of life threatening medical or surgical emergencies. Early recognition is mandatory for preventing delay in management and potential complications. Gastric duplication is rare and mostly diagnosed in infancy with only a few cases documented in the medical literature presenting in childhood. We present a three-year-old Vietnamese female with recurrent vomiting. Obstruction and sepsis were ruled out as a cause of the recurrent vomiting by history and appropriate tests. Persistent vomiting and paucity of air on the plain abdominal films provided a clue to the diagnosis. A CT scan of the abdomen with contrast revealed a uniformly thin walled fluid attenuation mass in the epigastric region which did not opacify with contrast. An abdominal ultrasound confirmed gastric duplication cyst and the patient was taken to the operating room for excision of the cyst.

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The aetiopathologies of Ménière's disease: a contemporary review.

Related Articles

The aetiopathologies of Ménière's disease: a contemporary review.

Acta Otorhinolaryngol Ital. 2017 Feb 28;:

Authors: Oberman BS, Patel VA, Cureoglu S, Isildak H

Abstract
Ménière's disease, a condition first described in the 1800's, has been an advancing area of clinical interest and scientific research in recent decades. Guidelines published by the American Academy of Otolaryngology - Head and Neck Surgery remained nearly static for almost 20 years, although we have certainly expanded our knowledge of the aetiology of the disease since that time. This review of the literature highlights the breadth and detail of the current theories in understanding the pathophysiology of this enigmatic disease. Histopathological specimens providing evidence of many of the aetiologies are presented as well. We aim to provide a centralised and updated resource regarding current and emerging theories for Ménière's disease.

PMID: 28244505 [PubMed - as supplied by publisher]

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Crazy New Journals: Quintessential extracts of mediocrity

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Evolution of cutaneous leishmaniasis in the last 30 years in a tertiary hospital of the European Mediterranean coast

Abstract

Background

Although with a lower incidence than in other geographic areas, leishmaniasis is also endemic on the European Mediterranean coast. However, there are few studies on the clinical features of cutaneous lesions of leishmaniasis in Europe. Our objective was to review the clinical features of cutaneous leishmanial lesions in our European Mediterranean population in the last 30 years and compare the clinical features of immunosuppressed and nonimmunosuppressed patients.

Methods

The clinical features of cutaneous lesions of leishmaniasis diagnosed between 1987 and 2016 at Bellvitge Hospital in Barcelona, Spain, were retrospectively analyzed.

Results

Cutaneous lesions of leishmaniasis were diagnosed in 68 patients (40 male and 28 female, mean age 53.60 years, SD 19.68). Thirteen patients were immunosuppressed because of acquired immune deficiency syndrome (AIDS) (7), renal transplantation (1), lymphoma (1), and anti-TNF agents (4). Our immunosuppressed patients had more lesions (3.33 vs. 1.80, P = 0.021), with greater maximum diameter (33.00 vs. 13.33 mm, P = 0.001), and their lesions were more frequently disseminated (P = 0.008). Visceral leishmaniasis was observed only in immunosuppressed patients. Patients treated with anti-TNF drugs developed unusually large skin lesions with crusted, eroded surfaces and without a tendency to spontaneous remission.

Conclusion

With the widespread use of anti-TNF agents, an increase in severe forms of leishmaniasis can be expected. The development of persistent, crusted, or eroded erythematous-brownish plaques in patients treated with anti-TNF drugs who live or had traveled to endemic areas of Leishmania infection warrants consideration of a diagnosis of cutaneous leishmaniasis.

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Regulatory T-cell cytokines in patients with nonsegmental vitiligo

Abstract

In the etiopathogenesis of vitiligo, the role of suppressor cytokines, such as transforming growth factor-β (TGF-β) and interleukin-10 (IL-10), associated with regulatory T-cells (Treg) is not completely known. In this study, the role of Treg-cell functions in the skin of patients with nonsegmental vitiligo was investigated. Lesional and nonlesional skin samples from 30 adult volunteers ranging in age from 18 to 36 years with nonsegmental vitiligo were compared with normal skin area excision specimens of 30 benign melanocytic nevus cases as controls. All samples were evaluated staining for forkhead box P3 (Foxp3), TGF-β, and IL-10 using the standardized streptavidin–biotin immunoperoxidase immunohistochemistry method. Foxp3 expression was lower in lesional vitiligo skin specimens compared to controls; it was also lower in lesional vitiligo specimens than nonlesional vitiligo specimens. IL-10 levels were lower in lesional vitiligo specimens compared to the controls, whereas IL-10 expression was significantly lower in lesional specimens compared with nonlesional specimens. TGF-β expression was higher in both lesional and nonlesional skin specimens of patients with vitiligo compared to controls. TGF-β expression was lower in lesional skin specimens than nonlesional skin specimens. In addition, there was no significant correlation between Foxp3 expression with TGF-β and IL-10 expressions in lesional skin specimens in the vitiligo group. In this study, results supporting the contribution of Treg cells and IL-10 deficiency to the autoimmune process were obtained. Therefore, future studies are necessary to demonstrate the definitive role of Treg-cell functions in the etiopathogenesis of vitiligo.

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Seborrheic keratosis arising on an epidermal nevus with HRAS p.G13R mutation

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Effectiveness of dermoscopy in Mohs micrographic surgery (MMS) for nonmelanoma skin cancer (NMSC)

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Disparities in access to a dermatologist for acne care in the United States

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Management of radiodermatitis associated with cetuximab in squamous cell carcinomas of the head and neck

Abstract

The objective of this review is to report to the medical community the most recent knowledge on prevention and management of dermatitis with the use of cetuximab simultaneously with radiotherapy in the treatment of squamous cell carcinomas of the head and neck. A review was conducted in PubMed of English language publications between 2010 and 2015. The search employed the terms 'skin toxicity', 'radiodermatitis', 'cetuximab', 'radiotherapy', and 'head and neck cancer'. Data related to the classification and management of dermatitis, associated with cetuximab with concomitant radiotherapy (n = 22), were critically reviewed. We conclude that dermatitis associated with bioradiotherapy is a predictable, treatable, and reversible event that does not affect administration of therapy or its clinical outcome when treated appropriately.

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Calcium hydroxylapatite: A review on safety and complications

Summary

Background

Radiesse^®, or calcium hydroxylapatite (CaHA), is a biodegradable, biostimulatory soft tissue filler suitable for deeper folds and wrinkles. In the literature, good results have been documented with the use of CaHA and patient satisfaction scores are high. This study reviews the current literature on safety and complications of CaHA.

Methods

A literature search in MEDLINE/PubMed electronic database was conducted. A total of 21 articles were included and screened for reports of adverse events (AEs).

Results

Twenty-one peer-reviewed articles, published between 2004 and 2015, were included. A total of 5081 treatments with CaHA were performed on 2779 patients. A total of 173 (3%) AEs were reported. The assessed types of AEs consisted of nodules (n=166, 96%), persistent inflammation/swelling (n=4, 2%), persistent erythema (n=2, 1%), and overcorrection (n=1, 1%).

Conclusion

Based on the results in this study, CaHA appears to have a good safety profile. Nodules are by far the most common AE. Of the reported nodules, 49% occurred in "dynamic" areas currently known for having a higher tendency for nodules. Several treatment approaches exist for managing CaHA nodules; however, in most cases, CaHA nodules are not visible and resolve without intervention.

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Toll-like receptor induced expression of epithelial cytokine receptors on hemopoietic progenitors is altered in allergic asthma

Abstract

Background

Hemopoietic progenitor cells (HPC) migrate to sites of allergic inflammation where, upon stimulation with epithelial cytokines, they produce Th2 cytokines and differentiate into mature eosinophils and basophils. They also express Toll-like receptors (TLR) involved in anti-microbial responses.

Objective

The objective of this study was to compare TLR expression on peripheral blood HPC and TLR-induced responses, in particular changes in epithelial cytokine receptors, in healthy and asthmatic subjects at baseline and following allergen challenge.

Methods

Ten healthy and 11 allergic asthmatic subjects were studied. HPC-enriched cell populations were stimulated with TLR-2, TLR-4 or TLR-9 ligands. TLR expression by circulating HPC and interleukin (IL)-25 (IL-17RB), IL-33 (ST2) and thymic stromal lymphopoietin (TSLPR) receptor expression after TLR ligation, were examined by flow cytometry at baseline and, in asthmatics, following allergen challenge. The effects of dexamethasone (Dex) on TLR-induced responses were also assessed.

Results

Asthmatics had significantly lower circulating HPC expressing TLR-2 and TLR-9 with a similar trend for TLR-4. TLR-4 stimulation of HPC yielded higher number of TSLPR+ cells in asthmatics compared with healthy subjects. A similar trend was seen for TLR-9 ligation, an effect further augmented by allergen inhalation. Allergen challenge also enhanced TLR-induced ST2 expression on HPC. Treatment with Dex in vitro increased TLR-4-induced TSLPR expression but had no effect on other epithelial cytokine receptors.

Conclusions & Clinical Relevance

These data demonstrate an interaction between allergen and TLR ligand exposure in asthmatics. Allergen inhalation augments the TLR-induced inflammatory response by HPC, possibly leading to increased "in situ hemopoiesis" through upregulation of TSLPR. These findings show that HPC may be a part of the pro-inflammatory cascade in pathogen-induced asthma exacerbation through their increased responsiveness to TLR stimulation.

This article is protected by copyright. All rights reserved.

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Burning Mouth Syndrome: A Systematic Review of Treatments

Abstract

Burning mouth syndrome (BMS) is a chronic oral pain syndrome that primarily affects peri- and postmenopausal women. It is characterized by oral mucosal burning and may be associated with dysgeusia, paresthesia, dysesthesia, and xerostomia. The etiology of the disease process is unknown, but is thought to be neuropathic in origin. The goal of this systematic review was to assess the efficacy of the various treatments for BMS. Literature searches were conducted through PubMed, Web of Science, and Cochrane Library databases, which identified 22 randomized, controlled trials. Eight studies examined alpha-lipoic acid (ALA), three clonazepam, three psychotherapy and two capsaicin, which all showed modest evidence of potentially decreasing pain/burning. Gabapentin was seen in one study to work alone and synergistically with ALA. Other treatments included vitamins, benzydamine hydrochloride, bupivacaine, Catuama, olive oil, trazodone, urea and Hypericum perforatum. Of these other treatments, Catuama and bupivacaine were the only ones with significant positive results in symptom improvement. ALA, topical clonazepam, gabapentin, and psychotherapy may provide modest relief of pain in BMS. Gabapentin may also boost the effect of ALA. Capsaicin is limited by its side effects. Catuama showed potential for benefit. Future studies with standardized methodology and outcomes containing more patients are needed.

This article is protected by copyright. All rights reserved.

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The Microbiome in Allergic Disease: Current Understanding and Future Opportunities – 2017 PRACTALL Document of the American Academy of Allergy, Asthma & Immunology and the European Academy of Allergy and Clinical Immunology

Publication date: Available online 28 February 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Yvonne J. Huang, Benjamin J. Marsland, Supinda Bunyavanich, Liam O'Mahony, Donald Y.M. Leung, Antonella Muraro, Thomas A. Fleisher
PRACTALL is a joint initiative of the American Academy of Allergy, Asthma and Immunology (AAAAI) with the European Academy of Allergy and Clinical Immunology (EAACI) to provide shared evidence-based recommendations on cutting-edge topics in the field of allergy and immunologyPRACTALL 2017 is focused on what has been established regarding the role of the microbiome in asthma, atopic dermatitis (AD) and food allergy. This is complemented by outlining important knowledge gaps regarding its role in allergic disease and delineating strategies necessary to fill these gaps. In addition, a review of progress in approaches used to manipulate the microbiome will be addressed, identifying what has and has not worked to serve as a baseline for future directions to intervene in allergic disease development and/or progression.



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Tackling Inpatient Penicillin Allergies: Tools for Antimicrobial Stewardship

Publication date: Available online 28 February 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Kimberly G. Blumenthal, Paige G. Wickner, Shelley Hurwitz, Nicholas Pricco, Alexandra E. Nee, Karl Laskowski, Erica S. Shenoy, Rochelle P. Walensky
BackgroundReported penicillin allergy rarely reflects penicillin intolerance. Failure to address inpatient penicillin allergies results in more broad-spectrum antibiotic use, treatment failures, and adverse drug events.ObjectiveWe aimed to determine the optimal approach to penicillin allergies among medical inpatients.MethodsWe evaluated internal medicine inpatients reporting penicillin allergy in three periods: (1) standard of care (SOC), (2) penicillin skin testing (ST), and (3) computerized guideline application with decision support (APP). The primary outcome was use of a penicillin or cephalosporin, comparing interventions to SOC using multivariable logistic regression.ResultsThere were 625 patients: SOC 148, ST 278, and APP 199. Of 278 ST patients, 179 (64%) were skin test eligible; 43 (24%) received testing and none were allergic. In the APP period, there were 292 unique website views; 112 users (38%) completed clinical decision support. While ST period patients did not have an increased odds of penicillin or cephalosporin use overall (aOR 1.3 [95% CI 0.8, 2.0]), we observed a significant increased odds of penicillin or cephalosporin use overall in the APP period (aOR 1.8 [95% CI 1.1, 2.9]), and in a per protocol analysis of the skin tested subset (aOR 5.7 [95% CI 2.6, 12.5]).ConclusionsBoth the computerized guideline with decision support and penicillin skin testing − when completed − increased use of penicillin and cephalosporin antibiotics among inpatients reporting penicillin allergy. While the skin tested subset showed an almost 6-fold impact, the computerized guideline significantly increased penicillin or cephalosporin use overall nearly 2-fold and was readily implemented.



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The National Biome Initiative: An Allergy Perspective

Publication date: Available online 28 February 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Glenn T. Furuta, Seema S. Aceves




http://ift.tt/2lps7HL

In vitro efficacy of a novel potassium oxalate hydrogel for dentin hypersensitivity

A novel potassium oxalate-based hydrogel is proposed for treating dentin hypersensitivity and this study evaluates its in vitro performance as a remineralizing, desensitizing agent. Etched disks of human dentin were treated for 10 or 20 min using the test hydrogel, to mimic a professional application with dental mouth guards. Dentin disks were evaluated in terms of permeability indexes in a fluid-filled system, the surface morphology was assessed by scanning electron microscopy, and the structural properties were studied using X-ray diffraction analysis. The potassium oxalate hydrogel significantly reduced dentin permeability, in a time-dependent manner, and occluded most of the patent dentinal tubules via crystal precipitation, forming a remineralized layer. After hydrogel treatments, an acid solution (pH 4.2) was applied to the disks for 30 s, or 1, 2, or 5 min, in order to reproduce a plaque-like oral acidity, and further analysis showed a good resistance of the remineralized layer to the acid challenge. The potassium oxalate-based hydrogel showed a better performance over commercially available products and artificial saliva, appearing a promising candidate for the treatment of dentin hypersensitivity.

http://ift.tt/2lVMoq2

Nonepisodic angioedema with eosinophilia: A case series from Thailand

Publication date: Available online 28 February 2017
Source:Allergology International
Author(s): Thatchai Kampitak




http://ift.tt/2ms1k2c

The burden of skin disease in the United States

Since the publication of the last US national burden of skin disease report in 2006, there have been substantial changes in the practice of dermatology and the US health care system. These include the development of new treatment modalities, marked increases in the cost of medications, increasingly complex payer rules and regulations, and an aging of the US population. Recognizing the need for up-to-date data to inform researchers, policy makers, public stakeholders, and health care providers about the impact of skin disease on patients and US society, the American Academy of Dermatology produced a new national burden of skin disease report.

http://ift.tt/2m6Xzye

Burden of skin disease report: Implications for dermatology

The most recent American Academy of Dermatology burden of skin disease report builds on the prior report in 2004 in providing strong evidence of the serious nature of skin disease.1 With nearly 85 million Americans treated for at least 1 skin condition in 2013 at a direct cost of $75 billion, and an additional indirect cost of $11 billion, the findings of this study highlight the impact of skin disease on patients and our health care system and cannot be ignored.

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Peak Nasal Inspiratory Flow Correlates with Quality of Life in Functional Endoscopic Sinus Surgery

Abstract

Objectives

Whilst nasal function and airflow improve subjectively following functional endoscopic sinus surgery (FESS), a clinically useful and objective tool for quantifying such improvement is lacking. The peak nasal inspiratory flow (PNIF) meter offers convenient and objective measures of nasal patency. However, it has not yet been established whether changes in PNIF after surgery reflect changes in subjective disease burden. In this study we aimed to determine whether changes in PNIF correlate with commonly used subjective symptom and quality of life outcome measures following FESS for chronic rhinosinusitis (CRS).

Design

Prospective cohort.

Setting

Royal National Throat Nose and Ear Hospital.

Participants

Thirty-seven patients undergoing FESS for CRS, with or without polyps (21 male, mean age 48.8).

Main Outcome Measures

PNIF, 'SNOT-22′, 'NOSE' and 'VAS' questionnaires were performed before and after surgery.

Results

In all patients, there was a strong negative correlation between change in PNIF and change in 'SNOT-22′ score following surgery (Pearson r=-0.64, p<0.0001). Strong negative correlations were also seen during subgroup analysis of patients with and without polyps (r=-0.57, p=0.006 and r=-0.67, p=0.005 respectively). Change in PNIF correlated significantly with change in 'NOSE' score following surgery in all patients and those without polyps (r = -0.54, p = 0.0005 and r = -0.68, p = 0.003). There were no significant correlations between PNIF and VAS (nasal obstruction).

Conclusions

Changes in PNIF after FESS appear to best reflect improvements in quality of life in CRS as measured using the 'SNOT-22′ questionnaire.

This article is protected by copyright. All rights reserved.

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Oral Histoplasmosis

Abstract

A 44-year-old female presented to her general dentist with the chief complaint of a painful mouth sore of 2 weeks duration. Clinical examination revealed an irregularly shaped ulcer of the buccal and lingual attached gingiva of the anterior mandible. A biopsy was performed and microscopic evaluation revealed histoplasmosis. Histoplasmosis, caused by Histoplasma capsulate, is the most common fungal infection in the United States. Oral lesions of histoplasmosis are generally associated with the disseminated form of histoplasmosis and may present as a fungating or ulcerative lesion of the oral mucosa. The histologic findings and differential diagnosis for oral histoplasmosis are discussed.

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Genetic Characterization of Adenoid Cystic Carcinoma of the Minor Salivary Glands: A Potential Familial Occurrence in First-Degree Relatives

Abstract

Adenoid cystic carcinoma (AdCC) is a malignant salivary gland tumor. To date, no cases of AdCC in first-degree relatives have been reported in the literature. We present a 50-year-old female (Case 1) and this patients' father (Case 2), both of whom were diagnosed with AdCC of the minor salivary glands. Histology of Case 1 demonstrated a tubulocribriform AdCC whereas Case 2 primarily was an AdCC of solid type. Both cases harbored the MYB–NFIB gene fusion as demonstrated by FISH and RNA-sequencing. After filtering and selection of putative deleterious variants, whole exome sequencing identified 18 germline variants in common between Case 1 and Case 2. However, none of the variants were associated with AdCC or other head and neck cancers. To our knowledge, we present the first potential case of familial AdCC. The presented genetic data may contribute to further investigations of the underlying genetic mechanisms for AdCC susceptibility.

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Giant Prolactinoma Presenting As a Base of Skull Tumor With Nasopharyngeal Extension: A Potential Diagnostic Pitfall in Neuroendocrine Lesions of the Base of Skull

Abstract

Pituitary adenomas presenting in uncommon anatomical locations are commonly misdiagnosed. Dramatic clinical presentation with hemorrhage and infarction, along with a lack of endocrine symptoms may further confound the diagnosis in some patients as illustrated in one of our two previously reported cases of non-small cell neuroendocrine carcinoma of the sinonasal tract and nasopharynx. This report presents the clinical progress of case number 2, which has a revised diagnosis of giant lactotroph pituitary adenoma. Common clinical, radiological and pathological pitfalls in diagnosis of neuroendocrine neoplasms of the sinonasal tract and base of skull are discussed.

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Ultrastructural Characterization of Mammary Analogue Secretory Carcinoma of the Salivary Glands: A Distinct Entity from Acinic Cell Carcinoma?

Abstract

Mammary analogue secretory carcinoma (MASC) of the salivary glands is a recently described neoplasm of the salivary glands with a characteristic morphology complemented by a specific cytogenetic translocation and gene rearrangements. Although immunophenotypic and cytogenetic differences allow for a more reliable distinction, ultrastructural features can also provide important information about the relationship between MASC, classic acinic cell carcinoma (AciCC), and AciCC intercalated duct cell-predominant variant. Following approval from the hospital's institutional review board, 7 cases of MASC, 8 cases of classic AciCC, and 4 cases of AciCC intercalated duct cell-predominant variant were retrieved from the pathology files of Massachusetts General Hospital from 2012 to 2015. Electron microscopy was performed using formalin-fixed, paraffin-embedded tissue. Ultrastructural features of all 19 neoplasms of the salivary glands were recorded. The predominant cell-types observed in MASC are those with intercalated/striated duct cell differentiation. These features include prominent invaginations of the cell surface studded with microvilli, and some intra- and intercellular lumina also with a microvillous surface. Classic AciCC dominant cell-type recapitulates acinar cell differentiation. These cells contain large intracytoplasmic zymogen-like granules. AciCC intercalated duct cell-predominant variant showed both cell populations in various proportions with the intercalated/striated duct cell type usually being the dominant one. MASC presents with distinctive ultrastructural features that allows its proper differentiation from classic AciCC. However, significant ultrastructural features overlaps between both AciCC intercalated duct cells-predominant and classic AciCC and MASC. These findings indicate a very close proximity between these tumors.

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

Abstract

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

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Human Papillomavirus Associated Cancers of the Head and Neck: An Australian Perspective

Abstract

Human papillomavirus (HPV) associated head and neck squamous cell carcinomas (HNSCCs), have become a serious global health problem. Despite decreases in HPV-negative HNSCCs, the prevalence of HPV-positive HNSCCs has significantly increased. HPV-positive cancers are associated with superior survival outcomes when compared to HPV-negative cancers, which appears likely to be associated with differences in the molecular pathogenesis of the two diseases. While therapies are still problematic, the current HPV vaccine programs hold a promise for the primary prevention of HPV-related HNSCCs and since Australia was the first to introduce a nationwide HPV vaccine program, it is in a unique position to observe the effects of the vaccine on HNSCCs. This review discusses the epidemiological trends associated with HPV in HNSCC, with reference to the differences between HPV-positive and HPV-negative HNSCCs and the prevention potential of HPV vaccines.

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SMARCA4-deficient Sinonasal Carcinoma

Abstract

The term "sinonasal undifferentiated carcinoma (SNUC)" has been coined in 1986 for a highly aggressive sinonasal tract epithelial neoplasm showing distinctive morphology, but lacking any specific line of differentiation. Recent developments resulted in a dynamic splitting of new entities traditionally included in the spectrum of SNUC. Sinonasal NUT-midline carcinoma, adamantinoma-like Ewing family tumors and most recently, SMARCB1(INI1)-deficient sinonasal carcinoma are the main entities defined by specific genetic aberrations. To our knowledge, involvement of subunits of the SWItch/Sucrose Non-fermentable (SWI/SNF) chromatin remodeling complex other than SMARCB1 has not been implicated in the pathogenesis of SNUC-like neoplasms. We herein describe a 40-year-old woman who presented with a large infiltrative mass involving the right nasal cavity and the sinuses with extension into the skull base and periorbital tissue (cT4N2M0). Biopsies were interpreted initially as poorly differentiated neuroendocrine carcinoma followed by surgical resection and radiochemotherapy. No other extra-nasal tumor was detected on imaging. The patient was alive with disease at last follow-up (9 months from initial diagnosis). Histological evaluation showed poorly differentiated small round blue cell neoplasm with diffuse expression of pancytokeratin but not high molecular weight cytokeratin subsets, CK7, p63, S100, desmin or NUT. Neuroendocrine markers showed limited focal weak reactivity. SMARCB1, SMARCA2 and ARID1A were intact in the tumor cells but SMARCA4 was completely lost. This case highlights the rare occurrence of SMARCA4-deficiency in poorly differentiated sinonasal carcinomas and points to the importance of including other SWI/SNF complex subunits in the evaluation of SMARCB1-intact sinonasal malignancies.

http://ift.tt/2jYYLnr