Trans-oral robotic assisted tongue base mucosectomy for investigation of cancer of unknown primary in the head and neck region. The UK experience

Abstract

Introduction

The diagnosis of cancer of unknown primary (CUP) in head and neck occurs when the treating clinicians have utilised all available diagnostic tests and failed to identify the origin of the disease. There is no agreed consensus on which diagnostic investigations to use, or the order in which to use them in, although broad recommendations exist. Small tumours arising in the tongue base can be below the limits of resolution of conventional diagnostic techniques. Given the difficulty in targeting the tongue base, current practice involves blind random biopsies, which leads to a variable detection rate.

Robotically assisted surgical removal of the tongue base, tongue base mucosectomy (TBM) has been shown to improve diagnostic yield. This study reports the diagnostic hit rate for tongue base primaries using this technique from three centres in the UK.

Methods

Thirty-two patients from three UK head and neck cancer centres were classified as CUP after clinical examination, cross-sectional imaging, PET-CT as well as tonsillectomy and guided biopsies failed to identify a primary tumour.

Results

The primary tumour site was identified in the tongue base in 53% (n=17) of patients. In 15 patients the tumour was in the ipsliateral tongue base (88%) while in two cases (12%) the tumour was located in contra lateral tongue base.

Conclusion

Trans-oral robotic assisted TBM raises the possibility of identifying over 50% of tumours that would otherwise be classified as CUP. Identifying these in the contralateral tongue base has implications for treatment planning and outcome.

This article is protected by copyright. All rights reserved.

http://ift.tt/2mXFaB5

Cover 1

Publication date: March 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 3





http://ift.tt/2m6rXIE

Brief Overview of This Month's JACI

Publication date: March 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 3





http://ift.tt/2lp1Qy6

Reply

Publication date: Available online 3 March 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Phillip L. Lieberman, Dale T. Umetsu, Gillis J. Carrigan, Abdelkader Rahmaoui




http://ift.tt/2mQ2Msk

Table of Contents

Publication date: March 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 3





http://ift.tt/2m6yAea

Editorial Board

Publication date: March 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 3





http://ift.tt/2mPWsRB

Information for Readers

Publication date: March 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 3





http://ift.tt/2m6BKhT

News & Notes

Publication date: March 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 3





http://ift.tt/2mPNT9l

MicroRNA-155 is a critical regulator of type 2 innate lymphoid cells and IL-33 signaling in experimental models of allergic airway inflammation

Publication date: March 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 3
Author(s): Kristina Johansson, Carina Malmhäll, Patricia Ramos-Ramírez, Madeleine Rådinger
BackgroundAllergic airway inflammation is triggered by allergen exposure through several steps including release of IL-33, which promotes cytokine (IL-5, IL-13) production by type 2 innate lymphoid cells (ILC2s). MicroRNA (miR)-155 has recently been described to regulate adaptive responses in allergic inflammation. However, the role of miR-155 in the regulation of ILC2s remains unexplored.ObjectiveWe sought to elucidate the contribution of miR-155 in ILC2 expansion using experimental murine models of allergic airway inflammation.MethodsTo determine the role of miR-155 in the regulation of ILC2s in allergic airway inflammation, miR-155 deficient (miR-155^−/−) and wild-type (WT) mice were subjected to acute or chronic allergen-induced inflammation or treated with recombinant IL-33.ResultsmiR-155 was 10-fold upregulated in WT-derived ILC2s in response to IL-33. Furthermore, miR-155^−/− mice demonstrated impaired lung IL-33 levels in response to allergen challenge and the number of ILC2s was significantly reduced in allergen-challenged miR-155^−/− mice compared with WT mice. Exogenous IL-33 treatment revealed that miR-155 is needed for IL-33–induced ILC2 expansion and eosinophilic airway inflammation. Indeed, ILC2s from IL-33–challenged miR-155^−/− lungs exhibited impaired proliferation, GATA-3 expression, and IL-13 production as compared with IL-33–challenged WT ILC2s.ConclusionsOur findings for the first time demonstrate that ILC2s and IL-33 signaling are regulated by miR-155 in allergic airway inflammation.



http://ift.tt/2m6xU8y

CME Activities Calendar

Publication date: March 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 3





http://ift.tt/2mPNRyf

Targeted strategies directed at the molecular defect: Toward precision medicine for select primary immunodeficiency disorders

Publication date: March 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 3
Author(s): Luigi D. Notarangelo, Thomas A. Fleisher
Primary immunodeficiency disorders (PIDs) represent a range of genetically determined diseases that typically have increased susceptibility to infections and in many cases also have evidence of immune dysregulation that often presents as autoimmunity. Most recently, the concept of gain-of-function mutations associated with PIDs has become well recognized and adds a new dimension to the understanding of this group of disorders, moving beyond the more commonly seen loss-of-function mutations. The rapidly expanding genetic defects that have been identified in patients with previously uncharacterized PIDs has opened up the potential for targeted therapy directed at the specific disease-causing abnormality. This has been driven by linking PID-specific genetic defects to the associated unique abnormalities in cellular signaling pathways amenable to directed therapies. These include agents that either block overactive or enhance underresponsive cellular pathways. Selected primary immunodeficiencies were chosen, the genetic defects of which have been recently characterized and are amenable to targeted therapy, as a reflection of the power of precision medicine.



http://ift.tt/2m6yx1Y

Targeted strategies directed at the molecular defect: Toward precision medicine for select primary immunodeficiency disorders

Publication date: March 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 3





http://ift.tt/2mPNQKH

New frontiers in the therapy of primary immunodeficiency: From gene addition to gene editing

Publication date: March 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 3
Author(s): Donald B. Kohn, Caroline Y. Kuo
The most severe primary immune deficiency diseases (PIDs) have been successfully treated with allogeneic hematopoietic stem cell transplantation for more than 4 decades. However, such transplantations have the best outcomes when there is a well-matched donor available because immune complications, such as graft-versus-host disease, are greater without a matched sibling donor. Gene therapy has been developed as a method to perform autologous transplantations of a patient's own stem cells that are genetically corrected. Through an iterative bench-to-bedside-and-back process, methods to efficiently add new copies of the relevant gene to hematopoietic stem cells have led to safe and effective treatments for several PIDs, including forms of severe combined immune deficiency, Wiskott-Aldrich syndrome, and chronic granulomatous disease. New methods for gene editing might allow additional PIDs to be treated by gene therapy because they will allow the endogenous gene to be repaired and expressed under its native regulatory elements, which are essential for genes involved in cell processes of signaling, activation, and proliferation. Gene therapy is providing exciting new treatment options for patients with PIDs, and advances are sure to continue.



http://ift.tt/2m6nrds

Treatment of infants identified as having severe combined immunodeficiency by means of newborn screening

Publication date: March 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 3
Author(s): Morna J. Dorsey, Christopher C. Dvorak, Morton J. Cowan, Jennifer M. Puck
Severe combined immunodeficiency (SCID) is characterized by severely impaired T-cell development and is fatal without treatment. Newborn screening (NBS) for SCID permits identification of affected infants before development of opportunistic infections and other complications. Substantial variation exists between treatment centers with regard to pretransplantation care, and transplantation protocols for NBS identified infants with SCID, as well as infants with other T-lymphopenic disorders detected by using NBS. We developed approaches to management based on the study of infants identified by means of NBS for SCID who received care at the University of California, San Francisco (UCSF). From August 2010 through October 2016, 32 patients with NBS-identified SCID and leaky SCID from California and other states were treated, and 42 patients with NBS-identified non-SCID T-cell lymphopenia were followed. Our center's approach supports successful outcomes; systematic review of our practice provides a framework for diagnosis and management, recognizing that more data will continue to shape best practices.



http://ift.tt/2mPU3WY

Immune defects caused by mutations in the ubiquitin system

Publication date: March 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 3
Author(s): Amos Etzioni, Aaron Ciechanover, Eli Pikarsky
The importance of the ubiquitin system in health and disease has been widely recognized in recent decades, with better understanding of the various components of the system and their function. Ubiquitination, which is essential to almost all biological processes in eukaryotes, was also found to play an important role in innate and adaptive immune responses. Thus it is not surprising that mutations in genes coding for components of the ubiquitin system cause immune dysregulation. The first defect in the system was described 30 years ago and is due to mutations in the nuclear factor κB (NF-κB) essential modulator, a key regulator of the NF-κB pathway. With use of novel sequencing techniques, many additional mutations in different genes involved in ubiquitination and related to immune system function were identified. This can be clearly illustrated in mutations in the different activation pathways of NF-κB, which result in aberrations in production of various proinflammatory cytokines. The inherited diseases typically manifest with immunodeficiency, autoimmunity, or autoinflammation. In this perspective we provide a short description of the ubiquitin system, with specific emphasis given to its role in the immune system. The various immunodeficiency conditions identified thus far in association with defective ubiquitination are discussed in more detail.



http://ift.tt/2m6HW9T

A Special Thank-You to Our Reviewers

Publication date: March 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 3





http://ift.tt/2m6BPSL

The Editors' Choice

Publication date: March 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 3
Author(s): Cezmi A. Akdis, Zuhair K. Ballas




http://ift.tt/2mPRRyE

News Beyond Our Pages

Publication date: March 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 3
Author(s): Marc E. Rothenberg, Jean Bousquet




http://ift.tt/2mCM42H

Methylprednisolone aceponate for atopic dermatitis

Abstract

Background

The 4th generation topical corticosteroids (TCS) have demonstrated a most favorablerisk–benefit ratio. Methylprednisolone aceponate (MPA) is a non-halogenated corticosteroid with a methyl group at C6, which confers higher intrinsic activity. MPA is included in the group of potent TCS (category III/IV).

Methods

A literature review is carried out of the clinical efficacy, pharmacokinetics, and adverse effects of MPA, especially for the treatment of atopic dermatitis (AD).

Results

Several clinical studies support the use of MPA in infants and children, with minimal local or systemic adverse effects reported. The pharmacokinetic profile and the low rate of adverse effects of MPA are most suitable for the treatment of atopic dermatitis (AD), a chronic disease with frequent flaring that can involve extensive areas of the skin.

Conclusions

Most patients with AD can be easily brought into control with the use of only TCS. Achieving a complete healing of eczema is key in AD, and once the skin is clinically healthy, emollients can be used according to the physician and patient preferences. Physicians should be trained in the recognition of early or subtle manifestations of active eczema that are most suitably treated with topical TCS to achieve a most rapid and satisfactory control of the disease. If the whole area with eczema is not treated, active eczema will remain and treatment will be ineffective. Insufficient use of TCS will lead to inefficiency and frustration.

http://ift.tt/2lGxVfY

Lichen scrofulosorum: importance of early recognition

Summary

Lichen scrofulosorum (LS), a tuberculid affecting children and young adults, usually presents with asymptomatic skin-coloured to erythematous follicular and perifollicular papules over the trunk and extremities. An underlying focus of tuberculosis can be detected, but occasionally other mycobacterial infections may be responsible. The eruption is associated with a positive tuberculin test or positive interferon-gamma release assay. Perifollicular granulomas and absence of bacilli are the histopathological characteristics. LS can go unsuspected because of its waxing and waning course and close resemblance to other dermatoses. This article reviews the different clinical presentations and various associations of LS. We reiterate that the focus of internal infection may be subtle and go undetected, emphasizing the need for correct diagnosis and early treatment.

http://ift.tt/2mCPcM7

Olfactory and gustatory functions in patients with non-complicated type 1 diabetes mellitus

Abstract

The aim of this study was to evaluate any possible relationship between diabetic state and olfactory and gustatory functions in patients with non-complicated diabetes mellitus type 1 (T1D), and also to present evidence of the association between olfactory and gustatory scores and HbA1c values and disease durations. The study included 39 patients with non-complicated T1D and 31 healthy controls. Clinical characteristics such as age, gender, duration of disease, education levels and biochemical analyses (fasting blood glucose, urea, creatinine, total cholesterol, low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein (HDL-C), triglyceride, HbA1c, C-peptide, postprandial blood glucose) were measured. Subjective olfactory and gustatory tests were performed for all participants. There were no significant differences in olfactory tests between the two groups (odor thresholds 8.63 ± 0.91 vs. 8.55 ± 0.57, p = 0.66; odor discrimination 12.97 ± 0.80 vs. 12.74 ± 0.79, p = 0.24; odor identification 13.81 ± 0.98 vs. 13.72 ± 0.89, p = 0.69; TDI score 35.34 ± 1.94 vs. 34.97 ± 1.4, p = 0.37). There were also no significant differences in gustatory tests between the two groups (bitter 3.45 ± 0.51 vs. 3.44 ± 0.50, p = 0.90; sweet 3.32 ± 0.48 vs. 3.38 ± 0.49, p = 0.60; salty 3.13 ± 0.72 vs. 3.10 ± 0.72, p = 0.88; total score of taste 13.16 ± 1.61 vs. 13.13 ± 1.22, p = 0.92). Comparison of gustatory and olfactory scores according to disease duration of type 1 diabetes mellitus patients revealed that there were no differences between groups (all p > 0.05). T1D without complications may not be associated with olfactory and gustatory dysfunction according to subjective testing. We also found that gustatory and olfactory functions may not be related with HbA1c values and disease duration in non-complicated T1D.

http://ift.tt/2mPyFkC

Adaptation and validation of the Dutch version of the nasal obstruction symptom evaluation (NOSE) scale

Abstract

The nasal obstruction symptom evaluation (NOSE) scale is a validated disease-specific, self-completed questionnaire for the assessment of quality of life related to nasal obstruction. The aim of this study was to validate the Dutch (NL-NOSE) questionnaire. A prospective instrument validation study was performed in a tertiary academic referral center. Guidelines for the cross-cultural adaptation process from the original English language scale into a Dutch language version were followed. Patients undergoing functional septoplasty or septorhinoplasty and asymptomatic controls completed the questionnaire both before and 3 months after surgery to test reliability and validity. Additionally, we explored the possibility to reduce the NOSE scale even further using graded response models. 129 patients and 50 controls were included. Internal consistency (Cronbach's alpha 0.82) and test–retest reliability (intraclass correlation coefficient 0.89) were good. The instrument showed excellent between-group discrimination (Mann–Whitney U = 85, p < 0.001) and high response sensitivity to change (Wilcoxon rank p < 0.001). The NL-NOSE correlated well with the score on a visual analog scale measuring the subjective sensation of nasal obstruction, with exception of item 4 (trouble sleeping). Item 4 provided the least information to the total scale and item 3 (trouble breathing through nose) the most, particularly in the postoperative group. The Dutch version of the NOSE (NL-NOSE) demonstrated satisfactory reliability and validity. We recommend the use of the NL-NOSE as a validated instrument to measure subjective severity of nasal obstruction in Dutch adult patients.

http://ift.tt/2loCiky

Evidence-Based Tightrope Walking: The 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum

Thyroid Mar 2017, Vol. 27, No. 3: 309-311.


http://ift.tt/2lGmGEr

The proteomic profile of the acquired enamel pellicle according to its location in the dental arches

Publication date: Available online 3 March 2017
Source:Archives of Oral Biology
Author(s): Talita Mendes da Silva Ventura, Luiza de Paula Silva Cassiano, Cíntia Maria de Souza e Silva, Even Akemi Taira, Aline de Lima Leite, Daniela Rios, Marília Afonso Rabelo Buzalaf
ObjectiveThis study evaluated the variation in the protein profile of the acquired enamel pellicle (AEP) formed in vivo according to its location in the dental arches.DesignThe AEP was formed for 120minutes in 9 volunteers. Pellicle formed at upper+lower anterior facial (ULAFa; teeth 13-23 and 33-43), upper anterior palatal (UAPa; teeth 13-23), lower anterior lingual (LALi; teeth 33-43), upper+lower posterior facial (ULPFa; teeth 14-17 24 to 27, 34 to 37 and 44 to 47), upper posterior palatal (UPPa; teeth 14 to 17 and 24 to 27) and lower posterior lingual (LPLi; teeth 34 to 37 and 44 to 47) regions was collected separately and processed for analysis by label-free LC-ESI-MS/MS.ResultsThree-hundred sixty three proteins were identified in total, twenty-five being common to all the locations, such as Protein S100-A8, Lysozyme C, Lactoferrin, Statherin, Ig alpha-2, ALB protein, Myeloperoxidase and SMR3B. Many proteins were found exclusively in the AEP collected from one of the regions (46-UAPa, 33-LALi, 59-ULAFa, 31-ULPFa, 44-LPLi and 39-UPPa).ConclusionsThe protein composition of the AEP varied according to its location in the dental arches. These results provide important insights for understanding the differential protective roles of the AEP as a function of its location in the dental arches.



http://ift.tt/2m69SuA

The proteomic profile of the acquired enamel pellicle according to its location in the dental arches

Publication date: Available online 3 March 2017
Source:Archives of Oral Biology
Author(s): Talita Mendes da Silva Ventura, Luiza de Paula Silva Cassiano, Cíntia Maria de Souza e Silva, Even Akemi Taira, Aline de Lima Leite, Daniela Rios, Marília Afonso Rabelo Buzalaf
ObjectiveThis study evaluated the variation in the protein profile of the acquired enamel pellicle (AEP) formed in vivo according to its location in the dental arches.DesignThe AEP was formed for 120minutes in 9 volunteers. Pellicle formed at upper+lower anterior facial (ULAFa; teeth 13-23 and 33-43), upper anterior palatal (UAPa; teeth 13-23), lower anterior lingual (LALi; teeth 33-43), upper+lower posterior facial (ULPFa; teeth 14-17 24 to 27, 34 to 37 and 44 to 47), upper posterior palatal (UPPa; teeth 14 to 17 and 24 to 27) and lower posterior lingual (LPLi; teeth 34 to 37 and 44 to 47) regions was collected separately and processed for analysis by label-free LC-ESI-MS/MS.ResultsThree-hundred sixty three proteins were identified in total, twenty-five being common to all the locations, such as Protein S100-A8, Lysozyme C, Lactoferrin, Statherin, Ig alpha-2, ALB protein, Myeloperoxidase and SMR3B. Many proteins were found exclusively in the AEP collected from one of the regions (46-UAPa, 33-LALi, 59-ULAFa, 31-ULPFa, 44-LPLi and 39-UPPa).ConclusionsThe protein composition of the AEP varied according to its location in the dental arches. These results provide important insights for understanding the differential protective roles of the AEP as a function of its location in the dental arches.



http://ift.tt/2m69SuA

Patient-Centered Anesthesia Triage System Predicts ASA Physical Status.

BACKGROUND: The purpose of this study was to validate a patient-centered anesthesia triage system (PCATS) by examining its association with, and predictive value of, ASA physical status (PS) classification. ASA PS classification is a widely used indicator of health status and the predictor of risk of perioperative complications. Thus, ASA PS is a good triage point such that healthy surgical patients (ASA PS I and II) undergoing low-complexity surgery are assessed by telephone, whereas less-healthy patients (ASA PS III and IV) or those patients undergoing highly complex surgery are seen in person at a presurgical clinic. However, ASA PS is not commonly available in electronic health records or easily determined by nonanesthesiologists. PCATS criteria, including the number of prescription medications used daily, body mass index (BMI), age, and surgical complexity, are readily available in electronic health records. Nonclinical scheduling personnel can use PCATS to make appropriate preassessment appointments for elective surgical patients before surgery. METHODS: After getting approval from the University of Florida IRB for an exempt study, 300 -consecutive patients scheduled in the presurgical clinic over a 1-week span were retrospectively enrolled. Each of the records was reviewed and collated for study identification number, number of prescription medications, BMI, and ASA PS classification assigned on the day of surgery. In addition, a surgical complexity score was assigned to each procedure (high, moderate, minimal). The association between PCATS and individual PCATS criteria and ASA PS was assessed by [chi]2 test. The utility of PCATS to discriminate between ASA PS classifications was assessed using receiver operating characteristic (ROC) curves as well as other indicators of clinical validity: sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive clinical utility index ([CIU+] = sensitivity x PPV) and negative CIU ([CIU-] = specificity x PPV). RESULTS: BMI (P = .002), age (P = .01), surgical complexity (P 35, age > 80 years, 5 or more prescriptions, and high surgical complexity. Eighty-seven percent of patients with any PCATS criterion were ASA PS classification III or IV. From ROC curve analysis, PCATS emerged as a significant, and moderately good, predictor of ASA PS class (area under the curve = 0.75, 95% confidence interval [CI] = 0.69-0.83). PCATS was highly sensitive (0.88, 95% CI = 0.84-0.92) and specific (0.74; 95% CI = 0.61-0.86), and had excellent utility in confirmation/case finding (CUI+ = 0.83, 95% CI = 0.82-0.84) and moderate utility in screening out cases (CUI- = 0.43, 95% CI = 0.41-0.44). CONCLUSION: PCATS serves as a useful, and valid, predictor of ASA PS classification. Thus, it may also serve as a tool to triage patients to an appropriate venue for preoperative assessment that can be utilized by nonclinical schedulers. Using a simple tool such as PCATS may help streamline the presurgical patient experience and improve clinic staff utilization. (C) 2017 International Anesthesia Research Society

http://ift.tt/2mPCfew

Nodular fasciitis of the breast clinically resembling breast cancer in an elderly woman: a case report

Nodular fasciitis is a benign reactive proliferative lesion of fibroblast cells, which can occur throughout the body. However, it has rarely been reported in the breast of an elderly woman.

http://ift.tt/2mWlCgK

Diffuse heterotopic calcification of fibula flap: a previously unreported case

Publication date: Available online 3 March 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): P. Lugaric, C. Frezzini, A. Patterson




http://ift.tt/2mWwLhk

Nerve Blocks Under General Anesthesia: Time to Liberalize Indications?.

No abstract available

http://ift.tt/2mWnnum

Anterior Suprascapular Nerve Block Versus Interscalene Brachial Plexus Block for Shoulder Surgery in the Outpatient Setting: A Randomized Controlled Patient- and Assessor-Blinded Trial.

Background and Objectives: The interscalene brachial plexus block (ISB), a potent option to control pain after shoulder surgery, has notable adverse effects. The anterior suprascapular nerve block (SSNB) might provide comparable analgesia and cause less grip-strength impairment. These characteristics were studied in this randomized controlled patient- and assessor-blinded trial. Methods: Outpatients were randomized to single-shot ultrasound-guided SSNB (10 mL ropivacaine 1%) or ISB (20 mL ropivacaine 0.75%) before general anesthesia for arthroscopic shoulder surgery. Pain (Numerical Rating Scale, 0-10), grip strength, degree of satisfaction, and strength of recommendation were assessed. Results: We randomized 168 patients to each group and analyzed 164 in the SSNB group and 165 in the ISB group. Nerve blocks were successful in 98% of the patients from each group. Both procedures provided good postoperative analgesia, and the mean pain level for SSNB was slightly but significantly lower by 0.32 units (95% confidence interval, 0.18-0.46; P

http://ift.tt/2m61R8P

The impact of time to treatment initiation on survival from head and neck cancer in north-eastern Italy

Publication date: April 2017
Source:Oral Oncology, Volume 67
Author(s): Jerry Polesel, Carlo Furlan, Silvia Birri, Vittorio Giacomarra, Emanuela Vaccher, Giuseppe Grando, Carlo Gobitti, Federico Navarria, Ornella Schioppa, Emilio Minatel, Ettore Bidoli, Luigi Barzan, Giovanni Franchin
ObjectivesTo evaluate the impact of time to treatment initiation (TTI) on overall survival in patients with head-and-neck squamous cell carcinoma (HNSCC).Materials and methodsIn the period 2003–2009, 1616 HNSCC patients were diagnosed in Friuli Venezia Giulia Region, Northeastern Italy, including 462 oral, 346 oropharyngeal, 212 hypopharyngeal, and 596 laryngeal cancers. Clinical information, including date and type of first treatment, and follow-up were retrieved from the regional Cancer Registry and a population-based health database collecting comprehensive health information on people living in the Region. Multivariate hazard ratio (HR) and confidence intervals (CI) were calculated through Cox model.ResultsOverall, the median TTI was 28days, (Q1-Q3: 13–45days), but significant variations emerged according to anatomical site, cancer stage, treatment approach, and care transition to specialized centers. Five-year overall survival decreased with increasing treatment delay from 62% for TTI<30days to 39% for TTI≥90days (p<0.01). HR of death was 1.13 (95% CI: 0.92–1.39) for TTI between 45–89days, and 1.47 (1.05–2.05) for TTI≥90days. The association between TTI and poor prognosis was stronger for laryngeal cancers and early-stage HNSCCs. Further, care transition from community hospitals to specialized centers was associated to a better prognosis (HR=0.73; 95% CI: 0.60–0.88).ConclusionOur study findings suggest that HNSCC patients treated within 45days from diagnosis have increased survival probabilities and that early-stage patients suffered the most from treatment delay. Furthermore, care transition to specialized centers –though competitive to timely treatment– improves survival by providing the most innovative technologies and treatment approaches.



http://ift.tt/2lFAPlj

SOP – Aufnahmekriterien auf die Palliativstation

http://ift.tt/2lIN7Kp

Periosteal fasciitis in a 7-year old girl: a diagnostic dilemma

Periosteal fasciitis, considered a subtype of nodular fasciitis, is a rare benign soft tissue mass often misdiagnosed as a malignant lesion due to its fast and infiltrative growth pattern and histological features. Nodular fasciitis is usually found in the upper extremities in adults and in the head and neck region in children. Incorrect diagnosis may lead to overtreatment, potentially causing disturbed orofacial development in growing children. A rapidly growing asymptomatic mass, initially suspected to be a malignant bone tumour, was found in the left angle area of the mandible in a healthy 7-year-old girl.

http://ift.tt/2m5h7mc

First signs of late-presenting cervical lymph node metastasis in oral cancers during follow-up

One of the most important prognostic factors in oral squamous cell carcinoma (OSCC) is the presence of lymph node metastasis. Therefore, the early detection of late-presenting cervical lymph node metastasis is important. Although many studies have assessed diagnostic modalities for detecting metastatic cervical lymph nodes, no study has evaluated the process, especially first signs, for detecting late-presenting cervical lymph node metastasis. A retrospective analysis comparing methods for detecting the first signs of late-presenting lymph node metastasis was performed.

http://ift.tt/2mPcQ4E

Sarcoidosis of the ocular adnexa

Sarcoidosis is an idiopathic multisystem disorder that commonly affects the lung, skin, lymph nodes, and eye. The ocular involvement ranges from 25% to 60%, with anterior uveitis being the most common ophthalmic manifestation in systemic sarcoidosis.1 Orbital and adnexal involvements are historically rare. The most common orbital manifestation is lacrimal gland involvement manifesting as dacryoadenitis.1 We present a rare case of sarcoidosis of the ocular adnexa in a man with clinical features suggestive of chronic dacryocystitis.

http://ift.tt/2m4cqrl

2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum

Thyroid Mar 2017, Vol. 27, No. 3: 315-389.


http://ift.tt/2lEZBBT

Future Meetings

Thyroid Mar 2017, Vol. 27, No. 3: 479-480.


http://ift.tt/2lFdcJp

Allergy is associated with reduced risk of glioma: A meta-analysis

Publication date: Available online 3 March 2017
Source:Allergologia et Immunopathologia
Author(s): C. Zhang, Q.-X. Zhu
BackgroundIncreasing evidences suggest that allergy may reduce the risk of glioma, so it is necessary to perform an up-to-data literature search and investigate this relationship by meta-analysis.MethodsWe identified the included studies by searching PubMed and Web of Science and excluding irrelevant or ineligible articles. Nineteen studies from 15 articles, including 8435 cases and 118,719 controls, were selected for data extraction and synthesis.ResultsPooled outcomes showed that there was an inverse association between allergy and risk of glioma (OR=0.64, 95% CI=0.52–0.78, P<0.001). Meanwhile, asthma and eczema would reduce the risk of glioma by 33% and 23% (OR=0.67, 95% CI=0.59–0.75, P<0.001; OR=0.77, 95% CI=0.68–0.86, P<0.001), respectively. Sensitivity analyses confirmed the stability of these findings. Besides, no publication biases were detected regarding all the investigations.ConclusionsOverall or specific allergy is protective against glioma. More prospective cohort studies or molecular laboratory experiments are warranted to elucidate the causation and key mechanism.



http://ift.tt/2mBQxmf

Two cases of Mazabraud syndrome and identification of a GNAS R201H mutation by next-generation sequencing

http://ift.tt/2m43u5a

Gene promoter-associated CpG island hypermethylation in squamous cell carcinoma of the tongue

Abstract

The present study was undertaken to explore and validate novel hypermethylated DNA regions in squamous cell carcinoma of the tongue (SCCT). Genome-wide methylation changes were identified by differential methylation hybridization (DMH) microarray and validated by bisulfite genome sequencing (BGS). The results were compared against datasets from The Cancer Genome Atlas head and neck squamous cell carcinoma (TCGA-HNSCC), Gene Expression Omnibus (GSE26549), and ArrayExpress (E-MTAB-1328). DMH identified 116 hypomethylated and 241 hypermethylated regions. Of the latter, 24 were localized to promoter or 5′-UTR regions. By BGS, promoter sequences of DAPK1, LRPPRC, RAB6C, and ZNF471 were significantly hypermethylated in tumors when compared with matched normal tissues (P < 0.0001). A TCGA-HNSCC dataset (516 cases of cancer and 50 normal tissue samples) further confirmed hypermethylation of DAPK1, RAB6C, and ZNF471. Sensitivity and specificity of methylation markers for a diagnosis of cancer were in the range of 70–100% in our study and from TCGA-HNSCC datasets, with an area under curve (AUC) of 0.83 and above. Kaplan-Meier survival analysis of TCGA-HNSCC expression data revealed that patients with low expressions of DAPK1, RAB6C, and ZNF471 showed poorer survival than patients with high expression (P = 0.02). Human papillomavirus (HPV) was found in 55% of cases, HPV16 being the predominant genotype. DAPK1 immunohistochemical staining was lower in SCCT than in normal buccal epithelial cells. This is the first study to report hypermethylation of LRPPRC, RAB6C, and ZNF471 in SCCT and its diagnostic and prognostic potentials in a specific head and neck squamous cell carcinoma.

http://ift.tt/2lnBtIH

Fístula csc lateral e deiscência facial por cole

Fístula csc lateral e deiscência facial por col

http://ift.tt/2mBD2TK

Top Five Things to Tell Patients: Preventing Skin Cancer

These messages may resonate most with young, fair-skinned patients at risk for skin cancer.
CDC Expert Commentary

http://ift.tt/2lDuaZm

IL-31 Inhibitor Improves Atopic Dermatitis

An interleukin-31 inhibitor significantly improved pruritus for patients whose moderate to severe atopic dermatitis did not respond to topical therapy, a phase 2 clinical trial found.
Medscape Medical News

http://ift.tt/2lhiX4P

Characteristics of Zika Virus Rash Identified

Reuters Health Information

http://ift.tt/2lABQfg

Progress in difficult airway management

http://ift.tt/2mV3rI1

The role of Perioperative Surgical Home on health and longevity in society: importance of the surgical prehabilitation program

http://ift.tt/2mjULhB

Management of recurrent tonsillitis in children

Publication date: Available online 3 March 2017
Source:American Journal of Otolaryngology
Author(s): Diaa El Din El Hennawi, Ahmed Geneid, Salah Zaher, Mohamed Rifaat
ObjectiveTo compare azithromycin (AZT) and benzathine penicillin (BP) in the treatment of recurrent tonsillitis in children.MethodsThe study comprised of 350 children with recurrent streptococcal tonsillitis, 284 of whom completed the study and 162 children received conventional surgical treatment. The rest of the children, 122, were divided randomly into two equal main groups. Group A children received a single intramuscular BP (600,000IU for children≤27kg and 1,200,000IU for ≥27kg) every two weeks for six months. Group B children received single oral AZT (250mg for children≤25kg and 500mg for ≥25kg) once weekly for six months.ResultsBoth groups showed marked significant reduction in recurrent tonsillitis that is comparable to results of tonsillectomy. There were no statistical differences between group A and B regarding the recurrence of infections and drug safety after six-month follow-up. Group B showed better compliance.ConclusionAZT proved to be good alternative to BP in the management of recurrent tonsillitis with results similar to those obtained after tonsillectomy.



http://ift.tt/2mBhAhp

The role of surgery in anaplastic thyroid cancer: A systematic review

Publication date: Available online 3 March 2017
Source:American Journal of Otolaryngology
Author(s): Shirley Hu, Samuel N. Helman, Elyse Hanly, Ilya Likhterov
ObjectiveTo elucidate the role of surgery in the management of anaplastic thyroid cancer.MethodsOvid MEDLINE, Cochrane Library, and Google Scholar databases were searched for publications from December 2000 to July 2016. Selection criterion was a focus on the management of anaplastic thyroid cancer in adults. Studies addressing only nonsurgical management and review articles were excluded. Data extraction was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Kaplan-Meier analysis was performed on a subset of patients.Results40 publications were included in the study. Approaches to unresectability and interpretations of resection varied widely. For patients undergoing primary surgery, the median survival was 6.6months. The median survival for non-surgical patients was 2.1months. In the subgroup analysis, the median survival time for patients undergoing surgery was significantly longer in Stage IVB (p=0.022) but not IVC disease. Negative margins did not afford a statistically significant survival benefit.ConclusionSurgery is a mainstay of treatment for Stage IVA and IVB disease. For Stage IVC cancer, distant metastasis was not a strict criterion against surgical candidacy among surgeons. The extent of resection and the definition of resectability remain controversial. Negative margins did not significantly increase survival.



http://ift.tt/2lDgUn0

Lésions cutanées de médecine traditionnelle soudanaise

Publication date: Available online 3 March 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): P. Charlier, F. Bou Abdallah, Y. Mostefai, L. Brun, C. Hervé




http://ift.tt/2lmH5TH

Rare case of severe serotonin syndrome leading to bilateral compartment syndrome

The term 'serotonin syndrome' describes a constellation of symptoms caused by serotonergic overstimulation. Its characteristic clinical presentation consists of encephalopathy, neuromuscular signs and autonomic hyperactivity. After removal of the offending agent, the clinical course is usually self-limited but can occasionally lead to severe symptoms. We report the case of a 68-year-old woman who presented emergently with encephalopathy. Home medications included paroxetine and dextroamphetamine/amphetamine. Physical examination revealed tachycardia, tachypnoea, diaphoresis, rigidity, hyperreflexia and clonus. Given the fast onset of symptoms, a diagnosis of serotonin syndrome was made. Laboratory studies showed acute-on-chronic kidney injury and elevated creatine kinase. The patient's mental status quickly returned to baseline with supportive care. Her rhabdomyolysis, however, persisted and led to acute compartment syndrome in her lower extremities. After bilateral leg fasciotomies and treatment of a severe wound infection with intravenous antibiotics, the patient has now recovered with complete resolution of her symptoms.

http://ift.tt/2mjehdU

Extraskeletal orbital mesenchymal chondrosarcoma: surgical approach and mini review

Extraskeletal orbital mesenchymal chondrosarcoma (MC) is an extremely rare and highly aggressive tumour. It has characteristic radiological features and pathognomic histological biphasic pattern. Radical resection with negative margins is the mainstay of treatment; role of adjuvant chemotherapy and radiotherapy is yet not well defined. We report a rare case of 18-year-old man who was diagnosed to have orbital MC. He presented with locally advanced disease with no vision in the affected eye. He underwent right orbital exenteration; a transcranial intradural approach was used to divide the optic nerve, and the temporalis muscle flap was utilised to fill the exenterated orbit. Though optic nerve involvement is rare in orbital MCs, a transcranial approach may be used effectively to avoid traction on optic chiasma and ensure margin-free resection in case of optic nerve involvement up to orbital apex. Unfortunately, prognosis remains dismal in MCs despite treatment.

http://ift.tt/2lDhFfV

IMRT Plus Cisplatin Versus IMRT in Patients With Stage 2 Nasopharyngeal Carcinoma

Condition:   Nasopharyngeal Carcinoma
Interventions:   Radiation: Intensity modulated radiotherapy;   Drug: Cisplatin
Sponsor:   Nanfang Hospital of Southern Medical University
Not yet recruiting - verified September 2016

http://ift.tt/2m3lOLI

Stereotactic Radiotherapy Combined With Chemotherapy or Not for Treatment of Oligometastases in HNSCC

Condition:   Head and Neck Squamous Cell Carcinoma
Interventions:   Drug: Chemotherapy;   Radiation: Stereotactic radiotherapy
Sponsor:   Groupe Oncologie Radiotherapie Tete et Cou
Recruiting - verified February 2017

http://ift.tt/2lmt5ZY

Ambu’s pediatric laryngeal tube innovation is a game-changer for prehospital providers

The following is paid content sponsored by Ambu By Jonathan Lee for EMS1 BrandFocus It has been almost a decade since the American Heart Association began to recognize the value of supraglottic airways (SGA) and deemphasize the role of intubation within its guidelines. Despite these recommendations, the smaller the patient gets, the less likely prehospital providers are to use an SGA. Research indicates ...

http://ift.tt/2mAMGFV

Clinical scenario: A patient with a possible airway obstruction

Engine 21, respond Priority 1 to 226 South Main St. at the Sunrise Café. Two separate callers report a man choking. You walk into the restaurant and bystanders direct you to a booth in the corner. Your patient is sitting on the floor propped up against the bench with several people standing around. A woman introduces herself as an off-duty nurse and states that the man was eating alone and abruptly ...

http://ift.tt/2mTJsJQ

5 primary assessment tips for EMS providers

The primary assessment as taught to EMS students generally involves some combination of the ABC's, level of consciousness, a general impression of the patient's condition and a definition of treatment priorities for the call. This assessment still plays an important role in determining the flow of a call from start to finish. The stepwise method taught in school is a great way to remember ...

http://ift.tt/2mARpI1

COPD exacerbation: 5 things EMS providers need to know

By Bob Sullivan Chronic obstructive pulmonary disease affects approximately 32 million Americans, and it is the fourth leading cause of death in the United States. COPD includes a group of degenerative conditions that impair airflow through the lungs. Cigarette smoking is the most common cause of COPD, and chronic bronchitis and emphysema are the two main types [1]. COPD exacerbations are frequently ...

http://ift.tt/2mTOwhd

Remember 2 Things: Piercings and airway management

Steve Whitehead, host of Remember 2 Things, breaks down two things to think about when you encounter a patient with piercings in their airway while you're trying to manage it.

http://ift.tt/2mANbjv

How to use an metered-dose inhaler with closed-mouth technique

The Chronic Obstructive Pulmonary Disease Foundation demonstrates how to properly use a metered-dose inhaler with a closed-mouth technique.

http://ift.tt/2mTGllp

Cardiac arrest in accidental hypothermia: Work the patient or don't start resuscitation?

A wrongful death lawsuit for failing to initiate resuscitative efforts was filed against EMS providers by the family of Jake Anderson in late 2016. According to publicly available news sources, Anderson, 19, was found unconscious with no apparent signs of life in freezing temperatures and declared dead with no interventions or transport to a hospital. The plaintiff is alleging that the responders failed ...

http://ift.tt/2mAMFBR

Remember 2 Things: How to improve cardiac arrest response

Do you remember your first cardiac arrest call" Remember 2 Things host Steve Whitehead shares two tips for responding to a patient in cardiac arrest and to increase the likelihood of ROSC.

http://ift.tt/2mTEXiC

Prehospital use of ketamine

Watch this video about the mechanism of action, indications and administration routes for prehospital use of ketamine. After watching read the Ketamine Drug Why article and three reasons to use ketamine for prehospital analgesia.

http://ift.tt/2mABLMG

Machine keeps lungs awaiting transplant perfused

Learn how a machine keeps lungs awaiting transplant perfused. Also watch to observe normal lung ventilation during mechanical ventilation.

http://ift.tt/2mTJJg1

CPR Turns 50 This Year! Help Celebrate a Half-Century of Saving Lives!

The San Francisco Paramedic Association, the City and County of San Francisco, the Sudden Cardiac Arrest Association, the American Heart Association and the Heart Safe Region Task Force are working to improve the survival rate from cardiac arrest in the Bay Area. In observance of National CPR & AED Awareness week, we will present various events throughout the Bay Area on Tuesday, June 1, 2010. We ...

http://ift.tt/2mARonr

Medicine is Dynamic – Keep an Open Mind

Medicine is dynamic. We don't do things that we used to. In the future, we may not do things that we do now.

http://ift.tt/2mTOtC3

SLAM Perils & Pearls Conference on Procedural Sedation & Advanced Airway Management

The SLAM Airway Training Institute and Clinical Solutions International have formed a strategic alliance to present an exciting new seminar for clinicians involved in the practice of emergency airway management, moderate sedation, procedural sedation and/or advanced airway management. The SLAM Perils & Pearls Conference on Procedural Sedation & Advanced Airway Management will be held at Parker ...

http://ift.tt/2mAPEKy

Transcranial LED therapy on amyloid-β toxin 25–35 in the hippocampal region of rats

Abstract

Excessive Aβ deposition in the brain is associated with the formation of senile plaques, and their diffuse distribution is related to Alzheimer's disease. Thirty rats (EG) were irradiated with light-emitting diode (photobiomodulation (PBM)) in the frontal region of the skull after being inoculated with the Aβ toxin in the hippocampus; 30 rats were used as the control group (CG). The analysis was conducted at 7, 14, and 21 days after irradiation. We observed a decreased in Aβ deposits in treated animals compared with animals in the CG. The behavioral and motor assessment revealed that the EG group covered a larger ground distance and explored the open field than the CG group on days 14 and 21 (p < 0.05). The EG group was statistically significant in the spatial memory test compared to the CG group on day 14. The use of PBM significantly reduced the presence of Aβ plaques and improved spatial memory and behavioral and motor skills in treated animals on day 21.

http://ift.tt/2m0s6gY

Polymorphism 4G/5G of the plasminogen activator inhibitor 1 gene as a risk factor for the development of allergic rhinitis symptoms in patients with asthma

Abstract

Plasminogen activator inhibitor-1 (PAI-1) is a glycoprotein which has a role in tissue remodelling after inflammatory processes. The objective is to investigate the frequency of PAI-1 gene polymorphism (4G/5G) in patients with a lung ventilation dysfunction in asthma and allergic rhinitis. Genomic DNA was isolated and genotypes of polymorphism of PAI-1 4G/5G and ABO were determined using the methods of RT-PCR and PCR-SSP. Study group includes 145 adult patients diagnosed with chronic asthma, with all clinically relevant parameters and the laboratory markers of pO₂, IgE and eosinophils in sputum and nasal swab. In the processing of data, appropriate statistical tests (Kolmogorov–Smirnov test, median, interquartile ranges, χ ² and Mann–Whitney U tests) were used. Patients with symptoms of allergic rhinitis were significantly younger and had an almost four time higher levels of IgE (P = 0.001), higher pO₂ (P = 0.002) and PEF (P = 0.036), compared to those who do not have these symptoms. Genotype PAI 4G/4G is significantly more common in patients with allergic rhinitis (28.1% vs. 16.1%; P = 0.017) compared to the genotype 5G/5G. Carriers of the genotype 4G/5G also have a borderline statistical significance. There were no statistically significant difference in the incidence of allergic rhinitis in the carriers of any ABO genotypes. The frequency of PAI genotype 4G/4G is significantly more common in patients with allergic rhinitis. The results suggest that the carriers of at least one 4G allele are at a higher risk for developing symptoms of allergic rhinitis in asthma.

http://ift.tt/2mTcysO

Comments on: “The comparison of edema and ecchymosis after piezoelectric and conventional osteotomy in rhinoplasty.”

http://ift.tt/2llV646

Current trends of balloon laryngoplasty in Thailand

Abstract

Objective

To describe the current trend in balloon laryngoplasty usage and experience by practicing otolaryngologists in Thailand.

Study design

Anonymous 11 question online and paper survey of otolaryngologists on their current balloon laryngoplasty practices.

Subjects and Methods

Current practices and experience in balloon laryngoplasty were queried with multiple choice and open-ended questions.

Results

Laser use is the most commonly utilized instrument to treat airway stenosis in Thailand. 86% of respondents do not have experience with balloon dilatation; yet, almost half (47.6%) report they perform a minimum of five airway surgeries per year. Most respondents had been in practice for less than 6 years (41%) and reported that they did not have exposure to balloon use during residency training. The largest barrier reported for the use of balloon instrumentation in the airway is inexperience (44.4%) followed by cost (38.3%), yet most feel that treatment in airway stenosis could benefit by usage of balloons (95.5%).

Conclusions

Most otolaryngologists in Thailand do not have experience with the use of balloon dilatation and lack of exposure remains the largest barrier to its use. Otolaryngologists in Thailand feel that increased usage of balloons in the airway could improve airway stenosis treatment in the country.

http://ift.tt/2mTcx8e

Force measurements during posterior calvarial vault osteodistraction: a novel measurement method

Posterior calvarial vault osteodistraction (PCVO) has become increasingly popular in the correction of craniosynostosis. When compared to cranioplasty, PCVO offers a shorter, less invasive operation, greater intracranial volume advancement and a lower rate of relapse.In general, distraction protocols are based primarily on clinical observations rather than systematic research. Faster distraction protocols may reduce complications. However, distraction protocols producing higher forces can increase complications.

http://ift.tt/2llOoLp

Surgical nodulectomies can heal in patients with lymphoedema secondary to Podoconiosis in resource poor settings

Abstract

In Ethiopia severe lymphoedema of the legs resulting from podoconiosis affects approximately 1 million people¹. Woody-hard fibrous nodules which complicate this renders the condition resistant to conventional treatment. We present a series of nodulectomies performed in a rural, resource limited setting.

This article is protected by copyright. All rights reserved.

http://ift.tt/2migx5h

Lipocalin-2 is expressed by activated granulocytes and keratinocytes in affected skin and reflects disease activity in acne inversa / hidradenitis suppurativa

Summary

Background

Acne inversa (AI)/Hidradenitis suppurativa is a chronic inflammatory disease characterized by painful axillary, inguinal, and perianal skin lesions with deep-seated nodules, abscesses, and fistulae.

Objectives

This study aimed at the identification and characterization of key players in AI pathogenesis.

Methods

Epidemiologic and anamnestic data as well as blood and skin samples of AI patients were collected. Healthy participants and psoriasis patients served as controls. Assessment of samples and cultures of primary cells was performed by ELISA, qRT-PCR, and immunohistochemistry.

Results

Among 35 mediators quantified in blood of AI patients, lipocalin(LCN)-2 appeared as one of the most significantly upregulated parameters compared to healthy participants [85.8±12.2 (n=18) versus 41.8±4.2 (n=15); P=0.000]. Strongly elevated LCN2 expression was present in AI lesions, with granulocytes and, to a lower extent, keratinocytes being sources of this expression. In vitro, these cells upregulated LCN2 production in response to TNF-α, and a positive relationship between systemic TNF-α and LCN2 levels (r_s=0.55; P=0.011; n=20) was evident for AI. LCN2 blood levels correlated with AI disease severity (r_s=0.65; P=0.000, n=29), but not with disease duration, age, sex, BMI, or smoking habit. Detailed analyses revealed a link with the number of skin regions containing nodules and fistulae, but not scars.

Conclusions

LCN2 might serve as a blood biomarker for objective assessment of inflammatory activity in AI. Additionally, we suggest a self-amplification loop comprising TNF-α, neutrophilic granulocytes, and LCN2, that contributes to the recurrent skin neutrophil infiltration in AI, clinically evident as pus.

This article is protected by copyright. All rights reserved.

http://ift.tt/2lBK0TF

Recent advances in the understanding of severe cutaneous adverse reactions

Abstract

Severe cutaneous adverse reactions (SCARs) encompass a heterogeneous group of delayed hypersensitivity reactions, which are most frequently caused by drugs. Our understanding of several aspects of SCAR syndromes has evolved considerably over the previous decade. This review explores evolving knowledge on the immunopathogenic mechanisms, pharmacogenomic associations, in-vivo and ex-vivo diagnostics for causality assessment and medication cross-reactivity data related to SCAR syndromes. Given the rarity and severity of these diseases, multidisciplinary collaboration through large international, national and/or multicentre networks to collect prospective data on patients with SCAR syndromes should be prioritized. This will further enhance a systematised framework for translating epidemiological, clinical, and immunopathogenetic advances into preventive efforts and improved outcomes for patients.

This article is protected by copyright. All rights reserved.

http://ift.tt/2mirt2O

The Oncogenic role of miR-155 in Mycosis Fungoides: an in vitro and xenograft mouse model study

Summary

Background

miR-155 contributes to the proliferation of mycosis fungoides (MF) in vitro and is upregulated in tumours of MF compared to early MF lesions.

Objectives

To investigate the contribution of miR-155 to the cancerous phenotype and drug resistance of MF/Sezary cell lines.

Methods

miR-155 was inhibited in MF cell lines (MyLa and MJ) by transduction of miRZip anti-miR-155 and overexpressed in Hut78 cells by transduction of miRVec-miR-155; empty plasmids served as a control. Cells were analysed for response to inducers of apoptosis and cell cycle arrest using FACS. The transduced MyLa cells were subcutaneously injected into SCID mice, and tumours were analysed immunohistochemically and for final size.

Results

MyLa and MJ cells expressed a high level of miR-155 whereas Hut78 cells expressed a low level. MF cell lines stably expressing miR-155 inhibitor showed increased G2/M arrest in response to SL111, a cell-cycle-arrest inducer, followed by increased apoptosis. Additionally, they showed increased apoptosis in response to SAHA, a histone deacetylase inhibitor. Tumours formed in mice from injected anti-miR-155-expressing MyLa cells had a significantly lower volume and more apoptosis than controls. Stable overexpression of miR-155 in Hut78 cells had no effect.

Conclusions

Oncogenic miR-155 appears to contribute to the cancerous phenotype of MyLa and MJ cells, but not of Hut78 cells, by interrupting activation of the G2/M checkpoint in response to SL111 and decreasing apoptosis in response to SL111 and SAHA, thereby facilitating tumor growth. These findings have implications for the potential development of novel therapeutic modalities for MF incorporating miR-155 inhibitors.

This article is protected by copyright. All rights reserved.

http://ift.tt/2lBQuSF

The mTOR inhibitor everolimus suppresses proliferation, metabolic activity and collagen synthesis of human fibroblasts in vitro and exerts antifibrogenic effects in vivo

Abstract

Fibrosclerotic and fibroproliferative diseases remain a therapeutic challenge in dermatology. Everolimus, an inhibitor of the mammalian target of rapamycin (mTOR), is approved for prophylaxis against allograft rejection, treatment of renal cell carcinoma, and use as a drug-eluting stent¹. Interestingly, rapamycin improved skin stiffness and mobility in a patient with systemic sclerosis (SSc)². A randomized, single-blind pilot study confirmed that rapamycin has beneficial effects on the modified Rodnan skin thickness score and on the patient's global assessment in SSc³.

This article is protected by copyright. All rights reserved.

http://ift.tt/2miBfln

Prevalence and current therapies of psoriatic arthritis in Japan: A survey by the Japanese Society of Psoriasis Research in 2016

http://ift.tt/2m2Ch4J

Clear cell sarcoma with intraepidermal nests requiring the differential diagnosis of malignant melanoma

http://ift.tt/2mNNzYN

Non-bullous lesions as the first manifestation of bullous pemphigoid: A retrospective analysis of 181 cases

Abstract

The aim of the present study was to explore the clinical and histopathological characteristics and treatment of patients with bullous pemphigoid (BP) that initially manifested as non-bullous lesions and provide information for early diagnosis and improved treatment. Medical records of 491 cases of BP were collected. The clinical and histopathological characteristics, treatment and outcomes of patients who initially presented with non-bullous lesions (prodromal BP, PBP) were analyzed and compared with those from patients who initially presented with bullous lesions (classical BP, cBP). Of the BP patients studied, 36.8% had PBP and presented with diversified initial lesions before the appearance of typical bullae, with erythema as the most frequent (31.67%), followed by concurrent erythema and papules (30.4%). The mean duration before bullae appearance was 15.91 ± 0.65 months. The degree of itch in PBP patients was higher than that in cBP patients. There was no difference in the hospital stay and time to disease control between the PBP and cBP patients. However, the mean glucocorticoid dose for control of the lesions in PBP patients was significantly higher than that in cBP patients. In addition, the PBP patients experienced side-effects more frequently than did the cBP patients (87.85% vs 17.41%). In conclusion, intensive treatment is required for PBP patients due to delayed diagnosis and advanced development of the disease. Itching, concurrent erythema and papules occurring in the elderly may be clues for the early diagnosis of PBP.

http://ift.tt/2m2Dclp

Thymoma-associated multi-organ autoimmunity: A case of graft-versus-host disease-like erythroderma complicated by Good syndrome successfully treated by thymectomy

Abstract

Thymoma-associated multi-organ autoimmunity disease (TAMA) is a rare paraneoplastic disorder, clinicopathologically similar to graft-versus-host disease (GVHD). Many reported cases follow a difficult course; half of them die from serious infectious diseases subsequent to immunosuppression induced by chemotherapy for unresectable thymoma, or intensive therapies including systemic steroids for complicating autoimmune diseases and GVHD-like symptoms. We report a patient whose skin symptoms were improved subsequently to total thymectomy. The patient also presented with hypogammaglobulinemia, which led to the diagnosis of complicated Good syndrome. Taking account of her immunodeficient condition, antibiotics and i.v. immunoglobulin were administrated promptly on onset of bacterial pneumonia, which was successfully treated. According to a review of the published work, treatments with systemic steroids for skin symptoms have limited effects and may contribute to serious infection. Our case indicates that successful treatment of thymoma itself may lead to the amelioration of the disease. The management priority should be given to the treatment of thymoma and the control of subsequent immune abnormality other than GVHD-like erythroderma.

http://ift.tt/2mO18Y3

Dermoscopic features of dermatofibroma with overlying sebaceous hyperplasia

http://ift.tt/2m2tAqR

Treatment patterns of postherpetic neuralgia patients before and after the launch of pregabalin and its effect on medical costs: Analysis of Japanese claims data provided by Japan Medical Data Center

Abstract

Except for neurotrophin, no drug had an indication for postherpetic neuralgia (PHN) in Japan prior to pregabalin approval. This approval might have changed PHN treatment patterns. This study aimed to compare PHN treatment patterns and medical costs between patients who started treatment before and after pregabalin approval. Japanese claims data were used to identify patients aged 18 years or more with PHN, postherpetic trigeminal neuralgia or postherpetic polyneuropathy who were initiated on their first PHN-associated prescription through May 2010 (before approval) or from June 2010 (after approval). From these claims, 6-month treatment patterns from first prescription were compared for the periods before and after approval. These patterns included pain-related medications and the frequency of pain-relief procedures. All-cause and pain-related medical costs were also compared for these periods. The number of PHN patients who were initiated on treatment before and after approval were 107 (mean age, 47.4 ± 13.0 years) and 505 (45.9 ± 13.0), respectively. Post-approval, significant reductions were observed for prescription of non-steroidal anti-inflammatory drugs, tricyclic antidepressants and neurotrophin relative to before approval. Excluding pregabalin acquisition costs, mean costs per patient for medications associated with PHN for 6 months from the first prescription were significantly lower after approval, ¥2882 vs ¥4185. Total medical costs were similar in both periods. Approval of pregabalin appeared to result in a treatment paradigm toward use of an approved therapy with demonstrated efficacy.

http://ift.tt/2mNKS9A

Epidermal p16INK4a expression is more frequently and intensely upregulated in lichen planus than in eczema, psoriasis, drug eruption and graft-versus-host disease

http://ift.tt/2m2qljo

Cutaneous side-effects of biologics in immune-mediated disorders: A histopathological perspective

Abstract

Advances in understanding molecular mechanisms and targets in immune regulation have led to the widespread use of biologic targeted therapies, and, as such, reformed the course of many disabling diseases. However, with their expanded use, various side-effects, including cutaneous, have emerged. Many times a clear-cut relationship exists between the drug and the clinical manifestations; however, when a biopsy is warranted, various histopathological patterns may be observed and may cause confusion to the dermatopathologist. The aim of this review is to shed light on the different histopathological patterns observed as a manifestation secondary to biologics.

http://ift.tt/2mNH488

Folliculosebaceous neoplasms: A review of clinical and histological features

Abstract

Numerous benign and occasionally malignant tumors arise from the folliculosebaceous apparatus. Confusing terminology, rarity of malignant variants and overlapping histological features can lead to diagnostic uncertainty. This review highlights the clinical and histopathological features that help to classify these entities, as well as the various syndromes associated with certain members of this large family of tumors.

http://ift.tt/2m2WK9p

Topics in histopathology of sweat gland and sebaceous neoplasms

Abstract

This article reviews several topics regarding sweat gland and sebaceous neoplasms. First, the clinicopathological characteristics of poroid neoplasms are summarized. It was recently reported that one-fourth of poroid neoplasms are composite tumors and one-fourth are apocrine type lesions. Recent progress in the immunohistochemical diagnosis of sweat gland neoplasms is also reviewed. CD117 can help to distinguish sweat gland or sebaceous tumors from other non-Merkel cell epithelial tumors of the skin. For immunohistochemical differential diagnosis between sweat gland carcinoma (SGC) other than primary cutanesous apocrine carcinoma and skin metastasis of breast carcinoma (SMBC), a panel of antibodies may be useful, including p63 (SGC⁺, SMBC⁻), CK5/6 (SGC⁺, SMBC⁻), podoplanin (SGC⁺, SMBC⁻) and mammaglobin (SGC⁻, SMBC⁺). Comparison of antibodies used for immunohistochemical diagnosis of sebaceous carcinoma (SC) suggests that adipophilin has the highest sensitivity and specificity. Some authors have found that immunostaining for survivin, androgen receptor and ZEB2/SIP1 has prognostic value for ocular SC, but not extraocular SC. In situ SC is rare, especially extraocular SC, but there have been several recent reports that actinic keratosis and Bowen's disease are the source of invasive SC. Finally, based on recent reports, classification of sebaceous neoplasms into three categories is proposed, which are sebaceoma (a benign neoplasm with well-defined architecture and no atypia), borderline sebaceous neoplasm (low-grade SC; an intermediate tumor with well-defined architecture and nuclear atypia) and SC (a malignant tumor with invasive growth and evident nuclear atypia).

http://ift.tt/2mNCYgn

Mimickers of classic acantholytic diseases

Abstract

Acantholysis is a commonly encountered histological pattern which typically generates a differential of the pemphigus variants, Hailey–Hailey, Darier's and Grover's diseases. In addition to these diseases, the dermatologist and dermatopathologist must be aware of entities that mimic classic acantholytic dermatoses and of rare disease variants, which are characterized by acantholysis.

http://ift.tt/2m2WHKL

Preface to Journal of Dermatology special issue: Dermatopathology

http://ift.tt/2mNHDPq

Immunoglobulin G4-related disease and its skin manifestations

Abstract

Immunoglobulin G4-related disease (IgG4-RD) is a systemic inflammatory condition characterized by tissue infiltration with IgG4⁺ plasma cells and an elevated serum IgG4 level. It usually occurs in middle-aged or older patients, with male predominance, and can involve multiple organs synchronously or metachronously. Patients with IgG4-RD generally respond to steroid therapy. IgG4-related skin lesions are typically erythematous and itchy plaques, subcutaneous nodules, or papules like prurigo nodularis located on the head and neck areas. Histologically, lymphoplasmacytic infiltrates with abundant IgG4+ plasma cells are seen in the dermis and/or subcutaneous tissue. The skin condition of IgG4-RD does not necessarily exhibit infiltration of IgG4⁺ plasma cells, which is a prerequisite for IgG4-related skin disease, but such skin lesions without infiltration by IgG4⁺ plasma cells can be included in the skin manifestations of IgG4-RD.

http://ift.tt/2m2Fdy3

Issue Information

http://ift.tt/2mNKnw5

Issue Information

http://ift.tt/2m2vd7S

Advances in histopathological diagnosis of keratoacanthoma

Abstract

Keratoacanthoma is a common epithelial lesion, but its nature is controversial. Although a distinct crateriform appearance is a hallmark of keratoacanthoma, other benign or malignant skin lesions may show a similar architecture. Moreover, as lesions diagnosed as conventional keratoacanthoma may show malignant behavior, some authors consider keratoacanthoma to be a variant of squamous cell carcinoma, whereas others consider it as a distinct self-resolving squamous proliferative lesion. The controversy seems to originate from the diverse behavior of keratoacanthoma-like epithelial lesions. However, a reproducible histopathological classification criterion has been recently proposed in the diagnosis of keratoacanthoma-like epithelial lesions, and its validity is supported by several reports that deal with the natural course or molecular aspects of these lesions. This article attempts to provide a comprehensive review on recent insights and advances in the histopathological diagnosis of keratoacanthoma or related lesions, as well as summary of related published works.

http://ift.tt/2mNES0m

Granular cell differentiation: A review of the published work

Abstract

Since the initial description of the granular cell tumor in 1926, numerous other neoplasms, both benign and malignant, have been described to exhibit granular cell change. In most cases, diagnosis remains straightforward via recognition of retained histopathological morphology of the archetypal tumor, despite the presence of focal granular appearance. However, tumors with granular cell differentiation can present a diagnostic challenge either by mimicking alternative diagnoses, or by failing to exhibit architectural clues of the primary entity, thus requiring an immunohistochemical work-up. In light of this, it is important to be aware of the various entities that have been reported to exhibit granular cell morphology. In this review such tumors are discussed along with pertinent clinical and histopathological features.

http://ift.tt/2m2zY1b

What is new in the histogenesis of granulomatous skin diseases?

Abstract

A granuloma is a form of inflammation, which predominantly consists of macrophages. It typically develops when the immune system attempts to enclose substances that are usually insoluble and cannot be eliminated to prevent the spread of these substances to the other body compartments. According to the source of the substances, granulomatous diseases can be divided into two groups: infectious and non-infectious. The mechanisms of infectious granuloma formation have been widely investigated because of its easy reproducibility in experimental models, both in vivo and in vitro. On the contrary, mechanisms of non-infectious granuloma formation have not been well investigated because of the difficulty to reproduce this formation in experimental models. In this article, we review our recent understanding of the histogenesis and pathogenesis of granuloma formation, confirmed from studies of infectious granulomas, and we present potential hypotheses of the histogenesis and pathogenesis of non-infectious granulomas based on clinical investigations.

http://ift.tt/2mNNKn5

Nail neoplasms

Abstract

Nail neoplasms include all tumors occurring in the nail or periungual apparatus tissue. While some nail tumors can be similar to tumors located on the skin, others are unique. Both benign and malignant lesions can affect the nail apparatus. In particular, early malignant tumors like melanoma and squamous cell carcinoma can present similarly to onychomycosis or benign melanonychia and frequently missed by clinicians. Therefore, physicians should be aware of nail structures and the characteristics of nail tumors. Our review covers the normal nail structure and the most common nail tumors from benign to malignant.

http://ift.tt/2m2DFEc

Imaging Blood Vessel Morphology in Skin: Dynamic Optical Coherence Tomography as a Novel Potential Diagnostic Tool in Dermatology

Abstract

Conventional optical coherence tomography (OCT) enables the visualization of morphological changes of skin cancer. The use of OCT in the diagnostic investigation and in the therapy decision of non-melanoma skin cancer and other skin changes is already established, and has found its way into routine practice. With the development of speckle-variance OCT, also named dynamic OCT (D-OCT), the vascular architecture and the blood flow of the skin can be displayed in vivo and in 3D. This novel angiographic variant of OCT offers the ability to visualize and measure vessel morphology providing a new insight into healthy, inflammatory and neoplastic skin lesions such as malignant melanoma. This review focuses on the possibilities of using D-OCT on healthy and diseased skin. We suggest and illustrate key diagnostic characteristics by analyzing the initial publications and preliminary unpublished data on vessel morphology and distribution. The potential of D-OCT as a diagnostic tool in dermatology is examined and may give rise to future studies on D-OCT, which are needed to confirm the aforementioned features.

http://ift.tt/2lBvKdG

Otogenic Temporomandibular Arthritis in Children.

Otogenic Temporomandibular Arthritis in Children.

JAMA Otolaryngol Head Neck Surg. 2017 Mar 02;:

Authors: Burgess A, Celerier C, Breton S, Van den Abbeele T, Kadlub N, Leboulanger N, Garabedian N, Couloigner V

Abstract
Importance: Septic arthritis of the temporomandibular joint (SATMJ) is a very rare but potentially severe complication of pediatric middle ear infections because it presents risks of TMJ ankylosis.
Objective: To describe the clinical, radiological, biological, and microbiological characteristics and evolution of SATMJ complicating middle ear infections (otogenic SATMJ) in children.
Design, Setting, and Participants: This multicenter retrospective study included all children younger than 18 years referred between January 1, 2005, and December 31, 2015, for otogenic SATMJ or for TMJ ankylosis that occurred a few months to a few years after an acute mastoiditis. Nine children were included in the study. Review of the children's medical charts was conducted from February 1, 2016, to April 1, 2016.
Main Outcomes and Measures: Patients' demographic characteristics and symptoms; radiological, biological, and bacteriological findings, including reanalysis of initial imaging; and treatment and outcome of SATMJ.
Results: Of the 9 children, 6 were boys and 3 were girls; the mean age was 2.1 years (range, 6 months to 4.7 years). In 7 cases (78%), the primary middle ear infection was acute mastoiditis. Clinically, 5 children (55%) had preauricular swelling and only 1 (11%) had trismus. Associated thrombophlebitis of the lateral sinus or intracranial collections was present in 7 cases (78%). An initial computed tomographic scan was performed for all but 1 patient, and second-line analysis detected clear signs of TMJ inflammation in all 8 children who had a computed tomographic scan. However, SATMJ was diagnosed in only 3 cases at the time of the initial middle ear infection, leading to the recommendation of TMJ physical therapy for several months. The most frequently involved bacteria was Fusobacterium necrophorum, which was found in 4 cases. Long-term ankylosis was identified in 6 cases (67%), and 5 of these children required surgical treatment.
Conclusions and Relevance: Clinicians and radiologists must thoroughly look for signs of SATMJ in children with acute mastoiditis to detect this complication, which can lead to disabling and hard-to-treat TMJ ankylosis.

PMID: 28253398 [PubMed - as supplied by publisher]

http://ift.tt/2m2CnJh

Slow-Growing Infiltrative Sinonasal Mass.

Slow-Growing Infiltrative Sinonasal Mass.

JAMA Otolaryngol Head Neck Surg. 2017 Mar 02;:

Authors: Coughlin KC, Weiss JP, Fredenburg KM, Justice JM

PMID: 28253397 [PubMed - as supplied by publisher]

http://ift.tt/2mNG6J7

Technique and Preliminary Analysis of Drug-Induced Sleep Endoscopy With Online Polygraphic Cardiorespiratory Monitoring in Patients With Obstructive Sleep Apnea Syndrome.

Technique and Preliminary Analysis of Drug-Induced Sleep Endoscopy With Online Polygraphic Cardiorespiratory Monitoring in Patients With Obstructive Sleep Apnea Syndrome.

JAMA Otolaryngol Head Neck Surg. 2017 Mar 02;:

Authors: Gobbi R, Baiardi S, Mondini S, Cerritelli L, Piccin O, Scaramuzzino G, Milano F, Melotti MR, Mordini F, Pirodda A, Cirignotta F, Sorrenti G

Abstract
Importance: Drug-induced sleep endoscopy is a diagnostic technique that allows dynamic evaluation of the upper airway during artificial sleep. The lack of a standardized procedure and the difficulties associated with direct visual detection of obstructive events result in poor intraobserver and interobserver reliability, especially when otolaryngology surgeons not experienced in the technique are involved.
Objectives: To describe a drug-induced sleep endoscopy technique implemented with simultaneous polygraphic monitoring of cardiorespiratory parameters (DISE-PG) in patients with a diagnosis of obstructive sleep apnea syndrome and discuss the technique's possible advantages compared with the standard procedure.
Design, Setting, and Participants: This prospective cohort study included 50 consecutive patients with obstructive sleep apnea syndrome who underwent DISE-PG from March 1, 2013, to June 30, 2014. A standard protocol was adopted, and all the procedures were carried out in an operation room by an experienced otolaryngology surgeon under the supervision of an anesthesiologist. Endoscopic and polygraphic obstructive respiratory events were analyzed offline in a double-blind setting and randomized order.
Main Outcomes and Measures: The feasibility and safety of the DISE-PG technique, as well as its sensitivity in detecting respiratory events compared with that of the standard drug-induced sleep endoscopy procedure.
Results: All 50 patients (43 men and 7 women; mean [SD] age, 51.1 [12.1] years) underwent DISE-PG without technical problems or patient difficulties regarding the procedure. As expected, polygraphic scoring was more sensitive than endoscopic scoring in identifying obstructive events (mean [SD] total events, 13.3 [6.8] vs 5.3 [3.6]; mean [SD] difference, 8.8 [5.6]; 95% CI, 7.3 to 10.4; Cohen d, -1.5). This difference was most pronounced in patients with a higher apnea-hypopnea index (AHI) at baseline (mean [SD] difference for AHI >30, 27.1% [31.0%]; 95% CI, -36.2% to 90.4%; Cohen d, 0.2; for AH I >40, 76.0% [35.5%]; 95% CI, 4.6% to 147.4%; Cohen d, 0.5; for AHI >50, 92.2% [37.2%]; 95% CI, 17.3% to 167.1%; Cohen d, 0.6) and a high percentage of hypopneas (≥75% of all obstructive events) at baseline (mean [SD] difference, 20.2% [5.4%]; 95% CI, 9.2% to 31.3%; Cohen d, 1.1). No other anthropomorphic or polygraphic features at baseline were associated with the differences between the DISE-PG and baseline home sleep apnea test.
Conclusions and Relevance: The DISE-PG technique is feasible, safe, and more sensitive at detecting an obstructed breathing pattern than is drug-induced sleep endoscopy alone. The DISE-PG technique could be helpful for accurate comprehension of upper airway obstructive dynamics (ie, degree of obstruction and multilevel pattern) and a nonobstructive breathing pattern (ie, central apneas).

PMID: 28253389 [PubMed - as supplied by publisher]

http://ift.tt/2m2zmch

Addressing Estimated Hearing Loss in Adults in 2060.

Addressing Estimated Hearing Loss in Adults in 2060.

JAMA Otolaryngol Head Neck Surg. 2017 Mar 02;:

Authors: Goman AM, Reed NS, Lin FR

PMID: 28253386 [PubMed - as supplied by publisher]

http://ift.tt/2m2Vgds

Force measurements during posterior calvarial vault osteodistraction: a novel measurement method

Publication date: Available online 2 March 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): A. Ritvanen, M. Savolainen, D. Nowinski, D. Saiepour, M. Paulasto-Kröckel, J. Hukki, E. Tukiainen, J. Leikola
Posterior calvarial vault osteodistraction (PCVO) has become increasingly popular in the correction of craniosynostosis. When compared to cranioplasty, PCVO offers a shorter, less invasive operation, greater intracranial volume advancement and a lower rate of relapse.In general, distraction protocols are based primarily on clinical observations rather than systematic research. Faster distraction protocols may reduce complications. However, distraction protocols producing higher forces can increase complications. Thus, we need to understand these forces in order to improve distraction protocols and devices.We developed a force measurement method that can be used on PCVO devices. Here, we present preliminary data about the forces developed during PCVO. We measured the forces in four syndromic craniosynostosis patients during PCVO.We observed a linear-like trend between the force increase and the distraction distance within distraction sessions. We also observed a step-wise force increase between distraction sessions and found that the distraction force relaxed rapidly shortly after the distraction session. The mean maximum pre-distraction force for one distracter was 20.4 N, while the mean maximum end-distraction force for one distracter was 57.6 N. Our data suggests that current treatment protocols might be re-evaluated favouring shorter distraction distances and more frequent distraction sessions.



http://ift.tt/2m2LIzg

Periosteal fasciitis in a 7-year old girl: a diagnostic dilemma

Publication date: Available online 2 March 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): M. Lääveri, K. Heikinheimo, D. Baumhoer, P.J. Slootweg, R.-P. Happonen
Periosteal fasciitis, considered a subtype of nodular fasciitis, is a rare benign soft tissue mass often misdiagnosed as a malignant lesion due to its fast and infiltrative growth pattern and histological features. Nodular fasciitis is usually found in the upper extremities in adults and in the head and neck region in children. Incorrect diagnosis may lead to overtreatment, potentially causing disturbed orofacial development in growing children. A rapidly growing asymptomatic mass, initially suspected to be a malignant bone tumour, was found in the left angle area of the mandible in a healthy 7-year-old girl. Radiographic examination revealed an exophytic, expansile and destructive nodule arising from the periosteal region. A diagnosis of periosteal fasciitis was established based on histological findings in an open biopsy specimen and the lesion was subsequently enucleated. Fluorescence in situ hybridization analysis revealed a USP6 gene rearrangement and confirmed the diagnosis molecularly. Due to the aggressive growth pattern without external trauma and the results of the gene rearrangement test, it is suggested that nodular fasciitis be regarded as a benign neoplasm rather than as a reactive process. The patient remains free of disease at 3 years after surgery.



http://ift.tt/2mSODtD

First signs of late-presenting cervical lymph node metastasis in oral cancers during follow-up

Publication date: Available online 2 March 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): J. Sumino, N. Uzawa, Y. Ohyama, Y. Michi, A. Kawamata, M. Mizutani, M. Yamashiro
One of the most important prognostic factors in oral squamous cell carcinoma (OSCC) is the presence of lymph node metastasis. Therefore, the early detection of late-presenting cervical lymph node metastasis is important. Although many studies have assessed diagnostic modalities for detecting metastatic cervical lymph nodes, no study has evaluated the process, especially first signs, for detecting late-presenting cervical lymph node metastasis. A retrospective analysis comparing methods for detecting the first signs of late-presenting lymph node metastasis was performed. A total of 65 OSCC patients were assessed. These patients were identified retrospectively as having presented late metastasis during follow-up after initial treatment with curative intent. The findings of four detection methods were analyzed: palpation, ultrasonography, computed tomography, and subjective symptoms. The numbers of cases identified by each method were as follows: palpation, 31 (47.7%); ultrasonography, 17 (26.1%); computed tomography, 12 (18.5%); and subjective symptoms, 5 (7.7%). Palpation played a major role in the discovery of late-presenting lymph node metastasis. In contrast, metastatic lymph nodes were detected by other methods in about half of the cases. The results suggest a possible stratification of the various methods used for metastatic lymph node detection, depending on the characteristics of individual cases.



http://ift.tt/2lloQOv

Biologic Response Modifiers: Indications, Implications and Insights

Publication date: Available online 2 March 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Benjamin P. Davis, Zuhair K. Ballas
The field of biologic immune-modulators is currently mushrooming at a dizzying pace. While most of these biologics are tested and approved for one or a few indications, their un-anticipated side effects and their off-label use have contributed significantly to our understanding of basic immune mechanisms, of the involvement of cytokines in several apparently non-immunologic diseases, and of the importance of compartmentalized immune responses. In this review, we attempt to give a bird's-eye view of the major biologics and to highlight insights and implications derived from their secondary effects and adverse reactions.



http://ift.tt/2mNqANh

Perineural Versus Intravenous Dexamethasone as an Adjuvant for Peripheral Nerve Blocks: A Systematic Review and Meta-Analysis.

Background and Objectives: Dexamethasone is a useful adjuvant in regional anesthesia that is used to prolong the duration of analgesia for peripheral nerve blocks. Recent randomized controlled trials (RCTs) have demonstrated conflicting results as to whether perineural versus intravenous (IV) administration is superior in this regard, and the perineural use of dexamethasone remains off-label. Therefore, we sought to perform a systematic review and meta-analysis of RCTs. Methods: In accordance with PRISMA guidelines, we performed a random-effects meta-analysis of RCTs comparing perineural versus IV dexamethasone with duration of analgesia as the primary outcome. Results: Eleven RCTs met the inclusion criteria with a total of 1076 subjects. Perineural dexamethasone prolonged the duration of analgesia by 3.77 hours (95% confidence interval [CI], 1.87-5.68 hours; P

http://ift.tt/2mSurrZ

Ipilimumab has efficacy in metastatic Merkel Cell Carcinoma: a case series of five patients

Abstract

Immunotherapy with immune checkpoint blockers such as the CTLA-4 antibody ipilimumab and PD-1 antibodies has revolutionized oncological treatment options¹. MCC is an immunogenic tumor and the efficacy of PD-1 blockade has recently been demonstrated^2,3,4. Here, we present a retrospective analysis of five patients with metastatic MCC individually treated with ipilimumab between 2012 and 2015. Administration of four cycles (3 mg/kg every three weeks) was planned. Informed consent was obtained from all patients. Patient characteristics are depicted in table 1. All patients had received previous surgical and radiation therapy before initiation of ipilimumab.

This article is protected by copyright. All rights reserved.

http://ift.tt/2mhu2SM

One more step towards a clinically applicable tolerance induction protocol in solid organ transplantation?.

No abstract available

http://ift.tt/2mkQD0W

Deceased organ donors and PHS risk identification: impact upon organ usage and outcomes.

Background: In 2013, the PHS changed the criteria intended to identify organ donors that put the associated organ recipients at increased risk for acquiring HIV, HBV and HCV. The changing donor demographics, organ utilization and outcomes associated with this change is not known. Methods: A review of the OPTN database was performed to assess the impact of PHS donor designation upon organ utilization and outcomes. Results: After the 2013 modification, over 20% of all deceased organ donors in the US were identified as PHS increased risk. Compared to the standard risk deceased organ donor, the PHS donor was younger, male, died from anoxia, more likely to be HCV and HBcAb+ and less likely to have diabetes or hypertension. Organs from the 18 to 34-year-old deceased donors with PHS risks (but relatively few medical comorbidities) and tested negative for HCV were less frequently transplanted compared to the standard risk donors, 3.9 vs 4.2 OTPD. However, the transplant patient and graft survival as well as risk of unexpected transmission of HIV, HBV and HCV were equivalent, irrespective of PHS donor status. Conclusion: The rationale of using PHS donor designation that negatively impacts utilization of high quality organs without the benefit of identifying the subset of organs with demonstrable proclivity to transmit HIV, HBV or HCV needs to be re-examined. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2mSi1jL

Successful Transplantation of 2 Discolored Kidneys Caused by Myoglobin Casts from a Donor with Rhabdomyolysis.

No abstract available

http://ift.tt/2mkXZBG

Timing is Everything: Managing Hepatitis C in Liver Transplant Candidates.

No abstract available

http://ift.tt/2mSrRSx

Epitope-based HLA-matching: A Useful Strategy With Many Shortcomings to Overcome.

No abstract available

http://ift.tt/2mkVxv0

Diffuse Extent of Peritubular Capillaritis in Late Antibody-mediated Rejection: Associations With Levels of Donor-specific Antibodies and Chronic Allograft Injury.

Background: Recently, diffuse peritubular capillaritis (ptc) has been suggested to independently predict chronic transplant injury and loss and while the ptc score is a diagnostic criterion for antibody-mediated rejection, the utility of diffuse ptc is under debate. Methods: We evaluated the diagnostic value of ptc characteristics in this cross-sectional study including 85 biopsies of patients with donor-specific antibodies (DSA). Biopsies were reevaluated for the extent (diffuse vs. focal), score and leukocytic composition in relation to DSA binding strength (MFI_max). Chronic allograft injury [transplant glomerulopathy (cg) or chronic lesion score (CLS)] were associated with ptc features. Results: Ptc was detected in 50% (76% mononuclear ptc). Ptc scores 1, 2, and 3 were present in 36%, 55% and 9 %, and focal or diffuse ptc in 36% or 64%. Diffuse ptc was associated with DSA MFI_max [median: 4407 vs. 2419 (focal ptc; p=0.04) or 1946 (no ptc; p=0.004)], cg [58% vs. no ptc 24% (p=0.02)] and higher CLS [mean: 6.81 vs. 4.67 (focal ptc, p=0.01) or 5.18 (no ptc, p=0.001)], respectively. The association of ptc score >=2 with cg was slightly better than with diffuse ptc. Diffuse ptc and ptc score >=2 remained independently related to cg after adjusting for DSA_MFI_max, C4d or previous rejection episodes, however lost their independent relation after adjusting for total microcirculation scores. Diffuse ptc was the only ptc characteristic independently related to CLS. Conclusion: Our results emphasize the clinical relevance of reporting diffuse ptc, which may relate to DSA binding strength and potentially to chronic graft injury. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2mSmQJK

International Liver Transplant Society Consensus Statement on HEPATITIS C MANAGEMENT IN LIVER TRANSPLANT CANDIDATES.

No abstract available

http://ift.tt/2mkXZ4E

International Liver Transplant Society Consensus Statement on HEPATITIS C MANAGEMENT IN LIVER TRANSPLANT RECIPIENTS.

No abstract available

http://ift.tt/2mShPAS