Eradication rate of Helicobacter Pylori infection is directly influenced by adherence to therapy in children

Abstract

Background

Current commonly accepted strategies to eradicate Helicobacter pylori in children are a 10-day sequential treatment or a triple therapy for 7-14 days. To avoid further expensive and possibly risky investigations as well as induction of secondary antimicrobial resistance, a success rate of elimination strategies over 90% in a per-protocol analysis is the target goal but rates observed in clinical trials are lower. Antimicrobial resistance is a well-recognized risk factor for treatment failure; therefore, only a treatment tailored to susceptibility testing should be recommended. Adherence to therapy is also a risk factor for treatment failure but that has been poorly studied. The purpose of this study was to evaluate the influence of adherence to therapy on the elimination rates obtained with different treatment regimens.

Methods

Cohort study analysis of children, aged 2-17 years, treated for Helicobacter pylori infection between October 2011 and December 2013. As a routine clinical practice, children infected with a strain susceptible to clarithromycin and to metronidazole received either a sequential regimen or a 10-day triple therapy while children infected with a strain resistant to clarithromycin or metronidazole received a 10-day triple regimen tailored to antimicrobial susceptibility. The eradication rate was assessed by a negative ¹³C-urea breath test performed at least 8 weeks after the end of the treatment and adherence evaluated using a diary.

Results

One hundred forty-five children (67 girls/78 boys, median age 9.7 years) fulfilled the inclusion criteria, 118 being infected with a strain susceptible to both clarithromycin and metronidazole, 10 with a clarithromycin resistant, and 17 with a metronidazole resistant strain. A sequential regimen was prescribed in 44, a triple therapy containing clarithromycin in 84 and containing metronidazole in 17. Follow-up data were available for 130/145 and clearance of the infection observed in 105 of them. A concordance of more than 90% between the prescribed and the ingested drugs was observed in 109 children, between 50 and 90% in eight, less than 50% in 11 while these data were unknown for 2/130. A successful eradication was achieved for 89.9% of patients that received at least 90% of the prescribed drugs, whereas the eradication rate for nonadherent patients was 36.6%. Adherence above 90% was significantly higher in the absence of chronic concomitant disease, in the absence of adverse event and results in a significantly higher eradication rate. With the proposed strategy and an adherence higher than 90%, eradication was obtained in 98/109 children, the rate being only significantly superior to 90% with the sequential regimen.

Conclusion

Adherence to therapy is a very important factor for the outcome and has to be assessed when evaluating the outcome of an H. pylori eradication regimen in order to understand the reasons of treatment failure. As we treated only after evaluation of the resistance of the H. Pylori strains, we were expecting to reach the given objective of 90% successful treatment. Children with adherence to treatment above 90% had a successful outcome of 89,9%, whereas nonadherent had a successful outcome of 36,8%. This is the first time that adherence has been assessed accurately.

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Cholesterotic fibrous histiocytoma with no associated dyslipidemia

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Hail, Glorious St Patrick Hail, glorious Saint Patrick, dear saint of our Isle, On us thy poor children bestow a sweet smile; And now thou art high in the mansions above, On Erin's green valleys look down in thy love. On Erin's green valleys, on Erin's green valleys, On Erin's green valleys look down in thy love. Hail, glorious Saint Patrick, thy words were once strong Against Satan's wiles and an infidel throng; Not less is thy might where in heaven thou art; O, come to our aid, in our battle take part. On Erin's green valleys, on Erin's green valleys, On Erin's green valleys look down in thy love. In the war against sin, in the fight for the faith, Dear saint, may thy children resist unto death; May their strength be in meekness, in penance, their prayer, Their banner the cross which they glory to bear. On Erin's green valleys, on Erin's green valleys, On Erin's green valleys look down in thy love. Thy people, now exiles on many a shore, Shall love and revere thee till time be no m

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

6948891480

alsfakia@gmail.com

Unhealthful Food-and-Beverage Advertising : Targeted Marketing, Vulnerable Groups, Dietary Intake, and Poor Health.

http://orlhealth.blogspot.com/2017/03/unhealthful-food-and-beverage.html

Abstract

Unhealthful food-and-beverage advertising often targets vulnerable groups. The extent of such advertising in subway stations has not been reported and it is not clear how ad placement may relate to subway ridership or community demographics, or what the implications might be for diets and diet-related health in surrounding communities. Riding all subway lines (n = 7) in the Bronx, NY, USA, investigators systematically assessed all print ads (n = 1586) in all stations (n = 68) in 2012. Data about subway ridership came from the Metropolitan Transportation Authority. Demographic data on surrounding residential areas came from the U.S. Census Bureau. Data on dietary intake and diet-related conditions came from a city health-department survey. There were no ads promoting "more-healthful" food-or-beverage items (i.e., fruits, vegetables, whole grains, nuts, water or milk). There were many ads for "less-healthful" items (e.g., candies, chips, sugary cereals, frozen pizzas, "energy" drinks, coffee confections, hard alcohol, and beer). Ad placement did not relate to the number of riders entering at stations. Instead, exposure to food-or-beverage ads generally, and to "less-healthful" ads particularly (specifically ads in Spanish, directed at youth, and/or featuring minorities), was directly correlated with poverty, lower high-school graduation rates, higher percentages of Hispanics, and/or higher percentages of children in surrounding residential areas. Correlations were robust to sensitivity analyses. Additional analyses suggested correlations between ad exposures and sugary-drink consumption, fruit-and-vegetable intake, and diabetes, hypertension, and high-cholesterol rates. Subway-station ads for "less-healthful" items were located disproportionately in areas home to vulnerable populations facing diet and diet-related-health challenges. The fact that uneven ad placement did not relate to total rider counts suggests ads were not directed at the largest possible audiences but rather targeted to specific groups.

KEYWORDS:

Advertising; Black-African American; Children; Diabetes; Diet-related diseases; Dyslipidemia; Food and Beverages; Fruits and vegetables; Hypertension; Latino/Hispanic; Nutrition; Obesity; Socio-economic status; Sugar-sweetened beverages; Vulnerable groups

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

6948891480

alsfakia@gmail.com

Presentation, workup, and management of penetrating transorbital and transnasal injuries: A case report and systematic review

http://ift.tt/2mVyoia

21st century rhinology

http://ift.tt/2nLhocd

Effect of doxycycline on epithelial-mesenchymal transition via the p38/Smad pathway in respiratory epithelial cells

http://ift.tt/2mVvE4g

Cigarette smoke extract increases vascular endothelial growth factor production via TLR4/ROS/MAPKs/NF-kappaB pathway in nasal fibroblast

http://ift.tt/2nLeBQm

Nitric oxide production is stimulated by bitter taste receptors ubiquitously expressed in the sinonasal cavity

http://ift.tt/2mVRDIz

Monoclonal antibody therapy in sinonasal disease

http://ift.tt/2nLlcu3

Normal saline solution nasal-pharyngeal irrigation improves chronic cough associated with allergic rhinitis

http://ift.tt/2mVtZvV

Respiratory viral detection in the paranasal sinuses of patients with cystic fibrosis

http://ift.tt/2nLxkuQ

Complete surgical resection and short-term survival in acute invasive fungal rhinosinusitis

http://ift.tt/2mVu0jt

Evolution of sinonasal symptoms and mucosal healing after minimally invasive pituitary surgery

http://ift.tt/2nLcYSE

The use of polydioxanone plates for endoscopic skull base repair

http://ift.tt/2mVvD0c

Excavating meningoencephaloceles: A newly recognized entity

http://ift.tt/2nLAUFc

Auditory Enhancement in Cochlear-Implant Users Under Simultaneous and Forward Masking

Abstract

Auditory enhancement is the phenomenon whereby the salience or detectability of a target sound within a masker is enhanced by the prior presentation of the masker alone. Enhancement has been demonstrated using both simultaneous and forward masking in normal-hearing listeners and may play an important role in auditory and speech perception within complex and time-varying acoustic environments. The few studies of enhancement in hearing-impaired listeners have reported reduced or absent enhancement effects under forward masking, suggesting a potentially peripheral locus of the effect. Here, auditory enhancement was measured in eight cochlear-implant (CI) users with direct stimulation. Masked thresholds were measured under simultaneous and forward masking as a function of the number of masking electrodes, and the electrode spacing between the maskers and the target. Evidence for auditory enhancement was obtained under simultaneous masking, qualitatively consistent with results from normal-hearing listeners. However, no significant enhancement was observed under forward masking, in contrast to earlier results with normal-hearing listeners. The results suggest that the normal effects of auditory enhancement are partially but not fully experienced by CI users. To the extent that the CI users' results differ from normal, it may be possible to apply signal processing to restore the missing aspects of enhancement.

http://ift.tt/2mV6Zgt

Identifying the Origin of Effects of Contralateral Noise on Transient Evoked Otoacoustic Emissions in Unanesthetized Mice

Abstract

Descending neural pathways in the mammalian auditory system are known to modulate the function of the peripheral auditory system. These pathways include the medial olivocochlear (MOC) efferent innervation to outer hair cells (OHCs) and the acoustic reflex pathways mediating middle ear muscle (MEM) contractions. Based on measurements in humans (Marks and Siegel, companion paper), we applied a sensitive method to attempt to differentiate MEM and MOC reflexes using contralateral acoustic stimulation in mice under different levels of anesthesia. Separation of these effects is based on the knowledge that OHC-generated transient evoked otoacoustic emissions (TEOAE) are delayed relative to the stimulus, and that the MOC reflex affects the emission through its innervation of OHC. In contrast, the MEM-mediated changes in middle ear reflectance alter both the stimulus (with a short delay) and the emission. Using this approach, time averages to transient stimuli were evaluated to determine if thresholds for a contralateral effect on the delayed emission, indicating potential MOC activation, could be observed in the absence of a change in the stimulus pressure. This outcome was not observed in the majority of cases. There were also no statistically significant differences between MEM and putative MOC thresholds, and variability was high for both thresholds regardless of anesthesia level. Since the two reflex pathways could not be differentiated on the basis of activation thresholds, it was concluded that the MEM reflex dominates changes in TEOAEs induced by contralateral noise. This result complicates the identification of purely MOC-induced changes on OAEs in mice unless the MEM reflex is inactivated surgically or pharmacologically.

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Office-based rhinologic surgery: A modern experience with operative techniques under local anesthetic

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Transseptal access with crossing multiple incisions for improved pedicle control and septum preservation: “How I do it”

http://ift.tt/2nLgCvE

Low 22-Item Sinonasal Outcome Test Scores in Chronic Rhinosinusitis: Why Do Patients Seek Treatment?

http://ift.tt/2nL9SOn

Systemtherapie prognostisch ungünstiger CUP-Syndrome

Zusammenfassung

Hintergrund

Beim CUP-Syndrom („cancer of unknown primary") handelt es sich um eine Tumorerkrankung, bei der eine Metastasierung klinisch und histologisch gesichert ist, aber trotz ausführlicher Diagnostik kein Primärtumor nachgewiesen werden kann. CUP-Syndrome machen etwa 2–3 % aller soliden Tumorerkrankungen aus. In den meisten Fällen zeigt sich histologisch ein Adenokarzinom oder ein undifferenziertes Karzinom.

Ergebnisse

An einem CUP-Syndrom erkrankte Patienten, die nicht lokal mit Operation oder Strahlentherapie behandelt werden können und deren Erkrankung nicht einer der definierten günstigen Untergruppen zuzuordnen ist, werden typsicherweise mit einer empirischen Chemotherapie behandelt, auch wenn die Evidenz hierfür aus klinischen Studien aufgrund der Heterogenität und Seltenheit des CUP-Syndroms begrenzt ist. Dabei scheint die Kombination eines der Platinpräparate Carboplatin oder Cisplatin mit einem Taxan wie Paclitaxel am effektivsten zu sein. Alternativ kommt auch eine Behandlung mit einem Platinpräparat zusammen mit Gemcitabin in Betracht. Dreifachkombinationen scheinen keine relevante Verbesserung der Prognose zu erreichen. Noch ist unklar, ob das Ansprechen auf die Chemotherapie durch die Hinzunahme eines Antikörpers verbessert werden kann. Zu dieser Fragestellung werden aktuell die Ergebnisse der deutschen PACET-CUP-Studie erwartet, die randomisiert die Hinzunahme des Antikörpers Cetuximab zu einer Chemotherapie mit Carboplatin und Paclitaxel untersucht. Da die Prognose dieser Patienten trotz empirischer Chemotherapie enttäuschend ist und die meisten Patienten binnen 2 Jahren versterben, werden große Hoffnungen in neue Substanzen gesetzt, die nach einer Mutationsanalyse des Tumorgewebes zielgerichtet eingesetzt werden können. Ein entsprechendes Studienkonzept wird aktuell erarbeitet.

Schlussfolgerung

Disseminierte CUP-Syndrome werden chemotherapeutisch behandelt. Dabei werden typischerweise Kombinationstherapien eines Platinpräparats mit Paclitaxel oder Gemcitabin eingesetzt. Zunehmend kommen auch zielgerichtete Substanzen auf der Grundlage von Mutationsanalysen des Tumorgewebes zum Einsatz.

http://ift.tt/2n4vWXi

Management of a Life Threatening Bleeding Following Extraction of Deciduous Second Molar Related to a Capillary Haemangioma

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1598102

Various forms of vascular lesion affect the head and neck region. The head and neck vascular lesions are classified into neoplasms and malformations. Neoplasm presents either as hemangioma or lymphangioma; neoplasm usually presents in young age compared with vascular malformation. A 9-year-old female patient presented to the outpatient clinic referred from the department of pedodontics after extraction of a right mandibular second deciduous molar. Extraction was done by dental GP in outpatient clinic. Massive bleeding followed the extraction. Bleeding was controlled by electrocoagulation of bleeding site and systemic and local application of antifibrinolytic agent. An intravenous line was placed to provide fluid replacement. Injection of intravenous cyklokapron was given to stabilize the blood clot. Selective embolization was performed 24 hours prior to surgical resection of lesion and the lesion was removed under general anesthesia followed by peripheral ostectomy of bone to remove any feeders. Different protocols are used to control life-threatening bleeding. Primary local measures such as Gelfoam packing, Tranexamic or Aminocaproic topical application, Surgicel application, Electrocautery, Bone wax, Ligation of External Carotid or Common Carotid Artery, or Selective Embolization of feeder vessel may be used to control the bleeding. Interventional radiographic blockage of feeder vessel currently shows high success rate in the management of life-threatening bleeding compared with previous techniques.
[...]

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

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Geburtshilfe: die Kunst der guten Anästhesie und Analgesie

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 166-167
DOI: 10.1055/s-0043-103395

Georg Thieme Verlag KG Stuttgart · New York

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DSL und DGS begrüßen Gesetz zur Verordnung von Cannabis als Medizin

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 163-163
DOI: 10.1055/s-0043-103360

Georg Thieme Verlag KG Stuttgart · New York

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Zwei Fragen zur Sepsis: Selen? Procalcitonin?

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 157-157
DOI: 10.1055/s-0043-103029

Georg Thieme Verlag KG Stuttgart · New York

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Geburtshilfe: Anästhesie bei fetaler Chirurgie

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 204-213
DOI: 10.1055/s-0042-105989

Die Fetalchirurgie stellt für den Anästhesisten eine herausfordernde operative Disziplin dar, da sowohl die schwangerschaftsbedingten Veränderungen der Mutter, die Physiologie des Feten sowie die komplexen chirurgischen Bedürfnisse beachtet werden müssen. Unter anderem sind neben der Erhaltung eines stabilen Perfusionsdruckes zugunsteneiner adäquaten plazentaren Versorgung des Feten, eine ausgeglichene Oxygenierung und Ventilation, ein konsequentes Temperaturregime sowie die Diagnostik und Therapie eines potentiellen mütterlichen Lungenödems Hauptaugenmerk des anästhesiologischen Managements in der Fetalchirurgie. Der Artikel erläutert die Grundlagen der Fetalchirurgie, anästhesierelevante hämodynamische und respiratorische Veränderungen während der Schwangerschaft sowie das anästhesiologische Procedere.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Ist eine lungenprotektive Beatmung auch im OP sinnvoll?

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 158-159
DOI: 10.1055/s-0043-103425

Georg Thieme Verlag KG Stuttgart · New York

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Anästhesie in der Gefäßchirurgie

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 164-164
DOI: 10.1055/s-0042-120960

Georg Thieme Verlag KG Stuttgart · New York

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Epidurale Kortikosteroide bei Schmerzen durch Bandscheibenvorfall?

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 159-160
DOI: 10.1055/s-0043-103424

Georg Thieme Verlag KG Stuttgart · New York

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Geburtshilfe: hypertensive Erkrankungen in der Schwangerschaft

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 184-195
DOI: 10.1055/s-0042-105990

Hypertensive Schwangerschaftserkrankungen sind eine der häufigsten Schwangerschaftskomplikationen und nach wie vor mit einer hohen Morbidität und Mortalität für Mutter und Kind verbunden. Obwohl 99 % aller mütterlichen Todesfälle in Entwicklungsländern auftreten, sterben auch in den Industrienationen nach wie vor Frauen an den Folgen hypertensiver Schwangerschaftserkrankungen. Diese umfassen die vorbestehende chronische Hypertonie sowie die in der Schwangerschaft neu auftretenden Pathologien wie schwangerschaftsinduzierte Hypertonie und Präeklampsie. Die physiologischen Veränderungen in der Schwangerschaft erschweren die frühzeitige Unterscheidung zwischen harmlosen Beschwerden und potenziell lebensbedrohlichen Zuständen. Nur durch interdisziplinäre Zusammenarbeit aller in der Geburtshilfe tätigen Fachpersonen kann eine adäquate Versorgung dieser Frauen sichergestellt werden. Der vorliegende Artikel stellt die Ausprägungsformen, Diagnostik und Therapie verständlich dar und diskutiert in diesem Zusammenhang die wichtigsten neuen Erkenntnisse zu hypertensiven Schwangerschaftserkrankungen.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Elektive Hüft-TEP: Reduziert Tranexamsäure den Blutverlust?

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 160-161
DOI: 10.1055/s-0043-103027

Georg Thieme Verlag KG Stuttgart · New York

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Kasuistik: Late-onset Small-Fiber-Neuropathie nach kritischer Erkrankung

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 220-226
DOI: 10.1055/s-0043-102813

Eine 43-jährige Patientin, mit Z. n. schwerer Sepsis und Entwicklung einer Critical-Illness-Myopathie/Polyneuropathie, stellt sich nach 5 Monaten mit einer akut aufgetretenen Allodynie/Hyperalgesie vor. Diese betrifft alle 4 Extremitäten distal, mit deutlicher Betonung im Versorgungsgebiet der Nn. ulnarii. Nach differenzialdiagnostischer Abklärung wird die Diagnose einer „Late-onset Small-Fiber-Neuropathie nach Critical Illness" gestellt. Small-Fiber-Neuropathien, bei kritischer Erkrankung und auch im Follow-up, einhergehend mit neuropathischen Beschwerden, konnten in einigen neueren Studien gezeigt werden. Pathophysiologisch ist am ehesten eine Dysfunktion der spannungsabhängigen Natriumkanäle, im Rahmen einer erhöhten Insulinresistenz während der kritischen Erkrankung, zu vermuten. Therapeutisch sind somit Kühlung, Carbamazepin/Oxcarbazepin, trizyklische Antidepressiva und serielle Injektionen mit Lokalanästhetika am ehesten zu empfehlen.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Mehrfachresistenter Acinetobacter baumannii häufig inadäquat behandelt

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 161-161
DOI: 10.1055/s-0043-103026

Georg Thieme Verlag KG Stuttgart · New York

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Ein Muss für alle Notfallmediziner

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 164-164
DOI: 10.1055/s-0042-104427

Georg Thieme Verlag KG Stuttgart · New York

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http://ift.tt/2m7Vund

Angriff der Antibiotika

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 162-162
DOI: 10.1055/s-0043-103355

Georg Thieme Verlag KG Stuttgart · New York

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Erforderliches Wissen kompakt vermittelt

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 165-165
DOI: 10.1055/s-0042-114762

Georg Thieme Verlag KG Stuttgart · New York

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Terrorgefahr: Mediziner fordern Tourniquets in Rettungswagen

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 162-162
DOI: 10.1055/s-0043-103357

Georg Thieme Verlag KG Stuttgart · New York

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Geburtshilfe: kombinierte Spinal-Epidural-Analgesie (CSE)

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 168-182
DOI: 10.1055/s-0042-105988

Die CSE verbindet einen schnellen Wirkeintritt mit suffizienter Analgesie infolge intrathekaler Applikation mit der Möglichkeit einer zeitlich unbegrenzten neuraxialen geburtshilflichen Schmerzlinderung über den liegenden EDK. Eine Überlegenheit der CSE über die EDA lässt sich vor allem aus dem schnellen Wirkeintritt, der exzellenten Analgesie, der fehlenden motorischen Blockade nach alleiniger intrathekaler Opioidgabe, der geringeren Rate an unilateralen Blockaden und der geringeren Notwendigkeit epiduraler Nachinjektionen ableiten. Häufigste Nebenwirkung ist Pruritus, welcher harmlos ist und in der Regel keiner therapeutischen Intervention bedarf. Auch wenn sich keine Auswirkungen auf Sectiorate und APGAR-Werte zeigen, muss die erhöhte Rate fetaler Bradykardien nach CSE beachtet werden. Die Reduktion dieser fetalen Bradykardien und auch die Prolongation der Analgesie nach intrathekaler Gabe durch geeignete Medikamentenkombinationen oder Additiva sollte Gegenstand zukünftiger Forschung sein.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Berufsbegleitende Weiterbildung zum Manager für klinische Notfall- und Akutmedizin

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 162-163
DOI: 10.1055/s-0043-103358

Georg Thieme Verlag KG Stuttgart · New York

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Geburtshilfe: die peripartale Kardiomyopathie

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 196-203
DOI: 10.1055/s-0042-101049

Die peripartale Kardiomyopathie (PPCM) ist eine idiopathische Herzinsuffizienz mit Auftreten gegen Ende der Schwangerschaft und in den Monaten postpartal. Andere Ursachen müssen ausgeschlossen sein. Der aktuelle Wissensstand zur PPCM wird anhand eines Mini-Literatur-Reviews aufgearbeitet. Besonderes Augenmerk gilt dem peripartalen anästhesiologischen Management sowie dem Fall einer akuten respiratorischen Insuffizienz nach erfolgter Sectio caesarea im Rahmen einer PPCM mit schwer reduzierter linksventrikulärer Funktion und linksführender kardialer Dekompensation.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Erforschung lebender Schäume für die Wundheilung

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 163-163
DOI: 10.1055/s-0043-100284

Georg Thieme Verlag KG Stuttgart · New York

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Geburtshilfe: Anästhesie bei EXIT-Prozedur

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 214-219
DOI: 10.1055/s-0042-105986

Die Ex-utero-Intrapartum-Treatment-(EXIT-)Prozedur wird im Rahmen einer erweiterten Sectio caesarea beispielsweise bei fetaler Atemwegsanomalie durchgeführt. Dazu ist die Aufrechterhaltung der uteroplazentaren Versorgung des Feten bei optimaler Uterusrelaxation erforderlich. Eine „balancierte" Anästhesie, Tokolyse und maternale arterielle Blutdruckeinstellung in engen Grenzen wird empfohlen. Das fetale Standardmonitoring umfasst dabei die Pulsoxymetrie und Echokardiografie. Es werden die physiologischen Besonderheiten und anästhesiologischen Ziele der EXIT-Prozedur und Möglichkeiten der Anästhesieführung dargestellt sowie ein Ausblick auf mögliche Neuerungen gegeben.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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An Analysis of New Approaches and Drug Formulations for Treatment of Chronic Low Back Pain

Publication date: Available online 14 March 2017
Source:Anesthesiology Clinics
Author(s): Karishma Patel Bhangare, Alan David Kaye, Nebojsa Nick Knezevic, Kenneth D. Candido, Richard D. Urman

Teaser

The prevalence of chronic low back pain (CLBP) is increasing. Treatment is effective in less than 50% of patients after 1 year. This review investigates new treatments for CLBP. An extensive literature focused on new treatments for CLBP. Their safety and efficacy were evaluated and are described in detail in this review. The investigation identified new treatments for CLBP including chemonucleolysis, platelet-rich plasma injections, artemin, tanezumab, and stem cells. Further research and innovation are needed to implement these methods into practice and assess clinical significance. The current evidence suggests that there are promising new agents for the treatment of CLBP.


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Revisiting Oxycodone Analgesia

Publication date: Available online 14 March 2017
Source:Anesthesiology Clinics
Author(s): Xiulu Ruan, Ken F. Mancuso, Alan David Kaye

Teaser

Oxycodone, a semisynthetic opioid analgesic, is widely used in clinical practice. Oxycodone and morphine seem to be equally effective and equipotent; however, morphine is 10 times more potent than oxycodone when given epidurally. This article provides an updated review of the basic pharmacology of oxycodone with a special focus on pharmacokinetic/pharmacodynamics properties. The controversy regarding oxycodone-mediated effects for visceral pain via agonism and the possible role of peripheral opioid analgesia are discussed in the present investigation in an attempt to propose a plausible explanation to the perplexing question of oxycodone analgesia.


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Pharmacology of Acetaminophen, Nonsteroidal Antiinflammatory Drugs, and Steroid Medications: Implications for Anesthesia or Unique Associated Risks

Publication date: Available online 14 March 2017
Source:Anesthesiology Clinics
Author(s): Kenneth D. Candido, Oscar J. Perozo, Nebojsa Nick Knezevic

Teaser

Acetaminophen, nonsteroidal antiinflammatory drugs (NSAIDs), and corticosteroids, historically used in perioperative management, are potent analgesic medications. They primarily inhibit the cyclooxygenase (COX) enzyme, decreasing the synthesis of prostaglandins, and modulating pain and temperature. Acetaminophen does not inhibit this synthesis at the inflammatory site. The primary mechanism of action of corticosteroids involves regulation of nuclear expression of genes involved in inflammatory pathways and other systemic effects. Metaanalyses have added purposeful perioperative indications, clarified misconceptions, and established protocols for administering these drugs. Some indications, doses, clinical considerations, and adverse effects need to be further studied.


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Auditory Enhancement in Cochlear-Implant Users Under Simultaneous and Forward Masking

Abstract

Auditory enhancement is the phenomenon whereby the salience or detectability of a target sound within a masker is enhanced by the prior presentation of the masker alone. Enhancement has been demonstrated using both simultaneous and forward masking in normal-hearing listeners and may play an important role in auditory and speech perception within complex and time-varying acoustic environments. The few studies of enhancement in hearing-impaired listeners have reported reduced or absent enhancement effects under forward masking, suggesting a potentially peripheral locus of the effect. Here, auditory enhancement was measured in eight cochlear-implant (CI) users with direct stimulation. Masked thresholds were measured under simultaneous and forward masking as a function of the number of masking electrodes, and the electrode spacing between the maskers and the target. Evidence for auditory enhancement was obtained under simultaneous masking, qualitatively consistent with results from normal-hearing listeners. However, no significant enhancement was observed under forward masking, in contrast to earlier results with normal-hearing listeners. The results suggest that the normal effects of auditory enhancement are partially but not fully experienced by CI users. To the extent that the CI users' results differ from normal, it may be possible to apply signal processing to restore the missing aspects of enhancement.

http://ift.tt/2mV6Zgt

Identifying the Origin of Effects of Contralateral Noise on Transient Evoked Otoacoustic Emissions in Unanesthetized Mice

Abstract

Descending neural pathways in the mammalian auditory system are known to modulate the function of the peripheral auditory system. These pathways include the medial olivocochlear (MOC) efferent innervation to outer hair cells (OHCs) and the acoustic reflex pathways mediating middle ear muscle (MEM) contractions. Based on measurements in humans (Marks and Siegel, companion paper), we applied a sensitive method to attempt to differentiate MEM and MOC reflexes using contralateral acoustic stimulation in mice under different levels of anesthesia. Separation of these effects is based on the knowledge that OHC-generated transient evoked otoacoustic emissions (TEOAE) are delayed relative to the stimulus, and that the MOC reflex affects the emission through its innervation of OHC. In contrast, the MEM-mediated changes in middle ear reflectance alter both the stimulus (with a short delay) and the emission. Using this approach, time averages to transient stimuli were evaluated to determine if thresholds for a contralateral effect on the delayed emission, indicating potential MOC activation, could be observed in the absence of a change in the stimulus pressure. This outcome was not observed in the majority of cases. There were also no statistically significant differences between MEM and putative MOC thresholds, and variability was high for both thresholds regardless of anesthesia level. Since the two reflex pathways could not be differentiated on the basis of activation thresholds, it was concluded that the MEM reflex dominates changes in TEOAEs induced by contralateral noise. This result complicates the identification of purely MOC-induced changes on OAEs in mice unless the MEM reflex is inactivated surgically or pharmacologically.

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Odontogenic orbital abscess: a case report and review of literature

Abstract

Odontogenic orbital abscess is a rare but well-documented complication of sinusitis and infections spreading from dental apical lesion. We report a case of orbital abscess with periorbital cellulitis, in a 35-year-old man with positive recent dental history of a periapical dental infection arising from the second upper left premolar spread into maxillary sinus. The patient has shown facial edema, ocular pain, ophthalmoplegia, proptosis, and initial visual symptoms. A surgical intervention to drain the abscess and a revision of the dental lesion and maxillary sinus were required. A review of literature is also reported focusing on etiology and treatment options dealing with odontogenic orbital abscess and cellulitis.

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Subcuticular Suture Technique: Alternative to Frost Suture to Prevent Ectropion After Transcutaneous Incision of Lower Eyelid

Abstract

Introduction

An ectropion is a complication that can arise from reconstruction in the infraorbital region. Often, this complication occurs despite proper positioning of the lower lid at the time of closure. Various transcutaneous approaches to orbit skeleton have investigated in view of complication arising from them. A subtarsal approach with a postoperative Frost suture gives an advantage to reduce the occurrence of ectropion especially after treatment of orbital floor fractures.

Material and methods

This case describes a method of subcuticular suturing technique for subtarsal incision of lower lid which can be used to support the lid during healing period, thus decreasing the rate of ectropion.

Conclusion

The technique described here is an alterative method for frost suturing with certain advantages.

http://ift.tt/2m7jU05

Comparison of Micromarsupialization and Modified Micromarsupialization for the Management of Mucocoele of Lower Lip: A Prospective Randomized Clinical Trial

Abstract

Background

This study was undertaken to compare micromarsupialization and modified micromarsupialization for the management of mucoceles.

Materials and Methods

A prospective randomized clinical study was done on thirty patients having mucocele on lower lip. In Group A (n = 15), micromarsupialization and in Group B (n = 15), modified micromarsupialization technique was used. The outcome variables were duration of surgery, intraoperative pain, postoperative pain, healing and recurrence. t test and p values were used to compare the age, duration of lesion, duration of treatment and time taken for healing. The results were expressed as mean with SD. Statistical significance was established at the p ≤ 0.05 level. Analysis of pain (intraoperative, on 3rd, 7th day), intraoperative bleeding and recurrence was done using Fischer's exact test (p = 0.875, NS).

Results

The average duration of treatment for Group A was 4.10 ± 0.39 min and for Group B was 5.33 ± 0.2 min. The difference was found to be statistically highly significant (p value ≤0.000). The observed power was 1.000. The difference in the intraoperative and postoperative pain on 3rd and 7th day was not found to be significant as per Fischer's exact test. The mean time taken for healing of the surgical site in Group A was 7.47 ± 0.64 days and in Group B was 9.87 ± 1.88 days, and the difference was found to be highly significant. The observed power was 0.995.

Conclusions

Modified micromarsupialization appears to be a safe technique for the management of mucoceles. However, in comparison with micromarsupialization, it has a higher operating and healing time.

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Incomplete partition type III: A rare and difficult cochlear implant surgical indication

Publication date: Available online 16 March 2017
Source:Auris Nasus Larynx
Author(s): Levent Sennaroğlu, Münir Demir Bajin
ObjectivePresenting the clinical features and treatment options for incomplete partition type-III.MethodsNine primary and 1 revision incomplete partition type-III cochlear implant cases treated between 2004 and 2015 in Hacettepe University Department of Otolaryngology were included in the study. Treatment options and particularly cochlear implantation tecnique were described.ResultsNine primary and 1 revison cases were all succesfully implanted. Eight cases were standart cases with no secondary intervention. Case #9 has to be revised intraoperatively and case #10 were operated four times in another center and revised in our department.ConclusionIncomplete partition type-III is one of the rarest inner ear anomaly and the rarest among incomplete partition group. Treatment options may differ depending on the hearing loss level of the patient. Stapes surgery should be avoided because it will lead to gusher and further hearing loss. Preoperative imaging is mandatory in order to avoid unnecessary stapes surgery. Incochlear implantation surgery a gusher and misplacement into the IAC may complicate the surgery. Gusher should be controlled intraoperatively and the position of the electrode should be controlled via intraoperative imaging.



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Multicolor immunofluorescence reveals that p63- and/or K5-positive progenitor cells contribute to normal breast epithelium and usual ductal hyperplasia but not to low-grade intraepithelial neoplasia of the breast

Abstract

We contend that knowledge about the cellular composition of normal breast epithelium is a prerequisite for understanding proliferative breast disease. Against this background, we used multicolor immunofluorescence to study normal breast epithelium and two types of intraepithelial proliferative breast lesion for expression of the p63, basal keratin K5, glandular keratin K8/18, SMA, ER-alpha, and Ki67. We studied eight normal breast epithelium samples, 12 cases of usual ductal hyperplasia, and 33 cases of low-grade intraepithelial neoplasia (9 flat epithelial atypia, 14 low-grade ductal carcinoma in situ and 10 cases of lobular neoplasia). Usual ductal hyperplasia showed striking similarity to normal luminal breast epithelium including p63+ and/or K5+ luminal progenitor cells and the full spectrum of luminal progeny cells. In normal breast epithelium and usual ductal hyperplasia, expression of ER-alpha was associated with lack of expression of the proliferation antigen Ki67. In contrast, we found in both types of low-grade intraepithelial neoplasia robust expression of keratin K8/18 and a positive association between ER-alpha and Ki67 expression. However, these lesions were consistently negative for p63 and/or K5. Our observational study supports the view that usual ductal hyperplasia and low-grade intraepithelial neoplasia are different entities rather than part of a spectrum of the same disease. We propose a new operational model of cell differentiation that may serve to better understand correlations between normal breast epithelium and proliferative breast diseases. From our data we conclude that p63+ and/or K5+ progenitor cells contribute to maintenance of normal epithelium and usual ductal hyperplasia, but not to low-grade intraepithelial neoplasia of the breast.

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The caries preventive effect of 1-year use of low-dose xylitol chewing gum. A randomized placebo-controlled clinical trial in high-caries-risk adults

Abstract

Objectives

The caries preventive effect of long-term use (1 year) of low-dosage (2.5 g/die) of xylitol chewing gum in a high-caries-risk adult population was evaluated.

Materials and methods

In this randomized clinical trial, 179 high-caries-risk adults were assigned to two experimental groups, xylitol and polyols. Caries status, salivary mutans streptococci (MS), and plaque pH were re-evaluated after 2 years from baseline in 66 xylitol and 64 polyol subjects. Outcomes (the net caries increment for initial, moderate, and extensive caries lesions and for the caries experience) were evaluated using the nonparametric Mann–Whitney U test.

Results

The total caries experience increment was 1.25 ± 1.26 in the xylitol group and 1.80 ± 2.33 in the polyol group (p = 0.01). Subjects treated with xylitol chewing gums had a reduction of risk rate at tooth level of 23% with respect to those treated with polyols with a number needed to treat of 55 teeth. The area under the curve at pH 5.7 was statistically significantly lower (p = 0.02) during the experimental period in the xylitol group. A decrease of the concentration of salivary MS was noted in the xylitol group (p < 0.01).

Conclusions

Subjects using the low-dose xylitol chewing gum showed a significantly lower increment of initial and extensive caries lesions and overall a lower increment of caries experience.

Clinical relevance

One-year use of chewing gums provides an effective means for the prevention of caries disease.

Trial registration number

NCT02310308

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Association between maternal exposure to tobacco, presence of TGFA gene, and the occurrence of oral clefts. A case control study

Abstract

Objective

To determine the association between maternal tobacco use or exposure, presence of variant transforming growth factor alpha (TGFA) gene, and the occurrence of oral clefts.

Methods

The present case control study was carried out for 5 months in three tertiary government hospitals in Chennai city with a sample of 100 children (50 children with non syndromic cleft and 50 control) aged 0–24 months. The details of maternal risk factors during the period of gestation were recorded from case and control parents through a pre-validated questionnaire, following which blood samples from 92 children (46 case and 46 controls) based on consent were obtained and evaluated for TGFA gene polymorphism.

Results

A significant number of case mothers (48%) were exposed to secondhand smoke during the period of gestation than their control counterparts (24%) (P = 0.01) with an odds ratio of 2.46 (95% CI = 0.99–6.08). Electrophoresis of the restriction fragment length polymorphism (RFLP) product revealed the presence of the homozygous C1C1 allele in all the tested 92 samples with no homozygous C2C2 allele or heterozygous C1C2 allele.

Conclusion

The present study has highlighted the role of passive smoking in the causation of non syndromic oral clefts in a developing country like India; however, the involvement of TGFA in causing the same disease in an ethnically Dravidian Indian population is uncertain.

Clinical significance

The study has brought into forth the role of passive smoking in the development of oral clefts thereby warranting an effective public health policy to tackle the same.

http://ift.tt/2mxqet3

Epidemiology of firearm and other noise exposures in the United States

Objective

Identify contemporary noise exposures and hearing protection use among adults.

Study Design

Cross-sectional analysis of national health survey.

Methods

Adult respondents in the 2014 National Health Interview Series hearing survey module were analyzed. Potentially harmful exposures to occupational and recreational noises in the past 12 months were extracted and quantified. Patterns of hearing protection use also were analyzed.

Results

Among 239.7 million adults, "loud" and "very loud" occupational noise exposures were reported by 5.3% and 21.7%, respectively. Of those exposed to "loud" or "very loud" sounds at work, only 18.7% and 43.6%, respectively, always used hearing protection. A total of 38.2% (1.9 million) of those with "very loud" occupational exposures never used hearing protection. Frequent (> 10/year) "loud" and "very loud" recreational noise exposures were reported by 13.9% and 21.1%, respectively, most commonly to lawn mowers (72.6% and 55.2%, respectively). When exposed to recreational "loud/very loud" noise, only 11.4% always used hearing protection, whereas 62.3% (6.3 million) never used any protection. Lifetime exposure to firearm noise was reported by 36.6% of adults, 11.5% of whom had used firearms in the prior 12 months. Of those, only 58.5% always used hearing protection, whereas 21.4% (7.4 million) never used hearing protection.

Conclusion

Substantial noise exposures with potentially serious long-term hearing health consequences frequently are occurring in occupational and recreational settings, and with the use of firearms. Only a minority of those exposed consistently are using hearing protection. Healthcare providers should actively identify and encourage the use of hearing protection with those patients at risk.

Level of Evidence

4. Laryngoscope, 2017

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Stellenwert der nasalen Provokation bei Hausstaubmilbenallergie

Zusammenfassung

Hausstaubmilbenallergiker zeigen häufig deutlich unterschiedliche Symptome gegenüber Patienten mit Allergien auf andere Inhalationsallergene. Das Vorkommen eines allergischen Asthmas ist deutlich erhöht. Die Diagnostik kann daher eine Herausforderung sein. Vor allem ist es wichtig, eine klinisch „stumme" Sensibilisierung von einer manifesten Allergie zu differenzieren. Die nasale Provokationstestung (NPT) ist eine geeignete Methode, Patienten zu selektieren, um sie einer kausalen Therapie (spezifische Immuntherapie) zuzuführen. Positionspapiere zur Methodik und Beurteilung der NPT sind verfügbar. Es zeigt sich zwar eine Korrelation der Provokationsergebnisse mit den gängigen Testverfahren (Pricktest, allergenspezifisches IgE), allerdings ist dies teilweise ungenau. Die Durchführung einer NPT bei Verdacht auf Vorliegen einer Hausstaubmilbenallergie ist bei Patienten mit fragwürdiger Anamnese bzw. unklaren Haut- und Bluttestergebnissen empfehlenswert, insbesondere vor Beginn einer Immuntherapie.

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Relationship between functional endoscopy and impedance–pH measurement

Abstract

Classic gastroenterological diagnostic tools have proven to be insufficient in identifying the causal relationship between extra-esophageal symptoms and presumed pathological reflux activity. Some new methodological approaches, such as functional endoscopy (video panendoscopy, VPE), are considered to be helpful. However, there are currently no data objectively verifying the success of this method. In a previous study, we found a good correlation between the reflux symptom index (RSI) according to Belafsky and endoscopic findings. Impedance–pH measurement is considered to be the gold standard in esophageal reflux disease diagnostics. Therefore, the relationship between endoscopic findings and the results of impedance–pH monitoring is now studied in patients with extra-esophageal reflux symptoms. The pathological findings of the VPE correlate with impedance–pH measurements regarding the parameters "number of reflux episodes," "fraction time," and "DeMeester score."

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Technische Entwicklungen bei Cochleaimplantaten

Zusammenfassung

Es ist gerade 20 Jahre her, da waren Cochleaimplantate (CI) ausschließlich bei nahezu oder komplett ertaubten Patienten indiziert. Während aus heutiger Sicht die Systeme damals klobig waren und nur eingeschränktes Sprachverstehen in halbwegs ruhigen Umgebungen boten, haben sich seitdem dank kontinuierlicher technischer Verbesserungen und folglich immer besser werdender Hörergebnisse mit diesen Systemen die Indikationskriterien stets in Richtung deutliche Resthörigkeit verschoben. Während die Weiterentwicklungen bei der Implantat- und Prozessorelektronik ein Schlüsselelement für die Verbesserung des Hörvermögens darstellen, hat die Entwicklung der elektrisch-akustischen CI-Systeme – zusammen mit dem Einsatz atraumatischer Implantationskonzepte – ebenfalls zu enormen Hörverbesserungen in der entsprechenden Patientengruppe mit tieftonalem Restgehör geführt. Speziell für diese Patientengruppe entwickelten Hersteller Prozessoren mit integrierten Hörgerätekomponenten, die sowohl die elektrische als auch die akustische Stimulation bewerkstelligen können. Ein weiterer Meilenstein zur Verbesserung des Hörens in schwierigen Hörsituationen waren die Übernahme von Signalvorverarbeitung zur Störgeräuschunterdrückung und die Verwendung von Zubehör zur verbesserten Audioübertragung aus der Hörgeräteindustrie. Der Artikel gibt eine Übersicht über den aktuellen Stand der Technik in den genannten Bereichen.

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Generalisierte zirkumskripte Sklerodermie mit Blasenbildung

Zusammenfassung

Bei der hier vorgestellten Patientin entwickelten sich nach über 20-jährigem Verlauf einer generalisierten zirkumskripten Sklerodermie gruppiert stehende Blasen in umschriebenen Bereichen der betroffenen Hautareale. Das Auftreten der subepidermal gelegenen Blasen ist bei allen klinischen Formen der zirkumskripten Sklerodermie beschrieben worden. Ätiologie und Pathogenese der Blasenbildung sind nicht geklärt. Favorisiert wird eine Obstruktion der Lymphbahnen infolge der eingetretenen Sklerose. Die Behandlung der bullösen zirkumskripten Sklerodermie gilt als schwierig. Mit wechselndem Erfolg wurden unter anderem Glukokortikoide, Methotrexat, Hydroxychloroquin und PUVA-Verfahren eingesetzt.

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Bullöses Sweet-Syndrom mit pulmonaler Beteiligung

Zusammenfassung

Die akute febrile neutrophile Dermatose (Sweet-Syndrom) ist eine seltene Dermatose, gekennzeichnet durch schmerzhafte Papeln und Plaques, bedingt durch kutane Infiltration mit neutrophilen Granulozyten. In seltenen Fällen kommt es zu ausgeprägter Blasenbildung. Wir berichten über einen Patienten mit Osteomyelofibrose, der Fieber und schmerzhafte, konfluierende Infiltrate an den Extremitäten entwickelte. Der Krankheitsverlauf war durch kutane Blasenbildung und Lungeninfiltrate erschwert. Nach Etablierung der Diagnose eines bullösen Sweet-Syndroms erfolgte die erfolgreiche Therapie mit systemischen Glukokortikoiden.

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Speckle Tracking Strain of the Right Ventricle: An Emerging Tool for Intraoperative Echocardiography.

No abstract available

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Inhaled Sedation in Patients With Acute Respiratory Distress Syndrome Undergoing Extracorporeal Membrane Oxygenation.

Six patients suffering from acute respiratory distress syndrome with the need for extracorporeal membrane oxygenation (ECMO) therapy in deep sedation were included. Isoflurane sedation with the AnaConDa system was initiated within 24 hours after initiation of ECMO therapy and resulted in a satisfactory sedation (Richmond Agitation-Sedation Scale -4 to -5). Despite deep sedation, spontaneous breathing was possible in 6 of 6 patients. We observed a reduced need for vasopressor therapy and improved lung function (PaO2, PaCO2, delta P, and tidal volume) during isoflurane sedation. Opioid consumption could be reduced, and only very low doses of isoflurane were needed (1 mL/h to 3 mL/h). This small case series supports the feasibility of sedation using inhaled anesthetics concurrently with venovenous ECMO. (C) 2017 International Anesthesia Research Society

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In the Beginning-There Is the Introduction-and Your Study Hypothesis.

Writing a manuscript for a medical journal is very akin to writing a newspaper article-albeit a scholarly one. Like any journalist, you have a story to tell. You need to tell your story in a way that is easy to follow and makes a compelling case to the reader. Although recommended since the beginning of the 20th century, the conventional Introduction-Methods-Results-And-Discussion (IMRAD) scientific reporting structure has only been the standard since the 1980s. The Introduction should be focused and succinct in communicating the significance, background, rationale, study aims or objectives, and the primary (and secondary, if appropriate) study hypotheses. Hypothesis testing involves posing both a null and an alternative hypothesis. The null hypothesis proposes that no difference or association exists on the outcome variable of interest between the interventions or groups being compared. The alternative hypothesis is the opposite of the null hypothesis and thus typically proposes that a difference in the population does exist between the groups being compared on the parameter of interest. Most investigators seek to reject the null hypothesis because of their expectation that the studied intervention does result in a difference between the study groups or that the association of interest does exist. Therefore, in most clinical and basic science studies and manuscripts, the alternative hypothesis is stated, not the null hypothesis. Also, in the Introduction, the alternative hypothesis is typically stated in the direction of interest, or the expected direction. However, when assessing the association of interest, researchers typically look in both directions (ie, favoring 1 group or the other) by conducting a 2-tailed statistical test because the true direction of the effect is typically not known, and either direction would be important to report. (C) 2017 International Anesthesia Research Society

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Effects of Sevoflurane on Hemodynamics and Inducible Nitric Oxide Synthase/Soluble Guanylate Cyclase Signaling Pathway in a Rat Model of Pulmonary Arterial Hypertension.

BACKGROUND: The effects of sevoflurane on right ventricular (RV) function are incompletely understood. In a rat model of experimentally induced pulmonary arterial hypertension (PAH), we studied effects of sevoflurane on RV function and the expression of inducible nitric oxide synthase/soluble guanylate cyclase (iNOS/sGC) signaling pathway. We hypothesized that sevoflurane would improve RV function in rats with PAH via a iNOS/sGC pathway. METHODS: To induce PAH, Sprague-Dawley rats were randomly assigned to treatment with monocrotaline or normal saline. Four weeks later, rats were then randomly assigned to either control or sevoflurane inhalation. After rats were anesthetized and instrumented with a pulmonary artery or RV conductance catheter, they were treated with inhaled sevoflurane at 3 doses for 90 minutes each. Hemodynamic changes and expression of iNOS and sGC were recorded. RESULTS: Sevoflurane inhalation depressed RV function in both normal and PAH rats. However, RV dP/dtmax fell to a lesser degree in rats with PAH than normal rats. Sevoflurane inhalation increased iNOS expression, but decreased sGC expression. CONCLUSIONS: Sevoflurane depressed RV contractility to a lesser degree in PAH than in normal rats. Sevoflurane also upregulated iNOS expression and downregulated sGC expression in PAH, but not control rats. This observation may explain the differential effects of sevoflurane on RV function in rats with and without PAH. (C) 2017 International Anesthesia Research Society

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In Response.

No abstract available

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Analgesia for Total Knee Arthroplasty: What Is the Best Option?.

No abstract available

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Trismus and Swelling on the Side of the Face

A woman presented with mild to moderate trismus and swelling on the left side of the face of a few months' duration; physical examination was remarkable for left-sided facial swelling, and no deficits of the facial or trigeminal nerves were detected. What is your diagnosis?

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Survival Outcomes in Oropharyngeal Small-Cell Carcinoma

This study uses SEER data to evaluate the survival outcomes of oropharyngeal small-cell carcinoma, compared with squamous cell carcinoma.

http://ift.tt/2myCUQZ

Traumatic Facial Injuries Among Elderly Nursing Home Residents

This population-based study estimates the incidence of facial trauma among elderly nursing home residents and details mechanisms of injury, injury characteristics, and patient demographic data.

http://ift.tt/2m5UT5f

Association of Body Mass Index in Head and Neck Reconstructive Surgery

This cohort study examines whether elevated body mass index is an independent risk factor for perioperative and postoperative infections after free tissue transfer in patients undergoing head and neck reconstructive surgery.

http://ift.tt/2myJzef

Demonstration of transoral robotic supraglottic laryngectomy and total laryngectomy in cadaveric specimens using the Medrobotics Flex System

ABSTRACT

Background

Current management of laryngeal malignancies is associated with significant morbidity. Application of minimally invasive transoral techniques may reduce the morbidity associated with traditional procedures. The purpose of this study was to present our investigation of the utility of a novel flexible robotic system for transoral supraglottic laryngectomy and total laryngectomy.

Methods

Transoral total laryngectomy and transoral supraglottic laryngectomy were performed in cadaveric specimens using the Flex Robotic System (Medrobotics, Raynham, MA).

Results

All procedures were completed successfully in the cadaveric models. The articulated endoscope allowed for access to the desired surgical site. Flexible instruments enabled an atraumatic approach and allowed for precise surgical technique.

Conclusion

Access to deep anatomic structures remains problematic using current minimally invasive robotic approaches. Improvements in visualization and access to the laryngopharyngeal complex offered by this system may improve surgical applications to the larynx. This study demonstrates the technical feasibility using the Flex Robotic System for transoral robotic supraglottic laryngectomy and total laryngectomy. © 2017 Wiley Periodicals, Inc. Head Neck, 2017

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Expression of AKR1B10 as an independent marker for poor prognosis in human oral squamous cell carcinoma

ABSTRACT

Background

Aldo-keto reductase family 1 member B10 (AKR1B10) is implicated in xenobiotic detoxification and has disparate functions in tumorigenesis that are dependent on the cell types. The purpose of this study was to investigate the clinicopathological significance of AKR1B10 as a prognostic marker for oral squamous cell carcinomas (OSCCs).

Methods

AKR1B10 protein expression was analyzed by immunohistochemistry in 77 patients with OSCC.

Results

The AKR1B10 labeling score for OSCCs (1.16 ± 1.14) was significantly higher than that for normal oral mucosa (0.10 ± 0.23; p < .0001). High expression of AKR1B10 significantly correlated with large tumor size (p = .041), advanced TNM classification (p = .037), and patient's areca quid chewing habit (p = .025). Multivariate analysis revealed that high AKR1B10 labeling score >1.16 (hazard ratio, 3.647; p = .001) significantly correlated with mortality.

Conclusion

AKR1B10 overexpression is an independent poor prognostic biomarker for OSCC. AKR1B10 inhibitors may be promising in clinical trials against OSCC. © 2017 Wiley Periodicals, Inc. Head Neck, 2017

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Effect of daily fraction size on laryngoesophageal dysfunction after chemoradiation for squamous cell carcinomas of the larynx and hypopharynx

ABSTRACT

Background

The purpose of this study was to determine the effect of fraction size on laryngoesophageal dysfunction among patients treated by chemoradiotherapy for laryngeal and hypopharyngeal cancer.

Methods

Forty patients underwent chemoradiotherapy for stage III/IV squamous cell carcinomas of the larynx and hypopharynx. Median radiation dose was 70 Gy (range, 69.3–70.4 Gy) with daily fractionation ranging from 2 Gy to 2.2 Gy.

Results

When comparing 2 Gy versus >2 Gy daily fractionation, there was no difference in 2-year overall survival (71% vs 72%; p = .68), locoregional control (79% vs 77%; p = .43), or laryngectomy-free survival (60% vs 61%; p = .72). Use of 2 Gy versus >2 Gy fractionation improved laryngoesophageal dysfunction-free survival (2-year estimates, 49% vs 27%; p = .07). Patient-reported voice and swallowing were improved with the former.

Conclusion

As the importance of a functional larynx becomes recognized as an endpoint for patients treated by voice preservation, the results of our study help refine treatment guidelines. © 2017 Wiley Periodicals, Inc. Head Neck, 2017

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Survival impact of induction chemotherapy in advanced head and neck cancer: A National Cancer Database analysis

ABSTRACT

Background

Adding induction chemotherapy to concurrent chemotherapy and radiotherapy (RT) has generally not improved the overall survival (OS) in randomized trials of patients with head and neck cancer. This failure may stem from inadequate power or inappropriate patient selection, prompting this National Cancer Data Base analysis.

Methods

8031 patients with T4 or N2b to N3 disease undergoing RT and chemotherapy were divided into induction chemotherapy and concurrent chemotherapy cohorts. Multivariate analysis was used to explore the association of treatment with survival and to identify predictors of radiation dose.

Results

On multivariate analysis incorporating sociodemographic and clinical variables, survival of the induction chemotherapy cohort was not significantly different from that of the concurrent cohort (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.88–1.05; p = .35), nor on subgroup analyses of advanced disease. Multivariate analysis demonstrated increased odds of receiving <66 Gy among the patients in the induction chemotherapy cohort (p < .01).

Conclusion

Induction chemotherapy subjects experienced no survival advantage over concurrent chemotherapy subjects but were more likely to receive lower RT doses. © 2017 Wiley Periodicals, Inc. Head Neck, 2017

http://ift.tt/2m5z1H8

Therapeutic challenge of a paediatric case of Graves' disease with severe ophthalmopathy

Description

An otherwise healthy girl aged 4 years was observed because of a 6-month history of tachycardia, polyphagia, chronic cough and agitation. Physical examination revealed hiperhydrosis, exuberant exophthalmia (figure 1) and a palpable, elastic and painless goitre. Laboratory work up showed an increased FT4, low thyroid-stimulating hormone (TSH) and positive thyrotropin receptor antibodies (TRABs) (figure 2), and thyroid ultrasonography demonstrated a diffusely heterogeneous, enlarged gland with no nodules, compatible with Graves' disease. The girl was initiated immediately to treatment with tiamazole (MTZ) and propranolol, and after few months, an euthyroid state was achieved and maintained until 2 years (figure 2). After this period, MTZ treatment was suspended and 1 month later, she returned with restless sleep and daytime agitation. Laboratory work up showed a TSH<0.005 μU/mL, T4L of 0.98 ng/mL and a positive TRABs and MTZ treatment (figure 2) was reintroduced.

http://ift.tt/2nwiMjE

Severe co-trimoxazole-induced hypoglycaemia in a patient with microscopic polyangiitis

A 69-year-old man presented to the emergency department with lower respiratory tract infection and febrile neutropaenia. He was recently discharged following a 50-day hospital stay with newly diagnosed microscopic polyangiitis, complicated by pulmonary haemorrhage and severe renal dysfunction requiring renal replacement therapy, plasma exchange and immunosuppression (cyclophosphamide and methylprednisolone). High risk of pneumocystis pneumonia (PCP) led to an escalation in treatment from prophylactic to therapeutic oral co-trimoxazole, alongside broad-spectrum antibiotics. The patient suffered from severe and protracted hypoglycaemia, complicated by a tonic–clonic seizure 7 days after escalation to therapeutic co-trimoxazole. Endogenous hyperinsulinaemia was confirmed and was attributed to co-trimoxazole use. Hypoglycaemia resolved 48 hours after discontinuation of co-trimoxazole. PCP testing on bronchoalveolar lavage was negative. Owing to the prescription of heavy immunosuppression in patients with vasculitis and the subsequent risk of PCP warranting co-trimoxazole prophylaxis, we believe that the risk of hypoglycaemia should be highlighted.

http://ift.tt/2m5AKMM

Unusual association of emphysematous cystitis and chronic alcoholism

Description

A Caucasian woman aged 65 years with a history of chronic alcoholism presented to the hospital with confusion. Abdominal examination revealed lower abdominal tenderness with no guarding or rigidity. Ethanol level was 378 mg/dL (<10 mg/dL: absent; >300 mg/dL: potentially fatal level) and blood counts in low normal range. Lactic acid was elevated to 3.6 mmol/L and urinalysis revealed pyuria, haematuria, 4+bacteria and positive leucocyte esterase. CT scan of the abdomen showed air within the bladder wall without urinary calculus or obstruction (figures 1 and 2). Patient's mental status improved with intravenous hydration and ertapenem. Urine culture showed heavy growth of levofloxacin-sensitive Escherichia coli and the antibiotic was narrowed down. Abdominal ultrasound scan performed after 14 days showed resolution of free air in bladder walls.

Figure 1

Sagittal CT image of the abdomen showing free air in bladder walls diagnosed as emphysematous cystitis.

...

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Amyand's hernia containing an appendiceal goblet cell carcinoid tumour

Amyand's hernia is a rare occurrence where the appendix is trapped within an inguinal hernia. Appendicitis within the hernia is even rarer. However, the presence of an appendiceal neoplasm in an inguinal hernia is almost unheard of with only two cases reported in the literature. We present an extremely rare case of an inflamed appendix within an Amyand's hernia, which was found to be a goblet cell type carcinoid tumour requiring further oncological resection and treatment.

http://ift.tt/2m5KUwT

Rhabdomyolysis-induced compartment syndrome secondary to atorvastatin and strenuous exercise

A 50-year-old male UK resident with a history of hypertension and hypercholesterolaemia presented to the emergency department with a 48-hour history of sudden onset bilateral thigh swelling and pain unrelieved by regular analgesia. 3 days prior to presentation, he performed a vigorous workout in the gym. His medications included ramipril 5 mg once daily and atorvastatin 20 mg at night time. He was a non-smoker and did not consume alcohol. He reported no known drug allergies. Physical examination confirmed bilateral swollen thighs, with no overlying skin changes, clinically suggestive of compartment syndrome. His creatine kinase was >50 000 IU with normal renal and liver function tests. Further investigation with MRI-identified prominent swelling of the vastus intermedius and medialis muscles, more marked on the left, with extensive diffuse short tau inversion recovery (STIR) signal hyperintensity and isointensity on T1 sequences, suggestive of rhabdomyolysis. He underwent bilateral fasciotomies of his thighs and aggressive intravenous fluid resuscitation with close monitoring of his electrolytes. Intraoperatively his muscle was healthy, with no evidence of haematoma or necrosis. His medication atorvastatin was stopped due to his rhabdomyolysis. 48 hours later, he returned to theatre and review of his fasciotomy wounds was unremarkable. 4 days later, he was discharged uneventfully. His postoperative recovery was complicated by a serous discharge from his left medial thigh wound. Further investigation with an ultrasound confirmed a 4x1x1cm multiloculated collection within the superficial tissue directly underlying the wound. An aspirate was performed and cultures revealed no growth. He remains under review in the department of plastic surgery. This case report discusses the aetiological spectrum, clinical presentation, pathophysiology, differential diagnosis, investigations, management and complications of rhabdomyolysis.

http://ift.tt/2mNpMso

Clear cell adenocarcinoma of cervix in 1-year-old girl without in utero exposure to diethylstilbestrol: an uncommon tumour at an uncommon age and site

Adenocarcinoma of cervix constitutes about 10–15% cases of carcinoma cervix. Clear cell variant is even a rarer variant of adenocarcinoma. It rarely occurs in the paediatric age group and a known risk factor is in utero exposure to diethylstilbestrol (DES). We report here a case of primary cervical tumour in a 1-year-old girl, which was initially suspected to be an embryonal rhabdomyosarcoma botryoides. Histopathology with immunohistochemical analysis revealed clear cell adenocarcinoma. There was no maternal history of DES intake during pregnancy. We discuss the histopathological characteristics and clinical course of this unusual tumour.

http://ift.tt/2m5AY6l

Vascular challenges from pancreatoduodenectomy in the setting of coeliac artery stenosis

Coeliac artery stenosis due to median arcuate ligament compression or atherosclerotic disease is a frequently unrecognised challenge to recovery after pancreatoduodenectomy. The described case illustrates management with intraoperative superior mesenteric artery to hepatic artery bypass graft that led to haemorrhagic challenges postoperatively but ultimately a good recovery. Aspects of preoperative diagnosis, preoperative intervention and intraoperative management options are reviewed. Surgeons need to possess these tools to prevent complications from coeliac artery stenosis when pancreatoduodenectomy is required.

http://ift.tt/2myqhFC

Analysis of the psychosocial impact of caretaking on the parents of an infant with severe congenital heart defect

This case report considers the psychosocial burden of caring for an infant with a severe congenital heart defect (CHD) on parents. Improved prenatal diagnostics and postnatal surgical intervention have created a new and increasing demographic of children and adults with CHDs that require lifelong medical care. For this reason, primary caregivers spend excessive amounts of time in hospitals and medical facilities, and must regularly decipher vast amounts of unfamiliar medical terminology and concepts with varying levels of assistance from medical personnel. This often leads to marked psychological morbidities in parental caregivers, such as stress, anxiety and depression. The financial cost of caring for infants with CHD, including loss of employment opportunities, is another important factor that impacts the quality of life of caregivers. Frequent and extended travel to seek specialised medical care, often at distant medical centres, represents an additional burden.

http://ift.tt/2m5AD3O

Diffuse large B-Cell lymphoma developing in erythrodermic cutaneous T-cell lymphoma: a case series

Abstract

Mycosis fungoides (MF) and its leukemic form, Sezary Syndrome (SS), are the most common forms of cutaneous T-cell lymphoma (CTCL). CTCL is associated with an increased risk of secondary cancers, including lymphomas.¹ Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin's lymphoma (NHL) in the western world and can involve both nodal and extranodal sites including the skin.² DLBCL is invariably associated with an aggressive course if left untreated.

This article is protected by copyright. All rights reserved.

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Cutaneous Adverse Drug Reactions Referrals to a Liaison Dermatology Service

Abstract

Adverse drug reactions (ADRs) are a common consequence of medications, with an estimated 10-20% of all hospitalised patients experiencing a drug side effect^1-2; those affecting the skin being the most frequently recorded. The need to optimise management of cutaneous ADRs has been underlined by the recent publication of NICE Guidelines on Drug Allergy³, setting out a range of standards to enhance the diagnosis and management of patients developing allergic reactions to drugs. This study was undertaken to assess the number of drug allergy referrals, and the types of cutaneous drug reaction encountered in the in-patient population.

This article is protected by copyright. All rights reserved.

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Interleukin-32 is highly expressed in lesions of hidradenitis suppurativa

Summary

Background

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease. Its immunopathogenic mechanisms are still poorly understood. Previous studies could demonstrate that the pro-inflammatory cytokine Interleukin-32 (IL-32) is implicated in the pathogenesis of other inflammatory diseases.

Objectives

The aim of our study was to investigate the tissue expression and systemic levels of IL-32 as well as its cellular sources in HS patients in comparison to healthy donors and to patients suffering from two other inflammatory skin diseases: psoriasis (PS) and atopic dermatitis (AD).

Methods

Tissue samples were obtained from healthy skin and lesional HS, PS and AD skin to analyse the expression of IL-32 by immunohistochemistry and semi-quantitative real-time PCR. The cellular source of the cytokine was determined by double immunofluorescence staining. Serum of the four donors groups was used to measure systemic levels of IL-32 by enzyme-linked immunosorbent assay (ELISA).

Results

IL-32 was upregulated in HS patients in both lesional skin and serum when compared to healthy donors or AD and PS patients. In HS, IL-32 was found to be expressed by NK cells, T cells, macrophages and dendritic cells in highly infiltrated areas of the dermis. High IL-32 mRNA levels in lesional HS skin coincided with high amounts of T cells and macrophages present. Additionally, IL-32 mRNA levels in lesional HS skin correlate positively with IFNγ and IL-17 and negatively with IL-13.

Conclusions

Our findings suggest that IL-32 is overexpressed in HS. Targeting IL-32 may therefore represent a new therapeutic option for the treatment of this recalcitrant disease.

This article is protected by copyright. All rights reserved.

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Response to “Frontal fibrosing alopecia in men—an association with facial moisturisers and sunscreen”

Abstract

We applaud Debroy-Kidambi et al for repeating their questionnaire study in male patients to determine possible environmental exposures that could be contributing to the increasing incidence of frontal fibrosing alopecia (FFA). In fact, in our own clinic we have noted that patients are often as interested in the possible causes of this condition as they are in available treatment methods. The discrepancy in facial moisturizer use between men with FFA compared to controls (94% versus 32%, p<0.0001) and the consistent use of primary sunscreens among FFA patients (35% versus 4%, p=0.0012) lends support to the hypothesis that a component of leave-on cosmetics may be contributing to the development of this condition.

This article is protected by copyright. All rights reserved.

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Cutaneous squamous cell carcinoma and the PARK2 gene

Abstract

We read with great interest the excellent review by Green and Olsen on the epidemiology of cutaneous squamous cell carcinoma of skin (cSCC). The authors reported that one of the genes found to be associated with SCC in GWAS studies is PARK2, and that its' function is unknown. Parkinson's disease (PD) literature may provide some insights to the contribution of PARK2 to skin cancers. PD patients are at higher risk than the general population for skin cancers.

This article is protected by copyright. All rights reserved.

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A Topical Treatment Optimisation Programme (TTOP) improves clinical outcome to calcipotriol/betamethasone gel in psoriasis: Results of the 64-week, multinational, randomized, phase IV study in 1790 patients (PSO-TOP)

Abstract

Background

Around two-thirds of psoriasis patients do not adhere to topical treatment. The 'Topical Treatment Optimisation Programme' (TTOP), a five-element tool, includes guidance for the conversation between dermatologists/nurses and patients, patient information material, telephone/email helpdesks and treatment reminders. It has been developed by patients and dermatologists to help increase adherence in psoriasis.

Objective

To compare TTOP with standard of care ('non-TTOP') within a large European investigator-initiated study, PSO-TOP (Clinicaltrials. gov NCT01587755).

Methods

Patients with mild to moderate psoriasis received calcipotriol/betamethasone dipropionate gel as standardized study medication and were randomized 1:1 to either TTOP or non-TTOP management. Study medication was applied once-daily for 8 weeks followed by 'as-needed' application for additional 56 weeks. A physicians' global assessment (PGA) of 'clear' or 'almost clear' was defined as response.

Results

In 1790 patients (full-analysis set), response rates after 8 weeks (primary objective) were significantly higher for TTOP (36.3%) than for non-TTOP (31.3%; P=0.0267). Better clinical outcome was accompanied by higher rates of patients feeling well informed about their skin condition and treatment and other factors related to adherence, but the dermatology life quality index (DLQI) was not statistically different. TTOP patients regarded the structured one-to-one conversations with their dermatologist/nurse as the most important element of TTOP.

Conclusions

Patients randomized to the TTOP intervention had a better clinical response than patients receiving standard of care. Improved communication between the healthcare provider and patient might be an important element in increasing adherence to topical therapy in psoriasis.

This article is protected by copyright. All rights reserved.

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Protruding Glistening Mass on the Posterior Surface of the Auricle

A man had a slow-growing mass on the posterior surface of the left auricle; histopathological examination revealed the tumor to be overall hypocellular and composed of bland spindle cells with no mitotic activity in a slightly basophilic myxoid matrix. What is your diagnosis?

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Shared Decision Making for Treatment of Sleep-Disordered Breathing

This Viewpoint assesses the use of grounded theory and thematic saturation to develop guidelines for best practices in the treatment of childhood sleep-disordered breathing.

http://ift.tt/2hlxsSP

Incorrectly Reported Data

In the Original Investigation titled "Navigation Guidance During Free Flap Mandibular Reconstruction: A Cadaveric Trial," published online November 17, 2016, errors in data reporting occurred in the Results section of the abstract and in the article itself. No P values should have been reported, and some confidence intervals were reported incorrectly. This article was corrected online.

http://ift.tt/2m5nnwc

USPSTF Recommendation for Obstructive Sleep Apnea Screening in Adults

The US Preventive Services Task Force (USPSTF) was created in 1984 as an independent, volunteer panel of national experts in prevention and evidence-based medicine. It works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services such as screenings, counseling services, and preventive medications. Any USPSTF recommendation on a clinical service is based on a review of existing peer-reviewed medical evidence, and the clinical service is then assigned a grade of A through D, where A recommends for and D against the service, or an "I statement" when evidence is insufficient or of too poor quality to assess the balance of benefits and harms. USPSTF recommendations do not consider the costs of a preventive service.

http://ift.tt/2jZwUTp

A Young Boy With Progressive Dysphonia

A young boy presented with dysphonia and laryngeal abnormalities; flexible laryngoscopy revealed 2 laryngeal lesions, and tracheobronchoscopy revealed a distal tracheal submucosal mass. What is your diagnosis?

http://ift.tt/2ikWvS6

Adenotonsillectomy for Children With Sleep-Disordered Breathing

In this study, parents of children with sleep-disordered breathing were interviewed to understand their care experiences and decision making for diagnosis and treatment of their children.

http://ift.tt/2mNeg06

Evidence-Based Perioperative Treatment After Free Tissue Reconstruction

The use of free tissue transfer (FTT) in the head and neck has made considerable strides since the first procedures were performed nearly 40 years ago. Free tissue transfer began as a risky and extremely time-consuming procedure, yet through improved instrumentation and accumulated experience, head and neck defects are now routinely treated with FTT. Furthermore, the expansion of indications for FTT has resulted in surgeons tackling cases of increasingly greater difficulty with regularity.

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Navigation Guidance During Free Flap Mandibular Reconstruction

This cadaver study compares surgical techniques to achieve mandible alignment in reconstructive surgery after mandibulectomy.

http://ift.tt/2hlBz1e

A Young Man With Enlarging Unilateral Tonsil Mass

A teenager had enlarged tonsils and recurrent tonsillitis, and one tonsil had a smooth, pedunculated, flesh-colored mass; histologic sections revealed a polypoid structure composed of a fibrovascular core covered by stratified squamous epithelium. What is your diagnosis?

http://ift.tt/2nJ1HCl

The Value of an Otolaryngology and Ophthalmology Emergency Department

This study surveyed patients of an ophthalmology- and otolaryngology-specific emergency department to assess the value of acute specialty care.

http://ift.tt/2h9kIv8

Appropriate Treatment of T3 Glottic Cancer

To the Editor We read the article "Surgical vs Nonsurgical Treatment Modalities for T3 Glottic Squamous Cell Carcinoma" by Al-Gilani et al and we congratulate the authors; however, some potentially misleading details may be found in their article.

http://ift.tt/2hcmNqI

Complications After Obstructive Sleep Apnea Upper Airway Surgery

This cohort study investigates association between the severity of obstructive sleep apnea and the number and anatomical sites of upper airway operations with operative complications.

http://ift.tt/2h9gkfF

March 2017 Issue Highlights

http://ift.tt/2m5vV66

An Ovine Model for Exclusive Endoscopic Ear Surgery

This experimental study describes the development and validation of an ex vivo animal model for exclusive endoscopic ear surgery.

http://ift.tt/2gHlPBP

Perioperative Care in Head and Neck Cancer Surgery

This systematic review examines optimal perioperative care in patients undergoing major head and neck cancer surgery with free flap reconstruction.

http://ift.tt/2m5sa0v

Adjuvant Chemotherapy in p16-Positive OPSCC

This cohort study compares survival between surgically managed patients with p16-positive oropharyngeal squamous cell carcinoma who received adjuvant chemoradiotherapy vs patients who received adjuvant radiotherapy alone.

http://ift.tt/2gHoefI

Recurrent Pneumonia in an Infant

A neonate had respiratory distress requiring endotracheal intubation; videofluoroscopic swallow study demonstrated aspiration with all consistencies, and she had Klebsiella pneumoniae sepsis and persistent lung collapse. What is your diagnosis?

http://ift.tt/2m5il2p

Parent’s Decision Making Regarding Adenotonsillectomy or Tympanostomy Tube Insertion

This cohort study describes the level of decisional conflict and decisional regret experienced by parents considering surgery for their children and determines relations among decisional conflict, decisional regret, and shared decision making.

http://ift.tt/2hlwRjN

A Young Man With Hypercalcemia

A young man had a significantly elevated calcium level, and imaging revealed a lesion in the location of the right inferior parathyroid gland and lytic bone lesions of the left mandibular ramus, left scapula, and C5 vertebra. What is your diagnosis?

http://ift.tt/2m5s74P

TORS, Site Detection, and Treatment in Carcinoma of Unknown Primary

This case series analyzes the role of transoral robotic surgery in facilitating the identification of a primary tumor site for patients presenting with squamous cell carcinoma of unknown primary.

http://ift.tt/2gHjQgC

Natural Course of Euthyroidism and Clues for Early Diagnosis of Thyroid Dysfunction: Tehran Thyroid Study

Thyroid , Vol. 0, No. 0.


http://ift.tt/2mxRKrc

Reaching complete or near complete resolution of psoriasis: benefit and risk considerations

Abstract

The incremental benefits of obtaining higher levels of skin clearance for patients with psoriasis have been established across several patient reported outcomes (PROs). Patients who obtain clear or almost clear skin are more likely to report no impact of psoriasis on health-related quality of life (HRQoL) and other symptom measures. While the benefits of obtaining higher skin clearance have been reported with different therapeutic agents, the question of whether the benefits of such high levels of response may be offset by an increased risk for adverse outcomes has not been fully explored with biologics.

This article is protected by copyright. All rights reserved.

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Beneficial effect of ustekinumab in familial pityriasis rubra pilaris with a new missense mutation in CARD14

Summary

Pityriasis rubra pilaris (PRP) represents a group of rare chronic inflammatory skin disorders in which ~1 in 20 affected individuals show autosomal dominant inheritance. In such cases, there may be gain-of-function mutations in CARD14, encoding caspase recruitment domain-containing protein 14 (CARD14) that activates the non-canonical nuclear factor-kappa B (NF-κB) pathway, thereby promoting cutaneous inflammation. Here, we report a mother and son with PRP due to a new missense mutation in CARD14 and describe the beneficial clinical effects of ustekinumab, a monoclonal antibody against interleukins-12 and -23, in both subjects. A 49 year-old female and her 20 year-old son had lifelong, generalised, patchy erythematous scale with a few islands of sparing, as well as minor nail ridging and mild palmoplantar keratoderma, features consistent with generalised PRP. Topical steroids, phototherapy and oral retinoids proved ineffective therapies. Following informed consent, Sanger sequencing of CARD14 in both individuals revealed a new heterozygous single nucleotide transversion in exon 16, c.356T>G, resulting in the missense mutation, p.Met119Arg. Ustekinumab, at a dose of 45mg every 12 weeks, brought about a significant physical and emotional improvement in both the mother and son within a few days of the initial dose, which was sustained on maintenance dosing. This report highlights the therapeutic potential of biologics that downregulate NF-kB signalling in familial PRP with mutations in CARD14.

This article is protected by copyright. All rights reserved.

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Case 8-2017: A 39-Year-Old Zimbabwean Man with a Severe Headache

Presentation of Case. Dr. A. Tariro Makadzange: A 39-year-old man was admitted to a large, urban tertiary-care hospital in Zimbabwe (where a physician affiliated with this hospital works) because of a severe headache. The patient had been in his usual health until approximately 1 month before…

http://ift.tt/2m4c3QE

Odontogenic orbital abscess: a case report and review of literature

Abstract

Odontogenic orbital abscess is a rare but well-documented complication of sinusitis and infections spreading from dental apical lesion. We report a case of orbital abscess with periorbital cellulitis, in a 35-year-old man with positive recent dental history of a periapical dental infection arising from the second upper left premolar spread into maxillary sinus. The patient has shown facial edema, ocular pain, ophthalmoplegia, proptosis, and initial visual symptoms. A surgical intervention to drain the abscess and a revision of the dental lesion and maxillary sinus were required. A review of literature is also reported focusing on etiology and treatment options dealing with odontogenic orbital abscess and cellulitis.

http://ift.tt/2nIJ7dr

PD-1 Knockout Engineered T Cells for Advanced Esophageal Cancer

Condition:   Esophageal Cancer
Interventions:   Drug: Cyclophosphamide;   Drug: Interleukin-2;   Other: PD-1 Knockout T Cells
Sponsor:   Hangzhou Cancer Hospital
Not yet recruiting - verified March 2017

http://ift.tt/2nvEaFI

Regional Anaesthesia and Substance P in Neck Cancer

Condition:   Oropharyngeal Cancer
Interventions:   Procedure: SPRANC Block group;   Procedure: SPRANC Control group
Sponsor:   Charite University, Berlin, Germany
Recruiting - verified March 2017

http://ift.tt/2mML35g

Migratory large vessel vasculitis preceding acute myeloid leukemia: a case report

Large vessel vasculitis is a rare disorder usually occurring in the context of the autoimmune conditions of giant cell arteritis and Takayasu's arteritis. Case reports have described large vessel vasculitis oc...

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Issue Information

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Ultrasonography findings of intradermal nodular fasciitis: a rare case report and review of the literature

http://ift.tt/2m48D0l

Improvement in moderate to severe vitiligo using a novel combination of 308 nm excimer laser and a surgical needling technique

Click here for the corresponding questions to this CME article.

http://ift.tt/2mMg2yu

Risk factors for cardiovascular disease in patients with hidradenitis suppurativa

Abstract

We read with great interest the article by Pascual et al., in which subclinical atherosclerosis in patients with hidradenitis suppurativa (HS) was assessed using carotid ultrasound. They found a higher prevalence of subclinical atherosclerosis in HS patients (30.7%) compared with controls (16.1%) and the association was significant in patients 40 years and older. Furthermore, traditional cardiovascular (CV) risk factors like hypertension (41.9%), diabetes mellitus (22.6%), and metabolic syndrome (38.7%) along with elevated systemic inflammatory markers including high-sensitivity C-reactive protein (Hs-CRP) (61.1%), erythrocyte sedimentation rate (ESR) (46.8%), and neutrophil-to-lymphocyte ratio (NLR) (59.7%) were more common in patients with HS (1).

This article is protected by copyright. All rights reserved.

http://ift.tt/2mwYF3V

Assessment of subclinical atherosclerosis in Hidradenitis Suppurativa. Reply to Dr Vinkel′s letter

Abstract

We read with great interest the letter by Vinkel et al., commenting on our published article "Assessment of subclinical atherosclerosis in hidradenitis suppurativa"¹.We reported that patients with hidradenitis suppurativa may have a higher prevalence of subclinical atherosclerosis, especially in patients 40 years and older. These findings may not be attributable exclusively to traditional risk factors alone. Vinkel et al., assessed the presence of traditional cardiovascular risk factors in Danish patients with HS.

This article is protected by copyright. All rights reserved.

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Acquired perforating dermatosis: clinicopathological study of 31 cases, emphasizing pathogenesis and treatment

Abstract

Background

Acquired perforating dermatosis (APD) is a rare group of skin disorders of unknown aetiology and pathogenesis, and is associated with several systemic diseases.

Objective

We review the clinicopathological features, associated systemic diseases, and treatment response in a series of APD patients.

Methods

We conducted a retrospective observational study of all patients histologically diagnosed with APD in Hospital San Jorge (Huesca, Spain) between 2002 and 2014. Demographic and clinical features were collected from medical records. Statistical analyses were carried out using SPSS software (version 20.0; IBM Corp, Armonk, NY).

Results

The study population consisted of 31 patients (19 women and 12 men), with a mean age of 54 years. Reactive perforating collagenosis (n=15, 45%) was the most common histopathologic type. The most frequently affected area was the lower limbs (66.6%, n=22) and pruritus was present in 19 patients (61.3%, p=0.005). Arterial hypertension (30.3%) was the most common associated condition. Five patients were receiving treatment with infliximab when diagnosed with APD. Most patients responded to topical steroids and oral antihistamines (n=15).

Limitations

This study is retrospective, and the sample size is limited.

Conclusion

APD is an underdiagnosed dermatosis frequently associated with systemic disorders. Its pathogenesis may involve vascular damage, not only in patients with diabetes, but also in those with arterial hypertension and chronic venous insufficiency. Control of pruritus and underlying extracutaneous disorders, as well as discontinuation of the treatment with biologics, are important aspects of the management of this dermatosis.

This article is protected by copyright. All rights reserved.

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Prevalence and incidence of hidradenitis suppurativa: An exercise on indirect estimation from psoriasis data

Abstract

while hidradenitis suppurativa (HS) is recently attracting much attention, uncertainty surrounds the actual extent of the occurrence of this disease. A comprehensive review of the epidemiology of HS¹ reported data ranging from <0.1%^2,3 to 8%⁴, allowing the Authors to conclude that the prevalence of HS may approach that of psoriasis¹. Starting from this statement, we compared occurrence data of HS with those of psoriasis in a large clinical data set collected in a dermatological reference center, to provide a "ballpark" estimate of prevalence and incidence of HS in Italy.

This article is protected by copyright. All rights reserved.

http://ift.tt/2mS1Ci8

Assessing finasteride-associated sexual dysfunction using the FAERS database

Abstract

Background

Post-marketing reports suggest that finasteride causes sexual dysfunction despite a low incidence reported in clinical trials. Therefore, the extent of risk remains unknown.

Objective

To determine whether the risk of sexual dysfunction is higher among individuals treated with finasteride compared to a baseline risk for all other drugs using the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) database.

Methods

A case by non-case disproportionality approach was used whereby a Reporting Odds Ratio (ROR) with 95% confidence interval (CI) was calculated. The National Ambulatory Medical Care Survey (NAMCS) was used to confirm results.

Results

A significant disproportionality in reporting of sexual dysfunction with the use of finasteride was observed whether finasteride was indicated for hair loss (ROR = 138.17, 95% CI: 133.13, 143.4), prostatic hyperplasia (ROR= 93.88, 95% CI: 84.62, 104.16) or any indication (ROR= 173.18, 95% CI: 171.08, 175.31). When these results were stratified by age, disproportionality was strongest at 31-45 years.

Conclusion

Use of finasteride has led to an increase in reports of sexual dysfunction where it is believed to be the primary suspect.

This article is protected by copyright. All rights reserved.

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Monilethrix in monozygotic twins with very rare mutation in KRT 86 gene

Abstract

Monilethrix is a heretitary disorder, characterized by abnormal hair shafts with nodes and narrow internodes [1], typically caused by autosomal dominant mutations in type II hair keratin genes KRT 81, KRT 83 and KRT 86 [2-8]. Rarely, autosomal recessive mutation in desmoglein 4 gene may be responsible for the disease [9,10]. Among affected family members, symptoms may vary from almost normal scalp to alopecia, moreover the severity of the disease may change during patient life.

This article is protected by copyright. All rights reserved.

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Chemoprävention – Was ist gesichert?

Zusammenfassung

Hintergrund

Durch Prävention kann das Risiko für viele maligne Tumoren günstig beeinflusst werden. Neben der Modifikation von Lebensstilfaktoren und der Teilnahme an Früherkennungsverfahren für bestimmte Krebserkrankungen stellt die Chemoprävention einen weiteren Ansatz dar.

Methode

Eine selektive Literaturrecherche wurde durchgeführt.

Ergebnisse

Unter Chemoprävention wird der Einsatz von natürlichen oder synthetischen Substanzen verstanden, die die Karzinogenese verhindern, verzögern oder umkehren können. Die meisten Daten liegen zur Chemoprävention von kolorektalen Adenomen und Karzinomen durch Acetylsalicylsäure (ASS) vor. Zahlreiche Studien belegen einen möglichen Nutzen in der Prävention des kolorektalen Karzinoms sowie des Rezidivs nach Abtragung von Adenomen.

Schlussfolgerung

Aufgrund des Nebenwirkungsprofils von ASS und des noch fehlenden Nachweises durch randomisierte kontrollierte Studien, dass ASS das Risiko, an einem kolorektalen Karzinom zu erkranken, senken kann, wird der primäre Einsatz von ASS zur Chemoprävention des kolorektalen Karzinoms aktuell nicht empfohlen. Auch für andere Tumorentitäten liegen bislang nicht ausreichend Daten vor, die eine Chemoprävention rechtfertigen würden.

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Psoriasis and increased drug utilization: a true burden of psoriasis or potential surveillance bias of comorbidities?

Linked Article: Dowlatshahi et al. Br J Dermatol 2017; 176:634–642.

http://ift.tt/2mwHTC1

Every dermatology consultation: think adherence

Linked Articles: Alinia et al. Br J Dermatol 2017; 176:759–764.

Thorneloe et al. Br J Dermatol 2017; 176:667–676

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Systems medicine and psoriasis

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Could maternal stress increase the risk of developing psoriasis in the offspring?

Linked Article: Liu et al. Br J Dermatol 2017; 176:659–666.

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