Treatment of Nevus lipomatosus cutaneous superficialis with CO2 laser

Summary

Nevus lipomatosus cutaneous superficialis (NLCS) is an uncommon lesion characterized by ectopic adipose tissue in the dermis and can be generalized or localized. It presents as a soft skin colored to yellowish papules or cerebriform plaques occurring usually on the buttock or thigh in a segment distribution. We report a case of NLCS in 38-year-old female, which was treated using the ultrapulse mode CO₂ Laser. We describe the scientific logic and clinical results of using the ultrapulse mode in relation to the pathology of NLCS.

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A Giant Cavernous Hemangioma of the Left Atrioventricular Groove

A 10-year-old Chinese female diagnosed with an asymptomatic giant cardiac cavernous hemangioma was reported. The patient originally tended to observation because this unusual cardiac tumoral mass was discovered incidentally during routine health examination of transthoracic echocardiography. Over 5 years of follow-up, the mass had enlarged obviously, and the patient visited our outpatient clinic and was prone to excision. Subsequently, a total resection surgery of the tumor was performed, and the tumor was found to be located on the left atrioventricular groove with complete packing membrane. The patient was discharged on postoperative day 4 and remains asymptomatic on last follow-up.

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Staphylococcus aureus colonization in atopic eczema and its association with filaggrin gene mutations

Abstract

Background

Atopic dermatitis (AD) is a prevalent disease with significant impact on physical health and quality of life. Staphylococcus aureus (S. aureus) has been directly correlated to disease severity, and may also be a contributing causal factor in the pathogenesis of AD. The primary aim of the present study was to assess differences in S. aureus colonization in AD patients with and without filaggrin gene (FLG) mutations. Secondarily, to assess disease severity in relation to S. aureus colonization. Exploratory analyses were performed to investigate S. aureus genetic lineages in relation to FLG mutations and disease severity (SCORAD).

Methods

101 adult AD patients were included in the study. Bacterial swabs were taken from lesional skin, non-lesional skin and nose. Swabs positive for S. aureus were characterized by spa and the respective clonal complex (CC) type assigned. Patients were characterized with respect to disease severity (SCORAD) and FLG mutations (n=88). Fischer's exact test was used to analyze differences in S. aureus colonization in relation to FLG mutations.

Results

Of the 101 patients included, 74 patients (73%) were colonized with S. aureus. Of the colonized patients, 70 patients (95%) carried only one CC type in all three different sampling sites. In lesional skin S. aureus was found in 24 patients with FLG mutations (n=31), versus 24 wild-type patients (n=54) (p=0.0004). S. aureus CC1 clonal lineage was more prevalent in patients with FLG mutations (n=10) than in wild-type patients (n=2) (p=0.003). No specific bacterial lineage was linked to disease severity.

Conclusion

Increased S. aureus colonization in AD patients with FLG mutations, and increased prevalence of CC1 in patients with FLG mutations, suggest that host-microbe interactions and clonal differences in S. aureus are important for colonization of AD skin.

This article is protected by copyright. All rights reserved.

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Response

Publication date: Available online 18 March 2017
Source:Auris Nasus Larynx
Author(s): Abdulvahap Akyigit, Turgut Karlidag




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Analysis of the dura involvement in cholesteatoma surgery

Publication date: Available online 19 March 2017
Source:Auris Nasus Larynx
Author(s): David Schwarz, Antoniu-Oreste Gostian, Sami Shabli, Philipp Wolber, Karl Bernd Hüttenbrink, Andreas Anagiotos
ObjectiveThe involvement of the dura is a rare yet potentially life-threatening complication during cholesteatoma surgery. Thus, the knowledge about treatment and consequences of this issue is of great importance to every ear surgeon.MethodsThis retrospective study analyzed the dura involvement with regard to the type of defect, reconstruction method used, and the post-operative complications of 1291 pediatric and adult cholesteatoma surgeries performed at an academic tertiary care center over a twelve-year period.ResultsFrom a total of 1291 cholesteatoma surgeries, we identified 84 patients (6.5%) with dura involvement intraoperatively, most of them adult patients. The majority of the reported cases were bony defects and exposed dura without CSF leakage (79.73%, 67 out of 84). In 14.28% of the cases (12 out of 84) a meningo(encephalo)cele or dura defect with liquorrhea were detected. In 30 surgeries (35.7%, 30 out of 84) no reconstruction of the lateral skull base was considered necessary. The most common material used for reconstruction was conchal cartilage (25.0%, 21 out of 84), followed by polydioxanone (PDS)-foil (11.9%, 10 out of 84), bone pâté (9.5%, 8 out of 84) and a combination of materials (17.9%, 15 out of 84). Revision surgery of the reconstruction was necessary in 16.7% (14 out of 84) of the cases. Long-term evaluation (mean of 19.3 months) showed no complication related to the skull base defect.ConclusionDuring cholesteatoma surgery, bony and dura defects can be managed effectively, with good long-term reliability. No intracranial or mastoidal complications are expected.



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Analysis of the dura involvement in cholesteatoma surgery

The involvement of the dura is a rare yet potentially life-threatening complication during cholesteatoma surgery. Thus, the knowledge about treatment and consequences of this issue is of great importance to every ear surgeon.

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Evaluation of oral manifestations of patients with mucopolysaccharidosis IV and VI: clinical and imaging study

Abstract

Objective

The aim of this study is to assess oral manifestations in patients with mucopolysaccharidosis IV (MPS IVA) and mucopolysaccharidosis VI (MPS VI).

Materials and methods

Seventeen patients were assessed, nine with MPS IVA and eight with MPS VI, treated at the Medical Genetics Outpatient Clinic of Hospital Universitário Alcides Carneiro (HUAC) in Campina Grande, Paraíba State, Brazil. Assessments included clinical and intraoral examinations, analysis of occlusal function, and panoramic X-rays.

Results

Among all, 64.7% of the patients had unerupted teeth and 52.9% of them had enamel hypoplasia. Regarding the temporomandibular joint, 88.2% of the patients showed flattening of the mandibular condyle, 52.9% showed condylar hypoplasia, and all of them showed decreased mobility. Enamel hypoplasia was observed only in patients with MPS IVA (p < 0.05). On the other hand, only MPS VI patients presented with anterior open bite, restricted mouth opening (p < 0.05), and a higher rate of unerupted teeth, hyperplastic tooth follicle, and condylar defects (p < 0.05).

Conclusions

Enamel hypoplasia was observed only in patients with MPS IVA, whereas anterior open bite was observed only in patients with MPS VI. Abnormal findings in the maxillomandibular complex were more frequent in patients with MPS VI.

Clinical relevance

The relevant frequency of MPS VI and IVA in the sample allows us to compare the changes occurring in both groups of patients, therefore enabling us to further comprehend the oral manifestations in specific types of MPS.

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Community Acquired Rhinovirus Infection Is Associated With Changes in the Airway Microbiome

Publication date: Available online 19 March 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Kirsten M. Kloepfer, Vishal K. Sarsani, Valeriy Poroyko, Wai Ming Lee, Tressa E. Pappas, Theresa Kang, Kristine A. Grindle, Yury A. Bochkov, Sarath Chandra Janga, Robert F. Lemanske, James E. Gern

Teaser

In school-age children with asthma, RV infection changes the upper airway microbiome and these changes are associated with symptom severity and viral load.


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Training Groups

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Editorial Board

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Anterior open bite correction by Le Fort I osteotomy with or without anterior segmentation: which is more stable?

Publication date: Available online 18 March 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): I.N. Ismail, Y.Y. Leung
A retrospective cohort study was conducted to analyze the relapse rate of anterior open bite (AOB) correction comparing Le Fort I osteotomy with and without anterior segmentation. The risk factors that might contribute to relapse were also assessed. Lateral cephalograms obtained at six different times were analyzed. A total of 81 patients with AOB were recruited. Thirty-five patients underwent Le Fort I osteotomy without anterior segmentation and 46 patients underwent anterior segmentation. Le Fort I osteotomy with anterior segmentation resulted in significantly more AOB relapse when compared to that without anterior segmentation at 7 weeks postoperative (15.2% vs. 0%, P=0.016). During the early postoperative period, factors that contributed to AOB relapse in Le Fort I osteotomy with anterior segmentation were AOB closure ≥4mm and inferior positioning of the anterior segment >2mm. Over the long term, AOB closure ≥4mm and intraoral vertical ramus osteotomy as the only mandibular procedure were factors identified as causing more AOB relapse in those treated by Le Fort I osteotomy with anterior segmentation. In conclusion, Le Fort I osteotomy without anterior segmentation was found to be more stable in the surgical correction of AOB in the early and late postoperative periods.



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Roles of alternatively activated M2 macrophages in allergic contact dermatitis

Publication date: Available online 18 March 2017
Source:Allergology International
Author(s): Kotaro Suzuki, Kazuyuki Meguro, Daiki Nakagomi, Hiroshi Nakajima
Alternatively activated macrophages (M2 macrophages) play key roles in the suppression of Th1 cell responses and the orchestration of tissue repair. However, recent studies have shown that M2 macrophages have potentials to produce high levels of proinflammatory cytokines such as IL-1β, IL-6, and TNF-α, suggesting that M2 macrophages may exacerbate inflammation in some settings. In this regard, we have recently shown that large numbers of M2 macrophages accumulate in the sites of hapten-induced contact hypersensitivity (CHS), an animal model of allergic contact dermatitis, and that M2 macrophages exacerbate hapten-induced CHS by producing matrix metalloproteinase 12 (MMP12). We have also shown that suppressor of cytokine signaling-3 (SOCS3), a member of SOCS family proteins that are cytokine-inducible negative regulators of the JAK/STAT signaling pathways, is highly and preferentially expressed in M2 macrophages in hapten-induced CHS and that SOCS3 expressed in M2 macrophages is involved in the attenuation of CHS by suppressing MMP12 production. These findings underscore the importance of M2 macrophage-derived MMP12 in the development of CHS, and suggest that inhibition of M2 macrophages or MMP12 could be a potential therapeutic strategy for the treatment of allergic contact dermatitis.



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Response

In this study, we report the results of inlay myringoplasty operations with endoscopic butterfly technique in pediatric patients [1]. The external auditory canal of pediatric patients was examined endoscopically before the operation and was evaluated whether the canal was wide enough for the operation of the endoscope and the surgical tool. Then, endoscopic butterfly myringoplasty was applied to the patients with an operable external auditory canal. The patients with a clear view of perforation edges on endoscopic tympanum examination were included in the study.

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Increase of circulating α4β7+ conventional memory CD4 and regulatory T cells in patients with common variable immunodeficiency (CVID)

Publication date: Available online 18 March 2017
Source:Clinical Immunology
Author(s): Karina Mescouto de Melo, Susanne Unger, Baerbel Keller, Sylvia Gutenberger, Ina Stumpf, Sigune Goldacker, Klaus Warnatz
This study investigated whether circulating α4β7⁺ expressing T cells could serve as a potential marker for gastrointestinal (GI) disease activity in patients with CVID. The analysis of α4β7⁺ T cells in the peripheral blood of 36 patients and 22 healthy donors (HD) revealed increased percentages of α4β7⁺ conventional memory CD4 T cells and Tregs, but not among CD8 T-cell populations in patients with CVID compared to HD. No differences between patients with and without chronic or acute GI symptoms were observed. EUROClass smB− and 21lo patients, had higher percentages of α4β7⁺ memory CD4 T cells compared to HD and smB+ or 21norm patients, respectively. In summary, the detection of α4β7⁺ T cells in the peripheral blood did not correlate with active or chronic gastrointestinal disease. The increase of these cells in smB− and 21lo patients adds another piece to the immune dysregulation observed in these patients.



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The Great Impostor: Transaminitis Masking the Coinfection of Syphilis and Human Immunodeficiency Virus

Introduction. The incidence of syphilis continues to rise in the United States over the past 15 years. This disease process is classified into stages and may present with a coinfection of Human Immunodeficiency Virus (HIV). Case Report. We present a case of a 32-year-old African American male who presented with cutaneous manifestations of secondary syphilis and transaminitis. A workup revealed that the transaminitis was secondary to underlying syphilitic hepatitis in the presence of HIV coinfection. The patient had a reactive rapid plasma reagin (RPR) of 1 : 64 TU and reactive Treponema pallidum particle agglutination assay (TPPA). Lab findings showed alkaline phosphate (ALP) of 648 unit/L, aspartate aminotransferase (AST) of 251 unit/L, and alanine aminotransferase (ALT) of 409 unit/L. Conclusion. Syphilitic hepatitis is a recognized entity in the medical literature. It is a manifestation of secondary syphilis and it is more commonly seen in coinfected patients with both syphilis and HIV. Therefore, primary care physicians should keep infectious etiologies (e.g., syphilis and HIV) in the differential diagnosis of patients who present with unexplained liver dysfunction in a cholestatic pattern.

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Perioperative Anaphylaxis to Chlorhexidine during Surgery and Septoplasty

Chlorhexidine is an antiseptic and disinfectant used in surgical and clinical practice since 1954 and is available in aqueous or alcoholic solutions 0.5%–4.0% and has a broad-spectrum activity. Despite their widespread use, allergic reactions with chlorhexidine are rarely reported. We describe a case of anaphylaxis with chlorhexidine during a septoplasty, turbinectomy, and maxillary sinusectomy. The patient presented with periorbital edema, hives, hypotension, and wheezing. Immediately after the diagnosis of anaphylaxis promethazine, hydrocortisone, and epinephrine were administered with immediate clinical improvement. This case highlights the importance of assessing whether there is a previous clinical history of hypersensitivity to chlorhexidine in patients who will undergo surgical procedures.

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Ophthalmic outcomes of fractured zygomas

In patients with fractures of the zygomatic complex, computed tomography (CT) often identifies extensive defects in the orbital floor. Some surgeons recommend routine exploration and repair of these defects during repair of the zygoma, while others advocate a more selective approach, but there is a paucity of evidence either way. We report a retrospective case series of 50 patients who had open reduction and internal fixation of zygomatic fractures by a single surgeon in the maxillofacial department at the John Radcliffe Hospital, Oxford, between 2011and 2014.

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Effectiveness of binaural beats in reducing preoperative dental anxiety

Binaural beats are an auditory illusion perceived when two different pure-tone sine waves are presented one to each ear at a steady intensity and frequency. We evaluated their effectiveness in reducing preoperative anxiety in dentistry. Sixty patients (30 in each group) who were to have impacted third molars removed were studied (experimental group: 20 women and 10 men, mean (range) age 24 (18-35) years, and control group: 22 women and 8 men, mean (range) age 28 (15-47) years). All patients were fully informed about the operation preoperatively, and their anxiety recorded on a visual analogue scale (VAS).

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Corrigendum to “Comparison of cardiovascular responses after injection of lidocaine with either clonidine or adrenaline: a two-year comparative analysis” [Br J Oral Maxillofac Surg 55 (2017) 67–70]

The authors regret that on p. 67 the second paragraph was given in error as follows:"It has been hypothesised that the amount of lidocaine absorbed after local dental anaesthesia is less than the amount produced endogenously in response to pain that results from inadequate anaesthesia or anxiety associated with the procedure.​2"

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Patients’ experience in the early recovery phase after removal of intraoral squamous cell carcinoma with carbon dioxide laser

Laser excision of oral cancer is well established. The aim of this cross-sectional survey was to ask patients about their main symptoms and the severity of them during the first postoperative weeks. We devised a short questionnaire in collaboration with patients, and did a cross-sectional survey of 50 consecutive patients who had laser excision of T1 and T2 oral cancers over a two-year period. The response rate was 76% (38/50). Twenty patients reported that eating was "quite a bit" or "very much of a problem" and 13 reported similar for pain.

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Re: Argument for the conservative management of mandibular ameloblastomas

We read with great interest the recent paper by Haq et al1 and congratulate them for sharing their work on this controversial topic.

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Pembrolizumab for metastatic melanoma in a renal allograft recipient with subsequent graft rejection and treatment response failure: a case report

Transplant patients were excluded from the pivotal phase III trials of checkpoint inhibitors in metastatic melanoma. The efficacy and toxicity profiles of checkpoint inhibitors in this cohort of patients are n...

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New concepts of personalized therapy in salivary gland carcinomas

During embryonal development, the primitive oropharynx epithelia form tubules which differentiate to adenoid tissues of salivary glands and lungs. Despite this similar ontogenetic origin, both tissues have different vulnerability to carcinogenic factors and may give rise to different adenoid cancer types. Most lung cancers can be grouped into neuroendocrine/small cell, adenocarcinomas and squamous carcinomas and the major risk factor is smoking. In contrast to lung cancer (smoking) but also in contrast to oral squamous carcinomas (smoking, alcohol, human papilloma virus), salivary gland carcinomas have no such common risk factors [1,2].

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Ambulatory surgery for primary hyperparathyroidism: A 67-case series

Publication date: Available online 18 March 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): D. Culié, B. Pescetto, O. Dassonville, N. Guevara, D. Benisvy, J. Santini
IntroductionSurgery for primary hyperparathyroidism, targeted by ultrasound and scintigraphy, satisfies the theoretical criteria allowing ambulatory surgery. The purpose of this study was to validate this strategy on a homogeneous case series assessed by this imaging strategy.Material and methodsAll patients operated for primary hyperparathyroidism by ambulatory surgery from 01/01/13 to 30/04/15 were included in this retrospective study. The usual endpoints of ambulatory surgery were evaluated.ResultsA total of 144 patients were operated for primary hyperparathyroidism during the study period. Ambulatory surgery was possible in 67 patients, who all had a preoperative diagnosis of parathyroid adenoma. All patients were assessed by ultrasound and 66 patients were assessed by sestamibi scintigraphy, resulting in targeted unilateral neck surgery in 98.5% of cases. Two patients had to be hospitalised overnight due to minor complications.ConclusionSurgery for primary hyperparathyroidism can be performed with short operating times in carefully selected patients with a low complication rate, thereby allowing ambulatory surgery.



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Kimura's disease of the orbit: A modern diagnostic challenge

Publication date: Available online 18 March 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): P. Clarós, V. Fokouo, F. Nyada, A. Clarós




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Nephrogenic systemic fibrosis: A 15-year retrospective study at a single tertiary care center

Despite multiple therapeutic approaches for nephrogenic systemic fibrosis (NSF), no single treatment has convincingly shown consistent benefit. The most successful outcomes have been associated with recovery of renal function, although evidence remains limited and past studies have been inconclusive.

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Updated recommendations on the use of hydroxychloroquine in dermatologic practice

Hydroxychloroquine has unique immunomodulatory properties and an attractive adverse effect profile. Over the past 10 years, research has led to significant updates in clinical recommendations concerning the optimal use of hydroxychloroquine and monitoring of patients taking it. We discuss updated recommendations concerning hydroxychloroquine daily dosing, retinopathy screening, serologic monitoring, use in smokers, use in pregnant women, and adverse effect risk and monitoring. This review can hopefully serve as an aid to dermatologists and help ensure they continue using hydroxychloroquine safely and effectively.

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Predicting neurofibromatosis type 1 risk among children with isolated café-au-lait macules

Although isolated cafe-au-lait macules (CALMs) are a common skin finding, they are an early feature of neurofibromatosis type 1 (NF1).

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