Retroperitoneal ectopic thyroid tissue
Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480
Τρίτη 21 Μαρτίου 2017
Abdominal CT scan showed a well-delineated, low-density area that exhibited heterogeneous contrast enhancement. The area measured about 20 mm in size and was to the left of the aorta at the level of the inferior mesenteric artery. MRI showed a mass with heterogeneous hypointensity on T1-weighted images and heterogeneous hyperintensity on T2-weighted images. PET-CT scan showed slightly increased 18F-fluorodeoxyglucose accumulation within the mass. : Retroperitoneal ectopic thyroid tissue
Facial Analysis to Classify Difficult Intubation
Condition: Difficult Intubation
Intervention: Other: photographing head and neck
Sponsor: Wake Forest University Health Sciences
Recruiting - verified March 2017
http://ift.tt/2nQA7DP
Intervention: Other: photographing head and neck
Sponsor: Wake Forest University Health Sciences
Recruiting - verified March 2017
http://ift.tt/2nQA7DP
Clinicians' Views on Management and Terminology for Papillary Thyroid Microcarcinoma: A Qualitative Study
http://ift.tt/2nbRalJ
Bone formation of demineralized human dentin block graft with different demineralization time: in vitro and in vivo study
To evaluate structural and physicochemical characteristics of demineralized human dentin block with increasing demineralization time and to assess new bone formation when onlay grafted at different demineralization times in rat calvaria.
http://ift.tt/2mr5DeR
Maxillofacial growth and speech outcome after one-stage or two-stage palatoplasty in unilateral cleft lip and palate. A systematic review
The number of surgical procedures to repair a cleft palate may play a role in the outcome for maxillofacial growth and speech. The aim of this systematic review was to investigate the relationship between the number of surgical procedures performed to repair the cleft palate and maxillofacial growth, speech and fistula formation in non-syndromic patients with unilateral cleft lip and palate.
http://ift.tt/2mSVa7V
Current thinking about the management of dysfunction of the temporomandibular joint: a review
Increasingly the management of TMJ pathology is becoming a subspecialist interest. The number of patients having TMJ joint replacement had steadily increased over the last decade and there is now NICE guidance on this matter. Whilst the evidence of the management of TMJ disease is limited and there are few randomised controlled trials, the incidence of TMJ pathology has not changed and there is a requirement for guidance on the management. Whilst previously patients with TMJ pain were managed surgically, this is changing, and the vast bulk of initial management is non-surgical/medical.
http://ift.tt/2o2yYIO
Corrigendum to “malignant transformation of keratocystic odontogenic tumor: Two case reports” [American journal of otolaryngology 34 (2013) 357–361]
The author Sok Yan Tay was incorrectly listed as Tay Sok Yan in the original publication of the article. The correct name is Sok Yan Tay as reproduced above.
http://ift.tt/2nzrHUh
Volumetric analysis of the maxillary, sphenoid and frontal sinuses: A comparative computerized tomography based study
To study volume characteristics of the maxillary, sphenoid and frontal sinuses among healthy Caucasians adults, using computed tomography (CT) scans.
http://ift.tt/2nz82DP
Prevention of respiratory complications of the surgical patient: actionable plan for continued process improvement.
http://ift.tt/2mqwozU
Codeine and opioid metabolism: implications and alternatives for pediatric pain management.
Purpose of review: Use of perioperative opioids for surgical pain management of children presents clinical challenges because of concerns of serious adverse effects including life-threatening respiratory depression. This is especially true for children with history of obstructive sleep apnea. This review will explore current knowledge of clinically relevant factors and genetic polymorphisms that affect opioid metabolism and postoperative outcomes in children. Recent findings: Within the past several years, an increasing number of case reports have illustrated clinically important respiratory depression, anoxic brain injuries and even death among children receiving appropriate weight-based dosages of codeine and other opioids for analgesia at home setting particularly following tonsillectomy. Several national and international organizations have issued advisories on use of codeine in pediatrics, based on cytochrome P450 family 2 subfamily D type 6 (CYP2D6) pharmacogenetics. We have discussed the pros and cons of alternatives to codeine for pain management. Summary: Although routine preoperative genotyping to identify children at risk and personalized opioid use for pediatric perioperative pain management is still a distant reality, current known implications of CYP2D6 pharmacogenetics on codeine use shows that pharmacogenetics has the potential to guide anesthesia providers on perioperative opioid selection and dosing to maximize efficacy and safety. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2mSp1xj
http://ift.tt/2mSp1xj
Safety interventions on the labor and delivery unit.
http://ift.tt/2mqLNQO
Clinical 'pearls' of maternal critical care Part 2: sickle-cell disease in pregnancy.
http://ift.tt/2mSqkMP
Perioperative management of patients with renal cell carcinoma with high level of IVC tumor thrombus invasion revisited
We have read with great interest the recent report regarding the perioperative management and outcomes of 8 patients with renal cell carcinoma with level IV inferior vena cava (IVC) tumor thrombus extension [1]. The authors should be commended for their clinical skills in addressing this challenging and complex problem. However, we would like to draw the authors' and readers' attention to several points of great importance, both clinical and academic.
http://ift.tt/2nb57QY
Perioperative strokes after coronary artery bypass grafting with staged carotid endarterectomy: A nationwide perspective
To examine the risk of perioperative stroke on in-hospital morbidity and mortality in staged coronary artery bypass grafting (CABG) and carotid endarterectomy (CEA) procedures.
http://ift.tt/2mSbkhK
A Self-Retaining Lingual Flap Guarding Device During Surgical Removal of Impacted Mandibular Third Molar
Abstract
Introduction
Lingual nerve damage is one of the common complications following mandibular third molar surgery. On considering the impact of lingual nerve damage on the patient's quality of life, it is necessary to exercise caution to minimize its occurrence.
Material and methods
Although many lingual retractors are available, in this article we describe an indigenously designed lingual retractor for use in mandibular third molar surgery.
Conclusion
The indigenous lingual retractor described in this article provides advantages like clear access and excellent retention unlike conventional retractors.
http://ift.tt/2mNhNKj
Epigenetics in the pathogenesis of RA
Abstract
Epigenetic modifications can stably alter gene expression and have been shown to be important in the maintenance of cell type-specific functions as well as in cell differentiation, e.g., in T and B cell maturation. In RA, alterations in DNA methylation, histone modifications, and microRNA expression have been found in immune as well as in stromal cells. These changes in the epigenome in RA patients influence key inflammatory and matrix-degrading pathways and are suspected to play a major role in the pathogenesis of RA. In this manuscript, we explain the basic mechanisms of epigenetics, review studies that analyzed epigenetic changes in RA, and assess their potential as therapeutic targets.
http://ift.tt/2nyeKK8
Identification and characterization of a β-defensin gene involved in the immune defense response of channel catfish, Ictalurus punctatus
Source:Molecular Immunology, Volume 85
Author(s): Jieyao Zhu, Hong Wang, Jun Wang, Xingli Wang, Shuang Peng, Yi Geng, Kaiyu Wang, Pin Ouyang, Zhiqiong Li, Xiaoli Huang, Defang Chen
Antimicrobial peptides are small peptides that play important roles in a host's innate immune response. As an important antimicrobial peptide, β-defensin widely distribute in mammals, insects and plants with broad-spectrum antimicrobial activity. In this study, the β-defensin gene of the channel catfish, Ictalurus punctatus, was cloned, sequenced, and subjected to a bioinformatic analysis. The β-defensin gene of the channel catfish contains three exons and two introns, and encodes a precursor peptide consisting of two domains: a signal peptide of 24 amino acid residues and a mature peptide of 43 amino acid residues. The mature peptide is estimated to have a molecular mass of 7.1kDa and a theoretical isoelectric point of 8.21. Channel catfish β-defensin (ccBD) has six conserved cysteine residues, forming three disulfide bridges at C1–C5, C2–C4, and C3–C6, and a β-sheet in the predicted three-dimensional structure. A phylogenetic analysis suggests that ccBD belongs to the type 1 β-defensins. Real-time quantitative PCR showed that channel catfish β-defensin transcripts are constitutively expressed in various tissues in healthy fish, with highest expression in the skin. The expression of ccBD in vivo increased significantly in the head kidney (2.9-fold), gill (2.2-fold), and skin (6.6-fold) at 48h after bacterial (Edwardsiella ictaluri) challenge. In vitro, lipopolysaccharide (LPS), a bacterial mimic, induced significant changes in ccBD expression in leukocytes from the spleen (3.4-fold) and head kidney (3.9-fold) 24h after stimulation. Chemically synthesized ccBD displayed marked inhibitory activity against a broad range of bacteria. These results suggest that ccBD is involved in the innate antibacterial defenses of the channel catfish.
http://ift.tt/2ny6eeu
Porcine parvovirus induces activation of NF-κB signaling pathways in PK-15 cells mediated by toll-like receptors
Source:Molecular Immunology, Volume 85
Author(s): Liyan Cao, Jianfei Chen, Yanwu Wei, Hongyan Shi, Xin Zhang, Jing Yuan, Da Shi, Jianbo Liu, Xiangdong Zhu, Xin Wang, Shangjin Cui, Li Feng
Porcine parvovirus (PPV) is a pathogenic factor that primarily induces severe reproductive failure of pregnant swine, which results in extensive losses to the swine industry worldwide. In this study, a potential mechanism of PPV-induced activation of the nuclear transcription factor-kappaB (NF-κB) by infection in porcine kidney cells (PK-15) was elucidated for the first time. The subcellular localization of p65 analyzed by immunofluorescence assay (IFA) showed that PPV infection induced p65 translocation from the cytoplasm to the nucleus. p65 phosphorylation was detected in PK-15 cells with progression of PPV infection. NF-κB-regulated gene expression was enhanced in a viral dose-dependent manner using the NF-κB luciferase reporter assay system. Furthermore, PPV-induced NF-κB activation was closely related to the inhibitory kappa B alpha (IκBα) degradation. Treatment with a NF-κB-specific inhibitor demonstrated that the production of PPV progeny viruses was enhanced to some extent. In addition, these results demonstrated that the adapter molecule TIR domain-containing adapter inducing IFN-β (TRIF) and myeloid differentiation primary-response protein 88 (MyD88)-dependent signaling pathways were involved in PPV-induced NF-κB activation. Together, these results provide evidence that the toll-like receptor (TLR) pathway participates in recognition of PPV and induction of NF-κB activation, and add to understanding of the molecular mechanisms underlying PPV infection.
http://ift.tt/2o1sl9w
Trametinib in Combination With Paclitaxel in the Treatment of Anaplastic Thyroid Cancer
Condition: Anaplastic Thyroid Cancer
Interventions: Drug: Trametinib; Drug: Paclitaxel
Sponsors: Memorial Sloan Kettering Cancer Center; Novartis
Recruiting - verified March 2017
http://ift.tt/2o1rINc
Interventions: Drug: Trametinib; Drug: Paclitaxel
Sponsors: Memorial Sloan Kettering Cancer Center; Novartis
Recruiting - verified March 2017
http://ift.tt/2o1rINc
Targeting PD-1 Therapy Resistance With Focused High or High and Low Dose Radiation in SCCHN
Condition: Head and Neck Cancer
Interventions: Drug: Pembrolizumab; Radiation: Radiation
Sponsors: Dana-Farber Cancer Institute; Merck Sharp & Dohme Corp.
Not yet recruiting - verified March 2017
http://ift.tt/2njJkad
Interventions: Drug: Pembrolizumab; Radiation: Radiation
Sponsors: Dana-Farber Cancer Institute; Merck Sharp & Dohme Corp.
Not yet recruiting - verified March 2017
http://ift.tt/2njJkad
Thyroid incidentalomas on 18FDG-PET/CT: a metabolico-pathological correlation
Thyroid incidentaloma is defined as an unsuspected thyroid lesion found on imaging study or while performing a surgery non-related to the thyroid gland. Most recent scientific literature tends to demonstrate a...
http://ift.tt/2nOW0DL
Corrigendum to “malignant transformation of keratocystic odontogenic tumor: Two case reports” [American journal of otolaryngology 34 (2013) 357–361]
Source:American Journal of Otolaryngology
Author(s): Bernard Tan, Sok Yan Tay, Lee Shermin, Kwa Chong Teck, Poon Choy Yoke, Christopher Goh, Abhilash Balakrishnan
http://ift.tt/2mpBTPk
Giant right ventricle secondary to severe pulmonary hypertension
Description
A man aged 64 years presented to emergency department with chest pain and shortness of breath. On cardiac auscultation, he had loud P2 and parasternal heave; however, lung auscultation was normal. Bilateral lower limb pitting oedema was present. CBC, CMP and cardiac biomarkers were normal. D-dimer and CT chest were performed and it excluded pulmonary embolism. His EKG was suggestive of right ventricular strain. He was being treated for systemic and pulmonary hypertension, taking carvedilol 3.125 mg two times per day, furosemide 40 mg once daily, sildenafil 20 mg three times a day, treprostinil 0.5 mg two times per day, amlodipine 2.5 mg two times per day, atorvastatin 40 mg once daily, aspirin 81 mg once daily and clopidogrel 75 mg once daily. Trans-thoracic echocardiography showed his systolic function was normal, his estimated ejection fraction was 60–65% with markedly dilated right ventricle (RV), no valve defect was detected and peak pulmonary artery pressure (Ppa) was 80 mm Hg....
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Misdiagnosing Whipple's disease in the young
Whipple's disease is considered an infection of middle-aged white men of European ancestry. Cases are rare and disproportionately associated with occupational exposure to soil or animals. We report the case of a man aged 22 years with no risk factors, erroneously diagnosed with, and treated for, toxoplasmosis on the basis of consistent lymph node histology. The correct diagnosis was delayed by the dramatic symptomatic improvement resulting from this therapy. Whipple's disease should be considered in cases of granulomatous lymphadenopathy of unknown cause, even if the age of the patient does not fit the classic presentation of the disease.
http://ift.tt/2mpAJn4
Near death by milk of magnesia
We report a case of hypermagnesemia associated with the use of milk of magnesia in a male patient with end-stage renal disease. After experiencing nausea and vomiting, he developed severe bradycardia and then asystole. Resuscitation efforts were successful; however, he developed atrial fibrillation with severe widening of the QRS and diffuse ST elevation, hypothermia, hypotension and apnoea requiring intubation. Initial diagnoses included ST-elevation myocardial infarction, cardiogenic and/or septic shock and hyperkalaemia. However, serum magnesium was later found to be >4.1 mmol/L (equivalent to >10 mg/dL). He underwent haemodialysis (HD) to remove serum magnesium with remarkable overall improvement. Severe hypermagnesemia can manifest with severe bradycardia and asystole, shock, hypothermia and respiratory failure and can mimic acute coronary syndromes complicated with cardiogenic shock or septic shock. Therefore, clinicians should be aware of this life-threatening condition in patients with significant renal dysfunction. Timely treatment with HD is highly effective and lifesaving.
http://ift.tt/2mR5Q76
Carcinosarcoma of the bladder following local schistosomiasis infection
A young patient from central Africa presented acute renal insufficiency due to extrinsic compression of the distal ureters by a pelvic mass. After initial medical management, a biopsy revealed poorly differentiated bladder cancer and Schistosoma haematobium eggs embedded in the bladder wall. The initial workup showed evidence of locoregional disease. Radical cystectomy with an incontinent urinary diversion was performed with no complications. Carcinosarcoma of the bladder was diagnosed by pathological analysis of the surgical specimen. After a short follow-up, the patient was readmitted presenting with lung and bone metastases. At 60 days after diagnosis, he died of respiratory insufficiency caused by pulmonary metastatic disease.
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Face presentation in delivery room: what is strategy?
Description
A few hours after birth, a newborn was admitted to Santobono-Pausilipon III level Hospital. Suspected eye injury was reported. During childbirth, the baby showed a face presentation and to help with the delivery, a vacuum extractor (VE) method was used. Body weight of the baby at the time of birth was 3200 g, length 50 cm and head circumference 35 cm. Apgar scores were 7I and 8V. The newborn was subjected to examinations by an ophthalmologist and a neurologist and tested by a CT. The ophthalmological examination of the right eye revealed an extensive conjunctiva haemorrhage, dioptric media was transparent, anterior chamber was normal, optical disc had defined margins and retinal haemorrhages were absent. A neurological examination reported extensive haematoma of the right half-face and excoriations of the right eyelid (figure 1A, B). Bregmatic fontanelle was normotensive, archaic reflexes were present and symmetrical. CT scan results confirmed the...
http://ift.tt/2mR86v5
Amiodarone-induced interstitial pneumonitis
Description
A man aged 62 years presented with shortness of breath (SOB) for 1 week. He has a history of non-ischaemic cardiomyopathy, diabetes mellitus and atrial fibrillation (AF). ECG revealed AF with rapid ventricular rate and chest X-ray was consistent with pulmonary congestion. He was treated with furosemide and electrically cardioverted for AF. The patient was started on amiodarone 400 mg once daily for maintenance of sinus rhythm. Eight months later, he presented with gradual onset SOB and dry cough. SOB did not improve with diuresis (13 L negative) empiric broad-spectrum antibiotics and mechanical ventilation. Blood cultures for bacteria did not reveal any growth. Urine antigen for legionella was negative, sputum cultures did not show any bacterial growth and PCR testing for Influenza A and B, H1N1, Adenovirus, Respiratory Syncitial Virus, Human Metapneumo Virus, Parainfluenza Virus were negative. The patient underwent flexible bronchoscopy and the mucosa of the visualised airway was...
http://ift.tt/2mpCv7w
Air everywhere: colon perforation after colonoscopy
Colonoscopy is being widely used since the 1980s and is the leading diagnostic procedure for colorectal cancer. For many colorectal diseases, it is also a therapeutic tool. Like many other procedures in Medicine, it has its drawbacks and complications, some of which if not readily diagnosed can represent a serious risk to the patient's health and well-being. We describe a case of colon perforation during diagnostic colonoscopy in a patient, resulting in exuberant pneumoretroperitoneum, pneumoperitoneum, pneumomediastinum and subcutaneous emphysema, who successfully underwent laparoscopic colonic resection with primary anastomosis. There are only a few cases of combined intraperitoneal and retroperitoneal perforations described in the literature.
http://ift.tt/2mRciee
Gas in the superior mesenteric artery
Description
A woman aged 83 years with mediastinal tumour was admitted to our hospital with 2 days of abdominal pain. She had reduced consciousness and abdominal tenderness with peritoneal signs. Vital signs, physical examination and laboratory findings indicated sepsis and disseminated intravascular coagulation (DIC) with pan-peritonitis. Contrast-enhanced CT showed lack of enhancement in the intestinal and caecal wall, with intramural gas (figure 1A), portal venous gas (figure 1B) and gas in the superior mesenteric artery (SMA) (figure 1C). Diffuse intestinal necrosis with SMA occlusion was diagnosed. SMA thromboembolism was suspected and Trousseau's syndrome cannot be ruled out as the exacerbation factor. We performed bowel resection and anastomosis; portions of the small intestine, caecum and ascending colon were resected (figure 2). A total of 375 cm were resected, leaving 160 cm of the intestine. She recovered from sepsis and DIC and resumed feeding on...
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Herniation of a urinary bladder diverticulum: diagnosis and management of a fluctuating inguinal mass
Inguinal herniation of a bladder diverticulum is a rare finding. The diagnosis should be suspected if the size of hernia is variable on urination. These patients may also experience obstructive voiding symptoms. Various imaging modalities may clarify the diagnosis. In our patient, intravenous urography precisely showed a bladder diverticulum in the right inguinal area. The patient underwent open simple prostatectomy and herniorrhaphy. He remains symptom-free on follow-up.
http://ift.tt/2mR82eP
Body mass index and prognosis in patients with head and neck cancer
ABSTRACT
Background
Body mass index (BMI) has been associated variably with head and neck cancer outcomes. We evaluated the association between BMI at either diagnosis or at early adulthood head and neck cancer outcomes.
Methods
Patients with invasive head and neck squamous cell cancer at Princess Margaret Cancer Centre in Toronto, Canada, were surveyed on tobacco and alcohol exposure, performance status, comorbidities, and BMI at diagnosis. A subset also had data collected for BMI at early adulthood.
Results
With a median follow-up of 2.5 years, in 1279 analyzed patients, being overweight (hazard ratio [HR], 0.55; 95% confidence interval [CI], 0.4–0.8; p = .001) at diagnosis was associated with improved survival when compared with individuals with normal weight. In contrast, underweight patients at diagnosis were associated with a worse outcome (HR, 1.89; 95% CI, 1.2–3.1; p < .01).
Conclusion
Being underweight at diagnosis was an independent, adverse prognostic factor, whereas being overweight conferred better prognosis. BMI in early adulthood was not associated strongly with head and neck cancer outcomes. © 2017 Wiley Periodicals, Inc. Head Neck, 2017
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Induction of tumor regression by intratumoral STING agonists combined with anti–programmed death-L1 blocking antibody in a preclinical squamous cell carcinoma model
ABSTRACT
Background
Cyclic dinucleotides (CDNs) are bacterial intracellular messengers that have demonstrated antitumor activity in melanoma and breast tumors, although their role in immunotherapy of head and neck squamous cell cancers (HNSCCs) has not been well investigated.
Methods
We measured primary tumor growth rates, mechanism of antitumor activity, and efficacy of programmed death-L1 blockade combinatorial therapy in SCCFVII tumor-bearing C3H/HeOUJ mice undergoing intratumoral injections with RR-cyclic-di-guanine (synthetic CDG), CDG (natural cyclic-di-guanine), R848 (TLR 7/8 agonist), or phosphate buffered saline (PBS, control).
Results
Intratumoral CDN treatment groups showed decreased tumor size and enhanced splenocyte Th1 response when compared to the PBS treatment control group (p < .05). The RR-CDG tumor microenvironment showed upregulated interferon (IFN)-γ+CD8+ and programmed death-L1. Combining programmed death-L1 blocking antibody with RR-CDG induced regression of established tumors.
Conclusion
This study demonstrates the antitumor effects of CDNs in a HNSCC cell line. These preclinical data strongly support the future clinical development of intratumoral CDN in patients with HNSCC. © 2017 Wiley Periodicals, Inc. Head Neck, 2017
http://ift.tt/2mQLsTD
A new peptide vaccine OCV-501: in vitro pharmacology and phase 1 study in patients with acute myeloid leukemia
Abstract
Wilms' tumor 1 (WT1) is a promising target of new immunotherapies for acute myeloid leukemia (AML) as well as for other cancers. OCV-501 is a helper peptide derived from the WT1 protein. OCV-501 induced OCV-501-specific Type 1 T-helper (Th1) responses dose-dependently and stimulated helper activity of the specific Th1 cells in peripheral blood mononuclear cells from healthy donors. OCV-501 also enhanced the increase in WT1-killer peptide-specific cytotoxic T lymphocytes. OCV-501 stimulated the OCV-501-specific Th1 clones in an HLA class-II restricted manner and formed a complex with HLA class-II protein. OCV-501-specific Th1 clones demonstrated significant OCV-501-specific cytolytic activity against OCV-501-pulsed B-lymphoblastoid cell line cells. Based on the pre-clinical results, phase 1 clinical trial was conducted. The result of this trial suggested that the subcutaneous administration of OCV-501 once weekly for 4 weeks at doses of 0.3, 1, and 3 mg in older patients with AML during complete remission was safe and well tolerated. The maximum tolerated dose was considered to be ≥3 mg. Of the nine subjects enrolled, neither relapse nor blast cells were observed during the study. Immunological responses were observed in OCV-501-specific delayed-type hypersensitivity test. This trial was registered at http://ift.tt/PmpYKN as NCT 01440920.
http://ift.tt/2n39HPi
A case of chilblain lupus erythematosus with lupus erythematosus/lichen planus overlap syndrome
Abstract
Chilblain lupus erythematosus (CHLE) is an acral erythema with cutaneous lesion of lupus erythematosus (LE) that is exacerbated during the winter (1). LE/lichen planus (LP) overlap syndrome is a rare cutaneous disorder characterized by mixed histological features of LE and LP at the same lesion (2). Although both CHLE and LE/LP overlap syndrome are immune mediated diseases (3), there is no indication that the same lymphocyte subset induces two distinct cutaneous lesions.
This article is protected by copyright. All rights reserved.
http://ift.tt/2nicbeX
Systemic treatment of severe adult Atopic dermatitis in clinical practice: Analysis of prescribing pattern in a cohort of 241 patients
Abstract
Adult Atopic dermatitis (AD) is a chronic, inflammatory skin disease which may severely impact quality of life. In patients with moderate to severe AD, major defects in skin barrier function and structure have been observed in both non lesional and lesional skin (1).Systemic treatment should be considered in patients who cannot be managed with topical therapies(2). The Guidelines do not give clear recommendations regarding which agents to use first based upon the benefits and risks of available systemic treatments(3). The objective of our study was to evaluate the prescribing patterns of systemic treatments inpatients with severe AD who attended a day care center and the inpatient department of a tertiary care center.Adult patients with severe AD were defined as patients who had uncontrolled AD requiring admission to the day care center or the inpatient hospitalisation unit.
This article is protected by copyright. All rights reserved.
http://ift.tt/2nZZfYl
Efficacy of ixekizumab compared to etanercept and placebo in patients with moderate to severe plaque psoriasis and non-pustular palmoplantar involvement: results from three phase 3 trials (UNCOVER-1, -2, and -3)
Abstract
Background
Palmoplantar psoriasis has significant physical and emotional impact on patients and can be difficult to treat.
Objective
To evaluate the efficacy of ixekizumab in the treatment of patients with moderate-to-severe non-pustular palmoplantar involvement and moderate-to-severe plaque psoriasis.
Methods
In three phase 3, double-blind, placebo-controlled trials, patients with moderate-to-severe non-pustular plaque psoriasis (UNCOVER-1 (N=1296), UNCOVER-2 (N=1224), UNCOVER-3 (N=1346)) were randomised to subcutaneous 80 mg ixekizumab every 2 or 4 weeks (Q2W, Q4W), after a 160 mg starting dose, or placebo through week 12. Additional UNCOVER-2 and -3 cohorts were randomised to 50 mg etanercept bi-weekly. Patients entering the open-label long-term extension (UNCOVER-3) received ixekizumab Q4W weeks 12-60. Moderate-to-severe palmoplantar involvement was defined as Palmoplantar Psoriasis Area and Severity Index (PPASI) ≥8.
Results
Twenty-eight percent of UNCOVER-1,-2,-3 patients had baseline palmoplantar involvement (PPASI≥0, n=1092) and 9.1% (n=350) had moderate-to-severe involvement, with mean baseline PPASI ~20, PASI ~24, and most (>60%) had static Physician's Global Assessment ≥4. Higher percentages of patients treated with ixekizumab versus placebo or etanercept achieved PPASI 50 (approximately 80% versus 32.9%, 67.8%; ixekizumab, placebo, etanercept, respectively) and PPASI 75 (approximately 70% versus 18.8%, 44.1%; ixekizumab, placebo, etanercept, respectively) at week 12 (all P<0.05). PPASI 100 was achieved by higher percentages of ixekizumab-treated patients versus placebo (approximately 50% versus 8.2%, P<0.001) and ixekizumab Q2W-treated patients versus etanercept (51.8% versus 32.2%, P<0.05). Outcomes were maintained or improved in patients continuing on ixekizumab Q4W through week 60. Differences between ixekizumab and placebo or etanercept were statistically significant as early as week 1.
Conclusion
In a subpopulation analysis of patients from phase 3 trials with moderate-to-severe non-pustular palmoplantar involvement and moderate-to-severe plaque psoriasis, ixekizumab treatment resulted in greater and more rapid improvements than placebo and etanercept at week 12; improvements were sustained with continued treatment.
This article is protected by copyright. All rights reserved.
http://ift.tt/2nicuGJ
Progressive multifocal leukoencephalopathy associated with fumaric acid esters treatment in psoriasis patients
Abstract
Background
Fumaric acid esters (FAEs) are a systemic treatment for psoriasis considered to have a favorable long-term safety profile without an increased risk for immunosuppression. However, progressive multifocal leukoencephalopathy (PML), a rare, opportunistic viral infection of the central nervous system, has been linked anecdotally to FAE treatment.
Objective
to assess clinical features and outcomes of FAE-associated PML cases.
Methods
Systematic literature search in multiple databases up to February, 25th 2016 for reports of PML in psoriasis patients treated with FAEs.
Results
Eight cases (4 male, 4 female) of FAE-associated PML were identified. Median age was 64 years (range 42-74 years); median FAE treatment duration was 3 years (range 1.5-5 years). Six patients were treated with a formulation containing dimethylfumarate (DMF) and monoethylfumarates, and 2 patients with a DMF-formulation. Patients exhibited neurological symptoms, such as aphasia, hemiparesis, and dysarthria. PML diagnosis was based on MRI findings and presence of JC virus in cerebrospinal fluid and/or brain tissue. All cases were linked to moderate-to-severe reductions in absolute lymphocyte-counts, with nadirs ranging from 200 to 792 cells per mm3. Median exposure to lymphocytopenia was 2 years (range 1-5 years). In all cases, FAE treatment was discontinued; PML was treated with mefloquine plus mirtazapine. Three patients improved, 2 had stable disease, 2 had residual symptoms, and 1 patient died to an immune reconstitution inflammatory syndrome.
Conclusion
PML is infrequently linked to FAE treatment, but underreporting cannot be excluded. Physicians treating patients with FAEs should be vigilant for the occurrence of PML, and both clinicians and patients should be alert for onset of new neurological symptoms. Periodic monitoring of lymphocyte-counts and FAE discontinuation in case of moderate-to-severe lymphocytopenia are recommended to minimize the risk for PML.
This article is protected by copyright. All rights reserved.
http://ift.tt/2o06RKf
Thyroid incidentalomas on 18FDG-PET/CT: a metabolico-pathological correlation
Abstract
Background
Thyroid incidentaloma is defined as an unsuspected thyroid lesion found on imaging study or while performing a surgery non-related to the thyroid gland. Most recent scientific literature tends to demonstrate a detection rate of 0.1–4.3% for incidental findings of thyroid focal uptake identified by 18F-fluorodeoxyglugose Positron Emission Tomography with computed tomography (18FDG-PET/CT) initially prescribed for nonthyroid disease. From 10.3 to 80.0% of patients who underwent further evaluation are diagnosed with malignant lesions.
Our first objective is to determine the risk of malignancy confined in thyroid incidentalomas(IT) detected on 18FDG-PET/CT in patients treated in a tertiary care center (Centre Hospitalier Universitaire de Sherbrooke). Second, we want to identify a cut-off value for SUVmax in order to distinguish benign from malignant IT. Third, we look for predictive criterion that can be outlined to help in their management.
Methods
We retrospectively reviewed 40 914 charts of patients who had a 18FDG-PET/CT done in a tertiary center from 2004 to 2014. For each patient where a thyroid incidentaloma has been identified, Maximum Standardized Uptake Value (SUVmax), ultrasound report, cytology and histopathological results as well as oncologic outcomes were compiled and analyzed.
Results
In this study, the incidence for thyroid incidentaloma detected with 18FDG-PET/CT is 0.74%. The rate of malignancy present in IT is 8.2% based on histopathological results. Of the patients who underwent surgery, thyroid malignancy was identified in 54.3% of them. Cytoponction showed a strong correlation with final histopathological results (p = 0.009).
Conclusion
Thyroid incidentalomas detected with 18FDG-PET/CT are relatively infrequent, but the potential risk of malignancy remains elevated. Fine needle aspiration biopsy is the investigation of choice to rule out a malignant incidentaloma when there is no other element in the clinical portrait to preclude such additional work up.
http://ift.tt/2mPZPI1
Efficacy of Tranexamic acid on side effects of rhinoplasty: A randomized double-blind study
Publication date: Available online 21 March 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Mohammad Ali Ghavimi, Koroush Taheri Talesh, Arezoo Ghoreishizadeh, Mir Amir Chavoshzadeh, Ali Zarandi
IntroductionThe aim of this randomized double-blind study was to evaluate the efficacy of Tranexamic acid (TXA) on intraoperative bleeding, postoperative eyelid edema, and postoperative periorbital ecchymosis in rhinoplasty.Materials and methodsSixty rhinoplasty patients who needed hump reduction and lateral osteotomy were included and then randomly assigned into two groups. In the intervention group (n =30), 10mg/kg of TXA was administered prior to the operation and in the control group, the patients were given 20 mL of normal saline. Intraoperative bleeding was evaluated by gravimetric method and pre and postoperative hemoglobin and hematocrit levels were determined. Eyelid edema and periorbital ecchymosis were evaluated using 0-4 points scoring system. Surgeon satisfaction was measured by asking questions of the surgeon. Data were analyzed by SPSS 20.0 (P < 0.05).ResultsIn total, 10 participants were excluded from the research, and 50 patients were included in the study. Mean (SD) of intraoperative bleeding was 213 (65) mL and 254 (55) mL in the intervention and control group, respectively, based on the clinical methods (P=0.013). Level of hemoglobin was 266.69 in the control group versus 241.25 in the TXA group, indicating that this effect on the intraoperative bleeding was not significant (P=0.1). Hematocrit differences before and after operation were significant (p=0.03) (247.06 mL in TXA vs. 279.2 mL in the control group). TXA had a statistically significant effect on the eyelid edema (P=0.03), periorbital ecchymosis (P=0.04), and surgeon satisfaction (P=0.03).ConclusionAdministration of 10 mm/kg TXA had a significant effect in decreasing the intraoperative bleeding rate, eyelid edema, and periorbital ecchymosis in the rhinoplasty with minimal side effects.
http://ift.tt/2nZT4n5
Seasonality of auricular amputations in rabbits
This retrospective observational analysis hypothesizes that an increase occurs in online reports and images of auricular amputations of confectionary rabbits during the spring. Using the online search engine Google, online content and visual portrayals of confectionary rabbit auricular amputations from 2012 to 2017 were identified and trended against seasonal variations. To determine incidence, commercial availability of chocolate rabbits in retail facilities were assayed. A statistically significant increase in mention of rabbit auricular amputations occurred during the spring. Mapping techniques showed the annual peak incidence for 2012 to 2017 to be near Easter for each year studied. Human adults and children appear to be wholly responsible for the reports of rabbit auricular amputations. Reconstructive techniques are dependent on the percentage of auricular defect. Laryngoscope, 127:773–775, 2017
http://ift.tt/2nw2EkP
Increased long-term risk of hearing loss in patients with traumatic brain injury: A nationwide population-based study
Objectives/Hypothesis
We investigated incidences of hearing loss among patients with traumatic brain injury (TBI) to evaluate whether they had a higher risk of hearing loss than the general population.
Study Design
Cohort study.
Methods
Inpatient data from the Taiwan National Health Insurance Research Database from January 1, 2000 to December 31, 2010 were recorded. Patients with TBI and a retrospective comparison cohort were analyzed. Each subject was individually traced from their index date to identify subjects who subsequently received a diagnosis of hearing loss. Cox regression analyses were applied to determine the risk of TBI-related hearing loss.
Results
Follow-up data from the TBI and comparison cohorts were collected over 10 years for 553,286 and 1,106,572 patients, respectively. Multivariate analyses demonstrated that TBI significantly increased the risk of hearing loss (adjusted hazard ratio = 2.125, 95% confidence interval = 2.045-2.546, P = .027). In our subgroup analyses by type of injury, patients with TBI due to traffic injury had the highest associated risk of hearing loss compared with the risk of non-TBI traffic injury patients, followed by patients with crushing/cutting/piercing injuries and falls.
Conclusions
Our study shows that TBI led to a higher risk of long-term hearing loss. Traffic injuries were the most common injury related to hearing loss. Prevention, rather than treatment, may be the best policy for preventing hearing loss.
Level of Evidence
2b Laryngoscope, 2017
http://ift.tt/2nvZaid
Superior turbinate eosinophilia correlates with olfactory deficit in chronic rhinosinusitis patients
Objective
To evaluate if molecular markers of eosinophilia in olfactory-enriched mucosa are associated with olfactory dysfunction.
Study Design
Cross-sectional study of tissue biopsies from 99 patients, and an additional 30 patients who underwent prospective olfactory testing prior to sinonasal procedures.
Methods
Tissue biopsies were processed for analysis of inflammatory markers using quantitative real time polymerase chain reaction (qRT-PCR). Ipsilateral olfactory performance was assessed using the Sniffin' Sticks (Burghart, Wedel, Germany) threshold component and the University of Pennsylvania Smell Identification Test (Sensonics, Haddon Heights, NJ). Age-adjusted data was correlated with inflammatory marker expression and clinical measures of obstruction from computed tomography and endoscopy.
Results
Gene expression of the eosinophil marker CLC (Charcot Leyden crystal protein) was elevated in superior turbinate (ST) tissue in chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) compared to ST and inferior turbinate tissue in CRS without nasal polyps (CRSsNP) and control patients (all P < 0.001, respectively). CLC in ST tissue was correlated with IL-5 and eotaxin-1 expression (all P < 0.001; P = 0.65, and 0.49, respectively). CLC expression was strongly correlated with eosinophilic cationic protein levels (P < 0.001; r = −0.76), and ST CLC expression was inversely related to olfactory threshold (P = 0.002, r = −0.57) and discrimination scores (P = 0.05, r = −0.42). In multiple linear regression of CLC gene expression, polyp status, and radiographic and endoscopic findings with olfactory threshold, CLC was the only significantly correlated variable (P < 0.05).
Conclusion
Markers of eosinophils are elevated in the ST of patients with CRSwNP and correlate with olfactory loss. These findings support the hypothesis that olfactory dysfunction in CRS correlates local eosinophil influx into the olfactory cleft.
Level of Evidence
NA. Laryngoscope, 2017
http://ift.tt/2mLdDT7
Patient compliance following isolated mandibular fracture repair
Objective
Compliance with postoperative care in the maxillofacial trauma population often is considered poor. This lack of follow-up does not seem to be a function of decreased access to care but rather its anticipated lack of utilization. The goal of this study is to identify what factors are associated with increased compliance in postoperative management of mandible fractures.
Study Design
Retrospective cohort study.
Methods
Using Current Procedural Terminology codes to identify maxillofacial injuries requiring operative repair, a subset of isolated mandibular fractures was identified. Age, gender, race, insurance type, travel distance, mandible fracture location, surgical approach, and complications were used as variables in univariate regression modeling to examine factors associated with compliance to postoperative care.
Results
Between 2010 and 2013, 344 isolated mandible fractures were identified. A total of 83.1% of patients made their first postoperative follow-up visit. Demographic data, fracture location, distance to medical center (odds ratio [OR] = 1, P = 0.75), type of repair, use of drains (OR = 1.27, P = 0.61), or nonabsorbable suture (OR = 1.44, P = 0.32) did not appear to be associated with compliance. No association between complications and postoperative compliance was observed (OR = 2.37, P = 0.17). Trends toward improved compliance were observed when evaluating insurance type and use of temporary fixation hardware. The presence of current tobacco use was found to be negatively associated with patient compliance (OR = 0.33, P < 0.01).
Conclusion
Postoperative compliance after surgical repair is better than what is currently represented in the literature. It appears that postoperative compliance is dependent on patient-related factors more so than what can be modified by the surgeon.
Level of Evidence
4. Laryngoscope, 2017
http://ift.tt/2nvT9Ct
Radio-anatomical analysis of the pericranial flap “money box approach” for ventral skull base reconstruction
Objectives/Hypothesis
To evaluate the versatility of the pericranial flap (PCF) to reconstruct the ventral skull base, using the frontal sinus as a gate for its passage into the sinonasal corridor "money box approach."
Study Design
Anatomic-radiological study and case series.
Methods
Various approaches and their respective defects (cribriform, transtuberculum, clival, and craniovertebral junction) were completed in 10 injected specimens. The PCF was introduced into the nose through the uppermost portion of the frontal sinus (money box approach). Computed tomography (CT) scans (n = 50) were used to measure the dimensions of the PCF and the skull base defects. The vertical projection of the external ear canal was used as the reference point to standardize the incisions for the PCF.
Results
The surface area and maximum length of the PCF were 121.5 ± 19.4 cm2 and 18.3 ± 1.3 cm, respectively. Using CT scans, we determined that to reconstruct defects secondary to transcribriform, transtuberculum, clival, and craniovertebral approaches, the PCF distal incision must be placed respectively at −3.7 ± 2.0 cm (angle −17.4 ± 8.5°), −0.2 ± 2.0 cm (angle −1.0 ± 9.3°), +5.5 ± 2.3 cm (angle +24.4 ± 9.7°), +8.4 ± 2.4 cm (angle +36.6 ± 11.5°), as related to the reference point. Skull base defects in our clinical cohort (n = 6) were completely reconstructed uneventfully with the PCF.
Conclusions
The PCF renders enough surface area to reconstruct all possible defects in the ventral and median skull base. Using the uppermost frontal sinus as a gateway into the nose (money box approach) is feasible and simple.
Level of Evidence
NA Laryngoscope, 2017
http://ift.tt/2mQ5Ioj
Long-term local control rates of patients with adenoid cystic carcinoma of the head and neck managed by surgery and postoperative radiation
Objectives
To report long-term local control in patients with adenoid cystic cancer (ACC) of the head and neck managed by surgery and identify factors predictive for local failure.
Study Design
Single-institution retrospective cohort study.
Methods
Eighty-seven patients who had surgery for ACC between 1985 and 2009 were identified. Patient, tumor, and treatment characteristics were recorded. Local recurrence-free survival (LRFS) was recorded by the Kaplan-Meier method. Predictors of local control were identified.
Results
The median age was 54 years. Seventy-two (83%) patients had perineural invasion, 61 (70%) had close/positive margins, and 58 (67%) had pT 1T2. Fifty-nine (68%) patients had postoperative radiation therapy (PORT). With a median follow-up of 85 months, the 10-year LRFS was 78.7%. There were 14 local recurrences. On multivariable analysis, pathological tumor (T)3T4 stage and no PORT were independent predictors for local failure. Patients with no PORT had a 13-fold increased risk of local failure compared to patients treated with PORT (P = 0.003) after adjusting for stage.
Conclusion
After adjusting for T stage, patients who do not get PORT are more likely to have local recurrence.
Level of Evidence
4. Laryngoscope, 2017
http://ift.tt/2mLfebo
Effectiveness of training patients using DVD in the accurate use of inhalers for the treatment of bronchial asthma
Publication date: Available online 21 March 2017
Source:Allergology International
Author(s): Koichiro Takita, Rieko Kondo, Takahiko Horiguchi
BackgroundInhalants are the standard treatment for patients with bronchial asthma. Inaccurate inhaler use leads to inadequate therapeutic effects and unnecessary dosage increases. However, it is a challenge for practitioners to master the various devices available and train patients on the accurate use of inhalers. Thus, establishing a system to instruct patients on how to accurately use inhalers is essential. We prepared a DVD and accompanying user manual explaining the operation of each inhaler device used in Japan. This pilot study aimed to examine the efficacy of these materials.MethodsThe subjects were 33 outpatients with bronchial asthma who received treatment in our facility for asthma and had already received conventional inhalant training. The oral medication and inhalants used by the patients were not changed. The patients were randomly assigned to a DVD viewing group or non-viewing group; various parameters were comparatively examined after 4 weeks.ResultsSignificant improvements in Asthma Control Test scores, inhalation technique, forced vital capacity, forced expiratory volume in 1 s, impulse oscillometry resonant frequency, and induced sputum eosinophil count were observed in the DVD viewing group at 4 weeks post training.ConclusionsPulmonary function and inflammatory parameters improved significantly in the DVD viewing group. These findings suggest that unnecessary step-up of asthma treatment can be avoided, leading to treatment cost reduction. Training patients with asthma in accurate inhaler use improves quality of life and therefore has great clinical significance. Hence, this method should be used more extensively in Japan and worldwide.
http://ift.tt/2n3qxxn
Two cases of alopecia areata treated with ruxolitinib: a discussion of ideal dosing and laboratory monitoring
Abstract
Background
Alopecia areata is a relatively common condition affecting patients seen in community dermatology clinics. A 2014 study implicated the JAK1/JAK2 inhibitor, ruxolitinib in short-term treatment of alopecia, however little information exists about the long-term use in otherwise healthy individuals in the community setting.
Methods
A patient with chronic alopecia areata and a patient with acute onset alopecia universalis were treated with oral ruxolitinib for over a year.
Results
Both patients experienced sustained, near-complete regrowth without hematologic or other complications after one year of treatment. Oral ruxolitinib effectively and safely treated alopecia in two women.
Conclusions
Ruxolitinib should be considered for cases of unresponsive alopecia in the community.
http://ift.tt/2n3e39f
Cutaneous surgery under local anesthesia in very elderly patients 90 years of age and older is as safe as in elderly patients ranging in age from 75 to 80 years old
Abstract
Background
The number of very elderly patients who require surgery for cutaneous tumors is increasing. However, there is limited information on the safety of cutaneous surgery in such patients.
Methods
To evaluate the safety of cutaneous surgery in patients 90 years of age and older, we retrospectively reviewed the elderly patients who underwent surgery for cutaneous tumors under local anesthesia. Consecutive patients 90 years of age and older and 75–80 years old were included in the elderly group and the control group.
Results
The elderly and control groups included 104 and 106 patients, respectively. The mean age of the patients was 93.4 years (range, 90–101 years) in the elderly group and 77.4 years (range, 75–80 years) in the control group. The preoperative performance status was significantly worse in the elderly group than in the control group (P < 0.001). The surgical time was not significantly different between the two groups (P = 0.09). The occurrences of intraoperative and postoperative complications were not significantly different between the two groups (P = 0.19 and P = 0.07, respectively).
Conclusions
The result of the present study indicates that cutaneous surgery for very elderly patients 90 years of age and older is as safe as for patients ranging in age from 75–80 years old.
http://ift.tt/2moaI7G
Porphyria cutanea tarda: an intriguing genetic disease and marker
Abstract
Porphyrias are a group of intriguing genetic diseases of the heme pathway, of which porphyria cutanea tarda (PCT) is the most common. Resulting from a defect in enzymes in the porphyria pathway, PCT has been linked to several conditions. Recent studies have demonstrated a change in thinking regarding the human immunodeficiency virus (HIV) and development of PCT. The exacerbation of PCT with contraction of HIV is now believed to result from coinfection from the hepatitis C virus (HCV). Blistering of sun-exposed skin, a classic presenting sign of PCT, is not exclusive to the condition. Cutaneous findings must also trigger physicians to consider additional types of porphyrias, such as variegate porphyria. The diagnosis of pseudoporphyria, which does not result from enzymatic absence, must be considered in patients with photosensitivity and cutaneous bullae. Recent health food trends, such as chlorophyll, have been linked to pseudoporphyria. PCT is a serious condition in which accurate diagnosis is necessary for appropriate management.
http://ift.tt/2modzNH
Applying the community health worker model in dermatology: a curriculum for skin cancer prevention education training
Abstract
Background
Incidence of skin cancer is rising in Hispanic populations and minorities often have more advanced disease and experience higher mortality rates. Community health worker (CHW) programs to promote primary and secondary prevention show promise for many diseases, but an adequate training program in skin cancer prevention is not documented. We present a model for CHW specialty certification in skin cancer prevention for underserved, Hispanic communities.
Methods
We designed a culturally appropriate CHW training program according to an empowerment model of education for skin cancer prevention and detection in underserved Hispanic communities. We partnered with a large nonprofit clinic in South Florida.
Results
Nineteen CHWs completed the 2-h training course. After the course, 82.4% (n = 14) strongly agreed with the statement "I feel confident I can educate others on the warning signs of melanoma." Eighty-eight percent (88.2%, n = 15) strongly agreed that they felt confident that they could educate others on the importance of sun safety. One hundred percent (n = 19) answered each question about how the sun affects the skin correctly while 84.2% (n = 16) were able to identify the "ABCDEs" of melanoma. Nearly 90% strongly agreed with "I plan to change my personal sun safety behaviors based on what I learned today".
Discussion
Our results indicate successful transfer of information and empowerment to CHWs with high levels of confidence. Disease specific "specialty certifications" are a component of effective CHW policies. An appropriate training tool for skin cancer education is an important addition to a growing list of CHW specialty certifications.
http://ift.tt/2nvEV4u
Utilizing non-ablative fractional photothermolysis prior to ALA-photodynamic therapy in the treatment of acne vulgaris: a case series
Abstract
Aminolevulinic acid (ALA) photodynamic therapy (PDT) is an emerging modality in the treatment of acne. While ablative fractional lasers have been used to enhance drug delivery into the epidermis, recent evidence suggests that non-ablative fractional photothermolysis may also improve uptake of ALA. We explored the use of non-ablative 1550 nm laser as a safe alternative in the delivery of ALA prior to red-light PDT for refractory inflammatory and cystic acne. Subjects referred for treatment of acne refractory to several topical and oral regimens, including isotretinoin, were pre-treated with non-ablative fractional photothermolysis (NAFP). This was followed by 20 % ALA application with an incubation time of 1–3 h and then exposure to 50–100 J/cm2 red light. Follow-up was at 1, 3, and 6 months. In all three cases, patients demonstrated marked reduction in inflammatory lesions. Two subjects had remission of acne after a single combination treatment. Non-ablative fractional laser applied immediately prior to PDT may be used in the treatment of acne with minimal side effects and fewer sessions needed than PDT alone. This may be due to enhanced delivery of ALA from pre-treating the skin with non-ablative fractional photothermolysis.
http://ift.tt/2nvyFJG
Photobiomodulation of wound healing via visible and infrared laser irradiation
Abstract
Fibroblast cells are known to be one of the key elements in wound healing process, which has been under the scope of research for decades. However, the exact mechanism of photobiomodulation on wound healing is not fully understood yet. Photobiomodulation of 635 and 809 nm laser irradiation at two different energy densities were investigated with two independent experiments; first, in vitro cell proliferation and then in vivo wound healing. L929 mouse fibroblast cell suspensions were exposed with 635 and 809 nm laser irradiations of 1 and 3 J/cm2 energy densities at 50 mW output power separately for the investigation of photobiomodulation in vitro. Viabilities of cells were examined by means of MTT assays performed at the 24th, 48th, and 72nd hours following the laser irradiations. Following the in vitro experiments, 1 cm long cutaneous incisional skin wounds on Wistar albino rats (n = 24) were exposed with the same laser sources and doses in vivo. Wound samples were examined on 3rd, 5th, and 7th days of healing by means of mechanical tensile strength tests and histological examinations. MTT assay results showed that 635 nm laser irradiation of both energy densities after 24 h were found to be proliferative. One joule per square centimeter laser irradiation results also had positive effect on cell proliferation after 72 h. However, 809 nm laser irradiation at both energy densities had neither positive nor negative affects on cell viability. In vivo experiment results showed that, 635 nm laser irradiation of both energy densities stimulated wound healing in terms of tensile strength, whereas 809 nm laser stimulation did not cause any stimulative effect. The results of mechanical tests were compatible with the histological evaluations. In this study, it is observed that 635 nm laser irradiations of low energy densities had stimulative effects in terms of cell proliferation in vitro and mechanical strength of incisions in vivo. However, 809 nm laser irradiations at the same doses did not have any positive effect.
http://ift.tt/2nrRv4u
Cephalometric Findings among Children with Velopharyngeal Dysfunction following Adenoidectomy – a retrospective study
Abstract
Objectives
To characterize the craniofacial structure by cephalometry, especially the skull base and nasopharyngeal space, in children who underwent adenoidectomy and developed persistent velopharyngeal dysfunction (VPD).
Design
Retrospective study.
Setting
Speech and swallowing clinic of a single academic hospital.
Participants
39 children with persistent VPD following adenoidectomy (mean age 8.0±3.6 years) and a control group of 80 healthy children.
Main outcome measures
Cephalometric landmarks were chosen; craniofacial linear and angular dimensions were measured and analyzed.
Results
The linear dimensions of the nasopharyngeal area were shorter in the VPD group, S-Ba (41.6±4.2 mm, p<.05) and S-Ptm (42.4±5.1mm, p<.05). The anterior skull base, N-S, was similar (68.1mm±6.8).
The velum length, Ptm-P was significantly shorter in the VPD group (27.8±4.3 mm, p<.001). The Ba-S-Ptm angle was significantly larger in the VPD group (63.5±5.6°, p<.001). There was no significant difference in cranial base angle (CBA), Ba-S-N, between the two groups.
Conclusions
Cephalometry may provide information regarding persistent postoperative VPD. The nasopharyngeal space angle and velar length appear to be risk factors for persistent VPD after adenoidectomy.
This article is protected by copyright. All rights reserved.
http://ift.tt/2nZpNJ6
Prevalence of hearing loss and clinical otologic manifestations in patients with 22q11.2 deletion syndrome: a literature review
Abstract
Background
Hearing loss and otitis media are frequently reported in patients with 22q11.2 deletion syndrome.
Objective of review
Our objective was to review the current literature on the prevalence of hearing loss and otologic manifestations in patients with 22q11.2 deletion syndrome.
Type of review
Systematic review.
Search strategy
We conducted a systematic search in PubMed and Embase combining the term '22q11.2 deletion syndrome' and synonyms with 'hearing loss' and 'otologic manifestations' and synonyms.
Evaluation method
We screened title/abstract and full text of all retrieved articles on predefined in- and exclusion criteria. The remaining articles were assessed on risk of bias. Outcome measures included the prevalence of hearing loss and otologic manifestations such as otitis media.
Results
Our search yielded 558 unique studies of which a total of 25 articles were included for critical appraisal and data extraction. 21 studies reported on hearing loss and 21 studies on otologic manifestations. The prevalence of hearing loss varied from 6.0% to 60.3%, where in most studies conductive hearing loss was most prevalent. Rates of recurrent or chronic otitis media varied from 2.2% to 89.8%.
Conclusion
Although a very broad range in prevalences is reported in different studies, hearing loss and recurrent or chronic otitis media are frequently present. Regular check-ups and audiometric testing is advised in patients with 22q11.2 deletion syndrome.
This article is protected by copyright. All rights reserved.
http://ift.tt/2nvh7gQ
Double-handed endoscopic myringoplasty with a holding system in children: Preliminary observations
Publication date: May 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 96
Author(s): L.O. Redaelli De Zinis, M. Berlucchi, N. Nassif
ObjectivesEndoscopic transcanal myringoplasty is a newly-introduced technique for reconstruction of tympanic membrane perforation that offers the advantage to obviate postauricular incision. The objective of this study was to evaluate the feasibility of a double-handed endoscope holder transcanal myringoplasty in children. This technique permits bimanual execution of the procedure and allows the surgeon to overcome the two significant issues of single-handed endoscope surgery, i.e. easy domination of a bloody field and smooth introduction of the graft.MethodsA prospective non-randomized study of 10 consecutive primary endoscope holder-aided myringoplasties was performed; 3 mm or 4 mm 0° rigid endoscopes were used. A xenograft, biologic soft tissue, was applied in all cases.ResultsAll procedures were performed successfully. Duration of surgery was faster than with a single-handed procedure and varied between 20 and 60 min. The tympanic membrane healed successfully in all patients.ConclusionsIn this preliminary experience in children, a bimanual endoscopic holder-aided myringoplasty technique offers the possibility to overcome the obstacles encountered in a single-handed technique, since it can replicate the same concept of a bimanual microscopic approach and allow for easy management of a bloody field and introduction of the graft in the middle ear.
http://ift.tt/2mKJUcV
Hidradenitis suppurativa gains increasing interest on World Wide Web: a source for patient information?
Abstract
Background
Gathering health information from Internet websites is increasingly utilized by patients. No data exist about hidradenitis suppurativa (HS)-related online health information.
Thus, we aimed to study the quality, popularity, readability, and timeliness of the most frequented websites on HS.
Methods
Google Trends was used to evaluate the public interest in HS. An Internet search on Google was performed for the terms "hidradenitis suppurativa," "acne inversa," and "Verneuil's disease." Readability scores, HONcode quality certification, Alexa popularity rank, and content were assessed.
Results
Google search queries on HS have steadily risen in the last 10 years. The website analysis revealed 39 unique websites, which were difficult to read. Ten websites (26%) had HONcode quality certification, and the median (IQR) Alexa popularity rank was 48871 (2333–361275). Thirteen websites (33%) yielded disease-specific photos with a median rating between "quite useful" and "uncertain." A therapy option with adalimumab was mentioned on 11 websites (28%).
Conclusions
In addition to an increasing interest, we found a broad variation in the quality, readability, popularity, and timeliness of content on HS-related websites. Improvement of the quality and readability of HS-related websites is desirable to potentially raise disease awareness and contribute to an earlier presentation of patients suffering with undiagnosed HS.
http://ift.tt/2nZ5oDU
Histoid leprosy: a retrospective clinicopathological study from central Nepal
Abstract
Background
Histoid leprosy is a rare variant of lepromatous leprosy characterized by varied morphological and histopathological appearance while having a high bacillary load. These factors contribute to an ominous threat to the elimination status of leprosy, whereby these patients may act as a reservoir of infection.
Objective
To identify the clinicopathological characteristics of histoid leprosy in Chitwan, Nepal.
Methods
A retrospective hospital-based study spanning a period of 6 years was carried out at our department. All cases clinically and histopathologically suggestive of histoid leprosy were included in our study, and all relevant data were recorded and analyzed as per standard protocol.
Results
Histoid leprosy comprised 2.9% of all leprosy cases. Mean age of 39.45 years and male:female ratio of 1.75:1 were seen. Previous history of leprosy was obtained in 72.7%, and de novo development of histoid leprosy took place in 27.3%. Papules were the most common lesion seen, and upper limbs were the most frequent site of involvement, and the ulnar nerve was enlarged in most cases. Mean bacillary index was 5.39. Histopathology showed epidermal atrophy, positive Fite-Faraco stain for lepra bacilli, spindle-shaped histiocytes arranged in various patterns, and a well-circumscribed area of cells in the dermis in all cases. Grenz zone and pseudocapsule were seen in the majority of patients. All cases responded well to multibacillary multidrug therapy (MB-MDT) of 2 years.
Conclusion
A high index of suspicion is essential for diagnosing histoid leprosy, both clinically and histopathologically.
http://ift.tt/2nhmVKG
Efficacy of Tranexamic acid on side effects of rhinoplasty: A randomized double-blind study
The aim of this randomized double-blind study was to evaluate the efficacy of Tranexamic acid (TXA) on intraoperative bleeding, postoperative eyelid edema, and postoperative periorbital ecchymosis in rhinoplasty.
http://ift.tt/2nNaS5q
Nose burns: 4-dimensional analysis
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): J. Bouguila, C. Ho Quoc, R. Viard, A. Brun, D. Voulliaume, J.-P. Comparin, J.-L. Foyatier
The nose is the central organ of the face. It has two essential roles, aesthetic and breathing. It is often seriously damaged in the context of facial burns, causing grotesque facial disfigurement. As this disfigurement is visible on frontal and profile views, the patient suffers both socially and psychologically. The nose is a three-dimensional organ. Reconstruction is therefore more difficult and needs to be more precise than in other parts of the face. Maintaining symmetry, contour and function are essential for successful nasal reconstruction. Multiple factors determine the optimal method of reconstruction, including the size of the defect, its depth and its site. Satisfactory social life is recovered only after multiple surgical procedures and long-term rehabilitation and physiotherapy.
http://ift.tt/2mPrWH0
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