Δευτέρα 10 Απριλίου 2017
Primary cutaneous nocardiosis caused by Nocardia brasiliensis following a wasp sting
Summary
We report a case of an 87-year-old woman who presented with painful erythema of her right forearm 10 days after she had been stung by a wasp on her right hand. The lesion had rapidly deteriorated during the week before presentation, and treatment with antibiotics and glucocorticoids did not improve the condition. After careful evaluation, we performed cultures from the lesion aspiration, and morphological and genetic analysis of bacteria cultures confirmed a bacterial infection with Nocardia brasiliensis. The patient recovered after 3 weeks. Primary cutaneous nocardiosis due to Nocardia spp. is relatively uncommon in clinics, but it was the distance of the lesions from the affected area of the wasp sting that has made this an even rarer case and of interest to report.
http://ift.tt/2nXyKlP
The role of fillers in the management of acne scars
Summary
Acne scars are present in 95% of patients with acne, and can cause profound psychosocial morbidity. Fillers are commonly used for facial soft tissue augmentation, and there is increasing interest in their use for the treatment of acne scars, particularly for the atrophic subtype. We review the evidence for the use of temporary, semi-permanent and permanent fillers for acne scars. The use of permanent methylmethacrylate fillers for acne scarring is supported by a randomized controlled trial, and is approved by the United States Food and Drug Administration. There is initial evidence supporting the use of poly-L-lactic acid and hyaluronic acid fillers, but evidence is still lacking about the use of polyacrylamide and polyalkylimide fillers.
http://ift.tt/2om0PXb
Extensive levamisole-induced vasculitis
Summary
Levamisole (an increasingly frequent contaminant of cocaine) can cause antineutrophil cytoplasmic antibody-associated vasculitis. Dermatologists should consider a diagnosis of cocaine/levamisole-associated cutaneous vasculopathy syndrome in cases of purpura of the ears and/or extensive retiform purpura in drug users. We report a case of particularly severe levamisole-induced necrotic purpura and immunological abnormalities in a 40-year-old woman.
http://ift.tt/2nXyJON
Role of nail bed methotrexate injections in isolated nail psoriasis: conventional drug via an unconventional route
Summary
Nail psoriasis can be a debilitating condition; however, in patients with isolated nail involvement, the use of toxic systemic therapies such as methotrexate may not be justified. We report on 4 patients (30 involved nails between them), who were treated with injections of methotrexate (0.1 mL of a 25 mg/mL solution) into the nail bed at 3-weekly intervals. Mean baseline Nail Psoriasis Severity Index (NAPSI) was 4.77 (range 2–8, cumulative score 143; n = 30); dropping successively at each visit to 2.43 (range 0–4, cumulative score 73; n = 30) at 15 weeks. The decline in mean NAPSI from 4.87 to 2.17 was statistically significant (P < 0.001; Friedman analysis). Reported adverse effects were pain, injection site pigmentation and nail bed haemorrhage. Administration of specific targeted therapy to the nail bed may help manage nail psoriasis effectively.
http://ift.tt/2nXNIrY
Sinus procedures in the Medicare population from 2000 to 2014: A recent balloon sinuplasty explosion
Objective
To describe sinus procedure trends from 2000 to 2014, particularly following the introduction of balloon sinuplasty Common Procedural Technology (CPT) codes in 2011.
Study Design
Retrospective review of Medicare billing data available to the public.
Methods
Procedure and beneficiary data from 2000 to 2014 and provider data from 2012 to 2014 were obtained online from the Centers for Medicare and Medicaid Services. Sinus CPT codes were classified as balloon sinus procedure (BSP) or nonballoon sinus procedure (nBSP). Providers billing for sinus procedures were categorized as BSP only, nBSP only, or both. For comparison, data on septoplasty procedures from 2000 to 2014 were obtained.
Results
From 2000 to 2014, the total number of sinus procedures per 10 thousand beneficiaries (PP10K) nationwide increased by 3.7% annually. From 2011 to 2014, nBSP PP10K decreased by 3.1% annually, and BSP PP10K increased by 59% annually. Septoplasty PP10K changed by < 1% annually between 2000 and 2014. States with the highest BSP PP10K from 2012 to 2014 were Kansas, Texas, and Louisiana. Providers performing sinus procedures increased by 30.9% from 2012 to 2014. There was a 244% increase in BSP-only providers, a 0.7% increase in nBSP-only providers, and an 83.3% increase in providers using both. Septoplasty providers increased by 4.1%.
Conclusion
Although the total number of sinus procedures increased from 2000 to 2014, the number of BSP increased at a substantially greater rate since the introduction of CPT codes for these procedures in 2011. Nationwide increases in sinus providers were driven by new providers performing balloon-guided procedures.
Level of Evidence
4. Laryngoscope, 2017
http://ift.tt/2p087Ry
Polydioxanone plates are safe and effective for L-strut support in functional septorhinoplasty
Objectives/Hypothesis
To evaluate the safety, efficacy, and result stability of polydioxanone (PDS) plate use for L-strut stabilization.
Study Design
Retrospective analysis of a prospective cohort.
Methods
Patients who underwent functional septorhinoplasty with the use of PDS plates between January 2013 and January 2017 were administered the Nasal Obstruction Symptom Evaluation (NOSE) scale pre- and postoperatively at 2, 4, 6, and 12 months. Patient demographics, reason for PDS use, graft type, complications, and outcomes were analyzed.
Results
Eighty-eight patients aged 34.3 years (standard deviation [SD] = 15.7 years; range, 7.5–71.5 years) were included. All patients were found to have a fracture and/or severe deviation of the L-strut for which the PDS plate was used for rigid support. Mean preoperative NOSE score 65.2 (SD = 22.1) significantly decreased to 19.6 (SD = 21.6) at 7.2 months (SD = 5.5 months) postoperatively. There were no significant differences in NOSE scores between follow-up time points. There was one complication, a septal abscess, and one revision.
Conclusions
A PDS plate is a safe and effective material to be utilized in functional septorhinoplasty for patients with a fracture or iatrogenic injury to the septal L-strut or poor quality septal cartilage that requires stability without additional width. Outcomes are stable at 6 and 12 months, after the plate has dissolved. The use of a PDS plate may decrease the need for rib grafting in patients with a history of previous septoplasty and persistent nasal obstruction with a dorsal or caudal C-shaped septal deformity or fracture of the L-strut.
Level of Evidence
2c Laryngoscope, 2017
http://ift.tt/2olypLm
Change of somatosensory function of the tongue caused by chorda tympani nerve disorder after stapes surgery
Objectives
Patients after middle ear surgery often complain of taste disturbance and a lingual numbness. The purpose of this study was to objectively assess changes in the somatosensation of the tongue and taste function in patients undergoing stapes surgery.
Study Design
Prospective study.
Methods
Symptoms of taste disturbance and tongue numbness after surgery were investigated before and after surgery in 41 patients (13 males, 28 females; mean age 41.8 years) who underwent stapes surgery. Twenty-eight patients (9 males, 19 females; mean age 43.1 years) underwent sensory and taste function tests before and after surgery. Sensory function of the tongue was measured at the operated side and the nonoperated side using the 2-point discrimination test and an electrostimulator test. Taste function was assessed with electrogustometry (EGM).
Results
The chorda tympani nerve (CTN) was gently touched or stretched in all patients. Postoperative thresholds on the operated side were significantly higher than preoperative thresholds in all tests in the patients who underwent all three kinds of tests. Tongue somatosensory symptoms improved significantly earlier than the taste disturbance postoperatively, and the sensory thresholds returned to the baseline along with recovery of symptoms.
Conclusion
These findings suggest that dysfunction of the CTN occurred following surgery even when the CTN was preserved, and that the sensory nerve threshold of the tongue correlated with the symptom of lingual numbness. The CTN may play a role not only in taste function but also in the somatosensory function of the tongue.
Level of Evidence
4. Laryngoscope, 2017
http://ift.tt/2oZTdeo
Recent trends in oropharyngeal cancer funding and public interest
Objectives/Hypothesis
The incidence of oropharyngeal cancer (OPC) has increased in the United States. This has been driven by an increase in human papillomavirus (HPV)-positive OPC. Our objective is to determine trends in National Institutes (NIH)-supported research funding and public interest in OPC.
Methods
The NIH Research Portfolio Online Reporting Tools database was evaluated for projects related to OPC between 2004 and 2015. Projects were evaluated for total funding, relation to HPV, principal investigator departmental affiliation and degree, and NIH agency or center responsible for grant. The Google Trends database was evaluated for relative Internet search popularity of oropharyngeal cancer and related search terms between 2004 and 2015.
Results
In terms of NIH funding, 100 OPC-related projects representing 242 grant years and $108.5 million were funded between 2004 and 2015. Total NIH funding for OPC projects increased from $167,406 in 2004 to $16.2 million in 2015. Funding for HPV-related OPC increased from less than $2 million yearly between 2004 and 2010 up to $12.7 million in 2015. Principal investigators related to radiation oncology ($41.8 million) and with doctor of medicine degrees ($52.8 million) received the largest share of total funding. Relative Internet search popularity for oropharyngeal cancer has increased from 2004 to 2015 compared to control cancer search terms.
Conclusion
Increased public interest and NIH funding has paralleled the rising incidence of OPC. NIH funding has been driven by projects related to the role of HPV in OPC.
Level of Evidence
2c. Laryngoscope, 2017
http://ift.tt/2olrKB1
MRI surveillance of vestibular schwannomas without contrast enhancement: Clinical and economic evaluation
Objectives
To determine if high-resolution T2-weighted (HRT2) magnetic resonance imaging (MRI) is a comparably accurate and economical alternative to the gold standard of contrast-enhanced T1-weighted (T1C) MRI for surveillance of know vestibular schwannomas (VSs).
Study Design
Retrospective case-control analysis, systematic review, and economic evaluation.
Methods
Vestibular schwannoma size in anteroposterior, mediolateral, and superoinferior axes were measured by two neuroradiologists, both blinded to previous measurements, for 50 randomized patients with T1C and HRT2 on two separate occasions. Measurements were assessed by Pearson product-moment correlation coefficients, and differences were analyzed by Student t test. Once the data were analyzed, appropriate economic evaluation was performed utilizing institutional-, federal-, and literature-based estimates of cost and incidence/prevalence.
Results
Pearson correlations (r) between T1C and HRT2 were 0.991 and 0.973 for radiologists 1 and 2, respectively, with no statistically significant differences (P ≤ 0.05) between imaging techniques. Intraobserver and interobserver reliability estimates (κ) were 0.88 to 1 for both T1C and HRT2, indicating very high reliability. Cost-minimization analysis demonstrated cost and charge differences of $148.02 and $1,284 per patient per scan, respectively. This represents an overall cost and charge savings for this 50-patient cohort of $7,401 and $64,200, respectively.
Conclusion
HRT2 imaging is a highly reliable and lower-cost alternative to T1C for follow-up surveillance scans in patients with VS.
Level of Evidence
2C. Laryngoscope, 2017
http://ift.tt/2p09Czs
Microbiomes of the normal middle ear and ears with chronic otitis media
Objective
The aim of this study was to profile and compare the middle ear microbiomes of human subjects with and without chronic otitis media.
Study Design
Prospective multicenter cohort study.
Methods
All consecutive patients undergoing tympanoplasty surgery for chronic otitis media or ear surgery for conditions other than otitis media were recruited. Sterile swab samples were collected from the middle ear mucosa during surgery. The variable region 4 of the 16S rRNA gene in each sample were amplified using region-specific primers adapted for the Illumina MiSeq sequencer (Illumina, CA, USA)). The sequences were subjected to local blast and classified using Metagenome@KIN (World Fusion, Tokyo, Japan).
Results
In total, 155 participants were recruited from seven medical centers. Of these, 88 and 67 had chronic otitis media and normal middle ears, respectively. The most abundant bacterial phyla on the mucosal surfaces of the normal middle ears were Proteobacteria, followed by Actinobacteria, Firmicutes, and Bacteroidetes. The children and adults with normal middle ears differed significantly in terms of middle ear microbiomes. Subjects with chronic otitis media without active inflammation (dry ear) had similar middle ear microbiomes as the normal middle ears group. Subjects with chronic otitis media with active inflammation (wet ear) had a lower prevalence of Proteobacteria and a higher prevalence of Firmicutes than the normal middle ears.
Conclusion
The human middle ear is inhabited by more diverse microbial communities than was previously thought. Alteration of the middle ear microbiome may contribute to the pathogenesis of chronic otitis media with active inflammation.
Level of Evidence
2b. Laryngoscope, 2017
http://ift.tt/2olK2lK
Oral sensory dysfunction following radiotherapy
Objectives/Hypothesis
To assess differences in oral tactile sensation between subjects who have undergone radiation therapy (XRT) compared to healthy controls.
Study Design
Cross-sectional cohort comparison.
Methods
Thirty-four subjects with a history of XRT were compared with 23 healthy controls. There was no difference in age (P = .23), but there were slightly more males in the XRT cohort (P = .03). The mean (standard deviation) time after XRT completion was 3.84 (4.84) years. Fifty-six percent of the XRT cohort received chemotherapy. Using our previously validated methodology to measure oral tactile sensory threshold quantitatively with Cheung-Bearelly monofilaments, sensory thresholds of four subsites (anterior tongue, buccal mucosa, posterior tongue, soft palate) were compared for the two cohorts.
Results
Site-by-site comparisons showed higher forces were required for stimulus detection at all four subsites among subjects in the XRT cohort compared to healthy controls. Mean force in grams for XRT versus control cohorts were: anterior tongue, 0.39 (1.0) versus 0.02 (0.01); buccal mucosa, 0.42 (0.95) versus 0.06 (0.05); posterior tongue, 0.76 (1.46) versus 0.10 (0.07); and soft palate, 0.86 (1.47) versus 0.08 (0.05) (P < .001 for all comparisons). Combining all four subsites into a single metric to assess an overall level of oral tactile dysfunction, the XRT cohort had reduced sensation by 18.7 dB (P < .001).
Conclusions
After radiation therapy, the oral cavity and oropharynx exhibit global tactile sensory dysfunction, manifested by increased tactile forces required for stimulus detection. The magnitude of sensory impairment is 18.7 dB.
Level of Evidence
3b. Laryngoscope, 2017
http://ift.tt/2oZVExg
Does incidental mastoid opacification on computerized tomography necessitate referral to ENT?
Objective
The prevalence of incidental temporal bone disease on magnetic resonance imaging has been widely reported in the medical literature. Despite this, there currently is little evidence regarding incidental otological disease on computerized tomography (CT). Thus, the study aimed to review the CT prevalence of asymptomatic adult ear disease and evaluate the appropriateness of ear, nose, and throat (ENT) referral following its discovery.
Study Design
Retrospective observational study of 468 CT scans.
Methods
All CT head scans performed between January 2015 and January 2016 containing the keyword mastoid in the radiological report initially were recruited for the study. Scans performed in the pediatric population following head trauma or for otological indications were excluded, leaving 468 eligible radiological images. The presence of prior otological disease or referral subsequently was established using electronic patient records.
Results
Mastoid and/or middle ear opacification was noted to be present in 62 patients (13%). Of these patients, 10 subsequently were found to have prior otological intervention or review. Following exclusion of these patients, the rate of incidental temporal bone disease was recorded as 11%.
Conclusion
Data from this study suggests that incidental findings in an asymptomatic individual do not necessitate referral or further intervention. Furthermore, it is the author's recommendation that radiological findings be closely correlated with clinical examination to reduce false diagnosis and inappropriate referral to ENT.
Level of Evidence
4. Laryngoscope, 2017
http://ift.tt/2olIlot
Asian and non-Asian disparities in outcomes of non-nasopharyngeal head and neck cancer
Objectives/Hypothesis
To evaluate disparities in overall survival (OS) between Asian and non-Asian patients diagnosed with non-nasopharyngeal head and neck cancer (HNC).
Study Design
This was a population-based, retrospective study of patients diagnosed with non-nasopharyngeal HNC of squamous cell carcinoma histology between 2001 and 2010 in British Columbia, Canada.
Methods
Using Kaplan-Meier methods and Cox regression models, we examined the relationship between race and OS.
Results
A total of 3,036 patients were included in the study. Median age was 64 years, 74% were men, and 7% were Asians. Asians had worse Eastern Cooperative Oncology Group (ECOG) status (29% vs. 23%, P = .07) and larger tumors (33% vs. 21%, P = .02), and were more likely to be diagnosed with oral cavity cancers (38% vs. 25%, P < .001) than non-Asians. Asians were also less likely to receive multimodality therapy than non-Asians (90% vs. 95%, P = .02). Asians were more likely to have never smoked (49% vs. 15%, P < .001) and to be married or with a partner (80% vs. 69%, P = .02). Multivariate models showed that Asians had better OS than non-Asians (hazard ratio [HR] = 0.50, 95% confidence interval [CI] = 0.25-0.99, P = .05). Three-year OS did not differ significantly between Asians and non-Asians (41% vs. 42%, P = .18); however, 5-year OS did (22% vs. 19% P = .03). Stratifying by treatment type, outcomes were comparable in both groups except for radiotherapy alone, where Asians showed significantly better OS (HR = 0.71, 95% CI = 0.51-0.99, P = .04). Advanced age, worse ECOG, greater tumor size, and lack of treatment also correlated with inferior OS.
Conclusions
Despite several worse prognostic features and less aggressive treatment, Asians tended to exhibit better OS than non-Asians.
Level of Evidence
2c. Laryngoscope, 2017
http://ift.tt/2oZSjyg
Head and neck sweat gland adenocarcinoma: A population-based perspective of a rare entity
Objectives
Head and neck sweat gland adenocarcinoma (HNSGA) is an extremely rare malignancy. We present the first population-based analysis regarding this entity.
Study Design
Retrospective population-based analysis.
Methods
Using the Surveillance, Epidemiology, and End Results registry from 2000 to 2013, we extracted 627 cases of HNSGA. Data were analyzed for incidence trends, demographic and clinicopathologic traits, and predictors of disease-specific survival (DSS).
Results
The majority HNSGA cases were white, male, and 60 to 79 years old. The incidence was 0.036 per 100,000 people. Tumors most often presented as localized disease and histological grade II/III. The skin of the face was the most common primary site (43.4%), followed by the scalp and neck (31.6%). Overall 5-, 10-, and 20-year DSS were 94.6%, 89.6%, and 79.8%, respectively. Ethnicity did not affect survival, whereas a younger age at diagnosis and female sex conferred an advantage at 10 years (P = 0.0386) and 5 years (P = 0.0191), respectively. The origin of the HNSGA (apocrine vs. eccrine) did not affect outcomes. Regional and distant disease predicted worse DSS at 5, 10, and 20 years (P = 0.0026, P < 0.001, P < 0.001, respectively). Compared to grade I/II disease, grade III/IV dramatically worsened 5-, 10-, and 20-year DSS (P = 0.0035, P < 0.0001, P = 0.0011, respectively). Scalp and neck HNSGA exhibited the poorest 20-year DSS compared to other primary sites (P = 0.0024).
Conclusion
We present the largest cohort of HNSGA. Significant poor prognostic indicators include older age, higher tumor grade, greater extent of invasion, and primary site of the scalp or neck.
Level of Evidence
4. Laryngoscope, 2017
http://ift.tt/2olwPsQ
TSH ≥2.5 mIU/l is Associated with the Increased Oxidative Damage to Membrane Lipids
από Karbownik-Lewinska, Malgorzata στο Hormon- und Stoffwechselforschung
Μετάφραση άρθρου
Horm Metab Res
DOI: 10.1055/s-0042-120712
According to current recommendations, a TSH value of <2.5 mIU/l should be maintained during preconception and pregnancy. The same recommendation, however, does not relate to all women of childbearing age. The aim of the study was to evaluate relationship between lipid peroxidation (LPO; index of oxidative damage to membrane lipids) and thyroid tests and other parameters, which may be affected by thyroid dysfunction, in euthyroid women of childbearing age. Ninety nine female inpatients with normal thyroid tests (TSH 0.27–4.2 mIU/l), aged 18–48 years, were prospectively enrolled. Blood concentrations of malondialdehyde+4-hydroxyalkenals (LPO index) were measured spectrophotometrically. Thyroid tests (TSH, FT4, FT3), thyroid antibodies and other laboratory parameters [cholesterol, HDL cholesterol (HDLC), LDL cholesterol, HDLC/cholesterol ratio, triglycerides, glucose, CRP, iron] were measured with standard methods. Blood LPO level was higher in women with TSH≥2.5 mIU/l than in women with TSH<2.5 mIU/l. Positive correlation was found between TSH concentration and LPO level (r=0.210, p=0.037). In the univariate regression analysis, blood LPO level did constitute the only independent factor associated with TSH≥2.5 mIU/l. Abnormal HDLC/cholesterol ratio occurred more frequently in subjects with TSH≥2.5 mIU/l. Additionally, LPO level correlated positively with triglyceride concentration (r=0.340, p=0.001), whereas it correlated negatively with HDLC concentration (r=–0.335, p=0.001) and with HDL/cholesterol ratio (r=–0.331, p=0.001). In conclusion, in women of childbearing age with normal thyroid tests, TSH≥2.5 mIU/l is associated with higher oxidative damage to membrane lipids and less favorable lipid profile, which supports our standpoint that TSH of less than 2.5 mIU/l should be maintained in all women of childbearing age.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480
Cardiotoxicity with Itraconazole
Μετάφραση άρθρου
Itraconazole is a commonly used antifungal drug. In addition to commonly described adverse effects, there have been few reports of heart failure with its use. We present two cases that developed acute systolic heart failure with Itraconazole use. A man in his early 30s was admitted with worsening leg swelling and dyspnoea on exertion. He had been on Itraconazole for blastomyces skin ulcer. His ejection fraction (EF) was found to be 10%–15%. Another man in his 50s was admitted with similar symptoms; his EF was 40%–45%. He had been on Itraconazole for forearm cellulitis. No other aetiology was identified in both patients despite extensive work-up including cardiac catheterisation. Itraconazole was stopped in both the cases. Our first patient did not improve even months after cessation of therapy and was referred for heart transplant. Our second patient improved after a few weeks, and his ejection fraction had improved on repeat testing.
Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480
Lymph Node Central Necrosis on the Computed Tomography as the Predictor of the Extra Capsular Spread
στο Otolaryngology Indian
Μετάφραση άρθρου
Abstract
The aim of this study is to investigate the relationship between the presence of the cervical lymph node with central necrosis as on the preoperative imaging and postoperative histopathological identification of the lymph node extra capsular spread. This study is a prospective study conducted at J.L.N. Hospital and Research Centre, Bhilai (C.G), from August 2011 to January 2014. Thirty patients with metastatic head and neck squamous cell carcinoma were enrolled. All candidates were subjected to a detailed history taking and clinical examination. Their preoperative computed tomography (CT) scans were assessed with attention to the presence and absence of lymph node, lymph node size, shape, level, presence or absence of the lymph node central necrosis and other signs of the ECS such as thick walled enhancing nodal margin, loss of margin definition, alteration of adjacent fat planes. These patients then underwent surgery which included resection of the primary with the neck dissection. The preoperative records of the lymph node size and location were observed radio-graphically and analyzed with the resected lymph node histopathologically. These data was used for finding out correlation. Of the total 30 patients studied, 24 patients were male and 6 patients female with ratio of 4:1. The most common group of the patients were of malignancy of gingivobuccal sulcus. Out of the 30 patients 19 patients had the radiographic evidence of the central necrosis, out of which 11 had the extra capsular spread on the histological analysis. In no patients did we found histopathology extra capsular spread without central necrosis. Thus the central necrosis on the CT has the high sensitivity for detection of the extra capsular spread. Out of the 19 lymph node without extra capsular spread, 11 lymph nodes had no central necrosis on the preoperative CT, remaining 8 lymph node were having central necrosis on CT whereas post op histopathology of these 8 lymph nodes showed metastatic deposit, indicating the low specificity of the central necrosis in detection of the ECS. Lymph node central necrosis on pre-operative CT is sensitive indicator with a high negative predictive value for lymph node extra capsular spread. Future studies focusing on identifying molecular mediator involved in ECS to determine targets for adjuvant therapies in this subset of patients are recommended.
Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480
Videosprechstunde darf persönlichen Kontakt nicht ersetzen
Die Videosprechstunde ist auf dem Weg in die Regelversorgung. Jetzt wurden technische Anforderungen veröffentlicht, ab Juli 2017 soll es eine eigene EBM-Ziffer geben. Alles andere als unmissverständlich sind jedoch die berufsrechtlichen Rahmenbedingungen.
http://ift.tt/2o29qvM
Bezolds Reisegepäck
Die medizinische Wissenschaft will messen, vergleichen und einordnen. Die ersten Höhepunkte der vergleichenden Hörprüfungen mit mechanischen Instrumenten verdanken wir Friedrich Bezold und seiner „kontinuierlichen Tonreihe", die im Münchener Physikalisch-Mechanischen Institut von Max T. Edelmann ab 1893 gefertigt wurden.
http://ift.tt/2olCCRa
„Es klappt ja doch mit Familie!“
Beruf und Familie – das funktioniert auch in eigener Praxis. Vielleicht sogar besser als im Krankenhaus. Diese Erkenntnis konnten junge Ärzte vom „Tag der Chancen" in Thüringen im März mitnehmen.
http://ift.tt/2o2dqw8
Moderne Wiederherstellungschirurgie mit freien Lappen
Moderne Kopf-Hals-Chirurgie wäre ohne die Einführung von freien, mikrovaskulären Transplantaten vor etwa vier Jahrzehnten in der heutigen Form nicht denkbar. Erst dadurch wurde der Verschluss großer Weichteildefekte möglich oder erheblich vereinfacht. Im Folgenden soll insbesondere auf Aspekte der modernen rekonstruktiven Möglichkeiten im Bereich des Pharynx und der Mundhöhle eingegangen werden.
http://ift.tt/2olBjBJ
Neue Optionen der Teamarbeit in Kommunen
Eine Versorgung chronisch Kranker über alle Sektoren und Betreuungsbereiche hinweg ist in Deutschland meist noch Utopie. Doch mancherorts gibt es Keimzellen für neue Modelle mit Vorbildcharakter.
http://ift.tt/2o23oLM
Praxischefs ziehen Lehren aus Online-Bewertungen
Patientenkritik an der Praxis auf Online-Portalen lassen Praxischefs meist nicht kalt. Mehr als die Hälfte hat bereits reagiert, um die Prozesse in ihrem Versorgungsalltag zu optimieren.
http://ift.tt/2o2hWLp
Otitis media: keine verkürzte Antibiose bei Babys
Gute Gründe sprechen einem US-Ärzteteam zufolge gegen die Abkürzung einer antibiotischen Therapie bei Babys mit Otitis media. In der randomisierten, placebokontrollierten Studie schlug die fünftägige Behandlung deutlich schlechter an als das Standardregime über zehn Tage, und die Kinder benötigten letztlich mehr Antibiotika pro Erkältungssaison.
http://ift.tt/2olICcn
SLIT: gute Lebensqualität und hohe Adhärenz
Die Adhärenz zu einer Behandlung mit sublingualer Immuntherapie wird umso besser sein, je mehr ein Patient einen Therapieeffekt etwa in Form einer verbesserten Lebensqualität spürt. Eine Praxisstudie liefert Daten zu diesem postulierten Zusammenhang.
http://ift.tt/2o2aQ9y
Larynx- und Hypopharynxkarzinom: Langzeitergebnisse zum Larynxerhalt
In der Studie EORTC 24954 wurden die sequenzielle und die alternierende Radiochemotherapie bei Patienten mit lokal fortgeschrittenem Larynx- und Hypopharynxkarzinom über einen Zeitraum von zehn Jahren verglichen.
http://ift.tt/2olupMu
ISDN-Abschied ohne Schrecken
2018 soll Schluss sein mit dem ISDN-Netz. Dann wollen die Telekom, 1&1 und andere große Telefonnetzanbieter ihre Leitungen endgültig auf „All-IP" umstellen. Gerade gewerbliche Kunden wie Arztpraxen kann es auch schon früher treffen. Welche Optionen haben Betroffene?
http://ift.tt/2olIObT
Cardiotoxicity with Itraconazole
Itraconazole is a commonly used antifungal drug. In addition to commonly described adverse effects, there have been few reports of heart failure with its use. We present two cases that developed acute systolic heart failure with Itraconazole use. A man in his early 30s was admitted with worsening leg swelling and dyspnoea on exertion. He had been on Itraconazole for blastomyces skin ulcer. His ejection fraction (EF) was found to be 10%–15%. Another man in his 50s was admitted with similar symptoms; his EF was 40%–45%. He had been on Itraconazole for forearm cellulitis. No other aetiology was identified in both patients despite extensive work-up including cardiac catheterisation. Itraconazole was stopped in both the cases. Our first patient did not improve even months after cessation of therapy and was referred for heart transplant. Our second patient improved after a few weeks, and his ejection fraction had improved on repeat testing.
http://ift.tt/2nzlc4K
Comparison of self-reported signs of facial ageing among Caucasian women in Australia versus those in the USA, the UK and Canada
Abstract
Background/Objectives
Australians are more exposed to higher solar UV radiation levels that accelerate signs of facial ageing than individuals who live in temperate northern countries. The severity and course of self-reported facial ageing among fair-skinned Australian women were compared with those living in Canada, the UK and the USA.
Methods
Women voluntarily recruited into a proprietary opt-in survey panel completed an internet-based questionnaire about their facial ageing. Participants aged 18–75 years compared their features against photonumeric rating scales depicting degrees of severity for forehead, crow's feet and glabellar lines, tear troughs, midface volume loss, nasolabial folds, oral commissures and perioral lines. Data from Caucasian and Asian women with Fitzpatrick skin types I–III were analysed by linear regression for the impact of country (Australia versus Canada, the UK and the USA) on ageing severity for each feature, after controlling for age and race.
Results
Among 1472 women, Australians reported higher rates of change and significantly more severe facial lines (P ≤ 0.040) and volume-related features like tear troughs and nasolabial folds (P ≤ 0.03) than women from the other countries. More Australians also reported moderate to severe ageing for all features one to two decades earlier than US women.
Conclusions
Australian women reported more severe signs of facial ageing sooner than other women and volume-related changes up to 20 years earlier than those in the USA, which may suggest that environmental factors also impact volume-related ageing. These findings have implications for managing their facial aesthetic concerns.
http://ift.tt/2otEesf
What Is the “Screening Effect” Six Years After the Fukushima Nuclear Power Plant Accident?
http://ift.tt/2nXfGUR
Zukunft jetzt − Implementierung eines IT-gestützten Distress-Screenings
Zusammenfassung
Hintergrund
Eine bedarfsgerechte integrierte Mitbehandlung psychischer Belastungen und Störungen gehört zu den Herausforderungen einer modernen Krebsmedizin. Ohne standardmäßiges Screening auf psychischen Distress bleibt ein großer Teil der versorgungsbedürftigen Krebspatienten unerkannt. Mit der verpflichtenden Einführung von Distress-Screenings in die onkologische Routineversorgung entsteht für die deutschen Krebszentren ein erhöhter Dokumentationsaufwand. IT-gestützte Screening-Prozeduren können diesen kompensieren. Während die S3-Leitlinie Psychoonkologie Methoden und strukturelle Maßnahmen zur fachkundigen Umsetzung eines standardgemäßen Screenings beschreibt, fehlen bisher Handlungsempfehlungen zur Implementierung eines IT-gestützten Distress-Screenings.
Methoden
Es wurde ein Konsensusmeeting „IT-gestütztes Distress-Screening in der onkologischen Routineversorgung" durchgeführt.
Ergebnisse
Es wurden Konsensempfehlungen zur Implementierung und Nutzung IT-gestützter Distress-Screenings ausgearbeitet. Diese beziehen sich auf: 1) Vorbereitung der Implementierung, 2) IT-Ausstattung, 3) Implementierung, 4) Praktische Nutzung, 5) Qualitätssichernde Maßnahmen im Forschungskontext. Ausgewählte deutschsprachige Forschungsprojekte und aktuelle Entwicklungen in der klinischen Versorgungsforschung unterstreichen, welches Potenzial in der Zusammenführung von klinischer Expertise mit der Informationstechnologie steckt.
Schlussfolgerungen
Mit den Ergebnissen des Konsensusmeetings stehen nun ein Leitfaden und Kriterienkatalog für die Implementierung eines IT-basierten Distress-Screenings in der onkologischen Routineversorgung zur Verfügung. Die Umsetzung dieser Empfehlungen kann die Versorgungsqualität von Krebspatienten in Deutschland verbessern.
http://ift.tt/2oZKHJg
Security “high-tech” individual extra-light device mask 2.0: CAD/CAM evolution
In 2008, we presented our security "high-tech" individual extra-light device mask (SHIELD), a protective shield based on the face cast of an injured soccer player that can be customised. It allows a shortened convalescent period, is comfortable, fits well, and allows the patient to continue to play at a professional level in their chosen sport or activity in the shortest time possible. It has been used often in both amateur and professional categories of many sports, and we now present an update.
http://ift.tt/2p15HzC
Lymph Node Central Necrosis on the Computed Tomography as the Predictor of the Extra Capsular Spread in Metastatic Head and Neck Squamous Cell Carcinoma
Abstract
The aim of this study is to investigate the relationship between the presence of the cervical lymph node with central necrosis as on the preoperative imaging and postoperative histopathological identification of the lymph node extra capsular spread. This study is a prospective study conducted at J.L.N. Hospital and Research Centre, Bhilai (C.G), from August 2011 to January 2014. Thirty patients with metastatic head and neck squamous cell carcinoma were enrolled. All candidates were subjected to a detailed history taking and clinical examination. Their preoperative computed tomography (CT) scans were assessed with attention to the presence and absence of lymph node, lymph node size, shape, level, presence or absence of the lymph node central necrosis and other signs of the ECS such as thick walled enhancing nodal margin, loss of margin definition, alteration of adjacent fat planes. These patients then underwent surgery which included resection of the primary with the neck dissection. The preoperative records of the lymph node size and location were observed radio-graphically and analyzed with the resected lymph node histopathologically. These data was used for finding out correlation. Of the total 30 patients studied, 24 patients were male and 6 patients female with ratio of 4:1. The most common group of the patients were of malignancy of gingivobuccal sulcus. Out of the 30 patients 19 patients had the radiographic evidence of the central necrosis, out of which 11 had the extra capsular spread on the histological analysis. In no patients did we found histopathology extra capsular spread without central necrosis. Thus the central necrosis on the CT has the high sensitivity for detection of the extra capsular spread. Out of the 19 lymph node without extra capsular spread, 11 lymph nodes had no central necrosis on the preoperative CT, remaining 8 lymph node were having central necrosis on CT whereas post op histopathology of these 8 lymph nodes showed metastatic deposit, indicating the low specificity of the central necrosis in detection of the ECS. Lymph node central necrosis on pre-operative CT is sensitive indicator with a high negative predictive value for lymph node extra capsular spread. Future studies focusing on identifying molecular mediator involved in ECS to determine targets for adjuvant therapies in this subset of patients are recommended.
http://ift.tt/2ojaldG
Septorhinoplasty: Our Experience
Abstract
Rhinoplasty is one of the oldest known surgeries to the human kind. However, being a cosmetic of surgery of utmost importance, it has been an attractive and fascinating surgery for the otolaryngologists and plastic surgeons. Along with the evolution of improved techniques and better surgical modalities, this surgery has been growing in panorama including its indications, needs and techniques. We present our experience with rhinoplasty in a tertiary care center of north India. We have included all cases operated with septorhinoplasty from 2001 to 2014 by the senior author in the manuscript. We reviewed their presentations, investigations, preoperative counselling records, operative details and post-operative clinical records to audit our results and hence to document our experiences in septorhinoplasties. A total of 53 cases including 37 males and 16 females had undergone rhinoplasty surgeries. The most common reason of disfigurement was road traffic accident (58.5%). All these patients included different deformities and required varied corrections. There were no major post-operative complications except persistent edema with longest lasting for 23 weeks. Thermal splints gave a better patient satisfaction in post-op compared to POP splints. Results were completely and partially satisfying for 50 patients and not satisfying for three. Unrealistic expectations from the procedure might be the reason for non-satisfactory results in rhinoplasty. Rhinoplasty is a delicate procedure and has greater aesthetic implications in planning surgical techniques and approaches. For better satisfaction of patients, adequate preoperative counseling and realistic expectations are warranted. Skillful surgical techniques null chances of complications.
http://ift.tt/2oZaSQk
Kontaktallergien der Kopfhaut
Zusammenfassung
Kontaktallergien der Kopfhaut stellen eine wichtige Differenzialdiagnose von Kopfhauterkrankungen dar. Die typischen Effloreszenzen bekräftigen zusammen mit Streuherden, Juckreiz und Anamnese die Verdachtsdiagnose. Da die behaarte Kopfhaut eher unempfindlich gegenüber einer Kontaktdermatitis ist, verursachen hier applizierte Allergene oft Reaktionen um Augen, Ohren und Hals. Potente Allergene, wie z. B. para-Phenylendiamin, können aber durchaus auch auf der behaarten Kopfhaut starke Reaktionen auslösen. Die häufigsten für die Kopfhaut relevanten Allergene finden sich in Haarfarben und Bleichmitteln, Shampoos und Haarspülungen, Produkten für Dauerwelle und Haarglättung sowie in topischen Medikamenten. Neben den aktiven Wirkstoffen sind Vehikel und Konservierungsmittel häufige auslösende Allergene. Mittels topischer Steroide und oraler Antihistaminika kommt es rasch zur Abheilung, nur bei schweren Reaktionen werden systemische Steroide benötigt. Eine adäquate Epikutantestung mittels vorhandener Testreihen, kombiniert mit den Inhaltsstoffen patienteneigener Produkte, bekräftigt oder widerlegt die Diagnose und ermöglicht die Allergenkarenz sowie die Auswahl geeigneter Ersatzprodukte.
http://ift.tt/2nWCeVF
Dexamethasone for nerve blocks: Design matters!
With a few notable exceptions, efforts to prolong peripheral nerve blocks with adjuvant drugs have been generally disappointing. One prime exception is dexamethasone: it has been demonstrated to prolong analgesia as well as sensory and motor block in multiple contexts, although numbers are too low to make definitive statements about safety [1]. All the early studies, however, assumed the action of dexamethasone was on the peripheral nerve and therefore did not include systemic controls. Desmet and colleagues upset the apple cart in 2013 with their report that 10mg of systemic dexamethasone appears to prolong the time to first analgesic request as much as perineural administration [2].
http://ift.tt/2p0kfiX
Occupational stress of anesthesia: Effects on aging
Anesthesiology has been identified as a stressful specialty. Chronic psychological stress may lead to biological aging and skin aging.
http://ift.tt/2nyNFHM
Labetalol, nitroglycerin, controlled hypotension, sinus endoscopic surgery
To assess the efficacy of labetalol versus nitroglycerin for induction of controlled hypotension during sinus endoscopic surgery.
http://ift.tt/2p0khaz
High molecular weight components containing N-linked oligosaccharides of Ascaris suum extract inhibit the dendritic cells activation through DC-SIGN and MR
Source:Molecular Immunology, Volume 87
Author(s): Bruna C. Favoretto, Adriana A.C. Casabuono, José A. Portes-Junior, Jacqueline F. Jacysyn, Alicia S. Couto, Eliana L. Faquim-Mauro
Helminths, as well as their secretory/excretory products, induce a tolerogenic immune microenvironment. High molecular weight components (PI) from Ascaris suum extract down-modulate the immune response against ovalbumin (OVA). The PI exerts direct effect on dendritic cells (DCs) independent of TLR 2, 4 and MyD88 molecule and, thus, decreases the T lymphocytes response. Here, we studied the glycoconjugates in PI and the role of C-type lectin receptors (CLRs), DC-SIGN and MR, in the modulation of DCs activity. Our data showed the presence of glycoconjugates with high mannose- and complex-type N-linked oligosaccharide chains and phosphorylcholine residues on PI. In addition, these N-linked glycoconjugates inhibited the DCs maturation induced by LPS. The binding and internalization of PI-Alexa were decreased on DCs previously incubated with mannan, anti-DC-SIGN and/or anti-MR antibodies. In agreement with this, the incubation of DCs with mannan, anti-DC-SIGN and/or anti-MR antibodies abolished the down-modulatory effect of PI on these cells. It was also observed that the blockage of CLRs, DC-SIGN and MR on DCs reverted the inhibitory effect of PI in in vitro T cells proliferation. Therefore, our data show the involvement of DC-SIGN and MR in the recognition and consequent modulatory effect of N-glycosylated components of PI on DCs.
http://ift.tt/2okhavu
Longevity of metal-ceramic crowns cemented with self-adhesive resin cement: a prospective clinical study
Abstract Resin cements are often used for single crown cementation due to their physical properties. Self-adhesive resin cements gained widespread due to their simplified technique compared to regular resin cement. However, there is lacking clinical evidence about the long-term behavior of this material. The aim of this prospective clinical trial was to assess the survival rates of metal-ceramic crowns cemented with self-adhesive resin cement up to six years. One hundred and twenty-nine subjects received 152 metal-ceramic crowns. The cementation procedures were standardized and performed by previously trained operators. The crowns were assessed as to primary outcome (debonding) and FDI criteria. Statistical analysis was performed using Kaplan-Meier statistics and descriptive analysis. Three failures occurred (debonding), resulting in a 97.6% survival rate. FDI criteria assessment resulted in scores 1 and 2 (acceptable clinical evaluation) for all surviving crowns. The use of self-adhesive resin cement is a feasible alternative for metal-ceramic crowns cementation, achieving high and adequate survival rates.
http://ift.tt/2oRZ3P2
Dental Management Survey Brazil (DMS-BR): creation and validation of a management instrument
Abstract Questionnaires for the assessment of knowledge and self-perception can be useful to diagnose what a dentist knows about management and administration. The aim of the present study was to create and validate the Dental Management Survey Brazil (DMS-BR) scale, based on meetings with experts in the field. After having elaborated the first version, 10 audits were performed in dental offices in order to produce the final version, which included nine dimensions: location, patient, finance, marketing, competition, quality, staff, career, and productivity. The accuracy of the instrument was measured by intrarater and interrater reliability. In the validation phase, 247 Brazilian dentists answered a web-based questionnaire. The data were processed using Stata 13.0 and the significance level was set at 95%. The instrument had intrarater and interrater reliability (ICC-0.93 and 0.94). The overall average of respondents for the DMS-BR scale was 3.77 (SD = 0.45). Skewness and kurtosis were below absolute values 3 and 7, respectively. Internal validity measured by Cronbach's alpha was 0.925 and the correlation of each dimension with the final result of the DMS-BR ranged between 0.606 and 0.810. Correlation with the job satisfaction scale was 0.661. The SEM data ranged between 0.80 and 0.56. The questionnaire presented satisfactory indicators of dentists' self-perception about management and administration activities.
http://ift.tt/2o1dCf4
Effects of avocado/soybean unsaponifiables (ASU) on the treatment of ligature-induced periodontitis in rats
Abstract The purpose of this study is to evaluate the effect of the avocado/soybean unsaponifiables (ASU) on the treatment of induced periodontitis in rats. Periodontitis was induced in 84 rats via ligature placement around the second upper molar, which was removed after 7 days, and scaling and root planning (SRP) was performed at this time. Subsequently, the rats were randomly allocated to four groups with 21 animals each: One SRP group in which saline solution was administered (SS), and three groups in which ASU was administered (0.6 g/kg/day), beginning either 7 days before the induction of periodontitis (SRP/ASU-7), on the day of periodontitis induction (SRP/ASU0), or on the day of treatment (SRP/ASU+7). ASU and SS were administered daily by gavage until the sacrifice of the animals (7, 15, and 30 days after SRP). The % bone in the furcation area was evaluated by histomorphometry and micro-CT. The expression of proteins (TRAP, RANKL, and alkaline phosphatase) and mRNA (IL-1β, TNF-α, IL-6, RANKL, and alkaline phosphatase) were evaluated by immunohistochemistry and qPCR. The SRP/ASU+7 group presented a higher percentage of bone fill in the furcation area and higher expression of alkaline phosphatase than in the SRP group (at 7 and 30 days, respectively). The SRP/ASU0 and SRP/ASU+7 groups presented lower expression levels of RANKL mRNA than the SRP and SRP/ASU-7 groups at 15 days. ASU administration on the day of the SRP treatment of the ligature-induced periodontitis promoted subtle beneficial effects on periodontal repair following the treatment of induced periodontitis within the experimental period of 7 days.
http://ift.tt/2oS4Lk9
Influence of root dentin treatment on the push-out bond strength of fibre-reinforced posts
Abstract This study evaluates the influence of root dentin treatment with NaOCl alone and combined with EDTA, with and without ultrasound activation, on the push-out bond strength (BS) of fiber-reinforced posts in weakened roots, cemented with RelyX or Panavia. The root canals of 42 maxillary canines were instrumented with Reciproc and 2.5% NaOCl. In the coronal 12mm of all canals, experimental weakening of the roots was produced by reducing dentin thickness with 2.44mm diameter diamond burs. The roots were assigned to 3 groups (n = 14) according to root dentin treatment: 2.5% NaOCl; 2.5% NaOCl + 17% EDTA; and 2.5% NaOCl + 17% EDTA, with solutions agitated using passive ultrasonic irrigation. After cementation of the fiber-reinforced posts the roots were divided in thirds. The first slice of each third was used for the push-out BS test, the second slice for confocal laser scanning microscopy and dentin microhardness (Knoop) analysis. Data were analysed by a two-way ANOVA and Tukey test (a = 0.05). NaOCl + EDTA provided highest BS values than NaOCl (p < 0.0001). Specimens cemented with Panavia presented significantly higher BS than those with RelyX in the three root thirds (p < 0.0001). The highest BS values occurred in the cervical third (p < 0.001). Ultrasound-activated NaOCl + EDTA promoted the greatest reduction in dentin microhardness, followed by NaOCl/EDTA and NaOCl. Ultrasonic activation of NaOCl and EDTA reduced root dentin microhardness, but did not improve the push-out BS of resin-based cements. Panavia presented higher BS than RelyX. RelyX was not influenced by the root dentin treatment protocols.
http://ift.tt/2o18sA3
Dermoscopy Can Help Distinguish Melanoma From Benign Skin Lesions
Dermoscopy can help identify seborrheic keratosis (SK)-like melanomas that are challenging to detect otherwise, researchers say.
Reuters Health Information
http://ift.tt/2o7dQUK
The Higher the Insulin Resistance the Lower the Cardiac Output in Men with Type 1 Diabetes During the Maximal Exercise Test
Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.
http://ift.tt/2oRQcx5
Assessing the Impact of Insulin Glargine and Detemir Treatment to Serum Total IGF1 Levels in the Insulin-Naive Type 2 Diabetic Patients
Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.
http://ift.tt/2o0YJcG
Diagnostic and Prognostic Significance of Computerized Cytologic Morphometry of the Thyroid Neoplasm
Condition: Computerized Cytomorphometry
Intervention: Other: computerized cytomorphometry
Sponsor: National Taiwan University Hospital
Recruiting - verified April 2017
http://ift.tt/2oXTGOg
Intervention: Other: computerized cytomorphometry
Sponsor: National Taiwan University Hospital
Recruiting - verified April 2017
http://ift.tt/2oXTGOg
Studying Survivorship Care Plans in Head and Neck Cancer
Condition: Head and Neck Cancer
Intervention: Other: educational materials
Sponsor: Duke University
Not yet recruiting - verified March 2017
http://ift.tt/2ojX9ne
Intervention: Other: educational materials
Sponsor: Duke University
Not yet recruiting - verified March 2017
http://ift.tt/2ojX9ne
The Microbiome in Subfertility and Assisted Reproductive Technologies (ART)
Conditions: Infertility; Subfertility
Intervention: Other: 3 Sampling points
Sponsor: Universitair Ziekenhuis Brussel
Recruiting - verified April 2017
http://ift.tt/2oYkiym
Intervention: Other: 3 Sampling points
Sponsor: Universitair Ziekenhuis Brussel
Recruiting - verified April 2017
http://ift.tt/2oYkiym
Comparing immediate type food allergy in humans and companion animals – revealing unmet needs
Abstract
Adverse food reactions occur in human as well as veterinary patients and systematic comparison may lead to improved recommendations for prevention and treatment in both. In this position paper, we summarize the current knowledge on immediate type food allergy versus other food-adverse reactions in companion animals, and compare this to the human situation. While the prevalence of food allergy in humans has been well studied for some allergens, this remains to be investigated for animal patients, where owner-reported as well as veterinarian-diagnosed food adverse reactions are on the increase. The characteristics of the disease in humans versus dogs, cats, and horses are most often caused by similar, but sometimes species-dependent different, pathophysiological mechanisms, prompting the specific clinical symptoms, diagnoses and treatments. Furthermore, little is known about the allergen molecules causative for type I food allergy in animals which, like in human patients, could represent predictive biomarkers for risk evaluation. The definite diagnosis of food allergy relies -as in humans- on elimination diet and provocation tests. Besides allergen avoidance in daily practice, novel treatment options and tolerization strategies are underway.
Taken together, numerous knowledge gaps were identified in veterinary food allergy, which need to be filled by systematic comparative studies.
This article is protected by copyright. All rights reserved.
http://ift.tt/2nxIiJ2
Heterotopic pancreatic tissue associated with type 1 choledochal cyst, cystolithiasis and gall bladder stones: a rare entity with review of literature
Choledochal cyst is a rare congenital malformation, particularly when associated with stones in cyst (cystolithiasis), gallstones and heterotopic pancreatic tissue within the cyst wall. The current case represents a 5-year-old boy with abdominal pain, pale colored stools, and jaundice. Magnetic resonance cholangiopancreatography showed a cystic lesion, arising from common bile duct with cystolithiasis and cholelithiasis. He underwent excision of choledochal cyst and gallbladder with Roux-en-Y hepaticojejunostomy. Microscopic examination showed a cyst wall composed of fibrocollagenous tissue lined by cuboidal to low columnar epithelium. The subserosal layer of cyst wall showed presence of heterotopic exocrine pancreatic tissue comprising of pancreatic acinar cells and ducts. We report the first case of heterotopic pancreatic tissue associated with choledochal cyst and cystolithiasis and cholelithiasis occurring at the same time.
http://ift.tt/2nxkZyO
Patients with high c-MYC expressing squamous cell carcinomas of the tongue show better survival than those with low and medium expressing tumours
Abstract
Background
c-MYC is a potent oncoprotein with roles in a wide range of cellular processes such as differentiation, apoptosis and growth control. Deregulation of the MYC gene is commonly seen in human tumours resulting in overexpression of the protein. Here we studied expression of c-MYC in correlation to clinical outcome in patients with primary squamous cell carcinoma of the mobile tongue.
Methods
Immunohistochemistry was used to identify c-MYC in a group of 104 tongue squamous cell carcinomas with an antibody directed against the N-terminal part of the protein. Staining was evaluated by multiplying the percentage of c-MYC expressing cells with staining intensity, giving a quick score (QS) for each tumour.
Results
All 104 tumours expressed c-MYC at varying levels. Quantitation according to percent of positive cells and staining intensity revealed that most (15/21; 71%) high expressing tumours were seen in males. Within the group of high c-MYC expressing tumours the majority were alive 2 and 5 years after treatment.
Conclusions
The present findings show that expression of c-MYC has prognostic value in squamous cell carcinoma of the tongue, and could be useful in choice of therapy.
This article is protected by copyright. All rights reserved.
http://ift.tt/2oj0piW
Type 3 Neovascularization Associated with Retinitis Pigmentosa
Purpose: To report a case of type 3 neovascular lesion in a patient with retinitis pigmentosa (RP) complicated by macular edema. Case Report: A 78-year-old man with a long follow-up for RP was referred for painless visual acuity decrease in the right eye. Best-corrected visual acuity was 20/125 in the right eye and 20/40 in the left. Fundus examination showed typical RP and macular edema in both eyes. In the right eye, spectral domain optical coherence tomography revealed a marked cystic macular edema associated with disruption of the Bruch membrane/retinal pigment epithelium complex overlying a pigmentary epithelium detachment, with a vascular structure which appeared to originate from the deep capillary plexus and to be connected with the subretinal pigment epithelium space. Optical coherence tomography angiography showed a high-flow vessel infiltrating the outer retinal layers in the deep capillary plexus segmentation, and a tuft-shaped, bright, high-flow network that seemed to be connected with the subretinal pigment epithelium space in the outer retinal layer segmentation. This presentation was consistent with an early type 3 neovascular lesion in the right eye. Conclusion: Type 3 neovascularization may be considered a possible complication of RP.
Case Rep Ophthalmol 2017;8:245–249
http://ift.tt/2oXDTfi
Case Rep Ophthalmol 2017;8:245–249
http://ift.tt/2oXDTfi
Long-Term Clinical Course in a Patient with Complete Congenital Stationary Night Blindness
Background: This report describes a 45-year-old man with complete congenital stationary night blindness (CSNB1) who has been followed up for 38 years. Case: The patient first visited our hospital as a 7-year-old boy with a complaint of low visual acuity. Best corrected visual acuity (BCVA) was 0.5 in the right eye and 0.6 in the left eye. The refractive error was approximately –5.0 D in both eyes. The fundus showed only myopic changes. A bright-flash electroretinogram (ERG) revealed a negative configuration. We diagnosed CSNB and corrected the refractive error with glasses. We continued to monitor the ERG and various waveform components as well as visual acuity and the appearance of the fundus. All NYX exons were screened for a causative mutation by polymerase chain reaction amplification, and direct sequencing was performed. Results: By 10 years of age, BCVA had increased to 0.8 on the right and 0.9 on the left, with little change thereafter. The fundus continued to show only myopic changes. No changes were seen in the amplitude or implicit time of the a-wave or b-wave or in the b/a-wave ratio. A novel hemizygous insertion mutation, c.1205_1206insT, p.(Glu404Argfs*89), was detected in exon 2 of the NYX gene. Conclusion: To our knowledge, this is the longest follow-up of a patient with CSNB1. No changes in the clinical course have been seen during follow-up. We believe that it is important to continue observations and accumulate clinical data for prognostic purposes on patients with CSNB1.
Case Rep Ophthalmol 2017;8:237–244
http://ift.tt/2nx6CdU
Case Rep Ophthalmol 2017;8:237–244
http://ift.tt/2nx6CdU
Spontaneous Unilateral Subperiosteal Hematoma in the Orbit due to Self-Induced Asphyxia: Unusual Cause of Unilateral Exophthalmos
Background: To report an unusual case of subperiosteal bleeding of nontraumatic etiology. Case Description: A 48-year-old female presented with an acute protrusion of the left eye after nonaccomplished suicide by means of asphyxia using a cable around the neck. At the time of presentation, the MRI showed an orbital subperiosteal hematoma causing an exophthalmos. After conservative treatment, there was a complete remission of the lesion. Conclusion: Nontraumatic subperiosteal bleedings without involvement of the intraocular structures and no vision-threatening intraorbital changes should be treated conservatively.
Case Rep Ophthalmol 2017;8:232–236
http://ift.tt/2oXDSYM
Case Rep Ophthalmol 2017;8:232–236
http://ift.tt/2oXDSYM
Long-Term Follow-Up of Polypoidal Choroidal Vasculopathy Secondary to Angioid Streaks Treated by Intravitreal Aflibercept and Ranibizumab
Purpose: Angioid streaks (AS) are dehiscences in Bruch's membrane that may be idiopathic or associated with numerous systemic illnesses. Polypoidal choroidal vasculopathy (PCV) is an underdiagnosed exudative chorioretinopathy often characterised by serosanguineous detachments of the pigmented epithelium. The use of the anti-VEGF agents ranibizumab and aflibercept in the management of PCV secondary to AS has not been previously documented. We report 3 patients with active PCV secondary to AS, 1 of which had a family history of PCV secondary to AS, not previously reported in the literature. All patients were symptomatic and treated with intravitreal anti-VEGF therapy with and without combination photodynamic therapy (PDT). Methods: This is a long-term retrospective case review of 3 eyes of 3 patients with AS and clinical features of PCV. The patients were examined using fundoscopy, spectral domain optical coherence tomography, fluorescein angiography, and indocyanine green angiography. All patients were managed with intravitreal anti-VEGF using a treat-and-extend protocol according to specific retreatment criteria. One patient had 1 session of PDT in combination with anti-VEGF injections. Results: The mean follow-up time in all patients was 4 years. In all 3 cases, the treatment resulted in improved visual acuity and regression of active PCV lesions with a longer duration between injections. Conclusion: The treat-and-extend protocol with intravitreal aflibercept or ranibizumab with or without PDT is effective and safe for PCV secondary to AS.
Case Rep Ophthalmol 2017;8:221–231
http://ift.tt/2nx6DP0
Case Rep Ophthalmol 2017;8:221–231
http://ift.tt/2nx6DP0
Optical Coherence Tomography Angiography of Retinal Microvascular Changes Overlying Choroidal Nodules in Neurofibromatosis Type 1
Purpose: To report 3 cases of neurofibromatosis type 1 (NF1) with choroidal nodules associated with retinal microvascular changes imaged with optical coherence tomography angiography (OCTA). Methods: Small case series in 3 NF1 patients. OCTA examinations were performed by a trained examiner (J.J.) after pupillary dilation. A standard scan, centered over the macula measuring 6 × 6 mm and 3 × 3 mm was obtained according to the findings on standard color photography. Additional scans were obtained in the zones with microvascular abnormalities. The segmentation provided by the machine software was used. Results: Corkscrew retinal vessels were observed in association with "placoid"-type choroidal nodules as shown by near-infrared reflectance imaging. In all cases, multiple lesions were found. They were second- or third-order tortuous vessels originating from the superior or inferior temporal veins. OCTA demonstrated that the tortuous venules were located in the superficial capillary plexus, and no abnormalities were found in the deep capillary plexus. Discussion: Corkscrew retinal vessels are part of a spectrum of retinal microvascular alterations seen in association, sometimes overlying choroidal nodules in patients with NF1 and are visualized in the superficial capillary plexus on OCTA. We demonstrated with OCTA that they are not associated with flow loss or ischemia in the superficial and deep capillary plexus. The link between the underlying nodule remains unclear. Since neovascularization was described in choroidal ganglioneuroma, we hypothesize that corresponding secretory substances from Schwann cells, ganglion cells, or melanocytes in choroidal nodules might alter the retinal vasculature. Conclusion: We report on 3 cases of NF1 with choroidal nodules in association with retinal microvascular changes imaged with OCTA. OCTA demonstrated preservation of the blood flow in the deep and superficial capillary plexus of the retina. We hypothesize that angiogenic factors secreted by the underlying choroidal nodules could have an effect on the retinal vasculature. Further immunohistological studies in NF1 patients with choroidal nodules to detect angiogenic factors (such as VEGF) are necessary to confirm this hypothesis.
Case Rep Ophthalmol 2017;8:214–220
http://ift.tt/2oXzc51
Case Rep Ophthalmol 2017;8:214–220
http://ift.tt/2oXzc51
Delirium and High Creatine Kinase and Myoglobin Levels Related to Synthetic Cannabinoid Withdrawal
Synthetic cannabinoids (SCs) are included in a group of drugs called new psychoactive substances. Effects of SCs on the central nervous system are similar to other cannabinoids, but 2–100 times more potent than marijuana. Thus, addiction and withdrawal symptoms are more severe than natural cannabinoids. Withdrawal symptoms of SCs were reported in the literature previously. But there is no report about SC withdrawal delirium and its treatment. Several studies reported that agonists of CB1 receptors play a role in GABA and glutamatergic neurotransmission, which is similar to the effects of alcohol on GABA and glutamatergic receptors. Previous studies on alcohol delirium cases suggested that elevated creatine kinase (CK) can be a marker of progress. This study reports delirium and high serum CK levels related to SC withdrawal and offers a treatment with benzodiazepine for them. We described two cases treated in our inpatient clinic about SC withdrawal with increase of serum CK level and other laboratory parameters. One of them demonstrated delirium symptoms and the other did not with early rapid treatment.
http://ift.tt/2oiysru
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