Exacerbations of oral lichen planus and elevated levels of aminotransferases

Abstract

Background

Liver enzymes appear to be involved in oral lichen planus (OLP), but it is not known whether the elevation develops concomitantly with exacerbations of disease. We compared the levels of serum hepatic aspartate (AST) and alanine (ALT) aminotransferases as markers of OLP exacerbation in patients with chronic hepatitis C from those with chronic liver disorders, seronegative for hepatitis C virus (HCV).

Methods

We studied 71 patients with OLP, (48 HCV seropositive and 23 HCV seronegative with chronic liver diseases) measuring AST and ALT. Association of HCV infection status with serum aminotransferase levels in relation to several types of OLP, exacerbations, and clinical score was studied by means of logistic and linear regression (correcting for age and sex).

Results

Of 476 patients screened, 71 were eligible for the study. Patients in the HCV seropositive group had more elevation of AST and ALT levels (mean level, 51.0 U/l; normal level, <45) than patients in the HCV seronegative group (mean level, 47.5 U/l). Mean serum AST and ALT exceeded the upper limit of the normal range in 33 of 48 (68.8%) in the HCV antibody-positive group and in 9 of 23 (39.5%) in the HCV antibody-negative group. Exacerbations of OLP were more frequent in the high-level AST and ALT group, while HCV status group played a minor role.

Conclusions

Among patients with OLP, mild elevation in aminotransferase levels was more common in patients infected with HCV. AST and ALT concentrations were elevated in association with exacerbation of OLP.

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Pyodermatitis-pyostomatitis vegetans associated with asymptomatic inflammatory bowel disease

http://ift.tt/2pGgAch

Complete involution of congenital melanocytic nevus without halo phenomenon in an infant

http://ift.tt/2pfndQk

Identification of students with asthma in Chicago schools

Publication date: Available online 4 May 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Anna Volerman, Stacy Ignoffo, Ashley Hull, Syrennia McArthur Hanshaw, Susan Taylor, Monica Vela, Valerie G. Press




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Influence of FLG mutations and TSLP polymorphisms on atopic dermatitis onset age

Publication date: Available online 4 May 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Joy Wan, Nandita Mitra, Ole J. Hoffstad, David J. Margolis




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Predictors of emergency department use in children with persistent asthma in metropolitan Atlanta, Georgia

Publication date: Available online 4 May 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Jeffery M. Franklin, Jocelyn R. Grunwell, Alice C. Bruce, Robin C. Smith, Anne M. Fitzpatrick
BackgroundRacial disparities are evident among children with asthma in the United States, with non-Hispanic black children at particularly high risk for poor asthma outcomes, including frequent emergency department (ED) use for asthma exacerbations.ObjectiveTo compare asthma features in non-Hispanic black vs white children in Atlanta, Georgia, and determine what clinical features predict future ED use for asthma.MethodsSelf-reported black and white children 6 to 17 years of age with persistent asthma treated with controller medications completed medical history questionnaires, lung function testing, aeroallergen sensitization testing, and venipuncture. Medical records were reviewed for asthma-related ED visits for 12 months after the initial study visit.ResultsA total of 276 children were enrolled. Black children, compared with white children, resided in more disadvantaged zip code areas and were more likely to have public insurance. Black children also had more features of asthma severity and more ED visits during the study period. Predictors of ED use, aside from a previous ED visit, differed by race. After adjustment for socioeconomic status, predictors of ED use in white children included an ED visit in the previous year and sensitization to pets and dust; in black children, predictors included ED use in the previous year, the number of asthma controller medications, forced expiratory volume in 1 second less than 80% predicted, blood eosinophil count greater than 4%, and mold sensitization.ConclusionAsthma features and ED use differ between black and white children in metropolitan Atlanta. Strategies to eliminate allergen exposure in the home and improve asthma control in these children may require tailoring for different racial groups.



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The presence of atopy and its effect on bacterial colonization of the upper airways in children with adenoid vegetation

Publication date: Available online 3 May 2017
Source:Alergologia Polska - Polish Journal of Allergology
Author(s): Gabriela Bugova, Barbora Uhliarova, Milos Jesenak, Andrej Hajtman
Background: The aim of this study was to determine the frequency of atopy and the influence of atopy on bacterial colonization of upper airway in children with adenoid hypertrophy. Material and methods: Forty children were enrolled in the prospective study. Presence of atopy was diagnosed by skin-prick test. Differences in bacterial colonization of middle nasal meatus and nasopharynx according to the presence of atopy were analyzed. Results: Atopy was diagnosed in 75% children with adenoid hypertrophy. Presence of atopy was associated with significantly more often colonization of pathogenic bacteria (Streptococcus pneumoniae, Hemophillus influaenzae, Moraxella catarrhalis, Staphylococcus aureus) in the middle nasal meatus but not in nasopharynx (P=0.045, P=0.483, respectively). Identification of pathogenic bacteria in middle nasal meatus did not correlate with isolation of pathogenic bacteria in nasopharynx in both groups of children. Conclusion: There is a high incidence of atopy in children with adenoid hypertrophy. Atopy is related to increased colonization by pathogenic bacteria in middle nasal meatus but not in nasopharynx.



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Influence of FLG mutations and TSLP polymorphisms on atopic dermatitis onset age

Atopic dermatitis (AD) is a chronic, inflammatory skin disorder driven by complex biologic and environmental influences. AD has been divided into early-onset and late-onset forms, with some speculating that early-onset AD is driven predominantly by genetic factors, whereas late-onset disease is driven by environmental exposures.1 Among many genetic factors relevant to AD are filaggrin (FLG), an epidermal barrier protein, and thymic stromal lymphopoietin (TSLP), an interleukin 7–like cytokine that promotes TH2 cell differentiation.

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Predictors of emergency department use in children with persistent asthma in metropolitan Atlanta, Georgia

Racial disparities are evident among children with asthma in the United States, with non-Hispanic black children at particularly high risk for poor asthma outcomes, including frequent emergency department (ED) use for asthma exacerbations.

http://ift.tt/2qFV2Lt

Identification of students with asthma in Chicago schools

Asthma is the most common chronic childhood condition, affecting 1 of every 11 children in the United States. Disparities are well documented, with minority and underserved youth disproportionately affected.1 In addition to causing medical complications that lead to emergency department visits and hospitalizations, asthma negatively affects school attendance, readiness, and achievement.2

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Mucosal and systemic immune response to sublingual or intranasal immunization with phosphorylcholine

Publication date: Available online 4 May 2017
Source:Auris Nasus Larynx
Author(s): Yoshiko Maseda, Junichiro Ohori, Norimitsu Tanaka, Hiromi Nagano, Keiichi Miyashita, Yuichi Kurono
ObjectivePhosphorylcholine (PC) is a structural component of a wide variety of pathogens including Streptococcus pneumoniae and Haemophilus influenzae. Here, the immune response in mice to PC immunization via the sublingual (SL) route versus the intranasal (IN) route was investigated in terms of efficacy and safety.MethodsBALB/c mice were immunized with PC-keyhole limpet hemocyanin (KLH) plus cholera toxin (CT) or CT alone via the IN or SL route. The immune response generated was studied in terms of PC-specific antibody titers, interferon (IFN)-γ and interleukin (IL)-4 production by CD4⁺ T cells, and cross-reactivity of PC-specific immunoglobulin (Ig)-A antibodies in nasal washes against S. pneumoniae and non-typeable H. influenzae.ResultsSL and IN immunization with PC-KLH plus CT resulted in a marked increase in the levels of PC-specific, mucosal IgA and serum IgM, IgG, and IgA antibodies. Additionally, SL immunization elicited significantly higher levels of PC-specific IgG2a subclass antibodies and IFN-γ in serum. On the other hand, IN immunization with CT alone remarkably increased the total IgE level in serum compared with SL and IN immunization with PC-KLH plus CT. PC-specific IgA antibodies in nasal wash samples reacted to most strains of S. pneumoniae and non-typeable H. influenzae.ConclusionSL immunization is as effective as IN immunization to induce PC-specific immune responses and more effective than IN immunization to reduce the production of IgE and to prevent the sensitization to allergen causing type I allergy.



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Vestibular syncope: A disorder associated with drop attack in Ménière’s disease

Publication date: Available online 3 May 2017
Source:Auris Nasus Larynx
Author(s): Ilmari Pyykkö, Vinaya Manchaiah, Jing Zou, Hilla Levo, Erna Kentala
ObjectiveExperiments in humans and animals indicate that vestibular influx through vestibular sympathetic reflex is an important and vital part of the regulatory system of circulation. The otolith organ adjusts the circulatory responses through the vestibular sympathetic reflex during an upright stance and may trigger a vasovagal attack of syncope. The aim of the present study was to evaluate the prevalence and association of syncope attacks among patients with Ménière's disease (MD). Vestibular syncope was defined as a sudden and transient loss of consciousness, which subsides spontaneously in people with vestibular disorders and without localizing neurological deficit.MethodsDuring clinical interactions, we encountered 5 patients with syncope during a Tumarkin attack of MD. Thereafter we evaluated data from 952 patients collected with a questionnaire from the Finnish Ménière Association (FMA). The data contained case histories with special attention to Tumarkin attacks, participation restriction, migraines, and syncope attacks. The mean age of the subjects participating in the study was 60.6 years (range 25–75 years). The duration of the disease was on average 9.8 years (range 0.5–35 years).ResultsIn the current study sample, attacks of syncope were reported by 38 patients (4%) in association with the vertigo attack. Syncope was associated with Tumarkin attacks (X²=16.7, p<0.001), migraine (X²=7.4, p<0.011), history of ischemic heart disease (X²=6.0, p<0.025), and history of cerebrovascular disease (X²=11.7, p<0.004). Duration of MD was correlated with syncope. Syncope was provoked by physical strain and environmental pressure, and was associated with impairment of the visual field (i.e., visual blurring). In logistic regression analysis, syncope was significantly associated with Tumarkin attacks (odds ratio 3.2), migraines (odds ratio 2.3) and nausea (odds ratio 1.3). The attack of syncope was experienced as frightening, and general health related quality of life (HRQoL) was significantly worsened. Also, the patients suffered more from fatigue.ConclusionThe current study indicates that patients with MD who suffer from Tumarkin attacks can suffer from syncope. It confirms the role of the otolith organ in controlling the circulatory homeostasis of the body. The actions are mediated through the vestibular sympathetic reflex.



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Antigen processing and presentation in the thymus: implications for T cell repertoire selection

Kenta Kondo | Kensuke Takada | Yousuke Takahama

http://ift.tt/2qJZXdi

Mucosal and systemic immune response to sublingual or intranasal immunization with phosphorylcholine

Phosphorylcholine (PC) is a structural component of a wide variety of pathogens including Streptococcus pneumoniae and Haemophilus influenzae. Here, the immune response in mice to PC immunization via the sublingual (SL) route versus the intranasal (IN) route was investigated in terms of efficacy and safety.

http://ift.tt/2qFrrBS

Development and Characterization of Canine Distemper Virus Monoclonal Antibodies

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy , Vol. 0, No. 0.


http://ift.tt/2q4uVk2

TLR2 mediates autophagy through ERK signaling pathway in Mycoplasma gallisepticum-infected RAW264.7 cells

Publication date: July 2017
Source:Molecular Immunology, Volume 87
Author(s): Ziyin Lu, Daoyuan Xie, Ying Chen, Erjie Tian, Ishfaq Muhammad, Xueping Chen, Yusong Miao, Wanjun Hu, Ziyong Wu, Huili Ni, Jiuqing Xin, Yuan Li, Jichang Li
Toll-like receptor 2 (TLR2) plays a crucial role in early innate immune response of host to various microorganisms. Mycoplasma gallisepticum (MG) is one of the major pathogen that can cause chronic respiratory diseases in chickens, but the molecular mechanism of MG infection still remained unclear. In this study, we examined the typical hallmarks of autophagy and multiple signaling pathways by western blot, immunofluorescence microscopy and electron microscopy. The results indicated that infection of mouse macrophage cell line RAW264.7 with MG activated autophagy and mitogen-activated protein kinases (MAPKs). Silencing of TLR2 by siRNA substantially down-regulated MG-triggered autophagy in macrophages, and markedly reduced MG-induced extracellular regulated protein kinase (ERK) in macrophages but did not down-regulate c-Jun N-terminal kinase (JNK) and p38. Importantly, in macrophages, inhibition of ERK by PD98059 (ERK inhibitor) also significantly attenuated the level of autophagy upon MG infection, and the simultaneous treatment of TLR2 siRNA and PD98059 showed a similar effect on MG-induced autophagy as compared with TLR2 siRNA treatment alone. These findings thus demonstrate that TLR2 may mediate MG-induced autophagy through ERK signaling pathway in macrophage.



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Influence of Deviated Nasal Septum on Nasal Epithelium: An Analysis

Abstract

Nasal obstruction is one of the most common complaint that ENT surgeon faces in his day to day practice. Deviated nasal septum is the most common cause for the nasal obstruction. It causes altered airflow dynamics which leads to various histopathological changes in nasal mucosa.Histopathological changes like lymphocytic infiltration and squamous metaplasia were studied and comparison was done between convex and concave side. A prospective randomized study conducted on 42 patients of deviated nasal septum from January 2015 to December 2015 selected from inpatient department of Otorhinolaryngology, KLES Dr. Prabhakar Kore Hospital and Medical Research Center, Belagavi. This study determined significantly higher rate of squamous metaplasia and lymphocytic infiltration in septal mucosa on concave side when compared with convex side. Furthermore, there was increased lymphocytic infiltration and squamous metaplasia in lateral wall mucosa on concave side as compared to convex side but the difference was not statistically different. Deviated nasal septum predisposes the nasal epithelium to chronic inflammation and squamous metaplasia as a result of altered airflow. Due to changes in pathophysiology the patient is more susceptible to chronic rhinitis/rhinosinusitis.

http://ift.tt/2q2LpcF

Novel compound heterozygous MYO7A mutations in Moroccan families with autosomal recessive non-syndromic hearing loss

by Amina Bakhchane, Majida Charif, Amale Bousfiha, Redouane Boulouiz, Halima Nahili, Hassan Rouba, Hicham Charoute, Guy Lenaers, Abdelhamid Barakat

The MYO7A gene encodes a protein belonging to the unconventional myosin super family. Mutations within MYO7A can lead to either non syndromic hearing loss or to the Usher syndrome type 1B (USH1B). Here, we report the results of genetic analyses performed on Moroccan families with autosomal recessive non syndromic hearing loss that identified two families with compound heterozygous MYO7A mutations. Five mutations (c.6025delG, c.6229T>A, c.3500T>A, c.5617C>T and c.4487C>A) were identified in these families, the latter presenting two differently affected branches. Multiple bioinformatics programs and molecular modelling predicted the pathogenic effect of these mutations. In conclusion, the absence of vestibular and retinal symptom in the affected patients suggests that these families have the isolated non-syndromic hearing loss DFNB2 (nonsyndromic autosomal recessive hearing loss) presentation, instead of USH1B.

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Conservative Surgical and Non-surgical Options in Management of T3 Laryngeal Cancer

Abstract

Purpose of Review

We herein address the most up-to-date findings in the literature in relation to surgical and non-surgical organ preservation strategies aimed at treatment of T3 laryngeal cancer.

Recent Findings

T3 laryngeal cancer represents an advanced stage of neoplastic lesions that poses significant challenges in terms of oncologic outcomes as well as function preservation. In the present form of the TNM staging system, T3 of the larynx includes a wide range of different neoplasms that spread into the visceral (paraglottic and pre-epiglottic) spaces of the organ or tend to infiltrate its cartilaginous framework. A number of therapeutic tools are available for its management and include transoral laser microsurgery, open-neck partial laryngectomies, non-surgical organ preservation strategies (mainly in the form of concurrent chemoradiation), and total laryngectomy with/without complementary (chemo)-radiotherapy according to the postoperative histopathologic evaluation of the surgical specimen.

Summary

No prospective randomized controlled trial has been performed to compare the different options in terms of oncologic and functional outcomes due to the multiple tumor and patient-related variables that should ideally be taken into account. Therefore, lacking precise evidence-based data, the choice among the different therapeutic alternatives, even in the presence of a multidisciplinary head and neck cancer team, is mainly made on the basis of institutional and cultural preferences.

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A Study to Assess The Efficacy of Local Application of Oral Probiotic in Treating Recurrent Aphthous Ulcer and Oral Candidiasis

Abstract

To study the efficacy of local application of oral probiotics in improving oral health in recurrent aphthous ulcer and oral candidiasis. Eighty patients with diagnosis of recurrent aphthous ulcer and oral candidiasis were included in the study. They were divided into group A = 40 patients (patients treated with oral application of probiotic as an adjuvant) and group B = 40 patients (patients treated without probiotic). Both the groups were divided into two subgroups, group AU and group BU for recurrent aphthous ulcer and group AC and BC for oral candidiasis. Clinical signs and symptoms were assessed at the beginning of the study and at the end of the study. Pregnant or lactating women, patients with localised or systemic diseases such as Steven Johnson syndrome, ulcerative colitis, Behcet's syndrome and patients on chemotherapy or radiotherapy were excluded from the study. Bacillus Clausii, was used as a probiotic in our study. Patients in group A showed significant improvement in erythema (p = 0.001), pain reduction (p = 0.0001), decreased oral thrush (p = 0.006) and burning sensation in the mouth (p = 0.005) on day 5, whereas there was no significant difference on day 10 follow up. The study demonstrated the efficacy and rapidity of response to oral probiotic as an adjuvant in treating aphthous ulcer and oral candidiasis. Hence, oral application of probiotics can be used as an adjuvant in treating various oral pathology.

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Botulinum toxin-induced acute anterior uveitis in a patient with Behçet’s disease under infliximab treatment: a case report

Injections of lipopolysaccharide in animal models generate acute anterior uveitis (also known as endotoxin-induced uveitis), but the effects of lipopolysaccharide injection are unknown in humans. We describe a...

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A splenic artery aneurysm presenting with multiple episodes of upper gastrointestinal bleeding: a case report

Splenic artery aneurysm is rare and its diagnosis is challenging due to the nonspecific nature of the clinical presentation. We report a case of a splenic artery aneurysm in which the patient presented with ch...

http://ift.tt/2p1Lc9r

Influence of Deviated Nasal Septum on Nasal Epithelium: An Analysis

Abstract

Nasal obstruction is one of the most common complaint that ENT surgeon faces in his day to day practice. Deviated nasal septum is the most common cause for the nasal obstruction. It causes altered airflow dynamics which leads to various histopathological changes in nasal mucosa.Histopathological changes like lymphocytic infiltration and squamous metaplasia were studied and comparison was done between convex and concave side. A prospective randomized study conducted on 42 patients of deviated nasal septum from January 2015 to December 2015 selected from inpatient department of Otorhinolaryngology, KLES Dr. Prabhakar Kore Hospital and Medical Research Center, Belagavi. This study determined significantly higher rate of squamous metaplasia and lymphocytic infiltration in septal mucosa on concave side when compared with convex side. Furthermore, there was increased lymphocytic infiltration and squamous metaplasia in lateral wall mucosa on concave side as compared to convex side but the difference was not statistically different. Deviated nasal septum predisposes the nasal epithelium to chronic inflammation and squamous metaplasia as a result of altered airflow. Due to changes in pathophysiology the patient is more susceptible to chronic rhinitis/rhinosinusitis.

http://ift.tt/2q2LpcF

Influence of Deviated Nasal Septum on Nasal Epithelium: An Analysis

Abstract

Nasal obstruction is one of the most common complaint that ENT surgeon faces in his day to day practice. Deviated nasal septum is the most common cause for the nasal obstruction. It causes altered airflow dynamics which leads to various histopathological changes in nasal mucosa.Histopathological changes like lymphocytic infiltration and squamous metaplasia were studied and comparison was done between convex and concave side. A prospective randomized study conducted on 42 patients of deviated nasal septum from January 2015 to December 2015 selected from inpatient department of Otorhinolaryngology, KLES Dr. Prabhakar Kore Hospital and Medical Research Center, Belagavi. This study determined significantly higher rate of squamous metaplasia and lymphocytic infiltration in septal mucosa on concave side when compared with convex side. Furthermore, there was increased lymphocytic infiltration and squamous metaplasia in lateral wall mucosa on concave side as compared to convex side but the difference was not statistically different. Deviated nasal septum predisposes the nasal epithelium to chronic inflammation and squamous metaplasia as a result of altered airflow. Due to changes in pathophysiology the patient is more susceptible to chronic rhinitis/rhinosinusitis.

http://ift.tt/2q2LpcF

The Duffy Antigen Receptor for Chemokines (DARC) Regulates Asthma Pathophysiology

Abstract

Background

The Duffy Antigen Receptor for Chemokines (DARC) is an atypical receptor that regulates pro-inflammatory cytokines. However, the role of DARC in asthma pathophysiology is unknown.

Objective

To determine the role of DARC in allergic airways disease in mice, and the association between DARC single nucleotide polymorphisms (SNPs) and clinical outcomes in patients with asthma.

Methods

Mice with targeted disruption of the Darc gene (Darc^∆E2) or WT mice were challenged over three weeks with house dust mite (HDM) antigen. Allergic airways disease was assessed 24 hours and 7 days following the final challenge. Additionally, associations between DARC SNPs and clinical outcomes were analyzed in a cohort of poorly-controlled asthmatics.

Results

Total airway inflammation following HDM did not differ between Darc^∆E2 and WT mice. At 24 hours, Darc^∆E2 mice had increased airway hyperresponsiveness; however, at 7 days airway hyperresponsiveness had completely resolved in Darc^∆E2 but persisted in WT mice. In poorly-controlled asthmatics, DARC SNPs were associated with worse asthma control at randomization and subsequent increased risk of healthcare utilization (odds ratio 3.13(1.37-7.27), p=0.0062).

Conclusions and Clinical Relevance

Our animal model and human patient data suggest a novel role for DARC in the temporal regulation in asthma pathophysiology and symptoms.

This article is protected by copyright. All rights reserved.

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Association Between Ibuprofen Use and Surgically Managed Posttonsillectomy Hemorrhage

This cohort study evaluates the association between ibuprofen use and severity of posttonsillectomy hemorrhage using transfusion events as a marker of severity in pediatric patients undergoing tonsillectomy.

http://ift.tt/2pDilH3

Posttonsillectomy Hemorrhage in the Ibuprofen Era

The perioperative treatment of children undergoing tonsillectomy with or without adenoidectomy has changed considerably since the publication of the American Academy of Otolaryngology–Head and Neck Surgery Foundation "Clinical Practice Guideline: Tonsillectomy in Children" in 2011. Intraoperative dexamethasone has been advocated, perioperative antibiotics have been discouraged, and the previously commonly used combination of acetaminophen and narcotics (codeine or oxycodone hydrochloride) for postoperative pain management has been replaced by the alternative combination of acetaminophen and nonsteroidal anti-inflammatory drugs, principally ibuprofen. The latter recommendation is based principally on the following 3 factors: the comparative effectiveness of ibuprofen to narcotics for posttonsillectomy pain control; the absence of evidence in systematic review that the use of nonsteroidal anti-inflammatory drugs after tonsillectomy is associated with an increased risk for bleeding or clinical intervention owing to bleeding; and concerns regarding the ultrarapid metabolism of codeine and, to a lesser degree, oxycodone in specific individuals, resulting in significantly higher plasma concentrations of morphine compared with normal metabolizers. Indeed, documentation from 1969 to 2012 of multiple cases of death or overdose after tonsillectomy in pediatric patients who had taken codeine postoperatively prompted the US Food and Drug Administration to issue a black box warning in 2013 stating that codeine use was contraindicated in children for this indication.

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Targeted Training in Flexible Transnasal Laryngoscopy Diagnosis

This study assesses the value of targeted education of interns in identifying abnormal fiberoptic laryngoscopy findings.

http://ift.tt/2pDigTL

An Enlarging Neck Mass

A man in his 50s presented with sudden onset of neck swelling, pain, respiratory distress, and jaw pain; his neck was diffusely swollen without palpable fluctuance, induration, or a discrete mass, and imaging showed a large hyperdense mass. What is your diagnosis?

http://ift.tt/2pdiej3

Severity Staging System for Nonmetastatic Papillary Thyroid Carcinoma

This cohort study evaluates whether patient demographic, clinical, and morphologic information can be used to create a more prognostically accurate cancer staging system for nonmetastatic papillary thyroid carcinoma.

http://ift.tt/2pDliYv

Interview mit Herrn Magnus v. Stackelberg, stellvertretender Vorstandsvorsitzender des GKV-Spitzenverbands

http://ift.tt/2pDch1s

Autotransplantation of teeth using computer-aided rapid prototyping of a three-dimensional replica of the donor tooth: a systematic literature review

Publication date: Available online 3 May 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): J.P. Verweij, F.A. Jongkees, D. Anssari Moin, D. Wismeijer, J.P.R. van Merkesteyn
This systematic review provides an overview of studies on autotransplantation techniques using rapid prototyping for preoperative fabrication of donor tooth replicas for preparation of the neo-alveolus. Different three-dimensional autotransplantation techniques and their treatment outcomes are discussed. The systematic literature search yielded 19 articles that satisfied the criteria for inclusion. These papers described one case–control study, four clinical observational studies, one study with a clinical and in vitro part, four in vitro studies, and nine case reports. The in vitro studies reported high accuracy for the printing and planning processes. The case reports all reported successful transplantation without any pathological signs. The clinical studies reported a short extraoral time of the donor tooth, with subsequent success and survival rates of 80.0–91.1% and 95.5–100%, respectively. The case–control study reported a significant decrease in extraoral time and high success rates with the use of donor tooth replicas. In conclusion, the use of a preoperatively designed surgical guide for autotransplantation enables accurate positional planning, increases the ease of surgery, and decreases the extraoral time. However, the quality of the existing body of evidence is low. Further research is therefore required to investigate the clinical advantages of this innovative autotransplantation technique.



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Immediate implant placement into fresh extraction sockets versus delayed implants into healed sockets: A systematic review and meta-analysis

Publication date: Available online 3 May 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): C.C. Mello, C.A.A. Lemos, F.R. Verri, D.M. dos Santos, M.C. Goiato, E.P. Pellizzer
The aim of this systematic review and meta-analysis was to compare the survival rate of the implants and the peri-implant tissue changes associated with implants inserted in fresh extraction sockets and those inserted in healed sockets. This review has been registered at PROSPERO under the number CRD42016043309. A systematic search was conducted by two reviewers independently in the databases PubMed/MEDLINE, Embase, and the Cochrane Library using different search terms; articles published until November 2016 were searched for. The searches identified 30 eligible studies. A total of 3,049 implants were installed in a total of 1,435 patients with a mean age of 46.68 years and a minimum of 6 months of follow-up. The survival rate of delayed implants (98.38%) was significantly greater than immediate implants (95.21%) (p=.001). For the marginal bone loss (p=.32), implant stability quotients values (p=.44), and pocket probing depth (p=.94) there was no significant difference between the analysed groups. The immediate implants placed in fresh sockets should be performed with caution because of the significantly lower survival rates than delayed implants inserted in healed sockets.



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Vagal nerve stimulator masquerading as an inhaled foreign body in a child

Description

An 8-year-old girl with a history of cyclin-dependent kinase-like 5 (CDKL5) disorder was presented to the emergency department with a short history of stridor and intermittent respiratory distress following eating a biscuit. She had a background of CDKL5 disorder causing neurodevelopmental delay, including being non-verbal, and refractory epilepsy for which she had received a vagal nerve stimulator (VNS) implanted 2 years prior. On initial examination she was noted to be maintaining her oxygen saturations but with intermittent worsening of her stridor and a barking cough. There was no clear preceding history of an upper respiratory tract infection. Given the concerns regarding a potential inhaled foreign body and only minor improvement with steroids and nebulised adrenaline, she was transferred to theatre for formal microlaryngobronchoscopy.

Microlaryngobronchoscopy confirmed oedema of the glottis (figure 1) and subglottis but no inhaled foreign body. It was noted that there was intermittent laryngospasm affecting...

http://ift.tt/2pcLNkD

To show the efficacy of compressive sutures alone in the management of acute hydrops in a keratoconus patient

A 17-year-old boy presented with sudden loss of vision in the left eye (OS) for 3 days. He was diagnosed with acute hydrops following keratoconic progression in OS. The patient was initially started on topical medical therapy, including steroids and hypertonic eye drops; showing no signs of resolution. Hence, the patient was planned for full-thickness compressive corneal sutures. Four sutures were placed along the central oedematous area covering the area of ruptured Descemet's membrane. Signs of resolution were noticed by 1st week and there was complete resolution of oedema by 3rd post-op week. Sutures were removed by 7th postoperative week/45th day. The patient was doing fine with visual acuity of 6/60 in the last visit with no symptoms of discomfort and no signs of corneal vascularisation. Full-thickness corneal compressive sutures is an effective alternative in cases of acute hydrops if perfluoropropane gas is not available.

http://ift.tt/2pCxXuH

Median philtrum sinus: a rare presentation and review of management options

Nasal dermoids are rare congenital abnormalities, and there is only one previously reported case of a philtrum sinus tract extending to the skull base. A 2-month-old boy was presented with an incidental finding of a median philtrum sinus with no infective features and no other abnormal clinical findings. MRI demonstrated a sinus tract extending from the philtrum to the crista galli. On multidisciplinary review, a conservative approach was taken due to the asymptomatic nature of the patient. Given the rarity of nasal dermoids, diagnosis requires precise clinical examination and MRI to identify the extent of the tract. Management options require a multidisciplinary case-specific approach and include non-surgical as well as surgical approaches.

http://ift.tt/2pcTRBU

Atraumatic chylous ascites: an unusual presentation of bladder cancer

We describe a case of bladder cancer presenting with atraumatic chylous ascites, which remains an extremely rare presentation of this condition. A previously well, elderly ex-smoker with no prior history of abdominal surgery was referred for investigation of progressive dyspnoea, increasing peripheral oedema and new-onset ascites, on a background of long-standing alcohol consumption (four standard drinks daily). Liver biochemistry and coagulation profile were normal apart from marked hypoalbuminaemia. Doppler ultrasound of the liver demonstrated normal echotexture and patent vasculature. Abdominal paracentesis yielded 8 L of milk-coloured, triglyceride-rich fluid with abundant malignant cells. Urine cytology demonstrated malignant transitional cells, with radiological evidence of a large enhancing bladder mass, with evidence of adjacent lymphadenopathy and omental involvement. A diagnosis of metastatic stage IV transitional cell bladder cancer was made. The patient declined palliative chemotherapy and passed away 2 months after their initial presentation.

http://ift.tt/2pCHfqr

ERG and OCT findings of a patient with a clinical diagnosis of occult macular dystrophy in a patient of Ashkenazi Jewish descent associated with a novel mutation in the gene encoding RP1L1

A 57-year-old man with a past medical history of diabetes presented for consultation with a several year history of slowly progressive vision loss in both eyes, which continued to deteriorate over 7 years of follow-up. Multimodal imaging was performed and was significant for the following: on spectral domain optical coherence tomography, a gap lesion was present in the ellipsoid layer, beneath the umbo, as well as subtle macular changes on auto fluorescence imaging. Multifocal electroretinography was performed and was abnormal, and a clinical diagnosis of occult macular dystrophy was made. The patient was subsequently evaluated with genetic testing that revealed a novel p.P73S:c 217C>T nonsense mutation within the retinitis pigmentosa 1-like-1 (RP1L1) gene. The clinical significance of the identified variation will require further investigation.

http://ift.tt/2pcya5b

Cytogenetically confirmed primary Ewings sarcoma of the pancreas

Ewing's sarcoma is a highly aggressive malignant tumour most commonly affecting long bones in children and adolescents. It is part of the Ewing's sarcoma family of tumours (ESFTs) that also include peripheral primitive neuroectodermal tumour and Askin's tumours. ESFTs share common cytogenetic aberrations, antigenic profiles and proto-oncogene expression with an overall similar clinical course. In 99% of ESFTs, genetic translocation with molecular fusion involves the EWSR1 gene on 22q12. Approximately 30% of ESFTs are extraosseous, most commonly occurring in the soft tissues of extremities, pelvis, retroperitoneum and chest wall. Primary presentation in solid organs is very rare but has been described in multiple sites including the pancreas. Accurate diagnosis of a Ewing's sarcoma in a solid organ is critical in facilitating correct treatment. We report the case of a 17-year-old girl with cytogenetically confirmed primary pancreatic Ewing's sarcoma and provide a brief review of the published literature.

http://ift.tt/2pCBokN

Look before you leap: a curious case of giant pulmonary bulla

Description

A 56-year-old white woman with a history of chronic obstructive pulmonary disease, hypertension, deep vein thrombosis and chronic alcohol abuse was brought to the emergency room after having two episodes of seizures at home. She was confused and could not give any history. Vital signs were stable and limited neurological exam was unremarkable except for confusion. CT scan of the head was negative for any acute intracranial abnormality and she was admitted for presumed alcohol withdrawal. Soon after admission, she developed shortness of breath, tachycardia and a low-grade fever. On auscultation, she was found to have no breath sounds on the right and a chest X-ray was obtained which showed a large lucency occupying the majority of the right hemithorax (figure 1). The next question for us was if this was a tension pneumothorax and if the patient needs an urgent tube thoracostomy. However, because...

http://ift.tt/2pcWT9a

First US experience with Pipeline Flex with Shield Technology using aspirin as antiplatelet monotherapy

Flow diversion has revolutionised the treatment of intracranial aneurysms, and the Pipeline Embolization Device (PED) remains the only flow diverter (FD) approved in the USA. However, thromboembolic events remain an issue for FDs. Attempting to minimise these incidents, a newer PED has been developed with the use of covalent bonding of phosphorylcholine onto the Pipeline device that has been known as Shield Technology (PED Shield), which in vitro has demonstrated a significant reduction in material thrombogenicity. We report the first US experience of the PED Shield in the treatment of a ruptured fusiform aneurysm located in the right vertebral artery in an attempt to mitigate complications related to the use of dual-antiplatelet therapy and discuss our rationale for using the new FD, using aspirin only as the antiplatelet regimen.

http://ift.tt/2pCHaTF

Secondary multifocal osteosarcoma developing on the background of bone infarct

Description

A 49-year-old-man presented to orthopaedics clinic with complaint of recently growing thigh pain. He had a history of oral and inhaler forms of steroid usage for asthma and allergy on his background. X-ray examination of the left femur showed medullary lytic lesions localised in distal diaphysis–metaphysis causing cortical destruction (figure 1). Contrast-enhanced MRI revealed medullary bone infarcts in distal diaphysis–metaphysis of the distal femur and proximal tibia bilaterally (figure 2). In this infarct area, there were multiple lesions causing cortical destructions with soft tissue components, and showing prominent enhancement on postcontrast images. The largest one is measured 4x2.5 cm. Multiple smaller lesions which were presenting similiar imaging characteristics without soft tissue components were also seen. Histological evaluation revealed the diagnosis of osteosarcoma.

Figure 1

(A, B) X-ray examination of the left femur showed the medullary lytic lesions (arrows) localised in distal diaphysis–metaphysis causing cortical...

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Chronische Urtikaria im Kindesalter

Zusammenfassung

Die chronische Urtikaria (CU) ist definiert durch urtikarielle Episoden mit oder ohne Angioödeme, die länger als 6 Wochen täglich oder fast täglich auftreten. Ihre plötzliche Manifestationsform mit und ohne bekannte Ursache wird als chronische spontane Urtikaria bezeichnet. Hiervon wird die chronische induzierbare Urtikaria abgegrenzt. Das differenzialdiagnostische Spektrum der CU im Kindesalter reicht von selbstlimitierenden Dermatosen bis zu schwerwiegenden Systemerkrankungen. Nur bei entsprechendem anamnestischem Verdacht werden weitere, gezielte Untersuchungen zur Detektion potenzieller Triggerfaktoren oder Grunderkrankungen unternommen. Die Behandlung der CU folgt internationalen Leitlinien und wird zunächst mit modernen, nichtsedierenden H₁-Antihistaminika auch in hoher Dosierung durchgeführt. Bei Beschwerdepersistenz können nach sorgfältiger, individueller Abwägung zusätzlich Omalizumab, Ciclosporin oder Montelukast eingesetzt werden.

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Commentary to: Long-term results of a modified expansion sphincter pharyngoplasty for sleep-disordered breathing

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"Commentary to: 'Endoscopic and clinical benefits of hyaluronic acid in children with chronic adenoiditis and middle ear disease'"?

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In-flight allergic emergencies

Allergic and hypersensitivity reactions such as anaphylaxis and asthma exacerbations may occur during air travel. Although the exact incidence of in-flight asthma and allergic emergencies is not known, we have...

http://ift.tt/2pBA166

UPCC 36315 A Phase II Study Of Everolimus (RAD001) And Lenvatinib (E7080) In Patients With Metastatic Differentiated Thyroid Cancer Who Have Progressed on Lenvatinib Alone

Condition:   Thyroid Cancer
Interventions:   Drug: Lenvatinib;   Drug: Everolimus
Sponsor:   Abramson Cancer Center of the University of Pennsylvania
Recruiting - verified May 2017

http://ift.tt/2pc2f4G

A Randomized Phase II Study to Compare the Safety and Efficacy of Dalteparin vs. Rivaroxaban for Cancer-associated Venous Thromboembolism

Conditions:   Cancer-associated Thrombosis;   Esophageal Cancer;   Gastric Cancer;   Hepatobiliary Cancer;   Pancreatic Cancer;   Duodenal Cancer
Interventions:   Drug: Rivaroxaban;   Drug: Dalteparin
Sponsor:   Asan Medical Center
Recruiting - verified May 2017

http://ift.tt/2p0Z8Rf

Robot-assisted IVOR-LEWIS Esophagectomy

Condition:   Clinical or Oncologic Benefits of Robot-assisted IVOR-LEWIS in Esophageal Cancer
Intervention:  
Sponsor:   Ruijin Hospital
Recruiting - verified May 2017

http://ift.tt/2pchaM8

Ramucirumab Plus Irinotecan for Previously Treated Advanced Gastric or Gastro-esophageal Junction Adenocarcinoma

Conditions:   Gastric Adenocarcinoma;   Gastro-esophageal Junction Adenocarcinoma
Interventions:   Drug: Irinotecan;   Drug: Ramucirumab;   Genetic: Blood for angiome profiling;   Genetic: Blood for cfDNA
Sponsors:   Washington University School of Medicine;   Eli Lilly and Company
Not yet recruiting - verified May 2017

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Cardioversion of a supraventricular tachycardia (SVT) in a 7-year-old using a postural modification of the Valsalva manoeuvre

A boy aged 7 years presented with his parents to the emergency department (ED). He had a known diagnosis of paroxysmal supraventricular tachycardia (SVT) and was under the care of paediatricians. He had been suffering episodes of palpitations and chest pain for over a year and had been prescribed atenolol 25 mg ON, though the side effects meant he had not taken it for a month prior to presentation. He had 2 previous confirmed episodes of SVT, one that reverted with Valsalva manoeuvres, and the other with intravenous adenosine. In the ED, an ECG was recorded showing SVT at 180 bpm. Aside from his tachycardia, he was haemodynamically stable. The postural modification of the Valsalva technique was performed within 5 min of arrival, with reversion to sinus rhythm occurring during the leg-lift phase on the first attempt. After 30 min of observation, the child remained stable and was discharged home.

http://ift.tt/2pcfeDo

Intergenerational preferences for radio loudness during automobile driving

Publication date: July 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 98
Author(s): Frederick Howard Bateman Hanser, Eric Adjei Boakye, Anthony Alan Mikulec
IntroductionThe comparative contribution to human noise exposure from the vehicular radio is unknown, as are the radio volume preferences of different generations when driving an automobile.Materials and MethodsA single vehicle was used to measure radio listening level in decibels of three generations (age 16–17 years, age 32–50 years, and age 51–73 years) in various conditions, ranging from engine off with windows closed to 60 miles per hour (mph) with windows open.ResultsNo differences in radio loudness based on the sex of the driver were found. Statistically significant differences were identified in preferred signal to noise ratio among multiple vehicular paradigms, with the youngest generation preferring the largest signal to noise ratio in conditions with low background noise.ConclusionsThe youngest generation favored the largest signal to noise ratio (radio level above background noise), a preference which waned with increasing background noise.



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Sinonasal Characteristics in Patients with Obstructive Sleep Apnea Compared to Healthy Controls

Background. The difference in nasal obstruction between OSA patients and healthy individuals is not adequately documented. Our aim was to describe the sinonasal quality of life and nasal function in OSA patients and healthy controls using the sinonasal outcome test-20 (SNOT-20), nasal obstruction visual analog scale (NO-VAS), and peak nasal inspiratory flow (PNIF). Methodology and Principal. Ninety-three OSA patients and 92 controls were included in a case-control study from 2010 to 2015. Results. Mean SNOT-20 score in the OSA group was 1.69 (SD 0.84) compared to 0.55 (SD 0.69) in controls (, 95% CI [0.9, 1.4]). The mean NO-VAS score was 41.3 (SD 12.8) and 14.7 (SD 14.4) in the OSA group and controls, respectively, (, 95% CI [22.7, 30.6]). PNIF measured 105 litres/minute in the OSA group and 117 litres/minute in controls (, 95% CI [−21.8, −3.71]). There was a positive correlation between subjective nasal obstruction and change in PNIF after decongestion in the control group alone. Conclusions. OSA patients have a reduced sinonasal QoL and lower peak nasal inspiratory flow compared to controls. Treatment of nasal obstruction in OSA patients should be made a priority along with treatment of the ailment itself.

http://ift.tt/2quzBjl

Transsphenoidal and infralabyrinthine approach of the petrous apex cholesterol granuloma

Abstract

Space-demanding or destructive changes in the petrous bone are often challenging differential diagnosis. Cholesterol granulomas of the petrous apex can clinically present in a combination of hearing loss, vertigo, tinnitus, chronic cephalgia, impairment of facial nerve function, neuralgic pain of the nervus trigeminus, or manifest diplopia by the nerve palsy of the nervus abducens. CT-morphologically cholesterol granulomas appear as soft-tissue density masses, which may display a discrete rim after intravenous administration of a contrast agent. The MRI, T1 as well as T2-weighted images show a strong signal in the area of the lesion. Depending on the individual anatomical conditions, the surgical access must be carefully chosen between transsphenoidal, transtemporal, infracochlear/-labyrinthine, or translabyrinthine. Here, we present the transsphenoidal and translabyrinthine access for the excision of cholesterol granulomas of the petrous apex. The different accesses are compared using a neuro-navigation-supported surgical technique with respect to its complications, drainage possibilities, outcomes, and recurrence of symptoms.

http://ift.tt/2pIrnB3

Back to the History

Foreword. In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows. Stage. An 82-year-old man presented to…

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What can Sjögren's syndrome-like disease in mice contribute to human Sjögren's syndrome?

Publication date: Available online 3 May 2017
Source:Clinical Immunology
Author(s): Ammon B. Peck, Cuong Q. Nguyen
For decades, Sjögren's syndrome (SS) and Sjögren's syndrome-like (SS-like) disease in patients and mouse models, respectively, have been intensely investigated in attempts to identify the underlying etiologies, the pathophysiological changes defining disease phenotypes, the nature of the autoimmune responses, and the propensity for developing B cell lymphomas. An emerging question is whether the generation of a multitude of mouse models and the data obtained from their studies is actually important to the understanding of the human disease and potential interventional therapies. In this brief report, we comment on how and why mouse models can stimulate interest in specific lines of research that apparently parallel aspects of human SS. Focusing on two mouse models, NOD and B6·Il14α, we present the possible relevance of mouse models to human SS, highlighting a few selected disease-associated biological processes that have baffled both SS and SS-like investigations for decades.



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The value of rituximab treatment in primary Sjögren's syndrome

Publication date: Available online 3 May 2017
Source:Clinical Immunology
Author(s): Gwenny M. Verstappen, Jolien F. van Nimwegen, Arjan Vissink, Frans G.M. Kroese, Hendrika Bootsma
The rationale for B-cell depletion therapy with rituximab in pSS relies upon the well-established role of B-cell hyperactivity in immunopathogenesis. In line with this notion, several biomarkers of B-cell activity are significantly affected by treatment, both in the target organs and periphery. In contrast to most biological outcomes, clinical outcomes are not consistent between studies. Although two large RCTs did not meet their primary endpoint, several beneficial clinical effects of treatment have been shown. As discussed in this review, differences in study design and patient characteristics could explain the variation in results. Interestingly, a newly developed composite endpoint of subjective and objective outcomes did show a significant effect of rituximab in one of the large RCTs. Response predictors need to be identified to define more targeted inclusion criteria and achieve precision medicine. The positive effects seen on biological and clinical parameters warrant future studies to investigate this promising treatment modality.



http://ift.tt/2qHWIn1

IgG4-related disease in autoimmune lymphoproliferative syndrome

Publication date: Available online 3 May 2017
Source:Clinical Immunology
Author(s): Annick A.J.M. van de Ven, Maximilian Seidl, Vanessa Drendel, Annette Schmitt-Graeff, Reinhard E. Voll, Anne Rensing-Ehl, Carsten Speckmann, Stephan Ehl, Klaus Warnatz, Florian Kollert
A patient with autoimmune lymphoproliferative disorder (ALPS) developed IgG4-related disease. In retrospect, he had high levels of serum IgG4 for several years prior to presenting with IgG4-related pancreatitis. These high IgG4 levels were masked by hypergammaglobulinemia, a common feature of ALPS. We next screened 18 ALPS patients; four of them displayed increased levels of IgG4. Hence, IgG4-related disease should be considered in ALPS patients, especially in those manifesting lymphocytic organ infiltration or excessive hypergammaglobulinaemia. Screening of IgG4-related disease patients for ALPS-associated mutations would provide further information on whether this disease could be a late-onset atypical presentation of ALPS.



http://ift.tt/2qv7PD8

Raman spectroscopy enables noninvasive biochemical identification of the collagen regeneration in cutaneous wound healing of diabetic mice treated with MSCs

Abstract

Mesenchymal stem cells (MSCs) had been reported as a novel therapeutic strategy for non-healing diabetic cutaneous wound mainly by promoting the formation of extracellular matrix (ECM) and neovasculature. Collagen regeneration is one of the key processes of ECM remodeling in wound healing. Accordingly, rapid assessment of the collagen content in a noninvasive manner can promptly provide objective evaluation for MSC therapy of cutaneous wound healing and strength evidence to adjust therapeutic regimen. In the present study, noninvasive Raman microspectroscopy was used for tracing the regeneration status of collagen during diabetic wound healing with MSCs. Wound tissues of normal mice, diabetic mice, and MSC-treated diabetic mice were subjected to Masson trichrome staining assay and submitted to spectroscopic analysis by Raman microspectroscopy after wounding 7, 14, and 21 days. Masson trichrome staining demonstrated that there was more collagen deposition in diabetic + MSCs group relative to diabetic group. The relative intensity of Raman collagen peak positions at 937, 1004, 1321, 1452, and 1662 cm⁻¹ increased in MSC-treated diabetic group compared to diabetic group, although normal mice group had the highest relative intensity of collagen peak bands. Correlation analysis suggested that the spectral bands had a high positive correlation with the collagen intensity detected by Masson trichrome staining in wound tissues of three groups. Our results demonstrate that Raman microspectroscopy has potential application in rapidly and quantitatively assessing diabetic wound healing with MSCs by monitoring collagen variation, which may provide a novel method for the study of skin regeneration.

http://ift.tt/2pAY6dn

Unusual pulmonary manifestations in hepatitis B associated polyarteritis nodosa

Publication date: Available online 2 May 2017
Source:Alergologia Polska - Polish Journal of Allergology
Author(s): Animesh Ray, Vivek Nangia, Rajat Chatterji, Navin Dalal




http://ift.tt/2pbBJII

News Beyond Our Pages

Publication date: May 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 5
Author(s): Marc E. Rothenberg, Jean Bousquet




http://ift.tt/2pAyrRL

Airway microbiome and responses to corticosteroids in corticosteroid-resistant asthma patients treated with acid suppression medications

Publication date: Available online 3 May 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Elena Goleva, J. Kirk Harris, Charles E. Robertson, Leisa P. Jackson, Richard J. Martin, Donald Y.M. Leung




http://ift.tt/2q1cmNN

Biologics and biomarkers for asthma, urticaria, and nasal polyposis

Publication date: May 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 5
Author(s): Thomas B. Casale
Many patients with allergic disorders continue to have uncontrolled symptoms despite new and better pharmacologic options. Novel biologic agents that target specific and critical pathophysiologic pathways have been developed to better manage these patients. The utility of biologic agents for the management of allergic diseases has been facilitated by recent advances in better characterizing patients, including identification of relevant biomarkers that predict clinical responsiveness. This has led to the ability to phenotype and endotype patients, allowing for a more rational approach to picking a specific biologic agent for a specific patient. In this review I focus on point-of-care biomarkers that enhance the usefulness of biologics to manage uncontrolled asthma, urticaria, and nasal polyposis. I discuss biologic agents already approved for the management of allergic and respiratory disorders and biologics currently in development or recently abandoned because of a lack of efficacy or intolerable side effects. The successes and failures of biologics in clinical trials have facilitated our ability to better understand which molecules and pathways are most important in the pathogenesis of allergic diseases and in the development of symptoms and impairment in individual patients.



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Biologics and biomarkers for asthma, urticaria, and nasal polyposis

Publication date: May 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 5





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Biologics in patients with skin diseases

Publication date: May 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 5
Author(s): Mylène S. Veilleux, Neil H. Shear
Biologic agents are important therapeutic options for treating multiple moderate-to-severe cutaneous diseases. Monoclonal antibodies already in use or under investigation are targeted for psoriasis, atopic dermatitis, melanoma, hidradenitis suppurativa, and pemphigus vulgaris.



http://ift.tt/2pIplAX

Omalizumab in children with uncontrolled allergic asthma: Review of clinical trial and real-world experience

Publication date: May 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 5
Author(s): Bradley E. Chipps, Bob Lanier, Henry Milgrom, Antoine Deschildre, Gunilla Hedlin, Stanley J. Szefler, Meyer Kattan, Farid Kianifard, Benjamin Ortiz, Tmirah Haselkorn, Ahmar Iqbal, Karin Rosén, Benjamin Trzaskoma, William W. Busse
Asthma is one of the most common chronic diseases of childhood. Allergen sensitization and high frequencies of comorbid allergic diseases are characteristic of severe asthma in children. Omalizumab, an anti-IgE mAb, is the first targeted biologic therapeutic approved for the treatment of moderate-to-severe persistent allergic asthma (AA) that remains uncontrolled despite high-dose inhaled corticosteroids plus other controller medications. Since its initial licensing for use in adults and adolescents 12 years of age and older, the clinical efficacy, safety, and tolerability of omalizumab have been demonstrated in several published clinical trials in children aged 6 to less than 12 years with moderate-to-severe AA. These studies supported the approval of the pediatric indication (use in children aged ≥6 years) by the European Medicines Agency in 2009 and the US Food and Drug Administration in 2016. After this most recent change in licensing, we review the outcomes from clinical trials in children with persistent AA receiving omalizumab therapy and observational studies from the past 7 years of clinical experience in Europe. Data sources were identified by using PubMed in 2016. Guidelines and management recommendations and materials from the recent US Food and Drug Administration's Pediatric Advisory Committee meeting are also reviewed.



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IL-33 in clinical practice: size matters?

Publication date: Available online 4 May 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Hideaki Morita, Susumu Nakae, Hirohisa Saito, Kenji Matsumoto




http://ift.tt/2pAJxGN

The Editors' Choice

Publication date: May 2017
Source:Journal of Allergy and Clinical Immunology, Volume 139, Issue 5
Author(s): Cezmi A. Akdis, Zuhair K. Ballas




http://ift.tt/2pIgqzE

A Case of Urachal Carcinoma of the Abdominal Wall in a Kidney Transplant Recipient

Urachal carcinoma is an extremely rare malignant tumor arising from the urachus in the fetus. We report a patient who developed urachal carcinoma 18 years after kidney transplantation. A 59-year-old man was admitted because of abdominal pain and massive ascites. He had undergone kidney transplantation 18 years earlier and had end-stage renal disease requiring dialysis. Abdominal CT showed massive ascites and an abdominal wall cystic mass separated from the peritoneal cavity. Hemodialysis was started, and paralytic ileus was diagnosed and treated. His ileus symptoms improved temporarily, but he died of myocardial infarction. An autopsy was performed, which revealed cystadenocarcinoma in the abdominal wall mass, leading to a diagnosis of urachal carcinoma.

http://ift.tt/2oZZO9q

Cardiac intimal sarcoma with PDGFRβ mutation and co-amplification of PDGFRα and MDM2 : an autopsy case analyzed by whole-exome sequencing

http://ift.tt/2p8hMlf

Importance of anchoring sleeve in pacemaker implantation

Description

The greatest benefit of the cephalic approach is its margin of safety compared with that of the axillary/subclavian stick as there is almost no risk of pneumothorax or haemothorax.1 Permanent pacemaker was implanted in a 60-year-old man with sick sinus syndrome from right side by cephalic cut-down approach. On the next day, patient complained of one episode of syncope. Pacing interrogation revealed minimally elevated impedance with intermittent failure to capture. Fluoroscopic examination (figure 1A–C) showed partial lead transaction (concomitant conductor fracture and insulation defect). It occurred because of a very tight knot which was put directly over the vein to anchor the lead as there was no fixation sleeve between the lead and inner wall of cephalic vein causing direct mechanical trauma of lead. The lead was removed and replaced with another lead via subclavian route. Lead conductor fracture is associated with infinitely high lead impedance...

http://ift.tt/2qC1XFq

Malar rash in classical homocystinuria

Description

An 8-year-old girl with intellectual disability and severe myopia presented with subacute bilateral painless loss of vision. Anthropometric examination showed a weight of 26 kg (–0.1 Z score), height of 122.5 cm (between –1 and –2 Z score), arm span of 129 cm (6.5 cm longer than the height) and head circumference of 51 cm (between –1 and –2 Z score). Physical examination showed thin, hypopigmented hair with malar rash (figure 1A), acral hyperpigmentation, bilateral inferonasal subluxation of lens and bilateral optic atrophy. Other marfanoid features such as arachnodactyly, high-arched palate, joint hyperlaxity and cardiac anomalies were absent. A clinical diagnosis of classical homocystinuria was considered. Investigations showed elevated plasma homocysteine of 209 µmol/L (range 5–15 µmol/L), urine homocystine of 76 mmol/mol creatinine (range 0–4 mmol/mol creatinine), serum vitamin B₁₂ of 445 pg/mL (211–911 pg/mL), normal methionine of 51 µmol/L (0–75 µmol/L) and a normal carnitine profile, which confirmed our clinical diagnosis. MRI of the brain showed normal parenchyma with bilateral...

http://ift.tt/2pJUgyS

Atrioventricular block: an unusual complication of Graves disease

We report the case of a 10-year-old girl treated with atenolol and carbimazole for tachycardia and hypertension associated with Graves' disease who developed symptomatic 2:1 heart block. 2:1 heart block resolved following cessation of atenolol, reduction in carbimazole dose and treatment of suspected tonsillitis. First-degree atrioventricular block persisted, but gradually normalised following improvement in thyroid status.

http://ift.tt/2qBDxfn

Seizure induced by sudden cessation of pregabalin in a patient with chronic kidney disease

A middle-aged woman with diabetic nephropathy on pregabalin for neuropathic pain presented with a diarrhoeal illness. She was found to have acute on chronic renal impairment with an estimated glomerular filtration rate (eGFR) of 10 mL/min, and her usual 150 mg/day of pregabalin was abruptly ceased. Although renal recovery to her baseline of eGFR 15 mL/min was achieved within 3 days, her pregabalin was not restarted. She suffered a tonic–clonic seizure 4 days later, thought to be due to pregabalin withdrawal as there were no other likely causes identified. She suffered no further seizures on recommencement of pregabalin at a renally adjusted dose of 75 mg/day.

http://ift.tt/2pJZvi7

Full-thickness macular hole: a rare complication of Borrelia burgdorferi neuroretinitis

Borrelia burgdorferi is a known infective cause of neuroretinitis. We present a case of B burgdorferi neuroretinitis complicated by macular hole in a 22-year-old man. The neuroretinitis was managed with early high-dose intravenous corticosteroid and oral antibiotic. The macular hole was managed with macular hole surgery after intraocular inflammation had resolved.

http://ift.tt/2qBvhMd

A giant left atrial thrombus

Description

A 57-year-old woman with hypertension, dyslipidaemia, diabetes mellitus type 2, paroxysmal atrial fibrillation (AF), porcine mitral valve replacement and dilated cardiomyopathy requiring an automatic implantable cardioverter defibrillator presented with palpitation for 2 days. She had tiny left atrial thrombus (LAT), which resolved completely with warfarin 6 months ago. She was not in compliance with warfarin thereafter. Physical examination had no evidence for systemic embolisations and cardiovascular examination was unremarkable. ECG showed AF with rapid ventricular response of 132 beats per minutes. Chest X-ray showed remarkable cardiomegaly without congestion. Transthoracic echocardiogram (TTE) 6 months prior revealed a small LAT, normal bioprosthetic mitral valve and mild biventricular dilation with a severely reduced left ventricular ejection fraction of 25%–30%. Repeated TTE exposed a giant LAT measuring 4 cm x 3.5 cm (figure 1A–D, arrows). Surgical removal was recommended due to high risk of embolisation but patient deferred. Enoxaprin overlapping with warfarin was initiated and a rapid reduction in...

http://ift.tt/2pK1XFv

Pasteurella multocida meningoencephalitis in an immunocompetent adult with multiple cat scratches

We present the case of a 49-year-old woman admitted to our Acute Medical Unit with a 2-day history of fever, vomiting and confusion. The patient was alcohol dependent and had sustained several scratches from her pet cat, which her pet dog had licked. She deteriorated in the Emergency Department—developing high fever, worsening confusion and meningism. Blood cultures were taken and broad spectrum antibiotics commenced prior to CT scanning and diagnostic lumbar puncture. Blood cultures and CSF 16S ribosomal PCR confirmed a diagnosis of Pasteurella multocida bacteraemia and meningoencephalitis. The patient was successfully treated with 14 days of intravenous antibiotics. P multocida is a Gram-negative coccobacillus which frequently colonises the nasopharynx of animals; it is a recognised but very rare cause of meningoencephalitis in immunocompetent adults. This case highlights the need to consider P multocida infection in patients with prior animal contact, regardless of their immune status.

http://ift.tt/2qBSCO3

Helcococcus kunzii prosthetic valve endocarditis secondary to lower extremity cellulitis

An 88-year-old man with history of bioprosthetic aortic valve replacement was hospitalised with fever, chills, malaise and right lower extremity cellulitis. Laboratory investigations revealed leucocytosis and blood cultures grew Helcococcus kunzii. Although transoesophageal echocardiography was negative for endocarditis, the patient was treated with 4 week of intravenous ceftriaxone. However, he was readmitted 6 weeks later with symptoms of fever, chills and hypoxia in setting of recurrent H. kunzii bacteraemia. A repeat transoesophageal echocardiogram revealed a mobile mass on bioprosthetic aortic valve, severe perivalvular insufficiency with pseudoaneurysm formation, and severe native mitral and tricuspid valve regurgitation. Cardiothoracic surgery was consulted and the patient underwent replacement of aortic valve and aortic root, and tricuspid and mitral valve repairs. Histological examination of excised bioprosthetic aortic valve revealed active endocarditis with cocci identified on silver stain. Patient was successfully treated with 4-week course of intravenous ceftriaxone and was doing well at 2-year follow-up.

http://ift.tt/2pKbpZs

Emergency splenectomy postelective colonoscopy

Colonoscopy is the gold standard for investigation of colorectal carcinoma and inflammatory bowel disease. Splenic injury is a rare but potentially fatal complication of colonoscopy. The present case study outlines the early clinical presentation and rapid deterioration of a patient with a splenic injury after an elective colonoscopy. A 70-year-old female underwent a colonoscopy for investigation of altered bowel habit. The procedure was documented as difficult due to the presence of 'stiff loopy colon'. In recovery, patient's condition deteriorated and she was moved to the ward for further assessment. She gradually became haemodynamically unstable and displayed signs of peritoneal irritation. Initial attempts of fluid resuscitation failed to improve patient's clinical condition. Further testing revealed a significant drop in haemoglobin and CT confirmed the diagnosis of a splenic rupture. She underwent an emergency splenectomy that evening. Postoperatively she was managed in the high dependency unit.

http://ift.tt/2qBKQU8

The diagnostic and therapeutic challenges of infective endocarditis presenting as acute stroke

Description

An 81-year-old man presented with sudden-onset slurred speech and right-sided weakness commencing 2 hours previously. Initial National Institute of Health Stroke Scale score was 13. Non-contrast CT brain scan excluded haemorrhage, and he received intravenous thrombolysis. Medical history included tissue aortic valve replacement. On arrival, his temperature was 38°C. Two hours after thrombolysis he had two seizures, and his Glasgow Coma Scale score dropped from 15/15 to 6/15 (breakdown: eyes 1, voice 1, motor 4). Repeat CT demonstrated a left middle cerebral artery territory infarct, and he was transferred to the intensive care unit (figure 1). Transthoracic and transoesophageal echo identified an aortic root abscess and 10x6 mm aortic valve vegetation (figure 2). He was transferred to a cardiothoracic centre and underwent successful aortic root replacement. Blood cultures were negative, but aortic valve biopsy grew staphylococcus epidermidis. He remains aphasic with a right haemiplegia.

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Antacid abuse: a rare cause of severe hypercalcaemia

We discuss a case of an 81-year-old man who presented to hospital with a case of severe hypercalcaemia (5.07 mmol/L). The two most common causes of hypercalcaemia, making up around 90% of the cases, are malignancy and primary hyperparathyroidism. Initial investigations are guided by this knowledge. In this case, no underlying malignancy or evidence of a parathyroid adenoma causing primary hyperparathyroidism was found. Instead, on further history, it was found that this patient had troublesome dyspepsia symptoms for which he had ingested 10–12 calcium carbonate tablets a day for the preceding 2 years. This amounts to 6.6–7.9 g of calcium carbonate per day compared with the guideline daily intake of calcium of 1 g. His presentation of severe hypercalcaemia was therefore diagnosed as milk-alkali syndrome secondary to calcium carbonate tablet abuse.

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Knotted urethral catheter: a twist in the tail

Inadvertent knotting of infant feeding tubes used for clean intermittent catheterisation (CIC) is a rare complication in paediatric patients. The small flexible tubes used in infants if advanced too far into the bladder may form a knot as the bladder empties. Surgical intervention is required especially if it is lodged in the urethra. We present a case of a baby boy aged 4 months on CIC with a 6 Fr feeding tube, which required a meatotomy for removal. Education while instituting CIC must emphasise the length of catheter insertion, the chance of knotted catheter and steps to take if it occurs. A dedicated urotherapy nurse would be ideal.

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Compensating for loss: running on one tibialis anterior

Rupture of the tibialis anterior (TA) tendon is rare and may be either traumatic or spontaneous. TA is the main ankle dorsiflexor, providing 80% of the power, as well as contributing to inversion of the foot. We describe a case of an 84-year-old male who was incidentally diagnosed with absence of his left TA at age 46 while preparing for his first-ever marathon. There was no history of specific injury to this tendon. He subsequently went on to lead an active sporting life, completing over 20 marathons with a best time of 3 hours 12 min.

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A case of pulsatile scalp swelling in a child

Arteriovenous fistulas (AVF) are an entity most commonly seen in the head and neck region. An AVF is a direct connection between the arterial feeders and the draining veins without intervening capillary beds (unlike an arteriovenous malformation in which a nidus intervenes between the arteries and veins). We describe a case of traumatic AVF in a child aged 9 years, who presented with a pulsatile scalp swelling following blunt trauma to the head. It turned out to be an AVF between the superficial temporal artery and vein. Correct diagnosis of an AVF involves Doppler examination with digital subtraction angiography providing a good roadmap for treatment, which can be either endovascular or surgical.

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