Comparison of pharyngocutaneous fistula closure with and without bacterial cellulose in a rat model

Publication date: Available online 6 May 2017
Source:Auris Nasus Larynx
Author(s): Berat Demir, Murat Sarı, Adem Binnetoglu, Ali Cemal Yumusakhuylu, Deniz Filinte, İshak Özel Tekin, Tekin Bağlam, Abdullah Çağlar Batman
ObjectiveThe present study aimed to compare the effects of bacterial cellulose used for closure of pharyngocutaneous fistulae, a complication of total laryngectomy, with those of primary sutures in a rat model.MethodsThirty female Sprague-Dawley underwent experimental pharyngoesophagotomy and were grouped depending on the material used for pharyngocutaneous fistula closure: group I, which received primary sutures alone, group II, which received bacterial cellulose alone; and group III, which received both. After 7 days, the rats were sacrificed. Pharyngocutaneous fistula development was assessed, the gross wound was inspected, and histological examination was conducted.ResultsPharyngocutaneous fistulae developed in 12 rats (41%) in all: 6 from group I (21%), 4 from group II (14%) and 2 from group III (7%).ConclusionFibroblast density and inflammatory cell infiltration were significantly greater in group III than group I. We concluded that bacterial cellulose may be useful for pharyngocutaneous fistula closure.



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Recurrent plexiform schwannoma involving the carotid canal

Publication date: Available online 6 May 2017
Source:Auris Nasus Larynx
Author(s): Kei Ijichi, Masahiro Muto, Ayako Masaki, Shingo Murakami
Plexiform schwannoma (PS) is a rare variety of benign nerve sheath tumor characterized by a multinodular plexiform growth pattern. PS is usually confined to the head and neck or skin. The pre-operative diagnosis of PS is difficult, and this has lead to a common misdiagnosis as a schwannoma. In addition, studies have indicated that an incomplete resection of PS often results in tumor recurrence. Here we describe a rare case of PS presented in the parapharyngeal space. Our case involved a 36-year-old man with swelling of the pharynx, who presented with a soft cervical mass. MRI revealed a multinodular mass in the left parapharyngeal space, and further pathological diagnosis by the referral hospital indicated schwannoma. A cervical approach was taken and the tumor was removed with preservation of the nerve sheath by intracapsular resection. The tumor recurred within one year after the first surgery in the same lesion of the left parapharyngeal space. The second surgical approach was a combination of a facial dismasking flap and trans-pterygopalatine fossa. The mass was resected completely, and the diagnosis of PS was confirmed by histopathology. While schwannoma commonly occurs in the head and neck, parapharyngeal space PS is rare, and pre-operative pathological diagnosis of PS is difficult. MRI studies of PS revealed distinctive features that we found useful in pre-operative diagnosis. Intracapsular resection of PS with nerve preservation has a very high recurrence rate of the tumor. Therefore, if MRI findings suggest PS we recommend removing the tumor completely without nerve preservation will offer the most curative outcome.



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Inadequacy of current pediatric epinephrine autoinjector needle length for use in infants and toddlers

Epinephrine injection represents the standard of care for anaphylaxis treatment. It is most effective if delivered intramuscularly, whereas inadvertent intraosseous injection may be harmful. The needle length in current pediatric epinephrine autoinjectors (EAIs) is 12.7 mm; however, the ideal needle length for infants and toddlers weighing less than 15 kg is unknown.

http://ift.tt/2pT3mHN

Comparison of pharyngocutaneous fistula closure with and without bacterial cellulose in a rat model

The present study aimed to compare the effects of bacterial cellulose used for closure of pharyngocutaneous fistulae, a complication of total laryngectomy, with those of primary sutures in a rat model.

http://ift.tt/2pNRbNW

Recurrent plexiform schwannoma involving the carotid canal

Plexiform schwannoma (PS) is a rare variety of benign nerve sheath tumor characterized by a multinodular plexiform growth pattern. PS is usually confined to the head and neck or skin. The pre-operative diagnosis of PS is difficult, and this has lead to a common misdiagnosis as a schwannoma. In addition, studies have indicated that an incomplete resection of PS often results in tumor recurrence. Here we describe a rare case of PS presented in the parapharyngeal space. Our case involved a 36-year-old man with swelling of the pharynx, who presented with a soft cervical mass.

http://ift.tt/2qNEp0o

Reply to: Influence of possible predictor variables on the outcome of primary oral squamous cell carcinoma: a retrospective study of 392 consecutive cases at a single centre

We have read the Letter to the Editor and thank you for the opportunity to respond to the concerns regarding our methodology/statistical analyses1. We appreciate the work of these colleagues and would like to comment on these considerations.

http://ift.tt/2pm9IOw

Model study of combined electrical and near-infrared neural stimulation on the bullfrog sciatic nerve

Abstract

This paper implemented a model study of combined electrical and near-infrared (808 nm) neural stimulation (NINS) on the bullfrog sciatic nerve. The model includes a COMSOL model to calculate the electric-field distribution of the surrounding area of the nerve, a Monte Carlo model to simulate light transport and absorption in the bullfrog sciatic nerve during NINS, and a NEURON model to simulate the neural electrophysiology changes under electrical stimulus and laser irradiation. The optical thermal effect is considered the main mechanism during NINS. Therefore, thermal change during laser irradiation was calculated by the Monte Carlo method, and the temperature distribution was then transferred to the NEURON model to stimulate the sciatic nerve. The effects on thermal response by adjusting the laser spot size, energy of the beam, and the absorption coefficient of the nerve are analyzed. The effect of the ambient temperature on the electrical stimulation or laser stimulation and the interaction between laser irradiation and electrical stimulation are also studied. The results indicate that the needed stimulus threshold for neural activation or inhibition is reduced by laser irradiation. Additionally, the needed laser energy for blocking the action potential is reduced by electrical stimulus. Both electrical and laser stimulation are affected by the ambient temperature. These results provide references for subsequent animal experiments and could be of great help to future basic and applied studies of infrared neural stimulation (INS).

http://ift.tt/2phprxH

Pattern of invasion in squamous cell carcinomas of the lower lip and oral cavity

Publication date: Available online 5 May 2017
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Shahroo Etemad-Moghadam, Mojgan Alaeddini
BackgroundA number of factors may be responsible for the differences in the biologic behaviors of oral and lower lip squamous cell carcinomas (SCCs). Immunohistochemical invasion profiles have been used to detect invasion patterns like epithelial-mesenchymal-transition (EMT) and collective-cell-invasion (CCI), which have not been investigated in lower lip neoplasms. The aim of the present study was to compare the invasive phenotypes of SCCs of the lower lip and oral cavity.MethodA total of 44 OSCCs and 37 lower lip SCCs were immunostained with E-Cadherin, N-Cadherin, and podoplanin. Based on their expression patterns, tumors were allocated to EMT, CCI or non-EMT/non-CCI categories.ResultsNone of the oral SCCs showed EMT; while 5 lower lip SCCs demonstrated this phenotype. CCI was observed in 12 oral SCCs and 4 lower lip SCCs. The third group included 32 and 28 cases of oral and lower lip tumors, respectively. A significant difference in invasive phenotype was found between the two locations (P=0.009).ConclusionOral cavity and lip tumors differ in various aspects and according to our results; the pattern of invasion may be added to these features. Between the two major invasion patterns, EMT was more prevalent in lip tumors while CCI was observed more commonly in oral neoplasms. The significance of the different expression patterns of the non-EMT/non-CCI category requires further investigation.



http://ift.tt/2pSr9HB

Baha implant as a hearing solution for single-sided deafness after retrosigmoid approach for the vestibular schwannoma: surgical results

Abstract

Skull base tumors and, in particular, vestibular schwannoma (VS) are among the etiological reasons for single-sided deafness (SSD). Patients with SSD have problems in understanding speech in a noisy environment and cannot localize the direction of sounds. Baha is one of the most frequently used systems for SSD compensation. Out of 38 patients with SSD after retrosigmoid removal of VS who underwent testing with Baha softband, 16 were satisfied and were indicated for Baha implantation. Two surgical approaches have been used—the Nijmegen linear incision technique with subdermal thinning (Group I, implant BI300) and fast surgery technique without subdermal thinning (Group II, implant BIA400). The duration of the surgery, the implant stability measured by Ostell, and skin or soft tissue reactions in long range follow-up were evaluated and compared between Group I and II. There was a difference in duration of surgery, in Group II procedures averaged significantly faster (p > 0.001). In both groups, there was a similar trend of the gradual increase of implant stability. In the Group I and II, there was comparable rate of the skin or soft tissue reactions grade 0, I, II, or III. We have proved Baha to be a suitable possibility for SSD patients after the removal of VS, regardless of the approach. After the retrosigmoid approach to the VS, the key step of Baha implantation must be to reach intact healthy bone to avoid implantation into scar tissue.

http://ift.tt/2pgEKql

A comparison of piezosurgery with conventional techniques for internal osteotomy

Abstract

To compare conventional osteotomy with the piezosurgery medical device, in terms of postoperative edema, ecchymosis, pain, operation time, and mucosal integrity, in rhinoplasty patients. In this prospective study, 49 rhinoplasty patients were randomly divided into two groups according to osteotomy technique used, either conventional osteotomy or piezosurgery. For all patients, the total duration of the operation was recorded, and photographs were taken and scored for ecchymosis and edema on postoperative days 2, 4, and 7. In addition, pain level was evaluated on postoperative day 2, and mucosal integrity was assessed on day 4. All scoring and evaluation was conducted by a physician who was blinded to the osteotomy procedure. In the piezosurgery group, edema scores on postoperative day 2 and ecchymosis scores on postoperative days 2, 4, and 7 were significantly lower than in the conventional osteotomy group (p < 0.05). On postoperative day 2, the pain level was lower in the piezosurgery group than in the conventional osteotomy group (p < 0.05). In an endoscopic examination on postoperative day 4, while 24% of the patients in the conventional osteotomy group had mucosal damage, no such damage was observed in the piezosurgery group. When total operation duration was compared, there was no significant difference between the groups (p > 0.05). Piezosurgery is a safe osteotomy method, with less edema (in the early postoperative period) and ecchymosis compared with conventional osteotomy, as well as less pain, a similar operation duration, and no mucosal damage.

http://ift.tt/2qCXNjC

Balloon Eustachian Tuboplasty in children

Abstract

Endonasal ballon dilatation of the Eustachian tube (BET) is a promising treatment for Eustachian tube dysfunction with encouraging results over the last years in adults. In addition, in children, single studies demonstrated promising results, but revealed the necessity for broader and additional studies. Our retrospective analysis presents outcomes with BET in children with chronic obstructive dysfunction of the Eustachian tube, showing resistance to the conventional therapy after adenotomy with paracentesis or grommets (ventilation tubes). The data of 52 children, having undergone BET from April 2011 to April 2016, were retrospectively evaluated. Most children in our study presented middle ear effusion (47%), adhesive (21%), chronic otitis media (13%), or recurrent acute otitis media (11%). In 24 (37%) children, we combined BET with a paracentesis, in 5 (8%) patients with a tympanoplasty type I and in 3 (5%) patients with a type III. All children were assessed using an audiogram, tympanometry, and tubomanometry (50 mbar) before and after BET. In addition, we evaluated the results of the Lübecker questionnaire, which we performed before and after BET. The childrens' ear-related and quality of life-related symptoms, such as pressure equalization, ear pressure, hearing loss, pain and limitation in daily life, and satisfaction pre- and postoperatively, were analyzed. In the majority of patients, we could see an improvement in the ear pressure, hearing loss, limitation in daily life, and satisfaction with recurrent inflammations, underlined by better outcomes in the tubomanometry and the tympanogram. BET in children is a safe, efficient, and promising method to treat chronic tube dysfunction, especially as a second line treatment, when adenotomy, paracentesis, or grommets failed before.

http://ift.tt/2pgJE6G

Efficacy of steroid therapy based on symptomatic and functional improvement in patients with vestibular neuritis: a prospective randomized controlled trial

Abstract

The aim of this study was to examine the efficacy of methylprednisolone in vestibular neuritis (VN) by objective and subjective measures. This prospective controlled randomized study was conducted at one tertiary hospital. Twenty-nine VN patients were randomized to either the steroid (n = 15) or the control (n = 14) group. The steroid group received methylprednisolone for 2 weeks, whereas control patients did not; both groups underwent regular vestibular exercises and were prescribed a Ginkgo biloba. Vestibular function tests including caloric test, video head impulse test (vHIT), and sensory organization test (SOT) were performed, and dizziness handicap index (DHI) was determined at enrollment; all tests were repeated at 1 and 6 months after enrollment. Both groups showed statistically significant improvements in caloric weakness and vHIT gain at 1- and 6-month follow-up evaluations compared to the initial examination; however, differences were not significant. The rates of normalization of canal paresis at 1 and 6 months were 50 and 64% in the control group and 33 and 60% in the steroid group, respectively, with no differences between the two groups. The rates of vHIT normalization at 1 and 6 months after treatment were 57 and 78% in the control group and 53 and 87% in the steroid group, respectively, with no differences between the two groups. Finally, there were no significant differences in the improvement of composite scores of SOT and the DHI scores between the two groups. In this prospective RCT, methylprednisolone had no additional benefit in patients with VN who underwent vestibular exercises and received a Ginkgo biloba.

Trial registration: Clinicaltrials.gov Identifier, NCT02098330; Trial title, The Efficacy of Steroid Therapy in Vestibular Neuritis.

http://ift.tt/2pgqXQC

Cerebral metabolic changes related to clinical parameters in idiopathic anosmic patients during olfactory stimulation: a pilot investigation

Abstract

Idiopathic olfactory loss neural consequences have been studied especially by means of magnetic resonance imaging. Since other functional neuroimaging technique findings are lacking in the literature, present study used a validated ¹⁸F-2-fluoro-2-deoxy-d-glucose (FDG) functional positron emission tomography procedure under olfactory stimulation (OS) to assess brain changes in idiopathic anosmic patients (IAPs) in comparison with healthy subjects (HS). A voxel-based analysis between these groups was used to evaluate FDG uptake in the brain and perform a correlation analysis between metabolic responses and the Sniffin' stick test as well as intensity visuo-analogue scores and disease duration (DD). A significant relative decrease of glucose metabolism in the right and left frontal lobes, left insula, right parietal lobe, and left occipital, temporal and parietal lobes was found in IAPs during OS. The same condition resulted in a relative higher glucose metabolism in the right cerebellum in IAPs. Moreover, a negative correlation between DD and FDG uptake in the left temporo-parietal joint was found in IAPs. Such a correlation suggested a possible involvement of this area metabolic decrease in self-consciousness impairment, which is known to affect IAPs. Present preliminary functional results could be of interest to further deepen such neural impairments possibly useful for future perspective in pharmaceutical and rehabilitative protocols.

http://ift.tt/2qDpecP

Erythropoietin levels in patients with sleep apnea: a meta-analysis

Abstract

Currently available data regarding the blood levels of erythropoietin (EPO) in sleep apnea (SA) patients are contradictory. The aim of the present meta-analysis was to evaluate the EPO levels in SA patients via quantitative analysis. A systematic search of Pubmed, Embase, and Web of Science were performed. EPO levels in SA group and control group were extracted from each eligible study. Weight mean difference (WMD) or Standard mean difference (SMD) with 95% confidence interval (CI) was calculated by using fixed-effects or random effect model analysis according to the degree of heterogeneity between studies. A total of 9 studies involving 407 participants were enrolled. The results indicated that EPO levels in SA group were significantly higher than that in control group (SMD 0.61, 95% CI 0.11–1.11, p = 0.016). Significantly higher EPO levels were found in patients with body mass index <30 kg/m², and cardiovascular complications in the subsequent subgroup analysis (both p < 0.05). High blood EPO levels were found in SA patients in the present meta-analysis.

http://ift.tt/2pgzKlD

Response to the letter to the editor regarding “Comparison of the anatomic and hearing outcomes of cartilage type 1 tympanoplasty in pediatric and adult patients”

http://ift.tt/2pgJDzE

Immunoexpression of GLUT-1 and angiogenic index in pleomorphic adenomas, adenoid cystic carcinomas, and mucoepidermoid carcinomas of the salivary glands

Abstract

This study aimed to evaluate and compare the immunoexpression of glucose transporter-1 (GLUT-1) and angiogenic index between pleomorphic adenomas (PAs), adenoid cystic carcinomas (ACCs), and mucoepidermoid carcinomas (MECs) of the salivary glands, and establish associations with the respective subtype/histological grade. Twenty PAs, 20 ACCs, and 10 MECs were submitted to morphological and immunohistochemical analysis. GLUT-1 expression was semi-quantitatively evaluated and angiogenic index was assessed by microvessel counts using anti-CD34 antibody. Higher GLUT-1 immunoexpression was observed in the MECs compared to PAs and ACCs (p = 0.022). Mean number of microvessels was 66.5 in MECs, 40.4 in PAs, and 21.2 in ACCs (p < 0.001). GLUT-1 expression and angiogenic index showed no significant correlation in the tumors studied. Results suggest that differences in biological behavior of the studied tumors are related to GLUT-1. Benign and malignant salivary gland tumors differ in the angiogenic index; however, angiogenesis may be independent of the tumor cell's metabolic demand.

http://ift.tt/2qD86Uu

Circulating calprotectin as a biomarker of laryngeal carcinoma

Abstract

Calprotectin is an S100 protein and marker of inflammation found in neutrophils and monocytes; S100 proteins are a family of calcium-modulated proteins. The aim of this study was to determine if the serum concentration of calprotectin is higher in patients with laryngeal carcinoma than in patients with benign laryngeal pathologies and controls. The study included 107 participants. The serum calprotectin concentration was analyzed using the calprotectin ELISA (enzyme-linked immunosorbent assay) kit (Calpo AS, Norway). EDTA-serum for analysis was collected prior to surgery from patients with laryngeal carcinoma (n = 41), those with a benign laryngeal pathology (Reinke's edema, vocal nodules, etc.) (n = 32), and healthy controls (n = 34). The median serum calprotectin concentration was significantly higher in the laryngeal carcinoma group (2179.6 μg L⁻¹) than in the benign laryngeal pathology group (727.84 μg L⁻¹) and control group (733.73 μg L⁻¹) (P < 0.05). The median serum calprotectin concentration in patients with advanced-stage laryngeal cancer (5854.,4 μg L⁻¹) was significantly higher than in those with early-stage laryngeal cancer (971.84 μg L⁻¹) (P < 0.05); however, there was not a significant difference in the median calprotectin concentration between the control and benign laryngeal pathology groups (P > 0.05). Furthermore, the median serum calprotectin concentration in the patients with early-stage laryngeal cancer (n = 21) (971.84 μg L⁻¹) was significantly higher than that in the benign laryngeal pathology and control groups (n = 64) (730.6 μg L⁻¹) (P < 0.05). The serum calprotectin concentration was strongly correlated with poor survival and advanced-stage laryngeal carcinoma. Malignant laryngeal cancer patients (n = 4) that died during follow-up had a higher median serum calprotectin concentration (9468.4 μg L⁻¹) than those that remained alive (n = 37) (857.78 μg L⁻¹) (P < 0.05). The serum calprotectin concentration is higher in patients with laryngeal carcinoma than in those with benign laryngeal pathologies and healthy controls. The present findings show that the serum calprotectin concentration might be used as a marker to discriminate between laryngeal carcinoma and benign laryngeal pathologies. Additional research is needed to further assess the value of this parameter as a useful tumor marker for the diagnosis, treatment, and follow-up of laryngeal carcinoma.

http://ift.tt/2pgyq2d

A retrospective study of ultrasound and FNA cytology investigation of thyroid nodules: working towards combined risk stratification

Abstract

The British Thyroid Association recommended in new guidelines on thyroid cancer treatment [Kwak et al. (Korean J Radiol 14:110–117, 2013)] that ultrasound grading of thyroid nodules should be incorporated into MDT management. A retrospective study was carried out to determine that the impact of US grading has had on MDT decision making in practice. The design used in the study is a retrospective review of case notes. The study was carried out in the hub hospital for thyroid cancer in the North west London Cancer network. We included consecutive patients referred to the regional thyroid multidisciplinary meeting between August 2014 and May 2015 for investigation of thyroid nodules. Data were collected on patient demographics, co-morbidity, thy grading, ultrasound grading, surgery, post-operative histology, and radioactive iodine treatment details. Accuracy of cytology and ultrasound in diagnosing malignancy was correlated to definitive histology. 99 patients with thyroid nodules were included in the study. 97% of patients had at least one fine needle aspiration and 75% had ultrasound grading. Thy3f (Bethesda IV) nodules were more likely to be carcinoma if associated with a U4 grade rather than U3 (67 vs 18%, p = 0.028). Ultrasound grading has recently been introduced to the standard practice in investigation of thyroid nodules. Further assessment of the accuracy of ultrasound grading in clinical practice may allow us to risk-stratify thy3a/thy3f (Bethesda III/IV) lesions and personalise treatment.

http://ift.tt/2qDiiwx

Laser Eustachian Tuboplasty for Eustachian Tube Dysfunction: a case series review

Abstract

The authors reviewed the literature regarding the safety and efficacy of Laser Eustachian Tuboplasty (LETP) in the treatment of Eustachian tube dysfunction (ETD). Medline via Pubmed, OvidSP and Science Direct were consulted, with a supplementary manual review of citations. English language case series constituted a baseline for inclusion. Primary outcome measures were pre- and post-operative tympanometry, otoscopy findings, subjective symptoms and pure tone audiometry, and findings were stratified into short term (≤6 months) and long term (>6 months–5 years). Eight unique case series were identified, detailing LETP procedures in 306 patients (462 Eustachian tubes). LETP demonstrated mixed short-term and positive long-term results across primary outcome measures. There was an overall complication rate of ≈4.4%, and no major adverse events were reported. Poor documentation of pre- and post-operative primary outcome measures and inter-study outcome heterogeneity prevents substantive comment on efficacy. Whilst LETP is safe, its use should remain limited to research in adults. Future trials should be case controlled, and detail pre- and post-operative tympanometry, otoscopy findings, subjective symptoms, and pure tone audiometry. Patients should also be stratified into those suffering from baro-challenge induced ETD, and those suffering from ETD with intractable sequelae, such as Chronic Otitis Media.

http://ift.tt/2pgMAQG

Cancer of unknown primary (CUP) of the head and neck: retrospective analysis of 81 patients

Abstract

The treatment of patients with cervical lymph node metastases without detectable primary tumor remains an important challenge, until today, no standard therapy is available. The present study investigated the multimodal treatment of patients with head and neck CUP syndrome (HNCUP) and their follow-up retrospectively. 81 patients with cervical lymph node metastases without a primary tumor were treated at the Departments of Otorhinolaryngology as well as Radiotherapy and Radiation Oncology at the University of Saarland in Homburg, Germany in the period between 1991 and 2013. All patients received routine work-up consisting of CUP panendoscopy and imaging. Neck dissection was then performed in 77% of the patients. The most common histology was squamous cell carcinoma (80%). Ten percent of the patients had distant metastases. All patients underwent primary or adjuvant radiation therapy, or simultaneous radiochemotherapy. After a median follow-up of 3.5 years, the 5-year survival rate was 30%. There was a local recurrence that was known in 20/63 patients (31%) and distant metastases were documented in 19/61 M0 patients (31%). Higher grade late toxicity (grade 3–4) was observed in 12% of patients. Neck dissection and radiation therapy remains an integral part of HNCUP therapy, while the use of chemotherapy could be considered in selected cases. Prospective multicenter randomized trials would be necessary to identify the best target volume and to clarify the role of chemotherapy.

http://ift.tt/2pMacjP

MicroRNAs: effective elements in ear-related diseases and hearing loss

Abstract

miRNAs are important factors for post-transcriptional process that controls gene expression at mRNA level. Various biological processes, including growth and differentiation, are regulated by miRNAs. miRNAs have been demonstrated to play an essential role in development and progression of hearing loss. Nowadays, miRNAs are known as critical factors involved in different physiological, biological, and pathological processes, such as gene expression, progressive sensorineural hearing loss, age-related hearing loss, noise-induced hearing loss, cholesteatoma, schwannomas, and inner ear inflammation. The miR-183 family (miR-183, miR-96 and miR-182) is expressed abundantly in some types of sensory cells in inner ear specially mechanosensory hair cells that exhibit a great expression level of this family. The plasma levels of miR-24-3p, miR-16-5p, miR-185-5p, and miR-451a were upregulated during noise exposures, and increased levels of miR-21 have been found in vestibular schwannomas and human cholesteatoma. In addition, upregulation of pro-apoptotic miRNAs and downregulation of miRNAs which promote differentiation and proliferation in age-related degeneration of the organ of Corti may potentially serve as a helpful biomarker for the early detection of age-related hearing loss. This knowledge represents miRNAs as promising diagnostic and therapeutic tools in the near future.

http://ift.tt/2qDijR7

Surgical and pathogenetic considerations of frontal sinus fungus ball

Abstract

Fungus ball (FB) is an non-invasive form of mycosis, that generally affects immunocompetent and non-atopic subjects. Involvement of the frontal sinus is extremely rare. We report two cases with frontal sinus fungus ball that underwent endoscopic endonasal frontal Draf type IIb or III sinusotomy with complete removal of the cheesy clay-like material. There were no intra-operative or postoperative complications, and no recurrence of disease was evident during the follow-up of 51 and 26 months, respectively. The Draf type IIb or type III frontal sinusotomy seems to be highly effective for the treatment of frontal sinus FB and can represent a valid alternative to the traditional external approaches.

http://ift.tt/2pgynn3

Nonanaplastic follicular cell-derived thyroid carcinoma: mitosis and necrosis in long-term follow-up

Abstract

Nonanaplastic follicular cell-derived thyroid carcinoma (NAFCTC) includes differentiated- (DTC) and poorly differentiated thyroid carcinoma (PDTC). DTC has an excellent prognosis, while PDTC is situated between DTC and anaplastic carcinomas. Short-term studies suggest that PDTC patients diagnosed only on tumor necrosis and/or mitosis have a prognosis similar to those diagnosed according to the TURIN proposal. The purpose of this study was to evaluate prognosis for NAFCTC based on long-term follow-up illuminating the significance of tumor necrosis and mitosis. A cohort of 225 patients with NAFCTC was followed more than 20 years. Age, sex, distant metastasis, histology, tumor size, extrathyroidal invasion, lymph node metastasis, tumor necrosis and mitosis were examined as possible prognostic factors. Median follow-up time for patients alive was 28 years (range 20–43 years). Age, distant metastasis, extrathyroidal invasion, tumor size, tumor necrosis and mitosis were independent prognostic factors in multivariate analysis for overall survival (OS). In disease specific survival (DSS) age was not significant. Using only necrosis and/or mitosis as criteria for PDTC the 5-, 10- and 20-year OS for DTC was 87, 79 and 69%, respectively. In DSS it was 95, 92 and 90%. For PDTC the 5-, 10- and 20-year OS was 57, 40 and 25%, respectively. In DSS it was 71, 55 and 48%. Tumor necrosis and mitosis are highly significant prognostic indicators in analysis of long time survival of nonanaplastic follicular cell-derived thyroid carcinoma indicating that a simplification of the actually used criteria for poorly differentiated carcinomas may be justified.

http://ift.tt/2qDuaym

The controversial role of electrochemotherapy in head and neck cancer: a systematic review of the literature

Abstract

Electroporation, also known as electrochemotherapy, combines an antineoplastic agent with electroporation, causing localized progressive necrosis in the treated area. Today it is primarily used in the palliative treatment of cutaneous and subcutaneous metastases and has been found to be safe and efficacious in head and neck cancer recurrences. Despite the steady increase in the number of published studies this treatment is not universally available and used systematically in head and neck carcinomas. To shed light on its limitations and analyze treatment outcome we have, therefore, reviewed all available literature regarding this topic. This systematic review includes 16 studies on head and neck squamous cell carcinoma and reports the data of 200 treated patients. The combined results show a very heterogeneous overall response rate, ranging from 0 to 100%, while the complete response rate ranges between 0 and 83.3%. No major side effects have been described in those who used electrochemotherapy as a mono modality palliative treatment. This systematic review shows how standardization of treatment is still pivotal to achieve a more homogeneous response rate in the approach to head and neck tumors. In conclusion, due to the scarcity of alternatives of treatment in advanced stage cancer in this anatomical region and the good tolerability and mostly high success rates of electrochemotherapy, this palliative approach should be taken into consideration in these patients.

http://ift.tt/2qLKyKl

Meningocele manque

Description

A 53-year-old man presented with right-sided sciatic-like pain. He was otherwise asymptomatic with no weakness, sphincter disturbances or gait problems. On examination, upper motor neuron signs were elicited in both lower limbs and an MRI of the whole spine was requested.

MRI showed dorsal tethering of the spinal cord secondary to a fibrous band, associated with two midline lipomas (figure 1). The affected cord segment was triangular in cross section (figure 2), and a syrinx was also observed at the affected level. Radiological appearances were compatible with meningocele manqué (MM).

Figure 1

Sagittal T2-weighted (A) and T1-weighted (B) MRI of the cervical spine shows a thin band of tissue tethering the dorsal cord to the dura at T1–2 level (arrow) with resultant formation of a syrinx. At T2–3 level, there is a focal lesion at the dorsal aspect of the thoracic cord...

http://ift.tt/2pRGYyf

A curious cause of pseudo-haematuria: a neglected vaginal pessary

Description

Vaginal pessaries represent a valid therapeutic option for the management of female pelvic organ prolapse in elderly women with significant comorbidities. Although leading to good functional and quality of life outcomes, when neglected, they can cause significant and severe complications.1

An 87-year-old woman semidependent and uncooperative due to progressive Alzheimer's dementia, who has lived in a nursing home for the last 5 years, presented to our outpatient clinic for 'intermittent hematuria'. She carried a pelvic ultrasound documenting a 'polypoid formation with 23 mm on the posterior bladder wall suggesting a bladder tumour'.

The blood loss had been detected intermittently in the diaper that she uses for hygienic purposes.

There were no analytical abnormalities except for leucoerythrocyturia with positive Escherichia coli urine culture. The hypothesis of a urothelial lesion led to the scheduling of a cystoscopy under anaesthesia and an abdominopelvic CT scan.

The abdominopelvic CT scan documented...

http://ift.tt/2pQZ45G

You are what you eat: ophthalmological manifestations of severe B12 deficiency

Severe B₁₂ vitamin deficiency due to diminished dietary intake is a known cause of severe pancytopenia with bleeding diathesis. The authors report a case with sudden-onset bilateral vision loss, severe pancytopenia and multiple organ failure secondary to B₁₂ vitamin deficiency in a patient with a strict vegetarian diet. On funduscopic examination the patient had multiple bilateral exuberant haemorrhages in all retinal layers. Five months after presentation, he had a complete visual recovery without ophthalmological intervention.

http://ift.tt/2pRt5Aj

Unilateral infective sacroiliitis in a boy presenting with a limp

A 9-year-old boy admitted to a district general hospital with a 1-week history of fever and a 2-day history of right hip pain. Initial workup revealed raised inflammatory markers and unremarkable imaging studies. After clinical review, there was minimal improvement of the patient's condition 5 days after presentation; therefore, an MRI of the pelvis/hips was carried out, which supported a clinical diagnosis of right-sided infective sacroiliitis. Infective sacroiliitis is rare and only represents 1%–2% of septic arthritis in children. The condition still remains a diagnostic challenge first due to poor localisation of symptoms with referred pain to the hip, thigh and lower back and second due to a lack of awareness by non-specialist clinicians. Early diagnosis is a key to avoid sequelae such as an abscess, degenerative changes of the sacroiliac joint and can be achieved by a thorough clinical examination, monitoring inflammatory markers and MRI.

http://ift.tt/2pQNrM0

Management of a cutaneous squamous cell carcinoma overlying an AV fistula

Cutaneous squamous cell carcinoma (cSCC) currently affects over 700 000 patients per year in the USA alone, and its incidence continues to rise in recent years. A known risk factor for cSCC is chronic inflammation; a cSCC that develops at a site of chronic inflammation is known as Marjolin's ulcer. We present the case of a 76-year-old man with end-stage renal disease requiring chronic haemodialysis who developed an invasive cSCC at the cannulation site of an underlying arteriovenous (AV) fistula. In this instance, treatment with standard surgical excision or Mohs surgery would pose unique risks associated with injury to an otherwise functional AV fistula. Thus, the lesion was treated with electron beam radiation therapy, which offers a similar efficacy to surgery while minimising risk to the fistula. This resulted in a successful oncological outcome with no complications.

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Myeloneuropathy due to multiple giant plexiform neurofibromas - an unusual presentation of neurofibromatosis type 1

Description

A man aged 33 years presented with a 10-year progressive history of difficulty in walking with poor gripping of flip-flops on feet. It was further associated with foot drop and weakened handgrip. There was a recent history of multiple falls and difficulty in climbing stairs or standing from a squatting position. Family history was suggestive of neurofibromatosis type 1 (NF-1) in grandfather, father, paternal aunt and cousin. Physical examination revealed multiple café-au-lait spots, axillary freckling, Lisch nodules with cutaneous and subcutaneous neurofibromas. On neurological examination, there was spastic quadriparesis with foot drop, distal sensory loss and absent ankle reflexes, which were suggestive of myeloneuropathy. MRI of the cervical spine and whole spine showed characteristic dumbbell-shaped neurofibromas, extending along the Intraspinal and extraspinal areas at multiple cord levels and also along various nerves of the upper and lower limb involving plexuses and roots (figure 1 and

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Radiological, pathological and gross correlation of an isolated renal cell carcinoma metastasis to the stomach

Description

A 59-year-old asymptomatic woman presented for follow-up CT thorax, abdomen and pelvis (CT-TAP). Fifteen months previously she underwent a left radical nephrectomy for a T1bN0MO, 5.5 cm Fuhrman grade 4 clear cell renal cell carcinoma (CCRCC) (figure 1).

Figure 1

Portal venous phase coronal image CT-TAP. The 6.8 cm expansile, heterogenous lesion is centred in the renal cortex of the mid/upper pole of the left kidney (yellow circle). It appears well encapsulated (red arrows) and abuts the renal sinus with no clear invasion. The low attenuation may be due to necrosis or cystic components. CT-TAP, CT thorax, abdomen and pelvis.

The CT-TAP revealed a new 3.6 cm peripherally enhancing, centrally necrotic, intramural lesion in the fundus of the stomach (figure 2). It was decided to biopsy the lesion via oesophago-gastro duodenoscopy (OGD). It was not apparent on direct visualisation of the stomach mucosa, thus...

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Fever without a source: evolution of a diagnosis from Kawasaki disease to acute myelogenous leukaemia

A previously healthy 11-month-old male patient presented with fever, abdominal pain and irritability. As part of an extensive evaluation for the cause of his fevers, an echocardiogram was performed and showed mildly dilated coronary arteries, leading to a diagnosis of incomplete Kawasaki disease (KD). He was treated with intravenous immunoglobulin (IVIG), defervesced and was discharged home. Two weeks later, he presented with anaemia initially attributed to haemolytic anaemia secondary to IVIG and received a red blood cell transfusion. However, his anaemia recurred 2 weeks later with leucocytosis, prompting a bone marrow aspirate 4 weeks after his diagnosis of KD. This demonstrated acute myelogenous leukaemia most consistent with acute megakaryocytic leukaemia. This case highlights the potentially subtle presentation of acute leukaemia and the need to keep an open mind and reconsider the initial diagnosis as new information comes to light in the care of an ill child.

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Comparison of the recovery rate of otomycosis using betadine and clotrimazole topical treatment

Publication date: Available online 6 May 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Mohammad Reza Mofatteh, Zahra Naseripour Yazdi, Masoud Yousefi, Mohammad Hasan Namaei
IntroductionOtomycosis is one of the common diseases that associated with many complications including involvement of the inner ear and mortality in rare cases. Management of otomycosis can be really challenging, and requires a close follow-up. Treatment options for otomycosis can include local debridement, local and systemic antifungal agents and utilization of topical antiseptics. The topical medications recommended for the treatment of otomycosis.ObjectiveThis study was designed to compare the recovery rate of otomycosis using two therapeutic methods of topical betadine (Povidone-iodine) and clotrimazole.MethodsIn this single-blind clinical trial, 204 patients with otomycosis were selected using a non-probability convenient sampling method and were randomly assigned to two treatment groups of topical betadine and clotrimazole (102 patients in each group). Response to treatment was assessed at 4, 10 and 20 days after treatment. Data were analyzed using the independent t-test, Chi-Square and Fisher exact test in SPSS v.18 software, at a significance level of p<0.05.ResultsThe results showed that out of 204 patients with otomycosis, fungi type isolated included Aspergillus in 151 cases (74%), and Candida albicans in 53 patients (26%). On the fourth day after treatment, 13 patients (13.1%) in the group treated with betadine and 10 patients (9.8%) in the group treated with clotrimazole had a good response to treatment (p=0.75). While, a good response to treatment was reported for 44 (43.1%) and 47 patients (46.1%) on the tenth day after the treatment (p=0.85); and 70 (68.6%) and 68 patients (67.6%) on the twentieth day after treatment (p=0.46) in the group treated with betadine and clotrimazole, respectively. So, the response to treatment was not significantly different in the two groups.ConclusionIn the present study the efficacy of betadine and clotrimazole were the same in the treatment of otomycosis. The result of this study supports the use of betadine as an effective antifungal in the otomycosis treatment that can help to avoid the emergence of resistant organisms.



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Body mass index and acoustic voice parameters: is there a relationship

Publication date: Available online 6 May 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Lourdes Bernadete Souza de Rocha, Marquiony Marques dos Santos
IntroductionSpecific elements such as weight and body volume can interfere in voice production and consequently in its acoustic parameters, which is why it is important for the clinician to be aware of these relationships.ObjectiveTo investigate the relationship between body mass index (BMI) and the average acoustic voice parameters.MethodsObservational, cross-sectional descriptive study. The sample consisted of 84 women, aged between 18 and 40years, an average of 26.83 (±6.88). The subjects were grouped according to BMI: 19 underweight; 23 normal ranges, 20 overweight and 22 obese and evaluated the fundamental frequency (f0) of the sustained vowel [a] and the Maximum Phonation Time (MPT) of the vowels [a], [i], [u], using PRAAT software. The data were submitted to the Kruskal–Wallis test to verify if there were differences between the groups regarding the study variables. All variables showed statistically significant results and were subjected to non-parametric test Mann–Whitney.ResultsRegarding to the average of the fundamental frequency, there was statistically significant difference between groups with underweight and overweight and obese; normal range and overweight and obese. The average MPT revealed statistically significant difference between underweight and obese individuals; normal range and obese; overweight and obese.ConclusionBody mass index influenced the average fundamental frequency of overweight and obese individuals evaluated in this study. Obesity influenced in reducing MPT average.



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Evaluation of pre- and post-pyriform plasty nasal airflow

Publication date: Available online 6 May 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Oscimar Benedito Sofia, Ney P. Castro Neto, Fernando S. Katsutani, Edson I. Mitre, José E. Dolci
IntroductionNasal obstruction is a frequent complaint in otorhinolaryngology outpatient clinics, and nasal valve incompetence is the cause in most cases. Scientific publications describing surgical techniques on the upper and lower lateral cartilages to improve the nasal valve are also quite frequent. Relatively few authors currently describe surgical procedures in the piriform aperture for nasal valve augmentation. We describe the surgical technique called pyriform plasty and evaluate its effectiveness subjectively through the NOSE questionnaire and objectively through the rhinomanometry evaluation.ObjectiveTo compare pre- and post-pyriform plasty nasal airflow variations using rhinomanometry and the NOSE questionnaire.MethodsEight patients submitted to pyriform surgery were studied. These patients were screened in the otorhinolaryngology outpatient clinic among those who complained of nasal obstruction, and who had a positive response to Cottle maneuver. They answered the NOSE questionnaire and were submitted to preoperative rhinomanometry. After 90 days, they were reassessed through the NOSE questionnaire and the postoperative rhinomanometry. The results of these two parameters were compared pre- and postoperatively.ResultsRegarding the subjective measure, the NOSE questionnaire, seven patients reported improvement, of which two reported marked improvement, and one patient reported an unchanged obstructive condition. Regarding the rhinomanometry assessment, of 96 comparative measurements between the preoperative and postoperative periods, we obtained 68 measurements with an increase in nasal airflow in the postoperative period, 26 negative results, and two cases that remained unaltered between the preoperative and postoperative periods.ConclusionWhen analyzing the results obtained in this study, we can conclude that the piriform plasty surgical procedure resulted in nasal airflow improvement in most of the obtained measurements.



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A patient with a history of breast cancer and multiple bone lesions: a case report

Long-term severe hyperparathyroidism leads to thinning of cortical bone and cystic bone defects referred to as osteitis fibrosa cystica. Cysts filled with hemosiderin deposits may appear colored as "brown tumors....

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Vaccinations and Risk of Systemic Lupus Erythematosus and Rheumatoid Arthritis: A Systematic Review and Meta-analysis

Publication date: Available online 5 May 2017
Source:Autoimmunity Reviews
Author(s): Bin Wang, Xiaoqing Shao, Dan Wang, Donghua Xu, Jin-an Zhang
BackgroundIn the past several years, more and more studies proposed some concerns on the possibly increased risk of autoimmune diseases in individuals receiving vaccinations, but published studies on the associations of vaccinations with risks of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) reported conflicting findings. A systematic review and meta-analysis was carried out to comprehensively evaluate the relationship between vaccinations and risk of SLE and RA.MethodsPubmed, Web of Science and Embase were searched for observational studies assessing the associations of vaccinations with risks of RA and SLE. Two authors independently extracted data from those eligible studies. The quality of eligible studies was assessed by using the Newcastle-Ottawa Scale (NOS). The pooled relative risk (RR) with 95% confidence intervals (CI) was used to measure the risk of RA and SLE associated with vaccinations, and was calculated through random-effect meta-analysis.ResultsSixteen observational studies were finally considered eligible, including 12 studies on the association between vaccinations and SLE risk and 13 studies on the association between vaccinations and RA risk. The pooled findings suggested that vaccinations significantly increased risk of SLE (RR=1.50; 95%CI 1.05–2.12, P=0.02). In addition, there was an obvious association between vaccinations and increased risk of RA (RR=1.32; 95%CI 1.09–1.60, P=0.004). Meta-analysis of studies reporting outcomes of short vaccinated time also suggested that vaccinations could significantly increase risk of SLE (RR=1.93; 95%CI 1.07–3.48, P=0.028) and RA (RR=1.48; 95%CI 1.08–2.03, P=0.015). Sensitivity analyses in studies with low risk of bias also found obvious associations of vaccinations with increased risk of RA and SLE.ConclusionThis study suggests that vaccinations are related to increased risks of SLE and RA. More and larger observational studies are needed to further verify the findings above and to assess the associations of vaccinations with other rheumatic diseases.



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Are neutrophil/lymphocyte and platelet/lymphocyte ratios related with formation of sudden hearing loss and its prognosis?

Publication date: Available online 5 May 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): H.E. Koçak, M.S. Elbistanlı, H. Acıpayam, W.M.E. Alakras, M.N. Kıral, F.T. Kayhan
ObjectivesThe aim of our study was to see whether the neutrophil/lymphocyte ratio (NLR) and the platelet/lymphocyte ratio (PLR) are the markers of idiopathic sudden hearing loss to be used in prognosis or not.Materials and methodsThis study is a retrospective, case-control clinical trial. Forty-five patients diagnosed with idiopathic sudden hearing loss and treated with the same treatment protocol between March 2014 and December 2015 and 47 healthy volunteers coming to the hospital for a routine health check and accepting audiological and laboratory tests were included in our study. NLR and PLR values were calculated in consequence of complete blood count results obtained from the study and control groups. In addition, the study group was classified as treatment responsive and treatment unresponsive groups as a result of audiological examination performed after three months according to the Siegel criteria. NLR and PLR ratios between the groups were statistically evaluated.ResultsAverage NLR and PLR values were significantly higher in the study group compared to the control group (P<0.001). Average NLR ratio of the group, which was treated with the same protocol but did not respond to treatment was found to be significantly higher compared to the group which responded to the treatment (P<0.001). There was no significant change in average PLR ratio.ConclusionAlthough NLR and PLR are two important markers that can be detected from peripheral blood samples of patients developing idiopathic sudden hearing loss and can be calculated easily, increased NLR values were also found to be related to poor prognosis.



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Blood count values and ratios for predicting sleep apnea in obese children

Publication date: July 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 98
Author(s): Ibrahim Erdim, Omer Erdur, Fatih Oghan, Fatih Mete, Mustafa Celik
ObjectivesTo detect whether the mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) are contributing factors in the diagnosis and severity of sleep apnea in obese children.IntroductionObesity is a public health problem, and its prevalence increases daily. Although PSG is the gold standard test in the investigation of sleep apnea, the application of this test requires equipment, personnel, time, and cost. There is no simple laboratory test for diagnosing and determining the severity of sleep apnea. Recently, MPV, NLR, and PLR, known as the inflammatory markers in CBC test parameters, have been investigated in some studies. We aim to investigate whether these parameters could provide a method for diagnosing and determining the severity of OSAS in obese children.MethodsClinical records of 180 patients were evaluated. All subjects had venous blood samples collected from the antecubital vein in the morning, after an overnight fasting, one day before PSG. Hemoglobin, RDW, MPV, PLT, platelet distribution width (PDW), and WBC count were measured. After anthropometric and laboratory analysis, 127 obese children were assessed for sleep study. Eighty-three patients who met the required polysomnographic criteria were divided into three groups as follows: group A [non-OSAS, apnea-plus-hypopnea index (AHI) < 1], groupB (1 ≤ AHI < 5), and groupC (AHI ≥ 5).ResultsTotal recording time, total sleep time, sleep efficiency, REM, and NREM sleep stage latency values were not statistically significant among groups. However, the number of awakenings, AHI, oxygen desaturation events, mean oxygen saturation, lowest oxygen saturation, average desaturation, and snoring time values had significant difference among the groups. There was no statistically significant difference among the groups in terms of WBC, Hemoglobin, platelets, PDW, neutrophil, and lymphocyte values. However, RDW values showed a statistically significant difference between groups A and C. Although there was no statistically significant difference of MPV values among groups, NLR and PLR values were statistically significant between groups A and C.ConclusionAccording to our study, NLR, PLR, and RDW were found to be significantly higher in children whose AHI was ≥5 than in children from the other groups. However, no correlation was found between MPV levels and OSAS in children.



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Editorial Board

Publication date: June 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 97





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Mandarin compound vowels produced by prelingually deafened children with cochlear implants

Publication date: June 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 97
Author(s): Jing Yang, Li Xu
ObjectiveCompound vowels including diphthongs and triphthongs have complex, dynamic spectral features. The production of compound vowels by children with cochlear implants (CIs) has not been studied previously. The present study examined the dynamic features of compound vowels in native Mandarin-speaking children with CIs.MethodsFourteen prelingually deafened children with CIs (aged 2.9–8.3 years old) and 14 age-matched, normal-hearing (NH) children produced monosyllables containing six Mandarin compound vowels (i.e., /aɪ/, /aʊ/, /uo/, /iɛ/, /iaʊ/, /ioʊ/). The frequency values of the first two formants were measured at nine equidistant time points over the course of the vowel duration. All formant frequency values were normalized and then used to calculate vowel trajectory length and overall spectral rate of change.ResultsThe results revealed that the CI children produced significantly longer durations for all six compound vowels. The CI children's ability to produce formant movement for the compound vowels varied considerably. Some CI children produced relatively static formant trajectories for certain diphthongs, whereas others produced certain vowels with greater formant movement than did the NH children. As a group, the CI children roughly followed the NH children on the pattern of magnitude of formant movement, but they showed a slower rate of formant change than did the NH children.ConclusionsThe findings suggested that prelingually deafened children with CIs, during the early stage of speech acquisition, had not established appropriate targets and articulatory coordination for compound vowel productions. This preliminary study may shed light on rehabilitation of prelingually deafened children with CIs.



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Reducing blood splatter in dermatological surgery: reply from authors

We thank Owen et al for their comment on our study about the incidence and risk factors of surgical blood splatter. They recommend the use of cotton gauze swabs over the tips of the bipolar forceps to minimize the risk of blood splatter. This is an interesting and novel approach. We wonder however, if this technique could result in loss of precise visualization of the surgical field, risking inadvertent cautery of adjacent structures and more difficult haemostasis.

This article is protected by copyright. All rights reserved.

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Updating the diagnosis, classification and assessment of rosacea by effacement of subtypes

Abstract

Tan, et al.,(ROSCO) propose to "transition beyond a subtype classification", which they ascribe to the National Rosacea Society's Classification of Rosacea (NRSCOR), asserting "Subtype classification may not fully cover the range of clinical presentations and is likely to confound severity assessment, whereas a phenotype-based approach could improve patient outcomes by addressing an individual patient's clinical presentation and concerns"(1). NRSCOR did not invent the phenotypic subtypes, described by expert dermatologists over preceding decades, but sought a common terminology for use in communicating ideas about rosacea (compare use in Fig. 1 by ROSCO). NRSCOR emphasized the potential evolution from one phenotypic subtype to another, and that phenotypic subtypes can occur together. ROSCO's claimed 'phenotypic approach' seems to be simply the elimination of these phenotypic subtypes.

This article is protected by copyright. All rights reserved.

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A foot tumor as late cutaneous Lyme borreliosis: a new entity?

Abstract

Acrodermatitis Chronica Atrophicans (ACA) is the late cutaneous form of Lyme borreliosis. It is a rare tertiary manifestation characterized by a slowly progressive course over many weeks to months. The early inflammatory phase manifests with a bluish-red discoloration and doughy swelling of the skin. Atrophic phase represents a late-phase process with red discoloration, thin and wrinkled appearance to the skin. We present a patient who exhibited a previously non-described form of late cutaneous Lyme borreliosis (LCLB) with a foot tumor.

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Identifying priority areas for research into the diagnosis, treatment and prevention of cellulitis (erysipelas) – results of a James Lind Alliance Priority Setting Partnership

Abstract

Priority setting partnerships give patients and heath care professionals an equal voice in driving priorities for future research. This ensures that research answers the most important questions that are needed to inform clinical practice¹.

Cellulitis (also known as erysipelas) is an acute infection of the skin and underlying tissue that often recurs.

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Paradoxical ulcerative colitis during Adalimumab treatment of psoriasis resolved by switch to Ustekinumab

Abstract

Here we report the case of a psoriasis patient who developed an ulcerative colitis (UC) most likely caused by Adalimumab. After cessation of Adalimumab, colitis improved significantly. However, since psoriasis worsened, the patient was switched to Ustekinumab which resulted in complete cessation of colitis. During the two-year follow-up under Ustekinumab therapy no further gastrointestinal complaints occurred. Paradoxical psoriasis manifestations in inflammatory bowel disease (IBD) under TNF-inhibitor therapy have been reported and rarely paradoxical IBD occurred (mostly Crohn's disease) in rheumatologic patients treated with Infliximab or Etanercept. Due to the highly probable association of Adalimumab with the onset of colitis in this case, we would like to suggest the term of paradoxical ulcerative colitis (PUC) for this yet only extremely scarcely reported phenomenon. To the best of our knowledge this is the first description of a paradoxical UC in a psoriasis patient and in Adalimumab treatment. Our observation suggests that Ustekinumab is an effective treatment option in patients with paradoxical anti-TNF driven inflammatory reactions like psoriasis or inflammatory bowel disease.

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Adulterant – Contaminant in MT-45 or Coingestion?

Abstract

We thank Helander et al for sharing their fascinating MT-45 (1-cyclohexyl-4-(1,2-diphenylethyl)piperazine) cases (Br J Dermatol 2016 Dec 14. http://ift.tt/2pQgG1C. [Epub ahead of print]). MT-45 is a piperazine derivative and was investigated as an opioid analgesic in the 1970s. Laboratory studies suggest its pharmacology is complex and involves opioid receptors and non-opioid targets. MT-45 has emerged on the new psychoactive substances market where it is mostly sold on the Internet. The majority of reported clinical features of MT-45 are that associated with traditional opioids (e.g., reduced level of consciousness or coma, reduced respiratory effort, oxygen saturation or cyanosis, miosis, and hearing loss) and patients often present with decreased level of consciousness and respiratory depression that responded well to naloxone treatment.

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Reducing blood splatter in dermatological surgery

Abstract

Aguilar-Duran et al (BJD 2017,176, pp275-6) reconfirmed the increased risk of blood splatter specifically associated with the use of bipolar electrosurgery and recommended wearing a mask with a visor when it is used¹. Bipolar Electrosurgery is an excellent means of achieving haemostasis and is an important technique in dermatological surgery. Inadvertent blood splatter may be virtually eliminated by the simple expedient of the surgeon placing a cotton gauze swab over the tips of the bipolar forceps prior to activating the current.

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Cytological and cytomorphometric evaluation of the oral mucosa in HIV-infected patients undergoing antiretroviral therapy

Abstract

Background

To evaluate HIV infection-induced alterations in the oral mucosa by comparing inflammation, cell maturation and cytomorphometric changes in oral mucosal cells between HIV-infected patients undergoing highly active antiretroviral therapy (HAART) and non-HIV-infected patients. \

Methods

Thirty HIV-infected patients undergoing HAART and 30 non-HIV-infected patients were studied. Four smears were obtained from the lateral border of the tongue and floor of the mouth with a cytobrush. One sample was stained by the Papanicolaou technique and three samples were processed for Feulgen staining. Papanicolaou-stained smears were analyzed by light microscopy and the cytoplasmic (CA) and nuclear (NA) area was measured with the Axion Vison 4.7 program (Carl Zeiss).

Results

The Wilcoxon signed-rank test showed a significant difference in intermediate epithelial cell types between the HIV-infected and non-HIV-infected groups (p=0.005). However, this difference was not observed for superficial epithelial cell types with (p=0.672) and without a nucleus (p=0.069). Comparative analysis revealed no significant difference in CA (p=0.604), NA (p=0.298) or NA/CA (p=0.456) between the HIV-infected and non-HIV-infected groups. Keratohyalin granules were more frequent in the non-HIV-infected group (p=0.0001).

Conclusions

The results showed alterations in cell maturation in HIV-infected patients undergoing HAART with undetectable viral load, but no morphometric changes were observed.

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The potential role of in vivo optical coherence tomography for evaluating oral soft tissue: a systematic review

Abstract

Background

The introduction of optical coherence tomography (OCT) in dentistry enabled the integration of already existing clinical and laboratory investigations in the study the oral cavity. This systematic review, presents an overview of the literature, to evaluate the usefulness of in vivo OCT for diagnosing oral soft tissues lesions, to compare the OCT results with traditional histology, and to identify limitations in prior studies so as to improve OCT applications. Methods: We performed a review of the literature using different search engines (PubMed, ISI Web of Science, and the Cochrane Library) employing MeSH terms such as "optical coherence tomography" and "OCT" in conjunction with other terms. We utilised the Population, Intervention, Comparison, Outcomes and Study design (PICOS) method to define our study eligibility criteria.

Results

Initial results were 3155. In conclusion, there were only 27 studies which met our selection criteria. We decided to allocate the 27 selected items into three groups: healthy mucosa; benign, premalignant, and malignant lesions; and oral manifestations of systemic therapies or pathological conditions.

Conclusions

Although the OCT is an easy to perform test and it offers an attractive diagnostic and monitoring prospect for soft tissues of the oral cavity, further studies are needed to complete the current knowledge of this imaging technique.

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