Imatinib mesylate- and dasatinib-induced eosinophilia in a patient with chronic myelocytic leukemia

Publication date: Available online 9 May 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Kris McGrath, Brady Stein, Lindsey Kalhagen, Lauren Leighton




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Thanks

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Gelfoam Interposition Minimizes Risk of Fistula and Postoperative Bleeding in Modified-Furlow Palatoplasty.

Failure to accomplish a tension-free, watertight closure predisposes the palatoplasty patient to fistula formation. Perioperative bleeding also places the patient at risk for adverse airway events (AAE). This study introduces the incorporation of a hemostatic gelatin sponge (Gelfoam) into layered palatoplasty to minimize adverse postoperative bleeding and fistula formation. A retrospective chart review was performed to identify subjects who underwent Furlow palatoplasty with insertion of Gelfoam from 2010 to 2015. Exclusion criteria include age >3 years, prior palate surgery,

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Reconstruction of Pediatric Scalp Avulsion Injuries After Dog Bites.

Dog bite injuries are common and the head and neck is most frequently involved in pediatric patients. In severe cases, the combination of crushing, tearing, and puncturing can result in scalp avulsion. Currently, microsurgical replantation of the avulsed scalp remains the gold standard but may not always be possible. The authors present their treatment algorithm with 2 patient examples. In Patient 1, the scalp was deemed unsuitable for replantation due to extensive soft tissue injury; in Patient 2, the scalp was not available on presentation. Both patients underwent debridement and early wound coverage followed by multistage secondary revision through serial tissue expansion and excision. At 3-years follow-up, both patients have achieved satisfactory aesthetic outcomes following the initial loss of 70% and 40% of hair-bearing scalp. There were no infective complications or wound dehiscence and the areas of scar alopecia are much improved with preservation of the hairline. Pediatric scalp avulsion injuries resulting from dog bites are uncommon and involve a unique injury mechanism. Coupled with the diminutive size of vessels in this patient population, replantation may be precluded altogether. A delayed and staged approach to reconstruction can restore a hair-bearing scalp for satisfactory outcomes. (C) 2017 by Mutaz B. Habal, MD.

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Anisocoria After Repair of Blowout Fracture.

Anisocoria may indicate a life-threatening neurosurgical emergency, unlike bilateral mydriasis. In patients with periorbital fracture, anisocoria can be caused by direct or indirect injury to the oculomotor nerve, excessive retraction of the orbital contents, or constriction of the muscles responsible for eyeball movement. Herein, the author reports a patient, 15-year-old boy, who developed anisocoria after an operation for a blowout fracture. The anisocoria was improved, self-limiting, and transient. The author has also reviewed the literature regarding anisocoria. (C) 2017 by Mutaz B. Habal, MD.

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Outer Side of the Nasal Bone Osteoma.

Osteomas are located mostly in the mandible followed by paranasal sinuses such as frontal sinuses, ethmoid air cells, maxillary sinuses and rarely based on nazal cavitiy or turbinate. The osteoma located on outside of nazal bone is extremely rare. The authors report an unusual patient of nasal bone osteoma associated with aesthetic problem on nasal dorsum. Outer side of nasal bone osteoma in large diameter causes aesthetic problems. The authors believe that open rhinoplasty approach is successful in this type of patients. (C) 2017 by Mutaz B. Habal, MD.

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Surgical Resolution of Bilateral Hypertrophy of Masseter Muscle Through Intraoral Approach.

Masseter muscle hypertrophy is an untypical anomaly with no definite cause and its diagnosis is easily completed through physical examination and imaging examinations. In some cases, patient may report signs and symptoms of well-localizated pain. However, it is generally asymptomatic and patient's chief complaint is about esthetic because of facial asymmetry. In this case, surgery is carefully indicated. The aim of this article is to report a case of a male patient with no painful and functional complaints but an important unease over his facial asymmetry. Patient underwent surgery involving bilateral resection of mandibular angles and unilateral resection of masseter muscle through intraoral approach. Surgical approaches and techniques rely heavily on surgeon. There are few reports in the literature about this anomaly, but those available present several techniques. The surgeon's dexterity and knowledge become extremely important, whereas this procedure is essentiallyesthetic. (C) 2017 by Mutaz B. Habal, MD.

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Surgical Management of Traumatic Peripheral Osteoma of the Mandible.

Osteomas are benign osteogenic lesions that result from the proliferation of mature bone. Three variants are known: central, peripheral, and extraskeletal. The peripheral variant is the most common and it most frequently affects the paranasal sinuses, rarely occurring in the jaws. This article describes the case of a 33-year-old white male patient who was referred complaining of facial asymmetry. Clinical examination revealed an increase in volume at the base of the right side of the mandible, hard bony consistency and well delimited, painless to the touch, without signs of infection or intraoral alterations. Radiographic examination revealed an oval lobulated, radiopaque sessile lesion adhered to the mandibular base near the insertion of the masseter muscle. The patient reported practicing martial arts many years ago. Owing to the limited access, it was decided to perform the complete lesion removal through an extraoral surgical approach, by using a skin crease in the upper neck region below the lesion. The patient recovered well and the histopathological analysis confirmed the diagnosis of osteoma. The etiopathogenesis of osteoma is not completely elucidated, and 3 theories are more accepted: developmental defect, neoplastic nature, and reactive lesion owing to trauma or local infection. The clinicopathological correlation in the present case supports a traumatic origin. Traumatic peripheral osteoma should be considered in the differential diagnosis of nodular bone-forming lesions affecting the mandible. (C) 2017 by Mutaz B. Habal, MD.

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Review of "Effectiveness of an Integrated Video Recording and Replaying System in Robotic Surgical Training" by Yang K, Perez M, Hubert N, Hossu G, Perrenot C, Hubert J in Ann Surg 265: 521-526, 2017.

No abstract available

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Unilateral Blindness After Septoplasty.

Septoplasty is a frequently performed procedure with mostly minor complications. Nevertheless, it may lead to serious complications. The authors present a 29-year-old patient admitted to their hospital 10 days after septoplasty in another institution. He suffered a total loss of vision immediately after the surgery. High-resolution computed tomography and magnetic resonance imaging revealed a direct trauma of the optic canal and an inflamed and edematous optic nerve. Even though a successful endoscopic optic nerve was performed, the patient's loss of vision did not improve after the surgery. Blindness after septoplasty is an extremely rare but a devastating complication. There are only few patients that indicates the optic nerve injury caused by a direct trauma. (C) 2017 by Mutaz B. Habal, MD.

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Heavy mite exposure in the environment can induce allergic systemic reactions.

http://alexsfakianakis.blogspot.com/2017/05/mite-hypersensitivity.html

Anaphylaxis

Anaphylaxis is an acute emergency that is potentially fatal and commonly related to an allergic and immunologic trigger requiring immediate effective life-saving treatment [151]. Heavy mite exposure in the environment can induce allergic systemic reactions. More recently, the induction of anaphylaxis through ingestion of mite-contaminated foods has been described [152].

Pancake anaphylaxis, also called oral mite anaphylaxis (OMA), is a relatively new syndrome characterized by severe allergic symptoms occurring immediately after eating foods, especially containing flours, contaminated with mites. These cooked foods contain thermoresistant mite allergens and contaminated wheat flour used to make pancakes is its most common presentation [152]. A variant clinical picture is provoked by physical exercise and is called dust mite ingestion-associated exercise-induced anaphylaxis [153]. OMA is more prevalent in tropical and subtropical areas of the globe where mites grow easily in their warm and humid environments [154]. There are reports in the literature of two fatalities associated with the ingestion of foods contaminated with mites [155, 156]. Mites responsible for OMA include domestic and storage species and can be present in any type of flours. There is an intriguing association of OMA and hypersensitivity to aspirin and nonsteroidal anti-inflammatory drugs (NSAIDS) for which there is no good explanation yet and it is more prevalent in patients with house dust mite allergic rhinitis and/or asthma [157]. The higher the contaminated mite ingestion the greater the risk for anaphylaxis. OMA confirmation requires the microscopic documentation and identification of mites in the suspected flour. Alternatively the immunoassay for demonstration of the presence of mite allergens in the suspected flour can be used. It is imperative to try to prevent the worldwide OMA delineating predisposing genetic factors and determining if mite immunotherapy might be efficacious modifying the clinical course of this important variety of food anaphylaxis [152, 158].

Co-sensitization to cockroaches, some crustaceans (shrimp, crab, lobster), shellfish (clams, mussels), and mollusks (snails) is often described and likely due to the presence of allergens in the tropomyosins family, present in some crustaceans (major allergen of shrimp: Pen 1), insects (some flies, mosquitoes, cockroaches), gastropods and mites (Der f 10) [122].

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Prevention of Dust Mite and Dust Mite Allergen Exposure

http://alexsfakianakis.blogspot.com/2017/05/mite-hypersensitivity.html

Justification for Dust Mite Exposure Control

The decision to initiate environmental controls to reduce dust mite exposure can be complex. Total prevention of exposure to mite allergenic material to prevent IgE sensitization to mite allergens in genetically susceptible individuals requires strict, continuous avoidance of mite exposure, which is practically all but impossible [199]. Furthermore, to curtail development of all cross-reacting specific IgE, avoidance of all arthropods would probably be required [200]. The majority of the world's population lives on seacoasts [201] or along rivers [202] and these areas typically have adequate humidity to support growth of dust mites and storage mites during all parts of the year.

Much research has been conducted to determine if it is possible to reduce development of mite-specific IgE-mediated sensitization (primary prevention). Several studies comparing dust mite sensitization rates in children from areas endemically low and areas endemically high in dust mite allergen indicated that the prevalence and degree of sensitization to dust mite was strongly associated with the amount of exposure to mite allergens [203, 204]. A prospective study of mite allergen avoidance in Manchester, UK, [205, 206] using a combination of interventions, decreased Der p 1 from mattresses by 97% to the nanogram range during pregnancy and 12 months after birth in the active group [205]. However, with all possible dust mite exposures at homes of friends and family, on public transportation and in public places and at schools and day care centers, primary prevention of dust mite sensitization by mite allergen avoidance may not be possible [207, 208, 209].

Secondary prevention, or the attempt to reduce the risk of asthma in dust mite sensitized children has also received much attention. The link between asthma and dust mite exposure is one of the most extensively studied relationships between environmental exposure and disease development [210, 211, 212, 213]. In all climates conducive to the growth of dust mites, mite exposure may be one of the factors contributing to the development of asthma [112, 214]. Secondary prevention has also been the goal for many children with allergic rhinitis who are at risk of the subsequent development of asthma. However, to date there is no evidence-based information as to whether mite avoidance may be effective as a secondary preventive measure to prevent/delay asthma development among mite-sensitized individuals, or those with allergic rhinitis.

The relation of dust mite allergen exposure and the worsening of allergic respiratory symptoms is well documented [215]. In one study of 311 subjects both sensitized and exposed to high levels of indoor allergen including dust mite allergen there was significantly lower FEV1% predicted values (mean, 83.7% vs 89.3%; mean difference, 5.6%; 95% CI, 0.6%-10.6%; P = .03), higher eNO values (geometric mean [GM], 12.8 vs 8.7 ppb; GM ratio, 0.7; 95% CI, 0.5-0.8; P = .001), and more severe airways reactivity (PD20 GM, 0.25 vs 0.73 mg; GM ratio, 2.9; 95% CI, 1.6-5.0; P < .001) as compared with subjects not sensitized and exposed [216]. Adults in a 4-year study who were both sensitized and exposed to high levels of dust mite allergens had increased bronchial hyper-responsiveness [217]. Many additional links between dust mite exposure and allergic disease are documented in the recent environmental practice parameter on dust mites [198]. A reduction in the symptoms experienced by those with atopic dermatitis has also been linked to house dust-mite allergen avoidance [218].

Facilitative factors and Allergen Reservoirs

Controlling factors that facilitate the growth and reproduction of dust mites has been an often sought goal in exposure control. The dependence of dust mites on the water content of the air has been extensively documented [219, 220]. Arid climates have an intrinsically low abundance of dust mites, and the most effective method of controlling dust mite exposure is to live in a very dry climate such as the high desert of New Mexico in the US or the Altiplano or Bolivian Plateau, in west-central South America [202]. Since this is not a practical solution, mimicking these conditions in the home environment as much as possible provides an opportunity to control mite population growth.

Humidity control should be the mainstay of any mite control efforts. The most important factor facilitating dust mite growth, reproduction and allergen production is the availability of water in the surrounding environment [220]. Mites absorb moisture directly from their surroundings under conditions of high moisture and lose water when moisture is low. The mite moisture equilibrium therefore is not directly relative humidity dependent. It is instead dependent of the moisture situation of the local microenvironment and the moisture retention ability of the mite's immediate surroundings such as carpet dust reservoirs or bedding. A simple measurement of relative humidity may not assure an environment free of dust mite activity. Microenvironments that exist in bedding, in carpet next to concrete or in pet lounging areas may provide adequate moisture for mite survival in climates not expected to have a mite presence. A mite surrounded by a hygroscopic microenvironment as moist bedding can survive much dryer conditions than would be expected. Of note, exposure to a moisture rich environment for only a short period can provide enough moisture for growth and metabolism [221].

Although directly linked to water content of the air in the calculation of relative humidity, temperature is also a factor in dust mite survival. Conditions at the extreme ends of the temperature spectrum, either to cold or to hot can impact mite survival although elevated temperature conditions tend to be more lethal than freezing. Mites and their eggs survive poorly when exposed to hot water and clothes dryers but survive during short periods of freezing conditions. The exposure to direct sunlight is an often forgotten factor in the destruction of dust mites [222].

It is not enough to address mite factors facilitating mite population growth. Reservoirs of mite allergen must also be eliminated. House dust mites can be found in any area of the home, however they are most often associated with certain indoor environments including the bedroom carpet, mattresses and bedding, frequently occupied upholstered furniture and in pet lounging areas [223, 224]. Recent investigations have questioned the traditional concepts of the location of dust mite reservoirs indicating that significant exposure can occur in public transportation conveyances and associated with work environments as well as clothing [207].

Climate Factors

Although residents of cold and arid climates are less likely to be exposed to house dust mites, the large majority of the world population is exposed to house dust mites. Nearly half of the people in the world live within 200 km of the coast where humidity levels are typically higher. The rate of population growth in coastal areas is accelerating. In China alone over 400 million live in coastal cities. Dust mite exposures and the allergic problems related to those exposures are likely to increase [201].

Although many climates are naturally conducive to mite growth and allergen production, the artificial control of indoor climates is increasing. Even though it is energy intensive, the use of forced air heating and air conditioning is growing around the world and especially in more affluent economies. Dust mite allergen exposure control is therefore a viable option for large numbers of persons. In many areas seasonal heating requirements result in very dry indoor environments and subsequently dust mite exposure is a seasonal phenomenon. Low humidity conditions can also be obtained through use of air conditioning and dehumidification. Yet, in many areas of the world ambient humidity levels are high enough that producing low humidity levels sufficient to preclude dust mite growth is not practically achievable. The recent Cochrane study on dehumidification alone indicates that evidence of clinical benefits of dehumidification using mechanical ventilation with dehumidifiers is scanty [225]. Indeed, the meta-analysis of multiple dust mite control studies would lead the reader to believe that there is nothing that can be physically done to control dust mites and improve health. Yet, this conclusion is disputed by many experts in the field of allergy [226]. Furthermore, the nature of single source exposure control studies may preclude successful clinical improvement because allergen sensitization is typically to multiple agents.

A significant amount of work has been done on removal of mites and mite allergens through cleaning. It goes without saying that efforts to control mite infestations of the skin and remove mite infestations from clothing are essential in the maintenance of overall health [227]. Humans have been living with dust mites for generations and they might even be described as among our "old friends" [228]. But no physician would advocate for wearing mite infested clothing or sleeping in mite infested bedding. Mite sensitization is likely to occur in genetically susceptible individuals, therefore efforts to reduce instances of elevated mite exposure and thus reduce allergic symptoms are only prudent [229].

Since mite allergens are located in known areas of a typical house [229, 230] removing mite allergen reservoirs is a very effective way to reduce mite allergen exposure. Efforts to remove carpets, drapes, upholstered furniture and any other fabric covered objects from the living environment can effectively reduce mite allergen exposure. The extent to which these items are removed will ultimately be a matter of personal preference. Since mite allergens are known to be heavy and not aerodynamically suited for airborne disbursal [34] and high humidity microenvironments are known to exist in bedding it is logical to focus dust mite reduction efforts on bedding. Efforts to enclose mattresses, box springs and pillows in mite-impermeable covers are known to be very effective [231]. However, it is important to mention that the efficacy of allergen avoidance in patients with already established rhinitis or asthma is a matter of debate [232, 233, 234, 235].

Washing bedding in hot water and even with bleach and drying bedding in very hot conditions or even in direct sunlight are known to reduce both the presence of mite allergen and the mites themselves [236, 237]. Washing bedding and clothing removes mite allergens and kills mites. Most of the killing is through drowning, although washing in hotter water kills more mites. The temperature used to wash bedding has become an issue. Elevated temperatures are more energy intensive and hotter water is a scalding hazard. Experts agree that washing is better than not washing and washing with water that is 48° Celsius provides optimum mite killing and home safety [199].

Heat treatment can be effective in killing mites and their eggs. Treatment of cloth at 95° Celsius killed all mites present [238]. However, treatment at 40 °C under dry and wet conditions allowed approximately 80% of all mite eggs to survive. Under dry heat at 50 °C, the thermal death point of dust mite eggs occurred at 5 h and at 60 °C death occurred almost instantaneously [239]. Presumably the eggs survive heat better than the mites themselves. Homes treated with heat-steam over a period of months showed a sustained reduction of Der p 1 and Der p 2 compared to sham treated homes [240] However, mite allergens have been demonstrated to be stable even at elevated temperatures [241].

Although the practice has fallen into senescence in the modern world of appliances, there was a time when frequently placing bedding in direct sunlight for several hours was practiced in many cultures. It has been demonstrated that ultraviolet irradiation is lethal to many organisms including dust mites [242, 243].

Many harsh chemicals are known to kill dust mites or denature mite allergens in industrial and household settings. Agents like tannic acid, Benzyl benzoate, Disodium octaborate tetrahydrate, tri-n-butyl tin maleate, pirimiphos methyl and even "essential oils" like methyl eugenol have been described in the literature to effectively kill mites [244, 245, 246, 247, 248]. However, they are all dangerous at some concentration and cannot be recommended for use by patients or homeowners [199].

It has been suggested that freezing can be effective in killing dust mites and the recommendation to place small cloth items like stuffed animals in the freezer compartment of house hold refrigerators has been frequently given out by allergists. However, there is little evidence that this is effective. There may be some mite death due to desiccation in the dry environment of a household freezer. But, dust mite eggs have been shown to resist freezing at temperatures above −70° Celsius [222]. And, freezing is not effective in removing dust mite allergen from reservoirs because dust mite allergen is stable at low temperatures for extended periods of time [239].

Air conditioning would have a twofold impact on dust mite populations. The cool temperatures will slow mite metabolism and reproduction and reduce moisture need for mite survival. Microenvironments or increased humidity can be reduced using a dehumidifier and/or air conditioning. The absence of air conditioning has been shown to be a factor contributing to increased mite allergen levels in US homes [249]. Air conditioners must be operated for a long time to remove sufficient moisture from the air to effectively decrease room humidity. Mechanical ventilation heat pump recovery units in the UK failed to achieve the desired mite reduction results [250].

Evidence on clinical benefits of dehumidification using mechanical ventilation with dehumidifiers remains scanty [225]. Although dehumidification and air conditioning doubtlessly reduce overall dust mite exposure [251], the difficulty in using dehumidification alone in damp environments to decrease dust mite antigen exposure has been described in a recent Cochrane review [225].

Summary of current recommendations

Most publications on allergy and dust mite control would agree that a comprehensive program of personal hygiene, bed hygiene, properly fitted allergen-impermeable covers, cleaning, dehumidification or air conditioning and appropriate food storage in very damp climates can reduce exposure to house dust mite allergens. It is a stretch further to conclude that the above steps can improve symptoms in those already allergic to dust mites. However, depending on the sensitivity and life style of the allergic person, prudent efforts over an extended period of time are likely to result in gradual improvement in health. The fact that current studies do not provide sufficient evidence for critical reviews to conclude there is unequivocal benefit is no reason to abandon logical and prudent efforts to reduce mite exposure.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Mite Allergy Research The authors view the following as currently unmet needs in mite allergy research: Since mites constitute the most important allergen source worldwide the information contained in this document needs to be disseminated to all ranks of the medical establishment for educational purposes and to stimulate research Increased knowledge on the cellular basis of the immune responses to mites A better understanding of the link between mite sensitization and allergic diseases Better insights into the genetic influences controlling IgE responses to mite allergens. Effects of epigenetic factors Improved mite allergen standardization Development of purified mite allergens with defined clinically relevant epitopes for molecular diagnosis and evaluation of the response to immunotherapy Development of objective methods to assess allergen exposure and environmental control outcomes Better strategies for immunotherapy and immunoprophylaxis of mite allergy: recombinant allergens, h

http://alexsfakianakis.blogspot.com/2017/05/mite-hypersensitivity.html

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Sporotrichosis among children of a hyperendemic area in Peru: an 8-year retrospective study

Abstract

Background

The clinical and epidemiologic characteristics of pediatric sporotrichosis are poorly understood.

Objective

To describe the incidence and clinical characteristics of cases of sporotrichosis in children 14 years of age and younger reported in Abancay from 2004 to 2011, stratified according to age.

Methods

We performed a retrospective review of pediatric patients 14 years of age and younger who were diagnosed with sporotrichosis in a referral center at Abancay, a poor area located in the south central highlands of Peru, to estimate the incidence rates (per 100,000 person-years) according to age and sporotrichosis type (lymphocutaneous and fixed), and clinical characteristics of these patients.

Results

Of the 240 pediatric cases identified, 131 (54.6%) were male. The median age at baseline was 6 years. The mean incidence rate was 81.4 cases per 100,000 person-years for the period from 2004 to 2011, and was highest among children ranging in age from 5–9 years. The incidence of lymphocutaneous sporotrichosis and fixed sporotrichosis was 55 and 27 cases per 100,000 person-years, respectively, and the face was the most commonly affected anatomic site. Ninety-six of the 240 patients (40%) reported previous contact with cats, and 46 (19.2%) had a clear history of traumatic inoculation with plant material. The therapeutic response to treatment with potassium iodide was satisfactory.

Conclusion

In this retrospective study, we described a high incidence of sporotrichosis in children in the south central highlands of Peru, which increased with age. Lymphocutaneous sporotrichosis was the more common type with an incidence rate twice that of the fixed type. The face was the most commonly affected anatomic site, and infection appeared to be acquired predominantly through contact with cats.

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Rick factors for medical and allergic events during air travel An increase of passenger’s age Flight stress and anxiety, including increased security procedures Disruption of routine Changes in the cabin environment (temperature, humidity, air pressure) Decreased seat space Flight delays Alcohol/drug intake Longer flights Altered circadian rhythm Jet lag Pre-existing medical conditions

http://alexsfakianakis.blogspot.com/2017/05/in-flight-allergic-emergencies.html

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

In-flight treatment of allergic emergencies and asthma Treating medical emergencies during flight is a major challenge and air travel is an important concern for subjects with asthma and a history of a SAR. The resources to treat allergic emergencies are somewhat limited. In the United States, the Federal Aviation Administration requires the inclusion of epinephrine in medical kits carried on board [18]. These emergency medical kits typically contain the following medications [19]: Aqueous epinephrine (adrenaline) 1:10000 and 1:1000 dilution. Albuterol (salbutamol) for nebulization. Bronchodilator aerosol inhaler. Cortisol (hydrocortisone). Antihistamines tablets and injectable (commonly diphenhydramine). A recommendation from this World Allergy Organization (WAO) expert group for in-flight treatment of a SAR and AE is: a) For AE, inhaled bronchodilator and oxygen. Consider an oral, intramuscular or intravenous corticosteroid for moderate to severe symptoms and intramuscular epinephr

http://alexsfakianakis.blogspot.com/2017/05/in-flight-allergic-emergencies.html

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Measures that reduce the risk of an in-flight reaction to peanut and tree nuts 1. Passengers requesting any kind of special accommodation (e.g., peanut/tree nut snacks not be distributed, announcement to not eat items with peanut/tree nut, request special peanut/tree nut-free meal, buffer zone, pre-board, request to sit in a certain seat/zone). 2. Peanut/tree nut-free meals. 3. Wiping of tray tables 4. Avoidance of airline pillows or blankets 5. Buffer zones around which peanut or nut products cannot be consumed 6. Request other passengers not to consume peanut/tree nut-containing products 7. Announcement that passengers do not eat peanut/tree nut containing goods 8. Not consuming airline-provided food

http://alexsfakianakis.blogspot.com/2017/05/in-flight-allergic-emergencies.html

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Recommendations to prevent and manage in-flight allergic events • Promote the prevention of allergic diseases via passenger education • Medical consultation for high-risk passengers before traveling • Train and re-train aircrews • Promote general preventive measures during the flight: hydration, food allergen avoidance (especially peanuts, tree nuts, other foods, as necessary) • Provide an appropriate place for furry pets away from subjects with pet allergy • Provide for sufficient quantities of appropriate medications: epinephrine (adrenaline), β2 agonists for inhalation and nebulization, oral and injectable corticosteroids and antihistamines • Oxygen

http://alexsfakianakis.blogspot.com/2017/05/in-flight-allergic-emergencies.html

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Rapid diagnosis of herpes zoster by loop-mediated isothermal amplification in a pregnant woman showing folliculitis-like eruption without vesicles

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The multidisciplinary team approach for high-risk and major cancer surgery

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The efficacy of a lip balm containing pseudo-ceramide on the dry lips of sensitive skin-conscious subjects

Summary

Background

Many people use lip care products daily to prevent dry lips. However, some people, especially those with sensitive skin-consciousness, complain of various skin problems on their lips including contact dermatitis caused by lip care products. Dry lips have decreased water holding capacity and cutaneous barrier function as well as reduced stratum corneum ceramide levels. In this study, we investigated the usefulness of a newly formulated lip balm containing pseudo-ceramide for the dry lips of subjects with sensitive skin.

Method

Thirty subjects with dry lips and sensitive skin-consciousness used the test lip balm more than twice a day for 4 weeks. Lip conditions were evaluated before and after 2 and 4 weeks.

Result

Visual evaluation by a dermatologist showed that overall improvements were observed in all subjects as early as week 2. After 4 weeks of usage, 27% of the subjects were objectively judged as "markedly improved" and 60% of the subjects were judged as "improved". No adverse event developed throughout the test period, and all subjects were able to use the lip balm safely for 4 weeks. Usefulness was judged based on all evaluation items, and 27%, 70%, and 3% of the subjects were judged as "very useful," "useful," and "slightly useful," respectively. Ninety percentage of the subjects expressed improvement and acceptance of the lip balm.

Conclusion

Based on these results, the newly formulated lip balm containing pseudo-ceramide is very useful for the lip care of sensitive skin-conscious subjects as well as for daily use by healthy subjects.

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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...

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Re “International survey on skin patch test procedures, attitudes and interpretation” L.K. Tanno et al., WAOJ (2016) 9:8

A previous survey on the practice of diagnostic patch testing among representatives of member societies of the World Allergy Organization (WAO) has, in some countries, not addressed those stakeholders actually...

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Molecular fingerprinting of complex grass allergoids: size assessments reveal new insights in epitope repertoires and functional capacities

Subcutaneous allergen immunotherapy (SCIT) is a well-documented treatment for allergic disease which involves injections of native allergen or modified (allergoid) extracts. The use of allergoid vaccines is a ...

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International consensus (ICON) on: clinical consequences of mite hypersensitivity, a global problem

Since mite allergens are the most relevant inducers of allergic diseases worldwide, resulting in significant morbidity and increased burden on health services, the International Collaboration in Asthma, Allerg...

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Asthma control in primary care: the results of an observational cross-sectional study in Italy and Spain

Poor asthma control observed in several surveys may be related to a lack of systematic assessment by physicians and/or to patient underestimation of symptoms. Along this line, the purpose of this study was to ...

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Prognostic role of BAP1 in pT1 clear cell carcinoma in partial nephrectomy specimens

Abstract

BAP1 is a gene situated on chromosome 3p in a region that can be modified in renal cell carcinomas (RCCs). Mutations that cause loss of expression of BAP1 frequently occur in primary clear cell renal carcinoma (ccRCC). In a previous work, we observed that loss of nuclear BAP1 expression was crucial in ccRCC progression; in the current study, we investigated BAP1 expression in a large series of small conventional ccRCCs treated with partial nephrectomy, to assess a possible role as biomarker and the prognostic value in terms of patients' survival at long-term follow-up. One hundred sixty-two patients with single pT1 ccRCC were selected from those who underwent surgery at our Institute of Urology between 1987 and 2000. The features considered in this study were gender, age, tumor size, grade, incidence of metastasis, and patient-specific survival; they were correlated with immunohistochemical BAP1 nuclear expression in tumoral tissue. Median follow-up was 197.24 months (range 19 to 274); median survival was 125.34 months (range 5 to 274 months). None of our pT1 ccRCCs showed total loss of nuclear BAP1 staining; we found a significant negative correlation between nuclear BAP1 expression and tumor size and between nuclear BAP1 expression and grade. In small ccRCCs, nuclear BAP1 staining was not correlated with disease-specific 5-year survival.

Our data confirm the established role of BAP1 as a tumor suppressor protein. This is the first report where BAP1 has been studied in pT1 ccRCC tumors, but nuclear BAP1 expression cannot help identify patients having high-risk disease in these patients.

http://ift.tt/2qXUorY

Clinical and pathological characteristics of gastrointestinal stromal tumor (GIST) metastatic to bone

Abstract

Our aim in this study was to describe the clinical, morphological, and molecular profile of gastrointestinal stromal tumor (GIST) metastatic to bone. We analyzed the morphological, phenotypic, and molecular characteristics of seven cases, and in addition reviewed 17 cases from literature. Sequence analysis of KIT and PDGFRA genes was possible for six cases. For the GIST cases with bone metastasis, the most common primaries were small intestine (29%), stomach (25%), and rectum (21%). Sites of bone metastases were vertebrae (11), pelvis (8), femur (8), ribs (6), humerus (5), skull (3), scapula (1), and mandible (1). The size ranged from 1.5 to 13 cm (median, 3.8 cm). Bone metastases without involvement of any other organ were seen in 17% of the cases and were solitary in 14 (58%). Adjacent soft tissue involvement was present in nearly half of the patients. Bone metastasis was either manifest at the time of diagnosis (28%) or occurred after a mean period of 4.7 years (3 months–20 years). Morphologically, neoplastic cells were spindle in 67%, epithelioid in 13%, and mixed epithelioid and spindle in 20%. CD117, DOG1, and CD34 were positive in 88, 86, and 85% of the cases, respectively. KIT Exon 11 mutations were the most frequent gene alteration (78%), followed by KIT Exon 13 mutations. Of 17 of the cases with available follow-up information, 7 (41%) patients developed bone metastasis under imatinib therapy. Five patients (29%) died of disease within a mean of 17 months. Bone metastases from GIST are usually found in patients with advanced disease and typically present as lytic masses with occasional soft tissue involvement. We could not identify any KIT or PDGFRA alterations predisposing to bone metastasis.

http://ift.tt/2qXCQfx

Secondary sinus lift: a viable option to increase contact of bone to implant

The secondary sinus lift is a new treatment for patients with osseointegrated implants and insufficient height of the alveolar remnant. This can be caused by the loss of a graft after the initial procedure, or when the sinus has not been augmented in the first instance.1,2 Our protocol is simple. It means that the original implants do not need to be removed, and it aims to increase their stability and longevity (Fig. 1).

http://ift.tt/2qPLQa2

Venous thromboembolism in patients with pemphigus: A cohort study

Venous thromboembolism (VTE) has been reported to be a significant cause of death in patients with pemphigus.

http://ift.tt/2q1BQtN

Aggressive digital papillary adenocarcinoma: A clinicopathological study of 19 cases

Aggressive digital papillary adenocarcinomas (ADPA) are malignant tumors of sweat glands having recurrence/metastatic potential.

http://ift.tt/2q43OTK

Definitive radiotherapy for Merkel cell carcinoma confers clinically meaningful in-field locoregional control: A review and analysis of the literature

Merkel cell carcinoma (MCC) is an uncommon radiosensitive, neuroendocrine malignancy. Treatment often involves surgery; however, older, sicker patients may not be candidates for an operation. Institutions have published data favoring the role of definitive radiotherapy for macroscopic locoregional disease.

http://ift.tt/2q1MLU0

Risk for hepatitis B and C virus reactivation in patients with psoriasis on biologic therapies: A retrospective cohort study and systematic review of the literature

Patients with psoriasis on biologic therapies and a history of viral hepatitis carry a risk for reactivation.

http://ift.tt/2q1RTHU

Ten-year study of postoperative complications following dental extractions in patients with inherited bleeding disorders

Dental extractions challenge the body's haemostatic mechanism. Postoperative bleeding from dental extraction can be prolonged, or even life threatening in patients with inherited bleeding disorders. Pre- and postoperative clotting factor replacements or systemic desmopressin (ddAVP) have been advocated at our institution to prevent bleeding complications in these patients. This study aimed to assess the postoperative bleeding rate in patients with inherited bleeding disorders that underwent dental extractions at our institution between 2003 and 2012.

http://ift.tt/2qZKruN

Influence of implant location in patients with and without type 2 diabetes mellitus: 2-year follow-up

The aim of the present cross-sectional retrospective 2-year follow-up clinical study was to assess the influence of implant location on clinical and radiographic parameters around dental implants placed in patients with and without type 2 diabetes mellitus (T2DM). Twenty-seven patients with T2DM and 25 non-diabetic controls were included. Implants were classified into three zones according to their location: (1) anterior zone: implant/s replacing anterior teeth, (2) middle zone: implant/s replacing premolars, and (3) posterior zone: implant/s replacing molars.

http://ift.tt/2qp5aev

Multiple central giant cell tumour lesions are exclusively linked to syndromes related to RAS/MAPK pathway anomalies

We read the article entitled "SH3BP2-encoding exons involved in cherubism are not associated with central giant cell granuloma" by Teixeira et al. with great interest1. They claim that SH3BP2-encoding exons, as involved in cherubism, are not associated with central giant cell granuloma (CGCG). However, only patients with a solitary lesion were included in their study. In the case of multiple lesions, we have observed a relationship with cherubism and RASopathies. Extensive reviews on these conditions have been published by Hyckel et al.

http://ift.tt/2qZUT5H

Nasolabial changes after two different approaches for surgically assisted rapid maxillary expansion

This retrospective study evaluated the nasolabial changes in patients who underwent surgically assisted rapid maxillary expansion (SARME) using two different approaches. Nineteen patients were included in the study, divided into two groups according to the kind of surgical approach performed: group 1 (n=9), SARME performed through the standard Le Fort I circumvestibular approach followed by the alar base cinch, and group 2 (n=10), SARME performed through a subtotal vestibular approach associated to a V-shaped incision at the maxillary midline in the labial frenulum region, without alar base cinch.

http://ift.tt/2qp6ldS

New approach to establish an object reference frame for dental arch in computer-aided surgical simulation

The purpose of this study was to develop a principal component analysis-based adaptive minimum Euclidean distances (PAMED) approach to establish an optimal object reference frame for symmetrical alignment of the dental arch during computer-aided surgical simulation (CASS). It was compared with our triangular methods and the standard principal component analysis (PCA) method. Thirty sets of maxillary digital models were used. Midsagittal and occlusal planes were ranked by three experienced evaluators based on their clinical judgment.

http://ift.tt/2qZTpbo

Erratum to: Looking forward to new targeted treatments for chronic spontaneous urticaria

http://ift.tt/2qpmXSR

Early childhood risk factors for rhinoconjunctivitis in adolescence: a prospective birth cohort study

Rhinoconjunctivitis is a global health problem and one of the most common chronic conditions in children. Development of rhinoconjunctivitis depends on both genetic and environmental factors. Many studies have...

http://ift.tt/2qZDolV

Abstracts from the Food Allergy and Anaphylaxis Meeting 2016

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The state of asthma epidemiology: an overview of systematic reviews and their quality

Recently, we have published an overview of systematic reviews in allergy epidemiology and identified asthma as the most commonly reviewed allergic disease. Building on this work, we aimed to investigate the qu...

http://ift.tt/2q0OzMP

Low percentage of clinically relevant pistachio nut and mango co-sensitisation in cashew nut sensitised children

Cashew nut, pistachio nut and mango belong to the Anacardiaceae family and are botanically related. Therefore, cashew nut sensitised children are frequently advised to eliminate cashew nuts and pistachio nuts fro...

http://ift.tt/2px7Jr7

Imatinib mesylate- and dasatinib-induced eosinophilia in a patient with chronic myelocytic leukemia

We present a case of a woman being treated for chronic myelocytic leukemia (CML) who developed eosinophilia without systemic involvement from imatinib mesylate (imatinib) confirmed by rechallenge with imatinib followed by eosinophilia recrudescence from dasatinib.

http://ift.tt/2qXnYhm

Development and validation of an administrative data algorithm to identify adults who have endoscopic sinus surgery for chronic rhinosinusitis

This was a diagnostic accuracy study to develop an algorithm based on administrative database codes that identifies patients with Chronic Rhinosinusitis (CRS) who have endoscopic sinus surgery (ESS).

http://ift.tt/2ptyvQb

Management delays in patients with squamous cell cancer of neck node(s) and unknown primary site: a retrospective cohort study

We aim to characterize the workup received by and identify any delays to diagnosis or treatment in patients referred to a tertiary cancer centre with the diagnosis of squamous cell carcinoma in neck node(s) an...

http://ift.tt/2qPLEYC

Predictors of failure of DISE-directed adenotonsillectomy in children with sleep disordered breathing

Adenotonsillectomy (AT) is the most commonly performed procedure for sleep disordered breathing (SDB) in pediatrics. However, 20-40% of patients will have persistent signs and symptoms of SDB after AT. Drug-in...

http://ift.tt/2ptBR5L

IL-5 and IL-6 are increased in the frontal recess of eosinophilic chronic rhinosinusitis patients

Eosinophilic chronic frontal sinusitis is difficult to treat compared with non-eosinophilic sinusitis because of recurring inflammation and polyp formation in the frontal recess after the post-operative follow...

http://ift.tt/2qPIiox

Maxillofacial prosthodontics practice profile: a survey of non-United States prosthodontists

This study surveyed non-United States maxillofacial prosthodontists (MFP) to determine their practice profile and rationale for pursuing an MFP career.

http://ift.tt/2ptwYtn

Is OperaVOX a clinically useful tool for the assessment of voice in a general ENT clinic?

Objective acoustic analysis is a key component of multidimensional voice assessment. OperaVOX is an iOS app which has been shown to be comparable to Multi Dimensional Voice Program for most principal measures ...

http://ift.tt/2pi1oU3

The risk of bias in randomized controlled trials in otorhinolaryngology: hardly any improvement since 1950

Randomized Controlled Trials (RCTs) represent the most valuable study design to evaluate the effectiveness of therapeutic interventions. However, flaws in design, conduct, analysis, and reporting of RCTs can c...

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Lipoma of Columella with septal extension in Pai syndrome: report of a rare case

Lipoma in nasal region in a case of Pai syndrome is very rare. Very few cases of Pai syndrome with columellar lipoma with extension to septum and tip have been reported till date.

http://ift.tt/2phXqL7

Reliability of inertial sensors in the assessment of patients with vestibular disorders: a feasibility study

Vestibular disorders affect an individual's stability, balance, and gait and predispose them to falls. Traditional laboratory-based semi-objective vestibular assessments are intrusive and cumbersome provide li...

http://ift.tt/2qXtP6q

Quality of life and symptoms before and after nasal septoplasty compared with healthy individuals

The goal of this study is to compare quality of life (Qol) and symptoms in 91 patients with a deviated nasal septum preoperatively and postoperatively with a control group of 93 healthy individuals.

http://ift.tt/2phZlQ5

Evaluating the biomechanical effects of implant diameter in case of facial trauma to an edentulous atrophic mandible: a 3D finite element analysis

Rehabilitation using an implant supported overdenture with two implants inserted in the interforaminal region is the easiest and currently accepted treatment modality to increase prosthetic stabilization and p...

http://ift.tt/2qXCSUK

Treatment of infants with Syndromic Robin sequence with modified palatal plates: a minimally invasive treatment option

Infants with Robin sequence (RS) suffer from upper airway obstruction (UAO) and feeding problems. We developed an oral appliance with a velar extension in combination with functional treatment and appropriate ...

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Relationship between the degree and direction of nasal septum deviation and nasal bone morphology

Nasal septal deviation may affect nasal bone growth and facial morphology. Knowledge of nasal morphologic parameters may plays an important role in planning successful rhinoplasty and septoplasty operation. Th...

http://ift.tt/2qXFdim

Comparison of digital panoramic radiography versus cone beam computerized tomography for measuring alveolar bone

Cone beam computerized tomography (CBCT) has been widely used in dental implanting. However, the local hospitals usually don't have access to CBCT due to the cost and medical investment, especially in West of ...

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Incidence of pulp sensibility loss of anterior teeth after paramedian insertion of orthodontic mini-implants in the anterior maxilla

The aim of this retrospective investigation was to evaluate the incidence of loss to pulp sensibility testing (PST) of maxillary front teeth after paramedian (3 to 5 mm away from the suture) orthodontic mini-i...

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Respiratory Impedance Reference Values for Forced Oscillation Technique Predicted by Arm Span and Height in Thai Preschool Children

Pediatric Allergy, Immunology, and Pulmonology , Vol. 0, No. 0.


http://ift.tt/2qZFL8n

Cognitive-Behavioral Therapy and Eye Movement Desensitization and Reprocessing in an Adolescent with Difficult-to-Control Asthma

Pediatric Allergy, Immunology, and Pulmonology , Vol. 0, No. 0.


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The outcomes of overlay myringoplasty: Endoscopic versus microscopic approach

Publication date: Available online 9 May 2017
Source:American Journal of Otolaryngology
Author(s): Yuvatiya Plodpai, Nanatphong Paje
PurposeTo investigate the outcomes of overlay myringoplasty by comparing the endoscopic versus the microscopic approach.Materials and methodsThis is a retrospective comparative study of 181 patients who underwent myringoplasty with overlay techniques between January 2010 and 2016 at Songklanagarind Hospital, Thailand. Group 1 underwent an endoscopic-assisted (n=90), and group 2 underwent the microscopic-assisted (n=91) overlay myringoplasty. The outcomes were graft take rates, the audiometric results, the need of canalplasty, complications and operative time. All patients were followed up for at least 6months.ResultsThe graft take rates were 96.7% in the endoscopic group and 91.2% in the microscopic group, p=0.22. The operative time was 98.9±11.0min for the endoscopic group, and 176.6±14.9min for the microscope group, p<0.001. There was no need for intraoperative canalplasty in the endoscopic group; however, 4% of cases in the microscopic group required canalplasty, p=0.12. The postoperative air-bone gap (ABG) closure was not different between both groups, p=0.09. Postoperative complications including post auricular numbness (p<0.001), aural fullness (p=0.002), and ear protrusion (p=0.005) were found in the microscopic group more than the endoscopic group.ConclusionsEndoscopic overlay myringoplasty provided satisfactory surgical as well as audiometric outcomes when compared with the microscopic approach. The graft take rate and postoperative hearing were similar in both groups. The endoscopic approach seemed to be superior than the microscopic approach in term of operative time, complication, and no need for canalplasty.



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Fungal granulomatous disease of the nasal cavity: A case report of a rare entity

Publication date: Available online 8 May 2017
Source:American Journal of Otolaryngology
Author(s): Samuel N. Helman, Peter Filip, Ameet Kamat




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Head and neck desmoplastic melanoma: Utility of sentinel node biopsy

Publication date: Available online 9 May 2017
Source:American Journal of Otolaryngology
Author(s): John R. Sims, Carilyn N. Wieland, Jan L. Kasperbauer, Eric J. Moore, Daniel L. Price
PurposeThe utility of sentinel lymph node biopsy in desmoplastic melanoma has been questioned due to multiple reports of a low rate of occult nodal metastasis in this variant of melanoma. We describe a single institution experience with management of desmoplastic melanoma of the head and neck and discuss the utility of sentinel lymph node biopsy.Materials and methodsA retrospective review was performed of 49 patients with desmoplastic melanoma of the head and neck at a tertiary care center from 1994 to 2014.ResultsSentinel lymph node biopsy was performed in 15 patients. Only 1 (6.7%) of these patients was found to have a positive sentinel node. Of the 46 patients without evidence of neck disease at presentation, 3 (6.5%) were found to have occult nodal disease or developed neck recurrences. When looking at the entire cohort, there were a total of 16 recurrences in 14 patients (28.6%). The majority (85.7%) of recurrences were either local or distant metastasis with only 2 (14.3%) recurrences being in regional lymph node basins. The overall rates of local, regional, and distant recurrences were 14.2%, 4.1%, and 10.2% respectively. The mixed pathologic subtype was not associated with a higher rate of nodal metastasis.ConclusionsDesmoplastic melanoma has a low rate of occult nodal metastasis and a high propensity to recur locally or as a distant metastasis, regardless of regional node status. Our experience combined with the uncertain impact that sentinel node status has on survival raises the question of the utility of routine sentinel node biopsy in this specific variant of melanoma.



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Therapeutic effect of hyaluronic acid in reducing nasal mucosa recovery time after septoplasty

Francesco Klinger, MD; Fabio Caviggioli, MD; Andrea Vittorio Emanuele Lisa, MD; Luca Maione, MD; Valeriano Vinci, MD; Mattia Siliprandi, MD; Federico Barbera, MD; Marco Klinger, MD; Luca Malvezzi, MD

Abstract

Mucociliary clearance represents a host defense mechanism of airways that can be compromised by various pathologic conditions, such as nasal septal deviation. Although septoplasty can resolve obstruction, it impairs mucociliary clearance in the immediate postoperative period. Clinical studies have demonstrated how hyaluronic acid can interfere with this function. Our study aims to provide evidence of a therapeutic effect of hyaluronic acid on nasal mucosa recovery after septoplasy. Sixty-five patients underwent septoplasty. On postoperative day 1, patients were randomized to a control arm that was treated with mupirocin ointment or an experimental arm that received additional treatment with sodium hyaluronate solution. Pre- and postoperatively, anterior rhinoscopy was performed to analyze mucosal status, and mucociliary clearance was measured by using the saccharin transit time (STT) method. The t test was used for independent groups. During the preoperative evaluation, we observed a significant difference in STT between the convex and concave side in both groups. Fifteen days after surgery, we observed a significant difference preoperatively to postoperatively for both the convex and the concave side (p < 0.02 and p < 0.008, respectively). One month after surgery, we observed a reduction of STT when comparing preoperative control group values and, after 1 month, postoperative values in both sides (p < 0.015 and p < 0.005, convex and concave side, respectively). Our results show a significant reduction of the STT for both nasal sides as soon as 15 days after septoplasty in patients randomized to additional treatment. Our experience provides further evidence for the therapeutic effect of hyaluronic acid in accelerating nasal mucosa recovery after septoplasty.

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Histologic correlation of VEGF and COX-2 expression with tumor size in squamous cell carcinoma of the larynx and hypopharynx

Rodrigo Gonzalez Bonhin, MD; Guilherme Machado de Carvalho, MD; Alexandre Caixeta Guimaraes, MD; Vanessa Brito Campoy Rocha, MD; Carlos Takahiro Chone, MD, PhD; Agrício Nubiato Crespo, MD, PhD; Eliane Maria Ingrid Amstalden, MD, PhD

Abstract

The prognosis and survival of patients with laryngeal and hypopharyngeal squamous cell carcinoma (SCC) are related to the clinical staging. Tumor growth and metastasis are closely related to angiogenesis. Vascular endothelial growth factor (VEGF) and cyclooxygenase 2 (COX-2) are intimately related to the angiogenic process in which the blood supply required for neoplastic evolution is ensured. Considering the contributions of VEGF and COX-2 to the formation, growth, and progression of primary tumors, as well as their metastasis, it has been thought that the expression of these two factors might be related to the size and/or aggressiveness of laryngeal and hypopharyngeal cancer. To test that theory, we conducted a retrospective study to evaluate the expression of VEGF and COX-2 markers in archived specimens of SCC of the larynx and hypopharynx to correlate their expression with tumor size. These specimens had been obtained from 35 patients-31 men and 4 women, aged 37 to 75 years (mean: 57)-who had been treated for laryngeal or hypopharyngeal SCC at our tertiary care university hospital over a period of 15 years. Immunohistochemical analyses were performed with avidin-biotin-peroxidase staining for VEGF and COX-2 antibodies. The degree of VEGF and COX-2 expression was based on the German scale of immunoreactivity. Specimens were separated into groups based on the intensity of expression (none/low and moderate/strong) and tumor size (TNM categories T1/T2 and T3/T4). A total of 7 patients exhibited moderate or strong VEGF expression (3 from the T1/T2 group and 4 from the T3/T4 group), and 17 patients demonstrated moderate or strong COX-2 expression (8 from the T1/T2 group and 9 from the T3/T4 group). We found no statistically significant relationship between tumor size and either VEGF or COX-2 expression. Our study demonstrated that despite the intrinsic connection between and VEGF and COX-2, neither appears to be related to the size of the SCCs of the larynx or hypopharynx. Other factors must be involved in the pathogenesis and progression of this disease, and further studies are needed to identify them.

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Role of intraoperative ropivacaine in adult post-tonsillectomy pain control: A randomized controlled trial

William C. Yao, MD; Christian A. Corbitt, MD; Masayoshi Takashima, MD

Abstract

We sought to evaluate the efficacy of ropivacaine in post-tonsillectomy pain management in adults and evaluate the timing of intraoperative ropivacaine administration for this purpose. A prospective, double-blinded, randomized, controlled trial with a paired design was performed in 25 consecutive adults undergoing tonsillectomy. To date, no studies examining the efficacy of local anesthetics in post-tonsillectomy pain control have used a paired design to account for the variability in pain difference between individuals. Patients were prerandomized into those receiving tonsillar fossa injections before or after the tonsillectomy. All surgeries were performed by the senior author. The tonsil on 1 side was injected with saline and the tonsil on the other side with ropivacaine. Patient responses were obtained via written questionnaire. Three of 25 patients were excluded from the study. Sixteen of 22 patients had lateralization of pain to 1 side during recovery. No statistically significant difference in pain control was observed between ropivacaine and normal saline. Local anesthetic decreased pain in 7 of 22 patients, and increased pain was experienced on the side with local anesthetic in 9 of 22 patients. Six of 22 patients had no difference in pain from one side to the other. The time to equalization of pain based on laterality was 8.8 and 6.8 days, respectively, in the patients injected before or immediately after the tonsillectomy. Administration of the local anesthetic ropivacaine does not affect post-tonsillectomy pain. Moreover, timing of injection does not affect postoperative pain. We recommend against the use of intraoperative ropivacaine for pain control in patients undergoing tonsillectomy.

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Nasal, pharyngeal, and laryngeal pemphigus vulgaris successfully treated with rituximab

Naveed Sami, MD

Abstract

Pemphigus vulgaris is a potentially fatal autoimmune blistering disease that can involve the nasopharyngeal and laryngeal tissues. The disease can be recalcitrant to conventional oral treatments, and treatment alternatives are limited. This retrospective study evaluated the efficacy of rituximab as a rescue agent in 5 patients with recalcitrant pemphigus vulgaris involving nasopharyngeal and laryngeal mucosa. All 5 patients were unresponsive to systemic steroids and at least one conventional oral immunosuppressive agent. The patients received rituximab infusions as a rescue agent because of recalcitrant disease. All 5 patients had a complete clinical response to rituximab and could discontinue systemic steroids and reduce the dosage of their initial immunosuppressive agent. No major adverse reactions were observed or reported with rituximab. Rituximab can be used as an effective rescue agent in the treatment of severe pemphigus vulgaris with nasopharyngeal and laryngeal involvement.

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Atypical presentation of vocal fold granulomas

Raj B. Patel, MD; Aaron Jaworek, MD; Robert T. Sataloff, MD, DMA, FACS

Vocal fold granulomas usually form near the vocal process or on the mucosa covering the medial surface of the arytenoid cartilage. These lesions are not true granulomas and consist of fibroblasts, collagen, leukocytes, and proliferating capillaries.

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Endoscopic view of long-term patency of the sphenoid ostium following balloon dilation

Joseph P. Mirante, MD, MBA, FACS; Dewey A. Christmas, MD; Eiji Yanagisawa, MD, FACS

In this case a 32-year-old patient with a history of recurrent sphenoid sinusitis had undergone balloon dilation of the sphenoid sinus ostium approximately 7 years earlier.

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A huge parapharyngeal space tumor in a child

Yuntsung Hung, MD; Chi-Shiun Huang, MD; Liang-You Yang, MD

Most clinicians will see only a small number of cases of parapharyngeal space tumors during their careers.

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In-office vs. operating room procedures for recurrent respiratory papillomatosis

Anya J. Miller, MD; Glendon M. Gardner, MD

Abstract

We conducted a study to analyze hospital and patient costs, outcomes, and patient satisfaction among adults undergoing in-office and operating room procedures for the treatment of recurrent respiratory papillomatosis. Our final study population was made up of 17 patients-1 man and 16 women, aged 30 to 86 years (mean: 62). The mean number of in-office laser procedures per patient was 4.2, and the mean interval between procedures was 5.4 months (although 10 patients underwent only 1 office procedure); the mean number of operating room procedures was 13.5, and the mean interval between procedures was 14.3 months. An equal number of patients reported complications or adverse events with the two types of procedures-5 each. The difference in cost between the office procedure (mean: $3,413.00) and the operating room procedure (mean: $12,382.59) was almost $9,000, but these savings were offset by the fact that the office procedures needed to be performed three times as often. Patients reported slightly more anxiety and discomfort during the office procedures and, overall, they appeared to prefer the operating room procedure. We conclude that office procedures are significantly more cost-effective than operating room procedures, but their use may be limited by patient tolerance and the increased frequency of the procedure.

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Facial nerve mimicking the fibrocartilaginous annulus of the tympanic membrane

Hande Senem Deveci, MD; Tülay Erden Habe&scedil;o&gbreve;lu, MD; Cem Karata&scedil;, MD; Selami Uzun, MD

In this case, the mastoid segment of the facial nerve was mobilized with a microelevetor at the posterior quadrant, but the facial nerve was preserved.

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Elastofibroma

Lester D. Thompson, MD

Imaging findings of elastofibromas show poorly circumscribed, heterogenous soft-tissue masses that have contrast enhancement, quite frequently bilateral.

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Morbus Castleman – eine harmlose Differenzialdiagnose einer Lymphadenitis colli? – Eine Fallserie

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-102058

Der sehr seltene Morbus Castleman kann als potentiell schwerwiegende lymphoproliferative Erkrankung in Form einer zervikalen Lymphadenopathie manifest werden. Dem HNO-Arzt kommt dann eine entscheidende Rolle in der Diagnostik und Therapie zu. Ziel dieser Arbeit ist es, anhand einer Fallserie die Symptomatik, den Krankheitsverlauf bis zur Diagnosestellung und Nachsorge vor dem Hintergrund bestehender Evidenz zu beleuchten. Eingeschlossen wurden Patienten, bei denen in den Jahren 2011–2015 die Erstdiagnose eines Morbus Castleman in der HNO-Klinik der Universität Ulm gestellt wurde. Evaluiert wurden u. a. die Dauer der bestehenden Symptome sowie die diagnostischen und therapeutischen Maßnahmen. Gefunden wurden 5 Patienten (3 männlich, 2 weiblich) im Alter zwischen 15 und 43 Jahren. Die Dauer der wenig ausgeprägten Symptome war inkongruent und lag zwischen 14 Tagen und 14 Jahren. Bei allen Patienten konnte nach diagnostischer Exstirpation der Nachweis der hyalin-vaskulären Variante eines Morbus Castleman erbracht werden. In einem der 5 Fälle lag ein multizentrischer Typ mit zusätzlichem axillärem Befall vor, die anderen Fälle waren monozentrisch. Die diagnostische Exstirpation war in allen Fällen immer zugleich auch suffiziente Therapie ohne zusätzliche medikamentöse Adjuvanz. Zum Zeitpunkt der Veröffentlichung befinden sich alle Patienten in Remission (medianes Follow up=27 Monate). Dem HNO-Arzt begegnet der Morbus Castleman zumeist als therapieresistente und längerfristig bestehende zervikale Lymphadenopathie mit wenig ausgeprägter Begleitsymptomatik und meist fehlenden laborchemischen Auffälligkeiten. Aufgrund der potentiell ungünstigen Verläufe ist eine zügige diagnostische Lymphknotenexstirpation in Vollnarkose indiziert, welche in den meisten Fällen gleichzeitig die suffiziente Therapie darstellt.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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Ein multimediales Programm zum Trainieren der Schilddrüsensonografie für Medizinstudenten

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-104863

Ärzte in Ausbildung haben häufig bei Berufseintritt aufgrund mangelnder Trainingsangebote im Rahmen ihres Medizinstudiums kaum Erfahrung in der Anwendung und Beurteilung der Sonografie. Daher sollte ein multimediales Programm für das schrittweise Erlernen und das Training der Schilddrüsensonografie entwickelt werden. Es wurde eine Software zur Gestaltung eines multimedialen Lernprogrammes für ein tragbares Ultraschallsystem genutzt. Die Software erlaubt die Darstellung von Texten und Bildmaterial parallel zur Untersuchung, um eigene Befunde mit Beispielen aus einer Datenbank vergleichen zu können. Das fertiggestellte Tutorial wurde durch 8 Studierende evaluiert und mit einem Tutor-geführten Training verglichen. Es wurde eine strukturierte, stufenweise Anleitung zur Schilddrüsensonografie mit einer Vielzahl von Beispiel-Sonografien in verschiedenen Schnittbildebenen gestaltet, die der Nutzer parallel am Probanden mit dem Ultraschallgerät nachstellt. Der Informationsgehalt des Tutorials und die Nachvollziehbarkeit der Untersuchungsschritte wurden positiv eingeschätzt. Die Übersichtlichkeit, die Eignung für Anwender mit fehlender Erfahrung und somit auch der Lernerfolg wurden hingegen unterschiedlich bewertet. Das Tutorial zum Erlernen und zum Training der Schilddrüsensonografie ist ein Instrument zum Selbstlernen und zur Verbesserung der praktischen Ausbildung. In der nächsten Version wird die Untersuchungsanleitung noch detaillierter aufgebaut sein.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Isoliert hochfrequente vestibuläre Läsion bei Patienten mit chronischen Schwindelbeschwerden

Laryngo-Rhino-Otol
DOI: 10.1055/s-0042-124507

In der vorliegenden Studie wurde bei 72 Patienten, die zum Zeitpunkt der Untersuchung bereits seit mehr als 3 Monaten unter Schwindelbeschwerden litten und bei denen bisher keine peripher-vestibuläre Genese der Beschwerden mittels bithermischer und rotatorischer Testung nachgewiesen werden konnte, der hochfrequente Anteil des vestibulo-okulären Reflexbogens mittels des Videokopfimpulstestes (vKIT) analysiert. Hierzu wurde der vKIT bei 72 Patienten retrospektiv ausgewertet und mit den Ergebnissen von Rotatorik und Kalorik verglichen. Analysiert wurde beim vKIT das Auftreten von Catch-Up Sakkaden sowie der Gain bzw. Gainseparation. 10 Patienten (n=10; 13,8%) zeigten einen pathologischen veränderten hVOR-Bogen bei hochfrequenter Überprüfung mittels vKIT. Der mittlere Gain der restlichen Gruppe (n=62, 86,2%) zeigte sich mit 0,85 bei horizontaler Testung nach rechts sowie mit 0,87 bei 60 ms bei horizontaler Testung nach links normwertig. Bei Patienten mit chronischen Schwindelbeschwerden, die in der klassischen vestibulären Routinediagnostik mit Kalorik und Rotatorik keine Pathologien aufweisen, sollte eine komplette rezeptor- und frequenzspezifische Diagnostik durchgeführt werden, um eine isoliertes hochfrequentes Schädigungsmuster des vestibulookulären Reflexbogens objektivieren und dokumentieren zu können. Bei einer unklaren Begutachtungssituation sollte daher diese erweiterte Schwindeldiagnostik nicht mehr fehlen.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Mandible reconstruction with free fibula flaps: outcome of a cost-effective individual planning concept compared with virtual surgical planning

The free osteomyocutaneous fibular flap has become one of the primary options for mandibular reconstruction, because of the later introduction and development of virtual surgical planning (VSP). However, VSP is associated with high additional pre-operative effort and costs. Therefore, the purpose of the study was to develop a new individual cost-effective pre-operative planning concept for free fibula mandible reconstruction and to compare it with VSP regarding clinical parameters and post-operative outcome.

http://ift.tt/2q0gSei

The outcomes of overlay myringoplasty: Endoscopic versus microscopic approach

To investigate the outcomes of overlay myringoplasty by comparing the endoscopic versus the microscopic approach.

http://ift.tt/2qXkvz9

Head and neck desmoplastic melanoma: Utility of sentinel node biopsy

The utility of sentinel lymph node biopsy in desmoplastic melanoma has been questioned due to multiple reports of a low rate of occult nodal metastasis in this variant of melanoma. We describe a single institution experience with management of desmoplastic melanoma of the head and neck and discuss the utility of sentinel lymph node biopsy.

http://ift.tt/2phNFfX

Panorama Dermatologische Praxis

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The impact of rapid maxillary expansion on maxillary first molar root morphology of cleft subjects

Abstract

Objectives

The aim of this prospective cohort study was to determine the effects of rapid maxillary expansion (RME) on the first molar roots of cleft lip and palate subjects along different root development stages.

Materials and methods

Thirty participants with unilateral cleft lip and palate were divided into three groups (n = 10), according to the type of expander used: Hyrax, iMini and Fan-type. A cone beam CT scan was performed before (T1) and 3 months after stabilization of the appliance (T2). Measurements of root lengths of the first permanent maxillary molars were taken to evaluate root development and external apical root resorption (EARR).

Results

Roots presenting open apexes before treatment exhibited a statistically significant increase in root length after treatment (P < .001). Conversely, there were no significant changes in the root length of roots that had closed apexes at the beginning of treatment (P > .05). Furthermore, there were no differences among groups, or correlation between cleft side and gender was found vis-à-vis to changes in the root length (p > .05).

Conclusions

Orthopaedic forces of RME were neither able to interrupt the root development process nor to cause EARR in cleft subjects.

Clinical relevance

As the RME is the most common orthodontic procedure in patients with cleft lip and palate, understanding its impact on dental structures is of fundamental importance.

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Efficacy of Ace Inhibition with Zofenopril, Lisinopril, or Ramipril in Postacute Myocardial Infarction Patients With or Without Metabolic Syndrome: A Pooled Individual Data Analysis of Four Randomized, Double-Blind, Controlled, Prospective Studies

Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.


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Respiratory Impedance Reference Values for Forced Oscillation Technique Predicted by Arm Span and Height in Thai Preschool Children

Pediatric Allergy, Immunology, and Pulmonology , Vol. 0, No. 0.


http://ift.tt/2qX5cqp

Cognitive-Behavioral Therapy and Eye Movement Desensitization and Reprocessing in an Adolescent with Difficult-to-Control Asthma

Pediatric Allergy, Immunology, and Pulmonology , Vol. 0, No. 0.


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Use of Bouillon Cubes Is a Major Source of Alleviating Iodine Deficiency in Haiti

Thyroid , Vol. 0, No. 0.


http://ift.tt/2pwVE53

Visual analogue scale (VAS) as a monitoring tool for daily changes in asthma symptoms in adolescents: a prospective study

Success in asthma management hinges on patients' competency to detect and respond to ever-changing symptom severity. Thus, it is crucial to have reliable, simple, and sustainable methods of symptom monitoring ...

http://ift.tt/2pwqNpr

Systemic mastocytosis with KIT V560G mutation presenting as recurrent episodes of vascular collapse: response to disodium cromoglycate and disease outcome

Mastocytosis are rare diseases characterized by an accumulation of clonal mast cells (MCs) in one or multiple organs or tissues. Patients with systemic mastocytosis (SM), whose MCs frequently arbor the activat...

http://ift.tt/2pZJbJP

Preconception allergen sensitization can induce B10 cells in offspring: a potential main role for maternal IgG

The mechanisms through which allergies can be inhibited after preconception immunization with allergens are not fully understood. We aimed to evaluate whether maternal immunization can induce a regulatory B (B...

http://ift.tt/2pwcNvS

Regulation of Th2 responses by different cell types expressing the interleukin-31 receptor

Interleukin-31 (IL-31) is a recently identified cytokine produced by Th2 cells that is involved in the development of atopic dermatitis-induced skin inflammation and pruritus. Its receptor, IL-31RA, is express...

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Canadian Society of Allergy and Clinical Immunology annual scientific meeting 2016

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Recurrent Acute Otitis Media: What Are the Options for Treatment and Prevention?

Abstract

Purpose of Review

To survey current strategies for treatment and prevention of recurrent acute otitis media (rAOM).

Recent Findings

Treatment with systemic antibiotics is required in recurrent episodes of acute otitis media. A cautious attitude is recommended due to antibiotic resistance. Antibiotics also provide effective prophylaxis for rAOM. Topical treatment with ear drops is recommended in rAOM with otorrhea from tympanostomy tubes. Pneumococcal conjugated vaccines seem to have a moderate reductive effect on overall otitis media. The effect on rAOM is still unclear. Different administrations of immunoglobulins have not been effective against rAOM. Breastfeeding had a protective effect against rAOM. A recommendation against cigarette smoke exposure as a measure to prevent otitis seems warranted. An effect for adenoidectomy in children <2 years old with rAOM has been suggested. There is a strong genetic connection with rAOM. Probiotics and nasal spray with Streptococci might offer future opportunities as prophylaxis. Too little is known about complimentary treatments to give any recommendations.

Summary

Systemic antibiotics are still needed as treatment against episodes of AOM in rAOM children. There are several preventive measures that can be taken to reduce the burden of AOM but they all have a small-moderate effect. Systemic antibiotics provide effective prophylaxis in rAOM, but must be used with extreme caution due to the emerging antibiotic resistance.

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Tender swelling of the posterior mandible

Publication date: Available online 8 May 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Sasha J. Betz, Li Zhen Lim, Andres D. Flores-Hidalgo, Robert J. Riggs, Alice E. Curran




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Langerhans cell histiocytosis of the maxillae in a child treated only with chemotherapy: a case report

Langerhans cell histiocytosis is a sporadic disease caused by an uncontrolled pathogenic clonal proliferation of dendritic cells that have Langerhans cell characteristics. New treatment protocols provided by t...

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Adrenaline overdose in pediatric anaphylaxis: a case report

Adrenaline is the standard treatment for anaphylaxis but appropriate administration remains challenging, and iatrogenic overdose is easily overlooked. Despite the established importance of pediatric blood pres...

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Complicated infective endocarditis: a case series

Infective endocarditis is associated with not only cardiac complications but also neurologic, renal, musculoskeletal, and systemic complications related to the infection, such as embolization, metastatic infec...

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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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Perforated acute appendicitis with no peritonitis in a premature baby: a case report

Acute appendicitis in a neonate and premature baby is still considered a rare entity as diagnosis is always made after surgical exploration for acute abdominal findings mimicking necrotizing enterocolitis.

http://ift.tt/2q3oY4l

Cancer of unknown primary (CUP) presenting as a Spigelian hernia: a case report

<span class="paragraphSection"><div class="boxTitle">Abstract</div>Cancer of unknown primary (CUP) is a well-known entity that can present in a multitude of clinical presentations. Based on the extent and organ of involvement, the presentation will be varied. For instance, patients presenting with axillary lymphadenopathy would lead toward a primary breast cancer, whereas patients presenting with abdominal distention due to ascites would tend toward a gastrointestinal origin. We present a case of a 73-year-old female who presented with an abdominal wall mass; on laparoscopy, she was found to have a spigelian hernia due to an omental metastatic lesion from a CUP.</span>

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Gastric outlet obstruction secondary to caecal herniation into the lesser sac

<span class="paragraphSection"><div class="boxTitle">Abstract</div>Internal hernias comprise 1% of hernias, 8% of which are through the foramen of Winslow into the lesser sac. These hernias can mimic gastric outlet obstruction and cause associated morbidity. In this case, we describe a caecal herniation into the lesser sac presenting as true gastric outlet obstruction in a 69-year-old female. Initial computed tomography (CT) imaging demonstrated a distended stomach with collapsed small bowel representing likely gastric outlet obstruction. Nasogastric tube insertion decompressed the stomach but the clinical picture progressed to that of small bowel obstruction with generalized abdominal distension and hypoactive bowel sounds. Repeat CT demonstrated caecal herniation into the lesser sac. This was confirmed at exploratory laparotomy with the caecum found in the lesser sac via the foramen of Winslow. The caecum was grossly ischaemic with patchy necrosis. A limited right hemicolectomy was performed. The patient made an uncomplicated recovery and was discharged on the eighth post-operative day.</span>

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Rhabdomyosarcoma of the genital tract in an 18-month-old girl

<span class="paragraphSection"><div class="boxTitle">Abstract</div>Embryonal Rhabdomyosarcoma 'Botryoid Type' is a rare soft tissue tumor that arises within the wall of the bladder or vagina and seen almost exclusively in infants. Treatment is combination of surgery with adjuvants chemotherapy and radiotherapy. We report a case of an 18-month-old Saudi girl presented with history of abdo-pelvic mass, bleeding per vagina and a mass protruding through the introitus. Computed tomography (CT) done reveling large heterogeneous pelvic mass arising from the uterus, biopsy of mass confirmed the diagnosis (sarcomabotryoidal). The patient received multiple cycles of combination chemotherapy as a neoadjuvant treatment then underwent total abdominal hysterectomy with upper vaginectomy. Postoperatively, the patient received more cycles of chemotherapy. CT scan for post-treatment evaluation was done and showed no evidence of local recurrence or distant metastasis. Currently, she is disease-free on remission with no complains.</span>

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An unusual cause of back pain: a case of large nonfunctioning retroperitoneal paraganglioma presented as a large cystic lesion. A case report and review of literature

<span class="paragraphSection"><div class="boxTitle">Abstract</div>Pheochromocytoma arising from outside the adrenal glands is also called paraganglioma. When it occurs below the diaphragm, in the organ of Zuckerkandl or retroperitoneum, it is also called extra-adrenal pheochromocytoma.Paragangliomas are rare tumors which arise from neuroendocrine cells and extra-adrenal paragangliomas (EAPs) account for only 10–15% if all paragangliomas and may present incidentally as a symptomless mass. Typical triad of sweating, headache and fluctuating hypertension if not present makes preoperative diagnosis difficult. Surgical excision is the treatment of choice. Definitive diagnosis is usually made with histological findings. We report a case of large retroperitoneal tumor with size >10 cm which was a high risk depicting malignancy.</span>

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Subacute bowel obstruction secondary to an obturator hernia: case report and a review of the literature

<span class="paragraphSection"><div class="boxTitle">Abstract</div>Obturator hernias are rare and are often diagnosed late. This case report discusses an 82-year-old female who had symptoms of subacute bowel obstruction. Following a computed tomography abdomen pelvis, she underwent a laparotomy for an incarcerated right obturator hernia. The hernia was repaired using a single suture and she made a good recovery. A review of the literature around obturator hernias is discussed.</span>

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The presence of donor liver granuloma requiring further workup to rule out parasitic disease

<span class="paragraphSection"><div class="boxTitle">Abstract</div>A shortage of donor organs is a major limitation to liver transplantation. Expansion of donor pool criteria to include patients with schistosomiasis diagnosed on liver biopsy might allow the allocation of more transplant livers. Schistosomiasis is a chronic parasitic disease affecting millions in endemic areas including sub-Sahara Africa that might lead to the development of granulomas as a response to the parasite's ova and might cause chronic liver disease and portal hypertension. Due to increased mobility globally, schistosomiasis may be encountered in non-endemic areas. Currently, the usage of donor livers with known Schistosomiasis is not universally defined.</span>

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Rendering a ruptured arteriovenous malformation more susceptible to spontaneous obliteration as a possible treatment strategy for cerebral AVM

<span class="paragraphSection"><div class="boxTitle">Abstract</div>Spontaneous regression of cerebral arteriovenous malformation (AVM) is a rare phenomenon, but its occurrence is an important consideration in treatment planning. A 58-year-old male was found to have a high-flow AVM of Spetzler–Martin Grade III. Before his scheduled treatment, the AVM ruptured with a large parenchymal hemorrhage. Following emergency decompressive surgery, a targeted embolization procedure was performed to obliterate the ruptured weak point and to reduce the shunting flow. The residual AVM became a malformation harboring angio-architectural factors favoring spontaneous obliteration. Together with other favorable clinical factors, including prior parenchymal hemorrhage and neurosurgical intervention, the residual AVM spontaneously regressed in 2 months. This case highlighted a possible treatment strategy in that, for a ruptured AVM in which definite treatment is not possible, an alternative is to treat the AVM into a situation in which as many favorable factors as possible for spontaneous AVM regression are present.</span>

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Synchronous small cell carcinoma and adenocarcinoma of the rectum

<span class="paragraphSection"><div class="boxTitle">Abstract</div>Small cell carcinoma (SCC) is derived from neuroendocrine cells primarily found in the lung. Extra-pulmonary SCC is relatively rare, comprising <5% of all SCCs. Most extra-pulmonary SCCs are found in the gastrointestinal tract; however, SCC of the rectum is extremely rare. The tumour biology of rectal SCC is similar to that of pulmonary SCC, an aggressive tumour that results in frequent distant metastases associated with poor response to chemotherapy. Combination chemotherapy, based on regimens for pulmonary SCC, has been used to treat extra-pulmonary SCC, and surgical resection followed by radiation therapy has been suggested; however, an optimal treatment modality has not been established due to the rarity of these cases. Here, we present a case of synchronous SCC and adenocarcinoma of the rectum that was managed by radical surgery followed by chemotherapy, but recurred with rapid progression in the regional and distant lymph nodes.</span>

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Candida parapsilosis associated with cervical necrotizing fasciitis and descending mediastinitis

<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>This report presents an immunocompetent lady suffering from <span style="font-style:italic;">Candida parapsilosis</span> associated with polybacterial cervical necrotizing fasciitis and descending mediastinitis. A literature review and management of invasive candidiasis is discussed.<div class="boxTitle">Methods</div>A 57-year-old healthy lady presented with cervical necrotizing fasciitis and descending mediastinitis. She was promptly managed with emergency debridement. Both blood and tissue culture yielded multiple microorganisms including <span style="font-style:italic;">C. parapsilosis</span>.<div class="boxTitle">Results</div>The patient recovered progressively. She was discharged 2 months later.<div class="boxTitle">Conclusions</div>Fungal infection is emerging in this medical era. Vigilance in patient management and as well as considering atypical microorganisms in aetiology may improve patient outcome.</span>

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Rare cause of massive lower gastrointestinal bleeding due to primary isolated ilio-rectal fistula

<span class="paragraphSection"><div class="boxTitle">Abstract</div>Massive lower gastrointestinal from primary isolated ilio-rectal fistula is a rare condition and difficult to diagnosis and emergency surgery for this situation has a high mortality rate. This report describes a successful operation in an 88-year-old man at present with massive lower gastrointestinal hemorrhage from ilio-rectal fistula and hypovolemic shock. Underlying diseases are prostate cancer, hypertension, dyslipidemia, aortic stenosis, mitral valve stenosis and chronic renal disease. Operative treatment is to explore laparotomy with internal iliac artery ligation and rectal resection. During postoperative period patient developed acute cholecystitis and treated by cholecystectomy 1 month after operation the patient went home without morbidity and 1-year follow-up he had not any complications.</span>

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Splenic abscess caused by Streptococcus anginosus following laparoscopic sleeve gastrectomy: a case report of a rare complication of bariatric surgery

<span class="paragraphSection"><div class="boxTitle">Abstract</div>Splenic abscess as a complication of laparoscopic sleeve gastrectomy (LSG) is rare. There have only been six cases in the literature. In most of these cases, the classic predisposing factors for developing splenic abscess were absent, leading to the hypothesis that transient bacteraemia caused by mucosal disruption during the surgical procedure and splenic ischaemia may play a role. These patients usually present in the late post-operative period with abdominal pain, fever and leucocytosis. The preferred treatment is intravenous antibiotics and percutaneous drainage or splenectomy. We report a case of splenic abscess caused by <span style="font-style:italic;">Streptococcus anginosus</span> that occurred 20 days after LSG in a 45-year-old woman without immunosuppressive conditions. The patient was successfully treated with antibiotic therapy and percutaneous drainage.</span>

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A rare case of mediastinal functioning parathyroid adenoma removed successfully with thoracoscopy

<span class="paragraphSection"><div class="boxTitle">Abstract</div>We report here a rare case of primary hyperparathyroidism that was associated with an ectopic parathyroid adenoma located in the mediastinum. A 66-year-old woman suffering from primary hyperparathyroidism had been followed-up on an outpatient basis for over 10 years. She suffered from persistent urolithiasis and osteopenia due to hypercalcemia. After technetium-99-sestamibi (99mTc-MIBI) scintigraphy revealed an ectopic adenoma in the superior mediastinum, thoracoscopic resection of the tumor was performed. Subsequently, her serum parathyroid hormone (PTH) level decreased dramatically and her serum calcium concentration was restored to normal. Two years following surgery, her serum PTH and Ca levels remain stable.</span>

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Ancient schwannoma in the sublingual space masquerading as a plunging ranula

<span class="paragraphSection"><div class="boxTitle">Abstract</div>Ancient schwannomas are benign, slow-growing tumours derived from the neural sheath. They are characterized by degenerative changes which are not seen in the common schwannoma. An unusual case of ancient schwannoma of the sublingual space is reported to highlight the diagnostic challenge that this tumour presents. A 49-year-old male patient presented with an 8-month history of a right-sided neck swelling, palpable in the anterior part of the submandibular triangle. Pre-operative imaging showed a non-enhancing mass in the sublingual space spilling into the submandibular triangle, consistent with a plunging ranula. Fine needle aspiration cytology was inconclusive. However, histopathology of the lesion confirmed the diagnosis of an ancient schwannoma, which is seldom found in the sublingual space.</span>

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Isolated dilatation of the cystic duct-Type VI choledochal cyst: a rare case presentation and review of the literature

<span class="paragraphSection"><div class="boxTitle">Abstract</div>An isolated cystic dilatation of the cystic duct is extremely rare and very few cases have been reported in the world literature. The existing Todani's classification does not include this as a separate entity and thereby, it has been vaguely termed as a Type VI choledochal cyst by some authors in the past. We describe a case of a young male with a Type VI choledochal cyst suspected preoperatively on imaging studies and confirmed intraoperatively by laparoscopy. The cyst was localized to the cystic duct with no involvement of the common bile duct. It was excised <span style="font-style:italic;">en masse</span> with the gall bladder by laparoscopic cholecystectomy. Considering the rarity of these lesions, an insight into the cases reported in the world is required and knowledge about the approach to managing such cases is important in surgical practice.</span>

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Thymoma (World Health Organization type B3) with neuroendocrine differentiation in multiple endocrine neoplasia type 1

<span class="paragraphSection"><div class="boxTitle">Abstract</div>Thymic epithelial tumors occur in 1–5% of patients with multiple endocrine neoplasia type 1 (MEN 1). Majority of these thymic epithelial tumors are thymic carcinoids and patients with thymoma in MEN 1 is rare. Furthermore, thymoma with neuroendocrine differentiation was also rarely reported. Herein, we report a 68-year-old man having type B3 thymoma with neuroendocrine differentiation in MEN 1 and to the best of our knowledge this is the first such case ever reported.</span>

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