Transnasal endoscopic ultrasound-guided reduction of maxillary sinus wall fracture

Abstract

Surgical morbidity from open reduction and internal fixation (ORIF) of maxillary sinus wall fracture often surpasses the benefits of ORIF. Hence, the authors devised transnasal endoscopic-assisted reduction of maxillary sinus wall fracture (TERM) without internal fixation as a minimally invasive surgery for maxillary sinus wall fracture. The purpose of this study was to investigate the feasibility of TERM in cadavers and patients. Six cadavers were dissected to evaluate the feasibility of TERM. In addition, 20 patients with maxillary sinus wall fractures who underwent TERM in a tertiary hospital from August of 2013 to December of 2015 were enrolled in this study. Demographic factors, type of anesthesia, computed tomography (CT) scans, clinical characteristics of patients, and patient satisfaction with surgery were analyzed. Cadaveric study showed that endoscopic inferior meatus antrostomy is a feasible method of approaching the maxillary sinus wall in cadavers. In addition, counterforce could be applied to the maxillary sinus wall by pushing packed Vaseline-soaked gauze or using a zygomatic process approach via a Gillies incision. Clinical experience revealed that patients experienced good facial contour restoration postoperatively. The extent of fractured bony segments was reduced on postoperative CT without complications. Patient satisfaction with TERM was greater than that with ORIF (p = 0.031). TERM showed its feasibility in both cadaveric study and clinical study. TERM can be a good alternative to ORIF, especially in patients who are reluctant to undergo a facial incision.

http://ift.tt/2rh3DYN

Clinical evaluation of zirconia-based all-ceramic single crowns: an up to 12-year retrospective cohort study

Abstract

Objectives

This study aims to investigate the incidence of clinical complications with tooth-supported zirconia-based all-ceramic single crowns and identify pertinent risk parameters.

Materials and methods

A retrospective cohort study (May 2004 to April 2016) utilizing clinical records of patients receiving yttrium-oxide–partially stabilized zirconia (Y-TZP)-based all-ceramic crowns placed at Tohoku University Hospital was performed. The length of time of treatment success (complication event-free) and restoration survival (including minor complication events and remaining clinically functional) were estimated using Kaplan–Meier analysis. Multilevel survival analysis was used to identify risk factors.

Results

One hundred thirty-seven crowns were evaluated (mean follow-up time, 7.0 years). A total of 21 crowns experienced at least one complication with fracture of veneering ceramic being the most common (16 crowns). Estimated success and survival rates at 5 years (96.9 and 98.5%, respectively) decreased at 10 years to 62.1 and 67.2%, respectively. The risk of complications was significantly higher for molar crowns compared to anterior crowns (p < 0.01). A significant association of complications with metal antagonist restorations was shown by univariate analysis (p < 0.01).

Conclusions

Given the study limitations, Y-TZP single crowns placed on anterior teeth demonstrated encouraging clinical results over a period of up to 10 years. However, there is a substantial risk of complications with posterior teeth within 10 years of restoration placement.

Clinical relevance

Treatment with zirconia-based all-ceramic crowns for molar teeth with metal antagonist occlusion should be undertaken with caution.

http://ift.tt/2sdwOLJ

Craniofacial and dental characteristics of patients with vitamin-D-dependent rickets type 1A compared to controls and patients with X-linked hypophosphatemia

Abstract

ᅟObjectives

Vitamin-D-dependent rickets type 1A (VDDR1A) is a rare inherited disease caused by defective activation of vitamin D. The aim of the study was to describe the craniofacial characteristics and the dental phenotype of patients with genetically confirmed VDDR1A. The VDDR1A findings were compared to findings in patients with X-linked hypophosphatemia (XLH) and healthy controls.

Material and methods

Ten patients with VDDR1A were identified. The reference group for the comparison of cephalometric findings was 49 adults without chronic disease. The reference group for the comparison of dental findings was 30 adults with XLH. Clinical examination, clinical photos, and radiographs were obtained. Cephalometric analysis was performed. Photos and radiographs were visually evaluated.

Results

The depth of the posterior cranial fossa (d-p and d-s-iop) in VDDR1A adults was reduced compared to the reference group (p < 0.05). Five (83%) of six adults with VDDR1A and one (4%) of 25 adults with XLH had enamel hypoplasia on several incisors and/or canines (p < 0.001). Three (75%) of four adults with VDDR1A and none of 16 adults with XLH had several first molars with enamel hypoplasia (p = 0.004). Five of 7 (71%) adults with VDDR1A and 24 of 30 (80%) adults with XLH had endodontically affected teeth.

Conclusions

The dental aberration of VDDR1A is more in line with the dental aberration of nutritional rickets than with the dental aberrations in XLH, suggesting the combination of low availability of both calcium and phosphate to be critical in periods of enamel formation.

Clinical relevance

Knowledge on craniofacial and dental aberration in patients with rare diseases, e.g., inherited rickets, is of importance to the dental practitioner, especially during diagnostics and treatment in special care units.

http://ift.tt/2tboLwa

Perioperative goal-directed therapy with uncalibrated pulse contour methods: impact on fluid management and postoperative outcome

Abstract

Previous meta-analyses suggest that perioperative goal-directed therapy (GDT) is useful to decrease postoperative morbidity. Most GDT studies analysed were done with pulmonary artery catheters, oesophageal Doppler and calibrated pulse contour methods. Uncalibrated pulse contour (uPC) techniques are an appealing alternative but their accuracy has been questioned. The effects of GDT on fluid management (volumes and volume variability) remain unclear. We performed a meta-analysis of randomized controlled trials investigating the effects of GDT with uPC methods on postoperative outcome. The primary endpoint was postoperative morbidity. Fluid volumes and fluid volume variability (standard deviation/mean) over the GDT period were also studied. Nineteen studies met the inclusion criteria (2159 patients). Postoperative morbidity was reduced with GDT (OR 0.46, 95% CI 0.30–0.70, P<0.001). The volume of colloids was higher [weighted mean difference (WMD) +345 ml, 95% CI 148–541 ml, P<0.001] and the volume of crystalloids was lower (WMD –429 ml, 95% CI –634 to –224 ml, P<0.01) in the GDT group than in the control group. However, the total volume of fluid (WMD –220 ml, 95% CI –590 to 150 ml, P=0.25) and the variability of fluid volume (34% vs 33%, P=0.98) were not affected by GDT. The use of GDT with uPC techniques was associated with a decrease in postoperative morbidity. It was not associated with an increase in total fluid volume nor with a decrease in fluid volume variability.

http://ift.tt/2r9IpZ1

Modified Frailty Index Score and Perioperative Risk in Laryngectomy : The 11 Variables Included in Modified Frailty Index Assessment : History of diabetes Functional status (not independent at baseline) History of pneumonia or chronic obstructive pulmonary disease History of congestive cardiac failure History of myocardial infarction History of percutaneous coronary intervention, stent placement, or angina History of hypertension (requiring medical treatment) History of peripheral vascular disease or ischemic rest pain History of impaired sensorium History of transient ischemic attack or cerebrovascular accident History of cerebrovascular accident with neurologic deficit

http://orlhealth.blogspot.com/2017/06/modified-frailty-index-score-and.html

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

6948891480

alsfakia@gmail.com

Barking Cough

https://youtu.be/IgZuVo81298?t=33

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

6948891480

alsfakia@gmail.com

Bovine cough

http://orlhealth.blogspot.com/2017/06/hoarse-voice-and-bovine-cough.html

<iframe width="640" height="360" src="https://www.youtube.com/embed/pLzezVufJ1o" frameborder="0" allowfullscreen></iframe>

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

6948891480

alsfakia@gmail.com

Hyperspectral X-ray transmission imaging................................3D chemical imaging

http://orlhealth.blogspot.com/2017/06/hyperspectral-x-ray-transmission.html

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

6948891480

alsfakia@gmail.com

Persistent lesion hyperintensity on brain diffusion-weighted MRI

http://orlhealth.blogspot.com/2017/06/persistent-lesion-hyperintensity-on.html

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

6948891480

alsfakia@gmail.com

Nausea, vomiting, loss of appetite and oliguria : haemoglobin =12.7 g/dL, indirect bilirubin =2.0 mg/dL, haptoglobin ≤6 mg/dL, platelet count =121 000/μL and schistocytes on peripheral smear.

http://orlhealth.blogspot.com/2017/06/nausea-vomiting-loss-of-appetite-and.html

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

6948891480

alsfakia@gmail.com

MFHAS1 suppresses TLR4 signaling pathway via induction of PP2A C subunit cytoplasm translocation and inhibition of c-Jun dephosphorylation at Thr239

Publication date: August 2017
Source:Molecular Immunology, Volume 88
Author(s): Qiqing Shi, Bo Xiong, Jing Zhong, Huihui Wang, Duan Ma, Changhong Miao
TLR4, an important Toll-like receptor in innate immunity, can be activated by LPS and induce proinflammatory cytokines to resist invasion of pathogenic microorganism, but excessive inflammation can trigger tissue injury. Many genes negatively regulate TLR4 signaling pathway. Recent studies found that malignant fibrous histiocytoma amplified sequence 1 (MFHAS1) suppressed the expression of cytokine IL6 in Raw264.7 cells stimulated by LPS, but the mechanisms remained unclear. This study investigated the role of MFHAS1 in TLR4 signaling pathway and the possible mechanisms implicated. The results indicated that the expression of MFHAS1 was significantly increased in cells stimulated with LPS. Up-regulation of MFHAS1 effectively suppressed inflammatory cytokine expression in cells exposed to LPS, whereas down-regulation of MFHAS1 markedly increased inflammatory cytokines expression. Co-immunoprecipitation, pull-down and immunofluorescence tests demonstrated that MFHAS1 combined with the B and C subunits of PP2A and induced cytoplasm translocation of the C subunit, leading to decrease dephosphorylation of c-Jun at Thr239 and increase degradation of c-Jun. Reduction of c-Jun protein results in decreased AP-1 activity, which is independent of inhibition of JNK or p38MAPK phosphorylation. Taken together, these results indicate that MFHAS1 suppresses TLR4 signaling pathway through induction of PP2A C subunit cytoplasm translocation and subsequent c-Jun degradation, leading finally to decrease AP-1 activity and cytokines expression.



http://ift.tt/2s0fKXm

Transoral thyroidectomy and parathyroidectomy – A North American series of robotic and endoscopic transoral approaches to the central neck

Publication date: August 2017
Source:Oral Oncology, Volume 71
Author(s): Jonathon O. Russell, James Clark, Salem I. Noureldine, Angkoon Anuwong, Mai G. Al Khademh, Hoon Yub Kim, Vaninder K. Dhillon, Gianlorenzo Dionigi, Ralph P. Tufano, Jeremy D. Richmon
ObjectiveMost thyroid surgery in North America is completed via a cervical incision, which leaves a permanent scar. Approaches without cutaneous incisions offer aesthetic advantages. This series represents the largest series of transoral vestibular approaches to the central neck in North America, and the first published reports of robotic transoral vestibular thyroidectomy for thyroid carcinoma.Materials and methodsData was prospectively collected for patients that underwent transoral vestibular approach thyroidectomy and/or parathyroidectomy between April 2016 and February 2017.ResultsFifteen patients underwent the procedure for removal of the thyroid (n=12), parathyroid (n=2) or both thyroid and parathyroid glands (n=1). The first case was converted to an open procedure. Fourteen were completed through these remote access incisions, including patients with a body mass index as high as 44. There were no permanent complications. The postoperative median Dermatology Life Quality Index score was 3, which indicates a small effect on quality of life.ConclusionThe transoral vestibular approach to the central neck is a promising technique for patients who desire to optimize aesthetics.



http://ift.tt/2siaZvc

Prognostic value of the eighth edition AJCC TNM classification for differentiated thyroid carcinoma

Publication date: August 2017
Source:Oral Oncology, Volume 71
Author(s): Tae Hyuk Kim, Young Nam Kim, Hye In Kim, So Young Park, Jun-Ho Choe, Jung-Han Kim, Jee Soo Kim, Young Lyun Oh, Soo Yeon Hahn, Jung Hee Shin, Kyunga Kim, Jong Gill Jeong, Sun Wook Kim, Jae Hoon Chung
BackgroundThe prognostic value of the proposed eighth edition of the American Joint Committee on Cancer (AJCC) tumor, node, and metastasis (TNM) classification is currently unclear. The aim of the study was to evaluate the prognostic value of the eighth edition of the AJCC TNM classification.MethodsWe retrospectively assessed 3176 patients with differentiated thyroid carcinoma (DTC) who underwent thyroidectomy at a tertiary Korean hospital from 1996 to 2005. Cancer-specific survival (CSS) was analyzed using the Kaplan–Meier method and compared using the log-rank test. Performance of the eighth edition TNM with respect to prediction of CSS was assessed against the current seventh edition.ResultsUpon reclassification according to the eighth edition, 37.6% of patients were down-staged. The proportions of stage I and II tumors increased from 61.9% to 81.1% and from 1.7% to 16.0%, respectively, whereas those of stage III and IVB (formerly IVC in the seventh edition) decreased from 27.6% to 2.3% and 0.8% to 0.5%, respectively. The proportions of variance explained (PVEs) for the ability of the eighth and the seventh edition to predict CSS were 3.9% and 2.9%, respectively. The C-index values were 0.765 (95% confidence interval 0.764–0.766) for the eighth edition and 0.736 (0.735–0.737) for the seventh edition.ConclusionOur results demonstrate that the eighth edition TNM more accurately predicts CSS for patients with DTC than does the seventh edition.



http://ift.tt/2sRiaHP

Dose-dependent enhancement of T-lymphocyte priming and CTL lysis following ionizing radiation in an engineered model of oral cancer

Publication date: August 2017
Source:Oral Oncology, Volume 71
Author(s): Megan Morisada, Ellen C. Moore, Rachel Hodge, Jay Friedman, Harrison A. Cash, James W. Hodge, James B. Mitchell, Clint T. Allen
ObjectivesDetermine if direct tumor cell cytotoxicity, antigen release, and susceptibility to T-lymphocyte killing following radiation treatment is dose-dependent.Materials and methodsMouse oral cancer cells were engineered to express full-length ovalbumin as a model antigen. Tumor antigen release with uptake and cross presentation of antigen by antigen presenting cells with subsequent priming and expansion of antigen-specific T-lymphocytes following radiation was modeled in vitro and in vivo. T-lymphocyte mediated killing was measured following radiation treatment using a novel impedance-based cytotoxicity assay.ResultsRadiation treatment induced dose-dependent induction of executioner caspase activity and apoptosis in MOC1 cells. In vitro modeling of antigen release and T-lymphocyte priming demonstrated enhanced proliferation of OT-1 T-lymphocytes with 8Gy treatment of MOC1ova cells compared to 2Gy. This was validated in vivo following treatment of established MOC1ova tumors and adoptive transfer of antigen-specific T-lymphocytes. Using a novel impedance–based cytotoxicity assay, 8Gy enhanced tumor cell susceptibility to T-lymphocyte killing to a greater degree than 2Gy.ConclusionIn the context of using clinically-relevant doses of radiation treatment as an adjuvant for immunotherapy, 8Gy is superior to 2Gy for induction of antigen-specific immune responses and enhancing tumor cell susceptibility to T-lymphocyte killing. These findings have significant implications for the design of trials combining radiation and immunotherapy.



http://ift.tt/2shFJfP

The impact of a head and neck microvascular fellowship program on otolaryngology resident training

Objective

To assess the impact of a microvascular head and neck (H&N) fellowship on senior residents' surgical experience.

Study Design

Retrospective review of Accreditation Council for Graduate Medical Education-generated operative case log reports, retrospective chart review, and electronic survey.

Methods

A retrospective review of one institution's residents' H&N operative case logs and free flap operative reports was performed to determine changes in key indicator cases (KICs) after the addition of a H&N fellowship. An electronic survey was distributed to senior residents at all U.S. otolaryngology residency programs to determine residents' perceptions of a H&N fellow's impact on their surgical experience. An electronic survey was distributed to senior medical students applying to surgical residencies to explore the perceived impact that a fellowship has on the desirability of a residency program.

Results

The average number of each postgraduate year (PGY)5's H&N KIC before and after the addition of the fellowship were: parotidectomy, 19 versus 17.8; neck dissection, 33.2 versus 40.6; oral cavity resection, 15.3 versus 12.6; thyroid/parathyroid, 45.5 versus 45.6; and flaps/grafts, 56.7 versus 42. PGY5 participation as first assistant in free flaps dropped from 78% to 17%; however, residents still participated in some aspect of 45% of the cases. Seventy percent of senior residents reported a positive perception of the H&N fellow on their H&N operative experience. Eighty-nine percent of senior medical student respondents reported a nonnegative perception of a fellowship in their applied field.

Conclusion

The addition of a H&N fellowship did not decrease senior residents' H&N KIC, and most senior residents at programs with fellowships report that the fellow has a positive impact on their H&N operative experience.

Level of Evidence

4. Laryngoscope, 2017

http://ift.tt/2rkx2g0

Clinical evaluations of complete autologous fibrin glue, produced by the CryoSeal® FS System, and polyglycolic acid sheets as wound coverings after oral surgery

Publication date: Available online 10 June 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Atsumu Kouketsu, Shinnosuke Nogami, Minami Yamada-Fujiwara, Hirokazu Nagai, Kensuke Yamauchi, Shiro Mori, Hitoshi Miyashita, Tadashi Kawai, Aritsune Matsui, Yoshihiro Kataoka, Norihisa Satomi, Yushi Ezoe, Satoko Abe, Yuri Takeda, Takeshi Tone, Bunnichi Hirayama, Tsuyoshi Kurobane, Kazuki Tashiro, Yuta Yanagisawa, Tetsu Takahashi




http://ift.tt/2shEjSK

Effect of pre-emptive analgesia on clinical parameters and tissue levels of TNF-α and IL-1β in third molar surgery: a triple-blind, randomized, placebo-controlled study

Publication date: Available online 10 June 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): A.F.M. Albuquerque, C.S.R. Fonteles, D.R. do Val, H.V. Chaves, M.M. Bezerra, K.M.A. Pereira, P.G. de Barros Silva, B.B. de Lima, E.C.S. Soares, T.R. Ribeiro, F.W.G. Costa
This study aimed to evaluate whether pre-emptive analgesia modifies the tissue expression of tumour necrosis factor alpha (TNF-α) and interleukin 1 beta (IL-1β), and whether there is an association with postoperative surgical outcomes. A triple-blind, randomized, placebo-controlled study of patients undergoing mandibular third molar removal was performed. Volunteers were allocated randomly to receive etoricoxib 120 mg, ibuprofen 400 mg, or placebo 1h before surgery. Twenty-four surgical sites per group were required (95% confidence level and 80% statistical power). Pain scores differed significantly between groups (P<0.001). Etoricoxib and ibuprofen reduced pain scores compared to placebo (P<0.05). Pain scores peaked at 4h postoperative in the experimental groups, but at 2h postoperative in the placebo group (P<0.05). A significant reduction in TNF-α concentration from time 0′ to time 30′ was seen for ibuprofen (P=0.001) and etoricoxib (P=0.016). The ibuprofen group showed a significant reduction in IL-1β levels from time 0′ to time 30′ (P=0.038). In conclusion, TNF-α and IL-1β levels and the inflammatory events in third molar surgery were inversely associated with the degree of cyclooxygenase 2 selectivity of the non-steroidal anti-inflammatory drugs used pre-emptively. Patients given pre-emptive analgesia showed significant reductions in the clinical parameters pain, trismus, and oedema when compared to the placebo group.



http://ift.tt/2rjIAjo

Superolateral dislocation of the intact mandibular condyle: report of a rare case with a review

Publication date: Available online 10 June 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): N. Srinath, D.N. Umashankar, C. Naik, J. Biradar
Dislocation of the temporomandibular joint, which represents 3% of all dislocated joints reported in the body, occurs when the mandibular condyle is displaced anteriorly beyond the articular eminence. Although anterior dislocation of the mandibular condyle is well documented in the literature, superior, lateral, and posterior dislocation of the condyle is rare. Only a few reports documenting superolateral dislocation with anterior mandible fractures have been published in the past. However such dislocations without any associated fractures are even rarer. This report documents a case of superolateral dislocation of an intact mandible in a 48-year-old woman following a traumatic incident. This paper also reviews previously documented case reports and focuses on the causative mechanism, dynamics, and management of such dislocations.



http://ift.tt/2rOKsVa

Mandibular symphyseal midline distraction osteogenesis for micrognathia associated with aglossia and situs inversus totalis

Publication date: Available online 10 June 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): X.C. Ren, Y.F. Li, Y. Liu, S.S. Zhu
Aglossia is a rare congenital abnormality, often associated with micrognathia and limb defects. Situs inversus totalis is also a rare congenital abnormality, defined as a mirror-image reversal of all the asymmetric organs of the thorax and abdomen. The concurrence of these two abnormalities has only been reported in eight similar cases in the literature. Although micrognathia and malocclusion were observed in all of these cases, few treatments were performed for the patients' dentofacial deformities. This report describes the case of a 7-year-old boy suffering from micrognathia, aglossia, and situs inversus totalis simultaneously, and the treatment for his micrognathia by mandibular symphyseal midline distraction osteogenesis, guided by virtual surgical planning and a three-dimensional printed surgical template. In a review of the literature, this is the first case of micrognathia associated with aglossia and situs inversus totalis that has been treated by mandibular symphyseal midline distraction osteogenesis for the dentofacial deformity.



http://ift.tt/2rjiZaq

Simulation of three surgical techniques combined with two different bone-borne forces for surgically assisted rapid palatal expansion of the maxillofacial complex: a finite element analysis

Publication date: Available online 10 June 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): S.C. Möhlhenrich, A. Modabber, K. Kniha, F. Peters, T. Steiner, F. Hölzle, U. Fritz, S. Raith
Surgically assisted rapid palatal expansion (SARPE) is a common treatment to correct transverse maxillary deficiencies. Finite element analysis was simulated for six designs of SARPE based on a computed tomography scan of a human skull: median osteotomy with palatal (type A) or alveolar ridge (type B) bone-borne force, additional lateral osteotomy with palatal (type C) or alveolar ridge (type D) bone-borne force, and additional pterygomaxillary separation with palatal (type E) or alveolar ridge (type F) bone-borne force. The transverse expansion was about 1.0mm. The distribution of von Mises stress and the displacement were evaluated. The largest stress distribution was after types A and B, followed by types C and D, and finally types E and F. Displacement increased simultaneously. Palatal bone-borne forces (types A, C, and E) led to higher stress distributions in the midface and maxilla, but to a more parallel expansion compared with alveolar ridge-borne forces (types B, D, and F). The largest bony displacements at the midpalatal suture were anterior in all models. Increased weakening of the bony pillar of the facial skeleton and the use of palatal bone-borne forces leads to a decrease in stress distribution in the midface and to a more parallel transverse expansion of the maxilla.



http://ift.tt/2rOwJ0e

Ischemic stroke complicating thrombolytic therapy with tenecteplase for ST elevation myocardial infarction: two case reports

Hemorrhagic complications are quite common in the rare cases where thrombolysis is performed. Ischemic stroke in the aftermath of thrombolysis for a ST elevation myocardial infarction is a very rare and parado...

http://ift.tt/2reAr4T

25 (OH) D3 levels, incidence and recurrence of different clinical forms of BPPV

Publication date: Available online 11 June 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Sinisa Maslovara, Silva Butkovic Soldo, Anamarija Sestak, Katarina Milinkovic, Jasna Rogic-Namacinski, Anamarija Soldo
IntroductionBenign Paroxysmal Positional Vertigo (BPPV) is the most common cause of dizziness in the general population. It is a condition with potential impact of reduced levels of vitamin D on its recurrent attacks.ObjectivesThe aim of this study was to measure the serum levels of 25-hydroxyvitamin D3 (25-OH D3) in patients with BPPV and determine whether there is a difference in the serum levels of vitamin D3 between patients with and without recurrence, as well as between the different clinical forms of BPPV.MethodsThe study included 40 patients who came to the regular medical examination, diagnosed with PC-BPPV based on the positive Dix-Hallpike's test. All patients underwent Epley manoeuvre after the diagnosis. Patients were classified according to current guidelines for levels of vitamin D3 in the serum in three groups: the deficiency, insufficiency and adequate level.ResultsThe average serum level of 25-OH D3 among respondents was 20.78ng/mL, indicating a lack or insufficiency of the aforementioned 25-OH D3. According to the levels of 25-OH D3, most patients suffer from deficiency (47.5%). 7 (17.5%) respondents had adequate blood level of 25-OH D3, and 14 (35%) respondents suffer from insufficiency. A significant difference was not found in the serum level of 25-OH D3 between patients with and without BPPV recurrence. There was a significant difference in the serum levels of 25-OH D3 in comparison to the clinical form of the disease. Lower 25-OH D3 values were found in patients with canalithiasis compared to those with cupulolithiasis.ConclusionsThere were no significant differences in the vitamin D3 serum level in patients with and without recurrence. The study showed a low level of serum vitamin D3 in most patients, indicating the need for supplemental therapy.



http://ift.tt/2r7JIaw

Recurrence of melanocytic lesions after laser treatment: benign versus malignant upon dermoscopy

Abstract

The treatment of pigmented lesions includes several approaches depending on the nature of the cutaneous lesion to be treated. When considering melanocytic lesions, a balance between therapeutic aspects and cosmetic concerns for aesthetic sites have to be taken into account, with particular attention for the differential diagnosis between benign and malignant.^1-3 In particular, the increasing awareness for good cosmetic results lead to the development of less invasive techniques, although they hamper the histological assessment, which is the gold standard for the diagnosis of melanocytic lesions.

This article is protected by copyright. All rights reserved.

http://ift.tt/2rOjxZo

Baldness and scalp melanoma

Abstract

Nearly 20% of melanomas occur on the head and neck area¹ but only 2-5% arise on the scalp.² Several studies reported a worse prognosis of scalp melanoma compared to other body sites, being unclear the reason for this phenomenon.³ Melanoma and non-melanoma skin cancer of the scalp are most frequent in bald men older than 65 years.

This article is protected by copyright. All rights reserved.

http://ift.tt/2riP8Po

Secukinumab demonstrates greater sustained improvements in daily activities and personal relationships than ustekinumab in patients with moderate-to-severe plaque psoriasis: 52-week results from the CLEAR study

Abstract

Background

Psoriasis can greatly impact patients' lives by influencing clothing worn as well as by impairing sexual functioning. Secukinumab, a human monoclonal antibody selectively neutralizing interleukin-17A, has demonstrated good efficacy and safety in the treatment of moderate-to-severe psoriasis and psoriatic arthritis with a rapid onset of action and sustained response.

Objective

This analysis using the CLEAR study, a phase 3b double-blind study comparing the efficacy and safety of secukinumab versus ustekinumab in adults with moderate-to-severe plaque psoriasis, evaluated the treatment effects on patient's daily activities and personal relationships.

Methods

Impact on daily activities (interference with home/shopping/garden, and influence on clothes worn) and impact on personal relationships (problems with partner/others, and sexual difficulties) as well as their corresponding subscales were selected from the Dermatology Life Quality Index scale and evaluated for patients treated with secukinumab vs. ustekinumab from the CLEAR study. Treatment differences in mean scores and proportions of responders (score = 0, indicating no impact) were evaluated through 52 weeks. Time to response was evaluated through week 16.

Results

Significant differences between secukinumab and ustekinumab were observed for daily activities and personal relationship at week 16 and sustained through Week 52 (Week 52 response rates for daily activities: 82.9% vs. 73.5%, including interference with home/shopping/garden: 88.5% vs. 78.2%, and influence on clothes worn: 85.6% vs. 74.4%; personal relationship: 86.1% vs. 73.7%, including problems with partner/others: 86.6% vs. 74.8%, and sexual difficulties: 88.5% vs. 74.3%; all P < 0.01). The median time to response was 4 weeks for secukinumab versus 8 weeks for ustekinumab for daily activities and personal relationships (both P < 0.05).

Conclusion

Secukinumab treatment helps patients with moderate-to-severe plaque psoriasis have a more normal life faster when compared to ustekinumab, by providing greater and sustained improvement in clothing choice and sexual functioning.

This article is protected by copyright. All rights reserved.

http://ift.tt/2rOaUOC

Increased expression of the interleukin-36 cytokines in lesions of hidradenitis suppurativa

Summary

Background

Hidradenitis suppurativa (HS) is a recalcitrant chronic skin disease with poorly understood immunopathogenic mechanisms. Previous studies reported that the interleukin-36 (IL-36) cytokines (IL-36α, IL-36β, IL-36γ, and IL-36 receptor antagonist [IL-36RA]) are important players in the pathogenesis of psoriasis (PS).

Objective

We aim to determine whether the IL-36 cytokines are upregulated in HS patients. For this purpose, we analysed local expression and systemic levels of the IL-36 cytokines in HS patients and compared the results to healthy donors and PS patients.

Methods

Skin biopsies from healthy donors and HS and PS patients were analysed for expression of the IL-36 cytokines by immunohistochemistry and semiquantitative real-time PCR. The enzyme-linked immunosorbent assay (ELISA) was used to measure systemic levels of the IL-36 cytokines in the serum of the three donor groups.

Results

The agonists IL-36α, IL-36β, and IL-36γ were found to be upregulated in HS both systemically and lesionally, while the IL-36RA was not differently regulated in comparison to healthy donors.

Conclusion

Our findings suggest that the agonistic IL-36 isoforms are upregulated in HS. The relevance of the enhanced production of IL-36 cytokines in HS pathogenesis remains to be determined.

This article is protected by copyright. All rights reserved.

http://ift.tt/2rO4bE5

Compression therapy for venous leg ulcers: Risk factors for Adverse Events and Complications, Contraindications. A review of present Guidelines

Abstract

Introduction

The adequate use of compression in venous leg ulcer treatment is equally important to patients as well as clinicians. Currently there is a lack of clarity on contra-indications, risk factors, adverse events and complications, when applying compression therapy for venous leg ulcer patients.

Methods

The project aimed to optimize prevention, treatment and maintenance approaches by recognizing contra-indications, risk factors, adverse events and complications, when applying compression therapy for venous leg ulcer patients. A literature review was conducted of current guidelines on venous leg ulcer prevention, management and maintenance.

Results

Searches took place February 29 to April 30, 2016, were prospectively limited to publications in the English and German languages and publication dates were between January 2009 and April 2016. Twenty Guidelines, clinical pathways and consensus papers on compression therapy for venous leg ulcer treatment and for venous disease, were included. Guidelines agreed on the following absolute contraindications: Arterial occlusive disease, heart failure and ankle brachial pressure index (ABPI) < 0.5, but gave conflicting recommendations on relative contraindications, risks and adverse events. Moreover definitions were unclear and not consistent.

Conclusions

Evidence based guidance is needed to inform clinicians on risk factor, adverse effects, complications and contraindications. ABPI values need to be specified and details should be given on the type of compression that is safe to use. Ongoing research challenges the present recommendations, shifting some contraindications into a list of potential indications. Complications of compression can be prevented when adequate assessment is performed and clinicians are skilled in applying compression.

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Self-diagnosed drug allergies: the belief of patients

Abstract

The term of "drug allergy" (DA) may include true hypersensitivity or non-allergic reactions. The rate of self-reporting DA ranges from 4.7% to 11% regardless of age. When patients report a DA, the medical team often decides a full and definitive elimination of the incriminated drug from future therapy, which deeply affects medical care.

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