Head and Neck Medicine by Alexandros G.Sfakianakis: 06/13/17

Τρίτη 13 Ιουνίου 2017

The risk of malignancy among biologic-naïve pediatric psoriasis patients: A retrospective cohort study in a US claims database

Little published literature exists regarding malignancy risk in pediatric psoriasis patients.

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Real-world burden of comorbidities in US patients with psoriasis

Understanding background comorbidity rates in psoriasis can provide perspective for adverse events associated with new therapies.

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Healthy Skin for Everyone: The effectiveness of a community-based skin cancer education program in an underserved population

"Healthy Skin for Everyone," or "Piel Saludable Para Todos," is a community-based initiative to address the rising rates of skin cancer in minority populations that is coupled with poor mortality rates and lack of evidence-based interventions. In our study, community health workers from a large nonprofit, free clinic were trained to lead 45-minute interactive educational workshops followed by participant enrollment in a 12-week text-messaging program. Spanish-speaking adults over the age of 18 regardless of educational level were included.

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Corrigendum to “Can a surgery-first orthognathic approach reduce the total treatment time?” [Int. J. Oral Maxillofac. Surg. 46 (2017) 473–482]

The authors regret the oversight that requires the following modification in Table 2. The last line for treatment time in Table 2 should be changed to 22.0 months in orthodontics-first group and 14.6 months in surgery-first group.

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Nasal airway evaluation in obstructive sleep apnoea patients: volumetric tomography and endoscopic findings

Obstructive sleep apnoea (OSA) results from the recurrent collapse of the upper airway during sleep. Nasal abnormalities influence the stability of the pharynx. The aim of this study was to evaluate the volumetric and anatomical changes of the nasal cavity in patients with OSA. The Nasal Obstruction Symptom Evaluation (NOSE) scale was used to grade nasal obstruction. Sleep-related breathing disorders were evaluated by polysomnography. The nasal airway volume was obtained from computed tomography scans through volumetric reconstruction of the nasal airway.

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Regional Anesthesia and Pain Medicine: US Anesthesiology Resident Training-The Year 2015.

Background and Objectives: The Anesthesiology Review Committee of the Accreditation Council for Graduate Medical Education sets core requirements for residency program accreditation. We periodically report and analyze the US anesthesiology residents' training experience in regional anesthesia and pain medicine. Methods: Resident caseload, procedure, and pain medicine evaluation data were aggregated for the resident cohort who graduated in 2015. These data were analyzed for present-day experience and compared with previous reports from years 1980, 1990, and 2000 graduates. Results: Data were available for 1631 residents who graduated from 129 training programs. Regional anesthesia as a portion of the overall anesthesiology residents' training experience remains unchanged since 1990. The distribution of regional anesthesia training has shifted from neuraxial to peripheral blocks. All residents at the 10th percentile and above achieved the benchmark for spinal, epidural, and peripheral nerve block anesthetics and for new pain evaluations. Conclusions: The focus of US anesthesiology resident training in regional anesthesia and pain medicine has changed over the past 15 years by shifting from neuraxial to peripheral nerve block techniques. Previous training deficits have resolved for spinal anesthesia and peripheral nerve block. Procedural experience in pain medicine overwhelmingly involves epidural and facet injections. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.

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Biochemical and Pharmacological Characterization of a Mice Model of Complex Regional Pain Syndrome.

Background and Objectives: Complex regional pain syndrome is a challenging disease to treat. Recently, a mouse fracture model of complex regional pain syndrome has been developed that has many signs of the clinical syndrome. However, many aspects of the sensory neuron biochemistry and behavioral and pharmacological characterization of this model remain to be clarified. Methods: Mice were randomly assigned to fracture/cast or control (naive) groups. Fracture/cast mice underwent a closed distal tibia facture, with hindlimb wrapped in casting tape for 3 weeks. After cast removal, mice were tested for mechanical allodynia, burrowing behavior, and motor ability over a 12-week period. Protein immunohistochemistry was performed for substance P, calcitonin gene-related peptide, tropomyosin receptor kinase A, nerve growth factor, Nav1.7, and transient receptor potential cation-channel V1, colocalized in neurons, in the ipsilateral lumbar dorsal root ganglia (DRGs). Analgesic drugs were tested for pain-relieving efficacy. Results: Mechanical allodynia was greater in the ipsilateral hindpaw (P = 0.0002) in the fracture/cast group versus the control group, over the 3- to 12-week period. The amount of burrowing material removed was decreased (P = 0.0026), and there were deficits in spontaneous motor-rearing behavior (P = 0.018). Immunostaining of substance P, calcitonin gene-related peptide, Trk A receptor, nerve growth factor, Nav1.7, and transient receptor potential cation-channel V1 all demonstrated up-regulation in the DRGs of fracture mice versus controls (all P

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Recognition of Viral RNA by Pattern Recognition Receptors in the Induction of Innate Immunity and Excessive Inflammation During Respiratory Viral Infections

Viral Immunology , Vol. 0, No. 0.

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Regional Immune Responses in the Lung After Respiratory Virus Infections

Viral Immunology , Vol. 0, No. 0.

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Early bony changes associated with bisphosphonate-related osteonecrosis of the jaws in rats: A longitudinal in vivo study

Publication date: October 2017
Source:Archives of Oral Biology, Volume 82
Author(s): Josy Lorena Peres Vilarinho, Nathália Ferrare, Andreia Maria Rocha Moreira, Helora Freitas Moura, Ana Carolina Acevedo, Sacha Braun Chaves, Nilce Santos Melo, André Ferreira Leite, Sérgio Bruzadelli Macedo, Melissa Paoletti de Souza, Ana Tereza Bittencourt Guimarães, Paulo Tadeu Figueiredo
ObjectiveTo evaluate early bony changes in an animal model of Medication-Related Osteonecrosis of the Jaw (MRONJ) at the side of the local trauma and at the contralateral side, comparing with a control group. Bony changes were evaluated by Microcomputed Tomography (MicroCT) at three times points: at baseline (T0), after drug administration (T1) and after dental extraction (T2).DesignTwo groups were compared: the experimental group in which zoledronic acid (ZA) was administered (17 rats) and the control group (13 rats). Dental extractions of the lower left first molars were performed in all animals. The left side was considered as the supposed affected area in the ZA group, and the right side was considered as the unaffected area. In these areas, the following structural microtomographic bone parameters were calculated: Bone Mineral Density (BMD), Trabecular Thickness (Tb.Th), and Bone Volume Proportion (BV/TV). The comparison of quantitative bone parameters among the different sides and experimental phases of both studied groups were performed by ANOVA-factorial.ResultsNone of the animals of the control group developed MRONJ. In the ZA group, 76% presented bone exposure. From T0 to T1, Tb.Th and BV/TV increased, and in T2, the mean values were higher in ZA group than in the control group. BMD increased throughout the different phases of both groups.ConclusionsStructural bony changes occurred in the ZA group at both mandibular sides before the dental extraction (T1). Tb.Th and BV/TV should be further investigated as potential early bone markers of MRONJ.

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Immunological and epidemiological factors affecting candidiasis in HIV patients beginning antiretroviral therapy in an Asian clinic

Publication date: October 2017
Source:Archives of Oral Biology, Volume 82
Author(s): Endah A.T. Wulandari, Henny Saraswati, Robiatul Adawiyah, Samsuridjal Djauzi, Retno Wahyuningsih, Patricia Price
ObjectivesOropharyngeal candidiasis (OPC) is common in HIV patients beginning antiretroviral therapy (ART). Here we address the response to ART, and the roles of poor oral hygiene and defects in local innate immunity with a focus on salivary β-defensins, as they are implicated in control of candidiasis but have not been investigated in this context.DesignART naïve HIV-infected adults (n=82) with <200 CD4⁺ T-cells/mm³ attending clinics at Cipto Mangunkusumo Hospital, Jakarta, were examined at the commencement of ART, and 73 were re-examined after 3 months. OPC was detected by clinical examination, and Candida albicans and fungal burdens were determined following culture on CHROMagar and saboroud-dextrose agar (resp). Salivary β-defensins (−2 and −3) were quantified by ELISA. Healthy control subjects (n=40) matched the patients by age and gender.ResultsOPC was evident in 47 patients before ART, and associated with greater fingal burdens. No OPC was detected in healthy controls and culture positivity was rare. ART decreased the prevalence of OPC to 8/73 HIV patients re-examined after 3 months, with reduced total fungal and C. albicans burdens. The incidence of OPC was independent of oral hygiene. Hyposalivation was more common in untreated HIV patients (16%) than after 3 months on ART and was rare in healthy controls. HIV patients were also more likely to have acidic saliva. Salivary β-defensin-2 was elevated in the presence of C. albicans pseudohyphae and OPC after 3 months on ART, but β-defensin-3 was not affected by OPC or ART.ConclusionsART reduces the prevalence of OPC, and the total fungal and C. albicans burden. Levels of salivary β-defensin-2 may associate with OPC in HIV patients responding to ART.

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Early bony changes associated with bisphosphonate-related osteonecrosis of the jaws in rats: A longitudinal in vivo study

Immunological and epidemiological factors affecting candidiasis in HIV patients beginning antiretroviral therapy in an Asian clinic

Anagen Effluvium in Association With Extracorporeal Membrane Oxygenation

Abstract

Anagen effluvium (AE) is a type of alopecia with hair loss during the growth phase of a hair follicle and is most often associated with cytotoxic chemotherapy. This report describes a case of AE in a critically ill 2-year-old boy who developed cardiorespiratory failure requiring extracorporeal membranous oxygenation. We postulate that the combination of hypotension and hypoxia with subsequent reperfusion triggered an apoptotic cascade in the hair matrix, resulting in AE.

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Geographic distribution of phylogenetic species of the Fusarium graminearum species complex and their 8-ketotrichothecene chemotypes on wheat spikes in Iran

Abstract

Isolates of the Fusarium graminearum species complex (FGSC, n = 446) were collected from wheat spikes from northern and western regions of Iran with a history of Fusarium head blight (FHB) occurrences. The trichothecene mycotoxin genotypes/chemotypes, the associated phylogenetic species, and geographical distribution of these isolates were analyzed. Two phylogenetic species, Fusarium asiaticum and F. graminearum, were identified and were found to belong to sequence characterized amplified region (SCAR) groups V and I. Isolates from F. asiaticum species lineage 6 were within SCAR group V, whereas F. graminearum species lineage 7 were of SCAR group I. Of the 446 isolates assayed, 274 were F. asiaticum species predominantly of the nivalenol (NIV) genotype, while other isolates were either deoxynivalenol (DON) plus 3-acetyldeoxynivalenol (3-AcDON) or DON plus 15-acetyldeoxynivalenol (15-AcDON) genotype. Based on Tri7 gene sequences, a new subpopulation of 15-AcDON producers was observed among F. asiaticum strains in which 11-bp repeats were absent in the Tri7 sequences. The trichothecene chemotype was confirmed and quantified by high-performance liquid chromatography (HPLC) in 46 FGSC isolates. Isolates produced NIV (33.4–108.2 μg/g) and DON (64.7–473.6 μg/g) plus either 3-AcDON (51.4–142.4 μg/g) or 15-AcDON (24.1–99.3 μg/g). Among FGSC isolates, F. asiaticum produced the highest levels of trichothecenes. Using BIOCLIM based on the climate data of 20-year during 1994–2014, modelling geographical distribution of FGSC showed that F. asiaticum was restricted to warmer and humid areas with a median value of mean annual temperature of about 17.5 °C and annual rainfall of 658 mm, respectively (P < 0.05). In contrast, F. graminearum (only 15-AcDON producers) was restricted to cooler and drier areas, with a median value of the mean annual temperature of 14.4 °C and an annual rainfall of 384 mm, respectively (P < 0.05). Based on climate parameters at anthesis, the recorded distribution of F. graminearum and F. asiaticum was similar to that based on BIOCLIM parameters. Therefore, geographic differences on the wheat-growing areas in Iran have had a significant effect on distribution of FGSC and their trichothecene chemotypes.

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Bilaterale Stimmbandparese eines langzeitbeatmeten Patienten mit DISH

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-112161

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents | Full text

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Schädigung von mikrochirurgischen Instrumenten durch Aufbereitung in einer Zentralsterilisation

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-110857

Jedes Jahr werden in Krankenhäusern Risikomeldungen zu Verunreinigungen, Korrosion, Deformation oder vorzeitigem Verschleiß von Medizinprodukten gemacht. Zu den Auswirkungen des Aufbereitungsprozesses auf die Qualität und Haltbarkeit empfindlicher und sehr feiner Instrumente gibt es bisher sehr wenige Daten. Diese Arbeit untersucht, ob und gegebenenfalls in welchem Umfang mikrochirurgische Instrumente durch den Aufbereitungsprozess geschädigt werden. Material und Methoden Gegenstand der Untersuchung waren 22 mikrochirurgische Instrumente aus der Stapeschirurgie. Die fabrikneuen Instrumente zweier unterschiedlicher Hersteller A und B wurden jeweils 30 Mal einem Aufbereitungsprozess unterzogen, ohne dass sie jemals operativ oder anderweitig benutzt wurden. Nach jedem Aufbereitungsprozess wurden die Instrumente makroskopisch und mikroskopisch überprüft. Die Ergebnisse wurden mittels einer Fotodokumentation dargestellt und auf Basis dieser ausgewertet. Ergebnisse Bei nahezu allen Instrumenten kam es zu mechanischen Beschädigungen allein durch den Aufbereitungsprozess. In einigen Fällen wiesen die Instrumente bei der mikroskopischen Sichtkontrolle Verschmutzungen und Flecken auf. Schlussfolgerung Die Arbeit zeigt auf, wie elementar ein sorgfältiger Umgang mit empfindlichen Instrumenten bei deren Aufbereitung ist. Sie weist außerdem auf Probleme der bei mikrochirurgischen Instrumenten üblichen Lagerung mit Schutzhülsen hin. Als zukünftige Alternative sollte über eine statische Lagerung von mikrochirurgischen Instrumenten in speziellen Racks nachgedacht werden.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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

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Factors associated with the choice of the first biologic in psoriasis: Real life analysis from the Psobioteq cohort

Abstract

Background

Decision making is a complex process. The aim of our study was to assess factors associated with the choice of the first biological treatment in patients with moderate-to-severe psoriasis.

Methods

Data on all patients included in the French prospective, observational, cohort, Psobioteq and initiating a first biologic prescription between July 2012 and July 2016 were analysed. Demographic information and clinical features were collected during routine clinical assessments by the dermatology team at the recruiting centres using a standardized case report form. The primary outcome was the nature of the first biologic treatment. Four groups were identified: adalimumab, etanercept, ustekinumab and infliximab groups. Factors associated with the choice of the first biological agent were determined by a multinomial logistic regression model adjusted on year of inclusion.

Results

The study population included the 830 biological-naïve patients who initiated a first biological agent. The mean age was 46.6 years (+/-SD 13.9), and 318 patients (38.3%) were female. The most commonly prescribed biologic was adalimumab: 355 (42.8%) patients, then etanercept (n=247, 29.8%), ustekinumab (n=194, 23.4%) and infliximab (n=34, 4.0%). In the multinomial logistic regression analysis, patients were significantly more likely to receive adalimumab if they had a severe psoriasis as defined by baseline PASI or if they had psoriatic arthritis compared to etanercept (aOR, 0.42; 95%CI, 0.16 to 1.07) and ustekinumab (aOR, 0.15; 95%CI, 0.04 to 0.52). Patients were significantly more likely to receive ustekinumab (aOR, 2.39; 95%CI, 1.04 to 5.50) if they had a positive screening for latent tuberculosis compared to adalimumab. Younger patients were also more likely to receive ustekinumab. Patients with chronic obstructive pulmonary disease were more likely to be prescribed ustekinumab or etanercept compared to adalimumab. There was a trend in favor of etanercept prescription in patients with cardiovascular co-morbidities, metabolic syndrome and in patients with a history of cancer.

Conclusion

We identified patient and disease related factors that have important influence on the choice of the first biological agent in clinical practice. Clinicians appear to have a holistic approach to patient characteristics when choosing a biological agent in psoriasis.

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Cryptogenic cirrhosis: misunderstood cause of yellow urticaria

Abstract

We read with great interest the paper by Combalia et al recently appeared on Journal of European Academy of Dermatology¹. The authors reported two cases of yellow urticaria related to liver cirrhosis, one due to hemochromatosis, and the other one to alcohol¹. With a total of ten cases reported in literature by now, we considered relevant to report another case we recently came across.

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Satisfaction of mountain guides with high sun protection as a tool to prevent NMSC

Abstract

Background

NMSC is an occupational disease for outdoor workers in Germany since 2015. Sustainable prevention is demanded and sunscreen promoted as an effective tool. However, studies on the satisfaction of sunscreen users are rare.

Objective

To evaluate the satisfaction of mountain guides using a high SPF sunscreen product as an appropriate prevention tool for mountain guides.

Methods

Motivating mountain and ski guides in Germany to use very high protection sunscreen (SPF50+, Actinica Lotion) during a 4 to 8 hours workday followed by the completion of a self-filled paper-based questionnaire about their experience and satisfaction with the product.

Results

Of 88 mountain and ski guides (61 men, 27 women) included in the study, 61.4% reported regular sunscreen use with the application of very high protection (SPF50+) in 18.6% of all cases. At the end of the workday, 78.6% found the product convenient and easy to include into their daily work and 79.3% felt sufficiently protected against the sun.

Conclusion

Overall satisfaction with the use of high SPF products during work is high in mountain and ski guides and could be an effective tool in prevention campaigns.

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Psoriasis Comorbidity affects Multiple Sclerosis Neurological Progression: a retrospective case –control analysis

Abstract

Background

Multiple sclerosis (MS) and psoriasis are inflammatory disorders, with epidemiological and biological associations. The impact of one disease on the course of the other has not been studied.

Objective

To characterize patients with psoriasis and MS, and to assess whether psoriasis comorbidity affected the progression of MS.

Methods

A retrospective case control study. Patients with psoriasis comorbidity were identified from 3456 patients included in the Sheba Hospital Multiple Sclerosis Center database. Clinical and demographical characteristics and MS progression-related outcomes in patients whose follow up exceeded 5 years were analyzed and compared to those of a matched control cohort of MS-only (MSO) patients.

Results

Forty-five (1.3%) MS patients had psoriasis comorbidity. Psoriasis preceded MS in thirty-five (78%) cases. The psoriasis was defined as mild, moderate, and severe in twenty-four (53%), twelve (27%), and nine (20%) cases, respectively. MS progression-related outcomes were evaluated in 35 patients that had follow-up over 5 years. Patients with psoriasis onset preceding relapsing-remitting MS (RRMS) had slower progression of disease compared to MSO patients, as manifested by a longer time to second relapse (p<0.01) and a longer time to significant neurological disability scores (p<0.03).

Conclusion

Psoriasis comorbidity preceding the onset of MS is associated with slower progression of disability.

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Prevention of livedoid vasculopathy recurrence by prolonged administration of rivaroxaban

Abstract

A 49-year-old man with known livedoid vasculopathy presented with recurrent painful (VAS 8/10) ulceration and necrosis on the foot (Figure 1). He was formerly treated with prostacyclin infusions, acetylsalicylic acid, intravenous immunoglobulins, different systemic antibiotics and a skin grafting. At admission an antithrombotic therapy with enoxaparin (Clexane^®) in a dose of 1 mg/ kg bodyweight (100 mg) once daily was initiated.

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Natural history of skin prick test reactivity

Allergic reactions to airborne allergens may have important consequences for affected individuals and are believed to be unstable through life, although evidence from longitudinal studies is limited.

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Validation of International consensus equation for acute serum total tryptase in mast cell activation: A perioperative perspective

Abstract

Introduction

There is no standardised method for assessing serum total mast cell tryptase (MCT) in anaphylaxis. The consensus equation (peak MCT should be>1.2x baseline tryptase+2mg/L) has been proposed to interpret acute MCT in mast cell activation syndrome (MCAS).

Aim

To validate consensus equation in a setting of perioperative anaphylaxis.

Methods

Analyses of suspected perioperative anaphylaxis during general anaesthesia (GA). Anaphylaxis was defined as per World Allergy Organisation (WAO) criteria. Timed serial MCT measurements were mapped against the consensus equation and receiver operating characteristic (ROC) curves produced.

Results

82 patients (60 females, mean age 56.5 years ± SD17.2) underwent investigation. 60 (73%) patients fulfilled WAO criteria for anaphylaxis and 22 patients did not (controls). Aetiology: 59% IgE-mediated anaphylaxis, 2% non-IgE mediated anaphylaxis, 12% anaphylaxis of unknown cause, and 27% deemed non-anaphylaxis. IgE-mediated anaphylaxis included - NMBA (35%), antibiotics (46%), chlorhexidine (8%), patent blue dye (8%) and others (8%). An acute MCT with a comparable baseline was available in 71/82 (87%) patients (60-anaphylaxis and 11-controls).The median (IQR) time from reaction to peak MCT was 1.34 (0.82-2.51) hours. Analyses confirmed that a rise in acute MCT greater than that defined by the equation had a sensitivity, specificity, positive predictive value (PPV) and negative (N) PV of 78%, 91%, 98%, and 44% respectively. The magnitude of increase in acute MCT above the threshold predicted by consensus equation was higher in the anaphylaxis group compared to controls (P=0.0001).

Conclusion

This equation has a high specificity, PPV with a moderate NPV and sensitivity in perioperative anaphylaxis.

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Association between polymorphisms in pre-miRNA genes and risk of oral squamous cell cancer in a Chinese population

by Enjiao Zhang, Zhongfei Xu, Weiyi Duan, Shaohui Huang, Li Lu

Background

MicroRNAs play important roles in the development of human cancers. This case-control study is to evaluate the roles of the polymorphisms in pre-miRNAs on risk of oral cancer in a Chinese population.

Methods

The genotypes of three polymorphisms were determined in 340 patients with oral squamous cell cancer and 340 healthy controls who were frequency matched for age and sex. Odds ratios (ORs) and 95% confidence intervals (95%CIs) were calculated to assess the association. All analyses were performed using the SPSS software. 3.154() 0.001.

Results

For miR-499 rs3746444, individuals carrying homozygous CC genotype had increased risks of oral cancer compared with the homozygous wild TT genotype (adjusted OR was 3.154, 95%CI was 1.555–6.397, P value was 0.001). The C allele of miR-499 rs3746444 was associated with a higher risk of oral cancer with significant odds ratio of 1.453. In the stratified analyses by sex, the associations between miR-499 rs3746444 and miR-146a rs2910164 polymorphisms with the susceptibility of oral squamous cell cancer were significant in males. However, with 1/4 as many subjects there were no significant associations between the three polymorphisms and oral cancer risks in females. The joint effects of miRNA polymorphisms and smoking on the risk of OSCC were analyzed and the results suggested that the association between microRNA genetic variants and OSCC risk was modified by smoking.

Conclusions

These findings suggest that miR-499 rs3746444 and miR-146a rs2910164 polymorphisms may contribute to genetic susceptibility to oral squamous cell cancer.

http://ift.tt/2rX75ql

Osteosarcoma of the lower limb metastasized to the septum and right side of the heart: a case report

Metastatic cardiac tumors are far more common than primary tumors. Although the hematogenous spread of osteosarcoma is well known, the imaging findings of cardiovascular involvement by osteosarcoma are seldom ...

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Chronic exposure to tetracyclines and subsequent diagnosis for non-melanoma skin cancer in a large Midwestern U.S. patient population

Abstract

Tetracyclines (TCNs) are commonly used in the management of several chronic dermatological disorders, partly due to their affinity for inflamed skin tissue, as they are known to suppress cytokines including tumor necrosis factor-alpha and interleukin-6 that are typically involved in inflammatory skin disorders.¹ TCNs are known to be photoreactive following ultraviolet (UV) radiation exposure, a known risk factor for the development of nonmelanoma skin cancer (NMSC), notably basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).² Previous studies examining the relationship between photoreactive medications, including psoralen compounds and sulfonamide moieties, and NMSC suggest an association.

http://ift.tt/2rnOVj0

Digit preserving surgery of subungual melanoma, a case series using vacuum assisted closure and full thickness skin grafting

Abstract

Acrolentiginous melanoma (ALM) is the second most common nail organ tumour and frequently, affects the thumb or the great toe.^1,2 Digit amputation is still the gold standard for many surgeons;³ it does, however, not protect against local recurrence. An alternative represents complete tumour resection with distal phalanx preservation, which has proven valuable, especially for well demarcated thinner tumours.^4,5

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Nodular scabies in infants: dermoscopic examination may avoid a diagnostic pitfall

Abstract

infantile scabies sometimes manifests with atypical clinical presentation, leading to misdiagnosis. Monomorphic primary lesions or different coexisting lesions may be present. Specific pediatric localizations are scalp and face¹, but in infants the most common are palms, soles and axillae. Irritability and poor feeding are more often referred by parents than itching.

http://ift.tt/2rodY5a

Hyperbilirubinemia: The common denominator of Yellow Urticaria

Abstract

Rosso et al recently enlarged to ten the list of patients diagnosed with yellow urticaria (YU). These cases of YU remind clinicians that the skin, besides forming a biological barrier to protect internal organs and systems from the external environment, frequently reflects underlying internal diseases.

YU has been described secondary to infective hepatitis1, liver cirrhosis (regardless of the cause) ^{2, 3, 4, 5, 6}, acute liver failure⁷, and metastatic disease of the liver⁸.

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Diagnostic accuracy of skin lesions amongst plastic surgeons and a dermatologist

Abstract

There have been few studies investigating diagnostic accuracy between plastic surgeons, or comparing this with dermatologists. Use of dermoscopy by dermatologists has widened the diagnostic gap between dermatologists and plastic surgeons, with plastic surgery lagging behind dermatology in learning this technique. Consequently, plastic surgeons are likely to have a lower threshold for performing a diagnostic or excisional biopsy than dermatologists, leading to a higher rate of intervention for lesions that could otherwise be managed non-surgically.

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Practice-Changing Study for Melanoma Surgery

A major clinical trial settles the matter of whether or not to remove all of a melanoma patient's regional lymph nodes when some 'sentinel' nodes have cancer.
Medscape Medical News

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Tanning Bed Use Declining Among U.S. Adults

The number of U.S. adults using indoor tanning machines decreased by a third between 2010 and 2015, a recent study suggests.
Reuters Health Information

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Treating Psoriasis May Curb Vascular Inflammation

Improving psoriasis severity is associated with improvement in aortic vascular inflammation, suggesting that alleviating inflammation in the skin can favorably affect the vasculature, researchers say.
Reuters Health Information

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Analysis of adipose tissue immune gene expression after vaccination of rainbow trout with adjuvanted bacterins reveals an association with side effects

Publication date: August 2017
Source:Molecular Immunology, Volume 88
Author(s): Kimberly A. Veenstra, Tiehui Wang, Ayham Alnabulsi, Alex Douglas, K. Spencer Russell, Lincoln Tubbs, Juliette Ben Arous, Christopher J. Secombes
Most existing fish vaccines are presented in the form of oil-based emulsions delivered by intraperitoneal injection. Whilst very effective they are frequently associated with inflammatory responses that can result in clinically significant side-effects often involving the adipose tissue that is in direct contact with the vaccine. To explore the potential of immune gene expression changes in the adipose tissue of fish to be markers of vaccination efficacy or development of side-effects we have studied the response to a bacterial (Aeromonas salmonicida) vaccine administered with two different adjuvants. The first adjuvant was Montanide™ ISA 763A VG, thought to induce a mostly humoral response, and the second was Montanide™ ISA 761 VG that gives a more balanced humoral and cell mediated response. Following vaccination tissue samples were collected at days 3, 14 and 28 for RTqPCR analysis. Fifty immune genes were studied with a focus on a) pro-inflammatory associated molecules and b) adaptive immune response related molecules linked with possible Th1, Th2, Th17 and T-regulatory pathways, with the expression data analysed for associations with Speilberg post-vaccination side effect scores. The results showed that the adipose tissue is a particularly sensitive and discriminatory tissue for studying adjuvant effects. A clear upregulation of many immune genes occurred in response to both vaccine groups, which persisted over time and overlapped with the appearance of visible adhesions. Our analysis revealed a relationship between adipose tissue immune function and the development of vaccine-induced adhesions giving the potential to use immune gene expression profiling in this tissue to predict the side-effects seen.

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Editorial Board

Publication date: June 2017
Source:British Journal of Oral and Maxillofacial Surgery, Volume 55, Issue 5

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Challenging hierarchy in healthcare teams – ways to flatten gradients to improve teamwork and patient care

Publication date: June 2017
Source:British Journal of Oral and Maxillofacial Surgery, Volume 55, Issue 5
Author(s): B. Green, R.S. Oeppen, D.W. Smith, P.A. Brennan
In healthcare, mistakes that are potentially harmful or fatal to patients are often the result of poor communication between members of a team. This is particularly important in high-risk areas such as operating theatres or during any intervention, and the ability to challenge colleagues who are in authority when something does not seem right or is clearly wrong, is crucial. Colleagues in oral and maxillofacial surgery recognised the importance of this as early as 2004, and it is now well known that failure or reluctance to challenge others who might be wrong can severely compromise a patient's safety. The Royal College of Surgeons of Edinburgh runs popular regular courses (Non-technical Skills for Surgeons, NOTSS) that teach how to ensure safety through good communication and teamwork. In this paper we introduce the concept of hierarchical challenge, and discuss models and approaches to address situations when problems arise within a team.

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Three-dimensional facial changes correlated with sagittal jaw movements in patients with class III skeletal deformities

Publication date: June 2017
Source:British Journal of Oral and Maxillofacial Surgery, Volume 55, Issue 5
Author(s): M. Verdenik, N. Ihan Hren
The aim of this prospective study was to correlate the postoperative 3-dimensional facial changes in skeletal class III deformity with sagittal jaw movements in 84 patients who had been treated by one piece Le Fort I maxillary advancement only (n=18), mandibular setback only (n=38), or both procedures (n=28). At the times of evaluation before and six months after operation all patients had fixed orthodontic appliances. Soft tissue changes were evaluated on optical 3-dimensional scans, while lateral cephalograms were superimposed to assess sagittal jaw movements. Three-dimensional surface facial scans were divided into 11 regions. We modelled soft tissue changes in each region by linear regression with maxillary (point A) and mandibular (point B) sagittal movements as predictors, and adjusted for sex, age, body mass index, type of operation, and interincisal angle. We found the highest values of regression coefficients (around 0.5) for the sagittal movements of the variables points A and B within the regions of the upper and lower lips. This meant that for each mm of maxillary advancement and mandibular setback, the soft tissue moved 0.5mm. In the sides of the face the regression coefficients were between 0.1 and 0.3, as were those within regions indirectly affected by the operations.

http://ift.tt/2spibFU

Training Groups

Publication date: June 2017
Source:British Journal of Oral and Maxillofacial Surgery, Volume 55, Issue 5

http://ift.tt/2sY5hvz

Safer alternative for extraction of impacted supernumerary teeth of a patient in the mixed dentition stage with the aid of an image-guided operating system

Publication date: June 2017
Source:British Journal of Oral and Maxillofacial Surgery, Volume 55, Issue 5
Author(s): W. Wang, M. Somar, K. Lv

http://ift.tt/2re6qy9

Use of Thudichum nasal speculum for retraction during insertion of dental implants

Publication date: June 2017
Source:British Journal of Oral and Maxillofacial Surgery, Volume 55, Issue 5
Author(s): Ashwant Kumar Vadepally, Ramen Sinha

http://ift.tt/2sxJTjH

Two different techniques of manufacturing TMJ replacements – a technical report

Publication date: Available online 12 June 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Marcin Kozakiewicz, Tomasz Wach, Piotr Szymor, Rafał Zieliński
IntroductionPresently, during the surgical treatment of the patients in maxillofacial surgery, one can use various medical implants. Moreover custom made implants are being used. Replacements may be fitted to the structure and shape of the human skull owing to CAD/CAM (custom aided design/manufacture) called customized implants. This study was aimed to report for the first time clinical material from which custom implants, using two different techniques, were manufactured to reconstruct the temporomandibular joint (TMJ).Material and methodsIn this study, eleven patients with an average age of 54 years were included. All of the patients underwent TMJ reconstruction using direct metal laser sintering (DMLS) or computer numerical control milling (CNC) techniques for implant manufacture. Four of the eleven patients had a malignancy diagnosis, and seven had a benign diagnosis. Patients complained of hypomobility of the TMJ, facial asymmetry, pain and swelling of the preauricular region. Treatment included 7 CNC milled implants and 4 implants in DMLS.ResultsMore metallic implant parts with a rough surface were associated with the DMLS technique. Post operational, uneventful healing was observed in all clinical cases during an average of 26.8 months of follow-up. Three months post-operation, facial nerve palsy, swallowing disturbances and pain were not observed. Infections, allergic reactions to materials and re-ankylosis were also not observed. Replacements received correct forms and functions owing to the CAM techniques. Post-operational maximal interincisal opening improved (p<0.01) and was not significantly related to preoperational opening, age, sex, diagnosis or adjuvant radiotherapy.ConclusionConsidering both methods, the feature that differentiates the manufacture technique is the more subtractive surface finishing required for the DMLS implant than the CNC implant. Both techniques resulted the same clinical outcomes and can be used successfully in patients with neoplastic lesions and other TMJ disorders. Unfortunately, DMLS is more vulnerable to fracture.

http://ift.tt/2sp1WJh

Sulfhaemoglobinaemia caused by ferrous sulfate

A 78-year-old man was referred from his primary care clinic to the emergency department due to bluish discolouration of his lips and decreased oxygen saturation on pulse oximetry. The patient was asymptomatic. Physical exam was normal except for lip cyanosis. A CT pulmonary angiogram was negative for pulmonary embolism. Arterial blood gas (ABG) analysis with co-oximetry showed low oxyhaemoglobin, normal partial pressure of oxygen and methaemoglobinaemia, but an unexplained 'gap' in total haemoglobin saturation. This gap was felt to be due to sulfhaemoglobinaemia. After a thorough review of his medications, ferrous sulfate was stopped which resulted in resolution in patient's cyanosis and normalisation of his ABG after 7 weeks.

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A phase II study of ipilimumab plus temozolomide in patients with metastatic melanoma

Abstract

Checkpoint blockade has revolutionized the treatment of melanoma; however, it benefits only the minority of patients. Several agents have been combined with immunotherapy to improve T-cell activation and persistence including growth factor, chemotherapy, and radiation. Preclinical data suggest that temozolomide, which metabolizes to the same active compound as dacarbazine, selectively depletes regulatory T cells. This potential immunomodulatory effect of temozolomide provides rationale for combination with ipilimumab. We performed an open-label single-arm phase II study of ipilimumab plus temozolomide in the frontline setting for patients with metastatic melanoma and LDH ≤2× upper limit of normal. Ipilimumab was given at 10 mg/kg on day 1 and temozolomide 200 mg/m² orally days 1–4 every 3 weeks for four doses followed by maintenance ipilimumab every 12 weeks plus temozolomide every 4 weeks. The primary objective of the study was 6-month PFS. A total of 64 patients were enrolled and the 6-month PFS was 45% with median OS of 24.5 months. There were 10 (15.6%) confirmed partial responses and 10 (15.6%) confirmed complete responses. Duration of response amongst responders is 35 months with 10 patients demonstrating an ongoing response at median follow-up of 20 months. There were no deaths or unexpected toxicities on study. The most common gastrointestinal side effects were nausea and constipation rather than diarrhea or colitis. These results suggest that the combination of induction ipilimumab plus temozolomide could potentially be an effective strategy to enhance antitumor activity with a manageable toxicity profile. These findings warrant further evaluation in a large prospective study.

http://ift.tt/2sjxu2f

Modifications to a 3D-printed temporal bone model for augmented stapes fixation surgery teaching

Abstract

Functional outcomes and complications in otosclerosis surgery are governed by the surgeon's experience. Thus, teaching the procedure to residents to guide them through the learning process as quickly as possible is challenging. Artificial 3D-printed temporal bones are replacing cadaver specimens in many institutions to learn mastoidectomy, but these are not suitable for middle ear surgery training. The goal of this work was to adapt such an artificial temporal bone to aid the teaching of otosclerosis surgery and to evaluate this tool. We have modified a commercially available 3D-printed temporal bone by replacing the incus and stapes of the model with in-house 3D-printed ossicles. The incus could be attached to a 6-axis force sensor. The stapes footplate was fenestrated and attached to a 1-axis force sensor. Six junior surgeons (residents) and seven senior surgeons (fellows or consultants) were enrolled to perform piston prosthesis placement and crimping as performed during otosclerosis surgery. The time required to perform the tasks and the forces applied to the incus and stapes were collected and analyzed. No statistically significant differences were observed between the junior and senior groups for time taken to perform the tasks and the forces applied to the incus during crimping and placement of the prosthesis. However, significantly lower forces were applied to the stapes by the senior surgeons in comparison with the junior surgeons during prosthesis placement (junior vs senior group, 328 ± 202.9 vs 80 ± 99.6 mN, p = 0.008) and during prosthesis crimping (junior vs senior group, 565 ± 233 vs 66 ± 48.6 mN, p = 0.02). We have described a new teaching tool for otosclerosis surgery based on the modification of a 3D-printed temporal bone to implement force sensors on the incus and stapes. This tool could be used as a training tool to help the residents to self-evaluate their progress with recording of objective measurements.

http://ift.tt/2th17yq

Incidence of second surgery following pediatric adenotonsillar surgery: a population-based cohort study

Abstract

The aim of the study is to evaluate the incidence and risk factors of a second surgery of the adenoids or tonsils for hypertrophy in children who have already undergone surgery for the same condition. This is a retrospective study (2004–2013) based on data from the National patient registry in Sweden. A total of 41,401 children underwent a first surgery of the adenoids or tonsils during the studied period. The most commonly performed (first) surgical procedure was adenoidectomy followed by adenotonsillotomy, adenotonsillectomy, tonsillotomy, and tonsillectomy. A total of 4459 patients underwent a second surgery for the same condition. The incidence of a second surgery was the highest in the primary adenoidectomy group (72.2, 95% CI 69.7–74.7) and lowest in the primary adenotonsillectomy group (14.2, 95% CI 12.6–15.9). A lower age at first surgery significantly increased the risk for a second surgery. A second surgery of the adenoids and tonsils due to lymphoid hypertrophy was common in the pediatric population. Adenoidectomy stands out in a negative way in most aspects of this study compared to the other types of first surgery. However, due to the design of this study, the results of this study cannot be taken as proof of a full adenotonsillectomy as the most appropriate first surgery in children with lymphoid upper airway obstruction. Nevertheless, the results clearly show that the topic needs to be addressed in future studies.

http://ift.tt/2sjxvTW

Intermediate osteotomies in rhinoplasty: a new perspective

Abstract

The nasal dorsum framework plays a major role in nasal and facial harmony. This study presents a new approach to an already known technique, intermediate osteotomies, which can be used routinely in patients with cosmetically unpleasant changes in eyebrow-tip line features, allowing the acquisition of a natural, aesthetically agreeable and harmonious dorsum contour, while preserving nasal function. The approach was evaluated retrospectively in 50 consecutive patients at a tertiary referral hospital. Patients were asked to complete a survey to rate their satisfaction with the cosmetic outcome on a 5-point visual analog scale (VAS) and to compare the impact of nasal obstruction on their quality of life, pre- and postoperatively, by completing the validated Nasal Obstruction Symptom Evaluation (NOSE) scale. Satisfaction was scored as excellent (satisfaction level VAS average score, 4.4), with more than 50% of the patients completely satisfied with the aesthetic result, while NOSE scale scores demonstrated preservation of nasal function postoperatively. Typical complications of the upper third of the nose following osteotomies were not observed.

http://ift.tt/2tgSzHK

Computer-aided diagnosis of malignant or benign thyroid nodes based on ultrasound images

Abstract

The objective of this study is to evaluate the diagnostic value of combination of artificial neural networks (ANN) and support vector machine (SVM)-based CAD systems in differentiating malignant from benign thyroid nodes with gray-scale ultrasound images. Two morphological and 65 texture features extracted from regions of interest in 610 2D-ultrasound thyroid node images from 543 patients (207 malignant, 403 benign) were used to develop the ANN and SVM models. Tenfold cross validation evaluated their performance; the best models showed accuracy of 99% for ANN and 100% for SVM. From 50 thyroid node ultrasound images from 45 prospectively enrolled patients, the ANN model showed sensitivity, specificity, positive and negative predictive values, Youden index, and accuracy of 88.24, 90.91, 83.33, 93.75, 79.14, and 90.00%, respectively, the SVM model 76.47, 90.91, 81.25, 88.24, 67.38, and 86.00%, respectively, and in combination 100.00, 87.88, 80.95, 100.00, 87.88, and 92.00%, respectively. Both ANN and SVM had high value in classifying thyroid nodes. In combination, the sensitivity increased but specificity decreased. This combination might provide a second opinion for radiologists dealing with difficult to diagnose thyroid node ultrasound images.

http://ift.tt/2sjFJv2

The role of upper airway obstruction and snoring in the etiology of monosymptomatic nocturnal enuresis in children

Abstract

This study evaluated the necessity of examining the upper airway in children with nocturnal enuresis. 225 children (aged 5–16 years), who were referred from the urology outpatient clinic between May 2015 and May 2016 and who had completed toilet training, were included in this study. Participants were separated into monosymptomatic nocturnal enuresis (MNE) (group 1) and without MNE (group 2) groups. Tonsil hypertrophy, adenoid vegetation, septal deviation, turbinate hypertrophy, allergic rhinitis, upper airway obstruction, and snoring etiology were assessed. In total, 112 children with MNE (group 1) participated in addition to 113 children selected randomly without MNE (group 2). Adenoid score (p = 0.016), septal deviation (p = 0.017), and snoring (p = 0.007) were significantly different between the groups. No differences in tonsil score (p = 0.618), turbinate hypertrophy (p = 0.424), and allergic rhinitis (p = 0.544) were detected between the groups. Possible causes of upper airway obstruction and snoring which is a symptom of obstructive sleep-disordered breathing in the pediatric population, including adenoid hypertrophy and septal deviation, should be considered as possible etiological factors in children with MNE.

http://ift.tt/2th9R7P

How we do it: the intra-operative identification of a pharyngocele

Abstract

A pharyngocele is an uncommon condition, where pharyngeal mucosa herniates through the thyrohyoid membrane. It can be difficult to locate when the patient is at rest. To locate the pharyngocele intra-operatively, a bag valve mask was used to inflate the herniated mucosa. We describe a cost-effective and simple way to locate the pharyngocele intra-operatively.

http://ift.tt/2sjq1A6

Gender differences in the bacteriology of rhinosinusitis

Abstract

Evaluating gender differences in pathogens involving sinonasal tract disease in patients undergoing nasal surgery for chronic and recurrent rhinosinusitis (C/R RS). Retrospective analysis of 164 positive sinonasal swab cultures taken during endoscopic sinonasal surgery between the years 2006 and 2013. Study population included 79 (48.8%) female patients and 84 (51/2%) males with a mean age of 47.3 (13–88) years. Positive Staphylococcal growth was found in 38 (23.2%) patients, positive anaerobic growth in 25 (15.2%) patients and 67 (40.9%) patients had polymicrobial growth. Staphylococcal growth in the male population was significantly higher compared to the female population (p = 0.04). Odds ratio for a polymicrobial infection in males over 60 years old compared to females was 2.17 (CI 0.63–8.08, 95%). Anaerobes were found to be more frequent in males (17.9%) than in females (12.5%). Species of Streptococci showed no difference between gender and age groups. The results obtained suggest a difference between the causing pathogens in C/R RS between females and males. In the male population, staphylococcal species were found to be significantly more common with a greater tendency to polymicrobial pathogens and higher rates of anaerobes. These results might suggest different management protocols perioperatively in males and females.

http://ift.tt/2tgViRJ

The value of Gesell score in predicting the outcome of cochlear implantation in children

Abstract

The purpose is to determine the value of preoperative evaluation on developmental levels using Gesell score in predicting the postoperative outcome in pediatric cochlear implantation (CI) recipients. 78 children who underwent CI were included in our study. Age at the time of CI ranged from 6 to 67 months. The Gesell score including adaptability, fine motor, gross motor, language, and social skill was used for evaluating the patients' developmental levels before the CI, and a developmental quotient (DQ) was calculated by the following formula: (developmental age/actual age) × 100. The auditory perception and speech production abilities were evaluated using the categories of auditory performance (CAP) and speech intelligibility rating (SIR) before CI and at 1 year after CI. The associations between the preoperative Gesell score/DQ and the improvement of postoperative CAP/SIR outcomes were analyzed. Preoperative developmental evaluation of CI candidates suggested that the developmental delay was common in children with profound hearing loss. The mean of language DQ (46.72 ± 17.59) was significantly decreased than the mean of others' ability DQ in the enrolled children. The older the pediatric CI candidates were, the lower the DQ were. Age/adaptability DQ and improvement of postoperative CAP/SIR 1 year after CI were related. Age was negative correlation with the CI outcome and adaptability DQ was positive correlation with the CI outcome. The mean of CAP 1 year after CI was 4.16, and the mean of SIR 1 year after CI was 2.03. The first logistics regression equation was Y1 = exp (−18.123 + 0.199 × adaptability DQ − 0.163 × age), and Y1 was the possibility which CAP was lower than 5 1 year after CI. The sensitivity of first regression equation was 84.2% and specificity was 70.8%. The second logistics regression equation was Y2 = exp (−23.347 + 0.268 × adaptability DQ − 0.164 × age), and Y2 was the possibility which SIR was lower than 3 1 year after CI. The sensitivity of second regression equation was 85.7% and specificity was 72.7%. Preoperative Gesell score may be value in predicting the postoperative outcome in pediatric CI recipients. The older children are more serious developmental delay occur, so the CI operation should be finished as early as possible. Adaptability DQ combined with age has predictive effect on the postoperative outcome of cochlear implantation in children.

http://ift.tt/2sjwCKN

Trigeminocardiac reflex during endoscopic juvenile nasopharyngeal angiofibroma surgery: an appraisal

Abstract

Juvenile nasopharyngeal angiofibroma is a locally aggressive benign tumour which has propensity to erode the skull base. The tumour spreads along the pathways of least resistance and is in close proximity to the extracranial part of trigeminal nerve. Advancements in expanded approaches for endoscopic excision of tumours in infratemporal fossa and pterygopalatine fossa increase the vulnerability for the trigeminocardiac reflex. The manipulation of nerve and its branches during tumour dissection can lead to sensory stimulation and thus inciting the reflex. The aim of our study is to report the occurrence of trigeminocardiac reflex in endoscopic excision of juvenile nasopharyngeal angiofibroma. To describe the occurence of trigeminocardiac reflex during endoscopic endonasal excision of juvenile nasopharyngeal angiofibroma. We studied the occurrence of TCR in 15 patients (out of 242 primary cases and 52 revision cases) operated for endoscopic endonasal excision of JNA. The drop in mean arterial blood pressure and heart rate were observed and measured. To the best of our knowledge of English literature, this is the first case series reporting TCR as complication in endoscopic excision of JNA. occurence of this reflex has been mentioned in various occular, maxillofacial surgeries but its occurence during endoscopic excision of JNA has never been reported before. Manifestation of trigeminocardiac reflex during surgery can alter the course of the surgery and is a potential threat to life. It is essential for the anesthetist and surgeons to be familiar with the presentations, preventive measures and management protocols.

http://ift.tt/2tgSwM4

Radiological and clinical interpretation of the patients with CSF leaks developed during or after endoscopic sinus surgery

Abstract

Cerebrospinal fluid (CSF) leaks associated with endoscopic sinus surgery (ESS) are a rare complication related to anatomical and technical factors. The anatomical variations at skull base level are imperative to be detected preoperatively by CT scan to avoid this complication. Identifying the factors playing a role in the incidence of the CSF leaks during and after ESS and the common leak sites. A retrospective review of 24 patients presented with incidental CSF leaks, gathered from 1999 to 2016 was performed. Images interpretation of the skull base area was done using four parameters includes Keros classification, skull base slope, fovea plane and maxillary ethmoid height ratio (MER). Each parameter is classified into three types according to the anatomical configuration, then these parameters scores categorized according to the level of the safety into a level I, II and III, all levels were correlated with each other and with the site of leakage. It was found that the major group presented with the level I and the least group with level III safety, with an evidence of the most unsafe anatomical variation was the least relevant. Parameters measurements revealed that the larger group of the anatomical variation type III was in the MER and the commonest leak site was in the posterior ethmoidal roof. CT scan study of the skull base is crucial in delineating the variations and be a roadmap to proceed safely through the dissection remembering that incidental CSF leaks are multifactorial in etiology.

http://ift.tt/2sjoQ3H

Factors influencing endoscopic dacryocystorhinostomy outcome

Abstract

Endoscopic dacryocystorhinostomy (DCR) is a widely accepted treatment option for epiphora and dacryocystitis. To elucidate the cause of treatment failure after surgery, we analyzed patients' characteristics and perioperative background in association with poor outcome. We analyzed 165 patients with 213 sides who had endoscopic DCR. The influence of age, duration of symptoms, occlusion site and stent insertion were analyzed. Symptoms were completely cured in 85.0% (181/213) sides. Higher age (≥65 years) and proximal obstruction were associated with a poor prognosis while stent insertion and duration of symptoms were not. Higher age and proximal obstruction site were associated with a poor prognosis. Patients with a long history can be treated as per normal. The stent is not necessarily inserted in cases where the obstruction occurs distal to the lacrimal sac.

http://ift.tt/2th5yJD

The effects of septoplasty surgery on serum oxidative stress levels

Abstract

The aim of this study is to compare the total antioxidant status (TAS), total oxidant status (TOS), and paraoxonase (PON1) serum levels in patients who have undergone septoplasty (NSD). Forty-six patients (mean age 33.7) aged between 18 and 50 years who were diagnosed with nasal septal deviation (NSD) were included in the study. The TAS, TOS, and PON1 levels were compared in the serum samples obtained 1 month before the septoplasty and 3 months after surgery. There was a significant increase in mean TAS after septoplasty (1.041 vs. 1.124 mmol/L, p = 0.011). The mean TOS decreased significantly after septoplasty (20.631 vs. 5.946 mmol/L, p = 0.011). The mean pre- and postoperative PON1 levels were similar (326.93 ± 215.22 vs. 275.20 ± 167.76 U/L, p = 0.253). Increased TAS and decreased TOS after septoplasty show that patients with NSD are under oxidative stress that is relieved following septoplasty.

http://ift.tt/2sjxkbh

Association of endotracheal tube repositioning and acute laryngeal lesions during mechanical ventilation in children

Abstract

The objective of this study is to determine the incidence of post-extubation acute laryngeal lesions in a pediatric intensive care unit (PICU) and potential risk factors. Children, aged 28 days to 5 years, admitted to the PICU who required endotracheal intubation for at least 24 h were enrolled. Exclusion criteria were a previous intubation, history of laryngeal disease, current or past tracheostomy, the presence of craniofacial malformations and patients considered on palliative care. All patients underwent flexible fiber-optic laryngoscopy (FFL) not later than 8 h after extubation. A blinded researcher identified and classified laryngeal lesions based on recorded media. 231 children were enrolled between November 2005 and December 2015. At FFL examination, 102 children (44.15%) presented moderate to severe laryngeal lesions. On a multivariable analysis, we found that for each additional day with repositioning of the endotracheal tube, there was an increase of 7.3% (RR 95% CI 1.012–1.137; P = 0.018) on the baseline risk of developing moderate to severe acute laryngeal lesions. Furthermore, for each additional dose of sedation per day of intubation, there was also an increase of 3.5% on the same baseline risk (RR 95% CI 1.001–1.070; P = 0.041). The amount of tube repositioning episodes and the need for extra doses of sedation (as a proxy for possible agitation) were found to be associated with acute laryngeal lesions. Adequate sedation and minimized tube repositioning should be pursued to possibly prevent the development of post-extubation airway compromise.

http://ift.tt/2thbHp3

Translation and validation of the Rhinosinusitis Disability Index for use in Nigeria

Abstract

The Rhinosinusitis Disability Index (RSDI) is a validated and reliable measure of severity of chronic rhinosinusitis. The objective of this study was to translate and validate the instrument for use in Nigeria. This is a methodological study. 71 patients with chronic rhinosinusitis attending two Otolaryngology clinics in Lagos, Nigeria. Using standardized methods and trained translators, the RSDI was translated to vernacular (Yoruba language) and back-translated to culturally appropriate English. Data analysis comprised of assessment of the item quality, content validity and internal consistency of the back-translated Rhinosinusitis Disability Index (bRSDI), and correlation to the original RSDI. Content validity (floor and ceiling effects) showed 0% floor and ceiling effects for the total scores, 0% ceiling effects for all domains and floor effect for physical domain, and 9.9 and 8.5% floor effects for functional and emotional domains, respectively. The mean item-own correlation for physical domain was 0.54 ± 0.08, 0.72 ± 0.08 for functional domain and 0.74 ± 0.07 for emotional domain. All domain item-own correlations were higher than item-other domain correlations. The total Cronbach's alpha was 0.936 and was higher than 0.70 for all the domains representing good internal consistency. Pearson correlation analysis showed strong correlation of RSDI to bRSDI (total score 0.881; p = 0.000, and domain subscores—physical: 0.788; p = 0.000, functional: 0.830; p = 0.000, and emotional: 0.888; p = 0.000). The back-translated Rhinosinusitis Disability Index shows good face and content validity with good internal consistency while correlating linearly and significantly with the original Rhinosinusitis Disability Index and is recommended for use in Nigeria.

http://ift.tt/2sjbKU6

Perineural spread-susceptible structures: a non-pathological evaluation of the skull base

Abstract

Perineural spread adenoid cystic carcinoma can alter the dimension of foramina and canals of the skull base. The objective of this study was to determine the range of normal variation of the foramina and canals of both hemicranium. We analyzed 200 individuals with no alterations of the skull base in a retrospective manner using high-resolution computed tomography. We measured the short and long axis diameters of the foramen rotundum (FR), foramen ovale (FO), stylomastoid foramen (SMF), pterygoid canal (PTC), internal auditory canal (IAC), and the facial nerve canal in its labyrinthine portion (LPFC) to calculate the area in each hemicranium, compare them and obtain the normal range of asymmetry. Parametric and non-parametric comparison tests were realized. The structures that had the lowest range of asymmetry were the LPFC (0.00–0.79 mm²) and the FR (0.00–2.12 mm²). The one that had the highest asymmetry range was the FO (0.00–9.16 mm²). Significant differences were found in the FO (p = 0.01) and the IAC (p = 0.00) in the gender comparison. We determined a normal asymmetry range of the susceptible foramina and canals of the skull base. This study reports a useful and objective measure to differentiate anatomical from pathological variations of the foramina and canals of the skull base by age and gender. Our results establish a basis for future studies that evaluate this range as a diagnostic tool of metastasis in the skull base as a complement of other imaging techniques.

http://ift.tt/2tgTQyr

Radioguided occult lesion localization for locally recurrent thyroid carcinoma

Abstract

The aim of this study was to present our experiences with patients operated on for the recurrence of papillary thyroid cancer with the combined use of preoperative ultrasonographic mapping and radioguided occult lesion localization (ROLL). Twenty patients who had already undergone total thyroidectomy and central/lateral neck dissection for papillary thyroid carcinoma were reoperated on due to locoregional metastasis. The patients with proven recurrences and high Tg wash-out levels in cytopathologic aspirates were operated on. For each patient, numbers of marked and non-marked lesions, and the metastatic and total numbers of marked/non-marked and non-mentioned lesions in the maps were recorded. Thirty-four of 40 (85%) lesions removed with ROLL were found to be malignant. In addition to the marked lesions during mapping, 60 additional lesions had been defined as suspicious. Fifty-six of these lesions were found at exact anatomic sites and localizations described and removed. Of 56 lesions, 36 (64%) were found to be metastatic. During postoperative follow-up, chylous leak with spontaneous regression in 7 days and seroma occurred in one patient. Radioguided occult lesion localization and preoperative mapping contribute to the safety and comfort of patients in planned reoperations on lateral and central neck regions.

http://ift.tt/2sjpWfM

Development of classification criteria for discoid lupus erythematosus: Results of a Delphi exercise

No classification criteria currently exist for discoid lupus erythematosus (DLE), which has led to problematic heterogeneity in both observational and interventional research efforts.

http://ift.tt/2sXyEhy

Impact of atopic dermatitis on health-related quality of life and productivity in adults in the United States: An analysis using the National Health and Wellness Survey

Given its public health impact, there is need for broad and representative data on the humanistic burden of atopic dermatitis (AD).

http://ift.tt/2so4gzR

Health-related quality of life and work productivity associated with HiSCR and NRS30 response among patients with moderate to severe hidradenitis suppurativa

Objective: Skin pain in patients with hidradenitis suppurativa (HS) is an important and potentially debilitating symptom impairing patients' health-related quality of life (HRQL). This study quantified HRQL and work productivity benefit associated with lesion control (ie, Hidradenitis Suppurativa Clinical Response, HiSCR – a ≥50% reduction in inflammatory lesion count, and no increase in abscess or draining fistula) and skin pain control (ie, NRS30 – at least 30% reduction on a numerical rating scale between 0 and 10).

http://ift.tt/2sXsUEC

Lumbosacral hemangiomas and tethered cord

Introduction: Lumbosacral hemangiomas have been associated with several conditions, including LUMBAR syndrome (lower-body hemangioma and other skin abnormalities, ulceration, urogenital abnormalities, myelopathy, bony deformities, arterial abnormalities, anorectal malformations, and renal abnormalities). The diagnosis and surgical challenges of lumbosacral hemangiomas with tethered cord will be discussed.

http://ift.tt/2snYRZY

Persistent granulomatous cutaneous drug eruption to a BRAF inhibitor

Targeted BRAF-inhibitors (BRAF-I) are exciting new therapeutic options for patients with metastatic melanoma. Cutaneous toxicity from BRAF-I is widely reported and poses a management challenge. We present a rare manifestation of persistent cutaneous toxicity to a BRAF-I. A 41-year-old female had a pT2b melanoma (Breslow 1.01mm) excised from her right thigh. BRAF V600E mutation was detected. Sentinel lymph node biopsy was positive so she underwent femoral/ilioinguinal lymph node dissection. Staging CT scan showed subcarinal lymphadenopathy and small pulmonary metastasis.

http://ift.tt/2sXvLxv

Quality-of-life impact of sensitive body areas affected by psoriasis: Results from an epidemiological study of psoriasis in Taiwan

Background: Psoriasis is often associated with discomfort, pain, physical disability, social stigma, and psychological distress, and strongly impacts on health-related quality of life. This study aimed to assess the impact of moderate to severe psoriasis affecting sensitive body areas such as face, scalp, hands, feet, genitals, and fingernails on quality of life (QoL) and work disability in Taiwan.

http://ift.tt/2snWK8c

Nivolumab-associated vitiligo-like depigmentation in a patient with acute myeloid leukemia: A novel finding

Background: Nivolumab is a programmed cell death-1 receptor (PD-1) inhibitor approved by the U.S. Food and Drug Administration for the treatment of melanoma, non-small cell lung cancer, renal cancer, and classical Hodgkin lymphoma. For patients on immune checkpoint modulators such as PD-1 inhibitors, cutaneous immune-related adverse events (irAEs) are a significant concern. Dermatologic toxicities include pruritus, vitiligo, eczema, lichenoid eruptions and Stevens-Johnson syndrome. Vitiligo-like depigmentation has been well described in melanoma patients receiving treatment with PD-1 inhibitors.

http://ift.tt/2sXQC3R

RICH- or not?

This female infant presented at birth with a firm mass on the right lower leg. On day 2, her platelet count was 47 × 109, with a normal fibrinogen level of 1.9 g/L. On day 4, she received her first platelet transfusion after the platelet count had dropped to 19 × 109. Fibrinogen was 0.8 g/L and the international normalized ratio (INR) was 1.1. She was referred for further assessment on day 5. On examination she had a firm, warm, non-pulsatile bluish mass on the medial aspect of the right lower leg, which did not appear to be tender.

http://ift.tt/2sXxsLh

Primary cutaneous anaplastic large cell lymphoma treated with low dose methotrexate

Primary cutaneous anaplastic CD30-positive large cell lymphoma is a rare type of non-Hodgkin's lymphoma that is defined by a predominance of large clusters of CD30+ blast cells on histology. Considered a part of the spectrum of CD30+ lymphoproliferative cutaneous processes, this neoplasm often presents clinically in two forms: systemic and primary cutaneous. The diagnosis is confirmed with histologic examination, radiologic imaging, and supportive immunohistochemistry. The primary cutaneous form occurs in the skin with no evidence of disease elsewhere after a thorough workup.

http://ift.tt/2so7hAu

Papular acne scars on the chin treated with pinhole method

Papular acne scars are skin colored or hypopigmented, soft, elevated lesions on the chin and trunk. Especially the scars on the chin are 1-3 mm in size, and look like the cobblestones frequently. They result from destruction of collagen and elastin fibers in the dermal tissues around the hair follicles after acne inflammation. These papular scars are one of the most difficult acne scars to treat. The pinhole method using an Er:YAG laser creates multiple tiny holes penetrating from the epidermis to the deeper dermis.

http://ift.tt/2sXI7FW

Modern sunscreen formulations do not interfere with sweating during exercise

People often wear sunscreens on hot summer days for outdoor activities. Most recreational sunscreens are designed to be water- and sweat-resistant, so sweating will not wash off the protection needed. Sweating plays a critical role in maintaining thermal balance in the body and keeping skin cool. However, it is not clear based on literature whether wearing sweat-resistant sunscreen may impede natural sweating, therefore exaggerating thermal stress and further elevating skin temperature during exercise.

http://ift.tt/2sowLNU

High SPF sunscreen provides significant clinical benefit in actual use conditions: SPF 100+ is more effective than SPF 50+

In the 2011 proposed monograph, the US Food and Drug Administration requested additional data stating "there is currently insufficient evidence that there is clinical benefit to the consumer at SPF above 50." In real-world settings, consumers apply sunscreens at densities lower than are used to clinically determine SPF and the linear dependence of SPF to application density is well established. It is hypothesized that a sunscreen with a higher SPF would provide greater in-use efficacy compared with one currently labeled at the proposed maximum of SPF 50+.

http://ift.tt/2sXsY7u

Recurrent nevus arising in a halo nevus: Dermoscopy and confocal microscopy features

Spontaneous nevus involution is a natural phenomenon that can be expected though lifetime. It occurs mostly with progressive fading but less frequently can manifest with "targetoid" features (halo, cockade or "Meyerson nevi"). In the halo nevus, spontaneous and progressive involution of the central nevus develops from months to years, disappearing completely in 50% of cases. It is commonly associated with benign melanocytic nevus, but rarely it also occurs in nevi with various degrees of atypia, non-melanocytic tumors, inflammatory and in melanoma(3).

http://ift.tt/2snWBla

Pseudoxanthoma elasticum–like papillary dermal elastolysis: A single case report

Background: Pseudoxanthoma elasticum–like papillary dermal elastolysis (PXE-PDE) is a rare, acquired clinicopathological entity occurring in women after their fifth decade. There is no systemic involvement. We report a 64-year-old woman who presented with soft, yellow papules on her neck.

http://ift.tt/2sXxmTV

Platelet-rich plasma for the treatment of androgenetic alopecia: A patient survey

Background: Although androgenetic alopecia is extremely common, FDA-approved treatments are limited to minoxidil, which may be cumbersome, and finasteride, which has controversial side effects. Platelet-rich plasma (PRP) is a promising new option to fill the gap between medical and surgical options for androgenetic alopecia, with several clinical studies demonstrating PRP's efficacy on a variety of objective measures including hair density. As patient satisfaction is the ultimate goal of treating this aesthetic condition, we sought to determine benefit and satisfaction from a patient perspective.

http://ift.tt/2sol2Pr

Patient-reported symptoms and signs in patients with moderate-severe plaque psoriasis treated with guselkumab or adalimumab: Results from VOYAGE 1, a phase III clinical trial

Background: Guselkumab, a selective IL-23 blocker, is highly efficacious for treating psoriasis (PsO). Patient-reported symptoms & signs were evaluated in PsO patients treated with GUS or adalimumab (ADA).

http://ift.tt/2sXAQG2

OBT-HAECL versus HYL-HAJU for the treatment of moderate-to-severe nasolabial folds: A phase III, randomized, evaluator-blinded study

Purpose: The new hyaluronic acid (HAOBT) range of products consists of five hyaluronic acid (HA) dermal fillers formulated through a unique process called Optimal Balance Technology (OBT). HAOBT products have a concentration of 20 mg/mL. Their distinctive physical properties are obtained by varying the cross-linking degree and particle size. This study was conducted to compare the efficacy and safety of one of the new small particle size HAOBT products (OBT-HAECL) to a comparable marketed hyaluronic acid gel based on the HylacrossTM technology (HYL-HAJU).

http://ift.tt/2so8GqM

Nail changes in alopecia areata: Case report and review of the literature

A 54-year-old man was referred to our nail clinic with ridging of his fingernails. He was diagnosed with alopecia areata (AA) one year prior to the nail changes. His hair loss progressed rapidly, with loss of all scalp, facial and body year within a month. Physical examination was significant for severe ridging and trachyonychia of all his fingernails, without toenail involvement. A nail biopsy was performed. Histologic examination revealed abnormal keratinization of the nail plate with superficial matrical dyshesion and premature dyskeratosis.

http://ift.tt/2sXusyi

Median time to treatment response in patients with moderate-to-severe plaque psoriasis treated with brodalumab 210 mg or ustekinumab: A pooled analysis of data from two phase 3 randomized clinical trials (AMAGINE-2 and AMAGINE-3)

Background: Brodalumab is a human monoclonal antibody that binds to and blocks IL-17RA, the receptor subunit shared by the pro-inflammatory cytokines IL-17A, IL-17F, and IL-17A/F. While results from phase 3 studies demonstrated high degrees of efficacy for brodalumab in the treatment of moderate-to-severe plaque psoriasis, also important is its speed of response compared to ustekinumab.

http://ift.tt/2snXASk

How Viagra may cause melanoma: A histopathologic study providing a potential physiological/etiopathological mechanism

Objective: To identify cases of melanoma with closely associated, markedly dilated, thin-walled vessels and to define the relationship to Viagra use.

http://ift.tt/2sXEKPg

Morphometric analysis of high-intensity focused ultrasound-induced lipolysis on cadaveric abdominal and thigh skin

Abstract

Non-focused ultrasound and high-intensity focused ultrasound (HIFU) devices induce lipolysis by generating acoustic cavitation and coagulation necrosis in targeted tissues. We aimed to investigate the morphometric characteristics of immediate tissue reactions induced by 2 MHz, 13-mm focused HIFU via two-dimensional ultrasound images and histologic evaluation of cadaveric skin from the abdomen and thigh. Acoustic fields of a 2 MHz, 38-mm HIFU transducer were characterized by reconstruction of the fields using acoustic intensity measurement. Additionally, abdominal and thigh tissues from a fresh cadaver were treated with a HIFU device for a single, two, and three pulses at the pulse energy of 130 J/cm² and a penetration depth of 13 mm. Acoustic intensity measurement revealed characteristic focal zones of significant thermal injury at the depth of 38 mm. In both the abdomen and thigh tissue, round to oval ablative thermal injury zones (TIZs) were visualized in subcutaneous fat layers upon treatment with a single pulse of HIFU treatment. Two to three HIFU pulses generated larger and more remarkable ablative zones throughout subcutaneous fat layers. Finally, experimental treatment in a tumescent infiltration-like setting induced larger HIFU-induced TIZs of an oval or columnar shape, compared to non-tumescent settings. Although neither acoustic intensity measurement nor cadaveric tissue exactly reflects in vivo HIFU-induced reactions in human tissue, we believe that our data will help guide further in vivo studies in investigating the therapeutic efficacy and safety of HIFU-induced lipolysis.

http://ift.tt/2rqsUv4

The effect of Er:YAG laser irradiation on the bond stability of self-etch adhesives at different dentin depths

Abstract

The aim of this study was to evaluate the effect of Er:YAG laser irradiation on the micro-shear bond strength of self-etch adhesives to the superficial dentin and the deep dentin before and after thermocycling. Superficial dentin and deep dentin surfaces were prepared by flattening of the occlusal surfaces of extracted human third molars. The deep or superficial dentin specimens were randomized into three groups according to the following surface treatments: group I (control group), group II (Er:YAG laser; 1.2 W), and group III (Er:YAG laser; 0.5 W). Clearfil SE Bond or Clearfil S³ Bond was applied to each group's dentin surfaces. After construction of the composite blocks on the dentin surface, the micro-shear bond testing of each adhesive was performed at 24 h or after 15,000 thermal cycles. The data were analyzed using a univariate analysis of variance and Tukey's test (p < 0.05). Laser irradiation in superficial dentin did not significantly affect bond strength after thermocycling (p > 0.05). However, deep-dentin specimens irradiated with laser showed significantly higher bond strengths than did control specimens after thermocycling (p < 0.05). Thermocycling led to significant deterioration in the bond strengths of all deep-dentin groups. The stable bond strength after thermocycling was measured for all of the superficial-dentin groups. No significant difference was found between the 0.5 and 1.2 W output power settings. In conclusion, the effect of laser irradiation on the bond strength of self-etch adhesives may be altered by the dentin depth. Regardless of the applied surface treatment, deep dentin showed significant bond degradation.

http://ift.tt/2rVAOjq

Temperature-monitored optical treatment for radial tissue expansion

Abstract

Esophageal stricture occurs in 7–23% of patients with gastroesophageal reflux disease. However, the current treatments including stent therapy, balloon dilation, and bougienage involve limitations such as stent migration, formation of the new strictures, and snowplow effect. The purpose of the current study was to investigate the feasibility of structural expansion in tubular tissue ex vivo during temperature-monitored photothermal treatment with a diffusing applicator for esophageal stricture. Porcine liver was used as an ex vivo tissue sample for the current study. A glass tube was used to maintain a constant distance between the diffuser and tissue surface and to evaluate any variations in the luminal area after 10-W 1470-nm laser irradiation for potential stricture treatment. The 3D goniometer measurements confirmed roughly isotropic distribution with less than 10% deviation from the average angular intensity over 2π (i.e., 0.86 ± 0.09 in arbitrary unit) from the diffusing applicator. The 30-s irradiation increased the tissue temperature up to 72.5 °C, but due to temperature feedback, the interstitial tissue temperature became saturated at 70 °C (i.e., steady-state error = ±0.4 °C). The irradiation times longer than 5 s presented area expansion index of 1.00 ± 0.04, signifying that irreversible tissue denaturation permanently deformed the lumen in a circular shape and secured the equivalent luminal area to that of the glass tube. Application of a temperature feedback controller for photothermal treatment with the diffusing applicator can regulate the degree of thermal denaturation to feasibly treat esophageal stricture in a tubular tissue.

http://ift.tt/2rquLji

Laser acupuncture versus reflexology therapy in elderly with rheumatoid arthritis

Abstract

The purposes of this study are to determine and compare efficacy of laser acupuncture versus reflexology in elderly with rheumatoid arthritis. Thirty elderly patients with rheumatoid arthritis aged between 60 and 70 years were classified into two groups, 15 patients each. Group A received laser acupuncture therapy (904 nm, beam area of 1cm², power 100 mW, power density 100 mW/cm², energy dosage 4 J, energy density 4 J/cm², irradiation time 40 s, and frequency 100,000 Hz). The acupuncture points that were exposed to laser radiation are LR3, ST25, ST36, SI3, SI4, LI4, LI11, SP6, SP9, GB25, GB34, and HT7. While group B received reflexology therapy, both offered 12 sessions over 4 weeks. The changes in RAQoL, HAQ, IL-6, MDA, ATP, and ROM at wrist and ankle joints were measured at the beginning and end of treatment. There was significant decrease in RAQoL, HAQ, IL-6, and MDA pre/posttreatment for both groups (p < 0.05); significant increase in ATP pre/posttreatment for both groups (p < 0.05); significant increase in ankle dorsi-flexion, plantar-flexion, wrist flexion, extension, and ulnar deviation ROM pre/posttreatment in group A (p < 0.05); and significant increase in ankle dorsi-flexion and ankle plantar-flexion ROM pre/posttreatment in group B (p < 0.05). Comparison between both groups showed a statistical significant decrease in MDA and a statistical significant increase in ATP in group A than group B. Percent of changes in MDA was 41.82%↓ in group A versus 21.68%↓ in group B; changes in ATP was 226.97%↑ in group A versus 67.02%↑ in group B. Moreover, there was a statistical significant increase in ankle dorsi-flexion, ankle plantar-flexion, wrist flexion, wrist extension, and radial deviation in group A than group B. Laser therapy is associated with significant improvement in MDA and ATP greater than reflexology. In addition, it is associated with significant improvement in ankle dorsi-flexion, ankle plantar-flexion, wrist flexion, wrist extension, and radial deviation greater than reflexology in elderly patients with rheumatoid arthritis.

http://ift.tt/2rVHRZA

Psoriasis in Latin America and the Caribbean: a systematic review

Abstract

Background

Psoriasis is a chronic inflammatory disease that generally affects the skin, nails and joints. The burden of psoriatic disease in Latin America and the Caribbean (LAC) remains largely unknown.

Objective

To estimate the burden of psoriasis in LAC.

Methods

We conducted a systematic review following the MOOSE and PRISMA statements. We searched published studies in MEDLINE, EMBASE, LILACS, and CENTRAL from January 1, 2000 to August 5, 2015. We included studies that reported incidence, prevalence, health resource use and health expenditures, treatment patterns, comparative effectiveness of different drugs, patients reported outcomes, adherence to treatment and patient preferences in LAC. Risk of bias was assessed evaluating selection of participants, control of cofounders, measurement of exposure and outcome and conflict of interest. Pairs of reviewers independently selected, extracted and assessed the bias risk of the studies. The systematic review was registered at PROSPERO (CRD42016038325).

Results

A total of 18 studies from 12 LAC countries were included. Most were observational studies, between which there was a large heterogeneity of outcomes. Population-based studies were not found and most data came from hospital registries. One study reported an incidence of psoriatic arthritis in 6.26 cases per 100,000 person-years. Another study found an incidence of psoriasis 1,020 per 100,000 patient-year attending at a dermatology clinic. The prevalence reported in the Argentinean health service was 74 cases per 100,000. Further, psoriasis has been shown to have a substantial negative impact on quality of life. A number of studies also indicated that non-communicable disease burden increases with the presence and severity of psoriasis. With regard to treatment pattern, methotrexate was the dominant systemic therapy.

Conclusion

There is an important lack of information from LAC concerning the burden of psoriasis. Further studies investigating the burden of psoriasis in representative LAC populations are needed.

http://ift.tt/2soannM

A Rare Cause of Upper Airway Obstruction in a Child

Ventricular band cyst is a rare condition in children but can result in severe upper airway obstruction with laryngeal dyspnea or death. The diagnosis should be considered in any stridor in children with previous history of intubation or respiratory infections. We report a case of a 4-year-old girl, received in an array of severe respiratory distress, emergency endoscopy was done, and a large ventricular tape band cyst obstructing the air way was found. Complete excision was made, and postoperative prophylaxis tracheotomy was done. The postoperative course was uneventful with improvement of clinical and endoscopic signs.

http://ift.tt/2rVQfIA

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

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.

http://ift.tt/2tgETfK

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

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.

http://ift.tt/2sj3RxZ

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

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.

http://ift.tt/2th1mtc

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

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).

http://ift.tt/2sj2waw

Angioedema suppressed by a combination of anti-histamine and leukotriene modifier

Angioedema without co-existent urticaria is due to a limited number of causes, including hereditary and acquired C1 esterase inhibitor deficiency, drug-induced angioedema or idiopathic histaminergic or non-his...

http://ift.tt/2rW1hgL

The differential diagnosis of parotid gland tumors with high-resolution ultrasound in otolaryngological practice

Abstract

The aim of the study is to define the utility of ultrasound (US) in differentiating benign from malignant parotid tumors as well as pleomorphic adenomas (PA) from monomorphic adenoma (MA). Seventy-two consecutive parotid gland tumors were analysed with high-resolution ultrasonography (12 MHz) with color Doppler imagining. The histopathological diagnosis was confirmed after parotidectomy for each lesion. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) for the US were established. Receiver operating characteristic curves were constructed to determine the predictive values of echogenicity, heterogeneity, and vascularity on color Doppler. Area under the curve (AUC) was calculated for each parameter considered. The analysed material included 27 MA, 26 PA, 1 basal cell adenoma, 8 inflammatory conditions, and 10 malignant neoplasms. The sensitivity, specificity, and accuracy of US in differentiation of malignant from benign lesions in the parotid gland were 60, 95.2, and 90.3%, respectively. The predictive values were: PPV 66.8% and NPV 93.6%. Differentiating diagnoses between PA and MA with US resulted in a sensitivity of 61.5%, specificity of 81.5%, and accuracy of 73.1%. The predictive values were: PPV 50% and NPV 68.8%, respectively. For distinguishing malignant from benign tumors, the highest AUC values noted were for heterogeneity and vascularization (0.8 and 0.743, respectively). The AUC values were the highest for hypoechogenicity and vascularization in separating PA from MA (0.718 and 0.685, respectively).

http://ift.tt/2snQWf4

Quantification of bleeding during dental extraction in patients on dual antiplatelet therapy

Publication date: Available online 12 June 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): F. Buhatem Medeiros, N. Pepe Medeiros de Rezende, J. Bertoldi Franco, A.C. Porrio de Andrade, L. Timerman, M. Gallottini, I.L. Itagiba Neves, K.L. Ortega
In spite of the possibility of triggering thromboembolic events, many professionals indicate the suspension of antiplatelet agents before dental surgical procedures. The aim of this study was to perform a quantitative assessment of intraoperative bleeding in patients on dual antiplatelet therapy. A case–control study was conducted in patients on dual antiplatelet therapy (APT group) and in patients who did not use these medications (control group). The following examinations were requested: complete blood cell count, blood coagulation tests, and platelet aggregation. The quantity of bleeding was measured intraoperatively by collection of aspirated blood. The mean volume of blood lost during the surgical procedure was 6.10ml in the control group and 16.07ml in the APT group (P=0.002). The mean volume of blood lost per minute was 0.60ml/min in the control group and 1ml/min in the APT group (P=0.001), with local haemostatic methods being sufficient to control the bleeding. There was no postoperative bleeding complication in any case. Patients on dual antiplatelet therapy presented a larger volume of bleeding, but this could be controlled by means of local haemostatic measures. Therefore, there is no need to stop either of the two dual antiplatelet therapy medications before dental extractions.

http://ift.tt/2rVRK9v

Middle ear adenoma with uncommon presentation and literature review

Middle ear adenoma (MEA) is a rare benign tumour. Here we report a case of MEA in a 39-year-old man with hearing loss. Some significant histopathological features of MEA and neuroendocrine differentiation identified by immunohistochemistry are described. The tumour showed remarkable and rare degenerative histological characteristics. There were a few tumour cells which were covered by degenerated tissue. Consequently, following frozen biopsy, the tumour was misdiagnosed as chronic ear inflammation. No recurrence was seen in this patient after 45 months of follow-up; regular clinical and radiological follow-up is necessary since recurrence is possible. A literature review for MEA is presented and this type of tumour is discussed clinically, microscopically and immunohistochemically. The differential diagnosis and associated treatment are described.

http://ift.tt/2rdIgUr

Maximizing Functional Outcomes in Head and Neck Cancer Survivors

With increases in survivorship for patients with head and neck cancer, attention is turning to quality-of-life issues for survivors. Care for these patients is multifaceted. Dysphagia and issues of voice/speech, airway obstruction, neck and shoulder dysfunction, lymphedema, and pain control are important to address. Rehabilitation interventions are patient-specific and aim to prevent, restore, compensate, and palliate symptoms and sequelae of treatment for optimal functioning. Central to providing comprehensive interdisciplinary care are the head and neck surgeon, laryngologist, and speech-language pathologist. Routine functional assessment, long-term follow-up, and regular communication and coordination among these specialists helps maximize quality of life in this challenging patient population.

http://ift.tt/2sinLt7

Changes at the Dinner Table and Beyond

Patients with head and neck cancers (HNC) can experience significant distress from presentation of symptoms to surveillance/survivorship and end-of-life. It is of value to all members of the HNC team to practice patient-centered care in assessment and interventions with patients and their support systems to achieve the best possible outcome given patient health status. Early assessment and referral to ancillary support provide a strong foundation across the illness trajectory. Specific attention should be given to the psychosocial implications of changes in physiologic functioning. Support around these changes involves a strong multidisciplinary team familiar with the biopsychosocial effects of HNC and its treatment.

http://ift.tt/2tgmu2W

It Takes a Village: The Importance of Multidisciplinary Care

This article explores the evolving world of cancer care that requires increasing collaboration and is focused on value, quality, and efficiency, while placing the utmost importance on patient autonomy and individualized care plans. The expanding membership of the multidisciplinary team and the role integrated patient care units are reviewed in the context of care for the patient with head and neck cancer.

http://ift.tt/2siokTB

Cytoplasmic neuropilin 2 is associated with metastasis and a poor prognosis in early tongue cancer patients

Neuropilin 2 (Nrp2) plays an important role in regulating lymphangiogenesis. Nrp2 expression in early tongue cancer was investigated to predict lymph node metastasis and the long-term prognosis. The relationships between clinicopathological variables of cT1–T2N0 tongue squamous cell carcinoma (SCC) and overexpression of Nrp2, vascular endothelial growth factor C (VEGFC), vascular endothelial growth factor receptor 3 (VEGFR3), and semaphorin 3F (Sema3F) were analyzed. Expression levels were compared using oral SCC cell lines.

http://ift.tt/2s5Iu0M

Cervical spinal glioblastoma multiforme in the elderly

Spinal glioblastoma multiforme (GBM) is uncommon, and its diagnosis may be challenging. This is especially true in the elderly population. Best management strategy remains to be defined. The purpose of this report is to document this rare condition, increase awareness (as a potential differential diagnosis) and propose treatment options in the elderly; a review of the relevant literature is included. A biopsy may be beneficial in given circumstances as cervical spinal GBM carries a better prognosis compared with intramedullary metastasis.

http://ift.tt/2sWYxxY

Giant iridodialysis with wound dehiscence following penetrating keratoplasty: an ocular emergency

Description

Wound dehiscence is a known complication of keratoplasty which can occur even many years following the surgery. Usually trivial trauma is the causative factor for wound dehiscence, but spontaneous dehiscence has also been reported in the literature.1

A 45-year-old man presented with sudden loss of vision in the left eye following a blunt trauma. History revealed penetrating keratoplasty in the left eye for perforated corneal ulcer 2 years ago. On examination, visual acuity was hand movement close to face in the left eye and right eye being within normal limits with 20/20 visual acuity. Slit-lamp biomicroscopic examination showed broken monofilament nylon sutures leading to superior 6 clock hours (09:00 to 03:00 clock hours) of wound dehiscence, with corresponding 6 clock hours of giant iridodialysis prolapsing anteriorly (figure 1). The lens was completely extruded along with vitreous at the wound. Based on the relevant history and clinical findings, a...

http://ift.tt/2snJhgy

Αρχειοθήκη ιστολογίου

Τρίτη 13 Ιουνίου 2017

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