Source:British Journal of Oral and Maxillofacial Surgery
Author(s): C.-B. Man, R. Patel, K. Karavidas
http://ift.tt/2s9l2yj
Σάββατο 24 Ιουνίου 2017
Intraoperative sialendoscopy to assist with and confirm repair of Stensen’s duct
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): C.-B. Man, R. Patel, K. Karavidas
http://ift.tt/2s9l2yj
The Emerging Zika Virus Threat: A Guide for Dermatologists
What should dermatologists be alert for when encountering patients with a rash and clinical history suggestive of Zika virus infection?
American Journal of Clinical Dermatology
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A large choledochocystolithiasis mimicking Mirizzi syndrome
An 18-year-old man presented with spontaneous severe epigastric pain, progressing and radiating to back since 3 days. It was associated with epigastric tenderness, bilious vomiting and jaundice. He had been intermittently experiencing these symptoms for the last 1 year. No known comorbid. Ultrasound showed a poorly visualised heterogeneous focus at porta hepatis; considering poor visualisation, this might represent an enlarged calcified lymph node or cystic duct calculus causing extrinsic compression or a large sludge ball within the common bile duct (CBD), leading to dilatation of common hepatic duct and intrahepatic biliary system. Subsequent magnetic resonance cholangiopancreatography revealed a focal saccular dilatation of middle part of CBD, a type I-B choledochal cyst, large heterogeneous focus seen within it representing choledochocystolithiasis. Later, CT was performed for further characterisation of surrounding anatomy and pathology, which confused the appearance of choledochocystolithiasis for Mirizzi syndrome. Later, surgery and histopathology confirmed type I-B choledochocystolithiasis and chronic cholecystitis.
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Bilateral recurrent pyosalpinx in a sexually inactive 12-year-old girl secondary to rare variant of Mullerian duct anomaly
Pyosalpinx is a severe sequel of chronic pelvic inflammatory disease, whereby the fallopian tubes become filled with pus.1 2 Pyosalpinx often affects sexually active women and rarely is seen in celibate adolescent girls.3 We report a case of a 12-year-old girl with no prior sexual history who presented to our emergency department with complaints of severe right lower quadrant pain of 1-day duration. Ultrasonography and CT scan of the abdomen and pelvis revealed free fluid collections in the pelvis without visualisation of the appendix. A preoperative diagnosis of acute ruptured appendicitis was given and she was taken to the operating room. Peroperative findings included bilaterally distended, pus-filled pyosalpinges. A definitive diagnosis of bilateral pyosalpinx was then made. Two-week antibiotic therapy was successful but the patient returned with recurrent pyosalpinx and a pelvic abscess 9 weeks later.
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Transmission analysis of TGFB1 gene polymorphisms in non-syndromic cleft lip with or without cleft palate
Publication date: September 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 100
Author(s): Ginila T. Raju, Bhaskar V.K.S. Lakkakula, Jyotsna Murthy, Munirajan Arasambattu Kannan, Solomon F.D. Paul
ObjectivesTransforming growth factor beta1 (TGF-β1) plays a significant role in craniofacial development. Previous linkage studies reported that the TGF-β1-locus at 19q13.1 harbour predisposing genes for non-syndromic oral clefts. In the present study case parents triads were evaluated to find the transmission effects of genetic variants in TGF- β1 towards non-syndromic cleft lip or palate (NSCL/P).MethodsUsing allelic discrimination method148 families (case-parent triads) were assessed for single nucleotide polymorphisms (SNPs) in TGF-β1 gene. The SNPs were checked for mendelian errors and Hardy-Weinberg equilibrium (HWE). Transmission disequilibrium test and haplotype frequencies were estimated.ResultsThe TGF-β1 SNPs showed very low minor allele frequencies (MAFs) and observed heterozygosity (Hobs). The transmission disequilibrium test (TDT) and parent-of-origin likelihood ratio tests (PO-LRT) were not significant for any of the SNPs tested. Strong linkage disequilibrium (r2 = 0.722) was found between rs1800469 and rs1800470 SNPs. Haplotype analysis ignoring parent of origin showed strong evidence of excess transmission but it is not significant (p-value = 0.293).ConclusionTransmission of minor alleles were not observed from either parent indicating that the TGF-β1 gene polymorphisms by themselves do not confer risk for non-syndromic oral clefts but, rather, modify the stability and the activation process of TGF-β1. As the number of families included in the study are less, results must be considered still preliminary and require replication using more families.
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Study of the effects of hearing on static and dynamic postural function in children using cochlear implants
Source:International Journal of Pediatric Otorhinolaryngology, Volume 100
Author(s): Malihah Mazaheryazdi, Abdollah Moossavi, Javad Sarrafzadah, Saeed Talebian, Shohreh Jalaie
ObjectiveThe present study aimed to evaluate the postural control perturbations by the center of pressure parameters in two main approaches, cochlear implant turned "on" and "off".MethodsWe included 25 children aged 8–10 years with unilateral cochlear implants and bilateral vestibular hypofunction deficit. To evaluate the postural function, each children was asked to stand on the force plate under 3 different conditions and cochlear implant turned "on" and "off": Condition (A) double stance from open eyes to closed eyes, Condition (B) double stance with open eyes engaging in the dual task and Condition (C) From double leg stance to one leg stance with open eyes for assessment of dynamic postural control. Also to calculate the center of pressure parameters, we designed new software for the force plateResultsIn condition A: although the results demonstrated an overall reduction in the mean of center of pressure parameters when the cochlear implant was "on", only the significant differences were seen in mean and standard deviations for anterior-posterior displacement, mediolateral displacement, area and mean velocity (P =0.00, P=0.04, P=0.02 and P=0.00, respectively) in open eyes In condition B: no significant difference was found between "on" and "off" cochlear implant in single or dual-task situations. In condition C: mean velocity variable demonstrated a significant difference (P=0.00) in the cochlear implant "on" condition in double leg stance only. Also, anterior-posterior displacement demonestrated a significant difference (P=0.00) when the cochlear implant was turned "on" in one leg stance situation.ConclusionThe results of our study show that auditory information can improve postural stability and reduce body sways in different situations as an underlying system for reinforcement of the postural control in children without complete normal balance subsystems.
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Auditory, visual and auditory-visual memory and sequencing performance in typically developing children
Source:International Journal of Pediatric Otorhinolaryngology, Volume 100
Author(s): Roshni Pillai, Asha Yathiraj
ObjectiveThe study evaluated whether there exists a difference/relation in the way four different memory skills (memory score, sequencing score, memory span, & sequencing span) are processed through the auditory modality, visual modality and combined modalities.MethodsFour memory skills were evaluated on 30 typically developing children aged 7 years and 8 years across three modality conditions (auditory, visual, & auditory-visual). Analogous auditory and visual stimuli were presented to evaluate the three modality conditions across the two age groups.ResultsThe children obtained significantly higher memory scores through the auditory modality compared to the visual modality. Likewise, their memory scores were significantly higher through the auditory-visual modality condition than through the visual modality. However, no effect of modality was observed on the sequencing scores as well as for the memory and the sequencing span. A good agreement was seen between the different modality conditions that were studied (auditory, visual, & auditory-visual) for the different memory skills measures (memory scores, sequencing scores, memory span, & sequencing span). A relatively lower agreement was noted only between the auditory and visual modalities as well as between the visual and auditory-visual modality conditions for the memory scores, measured using Bland-Altman plots.ConclusionsThe study highlights the efficacy of using analogous stimuli to assess the auditory, visual as well as combined modalities. The study supports the view that the performance of children on different memory skills was better through the auditory modality compared to the visual modality.
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Absence of KCNQ4 mutation in Bengali families with ADNSHL originated from West Bengal, India
Source:International Journal of Pediatric Otorhinolaryngology, Volume 100
Author(s): Bidisha Adhikary, Biswabandhu Bankura, Subhradev Biswas, Silpita Paul, Madhusudan Das
ObjectiveAutosomal Dominant Non-Syndromic Hearing Loss (ADNSHL) is extremely heterogeneous in nature. More than 60 loci with 30 different genes have been identified linked to ADNSHL. Mutation in KCNQ4 is considered as one of the most common causative factor responsible for ADNSHL. No study focused on the genetic alteration of KCNQ4 gene among hearing loss patients in India. The present study for the first time was carried out to determine the mutation spectrum of KCNQ4 gene in ADNSHL patients of West Bengal state, India.MethodTwenty nine individuals from 10 independent ADNSHL family (with two or more generation affected) were studied both clinically and genetically. Most of the patients showed moderate progressive sensorineural hearing loss. Mutation analysis was conducted for KCNQ4 gene using polymerase chain reaction followed by direct sequencing.ResultsNeither any reported nor a novel pathogenic mutation in KCNQ4was detected in our studied group, in contrast to the findings among East Asians.ConclusionThe result of the present study suggests that mutations in KCNQ4 gene are unlikely to be a major causative factor of ADNSHL in our studied patients from West Bengal, India, pointing to other genes might be responsible for ADNSHL in our studied patients.
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Bilateral congenital cholesteatoma: Surgical treatment and considerations
Publication date: August 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 99
Author(s): Daniele Marchioni, Alessia Rubini, Mauricio Gonzalez-Navarro, Matteo Alicandri-Ciufelli, Adrian James, Livio Presutti
ObjectivesTo describe a multicenter study regarding surgical management of bilateral congenital cholesteatoma (BCC) and underline the importance of endoscopes in the management of this condition. In BCC, hearing preservation is more crucial than in unilateral cases. The endoscopic approach allows complete removal of cholesteatoma via a minimally invasive technique offering low residual disease rates while preserving the normal physiology of the middle ear and possibly the ossicular chain.Study designRetrospective chart and surgical video review of patients with BCC who underwent surgery at Otolaryngology Department of Modena and Verona University Hospitals and the Hospital for Sick Children, Toronto.MethodsFrom 2002 to November 2016, six patients were identified with bilateral congenital cholesteatoma and included in this study. Pre-operative assessments, surgical treatments and outcomes were collected and described.ResultsThe median age at presentation was 4 years (range 2–7 years). A microscopic post auricular tympanoplasty was performed in two ears, four underwent a canal wall up mastoidectomy procedure and in the other six a transcanal endoscopic approach (TEA) was used. No intra- or post-operative complications were observed in any patients. The mean follow up period was 54.5 months.ConclusionsWhen both ears are involved with congenital cholesteatoma, it is particularly important to use a minimally invasive technique that preserves normal ossicular and mastoid structure and function whenever possible. In many cases this can be achieved with TEA, even in young children. In addition the endoscope allows good surgical control of cholesteatoma removal from hidden recesses.
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MD-2 regulates LPS-induced NLRP3 inflammasome activation and IL-1beta secretion by a MyD88/NF-κB-dependent pathway in alveolar macrophages cell line
Source:Molecular Immunology, Volume 90
Author(s): Man Luo, Lijuan Hu, Dandan Li, Yanying Wang, Yuting He, Lei Zhu, Weiying Ren
Myeloid differentiation protein 2 (MD-2) is required in the recognition of lipopolysaccharide (LPS) by toll-like receptor 4 (TLR4), and participates in LPS-induced alveolar macrophage (AM) inflammation during acute lung injury (ALI). Activation of the NOD-like receptor family, pyrin domain containing 3 (NLRP3) inflammasome aggravates inflammation in LPS-induced ALI. However, there is currently little known about the relationship between MD-2 signaling and the NLRP3 inflammasome. This study showed that NLRP3 expression, IL-1beta (IL-1β) secretion, and pyroptosis were up-regulated after LPS stimulation in the NR8383 AM cell-line. MD-2 gene knock-down reduced LPS-induced mRNA and protein expression of NLRP3 and IL-1β secretion in NR8383 cells, and inhibited the MyD88/NF-κB signaling pathway. Conversely, over-expression of MD-2 not only heightened NLRP3, MyD88, and NF-κB p65 protein expression, it also aggravated the LPS-induced inflammatory response. Furthermore, the NF-κB inhibitor SN50 had a beneficial role in decreasing NLRP3 and caspase-1 mRNA and protein expression. The observations suggest that MD-2 helps to regulate LPS-induced NLRP3 inflammasome activation and the inflammatory response in NR8383 cells, and likely does so by affecting MyD88/NF-κB signaling.
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Acromegaly discovered during a routine out-patient surgical procedure: a case report
Acromegaly is a rare syndrome in which there is unregulated hypersecretion of growth hormone. The anesthetic management of patients with this disorder is particularly challenging due to pre-existing cardiovasc...
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Melanoma mortality is rising in susceptible Australians
Abstract
The number of invasive melanomas removed from Australians has steadily increased since data were recorded in 1982 (1). However, the age standardized mortality rate (ASMR) from melanoma has not increased as quickly and is levelling off (2). The discrepancy between a steep rise in the number of melanomas removed and a stable mortality rate has been attributed to the increased detection of thin melanomas, lesions that are unlikely to metastasize (3).
This article is protected by copyright. All rights reserved.
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Vismodegib for Recurrent Locally Destructive Basal Cell Carcinoma in a Renal Transplant Patient
Abstract
Solid organ transplant patients are at an increased risk of developing cutaneous malignancies owing to long-lasting immunosuppression. The strongest increase in incidence (35-fold) has been reported for cutaneous squamous cell carcinoma [1]. Basal cell carcinoma (BCC) may occur even more frequently, especially during the first years after transplantation [2]. The hedgehog-inhibitor vismodegib has been safely used for the treatment of locally advanced or metastatic BCC in immunocompetent patients since 2012 [3].
This article is protected by copyright. All rights reserved.
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Novel TMC8 splice site mutation in epidermodysplasia verruciformis and review of HPV infections in patients with the disease
Abstract
Background
Epidermodysplasia verruciformis (EV) is a genodermatosis leading to infections with cutaneous HPV, persistent plane warts and a high rate of non-melanoma skin cancer (NMSC). Biallelic loss-of-function mutations in TMC6 and TMC8 are known to be causative.
Objective
The aim of this study was to report EV-causing mutations in four patients with EV and to give an overview of all described EV patients.
Patients and methods
We investigated four patients with classical features of EV from two families. All patients were affected by plane warts with typical EV histology since early childhood and β-HPVs were detected on their skin. One patient had recurring cutaneous squamous cell carcinomas (cSCC) and carcinomas in situ (Bowen type). We sequenced both TMC6/8 for disease-causing mutations and quantified levels of gene expression. We also performed a systematic literature review to discuss these patients in the context of previously reported cases, mutations already identified, as well as HPV types.
Results
Three patients of one family carried a homozygous splice site mutation in TMC8 resulting in aberrantly spliced transcripts that were not degraded. By contrast, no TMC6/8 mutation was detected in the patient from the other family. A systematic literature review revealed 501 described EV patients. Around 40% of EV patients analysed for genetic alterations carried no mutation in TMC6/8. While β-HPVs were identified in the majority of cases, α-HPVs were detected in several individuals.
Conclusion
The relatively high proportion of EV patients without mutation in TMC6/8 indicates the existence of EV-causing mutations in additional, presently unknown gene(s). However, a homozygous TMC8 splice site mutation in our patients resulted in aberrant transcripts which cannot retain the healthy phenotype. The literature review revealed that HPV-5 is the most commonly identified HPV in EV patients, but HPV-3, HPV-14, and HPV-20 were unexpectedly identified more frequently than HPV-8.
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Validation of psoriasis severity classification based on use of topical or systemic treatment
Abstract
In recent years, population-based studies have reported a considerable burden of disease among patients with psoriasis. Cumulative epidemiological data suggests that patients with psoriasis have an increased incidence and prevalence of cardio-metabolic comorbidities and a disease-severity dependent relationship is often reported. An accepted classification system is the Psoriasis Area and Severity Index (PASI), where one proposed categorization suggests that a score of less than 7 as mild, a score between 7 and 12 is moderate, and a score greater than 12 is consistent with severe psoriasis.
This article is protected by copyright. All rights reserved.
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Dowling–Degos disease with mutation in the exon 1 of the keratin 5 gene
Abstract
Dowling–Degos disease (DDD) is an autosomal dominant genodermatosis characterised by acquired hyperpigmentation in a reticulate pattern, particularly affecting the flexural areas and other major skin folds. Mutations in KRT5, POFUT1 and POGLUT1 genes have been identified as causative genetic defects1,2,3. We report a new mutation in KRT5 in a sporadic Chinese patient with classical features of DDD. The patient, a 54-year-old man presented a 10-year history of progressively prutitic reticulated hyperpigmented macules in the flexural areas. He had no family history of similar skin eruptions.
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Urétrite à Neisseria meningitidis : deux cas
Publication date: Available online 23 June 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): C. Dubois, A.-L. Liegeon, C. Fabbro, F. Truchetet
IntroductionNeisseria meningitidis (NM) est une bactérie commensale présente dans la flore oropharyngée et responsable d'infections invasives. Plus rarement, des localisations génitales ont été décrites. Nous présentons deux cas d'urétrite aiguë à NM.ObservationsDeux hommes de 30 et 31 ans, dont l'un homosexuel séropositif pour le VIH, présentaient un écoulement urétral compatible avec le diagnostic d'urétrite aiguë. Les prélèvements urétraux identifiaient la présence de NM de sérogroupes B et C. L'un des antibiogrammes montrait une sensibilité intermédiaire à la pénicilline G et à l'amoxicilline.DiscussionLa présentation clinique des urétrites aiguës à NM est aspécifique, justifiant la réalisation de prélèvements urétraux devant toute urétrite aiguë. Les urétrites à NM sont peu fréquentes, affectant principalement les hommes ayant des relations sexuelles avec des hommes (HSH). Leur recrudescence s'expliquerait par celle des pratiques sexuelles orogénitales non protégées. L'émergence de résistances de NM impose la réalisation systématique d'un antibiogramme afin d'adapter les stratégies thérapeutiques et prophylactiques. Des cas d'infections invasives à méningocoques de sérogroupe C ont été recensés dans la population HSH avec l'hypothèse d'une porte d'entrée sexuelle. Aussi le Haut conseil de la santé publique recommande-t-il la vaccination contre le méningocoque de sérogroupe C dans cette population.BackgroundNeisseria meningitidis (NM) is a commensal bacteria present in the oropharyngeal flora that causes invasive infections. There have been rarer reports of presence in the genital region. Herein, we present two cases of acute NM urethritis.Patients and methodsTwo men aged 30 and 31years, one of whom is homosexual and seropositive for HIV infection, presented urethral discharge which was diagnosed as acute urethritis. The unit through samples indicated the presence of NM of serogroups B and C. One of the antibiotic sensitivity tests revealed intermediate susceptibility to penicillin G and to amoxicillin.DiscussionThe clinical presentation of acute NM urethritis is non-specific, because of which urethral samples should be taken wherever acute urethritis is suspected. NM urethritis is infrequent and primarily affects men who have sex with men (MSM). Its current increase is due to unprotected oral-genital sexual practices. Due to the emergence of resistance to NM, antibiotic susceptibility testing should be carried out routinely to ensure appropriate therapy and prophylaxis. Cases of invasive serogroup C meningococcal infections have been recorded within the MSM population with hypothetical sexual port of entry. Thus, the French High Public Health Authority recommends vaccination against meningitis C in this population.
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Measuring the societal impact of psoriasis in the United Kingdom through a non-interventional study of patients
Abstract
This cross-sectional study aimed to measure total societal costs of moderate-to-severe, chronic plaque psoriasis in adults, and was conducted at 10 National Health Service hospitals in the United Kingdom between June-November 2014. Data capture was via hand-held electronic devices. Investigators at participating sites identified participants. Eligible patients were ≥18 years of age and diagnosed with moderate-to-severe plaque psoriasis for at least 6 months (Psoriasis Area and Severity Index (PASI) ≥10, and Dermatology Life Quality Index (DLQI) >10).
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Atopic dermatitis is inversely associated with hepatitis B antigen positivity: a population-based cohort study
Abstract
Background
No clear association between hepatitis B virus (HBV) infection and atopic dermatitis (AD) has been established. Some studies have reported that subjects with HBV had an increased risk of atopy; other studies reported an inverse association between HBV seropositivity and allergic diseases.
Objective
We evaluated the association between AD and hepatitis B antigen (HBsAg) positivity using Korean National Health and Nutrition Examination Survey data.
Methods
In total, 14,776 participants aged > 19 years were included in the analysis. Multiple logistic regression analyses were used to evaluate the odds ratio of HBsAg positivity in association with AD and asthma.
Results: The prevalence of HBsAg positivity was lower in individuals with AD than in those without AD (mean [SE], 0.7% [0.4] vs. 3.7% [0.2]; P < 0.001). However, HBsAg positivity was not significantly associated with asthma (3.7% [0.2] vs. 2.8% [0.8]; P < 0.001). HBsAg positivity decreased the risk of AD significantly (OR = 0.223; 95% CI = 0.069–0.72).
Conclusions
This study demonstrates an inverse association between AD and HBsAg positivity using a nationwide, population-based, cross-sectional health examination and survey.
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Premonitory Symptoms of Migraine in Childhood and Adolescence
Abstract
Purpose of Review
Premonitory symptoms in migraine; symptoms occurring before the onset of migraine pain or aura, are an increasingly recognised area of interest within headache research. It has been recently documented in the literature that these symptoms also occur in children and adolescents, with a comparable phenotype to adults. This review discusses the wide presentation of premonitory symptoms in migraine in children and adolescents, and the importance of understanding how these early symptoms are mediated in order to ensure that targeted abortive therapies are developed in the future. Recognition of these symptoms by parents, guardians, teachers and carers is of importance in ensuring early and effective attack treatment.
Recent Findings
A previous clinic-based questionnaire study in 103 children found a prevalence of premonitory symptoms in paediatric migraine of 67%, with a mean number of reported symptoms of two. A recent study found that in a clinic population of 100 children or adolescents with a migraine diagnosis who were preselected as having at least one premonitory symptom associated with their attacks, two or more premonitory symptoms were reported by 85% of patients. The most common symptoms were fatigue, mood change and neck stiffness.
Summary
Although the population prevalence of premonitory symptoms in migraine within the paediatric population, or their ability to predict accurately the onset of an impending headache cannot be deduced from the retrospective studies performed to date, premonitory symptoms occur in children as young as 18 months old. Understanding the biological basis of these, and their heterogeneous phenotype may help future targeted therapeutic research, helping the development of drugs that act before the onset of pain, limiting the morbidity associated with the migraine attack.
http://ift.tt/2u0j58C
Formulating a clinicopathological algorithm for oral lichenoid dysplasia and related lesions
The term OLD is used to designate a primary oral epithelial dysplasia with secondary lichenoid features [1]. An OLD may be unilateral or bilateral in the presentation. Can exhibit clinical patterns similar to the various types of oral lichen planus ranging from the most common reticular type to the rare bullous variant. OLD may also show features similar to oral leukoplakia (flat white patch). OLD histopathology consists of 2 components: epithelial dysplasia and lichenoid features. The dysplastic features may range from mild to severe based on the World Health Organization (WHO) grading of oral epithelial dysplasia [2].
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Need for molecular characterization in immortalized cell lines
The past few decades have seen a significant rise in the use of cell lines in molecular oncology. Most researchers purchase cell lines from commercial laboratories. Thus it is vital to analyze the factors influencing the phenotypic and genotypic characteristics of the purchased cell lines prior to the study. At present most laboratories employ immortalization to increase the productivity of the cell lines. Although immortalization increases the life span of the cell lines and provides additional time for the researcher, there are few drawbacks to immortalization.
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Prognostic significance of gene amplification of ACTN4 in stage I and II oral tongue cancer
Source:International Journal of Oral and Maxillofacial Surgery, Volume 46, Issue 8
Author(s): T. Kakuya, T. Mori, S. Yoshimoto, Y. Watabe, N. Miura, H. Shoji, K. Onidani, T. Shibahara, K. Honda
Despite complete resection of the early stage of oral tongue cancer by partial glossectomy, late cervical lymph node metastasis is frequently observed. Gene amplification of ACTN4 (protein name: actinin-4) is closely associated with the metastatic potential of various cancers. This retrospective study was performed to demonstrate the potential usefulness of ACTN4 gene amplification as a prognostic biomarker in patients with stage I/II oral tongue cancer. Fifty-four patients with stage I/II oral tongue cancer were enrolled retrospectively, in accordance with the reporting recommendations for tumour marker prognostic studies (REMARK) guidelines. The copy number of ACTN4 and the protein expression of actinin-4 were evaluated by fluorescence in situ hybridization (FISH) and immunohistochemistry (IHC), respectively. The overall survival time of patients with gene amplification of ACTN4 was significantly shorter than that of patients without gene amplification (P=0.0010, log-rank test). Gene amplification of ACTN4 was a significant independent risk factor for death in patients with stage I/II oral tongue cancer (hazard ratio 6.08, 95% confidence interval 1.66–22.27). Gene amplification of ACTN4 is a potential prognostic biomarker for overall survival in oral tongue cancer.
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Editorial Board/Reviewing Committee
Source:International Journal of Oral and Maxillofacial Surgery, Volume 46, Issue 8
http://ift.tt/2t2avJw
Dental implants in patients with osteoporosis: a systematic review with meta-analysis
Publication date: Available online 23 June 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): F.C.F.L. de Medeiros, G.A.H. Kudo, B.G. Leme, P.P. Saraiva, F.R. Verri, H.M. Honório, E.P. Pellizzer, J.F. Santiago Junior
There is currently no consensus regarding the survival rate of osseointegrated implants in patients with osteoporosis. A systematic review with meta-analysis was performed to evaluate the survival rate of implants in such patients. The PubMed/MEDLINE, Web of Science, Cochrane Library, and SciELO databases were used to identify articles published up to September 2016. The systematic review was performed in accordance with PRISMA/PICO requirements and the risk of bias was assessed (Australian National Health and Medical Research Council scale). The relative risk (RR) of implant failure and mean marginal bone loss were analyzed within a 95% confidence interval (CI). Fifteen studies involving 8859 patients and 29,798 implants were included. The main outcome of the meta-analysis indicated that there was no difference in implant survival rate between patients with and without osteoporosis, either at the implant level (RR 1.39, 95% CI 0.93–2.08; P=0.11) or at the patient level (RR 0.98, 95% CI 0.50–1.89; P=0.94). However, the meta-analysis for the secondary outcome revealed a significant difference in marginal bone loss around implants between patients with and without osteoporosis (0.18mm, 95% CI 0.05–0.30, P=0.005). Data heterogeneity was low. An increase in peri-implant bone loss was observed in the osteoporosis group. Randomized and controlled clinical studies should be conducted to analyze possible biases.
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The effect of a hydroxyapatite impregnated PCL membrane in rat subcritical calvarial bone defects
Publication date: October 2017
Source:Archives of Oral Biology, Volume 82
Author(s): Monica Feresini Groppo, Paulo Henrique Caria, Alexandre Rodrigues Freire, Sidney R. Figueroba, Wilson Alves Ribeiro-Neto, Rosario Elida Suman Bretas, Felippe Bevilacqua Prado, Francisco Haiter-Neto, Flavio Henrique Aguiar, Ana Claudia Rossi
ObjectiveThe present study evaluated the effect of polymeric-nanofibers membranes impregnated with microparticulate hydroxyapatite (HA) in the subcritical calvarial bone defects (SCBD) healing.DesignPCL membranes with and without HA were obtained by electrospinning. SCBD were perforated (3.3mm) in left and right sides of 36 rat calvarias. The right-side SBCD of 18 animals was filled with HA mixed with blood clot and blood clot at the contralateral side. The remaining animals received PCL+HA membrane at the right-side SCBD and PCL membrane at the contralateral side. Animals were killed after 30, 60 and 90days after surgery. Bone defect volume (in mm3) was measured by tomography (CBCT). Qualitative histological analysis and SBCD area (in mm2) were measured. Quantitative data were submitted to Kruskal-Wallis/Dunn tests.ResultsReduction of SBCD volume was observed in all treatments but PCL. Association with HA significantly improved bone healing induced by PCL and blood clot. PCL+HA induced the lowest SBCD volume at 60 and 90days. Complete bone healing was not observed even at 90days in SCBD treated with blood clot. In every period, more bone formation was observed for SCBD treated with membranes.ConclusionsWe concluded that both PCL membrane and HA were able to improve bone healing.
Graphical abstract
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Morphological characteristics and HPV genotype predict the treatment response in cutaneous warts
Abstract
Background
Cutaneous warts have a cure rate after therapy of no more than approximately 50%. Recently, we developed and validated a standard assessment tool for warts (CWARTS) based on phenotypical characteristics.
Objectives
To assess whether patient and morphological wart characteristics predict the HPV type in the specific wart and whether these characteristics as well as the HPV type predict a favourable treatment response.
Methods
Photographs were used to score 9 morphological wart characteristics using the newly developed CWARTS tool. Genotyping of 23 wart-associated HPV types was performed using the HSL-PCR/MPG assay. The results were correlated with a favourable response to treatment with monochloroacetic acid, cryotherapy or a combination of cryotherapy and salicylic acid. Odds ratios were calculated using logistic regression in a Generalised Estimating Equations (GEE) model.
Results
Black dots (capillary thrombosis) strongly predicted the presence of any HPV type in a wart. From all characteristics tested, the HPV type most strongly predicted the treatment response when the warts were treated with monochloroacetic acid or the combination of cryotherapy and salicylic acid with a significantly decreased treatment response if the warts contained HPVs of the alpha genus (HPV2, HPV27 or HPV 57). When cryotherapy alone was used for common warts, HPV type did not play a role, but cryotherapy was less effective when the wart showed callus and was located deeper in the skin.
Conclusions
Morphological characteristics of the warts and the HPV genotype influence treatment outcome and thus potentially influence future treatment decisions for common and plantar warts.
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Biosimilars for Psoriasis: Worldwide Overview of Regulatory Guidelines, Uptake and Implications for Dermatology Clinical Practice
Abstract
The introduction of biologic drugs for the treatment of patients with psoriasis has revolutionized treatment paradigms and enabled numerous patients to achieve disease control with an acceptable safety profile. However, the high cost of biologics limits access to these medications for the majority of patients worldwide. In recent years, the introduction of biosimilars for inflammatory diseases has become a fast evolving field. The future use of biosimilars offers the potential for decreased cost and increased access to biologic drugs for patients with psoriasis. For their approval, different regulatory agencies use highly variable methods for definition, production, approval, marketing, and post-marketing surveillance of biosimilars. Due to potential interchangeability between biologics and biosimilars, traceability and pharmacovigilance are required to collect accurate data about adverse events in psoriasis patients; spontaneous reporting, registries, and use of "big data" should facilitate this process on a global basis. The current article describes biosimilar regulatory guidelines and examples of biosimilar uptake in clinical practice in several countries around the world. As it is apparent that biologic treatment decisions may become more physician-independent, the International Psoriasis Council recommends that dermatologists should take an active role in the development of biosimilar prescribing policies with their respective healthcare settings and governmental agencies.
This article is protected by copyright. All rights reserved.
http://ift.tt/2tFhhml
Sebum lipids influence macrophage polarization and activation
Summary
Background
As lipids are known to regulate macrophage functions it is reasonable to suppose that a sebocyte – macrophage axis mediated by sebum lipids may exist.
Objective
To investigate if sebocytes could contribute to the differentiation, polarization and function of macrophages with their secreted lipids.
Methods
Oil-red-O lipid staining and Raman spectroscopy were used to assess the dermal lipid content and penetration. Immunohistochemistry was used to analyse the macrophage subsets. Human peripheral blood monocytes were differentiated in the presence of either supernatant from human SZ95 sebocytes or major sebum lipid components and activated with Propionibacterium acnes. Macrophage surface markers and their capacity to uptake FITC-Propionibacterium acnes were detected by FACS measurements. Cytokine protein levels were evaluated by ELISA and Western blot analysis.
Results
Sebaceous gland rich skin had an increased dermal lipid content compared to sebaceous gland poor skin to which all the tested sebum component lipids could contribute by penetrating through the dermo-epidermal barrier. Of the lipids, oleic and linoleic acids promoted monocyte differentiation into alternatively activated macrophages. Moreover, linoleic acid also had an anti-inflammatory effect in Propionibacterium acnes activated macrophages, inhibiting the secretion of IL-1B, IL-6 and TNF-Α. Squalene, palmitic, stearic and oleic acids augmented the secretion of IL-1B even in the absence of Propionibacterium acnes, while oleic acid had a selective effect of inducing IL-1B, but down-regulating IL-6 and TNF-A secretion.
Conclusions
Our results suggest a role for sebaceous glands in modulating innate immune responses via their secreted lipids that are of possible pathologic and therapeutic relevance.
This article is protected by copyright. All rights reserved.
http://ift.tt/2t5KfyB
A systematic review of pharmacogenetic studies on the response to biologics in psoriasis patients
Abstract
Biologics are indicated for treating moderate to severe psoriasis. As the number of biologics registered for psoriasis increases, so does the need for biomarkers to guide personalized therapeutic decisions. Genetic variants might serve as predictors for treatment response, a field of research known as pharmacogenetics. The aim of this systematic review was to assess which genetic variants are associated with the response to biologics in psoriasis patients. A systematic search was performed in EMBASE, MEDLINE, the Cochrane Library and Web of Science. Twenty-six papers were included in this systematic review: 24 original studies and two meta-analyses. Quality was assessed using a predesigned form. Risk of bias was assessed using the Newcastle-Ottawa Scale. The majority of studies reported a candidate gene approach, focusing on polymorphisms in genes related the therapeutical target or to psoriasis susceptibility. Studied populations were small and results were divergent, especially for studies investigating tumour necrosis factor inhibitors. The evidence for the role of HLA-Cw6 in ustekinumab efficacy shows minimal heterogeneity, with a higher response rate among HLA-Cw6 positive patients reported across three out of five studies. However, replication of these findings in larger cohorts is required. Large scale hypothesis-free searches for genetic biomarkers are needed to uncover the complete genetic background of biologics treatment outcome.
This article is protected by copyright. All rights reserved.
http://ift.tt/2tFOqyi
Clinical experience with infliximab biosimilar in psoriasis
Abstract
biosimilar medicines are biological medicine that have been developed to be highly similar and clinically equivalent to an existing biological medicine. Just as patent expiry for conventional drugs has led to the marketing of generic versions, the expiry of data protection and patents for original biologics has prompted development of biosimilars.
This article is protected by copyright. All rights reserved.
http://ift.tt/2t5YlQl
Malignancies and ustekinumab: an analysis of the FDA Adverse Event Reporting System and the European Union Drug Regulating Authorities Pharmacovigilance database
Abstract
Ustekinumab is a fully human monoclonal antibody that targets the common p40 subunit shared by interleukins (IL)-12 and IL-23, approved in the United States and in Europe on September 2009, for treatment of moderate to severe psoriasis and on September 2016 for moderately to severely active Crohn's disease1. Pre-marketing studies supported an acceptable risk-to-benefit profile2-4.
This article is protected by copyright. All rights reserved.
http://ift.tt/2tFijOW
The effect of a hydroxyapatite impregnated PCL membrane in rat subcritical calvarial bone defects
Publication date: October 2017
Source:Archives of Oral Biology, Volume 82
Author(s): Monica Feresini Groppo, Paulo Henrique Caria, Alexandre Rodrigues Freire, Sidney R. Figueroba, Wilson Alves Ribeiro-Neto, Rosario Elida Suman Bretas, Felippe Bevilacqua Prado, Francisco Haiter-Neto, Flavio Henrique Aguiar, Ana Claudia Rossi
ObjectiveThe present study evaluated the effect of polymeric-nanofibers membranes impregnated with microparticulate hydroxyapatite (HA) in the subcritical calvarial bone defects (SCBD) healing.DesignPCL membranes with and without HA were obtained by electrospinning. SCBD were perforated (3.3mm) in left and right sides of 36 rat calvarias. The right-side SBCD of 18 animals was filled with HA mixed with blood clot and blood clot at the contralateral side. The remaining animals received PCL+HA membrane at the right-side SCBD and PCL membrane at the contralateral side. Animals were killed after 30, 60 and 90days after surgery. Bone defect volume (in mm3) was measured by tomography (CBCT). Qualitative histological analysis and SBCD area (in mm2) were measured. Quantitative data were submitted to Kruskal-Wallis/Dunn tests.ResultsReduction of SBCD volume was observed in all treatments but PCL. Association with HA significantly improved bone healing induced by PCL and blood clot. PCL+HA induced the lowest SBCD volume at 60 and 90days. Complete bone healing was not observed even at 90days in SCBD treated with blood clot. In every period, more bone formation was observed for SCBD treated with membranes.ConclusionsWe concluded that both PCL membrane and HA were able to improve bone healing.
Graphical abstract
http://ift.tt/2sBCEX4
Formulating a clinicopathological algorithm for oral lichenoid dysplasia and related lesions
Source:Oral Oncology
Author(s): A. Thirumal Raj
http://ift.tt/2tFr77v
Need for molecular characterization in immortalized cell lines
Source:Oral Oncology
Author(s): Thirumal Raj A.
http://ift.tt/2t69uAU
Long-term toxicities in 10-year survivors of radiation treatment for head and neck cancer
Source:Oral Oncology, Volume 71
Author(s): Yanqun Dong, John A. Ridge, Tianyu Li, Miriam N. Lango, Thomas M. Churilla, Jessica R. Bauman, Thomas J. Galloway
ObjectivesTo characterize the recognized but poorly understood long-term toxicities of radiation therapy (RT) for head and neck cancer (HNC).Materials and methodsWe retrospectively evaluated patients treated with curative-intent RT for HNC between 1990 and 2005 at a single institution with systematic multidisciplinary follow-up ≥10years. Long-term toxicities of the upper aerodigestive tract were recorded and assigned to two broad categories: pharyngeal-laryngeal and oral cavity toxicity. Kaplan-Meier estimates and Chi-square tests were used for univariable analysis (UVA). Cox model and logistic regression were used for multivariable analysis (MVA).ResultsWe identified 112 patients with follow-up ≥10years (median 12.2). The primary tumor sites were pharynx (42%), oral cavity (34%), larynx (13%), and other (11%). Forty-four percent received postoperative RT, 24% had post-RT neck dissection, and 47% received chemotherapy.Twenty-eight (25%) patients developed pharyngeal-laryngeal toxicity, including 23 (21%) requiring permanent G-tube placed at median of 5.6years (0–20.3) post-RT. Fifty-three (47%) developed oral cavity toxicity, including osteoradionecrosis in 25 (22%) at a median of 7.2years (0.5–15.3) post-RT.On MVA, pharyngeal-laryngeal toxicity was significantly associated with chemotherapy (HR 3.24, CI 1.10–9.49) and age (HR 1.04, CI 1.00–1.08); oral cavity toxicity was significantly associated with chemotherapy (OR 4.40, CI 1.51–12.9), oral cavity primary (OR 5.03, CI 1.57–16.1), and age (OR 0.96, CI 0.92–1.00).ConclusionAmong irradiated HNC patients, pharyngeal-laryngeal and oral cavity toxicity commonly occur years after radiation, especially in those treated with chemotherapy. Follow-up for more than five years is essential because these significant problems afflict patients who have been cured.
http://ift.tt/2tFmjiE
Treatment guidelines and patterns of care in oral cavity squamous cell carcinoma: Primary surgical resection vs. nonsurgical treatment
Source:Oral Oncology, Volume 71
Author(s): Rance J.T. Fujiwara, Barbara Burtness, Zain A. Husain, Benjamin L. Judson, Aarti Bhatia, Clarence T. Sasaki, Wendell G. Yarbrough, Saral Mehra
BackgroundThe 2017 National Comprehensive Cancer Network Clinical Practice Guidelines recommend surgical resection or definitive radiation therapy for early-stage oral cavity malignancies, and surgical resection or multimodality clinical trials for late-stage disease. Few studies have been conducted to identify predictors of choice of treatment modality for oral cavity malignancies.MethodsAll patients in the National Cancer Data Base (NCDB) diagnosed with oral cavity squamous cell carcinoma (OCSCC) between 1998 and 2011 were identified. Chi-square and binary logistic regression were used to identify factors predictive of surgical or nonsurgical treatment; multiple imputation was used for missing data. Cox proportional hazards models were generated to identify associations between treatment modality and overall survival (OS).ResultsOf 23,459 patients, 4139 (17.6%) underwent primary nonsurgical treatment. Among NCDB-registered facilities, there has been a decrease in use of nonsurgical treatment for OCSCC (OR 0.97, p<0.001). Older age, non-white race, Medicaid insurance, low income, low education, and later-stage disease were associated with nonsurgical therapy, while patients at academic/research programs were more likely to undergo surgery (OR 0.38, p<0.001). Nonsurgical treatment was associated with decreased OS (HR=2.02, p<0.001); this was upheld on subgroup analysis of early- and late-stage disease.ConclusionsUse of primary nonsurgical treatment for OCSCC has decreased over time among NCDB-registered facilities and is associated with factors related to access to care. Surgical resection for the primary treatment of oral cavity cancer may be associated with improved OS, though conclusions regarding survival are limited by the non-randomized nature of the data.
http://ift.tt/2t5NaqU
The long-term oncological and functional outcomes of transoral robotic surgery in patients with hypopharyngeal cancer
Source:Oral Oncology, Volume 71
Author(s): Young Min Park, Chan Min Jung, Dongchul Cha, Se-Heon Kim
ObjectiveWe conducted a prospective clinical trial of transoral robotic surgery in patients with hypopharyngeal cancer and herein report the long-term oncological and functional outcomes.Materials and methodsBetween April 2008 and March 2014, 45 patients diagnosed with hypopharyngeal cancer participated in this prospective study.ResultsAll patients were male with a mean age of 66.7years. The median follow-up period was 60months. Patients were classified using the staging system of the American Joint Commission on Cancer, as follows: Stage I, 7.9%; Stage II, 5.3%; Stage III, 15.8%; Stage IV, 71.1. Of all 38 patients, 17 (44.7%) were alive with no evidence of disease at the last follow-up. Seven patients (18.4%) died of TNM-related disease and fourteen (36.8%) from other causes. The 5-year disease-specific survival rate of stage I and II patients was 100.0%, and that of stage III and IV patients was 74.0%. The 5-year disease-free survival rate was 100.0% for stage I and II patients and 68.6% for stage III and IV patients.ConclusionsPatients who underwent TORS exhibited oncological outcomes comparable to those of conventional therapies and rapid functional recovery with low surgical morbidity. TORS and simultaneous neck dissection, with or without adjuvant therapy, may be effective alternatives to existing treatment methods.
http://ift.tt/2tFM6Y6
Dental implants in patients with osteoporosis: a systematic review with meta-analysis
There is currently no consensus regarding the survival rate of osseointegrated implants in patients with osteoporosis. A systematic review with meta-analysis was performed to evaluate the survival rate of implants in such patients. The PubMed/MEDLINE, Web of Science, Cochrane Library, and SciELO databases were used to identify articles published up to September 2016. The systematic review was performed in accordance with PRISMA/PICO requirements and the risk of bias was assessed (Australian National Health and Medical Research Council scale).
http://ift.tt/2sMwbXT
Should we be taking the p (value) out of statistics?
In February 2014, the new editor of Basic and Applied Social Psychology (BASP) announced to the readership in his first editorial that the use of inferential statisticsa would no longer be a requirement for publication in that journal.1 A year later this was followed by the statement in a further editorial that after a "grace period" the journal was banning the publication of test statistics, such as p-values,2 and manuscripts would be sent on to review only once all the "vestiges" of inferential statistics had been removed.
http://ift.tt/2t5Kc5R
Disseminated histoplasmosis in a patient with HIV diagnosed by simple bedside investigations
Description
A 41-year-old HIV-infected woman presented with prolonged fever at another hospital. Besides low CD4 count (8 cell/mm3) and pancytopaenia, blood cultures, chest radiograph, chest–whole abdominal CT and bone marrow examination were unremarkable. Empirical treatment for tuberculosis was given. One week later, she developed rash and was transferred to our hospital. Physical examination showed multiple pruritic erythematous purplish maculopapular rashes with central necrotic areas predominantly on face, back-chest wall and both forearms (figure 1). Peripheral blood smear (figure 2) and skin scraping (figure 3) revealed multiple intracellular yeast-like organisms suggestive of Histoplasma capsulatum. Intravenous amphotericin B was given, followed by oral itraconazole. Her condition improved after 2 weeks of treatment. Antiretroviral medications were initiated 1 month later.
Figure 1
Multiple pruritic erythematous purplish maculopapular rashes with some central necrotic areas predominantly on the (A) face, (B) back-chest wall and (C,D) both forearms.
...http://ift.tt/2sMrg9e
Down syndrome and Moyamoya disease: unusual cause of stroke
Down syndrome is a frequent clinical entity, being considered one of the most frequent chromosomal aberrations. It is characterised by a typical clinical phenotype and is associated with a heterogeneous group of organ and system-specific abnormalities. The cardiovascular system is commonly affected and if so, it may be associated with an increased morbidity and mortality. Cerebrovascular events in patients with Down syndrome are multifactorial, being possibly related to congenital heart disease, vascular malformations and traditional cardiovascular risk factors. Moyamoya disease is a rare chronic occlusive vascular disease causing stenosis of the distal portion of the internal carotid artery, which has been associated with Down syndrome. The authors report the case of a 26-year-old woman with Down syndrome who presented with an acute stroke secondary to Moyamoya disease. The case is noteworthy for the rarity of this clinicopathological entity, and serves as a reminder for the possible association between these two conditions.
http://ift.tt/2s24CMU
Microcephaly in infantile Sandhoff's disease
Description
We evaluated a boy aged 16 months with developmental arrest at the age of 6 months followed by neuroregression and recurrent generalised seizures. Perinatal and family history was not contributory. He was first born to non-consanguineous parents by term, uncomplicated vaginal delivery and weighed 2.8 kg at birth. On examination, he was unable to hold neck, fixate, coo or smile and showed no interest in the surroundings. His weight was 9.5 kg (between 15th and 50th centile), length 78 cm (between 15th and 50th centile) and head circumference 44.4 cm (below 3rd centile) with normal head circumference of father (54 cm) and mother (51 cm). He also had hyperacusis, bilateral cherry-red spot, generalised hypotonia, brisk muscle stretch reflexes, bilateral Babinski's sign and no organomegaly. In view of infantile-onset neuroregression, microcephaly, seizures, cherry-red spot and spasticity, clinical diagnoses of GM2 (Tay-Sach's and Sandhoff's disease), GM1 gangliosidosis and Krabbe's disease were considered initially. Skull radiograph showed J-shaped...
http://ift.tt/2sMrfSI
Perforated duodenal diverticulum: a rare complication in a common condition
The authors present a rare case of perforated duodenal diverticulum diagnosed in an 80-year-old Caucasian woman with vomiting and abdominal pain localised to the epigastrium. CT scan showed thickening of the second portion of the duodenum with retroperitoneal fat stranding and perihepatic free fluid, with a presumptive diagnosis of a duodenal perforation. A laparotomy was performed which showed a perforated diverticulum in the second portion of the duodenum. A diverticulectomy with single-layer closure was performed, without complications. The postoperative course was uneventful.
http://ift.tt/2s2sr7h
Advances in atopic dermatitis and urticaria, 2016
Source:Journal of Allergy and Clinical Immunology
Author(s): Tetsuya Honda, Takashi Nomura, Kenji Kabashima
This review highlights recent key advances in the pathology and therapies of inflammatory skin diseases, focusing on atopic dermatitis (AD) and chronic spontaneous urticaria (CSU). Regarding AD, transcriptomic analysis using human samples revealed different immune profiles between childhood AD and adult AD. Phase III clinical trials of dupilumab, an anti-IL4 receptor alpha antibody, on AD have successfully finished, and dupilumab will appear in clinical practice as the first biologics for AD in 2017. In addition, a novel biologics that targets IL-31 shows promising results in a phase II trial. As for the skin microbiome study, novel insights into the mechanisms of microbial dysbiosis such as the colonization of Staphylococcus aureus, a common feature of AD, were proposed. Regarding CSU, autoreactive CD4+ T cells that react to FcεRI were discovered, which may potentially contribute to the development of CSU. These findings give new insights into the pathogenesis of AD and CSU, and will lead to more specific and personalized treatments.
http://ift.tt/2sBGcbJ
New pathways for itching in atopic dermatitis?
Source:Journal of Allergy and Clinical Immunology
Author(s): Jennifer Heimall, Jonathan M. Spergel
http://ift.tt/2s6KbcS
An Update on the Risk of Lymph Node Metastasis for the Follicular Variant of Papillary Thyroid Carcinoma with the New Diagnostic Paradigm
Abstract
Previous data has shown that the risk of nodal metastases is significantly greater for classical papillary thyroid carcinoma (PTC) as compared to the follicular variant (FVPTC). Given a recent change in diagnostic paradigm and definition of the noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) we intended to investigate if there remains a significant difference in nodal involvement between classical PTC and FVPTC. A 6-year retrospective review of all cases with FVPTC in the diagnostic line from the University of Utah/ARUP Laboratories was conducted. Two pathologists reviewed the remaining cases using the recently described histologic criteria of NIFTP to determine the total number the FVPTCs fitting the new classification paradigm. Histologic and clinical follow-up was tracked for all patients to determine the rate of nodal disease for all groups. 127 cases were identified using the above listed criteria. Forty-seven cases (37%) were classified as NIFTPs. None of the 47 patients had nodal disease either at the time of surgery or on follow-up. Twenty-eight cases met the current criteria for FVPTC (21%); of these 7/28 (25%) had evidence of nodal disease. By comparison, 17/45 (38%) of patients with mixed classical and FVPTC had nodal disease. Overall, there was no statistically significant difference in the risk of nodal metastasis between the pure FVPTC and mixed classical/FVPTC groups (p = 0.43). Our data indicates that implementing new definition for FVPTC will narrow the gap in the risk of nodal metastases between the classical PTC and FVPTC histologic subtypes.
http://ift.tt/2t1EH7z
The landmark for removal of sialoliths using sialendoscopy alone in parotid gland sialolithiasis
To assess the general guidelines for removal of sialoliths in parotid gland sialolithiasis using sialendoscopy alone.
http://ift.tt/2tETqCZ
An Update on the Risk of Lymph Node Metastasis for the Follicular Variant of Papillary Thyroid Carcinoma with the New Diagnostic Paradigm
Abstract
Previous data has shown that the risk of nodal metastases is significantly greater for classical papillary thyroid carcinoma (PTC) as compared to the follicular variant (FVPTC). Given a recent change in diagnostic paradigm and definition of the noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) we intended to investigate if there remains a significant difference in nodal involvement between classical PTC and FVPTC. A 6-year retrospective review of all cases with FVPTC in the diagnostic line from the University of Utah/ARUP Laboratories was conducted. Two pathologists reviewed the remaining cases using the recently described histologic criteria of NIFTP to determine the total number the FVPTCs fitting the new classification paradigm. Histologic and clinical follow-up was tracked for all patients to determine the rate of nodal disease for all groups. 127 cases were identified using the above listed criteria. Forty-seven cases (37%) were classified as NIFTPs. None of the 47 patients had nodal disease either at the time of surgery or on follow-up. Twenty-eight cases met the current criteria for FVPTC (21%); of these 7/28 (25%) had evidence of nodal disease. By comparison, 17/45 (38%) of patients with mixed classical and FVPTC had nodal disease. Overall, there was no statistically significant difference in the risk of nodal metastasis between the pure FVPTC and mixed classical/FVPTC groups (p = 0.43). Our data indicates that implementing new definition for FVPTC will narrow the gap in the risk of nodal metastases between the classical PTC and FVPTC histologic subtypes.
http://ift.tt/2t1EH7z
Survey of nulliparous parturients' attitudes regarding timing of epidural analgesia initiation
At our hospital, although >90% of nulliparous parturients eventually choose epidural analgesia for labor, many delay its initiation, experiencing considerable pain in the interim. This survey probed parturients' views about the timing of initiation of epidural labor analgesia.
http://ift.tt/2sBzra2
An Update on the Risk of Lymph Node Metastasis for the Follicular Variant of Papillary Thyroid Carcinoma with the New Diagnostic Paradigm
Abstract
Previous data has shown that the risk of nodal metastases is significantly greater for classical papillary thyroid carcinoma (PTC) as compared to the follicular variant (FVPTC). Given a recent change in diagnostic paradigm and definition of the noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) we intended to investigate if there remains a significant difference in nodal involvement between classical PTC and FVPTC. A 6-year retrospective review of all cases with FVPTC in the diagnostic line from the University of Utah/ARUP Laboratories was conducted. Two pathologists reviewed the remaining cases using the recently described histologic criteria of NIFTP to determine the total number the FVPTCs fitting the new classification paradigm. Histologic and clinical follow-up was tracked for all patients to determine the rate of nodal disease for all groups. 127 cases were identified using the above listed criteria. Forty-seven cases (37%) were classified as NIFTPs. None of the 47 patients had nodal disease either at the time of surgery or on follow-up. Twenty-eight cases met the current criteria for FVPTC (21%); of these 7/28 (25%) had evidence of nodal disease. By comparison, 17/45 (38%) of patients with mixed classical and FVPTC had nodal disease. Overall, there was no statistically significant difference in the risk of nodal metastasis between the pure FVPTC and mixed classical/FVPTC groups (p = 0.43). Our data indicates that implementing new definition for FVPTC will narrow the gap in the risk of nodal metastases between the classical PTC and FVPTC histologic subtypes.
http://ift.tt/2t1EH7z
Prescription patterns and costs of acne/rosacea medications in Medicare patients vary by prescriber specialty
Prescription patterns for acne/rosacea medications have not been described in the Medicare population, and comparisons across specialties are lacking.
http://ift.tt/2t5H4a3
Cryotherapy to treat anogenital warts in nonimmunocompromised adults: Systematic review and meta-analysis
Cryotherapy is one of the most commonly used therapeutic modalities to treat anogenital warts (AGWs), but this treatment was not clearly established in the recent international recommendations.
http://ift.tt/2tEOm1x
Clostridium perfringens 's necrotizing acute pancreatitis: a case of success
Abstract
The authors report a case of a 62-year-old man with upper abdominal pain with few hours of onset and vomits. The initial serum amylase was 2306 U/L. The first CT showed signs of a non-complicated acute pancreatitis. He suffered clinical deterioration and for this reason he was admitted on the intensive care unit where he progressed to multiple organ failure in <24 h. A new CT scan was performed that showed pneumoperitoneum and pneumoretroperitoneum. He underwent an exploratory laparotomy and pancreatic necrosectomy and vacuum pack laparostomy were performed. Intraoperative peritoneal fluid culture was positive for Clostridium perfringens confirming the diagnosis. He was discharged from hospital after 61 days. According to our research this is the second case reported in literature of a spontaneous acute necrotizing pancreatitis caused by C. perfringens, with pneumoretroperitoneum and pneumoperitoneum on evaluation by CT scan, that survived after surgical treatment and vigorous resuscitation.http://ift.tt/2sMuhX4
Familial spontaneous splenic rupture in a patient with idiopathic splenomegaly—report of a case
Abstract
Spontaneous splenic rupture in a healthy individual is a rare phenomenon. This article reports on a patient with an uneventful medical history, presenting with atraumatic splenic rupture. Three family members of the patients experienced the same in the past.http://ift.tt/2sM9Fy1
Robotic right segmental hepatectomy for the treatment of a giant hepatic hemangioma—a case report
Abstract
Hemangioma is the most common benign hepatic tumor. We present the case of a patient with a giant symptomatic hemangioma, treated with segmental liver resection using the Da Vinci Robotic System. A 38-year-old woman presented to our surgical out-patient Department complaining about abdominal discomfort and recurrent episodes of acute abdominal pain. CT-scan and MRI imaging of the abdomen revealed the presence of a giant hepatic hemangioma (>5 cm) involving segments VI and VII. Robotic right segmental hepatectomy was performed. The procedure was successfully completed in 120 min and with intraoperative blood loss of only 450 ml. Postoperative period was uneventful and the patient was discharged on the second postoperative day. In case of giant hemangiomas, a minimally invasive robotic major hepatic resection is a viable option that can be performed with minimal complications. A careful preoperative and intraoperative strategy is required, while significant experience in liver and robotic surgery is mandatory.http://ift.tt/2sMiOXr
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