Significance of interferon gamma in the prediction of successful therapy of common warts by intralesional injection of Candida antigen

Abstract

Background

Treatment of common warts remains a continuing challenge for both patients and physicians. Recently, intralesional immunotherapy by different antigens has proved efficacious in the treatment of warts, however, no definite predictive factors for successful therapy have been established. Herein, we evaluate the efficacy and safety of Candida antigen in the treatment of common warts and the significance of interferon gamma (IFN-γ) in the prediction of successful therapy.

Methods

The study included 54 patients with multiple common warts. A blood sample was collected from patients before therapy, cultured, and treated with Candida antigen for evaluation of IFN-γ. Candida antigen was directly injected into the largest wart at 2-week intervals until complete clearance or for a maximum of five treatments. Follow-up was made for 6 months to detect any recurrence.

Results

Complete clearance of the lesions was seen in 61.1% of the studied patients. IFN-γ was statistically higher in responded cases as compared to nonresponders. Adverse effects were insignificant, and no recurrence of warts was observed.

Conclusions

Candida antigen is a promising, effective, and safe immunotherapeutic modality for common warts, and IFN-γ may serve as a good predictor of its therapeutic response.

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Author's response

The correspondents raise an important point regarding the drug–device interaction and their references support their concern.1 Indeed, there can be a significant interaction between the delivery device and the drug that can affect systemic delivery to the body.2 Our comment was directed at the amount coming out of the metered-dose inhaler to the mouth and that the total fraction is decreased with a spacer. There are many factors, as summarized in our review, that ultimately affect the amount of drug that is systemically absorbed from the lung or the gastrointestinal tract that can modify the amount available systemically in the body.

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Editorial Board

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Author's response

Our primary hopes with the publication of this review1 were 2-fold: (1) to add to the body of literature supporting the safety of subcutaneous aeroallergen immunotherapy and (2) to provide a template for allergists who might want to use cluster or rush schedules but have been dissuaded by historically high systemic reaction rates. We recognize that our retrospective analysis of more than 2.5 million injections was not designed to best determine why our systemic reaction rates were lower than those previously published.

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Uptake of EpiPen and Allerject (Auvi-Q) epinephrine auto-injectors in Manitoba children

Anaphylaxis guidelines1,2 recommend that all individuals at increased risk of anaphylaxis in the community carry epinephrine auto-injectors (EAIs) to facilitate timely injection of epinephrine during anaphylaxis and decrease the risk of hospitalization and death.3,4

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Immunotherapy and systemic reactions

We read with interest the recent retrospective review by Winslow et al.1 The authors reported systemic reaction (SR) rates lower than those previously published.2 Of note, they use "standard build" for what is typically referred to as "conventional build-up". The advantage of reporting SR rates within a single large practice is the assumed consistency and standardization of immunotherapy delivery.

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Food allergen extracts to diagnose food-induced allergic diseases

To review the manufacturing procedures of food allergen extracts and applicable regulatory requirements from government agencies, potential approaches to standardization, and clinical application of these products. The effects of thermal processing on allergenicity of common food allergens are also considered.

http://ift.tt/2vDum39

Adult-onset food allergies

Although it is known that many food allergies that start in childhood will remain into adulthood (eg, peanut, tree nuts, and seafood), there is a paucity of data and literature on adult-onset food allergies. Although not as common as childhood-onset food allergy, clinicians caring for patients with allergy should be aware of these various presentations and syndromes. In this review, we examine food allergies in adults, with a focus on those syndromes that more commonly have an onset in adulthood.

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Table of Contents

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Understanding the biology of disease in underserved children with asthma

African American children are disproportionately affected by asthma compared with non-Hispanic white children. Recent data from the Centers for Disease Control and Prevention indicate that asthma prevalence rates (10.3% vs 7.8%) remain higher among non-Hispanic black children than non-Hispanic white children, and non-Hispanic black children are almost 3 times as likely to die of asthma as non-Hispanic white children.1 Studies have also found that African American children have more frequent and burdensome asthma symptoms and use emergency department (ED) care more frequently than white children.

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Drug–device interaction for systemic effects of fluticasone in patients with asthma

The recent review article by Carr and Szefler on the systemic safety of inhaled corticosteroids concluded with the erroneous assertion, "Another option to reduce systemic exposure is to use spacers or valved holding chambers with pressurized MDI's."1 For drugs such as fluticasone, the systemic bioactivity is purely determined by lung bioavailability because of its almost complete first-pass hepatic inactivation for the swallowed dose. Hence, increasing lung deposition by using fluticasone through a pressurized metered-dose inhaler in conjunction with a spacer will greatly increase systemic bioactivity, as assessed by measuring cortisol suppression.

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Instructions for Authors

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Information for Readers

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Incontinentia pigmenti in a male (XY) infant with long-term follow up over 8 years

Abstract

Incontinentia pigmenti (IP) is an X-linked genodermatosis affecting the skin and other sites, including the teeth, nails, hair, eyes and nervous system defects in female patients. Generally lethal in males, there are only a few known cases of males surviving this condition. Nuclear factor (NF)-κB essential modulator (NEMO), also known as inhibitor of kappa light polypeptide gene enhancer in B cells, kinase gamma (IKBKG), constitutes an essential activator of NF-κB. Over 80% of female patients with IP carry a common deletion mutation involving exons 4–10 of the IKBKG/NEMO gene. We present the case of a male infant (XY) with IP with no concomitant complications. Polymerase chain reaction (PCR) assay showed that the exon 4–10 deletion band was significantly stronger in the skin sample than in blood. Subsequently, long-range PCR was performed periodically to confirm the spontaneous regression of mutant cells from his blood. Over a period of 6 years, the 2.6-kb mutant band gradually became weaker, but we did not confirm complete regression. Our patient was a healthy, 8-year-old male child with no complications despite the presence of a 2.6-kb mutant band in his blood. Further follow up is necessary to assess for complications that may develop later.

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Child abuse and fabricated or induced illness in the ENT setting: a systematic review

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Hearing aid fitting for visual and hearing impaired patients with Usher syndrome type IIa

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The diagnostic accuracy of non‐imaging screening protocols for vestibular schwannoma in patients with asymmetrical hearing loss and/or unilateral audiovestibular dysfunction: a diagnostic review and meta‐analysis

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The increased expression of TCF3 is correlated with poor prognosis in Chinese patients with nasopharyngeal carcinoma

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Maxillary sinus volume: new physiopathological data in fungal ball genesis? A retrospective study

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New olfactometric findings in Parkinson's disease

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Inner ear disorders in 68 pregnant women: a 20‐year experience

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Comparison of radiologically and histologically determined thickness of bone overlying the superior semicircular canal in sixty‐six cadaveric specimens: impact on the diagnosis of Minor's Syndrome

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Local control of 151 head and neck cutaneous squamous cell carcinoma after radiotherapy: a retrospective study on efficacy and prognostic factors

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High‐frequency sensorineural hearing loss associated with vestibular episodic syndrome

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Laryngological presentations of Ehlers–Danlos syndrome: case series of nine patients from two London tertiary referral centres

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Introduction of an outpatient clinic safety checklist: our experience

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Screening not staging: a retrospective study of the rate of synchronous primary malignancy in 44 T1/T2 laryngeal cancer in a tertiary head and neck unit

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Surgical management of petrous apex cholesterol granulomas by an infralabyrinthine approach: our experience with fourteen cases

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Minimally invasive endo‐orbital approach to sphenoid wing meningiomas improves visual outcomes – our experience with the first seven cases

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Modification of facial artery myomucosal flap: a novel perforator flap for upper aerodigestive tract reconstruction after head and neck cancer ablation

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Consequences and complications of surgery for tumours of the pre‐ versus post‐styloid parapharyngeal spaces in 41 patients

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Pressure monitoring of the Muller manoeuvre: our experience in twenty‐five obstructive sleep apnoea hypopnoea syndrome patients with oropharyngeal obstruction

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Treating paediatric anterior glottic web: single‐centre experience of 20 patients with comparison among techniques

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Ambulant management of acute tonsillitis in adult patients, a study on 330 patients

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Papillary fibroelastoma diagnosed through multimodality cardiac imaging: a rare tumour in an uncommon location with review of literature

We describe the case of a woman presenting with transient ischaemic attack, who was found to have a papillary fibroelastoma arising from the aortic wall, an extremely rare location. We describe the multimodality imaging techniques used in diagnosing this patient and review the most recent literature on evaluation and management of patients with cardiac papillary fibroelastomas.

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Editorial Board

Publication date: September 2017
Source:British Journal of Oral and Maxillofacial Surgery, Volume 55, Issue 7





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Re: Current thinking about the management of dysfunction of the temporomandibular joint: a review

Publication date: Available online 8 August 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): A. Graham




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Re: Segmental mandibulectomies made easier: a simple drill guide

Publication date: September 2017
Source:British Journal of Oral and Maxillofacial Surgery, Volume 55, Issue 7
Author(s): Y.J. Kim, Y.C. Lee, Y.G. Eun, J.W. Lee




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Diathermy of split-thickness skin graft donor site: a new technique

Publication date: September 2017
Source:British Journal of Oral and Maxillofacial Surgery, Volume 55, Issue 7
Author(s): A.M. Holden, A.N. Beech, J.N. Farrier




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Training Groups

Publication date: September 2017
Source:British Journal of Oral and Maxillofacial Surgery, Volume 55, Issue 7





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Editorial Board

Publication date: August 2017
Source:Journal of Oral Biosciences, Volume 59, Issue 3





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Evolution of the IgE and IgG repertoire to a comprehensive array of allergen molecules in the first decade of life

Abstract

Background

In early childhood, the allergen-specific IgG repertoire is mainly directed to animal and vegetable food molecules and infrequently to airborne molecules. It is unknown whether this early pattern is maintained throughout childhood.

Objective

To investigate the evolution of IgG and IgE responses to a broad panel of allergenic molecules from birth to age 10yrs.

Methods

We examined the sera collected between birth and age 10yrs from participants in the German Multicentre Allergy Study, a birth cohort born in 1990. The IgE (cut-off ≥0.30 ISU) and IgG (cut-off ≥0.10 ISU) responses to 35 genuine allergenic molecules were measured with a multiplex microarray approach (ImmunoCAP ISAC^™).

Results

IgE responses were mostly directed against a restricted group of airborne molecules, with a sequence and prevalence hierarchy (Phl p 1 > Bet v 1 > Fel d 1 > Phl p 5 > Der p 2 > Der p 1) largely maintained over time. Conversely, the IgG repertoire was much broader, starting with animal foodborne, then spreading to vegetable foodborne and finally to airborne molecules. A strong and persistent IgG response to a given airborne molecule almost invariably preceded or accompanied an IgE response to that molecule.

Conclusions

The evolution of IgG and IgE responses throughout childhood differs widely at population level. IgG responses are mostly directed to animal food allergens while IgE responses are dominated by airborne allergens. However, a strong IgG response almost invariably precedes or accompanies the appearance of IgE to the same molecule in specifically sensitized subjects.

This article is protected by copyright. All rights reserved.

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Allergic sensitization to laboratory animals is more associated with asthma, rhinitis and skin symptoms than sensitization to common allergens

Summary

Background

Workers exposed to laboratory animals have a high risk of developing laboratory animal allergy (LAA). Atopy seems to be the main risk factor for LAA. We hypothesized that occupational sensitization is a better predictor for the development of asthma, rhinitis and bronchial hyperresponsiveness than common sensitization.

Objective

To investigate the association between occupational sensitization to laboratory animals and clinical outcomes.

Methods

This was a cross-sectional study performed at two universities on students and employees dealing with small rodents. The subjects were allocated in groups: non-sensitized, common sensitization or occupational sensitization, according to the results of the skin prick test (SPT). All subjects answered a questionnaire about animal exposures, symptoms, allergic diseases, and underwent spirometry and bronchial challenge test with mannitol. Multivariate analysis was performed by using Poisson regression to estimate the prevalence ratio (PR).

Results

Data from 453 volunteers were analyzed. Non-sensitized group comprised 237 subjects; common sensitization group, 142 subjects; and occupational sensitization group, 74 subjects. Occupational sensitization was associated with greater risk for all outcomes studied. When the common sensitization group was reference, skin symptoms had PR of 1.36; 95% confidence interval (CI): 1.01-1.85; wheezing had PR of 1.75; CI 95%: 1.21-2.53; rhinitis had PR of 1.25; 95%: 1.11-1.40; nocturnal dyspnea had PR of 2.40; 95% CI: 1.31-4.40; bronchial hyperresponsiveness had PR of 2.47; 95% CI: 1.50-4.09; and confirmed asthma had PR of 2.65; 95% CI: 1.45-4.85. In addition, the overlap of asthma, rhinitis and skin symptoms in a same subject was significantly more prevalent in the occupational sensitization group, 16.2% versus 4.9% in the common sensitization group.

Conclusion and Clinical Relevance

Occupational sensitization is associated with allergic symptoms and respiratory diseases. SPT with occupational allergens along with other parameters may contribute to detection of risk for allergic and respiratory diseases associated with exposure to laboratory animals.

This article is protected by copyright. All rights reserved.

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Association between infection with H. pylori and atopy in young Ethiopian Children: a longitudinal study

Abstract

Background

Epidemiological evidence from developed countries indicates that Helicobacter pylori infection correlates with a reduced risk of atopy and allergic disorders, however limited data are available from low-income countries.

Objective

We examined associations between H. pylori infection in early childhood and atopy and reported allergic disorders at the age of 6.5 years in an Ethiopian birth cohort.

Methods

A total of 856 children (85.1% of the 1006 original singletons in a population-based birth cohort) were followed up at age six and half years. An interviewer-led questionnaire administered to mothers provided information on demographic and lifestyle variables. Questions on allergic disease symptoms were based on the International Study of Asthma and Allergies in Children (ISAAC) core allergy and environmental questionnaire. Serum samples were analysed for total IgE levels and anti-H. pylori cytotoxin associated gene A (CagA) IgG antibody using commercially available ELISA kits. Stool samples were analysed for H. pylori antigen using a rapid immunochromatographic test. The independent effects of H. pylori infection (measured at age 3, 5 and 6.5 years) on prevalence and incidence of atopy and reported allergic disorders (measured at age 6.5 years) were determined using multiple logistic regression.

Results

In cross-sectional analysis, current H. pylori infection at age 6.5 years was inversely, though not significantly, related to prevalence of atopy and 'any allergic condition' at age 6.5 years. However detection of H. pylori infection at any point up to age 6.5 years was associated with a significantly reduced odds of both atopy and 'any allergic condition' (adjusted OR AOR, 95% CI, 0.54; 0.32 to 0.92, p=0.02, and 0.31; 0.10 to 0.94, p=0.04, respectively). In longitudinal analyses, H. pylori infection at age 3 was inversely associated with incidence of atopy (AOR, 95% CI, 0.49; 0.27 to 0.89, p=0.02). Furthermore, among H. pylori infected children, those with a CagA+ strain had a more pronounced reduction in odds of atopy (AOR=0.35 vs. 0.63 for CagA+ vs. CagA-) and this reduction reached borderline significance.

Conclusion

These data are consistent with the hypothesis that early exposure to H. pylori is inversely associated with atopy and allergic conditions. A possible modest protective association against atopy was observed in those infected with a more virulent CagA+ strain of H. pylori.

This article is protected by copyright. All rights reserved.

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Specialist Peri-Operative Allergy Clinic Services in the UK 2016: Results from the Royal College of Anaesthetists Sixth National Audit Project (NAP6)

Abstract

Background

Guidelines for investigation of perioperative drug allergy exist, but the quality of services is unknown. Specialist perioperative anaphylaxis services were surveyed through the Royal College of Anaesthetists 6^th National Audit Project.

Objectives

We compare self-declared UK practice in specialist perioperative allergy services with national recommendations.

Methods

A SurveyMonkey^™ questionnaire was distributed to providers of allergy services in the UK. Responses were assessed for adherence to the best practice recommendations of the British Society for Allergy and Clinical Immunology, the Association of Anaesthetists of Great Britain and Ireland and the National Institute for Health and Care Excellence (NICE) Guidance on Drug Allergy - CG183.

Results

Over 1200 patients were evaluated in 44 centres annually. Variation in workload, waiting times, access, staffing and diagnostic approach was noted. Paediatric centres had the longest routine waiting times (most wait >13 weeks) in contrast to adult centres (most wait <12 weeks). Service leads are allergists/immunologists (91%) or anaesthetists (7%).

Potentially important differences were seen in: testing repertoire [10/44 (23%) lacked BSACI compliant NMBA panels and 17/44 (39%) lacked a NAP6-defined extended panel; many failed to screen all cases for chlorhexidine 19/44 (43%) or latex 21/44 (48%)], staffing [only 26/44 (59%) had specialist nurses and 18/44 (41%) an anaesthetist], and provision of information [18/44 (41%) gave immediate information in clinic, and 5/44 (11%) on support groups].

Most centres were able to provide diagnostic challenges to antibiotics [40/44 (91%]) and local anaesthetics [41/44 (93%)].

Conclusions and Clinical Relevance

Diagnostic testing is not harmonised, with marked variability in the NMBA panels used to identify safe alternatives. Chlorhexidine and latex are not part of routine testing in many centres.

Poor access to services and patient information provision require attention. Harmonisation of diagnostic approach is desirable, particularly with regard to a minimum NMBA panel for identification of safe alternatives.

This article is protected by copyright. All rights reserved.

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Application of a newly designed mandibular distraction device for navigation surgery in goats

This animal study is to investigate the accuracy of navigation-guided mandibular distraction osteogenesis with a special designed distraction device by TBNavis-CMFS navigation system.

http://ift.tt/2vCVqjf

International Journal of Otolaryngology and Head & Neck Surgery Vol.6,No.4 (July 2017)

Parathyroid Embryology, Anatomy, and Pathophysiology of Primary Hyperparathyroidism
Parathyroid Anatomy, Parathyroid Histology, Parathyroid Pathophysiology
Paper Information Full Paper: PDF (Size:426KB)
DOI: 10.4236/ijohns.2017.64007

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Re: Current thinking about the management of dysfunction of the temporomandibular joint: a review

I was pleased to read this excellent summary,1 as it offers structured guidance for the management of disorders of the temporomandibular joint (TMJ), which are sometimes difficult to treat. I agree that there is a lack of evidence for some recommended treatments and, as a result, an evidence-based approach is difficult.

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Characteristics of severe asthma with fungal sensitization

Some patients with severe asthma also have fungal sensitization and are considered to have severe asthma with fungal sensitization. However, there is limited information on the clinical features of SAFS.

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Allergens displayed on Virus-Like Particles are highly immunogenic but fail to activate human mast cells

Abstract

The goal of allergen-specific immunotherapy is the induction of protective immune responses in the absence of anaphylactic reactions. We have previously shown that Fel d 1, the major cat allergen, displayed in a repetitive fashion on virus-like particles (VLPs) may fulfill these criteria. Specifically, Fel d 1 on VLPs induced strongly increased IgG responses compared to the free allergen in mice while anaphylactic reactions were essentially abolished. Here we extend these findings to human mast cells and offer a mechanistic explanation for the reduced anaphylactic activity. By performing allergen binding studies and cellular activation assays, we demonstrate that the inability of Fel d 1 displayed on VLPs to activate mast cells is based on a biophysical as well as a biochemical mechanism. Firstly, Fel d 1 on VLPs showed a strongly impaired ability to bind to surface-bound IgE as assessed by Surface Plasmon Resonance (SPR) as well as flow cytometry. Secondly, despite residual binding, repetitively displayed allergen on VLPs failed to cause mast cell activation.

These findings indicate that repetitively displaying allergens on VLPs increases their immunogenicity while reducing their potential to cause anaphylactic reactions by essentially eliminating IgE-mediated activation of mast cells.

This article is protected by copyright. All rights reserved.

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Doctors Say Info From Pharma Reps Is Stale

A physician survey suggests that as doctors get more information online, drug reps are falling behind in their sales pitches.
Medscape Medical News

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The utilization of round window membrane surface tension in facilitating slim electrodes insertion during cochlear implantation

Abstract

This is a prospective randomized study aimed to evaluate the round window membrane (RWM) surface tension in facilitating slim electrodes insertion during cochlear implantation. A total number of (118) children were included in this study (118 implantations). Mean age was 36.72 months (range from 18 to 60 months). This study was conducted from January 2015 to September 2016 at a cochlear implant centre in a tertiary referral hospital. Slit incision in the anterosuperior quadrant of the RWM was done in 70 cases, While RWM cruciate incision was done in 48 cases. Of the 48 patients who underwent RWM cruciate incision, 13 cases had no problem, while in 35 cases, we faced difficult insertion. When slit incision of the RWM was done (70 cases), 68 cases showed smooth insertion, meanwhile, we faced increased operative time due to flopping of the electrode in 2 cases only. Moreover, residual low-frequency hearing preservation was more achieved when slit incision of the RWM was done. Tensile strength of the round window membrane after slit incision of the RWM offers support to slim electrodes during introduction, decreasing incidence of kinking and floppiness, hence shortening the maneuver time and minimizing the number of trials. This facilitates easy smooth slim electrodes introduction, decreasing intracochlear trauma. Moreover, slit incision of the RWM may offer better residual hearing preservations than cruciate incision of the RWM during slim electrodes introduction.

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Evidence-based medicine in plastic surgery

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Effects of transcutaneous electrical stimulation on vocal folds adduction

Abstract

According to most previous studies, inducing movements in internal laryngeal muscles by transcutaneous electrical stimulation (TES) was impossible. However, the movements have been reported after using needle electrodes inserted into the internal superior laryngeal nerve (ISLN). Herein, we aimed to apply an innovative TES protocol to cause movements in vocal folds. A short duration and high frequency electrical current was applied by two surface electrodes just above the entrance of ISLN to larynx. The subjects were 32 normal participants (mean age = 23.87; SD = 3.43). During TES application, the vocal folds' movements were examined by flexible videonasolaryngoscopy. Statistical paired t test was used to analyze the differences of vocal folds opening angle, in degrees, during rest and TES periods. Furthermore, the movements were judged by seven experienced speech pathologists via a 9-point rate scale from −1 (any abduction) to 8 (complete adduction). The mean vocal folds adduction increased by 35.68° (t = 9.35, p > 0.001) due to TES application. The mean qualitative scores assigned by raters to each subject were between 6 and 7 points, which indicate an acceptable adduction in vocal folds through TES. Unlike previous studies, the applied TES protocol in this research induced significant vocal fold movements. This might be attributed to our different stimulation parameters, which were designed to penetrate deeply and stimulate ISLN specifically. It is worth noting that we introduced a novel TES protocol, which should be confirmed and then examined as a complementary therapy for neurologic voice disorders in future studies.

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‘Conservative’ approach to periocular necrotising fasciitis with paranasal sinus involvement

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Letter to the editor on “The therapeutic effect of thymoquinone on acoustic trauma-induced hearing loss in rats”

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Erratum to: Exercise induced laryngeal obstruction: a review of diagnosis and management

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Reply to the letter to the editor concerning: “The therapeutic effect of thymoquinone on acoustic trauma-induced hearing loss in rats”

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Safety of flexible endoscopic biopsy of the pharynx and larynx under topical anesthesia

Abstract

Recent advancements in transnasal endoscopy enable a shift in diagnostic workup of lesions in the pharynx and larynx, from an examination with biopsy under general anesthesia to an office-based examination with flexible endoscopic biopsy under topical anesthesia. Procedural complications were evaluated to assess the safety of office-based flexible endoscopic biopsy in patients with benign and malignant laryngopharyngeal lesions. Patients who underwent flexible endoscopic biopsy from 2012 to 2016 were evaluated retrospectively. Complications were classified using the Clavien–Dindo classification of surgical complications. A total of 201 flexible endoscopic biopsies were performed in 187 patients. Two Clavien–Dindo grade I (laryngospasm and anterior epistaxis), one grade II (laryngeal bleeding), and one grade IIIb (laryngeal edema) complication were observed. The first complication was self-limiting and the other three required an intervention. All patients fully recovered without sequelae. Flexible endoscopic biopsy appears to be a safe office-based procedure for the diagnosis of benign and malignant laryngopharyngeal lesions.

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Response to letter to the editor: “is drug induced sedation endoscopy surgical decision making process objective and systematic?”

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The clinical outcomes of using a new cross-linked hyaluronan gel in endoscopic frontal sinus surgery

Abstract

In endoscopic sinus surgery (ESS) synechiae formation and ostial stenosis are frequently encountered. This is not uncommon after frontal recess and ostium interventions due to the narrow recess and difficult anatomy of the region. The goal of this study is to evaluate the efficacy of the new cross-linked hyaluronan gel—PureRegen^® Gel Sinus—on wound healing and synechiae prevention in endoscopic frontal sinus surgery. The study consists of two groups of patients who underwent ESS, including frontal sinus surgery. In the study group of 37 patients, PureRegen^® Gel Sinus was applied to both the frontal recess and ostium at the end of the procedure. The control group consisted of 28 patients. In this group, nasal dressing material was not applied at the end of surgery—neither to the frontal recess nor to the ostium. Postoperatively, epithelization was found to be significantly better at 2 and 4 weeks in the study group when compared with the findings in patients where no postoperative dressing was applied. In the eighth week, there was no significant difference found between the two groups in terms of epithelization. Synechiae formation was significantly lower in the PureRegen^® Gel Sinus group than the control group at all 2, 4 and 8 weeks postoperative evaluations. The effects of PureRegen^® Gel Sinus on wound healing, especially in reepithelization, have shown to occur earlier in the postoperative period. Rapid reepithelization and control of infection related granulation tissue formation with antibiotics in the early postoperative period may explain the low stenosis rate in frontal sinus ostia in PureRegen^® Gel Sinus applied patients.

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Comparing the outcome of tympanoplasties using bovine pericardium underlay xenografts versus butterfly inlay autografts

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Butterfly cartilage tympanoplasty: an alternative new technique instead of conventional surgery method

Abstract

Butterfly graft inlay tympanoplasty is a well-established technique for the repair of small- and medium-sized perforations. There are some difficulties with application of conventional butterfly technique and it affects our success rate of graft healing. With some modifications of graft preparation we can make better success rates. The aim of this study was to present the new renovation of conventional method, describe about what kind of changes we made and its technical facilities about the procedure. The study design is a prospective case series. This study was carried out on 18 patients who underwent inlay butterfly cartilage tympanoplasty with the new technique for anterior and inferior perforations at an otolaryngology department of a tertiary medical center between November 2015 and August 2016. Patients were followed with otoscopy and audiometry, and graft healing's success. Anatomic closure at 6th month after tympanoplasty was found in all 18 patients. There was no incidence of cartilage graft rejection or displacement. Preoperative mean PTA was 27.7 dB, which improved 6 months after surgery to 10.5 dB (the average value of hearing thresholds at 0.5, 1, 2 and 4 kHz). Butterfly cartilage tympanoplasty technique is safe and efficient in terms of both anatomical closure of the defect and improvement in hearing. We believe with this new technique, we facilitate this procedure in addition to the improvement of patients' comfort and decrease the morbidity of the procedure.

http://ift.tt/2fqdsyo

Functional outcomes of endoscopic arytenoid abduction lateropexy for unilateral vocal cord paralysis with dyspnea

Abstract

In unilateral vocal cord paralysis (UVCP), hoarseness is usually the leading symptom; however, the diminished airway might lead to breathing problems as well, especially with exertion. The application of the classic resection glottis enlarging or medialization procedures might shift the breathing and/or the voice to a worse condition. The non-destructive endoscopic arytenoid abduction lateropexy (EAAL) might be a solution for this problem. The aim of our study was to analyze the phonatory and respiratory outcomes of this treatment concept. The first year phoniatric [Jitter, Shimmer, harmonics-to-noise ratio (HNR), maximum phonation time (MPT), fundamental frequency (F ₀), Voice Handicap Index (VHI), Dysphonia Severity Index (DSI), Global-Roughness-Breathiness scale (GRB)], peak inspiratory flow (PIF), and quality of life (QoL) were evaluated in ten UVCP patients treated by EAAL for dyspnea generally presented on exertion. PIF, Jitter, QoL, GRB, and VHI significantly improved. DSI, HNR, and MPT got non-significantly better. F ₀ slightly increased in all patients, a mild deterioration of shimmer was observed. These results prove that improving respiratory function is not necessarily associated with a deterioration in voice quality. The EAAL provides a significant improvement in breathing and the vibratory parameters of the postoperative, more tensed and straightened vocal cords proved to be more advantageous than the original (para) median 'loose' position. The over-adduction of the contralateral side more or less compensates for the disadvantageous, more lateral position of the operated side. EAAL might be an alternative treatment for unilateral vocal cord paralysis associated with breathing problems.

http://ift.tt/2vgquUK

Identification of a novel mutation in PEX10 in a patient with attenuated Zellweger spectrum disorder: a case report

The peroxisome biogenesis disorders, which are caused by mutations in any of 13 different PEX genes, include the Zellweger spectrum disorders. Severe defects in one of these PEX genes result in the absence of fun...

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Application of a newly designed mandibular distraction device for navigation surgery in goats

Publication date: Available online 8 August 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Ming Cai, Yang Chen, Xiaofeng Lu, Lei Xu, Xudong Wang, Guofang Shen
PurposeThis animal study is to investigate the accuracy of navigation-guided mandibular distraction osteogenesis with a special designed distraction device by TBNavis-CMFS navigation system.Materials and methodsFour goats were included in this study. The 3D simulation unilateral mandibular distraction osteogenesis was simulated for 14mm lengthening in TBNavis-CMFS navigation system. A new designed mandibular distraction device with the detachable adaptor for navigation surgery in combination with the specific mandibular dynamic reference frame was applied. Navigation guided distraction osteogenesis was performed on goats and mandible was gradually distracted according to the simulation. Postsurgical 3-D skeletal measurements of presurgical simulations and postsurgical outcomes were compared statistically.ResultsNavigation assisted distraction osteogenesis was successfully performed and the new designed distraction devices worked uneventful. The accuracy of intra-operative registration was within 1 mm. The mandible was lengthened for 14.25mm in average (13.87 to 14.36mm). There were no significant differences between simulation distraction and post-operative 3-D measurements (p>0.05).ConclustionsA new designed distraction device could be used in navigation guided mandibular distraction osteogenesis on goats with high accuracy by using the TBNavis-CMFS navigation system.



http://ift.tt/2wrxCMz

Cementoblastoma: an updated analysis of 258 cases reported in the literature

Publication date: Available online 8 August 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Bruno Ramos Chrcanovic, Ricardo Santiago Gomez
PurposeTo investigate the recurrence rate of cementoblastomas for different variables aside from the clinical/radiologic features.MethodsAn electronic search was undertaken in November/2016. Eligibility criteria included publications having enough clinical/radiological/histological information to confirm the diagnosis.Results141 publications (258 cementoblastomas) were included. There was an equal sex distribution. There was a high prevalence in the second/third decades of life, in the posterior regions, and in mandibular first molars. Lesions were commonly associated with bone expansion (74.9%), presence of clinical symptoms (70.2%), vital teeth (78%), root resorption (59.8%). Observations not as frequent: cortical bone perforation (16.3%), inferior displacement of the mandibular canal (23.6%). Treatment was reported for 229 cases. Twenty (11.8%) out of 170 recurred. Preservation of the involved teeth and location seem to not influence the recurrence rate, but there was a 687% higher probability (odds ratio 7.875; p=0.048) of recurrence for lesions associated with bone expansion, and a 217% higher probability (odds ratio 3.173; p=0.023) of recurrence for lesions presenting cortical bone perforation.ConclusionsAlthough the recurrence rate of cementoblastomas is not as high as previously believed, it is a relevant phenomenon (11.8%). The presence of bone expansion and cortical bone perforation seem to influence the recurrence rate.



http://ift.tt/2vgYoJ5

Thyrotropin Suppressive Therapy for Low-Risk Small Thyroid Cancer: A Propensity Score–Matched Cohort Study

Thyroid , Vol. 0, No. 0.


http://ift.tt/2vjn2r3

Prognostic value of pathologic grade for patients with oral squamous cell carcinoma

Abstract

Objective

The purposes of this study were to explore both the prognostic value of pathologic grade and the relationships between differentiation and clinicopathological characteristics in oral squamous cell carcinoma.

Methods

This retrospective cohort study included the records of 2036 patients with oral squamous cell carcinoma who were surgically treated from June 1999 to December 2011. Chi square test, Kaplan-Meier analysis and Cox proportional-hazards regression model were performed for statistical analysis.

Results

Many clinicopathological characteristics were associated with pathologic grade. Kaplan-Meier analysis showed that well-differentiated tumors had a better prognosis than the other two grades. Cox regression model showed that differentiation was an independent risk factor for prognosis in patients with early stage, but not with advanced stage. The predictive abilities of pathologic grade, T stage, N status and lymph node ratio were similar, but the presence of extracapsular spread and perineural invasion were stronger prognostic factors than pathologic differentiation.

Conclusions

Pathologic grade was found to be an independent risk factor for early stage oral squamous cell carcinoma, but not for advanced stage. Many important clinicopathological characteristics were associated with histological classification; however, its prognostic value was limited.

This article is protected by copyright. All rights reserved.

http://ift.tt/2ummqj9

Phénomène de Renbök vs phénomène de Flow

Publication date: Available online 7 August 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): D. Lipsker




http://ift.tt/2vMllFF

Hypoplasie dermique focale (syndrome de Goltz) associée à une bicuspidie de l’aorte

Publication date: Available online 7 August 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): F. Belarbi, S. Amal, N. Akhdari, S. Amouzoune, A. Belbachir, H. Rais, O. Hocar




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Carcinome épidermoïde associé à une dépigmentation volontaire

Publication date: Available online 8 August 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): O. Faye, A.-A. Dicko, S. Berthé, L. Cissé, B. Traoré, A. Keita, Y. Fofana, K. Coulibaly, B. Keita
IntroductionL'utilisation de produits dépigmentants à visée cosmétique est largement répandue chez les femmes d'Afrique subsaharienne. De nombreuses complications (cutanées et systémiques) associées à cette pratique ont pourtant été décrites. La survenue de carcinomes épidermoïdes a longtemps été évoquée mais rarement rapportée, puisque seules trois observations ont été publiées. Nous en décrivons le premier cas observé au Mali.ObservationUne femme de 30 ans, sans antécédent pathologique notable, consultait pour une ulcération du cou évoluant depuis 5 ans. Elle utilisait des produits cosmétiques à base d'hydroquinone et de corticoïdes depuis environ 10 ans. À l'examen clinique, elle avait une large ulcération localisée à la face latérale gauche du cou. Les sérologiques des hépatites virales et du VIH étaient négatives. Le diagnostic de carcinome épidermoïde était confirmé par l'examen histopathologique. Une exérèse chirurgicale de la lésion était effectuée ; elle était suivie d'une récidive locale précoce trois mois plus tard, nécessitant une reprise chirurgicale.DiscussionLa prévalence élevée de l'usage des produits cosmétiques dépigmentants contraste avec la rareté du carcinome épidermoïde sur terrain dépigmenté. Toutefois, le délai de survenue d'une telle complication et le nombre croissant des cas rapportés doivent inciter les praticiens à promouvoir la prévention par des messages éducatifs, l'usage de filtres solaires et la biopsie systématique de toute ulcération chez les femmes employant des produits dépigmentants, en particulier lorsqu'il s'agit d'une localisation cervicale.BackgroundWomen widely use skin-lightening products for cosmetic purposes in sub-Saharan Africa despite numerous reported cutaneous and systemic complications. The occurrence of epidermoid carcinoma has long been reported, but only three cases have been published so far. We report the first case in Mali.Patients and methodsA 30-year old woman with no noteworthy medical history was seen at our outpatient center for cervical ulceration that had been present for the last 5 years. She had used cosmetic bleaching cream over a period of around ten years. Physical examination revealed extensive ulceration on the left side of her neck. Blood tests for viral hepatitis and human immunodeficiency virus were negative. The pathological examination of the skin biopsy confirmed the diagnosis of squamous cell carcinoma. After failure of the initial excision with early relapse, multiple surgical ablations were performed 3 months later.DiscussionThe high prevalence of skin-lightening cosmetic use contrasts with the rarity of epidermoid carcinoma in depigmented skin. However, a large chronic ulcer on uncovered parts of the upper body, particularly the neck, should prompt physicians to consider skin cancer. Appropriate preventive measures include the promotion of educational messages for the general population, the use of sun-protection devices, and routine skin biopsy for all women presenting chronic cervical ulceration after long-term use of skin-lightening products.



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Editorial Board/Aims & Scope

Publication date: September 2017
Source:Oral Oncology, Volume 72





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Paradigm shifts in staging of thyroid cancer

Publication date: September 2017
Source:Oral Oncology, Volume 72
Author(s): Ashok R. Shaha




http://ift.tt/2vLZGNS

Basal cell adenocarcinoma of the skull base: A diagnostic challenge

Publication date: September 2017
Source:Oral Oncology, Volume 72
Author(s): Zachary A. Zimmerman, John Shapiro, C. Arturo Solares, Paul Biddinger, James K. Byrd




http://ift.tt/2wEYXu1

Validation and comparison of the 7th and 8th edition of AJCC staging systems for non-metastatic nasopharyngeal carcinoma, and proposed staging systems from Hong Kong, Guangzhou, and Guangxi

Publication date: September 2017
Source:Oral Oncology, Volume 72
Author(s): Pu-Yun OuYang, Yao Xiao, Kai-Yun You, Lu-Ning Zhang, Xiao-Wen Lan, Xiao-Min Zhang, Fang-Yun Xie
ObjectivesWe aimed to validate and compare the 7th and 8th edition of AJCC staging systems for non-metastatic nasopharyngeal carcinoma, and proposed staging systems from Hong Kong, Guangzhou, and Guangxi.Materials and methodsWe retrospectively included 899 patients treated between November 5, 2002 and May 27, 2010. Separation and discrimination of each staging system in overall survival were primarily compared.ResultsCompared with the 7th AJCC, the 8th AJCC and all proposed staging systems well separated across T-classification. T-classification from Guangzhou seemed to perform best in discrimination (C-index 0.6454), followed by the 8th AJCC (0.6451), the 7th AJCC (0.6386), Hong Kong (0.6376) and Guangxi (0.5889). For N-classification, no staging systems improved the weakness of the 7th AJCC in separating N2 and N1, except that suggestion from Guangzhou showed higher potential (P=0.096). Besides, N-classification from Guangzhou had a C-index of 0.6444, larger than that of the 8th AJCC (0.6235), the 7th AJCC (0.6179), Hong Kong (0.6175) and Guangxi (0.6175). Accordingly, stage group of staging system from Guangzhou showed higher discrimination (C-index 0.6839), compared with the 8th AJCC (0.6791), the 7th AJCC (0.6766), Hong Kong (0.6765) and Guangxi (0.6688), despite that stage I and II remained inseparable (P=0.322).ConclusionsThe 8th AJCC staging system appeared to be better than the 7th AJCC. But the proposed staging system from Guangzhou was more likely to improve the separation and discrimination abilities.



http://ift.tt/2vLZFti

Corrigendum to “Orthotopic non-metastatic and metastatic oral cancer mouse models” [Oral Oncol. 51(5) (2015) 476–482]

Publication date: September 2017
Source:Oral Oncology, Volume 72
Author(s): Manish V. Bais, Maria Kukuruzinska, Philip C. Trackman




http://ift.tt/2wEJJVV

Evaluation of the Xpert® HPV assay in the detection of Human Papillomavirus in formalin-fixed paraffin-embedded oropharyngeal carcinomas

Publication date: September 2017
Source:Oral Oncology, Volume 72
Author(s): Maria Gabriella Donà, Francesca Rollo, Barbara Pichi, Giuseppe Spriano, Raul Pellini, Renato Covello, Edoardo Pescarmona, Giulia Fabbri, Manuela Scalfari, Tarik Gheit, Maria Benevolo
ObjectivesThe increasing incidence of HPV-related Oropharyngeal Squamous Cell Carcinoma (OPSCC) and the improved survival of HPV-positive OPSCC highlight the need for effective tools in evaluating HPV status on formalin-fixed paraffin-embedded (FFPE) cancers. To date, there is no agreement regarding the most appropriate method for HPV testing on FFPE materials. We aimed to investigate the performance of the Xpert® HPV assay (Cepheid) on crude lysates from OPSCC FFPE tissues.Materials and methodsCrude lysates were obtained by proteinase K digestion of FFPE tissues that had already been analyzed by the INNO-LiPA HPV assay and p16^ink4a immunostaining.Results159 FFPE OPSCCs were evaluated. All the samples provided valid results with the Xpert, whereas three samples (1.8%) were invalid using the INNO-LiPA. Among the remaining 156 cases, 65 (41.7%) were concordantly positive and 87 (55.8%) concordantly negative (raw agreement 0.97, 95% CI: 0.93–0.99; Cohen K 0.95, 95% CI: 0.90–0.99). Type-specific data for the cases that were positive by both methods were completely concordant. Three samples were HPV16-positive with Xpert but negative with INNO-LiPA, while one OPSCC tested negative with Xpert and positive with INNO-LiPA. A very good agreement was observed between the Xpert and the p16 results, which was slightly higher than that for INNO-LiPA (Cohen K 0.87vs. 0.85).ConclusionThe Xpert HPV assay appears to be a very good method for HPV detection and genotyping on FFPE OPSCCs, and requires no prior purification of nucleic acids. This assay showed a very good agreement with INNO-LiPA and p16 findings.



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Mast cells are critical for the limitation of thrombin-induced skin inflammation

Abstract

Thrombin, a key player in coagulation, is widely held to induce and promote inflammation. As of now, the features, kinetics, and control of thrombin's proinflammatory effects on the skin remain to be characterized in detail. We, therefore, injected thrombin into the ear skin of mice and observed strong, dose-dependent, and transient ear swelling responses as well as mast cell degranulation. Unexpectedly, thrombin induced even stronger, not reduced, ear swelling in mast cell-deficient Kit^W-sh/W-sh mice. Prior local reconstitution of Kit^W-sh/W-sh mice with mast cells inhibited this effect, indicating that mast cells may contribute to the control of thrombin-induced skin inflammation. In line with previous studies we found that mast cells express the thrombin receptors PAR1, PAR3 and PAR4, thrombin induces direct and dose-dependent mast cell degranulation and that degranulated mast cells inactivate thrombin. Further findings suggested that MC-mediated protection from thrombin-induced inflammation is likely to rely on the effects of mast cell proteases. We show for the first time, that mast cell-deficient mice and mast cell protease 4-deficient mice with normal numbers of MCs show markedly increased ear swelling in response to thrombin as compared to wild type mice. Taken together, these results suggest that thrombin-induced skin inflammation is controlled, in part, by mast cell protease 4 released from activated mast cells. For MC-driven diseases such as chronic spontaneous urticaria, which has been linked to increased thrombin generation, this might mean that MCs may contribute to the resolution of skin inflammatory responses.

This article is protected by copyright. All rights reserved.

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Twisted intra-abdominal cyst in a neonate: a surprise revelation

We, herein, present a male neonate with an antenatally detected intra-abdominal cyst who presented at 18 days of life at which time, the ultrasound revealed a 5x4 cm cyst. Since he was asymptomatic, we planned to repeat the ultrasound a month later and operate if the cyst showed no regression. However, a week later, he presented with an acute abdomen, irritable cry and a repeat ultrasound showing a larger (8x6 cm) cystic mass with debris within. He was taken up for an emergency laparotomy. Intraoperatively, the cyst was found arising from the left lateral abdominal wall free from all structures with a twisted pedicle. Histopathology surprisingly revealed seminiferous tubules within the cyst wall with the vas deferens, thus confirming the diagnosis of a torsion of intra-abdominal testis. Hence, we emphasise the importance of examining for an undescended testis when dealing with a male neonate presenting with a cystic intra-abdominal mass.

http://ift.tt/2ul5MAk

Staged retroperitoneal mesenteric revascularisation and aortobifemoral bypass after endovascular rescue for acute mesenteric ischaemia

Visceral artery revascularisation through a retroperitoneal approach provides an infrequent yet viable, alternative means of managing mesenteric ischaemia in patients with previous abdominal operations. We present a unique case implementing this surgical approach in a 55-year-old man in which we performed a retroperitoneal aortobifemoral bypass with concomitant retrograde jump graft from the aortic prosthesis to the superior mesenteric artery (SMA) for bilateral lower extremity rest pain and chronic mesenteric ischaemia. Three months previously, the patient had presented with acute mesenteric ischaemia and colonic perforation. He underwent emergent celiac artery stenting followed by an exploratory laparotomy with total abdominal colectomy and diverting loop ileostomy. Given the patient's hostile abdomen, a retroperitoneal approach to SMA revascularisation was elected over a transabdominal approach during concomitant lower extremity revascularisation for critical limb ischaemia. We achieved an excellent technical result with resolution of limb ischaemia and abdominal symptoms.

http://ift.tt/2vJlNn8

Effect analysis of intradermal hyaluronic acid injection to treat enlarged facial pores

Summary

Objective

To investigate the clinical application and efficacy of intradermal injection of low molecular weight hyaluronic acid (LMW-HA) for treating enlarged facial pores.

Methods

From January 2015 to May 2016, 42 subjects who sought aesthetic treatment underwent intradermal injection of LMW-HA to improve enlarged facial pores. For each treatment, 2.5 mL (25 mg) of LMW-HA was injected into the skin of the full face. The treatment was repeated 2-5 times with an interval of 1 to 1.5 months between consecutive treatments. The postoperative follow-up period was 1 to 6 months. Statistical analysis was used to compare the degree of enlargement of facial pores before and after injection. The clinical efficacy and adverse effects were recorded.

Results

The enlarged facial pores before and after treatment were categorized and subjected to the Wilcoxon matched-pairs signed-rank test. The difference was statistically significant (P<.01). The improvement rate was 40.03±18.41%. No infection, nodules, or pigmentation was reported at the injection sites in the subjects who sought aesthetic treatment. The overall satisfaction rate was 92.8%.

Conclusion

Intradermal injection of LMW-HA can significantly improve skin texture, reduce pore size, and enhance skin radiance. The injection technique was simple, safe, and effective and could easily be extended to clinical practice.

http://ift.tt/2vJqjSA

Oral supplementation with specific bioactive collagen peptides improves nail growth and reduces symptoms of brittle nails

Summary

Background

Brittle nail syndrome is a common problem among women and refers to nails that exhibit surface roughness, raggedness, and peeling.

Aim

The goal of this study was to investigate whether daily oral supplementation with collagen peptides alleviates the symptoms of brittle nails and improves nail growth rate.

Methods

In this open-label, single-center trial, 25 participants took 2.5 g of specific bioactive collagen peptides (BCP, VERISOL^®) once daily for 24 weeks followed by a 4-week off-therapy period. Nail growth rate and the frequency of cracked and/or chipped nails as well as an evaluation of symptoms and global clinical improvement score of brittle nails were assessed by a physician during treatment and 4 weeks after discontinuation.

Results

Bioactive collagen peptides treatment promoted an increase of 12% nail growth rate and a decrease of 42% in the frequency of broken nails. Additionally, 64% of participants achieved a global clinical improvement in brittle nails, and 88% of participants experienced an improvement 4 weeks post-treatment. The majority of participants (80%) agreed that the use of BCP improved their nails' appearance, and were completely satisfied with the performance of the treatment.

Conclusions

This study demonstrated that the daily ingestion of BCP increased nail growth and improved brittle nails in conjunction with a notable decrease in the frequency of broken nails.

http://ift.tt/2ukUkVf

Pediatric Angioedema

Abstract

Purpose of Review

The aims of this study are to update the clinician on current understanding of angioedema as it presents in the pediatric population and to review proper diagnostic techniques and treatment modalities for various types of angioedema.

Recent Findings

Angioedema is still best classified by whether it is likely histaminergic or kinin-mediated. New guidelines have been published around the world to help diagnose and treat both forms (urticaria/angioedema and hereditary angioedema). The vast majority of the studies on treatment have been conducted in the adult population; however, there are data available in the pediatric population. In the realm of hereditary angioedema, there are multiple new therapies that have been studied in the pediatric population (down to 2 years in some studies) in recent years and offer the clinician options for treatment.

Summary

Angioedema (whether occurring with or without urticaria) is common in the pediatric population. The majority of the recent studies has been conducted in hereditary angioedema, and now, the clinician should have various options to treat all forms of angioedema. Many treatment options, especially for hereditary angioedema, are further being examined specifically in the pediatric population.

http://ift.tt/2vAwMzv

Atezolizumab bei Cisplatin-ungeeigneten Patienten mit fortgeschrittenem oder metastasiertem Urothelkarzinom

http://ift.tt/2wprkx5

Grundlagen der Krebsimmuntherapie

Zusammenfassung

Hintergrund

Tumoren können vom Immunsystem erkannt werden. Physiologische Mechanismen der immunologischen Toleranz und Ignoranz führen jedoch dazu, dass Tumoren trotzdem nicht abgestoßen werden. Der Weg von der Induktion einer Immunantwort bis zu einer Abstoßungsreaktion ist komplex und störanfällig, bildhaft dargestellt im Krebsimmunzyklus von Chen und Mellman.

Ergebnisse

Mit kontinuierlich verbesserter Methodik wurde eine Vielzahl von Antigenen unterschiedlicher Expressionsmuster identifiziert, die sich als Zielstrukturen für die Krebsimmuntherapie eignen. Es ist jetzt möglich, individuelle mutierte Neoantigene mit vertretbarem Aufwand zu identifizieren. Die therapeutische Impfung zielt ebenso wie die Checkpointblockade auf die Rekrutierung körpereigener Abwehrmechanismen. Die unzulänglichen Ergebnisse bisheriger Impfstudien werden v. a. damit erklärt, dass diese weder die Individualität der Tumor-Wirt-Interaktion noch immunologische Gegenregulation und die Durchbrechung tumoreigener Immunbarrieren in ausreichendem Maße beinhalteten. Die klinischen Erfolge der Checkpointblockade unterstreichen − wenn auch nur bei einer Subgruppe von Patienten mit nachhaltigem Effekt − das im körpereigenen Immunrepertoire liegende Potenzial.

Schlussfolgerungen

Technologische Fortschritte und eine enge Verzahnung von grundlagen- und anwendungsorientierter Forschung haben nahezu exponentiell wachsende Optionen für die Entwicklung neuer Immuntherapeutika geschaffen. Um dies nachhaltig und breit nutzen, ist es essenziell, immunologisch relevante prädiktive Biomarker zu entdecken und für den differenzierten Einsatz unterschiedlicher Immuntherapieverfahren und deren rationale Kombination auch mit nichtimmunologischen Therapien zu etablieren, um den Krebsimmunzyklus in Gang zu halten.

http://ift.tt/2vfEhLl

Versorgungsforschung in der Onkologie

Zusammenfassung

Hintergrund

Die onkologische Versorgungsforschung gewinnt zunehmend an Bedeutung. Die Rahmenbedingungen zu ihrer Durchführung verbessern sich insbesondere im Hinblick auf öffentliche Fördermöglichkeiten. Doch auch die Erwartungen an die onkologische Versorgungsforschung steigen. Ziel dieses Beitrags ist die Analyse der derzeitigen Situation in der onkologischen Versorgungsforschung und die Ableitung von zukünftigen Fragen und Aufgaben.

Ergebnisse

Bislang zeigen sich noch Defizite und Wissenslücken insbesondere im Hinblick auf sektoren- und phasenübergreifende Fragestellungen, auf die besonderen Herausforderungen personalisierter Therapien, auf psychosoziale Belastungen und Unterstützungsmöglichkeiten für Betroffene und Angehörige und hinsichtlich der besonderen Bedürfnisse vulnerabler Patientengruppen.

Schlussfolgerungen

Um ihren Aufgaben gerecht zu werden, muss die onkologische Versorgungsforschung zukünftig vermehrt interdisziplinär und partizipativ angelegt sein, damit Erkenntnisgewinn und Transferpotenzial maximiert wird. Es gilt, die zur Verfügung stehenden primären und sekundären Datenformen und -quellen zu nutzen und zu verknüpfen, um komplexe Fragestellungen beantworten zu können. Es werden zusätzliche methodische Aus‑, Fortbildungs- und Beratungsangebote für Versorgungsforscher und Kliniker entwickelt und angeboten werden müssen, um zukünftig qualitativ hochwertige onkologische Versorgungsforschung realisieren zu können.

http://ift.tt/2wpMBH9

Psychoonkologische Versorgung in Stadt und Land

Zusammenfassung

Hintergrund

Das Auftreten einer Krebserkrankung geht häufig mit psychosozialen Belastungen einher − und zwar nicht nur beim Patienten, sondern oft auch bei dessen Angehörigen. Mittlerweile gibt es eine Reihe von fachspezifischen Angeboten, die Unterstützung leisten können. Es ist jedoch unklar, ob diese ausreichend flächendeckend vorhanden sind und auch entsprechend genutzt werden.

Fragestellung

Das Ziel dieser Untersuchung war, anhand einer epidemiologischen Stichprobe mit Schwerpunkt auf dem ländlichem Raum festzustellen, ob in der Breitenversorgung noch Defizite bestehen, was ggf. Gründe dafür sind und insbesondere, wie es um die Bedürfnisse von Angehörigen bestellt ist.

Material und Methode

Die Autoren rekrutierten 585 Patienten mit Brust‑, Darm- oder Prostatakrebs sowie 488 Angehörige in 74 haus- oder fachärztlichen Praxen. Diese wurden hinsichtlich Distress, Depressivität und Ängstlichkeit sowie Inanspruchnahme von psychosozialen Angeboten befragt. Außerdem konnten sie Wünsche bezüglich Versorgungsangeboten äußern.

Ergebnisse

Von den Patienten gaben gut 2 Jahre nach Ersterkrankung 48 % erhöhten Distress an und bei 25 % bestanden Anzeichen für eine Angststörung oder depressive Störung. Die Angehörigen als Gesamtgruppe wiesen nahezu identische Belastungshäufigkeiten auf. Demgegenüber hatten nur 22 % der Patienten und 6 % der Angehörigen irgendein psychologisches Unterstützungsangebot in Anspruch genommen.

Schlussfolgerungen

Während die sozialrechtliche Beratung inzwischen bei der Mehrheit der Patienten etabliert ist, bleibt die Inanspruchnahme psychologischer Unterstützungsangebote noch verbesserungswürdig. Besonders Angehörige sollten über die ihnen zur Verfügung stehenden Möglichkeiten informiert werden.

http://ift.tt/2vfclr5

Anaphylaxis after disinfection with 2% chlorhexidine wand applicator

A 54-year-old man with end-stage renal failure attended for dialysis. Within seconds of applying 2% w/v chlorhexidine (ChloraPrep 3 mL Wand Applicator) to the skin surrounding the insertion point of his dialysis catheter (Tesio catheter), he developed pruritus, urticaria, shortness of breath, hypotension and reduced responsiveness. Treatment for anaphylaxis was initiated with rapid improvement of his symptoms, and he made a full recovery. Allergy to chlorhexidine was confirmed with skin testing, and the patient was warned against all future exposure to chlorhexidine. Subsequent dialysis without chlorhexidine was uneventful.

http://ift.tt/2ulbwd7

Cor triatriatum and stroke

Cor triatriatum sinistrum (CTS) is a congenital anomaly where the left atrium is divided into two compartments by a fibromuscular membrane. This report aims to add to the literature on a rare cardiac condition that can cause neurological morbidity. We report a case of a 19-year-old female with an infarct in the right middle cerebral artery (MCA) territory initially maintained on aspirin. Eighteen months later, she had recurrence of weakness, for which repeat transthoracic echocardiography (TTE) and re-evaluation of the first TTE demonstrated a hyperechoic membrane spanning the width of the left atrium, clinching the diagnosis of CTS. Despite anticoagulation with apixaban, she was admitted for a third stroke where she succumbed to hospital-acquired pneumonia. Among cases of CTS associated with stroke, anticoagulation and surgery were the main modes of treatment. This case has the longest follow-up and the first to demonstrate failure of antiplatelet therapy and anticoagulation.

http://ift.tt/2vJpHMC

Severe aortic complications in a patient with variant Shone's complex and bicuspid aortic valve

Description

A 47-year-old man presented with new onset exertional dyspnoea. He received a surgical repair of coarctation of the aorta (COA) at the age of 21 years and aortic root grafting with mechanical aortic valve replacement for type A aortic dissection and bicuspid aortic valve (BAV) at the age of 28 years. He had been otherwise healthy and did not follow-up with a cardiologist or surgeon after his last surgery. An echocardiogram (Echo) revealed normal left ventricular size and wall thickness, with an ejection fraction of 45%–50%. There was a parachute mitral valve (MV) (figure 1), with only one severely underdeveloped lateral papillary muscle. The mechanical aortic valve was functioning normally. There was a massively dilated distal aortic arch and proximal descending aorta with maximum dimension of up to 65 mm (figure 2). There was no Doppler evidence of recurrent COA. The CT angiogram confirmed the giant aneurysm,...

http://ift.tt/2ukJSgJ

Kaposi's sarcoma of the tonsils

Description

A 19-year-old HIV-positive man was referred to the ENT (ear, nose and throat) team with dysphagia and intermittent hearing loss. He had a CD4 count of 70 cells/mm³ (9%) and was receiving antiretroviral treatment (Raltegravir and Truvada). He had known Kaposi's sarcoma (KS) skin lesions on the neck and arms, and a left-sided level 5 neck node biopsy was positive for KS.

He gave a 2-week history of dysphagia at the level of the hyoid bone, as well as intermittent episodes of haemoptysis and haematemesis. He also described bilateral intermittent hearing loss over 2 weeks.

On examination there were large, irregular lesions on both tonsils, which clinically appeared to be KS (figure 1). There were several firm lymph nodes in the posterior triangle of the neck bilaterally and in the left supraclavicular fossa. Both tympanic membranes were dull and retracted. Flexible nasoendoscopy revealed a large adenoid...

http://ift.tt/2vJpF7s

Pediatric Angioedema

Abstract

Purpose of Review

The aims of this study are to update the clinician on current understanding of angioedema as it presents in the pediatric population and to review proper diagnostic techniques and treatment modalities for various types of angioedema.

Recent Findings

Angioedema is still best classified by whether it is likely histaminergic or kinin-mediated. New guidelines have been published around the world to help diagnose and treat both forms (urticaria/angioedema and hereditary angioedema). The vast majority of the studies on treatment have been conducted in the adult population; however, there are data available in the pediatric population. In the realm of hereditary angioedema, there are multiple new therapies that have been studied in the pediatric population (down to 2 years in some studies) in recent years and offer the clinician options for treatment.

Summary

Angioedema (whether occurring with or without urticaria) is common in the pediatric population. The majority of the recent studies has been conducted in hereditary angioedema, and now, the clinician should have various options to treat all forms of angioedema. Many treatment options, especially for hereditary angioedema, are further being examined specifically in the pediatric population.

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European dermatology forum S1-guideline on the diagnosis and treatment of sclerosing diseases of the skin, Part 2: Scleromyxedema, scleredema and nephrogenic systemic fibrosis

Abstract

The term 'sclerosing diseases of the skin' comprises specific dermatological entities which have fibrotic changes of the skin in common. These diseases mostly manifest in different clinical subtypes according to cutaneous and extracutaneous involvement and can sometimes be difficult to distinguish from each other. The present guideline focuses on characteristic clinical and histopathological features, diagnostic scores and the serum autoantibodies most useful for differential diagnosis. In addition, current strategies in the first- and advanced-line therapy of sclerosing skin diseases are addressed in detail. Part 2 of this guideline provides clinicians with an overview of the diagnosis and treatment of scleromyxedema, scleredema (of Buschke) and nephrogenic systemic sclerosis (nephrogenic fibrosing dermopathy).

http://ift.tt/2fphVBD

Survey of moniliformin in wheat- and corn-based products using a straightforward analytical method

Abstract

A straightforward analytical method was developed and validated to determine the mycotoxin moniliformin in cereal-based foods. Moniliformin is extracted with water and quantified with liquid chromatography tandem mass spectrometry, and its presence confirmed with liquid chromatography-Orbitrap-high-resolution mass spectrometry. The method was validated for flour, bread, pasta and maize samples in terms of linearity, matrix effect, recovery, repeatability and limit of quantification. Quantification was conducted by matrix-matched calibration. Positive samples were confirmed by standard addition. Recovery ranged from 77 to 114% and repeatability from 1 to 14%. The limit of quantification, defined as the lowest concentration tested at which the validation criteria of recovery and repeatability were fulfilled, was 10 μg/kg. The method was applied to 102 cereal-based food samples collected in the Netherlands and Germany. Moniliformin was not detected in bread samples. One of 22 flour samples contained moniliformin at 10.6 μg/kg. Moniliformin occurred in seven out of 25 pasta samples at levels around 10 μg/kg. Moniliformin (MON) was present in eight out of 23 maize products at levels ranging from 12 to 207 μg/kg.

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Long Standing Esophageal Perforation due to Foreign Body Impaction in Children: A Therapeutic Challenge in a Resource Limited Setting

Late presentation of foreign body impaction in the esophagus, complicated by perforation in children, has rarely been reported in the literature. Esophageal surgery is very difficult and challenging in Cameroon (a resource limited setting). We are reporting herein 2 cases of esophageal perforation in children seen very late (12 days and 40 days) after foreign body impaction, complicated with severe sepsis, who were successfully operated upon with very good results.

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Is Outpatient Thyroid Surgery for Everyone?

Thyroidectomy is a common surgical procedure. Traditionally, surgeons have performed thyroidectomy on an inpatient basis. However, consistent with current trends in surgery, some practices are transitioning thyroidectomy to an outpatient setting. Although concerns for hypocalcemia and postoperative bleeding exist regardless of surgeon experience, multiple studies demonstrate that outpatient thyroidectomy is safe in the hands of high-volume surgeons. Indeed, experienced thyroid surgeons who perform thyroidectomy in an outpatient setting experience excellent patient outcomes and reduced costs. However, outpatient thyroidectomy may not be suitable for all surgeons, hospitals, or patients. When evaluating whether to implement an outpatient thyroid program, a practice should consider a number of important factors including the team performing the procedure, the hospital, and the patient. With the appropriate staff education and experience, hospital setting, and patient selection, practices in a multitude of settings can successfully develop a safe, cost-effective outpatient thyroid program.

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Laser-Induced Choroidal Neovascularizations: Clinical Study of 3 Cases

Background: We report 3 patients with laser-induced choroidal neovascularization (CNV). Method: Retrospective, observational case series. Medical charts and photographs were reviewed. Results: Two patients with central serous chorioretinopathy who developed iatrogenic CNV after focal laser photocoagulation were treated with intravitreal ranibizumab injections. One patient with CNV secondary to thermal laser photocoagulation for diabetic macular edema was treated with photodynamic therapy (PDT). Visual improvement has been demonstrated in the patients treated with intravitreal ranibizumab injections, and their successful visual outcome was stable for more than 2 years. Stable visual acuity was also observed in the patient treated with PDT, no visual improvement was observed possibly due to the macular scar and macular ischemia. No systemic or ocular complications were detected among the 3 cases. Conclusion: To prevent a laser-induced CNV, it is critical to avoid heavy small-spot laser burns and repeated application. Patients should be monitored carefully for CNV after laser treatment. In our cases, PDT and intravitreal ranibizumab injections were effective for the treatment of laser-induced CNV.
Case Rep Ophthalmol 2017;8:429–435

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Electroencephalographic effect of age-adjusted 1 MAC desflurane and sevoflurane in young, middle-aged, and elderly patients

Abstract

Purpose

We examined the hypothesis that 1 minimum alveolar concentration (MAC) of desflurane and sevoflurane provides different depth of anesthesia.

Methods

One hundred and twenty young (20–30 years), middle-aged (31–65 years), and elderly (66–80 years) patients were randomly allocated to receive either desflurane or sevoflurane (n = 20, each group). General anesthesia was induced with propofol 2 mg/kg bolus and remifentanil 0.25 µg/kg/min, which was stopped after tracheal intubation. Maintenance of anesthesia was started with an end-tidal concentration of desflurane or sevoflurane at age-adjusted 1 MAC and maintained for 10 min, followed by 1-min assessment of bispectral index (BIS), 95% spectral edge frequency (SEF95), and amplitude of the electroencephalogram taken at 10-s intervals.

Results

BIS and SEF95 in patients receiving 1 MAC desflurane were significantly lower than those receiving 1 MAC sevoflurane including all age groups [35 (29, 39) vs. 41 (38, 49); 12.53 (10.99, 13.95) Hz vs. 14.42 (12.99, 17.17) Hz median (25, 75 percentile), respectively, P < 0.001 for both]. Both BIS and SEF95 in young patients were lower than in middle-aged and elderly patients receiving either desflurane or sevoflurane (P < 0.001 for both). There were no differences in amplitude between patients receiving desflurane and sevoflurane.

Conclusions

BIS as well as SEF95 were lower in patients receiving 1 MAC desflurane than those receiving 1 MAC sevoflurane, suggesting that desflurane provides higher depth of anesthesia than sevoflurane at 1 MAC.

http://ift.tt/2hFzeyX

Survival and laryngeal preservation tradeoff in advanced laryngeal cancer: From the otorhinolaryngology patient to the managing physician

Abstract

Background

The purpose of this study was to document the tradeoff between survival and laryngeal preservation in advanced-stage laryngeal cancer amenable to chemoradiation or total laryngectomy.

Methods

We conducted a prospective analysis based on a questionnaire completed by 209 laryngeal cancer specialists and 269 volunteers from an otorhinolaryngology clinic.

Results

Of the responders, 34.5% would not consider any decrease in survival to preserve their larynx. This percentage varied from 52% in otorhinolaryngologists to 27.3% in radiotherapists and 28.6% in volunteers (P < .001). Among the responders prepared to trade, the percentage of survival they were willing to trade to preserve their larynx varied from 5% to 100% (median 30%). On univariate analysis, 3 variables significantly affected this percentage: (1) the living status (single or not); (2) the existence of children; and (3) the study group (volunteers, radiation therapists, or otorhinolaryngologists) to whom the responders belong.

Conclusion

The significant variations noted should develop modes of practice that cater to this and stimulate further research in this field.

http://ift.tt/2vIpPfu

Opioid Medications in the Management of Chronic Abdominal Pain

Abstract

Purpose of Review

Chronic abdominal pain is a complex medical condition. The causes of chronic abdominal pain are extremely diverse ranging from chronic pancreatitis, Crohn's disease, to chronic pain with no clear etiology. Treatment of chronic abdominal pain remains a challenge in our clinical practice. While current interventions with celiac plexus blocks and pain medications provide some relief for these patients, but these treatments are typically less efficacious and limited by various adverse effects. Opioid medications are commonly used to manage chronic pain syndromes that are refectory to other pain management interventions. The potential problems related to opioids include misuse, abuse, constipation, nausea pruritus, et al. Moreover, according to the recent centers for disease (CDC) control report, opioid abuse has reached epidemic proportions in the USA (LJ P. Centers for Disease Control and Prevention. 2016) and accounted for 28,000 deaths in 2014. Rudd et al. (MMWR Morb Mortal Wkly Rep 64(50–51):1378–82, 2016) Given this current situation, it is apparent that a careful review of clinical evidences supporting the use of opioid medications is necessary to guide our treatment approaches in the management of complex chronic abdominal pain patients. This review is set out to analyze efficacy of opioid medications for chronic abdominal pain.

Recent Findings

The literature referenced was obtained via a computer search with Google Scholar, Pubmed, Medline, and EMbase. The search terms used included Opioid, Oxycodone, Buprenorphine, Morphine, Fentanyl, Oxymorphone, Hydromorphone, chronic abdominal pain, Crohn's disease, and pancreatitis. All studies were considered eligible for inclusion if they were clinical studies evaluating the efficacy of opioid medications for chronic abdominal pain. Two studies were found according to these criteria.

Summary

Chronic abdominal pain is a challenging medical condition in our daily practice. This condition often requires opioid medications when other treatments fail. This review provided very limited clinical evidence to support long-term opioid use for chronic abdominal pain. Given recent CDC report of opioid epidemic, it is prudent to use the best medical practice with appropriate evaluation of psychological comorbidities, urine drug screening, prescription drug monitor, and opioid treatment agreements to minimize adverse side effects related to opioids. Furthermore, well-designed clinical trials are needed to evaluate the effectiveness of long-term use of opioid medications, and more clinical research on which opioid medication is more effective for chronic abdominal pain.

http://ift.tt/2uBuoUB