Τρίτη 15 Αυγούστου 2017
Superficial hemangioma is better treated by topical 5-aminolevulinic followed by 595-nm pulsed dye laser therapy rather than 595-nm laser therapy alone
Abstract
The aim of this study was to compare the efficacy and adverse effects of a 595-nm pulsed dye laser therapy alone (PDL alone) with a 5-aminolevulinic (5-ALA) local application followed by a 595-nm PDL (5-ALA PDL) in the treatment of superficial hemangioma (SH). A prospectively randomized study in 181 patients with SH was carried out over a period of 24 months. One hundred and ninety-three patients were seen. One hundred and eighty-one patients with SH were enrolled, of which 165 completed final follow-up. One hundred and nineteen patients received PDL alone and 46 received 5-ALA PDL. The patients were assessed clinically and the patient's parents were given a satisfaction questionnaire. Baseline patient data (gender, lesion size, lesion site, treatment times, cure rate, and adverse reactions) were recorded and the results of the treatment of the two groups were analyzed and compared. Complete clearing of the lesion (recovery grade 4) was achieved in 44/119 (37.0%) of the PDL alone group and 31/46 (67.4%) of the 5-ALA PDL group (X 2 = 10.30, p < 0.001). Atrophic scars, hyper- and hypopigmentation occurred in both groups (X 2 = 3.32, p = 0.564). The patients' parents' satisfaction was greater in the 5-ALA PDL group. The clinical outcome of 5-ALA PDL was superior to that of PDL alone in the treatment of SH and only minor adverse events occurred in each group.
http://ift.tt/2uNRoAX
Einfach mal skypen ist nicht erlaubt
Seit April 2017 können Ärzte Videosprechstunden als EBM-Leistung über ihre KV abrechnen. Allerdings nur, wenn die Kommunikationsdienste, die sie hierfür nutzen, strenge technische Voraussetzungen erfüllen. Und genau das hat noch einen Haken: Noch gibt es auf dem Markt nur eine überschaubare Zahl von Videodiensten, die das leisten.
http://ift.tt/2fKihCT
Behandlung von Striae distensae: Viele Versprechen, kaum Beweise
Cremen, peelen oder doch lasern? Menschen, die sich an ihren Dehnungsstreifen stören, haben viele Behandlungsoptionen. Doch keines der angebotenen Verfahren konnte seine Wirksamkeit bislang mit harten Daten ausreichend belegen.
http://ift.tt/2i44Oql
Viele Muttermale im Kindesalter — Hautkrebsrisiko erhöht?
Die Zahl der Muttermale im Kindesalter korreliert offenbar mit dem Risiko, später gehäuft (atypische) Nävi zu entwickeln. Darauf weisen die Ergebnisse einer Studie hin, in der mehr als 400 Kinder von der achten bis zur elften Klasse dermatoskopisch überwacht wurden.
http://ift.tt/2i4SzKg
Fraktionierte Laser
Die Einführung der fraktionierten Lasertherapie vor beinahe 15 Jahren hat die Möglichkeiten der minimalinvasiven Gesichts- und Hautbildbehandlungen revolutioniert. Inzwischen wird die Methode fachübergreifend in vielen verschiedenen Indikationen eingesetzt.
http://ift.tt/2i4Svu0
Einmalspritzen zur Behandlung mit Botulinumtoxin Typ A
Der Trend, kleinste Mengen Botulinumtoxin Typ A (BoNT/A) zu injizieren, nimmt weiterhin zu. Herkömmliche Spritzen sind dafür nicht konzipiert worden. Neue Systeme sollen die Injektion von Mikro-Dosen erleichtern und zudem grundsätzlich für höhere Präzision sorgen.
http://ift.tt/2i3cedw
Hyaluronsäurefiller: DACH-Guideline für sicheres Arbeiten
Die Zahl der Fillerapplikationen ist in den letzten Jahren unaufhaltsam gestiegen. Mit ihrer Verbreitung mehren sich auch die Berichte über unerwünschte Nebenwirkungen. Nicht selten liegt die Ursache in einer fehlerhaften Anwendung.
http://ift.tt/2i4SI0g
Wie Spielfilme ein Vorurteil verstärken
Vom Aussehen auf den Charakter eines Menschen zu schließen, ist ein häufiger Grund für Vorurteile. Filme bedienen sich des Mittels zu dramaturgischen Zwecken, oft sind Hautkrankheiten im Spiel. Das verstärkt die Stigmatisierung von Patienten.
http://ift.tt/2i56KPq
Haben Wundinfektionen im Sommer Hochsaison?
In den warmen Sommermonaten steigt in Kliniken offenbar das Risiko für postoperative Wundinfektionen. Forscher aus den USA spekulieren daher, ob es sinnvoll sein könnte, elektive Operationen möglichst in kühlere Monate zu legen.
http://ift.tt/2fINNkZ
Laserbehandlung der Onychomykose
Es wäre doch sehr schön und recht nützlich, über eine Alternative zur langwierigen lokalen und oralen Behandlung der Nagelmykose mit ihren Problemen bei der Compliance und der Verträglichkeit zu verfügen. Mit dem Laser gibt es eine mögliche Alternative.
http://ift.tt/2fK3et4
Der Begriff der Gleichwertigkeit
Nicht jede vom Arzt erbrachte Leistung ist in der Gebührenordnung für Ärzte (GOÄ) abgebildet. § 6 Abs. 2 der GOÄ berücksichtigt diesen Aspekt und ermöglicht die Abrechnung nicht in der GOÄ enthaltener Leistungen analog gleichwertig vorhandener Positionen. Im ersten Teil des Beitrags werden allgemeine Aspekte der analogen Berechnung sowie die Abrechnung von Laseranwendungen erläutert. In der nächsten Ausgabe folgen weitere Abrechnungsbeispiele zu Unterspritzungen, photodynamischer Therapie und Hautkrebsscreening.
http://ift.tt/2i4c5q7
Die Haut als Spiegel der Seele
Der Zusammenhang zwischen Stress, psychosozialer Belastung und chronisch-entzündlichen Hauterkrankungen wird seit einigen Jahren zunehmend besser verstanden. Die Erkenntnisse tragen entscheidend zu einer optimalen Behandlung der betroffenen Patienten bei.
http://ift.tt/2wOm72c
Efficacy of fractional lasers in treating alopecia: a literature review
Abstract
Hair loss stemming from different types of alopecia, such as androgenic alopecia and alopecia areata, negatively affects over half the population and, in many circumstances, causes serious psychosocial distress. Current treatment options for alopecia, such as minoxidil, anthralin, and intralesional corticosteroids, vary efficacy and side effect profiles. It is known that low-level laser/light therapies (LLLT), or photobiomodulations, such as the US FDA-cleared HairMax Lasercomb®, He-Ne laser, and excimer laser, are relatively affordable, user-friendly, safe, and effective forms of treatment for hair loss. While less is known about the effectiveness of fractional lasers for combating hair loss, research suggests that by creating microscopic thermal injury zones, fractional lasers may cause an increase in hair growth from a wound healing process, making them potential therapeutic options for alopecia. A literature review was performed to evaluate the effectiveness of fractional lasers on hair regrowth. The specific fractional laser therapies include the 1550-nm nonablative fractional erbium-glass laser, the ablative fractional 2940-nm erbium:YAG laser, and the ablative fractional CO2 fractional laser. Additional randomized controlled trials are necessary to further evaluate the effectiveness of the lasers, as well as to establish appropriate parameters and treatment intervals.
http://ift.tt/2w8zywD
Immunological Reactivity Using Monoclonal and Polyclonal Antibodies of Autoimmune Thyroid Target Sites with Dietary Proteins
Many hypothyroid and autoimmune thyroid patients experience reactions with specific foods. Additionally, food interactions may play a role in a subset of individuals who have difficulty finding a suitable thyroid hormone dosage. Our study was designed to investigate the potential role of dietary protein immune reactivity with thyroid hormones and thyroid axis target sites. We identified immune reactivity between dietary proteins and target sites on the thyroid axis that includes thyroid hormones, thyroid receptors, enzymes, and transport proteins. We also measured immune reactivity of either target specific monoclonal or polyclonal antibodies for thyroid-stimulating hormone (TSH) receptor, 5′deiodinase, thyroid peroxidase, thyroglobulin, thyroxine-binding globulin, thyroxine, and triiodothyronine against 204 purified dietary proteins commonly consumed in cooked and raw forms. Dietary protein determinants included unmodified (raw) and modified (cooked and roasted) foods, herbs, spices, food gums, brewed beverages, and additives. There were no dietary protein immune reactions with TSH receptor, thyroid peroxidase, and thyroxine-binding globulin. However, specific antigen-antibody immune reactivity was identified with several purified food proteins with triiodothyronine, thyroxine, thyroglobulin, and 5′deiodinase. Laboratory analysis of immunological cross-reactivity between thyroid target sites and dietary proteins is the initial step necessary in determining whether dietary proteins may play a potential immunoreactive role in autoimmune thyroid disease.
http://ift.tt/2w6uxVh
SKELETAL MATERIAL FROM THE CEMETERY OF THE 19th CENTURY COPENHAGEN HOSPITAL FOR THE POOR: AUTOPSIES, SURGICAL TRAINING AND ANATOMICAL SPECIMENS
Abstract
The skeletal material of 299 individual skeletons was recovered from 78 graves in central Copenhagen in 2006. The graves were part of a temporary cemetery serving the Copenhagen Hospital for the Poor in the period 1842-1858. It is known that the hospital supplied cadavers for teaching and dissection. 52 skeletons and bones were found to have cut marks and saw marks, indicative of post-mortem surgical interventions: Dissection, autopsy, anatomical specimens and surgical practice. The material was closely examined for healing at the sawn edges and signs of diseases. It was attempted to differentiate the surgical procedures from one another and give an overview of the material and historical context. We were mostly unable to attach a specific post-mortem surgical procedure to the skeletal elements; however we present some cases that most likely represent a specific surgical intervention. An excavation of similarly processed bone material from London Hospital from the same time period was used as the main reference material. The skeletal material described here offers a view upon the medical development, teaching and training amongst surgeons and anatomists in mid-19th century.
http://ift.tt/2uH1lUF
DNA degrades during storage in formalin-fixed and paraffin-embedded tissue blocks
Abstract
Formalin-fixed paraffin-embedded (FFPE) tissue blocks are widely used to identify clinically actionable molecular alterations or perform retrospective molecular studies. Our goal was to quantify degradation of DNA occurring during mid to long-term storage of samples in usual conditions. We selected 46 FFPE samples of surgically resected carcinomas of lung, colon, and urothelial tract, of which DNA had been previously extracted. We performed a second DNA extraction on the same blocks under identical conditions after a median period of storage of 5.5 years. Quantitation of DNA by fluorimetry showed a 53% decrease in DNA quantity after storage. Quantitative PCR (qPCR) targeting KRAS exon 2 showed delayed amplification of DNA extracted after storage in all samples but one. The qPCR/fluorimetry quantification ratio decreased from 56 to 15% after storage (p < 0.001). Overall, remaining proportion of DNA analyzable by qPCR represented only 11% of the amount obtained at first extraction. Maximal length of amplifiable DNA fragments assessed with a multiplex PCR was reduced in DNA extracted from stored tissue, indicating that DNA fragmentation had increased in the paraffin blocks during storage. Next-generation sequencing was performed on 12 samples and showed a mean 3.3-fold decrease in library yield and a mean 4.5-fold increase in the number of single-nucleotide variants detected after storage. In conclusion, we observed significant degradation of DNA extracted from the same FFPE block after 4 to 6 years of storage. Better preservation strategies should be considered for storage of FFPE biopsy specimens.
http://ift.tt/2x1U92j
Quality of Life Related to Different Treatment Protocols for Post-thyroidectomy Hypoparathyroidism
Conditions: Hypoparathyroidism Postprocedural; Quality of Life
Interventions: Other: Empiric use of Calcium Carbonate and Calcitriol; Other: PTH based Calcium Carbonate and Calcitriol repletion
Sponsor: CHU de Quebec-Universite Laval
Not yet recruiting - verified August 2017
http://ift.tt/2x0hwcf
Interventions: Other: Empiric use of Calcium Carbonate and Calcitriol; Other: PTH based Calcium Carbonate and Calcitriol repletion
Sponsor: CHU de Quebec-Universite Laval
Not yet recruiting - verified August 2017
http://ift.tt/2x0hwcf
Bond strength of etch-and-rinse and self-etch adhesive systems to enamel and dentin irradiated with a novel CO 2 9.3 μm short-pulsed laser for dental restorative procedures
Abstract
The objective of this study was to evaluate the influence of CO2 9.3 μm short-pulsed laser irradiation on the shear bond strength of composite resin to enamel and dentin. Two hundred enamel and 210 dentin samples were irradiated with a 9.3 µm carbon dioxide laser (Solea, Convergent Dental, Inc., Natick, MA) with energies which either enhanced caries resistance or were effective for ablation. OptiBond Solo Plus [OptiBondTE] (Kerr Corporation, Orange, CA) and Peak Universal Bond light-cured adhesive [PeakTE] (Ultradent Products, South Jordan, UT) were used. In addition, Scotchbond Universal [ScotchbondSE] (3M ESPE, St. Paul, MN) and Peak SE self-etching primer with Peak Universal Bond light-cured adhesive [PeakSE] (Ultradent Products) were tested. Clearfil APX (Kuraray, New York, NY) was bonded to the samples. After 24 h, a single plane shear bond test was performed. Using the caries preventive setting on enamel resulted in increased shear bond strength for all bonding agents except for self-etch PeakSE. The highest overall bond strength was seen with PeakTE (41.29 ± 6.04 MPa). Etch-and-rinse systems achieved higher bond strength values to ablated enamel than the self-etch systems did. PeakTE showed the highest shear bond strength with 35.22 ± 4.40 MPa. OptiBondTE reached 93.8% of its control value. The self-etch system PeakSE presented significantly lower bond strength. The shear bond strength to dentin ranged between 19.15 ± 3.49 MPa for OptiBondTE and 43.94 ± 6.47 MPa for PeakSE. Etch-and-rinse systems had consistently higher bond strength to CO2 9.3 µm laser-ablated enamel. Using the maximum recommended energy for dentin ablation, the self-etch system PeakSE reached the highest bond strength (43.9 ± 6.5 MPa).
http://ift.tt/2w6rGMd
Successful intravenous thrombolysis for ischemic stroke after reversal of dabigatran anticoagulation with idarucizumab: a case report
Non-vitamin K antagonist oral anticoagulants, including dabigatran, are currently widely used for the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation. Recently, ida...
http://ift.tt/2vXUGp7
Oral manifestations, dental management, and a rare homozygous mutation of the PRDM12 gene in a boy with hereditary sensory and autonomic neuropathy type VIII: a case report and review of the literature
Hereditary sensory and autonomic neuropathy type VIII is a rare autosomal recessive inherited disorder. Chen et al. recently identified the causative gene and characterized biallelic mutations in the PR domain-co...
http://ift.tt/2vF0wJ6
A Case of Immediate Hypersensitivity Reaction to Maltitol
Background. Maltitol is a sugar alcohol that is frequently used as a noncaloric sweetener, although it is also used as an excipient, a plasticizer in gelatin capsules, and an emollient. It has not been previously described as an agent involved in immediate hypersensitivity reactions. Methods. We report on an anaphylactoid reaction with pharyngeal occlusion suffered by a 60-year-old man after ingestion of a candy containing maltitol syrup. A prick-to-prick test was performed with the candy and maltitol powder. Other allergens were excluded as causative agents of the adverse reaction, although the patient refused to undergo an oral challenge test with the candy. A basophil activation test (BAT) was performed with maltitol powder, and a dose-response curve was generated. The test was also performed in 3 healthy controls. Results. Both prick-to-prick tests were negative. The result of the BAT was positive at all the concentrations tested in the patient's blood and negative in all the controls. Conclusions. The BAT can help to clarify the agents implicated in an adverse reaction and can reduce the risk involved in diagnosis. The BAT can also prove useful in the study of reactions caused by low-molecular-weight antigens, for which routine diagnostic tests are not feasible.
http://ift.tt/2w9jA4F
Etiologies and management of cutaneous flushing
The second article in this 2-part continuing medical education series reviews the following malignant causes of flushing: mastocytosis, medullary thyroid carcinoma, pheochromocytoma, carcinoid tumors, gastroenteropancreatic neuroendocrine tumors, bronchogenic carcinoma, vasointestinal polypeptide secreting tumors, and renal cell carcinoma. The information provided will allow physicians to better distinguish patients who have worrisome presentations that require a more thorough investigation. Appropriate diagnostic workup and treatment options for these malignancies are reviewed.
http://ift.tt/2uF7Jf3
Etiologies and management of cutaneous flushing
The flushing phenomenon may represent a physiologic or a pathologic reaction. Although flushing is usually benign, it is prudent that the physician remains aware of potentially life-threatening conditions associated with cutaneous flushing. A thorough investigation should be performed if the flushing is atypical or not clearly associated with a benign underlying process. The diagnosis often relies on a pertinent history, review of systems, physical examination, and various laboratory and imaging modalities, all of which are discussed in the 2 articles in this continuing medical education series.
http://ift.tt/2uEXmbh
Partial biopsies and persistent nevi: Communicate clearly and proceed with caution
To the Editor: We read the article by Hiscox et al1 with great interest. The authors identified 147 nevi with positive histologic margins and a diagnosis of moderate cytologic atypia (MDN). Only 6 recurred over an average interval of 624 days. The authors concluded that "given the low recurrence in our sample of MDN with nevus cells detectable at histologic margins, it seems appropriate to not re-excise these lesions."
http://ift.tt/2uFrfYN
Fractional carbon dioxide laser in combination with topical corticosteroid: An innovative treatment for hypertrophic lichen planus
Hypertrophic lichen planus (HLP) is a treatment-resistant variant of lichen planus.1 No treatment option has been found to be universally effective in HLP. Intralesional injections of triamcinolone acetonide have been found to be effective, but the treatment is associated with significant pain. We describe the novel use of fractional CO2 laser–assisted corticosteroid delivery into treatment-resistant HLP, leading to complete resolution of the lesions.
http://ift.tt/2uFgk1y
Response to: “The role of cannabinoids in dermatology”
To the Editor: We recently read with interest the timely review article "The role of cannabinoids in dermatology" by Mounessa et al.1 Cannabinoids may have the potential to treat a variety of cutaneous inflammatory diseases, and we applaud the authors for their groundbreaking piece. Not addressed in this article, however, were potential negative consequences of cannabinoid use for skin diseases. Additionally, it is important to distinguish between endogenous cannabinoids, synthetic cannabinoids, and phytocannabinoids.
http://ift.tt/2uXRWDm
Gifts: Are there strings attached?
The holiday season is associated with gifts to friends and to people who provide a service to you. The most common gifts from patients to physicians include baked goods, cards, clothing, or handcrafted items.1 One study reported that 20% of physicians received a gift within the past 3 months.2,3 While gift-giving is generous and appreciated, the motivations of the patient and how the physician reciprocates are important. Whether the physician accepts or politely refuses the gift involves several ethical issues, including the right or autonomy of patients to give gifts as a sign of appreciation, beneficence, and nonmaleficence.
http://ift.tt/2uFmcYi
Measuring ultraviolet A protection in sunscreen products
To the Editor: The results concerning ultraviolet A light (UVA) protection in United States (US) sunscreen products compared with the UVA guidelines for sunscreens in the European Union (EU) published in the Journal by Wang et al1 deserve comment.
http://ift.tt/2uXn5Hd
Prevalence of chronic hepatitis B and C in psoriasis patients: A cross-sectional study in a large US population
To the Editor: An association between psoriasis and hepatitis B and C is inconsistently reported in the literature.1-3 Because both hepatitis B and C viruses have been hypothesized to exacerbate psoriasis and because biologic treatments for psoriasis may be contraindicated in patients infected with hepatitis viruses, exploring this possible relationship for each virus may lead to better management.1 Consequently, this study aimed to determine the prevalence of hepatitis B and C in patients with psoriasis within a large, single-center, US patient population.
http://ift.tt/2uY18aR
How similar are the treatment responses to biosimilars in patients with psoriasis? A systematic review of statistical margins in comparative clinical trials
To the Editor: Biosimilars are medications that have no clinically meaningful differences in terms of safety, purity, and potency relative to a reference drug product that has already obtained approval from the Food and Drug Administration.1 These drugs are often investigated by equivalence trials wherein the biosimilar is determined clinically to be neither inferior nor superior when compared with its originator. Because of the complex molecular nature of biosimilars, manufacturing identical replicas of corresponding originators is impossible.
http://ift.tt/2uXUqSl
Fractionated cryotherapy
Cryotherapy is a commonly performed procedure in dermatology outpatient departments for destruction of pathologic tissue. It is an easy-to-perform, inexpensive, and sutureless technique and carries a minimal risk of infection. However, the procedure is associated with many complications and sequelae such as blistering, ulceration, necrosis, and permanent or longstanding pigmentary alterations. This limits its use on cosmetically sensitive sites and for indications like facial rejuvenation, particularly in people with pigmented skin.
http://ift.tt/2uFm5fk
Circulating vitamin D–binding protein and free 25-hydroxyvitamin D concentrations in patients with melanoma: A case-control study
To the Editor: Novel risk factors and biomarkers are being sought for cutaneous melanoma, given its increasing incidence and mortality worldwide. Although ultraviolet radiation is an established melanoma risk factor, paradoxically, vitamin D (VD) deficiency has been linked to increased melanoma risk and progression with conflicting results.1 A majority of 25-hydroxyvitamin D [25(OH)D] and 1,25(OH)2D circulate bound to VD-binding protein (DBP) (85%-90%) and albumin (10%-15%), with <1% circulating in its free form.
http://ift.tt/2uXRR2z
The Potential for Emerging Microbiome-Mediated Therapeutics in Asthma
Abstract
Purpose of Review
In terms of immune regulating functions, analysis of the microbiome has led the development of therapeutic strategies that may be applicable to asthma management. This review summarizes the current literature on the gut and lung microbiota in asthma pathogenesis with a focus on the roles of innate molecules and new microbiome-mediated therapeutics.
Recent Findings
Recent clinical and basic studies to date have identified several possible therapeutics that can target innate immunity and the microbiota in asthma. Some of these drugs have shown beneficial effects in the treatment of certain asthma phenotypes and for protection against asthma during early life.
Summary
Current clinical evidence does not support the use of these therapies for effective treatment of asthma. The integration of the data regarding microbiota with technologic advances, such as next generation sequencing and omics offers promise. Combining comprehensive bioinformatics, new molecules and approaches may shape future asthma treatment.
http://ift.tt/2uJM2GA
Glattmuskelhamartom in volarer Haut
Zusammenfassung
Wir berichten von einer 12-jährigen Patientin mit volarem Glattmuskelhamartom. Da in volarer Haut Haarfollikel und entsprechend Mm. arrectores pilorum fehlen, sind Herde an Fingern und Zehen ungewöhnlich und könnten aus glatten Anteilen der Gefäßwandmuskulatur entstehen. Insbesondere die histologische Abgrenzung zum Becker-Nävus ist aufgrund vieler Überlappungen problematisch. Ob es sich beim Glattmuskelhamartom und Becker-Nävus um 2 Erkrankungen oder vielmehr Varianten eines fließenden Krankheitsspektrums handelt, bleibt unklar.
http://ift.tt/2uXDprv
The Potential for Emerging Microbiome-Mediated Therapeutics in Asthma
Abstract
Purpose of Review
In terms of immune regulating functions, analysis of the microbiome has led the development of therapeutic strategies that may be applicable to asthma management. This review summarizes the current literature on the gut and lung microbiota in asthma pathogenesis with a focus on the roles of innate molecules and new microbiome-mediated therapeutics.
Recent Findings
Recent clinical and basic studies to date have identified several possible therapeutics that can target innate immunity and the microbiota in asthma. Some of these drugs have shown beneficial effects in the treatment of certain asthma phenotypes and for protection against asthma during early life.
Summary
Current clinical evidence does not support the use of these therapies for effective treatment of asthma. The integration of the data regarding microbiota with technologic advances, such as next generation sequencing and omics offers promise. Combining comprehensive bioinformatics, new molecules and approaches may shape future asthma treatment.
http://ift.tt/2uJM2GA
Combined Central and Peripheral Degenerative Vestibular Disorders: CANVAS, Idiopathic Cerebellar Ataxia with Bilateral Vestibulopathy (CABV) and Other Differential Diagnoses of the CABV Phenotype
Abstract
Purpose of Review
The traditional dichotomy of central versus peripheral causes of imbalance may be viewed as an obstacle, rather than an aid to diagnosis. This paper aims to review the clinical assessment of conditions with combined central and peripheral vestibular impairment and the more common conditions which may manifest this joint pathology.
Recent Findings
Cerebellar ataxia with bilateral vestibulopathy (CABV) was initially believed to be a distinct syndrome but has more recently been recognised as a phenotype which may be found in a number of disorders including CANVAS, Friedreich's ataxia, spinocerebellar ataxia types 3 and 6 and multiple system atrophy. Oculomotor assessment provides a valuable means of identifying such patients and centres around the identification of an abnormal visually enhanced vestibulo-ocular reflex.
Summary
Identification of the CABV phenotype limits the differential diagnoses and then provides a directed investigation pathway.
http://ift.tt/2vzp7AS
Juvenile melanomas: Western Australian Melanoma Advisory Service experience
Abstract
Background/Objectives
Juvenile melanoma (before 20 years of age) is a rare condition with poorly defined risk factors. We describe features of juvenile melanoma in Western Australia over the last two decades.
Method
A retrospective review of juvenile melanomas was conducted from prospectively maintained databases, reviewed for patients' characteristics, clinical information, histology, treatment, recurrence and survival data.
Results
Altogether 95 cases of juvenile melanoma were reported to the Western Australian Cancer Registry between 2000 and 2013. Of these, 27 patients were referred to the Western Australian Melanoma Advisory Service. Over 72% were aged between 13 and 19 years. The most common site for primary melanoma was the head and neck (31.8%). Eight patients (36.4%) had a pre-existing naevus, 13.6% reported 1–5 blistering sunburns in the past and 59.1% had a Fitzpatrick skin grade of 3 or less. Most (88%) were diagnosed with a primary invasive lesion at presentation. Superficial spreading melanomas predominated (27.3%). All but one patient had localised disease at presentation, with six patients undergoing further treatment, including chemotherapy and neck dissection for metastases. At the time of review, two patients had died, due to stroke and metastatic disease.
Conclusions
Juvenile melanoma remains a rarity in Western Australia despite a very high incidence of adult melanoma. Unlike in adults, no definitive risk factors have been established. A significant proportion of this cohort had a pre-existing naevus and while most melanomas occurred in sun-exposed areas in light-skinned individuals the association between sunburn and melanoma was not strong.
http://ift.tt/2i1bAxb
Clinical investigation of 38 cases of oral mucosal melanoma: A multicentre retrospective analysis in Japan
Abstract
Background/Objectives
The aim of the present study was to investigate treatment modalities and outcomes in oral mucosal melanoma.
Methods
The clinical and pathological data of 38 consecutive patients with oral mucosal melanoma were retrospectively analyzed. Patients' characteristics were analyzed and overall survival (OS) rates were calculated.
Results
Sixteen patients had stage III (42%), 19 IVA (50%), and three had stage IVC (8%) disease. Among the therapeutic approaches used, 31 patients (82%) received radical therapy (surgery +/− chemotherapy). The 5-year OS rate was 40%. Five-year OS rates according to the clinical stage were 71% for stage III, 24% for stage IVA, and 0% for stage IVC. Five-year OS rates according to therapeutic approaches were 52% in the radical therapy group and 0% in the palliative therapy and best supportive care groups.
Conclusions
The results of this multicentre retrospective analysis of patients with oral mucosal melanoma suggest that radical therapy based on surgical treatments with complete surgical excision with clear margins leads to a better prognosis.
http://ift.tt/2fH9m5m
Chronic Pain and Associated Factors in India and Nepal: A Pilot Study of the Vanderbilt Global Pain Survey.
BACKGROUND: Evaluation and treatment of chronic pain worldwide are limited by the lack of standardized assessment tools incorporating consistent definitions of pain chronicity and specific queries of known social and psychological risk factors for chronic pain. The Vanderbilt Global Pain Survey (VGPS) was developed as a tool to address these concerns, specifically in the low- and middle-income countries where global burden is highest. METHODS: The VGPS was developed using standardized and cross-culturally validated metrics, including the Brief Pain Inventory and World Health Organization Disability Assessment Scale, as well as the Pain Catastrophizing Scale, the Fibromyalgia Survey Questionnaire along with queries about pain attitudes to assess the prevalence of chronic pain and disability along with its psychosocial and emotional associations. The VGPS was piloted in both Nepal and India over a 1-month period in 2014, allowing for evaluation of this tool in 2 distinctly diverse cultures. RESULTS: Prevalence of chronic pain in Nepal and India was consistent with published data. The Nepali cohort displayed a pain point prevalence of 48% to 50% along with some form of disability present in approximately one third of the past 30 days. Additionally, 11% of Nepalis recorded pain in 2 somatic sites and 39% of those surveyed documented a history of a traumatic event. In the Indian cohort, pain point prevalence was approximately 24% to 41% based on the question phrasing, and any form of disability was present in 6 of the last 30 days. Of the Indians surveyed, 11% reported pain in 2 somatic sites, with only 4% reporting a previous traumatic event. Overall, Nepal had significantly higher chronic pain prevalence, symptom severity, widespread pain, and self-reported previous traumatic events, yet lower reported pain severity. CONCLUSIONS: Our findings confirm prevalent chronic pain, while revealing pertinent cultural differences and survey limitations that will inform future assessment strategies. Specific areas for improvement identified in this VGPS pilot study included survey translation methodology, redundancy of embedded metrics and cultural limitations in representative sampling and in detecting the prevalence of mental health illness, catastrophizing behavior, and previous traumatic events. International expert consensus is needed. (C) 2017 International Anesthesia Research Society
http://ift.tt/2wZVFBE
http://ift.tt/2wZVFBE
Systemic Hypotension Following Intravenous Administration of Nonionic Contrast Medium During Computed Tomography: Iopromide Versus Iodixanol.
BACKGROUND: In light of the increasing number of radiologic interventions performed under general anesthesia, the effects of contrast media (CM) on circulation and organ perfusion are of paramount importance. The objectives of this study were to systematically quantify effects on blood pressure, heart rate, and kidney function following intravenous administration of nonionic CM with normal and low osmolality. METHODS: In this controlled, double-blinded phase IV clinical trial, 40 consecutive patients were randomly assigned to receive repeated measures of either low-osmolar iopromide or iso-osmolar iodixanol. Normal saline solution (NSS) served as control. Blood pressure and heart rate were measured continuously from 1 minute before until 3 minutes after administration of CM and NSS. Urine output was recorded hourly. RESULTS: Administration of iopromide resulted in systemic hypotension lasting up to 300 seconds (105 +/- 61 seconds) with the lowest mean arterial pressure of 39 mm Hg (56.7 +/- 12.2 mm Hg). Iopromide caused a systolic/diastolic decrease of 31/26 mm Hg (P .640). CONCLUSIONS: Administration of low-osmolar iopromide was followed by a significant transient decrease in blood pressure and a rise in heart rate. Anesthetists and radiologists should be aware of these effects in patients in whom short episodes of disturbed tissue microcirculation may pose a clinical risk. (C) 2017 International Anesthesia Research Society
http://ift.tt/2x023cu
http://ift.tt/2x023cu
Refractory Intracranial Hypertension: The Role of Decompressive Craniectomy.
Raised intracranial pressure (ICP) is associated with worse outcomes after acute brain injury, and clinical guidelines advocate early treatment of intracranial hypertension. ICP-lowering therapies are usually administered in a stepwise manner, starting with safer first-line interventions, while reserving higher-risk options for patients with intractable intracranial hypertension. Decompressive craniectomy is a surgical procedure in which part of the skull is removed and the underlying dura opened to reduce brain swelling-related raised ICP; it can be performed as a primary or secondary procedure. After traumatic brain injury, secondary decompressive craniectomy is most commonly undertaken as a last-tier intervention in a patient with severe intracranial hypertension refractory to tiered escalation of ICP-lowering therapies. Although decompressive craniectomy has been used in a number of conditions, it has only been evaluated in randomized controlled trials after traumatic brain injury and acute ischemic stroke. After traumatic brain injury, decompressive craniectomy is associated with lower mortality compared to medical management but with higher rates of vegetative state or severe disability. In patients with stroke-related malignant hemispheric infarction, hemicraniectomy significantly decreases mortality and improves functional outcome in adults 60 years, but results in a higher proportion of severely disabled survivors compared to medical therapy in this age group. Decisions to recommend decompressive craniectomy must always be made not only in the context of its clinical indications but also after consideration of an individual patient's preferences and quality of life expectations. This narrative review discusses the management of intractable intracranial hypertension in adults, focusing on the role of decompressive craniectomy in patients with traumatic brain injury and acute ischemic stroke. (C) 2017 International Anesthesia Research Society
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http://ift.tt/2w65OjU
Risk Stratification for Major Postoperative Complications in Patients Undergoing Intra-abdominal General Surgery Using Latent Class Analysis.
BACKGROUND: Preoperative risk stratification is a critical element in assessing the risks and benefits of surgery. Prior work has demonstrated that intra-abdominal general surgery patients can be classified based on their comorbidities and risk factors using latent class analysis (LCA), a model-based clustering technique designed to find groups of patients that are similar with respect to characteristics entered into the model. Moreover, the latent risk classes were predictive of 30-day mortality. We evaluated the use of latent risk classes to predict the risk of major postoperative complications. METHODS: An observational, retrospective cohort of patients undergoing intra-abdominal general surgery in the 2005 to 2010 American College of Surgeons National Surgical Quality Improvement Program was obtained. Known preoperative comorbidity and risk factor data were entered into LCA models to identify the latent risk classes. Complications were defined as: acute kidney injury, acute respiratory failure, cardiac arrest, deep vein thrombosis, myocardial infarction, organ space infection, pneumonia, postoperative bleeding, pulmonary embolism, sepsis/septic shock, stroke, unplanned reintubation, and/or wound dehiscence. Relative risk regression determined the associations between the latent classes and the 30-day complication risks, with adjustments for the surgical procedure. The area under the curve (AUC) of the receiver operator characteristic curve assessed model performance. RESULTS: LCA fit a 9-class model on 466,177 observations. The composite complication risk was 18.4% but varied from 7.7% in the lowest risk class to 56.7% in the highest risk class. After adjusting for procedure, the latent risk classes were significantly associated with complications, with risk ratios (95% confidence intervals) (compared to the class with the average risk) varying from 0.56 (0.54-0.58) in the lowest risk class to 2.15 (2.11-2.20) in the highest risk class, a 4-fold difference. In models incorporating surgical procedure, latent risk class, and the American Society of Anesthesiologists Physical Status, the AUC for composite complications was 0.76 (0.76-0.76). However, for individual complications, there was heterogeneity in model performance using these variables, with AUCs ranging from 0.70 (0.69-0.71) for pulmonary embolus to 0.90 (0.90-0.90) for acute respiratory failure. CONCLUSIONS: LCA can be used to classify patients undergoing intra-abdominal general surgery based on preoperative risk factors, and the classes are independently associated with postoperative complications. However, model performance is not uniform across individual complications, resulting in variations in the utility of preoperative risk stratification tools depending on the complication evaluated. (C) 2017 International Anesthesia Research Society
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http://ift.tt/2wZVPt4
The Opiorphin Analog STR-324 Decreases Sensory Hypersensitivity in a Rat Model of Neuropathic Pain.
BACKGROUND: Neuropathic pain represents a therapeutic challenge, and treatments with increased efficacy and tolerability still need to be developed. Opiorphin protects endogenous enkephalins from degradation, potentiating enkephalin-dependent analgesia via the activation of opioid pathways. Enkephalins are natural ligands of opioid receptors, with strong affinity for [delta]-opioid receptors. Expression of functional [delta]-opioid receptors increases in sensory neurons after peripheral nerve injury in neuropathic pain models. In a postoperative pain model, opiorphin and its stable analog STR-324 have an analgesic potency comparable to that of morphine, but without adverse opioid-related side effects. Consequently, administration of endogenous opiorphin peptides or STR-324 might be effective in managing peripheral neuropathic pain. METHODS: In this study, STR-324 was administered intravenously over the course of 7 days to rats with mononeuropathy induced by L5-L6 spinal nerve root ligation. The rats exhibited mechanical allodynia, thermal hyperalgesia, and spontaneous pain-related behavior throughout the testing period. RESULTS: Here, we report that the continuous administration of STR-324 significantly reduced mechanical allodynia and spontaneous pain-related behavior from day 2 to day 7 in animals that received 10 or 50 [micro]g/h of STR-324 as compared to placebo-treated animals (P
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http://ift.tt/2w5LwY6
The Effect of Adductor Canal Block on Knee Extensor Muscle Strength 6 Weeks After Total Knee Arthroplasty: A Randomized, Controlled Trial.
BACKGROUND: Total knee arthroplasty (TKA) reduces knee extensor muscle strength (KES) in the operated limb for several months after the surgery. Immediately after TKA, compared to either inguinal femoral nerve block or placebo, adductor canal block (ACB) better preserves KES. Whether this short-term increase in KES is maintained several weeks after surgery remains unknown. We hypothesized that 48 hours of continuous ACB immediately after TKA would improve KES 6 weeks after TKA, compared to placebo. METHODS: Patients scheduled for primary unilateral TKA were randomized to receive either a continuous ACB (group ACB) or a sham block (group SHAM) for 48 hours after surgery. Primary outcome was the difference in maximal KES 6 weeks postoperatively, measured with a dynamometer during maximum voluntary isometric contraction. Secondary outcomes included postoperative day 1 (POD1) and day 2 (POD2) KES, pain scores at rest and peak effort, and opioid consumption; variation at 6 weeks of Knee Osteoarthritis Outcome Score, patient satisfaction, and length of hospital stay. RESULTS: Sixty-three subjects were randomized and 58 completed the study. Patients in group ACB had less pain at rest during POD1 and during peak effort on POD1 and POD2, consumed less opioids on POD1 and POD2, and had higher median KES on POD1. There was no significant difference between groups for median KES on POD2, variation of Knee Osteoarthritis Outcome Score, patient satisfaction, and length of stay. There was no difference between groups in median KES 6 weeks after surgery (52 Nm [31-89 Nm] for group ACB vs 47 Nm [30-78 Nm] for group SHAM, P= .147). CONCLUSIONS: Continuous ACB provides better analgesia and KES for 24-48 hours after surgery, but does not affect KES 6 weeks after TKA. Further research could evaluate whether standardized and optimized rehabilitation over the long term would allow early KES improvements with ACB to be maintained over a period of weeks or months. (C) 2017 International Anesthesia Research Society
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http://ift.tt/2w5Xj8E
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