For some people, frequent washing can damage hair and cause a dry, itchy scalp. How often should you wash your hair with shampoo?
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Σάββατο 28 Οκτωβρίου 2017
Should you wash your hair everyday?
Identification and management of inverted or everted edges of traumatic tympanic membrane perforations
Publication date: Available online 28 October 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Zhengcai Lou, Zi-Han Lou
IntroductionMost of traumatic tympanic membrane perforations have inverted or everted edges, however, the effects of inverted and everted edges on the spontaneous healing of the eardrum remain controversial.ObjectiveWe investigated the influence of inverted or everted edges on the spontaneous healing of traumatic tympanic membrane perforations.MethodsThe clinical records of patients with a traumatic tympanic membrane perforations who met the study criteria were retrieved and categorized into two groups, based on whether the eardrum was inverted or everted. The features along the edge of each inverted or everted eardrum were described using 30° and 70° endoscopes.ResultsIn total, 196 patients (196 ears) met the inclusion criteria; of these, 148 had inverted or everted eardrums while 48 did not. Of the 148 patients with inverted or everted eardrums, the perforation edges were everted in 77 patients, inverted in 44 patients, drooping in 17 patients, and both inverted and everted in 10 patients. The perforation shape was triangular in 18.9% of patients, sector-shaped in 11.5%, kidney-shaped in 14.2%, ovoid in 20.3%, and irregularly shaped in 35.1% of patients. The difference was not significant between the with and without inverted/everted eardrum edges groups in terms of the closure rate or closure time. Similarly, the difference was not significant between the with and without edge approximation groups in terms of the closure rate or closure time at the end of the 12-month follow-up period.ConclusionThis study suggests that endoscopic inspection can clearly identify inverted/everted eardrum edges using 30° and 70° endoscopes. The edge is glossy in inverted/everted eardrums, whereas the edge is rough and irregular in non-inverted/everted cases. The inverted/everted eardrums gradually became necrotic, but this did not affect the healing process. Additionally, edge approximation did not improve the healing outcome of traumatic tympanic membrane perforations.
http://ift.tt/2icjlNI
Comparison between chloral hydrate and propofol-ketamine as sedation regimens for pediatric auditory brainstem response testing
Publication date: Available online 28 October 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Kamal Abulebda, Vinit J. Patel, Sheikh S. Ahmed, Alvaro J. Tori, Riad Lutfi, Samer Abu-Sultaneh
IntroductionThe use of diagnostic auditory brainstem response testing under sedation is currently the "gold standard" in infants and young children who are not developmentally capable of completing the test.ObjectiveThe aim of the study is to compare a propofol-ketamine regimen to an oral chloral hydrate regimen for sedating children undergoing auditory brainstem response testing.MethodsPatients between 4 months and 6 years who required sedation for auditory brainstem response testing were included in this retrospective study. Drugs doses, adverse effects, sedation times, and the effectiveness of the sedative regimens were reviewed.Results73 patients underwent oral chloral hydrate sedation, while 117 received propofol-ketamine sedation. 12% of the patients in the chloral hydrate group failed to achieve desired sedation level. The average procedure, recovery and total nursing times were significantly lower in the propofol-ketamine group. Propofol-ketamine group experienced higher incidence of transient hypoxemia.ConclusionBoth sedation regimens can be successfully used for sedating children undergoing auditory brainstem response testing. While deep sedation using propofol-ketamine regimen offers more efficiency than moderate sedation using chloral hydrate, it does carry a higher incidence of transient hypoxemia, which warrants the use of a highly skilled team trained in pediatric cardio-respiratory monitoring and airway management.
http://ift.tt/2gKCNka
Standard classification and pathophysiology of rosacea: The 2017 update by the National Rosacea Society Expert Committee
In 2002, the National Rosacea Society assembled an expert committee to develop the first standard classification of rosacea. This original classification was intended to be updated as scientific knowledge and clinical experience increased. Over the last 15 years, significant new insights into rosacea's pathogenesis and pathophysiology have emerged, and the disorder is now widely addressed in clinical practice. Growing knowledge of rosacea's pathophysiology has established that a consistent multivariate disease process underlies the various clinical manifestations of this disorder, and the clinical significance of each of these elements is increasing as more is understood.
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Sleep disturbance in children with moderate/severe atopic dermatitis: A case-control study
Sleep is disturbed in 60% of children with atopic dermatitis (AD).
http://ift.tt/2zfd8vh
Evidence-based update on rosacea comorbidities and their common physiologic pathways
Rosacea is a common chronic inflammatory disease affecting the facial skin whose etiology and pathophysiology are the subject of much investigation. Risk factors include genetic and environmental elements that may predispose individuals to localized inflammation and abnormal neurovascular responses to stimuli. Recent studies have introduced an array of systemic rosacea comorbidities, such as inflammatory bowel disease and neurologic conditions, that can be challenging to synthesize. We critically review the current data behind reported rosacea comorbidities and identify and highlight underrecognized physiologic mediators shared among rosacea and associated comorbidities.
http://ift.tt/2zf269t
Quantitative analysis of facial soft tissue perfusion during hypotensive anesthesia using laser-assisted indocyanine green fluorescence angiography
The aim of this study was to quantitatively evaluate the efficacy of induced hypotensive anesthesia in decreasing facial soft tissue perfusion during orthognathic surgery using laser-assisted indocyanine green fluorescence angiography. This retrospective study involved the evaluation of 16 patients who underwent orthognathic surgery. Data collection included facial tissue perfusion of the bilateral cheeks and chin at normotension and with pharmacologically induced hypotensive anesthesia. There were statistically significant differences in the facial tissue perfusion at normal and depressed levels of blood pressure (P<0.001).
http://ift.tt/2idFWcz
Treatment of lower lip pits in Van der Woude syndrome: a systematic review
The presence of lower lip pits in individuals with Van der Woude syndrome (VWS) may cause discomfort due to saliva secretion. Furthermore, one of the main complaints in relation to lip pits is poor aesthetics, which often affects quality of life. The aim of this systematic review was to identify the best technique for the surgical removal of lower lip pits in terms of aesthetic and functional characteristics. A search of the PubMed, Embase, Web of Science, Science Direct, and Scopus databases was performed on December 27, 2016, which retrieved 88 records without duplicates.
http://ift.tt/2zdAYra
Cerebellar ataxia with neuropathy and vestibular areflexia syndrome (CANVAS)
Cerebellar ataxia with neuropathy and bilateral vestibular areflexia syndrome (CANVAS) is a novel ataxic disorder consisting of the triad of cerebellar impairment, bilateral vestibular hypofunction, and a somatosensory deficit. We report the first Japanese case of CANVAS. The patient is a 68-year-old Japanese male. He was referred to our university for further evaluation of progressive gait disturbance and ataxia. He exhibited horizontal gaze-evoked nystagmus and sensory deficit. Nerve conduction studies showed sensory neuronopathy.
http://ift.tt/2z0LRvy
A rare case of bilateral vagus nerve schwanomatosis
Schwanomatosis is the third most common form of neurofibromatosis. Schwanomatosis affecting the vagus nerve is particularly rare. In this report, we describe an extremely rare case bilateral vagus nerve schwanomatosis in a 45-year-old male patient. The patient initially presented with bilateral neck tumors and hoarseness arising after thoracic surgery. We performed left neck surgery in order to diagnose and resect the remaining tumors followed by laryngeal framework surgery to improve vocal cord closure and symptoms of hoarseness.
http://ift.tt/2yVVLNc
Dengue hemorrhagic fever complicated with transient diabetic ketoacidosis: a case report
The increasing global prevalence of both dengue and diabetes may warrant closer observation for glycemic control and adapted fluid management to diminish the risk for a severe clinical presentation of dengue. ...
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Editorial Board
Publication date: November 2017
Source:Clinical Immunology, Volume 184
http://ift.tt/2gK04CU
Reprint of “Dual blockade of the pro-inflammatory chemokine CCL2 and the homeostatic chemokine CXCL12 is as effective as high dose cyclophosphamide in murine proliferative lupus nephritis”
Source:Clinical Immunology
Author(s): Satish Kumar Devarapu, Santhosh Kumar VR, Khader Valli Rupanagudi, Onkar P. Kulkarni, Dirk Eulberg, Sven Klussmann, Hans-Joachim Anders
Induction therapy of proliferative lupus nephritis still requires the use of unselective immunosuppressive drugs with significant toxicities. In search of more specific drugs with equal efficacy but fewer side effects we considered blocking pro-inflammatory chemokine monocyte chemoattractant protein-1 (MCP-1/CCL2) and homeostatic chemokine stromal cell-derived factor-1 (SDF-1/CXCL12), which both contribute to the onset and progression of proliferative lupus nephritis yet through different mechanisms. We hypothesized that dual antagonism could be as potent on lupus nephritis as the unselective immunosuppressant cyclophosphamide (CYC). We estimated serum levels of CCL2 and CXCL12 in patients with SLE (n=99) and compared the results with healthy individuals (n=21). In order to prove our hypothesis we used l-enantiomeric RNA Spiegelmer® chemokine antagonists, i.e. the CCL2-specific mNOX-E36 and the CXCL12-specific NOX-A12 to treat female MRL/lpr mice from week 12 to 20 of age with either anti-CXCL12 or anti-CCL2 alone or both. SLE patients showed elevated serum levels of CCL2 but not of CXCL12. Female MRL/lpr mice treated with dual blockade showed significantly more effective than either monotherapy in preventing proteinuria, immune complex glomerulonephritis, and renal excretory failure and the results are at par with CYC treatment. Dual blockade reduced leukocyte counts and renal IL-6, IL-12p40, CCL-5, CCL-2 and CCR-2 mRNA expression. Dual blockade of CCL2 and CXCL12 can be as potent as CYC to suppress the progression of proliferative lupus nephritis probably because the respective chemokine targets mediate different disease pathomechanisms, i.e. systemic autoimmunity and peripheral tissue inflammation.
http://ift.tt/2icvIZW
Plumbagin mediating GLUT1 suppresses the growth of human tongue squamous cell cancer
Abstract
Objective
The purpose of this study is to investigate the clinical and histopathological characteristics of GLUT1 in human tongue squamous cell carcinoma (TSCC) and the role of Plumbagin (PLB) mediating GLUT1 in the growth of TSCC.
Subjects And Methods
45 cases of TSCC samples were collected and the expression and location of GLUT1 was analyzed. The role and mechanism of PLB meditating GLUT1 in the inhibitory growth of human TSCC cell line CAL27 was investigated in vitro and vivo.
Results
The expression of GLUT1 was observed in all samples of human TSCC by immunohistochemical staining. GLUT1 expression was significantly correlated with lymph node metastasis and clinical stage in TSCC. PLB treatment decreased cell viability and colony formation, and increased cell apoptosis in association with the downregulation of GLUT1 via inhibiting PI3K/Akt pathway in vitro and PLB suppressed tumor growth in correlation with downregulation of GLUT1, compared with control group in vivo.
Conclusions
The findings demonstrated a novel anti-cancer mechanism of PLB, inhibitory TSCC growth via suppressing PI3K/Akt/GLUT1 pathway, which will supply a theoretical basis for PLB to treat TSCC.
This article is protected by copyright. All rights reserved.
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Prenatal and Early Life Triclosan and Parabens Exposure and Allergic Outcomes
Source:Journal of Allergy and Clinical Immunology
Author(s): Kathleen Lee-Sarwar, Russ Hauser, Antonia M. Calafat, Xiaoyun Ye, George T. O'Connor, Megan Sandel, Leonard B. Bacharier, Robert S. Zeiger, Nancy Laranjo, Diane R. Gold, Scott T. Weiss, Augusto A. Litonjua, Jessica H. Savage
BackgroundIn cross-sectional studies, triclosan and parabens, ubiquitous ingredients in personal care and other products, are associated with allergic disease.ObjectivesWe investigated the association between prenatal and early life triclosan and parabens exposure and childhood allergic disease in a prospective, longitudinal study.MethodsSubjects were enrollees in VDAART, the Vitamin D Antenatal Asthma Reduction Trial. Triclosan, methyl paraben and propyl paraben concentrations were quantified in maternal plasma samples pooled from first and third trimesters and urine samples from children at age 3 or 4 years. Outcomes were parental report of physician-diagnosed asthma or recurrent wheezing, and allergic sensitization to food or environmental antigens based on serum specific IgE levels at age 3 in high-risk children.ResultsAnalysis included 467 mother-child pairs. Overall, there were no statistically significant associations of maternal plasma or child urine triclosan or parabens concentrations with asthma or recurrent wheeze, food or environmental sensitization at age 3. A trend toward an inverse association between triclosan and parabens exposure and allergic sensitization was observed. There was evidence of effect measure modification by sex, with higher odds of environmental sensitization associated with increasing concentrations of parabens in males compared to females.ConclusionsWe did not identify a consistent association between prenatal and early life triclosan or parabens concentrations and childhood asthma, recurrent wheeze or allergic sensitization in the overall study population. The differential effects of triclosan or parabens exposure on allergic sensitization by sex observed in this study warrants further exploration.
http://ift.tt/2hi2CZH
Association of Rhinovirus Species with Common Cold and Asthma Symptoms and Bacterial Pathogens
Source:Journal of Allergy and Clinical Immunology
Author(s): Hiba Bashir, Kris Grindle, Rose Vrtis, Fue Vang, Teresa Kang, Lisa Salazar, Elizabeth Anderson, Tressa Pappas, Ronald Gangnon, Michael D. Evans, Daniel J. Jackson, Robert F. Lemanske, Yury A. Bochkov, James E. Gern
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The Notch Pathway Inhibitor SAHM1 Abrogates the Hallmarks of Allergic Asthma
Source:Journal of Allergy and Clinical Immunology
Author(s): Alex KleinJan, Irma Tindemans, Jeffrey E. Montgomery, Melanie Lukkes, Marjolein J.W. de Bruijn, Menno van Nimwegen, Ingrid Bergen, Raymond E. Moellering, Henk C. Hoogsteden, Louis Boon, Derk Amsen, R.W. Hendriks
BackgroundThe Notch signaling pathway has been implicated in the pathogenesis of allergic airway inflammation. Targeting the active Notch transactivation complex by the cell-permeable, hydrocarbon-stapled synthetic peptide SAHM1 was results in genome-wide suppression of Notch-activated genes in leukemic cells and other models. However, efficacy of SAHM1 in allergic asthma models has remained unexplored.ObjectiveWe aimed to investigate therapeutic efficacy of SAHM1 in a house dust mite (HDM)-driven asthma model.MethodsTopical therapeutic intervention with SAHM1 or a control peptide was performed during sensitization and/or challenge with HDM in mice. Airway inflammation was assessed by multi-color flow cytometry and bronchial hyperreactivity (BHR) was studied. Additionally, SAHM1 therapy was investigated in established asthma and in a model in which we neutralized IFNγ during HDM challenge to support the Th2 response and exacerbate asthma.ResultsSAHM1 treatment during the challenge phase led to a marked reduction of eosinophils and T-cells in bronchoalveolar lavage (BAL), compared with diluent-treated or control peptide-treated mice. Likewise, T-cell cytokine content and BHR were reduced. SAHM1 treatment dampened Th2-inflammation during ongoing HDM challenge and enhanced recovery following established asthma. Additionally, in the presence of anti-IFNγ antibodies, SAHM1 downregulated expression of the key Th2 transcription factor (TF) GATA3 and intracellular IL-4 in BAL T-cells, but expression of the Th17 TF RORγt or intracellular IL-17 was not affected. SAHM1 therapy also reduced serum IgE levels.ConclusionsTherapeutic intervention of Notch signaling by SAHM1 inhibits allergic airway inflammation in mice and is therefore an interesting new topical treatment opportunity in asthma.
http://ift.tt/2hir0Kz
Home freezers kill house dust mites
Source:Journal of Allergy and Clinical Immunology
Author(s): Ciara R. Feichtner, Larry G. Arlian, Marjorie S. Morgan, DiAnn L. Vyszenski-Moher
http://ift.tt/2zM4sIR
MCPIP1 controls allergic airway inflammation by suppressing IL-5-producing Th2 cells through Notch/Gata3 pathway
Publication date: Available online 27 October 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Hui Peng, Huan Ning, Qinghong Wang, Wenbao Lu, Yingzi Chang, Tony T. Wang, Jinping Lai, Pappachan E. Kolattukudy, Rong Hou, Daniel F. Hoft, Mark S. Dykewicz, Jianguo Liu
BackgroundAsthmatic and allergic inflammation is mediated by Th2 cytokines (IL-4, IL-5 and IL-13). Though we have learned much about how Th2 cells are differentiated, the Th2 checkpoint mechanisms remain elusive.ObjectivesIn this study, we investigate how monocyte chemotactic protein induced protein-1 (MCPIP1, encoded by zc3h12a gene) regulates IL-5-producing Th2 cell differentiation and Th2-mediated inflammation.MethodsThe functions of zc3h12a-/- CD4 T cells were evaluated by checking the expression of Th2 cytokines and transcription factors in vivo and in vitro. Allergic airway inflammation of zc3h12a-/- mice was examined with murine asthma models. In addition, antigen-specific CD4 T cells deficient in MCPIP1 were transferred to WT recipient mice, challenged with OVA or HDM, and accessed for Th2 inflammation.ResultsZc3h12a-/- mice spontaneously develop severe lung inflammation, with an increase mainly in IL-5- and IL-13-producing but not IL-4-producing Th2 cells in the lung. Mechanistically, the differentiation of IL-5-producing zc3h12a-/- Th2 cells is mediated through Notch signaling and Gata3 independent of IL-4. Gata3 mRNA is stabilized in zc3h12a-/- Th2 cells. MCPIP1 promotes Gata3 mRNA decay via the RNase domain. Furthermore, deletion of MCPIP1 in OVA- or HDM-specific T cells leads to significantly increased Th2-mediated airway inflammation in OVA or HDM murine models of asthma.ConclusionsOur study reveals that MCPIP1 regulates the development and functions of IL-5-producing Th2 cells through Notch/Gata3 pathway. MCPIP1 represents a new promising target for the treatments of asthma and other Th2-mediated diseases.
Graphical abstract
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Methotrexate versus azathioprine in patients with atopic dermatitis: two years follow-up data
Source:Journal of Allergy and Clinical Immunology
Author(s): Evelien Roekevisch, Mandy Elvira Schram, Mariska Maria Geertruida Leeflang, Marijke Willemijn Dorothée Brouwer, Louise Anna Andrea Gerbens, Jan Dositheus Bos, Phyllis Ira Spuls
http://ift.tt/2hhYicT
Ruxolitinib partially reverses functional NK cell deficiency in patients with STAT1 gain-of-function mutations
Source:Journal of Allergy and Clinical Immunology
Author(s): Alexander Vargas-Hernandez, Emily M. Mace, Ofer Zimmerman, Christa S. Zerbe, Alexandra F. Freeman, Sergio Rosenzweig, Jennifer W. Leiding, Troy Torgerson, Matthew C. Altman, Edith Schussler, Charlotte Cunningham-Rundles, Ivan K. Chinn, Alexandre F. Carisey, Imelda C. Hanson, Nicholas L. Rider, Steven M. Holland, Jordan S. Orange, Lisa R. Forbes
BackgroundNatural Killer (NK) cells are critical innate effector cells whose development is dependent on the JAK-STAT pathway. NK deficiency can result in severe or refractory viral infections. Patients with Signal Transducer and Activator of Transcription (STAT)1 gain of function (GOF) mutations have increased viral susceptibility.ObjectiveWe sought to investigate NK cell function in STAT1 GOF patients.MethodsNK cell phenotype and function were determined in 16 STAT1 GOF patients. NK cell lines expressing patient mutations were generated with CRISPR-Cas9 mediated gene editing. STAT1 GOF NK cells were treated in vitro with ruxolitinib.ResultsPeripheral blood NK cells from of STAT1 GOF patients had impaired terminal maturation. Specifically, patients with STAT1 GOF mutations have immature CD56dim NK cells with decreased expression of CD16, perforin, CD57 and impaired cytolytic function. STAT1 phosphorylation was elevated but STAT5 was aberrantly phosphorylated in response to IL-2 stimulation. Upstream inhibition of STAT signaling with the small molecule JAK1/2 inhibitor ruxolitinib in vitro and in vivo restored perforin expression in CD56dim NK cells and partially restored NK cell cytotoxic function.ConclusionsProperly regulated STAT1 signaling is critical for NK cell maturation and function. Modulation of elevated STAT1 phosphorylation with ruxolitinib is an important option for therapeutic intervention in patients with STAT1 GOF mutations.
http://ift.tt/2zNmpXx
Towards global consensus on core outcomes for Hidradenitis Suppurativa research: An update from the HISTORIC consensus meetings I and II
Abstract
Background
A Core Outcomes Set (COS) is an agreed minimum set of outcomes that should be measured and reported in all clinical trials for a specific condition. Hidradenitis suppurativa (HS) has no agreed upon COS. A central aspect in the COS development process is to identify a set of candidate outcome domains from a long list of items. Our long list had been developed from patient interviews, a systematic review of literature and a health care professionals (HCPs) survey and initial votes had been cast in two e-Delphi surveys. In this manuscript, we describe two in-person consensus meetings of Delphi participants designed to ensure an inclusive approach to generation of domains from related items.
Objectives
The main objectives were to consider which items from a long list of candidate items to exclude and which to cluster into outcome domains.
Methods
The study used an international and multi-stakeholder approach, involving patients, dermatologist, surgeons, the pharmaceutical industry and medical regulators. The study format was a combination of formal presentations, small group work based on nominal group theory and a subsequent online confirmation survey.
Results
41 individuals from 13 countries and four continents participated. Nine items were excluded and there was consensus to propose seven domains: disease course, physical signs, HS-specific quality of life, satisfaction, symptoms, pain, and global assessment.
Conclusions
The HISTORIC consensus meetings I and II will be followed by further e-Delphi rounds to finalize the core domain set, building on the work of the in-person consensus meetings.
This article is protected by copyright. All rights reserved.
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Index des auteurs
Source:Annales de Dermatologie et de Vénéréologie
http://ift.tt/2yYyfkq
Programme des communications orales
Source:Annales de Dermatologie et de Vénéréologie
http://ift.tt/2lpf3qY
Incidence and relative survival of melanoma in children and adolescents in the Netherlands, 1989-2013
Abstract
Background
Melanoma is rare in the first two decades of life. Trends in incidence differ across countries.
Objective
To describe incidence and relative survival of children and adolescents with melanoma in the Netherlands for children (0 through 11 years) and adolescents (12 through 19 years) separately. We hypothesized that adolescent melanoma increased in contrast to childhood melanoma, possibly due to a difference in cancer biology and sun exposure patterns.
Methods
Data on all patients of 0-19 years diagnosed between 1989-2013 with histologically confirmed cutaneous invasive melanoma were retrieved from the Netherlands Cancer Registry (NCR). Incidence trends were analyzed with Joinpoint regression. Relative survival analysis was performed.
Results
Between 1989 and 2013, 80 children and 544 adolescents with melanoma were registered in the NCR. Median age at diagnosis was 17 years (IQR 15-18); the female to male ratio was 1.7:1 Statistically significant incidence trends were found in the older age group (12-19 years): an increasing incidence since 1991 (annual percentage change [APC] 3.2%, 95%CI 1.3-5.1) followed by a decrease from 2005-2013 (APC -4.9%, 95%CI -9.6-0.0). No incidence trends for childhood melanoma were observed (APC 0.3%, 95% CI -3.0-3.8%). Relative survival at 1, 5 and 10 years was 98% (95% CI 97-99%), 94% (95% CI 92-96%) and 90% (95% CI 87-92%) respectively. Survival was worse in males and higher Breslow thickness.
Conclusion
Melanoma is very rare under the age of 12 with stable incidence rates. In comparison to childhood melanoma, melanomas in adolescents are more common with a decreasing trend in the past decade. Male sex and increasing Breslow thickness are associated with worse survival in pediatric melanoma patients.
This article is protected by copyright. All rights reserved.
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Koebner's sheep in Wolf's clothing: does the isotopic response exist as a distinct phenomenon?
Abstract
Until 1995, a case of psoriasis developing within the dermatome of a healed herpes zoster was taken as a Koebner phenomenon. In this year, however, the term "isotopic response" was introduced by Wolf et al. to describe "the occurrence of a new skin disorder at the site of another, unrelated and already healed skin disease", thus appearing "on apparently unaffected and healthy skin." Initially, the term was mainly related to herpes zoster, but today the name "Wolf's isotopic response" is used to include a plethora of other triggering factors such as healed cutaneous leishmaniasis, tinea, or varicella. For obvious reasons, such triggering factors cannot be taken as examples of "unaffected and healthy skin". Notably, the authors themselves have categorized the dermatome of a healed herpes zoster as a "vulnerable area". In a recent commentary, Wolf et al. have expanded the definition of healed skin diseases triggering an "isotopic response". They now included "scars, pigment changes, color changes or various other minimal changes by the first disease." Hence, there is no clear-cut criterion to distinguish the isotopic response from a Koebner reaction. Wolf et al. even argue that, if the triggered disorder precedes the appearance of generalized skin lesions, then it is not a Koebner reaction but "Wolf's isotopic response". In our view, such definition is unacceptable. All reactions of this kind represent examples of a Koebner phenomenon. Accordingly, the "isotopic response" should today be taken as a historical error.
This article is protected by copyright. All rights reserved.
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Oral manifestations as the main feature of late-onset recessive dystrophic epidermolysis bullosa
Abstract
Dystrophic epidermolysis bullosa (EB) is a heterogeneous group of inherited blistering diseases with skin cleavage beneath the basement membrane caused by mutations in COL7A1, encoding collagen VII (1). Clinical features include skin and mucosal blistering and scarring, and cover a broad range of degrees of severity. Clinical manifestations of severe generalized dystrophic EB due to loss-of-function mutations are typical, allowing a clinical diagnosis.
This article is protected by copyright. All rights reserved.
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Reply to - Chronic exposure to tetracyclines and subsequent diagnosis for non-melanoma skin cancer in a large Mid-Western US population
Abstract
We thank Drs Nwabudike and Tatu for their interest in our recently published report "Chronic exposure to tetracyclines and subsequent diagnosis for non-melanoma skin cancer in a large Midwestern U.S. patient population" [1]. In their correspondence, Nwabudike and Tatu [2] raised some interesting and thought-provoking questions.
This article is protected by copyright. All rights reserved.
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Sporotrichosis transmitted by a cockatiel (Nymphicus hollandicus)
Abstract
Sporotrichosis is caused by dimorphic, pathogenic species from the genus Sporothrix, which are found in nature as saprophytes in decaying vegetation and soil. Classic transmission occurs after traumatic inoculation while manipulating contaminated plant material, and zoonotic transmission is uncommon. The genus Sporothrix contains relevant species with diverse clinical features, infection routes and virulence traits.
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Ultrastructure of Acrokeratoelastoidosis
Abstract
Acrokeratoelastoidosis (AKE) is a genodermatosis characterized by small, firm papules or plaques on the sides of the hands and feet 1, it was first described in 1953 by Costa, in a Brazilian patient. It is a rare disease, both autosomal dominant and sporadic forms have been observed 2. It is characterized by multiple hyperkeratotic papules on the palms, soles, and dorsum of the hands and feet.
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Dermatological moulage collections in the Nordic countries
Abstract
Background
The art of producing and acquiring dermatological wax models, moulages, flourished all over Europe in the beginning of the twentieth century, whereas very little is known about the existence of moulage collections in the Nordic countries.
Objective
The aim of this paper is to elucidate the presence, the origin, the production place, the use and the condition of dermatological moulage collections in the Nordic countries.
Methods
In each Nordic country, an extensive survey was undertaken during spring 2016. Dermatological departments, museums with medical collections, persons assumed to have specific information about wax moulages as well as secondary sources were contacted and interviewed.
Results
Several hitherto undescribed collections have survived in each country, most however damaged and in disrepair. One Danish and part of a Finnish collection have been restored. Only few moulages are exhibited some have been photographed and digitalized. Denmark and Sweden have had a local moulage production.
Responses to the survey indicate that the result covers all collections of dermatological moulages in the Nordic countries, though some moulages may remain in private collections unknown to the authors, or uncatalogued in museums.
Conclusion
Moulages are medical gems from bygone days before modern technology facilitated new means of communication. Restoration and appropriate storing should be considered for at least selected items from the Nordic collections.
This article is protected by copyright. All rights reserved.
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Body mass index (BMI) and body surface area (BSA) in scleroderma patients
Abstract
Dysfunctions of the digestive tract in the course of systemic sclerosis were observed in as many as 90% cases [1]. It causes fluctuations of body composition and consequently lead to body mass disorders. Among the methods of assessing the nutritional condition, the most traditional is BMI (Body Mass Index) technique. Moreover, the BSA (Body Surface Area) is also used.
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A severe case of mango dermatitis
Abstract
A 27-year-old Japanese woman visited our hospital with eruptions on the lips, which had appeared two days after she took acetaminophen. At day 15, her lips were severely swollen with erosions, most of which were covered with dense crusts (Figure 1). Clinically, Stevens–Johnson syndrome due to acetaminophen was suspected. However, the drug-induced lymphocyte stimulation test for the reagent was negative (stimulation index: 156%; normal: < 179%), and the eruption did not recur after she resumed acetaminophen.
This article is protected by copyright. All rights reserved.
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Response to - Chronic exposure to tetracyclines and subsequent diagnosis for non-melanoma skin cancer in a large Mid-Western US population
Abstract
I would first of all like to begin by congratulating the authors on their work1, which, with the large population analysed, has the potential to pertinently contribute to answering the question of risk of non-melanoma skin cancer (NMSC) with tetracycline use. Certain questions arise from a reading of this work, which I would request of the authors to clarify for all readers.
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Protocol for mandibular reconstruction with zygomatic implants (zygomatic mandibular implant)
Abstract
Introduction
This study describes a modified protocol using transmandibular zygomatic implants with immediate occlusal loading for the comprehensive dental rehabilitation of previously reconstructed mandibular defects and reports preliminary results of this modified protocol.
Materials and methods
Fifteen patients (6 female and 9 male), with a mean of age 40.26 years (range 12 to 68 years), had previously undergone immediate mandibular reconstruction using either autologous bone grafting, bone transport, or microvascular free-flap reconstruction for a variety of diagnoses. Transmandibular zygomatic implants were subsequently placed, depending on the type of defect. Implant stability was evaluated by insertion torque, percussion testing, and the implant stability quotient (ISQ). The patients were rehabilitated with an immediate provisional prosthesis. All patients' records included pre and postoperative clinical examination, radiographs, CT scan, and photographic analysis. All patients were followed for a minimum of 36 months.
Results
All patients were dentally rehabilitated immediately with functional and esthetic hybrid dentures based on either acrylic or porcelain on a metal framework. Among all cases of transmandibular zygomatic implants, the ISQ was greater than 75, which allowed immediate prosthetic loading. The zygomatic implants were considered to be successful if they were asymptomatic with no clinical mobility and no sign of infection. We have also added new indications for placement of transmandibular implants in cases of sequelae of gunshot trauma, dentoalveolar defects, and complications of orthognathic surgery, partially edentulous and/or failure of prior mandibular reconstruction.
Conclusions
The zygomatic implant is an excellent immediate loading option for mandibular dental rehabilitation among patients with mandibular defects. According to our observation, immediate occlusal loading of transmandibular zygomatic implants has a very good potential for success.
http://ift.tt/2ybZdWM
OR072 Viscous oral cromolyn for the treatment of eosinophilic esophagitis: a double-blind, placebo-controlled trial
Publication date: November 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 5, Supplement
Author(s): J. Lieberman, J. Zhang, C. Cavender
http://ift.tt/2ySPMbJ
OR111 Determining the clinical relevance of positive patch testing to gold
Publication date: November 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 5, Supplement
Author(s): B. Yang, B. Sundquist, M. Pasha
http://ift.tt/2z0aTea
Table of Contents - Oral Abstract Sessions
Publication date: November 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 5, Supplement
http://ift.tt/2ySPGRp
OR082 Bovine colostrum supplementation in respiratory allergies according to sensitization: subgroup analysis of randomized controlled trial
Publication date: November 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 5, Supplement
Author(s): K. Oloroso-Chavez, P. Andaya, C. Wong
http://ift.tt/2z0aOqS
OR001 Drug rash eosinophilia and systemic symptoms (DRESS) syndrome identified in electronic health record allergy module
Publication date: November 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 5, Supplement
Author(s): A. Wolfson, L. Zhou, Y. Li, K. Blumenthal
http://ift.tt/2ySPCB9
OR062 Eosinophilia and an elevated immunoglobulin e in an elderly male
Publication date: November 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 5, Supplement
Author(s): J. Brooks, F. Lobo
http://ift.tt/2z0aJn4
OR002 Testing strategies for immediate and delayed reactions to cephalosporins
Publication date: November 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 5, Supplement
Author(s): C. Stone, E. Phillips
http://ift.tt/2ySPyRV
OR076 Age-related variations in reactions during positive oral food challenge to peanut protein
Publication date: November 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 5, Supplement
Author(s): S. Sindher, A. Long, D. Tupa, S. Andorf, N. Purington, R. Chinthrajah, K. Nadeau
http://ift.tt/2yY72P0
OR003 Common misconceptions in the recognition and treatment of anaphylaxis in community hospital based medical professionals
Publication date: November 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 5, Supplement
Author(s): J. Johnson, T. Abraham, M. Sandhu, B. Peppers, B. Lyman, C. Knorzer, G. Romanello, H. Tcheurekdjian, R. Hostoffer
http://ift.tt/2yTB7Nv
OR091 The disease severity and quality of life of asthmatic children after probiotics supplementation
Publication date: November 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 5, Supplement
Author(s): I. Wang, J. Hsu
http://ift.tt/2yY6XuG
OR004 Safe and effective implementation of chemotherapy outpatient desensitizations
Publication date: November 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 5, Supplement
Author(s): S. Barmettler, A. Wolfson, B. Slawski, J. Jordan, K. Blumenthal, A. Banerji
http://ift.tt/2yUiEk1
Title Page
Publication date: November 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 5, Supplement
http://ift.tt/2yY6Mzw
OR005 A penicillin skin testing initiative in an outpatient allergy practice
Publication date: November 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 5, Supplement
Author(s): A. Ramsey, S. Mustafa
http://ift.tt/2yThZ2f
OR064 Ocular manifestations in primary immunodeficiency (PID) patients within the us immunodeficiency network (USIDNET) registry
Publication date: November 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 5, Supplement
Author(s): M. Pham, M. Goldsmith, R. Fuleihan, K. Sullivan, C. Cunningham-Rundles
http://ift.tt/2yYefP8
OR006 Usability and comprehension of an illustrated Canadian Anaphylaxis Action Plan for Kids (Kids’ CAP study)
Publication date: November 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 5, Supplement
Author(s): W. Alqurashi
http://ift.tt/2yTauIA
OR074 Comparison of galactose-a-1,3-galactose specific IgE responses in children from rural Kenya and central Virginia
Publication date: November 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 5, Supplement
Author(s): J. Wilson, A. Schuyler, L. Workman, M. Perzanowski, H. James, S. Commins, P. Heymann, T. Platts-Mills
http://ift.tt/2yYec5U
OR011 Safety of multi-dose immunotherapy vials after routine use
Publication date: November 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 5, Supplement
Author(s): P. Nath, J. Freiler
http://ift.tt/2yThRzN
OR078 The prevalence of childhood food allergy in the United States: an update
Publication date: November 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 5, Supplement
Author(s): R. Gupta, C. Warren, J. Blumenstock, J. Kotowska, K. Mittal, B. Smith
http://ift.tt/2yYe86a
OR012 Simultaneous aerosolization of two perennial allergens in a novel, naturalistic Environmental Exposure Chamber (EEC) model
Publication date: November 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 5, Supplement
Author(s): V. Nelson, E. Beattie, P. Couroux, A. Salapatek
http://ift.tt/2ySZJpv
OR084 A novel mutation identified in the SATB1 gene, presenting as hyper IgM syndrome
Publication date: November 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 5, Supplement
Author(s): Y. Hamzavi Abedi, V. Bonagura
http://ift.tt/2yYe46q
Evaluating the Role of Balloon Sinuplasty in the Treatment of Pediatric Chronic Rhinosinusitis
Abstract
Purpose of Review
Balloon catheter sinuplasty's (BCS) role in the treatment algorithm of pediatric chronic rhinosinusitis (CRS) continues to evolve. Our review seeks to elucidate how best to use BCS when treating pediatric CRS based on the current literature.
Recent Findings
BCS as an adjuvant procedure to adenoidectomy or limited functional endoscopic sinus surgery potentially shows greater symptomatic improvements in both validated and non-validated questionnaires. BCS for recalcitrant CRS after adenoidectomy shows promise as well. BCS may not be as efficacious in patients with medical comorbidities or anatomic variants such as a hypoplastic maxillary sinus or Haller cells.
Summary
BCS as an adjuvant procedure, or as an additional procedure after adenoidectomy failure but before functional endoscopic sinus surgery, shows promising outcomes. Because of the limited evidence thus far, randomized-controlled prospective studies with higher power are needed to further clarify the efficacy of BCS. Further research regarding its role in acute complications of CRS is also needed.
http://ift.tt/2hh3IVl
Protocol for mandibular reconstruction with zygomatic implants (zygomatic mandibular implant)
Abstract
Introduction
This study describes a modified protocol using transmandibular zygomatic implants with immediate occlusal loading for the comprehensive dental rehabilitation of previously reconstructed mandibular defects and reports preliminary results of this modified protocol.
Materials and methods
Fifteen patients (6 female and 9 male), with a mean of age 40.26 years (range 12 to 68 years), had previously undergone immediate mandibular reconstruction using either autologous bone grafting, bone transport, or microvascular free-flap reconstruction for a variety of diagnoses. Transmandibular zygomatic implants were subsequently placed, depending on the type of defect. Implant stability was evaluated by insertion torque, percussion testing, and the implant stability quotient (ISQ). The patients were rehabilitated with an immediate provisional prosthesis. All patients' records included pre and postoperative clinical examination, radiographs, CT scan, and photographic analysis. All patients were followed for a minimum of 36 months.
Results
All patients were dentally rehabilitated immediately with functional and esthetic hybrid dentures based on either acrylic or porcelain on a metal framework. Among all cases of transmandibular zygomatic implants, the ISQ was greater than 75, which allowed immediate prosthetic loading. The zygomatic implants were considered to be successful if they were asymptomatic with no clinical mobility and no sign of infection. We have also added new indications for placement of transmandibular implants in cases of sequelae of gunshot trauma, dentoalveolar defects, and complications of orthognathic surgery, partially edentulous and/or failure of prior mandibular reconstruction.
Conclusions
The zygomatic implant is an excellent immediate loading option for mandibular dental rehabilitation among patients with mandibular defects. According to our observation, immediate occlusal loading of transmandibular zygomatic implants has a very good potential for success.
http://ift.tt/2ybZdWM
Reconstruction-The Final Dimension in Head and Neck Surgery: The 2017 Hayes Martin Lecture.
| Related Articles |
Reconstruction-The Final Dimension in Head and Neck Surgery: The 2017 Hayes Martin Lecture.
JAMA Otolaryngol Head Neck Surg. 2017 Oct 26;:
Authors: Wax MK
Abstract
The Hayes Martin lecture is dedicated to a giant who was essential to developing the surgical management of patients with head and neck cancer. Since that time, advents in anesthesia, intensive care, and improved diagnostic abilities have improved our ability to surgically manage and treat head and neck cancer. The original paradigm of resection, reconstruction, and rehabilitation was formulated as we endeavored to develop paradigms of treatment for our patients. We have maximized our resective and reconstructive abilities. Recognition that replacement of composition tissue defects allows one to best rehabilitate patients is persuasive throughout the field. The adoption of free tissue transfer has allowed us to reconstruct composition defects succinctly. The paradigm of a reconstructive ladder has been replaced with that of a reconstructive armamentarium. For most defects, compensate tissue is the preferred option. Rehabilitation of the maxillo/mandibular area requires providing patients with the ability to eat, drink, and articulate. Improvements in 3-dimensional modeling and surgical planning have allowed for exact reconstruction of the dental/alveolar/maxillary/mandibular structures. Thus, dental rehabilitation has markedly improved. Whereas it is still difficult to obtain this rehabilitation in many parts of the country, others are advancing the field to the concept of "teeth in a day." Patients will be able to undergo surgical resection and reconstruction and go home with functional dental implants. Finally, the ability to manipulate the milieu of the surgical and to promote cellular differentiation remains elusive but has tremendous potential to decrease the quantity of invasive surgery required to functionally rehabilitate our patients.
PMID: 29075779 [PubMed - as supplied by publisher]
http://ift.tt/2zKNGtR
Defining the Prevalence and Prognostic Value of Perineural Invasion and Angiolymphatic Invasion in Human Papillomavirus-Positive Oropharyngeal Carcinoma.
| Related Articles |
Defining the Prevalence and Prognostic Value of Perineural Invasion and Angiolymphatic Invasion in Human Papillomavirus-Positive Oropharyngeal Carcinoma.
JAMA Otolaryngol Head Neck Surg. 2017 Oct 26;:
Authors: Albergotti WG, Schwarzbach HL, Abberbock S, Ferris RL, Johnson JT, Duvvuri U, Kim S
Abstract
Importance: Recently, the American Joint Committee on Cancer (AJCC) updated its staging system for human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC). The prognostic significance of perineural invasion (PNI) and angiolymphatic invasion (ALI) within this staging system is unknown.
Objective: To examine the prevalence and prognostic significance of PNI and ALI in HPV-positive OPSCC.
Design, Setting, and Participants: A retrospective review was performed of all patients with HPV-positive OPSCC treated surgically at the University of Pittsburgh Medical Center from January 1, 1980, through December 31, 2015, with at least 1 year of follow-up or death within 1 year.
Interventions: Surgical treatment of HPV-positive OPSCC.
Main Outcomes and Measures: The prevalence of PNI and ALI was determined from review of pathologic data, and Kaplan-Meier curves were generated for overall survival and disease-free survival when stratified by the presence of PNI and ALI. Multivariate analysis was performed using a Cox proportional hazards regression model.
Results: A total of 201 patients met the inclusion criteria (mean [SD] age, 57.4 [9.0] years; 79.6% [3.0%] male, and 20.4% [3.0%] female). Perineural invasion was identified in 32 of 201 primary specimens (15.9%), whereas ALI was identified in 74 of 201 primary specimens (36.8%). Both were significantly associated with increasing T stage. On multivariate analysis, the presence of at least 1 risk factor was significantly associated with overall and disease-free survival (overall hazard ratio, 2.78; 95% CI, 1.15-6.76; disease-free survival hazard ratio, 3.10; 95% CI, 1.17-8.23). Among patients classified as having stage II disease according to the eighth edition of the AJCC manual, the presence of at least 1 risk factor was associated with worse overall survival (hazard ratio, 11.7; 95% CI, 1.2-111.7).
Conclusions and Relevance: Both PNI and ALI were commonly found in HPV-positive OPSCC, with increasing prevalence as T stage increased. The presence of at least 1 risk factor was associated with worse overall and disease-free survival. Specifically, among patients classified as having stage II disease according to the eighth edition of the AJCC manual, the presence of ALI or PNI may suggest a poorer prognosis.
PMID: 29075776 [PubMed - as supplied by publisher]
http://ift.tt/2zMldUk
Multidisciplinary Clinic Management of Head and Neck Cancer.
| Related Articles |
Multidisciplinary Clinic Management of Head and Neck Cancer.
JAMA Otolaryngol Head Neck Surg. 2017 Oct 26;:
Authors: Townsend M, Kallogjeri D, Scott-Wittenborn N, Gerull K, Jansen S, Nussenbaum B
Abstract
Importance: Contemporary management of head and neck cancer involves professionals from multiple specializations. Streamlined care that reduces delays yet allows for comprehensive evaluation is needed.
Objective: To evaluate a single-day, single-appointment, multidisciplinary head and neck clinic model for reduction in treatment delay and comprehensiveness of care.
Design, Setting, and Participants: A retrospective cohort analysis was conducted from June 1, 2015, to July 31, 2016, of outpatients at a single, academic medical center. All eligible outpatients seen in either the multiple-appointment, traditional clinic (n = 73) or the single-day multidisciplinary clinic (MDC) (n = 68) were included. Patients with new squamous cell carcinoma of the oropharynx, hypopharynx, sinonasal tract, and larynx, along with any mucosal site recurrence were eligible for the study.
Main Outcomes and Measures: Primary outcomes were delays between tertiary clinic referral or first appointment and treatment initiation in the MDC compared with the traditional clinic. Secondary outcomes were complete evaluations prior to treatment, enrollment in trials and registries, and rate of patient leak, defined as initiating therapy and then transferring to another center before completion. Outcome selection and hypothesis generation were performed a priori.
Results: Patient factors and tumor characteristics were similar between the traditional clinic cohort (19 women and 54 men; mean [SD] age, 64.0 [10.2] years) and the MDC cohort (8 women and 60 men; mean [SD] age, 61.0 [8.9] years). The MDC cohort had significantly fewer instances of delay greater than 30 days from referral to treatment initiation (28 [41%] vs 43 [59%]) and first appointment to treatment initiation (7 [10%] vs 17 [23%]). Actual median days in these categories were significantly different between the 2 clinic types after the patients in the traditional clinic who saw only a surgeon before treatment initiation were excluded (MDC, 28 days vs traditional, 35 days; median difference, -5 days; 95% CI, -11 to -1).
Conclusions and Relevance: Coordination of the management of head and neck cancer is complex. Treatment is time sensitive, and frequently clinician resources are limited. This MDC model was associated with improved efficiency and completeness of care.
PMID: 29075744 [PubMed - as supplied by publisher]
http://ift.tt/2zMFs4o
Aggressive-Appearing Pediatric Parotid Mass.
| Related Articles |
Aggressive-Appearing Pediatric Parotid Mass.
JAMA Otolaryngol Head Neck Surg. 2017 Oct 26;:
Authors: Weiss JP, Drew PA, Dziegielewski PT
PMID: 29075742 [PubMed - as supplied by publisher]
http://ift.tt/2zMoq6x
Long-term Functional and Quality-of-Life Outcomes After Transoral Robotic Surgery in Patients With Oropharyngeal Cancer.
| Related Articles |
Long-term Functional and Quality-of-Life Outcomes After Transoral Robotic Surgery in Patients With Oropharyngeal Cancer.
JAMA Otolaryngol Head Neck Surg. 2017 Oct 26;:
Authors: Achim V, Bolognone RK, Palmer AD, Graville DJ, Light TJ, Li R, Gross N, Andersen PE, Clayburgh D
Abstract
Importance: In recent years, transoral robotic surgery (TORS) has emerged as a useful treatment for oropharyngeal squamous cell carcinoma (OPSCC). In appropriately selected patients, the use of TORS may allow avoidance of adjuvant chemotherapy and/or radiotherapy, thereby avoiding the long-term adverse effects of these therapies.
Objective: To compare functional speech, swallowing, and quality-of-life outcomes longitudinally between those undergoing TORS only and those undergoing TORS and adjuvant radiotherapy (TORS+RT) or TORS and chemoradiotherapy (TORS+CRT).
Design, Setting, and Participants: This prospective, longitudinal cohort study performed from June 1, 2013, through November 31, 2015, included 74 patients undergoing TORS for initial treatment of OPSCC at a single tertiary academic hospital.
Main Outcomes and Measures: Data were collected at baseline, postoperatively (7-21 days), at short-term follow-up (6-12 months), and at long-term follow-up (>12 months). The quality-of-life metrics included the 10-item Eating Assessment Tool and the University of Michigan Head and Neck Quality of Life instrument. Data were also collected on tumor staging, surgical and adjuvant therapy details, patient comorbidities, tracheostomy and feeding tube use, and functional speech and swallowing status using the Performance Status Scale for Head and Neck Cancer Patients.
Results: Seventy-four patients were enrolled in the study (mean [SD] age, 61.39 [7.99] years; 68 [92%] male). Median long-term follow-up was 21 months (range, 12-36 months). The response rates were 86% (n = 64) postoperatively, 88% (n = 65) at short-term follow-up, and 86% (n = 64) at long-term follow-up. In all 3 groups, there was a significant worsening in pain and all swallowing-related measures postoperatively. There was subsequent improvement over time, with different trajectories observed across the 3 intervention groups. Postoperative dysphagia improved significantly more quickly in the TORS-only group. At long-term follow-up, weight loss differed between the TORS-only and TORS+RT groups (mean difference, -16.1; 97.5% CI, -29.8 to -2.4) and the TORS-only and TORS+CRT groups (mean difference, -14.6; 97.5% CI, -29.2 to 0) in a clinically meaningful way. In addition, the TORS-only group had significantly better scores than the TORS+CRT group on the Performance Status Scale-Eating in Public scale (mean difference, 21.8; 97.5% CI, 4.3-39.2) and Head and Neck Quality of Life-Eating scale (mean difference, 21.2; 97.5% CI, 4.0-38.3).
Conclusions and Relevance: Patients who underwent TORS+CRT demonstrated poorer long-term outcomes, with continued dysphagia more than 1 year after surgery. These findings support the investigation of adjuvant de-escalation therapies to reduce the long-term adverse effects of treatment.
PMID: 29075740 [PubMed - as supplied by publisher]
http://ift.tt/2yZUt5J
Complications From Surgically Assisted Rapid Maxillary Expansion With HAAS and HYRAX Expanders.
The current study aimed at comparing the number and type of undesired outcomes during and after the maxillary expansion performed with HYRAX and HAAS expanders. A total of 90 patients (41 males and 49 females, 45.6% and 54.4%, respectively) aged 18 to 59 (mean age of 26.1; standard deviation [SD] = 7.4) underwent subtotal Le Fort I osteotomy and pterygomaxillary disjunction following surgically assisted rapid maxillary expansion (SARME) carried out using HAAS (n = 29; 48.3% male and 51.7% female; mean age = 27: SD = 7.7) and HYRAX (n = 61; 44.3% male and 55.7% female; mean age = 26; SD = 7.2) expanders. Post-SARME dento-gingival, radiographic, and clinical undesired outcomes were evaluated. A total of 16 (17.8%) patients experienced at least 1 undesired outcome-7 (7.8%) and 9 (10.0%) in HAAS and HYRAX group, respectively. The most common undesired outcomes were radiographic asymmetric expansion-2 (2.2%) and 3 (3.3%) in HAAS and HYRAX group, respectively-followed by pain during out-of-clinic expansion 4 (4.4%) in HAAS group only-dental darkening 5 (5.5%) in HYRAX group, only, requiring root canal treatment, and local infection-2 (2.2%), 1 in each HAAS and HYRAX groups. Excepting for complications arising from the acrylic stop plate in HAAS expander, the number and severity of complications observed in the current study did not differ due to the use of HAAS and HYRAX appliances to perform maxillary expansion. Hygiene issues do not rule out the use of HAAS. The wider maxillary expansion performed, the more frequent are the cases of asymmetric expansion. (C) 2017 by Mutaz B. Habal, MD.
http://ift.tt/2gQAyPT
http://ift.tt/2gQAyPT
The Impact of Type-D Personality on Oral Health-Related Quality of Life in Cleft Lip and Palate Adolescents.
The purpose of this study was to investigate the oral health-related quality of life and type-D personality in cleft lip/palate (CLP) patients and the relationship between type-D personality and oral health-related quality of life (OHRQoL) in CLP patients. Fifty patients with CLP within age range from 8 to 15 years were chosen and asked to complete both Child Oral Health Impact Profile (COHI) and Type-D scale (DS14) questionnaire. Moreover, the participants of a control group matched with CLP patients were asked to complete the DS14 questionnaire. A significant difference between boys and girls on the subscale "emotional well-being" of COHIP (P = 0.001) and a positive significant correlation between "oral symptoms" and age (P = 0.029) were found among CLP patients. The prevalence of type-D personality was equal between clefts and nonclefts groups. However, there was a significant relationship between type-D personality and OHRQoL in CLP patients regarding mean scores of overall COHIP and its subscales (P
http://ift.tt/2yS4vq2
http://ift.tt/2yS4vq2
One-Stage Treatment of Giant Condylar Osteoma: Alloplastic Total Temporomandibular Joint Replacement Aided by Digital Templates.
Objectives: To introduce the surgical techniques and evaluate the effect of alloplastic total temporomandibular joint (TMJ) replacement aided by digital templates in giant condylar osteoma. Methods: Three patients with giant condylar osteoma were enrolled in this study. The maximal mouth opening was 1.9 cm on average. All the patients were underwent the computed tomography scan (slice thickness 1 mm) and the data were imported to Proplan 1.3 software for 3-dimensional bony segmentation and reconstruction. Osteotomy line and digital template according the 3-dimensional measurement were designed. All the joints were replaced with Biomet standard prosthesis under general anesthesia. Results: All the operations were successfully performed. The follow-up period was from 6 to 18 months (average, 12 months). Pain relief of the joint and mouth-opening improvement were significant in 3 patients. No infection or loosening the prostheses was occurred. The occlusal relationship kept stable in all patients. Conclusions: Total TMJ replacement with standard prosthesis is a good strategy for TMJ reconstruction after giant condylar osteoma excision. The joint pain and the mouth-opening limitation resulted from giant condylar osteoma were markedly improved. Long-term effect remains to be evaluated based on a long-term follow-up. (C) 2017 by Mutaz B. Habal, MD.
http://ift.tt/2gQEOPp
http://ift.tt/2gQEOPp
Myoepithelioma of the Soft Palate.
Myoepitheliomas are extremely rare salivary gland tumors. Myoepithelioma of salivary glands comprised only 1% of all salivary tumors, most commonly occurring in the parotid gland followed by the minor salivary glands in the oral cavity. Involvement of the soft palate is a rare occurrence. This tumor is usually benign, and its treatment is total lesion excision. Here, the author reports a case of myoepithelioma of the soft palate in a 42-year-old Turkish man. The mass was removed by local excision under general anesthesia. There was no recurrence during the follow-up period of 10 months. (C) 2017 by Mutaz B. Habal, MD.
http://ift.tt/2gQmHcG
http://ift.tt/2gQmHcG
Nasopharyngoscopic Analyses through Anterior Maxillary Distraction Osteogenesis for Adolescent Patients With Cleft Palate.
Anterior maxillary distraction osteogenesis (AMDO) is a novel technique for correcting hypoplastic maxilla by sagittal expansion of the maxilla. Recent reports suggest that AMDO does not have an effect on fragile velopharyngeal function in patients with cleft palate. Furthermore, no studies have evaluated the impact of AMDO on velopharyngeal function. We adopted AMDO to correct severe hypoplastic maxilla in adolescent patients with cleft palate and evaluated its impact on velopharyngeal space and function in 8 patients aged 12 to 21 years who underwent AMDO from 2006 to 2014. All the patients had received treatment for cleft palate; however, they still exhibited marginal velopharyngeal insufficiency. The mean activation of the distractor was 10.9 +/- 0.9 mm. We determined changes in velopharyngeal closure ratio and closure pattern via nasopharyngoscopy. Additionally, skeletal changes were evaluated using lateral cephalograms. The mean horizontal advancement in the cephalogram obtained 1 year after the distraction was +6.4 mm. Nasopharyngoscopic examination revealed that no deterioration of velopharyngeal gap had occurred after AMDO in all 8 patients. The velopharyngeal closure pattern changed from coronal to circular in 1 patient. Our results indicate that AMDO achieved correction of hypoplastic maxilla without deterioration in velopharyngeal gap and function. Therefore, AMDO is an effective and optimal approach for correcting hypoplastic maxilla especially in patients with fragile velopharyngeal function, such as those with cleft palate. (C) 2017 by Mutaz B. Habal, MD.
http://ift.tt/2yTHHWC
http://ift.tt/2yTHHWC
Oxygen, Left/Right Asymmetry, and Cleft Lip and Palate.
Cleft lip and palate is the most common craniofacial birth defect, and its etiology has been the focus of many reports in the literature. It is well accepted that both genetics and environment play a role in the condition; however, the authors still have not been able to translate what have been learned into clinical applications. This paper provides an interpretation of 2 possible mechanisms leading to cleft lip and palate in humans. First, the authors reflect on the known association between maternal cigarette smoking and risk for cleft lip and palate and the proposed hypoxic mechanism put forward to explain this association. Second, the authors reflect on the difference in frequency between left and right cleft lip and propose that without more extensive clinical definitions, it will be difficult to definitely unveil genetic targets that can be used for counseling. (C) 2017 by Mutaz B. Habal, MD.
http://ift.tt/2gPPrCn
http://ift.tt/2gPPrCn
Accessory Mental Foramen and Maxillofacial Surgery.
Accessory mental foramens should be considered in surgical procedures performed in mandibular body and symphysis. Location and content of these foramina has significant impact on the result of surgery. Lip numbness is the catastrophic result if these foramina are violated while their content is nerves that carry sensory inputs from lower lip. Examples of interferences with dental implant, orthognathic, and periapical surgeries are presented and it is discussed in which conditions they complicate oral surgical procedures. (C) 2017 by Mutaz B. Habal, MD.
http://ift.tt/2ySdkzW
http://ift.tt/2ySdkzW
Autogenous Partial Bone Chip Grafting on the Exposed Inferior Alveolar Nerve After Cystic Enucleation.
This prospective study evaluated the clinical effectiveness of the new approach of partial autogenous bone chip grafts for the treatment of mandibular cystic lesions related to the inferior alveolar nerve (IAN). A total of 38 patients treated for mandibular cysts or benign tumors were included in this prospective study and subsequently divided into 3 groups depending on the bone grafting method used: cystic enucleation without a bone graft (group 1), partial bone chip graft covering the exposed IAN (group 2), and autogenous bone graft covering the entire defect (group 3). We evaluated the symptoms, clinical signs, and radiographic changes using dental panorama preoperatively, immediate postoperatively, and at 1, 3, 6, and 12 months postoperatively. Radiographic densities were compared using Adobe Photoshop CS5 (Adobe Systems Inc., San Jose, CA). Repeated measures analysis of variance was used for statistical evaluation with SPSS 22.0 (SPSS Inc, Chicago, IL), and P
http://ift.tt/2gQhDF1
http://ift.tt/2gQhDF1
Changes in Anxiety and Depression Are Mediated by Changes in Pain Severity in Patients Undergoing Lower-Extremity Total Joint Arthroplasty.
Background: Depression and anxiety are common comorbidities in chronic pain including osteoarthritis patients undergoing total joint arthroplasty (TJA). What is not clear is whether psychiatric comorbidity precedes the manifestation of painful states or represents a reaction to living with chronic pain and associated functional impairment. The objective of this research was to explore whether decreases in depressive and anxiety symptoms after lower-extremity TJA could be due to postsurgical reductions in pain. Methods: We conducted a secondary analysis of data from 1448 TJA patients enrolled in the Analgesics Outcome Study. Patients completed measures of pain intensity, functional status, and depressive and anxiety symptoms preoperatively and at 3 and 6 months postoperatively. Data were analyzed using a structural equation modeling approach. Results: We found that improvement in pain and physical function from baseline to 6 months postoperatively was associated with improvement in depression and anxiety symptoms. We also found that a change in overall body pain at 3 months after surgery significantly mediated changes in both the depression and anxiety scores at 6 months after surgery even when controlling for age, sex, baseline body pain, education, opioid use, and type of surgery. Conclusions: Presurgical affective symptoms not only have an effect on change in postsurgical pain, whereby lower preoperative scores on depression and anxiety were associated with lower postsurgical pain, but also postsurgical decreases in pain were associated with lower levels of depression and anxiety after surgery. Taking these points into consideration may prove useful in working toward better outcomes for TJA. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.
http://ift.tt/2yTMYv3
http://ift.tt/2yTMYv3
Microbioma and probiotics: from gut to Mars
Publication date: Available online 27 October 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Bruno Acatauassú Paes Barreto
http://ift.tt/2ibs4zE
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