The importance of dermoscopy for the diagnosis of acquired bilateral telangiectatic macules: the angioid streak pattern reveals underlying chronic liver disease

Abstract

Background

Acquired bilateral telangiectatic macules (ABTM) are a newly recognized disease entity, which manifest as multiple telangiectatic pigmented macules confined mostly to the upper arms.

Objectives

To evaluate clinical and dermoscopic features in a group of 50 patients with ABTM and to determine the diagnostic usefulness of dermoscopy in ABTM

Methods

Patients were selected from two tertiary teaching hospitals in Korea (Pusan National University Hospitals [Busan and Yangsan]). Fifty patients (41 males and 9 females; mean age 48.1 years; range 26-78 years) with ABTM were included in the study. The dermoscopic findings were graded using a 4-point scale: none (0), mild (1), moderate (2), and severe (3). In addition, the results of 23 patients with and 27 patients without chronic liver disease (CLD) were compared to determine whether the presence of CLD affect dermoscopic findings.

Results

Three distinct dermoscopic patterns were observed; brown pigmentations, telangiectasia (linear-irregular vessels) and an angioid streak pattern. Brown pigmentation in the group without CLD had higher severity score than those in CLD group (mean score: 2.00 vs 1.48, P =0.033). However, mean telangiectasia severity score was higher in the CLD group (2.14 vs 1.39, P < 0.001). The angioid streak pattern was more severe and more common in patients with CLD than in those without (1.37 vs 0.35 (P < 0.001) and 63.0% vs. 26.1%, respectively).

Conclusion

Detailed observations with dermoscopy can provide first clues of the presence of ABTM and underlying chronic liver disease.

This article is protected by copyright. All rights reserved.

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Disfiguring facial mycoses- a diagnostic and therapeutic challenge

Some fungal infections may lead to devastating destruction of face, sometimes followed by fatal consequences. Conidiobolus coronatus is a rare, but serious emerging fungal pathogen of humans, causing Conidiobolomycosis, commonly infecting nasal mucosa and with potential to extend to involve vital structures such as brain and eyes. Treatment of this infection is extremely difficult and can cause significant disfiguring sequale, unless aggressively treated. We illustrate an interesting case, encountered within a short space of time affected by such infections and emphasize the need for thorough evaluation, investigation and aggressive initial treatment to achieve a good clinical response.

This article is protected by copyright. All rights reserved.

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Prevalence of papular urticaria caused by flea bites and associated factors in children 1–6 years of age in Bogotá, D.C.

Papular urticaria is a chronic inflammatory disease caused by exposure to arthropod bites. The disease has been reported in children attending medical centers, but the causes as the risk factors associated wit...

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A shared decision-making tool for obstructive sleep apnea without tonsillar hypertrophy: A randomized controlled trial

Objectives/Hypothesis

Shared decision-making is a process whereby patients and clinicians jointly establish a treatment plan integrating clinical evidence and patient values and preferences. Although this approach has been successfully employed in numerous medical disciplines, often using shared decision-making tools, otolaryngologic research assessing its use is scant. Our primary objective was therefore to determine if the tools we developed reduced decisional conflict for children with obstructive sleep apnea without tonsillar hypertrophy.

Study Design

Prospective, single-blind, randomized controlled trial.

Methods

We enrolled consecutive patients meeting inclusion criteria who were referred to our multidisciplinary upper airway center. Study patients used a shared decision-making tool whereas controls did not. Measures of decisional conflict (SURE [Sure of myself, Understanding information, Risk benefit ratio, Encouragement], CollaboRATE, and the Decisional Conflict Scale [DCS]) were obtained pre- and postvisit.

Results

We assessed 50 families (study group = 24, controls = 26). The mean age was 8.8 ± 6.6 years, 44% were female, 86% were white, and the mean obstructive apnea-hypopnea index was 12.7 ± 15.6 events/hour. The previsit mean DCS score was similar for controls (42.7) and study patients (40.8) (P = .38). The postvisit mean DCS score for controls was 13.3 and for study patients 6.1 (P = .034). Improvement in this score was greater in the study group (P = .03). At previsit evaluation, 63% of controls and 58% of study patients were unsure about their options. Postvisit, this improved to 4.1% and 0%, respectively.

Conclusions

Families counseled regarding treatment options using shared decision-making tools had significantly less decisional conflict than those who did not use these tools. These positive outcomes suggest that clinicians should consider integrating this approach into clinical practice.

Level of Evidence

1b Laryngoscope, 2017

http://ift.tt/2hRM0YT

Total septal perforation repair with a pericranial flap: Radio-anatomical and clinical findings

Objectives/Hypothesis

Endonasal surgeries are the primary cause of septal perforation (SP). However, trauma, inflammation, infections, neoplasms, or abuse of inhaled drugs can also cause SP. Septal repair is indicated in patients who experience nasal obstruction, crusting, intermittent epistaxis, purulent discharge, or nasal whistling and in those who fail conservative treatment. Multiple approaches have been suggested to repair the SP; however, none has been universally adopted. This study explores the feasibility of repairing a total SP using the pericranial flap (PCF).

Study Design

Anatomical cadaver and radiological study plus case study.

Methods

Total nasal septectomy and endoscopic reconstruction with a PCF was performed in 12 injected cadaveric specimens. Maximum length and area of the nasal septum and the PCF were measured in 75 computed tomography scans. Based on the anatomical study and the radiological measurements of the cadavers, one patient underwent total nasal septum repair.

Results

Anatomic measurements showed that the nasal septum has a mean length of 5.8 ± 0.7 cm, whereas the PCF was on average 18.4 ± 1.3 cm long (mean surface area 121.6 ± 17.7 cm²). Radiological measurements revealed that the PCF should provide a surface area of 40.9 ± 4.2 cm² to account for the total septal area and an additional 30% to account range for potential scar retraction. For total septum repair, the distal edge of the PCF had to be placed 0.8 ± 2.0 cm (3.4 ± 8.7°) from the adopted reference point (vertical projection of the external ear canal). Total septal reconstruction was performed successfully in one patient without complications.

Conclusions

Radio-anatomical data and a case study demonstrate that a PCF allows complete endoscopic repair of the nasal septum.

Level of Evidence

NA Laryngoscope, 2017

http://ift.tt/2Ak2rnx

Three-dimensional endoscopy for endoscopic salvage nasopharyngectomy: Preliminary report of experience

Background

Prospective, observational study to assess the efficacy of salvage nasopharyngectomy for recurrent nasopharyngeal carcinoma (NPC) via the endoscopic endonasal approach using a three-dimensional (3D) high-definition endoscopic system.

Methods

Between 2016 and 2017, 30 patients with recurrent NPC were recruited. Patient demographics, tumor characteristics, and perioperative data were recorded. Instrument ergonomics and perceived advantages were assessed by the operating, assisting, and observing surgeons.

Results

The majority (70%) of patients received radiotherapy alone as the initial treatment for NPC, and tumor recurred after a mean interval of 16.8 months. The tumor (T) classifications of the recurrent (R) tumors were: RT1: 46.7%; RT2: 33.3%; and RT3: 20.0%. The mean operative time was 293.3 minutes, and no conversion to open approach was necessary. Internal carotid artery dissection was required in nine patients, and the resection and repair of dura was required in six patients. The most common method of reconstruction was free vastus lateralis flap (46.7%). Microscopically clear resection margins were achieved in 73.3% of patients. The mean hospital stay was 6.8 days. There was no hospital mortality. One patient developed minor secondary hemorrhage, whereas the other developed transient contralateral vocal cord paralysis. On quantitative assessment, surgeons noticed a significant advantage of the 3D system with regard to depth and size perception, anatomy identification, and hand–eye coordination, whereas there was no significant difference in terms of strain sensation and dizziness.

Conclusion

The 3D high-definition endoscopic system improves the precision of endoscopic nasopharyngectomy, particularly when dissection of the internal carotid artery and dura is required.

Level of Evidence

4. Laryngoscope, 2017

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Telemedicine in laryngology: Remote evaluation of voice disorders-setup and initial experience

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The contribution of cochlear implants to postural stability

Objectives

To determine whether spatial auditory cues provided by cochlear implants can improve postural balance in adults with severe deafness.

Methods

In the presence of spatial white noise, 13 adult cochlear implantees wore head and lumbar-mounted inertial sensors while standing in the dark for 30 seconds in two auditory conditions: hearing assistive devices on and off.

Results

Stability was improved with implants on (aided condition) compared to off (unaided condition) with respect to differences in mean head velocity (Cohen's d = 0.912, P = 0.006) as well as to root mean square (RMS) acceleration (Cohen's d = 0.456, P = 0.048). This was particularly evident in measures of anteroposterior accelerations (mean difference = 0.034 m/s²; Cohen's d = 0.612; P = 0.011).

Conclusion

The decrease in RMS head acceleration and velocity while wearing cochlear implants suggests that they could be recognized as balance implants in addition to auditory implants. The clinical importance of this finding in various patient populations remains to be determined.

Level of Evidence

4. Laryngoscope, 2017

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When should therapeutic anticoagulation be restarted following major head and neck surgery?

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In reference to intervention for elevated intracranial pressure improves success rate after repair of spontaneous cerebrospinal fluid leaks

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Proton density–weighted laryngeal magnetic resonance imaging in systemically dehydrated rats

Objectives/Hypothesis

Dehydrated vocal folds are inefficient sound generators. Although systemic dehydration of the body is believed to induce vocal fold dehydration, this causative relationship has not been demonstrated in vivo. Here we investigate the feasibility of using in vivo proton density (PD)–weighted magnetic resonance imaging (MRI) to demonstrate hydration changes in vocal fold tissue following systemic dehydration in rats.

Study Design

Animal study.

Methods

Sprague-Dawley rats (n = 10) were imaged at baseline and following a 10% reduction in body weight secondary to withholding water. In vivo, high-field (7 T), PD-weighted MRI was used to successfully resolve vocal fold and salivary gland tissue structures.

Results

Normalized signal intensities within the vocal fold decreased postdehydration by an average of 11.38% ± 3.95% (mean ± standard error of the mean [SEM], P = .0098) as compared to predehydration levels. The salivary glands experienced a similar decrease in normalized signal intensity by an average of 10.74% ± 4.14% (mean ± SEM, P = .0195) following dehydration. The correlation coefficient (percent change from dehydration) between vocal folds and salivary glands was 0.7145 (P = .0202).

Conclusions

Ten percent systemic dehydration induced vocal fold dehydration as assessed by PD-weighted MRI. Changes in the hydration state of vocal fold tissue were highly correlated with that of the salivary glands in dehydrated rats in vivo. These preliminary findings demonstrate the feasibility of using PD-weighted MRI to quantify hydration states of the vocal folds and lay the foundation for further studies that explore more routine and realistic magnitudes of systemic dehydration and rehydration.

Level of Evidence

NA Laryngoscope, 2017

http://ift.tt/2Ak2kZ9

Development and external validation of a risk-prediction model to predict 5-year overall survival in advanced larynx cancer

Objectives/Hypothesis

TNM-classification inadequately estimates patient-specific overall survival (OS). We aimed to improve this by developing a risk-prediction model for patients with advanced larynx cancer.

Study Design

Cohort study.

Methods

We developed a risk prediction model to estimate the 5-year OS rate based on a cohort of 3,442 patients with T3T4N0N+M0 larynx cancer. The model was internally validated using bootstrapping samples and externally validated on patient data from five external centers (n = 770). The main outcome was performance of the model as tested by discrimination, calibration, and the ability to distinguish risk groups based on tertiles from the derivation dataset. The model performance was compared to a model based on T and N classification only.

Results

We included age, gender, T and N classification, and subsite as prognostic variables in the standard model. After external validation, the standard model had a significantly better fit than a model based on T and N classification alone (C statistic, 0.59 vs. 0.55, P < .001). The model was able to distinguish well among three risk groups based on tertiles of the risk score. Adding treatment modality to the model did not decrease the predictive power. As a post hoc analysis, we tested the added value of comorbidity as scored by American Society of Anesthesiologists score in a subsample, which increased the C statistic to 0.68.

Conclusions

A risk prediction model for patients with advanced larynx cancer, consisting of readily available clinical variables, gives more accurate estimations of the estimated 5-year survival rate when compared to a model based on T and N classification alone.

Level of Evidence

2c Laryngoscope, 2017

http://ift.tt/2hRLUjZ

Cricothyroid joint type as predictor for vocal fold elongation in professional singers

Objective

Vocal fold (VF) elongation vocal folds depends on two factors: the activity of the laryngeal muscles and the cricothyroid joint (CTJ). The aim of the study was to show the influence of the CTJ on VF elongation while singing a sustained vowel at different pitches.

Study Design

Prospective study.

Methods

Forty-nine female professional singers (25 sopranos, 24 altos) were recruited. Three-dimensional images of the larynx derived from high-resolution computed tomography scanning were obtained at the mean speaking fundamental frequency (F0) and one (F1) and two octaves (F2) above this pitch.

Results

From F0 to F1, all three CTJ types showed equal elongation of the VF (type A: 14%, type B/C: 13%). From F1 to F2, VF elongation was 8% in singers with type A and 4% in those with type B/C (P < 0.0001).

Conclusion

The stability of the CTJ directly influences VF during singing. This is the first study to show this relationship in vivo.

Level of Evidence

4. Laryngoscope, 2017

http://ift.tt/2AiDQj5

Lack of long-term add-on effect by montelukast in postoperative chronic rhinosinusitis patients with nasal polyps

Objectives/Hypothesis

Eosinophils and mast cells are among the key cells in inflammatory diseases like chronic rhinosinusitis (CRS) and asthma. Leukotriene antagonists have proven to be effective in the treatment of asthma, but data about their efficacy in CRS are scarce, whereas data on montelukast as an add-on treatment to intranasal corticosteroids (INCS) in a postoperative setting are completely lacking.

Study Design

Prospective, randomized, open-label trial.

Methods

In this trial with long-term follow-up, we evaluated the efficacy of montelukast as an add-on treatment to INCS in postoperative CRS with nasal polyp (CRSwNP) patients. CRSwNP patients (N = 72) undergoing endoscopic sinus surgery were randomized in two arms for the postoperative treatment. One group (N = 36) received INCS in monotherapy, whereas the other group (N = 36) received INCS in association with montelukast for 1 year. The efficacy of montelukast with INCS was evaluated by assessing both subjective (total five-symptom score [T5SS]) and objective (nasal polyp score [NPS], Lund-Mackay [LMK] score, and subjective olfactometry [Barcelona Smell Test 24]) outcome parameters and compared with the gold standard of INCS in monotherapy.

Results

After 1 year of surgery, T5SS, NPS, and LMK score were significantly reduced in patients treated with either INCS or INCS plus montelukast, without significant differences between the two treatment arms. Improvement of smell loss by olfactometry was also observed with no differences between arms. Similar findings were observed at 3 and 6 months.

Conclusions

These results suggest that the addition of montelukast to INCS should not be recommended in the treatment of postoperative CRSwNP patients.

Level of Evidence

1b Laryngoscope, 2017

http://ift.tt/2hRLRVl

Cough strength and expiratory force in aspirating and nonaspirating postradiation head and neck cancer survivors

Objective

Expiratory functions that clear aspiration from the airway are compromised in patients with neurogenic dysphagia for whom cough and expiratory force may be impaired by the primary disease process. The relationship between expiratory function, cough, and aspiration is less clear in head and neck cancer (HNC) survivors for whom the disease process does not directly impact the lower respiratory system. Our objective was to compare mechanisms of airway clearance (expiratory force and cough) with aspiration status in postradiated HNC survivors.

Study Design

Cross-sectional study.

Methods

One hundred and three disease-free HNC survivors ≥ 3-months postradiotherapy referred for modified barium swallow studies were prospectively enrolled regardless of dysphagia status. Maximum expiratory pressures (MEPs) and peak cough flow (PCF) measures were taken at enrollment and examined as a function of aspiration status using generalized linear regression methods.

Results

Thirty-four (33%) patients aspirated. Maximum expiratory pressure and PCF demonstrated a moderate positive correlation (Pearson's r = 0.35). Adjusting for sex and age, MEPs were on average 19.2% lower (21.1 cm H₂O, 95% confidence interval [CI] 5.3, 36.8) among aspirators. Peak cough flow was also 14.9% lower (59.6 L/minute, 95% CI 15.8, 103.3) among aspirators after adjusting for age and sex.

Conclusion

Expiratory functions were depressed in postradiated HNC aspirators relative to nonaspirators, suggesting that airway protection impairments may extend beyond disrupted laryngopharyngeal mechanisms in the local treatment field. Exercises to strengthen subglottic expiratory force-generating capacity may offer an adjunctive therapeutic target to improve airway protection in chronic aspirators after head and neck radiotherapy.

Level of Evidence

2b. Laryngoscope, 2017

http://ift.tt/2Ak2hMX

Examination of olfactory training effectiveness in relation to its complexity and the cause of olfactory loss

Objective

Although the effectiveness of olfactory training (OT) had already been documented, the optimal regimen for such training remains unexplored. We examined whether the complexity of OT, namely alteration of odor quantity and quality, increases its effectiveness.

Design

One-hundred eight patients (M_age = 60.1 ± 1) with postinfectious (n = 57) or idiopathic (n = 51) olfactory dysfunction underwent OT preceded and followed by examination of olfactory function.

Methods

Subjects were randomly assigned to one of the three experimental conditions: 1) simple training comprising four basic, single-molecule substances; 2) complex training involving four odor mixtures; and 3) odor-altering training in which patients changed sets of mixtures every 2 months.

Results

The analysis of variance revealed that the benefit seen in this sample was not affected by the complexity of OT with regard to odor mixtures or alteration of odor type. The highest increase of the Sniffin' Sticks (Burghardt GmbH; Wedel, Germany) threshold, discrimination, and identification (and overall TDI) score was observed in postinfectious patients.

Conclusion

We conclude that the outcomes of OT are not strongly influenced by the training regimen. However, further investigation of OT regimens is required, particularly with regard to training duration.

Level of Evidence

2b. Laryngoscope, 2017

http://ift.tt/2hRLPgb

Can Corticotomy (with or without bone grafting) Expand the Limits of Safe Orthodontic Therapy?

Publication date: Available online 7 November 2017
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Federico Brugnami, Alfonso Caiazzo, Pushkar Mehra
PurposeTo assess whether concomitant particulate bone grafting makes a difference in the ability to safely orthodontically reposition teeth outside the bony envelope after corticotomy.Material & MethodsRetrospective analysis of patients who underwent corticotomy as part of their orthodontic therapy for treatment of severe crowding. Patients were divided as: a) Group 1: corticotomy with bone grafting, and, b) Group 2: corticotomy without bone grafting. CT scan examinations were performed before and at the end of the treatment. Measurements of bone and tooth positions were obtained and differences between pre- and post-treatment values were calculated.ResultsThe study sample included 20 adult patients between the ages of 25 to 58 years. A total of 144 teeth were orthodontically repositioned outside their native bony envelope after corticotomy. Average follow-up was 9 months. Teeth that were repositioned after corticotomy and bone grafting maintained the alveolar bone volume around them while corticotomy without bone grafting was not successful in maintaining bone thickness around teeth that were moved outside the alveolar housing.ConclusionsCorticotomy in combination with guided bone regeneration has the potential to increase the scope of conventional orthodontic treatment by allowing for expansive movements beyond the traditional limits.



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3-O-Glyceryl-2-O-hexyl ascorbate suppresses melanogenesis by interfering with intracellular melanosome transport and suppressing tyrosinase protein synthesis

Summary

Background

Ascorbic acid (AsA) has multifunctional benefits on skin beauty, such as the reduction in oxidative stress and the induction of collagen production. Among them, the prevention and improvement of skin pigmentation by AsA is a most important benefit for people. However, it is well known that AsA not only is quite unstable in formulations but it also has a low capability of skin penetration due to its hydrophilic property. In addition, existing water-soluble AsA derivatives that were developed to improve its stability also have low skin penetration.

Aim

To investigate the potential of a newly synthesized amphiphilic derivative of AsA, 3-O-Glyceryl-2-O-hexyl ascorbate (VC-HG), which has an added glyceryl group and a hexyl group, on skin beauty focusing on its skin lightening/whitening effects.

Methods

DNA microarray analysis and real-time PCR were used to clarify the effects of VC-HG on melanogenesis using B16 mouse melanoma cells. The effects of VC-HG on melanin synthesis, tyrosinase protein levels, and the inhibition of tyrosinase activity were evaluated.

Results

DNA microarray analysis revealed that treatment with VC-HG downregulated the expression of genes encoding tyrosinase and MyosinVa. Further, real-time PCR analysis showed the downregulation of tyrosinase, MyosinVa, Rab27a, and Kinesin mRNAs following VC-HG treatment. In addition, VC-HG caused decreases in tyrosinase protein levels and melanin synthesis.

Conclusion

We conclude that VC-HG has an impact on skin lightening/whitening by inhibiting tyrosinase protein synthesis and interfering with intracellular melanosome transport.

http://ift.tt/2AqhQnc

Delayed Intraventricular Hemorrhage following a Ventriculoperitoneal Shunt Placement: Exploring the Surgical Anatomy of a Rare Complication

Ventriculoperitoneal shunt (VPS) placement is one of the commoner neurosurgical procedures worldwide. The purpose of this article is to report a case of delayed intraventricular hemorrhage (IVH) following a VPS and to review the literature regarding anatomic factors that could potentially explain this rare complication. A 78-year-old man with normal pressure hydrocephalus, who underwent an uneventful right VPS placement, suffered from a catastrophic isolated IVH five days later. The reported cases of delayed intracerebral hemorrhage (ICH) following VPS are rare and those with IVH are even rarer. Potential factors of surgical anatomy that could cause delayed ICH/IVH following a VPS procedure include erosion of vasculature by catheter cannulation, multiple attempts at perforation, puncture of the choroid plexus, improper placement of the tubing within the brain parenchyma, VPS system revision, venous infarction, vascular malformations, head trauma, and brain tumors. Other causes include generalized convulsion, VPS system malfunction, increased intracranial or blood pressure, sudden intracranial hypotension, and bleeding disorders. According to the current literature, our case is the first reported delayed isolated IVH after a VPS placement so far. Neurosurgeons should be aware of the delayed ICH/IVH as a rare, potentially fatal complication of VPS, as well as of its risk factors.

http://ift.tt/2AqpPk5

Thyroid High-Impact Articles

FREE ACCESS through November 21, 2017.
Read now:

Latest Impact Factor: 5.515
The Official Journal of: American Thyroid Association

The 2017 Bethesda System for Reporting Thyroid Cytopathology
Edmund S. Cibas, Syed Z. Ali 

The Role of Chemokines in Thyroid Carcinoma
Sharinie Yapa, Omar Mulla, Victoria Green, James England, John Greenman 

Childhood Thyroid Function Reference Ranges and Determinants: A Literature Overview and a Prospective Cohort Study
Ibrahim Önsesveren, Mirjana Barjaktarovic, Layal Chaker, Yolanda B. de Rijke, Vincent W.V. Jaddoe, Hanneke M. van Santen, Theo J. Visser, Robin P. Peeters, Tim I.M. Korevaar 

Temporal Changes in Thyroid Nodule Volume: Lack of Effect on Paranodular Thyroid Tissue Volume
Giorgio Grani, Rocco Bruno, Giuseppe Lucisano, Giuseppe Costante, Domenico Meringolo, Efisio Puxeddu, Massimo Torlontano, Salvatore Tumino, Marco Attard, Livia Lamartina, Antonio Nicolucci, David S. Cooper, Sebastiano Filetti, Cosimo Durante 

Projecting Survival in Papillary Thyroid Cancer: A Comparison of the Seventh and Eighth Editions of the American Joint Commission on Cancer/Union for International Cancer Control Staging Systems in Two Contemporary National Patient Cohorts
Lauren N. Pontius, Taofik O. Oyekunle, Samantha M. Thomas, Michael T. Stang, Randall P. Scheri, Sanziana A. Roman, Julie A. Sosa 

Automated MicroSPECT/MicroCT Image Analysis of the Mouse Thyroid Gland
Peng Cheng, Brynn Hollingsworth, Daniel Scarberry, Daniel H. Shen, Kimerly Powell, Sean C. Smart, John Beech, Xiaochao Sheng, Lawrence S. Kirschner, Chia-Hsiang Menq, Sissy M. Jhiang 

The post <i>Thyroid</i> High-Impact Articles appeared first on American Thyroid Association.

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Evaluation of peri-implant bone levels and soft tissue dimensions around zirconia implants—a three-year follow-up study

The aim of this study was to measure bone levels around zirconia implants during follow-up of up to 3 years. Additionally, the effect of clinical contact point positions on the papilla deficit was evaluated. Eighty-one patients with 105 zirconia implants were examined at the 3-year follow-up. Bone levels were measured on the date of implant placement and at 3 months, 1year, and 3 years thereafter. Distances between the first bone–implant contact and the contact point of the crowns and between the bone level at the adjacent tooth and the contact point of the crowns were assessed.

http://ift.tt/2zlUiCk

The effect of different dosage regimens of tranexamic acid on blood loss in bimaxillary osteotomy: a randomized, double-blind, placebo-controlled study

The purpose of this study was to compare the effects of three dosage regimens of intravenous tranexamic acid and normal saline placebo on blood loss and the requirement for transfusion during bimaxillary osteotomy. A prospective, randomized, double-blind, placebo-controlled study was performed. Eighty patients scheduled for elective bimaxillary osteotomy were divided into four groups: a placebo group and three groups receiving a single dose of tranexamic acid 10, 15, or 20mg/kg body weight after the induction of anaesthesia.

http://ift.tt/2hinKlG

Biomaterials in temporomandibular joint replacement: current status and future perspectives—a narrative review

The alloplastic total temporomandibular joint (TMJ) prosthesis has a long history, with many different materials and designs used. While several of these materials have proven valuable over time, many others have not been suitable for implantation, resulting in failure and the need for explantation of the implant. Because of the failure of several of these systems, the use of alloplastic prostheses has reduced dramatically, despite their advantages over autogenous restoration. The aim of this narrative review is to discuss the criteria that must be met by a biomaterial in order for it to be considered suitable for implantation, as well as the common complications that can occur.

http://ift.tt/2zkwr69

Immunologic, microbial, and epithelial interactions in atopic dermatitis

To provide an overview of studies contributing to the understanding of immunologic, microbial, and epithelial interactions in atopic dermatitis.

http://ift.tt/2yFyamO

Home-based program of maintaining unresponsiveness in children with allergic reactions to larger amounts of peanuts

Allergists currently advise most patients with peanut allergy to observe life-long avoidance. This is in contrast to milk and egg allergy, where many children are partly tolerant to the food and tolerance induction with food ladders is routine.1 Twenty-one percent of children with proven peanut allergy at challenges appear to outgrow their clinical reactivity.2 Furthermore, clinical trials using oral, subcutaneous, and epicutaneous peanut immunotherapy have demonstrated that patients vary in the amount of peanut needed to trigger a reaction and that desensitization and to some extent sustained unresponsiveness can be achieved in children and adolescents.

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P237 Real world effects of reslizumab: a retrospective chart review

Reslizumab was recently approved for certain patients with asthma. This study compares asthma control before and during treatment in a California allergy clinic.

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PRACTICAL MANAGEMENT OF ACNE FOR CLINICIANS An International Consensus from the Global Alliance to Improve Outcomes in Acne

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Rosacea and alcohol intake

To the Editor: The paper by Li1 on alcohol intake and risk for rosacea prompted us to make some considerations and report our experience. We previously showed that rosacea patients have a significantly higher prevalence of small intestinal bacterial overgrowth (SIBO) than controls and that SIBO eradication significantly improved their lesions.2,3 Later, we investigated the role of various microorganisms in rosacea, with a 3-year follow-up of patients that had been treated.4 Demodex folliculorum, Helicobacter pylori, and SIBO were examined and all played a pathogenic role; SIBO prevailed in papulopustular rosacea, H.

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A New Editor for Jaad

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It is vital to identify the underlying cause of chronic laryngopharyngeal neuropathy

We reviewed, with great interest, the paper entitled "Randomized double blind trial of amitriptyline versus placebo in treatment of chronic laryngopharyngeal neuropathy," by Jang et al. [1]. This is an excellent work. The authors found that subjective laryngopharyngeal symptoms improved in 67% patients of an amitriptyline group and in 44% patients of a placebo group. However, we believe that the inclusion criteria and exclusion criteria were somewhat inappropriate. Also, the measures of clinical outcomes could have been improved.

http://ift.tt/2zpYa2M

Adenoidectomy and chronic nasal obstruction developing after failure of nasal steroid therapy

We reviewed, with great interest, the paper entitled "Role of adenoidectomy in chronic nasal obstruction after nasal steroid therapy failure" by Ciolek et al. [1]. This is excellent work. In the study, the authors document an average rate of respiratory allergies, but a high rate of asthma, among patients who fail nasal steroid therapy to treat chronic nasal obstructions. The authors suggest that adenoidectomy was highly efficacious in this subset of patients. However, adenoidectomy may not be necessary.

http://ift.tt/2ye8ucN

Sigmoid volvulus in children: a case report

Sigmoid volvulus is frequently reported in the "volvulus belt" (Middle East, Africa, the Indian subcontinent, Turkey, and South America) and is the third leading cause of large bowel obstruction in North America.

http://ift.tt/2j7wziN

Lingual metastasis as an initial presentation of renal cell carcinoma: a case report

Renal cell carcinoma is the third most common tumor that metastasizes to the head and neck, after breast and lung carcinomas. Tongue metastasis as an initial presentation of renal cell carcinoma is extremely r...

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Factors Associated With Remission of Skin Disease in Dermatomyositis

This cohort study examines factors associated with clinical remission of skin disease in dermatomyositis.

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Risk factors for tooth loss in middle and older age after up to 10 years: An observational cohort study

Publication date: Available online 6 November 2017
Source:Archives of Oral Biology
Author(s): Alexander Jochen Hassel, Volkan Safaltin, Sabine Grill, Johannes Schröder, Hans-Werner Wahl, Anna-Luisa Klotz, Edriss Habibi, Peter Rammelsberg, Andreas Zenthöfer
ObjectiveThe objective of this research was to identify risk factors for tooth loss in two older birth cohorts, quinquagenarians and septuagenarians, after up to 10 years of clinical observation.DesignOne hundred and twenty-three participants were recruited from the Interdisciplinary Study of Adult Development (ILSE) and examined at baseline and up to 10 years after. Thirty-nine and 84 participants belonged to the older (OC; born in 1930/32) cohort and younger (YC; born in 1950/52) cohort, respectively. Each participant underwent a dental examination comprising evaluation of the dental status (number of teeth, prosthetic restorations), Plaque Index (PI), Gingival Index (GI), DMF-S, periodontal probing depths (PD) and tooth mobility (TM). Incidence of tooth loss over the study period was calculated for both cohorts as well as for the grouped dental target variables. A logistic regression model for tooth loss (0=tooth present/1=tooth lost) was compiled with possible binary confounders.ResultsDuring the study period, 1.2 (1.9) and 2.6 (2.6) teeth were lost in YC and OC, respectively, reflecting correspondent loss rates of 5% and 14% (p<0.001). However, primarily TM >1 merged into substantial tooth loss (60%). The regression analysis confirmed the bivariate findings. Middle- and older-aged people, quinquagenarians and septuagenarians, show relevant tooth loss. Older age and worse oral health issues were identified as risk factors for tooth loss (p<0.007).ConclusionsThe predominant predictor of tooth loss seems to be tooth mobility. With the rising challenges due to aging in several societies, knowing the risks might help clinicians when weighing treatment strategies and should encourage refining preventive measures for older patients.



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Risk factors for tooth loss in middle and older age after up to 10 years: An observational cohort study

Publication date: Available online 6 November 2017
Source:Archives of Oral Biology
Author(s): Alexander Jochen Hassel, Volkan Safaltin, Sabine Grill, Johannes Schröder, Hans-Werner Wahl, Anna-Luisa Klotz, Edriss Habibi, Peter Rammelsberg, Andreas Zenthöfer
ObjectiveThe objective of this research was to identify risk factors for tooth loss in two older birth cohorts, quinquagenarians and septuagenarians, after up to 10 years of clinical observation.DesignOne hundred and twenty-three participants were recruited from the Interdisciplinary Study of Adult Development (ILSE) and examined at baseline and up to 10 years after. Thirty-nine and 84 participants belonged to the older (OC; born in 1930/32) cohort and younger (YC; born in 1950/52) cohort, respectively. Each participant underwent a dental examination comprising evaluation of the dental status (number of teeth, prosthetic restorations), Plaque Index (PI), Gingival Index (GI), DMF-S, periodontal probing depths (PD) and tooth mobility (TM). Incidence of tooth loss over the study period was calculated for both cohorts as well as for the grouped dental target variables. A logistic regression model for tooth loss (0=tooth present/1=tooth lost) was compiled with possible binary confounders.ResultsDuring the study period, 1.2 (1.9) and 2.6 (2.6) teeth were lost in YC and OC, respectively, reflecting correspondent loss rates of 5% and 14% (p<0.001). However, primarily TM >1 merged into substantial tooth loss (60%). The regression analysis confirmed the bivariate findings. Middle- and older-aged people, quinquagenarians and septuagenarians, show relevant tooth loss. Older age and worse oral health issues were identified as risk factors for tooth loss (p<0.007).ConclusionsThe predominant predictor of tooth loss seems to be tooth mobility. With the rising challenges due to aging in several societies, knowing the risks might help clinicians when weighing treatment strategies and should encourage refining preventive measures for older patients.



http://ift.tt/2hbv1zX

Pathologic Reporting of Tall-Cell Variant of Papillary Thyroid Cancer: Have We Reached a Consensus?

Thyroid , Vol. 0, No. 0.


http://ift.tt/2zr3Jhp

Adenoidectomy and chronic nasal obstruction developing after failure of nasal steroid therapy

Publication date: Available online 7 November 2017
Source:American Journal of Otolaryngology
Author(s): Zhengcai Lou




http://ift.tt/2m5skFJ

Cultural Competence in Global Health

By Nathan Douthit

[I]n the…aim to produce cultural competence, one dimension to be avoided is… narrowly defining competence… in its traditional sense: an easily demonstrable mastery of a finite body of knowledge. Rather, cultural competence…is best described… as a commitment and active engagement in a lifelong process that individuals enter into on an ongoing basis with patients, communities, colleagues, and with themselves.^[1]

            Dunton et al describe the importance of cultural competence in taking care of patients in minority communities in "Navigating care for Bedouin patients with diabetes." They describe the case of a patient with a 30 year history of diabetes. Despite his best efforts, the doctor's success when, "encouraging the patient to make lifestyle changes… proved virtually impossible." He developed End Stage Renal Disease as a result, and then suddenly passed away, likely secondary to "a heart attack due to complications from chronic diabetes."

            In light of the rise of chronic disease, specifically as demonstrated in a "minority culture within a larger Western society," the training of culturally competent physicians is essential. In this case, fatalism plays a key role. The eldest son writes,

            "During my father's disease, his socioeconomic situation was good…. He could go to the experts…. [But] he didn't consider diabetes a major threat. He was shocked when he was told he needed dialysis. He initially refused treatment for a few weeks before we convinced him with the help of his doctor…. We were sorry that he died. But in our society, we believe in God and see this as the will of God. We can't do anything about it."

            Addressing fatalism, a "main obstacle in educating and motivating patients," requires a culturally sensitive dialogue. The authors recommend focusing on quality of life rather than threat of death. Having patients "consider how changes in lifestyle will help in remaining strong and active until the prewritten day of death," may help in addressing this issue.

            According to the authors, "the link between trust and the adherence to treatment regimens is found within many communities." Training culturally competent physicians must focus on having knowledge, skills, and respect and being able to implement these effectively in cross cultural situations.^[2] "Culturally appropriate intervention channels" are key to reducing stigma and raising patient awareness of available resources.

            Cultural competence has been shown to improve many health behaviors, specifically related to nutrition, exercise and substance use habits.^[3] Culturally competent physicians must be willing to partner with local leaders. As the authors write, "if community and leaders could establish the importance of diet as something on par with the importance of vaccinations, it would contribute to changing the culture positively."

BMJ Case Reports invites authors to publish cases regarding cultural competence and humility in training global health practitioners. Global health case reports can emphasize:

            -The effects of culturally appropriate health interventions

            -Training methods for culturally competent global health practitioners

            -Disease spread or exacerbation as a result of cultural incompetence

            -Innovation in culturally appropriate interventions

Manuscripts may be submitted by students, physicians, nurses or other medical professionals to BMJ Case Reports. For more information, review the blog on how to write a global health case report.

Read more about cultural competence and humility in the interaction of clinicians with patients at BMJ Case Reports

            –A Rohingya refugee's journey in Australia and the barriers to accessing healthcare

            –Ethiopian-Israeli community

            –Analysis of the psychosocial impact of caretaking on the parents of an infant with severe congenital heart defect.

Read more about cultural competence and humility from other sources

            -Tervalon M, Murray-Garcia J. Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. Journal of health care for the poor and underserved. 1998;9(2):117-25.

            -Brach C, Fraserirector I. Can cultural competency reduce racial and ethnic health disparities? A review and conceptual model. Medical Care Research and Review. 2000 Nov;57(1_suppl):181-217

            -Goode TD, Dunne MC, Bronheim S. The evidence base for cultural and linguistic competency in health care. New York^ eNY NY: Commonwealth Fund; 2006 Oct.

^[1] Tervalon M, Murray-Garcia J. Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. Journal of health care for the poor and underserved. 1998;9(2):117-25.

^[2] Brach C, Fraserirector I. Can cultural competency reduce racial and ethnic health disparities? A review and conceptual model. Medical Care Research and Review. 2000 Nov;57(1_suppl):181-217.

^[3] Goode TD, Dunne MC, Bronheim S. The evidence base for cultural and linguistic competency in health care. New York^ eNY NY: Commonwealth Fund; 2006 Oct.

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European guidelines on perioperative venous thromboembolism prophylaxis: Neurosurgery

No abstract available

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European guidelines on perioperative venous thromboembolism prophylaxis: Surgery during pregnancy and the immediate postpartum period

No abstract available

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European Guidelines on perioperative venous thromboembolism prophylaxis: Executive summary

No abstract available

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European guidelines on perioperative venous thromboembolism prophylaxis: Day surgery and fast-track surgery

No abstract available

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European guidelines on perioperative venous thromboembolism prophylaxis: Intensive care

No abstract available

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European guidelines on perioperative venous thromboembolism prophylaxis: Surgery in the obese patient

No abstract available

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European guidelines on perioperative venous thromboembolism prophylaxis: Cardiovascular and thoracic surgery

No abstract available

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European guidelines on perioperative venous thromboembolism prophylaxis: Chronic treatments with antiplatelet agents

No abstract available

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European guidelines on perioperative venous thromboembolism prophylaxis: Aspirin

No abstract available

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European guidelines on perioperative venous thromboembolism prophylaxis: Patients with preexisting coagulation disorders and after severe perioperative bleeding

No abstract available

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European guidelines on perioperative venous thromboembolism prophylaxis: Mechanical prophylaxis

No abstract available

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European guidelines on perioperative venous thromboembolism prophylaxis: Inferior vena cava filters

No abstract available

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European guidelines on perioperative venous thromboembolism prophylaxis

No abstract available

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Iguratimod ameliorates inflammatory responses by modulating the Th17/Treg paradigm in dextran sulphate sodium-induced murine colitis

Publication date: January 2018
Source:Molecular Immunology, Volume 93
Author(s): Xue-pei Jiang, Xie-lin Huang, Zao-peng Yang, Shun-cai Wang, Wei Xie, Lei Miao, Li Tang, Zhi-ming Huang
Inflammatory bowel disease (IBD) is an autoimmune disease with an abnormal and persistent immune response. Iguratimod, a novel anti-rheumatic drug, exhibits anti-inflammatory effects and regulates immune response. The role of iguratimod in intestinal mucosal inflammation and immunity has not been examined. The aim of this study was to investigate whether iguratimod ameliorates dextran sulphate sodium (DSS)-induced murine colitis and its potential regulatory mechanism. Murine colitis was induced by administering 2.5% DSS for 5days. Some mice were administered iguratimod (5, 30mg/kg) by oral gavage once daily for 7days, beginning on the day 3 after colitis induction. Our study showed that iguratimod alleviates the symptoms of colitis and suppresses intestinal tissue damage, including macroscopic and histopathological manifestations. Moreover, iguratimod reduced interleukin (IL)-6, IL-17, and tumour necrosis factor-α levels, and increased the expression levels of IL-10 and TGF-β. In addition, iguratimod downregulated the proportion of Th17 cells, the level of transcription factor retinoic acid-related orphan receptor γt (RORγt), and the phosphorylation of signal transducer and activator of transcription-3 (STAT3), and upregulated the proportion of Treg cells, the level of transcription factor forkhead box p3 (Foxp3), and the phosphorylation of STAT5 in the colonic tissues. In conclusion, iguratimod plays a protective role in mice with DSS-induced colitis via anti-inflammatory effects and regulation of Th17/Treg cells. Therefore, use of iguratimod may serve as a novel therapeutic strategy for the treatment of IBD.



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Buccal Plate Preservation with Immediate Implant Placement and Provisionalization: 5-Year Follow-Up Outcomes

Abstract

Purpose

Despite socket preservation and/or immediate implant placement, resorption of the buccal plate after dental extraction continues to pose esthetic challenges to clinicians. Buccal plate preservation (BPP) is a technique that has been recently proposed with an aim to reduce the incidence of such resorption. This study was conducted to assess the long-term efficacy of BPP in maintaining the thickness of the buccal cortical plate after immediate implant insertion and provisionalization.

Materials and Methods

Ten consecutive patients were included in this study. Each patient underwent extraction of a non-restorable tooth, BPPPBPP, single immediate implant placement and immediate provisionalization. Cone beam CT scans were taken 3 months after surgery (T1) and 5 years after surgery (T2) to evaluate the effectiveness and longevity of the BPPPBPP technique in maintaining the augmented bone width. Two distinct measurements were taken for bone evaluation: (a) R1: 1 mm apical to the implant platform and (b) R2: 5 mm apical to the implant platform. The long axis of the implant was used as a fixed reference. Statistical test analysis was conducted using the SPSS software. Student's t test was used to assess statistical significance, and a p value of < 0.05 was considered significant.

Results

There were six females and four males in the study. The mean age of the sample was 37.6 years (range 23–64 years). At T1, the mean bone thickness of the buccal plate was found to be 2.36 mm at R1 (range: 1.9–3.1), and 2.23 at R2 (range: 1.9–3). At the T2 interval, the mean thickness of the plate was 2.28 mm at R1 (range: 1.7–3) and 2.18 at R2 (range: 1.9–3). The differences in these mean values were not statistically significant.

Conclusions

BPPPBPP is an effective means for augmentation and maintenance of the buccal cortical plate around an immediately placed and provisionalized dental implant. It is a viable alternative to socket preservation with the added benefit that it allows for immediate implant placement.

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Laser und Narben

Zusammenfassung

Narben entstehen nach tiefdermalen Verletzungen der Haut und können sich in Abhängigkeit von Alter, Lokalisation, Ursache, Heilungsverlauf und individueller Disposition als unreife, reife, atrophe, hypertrophe oder keloidale Narben präsentieren. Vor allem Keloide und hypertrophe Narben sind häufig mit Juckreiz, Spannungsgefühl, Schmerzen und sogar Funktionseinschränkungen assoziiert und können die Lebensqualität von Patienten signifikant reduzieren. Auch vermeintlich physiologische Narbentypen, wie beispielsweise Ritznarben nach Selbstverletzungen, führen in vielen Fällen zu einem ausgeprägten Leidensdruck bei Betroffenen. Trotz intensiver Forschungsaktivität sind insbesondere die Pathomechanismen der überschießenden Narbenbildung bisher nur unzureichend verstanden und sicher wirksame Behandlungsmöglichkeiten bisher nicht verfügbar. Aufgrund zunehmend soliderer Studienlage werden heutzutage neben etablierten, konventionellen Verfahren vermehrt verschiedene Lasertechnologien und -wellenlängen zur Behandlung von verschiedenen Narbentypen eingesetzt.

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Clinical and microbiological effectiveness of photodynamic therapy on primary endodontic infections: a 6-month randomized clinical trial

Abstract

Introduction

This short-term randomized controlled trial evaluated the effectiveness of photodynamic therapy (PDT) on clinical success (periapical healing) and on the microbiota of primary endodontic infections.

Methods

Thirty-two patients presenting mandibular molars with apical periodontitis (one tooth/patient) were selected and randomly allocated into two therapeutic groups: control (chemo-mechanical debridement [CMD]; n = 16) and PDT (CMD + PDT; n = 16). All teeth in both groups had intracanal medication with calcium hydroxide for 7 days before final obturation. Follow-up radiographs were made at 3 and 6 months. Periapical healing was evaluated by the periapical index (PAI). Samples were obtained at baseline, after CMD with or without PDT, and just before root filling to determine the frequency and levels of 37 taxa by checkerboard.

Results

Significant decreases in PAI scores were observed in both groups over time, although at 6 months, the PDT group presented a significantly better healing score than the control (p < 0.05). At baseline, the most prevalent species in all samples were Candida albicans (46.9%), Dialister pneumosintes (31.2%), Prevotella nigrescens (28.2%), Prevotella tannerae (28.1%), and Peptostreptococcus anaerobius (25%). Most species reduced over time in both groups, and no significant differences in frequency and levels of the tested species were observed between groups in any time point evaluated. C. albicans and D. pneumosintes were still detected in high frequency in both groups at 3 months post-therapy.

Conclusions

Conventional endodontic therapy with or without PDT is effective in reducing microbial load, resulting in periapical healing. Nevertheless, adjunctive PDT provides better periapical healing at 6-month follow-up.

Clinical relevance

Teeth with apical periodontitis treated with PDT adjunct to conventional treatment would demonstrate superior healing and reduction of microorganisms.

http://ift.tt/2yCUayK

The effect of laser-assisted hatching on pregnancy outcomes of cryopreserved-thawed embryo transfer: a meta-analysis of randomized controlled trials

Abstract

It is well known that laser-assisted hatching (LAH) is the most popular and ideal embryo hatching technology, but the relevance to pregnancy outcomes of cryopreserved-thawed embryo transfer (ET) is controversial. The purpose of this meta-analysis was to evaluate the effects of LAH on pregnancy outcomes of cryopreserved-thawed ET. We searched for relevant studies published in the PubMed, EMBASE, and Cochrane Central databases up to March 2017. This meta-analysis was primarily used to evaluate the effect of laser-assisted hatching on assisted reproductive outcomes: clinical pregnancy, embryo implantation, multiple pregnancy, miscarriage, and live birth. Using the Mantel-Haenszel fixed effects model and random effects model, we determined the summary odds ratios (OR) with 95% confidence intervals (CIs). There were 12 randomized controlled trials (more than 2574 participants) included in our analysis. The rates of clinical pregnancy (OR = 1.65, 95% CI = 1.24–2.19, I ² = 49), implantation (OR = 1.59, 95% CI = 1.06–2.38, I ² = 82%), multiple pregnancy (OR = 2.30, 95% CI = 1.30–4.07, I ² = 33%), miscarriage (OR = 0.86, 95% CI = 0.50–1.48, I ² = 0%), and live birth (OR = 1.09, 95% CI = 0.77–1.54, I ² = 0%) revealed comparable results for both groups. In summary, this meta-analysis demonstrates that LAH is related to a higher clinical pregnancy rate, embryo implantation rate, and multiple pregnancy rate in women with cryopreserved-thawed embryos. However, LAH is unlikely to increase live birth rates and miscarriage rates. Due to the small sample evaluated in the pool of included studies, large-scale, prospective, randomized, controlled trials are required to determine if these small effects are clinically relevant.

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Anti-inflammatory effects of low-level laser therapy on human periodontal ligament cells: in vitro study

Abstract

Periodontal disease is a chronic inflammatory disease that is commonly treated with surgical and nonsurgical techniques. However, both approaches have limitations. Low-level laser therapy (LLLT) has been widely applied in reducing inflammatory reactions, and research indicates that LLLT induces an anti-inflammatory effect that may enhance periodontal disease therapy. The purpose of this study was to investigate the anti-inflammatory effect of LLLT on human periodontal ligament cells (hPDLCs) in an inflammatory environment and aimed to determine the possible mechanism of action. Cells were cultured and treated with or without lipopolysaccharide (LPS) from Porphryromonas gingivalis or Escherichia coli, followed by irradiation with a gallium-aluminum-arsenide (GaAlAs) laser (660 nm) at an energy density of 8 J/cm². Quantitative real-time polymerase chain reactions were used to assess the expression of pro-inflammatory genes, including tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-6, and IL-8. The dual-luciferase reporter assay was used to examine nuclear factor-κB (NF-κB) transcriptional activity. An enzyme-linked immunosorbent assay was used to monitor the concentration of intracellular cyclic adenosine monophosphate (cAMP). Both LPS treatments significantly induced the mRNA expression of pro-inflammatory cytokines. However, LLLT inhibited the LPS-induced pro-inflammatory cytokine expression and elevated intracellular levels of cAMP. The LLLT inhibitory effect may function by downregulating NF-κB transcriptional activity and by increasing the intracellular levels of cAMP. LLLT might inhibit LPS-induced inflammation in hPDLCs through cAMP/NF-κB regulation. These results should be further studied to improve periodontal therapy.

http://ift.tt/2AfjBmw

A Study of Clinical Significance of the Depth of Olfactory Fossa in Patients Undergoing Endoscopic Sinus Surgery

Abstract

The endoscope has revolutionized the diagnosis and treatment of diseases of the nose and paranasal sinuses. Endoscopic sinus surgery (ESS), like all minimally invasive surgery, is designed to combine an excellent outcome with minimal patient discomfort. Successful outcome with minimal complications can only be achieved with good knowledge of the endoscopic anatomy, appropriate training in the procedure and the understanding of the anatomical variations. The intraoperative complications of ESS are bleeding and injury to surrounding structures commonly the orbital structures and fovea ethmoidalis. This is a hospital based prospective observational study with an objective to define the distribution of Keros classification of the depth of olfactory fossa and its asymmetrical distribution rates based on Keros type. Prospective study in a tertiary rural based hospital. 100 patients above the age of 10 years from October 2013 to March 2015 for a period of one year six months undergoing endoscopic sinus surgery in the Department of ENT, P.E.S. Institute of Medical Sciences and Research, Kuppam were chosen randomly. The data was collected from these patients who will met the inclusion criteria of the study and before undergoing endoscopic sinus surgery by subjecting them to CT scan of paranasal sinuses. It is observed that a total of 100 patients had been studied in which the mean age of the population is 36.65 + 13.36 years. Youngest patient was 12 years old and eldest patient was 70 years old. Among the patients 50(50%) were males and remaining 50(50%) were females with a female to male ratio is 1:1. In the present study, the depth of olfactory fossa ranged from 2.1 to 8.3 mm inclusive of both sides in 200 CT images with a mean height of 5.21 mm. Of the 200 sides measured, the distribution of Keros classification is as the following—Keros type I 39(19.5%), Keros type II 143(71.5%) and Keros type III 18(9%) sides. Based on these observations, type II is the most common Keros type prevalent followed by type 1 Keros type and the least prevalent is the type III Keros type in the studied population. In the present study, on considering sides separately, the right side olfactory fossa depth ranged from 2.1 to 8.3 mm with a mean height of 5.43 mm and the left side olfactory fossa depth ranged from 2.1 to 8.1 mm with a mean height of 4.98 mm. On the right side, of 100 sides measured, the distribution of Keros classification is as the following—Keros type I 19(19%), Keros type II 68(68%) and Keros type III 13(13%) sides. On the left side, of 100 sides measured, the distribution of Keros classification is as the following—Keros type I 25(25%), Keros type II 70(70%) and Keros type III 5(5%) sides. Based on these observations, type II is the most common Keros type prevalent followed by type 1 Keros type and the least prevalent is the type III Keros type in the studied population on both sides. In the present study, out of 100 patients 23 patients were having asymmetric olfactory fossa between right and left sides based on Keros type, where as remaining 77% had symmetric Keros type on right and left sides. Out of 23 patients, 16 patients were having lower or deep olfactory fossa on right side, where as remaining 7 patients were having lower or deep olfactory fossa on left side. Based on these observations, a lower or deep ethmoid roof occurred more frequently on the right side than on the left side. Wilcoxon matched pair signed rank test is applied to see the significant difference between depth of right and left olfactory fossae. Since P value is < 0.001 the depth of olfactory fossa is significantly different from each other. The present study presents a precise, quantitative analysis of the olfactory fossa and ethmoid roof position as well as individual asymmetry. This information may be useful during pre-operative evaluation of CT images, as well as intraoperatively. The surgeon's understanding of the anatomy of a patient's ethmoid roof and its possible variations is crucial for countering possible complication risks during endoscopic sinus surgery.

http://ift.tt/2lYvyKV

A Study of Clinical Significance of the Depth of Olfactory Fossa in Patients Undergoing Endoscopic Sinus Surgery

Abstract

The endoscope has revolutionized the diagnosis and treatment of diseases of the nose and paranasal sinuses. Endoscopic sinus surgery (ESS), like all minimally invasive surgery, is designed to combine an excellent outcome with minimal patient discomfort. Successful outcome with minimal complications can only be achieved with good knowledge of the endoscopic anatomy, appropriate training in the procedure and the understanding of the anatomical variations. The intraoperative complications of ESS are bleeding and injury to surrounding structures commonly the orbital structures and fovea ethmoidalis. This is a hospital based prospective observational study with an objective to define the distribution of Keros classification of the depth of olfactory fossa and its asymmetrical distribution rates based on Keros type. Prospective study in a tertiary rural based hospital. 100 patients above the age of 10 years from October 2013 to March 2015 for a period of one year six months undergoing endoscopic sinus surgery in the Department of ENT, P.E.S. Institute of Medical Sciences and Research, Kuppam were chosen randomly. The data was collected from these patients who will met the inclusion criteria of the study and before undergoing endoscopic sinus surgery by subjecting them to CT scan of paranasal sinuses. It is observed that a total of 100 patients had been studied in which the mean age of the population is 36.65 + 13.36 years. Youngest patient was 12 years old and eldest patient was 70 years old. Among the patients 50(50%) were males and remaining 50(50%) were females with a female to male ratio is 1:1. In the present study, the depth of olfactory fossa ranged from 2.1 to 8.3 mm inclusive of both sides in 200 CT images with a mean height of 5.21 mm. Of the 200 sides measured, the distribution of Keros classification is as the following—Keros type I 39(19.5%), Keros type II 143(71.5%) and Keros type III 18(9%) sides. Based on these observations, type II is the most common Keros type prevalent followed by type 1 Keros type and the least prevalent is the type III Keros type in the studied population. In the present study, on considering sides separately, the right side olfactory fossa depth ranged from 2.1 to 8.3 mm with a mean height of 5.43 mm and the left side olfactory fossa depth ranged from 2.1 to 8.1 mm with a mean height of 4.98 mm. On the right side, of 100 sides measured, the distribution of Keros classification is as the following—Keros type I 19(19%), Keros type II 68(68%) and Keros type III 13(13%) sides. On the left side, of 100 sides measured, the distribution of Keros classification is as the following—Keros type I 25(25%), Keros type II 70(70%) and Keros type III 5(5%) sides. Based on these observations, type II is the most common Keros type prevalent followed by type 1 Keros type and the least prevalent is the type III Keros type in the studied population on both sides. In the present study, out of 100 patients 23 patients were having asymmetric olfactory fossa between right and left sides based on Keros type, where as remaining 77% had symmetric Keros type on right and left sides. Out of 23 patients, 16 patients were having lower or deep olfactory fossa on right side, where as remaining 7 patients were having lower or deep olfactory fossa on left side. Based on these observations, a lower or deep ethmoid roof occurred more frequently on the right side than on the left side. Wilcoxon matched pair signed rank test is applied to see the significant difference between depth of right and left olfactory fossae. Since P value is < 0.001 the depth of olfactory fossa is significantly different from each other. The present study presents a precise, quantitative analysis of the olfactory fossa and ethmoid roof position as well as individual asymmetry. This information may be useful during pre-operative evaluation of CT images, as well as intraoperatively. The surgeon's understanding of the anatomy of a patient's ethmoid roof and its possible variations is crucial for countering possible complication risks during endoscopic sinus surgery.

http://ift.tt/2lYvyKV

Autoimmune chronic spontaneous urticaria

Publication date: Available online 6 November 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Clive Grattan




http://ift.tt/2zk6SC4

Corticosteroid treatment is associated with increased filamentous fungal burden in allergic fungal disease

Publication date: Available online 6 November 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Marcin G. Fraczek, Livingstone Chishimba, Rob M. Niven, Mike Bromley, Angela Simpson, Lucy Smyth, David W. Denning, Paul Bowyer
BackgroundAllergic diseases caused by fungi are common. The best understood conditions are allergic bronchopulmonaryaspergillosis (ABPA) and severe asthma with fungal sensitisation (SAFS). Our knowledge of the fungal microbiome (mycobiome) is limited to a few studies involving healthy individuals, asthmatics and smokers. No study has yet examined the mycobiome in fungal lung disease.ObjectivesThe main aim of this study was to determine the mycobiome in lungs of individuals with well characterised fungal disease. A secondary objective was to determine possible effects of treatment on the mycobiome.MethodsAfter bronchoscopy, ITS1 DNA was amplified and sequenced and fungal load determined by RT-PCR. Clinical and treatment variables were correlated with the main species identified. ABPA (n=16), SAFS (n=16), severe asthma not sensitised to fungi, (n=9), mild asthma patients(n=7) and 10 healthy controls were studied.ResultsThe mycobiome was highly varied with severe asthmatics carrying higher loads of fungus. Healthy individuals had low fungal loads, mostly poorly characterised Malasezziales.The most common fungus in asthmatics was Aspergillus fumigatus complex and this taxon accounted for the increased burden of fungus in the high level samples. Corticosteroid treatment was significantly associated with increased fungal load (p<0.01).ConclusionsThe mycobiome is highly variable. Highest loads of fungus are observed in severe asthmatics and the most common fungus is Aspergillusfumigatus complex. Individuals receiving steroid therapy had significantly higher levels of Aspergillus and total fungus in their BAL.

Teaser

This article reports the first analysis of fungal communities in lungs of individuals with fungal disease. Effects of steroid and antifungal drugs suggest complex patterns of fungal burden with potential implications for treatment.


http://ift.tt/2hi5IQx

Reply

Publication date: Available online 6 November 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Pavel Kolkhir, Martin K. Church, Karsten Weller, Martin Metz, Oliver Schmetzer, Marcus Maurer




http://ift.tt/2zjKx7N

Cholesterol-α-glucosyltransferase gene is present in most Helicobacter species including gastric non-Helicobacter pylori helicobacters obtained from Japanese patients

Abstract

Background

Non-Helicobacter pylori helicobacters (NHPHs) besides H. pylori infect human stomachs and cause chronic gastritis and mucosa-associated lymphoid tissue lymphoma. Cholesteryl-α-glucosides have been identified as unique glycolipids present in H. pylori and some Helicobacter species. Cholesterol-α-glucosyltransferase (αCgT), a key enzyme for the biosynthesis of cholesteryl-α-glucosides, plays crucial roles in the pathogenicity of H. pylori. Therefore, it is important to examine αCgTs of NHPHs.

Materials and Methods

Six gastric NHPHs were isolated from Japanese patients and maintained in mouse stomachs. The αCgT genes were amplified by PCR and inverse PCR. We retrieved the αCgT genes of other Helicobacter species by BLAST searches in GenBank.

Results

αCgT genes were present in most Helicobacter species and in all Japanese isolates examined. However, we could find no candidate gene for αCgT in the whole genome of Helicobacter cinaedi and several enterohepatic species. Phylogenic analysis demonstrated that the αCgT genes of all Japanese isolates show high similarities to that of a zoonotic group of gastric NHPHs including Helicobacter suis, Helicobacter heilmannii, and Helicobacter ailurogastricus. Of 6 Japanese isolates, the αCgT genes of 4 isolates were identical to that of H. suis, and that of another 2 isolates were similar to that of H. heilmannii and H. ailurogastricus.

Conclusions

All gastric NHPHs examined showed presence of αCgT genes, indicating that αCgT may be beneficial for these helicobacters to infect human and possibly animal stomachs. Our study indicated that NHPHs could be classified into 2 groups, NHPHs with αCgT genes and NHPHs without αCgT genes.

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A case of Mirizzi syndrome that was successfully treated by laparoscopic choledochoplasty using a gallbladder patch

Abstract

The use of laparoscopic surgery in the treatment of Mirizzi syndrome is considered controversial due to the degree of technical difficulty. We herein describe the case of a 36-year-old woman who was admitted to our hospital due to appetite loss, nausea and back pain. Endoscopic retrograde cholangiography revealed a round-shaped filling defect at the confluence of the bile duct. The patient was diagnosed with Mirizzi syndrome Type II according to the Csendes classification. Before surgery, an endoscopic nasobiliary drainage tube was placed for intraoperative cholangiography. Based on the intraoperative findings, the anterior wall of Hartmann's pouch was excised to remove the impacted gallstone. The neck portion of the gallbladder wall was then used to make a gallbladder patch, which was sutured to cover the anterior wall of the common hepatic bile duct. Laparoscopic choledochoplasty using a gallbladder patch was a technically feasible treatment for Mirizzi syndrome Type II.

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Elasto fibroma Dorsi: a case report of bilateral tumours and excision of the symptomatic lesion in a male patient

Abstract

Elasto fibroma dorsi is a rare tumour of the shoulder girdle that usually arises at the infra scapular area. We present a 57-year-old male with a soft tissue swelling on his right infra scapular area of 6 months duration. It was a painless lesion which caused him discomfort while sleeping. Preoperative imaging revealed bilateral tumours but the left tumour was impalpable. The surgery itself was uneventful but post-operatively he developed a haematoma which was managed conservatively Elasto fibroma is a benign pseudo tumour of the shoulder girdle. It's aetiology is tied in to repetitive trauma of the shoulder girdle resulting in a pseudo tumour at the infra scapular area. Magnetic resonance imaging is the diagnostic modality of choice and is pathognomic in the presence of bilateral infra scapular tumours. Treatment is usually conservative and tissue diagnosis is essential as it can mimic a soft tissue sarcoma radiologically.

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Giant splenic hemangioma in a 10-year-old boy treated with a spleen saving surgery

Abstract

Tumors of spleen are rare. The most common benign tumor of spleen is hemangioma. Most splenic hemangiomas (SH) tend to be discovered in mid-30s to mid-50s. SH are discovered incidentally in most of the cases as they are usually asymptomatic. Small asymptomatic SH can be managed with observation. The treatment options for large hemangiomas are embolization of the splenic arterial branch, splenectomy by laparotomy or laparoscopy. Partial splenectomy can be done if the lesion is small and located at the poles of the spleen. We present a rare case of splenic hemangioma in a 10-year-old boy who presented with a painless palpable mass in the left upper abdomen. On CT scan—A large well-defined cystic lesion with few thin enhancing septa within it is seen involving the spleen. Laparotomy was done followed by Partial splenectomy. The histopathology report was suggestive of Cavernous Hemangioma of spleen.

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Clinical pathologic conference: diffuse papillomatous lesions of the gingiva with posterolateral neck skin tags

Publication date: Available online 6 November 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Susie I. Lin, Joseph R. Mort, Paul M. Hinchey, James S. Lewis, Jeffrey Zwerner




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Medication related osteonecrosis of the jaws associated with targeted therapy as monotherapy and in combination with anti-resorptives. a report of seven cases from the copenhagen ONJ cohort

Publication date: Available online 6 November 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Hoda Abel Mahedi Mohamed, Charlotte Emilie Nor Nielsen, Morten Schiodt
ObjectiveTo report cases of medication related osteonecrosis of the jaws (MRONJ) associated with Targeted Therapy (TT) with and without concomitant anti-resorptive treatment, among The Copenhagen ONJ Cohort, which includes all consecutive cases of MRONJ seen in Copenhagen.Study designWe retrospectively studied the medication of 204 consecutive MRONJ patients, seen between January 2010 and May 2016, in order to identify those associated with TT.ResultsWe detected seven cases of MRONJ associated with TT (3.4 %). Four patients received TT only, whereas three were concomitantly treated with bisphosphonates (n=3) and/or denosumab (n=3). The TT regimens included: sunitinib(Sutent®) (n=1), everolimus(Afinitor®) (n=1), erlotinib(Tarceva®) (n=1), bevacizumab(Avastin®) (n=3), dasatinib(Sprycel) (n=1) and imatinib(Glivec®) (n=1). The MRONJ stage included stage 1 and 2, and mean pain from the jaw was VAS 4.0.ConclusionHealth care providers should be aware of the possibility of MRONJ related to the TT agents sunitinib, everolimus and dasatinib and to patients with uncommon cancer types, including renal cell carcinoma, non-small-cell lung cancer, glioblastoma and leukemia, where MRONJ may also occur.



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Effects of single condylar neck fracture without condylar cartilage injury on traumatic heterotopic ossification around temporomandibular joint in mice

Publication date: Available online 6 November 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Ningjuan Ouyang, Xiaofang Zhu, Hongliang Li, Yuheng Lin, Jun Shi, Jiewen Dai, Guofang Shen
ObjectivesIn this study, we try to explore the effects of single condylar neck fracture without condylar cartilage injury during the pathogenesis process of traumatic heterotopic ossification around temporomandibular joint (THO-TMJ).Study designOne-month-old C57BL/6J male mice were divided into two groups. In group one, condylar cartilage was partially removed in the right joint to induce traumatic heterotopic ossification. In group two, a single fracture on the condylar neck was created using small scissors. The condylar head was repositioned to its original place if any displacement occurred. The phenotypes were observed using gross observation, micro-computed tomography scans and histological examination.ResultsThe results showed obvious hyperplasia in the right condyle in group one, with ectopic bones and cartilage in the periarticular region. In group two, the surface of condyle was smooth, but the size of the right condylar head became smaller.ConclusionsTaking these findings together, it can be concluded that the injured condylar cartilage, while not a single condylar neck fracture without condylar cartilage injury, contributes to the development of THO-TMJ.



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Effect of topical fluoride application on enamel after in-office bleaching, as evaluated using a novel hardness tester and a transverse microradiography method

This study evaluated the effect of topical fluoride application on enamel hardness after in-office bleaching. Twelve human incisors were cut along the long axis, resulting in 24 halves used in four treatment groups (n = 6 in each group): (i) untreated group (C); (ii) in-office bleaching material (B); (iii) treatment with surface reaction-type prereacted glass-ionomer varnish after in-office bleaching (B+PRG); and (iv) treatment with acidulated phosphate fluoride solution after bleaching (B+F). All specimens were subjected to pH-cycling for 4 wk. Knoop hardness was measured using a Cariotester. The decalcification of enamel was assessed quantitatively by measuring the integrated mineral loss (ΔIML). Games–Howell analysis was used to assess statistical significance of between-group differences. The Knoop hardness decreased significantly after bleaching for all groups. In treatment groups B+PRG and B+F, the Knoop hardness returned to the original unbleached values after the first pH cycle and did not change afterwards. In treatment groups C and B there was a gradual decrease in the Knoop hardness until the fourth pH cycle. The integrated mineral loss, ΔIML, was significantly higher in treatment group B+F after 2 wk than in the other treatment groups. After 4 wk, the ΔIML in treatment group B was significantly higher than in treatment group B+PRG. The application of fluoride-containing materials after bleaching results in recuperation of hardness to levels similar to those of unbleached enamel.

http://ift.tt/2ybF5A2