Τρίτη 14 Νοεμβρίου 2017
Two cases of infundibular squamous cell carcinoma on the nose with aggressive clinical behavior: Case report and review of the published work
Abstract
Case 1 was a 75-year-old Japanese man who presented with a poorly demarcated, dark-red nodule with a destructive defect in the center, measuring 3 cm × 2 cm on the right wing of his nose. The histological diagnosis was a common form of infundibular squamous cell carcinoma. Atypical neoplastic cells radiated from the wall of a follicular infundibulum. The majority of neoplastic cells were positive for AE1/AE3 and 34βE12. Cytokeratin 17 expression was seen in the suprabasal cells of the deeply situated neoplastic components. Case 2 was a 73-year-old Japanese man who presented with a poorly demarcated, dark-red nodule with an irregularly shaped ulcer in the center, measuring 3 cm × 2 cm on the left wing of his nose. The histological diagnosis was a crater form of infundibular squamous cell carcinoma. Atypical neoplastic cells radiated from the broad base of the central keratin-filled crater, continuous with two infundibular canals. In both cases, some of the more deeply situated aggregations were composed of neoplastic keratinocytes with eosinophilic glassy or pale cytoplasm. In addition, no atypical keratinocytes could be seen in the interfollicular epidermis. In case 1, a hematogenous metastasis to the vocal cord and the forehead occurred in addition to a lymph node metastasis. In case 2, a local recurrence occurred with an intralymphatic dissemination. We describe two cases of infundibular squamous cell carcinoma on the nose with aggressive clinical behavior, one of which was accompanied by a hematogenous metastasis while another revealed a local recurrence.
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Neonatal airway anomaly: vallecular cyst
Description
Neonatal laryngeal cysts are an uncommon but recognised cause of inspiratory stridor and respiratory distress in infants. Although a small cyst may be asymptomatic, due to the anatomical location and the small size of an infant's respiratory tract, larger cysts may cause acute airway obstruction.1 Affected infants typically display symptoms within the first week of life, which include inspiratory stridor, respiratory distress or feeding difficulties. Congenital vallecular cysts, also known as mucus retention cysts, may arise from the mucosal surface of the true vocal fold, epiglottis or vallecula.2 Vallecular cysts are particularly dangerous as they may cause posterior displacement of the supraglottis, causing collapse of the airway during inspiration leading to respiratory compromise. Additionally, several reports have documented an association between laryngomalacia and vallecular cysts.3 Diagnosis is typically obtained through flexible nasopharyngolaryngoscopy, and endoscopic marsupialisation is the recommended surgical approach in...
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Pyoderma gangrenosum: combination therapy with excellent results in a patient with underlying hepatitis C
Description
Pyoderma gangrenosum (PG) is defined as a neutrophilic dermatosis, not related to any infections or gangrenous causes.1 It usually appears with an underlying systemic disease. We report a 55-year-old man who presented with painful bilateral skin lesions on legs with no associated constitutional symptoms. Patient had a history of untreated hepatitis C infection with negative cryoglobulinaemia screen. Surgical debridement was performed in the emergency department, at that time without a diagnosis and a biopsy plus culture of the skin was done which disclosed no evidence of microorganism, vasculitis findings and perivascular lymphoplasmacytic infiltrate. A repeat biopsy showed neutrophilic infiltrate. Clinical and histopathological diagnosis of PG was made and patient was started on intravenous steroids with some improvement,2 followed with clinical deterioration that prompted intravenous immunoglobulin therapy with excellent results.3 Patient continues to get weekly wound care and was being seen by infectious disease and rheumatology...
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Septic arthritis of knee joint due to Parvimonas micra
Parvimonas species are anaerobic, Gram-positive cocci that are a constituent of normal oral and gastrointestinal flora. We present a case of right knee joint septic arthritis due to Parvimonas micra in an immunocompromised patient. A 61-year-old male renal and pancreatic transplant recipient on immunosuppressive therapy was admitted to our hospital due to intense pain, joint swelling and inability to move his right knee over the past 9 months. After synovial fluid was drawn, cultures were positive for P. micra, an anaerobic pathogen that is part of the flora of the oral cavity. We report a rare causative pathogen for septic arthritis in an immunocompromised patient.
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Carcinoma en cuirasse in a young female
Description
Cancer or carcinoma en cuirasse is an infrequent clinical presentation of metastatic cutaneous carcinoma.1 In this condition, the skin of the chest wall is studded with carcinomatous indurated plaques. It is often seen after a patient of breast cancer undergoes mastectomy operation and develops local recurrence. The patient usually presents after a few months or years after the surgery2 (figure 1). This patient, a 22-year-old woman, had already undergone right modified radical mastectomy for infiltrating ductal carcinoma (IDC) Not Otherwise Specified (NOS) grade II with triple-negative receptor status, 1 year ago. She had now presented with a lump in the left breast and multiple cutaneous lesions on the chest wall on the right side and on the left breast since the past 5 months (figure 2). Cutaneous metastasis or carcinoma en cuirasse has occurred on the right side after mastectomy, whereas they are...
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Isolated azygos vein thrombosis: a rare phenomenon
Description
A 57-year-old man with diabetes mellitus and liver cirrhosis was electively admitted for endoscopic retrograde cholangiopancreatography (ERCP). He had history of obstructive jaundice secondary to choledocholithiasis in the preceding month, during which a biliary stent was inserted. During ERCP, he developed acute chest pain and shortness of breath. ECG, cardiac enzymes, coagulation profile and chest radiograph were normal. He was then suspected to have acute pulmonary embolism.
CT pulmonary angiography (CTPA) showed a central tubular filling defect within the azygos vein (AV). This filling defect has a small attachment at the roof of the vessel, forming acute angle with the vessel wall (figures 1 and 2). The rest of the pulmonary vasculature was fully opacified. Lung fields were normal.
Figure 1
Selected axial (A) and coronal (B) sections of CT pulmonary angiography showing tubular filling defect within the azygos vein (arrows).
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Umbilical artery perforation: a potentially life-threatening complication of umbilical artery catheterisation
Umbilical artery catheterisation is frequently performed in preterm or critically ill newborn infants for invasive monitoring of blood pressure and blood sampling for laboratory tests. It is associated with well-known complications like catheter-related infections, thromboembolic events and aneurysmal formation of the aorta. In this report, we present another major complication of umbilical artery catheterisation: umbilical artery perforation. This complication occurred in a prematurely born infant and resulted in severe haemorrhagic shock, subsequent renal failure and severe periventricular leukomalacia. Ultimately, the patient deceased 3 weeks after birth. Review of the literature identified only a few case reports and retrospective postmortem studies describing this complication. Neonatologists and paediatricians performing umbilical artery catheterisation should be aware of this rare, but potentially life-threatening complication.
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Orbitonasal metallic foreign body
Description
A 23-year-old male patient presented with the history of metallic wire injury following a burst of an instrument. The duration of injury was 2 hours. Clinical examination revealed a visual acuity of 20/20 in each eye, right brow showed a superficial skin laceration. Medial side of the right orbit had an impacted curved metallic wire. Extraocular motility in the right eye was within normal limits (figure 1). Anterior segment and posterior segment examination was unremarkable in both the eyes. B-scan ultrasound revealed a high amplitude spike along the side of the right globe but without any penetration; however, it showed curvilinear course along the medial orbital wall (figure 2A).
Figure 1
Front and lateral clinical profile showing a curvilinear metallic foreign body impacted along the superior and nasal aspect of the right upper eyelid. Extraocular motilities were unaffected.
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Norethisterone enanthate-induced cerebral venous sinus thrombosis (CVST)
A 23-year-old East Indian woman with no significant medical history, except a depot-norethisterone enanthate injection taken 3 weeks prior to admission, presented with a gradually worsening headache for the past 5 days. She had no fever, vomiting, neck stiffness, focal weakness or rash, and examination was unremarkable with no focal neurological deficits. Vasculitic, thrombophilia and sepsis screens were normal. A brain CT scan showed a left parietal lobe venous infarct, secondary to a venous dural sinus thrombosis, with MRI and Magnetic Resonance Venogram (MRV) confirming a signal void. She was diagnosed to have multiple cerebral venous sinus thrombosis due to norethisterone enanthate. She made a complete recovery following treatment with mannitol, dexamethasone and anticoagulants. A follow-up brain MRI done at 6 months was normal.
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Reversible brain lesion following growth hormone replacement therapy in an adolescent
A 12.6-year-old girl presented with a 2-month history of headache, recurrent vomiting and 5 kg weight loss. She had been receiving recombinant human growth hormone (rhGH) replacement therapy at a dose of 0.035 mg/kg for the past 10 months, due to short stature. Investigations before initiating rhGH, including brain MRI, had been normal. Physical examination revealed a nystagmus and a mildly elevated arterial blood pressure. Brain MRI revealed a lesion in the posterior aspect of the medulla oblongata, adjacent to the foramen of Magendie. rhGH therapy was discontinued, followed by a gradual resolution of the symptoms. At follow-up 3 months later, she was asymptomatic and physical examination was unremarkable. A subsequent repeat brain MRI showed complete resolution of the lesion, supporting the diagnosis of a variant of reversible posterior leucoencephalopathy syndrome. This is the first case report of a reversible brain lesion linked to rhGH replacement therapy.
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Peripheral arterial disease as seen on X-ray and arteriography
Description
An 80-year-old woman was admitted for a 2months history of non-healing ulcers on both feet. She is known to have type 2 diabetes, dyslipidaemia and hypertension for 30 years. She has a history of a femoral fracture on the left incurred after a fall 2 years ago for which she underwent open reduction and internal fixation.
On physical examination, there were ulcers on the lateral aspect of both feet and on the right malleolar area. Dorsalis pedis pulses were absent bilaterally.
An X-ray of both femurs was requested to check if the fracture healed properly and to rule out a new fracture since the patient remained bedridden despite surgery to correct the fracture. The X-ray revealed a metal implant on the left femur and with no new fracture. Incidentally, the femoral arteries were noted to be calcified along their entire length indicative of atherosclerosis (figure 1).
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Unusual Salmonella typhi periprosthetic joint infection involving bilateral knees: management options and literature review
A 70-year-old Indian woman, who had undergone primary bilateral total knee arthroplasty (TKA) for rheumatoid arthritis 10 months prior, presented with 10 days history of pain, swelling and erythema over both knees with pus discharging from the right knee. She had type 2 diabetes mellitus and was on long-term steroid, leflunomide and antitumour necrosis factor therapy for rheumatoid arthritis. Her clinical and laboratory features were suggestive of a haematogenous periprosthetic joint infection (PJI). The final diagnosis of bilateral Salmonella typhi PJI was made based on culture reports. Considering her underlying immunosuppression, a bilateral two-stage revision TKA was done with complete remission of symptoms and good functional recovery at last follow-up after 18 months. S. typhi infection of prosthetic joint has not been reported in the literature. Patients presenting with gastrointestinal complaints and PJI should alert the clinician to the possibility of infection with such atypical organisms endemic to the region.
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Antenatal Bartter syndrome presenting with vomiting and constipation mimicking subacute intestinal obstruction in a 20-day-old neonate
Antenatal Bartter syndrome is a rare condition that can present with different clinical features. These features include early onset maternal polyhydramnios, failure to thrive, prematurity and nephrocalcinosis.
We are presenting this 20-day-old girl who had an antenatal history of polyhydramnios. She developed persistent non-bilious vomiting that was associated with constipation soon after birth. She presented with failure to thrive and features suggestive of intestinal obstruction. On the initial evaluation, she was noted to have hypokalaemic, hyponatraemic metabolic alkalosis. The initial work-up was done to exclude surgical and renal causes of her presentation, and the diagnosis was confirmed by gene analysis to be type III—classic Bartter syndrome. She was closely monitored for her growth and development with the appropriate salt replacement therapy.
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Ectopic ACTH syndrome complicated by multiple opportunistic infections treated with percutaneous ablation of the adrenal glands
Ectopic adrenocorticotropic hormone (ACTH)-related Cushing's syndrome can lead to multiple complications including severe immunosuppression. If the ACTH-secreting tumour cannot be found, definitive treatment is surgical adrenalectomy, typically followed by glucocorticoid replacement. Here, we present a case of fulminant respiratory failure secondary to coinfection with Pneumocystis jirovecii and cytomegalovirus in a patient with ectopic ACTH-dependent Cushing's syndrome with occult primary. Due to significant deconditioning, she was unable to undergo definitive adrenalectomy and instead underwent percutaneous microwave ablation of the adrenal glands.
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Barrier dysfunction in the nasal allergy
Publication date: Available online 14 November 2017
Source:Allergology International
Author(s): Ayumi Fukuoka, Tomohiro Yoshimoto
Epithelial cells form the first physiological barrier against invasion by pathogens and the infiltration of allergens. Tight junctions (TJ), a cell–cell junctional complex located on the apical side of epithelial cells, have a critical role in the maintenance of epithelial barrier function. Impaired TJ structures are observed in patients with asthma, atopic dermatitis and nasal allergy; therefore, the dysfunction of epithelial barriers might be involved in the initiation or progression of allergic diseases. Protease-containing allergens and environmental pollutants enhance paracellular transport in epithelial cells through disruption of epithelial barrier function. This suggests that the disruption of TJ leads to the promotion of allergen delivery into the subepithelia, resulting in the progression of allergic diseases. Thus, protection of the epithelial barrier function might prevent or inhibit the development or exacerbation of allergic diseases. Recently, we reported that diesel exhaust particles (DEP), the main component of particulate patter 2.5, exacerbated allergic rhinitis (AR) in a mouse model through TJ disruption. In addition, we revealed that the oxidative stress-mediated pathway is involved in the effects caused by DEP and that nasal treatment with a reactive oxygen species (ROS) scavenger suppressed DEP-induced TJ disruption and exacerbation of AR. In this review, we focus on the relationship between TJ disruption and allergic disease. Furthermore, we discuss our recent findings regarding TJ disruption and the exacerbation of AR.
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P272 Disseminated cutaneous warts in X-linked hyper-IGM syndrome: a case report
X-linked hyper-IgM syndrome (XHIGM) is a primary immunodeficiency caused by mutations in the CD40Ligand (CD40L) gene, leading to defective immunoglobulin class-switch recombination and impaired T-cell activation. Well-known manifestations of the syndrome include recurrent sinopulmonary infections, gastrointestinal complications, and neuroendocrine tumors. Cutaneous warts have rarely been reported in XHIGM.
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P271 Experience with two patients with activated PI3K delta syndrome: case reports
Activated Phosphoinositide-3 Kinase (PI3k) delta syndrome (APDS) is a combined immunodeficiency caused by gain of function mutations in PIK3 protein or receptor. We present two patients with APDS, one protein (APDS1) and one receptor mutation (APDS2).
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P428 The empty nose syndrome (ENS): a diagnostic and therapeutic challenge for the allergist-immunologist
ENS is a rare rhinological disorder occurring months to years after sinonasal surgery, with symptoms of paradoxical nasal obstruction, nasal dryness, crusting, and dyspnea. Little is known of its pathogenesis, although anatomical changes leading to disruption of mucosal cooling, and disordered neurosensory mechanisms are strongly implicated. Medical therapies include mucosal humidification, irrigations, emollients, and surgical therapy with turbinate reconstruction reserved for refractory cases.
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P427 Eosinophils in nasal discharge and nasal cavity culture in children
There are many infants having nose symptoms in general practice, but it is difficult to distinguish between recurrent upper respiratory inflammation and allergic rhinitis (AR). Skin tests, nasal mucous membrane provocation tests, and the presence of eosinophil in the nasal discharge (END) are necessary for the diagnosis of AR. We often check the END for infants who are uncooperative in medical examinations.
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NMSC: immer mehr Neuerkrankungen
Weltweit steigt die Zahl der nicht melanozytären Hautkrebsdiagnosen von Jahr zu Jahr — auch in Deutschland. Und es ist keine Trendwende in Sicht.
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Spezialist und Dienstleister in Weiß
Die Versorgungslandschaft wird sich noch gewaltig verändern. Davon sind junge Ärzte überzeugt. Eine aktuelle Studie der apoBank zeigt recht detailliert, was Heilberufler umtreibt.
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Fassaden als organische Gebäudehülle
Die Haut dient dem menschlichen Körper als Schutz — sie ist aber auch Medium der sinnlichen Wahrnehmung und wichtige Mittlerin zwischen dem Innen und Außen. Sie regelt den Wärmehaushalt des Körpers, absorbiert Sauerstoff und reproduziert sich selbst. All das sollen zunehmend auch moderne Gebäudefassaden leisten.
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Isotretinointherapie: kein Störfaktor für viele weitere Maßnahmen
Bis heute wird empfohlen, Isotretinoin vor einem dermatologischen Eingriff abzusetzen oder die Wirkung des Medikaments über sechs bis zwölf Monate abklingen zu lassen. Hautärzte aus den USA haben jetzt die Berechtigung für diese Vorsichtsmaßnahme anhand der Studienlage neu überprüft.
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PDT: ALA-Inkubation mit Mikronadeln verkürzen
Mit einem mit Mikronadeln gespickten Roller soll die Einwirkzeit der Aminolävulinsäure für die photodynamische Therapie der aktinischen Keratose verkürzt und die Prozedur für die Patienten erträglicher werden.
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Lymphknotenbiopsie bei T1-Melanom?
Antidepressiva verfügen über eine immunmodulatorische und antiphlogistische Wirkung. Inwieweit sich dieser Effekt für die Behandlung entzündlicher Dermatosen nutzen lässt, war Gegenstand eines aktuellen Reviews.
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Melanom: schlechte Prognose bei NRAS-Mutation
Eine retrospektive Untersuchung mit außerhalb von Studien versorgten Melanompatienten gibt Aufschluss über den Zusammenhang von Mutationsstatus und Prognose.
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Mit Antidepressiva Hautkrankheiten behandeln?
Antidepressiva verfügen über eine immunmodulatorische und antiphlogistische Wirkung. Inwieweit sich dieser Effekt für die Behandlung entzündlicher Dermatosen nutzen lässt, war Gegenstand eines aktuellen Reviews.
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Junge Ärzte kämpfen gegen Vorurteile älterer Kollegen
Dass Nachwuchsmediziner ihr Bedürfnis nach Freizeit über die Nöte ihrer Patienten stellen und zu hohe Anforderungen an Ausbilder und künftige Arbeitgeber haben, ist reines Schubladendenken, finden junge Ärzte — und fordern ein neues Arbeitsklima.
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Neurodermitis: ab wann systemisch behandeln?
Die Umstände, die für die Umstellung von Neurodermitspatienten auf eine systemische Therapie sprechen, gehen aus den Leitlinien nicht klar hervor. Daher hat ein internationales Expertengremium entsprechende Empfehlungen verfasst, die Ärzte und Patienten bei der Entscheidung unterstützen sollen.
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Kinder mit Psoriasis früh auf Komorbidität screenen
Bei pädiatrischen Psoriasispatienten sollten schon früh Risikofaktoren beachtet werden, die künftige Komorbiditäten ankündigen können. US-Mediziner haben zusammengetragen, worauf es hierbei ankommt.
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Development and face validation of a Virtual Reality Epley Maneuver System (VREMS) for home Epley treatment of benign paroxysmal positional vertigo: A randomized, controlled trial
To develop and validate a smartphone based Virtual Reality Epley Maneuver System (VREMS) for home use.
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Total caloric eye speed in patients with vestibular migraine
Vestibular migraine is a common cause of dizziness that lacks a known objective test. This study examined total eye speed on caloric testing as a diagnostic marker for vestibular migraine.
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Changes in maxillofacial morphology and velopharyngeal function with two-stage maxillary distraction–mandibular setback surgery in patients with cleft lip and palate
Maxillary distraction is increasingly used for the correction of severe maxillary retrusion in patients with cleft lip and palate. However, control of the maxillary movement is difficult, and the need to wear visible distractors for a long period of time causes psychosocial problems. A two-stage surgical approach consisting of maxillary distraction and mandibular setback was developed to overcome these problems. In this study, changes in maxillofacial morphology and velopharyngeal function were examined in 22 patients with cleft lip and palate who underwent this two-stage approach.
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Comparison of two physiotherapy programmes for rehabilitation after temporomandibular joint arthroscopy
The purpose of this study was to compare two physiotherapy programmes for rehabilitation after temporomandibular joint (TMJ) arthroscopy. The medical files of 137 consecutive patients diagnosed with closed lock and treated by arthroscopic lysis and lavage were analyzed retrospectively. Sixty-eight patients were rehabilitated with gradually increasing range of motion self-exercises (gradual programme) and 69 patients were rehabilitated with immediate full range of motion self-exercises (immediate programme).
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Herpes zoster in hospitalized adults: Practice gaps, new evidence, and remaining questions
Herpes zoster can present many uncertainties for consulting dermatologists. We review the current guidelines and recent literature on important issues that arise in the care of hospitalized patients with herpes zoster, including infection control isolation practices, treatment courses for zoster and acute zoster-associated pain, and indications for long-term prophylaxis. We present the findings of an inpatient zoster management practices survey of the membership of the Society of Dermatology Hospitalists, an expert resource group of the American Academy of Dermatology, and discuss directions for future investigation and potential opportunities for management improvements in light of these collective data.
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Age-induced and photoinduced changes in gene expression profiles in facial skin of Caucasian females across 6 decades of age
Intrinsic and extrinsic factors, including ultraviolet irradiation, lead to visible signs of skin aging.
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De novo head and neck cancer arising in solid organ transplantation recipients: The Asan Medical Center experience
De novo cancers of head and neck area in solid organ transplantation recipients show standardized incidence ratio (SIR) of 3.8. Immunosuppression following transplantation is suggested to play as a crucial factor in pathogenesis of secondary malignancy. Prognosis of head and neck cancer arising in solid organ transplantation recipients is proven to have poor prognosis. The incidence, risk, prognosis, and survival of de novo malignancy of head and neck area in solid organ transplantation recipients in single-tertiary medical center followed up for 20 years.
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Frontal sinus revision rate after nasal polyposis surgery including frontal recess clearance and middle turbinectomy: A long-term analysis
To determine the frontal sinus revision rate after nasal polyposis (NP) surgery including frontal recess clearance (FRC) and middle turbinectomy (MT), to search for predictive factors and to analyse surgical management.
http://ift.tt/2zFVCQ6
Success of anti-CD20 monoclonal antibody treatment for severe autoimmune hemolytic anemia caused by warm-reactive immunoglobulin A, immunoglobulin G, and immunoglobulin M autoantibodies in a child: a case report
Autoimmune hemolytic anemia is rare in children. First-line therapies for this disease consist of corticosteroids and intravenously administered immunoglobulin that are effective in most patients. However, a s...
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Does the surgical approach for treating mandibular condylar fractures affect the rate of seventh cranial nerve injuries? A systematic review and meta-analysis based on a new classification for surgical approaches
The purpose of this study was to determine the rate of facial nerve injury (FNI) when performing open reduction and internal fixation of mandibular condylar fractures by different surgical approaches.
http://ift.tt/2jrocP4
Subcutaneous Secukinumab Relieves Psoriatic Arthritis
The interleukin-17A inhibitor is effective and safe, according to first results from the ongoing FUTURE5 study, the largest controlled trial of a biologic for psoriatic arthritis to date.
Medscape Medical News
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Pilomatrixom in einem Tattoo
Zusammenfassung
Bei einem 31-jährigen Patienten entwickelte sich am rechten Oberarm innerhalb einer schwarzen Tätowierung ein schnell wachsender Tumor, der histopathologisch als Pilomatrixom eingeordnet werden konnte. Während das Alter des Patienten und das schnelle Wachstum des Tumors nicht als typische Befunde der Pilomatrixome angesehen werden können, zählt die Lokalisation am Oberarm zu deren Prädilektionsstellen. Trotz der in den letzten Jahrzehnten weiten Verbreitung von Tattoos wird nur selten über eine Tumorentstehung in tätowierter Haut berichtet. Ob die Inhaltsstoffe der Tätowiermittel für die Tumorinduktion verantwortlich sein können, ist dabei umstritten.
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Chromosome 9 mutations reported absent in some patients with Basal Cell Carcinoma Nevus Syndrome
Basal Cell Carcinoma Nevus Syndrome (BCCNS), also known as Gorlin syndrome, is a rare autosomal dominant condition with a substantial disease burden, thought to occur secondary to chromosome 9 mutation evoking a Hedgehog (Hh) signaling aberration that leads to early development of numerous basal cell carcinomas (BCCs). Individuals with BCCNS also present with keratocystic odontogenic tumors, medulloblastomas, and palmar or plantar pits1. This condition demonstrates variable expressivity, leading to differing phenotypes, even within the same family2. BCCNS diagnosis requires meeting two major or one major and two minor criteria (Table 1) or presence of Chromosome 9 and/or PTCH1 mutations1.
This article is protected by copyright. All rights reserved.
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The Sociotype in Dermatology
Skin diseases can be the cause of a significant psychosocial burden for those who suffer them. A number of studies have considered issues such as a lower quality of life, increased anxiety, depression, suicidal ideation and other psychological disorders1-3. However, adequate means for evaluating social interaction difficulties, diminished social networks, and the impoverished conversational exchanges that affect the wellbeing and mental health of the individual have not been sufficiently developed.
This article is protected by copyright. All rights reserved.
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Efficacy and safety of tofacitinib for moderate-to-severe plaque psoriasis: a systematic review and meta-analysis of randomized controlled trials
Abstract
The effects of tofacitinib in treating moderate-to-severe plaque psoriasis were unclear. We aimed to assess the effects of tofacitinib in treating moderate-to-severe plaque psoriasis. We searched PubMed, Cochrane Central Register of Controlled Trials, and EMBASE for relevant randomised controlled trials (RCTs), and conducted a systematic review and meta-analysis. Four RCTs with 2,724 participants were included. Compared to placebo, tofacitinib significantly improved psoriasis (≥ 75% reduction in the Psoriasis Area and Severity Index score: 5 mg BID: risk difference (RD) 0.32 (95% confidence interval (CI) 0.28-0.35), 10 mg BID: RD 0.51 (95% CI 0.43-0.58); ≥ 90% reduction in the Psoriasis Area and Severity Index score: 5 mg BID: RD 0.19 (95% CI 0.17-0.22), 10 mg BID: RD 0.36 (95% CI 0.31-0.42); Physician's Global Assessment 0/1: 5 mg BID: RD 0.31 (95% CI 0.27-0.35), 10 mg BID: RD 0.48 (95% CI 0.44-0.53)) and participants' life quality (Dermatology Life Quality Index 0/1: 5 mg BID: RD 0.24 (95% CI 0.20-0.2), 10 mg BID: RD 0.36 (95% CI 0.33-0.40)). Tofacitinib was associated with an increase in minor adverse events (upper respiratory tract infection: 5 mg BID: RD 0.02 (95% CI 0.00-0.03), 10 mg BID: RD 0.02 (95% CI 0.00-0.04); hypercholesterolaemia: 5 mg BID: RD 0.02 (95% CI 0.01-0.04), 10 mg BID: RD 0.02 (95% CI 0.01-0.04)). In conclusion, tofacitinib may be a treatment option for moderate-to-severe plaque psoriasis that is unresponsive to other therapies and patients who are intolerable to other therapies or prefer oral medications.
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Comments to: Compound heterozygotes for filaggrin gene mutations do not always show severe atopic dermatitis
recent paper by Akiyama and coworkers questions one more time about role of FLG in A.D.Since first reports of heterozygous mutations of FLG in A.D. patients (1) replicated in northern European populations (2-3-4) and therefore in other populations worldwide (5), genetic studies of patient with I.V. /intrinsic A.D. of different populations of different ancestry as African American (6), and Ethiopian (7) make clear that haploinsufficiency of other structural proteins of epidermis are pathogenic for this phenotype and confirmed the Elias et al. "Outside-to-Inside and back to outside" hypothesis, previously pointed out by permeability studies of stratum corneum of A.D. patients (8).
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Patient and physician satisfaction in an observational study with methyl aminolevulinate daylight-photodynamic therapy in the treatment of multiple actinic keratoses of the face and scalp in 6 European countries
Abstract
Background
Guidelines recommend treating actinic keratoses (AK) as they are recognized as precursors of invasive squamous cell carcinoma.
Objective
The objective of this study was to collect real-world clinical data on the use of methyl aminolevulinate daylight-photodynamic therapy (MAL DL-PDT) for the treatment of face and scalp AK in Europe.
Methods
A prospective, multicenter, non-interventional study was conducted in 6 European countries in patients receiving a single treatment of MAL DL-PDT for face and/or scalp AK. Patient-reported outcomes were assessed by patient questionnaires at baseline and at 3 months after treatment, efficacy was assessed at 3 months using a 6-point global improvement scale, and adverse events (AE) were recorded at each visit.
Results
Overall, 325 patients were enrolled from 52 investigational centers, 314 of whom attended the 3-month visit. Most patients had multiple lesions (58.4% had >10 lesions) with lesions mainly located on the scalp (60.0%) and/or forehead (54.2%). AK were predominantly grade I (39.4%) or grade II (33.2%) and 10.5% of patients had grade III lesions. The proportions of patients and physicians that were overall satisfied to very satisfied with the MAL DL-PDT treatment were 80.4% and 90.3%, respectively. The vast majority of patients (90.0%) would consider using MAL DL-PDT again if needed. Physician-assessed efficacy at 3 months was at least much improved in 83.5% of patients, with 45.9% of patients requiring no retreatment. Related AEs were reported in 15% of patients.
Conclusion
Use of MAL DL-PDT for multiple face and/or scalp AK resulted in high levels of patient and physician satisfaction in clinical practice in Europe, reflecting the good efficacy and high tolerability of this convenient procedure.
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Scalp melanoma after anti hair loss mesotherapy
Scalp melanoma comprises 3-5% of all cutaneous melanomas. The median age of the patients is 53 years and males are more frequently affected. The scalp melanomas tend to have nodular histology with a higher mitotic rate (>3/mm) and poorer prognosis (1). The risk factors for development of this tumor are still not defined but UV light and baldness may play a significant role (2-4). Mesotherapy is a non-surgical procedure currently being used to combat hair loss and promote hair growth. Usually a mixture of vitamins, minerals, growth factors, DHT blockers and/or stem cells extracts is injected into the dermal layer of skin (5,6). Although it is a widely used method, the safety profile of this procedure hasn′t been studied yet (7,8).
This article is protected by copyright. All rights reserved.
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ACS NSQIP risk calculator reliability in head and neck oncology: The effect of prior chemoradiation on NSQIP risk estimates following laryngectomy
Source:American Journal of Otolaryngology
Author(s): Angela Cao, Sarah Khayat, Elizabeth Cash, Christopher Nickel, John Gettelfinger, Paul Tennant, Jeffrey Bumpous
PurposeTo determine whether inclusion of chemoradiation history increases estimated risk for complications following total laryngectomy using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Surgical Risk Calculator.Materials and methodsA retrospective review of 96 patients with laryngeal cancer, approximately half of who had received prior chemoradiation, who underwent laryngectomy between January 2010 and December 2014. NSQIP estimates were calculated and compared to actual event occurrence using receiver operating characteristic (ROC) curves, Brier scores, and risk estimates.ResultsPatients who had received prior chemoradiation were at significantly greater risk for complication postoperatively (OR=2.63, 95% CI=1.145–6.043). NSQIP Calculator discriminability and accuracy were generally poor for this sample. While NSQIP estimates significantly predicted risk for any postoperative complication, pneumonia, and discharge to nursing care for primary laryngectomy patients, predictive capability was lost among salvage laryngectomy patients. NSQIP adjustments to both Somewhat Higher and Significantly Higher Risk categories did not improve predictive capability. Of the risk factors considered by NSQIP, preoperative functional status (p=0.041), age at time of surgery (p<0.008), and inclusion of neck dissection (p=0.035) emerged as significant predictors of actual postoperative complications, though again estimates lost significance among salvage laryngectomy patients.ConclusionsThe NSQIP Calculator may be poorly calibrated to estimate postoperative complication risk for patients previously exposed to chemoradiation undergoing salvage laryngectomy. Caution should be used when estimating postoperative risk among patients undergoing salvage procedures, especially those of older age, poorer functional status, and those requiring neck dissection.
http://ift.tt/2mqEEQT
Genome-wide association study identifies GALC as susceptibility gene for mucous membrane pemphigoid
Abstract
Background
Mucous membrane pemphigoid (MMP) is a rare, chronic, and often aggressive subepidermal autoimmune blistering disease potentially affecting several mucous membranes with blisters and secondary erosions and scars. The pathogenesis of MMP is poorly understood, and the contribution of genetic predispositions, other than HLA class II allele variants to MMP, is unknown.
Objectives
The objective of this study is to identify susceptibility genes for MMP in a British cohort of MMP patients.
Methods
A GWAS was conducted in a British cohort of 106 MMP patients. Publicly available genotypes of 2,900 blood donors of the UK Blood Service and of 6,740 individuals of the 1958 British Birth Cohort served as control. Subsequently, putative susceptibility genes were independently replicated in a German cohort of 42 MMP patients.
Results
The GWAS found 38 SNPs in 28 haploblocks with an odds ratio >2 reaching genome-wide significance (p<5.7x10-7). Replication confirmed an association of MMP with SNPs in rs17203398 (OR: 3.9), located intronically in the β-galactocerebrosidase gene (GALC) on chromosome 14, and with recessive polymorphisms in rs9936045 (OR: 3.1) in the intergenic region between CASC16 and CHD9 on chromosome 16.
Conclusions
The risk of developing MMP is partially genetically determined. SNPs in GALC enhance the risk for MMP, indicating that β-galactocerebrosidase may be involved in the pathogenesis of MMP. Likewise, impacts of polymorphisms in the intergenic region between CASC16 and CHD9 on the activity of neighboring genes may facilitate the emergence of MMP. The putative role of both polymorphisms requires functional studies in the future.
This article is protected by copyright. All rights reserved.
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Author's response to the comment to ‘Compound heterozygotes for filaggrin gene mutations do not always show severe atopic dermatitis’
FLG mutations play a causal role in the development of ichthyosis vulgaris (IV) and are known to be a predisposing factor for atopic dermatitis (AD) in European and Asian populations. However, it remains a matter of debate how loss of function of filaggrin leads to AD. Skin barrier dysfunction due to the loss of structural proteins in the epidermis makes it easy for allergens to invade, and sensitization to the allergens, increases in serum IgE, and dermatitis follow. In addition, loss of filaggrin results in increased pH in the stratum corneum, increased serine protease activity and hyper-activation of cytokine cascades.
This article is protected by copyright. All rights reserved.
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Potential link between m6A modification and systemic lupus erythematosus
Source:Molecular Immunology, Volume 93
Author(s): Lian-Ju Li, Yin-Guang Fan, Rui-Xue Leng, Hai-Feng Pan, Dong-Qing Ye
The field of m6A modification and epitranscriptomics has recently attracted much attention. More methods allowing for precise m6A site profiling and location are developed and crucial players of m6A modification machinery are increasingly identified. Although some challenges remain, m6A modification is found to modulate almost all aspects of RNA metabolism, such as splicing, stability, structure, translation, and export. Thus, m6A modification adds a new layer of post-transcriptional gene expression regulation, and it is implicated in T cell response to HIV infection, type I interferon production, and T cell differentiation and homeostasis. Moreover, evidence supporting its involvement in various human diseases including cancers is accumulating. Given the role of m6A modification in gene expression regulation and immune response, it invites the speculation that m6A modification may justify the pathogenesis of systemic lupus erythematosus (SLE) and take part in the initiation and progression of SLE. In this review, we introduce the widespread existence of m6A modification and briefly discuss components of m6A modification machinery in mammals. We mainly summarize the studies reporting the mechanisms of m6A modification in gene expression regulation through modulating pre-mRNA splicing, mRNA stability, RNA structure, translation, and pri-miRNA processing. Biological functions related to immune response of m6A modification and the implication of m6A modification in cancers are highlighted. In the end, we surmise the potential link between m6A modification and SLE.
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BMSCs-derived miR-223-containing exosomes contribute to liver protection in experimental autoimmune hepatitis
Source:Molecular Immunology, Volume 93
Author(s): Lu Chen, Feng-bin Lu, Da-zhi Chen, Jin-lu Wu, En-de Hu, Lan-man Xu, Ming-hua Zheng, Hui Li, Yu Huang, Xiao-ya Jin, Yue-wen Gong, Zhuo Lin, Xiao-dong Wang, Yong-ping Chen
Autoimmune hepatitis is a chronic inflammatory disease in the liver with potential to the development of liver fibrosis. Recent evidences suggest that bone marrow derived mesenchymal stem cells (BMSCs) may exert its therapeutic activity through exosomes. Moreover, miR-223 is highly expressed in BMSCs and plays an important role in autoimmune diseases. Therefore, in this study, hepatoprotective role of BMSCs and miR-223 was investigated in both mice and hepatocytes. Liver antigen S100 was used to establish autoimmune hepatitis model in mice while LPS and ATP were used to establish cell injury model in hepatocyte. Before the experiments, BMSCs were infected with pre-miR-223 and transfected with miR-223 inhibitor respectively. Exosomes from bone marrow stem cells were isolated by ultracentrifugation. Liver injury was evaluated by serum levels of ALT and AST as well as liver histology. Inflammation and cell death were examined by inflammatory cytokines and lactase dehydrogenase respectively. Both BMSCs-exo and BMSCs-exomiR−223(+) significantly reversed either S100 or LPS/ATP induced injury in mice and hepatocytes. Meanwhile, the expressions of cytokines, NLRP3 and caspase-1 were also downregulated by BMSCs-exo and BMSCs-exomiR−223(+) at both protein and mRNA levels in mice and hepatocytes. Moreover, BMSCs-exomiR−223(−) reverses the effects of BMSCs-exo and BMSCs-exomiR−223(+) in mouse AIH and in hepatocytes. In conclusion, bone marrow stem cell derived exosomes can protect liver injury in an experimental model of autoimmune hepatitis and the mechanism could be related to exosomal miR-223 regulation of NLRP3 and caspase-1.
http://ift.tt/2hpxo2q
Vibrio cholerae OmpU induces IL-8 expression in human intestinal epithelial cells
Source:Molecular Immunology, Volume 93
Author(s): Jae Seung Yang, Jun Ho Jeon, Mi Seon Jang, Seok-Seong Kang, Ki Bum Ahn, Manki Song, Cheol-Heui Yun, Seung Hyun Han
Although Vibrio cholerae colonizes the small intestine and induces acute inflammatory responses, less is known about the molecular mechanisms of V. cholerae-induced inflammatory responses in the intestine. We recently reported that OmpU, one of the most abundant outer membrane proteins of V. cholerae, plays an important role in the innate immunity of the whole bacteria. In this study, we evaluated the role of OmpU in induction of IL-8, a representative chemokine that recruits various inflammatory immune cells, in the human intestinal epithelial cell (IEC) line, HT-29. Recombinant OmpU (rOmpU) of V. cholerae induced IL-8 expression at the mRNA and protein levels in a dose- and time-dependent manner. Interestingly, IL-8 was secreted through both apical and basolateral sides of the polarized HT-29 cells upon apical exposure to rOmpU but not upon basolateral exposure. rOmpU-induced IL-8 expression was inhibited by interference of lipid raft formation with nystatin, but not by blocking the formation of clathrin-coated pits with chlorpromazine. In addition, rOmpU-induced IL-8 expression was mediated via ERK1/2 and p38 kinase pathways, but not via JNK signaling pathway. Finally, V. cholerae lacking ompU elicited decreased IL-8 expression and adherence to HT-29 cells compared to the parental strain. Collectively, these results suggest that V. cholerae OmpU might play an important role in intestinal inflammation by inducing IL-8 expression in human IECs.
http://ift.tt/2hpxdnM
Safety and Effectiveness of a Novel Facemask for Positive Pressure Ventilation
BACKGROUND: Manual positive pressure ventilation is an essential skill in a variety of clinical situations. The C&E technique is commonly used with standard facemasks to provide effective ventilation. The Tao mask is a novel design that allows a more ergonomic grip. A seal between the mask and face is made with downward pressure of the palm, centered on the mask, and jaw lift is achieved with 4 fingers centered under the mandible. The purpose of this study was to evaluate the safety and effectiveness of the Tao mask compared to a standard mask before and after the administration of neuromuscular blockade (NMB) using 2 previously established ventilation scales. METHODS: One hundred fifty-two patients >18 years of age who were scheduled for general anesthesia were recruited. All care team members were shown a brief instructional video on the use of the Tao mask. After induction of general anesthesia with a standardized protocol, each patient was ventilated with both the standard (Vital Signs #082510) and Tao masks and effectiveness was measured using the Han and Warters scales. This process was repeated after NMB. The sequence of masks was determined with a random-number generator. RESULTS: Tao mask ventilation scores were significantly better than standard mask scores on both the Han scale and the Warters scale before the administration of NMB (P
http://ift.tt/2hyScIg
http://ift.tt/2hyScIg
The Analgesic Effect of Ultrasound-Guided Quadratus Lumborum Block After Cesarean Delivery: A Randomized Clinical Trial
BACKGROUND: Landmark and ultrasound-guided transversus abdominis plane blocks have demonstrated an opioid-sparing effect postoperatively after cesarean delivery. The more posterior quadratus lumborum (QL) might provide superior local anesthetic spread to the thoracolumbar fascia and paravertebral space. The aim of our study was to evaluate the efficacy of the QL block after cesarean delivery. METHODS: A randomized, double-blind, controlled trial was performed. Forty parturients undergoing cesarean delivery received bilateral ultrasound-guided QL blocks with either 2 mg/mL ropivacaine or saline postoperatively. All patients received spinal anesthesia with bupivacaine and sufentanil and a postoperative analgesic regimen of paracetamol, ibuprofen, and ketobemidone administered by a patient-controlled analgesic pump. The ketobemidone consumption and time of each dose administered were recorded. The primary outcome was ketobemidone consumption during the first 24 hours postoperatively. Secondary and exploratory analyses compared repeated measures of pain scores, nausea, and fatigue, and total differences in time until patients were able to stand and able to walk 5 m, and the interaction between the effective analgesic score and time. RESULTS: All 40 patients completed the trial, 20 in each group. The cumulative ketobemidone consumption in 24 hours was reduced in the active group compared with the control group (P = .04; ratio of means = 0.60; 95% confidence interval, 0.37–0.97). The effective analgesic scores were significantly better in the treatment group compared with the placebo group both at rest (P
http://ift.tt/2jpp7Qi
http://ift.tt/2jpp7Qi
Ultrasound-Guided Dynamic Needle Tip Positioning Technique Versus Palpation Technique for Radial Arterial Cannulation in Adult Surgical Patients: A Randomized Controlled Trial
BACKGROUND: Radial arterial cannulation is most commonly done using palpation, but the use of ultrasound has increased the cannulation success rate. This improvement, albeit significant, has not led to a very high success rate especially in trainees. A modified ultrasound technique for vascular cannulation (dynamic needle tip positioning) has been described for peripheral venous cannulation. We therefore assessed the success rate of this technique compared to the palpation technique for radial artery cannulation in adult surgical patients. METHODS: We enrolled patients who were having nonemergent operations that required a radial arterial catheter for intraoperative monitoring. Patients were randomized to either palpation or dynamic needle tip positioning technique. Arterial cannulation was performed by anesthesia residents or faculty members. The primary end point was successful cannulation on the first pass. Secondary end points were overall 5-minute success rate and number of attempts within 5 minutes. RESULTS: Two hundred sixty patients were evaluated. The first-pass success rate was 83% in the dynamic needle tip positioning technique group (n = 132) and 48% in the palpation group (n = 128; P
http://ift.tt/2hz6qZW
http://ift.tt/2hz6qZW
General Anesthetics to Treat Major Depressive Disorder: Clinical Relevance and Underlying Mechanisms
Major depressive disorder is a frequent and devastating psychological condition with tremendous public health impact. The underlying pathophysiological mechanisms involve abnormal neurotransmission and a relatedly impaired synaptic plasticity. Since general anesthetics are potent modulators of neuronal activity and, thereby, can exert long-term context-dependent impact on neural networks, an intriguing hypothesis is that these drugs could enhance impaired neural plasticity associated with certain psychiatric diseases. Clinical observations over the past few decades appear to confirm this possibility. Indeed, equipotency of general anesthesia alone in comparison with electroconvulsive therapy under general anesthesia has been demonstrated in several clinical trials. Importantly, in the past 15 years, intravenous administration of subanesthetic doses of ketamine have also been demonstrated to have rapid antidepressant effects. The molecular, cellular, and network mechanisms underlying these therapeutic effects have been partially identified. Although several important questions remain to be addressed, the ensemble of these experimental and clinical observations opens new therapeutic possibilities in the treatment of depressive disorders. Importantly, they also suggest a new therapeutic role for anesthetics that goes beyond their principal use in the perioperative period to facilitate surgery. Accepted for publication September 19, 2017. Funding: None. The author declares no conflicts of interest. Reprints will not be available from the author. Address correspondence to Laszlo Vutskits, MD, PhD, Department of Anesthesiology, Pharmacology and Intensive Care, University Hospitals of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 4, Switzerland. Address e-mail to laszlo.vutskits@unige.ch. © 2017 International Anesthesia Research Society
http://ift.tt/2jpoIxg
http://ift.tt/2jpoIxg
Cardiac Arrest in the Operating Room: Resuscitation and Management for the Anesthesiologist Part 1
Cardiac arrest in the operating room and procedural areas has a different spectrum of causes (ie, hypovolemia, gas embolism, and hyperkalemia), and rapid and appropriate evaluation and management of these causes require modification of traditional cardiac arrest algorithms. There is a small but growing body of literature describing the incidence, causes, treatments, and outcomes of circulatory crisis and perioperative cardiac arrest. These events are almost always witnessed, frequently known, and involve rescuer providers with knowledge of the patient and their procedure. In this setting, there can be formulation of a differential diagnosis and a directed intervention that treats the likely underlying cause(s) of the crisis while concurrently managing the crisis itself. Management of cardiac arrest of the perioperative patient is predicated on expert opinion, physiologic rationale, and an understanding of the context in which these events occur. Resuscitation algorithms should consider the evaluation and management of these causes of crisis in the perioperative setting. Accepted for publication September 8, 2017. Funding: This manuscript was developed from previous iterations on behalf of the American Society of Anesthesiologists (ASA) and the Society of Critical Care Anesthesiologists. Portions of this manuscript appear verbatim and are used with the permission of the ASA. Conflicts of Interest: See Disclosures at the end of the article. Reprints will not be available from the authors. Address correspondence to Vivek K. Moitra, MD, Department of Anesthesiology, PH 527-B, College of Physicians & Surgeons of Columbia University, 630 West 168th St, New York NY 10032. Address e-mail to vm2161@cumc.columbia.edu. © 2017 International Anesthesia Research Society
http://ift.tt/2jr61Jy
http://ift.tt/2jr61Jy
Trial of Laryngeal Preservation Comparing Induced CT Followed by RT vs CT Concomitant to RT
Condition: Head and Neck Squamous Cell Carcinoma
Interventions: Drug: Docetaxel; Drug: Cisplatin; Drug: Fluorouracil; Radiation: radiotherapy
Sponsor: Groupe Oncologie Radiotherapie Tete et Cou
Recruiting
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Interventions: Drug: Docetaxel; Drug: Cisplatin; Drug: Fluorouracil; Radiation: radiotherapy
Sponsor: Groupe Oncologie Radiotherapie Tete et Cou
Recruiting
http://ift.tt/2zXEd6D
Adjuvant Nivolumab and Lirilumab in Patients With Relapsed, Resectable Squamous Cell Carcinoma of the Head and Neck
Condition: Squamous Cell Carcinoma of the Head and Neck
Interventions: Drug: Nivolumab; Drug: Lirilumab
Sponsors: Dana-Farber Cancer Institute; Bristol-Myers Squibb
Not yet recruiting
http://ift.tt/2zXEg2j
Interventions: Drug: Nivolumab; Drug: Lirilumab
Sponsors: Dana-Farber Cancer Institute; Bristol-Myers Squibb
Not yet recruiting
http://ift.tt/2zXEg2j
Nivolumab Plus Epacadostat in Combination With Chemotherapy Versus the EXTREME Regimen in Squamous Cell Carcinoma of the Head and Neck (CheckMate 9NA/ECHO-310)
Condition: Squamous Cell Carcinoma of the Head and Neck
Interventions: Drug: Nivolumab; Drug: Epacadostat; Drug: Placebo; Drug: Carboplatin; Drug: Cisplatin; Drug: Cetuximab; Drug: 5-Fluorouracil
Sponsors: Incyte Corporation; Bristol-Myers Squibb
Not yet recruiting
http://ift.tt/2zFA9qC
Interventions: Drug: Nivolumab; Drug: Epacadostat; Drug: Placebo; Drug: Carboplatin; Drug: Cisplatin; Drug: Cetuximab; Drug: 5-Fluorouracil
Sponsors: Incyte Corporation; Bristol-Myers Squibb
Not yet recruiting
http://ift.tt/2zFA9qC
Epiretinal Membrane in Dome-Shaped Macula Complicated with Serous Retinal Detachment: Transient Efficacy of Surgery
Dome-shaped macula (DSM) is an entity recently described as a convex anterior protrusion of the macular area within a posterior myopic staphyloma. Specific complications were associated with DSM, like serous retinal detachment (SRD). We describe a woman presenting with a decreased vision at 20/50. SD-OCT scans were performed, showing a macular bulge. SRD was present and an epiretinal membrane could also be observed. Fluorescein angiography and indocyanin green angiography did not show any leakage nor choroidal neovascularization. Epiretinal membrane peeling was performed, and 3 months after surgery, SRD completely disappeared. However, SRD reappeared 1 year after surgery and enlarged within 2 years following surgery. In conclusion, two mechanisms could be considered for physiopathology of SRD: first, the epiretinal membrane may have exerted traction on the macular retina, second, vitreous body might constitute a tank for cytokines and/or other factors, triggering subretinal fluid accumulation, leading to SRD.
Case Rep Ophthalmol 2017;8:510–515
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Seronegative Myasthenia Gravis, as a Rare Autoimmune Condition in Turner Syndrome
Girls with Turner syndrome (TS), especially with isochromosome 46,X,i(X)(q10), are prone to develop autoimmunity. Associations of several autoimmune conditions with TS have been frequently described in the past. However, the unique combination of TS and myasthenia gravis (MG) has been reported only once before in a girl with mosaic monosomy 45,X/46,XX. Here, we present the second case of a girl affected with seronegative MG but with mosaic isochromosome TS. This is a child with developmental delay presented with muscle weakness, frequent fall, and bilateral ptosis. Diagnosis of MG was made based on positive Tensilon and electromyography tests and excellent response to intravenous immunoglobulin. At the age of 11 years due to short stature and developmental delay, a karyotype was done and revealed the mosaic isochromosome 45,X/46,X,i(X)(q10). Overall, clinicians should be aware of the vulnerability of girls with TS to autoimmunity, especially if the isochromosome 46,X,i(X)(q10) karyotype is identified. Furthermore, if a child with TS develops muscle weakness, ptosis, or ophthalmoplegia, MG should also be included in the differential diagnosis, particularly if other concurrent autoimmune conditions are present.
http://ift.tt/2mo3AbA
Quimp (QUality of life IMPairment): an addition to the Quality of Life lexicon
There has been a constant growth in the number of publications each year concerning "quality of life (QoL)" and "dermatology," since the publication of the Dermatology Life Quality Index in 1994. Numerous dermatology and disease-specific QoL instruments have since been created. Quality of life is frequently assessed in clinical trials, educational activities and epidemiologic studies. QoL assessment is included in many national guidelines in dermatology. QoL assessment scores, together with disease severity measures, are used as guideline criteria for the use of biologics in dermatology and other clinical fields in many countries, and even for treatment reimbursement decisions. QoL assessment in dermatology is considered of benefit for routine clinical use. The European Academy of Dermatology and Venereology Task Force on QoL and Patient Oriented Outcomes (PO) is actively working to facilitate appropriate use of
This article is protected by copyright. All rights reserved.
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Direct intranasal application of the solid phase of ImmunoCAP® increases nasal specific immunoglobulin E detection in local allergic rhinitis patients
Background
The measurement of nasal specific IgE (NsIgE) in local allergic rhinitis (LAR) patients is challenging and shows variability. The objective of this work was to evaluate a minimally-invasive method of direct detection of NsIgE in patients with LAR to Dermatophagoides pteronyssinus (DP) using an automated immunoassay.
Methods
Fifty patients participated (LAR, n = 14; allergic rhinitis (AR), n = 20; healthy controls [HC], n = 16). Detection of NsIgE was performed by direct application of the solid phase of a commercial DP ImmunoCAP® test 24 hours after DP nasal provocation.
Results
There was no difference in the median volume of secretion absorbed by the solid phase of the ImmunoCAP test in the 3 studied groups (p = 0.17). According to receiver operating characteristic (ROC) curve analysis, NsIgE ≥0.1450 was the optimal cutoff point, obtaining in LAR patients 42.86% sensitivity with the highest specificity (100%), and 75% sensitivity and 100% specificity for AR.
Conclusion
This study demonstrates the detection of NsIgE to DP in LAR by using a simple, commercial device with high specificity.
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Otitis media with effusion and atopy: is there a causal relationship?
Otitis Media with Effusion (OME) is an inflammatory condition of the middle ear cleft, acute or chronic, with collection of fluid in the middle ear with an intact tympanic membrane. It is a very common disease...
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Collection of nasal secretions and tears and their use in allergology
Purpose of review The identification of immunological markers in nasal secretions and tears is becoming essential in the study of allergic diseases. The collection procedure of nasal and ocular secretions directly influences the results, thus it is of paramount importance to validate and standardize the sampling process. Recent findings Current techniques for nasal secretions sampling are mainly based on three principles: collection of spontaneous secretions, nasal washings, and absorption. Collection of spontaneous secretions is appropriate in subjects with nasal hypersecretion, whereas in healthy individuals the collected volume is frequently insufficient. Nasal washings are associated with an unpredictable, high dilution and concentrations of markers often fall below detection limits of immunological assays. Absorption seem to provide the best compromise between sufficient sample amounts and detectability of inflammatory mediators and immunoglobulin E. Tear samples can be obtained by glass capillary tubes, filter paper strips and ophthalmic sponges. Volumes are however small or highly diluted through reflex tearing. Summary Secretions reflect the local inflammatory activity and provide valuable information about the immunological reaction to allergens at the target organ. There is increasing evidence of the potential clinical role of their analysis, for diagnosis, and monitoring of allergic rhino-conjunctivitis. Appropriate collection and processing is very important and requires special attention. Correspondence to Paolo M. Matricardi, Department of Pediatric Pneumology and Immunology, Charité Medical University, Augustenburger Platz, 1, 13353 Berlin, Germany. Tel: +49 30 450 566 406; fax: +49 30 450 566 931; e-mail: paolo.matricardi@charite.de Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2iThCNC
http://ift.tt/2iThCNC
Prevalence and clinical characteristics of local allergic rhinitis to house dust mites
Purpose of review Local allergic rhinitis (LAR) is a recently classified subtype of rhinitis defined by a nasal allergic response in patients without systemic evidence of atopy. Recent studies have reported the prevalence, clinical course, culprit allergens, diagnostic methods and treatment outcomes of LAR. The purpose of this review is to summarize the most relevant and updated scientific evidence for LAR, especially focusing on its prevalence and clinical characteristics. Recent findings LAR is found in a significant proportion (3.7–61.9%) of patients previously diagnosed with nonallergic rhinitis, but the prevalence may differ among ethnic groups and countries. Common allergens of LAR are similar to those of allergic rhinitis, in which house dust mites are the most common cause, followed by grass pollen, tree pollen, weed pollen and animal dander confirmed by provocation tests. Although the nasal provocation test to a single allergen is considered the gold standard method, the detection of allergen-specific IgE and other inflammatory mediators from nasal secretions and the basophil activation test can assist in the diagnosis of LAR. Conjunctivitis and asthma are the most common comorbid conditions, and the occurrence rate of asthma increases over period. However, the conversion rate to allergic rhinitis was not significantly different between LAR and healthy controls. Summary LAR is a well-differentiated entity of rhinitis, which should be considered in patients with persistent and severe symptoms without any systemic evidence of atopy. Further research is needed to investigate the long-term outcome, and geographic and ethnic differences of LAR. Correspondence to Hae-Sim Park, MD, PhD, Department of Allergy and Clinical Immunology, Ajou University School of Medicine, 164, Worldcup-ro, Yeongtong-gu, Suwon 16499, South Korea. Tel: +82 31 219 5150; fax: +82 31 219 5154; e-mail: hspark@ajou.ac.kr Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2zIFmMo
http://ift.tt/2zIFmMo
Association between allergic and nonallergic rhinitis and obstructive sleep apnea
Purpose of review Allergic rhinitis and nonallergic rhinitis (NAR) are common disorders, which have been considered as potential risk factors for obstructive sleep apnea (OSA). This review summarizes the proposed underlying pathophysiological mechanisms to provide a better understanding of the relationship between these conditions. Recent findings In adults, allergic rhinitis and NAR may be considered as symptoms potentiating, rather than risk potentiating factors in the pathophysiology of OSA, whereas in children, these are considered to be independent predictors for sleep-disordered breathing (SDB) and failure of adeno-tonsillectomy, the recommended first-line therapy for children with OSA. Current advances suggest IL-6 may be important in regulating the sleep–wake cycle, and serum soluble IL-6 receptor (sIL-6R) levels may reflect the severity of OSA. Elevated Th17/Treg ratio correlates positively with apnea–hypopnea index of OSA patients, and Th17 and Treg imbalances caused by allergic rhinitis and OSA, respectively, may possibly promote each other, leading to further imbalance. Moreover, obesity is a strong risk factor for OSA, and leptin plays an important role in ventilatory function and upper airway obstruction. The variant trigeminocardiac reflex and nasotrigeminal reflex may also be involved in the association between rhinitis and OSA. Summary Allergic rhinitis/NAR and OSA are closely associated, and each condition can be detrimental to the other. Thus, clinicians should pay attention to the potential presence of allergic rhinitis/NAR in OSA patients and vice versa. Correspondence to Luo Zhang, MD, PhD, Beijing Institute of Otolaryngology, No. 17, HouGouHuTong, DongCheng District, Beijing 100005, China. Tel: +8610 65141136; fax: +8610 85115988; e-mail: dr.luozhang@139.com Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2iTF8Kq
http://ift.tt/2iTF8Kq
Collection of nasal secretions and tears and their use in allergology
Purpose of review The identification of immunological markers in nasal secretions and tears is becoming essential in the study of allergic diseases. The collection procedure of nasal and ocular secretions directly influences the results, thus it is of paramount importance to validate and standardize the sampling process. Recent findings Current techniques for nasal secretions sampling are mainly based on three principles: collection of spontaneous secretions, nasal washings, and absorption. Collection of spontaneous secretions is appropriate in subjects with nasal hypersecretion, whereas in healthy individuals the collected volume is frequently insufficient. Nasal washings are associated with an unpredictable, high dilution and concentrations of markers often fall below detection limits of immunological assays. Absorption seem to provide the best compromise between sufficient sample amounts and detectability of inflammatory mediators and immunoglobulin E. Tear samples can be obtained by glass capillary tubes, filter paper strips and ophthalmic sponges. Volumes are however small or highly diluted through reflex tearing. Summary Secretions reflect the local inflammatory activity and provide valuable information about the immunological reaction to allergens at the target organ. There is increasing evidence of the potential clinical role of their analysis, for diagnosis, and monitoring of allergic rhino-conjunctivitis. Appropriate collection and processing is very important and requires special attention. Correspondence to Paolo M. Matricardi, Department of Pediatric Pneumology and Immunology, Charité Medical University, Augustenburger Platz, 1, 13353 Berlin, Germany. Tel: +49 30 450 566 406; fax: +49 30 450 566 931; e-mail: paolo.matricardi@charite.de Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2iThCNC
http://ift.tt/2iThCNC
Prevalence and clinical characteristics of local allergic rhinitis to house dust mites
Purpose of review Local allergic rhinitis (LAR) is a recently classified subtype of rhinitis defined by a nasal allergic response in patients without systemic evidence of atopy. Recent studies have reported the prevalence, clinical course, culprit allergens, diagnostic methods and treatment outcomes of LAR. The purpose of this review is to summarize the most relevant and updated scientific evidence for LAR, especially focusing on its prevalence and clinical characteristics. Recent findings LAR is found in a significant proportion (3.7–61.9%) of patients previously diagnosed with nonallergic rhinitis, but the prevalence may differ among ethnic groups and countries. Common allergens of LAR are similar to those of allergic rhinitis, in which house dust mites are the most common cause, followed by grass pollen, tree pollen, weed pollen and animal dander confirmed by provocation tests. Although the nasal provocation test to a single allergen is considered the gold standard method, the detection of allergen-specific IgE and other inflammatory mediators from nasal secretions and the basophil activation test can assist in the diagnosis of LAR. Conjunctivitis and asthma are the most common comorbid conditions, and the occurrence rate of asthma increases over period. However, the conversion rate to allergic rhinitis was not significantly different between LAR and healthy controls. Summary LAR is a well-differentiated entity of rhinitis, which should be considered in patients with persistent and severe symptoms without any systemic evidence of atopy. Further research is needed to investigate the long-term outcome, and geographic and ethnic differences of LAR. Correspondence to Hae-Sim Park, MD, PhD, Department of Allergy and Clinical Immunology, Ajou University School of Medicine, 164, Worldcup-ro, Yeongtong-gu, Suwon 16499, South Korea. Tel: +82 31 219 5150; fax: +82 31 219 5154; e-mail: hspark@ajou.ac.kr Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2zIFmMo
http://ift.tt/2zIFmMo
Association between allergic and nonallergic rhinitis and obstructive sleep apnea
Purpose of review Allergic rhinitis and nonallergic rhinitis (NAR) are common disorders, which have been considered as potential risk factors for obstructive sleep apnea (OSA). This review summarizes the proposed underlying pathophysiological mechanisms to provide a better understanding of the relationship between these conditions. Recent findings In adults, allergic rhinitis and NAR may be considered as symptoms potentiating, rather than risk potentiating factors in the pathophysiology of OSA, whereas in children, these are considered to be independent predictors for sleep-disordered breathing (SDB) and failure of adeno-tonsillectomy, the recommended first-line therapy for children with OSA. Current advances suggest IL-6 may be important in regulating the sleep–wake cycle, and serum soluble IL-6 receptor (sIL-6R) levels may reflect the severity of OSA. Elevated Th17/Treg ratio correlates positively with apnea–hypopnea index of OSA patients, and Th17 and Treg imbalances caused by allergic rhinitis and OSA, respectively, may possibly promote each other, leading to further imbalance. Moreover, obesity is a strong risk factor for OSA, and leptin plays an important role in ventilatory function and upper airway obstruction. The variant trigeminocardiac reflex and nasotrigeminal reflex may also be involved in the association between rhinitis and OSA. Summary Allergic rhinitis/NAR and OSA are closely associated, and each condition can be detrimental to the other. Thus, clinicians should pay attention to the potential presence of allergic rhinitis/NAR in OSA patients and vice versa. Correspondence to Luo Zhang, MD, PhD, Beijing Institute of Otolaryngology, No. 17, HouGouHuTong, DongCheng District, Beijing 100005, China. Tel: +8610 65141136; fax: +8610 85115988; e-mail: dr.luozhang@139.com Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2iTF8Kq
http://ift.tt/2iTF8Kq
Nodular Lymphocyte-Predominant Hodgkin Lymphoma in Progressive Transformation of Germinal Centers
Nodular lymphocyte-predominant Hodgkin lymphoma is an uncommon variant of Hodgkin lymphoma. Progressive transformation of germinal centers has been associated with and can develop prior to, concurrent with, or after the diagnosis of nodular lymphocyte-predominant Hodgkin lymphoma. We present a patient with a history of progressive transformation of germinal centers of the right parotid who presented 4 years later with ipsilateral parotid mass and cervical adenopathy. Knowledge of her previous diagnosis raised our concern for lymphoma, influenced our surgical management, and spared the patient additional surgery with risk of facial nerve injury inherent in revision parotidectomy.
http://ift.tt/2mlXcS8
Prognostic Value of the Persistence of C1q-Binding Anti-HLA Antibodies in Acute Antibody-Mediated Rejection in Kidney Transplantation
Background The differential pathogenicity of anti-HLA donor-specific antibodies (DSAs) is not fully understood. The presence of complement-binding DSAs help better defining the prognosis of acute antibody-mediated rejection (ABMR). The evolution of these antibodies after the treatment of ABMR is unknown. Methods We included patients from the French multicenter RITUX ERAH study diagnosed with acute antibody-mediated rejection (ABMR) within the first year of renal transplantation, with circulating anti-HLA DSAs and treated randomly by rituximab or placebo (and intravenous immunoglobulins, plasma exchange). We centrally analyzed serum samples at the time of ABMR, 3 and 6 months after ABMR, with anti-HLA DSAs specificities and C1q-binding capacity assessment. Results Twenty-five patients were included: 68% had C1q-binding DSAs at the time of ABMR. The presence of C1q-binding DSAs was associated with a poorer evolution of chronic glomerulopathy at 6 months (p=0.036). The persistence of C1q-binding DSAs at 3 and/or 6 months after ABMR was associated with more severe chronic glomerulopathy (p=0.006), greater C4d score deposition score at 6 months after ABMR (p=0.008) and graft loss 5 years after ABMR (p=0.029). C1q-binding capacity was associated with the DSA MFI but 5 C1q-binding DSAs in 4 patients had low MFI values without a prozone effect. Conclusion The presence and persistence of anti-HLA C1q-binding DSAs after ABMR is a detrimental marker, leading to transplant glomerulopathy and graft loss. Assessment of the complement-binding capacities of DSAs could help decide treatment intensification. Corresponding author: Elodie Bailly, Service de Néphrologie - Transplantation rénale, 2 boulevard Tonnellé, 37000 Tours, France, elodie.bailly@univ-tours.fr E.B., Y.L. and M.B. participated in the research design. E.B., D.A. and M.B. participated in the writing of the paper. E.B., D.A., G.B., P.G., V.V., V.C., E.M., P.M., A.P., J.T., G.G., J.S., C.M., P.G., I.T., M.L.Q., R.P., P.-F.W., B.P., V.C., Y.L., F.D. and M.B. participated in the performance of the research. E.B., B.P., V.C., Y.L. and M.B. participated in data analysis. B.P., F.D. and V.C. contributed analytic tools. The authors declare no conflicts of interest. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2idV8r6
http://ift.tt/2idV8r6
Tissue-resident Lymphocytes in Solid Organ Transplantation: Innocent Passengers or the key to Organ Transplant Survival?
Abstract Short-term outcomes of solid organ transplantation have improved dramatically over the past several decades; however, long-term survival has remained static over the same time period, and chronic rejection remains a major cause of graft failure. The importance of donor, or 'passenger', lymphocytes to the induction of tolerance to allografts was recognized in the 1990s; however, their precise contribution to graft acceptance or rejection has not been elucidated. Recently, specialized populations of tissue-resident lymphocytes in nonlymphoid organs have been described. These lymphocytes include tissue-resident memory T cells (Trm), regulatory T cells (Treg), gamma-delta (γδ T cells, invariant natural killer T cells (iNKT), and innate lymphoid cells (ILC). These cells reside in commonly transplanted solid organs, including the liver, kidneys, heart and lung, however, their contribution to graft acceptance or rejection has not been examined in detail. Similarly, it is unclear whether tissue-resident cells derived from the pool of recipient-derived lymphocytes play a specific role in transplantation biology. This review summarises the evidence for the roles of tissue-resident lymphocytes in transplant immunology, focussing on the features, functions and relevance of Trm, Treg, γδ T, iNKT, and ILC cells in solid organ transplantation, with specific reference to liver, kidney, heart, and lung transplantation. Corresponding author: Amy C. Prosser BSc. Hons, School of Medicine and Pharmacology, Level 5, Harry Perkins Institute of Medical Research, 6 Verdun Street, Nedlands, Western Australia, Australia, 6009, Amy.prosser@research.uwa.edu.au Joint senior authors, Axel Kallies, PhD and Michaela Lucas, MBBS, Dr med, FRACP, FRCPA Author contributions: Amy Prosser – Writing and revision of the work. Axel Kallies – Conception, content and revision of the work. Michaela Lucas - Conception, content and revision of the work. The authors declare no conflicts of interest. Funding AK is a senior research fellow of the Sylvia and Charles Viertel Foundation. AP is supported by an Australian Government Research Training Program Scholarship. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2AEerAL
http://ift.tt/2AEerAL
Entwicklungen in der Dysphagiediagnostik
Zusammenfassung
Demographische Entwicklung und medizinischer Fortschritt bedingen, dass die schon heute hohe Prävalenz von Schluckstörungen weiter steigen wird. Bei unveränderten fachärztlichen und ökonomischen Ressourcen gilt es, Dysphagien effizient zu diagnostizieren und den Patienten ein individuelles Therapiekonzept anzubieten. Die mannigfaltigen und oft koexistenten Ursachen von Dysphagie begründen die wichtige interdisziplinäre Zusammenarbeit in diesem Bereich. Die fundierte Endoskopie des oberen Aerodigestivtrakts – eine Domäne der HNO-Ärzte und Phoniater – nimmt eine herausragende Rolle in der Dysphagiediagnostik ein. Das hier vorgestellte Konzept einer phoniatrisch geleiteten Dysphagie-Tagesklinik erlaubt eine fundierte und effiziente Abklärung von Schluckstörungen und bietet den Patienten ein entsprechend abgestimmtes Therapiekonzept. Technische Neuerungen wie der Einsatz von „narrow band imaging" (NBI) zur verbesserten Visualisierung des Speisebolus oder spezielle Untersuchungsmethoden wie das „Dipping-Manöver" zur direkten Inspektion der Subglottis und Trachea aus nächster Nähe haben die endoskopische Dysphagiediagnostik weiter verbessert. Es hat sich bewährt, den Untersuchungsablauf und die Auswahl von Testkonsistenzen und Placebotabletten individuell auf den Patienten abzustimmen, ohne strikten Schemata zu folgen. Aufgabe des HNO-Arztes bzw. Phoniaters ist es, den schluckgestörten Patienten individuell und abhängig von Grunderkrankung, Prognose, Lebensumständen sowie eigenen Wünschen zu beurteilen und zu beraten. Ein interdisziplinäres Team aus Ärzten und Therapeuten ermöglicht eine individuelle Beratung und Therapieplanung.
http://ift.tt/2zDYJbk
Non-IgE-mediated Adverse Food Reactions
Abstract
Purpose of Review
The purpose of this review is to update what is currently known about the major non-IgE-mediated food allergies: food protein-induced enterocolitis syndrome (FPIES), food protein-induced allergic proctocolitis (FPIAP), and food protein-induced enteropathy (FPE). These conditions are similar in that symptoms are regulated to the gastrointestinal tract; therefore understanding their specific features is important for diagnosis and management.
Recent Findings
The most progress has been made in understanding FPIES with several recent large cohorts being described. The first international consensus guidelines for FPIES were published in 2017 and propose specific diagnostic criteria for acute FPIES as well as guidance for diagnosing chronic FPIES. Recent studies in FPIAP have challenged our thinking about the recommended duration of food avoidance and that cow's milk avoidance is the primary management with reports of self-resolution without dietary management. FPE continues to appear to be on the decline.
Summary
FPIES, FPIAP, and FPE are distinguished from one another by their main clinical features: delayed repetitive vomiting in FPIES, benign blood in stool in FPIAP, and chronic diarrhea in FPE. Due to the risk of nutritional deficiencies with food avoidance in both infant and maternal diets if breastfeeding, confirmation of diagnosis with challenges is encouraged. Additional studies are needed for these conditions to elucidate pathophysiology, search for diagnostic markers, and understand natural history.
http://ift.tt/2AGQ7it
Non-IgE-mediated Adverse Food Reactions
Abstract
Purpose of Review
The purpose of this review is to update what is currently known about the major non-IgE-mediated food allergies: food protein-induced enterocolitis syndrome (FPIES), food protein-induced allergic proctocolitis (FPIAP), and food protein-induced enteropathy (FPE). These conditions are similar in that symptoms are regulated to the gastrointestinal tract; therefore understanding their specific features is important for diagnosis and management.
Recent Findings
The most progress has been made in understanding FPIES with several recent large cohorts being described. The first international consensus guidelines for FPIES were published in 2017 and propose specific diagnostic criteria for acute FPIES as well as guidance for diagnosing chronic FPIES. Recent studies in FPIAP have challenged our thinking about the recommended duration of food avoidance and that cow's milk avoidance is the primary management with reports of self-resolution without dietary management. FPE continues to appear to be on the decline.
Summary
FPIES, FPIAP, and FPE are distinguished from one another by their main clinical features: delayed repetitive vomiting in FPIES, benign blood in stool in FPIAP, and chronic diarrhea in FPE. Due to the risk of nutritional deficiencies with food avoidance in both infant and maternal diets if breastfeeding, confirmation of diagnosis with challenges is encouraged. Additional studies are needed for these conditions to elucidate pathophysiology, search for diagnostic markers, and understand natural history.
http://ift.tt/2AGQ7it
Neurolysis for Treatment of Infraorbital Neuropathy
Two patients, a woman aged 34 and a man aged 56, were included in the study. They reported the existence of pain in the areas of the infraorbital nerve, which, over the last four to five years, aggravated by the stimuli of eating, laughing, and being touched. 2 ml of 0.5% lidocaine was administered to these patients six times percutaneously. It was observed that the ease of pain lasted until the local anesthesia lost its effect, and the pain resumed its original intensity. Neurolysis with 0.5 ml of 50% ethanol was applied to the infraorbital nerve. This procedure was applied to the first patient twice and three times to the second. Thereafter, the patients were cured completely. For the treatment of idiopathic chronic infraorbital neuropathy, the neurolysis of the infraorbital nerve using 50% ethanol could be considered as an effective treatment alternative.
http://ift.tt/2mobDFw
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