Publication date: Available online 13 December 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Sunil Richardson, Shreya Krishna, Rakshit V. Khandeparker
http://ift.tt/2krOjlQ
Τετάρτη 13 Δεκεμβρίου 2017
A comprehensive management protocol to treat cleft maxillary hypoplasia
Stiffness and strength of cranioplastic implant systems in comparison to cranial bone
Publication date: Available online 13 December 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Johan Persson, Benedikt Helgason, Håkan Engqvist, Stephen J. Ferguson, Cecilia Persson
PurposeThe aim of this study was to evaluate skull replacement options after decompressive craniectomy by systematically investigating which combination of geometrical properties and material selection would result in a mechanical response comparable in stiffness to that of native skull bone and a strength as high or higher than the same. Materials and methods: The study was conducted using a Finite Element Model of the top part of a human skull. Native skull bone, autografts and commercial implants made of PEEK, solid titanium, two titanium meshes and a titanium-ceramic composite were modeled under a set load to evaluate deformation and maximum stress. Results: The computational result showed a large variation of the strength and effective stiffness of the autografts and implants. The stiffness of native bone varied by a factor of 20 and the strength by a factor of eight. The implants span the entire span of the native skull, both in stiffness and strength. Conclusion: All the investigated implant materials had a potential for having the same effective stiffness as the native skull bone. All the materials also had the potential to be as strong as the native bone. To match inherent properties, the best choice of material and thickness is thus patient specific, depending on the quality of the patient's native bone.
http://ift.tt/2zb0T1E
Commentary: “Maxillofacial growth and speech outcome after one-stage or two-stage palatoplasty in unilateral cleft lip and palate. A systematic review”
Publication date: Available online 13 December 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Bram J.A. Smarius, Corstiaan C. Breugem
http://ift.tt/2krOj5k
Comparative Study of Biomechanical Stability Of Resorbable And Titanium Fixation Systems After Sagittal Split Ramus Osteotomy With A Novel Designed In-Vitro Testing Unit
Publication date: Available online 13 December 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Murat Ulu, Emrah Soylu, Seyfi Kelebek, Serkan Dikici, Hakan Oflaz
IntroductionSagittal split ramus osteotomy (SSRO) is one of the most popular surgical procedures for correction of mandibular deformities. Several clinical and biomechanical studies exist in the literature which, comparing the stability of different osteosynthesis materials and techniques, were performed using two or three-point biomechanical test models. The aim of this study was to compare the stability of biodegradable and titanium materials for SSRO on one-piece polyurethane mandible samples which were fixed in a novel designed 6-point testing unit.Materials and Methods16 polyurethane one piece replicas of human mandibles were used and bilateral SSRO were performed by the manufacturer according to Dal Pont modification. Mandibles were fixed with titanium and PLLA/PGA fixation materials. Displacement amounts were measured under loading forces using a non-contact extensometer, and strain values at the screws were recorded by strain gauges.ResultsBicortical titanium screws (Group 2) showed significantly lower displacement values, while bicortical PLLA/PGA screws (group 4) showed significantly higher displacement values at 40 to 360N forces. (p<0.05). The highest strain value was measured on screws that were inserted upright in a proximal segment near the osteotomy line.ConclusionTo achieve more realistic results in biomechanical studies, test models should imitate jaw movements and test environments should be as similar as possible to physiological conditions. Newly designed six-point testing units will contribute to future biomechanical studies.
http://ift.tt/2zbFh58
Predictors of speech outcomes in children with Pierre Robin sequence
Publication date: Available online 13 December 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Anne Morice, Francis Renault, Véronique Soupre, Cécile Chapuis, Chantal Trichet Zbinden, Natacha Kadlub, Amerigo Giudice, Marie-Paule Vazquez, Arnaud Picard
BackgoundPierre Robin sequence (PRS) has worse speech outcomes than isolated cleft palate. We aimed to search for possible associations of phonological outcomes with PRS status (isolated vs syndromic), clinical severity, soft palate muscles deficiency, or surgical procedure.MethodsWe designed a retrospective study of 130 children (male/female ratio: 0.4) with isolated (96) or syndromic (34) PRS with cleft palate. Grading systems were used to classify retrognathia, glossoptosis, and respiratory and feeding disorders. Electromyography was used to investigate levator veli palatini muscles. Hard cleft palate was measured using maxillary casts. Intravelar veloplasty was performed using the Sommerlad's technique. Phonological outcomes were assessed using the Borel-Maisonny classification.ResultsCleft palate was repaired in one stage (65.5%) or hard palate closure was postponed (34.5%). Velopharyngeal insufficiency was more frequent in syndromic PRS (53%) vs isolated PRS (30.5%) (p = 0.01), but was not statistically associated with clinical grade, hard cleft palate width, soft palate electromyography, and surgical procedure.ConclusionsIn children with PRS, anatomic variables, initial clinical severity, and soft palate muscle deficiency are not predictors of speech prognosis.
http://ift.tt/2kr244u
Hemoglobin, C-reactive protein and ferritin in patients with oral carcinoma and their clinical significance - a prospective clinical study
Publication date: Available online 13 December 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Sebastian Blatt, Holger Schön, Keyvan Sagheb, Peer W. Kämmerer, Bilal Al-Nawas, Eik Schiegnitz
AimFor oral squamous cell carcinoma (OSCC), biomarkers are much in need to predict prognosis and to overcome possible resistance mechanisms to adjuvant therapies. The aim of this study was to evaluate serum level of hemoglobin, C-reactive protein (CRP) and ferritin as possible liquid biopsy to predict survival, metastasis and tumor relapse of OSCC.Material and MethodsA prospective clinical study was conducted. Overall, serum levels of hemoglobin, CRP and ferritin in 82 OSCC patients and 63 controls were preoperatively investigated.ResultsPatients with an anemia showed a significant lower survival than patients with no anemia preoperative. Patients with T3/T4 cancer had significant lower hemoglobin values (p=0.002). CRP and ferritin were statistically overexpressed in late tumor stages T3/T4 (ferritin: p=0.045, CRP: p<0.05,) compared to control. Log Rank testing indicated a statistical correlation of upregulated ferritin levels with local tumor recurrence (p=0.012) and local lymph node metastasis (p=0.008).ConclusionPresented biomarker CRP, ferritin and hemoglobin may serve as a liquid biopsy for prediction of OSCC especially for larger tumor sizes, overall survival and tumor relapse and demand a more radical therapy approach.
http://ift.tt/2zbzi0f
Resuscitative endovascular balloon occlusion of the aorta may increase the bleeding of minor thoracic injury in severe multiple trauma patients: a case report
The resuscitative endovascular balloon occlusion of the aorta, because of its efficacy and feasibility, has been widely used in treating patients with severe torso trauma. However, complications developing aro...
http://ift.tt/2ksJsBd
The forgotten organ
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): L.M. Roussel, C. Escalard, M. Hitier
http://ift.tt/2o1VJ4y
Early cutaneous eruptions after oral hydroxychloroquine in a lupus erythematosus patient: A case report and review of the published work
Abstract
Hydroxychloroquine (HCQ) is an effective treatment of lupus erythematosus. Although adverse effects, mainly gastrointestinal and cutaneous manifestations, are rare, they may result in the cessation of medication in some patients with severe reactions. Therefore, the evaluation of a patient's condition is important for a dermatologist to decide whether to cease or continue HCQ. We herein report a case of a 36-year-old Japanese woman with systemic lupus erythematosus and cutaneous eruptions caused by the p.o. administration of HCQ. Because she wanted to continue the medication and had only mild cutaneous eruptions without any adverse effects in other organs, we continued HCQ with careful monitoring. All cutaneous eruptions disappeared within 1 week. We also reviewed published case reports on skin lesions that developed after HCQ treatments, and propose strategies for early cutaneous eruptions after HCQ treatments. When the cutaneous reactions are mild without any reactions in other organs, withdrawal of the drug is not required. However, when cutaneous eruptions are accompanied by some common reactions, HCQ needs to be stopped for a period of time and may subsequently be carefully re-administrated.
http://ift.tt/2C4ZyYN
MRI screening of the internal auditory canal: Is gadolinium necessary to detect intralabyrinthine schwannomas?
Source:American Journal of Otolaryngology
Author(s): Johnathan C. Valesano, Carrie M. Carr, Laurence J. Eckel, Matthew L. Carlson, John I. Lane
ObjectiveNon-contrast MRI of the internal auditory canal (IAC) using high-resolution T2WI (T2 weighted image) has been proposed as the primary screening study in patients with sudden or asymmetric sensorineural hearing loss (ASNHL). However, there are concerns that non-contrast MRI may not detect labyrinthine pathology, specifically intralabyrinthine schwannomas (ILSs). The purpose of this study was to determine if non-contrast high-resolution T2WI alone are adequate to exclude these uncommon intralabyrinthine tumors.Methods31 patients with ILSs and 36 patients without inner ear pathology that had dedicated MRI of the IAC performed with both non-contrast T2WI and post-contrast T1WI (T1 weighted image) were identified. Three board-certified neuroradiologists reviewed only the T2WI from these 67 cases. When an ILS was identified, its location and size were recorded. Sensitivity, specificity, and accuracy were calculated using the post-contrast T1WI as the "gold standard." A consensus review of cases with discordant results was conducted.ResultsThe sensitivity, specificity, and accuracy were 1.0, 1.0, and 1.0 for Observer 1; 0.84, 1.0, and 0.96 for Observer 2; 0.90, 1.0, and 0.98 for Observer 3. The 5 ILSs with discordant results were correctly identified upon consensus review. The median size of the ILSs was 4.4mm (±2.9mm) and most (18/31) were intracochlear in location.ConclusionNon-contrast high-resolution T2WI alone can detect ILSs with 84–100% sensitivity, suggesting that gadolinium may be unnecessary to exclude ILSs on screening MRI. These findings have implications for reducing cost, time, and adverse events associated with gadolinium administration in patients presenting with sudden or ASNHL.Level of evidence4
http://ift.tt/2C3Llvg
Combined use of a nanocarbon suspension and 99mTc-MIBI for the intra-operative localization of the parathyroid glands
Publication date: Available online 13 December 2017
Source:American Journal of Otolaryngology
Author(s): Jun Chen, Qinyi Zhou, Jialin Feng, Jiadong Wang
ObjectiveTo investigate the combined use of a nanocarbon (NC) suspension and low-dose 99mTc-MIBI for parathyroid localization during surgery in patients with secondary hyperparathyroidism (sHPT).MethodsBetween March 2010 and September 2015, 40 patients with sHPT were enrolled in this study and were randomized to receive either low-dose 99mTc-MIBI+NC (group I) or low-dose 99mTc-MIBI (group II). Pre- and post-operative serum levels of intact PTH (iPTH), calcium and phosphorus between groups were compared and the intra-operative radioactive counts of the parathyroid glands were measured.ResultsThe post-operative iPTH level was significantly lower in patients of group I (24.2±31ng/L) than in those of group II (106±155ng/L) (P=0.03) while there were no significant differences in intra-operative parathyroid gland radioactive counts between the groups. The duration of the surgical procedure was shorter for patients of group I than patients of group II. There were no serious intra-operative or post-operative complications.ConclusionThe combined use of an NC suspension and 99mTc-MIBI for patients with sHPT is strongly recommended for the localization of parathyroid glands during surgery and is likely to improve clinical outcomes for patients.
http://ift.tt/2zbruvs
Nanoparticle delivery of RNA-based therapeutics to alter the vocal fold tissue response to injury
Objectives/Hypothesis
Our laboratory and others hypothesized that Smad3 is a principle mediator of the fibrotic phenotype in the vocal folds (VFs), and we further posited that alteration of Smad3 expression through short interfering (si)RNA holds therapeutic promise, yet delivery remains challenging. To address this issue, we employed a novel synthetic oligomer, lipitoid, complexed with siRNA to improve stability and cellular uptake with the goal of increased efficiency of RNA-based therapeutics.
Study Design
In vitro study and in vivo animal model.
Methods
In vitro, lipitoid cytotoxicity was quantified via colorimetric and LIVE/DEAD assays in immortalized human VF fibroblasts and primary rabbit VF fibroblasts. In addition, optimal incubation interval and solution for binding siRNA to lipitoid for intracellular delivery were determined. In vivo, a rabbit model of VF injury was employed to evaluate Smad3 knockdown following locally injected lipitoid-complexed siRNA.
Results
In vitro, lipitoid did not confer additional toxicity compared to commercially available reagents. In addition, 20-minute incubation in 1× phosphate-buffered saline resulted in maximal Smad3 knockdown. In vivo, Smad3 expression increased following VF injury. This response was significantly reduced in injured VFs at 4 and 24 hours following injection (P = .035 and .034, respectively).
Conclusions
The current study is the first to demonstrate targeted gene manipulation in the VFs as well as the potential utility of lipitoid for localized delivery of genetic material in vivo. Ideally, these data will serve as a platform for future investigation regarding the functional implications of therapeutic gene manipulation in the VFs.
Level of Evidence
NA Laryngoscope, 2017
http://ift.tt/2Cip9hW
An innovative solution for T-tube obstruction: The tracheostomy–customized stent combination
The Montgomery T-tube (MTT) is a useful tool for post-tracheostomy tracheal stenosis. However, MTTs can get blocked. We present a case series of life-threatening MTT blockage, wherein a split-function option was implemented, which was a customized silicone Dumon stent above the tracheostomy to maintain both airway and phonation. This tracheostomy–customized stent combination serves the same function as an MTT, with a greater margin of safety due to the easy suctioning capacity of the tracheostomy. With a fenestrated tracheostomy and stent above, speech is effectively preserved. We recommend this strategy in severe MTT blockage as a superior option to regular tracheostomy. Laryngoscope, 2017
http://ift.tt/2o37ebV
Clinical implications of magnetic resonance imaging in temporomandibular disorders patients presenting ear fullness
Objectives/Hypothesis
The aim of this study was to investigate whether findings detected by temporomandibular joint magnetic resonance imaging (TMJ-MRI) can provide pathognomonic evidence of temporomandibular disorders (TMD) in patients with nonspecific ear fullness (EF). The association of nonspecific EF with clinical characteristics of TMD based on TMJ-MRI findings was examined.
Study Design
Retrospective analysis.
Methods
Thirty-four subjects (42 ears) who had no detectable otologic problems as a cause of EF were enrolled in this study. Each subject underwent TMJ-MRI to identify pathology of the TMJ as a possible cause of nonspecific EF. All subjects participated in the re-evaluation process following TMD treatment.
Results
Anatomical abnormalities in TMJ-MRI, irrespective of TMD signs, were observed in 34 of the 42 ears (80.9%), such as degenerative change of the TMJ (16 ears), articular disc displacement (11 ears), and joint effusion (seven ears). Specific abnormalities of the TMJ were associated with nonspecific EF, and this symptom showed improvement following individualized TMD treatment in those with internal derangement and/or effusion of the TMJ. However, abnormal TMJ-MRI findings were also observed in seven of nine ears with no TMD signs, and there was no significant association between the presence of TMD signs and abnormal TMJ-MRI findings (χ2 = 0.075, P = .784).
Conclusions
Patients presenting with nonspecific EF may have TMD, which can be effectively diagnosed using TMJ-MRI. The present study revealed the causal relationship between nonspecific EF and abnormal TMJ findings based on MRI. Individualized TMD treatments based on TMJ-MRI led to improved treatment outcomes with special regard to nonspecific EF
Level of Evidence
4 Laryngoscope, 2017
http://ift.tt/2CfNZyZ
Brain volume changes in hyposmic patients before and after olfactory training
Objectives/Hypothesis
Olfactory dysfunction is thought to be associated with reduced gray matter (GM) volume in olfactory-related brain areas. The aim of this study was to determine GM structural changes within olfactory-related regions of the brain in patients with smell loss due to upper respiratory tract infection (URTI) before and after olfactory rehabilitation.
Study Design
Prospective intervention case-control study.
Methods
Magnetic resonance imaging structural brain images were collected from 30 patients with smell loss due to URTI and 31 controls. Patients exposed themselves to odors (olfactory training [OT]) over 12 weeks and then were rescanned. Olfactory testing was performed using the validated Sniffin' Sticks test. GM was investigated with voxel-based morphometry.
Results
GM volumes were found to be reduced in the limbic system and thalamus among pretraining patients compared to controls; in patients, OT was associated with a significant increase of GM volume in these two regions. The GM volume within other olfactory-related regions was not different between patients and controls. In addition, no relevant difference between the GM volume pre- and post-OT was observed in primary olfactory-related regions.
Conclusions
OT was associated with an increase in GM volume of the hippocampus and the thalamus, possibly pointing toward a strategy for more effective exploitation of olfactory signals based on a higher degree of attention toward odors and association of memories with olfactory input.
Level of Evidence
3b Laryngoscope, 2017
http://ift.tt/2o2k6yW
Use of autologous adipose-derived mesenchymal stem cells for creation of laryngeal cartilage
Objectives/Hypothesis
Adipose-derived mesenchymal stem cells (ASCs) are an exciting potential cell source for tissue engineering because cells can be derived from the simple excision of autologous fat. This study introduces a novel approach for tissue-engineering cartilage from ASCs and a customized collagen oligomer solution, and demonstrates that the resultant cartilage can be used for laryngeal cartilage reconstruction in an animal model.
Study Design
Basic science experimental design.
Methods
ASCs were isolated from F344 rats, seeded in a customized collagen matrix, and cultured in chondrogenic differentiation medium for 1, 2, and 4 weeks until demonstrating cartilage-like characteristics in vitro. Large laryngeal cartilage defects were created in the F344 rat model, with the engineered cartilage used to replace the cartilage defects, and the rats followed for 1 to 3 months. Staining examined cellular morphology and cartilage-specific features.
Results
In vitro histological staining revealed rounded chondrocyte-appearing cells evenly residing throughout the customized collagen scaffold, with positive staining for cartilage-specific markers. The cartilage was used to successfully repair large cartilaginous defects in the rat model, with excellent functional results.
Conclusions
This study is the first study to demonstrate, in an animal model, that ASCs cultured in a unique form of collagen oligomer can create functional cartilage-like grafts that can be successfully used for partial laryngeal cartilage replacement.
Level of Evidence
NA Laryngoscope, 2017
http://ift.tt/2CfNR2t
Effect of rural and urban geography on larynx cancer incidence and survival
Objectives/Hypothesis
Investigate the impact of rural geography on larynx cancer incidence and survival.
Study Design
Surveillance, Epidemiology, and End Results (SEER) database study.
Methods
Incidence and survival rates by Rural–Urban Continuum codes for larynx squamous cell carcinoma patients diagnosed from 2004 to 2012 were evaluated using SEER statistical software and Cox proportional hazards survival analysis.
Results
The lowest age-adjusted incidence rates for larynx cancer were seen in densely populated urban regions, with mean rates of 2.8 per 100,000 person years (95% confidence interval [CI]: 2.7-2.8); the highest were in the most rural areas, with mean rates of 5.3 per 100,000 person years (95% CI: 4.7-5.9). Nevertheless, of 23,659 larynx cancer patients diagnosed over this period, 19,556 (82.7%) arose in urban residents, compared with 1,428 or 6% from rural areas. Urban larynx cancer patients more likely lived in counties with an American College of Surgeons–approved cancer center and/or a fourfold greater otolaryngology physician supply. Nevertheless, frequency of advanced stage at initial presentation was similar. Cause-specific and overall survival were no different, both on univariable and multivariable analyses.
Conclusions
Compared with urban populations, Rural populations are at greater risk of developing larynx cancer, but initial stage and survival after diagnosis are comparable. Priority should be given to prevention strategies to decrease incidence rates.
Level of Evidence
4 Laryngoscope, 2017
http://ift.tt/2Ch4Hh6
Relationship between serum anti-varicella zoster virus antibody titer and time from onset of herpes zoster
Abstract
Herpes zoster is an internal reactivation of varicella zoster virus, and its onset depends on immunity against this virus. We have previously reported that antiviral antibody titers are inversely correlated with patient numbers. In this study, we hypothesized that patients with higher titers may be late visitors to the clinic, whose antibodies were already boosted at presentation because of the time lapse between onset of zoster and measurement of antibodies. We analyzed antibody titers of patients with acute herpes zoster who visited Fukuoka University Hospital from January 2009 to May 2016 (n = 141, 62 males and 79 females). Varicella zoster virus-specific immunoglobulin G, M and complement fixation tests were positive in 93.9%, 12.0% and 64.2% of the patients, respectively. Immunoglobulin G and complement fixation titers were strongly correlated (Spearman's r = 0.8634, P < 0.0001). Patients with high immunoglobulin G and complement fixation titers were immunoglobulin M-negative. Unexpectedly, immunoglobulin G and complement fixation titers showed large inter-subject variation, and were only weakly correlated with onset–measurement time lapse. Patients with consecutive tests tended to show increasing immunoglobulin G and complement fixation titers. Our data suggest that herpes zoster preferentially occurs in patients with low immunoglobulin G and complement fixation titers, and subsequently causes antibody elevation. However, the timing of elevation varies and can be as late as 10 days after zoster. The large variation in antibody titer over the time from onset to testing suggests that some mechanism exists that resists the local breakthrough of virus in the skin, and so delays the onset of blisters.
http://ift.tt/2o350JB
Postmenopausal craniofacial hyperhidrosis
Summary
Hyperhidrosis is a condition marked by excessive sweating, which can either be localized or generalized. Primary focal hyperhidrosis (PFH) can arise from the palms, plantar feet, axillae and also from the face and scalp. PFH primarily affects a younger population of children and young adults, with the majority presenting before the age of 25 years. We report a distinct subtype of craniofacial hyperhidrosis in 20 postmenopausal women; this subtype is often under-recognized.
http://ift.tt/2zbe0zJ
IL-25 is involved in CTCL progression by establishing Th2-dominant microenvironment
Summary
Background
Interleukin (IL)-25 is a member of the IL-17 family which can promote and augment T-helper type (Th) 2 responses. The expression of IL-25 and its cognate receptor, IL-25 receptor (IL-25R), is upregulated and correlated with disease activity in Th2-associated diseases.
Objective
To examine the expression and function of IL-25 in cutaneous T-cell lymphoma (CTCL).
Methods
Expression and localization of IL-25 in lesional skin was investigated using immunohistochemistry. The effect of various cytokines on IL-25 production from normal human epidermal keratinocytes was assessed by quantitative reverse-transcription real-time polymerase chain reaction. Serum IL-25 levels were measured by enzyme-linked immunosorbent assay. The direct effect of IL-25 on tumor cells was also examined using CTCL cell lines and peripheral blood mononuclear cells in Sézary syndrome patients.
Results
IL-25 expression was increased in epidermal keratinocytes in lesional skin of CTCL. Th2 cytokines, IL-4 and IL-13, and periostin induced IL-25 expression by normal human epidermal keratinocytes. Serum IL-25 levels were increased in patients with advanced CTCL (stage IIB-IV) and correlated with serum lactate dehydrogenase levels. MyLa cells expressed IL-25R and its expression was augmented by stimulation with IL-25. IL-25 enhanced IL-13 production from MyLa cells via phosphorylation of STAT6. Peripheral blood mononuclear cells from one patient with Sézary syndrome expressed IL-25R and showed increase of IL-13 production by IL-25.
Conclusions
Th2 cytokines highly expressed in CTCL lesional skin induce IL-25 production by epidermal keratinocytes, which may in turn lead to formation of Th2-dominant microenvironment through the direct induction of IL-13 by tumor cells.
This article is protected by copyright. All rights reserved.
http://ift.tt/2nX849Y
New technique to contour the paramedian forehead flap in nasal reconstruction
The paramedian forehead flap is a preferred method for the reconstruction of nasal deformities (that have been caused by injury or cancer) because the tint of the skin of the forehead matches that of the nasal skin.1 It is a little too thick, however, and needs to be thinned to achieve a contour that is acceptable cosmetically.1 We describe a new method of thinning the forehead flap that is easier, faster, and more reliable for depth of thinning.
http://ift.tt/2ACNj9I
Regulation of MAVS activation through post-translational modifications
Bingyu Liu | Chengjiang Gao
http://ift.tt/2ACTV83
A comprehensive management protocol to treat cleft maxillary hypoplasia
Maxillary hypoplasia is the most commonly encountered secondary deformity as a result of cleft lip and palate with a reported incidence of about 15-50%(Liao YF, Mars M 2005).The reasons understood for this hypoplasia are twofold, firstly that the cleft maxilla's intrinsic potential of growth is less due to the developmental deficiency. Secondly, the iatrogenic factor created due to the surgical repair of cleft lip and palate causes scarring which inhibits the normal growth of the maxilla (Ross 1987).Due to the class III malocclusion that develops in these patients, treatment in some form or other is required to restore facial aesthetics and function.
http://ift.tt/2AjcfyO
Predictors of speech outcomes in children with Pierre Robin sequence
Pierre Robin sequence (PRS) has worse speech outcomes than isolated cleft palate. We aimed to search for possible associations of phonological outcomes with PRS status (isolated vs syndromic), clinical severity, soft palate muscles deficiency, or surgical procedure.
http://ift.tt/2AkC7dk
Comparative Study of Biomechanical Stability Of Resorbable And Titanium Fixation Systems After Sagittal Split Ramus Osteotomy With A Novel Designed In-Vitro Testing Unit
Sagittal split ramus osteotomy (SSRO) is one of the most popular surgical procedures for correction of mandibular deformities. Several clinical and biomechanical studies exist in the literature which, comparing the stability of different osteosynthesis materials and techniques, were performed using two or three-point biomechanical test models. The aim of this study was to compare the stability of biodegradable and titanium materials for SSRO on one-piece polyurethane mandible samples which were fixed in a novel designed 6-point testing unit.
http://ift.tt/2zb8Mnw
Commentary: “Maxillofacial growth and speech outcome after one-stage or two-stage palatoplasty in unilateral cleft lip and palate. A systematic review”
We would like to congratulate Reddy et al with their recent publication "Maxillofacial growth and speech outcome after one-stage or two-stage palatoplasty in unilateral cleft lip and palate. A systematic review" published in J Craniomaxillofac Smarius and Breugem, 2015 45(6):995-1003(1). Although this review is a valuable adjunct to the medical literature, we do have some comments about this manuscript.
http://ift.tt/2za7xoM
Stiffness and strength of cranioplastic implant systems in comparison to cranial bone
The aim of this study was to evaluate skull replacement options after decompressive craniectomy by systematically investigating which combination of geometrical properties and material selection would result in a mechanical response comparable in stiffness to that of native skull bone and a strength as high or higher than the same. Materials and methods: The study was conducted using a Finite Element Model of the top part of a human skull. Native skull bone, autografts and commercial implants made of PEEK, solid titanium, two titanium meshes and a titanium-ceramic composite were modeled under a set load to evaluate deformation and maximum stress.
http://ift.tt/2Akzh8t
Hemoglobin, C-reactive protein and ferritin in patients with oral carcinoma and their clinical significance - a prospective clinical study
For oral squamous cell carcinoma (OSCC), biomarkers are much in need to predict prognosis and to overcome possible resistance mechanisms to adjuvant therapies. The aim of this study was to evaluate serum level of hemoglobin, C-reactive protein (CRP) and ferritin as possible liquid biopsy to predict survival, metastasis and tumor relapse of OSCC.
http://ift.tt/2za7idm
Methotrexate and azathioprine in severe atopic dermatitis: a 5-year follow up study of a randomised controlled trial
Summary
Background
Systemic treatment is indicated for moderate-to-severe atopic dermatitis (AD), refractory to topical treatment. Long-term evidence, up to 5 years, of off-label prescribed methotrexate (MTX) and azathioprine (AZA) is lacking.
Objectives
To investigate long-term effectiveness, safety and drug survival of MTX and AZA.
Methods
In an open-label follow up phase of a clinical trial patients were seen every 3 months for 5 years. MTX and AZA doses could be in- or decreased concurrent with daily clinical practice. Primary effectiveness outcomes were mean absolute and relative reduction in SCORing Atopic Dermatitis (SCORAD) index and Investigator Global Assessment (IGA) after 5 years compared to baseline. For safety type, frequency, severity and relatedness to treatment of adverse events were investigated. Drug survival was analysed by Kaplan-Meier curves.
Results
Thirty-five of 43 originally included patients participated, of which 27 completed follow up. At year 5 mean relative reduction in SCORAD index was similar in MTX and AZA group: 52.8% and 53.8% by descriptive analysis. Eleven serious adverse events occurred in 5 years; for three there was a possible causal relationship. Drug survival demonstrated a longer survival for MTX, but survival in both groups was low after 5 years (MTX n=5, AZA n=1).
Conclusion
Based on this relatively small pragmatic study, MTX and AZA seem to be effective and safe as maintenance treatments in moderate-to-severe AD up to 5 years. Few patients in both groups survive on their originally allocated drug although some discontinued due to controlled AD.
This article is protected by copyright. All rights reserved.
http://ift.tt/2AUQ0Qy
Combined use of a nanocarbon suspension and 99mTc-MIBI for the intra-operative localization of the parathyroid glands
To investigate the combined use of a nanocarbon (NC) suspension and low-dose 99mTc-MIBI for parathyroid localization during surgery in patients with secondary hyperparathyroidism (sHPT).
http://ift.tt/2ynXsRE
MRI screening of the internal auditory canal: Is gadolinium necessary to detect intralabyrinthine schwannomas?
Non-contrast MRI of the internal auditory canal (IAC) using high-resolution T2WI (T2 weighted image) has been proposed as the primary screening study in patients with sudden or asymmetric sensorineural hearing loss (ASNHL). However, there are concerns that non-contrast MRI may not detect labyrinthine pathology, specifically intralabyrinthine schwannomas (ILSs). The purpose of this study was to determine if non-contrast high-resolution T2WI alone are adequate to exclude these uncommon intralabyrinthine tumors.
http://ift.tt/2AATjQ5
Steroidpsychose als Folge einer regulären Hörsturztherapie in der HNO-Heilkunde
Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-123654
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
http://ift.tt/2yolADr
When to Stop Immunotherapy: First Response? Max Response? Toxicity?
There is an ongoing debate within the oncology community about when to stop immunotherapies, with treatment response, toxicity, and cost all playing important roles.
Medscape Oncology
http://ift.tt/2AAc9Xz
Distinctive cutaneous and systemic features associated with specific anti-myositis antibodies in adults with dermatomyositis: a prospective multicentric study of 117 patients
Abstract
Background
Identification of myositis-specific autoantibodies (MSA) for dermatomyositis (DM) could allow the characterization of an antibody-associated clinical phenotype.
Objective
We sought to define the clinical phenotype of DM and the risk of cancer, interstitial lung disease (ILD) and calcinosis based on MSA.
Methods
A 3.5-year multicenter prospective study of adult DM patients was conducted to determine the clinical phenotype associated with MSA and the presence of cancer, ILD and calcinosis.
Results
MSA were detected in 47.1% of 117 included patients. Patients with anti-melanoma differentiation-associated protein 5 antibodies (13.7%) had significantly more palmar violaceous macules/papules (odds ratio (OR) 9.9), mechanic's hands (OR 8), cutaneous necrosis (OR 3.2), and articular involvement (OR 15.2), and a higher risk of ILD (OR 25.3). Patients with anti-transcriptional intermediary factor-1 antibodies (11.1%), anti-nuclear matrix protein-2 antibodies (6.8%) and anti-aminoacyl-transfer RNA synthetase (5.1%) had, respectively, significantly more poikiloderma (OR 5.9), calcinosis (OR 9.8), and articular involvement (OR 15.2). Cutaneous necrosis was the only clinical manifestation significantly associated with cancer (OR 3.1).
Conclusion
Recognition of the adult DM phenotype associated with MSA would allow more accurate appraisal of the risk of cancer, ILD and calcinosis.
This article is protected by copyright. All rights reserved.
http://ift.tt/2z8UROQ
Perianal tuberculosis in an immunocompetent patient
Abstract
Tuberculosis (TB) is a major public health problem worldwide, considered to be the main cause of death from infectious diseases, ranking alongside HIV infection. Skin involvement occurs in 1.5% of the cases, and perianal involvement is extremely rare and tends to occur among immunocompromised patients. Due to its heterogeneous clinical presentation, the diagnosis of cutaneous TB is challenging, requiring a high level of suspicion.
This article is protected by copyright. All rights reserved.
http://ift.tt/2AiqmEm
Serum androgens and PSA levels in androgenetic alopecia - is there a difference between frontal and vertex baldness?
Abstract
Background
Androgenetic alopecia (AGA) seems to be a marker of increased risk of prostate cancer (PCa).
Objective
We sought to investigate potential pathophysiological differences between frontal and vertex balding that might have the impact on the incidence of PCa.
Methods
Serum concentrations of testosterone (T), dihydrotestosterone (DHT) and prostate-specific antigen (PSA) were measured in 88 subjects with AGA.
Results
We have examined sixty patients with frontal baldness and 28 patients with vertex baldness. The subgroups did not differ significantly in age, BMI and as regards age of AGA onset, duration of AGA and comorbidities. The mean value of DHT in serum of the men with vertex baldness was higher than those in the men with frontal baldness with statistical significance (p<0,05). The groups did not show significant differences in mean value of serum T and PSA levels, and DHT/T ratio. No correlation was found between the serum PSA level and serum androgen levels as well as DHT/T ratio.
Conclusions
Vertex baldness may signal higher exposures to circulating DHT. Serum PSA level cannot serve as surrogate diagnostic marker of increased androgenic activity in men with AGA.
This article is protected by copyright. All rights reserved.
http://ift.tt/2z9lEL6
Epidermodysplasia verruciformis in an adult patient with a germline ITK mutation and lymphoma: the case of inherited versus acquired
Abstract
Epidermodysplasia verruciformis (EV) is characterized by a clinically distinctive pattern of beta-HPV induced flat warts that may evolve into epithelial skin cancers. The current understanding is that EV encompasses two etiological situations: Classic, inherited type EV (IEV), beginning in childhood or adolescence, due to Trans Membrane Channel (TMC) - 6 and 7 (EVER-1 and 2) gene mutations 75% of patients, or to alterations resulting in T-Cell immune deficiencies (IDs) on Ras Homolog Family Member H (RHOH), Coronin 1A (CORO 1A), Macrophage Stimulating factor 1 (MST-1), or interleukin 7 (IL7) genes.
This article is protected by copyright. All rights reserved.
http://ift.tt/2AjuELA
Dermoscopy for discriminating between Trichophyton and Microsporum infections in tinea capitis
Abstract
Tinea capitis (TC) is an infection of the scalp, most often observed in pre-school or early school ages. Diagnosis of TC is based on clinical signs and laboratory examinations (direct microscopy and culture). Dermoscopy is a non-invasive diagnostic technique with an already established role in the evaluation of skin tumors, and with a gradually expanding application also in the field of inflammatory and infectious skin diseases.
This article is protected by copyright. All rights reserved.
http://ift.tt/2z9lh3a
Four cases of anti-Mi-2 antibody-positive dermatomyositis: relationship between anti-Mi-2 antibody titer and disease severity and activity
Abstract
Anti-Mi-2 antibody was found to be a specific marker for dermatomyositis (DM) [1, 2]. Patients with anti-Mi-2 antibody generally have a more favorable prognosis, such as milder muscle involvement and a lower risk of interstitial lung disease (ILD) and malignancy [3, 4]. However, it currently remains unclear whether the anti-Mi-2 antibody titer correlates with disease severity and activity, or if repeated testing for disease monitoring is beneficial.
This article is protected by copyright. All rights reserved.
http://ift.tt/2AlERaI
Firefighter Skin Cancer and Sun Protection Practices
This survey study examines skin cancer history, skin cancer screening, and sun protection habits among active Florida firefighters.
http://ift.tt/2AB3LqP
http://ift.tt/2AB3LqP
Clinical Findings and Gene Expression in Balloon Cell Melanoma
This case series describes 2 patients with balloon cell melanoma to evaluate the association of clinical and histopathologic characteristics with findings of gene expression profiling tests.
http://ift.tt/2yo0jd7
http://ift.tt/2yo0jd7
Tender Nodules on the Lower Legs
A man in his 20s with panhypopituitarism, septo-optic dysplasia, developmental delay, duodenal stricture, and a history of pancreatitis presented with a painful eruption on both lower legs. What is your diagnosis?
http://ift.tt/2ACtkYH
http://ift.tt/2ACtkYH
Noninvasive Gene Expression Testing in Amelanotic Melanoma
This case report describes noninvasive gene expression testing in a patient with amelanotic melanoma.
http://ift.tt/2ynEwCg
http://ift.tt/2ynEwCg
Hypercoagulable Conditions and Calciphylaxis in Renal Disease
This case-control study compares the hypercoagulability status of patients with calciphylaxis and renal disease with controls to identify conditions that are risk factors for developing calciphylaxis while controlling for chronic kidney disease.
http://ift.tt/2ABxFv8
http://ift.tt/2ABxFv8
15,000 Cases Reports Published
By Nathan Douthit
BMJ Case reports published its 15,000th case earlier this year. This milestone represents innumerable hours of patient interaction, research, writing, and editing. These cases have given a forum for health professionals and students to discuss difficult and interesting cases of high educational value and to use their patient experiences as a means to teach others.
Of particular importance is the 70+ global health cases published by BMJ Case Reports. While a small number in volume, these cases have helped bring to light issues faced by practitioners around the globe in a variety of settings, and established a formidable base of literature in their texts and references regarding the true causes of disease—the social determinants of health. As an author privileged to publish two of these cases with the journal, I can attest that they have been a formative part of my education in global health. As I encountered patients with avoidable negative outcomes, I reviewed the relevant literature on global health and social determinants in order to understand why these patients had been ill, had delayed presentation to care, and had so much pain wrought in their lives and the lives of their families. This helped me to suggest alternatives and solutions to the current state of affairs in these areas, and to learn innovative ways of dealing with difficult patient populations in low-resource settings.
As a global health associate editor I have reviewed all of these global health cases and am continually learning. Whether this includes the plight of Syrian refugees and their fear of losing their belongings, rare presentations of tuberculosis, the ill effects of complementary and alternative medicine in the USA and in Africa, or the common desire to die a death in accordance with local customs regardless of culture and medical history, there is something to be gleaned from every case. Paul Farmer, American Anthropologist and Physician wrote: "Human rights can and should be declared universal, but the risk of having one's rights violated is not universal."[1] Sadly, many of these situations are avoidable, and these case reports motivate all who read them to advocate for their patients in local, national and global settings. It is our hope that these cases will be used to educate practitioners and students about global health, so they can contribute to the solution to these complicated problems as they advance in their own careers.
The first 15,000 cases is truly something to be celebrated. Hopefully the next 15,000 will continue the work begun here by BMJ Case Reports. This literature base will be of great use to future clinicians as they attempt to change the world, one patient case at a time.
[1] Farmer P. Pathologies of power: Health, human rights, and the new war on the poor. Univ of California Press; 2004 Nov
http://ift.tt/2BZJmry
What’s in a Name—Dermoscopy vs Dermatoscopy
Dermoscopy improves diagnostic accuracy by uncovering dimensions of skin morphologic characteristics imperceptible to the naked eye. While the practice of dermoscopy has become common among dermatologists only in recent years, microscopic examination of the skin is actually a centuries-old practice.
http://ift.tt/2ABFT6B
http://ift.tt/2ABFT6B
Industry Influence in Dermatology Clinical Practice Guideline Development
In his farewell address to the nation, in 1961, President Dwight D. Eisenhower warned about the rising influence of the military establishment and the arms industry. "The potential for the disastrous rise of misplaced power exists," the President said, referring to the military-industrial complex, "and will persist."
http://ift.tt/2gT3Daa
http://ift.tt/2gT3Daa
The Most Beautiful People
This study used People magazine to compare standards of beauty in 1990 with present-day standards.
http://ift.tt/2hAVVRR
http://ift.tt/2hAVVRR
Chronic Urticaria in Children
Six years ago, we reviewed what was then known about chronic urticaria (CU) in children. We came to the conclusion that many important and interesting questions were unanswered. These included, but were not limited to, how common chronic spontaneous urticaria (CSU) and inducible urticaria are in children, the clinical presentation, underlying causes, impact on everyday life of CU in children, and the natural course of pediatric CU. We also suggested strategies to address and answer these questions and encouraged further studies to do so.
http://ift.tt/2xEm0Gd
http://ift.tt/2xEm0Gd
The Epidemic of Guns
The shooting in Las Vegas, Nevada, that left 59 people dead, 10 times that number wounded, and thousands of people with the psychological distress from being present at the scene during and after the massacre has once again raised the issue of what we as a nation can and should do about guns. The solution lies in not just focusing on Las Vegas and the hundreds of other mass shootings that have occurred in the United States in the last 14 months, but rather to underscore that on average almost 100 people die each day in the United States from gun violence. The 36 252 deaths from firearms in the United States in 2015 exceeded the number of deaths from motor vehicle traffic crashes that year (36 161). That same year, the US Centers for Disease Control and Prevention reported that 5 people died from terrorism. Since 1968, more individuals in the United States have died from gun violence than in battle during all the wars the country has fought since its inception.
http://ift.tt/2xQZppf
http://ift.tt/2xQZppf
A Transgender Woman With Anogenital Lichen Sclerosus
This case report describes a transgender woman with anogenital lichen sclerosus.
http://ift.tt/2ABEYCU
http://ift.tt/2ABEYCU
Industry Payments Among Dermatology Clinical Practice Guidelines Authors
This study uses data extraction from the Open Payments database to evaluate the monetary values and types of payments received by physician authors of dermatology guidelines and the accuracy of conflict of interest disclosure statements.
http://ift.tt/2yxBI9c
http://ift.tt/2yxBI9c
Dermatology in Epic Poetry—From Beowulf to The Odyssey
Epic poems have captured the imaginations of readers, listeners, and artists alike for millennia. Michelangelo painted part of the Sistine Chapel after being inspired by Dante's Divine Comedy. Shakespeare's 1602 play, Troilus and Cressida, is based on The Iliad, an ancient Greek epic poem attributed to Homer. All told, epic poems are captivating tales full of wonder and adventure. Particularly, they have often integrated dermatology in their unique plots. Beowulf is an Old English poem (written circa ad 700-1000) that tells of the powerful Geat hero Beowulf, who visits the mead hall, Heorot, to kill the evil monster Grendel. Grendel, bothered by the sounds of joy, has gruesomely slaughtered Heorot's inhabitants for years. Owing to his magical gifts, no one has been able to slay him. Grendel not only possesses incredible strength, but his skin is also impenetrable to any blade: "Every nail, claw-scale, of that heathen brute…was like barbed steel. To pierced him through, no time proofed blade could cut his brutal, blood-caked claw." Beowulf notably does not use a sword, but rather kills Grendel by directly ripping his arm off, causing him to bleed to death. In the 13th century German epic poem Das Nibelungenlied (The Song of the Nibelungs), the skin of a main character is a weakness rather than a strength. In the beginning of the story, the knight Siegfried is said to have slaughtered a dragon and bathed in his blood—rendering him invulnerable to weaponry. However, a leaf from a linden tree fell between his shoulders during this bath, leaving that area untouched with blood. His wife, Kriemhild, mentions, "There one might stab him, and thence is my care and dole," indicating that this is his only weakness (similar to Achilles' heel). Unfortunately, Siegfried is later murdered by Hagen, who spears the unsuspecting knight while he is drinking from a brook. His death inspires Kriemhild's revenge, which is the focus of the second half of Das Nibelungenlied. The Odyssey, a Greek epic poem by Homer, details the legendary return of Odysseus to his home of Ithaca after the Trojan war. Arriving after 20 years, he discovers that multiple suitors are courting his wife, Penelope, presuming he is dead. Odysseus is then transformed by Athena (the goddess of war) into an old man as a disguise. However, his housekeeper, Eurycleia, identifies him because of a hunting scar on his leg: "She immediately recognized the scar; which once a boar inflicted upon him." This discovery demonstrates Eurycleia's loyalty and allows the Odysseus and Penelope to reunite. Together, they plot to kill the suitors and eventually restore peace to Odysseus' kingdom. Ultimately, epic poems are full of fantastic details and magical characters. Many tales involve the skin, demonstrating dermatology's unique significance in literature. Hopefully, epic poetry will continue inspiring many more for ages to come.
http://ift.tt/2ACafWz
http://ift.tt/2ACafWz
Factors Associated With Chronic Urticaria in Children
This cohort study examined the resolution rate of chronic urticaria in children and whether there are biomarkers that can predict resolution.
http://ift.tt/2A3pfsm
http://ift.tt/2A3pfsm
Barber Recognition of Pseudofolliculitis Barbae and Acne Keloidalis Nuchae
This cross-sectional study analysis assesses barber knowledge and recommendations regarding various dermatologic conditions common among clients who use predominantly African American barbershops.
http://ift.tt/2yAq8dr
http://ift.tt/2yAq8dr
Diagnostic Accuracy of Pediatric Teledermatology Using Parent-Submitted Photographs
This randomized clinical trial assesses whether smartphone photographs of pediatric skin conditions taken by parents are of sufficient quality to permit accurate diagnosis.
http://ift.tt/2AOAaXz
http://ift.tt/2AOAaXz
Treatment of Psychiatric Disorders and Skin-Restricted Lupus Remission
This observational cohort study investigates the association between treatment of psychiatric disorders and skin-restricted lupus remission in a patient cohort over 2.5 years.
http://ift.tt/2xQskdh
http://ift.tt/2xQskdh
Sclerotherapy for Reticular Veins in the Lower Limbs
This randomized clinical trial compares sclerotherapy of reticular veins of the lower limb with 2% polidocanol diluted in 70% hypertonic glucose vs hypertonic glucose alone.
http://ift.tt/2xHRBHf
http://ift.tt/2xHRBHf
Prescription-Strength Topical Steroids Sold Without Prescription
This case report describes the use of a prescription-strength topical steroids obtained without prescription.
http://ift.tt/2iQbIjV
http://ift.tt/2iQbIjV
Alcohol-Related Mortality in Patients With Psoriasis
This cohort study investigates whether patients with psoriasis have an elevated risk of alcohol-related mortality.
http://ift.tt/2ynl8oY
http://ift.tt/2ynl8oY
Joseph Goldberger—Public Health Champion and Investigator of Pellagra
Joseph Goldberger, MD (1874-1929), was an American physician whose commitment to public health led him to risk his own health and to confront the medical and political establishments of his day. In 1899, not long after graduating from Bellevue Hospital Medical College, Goldberger joined the US Marine Hospital Service (later the Public Health Service). Initially, his duties included inspecting immigrants in the Port of New York, but he soon became fascinated by epidemiology and infectious diseases. As a quarantine officer, Goldberger traveled extensively to study outbreaks of yellow fever, dengue fever, and typhus, and managed to contract each of these on his visits.
http://ift.tt/2ABFS2x
http://ift.tt/2ABFS2x
Resilience and Depression in Patients With Hidradenitis Suppurativa
This survey study uses clinical data from a set of self-administered, self-graded questionnaires to examine the correlation among resilience, depression, and health-related quality of life for patients with hidradenitis suppurativa.
http://ift.tt/2yIyWzq
http://ift.tt/2yIyWzq
Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis
This Patient Page provides information on Stevens-Johnson syndrome and toxic epidermal necrolysis and advises patients on care and treatment as well as ways to avoid recurrences.
http://ift.tt/2Bj1YGh
http://ift.tt/2Bj1YGh
Long-term Change in the Risk of Skin Cancer After Organ Transplantation
This population-based nationwide cohort study evaluates the long-term change in the risk of skin cancer after organ transplantation in Norway.
http://ift.tt/2ipFAUc
http://ift.tt/2ipFAUc
Hypophysenadenome – nicht immer benigner Natur
Zusammenfassung
Hintergrund
Mit einer Prävalenz von 80–100 Fällen pro 100.000 Einwohner sind Hypophysenadenome häufiger als allgemein angenommen. Meist werden sie jedoch erst Jahre nach Entwicklung der ersten Symptome diagnostiziert. Besonders die seltenen aggressiven Verlaufsformen stellen eine besondere Herausforderung dar.
Ziel
Die aktuellen diagnostischen und therapeutischen Möglichkeiten von Hypophysenadenomen werden dargestellt.
Material und Methode
Review der Literatur.
Ergebnisse
Hormoninaktive Hypophysentumoren werden in der Regel erst bei Entwicklung von Lokalsymptomen, Nachweis eines relevanten Tumorwachstums oder bei der Entwicklung einer Hypophyseninsuffizienz operiert. Prolaktinome werden typischerweise medikamentös behandelt; abhängig von Tumorgröße und Präferenz des Patienten kann aber auch eine primäre Operation angeboten werden. Eine Akromegalie wird unverändert erst sehr spät nach Erstentwicklung von Symptomen diagnostiziert − und dann mit einem Makroadenom. Die Behandlung beinhaltet häufig eine Kombination von Operation und medikamentösen Therapieverfahren. Der M. Cushing bedarf einer sorgfältigen diagnostischen Klärung und wird operiert. In den letzten Jahren wurden verschiedene medikamentöse Therapieansätze zugelassen, um die Behandlung von residuellen Tumoranteilen oder Rezidiven zu verbessern. Die Prognose von aggressiven Hypophysentumoren hat sich aufgrund von Studien verbessert, die die Effektivität einer Chemotherapie mit Temozolomid nachgewiesen haben.
Schlussfolgerungen
Die Behandlung von Hypophysenadenomen stellt aufgrund der heterogenen klinischen Präsentation unverändert eine Herausforderung dar. Die Patienten sollten von einem Team, mindestens bestehend aus einem Endokrinologen, Neurochirurgen, Strahlentherapeuten und Pathologen, behandelt werden.
http://ift.tt/2o0hVvK
Pepsin in saliva as a diagnostic biomarker in laryngopharyngeal reflux: a meta-analysis
Abstract
Objective
Pepsin in saliva has been proposed as a biomarker for the diagnosis of laryngopharyngeal reflux (LPR), but the results remain controversial. We assessed the diagnostic value of pepsin in saliva for LPR.
Methods
PubMed, Embase, and Web of Science were searched for studies in English that evaluated the utility of pepsin in saliva in the diagnosis of LPR, published up to 15 March 2017. We used Stata 12.0 to summarize the diagnostic indexes for the meta-analysis.
Results
Eleven eligible studies met the inclusion criteria. After the meta-analysis of included studies, the pooled sensitivity and specificity were 64% [95% confidence interval (CI) 43–80%] and 68% (95% CI 55–78%), respectively; the positive (PLR) and negative (NLR) likelihood ratios were 2.0 (95% CI 1.4–2.9) and 0.54 (95% CI 0.33–0.87), respectively; the diagnostic odds ratio (DOR) was 4 (95% CI 2–8); and the area under the curve (AUC) was 0.71 (95% CI 0.67–0.75).
Conclusion
Pepsin in saliva has moderate value in the diagnosis of LPR. The cutoff value used could affect the diagnostic value. Therefore, further investigations are required to find the optimal method to detect salivary pepsin in diagnosing LPR.
http://ift.tt/2AVuGKT
Fachärztliches Basiswissen zur Wirksamkeit von Hörgeräten in Abhängigkeit der Art und Pathophysiologie einer Hörstörung
Zusammenfassung
Zum fachärztlichen Basiswissen gehören die hörstörungsspezifischen pathophysiologischen und psychoakustischen Defizite. Im vorliegenden Beitrag werden die sich daraus ergebenden notwendigen Wirkungen der Hörgeräte zum bestmöglichen Behinderungsausgleich definiert und kritisch diskutiert. Die wesentlichen Einschränkungen bestehen bei der Schallleitungsstörung in der pegelunabhängigen Dämpfung und dem damit verbundenen Lautstärkeverlust, die nahezu vollständig durch eine vom Schallpegel unabhängige Verstärkung kompensierbar sind. Bei der Innenohrhörstörung verursacht der irreversible Verlust an äußeren und inneren Haarzellen und die damit verbundene Degeneration der Hörnervenverbindung zu den Haarzellen eine Undeutlichkeit, die sich besonders bei der Sprachverständlichkeit im Störgeräusch bemerkbar macht und mit Hörgeräten nicht unmittelbar verbesserbar ist. Hier genügt nicht allein die jetzt vom Schallpegel abhängige Verstärkung, sondern es sind wirksame Maßnahmen zur Verminderung des Störgeräuschpegels wie Störgeräuschfilterung und v. a. Richtmikrofone notwendig. Die Reduzierung von Störgeräuschen ist vielfach auch bei retrocochleären Hörstörungen die einzig wirksame Methode zur Verbesserung der Sprachverständlichkeit.
http://ift.tt/2Cc71Gk
Multimycotoxin analysis of South African Aspergillus clavatus isolates
Abstract
Aspergillus clavatus poisoning is a neuromycotoxicosis of ruminants that occurs sporadically across the world after ingestion of infected feedstuffs. Although various toxic metabolites are synthesized by the fungus, it is not clear which specific or group of mycotoxins induces the syndrome. A. clavatus isolates were deposited in the culture collection of the Biosystematics Division, Plant Protection Research Institute, Agricultural Research Council during incidences of livestock poisoning (1988–2016). Six isolates were still viable and these plus three other South African isolates that were also previously deposited in the collection were positively identified as A. clavatus based on morphology and ß-tubulin sequence data. The cultures were screened for multiple mycotoxins using a liquid chromatography-tandem mass spectrometric (LC-MS/MS) method. Twelve A. clavatus metabolites were detected. The concentrations of the tremorgenic mycotoxins (i.e., tryptoquivaline A and its related metabolites deoxytryptoquivaline A and deoxynortryptoquivaline) were higher than patulin and cytochalasin E. Livestock owners should not feed A. clavatus-infected material to ruminants as all the South African A. clavatus isolates synthesized the same compounds when cultured under similar conditions.
http://ift.tt/2nWgPkQ
Role of Pharyngeal High Resolution Manometry and Impedance in Swallow Function of Head and Neck Cancer Patients
Conditions: Head and Neck Cancer; Dysphagia
Intervention: Diagnostic Test: pHRMi
Sponsor: Sidney Kimmel Comprehensive Cancer Center
Not yet recruiting
http://ift.tt/2ABbdCd
Intervention: Diagnostic Test: pHRMi
Sponsor: Sidney Kimmel Comprehensive Cancer Center
Not yet recruiting
http://ift.tt/2ABbdCd
Lasertherapie des Basalzellkarzinoms
Zusammenfassung
Mit einer deutlichen Zunahme der Inzidenz und einem immer früheren Beginn gelten für die Entwicklung von Basalzellkarzinomen als Hauptrisikofaktoren weiterhin die Sonnenexposition, helle Haut, Immunsuppression, Karzinogene wie Arsen, chronische Irritationen und gewisse Genodermatosen. Behandlungsmöglichkeiten für das lokalisierte resezierbare Basalzellkarzinom umfassen die mikrographisch kontrollierte Chirurgie, die einfache Exzision, Kürettage, Laserablation, Kryochirurgie, Imiquimod, 5‑Fluorouracil, photodynamische Therapie und Radiotherapie. Nichtchirurgische Behandlungsmöglichkeiten sind dabei eher für Fälle geeignet, bei denen ein chirurgisches Vorgehen zur Entstellung oder zu Funktionseinschränkungen führt, oder für Patienten mit erhöhten Operationsrisiken. Die Lasertherapie, ablativ und nichtablativ, als Monotherapie oder in Kombination, kann für ausgewählte Fälle eine sinnvolle Behandlungsoption darstellen. Die letzten Jahre haben einen Zuwachs an Wissen über Indikation und Wirkung der Lasertherapie des Basalzellkarzinoms gebracht, dennoch sind weitere Studien mit hohem Evidenzniveau notwendig.
http://ift.tt/2z8UML8
Nonalcoholic fatty liver disease in patients with psoriasis: A consequence of systemic inflammatory burden?
Abstract
Patients with psoriasis are at an increased risk for nonalcoholic fatty liver disease (NAFLD) compared to the general population. However, the pathophysiology underlying this comorbidity and elucidation of effective treatment strategies are unclear. This review provides insights into the possible role of chronic, low-grade inflammation in the pathogenesis of NAFLD in patients with psoriasis. Both conditions are associated with increased levels of pro-inflammatory adipokines (such as tumor necrosis factor-α and interleukin-6), and hepatokines, and decreased levels of adiponectin, an anti-inflammatory adipokine. This imbalance in inflammatory mediators could result in insulin resistance and, thereby, facilitate the occurrence and progression of NAFLD in a multistep manner. All patients with psoriasis should, therefore, be considered candidates for NAFLD screening and managed accordingly. Given the common etiology of inflammation between these conditions, it is hypothesized that biologic therapies for psoriasis may attenuate the systemic inflammatory process and progression of NAFLD in patients with psoriasis.
This article is protected by copyright. All rights reserved.
http://ift.tt/2iX6FLd
An observer blinded randomised controlled pilot trial comparing localised immersion psoralen ultraviolet A (PUVA) with localised narrowband ultraviolet B (NBUVB) for the treatment of palmar hand eczema
Summary
Background
Hand eczema is a common inflammatory dermatosis that causes significant patient morbidity. Symptoms such as pain, itch and localised swelling contribute to disruption of activities of daily living, lack of sleep, and missed days from work. The aetiology is often multifactorial. Previous studies comparing psoralen ultraviolet A (PUVA) and narrowband ultraviolet B (NBUVB) have been small, non-randomised and retrospective.
Objectives
To conduct an observer blinded randomized controlled pilot study using validated scoring criteria to compare immersion PUVA with NBUVB for the treatment of chronic hand eczema unresponsive to topical steroids.
Methods
60 patients (22 male, 38 female), median age 50 years (range 22, 73), with hand eczema unresponsive to clobetasol propionate 0.05% (Dermovate®) (25 (42%) severe), were randomised to receive either immersion PUVA (n=30) or NBUVB (n=30) twice weekly for 12 weeks with assessments at intervals of 4 weeks. The primary outcome measure was the proportion of patients achieving a 'clear' or 'almost clear' Physician's Global Assessment (PGA) treatment response at 12 weeks. Secondary outcome measures included assessment of the modified Total Lesion and Symptom Score (mTLSS) and the Dermatology Life Quality index (DLQI).
Results
In both treatment arms, 23 patients completed the 12-week assessment for the primary outcome measure. In the PUVA group, 5 patients achieved 'clear', and 8 'almost clear' (ITT response rate 43% (95%CI: 26%, 61%)). In the NB-UVB group, 2 achieved 'clear' and 5 'almost clear' (ITT response rate 23% (95%CI: 8%, 38%)). For the secondary outcomes, median (IQR) mTLSS scores were similar between groups at baseline (PUVA 9.5 (6.8,11), NBUVB 9 (6.8,12)) and at 12-weeks (PUVA 3 (1,6), NBUVB 4(2,8)). Changes in DLQI were similar with improvements in both groups.
Conclusions
In this randomised pilot trial recruitment was challenging. Once randomised, there were acceptable levels of compliance and safety in each treatment schedule, but lower levels of retention. Using validated scoring systems; PGA, mTLSS and DLQI as measures of treatment response, the trial demonstrated that both PUVA and NBUVB improved the severity of chronic palmar hand eczema. The study was not designed to demonstrate superiority of one treatment and a larger adequately powered RCT will be required to investigate this.
This article is protected by copyright. All rights reserved.
http://ift.tt/2BitN1r
Portable negative-pressure wound therapy for pyoderma gangrenosum: Report of two cases
Abstract
Pyoderma gangrenosum is a chronic non-infectious neutrophilic dermatosis that causes undermining ulcers. Topical therapies for the deep ulcers of pyoderma gangrenosum have not been established. To investigate whether negative-pressure wound therapy is effective for a pyoderma gangrenosum ulcer, we used the PICO single use negative-pressure wound therapy system (Smith & Nephew, London, UK) for two pyoderma gangrenosum patients. In these cases, the ulcers decreased in size and necrolytic tissue was removed notably. Moreover, there were no secondary infections nor was there Koebner phenomena. Our cases suggest that portable negative-pressure wound therapy can be a treatment option for deep, intractable ulcers caused by pyoderma gangrenosum. Because portable negative-pressure wound therapy devices afford increased mobility to patients, they can give the patient a better quality of life than standard negative-pressure wound therapy systems do.
http://ift.tt/2BhhYsp
Guideline for diagnostic criteria, severity classification and treatment of eosinophilic fasciitis
Abstract
We established diagnostic criteria and severity classification of eosinophilic fasciitis because there is no established diagnostic criteria or widely accepted severity classification of the disease. Also, there has been no clinical guideline for eosinophilic fasciitis, so we established its clinical guideline ahead of all over the world. In particular, the clinical guideline was established by clinical questions based on evidence-based medicine according to the New Minds Clinical Practice Guideline Creation Manual (version 1.0). We aimed to make the guideline easy to use and reliable based on the newest evidence, and to present guidance as specific as possible for various clinical problems in treatment of eosinophilic fasciitis.
http://ift.tt/2iZu92c
Dermoscopic features distinctive for extraocular sebaceous carcinoma
Abstract
We examined dermoscopic features of three cases of extraocular sebaceous carcinoma and reviewed the literatures. The yellowish structures, polymorphous vessels and ulceration were common findings in our cases and all cases of the previous reports. The appearance of whitish-pink areas has not been described previously. Our results suggested that the combination of four dermoscopic features, whitish-pink areas, yellowish structures, polymorphous vessels and ulceration might be distinctive in extraocular sebaceous carcinoma.
http://ift.tt/2z7656s
Long-term administration of oral macrolides for acne treatment increases macrolide-resistant Propionibacterium acnes
Abstract
Macrolide-resistant Propionibacterium acnes are frequently isolated from patients with acne vulgaris, and the most resistant isolates (>90% resistance) have the 23S rRNA mutation. An increase in resistant P. acnes with this mutation is thought to be caused by the inappropriate use of antimicrobials. Therefore, we studied the mutation frequency of macrolide resistance in P. acnes in vitro. When P. acnes mutants were exposed to clarithromycin after being incubated in broth without antimicrobials, resistant mutants with the 23S rRNA mutation were not isolated. However, the mutants were obtained at the frequency of 10−6 after being pre-incubated with 0.03 μg/mL of antimicrobials. This is the estimated epidermal concentration of clarithromycin after p.o. administration. The resistant mutants had the 23S rRNA mutations A2058G, A2059G and C2611G. When pre-incubated with clarithromycin, C2611G mutants which showed resistance to clarithromycin were obtained 32.1% more often than pre-incubated with clindamycin (P < 0.01). By contrast, when pre-incubated with clindamycin, A2058G mutants, which show high-level resistance to both clarithromycin and clindamycin, were more frequently obtained than pre-incubated with clarithromycin (87.5%, P < 0.01). No difference in the isolation rate of A2059G mutants, which show high-level resistance to macrolides but low-level resistance to clindamycin, was found with either treatment. These results indicate the possibility that long-term use of oral macrolides for acne treatment facilitate the increase of macrolide-resistant P. acnes.
http://ift.tt/2z80DAz
Painless aortic dissection presenting with multisystem organ failure and owls eyes sign of the spinal cord
Description
A 72-year-old woman presented to the hospital with 3 days of emesis, anorexia and generalised fatigue without any report of chest pain. Her physical examination was significant for mild confusion and bright red blood per rectum. On presentation she had bilateral lower extremity weakness, but was able to move both lower extremities; dorsalis pedis pulses were present bilaterally. Initial laboratory examinations demonstrated a white cell count of 16.7 K/μL, creatinine of 3.0 mg/dL, aspartate aminotransferase/alanine aminotransferase of 1189/382 U/L, lactate of 4.5 mmol/L and a troponin of 0.52 ng/mL. ECG was unremarkable. An initial chest X-ray showed a dilated aortic arch and a modestly widened mediastinum. A CT scan of the chest was not done. Several hours after presentation, the patient was noted to have flaccid lower extremities and diminished distal pulses, but with no skin changes or signs of distal ischaemia. Duplex ultrasound of the lower extremities demonstrated biphasic waveforms of distal vessels with no...
http://ift.tt/2ymohpm
Rare side effect of adjuvant ipilimumab after surgical resection of melanoma: Guillain-Barre syndrome
Guillain-Barré syndrome is a life-threatening neurological disorder that presents with rapid ascending paralysis and areflexia. Guillain-Barré syndrome is traditionally associated with infections from a gastrointestinal or respiratory tract source. We report the case of a 71-year-old man with melanoma who was treated with ipilimumab as adjuvant immunotherapy and subsequently developed Guillain-Barré syndrome. The diagnosis was made clinically through physical exam findings. He was successfully treated with a combination of intravenous immunoglobulin therapy and corticosteroids.
http://ift.tt/2ACyrI4
Posterior capsular rupture and spontaneous posterior dislocation of lens following electrical injury
Lenticular changes are often seen following electrical injury. We report an unusual case of electrical injury with late spontaneous posterior dislocation of lens nucleus with intact anterior capsule with ruptured posterior capsule in the right eye and anterior subcapsular cataract in the left eye. The right eye was managed with pars plana vitrectomy with cortical matter removal with multipiece intraocular lens insertion in ciliary sulcus. This report adds posterior capsular rupture and posterior dislocation of lens to the usual ocular complications of electrical injury.
http://ift.tt/2yme5wY
Emergency salpingectomy for ruptured ectopic pregnancy in patient with Melnick-Needles syndrome: a rare otopalatodigital syndrome
Melnick-Needles syndrome (M-NS) is a rare genetic disorder which primarily affects skeletal developments. M-NS may also affect the cardiorespiratory and renal systems. A 35 kg patient presented complaining of abdominal pain. Following a positive pregnancy test and ultrasound examination, she was diagnosed with a ruptured ectopic pregnancy. She had a significant background history of M-NS, obstructive sleep apnoea (with narrow gauge tracheostomy in situ), obstructive lung disease and scoliosis. She received fluid resuscitation, and the case was managed using an open salpingectomy and clot evacuation under combined spinal/epidural anaesthesia. Anticipated difficulty in securing a definitive airway was pivotal to choosing a regional anaesthetic technique. The operation was successful and the patient recovered well. This was a unique surgical and anaesthetic challenge due to abnormal facial, spinal and abdominal morphology compounded by the time-critical emergency nature of the case. Individually tailored perioperative management is frequently required for patients with rare syndromes.
http://ift.tt/2AA4bhl
Intermittent catatonia and complex automatisms caused by frontal lobe epilepsy in dementia
An 82-year-old man was admitted to the emergency department following bizarre behaviour. Police had noticed him driving erratically through his village. He did not stop when instructed, drove slowly home and appeared 'vacant' on questioning. While in hospital, he had approximately 15 episodes of catatonia, involving rigidity, negativism, mutism except echolalia and perseveration, automatic obedience and utilisation phenomena, lasting 2–20 min each. Between episodes, he was amnestic but otherwise well. Electroencephalography demonstrated bifrontal slowing with left-sided emphasis, and captured two focal onset partial seizures with the clinical correlate of the syndrome described above. He improved rapidly on levetiracetam and lorazepam, was discharged and received a diagnosis of dementia by his community mental health team shortly afterwards, based on chronic short-term memory loss, functional decline and MRI changes. This case has implications for our understanding of the neural correlate of catatonia, specifically frontal lobe pathway dysfunction.
http://ift.tt/2ymob0Y
Long-term follow-up of hepatitis-associated aplastic anaemia
Prognosis of hepatitis-associated aplastic anaemia (HAAA) was improved with haematopoietic stem cell transplantation (HSCT) and immunosuppression, but the long-term outcome remains undefined. Case 1: a girl aged 3 years with acute liver failure (ALF) submitted to orthotopic liver transplantation (OLT) subsequently developed aplastic anaemia and HSCT from a compatible sibling was performed. Post-HSCT, the patient developed post-transplant lymphoproliferative disorder and rituximab was administered with good response. Fifteen years later, both grafts show good outcome. Case 2: a girl aged 10 years submitted to OLT due to ALF, developed pancytopenia 2 months later. Due to the absence of a human leucocyte antigen compatible donor, she was treated with ciclosporin and antithymocyte globulin with very good long-term outcome. These clinical cases suggest that, for patients with HAAA that underwent OLT, aggressive therapy with HSCT or immunosuppression may provide a benign long-term outcome.
http://ift.tt/2AzjeHL
A play that went wrong: Unique presentation of bowel perforation from an unusually large per-rectal foreign body
Colorectal foreign bodies (FBs) are not unheard of in the province of surgery. They are commonly seen in men ranging from 20 to 90 years of age with a bimodal age distribution. A variety of objects have been described and reported in literature. Management involves a complete history and examination followed by the necessary investigations. Most of the time they can be removed at bedside with some manipulation techniques employing the use of some ingenious devices and/or endoscopy for adamant objects. But persistent FBs or those that are high in the rectum or those that present with complications will require operative management. We present a case of a 77 cm long FB inserted rectally for sexual gratification in a male patient, which caused a large bowel perforation, ending high intra-abdominally at the level of the spleen and diaphragm after traversing the entire abdominal cavity and requiring a laparotomy for removal.
http://ift.tt/2ymo3yw
Disseminated coccidioidomycosis-related cervical intramedullary lesion causing quadriplegia in an immunocompetent host
Description
A 41-year-old man with a history of crystal methamphetamine and alcohol abuse had progressive fever, nausea, headache, gait difficulties and seizures over 4 weeks while living in California and Mexico. He was diagnosed with meningitis, treated with antibacterials and discharged to a rehabilitation facility. One month later, he had recurrent symptoms with weakness of both arms and legs. Neuroimaging revealed extensive basilar pachymeningitis, leptomeningitis, hydrocephalus (figure 1A), cervical epidural enhancement (figure 1B) and a non-enhancing central cervical intramedullary lesion spanning C1 through C6 (figure 1C). He was started on fluconazole 800 mg daily due to his travel history, although a serum antibody test was negative by double immunodiffusion (<1:1). A ventriculoperitoneal shunt was placed for hydrocephalus and he was discharged but remained quadriplegic. Two weeks later, he developed confusion and was found to have bilateral subcortical strokes on MRI with evidence of arteritis...
http://ift.tt/2AANi60
Mycotic pulmonary artery aneurysm secondary to septic emboli
Description
A 16-year-old girl with a medical history of tetralogy of Fallot repaired as an infant with right ventricle (RV) to pulmonary artery (PA) conduit presented to the emergency department with sudden onset fever of 38.4°C, leg cramps and poor oral intake. At admission, she was hypotensive and tachycardic. Blood cultures were positive for methicillin-sensitive Staphylococcus aureus with white blood cell count of 6.1 x10^9/L and C reactive protein 8.1. An echocardiogram found evidence for moderate conduit stenosis and severe right ventricular hypertrophy, without occlusive vegetation directly visualised. An initial chest CT angiogram (CTA) confirmed these findings, showing an incompletely occlusive vegetation in the RV to PA conduit and multiple peripheral and nodular ground glass opacities, some with cavitation, scattered throughout both lungs consistent with septic emboli (figure 1A). After initiation of anticoagulation and antibiotics, her clinical symptoms steadily improved. Repeat blood cultures remained negative. Follow-up chest...
http://ift.tt/2ymnXHa
Exophytic cystic liver lesion: an unusual presentation of a hepatocellular carcinoma in a young female
Hepatocellular carcinoma (HCC) is one of the most common malignant primary liver tumours. However, primary hepatic carcinomas are rare in young adults, accounting for approximately 1% of tumours in people below the age of 20. Hepatitis B virus (HBV) and hepatitis C virus (HCV) infection are the two most important aetiological agents of HCC. The average age at onset of HBV-related HCC (~50 years old) is 10 years younger than that of HCV-related HCC (61–64 years). Evidence for an association between the oral contraceptive pill (OCP) and development of HCC remains inconclusive. Here, we describe a case of a 28-year-old woman with normal background liver, who presented with a large palpable abdominal mass due to a bilobar, exophytic, cystic lesion arising from the right lobe of the liver, later diagnosed as HCC on histological analysis. We highlight the need for considering HCC even in the unusual setting of a cystic, exophytic lesion.
http://ift.tt/2ABiDpm
Spigelian hernia and pitfalls of postoperative anticoagulation
Spigelian hernias are a rare lateral ventral abdominal hernia that carry a high risk of strangulation due to their smaller sizes, and require surgical intervention. In more complex cases involving an anticoagulated patient, perioperative management of anticoagulation must be monitored and reviewed to avoid potential pitfalls. We present an 81-year-old woman who presented with right groin pain, and was requiring warfarin anticoagulation due to her cardiac history. The spigelian hernia was diagnosed and reduced laparoscopically, and the defect was repaired and reinforced by mesh. However, the patient suffered from catastrophic complications postoperatively related to her anticoagulation management. Spigelian hernias require surgical interventions. However, in an anticoagulated patient with significant comorbidities, perioperative anticoagulation needs to be closely monitored to balance the risk of thromboembolic disease with acceptable postoperative bleeding risks.
http://ift.tt/2AzkuL1
Advanced abdominal pregnancy in a spontaneous heterotopic pregnancy
Spontaneous heterotopic pregnancy is a potentially life-threatening condition rarely considered when a patient with an intrauterine pregnancy is asymptomatic or presents with complaints such as abdominal pain. An advanced abdominal pregnancy as the form of the ectopic component, outside the context of assisted reproduction, is an even more unusual and perilous diagnosis with very few cases reported in the literature. We report such a case in a 34-year-old multipara, with no known risk factors for ectopic pregnancy. The pregnancy was initially misdiagnosed and managed as a dichorionic gestation, complicated with fetal demise of one of the twins. The correct diagnosis was only made after term delivery of the intrauterine pregnancy. The abdominal pregnancy was subsequently managed via laparotomy with no complications.
http://ift.tt/2yltXjm
Left-sided sinistroposition of the gall bladder: incidental presentation during elective cholecystectomy
A 59-year-old male patient presented with mild gallstone pancreatitis. He underwent laparoscopic cholecystectomy during the same admission, where we encountered a left-sided gall bladder (GB). This was managed during laparoscopic surgery by modifying the laparoscopic port positions, and we did not encounter any other variations in the biliary anatomy. Thorough knowledge regarding anatomical variations of the GB will help in managing rare cases and avoid injuries to vital structures.
http://ift.tt/2ABirXa
Progressive myoclonic epilepsy and horizontal gaze palsy: a rare aetiology
Gaucher's disease is a rare autosomal recessive, potentially fatal disorder but most common type among lysosomal storage disorders. The disease's incidence is around 1/40 000 to 1/60 000 births in the general population. A 32-year-old man, born out of non-consanguineous union, presented with generalised tonic–clonic seizures and myoclonus since 17 years of age. Seizures were noted to be resistant to multiple epileptic drugs. He developed gait imbalance, intentional tremor and dysarthria. Detailed examination revealed hepatosplenomegaly, bilateral pancerebellar signs with normal power, reflexes and sensory system. He had major cognitive impairment with impaired frontal and temporal lobar functions. Bone marrow evaluation revealed Gaucher cells, confirming the diagnosis.
http://ift.tt/2ym5A4O
Spontaneous retrobulbar haemorrhage in idiopathic thrombocytopenic purpura
Description
An 81-year-old male patient presented to the emergency department with complaints of intense and active subconjunctival haemorrhage, eyelid ecchymosis and proptosis of the right eye (optic disc, OD) with 1 hour of evolution (figure 1). The patient indicated no related pain, headache or recent head trauma. He referred to have reduced vision of the same eye 20 years prior to this event, which he could not explain. His medical history presented an idiopathic thrombocytopenic purpura (ITP), which had been treated with azathioprine for the past 4 years. Visual acuity (VA) of OD was 20/200 (same as previously), with no ocular motility restrictions or afferent pupillary defect. The intraocular pressure (IOP) OD was 22 mm Hg. Fundus examination revealed an OD of normal appearance, with no signs of posterior compression. A non-contrast CT of the brain and orbit revealed thickening and densification of the periorbital soft tissues, relative proptosis of OD...
http://ift.tt/2ABi1A4
Giant retrocardiac foregut duplication cyst presenting with left atrial compression and palpitations
A 35-year-old man presented with a 3-month history of palpitations and shortness of breath. An ECG showed premature atrial contractions and episodes of supraventricular tachycardia. A subsequent echocardiogram showed a retrocardiac cystic mass that was compressing the left atrium. A CT scan confirmed these findings by showing a large left-sided posterior mediastinal cyst compressing the left atrium and pulmonary veins. The cyst was successfully excised from the retrocardiac position via left thoracotomy after which there was complete resolution of the palpitations. Histopathology showed it to be a mediastinal cyst, most likely a foregut duplication of the enterogenic variant. This is an extremely unusual case of foregut duplication cyst presenting with compression of the left atrium and pulmonary veins leading to atrial arrhythmias.
http://ift.tt/2ym4hCX
Dysphagia caused by an inverted papilloma
Description
A previously healthy 57-year-old man presented with progressive dysphagia and sore throat with 1-month duration. Nasal obstruction was present but neglected. Examination revealed an enormous mass in the posterior wall of the oropharynx (figure 1) pending from the nasopharynx (figure 2), blocking the left nasal cavity and reaching the epiglottis. Differential diagnosis includes benign lesions such antrochoanal polyp, inflammatory polyp, angiofibroma or encephalocele and malignant neoplasms like epidermoid carcinoma or adenocarcinoma.1 At the beginning, for its clinical appearance, it was considered as an antrochoanal polyp. An office biopsy was performed, and the histopathological report confirmed a benign inverted papilloma with an exceptional presentation. A 14 cm inverted papilloma, arising from the left lateral nasal wall, was endoscopically resected, and no recurrence occurred after 1 year of follow-up. Unlike other benign lesions, close follow-up is mandatory in inverted papillomas because recurrence occur in 12%–15% and...
http://ift.tt/2Ayt2St
Tension pneumothorax and diffuse subcutaneous emphysema as a complication of cardiopulmonary resuscitation
Description
A 65-year-old man, with a medical history of interstitial lung disease and a recently diagnosed lung adenocarcinoma with known metastases to the bone, was brought to the emergency department after an episode of cardiopulmonary arrest and resuscitation by emergency medical services (EMS). The patient had a recent hospitalisation for bronchoscopic lung biopsy. It was complicated by a pneumothorax, and he was treated with chest tube insertion. The tube was removed 2 weeks prior to the current encounter and no residual leak was found. On the day of arrival, early morning, the patient's wife found him unresponsive with a temperature of 101 degrees Fahrenheit (38.3 Celsius). EMS was called and the patient was found in pulseless electrical activity. Advanced cardiac life support was initiated and he had a return of spontaneous circulation after two doses of 1 mg epinephrine over approximately 6 min of cardiopulmonary resuscitation (CPR). The patient was intubated in the field...
http://ift.tt/2ymnPHG
Foot-strike haemolysis in an ultramarathon runner
This case report describes mild anaemia and intravascular haemolysis in an otherwise healthy 41-year-old ultramarathon runner. In long-distance endurance athletes, trace gastrointestinal bleeding and plasma volume expansion are recognised sources of mild anaemia, often found incidentally. However, repetitive forceful foot striking can lead to blood cell lysis in the feet, resulting in a mild macrocytic anaemia and intravascular haemolysis, as was demonstrated in the patient described herein. Mild anaemia in runners, often called 'runner's pseudoanaemia', is typically clinically insignificant and does not require intervention. However, an unexplained anaemia can cause undue worry for otherwise healthy patients and lead to costly further testing, providing an argument against routine testing with complete blood counts in healthy, asymptomatic patients.
http://ift.tt/2AAYpvA
Correction: Diagnostik und Therapie akuter venöser Erkrankungen
Correction:
Hautarzt 2017
http://ift.tt/2nUA12o
Sehr geehrte Leserin, sehr geehrter Leser,
in Tab. 2 des oben genannten Beitrags ist leider ein Fehler unterlaufen. Die Erhaltungsdosierung von Rivaroxaban (Xarelto®) ab Tag 22 beträgt 20 mg 1‑mal/Tag. Die korrigierte …
http://ift.tt/2CcGPvp
Deep infiltrating ureteral endometriosis with catamenial hydroureteronephrosis: a case report
This aim of this case report is to raise awareness of ureteral endometriosis in women of reproductive age with hydronephrosis in the absence of urolithiasis to enable early diagnosis and prevent loss of renal ...
http://ift.tt/2C9xa8A
Osteomas of Temporal Bone: A Retrospective Study
Abstract
Osteomas of temporal bone are rare, slow growing benign tumours and they are reported in all parts of temporal bone. This study is a retrospective study of the clinical presentation, management and complications of temporal bone osteoma done from January 1999 through January 2017. The study population is thirteen patients, all who has been radiologically and histopathologically proven to be a case of osteoma. Total number of patients were 13 of which 7 were females and rest 6 were male. Presenting complaints included swelling behind the ear (6 cases), reduced hearing in 4 cases, 2 cases had ear discharge, 3 of them were asymptomatic in whom it was diagnosed accidently. The duration of symptoms ranged from 1 month to 10 years. Of total 13 patients 7 had external auditory canal involvement and 4 cases had mastoid region. Two patients were managed conservatively, one refused surgery and rest ten cases underwent excision. The specimen was sent for histopathological examination and diagnosis of osteoma was confirmed. The decision regarding whether to operate or not depends on each case depending on its size, symptoms and more importantly the complications. Excision of osteoma remains the treatment of choice.
http://ift.tt/2AQNuuD
Accessory Auricles: Systematic Review of Definition, Associated Conditions, and Recommendations for Clinical Practice
Abstract Accessory auricles are rare congenital abnormalities embryologically derived from the first branchial arch. Presentation may be variable with locations grouped into anatomical zones based on the frequency of location found in the literature. This study reviewed the papers between 1981 and 2017. Findings included an association with syndromes including Goldenhar, VACTERL, Treacher–Collins, Townes–Brocks, and Wolf–Hirschhorn. Based on histological and embryological evidence, the term "accessory auricle" is best used as an umbrella term to define this difference. Finally, indications are provided for imaging and laboratory investigations to guide the physician treating patients with accessory auricles. Address correspondence and reprint requests to Mark S. Lloyd, MPhil, FRCS(Plast), Department of Plastic Surgery, Autologous Ear Reconstruction Service, Birmingham Children's and Women's Hospital NHS Trust, 4th Floor, Ladywood House, Steelhouse Lane, Birmingham B4 6NH, UK; E-mail: marklloyd1@nhs.net Received 11 July, 2017 Accepted 1 September, 2017 The authors report no conflicts of interest. © 2017 by Mutaz B. Habal, MD.
http://ift.tt/2AiyK6K
http://ift.tt/2AiyK6K
A Rare Complication After Septoplasty: Visual Loss Due to Right Retinal Artery Spasm
Abstract Septoplasty is a commonly used procedure for correcting septal cartilage deformities. Hemorrhage, abscesses, scaling, adhesions, and scar tissue are often seen after the operation of the septoplasty, but temporary or permanent visual loss due to local anesthetic use has been reported very rarely in the literature. The authors also aimed to present a female patient with retinal artery spasm in the right eye after septoplasty in this article. A 27-year-old female patient was admitted to the authors' clinic with long-standing nasal obstruction and postnasal drip. There was no feature in her history and also no sign other than nasal septal deviation on physical examination. The patient was informed about the operation and the operation was planned. Emergency eye consultation was requested after the patient said that the right eye of the patient had never seen in the postoperative wake-up hall. Examination by an ophthalmologist; mild exotropia and total loss of vision in the right eye (including loss of light reflex) was detected. The light reaction in the affected eye was negative and indirect reaction was positive. After enlargement of the pupil, fundus examination revealed that the right posterior pole region (inside of the macula and vessel arches) was pale and no central retinal artery pulsation was observed. The patient was diagnosed with central retinal artery occlusion and emergency intervention was performed. The right eye massage, paracentesis, and hyperbaric oxygen therapy returned to the patient's visual function. Address correspondence and reprint requests to Dr Celal Günay, MD, Department of Otolaryngology, Head and Neck Surgery, Medipol University Hospital, Istanbul, Turkey; E-mail: gunaycelal@gmail.com Received 28 July, 2017 Accepted 27 August, 2017 The authors report no conflicts of interest. © 2017 by Mutaz B. Habal, MD.
http://ift.tt/2z61dhX
http://ift.tt/2z61dhX
Inferiorly Pedicled Nasolabial Flap for Reconstruction of Anterior Maxilla Defects Class I and II
Objectives: The aim of this study was to present the use of inferiorly pedicled nasolabial flap (IPNF) in the reconstruction of anterior maxilla defects class I and II. Methods: Seven patients, 4 females and 3 males, aging from 38 to 75 (mean = 55.9) years old, from 2014 to 2017 reconstructed anterior part of maxilla with or without oronasal communication were included in this study. Five patients diagnosed with squamous cell carcinoma, 1 patient presented with epithelial-myoepithelial carcinoma, and 1 patient had ameloblastoma. The IPNFs were harvested in 7 patients. Follow-up data were collected for a period ranging from 9 to 26 months. Speech, mastication, and aesthetic outcomes were evaluated with a questionnaire in interview. Results: All patients healed without infection, flap loss, and flap failure. Five patients without prothetic treatment had little pronunciation problem (score: 1 to 3 points), while 2 patients with removable partial denture had excellent speech clarity (score: 1 to 2 points). All patients had no problem with mastication (score: 1 to 2 points). Aesthetic outcomes were acceptable in all patients (score: 1 to 3 points). Conclusion: The IPNF is a good option for reconstruction of anterior maxilla defects class I and II. Address correspondence and reprint requests to Zhongcheng Gong, PhD, DDS, Chairman and Professor of Oncological Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Xinjiang Medical University, Stomatology School of Xinjiang Medical University, Stomatology Research Institute of Xinjiang Province, No. 137 South Liyushan Road, Wulumuqi, Xinjiang Uyghur Autonomous Region 830054, China; E-mail: gump0904@aliyun.com Received 12 May, 2017 Accepted 30 August, 2017 The authors report no conflicts of interest. © 2017 by Mutaz B. Habal, MD.
http://ift.tt/2Ah6QrY
http://ift.tt/2Ah6QrY
Primary Closure of Oroantral Communication Using Pedicled Buccal Fat Pad Following Maxillary Cyst Enucleation
Abstract Odontogenic keratocyst (OKC) is a clinically aggressive developmental odontogenic cyst with a high recurrence rate as 62%. Oroantral communication (OAC) is a gateway through the maxillary sinus and the oral cavity, which, if not treated, will develop into oroantral fistula or chronical sinus diseases. Different methods for closure of OAC were described but only few of them have common usage. In recent years, the use of a pedicled buccal fat pad (BFP) in closure of large oroantral defects has been become popular. In our patient, the OAC resulted from the surgical removal of OKC was closed with BFP. Address correspondence and reprint requests to Yusuf Emes, DDS, PhD, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Istanbul University 34093 Çapa, Istanbul, Turkey; E-mail: yusufemes@yahoo.com Received 27 July, 2017 Accepted 21 September, 2017 The authors report no conflicts of interest. © 2017 by Mutaz B. Habal, MD.
http://ift.tt/2AgHPgo
http://ift.tt/2AgHPgo
A Novel Method to Calculate the Volume of Alveolar Cleft Defect Before Surgery
Background: This study aimed to evaluate a novel subtractive method for the precise calculation of alveolar cleft defect volume before surgery using the three-dimensional imaging software Mimics. Methods: Ten patients (3 female, 7 male, age range 8–12 years) with unilateral alveolar cleft were enrolled in the study. Preoperative helical computed tomography scans were performed for all patients. A new subtractive method was introduced to precisely calculate the alveolar cleft defect volume before surgery with the aid of Mimics. The DICOM data of every patient were processed using the subtractive method. Statistical analyses were performed using Pearson's correlation test and t test. Results: The mean volume of the alveolar cleft defect was 1811.97 ± 817.90 mm3. The mean time spent to calculate an alveolar cleft defect volume was 60.60 ± 11.67 minutes. The Pearson correlation test (r = 0.38, P = 0.279) indicated a poor correlation between alveolar cleft defect volume and calculation time. Conclusions: Preoperative knowledge of defect volume is crucial in alveolar cleft repair. Accurate estimation of graft volume in alveolar cleft patients can be performed using this new subtractive method. Compared with previous methods, this new subtractive method is time-saving and suitable for both unilateral and bilateral clefts. Surgeons can use this method to design a surgical plan for each patient before surgery within a short time, and with less cost. Address correspondence and reprint requests to Hai D. Li, MD, Department of Cleft Lip and Palate, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Ba-da-chu, Beijing 100144, China; E-mail: 15910775061@yeah.net Received 2 June, 2017 Accepted 30 August, 2017 This study was supported by the Capital Clinical Feature Applied Research Fund of China (Z161100000516155). The study was approved by the ethics committee of the Plastic Surgery Hospital affiliated to Peking Union Medical College. The authors report no conflicts of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (http://ift.tt/2iuFjMi). © 2017 by Mutaz B. Habal, MD.
http://ift.tt/2z6qitf
http://ift.tt/2z6qitf
The Validity of Training Endoscopic Sinus and Skull Base Surgery Techniques on the Experimental Head Model
Objectives: The aim of this study was to better understand the usual learning curve in acquiring endonasal endoscopic sinus and skull base surgery (ESSBS) techniques during the novice training on the lamb's head model. Methods: Ten novices were asked to perform 10 bilateral dissections on the particular lamb's head each. The dissections were uniform, consisted of 10 well-defined steps, beginning from the simple removal of the inferior turbinate, and ending with more complicated procedures like cerebrospinal fluid leak repair, Draf 3 procedure for the frontal sinus and elevation of the nasal septal flap. The dissections have been supervised by experienced surgeons. A set of standard ESSBS instruments and 0° and 45° endoscopes have been used under the navigational system. The time required to complete each step has been measured in minutes. Results: In general and quite expectedly, time rates have been obviously lowering as the number of the dissections performed has been growing in each of the participants. Conclusion: Training of the endonasal ESSBS techniques on the lamb's head proved to be useful for novices in getting basic surgical skills in the field. Because of the high degree of anatomic similarity and high level of the anatomic dimensions congruency between the lamb's head and human head (sheep's head has bigger dimensions!) it proved to be an essential preparation for the human cadaveric dissection. The median values of the time rates having been needed to complete the particular of the 10 steps in the last novices' dissections could be accepted as an orientation, just suggesting that once the time needed to complete 1 of the 10 steps has been and achieved by the particular novice, this could be an approximate sign of the maturity for the exercises on human cadaver head. Address correspondence and reprint requests to Nuray Bayar Muluk, MD, Birlik Mahallesi, Zirvekent 2. Etap Sitesi, C-3 Blok, No 6-3/43, 06610 Çankaya, Ankara, Turkey; E-mail: nuray.bayar@yahoo.com; nurayb@hotmail.com. Received 23 August, 2017 Accepted 20 September, 2017 The authors report no conflicts of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (http://ift.tt/2iuFjMi). © 2017 by Mutaz B. Habal, MD.
http://ift.tt/2z79WQW
http://ift.tt/2z79WQW
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