Progressive delayed hemidystonia following clinically mild traumatic brain injury

A 16-year-old boy presented with progressive left hemidystonia over 3 years. The possibilities of symptomatic hemidystonia due to focal lesions such as infarct (vasculitis), tumours, tuberculoma, arteriovenous malformations or heredodegenerative disorders such as Wilson disease were considered. Imaging showed a peculiar scar involving right basifrontal region extending upto anterior, centromedian and dorsomedial nuclei of thalamus due to blowout fracture of roof of orbit. This scar was responsible for progressive left hemidystonia. On probing the history, it was revealed that patient had sustained a mild traumatic brain injury (mTBI) 3 years ago. Burke-Fahn-Marsden dystonia severity rating scale showed improvement from 19 to 6 after treatment with tablet trihexyphenidyl 16 mg and clonazepam 1 mg. A linear scar reaching upto thalamus due to blowout fracture of roof of orbit following clinically mTBI is unique. Delayed, progressive hemidystonia has been reported following severe head injury, however is less common following clinically mTBI.

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Endobronchial metastasis of mixed Mullerian tumour of the uterus

Endobronchial metastasis occurs in only 2%–5% of non-pulmonary cancers. Here we report on an 84-year-old woman who presented with breathlessness and light-headedness while on holiday in Australia, 2 years post-treatment for endometrial cancer. Initial CT pulmonary angiogram identified a soft tissue mass in the left hemithorax. A chest radiograph performed after repatriation was consistent with a large left pleural effusion, but bedside ultrasound showed a lobulated mass involving the left hemidiaphragm. A pleural procedure in the traditional 'triangle of safety' would have resulted in inadvertent puncture of the underlying mass. Serial imaging confirmed the mass was rapidly progressing, and metastatic malignant mixed Mullerian endometrial carcinoma was diagnosed by endobronchial biopsy. A tunnelled intrapleural catheter was inserted for symptom relief, and the patient deteriorated and died at home 2 weeks later. To our knowledge, this is the first case of endobronchial metastasis from malignant mixed Mullerian tumour of the uterus.

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Intramural oesophageal haematoma following traumatic neck injury

This case describes a previously well 90-year-old woman who presented with neck pain, swelling, dysphagia and hoarseness following a motor vehicle collision. Oesophageal oedema was visualised on CT of cervical spine and subsequent CT angiography highlighted an actively bleeding intramural oesophageal haematoma (IOH) extending from the cervical oesophagus to the carina. This rare phenomenon (IOH) has been described as a possible consequence of blunt trauma to the neck; however, we found no cases resulting from acceleration/deceleration injury. Although this was a potentially life-threatening injury, our patient made a full recovery with conservative management.

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A novel bivalent fusion vaccine induces broad immunoprotection against Staphylococcus aureus infection in different murine models

Publication date: Available online 28 December 2017
Source:Clinical Immunology
Author(s): Liuyang Yang, Heng Zhou, Ping Cheng, Yun Yang, Yanan Tong, Qianfei Zuo, Jiao Luo, Qiang Feng, Quanming Zou, Hao Zeng
With more and more drug-resistant Staphylococcus aureus strains emerging in hospitals, there is an urgent need to develop an effective vaccine to combat S. aureus infection. In this study, we constructed a novel bivalent fusion vaccine, SpA-DKKAA-FnBPA37-507 (SF), based on the D domain of staphylococcal protein A (SpA) and the A domain of fibronectin-binding protein A (FnBPA). Immunisation with SF induced a more ideal protective effect compared with the single components alone in a sepsis model. It also showed broad immunoprotection against seven FnBPA isotypes. Vaccination with SF induced strong antibodies responses and Th1/Th17 polarized cellular responses. Further we demonstrated the protective effect of antibodies by the opsonophagocytic assay (OPA) and passive immunisation. Moreover, vaccination with SF showed protective efficacy in a murine pneumonia model and skin abscess model. These results suggest that SF can be regarded as a promising vaccine candidate for the prevention of S. aureus infections.



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Appendicular and breast cancers in an old lady: a case report

Abstract

The presence of two or more malignant tumors of different histological entities in an individual is referred to as multiple primary malignant neoplasms (MPMN). These are becoming more frequently encountered and reported in clinical practice nowadays. Majority of MPMN are diagnosed in elderly, where senility might alter the management plan. Despite the increased reporting of MPMN in the literature, only a few elaborated on the management of such cases. Also, the combination of synchronous primary appendicular and breast cancers—to our knowledge—has never been reported. Here we present the first report of an appendicular adenocarcinoma synchronously presenting along with invasive ductal carcinoma of the breast. We highlight the diagnostic essentials and the multidisciplinary management approach including surgical excision and adjuvant therapy.

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Endoscopic management of duodeno-ileal fistula secondary to diffuse B-cell lymphoma

Abstract

Lymphoma arising in the gastrointestinal tract is relatively common and can affect multiple sites. The development of a gastrointestinal fistula secondary to lymphoma is very rare and has not previously been reported between the duodenum and ileum. This is the first reported care where a fistula secondary to lymphoma has been treated by an endoscopic covered duodenal stent occluding the defect rather than surgical intervention. This strategy permitted early commencement of curative intent chemotherapy which led to tumour shrinkage and fistula closure.

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Acute cholecystitis in a parastomal hernia causing a small bowel obstruction

Abstract

A parastomal hernia is the abnormal protrusion of intra-abdominal tissue and organs through a defect in the abdominal wall around an ostomy. Commonly, they involve intra-abdominal fat, omentum or bowel. However, there are rare cases that involve other organs. We present the case of an 89-year-old gentleman with a gallbladder in his parastomal hernia. Due to his acute cholecystitis, the distended gallbladder compressed adjacent bowel loops in the parastomal hernia, resulting in a mechanical bowel obstruction. The patient was treated with antibiotics and a nasogastric tube. As his cholecystitis resolved his ostomy function returned.

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Widespread papular eruption in an infant

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Association of the CYP17 MSP AI (T-34C) and CYP19 codon 39 (Trp/Arg) polymorphisms with susceptibility to acne vulgaris

Summary

The aim of this study was to detect the association of the cytochrome P450 (CYP) 17 T-34C and CYP19 T<C polymorphisms with the risk of acne vulgaris (AV). The study enrolled 198 patients with AV (mild, moderate and severe) and 195 unrelated age-matched healthy controls from western Iran who had Kurdish ethnic background. The presence of the CYP17 TC genotype significantly increased the risk of mild, moderate and severe AV by 2.68, 2.28 and 2.94 times, respectively, while the presence of the CYP19 TC genotype significantly elevated the risk of overall AV and mild AV by 2.1 and 3.2 times, respectively. There was a synergy between the CYP 17 TC and CYP19 TT genotypes, which increased the risk of AV by 2.45-fold (P < 0.001). To our knowledge, this is the first study showing that the CYP17 T-34C and CYP19 T<C variants and their synergy are associated with susceptibility to AV in an Iranian population.

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Evaluation of topical liposome incorporated clove oil in the treatment of idiopathic palmar hyperhidrosis: Single-blinded placebo-controlled study

Summary

Introduction

Palmar hyperhidrosis is of great concern to patients because of its physical, occupational, and psychological impact on quality of life. Topical clove oil has been used in many conditions due to its major component Eugenol that exerts blocking effect on nerve transmission.

Aim of the work

To assess the efficacy of topical liposome incorporated clove oil in decreasing the rate of sweating among patients with idiopathic palmar hyperhidrosis.

Patients and method

Forty patients with palmar hyperhidrosis were treated with clove oil 45% in liposome and another twenty patients were treated as a control group with 0.9% saline solution and evaluation was carried out before and after treatment through gravimetry testing and hyperhidrosis disease severity scale (HDSS).

Result

The gravimetry testing among clove oil-treated group showed that the mean sweating rate before treatment was 80.5 ± 41.85 (SD) mg/min which decreased significantly after treatment to 52.98 ± 37.94(SD) mg/min (P value < .001). On the other hand, the placebo-treated group,(control) the mean sweating rate before treatment was 77.40 ± 29.29(SD) which did not show significant improvement after placebo application 77.35 ± 28.29(SD; P value = .957).

Conclusion

The topical application of 45% clove oil in liposome twice daily for 2 weeks showing promising result evidenced by declining in the rate of palmar sweating among patients with idiopathic palmar hyperhidrosis.

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Tattoos: Evaluation of knowledge about health complications and their prevention among students of Tricity universities

Summary

Introduction

Tattooing is a very popular form of body modification among young people. However, this kind of procedure entails the risk of various health complications. The objective of the study was to evaluate the students' knowledge about contraindications, complications, and health risks that skin tattooing may cause. Additionally, the purpose of the study was to assess how the profile of education (medical vs nonmedical) impacts on the knowledge of the respondents.

Methods

We surveyed a group of 1199 people, of which 326 (27%) had tattoos. The base of the study is an anonymously filled, author's online survey consisting of 25 questions.

Results

Eighty six percent of the students from the Medical University of Gdańsk indicated the risk of HCV virus infection during tattooing, while only 34% of students from other Tricity universities were aware of this danger. Sixty seven percent of people with tattoos felt that having them does not affect any diagnostic and therapeutic procedures. Most of respondents mentioned the tattoo artist (79%) and the Internet (73%) as a source of information before having a tattoo, while only 5% and 8% respondents asked a doctor or read medical literature about it. Fourty nine percent of respondents reported that before the procedure, tattooist failed to ask them about their health condition and medications.

Conclusions

Knowledge of students about safety, contraindications, and complications associated with the performance of tattooing is insufficient. As a result, a need for a better education on the topic for both people who are getting tattoos and tattooists appears evident.

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Balloon dilatation of the Eustachian tube in adult patients with chronic dilatory tube dysfunction: a retrospective cohort study

Abstract

Objectives

The aim of this study is to assess the subjective and objective short-term results and safety of transnasal balloon dilatation of the Eustachian tube (BET) in adult patients with chronic dilatory Eustachian tube dysfunction (ETD).

Design

Retrospective cohort study. Data collection was performed preoperatively, 1 and 3 months after BET.

Setting

Tertiary referral hospital.

Participants

A cohort of 42 consecutive patients (66 ears).

Main outcome measures

ETDQ-7 score, bone conduction threshold, air-bone gap, the ability to perform Valsalva's and/or Toynbee's manoeuvre, tympanic membrane and middle ear conditions were collected pre- and postoperatively. Subjective satisfaction and complications were collected postoperatively.

Results

The ETDQ-7 score improved significantly from 4.28 to 3.09 1 month postoperatively and from 4.10 to 2.96 3 months postoperatively. Bone conduction thresholds did not differ significantly postoperatively. A significant improvement of air-bone gap was found postoperatively. The tympanic membrane and middle ear condition showed improvement in 62%. Subjective satisfaction 1 and 3 months postoperatively was around 43 and 48%. A small number of minor (self-limiting) complications did occur.

Conclusions

BET has shown to be a safe intervention, which may have a positive effect on objective and subjective indicators for chronic dilatory ETD in adult patients. We observed subjective positive effects in less than half of the patients. For certain indications, there was a measurable positive effect on the findings of the eardrum and ETDQ-7, whereas in other patients it seemed not to have any effect at all. Careful patient selection may improve this success rate. Randomized controlled trials with a prolonged follow-up are required to assess the value of BET in comparison to grommets.

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Reliability and validity study of Sino-nasal outcome test 22 (Thai version) in chronic rhinosinusitis

Abstract

Background

Chronic rhinosinusitis (CRS) is one of common health conditions that affects patients' health-related quality of life. Our purpose is to assess the reliability and validity of Thai-version of Sino-Nasal Outcome Test 22 in chronic rhinosinusitis.

Methods

Permission for translation of SNOT-22 from English language to Thai language was obtained from the developer. The translation process was done based on the international standard of translation method. A total of 80 subjects were recruited into the study and divided into two groups comprising of 50 patients with chronic rhinosinusitis and 30 healthy volunteers. Cronbach's α and Intraclass correlation coefficient were evaluated for its reliability. Validity test was evaluated against VAS score, SF-36 (Thai version) questionnaire and CT scan (based on Lund-Mackay score). Responsiveness was assessed between pre-operative and post-operative scores in 34 patients.

Results

The Thai version of SNOT-22 showed good reliability according to high value of Cronbach's α coefficient (r = 0.929) and intraclass correlation coefficient (r = 0.935). It also showed good validity by its ability to differential the patients with chronic rhinosinusitis from normal (p < 0.001), and different severity of symptoms (p < 0.05). In addition, the SNOT-22 Thai version also showed good responsiveness when compared between pre-operative and post-operative scores (p < 0.001) and also well-performed in effect size calculation (1.37).

Conclusion

We demonstrated that Thai -version of SNOT-22 has good reliability and validity, suitable for evaluation of chronic rhinosinusitis symptoms together with severity of the disease and response to treatment.

Trial registration

Thai clinical trials registry TCTR20170320003. Date of registration 20/03/2017 (retrospectively registered).

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Causes of higher symptomatic airway load in patients with chronic rhinosinusitis

Abstract

Background

Chronic rhinosinusitis display a variety of different phenotypes. The symptoms of disease are characterised by various signs and symptoms such as nasal congestion, nasal discharge, pressure sensation in the face and reduced or complete loss of smell.

In a patient population undergoing functional endoscopic sinonasal surgery (FESS) for chronic rhinosinusitis, we wanted to investigate the clinical features and explore if the presence of biofilm, nasal polyps or other disease characteristic could serve as predictor for the symptomatic load. A patient group undergoing septoplasty without disease of the sinuses was included as control.

Methods

The Sinonasal outcome test (SNOT-20), EPOS visual analogue scale (VAS) and the Lund-Mackey CT score (LM CT score) were used to examine 23 patients with chronic rhinosinusitis without nasal polyps (CRSsNP), 30 patient with nasal polyps (CRSwNP) and 22 patients with septal deviation. Tissue samples were collected prospectively during surgery. The cohort has previously been examined for the presence of biofilm.

Results

Patients with CRSsNP and CRSwNP had significantly higher degree of symptoms compared to the septoplasty group (SNOT-20 scores of 39.8, 43.6 and 29.9, respectively, p = 0.034). There were no significant differences in the total SNOT-20 or VAS symptoms scores between the CRSsNP and CRSwNP subgroups. However patients with nasal polyps showed significantly higher scores of symptoms related to sinonasal discomfort such as cough, runny nose and need to blow nose (p = 0.011, p = 0.046, p = 0.001 respectively). Patients with nasal polyps showed a significantly higher LM CT score compared to patients without polyps (12.06 versus 8.00, p = 0.001). The presence of biofilm did not impact the degree of symptoms.

Conclusion

The presence of nasal polyp formations in CRS patients was associated with a higher symptomatic airway load as compared to patients without polyps. These findings suggest that nasal polyps could be an indicator of more substantial sinonasal disease. The presence of biofilm did not impact the degree of symptoms, however, as biofilm seem to be a common feature of chronic rhinosinusitis (89% in this cohort), it is more likely to be involved in the development of the CRS, rather than being a surrogate marker for increased symptomatic load.

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Piezosurgery for Treatment of Large Recurrent Mandibular Osteoma

Background: Osteomas are infrequent benign bone tumors of uncertain etiology. They are usually situated at extremities and their occurrence in the jaws is relatively rare. There are 3 types of osteoma: central, peripheral, and extraskeletal. Preoperative presumptive diagnosis is performed by means of radiography using orthopantomographs, computerized tomographs, or cone beam scans. Treatment is surgical and consists of careful exeresis and curettage of the adjacent tissue. In recent years, piezoelectric surgery has been used to treat bone pathologies in the maxillofacial area, orthopedic surgery, and neurosurgery. When used for the exeresis of a bone lesion, the device minimizes risks and eliminates possible complications arising from affectation of the vascular and nerve structures close to the lesion. Objective: This clinical report describes a peripheral mandibular osteoma situated in the left mandibular basilar which recurred 45 years after surgical treatment at another center. Methods: For resection, the surgical approach followed the scar remaining from the earlier surgery and was performed using piezoelectric surgery. Surgery did not cause hemorrhagic complications, affect the sensitivity of the left labial menton, or cause paralysis of the lower lip. Conclusions: Based on the present patient, it may be concluded that mandibular osteoma treatment by means of piezoelectric surgery makes precise exeresis possible with less affectation of the important surrounding structures such as the inferior alveolar nerve and the marginal mandibular branch of the facial nerve. Address correspondence and reprint requests to Dr Josué Hernando, MD, PhD, Donostia University Hospital, Paseo Dr. Beguiristain s/n. San Sebastián (Guipuzkoa), Spain; E-mail: josue.hernando@gmail.com Received 12 July, 2017 Accepted 24 August, 2017 The authors report no conflicts of interest. © 2017 by Mutaz B. Habal, MD.

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Immediate Hypoglossal-Facial Anastomosis in Patients With Facial Interruption

Hypoglossal-facial anastomosis provides excellent motor supply to the mimetic muscles of the face when there is no chance of recovery of the damaged facial nerve. However, to achieve optimal results, the timing of facial nerve surgery based on electrophysiological testing and clinical evaluation requires close follow-up of the patient. Functional results after delayed surgery are not predictable and depend on the number of surviving fibers, type of injury, severity of damage, degree of infiltration of inflammatory cells, and local fibrosis. Facial hypertonia, synkinesis, and involuntary mass movement are the major problems of delayed reanimation of the facial nerve. Surgery in the vicinity of the facial nerve always aims to preserve neural integrity. However, immediate facial nerve grafting is sometimes required. We present our experience with 4 patients having normal facial function prior to surgery. The facial nerve was severed due to tumor infiltration and instantaneously reconstructed with the hypoglossal nerve. Two patients had House-Brackmann grade-II 10 days and 28 months after surgery, respectively, and another 2 patients had House-Brackmann grade-III facial paralysis 2 weeks and 6 months after surgery, respectively. Address correspondence and reprint requests to Sertac Yetiser, MD, Clinical Professor, Department of ORL and HNS, Anadolu Medical Center, Gebze, 41400 Kocaeli, Turkey; E-mail: syetiser@yahoo.com Received 19 September, 2016 Accepted 27 August, 2017 The author reports no conflicts of interest. © 2017 by Mutaz B. Habal, MD.

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Rabdomyosarcoma of the Mandible: An Uncommon Clinical Presentation

Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children and adolescents. Most patients present with a mass in the head and neck region, urogenital region, or with distal extremity involvement. The authors describe a challenging case of a 6-year-old male patient presenting with mandibular RMS. The clinical/radiographic/tomographic evaluations classified the tumor as an advanced stage (stage IV), with a mass of 6.0 cm involving the left side of the mandible and parotid region. The biopsy revealed round, spindled, and pleomorphic cells with hyperchromatic nuclei and rare larger rhabdomyoblasts with eosinophilic cytoplasm. The diagnosis was of embryonal RMS. The patient was referred for treatment with cycles of chemotherapy; however, pulmonary and bone marrow metastasis were identified. Radiotherapy and local surgery with microvascular reconstruction were performed later; however, the patient died after a few months. Early diagnosis is critical for a good prognosis and cure of patients with RMS. Correct diagnosis considering also the histological subtype is important for adequate treatment, which according to the literature is not uniform probably because of the rarity of this neoplasm. Address correspondence and reprint requests to Guilherme dos Santos Trento, DDS, PhD, Department of Diagnosis and Surgery, Araraquara Dental School, UNESP, 1680th Humaitá Street, 14.801-903 Araraquara, São Paulo, Brazil; E-mail: guilhermetrento@yahoo.com.br Received 20 July, 2017 Accepted 27 August, 2017 The authors report no conflicts of interest. © 2017 by Mutaz B. Habal, MD.

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Evaluation of Intersegmental Displacement After Mandibular Setback Split Ramus Osteotomy Using Modified L-Shaped Monocortical Plate: Cone-Beam Computed Tomography Superimposition

Purpose: The purpose of the current study is to compare intersegmental displacements after mandibular setback sagittal split ramus osteotomy (SSRO) using 4 types of osteosynthesis methods. Patients and Methods: This is a retrospective study of 53 subjects who presented underwent bilateral setback SSRO at Pusan National University Hospital from January 2009 to December 2013. The subjects were divided into 4 groups according to the osteosynthesis method applied: group A—modified L-type monocortical plate; B—conventional miniplate; group C—bicortical screws; group D—metal and absorbable screws. To obtain the intersegmental displacement, the mean of the differences of the 3-dimensional from T0 (2 days after surgery) to T1 (6 months after surgery) was calculated for the right and left condylar heads (condylion, Cd) and the right and left coronoid processes (Cps) using 3-dimensional imaging software (Ondemand 3D; Cybermed Co, Seoul, Korea). Results: For the condylion in the x, y, z coordinate system, in group A, there were significant differences in the y-axis for the right and left Cd; in group B, significant differences in the y-axis for the right Cd and in the y- and z-axes for the left Cd; in group C, no significant differences in the axis for the Cd; and in group D, there were significant differences in the y- and z-axes for the right Cd and in the x- and y-axes for the left Cd. For the Cps, the results are not much different from the condylion movement in all group. Conclusion: In the current study, group C manifested the greatest displacement for the healing period. Group A did not show the significant difference to group B. In view of these results, modified L-shaped monocortical plate can be applied for osteosynthesis effectively. Address correspondence and reprint requests to Hyeong Geun Lee, DDS, MSD, Clinical Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, 49 Busandaehak-ro, Mulgeum-eup, Yangsan 50612, South Korea; E-mail: hglee1982@gmail.com Received 17 February, 2017 Accepted 30 August, 2017 This work was supported by 2-Year Research Grant of Pusan National University. The authors report no conflicts of interest. © 2017 by Mutaz B. Habal, MD.

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Tripaddled Anterolateral Thigh Flap for the Reconstruction of Extensively Full-Thickness Cheek Defects by Stacking Two Skin Paddles as Kiss Pattern

Extended anterolateral thigh (ALT) flap can provide a large amount of skin to reconstruct the extensively full-thickness defects of cheek. However when the width of 1 skin paddle exceeds 8 cm, it always results in that the donor site cannot be closed primarily and need to be covered by split-thickness skin grafting, which delivers lots of impacts on the functional and cosmetic outcome of the thigh. The aim of this study was to introduce the authors' modification of stacking 2 skin paddles of the tripaddled ALT flap to reconstruct the extensive full-thickness defects in the cheek after the radical ablasion of advanced buccal squamous cell carcinoma. Ten patients of advanced buccal squamous cell carcinoma between March 2014 and December 2016 were enrolled in the authors' hospital. All the patients were received the soft-tissue reconstructions for the extensively full-thickness cheek defects by using the tripaddled ALT chimeric flaps. Among 3 skin paddles, the distal paddle was used to reconstruct the inner mucosa defect, and the other 2 large skin paddles were stacked side by side for outer mega cheek defect. The mean area of the intraoral defect was 32.2 cm2 and the mean area of the extraoral defect was 106.34 cm2. The mean width of the outer skin defect was 9.5 cm. All the flaps survived and all the donor sites were closed primarily. So, stacking 2 skin paddles of a tripaddled ALT flap as a kiss pattern is a novel modification on conventional flap design to provide customized coverage for extensive and full-thickness buccal defects while minimizing donor-site morbidity. Address correspondence and reprint requests to Ning Li, DDS, PhD, Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha, China; E-mail: liningoms@csu.edu.cn Received 11 July, 2017 Accepted 29 August, 2017 The authors report no conflicts of interest. © 2017 by Mutaz B. Habal, MD.

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Destructive Fibrosarcoma of the Maxillary Sinus

Paranasal fibrosarcoma of nasal cavity and paranasal sinuses is a very rare malignant tumor. It is usually presented with nasal obstruction and epistaxis. In this clinical report, clinical symptoms, pathogenesis, and treatment principles of a paranasal fibrosarcoma originating from the right maxillary sinus and obstructing the right nasal passage are discussed. A 55-year-old male patient was admitted to the authors clinic with complaints of nasal obstruction and epistaxis lasting for 2 years. Anterior rhinoscopy revealed a mass lesion which obstructed the right nasal passage and caused frequent epistaxis. An opacity consistent with soft tissue lesion which was originated from the right maxillary sinus and filled the right nasal passage was observed in paranasal tomography. Magnetic resonance imaging revealed that the mass lesion was contrasted. Tumor was seen to erode orbital floor, and lateral and anterior walls of the maxillary sinus. Biopsy result was reported as papilloma. The patient was treated with Denker approach as anterior wall of the maxillary sinus was eroded by the tumor lesion and the mass lesion was excised. The patient received postoperative radiotherapy as pathological diagnosis was reported as paranasal fibrosarcoma. Address correspondence and reprint requests to Dr Adnan Ekinci, MD, Hitit University Faculty of Medicine, Bahçelievler Mh, Camlik Cd. No: 2 19200 Corum, Turkey; E-mail: draekinci@hotmail.com Received 21 April, 2017 Accepted 30 August, 2017 The authors report no conflicts of interest. © 2017 by Mutaz B. Habal, MD.

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Can Tumor Size Be a Predictive Factor of Olfactory Dysfunction After Endoscopic Endonasal Trans-Sphenoidal Approach?

Background and Objective: The aim of this study is to investigate the relationships between tumor size, nasal symptoms including olfactory function, and posoperative atrophic mucosal changes after the endoscopic endonasal transsphenoidal approach (EETSA). Methods: This was a retrospective review of the medical records of 112 patients who underwent the 2 nostrils/4 hands EETSA with bilateral modified nasoseptal rescue flaps between February 2009 and January 2016. Pre- and postoperative paranasal sinus computed tomography, nasal cavity endoscopic images, the Connecticut Chemosensory Clinical Research Center (CCCRC) test, Cross-Cultural Smell Identification Test (CCSIT), the Nasal Obstruction Symptoms Evaluation, and the Sino-Nasal Outcome Test-20 were conducted. Nasal mucosal changes as determined by endoscopy were divided into 4 groups: normal to normal, Group A; atrophy to atrophy, Group B; normal to atrophy, Group C; and atrophy to more atrophy, Group D. The Mimics program was used to calculate nasal cavity volume changes after surgery. Results: There were significant differences between pre- and postoperative olfactory function as reflected by the CCCRC (P 

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A Giant Osteoma of the Ethmoid Sinus

Osteomas are slow-growing, benign bony tumors. Most are asymptomatic. Paranasal sinus osteoma in the pediatric population is rare; hence, there are few reports of symptomatic osteomas. The authors report the case of a giant ethmoid sinus osteoma in an 11-year-old girl who presented with diplopia and proptosis. Total excision and reconstruction of the medial orbital wall were performed via a coronal approach. The postoperative period was uneventful, the child's vision improved, and a good cosmetic result was obtained. Address correspondence and reprint requests to Yoshiaki Sakamoto, MD, Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ward, Tokyo 160-8582, Japan; E-mail: ysakamoto@z8.keio.jp Received 28 July, 2017 Accepted 19 September, 2017 The authors report no conflicts of interest. © 2017 by Mutaz B. Habal, MD.

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Computer-Assisted Volumetric Analysis and Quantitatively Anophthalmic Orbit Reconstruction With Dorsalis Pedis Flap and Bone Graft

Current approaches to orbit reconstruction are based on the assumption of facial symmetry and surgeons' experiences, and the reconstructed orbits are not precise. Through computer-assisted volumetric quantitative analysis, the volume of the bony orbit, and the volume of the soft tissues in both the anophthalmic orbit and the contralateral orbit are calculated in 39 anophthalmic patients. The rib graft is used for orbit reconstruction; the dosalis pedis flap and lipo-injection were used for soft tissue reconstruction and skin socket reconstruction. The size and the shape of the rib graft and soft tissues were designed according to the volumetric analysis. The size and the shape of the skin socket were designed according to measurement during surgery. Asymmetry eye sockets with adequate size were created in the 37 patients. Two patients presented with a poor asymmetry with the contralateral orbit, and got gradual extrusion of the eye prosthesis 4 months after operation, which was because of necrosis of the flaps. The flaps were remedied by frontal island flap and skin grafting. Further surgeries, such as lipoinjection, lid surgery, and canthoplasty, were applied to improve the surgical results. The eye prostheses fitted well in all of the reconstructed sockets using this technique. Our studies suggest that the computer-assisted volumetric analysis technique combined with quantitative bone graft and dorsalis pedis flap transfer, ± lipoinjection proved to be an accurate method and a quality assurance for optimization of bony orbit, soft tissue and skin socket reconstruction, and promised a successful postoperative outcome for patients' functional and esthetic appearance. Address correspondence and reprint requests to Yu-Guang Zhang, MD, PhD, Rong Jin, MD, Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Building 1, 16th Floor, 639 Zhi Zao Ju Road, Shanghai 200011, China; E-mail: zhangyg18@126.com; drliyingcheng@126.com Received 8 January, 2017 Accepted 20 September, 2017 L-Y.C., W-W.B. contributed equally to this study. The authors report no conflicts of interest. © 2017 by Mutaz B. Habal, MD.

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Rhinogenic Contact Point Headache: Surgical Treatment Versus Medical Treatment

Rhinogenic contact point headache (RCPH) is a headache syndrome secondary to mucosal contact points in the sinonasal cavities, in the absence of inflammatory signs, hyperplastic mucosa, purulent discharge, sinonasal polyps, or masses. It may result from pressure on the nasal mucosa due to anatomic variations among which the septal deviation, septal spur, and concha bullosa, are the most commonly observed. In recent years, RCPH has remained a subject of controversy regarding both its pathogenesis and treatment. This study aimed to investigate the effect of surgical and medical treatment of pain relief in patients with RCPH, evaluating the intensity, duration, and frequency of headaches, and the impact of different treatments on quality of life. Ninety-four patients with headache, no symptoms or signs of acute and chronic sinonasal inflammation and who present with intranasal mucosal contact points positive to the lidocaine test were randomized into 2 equal groups and given medical or surgical treatment. The authors used visual analog scale, number of hours, and days with pain to characterize the headache and Migraine Disability Assessment score (MIDAS) to assess the migraine disability score before and 3 to 6 months after treatment. After treatment the severity, duration, and frequency of the headache decreased significantly (P 

http://ift.tt/2DtFznp

A Study on Environmental Factors for Nonsyndromic Cleft Lip and/or Palate

The aim of the study was to investigate the association between environmental factors and nonsyndromic cleft of the lip and/or palate (NSCL/P) in Yantai District, China. A retrospective case–control study was carried out. A total of 236 NSCL/P children were selected from Department of Oral and Maxillofacial Surgery of Yantai Stomatological Hospital between September 2013 and December 2016 as cases; 209 controls were chosen from other diagnosis in the same department during the same period. The 2 groups matched age and sex. The parents of participants were inquired regarding the risk factors, and the answers were filled in a questionnaire by physicians. Chi-square and multivariate logistic regression analysis were used to analysis the data. There was significantly increased NSCL/P risk with high maternal age (P =0.002), family history (P = 0.001), abortion history (P = 0.033), poor parental education level (P  = 0.008), maternal smoking (P  = 0.044), maternal alcohol (P  = 0.039), common cold or fever (P = 0.035), drug use (P = 0.006), and maternal stress (P = 0.049). Reduced NSCL/P risk was found with folic acid supplementation (P = 0.005), adequate maternal age (P = 0.002), and high parental education (P  = 0.001). The proper amount of folic acid, the appropriate age of childbearing, and the high education were the protective factors of NSCL/P, whereas family history, abortion history, drug use during pregnancy, maternal tobacco and alcohol, and maternal stress were the risk factors for NSCL/P in Yantai District, China. Address correspondence and reprint requests to Ping-gong Du, MB, Department of Oral and maxillofacial Surgery, Yantai Stomatological Hospital, No. 142 North Great Street, Zhifu District, Yantai, Shandong 264000, P.R. China; E-mail: ytkqdupinggong@126.com Received 1 August, 2017 Accepted 21 September, 2017 D-PX and W-dQ are cofirst authors, and they equally contribute to this work. The authors report no conflicts of interest. © 2017 by Mutaz B. Habal, MD.

http://ift.tt/2CjusOk

Comments on “Outer Fascia of Orbicularis Oculi Muscle as an Anchoring Target Tissue in Double Eyelid Surgery”

No abstract available

http://ift.tt/2DsMNrP

Changes in Corneal Curvature After Epiblepharon Surgery in Children

Purpose: We aimed to determine the change in corneal topography for 2-different corneal zones and 4-quadrants after epiblepharon correction in children. Methods: We retrospectively reviewed 39 patients (74 eyes) who underwent epiblepharon surgery. Keratometry measurements of corneal curvature were performed for 2 optical zones defined as circular areas with a radius of 3 and 5 mm from the corneal apex. Each optical zone was divided into quadrants (nasal, superior, temporal, and inferior). Keratometry readings for each quadrant of zone were compared between the preoperative and postoperative examinations (at 1, 3, and 6 months). The correlation between corneal astigmatism and curvature change was analyzed for each quadrant of the 3-mm optical zone. Results: At 1 month postoperatively, the inferior and superior quadrants of the 3-mm optical zone became significantly flatter compared with the preoperative state, and this phenomenon became more pronounced at 3 months postoperatively (P 

http://ift.tt/2ClXtsZ

Evaluating Resident Perspectives on International Humanitarian Missions

Background: Opportunities for international missions are highly sought after by medical students, residents, and attending plastic surgeons. The educational benefits and ethical considerations of trainees participating in these ventures have been extensively debated. At the time of this writing, many surgical training programs lack the necessary infrastructure or funds to support missions of this sort. Despite the increasing interest, the perceived benefit of international work has not yet been well studied. The authors seek to evaluate residents' perspectives on the personal and educational benefits of international mission work. Methods: A 24-item online questionnaire was designed to measure residents' perspectives on humanitarian missions. Residents' perceptions on how participation in these missions may have influenced their career path were also evaluated. This questionnaire was disseminated to the plastic surgery residents in Accreditation Council for Graduate Medical Education (ACGME) accredited programs in the United States during the 2015 to 2016 academic year. Results: Of the 123 responses collected, 49 (40%) indicated that they had participated in international mission work prior to beginning residency, while 74 (60%) had not. Fifty-seven percent (n = 25) of those who had participated agreed that this experience impacted their choice to pursue plastic surgery as a specialty. Twenty-nine (24%) participated in 1 or more missions during residency. The most common type of mission work focused on cleft lip/palate repairs (n = 24) followed by nonsurgical medical relief (n = 18) and general plastics/combined (n = 6). Most respondents reported trips lasting 6 to 8 days (n = 29, 48%), though several reported trips lasting 9 to 10 days (n = 6, 10%) and 11 days or more (n = 16, 27%). When asked about the volume of procedures performed, 32 (65%) reported participating in more than 15 procedures, with 15 (31%) residents reporting participation in 26 procedures or more. When asked to evaluate the educational benefits in light of the 6 core competencies from the ACGME, there was an overwhelmingly positive response. Conclusions: Residents perceive international mission experiences to be valuable for professional development as well as an effective tool for surgical education, particularly in the setting of competency-based education goals and these ventures should be supported by training programs. An appropriately planned mission experience can impact the professional and educational development of the trainee. Address correspondence and reprint requests to Matthew D. Chetta, MD, 3555 West 13 Mile Rd, Ste N120, Royal Oak, MI 48073; E-mail: mchetta@oakland.edu Received 10 April, 2017 Accepted 6 August, 2017 This work was presented at the Plastic Surgery Research Council annual meeting, Durham, NC, May 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/2CkYgtO

A Patient With Submerged Sinonasal Angiosarcoma After Resection of Underlying Organizing Hematoma

A 30-year-old female patient with facial pain diagnosed as organizing hematoma of maxillary sinus by biopsy and imaging studies, and subsequently tumor was resected via an endoscope-assisted midfacial degloving approach. The tumor was histopathologically confirmed as organizing hematoma. In 3-week follow-up, asymptomatic emerging mass was observed at the same site, and needed a revision endoscopic resection. On pathologic examination, a low-grade angiosarcoma was identified, not organizing hematoma. After postoperative radiotherapy, she has been a status of no evidence of disease. This report emphasizes that complete and delicate resection of sinonasal tumor should be made to prevent recurrence and submerged malignant potential. Address correspondence and reprint requests to Jung Hyun Chang, MD, PhD, Department of Otorhinolaryngology, National Health Insurance Corporation Ilsan Hospital, Goyang-si, Gyeonggi-do 10444, South Korea; E-mail: jhrhino.chang@gmail.com Received 20 July, 2017 Accepted 24 August, 2017 The authors report no conflicts of interest. © 2017 by Mutaz B. Habal, MD.

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Betel and tobacco chewing habit and its relation to risk factors for periodontal disease

Abstract

Objectives

To comparatively assess periodontal status in patients who chew different products and patients who do not have this habit and to assess how this practice interacts with predisposing factors and risk indicators of disease.

Methods

Patients included in the dental care carried out in a rural community in India were considered for a cross-sectional study. The Simplified Oral Hygiene Index and the Community Periodontal Index (CPI) were assessed. Furthermore, a validated survey with items concerning chewing habits was administered. Statistical analysis of the effects of age range, gender, chewing products and hygiene status on CPI was performed.

Results

In total, 1,023 patients met the inclusion criteria. The chewer patients (430) exhibited a significantly higher CPI than the non-chewers (593). The chewing habit increased the likelihood of a higher CPI by 6.76-fold, while excellent/good oral hygiene status decreased the probability of a higher CPI by approximately 45%. CPI did not differ significantly among chewers of different products.

Conclusion

In the population studied, a chewing habit was associated with a worse periodontal status, and this association was not modified by gender and age as predisposing factors. Oral hygiene could decrease the effect of chewing habit on periodontal health.

This article is protected by copyright. All rights reserved.

http://ift.tt/2C646mj

Predicting reactivity threshold in children with anaphylaxis to peanut

Abstract

Background

Peanut allergy necessitates dietary restrictions, preferably individualised by determining reactivity threshold through an oral food challenge (OFC). However, risk of systemic reactions often precludes OFC in children with severe peanut allergy.

Objective

We aimed to determine if clinical and/or immunological characteristics were associated with reactivity threshold in children with anaphylaxis to peanut and secondarily, to investigate if these characteristics were associated with severity of the allergic reaction during OFC.

Methods

A double-blind placebo controlled food challenge (DBPCFC) with peanut was performed in 96 5-15-year-old children with a history of severe allergic reactions to peanut and/or sensitisation to peanut (skin prick test (SPT) ≥ 3 mm or specific immunoglobulin E (s-IgE) ≥ 0.35 kUA/L). Investigations preceding the DBPCFC included a structured interview, SPT, lung function measurements, serological immunology assessment (IgE, IgG and IgG₄), basophil activation test (BAT) and conjunctival allergen provocation test (CAPT). International standards were used to define anaphylaxis and grade the allergic reaction during OFC.

Results

During DBPCFC, all 96 children (median age 9.3, range 5.1, 15.2) reacted with anaphylaxis (moderate objective symptoms from at least two organ systems). Basophil activation (CD63+ basophils ≥ 15%), peanut SPT and the ratio of peanut s-IgE/total IgE were significantly associated to reactivity threshold and lowest observed adverse events level (LOAEL) (all p < 0.04). Basophil activation best predicted very low threshold level (< 3 mg of peanut protein), with an optimal cut-off of 75.8% giving a 93.5% negative predictive value. None of the characteristics were significantly associated with the severity of allergic reaction.

Conclusion and Clinical Relevance

In children with anaphylaxis to peanut, basophil activation, peanut SPT and the ratio of peanut s-IgE/total Ig-E were associated with reactivity threshold and LOAEL, but not with allergy reaction severity.

This article is protected by copyright. All rights reserved.

http://ift.tt/2CiFhQD

Post-tonsillectomy hemorrhage: Underlying factors and prevention

Tonsillectomy is the most frequently applied treatment for recurrent tonsillitis, tonsillar focal infection, and obstructive sleep apnea (OSA), while post-tonsillectomy hemorrhage (PTH) is a common complication. Although with continual innovation in techniques of tonsillectomy and surgical instruments, PTH still occur except for the different incidence of PTH. Thus, PTH remains a controversial subject in otolaryngology. Recently, in an excellent work, Burton and colleagues refined a technique to reduce PTH [1].

http://ift.tt/2EabkCY

Volumetric mandibular change after angle ostectomy and outer cortex grinding

Mandibular angle ostectomy is one of the most common surgical procedures for facial contouring in Asian women. However, some patients complain about mandibular angle hypertrophy recurrence after surgery. The present study evaluated volumetric change of the mandible after angle ostectomy and outer cortex grinding.

http://ift.tt/2lfTAhL

Fluorodeoxyglucose activity associated with a cosmetic poly-L-lactide filler: a potential confounder on positron emission tomography and computed tomography

Injectable cosmetic fillers are increasingly popular, but are not often considered as a cause of abnormal findings on imaging. We present a case of poly-L-lactic acid (PLLA) filler associated with 18-fluorodeoxyglucose (FDG) uptake, which had the potential to interfere with staging of a squamous cell carcinoma of the lateral tongue. We characterise the FDG-positron emission tomography/computed tomography (PET/CT) properties of a PLLA dermal filler, Sculptra® (Aventis), and highlight its potentially confounding appearance in the staging scans of oncological patients, particularly those with oral tumours.

http://ift.tt/2DsbUuz

Confidential Image Transfer: An Ethico-Legal Dilemma

Introduction: Oral and Maxillofacial Surgery is a very visual speciality: clinical photographs can help team decision- making, as well as acting as a medicolegal record. Images of the facial area are Patient Identifiable Information, and as such their storage and transfer must adhere to Caldicott Principles. Our unit has an experienced and helpful medical photography team, but outside of working hours there is no support for secure image acquisition and transfer.

http://ift.tt/2CjGG9K

Diagnostic potential and future directions of biomarkers in gingival crevicular fluid and saliva of periodontal diseases: Review of the current evidence

Publication date: March 2018
Source:Archives of Oral Biology, Volume 87
Author(s): Noha Ayman Ghallab
ObjectivesThe holy grail of biomarker research in periodontology is to develop a high impact diagnostics which have a significant impact on clinical decision-making, patient outcomes and healthcare providers. In the field of periodontal diagnostics, oral fluid-based biomarkers have been studied mainly in the gingival crevicular fluid (GCF) and saliva.MethodsA literature search was performed using the Cochrane library and PubMed databases from 2000 to January 2017.ResultsCurrently, there are more than 90 different components in the GCF that have been investigated as diagnostic and prognostic markers of periodontal disease progression involving; inflammatory mediators, markers of oxidative stress, host-derived enzymes, tissue-breakdown products and mediators of bone homeostasis. Furthermore, various biomarkers in saliva have been proposed which reveal a promising outlook for saliva as a key diagnostic medium for periodontal disease. Recent systematic reviews with high value of evidence have shown that potential salivary biomarkers can provide important complimentary diagnostic information and can be used as tests for screening diagnosis, prognosis and predicting periodontal disease progression.ConclusionFuture developments in proteomic analysis and personalized medicine will pave the way allowing novel diagnostic tools. Still, the application into the field of dentistry will depend on how practitioners will apply this into their daily clinical practice.Clinical relevanceStill, the application into the field of dentistry will depend on how practitioners will apply this into their daily clinical practice.



http://ift.tt/2BP0bGc

Diagnostic potential and future directions of biomarkers in gingival crevicular fluid and saliva of periodontal diseases: Review of the current evidence

Publication date: March 2018
Source:Archives of Oral Biology, Volume 87
Author(s): Noha Ayman Ghallab
ObjectivesThe holy grail of biomarker research in periodontology is to develop a high impact diagnostics which have a significant impact on clinical decision-making, patient outcomes and healthcare providers. In the field of periodontal diagnostics, oral fluid-based biomarkers have been studied mainly in the gingival crevicular fluid (GCF) and saliva.MethodsA literature search was performed using the Cochrane library and PubMed databases from 2000 to January 2017.ResultsCurrently, there are more than 90 different components in the GCF that have been investigated as diagnostic and prognostic markers of periodontal disease progression involving; inflammatory mediators, markers of oxidative stress, host-derived enzymes, tissue-breakdown products and mediators of bone homeostasis. Furthermore, various biomarkers in saliva have been proposed which reveal a promising outlook for saliva as a key diagnostic medium for periodontal disease. Recent systematic reviews with high value of evidence have shown that potential salivary biomarkers can provide important complimentary diagnostic information and can be used as tests for screening diagnosis, prognosis and predicting periodontal disease progression.ConclusionFuture developments in proteomic analysis and personalized medicine will pave the way allowing novel diagnostic tools. Still, the application into the field of dentistry will depend on how practitioners will apply this into their daily clinical practice.Clinical relevanceStill, the application into the field of dentistry will depend on how practitioners will apply this into their daily clinical practice.



http://ift.tt/2BP0bGc

Elevated expression of activated TH2 cells and milk-specific TH2 cells in milk-induced eosinophilic esophagitis

Eosinophilic esophagitis (EoE) is an allergic inflammatory disease that is triggered by food allergens and characterized by progressive esophageal dysfunction. Esophageal biopsy specimens are characterized by eosinophilia and expression of TH2 cytokines.

http://ift.tt/2pRCmMb

Risk factors and clinical outcomes associated with fixed airflow obstruction in older adults with asthma

Asthma in older adults is associated with increased morbidity and mortality compared with asthma in younger patients. Fixed airflow obstruction (FAO) is associated with decreased survival in younger patients, but its significance remains unclear in older adults with asthma.

http://ift.tt/2E8fJGJ

Living in lower income zip codes is associated with more severe chronic rhinosinusitis

Chronic rhinosinusitis (CRS) is a chronic inflammatory condition afflicting the upper airways. In 2014, approximately 29.4 million adults reported being told by a doctor or other health professional in the past 12 months that they had sinusitis.1 The pathogenesis of CRS is multifactorial, likely due to a combination of host and environmental factors.2 Determining whether the host factors are due to nonmodifiable, such as race, or modifiable risk variables is important. Previous analyses of the effect of socioeconomic status on CRS have yielded conflicting results.

http://ift.tt/2pQw8MP

Efficacy of omalizumab treatment in a man with occupational asthma and eosinophilic granulomatosis with polyangioitis

Omalizumab is a humanized monoclonal antibody that binds to free-circulating immunoglobulin E (IgE). Several studies have shown the clinical efficacy of omalizumab in severe, persistent allergic asthma, including occupational cases.1

http://ift.tt/2E8Ip23

The importance of reducing risk in peanut allergy: Current and future therapies

The prevalence of peanut allergy has steadily increased during the past 10 years, especially in children. A 2009 to 2010 survey of more than 40,000 children (aged 0–17 years) in the United States found that peanut allergy was the most common food allergy, affecting 2% (1.5 million) of children nationwide.1 Data from a 2014 meta-analysis of 29 studies from multiple European countries using various reporting methods estimated the occurrence of peanut allergy to be 0.3% (by positive food challenge result) to 4.1% (by peanut specific IgE positivity) in children aged 2 to 5 years and 0.4% (by self-reporting) to 9.8% (by peanut specific IgE positivity) in children aged 6 to 17 years.

http://ift.tt/2pRZQB0

Mevalonate kinase deficiency presenting as recurrent rectal abscesses and perianal fistulae

We present the case of a 13-month-old, nonconsanguineous, Hispanic boy with rectal abscesses and perianal fistulae beginning at 2 months of age. At the time of initial consultation, he had undergone 11 prior operations for abscess drainage. His infectious history was notable for recurrent upper respiratory tract infections, acute otitis media, chronic diarrhea, and an episode of thrush that resolved with oral nystatin at 2 months of age. He did not have a history of pneumonia, growth failure, or signs of endocrinopathy.

http://ift.tt/2E4WqxQ

Fluorodeoxyglucose activity associated with a cosmetic poly-L-lactide filler: a potential confounder on positron emission tomography and computed tomography

Publication date: Available online 28 December 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): K. Dwivedi, I.S. Prabhu, K.M. Bradley
Injectable cosmetic fillers are increasingly popular, but are not often considered as a cause of abnormal findings on imaging. We present a case of poly-L-lactic acid (PLLA) filler associated with 18-fluorodeoxyglucose (FDG) uptake, which had the potential to interfere with staging of a squamous cell carcinoma of the lateral tongue. We characterise the FDG-positron emission tomography/computed tomography (PET/CT) properties of a PLLA dermal filler, Sculptra^® (Aventis), and highlight its potentially confounding appearance in the staging scans of oncological patients, particularly those with oral tumours.



http://ift.tt/2pSOPiY

Gender effects in allergology – Secondary publications and update

http://ift.tt/2BTcv8p

Gender aspects and influence of hormones on bronchial asthma – Secondary publication and update

There is good evidence for gender-specific differences in asthma regarding all affected areas, from intra- to extra-cellular mediators to the whole organ structure und functioning of the lung. These result fro...

http://ift.tt/2Cemitb

Adverse reactions to food: the female dominance – A secondary publication and update

Gender-specific differences are evident in food intolerance and allergy. In this review, we will highlight and summarize the dissimilarities in prevalence of adverse food reactions, focusing on IgE-mediated fo...

http://ift.tt/2BQ3Weu

Sex hormone allergy: clinical aspects, causes and therapeutic strategies – Update and secondary publication

Sex hormone allergy as a clinical syndrome has been known for almost a century. Due to the diversity of clinical presentation regarding symptoms and disease patterns, the optimal patient care represents an eno...

http://ift.tt/2CivjBy

Gender aspects in allergies of pets – A secondary publication and update

Allergies need not only affect humans; this multifactorial and complex disease can also affect animals. Comparative allergology investigates the many similarities between the pathogenesis, clinics, diagnosis, ...

http://ift.tt/2BPdq9X

Lymphomas in IgG4-related disease: clinicopathologic features in a Western population

Abstract

Lymphomas that occur in the setting of IgG4-related disease (IgG4-RD) are uncommon. Most reported cases derive from Asia and are MALT lymphomas occurring in orbital IgG4-RD. The spectrum of lymphomas among IgG4-RD patients in the Western world remains poorly defined. The aim of this study was to report our experience with lymphomas occurring in IgG4-RD. Eight cases were identified from the pathology and consultation files. The median age was 61 years (range 22–68) at IgG4-RD diagnosis and 63.5 years (range 33–79) at lymphoma diagnosis, with a M:F ratio of 4:4. The diagnosis of lymphoma and IgG4-RD was concurrent in three cases and asynchronous in five (interval 4.3–16.4 years). Concurrent cases included a MALT lymphoma and a diffuse large B cell lymphoma (DLBCL) occurring with IgG4-related sialadenitis and a follicular lymphoma occurring with orbital IgG4-RD. Asynchronous cases included a lymphoplasmacytic lymphoma with large cell transformation and intervening IgG4-related pancreatitis, a MALT lymphoma after lacrimal IgG4-RD, two DLBCLs after multiorgan IgG4-RD, and a DLBCL after IgG4-related sialadenitis. Our findings suggest that lymphomas in IgG4-RD are more varied in location and type than the experience reported from Asia to date. Pathologists should be aware of the potential for lymphoma to develop in patients with IgG4-RD and should have a high degree of suspicion when lymphadenopathy or extranodal masses persist despite appropriate therapy for IgG4-RD. The co-occurrence of IgG4-RD and lymphoma that is reported here and previously suggests a possible etiologic association.

http://ift.tt/2zIz91e

Choreoathetosis – an unusual adverse effect of dihydroartemisinin-piperaquine: a case report

Dihydroartemisinin-piperaquine is a combination of dihydroartemisinin and piperaquine which is highly effective in the treatment of uncomplicated falciparum malaria. Its adverse effects are generally tolerable...

http://ift.tt/2zGZqx8

Facial Nerve Paralysis – A Rare Complication of Open Reduction of Zygomaticomaxillary Complex Fractures

Publication date: Available online 28 December 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Padmanidhi Agarwal, Ashi Chug, Shailesh Kumar, Kanav Jain
Facial nerve paralysis is an unusual formidable complication which can manifest after various maxillofacial surgeries, including open reduction of facial trauma. The branches more predisposed to such injury are the zygomatic and marginal mandibular branches.Zygomaticomaxillary complex (ZMC) fractures are frequently encountered in maxillofacial trauma. The facial nerve has not been described as endangered during ZMC surgery. Paralysis of the buccal branch following ZMC repair with delayed onset has only been reported once. We present a patient with immediate facial nerve paralysis following open reduction and internal fixation (ORIF) of an isolated ZMC fracture via an intra-oral approach. This is a previously unreported rare complication after ZMC fracture repair which should be discussed as a possibility with the preoperative consent.



http://ift.tt/2lngPWe

Computer-assisted surgery (CAS) in facial bipartition surgery

Publication date: Available online 28 December 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Matthias Schlund, Arnaud Paré, Aline Joly, Boris Laure
IntroductionFrontonasal dysplasia or median cleft syndrome is a rare condition, often associated with transverse maxillary deficiency for which facial bipartition is the proper surgical treatment. In this technical note, we describe the use and efficacy of three-dimensional virtual surgical planning and patient-specific cutting guides in facial bipartition.Material & MethodsAn 11-year-old boy presented with frontonasal dysplasia and a midline facial cleft. Computed tomography (CT) scanning revealed that intercanthal distance was 40 mm and the maxillary width at the second molar level was 46.2 mm. The osteotomies, amount of bone removal, and movement of the osteotomized bone were planned virtually based on CT findings: the intended postoperative intercanthal distance and maxillary width were 25.5 and 49.6 mm, respectively. Customized cutting guides and titanium miniplates were manufactured. Postoperative CT showed an intercanthal distance of 25.5 mm and a maxillary width of 49.7 mm.DiscussionThe intercanthal distances and maxillary widths were similar between the simulation and postoperative CT images, confirming the accuracy and utility of computer-assisted surgery in facial bipartition.



http://ift.tt/2leck0Z

Intraosseous Schwannoma of the Jaws: An Updated Review of the Literature and Report of 2 New Cases Affecting the Mandible

Publication date: Available online 28 December 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Dru Perkins, Tudor I. Stiharu, James Q. Swift, Tran Volong Dao, Gisele N. Mainville
Schwannomas are benign nerve sheath neoplasms composed almost entirely of Schwann cells. These tumors most often arise in the soft tissues of the head and neck. However, seldom do they occur within bone. This article presents a rare case of a recurrent intraosseous schwannoma of the anterior mandible and another case of a posterior intraosseous mandibular schwannoma accessed via a sagittal split ramus osteotomy. Furthermore, we provide an updated review of the literature on intraosseous schwannomas affecting the mandible and maxilla.



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Does open reduction internal fixation along with articular disc anatomical reduction and rigid anchorage manifested promising prospect in the treatment of intracapsular fractures?

Publication date: Available online 28 December 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Bo-Lei Cai, Rong Ren, Hong-Bo Yu, Peng-Chao Liu, Steve GF. Shen, Jun Shi
PurposeAs growing attention was paid to soft tissue reduction in the treatment of intracapsular condylar fractures (ICFs), a modified opening reduction technique was proposed and the functional and radiographic outcomes were evaluated in this study.MethodsA retrospective case series study of all types ICFs patients, which were treated with open reduction internal fixation (ORIF) along with articular disc anatomical reduction and rigid anchorage, was presented in this study. Inclusion and exclusion criteria were strictly executed. Preoperative and postoperative clinical examinations, such as malocclusion, maximum incisor opening (MIO), laterotrusion and temporomandibular disorder symptoms were recorded and analyzed. Computed tomography (CT) and magnetic resonance imaging (MRI) were taken to assess articular position, condyle morphology and position.ResultsThirty-four ICFs patients with 47 sides ICFs were treated with our modified ORIF technique. At 6 months of follow-up, no malocclusion was found and the MIO significantly expanded to 3. 56 ± 0.13cm. Only 4 (12%) patients had TMJ discomfort with mouth opening. Interestingly, for unilateral type B ICFs patients, laterotrusion distance to ORIF sides was significantly larger than to non-ORIF sides. Postoperative CT and MRIs showed that all the fragments were properly reduced and the condyles were in the normal position, postoperative anterior disc displacement happened to 4 sides and condyle morphological abnormalities (slight surface roughening and articular cartilage absorption) happened to 3 (6.4%) sides.ConclusionsOur modified ORIF technique, which achieved inspiring outcomes on the treatment of all types of ICFs, manifested promising prospect in the treatment of ICFs.



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Anesthetic Management and Procedural Outcomes of Patients Undergoing Off-Pump Transapical Implantation of Artificial Chordae to Correct Mitral Regurgitation: Case Series of 76 Patients

BACKGROUND: Transapical implantation of artificial chordae using the NeoChord system (NeoChord Inc, Minneapolis, MN) is an emerging beating-heart technique for correction of mitral regurgitation (MR) through a minimally invasive left minithoracotomy. The purpose of the study was to describe the anesthetic management and procedural success of patients undergoing this procedure. METHODS: All patients (n = 76) who underwent mitral valve repair with the NeoChord system in our institution from December 2011 to December 2016 were included in this observational prospective study. Balanced anesthesia with a combination of fentanyl, propofol, and sevoflurane was used in all patients. Each patient's core temperature was maintained at >36°C whenever possible. Two- and 3-dimensional transesophageal echocardiography was used in all patients to navigate the device to the posterior mitral valve leaflet (68 of 76 patients), anterior mitral valve leaflet (3 of 76 patients), or both leaflets (5 of 76 patients). After effective leaflet capture, the artificial chordae were deployed. Position and function of the artificial chordae were assessed by evaluating the degree of MR when the neochordae were tensed. After surgery, all patients were transferred to the intensive care unit. RESULTS: The mean age of the patients was 60 ± 13 years (range, 33–87 years), and the male/female ratio was 52/24. Most patients had severe MR (grade 4+ in 25 [33%] patients, grade 3+ in 51 [67%] patients). The average preoperative EuroSCORE II was 1.23% ± 1.16% (range, 0.46%–4.23%). The median duration of the procedure was 120 minutes (interquartile range [IQR] 115–145 minutes). After the procedure, 42 (56%) patients had trivial MR, 27 (36%) had grade 1+ MR, 4 (5%) had grade 2+ MR, and 2 (3%) had >2+ MR. One patient underwent conversion to conventional mitral valve repair due to perforation of the posterior mitral valve leaflet. The whole procedure was well tolerated by the patients, with hemodynamics remaining stable in the majority of the cases. Only 20 (26%) patients needed low-dose inotropic support perioperatively. All patients had an uneventful postoperative course. The median time to extubation was 4 hours (IQR, 2.6–6), and the length of intensive care unit stay was 22 hours (IQR, 21–24). Five (6.6%) patients required allogeneic blood products. CONCLUSIONS: Anesthesia for transapical NeoChord implantation can be safely performed under beating-heart conditions, with low perioperative morbidity and rare blood transfusions. Transesophageal echocardiography is crucial for the guidance, safety, and effectiveness of the procedure. Accepted for publication November 13, 2017. Funding: None. The authors declare no conflicts of interest. Supplemental digital content is 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 website (http://ift.tt/KegmMq). Institutional review board: Vilnius Regional Bioethics Committee, M. K. Ciurlionio St 21/27, LT 03101, Vilnius, Lithuania. E-mail: rbtek@mf.vu.lt. Reprints will not be available from the authors. Address correspondence to Arturas Lipnevicius, MD, Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, Santariskiu 2, Vilnius, LT 08661 Lithuania. Address e-mail to artaslip@yahoo.com. © 2017 International Anesthesia Research Society

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Clinical Utility of Intraoperative Motor-Evoked Potential Monitoring to Prevent Postoperative Spinal Cord Injury in Thoracic and Thoracoabdominal Aneurysm Repair: An Audit of the Japanese Association of Spinal Cord Protection in Aortic Surgery Database

BACKGROUND: Spinal cord ischemic injury is the most devastating sequela of descending and thoracoabdominal aortic surgery. Motor-evoked potentials (MEPs) have been used to intraoperatively assess motor tract function, but it remains unclear whether MEP monitoring can decrease the incidence of postoperative motor deficits. Therefore, we reviewed multicenter medical records of patients who had undergone descending and thoracoabdominal aortic repair (both open surgery and endovascular repair) to assess the association of MEP monitoring with postoperative motor deficits. METHODS: Patients included in the study underwent descending or thoracoabdominal aortic repair at 12 hospitals belonging to the Japanese Association of Spinal Cord Protection in Aortic Surgery between 2000 and 2013. Using multivariable mixed-effects logistic regression analysis, we investigated whether intraoperative MEP monitoring was associated with postoperative motor deficits at discharge after open and endovascular aortic repair. RESULTS: We reviewed data from 1214 patients (open surgery, 601 [49.5%]; endovascular repair, 613 [50.5%]). MEP monitoring was performed in 631 patients and not performed in the remaining 583 patients. Postoperative motor deficits were observed in 75 (6.2%) patients at discharge. Multivariable logistic regression analysis revealed that postoperative motor deficits at discharge did not have a significant association with MEP monitoring (adjusted odds ratio [OR], 1.13; 95% confidence interval [CI], 0.69–1.88; P = .624), but with other factors: history of neural deficits (adjusted OR, 6.08; 95% CI, 3.10–11.91; P

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Exploring Beyond the Duration of Analgesia: Can Adjuncts Improve More Meaningful Outcomes in Obstetric Patients?

No abstract available

http://ift.tt/2lmJw5N

Does Lactate Affect the Association of Early Hyperglycemia and Multiple Organ Failure in Severely Injured Blunt Trauma Patients?

BACKGROUND: Early hyperglycemia is associated with multiple organ failure (MOF) after traumatic injury; however, few studies have considered the contribution of depth of clinical shock. We hypothesize that when considered simultaneously, glucose and lactate are associated with MOF in severely injured blunt trauma patients. METHODS: We performed a retrospective investigation at a single tertiary care trauma center. Inclusion criteria were patient age ≥18 years, injury severity score (ISS) >15, blunt mechanism of injury, and an intensive care unit length of stay >48 hours. Patients with a history of diabetes or who did not survive the initial 48 hours were excluded. Demographics, injury severity, and physiologic data were recorded. Blood glucose and lactate values were collected from admission through the initial 24 hours of hospitalization. Multiple metrics of glucose and lactate were calculated: the first glucose (Glucadm, mg/dL) and lactate (Lacadm, mmol/L) at hospital admission, the mean initial 24-hour glucose (Gluc24hMean, mg/dL) and lactate (Lac24hMean, mmol/L), and the time-weighted initial 24-hour glucose (Gluc24hTW) and lactate (Lac24hTW). These metrics were divided into quartiles. The primary outcome was MOF. Separate Cox proportional hazard models were generated to assess the association of each individual glucose and lactate metric on MOF, after controlling for ISS, admission shock index, and disposition to the operating room after hospital admission. We assessed the interaction between glucose and lactate metrics in the multivariable models. Results are reported as hazard ratios (HRs) for an increase in the quartile level of glucose and lactate measurements, with 95% confidence intervals (CIs). RESULTS: A total of 507 severely injured blunt trauma patients were evaluated. MOF occurred in 46 of 507 (9.1%) patients and was associated with a greater median ISS (33.5, interquartile range [IQR]: 22–41 vs 27, IQR: 21–34; P

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A Simulation Study to Evaluate Improvements in Anesthesia Work Environment Contamination After Implementation of an Infection Prevention Bundle

BACKGROUND: Microbiological contamination of the anesthesia work environment (AWE) is a potential source of health care–associated infections. Medication syringes, stopcocks, and many other areas are routinely contaminated during anesthetic care, and adherence to hand hygiene recommendations is poor. Using a simulation model, we investigated whether AWE contamination could be reduced by implementing an intervention bundle focused on infection prevention. METHODS: Twenty-five anesthesia providers were enrolled in this nonrandomized simulation scenario crossover design study. Subjects were asked to complete 2 general anesthesia scenarios in a mock operating room: a baseline scenario and an intervention scenario in which the bundle was implemented. The bundle included: double gloving before intubation, confining all airway equipment to 1 area, and performing hand hygiene before touching the anesthesia cart. Before each scenario, a manikin's oropharynx and face were marked with ultraviolet fluorescent tracers. After each scenario, the AWE was inspected with a ultraviolet light source to detect contaminant, and all sites were photographed. A blinded observer scored the images for the presence or absence of tracer at 20 sites. Videos of the scenarios were analyzed for duration and number of hand hygiene and glove removal events. Data were analyzed using a mixed effects model. Subjects completed a survey about their experience and the value of the scenarios. RESULTS: The intervention was associated with a decreased subject contamination score of 4.0 (95% confidence interval, 2.2–5.6; P

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In Response

No abstract available

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The Syringe Driver: Continuous Subcutaneous Infusions in Palliative Care, 4th ed.

No abstract available

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Teledermatology Platform May Allow High-quality Acne Evaluation

Patient-taken iPhone photos transmitted and stored in the Network Oriented Research Assistant (NORA) teledermatology program may be as useful for acne evaluations as in-person consultations, a pilot study suggests.
Reuters Health Information

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Analytic survey of 57 cases of oral metastases

Abstract

Background

Oral lesions have been reported among the first signs of an undiagnosed metastatic disease. Accurate diagnosis of an occult metastasis remains critical in determining the treatment course. Previous studies regarding oral metastatic tumors present varied data regarding the most frequent metastases to the oral cavity. These discrepancies echo the changes in incidence rates for certain malignancies over time and demonstrate the need for periodic updates in oral metastasis studies.

Methods

Using Text Information Extraction System, a de-identified pathology database, we compiled 57 cases over a period of nineteen years using key terms to search for oral metastases.

Results

For both males and females, the most common primary sites were lung (21.1%), liver (12.3%), breast (10.5%), kidney (10.5%), and colorectal (8.8%). We found an equal number of lung and breast metastases in females and metastases from the liver to be the most prevalent for males. In most of our cases (54.9%), the patient had no history of the primary malignancy and the oral lesion preceded awareness of the widespread cancer.

Conclusions

As a departure from many previous case series, we found lung and breast metastases to be equally numerous in women and liver as the most common oral metastasis in men. Also, we identified a tendency for the patient to present with a previous history in certain malignancies, like breast cancer, whereas in other malignancies, such as renal cell carcinoma, our data demonstrated a propensity to present in the oral cavity without history of a primary tumor.

This article is protected by copyright. All rights reserved.

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Phase II trial of eribulin mesylate in recurrent or metastatic salivary gland malignancies

Abstract

Background

This study examined the microtubule inhibitor eribulin in recurrent/metastatic salivary gland cancers (RMSGCs), a disease where no therapeutic standard exists.

Methods

This phase II clinical trial treated patients with progressive recurrent/metastatic salivary gland cancers with eribulin 1.4 mg/m² i.v. on days 1 and 8 of a 21-day cycle until disease progression/unacceptable toxicities. The primary endpoint was the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 objective response rate.

Results

Between May 2012 and August 2015, 29 patients were enrolled in this study. The median age was 63 years (range 34-75 years) and 20 of the subjects were men (69%). The most common histologies were adenoid cystic carcinoma (ACC; n = 11) and adenocarcinoma (n = 4). Neutropenia was the most common toxicity (grade 3; n = 5; 17% and grade 4 n = 3; 10%). The objective responses were observed in 3 of 29 patients (10%), 20 of 29 patients (69%) demonstrated a decrement in tumor size, and disease control was observed in 26 of 29 patients (90%).

Conclusion

Although the objective responses to eribulin were uncommon, disease control was observed in the majority of patients.

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Improving learning and confidence through small group, structured otoscopy teaching: a prospective interventional study

Otologic diseases are common and associated with significant health care costs. While accurate diagnosis relies on physical exam, existing studies have highlighted a lack of comfort among trainees with regards...

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Neck rejuvenation by direct anterior medial cervicoplasty: the modified zigzag-plasty according to Tschopp

Abstract

Background

Conventional cervicofacial rhytidectomy has become the standard treatment of skin excess of the ageing neck. However, some patients want to avoid an extensive surgical procedure, especially if the anterior neck is the predominant problem zone.

Objective

To report on the efficacy and safety of a zigzag-shaped skin excision combined with platysma plication.

Methods & Materials

We present a retrospective case review series of 6 female patients. Skin excess was marked preoperatively using the skin pinching technique, then transferred into a zigzag-shaped area and finally excised using the method according to Tschopp, which is described. Patients were followed up for at least one year.

Results

All patients (age: 55 to 82 yrs., median: 65 yrs.) were very satisfied with the results. On an overall patient satisfaction scale of 1 to 10 (1 being the best), the scars were graded on average 1,85 (median: 2) 1 year after surgery. No scar hypertrophy, functional impairment, nerve damage or other serious complications were observed.

Conclusion

In selected patients, the direct anterior zigzag-shaped excision poses an effective, safe and easy surgical option for both skin and fat excess and platysma banding. The technique is easily reproducible, with low morbidity and high patient satisfaction.

This article is protected by copyright. All rights reserved.

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Role of T-helper 17 cells and T regulatory cells in alopecia areata: Comparison of lesion and serum cytokine between controls and patients

Abstract

Background

Alopecia areata (AA) is an organ-specific autoimmune disease with T-cell-mediated attack of hair follicle autoantigens. As T-helper 17 (Th17) cells and T regulatory (Treg) cells are crucially involved in the pathogenesis, the role of Th17 and Treg cytokines has not been studied yet.

Objective

To determine whether AA is associated with alterations in lesional and serum Th17 and Treg cytokines, and studied whether they were associated with clinical type.

Methods

Scalp skin samples from 45 patients and 8 normal controls were obtained for PCR specific for IFN-γ, TNF-α, TGF-β, IL-1, IL-2, IL-4, IL-10, IL-12A, IL-13, IL-17, IL-22 and IL-23. Serum cytokines were measured from 55 patients and 15 normal controls using ELISA.

Results

Lesional IL-17 and IL-22 were significantly increased in patients group. Moreover, positive correlations were shown between lesional IL-17, IL-22 and disease severity. Serum IL-1, IL-17, TNF-α, and TGF-β were significantly increased, and positive correlation was shown between serum IL-17 and disease severity.

Conclusion

These results showed significantly high Th17 cytokines in both lesion and serum in AA patients, which may highlight a functional role of these cytokines in the pathogenesis of AA.

This article is protected by copyright. All rights reserved.

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Design, development and optimization of a transungual duple nail lacquer for onychomycosis therapy

Abstract

Onychomycosis is a degenerative fungal infection inflicting toes and finger nails which is caused by both dermatophytes and non-dermatophytes such as Trichophyton rubrum and Candida spp. respectively. The infection apparently causes nail mutilation making nails stiff, skinny, flawed, and dyschromic. Owing to the anatomical presentation of the disease, a topical application is warranted which asserts positive attributes like ease of preparation, improved adherence, negligible drug interactions, low systemic adverse effects and voluntary removal.

This article is protected by copyright. All rights reserved.

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Letter on ‘European dermatology forum S1-guideline on the diagnosis and treatment of sclerosing diseases of the skin, Part 2: Scleromyxedema, scleredema and nephrogenic systemic fibrosis’

Abstract

We read with interest the guidelines recently published on sclerosing diseases of the skin (Part 2: Scleromyxedema, scleredema and nephrogenic systemic fibrosis)[1, 2]. However, we are concerned that the guideline recommendations proposed for prevention of nephrogenic systemic fibrosis (NSF) are potentially dangerous. Although we recognise the challenges in constructing comprehensive guidelines, we are concerned that this may be because the guidelines have not involved a multidisciplinary team.

This article is protected by copyright. All rights reserved.

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A novel scale for measurement of acquired dermal macular hyperpigmentation (ADHM) severity

Abstract

Acquired dermal macular hyperpigmentation (ADMH) is a hypernym which includes lichen planus pigmentosus (LPP), Riehl's melanosis (RM), pigmented contact dermatitis (PCD) and erythema dyschromicum perstans (EDP). There is considerable overlap between the clinical and histopathological features of these conditions. Despite affecting a large number of patients, there is no validated quantitative scale for LPP/EDP/RM/PCD/ADMH.

This article is protected by copyright. All rights reserved.

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The importance of reducing risk in peanut allergy: Current and future therapies

Publication date: Available online 28 December 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Wayne G. Shreffler, Joe L. Baumert, Benjamin C. Remington, Stef J. Koppelman, Chitra Dinakar, David M. Fleischer, Edwin Kim, Stephen A. Tilles, Jonathan M. Spergel




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Elevated expression of activated TH2 cells and milk-specific TH2 cells in milk-induced eosinophilic esophagitis

Publication date: Available online 28 December 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Antonella Cianferoni, Melanie A. Ruffner, Ryan Guzek, Shabo Guan, Terri Brown-Whitehorn, Amanda Muir, Jonathan M. Spergel
BackgroundEosinophilic esophagitis (EoE) is an allergic inflammatory disease that is triggered by food allergens and characterized by progressive esophageal dysfunction. Esophageal biopsy specimens are characterized by eosinophilia and expression of TH2 cytokines.ObjectiveTo ascertain whether TH2 cells can exist in the peripheral blood in patients with milk-induced EoE.MethodsPeripheral blood mononuclear cells from 20 children with milk-induced EoE were collected during active EoE (EoE-A) while consuming milk and inactive EoE (EoE-I) while not consuming milk, and 8 healthy patients without EoE were used as controls. The samples were analyzed for T-cell phenotype, including intracellular cytokines before and after incubation with milk antigens and assessed by flow cytometry.ResultsWe found a significant increase in CD4⁺ TH2 cells in the peripheral blood of patients with EoE-A compared with the controls. Furthermore, we observed a significant mean (SD) increase in the activation marker of CD154⁺ T cells (0.17% [0.047^%]) in patients with EoE-A compared with control patients (0.034% [0.007%]) and EoE-I (0.025% [0.008]). These CD4⁺ T cells expressed significantly increase levels of TH2 cytokines (interleukins 4, 5, and 13) compared with the EoE-I and control groups. CD3⁺CD4⁺CD154⁺IL-5⁺ cells were significantly increased by milk antigens in both milk-induced EoE-A (0.050% [0.008%] to 0.079% [0.017%]) and EoE-I (0.0045% [0.002%] to 0.014% [0.008%]) compared with the controls (0.008% [0.003%] to 0.003% [0.001%]).ConclusionOur findings indicate that in EoE peripheral T cells have specific activation to milk allergens.



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A Pathway-Based Association Analysis Identified FMNL1-MAP3K14 as Susceptibility Genes for Leprosy

Abstract

The nuclear transcription factor-κB (NF-κB) plays a pivotal role in controlling both innate and adaptive immunity and regulates the expressions of many immunological mediators. Abundant evidences have showed that the importance of NF-κB pathway in the host immune responses against Mycobacterium leprae in the development of leprosy. However, no particular association study between leprosy and NF-κB pathway related gene polymorphisms was reported. Here, we performed a large scale and two-stage candidate association study to investigate the association between 94 NF-κB pathway related genes and leprosy. Our results showed that rs58744688 was significantly associated with leprosy (P=7.57×10^-7, OR=1.12) by combining the previous genome wide association datasets and four independent validation sample series, consisting of a total of 4631 leprosy cases and 6413 healthy controls. This founding implicated that MAP3K14 and FMNL1 were susceptibility genes for leprosy, which suggested the involvement of macrophage targeting and NF-κB pathway in the development of leprosy.

This article is protected by copyright. All rights reserved.

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Characterization of the facial microbiome in twins discordant for rosacea

Abstract

Previously, we determined that genetic and environmental factors contributed equally towards rosacea in twins. To assess an environmental factor, we characterized the malar cheek bacterial microbiome from twins discordant for rosacea. We found no significant difference in facial microbiome alpha and beta diversity between related twins discordant for rosacea. However, the relative percentage abundance of Gordonia and Geobacillus, low abundant genera, was positively and negatively associated with rosacea severity, respectively. Our data demonstrate a significant correlation between facial microbiome and severity of rosacea in genetically matched twins and importantly that overall microbiome composition is largely unchanged.

This article is protected by copyright. All rights reserved

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The Partial Duplication of the 5′ Segment of KMT2A Revealed KMT2A-MLLT10 Rearrangement in a Boy with Acute Myeloid Leukemia

The duplication of 5′ segment of KMT2A is a rare molecular event in childhood leukemia, and the influence on prognosis is unknown. Here, we report on a boy who developed acute monocytic leukemia. Fluorescence in situ hybridization revealed the duplication of the 5′ segment with 2 normal alleles at KMT2A which was eventually found to be fused with MLLT10. Chemotherapy promptly induced the first complete remission in the patient at our facility, and the patient remained in first complete remission with negative minimal residual disease at 3.5 years from diagnosis. Our case is similar to two previously reported patients who had partial duplication of the 5′ segment of KMT2A with a KMT2A-MLLT10 rearrangement. Further studies and experience with this cryptic translocation may shed more light on the management of acute myeloid leukemia.

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Low-dose Methotrexate: Determinants for Adverse Events

What are the relative risks of adverse events in patients exposed to low-dose methotrexate vs. placebo, and what factors might predispose patients to these events?
The British Journal of Dermatology

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The Sphenopalatine Ganglion Block for Post-dural Puncture Headache

Condition:   Post-Dural Puncture Headache
Intervention:   Procedure: Sphenopalatine ganglion block
Sponsor:   Brigham and Women's Hospital
Not yet recruiting

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CXCR3 blockade combined with cyclosporine A alleviates acute graft-versus-host disease by inhibiting alloreactive donor T cell responses in a murine model

Publication date: February 2018
Source:Molecular Immunology, Volume 94
Author(s): Shengchao Miao, Bo Tang, Huihui Liu, Zhenhua Wang, Yongjin Shi, Yujun Dong, Wei Liu, Chenchen Qin, Hanyun Ren
Chemotaxis of T cells to acute graft-versus-host disease (aGvHD) target tissues directed by chemokines and their receptors plays a key role in the pathogenesis of aGvHD. Blockade of lymphocyte migration by targeting chemokine receptors may be a viable strategy for the prevention and treatment of aGvHD, which is quite distinguishable from typical efforts to use immunosuppressive medications that have been associated with some side effects. CXCR3 and its ligands have been reported to be correlated with aGvHD pathogenesis. Using the small-molecule CXCR3 antagonist AMG487, we demonstrated that AMG487 combined with cyclosporine A (CsA) effectively alleviated aGvHD with a prolonged mean survival time and significantly inhibited the infiltration of inflammatory cells in aGvHD target tissues in a murine aGvHD model. In addition, AMG487 combined with CsA inhibited the activation, proliferation and differentiation of donor-derived T cells in the spleens. Further results showed that the concentrations of Th1 cells associated with pro-inflammatory cytokines such as IFN-γ and TNFα in serum were decreased. In addition, AMG487 treatment did not alter CXCR3 and CCR5 expression in donor-derived T cells but elevated the serum CXCL9 and CXCL10 levels. This novel and effective approach has the potential to develop a new clinical method to prevent and treat aGvHD.



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Identification of the cognate peptide-MHC target of T cell receptors using molecular modeling and force field scoring

Publication date: February 2018
Source:Molecular Immunology, Volume 94
Author(s): Esteban Lanzarotti, Paolo Marcatili, Morten Nielsen
Interactions of T cell receptors (TCR) to peptides in complex with MHC (p:MHC) are key features that mediate cellular immune responses. While MHC binding is required for a peptide to be presented to T cells, not all MHC binders are immunogenic. The interaction of a TCR to the p:MHC complex holds a key, but currently poorly comprehended, component for our understanding of this variation in the immunogenicity of MHC binding peptides. Here, we demonstrate that identification of the cognate target of a TCR from a set of p:MHC complexes to a high degree is achievable using simple force-field energy terms. Building a benchmark of TCR:p:MHC complexes where epitopes and non-epitopes are modelled using state-of-the-art molecular modelling tools, scoring p:MHC to a given TCR using force-fields, optimized in a cross-validation setup to evaluate TCR inter atomic interactions involved with each p:MHC, we demonstrate that this approach can successfully be used to distinguish between epitopes and non-epitopes. A detailed analysis of the performance of this force-field-based approach demonstrate that its predictive performance depend on the ability to both accurately predict the binding of the peptide to the MHC and model the TCR:p:MHC complex structure. In summary, we conclude that it is possible to identify the TCR cognate target among different candidate peptides by using a force-field based model, and believe this works could lay the foundation for future work within prediction of TCR:p:MHC interactions.



http://ift.tt/2E8ttkq

Increased PD-1+CD154+ Tfh cells are possibly the most important functional subset of PD-1+ T follicular helper cells in adult patients with minimal change disease

Publication date: February 2018
Source:Molecular Immunology, Volume 94
Author(s): Tao Li, Yunpeng Shi, Weixia Sun, Haifeng Wang, Quan Wang, Yanfang Jiang
T follicular helper (Tfh) cells, especially programmed cell death protein 1 (PD-1)⁺ Tfh cells, exert important functions in the normal immune response. The purpose of this study was to determine the frequency of different subsets of PD-1⁺ Tfh cells and their functional effects in adult patients with minimal change disease (MCD). The frequencies of circulating PD-1⁺, PD-1⁺CD154⁺, and PD-1⁺interleukin (IL)-21⁺ Tfh cells, and CD38⁺CD19⁺ and CD38⁺CD19⁺CD40⁺ B cells, as well as serum IL-2, IL-4, IL-17A, IL-6, IL-21, and interferon (IFN)-γ were significantly increased in the MCD patients compared with the healthy controls (HCs) (P < 0.05). However, no significant difference was found in PD-1⁺BCL-6⁺ or PD-1⁺ICOS⁺ Tfh cells. Furthermore, the percentages of PD-1⁺ Tfh and PD-1⁺CD154⁺ Tfh cells were negatively correlated with the estimated glomerular filtration rate (eGFR), but positively correlated with the 24-h urinary protein concentration and serum IL-21 level. The percentages of PD-1⁺ Tfh and PD-1⁺CD154⁺ Tfh cells were positively correlated with the percentages of CD38⁺ plasma cells and active CD38⁺CD40⁺ plasma cells, respectively. After an 8–12-week treatment with prednisolone, the percentages of PD-1⁺, PD-1⁺CD154⁺, and PD-1⁺IL-21⁺ Tfh cells as well as the serum level of IL-21 were significantly reduced; in contrast, the serum levels of IL-4 and IL-10 were increased (P < 0.05). We conclude that increased PD-1⁺CD154⁺ Tfh cells are possibly the most important functional subset of PD-1⁺ Tfh cells and may contribute towards the pathogenesis of MCD.



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Forthcoming Meetings

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Cover Image

The cover image, by M. A. Blankestijn et al., is based on the Original Article Specific IgE to peanut 2S albumin Ara h 7 has a discriminative ability comparable to Ara h 2 and 6, DOI: 10.1111/cea.13030.

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Welcome to 2018

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Issue Information

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Reflectance confocal microscopy for the diagnosis of tinea nigra

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A Rare Case Report and Literature Review of External Auditory Canal Cholesteatoma with Circumferential Destruction of Canal Wall Exposing Facial Nerve

External auditory canal cholesteatoma (EACC) is a rare condition with an estimated incidence of 1.2 per 1000 new otological patients. It is often mistaken with keratosis obturans. We discuss an extensive primary EACC with an aural polyp in a male which was managed by modified radical mastoidectomy.

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Low dose treatment of mice with bacterial extract (OM-85) for attenuation of experimental atopic asthma in mice – Reply

Publication date: Available online 27 December 2017
Source:Allergologia et Immunopathologia
Author(s): P.M. Pitrez, R.T. Stein




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Case 40-2017: A 32-Year-Old Woman with Headache, Abdominal Pain, Anemia, and Thrombocytopenia

Presentation of Case. Dr. Emer McGrath (Neurology): A 32-year-old woman was admitted to this hospital in the fall because of severe headache and loss of peripheral vision. The patient had been in her usual state of health until 4 weeks before admission to this hospital, when she underwent elective…

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Post-tonsillectomy hemorrhage: Underlying factors and prevention

Publication date: Available online 28 December 2017
Source:American Journal of Otolaryngology
Author(s): Zheng-cai Lou, Zi-han Lou




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Inhalant allergen sensitization is an independent risk factor for the development of angioedema

Publication date: Available online 27 December 2017
Source:American Journal of Otolaryngology
Author(s): Jacob E. Kuperstock, Nicholas Pritchard, Michal Horný, Christopher C. Xiao, Christopher Brook, Michael P. Platt
Background/objectiveThe etiology and risk factors for angioedema remain poorly understood with causative triggers often going undiagnosed despite repeated reactions. The purpose of this study was to determine the relationship between inhalant allergen sensitization and angioedema.MethodsA retrospective review of patients who had in vitro inhalant allergy testing from 2006 to 2010 was performed. Patients with a diagnosis of angioedema who underwent inhalant allergy testing were identified. Analyses for co-morbidities, class of sensitization, seasonal timing of angioedema, and concurrent use of known hypertensive medications that can cause angioedema were performed.ResultsThere were 1000 patients who underwent inhalant allergy testing and qualified for the study. 37/1000 had at least one episode of angioedema and of these patients, 34 had positive inhalant sensitization testing results. Multivariate regression models showed overall sensitization status, seasonal allergen and epidermal/mite sensitization as independent risk factors (p<0.001, p=0.005, p=0.025 respectively) when controlling for ACE inhibitor use and other covariates. Tree, and epidermal/mite sensitizations were independent risk factors for angioedema in mono-sensitized subject analysis (p=0.028, p=0.029, respectively).ConclusionBoth seasonal and perennial allergen sensitizations are independent risk factors for the development of angioedema. In patients with angioedema and an unknown trigger, inhalant allergen sensitization should be considered as a potential contributing factor to the development of angioedema.



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Medium-term assessment of Eustachian tube function after balloon dilation

Publication date: Available online 28 December 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): D. Schmitt, M. Akkari, T. Mura, M. Mondain, A. Uziel, F. Venail
There is at present no consensus on the treatment of obstructive Eustachian tube dysfunction. In case of failure of well-conducted drug and pressure therapy, some authors recommend balloon dilation; the present study aimed to assess the efficacy and safety of Eustachian tube balloon dilation.Materials and methodsA single-center retrospective study assessed clinical and tubomanometric results of Eustachian tube balloon dilation, complications and satisfaction in a consecutive series managed between June 2012 and February 2015. Indications were based on clinical and paraclinical signs of obstructive tube dysfunction despite well-conducted medical treatment.ResultsForty-five procedures were performed in 38 patients. Improvement in clinical symptoms was assessed as 88%, 80% and 80% at respectively 2 months, 6 months, and>1 year. Improved function on tubomanometry was observed in 81% of cases. The procedure was well tolerated, with a minor complications rate of only 4%.ConclusionsThe present findings for efficacy, tolerance and safety were comparable to those in the literature, despite first-line failure in all patients. Eustachian tube function normalized in about one-third of cases. Despite these encouraging results, true efficacy remains to be confirmed in prospective studies with higher levels of evidence.



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