Are oral mucosal nevi potential precursors for oral mucosal melanoma?

Publication date: Available online 28 February 2018
Source:Oral Oncology
Author(s): A. Thirumal Raj, Shankargouda Patil, Chandini Rajkumar




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Fractional CO 2 laser for genitourinary syndrome of menopause in breast cancer survivors: clinical, immunological, and microbiological aspects

Abstract

The composition of vaginal microbiome in menopause and cancer survivor women changes dramatically leading to genitourinary syndrome of menopause (GSM) in up to 7% of patients. Recent reports suggest that laser therapy may be valuable as a not hormonal therapeutic modality. The aim of the present study was to evaluate the effects of fractional CO₂ laser treatment on the vaginal secretory pathway of a large panel of immune mediators, usually implicated in tissue remodeling and inflammation, and on microbiome composition in postmenopausal breast cancer survivors. The Ion Torrent PGM platform and the Luminex Bio-Plex platform were used for microbiome and immune factor analysis. The significant reduction of clinical symptoms and the non-significant changes in vaginal microbiome support the efficacy and safety of laser treatment. Moreover, the high remodeling status in vaginal epithelium is demonstrated by the significant changes in inflammatory and modulatory cytokine patterns. Laser therapy can be used for the treatment of GSM symptoms and does not show any adverse effects. However, further studies will be needed to clarify its long-term efficacy and other effects.

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Asthma exacerbation prediction: recent insights

Purpose of review Asthma attacks are frequent in children with asthma and can lead to significant adverse outcomes including time off school, hospital admission and death. Identifying children at risk of an asthma attack affords the opportunity to prevent attacks and improve outcomes. Recent findings Clinical features, patient behaviours and characteristics, physiological factors, environmental data and biomarkers are all associated with asthma attacks and can be used in asthma exacerbation prediction models. Recent studies have better characterized children at risk of an attack: history of a severe exacerbation in the previous 12 months, poor adherence and current poor control are important features which should alert healthcare professionals to the need for remedial action. There is increasing interest in the use of biomarkers. A number of novel biomarkers, including patterns of volatile organic compounds in exhaled breath, show promise. Biomarkers are likely to be of greatest utility if measured frequently and combined with other measures. To date, most prediction models are based on epidemiological data and population-based risk. The use of digital technology affords the opportunity to collect large amounts of real-time data, including clinical and physiological measurements and combine these with environmental data to develop personal risk scores. These developments need to be matched by changes in clinical guidelines away from a focus on current asthma control and stepwise escalation in drug therapy towards inclusion of personal risk scores and tailored management strategies including nonpharmacological approaches. Summary There have been significant steps towards personalized prediction models of asthma attacks. The utility of such models needs to be tested in the ability not only to predict attacks but also to reduce them.

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‘Hidden’ occupational allergens such as additives

Purpose of review With the development of innovative technologies, new agents are continually introduced to the workplace. Some of these agents can act as hidden allergens whenever they are not declared in the product labels or whenever their health hazards are unknown. This review article focuses on the identification and description of unusual and/or hidden allergens recently incriminated in occupational diseases. Recent findings Occupational exposure is an important global health issue that can induce respiratory and cutaneous disorders, as well as life-threatening anaphylaxis. Apart from the classic forms of occupational exposure, reports have emerged from nonconventional or newly identified allergens or additives. These compounds are substances added to another in order to alter or improve the general quality or to counteract undesirable properties, and some of them may behave as potent and frequently hidden allergens. These highly uncommon and/or hidden allergens belong to several categories: foods, spices, cosmetics, insects, enzymes, chemicals, drugs, preservatives, and coloring agents, among others. Summary A high level of suspicion and awareness about the potential hidden allergens is necessary to ascertain the allergens implicated. It is of utmost importance to identify the specific eliciting agents of the occupational diseases in order to avoid strictly further exposure to them.

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Evidence establishing a link between prenatal and early-life stress and asthma development

Purpose of review The objective of this review is to provide an update on our evolving understanding of the effects of stress in pregnancy and during early development on the onset of asthma-related phenotypes across childhood, adolescence, and into early adulthood. Recent findings Accumulating evidence over the past 2 decades has established that prenatal and early-life psychological stress and stress correlates (e.g., maternal anxiety or depression) increase the risk for childhood respiratory disorders. Recent systematic reviews and meta-analyses including numerous prospective epidemiological and case–control studies substantiate a significant effect of prenatal stress and stress in early childhood on the development of wheeze, asthma, and other atopic-related disorders (eczema and allergic rhinitis), with many studies showing an exposure–response relationship. Offspring of both sexes are susceptible to perinatal stress, but effects differ. The impact of stress on child wheeze/asthma can also be modified by exposure timing. Moreover, coexposure to prenatal stress can enhance the effect of chemical stressors, such as prenatal traffic-related air pollution, on childhood respiratory disease risk. Understanding complex interactions among exposure dose, timing, child sex, and concurrent environmental exposures promises to more fully characterize stress effects and identify susceptible subgroups. Although the link between perinatal stress and childhood asthma-related phenotypes is now well established, pathways by which stress predisposes children to chronic respiratory disorders are not as well delineated. Mechanisms central to the pathophysiology of wheeze/asthma and lung growth and development overlap and involve a cascade of events that include disrupted immune, neuroendocrine, and autonomic function as well as oxidative stress. Altered homeostatic functioning of these integrated systems during development can enhance vulnerability to asthma and altered lung development. Summary Mechanistic studies that more comprehensively assess biomarkers reflecting alterations across interrelated stress response systems and associated regulatory processes, in both pregnant women and young children, could be highly informative. Leveraging high-throughput systems-wide technologies to include epigenomics (e.g., DNA methylation, microRNAs), transcriptomics, and microbiomics as well as integrated multiomics are needed to advance this field of science. Understanding stress-induced physiological changes occurring during vulnerable life periods that contribute to chronic respiratory disease risk could lead to the development of preventive strategies and novel therapeutic interventions.

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Update on metal-induced occupational lung disease

Purpose of review Occupational and environmental exposures to metals can result in multiple pulmonary conditions. This article will review recent epidemiologic and mechanistic studies that have enhanced our understanding of the association between particular lung diseases and exposure to specific metals. Recent findings Recent studies have broadened our understanding of the mechanisms of lung diseases such as CBD in established industries and drawn attention to conditions that may arise from exposure to metals such as indium in developing technologies. New diagnostic techniques such as elemental tissue analysis may help establish a diagnosis of metal-induced occupational lung disease. Electronic cigarette devices, environmental pollutants, and the growing use of nanoparticle-sized metals pose additional risks to workers and consumers. Summary Recognizing the risks of pulmonary disease in workers exposed to metals and performing a thorough occupational history and diagnostic work-up in patients with unexplained respiratory findings is necessary to promote understanding and prevention of metal-induced lung disease.

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Role of epigenetics in the development of childhood asthma

Purpose of review Epigenetic marks are emerging as mediators of genetics and the environment on complex disease phenotypes, including childhood asthma and allergy. Recent findings Epigenome-wide association studies over the past year have added to the growing body of evidence supporting significant associations of epigenetic regulation of gene expression and asthma and allergy. Studies in children have identified signatures of eosinophils in peripheral blood, Th2 cell transcription factors and cytokines in peripheral blood mononuclear cells, and epithelial dysfunction in the respiratory epithelium. Importantly, studies at birth have begun to decipher the contribution of epigenetic marks to asthma inception. Few studies have also begun to address the contribution of genetics and the environment to these associations. Summary Next generation of epigenome-wide association studies that will deal with confounders, study the influence of the genetics and environment, and incorporate multiple datasets to provide better interpretation of the findings are on the horizon. Identification of key epigenetic marks that are shaped by genetics and the environment, and impact transcription of specific genes will help us have a better understanding of etiology, heterogeneity and severity of asthma, and will also empower us to develop biologically driven therapeutics and biomarkers for secondary prevention of this disease.

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Health surveillance for occupational asthma

Purpose of review The outcome for workers with occupational asthma is improved for those with an earlier diagnosis. Health surveillance at work is in principle designed to identify such cases, so that the risks to the individual worker, and coworkers, can be reduced. There is recent evidence to suggest that the uptake and quality of such surveillance could be improved. This review has assessed current approaches to health surveillance for occupational asthma. Recent findings The article covers a review of the utility of questionnaires, lung function testing, immunological investigations, and other tests, including exhaled nitric oxide, sputum eosinophilia, and exhaled breath condensate specifically in the context of workplace-based health surveillance. Summary Questionnaires remain a key component of respiratory health surveillance, although maybe limited by both sensitivity and specificity for early occupational asthma. The role of lung function testing is debated, although is recommended for higher level health surveillance. Various examples of immunological testing in health surveillance are discussed, but more evidence is needed in many specific areas before more general recommendations can be made. Evidence is discussed in relation to the utility of newer approaches such as exhaled nitric oxide, sputum eosinophilia, and exhaled breath condensate.

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Editorial introductions

No abstract available

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The emerging spectrum of exposure-related bronchiolitis

Purpose of review Exposure-related bronchiolitis is increasingly recognized as an important but challenging clinical diagnosis. Acute and chronic inhalational exposures are associated with variable clinical presentations and a spectrum of histopathologic abnormalities affecting the small airways. This review provides an overview of the histologic patterns and occupational settings for exposure-related bronchiolitis, along with recent advances in disease diagnosis and management. Recent findings The entire histopathologic spectrum of bronchiolitis (constrictive, obliterative, proliferative, lymphocytic, respiratory) has been reported in exposure-related bronchiolitis. Recent studies have shown that lung clearance index testing and impulse oscillometry are more sensitive than spirometry in detecting small airways abnormalities and may augment the diagnosis of occupational bronchiolitis. Prognosis in indolent occupational bronchiolitis appears more favorable than some other types of bronchiolitis but is variable depending on the extent of bronchiolar inflammation and the stage of disease at which exposure removal occurs. Summary No specific histopathologic pattern of bronchiolitis is pathognomonic for occupational bronchiolitis as one or more histologic patterns may be present. A high index of suspicion is needed for exposure and disease recognition. Recent advances that may aid in diagnosis include transbronchial cryobiopsy, lung clearance index testing, and impulse oscillometry, although further research is needed.

http://ift.tt/2oC0nmK

Assessing the impact of air pollution on childhood asthma morbidity: how, when, and what to do

Purpose of review Exposure to air pollutants is linked with poor asthma control in children and represents a potentially modifiable risk factor for impaired lung function, rescue medication use, and increased asthma-related healthcare utilization. Identification of the most relevant pollutants to asthma as well as susceptibility factors and strategies to reduce exposure are needed to improve child health. Recent findings The current available literature supports the association between pollutants and negative asthma outcomes. Ethnicity, socioeconomic status, and presence of certain gene polymorphisms may impact susceptibility to the negative health effects of air pollution. Improved air quality standards were associated with better asthma outcomes. Summary The link between air pollution and pediatric asthma morbidity is supported by the recent relevant literature. Continued efforts are needed to identify the most vulnerable populations and develop strategies to reduce exposures and improve air quality.

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Biomarkers and asthma management: analysis and potential applications

Purpose of review Asthma features a high degree of heterogeneity in both pathophysiology and therapeutic response, resulting in many asthma patients being treated inadequately. Biomarkers indicative of underlying pathological processes could be used to identify disease subtypes, determine prognosis and to predict or monitor treatment response. However, the newly identified as well as more established biomarkers have different applications and limitations. Recent findings Conventional markers for type 2-high asthma, such as blood eosinophils, fraction of exhaled nitric oxide, serum IgE and periostin, feature limited sensitivity and specificity despite their significant correlations. More distinctive models have been developed by combining biomarkers and/or using omics techniques. Recently, a model with a positive predictive value of 100% for identification of type 2-high asthma based on a combination of minimally invasive biomarkers was developed. Summary Individualisation of asthma treatment regimens on the basis of biomarkers is necessary to improve asthma control. However, the suboptimal properties of currently available conventional biomarkers limit its clinical utility. Newly identified biomarkers and models based on combinations and/or omics analysis must be validated and standardised before they can be routinely applied in clinical practice. The development of robust biomarkers will allow development of more efficacious precision medicine-based treatment approaches for asthma.

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Asthma in inner city children: recent insights United States

Purpose of review Children living in US inner cities experience disparate burdens of asthma, especially in severity, impairment, exacerbations, and morbidity. Investigations seeking to better understand the factors and mechanisms underlying asthma prevalence, severity, and exacerbation in children living in these communities can lead to interventions that can narrow asthma disparities and potentially benefit all children with asthma. This update will focus on recent (i.e. late 2016–2017) advances in the understanding of asthma in US inner city children. Recent findings Studies published in the past year expand understanding of asthma prevalence, severity, exacerbation, and the outcomes of guidelines-based management of these at-risk children, including: asthma phenotypes in US inner city children that are severe and difficult-to-control; key environmental determinants and mechanisms underlying asthma severity and exacerbations (e.g. allergy-mediated exacerbation susceptibility to rhinovirus); the importance of schools as a place for provocative exposures (e.g. mouse allergen, nitrogen dioxide) as well as a place where asthma care and outcomes can be improved; and the development and validation of clinically useful indices for gauging asthma severity and predicting exacerbations. Summary These recent studies provide a trove of actionable findings that can improve asthma care and outcomes for these at-risk children.

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Development of allergic sensitization and its relevance to paediatric asthma

Purpose of review The purpose of this review is to summarize the recent evidence on the distinct atopic phenotypes and their relationship with childhood asthma. We start by considering definitions and phenotypic classification of atopy and then review evidence on its association with asthma in children. Recent findings It is now well recognized that both asthma and atopy are complex entities encompassing various different sub-groups that also differ in the way they interconnect. The lack of gold standards for diagnostic markers of atopy and asthma further adds to the existing complexity over diagnostic accuracy and definitions. Although recent statistical phenotyping studies contributed significantly to our understanding of these heterogeneous disorders, translating these findings into meaningful information and effective therapies requires further work on understanding underpinning biological mechanisms. Summary The disaggregation of allergic sensitization may help predict how the allergic disease is likely to progress. One of the important questions is how best to incorporate tests for the assessment of allergic sensitization into diagnostic algorithms for asthma, both in terms of confirming asthma diagnosis, and the assessment of future risk.

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Precision medicine in the treatment of primary immunodeficiency diseases

Purpose of the review Since the 1990s with the advances in molecular biology, a number of genetic defects have been described. The International Union of Immunological Sciences has recently updated the classification of genetic defects associated with primary immune deficiencies that now number 354. With the ever-expanding list of new monogenic disorders and a better understanding of the immunobiology and function of these defective genes, new therapies have emerged particularly aimed at the autoimmune and inflammatory conditions that plague these patients. Recent findings Immune deficiencies associated with gain-of-function (GOF) mutations are a potential category for targeted therapies to control the GOF activities of the mutated gene. In addition to the increased susceptibility to infections these patients have autoimmune and inflammatory diseases that are difficult to control with conventional therapies. The dysregulated immune functions of the activated phospholipase-3-kinase δ syndrome, cytotoxic T lymphocyte-associated antigen-4 haploinsufficiency, lipopolysaccharide-responsive beige-like anchor deficiency, the GOF mutations of signal transducer and activator of transcription 1 and 3 immune deficiencies will be reviewed. The targeted therapies for each of these immune deficiencies using small molecule kinase inhibitors and fusion protein biologic modifiers will be described. Summary In this review, we explore the recent advances in precision medicine treatment of several primary immunodeficiency syndromes in which immune dysregulation is a key feature. Understanding the immunobiology associated with these GOF mutations has led to the use of biologic therapies to better control the associated autoimmune and inflammatory manifestations.

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Hypereosinophilic syndrome presenting acutely with neurologic signs

A 70-year-old white male with a longstanding history of allergic rhinitis and nasal polyposis, and relatively recent onset of chronic cough one year prior, presented to the hospital for one-week duration of neurologic complaints including chronic and worsening neck pain, bilateral upper extremity weakness, difficulty gripping objects, blurry vision, confusion, change in gait, and difficulty with initiation of urination. His medical history also included essential hypertension, dyslipidemia, gastroesophageal reflux, and shingles.

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Displacement of the Recurrent Laryngeal Nerve in Patients with Recurrent Goiter Undergoing Redo Thyroid Surgery

Thyroid reoperations are surgically challenging because of scarring and disturbances in the anatomy of the recurrent laryngeal nerve (RLN). This study was conducted on 49 patients who underwent redo surgery. 61 RLNs were identified and completely exposed. Their functional integrity was evaluated using intraoperative nerve monitoring (IONM). Indications for secondary surgery, anatomical changes secondary to recurrent goiter mass and prior surgery, and results of IONM were studied. Frequent indications for redo surgery were multinodular goiter (MNG) in 19 (38.8%) and results of cytology in 14 (28.5%) patients. The mean time interval between primary and redo thyroid surgery was 23.4 years. We laterally approached 41 (67.2%) thyroid lobes between the sternocleidomastoid and sternohyoid muscles. 16 (26.2%) RLNs were found to be adherent to the lateral surface of the corresponding thyroid lobe. The functional integrity of all RLNs was confirmed by IONM. The remnant thyroid tissue can then lead to goiter recurrence requiring secondary surgery after a long period of time. The indications for redo surgery were similar to primary cases. Lateral displacement of the RLN which is adherent to the lateral surface of recurrent goiter mass is common anatomic variation. Thyroid reoperations based on awareness of anatomical disturbances can be performed safely by an experienced surgeon with support of ancillary electrophysiological technology.

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Are oral mucosal nevi potential precursors for oral mucosal melanoma?

The origin of oral mucosal melanoma remains controversial with oral mucosal nevi being hypothesized to be a possible precursor. The hypotheses can be supported by the characteristics shared by the nevus cells and the melanoma cells including spindle-shaped, lack of dendritic processes, lack of contact inhibition and inability to transfer the melanosomes to the keratinocytes [1].

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Outcome of Head and Neck Squamous Cell Cancers in Low-Resource Settings

Head and neck squamous cell carcinomas (HNSCCs) are amongst the most common cancers in certain parts of the world. Low-income and low middle- income countries make up 65% of newly diagnosed HNSCC cases annually and account for about 75% of HNSCC global mortality. These countries also suffer from a significant shortage of skilled labor, equipment, and health facilities. This article discusses the burden of HNSCCs in developing countries and the differences in outcomes compared with developed countries.

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In vitro outlook of gold nanoparticles in photo-thermal therapy: a literature review

Abstract

Hyperthermia is an anti-cancer treatment in which the temperature of the malignant tumor is increased more than other adjacent normal tissues. Microwave, ultrasound, laser, and radiofrequency sources have been used for hyperthermia of cancerous tissues. In the past decade, near-infrared (NIR) laser for cancer therapy, known as photo-thermal therapy (PTT), was expanded in which the photo-sensitizer agent converts the light photon energy to heat. The heat following PTT can destroy cancer cells. There are some photo-sensitizer agents which have been used for PTT; however, owing to recent advances in nanotechnology, noble metal nanoparticles like gold (Au) nanoparticles (GNPs) have been used successfully in PTT. GNPs have some desirable specifications, including simple and controlled synthesis, small size, high level of biocompatibility, and surface plasmon resonance (SPR). The SPR effect of the GNPs increases the radiative properties like absorption and scattering; therefore, they can be used in PTT. In this article, we reviewed recent in vitro studies of PTT using GNPs in literature. At first, we focus on the physical properties of GNPs, their interaction with infrared radiation, and physical parameters governing the interaction of infrared radiation with the GNPs. Then, we review the passive and active targeting of GNPs using the different coating to induce the thermal damage in cancer cells using low-level laser PPT. The GNPs' cellular internalization into cancer cells is a challenge which is consequently considered. In this review, we also summarize the results of synergistic cancer therapy studies on the combination of radiation therapy as a routine cancer treatment and PTT: in which significant improvement occurs in treatment efficacy.

http://ift.tt/2F0rvXL

Paroxysmal Nocturnal Dyspnea Secondary to Right Ventricular Myxoma: A Novel Presentation of an Unusual Tumor

A 14-month-old male presented with paroxysmal nocturnal dyspnea and grade III/VI systolic ejection murmur at the upper left sternal border with an S4 gallop and was subsequently found to have a right ventricular cardiac myxoma. Prior presentations of these tumors have been with exertional syncope and murmur, asymptomatic murmur, or exertional dyspnea; the presentation of such a tumor with paroxysmal nocturnal dyspnea is novel.

http://ift.tt/2oFvXQn

Use of ultrasonic scalpel and monopolar electrocautery for skin incisions in neck dissection: a prospective randomized trial

Abstract

Purpose

Ultrasonic scalpel (UC) and monopolar electrocautery (ME) are standard equipment for soft tissue surgery. The aim of the present study was to compare intraoperative and postoperative patterns of patients using either UC or ME for skin incisions in neck dissection.

Material and methods

In a prospective randomized study of 30 patients, the thermal effects of UC (n = 15) and ME (n = 15) were examined using real-time infrared thermographic imaging. Additionally, tissue damage was evaluated histopathologically. The other measured variables were operation and bleeding time, postoperative pain score (only neck incision area), in-patient time, and complications.

Results

UC significantly reduces the thermal effects, compared to ME (p < 0.001). The mean depth of tissue damage (i.e., necrosis) was 272.7 μm for UC and 284.7 μm for ME with no significant difference (p = 0.285). From the third postoperative day, patients treated using UC had noticeably less pain in the neck incision area (t3 p = 0.010; t4 p < 0.001; t5 p < 0.005). Cutting time was reduced for ME by 36.1 s (p < 0.001) and the bleeding time was decreased by 40.9 s for UC (p < 0.001). The total preparation time was the same (p = 0.402). When comparing in-patient time (p = 0.723), as well as complications, no significant differences were seen.

Conclusion

UC results in less postoperative pain and less bleeding in the neck incision area. Accordingly, UC is superior to ME for skin incisions in neck dissection.

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Barriers to Adherence With Acne Medications and Physician Intervention

This qualitative analysis examines reasons for patient nonadherence with acne medications and proposes physician interventions to increase adherence.

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Methotrexate-Associated B-Cell Lymphoproliferative Disease in Cutaneous T-Cell Lymphoma

This case report describes a patient with cutaneous T-cell lymphoma who developed methotrexate-associated B-cell lymphoproliferative disease.

http://ift.tt/2t4tggU

Tanning and Sun-Protection Behaviors Among Sexual Minority Men

This cross-sectional analysis assesses the impact of sexual orientation on indoor tanning, sunless tanning, and sun-protection behaviors among men.

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CD56 Variation in a Patient With Blastic Plasmacytoid Dendritic Cell Neoplasm

This case report describes both CD56-negative and CD56-positive findings in the same patient with blastic plasmacytoid dendritic cell neoplasm.

http://ift.tt/2t37Xwe

Iododerma (?) in Cancer Treated With Complementary and Alternative Medicine

To the Editor I read with interest the insightful and balanced observation by Hamel and Selby. Some questions and issues arose, which I present to the authors:

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Iododerma (?) in Cancer Treated With Complementary and Alternative Medicine—Reply

In Reply We thank Dr Nwabudike for his kind remarks regarding our recent Observation. Herein, we provide additional details concerning our diagnosis of iododerma while expanding our opinion on the role of Hoxsey herbal therapy in the outcome of this case.

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Patient Follow-up Preferences After Excision of Localized Melanoma

This telephone survey study determined the proportion of adults treated for localized melanoma who prefer the standard scheduled visit frequency, according to Australian guideline recommendations, or fewer scheduled visits.

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Radiculomegaly: a case report of this rare dental finding with review of the associated oculo-facio-cardio-dental syndrome

Publication date: Available online 28 February 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Molly Housley Smith, Donald M. Cohen, Indraneel Bhattacharyya, Nadim M. Islam, Deeba Kashtwari
Background: Radiculomegaly, or root gigantism, is a rare dental abnormality with important clinical implications. It is highly specific for oculo-facio-cardio-dental syndrome (OFCD), which places dentists at the forefront of diagnosis for this syndrome. Only one case of non-syndromic radiculomegaly has been reported in the literature since the description of OFCD in 1996. We present the second confirmed, non-syndromic/non-familial case and review the literature for dental treatments in patients with this dental finding. Methods: A review of the English-language literature was performed within PubMed for patients with radiculomegaly or OFCD. Teeth affected by radiculomegaly, gender, oro-dental findings, presence of OFCD syndrome, and dental treatment methods were recorded. Results: Sixty-seven cases of radiculomegaly and 92 OFCD cases were found in the literature. Only one confirmed case of non-syndromic/non-familial radiculomegaly existed prior to our report. Ten cases reported dental treatment or treatment plan details, and even fewer detailed the specific methods. Conclusions: Because dental anomalies, especially radiculomegaly, are a primary feature of OFCD, dentists should be aware of the clinical and radiographic features. Radiculomegaly poses a distinct challenge to dentists, and reports of dental therapy provided to these patients are sparse. Early diagnosis of the syndrome may prevent dental challenges and improve prognosis.



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Adult Cranioplasty Reconstruction With Customized Cranial Implants: Preferred Technique, Timing, and Biomaterials

Introduction: Complex cranial defects requiring delayed reconstruction present numerous challenges. Delayed cranioplasties accompany frequent complications approaching an incidence of 35 to 40%. Therefore, the authors sought to collate their experience in hopes of sharing their perspective on several topics including technique, timing, and preferred biomaterials. Methods: The authors' 5-year consecutive experience over 430 customized cranial implants is described herein. Since its inception in 2012, the authors' team has employed the pericranial-onlay cranioplasty technique instead of the standard epidural approach. Optimal timing for cranioplasty is determined using objective criteria such as scalp healing and parenchymal edema, close collaboration with neuroplastic surgery, conversion from autologous bone to sterile implant in instances of questionable viability/storage, and the first-line use of solid poly(methylmethacrylate) implants for uncomplicated, delayed cases, first-line porous polyethylene (MEDPOR) implants for single-stage cranioplasty, and first-line polyether-ether-ketone implants for cases with short notice. Furthermore, the use of the pterional design algorithm with temporal bulking for all customized implants has helped to correct and/or prevent temporal hollowing deformities. Results: The authors' team has observed a three-fold reduction in reported complications as compared with the existing literature, with a major complication rate of 11%. The multidisciplinary center has provided an optimal stage for synergy and improved outcomes versus standard cranioplasty techniques. Conclusion: Secondary cranial reconstruction, or cranioplasty, can be challenging due to numerous reasons. These best practices, developed in collaboration with neuroplastic surgery and neurosurgery, appear to encompass the largest published experience to date. The authors find this approach to be both safe and reliable. Address correspondence and reprint requests to Chad Gordon, DO, FACS, Associate Professor of Plastic Surgery and Neurosurgery, Johns Hopkins University School of Medicine, 601 N. Caroline St, JHOC 8th floor, Baltimore, MD 21287; E-mail: cgordon@jhmi.edu Received 15 November, 2017 Accepted 22 December, 2017 CG is a consultant for Stryker Craniomaxillofacial (CMF) and Longeviti Neuro Solutions. The authors report no conflicts of interest. AW and GFS should be considered co-first authors. This paper was supported in part by a research grant received from Stryker Craniomaxillofacial (Kalamazoo, MI), which was reviewed and approved by the Johns Hopkins University in accordance with its conflict of interest policies. © 2018 by Mutaz B. Habal, MD.

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Pain Management for Nonsyndromic Craniosynostosis: Adequate Analgesia in a Pediatric Cohort?

Background: Postoperative pain following open craniosynostosis repair has not been studied extensively and is sometimes thought to be inconsequential. The purpose of this study was to assess postoperative pain in this pediatric population. Methods: We performed a retrospective chart review of patients (n = 54) undergoing primary open craniosynostosis repair from 2010 to 2016. Demographics, length of stay (LOS), pain scores, emesis events, and perioperative analgesics were reviewed. Multivariable regression models were designed to assess for independent predictors of LOS and emesis. Results: A high proportion had moderate to severe pain on postoperative day 0 (56.5%) and day 1 (60.9%). Opioid administered in postoperative period was 1.40 mg/kg/d in morphine milligram equivalent (MME) (±1.07 mg/kg/d MME). Majority of patients transitioned to enteral opioids on postoperative day 1 (24.5%) or day 2 (49.1%). Ketorolac was administered to 11.1% (n = 6). Emesis was documented in 50% of patients. LOS revealed a positive association with age (P = 0.006), weight (P = 0.009), and day of transition to enteral opioids (P 

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Maxillary Hypoplasia With Congenital Oligodontia Treated by Maxillary Distraction Osteogenesis

It is known that congenitally missing teeth can often cause differences in craniofacial morphology; however, there are few reported cases of orthognathic surgical treatment for these patients. Herein, the authors report a rare case of maxillary hypoplasia with congenital oligodontia treated by maxillary distraction osteogenesis with internal device. A 17-year-old male presenting with multiple tooth agenesis and maxillary recession was referred to our hospital for orthognathic surgical treatment. Preoperative simulation surgery was performed using Full-Color 3-dimensional salt model. After surgery, improvement in maxillary recession and occlusal stability was observed. This report demonstrates the advantages of the method used herein, which includes reduction in operating time with increase in the safety of the procedure. Address correspondence and reprint requests to Sayaka Mishima, DDS, Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan; E-mail: sayakams@kuhp.kyoto-u.ac.jp Received 5 April, 2017 Accepted 5 January, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Simple Technique for Reducing the Buccal Fat Pad During Mandibular Orthognathic Surgery

Sagittal split ramus osteotomy and intraoral vertical ramus osteotomy are commonly performed for the correction of jaw deformities. However, during mandibular orthognathic surgeries such as sagittal split ramus osteotomy and intraoral vertical ramus osteotomy , the authors sometimes encounter exposure of the buccal fat pad (BFP), which decreases the surgical field. The exposed BFP makes it difficult to perform these operations, may result in unexpected complications, and may increase the operation time. Therefore, the authors herein describe a simple, safe, and convenient technique for reducing the volume of the exposed BFP during mandibular orthognathic surgery using an electric knife in the coagulation mode. Address correspondence and reprint requests to Yoko Kawase-Koga, DDS, PhD, Department of Oral and Maxillofacial Surgery, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Tokyo 160-0023, Japan; E-mail: kogay@tokyo-med.ac.jp Received 28 September, 2017 Accepted 5 January, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Evaluation of the Olfactory Function With the “Sniffin’ Sticks” Test After Endoscopic Transsphenoidal Pituitary Surgery

The aim of this study was to evaluate the olfactory function of patients who had undergone endoscopic transsphenoidal pituitary surgery. In this prospective study, the "Sniffin' Sticks" test was performed between June 2016 and April 2017 at Izmir Katip Celebi University Ataturk Training and Research Hospital. Thirty patients who were scheduled to undergo endoscopic transsphenoidal pituitary surgery were evaluated preoperatively and 8 weeks postoperatively using the Sniffin' Sticks test battery for olfactory function, odor threshold, smell discrimination, and odor identification. The patients were evaluated preoperatively by an otolaryngologist. The patients' demographic data and olfactory functions were analyzed with a t test and Wilcoxon-labeled sequential test. The study group comprised 14 women (46.7%) and 16 men (53.3%) patients. The mean age of the patients was 37.50 ± 9.43 years (range: 16–53 years). We found a significant difference in the preoperative and postoperative values of the odor recognition test (P = 0.017); however, there was no significant difference between the preoperative and postoperative odor threshold values (P = 0.172) and odor discrimination values (P = 0.624). The threshold discrimination identification test scores were not significant (P = 0.110). The olfactory function of patients who were normosmic preoperatively was not affected postoperatively. This study shows that the endoscopic transsphenoidal technique for pituitary surgery without nasal flap has no negative effect on the olfactory function. Address correspondence and reprint requests to Ceren Kizmazoglu, MD, Department of Neurosurgery, Dokuz Eylul University School of Medicine, 35340 Balçova, Izmir, Turkey; E-mail: ceren.kizmazoglu@gmail.com Received 17 October, 2017 Accepted 3 January, 2018 The authors have no conflicts of interest to disclose. © 2018 by Mutaz B. Habal, MD.

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Frontal Mucocele Extended Orbita and Endoscopic Marsupialization Technique

Mucocele is benign, slow-growing, mucous-filled cystic lesions that arise in the paranasal sinuses. It causes progressive distension of the bony walls and induces compressive symptoms. Surgical treatment of paranasal sinus mucoceles includes endoscopic approach or external approach. The authors report a patient of frontal mucocele who presented with a history of progressive unilateral protrusion. Computed tomography scan revealed a large mucocele of the frontal sinus with orbital extension on the same side. He was successfully treated with endoscopic marsupialization without any serious complications. Address correspondence and reprint requests to Banu Atalay Erdogan, MD, Department of Otolaryngology, Kartal Dr. Lutfi Kirdar Education and Research Hospital, 34890 Cevizli, Kartal, Istanbul, Turkey; E-mail: banuatalay81@gmail.com Received 24 October, 2017 Accepted 5 January, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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A Reduction Technique for Depressed Medial Maxillary Fractures

The authors developed a technique for reducing the fractured segment by introducing an elevator through the accessory maxillary ostium (AMO). Through an upper gingivolabial vestibular incision, the fractured segments were exposed. In cases where no cleft was available for inserting the elevator, the blunt end of a Cottle elevator was inserted into the AMO via a nasal approach. The curved blunt end of a Cottle elevator was inserted into the middle meatus and the AMO was felt at the medial wall of the maxillary sinus. With gentle pressure, the tip was pushed into the maxillary sinus, and then pushed forward about 2 cm. An upward force was applied until the depressed segment was reduced to its original position. Through a gingivolabial vestibular incision, alignment of the reduced segments could be seen. Miniplate fixation can be applied. If the reduced segments are stable or too many segments are present, the fracture can be stabilized using tissue glue. The authors propose that in medial maxillary fractures where no cleft for the elevator is available, the fractured segment can be mobilized by introducing an elevator through the AMO. Address correspondence and reprint requests to Kun Hwang, MD, PhD, Department of Plastic Surgery, Inha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon 400-711, Korea; E-mail: jokerhg@inha.ac.kr Received 30 November, 2017 Accepted 5 January, 2018 This study was supported by a grant from National Research Foundation of Korea (NRF-2017R1A2B4005787). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Unilateral Orticochea Pharyngoplasty for Unilateral Velopharyngeal Dysfunction: Long-Term Outcomes Data

A unilateral deficit in velopharyngeal closure during speech production is an unusual presentation of velopharyngeal dysfunction (VPD) and few solutions have been described for this problem. This report details the long-term outcomes using this technique. We performed a retrospective chart review of all the patients who underwent a unilateral Orticochea pharyngoplasty for VPD. The authors identified 10 patients treated with 11 unilateral pharyngoplasty at a single tertiary care institutional setting. The mean age at repair was 8.6 years. The mean length of follow-up was 7.6 years. All the patients demonstrated improvement in velopharyngeal closure and speech resonance with 4 showing complete resolution of VPD. There were no revisions required or complications. One patient, after 10.7 years, required a unilateral procedure on the contralateral side which resulted in complete resolution of VPD postoperatively. Address correspondence and reprint requests to Arlen D. Denny, MD, FACS, Center for Craniofacial Disorders, P.O. Box 1997; MS C340, Milwaukee, WI 53201-1997; E-mail: adenny@chw.org Received 24 September, 2017 Accepted 7 January, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Ablation of Buccal Cancer and Functionality Buccal Reconstruction Using an Individuation Anterolateral Thigh Flap

The complex area for reconstruction of the head and the neck is the buccal because of difficult anatomy of this region. This article aimed to describe our individualized design for the reconstruction of the buccal using an different categories anterolateral thigh (ALT) flap. Ninety-four patients were involved in this study. Among 94cases, the number of using the musculocutaneous ALT flap was 57, using the fasciocutaneous ALT flap was 25, and using the thin ALT flap was 12. Postoperative vessel thrombosis occurred in 8 flaps, and required operative exploration in the perioperative period, 6 flaps were complete survival after the salvages, 2 flap was failure. The ALT flap represents a very good choice for the reconstruction of the complex defects at the cheek level. The flap can replace large volumes of tissues and the skin island is large and can be used both for the tegument reconstruction and for the oral mucosa reconstruction. Address correspondence and reprint requests to Dr. Guowen Sun, Department of Oral and Maxillofacial Surgery, Nangjing Stomatological Hospital,Medical School of Nanjing University,30 Zhongyang Road, Nanjing 210008, PR China; E-mail: guowensun@yahoo.com Received 3 September, 2017 Accepted 5 January, 2018 LZ and TZ contributed equally and should both be regarded as first authors. This research was supported by Jiangsu Provincial Special Program of Medical Science (BL2013005), Project of Health Department of Jiangsu province Nanjing science and technology development project (H201441), Nanjing science and technology development project (201503038) and Key project supported by Medical science and technology development Foundation Nanjing Department of Health (Ykk13150). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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A Rare Cause of Recurrent Cerebral Ischemia and Syncope: Eagle Syndrome

Eagle syndrome is defined as symptomatic elongation of the styloid process or calcification of the stylohyoid and stilomandibular ligament. The syndrome was described by WW Eagle in 1937. The styloid process is located between the internal and external carotid arteries and laterally in the tonsillar fossa. Patients with cerebrovascular ischemia causing syncope or hemiparesia due to Eagle syndrome are rarely published in the literature. The authors presented a patient with recurrent cerebrovascular attacks due to long styloid process. Address correspondence and reprint requests to Kemal Koray Bal, Resident Doctor, MD, Department of Otorhinolaryngology, Faculty of Medicine, University of Mersin, Mersin 33010, Turkey; E-mail: dr.kemalkoraybal@gmail.com Received 25 October, 2017 Accepted 7 January, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Nasolabial Morphology Following Nasoalveolar Molding in Infants With Unilateral Cleft Lip and Palate

Aim: The aim of the present study is to evaluate the effects of nasoalveolar molding (NAM) therapy on nasolabial morphology three dimensionally, and compare the nasolabial linear and surface distance measurements in infants with unilateral cleft lip and palate. Methods: Facial plaster casts of 42 infants with unilateral cleft lip and palate taken at the onset (pre-NAM) and finishing stage (post-NAM) of NAM were scanned with 3dMDface stereophotogrammetry system (3dMD, Atlanta, GA). Nineteen nasolabial linear and surface distance measurements were performed on three-dimensional images. In addition to standard descriptive statistical calculations (means and SDs), pre- and post-NAM measurements were evaluated by paired t test. Results: All measurements except lip gap, nostril floor width, and nostril diameter increased between pre-NAM and post-NAM. Nostril and lip height increased significantly on the cleft side (P 

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Postextraction Dental Implant in the Aesthetic Zone, Socket Shield Technique Versus Conventional Protocol

The aim of this randomized controlled trial was to evaluate the survival rate, the marginal bone level, and the aesthetic outcome; at 3 years' follow-up, of dental implants placed into a high-esthetic aesthetic zone by comparing 2 techniques of postextraction implant with immediate loading: the socket shied technique and the conventional insertion technique. Several clinical studies suggested that the avulsion of a dental element causes dimensional alterations of both soft and hard tissues at the postextractive site. To increase the aesthetic outcomes, the "socket-shield technique" has been proposed. This method involves maintaining the vestibular root portion and immediate insertion of the dental implant in close proximity to the root. Patients enrolled in this study were randomized to receive a postextraction implant in the aesthetic zone, either with the socket shied technique or with the conventional insertion technique. Implant survival, marginal bone level, and the pink aesthetic score were the outcomes evaluated. Implant survival rate was 100% in both the groups at 3 years. Implants inserted with the socket shield technique showed better values of both marginal bone level and pink aesthetic score (P 

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Does the Degree of the Mastoid Pneumatization Affect the Side of Bell Palsy?

Objective: The aim is to investigate the impact of degree of mastoid pneumatization on the affected side of Bell palsy (BP). Study Design: Retrospective study in tertiary academic hospital. Methods: In total, 52 patients who were diagnosed with as BP were included in the study. Each patient was staged using House–Brackmann (HB) staging system. All patients underwent temporal bone computed tomography imaging. House–Brackmann scores, side of the BP, and mastoid pneumatization of all of patients were evaluated in the present study. Results: Regarding the degree of the mastoid pneumatization, there were no significant differences between the affected side and the unaffected side (P = 0.439). The degree of the mastoid pneumatization of the affected side and the unaffected side did not differ between males and females (P = 0.918 for the affected side, P = 0.765 for the unaffected side, respectively). A negative correlation between the age and mastoid pneumatization of each side was found (P = 0.001, P = 0.025, respectively). There was no significant correlation between HB score and the degree of the mastoid pneumatization of each side (P = 0.789, P = 0.703). Conclusion: As a conclusion, the degree of the mastoid pneumatization is not one of the risk factors for BP. Further randomized studies with larger numbers of patients are needed to confirm these findings. Address correspondence and reprint requests to Dr Mustafa Çelik, MD, Bakirköy Dr Sadi Konuk Eğitim ve Araştirma Hastanesi, Zuhuratbaba Mah. Tevfik Sağlam Cad. No: 11, Bakirköy, 34147 Istanbul, Turkey; E-mail: dr.mcelik@yahoo.com Received 8 July, 2017 Accepted 1 December, 2017 The protocol for this study was approved by the hospital's local ethics committee (ethical committee number 2017/05/05). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Demystifying the “Triple Point: ” Technical Nuances of the Fronto-Orbital Advancement

Removal of the fronto-orbital bandeau is one of the most critical components for procedures designed to correct anomalies of the craniofacial skeleton and remodel the anterior calvarial vault. It is also used to improve exposure of the anterior cranial fossa. It is arguably one of the more difficult portions of some craniofacial procedures. While the technique for fronto-orbito-sphenoid osteotomy has been frequently described, it has only been minimally detailed. Separation of bone in this region remains challenging due to the bone thickness, adjacent vital structures, and limited direct visibility. The present paper describes the anatomy of this particular region, which the authors have termed the "triple point", to facilitate successful osteotomy and avoid potential injury. Address correspondence and reprint requests to Peter J. Taub, MD, FACS, Professor, Surgery, Pediatrics, Dentistry, and Neurosurgery; Professor, Medical Education; Program Director, Plastic and Reconstructive Surgery; Chief, Craniomaxillofacial Surgery, Icahn School of Medicine at Mount Sinai; Chief, Pediatric Plastic Surgery, Kravis Children's Hospital, 5 East 98th Street, New York, NY 10029; E-mail: Peter.taub@mountsinai.org Received 2 March, 2017 Accepted 30 June, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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Replacement of the distorted dentition of the Cone Beam Computed Tomography (CBCT) scans for orthognathic surgery planning

Publication date: Available online 28 February 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Turki Almutairi, Kurt Naudi, Neil Nairn, Xiangyang Ju, John Whitters, Aashraf Ayoub
PurposeCBCT imaging does not record dental morphology accurately due to the scattering produced by metallic restorations and the reported magnification. The aim of this study was the development and the evaluation of a new method for the replacement of the distorted dentition of CBCT scans with 3D dental image captured by a digital intraoral camera.
Materials and MethodSix dried skulls with orthodontics brackets fixed on the teeth were used in this study. Three intra-oral markers made of dental stone were constructed and attached to orthodontics brackets. The skulls were CBCT scanned and occlusal surfaces were captured using TRIOS ^® 3D intraoral scanner. The digital intra-oral scan (IOS) was fused into the CBCT models. This produced a new composite digital model of the skull and dentition. The skulls were scanned again using the commercially accurate Laser Faro^® arm to produce the 3D model "gold standard" for the assessment of the accuracy of the developed method. This was assessed by measuring the distance between the occlusal surfaces of the new composite model and the "gold standard" 3D laser scanned modelResultsThe results showed the errors related to the superimposition of the intra-oral image on the CBCT to replace the distorted dentition were between 0.11 and 0.20 mm.ConclusionThe results of this study suggests that the dentition in the CBCT can be accurately replaced with the digital IOS captured by an intra-oral scanner to create a composite model which will improve the accuracy of the digital orthognathic surgical planning and the fabrication of an occlusal wafer.



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Pesticides as risk factors for head and neck cancer: a review

Abstract

Humans may be exposed to pesticides such as fungicides, herbicides and insecticides, during occupational and non-occupational activities. Pesticides could be related to cancer development mainly because of their effects on the endocrine and immune systems and their cumulative effect. The present review evaluated in current literature evidence of an association between exposure to pesticides and the occurrence of head and neck cancer (HNC). A literature search for cohort studies was conducted in the PubMed, Web of science and Cochrane databases. Methodological quality of each study was rated with the Scottish Intercollegiate Guidelines Network (SIGN) checklist. One thousand one hundred thirty-two studies were identified. Thirty-two were included. Most of the studies found addressed occupational exposure to pesticides and were conducted in Europe and North America. Eleven high-quality studies were found. Most of them found no association between exposure to pesticides and increased risk of HNC. Two studies found some evidence of a positive association between pesticide (malathion and atrazine) exposure and thyroid cancer. The literature review does not support a clear evidence for association between pesticides exposure and HNC. Only limited evidence points to a positive association between exposure to some pesticides and thyroid cancer. Further standardized studies based on appropriate designs are required to clarify the effect of pesticides on the genesis of HNC, considering dose, length of exposure and type of pesticide.

This article is protected by copyright. All rights reserved.

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Monotherapy with a novel intervenolin derivative, AS-1934, is an effective treatment for Helicobacter pylori infection

Abstract

Background

Helicobacter pylori (H. pylori) infection causes various gastrointestinal diseases including gastric cancer. Hence, eradication of this infection could prevent these diseases. The most popular first-line treatment protocol to eradicate H. pylori is termed "triple therapy" and consists of a proton pump inhibitor (PPI), clarithromycin, and amoxicillin or metronidazole. However, the antibiotics used to treat H. pylori infection are hindered by the antibiotics-resistant bacteria and by their antimicrobial activity against intestinal bacteria, leading to side effects. Therefore, an alternative treatment with fewer adverse side effects is urgently required to improve the overall eradication rate of H. pylori.

Objective

The aim of this study was to assess the effectiveness and mechanism of action of an antitumor agent, intervenolin, and its derivatives as an agent for the treatment of H. pylori infection.

Results

We demonstrate that intervenolin, and its derivatives showed selective anti-H. pylori activity, including antibiotic-resistant strains, without any effect on intestinal bacteria. We showed that dihydroorotate dehydrogenase, a key enzyme for de novo pyrimidine biosynthesis, is a target and treatment with intervenolin or its derivatives decreased the protein and mRNA levels of H. pylori urease, which protects H. pylori against acidic conditions in the stomach. Using a mouse model of H. pylori infection, oral monotherapy with the intervenolin derivative AS-1934 had a stronger anti-H. pylori effect than the triple therapy commonly used worldwide to eradicate H. pylori.

Conclusion

AS-1934 has potential advantages over current treatment options for H. pylori infection.

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Exploring the in situ expression of vascular endothelial growth factor and endoglin in pemphigus foliaceus variants and pemphigus vulgaris

Abstract

Background

Erythroderma is a severe manifestation of pemphigus foliaceus (PF), a blistering disease mediated by IgG autoantibodies against desmoglein-1. Increasing evidence supports the contribution of angiogenic mediators in the pathogenesis of erythroderma.

Objective

To evaluate the in situ expression of vascular endothelial growth factor (VEGF) and endoglin in PF patients with erythroderma.

Methods

Formalin-fixed paraffin-embedded skin samples obtained from patients with erythrodermic PF (n=19; 12 patients with endemic PF), non-erythrodermic PF (n=17), pemphigus vulgaris (PV; n=10), psoriasis (n=10), and healthy individuals (HI; n=10) were processed in an automated immunohistochemistry platform utilizing anti-VEGF and anti-endoglin as primary antibodies. Reactivity was evaluated both manually (0=negative; 1+=mild; 2+=intense) and through an automated microvessel analysis algorithm.

Results

VEGF expression in erythrodermic PF was higher than in non-erythrodermic PF (p=0.034) and in HI (p=0.004), and similar to psoriasis (p=0.667) and PV (p=0.667). In non-erythrodermic PF, VEGF positivity was similar to HI (p=0.247), and lower than psoriasis (p=0.049) and PV (p=0.049). Both erythrodermic and non-erythrodermic PF presented similar endoglin expression (p=0.700). In addition, endoglin positivity during erythrodermic PF was similar to psoriasis (p=0.133) and lower than PV (p=0.0009). Increased expression of in situ VEGF suggests that healing processes are triggered in response to tissue damage led by autoantibodies in PF, especially during erythroderma. Reduced endoglin positivity suggests that an unbalanced angiogenesis may occur during erythrodermic PF. Further studies may help to confirm if the regulation of VEGF and endoglin expression in patients with PF can contribute to control the healing process and enable disease remission.

Conclusion

Overexpression of VEGF in erythrodermic PF as well as in PV and psoriasis points out a dysregulated repair process in severe forms of these diseases, and suggests VEGF and endoglin could act as prognostic markers and future therapeutic targets to enable proper healing in PF.

This article is protected by copyright. All rights reserved.

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Reply to Happle R. And al. Koebner's sheep in Wolf's clothing: does the isotopic response exist as a distinct phenomenon?

Abstract

We read with interest the issues raised by Happle and Kluger. The Koebner phenomenon is well-established and the number of diseases apparently showing this phenomenon has grown so much that a classification of subtypes exists. The concept of locus minoris resistentiae (lmr), which helps us explain why certain disorders occur in certain locations, appears to underlie both Koebner phenomenon and Wolf isotopic response. The isotopic response was initially defined as "the occurrence of a new disorder at the site of another, unrelated and already healed skin disease". Wolf himself cited lmr as a putative explanation for the occurrence of the isotopic response. Certain questions arise from the initial definition by Wolf and the ever growing extensions of the isotopic response we see today.

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Answer to Nwabudike LC and al. Koebner's sheep in Wolf's clothing: does the isotopic response exist as a distinct phenomenon?

Abstract

We thank Dr. Nwabudike for his interest in our article. We fully agree with him that the "isotopic response" is merely a variant of Koebner reaction. In fact, all forms of Koebner reaction can be taken as variants from each other.

This article is protected by copyright. All rights reserved.

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Hereditary palmoplantar keratodermas. Part I. Non-syndromic palmoplantar keratodermas: classification, clinical and genetic features

Abstract

The term palmoplantar keratoderma (PPK) indicates any form of persistent thickening of the epidermis of palms and soles, and includes genetic as well as acquired conditions. We review the nosology of hereditary PPKs that comprise an increasing number of entities with different prognoses, and a multitude of associated cutaneous and extracutaneous features. On the basis of the phenotypic consequences of the underlying genetic defect, hereditary PPKs may be divided into: i. non-syndromic, isolated PPKs, which are characterized by a unique or predominant palmoplantar involvement; ii. non-syndromic PPKs with additional distinctive cutaneous and adnexal manifestations, here named complex PPKs; iii. syndromic PPKs, in which PPK is associated with specific extracutaneous manifestations. To date, the diagnosis of the different hereditary PPKs is based mainly on clinical history and features combined with histopathological findings. In recent years, the exponentially increasing use of next generation sequencing technologies has led to the identification of several novel disease genes, and thus substantially contributed to elucidate the molecular basis of such a heterogeneous group of disorders. Here, we focus on hereditary non-syndromic isolated and complex PPKs. Syndromic PPKs are reviewed in the second part of this 2-part article, where other well-defined genetic diseases, which may present PPK among their phenotypic manifestations, are also listed and diagnostic and therapeutic approaches for PPKs are summarized.

This article is protected by copyright. All rights reserved.

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The depth of follicular extension in actinic keratosis correlates with the depth of invasion in squamous cell carcinoma: implication for clinical treatment

Abstract

Background

Actinic keratosis (AK) may show extension down follicules, not only in cases with full-thickness epidermal atypia ("bowenoid" AK), but also in cases with atypia limited to the epidermal basalis. Previous studies have demonstrated that in bowenoid AK, follicular extension is usually superficial, being limited to the upper follicular segment. Little is known about the depth of follicular involvement in cases of iSCC arising from AK and the role of the follicle in iSCC pathogenesis.

Objective

This study investigated the relationship between follicular extension of atypical keratinocytes in an AK and the development of iSCC from the follicular wall. The depth of follicular extension was correlated with the depth invasion of iSCC. Differences between the differentiated and classical pathways of iSCC were also examined.

Methods

We performed a retrospective histologic review of 193 biopsy specimens of iSCC with an associated AK. We assessed the presence and depth of follicular extension of atypical keratinocytes in the AK, using tumor (Breslow) thickness and the follicular unit level (infundibular, isthmic and sub-isthmic), as well as iSCC being present directly adjacent to the follicular basalis.

Results

Follicular extension was present in 25.9% of the cases (50 cases), usually extending into the lower follicular segment. The iSCC was present directly adjacent to the follicular basalis in 58% of the cases (29 cases), correlating highly with the depth of follicular extension (infundibular: 3/12; isthmic: 21/33; sub-isthmic 5/5).

Conclusion

The depth of follicular extension of atypical keratinocytes in an AK correlates with the development of depth of invasion of an associated iSCC, irrespective of the pathway of origin. It is therefore important to note the presence and the depth of follicular extension when diagnosing an AK, since follicular extension likely accounts for a significant proportion of recurrent AK and the development of iSCC following superficial treatment modalities.

This article is protected by copyright. All rights reserved.

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Clinical and Instrumental Evaluation of Late Dysphagia in Patients With Oropharynx and Nasopharynx Cancer, Candidates to Combined Radiochemotherapy With Intensity Modulated Technique (IMRT)

Conditions:   Cancer of Oropharynx;   Cancer of Nasopharynx
Intervention:  
Sponsor:   Azienda Ospedaliero, Universitaria Pisana
Recruiting

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The international WAO/EAACI guideline for the management of hereditary angioedema – the 2017 revision and update

Hereditary Angioedema (HAE) is a rare and disabling disease. Early diagnosis and appropriate therapy are essential. This update and revision of the global guideline for HAE provides up-to-date consensus recomm...

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Clinically diagnosed cholecystitis: a case series

Abstract

In patients presenting with classic signs and symptoms of cholecystitis, the diagnosis is made based on confirmatory imaging studies. However, the most commonly utilized imaging studies lack accuracy, especially in the case of acalculous disease. Here we discuss four cases of patients presenting with symptoms of cholecystitis. All four patients underwent multiple imaging studies, which yielded negative results. Due to persistent symptoms, the decision was made to proceed with cholecystectomy. Each patient underwent uncomplicated cholecystectomy, with resolution of symptoms post-operatively, and continued symptoms relief 6–10 months post-operatively. Cholecystitis is a clinical diagnosis. Negative imaging studies should not influence the management in a patient presenting with classic signs and symptoms of cholecystitis.

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False-positive radioiodine accumulation in a huge pelvic mass after thyroidectomy for papillary carcinoma, a case report from Syria

Abstract

Iodine has always been connected to thyroid gland, and the fact that thyroid tissue traps, organificates and stores iodine more than other tissues is well known, hence the use of radioiodine as a diagnostic and therapeutic tool for thyroid disorders. However, false-positive cases do occur. We present a case of a 34-year-old patient who underwent total thyroidectomy for papillary carcinoma. Results of follow up TSH, thyroglobulin and thyroglobulin antibody tests after surgery lead to two rounds of radioactive iodine. After that, a radioiodine whole-body scan showed high uptake in the pelvis above bladder. Computed tomography scan showed a pelvic heterogeneous mass with some calcifications. Surgical removal and subsequent pathology confirmed the absence of metastasis. The final pathological diagnosis was serous cystadenoma, endometriosis cyst and leiomyoma. As the real cause behind false-positive iodine uptake by these tissues has yet to be determined, careful assessment should be considered in any suspicious case.

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Bowel endometriosis treated with simultaneous ileocecal and rectal resection

Abstract

A 43-year-old female noticed hematochezia and lower-right abdominal pain during menstruation. Her family doctor detected a mass by computed tomography at the ileocecum. She was referred to our hospital and colonoscopy was performed. We observed extrinsic pressure resulting in mucosal change at the ileocecum. We also observed a submucosal tumor-like lesion at the rectosigmoid. We performed biopsy from both lesions, both were benign. Ileocecal resection and rectal low anterior resection were performed for diagnosis. Redness, induration and serosal dimpling were recognized at the ileocecum, rectosigmoid and upper rectum. All lesions had endometorial tissue in muscular layer, so pathological diagnosis was bowel endometriosis. Bowel endometriosis occurring in multiple parts and where two colectomies were performed simultaneously is very rare. To determine the optimal method of treatment for the bowel endometriosis, detailed preoperative examination must be performed, specifically complete surgical resection of the lesion for definite diagnosis.

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Seroclearance of hepatitis B surface antigen following hepatitis E exacerbation on chronic hepatitis E and B dual infection in a renal transplant recipient: a case report

Hepatitis E virus infection usually causes an acute and self-resolving hepatitis. In areas where chronic hepatitis B virus infection is prevalent, acute hepatitis E virus superinfection on chronic hepatitis B ...

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Uses of biologics in allergic diseases: what to choose and when

Publication date: Available online 27 February 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Tara Vinyette Saco, Amber Pepper, Thomas B. Casale




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The Eosinophil: for better or worse, in sickness and in health

Publication date: Available online 27 February 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Bruce S. Bochner




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Epinephrine auto-injector needle lengths can both subcutaneous and periosteal/intraosseous injection be avoided?

Publication date: Available online 27 February 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Sten Dreborg, Laura Kim, Gina Tsai, Harold Kim
BackgroundAdministration of epinephrine should be intramuscularly in the anterolateral aspect of the thigh. The length of the epinephrine autoinjector, EAI, needle should assure intramuscular injection.ObjectiveTo discuss suitable needle lengths of EAIs based on ultrasound measurements related to weight.MethodsThe skin to muscle distance (STMD) and skin to bone distance (STBD) was measured by ultrasound on the mid third anterolateral area of the right thigh, applying either high pressure (max)(8 lb.)(HPEAI) or low pressure (min)(LPEAI) on an ultra-sound probe. Three hundred two children and adolescents and 99 adults were included. The STMDmax and STMDmin as well as the STBDmax and STBDmin were estimated.ResultsUsing HPEAIs, the risk of periosteal/intraosseous penetration was 32% in children weighing less than 15 kg. The risk of subcutaneous injection was 12% in adolescents and 33% in adults. With LPEAIs, there was no risk of periosteal/intraosseous injection and the risk of subcutaneous injections in adolescents and adults was less, 2 and 10%, respectively. A new EAI aimed for injection in small children would have no risk of periosteal/intraosseous injection but 71% chance of subcutaneous deposit of epinephrine.ConclusionCommon HPEAIs have a high risk of periosteal/intraosseous penetration in children and subcutaneous injections in overweight and obese adults. The LPEAIs have some risk of subcutaneous injection in adults. HPEAIs 0.1 mg epinephrine and shorter needle has no risk of periosteal/intraosseous injection but a high risk of subcutaneous deposit. For use in adult, over-weight/obese patients, HPEAIs and LPEAIs should have longer needles. Future studies should focus on the triggering pressures and the variations in needle length.



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Hypereosinophilic syndrome presenting acutely with neurologic signs

Publication date: Available online 28 February 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Barbara A. Brunet, Rebecca M. Sugg, Patricia Stewart




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In vitro investigation on probiotic, anti-Candida, and antibiofilm properties of Lactobacillus pentosus strain LAP1

Publication date: May 2018
Source:Archives of Oral Biology, Volume 89
Author(s): Chirom Aarti, Ameer Khusro, Rakesh Varghese, Mariadhas Valan Arasu, Paul Agastian, Naïf Abdullah Al-Dhabi, Soundharrajan Ilavenil, Ki Choon Choi
ObjectiveTo investigate the probiotic characteristics, anti-Candida activity, and antibiofilm attributes of Hentak derived Lactobacillus pentosus strain LAP1.DesignThe probiotic properties of strain LAP1 was depicted by adapting standard protocols. The anti-Candida and antibiofilm properties of isolate were determined using agar well diffusion assay and ELISA reader test, respectively. The time-kill assay was performed using viable colony count assay. Further, the co-aggregation property of strain LAP1 was determined based on standard methodology.ResultsStrain LAP1 exhibited not only tolerance to acidic pH but also showed resistivity (P ≤ 0.05) to simulated gastric juice exposure. Similarly, the strain was able to tolerate bile salt, showed hyperproteolytic activity, and also depicted susceptibility to most of the antibiotics tested. Auto-aggregation phenomenon (37.5–60%), hydrophobicity nature (42.85%), and survival potentiality of strain LAP1 under freeze-dried condition (9.0 ± 0.01 log CFU/ml) made the isolate a promising probiotic candidate. Cell-free neutralized supernatant (CFNS) of strain LAP1 exhibited potent antifungal activities against C. albicans, C. tropicalis, and C. krusei with arbitrary unit of 150 ± 4.34, 200 ± 5.21, and 130 ± 5.13 AU/ml, respectively and depicted remarkable reduction in the biofilm formation of respective Candida sp. in a concentration dependent manner. Moreover, time-kill assay data provided the growth inhibition of all Candida sp. in a time dependent manner. Additionally, strain LAP1 revealed significant co-aggregate percentage with C. albicans, C. tropicalis, and C. krusei.ConclusionsL. pentosus strain LAP1 exhibited a good probiotic characteristics, potent anti-Candida activity, and significant antibiofilm property that could be undoubtedly recommended for its vast applications not only in food industries but also as biotherapeutic agent against Candida infections in pharmaceutical industries.



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In vitro investigation on probiotic, anti-Candida, and antibiofilm properties of Lactobacillus pentosus strain LAP1

Publication date: May 2018
Source:Archives of Oral Biology, Volume 89
Author(s): Chirom Aarti, Ameer Khusro, Rakesh Varghese, Mariadhas Valan Arasu, Paul Agastian, Naïf Abdullah Al-Dhabi, Soundharrajan Ilavenil, Ki Choon Choi
ObjectiveTo investigate the probiotic characteristics, anti-Candida activity, and antibiofilm attributes of Hentak derived Lactobacillus pentosus strain LAP1.DesignThe probiotic properties of strain LAP1 was depicted by adapting standard protocols. The anti-Candida and antibiofilm properties of isolate were determined using agar well diffusion assay and ELISA reader test, respectively. The time-kill assay was performed using viable colony count assay. Further, the co-aggregation property of strain LAP1 was determined based on standard methodology.ResultsStrain LAP1 exhibited not only tolerance to acidic pH but also showed resistivity (P ≤ 0.05) to simulated gastric juice exposure. Similarly, the strain was able to tolerate bile salt, showed hyperproteolytic activity, and also depicted susceptibility to most of the antibiotics tested. Auto-aggregation phenomenon (37.5–60%), hydrophobicity nature (42.85%), and survival potentiality of strain LAP1 under freeze-dried condition (9.0 ± 0.01 log CFU/ml) made the isolate a promising probiotic candidate. Cell-free neutralized supernatant (CFNS) of strain LAP1 exhibited potent antifungal activities against C. albicans, C. tropicalis, and C. krusei with arbitrary unit of 150 ± 4.34, 200 ± 5.21, and 130 ± 5.13 AU/ml, respectively and depicted remarkable reduction in the biofilm formation of respective Candida sp. in a concentration dependent manner. Moreover, time-kill assay data provided the growth inhibition of all Candida sp. in a time dependent manner. Additionally, strain LAP1 revealed significant co-aggregate percentage with C. albicans, C. tropicalis, and C. krusei.ConclusionsL. pentosus strain LAP1 exhibited a good probiotic characteristics, potent anti-Candida activity, and significant antibiofilm property that could be undoubtedly recommended for its vast applications not only in food industries but also as biotherapeutic agent against Candida infections in pharmaceutical industries.



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Impact of Previous Biologic Use on Efficacy and Safety of Brodalumab and Ustekinumab in Patients with Moderate-to-Severe Plaque Psoriasis: Integrated Analysis of AMAGINE-2 and AMAGINE-3

Abstract

Background

Biologics used increasingly used for treating moderate-to-severe psoriasis. Efficacy may differ in patients with previous biologics exposure.

Objective

To investigate the impact of previous biologic exposure on efficacy and safety of brodalumab and ustekinumab in moderate-to-severe plaque psoriasis.

Methods

Two placebo- and ustekinumab-controlled phase 3 clinical trials. Initial 12-week induction phase where patients were treated with brodalumab (210mg Q2W or 140mg Q2W), ustekinumab or placebo. Efficacy endpoints included: Psoriasis Area and Severity Index (PASI 75) and Physician's Global Assessment (sPGA 0/1) versus placebo, PASI 100 versus ustekinumab, Dermatology Life Quality Index (DLQI) and Psoriasis Symptom Inventory (PSI). Adverse events were monitored throughout.

Results

493 patients (334 [27%] brodalumab 210 mg Q2W and 159 [26%] ustekinumab) received prior biologics exposure; 150 (12%) and 62 (10%) reporting previously failed biologic. Brodalumab efficacy in patients with or without previous biologics exposure was statistically equivalent; 40.9% and 39.5% of bio-naïve and -experienced patients achieved PASI 100 at Week 12, compared with 21.1% and 17.0% with ustekinumab (both P<0.001). In patients where prior biologics had been successful or failed, 41.7% and 32.0% achieved PASI 100, compared with 21.1% and 11.3% with ustekinumab. Tolerability was similar, and did not appear to be influenced by previous biologic treatment.

Conclusions

Efficacy of brodalumab 210 mg Q2W was similar regardless of prior biologic therapy (P=0.31, 0.32 and 0.64 for PASI 75, 90, and 100 respectively). Almost twice as many patients achieved PASI 100 or complete clearance at Week 12 compared with ustekinumab; differences most noticeable where previous biologics had failed. Both treatments were well tolerated.

This article is protected by copyright. All rights reserved.

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Risk of intraocular and other extracutaneous involvement in patients with cutaneous juvenile xanthogranuloma

Abstract

Background/Objectives

Cutaneous juvenile xanthogranuloma is an uncommon, usually benign disease affecting infants and young children. Ocular and other systemic involvement have been reported, but their incidence is unclear, and the utility of routine screening is not well established. Our aim was to characterize the risk of ocular and systemic complications in children with cutaneous juvenile xanthogranuloma.

Methods

In this retrospective study, we reviewed the medical charts of children with cutaneous juvenile xanthogranuloma seen at Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois, between January 2000 and December 2015. A comprehensive literature review was also performed.

Results

Of 338 children with cutaneous juvenile xanthogranuloma, 76 (median age 6 months, 51% female) met inclusion criteria. The most frequently involved site was the head and neck region (40%). In 39 patients (51%), there was a single lesion. Multiple lesions (>5) were evident in 20 patients (26%). Most cutaneous juvenile xanthogranulomas were micronodular (77%). None of the patients had ocular involvement. One patient had multiple asymptomatic hepatic nodules on imaging that regressed spontaneously within several months. Literature review of pediatric cutaneous juvenile xanthogranuloma series, including our cohort, revealed that the incidence of ocular manifestations is 0.24% (7/2949) and of systemic manifestations is 0.75% (22/2949).

Conclusion

Cutaneous juvenile xanthogranulomas are generally limited to the skin. Because eye involvement is rare, a routine eye examination is of low yield and probably not warranted in children with no ocular or visual symptoms. New recommendations for systemic screening could not be drawn from this study.

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Familial papular epidermal nevus with “skyline” basal cell layer and multiple pilomatricomas: A new association?

Abstract

Papular epidermal nevus with "skyline" basal cell layer is a newly described keratinocytic nevus. Recently, papular epidermal nevus with "skyline" basal cell layer has been reported in association with extracutaneous involvement, and the term papular epidermal nevus with "skyline" basal cell layer syndrome is used to indicate a neurocutaneous syndrome characterized by the presence of papular epidermal nevus with "skyline" basal cell layer and different neurologic symptoms that seem to improve during infancy and adolescence. Multiple pilomatricomas have been reported in association with various syndromes. We report herein papular epidermal nevus with "skyline" basal cell layer associated with multiple pilomatricomas in two members of a family with the aim of drawing attention to this peculiar epidermal nevus to improve our knowledge of the syndrome.

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Color Atlas of Oral Diseases, Diagnosis and Treatment Edited by G. Laskaris Fourth edition Stuttgart, Germany: Thieme, 2017. ISBN 9783137170044

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Circulating BRAFV600E Levels Correlate with Treatment in Patients with Thyroid Carcinoma

Thyroid , Vol. 0, No. 0.


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Circulating BRAFV600E Levels Correlate with Treatment in Patients with Thyroid Carcinoma

Thyroid , Vol. 0, No. 0.


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Circulating BRAFV600E Levels Correlate with Treatment in Patients with Thyroid Carcinoma

Thyroid , Vol. 0, No. 0.


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Circulating BRAFV600E Levels Correlate with Treatment in Patients with Thyroid Carcinoma

Thyroid , Vol. 0, No. 0.


http://ift.tt/2ozzX50

Circulating BRAFV600E Levels Correlate with Treatment in Patients with Thyroid Carcinoma

Thyroid , Vol. 0, No. 0.


http://ift.tt/2ozzX50

Circulating BRAFV600E Levels Correlate with Treatment in Patients with Thyroid Carcinoma

Thyroid , Vol. 0, No. 0.


http://ift.tt/2ozzX50

Circulating BRAFV600E Levels Correlate with Treatment in Patients with Thyroid Carcinoma

Thyroid , Vol. 0, No. 0.


http://ift.tt/2ozzX50

Circulating BRAFV600E Levels Correlate with Treatment in Patients with Thyroid Carcinoma

Thyroid , Vol. 0, No. 0.


http://ift.tt/2ozzX50

Circulating BRAFV600E Levels Correlate with Treatment in Patients with Thyroid Carcinoma

Thyroid , Vol. 0, No. 0.


http://ift.tt/2ozzX50

Circulating BRAFV600E Levels Correlate with Treatment in Patients with Thyroid Carcinoma

Thyroid , Vol. 0, No. 0.


http://ift.tt/2ozzX50

Circulating BRAFV600E Levels Correlate with Treatment in Patients with Thyroid Carcinoma

Thyroid , Vol. 0, No. 0.


http://ift.tt/2ozzX50

Circulating BRAFV600E Levels Correlate with Treatment in Patients with Thyroid Carcinoma

Thyroid , Vol. 0, No. 0.


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Acquired perforating collagenosis in a non-diabetic patient with advanced prostate carcinoma: A review of perforating dermatosis associated with malignancy

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HLA-DRB1*04:05 in two cases of Vogt–Koyanagi–Harada disease-like uveitis developing from an advanced melanoma patient treated by sequential administration of nivolumab and dabrafenib/trametinib therapy

Abstract

Although uveitis is reported as a rare adverse event (AE) associated with dabrafenib/trametinib therapy or nivolumab, the occurrence of severe uveitis is extremely rare. We describe two cases of Vogt–Koyanagi–Harada (VKH)-like uveitis developing after the sequential administration of nivolumab and dabrafenib/trametinib therapy. Interestingly, both cases had HLA-DRB1*04:05, which is strongly associated with VKH disease, and achieved biologically complete remission after the treatment for uveitis. Our cases suggest a possible correlation between VKH-like uveitis as an AE and the clinical outcomes of sequential administration of nivolumab and dabrafenib/trametinib therapy for the treatment of advanced melanoma.

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Unusual association between digital mucous cyst and acquired ungual fibrokeratoma: A case report

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Case of pyoderma gangrenosum-like sporotrichosis caused by Sporothrix globosa in a patient with ulcerative colitis

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Landiolol hydrochloride to successfully treat refractory ventricular arrhythmia during weaning from cardiopulmonary bypass

We effectively treated refractory ventricular arrhythmia (RVA) at the time of weaning from the cardiopulmonary bypass (CPB) during aortic valve replacement with landiolol for three patients who failed to respond to electrical defibrillation. Demographic data, comorbid factors, and preoperative finding were noted [Table 1].

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Human factors study in untrained adolescents comparing an epinephrine prefilled syringe (symjepi™) with EpiPen® autoinjector

Self- or caregiver administration of epinephrine is considered the treatment of choice for acute anaphylaxis (1). In June 2017, US FDA approved Symjepi™, a prefilled syringe used for the administration of epinephrine (2).

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Uses of biologics in allergic diseases: what to choose and when

Choosing a biologic therapy for asthma, urticaria, atopic dermatitis, or nasal polyps should be based on disease phenotype, relevant biomarkers, comorbid allergic conditions, and FDA approval status.

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The Eosinophil: for better or worse, in sickness and in health

Key messages

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Epinephrine auto-injector needle lengths can both subcutaneous and periosteal/intraosseous injection be avoided?

Administration of epinephrine should be intramuscularly in the anterolateral aspect of the thigh. The length of the epinephrine autoinjector, EAI, needle should assure intramuscular injection.

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Surgical Care and Otolaryngology in Global Health

Surgical access is inadequate for most people. The Lancet Commission on Global Surgery established 6 indicators to measure surgical access: geographic accessibility, density of surgical providers, number of procedures performed, perioperative mortality, impoverishing expenditure, and catastrophic expenditure. Otolaryngology surgical, training, and research efforts use these 6 indicators to maximize impact and coordination of worldwide efforts in surgery. Research must be rigorous and consider the counterfactual. For otolaryngologists who want to contribute, focusing on 1 of the 6 indicators may be most impactful.

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Workforce Considerations, Training, and Diseases in Africa

Surgeons in sub-Saharan Africa face different challenges than those in developed countries: extreme shortages of otolaryngologists, speech pathologists, and audiologists; lack of training opportunities; and a paucity of otolaryngology services aggravated by population growth and aging. In addition to common Western diseases, patients have otolaryngology complications related to the human immunodeficiency virus, tuberculosis, malaria, and trauma. Less than 5% of the population has access to timely, safe, affordable surgery; 29 out of 52 African countries have no radiotherapy services. Discussion focuses on education and training, which can be achieved in several ways, some complimentary.

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Melanoma risk prediction using a multi-locus genetic risk score in the Women’s Health Initiative cohort

Single-nucleotide polymorphisms (SNPs) associated with melanoma have been identified though genome-wide association studies (GWASs). However, the combined impact of these SNPs on melanoma development remains unclear, particularly in post-menopausal women who carry lower melanoma risk.

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The Risk of Cardiovascular Events in Psoriasis Patients Treated with Tumor Necrosis Factor-alpha Inhibitors versus Phototherapy: An Observational Cohort Study

Psoriasis is a risk factor for cardiovascular events.

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Dermatologists are the primary treating physicians of skin cancer in the United States Medicare population

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Dermatology and climate change

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Title: Opioid, Alcohol, and Cannabis Misuse Among Patients with Hidradenitis Suppurativa: a population-based analysis in the United States

Patients with hidradenitis suppurativa (HS) experience chronic pain and have significant physical, emotional and psychological disease impact. These patients may be at risk for substance abuse.

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Surgical Pearl: Video chat to prevent wrong site surgery

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Similar survival of patients with multiple vs. single primary melanomas based on Utah SEER data (1973-2011)

Survival data are mixed comparing patients with multiple primary melanomas (MPM) to those with single primary melanomas (SPM).

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Drugs With a REMS: Benefit/Risk Counseling to Patients

Do you know what to do when counseling a patient on a drug with a REMS designation? Learn more with new guidance from the FDA.
FDA Expert Commentaries and Interviews

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Diagnosis and endoscopic endonasal management of nontraumatic pseudoaneurysms of the cranial base

Background

Nontraumatic pseudoaneurysms of the cranial base are rare and present unique diagnostic and treatment dilemmas compared with both true aneurysms and pseudoaneurysms outside of the cranial base. There is a dearth of knowledge regarding the management of these complicated lesions.

Methods

Nontraumatic pseudoaneurysms of the cranial base internal carotid artery (ICA) were retrospectively identified at the University of Pittsburgh Medical Center through a key word search of cranial base cases from 2010 to 2017.

Results

Three cases were identified, demonstrating pseudoaneurysms of the cavernous and petrous ICA. Each patient underwent diagnostic work-up with computed tomography, magnetic resonance imaging, and angiography, followed by endovascular occlusion and endoscopic endonasal surgery, which resulted in relief of presenting complaints and ablation of the pseudoaneurysm.

Conclusion

Symptomatic cranial base pseudoaneurysms should undergo treatment to obliterate the aneurysm and relieve the mass effect. First, formal angiography is necessary for accurate diagnosis and treatment planning. Next, endovascular occlusion is performed, with a preference for coiling or endoluminal reconstruction with a flow diverter. Last, endoscopic intervention follows in cases where: (1) decompression of vital structures is indicated; (2) diagnosis of the pseudoaneurysm cannot be definitively confirmed with angiography; or (3) the etiology of the confirmed pseudoaneurysm requires further investigation.

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Management of long-lasting phantosmia: a systematic review

Background

Interest in the pathophysiology and management of phantom smells has increased rapidly over the last decade. A PubMed search for the term "phantosmia" demonstrated a near-doubling of articles published on phantosmia within the past 7 years. We aimed to systematically review the literature on the management of phantosmia.

Methods

The PubMed, EMBASE, and Cochrane databases were searched for articles published since January 1990, using terms combined with pertinent Boolean search operators. We included articles evaluating management of phantosmia written in the English language, with original data and a minimum of 6 months of follow-up, on at least 2 patients and with well-defined and measurable outcomes.

Results

A total of 2151 unique titles were returned upon the initial search. Of these, 146 abstracts were examined, yielding 7 articles meeting the inclusion criteria. All articles were predominantly level 4 evidence. One prospective level 3 study was included. The studies included a total of 96 patients, with follow-up ranging from 6 months to 11 years. Endpoints were primarily based on subjective patient responses. Management options included observation and medical and surgical therapy. Olfactory mucosa excision was the only surgical intervention studied, with short-term symptomatic improvement in 10 of 11 patients. Forty-one patients were treated medically, which included antipsychotic, antimigraine, and antiseizure medications, transcranial stimulation, and topical cocaine application.

Conclusion

Despite increasing interest in the treatment of phantosmia and reports of successful therapies, there remains a paucity of data and lack of consensus regarding optimal management of this difficult condition.

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A challenge-response endoscopic sinus surgery specific checklist as an add-on to standard surgical checklist: an evaluation of potential safety and quality improvement issues

Background

The goal of this study was to develop and evaluate the impact of an aviation-style challenge and response sinus surgery–specific checklist on potential safety and equipment issues during sinus surgery at a tertiary academic health center. The secondary goal was to assess the potential impact of use of the checklist on surgical times during, before, and after surgery. This initiative is designed to be utilized in conjunction with the "standard" World Health Organization (WHO) surgical checklist. Although endoscopic sinus surgery is generally considered a safe procedure, avoidable complications and potential safety concerns continue to occur. The WHO surgical checklist does not directly address certain surgery-specific issues, which may be of particular relevance for endoscopic sinus surgery.

Methods

This prospective observational pilot study monitored compliance with and compared the occurrence of safety and equipment issues before and after implementation of the checklist. Forty-seven consecutive endoscopic surgeries were audited; the first 8 without the checklist and the following 39 with the checklist. The checklist was compiled by evaluating the patient journey, utilizing the available literature, expert consensus, and finally reevaluation with audit type cases. The final checklist was developed with all relevant stakeholders involved in a Delphi method.

Results

Implementing this specific surgical checklist in 39 cases at our institution, allowed us to identify and rectify 35 separate instances of potentially unsafe, improper or inefficient preoperative setup. These incidents included issues with labeling of topical vasoconstrictor or injectable anesthetics (3, 7.7%) and availability, function and/or position of video monitors (2, 5.1%), endoscope (6, 15.4%), microdebrider (6, 15.4%), bipolar cautery (6, 15.4%), and suctions (12, 30.8%).

Conclusion

The design and integration of this checklist for endoscopic sinus surgery, has helped improve efficiency and patient safety in the operating room setting.

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