Non-interventional study to collect data for the application of lidocaine gel 2% during scaling and root planing and professional mechanical plaque removal

Abstract

Objectives

Evaluation of the safety and efficacy of a topical lidocaine gel 2% (LG) during scaling and root planing (SRP) and professional mechanical plaque removal (PMPR).

Materials and methods

The anesthetic effects as well as unwanted effects of LG prior to or during SRP and PMPR were evaluated in an observational, non-randomized, non-interventional study design. A total of 385 treatments were recorded in 68 study centers all over Germany. Rating of the anesthetic effect of LG by treating personnel and patients using a four-item verbal rating scale (VRS), tolerability, safety (adverse effects), and need for additional local injection anesthesia (ALI).

Results

In SRP as well as in PMPR, application of LG allowed a sufficiently pain-free therapy in more than 90% of the patients as stated on the VRS (SRP: 97.8%, PMPR: 93.75%). Overall, ALI was needed in only 4.23% of the patients treated (SRP: 5.3%, PMPR: 2.62%). One adverse effect occurred within the observation.

Conclusions

Application of LG may offer a safe and effective way to achieve pain-free therapy in periodontal patients.

Clinical relevance

Patient compliance is key to the success of periodontal maintenance therapy. Effective and safe pain control during various kinds of periodontal therapy might increase patient compliance and therefore contribute to the long-term treatment success, among other factors. With regard to the patients observed in this study, 47% had previously received periodontal maintenance therapy and were therefore familiar with the treatment and the associated pain.

https://ift.tt/2HLsRD6

Laryngopharyngeal Reflux: Current Concepts on Etiology and Pathophysiology and Its Role in Dysphagia

Abstract

Purpose of Review

Laryngopharyngeal reflux (LPR) is one of the most commonly encountered chronic inflammatory conditions of the larynx. The lack of a unifying consensus regarding diagnosis and management makes it difficult to relate laryngeal disorders and dysphagia to this disease entity, particularly for an otolaryngologist. This article reviews diagnosis and management of LPR from an otolaryngological and gastroenterological perspective by reconciling current trends in the literature.

Recent Findings

More sophisticated testing via multichannel pH probes as well as the implementation of pepsin assays has potential in diagnosing LPR. This will hopefully more clearly delineate this disease entity, in the setting of dysphagia.

Summary

Dysphagia and LPR both have significant overlap with numerous disease entities. Though there is little literature to address outcomes in treatment and management of dysphagia in the setting of LPR, few studies show that managing LPR-related dysphagia may improve with surgical intervention if there is no improvement with conservative management.

https://ift.tt/2HH8qHd

Book review—Diagnostic Pathology: Cytopathology, 2nd edition

https://ift.tt/2HFq12b

CD14+ monocytes contribute to inflammation in chronic nonbacterial osteomyelitis (CNO) through increased NLRP3 inflammasome expression

Publication date: Available online 30 April 2018
Source:Clinical Immunology
Author(s): D. Brandt, E. Sohr, J. Pablik, A. Schnabel, F. Kapplusch, K. Mäbert, J.H. Girschick, H. Morbach, F. Thielemann, S.R. Hofmann, C.M. Hedrich
The pathophysiology of chronic nonbacterial osteomyelitis (CNO) remains incompletely understood. Increased NLRP3 inflammasome activation and IL-1β release in monocytes from CNO patients was suggested to contribute to bone inflammation. Here, we dissect immune cell infiltrates and demonstrate the involvement of monocytes across disease stages. Differences in cell density and immune cell composition may help to discriminate between BOM and CNO. However, differences are subtle and infiltrates vary in CNO. In contrast to other cells involved, monocytes are a stable element during all stages of CNO, which makes them a promising candidate in the search for "drivers" of inflammation. Furthermore, we link increased expression of inflammasome components NLRP3 and ASC in monocytes with site-specific DNA hypomethylation around the corresponding genes NLRP3 and PYCARD. Our observations deliver further evidence for the involvement of pro-inflammatory monocytes in the pathophysiology of CNO. Cellular and molecular alterations may serve as disease biomarkers and/or therapeutic targets.



https://ift.tt/2HDdQqW

Evaluation of a portable low-budget three-dimensional stereophotogrammetry system for nasal analysis

Three-dimensional (3D) photogrammetry has reached high standards and accuracy but is mainly conducted with stationary and expensive systems. The purpose of this study was to evaluate the accuracy of a low-budget portable system with special regard to the gracile and challenging nasal region.

https://ift.tt/2KtpAd0

Comparative evaluation of efficacy of EMLA and needleless jet anesthesia in non-surgical periodontal therapy

Publication date: Available online 30 April 2018
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Rajan Guptad, Satwinder Kaur, Parveen Dahiya, Mukesh Kumar
The treatment of periodontitis primarily consists of mechanical debridement carried out by means of thorough scaling and root planing that might sometimes be a painful procedure which requires the administration of some form of local anesthesia. The present study comparatively evaluates the anesthetic effect of three such forms, viz; eutectic mixture of 25mg/g lignocaine plus 25mg/g prilocaine (EMLA) and needleless jet anesthesia during SRP. 30 patients with probing depth of 5mm or more and visual analog scale (VAS) score of ≥30mm on probing were selected and asked to assess the pain by VAS and verbal rating scale (VRS) during SRP after application of the two agents. The difference between the visual analogue values of control, EMLA and Madajet XL is highly significant (p <0.001). According to the VRS scores, 6.7% of the subjects in the EMLA group reported no pain, 80% mild pain, and 13.3% moderate pain. In the Madajet XL group, 46.7% reported no pain and 53.3% mild pain. In the control group 100% of the patients reported moderate pain when none of the anesthetic was administered. None reported severe pain. Thus, the data suggest that both anesthetics are able to produce anesthesia of the tissues. The needleless anesthesia was relatively superior in performance to EMLA.



https://ift.tt/2rbG0yd

Use of Neodymium magnetic discs as pressure earrings for ear lobe keloid post-excision

https://ift.tt/2JBiGBp

2 to Z flap for reconstruction of adjacent skin defects

https://ift.tt/2ra1Brg

Effect of Petrolatum Coating on Fast-Absorbing Gut Suture

https://ift.tt/2JIShlj

Split Ear Lobe Repair with Piercing Preservation and Optimal Ear Lobe Aesthetics

https://ift.tt/2FtYdMx

Primary intestinal-type adenocarcinoma of the tongue

Primary intestinal-type adenocarcinoma (ITAC) of the tongue is a rare neoplasm. The case of a 59-year-old male with a painless mass in the dorsum of the oral tongue diagnosed as primary ITAC is reported here. The particular characteristic of the case was the patient's long-term medical history of 40years. The patient underwent resection of the tongue carcinoma through a midline approach and direct suture, with postoperative chemoradiotherapy. Immunohistochemical staining indicated that the tumour was positive for CK20 and negative for CK7.

https://ift.tt/2vZZI5l

First-Time Detection of Porcine Reproductive and Respiratory Syndrome Virus and Porcine Circovirus 2 in an Albanian Farrow-to-Finish Herd

Viral Immunology, Ahead of Print.


https://ift.tt/2JE8OXt

The Characterization of Monoclonal Antibodies to Mouse TLT-1 Suggests That TLT-1 Plays a Role in Wound Healing

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy, Volume 37, Issue 2, Page 78-86, April 2018.


https://ift.tt/2KqqeIv

Development of Monoclonal Antibodies Specifically Recognizing the Nonstructural Protein 12 of Type 2 Porcine Reproductive and Respiratory Syndrome Virus

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy, Volume 37, Issue 2, Page 73-77, April 2018.


https://ift.tt/2FvdigK

Multiple Tolerization Reduces Antibody Binding Against Tolerogen Cells: Implications for the Production of Monoclonal Antibodies

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy, Volume 37, Issue 2, Page 100-104, April 2018.


https://ift.tt/2KphzpD

Evidence That Graves' Ophthalmopathy Immunoglobulins Do Not Directly Activate IGF-1 Receptors

Thyroid, Ahead of Print.


https://ift.tt/2HCZ9UF

Thyroid Dysfunction and Anemia: A Prospective Cohort Study and a Systematic Review

Thyroid, Ahead of Print.


https://ift.tt/2raCdRG

PAs Less Accurate Than Dermatologists at Diagnosing Melanoma

Compared with dermatologists, physician assistants (PAs) are less likely to diagnose melanoma and more likely to perform more biopsies for each case of diagnosed skin cancer, researchers say.
Reuters Health Information

https://ift.tt/2HCR6TW

Pathologic significance of AKT, mTOR, and GSK3β proteins in oral squamous cell carcinoma-affected patients

Abstract

Phosphatidylinositol-3-kinases are kinases that lead to AKT phosphorylation and thus mTOR and GSK3β activation. These proteins are linked to tumorigenesis, but their roles in driving cervical lymph node (CLN) metastasis of oral squamous cell carcinoma (OSCC) cells are unknown. This study aimed to investigate the role of AKT, mTOR, and GSK3β proteins in the occurrence of CLN metastasis in OSCC patients. Ninety and 18 paraffin-embedded OSCC and oral mucosa samples were included, respectively. We divided our OSCC patients into non-metastasizing (PNM) and metastasizing (PM) groups, and the expression of total AKT, pAKT1^Thr308, pAKT^Ser473, GSK3β, pGSK3β^Ser9, and pmTOR^Ser2448 was analyzed by immunohistochemistry. The mean expression of GSK3β, pGSK3β^Ser9, total AKT, and pmTOR²⁴⁴⁸ was always higher in the OSCC tissues than that in the controls. A positive correlation was also found among these proteins. Total AKT, pmTOR^Ser2448, and pGSK3β^Ser9 expression was significantly higher in the PNM and PM groups than that in the control group. However, only GSK3β expression was significantly higher in the PM group compared with the PNM group. High expression levels of GSK3β and pGSK3β^Ser9 were significantly associated with CLN metastasis, but only GSK3β remained an independent predictor of CLN metastasis. pGSK3β^Ser9 and CLN metastasis were associated with a poor prognosis, but only the latter remained an independent prognostic parameter. Kaplan-Meier survival curves showed that pGSK3β^Ser9 and CLN metastasis were significantly related to reduced survival rates. These results suggest that AKT and mTOR proteins are involved in OSCC biology and that GSK3β itself may drive CLN metastatic spread of OSCC cells.

https://ift.tt/2HC3lE0

Intestinal paracoccidioidomycosis resembling Crohn’s disease in a teenager: a case report

Differential diagnosis of inflammatory bowel disease is often very challenging. Paracoccidioidomycosis is a fungal disease that can mimic manifestations of Crohn's disease.

https://ift.tt/2r9ruaL

De novo subgaleal abscess – a rare presentation of melioidosis: a case report

Melioidosis is an emerging infection in the tropics caused by the bacterium Burkholderia pseudomallei. Poorly controlled diabetes is a known risk factor. Melioidosis has a broad spectrum of clinical manifestation...

https://ift.tt/2JH5s6n

Experiencia clínica en pacientes con síndrome de Meige primario y disfonía espasmódica

Publication date: Available online 30 April 2018
Source:Acta Otorrinolaringológica Española
Author(s): María Fernanda Pedrero-Escalas, Isabel García-López, Susana Santiago-Pérez, Francisco Vivancos, Javier Gavilán
IntroducciónEl síndrome de Meige (SM) es considerado una distonía craneal segmentaria que afecta a dos o más músculos craneales. Específicamente, asocia blefaroespasmo a otra distonía craneal (oromandibular, cervical o laríngea). El objetivo de este artículo es presentar nuestra experiencia clínica en pacientes con disfonía espasmódica (DE) asociada a SM primario.Material y métodosEstudio retrospectivo realizado entre mayo de 2010 y junio de 2015. Incluyó 8 pacientes. Las variables recogidas fueron: sexo, edad, distonías asociadas, electromiografía laríngea y tratamiento. Los resultados clínicos objetivados fueron realizados, siempre por el mismo investigador, con la escala GRBAS(i) y el cuestionario VHI-30.ResultadosCincuenta y seis pacientes fueron tratados de SM por el servicio de Neurología. Ocho pacientes asociaron DE (prevalencia 14%). El 100% de nuestros pacientes tenían DE aductora. La mediana de edad para la aparición de DE fue de 71años. Todos los pacientes fueron tratados con infiltración intralaríngea de toxina botulínica bajo control electromiográfico. Se objetivó mejoría clínica tanto en la escala GRBAS(i) como en los cuestionarios VHI-30.ConclusiónEn el estudio de la DE siempre debe tenerse presente su posible asociación con el SM. Desde el punto de vista otorrinolaringológico, el uso conjunto de la escala GRBAS(i) y los cuestionarios VHI-30 es útil, fiable y eficiente como método para evaluar evolución y respuesta a tratamiento. La infiltración laríngea de toxina botulínica bajo control electromiográfico es la alternativa terapéutica que provee mejores resultados clínicos. El manejo de la DE asociada al SM no difiere del de la DE aislada.IntroductionMeige syndrome (MS) is part of the group of segmental cranial dystonias, which affect more than two cranial muscle groups. Specifically, blepharospasm is associated with another cranial dystonia (oromandibular, cervical or laryngeal). The aim of this paper was to report our experience in patients with spasmodic dysphonia (SD) associated with primary MS.Material and methodsA retrospective study involving 8 patients between May 2010 and June 2015. Variables recorded were: age, sex, associated dystonia, electromyographic pattern in laryngeal muscles and treatment given. Outcomes after treatment were assessed using GRBAS(i) scale and VHI-30 questionnaire, always provided by the same examiner.ResultsFifty-six patients with MS were treated in the Neurology Department. Eight patients of 56 were diagnosed with SD (prevalence of 14%). All of our patients had adductor SD. The median age was 71years. All the patients were treated with intralaryngeal botulinum toxin under electromyographic control. Clinically relevant improvements were found after treatment on both the GRBAS(i) scale and the VHI-30 questionnaire.ConclusionIn the study of SD, we should always rule out an association with MS. From the point of view of otorhinolaryngology, the joint use of the GRBAS(i) scale and the VHI-30 questionnaire are useful, reliable and efficient methods for assessing progress and response to treatment. Laryngeal infiltration under electromyographic control with botulinum toxin is the therapeutic alternative that provides better results. The management of SD associated with MS does not differ from isolated SD.



https://ift.tt/2FtlAWr

Safety and efficacy of HCV eradication during etanercept treatment for severe psoriasis

Dermatologic Therapy, EarlyView.


https://ift.tt/2Ftloq4

A Comprehensive Analysis of Benign Vocal Fold Lesions Causing Hoarseness of Voice and Our Experience with Cold Knife Endolaryngeal Surgery in a Tertiary Healthcare Centre

Abstract

Benign vocal fold lesions (BVFL) frequently affect the general population and cause significant hoarseness by interfering with daily communication. Healthcare for low income groups in India is all about affordability and availability without giving up on quality and providing maximum satisfaction. (1) To analyse over a period of 4 years, the demographics, clinical profile, diagnostics and management options of BVFL. (2) To assess the diagnostic potential of rigid laryngoscopy in diagnosing these lesions. (3) Cold knife endolaryngeal surgery as a cost effective, satisfactory and efficient treatment modality to tackle majority of these BVFL. A prospective cross sectional study over a period of 4 years from 2013 to 2017. 114 patients presenting with hoarseness of voice were evaluated by indirect laryngoscopy followed by video laryngoscopy and stroboscopy in the department of ENT, MYH Hospital Indore (M.P.). Male:female ratio of 1.59:1 with male predominance (61.4%) and maximum incidence in the third decade (32%). All cases presented with hoarseness (100%) while vocal fatigue (63%) was the most common associated complaint followed by foreign body sensation (60%). Housewives (32%) were most commonly involved non professional group while teachers (13%) constituted the most common group of professionals. Laryngitis (26%) involving bilateral vocal folds diffusely was the most common finding followed by vocal fold sulcus (18%) and vocal fold cysts (14%). The duration of symptom was 6 months to 1 year in 52% patients. The positive predictive value for rigid laryngoscopy was 100% for vocal nodules, arytenoid granulomas and anterior glottis web. Out of 114 patients, 66 patients improved on conservative management while 48 patients underwent cold knife endolaryngeal surgery. As per the GRBAS scale to assess the post therapeutic prognosis, all had good outcome of voice with only two recurrences due to patient non compliance. In this rapidly evolving era of sophisticated lasers which is a costly affair that requires skilled personnel and safety precautions, the prime goal in a government run setup has always been to provide affordable and quality healthcare to the common man. Cold knife endolaryngeal surgery is a simple, cost effective and efficient way to tackle most of these lesions and hence helps in achieving this goal.

https://ift.tt/2HFtbmB

Skin neurogenic inflammation

Abstract

The epidermis closely interacts with nerve endings, and both epidermis and nerves produce substances for mutual sustenance. Neuropeptides, like substance P (SP) and calcitonin gene-related protein (CGRP), are produced by sensory nerves in the dermis; they induce mast cells to release vasoactive amines that facilitate infiltration of neutrophils and T cells. Some receptors are more important than others in the generation of itch. The Mas-related G protein-coupled receptors (Mrgpr) family as well as transient receptor potential ankyrin 1 (TRPA1) and protease activated receptor 2(Par2) have important roles in itch and inflammation. The activation of MrgprX1 degranulates mast cells to communicate with sensory nerve and cutaneous cells for developing neurogenic inflammation. Mrgprs and transient receptor potential vanilloid 4 (TRPV4) are crucial for the generation of skin diseases like rosacea, while SP, CGRP, somatostatin, β-endorphin, vasoactive intestinal peptide (VIP), and pituitary adenylate cyclase-activating polypeptide (PACAP) can modulate the immune system during psoriasis development. The increased level of SP, in atopic dermatitis, induces the release of interferon (IFN)-γ, interleukin (IL)-4, tumor necrosis factor (TNF)-α, and IL-10 from the peripheral blood mononuclear leukocytes. We are finally starting to understand the intricate connections between the skin neurons and resident skin cells and how their interaction can be key to controlling inflammation and from there the pathogenesis of diseases like atopic dermatitis, psoriasis, and rosacea.

https://ift.tt/2vWfKNV

Potentially malignant disorders revisited—The lichenoid lesion/proliferative verrucous leukoplakia conundrum

Journal of Oral Pathology &Medicine, EarlyView.


https://ift.tt/2r5gPNA

Hyperacusis: major research questions

Abstract

Background

Hyperacusis is a troublesome symptom that can have a marked negative impact on quality of life.

Objectives

To identify major research questions in hyperacusis.

Materials and methods

Review of gaps in knowledge regarding hyperacusis, and where opportunities may lie to address these.

Results

Eight major research questions were identified as priorities for future research. These were: What is the prevalence of hyperacusis in adults and children? What are the risk factors associated with hyperacusis? What is the natural history of hyperacusis? How is 'pain hyperacusis' perceived? What mechanisms are involved in hyperacusis? What is the relationship between hyperacusis and tinnitus? Can a questionnaire be developed that accurately measures the impact of hyperacusis and can be used as a treatment outcome measure? What treatments, alone or in combination, are effective for hyperacusis?

Conclusion

This clinical/researcher-led project identified major research questions in hyperacusis. A further development to identify patient-prioritized research will follow.

https://ift.tt/2KnwVeg

Update HNO

https://ift.tt/2FtFLUa

Smartphone-App-gestützte Ansätze in der Tinnitusbehandlung

Zusammenfassung

In den letzten Jahren werden vermehrt Anwendungen für medizinische Zwecke entwickelt und vorgestellt, so auch Applikationen („Apps"), mit denen sich in Verbindung mit Mobiltelefonen (Smartphones) eine Diagnostik und Dokumentation von Hörproblemen wie Schwerhörigkeit und Tinnitus durchführen lässt. Auch Smartphone-Apps zur Therapie, besonders für Tinnitus, wurden auf den Markt gebracht. In dieser Übersichtsarbeit wird die bislang vorliegende wissenschaftliche Literatur zu diesen Smartphone-Applikationen erörtert. Für die Tinnitustherapie wurden internetbasierte und evaluierte Angebote der Verhaltenstherapie entwickelt. Zur Behandlung von Tinnitus vorgestellte Apps verbinden akustische Stimulation und Musik oder dienen der akustischen Stimulation kortikaler Regionen im Bereich der Tinnitusfrequenz. Sie gelten zwar als sehr innovativ, jedoch wurde bislang der wissenschaftliche Nutzen ihrer Wirksamkeit noch nicht erbracht. Ein generelles Problem bezüglich der Anwendung von Smartphone-Applikationen liegt in ihrer tatsächlichen Sicherheit in Bezug auf mögliche Nebenwirkungen wie auch bezüglich des persönlichen Datenschutzes. Dennoch können Internetangebote und Apps eine sinnvolle Ergänzung multimodaler Therapieformen bilden.

https://ift.tt/2r5fZQW

Bothersome tinnitus

Abstract

Tinnitus is not traceable to a single disease or pathology, but merely a symptom, which is distressing to some but not all individuals able to perceive it. The experience of tinnitus does not equate to tinnitus distress. Tinnitus suffering might be understood as a function of tinnitus-related distress in that bothersome tinnitus is an illness rather than a disease. In bothersome (distressing) tinnitus, the perception of the characteristic sound is a very disturbing and bothersome experience because of maladaptive psychological responses. Several cognitive and behavioral theoretical frameworks attempting to explain the nature and cause of tinnitus suffering have been introduced in and will be summarized here. Current treatment approaches are generally based on models that aim to: alleviate the perceptional experience by focusing on the tinnitus perception for habituation or even soothing purposes; decrease awareness of the sound by attentional training and cognitive interventions; decrease the maladaptive responses and the resulting distress by behavioral methods (i. e., exposure). The cognitive behavioral fear-avoidance model may offer an integrative cognitive behavioral approach that can lead to a new set of paradigms for studying the underlying mechanisms explaining chronic tinnitus suffering as well for developing innovative strategies to treat bothersome tinnitus.

https://ift.tt/2HFQbWD

A Comprehensive Analysis of Benign Vocal Fold Lesions Causing Hoarseness of Voice and Our Experience with Cold Knife Endolaryngeal Surgery in a Tertiary Healthcare Centre

Abstract

Benign vocal fold lesions (BVFL) frequently affect the general population and cause significant hoarseness by interfering with daily communication. Healthcare for low income groups in India is all about affordability and availability without giving up on quality and providing maximum satisfaction. (1) To analyse over a period of 4 years, the demographics, clinical profile, diagnostics and management options of BVFL. (2) To assess the diagnostic potential of rigid laryngoscopy in diagnosing these lesions. (3) Cold knife endolaryngeal surgery as a cost effective, satisfactory and efficient treatment modality to tackle majority of these BVFL. A prospective cross sectional study over a period of 4 years from 2013 to 2017. 114 patients presenting with hoarseness of voice were evaluated by indirect laryngoscopy followed by video laryngoscopy and stroboscopy in the department of ENT, MYH Hospital Indore (M.P.). Male:female ratio of 1.59:1 with male predominance (61.4%) and maximum incidence in the third decade (32%). All cases presented with hoarseness (100%) while vocal fatigue (63%) was the most common associated complaint followed by foreign body sensation (60%). Housewives (32%) were most commonly involved non professional group while teachers (13%) constituted the most common group of professionals. Laryngitis (26%) involving bilateral vocal folds diffusely was the most common finding followed by vocal fold sulcus (18%) and vocal fold cysts (14%). The duration of symptom was 6 months to 1 year in 52% patients. The positive predictive value for rigid laryngoscopy was 100% for vocal nodules, arytenoid granulomas and anterior glottis web. Out of 114 patients, 66 patients improved on conservative management while 48 patients underwent cold knife endolaryngeal surgery. As per the GRBAS scale to assess the post therapeutic prognosis, all had good outcome of voice with only two recurrences due to patient non compliance. In this rapidly evolving era of sophisticated lasers which is a costly affair that requires skilled personnel and safety precautions, the prime goal in a government run setup has always been to provide affordable and quality healthcare to the common man. Cold knife endolaryngeal surgery is a simple, cost effective and efficient way to tackle most of these lesions and hence helps in achieving this goal.

https://ift.tt/2HFtbmB

Analysis of the changes in scalp hair angles: In vivo and in vitro comparison before and after tumescence

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2rbOwwO

Association between clinical characteristics, quality of life, and sleep quality in patients with periorbital hyperchromia

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2HD16QO

Evaluation of selected skin parameters following the application of 5% vitamin C concentrate

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2rasudV

Evidence‐based treatment for gynoid lipodystrophy: A review of the recent literature

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2HD0XNg

Platelet‐rich plasma on female androgenetic alopecia: Tested on 10 patients

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2rask6j

Combination of fractional carbon dioxide laser with narrow band ultraviolet B to induce repigmentation in stable vitiligo: A comparative study

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2HD0SJs

Correlation between serum IL‐17A level and SALT score in patients with alopecia areata before and after NB‐UVB therapy

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2ras7A3

Serum Adenosine Deaminase Levels and Human Papillomavirus as Prognostic and Predictive Factors for Laryngeal and Pharyngeal Carcinomas

Abstract

Head and neck cancer is one of the most common cancers in the world, accounting for up to 30–40% malignancies in India. Research is always on the lookout for parameters that help in early diagnosis of such disease and to explore the possibility of discovering such parameters that would assist in management of the disease by its potential to predict and prognosticate the disease. To estimate serum ADA levels and to correlate with response to therapy and also to correlate between different clinical stages and serum ADA levels and to correlate HPV status to response to therapy. A prospective cohort study. 30 patients who were diagnosed with squamous cell carcinoma of the oropharynx, hypopharynx and larynx were considered in this study. The pre and post treatment values of serum ADA was estimated in these patients and the tumour was assessed for HPV status. The difference in the in the serum ADA levels before and after treatment was 9.982 which was statistically significant with a p value of < 0.001. HPV positive status and response to therapy in the form of recurrence shows a p value of 0.485 which is not statistically significant. Serum ADA level can be used as a parameter to assess the severity of the disease and the response to treatment in cases of carcinoma of the oropharynx, hypopharynx and larynx. HPV status of the disease has its limitation in prediction and prognosis of the disease.

https://ift.tt/2FsFYXD

Serum Adenosine Deaminase Levels and Human Papillomavirus as Prognostic and Predictive Factors for Laryngeal and Pharyngeal Carcinomas

Abstract

Head and neck cancer is one of the most common cancers in the world, accounting for up to 30–40% malignancies in India. Research is always on the lookout for parameters that help in early diagnosis of such disease and to explore the possibility of discovering such parameters that would assist in management of the disease by its potential to predict and prognosticate the disease. To estimate serum ADA levels and to correlate with response to therapy and also to correlate between different clinical stages and serum ADA levels and to correlate HPV status to response to therapy. A prospective cohort study. 30 patients who were diagnosed with squamous cell carcinoma of the oropharynx, hypopharynx and larynx were considered in this study. The pre and post treatment values of serum ADA was estimated in these patients and the tumour was assessed for HPV status. The difference in the in the serum ADA levels before and after treatment was 9.982 which was statistically significant with a p value of < 0.001. HPV positive status and response to therapy in the form of recurrence shows a p value of 0.485 which is not statistically significant. Serum ADA level can be used as a parameter to assess the severity of the disease and the response to treatment in cases of carcinoma of the oropharynx, hypopharynx and larynx. HPV status of the disease has its limitation in prediction and prognosis of the disease.

https://ift.tt/2FsFYXD

Acute invasive fungal rhinosinusitis in twenty‐one diabetic patients

Clinical Otolaryngology, EarlyView.


https://ift.tt/2reJlN1

Assessment of auditory discrimination in hearing-impaired patients

Publication date: Available online 30 April 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): E. Legris, M. Gomot, J. Charpentier, J.M. Aoustin, C. Aussedat, D. Bakhos
Hearing loss can impair auditory discrimination, especially in noisy environments, requiring greater listening effort, which can impact socio-occupational life. To assess the impact of hearing loss in noisy environments, clinicians may use subjective or objective methods. Subjective methods, such as speech audiometry in noise, are used in clinical practice to assess reported discomfort. Objective methods, such as cortical auditory evoked potentials (CAEPs), are mainly used in research. Subjective methods mainly comprise speech audiometry in noise, in which the signal-to-noise ratio can be varied so as to determine the individual speech recognition threshold, with and without hearing rehabilitation, the aim being to highlight any improvement in auditory performance. Frequency discrimination analysis is also possible. Objective methods assess auditory discrimination without the patient's active participation. One technique used for patients with auditory rehabilitation is the study of auditory responses by CAEPs. This electrophysiological examination studies cortical auditory rehabilitation oddball paradigms, enabling wave recordings such as mismatch negativity, P300 or N400, and analysis of neurophysiological markers according to auditory performance. The present article reviews all these methods, in order to better understand and evaluate the impact of hearing loss in everyday life.



https://ift.tt/2HHj4h4

The emergency paediatric surgical airway: A systematic review

BACKGROUND Although an emergency surgical airway is recommended in the guidelines for a paediatric cannot intubate, cannot oxygenate (CICO), there is currently no evidence regarding the best technique for this procedure. OBJECTIVE To review the available literature on the paediatric emergency surgical airway to give recommendations for establishing a best practice for this procedure. DESIGN Systematic review: Considering the nature of the original studies, a meta-analysis was not possible. DATA SOURCES MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Google Scholar and LILACS databases. ELIGIBILITY CRITERIA Studies addressing the paediatric emergency surgical airway and reporting the following outcomes: time to tracheal access, success rate, complications and perceived ease of use of the technique were included. Data were reported using a Strengths, Weaknesses, Opportunities and Threats analysis. Strengths and Weaknesses describe the intrinsic (dis)advantages of the techniques. The opportunities and threats describe the (dis)advantage of the techniques in the setting of a paediatric CICO scenario. RESULTS Five studies described four techniques: catheter over needle, wire-guided, cannula or scalpel technique. Mean time for placement of a definitive airway was 44 s for catheter over needle, 67.3 s for the cannula and 108.7 s for the scalpel technique. No time was reported for the wire-guided technique. Success rates were 43 (10/23), 100 (16/16), 56 (87/154) and 88% (51/58), respectively. Complication rates were 34 (3/10), 69 (11/16), 36 (55/151) and 38% (18/48), respectively. Analysis shows: catheter over needle, quick but with a high failure rate; wire-guided, high success rate but high complication rate; cannula, less complications but high failure rate; scalpel, high success rate but longer procedural time. The available data are limited and heterogeneous in terms of reported studies; thus, these results need to be interpreted with caution. CONCLUSION The absence of best practice evidence necessitates further studies to provide a clear advice on best practice management for the paediatric emergency surgical airway in the CICO scenario. Correspondence to Dr. Markus F. Stevens, Department of Anaesthesiology, Academic Medical Centre, Meibergdreef 15, Amsterdam 1105 AZ, The Netherlands E-mail: m.f.stevens@amc.uva.nl Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (https://ift.tt/2ylyqmW). © 2018 European Society of Anaesthesiology

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Intra-operative cutaneous temperature monitoring with zero-heat-flux technique (3M SpotOn) in comparison with oesophageal and arterial temperature: A prospective observational study

BACKGROUND Continuous monitoring of core temperature is essential during major surgery as a way of improving patient safety. Oesophageal probes or specific arterial catheters are invasive methods used in this setting. A new noninvasive device based on zero-heat-flux (ZHF) technique (SpotOn) seems promising but has been poorly investigated during rapid core temperature changes (RCTC). OBJECTIVE To assess the accuracy of a SpotOn sensor vs. an oesophageal probe or specific arterial catheter during a slow change in core temperature of less than 1 °C within 30 min and RCTC ≥ 1 °C within 30 min. DESIGN Prospective observational study. SETTING Operating rooms at the University Hospital of Poitiers, France. PATIENTS Fifty patients scheduled for major abdominal surgery under general anaesthesia were enrolled from June 2015 to March 2016. Data from 49 patients were finally analysed. Among these, 15 patients were treated with hyperthermic intraperitoneal chemotherapy. INTERVENTION Each patient had a ZHF sensor placed on the skin surface of the forehead (TempZHF) and an oesophageal probe (TempEso) used as a reference method. Twenty-two patients also had a thermodilution arterial catheter (TempArt) placed in the axillary artery. MAIN OUTCOME MEASURES Core temperature was continuously recorded from the three devices after induction of anaesthesia. Comparison of temperature measurements between methods was made using the Bland and Altman method during two separate periods according to the speed of core temperature changes. RESULTS Compared with TempEso, bias and limits of agreement for TempZHF were 0.1 ± 0.5 °C during slow core temperature changes periods and 0.6 ± 1.8 °C during RCTC periods (P = 0.0002). Compared with TempArt, these values were −0.1 ± 0.4 and 0.5 ± 1.7 °C, respectively (P = 0.0039). The ZHF sensor was well tolerated. CONCLUSION A SpotOn sensor using the ZHF method seems reliable for core temperature monitoring during abdominal surgery when variations in core temperature are slow rather than rapid. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02869828. Correspondence to Matthieu Boisson, Centre Hospitalier Universitaire de Poitiers, Poitiers, France E-mail: matthieu.boisson@chu-poitiers.fr © 2018 European Society of Anaesthesiology

https://ift.tt/2Kq3TL8

Managing the late effects of chemoradiation on swallowing: bolstering the beginning, minding the middle, and cocreating the end

Purpose of review Late dysphagia has a profound impact on quality of life in patients treated with chemoradiation therapy for advanced head and neck cancer and the number of survivors is growing. Traditional treatment methods are not uniformly successful in reducing the swallow impairment in these patients. Recent findings Manifestations of late dysphagia are complex and do not follow a uniform trajectory. Patient's experience of eating and engagement in treatment is critical given the complex, variable nature of late dysphagia. Novel swallow treatment methods target respiratory function including coordination and strength as well as patient adherence. Summary Head and neck cancer survivors deserve routine and fastidious surveillance beyond the 5-year survival point with respect to swallow function if the enormous biopsychosocial burden of late dysphagia is to be addressed. Correspondence to Tessa Goldsmith, MA, Massachusetts General Hospital, Boston, MA 02114, USA. E-mail: tgoldsmith@mgh.harvard.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2jeRI7v

Managing the late effects of chemoradiation on swallowing: bolstering the beginning, minding the middle, and cocreating the end

Purpose of review Late dysphagia has a profound impact on quality of life in patients treated with chemoradiation therapy for advanced head and neck cancer and the number of survivors is growing. Traditional treatment methods are not uniformly successful in reducing the swallow impairment in these patients. Recent findings Manifestations of late dysphagia are complex and do not follow a uniform trajectory. Patient's experience of eating and engagement in treatment is critical given the complex, variable nature of late dysphagia. Novel swallow treatment methods target respiratory function including coordination and strength as well as patient adherence. Summary Head and neck cancer survivors deserve routine and fastidious surveillance beyond the 5-year survival point with respect to swallow function if the enormous biopsychosocial burden of late dysphagia is to be addressed. Correspondence to Tessa Goldsmith, MA, Massachusetts General Hospital, Boston, MA 02114, USA. E-mail: tgoldsmith@mgh.harvard.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2jeRI7v

Occurrence of anembryonic pregnancy with use of levonorgestrel subdermal implant (JADELLE®): a case report

Progestin-only subdermal implants are one of the most effective contraceptive methods. Anembryonic pregnancy is not reported as a possible outcome in cases of contraceptive failure of these products. We presen...

https://ift.tt/2jilGHM

Ear Prosthesis for Postburn Deformity

Prosthodontics is not just confined to replacement of missing teeth but beyond one's scope. The fabrication of any extraoral maxillofacial prosthesis presents the prosthodontist with several phenomenal challenges. Psychologically, these patients are severely affected either by congenital absence or loss of ear due to trauma or burns. Replacement or reconstruction can be done by surgical or prosthetic approach. However, not all situations are favourable to surgical reconstruction. This article emphasises on the steps in fabrication of ear prosthesis for burn deformity.

https://ift.tt/2r5iZxw

A comparison of morpho-syntactic abilities in deaf children with cochlear implant and 5-year-old normal-hearing children

Publication date: July 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 110
Author(s): Samane Dehghani Golestani, Nahid Jalilevand, Mohammad Kamali
IntroductionChildren with cochlear implants (CIs) have problems in morpho-syntactic abilities more than other language skills. The current study was aimed to evaluate the language samples of children with CIs by using a numerical measurement tool, Persian developmental sentence scoring (PDSS).MethodIn this cross-sectional, descriptive, analytical study, 33 children (22 children with CIs and 11 with normal hearing) were recruited. Language samples of the children were recorded during the description of pictures. The PDSS was used as a reliable numerical measurement tool for analyzing the first 100 consecutive intelligible utterances.ResultsWe found a significant difference in the mean PDSS total scores (p = 0.0001) between the normal-hearing children and deaf children using CIs for 5 years. Similarly, the results revealed a significant difference in the mean PDSS total scores (p = 0.0001) between the normal-hearing children and 5-year-old deaf children with CIs. There was no significant difference in the mean PDSS total scores between the two groups of children with CIs.ConclusionChildren with CIs can form simple sentences but probably exhibit poor abilities for using complex sentences and essential morphology items.



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Fat Embolism Syndrome: A Case Report and Review Literature

Fat embolism syndrome (FES) is a life-threatening complication in patients with orthopedic trauma, especially long bone fractures. The diagnosis of fat embolism is made by clinical features alone with no specific laboratory findings. FES has no specific treatment and requires supportive care, although it can be prevented by early fixation of bone fractures. Here, we report a case of FES in a patient with right femoral neck fracture, which was diagnosed initially by Gurd's criteria and subsequently confirmed by typical appearances on magnetic resonance imaging (MRI) of the brain. The patient received supportive management and a short course of intravenous methylprednisolone.

https://ift.tt/2JAuBiN

The impact of complete embedding of remaining tissue in gynecological lymph node dissection specimen in surgical pathology on lymph node yield: is it clinically relevant?

Abstract

The assessment of nodal metastases in gynecological surgical specimen is an important staging parameter, directing further therapeutic procedures. Since the number of lymph nodes (LNs) removed is seen as an indicator of surgical and pathological quality, the demand for higher lymph node (LN) counts is raising. The goal of this prospective study was the comparison between lymph node counts of macroscopically detectable LNs and the LN yield by complete embedding and proceeding of all submitted LN-containing tissue in the pathology laboratory. One hundred six cases of cervical, uterine, or ovarian cancer, treated in three different hospitals within 3 years, were analyzed. All tissue submitted to the pathology from the surgically performed LN dissections was completely dissected and embedded in the institute of pathology. Subsequently, the amount of LN of all macroscopically detectable nodes was compared to the final histologically reached numbers of LN. Furthermore the histologically visible area of the LNs and their metastases was analyzed to assess the relation of LN numbers to the whole examined LN area. Complete embedding raises the average number of LN counted by 3 to 7 but did only minimally increase the LN area for microscopical examination by about 5% due to the small area of the additional LNs in the remaining fat tissue. The staging was in no case altered by complete embedding, even when additional nodal metastases were detected in the remaining fat tissue, since this was only seen in cases which had already metastatic nodes. Complete embedding of LN-containing tissue did not provide relevant additional staging information and seems therefore unnecessarily laborious, careful pathological work-up assumed.

https://ift.tt/2vXd0j6

“Flipped classrooms” in training in maxillofacial surgery: preparation before the traditional didactic lecture?

While virtual learning environments (VLE) can be used in medical education as stand-alone educational interventions, they can also be used in preparation for traditional "face-to-face" training sessions as part of a "flipped classroom" model. We sought to evaluate the introduction of this model in a single module on maxillofacial radiology from a course on trauma skills. Course delegates were randomised into two groups: one was given access to an e-learning resource (test group) and the other attended a traditional didactic lecture (control group).

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Re: Gillies temporal incision: an alternative approach to biopsy of the superficial temporal artery

We appreciate Shastri et al's interest in our paper.1

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Current thinking in medical education research: an overview

Medical education is fast becoming a separate focus, and together with their clinical commitments, many clinicians now seek higher qualifications and professional accreditation in the field. Research is also developing, and there is a need for evidence-based practice in education, just as in clinical work. This review gives an overview of research into medical education, and explains the fundamentals of educational theory and the specific considerations for the quantitative and qualitative research methods that pertain to it.

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Re: Gillies temporal incision: an alternative approach to biopsy of the superficial temporal artery

We read with interest the paper by Markose and Graham in which they proposed a modified Gillies approach for biopsy of the superficial temporal artery.1 They argued that a conventional preauricular approach creates an unsightly scar, decreases the yield of the biopsy to a shorter segment of the artery (with the risk of sampling an unaffected portion), and increases the risk of iatrogenic injury to the facial nerve.

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New technique for endoscopically-assisted particulate graft reconstruction of the mandible

The reconstruction of mandibular defects using particulate grafts is a proven technique that restores the osseous anatomy effectively. Secondary osseous reconstruction can be accomplished with endoscopic assistance and reduced-access incisions if an intermediate spacer is placed during resection. Two patients required reconstruction after resection of mandibular ameloblastomas. We used a modified protocol that involved the implantation of a graft of particulate corticocancellous bone after removal of the spacer, and prepared the recipient site under endoscopic guidance with small extraoral incisions.

https://ift.tt/2vTL0gh

Lemierres syndrome: a rare cause of sepsis presenting with an absence of throat symptoms

A 16-year-old boy presented to hospital with a 6-day history of diarrhoea, vomiting and abdominal pain. During his admission he was found to be hypotensive, tachycardic and persistently feverish. Blood cultures taken on admission isolated Fusobacterium necrophorum. CT scanning of his neck showed a non-occlusive thrombus of the right internal jugular vein and a small right parapharyngeal abscess. CT scans of the chest and abdomen revealed multiple pulmonary abscesses, bilateral pleural effusions and splenomegaly. Treatment consisted of an unfractionated heparin infusion and intravenous antibiotics. A right-sided intercostal drain was inserted for a complex right-sided empyema. He subsequently developed a left-sided pleural effusion which was treated with a video-assisted thoracoscopic surgery (VATS) pleurodesis procedure. His fever resolved after his VATS pleurodesis procedure 3 weeks after initial presentation. Clinically he made a slow recovery but now is improved after 6 weeks of intravenous antibiotics and was discharged home.

https://ift.tt/2JB1XxY

Novel management of vaginal chronic graft-versus-host disease causing haematometra and haematocolpos

Genital chronic graft-versus-host disease (GVHD) in women posthaematopoietic cell transplantation may cause vaginal mucosal sclerosis. Human papillomavirus (HPV) reactivation, also common post-transplantation, limits local immunosuppressive, but not oestrogen treatment. A 36-year-old nulliparous woman developed coincidental genital chronic GVHD and HPV 22 months after transplant for aplastic anaemia. Topical immunosuppression for GVHD led to an eruption of warts successfully treated with laser surgery and cone biopsy. She maintained normal ovarian function and used extended cycle combined hormonal contraception. A vaginal oestrogen ring used continuously limited most scarring for 8 years. Progressive apical vaginal scarring obstructed menstrual flow leading to haematocolpos and haematometra. Normal anatomy was restored with a cruciate incision in the cervicovaginal scar performed during menses. When HPV disease limits use of topical immunosuppression in women with vaginal GVHD, the local scar-reducing effect of a vaginal oestrogen ring is limited, and surgery may be needed and can be successful in treating haematocolpos.This study was registered in ClinicalTrials.gov with trial registration number of NCT00003838.

https://ift.tt/2jf7aAk

Treatment of end-stage renal disease with continuous ambulatory peritoneal dialysis in rural Guatemala

A 42-year-old indigenous Maya man presented to a non-profit clinic in rural Guatemala with signs, symptoms and laboratory values consistent with uncontrolled diabetes. Despite appropriate treatment, approximately 18 months after presentation, he was found to have irreversible end-stage renal disease (ESRD) of uncertain aetiology. He was referred to the national public nephrology clinic and subsequently initiated home-based continuous ambulatory peritoneal dialysis. With primary care provided by the non-profit clinic, his clinical status improved on dialysis, but socioeconomic and psychological challenges persisted for the patient and his family. This case shows how care for people with ESRD in low- and middle-income countries requires scaling up renal replacement therapy and ensuring access to primary care, mental healthcare and social work services.

https://ift.tt/2Jwtu3y

Correction: Unilateral retinitis pigmentosa occurring in an individual with a mutation in the CLRN1 gene

Sim PY, Jeganathan VSE, Wright AF et al. Unilateral retinitis pigmentosa occurring in an individual with a mutation in the CLRN1 gene. BMJ Case Rep 2018; doi: 10.1136/bcr-2017-222045.

The following text should have been included in the 'Presented at' section:

Dr V. Swetha E. Jeganathan was finalist for the Novartis Retina Case Awards, held on 27^th February 2013 at the City Hospital, Birmingham. Her case presentation was subsequently published in the Eye News supplement in March 2013.

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Treatment and reconstruction of a complicated infected scalp squamous cell carcinoma with CNS invasion

A 60-year-old male patient with a large infected cranial apex lesion was admitted with lethargy and mental status changes. The patient underwent evaluation with imaging studies, a skin biopsy, cultures with microscopy and a diagnostic burr hole. MRI and positron emission tomography/CT scan revealed a squamous cell carcinoma with ingrowth in the midline of the brain and subdural empyema infected with Streptococcus anginosus and Staphylococcus aureus.

High dose intravenous antibiotic treatment was initiated and the patient subsequently underwent a surgical resection of the carcinoma with a 1 cm margin of surrounding skin and skull. The defect was reconstructed using a titanium plate and a free microvascular lattisimus dorsi muscle flap then covered with a split skin graft.

The patient received 37 radiation therapy sessions (66 GY) as adjuvant therapy.

Intensive neurorehabilitation slowly improved an initial paraparesis. The 7-month follow-up revealed a satisfactory cosmetic result and residual gait impairment secondary to central nervous system invasion.

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Clostridium difficile cure with fecal microbiota transplantation in a child with Pompe disease: a case report

Recurrent Clostridium difficile infection is a growing problem among children due to both the increasing survival of medically fragile children with complicated chronic medical conditions resulting in prolonged a...

https://ift.tt/2vSBRVc

Performance validation of an amplicon-based targeted next-generation sequencing assay and mutation profiling of 648 Chinese colorectal cancer patients

Abstract

Next-generation sequencing (NGS) has become a promising approach for tumor somatic mutation detection. However, stringent validation is required for its application on clinical specimens, especially for low-quality formalin-fixed paraffin-embedded (FFPE) tissues. Here, we validated the performance of an amplicon-based targeted NGS assay, OncoAim™ DNA panel, on both commercial reference FFPE samples and clinical FFPE samples of Chinese colorectal cancer (CRC) patients. Then we profiled the mutation spectrum of 648 Chinese CRC patients in a multicenter study to explore its clinical utility. This NGS assay achieved 100% test specificity and 95–100% test sensitivity for variants with mutant allele frequency (MAF) ≥ 5% when median read depth ≥ 500×. The orthogonal methods including amplification refractory mutation system (ARMS)-PCR and Sanger sequencing validated that NGS generated three false negatives (FNs) but no false positives (FPs) among 516 clinical samples for KRAS aberration detection. Genomic profiling of Chinese CRC patients with this assay revealed that 63.3% of the tumors harbored clinically actionable alterations. Besides the commonly mutated genes including TP53 (52.82%), KRAS (46.68%), APC (24.09%), PIK3CA (18.94%), SMAD4 (9.47%), BRAF (6.15%), FBXW7 (5.32%), and NRAS (4.15%), other less frequently mutated genes were also identified. Statistically significant association of specific mutated genes with certain clinicopathological features was detected, e.g., both BRAF and PIK3CA were more prevalent in right-side CRC (p < 0.001 and p = 0.002, respectively). We concluded this targeted NGS assay is qualified for clinical practice, and our findings could help the diagnosis and prognosis of Chinese CRC patients.

https://ift.tt/2r7L7iP

Detection of abnormally shaped ears by a trained non-specialist allows for early non-surgical intervention

Publication date: July 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 110
Author(s): Daphne Y.D. Lu, Julie Pauwels, Lisa Jin, Frederick K. Kozak, Neil K. Chadha
IntroductionMany children are born with abnormally-shaped ears, including protruding ears or unusually-shaped outer ears. While the majority are benign, these may cause significant issues with self-esteem and bullying in childhood. Early molding can resolve some of these abnormalities, avoiding the need for future corrective surgery. However, newborns with these abnormalities are rarely identified early, within the first few days of life, when molding is most effective. In this study, we investigate whether a trained non-specialist can correctly identify ear shape abnormalities in newborns.MethodsA non-specialist (medical student) was trained on normal and abnormal ear anatomy using photographs and descriptions. Newborns <72 h of age were recruited from maternity wards. Newborns' ears were photographed and these images were assessed independently by two specialists and the non-specialist. External ear shape was classified as either normal or abnormal based on pre-determined criteria.ResultsA total of 661 ears of 334 newborns were photographed and assessed. High inter-rater agreement was achieved with a kappa statistic of 0.863 (SE 0.078). The non-specialist detected abnormally-shaped ears with a sensitivity and specificity of 90.9% and 91.1% respectively.ConclusionsOur study illustrates that non-specialist can be trained to accurately detect newborn ear abnormalities, providing a cost-effective means of ensuring that these children's health care needs are met in a timely fashion. Specifically, we recommend the integration of ear shape assessment into currently established programs such as the newborn hearing screening program.



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In this issue

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Dysphagia 27 years after cervical disc arthroplasty

Publication date: Available online 27 April 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): E. Lemaire, S. Ciftci, C. Debry
IntroductionDysphagia is a frequent postoperative symptom after anterior cervical disc arthroplasty. However, onset of dysphagia and neck pain a long time after surgery should suggest a diagnosis of prosthesis dislocation.Care reportA 65-year-old man with a history of cervical disc arthroplasty 27 years previously consulted for rapidly progressive dysphagia with no other associated symptoms. Physical examination and CT scan confirmed the diagnosis of anterior dislocation of the prosthesis with no signs of perforation. Surgical extraction via a neck incision allowed resolution of the symptoms.DiscussionProsthesis dislocation should be considered in a patient with a history of cervical disc arthroplasty presenting with dysphagia and neck pain. The clinical and radiological assessment confirmed the diagnosis and early surgical management allowed resolution of the symptoms and avoided complications such as pharyngo-oesophageal perforation.



https://ift.tt/2FprEiz

Semilunar conchal cartilage graft in saddle nose reconstruction

Publication date: Available online 27 April 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): I. Rašić, A. Košec, A. Pegan
IntroductionThe saddle nose deformity is easily recognized by the loss of septal support and nasal dorsal height with adverse functional and aesthetic consequences.TechniqueWe treated a 50-year-old woman and a 54-year old man that presented with a moderate saddle nose deformity following a previous septorhinoplasty (female patient) and a posttraumatic severe saddle nose deformity (male patient). The patients were treated by open approach rhinoplasty under general anesthesia, and the saddle nose deformity was reconstructed with a semilunar conchal cartilage graft. A semilunar part of the conchal cartilage is excised, lending its name to the graft. A smaller leaf shaped cartilage part is excised and sutured upside-down with PDS 5-0 sutures on the opposite of the cartilage, so that the concave surfaces are facing each other. The newly formed graft is then sutured in its place on the nasal dorsum in the supratip saddle area over the triangular cartilages to widen the inner nasal valve angle. The lateral tips of the semilunar graft are placed below the lateral alar crura to improve external nasal valve functionality.DiscussionThis modified conchal cartilage graft presents itself as an excellent reconstructive option, especially considering its low morbidity, availability and ability to retrieve an adequate amount of cartilage in the vast majority of patients. These modifications of the conchal cartilage are previously unreported, and provide the needed height and elasticity in saddle nose reconstruction without the need for additional grafting. It is important to stress that when positioned properly, a beneficial effect in peak nasal inspiratory flow may be observed, adding to its usefulness in repairing both function and aesthetics.



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Editorial Board

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Training Groups

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The importance of allergic disease in public health: an iCAALL statement

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A novel assessment and treatment approach to patients with Hashimoto’s encephalopathy

Summary

Hashimoto's encephalopathy (HE) is rarely reported with only a few hundred cases published. Diagnosis is made in patients with an appropriate clinical picture and high antithyroperoxidase (anti-TPO) antibodies after infectious, toxic and metabolic causes of encephalopathy have been excluded. There is little objective data on the neurocognitive impairment in patients with HE and their improvement with treatment. We present the case of a 28-year-old woman with HE. Approach to management was novel as objective neuropsychological assessment was used to assess her clinical condition and response to treatment. Intravenous immunoglobulin (IVIg) as the first-line treatment instead of steroids. She responded well. The case illustrates that a different approach is required for the diagnosis and treatment of HE. A new diagnostic criteria is proposed that includes neurocognitive assessment, serum and CSF antibodies, an abnormal EEG and exclusion of other causes of encephalopathy. Furthermore, treatment should be tailored to the patient.

Learning points:

Neurocognitive assessment should be carried out to assess the extent of brain involvement in suspected Hashimoto's encephalopathy pre- and post- treatment.

Treatment of Hashimoto's encephalopathy should be tailored to the patient.

Unifying diagnostic criteria for Hashimoto's encephalopathy must be established.

https://ift.tt/2HWie3q

Patients Screening Positive for Body Dysmorphic Disorder Show No Significant Health-Related Quality of Life Gain after Functional Septorhinoplasty at a Tertiary Referral Center

Facial plast Surg
DOI: 10.1055/s-0038-1632400

Body dysmorphic disorder (BDD) is a psychiatric disorder defined by an excessive concern about one's physical appearance, especially regarding slight or imagined abnormities of the body. This study was conducted to compare postoperative quality of life (QOL) changes after primary septorhinoplasty among patients screening positive and those screening negative for BDD. Two common instruments for the screening of BDD were used namely the Dysmorphic Concern Questionnaire (DCQ) and the BDD Concern Questionnaire (BDDQ). For the determination of QOL changes, three validated screening instruments were used. The Functional Rhinoplasty Outcome Inventory (FROI-17) and the Rhinoplasty Outcomes Evaluation (ROE) were used as disease-specific instruments and the Short Form 36 Health Survey (SF-36) was used as a general instrument. All patients completed the FROI-17, the ROE, and the SF-36 preoperatively and 60 months postoperatively. The BDD questionnaires were singularly obtained 60 months after surgery. The authors identified 9.8% of our patients with a possible BDD diagnosis. The patients screening positive for BDD showed significantly lower ROE scores postoperatively, compared with those screening negative for BDD. QOL gains detected by the disease-specific instruments (ROE and FROI-17) were only significant in the non-BDD group. No significant QOL gains were detectable with the FROI-17, the ROE, and the SF-36 in the BDD group. In patients screening negative for BDD, QOL, as measured with the SF-36, improved significantly in five categories: physical functioning, role-functioning physical, bodily pain, general health, and social functioning. Patients screening positive for BDD did not improve in any categories of the general SF-36 questionnaire. Instead, their score in the "mental health" category was significantly lower 5 years after their surgery compared with preoperatively. Patients retrospectively screening positive for BDD in our cohort did not improve in QOL postoperatively. Alternative nonsurgical treatments such as cognitive behavioral treatment and/or selective serotonin reuptake inhibitors have been reported to be effective and should be considered as the treatment of choice. Some studies suggest that a smaller subgroup of BDD patients may benefit from functional rhinoplasty. Further research and larger long-term prospective outcome studies are needed to understand the influence of BDD symptoms on postoperative satisfaction and QOL changes after septorhinoplasty.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

https://ift.tt/2HYyYHg

Complications of Polydioxanone Foil Use in Nasal Surgery: A Case Series

Facial plast Surg
DOI: 10.1055/s-0038-1632399

Polydioxanone (PDS) foil is widely recognized as a septal cartilage replacement during rhinoplasties and is thought to be completely resorbable and biodegradable. Since its United States Food and Drug Administration approval in 2010, PDS foil has drawn significant enthusiasm and many surgeons consider it an ideal implantable biomaterial as reflected in numerous studies highlighting its benefits. However, scant literature exists highlighting relevant complications of PDS plates that may potentially lead to cavalier overuse. This descriptive case series assesses the outcomes of PDS foil usage in three patients seen for septoplasty at two independent institutions over the past 5 years. Our results demonstrate that PDS plate usage can lead to septal cartilage loss and resultant saddle nose deformıty associated with prolonged postoperative edema and inflammation. To our knowledge, this is the largest case series of this reported phenomenon.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

https://ift.tt/2HyPtGI

Second Hand Smoke exposure increased the need for inhaled corticosteroids in children with asthma

Exposure to tobacco smoke (ETS) has been associated with increased risk for severity of asthma in children [1,2]. The question to be addressed is whether children with asthma with high environmental tobacco exposure would respond as well to inhaled corticosteroids as those with lower ETS exposure. Urine cotinine is a sensitive and specific biomarker for measuring the exposure to tobacco smoke. The aim of the study was to assess whether the high exposure to tobacco smoke measured by urine cotinine level can influence the daily dose of inhaled corticosteroids needed to achieve asthma control in exposed children.

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Development of a tool predicting severity of allergic reaction during peanut challenge

Reliable prognostic markers for predicting severity of allergic reactions during oral food challenges (OFC) have not been established.

https://ift.tt/2r4RaVm

The clinical outcome of skeletal anchorage in interceptive treatment (in growing patients) for class III malocclusion

A systematic review of the literature was performed regarding the clinical outcome (effectiveness) of bone anchorage devices in interceptive treatment for class III malocclusion. A search of Embase, PubMed and Web of Science databases yielded 285 papers. An additional two articles were retrieved through manual searching of the reference lists. After initial abstract selection, 32 potentially eligible articles were screened in detail, resulting in a final number of eight articles included in this review.

https://ift.tt/2HVqbWM

Treatments of tenosynovial giant cell tumours of the temperomandibular joint: a report of three cases and a review of literature

Tenosynovial giant cell tumours (TGCTs) are benign lesions affecting synovial joints. The classified subtypes are localized and diffuse. They seldom occur in the temporomandibular joint (TMJ). The aim of this study is to report on three new cases and to review the literature.One patient had surgical debulking with adjuvant external beam radiation therapy (EBRT). After 1year of follow-up, no evidence of disease was presented. The second patient was misdiagnosed and treated with denosumab. Debulking with adjuvant EBRT followed.

https://ift.tt/2JztOhY

Analysis of efficacy and safety of core-needle biopsy versus fine-needle aspiration cytology in patients with cervical lymphadenopathy and salivary gland tumour

In this study, we compared the diagnostic accuracy and safety of fine-needle aspiration cytology and core-needle biopsy in patients with cervical lymphadenopathy or salivary gland tumour, and provided a basis for selecting the appropriate diagnostic method in clinical situations. A total of 278 patients were included in this study. The sensitivities of fine-needle aspiration cytology and core-needle biopsy were 66.7% and 100%, respectively, and negative predictive values were 92.6% and 100%, respectively, for diagnosing malignancy.

https://ift.tt/2HX2HAw

The sequential treatment of temporomandibular joint ankylosis with secondary deformities by distraction osteogenesis and arthroplasty or TMJ reconstruction

The purpose of this study was to evaluate the sequential treatment of patients with temporomandibular joint (TMJ) ankylosis and secondary deformities by distraction osteogenesis and subsequent arthroplasty or TMJ reconstruction. This study included 40 patients treated at a stomatological hospital in China; they ranged in age from 9 to 53years (mean age 24.5years). Ten of these patients were diagnosed with unilateral TMJ ankylosis and 30 with bilateral TMJ ankylosis. Twenty-seven patients also presented obstructive sleep apnoea–hypopnoea syndrome (OSAHS).

https://ift.tt/2Jz00SZ

Evaluation of fine needle aspiration cytology in the diagnosis of cervical lymph node lymphomas

Surgical biopsy examination is the gold standard for the diagnosis of lymph node lymphomas. Fine-needle aspiration cytology (FNAC) is a quick and safe method in the management of cervical lymph nodes. Its value in confirming recurrent or residual lymphoma is well established. However, its role in the primary diagnosis of lymph node lymphoma remains controversial. The aim of this study was to assess, in our experience, the reliability of FNAC in the diagnosis of cervical lymph node lymphomas.

https://ift.tt/2HYMURJ

Numbness of the lower lip does not adversely affect quality of life or patients’ satisfaction after mandibular orthognathic surgery

Measures of patient-reported quality of life (QoL) are increasingly being used to tailor services that are funded by Clinical Commissioning Groups (CCG) in England. Mandibular osteotomies may result in altered sensation of the lower lip, but we know of limited evidence about the resulting effect on QoL. The modified Bristol orthognathic patient outcomes questionnaire was given to patients who had mandibular osteotomies at the Queen Elizabeth Hospital, Birmingham, between March 2006 and April 2016.

https://ift.tt/2Kl6J4a

Re: Retroseptal transconjunctival approach for fractures of the zygomaticomaxillary complex: a retrospective study

It is with great interest that we read the paper by Sharma et al.1

https://ift.tt/2FnHgmJ

The palatal septal cartilage implantation for snoring and obstructive sleep apnea

Patients with snoring and obstructive sleep apnea frequently have nasal and palatal obstruction. The objective of this study was to investigate the safety and feasibility of a palatal septal cartilage implant (SCI) for snoring and obstructive sleep apnea.

https://ift.tt/2I1ZuPY

Consideration of methods for identifying mite allergens

House dust mites are small arthropods that produce proteins—found in their feces, body parts, and eggs—that are major triggers of human allergies worldwide. The goal of this review is to describe the current m...

https://ift.tt/2vSkKmJ

Recurrent upper lumbar disc herniation treated via the transforaminal approach using microendoscopy-assisted lumbar discectomy: a case report

Although microendoscopy-assisted lumbar discectomy for lateral or extraforaminal lumbar disc herniations via the lateral approach has previously been reported, microendoscopy-assisted lumbar discectomy for cen...

https://ift.tt/2Hvh1Rs

Intussusception caused by an inverted colonic diverticulum: a case report

Intussusception is an unusual disorder among the complications of diverticula in adults. This study aimed to report intussusception due to an inverted colonic diverticulum. Such a large inverted colonic divert...

https://ift.tt/2r4GLZS

Contact Dermatitis Symposium

Australasian Journal of Dermatology, Volume 59, Issue S1, Page 13-16, May 2018.


https://ift.tt/2FoEspk

All About Acne

Australasian Journal of Dermatology, Volume 59, Issue S1, Page 12-12, May 2018.


https://ift.tt/2I5nfob

Miscellaneous and Other Surprises

Australasian Journal of Dermatology, Volume 59, Issue S1, Page 7-9, May 2018.


https://ift.tt/2FmuuEU

Author Index 2018

Australasian Journal of Dermatology, Volume 59, Issue S1, Page 130-134, May 2018.


https://ift.tt/2I5bkGC

Plenary Session 4 and Awarding of Prizes

Australasian Journal of Dermatology, Volume 59, Issue S1, Page 29-31, May 2018.


https://ift.tt/2FpX2ha

Poster Presentations

Australasian Journal of Dermatology, Volume 59, Issue S1, Page 32-129, May 2018.


https://ift.tt/2I7zUXG

Mohs Quality Assurance Program and Fellow Talks

Australasian Journal of Dermatology, Volume 59, Issue S1, Page 9-10, May 2018.


https://ift.tt/2Fmuchi

Paediatric Symposium

Australasian Journal of Dermatology, Volume 59, Issue S1, Page 16-19, May 2018.


https://ift.tt/2I2lYy0

What's New in Journals

Australasian Journal of Dermatology, Volume 59, Issue S1, Page 31-31, May 2018.


https://ift.tt/2FoEpd8

Psoriasis Symposium

Australasian Journal of Dermatology, Volume 59, Issue S1, Page 12-13, May 2018.


https://ift.tt/2I3d17D

Procedural Dermatology – Free Papers

Australasian Journal of Dermatology, Volume 59, Issue S1, Page 11-12, May 2018.


https://ift.tt/2FoEeP0

Registrar Training Session

Australasian Journal of Dermatology, Volume 59, Issue S1, Page 24-24, May 2018.


https://ift.tt/2I6tA2I

Dermatology Hospitalist

Australasian Journal of Dermatology, Volume 59, Issue S1, Page 22-24, May 2018.


https://ift.tt/2FnJ9zM

Translational Research

Australasian Journal of Dermatology, Volume 59, Issue S1, Page 25-28, May 2018.


https://ift.tt/2I1PCU1

Procedural Dermatology – Mohs Peer Review

Australasian Journal of Dermatology, Volume 59, Issue S1, Page 4-4, May 2018.


https://ift.tt/2FmTVGB

Melanoma & Skin Cancer Free Communications

Australasian Journal of Dermatology, Volume 59, Issue S1, Page 19-22, May 2018.


https://ift.tt/2I5n10j

Registrar & Fellow Update – Medical

Australasian Journal of Dermatology, Volume 59, Issue S1, Page 3-4, May 2018.


https://ift.tt/2FmTMmx

Registrar Forum

Australasian Journal of Dermatology, Volume 59, Issue S1, Page 4-7, May 2018.


https://ift.tt/2I94gsV

Dermatology Research

Australasian Journal of Dermatology, Volume 59, Issue S1, Page 31-32, May 2018.


https://ift.tt/2FmTlsp

Issue Information

Australasian Journal of Dermatology, Volume 59, Issue S1, Page 1-2, May 2018.


https://ift.tt/2I42iKb

Correction to: Evaluation of pharmacokinetic models of intravenous dexmedetomidine in sedated patients under spinal anesthesia

Inadvertently, the reference [8] was published incorrectly in the original publication of the article. The correct reference [8] is provided below:

https://ift.tt/2I3gFhU

Multi-disciplinary clinical protocol for the diagnosis of bulbar amyotrophic lateral sclerosis

Publication date: Available online 23 April 2018
Source:Acta Otorrinolaringológica Española
Author(s): Rita Chiaramonte, Carmela Di Luciano, Ignazio Chiaramonte, Agostino Serra, Marco Bonfiglio
Introduction and objectivesThe objective of this study was to examine the role of different specialists in the diagnosis of amyotrophic lateral sclerosis (ALS), to understand changes in verbal expression and phonation, respiratory dynamics and swallowing that occurred rapidly over a short period of time.Materials and methods22 patients with bulbar ALS were submitted for voice assessment, ENT evaluation, Multi-Dimensional Voice Program (MDVP), spectrogram, electroglottography, fiberoptic endoscopic evaluation of swallowing.ResultsIn the early stage of the disease, the oral tract and velopharyngeal port were involved. Three months after the initial symptoms, most of the patients presented hoarseness, breathy voice, dysarthria, pitch modulation problems and difficulties in pronunciation of explosive, velar and lingual consonants. Values of MDVP were altered. Spectrogram showed an additional formant, due to nasal resonance. Electroglottography showed periodic oscillation of the vocal folds only during short vocal cycle. Swallowing was characterized by weakness and incoordination of oro-pharyngeal muscles with penetration or aspiration.ConclusionsA specific multidisciplinary clinical protocol was designed to report vocal parameters and swallowing disorders that changed more quickly in bulbar ALS patients. Furthermore, the patients were stratified according to involvement of pharyngeal structures, and severity index.



https://ift.tt/2r3miEL

Which essential oils help get rid of wrinkles?

There are many lotions and creams that claim to help reduce the appearance of wrinkles, but some people may prefer a natural alternative. Many essential oils, including sandalwood, lavender, and rosemary, are believed to help. We look at the evidence for 10 essential oils that could help keep the skin looking young.

https://ift.tt/2Focfiq

Can you remove a skin tag yourself?

Skin tags are harmless, but some people choose to eliminate large or noticeable tags for cosmetic reasons. There are many simple methods of removal, including creams and freezing kits. In this article, we describe how to get rid of skin tags at home and when to see a doctor for professional removal.

https://ift.tt/2HusfFE

Dermatoporosis and vitamin C deficiency

Journal of the European Academy of Dermatology and Venereology, EarlyView.


https://ift.tt/2Jy24ui

Intra‐ and interobserver variability of image‐based PASI assessments in 120 patients suffering from plaque‐type psoriasis

Journal of the European Academy of Dermatology and Venereology, EarlyView.


https://ift.tt/2KmcKgW

Linear keratinocytic epidermal nevi on trunk skin caused by a somatic FGFR2 p.C382R mutation

The Journal of Dermatology, EarlyView.


https://ift.tt/2vQmdK1

Repeated hyperhidrosis and chilblain‐like swelling with ulceration of the fingers and toes in hereditary sensory and autonomic neuropathy type II

The Journal of Dermatology, EarlyView.


https://ift.tt/2r4mzbg

Systematic review of the prevalence of nodal metastases and the prognostic utility of sentinel lymph node biopsy in cutaneous squamous cell carcinoma

The Journal of Dermatology, EarlyView.


https://ift.tt/2HxleQs

Identification of a novel missense KRT86 mutation in a Chinese family with monilethrix

The Journal of Dermatology, EarlyView.


https://ift.tt/2r5qF2I

Peristomal pyoderma gangrenosum with high serum levels of interleukin‐8

The Journal of Dermatology, EarlyView.


https://ift.tt/2HBP7Pp

Rhabdomyolysis due to bacteremia from Enterobacter cowanii caused by a rose thorn prick

The Journal of Dermatology, EarlyView.


https://ift.tt/2qZn06H

Transoral robotic resection of benign tumors of the upper aerodigestive tract: Experience of the French group of GETTEC

Head &Neck, EarlyView.


https://ift.tt/2vRvAZT

Clinical and dermoscopic spectrum of discoid lupus erythematosus: novel observations from lips and oral mucosa

International Journal of Dermatology, EarlyView.


https://ift.tt/2FmgL10

A pruritic maculopapular eruption leaving a reticular hyperpigmentation

International Journal of Dermatology, EarlyView.


https://ift.tt/2I3jPCh

Onychoscopic evaluation of onychomycosis in a tertiary care teaching hospital: a cross‐sectional study from South India

International Journal of Dermatology, EarlyView.


https://ift.tt/2Fm0PvC

UVA‐1 phototherapy for the management of atopic dermatitis: a large retrospective study conducted in a low‐middle income country

International Journal of Dermatology, EarlyView.


https://ift.tt/2HTw86l

Effect of Polyglycolic Acid Mesh (Neoveil) in Thyroid Cancer Surgery

Conditions:   Thyroid Gland Carcinoma;   Thyroid Cancer;   Thoracic Duct Leak
Intervention:   Device: Neoveil (Polyglycolic Acid Mesh)
Sponsors:   Seoul National University Hospital;   Green Cross Corporation
Not yet recruiting

https://ift.tt/2HuOM5c

Metformin in Head and Neck Squamous Cell Carcinoma: Effect on Tissue Oxygenation

Conditions:   Head and Neck Cancer;   Oral Cavity Squamous Cell Carcinoma
Intervention:   Drug: Metformin
Sponsors:   University Hospital Inselspital, Berne;   University of Bern;   Werner und Hedy Berger-Janser – Stiftung
Not yet recruiting

https://ift.tt/2r54dWD

Vorolanib (X-82) Combined With Checkpoint Inhibitors in Patients With Solid Tumors

Conditions:   Solid Tumor;   Hepatocellular Carcinoma;   Gastric Cancer;   Gastroesophageal Junction Adenocarcinoma
Interventions:   Drug: Vorolanib;   Drug: Nivolumab;   Drug: Pembrolizumab;   Procedure: Peripheral blood draw
Sponsors:   Washington University School of Medicine;   Xcovery Holding Company, LLC
Not yet recruiting

https://ift.tt/2HvlYcQ

CHEckpoint Inhibition in Combination With an Immunoboost of External Body Radiotherapy in Solid Tumors

Conditions:   Urothelial Carcinoma;   Melanoma;   Renal Cell Carcinoma;   Non-small Cell Lung Cancer;   Head and Neck Cancer
Interventions:   Drug: Pembrolizumab or Nivolumab;   Radiation: SBRT
Sponsors:   University Hospital, Ghent;   GZA Ziekenhuizen Campus Sint-Augustinus;   AZ Sint-Lucas
Recruiting

https://ift.tt/2r6VZ0f

The Pringle maneuver reduces the infusion rate of rocuronium required to maintain surgical muscle relaxation during hepatectomy

Abstract

Introduction

We investigated the continuous infusion rates of rocuronium necessary to obtain the surgical muscle relaxation before, during, and after the Pringle maneuver on patients who underwent hepatectomy.

Methods

Fifteen patients were induced by total intravenous anesthesia with propofol. After obtaining the calibration of acceleromyography, the patient was intubated with rocuronium 0.6 mg/kg. Fifteen minutes after initial rocuronium injection, the continuous infusion was started at 7.5 µg/kg/min. The infusion rate was adjusted every 15 min so that the first twitch height (% T1) might become from 3 to 10% of control. The infusion rates at the time when the state of surgical muscle relaxation was achieved for more than 15 min were recorded before, during and after the Pringle maneuver. The 25% recovery time was measured after discontinuing the continuous infusion.

Results

The infusion rate of rocuronium before, during, and after the Pringle maneuver was 7.2 ± 1.8, 4.2 ± 1.4, and 4.7 ± 1.5 µg/kg/min (mean ± SD), respectively. The rocuronium infusion rate during the Pringle maneuver was decreased about 40% compared to that before this maneuver, and that after completion of the Pringle maneuver was not recovered to that before the Pringle maneuver. The 25% recovery time was 20 ± 7 min.

Conclusion

In case of continuous administration of rocuronium during surgery performing the Pringle maneuver, it was considered necessary to regulate the administration of rocuronium using muscle relaxant monitoring in order to deal with the decrease in muscle relaxant requirement by the Pringle maneuver.

https://ift.tt/2HUo8lQ

Type 1 cryoglobulinaemia presenting as digital ischaemia in chronic lymphocytic leukaemia

Description 

A 60-year-old Caucasian man with untreated chronic lymphocytic leukaemia presented with a 3-month history of recurrent arthralgia and joint swelling, predominantly affecting the knee, wrist and DIP joints. He subsequently developed painful, dusky fingers and was referred to the haematology department at the Royal Free Hospital for investigation (figure 1).

On admission, a full blood count revealed: Hb 92 g/L, white cell count 86.7x10⁹/L with a lymphocyte differential of 77.2x10⁹/L and platelets 332. Renal, liver and bone profiles within normal ranges. Cryoglobulins were detected, and subsequent immunofixation showed the presence of a type 1, monoclonal IgM lambda cryoglobulin.

Figure 1

Before treatment.

The patient was managed with a continuous iloprost infusion, high dose corticosteroid therapy, plasmapharesis, rituximab and subsequently a dose of cyclophosphamide. On discharge, he was referred to University College Hospital for long-term management of CLL. He was referred...

https://ift.tt/2JvwNYU

Bordetella bronchiseptica pneumonia: beware of the dog!

We report the case of a 35-year-old quadriplegic male with confirmed Bordetella bronchiseptica pneumonia, manifesting with acute hypoxic respiratory failure on a background of chronic hypercarbia requiring mechanical ventilation in intensive care.

B. bronchiseptica are known to colonise the upper respiratory tracts of many mammals but are very rarely responsible for acute respiratory tract infections in humans.

A review of the literature suggests preponderance for immunocompromised or immunoincompetent patients who have experienced environmental exposure to colonised animals. The disease pattern of B. bronchiseptica infection is non-uniform and while it is rarely described as a commensal or colonising organism, very few case reports describe severe respiratory infections.

https://ift.tt/2KikuQV

Streptococcus anginosus endocarditis and multiple liver abscesses in a splenectomised patient

An unusual case of infective endocarditis and concurrent multiple liver abscesses both caused by Streptococcus anginosus in a splenectomised patient is reported. The microorganism is a very rare cause of endocarditis and its presentation with multiple liver abscesses is highly unusual. It was initially misdiagnosed as Streptococcus sanguinis and issues relating to the different clinical presentations of S. anginosus including the rare cases of endocarditis, the role of the patient's splenectomy and problems that may contribute to its potential laboratory misidentifications are discussed.

https://ift.tt/2JsQG2E

Fever of unknown origin, bilateral sensorineural hearing loss with canal paresis and uveitis with iridocyclitis and episcleritis: a case of Cogans syndrome

Description

A 69-year-old Japanese woman presented with 1-month history of continuous spiking fever, proximal myalgia with weakness, weight loss, intermittent abdominal pain and lower back pain. Except for the use of oral hypoglycaemic drugs to control her diabetes mellitus over the last 7 years, she had been otherwise healthy until she developed these symptoms. Additionally, she had a history of recurrent tinnitus and vertigo for the last 2 years and was suspected to have Ménière's disease or benign paroxysmal positional vertigo by an otolaryngologist. Seven days prior to her first visit, she developed progressively worsening bilateral deafness. She was admitted to the surgical ward to assess intermittent abdominal pain and subsequently underwent gynaecological examination; however, no diagnosis was made. Five days after the admission, she developed progressive bilateral blurred visions and an ophthalmologist diagnosed her with uveitis with iridocyclitis and episcleritis (figure 1A). She was then referred to...

https://ift.tt/2Ki74o8

Herpes simplex virus type 1: an atypical presentation of primary infection

Description 

A 3-year-old female child with personal history of atopic dermatitis presented with confluent vesicular and shallow ulcers pruritic rash surrounded by an erythematous base located to both hands and wrists, with 1-week evolution. She had no fever or other symptoms. There was no personal or family history of herpetic infections. Topical antibiotic, topical corticosteroid and oral antihistaminic were tried with no improvement. Physical examination was unremarkable except for generalised dry skin and lesions in figure 1. On suspicion of superinfected viral rash or bullous impetigo she was treated with oral amoxicillin and clavulanic acid (concentration of 250 mg/62.5 mg with the dose of 50 mg/kg/day) and topical fusidic acid. One week later, at re-evaluation, there was progression of the rash (figure 2) and the mother reported herpes labialis on the father. At this time, the diagnosis of primary eczema herpetic infection was also considered. Oral acyclovir...

https://ift.tt/2JxG0Qu

Complete resolution of extensive thrombosis of atheromatous non-aneurysmal descending aorta and pulmonary embolism with warfarin therapy

A 54-year-old man underwent decompressive craniectomy following a stroke. He further developed right lower limb ischaemia, and CT aortography revealed extensive aortic atherosclerotic disease. Urgent embolectomy prevented him from having a major amputation. He subsequently developed pulmonary embolism. This was initially treated with heparin followed by warfarin apart from antiplatelets and statin. A follow-up aortography at 3 months interval showed near complete resolution of atheromatous disease of the aorta. This report raises the possibility that apart from antiplatelets and lipid-lowering agents, anticoagulation may be responsible for resolution of such an extensive atheromatous disease and whether this can be considered as part of regular treatment.

https://ift.tt/2KikrEJ

Balance performance of children and adolescents with sensorineural hearing loss: Repercussions of hearing loss degrees and etiological factors

Publication date: July 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 110
Author(s): Renato de Souza Melo, Andrea Lemos, Maria Cristina Falcão Raposo, Rosalie Barreto Belian, Karla Mônica Ferraz
IntroductionSome studies have demonstrated a parallelism between the extent of hearing loss and the frequency of vestibular dysfunction in children with sensorineural hearing loss (SNHL). Despite this, little is known about the repercussion of degrees of hearing loss and etiological factors on the balance performance in this children.ObjectiveCompare the balance performance between normal hearing (NH) children and those with SNHL, considering the sex and age range of the sample, and analyze balance performance according to the degrees of hearing loss and etiological factors in the latter group.MethodsCross-sectional study that assessed 96 children (48 NH and 48 with SNHL), aged between 7 and 18 years old. The balance performance was assessed by the Brazilian version of the Pediatric Balance Scale, validated for Brazilian child population and the Mann-Whitney test used for statistical analysis.ResultsThe group with SNHL showed lower average balance performance compared to NH (p = 0.000). This was also observed when the children were grouped by sex: female and male (p = 0.001). The same difference occurred when the children were stratified by age group: 7–14 years old (p = 0.000). There were no differences between the balance performance of the groups according to the degrees of hearing loss (p = 0.236) and the children with prematurity or post-natal meningitis as an etiological factor demonstrated the worst balance performance.ConclusionThe children with SNHL showed worse balance performance compared to NH of the same sex and age range between seven to fourteen years. There were no differences between balance performance and hearing loss degrees, and those children with prematurity or post-natal meningitis as an etiological factor demonstrated the worst balance performances.



https://ift.tt/2HA715o

Allergie de contact et photo-induite à l’huile essentielle d’argan

Publication date: May 2018
Source:Annales de Dermatologie et de Vénéréologie, Volume 145, Issue 4, Supplement
Author(s): Omar Boudghene Stambouli, Amal Tebbal, Boumediene Dahmani
IntroductionLes huiles essentielles sont des concentrés des composés aromatiques d'une plante ou des extraits d'amande. Elles sont utilisées en cosmétique et en aromathérapie. L'huile d'argan est extraite de l'amande oléagineuse de l'arganier. Nous rapportons un cas d'allergie de contact et photo-induite secondaire à l'application locale de l'huile d'argan.ObservationsB.Z., âgé de 54 ans, se présentait au service de dermatologie pour des lésions érythémato-squameuses prurigineuses apparues depuis 3 jours au niveau du visage. Il n'avait pas d'antécédent particulier. À l'examen clinique, on observait des lésions érythémateuses finement squameuses du visage s'étendant au pavillon d'oreille avec un œdème de ce dernier. À l'anamnèse, le patient signalait avoir appliqué 3 jours de suite de l'huile d'argan à l'endroit ou étaient apparues les lésions dans un délai de 48 H avec notion d'exposition solaire. Le patient n'avait pas bénéficié d'explorations photo-patch tests malheureusement.DiscussionL'arganeraie s'étire au sud-ouest du Maroc, c'est une espèce endémique, cet épineux appartient à la famille des sapotacées, une essence tropicale. L'huile d'argan est extraite du fruit de l'arganier, plus précisément des amandons contenus dans le noyau. Elle se décline en deux versions : l'une utilisée en gastronomie : diététique, l'autre en cosmétique : anti-radicalaire, anti-oxydante, et anti-inflammatoire. Elle est souvent perçue comme sans danger. Pourtant son utilisation peut provoquer des réactions irritatives, de contact et photo-allergiques. Il est intéressant de réaliser le photo-patch tests afin de démontrer cette réaction. À notre connaissance, il existe peu de cas montrant que l'exposition solaire aggrave la sensibilisation de contact aux huiles essentielles et c'est le premier cas à l'huile d'argan. Il est important d'informer des effets indésirables potentiels et de rester vigilants face à l'utilisation croissante de ces produits naturels.ConclusionL'huile d'argan utilisée en cosmétologie ; en aromathérapie est sensibilisante, occasionne des réactions de contact. Nous décrivons une allergie de contact à cette huile doublée d'une photo-allergie. Il est important de mettre en garde contre les dangers possibles de cette huile essentielle.



https://ift.tt/2KiMeFd

Profil épidémio-clinique de la consultation dermatologique dans le camp des réfugiés syriens de Zaatari-Jordanie

Publication date: May 2018
Source:Annales de Dermatologie et de Vénéréologie, Volume 145, Issue 4, Supplement
Author(s): M. El Amraoui, A. Bouhamidi, N. Hjira, M. Boui
IntroductionLes camps de réfugiés constituent un climat propice ou où sévit la pathologie dermatologique, favorisée par la promiscuité, le manque d'hygiène, la précarité, la malnutrition, le stress et les conditions météorologiques défavorables.Buts du travailNotre travail a comme objectifs d'étudier les caractéristiques sociodémographiques des consultants ainsi que les particularités des dermatoses qui surviennent sur ce terrain.Matériels et méthodesÉtude rétrospective, monocentrique, étalée sur une durée de trois mois, du 14/11/2014 au 14/02/2015, au sein du 1^er hôpital marocain médico-chirurgical de campagne, implanté à Zaatari en Jordanie, au profit des réfugiés syriens.RésultatsLa consultation dermatologique venait en troisième position des consultations spécialisées par 2736 consultations. Également 65 interventions ont été effectuées. Nous avons observé une discrète prédominance féminine avec une fréquence de 52 %. L'âge de nos patients variait de 17 jours à 100 ans avec une prédominance nette pour les tranches de [10–19] ans (27,16 %) et [0–9] ans (23,06 %). Les dermatoses infectieuses représentaient la moitié de la pathologie dermatologique (49,65 %), suivies par les dermatoses immuno-allergiques (20,83 %) et la pathologie tumorale (5,04 %), alors que, les autres dermatoses (24,48 %) étaient dominées par la pathologie inflammatoire, la pathologie du froid, les brûlures et les mutilations de guerre. Notant que 5,30 % des patients présentaient plus d'une dermatose, 4,27 % des dermatoses étaient surinfectées et 2,21 % des patients présentaient des IST.ConclusionLe camp de réfugiés est un climat propice où tous les facteurs sont réunis, pour favoriser l'émergence de la pathologie dermatologique. La promiscuité, la malnutrition et l'hygiène précaire favorisent les dermatoses infectieuses. Le froid et les conditions météorologiques défavorables optimisent les dermatoses immuno-allergiques, les gelures et les acrosyndromes. Le stress dévoile les dermatoses inflammatoires et psychosomatiques. La guerre et les installations insalubres favorisent les brûlures et les mutilations de guerre.



https://ift.tt/2JxGwhr

Tuberculose cutanée de l’enfant : encore un scrofuloderme

Publication date: May 2018
Source:Annales de Dermatologie et de Vénéréologie, Volume 145, Issue 4, Supplement
Author(s): O.B. Boudghene Stambouli, A. Dib Lachachi
IntroductionLa tuberculose cutanée occupe la cinquième place après les atteintes pleuropulmonaire, ganglionnaire, urogénitale et digestives. Nous rapportons un cas de tuberculose cutanée à type de scrofuloderme à double localisation révélant une atteinte osseuse et ganglionnaire sous-jacente.Matériel et méthodesUne fillette de six ans a été adressée au servie, pour la prise en charge d'une lésion ulcerosquamo-croûteuse de part et d'autre la cheville gauche, évoluant depuis un an.ObservationsLes traitements prescrits antérieurement (antibiotique, antiseptiques, antifongiques) n'ont donné aucune amélioration. L'anamnèse n'a pas trouvé la notion de traumatisme et la fillette était vaccinée par le BCG avec cicatrice de vaccination présente. L'examen clinique a retrouvé un état général conservé, sans fébricule avec courbe de croissance normale, mais la fillette ne pouvait pas marcher ou se tenir debout par la déformation de sa cheville ; on note également.Une lésion ulcéreuse d'allure cicatricielle au niveau du creux inguinal gauche surmontant une masse sous-jacente.RésultatsDes examens ont été réalisés et le diagnostic de tuberculose à type de scrofuloderme à double localisation surmontant un foyer osseux et ganglionnaire a été retenu ; une triple antibiothérapie antituberculeuse a été prescrite avec évolution très satisfaisante.DiscussionLes aspects de tuberculose cutanée chez l'enfant les plus fréquemment rencontrés sont le lupus vulgaire et le scrofuloderme, bien que dans une étude marocaine de Casablanca la gomme et le scrofuloderme étaient les formes les plus fréquentes. La preuve de la tuberculose étant rarement apportée, son diagnostic est difficile et se base le plus souvent sur un faisceau d'argument anamnestique, clinique, histologique, biologique, évolutif et thérapeutique.ConclusionLa forme clinique de tuberculose cutanée de l'enfant la plus fréquente reste le scrofuloderme.



https://ift.tt/2KhypXq

Atteinte cutanée au cours de la maladie de Vogt-Koyanagi-Harada

Publication date: May 2018
Source:Annales de Dermatologie et de Vénéréologie, Volume 145, Issue 4, Supplement
Author(s): C. Chouk, N. Litaiem, M. Jones, S. Harbaoui, S. Rammeh, N. Ezzine, F. Zeglaoui
IntroductionLa maladie de Vogt-Koyanagi-Harada (VKH) est une maladie multisystémique rare, affectant l'œil, le système nerveux central, l'oreille interne et les téguments. C'est une maladie auto-immune médiée par les lymphocytes T dont la cible est la cellule mélanocytaire. Nous rapporterons ici à travers 3 observations de VKH, les différentes manifestations cutanées observées au cours de cette maladie.ObservationsIl s'agit de 3 patients : un homme de 77 ans et deux femmes de 41 et 54 ans, suivis en ophtalmologie pour panuvéite bilatérale d'installation récente. Ils avaient comme antécédents : un vitiligo étendu d'évolution stable depuis plusieurs années chez un malade, un diabète sucré équilibré sous régime chez une patiente et une malformation cardiaque opérée dans l'enfance chez une patiente. À l'examen on notait la présence de larges plaques achromiques bien limitées du dos, du visage et des mains associées à une poliose du cuir chevelu chez un malade, des cils blancs avec quelques macules dépigmentées du corps chez une malade et des plaques hypopigmentées des membres inférieurs chez l'autre. Le diagnostic de VKH dans sa forme incomplète était retenu devant l'association de manifestations oculaires et cutanées de la maladie. Les 3 patients étaient traités par l'association d'une corticothérapie générale à 1mg/kg/j et cyclosporine à 3mg/kg/j avec stabilisation de l'atteinte ophtalmologique.DiscussionLa maladie de VKH est dans sa forme typique une panuvéite bilatérale associée à des manifestations extraoculaires, méningées, cutanées et intéressant l'oreille interne. Sa distribution est inégale dans le monde, affectant plus fréquemment les populations du pourtour méditerranéen, les asiatiques et les amérindiens. Une prédominance féminine est notée dans la plupart des études et l'âge moyen de la maladie est autour de 35 ans. Les manifestations cutanées du VKH sont d'apparition tardive à types de poliose au niveau des cils et des sourcils, des mèches de cheveux voire une canitie, une pelade et des macules leucodermiques. Une hyperesthésie cutanée est parfois rapportée à la phase prodromale de la maladie. Les macules leucodermiques sont assimilés par certains auteurs à un authentique vitiligo. Il s'agit d'une manifestation survenant à distance des signes initiaux d'uvéite, et elle est corrélée à la dépigmentation du fond d'œil (signe de Sugiura) qui demeure une manifestation tardive de la maladie.ConclusionLes macules leucodermiques dans la maladie de VKH sont corrélées à la dépigmentation du fond d'œil. Bien qu'il s'agisse d'un signe tardif de la maladie, sa valeur pronostique demeure incertaine.



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Surdosage au méthotrexate suite à une erreur de posologie : à propos d’un cas

Publication date: May 2018
Source:Annales de Dermatologie et de Vénéréologie, Volume 145, Issue 4, Supplement
Author(s): O.B. Boudghene Stambouli, I. Mahi
IntroductionLe méthotrexate est utilisé à de faibles doses en dermatologie pour le traitement du psoriasis Nous rapportons une observation d'une erreur de posologie au méthotrexate administré par voie orale dans le traitement d'un psoriasis et conduisant à des effets secondaires relativement graves.Matériel et méthodesNous rapportons le cas d'un homme atteint de psoriasis et traité par le méthotrexate.ObservationsUn homme âgé de 26 ans aux antécédents de psoriasis été adressé pour des ulcérations cutanées et muqueuses apparues suite à une erreur de posologie au méthotrexate. La dose administrée était de 20mg par semaine, mais le patient qui n'a pas reçu suffisamment de renseignements a pris 20mg de méthotrexate en dose quotidienne. Après une dose totale de 60mg, sont apparues des lésions érosives cutanées et muqueuses buccales, génitales et anales. L'examen ophtalmologique mettait en évidence une dystrophie maculaire. Les examens biologiques révélaient une thrombopénie, une leucopénie et un syndrome inflammatoire. Des cristaux était retrouvés lors de l'examen macroscopique et microscopique des urines.RésultatsLe diagnostic d'un surdosage au méthotrexate suite à une erreur de posologie était retenu et ce médicament a été immédiatement interrompu. Une hyperhydratation alcaline a été débuté avec soins locaux pour les lésions cutanées et muqueuses. L'évolution était favorable au bout de quelques jours.DiscussionC'est le cas pour notre patient qui a présenté des effets indésirables relativement graves suite à un surdosage au méthotrexate provoqué par une erreur de posologie. Les principales manifestations retrouvées chez notre patient ont été : une atteinte rénale avec formation de cristaux visibles macroscopiquement, une atteinte hématologique, des ulcérations cutanées et muqueuses avec atteinte buccale génitale duodénale anale et enfin une maculopathie dont l'imputabilité du méthotrexate n'a pu être confirmée. Afin d'éviter la récurrence de ce type d'erreur avec le méthotrexate par voie orale, des mesures préventives sont proposées au niveau international.ConclusionLe méthotrexate est un médicament largement employé en thérapeutique dermatologique l'information au patient de même qu'une bonne coopération médecin patient constituent une étape importante dans sa prescription permettant ainsi d'éviter des accidents graves voire mortels.



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