The cover image, by Dajiang Song et al., is based on the Original Article Chimeric thoracoacromial artery perforator flap for one-staged reconstruction of complex pharyngoesophageal defects: A single unit experience, DOI: 10.1002/hed.24962
A 73-year-old man presented with three episodes of dysphasia and disinhibited behaviour, a single seizure and transient ischaemic attack-like events characterised by right arm and/or leg weakness. These episodes were separated by month-long asymptomatic intervals. Medical history included rheumatoid arthritis, which was clinically quiescent on leflunomide.
Repeated cerebrospinal fluid examination showed a persistent lymphocytosis with mildly reduced glucose and elevated protein; oligoclonal bands and viral PCR were negative. MRI of the brain was initially normal, but 7 months after initial presentation revealed meningeal enhancement with bifrontal cortical hyperintensities on T2/fluid-attenuated inversion recovery. Brain biopsy demonstrated necrotising granulomatous meningitis with mixed T cell and B cell infiltrates and without evidence of vasculitis or infection. Serum anticyclic citrullinated peptide antibodies were strongly positive.
The diagnosis of rheumatoid meningoencephalitis was made on the basis of brain biopsy findings and serological evidence of active rheumatoid disease. Steroids and rituximab therapy were started leading to clinical stabilisation.
Description
A 33-year-old man presented with recurrent pain and swelling in the inguinal region since the last 8 years, occasional fever and loss of sex drive. The pain and swelling usually lasted for 2–3 weeks with a pain-free interval of 4–5 months. He felt that the size of the left testis is gradually reducing. He had been married for more than 5 years without having any children. Clinical examination revealed swelling and tenderness of the scrotum more on the right (figure 1A).
Fro Figure 1
(A) A 33-year- old man with right-sided testicular swelling. (B) Ultrasonography of the scrotum reveals a hypoechogenic, small right testis with irregularly echogenicity in periphery due to fibrosis. (C) Colour Doppler reveals absence of vascular flow on right-side testis.
Ultrasound examination showed swelling of both epididymis with the outer area appearing irregularly echogenic due to fibrosis (figure 1B)....
Radiation therapy is used in the management of a number of childhood cancers and can have significant effects on skeletal growth. We present the case of a 35-year-old woman who developed a hypoplastic pelvis and buttocks following radiotherapy for rhabdomyosarcoma of the vagina at the age of 2. At the age of 25, the patient underwent bilateral buttock augmentation with a two-stage reconstruction using tissue expansion followed by definitive augmentation with anatomical breast implant insertion. The patient continues to have a satisfactory outcome 10 years following reconstruction, having undergone a single uplift procedure and exchange of implants through the original incision 9 years postoperatively. This case represents a unique reconstructive challenge to plastic surgeons and was successfully managed with a novel approach.
A young man with a history of smoking presented with acute-onset chest pain after lifting weights. He also noticed a change in his voice, tightness in his neck and difficulty breathing. A chest radiograph showed soft tissue emphysema in the neck. A CT scan of the chest revealed moderate amount of pneumomediastinum tracking into the neck and down to the diaphragm. He was haemodynamically stable and had no hypoxia or dysphagia. He was monitored for 48 hours and discharged home after resolution of his symptoms. A chest radiograph repeated after 6 weeks was normal.
A 60-year-old man presented with impaired consciousness and psychomotor agitation after a second allogeneic haematopoietic stem cell transplantation (HSCT) from a matched unrelated donor for acute myeloid leukaemia. Clinical, biological and radiological evidence suggested a diagnosis of central nervous system graft-versus-host disease (CNS-GvHD). After intrathecal infusion of methylprednisolone, the clinical symptoms as well as the radiological abnormalities disappeared. The present report illustrates the difficulties in the diagnosis and the management of CNS-GvHD, a very rare and still challenging neurological complication that can occur after allogeneic HSCT.
Splenic rupture is an infrequent and underdiagnosed side effect of granylocyte colony-stimulating factor (G-CSF). We report the case of a 54-year-old woman with brain and bone metastasis in a lung adenocarcinoma who was admitted for faintness 28 days after a G-CSF injection. Abdominal CT scan confirmed the diagnosis of splenic rupture. A conservative treatment was chosen using a peritoneal cleansing during laparoscopic surgery. Clinicians should be aware of this rare toxicity as it could be severe, but easily reversible using appropriate surgical treatment. Even if prognosis remains poor for patients with lung cancer, invasive procedures could be considered in this rapidly evolving setting, especially in case of reversible adverse event.
A 39-week-old male newborn presented at birth with atrophic erythematous and purpuric skin lesions, in a typical right-sided segmental distribution. Lesions were persistent and unaffected by rewarming in the postpartum period. Postnatal echocardiogram showed a predominance of the right cavities and an upper atrial septal defect. Cerebral and abdominal ultrasound were normal along with ophthalmological examination. On follow-up, lower limbs asymmetry was noted. The right lower limb was shorter in length and had a smaller diameter. At 6 months, the right lower limb was 1.5 cm shorter than the left, most likely related to nutritive vessels malformations. The discrepancy was even more pronounced at the age of 9 months. This leg-length asymmetry can lead to severe functional limitations in the future.
Case of cerebrofacial arteriovenous metameric syndrome (CAMS) in a 9-year-old boy is described with arteriovenous malformation simultaneously involving the brain and face, with characteristic CAMS type 1 and 2 involvement. This patient demonstrates the wide spectrum of clinical manifestations of CAMS, and in this particular case, the patient exhibits features of hypopituitarism—an association that was not previously described in the literature to our knowledge. Awareness of the underlying embryological abnormality and recognition of resultant clinical and radiological presentations are paramount for diagnosis and treatment.
Vitamin B12 deficiency in vegans is a known cause of megaloblastic anaemia. We report an adolescent girl who presented with jaundice and weight loss for 6 months secondary to vitamin B12 deficiency, leading to megaloblastic anaemia. Replacement with vitamin B12 reversed her symptoms, resulting in weight gain, and normalised her haemoglobin, red blood cell morphology, bilirubin levels and serum vitamin B12 levels.
Tattoo popularity continues to rise, with 3 in 10 Americans bearing at least one. Among tattoo complications, non-tuberculous mycobacteria (NTM) has emerged as a global public health concern. NTM infections associated with tattooing of immunocompetent individuals have occurred as sporadic cases and community outbreaks. Water sources are considered the major pathogenic reservoirs. Tattoo-related inoculation has been linked to contamination of ink, either during the manufacturing process or during dilution of black ink using non-sterile water. NTM infections have also been documented in a number of cosmetic and surgical procedures, including cutaneous surgery, Mohs micrographic surgery, mesotherapy, liposuction and laser resurfacing. NTM inoculation through exposure to contaminated water or non-sterile instruments remains a challenge for dermatologists and risk to patients. We reported a case of cutaneous Mycobacterium massiliense infection following tattoo placement. This report underscores the importance of clinicians to consider NTM infections in the differential diagnosis of procedure-related reactions.
Description
A 31-year-old Indian man presented with drooping of the right eyelid since 1 month, slight deviation of the angle of the mouth to the right since 20 days, difficulty in swallowing (initially with regard to solids, and later on with regard to liquids) since 15 days, nasal regurgitation since 15 days and a nasal twang since 15 days. His past history was not significant, with no history of fever, weight loss, diarrhoea, swollen glands, rash, disfigurement of the hands and feet, loss of eyebrows, or any history suggestive of limb weakness, numbness or tingling. He was not on any medications. None of his parents had any health problems.
He had been previously treated for multibacillary leprosy (Hansen's disease) 3 years back and had taken treatment for 1 year for the same.
On examination, he was found to have bilateral lower motor neuron (LMN)-type glossopharyngeal and vagus nerve palsy; right-sided oculomotor nerve palsy as evidenced...
Description
After returning from a Carribean cruise, a 52-year-old woman spent an afternoon sitting on a sandy beach in Martinique with her husband. An initial burning sensation over her buttocks was followed the next day by an intensely pruritic eruption with 'red pinprick marks'. This was unsuccessfully treated on the cruise ship with antibiotics, antifungal agents, as well as topical and intramuscular steroids. Examination on day 10 revealed a serpiginous rash over her buttocks with a large number of discrete papular lesions (figure 1). The patient's husband was noted to be itching and examination revealed a rash with equivalent distribution and morphology (figure 2). A clinical diagnosis of cutaneous larva migrans was made.
Figure 1
Florid, serpiginous rash located on the buttock region of the patient.
Figure 2
Rash with identical morphology affecting the same region of patient's...
Patients with cirrhosis develop decompensation events during the natural history of the disease that encompass ascites, variceal bleeding, hepatic encephalopathy and jaundice. Coagulation failure, defined using the international normalised ratio, even though not a decompensation event, is important in patients with stratifying cirrhosis into those who require liver transplantation for long-term survival. Isolated coagulation failure in cirrhosis is rare and usually occurs with use of anticoagulants in the setting of vascular diseases. We reported the case of a patient with compensated cirrhosis in whom, isolated severe coagulation failure was found to be due to excessive use of fenugreek milk porridge as part of traditional healing. The coagulation failure was promptly reversed with avoidance of fenugreek and supplementation with vitamin K.
Description
A 68-year-old man with diabetes and chronic kidney disease presented with severe epigastric pain and nausea 30 min after scuba diving in Ishigaki Island, southern part of Okinawa Prefecture, Japan. He dived to 10 m (32.8 ft) twice, for an hour each diving. The length of bottom time was unknown. The temperature of the water was 29.0°C (84.2°F). His vital signs were stable. On palpation of abdomen, there was no evidence of guarding and tenderness. There was also no rash. Venous blood gas showed a pH of 7.314 and lactate of 3.03 mmol/L. Other laboratory values were unremarkable, including liver function tests and creatine kinase. An abdominal CT without contrast was performed because he had a history of allergic reaction to contrast agent. Abdominal CT demonstrated hepatic portal venous gas (HPVG, figures 1 and 2) and gases in the mesenteric vein (figure 2) and femoral vein (
A 32-year-old woman presents to outpatients 10 days postpartum, with symptoms of an intermittent vaginal lump and urinary incontinence. Vaginal examination revealed no demonstrable prolapse or stress incontinence. A swelling in the bladder was noted during an antenatal scan suggesting a ureterocoele. She was referred for pelvic floor physiotherapy in the first instance. Forty-eight hours later, she represented to casualty with discomforting vaginal lump symptoms and continuous urinary incontinence. At this stage on vaginal inspection, there was an evident dusky lump emerging from the urethra with continuous incontinence. An extravesical subsphincteric prolapsed ureterocoele was evident, 5 cm beyond the external urethral meatus. The diagnosis was confirmed with an MRI scan which demonstrated the prolapsed obstructing ureterocoele causing significant left-sided hydroureteronephrosis. The ureterocoele was managed with a cystoscopy and transurethral incision of the ureterocoele under anaesthesia, which facilitated drainage and resolution. At 3-month postoperatively, the patient remains continent and satisfied.
This study aimed to compare cervical vestibular-evoked myogenic potentials (cVEMP), ocular vestibular-evoked myogenic potentials (oVEMP) and video head impulse test (vHIT) results between patients with type 2 diabetes mellitus (DM) or diabetic polyneuropathy (DPN) and healthy controls to determine vestibular end-organ pathologies. The participants in the present study consisted of three groups: the type 2 DM group (n = 33 patients), the DPN group (n = 33 patients), and the age- and sex-matched control group (n = 35). Cervical VEMP, oVEMP and vHIT were performed for each participant in the study and test results were compared between the groups. Peak-to-peak amplitudes of cVEMP (p13–n21) and oVEMP (n10–p15) were significantly lower in the DM and DPN groups than the control group. The values of vHIT were not statistically different between the groups. To our knowledge, the present study is the first report investigating oVEMP and cVEMP responses combined with vHIT findings in patients with DM and DPN. Vestibular end-organ pathologies can be determined via clinical vestibular diagnostic tools in spite of prominent vestibular symptoms in patients with type 2 DM as well as patients with DPN.
Different methods of fibroblast application have been examined to treat recessive dystrophic epidermolysis bullosa (RDEB).
To compare the effects of intradermal injection of cultured allogeneic fibroblasts in healing RDEB wounds with that of fibroblasts seeded on amniotic membrane scaffolds (FAMS) or standard wound care (SWC) with Vaseline gauze as controls.
Seven patients were recruited, and seven wounds were assessed in each patient: three wounds were treated with injection of intradermal fibroblasts, three were treated with FAMS, and one was dressed with SWC. Changes in wound size were assessed after 2 and 12 weeks of treatment. Qualitative wound scores (QWS) were used to assess wound severity. Additionally, biopsies and antigen mapping were performed to detect type-VII collagen in the dermoepidermal junction.
In both treated areas, the QWS and wound size were significantly decreased (P<0.0001), whereas there were no changes in control group (P=0.29). After 2 and 12 weeks of treatment, the wound size was significantly decreased in wounds that were treated with fibroblast injection compared with those treated with FAMS (P<0.0001); but no significant changes were found in control group.
Fibroblast injection has been shown to promote healing of RDEB wounds and is superior to FAMS or the control treatment.
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Psoriasis is a chronic T cell-mediated skin disease with marked social and economic burdens. Current treatments are unsatisfactory, with unpredictable remission times and incompletely understood modes of action. Recent advances in our understanding of the pathogenesis of psoriasis identify the imbalance between CD4+ T effector cells, particularly the T helper (Th) 17 subset, and regulatory T cells (Treg) as key to the development of psoriatic lesions, and therefore a novel therapeutic target.
To quantify in patients the effects of three commonly used psoriasis treatment modalities on the Th1, Th2, Th17 and Treg subsets, and test whether any change correlates with clinical response.
Using flow cytometry to enumerate Th1, Th2, Th17 and Treg subsets in blood and skin of psoriatic patients before and after receiving any of the following treatments; narrow band UVB (NB-UVB), adalimumab and topical betamethasone/calcipotriol combination (Dovobet®).
All patients responded clinically to treatments. NB-UVB significantly increased the numbers of circulating and skin Treg, while, by contrast, adalimumab reduced Th17 cells in these compartments, and Dovobet had dual effects by both increasing Treg and reducing Th17 cells.
The differential effects reported here for the above-mentioned treatment modalities could be exploited to optimize or design therapeutic strategies to better overcome the inflammatory drivers and restore the Th17/Treg balance in psoriasis.
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Hyaluronan (HA) metabolism in skin fibroblasts is mediated by HYBID (HYaluronan Binding protein Involved in hyaluronan Depolymerisation, KIAA1199) and HA synthases 1/2 (HAS1/2). However, photoageing-dependent changes in HA and their molecular mechanisms, and the relationship between HA metabolism and clinical symptoms in photoaged skin remain elusive.
We examined amount, size and tissue distribution of HA and expression levels of HYBID and HAS1/2 in photoaged skin, and analysed their relationships to the degree of photoageing.
Photoageing-dependent changes of HA were investigated by studying skin biopsies isolated from photoprotected and photoexposed areas of the same donors, and the relationship between HA and photoageing symptoms such as skin wrinkling and sagging was examined.
Skin biopsy specimens showed that amount and size of HA are decreased in the photoexposed skin compared to the photoprotected skin, and this was accompanied by increased expression of HYBID and decreased expression of HAS1/2, respectively. Histologically, HA staining in the papillary dermis was decreased in photoexposed skin, showing reverse correlation with HYBID expression. HYBID expression in the photoexposed skin directly correlated with skin roughness and sagging parameters, and reduced HA staining in the papillary dermis in the photoexposed skin positively correlated with these symptoms.
These data demonstrate that imbalance between HYBID-mediated HA degradation and HAS-mediated HA synthesis may contribute to enhanced HA catabolism in the photoaged skin, and suggest that HYBID-mediated HA reduction in the papillary dermis is related to skin wrinkling and sagging of photoaged skin.
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Oral propranolol, first-line therapy for infantile haemangioma (IH) threatening functional impairment or cosmetic disfigurement, readily crosses the blood-brain barrier. Subsequently therefore, there are concerns about potential effects on infant development. Phillips et al. followed 200 children prescribed propranolol, observing sedative effects during treatment and reported gross motor abnormalities in 13 of 188 children, 7 of whom had delayed age (17-20 months) at first walking.
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Xeroderma pigmentosum (XP) is an autosomal recessive disease characterized by sensitivity to sunlight and increased risk of skin cancers. XP is classified into seven nucleotide excision repair-deficient types (A–G) and a variant type1. Differential diagnosis of XP from other genetic pigmentary disorders such as dyschromatosis symmetrica hereditaria (DSH) and dyschromatosis universalis hereditaria (DUH) should be considered, which is sometimes difficult without DNA repair tests or a genetic diagnosis2. DSH and DUH are autosomal dominant diseases characterized by hypo-and hyperpigmented maculae. Recently, ABCB6 was identified as a responsible gene for DUH3.
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The Hippo signaling pathway, which is highly conserved in organisms ranging from Drosophila to mammals, plays a key role in organ size control, cellular proliferation, survival and tumorigenesis1 Yes-associated protein (YAP) is the major downstream effector of Hippo signaling pathway and transcriptional co-activator with PDZ-binding motif (TAZ) is a YAP paralog. Recently, Zhang et al. found that YAP/TAZ acts as natural inhibitors of TANK binding kinase 1 (TBK1), which is a key component for cytosolic nucleic acid sensing antiviral defense and antiviral physiology2
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The aim of this study is to investigate the expression of the autophagy protein p62 in oral squamous cell carcinoma (OSCC) cells before and after chemotherapy. We also detected cancer-associated fibroblasts (CAFs) in these OSCC samples to explore the roles of p62 and CAFs in chemotherapy.
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The two-incision fistula technique for the treatment of oral ranulas has recently been introduced to clinical practice. We reviewed 52 patients who had recurrences after this treatment, and explored the possible causes and underlying mechanisms. A total of 13/53 ranulas had recurred, so we repeated the operation, and one patient had the ranula and the sublingual gland resected. We found that the thin mucous membrane cracked at the double incisions, which led to the formation of a fistula and promoted the drainage of cystic fluid.
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The adoption and adaptation of recent advances in digital technology, such as three-dimensional (3D) printed objects and haptic simulators, in dentistry have influenced teaching and/or management of cases involving implant, craniofacial, maxillofacial, orthognathic and periodontal treatments. 3D printed models and guides may help operators plan and tackle complicated non-surgical and surgical endodontic treatment and may aid skill acquisition. Haptic simulators may assist in the development of competency in endodontic procedures through the acquisition of psycho-motor skills. This review explores and discusses the potential applications of 3D printed models and guides, and haptic simulators in the teaching and management of endodontic procedures. An understanding of the pertinent technology related to the production of 3D printed objects and the operation of haptic simulators are also presented.
Histoplasma capsulatum is a dimorphic fungus predominately found in soils enriched with bird and bat excreta. Although several cases of histoplasmosis have been reported in India, diagnosis using cytology has bee...
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Patients with hidradenitis suppurativa (HS) and type II diabetes mellitus (DM) share severalclinical features.HS patients, particularly younger ones, have a significantly higher prevalence and greater odds of developing DM.Physicians should be aware of the association and monitor for signs and symptoms of DM.
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General anesthesia is still used for some cutaneous procedures.Local anesthesia provides outcomes that are at least equal to general anesthesia and with significantly lower costs.Local anesthesia should be used when feasible.
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What is genital cosmetic surgery, what are your options, and what should you look out for? We give you an overview based on specialist insights.
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Die Anfänge der Liposuktion reichen bis in die 20er-Jahre des letzten Jahrhunderts zurück, in denen sich der Pariser Chirurg Charles Dujarier zum ersten Mal mit Körperformung und Körperfettentfernung beschäftigte. Heute geht man davon aus, dass weltweit pro Jahr etwa 1.453.000 Liposuktionen erfolgen. In Deutschland alleine werden pro Jahr etwa 45.000 Liposuktionen durchgeführt. Eine Großzahl der Liposuktionen erfolgt als Selbstzahlerleistung. Der vorliegende Beitrag möchte die Entwicklung der Liposuktion umreißen, die einzelnen Verfahren und Methoden der Liposuktion erklären, die Indikationsstellung erleichtern und in der Literatur aufgeführte Komplikationen und Pitfalls aufzeigen.
To quantify the impact of acoustic neuroma on the quality-of-life (QOL) patients in the United Kingdom.
Online questionnaire survey.
Members of the British Acoustic Neuroma Association received PANQOL questionnaires.
Of the 880 BANA members contacted, 397 (45.1%) responded, although only 359 had complete datasets for analysis. Composite QOL scores were as follows: for microsurgery 58 (SD 35), for radiotherapy 56 (SD18), for combination of surgery and radiotherapy 49 (SD 14), and for the observation group 54 (SD 20). No statistical significance with ANOVA (p = 0.532). Mean (SD) composite QOL scores were as follows: for follow-up < 6 52 (SD 18), for follow-up 6–10 55 (SD 20) and follow-up > 10 years 65 (SD 45). Overall, these values were significantly different compared by ANOVA (p < 0.001). Patients with facial paralysis showed no statistical significant differences between the different treatment groups.
Short- (< 6 years) and long-term (> 10 years) QOL outcomes show no significant differences between the different treatment groups.
The aim of this study was to assess the infraorbital foramen (IOF) using CT in patients with Zygomaticomaxillary complex (ZMC) fractures (midface fracture).
This prospective study was carried out on 49 patients had ZMC fractures (98 sides) and 27 patients (54 sides) with craniomaxillofacial fractures rather than fractured ZMC as a control. Using CT, position of IOF was documented on 3D view in relation to inferior orbital rim, tooth root relation and finally with a novel imaginary line passing between anterior nasal spine and whitnall tubercle.
Position of IOF had fixed anatomical landmark: just lateral to a line drawn between the anterior nasal spine to whitnall tubercle (clinically between nasal tip—lateral canthal ligament) and lateral to vertical plane to root of maxillary canine also with variable distance from inferior orbital rim ranged from 4.56 to 18.03 mm with a mean of 7.9 ± 2.447 mm.
Even though ZMC fractures disturb the anatomical location of the ZMC bones, there are still preserved reliable fixed landmarks maxillofacial surgeons can depend on to identify and preserve ION.
Venous coupling devices are widely used during reconstructive surgery involving microvascular anastomosis but have not served as foreign bodies in head and neck surgical site infections.
We conducted a case report.
A patient underwent resection and free flap reconstruction for recurrent tongue squamous cell carcinoma. She developed a neck abscess due to Streptococcus intermedius 7 weeks postoperatively, days after starting chemoradiotherapy. The surgical site infection healed with drainage and antibiotics. Two surgical site infection relapses due to S. intermedius occurred 3 and 8 weeks after completing radiation, the second relapse after a prolonged course of i.v. antibiotics. Surgical exploration revealed a venous coupler within granulation tissue. The device was removed and no further surgical site infection relapses occurred.
To the best of our knowledge, this is the first report of a delayed-onset head and neck surgical site infection in which a venous coupler served as a foreign body. An infected foreign body should be suspected in relapsing surgical site infections due to a single organism.
Publication date: Available online 12 January 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Min-Jung Lee, Mi-Jin Kang, So-Yeon Lee, Eun Lee, Kangjin Kim, Sungho Won, Dong In Suh, Kyung Won Kim, Youn Ho Sheen, Kangmo Ahn, Bong-Soo Kim, Soo-Jong Hong
BackgroundPerturbations of the infant gut microbiota can shape the development of the immune system and link to the risk of allergic diseases.ObjectiveTo understand the role of the gut microbiome in atopic dermatitis, the metagenome of the infant gut microbiome was analyzed according to feeding types.MethodsThe composition of gut microbiota was analyzed in fecal samples from 129 infants (6-month-old) by pyrosequencing, including 66 healthy infants and 63 infants with atopic dermatitis. The functional profile of the gut microbiome was analyzed by whole metagenome sequencing (20 controls and 20 AD). In addition, the total number of bacteria in the feces was determined by real-time PCR.ResultsThe gut microbiome of 6-month-old infants was different by feeding types, and two microbiota groups (Bifidobacterium dominated and Escherichia/Veillonella dominated group) were found in breast-fed and mixed-fed infants. The bacterial cell amounts in the feces were lower in infants with AD than in controls. Although no specific taxa directly correlated with AD in 16S rRNA gene results, whole metagenome analysis revealed differences in functional genes related to immune development. The reduction of genes for oxidative phosphorylation, PI3K-Akt signaling, estrogen signaling, NOD-like receptor signaling, and antigen processing and presentation induced by reduced colonization of mucin-degrading bacteria (Akkermansia muciniphila, Ruminocccus gnavus, and Lachnospiraceae bacterium 2_1_58FAA) was significantly associated with stunted immune development in the AD group compared to the control group (P < .05).ConclusionsAlterations in the gut microbiome may be associated with atopic dermatitis due to different bacterial genes that can modulate host immune cell function.
The aim of this review is to conduct a systematic review and meta-analysis comparing the effectiveness of in-home or in-office treatments for dentin hypersensitivity.
An electronic search without restriction on dates or languages was performed in four electronic databases until March 2017. In addition, hand-searches in regular journals and in the gray literature were also conducted. To develop the search strategy, clinical questions were formulated using the PICOS method. Eligibility criteria included randomized clinical trials (RCTs) that compared the effectiveness of different agents for the treatment of dentin hypersensitivity through chemical occlusion, physical occlusion, nerve desensitization, or photobiomodulation (low-level light therapy). This systematic review was registered in PROSPERO under number CRD42016039394.
Twenty-five RCTs (16 parallel; 9 split-mouth), published from 1992 to 2016, were included. The results of the meta-analysis showed that in-office subgroups treated with chemical or physical occlusion of dentin tubules and nerve desensitization had a statistically significant difference from placebo, with P < 0.00001, P < 0.00001, and P = 0.02, respectively. For in-home treatments, the results of the meta-analysis showed that only those subgroups treated with chemical occlusion of dentin tubules and nerve desensitization exhibited a statistically significant difference from placebo, with P < 0.00001 and P = 0.03, respectively.
The results of pairwise meta-analysis suggest that among in-office treatments, dentinal tubule occlusion (whether chemical or physical) and nerve desensitization provide the best outcomes for treatment of dentin hypersensitivity. For in-home treatments, only chemical occlusion of dentin tubules and nerve desensitization showed a greater treatment efficacy than placebo and the difference was statistically significant.
Psoriasis is a chronic, immune-mediated disease, characterised by symptoms that include itching and skin pain and is often associated with comorbidities. Patients have a substantial detriment to quality of life (QoL) and work productivity with associated cost burden.
To investigate the incremental burden of comorbidities, itch, and affected body areas among systemic eligible patients with psoriasis, using a multinational survey of dermatologists and their psoriasis patients.
Multinational data from the Growth from Knowledge (GfK) Disease Atlas global real-world evidence programme were used. Eligible patients were identified as those who were currently having or had ever had moderate-to-severe psoriasis, and must have been receiving prescription treatments at the time of the survey. Multivariable regression analyses were conducted to assess the incremental burden among psoriasis patients with physical and psychological comorbidities, itch, and affected visible and sensitive body areas versus psoriasis patients without these conditions, respectively.
The study enrolled 3,821 psoriasis patients, from 9 countries, with an average Psoriasis Area and Severity Index score of 6.4. The presence of comorbidities was associated with a significant increase in the likelihood of skin pain, lower QoL, greater work impairment and increased usage of medical resources (except in psoriasis patients with obesity and type II diabetes). Psoriasis patients suffering from itch and those with visible and sensitive affected body areas also had impaired QoL versus those without these conditions.
Psoriasis patients with physical and psychological comorbidities, itch and, affected visible and sensitive body areas had lower QoL, and greater work impairment compared to those without these conditions.
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Use of spinal anesthesia (SA) in children may address concerns about potential neurocognitive effects of general anesthesia. We used near-infrared spectroscopy (NIRS) to assess the effects of SA on cerebral and tissue oxygenation in 19 patients aged 7 ± 3 months. Prior to SA placement, NIRS monitors were placed on the forehead (cerebral) and the thigh (tissue). Intraoperative cerebral and tissue saturation were 73 ± 7 and 80 ± 11%, respectively, before SA placement. NIRS measurements were monitored every minute for 30 min after SA placement and modeled using mixed-effects linear regression. Regression estimates showed that cerebral saturation remained stable from 67% [95% confidence interval (CI) 63, 71%] after SA placement to 68% (95% CI 65, 72%) at the conclusion of monitoring. After SA placement, tissue saturation was elevated compared to baseline values; but further change [from 91% (95% CI 89, 93%) to 93% (95% CI 91, 95%) at the end of monitoring] was clinically non-significant. All patients breathed spontaneously on room air without changes in oxygen saturation. Blood pressure and heart rate decreased after SA placement, but no changes in hemodynamic parameters required treatment. These data provide further evidence of the neutral effect of SA on cerebral oxygenation 30 min after block placement.
The purpose of this clinical review was to analyze the effectiveness of nonsurgical management options for human immunodeficiency virus (HIV)-associated parotid cysts.
We conducted systematic and meta-analysis reviews. Primary outcomes were complete or partial responses.
Systematic review identified 12 relevant studies. The average rates of complete response for antiretroviral therapy (ART), sclerotherapy, and fine-needle aspiration (FNA) were 52.8%, 55.5%, and 33.3%, respectively. Three radiotherapy studies, totaling 104 patients, were included in a meta-analysis. Patients receiving high-dose therapy achieved complete and partial response rates of 65.8% (95% confidence interval [CI] 54.3%-76.2%) and 25.2% (95% CI 16.1%-36.3%), respectively. Patients receiving low-dose therapy achieved complete and partial response rates of 23.2% (95% CI 1.2%-60.9%) and 22.3% (95% CI 5.2%-87.8%), respectively. The rate of complete response was significantly greater for high-dose radiotherapy compared to low-dose (P < .001).
Among nonsurgical treatment modalities for HIV-associated parotid cysts, radiotherapy has the highest number of reported outcomes in the literature and our analysis suggests that higher dose radiotherapy has higher rates of achieving complete response.
This study presents oncologic outcomes after transoral robotic surgery (TORS) ± adjuvant therapy for oropharyngeal squamous cell carcinoma (SCC).
Three hundred fourteen patients undergoing TORS ± adjuvant therapy for oropharyngeal SCC from May 1, 2007, to May 31, 2015, are analyzed.
Median follow-up was 3.3 years (interquartile range [IQR] 1.8-5.3 years; range 1 day to 9.3 years). Estimated locoregional recurrence-free survival, distant metastasis-free survival (DMFS), overall survival (OS), and cancer-specific survival (CSS) rates (95% confidence interval [CI] number still at risk) at 5 years after surgery were 92% (88-95; 92), 90% (86-94; 92), 86% (82-92; 98), and 94% (91-97; 98), respectively. Negative margins were achieved in 98% of cases. The adult comorbidity evaluation (ACE)-27 comorbidity index, human papillomavirus (HPV) status, pathologic N classification, and number of attempts to clear margins were associated with death due to cancer (P = .003, P = .002, P = .030, and P = .002, respectively).
The need to take ≥2 margins to achieve resection portends an increased risk of locoregional recurrence and death due to disease in oropharyngeal SCC.
The aim of this systematic review was to compare the root-coverage outcomes of using a partially exposed connective tissue graft (CTG) technique with a fully covered CTG technique for root coverage. An electronic search up to February 28th, 2017, was performed to identify human clinical studies with data comparing outcomes of root coverage using CTG, with and without a partially exposed graft. Five clinical studies were selected for inclusion in this review. For each study, the gain of keratinized gingiva, reduction of recession depth, number of surgical sites achieving complete root coverage, percentage of root coverage, gain of tissue thickness, and changes of probing depth and clinical attachment level were recorded. Meta-analysis for the comparison of complete root coverage between the two techniques presented no statistically significant differences. A statistically significant gain of keratinized tissue in favor of the sites with an exposed CTG and a tendency of greater reduction in recession depth were seen at the sites with a fully covered CTG. Based on the results, the use of a partially exposed CTG in root-coverage procedures could achieve greater gain in keratinized gingiva, while a fully covered CTG might be indicated for procedures aiming to reduce recession depth.
Nivolumab ist ein monoklonaler Antikörper, der an den PD-1-Rezeptor auf T‑Zellen bindet und die Interaktion mit den Liganden PD-L1 und PD-L2 auf Krebszellen hemmt. Dadurch hat Nivolumab immunstimulierende Eigenschaften. Zu den bekannten Nebenwirkungen dieser Therapie gehören Hautausschlag, Müdigkeit, Dysfunktion der Schilddrüse und Kolitis. Diese werden durch die immunregulatorischen Mechanismen des Medikaments erklärt. Hier berichten wir über den Fall eines 58-jährigen Patienten mit metastasiertem Zungengrundkarzinom, der unter einer Therapie mit Nivolumab eine de novo getriggerte Psoriasis entwickelt hat. Der Patient wurde monatelang mit der Diagnose einer generalisierten Mykose erfolglos behandelt. Dieser Fall hebt hervor, wie wichtig es ist, auch auf unerwartete kutane Nebenwirkungen einer Therapie mit immunstimulierenden Checkpoint-Inhibitoren zu achten.
Der Lichen ruber, auch Lichen ruber planus oder Lichen planus (LP) genannt, ist eine nichtkontagiöse Hauterkrankung entzündlicher Genese. Er ist der Hauptvertreter sowie Namensgeber der Gruppe der lichenoiden Erkrankungen, die durch kleine Papeln gekennzeichnet sind, die oft von starkem Juckreiz begleitet werden. Mit 65 % der Fälle ist der LP v. a. eine Erkrankung der Schleimhäute. In 20 % der Fälle findet sich die Erkrankung an Haut und Schleimhäuten, ein alleiniger Befall der Haut ist in nur etwa 10 % der Fälle zu sehen. Der kutane LP hat eine sehr günstige 1‑Jahres-Prognose mit fast 80 % Abheilungen im Unterschied zur Schleimhaut und den Adnexen. Histologisch sind den lichenoiden Erkrankungen durch Apoptose vakuolig untergehende Keratinozyten unter Hinterlassung von Kaminokörperchen und das charakteristische bandförmige lymphozytäre Infiltrat an der dermatoepithelialen Junktionszone gemeinsam. Oberflächlich „macht die Epidermis zu", d. h. die Hornschicht ist fest und kompakt und das Stratum granulosum prominent als Korrelat des Wickham-Phänomens. Die molekulare, noch teilhypothetische Interpretation dieser Erkrankung ist, dass Triggerfaktoren zur Präsentation von Eigen- oder Fremdantigenen führen. Die ausgelöste Entzündung verselbstständigt sich im Sinne einer klassischen zellulär vermittelten Autoimmunerkrankung. Nicht selten assoziieren sich mit dem LP andere Autoimmunerkrankungen. Therapeutisch dominieren klassische antiinflammatorisch immunsuppressive Konzepte, wobei die systemischen Retinoide in der höchsten Evidenzklasse für den LP der Haut rangieren mit Einschränkungen beim Einsatz in der Therapie des LP an Schleimhaut und Adnexen. In jüngerer Zeit wurden interessante und neue komplementärmedizinisch-phytotherapeutisch orientierte Ansätze herausgearbeitet.
Chronic spontaneous urticaria (CSU) is one of the commonest diseases in allergological and dermatological practice. It constitutes an interdisciplinary problem, and its pathogenesis is not always easily determined. It has been suggested that metabolic syndrome and hyperlipidaemia are more frequent in patients with CSU, but the influence of overweight and obesity on the development of CSU has not been thoroughly investigated.
To assess the association between body parameters and the development of CSU.
The study enrolled 85 patients with CSU, who were divided into three subgroups: patients whose only symptoms were weals, patients whose only symptom was angio-oedema, and patients with urticaria and accompanying angio-oedema. Mean weight, height, body mass index (BMI), body surface area, disease duration and age of disease onset were recorded
There was a statistically significant association between CSU and heavier weight, higher BMI, greater affected body surface area and older age at disease onset. Subjects with higher BMI values had a tendency towards longer disease duration. There were no statistically significant differences between the three subgroups.
Our results suggest that CSU, especially if of long duration, may be associated with overweight and obesity, while increased body mass can result in later onset of urticaria symptoms. Further analyses to confirm the presented results and possible association between obesity and CSU occurrence are needed.
Skin cancer incidence rates are rising in the UK, yet many areas are experiencing a shortage of dermatologists. We sought to compare skin cancer excision rates between general practice (GP) surgeons to identify factors associated with good practice, through a retrospective analysis of GP skin cancer histopathology reports in three Scottish Health Boards over a 4-year period. Postal questionnaires were used to explore factors affecting surgeons' excision rates. GPs excised 895 skin cancers (4.5% of the 19 853 regional total) during the period. Of the basal cell carcinomas, 308 would be classified as low-risk by current National Institute for Health and Care Excellence criteria. Of the returned questionnaires, 58 accounted for 631 (70.5%) of the excised skin cancers. Analysing completeness of skin cancer excision, there was a statistically significant difference between GPs performing excision on ≥ 11 lesions/month compared with those performing excision on ≤ 10/month. Policymakers may wish to consider systems to facilitate low-risk patients being treated by GPs who undertake frequent surgical procedures.
Summary
Chromosome 22q11.2 deletion syndrome (22q11.2DS) is a genetic syndrome that may present with hypocalcemia due to primary hypoparathyroidism (PH) at any age. We report a new diagnosis of 22q11.2DS in a 57-year-old man who presented with symptomatic hypocalcemia. It is important to consider genetic causes of hypocalcemia due to PH regardless of age.
Learning points:It is important to discard genetic cause of primary hypoparathyroidism in a patient without autoimmune disease or prior neck surgery.
A new diagnosis of a hereditary disease has familial implications and needs genetic counselling.
It is also important to discard other syndrome's comorbidities.
Summary
A case of follicular thyroid cancer with intense focal Methionine uptake on 11C-Methionine PET/CT is reported here. The use of 11C-Methionine PET in differentiated thyroid cancer is currently being investigated as a surrogate tracer compared to the more widely used 18F-FDG PET. This case illustrates the potential incremental value of this modality, not only in the localizing of parathyroid adenoma, but also indicating that 11C-Methionine PET might have a potential of increasing the pretest likelihood of thyroid malignancy in a cold nodule with highly increased Sestamibi uptake.
Learning points:11C-Methionine PET/CT and 18F-Fluorocholine PET/CT often visualizes the parathyroid adenoma in case of negative Tc-99m-MIBI SPECT/CT.
A cold nodule in Tc-99m Pertechnetat thyroid scintigraphy with a negative Sestamibi scintigraphy has a very low probability of being malignant.
However, the pretest likelihood of thyroid cancer in a cold nodule with increased Sestamibi uptake is low.
11C-Methionine PET might have a potential incremental value in increasing the pretest likelihood of thyroid malignancy in a cold nodule with highly increased Sestamibi uptake.
Figure 1: Monitoring of patient's molecular markers in liver and thyroid during the study. Alanine aminotransferase (ALT); Aspartate aminotransferase (AST); Alkaline phosphatase (AP); Gamma-glutamyl transferase (GGT); Indirect (unconjugated) bilirubin (IB); Free thyroxine (Free T4); Free triiodothyronine (Free T3); Liver function test (LFT); Thyroid hormones (TH).
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A 70-year-old man presented to our clinic with a 10-year history of recurrent pruritic erythema and plaques on his trunk and limbs. Based on the pathological findings and monoclonal rearrangement of the T-cell receptor (TCR)–Cβ1 gene, mycosis fungoides (T2N0M0B0 stage IB) was diagnosed. Despite combination therapy including histone deacetylase inhibitor (vorinostat), the symptoms slowly evolved into Sézary syndrome (SS; T4N1M0B2) over 4 years, with dense infiltrates due to atypical lymphocytes expressing CCR4 developing in the entire dermis. Anti-CCR4 monoclonal antibody (mogamulizumab) treatment was started. After seven courses, the CCR4-positive atypical lymphocytes decreased in the dermis to levels below those seen at the outset of treatment. To our knowledge, there is no previous report of a case of SS managed with vorinostat followed by mogamulizumab demonstrating such a remarkable change in the pathological state following treatment.
