No abstract available
http://ift.tt/2nWl1hR
Δευτέρα 12 Φεβρουαρίου 2018
Intensive Care Unit Enhanced Recovery Pathway for Patients Undergoing Orthotopic Liver Transplants Recipients: A Prospective, Observational Study
BACKGROUND: Liver transplant recipients continue to have high perioperative resource utilization and prolonged length of stay despite improvements in perioperative care. Enhanced recovery pathways have been shown in other surgical populations to produce reductions in hospital resource utilization. METHODS: A prospective, observational study was performed to examine the effect of an enhanced recovery pathway for postoperative care after liver transplantation. Outcomes from patients undergoing liver transplantation from November 1, 2013, to October 31, 2014, managed by the pathway were compared to transplant recipients from the year before pathway implementation. Multivariable regression analysis was used to assess the association of the clinical pathway on clinical outcomes. RESULTS: The intervention and control groups included 141 and 106 patients, respectively. There were no demographic differences between the control and intervention group including no differences between the length of surgery and cold ischemic time. Median intensive care unit length of stay was reduced from 4.4 to 2.6 days (P
http://ift.tt/2o2CDb2
http://ift.tt/2o2CDb2
Bascule syndrome associated with syncopal episodes
Abstract
Bascule syndrome is a recently described benign vasomotor dermatosis characterized by Bier anemic spots, cyanosis, and urticaria-like eruption. We report a case of a 13-year-old girl with cutaneous lesions consistent with Bascule syndrome who had had three exercise-related syncopal episodes. It would be recommended to exclude orthostatic intolerance or postural orthostatic tachycardia syndrome when evaluating patients with Bascule syndrome.
http://ift.tt/2nXla4J
Subacute cutaneous lupus erythematosus presenting in twins
Abstract
Subacute cutaneous lupus erythematosus is a clinically distinct form of cutaneous lupus erythematosus, with age of onset typically in the second to fifth decades. Eleven cases have been reported in childhood, and we present the first known case of subacute cutaneous lupus erythematosus in identical twins. Although flares are typically photo-induced, we present an annular eruption typical of subacute cutaneous lupus erythematosus with concurrent pinworm infestation, with recurrence of disease with cutaneous larva migrans. The patient's identical twin had a similar eruption with pinworm infection. This case highlights the possibility of parasitic infestation as a trigger for subacute cutaneous lupus erythematosus in genetically susceptible individuals.
http://ift.tt/2G89ra2
Congenital Langerhans cell histiocytosis presenting in a 27-week-gestation neonate
Abstract
Langerhans cell histiocytosis is exceedingly rare in premature infants, and the few cases reported suggest a poor prognosis with systemic involvement. We present a case of Langerhans cell histiocytosis limited to a single cutaneous lesion, presenting in a 27-week-gestation infant, which is the youngest gestational age of reported Langerhans cell histiocytosis cases. The lesion showed spontaneous resolution by 41 weeks corrected gestational age, and systemic involvement was absent, demonstrating a mild course of skin-only Langerhans cell histiocytosis in a premature infant.
http://ift.tt/2sqKV1V
Geographic tonguelike presentation in a child with pityriasis rosea: Case report and review of oral manifestations of pityriasis rosea
Abstract
Oral lesions are rarely reported in patients with pityriasis rosea. We report a case of a 3-year-old boy with clinical evidence of generalized pityriasis rosea who developed asymptomatic oral lesions similar in appearance to geographic tongue. The generalized eruption and tongue lesions resolved simultaneously within 4 weeks. We also review the literature on the oral manifestations of Pityriasis rosea.
http://ift.tt/2o6pvSz
Parental use of sun protection for their children—does skin color matter?
Abstract
Background/Objectives
Excessive sun exposure during childhood is a risk factor for skin cancer. This study aimed to compare the frequency of ideal sun protection use between parents with lighter- and darker-skinned children and explore their attitudes and beliefs on sun safety and their choice of sun protection.
Methods
Parents of children aged 6 months to 6 years completed self-administered questionnaires about sun protection practices for their children. Parents assessed their child's Fitzpatrick phototype and were divided into lighter- (Fitzpatrick phototype I-III) and darker-skinned (Fitzpatrick phototype IV-VI) groups. Sun safety guidelines from the Canadian Dermatology Association were used to qualify ideal sun protection.
Results
A total of 183 parents were included. Overall, 31 parents (17%) used ideal sun protection for their children. As their children grew older, parents were less likely to use ideal sun protection (odds ratio = 0.69, 95% confidence interval = 0.53-0.90). Parents in the lighter-skinned group were more likely to use ideal sun protection for their children (odds ratio = 7.4, 95% confidence interval = 2.7-20.1), believe that sun exposure was harmful (odds ratio = 17.2, 95% confidence interval = 4.0-74.9), and perceive value in sun protection (odds ratio = 11.4, 95% confidence interval = 3.3-39.0); the darker-skinned group believed that darker skin tones provided more sun protection (odds ratio = 12.4, 95% confidence interval = 6.1-25.4).
Conclusion
Ideal parental sun protection efforts are overall low, particularly in parents of darker-skinned children. The identified attitudes toward and beliefs about sun safety may aid in delivery of future sun protection interventions, especially in multiracial populations.
http://ift.tt/2Hd2GFs
Treatment outcomes of vitiligo in Asian children
Abstract
This retrospective study aimed to identify factors that predict treatment response in a cohort of Asian children with vitiligo. Shorter duration of vitiligo was associated with better repigmentation. Patients with focal vitiligo of short duration have a good chance of achieving repigmentation with topical agents alone.
http://ift.tt/2G9YAMG
Re: Acrylic stent to aid placement of footplate of palatal distractor during surgically-assisted rapid palatal expansion
Publication date: Available online 10 February 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): M.Y. Mommaerts
http://ift.tt/2EqNeYw
Transdermal scopolamine for the prevention of a salivary fistula after parotidectomy
Publication date: Available online 3 February 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Konstantinos Mantsopoulos, Miguel Goncalves, Heinrich Iro
Our aim was to investigate whether perioperative transdermal application of scopolamine could help to prevent fistulas after parotidectomy, and to this end we retrospectively studied the records of all patients (n=645) who had benign parotid tumours treated by partial parotidectomy between 2011 and 2016. We found that scopolamine led to a significant decrease in the incidence of salivary fistulas from 54/371(15%) in the group not given it to 10/274 (4%) in the group given it (p<0.0001). The "number needed to treat" was 9.17. There was a relatively low incidence of all adverse effects after scopolamine. Our results are encouraging. Thorough consideration of the contraindications and a knowledge of the potential adverse effects are crucial for its successful implementation.
http://ift.tt/2ChLxqh
Monitoring of free flaps and reconstruction for oral cancer
Publication date: Available online 2 February 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): A. Kanatas, M.W. Ho
http://ift.tt/2EmPxf3
Buccal fat pad and subperiosteal midface lifts in conjunction with open reduction and internal fixation to treat fractures of the zygomaticomaxillary complex
Publication date: Available online 2 February 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): G.B. Bottini, N. Berridge, A. Messiha
http://ift.tt/2CgbvdO
Genomic analysis to assess disease progression and recurrence in patients with oral squamous cell carcinoma: – a preliminary study
Publication date: Available online 1 February 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): A. Kanatas, P. Chengot, T.K. Ong, M.W. Ho, N. Sethi, M. Taylor, A. Glover, H.M. Wood
We studied the progression from dysplasia to invasive carcinoma and subsequent second primaries or locoregional recurrences in 11 patients with recurrent squamous cell carcinoma (SCC). Between one and six samples were sequenced/patient. DNA samples were prepared, and libraries multiplexed to between 40 and 80 samples/lane of an Illumina HiSeq 3000 and sequenced with 2×100bp paired end sequencing. Copy number data were generated by CNAnorm (Bioconductor package). Samples of recurrent SCC showed unique patterns of descent when compared with earlier samples from the primary tumour, and three main patterns emerged. In four patients there was convincing evidence that the later lesion was descended directly from cells from the first, and in a further four there were no detectable genomic events between the two lesions. Three patients had some shared events between the early and later lesions, but although there were enough differences to deduce that the two lesions had a shared ancestor, they were not directly descended from each other. We present the patients' characteristics in detail, including the overall survival in each group. There was a distinct genomic pattern after a second episode of SCC in all the groups. A larger study that uses similar methods and a longer duration could provide reliable conclusions with respect to survival. With the use of new techniques, genomic data can be available to clinical teams during the planning of treatment.
http://ift.tt/2EpFiXy
Re: Wrong tooth extraction: an examination of “Never Event” data
Publication date: Available online 10 February 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): G.J. Knepil
http://ift.tt/2CjX5cQ
Evaluation of stress by finite element analysis of the midface and skull base at the time of midpalatal osteotomy in models with or without pterygomaxillary dysjunction
Publication date: Available online 1 February 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): A. Esen, E. Soganci, E. Dolanmaz, D. Dolanmaz
Surgically-assisted rapid maxillary expansion (SARME) is commonly used to treat skeletally mature patients with transverse discrepancies. Some osteotomies are made in areas that resist expansion, but there is no clear consensus about the sequence in which the osteotomies are made. Some clinicians do the pterygomaxillary osteotomy last, while others do it before the midpalatal osteotomy. We used the finite element method to measure the stresses on the midface, cranial base and pterygoid plates at the time of midpalatal osteotomy in two models, one with and one without pterygomaxillary dysjunction (PMD). In both, SARME consisted of maxillary bilateral osteotomy from the piriform rim to the pterygoid plate. Midpalatal osteotomy was also done in both. In the PMD model, minimum principal stresses increased on the midface, and maximum principal and von Mises stresses increased at the cranial base and on the pterygoid plates. Our results suggest that the stresses on the midface and cranial base can be reduced during midpalatal osteotomy in adults if the pterygomaxillary osteotomy is done last.
http://ift.tt/2ElrtJD
Tuberculosis: the great imitator in the head and neck - our experience of 24 cases in 22 years
Publication date: Available online 1 February 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Y.A.M. El-Wajeh, M.G. Watson, D. Igoumenakis, P. Stathopoulos
This retrospective study covered over two decades, during which an individual head and neck surgeon treated 24 patients with cervicofacial lymphadenitis that was related to both Mycobacterium tuberculosis complex (n=17, made up of M tuberculosis (n=16) and M bovis (n=1)), and non-tuberculous mycobacteria. The seven cases of non-tuberculous mycobacteria were caused by M avium complex (n=3), M malmoense (n=3), and M kansaii (n=1). By using a tailored management approach, at times selective combined surgical and antimycobacterial treatment, he achieved a success rate of 23/24 cases, with only one recurrence and no major complications. The results suggest that patients with tuberculosis confined to the head and neck rarely develop constitutional symptoms, so the absence of such symptoms may not exclude tuberculosis. There was also a good correlation between predictive variables (immune state, inflammatory markers on admission, causative mycobacterium, and the antimycobacterial regimen used) and time spent under follow-up at the head and neck outpatient clinic.
http://ift.tt/2CfIuis
Assessment of the anterior loop of the inferior alveolar nerve using reformatted computed tomography: a retrospective study
Publication date: Available online 1 February 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): V.S. Todorovic, T.C. Postma, A.W. van Zyl
The anterior loop of the inferior alveolar nerve (IAN) is an important landmark in the anterior mandible that must be considered during the placement of dental implants. We measured the length and prevalence of loops of the IAN in 188 consecutive, dentate patients using reformatted computed tomography (CT). A total of 158/188 (84%) had at least one anterior loop; 111/188 (59%) had bilateral loops. The mean (SD) length of the loops in the third quadrant was 1.4 (0.7)mm; 95% CI 1.3 to 1.6; (range 0.3 – 4.0mm). The mean (SD) length of the loops in the fourth quadrant was 1.5 (0.9)mm; 95% CI 1.4 to 1.6; range 0.3 – 5.5mm. In total 42/188 (22%) had loops that were longer than 2mm in quadrants three and four. CT images that have been reformatted with specialised software may be useful to identify loops in the IAN, particularly when recent cone-beam CT images are not freely available. The prevalence of these loops is high while their length varies, which makes meticulous assessment necessary before the placement of implants.
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Structured review of the patient-reported outcome instruments used in clinical trials in head and neck surgery
Publication date: Available online 1 February 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): H. Boyes, J. Barraclough, R. Ratansi, S.N. Rogers, A. Kanatas
The number of clinical trials that relate to patients with cancer of the head and neck is growing. Patient-reported outcomes, which are rarely the primary outcome, are now an important component, and in this structured review to identify and report the characteristics of the questionnaires that have been used in these trials, we summarise the findings reported. We searched several online databases using the key terms: head and neck oncology, head and neck surgery, reconstruction, clinical trials patient-reported outcomes, questionnaires, quality of life (QoL), validated instruments, and patients' satisfaction. We screened 1342 papers to collect information about the topic of the paper, sample size, selection criteria, main advantages and disadvantages of the patient-reported outcome used, and if it was used in conjunction with another measure. A total of 54 were eligible, and from them we identified 22 questionnaires. The primary reason for using a questionnaire was its relevance to the focus of the paper, such as xerostomia, pain, or swallowing. To allow the experience of patients to be the focus of the primary outcome in a clinical trial, we recommend that the measures used should be appropriate, reliable, valid, responsive, precise, interpretable, acceptable, and feasible. The trials used validated questionnaires, but the patient-reported outcome measures tended not to be the focus. There is merit in such measures being the primary outcomes in future trials and these should be designed around an explicit hypothesis.
http://ift.tt/2ChBe5w
Management of self-inflicted gunshot wounds to the face: retrospective review from a single tertiary care trauma centre
Publication date: Available online 1 February 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): J.A. Murphy, S.R. McWilliams, M. Lee, G. Warburton
There are limited published data about the surgical management of self-inflicted facial gunshot wounds. The aim of this retrospective study was to review our management of subjects who initially survive such a wound and were admitted to a tertiary care trauma centre between 2002 and 2012. Only subjects with definitive evidence of a self-inflicted facial gunshot wound and who were admitted alive were included. Data collected included personal and clinical details, characteristics of the gunshot wound, and medical and surgical management. Types of operations and their duration were recorded, and primary reconstruction was divided into early (within the first 48hours after presentation) or delayed (longer than 48hours). Determinants of infection were assessed with univariate analysis.Seventy-six subjects (65 male and 11 female, mean (range) age 44 (18–83) years) were included in the study. Twenty-five patients needed an early surgical airway and five needed emergency intervention to control haemorrhage. Forty-five patients had primary reconstructions (28 early and 17 delayed) and 12 who were treated by delayed repair had a submental entry site to the wound. There were no significant differences in infection rates between those who had early, compared with those who had late, reconstructions.Early primary reconstruction can be successful for patients with self-inflicted facial gunshot wounds, particularly when the entry point of the bullet is in the upper and midface area. Delayed primary reconstruction was more common when the bullet entered the lower face.
http://ift.tt/2Enqp7Z
Hard lumps in the neck: diagnostic essentials
Publication date: Available online 1 February 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): A. Sayan, V. Ilankovan
http://ift.tt/2CjX4pi
Pediatric Intracranial Hypertension: a Current Literature Review
Abstract
Purpose of Review
The purpose of this review is to provide an update on pediatric intracranial hypertension.
Recent Findings
The annual pediatric incidence is estimated at 0.63 per 100,000 in the USA and 0.71 per 100,000 in Britain. The Idiopathic Intracranial Hypertension Treatment Trial found improvement in visual fields, optical coherence tomography, Frisen grade, and quality of life with acetazolamide compared to placebo in adult patients, and these findings have been translated to the pediatric population.
Summary
Pediatric intracranial hypertension is a disorder that if left untreated can lead to poor quality of life and morbidity. There are no current treatment studies in pediatrics, but adult data suggests acetazolamide remains an acceptable first-line medication.
http://ift.tt/2Hd3v10
Skin lesions serve as clues to relapse of pediatric blastic plasmacytoid dendritic cell neoplasm
Abstract
A 10-year-old girl with a history of blastic plasmacytoid dendritic cell neoplasm, a rare malignancy in children, presented with recurrent skin eruptions beginning while on maintenance chemotherapy, including mildly pruritic skin-colored plaques, tender indurated nodules, and violaceous bound-down plaques. This case highlights an unusual presentation of relapsed blastic plasmacytoid dendritic cell neoplasm on chemotherapy, with skin lesions providing important clues to the progression of systemic disease.
http://ift.tt/2F1XWlm
Maternal Thyrotropin Receptor Antibody Concentration and the Risk of Fetal and Neonatal Thyrotoxicosis: A Systematic Review
Thyroid Feb 2018, Vol. 28, No. 2: 257-264.
http://ift.tt/2nVB2EX
Rapid Remission of Graves' Hyperthyroidism Without Thionamides Under Immunosuppressive Treatment for Concomitant Autoimmune Hepatitis
Thyroid Feb 2018, Vol. 28, No. 2: 276-278.
http://ift.tt/2nV2kLl
SIRT1-Regulated Abnormal Acetylation of FOXP3 Induces Regulatory T-Cell Function Defect in Hashimoto's Thyroiditis
Thyroid Feb 2018, Vol. 28, No. 2: 246-256.
http://ift.tt/2o0ZnZ6
Clinical Impact of Detectable Antithyroglobulin Antibodies Below the Reference Limit (Borderline) in Patients with Papillary Thyroid Carcinoma with Undetectable Serum Thyroglobulin and Normal Neck Ultrasonography After Ablation: A Prospective Study
Thyroid Feb 2018, Vol. 28, No. 2: 229-235.
http://ift.tt/2o1yX9J
Time-resolved fluorescence spectroscopy for the diagnosis of oral lichen planus
Summary
Background
Lichen planus (LP) is a T-cell mediated autoimmune disorder of unknown aetiology that affects the skin, nails, oral and genital mucous membranes. Conventionally, oral LP (OLP) is diagnosed through clinical assessment and histopathological confirmation by oral biopsy.
Aim
To explore the use of time-resolved fluorescence spectroscopy (TRFS) to detect fluorescence lifetime changes between lesional OLP and perilesional normal mucosa.
Methods
In this pilot study, measurements of lesional and perilesional buccal and mouth floor mucosa were conducted in vivo with a TRFS system. Histopathological findings were consistent with OLP in 8 out of 10 patients biopsied. Two patients with histopathological diagnoses of frictional hyperkeratosis and oral candidiasis, respectively, were excluded from the study.
Results
Our preliminary data show that lifetime values in the 360–560 nm spectral range indicate a significant differentiation between normal and diseased tissue. In contrast to the standard oral biopsy procedure, this technique is noninvasive, painless, time-efficient and safe.
Conclusions
Future studies are needed to better elucidate the diagnostic capability of TRFS and to further explore the sources of fluorescence contrast. This pilot study suggests that, based on fluorescence lifetime parameters, TRFS is a very promising technology for the development of a novel OLP diagnostic technique.
http://ift.tt/2Ekk2SO
Clinical outcomes and prognostic factors in cisplatin versus cetuximab chemoradiation for locally advanced p16 positive oropharyngeal carcinoma
Publication date: April 2018
Source:Oral Oncology, Volume 79
Author(s): Christian L. Barney, Steve Walston, Pedro Zamora, Erin H. Healy, Nicole Nolan, Virginia M. Diavolitsis, Anterpreet Neki, Robert Rupert, Panos Savvides, Amit Agrawal, Matthew Old, Enver Ozer, Ricardo Carrau, Stephen Kang, James Rocco, Theodoros Teknos, John C. Grecula, Jessica Wobb, Darrion Mitchell, Dukagjin Blakaj, Aashish D. Bhatt
ObjectivesRandomized trials evaluating cisplatin versus cetuximab chemoradiation (CRT) for p16+ oropharyngeal cancer (OPC) have yet to report preliminary data. Meanwhile, as a preemptive step toward morbidity reduction, the off-trial use of cetuximab in p16+ patients is increasing, even in those who could potentially tolerate cisplatin. The purpose of this study was to compare the efficacy of cisplatin versus cetuximab CRT in the treatment of p16+ OPC and to identify prognostic factors and predictors of tumor response.Materials and methodsCases of p16+ OPC treated with cisplatin or cetuximab CRT at our institution from 2010 to 2014 were identified. Recursive partitioning analysis (RPA) classification was used to determine low-risk (LR-RPA) and intermediate-risk (IR-RPA) groups. Log-rank/Kaplan-Meier and Cox Regression methods were used to compare groups.ResultsWe identified 205 patients who received cisplatin (n = 137) or cetuximab (n = 68) CRT in the definitive (n = 178) or postoperative (n = 27) setting. Median follow-up was 3 years. Cisplatin improved 3-year locoregional control (LRC) [92.7 vs 65.4%], distant metastasis-free survival (DMFS) [88.3 vs 71.2%], recurrence-free survival (RFS) [86.6 vs 50.6%], and overall survival (OS) [92.6 vs 72.2%] compared to cetuximab [all p < .001]. Concurrent cisplatin improved 3-year OS for LR-RPA (97.1 vs 80.3%, p < .001) and IR-RPA (97.1 vs 80.3%, p < .001) groupings.ConclusionWhen treating p16+ OPC with CRT, the threshold for substitution of cisplatin with cetuximab should be maintained appropriately high in order to prolong survival times and optimize locoregional and distant tumor control. When cetuximab is used in cisplatin-ineligible patients, altered fractionation RT should be considered in an effort to improve LRC.
http://ift.tt/2EpiHKM
Laryngeal recurrence sites in patients previously treated with transoral laser microsurgery for squamous cell carcinoma
Abstract
Background
The laryngeal framework provides a natural barrier preventing tumour spread to extralaryngeal structures. Transoral laser microsurgery (TLM) for laryngeal squamous cell carcinoma (SCC) may violate these boundaries, altering the pathways of tumor spread for potential recurrences. Our project objective is to describe laryngeal SCC recurrence patterns and overall survival in patients requiring total laryngectomy (TL) after TLM.
Methods
Patients undergoing TLM for laryngeal SCC requiring salvage TL were identified from a prospective CO2 laser database containing all patients undergoing TLM for head and neck malignancies at the QEII Health Sciences Center in Halifax, Nova Scotia between March 2002 – May 2014. Surgical pathology reports were analyzed for tumor characteristics, extent of recurrence and invasion of local structures. Kaplan-Meier analyses were performed to evaluate overall survival, disease specific survival (DSS) and locoregional control.
Results
Fifteen patients were identified from the database as receiving salvage TL for recurrent disease after initial TLM resection for laryngeal SCC. Final pathology reports demonstrated that 67% (10/15) of patients had thyroid cartilage involvement while 53% (9/15) of patients had cricoid cartilage involvement on salvage TL pathology. 33% (5/15) of patients had perineural invasion and 27% (4/15) had lymphovascular invasion. Mean and median follow-up times were 36.7 months and 26.8 months respectively (range 3.9–112.6). The Kaplan-Meier estimate for overall survival at 36 months was 40% post TL with a standard error (SE) of 13.6%. DSS was 47% (SE 14.2%), and locoregional control was 55% (SE 14.5%) post TL.
Conclusions
Laryngeal recurrence sites following TLM seem to be consistent with historical data at known laryngeal sites of vulnerability. Treatment with TLM does not predispose patients to a lower rate of locoregional control and overall survival after total laryngectomy and salvage outcomes are consistent with literature values.
http://ift.tt/2BWJVXl
Reply to: “Psychiatric adverse events during treatment with brodalumab: Analysis of psoriasis clinical trials”
I want to thank Dr Rieder1 for drawing attention to the challenges faced by brodalumab. I agree with nearly all the points made, although I hope Dr Rieder's prediction that the Risk Evaluation and Mitigation Strategies (REMS) program will doom this drug prove to be untrue.
http://ift.tt/2nVdNe0
To fee or not to fee? The ethical issues of concierge medicine/dermatology
Concierge medicine is an emerging practice model that involves direct contracting with patients for medical services, often charging a flat monthly or yearly fee. There is considerable variation among concierge practices, but most include administrative service fees with an upfront annual payment to remain on a smaller patient panel.1
http://ift.tt/2nWRIvx
An open-label exploratory study evaluating the efficacy and safety of ingenol mebutate gel 0.05% for the treatment of verruca vulgaris
To the Editor: Current therapies for common warts (verruca vulgaris) often require months of treatment and focus on destruction, removal of callus, or stimulation of a local immune response.1-3 Topical use of ingenol mebutate gel, 0.05%, indicated for the treatment of actinic keratosis, induces necrosis and an inflammatory reaction.4 A recent case study series provided evidence for the efficacy of ingenol mebutate against anogenital warts.5
http://ift.tt/2o0kBWQ
Frontal fibrosing alopecia and cutaneous comorbidities: A potential relationship with rosacea
To the Editor: Frontal fibrosing alopecia (FFA) is an increasingly prevalent lymphocytic, cicatricial alopecia with a yet unknown etiopathogenesis. Some cutaneous diseases have been associated with FFA, but the existing literature is limited to retrospective studies and case reports.1-3 The objective of our study was to analyze the frequency of associated cutaneous conditions in a large cohort of FFA patients.
http://ift.tt/2nV5Up2
A cross-sectional study of YouTube videos about atopic dermatitis
To the Editor: Patients are increasingly looking to online platforms for health information.1 One popular online platform is YouTube, which is a free video-streaming service. The loose content regulations of YouTube allow users to broadcast false information as easily as accurate information. One study found that most of the YouTube videos about tanning beds portrayed them in a positive light and another found that half of YouTube videos on immunizations did not explicitly support them.2,3 We conducted a cross-sectional study on the information on YouTube about atopic dermatitis (AD) by performing 5 searches on YouTube using the search terms "atopic dermatitis," "eczema," "eczema tips," "eczema cure," and "eczema treatment." We screened the first 2 pages of results for inclusion.
http://ift.tt/2o2J4uP
Reply to: “The microbial flora of taxane therapy–associated nail disease in cancer patients”
See related letter on page 607
http://ift.tt/2nVkxbS
Response to: “Maintenance of Certification: A grandfatherly ethical analysis”
See related article on page 627
http://ift.tt/2o2IUUf
Crown vessels and follicular white dot: New dermoscopic findings in a case of solitary reticulohistiocytoma
A 17-year-old girl presented with 2-month history of solitary progressively enlarging asymptomatic 6- × 6-mm light pink-yellow nontender dome-shaped nodule over her left cheek with surface scaling, a solitary violaceous area, and peripheral telangiectasia (Fig 1).
http://ift.tt/2nVjqci
Referral patterns to an osteoporosis clinic for dermatology patients undergoing prolonged corticosteroid therapy
To the Editor: Glucocorticoids are frequently used in dermatology. Glucocorticoid-induced osteoporosis (GIOP) is a well-recognized side effect with substantial morbidity. GIOP prevention measures are essential for bone health. Studies have shown dermatologists are underutilizers of bisphosphonates, first-line agents for osteoporosis prevention.1 A high-risk osteoporosis clinic (HIROC) developed by the rheumatology department was established at the Geisinger Medical Center. This retrospective cohort study reviewed dermatology patients taking oral glucocorticoids for more than 30 consecutive days to determine referral patterns to the HIROC, completion rate of referrals, and follow-up interventions.
http://ift.tt/2o2SXsl
In response to Lebwohl et al, “Psychiatric adverse events during treatment with brodalumab: Analysis of psoriasis clinical trials”
To the Editor: I would like to commend Lebwohl et al for their thorough and transparent analysis of the psychiatric adverse events associated with the brodalumab trials.1 One of the first systemic agents for psoriasis to be examined in a study enrolling a population with no specific psychiatrically related exclusion criteria, brodalumab in some ways fell victim to its own noble aims. In retrospect, it should not have been unexpected that a trial enrolling a large cohort of middle-aged white men with moderate-to-severe psoriasis, some of whom had additional suicide risk factors, resulted in several episodes of suicidal ideation and behavior (SIB).
http://ift.tt/2o3eoJR
The microbial flora of taxane therapy–associated nail disease in cancer patients
See related letter on page e71
http://ift.tt/2o1klXL
Reconstruction of Tragus and External Auditory Meatus using Remnant Auricle during Microtia Reconstruction
Facial plast Surg
DOI: 10.1055/s-0037-1617436
This article investigates an effective method with which to reconstruct the tragus and external auditory meatus for microtia reconstruction. The external ear was reconstructed using a delayed postauricular skin flap in patients with congenital microtia. After the first stage of delaying the postauricular skin flap and the second stage of otoplasty with ear framework fabricated from autogenous rib cartilage draping with the delayed skin flap, the third stage involved tragus and external auditory meatus canaloplasty. After designing the remnant auricle flap, the lower part was trimmed and the tragus was reconstructed. The upper part was trimmed into a thin skin flap, which was rotated and used to cover the hollowed wound posterosuperior to the tragus so as to mimic the external auditory meatus. If remnant wounds were present, skin grafting was conducted. In total, 121 patients with congenital microtia were treated from March 2010 to March 2016. The reconstructed tragus and external auditory meatus were well formed, and all wounds healed well. No severe complications such as flap necrosis occurred. Six months postoperatively, the morphology of the reconstructed tragus and external auditory meatus was good. Overall, the patients and their families were satisfied. The use of remnant auricle to reconstruct the tragus and external auditory meatus is an effective auricular reconstruction technique.
[...]
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Article in Thieme eJournals:
Table of contents | Abstract | Full text
http://ift.tt/2Bq5r5B
Alum-adjuvanted allergoids induce functional IgE-blocking antibodies
Abstract
The only therapy that is able to modulate the cause of IgE-mediated allergy and to attain a long-term effect is allergen-specific immunotherapy (AIT). In conventional subcutaneous AIT, the vaccine consists of an extract from an allergen source that contains major and minor allergens as well as non-allergenic proteins. To reduce IgE-mediated side effects caused by the injection of intact allergens, chemically modified extracts with less IgE-binding activity, named allergoids, have been used for AIT since the 1980′s.
This article is protected by copyright. All rights reserved.
http://ift.tt/2ElgJXw
Differences in gene expression profile between vocal cord Leukoplakia and normal larynx mucosa by gene chip
Long non-coding RNAs (lncRNAs) play an important role in tumorigenesis. Vocal cord leukoplakia is a precancerous lesion in otolaryngological practice. Till now, the expression patterns and functions of lncRNAs...
http://ift.tt/2Enjtnl
Utility and Versatility of the Supraclavicular Artery Island Flap in Head and Neck Reconstruction
Publication date: January–February 2018
Source:Acta Otorrinolaringologica (English Edition), Volume 69, Issue 1
Author(s): José A. González-García, Carlos M. Chiesa-Estomba, Jon A. Sistiaga, Ekhiñe Larruscain, Leire Álvarez, Xabier Altuna
IntroductionThe supraclavicular island flap is a rotational pedicled flap and may have some advantages in head and neck reconstruction compared with free-tissue transfer when this kind of reconstruction is not affordable or recommended.Material and methodsWe present our experience during the year 2016 in the application of the supraclavicular island flap in five cases as an alternative to microvascular reconstruction in several defects after resection of head and neck tumours. In two patients, the flap was used to close the surgical pharyngostoma after total laryngectomy with partial pharyngectomy. In one patient, it was used in lateral facial reconstruction after partial resection of the temporal bone. In one case, it was used to close a skin defect after total laryngectomy with prelaryngeal tissue extension. And in the last case to close a neck skin defect after primary closure of a pharyngo-cutaneous fistula. There were no flap complications, and the result was satisfactory in all cases.ResultsThe supraclavicular artery island flap is useful and versatile in head and neck reconstruction. Operating room time in aged patients or those with comorbidities will be reduced compared to free flaps. The surgical technique is relatively easy and can be used for skin and mucosal coverage.ConclusionThe supraclavicular island flap could be a recommended option in head and neck reconstruction, its use seems to be increasing and provides a safe and time-saving option to free flaps in selected patients.
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Application of Flexible Endoscopy-Based Biopsy in the Diagnosis of Tumour Pathologies in Otorhinolaryngology
Publication date: January–February 2018
Source:Acta Otorrinolaringologica (English Edition), Volume 69, Issue 1
Author(s): Carlos Saga, Manuel Olalde, Ekhiñe Larruskain, Leire Álvarez, Xabier Altuna
Introduction and objectivesInterventional endoscopy allows us to act on the pathology of the patient with minimal discomfort, low costs and high efficiency. We assessed the validity of flexible endoscopic biopsies in our hospital, in lesions suspected of malignancy in the rhino-pharyngo-laryngeal space.Subjects and methodsRetrospective study of patients with a pathology suspected of malignancy assessed between 2006 and 2016 in our centre. We evaluated the effectiveness, the tolerance and the number of complications. We calculated the cost reduction in comparison with direct laryngoscopy in the operating room. We compared our sample with others of similar characteristics described in the literature.ResultsThirty patients were studied with a flexible endoscopic biopsy during that period. Nineteen patients obtained positive results which allowed them to start treatment for their pathology. Seven cases had no evidence of malignancy and required another biopsy under general anaesthesia, which confirmed the carcinoma diagnosis. Two samples ruled out malignancy which was confirmed by laryngeal microsurgery. One case showed inflammation and the lesion was cured after antibiotherapy. It was impossible to collect the sample in one case. Thus, we obtained sensitivity levels of 73% with a specificity of 100%. There were no complications. The cost reduction in our sample was above 80%.ConclusionsFlexible endoscopic biopsy has advantages over direct laryngoscopy that are relevant in the diagnosis of oncological pathology in otorhinolaryngology.
http://ift.tt/2slO5nu
Accuracy of FNAC and CT in the Differentiation of Benign and Malignant Parotid Tumours in a Case Series
Publication date: January–February 2018
Source:Acta Otorrinolaringologica (English Edition), Volume 69, Issue 1
Author(s): Marina A. Gavín-Clavero, Tomás Usón-Bouthelier, Úrsula M. Jariod-Ferrer, Arancha Fernández-Larrañaga, Bianca Pantilie, Fernando Lobera-Molina, M. Victoria Simón-Sanz, Bartolomé Nadal Cristóbal
IntroductionParotid tumours, in addition to the wide variety of types, are histologically complex. Differentiating between benign and malignant tumours in preoperative diagnosis is important in deciding the type of surgery required. Fine needle aspiration cytology (FNAC) is a simple, quick, low-cost, low-invasive and well-tolerated tool used in the preoperative diagnosis of these tumours.Material and methodswe calculated the sensitivity, specificity, predictive positive value (PPV) and negative predictive value (NPV) of FNAC and computed tomography (CT) in the differentiation of benign and malignant parotid tumours operated between 2010 and 2014 in the oral and maxillofacial surgery department of the University Hospital Miguel Servet.ResultsThe sensitivity of FNAC is 50%, while the specificity is high, at 98.7%. FNAC offers high reliability in the diagnosis of malignant tumours, despite its low sensitivity. However, when the diagnosis is indeterminate or benign, other than pleomorphic adenoma or Whartin tumour, the reliability to exclude malignancy decreases.ConclusionThe low sensitivity of FNAC to differentiate malignant from benign parotid tumours, means that we cannot rule out other diagnostic tests, clinical symptoms and especially the intraoperative vision of each surgeon. Especially when the diagnosis is indeterminate. Nevertheless, it is a technique used in a systematised way and helps in pre-surgical decision-making.
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Inlay Butterfly Miringoplasty. Our Experience
Publication date: January–February 2018
Source:Acta Otorrinolaringologica (English Edition), Volume 69, Issue 1
Author(s): Paula Cruz Toro, Ángela Callejo Castillo, Rafael Moya Martínez, Iván Domenech Juan
IntroductionMultiple surgical techniques have been proposed to close tympanic perforations. Eavey, two decades ago, described a technique aimed at closing central perforations in children. For this, he designed a butterfly-shaped cartilage graft that was placed between the tympanic membrane in an inlay manner. This technique showed great effectiveness for the closure of perforations as well as low morbidity, rapidity and great economic difference.MethodsWe performed a descriptive study of a series of cases analysing 32 interventions in children and adults with the modified Eavey technique, during the period from January 2012 to November 2016. We evaluated the surgical and audiometric functional results.ResultsSurgical success was achieved in 93% of cases, including complete closures in 27 patients (84%) and 3 cases in which minimal asymptomatic dehiscences occurred. There was rejection of the graft and persistence of the perforation in only one case. No major surgical or postoperative complications associated with the procedure were described. The mean improvement in the audiometric gap was from 17dB preoperatively to 7dB after the intervention.ConclusionsThe modified Eavey technique is a low morbidity, cost-effective procedure with a technical facility that proves effective for the closure of tympanic perforations in adults and children.
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On ciprofloxacin concentration in chronic rhinosinusitis
Publication date: January–February 2018
Source:Acta Otorrinolaringologica (English Edition), Volume 69, Issue 1
Author(s): José Gameiro dos Santos, Rosário Figueirinhas, José P. Liberal, João C. Almeida, Joana Sousa, Amílcar Falcão, Corália Vicente, João Paço, Cecília A. Sousa
ObjectiveConsidering that all the evidence indicates that chronic rhinosinusitis without nasal polyps (CRSsNP) and chronic rhinosinusitis with nasal polyps (CRSwNP) are distinct entities, the aim of this study was to compare the concentrations obtained in plasma and in sinonasal mucosa with oral and nasal topical ciprofloxacin, in patients with and without nasal polyps, without evaluating the effectiveness of the use of an antibiotic.MethodsProspective clinical study with single-blind randomization. The population consisted of patients with chronic rhinosinusitis with eligible for endonasal surgery, over 18 years old. It took place between January 2010 and December 2014. A single preoperative dose of ciprofloxacin (oral or nasal topic- spray, gel or drops) was given and samples of plasma and nasal mucosa (inferior turbinate, middle turbinate, ethmoid and maxillary sinus) were collected prior to surgery. The plasma and mucosal ciprofloxacin concentrations were assayed with high performance liquid chromatography (HPLC) with fluorescence detection (FD).ResultsThe oral ciprofloxacin achieved better mucosal concentrations but had a significant plasmatic expression in all patients. None of the topical formulations achieved measurable ciprofloxacin plasmatic levels. Among the topical formulations, the gel had the best mucosal results, despite the existence of polyposis.
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Transoral laser microsurgery as standard approach to hypopharyngeal cancer survival analysis in a hospital based population
Publication date: January–February 2018
Source:Acta Otorrinolaringologica (English Edition), Volume 69, Issue 1
Author(s): Eduardo Breda, Raquel Catarino, Eurico Monteiro
ObjectiveCancer of the hypopharynx remains one of the most challenging chapters in head and neck oncology. The objective of this study is to ascertain the relevance of a transoral laser approach as a valid functional option for treatment of cancer of the hypopharynx in Portugal, and additionally, to confirm the reproducibility of survival and functional outcomes described in other reference centers.Subjects and methodsThe outcomes of 37 out of 60 patients presenting hypopharyngeal carcinoma primarily treated by TLM (transoral laser microsurgery) and neck dissection and or adjuvant treatment when needed, with curative intention in tertiary referral center, were retrospectively evaluated and compared with published results.ResultsThere were no patients in stage I. Three-year and five-year overall survival (Kaplan–Meier) were 83.5% and 63.5% for stage II (n=12), 57.1% (only 3-year overall survival evaluable for this stage) for stage III (n=7), and 53.1% and 39.8% for stage IVa (n=18), respectively. Five-year local control rates were 90% for stage II and 87.5% for stage IVa, respectively; only three-year local control rates were possible to evaluate for stage III, with a 100% control rate. Five-year total larynx preservation rate was 97.3%.ConclusionsTLM, alone or with neck dissection and adjuvant therapy, is a valid procedure for treatment of hypopharyngeal cancer in different stages. Furthermore, this kind of approach can be replicated in different oncologic centers with similar oncologic and functional results.
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Hypoglossal Nerve Stimulation Surgery for Obstructive Sleep Apnoea: Our Preliminary Experience
Publication date: January–February 2018
Source:Acta Otorrinolaringologica (English Edition), Volume 69, Issue 1
Author(s): Peter Baptista, Octavio Garaycochea, Laura Álvarez-Gómez, Juan Alcalde, Manuel Alegre, Elena Urrestarazu
The objective of this communication is to describe our preliminary results in upper airway stimulation surgery via hypoglossal nerve stimulation implantation for obstructive sleep apnoea. We describe 4 cases and the outcomes of the surgery were analysed using the Epworth scale, apnoea-hypopnoea index, minimal O2 Sat, average O2 Sat and snoring intensity. In all cases a significant reduction in Epworth scale values and apnoea-hypopnoea index were obtained (P<.05). The minimum and average oxygen saturation had better values after the surgery, however, there was no statistically significant difference. The snoring severity measured subjectively changed from "intense" to "absent" in all cases. The preliminary results obtained with the upper airway stimulation surgery via hypoglossal nerve stimulation showed objective and subjective improvement after the implant activation.
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Inverted Papilloma of Middle Ear and Temporal Bone
Publication date: January–February 2018
Source:Acta Otorrinolaringologica (English Edition), Volume 69, Issue 1
Author(s): Ignacio Pla-Gil, Antonio Morant Ventura, Jaume Redondo Martínez, Jaime Marco Algarra
http://ift.tt/2sq1zyC
Silent sinus syndrome in children
Publication date: January–February 2018
Source:Acta Otorrinolaringologica (English Edition), Volume 69, Issue 1
Author(s): Francisco Rosa, Rosário Figueirinhas, Jorge Oliveira, Cecília Almeida e Sousa
http://ift.tt/2EEccmk
Cranio-cervical junction cerebrospinal fluid leak after microdebrider-assisted adenoidectomy – A rare case report
Publication date: January–February 2018
Source:Acta Otorrinolaringologica (English Edition), Volume 69, Issue 1
Author(s): Karthikeyan Ramasamy, Hemanth Vamanshankar, Sunil Kumar Saxena, Vignesh Karunakaran, Arun Alexander
http://ift.tt/2srZ8vC
A Rare Benign Tumour on the Dorsum Nasi
Publication date: January–February 2018
Source:Acta Otorrinolaringologica (English Edition), Volume 69, Issue 1
Author(s): Ignacio Pla-Gil, Pedro Segarra Cortés, Jaime Marco Algarra
http://ift.tt/2EB41Hv
Alagille's Syndrome: Hypoplasia of Posterior Semicircular Canals
Publication date: January–February 2018
Source:Acta Otorrinolaringologica (English Edition), Volume 69, Issue 1
Author(s): Alexandre Perez-Girbes, Miguel Mazón, Elena Pont
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Comments on “Alveolar sarcoma of the parapharyngeal space: A case report”
Publication date: January–February 2018
Source:Acta Otorrinolaringologica (English Edition), Volume 69, Issue 1
Author(s): Ana María Cano-Valdez, Diana Brisa Sevilla-Lizcano, Abelardo Meneses-García
http://ift.tt/2EChFdi
Transoral robotic surgery of parapharyngeal space tumours: a series of four cases
Publication date: Available online 12 February 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): M.G. Maglione, A. Guida, E. Pavone, F. Longo, C. Aversa, S. Villano, F. Ionna
Tumours arising from the parapharyngeal space (PPS) represent less than 1% of all head and neck tumours. Salivary gland tumours account for 40–50% of PPS lesions and are located in the pre-styloid parapharyngeal space. Pleomorphic adenomas represent 80–90% of salivary tumours in the PPS. Recently, transoral robotic surgery (TORS) has become common in head and neck surgery as a minimally invasive procedure. Four cases of benign PPS tumour treated with TORS are presented here. Preoperative diagnosis was conducted by fine needle aspiration biopsy and magnetic resonance imaging, and the results were used to plan the correct surgical approach. One case required a change of approach to conventional transoral blunt dissection. Patients required pain control and reported dysphagia symptoms for a period of weeks, but no nasogastric tube was needed at any time. This case series indicates that TORS is a safe surgical procedure for the excision of benign tumours of the PPS in selected cases.
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Face-to-face anti-tobacco intervention lowered cotinine level in asthmatic children
To assess the effectiveness of "face-to-face" intervention we have decided to measure urine cotinine levels. The secondary end point was to assess the effect of anti-tobacco parental interventions in children with asthma on their lung function.
http://ift.tt/2sn6K2A
Safe and effective intradermal influenza vaccine desensitization for delayed influenza vaccine allergy
We report a case of an 18-year-old Japanese male with delayed hypersensitivity to influenza virus vaccine, who completed seven years of successful annual vaccine desensitization using intradermal (ID) trivalent split-virion influenza vaccine (IIV3-ID) (Fluzone®, Intradermal, Sanofi Pasteur, Cambridge MA). Informed consent was obtained this repot. At four years of age, the patient was hospitalized for evaluation of possible compartment syndrome in Japan for his first reaction to the intramuscular influenza vaccine when large circumferential swelling developed over a period of 24-48 hours after vaccination, which was successfully treated with intravenous steroids.
http://ift.tt/2EzKTtw
Asthma mobile applications: are they ready for prime time?
We are moving rapidly into the era of digital healthcare, which includes mobile health applications, wearable devices, health information technology, telehealth and telemedicine, and personalized medicine. With the growth of the use of smartphones in the population, this has allowed for the rapid increase in the downloading and use of medical health applications. In June 2015, Krebs and Duncan did a cross sectional survey of 1604 mobile phone users in the US and found that slightly over half had downloaded a health-related mobile app.
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Problems in anticoagulation of a patient with antibiotic treatment for endocarditis: interaction of rifampicin and vitamin K antagonists
The cytochrome P450 is a superfamily of isoenzymes that are responsible for the metabolism of many drugs. Significant changes in pharmacokinetics and drug interactions may be due to induction of hepatic cytochrome P450 enzymes. Rifampicin is a common inducer of CYP3A4. We report a case of a 57-year-old woman who was suspected for endocarditis and therefore treated with rifampicin. Due to previous mechanical aortic valve replacement, she also received phenprocoumon for anticoagulation. Although continuing anticoagulant therapy, antibiotic coadministration led to normal international normalised ratio (INR) level. Fifteen days after the treatment with rifampicin ended, INR returned to therapeutic level.
http://ift.tt/2nV0gmM
Respiratory symptoms of an abdominal origin
Description
A 75-year-old, fully dependent woman was sent to the emergency department due to a sudden onset of fever (38°C), polypnoea and dyspnoea. The patient had a history of Parkinson's disease and vascular dementia, making it impossible to cooperate in the medical interview. She was feverish, breathing rapidly, although haemodynamically stable and with peripheral oxygen saturation of over 95%. Blood tests showed increase in C-reactive protein (8.51 mg/dL), leucocytosis (13x109/L, 67% neutrophils and 23.1% lymphocytes) and slight hypokalaemia (3 mmol/L), without respiratory insufficiency in the arterial blood. Chest X-ray showed no clear infectious consolidation.
Acute tracheobronchitis was assumed, so she was given an antibiotic and potassium chloride and was discharged. The patient returned the next day without fever but with all of the other symptoms, adding to them prostration. She was still breathing rapidly but her abdomen was larger and tympanic, with noticeable pain while it was being palpated, adding therefore...
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Basilar artery fenestration: an unusual possible cause of ischaemic stroke?
Basilar artery fenestration is an uncommon congenital dysplasia and may be associated with ischaemic stroke. We present a case of a previously healthy 36-year-old man who presented with vertigo and vomiting. MRI showed posterior circulation territory infarction. High-resolution magnetic resonance angiography revealed a slit-like fenestration in the basilar artery. This patient had no traditional vascular risk factors or aetiology of cryptogenic stroke. The patient recovered from his neurological deficit after antiplatelet therapy and was given prophylactic aspirin therapy. There was no recurrence of symptoms after 12 months of follow-up.
http://ift.tt/2nVJwMm
Propionibacterium acnes and Staphylococcus epidermidis olecranon bursitis/osteomyelitis: a case involving surgical and antibiotic treatment
This report describes a 63-year-old generally healthy male with septic olecranon bursitis caused by Propionibacterium acnes. The patient sustained a small laceration after striking the posterior aspect of his left elbow on a metal railing when he was at a public swimming pool. We concluded that P. acnes was not initially detected because cultures were only kept for 5 days. Consequently, initial antibiotic treatment failed. P. acnes and Staphylococcus epidermidis grew in a subsequent tissue culture. The infection did not respond to intravenous vancomycin although soft-tissue debridements were done. This likely reflected the presence of olecranon osteomyelitis (seen on MRI scans) in addition to inadequate treatment with this antibiotic in the setting of a polymicrobial infection. Eventually, the infection was eradicated with multiple soft-tissue debridements in addition to the continuation of vancomycin with daily intravenous piperacillin/tazobactam that was added for the final 4 weeks of antibiotic treatment.
http://ift.tt/2o0TGKP
Rhabdomyolysis: a rare complication of Hashimotos thyroiditis precipitated by statin therapy
Hashimoto's thyroiditis (HT) or chronic lymphocytic thyroiditis is the most common form of primary hypothyroidism. Muscular manifestations like weakness, pain, stiffness and elevated muscle enzymes have been noticed in hypothyroidism. Statins are also known to cause myositis and rhabdomyolysis. This is a case of a middle-aged man, on statin therapy, who presented with severe muscle aches and pain and was found to have rhabdomyolysis. Further evaluation revealed an underlying HT as the culprit for his condition. He was managed with intravenous fluids and levothyroxine along with cessation of statins, following which he improved.
http://ift.tt/2nWN1C5
Withdrawn: Cutaneous larva migrans with pulmonaryinvolvement
Maslin D, Wallace M. Cutaneous larva migrans with pulmonary involvement. BMJ Case Rep. Published Online: 12 Jan 2018. doi: 10.1136/bcr-2017-223508.
With no admission of liability, BMJ has removed this article voluntarily at the request of the patient concerned.
http://ift.tt/2o2mORN
Genetic and epigenetic alterations in the tumour, tumour margins, and normal buccal mucosa of patients with oral cancer
Despite adequate surgical resection, oral squamous cell carcinoma (OSCC) shows a high rate of recurrence and metastasis, which could be explained by the presence of molecular alterations in seemingly normal tumour margins and the entire oral mucosa. The aims of this study were (1) to assess the presence of gene amplification (c-Myc and HER2) and promoter methylation (p14 and p16) in the tumours, tumour margins, and unaffected oral mucosa of 40 OSCC patients, and (2) to evaluate the possibility of using these alterations as prognostic markers.
http://ift.tt/2EBF7r7
Improving the efficacy of PET-CT imaging in head and neck cancer management and surveillance through the multidisciplinary team: a multi-centre, retrospective cohort analysis of 51 patients
Abstract
- There has been a recent move towards image-guided surveillance of N2/N3 disease in HNSCC and neck dissection only in selected cases
- PET-CT demand is rising and alters management in a third of HNSCC patients
- PET-CT is expensive and can lead to unnecessary and harmful investigations, delaying treatment
- The MDT is significantly less likely to request an inappropriate PET-CT than the individual clinician
- Collaboration among specialists may minimise the ordering of inappropriate PET-CTs, reducing costs and improving patient safety and management
http://ift.tt/2nWIsHX
Effects of treatment for psoriasis on circulating levels of leptin, adiponectin and resistin: a systematic review and meta-analysis
Abstract
Background
Metabolic syndrome, a risk factor of cardiovascular disease, is more common in psoriatic patients compared to general population. Circulating adipokine concentrations are altered in psoriatic patients and are suggested to represent the pathophysiologic link between psoriatic lesions and metabolic alterations.
Objectives
To systematically review the literature for studies that investigated possible differences in the circulating levels of leptin, adiponectin or resistin in psoriatic patients before and after any treatment intervention and meta-analyze the best evidence available.
Methods
Search was conducted in three databases (PubMed, Central, EMBASE). Eligible for the review were studies that have assessed leptin, adiponectin or resistin concentrations in patients with psoriasis before and after any topical or systemic treatment.
Result
After treatment, blood concentrations of leptin were similar to the relevant ones before treatment (SMD: 0.06, 95% CI: -0.09 to 0.20), with no heterogeneity among studies (I2: 0%, p = 0.875). After treatment, blood concentrations of adiponectin were similar to the relevant ones before treatment (SMD: -0.14, 95% CI: -0.34 to 0.05), with significant heterogeneity among studies (I2: 36.8%, p = 0.032). After treatment, blood concentrations of resistin were significantly lower as compared to the relevant ones before treatment (SMD: 0.50, 95% CI: 0.20 to 0.79), with significant heterogeneity among studies (I2: 61.4%, p < 0.001).
Conclusions
There is no evidence that treatment for psoriasis modifies leptin and adiponectin concentrations. In the opposite way, treatment intervention reduces resistin concentrations, a finding that is expected to be of clinical importance.
This article is protected by copyright. All rights reserved.
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A randomized, multi-national, non-inferiority, phase III trial to evaluate the safety and efficacy of BF-200 ALA gel versus MAL cream in the treatment of non-aggressive basal cell carcinoma with photodynamic therapy (PDT)
Abstract
Background
Basal cell carcinoma (BCC) represents the most common non-melanoma skin cancer worldwide affecting mainly adult, fair-skinned individuals. The WHO distinguishes aggressive and non-aggressive forms of which prototypical variants of the latter are primary nodular and superficial BCC.
Objectives
To demonstrate non-inferiority of BF-200 ALA (a nanoemulsion gel containing 5-aminolaevulinic acid) compared to MAL (a cream containing methyl-aminolevulinate) in the treatment of non-aggressive BCC with photodynamic therapy (PDT). Non-inferiority of the primary efficacy variable (overall patient complete response 12 weeks after last PDT) would be declared if the mean response for BF-200 ALA was no worse than that for MAL, within a statistical margin of Δ = -15%.
Patients/Methods
The study was a randomized, phase III trial performed in Germany and the UK with ongoing 5-year follow-up. Of 281 randomized patients, 138 were treated with BF-200 ALA, 143 with MAL. Patients received two PDT sessions one week apart. Remaining lesions 12 weeks after the second PDT were retreated. Illumination was performed with a red light source (635 nm, 37 J/cm2). Results shown include clinical endpoints as well as patients' reassessment 12 months after the last PDT.
Results
Of the BF-200 ALA-treated patients, 93.4% were complete responders compared to 91.8% in the MAL group. The difference of means was 1.6 with a one-sided 97.5% CI of -6.5, establishing non-inferiority (p<0.0001). Results for secondary efficacy parameters were in line with the primary outcome. Recurrence rates 12 months after the last treatment were ≤ 10%.
Conclusions
Treatment of non-aggressive BCC with BF-200 ALA-PDT is highly effective and well tolerated with proven non-inferiority to MAL-PDT and demonstrates low recurrence rates after 1-year follow-up.
This article is protected by copyright. All rights reserved.
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Pilocarpine and Artificial Saliva for the Treatment of Xerostomia and Xerophthalmia of Sjögren's Syndrome: A double blind control trial
Abstract
Background
Sjögren's Syndrome (SS) is associated with xerostomia and xerophthalmia. Pilocarpine stimulates the secretion of saliva.
Objectives
Investigate and compare the efficacy of pilocarpine and artificial saliva as symptomatic treatments for xerostomia and xerophthalmia in patients with SS.
Patients and Methods
A double-blind, randomized, controlled study was performed. 72 patients with SS were assigned randomly to receive ten drops of pilocarpine (5 mg) or 10 drops of artificial saliva, orally, t.i.d.for 12 weeks. Patients were evaluated at baseline and periodically throughout the study by whole saliva and tear flow for global assessment of their dryness as well as for any adverse effects.
Results
Patients receiving pilocarpine had a statistically significant improvement in their salivary flow (p< 0.0001), lachrymal flow (p< 0.0001), and their subjective global assessment (p< 0.0001), compared with patients on artificial saliva. The most common side effects were sialorrhea and nausea.
Limitations
As the pilocarpine was in solution (drops), it was possible for the dosage to become inaccurate.
Conclusions
Pilocarpine is more effective than artificial saliva for enhancing salivary and lachrymal secretion in patients with SS. This is the first study comparing the efficacy of pilocarpine and artificial saliva as treatments for xerostomia and xerophthalmia in SS.
This article is protected by copyright. All rights reserved.
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The synergistic activities of the combination of TNF-α, IL-17A, and IFN-γ in epidermal keratinocytes
Abstract
Psoriasis vulgaris is a common chronic inflammatory skin disease characterized by abnormal epidermal hyperplasia and the infiltration of cells including neutrophils and T cells.1 Th1 and Th17 cells particularly infiltrate psoriatic lesions, and they are thought to play critical roles in the pathogenesis. Psoriatic keratinocytes are morphologically abnormal, and they are also involved in the cell infiltration.
Antibody agents that block key cytokines have been successfully used clinically for psoriasis.
This article is protected by copyright. All rights reserved.
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A Review of Clinical Trial Registry Use in Dermatology Systematic Reviews
Abstract
An inherent qualification of systematic reviews is that they attempt to collate all relevant empirical evidence. While properly conducted systematic reviews are considered the gold standard for determining health care policy and clinical decision making, they are vulnerable to publication bias1. Publication bias occurs when statistically nonsignificant data from unpublished literature are omitted from systematic reviews and meta-analyses2.
This article is protected by copyright. All rights reserved.
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Eccrine sweat glands associate with the human hair follicle within a defined compartment of dermal white adipose tissue
Summary
Background
Eccrine sweat glands (ESGs) are critical for thermoregulation and involved in wound healing. ESGs have traditionally been considered as separate skin appendages without connection to the pilosebaceous unit (PSU). However, recent preliminary evidence has encouraged the hypothesis that PSU and ESG are more interconnected than previously thought.
Objective
To reevaluate the morphology of human skin adnexa with an integrated 3D perspective in order to explore the possible interconnections that the PSU and the ESG may form.
Methods
A systematic 3D reconstruction method of skin sections, direct visualization of human scalp follicular unit transplant grafts and a scalp strip ex vivo were used to validate and further explore the hypothesis.
Results
We demonstrate that the coiled portion of most ESGs is morphologically integrated into the PSU of human scalp skin and forms a structural unit that is embedded into a specific, HF-associated region of dermal white adipose tissue (dWAT). This newly recognized unit is easily accessible and experimentally tractable by organ culture of follicular units and can be intravitally visualized.
Conclusions
We propose a model of functional human skin anatomy in which ESGs are closely associated with the PSU and the dWAT to form a common homeostatic tissue environment, which may best be encapsulated in the term adnexal skin unit (aSU). The challenge now is to dissect how each component of this superstructure of human skin functionally cooperates with and influences the other under physiological conditions, during regeneration/repair and in selected skin diseases.
This article is protected by copyright. All rights reserved.
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Role of TNFSF11 and Group 2 Innate Lymphoid Cells in Type 2 Inflammation in Chronic Rhinosinusitis with Nasal Polyps
Publication date: February 2018
Source:Journal of Allergy and Clinical Immunology, Volume 141, Issue 2, Supplement
Author(s): Noriko Ogasawara, Julie A. Poposki, Aiko I. Klingler, Bruce K. Tan, Kathryn E. Hulse, Whitney W. Stevens, Anju T. Peters, Leslie C. Grammer, Robert P. Schleimer, Kevin C. Welch, Stephanie S. Smith, David B. Conley, Joseph R. Raviv, Pejman Soroosh, Tetsuo Himi, Robert C. Kern, Atsushi Kato
http://ift.tt/2CdXihz
Recurrent Wheeze After Hospital Discharge Among Preschool Children Hospitalized With Acute Wheezing: 18-Months Follow-Up of A Multi-Center Study
Publication date: February 2018
Source:Journal of Allergy and Clinical Immunology, Volume 141, Issue 2, Supplement
Author(s): Patrada Thanee, Paskorn Sritipsukho, Orapan Poachanukoon, Araya Satdhabudha, Khlongtip Matchimmadamrong, Sasawan Chinratanapisit, Jitladda Deerojanawong, Pantipa Chatchatee, Narissara Suratannon
http://ift.tt/2EjK60x
IL33 Receptor Deficiency Leads To Steroid Resistant Asthma Due To TSLP-driven Increase In IL9+ILC2s And Mast Cells
Publication date: February 2018
Source:Journal of Allergy and Clinical Immunology, Volume 141, Issue 2, Supplement
Author(s): Mukesh Verma, Sucai Liu, Lidia Michalec, Anand Sripada, Magdalena M. Gorska, Rafeul Alam
http://ift.tt/2CfZ1mm
Table of Contents
Publication date: February 2018
Source:Journal of Allergy and Clinical Immunology, Volume 141, Issue 2, Supplement
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Group 2 innate lymphoid cells display ILC3-like functional plasticity in asthmatics and non-human primates
Publication date: February 2018
Source:Journal of Allergy and Clinical Immunology, Volume 141, Issue 2, Supplement
Author(s): Cameron H. Flayer, Moyar Qing Ge, Daniel G. Tompkins, Maya Juarez, Lisa Miller, Christopher M. Royer, Brian M. Morrissey, Nicholas J. Kenyon, Angela Haczku
http://ift.tt/2Cf8Dhg
Risk of Asthma Among Children from In-Utero Exposure to Traffic-Related Air Pollutants
Publication date: February 2018
Source:Journal of Allergy and Clinical Immunology, Volume 141, Issue 2, Supplement
Author(s): Christina D. Schwindt, Jun Wu, Ralph Delfino
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Meeting Announcement
Publication date: February 2018
Source:Journal of Allergy and Clinical Immunology, Volume 141, Issue 2, Supplement
http://ift.tt/2CeePpS
Identification of MEK2 and CBX7 as Top Steroid Resistant Genes in Airway ILC2s and Lymphocytes from Asthma
Publication date: February 2018
Source:Journal of Allergy and Clinical Immunology, Volume 141, Issue 2, Supplement
Author(s): Kapil Sirohi, Mukesh Verma, Lidia Michalec, Anand Sripada, Donald Rollins, James Good, Richard J. Martin, Magdalena M. Gorska, Rafeul Alam
http://ift.tt/2EnSMDe
TSLP and IL-33 Reciprocally Regulate Each Other’s Lung Protein Expression and Receptor Expression on ILC2 following Aeroallergen Challenge in Mice
Publication date: February 2018
Source:Journal of Allergy and Clinical Immunology, Volume 141, Issue 2, Supplement
Author(s): Shinji Toki, Baohua Zhou, Stokes Peebles
http://ift.tt/2CfoegP
COCKROACH SENSITIZATION AS DETERMINANT FACTOR IN ASTHMA CONTROL IN A TROPICAL URBAN YOUTH
Publication date: February 2018
Source:Journal of Allergy and Clinical Immunology, Volume 141, Issue 2, Supplement
Author(s): Julián E. Londoño Hernández, Rodrigo A. Gaviria, Jaime Ocampo, Victor Calvo, Ricardo Cardona
http://ift.tt/2EmkQqp
Effect of Food Allergy on Astma Control in children
Publication date: February 2018
Source:Journal of Allergy and Clinical Immunology, Volume 141, Issue 2, Supplement
Author(s): Sukruthi Jois, Betty Andy-Nweye, Alice N. Hackett, Opal J. Kamdar, Kylie N. Jungles, Ruchi S. Gupta, Mary C. Tobin, Mahboobeh Mahdavinia
http://ift.tt/2CgGarh
Overweight/Obesity as a risk factor for Severe Wheezing up to 5 years old
Publication date: February 2018
Source:Journal of Allergy and Clinical Immunology, Volume 141, Issue 2, Supplement
Author(s): Leticia Lambert, Luisa B. Savastano, Sephanie L. Vargas, Etienne L. Duim, Maria Celia C. Ciaccia, Vera E. Rullo
http://ift.tt/2Cf0zwX
Title Page
Publication date: February 2018
Source:Journal of Allergy and Clinical Immunology, Volume 141, Issue 2, Supplement
http://ift.tt/2EkZMjT
Novel evaluation method of dentin repair by direct pulp capping using high-resolution micro-computed tomography
Abstract
Objectives
We evaluated a novel micro-computed tomography (micro-CT) assessment for quality and quantity of dentin repair, which is difficult to visualize by histological analysis, after direct pulp capping under standardized cavity preparation.
Materials and methods
Standardized cavities were prepared on Wistar rats and direct pulp capping was performed using two commercial bioceramics, ProRoot MTA, and iRoot BP Plus. After 2 or 4 weeks, quality and quantity of tertiary dentin formation were evaluated using high-resolution micro-CT analyses including dentin mineral density, dentin mineral contents, compactness and integrity of tertiary dentin, and dentin volume with/without void space. Reproducibility of micro-CT analyses was confirmed by histological evaluation of the same specimen.
Results
The exposed pulp area sizes were similar between iRoot BP Plus and ProRoot MTA. Micro-CT analysis of 2-week samples showing compactness of tertiary dentin was significantly higher in iRoot BP Plus than ProRoot MTA (p < 0.05). Tertiary dentin volume without void space, dentin mineral contents, and density were not significantly different between the groups. In 4-week samples, a significant increase was observed in dentin mineral density, compactness, and dentin volume with/without void space induced by iRoot BP Plus (p < 0.05). Micro-CT analysis of tertiary dentin integrity demonstrated that some ProRoot MTA specimens had small defects and lacked continuity (6/512 images). No defects were observed with iRoot BP Plus.
Conclusions
Micro-CT analysis was confirmed as an accurate, objective, and inclusive approach for evaluating quality and quantity of dentin repair.
Clinical relevance
These multifaceted approaches to evaluate pulp capping materials may accelerate review processes, ultimately improving vital pulp therapy.
http://ift.tt/2o24h87
A technique for teaching and photo-documentation of direct endoscopic rigid oesophagoscopy
Abstract
Direct oesophagoscopy is largely a diagnostic procedure performed for a variety of symptoms (e.g. unilateral otalgia or odonophagia) or as part of a panendoscopy to exclude a synchronous primary; therefore good visualisation of abnormal mucosa is essential. The current standard oesophagoscopy technique involves direct visualisation from approximately 25cm down a narrow, illuminated oesophagoscope limiting visualisation of abnormal mucosa. Usually performed by a single operator, the technique is difficult to teach, as the trainee is unable to visualise what the trainer is seeing endoluminally and visa versa.
This article is protected by copyright. All rights reserved.
http://ift.tt/2BSXPcV
Differences in gene expression profile between vocal cord Leukoplakia and normal larynx mucosa by gene chip
Abstract
Background
Long non-coding RNAs (lncRNAs) play an important role in tumorigenesis. Vocal cord leukoplakia is a precancerous lesion in otolaryngological practice. Till now, the expression patterns and functions of lncRNAs in vocal cord leukoplakia have not been well understood. In this study, we used microarrays to investigate the aberrantly expressed lncRNAs and mRNAs in vocal cord leukoplakia and adjacent non-neoplastic tissues.
Methods
Gene Ontology and pathway analyses were performed to determine the significant function and pathways of the differentially expressed mRNAs. qRT-PCR was performed to further validate the expression of selected lncRNAs and mRNAs in vocal cord leukoplakia.
Results
Our study identified 170 differentially expressed lncRNAs and 99 differentially expressed mRNAs, including 142 up-regulated lncRNAs and 28 down-regulated lncRNAs, and 54 up-regulated mRNAs and 45 down-regulated mRNAs. Among these, XLOC_000605 and DLX6-AS1 were the most aberrantly expressed lncRNAs. Furthermore, we identified an antisense lncRNA (LOC100506801), an enhancer-like lncRNA (AK057351) and three long intergenetic noncoding RNAs including XLOC_008001, XLOC_011989 and XLOC_007341.
Conclusions
Our results revealed that many lncRNAs were differentially expressed between vocal cord leukoplakia tissues and normal tissue, suggesting that they may play a key role in vocal cord leukoplakia tumorigenesis.
http://ift.tt/2G3FXtZ
Important and specific role for basophils in acute allergic reactions
Abstract
IgE-mediated allergic reactions involve the activation of effector cells, predominantly through the high-affinity IgE receptor (FcεRI) on mast cells and basophils. Although the mast cell is considered the major effector cell during acute allergic reactions, more recent studies indicate a potentially important and specific role for basophils and their migration which occurs rapidly upon allergen challenge in humans undergoing anaphylaxis. We review the evidence for a role of basophils in contributing to clinical symptoms of anaphylaxis, and discuss the possibility that basophil trafficking during anaphylaxis might be a pathogenic (to target organs) or protective (preventing degranulation in circulation) response. Finally, we examine the potential role of basophils in asthma exacerbations. Understanding the factors that regulate basophil trafficking and activation might lead to new diagnostic and therapeutic strategies in anaphylaxis and asthma.
This article is protected by copyright. All rights reserved.
http://ift.tt/2EBHquA
Short chain fatty acids induce tissue plasminogen activator in airway epithelial cells via GPR41&43
Abstract
Background
Chronic rhinosinusitis (CRS) is a heterogeneous chronic inflammatory disease generally divided based on presence or absence of nasal polyps (NPs). One of the features of NPs is excessive fibrin deposition, which is associated with down regulation of tissue plasminogen activator (t-PA) in NPs. As t-PA is expressed in epithelial cells, and epithelium is readily accessible to topical therapies, identifying compounds that can mediate the induction of t-PA would be a potential new strategy for the treatment of NPs.
Objective
The objective of this study was to determine whether SCFAs can induce t-PA in airway epithelial cells via their known receptors GPR41 and GPR43.
Methods
We performed immunohistochemistry (IHC) to determine whether receptors for SCFAs, known as G protein coupled receptor 41/free fatty acid receptor 3 (GPR41/FFAR3) and GPR43/FFAR2, are expressed in nasal tissue. Primary normal human bronchial epithelial (NHBE) cells were stimulated with different concentrations of SCFAs to test induction of t-PA, which was analyzed by expression of mRNA and protein. Mediation of responses by SCFA receptors was evaluated by specific receptor gene silencing with siRNA.
Results
IHC study revealed that airway epithelial cells expressed GPR41 and GPR43. Acetic acid, propionic acid, butyric acid, and valeric acid significantly induced t-PA expression from 2-10 folds. The strongest inducer of t-PA from NHBE cells was propionic acid; cells stimulated with propionic acid released t-PA into the supernatant in its active form. Gene silencing of GPR41 and GPR43 revealed that induction of t-PA by SCFAs was dependent upon both GPR41 and GPR43.
Conclusions & Clinical Relevance
SCFAs were shown to induce airway epithelial cell expression of t-PA via GPR41 and GPR43. Topical delivery of potent compounds that activate these receptors may have value by reducing fibrin deposition and shrinking nasal polyp growth.
This article is protected by copyright. All rights reserved.
http://ift.tt/2skEJZa
Unusual AIP mutation and phenocopy in the family of a young patient with acromegalic gigantism
Summary
Early-onset acromegaly causing gigantism is often associated with aryl-hydrocarbon-interacting receptor protein (AIP) mutation, especially if there is a positive family history. A15y male presented with tiredness and visual problems. He was 201 cm tall with a span of 217 cm. He had typical facial features of acromegaly, elevated IGF-1, secondary hypogonadism and a large macroadenoma. His paternal aunt had a history of acromegaly presenting at the age of 35 years. Following transsphenoidal surgery, his IGF-1 normalized and clinical symptoms improved. He was found to have a novel AIP mutation destroying the stop codon c.991T>C; p.*331R. Unexpectedly, his father and paternal aunt were negative for this mutation while his mother and older sister were unaffected carriers, suggesting that his aunt represents a phenocopy.
Learning points:Typical presentation for a patient with AIP mutation with excess growth and eunuchoid proportions.
Unusual, previously not described AIP variant with loss of the stop codon.
Phenocopy may occur in families with a disease-causing germline mutation.
http://ift.tt/2EnyFoI
Quantitative Analysis of Global Proteome in Bone Samples From Patients With Osteoporotic and Nonosteoporotic Fracture
Condition: Femoral Neck Fractures
Intervention: Procedure: total hip arthroplasty
Sponsor: Second Affiliated Hospital of Soochow University
Not yet recruiting
http://ift.tt/2nTSdXi
Intervention: Procedure: total hip arthroplasty
Sponsor: Second Affiliated Hospital of Soochow University
Not yet recruiting
http://ift.tt/2nTSdXi
Biospecimen Procurement for NIDCD Clinical Protocols
Conditions: Hearing Disorder; Oral Mucosal Disease; Pharyngeal Neoplasm; Head and Neck Neoplasms; Laryngeal Disease
Intervention:
Sponsor: National Institute on Deafness and Other Communication Disorders (NIDCD)
Recruiting
http://ift.tt/2o1kbzF
Intervention:
Sponsor: National Institute on Deafness and Other Communication Disorders (NIDCD)
Recruiting
http://ift.tt/2o1kbzF
OPPOSITE: Outcome Prediction Of Systemic Treatment in Esophagogastric Carcinoma
Conditions: Gastric Neoplasm; Gastroesophageal Junction Adenocarcinoma; Esophageal Adenocarcinoma; Gastric Adenocarcinoma; Esophageal Neoplasms
Intervention: Procedure: Biopsy
Sponsors: University Hospital Heidelberg; University Hospital Dresden; German Cancer Research Center
Not yet recruiting
http://ift.tt/2nU60Nr
Intervention: Procedure: Biopsy
Sponsors: University Hospital Heidelberg; University Hospital Dresden; German Cancer Research Center
Not yet recruiting
http://ift.tt/2nU60Nr
PET and MRI in Prognosis Prediction of NPC
Condition: Nasopharyngeal Carcinoma
Intervention: Device: integrated PET/MRI
Sponsor: Chang Gung Memorial Hospital
Recruiting
http://ift.tt/2o1k1Z5
Intervention: Device: integrated PET/MRI
Sponsor: Chang Gung Memorial Hospital
Recruiting
http://ift.tt/2o1k1Z5
Rapidly progressive neovascular glaucoma following coronary artery bypass graft surgery in a patient with type 1 diabetes mellitus: a case report
Proliferative diabetic retinopathy leading to vitreous hemorrhage, tractional retinal detachment, and neovascular glaucoma is a major cause of severe sight impairment in adults of working age worldwide. Neovas...
http://ift.tt/2BqoZHl
Safe and effective intradermal influenza vaccine desensitization for delayed influenza vaccine allergy
Publication date: Available online 12 February 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Tsuzumi Kanaoka, Kazune Matsuoka, Marcus Shaker
http://ift.tt/2EArWXy
Efficacy of MAS063DP lotion vs 0.02% triamcinolone acetonide lotion in improving post-ablative fractional CO2 laser resurfacing wound healing: a split-face, triple-blinded, randomized, controlled trial
Abstract
Proven as effective acne scar treatment, ablative fractional carbon dioxide (AFCO2) laser requires post-laser wound healing care. MAS063DP is a multicomponent nonsteroidal anti-inflammatory moisturizer for effective post-laser treatment. This study compares the efficacy of MAS063DP and 0.02% triamcinolone acetonide (TA) lotion for post-laser wound healing and complications. A split-face, triple-blinded, clinical study was performed in 16 patients, aged 20–50 years, receiving AFCO2 on both sides of the face, with MAS063DP on one side and 0.02% TA on the other side for 7 days twice daily. Digital photography, hemoglobin, and melanin index at baseline were obtained immediately after laser treatment and then at days 3, 5, 7, and 30. Erythema, edema, crusting, adverse effects, and post-inflammatory hyperpigmentation (PIH) were followed every visit. Sixteen patients, mean age 38.6 (8.4) years, with moderate–severe atrophic scar and skin phototype III–IV completed the study. Clinical improvement of edema, erythema, crusting, and hyperpigmentation was observed from day 3 to day 30 (P < 0.001), with no statistically significant difference in both groups. There was also no statistical difference of hemoglobin, melanin index, and texture at days 3, 5, 7, and 30. Melanin index at day 30 was significantly less than baseline in both MAS063DP and 0.02% TA. With PIH in 50% of cases, both treatments demonstrated good safety profiles and no serious adverse reactions. MAS063DP could be an effective treatment for post-laser wound healing and complications, compatible to 0.02% TA.
http://ift.tt/2EjMDDU
The in-hospital burden of hidradenitis suppurativa in patients with inflammatory bowel disease: a decade nationwide analysis from 2004 to 2014
Abstract
Background
Hidradenitis suppurativa (HS) is a chronic inflammatory disease that significantly affects the patient's quality of life. Multiple studies have shown a strong association between HS and inflammatory bowel disease (IBD). Our primary goal was to explore the in-hospital burden of HS on patients with IBD. Our secondary goal was to establish unique baseline characteristics and comorbidities of IBD patients with HS.
Methods
This was a retrospective cohort study using the National Inpatient Sample (NIS) database for the years 2004 through 2014. All patients with ICD-9 CM codes for any diagnosis of IBD and HS were included. The primary outcome was the medical and financial burden of HS on patients with IBD. Medical burden was measured by in-hospital morbidity and mortality, and financial burden was measured by resource utilization.
Results
A total of 3,079,332 admissions with IBD were recorded, of which 4369 had a concomitant diagnosis of HS. IBD-HS patients were significantly younger and mostly African-American females; they were more likely to be smokers, obese, and have diabetes mellitus, depression, and anemia. There was no mortality difference between the IBD-HS and IBD-only groups; nevertheless, there was a higher likelihood of developing sepsis in the IBD-HS cohort (4.9% vs. 2.6%; P < 0.001). Patients with IBD-HS had an increased hospital length of stay (5 vs. 4 days; P < 0.001) and higher total hospitalization costs ($13,272 vs. $12,237; P = 0.013).
Conclusions
This large-scale study strengthens the evidence that these two inflammatory conditions are truly associated and establishes their joint effect on overall morbidity, mortality, and resource utilization.
http://ift.tt/2EVFwCw
Recent advances and development in epidermal and dermal drug deposition enhancement technology
Abstract
Skin is the largest and easily accessible organ of the body. Increases in incidences of dermatological disorders, demand for drug targeting, and patient compliance have increased the popularity of topical drug delivery amongst the people. However, drug delivery across the skin is still a challenge for researchers because permeation of maximum drugs is hindered by the upper layer of the epidermis (stratum corneum). Several approaches like use of chemical permeation enhancers and physical methods such as sonophoresis, iontophoresis, electroporation, microneedles, etc., have been used to deliver the drugs topically. These methods of topical drug delivery have some limitations and drawbacks. Therefore new techniques based on nano drug delivery system such as ultradeformable liposomes, nanostructured lipid carriers, nanoemulsions, solid lipid nanoparticles, lipospheres, nanoparticles, and ethosomes have been exploited for enhancing epidermal and dermal drug deposition. Development of these nanosytems requires a good understanding of mechanism of drug permeation, physicochemical properties of drug and carriers, and technological advancements in methodology. Therefore, this article covers recent advances in epidermal and dermal drug deposition enhancement approaches, biopharmaceutical challenges with dermal drug delivery, issues in formulation development, and regulatory aspects of nanosystem. This review article also discusses the concern of topical drug delivery in immunization, gene delivery, and cosmeceuticals.
http://ift.tt/2EmJqDi
Innovative real CSF leak simulation model for rhinology training: human cadaveric design
Abstract
Objective
To study the feasibility of designing a human cadaveric simulation model of real CSF leak for rhinology training.
Method
The laboratory investigation took place at the surgical academic center of Prince Sultan Military Medical City between 2016 and 2017. Five heads of human cadaveric specimens were cannulated into the intradural space through two frontal bone holes. Fluorescein-dyed fluid was injected intracranialy, then endoscopic endonasal iatrogenic skull base defect was created with observation of fluid leak, followed by skull base reconstruction. The outcome measures included subjective assessment of integrity of the design, the ability of creating real CSF leak in multiple site of skull base and the possibility of watertight closure by various surgical techniques.
Results
The fluid filled the intradural space in all specimens without spontaneous leak from skull base or extra sinus areas. Successfully, we demonstrated fluid leak from all areas after iatrogenic defect in the cribriform plate, fovea ethmoidalis, planum sphenoidale sellar and clival regions. Watertight closure was achieved in all defects using different reconstruction techniques (overly, underlay and gasket seal closure).
Conclusion
The design is simulating the real patient with CSF leak. It has potential in the learning process of acquiring and maintaining the surgical skills of skull base reconstruction before direct involvement of the patient. This model needs further evaluation and competence measurement as training tools in rhinology training.
http://ift.tt/2EXlFmp
Follicular dendritic cell sarcoma of the duodenum: an extremely rare entity
Extranodal follicular dendritic cell sarcoma (FDCS) is a very rare tumour, only reported in case reports and case series. It poses diagnostic and management challenge both to the clinician and pathologist. We present such a rare case of duodenal FDCS in a 56-year-old woman who was recently managed in our institution. Repeated pre surgical biopsies were non-diagnostic and the final diagnosis was made only after surgical excision of the tumour and with the help of histopathological and immunohistochemical studies. The patient had a complete en block resection of the tumour and was discharged home well 5 days postsurgery. To the best of our knowledge, this is the first case of FDCS reported arising from the duodenum.
http://ift.tt/2EkzB93
Atypical presentation of atypical haemolytic uraemic syndrome
A 17-year-old girl presented with fever, myalgia, vomiting for 1 month and oliguria and dyspnoea for 4 days. She was tachycardic,hypertensive, with pedal oedema and decreased breath sounds. She had high serum creatinine (3 mg/dL), anaemia, thrombocytopenia, leucocytosis and eosinophilia with schistocytes. Lactate dehydrogenase, transaminases were high , with low haptoglobin and high ferritin (5269 ng/mL). Complement C3/C4 and fibrinogen were normal. Urinalysis showed large blood and protein and stool studies were negative. Her ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) was normal. Kidney biopsy showed acute interstitial nephritis (AIN) in addition to thrombotic angiopathy. The differentials - haemolytic uraemic syndrome (HUS), thrombotic thrombocytopenia (TTP) and haemophagocytic lymphohistiocytosis (HLH) were ruled out. Her genetic testing was abnormal for large CFHR1–CFHR3 homozygous deletion and heterozygous missense variant in exon 2 of DGKE making the diagnosis of atypical HUS. She received eculizumab and was discharged on oral steroids for AIN and biweekly eculizumab infusions with excellent recovery.
http://ift.tt/2ETZyNL
Pityriasis rubra pilaris: a rare inflammatory dermatosis
Description
An 18-year-old Caucasian woman presented with a 2-week history of a pruritic rash commencing on the face and spreading distally to the trunk and limbs. There were no associated systemic symptoms. Her medical history was unremarkable and there was a family history of hypothyroidism. Physical examination revealed extensive confluent scaly erythema with islands of sparing on the trunk and scaling of the scalp. There was hyperkeratotic plugging of the hair follicles (figure 1 and figure 2). There was a waxy orange keratoderma affecting the palms and soles with associated painful fissuring (figure 3). A clinical diagnosis of pityriasis rubra pilaris (PRP) was made. Histopathology of involved skin showed focal parakeratosis and orthokeratosis alternating in both horizontal and vertical directions with an underlying perivascular inflammatory infiltrate. The patient had a raised thyroid stimulating hormone (TSH) and normal T4 indicative of subclinical hypothyroidism. Treatment for her...
http://ift.tt/2EkVo0o
Bilobed gallbladder: a rare congenital anomaly
Bilobed gallbladder is a rare form of duplication of gallbladder. Preoperative diagnosis is important to avoid peroperative complications; however, it is also a challenge as imaging reports are often confounding. A case of bilobed gallbladder managed successfully laparoscopically is presented.
http://ift.tt/2EYaSbZ
Spontaneous pneumomediastinum
Spontaneous pneumomediastinum is the presence of free air within the mediastinum that is not associated with trauma. It is a rare, self-limiting condition that can cause widespread subcutaneous surgical emphysema. We present the case of a 12-year-old boy who presented with widespread spontaneous surgical emphysema and pneumomediastinum, with no history of trauma or respiratory tract disease. We discuss our assessment of him and management with our multidisciplinary team (MDT), and whether radiological investigations including CT are helpful in such cases. In conclusion, we hypothesised that the child's coughing was the most likely cause of the tracheal rupture leading to the spontaneous surgical emphysema. Spontaneous pneumomediastinum in the paediatric patient is extremely rare. This case highlights how spontaneous pneumomediastinum can be successfully managed conservatively, and how MDT input can be helpful in guiding management in such unusual cases.
http://ift.tt/2EhYQsx
'If there were water we should stop and drink: neurofibromatosis presenting with diabetes insipidus
A 58-year-old right-handed woman presented to our institution with a 1-month history of polydipsia and polyuria. She had a remote history of neurofibroma excision by dermatology and, on examination, was noted to meet the clinical diagnostic criteria for neurofibromatosis type 1. Laboratory investigations revealed hypernatraemia and elevated serum osmolality, accompanied by reduced urinary osmolality. A subsequent water deprivation test confirmed central diabetes insipidus, which responded to treatment with desmopressin. MRI of the brain showed pituitary enlargement, which raised the possibility of an underlying pituitary adenoma or, alternatively, lymphocytic hypophysitis. Both conditions have rarely been described in neurofibromatosis.
http://ift.tt/2ETZsFT
Acute rheumatic fever presenting as complete heart block: report of an adolescent case and review of literature
A 14-year-old boy suffering from chronic rheumatic heart disease came to the emergency department with recurrent episodes of presyncope and syncope. He was found to have complete heart block (CHB) and required temporary pacemaker insertion. Further workup revealed that CHB was secondary to acute rheumatic carditis. His atrioventricular (AV) conduction abnormalities recovered in a stepwise fashion over 5 days while he was being treated with corticosteroids, without the need for permanent pacemaker insertion. This case illustrates that acute rheumatic carditis can rarely present with advanced AV conduction block, which may be reversible.
http://ift.tt/2EldNud
Immunotherapy for recurrent/metastatic head and neck cancer
Purpose of review In the last decade, after cetuximab (anti-epidermal growth factor receptor), none of the novel investigated compounds has demonstrated benefit in head and neck squamous cell cancers (HNSCC), both in advanced and curative settings. Therefore, prognosis of recurrent/metastatic (R/M) HNSCC patients remains dismal, especially in platinum-refractory cohort. In the last few years, a new important class of drugs has affirmed its role. HNSCC, even if less 'immunogenic' than other malignancies (e.g. melanoma), was field of application of several new immune agents. To date, the most important data regard drugs acting on PD-1 (programmed death-1)/PD-L1 (programmed death-ligand 1) axis that is a crucial checkpoint used by tumor for immune escape. Our purpose is to summarize the results of these PD-1/PD-L1 inhibitors, outlining some critical points and few practical suggestions. Recent findings Nivolumab was recently approved by main regulatory agencies as second-line treatment for platinum-refractory R/M HNSCC. In the same setting, pembrolizumab was approved by FDA. Atezolizumab and durvalumab have already showed similar benefit in phase Ia and II studies, respectively. Summary Anti-PD1/PD-L1 agents are new effective therapies in R/M HNSCC. Their combination with conventional/novel compounds, as well as a better selection of responding patients, could lead to improve current results. Correspondence to Salvatore Alfieri, MD, Department of Head and Neck Cancer Medical Oncology 3, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, zip code 20133, Milan, Italy. Tel: +39 02 2390 2765; e-mail: salvatore.alfieri@istitutotumori.mi.it Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2BU3m2Y
http://ift.tt/2BU3m2Y
Reducing morbidity and complications after major head and neck cancer surgery: the (future) role of enhanced recovery after surgery protocols
Purpose of review To review the development and the benefits of enhanced recovery after surgery (ERAS) protocols in non-head and neck disciplines and to describe early implementation efforts in major head and neck surgeries. Recent findings Several groups have adopted ERAS protocols for major head and neck surgery and demonstrated its feasibility and effectiveness. Summary There is growing evidence that clinical and financial outcomes for patients undergoing major head and neck surgery rehabilitation can be significantly improved by standardizing preoperative, intraoperative, and postoperative treatment protocols. Current experience is limited to single centers. A future goal is to broaden the adoption of ERAS in head and neck surgical oncology to include national and international collaboration, data sharing, and learning. Correspondence to Gerhard F. Huber, MD, MSc, Lead Head & Neck surgical oncology, ENT clinic, University Hospital of Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland. Tel: +41 71 494 6433; fax: +41 71 494 2888; e-mail: gerry.huber@usz.ch; Surgical oncology, ENT clinic, Kantonsspital St. Gallen, Rorschacher Strasse 95, 9007 St. Gallen, Switzerland. E-mail: gerhard.huber@kssg.ch Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2BmKZm6
http://ift.tt/2BmKZm6
Association of the nod-like receptor 3 (NLRP3) gene variability with recurrent aphthous stomatitis in the Czech population
Abstract
Background
Recurrent aphthous stomatitis (RAS) is a multifactorial disease with unclear etiopathogenesis in which disturbance of immunological processes maybe involved. The aim of our study was to investigate three single nucleotide polymorphisms (SNPs) rs3806265, rs4612666, rs10754558 in NOD-like receptor 3 (NLRP3), the gene encoding the component of inflammasome, in patients with RAS and healthy controls in the Czech population.
Methods
A total of 207 subjects were included in this case-control study. Sixty-four patients with RAS and 143 healthy controls were genotyped by a method based on polymerase chain reaction using 5′ nuclease TaqMan® assays. Detailed anamnestic, clinical and laboratory data were obtained from all subjects.
Results
The allele and genotype frequencies of NLRP3 polymorphisms (rs10754558 and rs3806265) between both groups were similar. However, statistically significant differences in NLRP3 rs4612666 genotypes between the patients with RAS and controls were found; carriers of the TT genotype had a higher risk of developing RAS than subjects with the CT+CC genotypes (OR=14.69, 95%CI=1.73-124.72, P=0.004, Pcorr<0.05). No associations between NLRP3 haplotypes and RAS were observed.
Conclusions
Our study indicates that the NLRP3 rs4612666 polymorphism may be involved in the development of RAS in the Czech population.
This article is protected by copyright. All rights reserved.
http://ift.tt/2spRB0b
Immunotherapy for recurrent/metastatic head and neck cancer
Purpose of review In the last decade, after cetuximab (anti-epidermal growth factor receptor), none of the novel investigated compounds has demonstrated benefit in head and neck squamous cell cancers (HNSCC), both in advanced and curative settings. Therefore, prognosis of recurrent/metastatic (R/M) HNSCC patients remains dismal, especially in platinum-refractory cohort. In the last few years, a new important class of drugs has affirmed its role. HNSCC, even if less 'immunogenic' than other malignancies (e.g. melanoma), was field of application of several new immune agents. To date, the most important data regard drugs acting on PD-1 (programmed death-1)/PD-L1 (programmed death-ligand 1) axis that is a crucial checkpoint used by tumor for immune escape. Our purpose is to summarize the results of these PD-1/PD-L1 inhibitors, outlining some critical points and few practical suggestions. Recent findings Nivolumab was recently approved by main regulatory agencies as second-line treatment for platinum-refractory R/M HNSCC. In the same setting, pembrolizumab was approved by FDA. Atezolizumab and durvalumab have already showed similar benefit in phase Ia and II studies, respectively. Summary Anti-PD1/PD-L1 agents are new effective therapies in R/M HNSCC. Their combination with conventional/novel compounds, as well as a better selection of responding patients, could lead to improve current results. Correspondence to Salvatore Alfieri, MD, Department of Head and Neck Cancer Medical Oncology 3, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, zip code 20133, Milan, Italy. Tel: +39 02 2390 2765; e-mail: salvatore.alfieri@istitutotumori.mi.it Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2BU3m2Y
http://ift.tt/2BU3m2Y
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