Αρχειοθήκη ιστολογίου

Αλέξανδρος Γ. Σφακιανάκης
ΩτοΡινοΛαρυγγολόγος
Αναπαύσεως 5
Άγιος Νικόλαος Κρήτη 72100
2841026182
6032607174

Τετάρτη 28 Μαρτίου 2018

Ethics of a therapeutic trial: addressing limitations of an active intervention in optic nerve lymphoma

We report a unique case of optic nerve lymphoma after completion of chemotherapy for non-Hodgkin's lymphoma. The uncommon nature of presentation, our therapeutic dilemma and the further course of treatment are reported. In cases with extremely poor prognosis, unnecessary treatment puts additional strain both financially and psychologically on the patients and their family. Therapeutic focus should be on hospice care and family counselling. The decision to not treat is a crucial component of cancer management; however, the ethics of this decision are yet to be suitably addressed by the literature.



https://ift.tt/2GjlUrZ

Secondary mania following cancer chemotherapy with capecitabine

Mania-like states occurring due to neurological, metabolic or toxic conditions, without a primary mood disorder have been reported in scientific literature as secondary mania. A major clinical problem in such situations often stems from the difficulty to understand if the mood disturbance is indeed secondary to an organic cause or a coincidental primary mood disorder. Chemotherapy regimens have been associated with multiple psychiatric complications, including psychosis, mania and anxiety. Capecitabine is implicated to be associated with encephalopathy whose clinical presentation often mimics that of psychosis. However, presentations with mania have not been reported until with the capecitabine and oxaliplatin combination chemotherapy regimen. In this report, we describe a case of secondary mania in a patient suffering from carcinoma colon on treatment with chemotherapy regimen of capecitabine and oxaliplatin.



https://ift.tt/2GzYhil

Large intra-abdominal seminoma in a left undescended testicle complicated by torsion

A 39-year-old man presented with a 2-day history of worsening constant, dull diffuse lower abdominal pain with associated constipation and known history of left undescended testicle. He was evaluated at an outside hospital where a non-contrasted CT scan revealed a 20 cm well-circumscribed soft tissue mass within the pelvis.

He was referred and further imaging revealed a 12 cm heterogeneous mass with foci of air that appeared to be contiguous with the left spermatic cord. This constellation of findings could represent torsion of undescended left testicle with infarction or underlying malignancy. Tumour markers were only significant for elevated lactate dehydrogenase of 1445. A subsequent ultrasound-guided biopsy of the mass demonstrated seminoma.

Surgical resection revealed a large intra-abdominal mass emanating from the left spermatic cord with 270° of torsion. There appeared to be a left atrophic remnant testicle at the base of the mass with final pathology confirming the diagnosis of classic seminoma.



https://ift.tt/2E3pS6b

Pneumatosis intestinalis in a preterm infant: should we treat all intestinal pneumatosis as necrotising enterocolitis?

Gastric pneumatosisis a very rare site of pneumatosis intestinalis (PI), and we report this finding in a preterm female infant with cyanotic congenital heart disease. The infant was stable initially on nasal intermittent mandatory ventilation; however, torrential pulmonary flow through a large patent ductus arteriosus prompted closure using oral ibuprofen. After an episode of haematochezia, she developed PI, affecting mainly the gastric wall and small intestine with portal venous gas. Her bowel movements were regular, with no abdominal distension or significant gastric aspirates. She was haemodynamically stable with negative infective markers. Management consisted of endotracheal intubation and ventilation, gastric decompression and broad-spectrum antibiotics. Both the gastric and intestinal pneumatosis resolved within 24 hours and she made an uneventful recovery. If PI is not due to necrotising enterocolitis, enteral nutrition can be initiated early and prolonged course of broad-spectrum antibiotics could have been avoided.



https://ift.tt/2GES6tl

Basilic vein haemangioma: an unusual differential diagnosis for cubital fossa mass

Subcutaneous masses along the cubital fossa can be a diagnostic dilemma. Most patients are asymptomatic and usually present for a cosmetic reason. Diagnosis can be confirmed by radiological findings and histopathology. We present a case report of a similar mass that turned out to be a haemangioma arising from the basilic vein with brief review of literature.



https://ift.tt/2Gh7lVN

Smart Phone Based Audiometry in City Traffic Police

Abstract

Noise induced hearing loss (NIHL) is defined as "reduction in auditory acuity associated with noise exposure". Traffic police is a bundle of people who are the usual sufferer of this type of increased hearing threshold. In developing countries like India, many of them are unable to access audiology services, because of shortage of trained professionals and limited sources. Smartphone based audiometry is easy and can detect hearing loss as early as possible. To study hearing threshold in traffic police. Total 88 persons were included in the study. An occupational history was taken regarding duration of posting followed by smart phone based audiometry (Hearing Test TM software) test. Out of total 88 persons, 80 were having increased hearing thresholds which were suggestive of noise induced hearing loss. Out of total 88 persons 8 were in normal group, 24 were in mild hearing loss group, 42 were in moderate hearing loss group and 14 were in severe hearing loss group. Total number of person with notch at 4000/6000 Hz was 28, suggestive of particular pattern of noise induced hearing loss. During the last decade, mobile phones have evolved like anything. Furthermore, the utilization of health-related applications has gained increased focus. Health-related applications are useful, less time consuming and with increased efficiency by early diagnoses. There are many of smart-phone hearing applications that are already in use. They use similar principle as audiometer. This kind of application will narrow down the supply and demand ratio of audiology service in developing countries.



https://ift.tt/2GgWKy7

Masses of the Paranasal Sinuses After Treatment of Nasopharyngeal Carcinoma: A Case Report

Abstract

The development of a new mass in the field of irradiation of a previously treated Nasopharyngeal carcinoma is generally considered a sign of recurrence. We report a case of a 46-year-old male, with a past history of undifferentiated NPC, with an expansive lesion discovered during radiological follow-up that occupied nasal cavity and paranasal sinuses. The endoscopic sinuses surgery was necessary in order to analyze and remove the mass with intraoperative frozen sections to highlight mucosa free from disease. The presence of non-malignant masses in the paranasal sinuses are rare complications after radiotherapy at the skull base, but represent an eventuality that must be considered in the differential diagnosis of a suspected recurrence or with a secondary malignancies after radiation therapy. It is therefore required a final diagnosis based on biopsy, follow-up and an eventual endoscopic surgical treatment.



https://ift.tt/2uuAiMK

Vertigo: Incidences, Diagnosis and Its Relations with Hearing Loss

Abstract

Vertigo is one of the most common complaints in our regular practice. Vertigo is of peripheral or central cause. The association of vertigo with or without hearing loss helps to narrow the differential diagnosis. The aim of the study is to evaluate the various causes of vertigo based on the vertigo attacks and hearing loss.



https://ift.tt/2Gjxiby

Smart Phone Based Audiometry in City Traffic Police

Abstract

Noise induced hearing loss (NIHL) is defined as "reduction in auditory acuity associated with noise exposure". Traffic police is a bundle of people who are the usual sufferer of this type of increased hearing threshold. In developing countries like India, many of them are unable to access audiology services, because of shortage of trained professionals and limited sources. Smartphone based audiometry is easy and can detect hearing loss as early as possible. To study hearing threshold in traffic police. Total 88 persons were included in the study. An occupational history was taken regarding duration of posting followed by smart phone based audiometry (Hearing Test TM software) test. Out of total 88 persons, 80 were having increased hearing thresholds which were suggestive of noise induced hearing loss. Out of total 88 persons 8 were in normal group, 24 were in mild hearing loss group, 42 were in moderate hearing loss group and 14 were in severe hearing loss group. Total number of person with notch at 4000/6000 Hz was 28, suggestive of particular pattern of noise induced hearing loss. During the last decade, mobile phones have evolved like anything. Furthermore, the utilization of health-related applications has gained increased focus. Health-related applications are useful, less time consuming and with increased efficiency by early diagnoses. There are many of smart-phone hearing applications that are already in use. They use similar principle as audiometer. This kind of application will narrow down the supply and demand ratio of audiology service in developing countries.



https://ift.tt/2GgWKy7

Masses of the Paranasal Sinuses After Treatment of Nasopharyngeal Carcinoma: A Case Report

Abstract

The development of a new mass in the field of irradiation of a previously treated Nasopharyngeal carcinoma is generally considered a sign of recurrence. We report a case of a 46-year-old male, with a past history of undifferentiated NPC, with an expansive lesion discovered during radiological follow-up that occupied nasal cavity and paranasal sinuses. The endoscopic sinuses surgery was necessary in order to analyze and remove the mass with intraoperative frozen sections to highlight mucosa free from disease. The presence of non-malignant masses in the paranasal sinuses are rare complications after radiotherapy at the skull base, but represent an eventuality that must be considered in the differential diagnosis of a suspected recurrence or with a secondary malignancies after radiation therapy. It is therefore required a final diagnosis based on biopsy, follow-up and an eventual endoscopic surgical treatment.



https://ift.tt/2uuAiMK

Vertigo: Incidences, Diagnosis and Its Relations with Hearing Loss

Abstract

Vertigo is one of the most common complaints in our regular practice. Vertigo is of peripheral or central cause. The association of vertigo with or without hearing loss helps to narrow the differential diagnosis. The aim of the study is to evaluate the various causes of vertigo based on the vertigo attacks and hearing loss.



https://ift.tt/2Gjxiby

Association Between Dose and Duration of Cisplatin Exposure with Cytotoxicity Effect on Nasopharyngeal Carcinoma Stem Cell

Abstract

Nasopharyngeal carcinoma (NPC) is ranked 6th of malignant tumors in Indonesia. To analyze the correlation of dose and duration of cisplatin exposure with cytotoxic effects on nasopharyngeal carcinoma stem cells. The biopsy NPC tissue was cultured and processed to obtain NPC stem cells to be treated with cisplatin different doses and durations (24 and 48 h). The number of dead cells after exposure will be calculated using a hemocytometer. Death stem cell density of NPC at exposure of 2 μg/ml cisplatin dose was 81.37%, while the smallest death cell density a dose of 0.05 μg/ml after a 72-h observation was 21.3%. The coefficient correlation 0.827 and value p = 0.000 (p < 0.05). The analysis of the correlation between cisplatin exposure duration and death cell was also significant with the correlation coefficient − 0.357 and the value p = 0.001 (p < 0.05). There was a correlation between the increased dose of cisplatin with the cytotoxicity effects on NPC stem cell.



https://ift.tt/2IcXNfg

Association Between Dose and Duration of Cisplatin Exposure with Cytotoxicity Effect on Nasopharyngeal Carcinoma Stem Cell

Abstract

Nasopharyngeal carcinoma (NPC) is ranked 6th of malignant tumors in Indonesia. To analyze the correlation of dose and duration of cisplatin exposure with cytotoxic effects on nasopharyngeal carcinoma stem cells. The biopsy NPC tissue was cultured and processed to obtain NPC stem cells to be treated with cisplatin different doses and durations (24 and 48 h). The number of dead cells after exposure will be calculated using a hemocytometer. Death stem cell density of NPC at exposure of 2 μg/ml cisplatin dose was 81.37%, while the smallest death cell density a dose of 0.05 μg/ml after a 72-h observation was 21.3%. The coefficient correlation 0.827 and value p = 0.000 (p < 0.05). The analysis of the correlation between cisplatin exposure duration and death cell was also significant with the correlation coefficient − 0.357 and the value p = 0.001 (p < 0.05). There was a correlation between the increased dose of cisplatin with the cytotoxicity effects on NPC stem cell.



https://ift.tt/2IcXNfg

Biguanides Metformin and Phenformin Generate Therapeutic Effects via AMP-Activated Protein Kinase/Extracellular-Regulated Kinase Pathways in an In Vitro Model of Graves' Orbitopathy

Thyroid, Ahead of Print.


https://ift.tt/2E43ids

Concurrent Milk Ingestion Decreases Absorption of Levothyroxine

Thyroid, Ahead of Print.


https://ift.tt/2GTpQ3X

Refined Approach to Preservation of the Inferior Alveolar Nerve during Resection and Primary Reconstruction of the Mandible

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0038-1639348

Sacrifice of the inferior alveolar nerve (IAN) during resection of the mandible is taken as a rule. In 1987, Jensen and Nock described a technique that permitted placement of dental implants in the atrophied mandibular alveolar ridge that lacked sufficient vertical height superior to the mandibular canal. This technique was used by some authors to preserve continuity of the IAN during resection of the mandible in patients with benign tumors. The described techniques are traumatic, time-consuming, and not precise. We propose a new refined technique of preservation of IAN with use of a guide to approach mandibular canal, cutting guides with a slot for a relocated IAN, and a new approach to positioning of the fixating screws. We assessed the effectiveness of this new technique with use of an electro-odontometer. In 21 cases, we demonstrated a refined approach to preservation of the IAN. In 7 patients (33%), the IAN was preserved on one side and in 14 patients (67%), on both sides. Sensation in the lower lip was restored in 18 patients (86%). These patients generally recovered sensation within 22 days postoperatively. This proposed technique makes preservation of IAN easier, faster, less traumatic, and more predictable. In this article, we describe criteria for the patients with cancer of oral mucosa to be admitted for this procedure. Restored sensation in the lower lip of the patients who have undergone resection of the mandible significantly improves their quality of life.
[...]

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

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



https://ift.tt/2GRUz14

Mast cell disorders: Protean manifestations and treatment responses

Mast cell disorders represent an emerging disease category notable for the diverse spectrum of presentations. Patients are clinically characterized by symptoms reflective of mast cell mediator release, which often includes episodes of urticaria with or without angioedema and flushing as well as episodes of recurrent potentially life-threatening anaphylaxis. Multiple systems can be targeted including cardiovascular, gastrointestinal (GI), psychiatric, respiratory and musculoskeletal. In addition, patients may have vague nonspecific complaints, such as abdominal discomfort or "brain fog".

https://ift.tt/2IYQNUh

Effect of IFN-λ2 on combined allergic rhinitis with nasal polyps

OBJECTIVE: This study sought to investigate the expression of interferon-λ2 (IFN-λ2) in patients with combined allergic rhinitis and nasal polyps (AR+NP), analyze the correlation between IFN-λ2 and tryptase, interleukin 10 (IL-10), and interleukin 12 (IL-12), and identify its peripheral blood cell origins.

PATIENTS AND METHODS: ELISA kits were used to investigate plasma levels of IFN-λ2, tryptase, IL-10, and IL-12 in AR+NP patients and healthy controls (HC). Flow cytometry analysis was carried out to detect IFN-λ2 expression in peripheral blood leukocytes. Immunocytochemical staining was performed to detect nasal polyp IFN-λ2 expression in AR+NP patients.

RESULTS: Elevated plasma IFN-λ2 levels and positive correlations between plasma IFN-λ2 and tryptase levels in AR+NP patients indicated that IFN-λ2 likely contributes to AR+NP pathogenesis. IFN-λ2 expression was upregulated in cytotoxic T cells and eosinophils in AR+NP patients. Nasal polyp mast cells and macrophages in AR+NP patients expressed IFN-λ2.

CONCLUSIONS: The close correlation between IFN-λ2 expression and AR+NP may provide experimental evidence for a possible effect of IFN-λ2 against the allergic inflammatory reaction. Therefore, IFN-λ2 actions may have a potential utility for the treatment and prevention of AR+AP.

L'articolo Effect of IFN-λ2 on combined allergic rhinitis with nasal polyps sembra essere il primo su European Review.



https://ift.tt/2DZpjKt

An atypical clinical presentation of lichen planus pigmentosus with typical dermoscopic pattern

Australasian Journal of Dermatology, EarlyView.


https://ift.tt/2GzsMF7

Detection of human papillomavirus 42 in a squamous cell carcinoma

Australasian Journal of Dermatology, EarlyView.


https://ift.tt/2GiVRBa

Treatment of scalp dysesthesia utilising simple exercises and stretches: A pilot study

Australasian Journal of Dermatology, EarlyView.


https://ift.tt/2GzdfFc

Teledermatologist expert skin advice: A unique model of care for managing skin disorders and adverse drug reactions in hepatitis C patients

Australasian Journal of Dermatology, EarlyView.


https://ift.tt/2E3Yh4O

Surgical indication of Furlow palatoplasty to treat submucous cleft palate

This study investigated the effects of Furlow palatoplasty on children with submucous cleft palate (SMCP) and identified surgical indications by comparing SMCP and control patients. Twenty-three SMCP children (average age 28.9 months) who were nonsyndromic and underwent surgery between April 2010 and December 2016 were included. Facial computed tomography (CT) was performed preoperatively and at least 1 year postoperatively after a language test. Facial CT measurements were taken for 140 children aged 0–6 years without deformities (control group).

https://ift.tt/2GlxvGW

Three-dimensional study of 31 cases of synostotic anterior plagiocephaly before and after surgical management

Synostotic anterior plagiocephaly is a rare pathological cranial malformation. Therapeutic options are rarely studied due to the rarity of the malformation and difficulties in diagnosis and care management.The objective of this study was to analyze the results obtained with the Lille protocol based on 62 CT-scans done before and after surgery in 31 patients.A specific analysis was designed for this work. Nine cephalometric measures enabled to evidence on each CT-Scan the corrections made on the fronto-orbital bandeau and the potential impact of surgery on the craniofacial structures.

https://ift.tt/2Ie7V7n

Better surgical outcome by image-guided navigation system in endoscopic removal of sinonasal inverted papilloma

The purpose of this study was to validate and compare treatment outcomes for endoscopic resection of sinonasal inverted papilloma (IP) with or without the use of a navigation system.

https://ift.tt/2pN0fCe

Detecting oropharyngeal carcinoma using multispectral, narrow‐band imaging and machine learning

The Laryngoscope, EarlyView.


https://ift.tt/2pLZlWu

Table of contents

The Laryngoscope, Volume 128, Issue 4, Page iii-vi, April 2018.


https://ift.tt/2E3zRbt

Masthead

The Laryngoscope, Volume 128, Issue 4, Page i-ii, April 2018.


https://ift.tt/2pMVNDE

A new method for selecting auricle positions in skull base reconstruction for temporal bone cancer

The Laryngoscope, EarlyView.


https://ift.tt/2GkldPk

In reference to Computed tomography image navigation patient tracker on the cheek during osteoplastic flaps

The Laryngoscope, EarlyView.


https://ift.tt/2pMxhTb

Is cricothyroid muscle twitch predictive of the integrity of the EBSLN in Thyroid Surgery?

The Laryngoscope, EarlyView.


https://ift.tt/2E1YBRy

Detection of bacteria by 16S rRNA PCR and sequencing in culture‐negative chronic rhinosinusitis

The Laryngoscope, EarlyView.


https://ift.tt/2GmG7wX

Assessing nontechnical skills in otolaryngology emergencies through simulation‐based training

The Laryngoscope, EarlyView.


https://ift.tt/2GiQRwr

Short‐ and long‐term outcomes of oropharyngeal cancer care in the elderly

The Laryngoscope, EarlyView.


https://ift.tt/2pLEGC8

Comparison of cricothyroid approximation and glottoplasty for surgical voice feminization in male‐to‐female transsexuals

The Laryngoscope, EarlyView.


https://ift.tt/2E3t7dD

Cochlear implantation and auditory brainstem implantation in neurofibromatosis type 2

The Laryngoscope, EarlyView.


https://ift.tt/2GCnIzS

FDG‐PET metabolic tumor parameters for the reirradiation of recurrent head and neck cancer

The Laryngoscope, EarlyView.


https://ift.tt/2E3t2Xn

Extracapsular dissection for warthin tumors despite the risk of ipsilateral metachronous occurrence

The Laryngoscope, EarlyView.


https://ift.tt/2GCnyIM

Microsurgical instrument‐assisted facial nerve dissection for deep lobe parotid tumors

The Laryngoscope, EarlyView.


https://ift.tt/2E3FtT8

Open access: Is there a predator at the door?

The Laryngoscope, EarlyView.


https://ift.tt/2GEmAf1

Expression of tenascin‐C in a rat vocal fold injury model and its regulation of fibroblasts

The Laryngoscope, EarlyView.


https://ift.tt/2E3FoyO

Predictive factors in 995 stapes surgeries for primary otosclerosis

The Laryngoscope, EarlyView.


https://ift.tt/2GEmtjB

In Vivo Biofilm Formation, Gram‐Negative Infections and TAS2R38 Polymorphisms in CRSw NP Patients

The Laryngoscope, EarlyView.


https://ift.tt/2E2QsfJ

Th‐17 response and antimicrobial peptide expression are uniformly expressed in gastric mucosa of Helicobacter pylori‐infected patients independently of their clinical outcomes

Helicobacter, EarlyView.


https://ift.tt/2GEkBY7

Non‐surgical treatment with basic fibroblast growth factor for atrophic scars in acne vulgaris

The Journal of Dermatology, EarlyView.


https://ift.tt/2GTp3Qe

Case of renal metastasis of melanoma successfully controlled by a combination therapy of nivolumab and radiation

The Journal of Dermatology, EarlyView.


https://ift.tt/2E3J1ES

Novel PSTPIP1 gene mutation in pyoderma gangrenosum, acne and suppurative hidradenitis syndrome

The Journal of Dermatology, EarlyView.


https://ift.tt/2GTp1b4

First Japanese case of atypical Spitz tumor exhibiting ROS1 rearrangement

The Journal of Dermatology, EarlyView.


https://ift.tt/2Icp4hE

Novel COL7A1 mutation in a family with bullous dermolysis of the newborn: Phenotypic variability associated with a COL7A1 mutation within the same family

The Journal of Dermatology, EarlyView.


https://ift.tt/2GUHfcc

Epidemiological and clinical features of rosacea in Korea: A multicenter cross‐sectional study

The Journal of Dermatology, EarlyView.


https://ift.tt/2E3IVNw

Hypohidrotic ectodermal dysplasia with strabismus

The Journal of Dermatology, EarlyView.


https://ift.tt/2GRckxu

Climber's knuckle excoriation

The Journal of Dermatology, EarlyView.


https://ift.tt/2E3pZ1q

Role of soluble CD147 in psoriatic patients: A preliminary study

The Journal of Dermatology, EarlyView.


https://ift.tt/2GT5sQt

Prognostic role of neutrophil to lymphocyte ratio in advanced melanoma treated with anti‐programmed death‐1 therapy

The Journal of Dermatology, EarlyView.


https://ift.tt/2IbiLLs

Case of childhood granulomatous periorificial dermatitis

The Journal of Dermatology, EarlyView.


https://ift.tt/2GTuAq3

Congenital peristernal dermal sinus: A case report and published work review

The Journal of Dermatology, EarlyView.


https://ift.tt/2Ief9Z7

Hidradenitis suppurativa in association with keratitis–ichthyosis–deafness syndrome treated with adalimumab

The Journal of Dermatology, EarlyView.


https://ift.tt/2GToAxs

Successful treatment of extramammary Paget's disease with S‐1 and docetaxel combination chemotherapy

The Journal of Dermatology, EarlyView.


https://ift.tt/2Ie3RE9

Increased uptake on 18F‐fluorodeoxyglucose positron emission tomography/computed tomography is indicative of occult skin lesions in a patient with intravascular large B‐cell lymphoma

The Journal of Dermatology, EarlyView.


https://ift.tt/2GTouWC

Case of mild X‐linked ichthyosis complicated with paroxysmal supraventricular tachycardia and anemia

The Journal of Dermatology, EarlyView.


https://ift.tt/2Ieycmb

Exacerbation of atopic dermatitis symptoms by ustekinumab in psoriatic patients with elevated serum immunoglobulin E levels: Report of two cases

The Journal of Dermatology, EarlyView.


https://ift.tt/2GTooOK

Cutaneous leishmaniasis caused by Leishmania tropica in Israel

The Journal of Dermatology, EarlyView.


https://ift.tt/2IeeOFT

Guselkumab, a human interleukin‐23 monoclonal antibody in Japanese patients with generalized pustular psoriasis and erythrodermic psoriasis: Efficacy and safety analyses of a 52‐week, phase 3, multicenter, open‐label study

The Journal of Dermatology, EarlyView.


https://ift.tt/2GRIfxZ

Evaluation of bone resection margins of segmental mandibulectomy for oral squamous cell carcinoma

Resection margins are frequently studied in patients with oral squamous cell carcinoma and are accepted as a constant prognostic factor. While most evidence is based on soft tissue margins, reported data for bone resection margins are scarce. The aim of this retrospective study was to evaluate and determine the utility of surgical margins in bone resections for oral cavity squamous cell carcinoma (OCSCC). The status of bone resection margins and their impact on survival was investigated in patients who had undergone segmental mandibulectomy for OCSCC.

https://ift.tt/2GPY4oJ

Responses in patients receiving sequential paclitaxel post progression on PD1 inhibitors

This report describes highlights the dramatic responses seen in patients who were given paclitaxel post progression on immunotherapy. There are multiple mechanisms by which synergistic effects of immunotherapy and chemotherapy occur. Further prospective studies on chemotherapy and immunotherapy are eagerly awaited.

https://ift.tt/2IYskyp

Topical N‐acetylcysteine in ichthyosis: Experience in 18 patients

Pediatric Dermatology, EarlyView.


https://ift.tt/2IXONMd

Pediatric Old World cutaneous leishmaniasis treated with oral fluconazole: A case series

Pediatric Dermatology, EarlyView.


https://ift.tt/2pNkaQG

Omeprazole‐induced hypertrichosis in two children

Pediatric Dermatology, EarlyView.


https://ift.tt/2J1O78v

Angiomatoid and desmoplastic Spitz nevus presenting as a keloidal nodule

Pediatric Dermatology, EarlyView.


https://ift.tt/2pPrUlb

Tularemia‐induced erythema multiforme minor in an 11‐year‐old girl

Pediatric Dermatology, EarlyView.


https://ift.tt/2J2d03Z

Generalized lymphatic anomaly successfully treated with long‐term, low‐dose sirolimus

Pediatric Dermatology, EarlyView.


https://ift.tt/2pNdyBS

Short anagen syndrome: Case series and literature review

Pediatric Dermatology, EarlyView.


https://ift.tt/2IYxJWd

Diffuse pityriasiform eruption in a pediatric patient after bone marrow transplantation

Pediatric Dermatology, Volume 35, Issue 2, Page 246-247, March/April 2018.


https://ift.tt/2pPrPhk

White scarlike lesions in a female infant with bilious emesis and sixth nerve palsy

Pediatric Dermatology, Volume 35, Issue 2, Page 242-243, March/April 2018.


https://ift.tt/2J3EAxB

Comment on “Congenital Lupus with Multiorgan Involvement: A Case Report and Review of Literature”

Pediatric Dermatology, Volume 35, Issue 2, Page 285-286, March/April 2018.


https://ift.tt/2pQsI9p

Pruritic reticulated eruption

Pediatric Dermatology, Volume 35, Issue 2, Page 239-241, March/April 2018.


https://ift.tt/2J3dkiW

Planar xanthomas secondary to post‐transplantation cholangiopathy in a 16‐month‐old boy

Pediatric Dermatology, EarlyView.


https://ift.tt/2pKDG0e

Exogenous Cushing syndrome from an unexpected source of systemic steroids

Pediatric Dermatology, EarlyView.


https://ift.tt/2J3dd70

Comment on “Bumps in the Road: Panniculitis in Children and Adolescents Treated with Vemurafenib”

Pediatric Dermatology, Volume 35, Issue 2, Page 287-288, March/April 2018.


https://ift.tt/2pNIiTb

Fractional ablative carbon dioxide laser followed by topical sodium stibogluconate application: A treatment option for pediatric cutaneous leishmaniasis

Pediatric Dermatology, EarlyView.


https://ift.tt/2J39t5B

Comment on “Scabies in babies”

Pediatric Dermatology, Volume 35, Issue 2, Page 284-284, March/April 2018.


https://ift.tt/2pMQOCb

Neutrophilic urticarial dermatosis as a presenting feature of systemic juvenile idiopathic arthritis

Pediatric Dermatology, EarlyView.


https://ift.tt/2J2Kxeu

Hidradenitis suppurativa in children: The Henry Ford experience

Pediatric Dermatology, EarlyView.


https://ift.tt/2pShsJY

Mohs micrographic surgery for cutaneous malignancies: A focus review of its indications in pediatric age groups

Pediatric Dermatology, EarlyView.


https://ift.tt/2J2Kqj4

Curvilinear, erythematous plantar patch in a toddler

Pediatric Dermatology, Volume 35, Issue 2, Page 251-252, March/April 2018.


https://ift.tt/2E3jdIZ

Forthcoming Meetings

Clinical &Experimental Allergy, Volume 48, Issue 4, Page 483-483, April 2018.


https://ift.tt/2Ie8YnX

Issue Information

Clinical &Experimental Allergy, Volume 48, Issue 4, Page 349-351, April 2018.


https://ift.tt/2pN1cup

Cover Image

Clinical &Experimental Allergy, Volume 48, Issue 4, Page i-i, April 2018.


https://ift.tt/2GhbwRG

Quintupling or quadrupling inhaled glucocorticoids to prevent asthma exacerbations?

Clinical &Experimental Allergy, Volume 48, Issue 4, Page 352-353, April 2018.


https://ift.tt/2pL30Ea

Chronic idiopathic erythroderma of elderly men is an independent entity that has a distinct TARC/IgE profile from adult atopic dermatitis

International Journal of Dermatology, EarlyView.


https://ift.tt/2pP09JE

Two‐stage surgical repair in 31 patients with stage II–III hidradenitis suppurativa

International Journal of Dermatology, EarlyView.


https://ift.tt/2IXN6yl

Galli‐Galli disease responsive to isotretinoin treatment

International Journal of Dermatology, EarlyView.


https://ift.tt/2pMywRq

Multiple keratoacanthoma and oral lichen planus successfully treated with systemic retinoids and review of multiple keratoacanthoma associated with lichen planus

International Journal of Dermatology, EarlyView.


https://ift.tt/2IXN3m9

A study of skin disease spectrum occurring in Angola phototype V–VI population in Luanda

International Journal of Dermatology, EarlyView.


https://ift.tt/2pMys48

Cutaneous angiosarcoma: the role of dermoscopy to reduce the risk of a delayed diagnosis

International Journal of Dermatology, EarlyView.


https://ift.tt/2IXN0GZ

Unique application of awake tracheoscopy and endobronchial ultrasound in the management of tracheal mucoepidermoid carcinoma

Head &Neck, EarlyView.


https://ift.tt/2GBCGWS

Differential expression and prognostic value of long non‐coding RNA in HPV‐negative head and neck squamous cell carcinoma

Head &Neck, EarlyView.


https://ift.tt/2GlVTIF

Quality of head and neck radiotherapy reporting in randomized controlled trials

Head &Neck, EarlyView.


https://ift.tt/2GBCDKG

Myoepithelial carcinoma of the nasopharynx: Rare case report with clinicopathologic and immunohistochemical features review of literature

Head &Neck, EarlyView.


https://ift.tt/2GkSGJt

Head and neck cancer reirradiation with interstitial high‐dose‐rate brachytherapy

Head &Neck, EarlyView.


https://ift.tt/2GBCAhY

Bocca's hemipharyngo‐total laryngectomy for hypopharyngeal carcinoma to avoid reconstruction with a pedicled flap

Head &Neck, EarlyView.


https://ift.tt/2GmvTN5

BRAFwild papillary thyroid carcinoma has two distinct mRNA expression patterns with different clinical behaviors

Head &Neck, EarlyView.


https://ift.tt/2GDOJTu

Depressive symptoms, social anxiety, and perceived neck function in patients with head and neck cancer

Head &Neck, EarlyView.


https://ift.tt/2GkLE7e

Issue Information

Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue 4, Page 505-510, April 2018.


https://ift.tt/2IchsM6

Predatory journals abuse the flood of publishable material

Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue 4, Page 511-512, April 2018.


https://ift.tt/2GPSPW5

Actinic keratoses seldom occur alone

Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue 4, Page 513-513, April 2018.


https://ift.tt/2Ie9TED

Laser‐ and RF‐based treatments for acne vulgaris: new interesting options a commentary

Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue 4, Page 514-514, April 2018.


https://ift.tt/2GPSDWR

Announcement

Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue 4, Page 646-646, April 2018.


https://ift.tt/2E2XjWy

Forthcoming Events

Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue 4, Page 645-645, April 2018.


https://ift.tt/2GPSse9

Issue Information

Journal of Cosmetic Dermatology, Volume 17, Issue 2, Page 117-117, April 2018.


https://ift.tt/2GERxzS

Dermatological manifestations in hemodialysis patients in Iran: A systematic review and meta‐analysis

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2E1O9cM

In vivo efficacy and properties of semisolid formulations containing panthenol

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2GyTFZT

JCD Editorial—April, 2018

Journal of Cosmetic Dermatology, Volume 17, Issue 2, Page 123-123, April 2018.


https://ift.tt/2Gmtu51

Atmospheric skin aging—Contributors and inhibitors

Journal of Cosmetic Dermatology, Volume 17, Issue 2, Page 124-137, April 2018.


https://ift.tt/2GynzNR

Three-dimensional study of 31 cases of synostotic anterior plagiocephaly before and after surgical management

Publication date: Available online 28 March 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Ambre Simon, Emmanuelle Bocquet, Philippe Pellerin, Matthieu Vinchon, Patrick Dhellemmes, Véronique Martinot, Alexis Wolber, Clotilde Calibre, Philippe Charlier, Pierre Guerreschi
Synostotic anterior plagiocephaly is a rare pathological cranial malformation. Therapeutic options are rarely studied due to the rarity of the malformation and difficulties in diagnosis and care management.The objective of this study was to analyze the results obtained with the Lille protocol based on 62 CT-scans done before and after surgery in 31 patients.A specific analysis was designed for this work. Nine cephalometric measures enabled to evidence on each CT-Scan the corrections made on the fronto-orbital bandeau and the potential impact of surgery on the craniofacial structures.Results show that surgical symmetry of the fronto-orbital bandeau in the transversal plane, according to the symmetrical axis of the semicircular canals, allows a normalization of the skull's growth and morphogenesis for the surgically affected structures but also adjacent ones.



https://ift.tt/2pMzf5Y

Better surgical outcome by image-guided navigation system in endoscopic removal of sinonasal inverted papilloma

Publication date: Available online 28 March 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Sang Hyeon Ahn, Eun Jung Lee, Jin Won Kim, Kwang Ha Baek, Hyung-Ju Cho, Joo-Heon Yoon, Chang-Hoon Kim
PurposeThe purpose of this study was to validate and compare treatment outcomes for endoscopic resection of sinonasal inverted papilloma (IP) with or without the use of a navigation system.Materials and MethodsA total of 58 patients who underwent endoscopic resection of sinonasal inverted papilloma by a single surgeon from 2007 to 2016 at our institution were retrospectively reviewed. Depending on the use of the navigation system, subj ects were divided into two groups: a conventional endoscopic resection group without navigation system (CER group) and a navigation-assisted endoscopic resection group (NER group).ResultsThere were 24 patients (41.4%) in the CER group and 34 patients (58.6%) in the NER group. Treatment outcomes showed that navigation-assisted endoscopic resection was a more beneficial surgical technique than conventional endoscopic resection for sinonasal IP. Post-surgical recurrence was noted in seven cases (29.2%) in the CER group and two cases (5.9%) in the NER group. Accordingly, the recurrence rate was significantly less in the NER group compared to the CER group (p=0.026). There were two cases of complications (8.3%) in the CER group comprising cerebrospinal fluid leak and periorbital fat exposure, while no complications were noted for the NER group (p=0.167).ConclusionThis study demonstrated that navigation-assisted endoscopic removal of sinonasal IP is helpful for reducing recurrence and avoiding surgical complications. Therefore, navigation systems should be always considered when performing endoscopic removal of sinonasal IP.



https://ift.tt/2IdY5m1

Socioeconomic determinants as risk factors for squamous cell carcinoma of the head and neck: a case-control study in Iran

Publication date: Available online 26 March 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): S. Azimi, N. Rafieian, S. Manifar, Z. Ghorbani, M. Tennant, E. Kruger
Our aim was to assess the association between different components of sociodemographic status and the risk of developing squamous cell carcinoma (SCC) of the head and neck after we had adjusted for the influence of the known behavioural risk factors of smoking and drinking alcohol. We selected 146 patients with histopathologically-confirmed SCC of the head and neck, and matched them for age and sex with 266 healthy controls for this case-control study. Personal details, occupation, socioeconomic status, smoking, and alcohol consumption were recorded. The association of sociodemographic variables with oral cancer was evaluated both separately and with a composite socioeconomic index. Chi squared tests, adjusted odds ratios (OR), and 95% CI were computed using logistic regression to estimate the effect. There was a significant difference between the two groups in the composite socioeconomic index (p<0.001). The group with "low" socioeconomic status had the highest risk of oral cancer (OR=3.89, 95% CI 1.28 to 11.82). Better-educated people with higher incomes had a lower risk of SCC of the head and neck after we had controlled for behavioural risk factors. However, marital and employment status and place of residence were not significantly associated with risk. Our findings confirm that some socioeconomic determinants were associated with the development of oral cancer in this study group.



https://ift.tt/2GzZR3I

Unilateral necrosis of the tongue caused by embolisation of cholesterol crystals

Publication date: Available online 26 March 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): N. Kitamura, E. Sasabe, H. Kitaoka, T. Yamamoto
Cholesterol crystals embolise when an aortic atherosclerotic lesion ruptures and cholesterol crystals are scattered and obstruct small peripheral arterioles. Risk factors include both iatrogenic factors such as intravascular catheterisation, and spontaneous factors for atherosclerosis such as aging, hypertension, dyslipidaemia, and smoking. We describe the case of an 83-year-old Japanese man who developed unilateral, superficial necrosis of the tongue as a result of spontaneous embolisation of cholesterol crystals.



https://ift.tt/2GmSKIk

…why remifentanil?



https://ift.tt/2I81fHV

Different concentrations of mesna application have an effect on the internal ear?

Publication date: June 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): Remzi Dogan, Sabri Baki Eren, Ozge Gedik, Alper Yenıgun, Mehmet Serif Aydın, Busranur Eser, Orhan Ozturan
ObjectiveThe use of Mesna as a chemical dissector in higher concentrations may reduce the length of time of operation by providing more effective dissection as well as being used in otologic pathologies such as tympanosclerosis. In this study, it was aimed to assess the effect of Mesna on the internal ear, which was applied intra-tympanically in higher concentrations than the conventional use.MethodsTwenty-four female rats were included in our study. The rats were randomly divided into three groups (Group 1: Mesna 50%, Group 2: Mesna 100%, Group 3: Saline). At the beginning of the study, DPOAE and ABR measurements were carried out on every rat on days 7 and 14. At the end of the study, cochleas of the rats were excised and histopathological assessments were carried out.ResultsBasal values and DPOAE and ABR values on day 7 and 14 of Group 1, Group 2, and Group 3 were similar to each other. No significant difference was detected among the three groups in the histopathological assessment carried out at the end of the study.ConclusionIt was revealed by audiological and histopathological parameters that the use of Mesna at 50% and 100% concentrations did not create toxicity effects on the internal ear. Mesna would be more effective by being used in higher concentrations in audiological surgeries, that its duration of operation world reduce and could being used in different indications including tympanosclerosis.



https://ift.tt/2GlLYCH

Efficacy of topical 2% mupirocin ointment for treatment of tympanostomy tube otorrhea caused by community-acquired methicillin resistant Staphylococcus aureus

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Publication date: June 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): Hilary Yankey, Glenn Isaacson
ObjectiveTo demonstrate the safety and effectiveness of topical 2% mupirocin ointment as an adjunctive therapy for tympanostomy tube otorrhea (TTO) caused by methicillin-resistant Staphylococcus aureus (MRSA).MethodsWe treated children with community-acquired MRSA TTO by aural suctioning and culture-directed systemic antibiotics (+/− ototopical drops) alone (control group) or with the addition of single 1 ml dose of mupirocin ointment applied to the tube and ear canal (mupirocin group). Patient age, laterality, response to treatment, associate hearing loss, duration of follow-up, and recurrence of infection by MRSA or by other organisms were compared.Results29 children (37 ears) with MRSA TTO were included. 8 children (12 ears) received adjunctive topical mupirocin ointment – 21 children (25 ears) did not. 8 of 12 ears in the mupirocin group received concomitant systemic antibiotics – 4 ears were treated with topical mupirocin alone. The mean duration of follow-up of the mupirocin group was 7 months (with 95% C.I of 7 ± 7). The control group was 24 months (with 95% C.I of 24 ± 9). Recurrence of MRSA TTO in the mupirocin and control groups were 0/12; 0% and 10/25; 40%, by ear, respectively (p = 0.015). Recurrence of non-MRSA TTO in the mupirocin and control groups were 6/12; 50% and 9/25; 36%, by ear, respectively (p = 1.0). There were no sensorineural hearing losses in the mupirocin-treated children.ConclusionIn this small series, a single application of topical mupirocin in combination with mechanical debridement, controlled infection by CA-MRSA without evidence of local reaction or subsequent hearing loss. Its role in treatment of MRSA TTO merits further investigation.



https://ift.tt/2GyuNkV

Deep neck space abscesses in children below 5 years of age and their complications

Publication date: June 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): Avani Jain, Ishwar Singh, Ravi Meher, Anoop Raj, Pragya Rajpurohit, Purodha Prasad
ObjectivesTo study the outcomes and complications of deep neck space abscesses in children less than 5 years of age over a period of 15 years.MethodsA retrospective analysis of children less than 5 years of age with deep neck space abscesses over a 15-year period was conducted at a tertiary care centre in India. Patients were evaluated with respect to the clinical, radiological and laboratory findings. All patients underwent surgical incision and drainage of the abscess and pus cultures were obtained. The incidence of complications was recorded. The collected data was tabulated and statistical analysis was done.ResultsA total of 510 children less than 5 years of age were identified who were admitted for deep neck space abscess over a 15-year period. The mean age was 23.6 months. The most common organism isolated in the pus was Staphylococcus aureus (21%). The incidence of methicillin resistant S. aureus (MRSA) was 9%. Complications were reported in 10% patients.ConclusionPaediatric deep neck abscesses can be managed with prompt surgical management and intravenous antibiotics. Children less than 2 years of age, and those with multiple abscesses or retropharyngeal abscess were more prone to complications.



https://ift.tt/2pN0lZW

'What Are These Bumps I See All Over?'

How would you approach a patient who comes to the primary care clinician with worries about bumps on her buttocks and knees?
Medscape Family Medicine

https://ift.tt/2pzn7nR

Depression Screening in Dermatology—Think Isotretinoin

To the Editor We applaud McDonald et al for publishing "The PHQ-2 in Dermatology—Standardized Screening for Depression and Suicidal Ideation." The importance of this work cannot be overemphasized. We agree that dermatologists are uniquely situated to identify psychiatric concerns related to skin disease, and the PHQ-2 (Patient Health Questionnaire-2) is a great screening tool for this. Since we published on the use of the PHQ-2 in the context of isotretinoin, we have had positive feedback on its use and wish to reemphasize the importance in association with the article by McDonald et al. Additionally, we believe that their algorithmic approach warrants an expansion.

https://ift.tt/2pLWxsG

Rechallenge With Nivolumab After Vemurafenib Treatment of Initially Nivolumab-Resistant Advanced Melanoma

This case report describes a patient with advanced melanoma initially resistant to nivolumab therapy, treated with vemurafenib, and then rechallenged with nivolumab after development of vemurafenib-related adverse effects.

https://ift.tt/2IdQBzx

Paucity of Lesbian, Gay, Bisexual, and Transgender Health-Related Content in the Basic Dermatology Curriculum

This cross-sectional study examines the extent to which an online dermatology curriculum for medical students incorporated lesbian, gay, bisexual, and transgender health-related content.

https://ift.tt/2pIQ1D6

Hair Loss Associated With Cucurbit Poisoning

This case report describes a patient experiencing hair loss following cucurbit poisoning.

https://ift.tt/2GiEssx

Drug Discontinuation, Effectiveness, and Safety in Clinical Trial Eligible vs Ineligible Patients

This observational study examines whether drug discontinuation, effectiveness, and rates of serious adverse events differ in patients with psoriasis being treated with biologics who have been categorized as eligible or ineligible for clinical trials.

https://ift.tt/2pM8peg

Solitary Asymptomatic Tumor in the Axilla

A woman in her 60s presented with a solitary, indolent, erythematous plaque in the right axilla and also reported a slowly growing subcutaneous node with progressive infiltration of the overlying skin. What is your diagnosis?

https://ift.tt/2GlJjcb

Exendin-4 Relieves the Inhibitory Effects of High Glucose on the Proliferation and Osteoblastic Differentiation of Periodontal Ligament Stem Cells

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Publication date: Available online 27 March 2018
Source:Archives of Oral Biology
Author(s): Zijun Guo, Rui Chen, Fujun Zhang, Ming Ding, Ping Wang
BackgroundWith the impaired regenerative potential in patients with diabetes mellitus (DM), Periodontal ligament stem cells(PDLSCs)are regarded as an attractive source of stem cells for periodontal cytotherapy. Recent studies have shown that Exendin-4(Ex-4) exerts cell-protective effects and bone remodeling ability on many types of cells. The aim of this study was to investigate whether Ex-4 alleviates the inhibition of high glucose on the proliferation and osteogenic differentiation of PDLSCs.MethodsPDLSCs were incubated in medium supplemented with 5.5 mM d-glucose (NG), 30 mM d-glucose (HG), NG plus Ex-4, and HG plus different concentration (1,10,20,100 nM) of Ex-4 respectively. Cell proliferation was detected by CCK-8 assay and cell cycle analysis. Osteogenesis was assessed by Alizarin Red S staining and evaluation of the mRNA expression of Runx2, ALP and Osx at day 7, 14 and 21. Intracellular level of reactive oxygen species(ROS) was detected using 5-(and-6)-chloromethyl-2′,7′-dichlorodihydro-fluorescein diacetate (CMH2DCF-DA).ResultsThe proliferation ability, mineralized nodules forming capacity and the mRNA expression of Runx2, ALP and Osx of PDLSCs in HG group were decreased, the ROS level was increased compared to NG group. With the treatment of Ex-4, the HG-inhibited proliferation ability and osteogenic differentiation ability of PDLSCs was significantly reversed, the HG-increased ROS level could be down-regulated. Moreover, Ex-4 enhanced the osteogenic differentiation of normal PDLSCs.ConclusionsEx-4 alleviates the inhibitory effect of HG on the proliferation and osteoblastic differentiation of PDLSCs, and has a significant enhance in the osteoblastic differentiation of normal PDLSCs, giving new insights into the possible therapeutic method of diabetic periodontitis.



https://ift.tt/2GiPG40

Exendin-4 Relieves the Inhibitory Effects of High Glucose on the Proliferation and Osteoblastic Differentiation of Periodontal Ligament Stem Cells

S00039969.gif

Publication date: Available online 27 March 2018
Source:Archives of Oral Biology
Author(s): Zijun Guo, Rui Chen, Fujun Zhang, Ming Ding, Ping Wang
BackgroundWith the impaired regenerative potential in patients with diabetes mellitus (DM), Periodontal ligament stem cells(PDLSCs)are regarded as an attractive source of stem cells for periodontal cytotherapy. Recent studies have shown that Exendin-4(Ex-4) exerts cell-protective effects and bone remodeling ability on many types of cells. The aim of this study was to investigate whether Ex-4 alleviates the inhibition of high glucose on the proliferation and osteogenic differentiation of PDLSCs.MethodsPDLSCs were incubated in medium supplemented with 5.5 mM d-glucose (NG), 30 mM d-glucose (HG), NG plus Ex-4, and HG plus different concentration (1,10,20,100 nM) of Ex-4 respectively. Cell proliferation was detected by CCK-8 assay and cell cycle analysis. Osteogenesis was assessed by Alizarin Red S staining and evaluation of the mRNA expression of Runx2, ALP and Osx at day 7, 14 and 21. Intracellular level of reactive oxygen species(ROS) was detected using 5-(and-6)-chloromethyl-2′,7′-dichlorodihydro-fluorescein diacetate (CMH2DCF-DA).ResultsThe proliferation ability, mineralized nodules forming capacity and the mRNA expression of Runx2, ALP and Osx of PDLSCs in HG group were decreased, the ROS level was increased compared to NG group. With the treatment of Ex-4, the HG-inhibited proliferation ability and osteogenic differentiation ability of PDLSCs was significantly reversed, the HG-increased ROS level could be down-regulated. Moreover, Ex-4 enhanced the osteogenic differentiation of normal PDLSCs.ConclusionsEx-4 alleviates the inhibitory effect of HG on the proliferation and osteoblastic differentiation of PDLSCs, and has a significant enhance in the osteoblastic differentiation of normal PDLSCs, giving new insights into the possible therapeutic method of diabetic periodontitis.



https://ift.tt/2GiPG40

Dysplasie unguéale isolée non syndromique des doigts : mutations homozygotes du gène SLC25A16

Publication date: Available online 28 March 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): O. Dereure




https://ift.tt/2pPxCU7

Plus d’arrêts de l’aprémilast en vie réelle que dans les essais cliniques

Publication date: Available online 28 March 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): J.-L. Schmutz




https://ift.tt/2J06N8I

Angioedema as the presenting feature of systemic lupus erythematosus

A young female in her early 20s presented with low-grade fever for 1 month, puffiness of face and abdominal distension for 15 days. Evaluation revealed pancytopenia with normocellular marrow, hypocomplementaemia and Coomb's positive haemolytic anaemia. She had angioedema with laryngospasm and worsening facial oedema which had dramatic response to steroids. Further workup lead to a diagnosis of systemic lupus erythematosus with neuropsychiatric involvement. Treatment with pulse steroids and cyclophosphamide resulted in dramatic improvement of her symptoms with no recurrence of angioedema during her follow-up visits.



https://ift.tt/2GhOfik

Rare case of cystic artery pseudoaneurysm

A patient with a cystic artery pseudoaneurysm (CAP) presented to the emergency department with upper abdominal and back pain. The patient also had clinical signs of sepsis. CT revealed gallstones with acute suppurative cholecystitis with a gallbladder perforation. In addition, a CAP was also suspected and subsequently diagnosed on CT angiography. The pseudoaneurysm was treated with embolisation and a cholecystostomy was performed for the gallbladder perforation. Following her acute admission, the patient underwent an elective cholecystectomy and made a good recovery post surgery.



https://ift.tt/2pL5cvd

Cortical laminar necrosis in a case of migrainous cerebral infarction

We report a 27-year-old woman, a known case of classical migraine headache, on oral contraceptive pills. She had a severe episode of migraine with visual aura attack, which continued late into the night. The next early morning, her headache persisted and she developed abrupt onset of dysarthria, right hemiparaesthesias. She attributed symptoms to her long-standing headache problem, and hence did not seek medical help for the next two weeks. The symptoms persisted despite her headache subsiding over the next 24 hours. She worsened 2 weeks later during another such episode of headache. This time, she developed right hemiparesis. The patient was admitted with provisional diagnosis of stroke. MRI of the brain showed left temporoparietal lesion and was radiologically compatible with cortical laminar necrosis.Extensive work-up was done to rule out other causes of young stroke. The patient improved with antiplatelets, antimigraine prophylaxis and stroke rehabilitation therapy.



https://ift.tt/2Gh7c4K

Management of a rhegmatogenous retinal detachment in a low-resource setting: treatment options when there is no vitreoretinal surgeon

We discuss the case of a 49-year-old soldier with a macula-on rhegmatogenous retinal detachment in Sierra Leone. The case highlights the challenge of accessing visually preserving ophthalmic specialist care in sub-Saharan Africa (SSA) for vitreoretinal (VR) disease. It highlights a shortage of VR surgeons in SSA, limited examination facilities, the larger issue of accessing specialist care urgently and the costs associated with accessing surgery out-of-country. It also identifies a shortage in epidemiological data on the issue which limits the assessment of the scale of the problem.



https://ift.tt/2pLMT9u

Sodium nitroprusside, a lifesaving treatment for neonatal hypertension: an Irish experience

We present a 30+2-weeks-old (30 weeks and 2 days) male, twin 1, born by emergency caesarean section due to twin-twin transfusion syndrome (absent end-diastolic flow and cardiac anomaly in twin 2) presenting with hypertensive crisis on day 3. He was already on milrinone and propranolol. His echocardiogram showed poor left ventricular contractility and after cardiology consultation received sodium nitroprusside, which eventually saved his life by decreasing his blood pressure and improving cardiac function. As sodium nitroprusside is very rarely used for hypertensive crisis in neonates, we would like to share our experiences on dosage, challenges in administration due to its fast onset of action, criteria for monitoring for complications and finally weaning. Baby developed severe bilateral periventricular leukomalacia as a potential complication of hypertensive crisis, preceded by bilateral periventricular flare secondary to twin-twin transfusion.



https://ift.tt/2Gh75WS

Gestational gigantomastia with spontaneous resolution in an Indian woman

We present the case of a 20-year-old woman, primigravida with 24 weeks of amenorrhoea due to pregnancy. She came with symptoms of rapidly increasing size of both the breasts since 8 weeks. On examination, both breasts were grossly enlarged, right more than left, with the level of the nipples reaching beyond the level of the umbilicus. Breast circumference was measured to be 72 cm on the right, and left breast was 66 cm. No palpable lumps in both breasts. No axillary lymphadenopathy noted. Hormonal studies were found to be within the normal range. The pregnancy was terminated due to pre-eclampsia. The patient opted for regular follow-up and observation. While regularly following up, the size of both breasts was observed to gradually reduce to a circumference of 40 cm on the right and 30 cm on the left.



https://ift.tt/2pKost8

Fulminant hepatic failure in the setting of progressive ANCA-associated vasculitis associated with a rare alpha-1 antitrypsin phenotype, PiEE'

Abnormalities in alpha-1 antitrypsin (AAT) proteins are risk factors for human disease. While the most common is AAT deficiency, a genetic disorder associated with chronic obstructive pulmonary disease, additional disorders associated with AAT abnormalities are increasingly recognised. We describe a middle-aged woman who presented with fulminant hepatic and multiorgan failure. Evaluation revealed the patient to have a rare AAT phenotype PiEE. Her clinical presentation was consistent with antineutrophilic cytoplasmic antibody-associated vasculitis, and her history suggested features of panniculitis. This is the first description of this rare homozygous AAT phenotype and possible disease associations with the 'E' protein. Given that abnormal AAT are under-recognised, and that new mutations and phenotypes continue to be identified, we will need to expand on our knowledge base and report clinical manifestations associated with these abnormal phenotypes.



https://ift.tt/2E1M9B6

Purpura fulminans causing acute cortical necrosis in postpartum period

Description

A 22-year-old woman underwent normal vaginal delivery; 3 days later, she developed fever and rashes over all four limbs followed by decreased urine output. Examination revealed pedal oedema, non-palpable purpuric lesions over extremities with erosions at few places, and blackish discolouration of second and third toe of right foot (figure 1A). On investigation, haemoglobin was 6.7 g/dL, white blood cell 26 200/mm3, platelet 39 000/mm3, prothrombin time 25 s (control 12–14 s), activated thromboplastin time 38 s (control 24–30 s) and serum creatinine 9.1 mg/dL. Urine showed albumin 1+. Ultrasound was suggestive of bilateral acute renal parenchymal disease. Work-up for tropical infections was negative. Clinical diagnosis of puerperal sepsis causing purpura fulminans and acute kidney injury was made.

Figure 1

Clinical photograph showing multiple non-palpable purpuric lesions over extremities with erosions at few places and blackish discolouration of toes (A). CT scan of abdomen showing acute bilateral renal cortical necrosis (B).

...

https://ift.tt/2pLMx2E

Localisation of ectopic mediastinal parathyroid adenoma by 18F-fluorocholine PET/CT

We report the case of two patients with newly diagnosed primary hyperparathyroidism: a 40-year-old woman during pregnancy and a 60-year-old man with initial hypercalcaemic crisis. In the first case, a bilateral neck exploration with parathyroidectomy during the second trimester of pregnancy was unsuccessful and the patient remained hypercalcaemic. Postpartum imaging assessment with technetium (99mTc)-sestamibi scintigraphy could not supply conclusive diagnostic results. The use of 18F-fluorocholine (FCH) positron emission tomography (PET)/CT provided the accurate localisation of an ectopic parathyroid adenoma in the anterior mediastinum which was successfully resected by a thoracoscopic approach. In the second case, 99mTc-sestamibi scintigraphy was inconclusive as well and FCH-PET/CT localised an ectopic parathyroid adenoma in the mediastinum and thus bilateral neck exploration could be spared. Both patients had surgical cure of their disease.



https://ift.tt/2E1JffR

Aural foreign body in situ for 9 years mimicking impacted wax

Description

An 11-year-old girl presented following a long-standing history of unilateral tinnitus, aural fullness and discomfort. She had seen multiple primary care doctors and repeatedly been diagnosed with unilaterally impacted wax. While on holiday in Bali she unfortunately suffered from tonsillitis and received a full ear, nose and throat (ENT) examination. A wax-coloured bead was identified in her external auditory canal (figures 1 and 2). On return to the UK she attended our ENT outpatient department for an uneventful removal of the foreign body under general anaesthetic.

Figure 1

View of foreign body in situ mimicking impacted wax.

Figure 2

Foreign body following removal.

On reflection, the child's mother recalled witnessing the child placing the bead in her ear at the age of 2. Fortunately, due to the inert nature of this...



https://ift.tt/2pLMiVi

Artery of Percheron: an unusual stroke presentation

An 86-year-old woman was admitted with multiple episodes of transient loss of consciousness. She was initially treated for seizures, and stroke was not considered likely. MRI on the same day of admission showed acute bilateral medial thalamic infarcts in keeping with the Artery of Percheron (AOP) territory infarcts. Investigation for polycythaemia and thrombocytosis showed JAK2 positive myeloproliferative neoplasm.

A diagnosis of AOP infarction is often missed or delayed because it is rare and presents with variable neurological symptoms. Initial imaging in the form of CT is often negative, and some report that initial MRI findings may also be normal.An awareness of a wide range of differential diagnoses alongside a multi-modality imaging approach is required to reach a diagnosis.

Although there are several other case reports of AOP infarction in the literature, this is the first to present with transient symptoms initially mistaken for seizure activity.



https://ift.tt/2Gk8VX2

Trauma-induced adiposis dolorosa (Dercums disease)

We present a case of a 39-year-old man who presented with chronic bilateral upper extremity pain associated with innumerable angiomyolipomas that developed 5 years after a motor vehicle accident involving his upper extremities. Our case notes the rare nature of painful adipose tissue deposits and the diagnostic challenges.



https://ift.tt/2pLLGPu

Hypoglossal nerve stimulation for obstructive sleep apnoea in a patient with previous tongue laceration

Upper airway stimulation of the tongue using an implantable neurostimulator has recently been approved for select patients with moderate to severe obstructive sleep apnoea (OSA) and intolerance to continuous positive airway pressure therapy. Effective implantation depends on the integrity of the hypoglossal nerve as well as the tongue musculature, notably the genioglossus. Prior trauma to either of these structures may be viewed as a relative contraindication to implantation. We describe a case of successful right hypoglossal nerve implantation in a patient with a history of left cardiac pacemaker placement and severe left penetrating tongue trauma with decreased mobility from contracture and deviation mimicking a hypoglossal nerve palsy. Preoperative and postoperative apnoea–hypopnoea index values were 52/hour and 5/hour, respectively. Prior soft tissue trauma to the tongue may not necessarily preclude surgical candidacy for upper airway stimulation in patients with OSA.



https://ift.tt/2E1IZgT

Diagnostic dilemma: think about anterior cutaneous nerve entrapment syndrome (ACNES) in patients with atypical abdominal pain and Crohns disease

Chronic abdominal pain can be a difficult diagnostic dilemma. Anterior cutaneous nerve entrapment syndrome (ACNES) is a potential differential diagnosis that should be considered because treatment is both easy and effective. We describe the case of a 51-year-old man presenting with 7 months of right lower quadrant abdominal pain on the background of known Crohn's disease. A circumspect surgical approach and multidisciplinary input was key to making the diagnosis of a nerve entrapment syndrome.



https://ift.tt/2pLLsI8

Spondylodiscitis in a 54-year-old female scuba diver

A 54-year-old woman presented to a Sports Physician with a 4-year history of haemochromatosis, and she had a medical history that included a congenital spondylolisthesis resulting in a fusion of L4-S1 at age 16 years, episodic mechanical low back pain and an absence of other significant musculoskeletal symptoms. On presentation, she reported 18 months of severe low back pain that started after a scuba diving trip. After the onset of this low back pain, she developed gastrointestinal symptoms from Salmonella. The gastrointestinal symptoms improved with a course of antibiotics, but the back pain persisted in spite of analgesics, non-steroidal anti-inflammatories and several attempts at different conservative management. CT imaging ordered by the Sports Physician demonstrated an erosive spondylodiscitis of L2/3 that was not present on initial investigations. However, even in the presence of significant bony changes, the patient was successfully treated with targeted conservative therapy.



https://ift.tt/2GhLzBl

Giant coronary artery aneurysms in a 12-week-old infant with incomplete Kawasaki disease

Kawasaki disease (KD) is an acute inflammatory vasculitis that occurs worldwide and disproportionately affects male children, most commonly between the ages of 6 months and 5 years. KD can present with only a few features and thus be difficult to diagnose, particularly in the youngest and oldest patients. We describe a 12-week-old Caucasian female infant who presented with rash and fever but no other features of KD, who developed giant coronary artery aneurysms. Considering how common is the presentation of a febrile infant with a rash, this case highlights the importance of considering KD early in the differential diagnosis for any infant with unexplained fever. Furthermore, it emphasises how echocardiography can help in the investigation of a febrile child with no clear source of infection.



https://ift.tt/2pLLkIE

Metastatic pheochromocytoma in MEN 2A: A rare association

A 45-year-old woman was diagnosed as having multiple endocrine neoplasia type 2A in 2014. She had bilateral pheochromocytoma, medullary thyroid carcinoma and biopsy-proven cutaneous lichen amyloidosis in the interscapular area. She underwent bilateral adrenalectomy; following which, she achieved clinical and biochemical remission. She was planned for total thyroidectomy at a later date; however, she was lost to follow-up. She presented to us again in December 2016 with abdominal pain. Examination revealed hypertension with postural drop. Positron emission tomography scan showed Ga68 and fluorodeoxyglucose (FDG)-avid suprarenal, hepatic, peritoneal and mesenteric masses with abdominal lymph nodes. Twenty-four-hour urinary metanephrines/normetanephrines were elevated. Serum calcitonin was as high as it was 2-1/2 years ago. Ultrasonography-guided fine-needle aspiration cytology (FNAC) from the liver mass revealed neuroendocrine cells that did not stain for calcitonin. Hence, a diagnosis of metastatic pheochromocytoma was made. She underwent total thyroidectomy and was started on cyclophosphamide, vincristine, dacarbazine-based chemotherapy regimen.



https://ift.tt/2E1IEuD

Drug-induced movement disorder and confusion associated with duloxetine

A 60-year-old woman with major depressive disorder, developed high blood pressure, confusion and dyskinesias of face, neck and jaw, following an increase in her dose of duloxetine. Routine blood tests including toxic, infective and metabolic workup were unremarkable. Cerebrospinal fluid analysis and electroencephalogram were also normal. MRI brain showed bilaterally symmetrical diffusion-restricted areas in deep cerebral white matter. Duloxetine was held on suspicion of drug adverse effect. She had complete resolution of symptoms within 48 hours and resolution of MRI brain changes over 6 weeks. Serotonin norepinephrine reuptake inhibitors such as duloxetine may have the potential to cause drug-induced movement disorders, confusion and high blood pressure and should be used cautiously especially in elderly.



https://ift.tt/2pLLWOs

Burn aggravated infected wart in a patient with type 2 diabetes: a medical challenge

An infectious wart of foot in a patient with diabetics is a medical challenge, and it gets worse when aggravated with burns. We present a case of a 67-year-old Pakistani man, diabetic for 20 years presented at our healthcare centre. While awaiting his culture sensitivity report, he was prescribed an empiric antibiotic therapy. Patient then travelled to Saudi Arabia for pilgrimage 3 days later with growth of Staphylococcus aureus and Proteus species in culture and sensitivity report; during his travel, he walked barefoot and the infected wart aggravated with severe burn. Patient continued empiric treatment for 14 days. On his arrival, infected wart worsened with dead burnt skin, heavy purulent discharge on plantar region. X-rays revealed marked arthritic changes. Cefepime 500 mg three times a day intravenously was initiated following wound debridement. Patient was switched to moxifloxacin 400 mg once daily postoperatively for 7 days until completely healed.



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De Garengeots hernia: a rare presentation of the wandering appendix

A hernia is defined as a protrusion of an organ or its fascia through a sac of its containing cavity. The presentation of an inflamed appendix inside an incarcerated femoral hernia is termed de Garengeot's hernia. Almost exclusively seen in the female patient, this type of hernia like all others can undergo strangulation leading to complications including appendicitis with or without perforation. Management as described in literature usually comprises open or laparoscopic approach, followed by appendectomy and repair of the femoral hernia with or without mesh. We describe a case of a female patient who presented with an irreducible groin swelling, found to have a femoral hernia containing the inflamed appendix intraoperatively and how it was managed surgically through a laparoscopic approach with a small mesh and closure of defect. Literature review on this rare form of hernia is discussed thereafter.



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Squamous Cell Papillomatosis in the Setting of Recurrent Respiratory Papillomatosis

Abstract

A 23 year old male presented to the Otolaryngology clinic with 6 months of hoarseness and poor voice projection without improvement from speech therapy or medical anti-reflux medication. Upon examination he was found to have multiple polypoid lesions emanating from bilateral false vocal folds, left true vocal fold, and the anterior commissure. Biopsy and potassium titanyl phosphate (KTP) laser ablation with bevacizumab injection provided treatment and confirmed the clinical suspicion of squamous cell papilloma. Despite 3 years of treatment, the papillomatosis proved difficult to control, requiring a procedure approximately every 3 months. In an attempt to control the course of the disease the patient received a series of three bevacizumab and three cidofovir injections. Serial biopsies showed mild atypia within the squamous cell papillomas. Two separate biopsies confirmed presence of human papillomavirus (HPV) 6/11 via in situ hybridization with appropriate controls. There is promising research that the quadrivalent HPV (types 6, 11, 16, and 18) vaccine both reduces the disease burden in patients with active disease and reduces the incidence of recurrent respiratory papillomatosis (RRP). Other studies have shown that local immunologic dysregulation may play a role in RRP pathogenesis. Therefore new treatment options, to include PDL-1 blockade, offer hope in treating this benign condition with high morbidity and rare mortality.



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Proof of concept: liver splitting during normothermic machine perfusion

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Abstract
Introduction
Despite utilizing extended criteria donors, there remains a shortage of livers for transplantation. No data exists on splitting donor livers with concurrent NMP-L.
Methods
A liver recovered from a donor after circulatory death was subjected to NMP-L using a red cell based fluid. During NMP-L, a 'classical' left lateral + right trisegmentectomy split was performed using an integrated bipolar/ultrasonic device. After splitting, blood flow was confirmed using Doppler ultrasound in each lobe.
Results
Prior to splitting, flow rates were maintained physiologically. Lactate decreased from 13.9 to 3.0 mmol/L. Lactate before and after splitting were similar in the hepatic arteries, portal veins and IVC. Doppler ultrasound demonstrated arterial and venous waveforms in both lobes after splitting.
Conclusions
'Classical' liver splitting during NMP-L is feasible, maintaining viability of both lobes. Establishing this procedure may attenuate cold ischaemic injury, allow pre-implantation monitoring of both grafts and facilitate logistics of transplanting two grafts.

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The use of magnetically controlled growing rods in paediatric Osteogenesis Imperfecta with early onset, progressive scoliosis

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Abstract
Osteogenesis Imperfecta (OI) is a condition of bone fragility and can present with early onset scoliosis that can cause respiratory complications in later life. The fear of instrumenting the spine in OI is the possibility of fracture either on primary insertion or subsequent lengthening. Magnetically controlled growing rods were inserted to control a scoliosis in a 6-year old with OI type IV. Fixation was obtained using pedicle screws proximally and distally with sublaminar bands around the ribs proximally. These rods have been remotely lengthened on multiple occasions over a 2-year period. This has controlled the scoliosis whilst also allowing the spine to grow. There are no complications to report. This case reports the use of magnetically controlled growth rods used to manage early onset scoliosis in OI. Frequent lengthening, achieving small increases in length on every occasion protects against the risk of fracture during the lengthening procedure.

https://ift.tt/2J1J2gD

Food ileus secondary to citrus fruit associated with a Meckel’s diverticulum: a case report and review of the literature

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Abstract
The case of an 11-year-old boy with an orange-associated ileus in the setting of a mesodiverticular band from a Meckel's diverticulum is reported herein. Computed tomography showed a small bowel feces sign. He underwent laparoscopic-assisted surgery, and intraoperative findings revealed a Meckel's diverticulum associated with a mesodiverticular band distal to dilated small bowel. After resection of the Meckel's diverticulum and inspection of the intestinal contents proximal to the obstruction, it was apparent that undigested food material was impacted proximal to the obstruction. Upon questioning postoperatively, it was revealed that the patient ate two citrus fruits with locular membranes several days prior to his clinical presentation. It was speculated that the combination of the citrus fruit impaction with the Meckel's band led to his obstruction. He was discharged uneventfully on postoperative Day 13. It is important to avoid eating large quantities of fruit rich in fiber and also to masticate well.

https://ift.tt/2pLJSoT

Combined Surgical Approach for Obstructive Sleep Apnea Patient

Obstructive sleep apnea (OSA) is a disease that is associated with high morbidity and mortality and can significantly impact the quality of life in a patient. OSA is strongly associated with obesity, and literature showed that weight loss will lead to improvement in OSA. The gold standard treatment for OSA is continuous positive airway pressure (CPAP). However, other methods of treatment are available. One of these methods is multilevel sleep surgery (MLS). Literature showed that bariatric surgery can also improve OSA. A common question is which surgical procedure of these two should be performed first. We present a 5-year follow-up of a patient who underwent simultaneously bariatric surgery and MLS. His apnea-hypopnea index (AHI) decreased from 53 episodes per hour to 5.2 per hour within the first 18 months, which was measured via a level 3 polysomnography. Five years after the surgery, a repeat level 3 polysomnography showed an AHI of 6.8 episodes per hour, and the patient is asymptomatic. The patient maintained his weight and did not use CPAP after the combined surgery during the five-year period.

https://ift.tt/2E1ZM3o

Squamous Cell Papillomatosis in the Setting of Recurrent Respiratory Papillomatosis

Abstract

A 23 year old male presented to the Otolaryngology clinic with 6 months of hoarseness and poor voice projection without improvement from speech therapy or medical anti-reflux medication. Upon examination he was found to have multiple polypoid lesions emanating from bilateral false vocal folds, left true vocal fold, and the anterior commissure. Biopsy and potassium titanyl phosphate (KTP) laser ablation with bevacizumab injection provided treatment and confirmed the clinical suspicion of squamous cell papilloma. Despite 3 years of treatment, the papillomatosis proved difficult to control, requiring a procedure approximately every 3 months. In an attempt to control the course of the disease the patient received a series of three bevacizumab and three cidofovir injections. Serial biopsies showed mild atypia within the squamous cell papillomas. Two separate biopsies confirmed presence of human papillomavirus (HPV) 6/11 via in situ hybridization with appropriate controls. There is promising research that the quadrivalent HPV (types 6, 11, 16, and 18) vaccine both reduces the disease burden in patients with active disease and reduces the incidence of recurrent respiratory papillomatosis (RRP). Other studies have shown that local immunologic dysregulation may play a role in RRP pathogenesis. Therefore new treatment options, to include PDL-1 blockade, offer hope in treating this benign condition with high morbidity and rare mortality.



https://ift.tt/2GekMKh

Squamous Cell Papillomatosis in the Setting of Recurrent Respiratory Papillomatosis

Abstract

A 23 year old male presented to the Otolaryngology clinic with 6 months of hoarseness and poor voice projection without improvement from speech therapy or medical anti-reflux medication. Upon examination he was found to have multiple polypoid lesions emanating from bilateral false vocal folds, left true vocal fold, and the anterior commissure. Biopsy and potassium titanyl phosphate (KTP) laser ablation with bevacizumab injection provided treatment and confirmed the clinical suspicion of squamous cell papilloma. Despite 3 years of treatment, the papillomatosis proved difficult to control, requiring a procedure approximately every 3 months. In an attempt to control the course of the disease the patient received a series of three bevacizumab and three cidofovir injections. Serial biopsies showed mild atypia within the squamous cell papillomas. Two separate biopsies confirmed presence of human papillomavirus (HPV) 6/11 via in situ hybridization with appropriate controls. There is promising research that the quadrivalent HPV (types 6, 11, 16, and 18) vaccine both reduces the disease burden in patients with active disease and reduces the incidence of recurrent respiratory papillomatosis (RRP). Other studies have shown that local immunologic dysregulation may play a role in RRP pathogenesis. Therefore new treatment options, to include PDL-1 blockade, offer hope in treating this benign condition with high morbidity and rare mortality.



https://ift.tt/2GekMKh

Role of IL-1β, IL-6 and TNF-α cytokines and TNF-α promoter variability in Plasmodium vivax infection during pregnancy in endemic population of Jharkhand, India

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Publication date: May 2018
Source:Molecular Immunology, Volume 97
Author(s): Krishn Pratap Singh, Shayan Shakeel, Namrata Naskar, Aakanksha Bharti, Asha Kaul, Shadab Anwar, Shweta Kumari, Amod Kumar, Jiv Kant Singh, Nutan Kumari, Birendra Kumar Gupta, Purwa Manna, Vishwaprakash Roy, Sneh Lata, Om P. Singh, Manoranjan Prasad Sinha, Ajay Kumar Sharma, Mohammad Sohail
BackgroundThe combinatorial effects of Plasmodium infection, perturbation of inflammatory responses and the dichotomic role of TNF promoter polymorphism has potential clinical and physiological relevance during pregnancy.Objective and MethodsThis coordinated orchestration instigated us to investigate the circulating level of inflammatory cytokines (IL-1β, TNF-α and IL-6) employing ELISA in a stratified group of samples and the plausible genetic association of TNF-α −308 G/A using PCR-RFLP/sequencing during Plasmodium vivax infection in pregnancy.ResultsWe observed significantly elevated concentrations of IL-1β were observed, followed by IL-6 and TNF-α in women with malaria (WWM) and in malaria in pregnancy (MIP). Further, elevated IL-1β, followed by TNF-α and IL-6 were detected in the non-infected pregnancy group. The differential dynamics of inflammatory cytokine concentration during each trimester of pregnancy with and without P. vivax infection were detected. For the first time, a high level of IL-6 was observed in the first trimester of MIP and high IL-1β in healthy pregnancies. In the second trimester, however, we observed a high level of IL-1β in the MIP group compared to a sustained high level of IL-1β in the healthy pregnancy group. In the third trimester, high IL-1β was sustained in the MIP group and healthy pregnancies acquired a high TNF-α level. The genotypic distribution for the TNF-α promoter −308 G/A position was observed to be nonsignificant and mildly associated during MIP (OR = 1.4) and in WWM (OR = 1.2). Moreover, based on genotypic distribution, we observed a well-correlated and significantly elevated TNF-α concentration in the mutant homozygote genotype (AA; p = 0.001) followed by heterozygotes (GA; p = 0.0001) and ancestral genotypes (GG; p = 0.0001) in both MIP and WWM subjects.ConclusionThe observation of elevated IL-1β and IL-6 in MIP and TNF-α in WWM may be regarded as a prognostic inflammatory marker of infection and pregnancy. Most particularly, the TNF-α concentration and its polymorphic variability in the promoter region may indicate genetic susceptibility and mildly influence the risk for P. vivax infection during pregnancy and in women with malaria.



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IgE and T-cell responses to house dust mite allergen components

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Publication date: Available online 28 March 2018
Source:Molecular Immunology
Author(s): Wayne R. Thomas
Using the terminology for Dermatophagoides pteronyssinus, IgE responses to house dust mites have been shown to be mostly directed to the serodominant Der p 1, 2 and 23 allergen components with mid -tier responses to Der p 4, 5, 7 and 21 that are made by 30–50% of subjects with titers proportional to those of the serodominant specificities. This pattern can be seen to evolve in childhood and although responses to minor allergens appear to contribute little to the total IgE they are at least markers for a greater propensity to develop disease. While Der p 23 is a component that induces prevalent IgE responses, sometimes in the absence of responses to Der p 1and 2, not all studies have found high titers so further investigation is needed. From limited knowledge adult onset IgE responses might have a different pattern that is not so centered on Der p 1 and 2. Responses that induce under 3.5 IU/ml of IgE antibody are not usually associated with disease and should be examined for cross reactivity expected from IgE responses to other allergens and antigens of infectious agents. Scabies that has 40% endemicity in some regions and is spread by immigration can give rise to high-titer binding that can be recognized by component resolved diagnosis. Recent studies with synthetic peptides representing allergens and non-allergenic HDM proteins now offer new research avenues on HDM induced immune responses, including the ability to use peptides representing the serodominant allergens as defined reagents for long overdue reproducible T-cell investigations.



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A Novel Device for Placement of a Secondary Tracheoesophageal Voice Prosthesis: A Preliminary Feasibility Study

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Background: Tracheoesophageal puncture (TEP) for post-laryngectomy speech rehabilitation can be performed at the time of laryngectomy (primary) or at a subsequent time (secondary). Traditionally, the secondary procedure is performed using a rigid esophagoscope. Diseases like esophageal stricture, limited neck extension, and soft-tissue fibrosis can make this procedure technically challenging or impossible. We developed a novel device to perform a secondary tracheoesophageal puncture using a flexible esophagoscope. Objective: To test the feasibility of a novel device used to create a secondary TEP in post-laryngectomy cadavers. Methods: In this study, we performed a total laryngectomy on 3 fresh cadavers to establish the feasibility of our prototype. In each cadaver, a flexible esophagoscope was passed into the pharynx with the prototype. The prototype was passed through a working port and deployed to distend the esophagus. The puncture was visualized and a wire was passed via the newly established fistula. The device was activated, securing the wire, and then the esophagoscope and device were removed. Results: There was 100% successful deployment of the prototype device, allowing rapid creation of the puncture and security of the guide wire in each cadaver. There was no evidence of collateral mucosal injury or esophageal perforation. Conclusions: The prototype device offers an alternative method to safely and efficiently perform a secondary TEP without the requirement of rigid esophagoscopy which can sometimes be technically impossible in this patient population.
ORL 2018;80:36–40

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Topical Corticosteroid-Resolved Rubeosis Iridis with Neovascular Glaucoma Caused by Noninfectious Granulomatous Uveitis

Purpose: We report a case of topical corticosteroid treatment-resolved rubeosis iridis with neovascular glaucoma (NVG) caused by noninfectious granulomatous uveitis. Case Report: A 61-year-old woman with left ocular pain and blurred vision was referred to our department. Visual acuity and intraocular pressure (IOP) were 20/60 and 37 mm Hg in the left eye, respectively. Inflammatory cells, hyphema, and rubeosis iridis were observed. All laboratory tests, including multiplex polymerase chain reaction for infection using aqueous humor, were negative, and there was neither retinal occlusive vasculitis nor retinal ischemia in the fundus. Our diagnosis was noninfectious granulomatous anterior uveitis-associated NVG. Topical corticosteroid treatment and anti-glaucoma agents resolved inflammation, rubeosis iridis, and NVG. IOP had decreased to 13 mm Hg by 1 month of treatment, and no recurrence was observed. Conclusion: Topical corticosteroid could resolve rubeosis iridis and NVG in an eye with noninfectious anterior uveitis. The pathogenesis of NVG in eyes with uveitis is still unknown, but inflammation might have a part in angiogenesis. Anti-inflammatory treatment can be selected as the first choice for anterior uveitis-associated NVG.
Case Rep Ophthalmol 2018;9:243–247

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A Rare Incidental Finding of a Foreign Body in the Nasopharynx during Adenotonsillectomy

Diverse foreign bodies may become lodged in the aerodigestive tract, and the discovery of such foreign bodies is an expected scenario for health-care practitioners. The foreign body insertion may be accidental or deliberate, and the object may be organic or inorganic. Most accidental foreign body aspirations occur in children, and some such cases are potential threats that go unnoticed. Very few cases of foreign bodies in the nasopharynx have been reported. Herein, we describe an unusual case in which a foreign body in a child's nasopharynx went unnoticed for 1 year and was detected intraoperatively.

https://ift.tt/2ux7MKo

Extracellular vesicle-mediated MHC cross-dressing in immune homeostasis, transplantation, infectious diseases, and cancer

Abstract

Eukaryotic cells employ different types of extracellular vesicles (EVs) to exchange proteins, mRNAs, non-coding regulatory RNAs, carbohydrates, and lipids. Cells of the immune system, in particular antigen (Ag)-presenting cells (APCs), acquire major histocompatibility complex (MHC) class I and II molecules loaded with antigenic peptides from leukocytes and tissue parenchymal and stromal cells, through a mechanism known as MHC cross-dressing. Increasing evidence indicates that cross-dressing of APCs with pre-formed Ag-peptide/MHC complexes (pMHCs) is mediated via passage of clusters of EVs with characteristics of exosomes. A percentage of the transferred EVs remain attached to the acceptor APCs, with the appropriate orientation, at sufficient concentration within localized areas of the plasma membrane, and for sufficient time, so the preformed pMHCs carried by the EVs are presented without further processing, to cognate T cells. Although its biological relevance is not fully understood, numerous studies have demonstrated that MHC cross-dressing of APCs represents a pathway of Ag presentation of acquired pre-formed pMHCs to T cells—alternative to direct and cross-presentation—participate in immune homeostasis and T cell tolerance, cross-regulate alloreactive T cells with different MHC restricted specificities, and is a mechanism of Ag spreading for autologous, allogeneic, microbial, tumor, or vaccine-delivered Ags. Here, we compare MHC cross-dressing with other mechanisms and terminologies used for pMHC transfer, including trogocytosis. We discuss the experimental evidence, mostly from in vitro and ex vivo studies, of the role of MHC cross-dressing of APCs via EVs in positive or negative regulation of T cell immunity in the steady state, transplantation, microbial diseases, and cancer.



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Data-Driven prioritisation of antibody-drug conjugate targets in head and neck squamous cell carcinoma

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Publication date: May 2018
Source:Oral Oncology, Volume 80
Author(s): Saskia H. Hanemaaijer, Stephanie E. van Gijn, Sjoukje F. Oosting, Boudewijn E.C. Plaat, Kirsten L. Moek, Ed M. Schuuring, Bernard F.A.M. van der Laan, Jan L.N. Roodenburg, Marcel A.T.M. van Vugt, Bert van der Vegt, Rudolf S.N. Fehrmann
BackgroundFor patients with recurrent or metastatic head and neck squamous cell carcinoma (HNSCC) palliative treatment options that improve overall survival are limited. The prognosis in this group remains poor and there is an unmet need for new therapeutic options. An emerging class of therapeutics, targeting tumor-specific antigens, are antibodies bound to a cytotoxic agent, known as antibody-drug conjugates (ADCs). The aim of this study was to prioritize ADC targets in HNSCC.MethodsWith a systematic search, we identified 55 different ADC targets currently targeted by registered ADCs and ADCs under clinical evaluation. For these 55 ADC targets, protein overexpression was predicted in a dataset containing 344 HNSCC mRNA expression profiles by using a method called functional genomic mRNA profiling. The ADC target with the highest predicted overexpression was validated by performing immunohistochemistry (IHC) on an independent tissue microarray containing 414 HNSCC tumors.ResultsThe predicted top 5 overexpressed ADC targets in HNSCC were: glycoprotein nmb (GPNMB), SLIT and NTRK-like family member 6, epidermal growth factor receptor, CD74 and CD44. IHC validation showed combined cytoplasmic and membranous GPNMB protein expression in 92.0% of the cases. Strong expression was seen in 65.9% of the cases. In addition, 86.5% and 67.7% of cases showed ≥5% and >25% GPNMB positive tumor cells, respectively.ConclusionsThis study provides a data-driven prioritization of ADCs targets that will facilitate clinicians and drug developers in deciding which ADC should be taken for further clinical evaluation in HNSCC. This might help to improve disease outcome of HNSCC patients.



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Locally advanced squamous cell carcinoma of the head and neck: A systematic review and Bayesian network meta-analysis of the currently available treatment options

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Publication date: May 2018
Source:Oral Oncology, Volume 80
Author(s): Oreste Iocca, Alessio Farcomeni, Arianna Di Rocco, Pasquale Di Maio, Paweł Golusinski, Simón Pardiñas López, Alfredo Savo, Raul Pellini, Giuseppe Spriano
BackgroundThere are still many unresolved questions in the management of locally advanced Head and Neck Cancer (HNC). Many chemotherapeutic drugs and radiotherapy fractionation schemes are available and not all have been evaluated in head-to-head clinical trials. This systematic review and Bayesian network meta-analysis aims to compare the available treatment strategies and chemotherapeutic options for locally advanced HNC.MethodsWe performed a search on bibliography databases, trials registries and meetings proceedings for published and unpublished randomized trials from January 1st 2000 to December 1st 2017. Trials had to compare systemic interventions and radiotherapy (RT) approaches for locally advanced, non-metastatic HNC. Trials recruiting patients whose surgery was the first treatment option, sample size less than 20 per arm or that did not use randomization for treatment allocation were excluded from the analysis. Summary estimates on Overall survival (OS), Progression-free survival (PFS) and toxicity outcomes (grade 3–4 mucositis and neutropenia) were extracted from the included studies on a predefined database sheet. Bias was assessed through the Chocrane risk of bias assessment tool. We performed a set of pair-wise meta-analyses using a random effect model. We also performed a random effect network meta-analysis under a Bayesian framework.FindingsFrom the 57 included trials, including 15,723 patients, was possible to conduct analysis on 26 treatments for OS, 22 treatments for PFS and 10 treatments for toxicity. In terms of OS Concurrent chemoradiotherapy (CCRT) with cisplatin (HR 0.70, 95% CrI [credible interval] 0.62–0.78) and cetuximab on top of CCRT (HR 0.7, 95% CrI 0.5–0.97) are clearly superior to conventional RT alone. Induction chemotherapy (IC) with cisplatin and fluorouracil (HR 0.74, 95% CrI 0.52–0.95), IC with docetaxel, cisplatin, fluorouracil (HR 0.55, 95% CrI 0.54–0.89) and IC with paclitaxel, cisplatin, fluorouracil (HR 0.55, 95% CrI 0.34–0.89) before CCRT are all superior to conventional RT. CCRT with cisplatin is also superior to altered fractionation RT (HR 0.74, 95% CrI 0.64–0.84). Altered fractionation RT is not superior to conventional RT (HR 0.95, 95% CrI 0.85–1.06). Regarding PFS, CCRT with cisplatin (HR 0.72, 95% CrI 0.63–0.83), cisplatin and fluorouracil (HR 0.67, 95% CrI 0.5–0.88), carboplatin (HR 0.63, 95% CrI 0.46–0.87), carboplatin and fluorouracil (HR 0.75, 95% CrI 0.56–1), IC with cisplatin and fluorouracil (HR 0.59, 95% CrI 0.45–0.78), IC with docetaxel, cisplatin and fluorouracil (HR 0.53, 95% CrI 0.41–0.68) and IC with paclitaxel, cisplatin and fluorouracil (HR 0.59, 95% CrI 0.35–0.99) are superior to conventional RT and altered fractionation RT. IC with docetaxel, cisplatin and fluorouracil shows a significant superiority against CCRT with cisplatin (HR 0.73 95% CrI 0.58–0.92). Altered fractionation RT is not superior to conventional RT (HR 0.91, 95% CrI 0.81–1.02).Altered fractionation increases the risk of developing grade 3–4 mucositis compared to conventional RT (OR 3.74 95% 1.64–8.67)InterpretationCCRT with cisplatin remains the gold standard of treatment. Taxane based IC regimens may have a impact on locally advanced disease. Altered fractionation RT is inferior to CCRT and also does not seem to be meaningfully better than conventionally fractionated RT alone. Its role in locally advanced disease should be reevaluated.



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Editorial Board/Aims & Scope

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Publication date: April 2018
Source:Oral Oncology, Volume 79





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Detection of the Merkel cell polyomavirus in the neuroendocrine component of combined Merkel cell carcinoma

Abstract

Merkel cell carcinoma (MCC) is an aggressive neuroendocrine carcinoma of the skin. The main etiological agent is Merkel cell polyomavirus (MCPyV), detected in 80% of cases. About 5% of cases, called combined MCC, feature an admixture of neuroendocrine and non-neuroendocrine tumor cells. Reports of the presence or absence of MCPyV in combined MCC are conflicting, most favoring the absence, which suggests that combined MCC might have independent etiological factors and pathogenesis. These discrepancies might occur with the use of different virus identification assays, with different sensitivities. In this study, we aimed to determine the viral status of combined MCC by a multimodal approach. We histologically reviewed 128 cases of MCC and sub-classified them as "combined" or "conventional." Both groups were compared by clinical data (age, sex, site, American Joint Committee on Cancer [AJCC] stage, immunosuppression, risk of recurrence, and death during follow-up) and immunochemical features (cytokeratin 20 and 7, thyroid transcription factor 1 [TTF1], p53, large T antigen [CM2B4], CD8 infiltrates). After a first calibration step with 12 conventional MCCs and 12 cutaneous squamous cell carcinomas as controls, all eight cases of combined MCC were investigated for MCPyV viral status by combining two independent molecular procedures. Furthermore, on multiplex genotyping assay, the samples were examined for the presence of other polyoma- and papillomaviruses. Combined MCC differed from conventional MCC in earlier AJCC stage, increased risk of recurrence and death, decreased CD8 infiltrates, more frequent TTF1 positivity (5/8), abnormal p53 expression (8/8), and frequent lack of large T antigen expression (7/8). With the molecular procedure, half of the combined MCC cases were positive for MCPyV in the neuroendocrine component. Beta papillomaviruses were detected in 5/8 combined MCC cases and 9/12 conventional MCC cases. In conclusion, the detection of MCPyV DNA in half of the combined MCC cases suggests similar routes of carcinogenesis for combined and conventional MCC.



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Immune cell expression of TGFβ1 in cancer with lymphoid stroma: dendritic cell and regulatory T cell contact

Abstract

Although cancer tissue generally shows limited immune responses, some cancers abound with lymphocytes, which generally show favorable prognosis. These cancers, despite their rarity, are important in analyzing immune responses in cancer tissue. Transforming growth factor β1 (TFGβ1) is a multifunctional cytokine, generally having an immunosuppressive function. The present study analyzes the in situ TGFβ1 expression in 23 cases of lymphocyte-rich gastric carcinomas (Ly-rich GCs) using immunohistochemistry and in situ hybridization. Immunohistochemistry revealed that latency-associated peptide (LAP) of TGFβ1 was localized in mainly immune cells in all cases, which was more abundant than in control GCs. Expression of LAP by cancer cells was only focal. In situ hybridization also confirmed abundant TGFβ1 mRNA expression in the lymphoid stroma. Double immunofluorescent microscopy identified LAP+ cells as macrophages, dendritic cells, and part of T cells. Close cell-to-cell contact was observed between LAP+ dendritic-shaped cells and FoxP3+ regulatory T cells (Treg cells). Mature dendritic cells in Ly-rich GCs expressed LAP more frequently than those in the secondary lymphoid organs. Our data revealed abundant expression of TGFβ1 in immune cells with contact to Treg cells in lymphoid stroma, which is consistent with the notion that TGFβ1 is one of the immunosuppressive factors in cancer stroma.



https://ift.tt/2Ge9tBY

Analysis of membranous Ki-67 staining in breast cancer and surrounding breast epithelium

Abstract

Membranous Ki-67 staining with the MIB-1 antibody has been described in hyalinising trabecular adenomas of the thyroid and sclerosing haemangiomas of the lung. Its relatively rare occurrence in breast tumours has also been documented. The aim of the present study was to assess the rate of any membranous MIB-1 staining in breast specimens. The staining was performed at room temperature with 1:100 dilution of the antibody. One hundred four core needle biopsies and 41 operative specimens were analysed. Membranous staining was noted in 36/144 invasive carcinomas, 20/42 in situ carcinomas and 46/99 cases of peritumoural benign/normal breast epithelium. Most often, it presented as focal and partial polarised luminal membranous staining although complete circumferential staining also occurred, and membranous labelling was sometimes accompanied by cytoplasmic staining, too. In a few cases tested, greater dilution of the primary antibody did not abolish the membranous staining, which was absent with the SP6 monoclonal Ki-67 antibody. The membranous staining of invasive tumours showed no association with histological grade, lumen formation, oestrogen or progesterone receptor status or the Ki-67 nuclear labelling. In contrast, it was associated with a HER2-positive status, although it occurred in all molecular subtypes approached by immunohistochemistry. The background of this membranous staining remains elusive. It is unlikely to represent an artefact. At least partial sharing of an epitope of the nuclear Ki-67 protein with an unidentified membranous protein and some functional differences between membranous staining producing tumours and tumours lacking this pattern of staining may both contribute to some extent.



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Blockade of TNFR1-dependent and -independent cell death is crucial for normal epidermal differentiation

Publication date: Available online 27 March 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Xuehua Piao, Ryosuke Miura, Sanae Miyake, Sachiko Komazawa-Sakon, Masato Koike, Ryodai Shindo, Junji Takeda, Akito Hasegawa, Riichiro Abe, Chiharu Nishiyama, Tetsuo Mikami, Hideo Yagita, Yasuo Uchiyama, Hiroyasu Nakano
BackgroundDelicate balance between cell death and proliferation of keratinocytes is crucial for normal development of the skin. Previous studies have reported that cellular FLICE-inhibitory protein (cFLIP) plays a crucial role in prevention of keratinocytes from TNFα-dependent apoptosis and blocking the development of dermatitis. However, a role for cFLIP in TNFα-independent cell death remains unclear.ObjectiveWe investigated contribution of TNFα-dependent and -independent signals to the development of dermatitis in epidermis-specific Cflar-deficient (CflarE-KO) mice.MethodsWe examined histology, and expression of epidermal differentiation markers and inflammatory cytokines of the skin of CflarE-KO ;Tnfrsf1a+/- and CflarE-KO ;Tnfrsf1a-/- mice. To block TNFα-independent cell death of CflarE-KO;Tnfrsf1a-/- mice, mice were treated with neutralizing antibodies against FasL and TRAIL.ResultsCflarE-KO;Tnfrsf1a-/- mice were born, but developed severe dermatitis and succumbed soon after birth. CflarE-KO;Tnfrsf1a+/- mice exhibited embryonic lethality due to massive apoptosis of keratinocytes. While keratinocytes from CflarE-KO;Tnfrsf1a-/- mice still died by apoptosis, neutralizing antibodies against FasL and TRAIL substantially prolonged survival of CflarE-KO;Tnfrsf1a-/- mice. Expression of inflammatory cytokines, such as interleukin (Il)6 and Il17a was elevated, conversely, expression of epidermal differentiation markers was severely downregulated in the skin of CflarE-KO;Tnfrsf1a-/- mice. Treatment of primary keratinocytes with IL-6, and to a lesser extent IL-17A suppressed expression of epidermal differentiation markers.ConclusionTNFR1-dependent or -independent apoptosis of keratinocytes promotes inflammatory cytokine production that subsequently blocks epidermal differentiation. Thus, blockade of both TNFR1-dependent and -independent cell death might be an alternative strategy to treat skin diseases when treatment with anti-TNFα antibody alone is not sufficient.

Teaser

Epidermis-specific deletion of Cflar gene uncovers that prevention of both TNFR1-dependent and -independent apoptosis is crucial for the maintenance of normal epidermal differentiation.


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