Transoral endoscopic thyroid surgery via the tri‐vestibular approach with a hybrid space‐maintaining method: A preliminary report

Head &Neck, EarlyView.


https://ift.tt/2Go3JBt

Systematic review evaluating randomized controlled trials of smoking and alcohol cessation interventions in people with head and neck cancer and oral dysplasia

Head &Neck, EarlyView.


https://ift.tt/2GDXSLT

Immune privilege disruption in folliculotropic mycosis fungoides: investigation of major histocompatibility complex antigen expression

International Journal of Dermatology, EarlyView.


https://ift.tt/2GHwYm9

Paederus dermatitis – touched by champion flies – three clinical manifestations of pederin toxin‐inflicted dermatitis

International Journal of Dermatology, EarlyView.


https://ift.tt/2GnV6a3

Editorial Board

Publication date: April 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 135, Issue 2





https://ift.tt/2E7RLKn

Contents

Publication date: April 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 135, Issue 2





https://ift.tt/2GZUMiT

Facial Fracture Patterns Associated with Traumatic Optic Neuropathy

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0038-1641172

Traumatic optic neuropathy (TON) is rare. The heterogeneity of injury patterns and patient condition on presentation makes diagnosis difficult. Fracture patterns associated with TON have never been evaluated. Retrospective review of 42 patients diagnosed with TON at the R. Adams Cowley Shock Trauma Center from May 1998 to August 2010 was performed. Thirty-three patients met criteria for study inclusion of fracture patterns. Additional variables measured included patient demographics and mechanism. Cluster analysis was used to form homogenous groups of patients based on different fracture patterns. Fracture frequency was analyzed by group and study population. Visual depiction of fracture patterns was created for each group. Cluster analysis of fracture patterns yielded five common "groups" or fracture patterns among the study population. Group 1 (n = 3, 9%) revealed contralateral lateral orbital wall (100%), zygoma (67%), and nasal bone (67%) fractures. Group 2 (n = 7, 21%) demonstrated fractures of the frontal bone (86%), nasal bones (71%), and ipsilateral orbital roof (57%). Group 3 (n = 14, 43%) involved fractures of the ipsilateral zygoma (100%), lateral orbital wall (29%), as well as frontal and nasal bones (21% each). Group 4 (n = 5, 15%) consisted of mid- and upper-face fractures; 100% fractured the ipsilateral orbital floor, medial and lateral walls, maxilla, and zygoma; 80% fractured the orbital roof and bilateral zygoma. Group 5 (n = 4, 12%) was characterized by fractures of the ipsilateral orbital floor, medial and lateral orbital walls (75% each), and orbital roof (50%). A notably high 15 of 33 patients (45%) sustained penetrating trauma. Our study demonstrates five fracture pattern groups associated with TON. Zygomatic, frontal, nasal, and orbital fractures were the most common. Fractures with a combination of frontal, nasal, and orbital fractures are particularly concerning and warrant close attention to the eye.
[...]

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

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

https://ift.tt/2IiGVUv

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/2Gp4ydt

Cost‐effectiveness of sialendoscopy versus medical management for radioiodine‐induced sialadenitis

The Laryngoscope, EarlyView.


https://ift.tt/2GrvER7

Post‐acute care use after major head and neck oncologic surgery with microvascular reconstruction

The Laryngoscope, EarlyView.


https://ift.tt/2GK7yV8

Allergic phenotype of chronic rhinosinusitis based on radiologic pattern of disease

The Laryngoscope, EarlyView.


https://ift.tt/2GrXJHN

Transoral resection of extensive pediatric supraglottic neurofibroma

The Laryngoscope, EarlyView.


https://ift.tt/2GK7vsq

A Multimodal analysis using flowmeter analysis, laser-Doppler spectrophotometry, and indocyanine green videoangiography for the detection of venous compromise in flaps in rats

Venous congestion results in tissue damage and remains the most common failure of free microvascular transfer if it is not recognized early. The purpose of this experimental study was to evaluate venous congestion and describe the findings with two different monitoring tools. A standardized epigastric flap was raised, and total occlusion of the draining vein was temporarily applied for 4, 5, 6, or 7 hours. Blood flow measurements, including laser-Doppler flowmetry, and tissue spectrophotometry (O2C) and indocyanine green (ICG) videoangiography using the FLOW® 800 tool, were performed systematically after each surgical step, an interval of venous occlusion, and 1 week of clinical observation.

https://ift.tt/2E8ajtS

Trajectory-guided biopsy of orbital tumor - Technology, principal considerations and clinical implementation -

Intraorbital space-occupying lesions always pose a challenge, both in terms of definite surgical removal as well as preoperative sampling for histopathological examination. Despite the use of modern high-resolution imaging techniques, the dignity of orbital lesions can often not be determined with sufficient certainty preoperatively. As the amount and complexity of treatment possibilities continue to increase, detailed diagnostics in advance of treatment choice are essential. Histological classification of orbital lesions can still be considered the gold standard for reliable diagnoses, leading to appropriate treatment.

https://ift.tt/2GZKeQS

Optimizing outcomes with polymethylmethacrylate fillers

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2GEPJqq

Biologics for pityriasis rubra pilaris treatment: a review of the literature

Pityriasis rubra pilaris (PRP) is a rare inflammatory papulosquamous skin disease, often refractory to conventional therapies. The off-label use of biologics, such as anti-TNF, -IL-12/IL-23, -IL-17 agents, has been proven successful, in the last two decades, in PRP treatment.Our aim was to analyse the literature for the use of biologics in PRP treatment. We conducted a review by "Pubmed" and "clinicaltrial.gov" searches. 68 articles met our selection criteria and were herein discussed. Out of 86 PRP patients, the vast majority of which treated with anti-TNF, -IL-12/IL-23, and -IL-17 biologics, either alone or in combination therapy, a marked-to-complete response (50-78%), a partial response (11-25%) or no/poor response (11-25%) was observed.

https://ift.tt/2Gm2UgD

Comparison of ethylenediaminetetraacetic acid-treated desmoglein ELISA and conventional desmoglein ELISA in the evaluation of pemphigus vulgaris in remission

https://ift.tt/2uEMFFM

Dual neutralization of both IL-17A and IL-17F with bimekizumab in patients with psoriasis: results from BE ABLE 1, a 12-week randomized, double-blinded placebo-controlled phase 2b trial

Neutralizing interleukin (IL)-17F in addition to IL-17A may provide a more complete and specific approach to inhibiting inflammation.

https://ift.tt/2Gm2S8v

Evaluation of postoperative changes in vascularized iliac bone grafts used for mandibular reconstruction

Publication date: Available online 30 March 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): T. Noguchi, S. Sarukawa, Y. Tsuchiya, N. Okada, J. Hayasaka, K. Sasaguri, H. Nishino, Y. Jinbu, Y. Mori
Vascularized iliac bone grafts are used for mandibular reconstruction, but the factors affecting graft maintenance are unknown. This study explored the postsurgical changes in vascularized iliac bone grafts in patients who had undergone mandibular reconstruction after segmental resection. The study involved 24 patients (16 men and eight women) with oral tumours or osteoradionecrosis. Thirteen patients required bare bone grafting (BBG) and 11 patients required reconstruction with soft tissue coverage (six with a skin paddle and five with direct closure). The bone graft maintenance rate (with regard to the height of the centre of the graft) was calculated immediately after surgery and at 3, 6, 12, 24, and 36months after surgery. The maintenance rate was significantly lower in the BBG group than in the soft tissue coverage group at 3, 6, 12, 24, and 36months, and in those who were fitted with dentures compared to those who were not at 6, 12, 24, and 36months. Local infection also influenced the maintenance rate, but not significantly so. These findings indicate that the reconstruction technique and denture use can affect the bone graft maintenance rate after mandibular reconstruction with vascularized iliac bone grafts.



https://ift.tt/2GqjaZW

Does two-dimensional vs. three-dimensional surgical simulation produce better surgical outcomes among patients with class III facial asymmetry?

Publication date: Available online 30 March 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): N. Udomlarptham, C.-H. Lin, Y.-C. Wang, E.W.-C. Ko
The aim of this study was to compare the outcomes of traditional two-dimensional planning (2DP) and three-dimensional surgical simulation (3DS) in the surgical correction of skeletal class III with facial asymmetry. This retrospective cohort study included 37 consecutive adult Taiwanese patients. Preoperative and postoperative three-dimensional cephalometric measurements were obtained from cone beam computed tomography scans. The outcome variables were the differences in preoperative and postoperative linear and angular measurements and the differences between the two groups after surgery. When the surgical result was compared between the 2DP and 3DS groups, significant differences were found for four cephalometric variables: the distance from gonion on the non-deviated side to the midsagittal plane (MSP), mid-gonion to the MSP, upper first molar on the non-deviated side to the Frankfort horizontal plane, and the yaw angle. In the 3DS group, mandibular symmetry was achieved because the centre between the bilateral gonions was improved, and because there was no significant difference in the horizontal gonion (Go to the MSP) between the deviated and non-deviated sides after surgery. 3DS provides all the necessary information for planned surgical movements for the correction of facial asymmetry; it should be considered during surgical planning to improve surgical outcomes, particularly the achievement of bilateral mandibular contour symmetry.



https://ift.tt/2GKHLw9

Prognostic value of lymph node count from selective neck dissection in oral squamous cell carcinoma

Publication date: Available online 30 March 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): S. Lee, H.J. Kim, I.-H. Cha, W. Nam
Unlike the levels of anatomical exploration, there is no consensus on the extent of lymph node dissection, or lymph node count (LNC), during selective neck dissection (SND). The aim of this study was to validate the prognostic impact of LNC on survival and to determine an optimal LNC cut-off value for SND. A retrospective investigation identified 78 patients with a diagnosis of oral squamous cell carcinoma (OSCC) who underwent SND (levels I–III or levels I–IV). LNC and clinicopathological variables were analyzed for any association with survival in Cox proportional hazards models. Based on the receiver operating characteristic curve, a cut-off value of 19 lymph nodes was found to predict overall survival (OS) (area under the curve 0.732, sensitivity 67.8%, specificity 75.0%; P=0.026) and disease-specific survival (DSS) (area under the curve 0.762, sensitivity 68.1%, specificity 77.8%; P=0.011). On Cox regression, LNC (≥19 vs. <19) was the only independent predictor of OS (hazard ratio 5.29, 95% confidence interval 1.39–20.05; P=0.014) and DSS (hazard ratio 6.76, 95% confidence interval 1.40–32.77; P=0.018). Similar results were obtained in the pathologically lymph node-negative subgroup (n=66). Based on the study findings, SND should include 19 or more lymph nodes for a survival benefit.



https://ift.tt/2GnCB5B

How to treat whiteheads on the nose

Whiteheads are stubborn acne lesions that develop just under the skin. The nose is a common site for whiteheads to form, as this part of the face produces a lot of oil and is touched frequently throughout the day. We look at several ways to treat whiteheads on the nose, as well as how to prevent them in the future.

https://ift.tt/2GlOxF6

Comparison of MRI in pediatric cochlear implant recipients with and without retained magnet

Publication date: June 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): Walker Brian, Norton Susan, Phillips Grace, Christianson Erin, Horn David, Ou Henry
ObjectiveTo report and compare medical, radiological, and audiological outcomes in pediatric cochlear implant recipients who underwent 1.5 and 3 Tesla strength MRI with and without retained magnet.MethodsRetrospective chart review at a tertiary care pediatric hospital and review of literature. Patients were identified via electronic medical records database search and were included if they had MRI after cochlear implant.ResultsOf twelve instances of MRI in pediatric cochlear implant recipients at our institution, two minor complications and one major complication were recorded. The rate of complication was equal between patients who underwent MRI with and without retained magnet. All minor complications resulted from MRI with retained magnet whereas the only major complication resulted from magnet removal. Two novel complications are reported, including: magnet removal resulting in silastic tear necessitating reimplantation and magnet dislocation with spontaneous reduction. Magnet removal significantly decreased the size of artifact, but did not alter the diagnostic utility of the MRI. While audiological measures varied chronologically from MRI scans, they did not appear to be appreciably altered by MRI.ConclusionMRI with and without magnet retention appear to carry risks of both major and minor complications. For the regions of interest for each scan, MRI quality was not appreciably altered by magnet status. Audiological measures appear unaffected by magnet status during MRI however, this may reflect natural variation.



https://ift.tt/2Gn8JWR

Oncologic outcomes of surgical treatment for T3 glottic laryngeal squamous cell carcinoma

Head &Neck, EarlyView.


https://ift.tt/2GjZhYl

New MRI Biomarkers in Head and Neck Cancers

Condition:   Head and Neck Cancer
Intervention:   Other: MRI examinations
Sponsor:   Memorial Sloan Kettering Cancer Center
Recruiting

https://ift.tt/2pNJmrd

Combat zone exposure and respiratory tract disease

International Forum of Allergy &Rhinology, EarlyView.


https://ift.tt/2GoyshY

Lacrimal sac exposure and a superior lateral anterior pedicle flap to improve outcomes of Draf type II and III procedures

International Forum of Allergy &Rhinology, EarlyView.


https://ift.tt/2pQgvSS

Comparing the efficacy of Silastic and gloved‐Merocel middle meatal spacers for functional endoscopic sinus surgery: a randomized controlled trial

International Forum of Allergy &Rhinology, EarlyView.


https://ift.tt/2Ig2fcV

A novel universal device“LINGUAL RING Ri.P.A.Ra” for TMDs and cranio-cervico-mandibular pains: preliminary results of a randomized control clinical trial

OBJECTIVE: The aim of this study was to evaluate functionality and clinical application of a novel immediate device in the treatment of temporomandibular disorders (TMDs). To address the research purpose, authors developed and implemented a randomized control clinical trial.

PATIENTS AND METHODS: Eighty patients were enrolled in this study and were randomly divided into two subgroups based on the treatment applied: patient group (PG) and control group (CG). The CG was not subjected to any kind of treatment, even placebo, in order to be able to assess the spontaneous development of the pathology over time. The PG was treated applying the novel device for a maximum of three months. The following parameters were evaluated at baseline (T0) and at the end of therapy (T1): presence/absence of articular noises, painful symptomatology (articular pains, muscle pains, headache, cervicalgia), parafunctional habits and duration of symptoms. The x2-index of association was performed, with a p-value < 0.05 considered as statistically significant.

RESULTS: No patient in the PG worsened its symptomatology. Thirteen patients (33%) declared themselves cured from their symptoms and were included in a monitoring protocol. Twenty-seven patients (67%) improved their symptoms and were treated with other conservative conventional methods to complete the therapeutic cycle. Therefore, 100% of PG obtained benefits from the application of the new therapeutic approach. In contrast, among patients of CG, eighteen subjects (45%) worsened their symptoms, while eighteen (45%) were defined as stationaries compared to T0 and only four (10%) were defined as improved.

CONCLUSIONS: The device presented the following advantages: immediacy of use, reduction of waiting times for its application, good tolerability and comfort and specificity in the execution of tongue rehabilitation exercises.

L'articolo A novel universal device"LINGUAL RING Ri.P.A.Ra" for TMDs and cranio-cervico-mandibular pains: preliminary results of a randomized control clinical trial sembra essere il primo su European Review.

https://ift.tt/2J6tVCv

Proceedings of the Canadian Society of Allergy and Clinical Immunology Annual Scientific Meeting 2017

https://ift.tt/2uxKMLb

High-dose thiamine and essential tremor

Essential tremor is a common neurological disease. The medical treatment of this affection currently involves the use of propranolol, primidone and other drugs. These drugs, however, are often not effective in reducing tremor and cause side effects in a large share of the patients treated. The treatment with intramuscular high-dose thiamine has led to a rapid, remarkable and persistent improvement of the symptoms in two patients with essential tremor. This result suggests the possibility that high doses of intramuscular thiamine may be an affordable alternative, highly effective and long-lasting medical treatment that has shown no relevant side effect.

https://ift.tt/2GoYEZN

Acute brainstem compression

Description

A 34-year-old African woman, whose medical history was unremarkable, presented to the emergency room with severe headache and vomiting. Temperature, blood cells count, plasma electrolytes and chest X-ray were normal. Clinical conditions were rapidly deteriorating and neurological exam disclosed drowsiness, opisthotonus and decerebrate response to pain. Brain CT scan showed a 'full' posterior fossa, mild supratentorial hydrocephalus and herniation of cerebellar tonsils: after contrast, a nodule with ring enhancement and conspicuous perilesional oedema was disclosed in the right cerebellar hemisphere.

The patient was given diuretics and steroids with no success. Since the neurological conditions were worsening, a neurosurgical operation was then performed in emergency: posterior fossa was decompressed, the cerebellar nodular lesion was removed en bloc with microsurgical technique and a transient ventricular drain was placed. Neurological conditions promptly recovered after surgery.

Possible differential diagnosis:

Metastasis

Pyogenic abscess

Primitive brain tumour

Abscess from non-pyogenic agents.

...

https://ift.tt/2pQmKGj

Rapid onset of multiple concurrent squamous cell carcinomas associated with the use of an arsenic-containing traditional medicine for chronic plaque psoriasis

We report a case of a 46-year-old Vietnamese man who developed widespread, numerous and concurrent cutaneous squamous cell carcinomas (SCCs) in non-sun exposed skin areas after taking a traditional medicine (TM) formulation for chronic plaque psoriasis. The SCC lesions began to develop within 12–15 months after beginning the arsenic-containing TM. The patient experienced both acute and chronic symptoms consistent with arsenic exposure. Laboratory investigation of a collected hair sample showed a significant arsenic level. The TM formulation used by the patient was tested and demonstrated an extremely high concentration of arsenic.

https://ift.tt/2IgXikm

Beckwith-Weidemann syndrome with IC2 (KvDMR1) hypomethylation defect: a novel mutation

The Beckwith-Wiedemann syndrome (BWS) is a rare genetic syndrome. However, this is one of the most common overgrowth syndromes. This is a genetically and clinically heterogeneous syndrome. Here, we report a case of Beckwith-Weidemann syndrome without macrosomia, visceromegaly and hemihyperplasia but having macroglossia, omphalocele and anterior linear ear lobe creases. The diagnosis was confirmed by gene analysis suggestive of imprinting centre 2 (KvDMR1) hypomethylation defect.

https://ift.tt/2pQmJ5d

Proximal tibiofibular joint dislocation treated using flexible and permanent syndesmosis fixation

We present the case of a 40-year-old man who suffered an isolated proximal tibiofibular dislocation of the left knee after a trauma during a soccer game. Physical examination and radiographic imaging revealed an anterolateral dislocation of the proximal fibula. The diagnosis was confirmed by MRI. The treatment choice was open reduction and internal fixation under direct visualisation using flexible and permanent internal fixation. Postoperative treatment includes knee immobilisation during the first week, and partial weight was allowed for 2 weeks progressing to full weight bearing over 4 weeks. The patient started a gradual and progressive physical therapy programme with range of motion exercises, muscle strengthening and gait training. Full knee range of motion was achieved after 4 weeks. No complaint of pain or hardware discomfort was reported, and the patient is back to daily life and sports activities after 6 months of surgical treatment.

https://ift.tt/2IeLIWM

Childhood obesity in Mexico: social determinants of health and other risk factors

Approximately 50 million children and adolescents in Latin America are affected by the childhood obesity pandemic. We present the case of a 5-year-old Mexican girl with obesity and gastro-oesophageal reflux disease (GORD), in whom prenatal, lifestyle and environmental risk factors were identified. Here, we demonstrate how childhood obesity is rooted since pregnancy and the perinatal stage, and how the social determinants of health like unsafe outdoor conditions, lack of infrastructure to exercise and a suboptimal physical activity curriculum in government schools strongly influence the development and maintenance of childhood obesity and complicate management.

https://ift.tt/2pQA65y

Pseudotumor cerebri as the presentation of Lyme disease in a non-endemic area

Intracranial hypertension is a rare entity in prepubertal children, and its differential diagnosis includes a number of systemic diseases, drugs, vitamin deficiencies and excesses, and hereditary conditions. Infectious aetiology is rare. The case of a 9-year-old boy with intracranial hypertension secondary to acute neuroborreliosis is described. He presented with daily pulsatile frontotemporal headache, pallor, photophobia and phonophobia. His neurological examination revealed papilledema with no nuchal rigidity. The lumbar puncture showed increased pressure (50 cm H₂O) and lymphocytic pleocytosis. Serum and cerebrospinal fluid (CSF) Borrelia burgdorferi antibodies were positive. This kind of infection is rare in Portugal but a trip to an endemic area was identified. A careful history, considering the exposure to rural areas together with the intracranial hypertension and inflammatory CSF, are important clues to the diagnosis, allowing the institution to select appropriate treatment.

https://ift.tt/2GoYce3

Essential thrombocytosis 40 years after splenectomy

Description

A 69-year-old man presented at our Department of Neurology in December 2016 with acute aphasia. His medical history was notable of splenectomy after a spleen rupture due to a car accident at the age of 25, a subarachnoidal haemorrhage (SAH) without evidence of cerebral aneurysm at the age of 35 and a non-ST elevation myocardial infarction at the age of 63. For this vascular event, a drug-eluting stent was placed into the ramus interventricularis anterior, followed by combined antiplatelet treatment for 2 years, and up to admission acetylsalicylic acid was given at a dose of 100 mg per day.

Now MRI revealed a left hemispheric ischaemic stroke (figure 1A). No major vascular risk factors were found. The only pathological finding was a thrombocytosis of 1700x10³ per µL, reference value 150–450x10³ per µL. A post-splenectomy syndrome was suspected. However, previous thrombocyte levels as documented during the SAH...

https://ift.tt/2pQGj1j

Adult scurvy associated with psychiatric disorders and breast feeding

Scurvy is a nutritional disease caused by ascorbic acid deficiency and is potentially fatal. It was originally described in the 18th century by James Lind and associated with long sea voyages and insufficient citrus consumption. Its prevalence has declined markedly over the years but has still been described sporadically in certain countries. A 22-year-old woman with an anxiety disorder and anorexia nervosa, recent pregnancy and ongoing breast feeding, presented with a 10-day history of spontaneous haematomas in the lower limbs, gingivorrhagia and fatigue. The examination was remarkable for signs of minor bleeding without haemodynamic compromise, gonalgia and pale skin. Work-up studies revealed the presence of anaemia. Direct anamnesis identified a diet based solely of tea and carbohydrates due to distorted body image. With the working diagnosis of scurvy, nutritional support and oral vitamin C supplementation was initiated. Her symptoms and anaemia resolved in 30 days and the diagnosis was confirmed biochemically.

https://ift.tt/2Goj2u2

Apixaban-induced subdural bleeding: case presentation and literature review

Apixaban is a factor Xa inhibitor which is a non-vitamin K dependent oral anticoagulant known tocause the lowest rate of intracranial bleeding among the same kind of inibitors. In this paper, we report a rare case in a 60-year-old man with a history of hypertension and oligodendroglioma on apixaban for deep venous thrombosis who presented to our hospital with decreased level of consciousness and slurred speech with rapid deterioration. We highlight the risk of subdural bleeding requiring immediate neurosurgical intervention due to apixaban, with literature review.

https://ift.tt/2pPrHPS

Synovial sarcoma of the transverse colon: a rare cause of intussusception

We report a third case of a primary intramural synovial sarcoma of the lower gastrointestinal tract. A 50-year-old woman presented with hematochezia, dizziness and shortness of breath. CT imaging revealed a transverse colo-colonic intussusception with a colonic mass serving as a lead point. A subtotal colectomy was performed with oncologic resection of a sausage-like mass in the mid-transverse colon. Pathological assessment showed a biphasic synovial sarcoma. The postoperative hospital course was without complications and the patient was discharged home with plans for postoperative surveillance.

https://ift.tt/2Ihyvwe

Comparison of Efficacy of Transalveolar Screws and Conventional Dental Wiring Using Erich Arch Bar for Maxillomandibular Fixation in Mandibular Fractures

Abstract

Introduction

Maxillomandibular fixation is required in nearly all cases of facial fractures which can be achieved by conventional dental wiring techniques or newer methods using transalveolar screws.

Material and Methods

A prospective randomized clinical study divided into two groups with thirty adult patients each with mandibular fractures was undertaken comparing the Maxillomandibular fixation technique using transalveolar screws and Erichs arch bar. Total time taken, rate of glove perforation, intraoperative and postoperative complications were noted in both the groups.

Results

The time taken for maxillomandibular fixation in minutes and rate of glove perforation was found to be statistically significantly less for transalveolar group compared to arch bar group (p < 0.05). However, there was no significant difference found in the oral hygiene and gingival status using the Glass index and Gingival index. The rate of screw breakage (04.67%), wire breakage (05.12%), non-vitality due to iatrogenic dental damage (01.66%), soft tissue injury and tooth loss were some of the noted complications during the study.

Conclusion

We found that transalveolar group offered advantages like less time taken with a definite decreased risk of percutaneous injury, while the iatrogenic complications like dental damage can be reduced by taking adequate precautions.

https://ift.tt/2ygMT3d

Cortical Bone Graft and GTR Membrane as “Ceiling Effect” in Alveolar Bone Grafting

Abstract

Background

In orofacial cleft deformity cases, bone grafting is a very essential step in reconstruction of the residual alveolar cleft defect.

Material and Methods

Though various authors have put forth different techniques and graft sources for alveolar bone grafting, at our center, we have used iliac crest as the graft source and cortical bone graft with GTR membrane as "ceiling effect".

Results

We have evaluated a series of cases of secondary alveolar bone grafting done with this technique by same surgeon at our center and have found great success.

Conclusion

In this clinical paper, we describe our surgical technique and also the key points from surgeons experience to ensure a better result.

https://ift.tt/2IiQtif

Facial Anthropometric Norms of the Young Iranian Population

Abstract

Introduction

Facial anthropometric measurement is considered an essential concern of surgeons, orthodontists, artists and forensic scientists. The aim of this study is to investigate facial anthropometric norms of the young Iranian population.

Methods

The study participants consisted of 200 healthy Iranian students (100 males, 100 females) aged 18–25 years old. Twenty-three liner and four angular measurements were investigated twice by a dentist. Independent-samples t test was used to compare indices between males and females and also between countries. A p value less than 0.05 was considered statistically significant.

Results

It was found that the mean measurements of c'–sn' of both sides, nasolabial angle, trichion–gnathion, tragion–tragion and gnathion–gnathion were statistically greater in Iranian males than in females (p < 0.05). Comparing Iranian anthropometric norms with North American Whites, Malays, Turkish and African American women demonstrated that there were statistically significant differences in most anthropometric measurements between Iranians and other populations (p < 0.05).

Conclusion

In Iranians, mean measurements of c'–sn' of the right and left sides, nasolabial angle, trichion–gnathion, tragion–tragion and gnathion–gnathion were greater in men than in women. Comparing Iranian males and females with different ethnicities indicated several interracial differences, which should be taken into consideration when dealing with patients or also practitioners originated in this region.

https://ift.tt/1WDktts

A Simple and Effective Scalp Tourniquet for Controlling Scalp Hemorrhage

https://ift.tt/2pQEJfU

Techniques to Improve Reliability and Predictability of the Dorsal Pedicled Tongue Flap in Closure of Palatal Defects and Oronasal Fistulae

Abstract

Introduction

Despite the improvement in surgical techniques in cleft palate surgery, oronasal fistulas continue to remain a challenge, usually the result of residual palatal and alveolar clefts and post-palatoplasty defects. The tongue flap is an extremely versatile, sturdy, reliable and efficient means of closure of anterior as well as posterior, unilateral and bilateral palatal defects, effectively functionally obliterating the oronasal communication, owing much of its success to its highly vascular structure, good mobility, texture match, central location and low donor site morbidity. However, it has a few drawbacks. Flap dehiscence and detachment during the early postoperative period is a troublesome complication owing to tongue movements during normal activities such as speaking, swallowing, yawning and coughing.

Aim

This article describes some of the methods which can be used to effectively alleviate these shortcomings.

Methods

A protocol of immobilizing the tongue by tethering it to the maxillary teeth for the 3-week postoperative period, and also maintaining the patient on nasogastric feeding, until the patient is taken up for surgical separation the pedicle, was employed in all patients in this case series.

Results

There was a successful and predictable take of the tongue flap at the donor site, namely the palatal/oronasal fistula with its successful closure, in all the patients.

Conclusion

Treatment of the oronasal fistula using a two-layer closure using the nasal mucoperiosteum together with an anteriorly based dorsal tongue flap is an easy and efficient method, whose reliability can be further increased by avoiding a common complication, namely tongue flap detachment in the postoperative period brought on by movements of the tongue, by immobilizing the tongue by tethering it to the maxillary teeth and also maintaining the patient on nasogastric feeding for the 3-week postoperative period.

https://ift.tt/2IgzX1Y

Infection, Alveolar Osteitis, and Adverse Effects Using Metronidazole in Healthy Patients Undergoing Third Molar Surgery: A Meta-analysis

Abstract

Purpose

The aim of this systematic review and meta-analysis was to evaluate the risk of surgical infection, alveolar osteitis, and adverse effects using systemic metronidazole in comparison with placebo in healthy patients undergoing third molar surgery.

Materials and Methods

The eligible reports were identified from diverse science sources. Clinical trials meeting the inclusion and exclusion criteria and an acceptable Oxford Quality Score were included in this study. The evaluation of risk was done using the Risk Reduction Calculator and Review Manager 5.3., from the Cochrane Library. A significant risk reduction was assumed when the upper limit of the 95% confidence intervals was <1 and the lower limit did not cross zero (negative number) alongside a p value of <0.05 for the overall test. Data of 667 patients from five clinical trials were used for the assessment of risk.

Results

Our analysis showed no reduction of the risk of infection or dry socket in patients receiving metronidazole compared to whom took placebo. Meanwhile, the adverse effects did not exhibit a difference between the studied groups.

Conclusion

The routine use of systemic metronidazole to prevent surgical site infection and/or dry socket in healthy patients undergoing third molar surgery is not recommended.

https://ift.tt/2pNdran

Postoperative Facial Baroparesis While Flying: A Rare Complication of Decompressing a Facial Nerve Schwannoma.

Postoperative Facial Baroparesis While Flying: A Rare Complication of Decompressing a Facial Nerve Schwannoma.

JAMA Otolaryngol Head Neck Surg. 2018 Mar 29;:

Authors: Kung RW, Roche JP, Gantz BJ

PMID: 29596587 [PubMed - as supplied by publisher]

https://ift.tt/2IjvzzA

Pulsatile Tinnitus With Imaging.

Pulsatile Tinnitus With Imaging.

JAMA Otolaryngol Head Neck Surg. 2018 Mar 29;:

Authors: Truesdale CM, El-Kashlan HK

PMID: 29596564 [PubMed - as supplied by publisher]

https://ift.tt/2J8xwzR

Tubular Neck Mass.

Tubular Neck Mass.

JAMA Otolaryngol Head Neck Surg. 2018 Mar 29;:

Authors: McSpadden RP, Orsini M, Higgins K

PMID: 29596558 [PubMed - as supplied by publisher]

https://ift.tt/2pSOkD1

Standardized Margin Assessment Is Needed Before Implementing Negative Margin as a Quality Measure.

Standardized Margin Assessment Is Needed Before Implementing Negative Margin as a Quality Measure.

JAMA Otolaryngol Head Neck Surg. 2018 Mar 29;:

Authors: Duvvuri U, Johnson JT, Chiosea SI

PMID: 29596555 [PubMed - as supplied by publisher]

https://ift.tt/2Idy46s

A Novel Approach to the National Resident Matching Program-The Star System.

A Novel Approach to the National Resident Matching Program-The Star System.

JAMA Otolaryngol Head Neck Surg. 2018 Mar 29;:

Authors: Salehi PP, Benito D, Michaelides E

PMID: 29596554 [PubMed - as supplied by publisher]

https://ift.tt/2IingE5

Thyroidectomy Practice After Implementation of the 2015 American Thyroid Association Guidelines on Surgical Options for Patients With Well-Differentiated Thyroid Carcinoma.

Thyroidectomy Practice After Implementation of the 2015 American Thyroid Association Guidelines on Surgical Options for Patients With Well-Differentiated Thyroid Carcinoma.

JAMA Otolaryngol Head Neck Surg. 2018 Mar 29;:

Authors: Hirshoren N, Kaganov K, Weinberger JM, Glaser B, Uziely B, Mizrahi I, Eliashar R, Mazeh H

Abstract
Importance: The recommended extent of surgery for well-differentiated thyroid carcinoma has been modified considerably in the updated 2015 American Thyroid Association guidelines published in January 2016. To date, the changes in clinical practice after publication of these new guidelines have not been demonstrated.
Objective: The aim of this study was to evaluate clinical practice changes associated with implementation of the updated guidelines on the surgical procedure rates of total thyroidectomy, thyroid lobectomy, and completion thyroidectomy at a single tertiary medical center.
Design, Setting, and Participants: This is a retrospective cohort study of 169 patients at the Hadassah-Hebrew University Medical Center, Jerusalem, Israel. Patients with pathologically proved, well-differentiated thyroid carcinoma who underwent surgery between January 1, 2013, and December 31, 2014, were compared with patients who underwent surgery from January 1 to December 31, 2016. A total of 434 thyroidectomy procedures were performed during the study period, and 251 had pathologically proved, well-differentiated thyroid carcinoma. Patients with tumors larger than 4 cm, involved lymph nodes, or bilateral nodules were excluded.
Main Outcomes and Measures: Primary outcomes were the rate of up-front total thyroidectomy vs lobectomy and the rates of completion thyroidectomy before and after the implementation of the new guidelines.
Results: Of the 169 patients in the final analysis, 118 (69.8%) were included from 2013 to 2014 and 51 (30.2%) in 2016. The mean (SD) age for the entire cohort was 44 (13.8) years, and 129 (76.3%) were women. Up-front total thyroidectomy was performed in 72 of 118 patients (61.0%) prior to the 2015 American Thyroid Association guidelines and 16 of 51 (31.4%) following their implementation (odds ratio, 0.29; 95% CI, 0.14-0.59). The rate of completion thyroidectomy also significantly decreased between these periods (73.9% vs 20.0%; odds ratio, 0.09; 95% CI, 0.04-0.19).
Conclusions and Relevance: The updated 2015 American Thyroid Association guidelines implementation was associated with a significant decrease in the rates of both up-front total thyroidectomy and completion thyroidectomy. According to these findings, only 1 of 5 patients who undergoes thyroid lobectomy will require a completion procedure.

PMID: 29596551 [PubMed - as supplied by publisher]

https://ift.tt/2pQvHiX

Preoperative Facial Nerve Mapping to Plan and Guide Pediatric Facial Vascular Anomaly Resection.

Preoperative Facial Nerve Mapping to Plan and Guide Pediatric Facial Vascular Anomaly Resection.

JAMA Otolaryngol Head Neck Surg. 2018 Mar 29;:

Authors: Bly RA, Holdefer RN, Slimp J, Kinney GA, Martinez V, Manning SC, Perkins JA

Abstract
Importance: Facial vascular anomalies are surgical challenges due to their vascularity and facial nerve distortion. To assist facial vascular anomaly surgical treatment, presurgical percutaneous facial nerve stimulation and recording of compound motor action potentials can be used to map the facial nerve branches. During surgery, the nerve map and continuous intraoperative motor end plate potential monitoring can be used to reduce nerve injury.
Objective: To investigate if preoperative facial nerve mapping (FNM) is associated with intraoperative facial nerve injury risk and safe surgical approach options compared with standard nerve integrity monitoring (NIM).
Design, Setting, and Participants: This investigation was a historically controlled study at a tertiary vascular anomaly center in Seattle, Washington. Participants were 92 pediatric patients with facial vascular anomalies undergoing definitive anomaly surgery (from January 1, 1999, through January 1, 2015), with 2 years' follow-up. In retrospective review, a consecutive FNM patient cohort after 2005 (FNM group) was compared with a consecutive historical cohort (1999-2005) (NIM group).
Main Outcomes and Measures: Postoperative facial nerve function and selected surgical approach. For NIM and FNM comparisons, statistical analysis calculated odds ratios of nerve injury and operative approach, and time-to-event methods analyzed operative time.
Results: The NIM group had 31 patients (median age, 3.3 years [interquartile range, 2.2-11.4 years]; 20 [65%] male), and the FNM group had 61 patients (median age, 4.4 years [interquartile range, 1.5-11.0 years]; 26 [43%] male). In both groups, lymphatic malformation resection was most common (19 of 31 [61%] in the NIM group and 32 of 61 [52%] in the FNM group), and the median anomaly volumes were similar (52.4 mL; interquartile range, 12.8-183.3 mL in the NIM group and 65.4 mL; interquartile range, 18.8-180.2 mL in the FNM group). Weakness in the facial nerve branches at 2 years after surgery was more common in the NIM group (6 of 31 [19%]) compared with the FNM group (1 of 61 [2%]) (percentage difference, 17%; 95% CI, 3%-32%). Anterograde facial nerve dissection was used more in the NIM group (27 of 31 [87%]) compared with the FNM group (28 of 61 [46%]) (percentage difference, 41%; 95% CI, 24%-58%). Treatment with retrograde dissection without identification of the main trunk of the facial nerve was performed in 21 of 61 (34%) in the FNM group compared with 0 of 31 (0%) in the NIM group. Operative time was significantly shorter in the FNM group, and patients in the FNM group were more likely to complete surgery sooner (adjusted hazard ratio, 5.36; 95% CI, 2.00-14.36).
Conclusions and Relevance: Facial nerve mapping before facial vascular anomaly surgery was associated with less intraoperative facial nerve injury and shorter operative time. Mapping enabled direct identification of individual intralesional and perilesional nerve branches, reducing the need for traditional anterograde facial nerve dissection, and allowed for safe removal of some lesions after partial nerve dissection through transoral or direct excision.

PMID: 29596549 [PubMed - as supplied by publisher]

https://ift.tt/2Igv0X6

Standardized Margin Assessment Is Needed Before Implementing Negative Margin as a Quality Measure-Reply.

Standardized Margin Assessment Is Needed Before Implementing Negative Margin as a Quality Measure-Reply.

JAMA Otolaryngol Head Neck Surg. 2018 Mar 29;:

Authors: Schoppy DW, Divi V

PMID: 29596548 [PubMed - as supplied by publisher]

https://ift.tt/2pQvCvF

Patients with integrated HPV16 in head and neck cancer show poor survival

Publication date: May 2018
Source:Oral Oncology, Volume 80
Author(s): Tara J. Nulton, Nak-Kyeong Kim, Laurence J. DiNardo, Iain M. Morgan, Brad Windle
ObjectivesWe previously reported identifying three categories of HPV16-positive head and neck tumors based on The Cancer Genome Atlas (TCGA) RNA and DNA sequence data. Category 1 had truly integrated HPV16 genomes, category 2 had simple episomal genomes, and category 3 had novel episomes that were a hybrid between viral and human DNA. Using our categorization, we investigated in this study survival of patients with integrated HPV16 tumors versus patients with episomal HPV16 tumors.Materials and methodsThe TCGA RNA-Seq sequence reads were used to quantify HPV E2 and E7 gene expression, which was used as a marker for HPV integration.ResultsThe results demonstrate that integration is associated with poor survival; those patients with integrated HPV tumors fared no better than non-HPV tumors in their five-year survival. Integrated HPV in tumors was found strikingly to be prevalent in patients born earlier while episomal HPV was prevalent in patients born later. We also observed a fairly constant incidence of all HPV forms among head and neck cancer patients over the last eight years of this study (2006–2013).ConclusionWe propose our characterization of HPV integrated and episomal state is more accurate than previous studies that may have mischaracterized the hybrid HPV-human DNA episomes as integrated. The state of integrated HPV is associated with a poor clinical outcome. Results suggest that the incidence of integrated HPV among all HPV forms peaked and is decreasing. We discuss the importance of our findings for the management of HPV positive head and neck cancer.



https://ift.tt/2J8M0jo

The opioid epidemic and pregnancy: implications for anesthetic care

Purpose of review This review summarizes evolving knowledge regarding adverse maternal, fetal, and neonatal effects of opioid exposure during pregnancy, and current treatment options for opioid use disorder (OUD). Maternal and fetal implications of maternal opioid maintenance with methadone and buprenorphine are described. Finally, acute and chronic pain management strategies in opioid-tolerant parturients are reviewed. Recent findings Opioid use among parturients has risen dramatically, with opioid use during pregnancy as high as 20%. Of women with chronic pain, most continue to take opioids during pregnancy. Medication-assisted therapy with methadone or buprenorphine is currently the standard for treatment of opiate use disorder. Buprenorphine has unique pharmacologic properties that account for its preference over methadone. It has also been shown to produce more favorable neonatal outcomes compared with methadone. Increased clearance and volume of distribution associated with pregnancy require adjustment of dosing regimens of both medications. Multimodal adjuncts can be important alternatives for treatment of pain in opioid-tolerant parturients. Summary The dramatic rise in OUD in pregnancy has had staggering socioeconomic consequences, carrying with it profound maternal and fetal health problems. Medication-assisted treatment utilizing either methadone, or more commonly buprenorphine, is considered the standard of care for OUD during pregnancy. Peripartum pain management for opioid-tolerant patients is challenging and requires consideration for regional anesthesia along with multimodal pharmacotherapy. Correspondence to Michael G. Richardson, Division of Obstetric Anesthesiology, Department of Anesthesiology, 4202 VUH, Vanderbilt University Medical Center, Nashville, TN 37232-7580, USA. Tel: +1 615 322 8476; e-mail: Michael.g.richardson@vanderbilt.edu Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2pQoEH3

Drug error in paediatric anaesthesia: current status and where to go now

Purpose of review Medication errors in paediatric anaesthesia and the perioperative setting continue to occur despite widespread recognition of the problem and published advice for reduction of this predicament at international, national, local and individual levels. Current literature was reviewed to ascertain drug error rates and to appraise causes and proposed solutions to reduce these errors. Recent findings The medication error incidence remains high. There is documentation of reduction through identification of causes with consequent education and application of safety analytics and quality improvement programs in anaesthesia departments. Children remain at higher risk than adults because of additional complexities such as drug dose calculations, increased susceptibility to some adverse effects and changes associated with growth and maturation. Major improvements are best made through institutional system changes rather than a commitment to do better on the part of each practitioner. Summary Medication errors in paediatric anaesthesia represent an important risk to children and most are avoidable. There is now an understanding of the genesis of adverse drug events and this understanding should facilitate the implementation of known effective countermeasures. An institution-wide commitment and strategy are the basis for a worthwhile and sustained improvement in medication safety. Correspondence to Professor Brian J. Anderson, PhD, FANZCA, FCICM, Department of Anaesthesiology, University of Auckland, Faculty of Medical and Health Sciences, Auckland 1023, New Zealand. Tel: +64 9 3074903; fax: +64 9 3078986; e-mail: briana@adhb.govt.nz Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2GoD1Zw

Developing drugs for treatment of atopic dermatitis in children (≥3 months to <18 years of age): Draft guidance for industry

Pediatric Dermatology, EarlyView.


https://ift.tt/2pQTY8F

Hyper‐immunoglobulin D syndrome with novel mutations in an afebrile infant

Pediatric Dermatology, EarlyView.


https://ift.tt/2IglpPW

Evolution in the Surgical Management of Chronic Rhinosinusitis: Current Indications and Pitfalls

Publication date: Available online 29 March 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Michael A. Kohanski, Elina Toskala, David W. Kennedy
Chronic rhinosinusitis (CRS) consists of a range of inflammatory conditions in the sinuses that may result in clinical symptoms and the underlying pathophysiology and its relationship to lower airway disease is complex. Current definitions of CRS may serve more as an indication for potential surgical intervention rather than a marker of disease state. CRS can be asymptomatic and may require medical management to avoid disease progression and to minimize the risk of lower airway disease. Endoscopic surgery has undergone a significant evolution and refinement but the most common surgical complication remains persistent inflammation and recurrence of disease. It is important to recognize that surgery alone rarely cures CRS and patients require long-term medical therapy for continued asymptomatic inflammation. Careful post-operative care and endoscopic follow-up to ensure resolution of inflammation is key to ensuring optimal surgical outcomes and reduce the risk of revision surgery. Future work on CRS endotypes will allow for discovery of new therapies to treat CRS as well as refine indications for medical or surgical intervention as well as post-operative care.



https://ift.tt/2E6dL8x

Addressing Gender Discrimination in Oral and Maxillofacial Surgery via the Social Norms Approach

Publication date: Available online 28 March 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Rachel Uppgaard




https://ift.tt/2pNXjoa

The association between Helicobacter pylori infection and the risk of advanced colorectal neoplasia may differ according to age and cigarette smoking

Helicobacter, EarlyView.


https://ift.tt/2Gjdfty

Application of precision medicine to the treatment of anaphylaxis

Purpose of review Recognize the presentation of anaphylaxis for prompt management and treatment and to provide tools for the diagnosis of the underlying cause(s) and set up a long-term treatment to prevent recurrence of anaphylaxis. Recent findings The recent description of phenotypes provides new insight and understanding into the mechanisms and causes of anaphylaxis through a better understanding of endotypes and biomarkers for broad clinical use. Summary Anaphylaxis is the most severe hypersensitivity reaction and can lead to death. Epinephrine is the first-line treatment of anaphylaxis and it is life-saving. Patients with first-line therapy-induced anaphylaxis are candidates for desensitization to increase their quality of life and life expectancy. Desensitization is a breakthrough novel treatment for patients with anaphylaxis in need of first-line therapy, including chemotherapy, mAbs, aspirin and others. Ultrarush with venom immunotherapy should be considered in patients who present with life-threatening anaphylaxis after Hymenoptera sting with evidence of IgE-mediated mechanisms. Food desensitization is currently being expanded to provide increased safety to adults and children with food-induced anaphylaxis. Correspondence to Mariana Castells, MD, PhD, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, The Building for Transformative Medicine, 5th floor, Room 5002N, 60 Fenwood Road, Boston, MA 02115, USA. Tel: +1 617 525 1265; fax: +1 617 525 1310; e-mail: mcastells@bwh.harvard.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2J6qegf

Avenues for research in food allergy prevention: unheeded ideas from the epidemiology

No abstract available

https://ift.tt/2pShPUN

How to diagnose food allergy

Purpose of review To assess the recent studies that focus on specific immunoglobulin E (sIgE) testing and basophil activation test (BAT) for diagnosing IgE-mediated food allergies. Recent findings The sIgE to allergen extract or component can predict reactivity to food. The cutoff value based on the positive predictive value (PPV) of sIgE can be considered whenever deciding whether oral food challenge (OFC) is required to diagnose hen's egg, cow's milk, wheat, peanut, and cashew nut allergy. However, PPV varies depending on the patients' background, OFC methodology, challenge foods, and assay methodology. Component-resolved diagnostics (CRD) has been used for food allergy diagnosis. Ovomucoid and omega-5 gliadin are good diagnostic markers for heated egg and wheat allergy. More recently, CRD of peanut, tree nuts, and seed have been investigated. Ara h 2 showed the best diagnostic accuracy for peanut allergy; other storage proteins, such as Jug r 1 for walnut, Ana o 3 for cashew nut, Ses i 1 for sesame, and Fag e 3 for buckwheat, are also better markers than allergen extracts. Some studies suggested that BAT has superior specificity than skin prick test and sIgE testing. Summary The sIgE testing and BAT can improve diagnostic accuracy. CRD provides additional information that can help determine whether OFCs should be performed to diagnose food allergy. Correspondence to Sakura Sato, MD, Department of Allergy, Clinical Research Center for Allergology and Rheumatology, Sagamihara National Hospital, 18-1 Sakuradai, Minami-ku, Sagamihara, Kanagawa 252-0392, Japan. Tel: +81 42 742 8311; fax: +81 42 742 5314; e-mail: s-satou@sagamihara-hosp.gr.jp Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2J5vOz7

How to prevent food allergy during infancy: what has changed since 2013?

Purpose of review The purpose of this review is to summarize recent studies and emerging consensus guidelines regarding food allergy prevention in infants of the past 5 years. Recent findings Prior to 2013, the general consensus regarding prevention of food allergy in infants was to recommend delayed introduction or complete avoidance of commonly allergenic foods, such as milk, egg and peanut. However, in the past 5 years, several landmark studies have been conducted, particularly with peanut. The results of these studies have led to a paradigm shift from recommending delayed introduction to early introduction and frequent feeding of highly allergenic foods such as peanut, with hopes of achieving primary and secondary prevention of food allergy in infants. Summary Recent clinical trials have demonstrated that early introduction and frequent feeding, rather than delayed introduction or complete avoidance, of commonly allergenic foods plays a critical role in preventing food allergy in infants. More studies are required to risk-stratify infants by personal and family atopic history to tailor guidelines for groups with inherently different risks. The universal acceptance of the guidelines and their application outcome are still to be determined. Correspondence to Amal Assa'ad, MD, Professor of Pediatrics, Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Mail Location 2000, Cincinnati, OH 45229, USA. Tel: +1 513 636 6771; fax: +1 513 636 5835; e-mail: amal.assaad@cchmc.org Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2pShGRf

How to predict and improve prognosis of food allergy

Purpose of review The prevalence of food allergy is increasing. More children are being diagnosed with food allergies, and it is taking longer to outgrow them, among those who develop tolerance. The aim of this review is to draw the profile of the persistent food allergic, so that prevention strategies can be developed and active treatment set up. Recent findings Many determinants are involved in food allergy prognosis: ethnicity and sex, type of food, innate immune system, eliciting dose, sensitization status and other biomarkers determination, gut microbiome composition, and the presence of comorbidities. Once identified, a persistent food allergy could be conveyed to active treatments, such as oral immunotherapy or the use of biologics, always taking into account their experimental nature. Summary A better understanding of prognostic factors and phenotypes of food allergy is crucial in decision-making when it comes to food allergy prevention and management. A good classification of the allergic patient allows to determine the degree of exclusion diets and the timing of the reintroduction of avoided food when possible. In the cases of persistent and severe food allergy, many promising interventions are emerging which could improve prognosis and quality of care. Correspondence to Lamia Dahdah, MD, University Department of Pediatrics, Division of Allergy, Pediatric Hospital Bambino Gesù, Piazza di Sant'Onofrio 4, Rome 00100, Vatican City, Italy. Tel: +39 046 6859 4777; fax: +39 046 6859 2020; e-mail: lamiaantanios.dahdah@opbg.net Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2pShNMF

Phenotypes/endotypes-driven treatment in asthma

Purpose of review Target therapy is the necessary step towards personalized medicine. The definition of asthma phenotypes and underlying mechanisms (endotypes) represent a key point in the development of new asthma treatments. Big data analysis, biomarker research and the availability of monoclonal antibodies, targeting specific cytokines is leading to the rapid evolution of knowledge. In this review, we sought to outline many of the recent advances in the field. Recent findings Several attempts have been made to identify asthma phenotypes, sometimes with contrasting results. More success has been obtained concerning the pathogenetic mechanism of specific asthma patterns with the consequent identification of biomarkers and development of effective ad hoc treatment. Summary We are in the middle of an extraordinary revolution of our mode of thinking about and approaching asthma. All the effort in the identification of clusters of patients with different disease clinical patterns, prognosis and response to treatment is closely linked to the identification of endotypes (Th2-low and Th2-high). This approach has allowed the development of the specific treatments (anti IgE, Anti IL5 and IL5R) that are now available and is leading to new ones. Correspondence to Angelica Tiotiu, MD, PhD, Pulmonology Department, CHRU Nancy, EA 3450 DevAH – Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, University of Lorraine, 9 Avenue de la Forêt de Haye, F- 54505 – Vandoeuvre-les-Nancy, France. Tel: +33 3 83 15 43 72; fax: +33 3 83 15 35 41; e-mail: a.tiotiu@chru-nancy.fr Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2J6hyq2

Current opinion in allergy and clinical immunology: a change in leadership

No abstract available

https://ift.tt/2J6WKi8

Kite surfing: epidemiology of trauma

Kite surfing has become an increasingly popular recreational activity worldwide. Thrill seekers can span the water at high speeds and reach great heights risking injury and death. We report the case of a young kite surfer who sustained a fracture dislocation of the right acetabulum that required specialised surgical management. We present this case with a review of the literature outlining the incidence of pelvic and acetabular fractures in the kitesurfing community. Overall, there is a low incidence of pelvic fractures in comparison with other orthopaedic traumas reported among kite surfers, and the most commonly injured sites are the foot and ankle. Emergency departments should be alert to this activity and its associated injury patterns due to its ever-increasing popularity.

https://ift.tt/2pQeYMG

Amelanotic melanoma: a unique case study and review of the literature

Amelanotic melanoma (AM) is a rare form of melanoma which lacks visible pigment. Due to the achromic manifestation of this atypical cutaneous malignancy, it has been difficult to establish clinical criteria for diagnosis. Thus, AM often progresses into an invasive disease due to delayed diagnosis. In this report, we describe the case of a 72-year-old Caucasian woman who had been diagnosed with AM after 3 years of failed treatments for what presented as a periorbital dermatitis. Her Clark's level 4, 1.30 mm thick melanoma required nine surgeries for successful resection and reconstruction. This case exemplifies the diagnostic pitfall of AM and the need for new criteria for early detection and management.

https://ift.tt/2GkLs8g