Pediatric Dermatology, EarlyView.
https://ift.tt/2Hia1nG
Παρασκευή 6 Απριλίου 2018
Apocrine hidrocystoma on the genitalia of a 9‐year‐old girl
Idiopathic facial aseptic granuloma—A diagnostic challenge in pediatric dermatology
Pediatric Dermatology, EarlyView.
https://ift.tt/2Esr4A2
A case of extensive acquired progressive lymphangioma
Pediatric Dermatology, EarlyView.
https://ift.tt/2Hi9z8Y
Occult dysraphism presenting with acro‐osteolysis
Pediatric Dermatology, EarlyView.
https://ift.tt/2Es0Uxm
Compound heterozygous mutations in desmoplakin associated with skin fragility, follicular hyperkeratosis, alopecia, and nail dystrophy
Pediatric Dermatology, EarlyView.
https://ift.tt/2Hi9qSY
Evidence‐based dosing of maintenance subcutaneous immunotherapy: a contemporary review of state‐of‐the‐art practice
International Forum of Allergy &Rhinology, EarlyView.
https://ift.tt/2qdWMwP
Hypoxia upregulates the expression of the pluripotency markers in the stem cells from human deciduous teeth
Abstract
Objectives
Cultivation under hypoxia promotes different responses in the mesenchymal stem cells and it has been producing promising results for clinical applications. Pulp tissue from deciduous teeth is a source of stem cells which has a high proliferative potential but this is usually discarded. This study has evaluated the effects of hypoxia on proliferation, apoptosis, and the expression of the pluripotency-related genes of the stem cells from human exfoliated deciduous teeth (SHED).
Materials and methods
The cells were isolated from dental pulp (n = 5) and characterized as mesenchymal stem cells, in accordance with the International Society for Cell Therapy. The cells were cultivated under hypoxia (3% oxygen) and compared to the normoxia cells (21% oxygen). The proliferation rate was evaluated by the Ki67 antibody for up to 7 days, while the metabolic activity was measured by the wst-8 assay for up to 14 days. The apoptotic cells were analyzed by Annexin V and propidium iodide staining at 24 h and 4 and 7 days. The expression of the pluripotent genes (OCT4, SOX2, and NANOG) was quantified by qPCR after 24 h, or 7 days, when cultivated under hypoxia or normoxia.
Results
No differences in the metabolic activity, the proliferation rate, and the apoptosis of SHED when cultivated under hypoxia or normoxia (p > 0.05) were observed. The expression of the pluripotent genes was significantly higher after 24 h and 7 days of the cells that were exposed to hypoxia (p < 0.01).
Conclusion
These findings have indicated an increase of the pluripotency-related genes within 7 days as being the main advantage of SHED culture under hypoxia.
Clinical relevance
Hypoxia culture may help maintain the quiescent state of the SHED, which could be advantageous for their future clinical applications.
https://ift.tt/2IvXRa3
American Society for Enhanced Recovery: Advancing Enhanced Recovery and Perioperative Medicine
As the population ages, the increasing surgical volume and complexity of care are expected to place additional care delivery burdens in the perioperative setting. In this age of integrated multidisciplinary care of the surgical patients, there is increasing recognition that an evidence-based perioperative pathway is associated with the optimal outcomes. These pathways, collectively referred to as Enhanced Recovery Pathways, have resulted in shortened length of hospital stay, reduced complications, and variance in outcomes, as well as earlier return to baseline activities. The American Society for Enhanced Recovery (ASER) is a multispecialty, nonprofit international organization, dedicated to the practice of enhanced recovery in perioperative patients through education and research. Perioperative Quality Initiatives were formed whose intent is to organize a series of consensus conferences on topics of interest related to perioperative medicine. The journal affiliation between American Society for Enhanced Recovery and Anesthesia& Analgesia will enable these evidence-based practices to be disseminated widely and swiftly to the practicing perioperative health care professionals so they can be adopted to improve the quality of perioperative surgical care. Accepted for publication March 12, 2018. Funding: None. Conflicts of Interest: See Disclosures at the end of the article. Reprints will not be available from the authors. Address correspondence to Tong J. Gan, MD, MBA, MHS, FRCA, Department of Anesthesiology, Stony Brook University, HSC Level 4, Rm 060, Stony Brook, NY 11794. Address e-mail to tong.gan@stonybrookmedicine.edu. © 2018 International Anesthesia Research Society
https://ift.tt/2uRHhj3
https://ift.tt/2uRHhj3
Dezocine Alleviates Morphine-Induced Dependence in Rats
BACKGROUND: Opioid dependence is a major public health issue without optimal therapeutics. This study investigates the potential therapeutic effect of dezocine, a nonaddictive opioid, in opioid dependence in rat models. METHODS: Dezocine was administered intraperitoneally to a morphine-dependent rat model to investigate its effect on withdrawal and conditioned place preference (CPP). Effect of dezocine on morphine withdrawal syndrome and CPP was analyzed using 2-way analysis of variance (ANOVA) followed by Tukey's post hoc test. Buprenorphine and vehicle solution containing 20% (v/v) dimethyl sulfoxide were used for positive and negative control, respectively. The astrocytes activation in nucleus accumbens was assessed by immunofluorescence assay of glial fibrillary acidic protein. Effect of dezocine and buprenorphine on the internalization of κ opioid receptor (KOR) was investigated using Neuro2A expressing KOR fused to red fluorescent protein tdTomato (KOR-tdT). Buprenorphine and dezocine were screened against 44 G-protein–coupled receptors, ion channels, and transporter proteins using radioligand-binding assay to compare the molecular targets. RESULTS: The mean withdrawal score was reduced in rats treated with 1.25 mg·kg−1 dezocine compared to vehicle-treated control animals starting from the day 1 (mean difference: 7.8; 95% confidence interval [CI], 6.35–9.25; P
https://ift.tt/2JsGb02
https://ift.tt/2JsGb02
Diagnostic Accuracy of Point-of-Care Gastric Ultrasound
BACKGROUND: Pulmonary aspiration of gastric contents is associated with significant perioperative morbidity and mortality. Previous studies have investigated the validity, reliability, and possible clinical impact of gastric ultrasound for the assessment of gastric content at the bedside. In the present study, we examined the accuracy (evaluated as sensitivity, specificity, and likelihood ratios) of point-of-care gastric ultrasound to detect a "full stomach" in a simulated scenario of clinical equipoise. METHODS: After a minimum fasting period of 8 hours, 40 healthy volunteers were randomized in a 1:1 ratio to either remain fasted or ingest a standardized quantity of clear fluid or solid. Each subject was randomized twice on 2 independent study sessions at least 24 hours apart. A gastric ultrasound examination was performed by a blinded sonographer following a standardized scanning protocol. Using a combination of qualitative and quantitative findings, the result was summarized in a dichotomous manner as positive (any solid or >1.5 mL/kg of clear fluid) or negative (no solid and ≤1.5 mL/kg of clear fluid) for full stomach. RESULTS: Data from 80 study sessions were analyzed. In this simulated clinical scenario with a pretest probability of 50%, point-of-care gastric ultrasound had a sensitivity of 1.0 (95% confidence interval [CI], 0.925–1.0), a specificity of 0.975 (95% CI, 0.95–1.0), a positive likelihood ratio of 40.0 (95% CI, 10.33–∞), a negative likelihood ratio of 0 (95% CI, 0–0.072), a positive predictive value of 0.976 (95% CI, 0.878–1.0), and a negative predictive value of 1.0 (95% CI, 0.92–1.0). CONCLUSIONS: Our results suggest that bedside gastric ultrasound is highly sensitive and specific to detect or rule out a full stomach in clinical scenarios in which the presence of gastric content is uncertain. Accepted for publication February 27, 2018. Funding: This study was supported by a peer-reviewed grant from Physician Services Incorporated, Ontario, Canada. Conflicts of Interest: See Disclosures at the end of the article. Trial Registry Number: Registration ID: NCT02588495. Reprints will not be available from the authors. Address correspondence to Anahi Perlas, MD, FRCPC, Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Department of Anesthesia, University of Toronto, 399 Bathurst St, McLaughlin Pavilion 2–405, Toronto, ON M5T 2S8, Canada. Address e-mail to anahi.perlas@uhn.ca. © 2018 International Anesthesia Research Society
https://ift.tt/2qbEFrq
https://ift.tt/2qbEFrq
Profound Intraoperative Hypotension Associated With Transfusion via the Belmont Fluid Management System
This retrospective observational case series conducted at 2 large academic centers over a 4-year period consists of 15 cases of profound hypotension in surgical patients immediately after initiation of the Belmont Fluid Management System for rapid transfusion of blood products. Halting the infusion and administering vasoactive agents led to resolution of hypotension. Repeat transfusion with the Belmont system resulted in repeat hypotension unless counteracted with vasopressors. No etiology was elucidated. This represents the largest documented association of acute hypotensive transfusion reaction with any rapid infusion system in surgical patients. Accepted for publication February 1, 2018. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Joanna Miller, MD, Mount Sinai Hospital, 1 Gustave Levy Pl, New York, NY 10129. Address e-mail to joanna.miller@mountsinai.org. © 2018 International Anesthesia Research Society
https://ift.tt/2ErII71
https://ift.tt/2ErII71
Comparison of Intraoperative Sedation With Dexmedetomidine Versus Propofol on Acute Postoperative Pain in Total Knee Arthroplasty Under Spinal Anesthesia: A Randomized Trial
BACKGROUND: In patients undergoing total knee arthroplasty under spinal anesthesia, we compared the postoperative analgesic effect of intraoperative sedation with dexmedetomidine versus propofol. We hypothesized that sedation with dexmedetomidine would result in lower postoperative opioid analgesic consumption than with propofol. METHODS: Forty-eight patients were enrolled and randomly assigned to either a dexmedetomidine group (n = 24), which received a loading dose of 1 μg/kg dexmedetomidine over 10 minutes, followed by a continuous infusion of 0.1–0.5 μg·kg−1·hour−1, or a propofol group (n = 24), which received a continuous infusion of propofol via a target-controlled infusion to maintain the effect-site concentration within a range of 0.5–2.0 μg/mL. The drug infusion rate was determined according to the sedation level, targeting a modified observer's assessment of alertness/sedation score of 3 or 4. The cumulative amounts of fentanyl administered via intravenous patient-controlled analgesia were recorded at 24 and 48 hours postoperatively (primary outcome). The postoperative numerical rating scale for pain was assessed at 6, 12, 24, and 48 hours (secondary outcome). The postoperative use of additional rescue analgesic (ketoprofen) and antiemetic drugs was also compared between the 2 groups at 24 and 48 hours. RESULTS: Dexmedetomidine significantly reduced postoperative fentanyl consumption (median [interquartile range]) during 0–24 hours (45 [30–71] vs 150 [49–248] μg, P = .004; median difference = −105 μg [99.98% CI, 210–7.5]), 24–48 hours (90 [45–143] vs 188 [75–266] μg, P = .005; median difference = −98 μg [99.98% CI, 195–45]), and 0–48 hours (135 [68–195] vs 360 [146–480] μg, P = .003; median difference = −225 μg [99.98% CI, 405–7.5]). The numerical rating scale (median [interquartile range]) was lower at 6 hours (1 [0–2] vs 2 [1–3], P = .003), 12 hours (1 [1–2] vs 3 [2–3], P
https://ift.tt/2ErU1fE
https://ift.tt/2ErU1fE
All-In-One Surgical Guide: A New Method For Cranial Vault Resection And Reconstruction
Great precision is required for craniofacial surgery, and computer-aided design (CAD) methods may be used to plan surgery before it is performed. In this study, three-dimensional (3D)-printed cutting guides are used to match computer models with surgical procedures. We describe a novel method of computer-aided surgery for autologous cranioplasty that includes a new strategy for generating and using cutting guides. These guides may be used not only for osteotomies, but also for many other steps in the surgical procedure.
https://ift.tt/2JrL8Gw
Effect of a domiciliary facial cooling system on generic quality of life after removal of mandibular third molars
Publication date: Available online 5 April 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): A.N. Beech, S. Haworth, G.J. Knepil
To evaluate quality of life (QoL) and patients' perceptions of a domiciliary facial cooling system (Hilotherm®, Hilotherapy UK Ltd, Coventry, UK), we asked 30 patients to complete a paper-based EQ-5D-3L QoL questionnaire (EuroQol Group 1990, Rotterdam, The Netherlands) each day for seven days after the removal of mandibular third molars. They were returned by 14 of the 20 patients who had not used the system and by all 10 who had. Patients aged between 18 and 25 who had their teeth removed in outpatients (in accordance with National Institute for Health and Care Excellence guidelines) under general anaesthesia (American Association of Anesthesiologists (ASA) class I or II) and did not smoke, were included. They were all treated by the same surgeon in the day surgery unit of a district general hospital. Patients found the system helpful and easy to use. They had no complications, their QoL was significantly improved (p<0.001), and the time taken to return to normal activities was reduced. The Hilotherm® domiciliary facial cooling system is safe and helps in the management of postoperative pain and swelling. Our findings confirm recently published meta-analyses that show the effectiveness of hilotherapy after facial surgery.
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Clinicopathological features of squamous cell carcinoma of the oral cavity and oropharynx in young patients
Publication date: Available online 5 April 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): R.C.-P. Martinez, H.P. Sathasivam, B. Cosway, V. Paleri, S. Fellows, J. Adams, M. Kennedy, R. Pearson, A. Long, P. Sloan, M. Robinson
Our aim was to examine the clinicopathological features of squamous cell carcinoma (SCC) of the oral cavity and oropharynx in a group of young patients who were dignosed during a 15-year period (2000–2014). Patients' clinical details, risk factors, and survival were obtained from medical records. Formalin-fixed, paraffin-embedded, tissue was tested for high-risk human papillomavirus (HPV). The results were compared with those of a matching group of older patients. We identified 91 patients who were younger than 45 years old, and the 50 youngest patients were studied in detail. The male:female ratio was 2:1, with more tumours located in the oral cavity than in the oropharynx (35 compared with 15). HPV-related SCC was restricted to the oropharynx. When matched for site, stage and HPV status, five-year overall survival was similar in young and matched older patients (log-rank test, p=0.515). Our findings suggest that young patients with oral SCC have a disease profile similar to that of older patients with the condition. It is plausible that prognostic information generally available for oral cancers is applicable to young patients with the disease.
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“Run-through” training at specialist training year 1 and uncoupled core surgical training for oral and maxillofacial surgery in the United Kingdom: a snapshot survey
Publication date: Available online 5 April 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): M. Garg, J. Collyer, D. Dhariwal
Training in oral and maxillofacial surgery (OMFS) in the UK has undergone considerable changes during the last 10years, and "core" surgical training has replaced "basic" surgical training. In 2014 a pilot "run-through" training programme from specialist training year one (ST1)-ST7 was introduced to facilitate early entry into the speciality. Run-through training guarantees that a trainee, after a single competitive selection process and satisfactory progress, will be given training that covers the entire curriculum of the speciality, whereas uncoupled training requires a second stage of competitive recruitment after the first one (for OMFS only) or two years of "core" training to progress to higher specialty training.The first two years of run-through training (ST1-ST2) are the same as for core surgical training. Dual-qualified maxillofacial aspirants and those in their second degree course are curious to know whether they should go for the uncoupled core surgical training or the run-through programme in OMFS. The General Medical Council (GMC) has now agreed that run-through training can be rolled out nationally in OMFS. To assess the two pathways we used an online questionnaire to gain feedback about the experience from all OMFS ST3 and run-through trainees (ST3/ST4) in 2016–2017. We identified and contacted 21 trainees, and 17 responded, including seven run-through trainees. Eleven, including five of the run-through trainees, recommended the run-through training programme in OMFS. Six of the seven run-through trainees had studied dentistry first. The overall mean quality of training was rated as 5.5 on a scale 0–10 by the 17 respondents. This survey gives valuable feedback from the current higher surgical trainees in OMFS, which will be useful to the GMC, Health Education England, OMFS Specialist Advisory Committee, and those seeking to enter higher surgical training in OMFS.
https://ift.tt/2HfpB3j
Urban versus Rural Residency and Allergy Prevalence among Adult Women: Iowa Women's Health Study
The association between residence and allergy has been well studied in children living on a farm; however, studies of this association in late adulthood are lacking.
https://ift.tt/2uQNf3o
Treatment of nevoid hyperkeratosis of the areola and nipple with topical tacalcitol: A case report
Dermatologic Therapy, EarlyView.
https://ift.tt/2ErHN6K
Reconstruction of a buttock defect after excision of inflammatory linear verrucous epidermal nevus
Dermatologic Therapy, EarlyView.
https://ift.tt/2HhChqw
Impact of oncogene panel results on surgical management of cytologically indeterminate thyroid nodules
Head &Neck, EarlyView.
https://ift.tt/2qc5ZVz
Overexpression of WD repeat domain 5 associates with aggressive clinicopathological features and unfavorable prognosis in head neck squamous cell carcinoma
Journal of Oral Pathology &Medicine, EarlyView.
https://ift.tt/2qfcQ0i
Patient-specific pre-contouring of osteosynthesis plates for mandibular reconstruction: Using a three-dimensional key printed solution
Publication date: Available online 6 April 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): J. Kraeima, H.H. Glas, M.J.H. Witjes, K.P. Schepman
PurposeIn mandibular reconstructive surgery, the osteosynthesis plates require contouring according to the patients' individual anatomical situation. These plates are frequently contoured around a three-dimensional (3D) printed model. However, the translation to the actual patient can introduce inaccuracies and unwanted rotations in the condyles and mandibular ramus, due to malpositioning of the pre-contoured plate.Materials and MethodsThis article describes an easy-access method for exact translation of the pre-contoured plate to the patient's mandible. This is done by using 3D printed guides that allow pre-drilling of screw holes in both the contour model and the patients' mandible. The accuracy of the Key Printed Solution was analysed by comparing the anatomical landmarks on both the 3D planned and post-operative models.ResultsThe method was applied to 4 cases. All landmarks were identified on both the 3D planning and post-operative computed tomographic data. This showed an average deviation of 1.0 mm between planning and the post-operative result. The inter-observer variation was 0.6 mm (intra-class correlation, 0.75).ConclusionThis article presents an easy-to-use method for pre-bending the osteosynthesis plate and subsequent accurate translation of the intended contour with corresponding screw hole locations. The method was proved to be accurate and time-efficient.
https://ift.tt/2H2jQbu
sAssessment of Regional Asymmetry of the Face Before and After Surgical Correction of Unilateral Cleft Lip
Publication date: Available online 6 April 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Dhelal Al-Rudainy, Xiangyang Ju, Steve Stanton, Felicity V. Mehendale, Ashraf Ayoub
This study was carried out on 26 unilateral cleft lip and palate (UCLP) cases with mean age 3.6 ± 0.7 months.3D facial images were captured for each infant 2–3 days before the repair of cleft lip and at 4 months following surgery at a mean age of 8.2 ± 1.8 months, using a stereophotogrammetry imaging system. An iterative closest point (ICP) algorithm was used to superimpose the 3D facial model to its mirror image using VRMesh software. After the superimposition, the face model was divided into seven anatomical regions. Asymmetry of the entire face and of the anatomical regions was calculated by measuring the absolute distances between the 3D facial surface model and its mirror image. Colour maps were used to illustrate the patterns and magnitude of the facial asymmetry before and after surgery. There were significant decreases in the asymmetry scores for the nose, upper lip and the cheeks as a result of the surgical repair of cleft lips. Surgery did not change the magnitude of the asymmetry scores for the lower lip and chin.The main outcome of the findings of this innovative study is to inform the required surgical refinement of primary repair of cleft lip in order to minimise facial asymmetry and to guide secondary corrective surgery. We have presented a sensitive tool that could be used for comparative analysis of lip repair at various cleft centres.
https://ift.tt/2IxLfz1
All-In-One Surgical Guide: A New Method For Cranial Vault Resection And Reconstruction
Publication date: Available online 6 April 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Alessandro Tel, Fabio Costa, Salvatore Sembronio, Andrea Lazzarotto, Massimo Robiony
IntroductionGreat precision is required for craniofacial surgery, and computer-aided design (CAD) methods may be used to plan surgery before it is performed. In this study, three-dimensional (3D)-printed cutting guides are used to match computer models with surgical procedures. We describe a novel method of computer-aided surgery for autologous cranioplasty that includes a new strategy for generating and using cutting guides. These guides may be used not only for osteotomies, but also for many other steps in the surgical procedure.Materials and MethodsPreoperatively, anatomical data were imported into a CAD package and used for virtual surgical planning (VSP). Cutting guides were designed after considering how to integrate all the surgical steps. Models of the microplates and micro-screws were also made. Surgical guides were exported and printed, and preoperative simulations using a replica of the patient's skull established the sequence of steps. The accuracy of the procedure was evaluated postoperatively using computed tomography (CT) scans.ResultsIn every patient examined, the all-in-one surgical-guide system was able to automate the many steps in the procedure and dramatically decreased the duration of surgery. The experimental guide enhanced every phase of surgery, including excising the lesion, and harvesting, positioning, and fixing the graft. In each step, precision was enhanced and the outcome corresponded with the VSP.ConclusionsThe few previous reports on cutting guides used in cranioplasty generally describe the use of separate guides for dismantling and reconstruction. The ability to perform more surgical sequences using a single tool can improve surgical accuracy. Clearly there is no single perfect surgical guide; however, effective surgical-design strategies should be used to build the best approach to each procedure.
https://ift.tt/2H4KpNk
Special focus issue on potentially premalignant oral epithelial lesions: introduction and perspective
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Nikolaos G. Nikitakis
https://ift.tt/2GIhH1e
Introduction to the Oral and Maxillofacial Pathology focus issue on “Preneoplastic Oral Epithelial Lesions”
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Paul C. Edwards
https://ift.tt/2JrC8Bd
Microsatellite instability associated with durable complete response to PD-L1 inhibitor in head and neck squamous cell carcinoma
Survival of recurrent or metastatic Head and Neck Squamous Cell Carcinoma patients (R/M-HNSCC) is still short. The median survival time of patients treated by platinum-based chemotherapy plus cetuximab is 10.1 months [1]. Recently, nivolumab, a PD-1 inhibitor, demonstrated a gain in overall survival in pretreated R/M-HNSCC in comparison to standard treatment [2]. Other checkpoint inhibitors targeting PD-1 (pembrolizumab) or PD-L1 (atezolizumab, durvalumab) also showed activity with objective response rates ranging between 13 and 18% [3–5].
https://ift.tt/2HeWg92
Behaviors of active sunbeds users and their knowledge on the potential health risks; results of cross‐sectional study in Poland
Journal of Cosmetic Dermatology, EarlyView.
https://ift.tt/2GCqmX7
Effect of voice therapy on vocal fold polyp treatment
Abstract
Purpose
To investigate the role of voice therapy (VT) and factors that may affect the response to VT in the treatment of vocal fold polyps, especially as a complement to phonosurgery.
Methods
Retrospective review of patients with vocal fold polyp undergoing surgery and/or VT in a tertiary medical center. The demographic data, phoniatric history, videolaryngostroboscopic findings, polyp characteristics, VHI-10 and GRB scores, and voice analysis data were recorded before and after the treatment. The patients were grouped as those who had undergone endolaryngeal microsurgery only (Group S), those who had first received VT then undergone surgery due to inadequate VT outcome (Group VTpS), and those who had only undergone VT with a follow-up plan (Group VT).
Results
Data were reviewed from 211 (108 M, 103 F) patients with a mean age of 41.3 ± 11 years. The improvement in all voice-related variables observed in the S and VTpS groups was significantly greater compared to the VT group despite the degree of improvement achieved in this group. At the end of the treatment period, improvements in G-R-B, VHI-10 and stroboscopy scores were significantly greater in the VTpS group than in the S and VT groups.
Conclusion
Voice therapy can improve voice quality to some extent during the treatment of vocal fold polyps. However, VT alone is unsatisfactory compared to surgery alone. Pre-surgical VT can enhance the ultimate success of treatment. A young age, small polyps, and short duration of dysphonia may increase the possibility of benefiting from VT.
https://ift.tt/2Hg2plu
Molecular markers in well-differentiated thyroid cancer
Abstract
Purpose
Thyroid nodules are of common occurrence in the general population. About a fourth of these nodules are indeterminate on aspiration cytology placing many a patient at risk of unwanted surgery. The purpose of this review is to discuss various molecular markers described to date and place their role in proper perspective. This review covers the fundamental role of the signaling pathways and genetic changes involved in thyroid carcinogenesis. The current literature on the prognostic significance of these markers is also described.
Methods
PubMed was used to search relevant articles. The key terms "thyroid nodules", "thyroid cancer papillary", "carcinoma papillary follicular", "carcinoma papillary", "adenocarcinoma follicular" were searched in MeSH, and "molecular markers", "molecular testing", mutation, BRAF, RAS, RET/PTC, PAX 8, miRNA, NIFTP in title and abstract fields. Multiple combinations were done and a group of experts in the subject from the International Head and Neck Scientific Group extracted the relevant articles and formulated the review.
Results
There has been considerable progress in the understanding of thyroid carcinogenesis and the emergence of numerous molecular markers in the recent years with potential to be used in the diagnostic algorithm of these nodules. However, their precise role in routine clinical practice continues to be a contentious issue. Majority of the studies in this context are retrospective and impact of these mutations is not independent of other prognostic factors making the interpretation difficult.
Conclusion
The prevalence of these mutations in thyroid nodule is high and it is a continuously evolving field. Clinicians should stay informed as recommendation on the use of these markers is expected to evolve.
https://ift.tt/2uQiYSp
New Gene Test Reduces Skin Reactions to Carbamazepine
A new gene variant test to guide treatment decisions led to reductions in the incidence of cutaneous adverse reactions to carbamazepine, a new study shows.
Medscape Medical News
https://ift.tt/2EjVmFj
Gastric Emptying During the Labour
Conditions: Pregnancy; Healthy Volunteers; Parturition
Intervention: Other: Ultrasound assessment of gastric emptying of a flavoured yoghourt.
Sponsor: Hospices Civils de Lyon
Not yet recruiting
https://ift.tt/2uN286M
Intervention: Other: Ultrasound assessment of gastric emptying of a flavoured yoghourt.
Sponsor: Hospices Civils de Lyon
Not yet recruiting
https://ift.tt/2uN286M
Avelumab With Chemoradiation for Stage II/III Resectable Esophageal Cancer
Condition: Resectable Esophageal Cancer
Interventions: Combination Product: Avelumab combined with Chemoradiation; Drug: Carboplatin; Drug: Paclitaxel; Radiation: Radiation
Sponsors: University of Wisconsin, Madison; National Cancer Institute (NCI)
Not yet recruiting
https://ift.tt/2HgsmBw
Interventions: Combination Product: Avelumab combined with Chemoradiation; Drug: Carboplatin; Drug: Paclitaxel; Radiation: Radiation
Sponsors: University of Wisconsin, Madison; National Cancer Institute (NCI)
Not yet recruiting
https://ift.tt/2HgsmBw
Topical timolol for Kaposi sarcoma: An innovation
Australasian Journal of Dermatology, EarlyView.
https://ift.tt/2GCE5NI
2q24 deletion in a 9-month old girl with anal atresia, hearing impairment, and hypotonia
Publication date: June 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): Peiwei Zhao, Bing Mao, Xiaonan Cai, Jun Jiang, Zhisheng Liu, Jun Lin, Xuelian He
Deletion of 2q24.2 is a rare cytogenetic aberration in patients, exhibiting heterogeneous clinical features, and common phenotypes included developmental delay, intellectual disability, hypotonia, and mild dysmorphic features. Hearing impairment and anal atresia are rarely described. Here we described a 9-month-old female patient with hypotonia in all four limbs, developmental delay, and intellectual disability. In addition, congenital anal atresia was diagnosed and treated after birth, and hearing impairment was found in right ear. Single nucleotide polymorphisms (SNP) array detected a 5.2 Mb deletion on 2q24.2q24.3, including 19 genes (ITGB6; TBR1; SLC4A10; KCNH7 SCN3A; SCN2A et al.). Among these genes, it is affirmative that TBR1 is a causative gene for intellectual disability; however, the pathogenic genes of other phenotypes remain unclear. We briefly review the knowledge of genes likely involved in these clinical features, including hearing impairment, anal atresia, and developmental delay.
https://ift.tt/2Iz1tbi
Urban versus Rural Residency and Allergy Prevalence among Adult Women: Iowa Women's Health Study
Source:Annals of Allergy, Asthma & Immunology
Author(s): Niharika P. Patel, Anna E. Prizment, Bharat Thyagarajan, Evan Roberts, Heather H. Nelson, Timothy R. Church, DeAnn Lazovich
BackgroundThe association between residence and allergy has been well studied in children living on a farm; however, studies of this association in late adulthood are lacking.ObjectiveThis study examined the association between residence and allergy in 25,393 women aged 55-69 years in the large prospective Iowa Women's Health Study (IWHS).MethodsIWHS questionnaires collected information on socio-demographic and anthropometric characteristics, medical history, lifestyle behaviors, dietary intake, residence and allergy. Residence reported at baseline (1986) was categorized into 5 groups based on living on a farm, rural, or urban areas and population size. Allergy was determined from four self-reported questions about physician-diagnosed asthma, hay fever, skin allergy, and other allergy. Logistic regression was used to determine significant risk factors for allergy and prevalence odds ratios (OR) and 95% confidence intervals (CI) for allergy associated with residence.ResultsCompared to large city of >10,000 residents, those living on farm, rural and smaller urban areas had decreased odds ratios of overall, skin, and other allergy in age and multivariable-adjusted models. The multivariable ORs (95% CI) for farm versus large city were decreased for overall allergy: 0.72 (0.66, 0.78) and all allergy types including asthma: 0.87 (0.75, 1.00), hay fever: 0.77 (0.69, 0.88), skin: 0.76 (0.68, 0.86), and other allergy: 0.76 (0.68, 0.86).ConclusionThis study supports a hypothesis that farm living is inversely associated with allergy, suggesting that environmental exposures may protect against allergy not only in childhood, but also in late adulthood.
https://ift.tt/2H4jPnC
Asthma-chronic obstructive pulmonary disease overlap (ACO): An emerging entity in allergic respiratory diseases
Publication date: April 2018
Source:Allergology International, Volume 67, Issue 2
Author(s): Jun Tamaoki, Kenji Izuhara
https://ift.tt/2JoQPoJ
In vitro effect of Porphyromonas gingivalis combined with influenza A virus on respiratory epithelial cells
Source:Archives of Oral Biology
Author(s): Xin Li, Chen Li, Jun-chao Liu, Ya-ping Pan, Yong-gang Li
ObjectiveRespiratory epithelial cells are the first natural barrier against bacteria and viruses; hence, the interactions among epithelial cells, bacteria, and viruses are associated with disease occurrence and development. The effect of co-infection by P. gingivalis and influenza A virus (IAV) on respiratory epithelial cells remains unknown. The aim of this study was to analyze in vitro cell viability and apoptosis rates in respiratory epithelial A549 cells infected with P. gingivalis or IAV alone, or a combination of both pathogens.DesignA549 cells were first divided into a control group, a P. gingivalis group, an IAV group, and a P. gingivalis + IAV group, to examine cell viability and apoptosis rates, the levels of microtubule associated protein 1 light chain 3 B (LC3-II), microtubule associated protein 1 light chain 3A (LC3-I), and sequestosome 1 (P62), and the formation of autophagosomes. The autophagy inhibitor, 3-methyladenine (3MA), was used to assess autophagy and apoptosis in A549 cells infected with P. gingivalis or IAV.ResultsAn MTT assay revealed that cell viability was significantly lower in the IAV group than in the P. gingivalis + IAV group (P < 0.05). Flow cytometry indicated that the apoptosis rate was significantly higher in the IAV group than in the P. gingivalis + IAV group (P < 0.05). The fluorescence levels of GFP-LC3 increased significantly, the LC3-II/LC3-I ratio was significantly higher, and the P62 protein levels were statistically lower in the P. gingivalis + IAV group compared with the IAV group (all P < 0.05). Western blotting revealed that the LC3- II/LC3-I ratio was significantly lower, and caspase-3 levels were significantly higher in the 3MA + P. gingivalis + IAV group compared to the P. gingivalis + IAV group (all P < 0.05).ConclusionIn vitro studies showed that infection by P. gingivalis combined with IAV temporarily inhibited apoptosis in respiratory epithelial cells, and this may be related to the initiation of autophagy.
https://ift.tt/2qaNvWh
In vitro effect of Porphyromonas gingivalis combined with influenza A virus on respiratory epithelial cells
Source:Archives of Oral Biology
Author(s): Xin Li, Chen Li, Jun-chao Liu, Ya-ping Pan, Yong-gang Li
ObjectiveRespiratory epithelial cells are the first natural barrier against bacteria and viruses; hence, the interactions among epithelial cells, bacteria, and viruses are associated with disease occurrence and development. The effect of co-infection by P. gingivalis and influenza A virus (IAV) on respiratory epithelial cells remains unknown. The aim of this study was to analyze in vitro cell viability and apoptosis rates in respiratory epithelial A549 cells infected with P. gingivalis or IAV alone, or a combination of both pathogens.DesignA549 cells were first divided into a control group, a P. gingivalis group, an IAV group, and a P. gingivalis + IAV group, to examine cell viability and apoptosis rates, the levels of microtubule associated protein 1 light chain 3 B (LC3-II), microtubule associated protein 1 light chain 3A (LC3-I), and sequestosome 1 (P62), and the formation of autophagosomes. The autophagy inhibitor, 3-methyladenine (3MA), was used to assess autophagy and apoptosis in A549 cells infected with P. gingivalis or IAV.ResultsAn MTT assay revealed that cell viability was significantly lower in the IAV group than in the P. gingivalis + IAV group (P < 0.05). Flow cytometry indicated that the apoptosis rate was significantly higher in the IAV group than in the P. gingivalis + IAV group (P < 0.05). The fluorescence levels of GFP-LC3 increased significantly, the LC3-II/LC3-I ratio was significantly higher, and the P62 protein levels were statistically lower in the P. gingivalis + IAV group compared with the IAV group (all P < 0.05). Western blotting revealed that the LC3- II/LC3-I ratio was significantly lower, and caspase-3 levels were significantly higher in the 3MA + P. gingivalis + IAV group compared to the P. gingivalis + IAV group (all P < 0.05).ConclusionIn vitro studies showed that infection by P. gingivalis combined with IAV temporarily inhibited apoptosis in respiratory epithelial cells, and this may be related to the initiation of autophagy.
https://ift.tt/2qaNvWh
Different ventilation techniques and hemodynamic optimization to maintain regional cerebral oxygen saturation (rScO 2 ) during laparoscopic bariatric surgery: a prospective randomized interventional study
Abstract
Purpose
The purpose of this study was to assess the changes in regional cerebral oxygen saturation (rScO2) in response to different ventilation strategies: inspired oxygen concentration (FiO2), end-tidal carbon dioxide (EtCO2), and positive end expiratory pressure (PEEP) in addition to optimizing mean arterial pressure (MAP) in obese patients subjected to laparoscopic bariatric surgery in the reverse trendelenburg position.
Methods
50 obese patients were randomly assigned into one of two groups. Each group is 25 patients. Control patients subjected to a ventilation strategy aimed to maintain FiO2 0.4 and EtCO2 30 mmHg without PEEP. Study patients were assigned to specific protocol; T0, baseline rScO2; T1, 5 min following induction; T2, PP/RTP (10 min after pneumoperitoneum and reverse trendelenburg position); T3, PEEP 10 cmH2O; T4, FiO2 1.0; T5, EtCO2 40 mmHg and T6, MAP/BL; MAP back to baseline in both groups.
Main results
10 min after PP/RTP, there was a significant decrease in rScO2 in both groups. At T4, with FiO2 1.0, there was significant improvement in rScO2 when compared to T2. At T5, with EtCO2 40 mmHg, rScO2 significantly enhanced when compared to EtCO2 30 mmHg. At T4 and T5, we observed highly significance difference between both groups. At the end of the procedure and when MAP increased back to baseline (T6) in both groups, rScO2 statistically increased in both groups when compared to T2.
Conclusion
In obese patients, subjected to laparoscopic bariatric surgery in reverse trendelenburg position, adjustment of ventilation strategies and hemodynamic optimization succeeded to improve rScO2.
https://ift.tt/2IxY0cX
ILC2s in infectious diseases and organ-specific fibrosis
Abstract
Type 2 immune responses evolved to provide host protection against parasitic infections and to support the repair of infection-induced tissue injury. However, persistent chronic organ damage can result in dysregulated production of critical type 2 cytokines supporting tissue remodeling and fibrosis development. Recently, group 2 innate lymphoid cells (ILC2s) were newly described as central innate mediators of type 2 responses. In particular, by secretion of the cytokines IL-5, IL-9, and IL-13 and the growth factor amphiregulin in response to the release of tissue-derived alarmins, ILC2s have been shown to substantially contribute to both the dismissal of metazoan parasites and the repair of infection-dependent or sterile tissue damage. Conversely, cytokine production by ILC2s emerged as a driving force for tissue remodeling and excessive fibrosis in several organ systems including the lung, liver, and skin. In this review, we discuss how ILC2s are specifically implicated in the body's immune response to different pathogenic infections and how dysregulated ILC2s may promote organ-specific fibrosis.
https://ift.tt/2uNwlTy
Utility of PET-CT in detecting nodal metastasis in cN0 early stage oral cavity squamous cell carcinoma
Source:Oral Oncology, Volume 80
Author(s): Han Zhang, Hadi Seikaly, Vincent L. Biron, Caroline C. Jeffery
BackgroundManagement of the clinically node-negative neck (cN0) in patients with early stage oral cavity squamous cell carcinoma (OCSCC) is challenging. Accurate imaging alternatives to elective neck dissections would help reduce surgical morbidity. While pooled studies suggest that imaging modalities have similar accuracy in predicting occult nodal disease, no study has examined the utility of PET-CT in this specific population of low-volume, clinically T1 and T2 OCSCC patients.MethodsA retrospective review of patients in the Alberta Cancer Registry who were diagnosed with cT1 or T2N0M0 OCSCC who underwent elective unilateral or bilateral neck dissections was performed. Pre-operative PET-CT and CT necks were reviewed for number of radiographically suspicious lymph nodes. Surgical pathology reports were reviewed to obtain the total number of nodes sampled and number of malignant nodes.ResultsBetween 2009 and 2013, 148 patients were diagnosed with cT1 or T2N0M0 OCSCC. Of these, 96 patients underwent elective neck dissections. All patients underwent preoperative CT of the neck with 32 patients having undergone additional preoperative PET-CT. Based on finally surgical pathology, the overall rate of occult metastasis was 13.5% (13/96). The overall sensitivity and specificity of PET-CT in this cohort was 21.4% and 98.4%, respectively with a negative predictive value of 99.1%. Although sensitivity improved in patients with tumors ≥2 cm and depth ≥4 mm, specificity remained unchanged.ConclusionIn patients with cT1 and T2N0 OCSCC, PET-CT has high negative predictive value. These patients can be considered for treatment with single modality surgical resection and elective neck dissection.
https://ift.tt/2GFSkwU
Asthma Across the Lifespan: Time for a Paradigm Shift
Publication date: Available online 5 April 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Stanley J. Szefler
We have a unique opportunity to significantly reduce the worldwide burden of asthma in children and impact respiratory outcomes in adults. However, this will require a paradigm shift that is directed at altering the natural history of asthma, reducing asthma exacerbations and preventing long-term adverse outcomes of childhood asthma. Attention should continue to be directed toward minimizing risk as well as impairment with a goal to achieve optimal control. Based on several NIH studies conducted over the last 10 years we now have the tools necessary to accomplish this goal. The tools include: assessment of lung function over time or defining trajectories of lung growth, the Composite Asthma Severity Score (CASI), a panel of useful biomarkers, the Seasonal Asthma Exacerbation Prediction Index (SAEPI), and rapidly advancing technology that includes adherence monitoring. Future guidelines revisions should consider incorporating recommendations to follow spirometry over time and defining trajectories of lung growth to assess risk for reduced lung growth and early decline, asthma burden, using biomarkers to select and monitor therapy, assessing social determinants of health, evaluating risk for seasonal exacerbations, and consideration of electronic adherence monitoring for asthma that is difficult to manage. Guidelines should continue to include a core dedicated to the diagnosis and treatment of intermittent and mild and moderate persistent asthma and include additional sections dedicated to the management of severe asthma.
https://ift.tt/2uQU0SL
A Jagged1-Notch4 Molecular Switch Mediates Airway Inflammation by Ultrafine Particles
Publication date: Available online 5 April 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Mingcan Xia, Hani Harb, Arian Saffari, Constantinos Sioutas, Talal A. Chatila
BackgroundExposure to traffic-related particulate matter (PM) promotes asthma and allergic diseases. However, the precise cellular and molecular mechanisms by which PM exposure acts to mediate these effects remain unclear.ObjectiveWe sought to elucidate the cellular targets and signaling pathways critical for the augmentation of allergic airway inflammation induced by ambient ultra fine particles (UFP).MethodsWe employed in vitro cell culture assays using lung-derived antigen presenting cells and allergen-specific T cells, and in vivo mouse models of allergic airway inflammation that employed myeloid lineage-specific gene deletions, cellular reconstitution approaches and antibody inhibition studies.ResultsWe identified lung alveolar macrophage (AM) as the key cellular target of UFP in promoting airway inflammation. Aryl hydrocarbon receptor (AhR)-dependent induction of Jagged 1 (Jag1) expression in AM was necessary and sufficient for the augmentation of allergic airway inflammation by UFP. UFP promoted Th2 and Th17 cell differentiation of allergen-specific T cells in a Jag1- and Notch4-dependent manner. Treatment of mice with an anti-Notch 4 antibody abrogated the exacerbation of allergic airway inflammation induced by UFP.ConclusionUFP exacerbate allergic airway inflammation by promoting a Jag1-Notch4-dependent interaction between Alveolar Macrophages and Allergen-Specific T cells, leading to augmented Th cell differentiation.
Graphical abstract
Teaser
Traffic related particulate matter induce the expression of Jagged1 on alveolar macrophages in an aryl hydrocabron receptor-dependent manner, which in turn interacts with Notch4 on Allergen-Specific T cells to promote allergic airway inflammation.https://ift.tt/2HcKID9
Viral induced overproduction of epithelial TSLP: Role in exacerbations of asthma and COPD?
Source:Journal of Allergy and Clinical Immunology
Author(s): Lena Uller, Carl Persson
https://ift.tt/2uQQNCJ
A rare case of a lingual mass in a neonate
Abstract
A large lingual cyst was noted on the 22-week antenatal ultrasound, which grew in proportion to the foetus on serial imaging. An elective c-section was performed in view of possible airway obstruction, and the neonate initially required oxygen to maintain saturations. Aged 1 month, the baby developed significant breastfeeding difficulties secondary to rapid cyst and secondary tongue enlargement, completely filling the oral cavity. Fifteen millilitres of fluid were aspirated in clinic, resulting in reduction of tongue size and immediate improvement in feeding. The patient subsequently underwent surgical excision of the cyst, which filled most of the anterior two-thirds of the tongue up to the foramen caecum. Histology supported the diagnosis of lingual thyroglossal duct cyst. A rare variant of thyroglossal duct cysts, these cysts can be potentially difficult to manage. More commonly located in the tongue base, we present an even rarer variant, that of an anterior tongue cyst.https://ift.tt/2HfSY5i
Obstructive hydrocephalus secondary to odontoid pannus: case report and review of literature
Abstract
Odontoid pannus or periodontoid pseudotumour is associated with a variety of rheumatological conditions. We report a case of an 80-year old man who presented with acute hydrocephalus following an emergency operation to amputate his infected left big toe. Imaging revealed a large tissue mass causing severe compression at the cervico-medullary junction and obstruction of CSF flow. The acute hydrocephalus was presumed to be related to neck manoeuvring during general anaesthesia. Following an initial emergency CSF diversion through external ventricular drainage catheter insertion, the patient subsequently underwent ventriculo-peritoneal insertion and posterior spinal decompression and fixation. To our knowledge, there have been no reported cases of tophaceous gout of the odontoid pannus causing acute hydrocephalus.https://ift.tt/2uQkaVZ
Two patients with spontaneous transomental hernia treated with laparoscopic surgery: a review
Abstract
Here, we report two patients with transomental hernia who were successfully treated with laparoscopic surgery. The first patient was a 58-year-old female who presented to our hospital with abdominal pain and vomiting; she had no history of abdominal surgery. Enhanced computed tomography revealed strangulation ileus due to an internal hernia. The second patient was a 36-year-old male who presented to our hospital with abdominal pain and no history of abdominal surgery. Enhanced computed tomography indicated transomental hernia. Emergency laparoscopic surgery in both patients revealed incarcerated bowel loops through defects in the greater omentum. The bowel segments were laparoscopically released, and the patients were uneventfully discharged on postoperative Days 4 and 8. Laparoscopic surgery is useful for the diagnosis and treatment of small bowel obstruction due to transomental hernia through the greater omentum.https://ift.tt/2HcKOe8
Giant anorectal condyloma acuminatum of Buschke–Löwenstein presents difficult management decisions
Abstract
Condyloma acuminata, or anogenital warts, caused by human papillomavirus are the most common sexually transmitted disease. In rare cases, the disease could progress to an extensive neoplasm called Buschke–Löwenstein tumor (BLT), also known as giant condyloma acuminatum. BLT differs from normal condyloma acuminata by presenting with locally invasive growth, lack of spontaneous resolution, tendency for recurrence after treatment and potential for malignant transformation. We examine a BLT case reaching large dimensions in the anorectal region treated with neoadjuvant chemoradiation therapy and surgical excision of residual lesions. Furthermore, continuous follow-up care can help identify and prevent recurrence or malignant transformation of the tumor.https://ift.tt/2Epmnab
Laparoscopic approach to non-communicating intestinal duplication cyst in adult
Abstract
Intestinal duplication is rare congenital pathology generally diagnosed in infancy or early childhood. Presentation in adults is extremely rare. We present a case of a 36-year-old otherwise healthy female patient without any past medical history. She presented with a month of lower abdominal pain, clinical examination revealed pain and a palpable mass in the lower abdomen. CT scan confirmed a cystic mass dependent of the cecum wall and colonoscopy showed an extrinsic compression of the lateral wall of the ascending colon. However, the mucosa and the rest of the colon appeared normal. Since pain became more intense laparoscopy was performed and a cystic mass dependent on the cecum was discovered. Laparoscopic hemicolectomy was performed. Patient underwent full recovery. On follow up controls, pathology described intestinal cystic duplication of the colonic wall.https://ift.tt/2HfSV9C
Mitral valve replacement for Libman–Sacks endocarditis in a patient with antiphospholipid syndrome secondary to systemic lupus erythematosus
Abstract
Libman–Sacks endocarditis is a relatively rare sterile verrucous vegetative lesion observed in systemic lupus erythematosus (SLE)/antiphospholipid syndrome (APLS) patients. Most patients with this condition are asymptomatic. Here we report a case of a 46-year-old woman with APLS secondary to SLE complicated with frequent thromboembolic events due to a mitral valve mass. We performed minimally invasive mitral valve replacement with a mechanical prosthetic valve, and she was successfully discharged 14 days after surgery. Thus, Libman–Sacks endocarditis may be an indication for mitral valve replacement.https://ift.tt/2EmjtD7
Inguinal hernia causing extrinsic compression of bilateral ureters leading to chronic obstructive uropathy
Abstract
Ureteral inguinal hernias are a well-documented cause of obstructive uropathy with ureteric involvement in the hernia sac. In this unique case, the left-sided inguinal hernia causes extrinsic compression of bilateral ureters outside of the hernia sac leading to chronic obstructive uropathy, which is demonstrated on non-contrast CT and cystogram. This patient was managed with nephrostomy and subsequently antegrade stenting with nephrostomy removal. Prior to nephrostomy removal, nephrostogram demonstrated tapering of the left ureter in the pelvis. The patient's renal function continues to improve and is awaiting repair if his inguinal hernia after which he will have his ureteric stent removed.https://ift.tt/2HfT9gY
Massive chronic irreducible rectal prolapse successfully treated with Altemeier’s procedure
Abstract
The guideline for the treatment of rectal prolapse recommends that surgeons select appropriate surgical procedures individually based on each patient's overall status. However, in cases of irreducible or incarcerated rectal prolapse, surgical options are quite limited. Here we present a case of an elderly woman with massive chronic irreducible rectal prolapse. An 87-year-old woman presented to our hospital with a complaint of massive rectal prolapse. The prolapsed rectum was over 20 cm long, and completely irreducible. She underwent perineal rectosigmoidectomy with levatorplasty known as Altemeier's procedure. More than 30 cm of rectosigmoid colon was resected. After the operation, rectal prolapse was resolved completely. Her postoperative course was uneventful, and her quality of life and bowel movements improved. She has since been healthy without recurrence for over 2 years. Altemeier's procedure is applicable even in cases of irreducible rectal prolapse and features acceptable safety and a satisfactory outcome.https://ift.tt/2Eoq9kt
Abdominal wall extra-adrenal myelolipoma, a case report and review of the literature
Abstract
Extra-adrenal myelolipomas (EAMLs) are extremely rare soft tissue tumours that constitute <15% of all myelolipomas. We present a 70-year-old patient with a midline swelling of the anterior abdominal wall. It was clinically diagnosed as an incisional hernia, though the computerized scan indicated an internal hernia. During laparoscopy a soft tissue tumour of the abdominal wall was identified and excised. Pathology confirmed an extra-adrenal myelolipoma of the anterior abdominal wall through the presence of adipocytes and trilineage haematopoetic cell lines. EAMLs are rare mesenchymal soft tissue tumours with less than a hundred cases reported in the English literature. Pathological diagnosis shows the presence of mature adipocytes as well as myeloid and erythroid cell lines. This is the first case report of an EAML of the anterior abdominal wall. This case report is made even more rare as it is present in a male patient.https://ift.tt/2HfSPig
Paraganglioma or pheochromocytoma? A peculiar diagnosis
Abstract
Paragangliomas and pheochromocytomas are rare catecholamine secreting neoplasms that arise in the extra-adrenal autonomic paraganglia and adrenal medulla, respectively. Although typically presenting with paroxysms of headaches, palpitations, diaphoresis and hypertension, a broad spectrum of clinical manifestations may occur. Diagnosis relies on biochemical studies followed by adequate imaging investigation. Cross sectional morphological and functional imaging modalities have improved diagnostic accuracy and are crucial in the surgical planning. The authors report on a case of a 64-year-old female that presented with severe hypertension, palpitations and fatigue as the manifestations of a catecholamine secreting neoplasm. Abdominal contrast enhanced computer tomography revealed a right sided 78 mm adrenal medullary tumor suggestive of a pheochromocytoma. Standard therapeutical strategies were initially unsuccessful, and additional investigation and therapy were required to cure the patient. The challenges faced by the multidisciplinary team in the pre-operative evaluation, medical management and surgical treatment are reported.https://ift.tt/2uQ3ZYH
CGRP Monoclonal Antibodies for the Preventative Treatment of Migraine
Abstract
Purpose of Review
CGRP is a key neuropeptide in migraine pathophysiology. The blockade of the CGRP pathway at the side of the CGRP receptor of the CGRP peptide leads to the interruption of trigeminal nerve system-mediated headache syndromes such as migraine. Monoclonal antibodies (mAbs) targeting the CGRP pathway have been developed and are currently under investigation for episodic (EM) and chronic migraine (CM) prevention. Here, we report data from these clinical trials.
Recent Findings
Placebo-controlled, randomized double-blind phase studies of CGRP mAbs in episodic and chronic migraine have shown that the specific blockade of the peptide or the CGRP receptor are both powerful mechanisms to reduce migraine frequency. Along with the reduction of acute migraine-specific medication intake, early onset of efficacy of mAbs has been demonstrated. Most common adverse events are injection sider reactions. Depending on the mAb, the administration mode is a monthly or even less frequently s.c. or I.V. formulation.
Summary
Phase II studies in EM and CM demonstrate that CGRP mAbs are effective anti-migraine preventatives with a beneficial adverse event profile. Further detailed results from larger phase III clinical trials are expected soon.
https://ift.tt/2qbDCad
Clinical utility of dynamic-enhanced MRI in salivary gland tumors: retrospective study and literature review
Abstract
Purpose
To improve the diagnoses of the salivary gland tumors, a dynamic-enhanced MRI (dMRI) was investigated.
Methods
We conducted a retrospective chart review of 93 cases of salivary gland tumors. The histological diagnoses were obtained from all patients using a surgical specimen and/or an open biopsy specimen. The dMRI as well as fine-needle aspiration cytology (FNAC) and intraoperative frozen section (IFS) were analyzed. This study focused on the time-intensity curve (TIC) after injection, peak time (Tpeak), washout ratio (WR) as well as the gradient of enhancement and washout profile.
Results
The histological diagnoses included pleomorphic adenoma (PMA) in 53 cases, the Warthin tumors (WT) in 14 cases and malignant tumors (MT) in 26 cases. Incorrect diagnosis rate of FNAC and IFS were 5.2 and 8.3%, respectively. The TIC revealed differences among the three types of tumors. Tpeak as well as WR also revealed significant differences (p < 0.001). Tpeak were lower in order of WT, MT, PMA, respectively. WR of TICs at 30, 45 and 105 s after Tpeak were higher in order of WT, MT, PMA, respectively (p < 0.001). The gradient of increment and washout in the TIC curve was also an important parameter to distinguish the three types of tumors. In MT, the rapid enhancement pattern was found in high or intermediate histological grade tumors, whereas the slow enhancement pattern was exhibited in low grade tumors.
Conclusions
Our findings indicate that using Tpeak and WR, it is possible to distinguish between WT, PMA and MT. Additionally, a rapid enhancement pattern may be a potential marker for these tumors.
https://ift.tt/2JoWOKq
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