Thyroid, Ahead of Print.
https://ift.tt/2r3dU8g
Πέμπτη 26 Απριλίου 2018
American Thyroid Association Guidelines and Statements: Past, Present, and Future
Over- and Under-Treatment of Hypothyroidism Is Associated with Excess Mortality: A Register-Based Cohort Study
Thyroid, Ahead of Print.
https://ift.tt/2Hy1nEA
Preparation of the Secretory Recombinant ALV-J gp85 Protein Using Pichia pastoris and Its Immunoprotection as Vaccine Antigen Combining with CpG-ODN Adjuvant
Viral Immunology, Ahead of Print.
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Cell Biology of T Cell Receptor Expression and Regulation
Annual Review of Immunology, Volume 36, Issue 1, Page 103-125, April 2018.
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Immune Responses to Retroviruses
Annual Review of Immunology, Volume 36, Issue 1, Page 193-220, April 2018.
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ZAP-70 in Signaling, Biology, and Disease
Annual Review of Immunology, Volume 36, Issue 1, Page 127-156, April 2018.
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IgA Function in Relation to the Intestinal Microbiota
Annual Review of Immunology, Volume 36, Issue 1, Page 359-381, April 2018.
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Apoptosis and Clearance of Apoptotic Cells
Annual Review of Immunology, Volume 36, Issue 1, Page 489-517, April 2018.
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Autophagy and Inflammation
Annual Review of Immunology, Volume 36, Issue 1, Page 73-101, April 2018.
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Regulation of the Cell Biology of Antigen Cross-Presentation
Annual Review of Immunology, Volume 36, Issue 1, Page 717-753, April 2018.
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Antigen Presentation by Extracellular Vesicles from Professional Antigen-Presenting Cells
Annual Review of Immunology, Volume 36, Issue 1, Page 435-459, April 2018.
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Host Control of Fungal Infections: Lessons from Basic Studies and Human Cohorts
Annual Review of Immunology, Volume 36, Issue 1, Page 157-191, April 2018.
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Self-Reactive B Cells in the Germinal Center Reaction
Annual Review of Immunology, Volume 36, Issue 1, Page 339-357, April 2018.
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Immune Responses in the Liver
Annual Review of Immunology, Volume 36, Issue 1, Page 247-277, April 2018.
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The Formation and Function of Granulomas
Annual Review of Immunology, Volume 36, Issue 1, Page 639-665, April 2018.
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The Immune Response to Mycobacterium tuberculosis in HIV-1-Coinfected Persons
Annual Review of Immunology, Volume 36, Issue 1, Page 603-638, April 2018.
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Human T Cell Leukemia Virus Type 1: Persistence and Pathogenesis
Annual Review of Immunology, Volume 36, Issue 1, Page 43-71, April 2018.
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Genetics of Natural Killer Cells in Human Health, Disease, and Survival
Annual Review of Immunology, Volume 36, Issue 1, Page 519-548, April 2018.
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Evolution of Alternative Adaptive Immune Systems in Vertebrates
Annual Review of Immunology, Volume 36, Issue 1, Page 19-42, April 2018.
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Connections Between Metabolism and Epigenetics in Programming Cellular Differentiation
Annual Review of Immunology, Volume 36, Issue 1, Page 221-246, April 2018.
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Rebooting Human Immunology
Annual Review of Immunology, Volume 36, Issue 1, Page 843-864, April 2018.
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Exploiting Nanobodies’ Singular Traits
Annual Review of Immunology, Volume 36, Issue 1, Page 695-715, April 2018.
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Immune Response to Dengue and Zika
Annual Review of Immunology, Volume 36, Issue 1, Page 279-308, April 2018.
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Antibody-based vaccine strategies against intracellular pathogens
Arturo Casadevall
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Lymphatic endothelial progenitor cells: origins and roles in lymphangiogenesis
Jan Kazenwadel | Natasha L Harvey
https://ift.tt/2vSxd9S
Extended IgE profile based on an allergen macroarray: a novel tool for precision medicine in allergy diagnosis
Precision medicine (PM) is changing the scope of allergy diagnosis and treatment. An in vitro IgE assay, a prototype PM method, was developed in the sixties and has garnered increasing interest because of the ...
https://ift.tt/2HPvZ3U
High dimensional immune biomarkers demonstrate differences in phenotypes and endotypes in food allergy and asthma
Advances in high throughput technologies and big data analytics are rapidly increasing our understanding of the role of various immune cells and factors associated with atopic disease beyond the Th1/Th2 axis. Many children and adults with atopy can suffer from co-morbid conditions like having food allergy and chronic asthma, which can increase the risk of anaphylaxis and fatal reactions to a food allergen. Further understanding of the contributions and roles of the different immune cell subsets would be of great value in understanding the food allergy-asthma co-morbid clinical phenotype.
https://ift.tt/2I2lrMl
From the pages of allergywatch June 2018
Allergic contact dermatitis (ACD) is a common condition in children, and may become a recurrent and chronic problem. Patch testing is the standard for diagnosis of ACD. The authors review their center's 10-year experience with pediatric patch testing. From 2005 to 2015, 157 children and adolescents underwent patch testing at the authors' dermatology department. Test procedures followed North American Contact Dermatitis Group standards. The median patient age was 13 years; 58.6% were female. Symptoms were present for 6 months to 2 years in about one-third of patients, and longer than 2 years in nearly half.
https://ift.tt/2FkeFyS
A combination of skeletal deformations of the dorsal mandible and temporomandibular region detected in orthopantomograms of patients with neurofibromatosis type 1 indicates an associated ipsilateral plexiform neurofibroma
Neurofibromatosis type 1 (NF1) is a tumour suppressor syndrome and also a bone disease. In the craniofacial region, local skeletal deformities have been recorded in patients with NF1. Obvious syndrome-related alterations of the jaws are particularly conspicuous in the mandible. Here we aimed to analyse the mandibular alterations of NF1-affected individuals from orthopantomograms (OPGs).
https://ift.tt/2vMP1TP
Characteristics of tinnitus found in anemia patients and analysis of population-based survey
This study analyzed the characteristics of tinnitus identified in anemia patients with cohort- and population-based studies in a single institute and suggests a management algorithm.
https://ift.tt/2HRkoS1
Inside EMS Podcast: Is intubation dead in EMS?
Download this podcast on iTunes, SoundCloud or via RSS feed In this Inside EMS Podcast episode, co-hosts Chris Cebollero and Kelly Grayson discuss the practice of airway management. Is intubation dead in EMS, and have we entered the world of supraglottic airways" Let us know your thoughts in the comment section below. Learn more about the EMS1 Academy and schedule a free demo.
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Have Laryngologists Found One More Disease to Treat With a Flexible Laryngoscope and a Needle?—Reply
In Reply We thank Dr Bradley for his commentary regarding our recently published article, "Serial In-Office Intralesional Steroid Injections in Airway Stenosis." We agree with his comment highlighting how advances in one discipline can forward another, and that the treatment of scarring has been well studied. Applying proven treatments for scarring in other locations of the body is prudent, and we foresee the application of a number of newer treatments for scarring (ie, flourourocil) in airway stenosis. We acknowledge the lack of a true control group in this particular study. In addition, we appreciate that it is not clear how many total injections are required to effect positive changes for any given patient. With future evaluation of a larger cohort, we anticipate elucidating this more clearly and will likely be able to target different etiologic subgroups more specifically. Recognizing that intralesional steroid injections for airway stenosis will not be a panacea, patients with different etiologies of subglottic stenosis will need to be treated slightly differently, tailoring treatment to the patient's disease. We use intralesional steroid injections largely in 3 different ways. The first is as an adjuvant after an endoscopic procedure; this is done for patients in all etiologic subgroups. For patients in the traumatic subgroup for whom intralesional steroid injection is effective (ie, without significant cartilage collapse), ongoing intervention may not be required because they do not have a relapsing disorder. On the other hand, patients with inflammatory causes of stenosis, who have a high chance of recurrence, can benefit from adjuvant injections after surgery as well as maintenance injections for early recurrence. Recent reports aimed at identifying the etiology of idiopathic subglottic stenosis (iSGS), have suggested a local, inflammatory, immune response. The early stage of recurrence in both iSGS and rheumatologic-types of stenosis is granulation and erythema in the subglottis, followed by healing with fibrosis. Intervention with intralesional steroid injections (or potentially another immune modulator) at this early stage may alter wound healing, avoid scar formation, and therefore circumvent the need for surgical intervention. Several studies have shown efficacy, safety, and tolerance in patients with iSGS in addition to reducing the need for surgical treatment. Last, as previously observed, we have seen steroid injections dissolve scar tissue that has already formed, therefore obviating the need for surgical intervention in some patients when presenting without critical stenosis. Investigating alternative treatments for scarring is relevant in subglottic stenosis, but we also suggest exploring ways to pharmacologically modulate the inflammatory phase of the disease.
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https://ift.tt/2r1hj8c
Extending the Ear-Kidney Association to Presbycusis
Understanding the causes of presbycusis is a major goal of health research because it is such a common human condition. The ear-kidney association has been known at least since the early 20th century, when the Alport and branchio-oto-renal syndromes were described. It was also noted that the cochlea and kidney share the presence of pericytes and podocytes in the glomeruli and inner ear, indicating similarities in microcirculation. The ear and kidney have in common some forms of organ-specific toxic effects (eg, due to treatment with aminoglycosides or cisplatin), and both organs are actively engaged in ion transport functions to maintain homeostasis. On the other hand, there has been little evidence that the ear-kidney association might be important in presbycusis.
https://ift.tt/2vRqcpG
https://ift.tt/2vRqcpG
Hearing Aid Use and Health Care Costs Among Older Adults
A number of studies have attempted to quantify the cost of hearing loss, including ones using the same data source but an earlier time. A systematic review that summarized many of these findings documented the financial results of hearing loss, but also highlighted the variability across studies and lack of standardization of how hearing loss is defined when using large data sets. Fewer data are available, however, on whether the use of hearing aids (HAs) mitigates, attenuates, or contributes to these costs. Given the lack of data, the increasing numbers of older adults who might benefit from the use of HAs and the current lack of health care coverage for hearing health care, Mahmoudi et al is exploring an important topic in this issue of JAMA Otolaryngology–Head and Neck Surgery. Elucidating the outcomes of HA use on health care costs could provide valuable data for those designing health care policy. The findings are interesting, yet raise a number of issues that could inform data interpretation as well as highlight additional research priorities.
https://ift.tt/2r0vJVY
https://ift.tt/2r0vJVY
Have Laryngologists Found One More Disease to Treat With a Flexible Laryngoscope and a Needle?
To the Editor "Learning and innovation go hand in hand. The arrogance of success is to think that what you did yesterday will be sufficient for tomorrow."—William Pollard
https://ift.tt/2vOVq0H
https://ift.tt/2vOVq0H
Cystatin C and 20-Year Incidence of Hearing Impairment
This longitudinal, population-based study uses data from the Epidemiology of Hearing Loss Study to investigate the association between cystatin C, both as an independent biomarker and as a marker of kidney function, and the 20-year incidence of hearing impairment in a cohort of middle-aged and older adults.
https://ift.tt/2r7A4XR
https://ift.tt/2r7A4XR
Hearing Aid Use and Health Care Use and Cost Among Older Adults With Hearing Loss
This population-based cohort study of older adults with hearing loss evaluates the association of hearing aid use and health care use and cost.
https://ift.tt/2vL8zru
https://ift.tt/2vL8zru
Effect of Perioperative Gabapentin Use in Patients Undergoing Head and Neck Mucosal Surgery
This randomized clinical trial investigates the effect of perioperative gabapentin treatment vs placebo on postsurgical pain in patients undergoing head and neck mucosal surgery.
https://ift.tt/2Jvopst
https://ift.tt/2Jvopst
Severe caries are a clue for child neglect: a case report
Child abuse and neglect have strong negative effects on the well-being of children, not only during childhood but also later in life. Therefore, early recognition is important.
https://ift.tt/2FmPZWw
The importance of endoscopic ultrasound fine-needle aspiration in the diagnosis of solid pseudopapillary tumor of the pancreas: two case reports
Solid pseudopapillary tumor of the pancreas, otherwise known as solid and cystic tumor or Frantz tumor, is an unusual form of pancreatic carcinoma, with unknown etiopathogenesis, that accounts for 0.2 to 2.7% ...
https://ift.tt/2I1xRUQ
Data Literacy in der Medizin
Zusammenfassung
Hintergrund
Die digitale Transformation des Gesundheitssystems verändert den Beruf des Arztes. Data Literacy wird hierbei als eine der führenden Zukunftskompetenzen erachtet, findet jedoch derzeit weder in den implementierten Curricula des Medizinstudiums noch in den aktuell laufenden Reformprozessen (Masterplan Medizinstudium 2020 und Nationaler Kompetenzbasierter Lernzielkatalog) Beachtung.
Ziel
Der Beitrag möchte zum einen die Aspekte beleuchten, die im Begriff der Data Literacy im medizinischen Kontext gebündelt werden. Zum andern wird ein Lehrkonzept vorgestellt, das Data Literacy im Zeichen der digitalen Transformation erstmals im Medizinstudium abbildet.
Material und Methoden
Das Blended-Learning-Curriculum „Medizin im digitalen Zeitalter" adressiert in 5 Modulen den diversen Transformationsprozess der Medizin von digitaler Kommunikation über Smart Devices und medizinische Apps, Telemedizin, virtuelle/augmentierte und robotische Chirurgie bis hin zu individualisierter Medizin und Big Data. Diese Arbeit stellt Konzept und Erfahrungen der erstmaligen Implementierung des 5. Moduls dar, welches transdisziplinär und integrativ den Aspekt Data Literacy erläutert.
Ergebnisse
Die Evaluation des Kurskonzepts erfolgte sowohl qualitativ als auch quantitativ und demonstriert einen Kompetenzgewinn in den Bereichen Wissen und Fertigkeiten sowie eine differenziertere Haltung nach Kursabschluss.
Schlussfolgerungen
Die curriculare Integration von Data Literacy ist eine transdisziplinäre und longitudinale Aufgabe. Bei der Entwicklung dieser Curricula sollten die hohe Geschwindigkeit des Veränderungsprozesses der digitalen Transformation beachtet und die curriculare Anpassung im Sinne eines Agility by Design bereits bei der Konzeption adressiert werden.
https://ift.tt/2vTsTas
E-Health-Angebote in der Onkologie
Zusammenfassung
Hintergrund
Die krankheits- und behandlungsbedingten Belastungen von Krebserkrankungen gehen in der Regel mit deutlichen Beeinträchtigungen der Lebensqualität der Betroffenen einher. Durch die starke Verbreitung des Internets in deutschen Haushalten stellen onkologische E‑Health-Angebote eine schnelle und einfach zugängliche mögliche Quelle der Unterstützung für Patienten und Angehörige dar. Angebote für Behandler umfassen z. B. Informationsportale, die Behandler auf die Bedürfnisse von Krebspatienten vorbereiten. Die Zukunft von onkologischen E‑Health Angeboten scheint in der Entwicklung von Angeboten für das Smartphone zu liegen.
Ziel
Die Autoren beschreiben E‑Health-Angebote in der Onkologie, v. a. hinsichtlich Form und Inhalt, Inanspruchnahme und Wirksamkeit.
Diskussion/Schlussfolgerung
In der Literatur ist eine große Anzahl von Studien zu finden, die Prozess und Outcome von E‑Health-Interventionen evaluieren. Jedoch wird weiterhin ein Bedarf für gut designte höherwertige RCTs (randomisierte kontrollierte Studien) konstatiert, unter anderem um genauere Aussagen zur Wirksamkeit der Angebote treffen zu können. Häufig berichtete Probleme der E‑Health-Angebote sind hohe Dropout-Raten und ein Nachhohlbedarf bei der bisher weitgehend fehlenden Implementierung der in Studien erprobten Ansätze in die Versorgungspraxis. Das Einbeziehen von potenziellen Zielgruppen in den Entwicklungsprozess der Angebote könnte hilfreich sein, um das Auftreten von hohen Dropout-Raten und Usability-Problemen zu vermindern und sicherzustellen, dass die Angebote dem Bedarf der Patienten entsprechen.
https://ift.tt/2HQKGDL
Oral Mycosis Fungoides: A Report of Three Cases and Review of the Literature
Abstract
Mycosis fungoides (MF) and Sézary syndrome are clonal T-cell proliferations that exhibit skin homing and represent the majority of cutaneous T-cell lymphomas. Early MF is a diagnostic challenge as both the clinical and microscopic features often mimic benign inflammatory conditions. Oral MF is very rare and has been associated in the past with advanced disease and a poor prognosis. Skin lesions are present for an average of > 6 years before oral involvement occurs. The clinical appearance is highly variable with tongue, palate and gingiva most often affected. We report 3 additional cases of oral MF, including one in which oral lesions are the initial disease presentation. Survival in patients presenting with oral MF is improving and can be attributed to advances in therapy.
https://ift.tt/2vUqzjc
Measuring Depth of Invasion in Early Squamous Cell Carcinoma of the Oral Tongue: Positive Deep Margin, Extratumoral Perineural Invasion, and Other Challenges
Abstract
The 8th edition of American Joint Committee on Cancer (AJCC 8th) staging manual incorporated depth of invasion (DOI) into pT stage of oral cavity cancer. The aim of this study was to characterize several histological findings that may complicate measurement of DOI in early conventional squamous cell carcinomas (SCC) of the oral tongue: (1) lack of or minimal residual carcinoma following biopsy; (2) positive deep margin; (3) extratumoral perineural invasion (PNI); and (4) lymphatic or vascular invasion. Conventional SCC of the oral tongue (n = 407) with the largest dimension of ≤ 4 cm and with a negative elective cervical lymph node dissection (pN0) were reviewed. A clear plastic ruler was used to measure DOI by dropping a "plumb line" to the deepest point of the invasive tumor from the level of the basement membrane of the normal mucosa closest to the invasive tumor. Examples of identifying reference point on the mucosal surface of oral tongue from which to measure the DOI are illustrated. In the experience of one contributing institution, the residual carcinoma was absent in 14.2% of glossectomies (34/239), while in 4.8% of cases (10/205) there was only minimal residual carcinoma. In 11.5% (21/183) of pT2 cases the deep margin was positive and thus DOI and pT may be underestimated. Of all cases with PNI, extratumoral PNI was identified in 23.1% (31/134) of cases, but represented the deepest point of invasion in only two cases. In one case, lymphatic invasion represented the deepest point of invasion and could have led to upstaging from pT1 to pT2. In conclusion, DOI measurement for SCC of the oral tongue may require re-examination of the diagnostic biopsy in up to 20% of cases due to the absence or only minimal residual carcinoma in glossectomy specimens. In 11.5% of apparently pT2 cases, DOI may be underestimated due to the positive deep margin. Rarely, extratumoral PNI or lymphatic invasion may be the deepest point of invasion. Overall, two issues (absent or minimal residual disease and positive deep margin) may confound DOI measurement in early SCCs of oral tongue.
https://ift.tt/2r2mC7i
Oral Mycosis Fungoides: A Report of Three Cases and Review of the Literature
Abstract
Mycosis fungoides (MF) and Sézary syndrome are clonal T-cell proliferations that exhibit skin homing and represent the majority of cutaneous T-cell lymphomas. Early MF is a diagnostic challenge as both the clinical and microscopic features often mimic benign inflammatory conditions. Oral MF is very rare and has been associated in the past with advanced disease and a poor prognosis. Skin lesions are present for an average of > 6 years before oral involvement occurs. The clinical appearance is highly variable with tongue, palate and gingiva most often affected. We report 3 additional cases of oral MF, including one in which oral lesions are the initial disease presentation. Survival in patients presenting with oral MF is improving and can be attributed to advances in therapy.
https://ift.tt/2vUqzjc
Immunotherapy in Combination With Chemoradiation in Patients With Advanced Solid Tumors
Conditions: Carcinoma, Squamous Cell of Head and Neck; Carcinoma, Non-Small-Cell Lung; Small Cell Lung Carcinoma
Interventions: Drug: Durvalumab; Drug: Tremelimumab; Drug: Cisplatin (dose level 4); Drug: Cisplatin (dose level 3); Drug: Carboplatin (dose level 1); Drug: Carboplatin (dose level 2); Drug: Etoposide (dose level 1); Drug: Etoposide (dose level 2); Drug: Paclitaxel; Drug: Pemetrexed; Radiation: External beam radiation (dose level 1); Radiation: External beam radiation (dose level 2); Radiation: External beam radiation (hyperfractionated); Drug: Cisplatin (dose level 1); Drug: Cisplatin (dose level 2); Radiation: External beam radiation (standard)
Sponsor: AstraZeneca
Not yet recruiting
https://ift.tt/2JuoLj3
Interventions: Drug: Durvalumab; Drug: Tremelimumab; Drug: Cisplatin (dose level 4); Drug: Cisplatin (dose level 3); Drug: Carboplatin (dose level 1); Drug: Carboplatin (dose level 2); Drug: Etoposide (dose level 1); Drug: Etoposide (dose level 2); Drug: Paclitaxel; Drug: Pemetrexed; Radiation: External beam radiation (dose level 1); Radiation: External beam radiation (dose level 2); Radiation: External beam radiation (hyperfractionated); Drug: Cisplatin (dose level 1); Drug: Cisplatin (dose level 2); Radiation: External beam radiation (standard)
Sponsor: AstraZeneca
Not yet recruiting
https://ift.tt/2JuoLj3
Case 13-2018: A 53-Year-Old Man with Cardiomyopathy and Recurrent Ventricular Tachycardia
Presentation of Case. Dr. Timothy W. Churchill: A 53-year-old man was admitted to this hospital because of shock and recurrent ventricular tachycardia after defibrillator placement for nonischemic cardiomyopathy. The patient had been in his usual state of health until 4 weeks before this admission,…
https://ift.tt/2HPlLRb
Combining Intraoral Scans, Cone Beam Computed Tomography and Face Scans: The Virtual Patient
Purpose: The aim of this literature review was to provide an update on the current scientific knowledge in the field of 3D virtual patient science and to identify a possible easy, smart, and affordable method to combine different file formats obtained from different digital devices. Methods: Electronic searches of the Medline database was performed, up to May 2017, for articles dealing with the construction of a 3D virtual patient; the matching of data acquired with different digital devices (cone beam computed tomography, CBCT; face scanner, FS; intraoral scanner, IOS; and desktop scanner, DS) was considered. The inclusion of studies was based on the superimposition of at least 2 different digital sources. Results: Twenty-five studies were selected for subsequent examination. Only 3 studies analyzed the feasibility of superimposition of 3 different types of 3D data (CBCT + FS + IOS/DS). The most frequently used matching procedure was between CBCT and FS and CBCT and IOS/DS. Conclusion: The procedure of superimposition of data from CBCT, IOS, and FS is currently feasible and it is now possible to create a 3D "virtual patient" to better diagnose, plan the treatment, and communicate with patients. Address correspondence and reprint requests to Francesco Guido Mangano, DDS, PhD, Piazza Trento 4, 22015 Gravedona (Como), Italy; E-mail: francescomangano1@mclink.net Received 6 November, 2017 Accepted 27 January, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2HV3Fgz
https://ift.tt/2HV3Fgz
Measuring Depth of Invasion in Early Squamous Cell Carcinoma of the Oral Tongue: Positive Deep Margin, Extratumoral Perineural Invasion, and Other Challenges
Abstract
The 8th edition of American Joint Committee on Cancer (AJCC 8th) staging manual incorporated depth of invasion (DOI) into pT stage of oral cavity cancer. The aim of this study was to characterize several histological findings that may complicate measurement of DOI in early conventional squamous cell carcinomas (SCC) of the oral tongue: (1) lack of or minimal residual carcinoma following biopsy; (2) positive deep margin; (3) extratumoral perineural invasion (PNI); and (4) lymphatic or vascular invasion. Conventional SCC of the oral tongue (n = 407) with the largest dimension of ≤ 4 cm and with a negative elective cervical lymph node dissection (pN0) were reviewed. A clear plastic ruler was used to measure DOI by dropping a "plumb line" to the deepest point of the invasive tumor from the level of the basement membrane of the normal mucosa closest to the invasive tumor. Examples of identifying reference point on the mucosal surface of oral tongue from which to measure the DOI are illustrated. In the experience of one contributing institution, the residual carcinoma was absent in 14.2% of glossectomies (34/239), while in 4.8% of cases (10/205) there was only minimal residual carcinoma. In 11.5% (21/183) of pT2 cases the deep margin was positive and thus DOI and pT may be underestimated. Of all cases with PNI, extratumoral PNI was identified in 23.1% (31/134) of cases, but represented the deepest point of invasion in only two cases. In one case, lymphatic invasion represented the deepest point of invasion and could have led to upstaging from pT1 to pT2. In conclusion, DOI measurement for SCC of the oral tongue may require re-examination of the diagnostic biopsy in up to 20% of cases due to the absence or only minimal residual carcinoma in glossectomy specimens. In 11.5% of apparently pT2 cases, DOI may be underestimated due to the positive deep margin. Rarely, extratumoral PNI or lymphatic invasion may be the deepest point of invasion. Overall, two issues (absent or minimal residual disease and positive deep margin) may confound DOI measurement in early SCCs of oral tongue.
https://ift.tt/2r2mC7i
Oral Mycosis Fungoides: A Report of Three Cases and Review of the Literature
Abstract
Mycosis fungoides (MF) and Sézary syndrome are clonal T-cell proliferations that exhibit skin homing and represent the majority of cutaneous T-cell lymphomas. Early MF is a diagnostic challenge as both the clinical and microscopic features often mimic benign inflammatory conditions. Oral MF is very rare and has been associated in the past with advanced disease and a poor prognosis. Skin lesions are present for an average of > 6 years before oral involvement occurs. The clinical appearance is highly variable with tongue, palate and gingiva most often affected. We report 3 additional cases of oral MF, including one in which oral lesions are the initial disease presentation. Survival in patients presenting with oral MF is improving and can be attributed to advances in therapy.
https://ift.tt/2vUqzjc
Measuring Depth of Invasion in Early Squamous Cell Carcinoma of the Oral Tongue: Positive Deep Margin, Extratumoral Perineural Invasion, and Other Challenges
Abstract
The 8th edition of American Joint Committee on Cancer (AJCC 8th) staging manual incorporated depth of invasion (DOI) into pT stage of oral cavity cancer. The aim of this study was to characterize several histological findings that may complicate measurement of DOI in early conventional squamous cell carcinomas (SCC) of the oral tongue: (1) lack of or minimal residual carcinoma following biopsy; (2) positive deep margin; (3) extratumoral perineural invasion (PNI); and (4) lymphatic or vascular invasion. Conventional SCC of the oral tongue (n = 407) with the largest dimension of ≤ 4 cm and with a negative elective cervical lymph node dissection (pN0) were reviewed. A clear plastic ruler was used to measure DOI by dropping a "plumb line" to the deepest point of the invasive tumor from the level of the basement membrane of the normal mucosa closest to the invasive tumor. Examples of identifying reference point on the mucosal surface of oral tongue from which to measure the DOI are illustrated. In the experience of one contributing institution, the residual carcinoma was absent in 14.2% of glossectomies (34/239), while in 4.8% of cases (10/205) there was only minimal residual carcinoma. In 11.5% (21/183) of pT2 cases the deep margin was positive and thus DOI and pT may be underestimated. Of all cases with PNI, extratumoral PNI was identified in 23.1% (31/134) of cases, but represented the deepest point of invasion in only two cases. In one case, lymphatic invasion represented the deepest point of invasion and could have led to upstaging from pT1 to pT2. In conclusion, DOI measurement for SCC of the oral tongue may require re-examination of the diagnostic biopsy in up to 20% of cases due to the absence or only minimal residual carcinoma in glossectomy specimens. In 11.5% of apparently pT2 cases, DOI may be underestimated due to the positive deep margin. Rarely, extratumoral PNI or lymphatic invasion may be the deepest point of invasion. Overall, two issues (absent or minimal residual disease and positive deep margin) may confound DOI measurement in early SCCs of oral tongue.
https://ift.tt/2r2mC7i
Errance médicale des patients atteints d’hidradénite suppurée : un problème majeur et persistant. Étude « R-ENS Verneuil »
Publication date: Available online 26 April 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): J. Loget, C. Saint-Martin, P. Guillem, L. Kanagaratnam, P.-A. Becherel, A. Nassif, A.-C. Fougerousse, M. Siham, C. Girard, H. Barthelemy, G. Chaby, G. Gabison, J.-L. Perrot, V. Pallure, N. Beneton, T. Boye, C. Jacobzone, E. Begon, P. Bernard, Z. Reguiai
ObjectifL'objectif principal de cette étude était d'analyser les facteurs associés à l'existence d'un délai diagnostique significatif chez les patients atteints d'hidradénite suppurée (HS) en France.Malades et méthodesCette étude nationale prospective multicentrique réalisée d'octobre 2015 à mars 2016 incluait tous les patients consultant pour une HS. Les données concernant les patients étaient recueillies à l'aide d'un questionnaire standardisé. Des analyses univariée et multivariée ont été effectuées afin de recueillir les facteurs associés à un délai diagnostique significatif, défini comme un délai d'au moins 5,5 ans entre les premiers signes de la maladie et son diagnostic formel.RésultatsLes 16 centres ont inclus 312 patients (62 % de femmes) d'âge moyen 35 ans. L'âge moyen de début de l'HS était de 22 ans. Respectivement 170 (54 %), 114 (37 %) et 45 (15 %) patients avaient consulté au moins 3, 5 et 10 médecins avant le diagnostic formel, qui était posé par un dermatologue dans 64 % des cas. Les premiers signes d'HS étaient apparus en moyenne 6,2 ans avant la première consultation de dermatologie et 8,4 ans avant le diagnostic. Un tabagisme actif (Odd Ratio (OR) ajusté 1,85; p=0,027) et un début des signes à un âge plus précoce (OR ajusté 0,92; p<0,001) étaient associés à un délai diagnostique significatif.ConclusionCes résultats soulignent l'errance médicale des patients atteints d'HS, mais ne montrent pas d'association entre les caractéristiques sociodémographiques ou économiques des patients et l'existence d'un délai diagnostique significatif.ObjectiveTo provide physicians with an understanding of the factors behind significant delays in the diagnosis of hidradenitis suppurativa (HS) in France.Patients and methodsThis prospective multicentre national study conducted from October 2015 to March 2016 included all patients consulting for HS. Patient data were collected by means of a standardized questionnaire. Univariate and multivariate analyses were conducted to collect factors associated with a significant time to diagnosis of at least 5.5years, defined as the period between the onset of initial clinical signs and the time of formal diagnosis.ResultsThe 16 participating centres enrolled 312 patients (62% women), of average age 35years. The average age at onset of HS was 22years. Before formal diagnosis by a dermatologist (64% of cases), 170 (54%), 114 (37%) and 45 (15%) patients had previously consulted at least 3, 5 and 10 general physicians, respectively. The average time between the initial clinical signs of HS, the first dermatology visit and the definitive diagnosis was 6.2 and 8.4 years, respectively. Active smoking (OR adjusted 1.85; P=0.027) and disease onset at a younger age (adjusted OR 0.92; P<0.001) were both associated with significant delays in diagnosis.ConclusionThese results emphasized misdiagnosis among HS patients but did not evidence any association between either sociodemographic or economic characteristics and the existence of significant times to diagnosis.
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Intraoperative pediatric acupuncture is widely accepted by parents
Publication date: July 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 110
Author(s): James W. Ochi, Andrew C. Richardson
ObjectiveMedical acupuncture is increasingly recognized for reducing postoperative pain, nausea and emergence agitation. Anesthetic induction is an ideal time to perform acupuncture in an effort to reduce the adverse side effects of surgery. Acupuncture is safe, inexpensive and does not lengthen the duration of anesthesia. There are however no published reports of how often patients will choose intraoperative acupuncture when given the opportunity to do so.MethodsA retrospective review of all surgical procedures performed by one surgeon over 12 months was done. This yielded 401 unique patients ranging in age from 3 months to 21 years with a mean of 6 years. Five of these patients had emergent surgery and 396 patients had scheduled surgery; there were a total of 822 surgical procedures performed on these individuals. Intraoperative acupuncture was offered only to the scheduled surgical patients.Results388 of 396 (98%) parents chose to have intraoperative acupuncture done for their child. No complications of acupuncture were encountered.ConclusionThese results demonstrate strong acceptance of intraoperative acupuncture by parents. We hope this report encourages surgeons to become trained in medical acupuncture.
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Vibrant Soundbridge Implantation: Floating Mass Transducer Coupled with the Stapes Head and Embedded in Fat
ORL 2018;80:159–164
https://ift.tt/2JthJee
Drug Induced Sleep Endoscopy Identification of Adenoid Regrowth in Pediatric Obstructive Sleep Apnea
Objective. To establish the incidence and possible contributing factors leading to adenoid regrowth in children with pediatric sleep apnea using drug induced sleep endoscopy (DISE). Methods. Children treated for obstructive sleep apnea following previous adenoidectomy were evaluated using DISE. Adenoid regrowth was scored by the same attending physician using a 5-point grading scale. Age, sex, body mass index (BMI) percent for age, polysomnogram results, initial adenoid size before adenoidectomy, and postoperative complications were evaluated. Results. Fifty-six patients (age range 22 months to 16 years) met inclusion criteria. Twenty-five children (44.6%) had Grade 2 adenoid or larger. Mean age at the time of DISE was 7.11 years, with an average of 1.75 years since initial adenoidectomy. Mean preadenoidectomy size based on intraoperative nasopharyngeal mirror assessment was Grade 2.55 (95% CI 2.30–2.79). Adenoid size at time of sleep endoscopy was Grade 1.64 (95% CI 1.30–1.98). Characteristics associated with adenoid regrowth were higher body mass index for age percentile at time of endoscopy (), initial adenoid size (), and time between initial adenoidectomy and endoscopy (). Conclusions. Body mass index for age percentile, initial adenoid size, and time between initial adenoidectomy and drug induced sleep endoscopy correlate with regrowth in childhood obstructive sleep apnea.
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Acid‐regulated gene expression of Helicobacter pylori: Insight into acid protection and gastric colonization
Helicobacter, EarlyView.
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Pediatric Helicobacter pylori gastropathy demonstrates a unique pattern of gastric foveolar hyperplasia
Helicobacter, EarlyView.
https://ift.tt/2qZyRRa
Bismuth improves efficacy of proton‐pump inhibitor clarithromycin, metronidazole triple Helicobacter pylori therapy despite a high prevalence of antimicrobial resistance
Helicobacter, EarlyView.
https://ift.tt/2HvS5ZK
Anaplasic astrocytoma with exophytic growth in Sylvian fissure in a pediatric patient: a case report
Abstract
Gliomas are the most frequent supratentorial intracranial tumors in the pediatric population. Usually, they are intra-axial lesions with a characteristic image pattern, however, there are few reported cases of gliomas with exophytic growth. There are no previous reports in the literature of gliomas with exophytic growth in the Sylvian fissure. Fourteen year-old female patient who started with seizures. In imaging studies, a neoplasic mass with an exophytic portion in the left Sylvian fissure was found. Macroscopically, total resection was performed, definitive diagnosis was anaplastic astrocytoma. She presented recurrence and is currently receiving adjuvant treatment. Supratentorial gliomas with exophytic growth are extremely rare. We report the first case in the pediatric population, and we consider it is important to know its imaging and macroscopic characteristics for its initial management and to take it into account as a differential diagnosis of exophytic lesions.https://ift.tt/2qVDb4X
Colovaginal and colo-ovarian fistula at a patient with asymptomatic diverticular disease
Abstract
Colovaginal and colo-ovarian fistulas are rare entities that could be attributed to diverticular disease after an episode of acute diverticulitis. Τhey could initially be manifested with symptoms that lead patients to the gynecologist. Gynecologists should consider them in the differential diagnosis, especially after recurrent episodes of sinusitis. We report the case of a 51-year-old woman with a colovaginal and a colo-ovarian fistula due to subclinical diverticular disease, which should be involved in the differential diagnosis in those complicated fistulas, even if the patient had never before a clinical episode of acute diverticulitis or known diverticular disease, and a successful surgical approach.https://ift.tt/2JrmncH
A rare presentation of acute appendicitis in right upper quadrant caused by renal agenesis
Abstract
Diagnosing acute abdominal pain will always be a challenging task, patients frequently present with atypical symptoms. It is crucial for a clinician to have good differential diagnosis to avoid delay in diagnosis and treatment. We present 37-year-old male who presented to emergency department with 2 days of abdominal pain. The pain started centrally around his umbilicus and localized to his right upper quadrant (RUQ). Clinical examination showed he has localized peritonitism on the RUQ hence he was further investigated with CT abdomen. CT revealed he has appendicitis. This is due to the congenital anomaly where he has congenital agenesis of his right kidney. This case illustrates in patients with congenital agenesis of right kidney, the diagnosis of acute appendicitis should be considered in right upper quadrant pain. He was commenced on IV antibiotics and proceeded to have laparoscopic appendicectomy. He had an uneventful post-operative recovery.https://ift.tt/2r0PGMC
A novel combined approach using a Penumbra catheter and balloon catheter for cerebral venous sinus thrombosis
Cerebral venous sinus thrombosis is sometimes fatal. We describe a case of sinus thrombosis in a 43-year-old woman presenting with generalized seizure, delirium, and a 2 week history of headache and nausea. The patient underwent mechanical thrombectomy using a novel combined approach, in which a Shouryu HR balloon catheter (Kaneka) was anchored in the right transverse sinus (TS), sigmoid sinus (SS), and superior sagittal sinus (SSS), while a Penumbra 5 MAX ACE (Penumbra) catheter was moved back and forth between the right TS, SS, and SSS. Additionally, back and forth movement of the inflated balloon with aspiration—the so-called 'dental floss technique'—was performed. Partial recanalization was eventually obtained. Follow-up angiography on postoperative day 7 showed a dramatic improvement in venous outflow. The patient was transferred to a rehabilitation hospital on postoperative day 42. We describe our combined approach using aspiration, and Penumbra and balloon catheters, to achieve mechanical thrombectomy for sinus thrombosis.
https://ift.tt/2Fk9I8W
Fungating breast mass in a developed country
Description
A 56-year-old woman presented to the emergency department with a left breast mass. Initially, she noticed two small lumps on the left breast that evolved in 18 months into an ulcerated mass with foul-odour drainage. Four months prior to admission, she developed fevers, fatigue and progressive dyspnoea. She normally could walk a block without limitations but progressed to dyspnoea with minimal exertion. Her family noted that she was spending most of the day in bed secondary to fatigue. Her fevers measured as high as 101.5°F and was alleviated by acetaminophen. One week prior to admission, she had a syncopal episode while standing up from her couch. Her mother came to visit after the syncope and noticed a foul odour. After she revealed the mass to her mother, she was taken to a primary care doctor who recommended the emergency department. The patient had no known medical history. She...
https://ift.tt/2KgWbTu
Psychosis, creativity and recovery: exploring the relationship in a patient
Relation between mental illness and creativity is intricate. While many creative people show signs of mental illness, persons with severe mental illness occasionally have creative output beyond the ordinary. We are presenting a patient with psychotic illness whose creative potential took a positive turn during the illness phase and grew further following symptomatic improvement and helped in her recovery process. Observing the contrast related to creative productivity pre and post psychotic phase raises the probability of whether psychotic illness or process might enhance creative potential. The case additionally illustrates how creativity can be a useful method supporting recovery from severe mental illnesses.
https://ift.tt/2Jr8hIm
Intensive care management of severe hypernatraemia in the context of group A streptococcal septicaemia
This case describes a 54-year-old woman with exudative eczema, who was admitted to the intensive care unit with a serum sodium concentration of 191 mmol/L, secondary to profound dehydration in the context of group A streptococcal septicaemia. Successful rehydration and electrolyte normalisation was achieved with continuous venovenous haemodiafiltration (CVVHDF), the replacement fluid of which was infused with hypertonic saline to limit the rate of sodium reduction. This case report comments on three areas of interest. First, hypernatraemia of this level is unusual. Second, the infusion of hypertonic saline into the replacement fluid of the CVVHDF filter is not common practice but successfully ensured a controlled reduction in serum sodium concentration while aggressively replacing a 9 L water deficit. Third, the notable physiological reserve demonstrated by the patient: despite an extraordinary serum sodium concentration in the context of overwhelming streptococcal septicaemia, she has made a full cognitive recovery.
https://ift.tt/2KgVKIS
Isolated solitary recurrent skull metastasis in papillary thyroid carcinoma
Description
A 38-year-old woman presented with history of painless expansible swelling in the right frontoparietal region since 2 years and rapidly increasing in size since the last 6 months. She was initially evaluated in another centre and was diagnosed as a meningioma. She had a history of total thyroidectomy and radioiodine ablation for a non-metastatic papillary carcinoma thyroid (PCT) in the year 2008. She was on a regular follow-up between 2009 and 2012 and during that period her serum thyroglobulin and whole-body iodine scan was normal. However, she was lost to follow-up but she had continued her suppressive doses of thyroxin.
Her T1-weighted MRI showed a lobulated expansile, intensely heterogeneously enhancing lesion arising from the right frontoparietal region (size 77x52x88 cm) (figure 1). The fluorodeoxyglucose-positron emission tomography (PET) CT scan showed a metabolically active expansile soft tissue lesion (standard uptake values, 64) with lytic area and bony spicules (
https://ift.tt/2Jvh8sJ
Cardiac CT confirmation of normal prosthetic mechanical aortic valve function in patient with presyncope and significantly increased Doppler velocities
Description
A 37-year-old man presented to our emergency department with unprovoked presyncope, breathlessness and atypical chest pain. His history included a Carbomedics 27 mm bileaflet mechanical aortic valve replacement (AVR) 18 years prior for endocarditis, severe aortic regurgitation and left ventricular systolic dysfunction (LVSD). A biventricular pacemaker (cardiac resynchronisation therapy with defibrillator (CRT-D)) was implanted 7 years later. Observations, including postural blood pressure, biventricular-paced ECG and bloods including troponin and D-dimer assays, were unremarkable. CRT-D interrogation demonstrated no arrhythmias. Although the international normalised ratio (INR) was satisfactory on admission (2.8), compliance with taking daily warfarin was inconsistent with poor anticoagulation clinic attendance. The time spent in therapeutic INR range was hence only 60%.
Given the above and increasing Doppler AVR velocities on transthoracic echocardiography (TTE) 2 years prior (VMax 2.6 m/s (mean gradient 26 mm Hg) vs VMax 1.6 m/s (mean gradient 7 mm Hg) 8 years ago), TTE was repeated (figure 1A,B). This...
https://ift.tt/2Ke22Jn
Fatal case of commercial moisture absorber ingestion
Description
One of the most commercially available moisture absorbers is a dehydrating agent containing calcium chloride. In humid environments such as basements, kitchens, cabinets and closets, calcium chloride provides effective moisture absorption by becoming highly concentrated calcium chloride brine. Ingestion of calcium chloride can lead to severe hypercalcaemia and can be fatal. In our case, hypercalcaemia developed from intentional ingestion of moisture absorber and the patient eventually died. To our knowledge, fatality from commercial moisture of absorber ingestion has not been reported. A 31-year-old man presented to the emergency department (ED) 20 min after intentionally ingesting 300 mL of commercial moisture absorber solution. It contained 300 g of calcium chloride (figure 1). The patient had a history of a pervasive developmental disorder. When the patient first presented to ED, he was alert. The patient's initial symptoms were nausea and vomiting. Gastric lavage was done, and activated charcoal was used....
https://ift.tt/2JsLtIk
Surgical simulation and applicant perception in otolaryngology residency interviews
The Laryngoscope, EarlyView.
https://ift.tt/2HZ1p5s
A case of acrodermatitis continua of Hallopeau (ACH) successfully treated with sulfasalazine
Dermatologic Therapy, EarlyView.
https://ift.tt/2FhW8mK
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