Publication date: Available online 4 May 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): V. L'Huillier, C. Badet, L. Tavernier
ObjectivesTo assess any differences in severity and management of epistaxis when complicating treatment by anti-vitamin K (AVK) or by new oral anticoagulants (NOAC).Materials and methodAll patients admitted to the ENT department of a University Hospital Center for epistaxis under oral anticoagulation therapy between January 2010 and June 2015 were included in a retrospective study. Severity was assessed in terms of management and of hemoglobin level at admission. Two groups were distinguished: treatment by AVK or by NOAC.ResultsOne hundred and thirty-four patients were included: 126 under AVK and 8 under NOAC. There was a significant difference in mean hospital stay: 4.5 days for AVK versus 3.5 days for NOAC (P=0.019; 95% CI [0.1921; 0.8907]). There were no significant differences for the other severity criteria. None of the patients died.ConclusionAdmission rates for epistaxis complicating NOAC therapy was low, and much lower than in case of AVK. Bleeding severity was equivalent with both treatments. NOACs significantly reduce hospital stay. Contrary to the study hypothesis, epistaxis is less serious when complicating NOAC than AVK therapy.
https://ift.tt/2FIibDj
Παρασκευή 4 Μαΐου 2018
Epistaxis complicating treatment by anti-vitamin K and new oral anticoagulants
Fronto-orbital feminization technique. A surgical strategy using fronto-orbital burring with or without eggshell technique to optimize the risk/benefit ratio
Publication date: Available online 4 May 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): A. Villepelet, A. Jafari, B. Baujat
The demand for facial feminization is increasing in transsexual patients. Masculine foreheads present extensive supraorbital bossing with a more acute glabellar angle, whereas female foreheads show softer features. The aim of this article is to describe our surgical technique for fronto-orbital feminization. The mask-lift technique is an upper face-lift. It provides rejuvenation by correcting collapsed features, and fronto-orbital feminization through burring of orbital rims and lateral canthopexies. Depending on the size of the frontal sinus and the thickness of its anterior wall, frontal remodeling is achieved using simple burring or by means of the eggshell technique. Orbital remodeling comprises a superolateral orbital opening, a reduction of ridges and a trough at the lateral orbital rim to support the lateral canthopexy. Frontal, corrugator and procerus myectomies, plus minimal scalp excision, complete the surgery. Our technique results in significant, natural-looking feminization. No complications were observed in our series of patients. The eggshell technique is an alternative to bone flap on over-pneumatized sinus. Fronto-orbital feminization fits into a wider surgical strategy. It can be associated to rhinoplasty, genioplasty, mandibular angle remodeling, face lift and laryngoplasty. Achieving facial feminization in 2 or 3 stages improves psychological and physiological tolerance.
https://ift.tt/2jtUx4J
The tolerogenic peptide hCDR1 immunomodulates cytokine and regulatory molecule gene expression in blood mononuclear cells of primary Sjogren's syndrome patients
Source:Clinical Immunology
Author(s): Zev Sthoeger, Amir Sharabi, Ilan Asher, Heidy Zinger, Rafael Segal, Gene Shearer, Ori Elkayam, Edna Mozes
Primary Sjogren's syndrome (pSS) is an autoimmune disease characterized by lymphocytic infiltration of exocrine glands. We investigated whether the tolerogenic peptide, hCDR1, that ameliorates lupus manifestations would have beneficial effects on pSS as well. The in vitro effects of hCDR1 on gene expression of pro-inflammatory cytokines and regulatory molecules were tested in peripheral blood mononuclear cells (PBMC) of 16 pSS patients. hCDR1, but not a control peptide, significantly reduced gene expression of IL-1β, TNF-α, MX-1 and BlyS and up-regulated immunosuppressive (TGF-β, FOXP3) molecules in PBMC of pSS patients. hCDR1 did not affect gene expression in patients with rheumatoid arthritis and anti-phospholipid syndrome. Further, hCDR1 up-regulated the expression of Indoleamine 2,3-dioxygenase (IDO) via elevation of TGF-β. IDO inhibition led to a significant decrease in the expression of FOXP3 which is crucial for the induction of T regulatory cells. Thus, hCDR1 is potential candidate for the specific treatment of pSS patients.
https://ift.tt/2KFO0A6
Comparative evaluation of soft and hard tissue changes following endosseous implant placement using flap and flapless techniques in the posterior edentulous areas of the mandible—a randomized controlled trial
Abstract
Background
Dental implant-supported restorations have long been used as a successful modality for replacing missing teeth. There are two well-established methods of implant placement. The traditional approach to implant surgery involves raising a mucoperiosteal flap and the alternative approach does not involve reflecting a flap, each having its own advantages and disadvantages. The purpose of the present study was to compare and evaluate the soft and hard tissue changes around endosseous implants placed using flap and flapless surgery in mandibular posterior edentulous sites over a period of time.
Materials and methods
A total of 20 systemically healthy patients with a single edentulous site in the posterior mandible were enrolled in this study and 20 endosseous implants were placed (10 in the flap group and 10 in the flapless group). The peri-implant probing depth was assessed. Radiographic assessment was done for changes in the marginal bone levels at the mesial and distal side of the implant with measurements made at baseline, 6 months, and 12 months. Patient-centered outcomes were assessed by using the visual analogue scale (VAS). All these parameters were statistically analyzed using the Wilcoxon signed-rank test, paired Student t test, and two-way ANOVA test and were considered to be significant if the p value was ≤ 0.05.
Results
Twenty patients were enrolled in the present study and endosseous implants were placed. Eighteen subjects were followed up throughout the study period and two patients were excluded from the study. The mean PD in the flapless group was comparatively less than the flap group at 12 months and was found to be statistically significant. During the observation period of 12 months, reduction of crestal bone height around the implants placed by flapless and flap surgery were statistically significant. The flapless group showed less change in the crestal bone height which was statistically significant compared to the flap group. The mean VAS score on day 0 in the flap and flapless group was statistically significant. The flapless group showed significantly less pain when compared to the flap group.
Conclusion
Although the flapless technique of endosseous implant placement had statistically significant less PD, bone loss, and pain than the flap technique, the difference was found to have uncertain clinical significance.
https://ift.tt/2HSaU5v
Comparative evaluation of soft and hard tissue changes following endosseous implant placement using flap and flapless techniques in the posterior edentulous areas of the mandible—a randomized controlled trial
Abstract
Background
Dental implant-supported restorations have long been used as a successful modality for replacing missing teeth. There are two well-established methods of implant placement. The traditional approach to implant surgery involves raising a mucoperiosteal flap and the alternative approach does not involve reflecting a flap, each having its own advantages and disadvantages. The purpose of the present study was to compare and evaluate the soft and hard tissue changes around endosseous implants placed using flap and flapless surgery in mandibular posterior edentulous sites over a period of time.
Materials and methods
A total of 20 systemically healthy patients with a single edentulous site in the posterior mandible were enrolled in this study and 20 endosseous implants were placed (10 in the flap group and 10 in the flapless group). The peri-implant probing depth was assessed. Radiographic assessment was done for changes in the marginal bone levels at the mesial and distal side of the implant with measurements made at baseline, 6 months, and 12 months. Patient-centered outcomes were assessed by using the visual analogue scale (VAS). All these parameters were statistically analyzed using the Wilcoxon signed-rank test, paired Student t test, and two-way ANOVA test and were considered to be significant if the p value was ≤ 0.05.
Results
Twenty patients were enrolled in the present study and endosseous implants were placed. Eighteen subjects were followed up throughout the study period and two patients were excluded from the study. The mean PD in the flapless group was comparatively less than the flap group at 12 months and was found to be statistically significant. During the observation period of 12 months, reduction of crestal bone height around the implants placed by flapless and flap surgery were statistically significant. The flapless group showed less change in the crestal bone height which was statistically significant compared to the flap group. The mean VAS score on day 0 in the flap and flapless group was statistically significant. The flapless group showed significantly less pain when compared to the flap group.
Conclusion
Although the flapless technique of endosseous implant placement had statistically significant less PD, bone loss, and pain than the flap technique, the difference was found to have uncertain clinical significance.
https://ift.tt/2HSaU5v
Detection of white spot lesions by segmenting laser speckle images using computer vision methods
Abstract
This paper aims to develop a method for laser speckle image segmentation of tooth surfaces for diagnosis of early stages caries. The method, applied directly to a raw image obtained by digital photography, is based on the difference between the speckle pattern of a carious lesion tooth surface area and that of a sound area. Each image is divided into blocks which are identified in a working matrix by their χ2 distance between block histograms of the analyzed image and the reference histograms previously obtained by K-means from healthy (h_Sound) and lesioned (h_Decay) areas, separately. If the χ2 distance between a block histogram and h_Sound is greater than the distance to h_Decay, this block is marked as decayed. The experiments showed that the method can provide effective segmentation for initial lesions. We used 64 images to test the algorithm and we achieved 100% accuracy in segmentation. Differences between the speckle pattern of a sound tooth surface region and a carious region, even in the early stage, can be evidenced by the χ2 distance between histograms. This method proves to be more effective for segmenting the laser speckle image, which enhances the contrast between sound and lesioned tissues. The results were obtained with low computational cost. The method has the potential for early diagnosis in a clinical environment, through the development of low-cost portable equipment.
https://ift.tt/2FIXx60
Assessing perceptions of oral health related quality of life in dental implant patients. Experience of a tertiary care center in India
Publication date: Available online 4 May 2018
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Arun Paul S, Sibu Simon S, Saurabh Kumar, Rabin K Chacko
BackgroundPatients perception of treatment outcomes are invaluable assessment tools and are effective indicators for future prognosis. Various tools of measurement have been used to assess the same. The oral health impact profile questionnaire (OHIP 14) has been effectively used to evaluate the oral health-related quality of life (OHRQoL) with regards to individual perceptions. This study was conducted to assess OHRQoL in patients who have had dental implants to replace missing teeth in the Department of Dental Surgery, Unit 1, Christian Medical College and Hospital, Vellore, TN, India by using the OHIP 14 questionnaire.Materials and MethodsA total of 107 patients who had treatment with dental implants were sent a modified form of the OHIP 14 questionnaire. An attempt was made to draw an inference by correlating scores of the OHIP 14 with data pertaining to key independent variables. Gamma regression was applied to the results as the outcome score distribution was skewed. All statistical analyses were performed using SPSS Version 21.0.ResultsThe mean score for the OHIP 14 was 16.82 with the highest score of 30 for a total score of 70. OHIP 14 scores were higher in patients with implant-supported fixed dental prosthesis as compared to patients with single implant supported crowns (P = 0.0069). Patients with no complaints scored 9% lesser than those who reported complaints (P = 0.0438).ConclusionAssessing quality of life with regards to specific treatment interventions may help to draw critical inferences that determine overall success. Results from the study enabled us to delineate and appreciate the success imparted by esthetics and function from the general well being imparted by treatment with dental implants. Social media could be used to positively improve responses in questionnaire based studies. Future studies using implant specific OHRQoL questionnaire may help to elicit unbiased patient perception in dental implant patients.
https://ift.tt/2rmruUm
A Qualitative Analysis of Disclosing Sexual Victimization by #NotOkay During the 2016 Presidential Election
Violence and Gender, Ahead of Print.
https://ift.tt/2wcIORf
Stenting the Eustachian tube to treat chronic otitis media - a feasibility study in sheep
Untreated chronic otitis media severely impairs quality of life in affected individuals. Local destruction of the middle ear and subsequent loss of hearing are common sequelae, and currently available treatmen...
https://ift.tt/2w9Nszi
Re: Is a fractured mandible an emergency?
I appreciate the comments by Lee and Knepil, and I am in complete agreement that non-surgical outcomes are important to patients with maxillofacial injuries. However, the state of the NHS suggests that increased rates of bed occupancy is an important issue.1 In an ideal world these patients would be treated as soon as possible, as all the points that they make are valid. Unfortunately, in the NHS a degree of pragmatism is sometimes required, when we are unable to manage the level of idealism that we all desire.
https://ift.tt/2rmtA7n
Ethnic differences and comorbidities of 909 Prurigo Nodularis patients
•Prurigo nodularis (PN) is a pruritic dermatosis of unknown etiology.•PN is associated with an increased risk of chronic kidney disease, diabetes, Hepatitis C, HIV, and several psychiatric comorbidities•Clinicians should be aware of psychiatric, metabolic, and infectious disease associations when treating PN patients.
https://ift.tt/2FLzUJR
Maxillofacial injuries in patients with major trauma
Major trauma is an important cause of mortality and morbidity worldwide. Mortality is high with rates over 10% commonly reported. We studied the epidemiology and aetiology of maxillofacial injuries in patients who presented with major trauma as recorded nationally by retrospectively analysing the database of the Trauma Audit Research Network from 2001 to 2015. All patients who had major trauma with associated maxillofacial injuries were included in the analysis. Of 104645 patients recorded as having had major trauma during the study period, 22148 (21.2%) had an associated maxillofacial injury.
https://ift.tt/2wcEscR
Cutaneous toxicity as a predictive biomarker for clinical outcome in patients receiving anticancer therapy
•There is an association between clinical outcomes and development of cutaneous toxicities due to anticancer therapeutics.•Vitiligo, rash, nail toxicity, or alopecia induced by anticancer therapeutics may be potential biomarkers in predicting treatment efficacy.•Identification of cutaneous toxicities may be an early and non-invasive way to determine cancer treatment efficacy.
https://ift.tt/2FLb6BO
Age-Related Hearing Loss
Age-related hearing loss is a multifactorial condition that affects more than one-third of the aging population. Left untreated it can increase the risk of cognitive decline, dementia, social isolation, depression, and falls. Hearing augmentation devices exhibit improved digital sound processing and Smartphone connectivity. Stigma remains one of the prominent barriers and todays devices offer in the canal models, miniature sizes, and camouflage with the hair or skin color. Although rigorous scientific efforts are made in the research field of inner ear regeneration and some clinical early phase studies do exist, to date, the clinical availability is still some time away.
https://ift.tt/2KzX4GS
Stenting the Eustachian tube to treat chronic otitis media - a feasibility study in sheep
Abstract
Background
Untreated chronic otitis media severely impairs quality of life in affected individuals. Local destruction of the middle ear and subsequent loss of hearing are common sequelae, and currently available treatments provide limited relief. Therefore, the objectives of this study were to evaluate the feasibility of the insertion of a coronary stent from the nasopharynx into the Eustachian tube in-vivo in sheep and to make an initial assessment of its positional stability, tolerance by the animal, and possible tissue reactions.
Methods
Bilateral implantation of bare metal cobalt-chrome coronary stents of two sizes was performed endoscopically in three healthy blackface sheep using a nasopharyngeal approach. The postoperative observation period was three months.
Results
Stent implantation into the Eustachian tube was feasible with no intra- or post-operative complications. Health status of the sheep was unaffected. All stents preserved their cylindrical shape. All shorter stents remained in position and ventilated the middle ear even when partially filled with secretion or tissue. One of the long stents became dislocated toward the nasopharynx. Both of the others remained fixed at the isthmus but appeared to be blocked by tissue or secretion. Tissue overgrowth on top of the struts of all stents resulted in closure of the tissue-lumen interface.
Conclusion
Stenting of the Eustachian tube was successfully transferred from cadaver studies to an in-vivo application without complications. The stent was well tolerated, the middle ears were ventilated, and clearance of the auditory tube appeared possible. For fixation, it seems to be sufficient to place it only in the cartilaginous part of the Eustachian tube.
https://ift.tt/2HUbGzc
Immediate function dental implants inserted with less than 30N·cm of torque in full-arch maxillary rehabilitations using the All-on-4 concept: retrospective study
The aim of this retrospective clinical study was to evaluate the short-term implant success rate and marginal bone loss in full-arch fixed prosthetic maxillary rehabilitations supported by implants in immediate function with the All-on-4 treatment concept placed with insertion torque of <30N·cm or ≥30N·cm. This study included 83 patients (69 female, 14 male) with 332 implants placed (120 inserted with <30N·cm and 212 inserted with ≥30N·cm) who were treated between January 2010 and March 2013. Outcome measures were implant success and marginal bone loss at 1year of follow-up.
https://ift.tt/2FLGpwj
A pilot study on the effects of direct contact of two different surgical burs on the cadaveric lingual nerve
The lingual guttering technique for third molar surgery carries the risk of injury to the lingual nerve if the surgical bur comes into direct contact with it. This study investigated the extent of nerve injury caused by two different burs, a tungsten carbide bur and the Dentium implant bur; the latter is designed to be soft tissue friendly. This study also examined whether ultrasound and magnetic resonance imaging are able to detect any injury inflicted. This cadaveric research involved subjecting 12 lingual nerves to the drilling effect of two different burs at two different speeds.
https://ift.tt/2KFkY3A
Management von Sprachentwicklungsstörungen und Aussprachestörungen bei Kindern
Zusammenfassung
Im internationalen Vergleich ist Deutschland scheinbar ein Land mit einer weit überdurchschnittlichen Prävalenz therapiebedürftiger Sprachstörungen bei Kindern. Da HNO-Ärzte in Praxis und Klinik häufig Sprach- und Sprechtherapie verordnen, wird im ersten Teil dieser Fortbildung die richtlinien- und leitliniengerechte Diagnose systematisch dargestellt. Es wird erläutert, wie eine Verdachtsdiagnose entwickelt wird, die sprachbefundliche Untersuchungen begründet. Darüber hinaus wird erörtert, wie aus den verfügbaren Tests eine sinnvolle Auswahl getroffen wird, die der Arzt selbst durchführen oder veranlassen kann, und wie daraus der Schweregrad beurteilt wird. Ein besonderer Schwerpunkt dieser Arbeit ist die Differenzialdiagnose zugrunde liegender Ursachen, z. B. Schwerhörigkeiten oder globale Entwicklungsstörungen. Beim Vorliegen aller erforderlichen Ergebnisse kann eine Arbeitsdiagnose erstellt und der Fall durch ICD-10-Codes klassifiziert werden.
https://ift.tt/2KEUvU6
Having concomitant asthma phenotypes is common and independently relates to poor lung function in NHANES 2007–2012
Evidence for distinct asthma phenotypes and their overlap is becoming increasingly relevant to identify personalized and targeted therapeutic strategies. In this study, we aimed to describe the overlap of five...
https://ift.tt/2wdIMIX
Postoperative renal function in parturients with severe preeclampsia who underwent cesarean delivery: a retrospective observational study
Abstract
Although postoperative renal dysfunction is relatively rare after cesarean delivery, preeclampsia is considered as the high-risk population. On the other hand, hydroxyethyl starch (HES) administration for preventing maternal hypotension induced by spinal anesthesia for cesarean delivery is a common practice. However, the effect of HES administration during cesarean delivery on postoperative kidney function in parturients with severe preeclampsia is not well investigated. We retrospectively reviewed both medical and anesthesia records of patients with severe preeclampsia who underwent cesarean delivery from January 2011 to December 2013. Preoperative blood examinations were compared with postoperative values. All parturients received 6% HES 70/0.5 for preventing anesthesia-induced hypotension or for volume resuscitation during cesarean delivery. A total of 87 severe preeclampsia parturients were underwent cesarean section during the period. The amounts of HES administration were 859 ± 206 mL. There was significant reduction in serum creatinine, from 0.70 ± 0.29 mg/dL preoperatively to 0.62 ± 0.17 mg/dL in 3–7 days after the cesarean. Only one patient had postoperatively elevated serum creatinine up to clinically significant level (from 0.64 mg/dL to 1.35 mg/kg).
https://ift.tt/2JVM7OR
Neonatal Screening for Prevalence of Hearing Impairment in Rural Areas
Abstract
Hearing is one of the most important sense organs for man. Hearing loss is often associated with delayed speech and language development in young children. Early identification and intervention improves the chance a child gets to lesser delays in development and improving the overall quality of life. To find out the prevalence of hearing loss in neonates in the rural taluka of Maval, Pune, Maharashtra, India. Prospective Non Randomized Clinical Study. The study was carried out between April 2012 and April 2015. A total of 8192 babies were screened across various centers around the Maval area. The babies who had some high risk factors were 1683 in number and babies who had no high risk factors i.e. well babies were 6509. In our study, the overall prevalence of hearing loss in neonates in Maval taluka of Maharashtra was found to be 3.54 per 1000 live births, in normal born neonates (well babies) was 1.689 per 1000 births, in high risk babies was 10.69 per 1000 high risk births. The prevalence of low birth weight neonates, hyperbilirubinemia neonates and neonates with craniofacial abnormalities developing hearing impairment was found to be 5.9, 3.56 and 1.18 per 1000 high risk births respectively. India is the second most populated country in the world with nearly a fifth of the world's population. There is a need for the universal neonatal screening for deafness for earlier detection of deafness and rehabilitation.
Level of Evidence: Level IV.
https://ift.tt/2rkCEd2
Sinonasal Mucormycosis: A to Z
Abstract
Mucormycosis caused by one of the members of Mucoraceae family, is one of the most rapidly spreading and fatal fungal infection occurring mostly in Diabetic or Immunocompromised patients especially in developing countries. 26 patients suffering from sinonasal mucormycosis admitted in SGRRIM&HS, Dehradun from January 2013 to January 2017 are discussed. Diagnosis of mucormycosis was established on strong clinical suspicion with presence of grayish black crusting on nasal endoscopy which is confirmed by histopathology examination. Immediate correction of underlying immunocompromised status with debridement with intravenous liposomal amphotericin B was done in all the 26 cases out of which 10 patients were cured. Early detection and aggressive multidisciplinary management is must for the successful treatment of mucormycosis.
https://ift.tt/2JTx08i
Neonatal Screening for Prevalence of Hearing Impairment in Rural Areas
Abstract
Hearing is one of the most important sense organs for man. Hearing loss is often associated with delayed speech and language development in young children. Early identification and intervention improves the chance a child gets to lesser delays in development and improving the overall quality of life. To find out the prevalence of hearing loss in neonates in the rural taluka of Maval, Pune, Maharashtra, India. Prospective Non Randomized Clinical Study. The study was carried out between April 2012 and April 2015. A total of 8192 babies were screened across various centers around the Maval area. The babies who had some high risk factors were 1683 in number and babies who had no high risk factors i.e. well babies were 6509. In our study, the overall prevalence of hearing loss in neonates in Maval taluka of Maharashtra was found to be 3.54 per 1000 live births, in normal born neonates (well babies) was 1.689 per 1000 births, in high risk babies was 10.69 per 1000 high risk births. The prevalence of low birth weight neonates, hyperbilirubinemia neonates and neonates with craniofacial abnormalities developing hearing impairment was found to be 5.9, 3.56 and 1.18 per 1000 high risk births respectively. India is the second most populated country in the world with nearly a fifth of the world's population. There is a need for the universal neonatal screening for deafness for earlier detection of deafness and rehabilitation.
Level of Evidence: Level IV.
https://ift.tt/2rkCEd2
Sinonasal Mucormycosis: A to Z
Abstract
Mucormycosis caused by one of the members of Mucoraceae family, is one of the most rapidly spreading and fatal fungal infection occurring mostly in Diabetic or Immunocompromised patients especially in developing countries. 26 patients suffering from sinonasal mucormycosis admitted in SGRRIM&HS, Dehradun from January 2013 to January 2017 are discussed. Diagnosis of mucormycosis was established on strong clinical suspicion with presence of grayish black crusting on nasal endoscopy which is confirmed by histopathology examination. Immediate correction of underlying immunocompromised status with debridement with intravenous liposomal amphotericin B was done in all the 26 cases out of which 10 patients were cured. Early detection and aggressive multidisciplinary management is must for the successful treatment of mucormycosis.
https://ift.tt/2JTx08i
Effect of Topical Steroids on Skin Prick Test: A Randomized Controlled Trial
Abstract
Introduction
Topically applied corticosteroids on the skin can significantly inhibit the wheal response to allergens in skin prick test (SPT). The duration of this effect is unknown. The aim of this study is to investigate the duration of the inhibitory effect of topical corticosteroids on SPT.
Methods
Twenty-two healthy subjects were included in a single-blinded randomized study. All subjects were skin prick tested using a standard inhalant allergen panel. The subjects were randomized to treat either the left or right forearm with Betnovat® cream (group III steroid) once a day for 10 days. Subsequently, the subjects were skin prick tested the following 5 days and at day 8 on both forearms.
Results
At baseline, the 22 individuals had positive SPT for a total of 72 allergens. Compared with the untreated arm, the mean size of the wheals was significantly reduced on day 1 (12 h after end of treatment) by 0.56 mm (95 % confidence interval (CI) [0.06; 1.06], p = 0.03) for allergens and 0.70 mm [0.32; 1.09] (p = 0.001) for histamine. On day 2 (36 h after end of treatment), the mean difference between treated and untreated arm was 0.47 mm [−0.08; 0.85] (p = 0.02) for allergen-induced wheals and 0.22 mm [−0.21; 0.64] (p = 0.31) for histamine-induced wheal. On day 3, 4, 5, and 8, there was no significant difference.
Conclusions
Treatment with topical steroid significantly inhibited the response to SPT for 36 h but for less than 3 days. In addition, we demonstrated that topical applied corticosteroids inhibit the mean wheal size of the positive histamine control for a shorter time than for the allergens. Consequently, positive response to histamine control is not a valid marker for reliable skin prick test in steroid-treated patients.
Plain Language Summary
Plain language summary available for this article.
https://ift.tt/2jwYR3c
Crimean-Congo hemorrhagic fever with hepatic impairment and vaginal hemorrhage: a case report
Crimean-Congo hemorrhagic fever is a tick-borne disease described in more than 30 countries in Europe, Asia, and Africa. Albania is located in the southwestern part of the Balkan Peninsula. In 1986, the first ...
https://ift.tt/2FKTo1c
Implementing an asthma action plan: Prevention, action and follow up
When it comes to respiratory distress calls in the field, EMS providers need to be aware they play a large part of the patient's continuing care story
https://ift.tt/2js2zLg
Study of MK-1697 in Participants With Advanced Solid Tumors (MK-1697-001)
Intervention: Biological: MK-1697
Sponsor: Merck Sharp & Dohme Corp.
Not yet recruiting
https://ift.tt/2jt6xDF
Preoperational Fine Needle Aspiration of Pathological Parathyroid Gland
Interventions: Diagnostic Test: pre operative parathyroid hormone level measurement; Diagnostic Test: pre operative parathyroid cytology; Diagnostic Test: parathyroid hormone level measurement; Diagnostic Test: parathyroid cytology
Sponsor: HaEmek Medical Center, Israel
Not yet recruiting
https://ift.tt/2HTQEAE
Hydrochlorothiazide and Skin Cancer: Raise the Red Flag
A dramatic association has been found between this common diuretic and nonmelanoma skin cancer.
Medscape Dermatology
https://ift.tt/2JSYGuc
cec moderadamente diferenciado e invasivo
cec moderadamente diferenciado e invasivo
https://ift.tt/2FGPHtJ
Petrosite inflamatória- Dra Mônica Alcântara
Petrosite inflamatória -Dra Mônica Alcântara
https://ift.tt/2juydYR
Pushing the limits of immune-related response: a case of “extreme pseudoprogression”
Abstract
The advent of immune checkpoint targeted immunotherapy has seen a spectrum of immune-related phenomena in both tumor responses and toxicities. We describe a case of pseudoprogression that pushes the limits of immune-related response criteria and challenges the boundaries and definitions set by trial protocols. A middle-aged man with conventional clear cell renal cell carcinoma (RCC) had received multiple prior systemic treatments including vascular endothelial growth factor receptor tyrosine kinase inhibitors, as well as multiple surgeries and radiotherapy treatments. He was eventually started on nivolumab—the anti-programmed death receptor-1 monoclonal antibody approved for the treatment of advanced RCC. Clinical deterioration was observed soon after a 100 mg dose of nivolumab, with onset of acute renal failure and declining performance status. Radiologic progression was documented in multiple sites including worsening tumor infiltration of his residual kidney. The patient was on palliative treatment and visited by the home hospice team in an end-of-life situation. The patient unexpectedly improved and went on to achieve a durable tumor response. The case is illustrative of an extreme manifestation of pseudoprogression, and impels us to probe the assumptions and controversies surrounding this phenomenon.
https://ift.tt/2Ib0Jwu
Changes in biofilm in chronic cholesteatomatous otitis media in children following the application of sodium 2-mercaptoethanesulfonate (MESNA)
Source:International Journal of Pediatric Otorhinolaryngology, Volume 110
Author(s): Carlos de la Torre González, Marisol Huante-Guido, Norma Velázquez Guadarrama, Diego Preciado, Genaro Patiño López
BackgroundPediatric cholesteatoma is a clinically challenging disease entity. Its biological behavior in the pediatric population differs from its behavior in adult population in terms of aggressiveness and recurrence. Several studies have shown the presence of biofilms associated with cholesteatoma that hinder the management and eradication of the infection. This led is to study the use of non-antimicrobial treatments impacting on the structure or composition of biofilms.ObjectiveTo evaluate the changes that occur in the biofilm of cholesteatoma in pediatric patients after the application of sodium 2-mercaptoethanesulfonate (MESNA).MethodsA pilot study of 10 pediatric patients, with a median age of 10 years and a diagnosis of cholesteatomatous chronic otitis media, who underwent surgery for primary or revision mastoidectomy in the Otorhinolaryngology Service of the Hospital Infantil de México Federico Gómez between January 2016 and May 2017. During the surgery, basal samples of cholesteatoma and tissue were taken after topical application of 4% MESNA for 10 min. The samples were then processed for confocal laser microscopy.ResultsIn all samples structures compatible with bacterial biofilms were identified. The most relevant finding was the changes in the structure of the biofilm after the application of MESNA, such as disintegration and separation of the underlying tissue.ConclusionsThis is the first study that showing changes associated with cholesteatoma in the structure of the bacterial biofilm after the application of MESNA. The observed disintegration of cholesteatoma biofilm ultrastructure could aid in the management of the chronic infection associated with cholesteatoma.
https://ift.tt/2whHNYm
Silent sinus syndrome without opacification of ipsilateral maxillary sinus
The Laryngoscope, EarlyView.
https://ift.tt/2Ih8aSP
Expression of endoplasmic reticulum stress protein in rabbit condyle cartilage following anterior disk displacement
Journal of Oral Pathology &Medicine, EarlyView.
https://ift.tt/2rkl5sK
Fetal cardiac arrhythmias: Current evidence
Annals of Pediatric Cardiology 2018 11(2):148-163
This article reviews important features for improving the diagnosis of fetal arrhythmias by ultrasound in prenatal cardiac screening and echocardiography. Transient fetal arrhythmias are more common than persistent fetal arrhythmias. However, persistent severe bradycardia and sustained tachycardia may cause fetal hydrops, preterm delivery, and higher perinatal morbidity and mortality. Hence, the diagnosis of these arrhythmias during the routine obstetric ultrasound, before the progression to hydrops, is crucial and represents a challenge that involves a team of specialists and subspecialists on fetal ultrasonography. The images in this review highlight normal cardiac rhythms as well as pathologic cases consistent with premature atrial and ventricular contractions, heart block, supraventricular tachycardia (VT), atrial flutter, and VT. In this review, the details of a variety of arrhythmias in fetuses were provided by M-mode and Doppler ultrasound/echocardiography with high-quality imaging, enhancing diagnostic accuracy. Moreover, an update on the intrauterine management and treatment of many arrhythmias is provided, focusing on improving outcomes to enable planned delivery and perinatal management.
https://ift.tt/2riVCjm
Eosinophilia to endomyocardial fibrosis: Documentation of a case
Annals of Pediatric Cardiology 2018 11(2):207-210
Endomyocardial fibrosis (EMF) is an important cause of restrictive cardiomyopathy in tropical countries. The etiopathogenesis of EMF remains obscure. The role of eosinophilia in the etiopathogenesis of EMF has been debated extensively, but remains unproven. Accordingly, we present a case wherein a patient with documented eosinophilia and heart failure at the age of three-and-a-half years presented with endomyocardial fibrosis at the age of nine years. Such documentation is important to highlight the central role of eosinophils in the pathogenesis of EMF.
https://ift.tt/2HNaPo2
Double-outlet left atrium: Successful repair of an extremely rare anomaly
Annals of Pediatric Cardiology 2018 11(2):204-206
The clinical detail, echocardiographic features, angiographic evaluation, and surgical repair of double-outlet left atrium (LA) in a 2-year-old boy are discussed. In a solitus position and normally connected systemic and pulmonary venous drainage setting, the only outlet of the right atrium was a secundum atrial septal defect. The LA thus received the entire venous return and then drained into both ventricles through a common atrioventricular valve.
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Ivabradine for congenital junctional ectopic tachycardia in siblings
Annals of Pediatric Cardiology 2018 11(2):226-228
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Long-term outcome of coronary artery dilatation in Kawasaki disease
Annals of Pediatric Cardiology 2018 11(2):125-129
Background: Kawasaki disease (KD) is an acute systemic vasculitis syndrome with a high incidence of coronary aneurysms in untreated children. The majority of aneurysms resulting from KD are known to regress with time. Aims: This study aimed to determine the course and outcome of coronary artery dilatation in patients with KD and ascertain whether there are any differences in the outcomes in the different branches. Setting and Design: This is a retrospective cohort study of patients diagnosed with KD with midterm follow-up data. Methods: Serial echocardiography was performed in all KD patients with coronary dilatation for 1–10½ years. The Kaplan–Meier curve was used for statistical analysis. Results: There were 154 patients with coronary dilatation studied. The frequency of coronary dilatation in acute phase was 33.3% and decreased to 7.9% 6–8 weeks later. Each patient could have dilatations at more than one branch, so the total number of dilatations was 245. The median time needed for regression was 2.6 months (mean: 10.5 months) while the median of follow-up duration was 41 months (mean: 23 months). Small- and medium-sized dilatations had more favorable outcomes compared to the giant ones. Location of dilatation did not influence the outcome. Conclusions: The majority (77.4%) of small- and medium-sized dilatations regress within 2 years, but giant aneurysms tend to persist. The outcome of coronary dilatation is determined by the diameter and not by the location. Regression rate is faster in smaller dilatations. Left main coronary artery is the most frequent location for dilatation.
https://ift.tt/2rfYNZ4
Cardiac involvement in hypereosinophilic syndrome
Annals of Pediatric Cardiology 2018 11(2):217-218
A 9-year-old boy with hypereosinophilic syndrome (HES) was referred for cardiac magnetic resonance (CMR) imaging following an abnormal echocardiogram that showed a large mass layered on the inferolateral wall of the left ventricle, causing secondary severe mitral regurgitation. Cardiac involvement in HES usually affects the ventricular apex. In our case, CMR confirmed the presence of a large mural thrombus of 0.9 cm × 4.2 cm. This unusual cardiac involvement in HES was diagnosed in its intermediate thrombotic stage. CMR is very sensitive and specific in staging the disease. It explained the etiology of mitral regurgitation and guided therapy, especially when echocardiography was nonconclusive.
https://ift.tt/2KA55f1
Simulation training improves team dynamics and performance in a low-resource cardiac intensive care unit
Annals of Pediatric Cardiology 2018 11(2):130-136
Introduction: Although simulation training has been utilized quite extensively in highincome medical environments, its feasibility and effect on team performance in lowresource pediatric Cardiac Intensive Care Unit (CICU) environments has not been demonstrated. We hypothesized that lowfidelity simulationbased crisis resource management training would lead to improvements in team performance in such settings. Methods: In this prospective observational study, the effect of simulation on team dynamics and performance was assessed in 23 healthcare providers in a pediatric CICU in Southeast Asia. A 5day training program was utilized consisting of various didactic sessions and simulation training exercises. Improvements in team dynamics were assessed using participant questionnaires, expert evaluations, and video analysis of time to intervention and frequency of closedloop communication. Results: In subjective questionnaires, participants noted significant (P < 0.05) improvement in team dynamics and performance over the training period. Video analysis revealed a decrease in time to intervention and significant (P < 0.05) increase in frequency of closedloop communication because of simulation training. Conclusions: This study demonstrates the feasibility and effectiveness of simulationbased training in improving team dynamics and performance in lowresource pediatric CICU environments, indicating its potential role in eliminating communication barriers in these settings.
https://ift.tt/2rjPNSQ
Population-based treated prevalence, risk factors, and outcomes of bicuspid aortic valve in a pediatric Medicaid cohort
Annals of Pediatric Cardiology 2018 11(2):119-124
Background: We investigated the treated prevalence of bicuspid aortic valve in a pediatric population with congenital heart disease and its incident complications. Materials and Methods: A 15-year retrospective data set was analyzed. Selection criteria included age ≤17 years, enrollees in the South Carolina State Medicaid program and diagnosed as having bicuspid aortic valve on one or more service visits. Results: The 15-year-treated prevalence of predominantly isolated bicuspid aortic valve was 2% (20/1000) of pediatric congenital heart disease cases, with a non-African American: African-American ratio of 3.5:1, and a male:female ratio of 1.6:1. Aortic stenosis (28.0%), ventricular septal defect (20.6%), and coarctation of the aorta (20.6%) were the most prevalent coexisting congenital heart lesions. Of the 378 bicuspid aortic valve cases examined, 10.3% received aortic valve repair/replacement, which was significantly more likely to be performed in children with diagnosed aortic stenosis (adjusted odds ratio = 12.90; 95% confidence interval = 5.66–29.44). Cohort outcomes over the study period indicated that 9.5% had diagnosed heart failure, but <1% had diagnosed supraventricular tachycardia, infective endocarditis, aneurysm, dissection, or death. Conclusions: The majority of isolated bicuspid aortic valve cases without aortic stenosis did not require surgical intervention. Outcomes for cases requiring repair/replacement were relatively benign.
https://ift.tt/2HPCPao
Predictive efficacy of procalcitonin, platelets, and white blood cells for sepsis in pediatric patients undergoing cardiac surgeries who are admitted to intensive care units: Single-center experience
Annals of Pediatric Cardiology 2018 11(2):137-142
Background: Sepsis is one of the major contributor of morbidity and mortality in pediatric cardiac surgeries. Aim: The aim of this study was to compare the predictive efficacy of total leukocyte counts (TC), platelet count (PC), and procalcitonin (PCT) for sepsis in patients undergoing cardiac surgeries who are admitted to the Intensive Care Unit. Materials and Methods: This prospective, single-center study included 300 neonates, infants, and pediatric patients who had undergone various open heart surgeries at our center from September 2014 to November 2015. Results: Overall, the incidence of sepsis was 14% in pediatric patients undergoing cardiac surgeries. TC of postoperative 48 h were significantly lower (11889.19 ± 5092.86 vs. 14583.22 ± 6562.96; P = 0.004) in septic patients. The low levels of platelets on postoperative 24 h and 72 h were observed in patients with sepsis as compared to patients without sepsis, whereas the levels of PCT at various time intervals (preoperative, postoperative - 24 h, 48 h, and 72 h) had shown no association with sepsis in the study population. Low PC (24 h) was the strongest predictor of sepsis showing an odds ratio of 1.9 (95% confidence interval [CI]: 1.42–3.51; P = 0.001) and area under curve of 0.688 with 95% CI of 0.54–0.83 (P = 0.018). Conclusion: We may conclude that in Indian pediatric population platelet levels are highly associated with sepsis as compared to any other hematological parameter. The immediate postoperative level of platelet is the strongest predictor of sepsis and could be effectively used in the clinical settings.
https://ift.tt/2riVU9W
Pulmonary artery-to-left atrial fistula discovered after the closure of atrial septal defect: A rare clinical scenario
Annals of Pediatric Cardiology 2018 11(2):211-213
A case of the right pulmonary artery-to- left atrial fistula with atrial septal defect (ASD) is presented. The fistula was detected after the patient developed desaturation following surgical closure of the ASD. It was managed with a transcatheter (trans-RPA route) closure of the fistula using a 12-mm Amplatzer ventricular septal defect closure device.
https://ift.tt/2KAT1u7
Percutaneous balloon dilatation for congenital aortic stenosis during infancy: A 15-year single-center experience
Annals of Pediatric Cardiology 2018 11(2):143-147
Background: Congenital aortic stenosis (AS) is a rare disease. Treatment options for newborns are challenging. Newborns may have higher reintervention rate and mortality. Objectives: The study aimed to identify the factors predictive of reintervention following balloon aortic valvuloplasty (BAV) for AS during infancy. Methods: Retrospectively, between 2001 and 2016, echocardiography (echo) and cardiac catheterization data for infants with AS were analyzed, including follow-ups and reinterventions. Percentage reduction was defined as the ratio between the drop of aortic valve (AV) peak gradient and the baseline peak gradient. Results: Sixty infants were included and 48 were followed up. Sixteen (27%) patients were neonates. Peak-to-peak gradient at AV was 64 ± 27 mmHg, which was reduced to 27 ± 13 mmHg. Percentage reduction was 53% ±24%. Forty-nine (82%) patients had adequate results (residual AV gradient <35 mmHg). There was no significant aortic insufficiency (AI) before procedure, while 6 (10%) patients had increased AI immediately after BAV. Of 48 patients, 14 (29%) required an additional BAV. Of 48 patients, 8 (17%) required surgical interventions following BAV. Reintervention was associated more with small left ventricular outflow tract (LVOT), high residual AV, and low percentage reduction. Mortality was 8.3%. Conclusions: BAV in infancy has a reasonable success rate (82%) with high rate of reintervention. Patent ductus arteriosus-dependent neonates carried the highest risk of mortality. Small LVOT, high AV residual gradient, and low percentage reduction resulted in more reinterventions.
https://ift.tt/2rlwfgD
Large nonapical right ventricular diverticulum in a patient with atrioventricular septal defect
Annals of Pediatric Cardiology 2018 11(2):222-223
Congenital diveticula and aneurysm of the heart are rare and most often located at the apex of the left ventricle. They pose a significant risk for cardiac failure and arrhythmias. In contrast, nonapical diverticula of the right ventricle (RV) have a much more benign course. We present a child with Trisomy 21, atrioventricular septal defect, and large nonapical diverticulum of the RV that was neither addressed during surgery nor needed any medical treatment during 1-year follow-up.
https://ift.tt/2KvjUzv
Is seeing believing: An obstructed bidirectional Glenn, that wasn't!
Annals of Pediatric Cardiology 2018 11(2):230-231
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Anatomy of the normal fetal heart: The basis for understanding fetal echocardiography
Annals of Pediatric Cardiology 2018 11(2):164-173
The rapid changes that have taken place in recent years in relation to techniques used to image the fetal heart have emphasized the need to have a detailed knowledge ofnormal cardiac anatomy. Without such knowledge, it is difficult, if not impossible, to recognize the multiple facets of congenital cardiac disease. From the inception of fetal echocardiographic screening, the importance of basic knowledge of cardiac anatomy has been well recognized. The current machines used for imaging, however, now make it possible potentially to recognize features not appreciated at the start of the specialty. So as to match the advances made in imaging, we have now revisited our understanding of normal cardiac anatomy in the mid-gestational fetus. This was made possible by our dissection of 10 fetal hearts, followed by production of addition histological sections that mimic the standard ultrasound views. The fetuses ranged in gestational age from between 20 and 28 weeks. We then correlated the obtained anatomic images with the corresponding ultrasonic images used in the standard fetal screening scan. We also interrogated the anatomic sections so as to clarify ongoing controversies regarding detailed features of the normal cardiac anatomy. We have been able to show that the views now obtained using current technology reveal many details of anatomy not always appreciated at earlier times. Knowledge of these features should now permit diagnosis of most congenital cardiac malformations. The anatomic-echocardiographic correlations additionally provide a valuable resource for both the understanding and teaching of fetal echocardiography.
https://ift.tt/2rjPM1e
Three-dimensional printing in surgical planning: A case of aortopulmonary window with interrupted aortic arch
Annals of Pediatric Cardiology 2018 11(2):201-203
Better anatomical understanding and conceptualization of complex congenital heart defects using three-dimensional (3D) printing may improve surgical planning, especially in rare defects. In this report, we utilized 3D printing to delineate the exact cardiac anatomy of a neonate with an aortopulmonary window associated with interrupted aortic arch to devise a novel approach to the repair.
https://ift.tt/2KxDv1Q
Developing congenital heart surgery in India: The travails and triumphs of a pioneer
Annals of Pediatric Cardiology 2018 11(2):174-180
Professor IM Rao, from All India Institute of Medical Sciences, New Delhi, was a pioneering cardiac surgeon who, against overwhelming odds, developed congenital heart surgery in India. He made many contributions to the evolution of his specialty, spanning more than four decades and three countries. This is a brief report of his professional life and accomplishments.
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Particle embolization of systemic-to-pulmonary collateral artery networks in congenital heart disease: Technique and special considerations
Annals of Pediatric Cardiology 2018 11(2):181-186
Systemic-to-pulmonary artery collateral networks commonly develop in patients with single-ventricle physiology and chronic hypoxemia. Although these networks augment pulmonary blood flow, much of the flow is ineffective and contributes to cardiac volume loading. This volume loading can have detrimental effects, especially for single-ventricle patients. Some data suggest that occluding collaterals may improve outcomes after subsequent operations, especially when the volume of collateral flow is significant. Traditional practice has been to coil occlude the feeding vessel. We perform particle embolization of these collateral networks for two primary reasons. First, access to the feeding vessel is not blocked as collaterals may redevelop. Second, particles occlude the most distal connections. Thus, embolization with particles should be considered as an alternative to coil occluding the proximal feeding vessel.
https://ift.tt/2rjo0So
Homocystinuria presenting as a calcified right atrial mass
Annals of Pediatric Cardiology 2018 11(2):214-216
Homocystinuria is a genetic inborn error of metabolism due to the deficiency of cystathionine β-synthase resulting in increased serum homocysteine and methionine and decreased cysteine which predisposes affected individuals to arterial and venous thromboembolic phenomena. We present a case of homocystinuria who presented to us as a calcified right atrial mass during the evaluation for lower respiratory tract infection. Our case reveals an unusual mix of findings using imaging with multiple detector computed tomography and radiographs.
https://ift.tt/2HMMCy5
Novel direct approach for placement of permanent transvenous pacing leads after Fontan procedure
Annals of Pediatric Cardiology 2018 11(2):187-190
The need for transvenous pacing (patients who have exhausted epicardial options) after a Fontan-type operation has been recognized. Many novel strategies have been proposed, but currently, all of them require additional maneuvers or rerouting of the leads to the pacemaker pocket. In this report, we describe a novel direct approach to transvenous pacing after a Fontan-type operation from a standard, prepectoral approach.
https://ift.tt/2rkP8R8
T-wave alternans in long QT syndrome
Annals of Pediatric Cardiology 2018 11(2):219-221
Long QT syndrome (LQTS) is a congenital disorder characterized by prolongation of QT interval in the electrocardiogram (ECG) and a propensity to develop ventricular arrhythmias, which may lead to syncope, cardiac arrest or sudden death. T-wave alternans (TWA), a phenomenon of beat-to-beat variability in the repolarization phase of the ventricles, has been closely associated with an increased risk of ventricular tachyarrhythmic events (VTE) and sudden cardiac death (SCD).
https://ift.tt/2HPq5AL
Cardiac CT provides uniquely accurate and comprehensive assessment of bioprosthetic aortic valve stenosis
Description
An 81-year-old man was referred to the cardiology clinic with breathlessness and angina. His history included triple-vessel coronary artery bypass graft (CABG) plus St Jude Epic 21 mm bioprosthetic aortic valve replacement (AVR) surgery 7 years prior.
Transthoracic echocardiography (TTE) demonstrated severely elevated Doppler AVR velocities (VMax 4.7 m/s) and severe AVR stenosis (valve area 0.7cm2). This was the suspected cause of symptoms, and transfemoral valve-in-valve AVR valve-in-valve transcatheter aortic valve implantation (VIV-TAVI) was being considered. However, TTE image quality was suboptimal due to echocardiographic windows and valve echogenicity, precluding accurate leaflet assessment (figure 1A–D). Transoesophageal echocardiography corroborated TTE findings (VMax 5.5 m/s) but failed to delineate the mechanism of AVR restriction (figure 1E–H). Degenerative leaflet calcification was evident on echocardiography, however echogenicity around the sewing ring prevented distinction between calcification and pannus, and ultrasound dropout precluded thrombus exclusion.
Figure 1
Top...
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Case of idiopathic isolated unilateral hypoglossal nerve palsy with spontaneous recovery
Isolated hypoglossal nerve palsy is uncommon because of its intimate relationship with the other lower cranial nerves. Keane reported that tumours, predominantly malignant, were the most common cause of hypoglossal nerve palsy. We report a case of isolated idiopathic unilateral hypoglossal nerve palsy in a 45-year-old Caucasian male where no cause could be identified despite extensive investigations. There was uncertainty around prognosis at onset due to the rarity of this condition. In the absence of a cause, an early referral to the speech and language therapist was made and interestingly our patient made an almost complete recovery within 18 months of onset. In a small case series, it has been reported that though rare, idiopathic hypoglossal nerve palsy has an excellent outcome in most cases, similar to the more common idiopathic seventh cranial nerve palsy (Bell's Palsy).We recommend an early referral for physiotherapy in such cases.
https://ift.tt/2jr5zaR
Ureterosciatic hernia treated with ureteral stent placement
A 92-year-old female with a history of asthma and chronic heart failure presented with left lumber back pain. Physical examination revealed knocking tenderness at the left costal-vertebral angle. Laboratory test results were within normal limits. Abdominal CT showed a left hydroureteronephrosis and an obstruction in the left distal ureter with herniation into the sciatic foramen. A ureteral stent was inserted into the left ureter and was removed after 2 months. She has not complained of pain or showed symptoms since the removal. Our case suggests that doctors consider the possibility of ureterosciatic hernias when examining older patients complaining of lower back pain.
https://ift.tt/2HVBhre
Focal segmental glomerulosclerosis in a patient with prefibrotic primary myelofibrosis
We report a case of 56-year-old man presented to us with chief complaints of frothy urine and leg swelling. A urinalysis revealed nephrotic-range proteinuria. Haematological investigations revealed thrombocytosis, leucocytosis and peripheral blood smear showed a leucoerythroblastic picture. JAK 2 mutation was positive. To confirm the diagnosis of myeloproliferative neoplasm, bone marrow biopsy was done, which was suggestive of primary myelofibrosis. The patient underwent kidney biopsy due to rapidly declining renal function and persistent proteinuria, which was suggestive of focal segmental glomerulosclerosis. Early glomerulopathy is rare in myeloproliferative neoplasm, and aggressive follow-up is required to prevent progression of kidney disease.
https://ift.tt/2jtxtTO
Focal osteopenia of pubic parasymphyseal bone as an underlying cause of groin pain in sports: a new perspective
Groin pain is a common problem in athletes. The diagnosis can be difficult because of the complexity of the groin anatomy, the numerous clinical entities presenting with similar symptoms, the concurrence of those entities and the confusing terminology. Thus, a dilemma in diagnosis may arise leading to long-standing symptoms, disabling groin pain, mismanagement and therefore to poor treatment. Hereby, we present such a case of a recreational athlete complaining for excruciate pubic pain after being misdiagnosed and subsequently mistreated affecting her quality of life. We report on a new interesting finding, the focal osteopenia over the pubic parasymphyseal bone, together with administration of bisphosphonates for first time, as a treatment, for this condition in this body area. Our purpose is to shed light on the pathomechanism of groin pain labelled as osteitis pubis. We also outline the importance of thorough history and physical examination combined with appropriate advanced imaging.
https://ift.tt/2wicpbQ
Splenic cyst and its management in a 21-month-old boy: a rare complication of invasive meningococcal disease
Splenic complications of invasive meningococcal disease (IMD) are well recognised, though cyst formation is rare, particularly in paediatric populations. The best approach to their management is not yet established. This case outlines the management of a splenic cyst in a 21-month-old boy following severe IMD. The case took place in the context of an acute emergence of serogroup W prompting significant media attention and subsequent change in vaccination practice at a jurisdictional level in Australia. The patient was critically unwell early in the illness, then later a collection in the left upper quadrant was detected, shown on ultrasound to be a 11.6x7.7 cm splenic cyst. In this case, the cyst was managed by ultrasound-guided drainage tube insertion. The residual collection was small and stable on subsequent imaging.
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Imaging appearance of malignancy associated gastrogastric intussusception in an elderly woman
Description
A 70-year-old woman who was a known case of gastric malignancy under treatment in complementary medicine presented with epigastric pain and multiple episodes of vomiting for 5 days. On examination, her vitals were stable, and she was afebrile. Slight pallor (+/4) and bilateral pedal oedema were seen. Abdominal examination revealed epigastric tenderness and guarding rigidity. Chest radiograph (figure 1A) showed crescentic lucencies under both hemidiaphragms suggestive of pneumoperitoneum. Abdominal ultrasound (figure 1B–D) showed a large lobulated gastric mass having frond-like margins arising from the upper part of the body of the stomach and seen telescoping into its lumen, carrying the omentum and gastric vessels along, suggestive of gastrogastric intussusception. CT of the abdomen (figure 2) confirmed the ultrasound findings and detected one more lesion along the lesser curvature. The site of perforation was detected in the fundus of the stomach, and few necrotic metastatic lymph...
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Angioedema of the small bowel caused by lisinopril
Description
A 42-year-old man with a history of chronic kidney disease (stage III) and hypertension presented to an outside hospital with acute onset of left lower quadrant abdominal pain that woke him from his sleep. He described the pain as 8/10 in severity, cramping in nature and worsened by eating or drinking. Pain was associated with nausea, intractable vomiting, dyspnoea and dizziness. Ten-point review of systems was negative except for the above reported symptoms.
Vitals on admission were stable. He had tenderness over the suprapubic and left lower quadrant. Physical exam was otherwise unremarkable. His white cell count was elevated at 14.6x103 per microlitre, haemoglobin was 17.0 g/dL, lactate was 1.9 mg/dL and lipase and stool studies were negative. Initial CT of the abdomen pelvis (figure 1) with contrast showed thick-walled small bowel loops of the proximal ileum and jejunum with surrounding haziness producing luminal narrowing. There was...
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A miraculous recovery: Bartonella henselae infection following a red ant bite
Infections caused by the Bartonella species are responsible for the human diseases collectively called 'bartonellosis'. The clinically important human infections are mostly caused by the three species (eg, B. bacilliformis, B. quintana and B. henselae) of Bartonella out of the many progressively increasing identified species. Bartonella henselae transmitted by the arthropod vector, fleas, after cat bite is responsible for the rare multisystem cat scratch disease in humans. We present an extremely rare case of B. henselae contracted presumably through a red ant bite. The patient had a prolonged hospital stay for persistent encephalopathy due to delay in diagnosis and initiation of antimicrobial therapy. His hospital course was complicated by two episodes of pulseless electrical activity cardiac arrest related to pulmonary embolism. However, he recovered to his baseline status in the hospital with timely administration of systemic anticoagulation and antimicrobials. He was discharged home with no neurological deficits.
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Treatment outcome of bimaxillary surgery for asymmetric skeletal class II deformity
Abstract
Objectives
Facial asymmetry is one of the main concerns in patients with a dentofacial deformity. The aims of the study were to (1) evaluate the changes in facial asymmetry after bimaxillary surgery for asymmetric skeletal class II deformity and (2) compare preoperative and postoperative facial asymmetry of class II patients with normal controls.
Materials and methods
The facial asymmetry was assessed for 30 adults (21 women and 9 men, mean age: 29.3 years) who consecutively underwent bimaxillary surgery for asymmetric skeletal class II deformity using cone-beam computed tomography before and at least 6 months after surgery. Thirty soft tissue and two dental landmarks were identified on each three-dimensional facial image, and the asymmetry index of each landmark was calculated. Results were compared with those of 30 normal control subjects (21 women and 9 men, mean age: 26.2 years) with skeletal class I structure.
Results
Six months after surgery, the asymmetric index of the lower face and total face decreased significantly (17.8 ± 29.4 and 16.6 ± 29.5 mm, respectively, both p < 0.01), whereas the asymmetric index of the middle face increased significantly (1.2 ± 2.2 mm, p < 0.01). Postoperatively, 53% of the class II patients had residual chin asymmetry. The postoperative total face asymmetric index was positively correlated with the preoperative asymmetric index (r = 0.37, p < 0.05).
Conclusions
Bimaxillary surgery for patients with asymmetric class II deformity resulted in a significant improvement in lower face asymmetry. However, approximately 50% of the patients still had residual chin asymmetry. The total face postoperative asymmetry was moderately related to the initial severity of asymmetry.
Clinical relevance
These findings could help clinicians better understand orthognathic outcomes on different facial regions for patients with asymmetric class II deformity.
https://ift.tt/2JNw5q7
ED50 of remifentanil for providing excellent intubating conditions when co-administered with a single standard dose of propofol without the use of muscle relaxants in children: dose-finding clinical trial
Abstract
Purpose
Previous studies evidenced that orotracheal intubation without neuromuscular blockers is feasible in children and has some potential advantages. Remifentanil has favorable pharmacodynamic and pharmacokinetic properties as an opioid for orotracheal intubation, but its dose for excellent intubation conditions when co-administered with propofol has not been established. This study was designed to find the minimum effective dose of remifentanil for excellent intubation conditions of children when co-administered with propofol, without neuromuscular relaxant drugs.
Method
Blinded adaptive clinical trial, with sequential allocation of 27 children between 2 and 9 years-old, American Society of Anesthesiologists' physical status PI or PII, scheduled for elective surgery under general anesthesia. Remifentanil dose began at 2 µg/kg and varied by 0.25 µg/kg according to the sequential allocation up-and-down rule designed by Dixon and Massey. Remifentanil was infused in 30 s and followed by propofol (3 mg/kg) in 20 s. Laryngoscopy and intubation were performed and assessed using Viby-Mogensen criteria, 90 s after the end of opioid administration. Inclusion of patients stopped after six crossovers, and remifentanil effective dose was estimated using pooled adjacent-violators algorithm.
Results
Remifentanil effective dose for 50% was established in 3.04 µg/kg (IC 95% 2.68–3.11, p < 0.05). The most frequent adverse effect was difficult positive pressure facial mask ventilation, which occurred in four children (15%).
Conclusion
Minimum remifentanil effective dose for providing excellent intubating conditions when co-administered with a single standard dose of propofol without the use of neuromuscular blockers in children is 3.04 µg/kg.
Trial registration
NCT02454868.
https://ift.tt/2jsbzA5
Clinical implications of food allergen thresholds
Clinical &Experimental Allergy, EarlyView.
https://ift.tt/2FGMr1p
Improving aesthetic outcomes after head and neck reconstruction
https://ift.tt/2IcLaEn
Modern management of osteoradionecrosis
https://ift.tt/2JRSsdZ
Improving aesthetic outcomes after head and neck reconstruction
https://ift.tt/2IcLaEn
Modern management of osteoradionecrosis
https://ift.tt/2JRSsdZ
Management of Post-Traumatic Subglottic Stenosis and Pharyngosubglottic Fistula
Abstract
Injury to the aerodigestive tract following external laryngeal trauma is rare. Reports of acquired laryngopharyngeal fistula are very few. We report a very rare presentation of penetrating neck trauma presenting with fracture of the cricoid cartilage, subglottic stenosis and pharyngosubglottic fistula. The term 'pharyngosubglottic fistula' is used here for the first time to describe a communication tract between hypopharynx and subglottis. The successful surgical management of this case is discussed.
https://ift.tt/2JQBexy
Spontaneous Medial Cribriform CSF Leak: Endoscopic Surgical Repair with Free Mucosal Graft—Our Experience
Abstract
Cribriform plate is the commonest site of spontaneous CSF leak, the fragility of the plate and juxtaposition of arachnoid's investment to the bone, where the olfactory nerve pierces the skull made this area, a vulnerable site for CSF leak. Transnasal endoscopic approach has gained popularity for CSF leak repair over the years. To describe the 5 year experience of spontaneous medial cribriform CSF leak repair with free mucosal graft in a tertiary medical centre. All patients who underwent transnasal endoscopic repair with free mucosal graft for spontaneous medial cribriform CSF leak in our institution between 2011 and 2016 were reviewed. Twelve patients were identified, all were women with a mean age of 44.5 years. The defect was localised by preoperative computed tomography scans with 1 mm cuts and MR cisternography. Via medial approach, the mucosa surrounding the entire defect was denuded and the defect was closed with free mucosal graft harvested either from the middle turbinate or from the nasal septum and middle turbinate was finally sutured with septum to stabilise the repair. The overall success rate was 100% with the first attempt with no recurrence or postoperative complications. Follow up ranged from 1 to 5 years. The endoscopic transnasal technique with free mucosal graft for the repair of spontaneous medial cribriform CSF rhinorrhoea is associated with a very high success rate and it should be considered for majority of cases.
https://ift.tt/2I9sDsR
High‐fluence 1064‐nm Q‐Switched Nd:YAG laser: Safe and effective treatment of café‐au‐lait macules in Asian patients
Journal of Cosmetic Dermatology, EarlyView.
https://ift.tt/2JNfuCE