Heterogeneity in Positive Predictive Value of RAS Mutations in Cytologically Indeterminate Thyroid Nodules

Thyroid, Ahead of Print.


https://ift.tt/2k4QIDx

Identification of a Recurrent LMO7–BRAF Fusion in Papillary Thyroid Carcinoma

Thyroid, Ahead of Print.


https://ift.tt/2rNkOyF

Predominantly cystic clear cell renal cell carcinoma and multilocular cystic renal neoplasm of low malignant potential form a low-grade spectrum

Abstract

Multilocular cystic renal cell carcinoma has been recently excluded from clear cell renal cell carcinoma (CCRCC) category and re-designated as multilocular cystic renal neoplasm of low malignant potential (MCRNLMP) due to its uniformly good outcomes. While strict distinction between MCRNLMP from predominantly cystic CCRCC (pc-CCRCC) is being emphasized, the significance of extensive true cystic component in CCRCC has not been investigated. Herein, we analyzed 57 MCRNLMP, 69 pc-CCRCC, and 46 non-cystic CCRCC. There were no statistically significant differences between the three subtypes in age, gender, and laterality. ISUP grades were 1 (73%) or 2 (27%) for MCRNLMP; for pc-CCRCC were 1 (31%), 2 (60%), and 3 (9%); and for non-cystic CCRCC were 1 (9%), 2 (52%), 3 (26%), and 4 (13%). MCRNLMP were either pT stage 1 (91%) or 2 (9%), pT stages for pc-CCRCC were 1 (92.5%), 2 (1.5%), and 3 (6%) and for non-cystic CCRCC were 1 (58.7%), 2 (6.5%), and 3 (34.8%). None of MCRNLMP patients developed recurrences or metastases, and only 1 contralateral kidney tumor and 1 metastasis developed in pc-CCRCC. In contrast, 19 patients with non-cystic CCRCC developed metastases (5-year PFS 58%, CI 38.3–73.5%), and 1 patient died of disease. Monosomy 3 was common in both MCRNLMP (3/3) and pc-CCRCC (6/7). This large series of MCRNLMP confirms its indolent behavior, shows that pc-CCRCC has significantly better prognosis than non-cystic CCRCC and may define the lower grade spectrum of CCRCC. We recommend that the presence and extent of CCRCC cystic component should be documented in the pathology report.

https://ift.tt/2rL6TZO

Allergen‐specific immunotherapy induces regulatory T cells in an atopic dermatitis mouse model

Allergy, EarlyView.


https://onlinelibrary.wiley.com/doi/abs/10.1111/all.13465?af=R

Incidence of pediatric atopic dermatitis following thymectomy: A Danish register study

Allergy, EarlyView.


https://onlinelibrary.wiley.com/doi/abs/10.1111/all.13457?af=R

A Commentary on: “Effects of Regular Physical Activity on the Cognitive Performance of Type 2 Diabetic Patients: A systematic Review” by Podolski et al. (Metab Syndr Relat Disord 2017;15:481–493)

Metabolic Syndrome and Related Disorders, Ahead of Print.


https://ift.tt/2Irb30l

La charte éthique et déontologique des facultés de médecine et d’odontologie françaises

Publication date: June 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 3
Author(s): O. Laccourreye, H. Maisonneuve




https://ift.tt/2IuTlsw

Un dernier Qui suis-je !

Publication date: June 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 3
Author(s): O. Laccourreye, A. Werner, I. McGill




https://ift.tt/2k12C0X

Évaluation de l’efficacité de la labioglossopexie dans la triade de Pierre Robin

Publication date: June 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 3
Author(s): H. Broucqsault, M.-D. Lamblin, G. Hosana, P. Fayoux
ObjectifsÉvaluer l'efficacité de la labioglossopexie sur le SAOS par polysomnographie chez des enfants porteurs d'une séquence de Pierre Robin.Matériel et méthodesÉtude rétrospective monocentrique de 2004 à 2015 chez des enfants ayant bénéficié d'une labioglossopexie pour un syndrome d'apnée obstructif du sommeil dans le cadre d'un syndrome de Pierre Robin. Dans le cadre du bilan préopératoire, une polysomnographie et une endoscopie laryngotrachéale étaient réalisées. Les données recueillies étaient le diagnostic syndromique, l'assistance respiratoire en pré opératoire et ses modalités. Le syndrome d'apnée obstructif du sommeil était classé en 3 catégories selon sa sévérité. La polysomnographie de contrôle était réalisée 1 mois après l'intervention.RésultatsAu total, 37 patients ayant eu une labioglossopexie ont été inclus. L'âge médian lors de l'intervention était de 45jours (8–210). Au total, 31 patients avaient une séquence de Pierre Robin isolée et 6 avaient un syndrome associé. Tous les patients avaient un syndrome d'apnée obstructif du sommeil sévère nécessitant une aide respiratoire en préopératoire : 8 intubations orotrachéale, 15 ventilations non invasive, 14 sondes nasopharyngées. La labioglossopexie améliore significativement la saturation en oxygène, la capnie et l'index d'apnée hypopnée (p<0,005). Dans certains cas, l'amélioration n'était pas suffisante et nécessitait la réalisation d'une trachéotomie (n=5) ou la mise en place d'une ventilation non invasive (n=3).ConclusionLa labioglossopexie améliore l'obstruction respiratoire chez les enfants avec un syndrome de Pierre Robin permettant d'éviter dans la plupart des cas (n=29) des thérapeutiques plus invasives.



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Place de l’allergie dans la caractérisation phénotypique et endotypique de la polypose nasosinusienne

Publication date: June 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 3
Author(s): G. Mortuaire, I. Gengler, M. Balden, M. Capron, G. Lefèvre
ObjectifsÉvaluer la place de l'allergie en tant que facteur influençant la présentation clinique (phénotype) et le profil inflammatoire (endotype) de la polypose nasosinusienne (PNS).Matériel et méthodesUne étude prospective monocentrique était menée sur 18 mois incluant 57 patients suivis pour PNS en situation d'échec du traitement médical. L'allergie était diagnostiquée sur la concordance des tests cutanés allergéniques et des manifestations cliniques. L'analyse du profil phénotypique s'appuyait sur le score de sévérité clinique, la taille des polypes et le score tomodensitométrique de Lund-Mackay. Le profil endotypique était établi par la mesure des concentrations dans le sang et les sécrétions nasales en IgE totales, IgA, interleukine-5, interleukine-9, ECP et EDN. Les taux de polynucléaires éosinophiles dans le sang, les sécrétions nasales et le polype étaient aussi comparés.RésultatsLes profils phénotypiques et endotypiques des patients allergiques (n=15) et non allergiques (n=42) étaient comparables. Seuls l'asthme et les IgE totales sanguines étaient associés à la présence d'une allergie.ConclusionCe travail suggère que l'allergie n'est pas directement impliquée dans l'expression clinique et les processus inflammatoires de la PNS. À l'heure de nouvelles approches thérapeutiques ciblant les voies de signalisation inflammatoire, l'identification de marqueurs sanguins et tissulaires pertinents constitue l'axe de recherche la plus susceptible de modifier la prise en charge de la PNS.



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Laryngectomie totale et pharyngolaryngectomie totale pour carcinome épidermoïde du larynx et de l’hypopharynx : fréquence, distribution et facteurs de risque de survenue de métastases ganglionnaires

Publication date: June 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 3
Author(s): D. Riviere, J. Mancini, L. Santini, A. Giovanni, P. Dessi, N. Fakhry
ObjectifsÉvaluer la fréquence et la distribution des métastases ganglionnaires chez des patients opérés de laryngectomie totale ou de pharyngolaryngectomie totale.Matériel et méthodesÉtude rétrospective monocentrique réalisée à partir de 136 patients ayant bénéficié d'une laryngectomie totale ou d'une pharyngolaryngectomie totale pour carcinome épidermoïde pharyngolaryngé associée à un traitement chirurgical des aires ganglionnaires.RésultatsAu total, 110 patients présentaient une tumeur du larynx et 26 patients une tumeur de l'hypopharynx. Soixante-trois patients étaient opérés en première intention et 73 patients étaient opérés en situation de récidive. Le taux de métastases ganglionnaires confirmées histologiquement était de 44,8 %, quelle que soit la localisation de la tumeur primitive. La localisation tumorale hypopharyngée était un facteur de risque de métastases ganglionnaires (73,1 %, p=0,002) tout comme la sous-localisation tumorale sus-glottique (64,3 %, p=0,039). Les groupes IIa et III étaient envahis dans 28,7 % et 25,7 % des cas respectivement. Parmi les patients ayant bénéficié d'un évidement des groupes VIb, le taux d'envahissement ganglionnaire dans ces territoires était de 23,8 %. Le taux de récidive ganglionnaire était de 10,3 % dans les groupes II à IV et de 13,2 % dans les groupes VIb.ConclusionsQuelle que soit la localisation tumorale, les groupes IIa et III sont les plus fréquemment envahis. L'importance du taux d'envahissement histologique dans les groupes VIb évidés, mais également de récidive, doit faire discuter un évidement ganglionnaire prophylactique bilatéral systématique de ces territoires dans certaines localisations tumorales.



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Editorial Board

Publication date: June 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 3





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Comparaison entre le Video Head Impulse Test (VHIT) et les épreuves caloriques dans la maladie de Menière définie unilatérale à un stade avancé

Publication date: June 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 3
Author(s): F. Rubin, F. Simon, B. Verillaud, P. Herman, R. Kania, C. Hautefort
ObjectifPeu de publications étudient le VHIT au cours de la maladie de Menière (MM), et ces études sont contradictoires (certaines observent un VHIT systématiquement normal au cours de la maladie, et d'autres non). Ces incohérences pourraient peut-être être liées au fait que les patients les moins sévères auraient des résultats différents des patients les plus sévères. Le but de cette étude était de comparer les résultats du VHIT aux épreuves caloriques chez des patients atteints de MM définie unilatérale à un stade avancé.Matériel et méthodeÉtude prospective de 37 patients inclus consécutivement, d'âge moyen 56 ans (±12). La surdité moyenne était de 59dB HL (±18) et 12 patients subissaient des crises de Tumarkin. L'anormalité des caloriques était définie par une hyporéflexie d'au moins 20 %. L'anormalité du VHIT était définie par la présence de saccades ou d'un gain <0,64 pour les canaux verticaux et 0,78 pour les horizontaux.RésultatsTous les patients avaient un VHIT normal et 3 patients avaient un calorique normal. L'hyporéflexie moyenne était de 45 % aux caloriques.ConclusionÀ ce jour, ce travail est le seul publié utilisant l'actuelle définition de MM (août 2015). Cette étude suggère qu'en dehors de toute crise, le VHIT est normal au cours de la MM définie unilatérale à un stade avancé, ceci contrastant avec des caloriques anormaux. Cette situation inhabituelle pourrait aider les cliniciens à distinguer les hydrops d'autres maladies de l'oreille interne et il serait très intéressant d'étayer cette hypothèse en étudiant davantage de patients souffrant d'hydrops.



https://ift.tt/2IuH0VC

Paralysie laryngée unilatérale idiopathique de l’adulte

Publication date: June 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 3
Author(s): F. Rubin, A. Villeneuve, L. Alciato, L. Slaïm, P. Bonfils, O. Laccourreye
ButAnalyse des caractéristiques de la paralysie laryngée unilatérale idiopathique de l'adulte.Matériel et méthodesÉtude rétrospective (difficultés diagnostiques, données cliniques, récupération) d'une cohorte de 100 patients avec une paralysie laryngée unilatérale idiopathique (groupe A) et comparaison avec une cohorte de 211 patients avec une paralysie laryngée unilatérale isolée non idiopathique et non traumatique (groupe B).RésultatsUne difficulté diagnostique était notée dans 24 % des cas, au sein du groupe A : huit patients avec une affection virale ORL commune concomitante à l'apparition de la paralysie, cinq patients avec une affection concomitante pouvant entrainer une immunodépression et 11 patients chez qui la surveillance notait l'apparition d'une affection tumorale maligne sur le trajet des nerfs pneumogastrique et laryngé ipsilatéraux ou au sein du larynx paralysé. En analyse actuarielle, aucune récupération de la mobilité laryngée ne survenait après le 51^e mois suivant le début de la paralysie pour un taux actuariel de récupération à cinq ans de 53,2 % dans le groupe A et de 17,9 % dans le groupe B (p<0,0001). Au sein du groupe A, la récupération de la mobilité laryngée survenait avant la fin de la deuxième année dans 93 % des cas. En analyse monovariée, la récupération de la mobilité laryngée au sein du groupe A était d'autant plus fréquente que le sujet était jeune (p=0,033), que le délai de consultation était court (p<0,001), et qu'il n'existait pas d'antécédent carcinologique (p=0,028). En l'absence de récupération, au sein du groupe A, une pathologie tumorale maligne sur le trajet des nerfs pneumogastrique ou laryngé inférieur ipsilatéraux apparaissait dans 17,2 % des cas dont 81 % étaient dépistés dans les 30 mois qui suivaient le début de la paralysie.ConclusionEn présence d'une paralysie laryngée unilatérale non traumatique isolée et en l'absence de récupération de la mobilité laryngée, chez l'adulte, une surveillance régulière poursuivie au moins trois ans est conseillée.



https://ift.tt/2k1Cinr

Caractéristiques épidémiologiques des cancers de la cavité buccale, de l’oropharynx, de l’hypopharynx, et du larynx sur l’île de la Réunion

Publication date: June 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 3
Author(s): A. Delagranda, G. Leterme, E. Chirpaz, C. Ferdynus, C. Fernandez, F. Rubin
ButsCette étude a deux objectifs : premièrement préciser et comparer les caractéristiques épidémiologiques des cancers de la cavité buccale, du pharynx et du larynx sur l'île de la Réunion, un territoire d'outre-mer Français. Deuxièmement, discuter le mode de présentation des incidences standardisées dans la littérature de ces types de cancers.Matériel et méthodeÉtude rétrospective d'une cohorte de 599 patients avec un cancer de la cavité buccale, de l'oropharynx de l'hypopharynx ou du larynx, diagnostiqués sur l'île de la Réunion entre 2009 et 2013. Analyse des caractéristiques démographiques, des intoxications tabagique et énolique, de la prévalence de l'infestation HPV. Calcul des incidences standardisées sur la population mondiale globale pour les deux sexes.RésultatsLe sex-ratio était de 7,77 et l'âge moyen de 60 ans. Le cancer était un carcinome épidermoïde dans 99,1 % des cas. On a relevé une intoxication énolique dans 81,25 % des cas (340/375), une intoxication tabagique dans 86,1 % des cas (309/359), une infestation HPV dans 16 % des cas (31/184). Selon les regroupements anatomiques proposés par l'International Agency for Research on Cancer, l'incidence des cancers du groupe « autre pharynx » était chez les hommes de 9,3/100 000, et les femmes 0,7. L'incidence des cancers du larynx était de 6,4 pour les hommes et 0,4 pour les femmes.ConclusionLa Réunion présente des particularités en termes d'incidences : les femmes sont au minimum deux fois moins atteintes qu'en métropole par tous ces cancers, alors que les incidences masculines sont parmi les plus hautes de France. La présentation des résultats par les registres des cancers pourrait être améliorée, en accord avec la pratique quotidienne des ORL.



https://ift.tt/2IuGRl2

Modèles animaux de l’otite moyenne aiguë – une mise au point avec des implications pratiques pour la recherche en laboratoire

Publication date: June 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 3
Author(s): N.H. Davidoss, Y.K. Varsak, P.L. Santa Maria
Un nombre considérable d'études animales s'est concentré sur le développement de nouvelles stratégies pour la prévention et le traitement de l'otite moyenne aiguë (OMA). Plusieurs modèles expérimentaux de l'OMA ont ainsi été développés. L'analyse de la littérature publiée dans la base de données PubMed, sur la période allant de 1975 à juillet 2016, en utilisant les mots clés « animal model » et « otitis media », notait 91 études et 123 modèles animaux. Le rat, la souris et le chincilla étaient les animaux les plus fréquemment utilisés pour les modèles expérimentaux d'OMA, avec leurs avantages et leurs désavantages propres. Streptococcus pneumoniae, Haemophilus influenzae et Moraxella catarrhalis, Streptococcus pneumoniae (types 3, 23 et 6A) et Haemophilus influenzae non typable (HINT) étaient les pathogènes les plus couramment utilisés pour induire des OMA chez les rats et les souris. L'ajout de pathogènes viraux tels que le VRS et le virus Influenza A, couplé à l'induction de dysfonctionnements au niveau des trompes d'Eustache, peut aussi être utile dans les modèles animaux de l'OMA. La prophylaxie antibiotique peut également interférer avec la réponse immunitaire sans réduire de manière significative la mortalité animale.



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La polypose nasale (ou rhinite olfactive chronique)

Publication date: June 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 3
Author(s): R. Jankowski, C. Rumeau, P. Gallet, D.T. Nguyen
Le concept de rhinosinusite chronique avec ou sans polype repose sur l'unicité structurale et fonctionnelle de la muqueuse pituitaire et sa réponse univoque aux agressions de l'environnement (allergènes, virus, bactéries, pollution…). Il est confronté dans la présente mise au point à la théorie évo-dévo des trois nez qui, au contraire, individualise la polypose nasale comme une maladie intrinsèque du nez olfactif et en particulier de la muqueuse non olfactive de l'ethmoïde (qui dans la théorie évo-dévo n'est pas un sinus mais l'os de la base du crâne abritant la muqueuse olfactive). L'approche évo-dévo permet un diagnostic positif simple et précis de la polypose nasale et de ses différentes formes cliniques, améliore le diagnostic différentiel en précisant les maladies chroniques du nez respiratoire et celles des sinus paranasaux, soulève l'hypothèse d'une origine auto-immune dirigée spécifiquement contre des auto-antigènes du système olfactif, et corrobore le concept chirurgical de nasalisation aux détriments de celui de chirurgie fonctionnelle des sinus et du complexe ostio-méatal. La ventilation sinusienne semble en effet mineure par rapport à sa fonction de production, stockage et libération active de monoxyde d'azote (NO) utile à l'oxygénation du sang artériel au niveau des alvéoles pulmonaires. Cette fonction respiratoire des sinus paranasaux est peut-être la plus importante de celles qui leur ont été attribuées. Le piégeage du NO dans les espaces ethmoïdaux permet en outre de comprendre certains aspects radiologiques associés à la polypose nasale.



https://ift.tt/2Iot27C

Reconstruction hypopharyngée à l’aide d’une pince à agrafage circulaire

Publication date: June 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 3
Author(s): P. Schultz, A. Dupret-Bories, S. Ciftci, L. Fath
L'anastomose distale par lambeau tubulisé est une des principales difficultés dans la reconstruction de l'hypopharynx. Si la probabilité de survie du lambeau est élevée grâce à l'expérience des équipes chirurgicales, deux complications restent courantes, la fistule et la sténose de la jonction lambeau- œsophage. L'usage d'une pince à agrafage circulaire permet de diminuer la fréquence de ces complications en réalisant une suture parfaitement circulaire et solide. La mise en place d'un stent salivaire n'est pas utile et l'alimentation peut-être reprise plus précocement. Son utilisation est simple moyennant quelques impératifs techniques, puisque les pinces disponibles n'ont pas été conçues dans cette indication. Nous décrivons ici, les indications, la procédure chirurgicale et les résultats globaux des cas réalisés. Le lambeau antébrachial est pour nous le lambeau idéal pour cette reconstruction, mais la technique autorise des lambeaux plus épais jusqu'au lambeau de grand pectoral avec cependant des résultats moins satisfaisants en terme de cicatrisation et de déglutition.



https://ift.tt/2IuGG9m

Technique de l’épiglottoplastie dans la chirurgie partielle du larynx par voie endoscopique

Publication date: June 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 3
Author(s): M. Moulin, C.A. Righini, P.F. Castellanos, I. Atallah
L'intérêt de la chirurgie partielle du larynx par voie endoscopique est de réaliser une exérèse tumorale de qualité tout en limitant les séquelles fonctionnelles permettant ainsi l'amélioration des suites postopératoires. Dans ce type de chirurgie, l'épiglotte est souvent partiellement sectionnée avec une zone d'exérèse laissée en cicatrisation dirigée, sans temps de reconstruction. La technique chirurgicale présentée s'intéresse au temps de reconstruction endoscopique en cas de section partielle de l'épiglotte. La suture du bord sectionné de l'épiglotte à la base de langue permet de recréer une néo-épiglotte avec un plan valléculaire, se rapprochant ainsi de l'anatomie préopératoire afin d'améliorer les capacités de déglutition dans les suites opératoires.



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L’injection de toxine botulinique par voie endoscopique en ambulatoire dans les mouvements anormaux du larynx

Publication date: June 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 3
Author(s): A. Kaderbay, C.A. Righini, P.F. Castellanos, I. Atallah
IntroductionL'injection de toxine botulinique est largement utilisée dans le traitement des mouvements anormaux du larynx. L'injection transcutanée sous contrôle électromyographique est la technique la plus commune pour réaliser l'injection intra-laryngée de toxine botulinique.ObjectifNous décrivons une approche endoscopique pour l'injection intra-laryngée de toxine botulinique sous anesthésie locale sans avoir recours à l'électromyographie.TechniqueUn vidéo-endoscope flexible avec un canal opérateur est utilisé. Après une anesthésie locale du larynx par instillation de lidocaïne, une aiguille flexible est insérée dans le canal opérateur afin d'injecter la dose désirée de toxine botulinique dans les plis vocaux et/ou vestibulaires.ConclusionL'injection de toxine botulinique par voie endoscopique sous anesthésie locale dans les mouvements anormaux du larynx est une technique fiable. Elle peut être réalisée par tout laryngologiste sans avoir recours à l'électromyographie. Elle est pratique pour l'opérateur et confortable pour le patient.



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Syndrome de Forestier et apnée obstructive du sommeil : traitement chirurgical

Publication date: June 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 3
Author(s): D.K. Ribeiro, J.A. Pinto, G.S. Freitas
IntroductionNous rapportons un cas d'apnée obstructive du sommeil causé par la maladie de Forestier et décrivons le traitement chirurgical réalisé.RésuméUn patient de 56 ans présentait une dysphagie aux solides et liquides, ainsi qu'un ronflement (score coté à 10) et une somnolence diurne excessive depuis cinq ans. Lors de l'examen nasofibroscopique, il y avait un œdème de la région inter-aryténoïdienne et une protrusion de la paroi postérieure du larynx. La radiographie cervicale a montré une protrusion des disques intervertébraux entre C3-C5 (hyperostose squelettique) et la polysomnographie a révélé un index d'apnée-hypopnée (IAH) de 56 événements/h. La chirurgie a été réalisée par les équipes d'otorhinolaryngologie et d'orthopédie. Le patient a évolué vers une résolution complète des symptômes et un IAH de 3,9 événements/h à la polysomnographie de contrôle.DiscussionIl s'agit du premier cas de syndrome de Forestier (SF) associé à l'apnée obstructive du sommeil (AOS) traitée par chirurgie avec amélioration complète des symptômes.



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Schwannome du sinus frontal

Publication date: June 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 3
Author(s): J. Petersen, L. Gilain, A. Coutu, N. Saroul
IntroductionLes schwannomes nasosinusiens sont rares, et particulièrement au niveau du sinus frontal.Cas cliniqueNous rapportons le cas d'une patiente atteinte d'un schwannome du sinus frontal gauche découvert lors d'une complication à type de sinusite frontale avec complications orbitaire et oculaire. Le geste a consisté en une exérèse tumorale par voie endonasale et un drainage par voie externe.DiscussionL'origine des schwannomes du sinus frontal sont multiples avec des expressions clinico-radiologiques variées, rendant leur diagnostic difficile leur exérèse étant par ailleurs complexe.



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Anosmie et obstruction nasale

Publication date: June 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 3
Author(s): J.J. Braun, S. Riehm




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Papillomatose laryngée au Sénégal : bilan d’une experience de 10 ans

Publication date: June 2018
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 3
Author(s): S. Maiga, C. Ndiaye, M. Diouf, B.K. Diallo, M. Ndiaye, M.S. Diouf, I.C. Ndiaye, R. Diouf
ObjectifsLes objectifs de cette étude étaient de montrer les aspects épidémiologiques, cliniques et thérapeutiques de la papillomatose laryngée, dans les services d'ORL et de chirurgie cervicofaciale du centre hospitalier national universitaire de Fann, Dakar, Sénégal.Patients et méthodesIl s'agit d'une étude rétrospective menée à la clinique ORL Lamine Sine Diop du CHNU de Fann du 01 janvier 2006 au 31 décembre 2015 concernant tous les patients hospitalisés pour la prise en charge d'une papillomatose laryngée. Les paramètres étudiés étaient épidémiologiques, cliniques et thérapeutiques. Les données obtenues ont été analysées par le logiciel spécialisé dans le traitement des données statistiques « SPSS 18 ».RésultatsL'âge médian au moment du diagnostic était de 11 ans, le sex-ratio était de 1,88. Le délai moyen de consultation était de 4,5 ans. La dysphonie était le symptôme le plus constant, elle était présente dans tous les cas, suivie de la dyspnée laryngée qui était présente dans 64,6 % des cas. La localisation glottique était présente chez tous les patients soit 100 % des cas. Une trachéotomie était réalisée chez 20,8 % des cas. Tous les patients de notre étude ont bénéficié d'une exérèse per endoscopique des papillomes à la pince.ConclusionLa papillomatose laryngée est la plus fréquente des tumeurs bénignes de l'enfant, mais elle peut aussi débuter à l'âge adulte. Son traitement a été révolutionné par les progrès de l'endoscopie et des traitements antiviraux. Cependant, la trachéotomie occupe toujours une place importante dans notre pratique.



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Weight-Loss Cognitive-Behavioural Treatment and Essential Amino Acid Supplementation in a Patient with Spinal Muscular Atrophy and Obesity

Spinal muscular atrophy is a genetic neuromuscular disease characterised by muscle atrophy, hypotonia, weakness, and progressive paralysis. Usually, these patients display increased fat mass deposition and reductions in fat-free mass and resting energy expenditure—an unfavourable condition that facilitates the development of obesity. However, weight management of these patients remains poorly described. Hence, the aim of this case report was to describe the clinical presentation and weight management of a 31-year-old male patient with spinal muscular atrophy type III, class I obesity, and metabolic syndrome treated for 1 year by means of a personalised multistep cognitive-behavioural treatment for obesity. The treatment produced a weight loss of 7.2 kg (7.1%), which was associated with a marked improvement in both the patient's self-reported general conditions and obesity-related cardiometabolic profile, and no adverse effects in terms of spinal muscular atrophy (i.e., reductions in fat-free mass or resting energy expenditure).

https://ift.tt/2rMbcVL

Rhinocerebrale Mucormykose

Laryngo-Rhino-Otol
DOI: 10.1055/a-0619-5143

Mucormykose ist eine Schimmelpilzinfektion, die insbesondere bei immunsupprimierten Patienten rasch progredient verlaufen kann. Uns wurde eine 47-jährige Patientin mit einer Ptosis links bei sonst unauffälligem augenärztlichen Befund vorgestellt. Die Blutzuckerwerte waren bei Diabetes mellitus deutlich erhöht.Das CT der Nasennebenhöhlen zeigte eine moderate Verlegung des Siebbeins links und in der cMRT erschienen der orbitale Fettkörper und die Augenmuskeln verdickt. Als noch eine Hebungseinschränkung des Bulbus auftrat, erfolgte die Nasennebenhöhlenoperation. Mikrobiologisch wurde dabei eine Mucormykose (Gattung Lichtheimia) gesichert. Die Patientin erblindete links, sodass die Indikation zur Exenteratio orbitae links und Re-Pansinusoperation zur Fokussanierung gestellt wurde. Liposomales Amphotericin B und Posaconazol wurden hochdosiert verabreicht und der Blutzucker wurde streng reguliert. Bei bildmorphologischem Progress waren weitere operative Eingriffe bis zur Duraresektion nötig.Der Verlauf war durch Komplikationen (rezidivierende septische Episoden, Niereninsuffizienz, ein bifrontales Epiduralhämatom sowie multiple zerebrale Mikroinfarkte) erschwert, doch schlussendlich konnte sie nach 8-monatiger Hospitalisation entlassen werden. Eine Epithese wurde angepasst und sie ist seit 24 Monaten (nach Diagnose) rezidivfrei.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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

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Die Rolle der elektiven Neck dissection bei Salvage Laryngektomie – eine retrospektive Analyse

Laryngo-Rhino-Otol
DOI: 10.1055/a-0619-5388

Im Rahmen der Salvage Laryngektomie (SLE) bei Rezidivkarzinomen des Larynx und Hypopharynx wird häufig, wie bei der primären Laryngektomie (LE), eine elektive beidseitige Neck dissection durchgeführt. Der therapeutische Nutzen muss angesichts des potentiell höheren Morbiditätsrisikos nach definitiver Radiochemotherapie gegenüber den Risiken abgewogen werden.In einer retrospektiven Analyse wurden onkologische Parameter von Patienten erfasst, welche bei Rezidivkarzinomen des Larynx und Hypopharynx nach primärer Radiochemotherapie eine SLE mit beidseitiger Neck dissection erhielten. Zum Vergleich wurden Daten von Patienten mit primärer LE und beidseitiger Neck dissection bei Larynx- und Hypopharynxkarzinomen erfasst.19 Patienten mit SLE und 83 Patienten mit LE wurden in die Analyse eingeschlossen. Bei der Mehrzahl der Patienten waren sowohl das initiale Tumorstadium als auch das Rezidiv-Tumorstadium vor SLE fortgeschritten. Vor SLE wiesen 5 % der Patienten (n = 1) klinisch metastasensuspekte Lymphknoten auf, vor LE 47 % (n = 39). Bei 17 % (n = 14) der Patienten mit LE wurden okkulte Lymphknotenmetastasen nachgewiesen, bei SLE lediglich bei 5 % der Patienten (n = 1). Insgesamt ergab sich ein pN+ -Stadium in 55 % (LE, n = 44) bzw. 10 % (SLE, n = 2) der Fälle. Die Gesamtzahl der entfernten Lymphknoten bei LE war höher als bei SLE (37,3 vs. 18,7, p < 0,001). Das 5-Jahres-Gesamtüberleben der Patienten lag nach LE bei 50,0 %, nach SLE bei 33,3 %.Patienten, welche bei Rezidivkarzinomen des Larynx oder Hypopharynx nach primärer Bestrahlung eine SLE erhalten, weisen selten Lymphknotenmetastasen auf. Dennoch kommt es in Einzelfällen zu einer okkulten Metastasierung. Bei der Planung der letzten kurativen Therapieoption sollte dies in Betracht gezogen werden.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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

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From the pages of allergywatch July 2018

Publication date: Available online 16 May 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Stanley M. Fineman, David A. Khan, Chitra Dinakar, David Michael Lang, Stephen A. Tilles




https://ift.tt/2L5mxIA

Omalizumab can inhibit respiratory reaction during aspirin desensitization

Publication date: Available online 16 May 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): David M. Lang, Mark A. Aronica, Elizabeth S. Maierson, Xiao-Feng Wang, Dorothy C. Vasas, Stanley L. Hazen
BackgroundAspirin desensitization has been associated with benefit in management of aspirin exacerbated respiratory disease (AERD). An intervention that would encourage aspirin desensitization to be performed more frequently has substantial potential for improving outcomes and quality of life in patients with AERD.ObjectiveWe investigated whether omalizumab administration would be associated with attenuation of aspirin-provoked bronchospasm in patients with AERD undergoing aspirin desensitization.MethodsWe carried out a randomized, double-blind, placebo-controlled study in which subjects with AERD who fulfilled label criteria for omalizumab received omalizumab or placebo for 16 weeks, and then underwent aspirin desensitization.ResultsEleven subjects completed aspirin desensitization. Of the seven who were randomized to omalizumab, 5 had no respiratory reaction during aspirin desensitization. Compared with placebo, omalizumab was associated with a significantly greater likelihood for subjects with AERD to have no respiratory reaction during desensitization (p=0.04, Fisher Exact Test). There was an overall difference in urinary LTE4 levels in subjects who received omalizumab and did not have respiratory reaction during desensitization compared to subjects randomized to placebo (p = 0.035, mixed model with interaction). Urinary LTE4 levels were significantly higher with respiratory reaction in placebo subjects compared with levels obtained after the 100 mg dose in AERD subjects who had no respiratory reaction (p < 0.001, mixed model with interaction).ConclusionIn atopic AERD subjects, omalizumab administration for 16 weeks was associated with "clinically silent" desensitization. Further studies to investigate the therapeutic utility of omalizumab in patients with AERD who are candidates for aspirin desensitization are warranted based on these findings.



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Notch inhibition counteracts Paneth cell death in absence of caspase-8

Abstract

Opposing activities of Notch and Wnt signaling regulate mucosal barrier homeostasis and differentiation of intestinal epithelial cells. Specifically, Wnt activity is essential for differentiation of secretory cells including Wnt3-producing Paneth cells, whereas Notch signaling strongly promotes generation of absorptive cells. Loss of caspase-8 in intestinal epithelium (casp8^∆int) is associated with fulminant epithelial necroptosis, severe Paneth cell death, secondary intestinal inflammation, and an increase in Notch activity. Here, we found that pharmacological Notch inhibition with dibenzazepine (DBZ) is able to essentially rescue the loss of Paneth cells, deescalate the inflammatory phenotype, and reduce intestinal permeability in casp8^∆int mice. The secretory cell metaplasia in DBZ-treated casp8^∆int animals is proliferative, indicating for Notch activities partially insensitive to gamma-secretase inhibition in a casp8^∆int background. Our data suggest that casp8 acts in the intestinal Notch network.

https://ift.tt/2Im8ArT

Editorial Board

Publication date: June 2018
Source:Molecular Immunology, Volume 98





https://ift.tt/2wMyujk

Introduction to the Special Issue: Nanomaterials in Immunology

Publication date: June 2018
Source:Molecular Immunology, Volume 98
Author(s): Justine D. Mintern, Angus P.R. Johnston




https://ift.tt/2IJXcpf

The potential of nanoparticle vaccines as a treatment for cancer

Publication date: June 2018
Source:Molecular Immunology, Volume 98
Author(s): David Urbanavicius, Tara Alvarez, Georgina K. Such, Angus P.R. Johnston, Justine D. Mintern
A complex and multifaceted relationship exists between cancer and the immune system. Advances in our understanding of this relationship have resulted in significant clinical attention in the possibilities of cancer immunotherapy. Harnessing the immune system's potent and selective destructive capability is a major focus of attempts to treat cancer. Despite significant progress in the field, cancer therapy still remains significantly deficient, with cancer being one of the largest contributors to morbidity and mortality in the developed world. It is evident that the design of new treatment regimes is required to exploit cancer immunotherapy. Herein we review the potential for nanotechnology to overcome the challenges that have limited the more widespread implementation of immunotherapy to cancer treatment.



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The association between sexual dysfunctions and severity of symptoms in patients with chronic spontaneous urticaria

https://ift.tt/2Go9gXK

Porcine Reproductive and Respiratory Syndrome Virus and Porcine Circovirus 2 in Albania

Viral Immunology, Ahead of Print.


https://ift.tt/2ILb0zK

Extensive Evaluation of Pulmonary Function Abnormalities by Different Techniques in Turkish Children and Young Adults with Sickle Cell Disease

Pediatric Allergy, Immunology, and Pulmonology, Ahead of Print.


https://ift.tt/2rN2ypT

An Unusual Case of Interstitial Lung Disease as the Primary Presentation of Mixed Connective Tissue Disease in a Child with Sickle Cell Disease

Pediatric Allergy, Immunology, and Pulmonology, Ahead of Print.


https://ift.tt/2wSjFvk

Extensive Evaluation of Pulmonary Function Abnormalities by Different Techniques in Turkish Children and Young Adults with Sickle Cell Disease

Pediatric Allergy, Immunology, and Pulmonology, Ahead of Print.


https://ift.tt/2L4LXpP

An Unusual Case of Interstitial Lung Disease as the Primary Presentation of Mixed Connective Tissue Disease in a Child with Sickle Cell Disease

Pediatric Allergy, Immunology, and Pulmonology, Ahead of Print.


https://ift.tt/2rRgrTs

Activated prothrombin complex concentrate to reverse the factor Xa inhibitor (apixaban) effect before emergency surgery: a case series

The lack of an antidote against factor Xa inhibitors in case of major bleeding or need for urgent surgery is a concern to clinicians. Guidelines on managing major bleeding in patients under anticoagulation wit...

https://ift.tt/2Iq0v1c

Acute blindness as a presenting sign of childhood endemic Burkitt’s lymphoma in Cameroon: a case report

Endemic Burkitt's lymphoma is found predominantly in malaria holoendemic zones, typically in the tropical rain forest of Africa. It usually presents as an extra-nodal tumour in children and young adults with p...

https://ift.tt/2k39H1a

Whole-Body Distribution and Clinical Association of Telangiectases in Systemic Sclerosis

This cross-sectional study evaluates the association between the presence and distribution of telangiectases and the severity of vasculopathy in patients with systemic sclerosis.

https://ift.tt/2GqfLt8

Improvement in Ulcerative Necrobiosis Lipoidica After JAK-Inhibitor Therapy for Polycythemia Vera

This case report describes a patient whose ulcerative necrobiosis lipoidica improved after being treated for a different condition, polycythemia vera, with Janus kinase inhibitor.

https://ift.tt/2L4KijK

Necrotizing Anogenital Ulcer in a Healthy 8-Month-Old Male

A healthy 8-month-old male infant was admitted for management of a rapidly progressive, painful anogenital ulcer; the lesion had developed acutely over 48 hours and had an associated symptom, but no fevers, chills, or other systemic symptoms. What is your diagnosis?

https://ift.tt/2GoOk38

Teaching Intuitive Visual Diagnosis of Melanoma

This diagnostic study compares the training efficacy of a novel web-based application to the publicly available Internet Curriculum For Melanoma Early Detection Skin Education Series to determine if intuitive visual diagnosis training is superior to a traditional rule-based algorithm in the diagnosis of melanomas.

https://ift.tt/2rKNtVS

Timing and Number of Cutaneous Squamous Cell Carcinomas in Transplant Recipients

This cohort study of 3652 recipients of solid organ transplants examines the timing and number of cutaneous squamous cell carcinomas that developed after transplantation.

https://ift.tt/2GpCwgW

Frontalis Myocutaneous Transposition Flap for Forehead Defect Reconstruction

This case series of 12 patients with large, deep forehead defects secondary to Mohs surgery assesses whether the frontalis myocutaneous transposition flap represents a good alternative for the reconstruction of forehead defects.

https://ift.tt/2L7Towm

Efficacy of Guselkumab Compared With Adalimumab and Placebo for Psoriasis in Specific Body Regions

This secondary analysis of 2 randomized clinical trials evaluates the effect of guselkumab vs adalimumab or placebo on psoriasis in specific difficult-to-treat body regions.

https://ift.tt/2Glki09

Omalizumab in Chronic Spontaneous Urticaria Refractory to Conventional Therapy: An Italian Retrospective Clinical Analysis with Suggestions for Long-Term Maintenance Strategies

Abstract

Introduction

Omalizumab is indicated for the treatment of patients affected by chronic spontaneous urticaria (CSU) refractory to antihistamines. The aim of this study was to assess the efficacy, safety, and recurrence of symptoms in a real-life experience of omalizumab as an add-on therapy for H₁-antihistamine-refractory CSU patients (refractory CSU).

Methods

A retrospective review of the clinical records of all refractory CSU treated with omalizumab at our dermatology center from June 2014 to April 2017 was performed. Patients previously treated with second-generation antihistamines at a fourfold increased dose without clinical responses at 4 weeks of treatment were selected. Omalizumab was administered at a single dosage of 300 mg every 4 weeks for 6 months. Disease severity was assessed using the 7-day Urticaria Activity Score (UAS7).

Results

Eighteen patients (14 women; mean age 51 years, range 25–74) were enrolled. Mean UAS7 at baseline was 27.3 (range 15–38). Symptoms improved in all patients at 4 weeks (UAS7 = 16.1, range 0–36). Treatment was completed in 17 patients (94.4%), and among these, a complete response (UAS7 = 0) was registered in 10 patients (58.8%). Adverse events included thrombocytopenia in 1 patient (5.6%) at 16 weeks; therapy was suspended after 20 weeks and the complication was resolved, resulting in a freedom from major adverse events of 94.4%. Symptom recurrence occurred in 3 patients (17.6%) at 4, 5, and 7 months from the end of the primary therapy. Retreatment with omalizumab was successful without any adverse effects. Mean follow-up was 9.5 months (range 1–28).

Conclusion

Add-on omalizumab therapy for refractory CSU in a real-life setting seems to be effective and safe with a relatively low incidence of symptom recurrence. Further research should investigate personalized omalizumab treatment dosages and administration intervals, and the identification of biomarkers for future treatment algorithms.

https://ift.tt/2IHdzCS

DCLK1 as a Marker/Indicator of Stem Cell Response in Barrett's Esophagus/Esophageal Adenocarcinoma

Conditions:   Barrett's Esophagus;   Esophageal Adenocarcinoma
Intervention:   Other: EMR and RFA effect on stem cell marker expression in BE/EAC
Sponsor:   University of Oklahoma
Recruiting

https://ift.tt/2InteE1

Cepstral Analysis of Normal and Pathological Voice in Spanish Adults. Smoothed Cepstral Peak Prominence in Sustained Vowels Versus Connected Speech

Publication date: May–June 2018
Source:Acta Otorrinolaringologica (English Edition), Volume 69, Issue 3
Author(s): Jonathan Delgado-Hernández, Nieves M. León-Gómez, Laura M. Izquierdo-Arteaga, Yanira Llanos-Fumero
Introduction and objectivesIn recent years, the use of cepstral measures for acoustic evaluation of voice has increased. One of the most investigated parameters is smoothed cepstral peak prominence (CPPs). The objectives of this paper are to establish the usefulness of this acoustic measure in the objective evaluation of alterations of the voice in Spanish and to determine what type of voice sample (sustained vowels or connected speech) is the most sensitive in evaluating the severity of dysphonia.MethodForty subjects participated in this study 40, 20 controls and 20 with dysphonia. Two voice samples were recorded for each subject (one sustained vowel/a/and four phonetically balanced sentences) and the CPPs was calculated using the Praat programme. Three raters perceptually evaluated the voice sample with the Grade parameter of GRABS scale.ResultsSignificantly lower values were found in the dysphonic voices, both for/a/(t[38]=4.85, P<.000) and for phrases (t[38]=5.75, P<.000). In relation to the type of voice sample most suitable for evaluating the severity of voice alterations, a strong correlation was found with the acoustic-perceptual scale of CPPs calculated from connected speech (rs=−0.73) and moderate correlation with that calculated from the sustained vowel (rs=−0.56).ConclusionThe results of this preliminary study suggest that CPPs is a good measure to detect dysphonia and to objectively assess the severity of alterations in the voice.



https://ift.tt/2IlBJDN

oVEMP as an objective indicator of successful repositioning maneuver

Publication date: May–June 2018
Source:Acta Otorrinolaringologica (English Edition), Volume 69, Issue 3
Author(s): Samir Asal, Osama Sobhy, Amany Balbaa
Background and objectiveBenign paroxysmal positioning vertigo (BPPV) is the most common peripheral vestibular disorder. Canalolithiasis in the posterior semi-circular canal is the most common underlying pathology that can be treated effectively by repositioning maneuvers. Our hypothesis suggested that successful maneuvers can lead to repositioning of dislodged otoconia to the utricle.Materials and methodsAir conducted oVEMP, which is thought to originate from the contra-lateral utricular organ was measured in twenty patients with unilateral BPPV and we compared n1•p1 peak to peak amplitude of the affected ears in 3 separate intervals: on pre-treatment when typical nystagmus was confirmed, immediately after, and 1 week after repositioning maneuvers to assess change, if any, in amplitude.ResultsThis study showed significant increase of oVEMP amplitude in the affected ears after successful repositioning maneuver that was more significant after 1 week.ConclusionsoVEMP can be used as a reliable objective test for ensuring a successful maneuver rather than subjective dependence on the patient's symptoms, which may be misleading due to a remission.



https://ift.tt/2KujFE0

Clinicopathologic Predictive Factors of Cervical Lymph Node Metastasis in Differentiated Thyroid Cancer

Publication date: May–June 2018
Source:Acta Otorrinolaringologica (English Edition), Volume 69, Issue 3
Author(s): Ronghao Sun, Hua Zhang, Kun Liu, Jinchuan Fan, Guojun Li, Xicheng Song, Chao Li
BackgroundCervical lymph node metastasis (LNM) has been proven to be a predictor for locoregional recurrence in differentiated thyroid carcinoma (DTC). Clinicopathological features could be effective predictive factors for central and lateral LNM of DTC, and provide references to surgeons for cervical neck dissection.MethodsRetrospective analysis of clinicopathological data was performed on 420 patients who underwent initial surgery from 2010 to 2015.ResultsThe incidence of central and lateral LNM was calculated. Of 420 patients, 247 (58.8%) exhibited central LNM, and 185 (44.1%) exhibited lateral LNM. There were 29 (6.9%) cases confirmed to have skip metastasis. Univariate and multivariate analysis revealed that tumour location, tumour size, multifocality, capsular invasion, affected lobes, and age were independent predictors of central LNM. Tumour location, capsular invasion, affected lobes, and tumour size were independent predictors of lateral LNM.ConclusionsOur findings suggest that tumour location, affected lobes, capsular invasion, age, tumour size and multifocality may be taken as predictive factors for cervical LNM of DTC. Meticulous perioperative evaluation of cervical LNM and prophylactic cervical lymph node dissection that aims to remove the occult lymph nodes may be an option for DTC with risk factors.



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Prognostic Significance of Extranodal Extension in Head and Neck Squamous Cell Carcinoma cN0 Patients With Occult Metastatic Neck Nodes

Publication date: May–June 2018
Source:Acta Otorrinolaringologica (English Edition), Volume 69, Issue 3
Author(s): Joan Lop, Antoni Rigó, Alberto Codina, Julia de Juan, Miquel Quer, Xavier León
Introduction and objectivesExtranodal extension in nodal metastases is an independent adverse prognostic factor in head and neck squamous cell carcinoma patients. However, few studies specifically address the subgroup of patients with no clinical evidence of nodal disease.Material and methodsWe retrospectively analysed data from 348 head and neck squamous cell carcinoma patients without any previous treatment and lacking clinical or radiological evidence of neck node metastases during the initial workup, treated with an elective neck dissection between 1992 and 2014. The incidence of occult metastatic neck nodes with extranodal extension and the impact of extranodal extension in survival were evaluated.ResultsThe proportion of patients with occult neck node metastases was 33%. Of these, 23.5% had at least one metastatic neck node with extranodal extension. There were significant differences in the disease-specific survival rate according to neck node status. Five-year disease-specific survival for patients without histopathological metastases was 90%, for patients with occult neck node metastases without extranodal extension it was 71.2%, and for patients with occult neck node metastases with extranodal extension it was 25.9% (P=.0001). The multivariate analysis revealed that the presence of occult node metastases with extranodal extension was the factor with strongest impact on survival. The inclusion of the extranodal extension as a criterion of histopathological evaluation in the 8th TNM classification edition improves the prognostic capacity compared to previous TNM editions.ConclusionsAppearance of metastatic neck nodes with extranodal extension is an adverse prognostic factor in head and neck squamous cell carcinoma patients without clinical evidence of regional disease during the initial workup of the tumour.



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Endoscopic Closure of Septal Perforations

Publication date: May–June 2018
Source:Acta Otorrinolaringologica (English Edition), Volume 69, Issue 3
Author(s): Isam Alobid
ObjectiveThe management of septal perforations is a challenge for the surgeon. A wide variety of surgical techniques have been described, with different approaches. There is no scientific evidence to support a particular approach. The objective of this review is to present a practical guide on the technique of choice for each case of septal perforation.DiscussionInspection of the nasal mucosa, the size of the perforation, the location and especially the osteo-cartilaginous support, are the pillars of a successful surgery. For the sliding or rotating flaps of the mucosa of the septum it is essential to know in advance if the elevation of the mucopericondrio or mucoperiosteo of the septum is possible, otherwise the use of these flaps would not be indicated. The flaps of the lateral wall or nasal floor are the alternative. The pericranial flap may be indicated in total or near total perforations.ConclusionThe remnant of the nasal septum and status of osteo-cartilaginous support are the determining factors in the management of septal perforations. Each case should be evaluated individually and the approach chosen according to the size and location of the perforation, mucosal quality, personal history, previous surgery and the experience of the surgeon.



https://ift.tt/2rIT3bw

Virtual Surgery for Patients With Nasal Obstruction: Use of Computational Fluid Dynamics (MeComLand®, Digbody® & Noseland®) to Document Objective Flow Parameters and Optimise Surgical Results

Publication date: May–June 2018
Source:Acta Otorrinolaringologica (English Edition), Volume 69, Issue 3
Author(s): Manuel A. Burgos, Maria Agustina Sevilla García, Enrique Sanmiguel Rojas, Carlos Del Pino, Carlos Fernández Velez, Francisco Piqueras, Francisco Esteban Ortega
IntroductionComputational fluid dynamics (CFD) is a mathematical tool to analyse airflow. We present a novel CFD software package to improve results following nasal surgery for obstruction.MethodsA group of engineers in collaboration with otolaryngologists have developed a very intuitive CFD software package called MeComLand^®, which uses the patient's cross-sectional (tomographic) images, thus showing in detail results originated by CFD such as airflow distributions, velocity profiles, pressure, or wall shear stress. NOSELAND^® helps medical evaluation with dynamic reports by using a 3D endoscopic view. Using this CFD-based software a patient underwent virtual surgery (septoplasty, turbinoplasty, spreader grafts, lateral crural J-flap and combinations) to choose the best improvement in nasal flow.ObjectiveTo present a novel software package to improve nasal surgery results. To apply the software on CT slices from a patient affected by septal deviation. To evaluate several surgical procedures (septoplasty, turbinectomy, spreader-grafts, J-flap and combination among them) to find the best alternative with less morbidity.ResultsThe combination of all the procedures does not provide the best nasal flow improvement. Septoplasty plus turbinoplasty obtained the best results. Turbinoplasty alone rendered almost similar results to septoplasty in our simulation.ConclusionsCFD provides useful complementary information to cover diagnosis, prognosis, and follow-up of nasal pathologies based on quantitative magnitudes linked to fluid flow. MeComLand^®, DigBody^® and NoseLand^® represent a non-invasive, low-cost alternative for the functional study of patients with nasal obstruction.



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Subglottis Inflammatory Pseudotumour in a 3-Year-old Child

Publication date: May–June 2018
Source:Acta Otorrinolaringologica (English Edition), Volume 69, Issue 3
Author(s): Javier Cervera Escario, Sara Sirvent Cerdá, Saturnino Santos Santos, Adolfo Sequeiros González




https://ift.tt/2rL283l

Spontaneous Rupture of Cervical Thoracic Duct: A Case Report

Publication date: May–June 2018
Source:Acta Otorrinolaringologica (English Edition), Volume 69, Issue 3
Author(s): Natalia Rodriguez, Maria Luisa Navarrete, Cesar Ortiz, Shelagh Dyer




https://ift.tt/2Ksc0pC

Lipoma of the pre-epiglottic space: A common pathology in an uncommon place

Publication date: May–June 2018
Source:Acta Otorrinolaringologica (English Edition), Volume 69, Issue 3
Author(s): Nuno Ribeiro Costa, Delfim Duarte, Miguel Viana




https://ift.tt/2Ikp5oh

Osteochondroma of Maxillary Sinus, an Unusual Location

Publication date: May–June 2018
Source:Acta Otorrinolaringologica (English Edition), Volume 69, Issue 3
Author(s): Ana Belén Gil Guerra, Esther Gómez San Martín, María Isabel Jiménez Cuenca




https://ift.tt/2KujbOc

Maxillary hydatid cyst

Publication date: May–June 2018
Source:Acta Otorrinolaringologica (English Edition), Volume 69, Issue 3
Author(s): Satvinder Singh Bakshi, Roopa Urs




https://ift.tt/2Il8il6

Tympanostomy tube placement and ear drops: Evidence-based cost saving models

Publication date: July 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 110
Author(s): Gabriel Gomez, Philip G. Chen
Objectives/IntroductionTympanostomy tube placement is the most common surgical procedure in the pediatric population with important financial implications to our healthcare institutions. The purpose of this study is to apply various cost models in different clinical environments to determine the most cost effective way to prescribe ear drops after tympanostomy tube insertion.MethodsTwo distinct practice models were designed: a Uniform Treatment Model and a Disease Specific Model. Different cost simulations were run based on which medication(s) was chosen for all tympanostomy tube cases performed over the course of 1 year in a practice composed of four pediatric otolaryngologist. Two categories of ear drop medications were seen: high cost and low cost. The cost associated with initiation of drops in the operating room versus initiation as an outpatient via a prescription was evaluated.ResultsIn both Uniform Treatment and Disease Specific Models, the most expensive simulations included antibiotic/steroid combination drop use intraoperatively. The treatment with an antibiotic/steroid combination drop was lower when delayed until the post-operative period. The hospital cost for ear drops increased by as much as 478% when dispensed within the operating room rather than from the hospital's outpatient pharmacy.ConclusionsOtolaryngologists should make an effort to become familiar with the cost of ototopical medications and the significant variability between inpatient and outpatient settings. Cost of ototopical agents should be shifted to the institution's outpatient pharmacy whenever possible especially for branded, higher cost combination drops. Patients should be treated based on the status of their ear disease at time of middle tube insertion.



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Unusual cystic lung metastasis

Description 

A 35-year-old woman was recently diagnosed with cervical cancer, confirmed by histology to be squamous cell cancer. A CT of the chest performed as a part of her initial workup did not show any clear evidence of metastasis (figure 1). She underwent chemoradiotherapy with external beam radiotherapy and cisplatin. A positron-emission tomography (PET)-CT of the chest 12 weeks later demonstrated multiple 18F-Fluorodeoxyglucose  (FDG)-avid lung nodules suggestive of disease progression (figure 2). She subsequently received palliative therapy with carboplatin and paclitaxel. A follow-up CT chest 4 months later showed multiple bilateral randomly distributed cystic lesions of different sizes (largest measuring 29 mm) that were not seen on prior imaging (figure 3). These have been diagnosed as metastatic cystic lung disease.

Figure 1

Normal initial CT scan.

Figure 2

Multiple FDG-avid lung nodules on positron - emission tomography-CT.

...

https://ift.tt/2IIwD3z

Metabolic acidosis in short bowel syndrome: think D-lactic acid acidosis

Short bowel syndrome (SBS) is a condition when a person's gastrointestinal function is insufficient to supply the body with essential nutrients and hydration. Patients with SBS suffer from diarrhoea and symptoms of malabsorption such as weight loss, electrolyte disturbances and vitamin deficiencies. Long-term management of this condition can be complicated by the underlying disease, the abnormal bowel function and issues related to treatment like administration of parenteral nutrition and the use of a central venous catheter. Here, we describe a case of D-lactic acid acidosis, a rarer complication of SBS, presenting with generalised weakness and severe metabolic acidosis.

https://ift.tt/2Ir1puG

Use of CSF infusion studies to unblock occluded hydrocephalus ventricular shunt catheters: a preliminary report of two patients

Two patients with ventriculoperitoneal shunts presented with symptoms of raised intracranial pressure indicative of possible shunt malfunction. During investigation, to eliminate this possibility, cerebral spinal fluid infusion studies were performed, which indicated proximal occlusion of the shunts in both cases. Retrograde flush of the ventricular catheter was performed during temporary compression of the siphon-control device, a manoeuvre which blocks distal flow. After the use of this technique, both patients' symptoms improved and they have remained symptom-free for over 2 years. This case report validates the role that infusion studies can play in clearing a blocked ventricular catheter shunt.

https://ift.tt/2IHymGn

Pyopericardium progressing to tamponade in a patient with immune thrombocytopenia

Pericardial effusion can develop during any stage of pericarditis, and small effusions that appear rapidly can cause cardiac tamponade. Pyopericardium is a rare aetiology for tamponade. This is a case of an elderly diabetic lady, on steroid therapy for immune thrombocytopenia, who presented with fever and acute dyspnoea. She developed cardiac tamponade due to pyopericardium with Staphylococcus as the causative organism. Staphylococcus pyopericardium, in the absence of a primary focus of infection, progressing to tamponade is an uncommon scenario.

https://ift.tt/2Ir1miu

Intraoperative intraluminal injection of N-acetylcysteine allowing treatment of distal intestinal obstruction syndrome without the need for enterotomy

We describe a case of an 18-year-old man who suffers from cystic fibrosis and developed distal intestinal obstruction syndrome while being treated as an inpatient. Following failed medical management, we proceeded to laparotomy where the small bowel was decompressed with retrograde milking into the stomach, leaving a section of impacted stool in the distal ileum. N-acetylcysteine was injected into the bowel lumen proximal to the obstruction. This resulted in dissolution of the stool without the need for enterotomy and is, to our knowledge, the first successful example of this technique in the literature.

https://ift.tt/2IKThZa

Pneumoperitoneum in a neonate weighing less than 500 g. What do we really know about it?

Pneumoperitoneum in preterm infants is a surgical emergency as it is usually indicative of intestinal perforation. Rare cases of idiopathic pneumoperitoneum have been described in the literature, the underlying causes and pathophysiology of which remain uncertain. We present a case of pneumoperitoneum in an extremely preterm infant with severe growth restriction. This occurred while she was receiving high frequency oscillatory ventilation. She had respiratory distress syndrome with pulmonary interstitial emphysema. The pneumoperitoneum occurred in isolation. Despite the insertion of two surgical drains and two exploratory laparotomies in which no obvious intestinal perforation was noted, the free air in the abdomen reaccumulated. A decision was made to manage it conservatively. She was successfully extubated on the fourth week of life and the pneumoperitoneum resolved spontaneously. She was discharged home on day 136 of life. This case highlights our limited understanding of the intricate physiology of extremely low birthweight preterm neonates.

https://ift.tt/2Ir1eQ2

Sturge-Weber syndrome-associated glaucoma and intraocular osseous metaplasia: a unique complicated case

A 30-year-old European man was admitted to our centre complaining about severe pain of the right eye (OD) and right part of the face, redness and no vision of the OD. He had an 18-year history of secondary to Sturge-Weber syndrome glaucoma, 6-month history of red eye and 1-week history of pain in OD. The best-corrected visual acuity was no light perception OD and 20/20 OS. Intraocular pressure was 36 mm Hg OD. Examination revealed endophthalmitis, Sturge-Weber syndrome-associated glaucoma and complicated cataract of OD.

Unfortunately, no prescribed treatment helped this patient, so evisceration of OD was performed. During the evisceration, a subretinal 20 mm in width and 22 mm in length osseous tissue, partially vascularised, was removed surgically and was sent to the histological laboratory. Histopathologically, there were data of active inflammatory process, retinal detachment due to huge subretinal osseous metaplasia, gliosis and retinal pigment epithelial hyperplasia, and druses with ossification.

https://ift.tt/2INM6Qc

Unusual case of iron overload with cancer-mimicking abdominal splenosis

A 48-year-old man, former alcohol abuser and drug addicted, was referred to our tertiary referral centre for iron disorders because of marked hyperferritinaemia. His clinical history revealed chronic hepatitis C, ß-thalassaemia trait and post-traumatic splenectomy at age of 22. MRI-estimated liver iron content was markedly elevated, while first-line genetic test for haemochromatosis was negative. Alpha-fetoprotein was increased but liver ultrasonography did not reveal focal liver lesions. Multiphasic contrast-enhanced CT confirmed this result but showed two abdominal masses (diameter of 9 cm and 7 cm, respectively) among bowel loops, strongly suspicious for cancer. However, biopsy of one of the masses led to the final diagnosis of abdominal splenosis.

https://ift.tt/2IngAF3

Unique presentation of a ruptured Meckels diverticulum after blunt trauma

Description 

A 25-year-old man with no significant medical or surgical history presented with a complaint of thick, dark drainage from a periumbilical wound for 1 month (figure 1). He reported first noticing the drainage several days after bumping into the corner of a machine at work. He was seen by his primary care physician and prescribed oral antibiotics for persistent drainage and erythema; however, his symptoms failed to improve.

Figure 1

Chronic umbilical wound sustained after blunt abdominal trauma, with drainage of a thick, dark fluid for 1 month.

On presentation to the emergency department, the patient was afebrile and haemodynamically stable. Lab work was within normal limits. An abdominal CT scan demonstrated a loculated periumbilical fluid collection, with extension intraperitoneally into a portion of thickened small bowel with suspicion of an enterocutaneous fistula (figure 2).

Figure...

https://ift.tt/2ILhq1D

Komplikationen und Nebenwirkungen bei konservativer Therapie rhinologischer Erkrankungen

Zusammenfassung

Hintergrund

Die Gruppe der rhinologischen Erkrankungen ist vielfältig, so auch ihre medikamentöse Therapie. Es sind allein 1272 Präparate in der ATC-Gruppe (anatomisch-therapeutisch-chemische Klassifikation) mit einer R01-Codierung (Rhinologika) gelistet. Die konservative Therapie der rhinologischen Erkrankungen beinhaltet zusätzlich die systemische – meist orale – Anwendung von Kortikosteroiden, Antibiotika und Immunmodulatoren.

Ziel der Arbeit

Dargestellt werden die Komplikationen der im klinischen Alltag gebräuchlichen Medikamente (unterteilt in ihre Wirkstoffklassen), die zur Therapie rhinologischer Erkrankungen eingesetzt werden. Insbesondere werden nützliche Behandlungs- bzw. Präventionsmaßnahmen vorgestellt.

Material und Methoden

Auf der Basis der Fachinformationen der Medikamente der ATC-Codes der R01-Gruppe sowie der Literaturrecherche in den Datenbanken PubMed, der Cochrane Library und MEDLINE werden Medikamente, die bei rhinologischen Erkrankungen eingesetzt werden, auf ihre Nebenwirkungen und deren Häufigkeit hin untersucht.

Ergebnisse

Intranasal applizierte Medikamente können insbesondere lokale Irritation, Brennen, Trockenheit und Epistaxis verursachen. Oral oder intravenös verabreichte rhinologische Medikamente können zu Nebenwirkungen der unterschiedlichen Organsysteme, u. a. Herzrhythmusstörungen oder Blutbildveränderungen, führen. Bei der Medikamentenverordnung wird die patientenspezifische Auswahl des Therapeutikums und die individualisierte Aufklärung des Patienten empfohlen.

Schlussfolgerung

Insbesondere für Kinder, stillende Mütter und Schwangere sollte die Indikation aller Rhinologika streng geprüft werden. Da eine Vielzahl von Rhinologika zur Verfügung steht, sollte unter Berücksichtigung des Nebenwirkungsprofils die optimale individuelle Therapie ausgewählt werden.

https://ift.tt/2L4KkIs

Rötlicher Knoten am Kapillitium eines jungen Mannes

https://ift.tt/2GnDnib

Midline Congenital Upper Lip Sinus: A Rare Case

Abstract

To present a rare case of a midline congenital upper lip sinus and its management. Background: A lip sinus is a rare condition, where a failure of the complete union during early stages of development leads to its formation. The prevalence of lower lip sinus is estimated to be about 0.00001% of the white population and that of upper lip sinus is even rarer. A congenital lip sinus maybe associated with syndromes such as; Von der Woude syndrome, or maybe present in isolation. A 25-year-old male presented to our clinic with intermittent swelling in the upper lip region. Clinical examination revealed a congenital midline lip sinus in the upper lip region, which had no intra-oral communication, and was managed by surgical excision. Till date, there has been a hand full of case reports of upper lip sinuses and fistulae, out of which only few are reported in India. We herein report a case of congenital upper lip sinus presenting as an intermittent swelling of the upper lip with its successful surgical management.

https://ift.tt/2IkBzMJ

Midline Congenital Upper Lip Sinus: A Rare Case

Abstract

To present a rare case of a midline congenital upper lip sinus and its management. Background: A lip sinus is a rare condition, where a failure of the complete union during early stages of development leads to its formation. The prevalence of lower lip sinus is estimated to be about 0.00001% of the white population and that of upper lip sinus is even rarer. A congenital lip sinus maybe associated with syndromes such as; Von der Woude syndrome, or maybe present in isolation. A 25-year-old male presented to our clinic with intermittent swelling in the upper lip region. Clinical examination revealed a congenital midline lip sinus in the upper lip region, which had no intra-oral communication, and was managed by surgical excision. Till date, there has been a hand full of case reports of upper lip sinuses and fistulae, out of which only few are reported in India. We herein report a case of congenital upper lip sinus presenting as an intermittent swelling of the upper lip with its successful surgical management.

https://ift.tt/2IkBzMJ

The role of nasopharyngeal examination and biopsy in the diagnosis of malignant diseases

Publication date: Available online 15 May 2018
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Necmi Arslan, Arzu Tuzuner, Alper Koycu, Songul Dursun, Sema Hucumenoglu
IntroductionIn direct proportion to the increasing rate of nasopharynx examinations applied, the early diagnosis and treatment of lesions in this region is possible. At times the clinical findings and the biopsy results are not consistent, so biopsies may have to be repeated.ObjectivesThe aim of this study was to evaluate the distribution of pathology test results obtained from cases of nasopharynx biopsy, to determine with which methods determination most often was made, and to investigate which kinds of cases required the biopsy to be repeated.MethodsThe study included a total of 1074 patients (500 female, 574 male) who underwent nasopharyngeal biopsy in our clinic between June 2011 and June 2017. Data were obtained from patient records of age, gender, clinical findings, imaging findings if available and pathological diagnosis. The pathological diagnoses were separated into 3 main groups as chronic nasopharyngitis, benign cytology and malignant cytology.ResultsThe examinations resulted in 996 cases reported as chronic nasopharyngitis, 47 as benign cytology and 31 as malignant cytology. Of the 31 malignant lesions, diagnosis was made in 15 patients (48.4%) with a single biopsy, and in 16 patients (51.6%), as a result of the pathology report when 2 or more biopsies were taken. In the comparison of the benign and malignant lesions in respect of the need for repeated biopsies, the cases determined with malignancy were found to have a statistically significantly higher rate of repeated biopsy (p<0.001).ConclusionIn comparison with cases of benign tumor, a statistically significantly greater number of repeated biopsies were required in cases diagnosed as malignant tumors to confirm the pathological diagnosis or when there was continued suspicion of malignancy. Therefore, when there is clinical suspicion, even if there are no findings of malignancy on the first biopsy, the biopsy should be repeated expeditiously.



https://ift.tt/2rMo6SW

Congenital Pyriform Sinus Fistula: Management of an Extra-Delayed and Atypical Case

Clinical presentations of pyriform sinus fistulas vary, and this sometimes leads to a delay in diagnosis and treatment. Recently, we experienced a case of recurrent cervical abscesses occurring after thyroidectomy in an adult affected by a bifidus pyriform sinus fistula. The diagnostic dilemma was related to the timing of events, with a single episode of acute suppurative thyroiditis having occurred 16 years before the onset of the more recent clinical scenario. An endoscopic approach allowed effective management of this clinical case.
ORL 2018;80:65–68

https://ift.tt/2InimKs

Spontaneous Slowing and Regressing of Tumor Growth in Childhood/Adolescent Papillary Thyroid Carcinomas Suggested by the Postoperative Thyroglobulin-Doubling Time

Background. Children and adolescents with papillary thyroid carcinomas (PTCs) have generally excellent prognoses despite their frequent extended disease. The tumor growth of young patients' PTCs might show spontaneous slowing postoperatively. We compared young PTC patients' postoperative thyroglobulin-doubling time (Tg-DT) with their preoperative hypothetical tumor volume-doubling time (hTV-DT). Methods. Fourteen PTC patients aged ≤18 years who underwent total thyroidectomy at Kuma Hospital in 1998–2016 had biochemically persistent disease postoperatively. We calculated their Tg-DTs and estimated their preoperative TV-DTs with the tumor size and the patient's age at surgery, presuming that a single cancer cell was present at the patient's birth. Results. Twelve patients had positive Tg-DTs ranging from 2.0 to 147 years, and the remaining two had negative Tg-DTs, indicating slow growth or even regression. The hTV-DTs were 0.3–0.6 years (median 0.5 years), which were significantly shorter than the Tg-DTs (), indicating much faster growth preoperatively. The analyses of the nine patients without radioactive iodine administration (RAI) gave similar results (). Conclusions. Irrespective of RAI, the patients' postoperative Tg-DTs were significantly longer than their preoperative hTV-DTs and were negative values in two patients, indicating that the growth of these young patients' PTCs had spontaneously slowed or even regressed postoperatively.

https://ift.tt/2k20oP6

History of burning mouth syndrome (1800–1950): A review

Oral Diseases, EarlyView.


https://ift.tt/2L5QNmI

CO2 laser and photodynamic therapy: Study of efficacy in periocular BCC

Dermatologic Therapy, EarlyView.


https://ift.tt/2rM0QnP

Malignes Melanom

https://ift.tt/2IogfWV

The usefulness integrity testing in children: A single institution experience of 86 tests over a period of 20 years

Clinical Otolaryngology, EarlyView.


https://ift.tt/2L3kuo8

Ulcerative Lesions: A Rare Cutaneous Manifestation of Brucellosis

Brucellosis is a disease that is transmitted from animals to humans mainly via the consumption of unpasteurized dairy products, and it can involve any organ all over the body. Here, we report a significant rare case of brucellosis with cutaneous manifestations in a 52-year-old male patient whose disease was diagnosed via a serology test. The patient received standard antibiotic treatment, and his cutaneous lesions healed quickly. Although the cutaneous manifestations of brucellosis are exceedingly rare, in case of encountering ulcerative lesions and other cutaneous findings, particularly in endemic areas, infection with brucellosis should be kept in mind as an important differential diagnosis.

https://ift.tt/2jZ52gA

Evaluation of Patients for Endoscopic DCR: Sac Syringing and Radionuclide Scintigraphy

Abstract

To evaluate the importance of sac syringing and radionuclide scintigraphy for pre operative work up of patients with epiphora. In this study, from the year Jan. 2013 to Jan. 2016, patients of epiphora were subjected to radionuclide scintigraphy of lacrimal apparatus in addition to sac syringing and probing. The significance of adding radionuclide scintigraphy in pre op assessment of epiphora was statistically assessed. 146 lacrimal systems were enrolled in the study. Out of them, 89 were males and 57 were females. The mean age of the patients was 42 years. Of the 146 lacrimal systems evaluated, scintigraphy detected 25 cases of common canalicular block versus 8 cases by sac syringing. Also radionuclide scintigraphy was able to detect 11 cases of functional obstruction which were patent on syringing. Results were analysed statistically. Correct diagnosis of site of obstruction is essential to predict a better surgical outcome of endoscopic DCR as it is a highly successful surgical procedure which can be done in distal NLDO only. We recommend that all patients of epiphora should undergo sac syringing as an initial test. This is a simple, inexpensive procedure which can be done as an OPD procedure in a short time. However, radionuclide scintigraphy can be added as an additional investigation to more accurately delineate site of block. It is an objective test and delineates the lacrimal system both anatomically and functionally. Also it diagnoses functional block which appears patent on syringing.

https://ift.tt/2IkoKSD

Effect of Duration of Exposure to Personal Listening Devices on Hearing Thresholds in Young Adults

Abstract

To analyze the effect of duration of use of personal listening devices on hearing impairment in young adults. Hospital-based cross-sectional study. Department of ENT, NEIGRIHMS, India. 50 consenting undergraduate medical students. This study was conducted over a period of 2 months. After eliminating all previous and current otological pathologies, Pure Tone Audiometry was conducted on each subject for both air and bone conducted sound stimuli. The subjects were divided into different groups based on duration of exposure. The audiograms were then closely evaluated for the existence of an association between the duration of personal listening devices (PLD) use and hearing impairment. The data was then evaluated by Chi Square test and Mann–Whitney U test using GraphPad InStat 3 software for the existence of an association between the duration of PLD usage and hearing impairment. The hearing thresholds varied only in isolated frequencies irrespective of the categorisation of duration of exposure to PLDs. There was no significant association between duration of use of personal listening devices and hearing impairment in young adults.

https://ift.tt/2Ks227T

Evaluation of Patients for Endoscopic DCR: Sac Syringing and Radionuclide Scintigraphy

Abstract

To evaluate the importance of sac syringing and radionuclide scintigraphy for pre operative work up of patients with epiphora. In this study, from the year Jan. 2013 to Jan. 2016, patients of epiphora were subjected to radionuclide scintigraphy of lacrimal apparatus in addition to sac syringing and probing. The significance of adding radionuclide scintigraphy in pre op assessment of epiphora was statistically assessed. 146 lacrimal systems were enrolled in the study. Out of them, 89 were males and 57 were females. The mean age of the patients was 42 years. Of the 146 lacrimal systems evaluated, scintigraphy detected 25 cases of common canalicular block versus 8 cases by sac syringing. Also radionuclide scintigraphy was able to detect 11 cases of functional obstruction which were patent on syringing. Results were analysed statistically. Correct diagnosis of site of obstruction is essential to predict a better surgical outcome of endoscopic DCR as it is a highly successful surgical procedure which can be done in distal NLDO only. We recommend that all patients of epiphora should undergo sac syringing as an initial test. This is a simple, inexpensive procedure which can be done as an OPD procedure in a short time. However, radionuclide scintigraphy can be added as an additional investigation to more accurately delineate site of block. It is an objective test and delineates the lacrimal system both anatomically and functionally. Also it diagnoses functional block which appears patent on syringing.

https://ift.tt/2IkoKSD

Effect of Duration of Exposure to Personal Listening Devices on Hearing Thresholds in Young Adults

Abstract

To analyze the effect of duration of use of personal listening devices on hearing impairment in young adults. Hospital-based cross-sectional study. Department of ENT, NEIGRIHMS, India. 50 consenting undergraduate medical students. This study was conducted over a period of 2 months. After eliminating all previous and current otological pathologies, Pure Tone Audiometry was conducted on each subject for both air and bone conducted sound stimuli. The subjects were divided into different groups based on duration of exposure. The audiograms were then closely evaluated for the existence of an association between the duration of personal listening devices (PLD) use and hearing impairment. The data was then evaluated by Chi Square test and Mann–Whitney U test using GraphPad InStat 3 software for the existence of an association between the duration of PLD usage and hearing impairment. The hearing thresholds varied only in isolated frequencies irrespective of the categorisation of duration of exposure to PLDs. There was no significant association between duration of use of personal listening devices and hearing impairment in young adults.

https://ift.tt/2Ks227T

American Contact Dermatitis Society: Frontiers in Dermatitis Fall 2017 Meeting Summary

No abstract available

https://ift.tt/2wJ8wNr

The Influence of Cultural Norms on Nickel Allergic Contact Dermatitis Prevalence Data

No abstract available

https://ift.tt/2k2c0Sf

The Medical Necessity of Comprehensive Patch Testing

Allergic contact dermatitis is associated with significant disease and economic burden in the United States. To properly manage allergic contact dermatitis, it is important to accurately identify the substance(s) implicated in the dermatitis to prevent disease recurrence. The commercially available T.R.U.E Test (36 allergens) screening panel has been reported to have a conservative hypothetical allergen detection rate of 66.0%, at most. Importantly, these calculations are based on the 78% of patients who had clinically relevant reactions to allergens present on the North American Contact Dermatitis Group screening series (70 allergens), without the use of supplemental allergens. Testing with supplemental allergens beyond a screening series can more fully evaluate an individual's environmental and occupational exposure, which may significantly increase diagnostic accuracy. Comprehensive patch testing with additional allergens in sunscreens, cosmetics, and fragrances, for example, may increase the diagnostic yield as well as the likelihood of achieving a cure if the dermatitis is chronic and recalcitrant.

https://ift.tt/2KrIsIE

SELF-ASSESSMENT

No abstract available

https://ift.tt/2IGVNzB

Genital Allergic Contact Dermatitis

Genital allergic contact dermatitis (ACD) is an uncommon disorder, yet it severely impairs the quality of life for both men and women. Because of cultural taboos, many patients self-treat and delay proper diagnosis before presenting to a provider. Diagnosis is further confounded by irritant contact dermatitis and other genital dermatoses, which can predispose to skin barrier dysfunction and allergen penetration. Genital ACD can present acutely with erythematous erosions and pruritus or chronically with lichenification. Patch testing helps determine the diagnosis and provide relief for the patient. Topical medications, including local anesthetics and corticosteroids, are the most common genital allergens. Other typical allergens include fragrances, preservatives, adhesives, dyes, and rubber products. Less commonly considered allergens include herbs, spices, and topical vehicle components. Here, we review the most common allergens for both men and women, discuss important patch-testing panels, and recommend safe products for patients with genital ACD.

https://ift.tt/2wJZi3E

Lymphomatoid Contact Dermatitis Induced by Acrylates Mimicking Lymphomatoid Papulosis

No abstract available

https://ift.tt/2IPJGjI

Bleach for Atopic Dermatitis

Individuals with atopic dermatitis (AD) have used bleach baths to treat superinfections, although their mechanism of action is not well understood. The ClinicalTrials.gov, National Eczema Association, and PubMed databases were searched for studies that investigate the role bleach plays in modulating AD. Fifteen studies were included in this review. Bleach bath improves clinical symptoms of AD and restores surface microbiome by eradicating bacteria, most notably Staphylococcus aureus. Many studies have noted that this antimicrobial effect has reduced the need for topical corticosteroids or topical antibiotics. In addition, bleach seems to have strong anti-inflammatory and antipruritogenic effects. Lastly, bleach baths seem to be safe on human skin, without disrupting epidermal barrier function. Although the effects of bleach are promising, studies that investigate the long-term use of bleach alone, without concomitant AD treatment modalities, are needed. The emergence of new bleach-containing products warrants future investigations to examine their effects on cutaneous microbiome, epidermal barrier function, and immunity.

https://ift.tt/2wHn54k

ALLERGY TO RUBBER GLOVES

No abstract available

https://ift.tt/2IKd7nm

Urushiol Patch Test Using the T.R.U.E. TEST System

Background Poison ivy, poison oak, and poison sumac are the most common causes of allergic contact dermatitis in North America. Although extensive efforts have been made to develop therapies that prevent and treat allergic contact dermatitis to these plants, there lacks an entirely effective method, besides complete avoidance. Efforts to develop a more effective preventive therapy, such as a vaccine, are ongoing. To accurately evaluate the efficacy of these new therapies, an appropriate assessment tool is needed. Objective The aim of this study was to evaluate the safety and appropriate doses of urushiol required for a patch test based on the hydrogel delivery system of the Thin-Layer Rapid Use Epicutaneous Patch Test. Methods Nine subjects were patch tested with various doses of urushiol and a negative control on day 0. Patch test sites were inspected for any local reaction on days 2, 4, 7, 14, and 21 after the initial exposure and graded by standard morphology. Conclusions All 9 subjects did not have any significant adverse effects. The urushiol patch test using the hydrogel delivery method demonstrated urushiol sensitivity. All doses of urushiol resulted in a local reaction, and severity of reactions was correlated with dosage of urushiol used in the patch test.

https://ift.tt/2wNN3mI

Patch Testing in a Patient on Dupilumab

No abstract available

https://ift.tt/2IKQkb3

Risk Assessment of the Skin Sensitization Induction Potential of Kathon CG in Rinse-off and Leave-on Personal Care and Cosmetic Products

Background Kathon CG is a commonly used cosmetic-grade preservative that contains active ingredients methylchloroisothiazolinone (MCI) and methylisothiazolinone (MI). Objective The aim of the study was to perform a skin sensitization induction risk assessment of daily exposure to Kathon CG after use of various personal care and cosmetic products. Methods We calculated an estimated daily consumer exposure level for rinse-off and leave-on products using the amount of product applied per application, number of applications per day, a retention factor, the MCI/MI concentration, and body surface area values. We assumed that the products contained the maximum recommended safe concentration of MCI/MI: 15 ppm in rinse-off products and 7.5 ppm in leave-on products. We compared estimated consumer exposure levels with the no expected sensitization induction level for MCI/MI and applied sensitization assessment factors to calculate product-specific margins of safety (MOSs). Conclusions The MOSs for rinse-off products ranged from 5 to 63, whereas the MOSs for leave-on products ranged from 0.03 to 1.49. Overall, our results provide evidence that some leave-on products containing the maximum recommended safe concentration of Kathon CG may increase the risk of sensitization induction due to exposure to MCI/MI. In contrast, rinse-off products were not associated with a potential increased risk of skin sensitization induction.

https://ift.tt/2KuIRu5

Positive Patch Test to Metals in a Patient With Symmetrical Intertriginous Skin Eruptions: Systemic Contact Dermatitis or Lichen Planus Pigmentosus Inversus?

No abstract available

https://ift.tt/2k37Idc

Occupational Contact Dermatitis in the Canadian Aircraft Industry

Background Aircraft building exposes workers to irritant and sensitizing products. Objective The aim of this article was to study occupational dermatoses among aircraft workers over 25 years. Methods The files of aerospace workers referred between 1990 and 2015 were extracted from the database of the McGill University Health Centre contact dermatitis clinic. These were subdivided according to demographics, type of work, patch testing results, and final diagnosis. Results Of 305 workers, 58% were 40 years or younger; one third were women. Onset of dermatitis varied from 2 months to 25 years, but 120 cases (39%) occurred during the first 3 years. Fifty-one percent of the cases involved assemblers, and 27% were composite material technicians, which were overrepresented as they constitute 10% of the workforce. Of the 305 workers, 152 suffered from allergic contact dermatitis, and 96 had irritant contact dermatitis. Of those with allergic contact dermatitis, 124 reacted to epoxy-based workplace products, but only 48 had positive patch tests to commercially available epoxy allergens. Conclusion More than 60% of the cases of epoxy allergy would have been missed without testing with workplace products.

https://ift.tt/2wQ687U

Childhood Atopic Dermatitis and Risk of Problematic Substance Use

No abstract available

https://ift.tt/2k0whav

Prevalence of Atopic Dermatitis and Pattern of Drug Therapy in Malaysian Children

Background Atopic dermatitis (AD) is a chronic relapsing, noncontagious skin inflammation characterized by dry skin and itch. Mutation in filaggrin gene leads to defective skin barrier, allowing entry of allergen and eliciting immunological response. Objectives The aims of this study were to investigate the prevalence of AD in Malaysian children and to understand the pattern of drug therapy. Such information could be useful to establish the relationship between ethnicity and family history of atopy and the development of associated signs and symptoms. Methods A cross-sectional survey was conducted among children attending kindergartens and nurseries. Standardized questionnaires were filled out by parents. Results Overall prevalence of AD was 13.4%. Of 384 participants recruited, the highest prevalence was observed in males, Malays, participants younger than 2 years, and those with atopic background such as asthma, hay fever, and family history of atopic diseases. Calamine and white soft paraffin were the preferred choice of nonprescription drugs, whereas topical hydrocortisone seemed to be the preferred choice of prescription drug in the management of AD. Conclusions The overall prevalence is comparable to that reported in the International Study of Asthma and Allergies in Childhood Phase One. There is an association between ethnicity and AD prevalence. Topical corticosteroids and emollients are the mainstay of AD management among Malaysians.

https://ift.tt/2wQ60oW

Trends in Eyelid Dermatitis: Erratum

No abstract available

https://ift.tt/2jXSPJ4

Positive Occluded Patch Test in the Face of Negative Repeat Open Application Test

No abstract available

https://ift.tt/2Konhr1

Abstracts Submitted to the Annual Meeting of the American Contact Dermatitis Society February 15, 2018, San Diego, California, USA

No abstract available

https://ift.tt/2IKd3nC

Case of generalized pustular psoriasis that might have progressed from terbinafine‐induced acute generalized exanthematous pustulosis

The Journal of Dermatology, EarlyView.


https://ift.tt/2wIraVV