Combo-VAS: an integrated outcome for assessing the perception of allergen immunotherapy effectiveness in clinical practice.

Publication date: Available online 28 June 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Giorgio Ciprandi, Michela Silvestri, Maria Angela Tosca




https://ift.tt/2N7Sp09

Mary Hewitt Loveless, MD, and the origin of venom immunotherapy

Publication date: Available online 28 June 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Stephen J. Galli




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Association between pre-operative biological phenotypes and postoperative pulmonary complications: An unbiased cluster analysis

BACKGROUND Biological phenotypes have been identified within several heterogeneous pulmonary diseases, with potential therapeutic consequences. OBJECTIVE To assess whether distinct biological phenotypes exist within surgical patients, and whether development of postoperative pulmonary complications (PPCs) and subsequent dependence of intra-operative positive end-expiratory pressure (PEEP) differ between such phenotypes. SETTING Operating rooms of six hospitals in Europe and USA. DESIGN Secondary analysis of the 'PROtective Ventilation with HIgh or LOw PEEP' trial. PATIENTS Adult patients scheduled for abdominal surgery who are at risk of PPCs. INTERVENTIONS Measurement of pre-operative concentrations of seven plasma biomarkers associated with inflammation and lung injury. MAIN OUTCOME MEASURES We applied unbiased cluster analysis to identify biological phenotypes. We then compared the proportion of patients developing PPCs within each phenotype, and associations between intra-operative PEEP levels and development of PPCs among phenotypes. RESULTS In total, 242 patients were included. Unbiased cluster analysis clustered the patients within two biological phenotypes. Patients with phenotype 1 had lower plasma concentrations of TNF-α (3.8 [2.4 to 5.9] vs. 10.2 [8.0 to 12.1] pg ml−1; P 

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Economic Analysis of Using Free Fat Graft or Acellular Dermis to Prevent Post-parotidectomy Frey Syndrome

Facial plast Surg
DOI: 10.1055/s-0038-1666871

A decision tree was constructed to determine the incremental cost-effectiveness ratio (ICER) of grafting techniques used to prevent Frey Syndrome. The authors performed a sensitivity analysis to calculate what the probability of preventing Frey Syndrome would have to be and maximum costs associated with using grafting techniques to warrant their use as more "cost-effective" choice than using neither. Decision pathways utilized were uses of (1) free fat graft (FFG), (2) acellular dermis, and (3) no grafting. The probability of developing Frey syndrome and costs were extracted from previous studies to construct the decision tree. The primary effectiveness was the ICER of FFG or acellular dermis to prevent Frey syndrome. The initial outcomes included preventing Frey syndrome (effectiveness = 1) or developing Frey syndrome (effectiveness = 0). Compared with not using a graft, the ICER of using FFG and acellular dermis were $10,628 and $50,813, respectively. Frey syndrome was found in 2.6% of patients postoperatively in FFG group, 9.8% of patients in acellular dermis group, and 30.7% of patients who did not have a graft. The ICER shows absolute dominance of FFG with lower cost and high effectiveness over acellular dermis. This economic evaluation strongly supports the use of FFG over acellular dermis as cost-effective approach for prevention of postparotidectomy Frey syndrome.
[...]

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

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Intraoperative Mapping of the Subfascial Plexus Using the Transillumination Method for Head and Neck Reconstruction with Free Style Anterolateral Thigh Flaps

Facial plast Surg
DOI: 10.1055/s-0038-1666783

Without well recognizing the vascular territories of the perforator, surgery might damage the pedicle and diminish flap survival. This study described a transillumination method for intraoperative mapping of the subfascial plexus of the perforator in the head and neck reconstruction with an anterolateral thigh (ALT) flap and also compared the perioperative outcomes and complications of the method with those of the conventional two-pedicle ALT flap. Between January 2011 and December 2017, 26 patients who underwent head and neck reconstruction with ALT flaps were evaluated as follows: 13 underwent the transillumination method (case group), and 13 (age- and sex-matched) underwent standard two-pedicle flap procedures (control group). Demographic factors, diagnosis, flap size, recipient site, perioperative data, and postoperative complications were compared between the two groups. There was no significant difference in age, sex, diagnosis, recipient sites, and flap size between the case and control groups. Regarding the perioperative outcomes, the harvesting time was significantly shorter in the case group than in the control group (60 vs. 100 minutes, p < 0.001). The operative time was shorter in the case group than in the control group, but this difference was not statistically significant (300 vs. 420 minutes, p = 0.058). The transillumination method can allow plastic surgeons to easily identify the perforator vascular plexus of the ALT flap, which facilitates intraoperative flap design in head and neck reconstruction.
[...]

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

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Direct Excision of the Lower Eyelid: A Safe and Effective Method for Treating Dermatochalasis and Pigmentation

Facial plast Surg
DOI: 10.1055/s-0038-1666787

The subciliary and skin pinch approaches are the most widely accepted techniques for treating dermatochalasis of the lower eyelid. Direct excision (DE) is an accepted method for treating festoons; however, it is not a popular technique for the treatment of dermatochalasis and pigment of the lower lid. DE of the lower lid offers a safe and excellent aesthetic result for dermatochalasis and pigment of the lower lid, without causing lower lid malposition, which can occur with more traditional methods. In addition to being able to remove significantly more skin without risking lower lid malposition, this procedure allows for removal of the most pigmented and poorly textured skin overlying the nasojugal groove. It is an effective alternative to the conventional subciliary and skin pinch approaches.
[...]

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

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Platelet-Rich Plasma for the Treatment of Androgenic Alopecia: A Systematic Review

Facial plast Surg
DOI: 10.1055/s-0038-1660845

The use of platelet-rich plasma (PRP) has become increasingly commonplace in facial plastic surgery for the treatment of androgenic alopecia (AGA). However, this treatment remains novel with a range of application techniques and outcomes described in the literature. Herein, the authors systematically review the existing literature on the use and efficacy of PRP for AGA. Systematic review of PubMed, Embase, and Cochrane databases was performed. Case reports were excluded. Twenty-four papers met inclusion criteria for this study: 8 randomized control trials and 16 prospective cohort studies. Twenty-one studies used clinical criteria to diagnose AGA, while three used confirmatory biopsies. PRP was injected with or without the use of a numbing agent, and most studies performed multiple injections (three or more separated by several weeks). Twenty-one studies reported positive outcomes by objective criteria (88%), while three suggested that there was no clinical improvement, although in two of these studies patients still reported increased satisfaction. There were no complications reported other than transient edema/erythema and pain/headache associated with the procedure. The existing literature suggests that PRP is a low-risk intervention to treat AGA associated with good patient satisfaction and objective improvements in outcomes. Further research is needed to optimize preparation and delivery methods as well as standardize measurements of clinical outcomes.
[...]

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

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A New Hybrid Technique for Performing a Safer Bilateral Sagittal Split Osteotomy: Combining Reciprocating Saw and Piezoelectric Devices

Facial plast Surg
DOI: 10.1055/s-0038-1666788

The sagittal split osteotomy (SSO) is an indispensable tool in the correction of dentofacial abnormalities. In elective orthognathic surgery, it is important that surgeons inform patients about the risk of complications related to inferior alveolar nerve damage and unfavorable split. The purpose of this article is to describe a novel, hybrid technique to SSO by combining a reciprocating saw and piezoelectric devices with several advantages over traditional "pure" methods (osteotomies performed by reciprocating saw or piezoelectric devices only) in terms of precision, rapidity, easier splitting, and decreased complications related to inferior alveolar nerve damage and bad split with reduced overall morbidity. The level of evidence was Level IV, therapeutic study.
[...]

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

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Stellenwert der Tubendilatation bei Mittelohradhäsivprozess

Laryngo-Rhino-Otol
DOI: 10.1055/a-0640-9270

Hintergrund Eine gestörte Tubenfunktion stellt einen häufigen Befund bei Patienten dar und kann verschiedene Mittelohrerkrankungen begünstigen. Mit Einführung der Ballondilatation wurde ein Verfahren zur Therapie der chronischen Tubenfunktionsstörung etabliert. In der vorliegenden Studie wurde der Stellenwert der Methode unter der speziellen Fragestellung des Erfolgs bei Mittelohradhäsivprozessen untersucht. Material und Methoden In einer retrospektiven Studie im Zeitraum 2011 bis 2016 wurden die Daten von 81 Patienten, die aufgrund einer chronischen Tubenventilationsstörung einer Tubendilatation unterzogen wurden hinsichtlich des präoperativen Vorliegens eines Adhäsivprozesses, ausgewertet. Der Erfolg der Tubendilatation wurde anhand der postoperativen Fähigkeit zur Durchführung des SVT-Tests sowie der Selbsteinschätzung der Patienten beurteilt. Bei einem mittleren Nachuntersuchungszeitraum von vier Monaten konnten bei insgesamt 13 Patienten mit Adhäsivprozess Daten zur prä- und postoperativen Tubenfunktion einbezogen werden. Ergebnisse Das Verfahren verlief in allen Fällen komplikationslos. Patienten mit einer Tubenventilationsstörung zeigten in 46 % postoperativ ein besseres Ergebnis, während es bei 31 % der Patienten mit Adhäsivprozess zu einer Besserung der Mittelohrbelüftung kam. Subjektiv gaben 54 % der Patienten eine Besserung ihrer Beschwerden an. Schlussfolgerung Trotz einer subjektiven Besserung der angegebenen Beschwerden in 54 % der Fälle, kam es in unserer Studie nur bei 31 % der Patienten mit einem Adhäsivprozess zu einem objektiv messbaren Erfolg. Zur Klärung der Frage, in wieweit die Kombination mit anderen mittelohrchirurgischen Eingriffen günstigere Therapierfolge hat, sind zukünftige Studien mit größeren Patientenkollektiven erforderlich.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Comprehensive review of the extended middle cranial fossa approach

Purpose of review To review the current literature on the extended middle cranial fossa (xMCF) approach and to provide a comprehensive description of the relevant anatomy, indications, surgical technique, results, and complications. Recent findings The xMCF approach expands the surgical exposure provided by the sMCF approach, allowing access to the internal auditory canal, cerebellopontine angle, prepontine cistern, anterior petrous apex, petrous carotid artery, Meckel's cave, cavernous sinus, mid and upper clivus, and posterior lesions approaching the jugular foramen. Preservation of serviceable hearing is possible with success rates approximating 50% in vestibular schwannoma and meningioma resection, and facial nerve outcome is excellent. Summary The xMCF is an important approach for difficult to access lesions that additionally offers the possibility of hearing preservation. This approach is also useful for vascular lesions, auditory brainstem implantation, and lesions of mid-brainstem. Correspondence to Ravi N. Samy, MD, FACS, Chief, Division of Otology/Neurotology, Program Director, Neurotology Fellowship, Department of Otolaryngology – Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; Neurosensory Disorders Center, University of Cincinnati Neuroscience Institute, 213 Albert Sabin Way, MSB 6407, Cincinnati, OH 45267-0528, USA. Tel: +1 513 558 1273; fax: +1 513 558 5203; e-mail: Ravi.Samy@UC.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Rare variability in adrenoleukodystrophy: a case report

X-linked adrenoleukodystrophy is a genetic disorder with diverse clinical phenotypes. Of these phenotypes, the cerebral form usually manifests during early childhood with rapid cognitive and neurological deter...

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Fine needle non-aspiration cytology for the diagnosis of cervical lymph node tuberculosis: a single center experience

Publication date: Available online 28 June 2018
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Moncef Sellami, Slim Charfi, Mohamed Amine Chaabouni, Salma Mrabet, Ilhem Charfeddine, Lobna Ayadi, Souha Kallel, Abdelmonem Ghorbel
IntroductionThe fine-needle cytology is being used as a first line of investigation in the diagnosis of head and neck swellings, as it is simple, cost effective and less invasive as compared to biopsy.ObjectiveThe aims of this study were to evaluate the results of the fine-needle non-aspiration cytology of cervical lymphadenopathy and to study the factors influencing the rate of non-diagnosis results.MethodsThis retrospective study was conducted on selected patients with cervical lymphadenopathy that had undergone a fine-needle non-aspiration cytology followed by a histological biopsy. The sensitivity, specificity, positive predictive value and negative predictive value of fine-needle non-aspiration cytology for diagnosing tuberculosis were estimated. The risk factors of non-diagnosis results were evaluated.ResultsThe sensitivity, specificity, positive predictive value rates of fine-needle non-aspiration cytology for tuberculosis were 83.3%, 83.3%, 78.9% and 86.9% respectively. In total, 47 out of the 131 samples (35.8%) were considered non-diagnosis. Of the non-diagnosis samples, 84.2% (38 out of 47) were benign mostly due to tuberculosis (30 cases). Among the studied factors, only tuberculosis (confirmed by histopathological examination) was significantly associated with non-diagnosis cytology (p=0.02, Odds-Ratio=2.35).ConclusionTuberculosis is currently the commonest cause of cervical lymphadenopathy in North Africa. Fine-needle non-aspiration cytology is safe and accurate in the diagnosis of cervical tuberculous lymph node that is associated with the risk of non-diagnosis cytology.



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The efficacy and safety of multiple sessions of multisite transcranial random noise stimulation in treating chronic tinnitus

Publication date: Available online 28 June 2018
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Samer Mohsen, Akram Pourbakht, Mohammad Farhadi, Saeid Mahmoudian
IntroductionRandom noise stimulation was reported as the more effective and safer type of electrical stimulation techniques in relieving tinnitus symptoms. The multisite protocol of transcranial random noise stimulation has shown additional favorable effects.ObjectiveHere we will discuss the role of applying eight sessions of multisite transcranial random noise stimulation in decreasing tinnitus loudness and annoyance without exerting additional adverse effects.MethodsTwenty-nine subjects (8 female), the mean age of (45.34±9.57) with chronic tinnitus received transcranial random noise stimulation in the multisite protocol, 10min of auditory-transcranial random noise stimulation applied over the T3, T4 preceded by 10min of prefrontal-transcranial random noise stimulation applied over F4, FP1. In the first group, only one session was applied and the multiple-sessions group contained eight repeated sessions. Visual analog scale scores for loudness and distress were recorded before and immediately after the treatment. Multivariate repeated measure ANOVA test was used and minimal detectable change calculated.ResultsThere was a statistically and clinically significant reduction in tinnitus loudness and annoyance in both groups (p<0.05, effect size (η²)>0.8), while the amount of annoyance suppression in the multiple-sessions group was significantly greater than the single-session group. The patients of the multiple-sessions transcranial random noise stimulation group reported an improvement in their sleep and lower tinnitus handicap inventory scores without experiencing any additional adverse effects of the intervention.ConclusionsThe results of this study showed a substantial improvement in tinnitus symptoms by using the multiple sessions of transcranial random noise stimulation in the multisite protocol without producing any additional side effects. We suggest further clinical trials with long-term follow-up be investigated.



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Costochondral grafting for paediatric temporomandibular joint reconstruction: 10-year outcomes in 55 cases

Publication date: Available online 28 June 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): D.H. Awal, M. Jaffer, G. Charan, R.E. Ball, G. Kennedy, S. Thomas, S.A. Farook, C. Mills, P. Ayliffe
Costochondral grafting (CCG) can be used for the reconstruction of ankylotic, hypoplastic, and resected temporomandibular joint (TMJ) defects. CCGs have previously been considered the gold standard in children due to their growth potential and autogenous origin, but the disadvantages are unpredictable growth and joint ankylosis. This was a retrospective study of all children who received CCGs for TMJ reconstruction from 1985 to 2004, to allow a 10-year follow-up. Fifty-five patients were included in this study, with 74 grafts being placed; their mean age was 7.9±4.2years. Infection-related ankylosis (18.2%) and craniofacial microsomia (16.4%) were the most common diagnoses. Overall, 58.2% of patients suffered one or more complications over the follow-up period, with ankylosis (32.7%) and overgrowth (16.4%) being most common. There was a significant correlation between those with infection-related ankylosis and subsequent complications (χ²=8.8, df=1, P<0.005), while ankylotic patients in general exhibited greater overall complication rates (χ²=9.0, df=1, P<0.005). Patients with congenital TMJ defects were more likely to be complication-free than those with acquired defects (χ²=4.0, df=1, P<0.05). Caution is advised when placing CCGs in paediatric patients with ankylosed TMJs, especially those with infection-related ankylosis.



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Chitins and Chitinase Activity in Airway Diseases

Publication date: Available online 28 June 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Steven J. Van Dyken, Richard M. Locksley
Chitin, one of the most abundant biopolymers on earth, is bound and degraded by chitinases, specialized enzymes that are similarly widespread in nature. Chitin catabolism impacts global carbon and nitrogen cycles through a host of diverse biological processes, but recent work has focused attention on systems of chitin recognition and degradation conserved in mammals, connecting an ancient pathway of polysaccharide processing to human diseases influenced by persistent immune triggering. Here, we review current advances in our understanding of how chitin-chitinase interactions impact mucosal immune feedback mechanisms essential to maintaining homeostasis and organ heath.



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Speech and Communicative Participation in Patients With Facial Paralysis

This survey study assesses the association of facial paralysis with communicative participation among US adults with unilateral facial paralysis caused by Bell palsy, tumor, and other causes.

https://ift.tt/2tIVz1u

Restrictions in Communicative Participation

Communication is about connecting with people. Whether for business, or leisure, or love, communication is about understanding and being understood. Communication disorders disrupt those connections in various ways. Vocal fold paralysis weakens your voice. Aphasia scrambles the meaning of words. Hearing loss leaves you grasping at fragments of conversations. On the surface, these examples represent disparate impairments of communication. However, careful listening to the lived experiences of people with different communication disorders reveals many shared stories. For example, with a communication disorder you cannot overpower loud and distracting background noise in restaurants to communicate with waitstaff. It is rare that you can order what you actually want—and to actually receive what you ordered. Thus, you shrug, point to the person sitting next to you, and say, "I'll have what he's having." Telephones and intercoms at drive-through windows—daily conveniences for most people—pose insurmountable barriers when you have a communication disorder, so you drive on by without your latte or takeout pizza. Other people regard you with a look, or tone of voice, or comment that reveals their discriminating assumptions that because you cannot talk well, you must not be able to think well, or do anything else well. Hearing the same stories from people with different communication disorders leads to the realization that communication cannot be reduced to the mechanics of vocal fold vibration or speech articulation. Symptoms of various disorders interact with common barriers in the physical and social environments, leading to shared restrictions in communicative participation; that is, restricted involvement in and fulfillment of communication needs in daily life.

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The Pathogenesis of Choanal Atresia

This case report describes a 3-month-old female infant with craniosynostosis, frontal bossing, and limb abnormalities who presented with nasal obstruction and failure to thrive.

https://ift.tt/2z0YTuX

Association of Video Head Impulse Test With Improvement of Dynamic Balance and Fall Risk

This study evaluates the vestibuloocular reflex gain and change in fall risks after administration of the video head impulse test among patients with subacute or chronic dizziness.

https://ift.tt/2lI91iG

Guideline for Management of Pediatric Gastroesophageal Reflux

This Clinical Guidline Synopsis from the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) introduces updated guidelines for the treatment of gastroesophageal reflux in infants and children.

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Clinical feasibility and efficiency of a 3-dimensional printed surgical template for mandibular angle osteotomy and mandibular angle splitting osteotomy

Publication date: Available online 28 June 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): D. He, W. Du, J. Li, L. Liu, E. Luo
Mandibular angle osteotomy (MAO) and mandibular angle splitting osteotomy (MASO) are the two main surgical approaches used to correct a square mandible for a desirable aesthetic appearance. However, there are concerns about the safety and accuracy of both procedures as they may lead to unsatisfactory results such as injury to the nerve. To achieve symmetry and security we designed and evaluated a 3-dimensional printed surgical template, which indicates the outer cortex splitting line of the MASO, and the curved cutting line of the MAO. We operated on 11 patients who had been diagnosed with broad mandibles using the assisted template. The mean duration of osteotomy, degree of numbness of the inferior alveolar nerve, and reduction in the width of the mandible (Go-Go) were recorded. The mandibular curve before and after operation was fitted to evaluate its accuracy. The results showed that mean duration of osteotomy and numbness of the nerve were reduced, and there was no significant difference between simulation and postoperatively. The mean (SD) reduction in the mandibular width was 15.2 (1.6)mm. The template facilitated accuracy and safety in both procedures.



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'A snake and a crescent moon in a coronary angiogram

Description 

A  coronary artery fistula   (CA F) is a direct connection between a coronary artery and any one of the cardiac chambers, the coronary sinus or superior vena cava, or a pulmonary artery or pulmonary vein close to the heart. CAF accounts for 48.7% of all congenital coronary anomalies.1 The most common drainage sites in a decreasing frequency are the right ventricle (41%), right atrium (26%), pulmonary artery (17%), coronary sinus (7%), left atrium (5%), left ventricle (3%) and superior vena cava (1%).2 Further occurrence of this CAF along with the presence of aortic sinus to pulmonary artery fistula is very rare.

We present a case of a 53-year-old, hypertensive man who had presented with a first episode of chest pain of 8 hours' duration. At presentation in the emergency department, his heart rate was 90/min and blood pressure measured 158/85 mm Hg. His cardiac and chest examinations were...

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Abdominal pain leading to incidental finding of polyarteritis nodosa

Description 

A 51-year-old man with new-onset hypertension presented with mild epigastric pain that started 3 days ago. The pain was associated with emesis, subjective fevers and diaphoresis. He denied haematemesis, haematochezia, melena, fatigue, night sweats, abnormal bowel movements, weight change, skin changes or neuropathy.

His vitals were significant for heart rate of 120 bpm. He appeared pale with peripheral cyanosis. Abdomen was diffusely tender with normal bowel sounds. There was no rebound tenderness. Complete blood count, comprehensive metabolic panel, amylase and lipase levels were normal. CT of the abdomen demonstrated an abdominal haematoma centred ventral to the third portion of the duodenum and bilateral renal wedge-shaped infarcts (figures 1–3). Abdominal angiogram showed irregular pancreaticoduodenal arcade with microaneurysms originating from a branch of the proximal superior mesenteric artery (figure 4). The rupture of one of the microaneurysms was presumed to be the...

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Tip of the iceberg: congenital cataract with pre-existing posterior capsule defect (PPCD): how vital is the role of ultrasound biomicroscopy?

Description

A 14-month-old female child presented to the outpatient clinic with abnormal white reflex of the left eye (LE) noticed by parents for the last 6 months. The right eye (RE) had similar history and was operated for a white cataract at an outside hospital 3 months before. Intraoperatively, pre-existing posterior capsule defect (PPCD) was noted in the RE with inadvertent lens matter drop, which occurred after hydrodissection and was removed subsequently. The PPCD was quite large and the RE had to be left aphakic. Anterior segment examination of the LE with fully dilated pupil showed total cataractous lens with invisible posterior capsular details (figure 1A). Ultrasound biomicroscopy (UBM) of the LE showed a large posterior capsular defect with subluxation of the lens into the vitreous cavity1 beyond the capsule (figure 1B). Care was taken to avoid lens drop during irrigation–aspiration. Viscoat can be used to coat the area of the PPCD to temporarily seal the defect....

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Rare case of Gordon Holmes syndrome

Young-onset cerebellar syndromes are quite interesting and challenging for treating clinicians. While dealing with such cases, a clinician should be aware of rare possible causes too. We report a rare case of Gordon Holmes syndrome—an autosomal recessive cerebellar ataxia with endocrinal abnormalities.

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Cavum vergae and psychiatric illness: substantive or serendipity?

Description

A 38-year-old woman presented with 1-month history of restlessness, decreased sleep, religious song auditory hallucination and delusion of persecution and reference. She had no insight into her illness. She was not on any long-term medications. There was no history of head trauma or exposure to toxins. She suffered from postpartum psychosis during both her pregnancies (8 and 11 years ago) which warranted inpatient treatment with antipsychotics and mood stabilisers. She defaulted treatment both times once she got better and did not experience any recurrence of symptoms until current episode. She had no other comorbidities or significant family history. Her general medical and neurological examination findings were within normal limits. Routine laboratory tests did not reveal any abnormality. A brain MRI diffusion weighted imaging sequence demonstrated cavum vergae (CV, figure 1A) and MRI brain apparent diffusion coefficient sequence showing CV and thinned out cavum septum pellucidum (CSP, figure 1B). She was initially...

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Acute subclavian artery occlusion with associated clavicle fracture managed with bypass graft alone

Subclavian artery injury is a rare consequence of clavicle fracture. It most often results from penetrating trauma but can result from blunt trauma with adjacent bone fragments causing rupture, pseudoaneurysm, dissection or thrombosis of the artery. If flow through the subclavian artery is compromised there is a risk of ipsilateral upper limb ischaemia. Life-threatening haemorrhage may result in cases of laceration, and cerebral infarction may result from dissection. Vascular injury in association with clavicle fracture is typically regarded as an indication for internal fixation of the fracture. We present a case of subclavian artery thrombosis in association with a comminuted midshaft clavicle fracture causing limb ischaemia managed by carotid to brachial artery bypass without internal fracture fixation. The fracture united at 4 weeks and there was no sustained vascular or neurological impairment at follow-up. We advocate urgent vascular intervention in subclavian artery injury. There is little discussion in the literature regarding non-operative management of clavicle fractures with subclavian artery injury. We suggest that select clavicle fractures with subclavian artery injury can be safely managed non-operatively.

https://ift.tt/2KuYUbu

A case of oligodendroglioma and multiple sclerosis: Occams razor or Hickams dictum?

Tumefactive appearing lesions on brain imaging can cause a diagnostic dilemma. We report a middle-aged man who presented with right-sided optic neuritis. A brain MRI showed enhancement of the right optic nerve, and non-enhancing white matter lesions including a 3 cm right frontal lesion with adjacent gyral expansion. Cerebrospinal fluid analysis showed five oligoclonal bands not present in serum. Glatiramer acetate was started for suspected tumefactive multiple sclerosis (MS). A follow-up brain MRI 6 months later showed persistence of the frontal gyral expansion. A brain biopsy led to the diagnosis of an oligodendroglioma, isocitrate dehydrogenase-mutant and 1 p/19q co-deleted (WHO grade II), managed with surgical resection and radiotherapy. Postoperative brain MRI showed a new enhancing periventricular lesion, making the choice of optimal disease-modifying therapy for MS challenging. This case highlights the possibility of coexistence of MS and oligodendroglioma, and emphasises the importance of a tissue diagnosis when atypical MS imaging features are present.

https://ift.tt/2KeWZM5

Early onset necrotising enterocolitis in association with congenital diaphragmatic hernia in a term baby

We report a case of a male, term newborn with known left congenital diaphragmatic hernia (CDH) who presented with circulatory compromise requiring maximal inotropic support in the first 24 hours of life. Repeat X-ray at 24 hours showed pneumatosis intestinalis. Emergency laparotomy was performed for suspected necrotising enterocolitis. The terminal ileum to the sigmoid colon were frankly necrotic with multiple perforations. Subtotal colectomy was performed. Although the recovery was protracted, the baby had a favourable outcome with progressive weight gain on follow-up at 3, 6 and 9 months of age.

This case of CDH had a postnatal systemic instability that was more severe than predicted, and as well as assessing for persistent pulmonary hypertension of newborn should trigger immediate suspicion for other organ involvement.

https://ift.tt/2Mx9gbo

Orbital blowout fracture from nose blowing

Orbital blowout fractures are nearly always caused by acute trauma. Non-traumatic cases of orbital blowout fractures have only been rarely described. In this case study, we discuss an orbital blowout fracture directly caused by nose blowing. The patient developed unilateral eye swelling and orbital emphysema. It is important for the clinician to investigate all suspected orbital blowout fractures with imaging and full ophthalmological examination regardless of a trauma history. Most cases of orbital emphysema resolve spontaneously, however one must always exclude compression of the central retinal artery. This may present as acute loss of vision and/or ophthalmoplegia.

https://ift.tt/2Ki9Opd

Post-transplant erythrocytosis refractory to ACE inhibitors and angiotensin receptor blockers

Post-transplant erythrocytosis (PTE) is a condition with elevated haematocrit (hct) in renal allograft recipients. The mainstay of treatment is ACE inhibitors (ACEi) or angiotensin II receptor blockers (ARB), but seldom phlebotomy. PTE must be recognised early to prevent major thromboembolic events. We present a case of PTE that was refractory to blockade of renin–angiotensin system (RAS) by ACEi and ARB and required phlebotomy for control of hct. Our review of medical literature about prevalence and pathophysiology of PTE suggests that approximately 22% of patients with PTE are refractory to ACEi/ARB treatment. There are four plausible pathways that appear to play a role in causing PTE: disruption of erythropoietin regulation, mitogenic effect of the RAS on erythroid lineage, insulin-like growth factor 1 and androgenic stimulation. Presently, there is no unifying hypothesis involving these factors, but refractoriness to ACEi/ARB may represent a distinct subcategory of PTE.

https://ift.tt/2KrmF4s

Acute COPD exacerbation presenting with pronounced intrabullous haemorrhage and haemoptysis

A 54-year-old man with history of chronic obstructive pulmonary disease (COPD) presented with subacute onset of chest pain, shortness of breath, productive cough with haemoptysis and night sweats. There were no fever or recent weight loss reported. The chest radiograph showed right upper lobe bullae with adjacent opacification and an emphysematous lung. Due to worsening haemoptysis and persistent chest pain, CT of the chest with contrast was performed, which revealed moderate to severe emphysema and numerous blood-filled bullae. Cardiac work-up for chest pain was negative for myocardial ischaemia and for aortic dissection. Further infectious work-ups for mycobacterial and invasive fungal infection were negative. The patient was treated for acute COPD exacerbation and responded well to the antibiotics with the resolution of haemoptysis. Follow-up CT of the chest revealed the gradual resolution of the haemorrhage, while the patient remained asymptomatic.

https://ift.tt/2Ke6jjm

Large cell neuroendocrine carcinoma and adenocarcinoma of gallbladder with concomitant hepatitis C infection

Neuroendocrinetumour (NET) of the gallbladder is an extremely rare tumour and with coexisting adenocarcinoma an even rarer occurrence. Mixed NETs have the tendency to invade the lymph nodes and the hepatic tissue from their high malignant potential, leading to poor prognosis. Survival rates of the patients with mixed NET can be improved with wide excision, adjuvant chemotherapy and radiation. We present a case of 62-year-old woman with history of hepatitis C infection, a risk factor for both hepatic and extrahepatic gastrointestinal malignancies. Patient underwent exploratory laparotomy with resection of the gallbladder and partial hepatectomy. Pathology showed high-grade larger cell neuroendocrine carcinoma 5x4x3 cm along with two separate lesions found out to be adenocarcinomas. In our patient, hepatitis C infection can be an inciting factor for the development of these carcinomas. We will discuss the presentation, treatment modalities and outcomes with this kind of coexisting tumours.

https://ift.tt/2MuSVnF

Acute liver failure due to liver parenchymal infiltration with acute myelogenous leukaemia in a patient with myelodysplastic syndrome

Liver involvement by acute leukaemia is rare and has a high mortality rate despite treatment. We report a case of a 66-year-old woman undergoing treatment for myelodysplastic syndrome with Vidaza (azacitidine) who presented with abnormal liver function tests. Despite negative serologic testing and unremarkable abdominal MRI, she continued to have significant elevation in bilirubin and international normalised ratio and worsening mental status. Liver biopsy was obtained and consistent with acute myelogenous leukaemia. The patient had rapid demise due to acute liver failure and was unable to undergo treatment.

https://ift.tt/2Kg0fHe

Regressive pyridoxine-induced sensory neuronopathy in a patient with homocystinuria

Pyridoxine (vitamin B6) is an essential vitamin playing a crucial role in amino acid metabolism. Pyridoxine is used for isoniazid side-effects prevention, pyridoxine-dependent epilepsy treatment and cystathionine beta-synthase deficiency (homocystinuria) treatment. However, vitamin B6 hypervitaminosis is neurotoxic and may provoke a progressive sensory neuronopathy (sensory ganglionopathy), usually when daily uptake is above 50 mg. We describe the case of a 30-year-old patient with homocystinuria who was treated with pyridoxine 1250–1750 mg/day for 20 years and developed progressive sensory neuropathy with ataxia and impaired sensation in the extremities. Electrodiagnostic testing demonstrated non-length-dependent abnormalities of sensory nerve potentials, and sensory ganglionopathy was diagnosed. Pyridoxine dosage was reduced to 500 mg/day, resulting in the disappearance of sensory symptoms and ataxia, and the normalisation of sensory nerve potentials. Our case indicates that pyridoxine-induced sensory ganglionopathy may be reversible, even after prolonged ingestion of high doses of vitamin B6 for more than 20 years.

https://ift.tt/2Kuw0sj

Disseminated histoplasmosis mimicking relapsed chronic lymphocytic leukaemia

Histoplasma microconidia when inhaled are presented in antigenic form to T cells, limiting the extent of infection; however, defects in cellular immunity results in disseminated disease. Chronic lymphocytic leukaemia (CLL) is a lymphoproliferative disorder resulting in functionally impaired lymphocytes, predisposing patients to various opportunistic infections. The author reports a recently treated patient with CLL presenting with constitutional symptoms accompanied by hepatosplenomegaly and diffuse adenopathy. Considering the recent diagnosis and treatment of CLL, initial suspicion was relapsed disease. However, considering the immune deficiency associated with CLL and its treatment, infectious aetiologies were strongly considered. Further investigation revealed a case of disseminated histoplasmosis mimicking CLL in this reported patient. Considering appropriate diagnosis and timely therapy, the reported patient had good prognosis despite being diagnosed with disseminated histoplasmosis. This case highlights consideration of disseminated histoplasmosis in patients presenting with diffuse adenopathy along with hepatomegaly and/or splenomegaly in the right clinical setting.

https://ift.tt/2KvJS8G

Breast cancer metastasis to the bladder: a literature review

Given the prevalence of breast cancer and the mortality associated with metastatic disease, it is imperative for physicians to not only be aware of common sites but also of rare metastatic destinations such as the bladder. A postmenopausal woman with a medical history of stage 2 invasive ductal carcinoma, oestrogen receptor/progesterone receptor positive and human epidermal growth factor receptor 2 negative, in remission for 9 years, presented to her primary care physician with concerns of increased urinary urgency, frequency and incontinence. The patient underwent cystoscopy with biopsy of an area of granulation tissue. Biopsy revealed adenocarcinoma consistent with breast primary. The common sites of metastases from breast cancer are lung, bone and liver. This case is unique where breast cancer was found to metastasise to the bladder. It is important for physicians to consider further investigation when a breast cancer survivor develops urinary symptoms even without haematuria.

https://ift.tt/2MuekNP

Untreated Congenital Hypothyroidism Mimicking Hirschsprung Disease: A Puzzling Case in a One-Year-Old Child

Congenital hypothyroidism is a clinical emergency due to its potential risk of mental retardation. Constipation might be present in hypothyroid children. However, Hirschsprung disease is rarely associated with congenital hypothyroidism. Herein, a case of congenital hypothyroidism in a one-year-old child mimicking Hirschsprung disease is described. Adequate treatment with levothyroxine sodium tablets controlled intestinal dysmotility that mimicked congenital intestinal aganglionosis due to the critical influence of thyroid hormones on bowel motility.

https://ift.tt/2tKO2iz

Aprepitant for CINV Induced by Chemoradiotherapy in HNSCC

Conditions:   Vomiting;   Nausea Post Chemotherapy;   Head Neck Cancer
Intervention:   Drug: Aprepitant
Sponsor:   Chinese Academy of Medical Sciences
Recruiting

https://ift.tt/2yOkRRJ

Surgical treatment of mucocele of the appendix: a systematic review and case report

Abstract

Introduction

Appendicular mucocele is a rare well-described clinico-pathological occurrence. It denotes an obstructive dilatation of the appendicular lumen by mucinous secretions.

Case report

A 60-year-old patient presented with right lower abdominal pain and nausea for 2 years. Abdominal CT scan suggested a diagnosis of a appendicular mucocele. Following informed consent, surgical exploration revealed a cystic mass arising from the body of the appendix with inflamed walls with no evidence of perforation. Simple appendectomy was performed as the caecum and the mesenteric nodes were free of pathological involvement. The final diagnosis of mucinous cystadenoma was confirmed by histopathology. Postoperative course was uneventful. The patient was in good health during a four years regular follow-up.

Discussion

Appendicular mucocele is a rare disease with vague symptoms. Abdominal imaging is an important diagnostic tool, but histopathology is the standard for definitive diagnosis. Surgery for benign appendicular mucoceles has an excellent long-term prognosis.

https://ift.tt/2tzjC3s

Adenoid size by drug induced sleep endoscopy compared to nasopharyngeal mirror exam

Publication date: September 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 112
Author(s): Habib G. Zalzal, Michele Carr, William Kohler, Steven W. Coutras
ObjectiveTo establish how assessment of adenoid size is correlated between drug-induced sleep endoscopy (DISE) with indirect mirror nasopharyngoscopy (IMN).Study DesignRetrospective chart review.SettingTertiary care academic hospital.MethodsOver a 6-year period, 154 pediatric patients underwent DISE for obstructive sleep apnea and had IMN. DISE videos were assessed by one reviewer, blinded to results of mirror exams. IMN findings were taken from operative notes recorded by one attending physician. Demographic data, co-morbidities, and sleep study results were also recorded.ResultsNinety-three (58.5%) males and 66 (41.5%) females were included. Mean age at DISE was 7.34 ± 3.99 years, with an average of 29 days after DISE until nasopharyngeal mirror examination. The mean initial adenoid size based on DISE assessment was 2.62 + 0.99, and on nasopharyngeal mirror assessment was 2.56 + 0.97. DISE and IMN assessment of adenoid size correlated well (Spearman's Rho = 0.82, P < 0.00001; Kendal tau = 0.764, P < 0.00001).ConclusionsDISE has proven to be an excellent tool to assess adenoid size prior to adenoidectomy in children with OSA.



https://ift.tt/2KpxW8u

Oropharyngeal cancer is no longer a disease of younger patients and the prognostic advantage of Human Papillomavirus is attenuated among older patients: Analysis of the National Cancer Database

Publication date: August 2018
Source:Oral Oncology, Volume 83
Author(s): Eleni M. Rettig, Munfarid Zaidi, Farhoud Faraji, David W. Eisele, Margueritta El Asmar, Nicholas Fung, Gypsyamber D'Souza, Carole Fakhry
ObjectivesHPV-positive oropharyngeal cancer (OPC) patients have been observed to be younger than patients with HPV-negative OPC at diagnosis. We evaluated recent trends in age at OPC diagnosis, and whether older age attenuates the survival benefit of HPV-positive tumor status.Materials and methodsPatients diagnosed with OPC from 2004 to 2014 represented in the National Cancer Database were included. HPV tumor status was available after 2010. Trends in age by calendar year were compared using linear regression. Overall survival was compared using Cox Proportional Hazards models.ResultsThe mean age of OPC patients (N = 119,611) increased significantly from 2004 to 2014 (ß = 0.21 years of age per calendar year, 95% confidence interval [CI] = 0.19–0.23). The increase in age from 2010 to 2014 was similar for HPV-positive (N = 21,880; ß = 0.63, 95%CI = 0.53–0.72) and HPV-negative (N = 11,504; ß = 0.59, 95%CI = 0.45–0.74) patients. Between 2010 and 2014, the proportion of OPCs that were HPV-positive increased significantly for all age groups, including for patients ≥70 years old (from 45% to 60%, ptrend < 0.001). Although patients ≥70 years with HPV-OPC had improved survival compared to those with HPV-negative OPC (adjusted hazard ratio [aHR] = 0.65, 95%CI = 0.55–0.76), the survival benefit of HPV-positive tumor status was significantly attenuated compared to younger HPV-OPC patients (50–59 years: aHR = 0.45, 95%CI = 0.39–0.51; pinteraction < 0.001).ConclusionThe age at OPC diagnosis is increasing for both HPV-positive and HPV-negative patients, and a rising proportion of older patients have HPV-positive tumors. These findings dispel the notion that HPV-positive OPC is a disease of younger patients, identify a growing elderly population of HPV-positive OPC patients with reduced survival, and have implications for evolving treatment paradigms.



https://ift.tt/2tKtLJZ

Perioperative considerations in free flap surgery: A review of pressors and anticoagulation

Publication date: August 2018
Source:Oral Oncology, Volume 83
Author(s): Mark K. Wax, James Azzi
Given the high stakes for microvascular reconstruction, the majority of reconstructive surgeons have developed paradigms for pre, intra, and postoperative management that have proven to result in individual high success rates. Much has been done to identify and avoid perioperative factors that could potentially increase flap failure rates. Two example of this practice has been the generalized use of anticoagulation in free tissue transfer and the prohibition against vasopressor use in patients that are undergoing free tissue transfer. This manuscript will discuss these issues.



https://ift.tt/2N9dNCi

Successful treatment of erythematotelangiectatic rosacea with intense pulsed light: Report of 13 cases

The Journal of Dermatology, EarlyView.


https://ift.tt/2KwwX2Y

Numerous plasmacytoid dendritic cell infiltration in HIV‐associated psoriasis relieved only with antiretroviral therapy

The Journal of Dermatology, EarlyView.


https://ift.tt/2N4rjad

Sézary syndrome in an anti‐human T‐cell lymphotropic virus type 1 seropositive carrier

The Journal of Dermatology, EarlyView.


https://ift.tt/2KuOSHE

Mycoplasma pneumoniae‐associated mucositis with severe blistering stomatitis and pneumonia successfully treated with azithromycin and infusion therapy

The Journal of Dermatology, EarlyView.


https://ift.tt/2tBkjt6

Prolonged growth of infantile hemangioma after pulsed dye laser and oral propranolol treatment

The Journal of Dermatology, EarlyView.


https://ift.tt/2IyYVJK

Psoriasiform dermatitis associated with common variable immunodeficiency 10 due to an Arg853* mutation in the NFKB2 gene

The Journal of Dermatology, EarlyView.


https://ift.tt/2tAUZDR

Identification of a missense mutation causing exon skipping in a neurofibromatosis type 1 patient

The Journal of Dermatology, EarlyView.


https://ift.tt/2IAivVZ

Remembering an Icon in Office Anesthesia

Publication date: Available online 27 June 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Roger A. Meyer




https://ift.tt/2KuTe4H

In reply

Publication date: Available online 27 June 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Stuart E. Lieblich




https://ift.tt/2MuhlOg

Effets indésirables des soins capillaires chez les utilisateurs

Publication date: Available online 27 June 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): D. Tennstedt, A. Herman, J.-M. Lachapelle
La panoplie des produits utilisés par les professionnels pour laver, modifier la couleur ou la forme ou embellir la chevelure n'est pas dénuée d'effets indésirables. Ces effets sont essentiellement des dermatites d'irritation et des eczémas de contact allergiques pouvant affecter le cuir chevelu mais aussi la nuque, la face antérieure du cou, le front et les régions périorbitaires, les joues. Parmi les allergènes les plus cités, il convient de mentionner la paraphénylènediamine (PPD) des teintures capillaires, le monothioglycolate de glycérol (GMTG) des permanentes acides, le persulfate d'ammonium des décolorations (ce dernier est responsable principalement d'urticaires de contact). Mais il ne faut pas oublier d'autres allergènes comme la cocamidopropylbétaïne parmi les tensioactifs, et aussi certains constituants de la formulation tels les conservateurs et les parfums (voire le minoxidil, si fréquemment utilisé par les patients).The panoply of products used by hair care professionals to wash, dye, shape and beautify hair is not entirely free from adverse events. Such effects consist mainly of irritation dermatitis and allergic contact eczema affecting the scalp, as well as the back and front of the neck, the forehead and periorbital areas, and the cheeks. The most frequently cited allergens include paraphenylenediamine (PPD) in hair dyes, glycerol monothioglycolate (GMTG) in acid perm lotions, and ammonium persulphate in hair lighteners (the latter substance being responsible primarily for contact urticaria). However, care should also be paid to other allergens such as cocamidopropyl betaine among surfactants, as well as certain components in hair formulations such as preservatives and fragrances (as well as minoxidil, frequently used by patients).



https://ift.tt/2IyCtjX

Plasminogen gene mutation with normal C1Inhibitor‐hereditary angioedema: Three additional French families

Allergy, Volume 0, Issue ja, -Not available-.


https://ift.tt/2MxGZll

Alteration of Serum Lipid in Oral Sub Mucous Fibrosis in Central India

Abstract

Oral sub mucous fibrosis is the most common precancerous lesion in India. Lipids are the major cell membrane components essential for various biological function including cell growth and division for the maintenance of cell integrity of normal and malignant tissue. Low levels of lipids serves as a marker and prognostic indicator in the early detection of oral precancerous and cancerous states. In spite of high prevalence and its potential to undergo malignant transformation, this condition has not widely been investigated with respect to serum lipid levels. In present study an attempt is made to analyze the complete serum profile, total cholesterol, triglycerides, high density lipoprotein. Low density lipoprotein, and very low density lipoprotein in oral precancerous lesion and control. Study was conducted in 30 clinically and histopathologically diagnosed cases of premalignant lesion and 30 age and sex match controls. The complete lipid profile including TC, TG, HDL, LDL, and VLDL was analyzed. Serum lipid levels were significantly lower in patients with oral lesion than in controls. From the finding it appears that the decreases in the lipid levels may be considered as useful marker in the early diagnosis of oral premalignant lesion.

https://ift.tt/2MuNwwX