EXTRACAPSULAR DISSECTION AND LIMITED PAROTIDECTOMY

Publication date: Available online 3 July 2018
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): David Myssiorek
Parotid surgery has evolved over the last century. Many of the long-held principles have been questioned and consequently modified. The basic tenets of parotid surgery for benign disease have been identifying and preserving the facial nerve and complete excision of the tumor with an adequate cuff of normal tissue. This can be safely accomplished by extracapsular dissection or limited/partial parotidectomy. Extracapsular dissection implies no attempt at finding the facial nerve, while limited or partial parotidectomy includes finding one (or more) branch of the facial nerve and then dissecting that branch in a retrograde fashion.Indications for extracapsular dissection or limited parotidectomy are similar to superficial parotidectomy. There is some evidence that this technique can be used safely without compromising oncological principles with low-grade cancers. Extracapsular dissection or limited parotidectomy should not be performed for large tumors, anatomically difficult to reach tumors and high-grade cancers.When compared to superficial parotidectomy, extracapsular dissection had similar recurrence rates. Extracapsular dissection had lower transient and permanent facial paralysis rates. Frey syndrome was also reported less frequently following extracapsular dissection. Sialoceles may be more frequent postoperatively but are easily treated and rarely last longer than three weeks.



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Neck dissection for salivary gland malignancies

Publication date: Available online 3 July 2018
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Serena Byrd, Luc G.T. Morris
Salivary gland carcinomas are diverse, and their biological behavior and surgical management are also variable and somewhat controversial. Cervical lymph node status is an important prognostic variable for salivary gland malignancies. Neck dissection should be undertaken if there is clinical or radiographic evidence of associated nodal metastasis in the neck. However, indications for elective neck dissections in a clinically N0 neck remains a controversial topic. This article describes indications for elective neck dissection in salivary gland malignancies, provides a detailed review of the neck dissection technique, and discusses postoperative management of these patients.



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Sublingual Gland

Publication date: Available online 4 July 2018
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Patrick J Bradley
It is infrequent for surgery to be necessary for the sublingual salivary gland. As such the anatomy of the floor of mouth is not well taught or understood to medical graduates and head and neck surgeons. Three diseases or conditions require surgical management: the ranula, neoplasm and sialolithiasis. In the benign conditions, the lingual nerve and submandibular duct must be identified and preserved to avoid patient morbidity. Malignant salivary gland neoplasms are rare, and hence an inaccurate diagnosis frequently delayed commencement of correct treatment. Most cases present at an advanced stage of disease. Surgical excision with a "safe margin" is required, and thus removal of the lingual nerve and submandibular gland are sequelae of the treatment rather than a complication.



https://ift.tt/2IQcTqT

Potentiation of PD-L1 blockade with a potency-matched dual cytokine–antibody fusion protein leads to cancer eradication in BALB/c-derived tumors but not in other mouse strains

Abstract

We have recently described a novel therapeutic antibody product (IL2–F8–TNF^mut), featuring the simultaneous fusion of murine IL2 and of a TNF mutant with scFv(F8), an antibody specific to the alternatively-spliced extra domain A of fibronectin (EDA). Here, we report on the in vivo characterization of the anti-cancer activity of IL2–F8–TNF^mut in four immunocompetent murine models of cancer, CT26, WEHI-164, F9 teratocarcinoma and Lewis lung carcinoma (LLC), using the product alone or in combination with a monoclonal antibody specific to murine PD-L1. All four models exhibited a strong expression of EDA-fibronectin, which was confined to vascular structures for F9 tumors, while the other three malignancies exhibited a more stromal pattern of staining. A complete and long-lasting tumor eradication of CT26 and WEHI-164 tumors was observed in BALB/c mice when IL2–F8–TNF^mut was used in combination with PD-L1 blockade. The combination treatment led to improved tumor growth inhibition in 129/SvEv mice bearing murine teratocarcinoma or in C57BL/6 mice bearing murine LLC, but those cancer cures were difficult to achieve in those models. A microscopic analysis of tumor sections, obtained 24 h after pharmacological treatment, revealed that the PD-L1 antibody had homogenously reached tumor cells in vivo and that the combination of PD-L1 blockade with IL2–F8–TNF^mut stimulated an influx of NK cells and of T cells into the neoplastic mass. These data indicate that potency-matched dual-cytokine fusion proteins may be ideally suited to potentiate the therapeutic activity of immune check-point inhibitors.

https://ift.tt/2Kylt39

The volatilome – investigation of volatile organic metabolites (VOM) as potential tumor markers in patients with head and neck squamous cell carcinoma (HNSCC)

Different organisms such as bacteria, molds and humans produce and release a relative unknown class of metabolites which are responsible for the individual olfactory pattern. These volatile organic metabolites...

https://ift.tt/2KL8s2m

The 678 Hz acoustic immittance probe tone: a more definitive indicator of PET than the traditional 226 Hz method

The accurate diagnosis of Eustachian tube (ET) dysfunction can be very difficult. Our aim is to determine whether a 678 Hz probe tone is a more accurate indicator of Patulous ET (PET) than the 226 Hz probe ton...

https://ift.tt/2NqedEb

Endoscopic endonasal transmaxillary ligation of a feeding artery and coblation plasma technology enables en bloc resection of advanced juvenile nasopharyngeal angiofibroma without preoperative embolization

Juvenile nasopharyngeal angiofibroma (JNA) is a hypervascular tumor and uncontrolled hemorrhage makes its removal very difficult. Although preoperative intravascular embolization of a feeding artery is recommended, serious complications such as iatrogenic thrombosis in the brain and insufficient decrease in blood flow to the tumor are concerns. Recently, coblation plasma technology has been reported to be useful for tumor removal with minimum hemorrhage under a clear surgical field. Here we report successful removal of advanced JNA without preoperative embolization, using intraoperative ligation of the maxillary artery and coblation plasma technology.

https://ift.tt/2KKeH9M

Short implants (≤8mm) compared to standard length implants (>8mm) in conjunction with maxillary sinus floor augmentation: a systematic review and meta-analysis

The objective was to test the hypothesis of no difference in the treatment outcome after the installation of short implants (≤8mm) in the posterior part of the maxilla compared to standard length implants (>8mm) in conjunction with maxillary sinus floor augmentation (MSFA) using the lateral window technique, after an observation period of ≥3years. A search of the MEDLINE, Embase, and Cochrane Library databases, in combination with a hand-search of relevant journals, was conducted. The search yielded 1102 titles.

https://ift.tt/2tU7pXt

Accuracy of two midsagittal planes in three-dimensional analysis and their measurement in patients with skeletal mandibular deviation: a comparative study

Our aim was to evaluate the accuracy of two midsagittal planes (MSP) to provide a better reference plane for studying the 3-dimensional structural symmetry in patients with skeletal mandibular deviation. Thirty adult patients with facial asymmetry were admitted to the Department of Orthodontics, Hospital of Stomatology, between January 2015 and 2017. The DICOM data were collected and reconstructed using ProPlan CMF® 2.0 (Materialise). Two sets of reference planes were set up. In the orbital margin plane group, the plane crossing the nasion (N) point and perpendicular to the frontozygomatic (FZ) suture line was used as the MSP.

https://ift.tt/2NnEwen

Efficacy of buccal infiltration anaesthesia with articaine for extraction of mandibular molars: a clinical trial

It is hard to provide adequate anaesthesia by infiltration of lidocaine into the mandible because of the thick buccal cortex. An inferior alveolar nerve block is often used but has a high failure rate, which has led research workers to look for an anaesthetic agent that will anaesthetise the lower teeth by buccal infiltration alone. We have assessed the efficacy of buccal infiltration anaesthesia with articaine by designing a double-blind controlled clinical trial in 133 patients who required extraction of mandibular molars.

https://ift.tt/2u3omxY

Knowledge of final-year medical students about oral and maxillofacial surgery: a two-centre study

The aim of this study was to assess the exposure of final-year medical students to oral and maxillofacial surgery (OMFS) and to find out how this has influenced them in terms of recruitment or possible future referral patterns. We sent questionnaires to final-year students at Oxford University and St George's University medical schools (n=100 in each) to find out how much experience they had had of the specialty, their knowledge of disease (through clinical situations), and specific knowledge about oral cancer.

https://ift.tt/2tSAhPZ

Tear of the sternocleidomastoid muscle: a rare complication of lifting weights that can be managed conservatively

A 24-year-old man presented to the emergency department with a five-day history of right-sided swelling of the neck, and pain. He also reported weakness and tingling of the right arm after he had moved a large sheet of metal (50kg) nine days previously. This slipped, which jolted his neck and caused pain for an hour after the injury, and was followed by a painful swelling in the neck that had not changed in size.

https://ift.tt/2u21uih

A Phase 2, Randomized Dose-Finding Study of Tapinarof (GSK2894512 Cream) for the Treatment of Atopic Dermatitis

Safe and efficacious topical treatments are needed for atopic dermatitis (AD).

https://ift.tt/2KMnnwi

Apremilast for moderate hidradenitis suppurativa: results of a randomized controlled trial

Effective anti-inflammatory treatments for hidradenitis suppurativa (HS) are limited.

https://ift.tt/2MIZi7e

A Comparison of Skin Cancer Screening and Treatment Costs at a Massachusetts Cancer Center, 2008 versus 2013

Temporal analyses of skin cancer costs are needed to examine how expenditure differences between diagnoses are changing.

https://ift.tt/2Kz7lqE

Chronic Non-Melanoma Skin Cancers and Health Related Impairment: A Case-Control Study

https://ift.tt/2MMScP3

Avocado-Induced Food Protein-Induced Enterocolitis Syndrome (FPIES): Case Series of an Emerging Trigger,

Acute food protein-induced enterocolitis syndrome (FPIES) is a non-IgE mediated gastrointestinal food hypersensitivity characterized by profuse vomiting and diarrhea leading to dehydration and lethargy. FPIES typically presents in infancy and early childhood.1 Unlike IgE-mediated food allergy, symptoms have delayed onset, often occurring 1-4 hours after ingestion of the culprit food.2 Milk and soy are the most common triggers within the first three months of life. Solid food FPIES has a later onset than cow's milk and soy induced FPIES, likely due to the timing of introduction of solid foods.

https://ift.tt/2z8RWrE

Glycemic dysregulation in a patient with type 2 diabetes treated with 5-azacitidine: a case report

Diabetes and myelodysplastic syndrome are two conditions that may coexist in a single patient, since both diseases are prevalent in the elderly. The pathophysiology of myelodysplastic syndrome involves recurre...

https://ift.tt/2KuCrQ0

Sub-acute intestinal obstruction – a rare complication of Plasmodium falciparum malaria in an adult: a case report

Malaria remains a major public health problem in most tropical countries. It occasionally presents with both typical and atypical signs and symptoms. Gastrointestinal manifestations are common in malaria endem...

https://ift.tt/2IQCQX7

Underuse of the Sentinel Lymph Node Biopsy for High-Risk SCC of the Skin—Reply

In Reply We read with interest the response by Glazer et al regarding our study on the underuse of sentinel lymph node biopsy (SLNB) for high-risk cutaneous squamous cell carcinoma (cSCC) and noted several important inquiries and comments.

https://ift.tt/2Nib0qt

Onychomadesis Following a Fish Pedicure

This case reports describe the occurrence of onychomadesis in a patient following a fish pedicure.

https://ift.tt/2tZ2ROM

An Annular Eruption in a Young Child

A young child had a 6-month history of an asymptomatic expanding erythematous eruption on the lower legs, abdomen, and buttocks; clinical examination was significant for faint, nonscaling annular serpiginous, erythematous plaques. What is your diagnosis?

https://ift.tt/2NpjuMn

Prescription to OTC Switch of Metronidazole and Azelaic Acid for Rosacea

This Viewpoint considers the advantages and disadvantages of topical treatments for rosacea, specifically metronidazole and azelaic acid, undergoing review to switch from prescription to over-the-counter availability.

https://ift.tt/2tZOGcn

The Future of JAMA Dermatology

I am deeply humbled to be selected to serve as Editor in Chief of JAMA Dermatology. The fundamental role of an editor in chief is to review, select, and publish the articles that best help clinicians practice more safely and effectively. The opportunity to illuminate the aspects of our field that deserve spotlight is a task both daunting and delightful. I am committed to do a deep dive into dermatology to identify what is most significant, what is most fascinating, what is most problematic, and to find opportunities to improve and elevate the practice of dermatologists. My ultimate goal is to ensure that dermatologists deliver the best patient care possible, and I consider it an incredible honor to be able to contribute to the specialty through this work.

https://ift.tt/2tStKEW

Dupilumab Treatment of Very Severe Refractory Atopic Hand Eczema

This case report describes the use of dupilumab to treat a patient with very severe refractory atopic hand eczema.

https://ift.tt/2z7EZ15

Underuse of the Sentinel Lymph Node Biopsy for High-Risk SCC of the Skin

To the Editor We read with interest the article by Ahadiat et al regarding the potential underuse of sentinel lymph node biopsy (SLNB) in patients with high-risk cutaneous squamous cell carcinoma (cSCC). Although SLNB may be underused in these patients, we have some inquiries regarding the research methods and generalizability of the data.

https://ift.tt/2NnsBxd

Human Papillomavirus Vaccine to Treat Cutaneous Basaloid Squamous Cell Carcinomas

This case report describes a woman with multiple, inoperable cutaneous basaloid squamous cell carcinomas who was treated with 9-valent human papillomavirus vaccine.

https://ift.tt/2tQgfVZ

Association of Inadequately Controlled Disease With Patient-Reported Disease Burden in Atopic Dermatitis

This cross-sectional study examines the association of atopic dermatitis severity and disease control with the patient-reported disease burden in clinical practice.

https://ift.tt/2zaaLL0

Patient-specific sub-periosteal zygoma implant for prosthetic rehabilitation of large maxillary defects after oncological resection

Publication date: Available online 2 July 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): N. Vosselman, B.J. Merema, K.P. Schepman, G.M. Raghoebar
A 74-year-old woman needed a subtotal bilateral maxillectomy due to squamous cell carcinoma of the palate. Immediate and secondary reconstruction of the defect was not feasible, so the defect was closed with an obturator prosthesis wired to the zygoma complex. To improve the patient's severely impaired speech and swallowing, a patient-specific sub-periosteal implant (psSPI) was designed that matched the remnants of the zygoma complex. First, the patient's post-surgical anatomy was visualized through segmentation of the pre- and post-maxillectomy computed tomography data. Next, based on the data, a customized zygoma-supported framework was designed to support the obturator prosthesis. Surgical guides for intraoperative navigation were designed and three-dimensionally printed, along with an obturator prosthesis to fit the planned outcome situation. The preoperatively manufactured psSPI and obturator prosthesis matched the intraoperative conditions. The postoperative results were favourable; within a week after surgery the patient could speak and swallow normally without nasal leakage. No problems occurred during follow-up. These results indicate that a psSPI-retained prosthesis can be considered for the restoration of speech and oral functioning in cases with a largely compromised maxillary bone anatomy, accompanied by impaired oral functioning and no feasible conventional reconstruction options.



https://ift.tt/2lUQGPb

Allergic components of eosinophilic esophagitis

Publication date: July 2018
Source:Journal of Allergy and Clinical Immunology, Volume 142, Issue 1





https://ift.tt/2KJvkCu

Epithelial origin of eosinophilic esophagitis

Publication date: July 2018
Source:Journal of Allergy and Clinical Immunology, Volume 142, Issue 1
Author(s): Mark Rochman, Nurit P. Azouz, Marc E. Rothenberg
Eosinophilic esophagitis (EoE) is a chronic, allergen-driven inflammatory disease of the esophagus characterized predominantly by eosinophilic inflammation, leading to esophageal dysfunction. Converging data have placed the esophageal epithelium at the center of disease pathogenesis. In particular, the main EoE disease susceptibility loci at 2p23 and 5p22 encode for gene products that are produced by the esophageal epithelium: the intracellular protease calpain 14 and thymic stromal lymphopoietin, respectively. Furthermore, genetic and functional data establish a primary role for impaired epithelial barrier function in disease susceptibility and pathoetiology. Additionally, the EoE transcriptome, a set of genes dysregulated in the esophagi of patients with EoE, is enriched in genes that encode for proteins involved in esophageal epithelial cell differentiation. This transcriptome has a high proportion of esophagus-specific epithelial genes that are notable for the unexpected enrichment in genes encoding for proteases and protease inhibitors, as well as in IL-1 family genes, demonstrating a previously unappreciated role for innate immunity responses in the esophagus under homeostatic conditions. Among these pathways, basal production of the serine protease inhibitor, Kazal-type 7 (SPINK7) has been demonstrated to be part of the normal differentiation program of esophageal epithelium. Profound lost expression of SPINK7 occurs in patients with EoE and is sufficient for unleashing increased proteolytic activity (including urokinase plasminogen activator), impaired barrier function, and production of large quantities of proinflammatory and proallergic cytokines, including thymic stromal lymphopoietin. Collectively, we put forth a model in which the esophagus is normally equipped as an anti-inflammatory sensing organ and that defects in this pathway, mediated by epithelial protease/protease inhibitor imbalances, unleash inflammatory responses resulting in disorders, such as EoE.



https://ift.tt/2MLbbtc

Allergic components of eosinophilic esophagitis

Publication date: July 2018
Source:Journal of Allergy and Clinical Immunology, Volume 142, Issue 1
Author(s): Jonathan Spergel, Seema S. Aceves
Information for Category 1 CME CreditCredit can now be obtained, free for a limited time, by reading the review articles in this issue. Please note the following instructions.Method of Physician Participation in Learning Process: The core material for these activities can be read in this issue of the Journal or online at the JACI Web site: www.jacionline.org. The accompanying tests may only be submitted online at www.jacionline.org. Fax or other copies will not be accepted.Date of Original Release: July 2018. Credit may be obtained for these courses until June 30, 2019.Copyright Statement: Copyright © 2018-2019. All rights reserved.Overall Purpose/Goal: To provide excellent reviews on key aspects of allergic disease to those who research, treat, or manage allergic disease.Target Audience: Physicians and researchers within the field of allergic disease.Accreditation/Provider Statements and Credit Designation: The American Academy of Allergy, Asthma & Immunology (AAAAI) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The AAAAI designates this journal-based CME activity for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.List of Design Committee Members: Jonathan Spergel, MD, PhD, and Seema S. Aceves, MD, PhD (authors); Zuhair K. Ballas, MD (editor)Disclosure of Significant Relationships with Relevant CommercialCompanies/Organizations: The authors have declared that they have no relevant conflicts of interest. Z. K. Ballas (editor) disclosed no relevant financial relationships.Activity Objectives:1. To understand the pathogenesis of eosinophilic esophagitis (EoE).2. To know the common triggers of EoE.3. To become familiar with testing methods and their limitations for identifying triggers in patients with EoE.Recognition of Commercial Support: This CME activity has not received external commercial support.List of CME Exam Authors: Sonia Joychan, MD; Fatima Khan, MD; and Warit Jithpratuck, MD (fellows), and Mark Ballow, MD, and Panida Sriaroon, MD (faculty mentors)Disclosure of Significant Relationships with Relevant CommercialCompanies/Organizations: The exam authors disclosed no relevant financial relationships.Eosinophilic esophagitis (EoE) is a disorder of increasing prevalence worldwide, causing clinical symptoms of vomiting, failure to thrive, and dysphagia and complications of esophageal remodeling with strictures and food impactions. Molecular profiling demonstrates EoE to be an eosinophil-predominant disorder with a TH2 cytokine profile reminiscent of other allergic diseases, such as asthma, allergic rhinitis, and atopic dermatitis. Environmental antigens in the form of foods and aeroallergens induce eosinophil, basophil, mast cell, and T-cell infiltration. Pathogenesis depends on local epithelial immune activation with production of thymic stromal lymphopoietin and eotaxin-3. Complications mirror asthmatic airway pathogenesis, with increases in subepithelial collagen deposition, angiogenesis, and smooth muscle hypertrophy. The removal of instigating antigens, especially foods, causes disease resolution in more than 50% of adults and children. The prevalence of concurrent atopic disorders in patients with EoE and the need to control antigen-specific TH2 inflammation underscore the importance of testing for allergens and treating the entire atopic subject to control the potential interplay between organ-specific allergic responses.



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Transfer of gene-corrected T cells corrects humoral and cytotoxic defects in patients with X-linked lymphoproliferative disease

Publication date: July 2018
Source:Journal of Allergy and Clinical Immunology, Volume 142, Issue 1
Author(s): Neelam Panchal, Ben Houghton, Begona Diez, Sujal Ghosh, Ida Ricciardelli, Adrian J. Thrasher, H. Bobby Gaspar, Claire Booth
BackgroundX-linked lymphoproliferative disease 1 arises from mutations in the SH2D1A gene encoding SLAM-associated protein (SAP), an adaptor protein expressed in T, natural killer (NK), and NKT cells. Defects lead to abnormalities of T-cell and NK cell cytotoxicity and T cell–dependent humoral function. Clinical manifestations include hemophagocytic lymphohistiocytosis, lymphoma, and dysgammaglobulinemia. Curative treatment is limited to hematopoietic stem cell transplantation, with outcomes reliant on a good donor match.ObjectivesBecause most symptoms arise from defective T-cell function, we investigated whether transfer of SAP gene–corrected T cells could reconstitute known effector cell defects.MethodsCD3⁺ lymphocytes from Sap-deficient mice were transduced with a gammaretroviral vector encoding human SAP cDNA before transfer into sublethally irradiated Sap-deficient recipients. After immunization with the T-dependent antigen 4-hydroxy-3-nitrophenylacetly chicken gammaglobulin (NP-CGG), recovery of humoral function was evaluated through germinal center formation and antigen-specific responses. To efficiently transduce CD3⁺ cells from patients, we generated an equivalent lentiviral SAP vector. Functional recovery was demonstrated by using in vitro cytotoxicity and T follicular helper cell function assays alongside tumor clearance in an in vivo lymphoblastoid cell line lymphoma xenograft model.ResultsIn Sap-deficient mice 20% to 40% engraftment of gene-modified T cells led to significant recovery of germinal center formation and NP-specific antibody responses. Gene-corrected T cells from patients demonstrated improved cytotoxicity and T follicular helper cell function in vitro. Adoptive transfer of gene-corrected cytotoxic T lymphocytes from patients reduced tumor burden to a level comparable with that seen in healthy donor cytotoxic T lymphocytes in an in vivo lymphoma model.ConclusionsThese data demonstrate that autologous T-cell gene therapy corrects SAP-dependent defects and might offer an alternative therapeutic option for patients with X-linked lymphoproliferative disease 1.



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The Editors' Choice

Publication date: July 2018
Source:Journal of Allergy and Clinical Immunology, Volume 142, Issue 1
Author(s): Zuhair K. Ballas




https://ift.tt/2KvjRHt

News Beyond Our Pages

Publication date: July 2018
Source:Journal of Allergy and Clinical Immunology, Volume 142, Issue 1
Author(s): Marc E. Rothenberg, Jean Bousquet




https://ift.tt/2MKEsUV

Hypoallergenic casein hydrolysate for peptide-based oral immunotherapy in cow's milk allergy

Publication date: July 2018
Source:Journal of Allergy and Clinical Immunology, Volume 142, Issue 1
Author(s): Hiroshi M. Ueno, Teruhiko Kato, Hidenori Ohnishi, Norio Kawamoto, Zenichiro Kato, Hideo Kaneko, Naomi Kondo, Taku Nakano




https://ift.tt/2KMmT9O

Specific IgG4 antibodies to cow's milk proteins in pediatric patients with eosinophilic esophagitis

Publication date: July 2018
Source:Journal of Allergy and Clinical Immunology, Volume 142, Issue 1
Author(s): Alexander J. Schuyler, Jeffrey M. Wilson, Anubha Tripathi, Scott P. Commins, Princess U. Ogbogu, Patrice G. Kruzsewski, Barrett H. Barnes, Emily C. McGowan, Lisa J. Workman, Jonas Lidholm, Sheryl L. Rifas-Shiman, Emily Oken, Diane R. Gold, Thomas A.E. Platts-Mills, Elizabeth A. Erwin
BackgroundAllergen-specific IgG4 (sIgG4) antibodies are often associated with tolerance, but sIgG4 antibodies to causally relevant foods have been reported recently in adults with eosinophilic esophagitis (EoE). Prevalence and levels of food sIgG4 are not well established in the general pediatric population.ObjectiveWe sought to investigate serum food sIgG4 with component diagnostics in children with EoE and children from an unselected birth cohort and to explore the effects of sex, age, and milk consumption on sIgG4 levels.MethodsSera from 71 pediatric patients with EoE and 210 early adolescent children from an unselected birth cohort (Project Viva) were assayed for sIgG4 and specific IgE (sIgE) to major cow's milk (CM) proteins (α-lactalbumin, β-lactoglobulin, and caseins) and to wheat, soy, egg, and peanut proteins.ResultsIn the EoE cohort high-titer sIgG4 (≥10 μg/mL) to CM proteins was more common than in control sera and achieved odds ratios for EoE ranging from 5.5 to 8.4. sIgE levels to CM proteins were mostly 4 IU/mL or less in patients with EoE, such that sIgG4/sIgE ratios were often 10,000 or greater. When adjusted for age and milk consumption, high-titer sIgG4 to CM proteins was strongly associated with EoE, with an odds ratio of greater than 20 to all 3 CM proteins in boys.ConclusionssIgG4 to CM proteins are common and high titer in children with EoE. Although it is not clear that this response is pathogenic, sIgG4 levels imply that these antibodies are an important feature of the local immune response that gives rise to EoE.

Graphical abstract

https://ift.tt/2MKKEwh

Surgical Techniques for the Management Submandibular Salivary Duct Strictures

Publication date: Available online 2 July 2018
Source:Atlas of the Oral and Maxillofacial Surgery Clinics
Author(s): Justine Moe, Joseph I. Helman




https://ift.tt/2NpgOhE

Robot-Assisted Glandular Surgery

Publication date: Available online 2 July 2018
Source:Atlas of the Oral and Maxillofacial Surgery Clinics
Author(s): Mark F. Marzouk




https://ift.tt/2KK38fC

Combined Surgical Approaches for the Removal of Submandibular Gland Sialoliths

Publication date: Available online 2 July 2018
Source:Atlas of the Oral and Maxillofacial Surgery Clinics
Author(s): Michael D. Turner




https://ift.tt/2NnZV7g

The Mucosal Scarring Index: reliability of a new composite index for assessing scarring following oral surgery

Abstract

Objectives

A critical and uniform assessment of mucosal scarring following oral surgery is needed to refine surgical decision-making. For that purpose, the Mucosal Scarring Index (MSI) was developed.

Materials and methods

The MSI is a composite index based on five parameters: width, height/contour, color, suture marks, and overall appearance. Each parameter is assessed with a 0–1–2 score, yielding a MSI score ranging from 0 (no scar) to 10 (most extreme scar). Five periodontists, 5 prosthodontists, and 5 orthodontists assessed scarring using the new index on the basis of 30 clinical photographs of post-surgical sites. Cases had been carefully selected making sure that the complete spectrum of the index would be represented in the analysis. Duplicate evaluation was performed with a 2-h interval and in random order of cases.

Results

On a total of 450 assessments, the mean MSI amounted to 4.91 (SD 3.087) with no significant differences between scores given by periodontists (mean 4.65; SD 3.054), orthodontists (mean 5.04; SD 3.301), or prosthodontists (mean 4.81; SD 2.842) (p = 0.548). The MSI appeared a highly reliable index given excellent inter- as well as intra-examiner agreement (ICC > 0.9; p < 0.001). Clinicians agreed most on 'overall appearance' (kappa = 0.582; p < 0.001) and least on 'suture marks' (kappa = 0.352; p < 0.001).

Conclusion

The MSI is an effective, easy-to-use, and reliable composite index to assess mucosal scarring following oral surgical procedures.

Clinical relevance

The MSI can be used as an adjunct to other indices in the esthetic evaluation of oral surgical procedures.

https://ift.tt/2KJNFiM

Knowledge of final-year medical students about oral and maxillofacial surgery: a two-centre study

Publication date: Available online 3 July 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): S. Hamid, B. McNeillis, N. Saeed
The aim of this study was to assess the exposure of final-year medical students to oral and maxillofacial surgery (OMFS) and to find out how this has influenced them in terms of recruitment or possible future referral patterns. We sent questionnaires to final-year students at Oxford University and St George's University medical schools (n=100 in each) to find out how much experience they had had of the specialty, their knowledge of disease (through clinical situations), and specific knowledge about oral cancer. In both, exposure to, and knowledge about, OMFS were poor, and patients had been referred inappropriately to ear, nose, and throat (ENT) or plastic surgery. Despite targeted teaching in OMFS at both institutions, further engagement is needed, and awareness of the specialty may need to be improved at all medical schools.



https://ift.tt/2MHTrz2

Efficacy of buccal infiltration anaesthesia with articaine for extraction of mandibular molars: a clinical trial

Publication date: Available online 3 July 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): F. Rayati, A. Noruziha, R. Jabbarian
It is hard to provide adequate anaesthesia by infiltration of lidocaine into the mandible because of the thick buccal cortex. An inferior alveolar nerve block is often used but has a high failure rate, which has led research workers to look for an anaesthetic agent that will anaesthetise the lower teeth by buccal infiltration alone. We have assessed the efficacy of buccal infiltration anaesthesia with articaine by designing a double-blind controlled clinical trial in 133 patients who required extraction of mandibular molars. They were randomly divided into two groups and given infiltration anaesthesia with either 4% articaine or 2% lidocaine by a single injection deep into the mucobuccal fold at the site of the tooth. After five minutes the mesial, distal, buccal, and lingual sides of the tooth were probed. Pain at this time or later during dissection of soft tissue by periosteal elevator was considered as failure, and an inferior alveolar nerve block was given. The amount of pain, and the number of patients who developed pain, were significantly greater in the group given 2% lidocaine (p<0.001). The two groups did not differ significantly in age or sex. Articaine is more successful in providing adequate depth of anaesthesia, but its efficacy was not sufficient to replace an inferior alveolar nerve block for extraction of mandibular molars (Registration code: IRCT2016062627111N2).



https://ift.tt/2KG0aw0

A Trial Evaluating the Addition of Nivolumab to Cisplatin-RT for Treatment of Cancers of the Head and Neck

Condition:   Squamous Cell Carcinoma of Head and Neck
Interventions:   Drug: Cisplatin;   Drug: Nivolumab;   Radiation: RT
Sponsors:   Groupe Oncologie Radiotherapie Tete et Cou;   Bristol-Myers Squibb
Not yet recruiting

https://ift.tt/2MHqwem

Dual-Time Point (DTP) FDG PET CT for the Post-Treatment Assessment of Head and Neck Tumors Following Definitive Chemoradiation Therapy

Conditions:   Malignant Neoplasms of Ill-defined Secondary and Unspecified Sites;   Head and Neck Primary Squamous Cell Carcinoma
Interventions:   Drug: FDG;   Procedure: PET/CT Scan;   Procedure: FDG PET/CT Scan
Sponsor:   M.D. Anderson Cancer Center
Recruiting

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Radiographic Imaging Does Not Reliably Predict Macroscopic Extranodal Extension in Human Papilloma Virus-Associated Oropharyngeal Cancer

Background: Radiographic concern for lymphatic extranodal extension (ENE) impacts upfront management decisions for patients with human papilloma virus (HPV) oropharyngeal squamous cell carcinoma (OPSCC). Therefore, we set out to evaluate the accuracy of preoperative contrast-enhanced computed tomography (CECT) to predict major ENE (#x3e; 2 mm). Methods: Twenty-seven consecutive patients with HPV-associated OPSCC who presented at our institutional multidisciplinary tumor board were staged radiographically with positron emission tomography (PET/CT) and CECT, and underwent primary transoral robotic resection and neck dissection. CECT imaging results were correlated with pathologic ENE (pENE). Results: CECT specificity for all pENE was 69 and 75% for radiologist 1 and 2, respectively. For pENE #x3e; 2 mm, the sensitivities were 88 and 100%, but specificities were 52.6 and 63.2%. Positive predictive values (PPV) were 43.8 and 53.3%; negative predictive values were 90.9 and 100%. On logistic regression analysis, only size ≥3 cm (OR 4.7–5.4, p #x3c; 0.02, 95% CI 1.3–44.0) demonstrated significant correlation with major ENE #x3e; 2 mm. Conclusions: Preoperative imaging for HPV-associated OPSCC had a PPV for pENE #x3e; 2 mm of 44–55%, based on any interruption in the capsule or invasion into the perinodal fat. The PPV is low and equipoise in treatment decision making for patients with HPV-associated OPSCC may require other imaging characteristics.
ORL 2018;80:85–95

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An Unusual Presentation of Kawasaki Disease: Gallbladder Hydrops and Acute Cholestatic Hepatitis

Kawasaki disease is the most common vasculitis of childhood. In its classical form, at least four of five diagnostic criteria including cervical lymphadenopathy (1.5 cm or more), nonsuppurative conjunctivitis, intraoral mucosal changes, edema in hands and feet, and maculopapular rash are required with prolonged fever over 5 days. Atypical cases which are different from the classical type or incomplete cases which does not include all the diagnostic criteria can be seen. The typical Kawasaki disease is a self-limiting disease with fever lasting for an average of two weeks. In such patients who have not been diagnosed and whose treatment has been delayed, coronary artery aneurysm, myocardial depression, arrhythmia, and vascular complications may increase morbidity and mortality. We would like to present a rare case of an atypical patient with gallbladder hydrops and acute cholestatic hepatitis.

https://ift.tt/2Nj59RE

A review of pediatric middle ear tumors and analysis of the demographics, management, and survival of pediatric rhabdomyosarcomas of the middle ear

Publication date: September 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 112
Author(s): Tyler A. Janz, P. Ryan Camilon, Anthony Y. Cheung, Shaun A. Nguyen, David R. White, Peter C. Weber
ObjectiveTo examine the types of pediatric middle ear tumors and review the demographics, management, and survival of pediatric patients with rhabdomyosarcoma (RMS) of the middle ear.MethodsPediatric patients in the Surveillance, Epidemiology, and End Results (SEER) database were included from 1973 to 2014 based on a diagnosis of middle ear tumors using the ICD O-3 code: C30.1: Middle ear primary site. Patients were included from ages 0–18 years.ResultsForty pediatric middle ear tumor cases were identified. Twenty patients were female (50%). Twenty-seven (67.5%) cases were rhabdomyosarcomas (RMS). Pediatric RMS patients tended to be diagnosed in early childhood (mean age 5.30 years, standard deviation 2.9, range 1.00–13.00, 59.3% of patients were ages 5 or below). Most pediatric RMS patients received chemotherapy and radiation therapy as part of the treatment regimen (88.8%). Finally, the 5-year overall and disease-specific survival rates were 59% and 63% respectively.ConclusionsPediatric middle ear tumors are rare. Females and male pediatric patients are both at risk for middle ear tumors. RMS is the most common malignant middle ear tumor affecting pediatric patients. Despite the use of multimodality therapies, survival rates for pediatric patients with RMS of the middle ear are low. Physicians may consider including middle ear tumors on the differential diagnosis for pediatric patients with symptoms presenting similarly to non-resolving otitis media.



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The child doesn't hear? On breaking bad news as perceived by parents and audiologists

Publication date: September 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 112
Author(s): Miriam Geal-Dor, Cahtia Adelman
ObjectiveThe object of this study was to explore how parents experienced receiving the news of their child's hearing loss, and how audiologists experienced the situation of conveying the diagnosis, in order to examine improvements to the current process.MethodA questionnaire regarding different aspects of breaking the news was developed. 48 Arabic and Hebrew speaking parents of hearing impaired children answered the questionnaire. A similar questionnaire was filled out by 31 audiologists.ResultsFindings demonstrate parents' general satisfaction with the manner in which the diagnosis was delivered.According to the parents' reports, receiving the diagnosis evoked negative feelings of fear, depression and difficulty believing the diagnosis. Parents' feelings were influenced by their cultural background, such as their ethnic identity, religious practice and difficulties due to language barriers.The audiologists described concern and anxiety when breaking bad news, but they felt they were able to present the diagnosis. The audiologists felt that they were not trained in this aspect, and the ability was acquired through experience.Both parents and audiologists agreed that the audiologist should be the professional to deliver the diagnosis. All emphasized sensitivity and professionalism as necessary qualities. Whereas audiologists were of the opinion that the most important information to transmit was the type of hearing loss, the parents were most interested in discussing their feelings, the rehabilitation process, and talking to other parents.ConclusionsOverall, results reveal that breaking bad news of a child's hearing loss has been done fairly well. Due to the parents' reports of the need for emotional support, it is suggested that audiologists receive further training and adjust to personal and cultural differences. Recommendations include establishing an appropriate setting and ensuring that an interpreter is available when necessary. Further emotional support may be provided through establishment of a family support network.



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Pediatric case of squamous cell carcinoma arising from a keratocystic odontogenic tumor

Publication date: September 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 112
Author(s): Lara Nokovitch, Anne-Gaelle Bodard, Nadège Corradini, Carole Crozes, Aurélie Guyennon, Sophie Deneuve
Keratocystic odontogenic tumors (KCOT) are exceptional in children and adolescents as they usually occur in the third decade. The present study reports the case of a 15 years old girl who was diagnosed with a KCOT that underwent malignant transformation. KCOT diagnostic was based on clinical, radiological, histopathological and immunohistochemical findings. A conservative treatment by enucleation was performed. Histopathological analysis of the surgical specimen concluded to a KCOT, with an infra-centimetric focus of well-differentiated squamous cell carcinoma. Owing to the well-differentiated character of the squamous cell carcinoma, a single clinical and MRI surveillance every 3 months was decided, without complementary treatment.



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Training Groups

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Editorial Board

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The inflammatory pseudotumor presenting periodic acid-Schiff-positive inclusions with acute unilateral facial nerve palsy

Although most acute peripheral facial palsies can be attributed to Bell's palsy, other factors, such as infection, trauma, and neoplasm, can cause facial palsy as well. Among these, facial nerve tumors are rare but should be considered in the differential diagnosis of facial palsy. Palsies due to facial nerve tumors usually present with slow onset but occasionally present as acute episodes. In such cases, facial nerve decompression is the treatment of choice to allow the tumor room to grow without compressing the nerve or its blood supply.

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The prevalence of vestibular schwannoma among patients treated as sudden sensorineural hearing loss

To assess the prevalence of vestibular schwannoma (VS) in patients with sudden sensorineural hearing loss (SSNHL).

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Idiopathic benign paroxysmal positional vertigo with persistent vertigo/dizziness sensation is associated with latent canal paresis, endolymphatic hydrops, and osteoporosis

The aim of the present study was to examine the association of neuro-otological examination, blood test, and scoring questionnaire data with treatment-resistant intractability in idiopathic benign paroxysmal positional vertigo (BPPV) patients.

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Immunotherapy with cancer peptides in combination with intravesical bacillus Calmette–Guerin for patients with non-muscle invasive bladder cancer

Abstract

Purpose

A phase I study using two peptide vaccines derived from M phase phosphoprotein 1 (MPHOSPH1) and DEP domain containing 1 (DEPDC1) demonstrated promising results for the treatment of advanced bladder cancer. Therefore, we further tested the ability of these peptides to prevent recurrence after transurethral resection of the bladder tumor in patients with non-muscle invasive bladder cancer (NMIBC).

Materials and methods

127 patients were enrolled in a multicenter, non-randomized phase II clinical trial. The primary endpoint was recurrence-free survival (RFS) rate, and secondary endpoints were safety and immunological response. HLA-A24-restricted peptides were subcutaneously administered in addition to intravesical BCG therapy. The exploratory endpoint evaluated differences of RFS rate between HLA-A*2402-positive (A24(+)) and -negative (A24(−)) groups.

Results

A 2-year RFS rate in all patients was 74.0%. The RFS rate in the A24(+) group (n = 75) and in the A24(−) group (n = 52) were 76.0 and 71.2%, respectively. This vaccine therapy was well-tolerated and feasible. MPHOSPH1 and DEPDC1 peptide-specific cytotoxic T lymphocyte responses were observed in 75.8 and 77.5% of the A24(+) group, respectively. Patients having both peptide-specific CTL responses showed significantly better RFS than patients without CTL response (P = 0.014). In the A24(+) group, patients who had positive reaction at the injection sites (RAI) had significantly lower rates of recurrence than RAI-negative patients (P = 0.0019).

Conclusions

Cancer peptide vaccines in combination with intravesical BCG therapy demonstrated good immunogenicity and safety, and may provide benefit for preventing recurrence of NMIBC.

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Zn-containing polymer nanogels promote cervical dentin remineralization

Abstract

Objective

Nanogels designing for effective treatment of eroded cervical dentin lesions.

Materials and methods

Polymethylmetacrylate-based nanoparticles (NPs) were doxycycline (D), calcium, or zinc loaded. They were applied on eroded cervical dentin. Treated surfaces were characterized morphologically by atomic force and scanning electron microscopy, mechanically probed by a nanoindenter to test nanohardness and Young's modulus, and chemically analyzed by Raman spectroscopy at 24 h and 7 days of storage. Data were submitted to ANOVA and Student-Newman-Keuls multiple comparisons tests.

Results

Dentin treated with Zn-NPs attained the highest nanomechanical properties, mineralization, and crystallinity among groups. Nanoroughness was lower in Zn-treated surfaces in comparison to dentin treated with undoped gels. Dentin treated with Ca-NPs created the minimal calcification at the surface and showed the lowest Young's modulus at peritubular dentin. Intertubular dentin appeared remineralized. Dentinal tubules were empty in samples treated with D-NPs, partially occluded in cervical dentin treated with undoped NPs and Ca-NPs, and mineral covered when specimens were treated with Zn-NPs.

Conclusions

Zn-loaded NPs permit functional remineralization of eroded cervical dentin. Based on the tested nanomechanical and chemical properties, Zn-based nanogels are suitable for dentin remineralization.

Clinical relevance

The ability of zinc-loaded nanogels to promote dentin mineralization may offer new strategies for regeneration of eroded cervical dentin and effective treatment of dentin hypersensitivity.

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Patient-specific sub-periosteal zygoma implant for prosthetic rehabilitation of large maxillary defects after oncological resection

A 74-year-old woman needed a subtotal bilateral maxillectomy due to squamous cell carcinoma of the palate. Immediate and secondary reconstruction of the defect was not feasible, so the defect was closed with an obturator prosthesis wired to the zygoma complex. To improve the patient's severely impaired speech and swallowing, a patient-specific sub-periosteal implant (psSPI) was designed that matched the remnants of the zygoma complex. First, the patient's post-surgical anatomy was visualized through segmentation of the pre- and post-maxillectomy computed tomography data.

https://ift.tt/2KAtcNB

Synchronous MALT lymphoma of the colon and stomach and regression after eradication of Strongyloides stercoralis and Helicobacter pylori

Mucosa-associated lymphoid tissue (MALT) is vital for host immunological surveillance against pathogens. MALT lymphoma, also known as extranodal marginal zone B cell lymphoma, is a non-Hodgkin's lymphoma subtype that predominantly arises in the gastrointestinal tract. Chronic Helicobacter pylori (H. pylori) infection is a common cause of gastric MALT lymphoma, although other infections are reported in association with extragastric MALT lymphomas. To our knowledge, here we report the first case of synchronous MALT lymphomas of the colon and stomach in the presence of Strongyloides stercoralis and H. pylori infections that resolved after eradication of both organisms.

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A case of deadly panniculitis

While the majority of panniculitides are benign in nature, there are rare instances when panniculitis presents as the initial sign of a complex disease state. We describe a case of panniculitis initially diagnosed as lupus profundus that was challenged when features of haemophagocytic lymphohistiocytosis became apparent. We illustrate how some key clinical features and newer investigations can help differentiate between benign and malignant panniculitis.

https://ift.tt/2KqJGZ7

Mesonephric adenocarcinoma of the vagina masquerading as a suburethral cyst

Mesonephric adenocarcinoma (MA) of the vagina is an extremely rare tumour of the female genital tract. There are currently 22 reported cases in the published literature. Consequently, its pathophysiology and disease progression remain poorly understood.

A 63-year-old woman presented with a history of a swelling in her vagina. Two-dimensional pelvic floor ultrasound and MRI demonstrated a multiloculated cyst with no malignant features. Initial workup provided a working diagnosis of a suburethral cyst. The diagnosis of MA was made on histology after excision of the cyst. Subsequent postoperative investigation showed no spread of the disease. The patient completed a course of prophylactic brachytherapy to prevent the possibility of any recurrence of disease. Due to its rarity, it remains difficult to diagnose MA of the vagina even on histological analysis. We would therefore recommend a low threshold to excise or perform tissue biopsy of unspecified vaginal masses.

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Unexpected cause of fever in a patient with untreated HIV

We report a case of a 27-year-old man with a history of untreated HIV who presented with fever, rash and leg cramps. Initial suspicion was high for an infectious process; however, after an exhaustive evaluation, thyrotoxicosis was revealed as the aetiology of his symptoms. Recent intravenous contrast administration complicated his workup to determine the exact cause of hyperthyroidism. Differentiation between spontaneously resolving thyroiditis and autonomous hyperfunction was paramount in the setting of existing neutropenia and the need for judicious use of antithyroid therapy. The inability to enlist a nuclear scan in the setting of recent iodinated contrast administration prompted alternative testing, including thyroid antibodies and thyroid ultrasound. In this case, we will discuss the diagnostic challenges of thyrotoxicosis in a complex patient, the sequelae of iodine contrast administration, effects of iodine on the thyroid and the predictive value of other available tests.

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Undiagnosed Chilaiditi syndrome presenting with pericarditis in a patient with congenital anomalies

Description

A 19-year-old male patient presented to the emergency room with dyspnoea and severe retrosternal chest pain. The patient's medical history is significant for cerebral palsy with spastic tetraplegia. He layed in a semirecumbent position as pain was severe on lying down. The pain radiated to the back, neck and shoulder. Pain was associated with gastro-oesophageal reflux disease and dysuria. On examination, he was breathless, and lungs were clear to auscultation. On auscultating over the heart, pericardial rub was heard. Abdomen was tender on palpation and he did not defecate for 2 days. He had a history of recurrent pneumonia that needed frequent hospital admissions and currently receiving treatment as the last episode was 1 month ago.

ECG showed widespread concave ST elevation and PR depression with reverse changes in aVR of ST depression and PR elevation with sinus tachycardia suggesting early stage of pericarditis. Sputum culture was negative. Chest X-ray was done...

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A case of suspected illegal abortion: how clinicians may assist the forensic pathologist

Abortion may be performed in a safe or unsafe manner, the latter being a frequent and dangerous event. It can also be performed in countries where abortion is legally recognised but, for various reasons, may be undertaken in an illegal environment. We present a case of a possible illegal abortion. A woman presented to the hospital with a dead fetus, saying that she was the victim of a car accident. Forensic and gynaecological examination of the woman were carried out, along with an autopsy of the fetus. It was discovered that the woman had performed a clandestine abortion. The differential diagnosis between illegal abortion and miscarriage represents a complicated issue and requires both clinical and forensic support. The gynaecologist may be of assistance to the forensic pathologist in confirming whether an illegal abortion has been performed.

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Photobiomodulation therapy reduces viral load and cell death in ZIKV-infected glioblastoma cell line

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Cochlear implantation in children with CHARGE syndrome: a report of eight cases

Abstract

Objective

To report neuroradiologic findings, surgical strategies and clinical and audiological results in a series of children with CHARGE syndrome (CS) who had been evaluated for cochlear implantation (CI).

Study design

Retrospective case series.

Setting

Tertiary referral university hospital.

Patients

Eight profoundly deafened children with CS were included. Routine audiometric measurements, speech perception categories and speech intelligibility ratings were performed pre- and post-operatively. Neuroradiological and intraoperative findings, surgical planning, and post-operative complications were analyzed.

Results

Six children were profoundly deaf from birth and 2 had progressive hearing loss to profound levels. Cochlear nerve deficiency (CND) was noted in 5 out of the 6 patients with congenital sensorineural hearing loss (SNHL). Seven children underwent CI. Surgery was performed using standard transmastoid facial recess approach in 3 ears, subtotal petrosectomy in 3, and transmastoid single-slit labyrinthotomy in one. Temporary facial palsy occurred in one patient. In the group of patients with congenital SNHL, 2 children benefitted from CI and developed spoken language; the remaining 3 children obtained improved access to environmental sounds and used signs and gestures as their main mode of communication. The two patients with progressive SNHL had preoperative verbal language and continued to use verbal language after CI.

Conclusions

The constant presence of temporal bone anomalies in children with CS requires surgical expertise in performing non-standard approaches for safe and effective CI. Patients with progressive SNHL and normal cochlear nerves had satisfactory results with CI. Limited benefits have been observed in presence of CND.

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Small bowel gastrointestinal stromal tumor disguised as an adnexal mass: a source for midgut volvulus

Abstract

Background: The abdominal cavity has an infinite number of potential pathologies and gynecologic pathology is often intertwined with intestinal disease. Case presentation: A 74-year-old female believed to have an adnexal mass on prior imaging presented with small bowel obstruction, which failed to resolve with non-operative management. Given her suspected adnexal mass, multidisciplinary operative intervention was arranged. She was found to have a large, extraluminal mass on her small intestines; serving as the lead point for her midgut volvulus and resultant small bowel obstruction. Conclusion: Physical exam and radiographic discordance should prompt consideration of alternative diagnoses. Making the appropriate initial diagnosis is key in correct patient management; however, this is not always possible and appropriate pre-operative planning should be arranged for best patient outcomes.

https://ift.tt/2MI9gWk

Parasitic leiomyoma of the greater omentum presenting as small bowel obstruction

Abstract

Parasitic leiomyomas (PL) are rare intra-abdominal tumors usually found in young women and are considered a type of uterine leiomyomas. They are usually reported in women who underwent laparoscopic morcellation of fibroids and frequently present with symptoms such as abdominal pain and distention. Treatment usually involves en bloc removal of the mass after dividing its blood supply from the host organ. In this case report, we describe the case of a middle-aged female who developed high-grade small bowel obstruction due to compression from a large PL with blood supply from the greater omentum. The patient underwent operative resection of the PL and subsequently fared very well. Meticulous attention to blood supply and attachments of PL to host organs is necessary for safe resection.

https://ift.tt/2KuMHI4

Gallbladder duplication and cholecystitis

Abstract

Cholecystitis is a common gallbladder pathology characterized by abdominal pain, positive Murphy sign and elevated white blood count. Abdominal ultrasound usually gives a definite diagnosis. Duplication of the gallbladder is a rare congenital anomaly that can either be asymptomatic or and can present with symptoms associated with cholelithiasis, cholecystitis, cholangitis or pancreatitis. Clinically indistinguishable from regular gallbladder pathologies. The management of duplicated gallbladder is similar to that of other gallbladder diseases, if one or both gallbladders cause symptoms, cholecystectomy should be done for both gallbladders. We present a case of a 50-year-old female patient, she presented to the emergency room with abdominal pain and tenderness. Ultrasound detected a gallbladder duplication with cholecystitis in one of them and magnetic resonance cholangiopancreatography confirmed this diagnosis. Surgery was decided and the patient underwent full recovery. Y-shaped gallbladder duplication with cholecystitis due to cholelithiasis in one of them was the final diagnosis.

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Thalamic germinoma: a challenging diagnosis, case report and literature review

Abstract

The thalamus and basal ganglia are unusual locations for an intracranial germ cell tumors. We are reporting a rare case of thalamic germinoma in an 18-year-old male. Challenging presentation, radiological appearance and pathological finding after surgical intervention delayed the diagnosis and treatment. Also, we are providing an extensive literature review. Diagnosis of thalamic germinoma is challenging because of non-specific symptoms, rare location and inconclusive radiological findings. An early tissue diagnosis associated with good outcome.

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Intussusception secondary to descending colon lipoma presenting with simultaneous acute appendicitis

Abstract

We report a patient with a descending colon lipoma presenting with hematochezia who developed intussusception, which was simultaneously accompanied by acute appendicitis. A 43-year-old man presented with hematochezia. Colonoscopy revealed a submucosal tumor with a reddish surface in the descending colon. A solid mass with fat density value measuring 5 cm in diameter was observed in the descending colon on CT. While awaiting elective resection, the patient developed lower abdominal pain. CT demonstrated antegrade colo-colonic intussusception in the descending colon. Simultaneously, the appendix was inflamed with a high density intraluminal lesion suspected to be a fecalith. The diagnosis of simultaneous intussusception and acute appendicitis was made. Appendectomy and partial resection of the descending colon was performed. Histopathological examination was consistent with descending colon lipoma and acute appendicitis. The mechanism for developing hematochezia and the risk for development of colo-colonic intussusception due to large colon lipoma and acute appendicitis were highlighted.

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Appendicular schwannoma presenting as vague abdominal pain

Abstract

Appendicular schwannomas are very rare condition with nonspecific clinical symptoms and frequently recognized during pathological examination. They arise less frequently in the gastrointestinal tract and comprise ~1% of all malignant gastrointestinal tumours. We presented a rare case of an appendicular schwannoma that was discovered incidentally in a 25-year-old student diagnosed with appendicular mucocoele with a suspected obstructing tumoural lesion based on computed tomography findings. A colonoscopy examination showed a bulging, nodular, erythematous lesion at the base of the caecum (appendiceal orifice). Biopsies showed mixed inflammatory infiltration in the lamina propria, with lymphoid-filled formations. No evidence of dysplasia or neoplasia. Tumour markers were negative. Appendicular neoplasms, such as schwannomas of the appendix, are rarely associated with nonspecific clinical symptoms and are frequently recognized during pathological examination of the resected appendix. Laparoscopic surgery with a clear resection margin is the cornerstone of treatment for appendicular schwannoma, and it is associated with a favourable prognosis.

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Multidisciplinary management of complicated bilateral renal artery aneurysm in a woman of childbearing age

Abstract

Ruptured renal artery aneurysm (RAA) during pregnancy is a rare condition associated with high mortality rates to both the mother and the foetus. We report on a 41-year-old woman at her second trimester who presented with shock to the emergency department as a result of a ruptured left RAA. While the bleeding was successfully treated with angiographic embolization, a contralateral RAA, also at risk of rupture, was discovered. Due to its position on the artery bifurcation, this lesion was considered not suitable for interventional radiology and was therefore managed by hand-assisted retroperitoneoscopic nephrectomy, ex-vivo repair and autotransplantation. This was done in order to preserve renal mass and give our patient a chance of having future pregnancies without risk of rupture. Three years later, her renal function is normal, there is no evidence of recurrence, and more importantly she had two successful and uncomplicated pregnancies.

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Small bowel obstruction as a result of an obturator hernia: a rare cause and a challenging diagnosis

Abstract

Obturator hernias are exceedingly rare in surgical routine, constituting 0.073% of all intra-abdominal hernias in the West and 1% in the far East. Commonly known as 'little old lady's hernia', obturator hernias are usually seen in frail, octogenarian multiparous women. This case report discusses an 85-year-old female who had symptoms of acute bowel obstruction; thanks to high degree of clinical suspicion and aided by a computed tomography (CT) of abdomen and pelvis, an incarcerated right obturator hernia was diagnosed preoperatively and treated successfully. Obturator hernia is a rare condition associated with a high rate of morbidity and mortality. CT scan is the most accurate imaging method for pre-operative diagnosis. Early diagnosis and surgical intervention are fundamentals to lead to better outcomes for the patients.

https://ift.tt/2KEx1kQ

Prolapsed fundic gastric polyp causing gastroduodenal intussusception and acute pancreatitis

Abstract

An 86-year-old female presented with a 6-month history of recurrent intermittent epigastric abdominal pain, postprandial fullness with nausea, vomiting, anemia and a 15-pound weight loss. A large fundic gastric polyp was intussuscepting into the duodenum causing intermittent compression and obstruction of the ampulla of Vater leading to acute pancreatitis. An overview of the clinical presentation, diagnosis and management of this entity, in addition to a review of the literature is provided.

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Recurrent FPIES to wheat after multiple tolerant exposures in a male infant

Publication date: Available online 3 July 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Lisa Martorano, Benjamin T. Prince, Irene Mikhail




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Thoraco-esophageal fistula during percutaneous tracheostomy

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