Pneumoperitoneum poses an important diagnostic sign determining the urgency of management of patients in an emergency department. Chilaiditi sign is a rare radiologic finding of large intestines transposition ...
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Σάββατο 15 Σεπτεμβρίου 2018
Chilaiditi syndrome – a rare case of pneumoperitoneum in the emergency department: a case report
Mutational and copy number asset of primary sporadic neuroendocrine tumors of the small intestine
Abstract
Small intestine neuroendocrine tumors (SI-NETs) represent the most common histotype among small intestine neoplasms, and metastatic disease is usually present at diagnosis. A retrospective series of 52 sporadic primary surgically resected SI-NETs, which were metastatic at diagnosis, was analyzed by high-coverage target sequencing (HCTS) for the mutational status of 57 genes and copy number status of 40 genes selected from recently published genome sequencing data. Seven genes were found to be recurrently mutated: CDKN1B (9.6%), APC and CDKN2C (each 7.7%), BRAF, KRAS, PIK3CA, and TP53 (each 3.8%). Copy number analysis showed frequent allelic loss of 4 genes located on chromosome 18 (BCL2, CDH19, DCC, and SMAD4) in 23/52 (44.2%) and losses on chromosomes 11 (38%) and 16 (15%). Other recurrent copy number variations were gains for genes located on chromosomes 4 (31%), 5 (27%), 14 (36%), and 20 (20%). Univariate survival analysis showed that SRC gene copy number gains were associated with a poorer prognosis (p = 0.047). Recurrent copy number variations are important events in SI-NET and SRC may represent a novel prognostic biomarker for this tumor type.
https://ift.tt/2xcIwYu
Nodal Staging of High Risk Cutaneous Squamous Cell Carcinoma
Nodal metastasis for cutaneous squamous cell carcinoma occurs in 4-6% of patients and sentinel lymph node biopsy is positive in 29.4% of Brigham and Women's Hospital stage T2b tumors. Nodal staging may be considered with high-risk cutaneous tumors without palpable lymphadenopathy via imaging and, if negative, sentinel lymph node biopsy.
https://ift.tt/2xjm53p
Analysis of Dermatologic Procedures Billed Independently by Non-Physician Practitioners in the United States
This study showed that non-physician practitioners in dermatology are expanding their scope of practices to more complicated procedures with higher proportions in the East Coast, Midwest, and Mountain states. It is prudent to recognize limitations of their training and to set benchmarks for proper supervision and utilization of dermatologic procedures.
https://ift.tt/2xmuLWJ
Long-term outcomes of laser treatment for congenital melanocytic nevus
Various lasers have been applied for removal of surgically challenging CMNs. We evaluated the efficacy of lasers on CMN with a long-term follow-up period. Repigmentation of CMN after laser treatment occurs quite frequently and gradually, therefore more than 4 years of follow-up is recommended to evaluate the efficacy of lasers.
https://ift.tt/2NdpFqq
Comparison of extrusion and patency of silicon versus thermoplastic elastomer tympanostomy tubes
This study aimed to assess the differences in the extrusion rate, patency and incidence of otorrhea according to the material properties of tubes in tympanostomy tube (TT) procedures.
https://ift.tt/2xjcMR1
Facial Palsy: Diagnostic and Therapeutic Management
Facial expression is an evolutionary adaption facilitating successful social interaction. Muscles of facial expression are pivotal to nonverbal communication, articulation, and corneal protection. Facial palsy results in functional, communicative, and social impairment with profound negative impact on quality of life and emotional well-being. Congenital absence or acute facial nerve insult results in flaccid paralysis. Ultimate recovery following facial nerve insult lies on a spectrum from persistence of dense paralysis to return of normal function; in between zonal permutations of varying degrees of static and kinetic hypoactivity and hyperactivity and synkinesis exist.
https://ift.tt/2pbTeKF
You’re Never Fully Dressed Without a Smile
Whether we like it or not, judgments based on facial appearance play a powerful role in how we treat others and how we ourselves are treated. Psychologists have long known that attractive people achieve better outcomes in practically all walks of life. We have all heard, "You never get a second chance to make a first impression." What is striking is that the judgment during the first impression is made within 1/10th of one second.1
https://ift.tt/2CZ11oX
Describing the mandible in patients with craniofacial microsomia based on principal component analysis and thin plate spline video analysis
Craniofacial microsomia (CFM) is most often described as a unilateral malformation of derivatives of the first and second branchial arches. The mandible has been classified using several classification systems. However, all are based on two-dimensional imaging. The aim of this study was to mathematically describe the deformed mandible based on principal component analysis (PCA) in a three-dimensional way. This may aid in defining the flaws in existing surgical corrections of the mandible through the identification of the differences in shape compared with a normal mandible in a holistic view with the help of videos.
https://ift.tt/2QyUBzh
« Poussées inflammatoires d’acné » sous isotrétinoïne révélant une hidradénite suppurée : 4 cas
Publication date: Available online 14 September 2018
Source: Annales de Dermatologie et de Vénéréologie
Author(s): F. Poli, J. Revuz
Résumé
Introduction
L'isotrétinoïne est le plus puissant des traitements d'acné ; des réactions paradoxales d'aggravation peuvent être observées. Des lésions folliculaires parfois acnéiformes sont courantes au cours de l'hidradénite suppurée et peuvent être confondues avec une acné vraie. Nous rapportons les observations de quatre patients ayant subi une aggravation de leur éruption acnéiforme sous isotrétinoïne, révélant le diagnostic d'HS.
Observations
Quatre patients de sexe masculin, d'âge compris entre 15 et 28 ans, nous étaient adressés pour une aggravation importante d'acné sous isotrétinoïne. Trois d'entre eux avaient des manifestations cliniques inhabituelles au cours de l'acné : atteinte de la nuque (2), kystes épidermiques rétro-auriculaires (2), lésion cicatricielle en « corde » (1), large poche séropurulente du visage (1), cicatrices du dos de grande taille déprimées en U (3). L'interrogatoire révélait que ces trois patients avaient déjà eu des épisodes de nodules inflammatoires dans les aisselles ou les creux inguinaux ; ils ne l'avaient pas signalé spontanément du fait de leur caractère peu gênant. Le quatrième avait des lésions caractéristiques d'HS en localisation faciale considérées auparavant comme de l'acné : nodules, sinus, cicatrices en corde ; il avait en outre des kystes épidermiques du scrotum et une folliculite pubienne. Un traitement antibiotique adapté à l'HS a permis une régression des lésions chez les 4 patients.
Discussion
Une poussée d'« acné » sous isotrétinoïne doit faire rechercher des signes d'HS. La présence de manifestations inhabituelles telles une atteinte de la nuque, de larges cicatrices en U, des « cordes » doivent alerter ; des manifestations typiques de l'HS doivent être recherchées à l'interrogatoire car elles peuvent être passées sous silence.
Summary
Background
Isotretinoin is the most potent treatment for acne but paradoxical flares can occur. HS lesions of the face may be mistaken for acne. We report on 4 patients in whom an "acne" flare on isotretinoin led to the correct diagnosis of HS.
Patients and methods
Four young male patients aged 15 to 28 years were referred to us because of an acne flare on isotretinoin. Three of them had clinical features considered unusual in acne : involvement of the nape of the neck (2), retroauricular cysts (2), a rope-like pre-sternal lesion (1), a large bag-like sinus on the face (1), large deep depressed U-type scars on the back (3). Questioning revealed that all three had previously experienced several attacks of inflammatory nodules in the axillae and/or inguinal folds; they had not mentioned these lesions since they seemed so minor. The fourth patient had lesions typical of HS comprising nodules, sinus, rope-like hypertrophic scars on the face mistaken for acne, epidermal cysts on the scrotum and pubic folliculitis. Treatment with systemic antibiotics resulted in regression of lesions in all 4 patients.
Discussion
An acne flare on isotretinoin requires investigations with a view to potential diagnosis of HS. Patients presenting "acne" and atypical features such as involvement of the neck, large U scars and cord-like structures should be questioned about the presence of nodules in the axillae and groin since patients with mild HS may not spontaneously acknowledge such typical symptoms.
https://ift.tt/2NRPtrT
Immunothérapies par blocage des points de contrôle immunologique en oncodermatologie : une révolution permanente
Publication date: Available online 14 September 2018
Source: Annales de Dermatologie et de Vénéréologie
Author(s): O. Dereure
https://ift.tt/2xlJbX6
Traitement des hémangiomes infantiles au Togo
Publication date: Available online 14 September 2018
Source: Annales de Dermatologie et de Vénéréologie
Author(s): B. Saka, J. Téclessou, S. Akakpo, G. Mahamadou, A. Mouhari-Toure, W. Soga Gottara, K. Kombaté, K. Tchangai-Walla, P. Pitché
https://ift.tt/2NJMH7M
Neutrophilic urticarial dermatosis: A review
Publication date: Available online 14 September 2018
Source: Annales de Dermatologie et de Vénéréologie
Author(s): L. Gusdorf, D. Lipsker
Summary
Neutrophilic urticarial dermatosis (NUD) is a rare form of dermatosis. In clinical terms, it consists of a chronic or recurrent eruption comprising slightly elevated, pink to reddish plaques or macules. The elementary lesion lasts 24 to 48 hours and resolves without leaving any residual pigmentation. Extra-cutaneous signs are common, particularly fever or arthralgia. At histopathology, the dermis contains dense neutrophilic interstitial infiltrate with leukocytoclasis, but without fibrinoid necrosis of vessel walls. NUD often occurs in a setting of underlying systemic disease. The most commonly associated diseases are adult-onset Still's disease, Schnitzler syndrome, lupus erythematosus and cryopyrin-associated periodic syndromes. Treatment of NUD depends on the clinical context. Dapsone and colchicine are often effective.
Résumé
La dermatose neutrophilique urticarienne (DUN) est une dermatose rare. Cliniquement, il s'agit d'une éruption chronique ou récurrente, faite de macules ou de plaques discrètement surélevées, roses à rouges. La lésion élémentaire dure 24 à 48 heures et disparaît sans laisser de pigmentation résiduelle. Des signes extra-cutanés sont fréquents, en particulier de la fièvre ou des arthralgies. Histologiquement, le derme est le siège d'un infiltrat de polynucléaires neutrophiles denses, interstitiel avec de la leucocytoclasie mais sans nécrose fibrinoïde des parois vasculaires. La DUN survient fréquemment dans un contexte de maladie systémique sous-jacente. Les maladies les plus fréquemment associées sont la maladie de Still de l'adulte, le syndrome de Schnitzler, le lupus érythémateux et les syndromes périodiques associés à la cryopyrine. Le traitement de la DUN dépend du contexte clinique. La dapsone et la colchicine sont souvent efficaces.
https://ift.tt/2xlP46v
Comparison of temporalis fascia and tragal cartilage grafts in type 1 tympanoplasty in elderly patients
Publication date: Available online 14 September 2018
Source: Auris Nasus Larynx
Author(s): Ismail Guler, Deniz Baklaci, Ihsan Kuzucu, Rauf Oguzhan Kum, Muge Ozcan
Abstract
Objective
To investigate the success rates and hearing outcomes of temporalis fascia and tragal cartilage grafts used for type-1 tympanoplasty in the elderly (³65 years)
Methods
The medical records of 73 elderly patients who underwent type-1 tympanoplasty at our center between January 2010 and June 2017 were retrospectively reviewed for age, gender, perforation side, presence of contralateral perforation, type and location of perforation, graft material types, preoperative and postoperative hearing levels, and length of follow-up.
Results
The graft success rate was 83.5% (61 patients) for the entire group, 76.2% (32 patients) for the fascia group, and 93.5% (29 patients) for the cartilage group. The success rate for the cartilage group was significantly higher than that for the fascia group (P = 0.048). The mean hearing gain was 12.5 ± 7.6 and 8.9 ± 6.1 dB in the fascia and cartilage groups, respectively, and postoperative ABG was 10 dB or better in 29 (69.0%) and 19 (61.3%) patients, respectively. The mean hearing gain was significantly higher in the fascia group than in the cartilage group (P = 0.028), whereas the mean ABG was significantly higher in the cartilage group than in the fascia group (P = 0.009). The functional success rates were similar in both groups (P = 0.490).
Conclusion
Tympanoplasty is a safe and effective procedure in elderly patients with a 83.5% of graft success rate. Tragal cartilage may be the first choice of graft material due to its high success rates. The functional outcomes did not show significant differences between the fascia and cartilage groups.
https://ift.tt/2xeB9Ql
Chemotherapy in combination with stereotactic body radiation therapy (SBRT) for oligometastatic pancreatic cancer
Metastatic pancreatic cancer is characterised by poor prognosis. High toxicity of chemotherapy limits its use in elderly patients with severe comorbidities. Meanwhile, in metastatic disease, local treatment did not show the positive effect on life expectancy. We present a clinical case of a 72-year-old woman with metastatic pancreatic adenocarcinoma tumour, node, metastases (T3N0M1) (according to the seventh TNM classification of the International Union Against Cancer). Chemotherapy led to partial response, but later was stopped due to severe toxicity. Thereafter, consolidating radiosurgical treatment was performed. Dose to pancreatic and liver lesions was 35 Gy in five fractions. After 9 months, only one liver lesion and primary pancreatic tumour, stable in size were determined by MRI. At present time, the patient is alive and in good condition, the disease is stable 50 months after stereotactic body radiation therapy (SBRT). SBRT provides a high level of local control and in combination with systemic treatment can potentially increase survival.
https://ift.tt/2xjJ3qV
Continent cutaneous diversion pouch calculi
Description
A 62-year-old female patient who presented at our centre with dull aching right flank pain of 6 months duration. She had a history of radical cystectomy and cutaneous continent urinary diversion (Indiana pouch) done 20 years ago for muscle invasive urothelial carcinoma of urinary bladder. The patient followed up regularly since operation. However, for last 3 years, the patient was lost to follow-up. On further eliciting the history, she mentioned her inability to perform pouch irrigation and clean intermittent catheterisation regularly during this period.
On examination, a lump was palpable in the right lumbar region in the region of continent pouch. It was firm in consistency around 5x5 cm in size and did not move with respiration. There was no pain/tenderness on palpation. The stoma was healthy, flush to skin, functioning and easily catheterisable.
Her complete haemogram including renal function test and liver function test were normal. A plain abdominal X-ray revealed multiple...
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Rare case of meningococcal sepsis-induced testicular failure, primary hypothyroidism and hypoadrenalism: Is there a link?
Severe illness can lead to multiple transient endocrinopathies. In adult patients, neuroendocrine alterations include sick euthyroid syndrome, an increase in corticosteroid levels, increase in prolactin levels, decreased insulin growth factor 1 levels and hypogonadism. We report the case of a 24-year-old man with meningococcal sepsis with multiple end-organ complications who developed persistent non-autoimmune hypothyroidism, adrenal insufficiency and primary hypogonadism all requiring hormone replacement. While adrenal insufficiency as part of the Waterhouse-Friderichsen syndrome is well described, reports of primary hypothyroidism and persistent primary hypogonadism in severe illness are exceedingly rare. Multiple combined endocrinopathies as in this case have not been reported previously. This case highlights the necessity of screening for endocrine abnormalities in severe illness and the need for treatment if persistent. It also raises a novel concept of meningococcal sepsis causing multiple endocrinopathies possibly via disseminated intravascular coagulopathy-related ischaemic damage.
https://ift.tt/2xnyQtw
Recurrent pleural effusion in a young woman: calcifying fibrous tumour of the pleura
We present the case of a 23-year-old woman with a long-standing history of recurrent left-sided pleural effusion unrelated to her menstrual cycle. At her last presentation, non-contrast-enhanced chest CT showed a pleural effusion and a lower left hemithorax mass, both large enough to cause complete collapse of the lower lobe and partial collapse of the upper lobe. Thoracoscopic surgery revealed a multilobulated mass originating from the dome of the diaphragm with pleural deposits. Histopathology diagnosed this as a calcifying fibrous tumour of the pleura, a rare benign tumour with excellent prognosis when completely excised.
https://ift.tt/2xbaVys
Natural killer/T-cell lymphoma and secondary haemophagocytic lymphohistiocytosis in pregnancy
Haemophagocytic lymphohistiocytosis (HLH) is a rare and potentially fatal disorder. It is challenging to diagnose due to its rarity and variation in clinical presentation, laboratory abnormalities and underlying aetiologies. A reproductive-aged woman, gravida 2 para 1001 at 27 weeks gestation presented with fever, hypotension and subacute upper respiratory infection. She delivered a male infant by caesarean section secondary to fetal distress. Subsequently, she was diagnosed with T-cell lymphoma and secondary HLH. Despite management with supportive care and multiple chemotherapeutic agents, she ultimately died of multiorgan failure. Patients with HLH secondary to malignancy have a particularly poor prognosis. This case highlights the importance of considering secondary HLH in the differential diagnosis of a patient with fever, pancytopenia and systemic symptoms of unclear aetiology in pregnancy.
https://ift.tt/2xidFcz
Primary intracranial leiomyosarcoma among patients with AIDS in the era of new chemotherapeutic and biological agents
Primary intracranial leiomyosarcoma (PIL) is a rare non-infectious aetiology of focal mass lesions among HIV-infected individuals. With only 16 published cases worldwide, information on its pathophysiology, risk factors, clinical course and management options is limited. We report two cases of PIL in HIV-infected Filipino men who presented with 1–3 months history of persistent headache, progressing in severity. Both had cranial MRI revealing intracranial mass diagnosed as leiomyosarcoma by excision biopsy and immunohistochemical staining. Both patients underwent adjuvant cranial radiotherapy and chemotherapy. Biologics were initiated in one patient. Both patients were alive with evidence of the disease.
https://ift.tt/2xcOEQN
Unilateral cataract associated with eyelid ash-leaf macule in tuberous sclerosis complex
A 9-month-old male child with tuberous sclerosis complex presented with ash-leaf macules on the left periocular region and ipsilateral dense cataract. Fundus showed retinal astrocytic hamartomas. This case is reported for unilaterality of congenital cataract on the same side of eyelid ash-leaf macule in tuberous sclerosis.
https://ift.tt/2xntrD4
Urachal adenocarcinoma
Description
A 40-year-old male patient presented at the outpatient department with ulcerative swelling with foul smelling discharge from lower half of abdomen for last 3 months. He had a history of haematuria with increased frequency of micturition for last 6 months accompanied by loss of appetite and subsequent weight loss. There was no history of nocturia, urgency or incontinence.
On physical examination, he was found to have an ulceroproliferative growth around 5x3 cm size in the infraumbilical region with urinary discharge near one end as shown in figure 1.
Figure 1
Ulceroproliferative growth in the infraumbilical region arising from urinary bladder.
It was small to begin with and progressively increased in size to reach the present state.
The growth demonstrated an unhealthy ulcer with everted margins and areas of slough. It was friable and bled actively on manipulation. Rest of the abdominal...
https://ift.tt/2x8DCvR
Common iliac artery thrombosis as a possible complication of the pluck technique in nephroureterectomy
Common iliac artery (CIA) thrombosis is a rare surgical complication which may cause serious leg damage and may occasionally be fatal. We experienced two cases of CIA thrombosis in nephroureterectomy with the pluck technique for upper tract urothelial carcinoma. Patients were treated using emergent femoro–femoral bypass, and one patient was treated with fasciotomy of the lower extremity for compartment syndrome. CIA thrombosis is considered a possible complication of nephroureterectomy, particularly with the pluck technique in open surgery. Arterial thrombosis in intrapelvic surgery including nephroureterectomy should be carefully considered for patients at risk.
https://ift.tt/2xlIwoj
Unusual presentation of pancreatitis with extrapancreatic manifestations
Pancreatitis, panniculitis and polyarthritis syndrome (PPP syndrome) is a rare and complex manifestation of pancreatitis that is currently reported in few cases. We present this case regarding a 77-year-old man who presented unusually with a 6-week history of bilateral lesions on his lower limbs. During this time, he experienced increasing fatigue, joint pain, and reported fevers and significant weight loss. An incidental serum amylase was found to be significantly elevated and remained elevated throughout his 2-month hospital stay. He never complained of abdominal pain or other typical symptoms of pancreatitis. Histological examination of the leg lesions reported evidence of fat necrosis and changes consistent with pancreatic panniculitis. An abdominal CT scan revealed a well-defined lesion posterior to the neck of the pancreas. Further examination by endoscopic ultrasound revealed chronic inflammatory changes. The patient experienced a long admission and was managed supportively until he was well enough to be discharged home.
https://ift.tt/2xeuGoK
Periocular contact dermatitis with use of topical voriconazole 1% in mycotic keratitis
We present two cases of culture-proven fungal keratitis on natamycin treatment which developed periocular erythema, oedema, burning sensation and pruritus within 48 hours of the addition of topical voriconazole. On clinical examination, periocular erythema with induration was noted. A diagnosis of orbital cellulitis was suspected, but the absence of pain and tenderness refuted the diagnosis on clinical grounds. A dermatology consultation was sought, and a diagnosis of periocular contact dermatitis with voriconazole was made. A skin patch test was performed with the same medication; however, it was negative. Topical voriconazole therapy was withdrawn, and the patient was prescribed cold compresses and oral antihistamine medication, to which they responded well.
https://ift.tt/2xlIjS3
Delayed pressure urticaria due to non-invasive blood pressure monitoring in a previously non-atopic man
Description
A 68-year-old man presented to us with voiding lower urinary tract symptoms due to benign prostatic hyperplasia for which he underwent photovapourisation of prostate using potassium titanyl phosphate laser. The procedure was completed in 104 min uneventfully. Eight hours after the procedure, the patient had burning and itching on his left arm circumferentially in the area where the cuff for non-invasive blood pressure (NIBP) monitoring was applied and on his back. We removed the cuff and in that region of his arm there was erythema along with multiple blisters (figure 1). A similar linear lesion was seen on the right side of his back along the 10th rib (figure 2). We recognised it to be some form of urticaria, and immediately gave the patient an antihistamine (pheniramine). The patient had no history of any skin lesion, neither did he give a history of any allergies. Both lesions...
https://ift.tt/2xeXPjB
Concurrent internal hernia and intussusception after Roux-en-Y gastric bypass
Description
A 32-year-old woman with medical history significant for open Roux-en-Y gastric bypass performed 11 years prior presented to an urgent care with sudden severe epigastric pain associated with nausea and vomiting. She was profoundly hypothermic (91°F) and bradycardic (40 bpm) but maintained normal blood pressure. Laboratory values were grossly within normal limits except for an elevated lactic acid (2.99 mmol/L). Rewarming protocol, broad-spectrum intravenous antibiotics (piperacillin–tazobactam and vancomycin) and intravenous fluid resuscitation were initiated at this time. CT of the abdomen with intravenous and oral contrast demonstrated intussusception at the site of the jejunojejunal anastomosis with severe oedema of the mesentery and focally dilated bowel consistent with a high-grade obstruction due to an internal hernia (figure 1A). The patient was emergently transferred to the hospital and underwent an exploratory laparotomy. Intraoperatively, the intussuscepted segment of small bowel surrounding the jejunojejunal anastomosis was identified with an associated...
https://ift.tt/2xjIi14
Late twiddler syndrome in a patient with a submuscular implantable cardioverter defibrillator
Description
A 20-year-old woman with long-QT syndrome received a submuscular Fortify DR-St Jude implantable cardioverter defibrillator (ICD) after an episode of cardiac arrest. She felt an ICD pocket vibration 23 months later due to a high lead impedance and loss of capture. Chest radiography (figure 1A,B) showed both lead displacement and winding of the leads beside the ICD generator. These findings were confirmed during surgery (figure 1C). The patient strongly denied any box manipulation. She was discharged after new leads implantation with no complications.
Figure 1
(A) and (B) Chest radiography showing both lead displacement and winding of the leads close implantable cardioverter defibrillator generator. (C) Intraoperative finding of lead twisting.
There is a report of three patients with ICD with submuscular devices in whom a twiddler's syndrome occurred despite any risk factors were be seen. It is discussed that the cause...
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Delayed lethal pulmonary air embolism after a gunshot head injury
We present a case of a young male patient with a fatal pulmonary air embolism following a penetrating gunshot head injury. He suffered from severe head trauma including a laceration of the superior sagittal sinus. Operative neurosurgical intervention did not establish a watertight closure of the wounds. Eight days after the trauma, the patient suddenly collapsed and died after an attempt to mobilise him to the vertical. Forensic autopsy indicated pulmonary air embolism as the cause of death. Retrospectively, we postulate an entry of air to the venous system via the incompletely occluded wounds and the lacerated superior sagittal sinus while mobilisation to the vertical created a negative pressure in the dural sinus.
https://ift.tt/2xntgYq
Is bromelain an effective drug for the control of pain and inflammation associated with impacted third molar surgery? Systematic review and meta-analysis
Publication date: Available online 14 September 2018
Source: International Journal of Oral and Maxillofacial Surgery
Author(s): R. de A.C. Almeida, F.C.M. de Sousa Lima, B.C. do E. Vasconcelos
Abstract
The aim of this systematic review was to determine whether bromelain is an effective drug for the control of pain and inflammation associated with third molar surgery. Randomized, controlled clinical trials on the subject were identified through a systematic search of the literature using the PubMed/MEDLINE, Scopus, and Cochrane Library databases. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Two independent, blinded reviewers selected studies based on the inclusion criteria. Divergences of opinion were resolved by consensus. A meta-analysis was performed for the outcomes pain and trismus and was based on the inverse variance method for continuous outcomes, considering the mean difference (MD) and corresponding 95% confidence interval (CI). A total of 186 articles were initially retrieved from the databases. After the different stages of the selection process, five articles reporting data for a total 252 patients remained and were included in the review. Bromelain proved to be effective at controlling postoperative pain at 48–72 h after surgery (P = 0.03; MD −0.89, 95% CI −1.70 to −0.09), but did not achieve a significant effect in comparison to the control group with regard to oedema or trismus.
https://ift.tt/2My8j2n
Asthma phenotypes based on health services utilization for allergic diseases in a province-wide birth cohort
Publication date: Available online 14 September 2018
Source: Annals of Allergy, Asthma & Immunology
Author(s): Miceline Mésidor, Andrea Benedetti, Mariam El-Zein, Dick Menzies, Marie-Élise Parent, Marie-Claude Rousseau
Abstract
Background
Previous studies on asthma phenotypes were often conducted in selected clinical populations and overlooked changes over the life course.
Objective
In a population-based cohort, we identified asthma phenotypes based on utilization of health services for allergic diseases in three life periods and documented transitions between phenotypes across life periods.
Methods
In a cohort of 78,211 individuals born in 1974 in the province of Québec (Canada), we documented medical visits and hospitalizations for asthma and other allergic diseases until 1994. Phenotypes based on clusters of health services utilization in childhood (8-12 years), adolescence (13-17 years), and young adulthood (18-20 years) were identified using Ward's method among 9,989 (12.8%) subjects who had at least one health encounter for asthma during follow-up. Population level probabilities of transitioning between phenotypes were estimated in the full study population.
Results
In the subset with asthma, six phenotypes were identified during both childhood and young adulthood, and seven during adolescence. The most common phenotype was "no asthma or allergic diseases": 58% in childhood, 42% in adolescence, and 54% in adulthood. Second most common was the "mild asthma/no allergic diseases" phenotype, representing respectively 36%, 31%, and 21% in these three periods. In the study population, 87% of the subjects remained in the "no asthma" phenotype over the follow-up. The vast majority of subjects in the asthma phenotypes transitioned over time.
Conclusion
Our study uniquely contributes to a better understanding, at the population level, of the manifestations and transitions in asthma phenotypes over the life course.
https://ift.tt/2NRuhlP
An In-Depth Characterization of a Large Cohort of Adults Patients with Eosinophilic Esophagitis
Publication date: Available online 14 September 2018
Source: Annals of Allergy, Asthma & Immunology
Author(s): Lyvia Y. Leigh, Jonathan M. Spergel
Abstract
BACKGROUND
Eosinophilic esophagitis (EoE) is a chronic allergic, immune-mediated disease associated with increased risk of comorbid atopic conditions.
OBJECTIVE
We aim to perform an in-depth characterization of a large cohort of manually verified adult EoE patients including evaluation of less studied associations such as pollen food allergy syndrome, anaphylaxis, autoimmunity and psychiatric comorbidities.
METHODS
We performed manual retrospective electronic medical record review of 1,218 patients with EoE identified by ICD-9 and 10 codes from the University of Pennsylvania Health Systems (UPHS). Through manual chart review, we evaluated patient demographics; family and smoking history; laboratory and endoscopic findings; treatment; and comorbid atopic, autoimmune, and psychiatric conditions.
RESULTS
950 out of 1,218 patients had biopsy-proven EoE. This cohort was predominantly male, Caucasian, never-smokers who presented most commonly with dysphagia with an initial biopsy showing 49 Eos/HPF, serum absolute eosinophilic count of 446, and average total IgE of 243. 55% had impaction (of which 38% required endoscopic removal), 56% had strictures/fibrosis (of which 56% underwent dilatation). Therapy used was predominantly (77%) medical only. Comorbid atopy, pollen food allergy syndrome, drug allergy, anaphylaxis, autoimmunity, and psychiatric illnesses were higher in the EoE cohort compared with the general UPHS population.
CONCLUSION
Our adult cohort of manually verified, biopsy-proven EoE showed increased risk of pollen food allergy syndrome, anaphylaxis, and comorbid autoimmune and psychiatric conditions compared with the UPHS population. There was also an increased prevalence of impaction and stricture/fibrosis requiring endoscopic intervention compared with the pediatric population.
https://ift.tt/2MycZ8w
Atopic dermatitis in African American patients is TH2/TH22-skewed with TH1/TH17 attenuation
Publication date: Available online 14 September 2018
Source: Annals of Allergy, Asthma & Immunology
Author(s): Riana D. Sanyal, Ana B. Pavel, Jacob Glickman, Tom C. Chan, Xiuzhong Zheng, Ning Zhang, Inna Cueto, Xiangyu Peng, Yeriel Estrada, Judilyn Fuentes-Duculan, Andrew F. Alexis, James G. Krueger, Emma Guttman-Yassky
Abstract
Background
African Americans/(AA) are disproportionately impacted by atopic dermatitis/(AD) with increased prevalence and therapeutic challenges unique to this population. Molecular profiling data informing development of targeted therapeutics for AD are derived primarily from European American/(EA) patients. These studies are absent in AA, hindering development of effective treatments for this population.
Objective
We sought to characterize the global molecular profile of AD in skin of AA patients as compared with that of EA AD and healthy controls.
Methods
We performed RNA-Seq with RT-PCR validation and immunohistochemistry studies in lesional and non-lesional skin of AA and EA AD patients versus healthy controls.
Results
AA AD lesions were characterized by greater infiltration of dendritic cells/(DCs) marked by the high-affinity IgE receptor/(FcεR1+) compared with EA AD (p<0.05). Both AD cohorts showed similarly robust upregulation of Th2-related (CCL17/18/26) and Th22-related markers (IL- 22, S100A8/9/12), but AA AD featured decreased expression of innate immune (TNF, IL-1β), Th1-related (IFN-γ, MX1, IL-12RB1), and Th17-related markers (IL-23p19, IL-36G, CXCL1) versus EA AD (p<0.05). Th2 (IL-13) and Th22-related products (IL-22, S100A8/9/12) and serum IgE were significantly correlated with clinical severity (SCORAD) in AA. Fillagrin (FLG) was exclusively downregulated in EA AD, while loricrin (LOR) was downregulated in both AD cohorts and negatively correlated with SCORAD in AA.
Conclusion
The molecular phenotype of AA AD skin is characterized by attenuated Th1 and Th17 but similar Th2/Th22-skewing to EA AD. Our data encourages a personalized medicine approach accounting for phenotypespecific characteristics in future development of targeted therapeutics and clinical trial design for AD.
https://ift.tt/2NRuaGV
Targeted Next Generation Sequencing Reveals OTOF mutations in Auditory Neuropathy Spectrum Disorder
Publication date: Available online 14 September 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Kaitian Chen, Min Liu, Xuan Wu, Ling Zong, Hongyan Jiang
Abstract
Objective
To study the genetic etiology of auditory neuropathy spectrum disorder (ANSD) in a Chinese family and perform a literature review of OTOF mutations and cochlear implantation (CI).
Methods
Sequential targeted next generation sequencing (NGS) and CI was performed for the proband. Further, 50 DNA samples from unrelated families with nonsyndromic deafness were examined for frequency determination. The impact of OTOF mutations on hearing recovery after CI was assessed through the literature survey.
Results
In the proband, the targeted NGS panel revealed five suspected variants in four genes (OTOF, EYA4, PCDH15, and GIPC3), of which two mutations—c.5098G>C (p.Glu1700Gln) and c.1702C>T (p.Arg568Trp)—in the OTOF gene were found to be correlated with ANSD. The c.5098G>C allele was identified in only one child from the 50 unrelated participants. The proband's hearing and speech abilities were restored 2 years after the surgery. Most ANSD patients (90.9%; 30/33) with OTOF mutations have acceptable surgical outcomes, as indicated by existing reports.
Conclusions
Our results support the feasibility of CI for patients with ANSD and OTOF mutations, and this hypothesis was supported by the review of existing data. A larger number of cases studies is required to determine possible modifies on the prognosis of surgery.
https://ift.tt/2xgFwty
Novel presentation of Cranial Fasciitis of the Mandible: Case Report and Literature Review
Publication date: Available online 14 September 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Katie de Champlain, Kyle C. Kurek, Warren K. Yunker
Abstract
Cranial fasciitis (CF) is a rare benign fibroblastic lesion of the scalp, most commonly affecting the pediatric population. The authors conducted a literature review and include a summary of reported cases of CF. CF is most commonly located in the parietal and temporal regions of the skull. The majority of cases are found in males and in children under a few years of ago. We describe the clinical, pathological and radiological findings of the first reported case of CF of the mandible. In this case, the patient was a 12 month-old male who presented with a one-month history of a rapidly enlarging mass along his left mandibular ramus. Treatment of CF involves surgical resection and has a low rate of recurrence. The patient in question was managed surgically with no complications and has not had any evidence of disease recurrence.
https://ift.tt/2xesvRT
Skull base anatomy and surgical safety in isolated and CHARGE-associated bilateral choanal atresia
Publication date: Available online 14 September 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Nicholas S. Fitzpatrick, Anthony C. Bartley, Elhamy Bekhit, Robert G. Berkowitz
Abstract
Introduction
Bilateral choanal atresia (BCA) is associated with a high incidence of congenital abnormalities that include skull base anomalies and defects. Surgical repair of BCA is necessary in the early neonatal period and any altered anatomy of the adjacent skull base will heighten the risk of intracranial injury. This risk may be further increased in patients with CHARGE syndrome.
Objectives
To measure surgically relevant nasal and skull base dimensions in neonates with BCA in order to determine whether any difference exists between isolated and CHARGE syndrome associated subgroups, thereby optimizing the safety of surgical repair.
Methods
A retrospective review of medical charts and computed tomography was undertaken at a tertiary pediatric hospital of all neonates diagnosed with BCA between 2004-2016. Isolated and CHARGE syndrome subgroups of BCA were identified from clinical records and CT data was analyzed and compared between the two. The skull base parameters measured were choanal width, choanal height, mid-nasal skull base height and skull base slope.
Results
Of the 13 patients included, 3 had CHARGE syndrome and 10 had isolated BCA. Whilst the difference in mid-nasal height approached significance for the two groups, numbers were too small for a statistical difference to be identified. The mean value for choanal width in the isolated BCA group was significantly less the largest series of normative data available in the literature for comparison (p < 0.001). No skull base anomalies were noted in either group.
Conclusion
While this is a small study with limited numbers, it is the first that has attempted to identify and measure the posterior nasal and skull base anatomy most pertinent to avoiding skull base injury in the surgical management of BCA.
https://ift.tt/2xl0V4S
Adenoid hypertrophy affects screening for primary ciliary dyskinesia using nasal nitric oxide
Publication date: Available online 14 September 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Tomas Rybnikar, Marian Senkerik, Jaroslav Chladek, Jirina Chladkova, David Kalfert, Lukas Skoloudik
Abstract
Aim
In patients with primary ciliary dyskinesia (PCD), the release of nitric oxide (NO) is extremely low by epithelia of the nasopharynx and sinuses. Measurement of nasal NO (nNO) is recommended as a screening test for PCD. The study aimed to evaluate if adenoids affects nNO and may deteriorate the performance of the test.
Methods
In 48 nonallergic patients between 5 and 18 years of age with chronic symptoms of nasal obstruction and indications for adenoidectomy, the measurements of nNO by chemiluminescence analyser and nasal patency by active anterior rhinomanometry were performed both before and after adenoidectomy. Adenoidal tissue size was graded during surgery under general anaesthesia using transoral endoscopy.
Results
Patients were stratified into groups with adenoids grades 1, 2 and 3 (<1/3, 1/3-2/3 and > 2/3 of the choana and post-nasal space covered by adenoids). Before adenoidectomy, the median of nNO decreased with the increasing grade of adenoids (920, 663, and 491 ppb, P<0.05). The rhinomanometry results were comparable and showed no correlation with nNO. Seven patients (14.6%) were incorrectly classified to have PCD based on a subthreshold value of the volume flow of nNO (FnNO < 77 nL/min). Following adenoidectomy, nNO of the grade 3 patients increased by 107 ppb (P < 0.05) and no differences were found between groups (P= 0.40). All patients had the postadenoidectomy FnNO > 77 nL/min.
Conclusions: nNO and FnNO are reduced in nonallergic children with obstructive adenoids. Adenoid hypertrophy can potentially cause a false positive result of the test for PCD.
https://ift.tt/2xehwIm
A Novel Gel Patch for Minimally Invasive Repair of Tympanic Membrane Perforations
Publication date: Available online 14 September 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Benjamin J. Rubinstein, Jesse D. Ranney, Parastoo Khoshakhlagh, Barry Strasnick, Elaine L. Horn-Ranney
https://ift.tt/2xfjJ5s
Anterior Skull Base Duplication Requiring Delivery Via EXIT Procedure: A Case Report
Publication date: Available online 14 September 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Courtney B. Shires, Jonathan P. Giurintano, Jennifer McLevy-Bazzanella, Jerome Thompson
Abstract
Duplication of the anterior skull base structures is an extremely rare malformation of failed midline blastogenesis. We present the case of a child with an obstructive oral cavity mass diagnosed on prenatal imaging. The child was successfully delivered by EXIT procedure, a tracheotomy was performed, and postnatal imaging demonstrated an array of craniofacial malformations, including complete duplication of the maxilla, pituitary glands, aqueducts of Sylvius, and basilar arteries. The child underwent excision of the duplicate maxilla, resulting in a wide cleft palate that will be repaired at a future date.
https://ift.tt/2xeSMQl
Administering a Telemedicine Program
Abstract
Purpose of Review
The purpose of this review is to describe the process of administering a telemedicine program including reviewing telemedicine guidelines; discussing licensing, credentialing, and privileging of providers; outlining scheduling and recruitment of patients; and measuring outcomes of a telemedicine program.
Recent Findings
Recent literature findings suggest that telemedicine in specialty clinics continues to grow at a rapid pace. Medical specialty programs should prepare to adopt a practice that includes telemedicine to better serve their patients and families who have expressed significant satisfaction with the delivery of healthcare in this manner.
Summary
With the appropriate support, any specialty clinic can provide their patients with a telemedicine option which has shown to be highly successful for Children's Mercy Allergy, Asthma, & Immunology Department.
https://ift.tt/2D14KSW
Protective effect of N-acetylcysteine against cisplatin ototoxicity in rats: a study with hearing tests and scanning electron microscopy
Publication date: Available online 14 September 2018
Source: Brazilian Journal of Otorhinolaryngology
Author(s): Mehmet Akif Somdaş, İnayet Güntürk, Esra Balcıoğlu, Deniz Avcı, Cevat Yazıcı, Saim Özdamar
Abstract
Introduction
Ototoxicity is a health problem appearing after powerful treatments in serious health conditions. It is sometimes inevitable when treatment of the serious disease is required. Cisplatin is an antineoplastic agent which was investigated previously to reveal increased nitrogen and reactive oxygen radicals that damages hair cells, resulting in ototoxicity. N-acetylcysteine, previously shown to decrease ototoxicity caused by different agents, is known to be a powerful in vitro antioxidant. Probably N-acetylcysteine, in addition to its antioxidant effect, blocks a cascade where reactive oxygen species result in apoptosis in the cochlea.
Objectives
The possible preventive effect of N-acetylcysteine in cisplatin ototoxicity was studied with auditory brain stem responses, otoacoustic emissions, and histopathological investigation of the cochlea in a scanning electron microscopy.
Methods
This study was conducted on 21 Wistar Albino rats in four groups. 1 mL/kg/day three times in total intraperitoneal (i.p.) Saline (n = 5), 500 mg/kg/day i.p. three times in total N-acetylcysteine (n = 5), i.p. 15 mg/kg cisplatin alone (single dose) (n = 5) and i.p. 15 mg/kg cisplatin plus 500 mg/kg/day N-acetylcysteine (n = 6) were administered. The rats were anesthetized to study the hearing tests before and after the experiment. The rats were sacrificed to investigate the cochleas by scanning electron microscopy.
Results
Auditory brain stem responses and otoacoustic emissions values were attenuated in the cisplatin group. The group that received N-acetylcysteine in addition to cisplatin had better auditory brain stem responses thresholds and otoacoustic emissions. The samples obtained from the cisplatin group showed surface irregularities, degeneration areas, and total or partial severe stereocilia losses. The changes were milder in the cisplatin + N-acetylcysteine group.
Conclusion
Cisplatin ototoxicity can be detected by auditory brain stem responses and otoacoustic emissions testing in rats. N-acetylcysteine may protect the cochlear cells from histopathological changes. We concluded that N-acetylcysteine given 4 h after cisplatin injection has a potential otoprotective effect against cisplatin ototoxicity. which suggests it could be used in clinical trials.
Resumo
Introdução
A ototoxicidade é um problema de saúde que surge após certos tipos de tratamentos para condições graves de saúde. Às vezes é inevitável quando o tratamento da doença é necessário. A cisplatina é um agente antineoplásico cuja utilização em pesquisas anteriores demonstrou aumentar os radicais livres de nitrogênio e espécies reativas de oxigênio que danificam as células ciliadas resultando em ototoxicidade. Por outro lado, a N-acetilcisteína, que já demonstrou diminuir a ototoxicidade causada por diferentes agentes, é conhecida por ser um potente antioxidante in vitro. Provavelmente a N-acetilcisteína, além de seu efeito antioxidante, bloqueia uma cascata onde espécies reativas de oxigênio resultam em apoptose na cóclea.
Objetivos
Estudar o possível efeito preventivo da N-acetilcisteína na ototoxicidade por cisplatina por meio de potencial evocado auditivo de tronco encefálico, emissões otoacústicas e investigação histopatológica da cóclea por microscopia eletrônica de varredura.
Método
Este estudo foi realizado em 21 ratos albinos Wistar, separados em quatro grupos. Foram administrados: 1 mL/kg/dia intraperitoneal (i.p.) de solução salina (n = 5), três vezes no total; 500 mg/kg/dia i.p. de N-acetilcisteína (n = 5), três vezes no total; 15 mg/kg i.p. (dose única) somente de cisplatina (n = 5) e 15 mg/kg i.p. de cisplatina e 500 mg/kg/dia i.p. de N-acetilcisteína (n = 6). Os ratos foram anestesiados para estudo dos testes auditivos antes e depois do experimento. Os ratos foram sacrificados para investigação da cóclea por microscopia eletrônica de varredura.
Resultados
Os potenciais evocados auditivos de tronco encefálico e os valores das emissões otoacústicas estavam atenuados no grupo cisplatina. O grupo que recebeu N-acetilcisteína além da cisplatina apresentou melhores limiares de respostas auditivas do tronco encefálico e emissões otoacústicas. As amostras obtidas do grupo cisplatina apresentaram irregularidades de superfície, áreas de degeneração, com perdas graves totais ou parciais de estereocílios. As alterações foram mais leves no grupo cisplatina + N-acetilcisteína.
Conclusão
A ototoxicidade por cisplatina pode ser detectada por meio de potenciais evocados auditivos de tronco encefálico e pelo teste de emissões otoacústicas em ratos. A N-acetilcisteína pode proteger as células cocleares contra alterações histopatológicas. Concluímos que a N-acetilcisteína administrada 4 horas após a injeção de cisplatina tem potencial efeito otoprotetor contra a ototoxicidade por cisplatina e pode ser utilizada em ensaios clínicos.
https://ift.tt/2Myy3eZ
Administering a Telemedicine Program
Abstract
Purpose of Review
The purpose of this review is to describe the process of administering a telemedicine program including reviewing telemedicine guidelines; discussing licensing, credentialing, and privileging of providers; outlining scheduling and recruitment of patients; and measuring outcomes of a telemedicine program.
Recent Findings
Recent literature findings suggest that telemedicine in specialty clinics continues to grow at a rapid pace. Medical specialty programs should prepare to adopt a practice that includes telemedicine to better serve their patients and families who have expressed significant satisfaction with the delivery of healthcare in this manner.
Summary
With the appropriate support, any specialty clinic can provide their patients with a telemedicine option which has shown to be highly successful for Children's Mercy Allergy, Asthma, & Immunology Department.
https://ift.tt/2D14KSW
Bcl2L12 plays a critical role in the development of airway allergy via inducing aberrant T helper-2 polarization
Publication date: Available online 15 September 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Zhi-Qiang Liu, Ying Feng, Li-Hua Mo, Xian-Hai Zeng, Jiang-Qi Liu, Rui-Di Xie, Zhi-Gang Liu, Ping-Chang Yang, Guang-Ji Zhang, Shan-Dong Wu
https://ift.tt/2xeXugG
Ondansetron or promethazine: Which one is better for the treatment of acute peripheral vertigo?
Publication date: Available online 14 September 2018
Source: American Journal of Otolaryngology
Author(s): Alia Saberi, Seyed Hashem Pourshafie, Ehsan Kazemnejad-Leili, Shadman Nemati, Sara Sutohian, Sara Sayad Fathi
Abstract
Background
Vertigo is a common annoying complaint needing emergent treatment. There are various treatment options for this condition with different outcomes and side effects.
Objectives
Assessment and comparison of the effectiveness of Ondansetron and Promethazine in the treatment of acute peripheral vertigo.
Materials and methods
This clinical trial was conducted in an academic hospital in the north of Iran in 2017. A total of 170 eligible patients were randomly allocated to groups A: received intramuscular (IM) promethazine; and B: received intravenous (IV) Ondansetron, using quadripartite blocks. The severity of vertigo, nausea, blood pressure, heart rate, side-effects, need for re-administration, and the time to become asymptomatic were assessed before the injections, 30 min after and 2 h after the injections.
Results
Excellent improvement in vertigo occurred in both groups (P < 0.001), with a more significant reduction in the promethazine-treated group (P < 0.001). Nausea was reduced more significantly in the ondansetron-treated group (P < 0.05). There were more side-effects seen in the promethazine-treated when compared to the group with ondansetron treatment (P < 0.001). No significant differences were seen in the blood pressures between groups (P > 0.05). Heart rates were reduced in both groups but the changes were insignificant (P > 0.05). The ondansetron-treated group showed a greater need for re-administration of the medication (50.6% vs. 27.1%). The relief score was significantly higher in the ondansetron-treated group compared with the group received promethazine (P < 0.001). The time to become asymptomatic showed no statistically significant difference between groups (p = 0.28).
Conclusion
Our results indicated that while promethazine cures peripheral vertigo more efficiently, ondansetron is more beneficial for the improvement of nausea and vomiting.
https://ift.tt/2CVEPvI
The clinical value of a thorough diagnostic evaluation for neurotologic complaints
Publication date: Available online 14 September 2018
Source: American Journal of Otolaryngology
Author(s): Natalie A. Krane, Brian McKinnon, Michelle White, Dani Ashak, Eileen L. Chang, Daniel Park, Sandeep Segar, Jeyanthan Jayakumaran, Clara Grayhack, Robert T. Sataloff
Abstract
Purpose
Determine the clinical efficacy of comprehensive neurotologic testing in patients presenting with complaints of hearing loss, tinnitus and/or dizziness.
Methods
This is a retrospective analysis of 1170 consecutive charts of patients who presented between 1980 and 2013 with neurotologic complaints. Demographic data, chief complaint, diagnostic imaging, audiograms, and blood tests were evaluated.
Results
Retrospective analysis of 1170 patient charts was performed. 762/1170 (65%) patients presented with subjective hearing loss, 575/1170 (49%) with dizziness, and 657/1170 (56%) with tinnitus. Audiometric testing revealed hearing loss in 1059/1169 (91%) patients. 536/1120 (48%) patients had abnormalities on Magnetic Resonance Imaging, and 343/1087 (32%) on Computed Tomography imaging. Endocrine and immunologic testing revealed 108/1135 (9.5%) patients were hyperglycemic; 125/1124 (11%) patients had elevated TSH; 149/1141 (13%) patients had a positive ANA; and 82/1133 (7.2%) patients were positive for RF. 198/1083 (18%) of patients were positive for HLA-B35, 246/1083 (23%) for HLA-Cw4, 454/1083 (42%) for HLA-Cw7, and 747/1060 (70%) of patients had absent HLA-DR4. 112/1085 (10%) of patients were positive for anti-68kD antibodies and 154/936 (17%) for protein 0. Many patients were diagnosed with previously unrecognized medical conditions.
Conclusion
Comprehensive neurotological workup results in diagnoses that would go unrecognized otherwise, allowing patients to receive prompt treatment for medically important conditions, some of which may be causally related to their neurotologic complaints. However, the value of each study for routine testing of patients with neurotologic complaints remains controversial; and the evidence presented herein should help practitioners determine what studies should be included in his/her patient assessment.
https://ift.tt/2NcifUq
Intensity-modulated radiotherapy for paranasal sinuses and base of skull tumors
Publication date: November 2018
Source: Oral Oncology, Volume 86
Author(s): Zhong-Guo Liang, Grace Kusumawidjaja, Farasat Kazmi, Joseph T.S. Wee, Melvin L.K. Chua
Abstract
Paranasal sinus and skull base tumors are rare aggressive head and neck cancers, and typically present in the locally advanced stages. As a result, achieving wide surgical resection with clear margins is a challenge for these tumors, and radiotherapy is thus usually indicated as an adjuvant modality following surgery to optimize local control. Given the integral role of radiotherapy in the management of this subgroup of head and neck tumors, the advent of intensity-modulated radiotherapy (IMRT) has led to substantial improvement of clinical outcomes for these patients. This is primarily driven by the improvement in radiation dosimetry with IMRT compared to conventional two dimensional (2D)- and 3D-techniques, in terms of ensuring dose intensity to the tumor target coupled with minimizing dose exposure to critical organs. Consequently, the evident clinical benefits of IMRT have been in reduction of normal tissue toxicities, ranging from critical neurological symptoms to less debilitating but bothersome symptoms of eye infections and radiation-induced skin changes. Another domain where IMRT has potential clinical utility is in the management of a subset of non-resectable T4 paranasal sinus and skull base tumors. For these inoperable lesions, the steep dose-gradient between tumor and normal tissue is even more advantageous, given the crucial need to maintain dose intensity to the tumor. Innovative strategies in this space also include the use of induction chemotherapy for patient selection. In this review, we summarized the data for the aforementioned topics, including specific discussions on the different histologic subtypes of paranasal sinus and skull base tumors.
https://ift.tt/2p9JnVN
Open transcatheter aortic valve implantation on a degenerated bioprosthetic valve conduit
Abstract
The degeneration of bioprosthetic aortic Conduit with hemodynamic dysfunction mostly requires a re-do surgery, which is associated with an increased perioperative risk. Considering this, an open implantation of a transcatheter aortic bioprothesis (TAVI) after resection of the degenerated valve leaflets could be of great benefit, reducing cross-clamp and cardiopulmonary bypass duration, especially in combined surgery in high-risk patients. This is a case of a high-risk female (78 years, EuroScore 59%) treated with an open TAVI as an alternative to conventional valve or aortic conduit replacement for degenerative aortic valve due to endocarditis lente, 2 years following a bio-Bentall procedure.https://ift.tt/2p6KZ2p
The Association Between Fecal Hemoglobin Concentration and Oral Potentially Malignant Disorders
Oral Diseases, Volume 0, Issue ja, -Not available-.
https://ift.tt/2NcgUwO
Esmolol, Antinociception, and Its Potential Opioid-Sparing Role in Routine Anesthesia Care
β-Adrenergic blockade is an important mechanism for reducing morbidity and mortality in patients with hypertension and heart failure. Esmolol has been used widely for its chronotropic and antihypertensive effects. However, there has been recent inquiry regarding perioperative esmolol use and nociceptive modulation. Conventional postoperative analgesic treatment has relied primarily on opioids, which present their own adverse effects and pharmacoepidemiologic repercussions. Esmolol, to date, has not shown any direct analgesic or anesthetic properties; however, recent studies suggest that esmolol may have antinociceptive and postoperative opioid-sparing effects. In this Daring Discourse narrative, we describe the role of esmolol in current perioperative β-blockade guidelines (related to noncardiac surgery), briefly describe studies supporting the antinociceptive effects of esmolol, propose mechanisms for esmolol antinociception, and forecast potential routine esmolol use intraoperatively (as part of a multimodal total intravenous anesthetic) and its effects on opioid sparing. The reading audience of regional anesthesiologists and acute pain medicine physicians is uniquely positioned to take a lead role in promulgating this care advance amid (i) the unwanted effects of the opioid epidemic and (ii) the uncertain notion of whether routine general anesthesia care (with fentanyl) may indirectly be contributing to the epidemic. Accepted for publication April 23, 2018. Address correspondence to: Brian A. Williams, MD, MBA, Department of Anesthesiology, University of Pittsburgh, Suite A-1305 Scaife Hall, 3550 Terrace St, Pittsburgh, PA 15261 (e-mail: williamsba@anes.upmc.edu). The authors declare no conflict of interest. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.
https://ift.tt/2QwP9wU
https://ift.tt/2QwP9wU
International assessment of inter‐ and intrarater reliability of the International Frontal Sinus Anatomy Classification system
International Forum of Allergy &Rhinology, EarlyView.
https://ift.tt/2Oph3K2
Moving slowly but surely toward more precise rhinologic care
International Forum of Allergy &Rhinology, EarlyView.
https://ift.tt/2QCUx1M
Survival differences in nasopharyngeal carcinoma among racial and ethnic minority groups in the United States: a retrospective cohort study
Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2OrexTD
Issue Information
Clinical Otolaryngology, Volume 43, Issue 5, Page ii-v, October 2018.
https://ift.tt/2QCUOBQ
Cover Image
Clinical Otolaryngology, Volume 43, Issue 5, Page i-i, October 2018.
https://ift.tt/2OomEQI
Author Guidelines
Clinical Otolaryngology, Volume 43, Issue 5, Page 1422-1423, October 2018.
https://ift.tt/2QCUHGq
Paraneoplastic pemphigus presenting lichen planus‐like lesions
The Journal of Dermatology, EarlyView.
https://ift.tt/2NLl26o
Successful outcome of early ambulation after extensive skin grafting in extramammary Paget's disease
The Journal of Dermatology, EarlyView.
https://ift.tt/2xjfeaa
Verrucous hemangioma (also known as verrucous venous malformation): A vascular anomaly frequently misdiagnosed as a lymphatic malformation
Pediatric Dermatology, EarlyView.
https://ift.tt/2MxI4ZY
The incidence of pediatric malignant soft tissue tumors of the skin and subcutaneous tissue
Pediatric Dermatology, EarlyView.
https://ift.tt/2p6Ec8V
A survey to assess use patterns and perceptions of efficacy of eczema action plans among pediatric dermatologists
Pediatric Dermatology, EarlyView.
https://ift.tt/2MxYDoD
Granulomatous dermatitis secondary to vemurafenib in a child with Langerhans cell histiocytosis
Pediatric Dermatology, EarlyView.
https://ift.tt/2p7ZPpp
Angiosarcoma arising from congenital primary lymphedema
Pediatric Dermatology, EarlyView.
https://ift.tt/2MxHKdI
Incidence of squamous cell carcinoma in oral lichen planus: a 25‐year population‐based study
International Journal of Dermatology, EarlyView.
https://ift.tt/2MAGiHk
Sensitive and specific assay for the serological diagnosis of anti‐laminin 332 mucous membrane pemphigoid
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2CXv4gA
Factors influencing pain and efficacy of topical photodynamic therapy: a retrospective study
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2xcuLsW
The utility of optical coherence tomography for diagnosis of basal cell carcinoma: A quantitative review
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2CYt1c5
Cancer is not a risk factor for bullous pemphigoid. A ten‐year population‐based cohort study
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2xd1M8g
Infrared spectroscopy as a novel tool to diagnose onychomycosis
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2D0IIQe
Management of congenital ichthyoses: European guidelines of care: Part One
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2xaUDFs
Infantile bullous pemphigoid successfully treated with combined pulse corticosteroids and high‐dose IVIG
Dermatologic Therapy, EarlyView.
https://ift.tt/2MA3vJQ
Travelers’ tropical skin diseases: Challenges and interventions
Dermatologic Therapy, EarlyView.
https://ift.tt/2QCKbiq
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