Cutaneous metastatic breast cancer is the most common cutaneous metastatic malignancy in women. The assessment of cutaneous metastatic disease can be perplexing because the clinical presentation appears simila...
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Παρασκευή 21 Σεπτεμβρίου 2018
Dermoscopy of skin metastases from breast cancer: two case reports
Rare case of Propionibacterium acnes-related splenic abscess
A 64-year-old woman with a medical history of morbid obesity, chronic hepatitis C, essential hypertension, multiple episodes of abdominal cellulitis, diabetes mellitus type 2 on insulin, intravenous and subcutaneous drug abuse presented to the emergency department complaining of left lower chest pain for 6 weeks along with multiple episodes of vomiting. Initial laboratory data revealed leucocytosis of 17 200x103/μL with left shift. She reported multiple episodes of fever spikes. Abdominal and pelvic CT showed a splenic hypodense lesion. Specimens from interventional radiology aspiration and splenectomy grew Propionibacterium acnes. Following splenectomy, patient's symptoms resolved. To the best of our knowledge, this would represent the fifth reported case of P. acnes splenic abscess.
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Alpha-2 antiplasmin-associated aortic valve thrombus presenting as a STEMI in a patient with Graves disease
Description
A 36-year-old Caucasian woman with a medical history of Graves disease presented to the emergency department with typical chest pain, and she was found to have a ST-elevation myocardial infarction (STEMI) via ECG and elevated troponins. Emergent cardiac catheterisation revealed distal blockages in the left anterior descending artery and second obtuse marginal artery (figure 1A,B). After distal balloon angioplasty, the decision was made to further treat the patient medically and discharge home after clinical stability was achieved. She was readmitted 2 days later for new onset of palpitations with up-trending troponins. Laboratory tests were significant for a low thyroid-stimulating hormone of <0.01 µLU/mL (reference range: 0.27–4.2 µLU/mL), and elevated free T4 of 4.02 µLU/mL (reference range: 0.9–1.7 ng/dL), free T3 of 4.8 pg/mL (reference range: 2.5–4.3 pg/mL) and a thyroid stimulating immunoglobulin of 386 (reference range: <140% baseline). She was immediately started on both methimazole 20 mg and potassium iodine oral solution (SSKI). Further workup...
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Haemorrhagic cholecystitis: a rare entity not to be forgotten
Haemorrhagic cholecystitis is a rare entity of acute cholecystitis that carries a high morbidity and mortality rate if management is delayed. Its clinical course can mirror that of acute cholecystitis. Characteristic findings on ultrasound or CT scan are useful clues to early diagnosis. Urgent cholecystectomy is required prior to progressing to perforation of gallbladder. Most of the literature are case reports with causes associated with anticoagulation. Herein, we described a morbidly obese patient with poorly controlled diabetes presenting with non-specific right upper quadrant pain and was subsequently diagnosed with haemorrhagic cholecystitis. A review of the literature was also performed to summarise the potential clinical presentations, distinctive imaging findings and management options available for this rare condition.
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Pneumomediastinum: a complication of reinserting a dislodged tracheostomy
Description
A 54-year-old woman with a background of obesity and hypertension presented following a pulseless electrical activity (PEA) cardiac arrest. Cardiopulmonary resuscitation (CPR) was commenced on arrival of the paramedics and she was intubated and ventilated (figure 1). Return of spontaneous circulation was achieved in the emergency department following a total of 45 min of CPR. No clear cause of her arrest was identified. She was transferred to the intensive care unit (ICU) for post-arrest management.
Figure 1
Initial chest radiograph following return of spontaneous circulation, with endotracheal tube present (included as a baseline for comparison).
Seizure activity off of sedation necessitated further investigation. Her CT head was unremarkable, but her lumbar puncture showed features in keeping with meningitis. She was therefore treated with antibiotics and antiepileptics. Her cerebrospinal fluid viral PCR and blood HIV tests were negative.
Although appropriate seizure control was achieved,...
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Naclerios V sign and continuous diaphragm sign after endoscopy
Description
An otherwise healthy 72-year-old woman presented with dyspnoea and systemic subcutaneous emphysema. She had undergone upper endoscopy, in which duodenal ulcer was found. The community hospital where the endoscopy was conducted transferred her to our tertiary hospital for further diagnosis and management. On arrival, she complained of severe difficulty in breathing; massive subcutaneous emphysema on her chest to the feet was observed on palpation. Chest X-ray image showed Naclerio's V sign (figure 1A, black arrow) and continuous diaphragm sign (figure 1A, white arrows). CT scan confirmed massive subcutaneous and mediastinal emphysema with pneumothorax, pneumopericardium and free air in retroperitoneal space (figure 1B,C). Emergent laparotomy revealed duodenal perforation, 9 mm in diameter at the descending part of duodenum (figure 1D, white arrow), and was surgically repaired. After the surgery, the emphysema gradually disappeared in weeks and had not recurred at 6-month follow-up.
...https://ift.tt/2PWjUKz
Hypertrophic pyloric stenosis following repair of oesophageal atresia and tracheo-oesophageal fistula in a neonate
Development of hypertrophic pyloric stenosis (HPS) after a few weeks of repair of an oesophageal atresia (OA) and tracheo-oesophageal fistula (TOF) is a rare condition in early infancy. Although vomiting or feeding intolerance in operated cases of OA+TOF are attributed to oesophageal stricture, gastro-oesophageal reflux and oesophageal dysmotility, it may also be caused by HPS. Herein, we report a newborn infant who had OA and TOF operation on day 2 of life and diagnosed to have HPS at 15th day of age. Even though it is a rare anomaly, HPS should be kept on mind in the presence of persistent vomiting following repair of OA.
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Primary renal angiosarcoma: a diagnostic and therapeutic challenge
Primary renal angiosarcoma is an exceedingly rare and aggressive neoplasm. Although it may occur in youth, this tumour is frequently reported in the sixth and seventh decades of life. The clinical presentation is frequently varied. Pathogenesis remains largely unknown and it has overlapping features with other tumours of the kidney. Current treatment options include variable combinations of surgery, chemotherapy and radiotherapy. Reports regarding the disease prognosis and natural history are limited. In this article, we chronicle the case of a patient with primary renal angiosarcoma presenting at an advanced stage as a widely metastasised tumour. Additionally, we undertake here a brief literature review highlighting the rarity and aggressiveness of this condition, its poor prognosis, and the lack of specific management guidelines.
https://ift.tt/2PWjTGv
Intestinal obstruction with a twist: a rare case of congenital portal vein aneurysm causing intestinal obstruction
Bilious vomiting is often a presenting feature of upper intestinal obstruction in newborn. We present a case of intestinal obstruction in a newborn baby caused by abnormal vascular band arising from portal vein aneurysm in association with a midgut volvulus. Congenital anomalies of portovenous system are very rare, and it usually presents with portal hypertension in late infancy or childhood. In this particular child, the portal vein aneurysm contributed to intestinal obstruction due to both a failure of intestinal rotation and a mechanical band over the transverse colon.
https://ift.tt/2NWZOmj
Significant cephalad lead migration with use of externally powered spinal cord stimulator
Spinal cord stimulation has been an effective therapy for treatment of chronic low back pain over the last four decades. Over the years, there have been significant technological advances in the neuromodulation devices. Externally powered neuromodulation devices, that do not require an internal pulse generator (IPG) implantation, have recently been approved for treatment of chronic pain and the data on potential pitfalls and unforeseen complications with these devices is minimal. Here, we report a case of a 60-year-old woman with chronic back pain who underwent the implantation of one of such devices and developed complication that required neurosurgical intervention. The epidural stimulator leads in the patient migrated cranially to the T2 level that required extensive neurosurgical exploration. We believe this is the first reported case of such significant cranial epidural lead migration with the use of neurostimulation devices and demands more research into the safety of externally powered neurostimulation devices.
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Intrahepatic sarcomatoid cholangiocarcinoma
Sarcomatoid carcinoma is a rare tumour composed of intermingled malignant epithelial and mesenchymal cells, and it has been reported in various organs including the liver. Sarcomatoid cholangiocarcinoma (CCC) is an extremely rare liver primary tumour. Here, we report a case of an elderly man who was admitted to our hospital after head trauma. He performed a head CT that diagnosed cerebral metastasis. On abdominal CT, he presented a 10x8x9 cm-sized hypodense liver mass in the VII and VIII segments, with peripheral enhancement. Histological and immunohistochemical examination of the tumour showed a malignant neoplasm with both carcinomatous and sarcomatous components and positive expression of cytokeratin and vimentin antibodies. The patient was diagnosed with intrahepatic sarcomatoid CCC at an advanced stage and died 45 days after the diagnosis. We emphasise the importance of immunohistochemistry which may provide a clue to proper diagnosis.
https://ift.tt/2O7mCzW
Case of colonic mucosal Schwann cell hamartoma and review of literature on unusual colonic polyps
Mucosal Schwann cell hamartomas (MSCH) are benign mesenchymal tumours rarely seen in the gastrointestinal tract. They occasionally present as incidental sessile polyps during colonoscopy. A 55-year-old asymptomatic female patient with a medical history of multiple sclerosis presented for a screening colonoscopy. A 5 mm low-risk tubular adenoma was noted in the caecum, and a second 5 mm polyp was found in the ascending colon. Histopathology of the ascending colon polyp showed proliferation of spindle cells without ganglion cells in the lamina propria. Immunohistochemical findings are compatible with an MSCH. Surveillance colonoscopy was scheduled in 5 years based on the presence of a single low-risk tubular adenoma.
https://ift.tt/2PXrxAn
Does Fracture Pattern Influence Functional Outcomes in the Management of Bilateral Mandibular Condylar Injuries?
Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0038-1668500
The purpose of this study was to compare the functional outcomes of different types of bilateral mandibular condylar fractures. This was a retrospective study of patients with bilateral mandibular condylar fractures at a level-1 trauma center over a 15-year period. The primary predictor variable was fracture pattern, classified as type I (bilateral condylar), type II (condylar–subcondylar), or type III (bilateral subcondylar). Secondary predictor variables were demographic, injury-related, and treatment factors. Bivariate associations between the predictors and complication rates were computed; a multiple logistic regression model was utilized to adjust for confounders and effect modifiers. Thirty-eight subjects with bilateral condylar injuries met the inclusion criteria. The sample's mean age was 37.6 + 18.2 years, and 16% were female. The most common mechanisms of injury were motor vehicle collisions (53%) and falls (29%). Seventy-four percent had associated noncondylar mandibular fractures, and 32% of cases had concomitant midface fractures. Fifty-three percent of cases were classified as type I, 21% as type II, and 26% as type III. Ten subjects (26%) were managed with open reduction and internal fixation. The average length of follow-up was 4.5 + 6.3 months. After adjusting for confounders and effect modifiers, the type of fracture was a significant predictor of functional complications with type II injuries having the highest likelihood of a poor functional outcome (odds ratio: 7.77, 95% confidence interval: 1.45–41.53, p = 0.02). Asymmetric bilateral mandibular condylar fractures may be associated with an increased risk of poor functional outcomes.
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Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Article in Thieme eJournals:
Table of contents | Abstract | Full text
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Visualization and quantification of tongue movement during articulation: is ultrasound a valid alternative to magnetic resonance imaging?
Quality of life in tumour patients following combined ablative and reconstructive head and neck surgery varies significantly. This is at least partially due to differences in speech and swallowing function. A tool to objectively evaluate articulation by magnetic resonance imaging (MRI) has now been tested alongside ultrasound examination.
https://ift.tt/2pqKQqy
What surgical approach has the lowest risk of the lower lid complications in the treatment of orbital floor and periorbital fractures? A frequentist network meta-analysis
Evidence on the best surgical approach with the lowest lower lid complications (LLCs) in the treatment of orbital floor (OF) and periorbital fractures (POFs) is limited because of the absence of head-to-head studies. We performed this network meta-analysis (NMA) to compare various surgical approaches in treatment of OFs and POFs, with respect to LLCs.
https://ift.tt/2pr4rXO
Advantages of performing mentoplasties with customized guides and plates generated with 3D planning and printing. Results from a series of 23 cases
To evaluate the benefits of performing mentoplasty using custom guides and plates in a series of 23 patients.
https://ift.tt/2I3gCT7
Risk factors for cervical lymph node metastasis in endoscopically resected superficial hypopharyngeal cancers
Hypopharyngeal cancer is a head and neck cancer with a poor prognosis, and most cases show metastases on diagnosis. Cervical lymph node (LN) metastasis is a poor prognostic factor in hypopharyngeal cancer patients. The identification of risk factors for LN metastasis can help guide surgical treatment strategies for these patients.
https://ift.tt/2QPRiUD
Penicillin minor determinants: History and relevance for current diagnosis
To review the history of the penicillin minor determinants and evaluate their relevance for current diagnosis.
https://ift.tt/2DmGMS4
Cytokine levels in persistent skin lesions of adult-onset Still disease
To the Editor: Adult-onset Still disease (AOSD) is an inflammatory disease characterized by fever, polyarthritis, and skin inflammation, with increased serum levels of interferon-γ (IFN-γ), interleukin 1β (IL-1β), IL-18, IL-6, tumor necrosis factor-α, IL-8, IL-2 receptor, C-X-C motif chemokine 10, and C-X-C motif chemokine 13 (CXCL13).1 The cutaneous manifestations of AOSD include the classic evanescent skin eruption (ESE) and atypical persistent skin eruptions (APSEs), the latter possibly being related to more severe AOSD forms.
https://ift.tt/2I4pzf5
Anesthesia Safety in Otolaryngology
This article highlights the important relationship between the otolaryngologist and anesthesiologist, focusing on intraoperative patient safety for otolaryngologic surgery. In addition, consideration of preoperative history, physical examination, and potential postoperative complications helps guide the otolaryngologist and anesthesiologist in formulating an appropriate and collaborative management strategy.
https://ift.tt/2xEM4SV
Simulation Saves the Day (and Patient)
Surgeons can use simulation to improve the safety of the systems they work within, around, because of, and despite. Health care is a complex adaptive system that can never be completely knowable; simulation can expose aspects of patient care delivery that are not necessarily evident prospectively, during planning, or retrospectively, during investigations or audits. The constraints of patient care processes and adaptive capacity of health care providers may become most evident during simulations conducted "in situ" using real teams and real equipment, in actual patient care locations.
https://ift.tt/2QN8LNr
Patient Safety and Quality for Office-Based Procedures in Otolaryngology
Office-based procedures have increased in frequency with the recent changes in the current health care climate prioritizing improved efficiency and greater value in the care that is delivered. This article focuses on patient safety and quality issues that are specific to procedures in the office setting of an Otolaryngologist. Specific topics are categorized into preprocedure planning, procedural execution, and postprocedure follow-up. Several best practice recommendations are included to promote and simplify the integration of these quality and safety measures into every office setting.
https://ift.tt/2xF8KlT
The molecular mechanisms of increased radiosensitivity of HPV-positive oropharyngeal squamous cell carcinoma (OPSCC): an extensive review
Abstract
Head and neck carcinomas (HNCs) collectively are the sixth most common cancer with an annual incidence of about 400,000 cases in the US. The most well-established risk factors for HNCs are tobacco and alcohol abuse. With the increasing public awareness, the incidence of HNCs is decreasing. But there is an increasing incidence of oropharyngeal squamous cell carcinoma (OPSCC) has been observed during the last decade. This phenomena is associated with persistent infection with high-risk HPV. HPV associated OPSCC patients tend to be younger males of high socioeconomic status. The increasing incidence causes a significant loss to social resources, given that it's reported that HPV associated OPSCC represents about 60% of OPSCC cases. There is a growing amount of data supporting the hypothesis that HPV-associated OPSCC has a better survival rate due to a higher sensitivity to chemotherapy and radiotherapy as compared to HPV-unrelated OPSCC. Although the HPV positivity is associated with increased radio-sensitivity, the underlying mechanisms are not yet fully understood. This review summarizes the current knowledge on the effects of HPV infection and its carcinogenesis on the radiosensitivity of OPSCC, from the molecular to histologic level, providing a comprehensive insight of this special tumor entity.
https://ift.tt/2MXNi1q
A new rocuronium formulation not causing vascular pain in a flexor reflex model of anesthetized rats
Abstract
Purpose
Intravenous administration of the brand formulation of rocuronium bromide, currently used as a muscle relaxant, has been associated with vascular pain accompanied by withdrawal movements of the arm and wrist. The purpose of this study was to identify the cause of vascular pain induced by the brand formulation and to develop a new rocuronium formulation, not causing vascular pain, using a vascular pain-evoked flexor reflex response model of anesthetized rats.
Methods
A rat flexor reflex model, monitored by electromyography, was used to evaluate a flexor reflex response as the index of vascular pain. A catheter for drug administration was inserted into the superficial caudal epigastric artery. A needle electrode was inserted into a muscle in the femoral area to obtain an electromyogram (EMG) value. The integrated EMG values obtained after the administration of each test drug were compared to the baseline value and quantified.
Results
The acetate buffer contained in the solvent could cause flexor reflex response. Furthermore, the flexor reflex response increased in an acid concentration-dependent manner. Based on these results, we prepared a new rocuronium formulation using a low-acid-concentration buffer solution and found that it decreased the integrated EMG value in the rat model. The integrated EMG value acquired using the brand formulation was reduced by pretreatment with the TRPA1 channel inhibitor.
Conclusion
Our findings suggest that the high acid concentration in the brand formulation buffer solution is the cause of vascular pain. The rocuronium formulation developed using a low-acid-concentration buffer solution might help eliminate vascular pain in the clinic.
https://ift.tt/2DiGmfq
Normocomplementaemic urticarial vasculitis: effective treatment with omalizumab
We report two patients with normocomplementaemic urticarial vasculitis with impressive response to omalizumab. This contrasts recent reports on hypocomplementaemic urticarial vasculitis syndrome, highlighting ...
https://ift.tt/2MSxTiw
Co-occurrence of mycotoxins in maize food and maize-based feed from small-scale farms in Brazil: a pilot study
Abstract
A limited survey was conducted to assess the co-occurrence of aflatoxins (AF) B1, B2, G1, and G2; fumonisins (FB) B1 and B2; ochratoxin A (OTA); zearalenone (ZEN); and deoxynivalenol (DON) in maize food (N = 26) and animal feed (N = 45) collected from 21 small-scale farms from the states of São Paulo (SP) and Santa Catarina (SC), Brazil. Samples evaluated were maize meal and maize flour for human consumption available in the farm households, and maize-based feed intended for broiler chicks, laying hens, and dairy cows. Analyses of mycotoxins were performed by ultra-performance liquid chromatography coupled with tandem mass spectrometry. The median levels of mycotoxins found in maize food were 2.5 μg/kg (total AF), 120 μg/kg (total FB), 13 μg/kg (ZEN), and 57 μg/kg (DON). All values were below the Brazilian tolerance limits, except for total FB in one sample of maize flour. In feed samples, median levels of total AF, total FB, ZEN, and DON were 100 μg/kg, 680 μg/kg, 160 μg/kg, and 200 μg/kg, respectively. The co-occurrence of two or more mycotoxins was confirmed in 35% and 51% of maize food and feed, respectively. Results indicate a low human exposure to mycotoxins in the small-scale farms evaluated and a higher exposure of farm animals to mycotoxins in the feed.
https://ift.tt/2MQJpuV
Traumatic arteriovenous fistula formation secondary to crush injury
Abstract
We describe a patient who suffered a crush injury after a motor vehicle accident leading to complex pelvic injuries complicated by an AV fistula. Traumatic arteriovenous (AV) fistulas from blunt, non-penetrating injuries are uncommon and rarely described in medical literature. A CT followed by pelvic angiogram performed by interventional radiology revealed a traumatic fistula which was then treated by embolization. Patient underwent exploratory laparotomy, craniotomy and open reduction internal fixation of pelvis and was stabilized prior to discharge to rehabilitation.https://ift.tt/2xEMXuS
Acute anterograde intussusception as a late complication of distal gastric bypass
Abstract
Small bowel intussusception is an uncommon cause of adult intestinal obstruction after gastric bypass for morbid obesity. It usually affects the Roux or the common limb at the jejunojejunostomy site and is mainly retrograde. An altered motility of the Roux limb seems to be the main explanation for its developement. We report the case of a patient with a late acute anterograde intussusception after a previous distal Roux-en-Y gastric bypass. Clinical, radiological and operative findings are presented and surgical solutions described in the literature are reviewed.https://ift.tt/2QPfI0r
Large rib osteochondroma in a child in Aleppo, Syria
Abstract
Background
Osteochondromas are the most common tumors of the long bones in children. Osteochondromas can rarely be seen in the chest wall and they are usually diagnosed at a young age. They can be sporadic or part of the hereditary multiple exostoses. Case presentation
We report a 12-year-old boy, who presented with a hard and large mass in the chest wall. The mass grew slowly after the original resection. Diagnosis and treatment were delayed because of the war. Radiological examination showed a large calcified tumor pushing the upper lung lobe. He was treated surgically. Pathology confirmed the diagnosis of an osteochondroma with no evidence of malignancy. Conclusion
Osteochondroma occur most frequently in long bones next to the metaphysic. These tumors can also develop in unusual sites. Wide total excision with negative margins is important to prevent recurrence.https://ift.tt/2xHTSmK
Wilkie’s syndrome, a missed opportunity
Abstract
Wilkie's syndrome is a rare cause of duodenal obstruction that can easily be missed at clinical practice. It is characterized by nausea, abdominal pain and vomit. It usually affects young adults, and it's caused by a low aortomesenteric angle resulting in vascular compression of the duodenum. Symptoms could resemble many of the symptoms presented in a patient with a suspected eating disorder. The non-specificity of the clinical signs and symptoms can confuse, delay the diagnosis and expose the patient to potentially hazardous therapies. We report a case of a 20-year-old patient who presented to the emergency room with a history of intermittent vomiting and abdominal pain. He had been previously misdiagnosed with an eating disorder and received physiological therapy. Nonetheless, his pain persisted. After further evaluation with the use of imaging techniques, a low aortomesenteric angle was discovered. He underwent surgery and completely recovered. On follow up controls patient is well and he no longer had episodes of vomiting.https://ift.tt/2QPg8nt
Resorption behaviour of the articular surface dome and functional outcome after open reduction and internal fixation of mandibular condylar head fractures using small-fragment positional screws
Publication date: Available online 20 September 2018
Source: Journal of Cranio-Maxillofacial Surgery
Author(s): Wenko Smolka, Carl-Peter Cornelius, Carolin Lechler
Summary
Purpose
The aim of the study was to evaluate the resorption of the mandibular condylar head after open reduction and internal fixation of fractures with small-fragment screws and to evaluate the functional outcome.
Patients and Method
Forty-eight patients (55 condylar head fractures) underwent surgical treatment. All kinds of complications were recorded. In a subgroup of 20 patients, the average loss of bone height of the condylar head joint surface was gauged by measuring the vertical distances from 3 selected reference points of the fixation hardware to the vertex of the condyle in views of multiplanar radiographs after 6 months. Functional outcome was analysed by Helkimo index score.
Results
Complication rates were low. Osteosynthesis loosening occurred in 4 cases. The mean bone resorption along the condylar head joint surface in the subgroup of 20 patients (with 23 joints) was 0.7 mm. Functional outcome was rated as follows: 8 patients - good, 11 patients – slightly impaired, 1 patient - moderately impaired.
Conclusion
Open reduction and internal fixation of condylar head fractures with small-fragment screws leads to reliable results in terms of joint surfaces relatively resistant to resorption and function. Low bone resorption on the joint surface of the condylar head can be expected.
https://ift.tt/2OFVOU9
Effects of Systemic Erythropoietin Treatment and Heterogeneous Xenograft in Combination on Bone Regeneration of a Critical-Size Defect in an Experimental Model
Publication date: Available online 20 September 2018
Source: Journal of Cranio-Maxillofacial Surgery
Author(s): Nurettin Diker, Hande Sarican, Alev Cumbul, Ertugrul Kilic
Summary
The aim of the present study was to evaluate the effects of systemic EPO treatment alone or in combination with xenogenic bone graft augmentation on bone regeneration. Eleven adult male Sprague-Dawley rats were used in the present study. Rats were subjected to bilateral 5 mm critical size bone defects on the parietal bones under general anaesthesia. Right parietal bone defects were augmented with xenogenic bone graft and left parietal bone defect was left empty. Rats were randomly assigned for one of the two groups. One group of rats received (i) vehicle (n=6) and other group received (ii) EPO (500IU kg/day) (n=5). EPO treatment was continued for 28 days. Vascularization was analysed by immunohistochemical staining of CD31 (PECAM-1) and new bone formation was histomorphometrically evaluated. Xenogenic graft augmentation enhanced bone formation and vascularization significantly in either vehicle or EPO treated groups (p<0.05). Histomorphometric results of angiogenesis was similar in the EPO treated group and the control group. However, angiogenesis was significantly higher in the combination of systemic EPO treatment with graft augmentation than graft augmentation alone (p<0.01). Graft augmentation for treatment of critical size bone defects seems essential for proper bone healing. Results of the present study suggest that EPO potentiates the regenerative processes of augmented bone defects.
https://ift.tt/2NXL46E
Relapse tendency after BSSO surgery differs between 2D and 3D measurements: a validation study
Publication date: Available online 20 September 2018
Source: Journal of Cranio-Maxillofacial Surgery
Author(s): Yi Sun, Lei Tian, Heinz-Theo Luebbers, Constantinus Politis
Abstract
Bilateral sagittal split ramus osteotomy (BSSO) surgery is used to correct various dento-skeletal deformities. Clinical outcomes are critically dependent on accurate and proper positioning of skeletal units created by BSSO. Monitoring skeletal changes postoperatively is a major part of follow-up. Between January 2015 and December 2015, 24 patients underwent BSSO surgery without any other segmental osteotomy (mean age, 29.9 ± 14.2 [range, 17–67] years; 18 females). Cephalometric X-rays and cone-beam computed tomography scans were performed 6 weeks and 12 months postoperatively. We compared the position displacement at three mandibular points at both postoperative time points using 2- and 3-dimensional analysis separately and examined the relationship between these methods. Horizontally in at least in 14/24 patients, the difference between 2-dimensional and 3-dimensional measurements was >1 mm. Vertically in at least in 16/24 patients, the difference between 2-dimensional and 3-dimensional measurements was >1 mm. A scatter plot with orthogonal regression indicated the relationships between the 2-dimensional measurement and the corresponding 3-dimensional measurement in the horizontal and vertical directions. Skeletal relapse with 2-dimensional-measurements differed significantly from the 3-dimensional measurements. There was no evidence of a relationship between the two types of measurements regarding the direction and the location of the landmarks.
https://ift.tt/2OHw7m8
The association with variables of fibular reconstructed mandible and bite force in oral cancer patients with dental implant rehabilitation
Publication date: Available online 20 September 2018
Source: Journal of Cranio-Maxillofacial Surgery
Author(s): Yi-Fang Huang, Chung-Ta Chang, Chih-Hsin Muo, Hsiang-Hsi Hong, Yu-Fu Shen, Chia-Chang Lin, Shih-Ping Liu
Summary
Purpose
The aim of this study was to investigate how the physical variables of fibular reconstructed mandibles with dental implants affects the relative bite force in oral cancer patients.
Materials and Methods
Over 7 years of follow-up, 13 oral cancer patients were enrolled who included 51 successful implants in the fibular flap. The tactile sensor analyzer evaluated the bite force. The crown-implant ratio, fibular, and rehabilitated dental length were measured using radiographic images. Linear regression was used to analyze the bite force related to the variables of the implants in the fibular reconstructed mandible.
Results
Even when the results showed no statistical significance (P >0.05), increasing the crown-implant ratio, length of the fibular flap, and implant prosthetic reconstructed dentition had a tendency to decrease the bite force (estimate from −0.08% to −4.27%); there was a positive trend of occlusal force and the length of rehabilitative dentition compared with the dental antagonist (estimate = 6.95).
Conclusion
In this study, the crown-implant ratio, implant dentition, and fibular flap length revealed no significant impact on the bite force or implant success in oral cancer patients; however, a trend to weaken the bite force was suggested once the numerical values of these variables increased.
https://ift.tt/2O1S2rb
Cleft palate formation after palatal fusion occurs due to the rupture of epithelial basement membranes
Publication date: Available online 20 September 2018
Source: Journal of Cranio-Maxillofacial Surgery
Author(s): Chisato Sakuma, Hideto Imura, Tomohiro Yamada, Toshio Sugahara, Azumi Hirata, Yayoi Ikeda, Nagato Natsume
Abstract
2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) induces cleft palate and hydronephrosis in the mouse embryo. Cleft palate occurs due to failure in palatal grow, but the underlying mechanisms are unclear. We investigated the mechanisms of cleft palate development in TCDD-exposed mouse embryos. We administered olive oil (control group) or TCDD diluted in olive oil (40 μg/kg) via gastric tubes to pregnant mice on gestational day (GD) 12. Embryos of control and TCDD-exposed groups were removed from pregnant mice on GD 14 and GD 15, respectively. One mouse embryo from the control group had anteroposterior palatal fusion. Palatal fusion was observed in three TCDD-exposed mouse embryos. Palates of TCDD-exposed mice fused from the interior to the middle of the palates, while the palates were separated in the posterior region. The middle of the embryonic palatal shelves in TCDD-exposed animals was narrow and split at the fusional position. At this position, palatal and blood cells were dispersed from the palatal tissue and the epithelium was split, with a discontinuous basement membrane. The results suggest that decreased intercellular adhesion or insufficient tissue strength of the palatal shelves may be involved in the development of cleft palate following palatal fusion.
https://ift.tt/2OEHPhC
Vascular malformations of the orbit (lymphatic, venous, arteriovenous): Diagnosis, management and results
Publication date: Available online 20 September 2018
Source: Journal of Cranio-Maxillofacial Surgery
Author(s): Giacomo Colletti, Federico Biglioli, Tito Poli, Margherita Dessy, Marco Cucurullo, Mario Petrillo, Stavros Tombris, Milton Waner, Enrico Sesenna
Summary
Vascular malformations are often found inside the orbit. Isolated venous malformations (frequently misnamed as cavernous hemangiomas) are the most frequent among these. However, also lymphatic and arteriovenous malformations can affect the orbit. The complex anatomy of the orbit and the fact that its content easily suffers from compartmental syndrome explain why treating orbital vascular malformations can be challenging and technically demanding.In this study, two institutions have retrospectively collected their cases, consisting in a total of 69 vascular malformations of the orbit. Each type of malformation has been evaluated separately in terms of diagnosis, indications for treatment, techniques and outcomes. Moreover, the authors have analyzed in detail venous malformations, identifying three different types, named orbital venous malformation (OVM) 1, 2 and 3. These behave differently from each other, and a prompt differential diagnosis is mandatory to pose correct indications, minimize risks and improve results.
Overall, surgery was the technique of choice for OVM1, microcystic lymphatic malformations (LM) and arteriovenous malformations (AVM). A pure transnasal approach with mass removal and reconstruction of the medial wall with polyethylene sheets was chosen for OVM1 (intra- or extraconal) located in the medial or superomedial compartment.
Sclerotherapy had a role in treating macrocystic LM and OVM3.
https://ift.tt/2NZrKWI
The Burden of Sinusitis in Hematologic Transplant Patients: A National Perspective
The Laryngoscope, EarlyView.
https://ift.tt/2PTJqAg
Using UV light for adhesive remnant removal after debonding of orthodontic accessories
https://ift.tt/2OLcmKN
Systemic melatonin application increases bone formation in mandibular distraction osteogenesis
Abstract This study aimed to investigate the effects of different doses of systemic melatonin application on new bone formation during mandibular distraction osteogenesis (DO) in rats. Mandibular DO was performed on 30 adult female Sprague-Dawley rats, which were randomly divided into three groups: control group (CNT), melatonin dose 1 (MLT-D1), and melatonin dose 2 (MLT-D2). A five-day latent waiting period and a ten-day distraction phase followed the surgery. After the surgery, rats from the MLT-D1 and MLT-D2 groups received 25 and 50 mg/kg melatonin, respectively, at 7, 14, 21, 28, and 35 days. The animals were euthanised 28 days after distraction, i.e. at 43 days after surgery. Histological and histomorphometric analyses revealed that the distracted bone area was completely filled with new bone formation in all three groups. The MLT-D2 group exhibited the most new bone formation, followed by MLT-D1 and CNT. The melatonin groups had more osteoclasts than the CNT (p < 0.05). The number of osteoblasts was higher in the melatonin groups than in the CNT group, and the MLT-D2 had more osteoclasts than the MLT-D1 group (p < 0.05). Finally, the osteopontin (OPN) and vascular endothelial growth factor (VEGF) levels were higher in the melatonin groups than in the CNT group, and the MLT-D2 had higher OPN and VEGF levels than the MLT-D1 (p < 0.05). This study suggests that systemic melatonin application could increase new bone formation in DO.
https://ift.tt/2O2w7QC
Effect of Reversed Tracking Method for Identification of EBSLN in Thyroid Surgery
Conditions: Thyroid Cancer; Recurrent Laryngeal Nerve Injuries
Intervention: Procedure: Reversed Tracking Method
Sponsor: Fujian Medical University
Not yet recruiting
https://ift.tt/2xGNn3B
Intervention: Procedure: Reversed Tracking Method
Sponsor: Fujian Medical University
Not yet recruiting
https://ift.tt/2xGNn3B
Correction to: Complement in the pathogenesis of Alzheimer’s disease
The presentation of Fig. 2 was incorrect.
https://ift.tt/2ptz2nE
Prevalence of potential contact allergens in baby cosmetic products
Clinical and Experimental Dermatology, EarlyView.
https://ift.tt/2OIjZBF
Real-world-Datenquellen für die Versorgungsforschung zum Hautkrebs
Zusammenfassung
Dermatologische Versorgungsforschung mit dem Ziel der Verbesserung von Prävention, effizienter Diagnostik und Therapie des Hautkrebses braucht Real-world-Daten aus allen Sektoren der Versorgung. Der Beitrag liefert eine Übersicht aktuell verfügbarer, relevanter Real-world-Datenquellen und ihres Nutzungspotenzials und führt beispielhaft Ergebnisse vorliegender Studien auf: Sekundärdatenanalysen mit Abrechnungsdaten der gesetzlichen Krankenkassen wurden genutzt, um u. a. die Teilnahmerate am gesetzlichen Hautkrebsscreening abzuschätzen. Diese betrug im Zweijahreszeitraum ca. 31 %, war in den westlichen Bundesländern höher als in den östlichen und bei Frauen höher als bei Männern. Für die dermatologische Versorgungsplanung stehen regionale Daten in Kombination mit sozialstrukturellen und soziodemografischen Indikatoren zur Verfügung, und die Analyse verweist auf einen Zusammenhang mit der Hautkrebsprävalenz. Primäre Daten sind verfügbar und notwendig zur Erfassung patientenberichteter Endpunkte sowie der arztseitigen Bewertung der Versorgung von Hautkrebspatienten. Umfangreiche histopathologische Datenbanken erfassen neben klinischen auch soziodemografische Parameter und deuten auf einen Zusammenhang von Diagnose- bzw. Therapiezeitpunkt mit dem Versicherungsstatus und Wohnortmerkmalen hin. Neben dem Nutzungspotenzial werden spezifische Limitationen der Datenquellen aufgeführt.
https://ift.tt/2PUgc46
A Critical Need: Increasing Interest in the Field of Allergy and Immunology in Medical Students and Residents
Publication date: Available online 20 September 2018
Source: Annals of Allergy, Asthma & Immunology
Author(s): Rebecca Scherzer
https://ift.tt/2MS0NQb
Omalizumab as single-dose therapy for vernal keratoconjunctivitis
Publication date: Available online 20 September 2018
Source: Annals of Allergy, Asthma & Immunology
Author(s): Rachel Simpson, Jason K. Lee
https://ift.tt/2ptr7a2
Prevalence of self-reported drug hypersensitivity reactions among Lithuanian children and adults
Publication date: Available online 20 September 2018
Source: Allergologia et Immunopathologia
Author(s): V. Kvedariene, B. Sitkauskiene, L. Tamasauskiene, O. Rudzeviciene, V. Kasiulevicius, G. Nekrosyte, E.R. Gomes, P. Demoly
Abstract
Introduction and objectives
Drug hypersensitivity reactions (DHRs) are the adverse effects of drugs that, when taken at doses generally tolerated by normal subjects, clinically resemble allergy. We aimed to assess the prevalence of self-reported DHRs among Lithuanian children and adults and to identify possible risk factors.
Materials and methods
A cross-sectional survey of a population visiting their general practitioners in Vilnius and Kaunas regions of Lithuania was performed. Thirty-five questions on drug allergy symptoms, in addition, food, pollen allergy and family history were included.
Results
3222 (60.0%) children and 2148 (40.0%) adults were included in the study. 7.9% of children and 13.8% of adults reported a DHR for at least one drug (p < 0.001). 69.8% of children and 47.3% of adults, who indicated DHRs, had skin symptoms. Rate of anaphylaxis was similar in both groups (about 10%). 4.5% of children and 7.3% of adults had DHRs induced by antibiotics and this was the most implicated group of drugs. Significant self-reported risk factors for DHRs were family history of DHRs (OR = 6.007, 95%CI 4.756–7.587), pollen allergy (OR = 2.0, 95%CI 1.573–2.544), food allergy (OR = 1.92, 95%CI 1.505–2.448), female gender (OR = 1.439, 95%CI 1.187–1.744) and age (OR = 1.017 in favour of adults, 95%CI 1.013–1.021).
Conclusions
The prevalence of self-reported DHRs in Lithuania is higher among adults than children. Drug-induced skin reactions were the predominant symptom in both groups. Besides female gender and age, a positive family history of DHR and presence of pollen or food allergy may be associated with DHR.
https://ift.tt/2pr7fnK
Molecular diagnostics improves diagnosis and treatment of respiratory allergy and food allergy with economic optimization and cost saving
Publication date: Available online 20 September 2018
Source: Allergologia et Immunopathologia
Author(s): S. Peveri, S. Pattini, M.T. Costantino, C. Incorvaia, M. Montagni, C. Roncallo, D. Villalta, E. Savi
Abstract
Background
Component resolved diagnosis (CRD) allows to precisely identify the sensitization to specific molecules of a given allergenic source, resulting in an important improvement in clinical management, particularly of polysensitized subjects. This will end in the correct prescription of allergen immunotherapy (AIT) for respiratory allergy and in adequate avoidance diets or prescription of self-injectable adrenaline in food allergy.
Objective
The aim of this multicenter, real life study is to evaluate the percentage change of the diagnostic-therapeutic choice in polysensitized patients with respiratory allergy and in patients with food allergy, after using CRD compared to a first level diagnosis, along with an economic analysis of the patient's overall management according to the two different approaches.
Methods
An overall number of 462 polysensitized patients, as suggested by skin prick tests (SPT), and with clinical symptoms related to a respiratory (275 pts) or food (187 pts) allergy, were recruited. All patients underwent CRD for specific IgE against food or inhalant recombinant molecules, which were chosen according to medical history and positivity to SPT. The first diagnostic-therapeutic hypothesis, based only on medical history and SPT, was recorded for each patient while the final diagnostic-therapeutic choice was based on the results from CRD. The rate of change of the diagnostic-therapeutic choice from the first hypothesis to the final choice was statistically evaluated. The economic impact of CRD on the overall management of the allergic patients was analyzed to evaluate whether the increase in the diagnostic costs would be compensated and eventually exceeded by savings coming from the improved diagnostic-therapeutic appropriateness.
Results
An approximate 50% change (k index 0.54) in the prescription of AIT for respiratory allergy as well as a change in the prescription of self-injectable adrenaline (k index 0.56) was measured; an overall saving of financial resources along with a higher diagnostic-therapeutic appropriateness was also detected.
Conclusion
There is moderate agreement concerning prescription of AIT and self-injectable adrenaline before and after performing CRD: this highlights the usefulness of CRD, at least in polysensitized patients, in indicating the risk assessment and therefore the correct therapy of respiratory and food allergy, which results in a cost-saving approach.
https://ift.tt/2MTTN5c
Omentin-1 protects against bleomycin-induced acute lung injury
Publication date: November 2018
Source: Molecular Immunology, Volume 103
Author(s): Yan Zhou, CaiXia Hao, Chen Li, XiaoTing Huang, XiaoHong Li, YiTing Tang, YanHong Huang, SiYuan Tang, Wei Liu, DanDan Feng, JianPing Xu, ShaoJie Yue, Hui Xie, ZiQiang Luo
Abstract
Acute lung injury (ALI) is characterized by inflammatory cell infiltration, macrophage activation, and excessive pro-inflammatory cytokine production. Bleomycin (BLM) is widely used to induce acute lung injury (ALI) and fibrosis in murine models. Intratracheally administration of BLM leads to the early stage of inflammatory response and the late stage of collagen deposition. Omentin-1 exerts an anti-inflammatory role in reducing tumor necrosis factor α (TNF-α)-induced cyclooxygenase-2 expression in endothelial cells and attenuating lipopolysaccharide (LPS)-induced ALI. However, the role of omentin-1 in BLM-induced ALI remains unclear. The aim of this study is to examine the effects of omentin-1 on BLM-induced ALI. We found that omentin-1 was decreased in lungs of BLM-induced ALI mice. Omentin-1 overexpression mediated by adenovirus alleviated lung injury and maintained the integrity of the alveolar septa. Omentin-1 overexpression also remarkably decreased the aggregation of neutrophil and macrophages activation, the expression of monocyte chemotactic protein 1 (MCP-1), and down-regulated expression of interleukin 1β (IL-1β) in lungs of BLM-induced ALI mice. Furthermore, we observed that omentin-1 reduced oxidative stress and suppressed the activation of NF-κB pathway in BLM-induced ALI and LPS-induced macrophages activation. Together, our findings indicated that omentin-1 protected mice from BLM-induced ALI may through reducing inflammatory cells recruitment and macrophages activation via alleviation of oxidative stress and NF-κB pathway. Thus, therapeutic strategies aiming to restore omentin-1 levels may be valuable for the prevention of BLM-induced ALI.
https://ift.tt/2O56grc
GM-CSF intrinsically controls eosinophil accumulation in allergic airway inflammation
Publication date: Available online 20 September 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Samuel Philip Nobs, Merve Kayhan, Manfred Kopf
Abstract
Background
Eosinophils are a therapeutic target in asthma and GM-CSF has been suggested to control various aspects of eosinophil biology including development, function and survival. However, to date the role of GM-CSF signaling in eosinophils in vivo is largely unclear.
Objective
We sought to elucidate the role of GM-CSF signaling in asthmatic inflammation.
Methods
Wild-type and wild-type alveolar macrophage-reconstituted GM-CSF receptor α (Csf2ra)-deficient mice were subjected to different models of airway inflammation to evaluate the impact of GM-CSF signaling deficiency on asthmatic inflammation in general and on eosinophils in particular
Results
We demonstrate that GM-CSF signaling, while being largely dispensable for eosinophil development in steady-state, intrinsically promotes the accumulation of eosinophils in the lung during allergic airway inflammation. In contrast, chitin-induced eosinophil accumulation in the peritoneal cavity occurs independent of GM-CSF indicating organ specificity. We show that GM-CSF induces chemokinesis and promotes eosinophil survival in vitro, which likely contribute to eosinophil accumulation in the airways in vivo.
Conclusion
GM-CSF is a lung-specific regulator of eosinophil biology in pulmonary allergic inflammation.
Graphical abstract
https://ift.tt/2pqJXhZ
Characterizing drug-induced capillary leak syndromes using the Wold Health Organization VigiBase
Publication date: Available online 20 September 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Philippe Mertz, Bénédicte Lebrun-Vignes, Joe-Elie Salem, Laurent Arnaud
https://ift.tt/2MQ261P
FPIES: increased prevalence of this great unknown. Results of PREVALE study
Publication date: Available online 20 September 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): S. Bellón, J. García, P. Torija, S. Díaz, M. Muñoz, P. Alonso, T. Bracamonte, S. Quevedo, L.Á. Echeverría
https://ift.tt/2pqJP1Z
Oral vitamin D3 5000 IU/day as an adjuvant in the treatment of atopic dermatitis: a randomized control trial
International Journal of Dermatology, EarlyView.
https://ift.tt/2xEIgBc
Gardner‐Diamond syndrome: a systematic review of treatment options for a rare psychodermatological disorder
International Journal of Dermatology, EarlyView.
https://ift.tt/2QNZeFV
Serum irisin: A prognostic marker for severe acne vulgaris
Journal of Cosmetic Dermatology, EarlyView.
https://ift.tt/2xrikK8
SWEET SYNDROME FOLLOWING A POSITIVE MANTOUX TEST DUE TO PULMONARY TUBERCULOSIS
Dermatologic Therapy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2xBh0n7
Topical diltiazem for ulceration of striae distensae associated with bevacizumab therapy
Dermatologic Therapy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2QOVljX
“Chemical” surgery in treating basal cell carcinoma in elderly
Dermatologic Therapy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2xGEEOS
A Randomized Trial of Early Endovenous Ablation in Venous Ulceration: a critical appraisal
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2psSG3g
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