Sporadic pemphigus foliaceus and class II human leucocyte antigen allele associations in the white British and Indo‐Asian populations in the UK

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2Pdt9pG

Screening and diagnosis of oral cancer: a critical quality appraisal of clinical guidelines

Abstract

Objectives

To assess the quality of clinical practice guidelines (CPGs) on screening and diagnosis of oral cancer and to describe the characteristics of their recommendations.

Materials and methods

We systematically searched EMBASE, MEDLINE, CPG' websites, and dentistry and oncology scientific societies to identify CPGs that were related to screening and diagnosis of oral cancer. The quality of selected CPGs was independently assessed by four appraisers using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. The inter-appraiser agreement was assessed. We performed a descriptive analysis of the recommendations included in the selected CPGs.

Results

Eight CPGs were selected. The overall agreement among reviewers was considered very good (ICC: 0.823; 95% CI: 0.777–0.861). The median scores of the six AGREE II domains were as follows: "scope and purpose" 97.9% (IQR: 96.2–100.0%); "stakeholder involvement" 86.1% (IQR: 69.8–93.1%); "rigor of development" 75.3% (IQR: 64.2–94.3%); "clarity of presentation" 91.7% (IQR: 82.6–94.4%); "applicability" 53.1% (IQR: 19.3–74.2%); and "editorial independence" 83.3% (IQR: 67.2–93.8%). Four CPGs were assessed as "recommended", four "recommended with modifications", and none "not recommended". Twenty-three recommendations were provided, mostly with a low or very low level of evidence.

Conclusion

The methodological quality of CPGs on screening and diagnosis of oral cancer is moderate. The "applicability" domain scored the lowest. Most recommendations were based on a low o very low level of evidence.

Clinical relevance

Greater efforts are needed to provide healthcare based on high-quality evidence-based CPGs in this field.

https://ift.tt/2O08qZX

Vitamin B12 deficiency-induced pseudothrombotic microangiopathy without macrocytosis presenting with acute renal failure: a case report

Vitamin B12 deficiency-induced thrombotic microangiopathy, known as pseudothrombotic microangiopathy, is a rare condition which resembles the clinical features of thrombotic thrombocytopenic purpura but requires ...

https://ift.tt/2Njclfb

Swept source optical coherence tomography and optical coherence tomography angiography in pediatric enhanced S-cone syndrome: a case report

Enhanced S-cone syndrome is an autosomal recessive retinal dystrophy related to a defect in a nuclear receptor gene (NR2E3) that leads to alteration in cells development from rod to S-cone. This retinal dystrophy...

https://ift.tt/2O1qXW4

Are spinal deformities in ancient dogs related to weight‐bearing? The importance of Fluctuating Asymmetry

International Journal of Osteoarchaeology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2xWbcFT

Investigation of high‐frequency hearing loss and outer hair cell function of the cochlea in patients with psoriasis: a case–control study

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2NdzIqJ

Differential expression of interferon‐induced genes and other tissue‐based biomarkers in acute graft‐versus‐host disease vs. lupus erythematosus in skin

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2Ndzv6V

Efficacy of localized hand and foot phototherapy: a review of patients treated in a teaching hospital setting

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2xTorXS

Public engagement lectures targeting prospective medical students: an opportunity for dermatology

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2xVhN3k

Risk factors for development of systemic lupus erythematosus in patients with cutaneous lupus: a retrospective review

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2Nh3ivq

Cutaneous hyperpigmentation and familial gastrointestinal stromal tumour associated with KIT mutation

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2xVhtBE

Acitretin as a successful treatment for Hailey–Hailey disease

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2Nhv1w3

The nose as the predominant site for pemphigus foliaceous

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2xVbEnH

Systematic review and meta‐analysis of prevalence of dermatological toxicities associated with vemurafenib treatment in patients with melanoma

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2NjpFR1

Penile necrobiosis lipoidica: case report and literature review

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2xTU4R8

A rare case of a tattoo‐induced morphoea reaction

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2NlgVdf

Cutaneous chromoblastomycosis effectively treated with local heat monotherapy

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2xTKgpU

Homocysteine plasma levels in patients affected by hidradenitis suppurativa: an Italian experience

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2NiSJrI

The effect of NB‐UVB on noncultured melanocyte and keratinocyte transplantation in treatment of generalized vitiligo using two different donor‐to‐recipient ratios

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2xVMuVZ

Effect of platelet‐rich plasma on proliferation and migration in human dermal fibroblasts

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2Nirldl

Effectiveness of short‐pulse width Nd:YAG in laser hair reduction

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2xVSkH3

Low‐fluence Q‐switched Nd:YAG laser for the treatment of melasma in Asian patients

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2NffQDr

Skin surface lipid differences in sensitive skin caused by psychological stress and distinguished by support vector machine

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2xUbddg

Reprogramming of mitochondrial metabolism by innate immunity

Johan Garaude

https://ift.tt/2NWVfJr

Hypereosinophilia successfully treated with the novel antihistamine bilastine

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2IwWmcK

Quantitative evaluation of skin shrinkage associated with non-invasive skin tightening: a simple method for reproducible linear measurement using microtattoos

Abstract

Non-invasive skin-tightening devices can induce thermal denaturation and skin shrinkage via externally applied radiofrequency emissions or high-frequency ultrasound. Therefore, the purpose of this study is to develop and test a method for measurement of skin reduction associated with application of such energy devices. Twenty-five healthy participants with mild to moderate skin laxity of the arms were enrolled. Pinpoint microtattoos were placed at each of the treatment sites to delineate two 6 × 12 cm rectangles per subject. A non-stretchable filament, tape and marking pen apparatus was used to measure the size of each rectangle before treatment and at follow-up visit by two blinded investigators. After randomization, one side received a single pass with a radiofrequency device (6.78 MHz), while the contralateral side received multiple passes. Participants underwent two treatment sessions to each side 2 weeks apart, and returned for follow-up 4 weeks after the second treatment. Length and area measurement were analyzed to assess precision and accuracy of measurements and to compare efficacy of treatment between pre- and post-treatment. Concordance correlation coefficients (CCC) demonstrated substantial inter-investigator reliability and precision in length measurements (CCC, 0.94 to 0.98 in pre-treatment; 0.95 to 0.98 in post-treatment). Measurements at the 6-week post-treatment follow-up demonstrated a statistically significant skin reduction in all six of the measured parameters. A simple skin measurement method requiring minimal instrumentation can quantitatively evaluate skin shrinkage associated with non-invasive skin-tightening devices.

https://ift.tt/2IwGzux

Combined effects of new complete denture fabrication and simplified dietary advice on nutrient intake in edentulous elderly patients for 6 months

Abstract

Objective

The aim was to evaluate the combined effects of a new complete denture fabrication and simple dietary advice (using unique pamphlets) by dentists on nutrient intake in edentulous elderly patients.

Materials and methods

A randomized controlled trial was performed on edentulous elderly patients who were randomly allocated to either an intervention or a control group. The intervention group received a new complete denture and simple dietary advice, whereas the control group received a new complete denture and denture care advice. The outcomes of this trial (nutrient intakes) were calculated using a brief-type self-administered diet history questionnaire (BDHQ) and assessed at three time points (pretreatment and 3 and 6 months post-treatment).

Results

At 3 months post-treatment, the intake of several nutrients such as proteins (p = 0.004), magnesium (p < 0.001), and vitamin B1 (p = 0.014) was significantly higher in the intervention group than the control group, whereas at 6 months post-treatment, plant protein (p = 0.028) intake was significantly higher in the intervention group than the control group. On the contrary, animal protein (p = 0.049) and vitamin B12 (p = 0.028) intakes were significantly higher in the control group.

Conclusions

New complete denture fabrication with simple dietary advice might improve nutrient intake in elderly edentulous patients; however, the effect is probably short term.

Clinical significance

New complete denture fabrication along with simple dietary advice by dentists might improve nutrient intake in edentulous elderly patients. Therefore, regular use of these interventions in the dental setting might have long-term effects on nutrient intake in elderly edentulous patients.

Trial registration

UMIN-CTR Clinical Trial, unique trial number: UMIN000017879

https://ift.tt/2zO7Vd3

The effect of age, gender, and time between blood draw and start of centrifugation on the size outcomes of platelet-rich fibrin (PRF) membranes

Abstract

Objectives

Platelet-rich fibrin (PRF) has been utilized in regenerative dentistry as a supra-physiological concentrate of autologous growth factors capable of stimulating tissue regeneration. Due to the variability in the macroscopic morphology/size of PRF membranes observed between patients, we were interested in studying the effects of patient age, gender, and time between blood draw and the start of centrifugation on the size outcomes of PRF membranes. Despite PRF therapy being increasingly more popular in private practice, to date, no study has investigated the effects of the delay between blood draw and the start of centrifugation in a clinical setting.

Materials and methods

A total of 60 patients enrolled in this study were divided into 6 groups of 10 patients each, including male and female patients categorized into age groups 21–40, 41–60, and 61–80 years. From each patient, a total of five PRF membranes were fabricated from 10-mL tubes following centrifugation starting after 0, 30, 60, 90, and 120 s. In total, 300 PRF membranes were produced in this study to investigate the effects of patient age, gender, and time on the size outcomes of PRF membranes.

Results

A longer delay by the clinician before starting centrifugation following blood draw led to a smaller final size of PRF membranes. At 90 s following blood draw, a significant (13%) reduction in PRF membrane size was observed. After 120 s, a significant (23%) reduction was observed. Additionally, female patients had on average 17% larger membranes compared to men (p < 0.05, 300 samples). Lastly, the size outcomes of the PRF membranes was largest in patients aged 61–80, followed by those aged 41–60 and 21–40. However, no statistically significant differences in PRF membrane sizes were reported between age groups.

Conclusions

The time at which a centrifugation procedure begins following blood draw is critical to optimize the size outcomes of PRF membranes. In general, approximately 15 s is required per tube to harvest 9–10 cc of blood. Therefore, a 60- to 90-s interval between blood draw and the start of centrifugation should be a parameter that is respected by clinicians to avoid significant changes in the macroscopic morphology/size of fabricated PRF membranes. Furthermore, females and older patients produced larger membranes, likely due to lower red blood cell counts derived from their peripheral blood.

Clinical relevance

The findings from the present study demonstrate that on average, a clinician has approximately 60–90 s between blood draw and the start of the centrifugation cycle to produce standard-sized PRF membranes. Shortly thereafter, a significant reduction in size is observed. Additionally, females and older patients were found to produce larger PRF membranes. Centrifugation protocols may therefore be adapted accordingly.

https://ift.tt/2O3w8ox

Penile cutaneous horn: still an enigma

Ajay Aggarwal<br />Sep 10, 2018; 2018:bcr-2018-225930-bcr-2018-225930<br />Images in...

https://ift.tt/2OvrYoJ

FDA Approves Sarecycline for Moderate to Severe Acne

The FDA has approved sarecycline (Seysara, Almirall) for patients aged 9 years and older with inflammatory lesions associated with non-nodular moderate to severe acne vulgaris.
FDA Approvals

https://ift.tt/2OsmU4q

Birch pollen‐related foods can cause late eczematous reactions in patients with atopic dermatitis

Allergy, EarlyView.


https://ift.tt/2zMu0sh

Aryl hydrocarbon receptor activation by diesel exhaust particles mediates epithelium‐derived cytokines expression in severe allergic asthma

Allergy, EarlyView.


https://ift.tt/2DQASJi

IgG4 anti‐infliximab in treated patients: Clinical impact and temporal evolution

Allergy, EarlyView.


https://ift.tt/2zM8wvK

Issue Information

International Forum of Allergy &Rhinology, Volume 8, Issue 10, Page 1077-1079, October 2018.


https://ift.tt/2Rj60Uo

Une masse faussement silencieuse

Publication date: October 2018

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 5

Author(s): X. Dubernard, E. Brenet, M. Makeieff

https://ift.tt/2y7W4Vb

Tumeur ethmoïdal et ostéomalacie oncogène : cas clinique et revue de la littérature

Publication date: October 2018

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 5

Author(s): A. Villepelet, O. Casiraghi, S. Temam, A. Moya-Plana

Résumé

Introduction

L'ostéomalacie oncogène est une pathologie très rare. Elle est causée le plus souvent par une tumeur mésenchymateuse phosphaturiante variante « tissu conjonctif mixte », sécrétant l'hormone FGF-23.

Objectif

Présenter le cas d'une tumeur ethmoïdale associée à une ostéomalacie oncogène et discuter la prise en charge en s'appuyant sur une revue de la littérature.

Résumé du cas clinique

Chez une patiente de 41 ans présentant des fractures multiples avec une impotence fonctionnelle majeure, le diagnostic d'ostéoporose précoce avait été posé. En raison d'une obstruction nasale concomitante, un scanner puis une IRM ont montré une lésion ethmoïdale droite venant au contact de la dure-mère et de la péri-orbite sans les envahir. Une exérèse par voie endoscopique avec reconstruction du défect basicrânien par lambeau naso-septal a été effectuée. Dans les suites on notait une disparition des symptômes rhinologiques et rhumatologiques. L'examen histologique a conclu à une tumeur mésenchymateuse phosphaturiante.

Discussion

Il existe à ce jour douze autres cas rapportés de tumeurs ethmoïdales mésenchymateuses associées à une ostéomalacie oncogène. Le dosage du FGF-23 et l'IRM corps entier en séquence STIR sont utiles pour le diagnostic. Dans la majorité des cas, l'évolution est très favorable après un traitement chirurgical.

https://ift.tt/2Rj3HAO

Corps étranger inhabituel transfixiant de la face : une approche chirurgicale multidisciplinaire

Publication date: October 2018

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 5

Author(s): A. Villarmé, C. Savoldelli, E. Jean-Baptiste, N. Guevara

Résumé

Introduction

Les traumatismes cervico-faciaux par corps étrangers transfixiants sont rares et associés à un risque important de lésions vasculo-nerveuses. Ils nécessitent une prise en charge chirurgicale pluridisciplinaire.

Observations

Ce travail rapporte le cas d'un homme de 20 ans, empalé par un morceau de bois, et la stratégie adoptée pour extraire le corps étranger sans causer de lésions irréversibles. Le projectile traverse la fosse infra temporale, avec un point d'entrée sous l'œil droit et un orifice de sortie au niveau cervical au contact de l'artère carotide interne gauche. La localisation du corps étranger implique une stratégie chirurgicale adaptée. L'artère carotide interne est contrôlée afin de suivre le projectile jusqu'à son entrée dans la base du crâne. La proximité avec l'œil et les vaisseaux jugulo-carotidiens ainsi que le trajet facial profond nécessite l'intervention des radiologues interventionnels, de chirurgiens cervico-faciaux, vasculaires et ophtalmologistes.

Discussion

La localisation du corps étranger, déterminée de façon précise en préopératoire, justifie la présence d'une équipe multidisciplinaire en vue d'une extraction rapide, qui limite le risque de lésion surajoutée. À 6 mois de suivi, le patient ne souffre d'aucune séquelle de son traumatisme facial.

https://ift.tt/2yhm6FB

Correction de l’ensellure nasale par greffe semi-lunaire de cartilage de conque

Publication date: October 2018

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 5

Author(s): Ivan Rašić, Andro Košec, Alan Pegan

Résumé

Introduction

L'ensellure nasale se reconnaît facilement par la perte du support cartilagineux septal et la diminution de hauteur du dorsum nasal avec des conséquences fonctionnelles et esthétiques.

Technique

Nous avons traité une femme âgée de 50 ans et un homme âgé de 54 ans qui présentaient pour l'une une ensellure nasale modérée suite à une précédente septorhinoplastie, et pour l'autre une ensellure nasale sévère post-traumatique. Les deux patients ont été traités par rhinoplastie ouverte sous anesthésie générale, et l'ensellure nasale a été corrigée par une greffe semi-lunaire de cartilage de conque. Cette greffe tire son nom de la forme semi-lunaire du cartilage de conque prélevé. Une plus petite partie de cartilage est prélevée en forme de feuille et suturée à l'envers avec des points de PDS 5-0 en face du cartilage de sorte que les surfaces concaves soient face à face. La greffe ainsi formée est alors suturée sur le dorsum nasal dans la zone de l'ensellure au niveau de la supra-pointe au-dessus des cartilages triangulaires afin d'élargir l'angle de la valve nasale interne. Les extrémités latérales de la greffe semi-lunaire sont placées sous la crus latérale du cartilage alaire afin d'améliorer la fonctionnalité de la valve nasale externe.

Discussion

Cette greffe de cartilage de conque modifiée constitue une excellente option de reconstruction, en raison notamment de sa faible morbidité, de sa disponibilité et de sa capacité à récupérer une quantité de cartilage appropriée pour la vaste majorité des patients. Ces modifications du cartilage de conque n'ont jamais été rapportées auparavant et offrent la hauteur et l'élasticité nécessaires dans la correction de l'ensellure nasale sans nécessiter de greffes ultérieures. Il est important de souligner que, lorsque la greffe est positionnée correctement, on peut observer une amélioration du pic de flux inspiratoire nasal, ce qui s'ajoute aux bénéfices fonctionnels et esthétiques.

https://ift.tt/2Rj4bqC

Technique de féminisation fronto-orbitaire. Une stratégie chirurgicale par fraisage fronto-orbitaire ± technique de la coquille d’œuf pour optimiser le rapport bénéfice/risque

Publication date: October 2018

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 5

Author(s): A. Villepelet, A. Jafari, B. Baujat

Résumé

La demande de féminisation faciale augmente au sein de la population des patients transsexuels. Le front masculin a des bosses supra-orbitaires avec un angle glabellaire plus aigu tandis que le front féminin a des traits plus doux. L'objectif de cet article est de décrire notre technique chirurgicale de féminisation fronto-orbitaire. La technique du mask-lift est un lifting de la partie supérieure de la face. Il permet un rajeunissement en corrigeant les traits effondrés et une féminisation fronto-orbitaire par un fraisage des rebords orbitaires et des canthopexies latérales. Selon la taille du sinus frontal et l'épaisseur de sa paroi antérieure, le remodelage frontal est effectué par fraisage simple ou par la technique de la coquille d'œuf. Le remodelage orbitaire comprend une ouverture supéro-externe de l'orbite, une réduction des rebords et un tunnel sur le rebord latéral pour guider la canthopexie. Des myectomies frontales du corrugateur et du procerus, ainsi qu'une excision minimale du scalp, complètent la chirurgie. Notre technique permet une féminisation significative et d'aspect naturel. Aucune complication n'a été observée dans notre série de patients. La technique de la coquille d'œuf est une alternative au volet osseux en cas de sinus frontal très pneumatisé. La féminisation fronto-orbitaire est au cœur d'une large stratégie chirurgicale. Elle peut être associée à une rhinoplastie, une génioplasie, un remodelage des angles mandibulaires, un lifting facial et une laryngoplastie. Entreprendre la féminisation faciale en 2 ou 3 étapes permet une meilleure tolérance physiologique et psychologique.

https://ift.tt/2y8nfPx

Ponction trachéo-œsophagienne secondaire en consultation et pose d’implant phonatoire chez les laryngectomisés

Publication date: October 2018

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 5

Author(s): E. Ricci, G. Riva, F. Dagna, E. Seglie, A.L. Cavalot

Résumé

La ponction trachéo-œsophagienne secondaire (PTO) avec mise en place d'un implant phonatoire est l'une des possibilités pour restaurer la fonction vocale après une laryngectomie totale. Cependant, certains patients ont des comorbidités qui contre-indiquent l'anesthésie générale. Dans notre service, une procédure de PTO en consultation pour mise en place d'un implant phonatoire par voie rétrograde a été développée. Celle-ci permet de mettre en place immédiatement la prothèse et d'éviter l'utilisation de dilatateurs. Nous avons décrit notre technique avec ses avantages et ses inconvénients. Le set de ponction Provox Vega a été utilisé. Notre technique de PTO secondaire en consultation sans anesthésie générale ni anesthésie à objectif de concentration était une procédure sûre et efficace. Elle permet d'utiliser le set de PTO traditionnel, avec possibilité de mettre en place un implant phonatoire après fermeture de la précédente PTO.

https://ift.tt/2Rm4AJ1

Consensus formalisé de la SFORL (version courte) : audiométrie de l’adulte et de l’enfant

Publication date: October 2018

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 5

Author(s): V. Favier, C. Vincent, É. Bizaguet, D. Bouccara, R. Dauman, B. Frachet, F. Le Her, C. Meyer-Bisch, S. Tronche, F. Sterkers-Artières, F. Venail

Résumé

Introduction

Consensus de la SFORL concernant les bonnes pratiques de la réalisation d'un examen audiométrique chez l'adulte et l'enfant.

Méthodes

Un groupe de travail multidisciplinaire a effectué une revue de la littérature. Des recommandations ont été érigées, relues par un groupe de lecture indépendant du groupe de travail et finalisées lors d'une réunion de synthèse.

Résultats

Il est recommandé de réaliser les examens audiométriques dans un environnement sonore maîtrisé (< 30 dBA), de contrôler l'étalonnage de l'audiomètre régulièrement et de suivre systématiquement les règles de l'assourdissement adaptées au sujet. Il est recommandé de s'assurer que le niveau d'assourdissement n'est pas retentissant. Il est recommandé d'interpréter l'audiométrie tonale de l'adulte en la confrontant avec les données cliniques, l'audiométrie vocale et l'impédancemétrie. En cas de discordance entre les données cliniques et audiométriques tonales et vocales, il est recommandé de réaliser des tests auditifs objectifs. Il est recommandé chez tout enfant de 2 ans ou moins, de réaliser l'audiométrie subjective avec les tests d'audiométrie comportementale adaptés à l'âge de l'enfant. Dès la suspicion d'une atteinte auditive, compléter systématiquement l'audiométrie comportementale par la réalisation de tests objectifs de l'audition pour préciser et confirmer le niveau et le type de l'atteinte auditive.

https://ift.tt/2y8n7zx

Exploration de la discrimination auditive chez le sujet malentendant

Publication date: October 2018

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 5

Author(s): E. Legris, M. Gomot, J. Charpentier, J.M. Aoustin, C. Aussedat, D. Bakhos

Résumé

Un déficit auditif peut entraîner une altération de la discrimination auditive notamment dans un environnement bruyant. Il en découle une augmentation de l'effort d'écoute qui peut avoir des conséquences sur la vie socioprofessionnelle. Pour évaluer l'impact de la surdité en environnement bruyant, le clinicien peut avoir recours à des techniques subjectives ou objectives. Les techniques subjectives, telles que l'audiométrie vocale dans le bruit, sont utilisées en pratique clinique pour évaluer la gêne décrite par le patient. Les techniques objectives, comme les potentiels évoqués auditifs corticaux (PEAc), sont essentiellement utilisées en recherche. Les méthodes subjectives correspondent principalement à l'audiométrie vocale dans le bruit où le rapport signal sur bruit est modifié, ce qui permet de déterminer le seuil d'intelligibilité du patient, avec et sans réhabilitation auditive. Le but de cet examen est de mettre en évidence une amélioration des performances auditives. Une analyse de la discrimination fréquentielle peut également être effectuée. Les méthodes objectives consistent à évaluer la discrimination auditive sans avoir recours à la participation du sujet. Une des techniques utilisées chez les patients avec une réhabilitation auditive est l'étude des réponses auditives par les PEAc. Cet examen électrophysiologique permet d'étudier la discrimination auditive corticale en utilisant des paradigmes oddball. Cela permet le recueil des ondes telles que la Mismatch Negativity, la P300 ou la N400, et l'étude de marqueurs neurophysiologiques en lien avec les performances auditives. Cette revue retrace l'ensemble de ces méthodes, dans le but de pouvoir mieux appréhender et évaluer l'impact d'une surdité dans la vie quotidienne des patients.

https://ift.tt/2RkjKOB

Actualisation de la nasalisation du concept à la technique et aux résultats

Publication date: October 2018

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 5

Author(s): R. Jankowski, C. Rumeau, D.T. Nguyen, P. Gallet

Résumé

La nasalisation est une technique chirurgicale proposée dans le traitement la polypose nasale en 1995. La description initiale de la technique reposait sur l'ouverture large des sinus maxillaires, sphénoïdaux et frontaux et sur la résection des cornets moyens dans le but de permettre une exérèse aussi complète que possible de la muqueuse des masses latérales de l'ethmoïde dans des conditions de sécurité maximale. Les données récentes sur l'évolution et le développement de l'organe naso-sinusien et sur la physiologie sinusienne permettent d'actualiser le concept et la technique de nasalisation. Dans la théorie évo-dévo, l'ethmoïde n'est pas considéré comme un sinus paranasal mais comme le squelette basi-crânien dans lequel se loge la muqueuse olfactive, qui chez l'humain peut être décomposée en muqueuse olfactive fonctionnelle dans le récessus supérieur des fentes olfactives et en muqueuse olfactive vestigiale dans le reste de l'ethmoïde. La polypose nasale apparaît cliniquement comme une maladie spécifique de la muqueuse olfactive vestigiale de l'ethmoïde humain (et non pas comme une forme particulière de rhinosinusite chronique). Le but du traitement chirurgical de la polypose devient ainsi l'exérèse aussi complète que possible de la muqueuse olfactive vestigiale et la conservation aussi longtemps que possible de l'olfaction. La fabrication, le stockage et la libération en bolus du monoxyde d'azote grâce à la fonction sphinctérienne de l'ostium des sinus paranasaux (maxillaires, frontaux et sphénoïdaux) leur confèrent un rôle respiratoire qui mérite d'être préservé autant que possible. La technique de nasalisation a été modifiée pour permettre l'éradication de la muqueuse olfactive vestigiale tout en préservant les différents ostiums sinusiens. La chirurgie du cornet moyen reste à évaluer. Sa résection concourt à une exérèse maximale de muqueuse olfactive vestigiale. Sa préservation respecterait l'intégrité de la fente olfactive. L'actualisation du concept de nasalisation permet ainsi l'intégration de la technique dans le concept évo-dévo de la rhinologie.

https://ift.tt/2y8mWUT

Hydrops retardé. Aspect du nystagmus en crise et intérêt de la labyrinthectomie chimique

Publication date: October 2018

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 5

Author(s): P. Reynard, A. Karkas, M. Gavid, Y. Lelonge, P. Bertholon

Résumé

Objectifs

L'objectif principal était de décrire les caractéristiques du nystagmus pendant une crise de vertiges d'hydrops endolymphatique retardé (HER), en particulier l'observation d'un nystagmus initial essentiellement vertical supérieur. L'objectif secondaire était de souligner l'intérêt de la labyrinthectomie chimique.

Méthodes

Le développement retardé de vertiges chez des patients présentant une surdité de perception, au moins profonde d'un côté, caractérisait l'HER de forme ipsilatérale, associé à une surdité de perception apparue secondairement de l'autre côté dans la forme controlatérale.

Résultats

Dix patients correspondaient aux critères d'un HER, dont sept de forme ipsilatérale et trois de forme controlatérale. Trois patients (HER ipsilatéral) ont été examinés pendant une crise de vertiges dont deux présentaient un nystagmus horizonto-rotatoire battant vers l'oreille saine. Un autre patient présentait un nystagmus atypique car vertical supérieur avec une petite composante rotatoire, devenu secondairement horizonto-rotatoire battant vers l'oreille saine. Quatre patients souffrant de vertiges invalidants dans un contexte de cophose unilatérale (HER ipsilatéral) ont été guéris par 1 à 3 injections transtympaniques de Gentalline.

Conclusion

Les caractéristiques du nystagmus pendant le vertige peuvent être très variables avec la possibilité d'un nystagmus initial essentiellement vertical supérieur qui, à notre connaissance, n'avait jamais été rapporté dans l'HER ou la maladie de Menière. Ce nystagmus pourrait correspondre à une inhibition du canal semi-circulaire supérieur (du côté de la cophose), suggèrant un hydrops débutant au niveau de ce canal. La labyrinthectomie chimique est une technique simple et efficace dans l'HER unilatéral, d'autant que le patient est souvent porteur d'une cophose du côté traité.

https://ift.tt/2Rj2rO3

Audiométrie vocale dans le bruit : mise au point du test VRB (vocale rapide dans le bruit)

Publication date: October 2018

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 5

Author(s): F. Leclercq, C. Renard, C. Vincent

Résumé

Introduction

La compréhension de la parole dans le bruit est un défi majeur pour la plupart des malentendants qu'ils soient appareillés ou non. Pour pallier l'insuffisance de tests francophones évaluant cette aptitude, un nouveau matériel vocal équilibré en difficulté a été développé.

Matériel et méthodes

Le matériel vocal est composé de 127 phrases du corpus « Marginal Benefit from Acoustical Amplification » (MBAA) contenant chacune trois mots-clés. Le bruit a été créé à partir de l'onde vocale globale (OVG) décrite par Dodelé. Les 127 couples phrase/bruit ont été enregistrés individuellement avec égalisation du niveau quadratique moyen. Dans une première expérience menée sur 10 adultes normo-entendants utilisant une méthode ascendante avec le bruit fixé à 73 dB SPL, le rapport signal bruit (RSB) permettant l'identification de 50 % des mots-clés dans chaque phrase (RSB-50) a été déterminé. Le niveau relatif entre les phrases et le bruit a alors été ajusté phrase par phrase pour amener les RSB-50 à 0 dB RSB. Une seconde expérience portant sur 12 normo-entendants a ensuite validé l'égalisation en difficulté des phrases.

Résultats

La moyenne des RSB-50 est de −6,64 dB RSB (σ = 1,47). La moyenne des RSB-50 ajustés est de +0,08 dB RSB (σ = 0,55). La moyenne des pentes des courbes psychométriques de 19,3 %/dB et les faibles écarts-types observés attestent de la sensibilité du matériel vocal.

Conclusion

Le test VRB (vocal rapide dans le bruit) utilisant des listes élaborées avec des phrases issues du corpus « Marginal Benefit from Acoustical Amplification » et un bruit type « onde vocale globale » à différents niveaux de rapport signal/bruit est réalisable et apte à refléter des variations subtiles de performance auditive dans le bruit entre sujets.

https://ift.tt/2y8mJ43

Tumeurs de la fosse infratemporale : quand suspecter une tumeur maligne ? Étude rétrospective d’une série de 62 cas

Publication date: October 2018

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 5

Author(s): Q. Lisan, N. Leclerc, R. Kania, J.-P. Guichard, P. Herman, B. Verillaud

Résumé

Objectifs

Les tumeurs de la fosse infratemporale (FIT) sont rares et leur épidémiologie mal connue. Il est parfois difficile pour le clinicien, rarement confronté à ces lésions, de distinguer une tumeur bénigne d'une tumeur maligne sur les seules données de l'examen clinique et de l'imagerie. Les objectifs de cette étude étaient, à partir d'une série rétrospective : (i) de décrire la prévalence des différents types histologiques de tumeurs de la FIT et (ii) d'étudier l'association entre certains signes cliniques et/ou radiologiques et la présence d'une tumeur maligne.

Matériel et méthodes

Il s'agit d'une étude rétrospective monocentrique, menée dans un centre hospitalier universitaire. Tous les nouveaux cas consécutifs de tumeur de la FIT pris en charge entre janvier 2000 et décembre 2016 ont été inclus. Le type histologique, les données démographiques, la présentation clinique ainsi que les données radiologiques ont été analysés.

Résultats

Un total de 62 patients ont été inclus. Il s'agissait de tumeurs bénignes dans 74 % des cas (n = 46) et de tumeurs malignes dans 26 % des cas. Le fibrome nasopharyngien, le carcinome adénoïde kystique et le schwannome étaient les types histologiques les plus fréquents (47 %, 16 % et 10 % respectivement). La présence d'un trismus, d'une douleur faciale, d'une hypoesthésie faciale et l'invasion nerveuse visualisée à l'IRM étaient significativement associées à la présence d'une tumeur maligne (valeur de p < 0,05).

Conclusion

Cette étude fournit des données épidémiologiques générales concernant les tumeurs de la FIT et identifie plusieurs signes cliniques et radiologiques devant faire suspecter une tumeur maligne.

https://ift.tt/2RjjFLe

Évaluation du dysfonctionnement naso-sinusien chronique avec adaptation transculturelle de l’auto-questionnaire DyNaChron

Publication date: October 2018

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 5

Author(s): K. Choukry, J. Hasnaoui, Z. Chafiki, M. Khdim, R. Abada, M. Mahtar

Résumé

Objectif

Les pathologies rhino sinusiennes génèrent six symptômes principaux, avec un retentissement organique et psychosocial majeur, que nous proposons de mesurer grâce à un auto-questionnaire évaluant les dysfonctionnements naso-sinusiens chroniques indépendamment de leurs étiologies. Le but de notre travail est de réaliser une adaptation transculturelle en version arabe dialectale et de valider l'auto-questionnaire DyNaChron afin de l'utiliser pour la population maghrébine.

Méthode

La traduction – adaptation marocaine du DyNaChron a été réalisée selon des recommandations internationales pour la traduction. Environ, 164 patients ont rempli le questionnaire à j0, j7 (sans traitement) et j60 après traitement. La validation statistique du questionnaire a été évaluée au cours d'une étude prospective multicentrique incluant la validité de convergence et la sensibilité au changement.

Résultats

L'âge moyen était de 35 ans. Le sexe masculin est prédominant (63 %). L'obstruction nasale représente le symptôme le plus fréquent (97,6 %). La cohérence interne a été confirmée avec un coefficient alpha de Cronbach élevé (0,97). Le coefficient de corrélation intra classe évaluant la reproductibilité était de 0,84. Une sensibilité au changement excellente chez la majorité de nos patients (taille d'effet = 0,97–6,69 ; RMS = 2,47–6,74)

Conclusion

Cette étude portant sur l'adaptation transculturelle du DyNaChron en version marocaine a montré une bonne validité, reproductibilité et sensibilité aux changements ainsi qu'une meilleure représentation de l'ensemble des symptômes générés par le DNSC. Il peut être utilisé pour évaluer l'impact psychosocial, organique et le traitement du DNSC.

https://ift.tt/2y82iEh

Amygdalectomie chez l’enfant et chez l’adulte : évolution des pratiques après ouverture d’une unité de chirurgie ambulatoire avec bloc opératoire dédié

Publication date: October 2018

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 5

Author(s): S. Bartier, I. Gharzouli, N. Kiblut, H. Bendimered, L. Cloutier, D. Salvan

Résumé

Buts

Étudier l'impact de l'ouverture d'une unité de chirurgie ambulatoire sur la pratique de l'amygdalectomie chez l'adulte et chez l'enfant à travers l'expérience de notre service ; et évaluer les complications en ambulatoire par rapport à l'hospitalisation conventionnelle.

Matériel et méthodes

Revue rétrospective de toutes les amygdalectomies pratiquées depuis l'ouverture d'un bloc opératoire dédié à la chirurgie en ambulatoire, à partir des bases de données ORL et urgences.

Résultats

D'octobre 2013 à décembre 2014, réalisation de 179 amygdalectomies (51 adultes et 128 enfants) dont 108 en ambulatoire. Entre 2012 et 2014, croissance de 12,7 % du nombre total d'amygdalectomies (+ 18,29 % enfants, stabilité du nombre d'adultes). La programmation en ambulatoire est devenue majoritaire en moins d'un an chez les enfants (73,19 %) et à part égale avec l'hospitalisation conventionnelle chez les adultes (47,22 %). La quasi-totalité des patients gardés à j0 le sont pour des raisons organisationnelles ou de défaut d'orientation (comorbidités ou environnement inadapté). L'amygdalectomie en ambulatoire chez l'enfant a un taux de complication dans les 30 jours similaire à la littérature (8,3 % de chute d'escarre) ; taux plus élevé chez l'adulte (35,3 %). Les complications postopératoires apparaissent en moyenne à j6 pour les adultes et j9 pour les enfants ; seuls 2 patients ont eu une complication survenue entre H6 et H24.

Conclusion

Cette étude montre que l'ouverture d'une unité de chirurgie ambulatoire entraîne une modification des pratiques avec une majorité des amygdalectomies maintenant pratiquée en ambulatoire, sans observer un accroissement des complications, notamment des complications immédiates. L'amygdalectomie en ambulatoire apparaît donc comme une solution de choix par rapport à l'hospitalisation conventionnelle, en termes de bénéfice économique et de confort pour le patient sans perdre en sécurité. L'existence d'un bloc dédié permet une facilité de gestion de programmation, permettant ainsi une augmentation de l'activité en UCA (amélioration des délais).

https://ift.tt/2Rgz92y

Vers un nouveau seuil de la valeur de p ?

Publication date: October 2018

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 5

Author(s): O. Laccourreye, H. Maisonneuve

https://ift.tt/2y8mqWX

Editorial Board

Publication date: October 2018

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 5

Author(s):

https://ift.tt/2RgyQ7U

Issue Information

Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue S3, Page 1-2, October 2018.


https://ift.tt/2zLmU7x

Safety and Efficacy of Nivolumab in Treating Oral Proliferative Verrucous Leukoplakia

Condition:   Leukoplakia, Oral
Intervention:   Drug: Nivolumab
Sponsors:   Dana-Farber Cancer Institute;   Bristol-Myers Squibb
Not yet recruiting

https://ift.tt/2Iw4WIQ

Durvalumab (MEDI4736) With Cetuximab in Previously Treated Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma

Conditions:   Recurrent Head and Neck Cancer;   Head and Neck Cancer;   Head and Neck Neoplasms;   Metastatic Cancer
Interventions:   Drug: Durvalumab;   Drug: Cetuximab
Sponsors:   Trisha Wise-Draper;   AstraZeneca
Recruiting

https://ift.tt/2Ri9jLs

A Study of Several Radiation Doses for Patients With Progression on Immunotherapy/Checkpoint Inhibitors

Conditions:   Metastatic Cancer;   Melanoma Cancer;   Lung Cancer;   Bladder Cancer;   Renal Cancer;   Head/Neck Cancers
Interventions:   Radiation: Stereotactic Body Radiotherapy;   Biological: checkpoint inhibitor
Sponsor:   Memorial Sloan Kettering Cancer Center
Recruiting

https://ift.tt/2IxYD7A

Dr. Kimishige Ishizaka 1926-2018 The discovery of IgE and the revolution in the study of allergic disease

Publication date: Available online 2 October 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Thomas A.E. Platts-Mills, Oscar Swineford

https://ift.tt/2Ix9wqp

Concordance of skin prick test and serum specific-IgE to locally produced-component-resolved diagnostics for cockroach allergy

Publication date: Available online 2 October 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Nitat Sookrung, Pichade Jotikaprasardhna, Chaweewan Bunnag, Wanpen Chaicumpa, Anchalee Tungtrongchitr

https://ift.tt/2RkfJdh

Haematometrocolpos due to transverse vaginal septum with distal atretic vagina

Description 

A 15-year-old girl presented with cyclical pelvic, lower abdominal pain and cramping beginning at age 13. She had not yet had onset of menarche and no history of sexual intercourse. On examination, she presented with lower abdominal distension, which felt like a firm mass extending up to the umbilicus and into the pelvic cavity. Abdominal ultrasound showed an ectopic right kidney in the paramedian position at the level of the umbilicus. Ultrasound also showed a large midline cystic structure located between the urinary bladder and rectum, containing low-level homogenous echoes suggestive of blood products. MRI confirmed the ultrasound findings as it showed the endometrial, endocervical and vaginal canal were distended by low-signal material (T2 and short-tau inversion recovery). Images appeared hyperintense on T1W1, suggestive of haematometrocolpos due to a complete transverse vaginal septum at the level of the pubic symphysis, distal portion of vagina was atretic (

https://ift.tt/2IALMli

Autoimmune autonomic ganglionopathy associated with Sjögrens syndrome presenting with recurrent abdominal distension

A 65-year-old woman with Sjögren's syndrome presented with recurrent abdominal distension, constipation, weight loss, orthostatic dizziness, loss of sweating and incomplete emptying of the bladder. Gastrointestinal dilatation but no evidence of malignancy or obstruction was found on CT of the abdomen, oesophagogastroduodenoscopy or colonoscopy. Postvoiding residual urine volume was increased. Antiganglionic acetylcholine receptor antibody was positive. We diagnosed as autoimmune autonomic ganglionopathy. The patient responded to corticosteroid treatment. One year after treatment, she continued to have mild gastrointestinal symptoms, but overall condition was stable without further intervention.

https://ift.tt/2xUFQ2i

Spontaneous rupture of a pancreatic pseudocyst

Description 

This is a case of a 50-year-old woman with medical history significant for chronic pancreatitis secondary to alcohol abuse who initially presented with a 3-week history of progressively worsening epigastric pain. The patient described the pain as sharp, radiating to the back, worsened with intake of both solid foods and liquids and relieved with self-induced emesis. On admission, the patient was hypertensive, but other vitals were within normal limits. The abdomen was soft; however, there is a firm palpable mass extending from the epigastric to the right and left upper quadrants. Labs were remarkable for hypokalaemia with potassium (K) 3 meq/L (normal range 3.5–4.9 meq/L), mildly elevated lipase 132 U/L (7–60 U/L) and an elevated alkaline phosphatase of 164 U/L (41–108 U/L). CT of the abdomen with contrast (figures 1 and 2) showed a large cystic structure measuring 12.9x21.2 cm directly adjacent to the body of the pancreas and...

https://ift.tt/2ICmhA5

Olmesartan-induced enteropathy

Olmesartan-induced enteropathy (OIE) typically presents with a constellation of signs and symptoms including chronic diarrhoea, weight loss and villous atrophy on biopsy. We describe a 68-year-old Caucasian woman with a history of hypothyroidism and hypertension who presented to our hospital with recurrent episodes of acute intermittent diarrhoea, nausea, vomiting, renal failure and 15 lbs weight loss. After an extensive workup, she was diagnosed with possible OIE. Cessation of the offending drug resulted in improvement of clinical symptoms and also hospital admissions for severe diarrhoea reinforcing the diagnosis of OIE. Among the adverse effects of drug therapy, diarrhoea is a relatively frequent adverse event accounting for about 7%. This report serves as an addition to existing literature and to increase the awareness of olmesartan-induced sprue-like enteropathy among the primary care physicians and gastroenterologists.

https://ift.tt/2xTqzPf

Saccular internal carotid artery aneurysm masquerading as a pituitary macroadenoma

Description 

An 84-year-old woman presented to the emergency department with a 3-day history of progressive binocular diplopia on right-sided horizontal gaze, accompanied with gradual-onset right-sided periorbital headache, vomiting and diarrhoea. Medical history consisted of hypertension and chronic kidney disease, stage 2.

Clinical examination demonstrated right-sided VI cranial nerve palsy, normal pupillary light reaction, visual acuity and fields. No other neurological deficits elicited. No clinical features of hypercortisolism, growth hormone excess or adrenal insufficiency were displayed.

Initial blood tests revealed an acute-on-chronic kidney injury (AKI). Admission estimated glomerular filtration rate was 42 mL/min, baseline 74; admission creatinine 180 μmol/L, baseline 142. An urgent CT head, non-contrast in view of the AKI, was performed. Intravenous fluids were administered. CT revealed a 39x18x14 mm sellar mass, involving the pituitary fossa, extending into the left and right cavernous sinus, sphenoid sinus and posterior sella turcica.

On the next day, MRI of the pituitary (figure...

https://ift.tt/2IvXFZy

Miliary tuberculosis and herpes pharyngitis after a trip to a developing country: dangers of biologics

The use of biologic drugs has expanded since its introduction in the late 1990s. With growing medical use and newer biologic drugs in development, opportunistic infections like Mycobacterium tuberculosis remain important adverse effects. It carries major public health concerns, yet evidence-based clinical guidelines for more routine interval screening in patients taking immunosuppressants and exposed to tuberculosis (TB) are lacking. We illustrate a case of an elderly Indian-born man living in the USA with psoriatic arthritis who was on adalimumab for 10 years. He presented with disseminated TB and herpes simplex virus type 1 (HSV-1) pharyngitis, a year after an innocuous trip to India. Our case draws attention to the adverse effects of biologic drugs and highlights the importance of regular rescreening for a high-risk population. As the use of biologic treatment increases, physicians must be vigilant in more frequent screening, monitoring and identifying related opportunistic infections, notably M. tuberculosis infections.

https://ift.tt/2xVAXpw

Ace the case: a 14-year-old with lower extremity weakness and blurry vision

Description 

A 14-year-old girl presented with progressive upper and lower extremity weakness. Symptoms started 5 months prior with intermittent bilateral calf pain coincident with onset of lower extremity weakness. Initial evaluation revealed normal complete blood count, complelete metabolic panel, inflammatory markers, muscle enzymes and MRI brain and spine with/without contrast. Electromyography demonstrated an acute to subacute polyradiculitis affecting the upper and lower extremities.

She was admitted for expedited evaluation. Examination was significant for lower extremity weakness and absent reflexes. Lumbar puncture (LP) showed lymphocytic pleocytosis and markedly elevated protein. Thorough infectious, oncological and rheumatological evaluations were all unremarkable. Most notable was that CSF Neuromyelitis Optica IgG and paraneoplastic antibody panel were negative, and serum ACE was normal. She was started on intravenous immunoglobulin for empiric treatment of chronic inflammatory demyelinating polyneuropathy (CIDP).

While hospitalised, she developed left eye blurred vision. Ophthalmological examination demonstrated bilateral optic nerve oedema. Repeat MRI...

https://ift.tt/2IwqwNr

Unusual and rare case of generalised lymphadenopathy: Kimuras disease

We report a case of Kimura's disease in a 65-year-old woman who presented with generalised itching, abdominal pain, facial puffiness, difficulty in swallowing and loss of appetite. She was found to have generalised lymphadenopathy and a fine-needle aspiration cytology initially done revealed 'reactive lymphadenitis' which was inconclusive. PET-CT done showed features suggestive of lymphoma. Hence, lymph node biopsy was done for confirmation and incidentally after immunohistochemistry staining it turned out to be Kimura's disease. High-dose steroid therapy was started and patient showed dramatic clinical and symptomatic improvement. Kimura's disease almost always presents as cervical lymphadenopathy and usually never causes compressive symptoms. Our patient presented with compressive symptoms and generalised lymphadenopathy which is a rarity.

https://ift.tt/2xRTW4e

Third-degree burns associated with transcutaneous pacing

A 69-year-old severely obese diabetic woman developed nausea, vomiting and diarrhoea which caused multiple metabolic alterations leading to hypotension and bradycardia due to slow atrioventricular junctional rhythm. Transcutaneous pacing (TCP) was initiated and maintained until the underlying heart rate and blood pressure normalised. TCP gel pads were kept in place prophylactically after pacing was terminated. Gel pads remained attached to the anterior thorax and back for a total of 36 hours. During this time the patient developed third-degree burns at the side of gel pad attachment. With appropriate wound care and after a long hospitalisation, the patient was discharged in stable condition. This case demonstrates that prolonged use of TCP gel pads without frequent replacement may lead to third-degree burns. It also suggest that prophylactic use of TCP gel pads should be avoided.

https://ift.tt/2IytReS

Dual ectopic thyroid gland

Description 

Ectopic thyroid tissue (ETT) occurs due to a disorder in the embryonic development of the thyroid gland with incomplete migration of the thyroid tissue from the median plate of the floor of the pharyngeal gut to its usual site. ETT is a rare entity, with an estimated prevalence of 1/100 000–300 000 in the general population, increasing to 1/4000–8000 in patients with thyroid dysfunction. The mechanisms responsible for thyroid morphogenesis have not yet been fully elucidated but certain transcription factors such as TITF1/NKX2-1, PAX8, HHEX or FOXE1 play a key role in this process. ETT mainly affects young women and is often asymptomatic.1 In 90% of the cases, ETT is located at the base of the tongue. The occurrence of two ectopic foci simultaneously is particularly rare.2 The authors present the case of a 30-year-old female patient under endocrinology's care due to autoimmune subclinical hypothyroidism. She...

https://ift.tt/2xU4u3b

Giant right coronary artery aneurysm complicated by a fistula to the right atrium, mimicking a ruptured sinus of Valsalva aneurysm

Patients with a coronary aneurysm alone do not generally exhibit continuous murmurs; however, murmurs may be detected in the presence of a fistula. A 57-year-old woman with chest pain was referred to us with a suspected diagnosis of a ruptured sinus of Valsalva aneurysm owing to the presence of a continuous murmur that was detected on physical examination. However, CT revealed a giant right coronary artery aneurysm draining into the right atrium. Consequently, surgery was performed. This case highlights the importance of implementing multiple imaging modalities for adequate differential diagnoses of patients presenting with continuous murmurs.

https://ift.tt/2IytJMq

Beliefs and reality of e-cigarette smoking

In this global health case study, we describe a case of nicotine addiction due to chronic use of electronic cigarettes (e-cigarette) and discuss the beliefs on safety and awareness of their side effects. Many people believe that smoking an e-cigarette (vaping) does not have any side effects, especially among teenagers and young adults. Teenagers using an e-cigarette at a young age are twice as likely to try cigarettes later in their life because of nicotine dependency or other social factors. More recent studies have shown long-term systemic side effects of vaping regardless of traditional cigarette smoking history. This report was done for further assessing their risk and to clear out misconceptions of this large-scale condition.

https://ift.tt/2y0VXeT

Advancement of the Harrington technique for reconstruction of pathological fractures of the acetabulum

A 59-year-old man presented with hip pain secondary to metastatic prostate carcinoma affecting multiple sites, including his left acetabulum. The patient's prognosis was good, he was active, independent, with a good quality of life, so was offered surgical reconstruction. The Harrington method involves passing metal rods from the ileum to the ischium and pubis to create a scaffold for hip replacement. This is the gold standard for reconstruction of acetabular metastatic defects. However, this method is prone to failure by medialisation of the construct in the long term. We present our technique of employing a novel modification to the Harrington reconstruction that offers additional support medially with a suprapectineal plate. This construct is strong and durable enough to facilitate immediate weight-bearing and prevent long-term medialisation.

https://ift.tt/2IyIEpI

Troubleshooting a dialysis line: when blue runs red

We present the case of a critically ill woman whose dialysis line was noted to be circulating bright red blood. Located in the right internal jugular vein, the line had previously been working normally with the change occurring shortly after the patient was liberated from positive pressure mechanical ventilation. An arterial malposition was ruled out and subsequent investigations revealed the presence of a left-sided partial anomalous pulmonary venous connection (PAPVC) that had been previously undiagnosed. The identification of a left-sided PAPVC from blood gas measurements taken from a right internal jugular vein dialysis catheter in this case provides an informative opportunity to consider the intricate physiological relationship between the respiratory and cardiovascular systems in critically ill patients requiring invasive procedures and treatments.

https://ift.tt/2xPaolW

Ehrlichiosis masquerading as thrombotic thrombocytopenic purpura

Ehrlichiosis is a rare tickborne illness that can manifest from an asymptomatic, self-limiting disease to a severe presentation with encephalopathy and renal failure. Ehrlichiosis is diagnosed largely based on patient history with confirmatory tests including peripheral blood smear, serology and PCR. Empiric treatment is warranted in patients with suspected tick bites as a delay in treatment can result in multiorgan failure. We discuss a case of ehrlichiosis that presented with the classic pentad of thrombotic thrombocytopenic purpura (TTP). A history of a tick bite was elicited and intravenous doxycycline 100 mg two times a day was initiated. Tick panel results revealed a positive Ehrlichia chaffeensis IgG and IgM titres, consistent with human monocytic ehrlichiosis. Autoimmune workup and antibodies to Borreliaburgdorferi were negative, and ADAMTS13 activity assay results were inconsistent with TTP. The patient completed 14 days of intravenous doxycycline and had an uneventful recovery.

https://ift.tt/2IyIu1A

Diabetic ketoalkalosis: misnomer or undiagnosed variant of diabetic ketoacidosis

Usually, hyperglycaemia crisis presents with acidotic pH, but ketoalkalosis is a rare and unheard entity presenting in diabetic ketoacidosis. We describe three unique cases where the patients present with hyperglycaemia >250 mg/dL, normal or alkalotic pH, and bicarbonate >20 meq/L, which does not meet criteria for diabetic ketoacidosis. However, once these patients were supplemented with intravenous fluids, diagnosis of diabetic ketoacidosis was evident in laboratory analysis. These case series provide a learning opportunity in diagnosing and management of this rare phenomenon.

https://ift.tt/2xRXKmq

Pancake kidney: an incidental finding in a young man

Description 

An 18-year-old man presented to the surgery emergency department with signs and symptoms of acute intestinal obstruction. There was a previous history of exploratory laparotomy for intestinal obstruction 8 years ago. Abdominal examination revealed a healthy transverse scar in the right lumbar region extending to the umbilical region, abdominal distension and no tenderness or guarding. The patient was managed conservatively by nasogastric tube decompression and intravenous fluids support. A contrast-enhanced computed tomography (CECT) of the abdomen was done. The patient responded well to the conservative management, and the intestinal obstruction was relieved. The CECT abdomen reported an ectopic location of bilateral kidneys, lying in the lower abdomen. The kidneys were para-median in location and extending between L4 and S2 vertebrae. Upper and mid-pole of both kidneys were fused across the midline (figures 1 and 2). No evidence of any calculus or hydronephrosis was seen. Opacification of bilateral...

https://ift.tt/2IAZEfi

First-line ibrutinib for Bing-Neel syndrome

The authors present a case of an elderly man with a history of Waldenstrom macroglobulinaemia in remission who presented with progressively worsening gait abnormalities and falls for several months. His examination was notable for bilateral lower extremity weakness and an unsteady gait. Brain and spinal MRI showed focal leptomeningeal enhancement in the brain and spinal column. Lumbar puncture was performed and cerebrospinal fluid flow cytometry demonstrated a monoclonal CD5/CD10-negative, CD20-positive B-cell lymphocyte population consistent with a diagnosis of Bing-Neel syndrome. He was started on ibrutinib, an oral Bruton's tyrosine kinase inhibitor, and had marked improvement in his weakness and gait. Repeat imaging 2 months after starting ibrutinib showed improvement in his leptomeningeal enhancement. During subsequent follow-up, he continued to tolerate ibrutinib and had a sustained clinical response.

https://ift.tt/2xRTUt8

Case of pneumomediastinum due to alveolar rupture following endotracheal intubation

Description 

A 57-year-old woman presented to the outpatient department with complaints of shortness of breath and fever for the past 2 days. She had no known comorbidities. She was admitted in intensive care unit (ICU) in view of type 1 respiratory failure. Initial chest X-ray showed bilateral lower zone non-homogenous opacity (figure 1A). She was initially managed with antibiotics and non-invasive ventilation. However, due to worsening respiratory failure and metabolic acidosis, patient was intubated. Postintubation, patient was connected to a ventilator in volume control mode with fraction of inspired oxygen of 90%, Positive end expiratory pressure (PEEP) of 10, tidal volume of 350 mL, respiratory set rate of 20 and the ratio of duration of inspiration to the duration of expiration (I:E ratio) of 1:3.3. Chest X-ray repeated following intubation showed features suggestive of pneumomediastinum (figure 1B). The CT thorax done post intubation showed pneumoprecardium (

https://ift.tt/2IyIej8

Pigmentary retinopathy in Kearns-Sayre syndrome

Description 

An 11-year-old girl with moderate ptosis and chronic progressive ophthalmoplegia (figure 1) was referred for retinal evaluation in view of nyctalopia. Visual acuity on presentation was 20/40 OU. Slit-lamp examination revealed a normal anterior segment. There was no similar family history. Multicolour scanning laser photographs (figure 2A, B) showed retinal pigment granularity in OU that was better appreciated on autofluorescence imaging as speckled hypoautofluorescence and hyperautofluorescence (figure 2C, D). Horizontal spectral domain optical coherence tomography scans through fovea revealed hyper-reflective deposits above the retinal pigment epithelium (figure 2E, F). Systemic workup revealed the gross motor weakness of both upper and lower limbs, mild hearing loss and no cardiac conduction defects. The patient was referred to a paediatric neurologist for further evaluation. Cerebrospinal fluid tap was done which showed elevated lactate (3.10 mg/dL) and protein levels (96 mg/dL). ECG showed no conduction blocks. A muscle biopsy showed...

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Anaesthesia and Perioperative Care for Transoral Robotic Surgery

Minimally invasive surgical techniques have gained increasing interest in recent years for their conferred recovery and postoperative advantages. Robot-assisted surgery requires special consideration for anaesthetic and perioperative management. The introduction of robot- assisted intra-oral surgery has important implications on anaesthesia provision, airway management and patient safety. Due to its relatively novel use we explore these considerations alongside our own experience in this field.
ORL 2018;80:125–133

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Pediatric Head and Neck Fibrosarcomas: A Demographical, Treatment, and Survival Review and Review of a Rare Case

Publication date: Available online 2 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Tyler A. Janz, Ramamoorthy Nagasubramanian, Julie L. Wei

Abstract

Objective

To examine pediatric head and neck fibrosarcoma cases and review the demographics, management, and survival for these patients.

Methods

Pediatric patients in the Surveillance, Epidemiology, and End Results (SEER) database were included from 1973-2014 based on a diagnosis of a head and neck fibrosarcoma using ICD-O-3 head and neck primary sites and histology codes. Patients were included from ages 0-18 years. Additionally, a pediatric case of a head and neck infantile fibrosarcoma treated at the Nemours Children's hospital in Orlando, Florida is presented.

Results

One hundred-thirteen pediatric head and neck fibrosarcomas were identified within the SEER database over the study period. The mean age at diagnosis was 9.8 years (SD: 6.2, range: 0.0-18.0). The mean age at diagnosis for infantile fibrosarcomas was 1.7 years (SD: 3.2, range: 0.0-12.0). Fifty-one (45.1%) patients were female. A majority (N=67, 59.3%) of patients had dermatofibrosarcoma followed by 18 (15.9%) who had infantile fibrosarcomas. Nearly all patients (N=107, 94.7%) received surgical intervention. 27.5% of patients with an infantile fibrosarcoma received chemotherapy as a part of their care compared to 1.5% of patients with a dermatofibrosaroma (p=.004). The 5-year disease-specific survival was 97%.

Conclusions

and Relevance: Pediatric patients with head and neck fibrosarcomas are most likely to present in Caucasian males or female during late childhood or early adolescence. Infantile fibrosarcomas present in pediatric patients at a much earlier age. Surgical management is common for pediatric head and neck fibrosarcomas. Additionally, chemotherapy may be used for infantile fibrosarcomas of the head and neck. Survival rates for pediatric patients with a head and neck fibrosarcoma are excellent.

https://ift.tt/2IwpMrF

Endoscopic Cricopharyngeal Myotomy in Infants

Publication date: Available online 2 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Keith J. Basler, Catherine Swanson, Steven M. Andreoli

Abstract

Cricopharyngeal achalasia is a rare cause of dysphagia in young children. Conservative treatments involve medical therapy and serial dilations or injections. Definitive cure can be achieved with cricopharyngeal myotomy. We report two cases of young children, each less than one year of age, who underwent endoscopic laser-assisted cricopharyngeal myotomy. Following surgery, both infants were able to advance to age appropriate diets prior to discharge. Post-operative modified barium swallow demonstrated complete resolution of achalasia in both patients. To the best of our knowledge, this is the first case series of infants undergoing successful endoscopic cricopharyngeal myotomy.

https://ift.tt/2NUvIjY

Autologous Cartilage Microtia Reconstruction: Complications and Risk Factors

Publication date: Available online 2 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Yao-yao Fu, Chen-long Li, Jun-li Zhang, Tian-yu Zhang

Abstract

Background

The Brent or Nagata techniques of microtia reconstruction and their modifications involve complicated frameworks; therefore, complications are inevitable. The authors aimed to provide comprehensive knowledge regarding the occurrence, development, prognosis, risk factors, and treatment of complications.

Methods

This study was a retrospective review of patients who underwent autologous cartilage microtia reconstruction at a single auricular plastic and reconstructive center between March 2005 and June 2016. Custom database software was used to process data from patients with microtia. Details of postoperative complications were collected during follow-up for analysis.

Results

A total of 470 procedures (stage I) were performed on 429 patients. The mean (±SD) age at surgery was 12.27±5.01 years (range, 6–32 years). The mean time to follow-up was 3.67±2.45 years (range, 1–11 years). The complication rate was 2.98% (4/134) with the Brent technique and 12.2% (38/311) with the Nagata technique. A multivariate logistic regression analysis of complications of microtia reconstruction revealed that age, sex, and laterality were not associated with postoperative complications (p > 0.05). Surgical technique affected the incidence of complications. The Nagata technique resulted in a higher risk for complications (OR 6.14 [95% CI 1.63–23.19]; p < 0.01).

Conclusion

The development of complications was a dynamic process. There was a learning curve associated with autologous cartilage microtia reconstruction. Orthopedists or otologists aspiring to master microtia reconstruction should have a fundamental understanding of the procedure and be aware of possible complications.

https://ift.tt/2IwoSeL

The heterogeneity of autoimmune polyendocrine syndrome type 1: Clinical features, new mutations and cytokine autoantibodies in a Brazilian cohort from tertiary care centers

Publication date: Available online 1 October 2018

Source: Clinical Immunology

Author(s): Fernanda Guimarães Weiler, Pärt Peterson, Beatriz Tavares Costa-Carvalho, Mayra de Barros Dorna, Joya Emilie de Menezes Correia-Deur, Soraya Lopes Sader, Daniela Espíndola-Antunes, Gil Guerra-Junior, Magnus Régios Dias-da-Silva, Marise Lazaretti-Castro

Abstract

Autoimmune polyendocrine syndrome type 1 (APS1) is characterized by multiorgan autoimmunity. We aim at characterizing a multi-center Brazilian cohort of APS1 patients by clinical evaluation, searching mutation in the AIRE gene, measuring serum autoantibodies, and investigating correlations between findings. We recruited patients based on the clinical criteria and tested them for AIRE mutations, antibodies against interferon type I and interleukins 17A, 17F and 22. We identified 12 unrelated families (13 patients) with typical signs of APS1 in the proband, and the screening of relatives recognized an asymptomatic child. Candidiasis was present in all cases, and 19 other manifestations were observed. All patients carried one of 10 different mutations in AIRE, being 3 new ones, and were positive for anti-interferon type I serum antibody. Anti-interleukin-17A levels inversely correlated with the number of manifestations in each patient. This negative correlation may suggest a protective effect of anti-interleukin-17A with a potential therapeutic application.

https://ift.tt/2Rgsc1n

Netrin-1 prevents the attachment of monocytes to endothelial cells via an anti-inflammatory effect

Publication date: November 2018

Source: Molecular Immunology, Volume 103

Author(s): Zhaoheng Lin, Jing Jin, Weirong Bai, Jiao Li, Xiyun Shan

Abstract

Netrin-1 is best known for its function guiding axon growth and migration. Netrin-1 has been shown to be involved in regulating cardiovascular function. In this study, we aimed to understand the biological role of Netrin-1 and its receptor Unc5b in endothelial cells. Our results demonstrate that Unc5b was moderately expressed in human aortic endothelial cells (HAECs) and TNF-α had a dose-dependent inhibitory effect on Unc5b level. Netrin-1 potently suppressed TNF-α-induced vascular adhesion molecules VCAM-1, ICAM-1, E-selectin and blocked the adhesion of monocytes to endothelial cells. Netrin-1 also suppressed TNF-α-induced production of cytokines including MCP-1, IL-1β, and IL-6. Importantly, Netrin-1 suppressed toll like receptor 4 (TLR4) expression and prevented NF-κB activation. Mechanistically, Netrin-1 reduced TNF-α-induced IKK and IκBα activation and prevented degradation of IκBα. Netrin-1 reduced nuclear accumulation of p65 and strongly suppressed NF-κB promoter activation. Collectively, our data demonstrated that signaling of Netrin-1 and its receptor Unc5b had an anti-inflammatory effect in endothelial cells. Netrin-1 signaling could be imperative for normal endothelial function.

https://ift.tt/2Ric8fI

The core promoter controls basal and inducible expression of duck retinoic acid inducible gene-I (RIG-I)

Publication date: November 2018

Source: Molecular Immunology, Volume 103

Author(s): Yanna Xiao, Matthew B. Reeves, Adam F. Caulfield, Danyel Evseev, Katharine E. Magor

Abstract

Retinoic acid inducible gene-I (RIG-I) is a cytoplasmic RNA sensor for detecting a variety of RNA viruses including influenza A viruses. Detection ultimately produces Type I interferon (IFN), which stimulates expression of interferon stimulated genes (ISGs), including RIG-I itself in a positive feedback loop. The structure and function of RIG-I is conserved across phylogeny, despite significant protein sequence divergence, however, the promoter sequences do not show the expected phylogenetic relationships and it is not known whether they are similarly regulated. We previously cloned duck RIG-I and showed it is highly induced during influenza A infection consistent with induction by the interferon produced. Here, we identified the Pekin duck RIG-I promoter and constructed promoter reporter vectors, which we transfected into duck embryonic fibroblasts or chicken DF-1 cells and tested in dual luciferase assays. We showed that activation of the Mitochondrial Antiviral Signalling (MAVS) pathway using the constitutively active N-terminal region of RIG-I or polyinosinic-polycytidylic acid (poly I:C) led to stimulation of duck RIG-I promoter activity. Using deletion constructs we showed the core promoter lies in the proximal 250 basepairs, and we identified essential cis-regulatory elements, a GC-box and an interferon-sensitive response element (ISRE), responsible for basal and inducible expression, respectively. Using mCherry-tagged interferon regulatory factors (IRFs) cloned from chickens and ducks, we show overexpression of chIRF7 induced the duck RIG-I promoter, and this required the ISRE site. Finally, we also demonstrated that overexpressed chIRF7 translocated to the nucleus, which was augmented by MAVS activation using RIG-I 2CARD. Our findings demonstrate that RIG-I expression is induced by chIRF7, in a positive regulatory loop. These studies show that the duck RIG-I promoter is appropriately regulated in chicken cells, necessary for the potential generation of transgenic chickens expressing RIG-I.

https://ift.tt/2y2tmVm

Lipemia Retinalis, Macular Edema, and Vision Loss in a Diabetic Patient with a History of Type IV Hypertriglyceridemia and Pancreatitis

Background: Lipemia retinalis is a rare but known complication of elevated serum triglycerides. This case describes the clinical course of a diabetic patient who presented with lipemia retinalis and macular edema, which responded to systemic and local treatments. Case Report: A 40-year-old female with a history of type II diabetes mellitus, hypertriglyceridemia, and pancreatitis presented with decreased vision in the left eye. She had peripapillary and macular edema, intraretinal hemorrhages, and prominent exudates in the setting of lipemia retinalis due to type IV hypertriglyceridemia. She was treated with serial intravitreal bevacizumab injections for macular edema and systemic lipid lowering therapy, and her visual acuity improved back to baseline. Conclusions: In the setting of lipemia retinalis and hypertriglyceridemia, the current patient developed macular edema and vision loss. The macular edema was treated with intravitreal injections of bevacizumab, and the patient experienced a rapid recovery of visual acuity.
Case Rep Ophthalmol 2018;9:425–430

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Surgical treatments for a case of superior canal dehiscence syndrome associated with patulous Eustachian tube

Publication date: Available online 2 October 2018

Source: Auris Nasus Larynx

Author(s): Ryoukichi Ikeda, Hiromitsu Miyazaki, Masahiro Morita, Daisuke Yamauchi, Tetsuaki Kawase, Yukio Katori, Toshimitsu Kobayashi

Abstract

Objectives

The patulous Eustachian tube (PET) and superior semicircular canal dehiscence syndrome (SCDS) have similarity in their symptoms and similar effects caused by positional changes, causing difficulty in the differentiation between the two disorders. This report describes a case of both SCDS and PET that was eventually successfully treated.

Methods

A 68-year-old man presented with hyperacusis to his own footsteps and gait disturbance. He had been diagnosed as PET two years before and had been treated by insertion of a silicone plug (Kobayashi plug) at the other hospital. Clinical case records, audiological data, cervical vestibular-evoked myogenic potential (cVEMP), Eustachian tube function tests and computed tomography (CT) were taken in the sitting position.

Results

While the CT confirmed superior semicircular canal dehiscence, the results of cVEMP was not typical of SCD likely due to preexisting hearing impairment in the right ear with a history of middle ear surgeries for the treatment of PET. He received round window reinforcement (RWR) and achieved relief from his symptoms but six months after the surgery, he visited again with complaints of autophony of his own voice and breathing. The tympanic membrane was found to move synchronous with respiration, and Eustachian tube function tests and the sitting CT confirmed the recurrence of severe PET. He had his silicone plug exchanged (increase in size of the Kobayashi plug) and achieved relief from symptoms.

Conclusions

The present case was a rare instance showing that PET and SCDS can occur simultaneously in a patient. The patient achieved relief from symptoms after treatment with RWR and insertion of the Kobayashi plug.

https://ift.tt/2RjjxLO

Simultaneous bilateral butterfly tympanoplasty using tragal cartilage from one ear

Publication date: Available online 2 October 2018

Source: Auris Nasus Larynx

Author(s): Mehmet Karataş, Emin Kaskalan

Abstract

Objective

To evaluate the outcomes of simultaneous bilateral inlay butterfly cartilage tympanoplasties (BIBCT) using tragal cartilage from one ear in patients with bilateral chronic otitis media (BCOM).

Methods

33 patients (66 ears) who underwent bilateral inlay butterfly cartilage tympanoplasties between June 2013 and September 2016 in Department of Otolaryngology–Head and Neck Surgery of Adiyaman University Education and Research Hospital, Adiyaman, Turkey — a tertiary care university teaching hospital. Anatomical success and functional success were assessed postoperatively. Air-bone gap (ABG), air-conduction thresholds, and bone-conduction thresholds were all assessed. The preoperative and postoperative averages of 0.5, 1, 2, and 3 kHz of pure-tone thresholds were used for the mean air- and bone-conduction thresholds according to the guidelines of the Committee on Hearing and Equilibrium.

Results

Anatomical success could be demonstrated in 57 of 66 ears (86.3%). The overall mean of ABG improved from 23.97 ± 8.63 dB preoperatively to 10.42 ± 4.82 dB postoperatively (p < 0.05). The ABG gain was 13.55 ± 8.17 dB. Postoperative percentages of patients with ABG less than 20 dB and 10 dB were excellently achieved to 98% (41% preoperatively) and 56% (10.6% preoperatively), respectively. The average length of operation time for both ears was 57.42 ± 9.39 min.

Conclusion

When compared with conventional two-staged tympanoplasty in patients with BCOM, simultaneous BIBCT using tragal cartilage from one ear is an advantageous approach for multiple reasons which include single hospital stay with resultant decreased risk of complications associated with anesthesia and surgery, less morbidity like cosmetic and hearing discomfort, time-savingness and cost-effectiveness.

https://ift.tt/2IzhK0U

In situ effect of fluoride toothpaste supplemented with nano-sized sodium trimetaphosphate on enamel demineralization prevention and biofilm composition

Publication date: Available online 1 October 2018

Source: Archives of Oral Biology

Author(s): Nayara Gonçalves Emerenciano, Alberto Carlos Botazzo Delbem, Juliano Pelim Pessan, Gabriel Pereira Nunes, Francisco Nunes Souza Neto, Emerson Rodrigues de Camargo, Marcelle Danelon

Abstract

Objective

To evaluate the effect of a fluoride toothpaste containing nano-sized sodium trimetaphosphate (TMPnano) on enamel demineralization in situ and composition of the biofilm.

Design

This crossover double-blind study consisted of four phases (seven days each) and 12 volunteers who wore oral appliances containing four enamel bovine blocks. The cariogenic challenge was performed by 30% sucrose solution (6x/day). The toothpaste treatments (3x/day) were as follows: no F/TMP/TMPnano (Placebo), 1,100 ppm F (1100 F), 1100 F plus 3% micrometric or nano-sized TMP (1100 F/TMP; 1100 F/TMPnano). Percentage of surface hardness loss (%SH), and integrated loss of subsurface hardness (ΔKHN), as well as enamel calcium (Ca), phosphorus (P), and fluoride (F) were determined. Moreover, biofilm formed on the blocks were analyzed for F, Ca, P, and insoluble extracellular polysaccharide (EPS) concentrations. Data were analyzed using one-way ANOVA, repeated measures followed by Fisher LSD test (p < 0.001).

Results

1100 F/TMPnano promoted the lowest %SH and ΔKHN among all groups (p < 0.001). Regarding the F concentrations in the enamel and in the biofilm, there were no significant differences between 1100 F and 1100 F/TMPnano, but significantly increased enamel Ca concentrations (p < 0.001). 1100 F/TMPnano showed lower values of EPS concentration when compared with 1100 F (~80%) (p < 0.001).

Conclusion

1100 F/TMPnano promoted a greater protective effect against enamel demineralization and significantly affected the composition of biofilm formed in situ when compared to 1100 F toothpaste.

https://ift.tt/2DZyct5

In situ effect of fluoride toothpaste supplemented with nano-sized sodium trimetaphosphate on enamel demineralization prevention and biofilm composition

Publication date: Available online 1 October 2018

Source: Archives of Oral Biology

Author(s): Nayara Gonçalves Emerenciano, Alberto Carlos Botazzo Delbem, Juliano Pelim Pessan, Gabriel Pereira Nunes, Francisco Nunes Souza Neto, Emerson Rodrigues de Camargo, Marcelle Danelon

Abstract

Objective

To evaluate the effect of a fluoride toothpaste containing nano-sized sodium trimetaphosphate (TMPnano) on enamel demineralization in situ and composition of the biofilm.

Design

This crossover double-blind study consisted of four phases (seven days each) and 12 volunteers who wore oral appliances containing four enamel bovine blocks. The cariogenic challenge was performed by 30% sucrose solution (6x/day). The toothpaste treatments (3x/day) were as follows: no F/TMP/TMPnano (Placebo), 1,100 ppm F (1100 F), 1100 F plus 3% micrometric or nano-sized TMP (1100 F/TMP; 1100 F/TMPnano). Percentage of surface hardness loss (%SH), and integrated loss of subsurface hardness (ΔKHN), as well as enamel calcium (Ca), phosphorus (P), and fluoride (F) were determined. Moreover, biofilm formed on the blocks were analyzed for F, Ca, P, and insoluble extracellular polysaccharide (EPS) concentrations. Data were analyzed using one-way ANOVA, repeated measures followed by Fisher LSD test (p < 0.001).

Results

1100 F/TMPnano promoted the lowest %SH and ΔKHN among all groups (p < 0.001). Regarding the F concentrations in the enamel and in the biofilm, there were no significant differences between 1100 F and 1100 F/TMPnano, but significantly increased enamel Ca concentrations (p < 0.001). 1100 F/TMPnano showed lower values of EPS concentration when compared with 1100 F (~80%) (p < 0.001).

Conclusion

1100 F/TMPnano promoted a greater protective effect against enamel demineralization and significantly affected the composition of biofilm formed in situ when compared to 1100 F toothpaste.

https://ift.tt/2DZyct5

Influence of different thickeners in at-home tooth bleaching: a randomized clinical trial study

Abstract

Objectives

To evaluate the effects of 10% carbamide peroxide (CP) with two different thickeners, carbopol (CPc) and natrosol (CPn), on color variation (CV), tooth sensitivity (TS), and cytotoxicity (CC).

Methods

Seventy subjects were distributed into the CPc or CPn groups (n = 35), in a parallel group, randomized, controlled, single-blind clinical trial. Bleaching gels were used by volunteers for 4 h daily for 2 weeks. Color evaluation was performed using a reflectance spectrophotometer, before bleaching treatment (BT), immediately after the first and second weeks of BT, and 1 week and 1 month after BT ended. TS was evaluated using two pain scales, before, during, and after BT. CC was evaluated using MTT after exposure of MDPC-23 cells to the bleaching gels for 4 h. Epoxy replicas of the subjects teeth were made before and after BT and analyzed using a scanning electronic microscope. The data was analyzed using statistical methods.

Results

CV and TS showed similar variation between both bleaching gels (p ≤ 0.05). None of the protocols affected cellular metabolism or the surface morphology of enamel.

Conclusions

Bleaching gels with carbopol and natrosol as thickening agents produced similarly effective tooth bleaching and TS, but did not cause cytotoxicity.

Clinical relevance

Natrosol could be an alternative as a thickener used in bleaching gels due to its similar bleaching effect and TS when compared with Carbopol.

https://ift.tt/2DO04zY

Ultrasound-guided versus blind temporomandibular joint injections: a pilot cadaveric evaluation

Publication date: Available online 2 October 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): Y.H. Cha, J. O, J.-K. Park, H.-M. Yang, S.H. Kim

Abstract

Temporomandibular disorders are painful conditions that require precise injection therapy in selected patients. This pilot cadaveric study was undertaken to compare the accuracy of temporomandibular joint (TMJ) injection between the anatomical landmark-based (blind) technique and an ultrasound-guided technique. TMJ injections using the blind technique or the ultrasound-guided technique were performed in 10 non-embalmed cadavers. After dissection, the accuracy of the TMJ injections was found to be significantly greater for the ultrasound-guided injections than for the blind technique (blind 55% vs. ultrasound 95%, P = 0.008). For injections into the upper joint space of the TMJ, the success rate of the injection was comparable for the two techniques (blind 80% vs. ultrasound 100%, P = 0.474). However, ultrasound-guided injections into the lower joint space had a much higher success rate than the blind technique (blind 30% vs. ultrasound 90%, P = 0.020). The blind technique was associated with a considerable proportion of failed or inappropriate injections, especially for lower joint space injections. Ultrasound-guided TMJ injections were accomplished with a higher accuracy than the conventional blind technique, especially in the case of injections targeting the lower joint space of the TMJ.

https://ift.tt/2zKLp4L

Direct percutaneous puncture digital-subtraction-angiography-based classification and treatment selection for soft-tissue arteriovenous malformations of maxillofacial region: a retrospective study

Publication date: Available online 2 October 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): H. Xun, K. Li, X. Li, Y. Liu, X. Du, Z. Qin

Abstract

Treatment of arteriovenous malformations (AVMs) should be individualized based on the imaging findings. A total of 117 AVM cases were categorized into three types based on the angio-architectural characteristics: Type I (n = 14, no draining vein or diameter of the draining vein <2 mm); Type II (n = 64, draining vein diameter 2–6 mm); and Type III (n = 39, draining vein diameter >6 mm). Subjects were randomly allocated to one of two treatment groups: Group A (n = 59) received multipoint percutaneous ethanol injection (MPEI), while Group B (n = 58) received super-selective angiograms followed by embolization with gelfoam (EFAG) plus MPEI. Patients were followed up for 2–6 years. A significant between-group difference with respect to treatment outcomes was observed only for Type III cases (P < 0.05). Direct percutaneous puncture digital-subtraction-angiography-guided classification of AVMs provides easy-to-follow guidelines for its clinical management. EFAG plus MPEI with reduced procedure time and the amount of ethanol should be used for Type III AVMs.

https://ift.tt/2y7LddO

Clinical features and outcomes in young adults with oral tongue cancer in young adults

Publication date: Available online 2 October 2018

Source: American Journal of Otolaryngology

Author(s): Courtney Miller, Aryan Shay, Bobby Tajudeen, Neilayan Sen, Mary Fidler, Kerstin Stenson, Paolo Gattuso, Samer Al-khudari

Abstract

Objective

To evaluate outcomes and survival in young patients with oral tongue cancer (OTC).

Methods

Retrospective chart review of patients aged 18–40 with OTC treated between 2000 and 2016. Tumor characteristics of p16 expression, perineural invasion (PNI), and lymph-vascular invasion (LVI) were evaluated. Recurrence-free (RFS) and overall survival (OS) data were analyzed according to Kaplan-Meier method with univariate analysis.

Results

A total of 23 patients were identified: 12 with early stage disease (ESD, stage I), and 11 with advanced stage disease (ASD, stage III or IV), (17 men and 6 women). Mean age at presentation was 34.5 years (±5 months) and mean follow-up was 46.6 months. For all patients, 5-year RFS was 62% and OS 66%. RFS for ESD was 73% and ASD 25% (log rank p = 0.011). OS for ESD was 100% and ASD 55% (log rank p = 0.012). 22% indicated tobacco use >5 pack-years and 9% heavy alcohol use. Factors associated with worse OS were neck disease (log rank p = 0.073), positive margins (log rank p = 0.001), and LVI (log rank p = 0.002). Factors associated with worse RFS were chemotherapy or radiation therapy prior to surgery (log rank p = 0.002), neck disease (log rank p = 0.047), positive margins (log rank p = 0.039), and PNI (log rank p = 0.001). Expression of p16 was observed in five cases and was not significantly associated with OS or RFS.

Conclusion

In young patients with OTC, factors associated with worse outcomes are similar to known predictors in older patients. p16 was not associated with improved OS. OS in patients with ESD was excellent (100%), and significantly worse for ASD.

https://ift.tt/2NWSibZ

Update on the diagnostic considerations for neurogenic nasal and sinus symptoms: A current review suggests adding a possible diagnosis of migraine

Publication date: Available online 2 October 2018

Source: American Journal of Otolaryngology

Author(s): Frederick A. Godley, Roy R. Casiano, Mark Mehle, Brian McGeeney, Christopher Gottschalk

Abstract

Background

Treatment of rhinosinusitis (RS) is one of the leading reasons for prescriptions of antibiotics, although they often fail to provide symptomatic relief. Appropriately diagnosing and treating patients presenting with RS for whom antibiotic therapy has failed or who have normal CT findings is a controversial topic. One explanation is that what these patients are experiencing is misinformation from the trigeminal nerve and autonomic nervous system. Midfacial pain and pressure with rhinorrhea and nasal congestion do not represent an infectious, or even inflammatory, condition within the sinus or nasal cavities, but a mirage that is best treated as a migraine variant.

Observations

Although there is not enough research to definitively prove this alternate etiology, we are reaching a tipping point where the clinical implications, real-world experience, and evolving literature support this possible alternate etiology. Four key factors support a midfacial migraine that mimics RS: 1) Pathophysiology: current pathophysiology literature offers a model of how migraine attacks could replicate clinical presentations of RS; 2) Clinical presentation: patients with infectious RS and midfacial migraine have similar symptomatic presentation, similar demographics, but poorly correlated radiological information; 3) Diagnosis: clinical studies support the proposition that there are alternative diagnostic tools for distinguishing patients with midfacial migraine; and 4) Prognosis: Select RS patients show significant improvement with migraine treatment.

Conclusions

We encourage medical professionals to consider migraine disease as a form of sensory misinformation and as a possible etiology of RS complaints. Clinicians can ask validated questions to determine if possible migraine could be an underlying cause, and there are standard preventative treatments for migraine that could alleviate patient symptoms. Dysfunctional vasomotor activity may be the root of the disturbances, particularly when antibiotic therapy fails and CT findings are discordant with symptoms. Until there is a diagnostic test for migraine, clinicians need to question a patient's self-diagnosis of rhinosinusitis. More research is needed to definitively answer this important question.

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Feasibility of Endoscopic Thyroidectomy via Axilla and Breast Approaches for Larger Goiters: Widening the Horizons

Scarless (in the neck) endoscopic thyroidectomy (SET) has evolved into a cosmetically preferred alternative to conventional thyroidectomy (ConT). Recently many of our patients are demanding SET; however their goitres are larger than the recommended size of 4–6 cm. Our aim was to compare the outcomes of ET for small (

https://ift.tt/2Rk1s0e

From VA Larynx to the future of chemoselection: Defining the role of induction chemotherapy in larynx cancer

Publication date: November 2018

Source: Oral Oncology, Volume 86

Author(s): Matthew E. Spector, Andrew J. Rosko, Paul L. Swiecicki, J. Chad Brenner, Andrew C. Birkeland

Abstract

Organ preservation protocols utilizing induction chemotherapy as a selection agent have played a critical role in the treatment of advanced laryngeal squamous cell carcinoma (LSCC). The selection of patients who will have a good response to chemoradiation allows for organ preservation in a significant group of patients and minimizes the rate of surgical salvage. While there remains debate regarding its utility when compared to surgery or other organ preservation regimens, the data does suggest an important role for induction chemotherapy in LSCC. In addition, there are continued opportunities to identify pretreatment biomarkers for induction chemotherapy, whether genetic, epigenetic or cellular, that could predict response to treatment and select patients to therapy (whether organ preservation or surgery). As our understanding of the biology of larynx cancer advances, induction paradigms have utility for the development and adoption of novel agents and therapeutics. The background of induction chemotherapy as a selection agent and future directions of this approach are discussed.

https://ift.tt/2NVWA37

Failure loads of all‐ceramic cantilever fixed dental prostheses on post‐restored abutment teeth: influence of the post presence and post position

European Journal of Oral Sciences, EarlyView.


https://ift.tt/2Qnb3lu

Docosahexaenoic acid attenuates inflammation‐induced hyperexcitability of trigeminal spinal nucleus caudalis neurons associated with hyperalgesia in rats

European Journal of Oral Sciences, EarlyView.


https://ift.tt/2zLFf4t

Bronchiolitis needs a revisit: distinguishing between virus entities and their treatments

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


https://ift.tt/2zKIDw9

In vitro allergy testing

Last month in clinic, I was asked to evaluate an adorable 4-year-old boy who had symptoms of chronic rhinitis, in addition to numerous other clinical conditions, including seizure disorder, chronic lung disease, G tube dependence, and developmental delay. His history and physical examination were not suggestive of an allergic origin, and he was already on medical management for allergies, including an antihistamine and a nasal steroid. We were unable to perform skin prick testing and decided to proceed with in vitro testing.

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Pediatric bronchial hyperresponsiveness and asthma phenotypes

Dr. Lee and colleagues have examined the intersection of 2 relevant aspects of asthma, bronchial hyperresponsiveness (BHR) and clinical patterns of childhood asthma.1 Using the novel approach of considering different patterns of BHR as characteristic phenotypes, Dr. Lee demonstrated a relationship between the BHR phenotypes and the clinical patterns of asthma in children. These investigators had previously demonstrated a relationship between atopic phenotypes and the development of BHR and asthma.

https://ift.tt/2IvMWyh

The challenge of choosing the correct biologic for the correct asthma patient

The treatment approach for severe asthma has changed significantly during the past decade. Omalizumab, a monoclonal antibody against immunoglobulin E (IgE), was the first biologic agent approved in the United States and Europe for the treatment of severe asthma. In 2018, 3 additional biologic agents—all targeting interleukin-5 (IL-5) or its receptor, are also available for use.1 In addition to choosing among various inhalers and other asthma medications, clinicians now face the additional challenge of deciding which biologic agent to use first, if at all, for the treatment of severe asthma.

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Information for Readers

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Information for Authors

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Authors' response

We thank Liccardi et al for their interest in our article and for raising the issue of prior pet sensitization as a risk factor for developing occupational asthma.1 Another study found that a prior history of pet ownership and sensitization was associated with an increased risk of work-related asthma in animal shelter workers.2 Thus, in those workers exposed to pet allergens at home and at work, the peak flow monitoring protocol described in our stepwise diagnostic approach would not always be useful in distinguishing between work-related and non–work-related asthma.

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Table of Contents

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Editorial Board

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Occupational exposure to furry animals and asthma

We read with interest the excellent review by Dao and Bernstein1 on the association between exposure to occupational agents and asthma. We would like to add some considerations, especially from a preventive point of view, on the section concerning the exposure to furry animals in certain classic settings, such as laboratories and farms. We believe that, in many cases, the border between occupational and daily exposure to epithelial products of furry animals may be very subtle. In the field of animal care, besides the veterinarians, several emerging professional activities have become common in recent years (ie, groomers, pet sitters, pet trainers).

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Management of food allergies and asthma in schools

A 5-year-old girl is seen for asthma and food allergies to peanut and tree nuts. Since her last visit, she had one allergic reaction during which she developed hives and wheezing after taking a bite of a muffin cross-contaminated with peanut. This incident was treated with epinephrine. This past winter, she had multiple upper respiratory tract infections that required 2 courses of oral corticosteroids. Her asthma is currently well controlled with daily inhaled fluticasone, with no nighttime awakenings.

https://ift.tt/2IwFN0t

Evaluating the role of tissue microRNA‐27b as a diagnostic marker for oral lichen planus and possible correlation with CD8

Journal of Oral Pathology &Medicine, Volume 0, Issue ja, -Not available-.


https://ift.tt/2QpPsZt

Prediction of femtosecond laser ablation profile on human teeth

Abstract

To predict the laser ablation profile on dental hard tissue which will enable the user to optimize laser parameters so as to carry out the laser treatment with minimal tissue damage. The present study constructs a mathematical model to predict the ablation profile based on Gaussian beam distribution of laser intensity and correlates the model with experimentally obtained ablation parameters (effective Gaussian beam radius, ablation threshold fluence, and effective energy penetration depth). To obtain the ablation parameters, laser ablation experiments were carried out on dental hard tissues using Ti:Sapphire femtosecond laser (800 nm, 100 fs, 10 kHz). The method is further extended to predict the ablation rate and efficiency as well. The profile predicted from the mathematical model is compared with that of experimental results. It is found that the predicted ablation profile agrees well with the experimental profile for both enamel and dentin except a slight deviation at higher fluence for dentin. The calculated ablation rate is comparable to that of experimental results whereas for ablation efficiency appreciable deviation is observed in the case of dentin. The model succinctly predicts the ablation profile, ablation rate, and ablation efficiency which will enable to perform dental surgery at optimized laser processing conditions with high precision thus reducing the tissue damage appreciably. Once the details of lesion are known through proper diagnostic tools, the method enables the user to readily obtain optimum laser parameters. It can be used as a handy reference for dentists to perform damage-free surgery, ensuring quicker healing.

https://ift.tt/2zLlnOD

Digital behavior surveillance: monitoring dental caries and toothache interests of Google users from developing countries

Oral Diseases, Volume 0, Issue ja, -Not available-.


https://ift.tt/2Ngtg26

Expression of ETS1 and LEF1 in Salivary Glands of Sjögren Syndrome Patients

Oral Diseases, Volume 0, Issue ja, -Not available-.


https://ift.tt/2Ov75tH

Real‐world database examining the association between hydroxychloroquine and retinopathy in Taiwan

British Journal of Dermatology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2xSJd9P