While coins are still the most common foreign bodies swallowed by children, ingestion of batteries has become more frequent among children due to the increasing access to electronic toys and devices.
https://ift.tt/2P0Gyoz
Τετάρτη 17 Οκτωβρίου 2018
Button battery removed from the stomach resulting in a missed aortoesophageal fistula – a multidisciplinary approach to rescuing a very young patient: a case report
A painless glomus tumor: a case report
Glomus tumor is a benign and vascular hamartoma that originates from the neuromyoarterial cells of the normal glomus apparatus in the reticular dermis. The etiology of glomus tumors is unknown. It usually pres...
https://ift.tt/2PF1y1b
Ideal treatment strategy for chylous mesenteric cyst: a case report
A mesenteric chylous cyst is defined as a cyst occurring in the mesentery of the gastrointestinal tract anywhere from the duodenum to the rectum and is diagnosed most often during the fifth decade of life.
https://ift.tt/2P0GsNJ
Bilateral Spontaneous Hyphemas in a Patient with Aplastic Anemia
Bilateral spontaneous hyphemas are a rare ophthalmic event. Aplastic anemia is a hematologic condition with well-documented manifestations in the posterior segment but not the anterior segment. We present a patient with aplastic anemia without obvious risk factors for hyphema who developed bilateral spontaneous hyphemas. To our knowledge, this is the first reported case of bilateral spontaneous hyphemas in a patient with aplastic anemia.
Case Rep Ophthalmol 2018;9:444–448
https://ift.tt/2J5SwaW
Detection of Candida Endophthalmitis in a Newborn Using Handheld Spectral-Domain Optical Coherence Tomography
In a newborn with candidemia, two retinal lesions were seen without external inflammatory signs or reaction in the anterior chamber or vitreous. However, handheld spectral domain-optical coherence tomography (HH SD-OCT) images show that one of the retinal lesions had a "firework display" projecting to the vitreous that was not identified in indirect ophthalmoscopy. This finding suggested a Candida endophthalmitis. HH SD-OCT findings allowed us to make an accurate diagnosis and, therefore, modified the decision-making process in the treatment of the pathology.
Case Rep Ophthalmol 2018;9:439–443
https://ift.tt/2OyWfDW
Thrombus straddling a patent foramen ovale, pulmonary embolism and paradoxical embolism: a rare trifecta
Description
A 55-year-old male presented to the emergency room after awakening with left facial droop, left-sided weakness and garbled speech. Vitals were significant for hypotension (73/43 mm Hg) and hypothermia (35.3°C). Physical examination was significant for left facial droop, dysarthria, bilateral upper extremity strength 4/5, bilateral lower extremity strength 3/5. Laboratory tests were significant for leucocytosis of 16.9x109/L thou/mcL, lactic acid 2.5 mmol/L, creatinine 3.07 mg/dL and troponin 0.07 ng/mL.
Chest X-ray revealed no acute process. Head CT revealed no acute process with old right basal ganglia and right frontal lobe infarcts. Head and neck magnetic resonance angiography (MRA) revealed no blockages or aneurysmal dilatations. Brain MRI revealed three areas of diffusion restriction in left temporal occipital lobe, compatible with acute infarcts. Tissue plasminogen activator was not given since he was outside the window. Stroke work-up was ordered, pancultures were sent, broad-spectrum antibiotics were started, and he was sent to the intensive care unit.
Transthoracic...
https://ift.tt/2J3ZE7Q
Pelvic hydatid: the great masquerader
Description
A 52-year-old man presented with urinary frequency and occasional lower abdominal pain for 4 months. His uroflow study and postvoid residual urine were normal and his digital rectal examination had grade 2 prostatic enlargement. His urinary symptoms were attributed to benign prostatic hyperplasia, and he was prescribed tamsulosin (0.4 mg) and solifenacin (5 mg) for his symptoms. One week later he only had partial relief of symptoms, thus an ultrasound was done that showed a cystic lesion abutting the urinary bladder in the region of right iliac fossa (figure 1). A contrast-enhanced CT (CECT) scan was then done, which showed a cystic lesion (3.8x4 cm) with enhancing internal septa and peripheral wall enhancement abutting the urinary bladder (figure 2). There was no other cyst in the abdomen so a provisional diagnosis of primary pelvic peritoneal hydatid cyst was made. We then carried out a cystoscopy to...
https://ift.tt/2Oz4Wy7
Development of acquired haemophilia A in a patient treated with alemtuzumab for multiple sclerosis
This case illustrates a 36-year-old man who presented with a factor VIII (FVIII) inhibitor (acquired haemophilia A) with cutaneous bleeding and a significant thigh haematoma. No traditional risk factors for the development of a FVIII inhibitor were identified. However, previous treatment with alemtuzumab for multiple sclerosis was noted in the patient's history. Alemtuzumab is an anti-CD52 monoclonal antibody and is known to be associated with the development of a number of autoimmune conditions, with a delay in onset of these conditions as long as 5 years after the cessation of treatment. To our knowledge, there have only been three previously documented cases of a FVIII inhibitor in the setting of alemtuzumab therapy. This case adds further evidence to the current body of literature suggesting alemtuzumab as a causative agent for the development of an FVIII inhibitor.
https://ift.tt/2J2xqu0
Meningococcemia: rare but life-threatening
Description
A previously healthy 5-month old girl, presented at the emergency department with high fever (40°C), vomiting and nasal congestion. She had no abnormalities on physical exam and was discharged home with diagnosis of a probable viral infection, after excluding urinary infection.
Ten hours later, the infant was readmitted with purpuric lesions and prostration (figure 1), rapidly presenting with labial cyanosis, capillary refill of 6 s, tachycardia, hypotension and anuria (cold shock). The patient was empirically treated with ceftriaxone and vancomycin, started inotropic and ventilator support, having been transferred to a hospital with a paediatric intensive care unit with a refractory shock, purpuric rash and disseminated intravascular coagulation (figure 2).
Figure 1
Petechiae and purpuric lesions only on the thoracoabdominal region.
Figure 2
Purpura fulminans with necrosis of extremities.
Blood workout revealed leucopenia (2.600/mm3) with neutropenia (2.00/mm3),...
https://ift.tt/2Ow59C3
Endoscopic resection of a huge orbital ethmoidal mucocele masquerading as dacryocystocele
Paranasal mucoceles are cystic masses lined with epithelium thought to result from chronic obstruction of an impaired sinus ostia. If sufficiency large, they can cause ophthalmological sequelae including diplopia, visual acuity, globe displacement as well as the rhinological symptoms of facial pain and headache. We present the case of a 57-year-old man who presented with a 1-year history of epiphora and right globe prominence with associated diplopia. Imaging demonstrated a mass located within the medial aspect of the orbit, closely associated to the lamina papyracea and nasolacrimal duct consistent with a dacryocystocele. An alternate diagnosis of an ethmoidal mucocele was considered preoperatively following rhinologist opinion. Complete endoscopic resection of the cyst was undertaken. Histopathology confirmed diagnosis of an ethmoidal mucocele. Our report highlights mucocele should be considered in patients with chronic symptoms secondary to a mass situated in the nasolacrimal duct without radiological orbital bone destruction.
https://ift.tt/2J4FXwz
Influenza A: another cause of SIADH?
The syndrome of inappropriate antidiuretic hormone (SIADH) secretion is a frequent cause of hyponatraemia. It is a dilutional hyponatraemia secondary to impaired urinary dilution in the absence of renal disease or any identifiable non-osmotic stimulus known to induce antidiuretic hormone secretion. SIADH can arise secondary to various respiratory tract infections; however, the association between SIADH and influenza A infection is described in only a few cases in the literature. The authors present a case report of influenza A that may have caused a profound SIADH-related hyponatraemia.
https://ift.tt/2OwPmmE
Verruciform xanthoma overlying inflammatory linear verrucous epidermal nevus and in broad segmental distribution
A 17-year-old woman presented with moderately itchy, non-progressive, linearly arranged verrucous plaques over dorsum of left foot since early childhood. Two years ago, she developed slowly increasing, verrucous exophytic growth in posterior most aspect of linear verrucous plaque. One year ago, she also developed multiple, linearly arranged, fleshy plaques with surface crusting over lateral aspect of right leg extending to thigh. Biopsy from both verrucous lesion on left foot and fleshy plaque on right leg showed an exophytic growth with significant papillomatosis, neutrophils in stratum corneum, acanthosis and infiltration of papillary dermis with foamy macrophages that were CD 68 positive, features compatible with verruciform xanthoma (VX). Biopsy from linear verrucous plaque over left foot was consistent with inflammatory linear verrucous epidermal nevus (ILVEN). A diagnosis of segmental VX and VX overlying ILVEN was made.
https://ift.tt/2J5rfpd
Churg-Strauss vasculitis presenting with steroid-responsive left ventricular cardiac mass
A 35-year-old black Saudi man, with a known case of bronchial asthma and allergic rhinitis since childhood, presented with joint pain and swelling, orthopnoea, paroxysmal nocturnal dyspnoea and lower extremity oedema. On examination, we found jugular venous distension, bilateral basal crepitation, wheezing and diffuse synovitis. Investigations were notable for peripheral blood eosinophilia, pericardial effusion and elongated structure in the left ventricular outflow tract on echocardiography, mediastinal and hilar lymphadenopathy and right upper lobe infiltrate on high-resolution CT scan. Pulmonary infiltrate biopsy confirmed eosinophilic vasculitis. Intracardiac mass resolved shortly after pulse steroids indicating an inflammatory mass.
https://ift.tt/2OtKwqa
Correction: Vacuum-assisted right atrial infected clot extraction due to persistent bacteraemia: a percutaneous approach for the management of right-sided endocarditis
Ahmed M, Montford JH, Lau E. Vacuum-assisted right atrial infected clot extraction due to persistent bacteraemia: a percutaneous approach for the management of rightsided endocarditis. BMJ. doi:10.1136/bcr-2018-226493.
The previous version of this manuscript contains an error in author's surname namely Jaime Hernandez Montford. It should read as:
Jaime Hernandez Montfort
instead of
Jaime Hernandez Montford
Also, the location of Baystate Medical Center should read as:
Baystate Medical Center, Springfield, MA, USA
Instead of
Baystate Medical Center, Springfield, Illinois, USA
https://ift.tt/2J1OtMG
Resolved heart tamponade and controlled exophthalmos, facial pain and diabetes insipidus due to Erdheim-Chester disease
A 69-year-old woman suffering from exophthalmos and facial pain came to us referred for aetiological diagnosis of exophthalmos. Orbital MRI showed thinned extrinsic ocular musculature, intraconal fat infiltration, retro-ocular compression and thickening of maxillary and sphenoid sinus walls. She had been suffering from diabetes insipidus for the last 7 years. During our diagnosis process, she presented signs of cardiac tamponade. Transthoracic heart ultrasound revealed large pericardial effusion and a heterogeneous mass that compressed the right ventricle. No osteosclerotic lesions on appendicular bones were present. Pericardiocentesis temporarily controlled tamponade and corticoid therapy temporarily abated exophthalmos. Pericardiectomy definitively resolved tamponade. Histological examination of pericardial tissue was conclusive of Erdheim-Chester disease. Exophthalmos responded to pegylated interferon-alpha-2a. Facial bone pain disappeared after zoledronic acid and interferon treatment. During interferon therapy, the patient suffered from a severe generalised desquamative exanthema that slowly resolved after discontinuing interferon. Diabetes insipidus remains controlled with desmopressin.
https://ift.tt/2OyRzxS
Regulation of metabolic supply and demand during B cell activation and subsequent differentiation
Takeshi Egawa | Deepta Bhattacharya
https://ift.tt/2yNoBzk
Forced oscillatory parameters in reversibility testing as predictors for chronic cough responsive to ICS/LABA
The cough guidelines recommend that asthma should always be considered as a potential etiology of chronic cough.1,2 The presence of airway hyperresponsiveness is consistent with, but not diagnostic of, cough due to mild asthma.A definitive diagnosis cannot be made until resolution of cough is achieved with specific therapy, including inhaled corticosteroid/long-acting β2 agonist (ICS/LABA) or ICS. Airway reversibility testing is often used to diagnose cough due to mild asthma; however, reversibility of forced expiratory volume in 1 second (FEV1) is smaller in mild asthma than in moderate asthma because baseline FEV1 values are normal or nearly normal in most patients with mild asthma.
https://ift.tt/2OvIeXy
Epidemiology of Nickel Sensitivity: Retrospective Cross-Sectional Analysis of North American Contact Dermatitis Group (NACDG) Data 1994-2014
Detailed analyses of trends in nickel sensitivity in North America are lacking. Clinicians should be aware of a significant increase in nickel sensitivity over time (14.3% to 20.1% from 1994 to 2014) and significant increase in current clinical relevance of reactions over time (44.1% to 51.6% from 1994 to 2014).
https://ift.tt/2Cqght7
Mandibular feminization osteotomy—preliminary results
Strong mandibular angles and a heavy chin are perceived as masculine features, so surgical feminization of female or transgender faces may warrant mandibular base narrowing (borders and angles) and a reduction in chin width and height. With this in mind, we have devised an interdental midline osteotomy (triangular in shape and with a caudal base) to accompany a box-shaped impaction osteotomy of the chin symphysis and horizontal triangular resection of the lateral mandibular border. The reduction of the intergonial width and of the mandibular border and chin widths takes place upon closure of the midline defect.
https://ift.tt/2PcQKKN
Evaluation of two-dimensional lateral cephalogram and three-dimensional cone beam computed tomography superimpositions: a comparative study
Superimposition of radiographic imaging is used to evaluate patient growth and the effects of surgical and/or orthodontic treatment. The purpose of this study was to compare the outcomes of superimposition between two-dimensional (2D) and three-dimensional (3D) superimpositions. 2D lateral cephalograms were generated from the initial and final cone beam computed tomography scans (CBCT) of 18 patients and superimposed. Both 3D CBCT and 2D CBCT generated lateral cephalograms were oriented to the Frankfort horizontal plane and superimposed according to the American Board of Orthodontics recommendations.
https://ift.tt/2PMtgZC
Hedgehog signaling pathway and vitamin D receptor gene variants as potential risk factors in odontogenic cystic lesions
Abstract
Objectives
Genetic variants in the hedgehog signaling pathway and VDR gene are involved in inflammatory responses and neoplastic transformation. Current study investigated whether single-nucleotide polymorphisms in the hedgehog pathway genes PTCH1, GLI1, SMO, and VDR contribute to susceptibility to odontogenic cystic lesions, odontogenic keratocysts, or inflammatory radicular cysts.
Material and methods
Current study examined polymorphisms of PTCH1 (rs357564) and PTCH1 insertion (IVS1-83), GLI1 (rs2228224, rs2228226), SMO (rs2228617), and VDR (rs2228570, rs731236, rs7975232). A case-control study was conducted on 41 keratocyst cases, 43 radicular cyst cases, and control group of 93 healthy individuals without cystic lesions, radiographically confirmed. Single-nucleotide polymorphisms were assessed by real-time and TaqMan SNP genotyping assays, while PTCH1 insertion 18 bp IVS1-83 polymorphism was determined by PCR.
Results
The difference in genotype distribution between keratocyst cases and control group was observed for PTCH1 IVS1-83 and GLI1 rs2228224 polymorphism (p = 0.022, p = 0.030, respectively). Homozygous mutant GG genotype within GLI1 rs2228224 is associated with increased susceptibility for odontogenous keratocysts, with adjusted odds ratio of 4.098 (confidence interval of 1.482–11.328, p = 0.007).
Conclusion
GLI1 rs2228224 and PTCH1 polymorphisms could predispose to odontogenic keratocysts.
Clinical relevance
Variants in hedgehog signaling pathway genes, such as GLI1 and PTCH1, and vitamin D receptor gene, might be considered as molecular risk factors in odontogenic cystic lesions and potential targets for novel therapeutic approaches.
https://ift.tt/2yLuKfF
Single-Nucleotide Polymorphisms in NOD1, RIPK2, MICB, PLCE1, TNF, and IKBKE Genes Associated with Symptomatic Dengue in Children from Colombia
Viral Immunology, Ahead of Print.
https://ift.tt/2R0wRnp
The expression of MHC class II molecules on murine breast tumors delays T-cell exhaustion, expands the T-cell repertoire, and slows tumor growth
Abstract
The expression of MHC class II molecules (MHCII) on tumor cells correlates with survival and responsiveness to immunotherapy. However, the mechanisms underlying these observations are poorly defined. Using a murine breast tumor line, we showed that MHCII-expressing tumors grew more slowly than controls and recruited more functional CD4+ and CD8+ T cells. In addition, MHCII-expressing tumors contained more TCR clonotypes expanded to a larger degree than control tumors. Functional CD8+ T cells in tumors depended on CD4+ T cells. However, both CD4+ and CD8+ T cells eventually became exhausted, even in MHCII-expressing tumors. Treatment with anti-CTLA4, but not anti-PD-1 or anti-TIM-3, promoted complete eradication of MHCII-expressing tumors. These results suggest tumor cell expression of MHCII facilitates the local activation of CD4+ T cells, indirectly helps the activation and expansion of CD8+ T cells, and, in combination with the appropriate checkpoint inhibitor, promotes tumor regression.
https://ift.tt/2PDYXEJ
Association of Caffeine and Caffeinated Coffee Intake With Risk of Incident Rosacea in Women
This large cohort study of participants in the Nurses' Health Study II evaluates the association between risk of incident rosacea in women and caffeine intake, including caffeinated coffee consumption.
https://ift.tt/2RUpRJP
https://ift.tt/2RUpRJP
One More Reason to Continue Drinking Coffee—It May Be Good for Your Skin
Who does not love a study that validates one of life's habitual pleasures? Whether it is an iced latte, a double espresso, or simply a hot cup of brown liquid in the hospital cafeteria, many of us in medicine have an emotional attachment as well as a physiologic dependence on coffee.
https://ift.tt/2EtLE8w
https://ift.tt/2EtLE8w
Utility of Test Result Monitoring in Patients Taking Terbinafine or Griseofulvin for Dermatophyte Infections
This study assesses the rate and utility of monitoring laboratory test result abnormalities in adults and children taking terbinafine and griseofulvin for treatment of dermatophyte infections.
https://ift.tt/2RXJQaO
https://ift.tt/2RXJQaO
Cicatrizing Blepharoconjunctivitis During Dupilumab Treatment and an Algorithm for Its Management
This case report describes a patient who developed cicatrizing blepharoconjunctivitis while undergoing dupilumab treatment and proposes an algorithm for the management of dupilumab-associated conjunctivitis.
https://ift.tt/2EutbsG
https://ift.tt/2EutbsG
Open-Label, Multicenter, Phase Ⅱ Study of Docetaxel and Cisplatin Combined With Nimotuzumab As First-Line Treatment in Patients With Recurrent or Metastatic Nasopharyngeal Carcinoma
Condition: Over Survival
Intervention: Drug: Docetaxel and Cisplatin and Nimotuzumab
Sponsor: Sun Yat-sen University
Not yet recruiting
https://ift.tt/2yqWy9H
Intervention: Drug: Docetaxel and Cisplatin and Nimotuzumab
Sponsor: Sun Yat-sen University
Not yet recruiting
https://ift.tt/2yqWy9H
Phase II Study of Perioperative Immunotherapy in Patients With Advanced Non-Virally Associated Squamous Cell Carcinoma
Conditions: Cancer; Carcinoma; Squamous Cell Carcinoma; Head and Neck Cancer
Interventions: Biological: Atezolizumab; Biological: Emactuzumab
Sponsors: University of California, San Francisco; Genentech, Inc.
Not yet recruiting
https://ift.tt/2yFYSsK
Interventions: Biological: Atezolizumab; Biological: Emactuzumab
Sponsors: University of California, San Francisco; Genentech, Inc.
Not yet recruiting
https://ift.tt/2yFYSsK
Active Surveillance of Low-Risk Papillary Thyroid Microcarcinoma: A Multi-Center Cohort Study in Korea
Thyroid, Ahead of Print.
https://ift.tt/2yMtysa
Aberrant histone modification and inflammatory cytokine production of peripheral CD4+ T cells in patients with oral lichen planus
Journal of Oral Pathology &Medicine, Volume 0, Issue ja, -Not available-.
https://ift.tt/2NJHQzn
Aloe vera in treatment of oral submucous fibrosis: a systematic review and meta‐analysis
Journal of Oral Pathology &Medicine, Volume 0, Issue ja, -Not available-.
https://ift.tt/2pWJTXx
Secukinumab is Superior to Ustekinumab in Clearing Skin in Patients with Moderate to Severe Plaque Psoriasis (16-Week CLARITY Results)
Abstract
Introduction
Secukinumab, a fully human anti-interleukin-17A monoclonal antibody, has demonstrated superior efficacy to ustekinumab in the phase 3b CLEAR study of moderate to severe plaque psoriasis. Here, we report 16-week results from CLARITY, a second head-to-head trial comparing secukinumab with ustekinumab.
Methods
In the phase 3b CLARITY study, patients were randomized 1:1 to receive subcutaneous secukinumab 300 mg or ustekinumab per label. The co-primary objectives were to demonstrate the superiority of secukinumab over ustekinumab at Week 12 in relation to the proportion of patients with (1) 90% or more improvement from baseline Psoriasis Area and Severity Index (PASI 90) and (2) a score of 0/1 (clear/almost clear) on the modified Investigator's Global Assessment (IGA mod 2011 0/1). Key secondary objectives were also assessed, as was Dermatology Life Quality Index (DLQI) 0/1 (no impact of skin disease on patients' quality of life) response. Missing values were handled by multiple imputation except for DLQI 0/1, where last observation carried forward techniques were utilized.
Results
Both co-primary objectives were met: secukinumab was superior to ustekinumab for the proportion of patients achieving a PASI 90 (66.5% vs. 47.9%) and IGA mod 2011 0/1 response (72.3% vs. 55.4%) at Week 12 (p < 0.0001). PASI 90 responses were greater with secukinumab compared to ustekinumab from as early as Week 4 (16.7% vs. 4.0%) and out to Week 16 (76.6% vs. 54.2%). Similarly, IGA mod 2011 0/1 findings were greater with secukinumab at Week 4 (26.9% vs. 7.8%) and at Week 16 (78.6% vs. 59.1%). DLQI 0/1 response rates were also greater with secukinumab compared to ustekinumab at Week 4 (33.9% vs. 18.0%), Week 12 (64.0% vs. 51.7%), and Week 16 (68.4% vs. 55.9%).
Conclusion
The results of this study confirm the superior efficacy of secukinumab over ustekinumab in treating patients with moderate to severe psoriasis.
Trial Registration
Clinicaltrials.gov Identifier, NCT02826603.
Funding
Novartis Pharma AG, Basel, Switzerland.
https://ift.tt/2NMRHV1
Response to the letter to the editor: Comment on “Streptococcus anginosus Dental Implant-Related Osteomyelitis of the Jaws: An Insidious and Calamitous Entity”
Publication date: Available online 16 October 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Paolo Scolozzi, Sibylle Chatelain, Jacques Schrenzel, Tommaso Lombardi
https://ift.tt/2NLzhEr
Les toxidermies graves sont-elles évitables ?
Publication date: Available online 16 October 2018
Source: Annales de Dermatologie et de Vénéréologie
Author(s): J.-L. Schmutz
https://ift.tt/2EqpmEP
Intraoperative Hypothermia is Associated With Reduced Acute Kidney Injury After Spine Surgery Under General Anesthesia: A Retrospective Observational Study
Background: Although hypothermia is known to have protective effects against ischemic injuries, the effects of hypothermia on kidney injury have not yet been elucidated. Therefore, this study aimed to identify the association between intraoperative hypothermia and postoperative acute kidney injury (AKI) in patients who underwent spine surgery under general anesthesia. Methods: In this retrospective observational study, we analyzed the medical records of adult patients who underwent elective spine surgery between January 2010 and March 2018. Patients were classified into the normothermia group (36.5 to 37.5°C), mild hypothermia group (35 to 36.5°C), and hypothermia group (
https://ift.tt/2NMjGEt
https://ift.tt/2NMjGEt
Cognitive Aids for the Diagnosis and Treatment of Neuroanesthetic Emergencies: Consensus Guidelines on Behalf of the Society for Neuroscience in Anesthesiology and Critical Care (SNACC) Education Committee
Cognitive aids and evidence-based checklists are frequently utilized in complex situations across many disciplines and sectors. The purpose of such aids is not simply to provide instruction so as to fulfill a task, but rather to ensure that all contingencies related to the emergency are considered and accounted for and that the task at hand is completed fully, despite possible distractions. Furthermore, utilization of a checklist enhances communication to all team members by allowing all stakeholders to know and understand exactly what is occurring, what has been accomplished, and what remains to be done. Here we present a set of evidence-based critical event cognitive aids for neuroanesthesia emergencies developed by the Society for Neuroscience in Anesthesiology and Critical Care (SNACC) Education Committee. The authors have no funding or conflicts of interest to disclose. Address correspondence to: Amie L. Hoefnagel, MD, Department of Anesthesiology, University of Florida College of Medicine—Jacksonville, 2nd Floor, Clinical Center, 655 West 8th Street, C72, Jacksonville, FL 32209 (e-mail: amie.hoefnagel@jax.ufl.edu). Received August 7, 2018 Accepted August 27, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved
https://ift.tt/2pZiu7i
https://ift.tt/2pZiu7i
Regional Versus General Anesthesia: Effect of Anesthetic Techniques on Clinical Outcome in Lumbar Spine Surgery A Prospective Randomized Controlled Trial
Background: There are only a few prospective clinical trials investigating the effects of different anesthetic techniques on clinical outcomes after lumbar spine surgery. The purpose of this study was to evaluate clinical outcomes in patients receiving general (GA) and regional anesthesia (RA) for lumbar spine surgery. Methods: This was a single-center, 2-arm, trial in which 100 patients undergoing lumbar spine surgery were randomized to receive either RA or GA (50 per group). The primary endpoint was morphine consumption during the first postoperative 48 hours. In addition, anesthesia time, transition time (defined as time from end of surgery to admission to the postoperative anesthesia care unit), visual analogue scale (VAS) for pain, and patient satisfaction at hospital discharge were recorded. Results: There was no difference in the primary endpoint (cumulative morphine consumption at 48 h) between the 2 anesthesia types. Anesthesia and transition times were significantly shorter in the RA compared with the GA group—anesthesia time 125.4±23.6 minutes for GA versus 99.4±13.5 minutes for RA, transition time 22.5 minutes for GA versus 10.0 minutes for RA (both P
https://ift.tt/2NLZF0K
https://ift.tt/2NLZF0K
The effect of compressive force combined with mechanical vibration on human alveolar bone osteoblasts
Publication date: Available online 16 October 2018
Source: Journal of Oral Biology and Craniofacial Research
Author(s): Chatchai Chatmahamongkol, Anute Pravitharangul, Srisurang Suttapreyasri, Chidchanok Leethanakul
Abstract
Objective
This study aimed to investigate the effects of compressive force combined with mechanical vibration on the expression of pro-inflammatory cytokines that promote osteoclastogenesis and related to orthodontic tooth movement acceleration in human alveolar bone osteoblasts in vitro.
Methods
Osteoblasts were subjected to compressive force (C), mechanical vibration (V), compressive force combined with mechanical vibration (CV), or no force as a control for 12, 24 and 48 h. Interleukin-1 beta (IL-1β), interleukin-6 (IL-6), receptor activator of nuclear factor kappa-Β ligand (RANKL) and osteoprotegerin (OPG) mRNA and protein expression were assessed using quantitative real-time polymerase chain reaction and enzyme-linked immunosorbent assays.
Results
In C and CV groups, IL-1β and IL-6 mRNA and protein expression were significantly higher and OPG mRNA and protein expression were significantly lower than control and V groups. However, the expressions were not different between C and CV groups. RANKL mRNA and protein expression were not different between any groups. While, OPG mRNA and protein expression in V group were significantly higher than control group.
Conclusions
Vibration neither enhanced nor inhibited the expression of IL-1β, IL-6, RANKL and OPG in compressed human alveolar bone osteoblasts.
https://ift.tt/2P2vpU6
Genomic mutations and proof of causation between dysplasia and squamous cell carcinoma in medicolegal cases: a useful approach or a waste of resources?
Publication date: Available online 16 October 2018
Source: British Journal of Oral and Maxillofacial Surgery
Author(s): A. Kanatas, D.A. Mitchell
https://ift.tt/2PAhsKc
In Their Own Words: Caregiver and Patient Perspectives on Stressors, Resources, and Recommendations in Craniofacial Microsomia Care
This study describes stressors, resources, and recommendations related to craniofacial microsomia (CFM) care from the perspective of caregivers of children with CFM and adults with CFM to inform improved quality of healthcare delivery. A mixed method design was used with fixed-response and open-ended questions from an online survey in English. The survey included demographics, CFM phenotypic information, and items about CFM-related experiences across settings. Themes were identified by qualitative analysis of responses to open-ended questions. Respondents (n = 51) included caregivers (n = 42; 90% mothers) and adults with CFM (n = 9; 78% female), who had a mean age of 45 ± 6 years. Most children were male (71%) with an average age of 7 ± 4 years. Respondents were primarily white (80%), non-Hispanic (89%), from the United States (82%), had a college degree (80%), and had private health insurance (80%). Reflecting the high rate of microtia (84%) in the sample, themes centered on the impact of hearing difficulties across settings with related language concerns. Negative social experiences were frequently described and school needs outlined. Multiple medical stressors were identified and corresponding suggestions included: providers need to be better informed about CFM, treatment coordination among specialists, and preference for a family-centered approach with reassurance, empathy, and clear communication. Advice offered to others with CFM included positive coping strategies. Overall, caregivers' and patients' responses reflected the complexity of CFM treatment. Incorporating these perspectives into routine CFM care has the potential to reduce family distress while improving their healthcare. Address correspondence and reprint requests to Alexis L. Johns, PhD, ABPP, Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS#96, Los Angeles, CA 90027; E-mail: ajohns@chla.usc.edu Received 31 January, 2018 Accepted 3 July, 2018 Portions of this paper were in a poster presentation at the Appearance Matters 8 Conference, June 2018, Bath, UK. Research reported in this paper was supported by the Center for Clinical and Translational Research at Seattle Children's Research Institute, grant UL1 TR000423 (Redcap). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2RXhDRs
https://ift.tt/2RXhDRs
Distraction Sugosteogenesis: Its Biologic Bases and Therapeutic Principles
Purpose: Recently, the terms sugosteogenesis and distraction sugosteogenesis have been introduced to the scientific literature. While the former describes a biologic phenomenon, the latter refers to the clinical technique which relies on the accelerated normal bone healing process that takes place at the osseous walls surrounding a cystic cavity when active negative pressure is applied. The purpose of this study is to provide the biologic bases and the therapeutic principles of this emerging technique. Employing well-stablished biologic principles, clinical evidence from analogous techniques, emerging experimental data, and circumstantial evidence, this study presents the possible mechanism of action of the evacuator for odontogenic cysts (Evocyst), a closed, vacuum-like drain system intended to treat cystic conditions using negative pressure. Methods: A review of the literature was done. Keywords for the Medline search were: marsupialization, decompression, odontogenic cysts, effects of negative pressure on bone, and negative pressure wound therapy. In addition, relevant publications from the reference list of the retrieved studies were considered. The matches were evaluated for relevance and analyzed accordingly. Clinical reports used to illustrate the concept of distraction sugosteogenesis were performed following the Declaration of Helsinki on medical protocol and ethics. Results: Currently, the standard of care to manage odontogenic cystic lesions includes marsupialization, enucleation and curettage, decompression, and surgical resection. However, there is a need for an alternative option in which the entity could be treated while promoting bone formation. With large odontogenic cystic conditions treated in a short period of time, distraction sugosteogenesis appears to be a choice. Conclusion: The application of negative pressure to osseous cells produces a stretching that creates mechanical cues that trigger signaling pathways, promotes fluid flow, and enhances angiogenesis. All of them, combined, may explain sugosteogenesis. The clinical application of such parameters may explain the good clinical results obtained with the Evocyst. Address correspondence and reprint requests to Dr Jaime Castro-Núñez, DMD, Research Department, Institución Universitaria Colegios de Colombia, Autopista Norte Km 20 via a Chía, Bogota, Colombia; E-mail: jacastron@hotmail.com Received 4 March, 2018 Accepted 9 July, 2018 The author reports no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2ErfDht
https://ift.tt/2ErfDht
Assessment of Vertical Triangular Spreader Graft Technique for Reconstruction of Middle Vault and Internal Nasal Valve Angle
Background: Rhinoplasty is a surgical procedure to smooth out the nasal deformities and to fix nasal breathing problems. Spreader grafts and flaps are used to prevent some complications such as middle vault collapse, narrowing the internal nasal valve and inverted V deformity. To obtain more stable middle vault, spreader grafts and flaps could be used together. Many researchers have tried different graft and flap techniques to reach more successful aesthetic and functional results. In this research, we investigated effects of triangular graft on the internal nasal valve angle, nasal breathing, and aesthetic outcomes when it used together with sprader flap. Methods: In this prospective study, 3 different groups were formed as: the spreader flap group (group 1); the spreader flap with the rectangular spreader graft group (group 2); and the spreader flap with the triangular spreader graft group (group 3). Preoperative nasal obstruction symptom evaluation (NOSE) scale was used to evaluate nasal breathing and visual analog scale (VAS) was used to evaluate aesthetic appearance. And also, measurement of the internal nasal valve angle was performed for each patients. These evaluations were repeated at postoperative 3rd month. Preoperative and postoperative comparisons between study groups were performed. Results: There were 12 patients in group 1, 14 patients in group 2, and 10 patients in group 3. In each group, statistically significant decrease in NOSE scores (P 0.05). On the contrary, the internal nasal valve angles were found statistically significant increased in group 3 according to other groups (P
https://ift.tt/2RXhv4q
https://ift.tt/2RXhv4q
Synovial Chondromatosis and Calcium Pyrophosphate Deposition of the Temporomandibular Joint: Challenging Diagnosis
Background: The association between the synovial chondromatosis (SC) and the calcium pyrophosphate deposition (pseudogotta) in temporomandibular joint (TMJ) is very rare and has been described just 1 patient in the literature. Clinical Presentation: A 64-year-old woman was referred to Dipartimento di Scienze Odontostomatologiche e Maxillo-Facciali, Sapienza Università di Roma after complaining about right temporomandibular pain, limitation in mandibular movements, and tumefaction in the right preauricular region. The patient was hospitalized for the surgery. The microscopic examination of the excised material revealed calcium pyrophosphate dihydrate (CPPD) deposits crystals associated with cartilaginous proliferation. Conclusion: The association between the SC and the calcium pyrophosphate deposition (pseudogotta) is a challenging diagnosis among TMJ neoplasms. Address correspondence and reprint requests to Valentino Vellone, MD, Department of Maxillofacial Surgery, "Sapienza" Università di Roma, Teano 35, Latina, Italy; E-mail: valentino.vellone@gmail.com Received 4 April, 2018 Accepted 3 June, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2EB0Nou
https://ift.tt/2EB0Nou
Asymmetric Protrusion of the Midface in Young Adults
Purpose: This study evaluated midfacial asymmetry using an alternative method that involved comparing bilateral patterns of the zygomaticomaxillary prominence in a young adult population. Materials and Methods: Three-dimensional reconstructed images based on computed tomography scans of 100 Koreans (mean age, 24.7 years) were evaluated with reference to lines spaced at 30° intervals and radiating from the center of an interporion line in a superior view. The surface inclination of the zygomaticomaxillary region was quantified on the same reference lines using a 3-dimensional ruler. Results: The 30°-interval line (at the level of the zygomaticotemporal suture) was longer on the left side than the right side in both males and females, whereas the left 60°-interval line (at the level of the zygomaticofrontal suture) was longer in females. Comparing the surface protrusion revealed that the zygomaticomaxillary region was more prognathic and inflated on the left side. Conclusion: Functional deviations are considered to be causes of asymmetric craniofacial growth. Postnatal growth allometry across the circummaxillary sutures as elucidated by this study could be useful information in craniofacial surgery. Address correspondence and reprint requests to Wu-Chul Song, MD, PhD, Department of Anatomy, Konkuk University School of Medicine, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Republic of Korea; E-mail: anatomy@kku.ac.kr Received 11 June, 2018 Accepted 24 July, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2RWXNpp
https://ift.tt/2RWXNpp
Aesthetic Assessment of Infants With Different Cleft Types Before, During, and After Orthopedic Treatment
Objective: The aim of the present study is to compare the aesthetic assessments of infants with different types of cleft before (T1), during (T2), and after (T3) orthopedic therapy (OT) by orthodontists, dentists, and laypersons. Methods: Photographs of 3 patients (incomplete lip [C1], complete unilateral [C2], and complete bilateral cleft [C3]) at T1 (C1, C2, C3 chronologic age: 5, 2, 2 days), T2 (C1, C2, C3 chronologic age: 32, 28, 35 days; using forehead anchoraged nasal stent or conventional nasoalveolar therapy plates), and T3 (C1, C2, C3 chronologic age: 80, 91, 105 days) were collected from the archive. The nasolabial region at stage T3 were masked and also added to the evaluation form (T4). Fifty-one evaluators (17 orthodontists, 17 dentists, and 17 laypersons; mean age = 30.1 ± 3.63) assessed 21 frontal photographs using Asher-McDade et al's 5-point scale. Results: The scores of the orthodontists for T1 photographs were statistically lower than the dentists and laypersons (P 0.05). The assessment scores progressively decreased from T1 to T3 (P > 0.05). The scores of both treatment methods were similar in the orthodontist group (P > 0.05), whereas the scores were lower for forehead anchored nasal stent in the other groups (P
https://ift.tt/2ErfCtV
https://ift.tt/2ErfCtV
The Effect of Spreader Graft and Mattress Suture Technique on Rhinoplasty in Patients With Nasal Hump Smaller Than 3 mm
Introduction: Rhinoplasty is a common plastic surgery that potentially has some complications such as postoperative deformities and breathing problems. A humpy nose is among the main reasons for rhinoplasty. Nasal valve (the narrowest part of the nasal airway) collapse may be occurred after nasal hump removal. Spreader graft is essential after more than 3 mm nasal hump removal. But the value of this graft is unknown for patients with nasal hump smaller than 3 mm. Mattress suture is another technique for widening the nasal valve angle. This study compares the effects of spreader graft and mattress suture technique on postoperative deformity and nasal valve patency in patients with nasal hump smaller than 3 mm as compared with control group (no graft and suture). Methods: In this clinical trial study 210 patients who underwent rhinoplasty with 2 different techniques involved. Their postoperative deformity and nasal valve patency were evaluated by subjective (questionnaire and digital photography) method before and after rhinoplasty during 6 months follow-up. Results: Statistically, nasal obstruction had no significant difference before and after rhinoplasty and no significant difference was observed between spreader graft and mattress sutures (P > 0.05), but significantly better results than control group (P
https://ift.tt/2RT5RHA
https://ift.tt/2RT5RHA
Ciliated HPV-Related Carcinoma: A Diagnostic Challenge on Frozen Section
Abstract
Oropharyngeal squamous cell carcinomas associated with high risk HPV show a wide morphological spectrum, including papillary, adenosquamous, lymphoepithelioma-like and sarcomatoid. We report an interesting case of ciliated HPV-related carcinoma arising from tonsillar tissue in a 55-year-old man which was associated with HPV33. This rare variant has been described in only a handful of cases in the literature, and to our knowledge this is the first case specifically associated with HPV33. The presence of cilia is a potential diagnostic problem as it has been traditionally considered a feature of benignancy, and could pose a particular challenge on frozen section. The diagnostic challenges, differential diagnosis of this tumor and the association with HPV33 are discussed.
https://ift.tt/2PDdVuB
The profiling of axial spondyloarthritis patient candidate to a biologic therapy: Consensus from a Delphi-panel of Italian experts
Publication date: Available online 16 October 2018
Source: Autoimmunity Reviews
Author(s): Ennio Giulio Favalli, Andrea Becciolini, Roberto Caporali, Monica Todoerti, Florenzo Iannone, Liliana Dinoia, Marco Sebastiani, Amelia Spinella, Elisa Gremese, Francesco Cianci, Fabiola Atzeni, Francesca Bandinelli, Gianfranco Ferraccioli, Giovanni Lapadula, GISEA Study Group
Abstract
Objective
The project aimed to collect expert consensus statements for the profiling of patients with axial spondyloarthritis (axSpA) candidate to biologic agents (bDMARDs) treatment, in order to better define the drivers for the best treatment choice.
Methods
The 6 more interesting topics about axSpA patient profiling were identified by the project steering committee and a panel of axSpA Italian experts. A systematic literature review (SLR) was performed for each of the selected topics according to the PICO format. Two rounds of a modified Delphi process were conducted. In the 1st round, the steering committee evaluated the results of the SLR in order to formulate statements for each topic. In the 2nd round, the experts panel discussed, rephrased when needed, and voted the level of agreement (on a 5-point Likert-type scale) for each statement. Consensus was defined as ≥66% agreement.
Results
The topics selected for the analysis were the differential efficacy of available bDMARDs on enthesitis/dactylitis, uveitis, radiographic progression and cardiovascular involvement, and the clinical response in non radiographic-axSpA and in patients receiving a second-line bDMARD. The Delphi rounds formulated 19 statements, all reaching the defined level of consensus in a second round including 25 rheumatologists highly skilled in the management of axSpA.
Conclusion
Identified consensus statements can help clinicians to apply to routine-care settings the results from clinical studies and international recommendations, providing a guide for individualization of treatment strategy in axSpA patients.
https://ift.tt/2pZzDOd
The styloglossus muscle: A critical landmark in onclogy and mandibular preservation surgery for squamous cell carcinoma of the lateral oropharynx
Publication date: Available online 16 October 2018
Source: European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): O. Laccourreye, R.K. Orosco, F. Rubin, F.C. Holsinger
Abstract
Goal
To document the role of the styloglossus muscle (SG) in the oncologic staging and mandibular preservation surgery for squamous cell carcinoma of the lateral oropharynx (SCCLO).
Method
Based on a search conducted within the Pubmed, Embase, and Cochrane databases, using the key words SG muscle, parapharyngeal space and oropharynx, the authors discuss the embryology, physiology, anatomy and radiology of this muscle as well as its role in the oncologic staging and mandibular preservation surgery of SCCLO.
Results
The most specific radiologic exam to evaluate the involvement of SG muscle in SCCLO is magnetic resonance imaging (MRI). Radiologic invasion of the SG muscle, at the time of MRI, leads to reclassify as T4a many tumors considered as T1-3 at the time of clinical and/or on computerized tomography evaluation. This must lead to extreme care when comparing oncologic results from series published prior and after the MRI era. When transoral resection of the SG muscle is advocated for SCCLO, one must know that this maneuver brings numerous arterial and venous structures within the operative field. If difficulties to achieve safe margins of resection and/or to control bleeding are encountered, a simple trans cervical maneuver described herein is most useful.
Conclusion
The importance of the SG muscle should be emphasized as a touchstone for staging and surgeon's guide to mandibular preservation surgery of SCCLO. The various approaches allowing the control of this muscle and its vascular environment must be taught at the time of initial training.
https://ift.tt/2P2yGCL
The speech perception after cochlear implantation: The hearing gain difference according to the implant systems is important?
Publication date: Available online 16 October 2018
Source: Auris Nasus Larynx
Author(s): Jeong Hun Jang, Hyoung Ah Mun, Oak-Sung Choo, Hun Yi Park, Yun-Hoon Choung
Abstract
Objective
The outcome of cochlear implantation (CI) is affected by various factors, including the manufacturer of the device. We validated the factors contributing to postoperative performance and evaluated the influence of different company devices on pure tone thresholds and postoperative performance.
Methods
Our study included 56 postlingually deaf adults who underwent CI between June 2005 and March 2016. The ears were divided into groups according to the implant manufacturer: A (n = 32 ears) and B (n = 24 ears) groups. The prognostic factors for CI outcome were evaluated using speech perception at 3, 6 and 12 months postoperatively and compared across devices.
Results
The duration of hearing aid use, age at CI, and mean pure tone threshold with the implant were correlated with postoperative speech perception. The mean pure tone thresholds with the implant (averages of 0.25, 0.5, 1, 2, 4 and 6 kHz) were 27.9 ± 3.7 dB HL in the group A and 33.5 ± 5.6 dB HL in the group B (P < 0.01). The open-set monosyllabic word, open-set disyllabic word and open-set sentence scores were not significantly different between the groups at 3, 6 and 12 months postoperatively.
Conclusion
The mean pure tone threshold with implant differed between the devices; however, no device-related effect on postoperative performance was observed. Additional multifactorial analyses are needed to clarify the relationship between free-field pure tone threshold with implant and postoperative speech perception.
https://ift.tt/2CSku9G
Human papillomavirus-related multiphenotypic sinonasal carcinoma: An emerging tumor type with a unique microscopic appearance and a paradoxical clinical behaviour
Publication date: December 2018
Source: Oral Oncology, Volume 87
Author(s): Justin A. Bishop, William H. Westra
Abstract
Human papillomavirus (HPV) is well established as a causative factor in most squamous cell carcinomas of the oropharynx (OPSCC). Indeed, a growing awareness over the past two decades that HPV-OPSCC is a distinct form of head and neck cancer has had a profound impact on diagnostic and clinical practices. The sinonasal tract is a second anatomic "hot spot" for HPV-related head and neck carcinomas, but certain pathologic features and the clinical behavior of HPV-related carcinomas at this site remain unclear. The enigmatic nature of HPV-positive sinonasal carcinomas is especially true for an emerging form recently designated as HPV-related multiphenotypic sinonasal carcinoma (HMSC). HMSC has come to the attention of the pathology community largely owing to its highly unusual microscopic appearance: it exhibits mixed salivary gland (e.g. adenoid cystic carcinoma) and squamous differentiation. At the same time, HMSC is largely unknown by the clinical community despite an unexpected clinical behavior that could affect therapy. HMSC is characterized by high grade histologic features, locally destructive growth, advanced T stage, and a propensity for local recurrence; and yet it appears to have little potential for metastatic spread or lethal behavior. This review will describe the unique pathologic features of HMSC, discuss its distinction from adenoid cystic carcinoma and squamous cell carcinoma, and draw attention to a behavior that departs from the expected clinical course of most high grade carcinomas of the head and neck.
https://ift.tt/2J1TuF7
Immunosuppression for immunodeficiency- getting smarter
Publication date: Available online 17 October 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Duan Lucy, Grunebaum Eyal
https://ift.tt/2P4riXH
RhoH deficiency induces psoriasis-like chronic dermatitis by promoting TH17 cell polarization
Publication date: Available online 17 October 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Norimasa Tamehiro, Kyoko Nishida, Yu Sugita, Kunihiro Hayakawa, Hiroyo Oda, Takeshi Nitta, Miwa Nakano, Akiko Nishioka, Reiko Yanobu-Takanashi, Motohito Goto, Tadashi Okamura, Reiko Adachi, Kazunari Kondo, Akimichi Morita, Harumi Suzuki
Abstract
Background
RhoH is a membrane-bound adaptor protein involved in proximal TCR signaling. Therefore, RhoH plays critical roles in the differentiation of T cells, however the function of RhoH in effecter phase of T cell response have not been fully characterized.
Objective
To explore the role of RhoH in inflammatory immune responses, we investigated the involvement of RhoH in the pathogenesis of psoriasis.
Method
We analyzed effector T cell and systemic inflammation in wild-type and RhoH-null mice. RhoH expression in T cells in human PBMC was quantified by RT-PCR.
Results
RhoH deficiency in mice induced TH17 polarization during effector T cell differentiation, thereby inducing psoriasis-like chronic dermatitis. Ubr5 and nr2f6 expression levels decreased in RhoH-deficient T cells, resulting in increased protein levels and DNA binding activity of RORγt. The consequential increase in IL-17 and IL-22 production induced T cells to differentiate into TH17 cells. Furthermore, IL-22BP/Fc chimeric protein reduced psoriatic inflammation in RhoH deficient mice. Expression of RhoH in T cells was lower in psoriatic patients with much severe symptoms.
Conclusion
Our results indicated that RhoH inhibits TH17 differentiation and thereby plays a role in the pathogenesis of psoriasis. Additionally, IL-22BP has therapeutic potential for the treatment of psoriasis.
Graphical abstract
https://ift.tt/2PBXiPO
Engulfment of mast cell secretory granules upon skin inflammation boosts dendritic cell migration and priming efficiency
Publication date: Available online 17 October 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Jan Dudeck, Julia Froebel, Johanna Kotrba, Christian H.K. Lehmann, Diana Dudziak, Stephan Speier, Sergei A. Nedospasov, Burkhart Schraven, Anne Dudeck
ABSTRACT
Background
Mast cells (MCs) are best known as key effector cells of allergic reactions but they also play an important role in host defense against pathogens. Despite increasing evidence for a critical impact of MCs on adaptive immunity, the underlying mechanisms are poorly understood.
Objective
Here, we monitored MC intercellular communication with dendritic cells (DCs), MC activation and degranulation and tracked the fate of exocytosed MC granules during skin inflammation.
Methods
Using a strategy to stain intracellular MC granules in vivo we tracked the MC granules fate following skin inflammation induced MC degranulation. Further, exogenous MC granules were applied to MC-deficient mice by intradermal injection. MC granule effects on DC functionality and adaptive immune responses in vivo were assessed by combining intravital multiphoton microscopy with flow cytometry and functional assays.
Results
We demonstrate that dermal DCs engulf the intact granules exocytosed by MCs upon skin inflammation. Subsequently, the engulfed MC granules are actively shuttled to skin-draining lymph nodes (LNs) and finally degraded inside DCs within the lymphoid tissue. Most importantly, MC-granule uptake promotes DC maturation and migration to skin-draining LNs, partially via MC-derived TNF, and boosts their T cell priming efficiency. Surprisingly, exogenous MC granules alone are sufficient to induce a prominent DC activation and T cell responses.
Conclusion
Our study highlights a unique feature of peripheral MCs to impact on lymphoid tissue borne adaptive immunity over distance by modifying DC functionality via the delivery of granule-stored mediators.
Graphical abstract
https://ift.tt/2P332oN
Plasma tryptase elevation during aspirin-induced reactions in aspirin-exacerbated respiratory disease (AERD)
Publication date: Available online 16 October 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Katherine N. Cahill, Katherine Murphy, Joseph Singer, Elliot Israel, Joshua A. Boyce, Tanya M. Laidlaw
https://ift.tt/2PAvStH
In Utero Diagnoses of Strikingly Similar Presentations of Complete Atrioventricular Septal Defects in a Pair of Dizygotic Twins Concordant for Trisomy 21
Trisomy 21, or Down syndrome (DS), is a genetic disorder affecting approximately 1 in 500–750 live births. The prevalence of DS has increased over the past two decades, correlating with a rise in the proportion of pregnancies complicated by advanced maternal age. There is also a correlation between advanced maternal age and dizygotic twinning rates. There is an increased risk of at least one twin being affected in dizygotic pregnancies compared to singletons. However, despite this greater relative risk, reports of concordance of DS in both dizygotic twins are very rare. Congenital heart disease (CHD) occurs in roughly 40% of individuals with DS, but there can be considerable phenotypic variation. The most common, atrioventricular septal defect accounts for only 40% of CHD seen in DS. There is also a higher incidence of CHD in twins, but also with a low incidence of concordance. There have been only five reported cases of concordant DS in dizygotic twins with confirmed chromosomal analyses; none of which describe concordant congenital heart disease. Here, we describe an unusual case of dizygotic twins of differing genders concordant for both Down syndrome and congenital heart disease of a strikingly similar presentation.
https://ift.tt/2OrTcNP
Correction to: Abstracts
In Poster Sessions, the author name G. Khlestova was incorrectly presented as 'K. Galina' in the authorship group for Abstract PS-18-017 (page S151). The name has been corrected in the authorship group shown above.
https://ift.tt/2QQPcmC
Ciliated HPV-Related Carcinoma: A Diagnostic Challenge on Frozen Section
Abstract
Oropharyngeal squamous cell carcinomas associated with high risk HPV show a wide morphological spectrum, including papillary, adenosquamous, lymphoepithelioma-like and sarcomatoid. We report an interesting case of ciliated HPV-related carcinoma arising from tonsillar tissue in a 55-year-old man which was associated with HPV33. This rare variant has been described in only a handful of cases in the literature, and to our knowledge this is the first case specifically associated with HPV33. The presence of cilia is a potential diagnostic problem as it has been traditionally considered a feature of benignancy, and could pose a particular challenge on frozen section. The diagnostic challenges, differential diagnosis of this tumor and the association with HPV33 are discussed.
https://ift.tt/2PDdVuB
Ciliated HPV-Related Carcinoma: A Diagnostic Challenge on Frozen Section
Abstract
Oropharyngeal squamous cell carcinomas associated with high risk HPV show a wide morphological spectrum, including papillary, adenosquamous, lymphoepithelioma-like and sarcomatoid. We report an interesting case of ciliated HPV-related carcinoma arising from tonsillar tissue in a 55-year-old man which was associated with HPV33. This rare variant has been described in only a handful of cases in the literature, and to our knowledge this is the first case specifically associated with HPV33. The presence of cilia is a potential diagnostic problem as it has been traditionally considered a feature of benignancy, and could pose a particular challenge on frozen section. The diagnostic challenges, differential diagnosis of this tumor and the association with HPV33 are discussed.
https://ift.tt/2PDdVuB
Anti-neutrophil cytoplasmic antibody-associated hypertrophic cranial pachymeningitis and otitis media: a review of literature
Abstract
Background and objective
It has been recognized that anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides may lead to hypertrophic pachymeningitis (HP) or intractable otitis media (OM). To our knowledge, few cases of coexistent ANCA-related HP and OM have been described previously. To increase awareness of this disease, we reviewed the literature describing patients with HP and intractable OM in a population with AAV to guide clinical decision making for otolaryngologists.
Methods
PubMed was searched with the following terms: ANCA-associated vasculitis, otitis media, and hypertrophic pachymeningitis. Only patients with concomitant AAV, OM and HP were considered and included in this review.
Results
A total of 243 articles were reviewed, and of these, 6 met inclusion criteria. Headache, cranial polyneuropathy, and intractable OM with effusion or granulation were common. Serum MPO–ANCA positivity was most common in Asian patients. Almost all patients had dural mater thickening on gadolinium-enhanced magnetic resonance imaging of the brain. Corticosteroids plus an immunosuppressant was more effective and most patients had improved hearing after treatment, but approximately 50% of subjects had disease relapse.
Conclusion
In this review, we summarized the current knowledge on the clinical features, diagnosis, treatment, and pathogenesis of this disease. We should carefully detect the potential cases of ANCA-related HP and OM in patients with intractable OM, HP, or AAV, and make the optimal treatment plan to avoid long-term neurological complications and irreversible hearing loss. Furthermore, due to an increased possibility of relapse, close follow-up, including a hearing test, ANCA titers, imaging examination, and detection of toxic and side effects of immunosuppressive therapy, are necessary.
https://ift.tt/2RWYwql
The disease of Sigmund Freud: oral cancer or cocaine-induced lesion?
Abstract
Purpose
Sigmund Freud, the father of modern psychoanalysis, suffered from what was considered to be a malignant tumour spreading from the back of his palate. He underwent numerous surgical interventions and radiation therapy over the course of 16 years. Such a long survival casts a shadow of doubt on the diagnosis of oral cancer that was given to Freud.
Methods
The book "Freud: Living and Dying", in which the personal physician of Freud described in detail his patient's fight with oral cancer, was reviewed. Current and past evidence, as well as epidemiological data, on oral cancer and cocaine-induced midline destructive lesions were also reviewed.
Results
Tobacco and cocaine are both responsible for oral lesions and Freud was a dedicated cigar smoker as well as a user and defender of cocaine. Freud's medical records indicate that the main cause of Freud's oral disease was excessive smoking. On the other hand, the diagnosis of oral cancer does not seem to be entirely consistent with the 16-year-long survival of Freud. Freud used cocaine regularly in the 1890s, as reported by his personal physician, and it is possible that he continued taking it beyond that time period without feeling the need to inform his doctor.
Conclusions
It is possible that the lesion that progressively and very slowly eroded the splanchnocranial structures of Freud was not a bona-fide cancerous malignancy, but rather, the necrotizing effect of cocaine use that has been previously reported to be responsible for some massive facial destructive lesions.
https://ift.tt/2PEj19Z
Non-Hodgkin’s Lymphoma of the Middle Ear Presenting as Mastoiditis
Lymphoma originating from the middle ear is rare. The diagnosis of lymphoma as with other cancers of the temporal bone is often made late, and this has a negative implication on the treatment and prognosis of the condition. The delay of diagnosis is mainly due to the similar presentation shared with other benign conditions of the middle ear. We present a case of a 62-year-old man who was treated as a case of chronic otitis media for a period of time before presenting with advanced symptoms; a final diagnosis of lymphoma of the middle ear was given. Other similar cases in the literature are discussed and reviewed. Severe and persistent symptoms of the middle ear should raise red flags and warrant detailed investigations.
https://ift.tt/2CngBIX
Bertolotti’s syndrome: an underdiagnosed cause for lower back pain
Abstract
Bertolotti's syndrome refers to the presence of pain associated to the anatomical variant of sacralization of the last lumbar vertebra. It is often a factor that is not addressed in the evaluation and treatment of lower back pain. The presence of a lumbosacral transitional vertebra is a common finding among general population with a prevalence that ranges between 4 and 30%, however, this finding is rarely associated to the cause of lower back pain and thus, the prevalence of Bertolotti's syndrome in general population is unknown doe to underdiagnosis. The sacralization of the fifth lumbar vertebra has been related to changes in the anatomy and biomechanics of the spine with no general agreement to its clinical significance, however Bertolotti's syndrome should be considered as a differential diagnosis for lower back pain, therefore, its pathophysiology, epidemiology and treatment must be a topic of general knowledge to physicians that often treat this condition.https://ift.tt/2P6tfCT
JAMA Otolaryngology-Head & Neck Surgery.
JAMA Otolaryngology-Head & Neck Surgery.
JAMA Otolaryngol Head Neck Surg. 2018 Sep 01;144(9):768
Authors:
PMID: 30326519 [PubMed - in process]
https://ift.tt/2yoHE3J
Highlights.
Highlights.
JAMA Otolaryngol Head Neck Surg. 2018 Sep 01;144(9):767
Authors:
PMID: 30326518 [PubMed - in process]
https://ift.tt/2yLY7OG
Errors in Figure 2 and Figure 3.
Errors in Figure 2 and Figure 3.
JAMA Otolaryngol Head Neck Surg. 2018 Sep 01;144(9):851
Authors:
PMID: 30326517 [PubMed - in process]
https://ift.tt/2ymC7L7
Commercial Claims-Based Comparison of Survival and Toxic Effects of Definitive Radiotherapy vs Primary Surgery in Patients With Oropharyngeal Squamous Cell Carcinoma.
Commercial Claims-Based Comparison of Survival and Toxic Effects of Definitive Radiotherapy vs Primary Surgery in Patients With Oropharyngeal Squamous Cell Carcinoma.
JAMA Otolaryngol Head Neck Surg. 2018 Sep 20;:
Authors: Sher DJ, Agiro A, Zhou S, Day AT, DeVries A
Abstract
Importance: Definitive radiotherapy (RT) and primary surgery (PS) are considered to be equally viable local therapy modalities for oropharyngeal squamous cell carcinoma (OPSCC). The comparative effectiveness of these therapies is often debated, and treatment decisions are based on a paucity of comparative data.
Objective: To examine the differences in overall survival and key toxic effects in patients with OPSCC treated with RT and PS.
Design, Setting, and Participants: This retrospective cohort analysis used the HealthCore Integrated Research Database to identify 884 patients diagnosed with OPSCC from January 1, 2007, to December 31, 2014. Patients were categorized as receiving definitive RT (with or without chemotherapy) or PS (with or without adjuvant RT or chemoradiotherapy). Administrative claims data were linked with state cancer registries from California, Connecticut, Georgia, Kentucky, New York, and Ohio. Data analysis was performed from February 29, 2016, to February 6, 2018.
Exposures: Definitive RT or PS.
Main Outcomes and Measures: Overall survival was analyzed using Cox proportional hazards regression. Risks of gastrostomy dependence, esophageal stricture, and osteoradionecrosis were determined through claims and analyzed using logistic regression.
Results: A total of 884 patients (608 [68.8%] in the RT group and 276 [31.2%] in the PS group; mean [SD] age, 61.5 [10.7] years; 727 [82.2%] male; 842 [95.3%] white) were included in this study. The 3-year overall survival was 76% among patients treated with RT and 81% among patients treated with PS (hazard ratio, 0.76; 95% CI, 0.54-1.01). On multivariable analysis, increasing age, female sex, and low income were associated with inferior survival; treatment type was not. Patients treated with RT were more likely to have gastrostomy dependence within the first year (391 [64.3%] vs 127 [46.0%]; adjusted OR, 0.57; 95% CI, 0.42-0.77). After treating chemotherapy as an effect modifier, there was no difference between modalities. Treatment type was not associated with esophageal stricture or osteoradionecrosis risk. Mean costs were approximately $100 000 for payers and $5000 for patients, with no adjusted differences between RT and PS.
Conclusions and Relevance: This study suggests that RT and PS are equally viable treatment options for OPSCC; therefore, local therapy decisions may be individualized to each patient. However, the frequent addition of chemotherapy was associated with increased gastrostomy dependence among patients undergoing RT, which may be relevant in clinical decision making.
PMID: 30326060 [PubMed - as supplied by publisher]
https://ift.tt/2COOLGG
Limitations to the Association of Risk of Airway Disease With Removal of Adenoids and Tonsils in Children.
Limitations to the Association of Risk of Airway Disease With Removal of Adenoids and Tonsils in Children.
JAMA Otolaryngol Head Neck Surg. 2018 Oct 11;:
Authors: Lüscher M, Thrane JF, Homøe P
PMID: 30326056 [PubMed - as supplied by publisher]
https://ift.tt/2yIRRr4
Outcomes of Open vs Endoscopic Skull Base Surgery in Patients 70 Years or Older.
Outcomes of Open vs Endoscopic Skull Base Surgery in Patients 70 Years or Older.
JAMA Otolaryngol Head Neck Surg. 2018 Sep 20;:
Authors: Stephenson ED, Lee SE, Adams K, Farquhar DR, Farzal Z, Ebert CS, Ewend M, Sasaki-Adams D, Thorp BD, Zanation AM
Abstract
Importance: The use of skull base surgery in patients 70 years or older is increasing, but its safety in this age group has not been evaluated to date.
Objectives: To describe outcomes in a cohort of patients 70 years or older undergoing skull base surgery and to evaluate whether age, type of disease process, and approach (endoscopic vs traditional open surgery) are associated with increased intraoperative and postoperative complications in this population.
Design, Setting, and Participants: This retrospective cohort study analyzed a population-based sample of 219 patients 70 years or older from a database of 1720 patients who underwent skull base surgery at University of North Carolina Hospitals, Chapel Hill, a tertiary referral center, between October 2007 and June 2017. Data were collected from June 2016 to July 2017 and analyzed in July 2017 and August 2017.
Exposure: Skull base surgery.
Main Outcomes and Measures: Data collected included demographic characteristics, surgical approach, and disease process. Intraoperative findings and postoperative complications were analyzed by age, surgical approach, and malignancy status.
Results: Of the 219 patients, 166 were aged 70.0 to 79.9 years and 53 patients were older than 80 years (mean [SD] age, 76.4 [4.7] years); 120 (54.8%) were men and 160 (73.7%) were white. There were 161 (73.5%) endoscopic and 58 (26.5%) open operations. The most common pathologic processes among the 219 patients were nonsellar malignant (81 [37.0%]), nonsellar benign (53 [24.2%]), and pituitary (49 [22.4%]) tumors. The most common intraoperative and postoperative complications were intraoperative major bleeding (5 of 219 patients [2.3%]) and postoperative bleeding (9 [4.1%]). Thirty-day mortality was zero. There was no clinically meaningful difference in complications between patients aged 70.0 to 79.9 years vs those older than 80 years, endoscopic vs open surgery, or benign vs malignant neoplasms. Specifically, between the endoscopic and open surgery groups, there was no difference in intraoperative major bleeding (3.9%; 95% CI, -0.7% to 12.9%), postoperative cerebrospinal fluid leak (-0.6%; 95% CI, -3.4% to 5.6%), or postoperative bleeding (1.5%; 95% CI, -3.9% to 10.6%).
Conclusions and Relevance: Skull base surgery is a safe option in persons 70 years or older, with similar outcomes across age ranges, surgical approaches, and disease processes.
PMID: 30326054 [PubMed - as supplied by publisher]
https://ift.tt/2yl9Owu
Clinical Application of 3-Dimensional Printing Technology for Patients With Nasal Septal Deformities: A Multicenter Study.
Clinical Application of 3-Dimensional Printing Technology for Patients With Nasal Septal Deformities: A Multicenter Study.
JAMA Otolaryngol Head Neck Surg. 2018 Sep 20;:
Authors: Kim DH, Yun WS, Shim JH, Park KH, Choi D, Park MI, Hwang SH, Kim SW
Abstract
Importance: Studies have shown the controllability and porosity of polycaprolactone as well as the use of 3-dimensional (3-D) printing for nasal reconstruction in animal models. The utility of polycaprolactone with 3-D technology in nasal cartilaginous framework reconstruction in humans remains unknown.
Objective: To investigate the safety and efficacy of 3-D printed, bioresorbable polycaprolactone nasal implants.
Design, Setting, and Participants: This multicenter clinical trial comprised 20 patients with caudal septal deviations who underwent septoplasty, which used a 3-D printed polycaprolactone mesh, at 2 centers in South Korea. Patients were included if they were aged 18 to 74 years and had nasal septal deviations, Nasal Obstruction Symptom Evaluation scores greater than 20, and persistent nasal obstructions. Twenty-two patients met the inclusion criteria, but 2 patients were excluded before the operation. The study was conducted from July 1, 2016, to June 30, 2017.
Main Outcomes and Measures: The change in total Nasal Obstruction Symptom Evaluation score between the preoperative examination and the week 12 postoperative examination was the primary outcome. Changes in bilateral nasal cavity minimum cross-sectional area and volume on acoustic rhinometry at weeks 4 and 12 after the operation as well as changes in the nasal cavity cross-sectional area at the osteomeatal unit and nasal septum angle in the paranasal sinus on computed tomography after week 12 were among the secondary outcomes.
Results: Of the 20 patients included in the study, 4 (20%) were female, 16 (80%) were male, with a mean (SD) age of 34.95 (11.96) years. The preoperative and week 12 postoperative results revealed significant changes in the minimal cross-sectional areas on acoustic rhinometry (0.41 [SD, 0.39] vs -0.11 [SD, 0.18]; difference, 0.42; 95% CI, 0.23-0.61), nasal septum angles on computed tomography (11.22 [SD, 6.57] vs 2.89 [SD, 3.12]; difference, 8.33; 95% CI, 5.08-11.58), and Nasal Obstruction Symptom Evaluation scores (73.50 [SD, 19.88] vs 3.75 [SD, 6.26]; difference, 69.75; 95% CI, 59.22-80.28). The surgeons' convenience level with the procedure was favorable (visual analog scale score [SD], 90.90 [9.45]), and so were the patients' symptom improvements and satisfaction after 12 weeks (visual analog scale score [SD], 88.30 [9.87]).
Conclusions and Relevance: The 3-D printed, homogeneous, composite, microporous polycaprolactone nasal implant demonstrated proper mechanical support and thinness with excellent biocompatibility and surgical manipulability. Polycaprolactone may be a clinically biocompatible material for use in various craniofacial reconstructions in the future.
PMID: 30326042 [PubMed - as supplied by publisher]
https://ift.tt/2yH8ZgZ
An Unusual Entity Presenting as Bilateral Cervical Lymphadenopathy.
An Unusual Entity Presenting as Bilateral Cervical Lymphadenopathy.
JAMA Otolaryngol Head Neck Surg. 2018 Sep 20;:
Authors: Shahi S, Gautam D, Pantha T
PMID: 30326034 [PubMed - as supplied by publisher]
https://ift.tt/2yhUwbS
Limitations to the Association of Risk of Airway Disease With Removal of Adenoids and Tonsils in Children.
Limitations to the Association of Risk of Airway Disease With Removal of Adenoids and Tonsils in Children.
JAMA Otolaryngol Head Neck Surg. 2018 Oct 11;:
Authors: Kitipornchai L, Mackay SG
PMID: 30326001 [PubMed - as supplied by publisher]
https://ift.tt/2yJMOXn
Association of the Duration of Antibiotic Therapy With Major Surgical Site Infection in Cochlear Implantation.
Association of the Duration of Antibiotic Therapy With Major Surgical Site Infection in Cochlear Implantation.
JAMA Otolaryngol Head Neck Surg. 2018 Oct 11;:
Authors: Sayed-Hassan A, Hermann R, Chidiac F, Truy E, Guevara N, Bailleux S, Deguine O, Baladi B, Gallois Y, Bozorg-Grayeli A, Lerosey Y, Godey B, Parietti-Winkler C, Pereira B, Mom T, and the Otolaryngology–Head and Neck Surgical Infection Survey Group (OSS Group) of Clermont-Ferrand
Abstract
Importance: Infection after cochlear implantation is a rare but serious event that can lead to meningitis. There is no consensus on prevention of infection in these patients, and each center applies its own strategy.
Objective: To describe the rates of major surgical site infection for patients undergoing cochlear implantation who receive prolonged antibiotic treatment compared with those who receive a single perioperative dose of antibiotic prophylaxis.
Design, Setting, and Participants: Retrospective cohort study of patients who underwent cochlear implantation between January 1, 2011, and July 8, 2015, with a postoperative follow-up of 1 to 3 years. In this multicenter study at 8 French university centers, 1180 patients (509 children and 671 adults) who underwent cochlear implantation during this period were included.
Interventions: Prolonged antibiotic treatment vs single-dose antibiotic prophylaxis.
Main Outcomes and Measures: Major infection and explantation.
Results: Among 1180 patients (509 children [51.7% female] with a mean [SD] age of 4.6 [3.8] years and 671 adults [54.9% female] with a mean [SD] age of 54.8 [17.0] years), 12 patients (1.0%) developed a major infection, with 4 infections occurring in the prolonged antibiotic treatment group and 8 infections occurring in the antibiotic prophylaxis group (odds ratio, 2.45; 95% CI, 0.73-8.17). Children (9 of 509 [1.8%]) were more likely to develop infection than adults (3 of 671 [0.4%]). Among children, 4 infections occurred in the prolonged antibiotic group (n = 344), and 5 infections occurred in the antibiotic prophylaxis group (n = 158) (odds ratio, 2.78; 95% CI, 0.74-10.49). Among adults, 3 infections occurred in the antibiotic prophylaxis group (n = 365), whereas no infections occurred in the prolonged antibiotic treatment group (n = 290).
Conclusions and Relevance: After cochlear implantation, infection was rare, was less common among those who received prolonged antibiotic treatment, and was less likely to occur in adults than in children.
PMID: 30325991 [PubMed - as supplied by publisher]
https://ift.tt/2yhUtwI
Empirical Proton Pump Inhibitor Therapy in Children.
Empirical Proton Pump Inhibitor Therapy in Children.
JAMA Otolaryngol Head Neck Surg. 2018 Oct 11;:
Authors: Prager JD
PMID: 30325988 [PubMed - as supplied by publisher]
https://ift.tt/2yKqJrR
Association of Proton Pump Inhibitors With Hospitalization Risk in Children With Oropharyngeal Dysphagia.
Association of Proton Pump Inhibitors With Hospitalization Risk in Children With Oropharyngeal Dysphagia.
JAMA Otolaryngol Head Neck Surg. 2018 Oct 11;:
Authors: Duncan DR, Mitchell PD, Larson K, McSweeney ME, Rosen RL
Abstract
Importance: Proton pump inhibitors (PPI) are commonly prescribed to children with oropharyngeal dysphagia and resultant aspiration based on the assumption that these patients are at greater risk for reflux-related lung disease. There is little data to support this approach and the potential risk for increased infections in children treated with PPI may outweigh any potential benefit.
Objective: The aim of this study was to determine if there is an association between hospitalization risk in pediatric patients with oropharyngeal dysphagia and treatment with PPI.
Design, Setting, and Participants: We performed a retrospective cohort study to compare the frequency and length of hospitalizations for children who had abnormal results on videofluoroscopic swallow studies that were performed between January 1, 2015, and December 31, 2015, and who were or were not treated with PPI, with follow-up through December 31, 2016. Records were reviewed for children who presented for care at Boston Children's Hospital, a tertiary referral center. Participants included 293 children 2 years and younger with evidence of aspiration or penetration on videofluoroscopic swallow study.
Exposures: Groups were compared based on their exposure to PPI treatment.
Main Outcomes and Measures: The primary outcomes were hospital admission rate and hospital admission nights and these were measured as incident rates. Multivariable analyses were performed to determine predictors of hospitalization risk after adjusting for comorbidities. Kaplan-Meier curves were created to determine the association of PPI prescribing with time until first hospitalization.
Results: A total of 293 patients with a mean (SD) age of 8.8 (0.4) months and a mean (SD) follow-up time of 18.15 (0.20) months were included in the analysis. Patients treated with PPI had higher admission rates (Incidence rate ratio [IRR], 1.77; 95% CI, 1.16-2.68) and admission nights (IRR, 2.51; 95% CI, 1.36-4.62) even after adjustment for comorbidities. Patients with enteral tubes who were prescribed PPIs were at the highest risk for admission (hazard ratio [HR], 2.31; 95% CI, 1.24-4.31).
Conclusions and Relevance: Children with aspiration who are treated with PPI have increased risk of hospitalization compared with untreated patients. These results support growing concern about the risks of PPI use in children.
PMID: 30325987 [PubMed - as supplied by publisher]
https://ift.tt/2ymtIHp
Limitations to the Association of Risk of Airway Disease With Removal of Adenoids and Tonsils in Children-Reply.
Limitations to the Association of Risk of Airway Disease With Removal of Adenoids and Tonsils in Children-Reply.
JAMA Otolaryngol Head Neck Surg. 2018 Oct 11;:
Authors: Byars SG, Stearns SC, Boomsma JJ
PMID: 30325985 [PubMed - as supplied by publisher]
https://ift.tt/2yKqHAf
Comparison of Objective Outcomes in Dynamic Lower Facial Reanimation With Temporalis Tendon and Gracilis Free Muscle Transfer.
Comparison of Objective Outcomes in Dynamic Lower Facial Reanimation With Temporalis Tendon and Gracilis Free Muscle Transfer.
JAMA Otolaryngol Head Neck Surg. 2018 Oct 11;:
Authors: Oyer SL, Nellis J, Ishii LE, Boahene KD, Byrne PJ
Abstract
Importance: Facial paralysis affects patients' physical, social, and psychological function. Dynamic smile reanimation can mitigate these effects, but there are limited data to guide the surgeon in selecting the best reanimation procedure for each patient.
Objective: To compare quantitative changes in oral commissure symmetry and smile excursion following temporalis tendon transfer (T3) and gracilis free muscle transfer.
Design, Setting, and Participants: Retrospective case series of 28 adults with unilateral facial paralysis seeking dynamic lower facial reanimation at a tertiary academic medical center between July 1, 2010, and July 30, 2014. Data were analyzed from May 1, 2016, to June 30, 2016.
Interventions: Minimally invasive T3 (n = 14) compared with gracilis free muscle transfer (n = 14).
Main Outcomes and Measures: Measured symmetry of the oral commissure between the healthy and paralyzed sides in the horizontal, vertical, and angular dimension and excursion of the paralyzed commissure following reanimation compared with the healthy commissure.
Results: Of the 28 patients, 19 (68%) were women; mean (SD) age was 51.7 (17) years. Commissure symmetry during smile improved significantly for the T3 patients in the vertical and angular dimensions, and the gracilis free muscle transfer patients had significant improvement in the vertical and horizontal dimensions. Commissure excursion significantly improved in both groups following surgery, with a larger improvement seen in the gracilis free muscle transfer group (11.3 mm; 95% CI, 7.0 to 15.5 mm) compared with the T3 group (4.8 mm; 95% CI, 0.2 to 9.3 mm), with a mean difference of 6.5 mm (95% CI, 0.7 to 12.4 mm; Cohen d, 0.86). Postoperative smile excursion of the paralyzed side was within 1.0 mm of the healthy side in the gracilis free muscle transfer group (95% CI, -2.1 to 4.0 mm).
Conclusions and Relevance: Temporalis tendon transfer and gracilis free muscle transfer both improve oral commissure symmetry and excursion in facial paralysis. The improvement in smile excursion appears to be larger in patients treated with gracilis free muscle transfer and, on average, the excursion approximates the contralateral healthy side.
PMID: 30325983 [PubMed - as supplied by publisher]
https://ift.tt/2yqsZoJ
Notice of Retraction: Schietroma M, Cecilia EM, Carlei F, Sista F, De Santis G, Lancione L, Amicucci G. Dexamethasone for the Prevention of Recurrent Laryngeal Nerve Palsy and Other Complications After Thyroid Surgery: A Randomized Double-blind Placebo-Controlled Trial. JAMA Otolaryngol Head Neck Surg. 2013;139(5):471-478.
Notice of Retraction: Schietroma M, Cecilia EM, Carlei F, Sista F, De Santis G, Lancione L, Amicucci G. Dexamethasone for the Prevention of Recurrent Laryngeal Nerve Palsy and Other Complications After Thyroid Surgery: A Randomized Double-blind Placebo-Controlled Trial. JAMA Otolaryngol Head Neck Surg. 2013;139(5):471-478.
JAMA Otolaryngol Head Neck Surg. 2018 Oct 11;:
Authors: Piccirillo JF, Bauchner H
PMID: 30325981 [PubMed - as supplied by publisher]
https://ift.tt/2yMqGM0
Helicobacter pylori VacA, a distinct toxin exerts diverse functionalities in numerous cells: An overview
Helicobacter, EarlyView.
https://ift.tt/2EtK9rb
Preemptive intravenous ibuprofen application reduces pain and opioid consumption following thyroid surgery
Publication date: Available online 16 October 2018
Source: American Journal of Otolaryngology
Author(s): Vahit Mutlu, Ilker Ince
Abstract
Objective
The primary aim of this study was to investigate the effects of preemptive a single dose IV ibuprofen on postoperative 48 h opioid consumption and postoperative pain in patients undergoing thyroidectomy.
Methods
The study included 40 patients aged 18 to 65, scheduled for elective thyroidectomy. Patients were randomly divided into 2 groups. Control group (n = 20) received 100 mL saline solution 15 min before surgery, while study group (n = 20) received 800 mg IV ibuprofen in 100 mL saline. The same general anesthesia protocol was applied in both groups, and all operations were performed by the same surgical team using the same technique. Postoperative analgesia was assessed using a visual analogue scale (VAS) and the amount of consumption of 48 h postoperative fentanyl with patient-controlled analgesia (PCA) and additional analgesia requirements were recorded. When additional analgesia was required, 1000 mg IV paracetamol was used.
Results
VAS scores in the ibuprofen group were found lower than the control group in the all-time points (p < 0.05). Opioid consumption in the 48 h was significantly higher in the control group than the ibuprofen group (p < 0.001). Using of rescue analgesia was significantly higher in the control group than the ibuprofen group, statistically (p < 0.05). A significant difference was observed between two groups in terms of side effects of fentanyl consumption (nausea and vomiting) (p < 0.001).
Conclusion
To use preemptive a single dose IV ibuprofen decreases pain scores and postoperative opioid consumption in patients following thyroidectomy. Additionally, this application increase the patient comfort reducing nausea and vomiting in early postoperative period.
https://ift.tt/2NLI8WG
BTK inhibition ameliorates kidney disease in spontaneous lupus nephritis
Publication date: Available online 16 October 2018
Source: Clinical Immunology
Author(s): Samantha A. Chalmers, Elizabeth Glynn, Sayra J. Garcia, Mark Panzenbeck, Josephine Pelletier, Janice Dimock, Elise Seccareccia, Todd Bosanac, Sara Khalil, Christian Harcken, Deborah Webb, Gerald Nabozny, Jay S. Fine, Donald Souza, Elliott Klein, Leal Herlitz, Meera Ramanujam, Chaim Putterman
Abstract
Lupus nephritis is a common disease manifestation of SLE, in which immune complex deposition and macrophage activation are important contributors to disease pathogenesis. Bruton's tyrosine kinase (BTK) plays an important role in both B cell and FcgammaR mediated myeloid cell activation. In the current study, we examined the efficacy of BI-BTK-1, a recently described irreversible BTK inhibitor, in the classical NZB × NZW F1 (NZB/W) and MRL/lpr spontaneous mouse models of SLE. NZB/W mice were randomly assigned to a treatment (0.3 mg/kg, 1 mg/kg, 3 mg/kg and 10 mg/kg) or control group and began treatment at 22 weeks of age. The experimental setup was similar in MRL/lpr mice, but with a single treated (10 mg/kg, beginning at 8–9 weeks of age) and control group. A separate experiment was performed in the MRL/lpr strain to assess the ability of BI-BTK-1 to reverse established kidney disease. Early treatment with BI-BTK-1 significantly protected NZB/W and MRL/lpr mice from the development of proteinuria, correlating with significant renal histological protection, decreased anti-DNA titers, and increased survival in both strains. BI-BTK-1 treated mice displayed a significant decrease in nephritis-associated inflammatory mediators (e.g. LCN2 and IL-6) in the kidney, combined with a significant inhibition of immune cell infiltration and accumulation. Importantly, BI-BTK-1 treatment resulted in the reversal of established kidney disease. BTK inhibition significantly reduced total B cell numbers and all B cell subsets (immature, transitional, follicular, marginal zone, and class switched) in the spleen of NZB/W mice. Overall, the significant efficacy of BI-BTK-1 in ameliorating multiple pathological endpoints associated with kidney disease in two distinct murine models of spontaneous lupus nephritis provides a strong rationale for BTK inhibition as a promising treatment approach for lupus nephritis.
https://ift.tt/2RWxeAH
National ENT workforce planning in the United Kingdom; An increasing cause for concern?
Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2J3rRLI
Surgical Treatment of Medication‐Related Osteonecrosis of the Upper Jaw: Case Series
Oral Diseases, Volume 0, Issue ja, -Not available-.
https://ift.tt/2ynRfI7
Legends of Allergology/Immunology
Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2pYi3Ki
Recent Developments and Highlights in Mechanisms of Allergic Diseases: Microbiome
Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2NLygw6
Novel immune signatures associated with dysplastic nevi and primary cutaneous melanoma in human skin
Experimental Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2EmzrCy
Photodynamic Therapy with a 5‐ALA‐Patch Does Not Increase the Risk of Conversion of Actinic Keratoses into Squamous Cell Carcinoma
Experimental Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2RUNlhW
Transcranial magnetic stimulation over contralateral primary somatosensory cortex disrupts perception of itch intensity
Experimental Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2EoLcIA
Effect of Intravenous Lidocaine, Dexamethasone, and Their Combination on Postoperative Sore Throat: A Randomized Controlled Trial
BACKGROUND: Postoperative sore throat (POST), hoarseness, and cough after tracheal intubation are not uncommon. Although both lidocaine and dexamethasone have been used independently to reduce these events, there is no study assessing the combined effects of lidocaine and dexamethasone. METHODS: This prospective, double-blind, randomized controlled study enrolled 180 patients requiring general anesthesia with endotracheal intubation for >90 minutes. They received 1 of the 4 intravenous agents just before induction of anesthesia: lidocaine (1.5 mg/kg-) in group L, dexamethasone (8 mg) in group D, lidocaine (1.5 mg/kg) with dexamethasone (8 mg) in group DL, and placebo as normal saline in group NS. Standard anesthesia protocol was followed. Incidence and severity of a sore throat, cough, and hoarseness of voice were assessed up to 24 hours postoperatively. The primary outcome was the incidence of POST, and the main effects of dexamethasone and lidocaine were the primary interest. RESULTS: Data of 45 patients in D, 44 in L, 44 in DL, and 43 in NS groups were analyzed. The incidence of a sore throat was 36%, 43%, 25%, and 56% in group D, L, DL, and NS, respectively (P = .02). Dexamethasone with or without lidocaine reduced the incidence of the POST (odds ratio, 0.44; 95% confidence interval, 0.24–0.82; P
https://ift.tt/2RUMQ7y
https://ift.tt/2RUMQ7y
Psoriasis is associated with a greater risk for cardiovascular procedure and surgery in patients with hypertension: A nationwide cohort study
The Journal of Dermatology, EarlyView.
https://ift.tt/2CPrhkM
Bradykinin mechanism is the main responsible for death by isolated asphyxiating angioedema in France
Clinical &Experimental Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2QTFXCo
Multiple yellowish white papules on the trunk and upper arms
International Journal of Dermatology, EarlyView.
https://ift.tt/2PCM39X
Atypical presentation of immunoglobulin A vasculitis in disseminated tuberculosis
International Journal of Dermatology, EarlyView.
https://ift.tt/2P6MpbK
Phosphorylation of the glucocorticoid receptor alters SMAD signaling in vocal fold fibroblasts
The Laryngoscope, EarlyView.
https://ift.tt/2QWobyh
Time Course of Recovery of Iatrogenic Vocal Fold Paralysis
The Laryngoscope, EarlyView.
https://ift.tt/2Ae03S4
Supporting cell survival after cochlear implant surgery
The Laryngoscope, EarlyView.
https://ift.tt/2QWnYet
How design characteristics of tracheostomy tubes affect the cannula and tracheal flows
The Laryngoscope, EarlyView.
https://ift.tt/2AeKN7D
Peak nasal inspiratory flow is a useful measure of nasal airflow in functional septorhinoplasty
The Laryngoscope, EarlyView.
https://ift.tt/2R158D9
Correlating videofluoroscopic swallow study findings with subjective globus location
The Laryngoscope, EarlyView.
https://ift.tt/2AdRMhd
ROS Is Involved in Disruption of Tight Junctions of Human Nasal Epithelial Cells Induced by HRV16
The Laryngoscope, EarlyView.
https://ift.tt/2QWnDZf
Epistaxis in the setting of antithrombotic therapy: A comparison between factor Xa inhibitors, warfarin, and antiplatelet agents
The Laryngoscope, EarlyView.
https://ift.tt/2AdPWwO
Office‐based laryngology: Technical and visual optimization by patient‐positioning maneuvers
The Laryngoscope, EarlyView.
https://ift.tt/2QWnzbX
Robotic versus conventional neck dissection: A systematic review and meta‐analysis
The Laryngoscope, EarlyView.
https://ift.tt/2AewEXU
Junior otolaryngology resident in‐service exams predict written board exam passage
The Laryngoscope, EarlyView.
https://ift.tt/2QSo0nB
Twelve‐month outcomes of Eustachian tube procedures for management of patulous Eustachian tube dysfunction
The Laryngoscope, EarlyView.
https://ift.tt/2Aex4O2
How does aging affect recognition of spectrally degraded speech?
The Laryngoscope, EarlyView.
https://ift.tt/2QWeoIj
Predictors of Short‐term Morbidity and Mortality in Open Anterior Skull Base Surgery
The Laryngoscope, EarlyView.
https://ift.tt/2AeWew1
Periotic sensory dysfunction via postauricular approach after otitis media surgery
The Laryngoscope, EarlyView.
https://ift.tt/2R14Jk7
Outpatient versus inpatient parotidectomy: Comparison of postoperative complication rates
The Laryngoscope, EarlyView.
https://ift.tt/2AeSSJj
Radiographic muscle invasion not a recurrence predictor in HPV‐associated oropharyngeal squamous cell carcinoma
The Laryngoscope, EarlyView.
https://ift.tt/2QWnvJf
Dynamics of Intrinsic Laryngeal Muscle Contraction
The Laryngoscope, EarlyView.
https://ift.tt/2AeWefv
The effects of cytosporone‐B, a novel antifibrotic agent, on vocal fold fibroblasts
The Laryngoscope, EarlyView.
https://ift.tt/2QYIcV1
Impact of neoadjuvant radiation on margins for non–squamous cell carcinoma sinonasal malignancies
The Laryngoscope, EarlyView.
https://ift.tt/2AdPUoG
A 13-year journey of a gastric band – ultimate destination terminal jejunum: a case report
Laparoscopic adjustable gastric banding has been the gold standard for surgical management of obesity over the last decades in USA and Europe. However, significant complications have been documented due to for...
https://ift.tt/2EsZiZM
Progression of Eales’ disease post-partum and long-term follow-up: a case report
Eales' disease is a difficult to treat idiopathic form of retinal vasculitis. We present such a case with peculiar epidemiology in which the only efficient therapeutic approach in order to maintain functional ...
https://ift.tt/2RSieng
Hydatidosis of infratemporal fossa with proptosis – an unusual presentation: a case report and review of the literature
Hydatid disease is one of the common zoonotic diseases caused by the larval stage of Echinococcus granulosus. It is endemic in sheep-raising and cattle-raising areas worldwide and humans are an accidental interme...
https://ift.tt/2EsZ58W
Recurrent optic neuritis as the only manifestation of chronic hepatitis B virus flare: a case report
Autoimmune reactions have been associated with acute hepatitis B virus infection. Among these optic neuritis is a rare presentation with only a handful of cases reported in the literature thus far. The pathoph...
https://ift.tt/2RWk4U1
Use of Absolute Risk Measurements in Dermatologic Observational Studies: Important Information For Decision Making Is Frequently Absent
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2NIoOJT
A case of Incontinentia Pigmenti associated with congenital absence of portal vein system and nodular regenerative hyperplasia
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2pYMoIQ
Association of auto‐immunity and long‐term complete remission in Sezary patients treated with mogamulizumab
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2NLrw1g
The burden of cutaneous adnexal carcinomas and the risk of associated squamous cell carcinoma: a population‐based study
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2pWbdFl
The good, the bad and the malignant
British Journal of Dermatology, Volume 179, Issue 4, Page 809-810, October 2018.
https://ift.tt/2NIoIlv
News and Notices
British Journal of Dermatology, Volume 179, Issue 4, Page 1017-1017, October 2018.
https://ift.tt/2pYqh5g
隐性 XLI: 神经系统疾病的高患病率
British Journal of Dermatology, Volume 179, Issue 4, Page e192-e192, October 2018.
https://ift.tt/2NIoECh
Issue Information
British Journal of Dermatology, Volume 179, Issue 4, Page i-v, October 2018.
https://ift.tt/2pYqfKG
An Oral Disease Severity Score for pemphigus vulgaris
British Journal of Dermatology, Volume 179, Issue 4, Page e169-e169, October 2018.
https://ift.tt/2NJZzqr
Editor's Choice
British Journal of Dermatology, Volume 179, Issue 4, Page ix-ix, October 2018.
https://ift.tt/2pYzomA
Revealing the mysteries of X‐linked recessive ichthyosis
British Journal of Dermatology, Volume 179, Issue 4, Page 821-822, October 2018.
https://ift.tt/2NLHx7l
Image Gallery: Granulomatous dermatitis due to infection with the chlorophyllic green alga Desmodesmus
British Journal of Dermatology, Volume 179, Issue 4, Page e167-e167, October 2018.
https://ift.tt/2pWuRAV
The utility of understanding atrophic acne scar formation for prevention and treatment
British Journal of Dermatology, Volume 179, Issue 4, Page 819-819, October 2018.
https://ift.tt/2NN5Q4K
银屑病的生物治疗和癌症风险
British Journal of Dermatology, Volume 179, Issue 4, Page e187-e187, October 2018.
https://ift.tt/2pUwcbk
A promising new treatment for SAPHO syndrome that deserves further studies
British Journal of Dermatology, Volume 179, Issue 4, Page 823-823, October 2018.
https://ift.tt/2NIoDOJ
Can antibiotics be harmful in atopic dermatitis?
British Journal of Dermatology, Volume 179, Issue 4, Page 807-808, October 2018.
https://ift.tt/2pWQJfH
Assessing benefits and risks of holiday sun exposure in children
British Journal of Dermatology, Volume 179, Issue 4, Page 822-823, October 2018.
https://ift.tt/2NJZAdZ
Generating new evidence for old medications: the TREAT trial in paediatric atopic dermatitis
British Journal of Dermatology, Volume 179, Issue 4, Page 813-814, October 2018.
https://ift.tt/2pW73x9
Is the Oral Disease Severity Score going to be useful for dermatologists when assessing pemphigus?
British Journal of Dermatology, Volume 179, Issue 4, Page 816-817, October 2018.
https://ift.tt/2NLRpxP
来自 AD 患者的金黄色葡萄球菌的局部抗生素耐药性
British Journal of Dermatology, Volume 179, Issue 4, Page e188-e188, October 2018.
https://ift.tt/2pXSZTC
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