BACKGROUND Axillary and infraclavicular brachial plexus blocks are commonly used for upper limb surgery. Clinicians require information on the relative benefits of each to make a rational selection for specific patients and procedures. OBJECTIVES The main objective of the study was to compare axillary and infraclavicular brachial plexus block in terms of the incidence and severity of tourniquet pain. DESIGN Single blinded, randomised trial. SETTING University affiliated hospital, level-1 trauma centre. PATIENTS Age more than 18 years, ASAI-III patients undergoing orthopaedic surgery distal to the elbow, with an anticipated tourniquet duration of more than 45 min were recruited. INTERVENTIONS Patients underwent either ultrasound guided axillary brachial plexus block or infraclavicular block (ICB). MAIN OUTCOME MEASURES Incidence of tourniquet pain (onset, severity, associated haemodynamic changes) and block characteristics (block performance/onset times, distribution, incidence of adverse events, patient satisfaction) were recorded. RESULTS Eighty two patients (40 in the axillary block and 42 in the ICB group) were recruited. The incidence (5/36 and 3/35; P = 0.71), onset time mean (SD) were 73.0 (14.8) and 86.6 (5.7) min (P = 0.18) and severity (mild/moderate; 4/1 and 1/2; P = 0.51) of tourniquet pain were similar in the two groups. The incidence of paraesthesia during block performance, and block performance time were greater in the axillary block group (P = 0.0054 and 0.012, respectively). The volume of local anaesthetic administered was greater in the ICB group (P
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Τρίτη 20 Νοεμβρίου 2018
Helicobacter pylori antimicrobial resistance during a 5‐year period (2013‐2017) in northern Spain and its relationship with the eradication therapies
Abstract
Background
Antibiotic resistance is the main cause for Helicobacter pylori therapy failure. Frequently, empirical regimens have been recommended in patients with various H. pylori eradication failures. In patients with H. pylori‐resistant to various families of antibiotics, the treatment guided by antimicrobial susceptibility testing allows the achievement of good eradication rates.
Aim
To evaluate the effectiveness of susceptibility‐guided antimicrobial treatment for H. pylori infection in patients with resistance to one or various families of antibiotics.
Methods
A total of 3170 consecutive patients infected by H. pylori during 2013‐2017 were tested for antimicrobial susceptibility. 66.6% patients showed resistance to one antimicrobial, 18.9% to two, and 2.4% to three families of antibiotics. A cohort of 162 H. pylori‐positive patients were enrolled in this study. Forty‐three with single H. pylori resistance to clarithromycin (CLR) were treated with omeprazole (PPI), amoxicillin (AMX), and levofloxacin (LVX)—OAL (31 subjects) or omeprazole, AMX, and metronidazole (MTZ)—OAM (12 patients) and 77 patients with dual H. pylori resistance (51 to CLR and MTZ, 12 to CLR plus LVX, and 14 to MTZ plus LVX) received OAL or OBTM (PPI, bismuth subcitrate, tetracycline, and MTZ), OAM, and OAC, respectively. Other 42 patients with triple H. pylori resistance (CLR, LVX, and MTZ) were treated with PPI, AMX, and rifabutin—OAR (18 subjects), PPI, AMX, and doxycycline—OAD (8), OADB (7), OBTM (6), and ODBR (3). All subjects received standard doses for 10 days. Eradication rate was confirmed by 13C‐UBT. Adverse events were assessed by a questionnaire.
Results
Intention‐to‐treat analysis demonstrates that eradication rates using triple therapies in patients with H. pylori resistance to one and to two families of antibiotics were 93% and 94.8%, respectively. In subjects with H. pylori‐resistant to three families of antibiotics, cure rate was higher in naïve patients treated with OAR‐10 days compared to those treated with bismuth‐containing quadruple therapies (90% vs 75%). Adverse events were limited (18 of 162, 11.1%), all of them mild‐moderate.
Conclusions
The implementation of susceptibility‐guided triple therapy for 10 days leads to eradication rate ≥95% in naïve patients with H. pylori resistance to one or two families of antimicrobials. In naïve patients with H. pylori resistance to three families, OAR treatment achieved a 90% of eradication.
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Reversible dilated cardiomyopathy as a complication of adrenal cortex insufficiency: a case report
Cardiovascular manifestations associated with Addison's disease are previously documented. We described a case of an 11-year-old girl who developed dilated cardiomyopathy as a complication to Addison's disease...
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ER Doctor, Pharmacist Among Dead in Chicago Hospital Shooting
Doctors unite in mourning on Twitter and vent at the NRA, using #ThisIsOurLane.
Medscape Medical News
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FDA OKs Gamifant, First Drug for Rare Immune Disease HLH
Emapalumab is an interferon gamma-blocking antibody that fills an unmet medical need for patients with primary hemophagocytic lymphohistiocytosis, the FDA says.
FDA Approvals
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Clinical Thyroidology®for the Public – Highlighted Article
From Clinical Thyroidology® for the Public: Thyroid hormones have major effects on the heart and palpitations and irregular heart rhythms are frequent symptoms caused by hyperthyroidism. Because of this, hyperthyroidism is associated with increased cardiac problems. Read More…
We welcome your feedback and suggestions. Let us know what you want to see in this publication.
Feedback & SuggestionsThe post Clinical Thyroidology<sup>®</sup>for the Public – Highlighted Article appeared first on American Thyroid Association.
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Double Fogarty balloon catheter technique for difficult to retrieve esophageal foreign bodies
Foreign body ingestion is common, especially in the pediatric population. Plans for retrieval should be tailored to the specific esophageal foreign bodies.
https://ift.tt/2zji4O2
Effectiveness of discovery learning using a mobile otoscopy simulator on knowledge acquisition and retention in medical students: a randomized controlled trial
Portable educational technologies, like simulators, afford students the opportunity to learn independently. A key question in education, is how to pair self-regulated learning (SRL) with direct instruction. A ...
https://ift.tt/2OUZnoV
Long term follow-up demonstrating stability and patient satisfaction of minimally invasive punch technique for percutaneous bone anchored hearing devices
Minimally Invasive Ponto Surgery (MIPS) was recently described to facilitate the placement of percutaneous bone anchored hearing devices. As early adopters of this new procedure, we sought to perform a quality...
https://ift.tt/2zhhmks
Cardiac metastasis in a living patient with oral cancer
Cardiac metastasis from head and neck cancers are very rare. Metastases to heart are mostly diagnosed at autopsy, and seldom found while patients are alive. Patients with cardiac metastasis do not present with specific symptoms in the early stages, and diagnosis is often delayed until the disease has advanced significantly. Here, we report a 66-year-old lady who was diagnosed with cardiac metastasis 10 months after surgical resection of oral cancer. She died one month following the discovery of cardiac metastasis.
https://ift.tt/2qVnGcN
Surgical deroofing in the treatment of patients with auricular pseudocyst
An auricular pseudocyst is a fluid filled cavity, characterized by a lack of epithelium, in the intra-cartilaginous space. Clinically, it presents as a painless lump on the upper anterior surface of the ear. Various treatment methods have been discussed in the literature, including aspiration, incision and drainage, or steroid injection. However, these approaches are associated with a high rate of recurrence and results are often esthetically unsatisfactory; therefore, a need for improved treatment approaches remains.
https://ift.tt/2FyqFCc
Occurrence of ochratoxin A in typical salami produced in different regions of Italy
Abstract
A total of 172 different salamis were purchased from farms and small salami factories located in four Italian regions (Piedmont, Veneto, Calabria, and Sicily) and analyzed for the presence of ochratoxin A (OTA). Analysis was performed by high-performance liquid chromatography coupled to a fluorimetric detector (HPLC-FLD). The detection limit (LOD) for the method used was 0.05 μg/kg, while the quantitation limit (LOQ) was 0.20 μg/kg; the average recovery rate was 89.1%. OTA was detected in 22 salamis, and 3 samples exceeded the Italian guidance value for OTA in pork meat (1 μg/kg). In particular, what emerges from this research is the high percentage of spicy salamis among positive samples (68.2%, 15 out of 22), although spicy salamis are only 27.3% of the total number of samples collected and analyzed. Red chili pepper contaminated by OTA could be responsible for the presence of the mycotoxin in these spicy salamis. It follow that, also the control of some ingredients used in the manufacture of these meat products, like spices, should not be neglected.
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Cyclical Hypersensitivity, Anaphylaxis and Related Hormonal Reaction
Case Report
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Title: Where does worsening asthma end and an asthma exacerbation begin?
When does worsening asthma end, and an asthma exacerbation begin?
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EARLY BIRD CATCHES THE SPOT: ACUTE FIXED DRUG ERUPTION
Fixed drug eruption (FDE) is a recurring cutaneous reaction that characteristically occurs in the same location(s) upon re-exposure to the same drug. Lesions normally appear 8 hours and up to 2 weeks after drug administration.
https://ift.tt/2R4yot6
Comparing oral health in patients with different levels of dental anxiety
Dental Anxiety is still today one of the most common fears and is therefore a great challenge for every dental practitioner. The aim of this study was to identify patients with dental anxiety using the Dental ...
https://ift.tt/2zk7LJH
Mitchell–Hoole–Kanatas (MHK) questionnaire: the first to measure patient-reported outcomes relating to problems with intimacy after diagnosis and treatment of head and neck cancer
Patient-reported outcomes are increasingly used by clinical teams as indicators of quality when assessing treatment after a diagnosis of head and neck cancer. About a third of patients report reduced sexual interest or enjoyment after such treatment but, despite that, there is no questionnaire about intimacy that has been developed specifically for them. The aim of this study was to develop such a questionnaire, to gain an indication of the relative incidence of individual items, and to compare characteristics such as age, stage, treatment, time since treatment for an established head and neck cancer, and a health-related quality of life (QoL) measure (European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-C30 with the Head and Neck 35 module).
https://ift.tt/2A8GcCH
Deep neck infection in patients with and without human immunodeficiency virus: a comparison of clinical features, complications, and outcomes
We retrospectively studied the clinical features, complications, and outcomes of deep neck infections in 31 adult patients with the human immunodeficiency virus (HIV) (HIV group) and 192 patients without (non-HIV group). In the HIV group, the cause was more likely to be odontogenic (21 (68%) compared with 90 (47%); odds ratio (OR) 2.38; 95% CI 1.06 to 5.32). In both groups, the parapharyngeal, submandibular, and masticator spaces, were those most often involved. However, in the HIV group, Ludwig's angina was common, and was the main cause of airway obstruction.
https://ift.tt/2A8Gae3
The Three Dimensional Orofacial Changes Occurring After Proportional Condylectomy in Patients with Condylar Hyperplasia Type 1B (Unilateral Hemimandibular Elongation)
Publication date: Available online 20 November 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Waseem A. Abboud, Maria Krichmar, Daniela Blinder, Alex Dobriyan, Gilad Yahalom, Ran Yahalom
Abstract
Purpose
To evaluate the three dimensional orofacial changes occurring after proportional condylectomy that was not followed by orthognathic surgery in patients with condylar hyperplasia type 1B (unilateral hemimandibular elongation).
Patients and Methods
A retrospective analysis of the medical records of 14 skeletally-mature patients. Transverse, vertical, and horizontal cephalometric analyses of photographs and radiographs were undertaken. A comparison of the preoperative and postoperative measurements was conducted.
Results
After proportional condylectomy, transverse chin position and vertical lip cant improved to various degrees; whereas, ramus-condyle height and mandibular lower border discrepancy worsened to different extents. The prominence of the gonial angle of the affected/operated side increased in all patients after surgery, and this contributed to better symmetry only when the preoperative prominence was small (flat); whereas, the opposite when the preoperative prominence was large (bulky). After condylectomy, there was a posterior displacement of the pogonion point (setback), which was favorable in cases with a preoperative concave profile and unfavorable in cases with a preoperative convex profile.
Conclusion
Proportional condylectomy can successfully arrest the hyperplastic growth of the affected condyle; however, it rarely achieves perfect symmetry of the face. While it improves some facial features, other facial traits are worsened. Surgeons should have a full understanding of the three-dimensional changes occurring after proportional condylectomy, and should be able to predict based on the preoperative findings the anticipated improvement or worsening of the different facial features.
https://ift.tt/2PLk8Ja
AllergyWatch - Feb-19
Publication date: Available online 20 November 2018
Source: Annals of Allergy, Asthma & Immunology
Author(s): John J. Oppenheimer, Vivian Hernandez-Trujillio, Stanley M. Fineman
https://ift.tt/2PGcbVp
"Drug Allergy in children and adults: is it the double X chromosome?"
Publication date: Available online 20 November 2018
Source: Annals of Allergy, Asthma & Immunology
Author(s): Allison Norton, Ana Dioun Broyles
https://ift.tt/2QYDUNN
Racial differences in Atopic Dermatitis
Publication date: Available online 20 November 2018
Source: Annals of Allergy, Asthma & Immunology
Author(s): Patrick M. Brunner, Emma Guttman-Yassky
https://ift.tt/2PLeSFq
The Glycerin Associated Pain (GAP) Study
Publication date: Available online 20 November 2018
Source: Annals of Allergy, Asthma & Immunology
Author(s): Christopher A. Coop, Karen Barker, Scott Dickson, Troy Baker, Kirk Waibel
https://ift.tt/2QZQ2hA
Immediate-hypersensitivity reactions to proton pump inhibitors – experience in a medical department
Publication date: Available online 20 November 2018
Source: Annals of Allergy, Asthma & Immunology
Author(s): Joana Sofia Pita, João Azevedo, Rosa-Anita Fernandes, Carlos Loureiro, Ana Todo Bom
https://ift.tt/2PDSM7A
Asthma in the Melting Pot
Publication date: Available online 20 November 2018
Source: Annals of Allergy, Asthma & Immunology
Author(s): Margee Louisias, Lakiea Wright, Wanda Phipatanakul
https://ift.tt/2QYEcUO
Inpatient Beta-lactam test-dose Protocol promotes Antimicrobial Stewardship in Patients with History of Penicillin Allergy
Publication date: Available online 20 November 2018
Source: Annals of Allergy, Asthma & Immunology
Author(s): Keith A. Sacco, Benjamin P. Cochran, Kevin Epps, Mark Parkulo, Alexei Gonzalez-Estrada
Abstract
Background
Penicillin allergy is the most commonly reported drug allergy in hospitalized patients, resulting in increased second-line antibiotic use, nosocomial infections, and healthcare utilization. Given that the vast majority of patients are not truly allergic, a safe strategy that empowers the admitting physician is needed.
Objective
To assess the impact on antibiotic prescribing practices for hospitalized patients with penicillin allergy using a validated intervention.
Methods
An intervention was implemented to educate providers on management of patients with penicillin allergy using a validated risk-stratification algorithm to guide testing and antibiotic use. 30 days of control data using current standard of care was compared with 60 days of post-intervention data measuring documentation of penicillin allergy history and antibiotic selection.
Results
The relative use of cephalosporin and penicillin antibiotics increased by 121.2% (p=0.027) and 256% (p=0.043) respectively without an increase in adverse drug reactions. There was a decrease in the use of broad-spectrum antibiotics; vancomycin 67.2% (p=0.036), quinolones 33.3% (p=0.31), carbapenems 81.9% (p=0.080), and aztreonam 73.8% (p=0.180).
Conclusion
The antibiotic choice in patients admitted to the hospital with a reported penicillin allergy can be improved by better evaluation of the allergy history and the use of a risk stratification guideline.
https://ift.tt/2PLeGpG
Implementation of the NIAID Peanut Allergy Guidelines: Outcomes and Experience
Publication date: Available online 20 November 2018
Source: Annals of Allergy, Asthma & Immunology
Author(s): Amanda L. Pratt, Jonathan A. Hemler
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A CASE OF CARRAGEENAN ALLERGY IN A PEDIATRIC PATIENT
Publication date: November 2018
Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 5, Supplement
Author(s): H. Kular, J. Dean, V. Cook
Introduction
Carrageenan is a common food additive obtained from Eucheuma, Chrondrus, and Gigartina species of seaweed. It is used in dairy, processed meat, sauces, pharmaceuticals and other food products as a thickener and stabilizer. It's soluble fiber properties are used to alter the consistency, appearance, and nutritional properties of food. Although it has been reported to cause adverse gastrointestinal effects, reports of IgE-mediated allergy appear limited to a case of anaphylaxis to carrageenan-containing barium enema. We present a unique case of carrageenan allergy in a pediatric patient.
Case Description
A 10-month-old male presented for assessment after developing lip angioedema immediately following ingestion of icing from a fruit cake. He had no associated urticaria, respiratory distress, hypotension, or gastrointestinal symptoms. He had a history of eczema, and was known to tolerate milk, egg, soy, peanuts, hazelnuts, and other cake icing without adverse reactions. Skin prick testing to the cake icing produced a positive wheal measuring 11 by 5 mm. Skin prick testing to cow's milk and melon contained in the cake was negative. A detailed ingredient list revealed carrageenan as an ingredient. Skin prick testing to carrageenan produced a positive wheal measuring 10 by 8 mm. Instructions regarding carrageenan avoidance were provided along with an epinephrine-auto-injector and anaphylaxis action plan.
Discussion
To our knowledge, this is the first reported case describing IgE-mediated reaction following carrageenan ingestion. Carrageenan continues to be a common food additive. This case highlights the importance of recognizing carrageenan as a potential cause of IgE-mediated reactions in unexplained food allergy presentations.
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INDEX OF ORAL AND POSTER ABSTRACT AUTHORS: * = Presenting Author
Publication date: November 2018
Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 5, Supplement
Author(s):
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Author disclosures
Publication date: November 2018
Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 5, Supplement
Author(s):
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THE DIFFICULT MANAGEMENT OF THREE PATIENTS WITH NETHERTON SYNDROME
Publication date: November 2018
Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 5, Supplement
Author(s): R. Saenz, M. Chen, A. Ahmed, Y. Gernez
Introduction
Netherton Syndrome (NS) is a rare congenital ichthyosis characterized by generalized scaling, erythema, and epidermal barrier defects due to homozygous defects in the SPINK5 gene that encodes for the serine protease inhibitor LEKT1. When mutated, the SPINK5 gene results in the breakdown and thinning of the stratum corneum. The ichthyosis of NS is difficult to manage, and we discuss the result of several systemic treatments attempted, including IVIG and dupilumab.
Case description
We describe three patients with NS, ranging in age from 9 months to 31 years. Infections among these three patients are common and range from recurrent skin infections and upper respiratory infections, to multi-organism bacteremia and sepsis complicated by metabolic acidosis, requiring ICU admission. Additionally, multiple food allergies were noted in one patient. Labs demonstrate a variety of immune abnormalities including mixed T and B cell lymphopenias, impaired cytotoxicity, intermittent eosinophilia, and significant elevations in IgE. Our genetic studies reveal several previously unidentified variants in SPINK5 that appear to cause clinical disease. Our three patients were started on IVIG. While prior studies demonstrated significant clinical improvement in patients on IVIG, only minimal to moderate subjective skin improvement was noted in two of the patients. In one patient, dupilumab was used in the context of increased IgE and eosinophilia, but to date has not proven useful.
Discussion
These cases provide insight into complexity of NS and challenge the existing theory that IVIG provides favorable outcomes. We suggest that new systemic/targeted therapeutics should be attempted for treatment of NS.
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RECURRENT ERYTHEMA MULTIFORME, RESOLVED AFTER IMMULOGLOBULIN REPLACEMENT THERAPY IN A PATIENT WITH NORMAL IMMUNOGLOBULIN LEVELS
Publication date: November 2018
Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 5, Supplement
Author(s): A. McInerney, S. Siegel
Introduction
While immunoglobulin has been used for Stevens-Johnson syndrome (SJS), its use in erythema multiforme (EM) is limited. Our case describes recurrent EM after SJS with antibiotic exposure and Mycoplasma pneumoniae infection, with normal immunoglobulin levels, which failed standard treatment but resolved following immunoglobulin replacement therapy (IRT).
Case Description
A 13-year-old boy developed fever, cough, and rash progressing to generalized sloughing bullae, with dyspnea that deteriorated to emphysematous lung changes. The lesions were targetoid with erythematous base, dusky center, including mucosa. Symptoms developed after treatment for presumed pneumonia with amoxicillin-clavulanate. He was admitted with SJS and Mycoplasma pneumoniae. Steroids, azithromycin, and acyclovir were given. Biopsy was consistent with EM. He was discharged on azithromycin, doxycycline, and valacyclovir for persistent lesions, although HSV titers and cultures were negative. Immune work-up was unremarkable. He lacked immunity to multiple pathogens, despite vaccination, but responded to re-immunization. Immunoglobulins remained normal. Lesions recurred frequently, with minimal response to steroids, and flares with weaning. IRT was administered during re-admission with near resolution. He was then started on IRT therapy. Steroids were weaned without recurrence.
Discussion
Traditionally described secondary to HSV, Mycoplasma and medications are implicated frequently in pediatric EM. Standard treatment includes prolonged antivirals, antibiotics, and steroids. With treatment failure, immunosuppressants, anti-malarials, and IRT are used. However, controlled trials and consistent data are lacking. As our patient demonstrates, IVIG's immunomodulatory effect can facilitate resolution of recurrent EM. Furthermore, prophylactic use for infections may prevent recurrence. Finally, IVIG represents an alternative to immunosuppressants in pediatric patients with recalcitrant EM despite normal immunoglobulins.
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DRESS TO TEN: IS THIS A CONTINUUM?
Publication date: November 2018
Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 5, Supplement
Author(s): F. Khan, J. Simonaire, N. Klaiber, S. Kumar
Introduction
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a potentially life-threatening severe cutaneous adverse drug reaction (SCAR) that can be triggered by medications. Toxic Epidermal Necrolysis (TEN) is also a type of SCAR. To the best of our knowledge, we present a first known clear case of DRESS which progressed to clinical TEN and was successfully treated.
Case Description
A 17-year old female was started on Lamotrigine and Escitalopram for a mood disorder. One week later, she developed tender cervical lymphadenopathy, fevers, and abdominal discomfort. About 2.5 weeks after starting these two medications, she developed a raised, pruritic, erythematous rash on her arms. Although the medication was discontinued, she failed to improve and developed facial angioedema, hepatic failure, eosinophilia and atypical lymphocytosis - all concerning signs for DRESS. Skin biopsy confirmed perivascular lymphocytic infiltrate with scattered eosinophils supporting DRESS. She was treated with intravenous immunoglobulin and eventually discharged home with a resolving rash. As Prednisone was tapered, the patient was readmitted with concerns for relapsing DRESS. She went on to develop TEN with mucosal involvement as well as greater than 30 percent skin involvement. She was successfully treated with a combination of Cyclosporine and high dose Prednisone.
Discussion
There is paucity of literature on SCAR overlap syndromes and we acknowledge the ambiguity and difficulty with this diagnosis given the overlapping presentation with SCAR syndromes. Although the mortality rate tends to be quite high for SCAR overlap syndromes, our patient was successfully treated with a combination of IVIG, steroids and Cyclosporine.
Progression towards TEN.
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A MYSTERIOUS RASH AROUND SURGICAL WOUNDS
Publication date: November 2018
Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 5, Supplement
Author(s): W. Jithpratuck, D. Kays, P. Sriaroon
Introduction
Contact dermatitis (CD) that occurs shortly after a surgery is often caused by a direct irritant effect of medical products or, infrequently, a delayed type hypersensitivity. Various agents have been reported to cause CD including topical medications, surgical instruments, and surgical glue. We present a patient who developed rash around surgical wounds. Skin patch testing identified the causative agent of his CD.
Case Description
A 15-year-old male presented with new onset of pruritic papulovesicular rash three weeks following Nuss procedure, a minimally invasive pectus excavatum repair using a metal bar. The rash initially appeared on upper extremities and chest wall around surgical wounds (Figure 1A). Later, new erythematous lesions occurred on foreskin of penis. Patient denied other systemic symptoms or prior history of metal or medication allergy. A delayed hypersensitivity to nickel or other components of stainless steel used in the pectus bar was suspected. Surgical removal of the bar was contemplated. A trial of oral prednisone 30mg BID led to resolution of the rashes (Figure 1B). Blood test for metal-lymphocyte proliferation assay was unremarkable. Skin patch test was negative to nickel and metal disc, and confirmed a reaction to 2-octyl cyanoacylate (surgical glue) (Figure 1C).
Discussion
Delayed-type hypersensitivity to surgical glue should be considered in patients who develop rash around surgical wounds. Evaluation of surgery-related CD requires a thorough understanding of procedure steps and potential exposures to medical products. Patch test can aid in identification of the offending agent and allow a recommendation of alternative products to avoid recurrence.
Figure. A. Rash around surgical wounds Figure 1B. Improvement of rash after a 5-day course of prednisone 30 mg BID treatment Figure 1C. Positive patch test to 2-octyl cyanoacrylate (Dermabond® surgical glue)
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HAND DERMATITIS IN A SURGEON: A DIFFICULT PROBLEM AND A THREE-PRONGED SOLUTION
Publication date: November 2018
Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 5, Supplement
Author(s): S. Mahapatra, L. Caraballo, V. Dimov, F. Eidelman
Introduction
Hand dermatitis is a common problem affecting up to 25% of health workers, it can be caused by contact dermatitis (CD). CD is categorized as irritant in 80% of patients and allergic in 20%.
Case Description
A 42-year old male surgeon with a history of recurrent eczematous lesions on hands and trunk presented with a recurrence of pruritic rash. The rash had persisted despite using OTC hydrocortisone, triamcinolone and OTC moisturizers. Hand dermatitis interfered with his work as a surgeon. Patch testing for allergic contact dermatitis was positive for 1, 3-diphenylguanidine, ammonium persulfate, carba mix, cinnamic aldehyde, cocamidopropyl betaine, coconut diethanolamide (cocamide DEA), colophony, formaldehyde, fragrance mix, hydrocortisone-17-butyrate, Iodopropynyl butylcarbamate, lidocaine-HCl and propylene glycol. The glove materials (1, 3-diphenylguanidine, carba mix), fragrances, preservatives (propylene glycol) and topical steroids were correlated with the patient's symptoms. After contact dermatitis was confirmed with patch testing, a targeted avoidance was recommended. Treatment modalities were adjusted. Triamcinolone and hydrocortisone were eliminated based on patch test results (triamcinolone 0.1% cream contained propylene glycol). Symptoms improved with: 1. topical calcineurin inhibitor (tacrolimus); 2. avoidance of irritants and allergens based on skin patch test; 3. use of barrier protection such as cotton undergloves.
Discussion
Hand dermatitis can have a potentially devastating effect on a surgeon's career based on the limitations it imposes on the ability to practice. The three-pronged approach described above can offer a clinical solution to a difficult problem.
https://ift.tt/2R0qwIU
AN EVOLVING DIAGNOSIS OF A DIFFUSE ERYTHRODERMIC RASH
Publication date: November 2018
Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 5, Supplement
Author(s): M. Kuder, F. Hsieh
Introduction
Lymphocytic variant hypereosinophilic syndrome (L-HES) is a rare condition that can be challenging to diagnose. In patients presenting with an erythrodermic skin rash and eosinophilia, it is imperative to review the L-HES diagnostic criteria and periodically reassess for alternative etiologies, particularly with disease progression.
Case Description
A 39-year-old female presented with a 4-year history of an erythematous, confluent plaque-like rash. Initially, her skin biopsy demonstrated granulomatous dermatitis with necrobiosis but no eosinophils. She had a peripheral absolute eosinophil count of 1100/uL. Her bone marrow biopsy demonstrated a CD4+, CD3-T-cell population with small, non-necrotizing granulomas and no clonal eosinophilia. She was diagnosed with L-HES and started on high-dose glucocorticoids with initial skin improvement; however, skin symptoms subsequently progressed, covering 90% of her body surface area. She was then managed as cutaneous sarcoidosis, but treatment with methotrexate and leflunomide did not improve symptoms. Given her persistent symptoms, she underwent repeat skin biopsy, which demonstrated cutaneous T-cell lymphoma. Symptoms improved with romidepsin.
Discussion
This patient had initial findings suggestive of L-HES but did not meet L-HES diagnostic criteria. She never had an absolute eosinophil count >1500/uL, nor tissue biopsy demonstrating eosinophil-mediated organ damage. Her disease progression led to re-evaluation and a malignancy diagnosis. Although patients with L-HES can progress to cutaneous T-cell lymphoma, clonal CD4+, CD3- T cells can be found in primary cutaneous T-cell lymphoma without prior HES diagnosis. This case illustrates the importance of continued diagnostic inquiry when the diagnosis is unclear and symptoms progress despite therapy.
https://ift.tt/2PE3ivq
IMPROVEMENT OF SYSTEMIC SCLEROSIS-LIKE SYMPTOMS AFTER THERAPY FOR MULTIPLE MYELOMA
Publication date: November 2018
Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 5, Supplement
Author(s): S. Davuluri, A. Tieng, G. Franchin, M. Niazi
Introduction
Systemic sclerosis is known to carry an increased risk of malignancy. In this report we describe a rare case of systemic sclerosis as the presenting sign of amyloidosis associated with multiple myeloma.
Case Description
A 59-year-old woman presented to the clinic with a 6-month history of bilateral hand pain and puffiness. Physical examination revealed melasma, multiple enlarged right supraclavicular lymph nodes, and sclerodactyly. Laboratory tests were positive for antinuclear antibodies (1:160) in a nucleolar pattern and nephrotic range proteinuria (>8g/day). The initial impression was systemic sclerosis associated arthritis and patient was treated with hydroxychloroquine, resulting in slight improvement in her range of motion. Computed tomography of the neck showed mildly enlarged right supraclavicular lymph nodes measuring up to 1.6 centimeters in diameter. Biopsy of a cervical lymph node revealed malignant lymphoma. Bone marrow biopsy showed plasma cell myeloma (>80%); serum immunoelectrophoresis revealed elevated levels of free kappa lambda light chains (8447 mg per liter; reference range, 3.3-19.4). Initial management included cyclophosphamide, bortezomib, and dexamethasone, resulting in significant improvement in joint pain. Furthermore, she developed multiple periorbital papules. A biopsy of her left upper eyelid lesion demonstrated apple-green birefringence after Congo red staining, compatible with a diagnosis of amyloidosis.
Discussion
This patient initially presenting with a picture suggestive of systemic sclerosis was subsequently diagnosed with multiple myeloma and amyloidosis. She developed significant improvement in the range of motion of her finger joints as well as the skin tautness after initiating chemotherapy.
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IATROGENIC SYSTEMIC ALLERGIC CONTACT DERMATITIS FROM CETIRIZINE AND LEVOCETIRIZINE
Publication date: November 2018
Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 5, Supplement
Author(s): D. Lei, C. Guo, P. Greenberger
Introduction
H1 antihistamines are frequently utilized in the management of dermatitis-associated pruritus; they may be overlooked and are rarely considered as an etiology for dermatitis.
Case Description
A 76-year-old woman with a history of allergic rhinitis and hypertension was referred for one year of pruritic, erythematous papules/plaques scattered throughout the body, worse over sun-exposed areas. Prior dermatologic evaluation and biopsy were suggestive of allergic contact dermatitis. Patch testing was positive for fragrance mix, ethylenediamine, and balsam of peru. The patient discontinued all products containing these substances without improvement. She continued to develop new lesions. There were no new medications except cetirizine and then levocetirizine, which she continued for the management of pruritus. She was treated with multiple courses of systemic and topical corticosteroids, and hydroxychloroquine, without resolution. The patient was advised to discontinue levocetirizine, avoid cetirizine, and initiate fexofenadine. At follow up at two weeks and one year later, she reported complete resolution of the rash after discontinuation of levocetirizine.
Discussion
Piperazine derivative antihistamines, such as hydroxyzine, cetirizine, and levocetirizine, share a similar structure with ethylenediamine, which is a common etiology of contact dermatitis. Hypersensitivity to H1 antihistamines is rare. Continued use of H1antihistamines, despite lack of improvement or worsening of symptoms, may be incorrectly interpreted as a failure of response to treatment. Development of generalized dermatitis induced by cetirizine or levocetirizine is rarely reported. This case illustrates the importance of re-evaluation in patients who fail to respond to treatment with consideration of piperazine derivative H1 antihistamines as a possible trigger.
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ATYPICAL PRESENTATION OF SCABIETIC URTICARIAL VASCULITIS
Publication date: November 2018
Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 5, Supplement
Author(s): J. Hanna, T. Bingemann
Introduction
Pruritic rash with burrows is pathognomonic for scabies. Classic lesions are seen less frequently as the incidence has increased. Our patient presented with none of the classic findings of scabies and biopsy features consistent with urticarial vasculitis.
Case Description
75-year old male presented with a generalized urticarial eruption for 1 month that burned and itched, and was accompanied by post-inflammatory hyperpigmentation. No new medications had been started. No family members had similar symptoms. Multiple urticarial plaques were noted with post-inflammatory changes without burrows. Dermatographism was present. Skin biopsy showed dense perivascular and superficial interstitial infiltrate, leukocytoclasis, and smudged small vessel walls. No mites or eggs were identified. No eosinophilia was present. Autoimmune work up and complement were normal. Treatment with Colchicine, Dapsone, Prednisone, and Hydroxychloroquine led to initial improvement but then relapse. When he was not improving, we sent him to dermatology again and they did not recommend any changes. As medications were changed, lesions again improved and then worsened. He called complaining of persistent lesions. When he was seen at that point, he had developed typical features of scabies and was treated with topical Permethrin and oral Ivermectin and rash completely subsided. After he improved, he was tapered off Dapsone without recurrence of his symptoms.
Discussion
Urticarial vasculitis is an uncommon presentation of scabies with frequently delayed diagnosis. This case serves as a reminder to reassess the diagnosis if the patient does not respond as expected to treatment and adds to the cases of scabies with atypical presentations.
https://ift.tt/2R3LxCI
Insights into the regeneration of skin from Acomys, the spiny mouse
Abstract
Members of the Acomys genus, known as spiny mice, are unique among mammals in being perfectly capable of regenerating large areas of skin that have been removed. During this regenerative process hairs, sebaceous glands, erector pili muscles, adipocytes and the panniculus carnosus all regenerate and the dermis does not scar. We review here the processes that the epidermis and the individual components of the dermis undergo in the regeneration process of the spiny mouse, the molecules that have been identified as potentially being important in regeneration and relate this to what has been proposed as playing a role in studies from the lab mouse, Mus musculus. Differences in the immune systems of spiny mice and lab mice are also highlighted as this is suggested to play a part not only in the perfect wound healing that embryos display but also in regeneration in lower vertebrates.
This article is protected by copyright. All rights reserved.
https://ift.tt/2R0s4T5
How chemotherapy and radiotherapy damage the tissue: Comparative biology lessons from feather and hair models
Abstract
Chemotherapy and radiotherapy are common modalities for cancer treatment. While targeting rapidly growing cancer cells, they also damage normal tissues and cause adverse effects. From the initial insult such as DNA double strand break, production of reactive oxygen species (ROS), and a general stress response, there are complex regulatory mechanisms that control the actual tissue damage process. Besides apoptosis, a range of outcomes for the damaged cells are possible including cell cycle arrest, senescence, mitotic catastrophe, and inflammatory responses and fibrosis at the tissue level. Feather and hair are among the most actively proliferating (mini‐)organs, and are highly susceptible to both chemotherapy and radiotherapy damage, thus provide excellent, experimentally tractable model systems for dissecting how normal tissues respond to such injuries. Taking a comparative biology approach to investigate this has turned out to be particularly productive. Started in chicken feather and then extended to murine hair follicles, it was revealed that in addition to p53‐mediated apoptosis, several other previously overlooked mechanisms are involved. Specifically, Shh, Wnt, mTOR, cytokine signaling, and ROS‐mediated degradation of adherens junctions have been implicated in the damage and/or reparative regeneration process. Moreover, we show here that inflammatory responses, which can be prominent upon histological examination of chemo‐ or radiotherapy‐damaged hair follicle, may not be essential for the hair loss phenotype. These studies point to fundamental, evolutionarily conserved mechanisms in controlling tissue responses in vivo, and suggest novel strategies for the prevention and management of adverse effects that arise from chemo‐ or radiotherapy.
This article is protected by copyright. All rights reserved.
https://ift.tt/2PI3da0
Induction of immune responses by a novel recombinant fusion protein of enterovirus A71 in BALB/c mice
Publication date: January 2019
Source: Molecular Immunology, Volume 105
Author(s): Nipatha Issaro, Fenfang Wu, Lei Weng, Mi Zhou, Zhaoxiang Fang, Sisi Huang, Vinothkumar Rajamanickam, Min Liu, Haishan Tian, Xiaokun Li, Chao Jiang
Abstract
Fusion protein technology is used in biotechnology and medical developments. In this study, recombinant fusion proteins from enterovirus A71 (EV-A71) subgenotype B5, Thailand were designed based two surface proteins (VP1 and VP2) and an internal protein (VP4), and named "VP0" (consisting of VP4-VP2) and "EV71" (consisting of VP4-VP2-VP1), respectively. The recombinant fusion proteins VP0 and EV71 were expressed in insect cells and successfully produced and secreted into the media. Both recombinant fusion proteins were shown to have immunogenic properties in BALB/c mice when formulated with Freund's complete/incomplete adjuvant (FA). Interestingly, EV71 formulated with FA- induced a level of IgG antibodies level similar to that induced by the recombinant protein VP1 formulated with FA (the positive control). Our results showed that VP1 alone is better at eliciting a strong cell-mediated immune response. Nontheless, EV71 formulated with FA was capable of inducing lymphocyte proliferation and increasing the cytokine-related mRNA expression levels of interferon-γ (IFN-γ), interleukin-2 (IL-2), and IL-10 in mice after immunization. Additionally, the number of CD4+ and CD8+ T lymphocyte cells after stimulation with purified EV71 in splenic cell culture showed highly specific CD4+ and CD8+ T-cell production. We suggest that EV71, which consists of VP4-VP2-VP1, could be used as the foundation for developing a novel recombinant fusion protein-based vaccine for EV-A71.
https://ift.tt/2A7fDha
Oral & Maxillofacial surgery is ready for patient-centred eHealth interventions − the outcomes of a scoping review
Publication date: Available online 19 November 2018
Source: International Journal of Oral and Maxillofacial Surgery
Author(s): S.C. van den Bosch, N.E.M. van de Voort, T. Xi, R.B. Kool, S.J. Bergé, M.J. Faber
Abstract
Within the field of oral and maxillofacial (OMF) surgery, eHealth is expected to be a tool to improve quality of care. The aim of this study is to map the research of patient-centred eHealth interventions within OMF surgery by means of a scoping review.
After a systematic literature search, relevant studies on patient-centred eHealth interventions for OMF-surgery patients were selected. The interventions were mapped based on their key components, target population and outcome measures. To gain insight in the research phase of evaluation, the framework of the Medical Research Council (MRC) was used.
Forty-one papers were included, comprising 34 unique interventions. Nineteen interventions were designed for head and neck cancer patients, 11 interventions concernd video-teleconsultation. According to the MRC framework, 26 papers fitted into the feasibility and piloting phase of research, 8 into the evaluation phase, 7 were in the development phase. No implementation studies were found.
This scoping review can be a starting point for those who are interested in applying and evaluating eHealth in their practice. Since many feasibility and pilot studies were found on similar interventions, a more extensive collaboration with and connecting to each other is recommended to catalyze the implementation of eHealth in daily practice. Profound involvement of patients in developing and evaluating eHealth interventions is essential to achieve true patient-centred OMF surgery.
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Clinical features of poorly differentiated thyroid papillary carcinoma
Publication date: Available online 19 November 2018
Source: Auris Nasus Larynx
Author(s): Masaaki Higashino, Yusuke Ayani, Tetsuya Terada, Yoshitaka Kurisu, Yoshinobu Hirose, Ryo Kawata
Abstract
Objective
To investigate the clinical feature of the poorly differentiated thyroid papillary carcinoma.
Methods
We investigate retrospectively 276 thyroid papillary carcinoma patients who underwent initial treatment at our Department who underwent initial treatment at our Department during the 13-year period from 2000 to 2012. We examine the pathological samples of papillary carcinoma retrospectively to investigate the prevalence of a poorly differentiated component in the tumor. Then the disease-specific survival rate, metastasis-free survival rate, and relapse-free survival rate were compared between patients with or without a poorly differentiated component. In addition, well differentiated carcinoma and poorly differentiated carcinoma were compared in relation to the age, sex, TNM stage, and recurrent laryngeal nerve infiltration.
Results
It was considered appropriate to define tumors with a poorly differentiated component of 10% or more as poorly differentiated carcinoma. There was a significant difference of the T classification but not the N classification between well and poorly differentiated thyroid papillary carcinomas. The disease-specific survival rate, metastasis-free survival rate, and relapse-free survival rate of patients with poorly differentiated carcinoma was significantly lower than that of patients with well differentiated carcinoma, and we considered that this might be due to the higher frequency of local infiltration in patients with poorly differentiated tumors.
Conclusion
The higher relapse rate compared with well differentiated carcinoma suggests that careful postoperative follow-up of patients with poorly differentiated carcinoma is important, particularly surveillance of distant metastasis.
https://ift.tt/2PG2Ahw
Squamous Cell Carcinoma of the Head and Neck in Children
Publication date: Available online 20 November 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Natasha D. Dombrowski, Nikolaus E. Wolter, Alexandria L. Irace, Caroline D. Robson, Antonio R. Perez-Atayde, Jennifer W. Mack, Reza Rahbar
Abstract
Objective
To discuss the presentation, evaluation, and management of squamous cell carcinoma of the head and neck in the pediatric population.
Methods
Medical records of pediatric (≤20 years) patients treated for squamous cell carcinoma of the head and neck between 1996 and 2016 were reviewed. Data pertaining to clinical presentation, diagnostic methods, treatment plan, complications, recurrence, follow-up, or outcome were collected.
Results
Eleven patients were diagnosed with squamous cell carcinoma. Seven of these patients had medical histories significant for prior malignancies, immunosuppressant therapy, and/or genetic syndromes. Lesions were identified in the oral cavity (n = 5, 45.5%), lip/upper lip (n = 3, 27.3%), larynx (n = 2, 18.2%), and nasal cavity (n = 1, 9.1%). Tumors were most commonly treated with surgical excision alone. Three patients underwent irradiation (2 adjuvant and 1 without surgery) and chemotherapy (1 adjuvant, 1 neoadjuvant, and 1 without surgery). Of these patients, one reported complications of hearing loss, loss of dentition, and laryngeal stenosis. Two patients developed local recurrence at 1 month and 5 years post-operatively, respectively. One patient developed an orocutaneous fistula and subsequently died. No other complications were reported. Median follow-up time was 4.6 years (interquartile range: 2.4-8.4 years). Complications of radiation included: laryngeal stenosis, wound breakdown, and orocutaneous fistula.
Conclusion
Squamous cell carcinoma is rare in the pediatric population. Most frequently, it is associated with previous malignancies, immunosuppressant therapy, and/or genetic conditions. Complete surgical excision is recommended to obviate the need for radiation whenever possible.
https://ift.tt/2PGNyIl
Airway findings in children with tracheostomies: When is diagnostic bronchoscopy and laryngoscopy indicated?
Publication date: Available online 19 November 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Banafsheh Sharif-Askary, Tracy Z. Cheng, Clifford S. Brown, James C. Campbell, Keven Seung Yong Ji, Eileen M. Raynor
Abstract
Objectives
To determine the utility of diagnostic laryngoscopy and bronchoscopy in children with tracheostomies and to describe the incidence of airway findings.
Methods
Retrospective cohort study examining children with tracheostomies who underwent direct laryngoscopy and bronchoscopy (DLB) at Duke University Hospital between 2008 and 2016.
Results
A total of 81 patients who underwent 114 bronchoscopies met inclusion criteria. The median time between tracheostomy and first DLB was 13 months (IQR 4.25-14.75). Sixty-six patients were diagnosed with findings on DLB (81.5%). Suprastomal granulation tissue was the most common complication (59.0%), followed by increased tracheal secretions (23%), stomal and peristomal granulation (13.2%), tracheal ulcer (3.3%), and suprastomal collapse (1.6%). The proportion of patients with airway findings who underwent endoscopy >6 months post-tracheostomy was higher than those <6 months post-tracheostomy, although this did not reach statistical significance (90.6% vs. 75.5%, p=0.087). However, when examining tracheostomy-related findings, the proportion of patients with airway findings who underwent DLB >6 months post-tracheostomy (61%) compared to <6 months post-tracheostomy (36%) was significantly different (p = 0.026). Patients who were symptomatic before bronchoscopy were more likely to have positive findings (91.9% vs. 72.7%, p=0.027) and patients were more likely to be symptomatic if they had DLB >6 months after tracheostomy versus <6 months after tracheostomy (68.8% vs. 30.6%; p<0.001).
Conclusion
The high incidence of airway findings, especially tracheostomy-related findings, noted on DLB supports the continued use of airway endoscopies in children post-tracheostomy. Timing of DLB may play a role in determining utility with evaluation and symptomatic patients should be more closely monitored as they demonstrate higher rates of airway findings.
https://ift.tt/2QZ5dHF
Injection Laryngoplasty in Neonates and Young Children with Unilateral Vocal Fold Immobility
Publication date: Available online 19 November 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Stephen Z. Shapiro, Scott E. Brietzke, Sweeti V. Shah, Samuel T. Ostrower
Introduction
Although injection laryngoplasty (IL) is a well-accepted treatment strategy in older children and adults with unilateral vocal fold immobility (UVFI), its efficacy and safety have not been well studied in neonates and young children.
Objectives
The main objective of this study was to evaluate the clinical and radiographic effects of IL on aspiration & dysphagia in neonates and young children with UVFI.
Methods
This was a retrospective chart review of infants and children who underwent IL at a tertiary children's hospital. The primary endpoints were improved aspiration and avoidance of gastrostomy tube placement. Additional endpoints included adverse airway and swallowing effects of IL.
Results
Eight patients were included in this case series. A total of 10 injection laryngoplasties were performed. Average corrected age of patients undergoing IL was 1.22 years(range 0.5-3.6y). Seven out of 8 patients had preoperative modified barium swallow (MBS). Five out of seven showed improvement in aspiration. Three out of six (50%) patients who did not have gastrostomy tube preoperatively, were able to avoid gastrostomy tube. No adverse effects were noted following IL. One patient with severe tracheomalacia ultimately required tracheostomy 5 months after IL.
Conclusion
Injection laryngoplasty appears to be a safe and effective therapeutic option in neonates and young children with unilateral vocal cord immobility and associated aspiration. It may be an effective treatment to improve aspiration and avoid gastrostomy tube placement. Further investigation is warranted.
Level Of Evidence
4.
https://ift.tt/2PK8YnJ
Deep cheek fat flap: new technique to augment the soft tissues of the mandibular alveolus
Publication date: Available online 19 November 2018
Source: British Journal of Oral and Maxillofacial Surgery
Author(s): Akeel Mosea
https://ift.tt/2TuNh9p
Macrophage Response and Surface Analysis of Dental Cementum after Treatment with High Intensity Focused Ultrasound
Publication date: Available online 19 November 2018
Source: Archives of Oral Biology
Author(s): U. Daood, A.S. Fawzy
Abstract
Objective
To investigate effects of HIFU on macrophage phenotype, surface micro-topography and nano-scale surface mechanical properties of dental cementum.
Materials and Methods
Root discs (2 mm thickness) were cut apical to CEJ and sectioned into quadrants. HIFU setup with bowl-shaped piezo ceramic transducer submerged in a water tank was used for exposure on each specimen for 15 s, 30 s or 60 s. The specimens of the control group were left without any HIFU exposure. HIFU was generated with a continuous sinusoidal wave of 120Vpp amplitude, 250 KHZ resonance-frequency and highest ultrasonic pressure of ~10 bar at the focus. Specimens for SEM were viewed, and micro-topography characterization performed, using AFM and Ra parameter and surface area (SA) calculated by specialized SPM surface analysis software. For nano-indentation testing, experiments were carried out using AFM. Macrophage cell isolation and culturing was performed on cementum to receive the HIFU treatment at different time periods. Raman spectroscopy were scanned to create spectra perpendicular to the cementum substrate to analyze generation of standard spectra for Raman intensity ratio of hydroxyapatite normalized to the peaks ν1 960 cm-1. Data was expressed as means ± standard deviations and analyzed by one-way ANOVA in term of Ra, SA, H and Er. Different points for fluorescence intensity ratio were analyzed by Raman using Wilcoxon rank sum test.
Results
HIFU exposure at 60 s removed the smear layer and most of cementum appeared smoothened. AFM characterisation, showed a slight decrease in the irregularity of the surface as exposure time increased. Intact macrophages can be identified in control and all experimental HIFU groups. The level of fluorescence for the control and HIFU 15 and 30 s were low as compared to HIFU 60 s.
Conclusion
If HIFU can be successfully implemented, it may be a possible alternative to current methods used in periodontal therapy to achieve smooth root surfaces.
Graphical abstract
https://ift.tt/2Q6P7P4
Macrophage Response and Surface Analysis of Dental Cementum after Treatment with High Intensity Focused Ultrasound
Publication date: Available online 19 November 2018
Source: Archives of Oral Biology
Author(s): U. Daood, A.S. Fawzy
Abstract
Objective
To investigate effects of HIFU on macrophage phenotype, surface micro-topography and nano-scale surface mechanical properties of dental cementum.
Materials and Methods
Root discs (2 mm thickness) were cut apical to CEJ and sectioned into quadrants. HIFU setup with bowl-shaped piezo ceramic transducer submerged in a water tank was used for exposure on each specimen for 15 s, 30 s or 60 s. The specimens of the control group were left without any HIFU exposure. HIFU was generated with a continuous sinusoidal wave of 120Vpp amplitude, 250 KHZ resonance-frequency and highest ultrasonic pressure of ~10 bar at the focus. Specimens for SEM were viewed, and micro-topography characterization performed, using AFM and Ra parameter and surface area (SA) calculated by specialized SPM surface analysis software. For nano-indentation testing, experiments were carried out using AFM. Macrophage cell isolation and culturing was performed on cementum to receive the HIFU treatment at different time periods. Raman spectroscopy were scanned to create spectra perpendicular to the cementum substrate to analyze generation of standard spectra for Raman intensity ratio of hydroxyapatite normalized to the peaks ν1 960 cm-1. Data was expressed as means ± standard deviations and analyzed by one-way ANOVA in term of Ra, SA, H and Er. Different points for fluorescence intensity ratio were analyzed by Raman using Wilcoxon rank sum test.
Results
HIFU exposure at 60 s removed the smear layer and most of cementum appeared smoothened. AFM characterisation, showed a slight decrease in the irregularity of the surface as exposure time increased. Intact macrophages can be identified in control and all experimental HIFU groups. The level of fluorescence for the control and HIFU 15 and 30 s were low as compared to HIFU 60 s.
Conclusion
If HIFU can be successfully implemented, it may be a possible alternative to current methods used in periodontal therapy to achieve smooth root surfaces.
Graphical abstract
https://ift.tt/2Q6P7P4
Comparing oral health in patients with different levels of dental anxiety
Abstract
Background
Dental Anxiety is still today one of the most common fears and is therefore a great challenge for every dental practitioner. The aim of this study was to identify patients with dental anxiety using the Dental Anxiety Scale and comparing different levels of dental anxiety with oral health using DMF-T and DMF-S index.
Methods
This study questioned 1549 patients over the course of three years (2002–2005). DAS questionnaires were handed out before treatment and the state of oral health was evaluated using DMF-T and DMF-S.
Results
There is no significant relation between high anxiety and the global DMF-T Score (p = 0.237), missing teeth (p = 0.034) and filled teeth (p = 0.237). There is however a significant increase in destroyed teeth, the higher the level of dental anxiety in the patient (p < 0.0001). There is as well a significant relationship between the global DMF-S Score (p = 0.042) and dental anxiety. No relationship was found comparing missing surfaces (p = 0.107) and filled surfaces (p = 0.516) with dental anxiety. Destroyed 16 surfaces are, however, significantly higher in patients with more dental anxiety (p < 0.0001). A higher dental anxiety therefore often causes minimalistic dentistry to fail due to more teeth being destroyed.
Conclusions
Patients with dental anxiety still have a worse oral hygiene than patients without dental anxiety. It is still necessary, in this time of caries prevention rather than over-treatment, to be educated so that patients suffering dental fear receive the right treatment.
https://ift.tt/2DOPisv
Double Fogarty balloon catheter technique for difficult to retrieve esophageal foreign bodies
Abstract
Background
Foreign body ingestion is common, especially in the pediatric population. Plans for retrieval should be tailored to the specific esophageal foreign bodies.
Case presentation
We present a difficult to retrieve esophageal foreign body in a 3-year-old girl who ingested a 2 cm glass pebble. Intraoperatively, attempts using conventional optical forceps and retrieval baskets were unsuccessful due to the size and smooth texture of the object. A novel strategy using double Fogarty embolectomy balloon catheters for retrieval of blunt esophageal foreign bodies was devised and described.
Conclusion
The double fogarty retrieval technique described appeared to be safe and efficacious, allowing for extraction of large esophageal foreign bodies under direct visualization.
https://ift.tt/2Kk2hTA
Long term follow-up demonstrating stability and patient satisfaction of minimally invasive punch technique for percutaneous bone anchored hearing devices
Abstract
Objective
Minimally Invasive Ponto Surgery (MIPS) was recently described to facilitate the placement of percutaneous bone anchored hearing devices. As early adopters of this new procedure, we sought to perform a quality assurance project using our own small prospective cohort to justify this change in practice. We chose to examine device stability and to gauge our patients' perspective of the surgery and their overall satisfaction with the process.
Methods
A total of 12 adult patients who underwent MIPS between 2016 and 2017 with a minimum post-operative follow-up of 12 months were included in this study. A prospective MIPS research clinic was used to follow patients, assess the implant site soft tissue status and gather qualitative information through patient interviews and surveys.
Results
The mean (SD) soft tissue status score averages using the IPS Scale were low for inflammation 0.1 (0.1), pain 0.1 (0.1), skin height 0.2 (0.1) and total IPS score 0.4 (0.3) indicating minimal soft tissue changes. Patient experiences with MIPS were overwhelmingly positive in reports through the MIPS modified SSQ-8. All patients reported speedy recoveries and no long-term complications. There were zero device losses.
Conclusion
The series presented in this paper represents the first MIPS cohort with long term follow-up to be published to date in North America. Our findings conclude both device stability and patient satisfaction with no loss of fixtures. Consequently, we have adopted MIPS as our procedure of choice for the placement of all percutaneous BAHDs.
https://ift.tt/2BljRDV
Effectiveness of discovery learning using a mobile otoscopy simulator on knowledge acquisition and retention in medical students: a randomized controlled trial
Abstract
Background
Portable educational technologies, like simulators, afford students the opportunity to learn independently. A key question in education, is how to pair self-regulated learning (SRL) with direct instruction. A cloud-based portable otoscopy simulator was employed to compare two curricula involving SRL. Pre-clerkship medical students used a prototype smartphone application, a 3D ear attachment and an otoscope to complete either otoscopy curriculum.
Methods
Pre-clerkship medical students were recruited and randomized to two curriculum designs. The "Discovery then Instruction" group received the simulator one week before a traditional lecture, while the "Instruction then Discovery" group received it after the lecture. To assess participants' ability to identify otoscopic pathology, we used a 100-item test at baseline, post-intervention and 2-week retention time points. Secondary outcomes included self-reported comfort, time spent using the device, and a survey on learning preferences.
Results
Thirty-four students completed the study. Analysis of knowledge acquisition and retention showed improvement in scores of both groups and no significant effects of group (F1,31 = 0.53, p = 0.47). An analysis of participants' self-reported comfort showed a significant group x test interaction (F1,36 = 4.61, p = 0.04), where only the discovery then instruction group's comfort improved significantly. Overall device usage was low, as the discovery then instruction group spent 21.47 ± 26.28 min, while the instruction then discovery group spent 13.84 ± 18.71 min. The discovery first group's time spent with the simulator correlated moderately with their post-test score (r = 0.42, p = 0.07). After the intervention, most participants in both groups (63–68%) stated that they would prefer the instruction then discovery sequence.
Conclusions
Both curricular sequences led to improved knowledge scores with no statistically significant knowledge differences. When given minimal guidance, students engaged in discovery learning minimally. There is value in SRL in simulation education, and we plan to further improve our curricular design by considering learner behaviours identified in this study.
https://ift.tt/2KlYpBp
CHRONIC ULCERATIVE STOMATITIS: a comprehensive review and proposal for diagnostic criteria
Abstract
Chronic ulcerative stomatitis (CUS) is an immune‐mediated disorder characterized by oral erosions and ulcers usually refractory to conventional treatments.
The disease often involves middle‐aged and older women with painful lesions sometimes resembling those of erosive oral lichen planus (OLP).
The most affected sites are the buccal mucosa, the gingiva and the tongue, but the skin is involved in 22.5% of cases.
Histopathologic features in CUS are non‐specific and indistinguishable from those of OLP, with the exception of the presence of a mixed infiltrate composed of lymphocytes and plasma cells.
Direct immunofluorescence (DIF) analysis reveals the presence of stratified epithelium‐specific antinuclear antibodies (SES‐ANA) in the lower third of the epithelium. The IgG antibodies detected on DIF are directed against the ∆Np63α isoform of p63 expressed in the nuclei of the epithelial basal cells.
A distinguishing feature of CUS is the low response to conventional corticosteroid therapy and the good outcome with hydroxychloroquine at the dosage of 200 mg/day or higher dosages.
This paper presents a comprehensive review of CUS and is accompanied by a new case report (the 73rd case) and a proposal for updated diagnostic criteria.
This article is protected by copyright. All rights reserved.
https://ift.tt/2TuWXkc
Cluster Analysis of Chronic Rhinosinusitis Suggests Gender-Based Differences
ORL 2019;81:1–9
https://ift.tt/2Twyz1Z
„Schmuckvoll konfigurierte Blasen“ am gesamten Integument bei erstdiagnostizierter Colitis ulcerosa
Zusammenfassung
Dargestellt wird der seltene Fall einer linearen Ig(Immunglobulin)A-Dermatose bei einem 61-jährigen Patienten mit zuvor stattgehabtem Erstereignis einer chronisch entzündlichen Darmerkrankung. Die Diagnose der Erkrankung basiert auf den klinischen und histologischen Befunden. Serologische Methoden wie indirekte Immunfluoreszenz, ELISA („enzyme-linked immunosorbent assay") oder Immunoblot eignen sich zur Spezifizierung der Autoantikörper. In diesem Fall gelang der Nachweis von IgA-Antikörpern entlang der Basalmembran mittels direkter Immunfluoreszenz. Abzugrenzen bei klinisch ähnlichen Befunden sind andere blasenbildende Dermatosen wie das IgG-vermittelte bullöse Pemphigoid. Die klassische Therapie der Erkrankung erfolgt systemisch mit Dapson (4,4′-Diaminodiphenylsulfon) sowie mit glukokortikoidhaltigen Externa und antiseptischen Maßnahmen.
https://ift.tt/2DyqILB
Detection of Asherman’s syndrome after conservative management of placenta accreta: a case report
We present a case involving conservative treatment of placenta accreta, with a subsequent diagnosis of Asherman's syndrome.
https://ift.tt/2TueskE
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