Αρχειοθήκη ιστολογίου

Αλέξανδρος Γ. Σφακιανάκης
ΩτοΡινοΛαρυγγολόγος
Αναπαύσεως 5
Άγιος Νικόλαος Κρήτη 72100
2841026182
6032607174

Παρασκευή 7 Δεκεμβρίου 2018

Proton therapy for skull base tumors: A review of clinical outcomes for chordomas and chondrosarcomas

Abstract

Background

Skull base chordomas and chondrosarcomas are rare tumors traditionally treated by surgical resection and adjuvant radiation therapy (RT). We will discuss data evaluating clinical outcomes of proton therapy in the treatment of skull base chordomas and chondrosarcomas.

Methods

A literature review was performed using a MEDLINE search from January 1990 to January 2017.

Results

The published data suggest that the dose intensification allowed by proton therapy has resulted in good clinical outcomes and a tolerable toxicity profile.

Conclusion

Proton therapy is a modern RT technique that has demonstrated improved preliminary clinical outcomes in the treatment of skull base chordomas and chondrosarcomas compared to conventional radiotherapy, and comparable to other advanced photon‐based RT techniques.



https://ift.tt/2BZO1wN

Promotion of skin wound healing using prevascularized oral mucosal cell sheet

Abstract

Background

This study examined the potential use of our newly developed prevascularized oral mucosal cell sheet for the treatment of skin wounds.

Methods

Mucosal cell sheets containing cultured keratinocytes and plasma fibrin without (K sheet) or with a mixture of fibroblasts and endothelial progenitor cells (PV sheet) were transplanted into full‐thickness skin excisional wounds of nude mice.

Results

This technique was successful for in vitro culture; expanding keratinocytes, fibroblasts, and endothelial progenitor cells; and generating prevascularized mucosal cell sheets. Cell sheets promoted in vivo wound healing with rapid wound closure and less scarring compared to controls. This result was more apparent in the PV than the K sheet (P < .05). Wounds covered with cell sheets showed less expression of TGFB1, ACTA2, and FN1 mRNAs than the controls (P < .05).

Conclusion

The prevascularized mucosal cell sheet showed in vivo efficacy and tissue plasticity in cutaneous wounds by promoting accelerated healing.



https://ift.tt/2BX3mhk

Prognostic significance of pretreatment 18F‐fluorodeoxyglucose positron emission tomography evaluation using metabolic tumor volume of the primary tumor and lymph nodes in advanced hypopharyngeal cancer

Abstract

Background

The purpose of this study was to retrospectively evaluate the usefulness of pretreatment positron emission tomography (PET) using metabolic tumor volume (MTV) of the primary tumor and lymph nodes in advanced hypopharyngeal cancer.

Methods

From June 2007 to December 2015, consecutive patients with advanced hypopharyngeal cancer who underwent PET and were treated with definitive radiation therapy were retrospectively reviewed.

Results

A total of 61 patients were eligible for this study. On multivariate analysis, MTV of the primary tumor (MTV‐T) was significantly related to the local control rate and overall survival (OS) (P = .036 and .012, respectively). In patients with lower MTV‐T, MTV of metastatic lymph nodes (MTV‐N) was significantly related to disease‐specific survival and OS (P = .012 and .017, respectively).

Conclusion

MTV‐T is a significant predictor in patients with advanced hypopharyngeal cancer, and MTV‐N is also significant in patients with lower MTV‐T.



https://ift.tt/2L2dgRK

Socioeconomic disparities in a population of patients undergoing total thyroidectomy for benign disease

Abstract

Background

This study examines the effect of insurance status (as a measure of socioeconomic status) on patient with benign thyroid disease.

Methods

A retrospective review was performed among 60 patients undergoing total thyroidectomy for benign thyroid disease. Univariate and multivariable analyses examined the relationship between insurance status and thyroid volume (sum of the left and right lobe volumes).

Results

Twenty‐eight (47%) patients were considered of underinsured/uninsured status, and 32 (53%) patients were considered of private/government/military insurance status. Median pathologic whole thyroid volume was 66 mL (range, 2‐855). After multivariable linear regression, underinsured/uninsured status was the only significant predictor of larger volume (correlation coefficient [r] = 118; 95% CI, 42 to 194; P = .003), after adjusting for age, sex, body mass index, and presence of concomitant thyroid disease and compressive symptoms.

Conclusion

Patients of underinsured/uninsured status suffered more severe disease presentations at time of thyroidectomy, as measured by larger thyroid volumes.



https://ift.tt/2BXNdrX

Pattern of urine iodine excretion with low iodine diet during preparation for radioactive iodine ablation in patients with thyroid cancer

Abstract

Background

The optimal period of low iodine diet during preparation for radioactive iodine (RAI) ablation in an area with iodine‐rich diet was investigated.

Methods

Ninety‐four patients with thyroid cancer who underwent low iodine diet and RAI were prospectively allocated into 2 groups—thyroxine withdrawal or using recombinant human thyroid stimulating hormone (rhTSH) for TSH stimulation. Their urinary iodine excretion (UIE) patterns were analyzed.

Results

There was no clinicopathological difference between the 2 groups except for tumor size and lymph node status. The UIE (median iodine to creatinine ratio, I/Cr) in the withdrawal group on the 7th and 14th day were 18.3 and 17.9 μg/gCr, respectively, with adequate preparation rate of 93.3% on both days (cutoff value 100 μg/gCr). In the rhTSH group, the median I/Cr on the 7th and 14th day were 48.0 and 45.7 μg/gCr (adequate preparation rates 91.8% and 93.8%), respectively.

Conclusion

One week of low iodine diet is sufficient preparation for RAI regardless of method of TSH stimulation.



https://ift.tt/2L4rotQ

Cutaneous malignant melanoma of the oral cavity following skin graft reconstruction: Case report

Abstract

Background: Malignant melanomas on skin graft recipient sites are rare, with few cases reported in the literature.

Methods: We present a case report of a patient with recurrent cutaneous melanoma in the grafted anterolateral thigh flap of the tongue.

Results: A patient underwent hemiglossectomy with free flap reconstruction for squamous cell carcinoma of the tongue. Five years later the patient was seen with a 1‐cm nodule and surrounding erythroplakia at the recipient site of the graft. Analysis revealed cutaneous malignant melanoma. Patient then related a remote history of a suspected skin melanoma of the donor leg that had been treated with excision, with unknown histology.

Conclusion: This may be the first reported case of a cutaneous malignant melanoma in the oral cavity following an anterolateral thigh free flap reconstruction, emphasizing the importance of obtaining a comprehensive history of skin cancers and closely inspecting the donor site prior to graft harvesting.



https://ift.tt/2BXyttt

Increased risk of postoperative complications after total thyroidectomy with Graves' disease

Abstract

Background

The effect of Graves' disease on the risk of postoperative complications in patients undergoing total thyroidectomy is unclear.

Methods

The incidence of recurrent laryngeal nerve (RLN) injury and hypoparathyroidism were analyzed between 165 patients with Graves' disease (GD group) and 1:1 matched patients with euthyroid states (control group).

Results

The matched cohorts did not differ in age, sex, body mass index, pathologic diagnosis, and extent of operation. Excised thyroid weight was higher in the Graves' disease than in the control group (60.1 g vs 22.6 g; P < .001). Multivariate analysis showed that Graves' disease significantly increased risks of transient RLN injury (odds ratio [OR] = 4.7, 95% confidence interval [CI] = 1.5‐15.5; P = .010) and transient hypoparathyroidism (OR = 2.8, 95% CI = 1.3‐5.8; P = .007). Rates of permanent complications were comparable in the Graves' disease and control groups.

Conclusions

Graves' disease can be a predictive factor for postoperative RLN injury and hypoparathyroidism after total thyroidectomy.



https://ift.tt/2L2RflN

Venous thromboembolism in head and neck surgery: Risk, outcome, and burden at the national level

Abstract

Background

Venous thromboembolism (VTE) can complicate major surgeries. This study examines the risk and outcomes of VTE in patients who underwent head and neck surgeries.

Methods

Retrospective cross‐sectional analysis utilizing the Nationwide Readmissions Database (2010‐2014). Study population included adults (≥18 year) patients who underwent head and neck surgeries.

Results

A total 386 VTE patients and 116 450 controls included. VTE risk was 0.37%, postoperative mortality was 4.87%. Of VTE, 57.02% identified within the initial admission for surgery, while the rest required readmission within 90 days. VTE high‐risk surgeries included: major ear/skull base surgeries, major nose/paranasal sinuses surgeries, major mouth/tonsil surgeries, major salivary glands/ducts surgeries, major maxillofacial bones/mandible surgeries, and major and nonmajor pharynx and larynx surgeries (P < .05). Those same surgeries were also associated with a high risk of readmission (P < .05).

Conclusions

VTE is associated with a significant mortality risk. Surgeries that involve the pharynx and larynx have the highest risk of VTE and readmission.



https://ift.tt/2BYBiKs

Two‐year prevalence of dysphagia and related outcomes in head and neck cancer survivors: An updated SEER‐Medicare analysis

Abstract

Background

The aim of the study was to examine prevalence of dysphagia at the population level in head and neck cancer (HNC) survivors.

Methods

Surveillance, Epidemiology, and End Results‐Medicare claims among 16 194 patients with HNC (2002‐2011) were analyzed to estimate 2‐year prevalence of dysphagia, stricture, and aspiration pneumonia, and derive treatment‐ and site‐specific estimates.

Results

Prevalence of dysphagia, stricture, pneumonia, and aspiration pneumonia was 45.3% (95% confidence interval [CI]: 44.5‐46.1), 10.2% (95% CI: 9.7‐10.7), 26.3% (95% CI: 25.6‐26.9), and 8.6% (95% CI: 8.2‐9.1), respectively. Dysphagia increased by 11.7% over the 10‐year period (P < .001). Prevalence was highest after chemoradiation and multimodality therapy.

Conclusion

Comparing to published rates using similar methodology the preceding decade (1992‐1999), prevalence of dysphagia based on claims data was similar in 2002‐2011 in this study. These results suggest persistence of dysphagia as a highly prevalent morbidity, even in the decade in which highly conformal radiotherapy and minimally invasive surgeries were popularized.



https://ift.tt/2L45BTb

Ototoxicity in locally advanced head and neck cancer patients treated with induction chemotherapy followed by intermediate or high‐dose cisplatin‐based chemoradiotherapy

Abstract

Background

This study evaluated ototoxicity in locally advanced head and neck cancer patients treated in the CONDOR study with docetaxel/cisplatin/5‐fluorouracil (TPF) followed by conventional radiotherapy with concomitant cisplatin 100 mg/m2 on days 1, 22, and 43 (cis100+RT) versus accelerated radiotherapy with concomitant cisplatin weekly 40 mg/m2 (cis40+ART).

Methods

Sixty‐two patients were treated in this study. Audiometry was performed at baseline, during TPF, before start of chemoradiotherapy, and 1, 4, 8, and 12 months after treatment.

Results

A complete dataset of audiometric data was available of 12 patients treated with high‐dose cisplatin and of 11 patients treated with intermediate‐dose cisplatin. Patients in the high‐dose group showed significant more hearing loss than in the intermediate group at 4 kHz ([z = 1.98; P = .04] and 8 kHz [z = 2.07; P < .03]). Interindividual variation was high in both groups.

Conclusion

After induction TPF, more ototoxicity was observed in chemoradiotherapy with cis100+RT than after chemoradiotherapy with cis40+ART.



https://ift.tt/2BYMfvU

Depth of invasion as a predictor of nodal disease and survival in patients with oral tongue squamous cell carcinoma

Abstract

Background

Depth of invasion (DOI) in oral cavity cancer is important in determining prognosis. This study aims to determine optimal cut‐points of DOI for detection of occult disease and survival.

Methods

A retrospective cohort study was completed of previously untreated early stage lateral oral tongue cancer. DOI cut‐points were computed. Multiple logistic regression and multivariate Cox proportional hazards models were used to assess predictors of occult nodal disease and overall survival (OS) and disease‐specific survival (DSS).

Results

Occult nodal disease was found in 55 (26%) of the 212 patients. DOI of 7.25 mm was most predictive for occult nodal disease and 8 mm for OS and DSS. DOI was an independent predictor of OS and DSS.

Conclusion

The optimal DOI cut‐point for detection of occult nodal metastasis was 7.25 and 8 mm for OS and DSS at 5 years. DOI is an independent predictor of OS and DSS.



https://ift.tt/2L69YwX

Sclerosis of the arytenoid cartilage and glottic carcinoma: A clinical‐pathological study

Abstract

Background

Given the relevance of any tumor invasion of the arytenoid cartilage or crico‐arytenoid unit to the planning open partial horizontal laryngectomy (OPHL) for laryngeal squamous cell carcinoma (LSCC), it is important to have a reliable radiological test to assess impairments of these structures.

Methods

We retrospectively compared the endoscopic, radiological, and pathological findings in patients with glottic LSCC who underwent OPHL.

Results

The endoscopic finding of a reduced (impaired or absent) vocal cord motility proved more sensitive, with better positive and negative predictive values, but less specific than the radiological finding of complete arytenoid sclerosis in detecting histologically assessable infiltration of the arytenoid cartilage.

Conclusions

Endoscopy retains a key role in the preoperative workup for glottic LSCC. CT evidence of complete sclerosis of the arytenoid cartilage is related to a dangerous contiguity of the tumor to the cartilage.



https://ift.tt/2LaKFKp

Elective neck dissection in metastatic cutaneous squamous cell carcinoma to the parotid gland: A systematic review and meta‐analysis

Abstract

Current management of metastatic cutaneous squamous cell carcinoma (CSCC) to the parotid is surgical excision and postoperative radiotherapy. In the node‐negative neck, there is debate about the role of elective neck dissection (END), irradiation or observation. This systematic review assesses the prevalence of occult cervical disease and the evidence for END. A literature search was performed using Medline and Embase. All papers describing management of the neck in metastatic CSCC to the parotid were assessed for inclusion. Eighty‐nine papers were identified and 17 met inclusion criteria. A total of 874 ENDs were performed in 874 patients with metastatic CSCC to the parotid with no clinically evident cervical disease. The overall prevalence of occult disease in a random effects model was 22.5% (95% confidence intervals 18.9‐26.0). The prevalence of occult cervical disease in metastatic CSCC to the parotid is high. END is recommended in this patient group.



https://ift.tt/2BYBk52

Factors of local recurrence and organ preservation with transoral laser microsurgery in laryngeal carcinomas; CHAID decision‐tree analysis

Abstract

Background

Indications of transoral laser microsurgery (TLM) are conditioned by the risk of local relapse.

Objective

To evaluate prognostic factors of local relapse and local control with TLM (LC‐TLM).

Methods

Local relapse and LC‐TLM were evaluated in 1119 patients. Logistic regression and CHAID decision tree analysis were performed.

Results

Local relapse correlated to previous radiotherapy failure (8.45, CI 95%: 2.64‐27.03; P < .001), paraglottic involvement (2.42, CI: 1.41‐4.15; P = .001), anterior commissure involvement (2.12, CI: 1.43‐3.14; P < .001), grade of differentiation (1.74, CI: 1.18‐2.57; P = .005), and alcohol consumption (1.4, CI: 0.99‐1.98; P = .057). Local relapse tended to inversely correlate with experience (0.73, CI: 0.51‐1.03; P = .078). The most important factors for local relapse were previous radiotherapy failure and anterior commissure involvement.

LC‐TLM inversely correlated with previous radiotherapy failure (0.09, CI: 0.03‐0.28; P < .001), paraglottic involvement (0.25, CI: 0.14‐0.43; P < .001), anterior commissure involvement (0.49, CI: 0.32‐0.77; P = .007), margins (0.56, CI: 0.30‐1.04; P = .068), and differentiation (0.68, CI: 0.44‐1.05; P = .087). LC‐TLM correlated with experience (1.71, CI: 1.13‐2.55; P = .010). The most important factors for LC‐TLM were previous radiotherapy failure and paraglottic involvement.

Conclusion

Previous radiotherapy failure is the most important factor for local relapse and LC‐TLM. In primary treatments, anterior commissure involvement and paraglottic involvement are the most important factors for local relapse and LC‐TLM, respectively.



https://ift.tt/2BZwPaN

Early experience of transoral thyroidectomy: Comparison of robotic and endoscopic procedures

Abstract

Background

The aim of this study was to evaluate the feasibility, safety, and early surgical outcomes of transoral thyroidectomy and to compare robotic and endoscopic procedures.

Methods

A total of 37 patients underwent robotic (23 cases) or endoscopic (14 cases) transoral thyroidectomy. We compared the outcomes of the two procedures.

Results

Of the 37 patients, 2 were converted to the robotic facelift approach as a result of an intraoperative CO2 embolism and inability to remove the tumor. The mean operative time was 172.8 ± 37.5 minutes. Transient recurrent laryngeal nerve palsy occurred in one case, and transient hypoparathyroidism in two cases. Most of patients were satisfied with the postoperative cosmesis. There were no significant differences between the robotic and endoscopic procedures, except for operative time, which was significantly longer in the robotic group.

Conclusion

Robotic and endoscopic transoral thyroidectomies are both feasible and safe in appropriate patients.



https://ift.tt/2L4ilJt

Second infield re‐irradiation with a resulting cumulative equivalent dose (EQD2max) of >180 Gy for patients with recurrent head and neck cancer

Abstract

Background

For locally recurrent head and neck cancer, re‐irradiation with modern techniques like stereotactic body radiotherapy is a promising, possibly curative alternative to palliative systemic therapy.

Methods

We report on 1 patient with nasopharyngeal carcinoma (NPC) and 1 patient with cutaneous squamous cell carcinoma (SCC). Both patients received full dose primary treatment (>66 Gy, EQD2), full dose re‐irradiation (>50 Gy, EQD2), and a second course of re‐irradiation via robotic radiosurgery (CyberKnife) for a second local recurrence.

Results

Both treatments resulted in adequate tumor response. No grade III‐IV acute or late toxicities occurred. Follow‐up at 6 months after third irradiation showed partial remission for the patient with NPC. In the second case (SCC), no toxicities occurred and the tumor was in remission 18 months after last treatment.

Conclusion

These cases show that a second course of re‐irradiation utilizing modern techniques like robotic radiosurgery might be feasible for carefully selected patients with head and neck cancer.



https://ift.tt/2L4rlOG

Choice of ANesthesia for EndoVAScular Treatment of Acute Ischemic Stroke (CANVAS): Results of the CANVAS Pilot Randomized Controlled Trial

Background: The effect of choice of anesthesia on clinical outcome for endovascular treatment (EVT) in patients with acute ischemic stroke (AIS) remains unclear. Methods: We conducted a pilot trial of 43 patients with acute anterior circulation ischemic stroke having EVT. Patients were randomly allocated to receive general anesthesia or conscious sedation. We documented the rate of recruitment and rate of conversion from conscious sedation to general anesthesia. In addition, we recorded the change in National Institute of Health stroke scale (NIHSS) on day 7, the rate of successful reperfusion and measured neurological function by certified researchers using modified Rankin Score (mRS 0 to 2) at 90 days. Results: The recruitment rate was 31.4% and majority of patients were excluded because of delay in hospital presentation and posterior circulation stroke. The rate of conversion from conscious sedation to general anesthesia was 18.2%. This was primarily related to excessive sedation and uncontrolled movement. Change in NIHSS score, rate of successful reperfusion and functional recovery were similar between groups. Conclusions: It was feasible to randomize AIS patients receiving either general anesthesia or conscious sedation for EVT. J.S. and F.L. contributed equally. Supported by the Beijing Municipal Administration of Hospitals Youth Program (code number: QML20150508), Ascent Plan (number: DFL20180502) Clinical Medicine Development of Special Funding Support (number: ZYLX201708) and China National key scientific research project (number: 2016YFC1301500). J.S., F.L., Y.P., Z.M., AW.G., M.T.V.C., and R.H.: helped with the study design and manuscript preparation. Y.P., and R.H.: equally contributed to the manuscript. J.S., F.L., Y.W., Y.Z., and Y.P.: involved in the data collection from neurosurgical anesthesia. L.Z. and Y.P.: helped with the data analyses. M.T.V.C. and R.H. are the members from the Editorial Board of Journal of Neurosurgical Anesthesiology. The remaining authors declare that they have nothing to disclose. Address correspondence to: Ruquan Han, MD, PhD, Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China (e-mail: ruquan.han@ccmu.edu.cn). Received July 24, 2018 Accepted October 22, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved

https://ift.tt/2EkPfVt

Retrospective Analysis of Perioperative Variables Associated With Postoperative Delirium and Other Adverse Outcomes in Older Patients After Spine Surgery

Background: The aim of this retrospective study was to identify perioperative variables predictive of the development of delirium in older surgical patients after spine surgery. Materials and Methods: We collected preoperative, intraoperative, and postoperative data on patients 65 years of age and above having spine surgery between July 1, 2015 and March 15, 2017. The primary outcome was the development of postoperative delirium. Data were analyzed using univariate and multivariable analysis. Results: Among the 716 patients included in this study 127 (18%) developed postoperative delirium. On multivariable analysis, independent predictors of postoperative delirium included older age (odds ratio [OR]=1.04; 95% confidence interval [CI], 1.00-1.09; P=0.048), American Society of Anesthesiologists physical status >2 (OR=1.89 [95% CI, 1.04-3.59]; P=0.042), metabolic equivalents of task

https://ift.tt/2RHmfKF

Screening and Identification of Linear B Cell Epitopes Within the Nonstructural Proteins of Enterovirus 71

Viral Immunology, Ahead of Print.


https://ift.tt/2RHfmsN

A scoring system to predict recurrence in patients with differentiated thyroid cancer



https://ift.tt/2UnBYAB

Snoring sound energy as a potential biomarker for disease severity and surgical response in childhood obstructive sleep apnoea: A pilot study



https://ift.tt/2B4aR4n

Impact of tumour profiling on clinical trials in salivary gland cancer



https://ift.tt/2Uqi6wD

A 20‐year observational cohort of a 5 million patient population—Tonsillectomy rates in the context of two national policy changes



https://ift.tt/2B35tyN

Survival differences in nasopharyngeal carcinoma among racial and ethnic minority groups in the United States: A retrospective cohort study



https://ift.tt/2Usr1xI

Benign paroxysmal positional vertigo in children



https://ift.tt/2B35uml

A mixed‐methods study of the management of hearing loss associated with otitis media with effusion in children with Down syndrome



https://ift.tt/2BaKY3h

Detection of high‐grade dysplasia, carcinoma in situ and squamous cell carcinoma in the upper aerodigestive tract: Recommendations for optimal use and interpretation of narrow‐band imaging



https://ift.tt/2Upv5hU

Log margin‐to‐thickness ratio improves disease‐specific survival prediction in oral cancer: A single cancer centre database



https://ift.tt/2AZ0AGH

Septoplasty versus non‐surgical management for nasal obstruction due to a deviated nasal septum in adults: A modelling study of cost‐effectiveness



https://ift.tt/2UoQzeR

Endoscopic approach in one hundred and seventy‐nine patients of dacryocystorhinostomy



https://ift.tt/2Usr1hc

Improved exposure of the hypoglossal branches during hypoglossal nerve stimulator implantation: Clinical outcomes of twenty patients at a single institution



https://ift.tt/2B4x0jo

Treatment of vocal cord paralysis by autologous fat injection: Our experience with 41 patients



https://ift.tt/2UoQBDv

Our experience of long‐term result of tympanoplasty using areolar tissue in 359 patients



https://ift.tt/2B1dfJb

The use of bone conduction hearing implants in paediatric chronic otitis media: An audit of outcomes of 32 devices in 22 patients



https://ift.tt/2UoQsQt

Balloon Eustachian tuboplasty under monitored anaesthesia care with different balloon dilation devices: A pilot feasibility study with 18 patients



https://ift.tt/2B35rqF

New tools for preoperative diagnosis of allergic fungal sinusitis? A prospective study about 71 patients



https://ift.tt/2UoQqIl

Analysis of inner ear malformations associated with a facial nerve anomaly in 653 children fitted with a cochlear implant



https://ift.tt/2B03HhM

Custom designing laryngoplasty implant using actual size CT scan images on a mobile device



https://ift.tt/2UqwODN

Lone Star retractor for endoscopic ear surgery



https://ift.tt/2B5Zg4S

False Identity: Lymphoid Hyperplasia Imitating a Large Paraganglioma

Abstract

The danger of the parapharyngeal space mass comes from the small space and vital neighboring structures. Its differential diagnosis is broad, however benign lymphoid hyperplasia in this region has not been previously reported. The clinical presentation, imaging, surgical findings and pathology slides were reviewed in an adult patient with a parapharyngeal space mass. The literature on somatostatin-positive parapharyngeal space lesions was reviewed. A 51-year old male with otalgia for 3 months, hearing loss, and tinnitus underwent audiogram, revealing asymmetric hearing loss. Laryngoscopy demonstrated a paretic true vocal cord. Subsequent MRI demonstrated 4.5 cm post-styloid parapharyngeal space mass displacing the carotid artery anterolaterally. Octreoscan scan showed significant uptake of the somatostatin analog. Angiogram showed prominent vascular blush. The mass was excised transcervically and histopathology demonstrated lymphoid hyperplasia. This case demonstrates that post-styloid parapharyngeal masses may be lateral retropharyngeal nodes. An octreotide-positive lymphoid hyperplasia has never been previously reported.



https://ift.tt/2zOqvRH

A Rare Case of Primary Tuberculous Otitis Media with Bezold’s Abscess

Abstract

Tuberculous Otitis Media is a rare clinical presentation. The signs and symptoms are variable that leads to delayed diagnosis and treatment. Persistent ear discharge not responding to topical and systemic antibiotics should be considered for investigation of tuberculosis. We report a case of Primary Tuberculous Otitis Media who presented with Bezold's Abscess. Patient underwent Mastoidectomy. Diagnosis was made with the Histopathological examination of the suspicious extensive pale granulation tissue. Patient was started on ATT immediately. Greater awareness regarding the disease is needed to make an early diagnosis. Late diagnosis increases the risk of complications. Anti Tubercular Therapy is the treatment of choice. Surgical intervention may be added to drug therapy. In cases with complications, radical surgery will be needed. Bezold's abscess is a rare complication of Otitis Media. CT imaging should be considered in suspected neck abscess patients with history of ear discharge to rule out aural cause of abscess.



https://ift.tt/2zPFc72

Extra Nasopharyngeal Angiofibroma from Lateral Nasal Wall: A Rare Case Report

Abstract

A 25-year-old male presented with left sided nasal obstruction and epistaxis. To study about a rare case of extranasopharyngeal angiofibroma. Endoscopic evaluation revealed a polypoid mass in the vestibule arising from the lateral wall of the nasal cavity anteroinferior to the left inferior turbinate. Computed tomography scan showed a soft tissue opacity in the vestibule of the left nasal cavity. After the endoscopic excision of the mass, postoperative and histopathological analyses confirmed the diagnosis of an angiofibroma.



https://ift.tt/2PtcaPT

Microscopic Thyroidectomy: A Prudent Option

Abstract

Microscopic Thyroidectomy is not a new surgical technique but it is not explored much. The routine use of microscope in thyroid surgery can reduce the rate of nerve palsy and hypocalcemia. Nine cases were done exclusively with the microscope only and postoperative nerve palsy and hypocalcemia were noted. We have also discussed about optimum working distances and magnification for critical structures during thyroid surgery. No patient has any nerve palsy while one patient reported transient hypocalcemia. Recurrent laryngeal nerve could be identified at 2 × but optimal magnification for dissection of nerve should be 4 ×. We find this technique easy to adopt and critical structures can be identified and preserved easily with microscopic thyroidectomy then conventional and loupe technique. It is better to have standardized and optimum working distance and magnification during different steps of surgery. It is great teaching tool in view of its better illumination and magnification.



https://ift.tt/2PsoOOW

Laryngeal Leiomyosarcoma: A Rare Case

Abstract

Laryngeal leiomyosarcoma is a rare smooth muscle malignancy of the head and neck region. Diagnosis is based on immunohistochemistry. Here we present a case of laryngeal leiomyosarcoma that was diagnosed and treated in our center, focusing on the clinical features, histological diagnosis and management of this rare disease.



https://ift.tt/2Ptcdv3

Prospective, randomized, controlled, open-label study to compare efficacy of a mineral-rich solution vs normal saline after complete ethmoidectomy

Abstract

Purposes

The purpose of this study was to compare the efficacy of a mineral-rich solution vs normal saline solution (0.9% NaCl) following endoscopic complete bilateral ethmoidectomy.

Methods

This was a prospective, multicenter, randomized, controlled, open-label trial in subjects suffering from steroid-resistant sinonasal polyposis. Adults performed 4 nasal irrigations of mineral or saline solutions daily for 28 days. Evaluations included subject-reported RHINO quality of life (QoL) and NOSE scores, tolerability, and satisfaction, the Lund–Kennedy endoscopic score and assessments of crusting, secretions and mucociliary clearance (rhinoscintigraphy).

Results

A total of 189 subjects were randomized. Clinically relevant improvements (> 20 points) in RhinoQOL and NOSE scores were measured in both groups without any significant inter-group difference. Among the subjects with impaired RhinoQOL at pre-inclusion, the change in Impact-RhinoQOL score was significantly superior in mineral-rich vs saline solution at day 21 (p = 0.028) and day 28 (p = 0.027). The Lund–Kennedy score continuously improved in both groups earlier with the mineral-rich solution. Crusts were significantly fewer in number and less severe/obstructive in patients receiving mineral-rich vs saline solution at day 7 (p = 0.026) and day 14 (p = 0.016). Furthermore, secretions disappeared significantly more quickly and were less thick/purulent with mineral-rich solution at day 14 (p = 0.002) and day 21 (p = 0.043). Less epistaxis was reported in the mineral vs saline solution (p = 0.008 at day 21).

Conclusions

Our findings indicate that the composition of a nasal irrigation solution influences endoscopic scores and QoL after sinus surgery for patients over 60, those with an initially poor QoL and higher symptom score, and smokers.



https://ift.tt/2Sv2qGu

Extra Nasopharyngeal Angiofibroma from Lateral Nasal Wall: A Rare Case Report

Abstract

A 25-year-old male presented with left sided nasal obstruction and epistaxis. To study about a rare case of extranasopharyngeal angiofibroma. Endoscopic evaluation revealed a polypoid mass in the vestibule arising from the lateral wall of the nasal cavity anteroinferior to the left inferior turbinate. Computed tomography scan showed a soft tissue opacity in the vestibule of the left nasal cavity. After the endoscopic excision of the mass, postoperative and histopathological analyses confirmed the diagnosis of an angiofibroma.



https://ift.tt/2PtcaPT

Microscopic Thyroidectomy: A Prudent Option

Abstract

Microscopic Thyroidectomy is not a new surgical technique but it is not explored much. The routine use of microscope in thyroid surgery can reduce the rate of nerve palsy and hypocalcemia. Nine cases were done exclusively with the microscope only and postoperative nerve palsy and hypocalcemia were noted. We have also discussed about optimum working distances and magnification for critical structures during thyroid surgery. No patient has any nerve palsy while one patient reported transient hypocalcemia. Recurrent laryngeal nerve could be identified at 2 × but optimal magnification for dissection of nerve should be 4 ×. We find this technique easy to adopt and critical structures can be identified and preserved easily with microscopic thyroidectomy then conventional and loupe technique. It is better to have standardized and optimum working distance and magnification during different steps of surgery. It is great teaching tool in view of its better illumination and magnification.



https://ift.tt/2PsoOOW

Laryngeal Leiomyosarcoma: A Rare Case

Abstract

Laryngeal leiomyosarcoma is a rare smooth muscle malignancy of the head and neck region. Diagnosis is based on immunohistochemistry. Here we present a case of laryngeal leiomyosarcoma that was diagnosed and treated in our center, focusing on the clinical features, histological diagnosis and management of this rare disease.



https://ift.tt/2Ptcdv3

A Rare Case of Primary Tuberculous Otitis Media with Bezold’s Abscess

Abstract

Tuberculous Otitis Media is a rare clinical presentation. The signs and symptoms are variable that leads to delayed diagnosis and treatment. Persistent ear discharge not responding to topical and systemic antibiotics should be considered for investigation of tuberculosis. We report a case of Primary Tuberculous Otitis Media who presented with Bezold's Abscess. Patient underwent Mastoidectomy. Diagnosis was made with the Histopathological examination of the suspicious extensive pale granulation tissue. Patient was started on ATT immediately. Greater awareness regarding the disease is needed to make an early diagnosis. Late diagnosis increases the risk of complications. Anti Tubercular Therapy is the treatment of choice. Surgical intervention may be added to drug therapy. In cases with complications, radical surgery will be needed. Bezold's abscess is a rare complication of Otitis Media. CT imaging should be considered in suspected neck abscess patients with history of ear discharge to rule out aural cause of abscess.



https://ift.tt/2zPFc72

False Identity: Lymphoid Hyperplasia Imitating a Large Paraganglioma

Abstract

The danger of the parapharyngeal space mass comes from the small space and vital neighboring structures. Its differential diagnosis is broad, however benign lymphoid hyperplasia in this region has not been previously reported. The clinical presentation, imaging, surgical findings and pathology slides were reviewed in an adult patient with a parapharyngeal space mass. The literature on somatostatin-positive parapharyngeal space lesions was reviewed. A 51-year old male with otalgia for 3 months, hearing loss, and tinnitus underwent audiogram, revealing asymmetric hearing loss. Laryngoscopy demonstrated a paretic true vocal cord. Subsequent MRI demonstrated 4.5 cm post-styloid parapharyngeal space mass displacing the carotid artery anterolaterally. Octreoscan scan showed significant uptake of the somatostatin analog. Angiogram showed prominent vascular blush. The mass was excised transcervically and histopathology demonstrated lymphoid hyperplasia. This case demonstrates that post-styloid parapharyngeal masses may be lateral retropharyngeal nodes. An octreotide-positive lymphoid hyperplasia has never been previously reported.



https://ift.tt/2zOqvRH

Letter to the Editor: Consensus‐based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part II. JEADV 2018, 32, 850–878. doi.org/10.1111/jdv.14888

Abstract

We read with interest and with full consent the new consensus‐based European guidelines for the treatment of atopic eczema, Part II1. However, we would like to comment on the section on microbial textiles where the recommendation to use silk garments with permanent antimicrobial in the management of children with moderate to severe eczema is raised. On the basis of an UK multicenter clinical trial2 which seemed to show that silk garments with permanent antimicrobial were ineffective in the treatment of children with atopic eczema, the guidelines deny now any clinical benefit of AEGIS‐coated silk textiles in children with atopic eczema and this contrary to the previous two guidelines3,4.

This article is protected by copyright. All rights reserved.



https://ift.tt/2QL7lpO

Brentuximab induced CD30+ cutaneous lymphoma responded to anti‐PD1 treatment

Abstract

Over the last decade major efforts have been made for the optimization of immune‐directed therapies against cancer. Regarding cutaneous lymphomas (CTCLs), brentuximab (BV) has been recently approved by FDA and EMA for the treatment of primary cutaneous anaplastic large cell lymphoma as well as CD30‐expressing mycosis fungoides, based on the ALCANZA trial favorable results. Concurrently, immune checkpoint inhibition has been shown to be of great value in the treatment of solid tumors and with promising results in a range of hematologic malignancies, however relevant data concerning CTCLs' treatment remain inconclusive.

This article is protected by copyright. All rights reserved.



https://ift.tt/2E5Z3SC

Rebound effect associated with JAK inhibitor use in the treatment of alopecia areata

Abstract

Alopecia areata (AA) is a common autoimmune disease driven by Th1 cytokines characterized by non‐scarring hair loss.1,2 Mouse models have demonstrated that IFN‐γ‐producing NKG2D+ CD8+ cytotoxic T lymphocytes (CTLs) are essential for disease pathogenesis, along with JAK‐STAT dependent cytokines IFN‐γ and IL‐15, which induce autoreactive T cell activation.1,3

This article is protected by copyright. All rights reserved.



https://ift.tt/2QL7j1a

Unexpected photosensitivity ‐ a patient with dermatomyositis and concomitant solar urticaria

Abstract

Dermatomyositis (DM) is a connective tissue disease with rare incidence, characterized by progressive muscle weakness and typical cutaneous manifestations. Its pathogenesis is still incompletely understood, but next to genetic predisposition environmental factors seem to be implicated in the development of DM (1). Photosensitivity is one important factor for the onset and exacerbation of DM, which is corroborated by the distribution of the cutaneous features on sun‐exposed areas and disease photoaggravation (2,3).

This article is protected by copyright. All rights reserved.



https://ift.tt/2QEQO6r

Dermoscopic evaluation of melanocytic nevi changes after photoepilation techniques: a prospective study

Abstract

Background

The clinical and dermoscopic changes of melanocytic nevi under the effects of photo‐epilation are poorly known.

Objective

Prospective study on clinical and dermatoscopic effects of photoepilation on melanocytic nevi.

Methods

Eighteen patients exposed to photo‐epilation gave consent to a follow‐up program from 2008 to 2017 at the Videodermatoscopic Office of the Dermatology Clinic of Cagliari (Italy), with clinical and dermoscopic assessment.

Results

A mean 2‐year follow‐up was recorded for 73 lesions. The most frequent clinical change was nevi colour, clearer than basal pictures, sometimes with increased pigmentation at the periphery, or residual islands of pigmentation, with vanishing borders. Acute burn with crusting was noted in few cases. Only one case showed progressive growth. Corresponding dermoscopic findings were bleaching of nevi, followed by pigment network disruption, appearance of white structureless areas and grey‐blue globules. Complete regression occurred in 32.8% of the lesions. The growing nevus was characterized by peripheral globules. Excision for histopathological examination showed a compound nevus with mild atypia.

Conclusions

Although malignant modifications of nevi after photo‐epilation have not been described, the clinical and dermoscopic changes we observed suggest to extend the follow for more than 24 months, as the potential long term adverse effects of photo‐epilation on melanocytic nevi are unknown.

This article is protected by copyright. All rights reserved.



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Itch relief in patients with psoriasis: effectiveness of calcipotriol plus betamethasone dipropionate foam

Abstract

Background

Itch is common in psoriasis, adversely affecting health‐related quality of life (HRQoL) and sleep.

Objective

We evaluated the efficacy of topical fixed‐dose combination calcipotriol 50 μg/g plus betamethasone dipropionate 0.5 mg/g cutaneous foam (Cal/BD foam) on itch, itch‐related sleep loss and HRQoL versus foam vehicle.

Methods

We pooled data from three Phase II/III trials (NCT01536886/NCT01866163/NCT02132936) of Cal/BD foam versus foam vehicle in adults with mild–severe psoriasis. For itch‐related analyses, patients with baseline itch VAS >40 (range 1–100) were analysed. Outcomes included: itch VAS reduction >40, ≥70% improvement in itch (Itch70) or itch‐related sleep loss, 75% improvement in modified PASI (excluding head) (mPASI75), and Dermatology Life Quality Index (DLQI) scores 0/1 through 4 weeks.

Results

Of 837 patients, 800 had baseline itch VAS >0 (Cal/BD foam, n=610; foam vehicle, n=190); 484 had baseline itch VAS >40. There was no correlation between itch VAS score and mPASI at baseline (R2 = 0.021). In patients with baseline itch VAS >40, more patients achieved itch VAS reduction >40 in the active versus vehicle group from Day 5 onwards (Day 5: 57.5 vs 40.2% [P<0.05]; Week 4: 83.0 vs 45.8% [P<0.001]). More Cal/BD foam4‐treated patients achieved Itch70 at Day 3 (34.2 vs 22.5%; P<0.05) through to Week 4 (79.3 vs 38.1%; P<0.001). In patients with baseline itch VAS >40 and sleep loss >20, improvements in itch‐related sleep loss occurred at Week 1 and continued through 4 weeks. Itch‐related improvements occurred before improvements in mPASI75. There were significant differences in the proportion of Cal/BD‐foam‐ versus foam‐vehicle‐treated patients with baseline DLQI >10 (N=172 vs N=50) achieving DLQI ≤1 (25.0% vs 4.0%; P=0.001) and DLQI 0 (17.4% vs 2.0%; P=0.006) at Week 4.

Conclusion

Compared with foam vehicle, Cal/BD foam offers more rapid and effective itch relief, with associated significant improvements in sleep and DLQI.

This article is protected by copyright. All rights reserved.



https://ift.tt/2QD0UFc

A potential contribution of trappin‐2 to the development of vasculopathy in systemic sclerosis

Abstract

Background

Trappin‐2/pre‐elafin is an endogenous inhibitor of human neutrophil elastase involved in inflammation, innate immunity and vascular remodeling, which consist of the complex pathological process of systemic sclerosis (SSc).

Objectives

To clarify the potential role of trappin‐2 in SSc.

Methods

Serum trappin‐2 levels were determined by enzyme‐linked immunosorbent assay in 51 SSc and 18 healthy subjects. Trappin‐2 expression was evaluated in SSc lesional skin and cultured endothelial cells treated with FLI1 siRNA by immunohistochemistry, reverse transcript‐real time PCR and/or immunoblotting. Fli1 binding to the PI3 promoter was assessed by chromatin immunoprecipitation.

Results

Since serum trappin‐2 levels inversely correlated with estimated glomerular filtration rate in SSc patients with renal dysfunction, SSc patients with normal renal function were analyzed. Although serum trappin‐2 levels were comparable between diffuse cutaneous SSc, limited cutaneous SSc and control subjects, the prevalence of digital ulcers or elevated right ventricular systolic pressure (RVSP) was significantly higher in SSc patients with elevated serum trappin‐2 levels than in those with normal levels. Furthermore, serum trappin‐2 levels were significantly increased in SSc patients with digital ulcers or elevated RVSP compared to those without. Moreover, serum trappin‐2 levels positively correlated with RVSP values in SSc patients. Importantly, trappin‐2 expression was enhanced in small vessels of SSc lesional skin. In cultured endothelial cells, trappin‐2 expression was elevated by gene silencing of FLI1 at mRNA and protein levels and Fli1 occupied the PI3 promoter.

Conclusions

Endothelial trappin‐2 up‐regulation partially due to Fli1 deficiency can be associated with the development of SSc vasculopathy.

This article is protected by copyright. All rights reserved.



https://ift.tt/2QDOug9

Dermoscopy of cutaneous smooth muscle neoplasms: a morphological study of 136 cases

Abstract

Background

A variety of cutaneous smooth muscle neoplasms may arise in the skin and are frequently unrecognized by clinicians. There is sparse data relating to the dermoscopy of piloleiomyiomas (PL) and nothing has been published about the dermoscopy of angioleiomyomas (AL) and leiomyosarcomas (LS).

Objectives

To evaluate the morphological findings of a large series of cutaneous PL, AL and LS under dermoscopic observation, comparing these findings among them.

Methods

Digital dermoscopic images of 136 histopathologically confirmed cases of cutaneous smooth muscle neoplasms (114 PL, 13 AL and 9 LS) collected from 10 Hospitals in Spain, Austria and Italy were evaluated for the presence of dermoscopic structures and patterns.

Results

The pattern composed of a symmetric, total delicate pigment network with the variable presence of multiple hypopigmented areas in a painful lesion is the most common dermoscopic pattern associated with PL. This pattern was found in 69.3% of PL and in no cases of AL and LS. The most common and characteristic pattern associated with AL was the one composed of symmetric pink‐reddish tumor with vessels, white structures and the absence of ulceration, which was found in 46.2% of AL, but also in 3.5% of PL, and in 22.2% of LS. Finally, the most common pattern associated with LS was the one composed of an asymmetric, multilobulated tumor with linear‐irregular or polymorphic‐atypical vessels and white structures, which was found in 44.4% of cases, but also in 0.9% of PL and in 15.4% of AL.

Conclusion

Dermoscopy is helpful in improving the diagnostic accuracy of PL. The dermoscopic patterns associated with AL and LS were more variable and less specific.

This article is protected by copyright. All rights reserved.



https://ift.tt/2zP3f6i

Optimization strategies for HIV, hepatitis and syphilis testing in Infectious Disease Clinic and Dermatology Unit of Modena: seven‐years results of collaboration experience

Abstract

Background

Screening tests for human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and syphilis infections performed in at‐risk population show a higher number of positive tests compared to those carried out in the general population. "Test & Counselling" Ambulatory of Infectious Disease Clinic (T&C‐IDC) and Sexually Transmitted Diseases Ambulatory of Dermatology Unit (STDs‐DU) of Modena began collaboration in 2010 and adopted a common diagnostic serological profile since 2013.

Objectives

The main objective was to analyse the number of screening tests performed in the T&C‐IDC and STDs‐DU, comparing the results obtained after the adoption of the shared protocol with the previous period. The secondary aim was to evaluate the linkage to care of newly diagnosed patients.

Methods

Consecutive patients referred to the T&C‐IDC and STDs‐DU from January 2010 to December 2016, with at least one performed screening test for HIV, HBV, HCV and syphilis were enrolled. Referral of patients with a new infection was obtained by capture‐recapture methods in hospital databases.

Results

During the seven‐years observation we collected 13117 admittances for 9154 patients. A significant increase in the number of screening tests (p<0.001) and ratio between tests and admissions (p=0.002) was observed. 644 (7.0%) people with at least one infection were diagnosed. Among these, the most common was syphilis (41.9%), followed by HBV (25.7%), HCV (21.4%) and HIV (10.9%). Syphilis occurred predominantly in Italians (72.5%) and males (75.7%), as like as HCV, while foreign‐born (85.5%) mainly harboured HBV infection. HIV diagnosis was detected more frequently among males (67.1%) with a similar proportion between Italians and foreign‐born. 543 out of 644 (84.3%) patients were linked to care.

Conclusion

The collaboration between T&C‐IDC and STDs‐DU has proven to work well increasing the diagnosis over the time and obtaining good results in linkage to care.

This article is protected by copyright. All rights reserved.



https://ift.tt/2E5Z5tI

Therapeutic strategies for skin regeneration based on biomedical substitutes

Abstract

Regenerative medicine and tissue engineering (TE) have experienced significant advances in the development of in vitro engineered skin substitutes, either for replacement of lost tissue in skin injuries or for the generation of in vitro human skin models to research. However, currently available skin substitutes present different limitations such as expensive costs, abnormal skin microstructure and engraftment failure. Given these limitations, new technologies, based on advanced therapies and regenerative medicine, have been applied to develop skin substitutes with several pharmaceutical applications that include injectable cell suspensions, cell‐spray devices, sheets or 3D‐scaffolds for skin tissue regeneration and others. Clinical practice for skin injuries has evolved to incorporate these innovative applications to facilitate wound healing, improve the barrier function of the skin, prevent infections, manage pain and even to ameliorate long‐term aesthetic results. In this article we review current commercially available skin substitutes for clinical use, as well as the latest advances in biomedical and pharmaceutical applications used to design advanced therapies and medical products for wound healing and skin regeneration. We highlight the current progress in clinical trials for wound healing as well as the new technologies that are being developed and hold the potential to generate skin substitutes such as 3D bioprinting‐based strategies.

This article is protected by copyright. All rights reserved.



https://ift.tt/2QN13pH

Non‐genetic and genetic predictors of a superficial first basal cell carcinoma

Abstract

Background

several observational studies have suggested differences in the risk factor profile between patients with superficial basal cell carcinomas (BCCs) and non‐superficial BCCs.

Objective

to test the reproducibility of previous study findings and to find new genetic and non‐genetic predictors for patients with a superficial first BCC.

Methods

14.628 participants of northwestern European descent aged 45 years or older from a prospective population‐based cohort study (Rotterdam Study) were linked with the Dutch Pathology Registry (PALGA) of whom 1,528 were identified as BCC patients. After exclusion, 948 eligible BCC patients remained for further non‐genetic analyses and 1,014 for genetic analyses. We included 11 phenotypic, environmental and tumor‐specific characteristics, and 20 candidate single nucleotide polymorphisms (SNP) as potential predictors for patients with a superficial first BCC. We performed binary logistic multivariable regression analyses.

Results

we found that patients with a superficial first BCC were significantly younger, almost two times more often female and 12‐18 times more likely to have their BCC on the trunk or extremities than patients with a non‐superficial first BCC. One SNP (rs12203592), mapped to IRF4, looked promising (OR 1.83, 95% CI 1.13‐2.97, p‐value <0.05), but after adjustment for multiple testing, no significant differences in genetic make‐up between superficial BCC and non‐superficial BCC patients were found.

Conclusion

we conclude that patients with a superficial BCC differ from non‐superficial BCC patients with respect to environmental factors (tumor localization as a proxy for UVR exposure) and phenotypic characteristics (age and sex), but we found no difference in genotype. As superficial BCC patients develop their first BCCs at a younger age, they could be at higher life‐time risk for subsequent skin cancers and therefore be an important group for secondary prevention.

This article is protected by copyright. All rights reserved.



https://ift.tt/2E5YR5Q

Work‐related skin diseases of Santa Claus

Abstract

The health of Santa Claus (SC) and work‐related risks have been discussed on very few occasions in the medical literature [1,2]. We believe that due to his unique line of work, the skin of SC is peculiarly at risk and SC may be exposed to various work‐related cutaneous hazards (table 1).

According to Finnish folklore, SC currently lives and mainly work during the year in Korvatunturi (literally "Ear fell") in Finnish Lapland [3].

This article is protected by copyright. All rights reserved.



https://ift.tt/2E5YI2i

Reply to a correspondence addressing the European guideline for treatment of atopic eczema, functional textiles and the CLOTHES trial

Abstract

We have read with interest the respectfully written correspondence by Wüthrich et al. regarding antimicrobial silk textiles for atopic dermatitis (AD) (1). Though it was submitted as a comment to the European consensus‐based S2k guidelines on treatment of atopic eczema (2,3), it is discussing in 70% of its length the CLOTHES trial – published in two non‐JEADV‐publications which we have neither designed nor authored (4,5).

This article is protected by copyright. All rights reserved.



https://ift.tt/2QBpDcX

Regrets after tattooing and tattoo removal in the general population of France

Abstract

The market of tattoo removal is constantly rising [1]. Recent American polls showed a growing proportion of tattooed individuals that regretted getting tattooed: nearly one fourth (23%) in 2016 against 14% in 2012 [2]. In France, a recent poll in 2016 in France showed that 7% of the tattooed individuals had a tattoo removed [3]. In 2017, we performed a national survey on 5000 French individuals that were representative from the general population to evaluate the prevalence and the characteristics of the tattooed population [4]. We report here about regrets and tattoo removal among the participants.

This article is protected by copyright. All rights reserved.



https://ift.tt/2E5YgB8

Methotrexate in atopic eczema. Comments to: Consensus‐based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part II

Abstract

The recent European guidelines for the treatment of atopic eczema (AE) are a thorough overview of therapeutic opportunities for AE.1 Among the systemic treatments, we propose to bring further insights on methotrexate (MTX) use in adult AE patients.

This article is protected by copyright. All rights reserved.



https://ift.tt/2QEQOmX

Prevalence and persistence of oral HPV infection in Italy

Abstract

Oral human papillomavirus (HPV) persistent infection may cause numerous tumors1,2 but little is known about the HPV clearance time and the variables that may influence the HPV persistence3.

We aimed to assess the prevalence of the oral HPV infection, the HPV persistence rate and the variables influencing the persistence.

This article is protected by copyright. All rights reserved.



https://ift.tt/2E5YckS

Methotrexate in atopic eczema – Reply to a letter

Abstract

Goujon et al. submit a letter‐type manuscript to JEADV (1), as a comment to the recently published European consensus‐based S2k guidelines or treatment of atopic eczema (2,3). The assigned writing subgroups for each topic were encouraged to include the 'best available evidence' for all chapters of the guideline (2). Data were included only if a reference had been published as a full paper in a peer‐reviewed journal by March 2017 (see page 661 of the guideline), but not based on an abstract or a conference presentation only (2).

This article is protected by copyright. All rights reserved.



https://ift.tt/2E5YvMy

Successful treatment of four types of chronic urticaria with anti-IgE omalizumab in the same patient

Urticaria is a skin disorder that is characterized by the appearance of wheals (hives), angioedema or both1. Chronic urticaria (CU) is defined as wheals (with or without angioedema) that persists for ≥6 weeks, and is further classified into two subtypes: chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CIndU)1. In most cases of CU a trigger cannot be identified. These cases are defined as CSU. The term inducible urticaria is used when a specific trigger can be linked to the development of CU.

https://ift.tt/2QlnrXq

Antibiotic choice and MRSA rate in children who are hospitalized for atopic dermatitis

Atopic dermatitis (AD) is the most common chronic inflammatory skin condition of childhood. It is associated with allergic co-morbities including asthma and allergic rhinitis. AD patients are also affected by sleep deprivation and psychosocial problems. Those with uncontrolled AD may require hospitalization.1 Previous studies have shown that about 70% of children who were treated inpatient for AD exacerbation were given an antibiotic.2,3 However, information on the choice of antibiotics used to treat AD exacerbation is limited.

https://ift.tt/2E8W1wF

The Expanding Saga of Hydrochlorothiazide and Skin Cancer



https://ift.tt/2GfJavg

Laryngeal temperature simulations during carbon dioxide laser irradiation delivered by a scanning micromanipulator

Abstract

We use scatter-limited phototherapy techniques to calculate the time-dependent temperature profiles of incisions made with a commercial carbon dioxide laser being used to make a 1-mm incision under computer control using the Digital Acublade™ and with incisions made with the same laser under manual control. The goal is to understand the differences in the amount of lateral thermal damage that is likely from the computer-controlled incisions versus the manually controlled incisions. The temperature profiles are calculated from the absorption and scatter of light in a homogeneous material. The resulting temperature profiles are presented as videos showing how the tissue heats up and cools down with the incident laser pulses. The time-dependent thermal distributions indicate that the computer-controlled laser incision could show as little as 210 μm of lateral thermal damage, whereas the manually controlled laser incisions could show as much as 375 μm of lateral thermal damage. The computer-controlled laser incision is able to control laser pulses fast enough that subsequent pulses can ablate away tissue with a significant amount of residual heat from the previous laser pulse. Using the scatter-limited phototherapy techniques, we can see how a computer-controlled laser can make incisions with less thermal damage by ablating away tissue holding a significant amount of heat from the previous pulse before it has time to diffuse through the tissue. This method of heat removal from laser incisions has not been previously described or demonstrated.



https://ift.tt/2PljBbH

5 fluorouracil as an adjuvant therapy along with microneedling in vitiligo



https://ift.tt/2rpEuc6

In Memoriam



https://ift.tt/2roIqtw

Further Thoughts on Dermatology and Equity-owned Dermatology Practices



https://ift.tt/2G5J61k

Reflectance confocal microscopy terminology glossary for non-melanocytic skin lesions: A systematic review

•Use of reflectance confocal microscopy terminology is inconsistent. We built a glossary of reflectance confocal microscopy terms for diagnosis non-melanocytic lesions. We identified terms with similar definition and histopathological correlates and reduced the total number of terms by 52.5%. This systematic review may form the basis for attaining terminology consensus.

https://ift.tt/2roCDUZ

Smoking, but not alcohol, is associated with risk of psoriasis in a Taiwanese population-based cohort study

Alcohol consumption and smoking have long been suspected of increasing the risk of developing psoriasis. Most evidence to date has derived from cross-sectional or case-control studies.

https://ift.tt/2RIrutA

5 natural ways to reduce breast size

Breast tissue is largely made up of fatty materials. Losing body fat is one effective way to reduce breast size naturally. In this article, we look at five methods people can use to reduce breast size, or the appearance of breasts.

https://ift.tt/2BWCJJn

Pretreatment Hearing Level-Another Prognostic Factor in Sudden Sensorineural Hearing Loss-Reply.

Pretreatment Hearing Level-Another Prognostic Factor in Sudden Sensorineural Hearing Loss-Reply.

JAMA Otolaryngol Head Neck Surg. 2018 Dec 06;:

Authors: Yu H, Li H

PMID: 30520981 [PubMed - as supplied by publisher]



https://ift.tt/2G76cEJ

Pretreatment Hearing Level-Another Prognostic Factor in Sudden Sensorineural Hearing Loss.

Pretreatment Hearing Level-Another Prognostic Factor in Sudden Sensorineural Hearing Loss.

JAMA Otolaryngol Head Neck Surg. 2018 Dec 06;:

Authors: Wu CH, Wang CT, Cheng PW

PMID: 30520942 [PubMed - as supplied by publisher]



https://ift.tt/2ElVaJW

Anterior Nasal Cavity Mass in a Neonate.

Anterior Nasal Cavity Mass in a Neonate.

JAMA Otolaryngol Head Neck Surg. 2018 Dec 06;:

Authors: Karempelis PS, Berger DM, Roby BB

PMID: 30521021 [PubMed - as supplied by publisher]



https://ift.tt/2EkwjpQ

Assessment of Publication Bias and Systematic Review Findings in Top-Ranked Otolaryngology Journals.

Assessment of Publication Bias and Systematic Review Findings in Top-Ranked Otolaryngology Journals.

JAMA Otolaryngol Head Neck Surg. 2018 Dec 06;:

Authors: Ross A, Cooper C, Gray H, Umberham B, Vassar M

PMID: 30520959 [PubMed - as supplied by publisher]



https://ift.tt/2EjIfsg

Association of Audiometric Age-Related Hearing Loss With Depressive Symptoms Among Hispanic Individuals.

Association of Audiometric Age-Related Hearing Loss With Depressive Symptoms Among Hispanic Individuals.

JAMA Otolaryngol Head Neck Surg. 2018 Dec 06;:

Authors: Golub JS, Brewster KK, Brickman AM, Ciarleglio AJ, Kim AH, Luchsinger JA, Rutherford BR

Abstract
Importance: Age-related hearing loss is highly prevalent and has recently been associated with numerous morbid conditions of aging. Late-life depression is also prevalent and can be resistant to available treatments. Preliminary studies examining the association between hearing loss and late-life depression have been limited by subjective hearing measures, small sample sizes, and primarily white populations.
Objective: To assess whether a cross-sectional association exists between objective audiometric hearing loss and depressive symptoms in older Hispanic adults.
Design, Setting, and Participants: This cross-sectional study uses 2008-2011 Hispanic Community Health Study/Study of Latinos data collected in Miami, Florida, San Diego, California, Chicago, Illinois, or the Bronx, New York, from 5328 Hispanic adults 50 years or older who had exposure, outcome, and covariate data. Data analyses were conducted from March 2018 to September 2018.
Exposure: Audiometric hearing loss (pure-tone average).
Main Outcomes and Measures: Center for Epidemiologic Studies Depression Scale, 10-item version (CESD-10) score of 10 or higher, which indicates clinically significant depressive symptoms.
Results: The median age (interquartile range) of the 5328 participants was 58 (53-63) years, and 3283 participants (61.6%) were female. The mean (SD) CESD-10 score was 7.7 (6.4). Of the 5328 included participants, 1751 (32.9%) had clinically significant depressive symptoms. The odds of having these symptoms increased 1.44 (95% CI, 1.27-1.63) times for every 20 dB of hearing loss, adjusting for hearing aid use, age, sex, educational level, study site, geographic background, cardiovascular disease, and antidepressant use. Compared with those for individuals with normal hearing (0 dB), the odds of having clinically significant depressive symptoms was 1.81 (95% CI, 1.48-2.22) times as high in individuals with mild hearing loss (median threshold, 32.5 dB), 2.38 (95% CI, 1.77-3.20) times as high in individuals with moderate hearing loss (median threshold, 47.5 dB), and 4.30 (95% CI, 2.61-7.09) times as high in individuals with severe hearing loss (median threshold, 80 dB).
Conclusions and Relevance: Objective hearing loss appears to be associated with clinically significant depressive symptoms in older Hispanic people, with greater hearing loss seemingly associated with greater odds of having depressive symptoms. Given the high prevalence of untreated hearing loss in older adults, hearing loss may be a potentially modifiable risk factor for late-life depression.

PMID: 30520955 [PubMed - as supplied by publisher]



https://ift.tt/2G3Olyv

Whatever Happened to Local Otolaryngology Societies?

Whatever Happened to Local Otolaryngology Societies?

JAMA Otolaryngol Head Neck Surg. 2018 Dec 06;:

Authors: Campbell BH

PMID: 30520937 [PubMed - as supplied by publisher]



https://ift.tt/2G76trf

Surgical outcome of jejunum-jejunum intussusception secondary to Rapunzel syndrome: a case report

Adult intestinal intussusception is a rare condition caused by the mechanical disruption of bowel motility. A bezoar is defined as indigestible material inside the gastrointestinal tract that develops into a t...

https://ift.tt/2E61jcp

Skin as an immune organ and clinical applications of skin-based immunotherapy

The prevalence of food allergy is increasing, and allergen avoidance continues to be the main standard of care. There is a critical need for safe and effective forms of immunotherapy for patients with food all...

https://ift.tt/2BWGej5

Making a difference by changing health behaviors

As an alternative to a traditional cigarette, an electronic nicotine delivery system, or vaping, is becoming more popular around the globe. Over half of the world's population live in the 62 countries that have available mechanisms for vaping.[1] In the case report, "Beliefs and reality of e-cigarette smoking," Menakuru et al report that an overwhelming 94% of 680 students said that e-cigarettes did not cause any harm to the body. They describe a patient who had never smoke a traditional cigarette. "[H]e admitted to smoking e-cigarettes throughout the day during his free time while driving, between meals and even during breaks at work…. His nicotine consumption would be about 192 mg/day." The patient lost his job and was unable to continue purchasing the necessary materials for vaping. As a result, the patient was diagnosed with nicotine withdrawal after presenting with "diaphoresis, restlessness, tachycardia, chills, nausea and a temperature of 38.3" which occurred after abrupt cessation of his smoking habits.

A study surveying marketing techniques for tobacco in countries across the globe, "detected substantially higher levels of tobacco marketing in the lower-income countries.[2] The use is particularly pronounced among students.[3] Despite some experts saying vaping is, "'95% safer'…. A BMJ report brought out the problems with the [claim, and]… can make one question [the experts'] scientific credibility." The case report quotes the multiple health risks associated with vaping, including the amount of nicotine, the inflammation present in the air was, and even toxic heavy metal exposure.

The World Health Organization Framework Convention on Tobacco Control (FCTC) released a report on electronic nicotine delivery systems.[1] While the FCTC has long stood against traditional cigarettes, this report also took a strong stance on vaping. This is a method which is pushed by some as a healthy alternative to traditional tobacco, but its efficacy in stopping traditional cigarette use has never been shown. The FCTC invited all countries to combat the rapid expansion of vaping with education, forbidding sale to minors, limiting advertising, prosecuting false health claims and monitoring among other interventions.

The regulatory fight against tobacco has in many ways been successful in many locations. Vaping, however, presents a new public health challenge that many practitioners may not be prepared to face. As health care professionals, part of advocating for our patients is ensuring their safety against predatory corporations which would trade their life and health for financial gain. Political action, education and treatment all play roles this endeavor.

BMJ Case Reports invites authors to submit global health case reports that describe the effects of health behaviors. These cases could focus on:

  • The factors contributing to these behaviors
  • The perception and knowledge surrounding these behaviors
  • Interventions that impact the behaviors of patients

Manuscripts may be submitted by students, physicians, nurses and allied health professionals to BMJ Case Reports at www.bmjcasereports.com. For more information, review our guidance on how to write a global health case report and look through our online collection

To read more about deleterious health behaviors at BMJ Case Reports, please review:

  • Childhood obesity in Mexico: social determinants of health and other risk factors
  • -Self-medication complicating pseudo membranous conjunctivitis
  • Snorting the clivus away: an extreme case of cocaine-induced midline destructive lesion

To read more about health behaviors, and specifically nicotine use globally from other cited sources, please review:

[1] World Health Organization. Provisional agenda item 4.4.2 Conference of the Parties to the WHO Framework Convention on Tobacco Control. Moscow, Russian Federation. Sixth Session, October 2014.

[2]Savell E, Gilmore AB, Sims M, Mony PK, Koon T, Yusoff K, Lear SA, Seron P, Ismail N, Calik K, Rosengren A. The environmental profile of a community's health: a cross-sectional study on tobacco marketing in 16 countries. Bulletin of the World Health Organization. 2015;93:851-61.

[3]Murthy VH. E-cigarette use among youth and young adults. JAMA pediatr 2017; 171:209.

The post Making a difference by changing health behaviors appeared first on BMJ Case Reports blog.



https://ift.tt/2G5xSKc

Evaluation of biochemical variables in patients with trigeminal neuralgia

Publication date: Available online 7 December 2018

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): A. Keskinruzgar, G. Yapici Yavuz, M. Koparal, I. Cag, M. Utkun, E. Gedik

Abstract

The aim of this study was to evaluate the calcium, sodium, potassium, serum iron, vitamin B12, and albumin concentrations, and alkaline phosphatase (ALP) activity, in samples of serum from patients with primary trigeminal neuralgia (TN), and investigate the associations between them. Results from 73 patients who had been diagnosed with primary TN between December 2015 and 2017 were compared with those of 70 healthy subjects. Calcium (p = 0.013), iron (p = 0.004), and albumin (p = 0.001) concentrations in the primary TN group were significantly lower than those in the control group, whereas the ALP activity was significantly higher in the TN group than in the control group (p = 0.007). However, there was no significant difference in the sodium, potassium, or vitamin B12 concentrations. Biochemical variables have a role in the pathogenesis and treatment of primary TN, but there are few studies that characterise the relations between the condition and the biochemical changes. Further studies are therefore necessary to gain more information.



https://ift.tt/2zGZ5xd

Qualitative study to identify issues affecting quality of life in adults with craniofacial anomalies

Publication date: Available online 7 December 2018

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): S.M. Visram, D. Gill, J.T. Shute, S.J. Cunningham

Abstract

Our objective was to identify key issues that affect the quality of life (QoL) of adult patients with craniofacial anomalies. This was a qualitative prospective study using in-depth, semi-structured interviews. Ten patients who fulfilled the inclusion criteria were recruited during their attendance at the Adult Craniofacial Clinic at the Eastman Dental Hospital, University College London Hospitals NHS Foundation Trust. Interviews ceased when no new themes arose. A framework method of analysis was used to identify themes that related to QoL. Opinions varied and, although some were positive, the eight main themes that emerged were mainly negative. One of the main themes was that of emotional issues. Within this theme, subthemes included teasing, bullying and abuse, as well as low mood, anxiety, depression, and self-harm. Participants experienced a range of feelings as a result of their craniofacial conditions and expressed the need for further support. Healthcare professionals involved in the treatment of these patients, should be aware of these issues and give advice about how to access further support.



https://ift.tt/2PkpFBf

Seldinger technique in repair of the parotid duct

Publication date: Available online 6 December 2018

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): A.J. Hills, R.Y. Kannan, M. Williams

Abstract

Injuries to the parotid ducts are difficult to locate, assess, and repair, and traditionally, solid metal dilators and soft plastic tubes have had only limited success. We describe the Seldinger technique with a central venous catheter, which makes repair easier.



https://ift.tt/2zODjHK

Evaluation of Antibiotic Treatment on the Duration of Hospitalization of Patients with Erysipelas and Bacterial Cellulitis

Abstract

Introduction

Erysipelas and bacterial cellulitis are two of the most common infectious skin diseases. They are usually caused by the β-hemolytic group of Streptococcus, and less frequently by other bacteria. The objective of the study was to assess the factors affecting the length of stay of patients admitted to hospital with erysipelas or bacterial cellulitis.

Methods

The study was based on the retrospective analysis of medical records of patients diagnosed with erysipelas or bacterial cellulitis. Selected clinical features of the disease, the results of additional tests, the treatment used, and the time of hospitalization were analyzed. Among an initial group of 78 pre-identified patients, 59 subjects aged from 32 to 89 years were included in the final analysis. The time spent in the hospital and the number of antibiotics necessary to cure the patient were chosen as the parameters of treatment efficacy.

Results

The average duration of stay in a hospital was 7.0 ± 2.9 days and was slightly longer for women than for men. Patients with chills on admission, with coexisting chronic venous insufficiency of the lower limbs, and with anemia were hospitalized for a significantly longer period than those without these conditions. A combination therapeutic regimen of amoxicillin + clavulanic acid was the most commonly used treatment option, and this therapy was linked with shortest duration of stay in the hospital; the length of hospital stay was significantly longer for those patients receiving cephalosporins or clindamycin as treatment. The combination therapy of amoxicillin + clavulanic acid as treatment option was also least often associated with the need to use other antibacterial agents.

Conclusions

Based on our evaluation of 59 subjects with either erysipelas or bacterial cellulitis, combination therapy with amoxicillin + clavulanic acid appears to be linked with the shortest stay in the hospital. We suggest that this combination therapy should be considered as a first-line treatment for patients hospitalized due to erysipelas or bacterial cellulitis, if other factors did not preclude the use of this therapy.



https://ift.tt/2RIT8Xu

Is there any association between green tea consumption and the risk of head and neck squamous cell carcinoma: Finding from a case-control study

Publication date: Available online 7 December 2018

Source: Archives of Oral Biology

Author(s): Rafieian Nasrin, Azimi Somayyeh

Abstract
Objective

Green tea consumption has been shown to reduce the incidence of head and neck Squamous cell Carcinoma (HNSCC) in experimental animal models, however the results from human studies are inconclusive. The aim of this study was to evaluate the relationship between green tea consumption and the risk of HNSCC.

Design

The study utilised a standardised questionnaire to investigate the relationship between green tea consumption and HNSCC experience. Data about amount of green tea consumption was recorded from 147 patients with HNSCC and 263 age and gender matched controls. The results were analyzed with SPSS statistical software Version 21 using Chi- square test, and Logistic Regression (with a 95% confidence interval). Significance levels were set at 95% and p-values less than 0.05 were considered significant.

Results

Statistical analysis indicated significant differences between different groups of tea consumers in terms of HNSCC risk (P < 0.001). The risk of developing oral cancer those who consume <1 cup of green tea daily was (OR = 0.29 (0.16-0.52) and for the group of > = 1 cup green tea consumers was 0.38(0.17- 0.86) of those who never consume green tea (Reference point) after adjustment for other risk factors.

Conclusions

The findings support that green tea consumption may reduce the risk of HNSCC. To confirm the efficacy of green tea intake in preventing the development of HNSCC in humans further investigation is needed.



https://ift.tt/2rotJ9Z

Is there any association between green tea consumption and the risk of head and neck squamous cell carcinoma: Finding from a case-control study

Publication date: Available online 7 December 2018

Source: Archives of Oral Biology

Author(s): Rafieian Nasrin, Azimi Somayyeh

Abstract
Objective

Green tea consumption has been shown to reduce the incidence of head and neck Squamous cell Carcinoma (HNSCC) in experimental animal models, however the results from human studies are inconclusive. The aim of this study was to evaluate the relationship between green tea consumption and the risk of HNSCC.

Design

The study utilised a standardised questionnaire to investigate the relationship between green tea consumption and HNSCC experience. Data about amount of green tea consumption was recorded from 147 patients with HNSCC and 263 age and gender matched controls. The results were analyzed with SPSS statistical software Version 21 using Chi- square test, and Logistic Regression (with a 95% confidence interval). Significance levels were set at 95% and p-values less than 0.05 were considered significant.

Results

Statistical analysis indicated significant differences between different groups of tea consumers in terms of HNSCC risk (P < 0.001). The risk of developing oral cancer those who consume <1 cup of green tea daily was (OR = 0.29 (0.16-0.52) and for the group of > = 1 cup green tea consumers was 0.38(0.17- 0.86) of those who never consume green tea (Reference point) after adjustment for other risk factors.

Conclusions

The findings support that green tea consumption may reduce the risk of HNSCC. To confirm the efficacy of green tea intake in preventing the development of HNSCC in humans further investigation is needed.



https://ift.tt/2rotJ9Z

Philtrum reconstruction in unilateral cleft lip repair

Publication date: Available online 7 December 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): S. Naidoo, K.-W. Bütow

Abstract

The philtrum is an important aesthetic structure in the midface. A number of philtrum reconstruction techniques have been advocated for secondary cleft lip revision procedures. Conventional surgical management involves end-to-end orbicularis oris muscle approximation during primary cleft lip repair, often resulting in a flat lip appearance that requires secondary revision surgery at a later stage. A novel modification of the approximation of the orbicularis oris muscle is described that may be implemented with any cleft lip technique in order to create an accentuated philtrum column for a natural looking philtrum. The muscle roll technique results in eversion of the orbicularis oris muscle, successfully recapturing the philtrum column topography. This is achieved by utilizing two inverted horizontal sutures, with an additional philtrum takedown suture placed in the region of the dimple to accentuate the philtrum anatomy and three-dimensional profile. This novel technique in unilateral cleft lip repair addresses philtrum architecture during primary surgery, which may reduce the requirement for secondary surgical intervention. Its application may be particularly suitable in outreach programmes where postoperative follow-up may be compromised.



https://ift.tt/2SwIOlm

Cetuximab in Head and Neck Cancer Patients

Conditions:   Head and Neck Cancer;   Squamous Cell Carcinoma
Intervention:   Drug: Cetuximab
Sponsors:   University of Wisconsin, Madison;   National Cancer Institute (NCI);   National Institute of Dental and Craniofacial Research (NIDCR)
Not yet recruiting

https://ift.tt/2UmuFcc

Proximal Femoral Fractures - Patient Population, Risk Factors, Surgical Performance and Outcome

Condition:   Proximal Femoral Fracture
Interventions:   Procedure: surgery for pertrochanteric femoral fracture;   Procedure: surgery for femoral neck fracture
Sponsor:   University Hospital, Basel, Switzerland
Recruiting

https://ift.tt/2UmuwWc

Temporally Feathered Radiation Therapy (TFRT) for Head and Neck Squamous Cell Carcinoma

Condition:   Head and Neck Cancer
Intervention:   Radiation: Temporally Feathered Radiation Therapy (TFRT)
Sponsor:   Case Comprehensive Cancer Center
Not yet recruiting

https://ift.tt/2B0cFeY

Assement of the Morphological Characteristics of the Hips and Correlating Them With the Pathology Found

Conditions:   Ischiofemoral Impingement;   Hip Pain Chronic;   Musculoskeletal Disease;   Femoral Anteversion
Intervention:   Radiation: MRI
Sponsor:   Universidad de Zaragoza
Not yet recruiting

https://ift.tt/2B1QEMP

Tabelecleucel in Combination With Pembrolizumab in Subjects With EBV+ Nasopharyngeal Carcinoma (ATA129-NPC-202)

Conditions:   Nasopharyngeal Carcinoma;   Nasopharyngeal Neoplasms;   Epstein-Barr Virus Infections;   Epstein-Barr Viraemia
Interventions:   Biological: tabelecleucel;   Biological: pembrolizumab
Sponsors:   Atara Biotherapeutics;   Merck Sharp & Dohme Corp.
Recruiting

https://ift.tt/2Upqr3p

Facteurs de risques de l’érythème fessier du nourrisson à l’hôpital gynéco-obstétrique et pédiatrique de Yaoundé, Cameroun

Publication date: Available online 7 December 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): A. Chiabi, J.-C. Ngamgo Kamdem, A.-G. Nkoro, H. Siyou, S. Hamo, F.-D. Nguefack, E. Mah, S. Nguefack, F. Angwafo



https://ift.tt/2zNhJU1

When is epinephrine prescribed for anaphylaxis?

Publication date: Available online 7 December 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Alberto Alvarez-Perea, Margarita Tomás-Pérez, Beatriz Ameiro, José M. Zubeldia, María L. Baeza



https://ift.tt/2G2qtvd

Wide diameter bone-anchored hearing system implants: a comparison of long-term follow-up data between tissue reduction and tissue preservation techniques

Abstract

Objective

To present long-term data on the Wide Ponto implant bone-anchored hearing system (BAHS) in regards to implant stability, soft tissue reaction and implant loss for two case series undergone either the tissue reduction- or the tissue preservation surgical technique.

Methods

Comparison of two consecutive, prospective case series. Each case series enrolled 24 patients. The case series underwent one-stage implantation of the Wide Ponto implant BAHS using either a linear incision technique with subcutaneous reduction or a linear incision technique without subcutaneous reduction. Implant stability quotient (ISQ) values were measured using resonance frequency analysis and soft tissue reactions were graded according to Holgers' classification system. Follow-up visits were performed at 10 days, 6 weeks, 6 months, 12 months and annually up to 4 years (tissue preservation) or 5 years (tissue reduction) postoperatively.

Results

The two case series had homogenous patient populations and followed an identical postoperative scheme. The ISQ values increased consistently the first 12 months for both groups (p ≤ 0.001), and were higher in the tissue preservation case series, (p = 0.04, 9 mm abutment). More than 91% of the soft tissue observations were assessed as Holgers' grade 0 or 1. One implant (2.1%) was lost due to trauma.

Conclusion

In both case series, the Wide Ponto implant showed increasing implant stability during the follow-up period from the time of surgery, irrespective of surgical technique, indicating good osseointegration. Soft tissue reactions were rare and of minor severity. Implant survival was high.



https://ift.tt/2Qi1HvS

A prospective histomorphometric and cephalometric comparison of bovine bone substitute and autogenous bone grafting in Le Fort I osteotomies

Publication date: Available online 6 December 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Andreas Naros, Bayazeed Bassem, Schwarz Ulrich, Nagursky Heiner, Siegmar Reinert, Rainer Schmelzeisen, Sebastian Sauerbier

Abstract
Purpose

The aim of the present study was the histomorphometric and cephalometric comparison of autogenous bone grafting of the anterior iliac crest and the application of bovine bone substitute concerning new bone formation and postoperative stability in patients undergoing orthognathic Le Fort I osteotomy.

Patients and Methods

Twenty-five patients requiring orthognathic surgery with Le Fort I osteotomy were included in this study. Patients were randomly divided into three groups receiving either autogenous iliac crest BONE grafting (BONE; n=8) or xenogenic bovine bone grafting (Bio-Oss®) in INTER (n=12) or in ONLAY (n=5) position. Histomorphometric analysis was performed using trephine bone biopsies from the autogenous, respectively xenogenic bone grafting region. Postoperative stability was evaluated using teleradiographies of three different timepoints.

Results

All groups showed comparable mineralized fractions in bone biopsies of 50.2% (±13.2%) INTER, 46.48% (±12.3%) ONLAY and 57.1% (±20.6%) BONE as well as comparable percentage of connective tissue. Patients in the INTER-group revealed the lowest relapse rate of 20.5% (INTER) compared to 30.3% (ONLAY) and 33.0% (BONE). All groups underwent comparable maxillary advancement and healing time.

Conclusions

Present results indicate that block shaped bovine bone substitute is a promising alternative to autogenous bone grafting to bridge the Le Fort I osteotomy gap in orthognathic surgery.



https://ift.tt/2rs2H1j

Acute open callus manipulation: clinical experience with a new surgical technique for solving old problems in distraction osteogenesis

Publication date: Available online 7 December 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Alberto R. Pereira, André P. Pereira

Summary
Background

Transport distraction osteogenesis is challenged as a potential alternative to free-flap reconstruction of segmental jaw defects due to its longer treatment time, vector control difficulties, need for additional bone-grafting, and problems creating a curvilinear shape. We propose a new technique of acute open callus manipulation and fixation (AOCMF), which addresses these challenges.

Methods

A retrospective analysis of all patients with jaw defects who underwent DO and AOCMF between 2006 and 2015 was performed. Clinical and demographic data were recorded and analysed. Representative treated cases were presented.

Results

Fourteen adult patients were treated, seven for maxillary and seven for mandibular defects of mixed etiology. The mean length of distraction was 4.9 cm (range 3–8 cm). AOCMF was performed between the first and third week of the consolidation phase. Average treatment time was 7.6 weeks (range 4–13 weeks). Mean follow-up was 38 months (range 25–76 months). Stable curvilinear bone shape and soft tissue coverage was achieved in all patients except one. Four complications were recorded.

Conclusions

AOCMF following DO is a safe and reliable technique for reconstruction of segmental defects. It represents a useful alternative to free-flap reconstruction in selected patients. When compared with traditional bone transport techniques, it allows a decrease in the number of surgical procedures and in average treatment time.



https://ift.tt/2G4N6PJ

Feeding Practices and Growth of Infants with Pierre Robin Sequence

Publication date: Available online 7 December 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Bonnie Dorise, Amit Trivedi, Claire Galea, Karen Walker, Bhavesh Mehta

Abstract
Objectives

To assess the impact of feeding practices on growth in infants with Pierre Robin Sequence (PRS) during their inpatient stay in a neonatal intensive care unit in a large tertiary paediatric hospital setting.

Methods

A retrospective review of feeding practices in infants with PRS was conducted between January 2006 and September 2017. Baseline demographics, nutrition-related and general outcomes were collected. Feeding difficulties, length of stay (LOS) and malnutrition were the primary outcome measures. Feeding difficulties included absence or poor-quality suck, episodes of aspiration, use of proton pump inhibitors or multiple episodes of vomiting. Malnutrition was classified as a weight-for-age Z score of <-1.

Results

Analysis was conducted on 49 infants with PRS that met eligibility criteria. Feeding difficulties correlated with a longer LOS (24.1 vs 6.8 days (p=0.001)) Z-scores differed significantly between birth and discharge (0.21(1.84) vs -1.27(2.14)) (p<0.001*) with malnutrition being evident in 26 infants of which only 17 infants were seen by a dietitian. Presence of intrauterine growth restriction (IUGR) increased the likelihood of malnutrition (OR 1.40(CI-1.11-1.77)).

Conclusion

Infants with PRS are highly likely to have feeding difficulties and malnutrition. Early intervention by a dietitian is recommended to reduce the impacts of feeding difficulties, meet elevated energy requirements and facilitate growth. Infants with a longer inpatient stay or presence of IUGR should have their growth and feeding routinely monitored.



https://ift.tt/2L0oAOv

The Role of Flexible Bronchoscopy Accomplished Through a Laryngeal Mask Airway in the Treatment of Tracheobronchial Foreign Bodies in Children

Publication date: Available online 6 December 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Alev Suzen, Suleyman Cuneyt Karakus, Nazile Erturk

Abstract
Introduction

We here present our experience with children who underwent flexible bronchoscopy for removal of inhaled tracheobronchial foreign bodies under general anesthesia via a laryngeal mask airway (LMA).

Materials and Methods

A total of 24 (16 male and 8 female, mean age: 30.75±29.68 months) patients who underwent flexible bronchoscopy under general anesthesia using a LMA for suspicion of tracheobronchial foreign bodies between July 2016 and April 2018 were retrospectively reviewed.

Results

The mean duration of admission to hospital was 162.56±309.56 hours. Sixteen (66.7%) patients were found to have tracheobronchial foreign bodies. All procedures were successfully accomplished through a LMA by using basket forceps, a Fogarty catheter and a suction without any need for rigid bronchoscopy. 11 (68.7%) of tracheobronchial foreign body locations were right bronchial, 3 (18.8%) were left bronchial and 2 (12.5%) were tracheal. The types of extracted tracheobronchial foreign bodies were organic in 14 (87.5%) and non-organic in 2 (12.5 %). There were no complications except laryngeal edema noted in 2 (8.3%) patients, relieved within 48 hours. The mean time of postoperative hospitalisation was 2.42±0.97 days.

Conclusion

Flexible bronchoscopy accomplished through a LMA is a safe, easy and effective technique, not only as a diagnostic procedure, but also as the initial therapeutic modality for retrieving tracheobronchial foreign bodies in children with high success and low complication rates. With further reports aforementioned, we hope that the flexible bronchoscopy will become a standard method in children.



https://ift.tt/2BVOgc9

Quantitative analysis of carotid arterial calcification using airway CT in obstructive sleep apnea

Publication date: Available online 7 December 2018

Source: Auris Nasus Larynx

Author(s): Tae Kyung Koh, Eun-Ju Kang, Woo Yong Bae, Sung Wan Kim, Chul Hoon Kim, Soo Kweon Koo, Sang Jun Kim, Moon Sung Kim, Jae Hoon Lee

Abstract
Objective

To evaluate the relationship between obstructive sleep apnea (OSA) severity and carotid arterial calcification by quantitative analysis using airway computed tomography (CT).

Methods

This study included a total of 180 consecutive OSA patients aged 45–80 years underwent polysomnography and airway CT between March 2014 and October 2016. The subjects were divided into three groups based on the results of the respiratory disturbance index (RDI): mild (RDI 5–14, n = 29), moderate (RDI 15–29, n = 50), and severe (RDI ≥ 30, n = 101). The extent of carotid arterial calcification on each airway CT scan was quantified according to the modified Agatston scoring method. Differences among the three groups in clinical characteristics including age, gender, body mass index (BMI), comorbid disease, blood pressure, total cholesterol, and carotid arterial calcification score (CarACS) were analyzed.

Results

The severe OSA group showed significantly stronger predominance for male and smoker, higher prevalence of diabetes, and larger BMI than those of mild and moderate OSA groups. The mean CarACS was significantly different among the three groups (mild RDI: 4.3 ± 13.4, moderate RDI: 7.4 ± 28.8, severe RDI: 48.6 ± 121.6, P = 0.011). Univariate linear regression showed that RDI, age, hypertension, male sex and diabetes significantly influenced on the CarACS. In a multivariate linear regression model, the CarACS was related to age, male sex, and diabetes.

Conclusions

The patients with severe OSA showed larger CarACS and a higher prevalence of atherosclerotic risk factors. The CarACS was correlated with severity of OSA, which might be more dependent on the conventional risk factors of atherosclerosis.



https://ift.tt/2GeBCca

Acute open callus manipulation: clinical experience with a new surgical technique for solving old problems in distraction osteogenesis

Transport distraction osteogenesis is challenged as a potential alternative to free-flap reconstruction of segmental jaw defects due to its longer treatment time, vector control difficulties, need for additional bone-grafting, and problems creating a curvilinear shape. We propose a new technique of acute open callus manipulation and fixation (AOCMF), which addresses these challenges.

https://ift.tt/2rycenX

A prospective histomorphometric and cephalometric comparison of bovine bone substitute and autogenous bone grafting in Le Fort I osteotomies

The aim of the present study was the histomorphometric and cephalometric comparison of autogenous bone grafting of the anterior iliac crest and the application of bovine bone substitute concerning new bone formation and postoperative stability in patients undergoing orthognathic Le Fort I osteotomy.

https://ift.tt/2G5lcDb

Staphylococcus aureus, epithelial disruption and nasal polyps. Are we one step ahead in combatting this foe?

Publication date: Available online 6 December 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Mahboobeh Mahdavinia, Pete S. Batra



https://ift.tt/2REKzNf

Adverse reactions to drugs and biologics in patients with clonal mast cell disorders: A Work Group Report of the Mast Cells Disorder Committee, American Academy of Allergy, Asthma & Immunology

Publication date: Available online 6 December 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Melody C. Carter, Dean D. Metcalfe, Almudena Matito, Luis Escribano, Joseph H. Butterfield, Lawrence B. Schwartz, Patrizia Bonadonna, Roberta Zanotti, Massimo Triggiani, Mariana Castells, Knut Brockow

Abstract

Providers caring for patients with mastocytosis are tasked with the decision to consider therapeutic options. This may come with some trepidation since the information available in the public domain lists numerous mast cell activators based on data that does not discriminate between primates, rodents and mast cell lines, does not consider dosage and does not take into account previous exposure and resultant clinical findings. This being said, there is support in the literature for an enhanced mast cell response in some patients with mastocytosis and where there is higher incidence of adverse reactions associated with certain antigens such as venoms as well as drugs. This report thus provides a comprehensive guide for those providers who must decide on therapeutic options in the management of patients with clonal mast cell disease.



https://ift.tt/2Qm3XSV

Comparative microbiome analysis of Dermatophagoides farinae, Dermatophagoides pteronyssinus, and Tyrophagus putrescentiae

Publication date: Available online 6 December 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Jinyoung Lee, Ju Yeong Kim, Myung-hee Yi, Younjee Hwang, In-Yong Lee, Sung-Hyun Nam, Dongeun Yong, Tai-Soon Yong



https://ift.tt/2QlhBFN

Electrodissection for Nevus Lipomatosus Cutaneous Superficialis Removal



https://ift.tt/2QiElpX

Colored dots on Trichoscopy - Beware of artefacts



https://ift.tt/2RLLdJa

Masculine Norms and Sunscreen Use among Adult Men in the United States: A cross-sectional study



https://ift.tt/2RGT1vJ

Anti-inflammatory and anti-remodeling effects of myrtenol in the lungs of asthmatic rats: Histopathological and biochemical findings

Publication date: Available online 6 December 2018

Source: Allergologia et Immunopathologia

Author(s): M.A. Bejeshk, M. Samareh Fekri, H. Najafipour, F. Rostamzadeh, E. Jafari, M.A. Rajizadeh, Y. Masoumi-Ardakani

Abstract
Introduction

Asthma is a chronic inflammatory disease of the airways. In this study, we evaluated the anti-inflammatory effects of myrtenol on the inflammatory indices in the pulmonary parenchyma and airways and on the inflammatory and oxidative indices of the bronchoalveolar lavage fluid (BALF) of asthmatic rats.

Methods

The allergic asthma was induced by sensitization (two weeks) followed by the inhalation of ovalbumin (four weeks). Animals were divided into two main groups: (1) Histopathology, and (2) measurement of inflammatory and oxidative biomarkers in the BALF. Each main group was subdivided into four subgroups: Control, Asthma, Asthma + Dexamethasone and Asthma + Myrtenol. (−)-Myrtenol (50 mg/kg) or Dexamethasone (2.5 mg/kg) was administered intraperitoneally once a day for one week, at the end of the inhalation period. On day 50, lung histopathologic parameters and inflammatory indices in BALF including INF-γ, IL-10, IL-1β, and TNF-α and oxidative stress biomarkers (MDA, SOD, and GPX) were measured.

Result

In the Asthma group, leukocyte infiltration, the thickness of smooth muscle and epithelium of airways wall and the number of goblet cells increased. Myrtenol reduced all of the above-mentioned indices except the epithelium thickness. It also inhibited the increase in BALF IL-1β, TNF-α and MDA and increased the levels of INF-γ, IL-10 and SOD.

Conclusion

Our results suggest that myrtenol reduced damage caused by experimental asthma by reducing the inflammatory indices, normalizing the level of interleukins and balancing oxidative stress in the lungs. It also prevented airway remodeling. Myrtenol may be suggested as a potent herbal medicine for the treatment of allergic asthma.



https://ift.tt/2BWrYXK

When is epinephrine prescribed for anaphylaxis?

Anaphylaxis represents a severe allergic reaction that is rapid in onset and can be fatal 1. Epinephrine is the first-choice medication in the treatment of anaphylaxis, both in the community and in the hospital setting 2. Nonetheless, epinephrine is largely underused 3. The purpose of this study was to examine the reasons that currently motivate professionals to treat anaphylaxis with epinephrine in the Emergency Department (ED) and the prescription of EAI for outpatient use after the allergy workup.

https://ift.tt/2rosx6n