Head and Neck Medicine by Alexandros G.Sfakianakis: 02/12/19

Τρίτη 12 Φεβρουαρίου 2019

Primary Osteosarcoma of Sphenoid and Ethmoid Sinus in a 17 Year Female: Case Report

Abstract

Primary osteosarcoma of sphenoid and ethmoid sinus present as a challenge in head neck cancer. A 17 year female presented with left sided hemifacial pain, headache with nasal discharge. Clinico-radiological finding showed mass in sphenoethmoid recess spreading to adjacent structures. Endoscopic resection was done. Histopathological diagnosis was osteosarcoma of sphenoid and ethmoid sinus. Adjuvant chemotherapy administered. Osteosarcomas of sphenoid and ethmoid sinus are aggressive tumors with variable clinical features warranting high clinical suspicion.

http://bit.ly/2ByXs5E

Randomized, single‐blinded, crossover study of a novel wound dressing vs current clinical practice after percutaneous collagen induction therapy

Summary

Introduction

Skin rejuvenation procedures have become common with sophisticated technologies with reduced downtime and related risks. Recently, microneedling has been paired with radiofrequency to create Fractional Radiofrequency Microneedling (FRFM) to induce neocollagenesis. Frequently, topical products are applied immediately after the needling. This procedure is known as percutaneous collagen induction therapy (PCIT). Postoperative topical wound care is critical for prompt rapid and safe healing, with moist wound healing deemed of primary importance for fast and correct scarring process. An ideal dressing enables a moist environment while reducing postprocedural inflammatory responses in the first stages of wound healing.

Objective

To evaluate whether an innovative silicone‐based wound dressing is superior than standard of care therapy in decreasing severity and duration of treatment‐site acute inflammatory reactions post PCIT.

Materials and Methods

Endymed PRO Intensif Handpiece (Endymed, Israel) was used for the full‐face FRFM procedure. Subjects (n = 20) applied treatment (Stratacel^®—Stratpharma SG, Switzerland) and control (Aquaphor^®—Beiersdorf Inc, USA) immediately after the procedure and daily; they were evaluated immediately postprocedure (baseline assessment), at 2, 3 and 7 days postprocedure. Digital and 3D pictures (Antera 3D Camera for Skin Analysis—Miravex, Ireland) were taken at each assessment.

Results

All patients healed properly without reporting adverse reactions to any of the studied products. Erythema at each study visit was significantly reduced with the use of the novel wound dressing (P < 0.001). A statistically significant difference in favor of the innovative wound dressing also emerged with respect to the patient‐rated product properties (P = 0.008), such as feel on skin, drying time and stickiness.

Conclusions

The novel wound dressing reduced signs of acute inflammation following PCIT when compared to standard of care, without reporting adverse events and resulting in a more favorable outcome from a patient perspective.

http://bit.ly/2N28jJS

Primary Tonsillar Epithelioid Follicular Dendritic Cell Sarcoma: Report of a Rare Case Mimicking Undifferentiated Carcinoma and a Brief Review of the Literature

Abstract

We present a 52 years old male with a left tonsillar follicular dendritic cell sarcoma with prominent epithelioid features that on light microscopical examination bore a striking resemblance to a lymphoepithelial or undifferentiated carcinoma. The tumor was immunohistochemically positive for CD21 and CD35 and negative for cytokeratins. Two distinct histopathological features (both present in our case) that may serve as clues to the correct diagnosis on light microscopical examination were formation of ectatic pseudovascular spaces lined by malignant cells and the presence of non-neoplastic multinucleated giant cells. Familiarity with the above-mentioned morphological clues, and awareness that this tumour may occur in anatomical sites outside the lymph node, are essential for accurate diagnosis.

http://bit.ly/2N1Pjeo

Primary Osteosarcoma of Sphenoid and Ethmoid Sinus in a 17 Year Female: Case Report

Abstract

http://bit.ly/2ByXs5E

Contribution of Nitric oxide synthase 3 genetic variants to nasopharyngeal carcinoma risk and progression in a Tunisian population

Abstract

Purpose

We conduct this study to evaluate the clinical and functional impact of Nitric Oxide Synthase 3 (NOS3) T-786C and G894T genetic variants on nasopharyngeal carcinoma (NPC) risk and progression in a Tunisian population.

Methods

259 NPC patients and 169 healthy controls were enrolled into our case–control study. Blood samples were genotyped by the RFLP-PCR analysis. The levels of Nitric oxide (NO) were measured by a colorimetric assay kit in the plasma of NPC patients, healthy controls and according to NOS3 genotypes. The correlation between the NOS3 variants and the clinicopathological parameters was examined.

Results

We found no linkage disequilibrium between NOS3 T-786C and G894T variants. These results showed that NOS3 variants were genetically independent. In contrast to NOS3 T-786C, a significant association was found between NOS3 G894T polymorphism and NPC risk. The 894T allele decreased significantly in NPC patients and appeared as protective factor (OR = 0.65, CI 95%= 0.48–0.88, p = 0.006). NPC patients had significantly higher levels of plasma NO as compared to healthy controls (p = 0.0011). The T-786C mutation reduced the levels of plasma NO and decreased risk of lymph node metastasis in NPC patients (OR = 0.64, 95% CI = 0.43–0.96; p = 0.03). In contrast, NOS3 G894T polymorphism had no effects neither on NO plasma levels nor clinical parameters.

Conclusions

This is the first study to associate NPC with significantly higher levels of plasma NO. NOS3-derived NO could play key roles in NPC pathogenesis. NOS3 variants differently contribute to NPC risk and progression in a Tunisian population. NOS3 G894T was associated with NPC risk. NOS3 T-786C decreased the levels of plasma NO and reduced the development of regional lymph node metastasis.

http://bit.ly/2GnioAv

Botulinumtoxin A für eine schönere Halskurve

Ein verkürzter Hals wird von vielen als unästhetisch angesehen. Er kann unter anderem durch eine Hypertrophie des Trapeziusmuskels entstehen. Die Injektion von Botulinumtoxin A kann das Erscheinungsbild maßgeblich verbessern und die Patientenzufriedenheit erhöhen.

http://bit.ly/2BykrOa

Upload nur mit Einverständniserklärung!

Wenn Patienten die neue E-Gesundheitsakte Vivy mit ihren Daten gefüllt sehen wollen, gibt es einige Aspekte zu beachten. Die Kassenärztliche Bundesvereinigung hat nun Informationen zusammengestellt.

http://bit.ly/2X861O2

Ärztliche Sorgfaltspflicht wahren

Der Deutsche Ärztetag hat das Fernbehandlungsverbot gelockert und damit einen wichtigen Grundstein für die Patientenbehandlung per Video, Telefon oder E-Mail gelegt. Ein Rechtsanwalt erklärt, für welche Patienten eine Fernbehandlung infrage kommt.

http://bit.ly/2TO0qdI

Wenn es beim Einlesen der E-Card hakt

Immer wieder kommt es in Arztpraxen beim Einlesen von Gesundheitskarten zu technischen Problemen. Die Kassenärztliche Vereinigung Nordrhein gibt einen Überblick über die gängigsten Fehlermeldungen und hat Tipps, was dann zu tun ist.

http://bit.ly/2TO0j1M

Strahlende Haut durch Nahrungsergänzungsmittel

http://bit.ly/2Bxepxp

Dauerhafte Hautstraffung bei Cellulite

http://bit.ly/2TO0eLw

Kein automatischer Urlaubsverfall zum Jahreswechsel

Mit zwei Urteilen hat der Europäische Gerichtshof (EuGH) wiederholt die Arbeitnehmerrechte im Hinblick auf Urlaubsansprüche gestärkt. Der EuGH hat mit seinen Entscheidungen den lange geltenden Grundsatz über Bord geworfen, dass Urlaubsansprüche zum Jahresende automatisch verfallen. Dies kann für jeden Praxisinhaber erhebliche Mehrkosten und -belastungen mit sich bringen. Es lohnt also ein Blick auf die Auswirkungen der Urteile für die tägliche Praxis und darauf, wie man sich vor nachteiligen Folgen schützen kann.

http://bit.ly/2BxejG3

Atrophe Aknenarben: gelen statt nadeln?

Der Schweregrad atropher Aknenarben war sechs Monate nach der Behandlung mit topischem Tazaroten-Gel bei guter Verträglichkeit in gleichem Maß verbessert wie nach Microneedling, so eine Studie.

http://bit.ly/2TTETQw

Ein Schritt in die richtige Richtung!

http://bit.ly/2BxegtR

Mit Laserlipolyse Körperfett entfernen und Bindegewebe straffen

http://bit.ly/2RZ6LkC

Methotrexat bei Alopecia areata/totalis?

Die Therapie von Alopecia areata/totalis mit Methotrexat (MTX) ist bisher nur unzureichend untersucht worden. In einer neuen Literatursuche fanden die Autoren Hinweise auf ein erneutes Haarwachstum nach MTX-Therapie.

http://bit.ly/2RYxY6Y

Betriebsausfall durch Unwetter einkalkulieren

Ist die Praxis aufgrund eines Hochwassers nicht zugänglich, drohen massive Betriebsausfälle — selbst im zweiten Stock. Praxen sollten sich deswegen gut gegen die möglichen Folgen versichern.

http://bit.ly/2WZwygf

Neue Befunde bestätigen: Dexpanthenol forciert die Wundheilung

http://bit.ly/2RZ6Dl8

Mit körpereigenen Ressourcen zu einem besseren Hautbild

Viele Patienten finden es besonders verlockend, ihr autologes Regenerationspotenzial zu nutzen. So erfreut sich die Anwendung einer aus dem eigenen Blut gewonnenen Thrombozytenfraktion wachsender Beliebtheit — auch in der ästhetischen Dermatologie.

http://bit.ly/2X1VFin

Wirksamkeit von OTC-Produkten bei Hyperpigmentierungen

Dank Over-the-counter-Produkten benötigen Menschen mit Hyperpigmentierungen nicht unbedingt ein Rezept vom Arzt, wenn sie ihr Hautbild verschönern möchten. Aber welche Cremes sind bei Patienten am beliebtesten, welche wirken am besten, wie lange werden sie eingesetzt — und sind verschreibungspflichtige Produkte vielleicht nicht doch besser? Das wurde jetzt in einer neuen Studie in den USA untersucht.

http://bit.ly/2RZ77Yu

„Ästhetik für Einsteiger“

http://bit.ly/2WWF93f

Hybrid-Plattform zur Körper- und Gesichtskonturierung

http://bit.ly/2RZ72Ea

DSGVO — wann droht eine Abmahnung?

Mit der Datenschutzgrundverordnung (DSGVO) wurden zahlreiche neue Verpflichtungen für die ärztliche Praxis eingeführt, die bereits viel diskutiert und aufbereitet sind. Unbeleuchtet bleibt dabei häufig die Frage, welche Rechtsfolgen ein Verstoß gegen die DSGVO überhaupt nach sich ziehen kann. Gerade die Sorge vor Sanktionen ist aber wesentlicher Anlass, sich mit der DSGVO intensiv zu beschäftigen.

http://bit.ly/2X031TK

Ist Body-Contouring nach bariatrischer Operation absolut notwendig?

http://bit.ly/2RZ6mi6

Medical Needling bei Verbrennungsnarben im Kindesalter

Verbrennungen im Kindesalter gehören zu den psychisch und physisch am stärksten traumatisierenden Verletzungen. Sie können eine lebenslange Stigmatisierung durch Narbenbildung hinterlassen. Die konservative Narbentherapie schließt direkt an die Akutbehandlung an, kann jedoch die Ausbildung von hypertrophen oder kontrakten und damit bewegungseinschränkenden Narben nicht immer verhindern. Besonders am kindlichen wachsenden Organismus müssen die Narben jahrelang behandelt und beobachtet werden, um die Entwicklung des Kindes nicht zu beeinträchtigen.

http://bit.ly/2X02WiU

Outcome of a giant coronary artery mycotic pseudoaneurysm secondary to non-typhoid Salmonella managed without surgical intervention

A 48-year-old woman with a history of AIDS, a recent coronary artery bypass graft operation and prior bacteraemia with non-typhoid Salmonella presented with non-exertional chest pain and elevated troponins. The cardiac catheterisation and coronary CT angiography revealed a 9 cm pseudoaneurysm arising from the proximal left anterior descending artery. The blood cultures confirmed non-typhoid Salmonella. Emergent surgery was initially deferred due to her complex anatomy. Moreover, the hospital course was complicated by Epstein-Barr virus meningitis and an associated decline in the patient's mentation. Consequently, the mycotic pseudoaneurysm was medically managed with antibiotics and strict blood pressure goals. The natural history of giant mycotic coronary artery pseudoaneurysm formation and progression is appreciated through this first reported medically managed case. The follow-up coronary CT angiography at 3 months showed evidence of pseudoaneurysm leakage into surrounding tissue. The patient expired at 5 months from an unknown cause.

http://bit.ly/2N1iNJk

Atypical presentation of IgG4 sclerosing cholangitis

IgG₄ sclerosing cholangitis (ISC) is a rare disease which usually presents in patients in their 60's or above. Patients often present with obstructive jaundice as the first symptom, especially when associated with autoimmune pancreatitis. We report the case of a 20-year-old man who presented with acute abdominal pain, which was subsequently diagnosed as ISC in addition to autoimmune pancreatitis following magnetic resonance cholangiopancreatography (MRCP). The patient was thus treated with steroids.

http://bit.ly/2SNUJ26

Child with unusual combination of sickle cell disease and autosomal recessive agammaglobulinemia associated with a novel CD79a gene mutation

This article describes a novel mutation in CD79a gene identified in a child with sickle cell disease (SCD), who was diagnosed with autosomal recessive agammaglobulinaemia in the context of prolonged febrile syndrome. The association of a primary immunodeficiency with SCD in the same child was unexpected.

http://bit.ly/2N42BHh

Bilateral maxillary palatal talon cusps in deciduous central incisors

'Talon cusp' is a developmental dental disturbance characterised by a cuspal projection in the cingulum area or cementoenamel junction, with normal enamel and dentin containing varying degrees of pulp tissue. The prevalence of talon cusp varies with race, age and the criteria used for diagnosis. It has been reported in the maxillary and mandibular arches of both the deciduous and permanent dentitions. The prevalence of the talon cusp in the deciduous dentition is reported to be 2.1% in Saudi Arabian subjects. The purpose of this paper is to report the rare bilateral presence of talon cusps on the deciduous maxillary central incisors of a 4-year-old female patient with a family history of consanguineous marriage.

http://bit.ly/2SNjoUi

Intermediate uveitis in a child with phosphatase and tensin homolog gene mutation and Bannayan-Riley-Ruvalcaba syndrome

Bannayan-Riley-Ruvalcaba syndrome (BRRS) is a congenital disorder characterised by macrocephaly, multiple hamartomas, lipomas, and pigmented macules of the glans penis. Intermediate uveitis is characterised by chronic inflammatory cells aggregates on the pars plana (snowbanks) and within the vitreous cavity (snowballs). We describe what we believe to be the first case of intermediate uveitis associated with BRRS. Early examination under anaesthesia should be considered in the management of young children diagnosed with this syndrome in order to provide appropriate ocular evaluation, treatment and follow-up. Further research is needed to establish a better understanding of the ophthalmic manifestations of this syndrome.

http://bit.ly/2N20Eew

Cutaneous angiosarcoma with lymphoedema: the Stewart-Treves syndrome

http://bit.ly/2SNUAM6

Isolated superior petrosal sinus dural arteriovenous fistula treated with selective sinus packing using a quadriaxial catheter system

A 67-year-old patient presented with a headache, vertigo and nausea, followed by a disturbance of consciousness. CT and MRI showed venous ectasia at the left cerebellopontine angle and extensive oedema in the left cerebellum. Angiography demonstrated a dural arteriovenous fistula that appeared at the left superior petrosal sinus–cavernous sinus) junction. After the evaluation of the shunt point, occluded areas were recanalised via the femoral vein with a quadriaxial catheter system using a 6-Fr guiding sheath, 6-Fr guiding catheter, 4.2-Fr catheter and microcatheter. Selective coil embolisation was performed, resulting in shunt removal.

http://bit.ly/2SL56Ub

The Devil Is in the Details

Foreword. In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information by sharing relevant background and reasoning with the reader (regular type). The authors' commentary follows. Stage. A 75-year-old woman…

http://bit.ly/2Gml3dV

β-Catenin nuclear expression discriminates deep penetrating nevi from other cutaneous melanocytic tumors

Abstract

Recent advances in genomics have improved the molecular classification of cutaneous melanocytic tumors. Among them, deep penetrating nevi (DPN) and plexiform nevi have been linked to joint activation of the MAP kinase and dysregulation of the β-catenin pathways. Immunohistochemical studies have confirmed cytoplasmic and nuclear expression of β-catenin and its downstream effector cyclin D1 in these tumors. We assessed nuclear β-catenin immunohistochemical expression in a large group of DPN as well as in the four most frequent differential diagnoses of DPN: "blue" melanocytic tumors, Spitz tumors, nevoid and SSM melanomas, and pigmented epithelioid melanocytomas (PEM). Nuclear β-catenin expression was positive in 98/100 DPN and 2/16 of melanomas (one SSM and one nevoid melanoma with a plexiform clone) and was negative in all 30 Spitz, 26 blue, and 6 PEM lesions. In 41% DPN, β-catenin expression was positive in more than 30% nuclei. No differences were observed in cytoplasmic and nuclear cyclin D1 expression between these tumor groups, suggesting alternate, β-catenin-independent, activation pathways. We have subsequently studied nuclear β-catenin expression in a set of 13 tumors with an ambiguous diagnosis, for which DPN was part of the differential diagnosis. The three out of four patients showing canonical DPN mutation profiles were the only β-catenin-positive cases. We conclude that nuclear β-catenin expression, independently from CCND1 expression, in a dermal melanocytic tumor is an argument for its classification as DPN. In ambiguous cases and in early combined DPN lesions, this antibody can be helpful as a screening tool. β-Catenin is also potentially expressed in a subset of malignant melanomas with CTNNB1 mutations.

http://bit.ly/2N0SP8M

Recent success and limitations of immune checkpoint inhibitors for cancer: a lesson from melanoma

Abstract

Several researches have been carried over the last few decades to understand of how cancer evades the immune system and thus to identify therapies that could directly act on patient's immune system in the way of restore or induce a response to cancer. As a consequence, "cancer immunotherapy" is conquering predominantly the modern scenario of the fight against cancer. The recent clinical success of immune checkpoint inhibitors (ICIs) has created an entire new class of anti-cancer drugs and restored interest in the field of immuno-oncology, leading to regulatory approvals of several agents for the treatment of a variety of malignancies. The first to be approved in 2011 was the anti-CTLA-4 antibody ipilimumab for the treatment of unresectable or metastatic melanoma. Subsequently, the anti-PD-1s, nivolumab and pembrolizumab, received regulatory approvals for the treatment of melanoma and several other cancers. More recently, three anti-PD-L1 antibodies have received approval: atezolizumab and durvalumab for locally advanced or metastatic urothelial carcinoma and metastatic non-small cell lung cancer (NSCLC) and avelumab for the treatment of locally advanced or metastatic urothelial carcinoma and metastatic Merkel cell carcinoma. This review, starting from the results of melanoma trials, highlights in turn different ICIs and data for different indications in several malignancies are included under each drug class.

http://bit.ly/2SKodO7

Two rare cases of endosalpingiosis in the axillary sentinel lymph nodes: evaluation of immunohistochemical staining and one-step nucleic acid amplification (OSNA) assay in patients with breast cancer

Abstract

Benign inclusions, such as endosalpingiosis, in an axillary sentinel lymph node (SLN) can be misdiagnosed as metastatic breast carcinoma. However, endosalpingiosis is rare in lymph nodes above the diaphragm. Among 792 patients with breast carcinoma who underwent sentinel lymph node biopsy at our center, 2 patients have experienced benign glandular inclusions in 3 SLNs, and all of these glandular inclusions were lined with columnar and ciliated epithelial cells. Immunohistochemistry revealed that the epithelial cells were positive for Müllerian markers (e.g., PAX8 and WT-1) and negative for mammary markers (e.g., mammaglobin, GCDFP-15, and GATA3), which confirm the diagnosis of endosalpingiosis. The epithelial cells were positive for CK19 but the one-step nucleic acid amplification assay revealed negative results for the axillary SLNs. Although endosalpingiosis is rare in axillary SLNs, care is needed to identify these rare cases and avoid unnecessary axillary lymph node dissection, overstaging, and overtreatment.

http://bit.ly/2N3kPbT

Does postoperative orbital volume predict postoperative globe malposition after blow-out fracture reconstruction? A 6-month clinical follow-up study

Abstract

Purpose

The aim of this study was to investigate the relationship between intraorbital volume change caused by orbital fracture and globe malposition (GMP) in blow-out fracture patients undergoing surgery and to clarify the significance of different radiologically detected predictors associated with GMP.

Patients and methods

A 6-month prospective follow-up study of unilateral isolated orbital fractures was designed and implemented. The main outcome variable was GMP (present or absent); the secondary outcome was orientation of GMP (horizontal or vertical). The primary predictor variable was postoperative orbital volume difference determined as the difference between the fractured and non-fractured orbit (measured in milliliter and analyzed in milliliter and percentages). The explanatory variables were gender, age, treatment delay from trauma to surgery, fracture site, horizontal depth of the fracture, fracture area, maximum vertical dislocation of the fracture, and preoperative volume difference.

Results

A total of 15 patients fulfilled the inclusion criteria and were followed for 6 months from a larger cohort. GMP was detected in 6/15 patients (40.0%). GMP was more often present in large (≥ 2.5 cm²) fractures (55.6%), in combined orbital fractures (50.0%), and in fractures with preoperative volume difference ≥ 2.5 ml (62.5%) regardless of the postoperative volume correction. Postoperatively, patients with and without GMP displayed overcorrection of orbital volume; 4.15% corresponded to 1.15 ml (with GMP) and 7.6% corresponded to 1.9 ml (without GMP).

Conclusion

GMP was present in large and combined orbital fractures. Clinically detectable postoperative GMP occurred despite satisfactory orbital reconstruction and overcorrection. Mild GMP, however, is not significant for the patient.

http://bit.ly/2SGdjcu

Outcome measures to be considered on asthma in elderly

Purpose of review Asthma is a chronic heterogeneous respiratory disease which is characterized by airflow limitation and variable respiratory symptoms. Asthma in patients more than 65 years of age has an important negative impact on quality of life. The pathophysiology and treatment of asthma in older patients are not as well identified as in younger groups of ages. In this review we intend to outline characteristics found in elderly adults which distinguish them from other age groups of patients with asthma. Recent findings With increasing age, there are alterations in the innate and adaptive immune responses, known as 'immunosenescence.' These age-associated modifications include an altered response after a pathogenic exposure or tissue injury, moderately mediated through an irreversible loss of cellular replication and defective tissue repair. Summary Asthma is a consequence of complex gene–environment interactions, with diversity in clinical presentation and the type and intensity of airway inflammation and remodeling. Age-associated changes in lung physiology and morphology may occur and contribute to asthma. Aging is correlated with a notable decrease in elastic recoil, greater chest wall rigidity, and poor respiratory muscle strength. Underreporting of symptoms by elderly patients is common because of multiple underlying causes. Video abstract http://bit.ly/2I7ztAi. Correspondence to Sandra Nora Gonzalez-Diaz, MD, PhD, Monterrey, Nuevo León, Mexico. Tel: +52 (818) 348 2459; e-mail: sgonzalezdiaz@yahoo.com Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.co-allergy.com). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2Gl9Qu7

Systematic review of the role of corticosteroids in cervicofacial infections

The role of corticosteroids in the management of cervicofacial infections continues to cause controversy. Systemic anti-inflammatory and immunomodulatory effects that reduce swelling and improve symptoms in the head and neck may make these agents an effective addition to the antibiotics used and to surgical management, although this same effect may dull the physiological response to infection, and allow infections to progress. We have systematically reviewed the evidence for the use of corticosteroids in common cervicofacial infections following the PRISMA guidelines.

http://bit.ly/2N0ApoE

Trends in hospitalizations related to anaphylaxis, angioedema and urticaria in the United States

Allergic disorders are a common clinical disorders with high rates of health care usage.1 Studies from developed countries have suggested an increasing prevalence of allergic diseases. 2–4 However, the data on the epidemiology of anaphylaxis, angioedema and urticaria are limited, with only small cohort studies available. 1,4 Recent studies from the United Kingdom (UK) and Australia have noted marked increase in hospitalizations related to urticaria, angioedema and anaphylaxis.1,4 Epidemiological study and incidence data of these conditions, however, depend on several factors, including diagnostic criteria used, variation in patient surveys, disease incidence in the general population and also diagnostic awareness among physicians.

http://bit.ly/2E6vcc9

Does angioedema influence the quality of life in chronic spontaneous urticaria patients?

Chronic spontaneous urticaria (CSU) symptoms are wheals in a number of cases accompanied by recurrent angioedema. The proportion of CSU patients manifesting both wheals and angioedema and those reporting only one type of symptoms is different - a similar number of patients experience both symptoms or wheals only, whereas 1–13% experience angioedema only1,2. Symptoms of CSU have a detrimental influence on patients' quality of life. Additionally, the coexistence between angioedema symptoms and wheals is related to prolonged disease duration2.

http://bit.ly/2UTwooX

Non Familial Cherubism: A Case Report

Abstract

Cherubism might occur in solitary cases or in several members of the family, often in many generations. Treatment depends on the clinical course of the disease. The reported case is an example of solitary sporadic occurrence within a family, which is a less documented condition in the literature.

http://bit.ly/2N0BFIs

Safety of outpatient admission and comparison of different surgical techniques in adult tonsillectomy

Abstract

Purpose

To investigate the safety of outpatient admission and the effects of surgical technique in tonsillectomy operations of adult patients.

Methods

The digital database was scanned for patients aged ≥ 15 years that underwent tonsillectomy in our institution between years 2014 and 2018. Demographic and clinical characteristics, the surgical technique, length of stay (LOS) in hospital, re-admissions after discharge, complications and interventions performed were recorded.

Results

A total of 276 patients met the inclusion criteria, comprising 139 (50.4%) females and 137 (49.6%) males with a mean age of 27.17 ± 9.41 years. The most common indication was recurrent tonsillitis (n = 223, 80.8%), and surgical techniques used were bipolar scissors (CURIS^®, Sutter Medizintechnik, Germany) (n = 137, 49.6%), cold dissection (n = 75, 27.2%) and/or plasma blade (PEAK Surgical, Medtronic, USA) (n = 64, 23.2%). A total of 43 (15.5%) re-admissions from 37 (13.4%) patients were recorded because of bleeding (n = 33, 70.2%) and/or odynodysphagia (n = 13, 27.7%). Non-surgical interventions were sufficient in 32 (74.4%) cases, while surgical interventions were required in 11 (25.6%) patients. In patients where "hot" techniques (bipolar scissors, plasma blade) were used and in patients with complaints in the first 24 h postoperatively, significantly increased rates of elongated LOS values for more than 1 day were determined (p < 0.01, p < 0.001).

Conclusions

Adult tonsillectomy is a safe surgical procedure with low complication, re-operation and mortality rates. Significantly increased rates of elongated LOS values for more than 1 day and re-admissions after discharge were determined in those patients having complications in the first 24 h postoperatively. Cold dissection seems to be more advisable than hot techniques for outpatient tonsillectomy among adult patients.

http://bit.ly/2BrR687

Different surface modifications combined with universal adhesives: the impact on the bonding properties of zirconia to composite resin cement

Abstract

Objective

The purpose of this study was to analyze the impact of plasma treatment and (universal adhesives) UAs on the bonding properties of zirconia.

Material and methods

Zirconia specimens (N = 744; n = 186/pretreatment) were prepared, highly polished, and pretreated: (i) plasma (oxygen plasma, 10s, 5 mm), (ii) airborne-particle abrasion (alumina, 50 μm, 0.05 MPa, 5 s, 10 mm), (iii) airborne-particle abrasion + plasma, and (iv) without pretreatment (highly polished surface). Surface roughness (R_a) and surface free energy (SFE) were measured (n = 6/pretreatment). Tensile bond strength (TBS) specimens (n = 180/pretreatment) were further divided (n = 18/conditioning): Clearfil Ceramic Primer (PCG), All-Bond Universal (ABU), Adhese Universal (AU), Clearfil Universal Bond (CUB), G-Premio Bond (GPB), Futurabond U (FBU), iBond Universal (IBU), One Coat 7 Universal (OCU), Scotchbond Universal (SBU), and no conditioning. PCG was luted with Panavia F2.0 and the remaining groups with DuoCem. After storage in distilled water (24 h; 37 °C) and thermocycling (5000×; 5 °C/55 °C), TBS was measured and fracture types (FTs) were determined. Data were analyzed using univariate ANOVA with a partial eta square (ƞ_P²), the Kruskal–Wallis H, the Mann–Whitney U, and the Chi² test (P < .05).

Results

Plasma treatment resulted in an increase of SFE but had no impact on R_a. Airborne-particle abrasion resulted in the highest R_a and a higher TBS when compared with plasma and non-treatment. SBU and AU obtained a higher TBS when compared with PCG. OCU, FBU, ABU, IBU, and GPB indicated comparable TBS to PCG. CUB revealed the lowest TBS.

Conclusions

Plasma treatment cannot substitute airborne-particle abrasion when bonding zirconia but MDP-containing adhesives are essential for successful clinical outcomes.

Clinical relevance

Airborne-particle abrasion with a low pressure (0.05 MPa) in combination with UAs promotes the clinical success of adhesively bonded zirconia restorations.

http://bit.ly/2SOhC5m

Non Familial Cherubism: A Case Report

Abstract

http://bit.ly/2N0BFIs

Development of an Experimental System “Computer-Aided Diagnosis in Neurotology (CADINO)” for Vertigo

Abstract

Computer-based medical diagnosis expert systems, when used by clinicians, familiar with the limitations of the system, were found both accurate and educationally helpful. Vertigo is one of the most common complaints of the patients and the specialists who manage these patients are not easily available. Diagnostic expert system can help clinicians including general practitioners in providing reasonable diagnostic suggestions while dealing with patients with vertigo/dizziness when the specialist doctors are not available. To provide an understanding about the method of making an expert system "Computer-Aided Diagnosis in Neurotology (CADINO)" for dizzy patients and highlight its potential uses. CADINO, developed during this original research project, is an expert computer program which is capable of making diagnoses in patients with vertigo. CADINO includes more than 100 causes of vertigo. It was developed in Microsoft Office using hyperlinks. CADINO has the potential of making diagnoses in patients with vertigo. It differs from most other programs for computer-assisted diagnosis in the generality of its approach and knowledge base. Specific deficiencies of CADINO include its inability to explain its thinking. CADINO can broaden the clinicians' scope and awareness regarding the findings which are important for making the differential diagnoses in patients with vertigo/dizziness. Though the CADINO on its face value seems to improve patient safety and quality of care by enhancing knowledge and cognitive skills of the clinicians, yet it remains a research tool and will need clinical evaluation in terms of diagnostic accuracy.

http://bit.ly/2TKQEsK

Roles of Ki-67 and p16 as biomarkers for unknown primary head and neck squamous cell carcinoma

Abstract

Purpose

Treatment guidelines have not been established for unknown primary head and neck squamous cell carcinoma (SCC). For these patients, chemoradiotherapy (CRT) can provide a better prognosis than that for patients with other head and neck cancers. The presence of HPV in the tumor is associated with a better outcome. However, not all patients with HPV-positive unknown primary head and neck SCC experience good treatment outcomes in actual clinical settings.

Methods

We thus retrospectively determined the Ki-67 proliferation index and p16 expression status to assess the associations of these parameters with treatment outcomes of patients with unknown primary head and neck SCC.

Results

The subjects were 13 patients who underwent CRT after surgery or excision biopsy between 1999 and 2016. The 2- and 5-year overall survival (OS) rate was 76.9% and 68.4%, respectively. The prognostic factor was age. There was no significant difference in survival between patients with a high Ki-67 vs. low Ki-67 or between patients with p16-positive vs. p16-negative metastases OS. However, all p16-positive patients with low Ki-67 showed good locoregional control.

Conclusions

The combination of ki67 expression and p16 expression status may allow prediction of local control more accurately than p16 expression status alone.

http://bit.ly/2TM1Bdl

Effects of azathioprine and its metabolites on inflammatory cytokines in human nasal polyp organ cultures

Background

Oral steroids are recommended for the treatment of nasal polyps (NPs), but prolonged use is avoided because of side effects. Topical steroids can also control NPs without significant complications; however, the response to this is partially successful, and additional therapies are needed to treat glucocorticoid‐resistant NPs. Azathioprine (AZA) and its first metabolite 6‐mercaptopurine (6‐MP) are important immunosuppressants used for the therapy of various diseases. The aim of this study was to investigate the effects of AZA and 6‐MP on inflammatory cytokines in organ‐cultured NPs.

Methods

NP explants were cultured using an air‐liquid interface method. Cultures were maintained in the absence and presence of steroid, AZA, and 6‐MP for 72 hours. Elaboration of cytokines tumor necrosis factor alpha (TNF‐α), interleukin (IL)‐2, IL‐4, IL‐5, and IL‐13 into the supernatant was quantitated using the enzyme‐linked immunosorbent assay (ELISA). The messenger RNA (mRNA) expression levels of TNF‐α, IL‐2, IL‐4, IL‐5, and IL‐13 in cultured mucosa were measured using real‐time polymerase chain reaction. Hematoxylin and eosin staining of cultured mucosa was performed to observe inflammatory cells. Immunohistochemistry was done to evaluate the distribution pattern of inflammatory cytokines in NP explants.

Results

On histologic examination, less inflammatory cell infiltration was found in NPs treated by steroid, AZA, and 6‐MP than in control, but there was no statistical significance (p = 0.218). On immunohistochemistry, IL‐13 showed a steady falling tendency in submucosal glands by steroid, AZA, and 6‐MP. Expression of TNF‐α, IL‐2, IL‐4, IL‐5, and IL‐13 mRNA in the NPs treated by steroid, AZA, and 6‐MP were significantly lower than those of the control (p < 0.001 for all). By ELISA, IL‐2 and IL‐13 were significantly lower with topical steroid, AZA, and 6‐MP treatment (p = 0.012 and p < 0.001).

Conclusion

Topical AZT decreases inflammatory cytokines on human NP explants and this could have future therapeutic implications for NPs.

http://bit.ly/2Gqy99U

Effect of commercial nasal steroid preparation on bacterial growth

Background

Topical budesonide (Pulmicort; AstraZeneca AB, Sodertalje, Sweden) is commonly used in the management of chronic rhinosinusitis (CRS). Although its use is due to its perceived anti‐inflammatory effect, studies have suggested that it may also have antibacterial properties. To make the hydrophobic steroid molecule suitable for topical administration, pharmaceutical excipients are used in commercial steroid formulations. Herein we investigated the antibacterial action of commercial budesonide and its excipients.

Methods

Planktonic and biofilm forms of Staphylococcus aureus and methicillin‐resistant Staphylococcus aureus (MRSA) were treated with Pulmicort or its excipients at clinically relevant concentrations. Bacterial growth was determined by optical density, resazurin assays, colony‐forming unit counts, and Giemsa staining. Minimum inhibitory concentration (MIC) studies assessed excipients' potentiation of antibiotics. Experiments were conducted in triplicate and results analyzed using one‐way analysis of variance.

Results

There was significant reduction in planktonic and biofilm growth of S aureus and MRSA on exposure to budesonide (p < 0.0001) and its excipients (p < 0.0001). Excipient ethylene diamine‐tetraactic acid (EDTA) demonstrated an antibacterial property even at the low concentrations used in topical preparations (p < 0.0001). With amoxicillin, excipients exhibited a potential additive/synergistic effect on MIC, whereas erythromycin and aminoglycosides showed an antagonistic action.

Conclusion

The commercial product Pulmicort has a direct antibacterial effect on the planktonic and biofilm forms of S aureus and MRSA. This effect is at least in part mediated through the excipient EDTA in the product. Excipients also influenced the antimicrobial activity of antibiotics depending on the bacterial strain and antibiotic tested.

http://bit.ly/2Im2jx1

Ein 7‑jähriger Junge mit leicht juckenden, weißlichen, stecknadelkopfgroßen Papeln

http://bit.ly/2IhG5MC

HPV as a marker for molecular characterization in head and neck oncology: Looking for a standardization of clinical use and of detection method(s) in clinical practice

Abstract

Background

A consensus about the most appropriate diagnostic method(s) for head and neck human papillomavirus (HPV)‐induced carcinogenesis is still lacking because most of the commercially available assays have been designed for the cervix.

Methods

This article summarizes current data and trends concerning HPV diagnostic strategies in oropharyngeal squamous cell carcinoma (OPSCC). Six main approaches are described.

Results

The diagnostic gold standard for HPV‐related OPSCC, focusing on E6/E7 mRNA detection, requires fresh samples. Because most frequently available samples are formalin‐fixed paraffin‐embedded (FFPE), the pros and cons of the different approaches were analyzed.

Conclusions

In the FFPE samples, the immunohistochemistry of p16, which is considered appropriate to assess HPV‐driven carcinogenesis in OPSCC according to the 8th American Joint Committee on Cancer TNM classification, may not be specific enough to become the diagnostic standard in the perspective of treatment deintensification. p16 may play a safer role in combination with another highly sensible assay. Other promising approaches are based on DNA detection through real‐time polymerase chain reaction and RNAscope.

http://bit.ly/2GFdCxO

Development of an Experimental System “Computer-Aided Diagnosis in Neurotology (CADINO)” for Vertigo

Abstract

http://bit.ly/2TKQEsK

Radiotherapy Plus Concurrent Nimotuzumab or Cisplatin in Stage II-III Nasopharyngeal Carcinoma

Conditions: Nasopharyngeal Carcinoma; Nasopharyngeal Neoplasms; Nasopharyngeal Diseases; Head and Neck Neoplasm
Interventions: Drug: Nimotuzumab; Drug: Cisplatin
Sponsors: Sun Yat-sen University; Affiliated Cancer Hospital & Institute of Guangzhou Medical University; Guangdong General Hospital; First Affiliated Hospital, Sun Yat-Sen University
Recruiting

http://bit.ly/2Go1ge2

Ponatinib in Advanced or Metastatic Medullary Thyroid Cancer

Condition: Medullary Thyroid Cancer
Intervention: Drug: Ponatinib
Sponsors: Antonio Fojo; Millennium Pharmaceuticals, Inc.
Not yet recruiting

http://bit.ly/2Ia7foi

Feasibility and Tolerance of Nivolumab Neoadjuvant Immunotherapy in High Risk HPV Driven Oropharynx Cancer

Condition: Oropharynx Cancer
Interventions: Drug: Nivolumab; Radiation: Chemoradiation
Sponsor: UNICANCER
Not yet recruiting

http://bit.ly/2Ia764e

Role of Microbiome as a Biomarkers in Locoregionally-Advanced Oropharyngeal Squamous Cell Carcinoma 2

Condition: Head and Neck Squamous Cell Carcinoma
Intervention: Drug: MET-4
Sponsors: University Health Network, Toronto; NuBiyota
Not yet recruiting

http://bit.ly/2GpiFTq

A Single Dry Needling Session of the Obliquus Capitis Inferior for the Altered Sensorimotor Function in People With Neck Pain

Conditions: Whiplash Syndrome; Neck Pain
Interventions: Other: dry needling; Other: Sham needling
Sponsor: University of Valencia
Recruiting

http://bit.ly/2Ia6XxI

Radikale Prostatektomie beim lokal fortgeschrittenen und metastasierten Prostatakarzinom

Zusammenfassung

Hintergrund

Der Anteil der Patienten mit lokal fortgeschrittenem oder (oligo)metastasiertem Prostatakarzinom (PCa) hat in den letzten Jahren zugenommen. Im Vergleich zu Patienten mit lokalisiertem PCa ist ohne eine Lokaltherapie das Risiko lokaler Komplikationen höher und die onkologischen Ergebnisse schlechter.

Ziel

Der Stellenwert der radikalen Prostatektomie (RP) bei klinisch lokal fortgeschrittenem oder metastasiertem Prostatakarzinom wird erörtert.

Material und Methoden

Es erfolgten eine systematische Literaturrecherche und Zusammenstellung relevanter Artikel aus PubMed und Medline.

Ergebnisse

Aktuelle Leitlinien empfehlen die RP als eine der Behandlungsoptionen bei Patienten mit lokal fortgeschrittenem PCa. Die Durchführung einer RP bei Patienten mit metastasiertem PCa hingegen sollte nur innerhalb klinischer Studien durchgeführt werden. Im Vergleich zu Patienten ohne eine lokale Behandlung verringert die RP das Risiko lokaler Komplikationen deutlich. Während beim lokal fortgeschrittenen PCa ein klarer onkologischer Nutzen für die RP gezeigt werden konnte, ist der Nutzen bei Patienten mit metastasierten Erkrankungen immer noch umstritten. Aufgrund schwierigerer Operationsbedingungen und einer erhöhten Wahrscheinlichkeit für ein multimodales Therapiekonzept werden in der Literatur eine höhere perioperative Morbidität und schlechtere funktionelle Ergebnisse im Vergleich zu Patienten mit lokalisiertem PCa berichtet.

Schlussfolgerung

Während die RP für Patienten mit lokal fortgeschrittenem PCa genauso wie im lokalisierten Stadium durchgeführt werden kann, muss der Nutzen bei Vorliegen einer metastasierten Erkrankung weiter geklärt werden. Alle Patienten, die sich einer RP unterziehen, müssen besonders im Hinblick auf das mögliche schlechtere funktionelle Ergebnis beraten werden.

http://bit.ly/2GnCxXh

Gastrointestinal stromal tumor of the lesser omentum: a case report and review of the literature

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Abstract

A 72-year-old woman visited our hospital for a routine health examination and underwent abdominal ultrasonography, which revealed an intra-abdominal tumor. Abdominal computed tomography and magnetic resonance imaging showed a well-defined solid mass of ~3 cm in diameter lying adjacent to the stomach. The mass was preoperatively diagnosed as gastrointestinal stromal tumor of the stomach. At laparotomy, a well-encapsulated tumor was found in the lesser omentum. It was slightly adherent to the stomach wall but was removed without difficulty. Therefore, only enucleation of the tumor was performed. The excised tumor, which was 35 × 30 × 25 mm³ in size, had a white cut surface without necrosis or hemorrhage. According to the pathological findings, the tumor was classified as a very low-risk gastrointestinal stromal tumor originating in the lesser omentum. Gastrointestinal stromal tumor of the lesser omentum is very rare, and surgical resection is the only effective treatment modality.

http://bit.ly/2GoeDdY

Perforation of Heterotopic Gastric Mucosa in ileal duplication in an adult: A case report

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Abstract

Bowel duplication with heterotopic gastric mucosa (HGM) is a known but uncommon pathology. It usually presents with intussusception or melena in the early years of life. We present a case of ileal duplication with HGM with a rare presentation of bowel perforation and peritonitis in an adult male.

http://bit.ly/2IhvPE6

Massive adult cystic lymphangioma of the breast

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Abstract

Adult cystic lymphangiomas are exceedingly rare tumors resulting from malformation of the lymphatic vessels. Like their pediatric counterparts, these lesions almost exclusively involve the head and neck. However, adult cystic lymphangiomas have been reported in several organs. Those involving the breast are exceptionally rare, with only a few reported instances. Here, we present the case of a 27-year-old woman who attended a surgical breast clinic with a 2-year history of a large, disfiguring left breast mass. Pathology was consistent with adult cystic lymphangioma of the breast. Measuring 21.0 × 20.0 × 6.0 cm³, this represents the second largest of its kind and the largest reported case in an African American patient.

http://bit.ly/2GmoZeG

Approach to a large rare diaphragmatic hernia in a patient undergoing cardiac surgery

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Abstract

Hernia of Morgagni is an unusual congenital defect of the sternal portion of the diaphragm. Its concurrence with cardiac surgical pathology is rarely described in the literature. Notwithstanding, huge hernia of Morgagni have been noted to cause serious peri-operative impediment and complications. We report the case of a 50-year-old gentleman with a massive Morgagni hernia that threatened strangulation during cardiopulmonary bypass. We describe the combined surgical approach undertaken to repair this hernia, with an accompanying review of the literature relating to misadventure and management of similar large hernia coinciding with cardiac surgery.

http://bit.ly/2I9NSvM

Recurrent acute pancreatitis in a patient with both gallbladder and cystic duct agenesis and polycystic liver disease

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Abstract

Agenesis of the gallbladder and cystic duct is a rare congenital anomaly occurring in <0.1% of the population. However, combined gallbladder and cystic duct agenesis (CDA) with polycystic liver disease associated with recurrent acute pancreatitis (RAP) has not been reported earlier. Herein we report a case of a 36-year-old female patient who was admitted to the hospital and successfully treated for acute pancreatitis most probably caused in the background of gallbladder and CDA with polycystic liver disease. In case of non-visualization of gallbladder with the presence of biliary symptoms after repeated ultrasonographic examinations, advanced techniques like MRCP, computed tomography, EUS and even endoscopic retrograde cholangiopancreatography (ERCP) to visualize biliary anatomy must be conducted before any surgical intervention. We present a case of gallbladder and CDA causing RAP by the formation of microlithiasis treated successfully with ERCP and without any unnecessary surgery, its management and review of the literature is assessed.

http://bit.ly/2GkWNsx

Spontaneous regression of a sporadic intra-abdominal located desmoid-type fibromatosis

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Abstract

Background

Desmoid-type fibromatosis (DTF) is a rare benign proliferation of myofibroblasts with an unpredictable disease course. Treatment of intra-abdominal located DTF is difficult because of the close relationship with vital organs.

Case presentation

A healthy young male presents with an asymptomatic palpable mass in the lower right abdominal quadrant. A computed tomography shows a 10 × 7 cm² pear-shaped mass, and pathological examination revealed DTF. A watchful waiting approach was initiated, as the patient was asymptomatic and surgery would imply a significant amount of intestinal resection. After a follow-up of 2 years, the tumor has regressed spontaneously and the patient is still without symptoms.

Conclusions

DTF is a difficult to treat condition where individualized management is appropriate. An asymptomatic patient could be treated with a watchful waiting approach, even with intra-abdominal location. Thereby sparing unnecessary morbidity as the tumor can be stable for many years or even regress spontaneously.

http://bit.ly/2I8Ge4M

Synovial Chondromatosis of the Temporomandibular Joint: A clinical and arthroscopic study of 16 cases

Publication date: Available online 11 February 2019

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Lee Mui Lee, Yao Min Zhu, Dan Di Zhang, Yong Qiang Deng, Ying Gu

Summary

Objective(s)

Present and overview the clinical finding, management and arthroscopic study of Synovial Chondromatosis (SC) cases in Temporomandibular Joint (TMJ) treated by our team.

Study Design

During year 2008-2018,16 TMJ SC cases were treated and reviewed. The clinical manifestations, radiographic data, arthroscopic study and pathologic findings were recorded and analyzed.

Results

Average age of first visit was 32.68.The ratio of male/female was 2/14,right/left was 7/9.The most common symptoms were pain, continuous crepitus and limited mouth opening (LMO).All cases were examined by computed tomography (CT) and magnetic resonance imaging (MRI) preoperative and proved by pathology postoperative. The diagnostic rates of CT and MRI were 12.5% and 93.75% respectively.1 case could not be detected by both, but by arthroscopy. Particles in all cases occurred in the upper joint cavity and were all removed by arthroscopic technique. No recurrence was found after 3 years follow-up.

Conclusion(s)

MRI and arthroscopic technique could be the first choice in the diagnosis and treatment of SC. Most cases were in stage 3 of the disease at the first visit. Low recurrence rate may be attributed to the improvement of intra-articular environment after surgery. Larger sample sizes are needed for further study.

http://bit.ly/2TKGjgv

The absolute and relative effects of presurgical nasoalveolar moulding in bilateral cleft lip and palate patients compared with nasal growth in healthy newborns

Publication date: Available online 11 February 2019

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Florian D. Grill, Andrea Rau, Franz X. Bauer, Fiona Hellmundt, Bettina Hilmer, Maximilian Roth, Alexandra V. Behr, Klaus-Dietrich Wolff, Denys J. Loeffelbein, Lucas M. Ritschl

Abstract

Background

This study investigated the efficiency of nasoalveolar moulding (NAM) in patients presenting with bilateral cleft lip and palate (BCLP). It focused explicitly on nasal outcome and therefore made comparisons with healthy age-matched infants with normal nasal development.

Methods

Nasal impressions from 19 BCLP patients were analysed at the beginning and at the end of NAM treatment. In addition, nasal impressions from 32 healthy newborns were taken monthly for 4 months. The casts were digitalized and analysed, using defined anatomic landmarks, by two independent observers. Initial values were compared with outcome parameters at the end of NAM therapy and with the healthy cohort.

Results

NAM significantly elongated the columella in BCLP patients, with an increase of 106.5% versus 14.5% in healthy newborns. Nostril height showed significant expansion from 4.2 mm to 5.6 mm on the right side, and from 4.3 mm to 6.2 mm on the left side.

Conclusion

NAM significantly elongated columella length and increased nostril height. The comparison with healthy newborns showed the effectiveness of early cartilage moulding. Detailed knowledge about absolute and relative early nasal growth was gained. However, despite highly effective NAM treatment in BCLP, nasal dimensions will not reach healthy proportions.

http://bit.ly/2Bv1ZWQ

Madurella mycetomatis infection of the buttock in an Eritrean refugee in Switzerland: a case report

Mycetoma is a neglected infectious disease caused by a fungus (eumycetoma) or bacteria (actinomycetoma); it is characterized by chronic local inflammation with sinus formation and purulent discharge. Its cours...

http://bit.ly/2GEeO4v

Factors of success of low‐dose macrolides in chronic sinusitis: Systematic review and meta‐analysis

Objective

To assess the prognostic factors that predict favorable outcomes of low‐dose macrolides (LDMs) in treating chronic rhinosinusitis (CRS).

Methods

Randomized controlled trials studying the effects of LDMs in treating CRS were included. Data were pooled for meta‐analysis. Primary outcome was Sino‐Nasal Outcome Test (SNOT). Six prognostic factors: CRS subtypes, serum immunoglobulin (Ig)E level, membered lactone ring of macrolides, concurrent endoscopic sinus surgery (ESS), and dosage and duration of the LDMs were assessed by subgroup analyses.

Results

Ten studies (608 patients) met the inclusion criteria. LDMs and placebo were not different in SNOT improvement (standardized mean difference [SMD] = −0.23, 95% confidence interval [CI]: −0.69 to 0.24). Subgroup analyses showed that the effects favored LDMs in the patients with CRS without polyps (SMD = −0.64, 95% CI: −1.01 to −0.27) compared to CRS with polyps, and the patients receiving a half dose (SMD = −0.64, 95% CI: −1.01 to −0.27) compared to a very low dose. There was no difference in SNOT improvement between LDMs plus standard treatment compared to standard treatment (SMD = −0.52, 95% CI: −1.57 to 0.53). Subgroup analyses showed that the effects favored LDMs in the patients receiving LDMs for a duration of 24 weeks (SMD = −1.68, 95% CI: −2.40 to −0.95) compared to 8 and 12 weeks. There was no difference between the 14‐membered and 15‐membered ring LDMs. Assessment of concurrent ESS found mixed results. Serum IgE level could not be assessed.

Conclusions

LDMs provided favorable outcomes in patients with CRS without polyps. A half dose of macrolides should be given for a duration of 24 weeks.

Level of Evidence

1a Laryngoscope, 2019

http://bit.ly/2Sq8YL3

In reference to pH‐neutralizing esophageal irrigations as a novel mitigation strategy for button battery injury

http://bit.ly/2DumByC

Therapieoptionen des lokal begrenzten Prostatakarzinoms

Zusammenfassung

Etablierte Therapieoptionen des lokalisierten Prostatakarzinoms (T1–2N0M0 [T: Tumorgrad, N: Lymphknotenstatus, M: Metastasen]), welche aufgrund des üblicherweise langsamen Krankheitsverlaufs bei Patienten mit einer Lebenserwartung von mindestens 10 Jahren empfohlen werden, sind die aktive Überwachung, die radikale Prostatektomie, die Brachytherapie und die perkutane Bestrahlung. Die Wahl der Therapieform orientiert sich am Tumorstadium bzw. der Risikogruppe, den Komorbiditäten sowie der Patientenpräferenz. Neben dem onkologischen Ergebnis sind die potenziellen Nebenwirkungen der jeweiligen Lokaltherapie mit dem Betroffenen zu diskutieren, wobei insbesondere Einschränkungen der Harnkontinenz und Erektionsfähigkeit möglich sind.

http://bit.ly/2RVHQOT

Langzeitlebensqualität bei Patienten mit Kopf-Hals-Tumoren

Zusammenfassung

Hintergrund

Die Diagnose eines Kopf-Hals-Tumors geht zwar nicht mit einer vielversprechenden Langzeitprognose einher, aber je nach Art des Tumors überleben annähernd 50 % der Patienten wenigsten 5 Jahre. Es gibt nur wenige wissenschaftliche Belege für die Lebensqualität dieser Langzeitüberlebenden.

Methoden

In der Datenbank PubMed wurde eine Suche nach Artikeln durchgeführt, die Ergebnisse zur Lebensqualität für Patienten mit einem Kopf-Hals-Tumor und einem Überleben von mindestens 5 Jahren enthalten.

Ergebnisse

Dabei wurden 8 Studien aus verschiedenen Ländern gefunden, in denen 4 verschiedene Messinstrumente verwendet wurden. Die Ergebnisse zeigen, dass die Überlebenden vor allem Schwierigkeiten mit dem Schlafen, Schmerzen, Fatigue, Dyspnoe, Schlucken und Kauen haben; die funktionellen Werte waren manchmal niedriger (schlechter) als die Ergebnisse in der Allgemeinbevölkerung, in einem Fall aber auch gleich.

Schlussfolgerung

Weiterhin fehlt ein klares Bild über die Lebensqualität in dieser speziellen Patientengruppe. Es gibt wissenschaftliche Belege dafür, dass einige Patienten Schwierigkeiten mit dem Schlucken und einen trockenen Mund haben sowie Probleme mit dem Schlafen, Fatigue, Schmerzen und Dyspnoe. Eine Studie mit einer großen Stichprobe aus dieser speziellen Patientengruppe ist erforderlich.

http://bit.ly/2SLo8dd

Phase II clinical trial of adoptive cell therapy for patients with metastatic melanoma with autologous tumor-infiltrating lymphocytes and low-dose interleukin-2

Abstract

Adoptive cell therapy using autologous tumor-infiltrating lymphocytes (TIL) has shown significant clinical benefit, but is limited by toxicities due to a requirement for post-infusion interleukin-2 (IL-2), for which high dose is standard. To assess a modified TIL protocol using lower dose IL-2, we performed a single institution phase II protocol in unresectable, metastatic melanoma. The primary endpoint was response rate. Secondary endpoints were safety and assessment of immune correlates following TIL infusion. Twelve metastatic melanoma patients were treated with non-myeloablative lymphodepleting chemotherapy, TIL, and low-dose subcutaneous IL-2 (125,000 IU/kg/day, maximum 9–10 doses over 2 weeks). All but one patient had previously progressed after treatment with immune checkpoint inhibitors. No unexpected adverse events were observed, and patients received an average of 6.8 doses of IL-2. By RECIST v1.1, two patients experienced a partial response, one patient had an unconfirmed partial response, and six had stable disease. Biomarker assessment confirmed an increase in IL-15 levels following lymphodepleting chemotherapy as expected and a lack of peripheral regulatory T-cell expansion following protocol treatment. Interrogation of the TIL infusion product and monitoring of the peripheral blood following infusion suggested engraftment of TIL. In one responding patient, a population of T cells expressing a T-cell receptor Vβ chain that was dominant in the infusion product was present at a high percentage in peripheral blood more than 2 years after TIL infusion. This study shows that this protocol of low-dose IL-2 following adoptive cell transfer of TIL is feasible and clinically active. (ClinicalTrials.gov identifier NCT01883323.)

http://bit.ly/2RX8p6u

Metronomic cyclophosphamide attenuates mTOR-mediated expansion of regulatory T cells, but does not impact clinical outcome in patients with metastatic renal cell cancer treated with everolimus

Abstract

Introduction

Metastatic renal cell cancer (mRCC) patients have a median overall survival (mOS) of approximately 28 months. Until recently, mammalian target of rapamycin (mTOR) inhibition with everolimus was the standard second-line treatment regimen for mRCC patients, improving median progression-free survival (mPFS). Treatment with everolimus supports the expansion of immunosuppressive regulatory T cells (Tregs), which exert a negative effect on antitumor immune responses. In a phase 1 dose-escalation study, we have recently demonstrated that a low dose of 50 mg oral cyclophosphamide once daily can be safely combined with everolimus in mRCC patients and prevents the everolimus-induced increase in Tregs.

Materials and methods

In a multicenter phase 2 study, performed in patients with mRCC not amenable to or progressive on a vascular endothelial growth factor (VEGF)-receptor tyrosine kinase inhibitor (TKI) containing treatment regimen, we assessed whether the addition of this metronomic dosing schedule of cyclophosphamide to therapy with everolimus could result in an improvement of progression-free survival (PFS) after 4 months of treatment.

Results

Though results from this study confirmed that combination treatment effectively lowered circulating levels of Tregs, addition of cyclophosphamide did not improve the PFS rate at 4 months. For this reason, the study was abrogated at the predefined interim analysis.

Conclusion

Although the comprehensive immunomonitoring analysis performed in this study provides relevant information for the design of future immunotherapeutic approaches, the addition of metronomic cyclophosphamide to mRCC patients receiving everolimus cannot be recommended.

http://bit.ly/2WYr7yf

Editorial Board

Publication date: March 2019

Source: Molecular Immunology, Volume 107

Author(s):

http://bit.ly/2IbBzPw

Does angioedema influence the quality of life in chronic spontaneous urticaria patients?

Publication date: Available online 12 February 2019

Source: Annals of Allergy, Asthma & Immunology

Author(s): A. Oles-Krykowska, K. Badura-Brzoza, Z. Brzoza

http://bit.ly/2UW1VGW

Identification of Four Novel Mutations in MYO7A Gene and Their Association with Nonsyndromic Deafness and Usher Syndrome 1B

Publication date: Available online 11 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Yunlong Li, Jie Su, Chao Ding, Fangqing Yu, Baosheng Zhu

Abstract

Introduction

MYO7A gene has been shown to be associated with Usher syndrome 1B and nonsyndromic deafness. Although a lot of mutations have been reported in MYO7A gene, novel MYO7A mutations are continuously to be identified.

Methods

Targeted next generation sequencing was performed on the two unrelated patients with Usher syndrome 1B and nonsyndromic deafness respectively. The identified mutations from targeted next generation sequencing were further validated by Sanger sequencing, and analyzed by bioinformatics tools, like SIFT, Polyphen-2, PyMOL, I-Mutant 2.0 and so on.

Results

By analyzing the sequencing data of these two patients, four novel MYO7A mutations were revealed: (i) MYO7A p.Tyr560Ser and p.Ala2039Pro were associated with Usher syndrome 1B. (ii) MYO7A c.2187 +2_+8 delTGAGCAC and p.Leu728Pro were related to nonsyndromic hearing loss. These mutations were further proved to be possibly disease-causing by segregation analysis, conservation analysis and bioinformatics tools.

Conclusions

Four novel MYO7A mutations were identified in the present study. These findings provided new evidence for the genetic counseling of Usher syndrome 1B and nonsyndromic deafness.

http://bit.ly/2UUitia

Comparison of three different surgical techniques for designing pharyngeal flaps according to findings of videonasopharyngoscopy and multiplanar videofluoroscopy

Publication date: Available online 11 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Pablo Antonio Ysunza, Kongkrit Chaiyasate, Matthew Rontal, Kenneth Shaheen, Blake Bartholomew

Abstract

Background

Velopharyngeal insufficiency (VPI) occurs when the velopharyngeal sphincter (VPS) is unable to completely seal anatomical closure between the nasal and oral cavities during speech. Palatal repair can restore VPS function but the prevalence of VPI after repair has been reported ranging from 20% to 40%. The combination of flexible videonasopharyngoscopy (FVNP) and multiplanar videofluoroscopy (MPVF) has been reported as the best approach for assessing the VPS mechanism and planning effective surgical procedures aimed to correct VPI.

Objective

To study the outcome of three different techniques for performing pharyngeal flaps with the common denominator of individually designing the flap according to findings of VFNP and MPVF.

Material and Methods

A total of 140 cases of pharyngeal flap surgery were reviewed. Three surgeons performed 3 different surgical techniques. All cases underwent nasometry, VNP and MPVF preoperatively. All surgical procedures were carefully planned and designed according to findings of VNP and MPVF.

Results

Nasal emission was completely eliminated in all cases. One-hundred-thirty-four patients (95%) demonstrated mean nasalance within normal limits after the surgical procedure whereas 6 patients persisted with mean nasalance scores above reference values postoperatively. There were no intraoperative or postoperative complications in any of the cases. No clinical data of sleep disordered breathing was detected in any of the cases after 2 months of postoperative follow-up. However, one case presented with clinical data of sleep disordered breathing 8 months postoperatively.

Conclusions

The results of this study suggest that as long as pharyngeal flaps are being designed according to the findings of imaging procedures, different surgical techniques can provide similar successful outcomes with minimal complications.

http://bit.ly/2E4cxO4

The anatomical and radiological evaluation of the Vidian canal on cone-beam computed tomography images

Abstract

Introduction

The aim of this study is to explore the anatomy of the Vidian nerve to elucidate the appropriate surgical approach based on preoperative cone-beam computed tomography (CBCT) images.

Materials and methods

The Vidian canal and its surrounding structures were morphometrically evaluated retrospectively in CBCT images of 400 cases by the Planmeca Romexis program. The types of the Vidian canal were determined and seven parameters were measured from the images.

Results

Three types of the Vidian canal according to the relationship with the sphenoid bone were found as follows: the Vidian canal totally protruded into the sphenoid sinus (19.75%), partially protruded into sphenoid sinus (44.37%) and embedded inside bony tissue of the body of sphenoid bone (35.87%). The position of the Vidian canal was medial (34.62%), on the same line (55.12%) and lateral (10.25%) to the medial plate of the pterygoid process. The distance between the Vidian canal and the vomerine crest, the mid-sagittal plane, the round foramen, the palatovaginal canal, and the superior wall of the sphenoid sinus, the length of the Vidian canal and the angle between the Vidian canal and the sagittal plane was found to be 16.69 ± 2.14, 13.80 ± 2.00, 8.88 ± 1.60, 5.83 ± 1.37, 23.98 ± 2.68, 13.29 ± 1.71 mm and 25.78° ± 3.68° in males, 14.62 ± 1.66, 11.43 ± 1.28, 8.51 ± 1.63, 5.78 ± 0.57, 22.37 ± 2.07, 12.91 ± 1.26 mm and 23.43° ± 3.07° in females, respectively.

Conclusions

Our results may assist with proper treatment for surgical procedures around the Vidian canal with a high success rate and minimal complications. Therefore, the results obtained in this study contribute to the literature.

http://bit.ly/2BxwJ9H

Sialendoscopy plus laser lithotripsy in sialolithiasis of the submandibular gland in 64 patients: A simple and safe procedure

Publication date: Available online 11 February 2019

Source: Auris Nasus Larynx

Author(s): Thomas Guenzel, Stephan Hoch, Niels Heinze, Thomas Wilhelm, Christian Gueldner, Achim Franzen, Annekathrin Coordes, Anja Lieder, Susanne Wiegand

Abstract

Objective

To demonstrate the safety and efficiency of holmium laser-assisted lithotripsy during sialendoscopy of the submandibular gland using a retrospective, interventional consecutive case series.

Methods

We performed 374 sialendoscopies between 2008 and 2015 and evaluated all patients regarding clinical symptoms, clinical findings, therapy and outcome. We performed 109 procedures of holmium laser-assisted lithotripsy in 64 patients whose sialoliths measured 5 mm or more in diameter. In addition to retrospective case note reviews, we performed telephone interviews of all patients in January 2017.

Results

We performed 374 consecutive submandibular gland sialendoscopy procedures in 276 patients between 2008 to 2015. Sialolithiasis had either previously been diagnosed, or symptoms highly suggestive of sialolithiasis of the submandibular gland presented in 197 patients.

Holmium laser-assisted Laser lithotripsy was performed in 109 cases (64.9%). Smaller mobile concrement was removed directly either by forceps or wire basket, or following marsupialisation of the submandibular duct. This was the case in 88 patients (29.1%). Three patients (0.8%) required surgical removal of the submandibular gland due to early abscess. The majority of patients (n = 374 procedures; 90.1%) remained symptom-free after two or more years following intervention. In the remaining procedures (n = 37 procedures; 9.9%), patients reported discreet postprandial problems but did not seek medical attention. In total, we managed to preserve the submandibular gland and avoid open surgery in 99% of patients through endoscopic management of submandibular concrement and duct stenosis.

Conclusion

Holmium laser-assisted lithotripsy is a simple, safe, and effective procedure for treating patients with sialolithiasis of the submandibular gland. Removal of the gland is rarely required, and removing the gland without prior sialendoscopy is no longer recommended. It should be offered to all patients with submandibular gland sialolithiasis, or such patients should be referred to the appropriate centre for sialendoscopy before submandibulectomy is considered.

http://bit.ly/2IaND3t

Feasibility of transnasal flexible carbon dioxide laser surgery for laryngopharyngeal lesions

Publication date: Available online 11 February 2019

Source: Auris Nasus Larynx

Author(s): Koji Araki, Masayuki Tomifuji, Kosuke Uno, Hiroshi Suzuki, Yuya Tanaka, Shingo Tanaka, Eiko Kimura, Akihiro Shiotani

Abstract

Objective

The fiber-guided carbon dioxide (CO₂) laser is a useful device for laryngopharyngeal surgery. The flexible CO₂ wave-guide laser has been developed and commercially available for several years. However, the transnasal use of CO₂ flexible wave-guided laser surgery through the instrument channel of a flexible endoscope (CO₂ TNFLS) is not permitted in Japan. This feasibility study aimed to assess the value and the safety of an in-office CO₂ TNFLS procedure.

Methods

Patients with small laryngopharyngeal diseases were enrolled from June 2015. Eligible patients had indications with lesions generally localized superficial lesions such as the benign tumor, leukoplakia, and premalignant lesion-like carcinoma in situ (CIS). Patients were locally well anesthetized using xylocaine. After removing as much of the lesion(s) as possible with flexible forceps, the remainder of the lesions were evaporated using CO₂ TNFLS through the instrument channel of a flexible endoscope under local anesthesia.

Results

Eighteen surgeries involving 13 patients, including 9 papilloma (7 recurrent respiratory papilloma [RRP]), 2 carcinoma in situ, 1 leukoplakia, and 1 large epiglottic cyst), were performed. Four patients with RRP required multiple surgeries. Except for 3 patients with RRP, all patients achieved disease control without additional intervention. All procedures were completed with no severe adverse events.

Conclusion

Office-based CO₂ TNFLS is safe and feasible for patients with laryngopharyngeal pathologies. It is especially valuable for RRP patients with small lesions to avoid surgery under general anesthesia.

http://bit.ly/2BrmpzV

Autophagy‐related Gene Expression Regulated by HIF‐1α in Salivary Adenoid Cystic Carcinoma

Abstract

Objectives

Salivary adenoid cystic carcinoma (SACC) is one of the most common malignant salivary gland tumors. Our study aims to investigate whether hypoxia‐induced autophagy was up‐regulated in the progression of SACC.

Materials and Methods

We performed differentially expressed gene analysis, pathway enrichment analysis and then calculated the correlation analysis on GSE59701 and GSE28996 datasets. The expression of HIF‐1ɑ and MAP1LC3B was analyzed in the paraffin‐embedded specimens by immunohistochemical method and in the hypoxic SACC‐LM cells by immunofluorescence. TEM microscopy was also performed to observe the formation of autophagosomes in SACC tissue and the hypoxic SACC‐LM cells.

Results

The autophagy pathway was up‐regulated in SACC datasets, and five genes including MAP1LC3B were positively correlated with HIF‐1ɑ. Immunohistochemistry results showed that autophagy was activated and the expression of HIF‐1ɑ and MAP1LC3B was positively correlated in SACC specimens. In hypoxic SACC‐LM cells, we also identified the up‐regulation of autophagy and the close correlation between HIF‐1ɑ and MAP1LC3B expression. Autophagosomes were observed both in the tissue and the hypoxic SACC‐LM cells by TEM microscopy.

Conclusions

Our study showed that autophagy is up‐regulated in dataset, SACC tissue and hypoxic cell line; hypoxia‐induced autophagy in SACC might play a vital role in the development of SACC.

http://bit.ly/2GkOEnX

Pratique et enjeux de la simulation en dermatologie

Publication date: Available online 11 February 2019

Source: Annales de Dermatologie et de Vénéréologie

Author(s): L. Martin, J.C. Granry

http://bit.ly/2DzSrtC

Blood-brain barrier disruption and neuroinflammation as pathophysiological mechanisms of the diffuse manifestations of neuropsychiatric systemic lupus erythematosus

Publication date: Available online 11 February 2019

Source: Autoimmunity Reviews

Author(s): Nancy P. Duarte Delgado, Gloria Vásquez, Blanca L. Ortiz-Reyes

Abstract

Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease that can involve nervous system commitment known as neuropsychiatric systemic lupus erythematosus (NPSLE). The diagnostic of NPSLE is complex because the symptoms range from focal symptoms (e.g., strokes, thrombotic events) to diffuse disorders affecting cognition, mood and level of consciousness (e.g. acute confusional state, psychosis). Both type of manifestations of NPSLE differ in their pathological mechanisms. The focus of this review will be on the mechanisms that lead to the blood-brain barrier (BBB) disruption and to the neuroinflammation related with the diffuse manifestations of NPSLE.

http://bit.ly/2TGVK97

Conceptual, statistical and clinical interpretation of results from a systematic review and meta-analysis of prevalence of cervical HPV infection in women with SLE

Publication date: Available online 11 February 2019

Source: Autoimmunity Reviews

Author(s): Rama Jayaraj, Chellan Kumarasamy

http://bit.ly/2TGVIhv

Editorial Board/Reviewing Committee

Publication date: March 2019

Source: International Journal of Oral and Maxillofacial Surgery, Volume 48, Issue 3

Author(s):

http://bit.ly/2I9bxfF

Nasal soft tissue changes after two different approaches for surgically assisted rapid maxillary expansion

Publication date: Available online 11 February 2019

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): Y. Fındık, T. Baykul, T. Yazıcı

Abstract

The aim of the study was to evaluate the nasal soft tissue changes in patients who underwent surgically assisted rapid maxillary expansion (SARME) using two different surgical approaches. Thirty-two patients were included in the study, and divided into two groups according to the type of surgical approach: in group A (n = 17), SARME performed with standard Le Fort I circumvestibular approach with alar base cinch and anterior nasal spine (ANS) exposure; and in group B (n = 15) operations were performed with the same standard Le Fort I circumvestibular approach with only alar base cinch. Measurements of height and width of the philtrum, nasal and subnasal width, and columella width were taken from three-dimensional facial images obtained before surgery (T1), after the distraction phase (T2) and 6 months postoperatively (T3). The mean maxillary expansion was 7.3 ± 0.7 mm for group A and 7.5 ± 1.5 mm for group B, without any significant difference between groups (P = 0.59). Both groups presented an increase in all vaules in T2 and T3. The approach used in group A resulted in smaller changes in the columella width. The results of the present study show that there is no need for intraoperative releasing of the soft tissues around the anterior nasal spine during SARME if columella width is sufficient. However, further randomized studies based on large patient groups are needed before final conclusions on this topic can be reached.

http://bit.ly/2GmNMPO

Reduced Akkermansia muciniphila and Faecalibacterium prausnitzii levels in the gut microbiota of children with allergic asthma

Publication date: Available online 11 February 2019

Source: Allergologia et Immunopathologia

Author(s): M. Demirci, H.B. Tokman, H.K. Uysal, S. Demiryas, A. Karakullukcu, S. Saribas, H. Cokugras, B.S. Kocazeybek

Abstract

Introduction and objectives

The amounts of Akkermansia muciniphila and Faecalibacterium prausnitzii in gut microbiota are reduced in patients with allergic diseases compared to healthy controls. We aimed to quantify levels of A. muciniphila and F. prausnitzii amounts using real-time quantitative PCR (qPCR) in the gut microbiota of children with allergic asthma and in healthy controls.

Materials and methods

In total, 92 children between the ages of three and eight who were diagnosed with asthma and 88 healthy children were included in the study and bacterial DNA was isolated from the stool samples using the stool DNA isolation Kit. qPCR assays were studied with the microbial DNA qPCR Kit for A. muciniphila and microbial DNA qPCR Kit for F. prausnitzii.

Results

Both bacterial species showed a reduction in the patient group compared to healthy controls. A. muciniphila and F. prausnitzii were found to be 5.45 ± 0.004, 6.74 ± 0.01 and 5.71 ± 0.002, 7.28 ± 0.009 in the stool samples of the asthma and healthy control groups, respectively.

Conclusions

F. prausnitzii and A. muciniphila may have induced anti-inflammatory cytokine IL-10 and prevented the secretion of pro-inflammatory cytokines like IL-12. These findings suggest that A. muciniphila and F. prausnitzii may suppress inflammation through its secreted metabolites.

http://bit.ly/2Dvcmdj

Neutrophilic Panniculitis in a child with MYSM1 deficiency

Abstract

Neutrophilic panniculitis (NP) with myelodysplasia has been described in adults but not in children. We report a case of NP associated with myelodysplasia in a child with MYSM1 deficiency, a newly described syndrome with primary immunodeficiency (PI), bone marrow failure, and developmental aberrations.

http://bit.ly/2Bx94Gl

Information for Readers

Publication date: March 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 3

Author(s):

http://bit.ly/2SFyWtp

Society Page

Publication date: March 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 3

Author(s):

http://bit.ly/2N067T2

Publication date: March 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 3

Author(s):

http://bit.ly/2SQ15xI

Standardisation of Tinnitus Handicap Inventory in Hindi

Abstract

Tinnitus is defined as perception of sound in ear continuously without presence of any external stimuli. It is mainly due to the activity within central nervous system without any mechanical or vibratory activity that stimulates the cochlea. It is purely subjective phenomenon that cannot be measured by the any physical scale. Tinnitus handicap inventory is very useful tool to measure the severity of impact of tinnitus on person's life. There is lack of questionnaire in Hindi and this work will help a lot in future. The English THI was translated to Hindi by person expert in both English and Hindi. The translated THI was given to 40 people with Hindi as mother tongue for rechecking the words. The final THI (Hindi) was used in assessment of severity in 100 tinnitus patient. The observed data was analysed by using Microsoft excel. Reliability of THI Hindi was high (Pearson correlation .98, test and retest method), factor analysis indicated that TH1 Hindi has unified. The THI Hindi version is reliable. THI Hindi can be used to assessment of severity of tinnitus in Hindi speaking population.

http://bit.ly/2TJ3kAk

Pioneers in dermatology and venereology: an interview with Prof. Enno Christophers

http://bit.ly/2WUOUPu

Issue Information

http://bit.ly/2RTBgIF

Long‐term efficacy of ixekizumab in erythrodermic and generalized pustular psoriasis patients

http://bit.ly/2WUOKrm

Commentary to ‘Minimal clinically important difference (MCID) for work productivity and activity impairment (WPAI) questionnaire in psoriasis patients’ by J.J. Wu et al.

http://bit.ly/2RYb6EC

Announcement

http://bit.ly/2WTOF7k

Forthcoming Events

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A functional gene expression analysis in epithelial sinonasal cancer: Biology and clinical relevance behind three histological subtypes

Publication date: March 2019

Source: Oral Oncology, Volume 90

Author(s): Loris De Cecco, Mara Serena Serafini, Carla Facco, Roberta Granata, Ester Orlandi, Carlo Fallai, Lisa Licitra, Edoardo Marchesi, Federica Perrone, Silvana Pilotti, Pasquale Quattrone, Cesare Piazza, Fausto Sessa, Mario Turri-Zanoni, Paolo Battaglia, Paolo Castelnuovo, Paolo Antognoni, Silvana Canevari, Paolo Bossi

Abstract

Epithelial sinonasal cancers (SNCs) are rare diseases with overlapping morphological features and a dismal prognosis. We aimed to investigate the expression differences among the histological subtypes for discerning their molecular characteristics.

We selected 47 SNCs: (i) 21 nonkeratinizing squamous cell carcinomas (NKSCCs), (ii) 13 sinonasal neuroendocrine cancers (SNECs), and (iii) 13 sinonasal undifferentiated cancers (SNUCs). Gene expression profiling was performed by DASL (cDNA-mediated annealing, selection, extension, and ligation) microarray analysis with internal validation by quantitative RT-PCR (RT-qPCR). Relevant molecular patterns were uncovered by sparse partial-least squares discriminant analysis (sPLS-DA), microenvironment cell type (xCell), CIBERSORT, and gene set enrichment (GSEA) analyses.

The first two sPLS-DA components stratified samples by histological subtypes. xCell highlighted increased expression of immune components (CD8⁺ effector memory cells, in SNUC) and "other cells": keratinocytes and neurons in NKSCC and SNEC, respectively. Pathway enrichment was observed in NKSCC (six gene sets, proliferation related), SNEC (one gene set, pancreatic β-cells), and SNUC (twenty gene sets, some of them immune-system related). Major neuroendocrine involvement was observed in all the SNEC samples.

Our high-throughput analysis revealed a good diagnostic ability to differentiate NKSCC, SNEC, and SNUC, but indicated that the neuroendocrine pathway, typical and pathognomonic of SNEC is also present at lower expression levels in the other two histological subtypes. The different and specific profiles may be exploited for elucidating their biology and could help to identify prognostic and therapeutic opportunities.

http://bit.ly/2I7amxt

Associations between pre-, post-, and peri-operative variables and health resource use following surgery for head and neck cancer

Publication date: March 2019

Source: Oral Oncology, Volume 90

Author(s): Hoda Badr, Maximiliano Sobrero, Joshua Chen, Tamar Kotz, Eric Genden, Andrew G. Sikora, Brett Miles

Abstract

Objective

We examined associations between pre-, post-, and peri-operative variables and health resource use in head and neck cancer patients.

Methods

Patients (N = 183) who were seen for a pre-surgical consult between January 2012 and December 2014 completed surveys that assessed medical history, a patient-reported outcome measure (PROM) of dysphagia, and quality of life (QOL). After surgery, peri-operative (e.g., tracheostomy, feeding tube) and post-operative (e.g., complications) variables were abstracted from patients' medical records.

Results

Multivariate regression models using backward elimination showed that pre-surgical University of Washington Quality of Life (UW-QOL) Inventory and M.D. Anderson Dysphagia Inventory (MDADI) composite scores, documented surgical complications, and having a tracheostomy, were all significant predictors of hospital length of stay, explaining 57% of the total variance (F(5, 160) = 18.71, p < .001). Male gender, psychiatric history, and lower pre-surgical MDADI scores significantly predicted thirty-day unplanned readmissions (30dUR). Pre-surgical MDADI composite scores also significantly predicted emergencey department (ED) visits within 30 days of initial hospital discharge (p = .02).

Conclusions

Assessment of PROMs and QOL in the pre-surgical setting may assist providers in identifying patients at risk for prolonged LOS and increased health resource use after hospital discharge.

http://bit.ly/2Gm8ZJE

Broad Immunglobulin G Repertoire in Chronic Rhinosinusitis with Nasal Polyps regulates pro-inflammatory IgE responses

Publication date: Available online 11 February 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Mohamed H. Shamji, Irene Thomsen, Janice Layhadi, Jasper Kappen, Gabriële Holtappels, Umit Sahiner, Amy Switzer, Stephen R. Durham, Oliver Pabst, Claus Bachert

Abstract

Background

Chronic rhinosinusitis with nasal polyps (CRSwNP) is often characterized by local production of polyclonal IgE-idiotypes. Whilst tissue IgE concentrations can be in the range of several thousand kU/L, the regulatory mechanisms by which IgE-mediated inflammation is controlled in the nasal polyps is not well understood.

Objective

We sought to determine whether locally induced IgG antibodies in the nasal polyps can inhibit IgE-mediated pro-allergic response.

Methods

Nasal polyp homogenates were collected from grass pollen allergics with CRSwNP and non-allergic controls. IgE levels were measured by ISAC. IgE-containing nasal polyp homogenates, with/without IgG depletion, were evaluated for their capacity to promote IgE-facilitated allergen presentation, basophil activation and histamine release. Local IgE and IgG repertoires were evaluated by Immunoglobulin 454 sequencing.

Results

We show that IgG plays a key role in controlling IgE-mediated inflammatory responses in nasal polyps. Depletion of IgG from nasal homogenates resulted in an increase in CD23-mediated IgE-facilitated allergen binding to B cells (IgE-FAB), but also enhanced FcεRI-mediated allergen driven basophil activation and histamine release. A similar response was observed in relation to specific IgE antibodies to Staphylococcus aureus (SE-IgE). The capacity of IgG in nasal polyps to limit IgE-mediated inflammation is based on the fact that IgG repertoires widely share the antigen targets with the IgE repertoires, in both allergic and non-allergic subjects.

Conclusion

Polyclonal IgE idiotypes in CRSwNP are functional, promote IgE-mediated pro-allergic inflammation and are partially antagonized by corresponding IgG-idiotypes. This is most likely due to the fact that IgE and IgG clonotypes are widely shared in nasal polyps.

http://bit.ly/2GBLTOo

Standardisation of Tinnitus Handicap Inventory in Hindi

Abstract

http://bit.ly/2TJ3kAk

Extension patterns of vestibular schwannomas towards the middle ear: three new cases and review of the literature

Abstract

Objective

Middle ear extension of vestibular schwannomas is not a common occurrence, and only a few cases have been described so far in past publications. We report three new cases of vestibular schwannomas extending to the middle ear and reviewed the literature to specify the patterns of such an extension.

Materials and methods

We analysed databases of previously published articles to search for additional cases of middle ear extension of vestibular schwannomas and compared them to the cases we have documented. Extension patterns of the tumours were analysed, especially focusing on the extension through the round and oval windows.

Results and conclusion

Middle ear vestibular schwannomas are uncommon tumours and only 13 cases have been published so far. The vestibular schwannoma (internal auditory canal or intralabyrinthine) has to invade the labyrinth first (complete invasion in 88% of the cases, n = 14), before reaching the middle ear. In the majority of cases (69%, n = 11/16), internal auditory canal vestibular schwannomas or intralabyrinthine schwannomas extended in the middle ear though the round window.

http://bit.ly/2E5NLxh

Post-contrast 3D-FLAIR in idiopathic sudden sensorineural hearing loss

Abstract

Purpose

Our study investigated correlations between clinical characteristics, particularly hearing recovery, interval time between onset and three-dimensional fluid attenuation inversion recovery magnetic resonance imaging (3D-FLAIR MRI), and the signal intensity of post-contrast 3D-FLAIR MRI in patients with idiopathic sudden sensorineural hearing loss (SSNHL).

Methods

The study enrolled 100 SSNHL patients. The signal intensities and asymmetry ratios of the inner ear structures, including the cochleae, vestibules and vestibulocochlear nerve, were evaluated and calculated. The relationships between the clinical characteristics and MRI findings were assessed.

Results

After intravenous gadolinium (Gd) injection, 3D-FLAIR revealed high signal intensities in 65 patients. The corrected asymmetry ratios of cochlea correlated closely with interval time between onset and MRI. The asymmetry ratios of the inner ear structures were significantly lower in patients with final complete to partial hearing recovery. The corrected asymmetry ratios of the inner ear structures correlated with initial/final pure tone audiometry (PTA) and hearing recovery in the affected ear. Notably, it was shown that the corrected asymmetry ratios identified a poor prognosis for hearing recovery, with a sensitivity and specificity of 67.9% and 75.0% in the cochlea, 83.3% and 75.0% in the vestibule, and 52.4% and 81.2% in the vestibulocochlear nerve, respectively.

Conclusions

Post-contrast 3D-FLAIR after intravenous Gd injection in SSNHL can be used to assess the permeability of the blood–labyrinth and blood–nerve barriers. The asymmetry ratios of the inner ear structures may identify patients with poor prognosis for hearing recovery. Signal characteristics are closely related to interval time between onset and MRI.

http://bit.ly/2UUcrhI

The speed limit of outer hair cell electromechanical activity

Abstract

The outer hair cell of Corti's organ provides mechanical feedback into the organ to boost auditory perception. The fidelity of voltage-dependent motility has been estimated to extend beyond 50 kHz, where its force generation is deemed a requirement for sensitive high-frequency mammalian hearing. Recent investigations have shown, however, that the frequency response is substantially more low pass at physiological membrane potentials where the kinetics of prestin impose their speed limit. Nevertheless, it is likely that the reduced magnitude of electromotility is sufficient to drive cochlear amplification at high frequencies.

http://bit.ly/2SL7HxA

Acute unilateral red eye in a patient with psoriasis

http://bit.ly/2Du4IQu

Longitudinal progress of transepidermal water loss, color, and sensory elements in split‐thickness skin graft donor sites in East Asians

Abstract

Background

There is little research available that describes the natural progression of split‐thickness skin graft (STSG) donor site wounds after re‐epithelialization. The purpose of this study was to evaluate the longitudinal clinical progress of transepidermal water loss (TEWL), color, and sensory elements in STSG donor sites in East Asians.

Methods

Eighteen patients participated in this study. The TEWL, color, pressure threshold, and static two‐point discrimination were evaluated from the center and upper lateral corner of the wounds and adjacent normal skin preoperatively and at 1, 2, 7, and 12 months postoperatively.

Results

The age was negatively correlated with preoperative values of TEWL (r = −0.49, P = 0.039). The elevated TEWL level from the STSG donor sites did not return to normal until 12 months after surgery. In the measurement of skin color, the elevated L* value normalized after 12 months following surgery, while the elevated a* and b* values persisted. In the sensory testing, there were no significant changes during the observation period except at 2 months postoperatively, representing a significant increase of pressure threshold in the periphery.

Conclusions

In East Asians, elevated skin lightness level in STSG donor sites returned to normal at 12 months postoperatively, while the elevated TEWL and skin redness levels were improved but were not normalized at 12 months after surgery.

http://bit.ly/2SHeSqu

Increased antistreptolysin O serum levels in cellulitis recurrences and head and neck disease localization

http://bit.ly/2MZC7qm

Unwelcomed face of scleromyxedema

http://bit.ly/2SJN6cS

Hautschäden durch troposphärisches Ozon

Zusammenfassung

Troposphärisches, das heißt bodennahes Ozon (O₃) ist ein sekundärer Schadstoff, der durch Sonnenlicht aus anderen Schadstoffen hervorgeht. Die O₃-Exposition ist mit einer erhöhten pulmonalen und kardiovaskulären Mortalität assoziiert und beeinträchtigt die reproduktive Gesundheit sowie das zentrale Nervensystem, dies sowohl akut als auch chronisch. Die Haut könnte ein potenziell verkanntes Zielorgan von O₃ aus der Umwelt sein. Experimentelle Daten deuten auf einen positiven Zusammenhang zwischen der O₃-Exposition und oxidativen Schäden, einem gestörten antioxidativen Schutz und einer proinflammatorischen Reaktion in der Haut hin. In Zeitreihenanalysen korrelierten akute Anstiege der O₃-Konzentration mit medizinischen Konsultationen wegen Hauterkrankungen; ob diese Ergebnisse spezifisch für O₃ sind, ist allerdings noch nicht sicher. Es gibt erste epidemiologische Belege dafür, dass die langfristige O₃-Exposition mit einer vorzeitigen Hautalterung assoziiert ist. Dieser Befund war unabhängig von der Koexposition gegenüber anderen hautschädigenden Umweltfaktoren, wie etwa ultravioletter Strahlung und Luftverschmutzung mit anderen Schadstoffen. Da die O₃-Konzentrationen in vielen Gegenden der Welt ansteigen, sind schädliche Wirkungen von O₃ auf die Haut ein relevantes Problem für die öffentliche Gesundheit.

http://bit.ly/2N3uKOB

Αρχειοθήκη ιστολογίου

Τρίτη 12 Φεβρουαρίου 2019

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