Comparison between Primary and Secondary Tracheoesophageal Puncture Prosthesis: A Systematic Review

Introduction: Since the introduction of tracheoesophageal puncture (TEP) and placement of voice prosthesis, this has become the method of choice to achieve speech rehabilitation after total laryngectomy. Objective: To compare the complications and success in speech rehabilitation of patients undergoing rehabilitation after primary and secondary TEP (TEP1 and TEP2) through a systematic review. Methods: The literature survey included research in MedLine, Scielo, Lilacs, Cochrane and Websco until June 2016. Results: The rate of leakage around the prosthesis was higher in TEP1 (22.5 vs. 6.9%, p = 0.03). There were higher rates of wound infection (9.1 vs. 3.9%) and tracheal stenosis (8.5 vs. 4.5%) in the TEP1 group compared to TEP2, however with no statistical significance. The evaluation of speech quality was not possible due to the heterogeneity of the studies. Conclusion: There is a reduction in the risk of leakage around the prosthesis among TEP2 patients.
ORL 2017;79:222-229

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Inflammatory Bowel Disease in Primary Immunodeficiencies

Abstract

Purpose of Review

Inflammatory bowel disease is most often a polygenic disorder with contributions from the intestinal microbiome, defects in barrier function, and dysregulated host responses to microbial stimulation. There is, however, increasing recognition of single gene defects that underlie a subset of patients with inflammatory bowel disease, particularly those with early-onset disease, and this review focuses on the primary immunodeficiencies associated with early-onset inflammatory bowel disease.

Recent Findings

The advent of next-generation sequencing has led to an improved recognition of single gene defects underlying some cases of inflammatory bowel disease. Among single gene defects, immune response genes are the most frequent category identified. This is also true of common genetic variants associated with inflammatory bowel disease, supporting a pivotal role for host responses in the pathogenesis.

Summary

This review focuses on practical aspects related to diagnosis and management of children with inflammatory bowel disease who have underlying primary immunodeficiencies.

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Superior Semicircular Canal Dehiscence: Pathophysiology and Surgical Outcomes

Abstract

Purpose of Review

Knowledge regarding superior semicircular canal dehiscence (SSCD) is quickly evolving. There are multiple aspects of SSCD that need to be considered in the diagnosis and treatment of this entity. Knowing the outcomes from treatment, the neuro-otologist is better equipped in counseling the patient regarding prognosis and individualized best management options.

Recent Findings

Now going on nearly 20 years since its initial description in the literature, the treatment options for SSCD have expanded and the results of treatment are being reported. Unfortunately, with variations in techniques and small numbers reported, comparison of differing techniques is challenging. Since 1998, our group has performed more than 400 SSCD surgical procedures of varying types. Much of this review is colored by this experience. We will review the pathophysiology and surgical outcomes for SSCD in order to give the reader a better appreciation of prognosis for treatment.

Summary

SSCD can have multiple unique presentations, with varying degrees of symptoms. The treatment options can range from non-surgical to minimally invasive to a variety of more invasive procedures. Knowing the pathophysiology and the outcomes from intervention can aid the physician in directing the patients care most appropriately.

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Systematic literature review to identify methods for treating and preventing bacterial skin infections in Indigenous children

Abstract

Background/Objectives

Bacterial skin infections in Indigenous children in Australia frequently lead them to access primary health care. This systematic review aims to identify and analyse available studies describing the treatment and prevention of bacterial skin infections in Indigenous children.

Methods

Electronic databases including Scopus, MEDLINE, CINAHL, ProQuest, Informit and Google Scholar were searched. Studies in English published between August 1994 and September 2016, with the subject of bacterial skin infections involving Indigenous children and conducted in Australia, New Zealand, the USA or Canada were selected.

Results

Initially 1474 articles were identified. After the application of inclusion and exclusion criteria, 10 articles remained. Strategies for the treatment and prevention of bacterial skin infections included the management of active infections and lesions, improving environmental and personal hygiene, the installation of swimming pools and screening and treatment.

Conclusion

There is a need for more, rigorous, large-scale studies to develop evidence for appropriate, culturally acceptable methods to prevent and manage bacterial skin infections in Indigenous children in Australia. The problem is complex with multiple determinants. Until underlying socioeconomic conditions are addressed skin infections will continue to be a burden to communities.

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Dermoscopy of lymphangioma circumscriptum: A morphological study of 45 cases

Abstract

Background/Objectives

The dermoscopy of lymphangioma circumscriptum, also known as superficial lymphatic malformation, remains to be clarified.

Methods

Digital dermoscopic images of 45 histopathologically confirmed cases of lymphangioma circumscriptum collected from nine hospitals in Spain, Italy and Turkey were evaluated for the presence of dermoscopic structures and patterns.

Results

Our study shows that the most common structure found in lymphangioma circumscriptum was the presence of lacunae (89% of cases). The latter were red or dark-coloured in 18 cases (45%), yellowish or whitish in 14 cases (35%) and multicoloured in eight cases (20%). The second most common dermoscopic structure was the presence of vascular structures, which were found in 82% of cases, followed by white lines (47%), the hypopyon sign or two-tone lacunae (42%) and scales (7%).

Conclusions

Dermoscopy is useful in improving the diagnosis of lymphangioma circumscriptum with characteristic structures and patterns and could assist in elucidating the presence of blood in lymphatic channels.

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Preliminary evaluation of reflectance confocal microscopy features of scalp melanoma

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Three cases of lymphocytic thrombophilic arteritis presenting with an annular eruption

Abstract

We describe three patients who presented with a striking erythematous non-blanching annular eruption and features of lymphocytic thrombophilic arteritis (LTA), with a prominent lymphocytic vasculitis involving deep dermal vessels. Lymphocytic inflammation was also evident in the superficial vessels and one patient had small superficial ulcers over the ankle area resembling livedoid vasculopathy (LV). Multiple biopsies demonstrated a persistent absence of neutrophils in the infiltrate consistent with a lymphocytic process. In addition to highlighting the annular morphology as a novel presentation of LTA, these cases suggest a possible relationship between LV and LTA and support the notion that they are distinct from neutrophilic vasculitides such as cutaneous polyarteritis nodosa.

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