Une consultation d’anthropologie médicale ouverte aux migrants : pour quoi faire ?

Publication date: Available online 15 December 2016
Source:Annales de Dermatologie et de Vénéréologie
Author(s): P. Charlier




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Obstructive ectopic intratracheal thyroid

Publication date: Available online 14 December 2016
Source:Acta Otorrinolaringológica Española
Author(s): Miguel Mayo Yáñez, Gonzalo Nemecio Esquía Medina, Juan Carlos Vázquez Barro




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Emphysematous pancreatitis: classic findings

Description

A 55-year-old man with diabetes presented to our hospital with recent onset acute abdominal pain and recurrent vomiting. He was immediately admitted to the intensive care unit for ionotropic and invasive respiratory support. He had an acutely tender abdomen with distension. Haematological examination showed leucopenia (880/mm³), thrombocytopenia (64 000/mm³), elevated C reactive protein (68 mg/mL), metabolic acidosis (pH: 6.88) with a severely elevated blood lactate (14 mmol/L), estimated creatinine clearance <14 mL/min, hyperlipidaemia (1280 U/L) and serum amylase levels of 5134 U/L. Plain CT revealed extensive gas in the pancreatic bed extending into the lesser sac and adjacent retroperitoneal space (figure 1A, B). A diagnosis of acute severe emphysematous pancreatitis was made; although the patient was aggressively treated, unfortunately he died. Retrospective blood cultures were positive for Enterobacter aerogenes.

Figure 1

(A) CT image showing the presence of air lucencies in the epigastric region at the level of L1–L2 vertebral...

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Unexplained lymphadenopathies: autoimmune lymphoproliferative syndrome in an adult patient

Autoimmune lymphoproliferative syndrome (ALPS) is characterised by massive enlargement of the lymphoid organs, autoimmune cytopenias and a predisposition to develop lymphoid malignancies. The basic defect is a disturbance of the lymphocyte apoptosis, and a high number of circulating TCRab CD3⁺CD4^–CD8^– T-cells (double-negative T cells (DNT cells)). We describe a case of a 41-year-old man with fever, hepatosplenomegaly, multiple lymphadenopathy, autoimmune haemolytic anaemia and severe thrombocytopenia. Peripheral blood immunophenotyping revealed elevation of the characteristic DNT cells in 8% and high levels of interleukin 10. Histopathological analysis of lymph nodes showed lymphadenitis with paracortical hyperplasia. It was assumed as a probable diagnosis of ALPS, and the procedure was to medicate the patient with steroids. As a result, a significant clinical improvement was achieved, and he has been in remission for 2 years. To our knowledge, this is the first case reported in a Portuguese adult patient.

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Concomitant multiple myeloma, gastric adenocarcinoma and Evan's syndrome in a patient presenting with anaemia

An association between multiple myeloma (MM) and solid tumours has been previously described.¹ Furthermore, autoimmune disorders can precede plasma cell dyscrasias, and the pathogenesis of MM maybe linked to chronic immune stimulation. ² We describe a case of concomitant MM and gastric adenocarcinoma preceded by Evan's syndrome. A previously healthy woman presented to the emergency room with symptomatic anaemia. Her initial workup was compatible with autoimmune haemolytic anaemia and monoclonal gammopathy of undetermined significance. On progression of the anaemia and development of thrombocytopenia, she was diagnosed with Evan's syndrome. Two months later, she presented with severe back pain and her MRI revealed L4–5 vertebral collapse. The clinical picture was compatible with MM. Occult blood was repeatedly positive in stools, and she underwent oesophagogastroduodenoscopy and was found to have gastric adenocarcinoma. The patient refused surgical resection of the adenocarcinoma and refused active treatment for MM.

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Rare cause of neck pain: tumours of the posterior elements of the cervical spine

Here we present two cases of primary bone tumours of the cervical spine in patients who had persistent neck pain—in one case, lasting 8 years. In each case, there was a delay in diagnosis and referral to a spine specialist was prolonged. Primary bone tumours of the spine are rare, which is in contrast to the wide prevalence of cervical neck pain. Many primary care providers may go an entire career without encountering a symptomatic primary cervical spine tumour. In this paper, we discuss the clinical course and treatment of each patient and review the current literature on primary bone tumours of the spine. Owing to the subtle roentgenographic findings of primary cervical tumours, we highlight the importance of advanced imaging in the clinical work-up of simple axial neck pain lasting >6 weeks to avoid misdiagnosis of serious pathology.

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Boari flap reconstruction in a male infant with solitary kidney and associated megaureter

A 1-year-old male infant presented with fever and abdominal lump for 3 months with increased leucocyte count (15 300/mm³) and serum creatinine (0.83 mg%). Abdominal ultrasound and renal scan demonstrated solitary left kidney with dilated tortuous left ureter. Voiding cystourethrogram was unequivocal. Left percutaneous nephrostomy was placed after poor response to perurethral catheterisation. His serum creatinine dropped to 0.58 mg/dL. Subsequent percutaneous nephrostogram and CT nephrostogram showed dilated left pelvicalyceal system, dilated, tortuous left ureter. A diagnosis of obstructed megaureter was made and ureteric plication and reimplantation planned. Intraoperatively, there were primitive ureteral valves until proximal one-third of the ureter. The distance between the upper ureter and bladder was ~6 cm. This defect was bridged by Boari flap. The postoperative period was uneventful and now after 6 months of follow-up, he is doing fine.

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Unusual case of bilateral maxillary fungus ball

An otherwise healthy 34-year-old man was referred to our ear, nose and throat (ENT) clinic for a bilateral maxillary radiologic opacity. This condition was accidentally discovered with a panoramic radiography performed during a follow-up visit after a bilateral endodontic treatment. The patient did not report any specific sinonasal symptom such as purulent nasal discharge, loss of smell and cough, apart from an unspecific sinus pressure. The CT scans showed a bilateral inflammatory process into the maxillary-ethmoidal sinuses and an iron-like density within the maxillary sinuses, while nasal endoscopy showed purulent discharge in the ostiomeatal complex. The patient underwent functional endoscopic sinus surgery under general anaesthesia and the inflammatory material collected was histologically diagnosed as a rare case of bilateral fungus ball. The patient was dismissed the following day with no complications; there were not any sign of recurrence or symptoms during a 4 month follow-up.

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Large intraocular foreign body following a firecracker injury

Description

An 8-year-old girl child presented with the history of firecracker injury to the right eye. There was a sudden loss of vision associated with pain, redness and watering. Primarily, she was diagnosed as panophthalmitis and started of intravenous antibiotics, but as the condition worsened she was referred to a tertiary eye hospital. Initial examination was painful tense upper and lower eyelid oedema (figure 1A) along with severely chemosed conjunctiva and with severely restricted extraocular motility in all the gazes; the child denied any perception of light in the right eye, whereas left eye was normal. Ultrasonography showed a large high-amplitude opacity filling almost two-third of the vitreous cavity with shadowing posterior. (figure 1B). Subsequent CT of the orbit showed large hyperdense foreign body almost filling the entire vitreous cavity. (figure 1C). The patient was started on intravenous antibiotics injection vancomycin 40 mg/kg...

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Pulmonary sarcoidosis: calcification within the galaxy sign

Description

A 34-year-old woman had breathlessness, dry cough and low-grade fever for 6 months. Chest X-ray showed bilateral hilar lymphadenopathy and patchy alveolar right mid-zone shadows along with bilateral lower zone nodular opacities (figure 1A). Contrast-enhanced high-resolution CT(HRCT) of thorax demonstrated enlarged, non-necrotic right paratracheal, subcarinal and bilateral hilar lymph nodes. The lung window in right upper lobe revealed a large nodule with irregular margins encircled by multiple small nodules suggestive of 'galaxy' sign (figure 1B). In addition, mediastinal window divulged dense calcification within the nodule and mediastinal lymphnodes (figure 1C). Fibreoptic bronchoscopy visualised multiple endobronchial granulomatous lesions throughout the tracheobronchial tree (figure 2A) and was confirmed on biopsy (figure 2B). The diagnosis of pulmonary sarcoidosis was based on (1) chest imaging, (2) elevated serum ACE levels (126 IU/mL [8–65 IU/mL]), (3) negative tuberculin test and (4) visible endobronchial lesions and...

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Melphalan-induced cardiotoxicity: ventricular arrhythmias

Description

A 61-year-old man, with multiple myeloma (IgA lambda), was planned for autologous stem cell transplantation (ASCT). He also suffered a left thalamic haemorrhagic stroke in 1998 secondary to aneurysmal bleed. Following melphalan infusion of 200 mg at 45 mL/min, he developed acute onset rhythm abnormalities (intermittent ventricular ectopic and ventricular tachycardia). The patient's premelphalan evaluation was unremarkable with normal ECG (1A), ejection fraction (55%) and renal/hepatic function. He was evaluated by sequential 2D echocardiography and troponin I (immediately, 2, 4, 12 and 24 hours) which were normal excluding acute STEMI. These rhythm abnormalities were dynamic probably secondary to the plasma melphalan concentrations and normalised by 18 h postinfusion (figure 1B–F). There has been no recurrence of these rhythm abnormalities thereafter. He was transplanted with abbreviated melphalan conditioning.

Figure 1

(A) Normal ECG before starting melphalan infusion. (B) ECG after 200 mg of melphalan infusion, showing acute onset ventricular rhythm...

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Rare case of glioblastoma multiforme located in posterior corpus callosum presenting with depressive symptoms and visual memory deficits

Most of the primary brain tumours are located in the supratentorial region, and it is uncommon to see tumour growth on deep brain structures such as posterior corpus callosum (PCC). In addition, lesions in PCC are also difficult to recognise, because construction apraxia, visuospatial perception and attentional capacity impairment may be the only presenting symptoms. Here, we represent a rare case of gliobastoma multiforme located in PCC, which solely presents with depressive symptoms and visual memory deficits. Initial manifestations of primary brain tumours with psychiatric symptoms and memory disturbances, in addition to headaches and seizures, should be kept in mind.

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Case 38-2016: A 52-Year-Old Woman with Recurrent Oligodendroglioma

Presentation of Case. Dr. Andrew S. Chi: A 52-year-old woman with a history of oligodendroglioma was seen in the outpatient neuro-oncology clinic of this hospital for routine follow-up. Twelve years earlier, the patient presented with a generalized tonic–clonic seizure 4 days after she had…

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Desmoid tumours of the head and neck in children: Review of management

Publication date: Available online 14 December 2016
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): M. Risoud, G. Mortuaire, X. Leroy, P. Leblond, P. Fayoux
ObjectiveDesmoid tumours of the head and neck in children are rare, local invasive and potentially fatal tumours. The purpose of this review is to discuss the management of these tumours in the light of a case series and a review of the literature.Material and methodsThis retrospective study summarised the medical data of children treated for desmoid tumours of the head and neck between 1976 and 2014.ResultsFive of the 6 children were treated by radical surgical resection, with positive surgical margins (R1) in 2 cases, followed by recurrence requiring further resection. One child with a very advanced lesion was treated by weekly methotrexate and vinorelbine chemotherapy for 18months, allowing 93% reduction of tumour volume without recurrence.ConclusionsDesmoid tumours of the head and neck in children are more aggressive than their adult counterparts and are associated with high morbidity and mortality and a high recurrence rate. CT and MRI imaging assessment should preferably be performed before biopsy. External beam radiotherapy must be avoided in children as it is less effective than in adults, and is responsible for long-term cosmetic and functional sequelae and even a risk of second tumours. Treatment is surgical whenever radical resection is possible. In patients presenting an excessive risk of morbidity and mortality, chemotherapy devoid of long-term adverse effects (such as methotrexate in combination with a Vinca alkaloid) can be proposed. Long-term follow-up must be ensured due to the risk of recurrence.



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Primary total laryngectomy and pharyngolaryngectomy in T4 pharyngolaryngeal cancers: Oncologic and functional results and prognostic factors

Publication date: Available online 14 December 2016
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): M. Roux, O. Dassonville, M. Ettaiche, E. Chamorey, G. Poissonnet, A. Bozec
ObjectivesThe aims of this study were to assess oncologic and functional outcome in primary total laryngectomy or pharyngolaryngectomy (TL/TL/TPL) for laryngeal or hypopharyngeal cancer with extra-laryngeal extension (T4) and to determine the predictive factors of these results.Material and methodsA retrospective analysis was performed on the computerized medical records of all patients undergoing primary TL/TPL for T4 larynx or hypopharynx squamous cell carcinoma between 2000 and 2014 at our institution. Predictive factors of oncologic and functional outcome were investigated on univariate and multivariate analysis.ResultsSixty-three patients (58 men, 5 women; mean age, 68.8±9.7 years) were included. Overall and disease-specific survivals were 69% and 80% at 3 years, and 56% and 69% at 5 years, respectively. On multivariate analysis, gender (female, P<0.001), ASA score (ASA≥3; P=0.006) and vascular embolism (P=0.006) had significant pejorative impact on overall survival. Six months after end of treatment, 90% of patients had recovered independent oral feeding and 83% of those with tracheoesophageal voice prostheses had recovered an intelligible voice.ConclusionPrimary TL/TPL remains the gold standard treatment for T4 larynx or hypopharynx cancer. It provides satisfactory oncologic and functional outcomes.



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The effect of non-diabetic chronic renal failure on olfactory function

Publication date: Available online 14 December 2016
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): S. Koseoglu, S. Derin, B. Huddam, M. Sahan
ObjectivesIn chronic renal failure (CRF), deterioration of glomerular filtration results in accumulation of metabolites in the body which affect all organs. This study was performed to investigate the olfactory functions, and determine if hemodialysis or peritoneal dialysis improves olfactory function in non-diabetic CRF patients.Materials and methodsThe olfactory functions were analyzed in CRF patients not on a dialysis program and had a creatinine level≥2mg/dL, in CRF patients on hemodialysis or peritoneal dialysis, and in healthy controls. Diabetic patients were excluded since diabetes alone is a cause of olfactory dysfunction. The study group consisted of a total of 107 individuals including 38CRF patients on a hemodialysis program, 15 CRF patients on peritoneal dialysis, 30 patients with a creatinine level ≥ 2mg/dL without any need for dialysis, and 24 healthy controls with normal renal functions. Olfactory functions were analyzed with "Sniffin' sticks" test, and the groups were compared for the test results.ResultsAll test parameters were impaired in patients with CRF. The median TDI scores of the patients with CRF and the healthy subjects were 24.75 (13–36) and 32.5 (27.75–37.75), respectively, with a statistically significant difference in between (P<0.001). The olfactory functions for the dialysis patients were better than those for the CRF patients not on a dialysis program (P=0.020).ConclusionNon-diabetic CRF affects olfactory functions negatively. Dialysis improves olfactory functions in those patients.



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A rare mandibular tumour

Publication date: Available online 14 December 2016
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): H. Touil, J. Hamila, M. Bouzaiene




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An unusual prenatal laryngeal image

Publication date: Available online 14 December 2016
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): J. Chevreau, C. Rieu, C. Page




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Evaluation of salicylic acid peeling in comparison with topical tretinoin in the treatment of postinflammatory hyperpigmentation

Summary

Background

Postinflammatory hyperpigmentation (PIH) is an acquired hyperpigmentation that involves areas of prior cutaneous inflammation. In addition to prevention, there are a variety of medications and procedures used to treat PIH.

Aim of the work

The aim of this work was to evaluate the efficacy, tolerability, and safety of salicylic acid peeling in comparison with topical tretinoin in the treatment of PIH.

Patients and Methods

This study included forty-five patients with PIH lesions. The patients were divided into three groups, group I was treated with salicylic acid peeling 20–30%, group II was treated with topical tretinoin 0.1%, and group III was treated with combination of salicylic acid peel and topical tretinoin. The patients were assessed clinically to evaluate the efficacy, tolerability, and safety of the treatment. Dermoscopy was carried out to the recurrent or nonimproved cases only.

Results

Combination of salicylic acid peel and topical tretinoin treatment showed significant clinical improvement of PIH than each treatment alone with no complications. There was no significant difference in the recurrence rate between the three groups. There was nonsignificant difference between the efficacy of the treatment and the PIH type in the studied groups. There was nonsignificant difference between the efficacy of the treatment and the duration of the PIH except for group III.

Conclusion

Combination treatment modality is believed to be preferred in the treatment of PIH due to its higher efficacy than single treatment alone, with well tolerability, less side effects, and low recurrence rate.

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Monitoring structural changes in Demodex mites under topical Ivermectin in Rosacea by means of Reflectance confocal microscopy: a case series

Abstract

Rosacea is a common inflammatory disease, mainly affecting the face and with significant impact on patients' life quality. Just recently, topical Ivermectin (Soolantra^® 10mg/g Crème) has been introduced in the treatment of rosacea thanks to its double anti-parasitic and anti-inflammatory activity, resulting in a reduction of papulo-pustular manifestations, blepharitis and cutaneous demodicosis.¹ Although the role of the human skin commensal Demodex folliculorum (DF) in the pathogenesis of the disease is still debated², numerous studied reported an abnormal increase in the density of mites (>5 mites/cm²) in patients affected by papulo-pustular rosacea, measured by regular and standardized superficial skin biopsy, skin scraping, PCR or reflectance confocal microscopy (RCM)^3-6.

This article is protected by copyright. All rights reserved.

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Determination of the nail psoriasis severity index (NAPSI) improvement rate standards for nail psoriasis treatment in a phase IV clinical trial of ustekinumab: the MARCOPOLO study

Clinical trials of psoriasis use efficacy assessment tools including the psoriasis area and severity index (PASI), body surface area, physicians' global assessment (PGA) score, and Dermatology Life Quality Index (DLQI). A 75% improvement in the PASI score (PASI75) is generally accepted as an indicator of therapeutic effectiveness, and a 90% improvement (PASI90) is thought to depict almost complete clearance. Nail psoriasis is also the target of biologics trials. The nail psoriasis and severity index (NAPSI) is used to evaluate nail improvement.¹ However, NAPSI-specific target improvement rates like PASI75 or PASI90 have not been established. Establishing standard rates would be helpful because they can be used to compare efficacy across trials and evaluate individuals objectively.

This article is protected by copyright. All rights reserved.

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Prospective multicentre cohort study on 9,154 surgical procedures to assess the risk of postoperative bleeding – A DESSI-Study

Abstract

Background

To date, there is still a debate how to deal with patients receiving antithrombotic agents prior to surgical procedures on the skin.

Objective

To prospectively assess complications after dermatosurgical interventions, especially bleeding, depending on anticoagulation therapy.

Methods

Patients underwent surgery consecutively as scheduled, without randomization, whether or not they were currently taking anticoagulants. Nine institutions of the DESSI (DErmatoSurgical Study Initiative) working group documented patient data prospectively on a standardized study sheet prior to and after 9154 dermatosurgical interventions.

Results

Bleeding complications were observed in 7.14% of cases (654/9,154 surgeries). A severe bleed requiring intervention by a physician occurred in 83 surgeries (0.91%). In multivariate analysis INR, length of the defect, perioperative antibiotic treatment, current treatment with anticoagulation therapy, age and surgery on hidradenitis suppurativa / acne inversa (HS/AI) were significant parameters independently influencing the risk of bleeding.

Discontinuation of phenprocoumon therapy and subsequent switching to low-molecular-weight heparin was associated with the highest risk of bleeding (9.26%).

Conclusion

Bleeding complications in skin surgery are generally rare. Even if slightly increased complication rates are found in patients taking anticoagulants during skin surgery, platelet inhibitors should not be stopped prior to surgery. If a surgical procedure in patients on a combination therapy of 2 or more antiplatelet cannot be postponed, it should be conducted with the patient remaining on combination therapy.

Discontinuation of DOACs is recommended 24 hours prior to surgery.

Bridging of phenprocoumon should be abolished. In patients with a bleeding history, the INR value should be within the therapeutic range.

This article is protected by copyright. All rights reserved.

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Trichobacteriosis axillaris caused by Dermabacter hominis

Trichobacteriosis is a frequent superficial bacterial infection of the hair, mainly affecting sweat gland bearing areas such as axillae and genital region, and also rarely the scalp.^1-3 The disease is characterized by bacterial overgrowth forming nodular concretions, usually of yellow color (infrequently black or reddish), which are firmly attached to the hair shaft.^1,4 Clinical hallmarks are rancid, acidic odor, unpleasant "dirty" sensation, and staining of clothes. Although most cases have been associated to different species of corynebacteria, the full etiologic spectrum of this infection is uncertain .^1,5 Here we report the first case of trichobacteriosis caused by Dermabacter hominis.

This article is protected by copyright. All rights reserved.

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Mohs micrographic surgery of rare cutaneous tumors

Abstract

Background

Recurrence rates after Mohs micrographic surgery (MMS) for rare cutaneous tumors are poorly defined.

Objective

Investigate the recurrence rate after MMS for rare cutaneous tumors at a university center.

Methods & Materials

Retrospective review of all rare cutaneous tumors treated with MMS at a large university center between January 2008 and December 2012. To detect all recurrences, patients were linked to The nationwide network and registry of histo- and cytopathology (PALGA).

Results

In total, 80 patients with 80 tumors were included. Tumor types included dermatofibrosarcoma protuberans (27), atypical fibroxanthoma (22), Merkel cell carcinoma (8), microcystic adnexal carcinoma (9), sebaceous carcinoma (6), extramammary Paget's disease (2), and other (6). Mean follow-up time was 3.7 years (standard deviation 1.4) during which two atypical fibroxanthomas recurred (2.5%).

Conclusion

This large case series shows that MMS is an appropriate treatment for rare cutaneous tumors with a recurrence rate less than 3%. Preferably, MMS for rare cutaneous tumors is performed in experienced multidisciplinary centers to further improve the quality of treatment.

This article is protected by copyright. All rights reserved.

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Treatment of Primary Hyperhidrosis with Oral Anticholinergic Medications: A Systematic Review

Abstract

Background

Primary hyperhidrosis is a condition characterised by excessive sweating. Patients are treated off-license with oral anticholinergic medications, and report adverse events associated with systemic anticholinergic interactions.

Objectives

This review assesses clinical evidence of efficacy, impact on quality of life and adverse events associated with oral anticholinergic therapy for primary hyperhidrosis.

Methods

PRISMA guidelines were implemented to complete a systematic review (PROSPERO:CRD42016036326). MEDLINE, EMBASE and PubMed were searched from 1946-2015. Inclusion criteria included: observational and experimental studies; anticholinergic medication use in primary hyperhidrosis; oral therapy; clear diagnostic and outcome measures.

Results

Twenty-three articles relevant to the inclusion criteria were analysed. Oxybutynin therapy improved symptoms in an average of 76.2% (range 60-97%) patients and improved QOL in 75.6% (range 57.6-100%) of patients. Methantheline bromide therapy was associated with a 41% reduction in axillary sweating, 16.4% reduction in palmar sweating, 25% decrease in HDSS score and 40.9% increase in DLQI score. Outcome measures of glycopyrrolate therapy were too variable to collate. Dry mouth was reported in 73.4% (range 43.3-100%) of participants taking oxybutynin 10 mg/d, 38.6% (range 27.8-63.2%) of patients taking glycopyrrolate and 68.8% of patients taking methantheline bromide. Nine studies reported that patients stopped therapy due to adverse events. In eight of these studies a mean of 10.9% of total participants ceased treatment due to dry mouth.

Conclusion

Evidence of oral anticholinergic therapy for hyperhidrosis is limited. However, its use is associated with improvement in quality of life and clinical symptoms but at the cost of considerable adverse events.

This article is protected by copyright. All rights reserved.

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Selection of epitopes from self-antigens for eliciting Th2 or Th1 activity in the treatment of autoimmune disease or cancer

Abstract

Vaccines have been valuable tools in the prevention of infectious diseases, and the rapid development of new vectors against constantly mutating foreign antigens in viruses such as influenza has become a regular, seasonal exercise. Harnessing the immune response against self-antigens is not necessarily analogous or as achievable by iterative processes, and since the desired outcome includes leaving the targeted organism intact, requires some precision engineering. In vaccine-based treatment of autoimmunity and cancer, the proper selection of antigens and generation of the desired antigen-specific therapeutic immunity has been challenging. Both cases involve a threshold of existing, undesired immunity that must be overcome, and despite considerable academic and industry efforts, this challenge has proven to be largely refractory to vaccine approaches leveraging enhanced vectors, adjuvants, and administration strategies. There are in silico approaches in development for predicting the immunogenicity of self-antigen epitopes, which are being validated slowly. One simple approach showing promise is the functional screening of self-antigen epitopes for selective Th1 antitumor immunogenicity, or inversely, selective Th2 immunogenicity for treatment of autoimmune inflammation. The approach reveals the importance of confirming both Th1 and Th2 components of a vaccine immunogen; the two can confound one another if not parsed but may be used individually to modulate antigen-specific inflammation in autoimmune disease or cancer.

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Rinite alérgica local [Livre artigo]

João Ferreira de Mello Junior
Braz J Otorhinolaryngol 2016;82:621-2

Resumo - Texto Completo - PDF

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Perfil audiológico de pacientes tratados de câncer na infância [Livre artigo]

Patricia Helena Pecora Liberman, Maria Valéria Schmidt Goffi-Gomez, Christiane Schultz, Paulo Eduardo Novaes, Luiz Fernando Lopes
Braz J Otorhinolaryngol 2016;82:623-9

Resumo - Texto Completo - PDF

http://ift.tt/2hQpwoK

Definição do ponto de referência endoscópica nasal ao acesso cirúrgico à base anterior por estudo anatômico em cadáveres [Livre artigo]

Andressa Vinha Zanuncio, Paulo Fernando Tormin Borges Crosara, Helena Maria Gonçalves Becker, Celso Gonçalves Becker, Roberto Eustáquio dos Santos Guimarães
Braz J Otorhinolaryngol 2016;82:630-5

Resumo - Texto Completo - PDF

http://ift.tt/2gNJAKY

Adaptação e validação transcultural da Sinus and Nasal Quality of Life Survey (SN-5) para o português brasileiro [Livre artigo]

Priscila Regina Candido Espinola Uchoa, Thiago Freire Pinto Bezerra, Élcio Duarte Lima, Marco Aurélio Fornazieri, Fabio de Rezende Pinna, Fabiana de Araújo Sperandio, Richard Louis Voegels
Braz J Otorhinolaryngol 2016;82:636-42

Resumo - Texto Completo - PDF

http://ift.tt/2hQA2fw

Associação de zumbido e perda auditiva em distúrbios otológicos: estudo epidemiológico de uma década em uma população do Sul da Índia [Livre artigo]

Santoshi Kumari Manche, Jangala Madhavi, Koralla Raja Meganadh, Akka Jyothy
Braz J Otorhinolaryngol 2016;82:643-9

Resumo - Texto Completo - PDF

http://ift.tt/2gNK4Ax

Relação entre perda auditiva senil e atividade vestibular [Livre artigo]

Hanifi Kurtaran, Baran Acar, Emre Ocak, Emre Mirici
Braz J Otorhinolaryngol 2016;82:650-3

Resumo - Texto Completo - PDF

http://ift.tt/2hQoc5c

Efeitos do tempo de permanência de splints intranasais sobre a colonização bacteriana, complicações no pós-operatório e desconforto do paciente após septoplastia [Livre artigo]

Abdullah Karatas, Filiz Pehlivanoglu, Mehti Salviz, Nuray Kuvat, Isil Taylan Cebi, Burak Dikmen, Gonul Sengoz
Braz J Otorhinolaryngol 2016;82:654-61

Resumo - Texto Completo - PDF

http://ift.tt/2hwmFET

O papel do volume plaquetário médio e a relação neutrófilos/linfócitos em abscesso periamigdaliano [Livre artigo]

Mehmet Şentürk, İsa Azgın, Gültekin Övet, Necat Alataş, Betül Ağırgöl, Esra Yılmaz
Braz J Otorhinolaryngol 2016;82:662-7

Resumo - Texto Completo - PDF

http://ift.tt/2hyF6pA

Vertigem refratária episódica: papel da gentamicina intratimpânica e potencial evocado miogênico vestibular [Livre artigo]

Erika Celis-Aguilar, Ramon Hinojosa-González, Olivia Vales-Hidalgo, Heloisa Coutinho-Toledo
Braz J Otorhinolaryngol 2016;82:668-73

Resumo - Texto Completo - PDF

http://ift.tt/2hweecP

Tradução para o português e validação do questionário de controle da rinite Rhinitis Control Assessment Test (RCAT) [Livre artigo]

Pedro Henrique Fernandes, Fausto Matsumoto, Dirceu Solé, Gustavo Falbo Wandalsen
Braz J Otorhinolaryngol 2016;82:674-9

Resumo - Texto Completo - PDF

http://ift.tt/2hwmWHR

Comprometimento na qualidade de vida de pacientes com câncer de cabeça e pescoço e de seus cuidadores: estudo comparativo [Livre artigo]

Laís Rigoni, Raphaella Falco Bruhn, Rafael De Cicco, Jossi Ledo Kanda, Leandro Luongo Matos
Braz J Otorhinolaryngol 2016;82:680-6

Resumo - Texto Completo - PDF

http://ift.tt/2hyLahN

Carcinoma ex-adenoma pleomórfico derivado de adenoma pleomórfico recorrente mostra diferença importante por array CGH em comparação com adenoma pleomórfico recorrente sem transformação maligna [Livre artigo]

Fernanda Viviane Mariano, Karina Giovanetti, Luis Fernando Vidal Saccomani, André Del Negro, Luiz Paulo Kowalski, Ana Cristina Victorino Krepischi, Albina Altemani
Braz J Otorhinolaryngol 2016;82:687-94

Resumo - Texto Completo - PDF

http://ift.tt/2hwe70T

Comparação de enxertos com fáscia do músculo temporal e cartilagem de espessura total em timpanoplastias tipo 1 em crianças [Livre artigo]

Yakup Yegin, Mustafa Çelik, Arzu Karaman Koç, Levent Küfeciler, Mustafa Suphi Elbistanlı1, Fatma Tülin Kayhan
Braz J Otorhinolaryngol 2016;82:695-701

Resumo - Texto Completo - PDF

http://ift.tt/2hyIK2R

Resultados de diferentes técnicas de reconstrução do nervo facial [Livre artigo]

Aboshanif Mohamed, Eigo Omi, Kohei Honda, Shinsuke Suzuki, Kazuo Ishikawa
Braz J Otorhinolaryngol 2016;82:702-9

Resumo - Texto Completo - PDF

http://ift.tt/2hwbFra

Presbiacusia: será que temos uma terceira orelha? [Livre artigo]

Luis Roque Reis, Pedro Escada
Braz J Otorhinolaryngol 2016;82:710-4

Resumo - Texto Completo - PDF

http://ift.tt/2hyPSwn

Leiomiossarcoma da tireoide: apresentação de dois casos e revisão da literatura [Livre artigo]

Mehmet İlhan Şahin, Alperen Vural, İmdat Yüce, Sedat Çağlı, Kemal Deniz, Ercihan Güney
Braz J Otorhinolaryngol 2016;82:715-21

Resumo - Texto Completo - PDF

http://ift.tt/2hwbHPM

Estudo do microfonismo coclear na neuropatia auditiva [Livre artigo]

Ilka do Amaral Soares, Pedro de Lemos Menezes, Aline Tenório Lins Carnaúba, Kelly Cristina Lira de Andrade, Otávio Gomes Lins
Braz J Otorhinolaryngol 2016;82:722-36

Resumo - Texto Completo - PDF

http://ift.tt/2hyOYQ8

Rouquidão: apresentação incomum de linfoma primário de tireoide com infiltração da laringe [Livre artigo]

Ozan Gökdoğan, Ahmet Koybasioglu, Erkin Ismail, Timucin Erol, Gokcen Alagoz, Banu Yagmurlu, Seref Komurcu
Braz J Otorhinolaryngol 2016;82:737-40

Resumo - Texto Completo - PDF

http://ift.tt/2hw9TXa

Lipoma do ângulo pontocerebelar em pacientes assintomáticos: relato de caso [Livre artigo]

Ricardo Rodrigues Figueiredo, Andréia Aparecida de Azevedo, João Alfredo de Mesquita Rodrigues Figueiredo, Norma de Oliveira Penido
Braz J Otorhinolaryngol 2016;82:741-2

Resumo - Texto Completo - PDF

http://ift.tt/2hyQMc4

Nachsorge des Endometriumkarzinoms

Zusammenfassung

Hintergrund

Obwohl die Prognose des Endometriumkarzinoms i. Allg. gut ist, kommt es bei ca. 15 % der im Stadium I und II erkrankten Patientinnen zu einem Rezidiv. Durch die im Einzelfall zugrunde liegende Primärtherapie resultieren unterschiedliche Nebenwirkungen und Langzeitfolgen.

Ziel

In der Übersichtsarbeit sollen die Ziele sowie die derzeit empfohlenen Maßnahmen und Untersuchungsintervalle für die Nachsorge des Endometriumkarzinoms dargestellt werden.

Material und Methoden

Eine selektive PubMed-Literaturrecherche zu Themen der Nachsorge des Endometriumkarzinoms wurde durchgeführt.

Ergebnisse

Das Ziel der Tumornachsorge ist es zum einen, zumeist erneut kurativ therapierbare Rezidive rechtzeitig zu entdecken, darüber hinaus aber auch Vorsorge vor Zweitmalignomen zu bieten. Ferner sollen Nebenwirkungen und Folgen der stattgehabten Behandlung erkannt, gelindert und behoben werden. Hierzu werden die spezifischen Empfehlungen und die vorliegende Datenlage vorgestellt.

Schlussfolgerung

Die Nachsorgeuntersuchung erfolgt im Wesentlichen klinisch und symptomorientiert in zunehmenden Zeitintervallen. Die Wertigkeit verschiedener Untersuchungsmaßnahmen wird diskutiert. Langfristiges Ziel der Nachsorge ist es, die Lebensqualität der Patientinnen zu erhalten.

http://ift.tt/2hyFWmb

Value of postmortem studies in deceased neonatal and pediatric intensive care unit patients

Abstract

Worldwide, various autopsy studies have shown a decrease in the diagnostic error rate over the last years. The cause of this positive development is mainly due to the improvement of modern medicine. However, intensive care unit patients are thought to have a higher risk for diagnostic errors, which is documented in several studies in the adult population. In contrast, there is only limited information about diagnostic errors in pediatrics, particularly in pediatric and neonatal intensive care units. The aims of this study were to analyze the spectrum of childhood death, determine the prevalence and distribution of autopsy-confirmed diagnostic errors, and describe patient characteristics that might have influenced the discordance between antemortem and postmortem findings. We analyzed 143 autopsy reports from 2004 to 2013 and correlated these with clinical reports. The overall autopsy rate during this interval was 20.3%. The leading causes of death were congenital malformations (28%), diseases closely associated with perinatal disorders (25%), disorders of the cardiovascular system (18%), and infections (15%). Additional findings were obtained in 23% of the autopsies. Major diagnostic errors were found in 6%, the lowest reported value in a developed country as yet. Most cases (75%) showed complete concordance between clinical diagnoses and postmortem findings, in line with improvements in diagnostic and therapeutic processes over the last decades. In conclusion, autopsy of neonates, infants, and children represents an important tool for monitoring the quality of pediatric and neonatal medical care.

http://ift.tt/2hyITmX

The clinical examination of non-word repetition tasks in identifying Persian-speaking children with primary language impairment

Publication date: February 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 93
Author(s): Yalda Kazemi, Soodeh Saeednia
ObjectiveThis study aimed to examine the diagnostic accuracy of a non-word repetition (NWR) test in identifying Persian-speaking preschool children with specific/primary language impairment (PLI). Children with PLI show consistently poorer performance in non-word repetition tasks than their typically developing language (TDL) counterparts. It is assumed that the ability to repeat non-words triggers language skills and that the absence of this ability may be responsible for language impairment in PLI children.MethodsTwenty preschool children with PLI participated in this study and were compared with 31 peers whose language skills were developing typically. The TDL children were randomly selected from daycare centers, and the children with PLI were referred by qualified speech-language pathologists from speech therapy clinics. A Persian NWR test was administered and scored using two levels of scoring: item-level scoring and syllable-level scoring.Data were analyzed in two phases. The first phase aimed to determine any differences between the two groups of children in terms of NWR ability. The second phase examined the diagnostic measures of the test.ResultsThe results of first phase documented that both scoring methods for the NWR test significantly differentiated between children with PLI and their normal peers. The second phase indicated that both scoring methods for the NWR test have good sensitivity and specificity in differentiating Persian-speaking children with PLI from their normal peers.ConclusionNon-word repetition can be a reliable clinical marker of PLI in Persian-speaking preschool children.



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A 45-Second Self-Test for Cardiorespiratory Fitness: Heart Rate-Based Estimation in Healthy Individuals

http://otorhinolarygology.blogspot.com/2016/12/a-45-second-self-test-for.html

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Acute skin and hair symptoms followed by severe, delayed eye complications in subjects using the synthetic opioid MT-45

Summary

Background

The introduction of unclassified new psychoactive substances (NPS) on the recreational drugs market through open online sale ('legal highs' or 'Internet drugs') continues unabated and represents a growing health hazard. The use of NPS has resulted in numerous, severe, adverse events and fatalities, due to unintended overdose or unknown toxic side-effects.

Objectives

To try to find a possible common underlying cause for the skin–hair–eye symptoms complex observed in three men.

Methods

From late 2013 to mid-2014, three Swedish men aged 23–34 years with a history of recreational drug use independently presented with similar and very remarkable clinical signs, requiring extensive examination and prolonged treatment.

Results

Common clinical signs included hair depigmentation, hair loss, widespread folliculitis and dermatitis, painful intertriginous dermatitis, dry eyes, and elevated liver enzymes. Two of them also showed transverse white Mees' lines (leukonychia striata) on the fingernails and toenails, suggesting a temporary, drug-induced, disorganized keratinization. The clinical signs gradually disappeared over time. However, later on, two developed severe bilateral secondary cataracts requiring surgery. Because drug tests within the Swedish STRIDA project had demonstrated intake of the NPS opioid MT-45 in all patients, this was suspected to be the common causative agent.

Conclusions

These cases highlight the importance for physicians and health professionals to consider the increasing number of novel, untested recreational drugs, as a potential cause of unusual and otherwise unrecognized clinical signs and symptoms.

http://ift.tt/2h2Wy4U

Early Detection of Xeroderma in Older Patients

This study discusses how clinicians might look for white scale sign to detect and diagnose xeroderma in aging patients.

http://ift.tt/2gJadCl

Answers to CME examination

http://ift.tt/2h0CO1K

Valuable or vain: An ethical analysis of free skin cancer screening

See related articles on pages 129 and 181

http://ift.tt/2gIWefD

CME examination

http://ift.tt/2h0JSvm

Reply to: “On the utility of soak and smear”

To the Editor: We thank our colleagues, Drs James, Gutman, and Kirby, for their comments. It is an honor to have the physicians who published the first study on soak and smear reflect on our work.1

http://ift.tt/2gJ2rs0

Prevention and management of glucocorticoid-induced side effects: A comprehensive review

Systemic glucocorticoids are an essential therapy for a range of conditions, but their multiple side effects can produce significant morbidity for patients. The objective of this review is to discuss these side effects while addressing 3 questions: 1) What dose and duration of glucocorticoid therapy should prompt concern for individual side effects?; 2) How should clinicians counsel patients about these complications?; and 3) How can these problems be prevented or managed? To accomplish these objectives, we have created a series of tables and algorithms based on a review of relevant data to guide counseling, prophylaxis, and management of 11 glucocorticoid side effects.

http://ift.tt/2gJbM31

Tender nodule on the finger

A 27-year-old man presented with a tender lesion on the fifth finger on his left hand. This lesion initially started as a linear laceration that he obtained while skinning a sheep 2 to 3 weeks earlier. The physical examination revealed a tender nodule with a central hemorrhagic crust, a white middle ring, and a violaceous periphery over the left fifth extensor finger (Fig 1). A shave biopsy specimen was obtained to confirm the diagnosis (Fig 2).

http://ift.tt/2h0Izwx

Information for Readers

http://ift.tt/2gJ8D3g

Pruritic annular papules and plaques on the face and back

A 35-year-old previously healthy man presented with a 1-year history of multiple pruritic lesions on both his face and back. The lesions presented with crops of papules measuring 1 to 2 mm in diameter, grouped to form annular plaques, with central hyperpigmentation (Fig 1). Antifungal treatment, including oral terbinafine for 2 weeks and topical bifonazole for 1 month, was given in another hospital without any improvement. A skin biopsy specimen was obtained from the patient's face. The histopathologic examination revealed a heavy infiltrate of eosinophils and lymphocytes surrounding the hair follicles and sebaceous glands.

http://ift.tt/2h0GD78

The natural history of actinic keratoses in organ transplant recipients

To the Editor: Actinic keratoses (AKs) are common, highly dynamic, sun-induced lesions that frequently regress and recur.1,2 We sought to investigate whether there is an association between the degree of AK turnover and squamous cell carcinoma (SCC) incidence.

http://ift.tt/2gJ2Hak

Violaceous papules and plaques associated with Crohn's disease

A 25-year-old woman with Crohn's disease that was well controlled with infliximab presented with a 10-month history of violaceous plaques. Physical examination revealed multiple red to violaceous papules and plaques on the extensor surfaces of her elbows, knees, toes, fingers, and dorsal aspects of her feet (Fig 1). She denied fever, arthralgias, pain, or other systemic symptoms. The skin lesions had been unsuccessfully treated with oral prednisone, intralesional triamcinolone, topical clobetasol, and pimecrolimus.

http://ift.tt/2h0CWi1

Reply to: “Is treatment of acne as simple as encouraging primary care physicians to prescribe more retinoids?”

To the Editor: Defining the role of the primary care provider in the management of skin diseases is a multifactorial issue. Perhaps from the dermatologist's perspective it might seem ideal for dermatologists to manage all cases of acne, as dermatologists have extensive training and experience with the condition. But acne is highly prevalent, and the existing shortage of dermatologists may make having every patient with acne see a dermatologist unfeasible, if not undesirable.1,2

http://ift.tt/2gJ07RH

Hyperkeratotic plaques on the trunk and extremities

An 8-year-old white boy presented for a lifelong skin condition. At birth he had widespread blisters and erosions and later developed generalized, thick scaly plaques on his body and thinner scaling on his face. Biopsy specimens obtained for electron microscopy performed at birth revealed dyscohesive keratinocytes and clumped keratin intermediate filaments of suprabasal keratinocytes (Fig 1). The physical examination revealed generalized, thick, scaly plaques predominantly involving the flexural surfaces and brown hyperkeratotic, verrucous, scaly plaques on his trunk, legs, and arms (Fig 2).

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Change of Address

http://ift.tt/2gIYMKT

Iotaderma #275

http://ift.tt/2h0H4hS

Use of a cotton-tipped applicator for superior clinical diagnosis and biopsy of suspected basal cell carcinoma of the nasal ala

Although the nose is a common location for basal cell carcinoma (BCC), the nasal ala represents a location where visualization and biopsy of suspected BCC can prove especially difficult. The ala's angulated structure and background features, such as telangiectases, can make the characteristic features of BCC challenging to appreciate (Fig 1). In addition, biopsy of the region can be cumbersome because of the inherent flexures of the nasal ala.

http://ift.tt/2gJ0AUe

A double-blind, placebo-controlled, phase-II clinical trial to evaluate oral simvastatin as a treatment for vitiligo

To the Editor: Vitiligo is an autoimmune disease caused by autoreactive CD8+ T lymphocytes that target melanocytes, and interferon-γ-induced CXCL10 plays an important role.1 Simvastatin inhibits interferon-γ signaling by blocking activation of STAT12 and prevented and reversed disease in our mouse model.3 A case report described a patient with vitiligo who repigmented with simvastatin.4 We conducted a small, randomized, double-blind, placebo-controlled, phase II clinical trial to test simvastatin as a treatment for vitiligo.

http://ift.tt/2h0LNAk

Wisely choosing thin melanomas for sentinel lymph node biopsy

To the Editor: The routine use of sentinel lymph node (SLN) biopsy (SLNB) in the management of thin melanomas is controversial. For this reason, we read with great interest the article of Wat et al1 in which the authors examined 1072 cases of melanoma submitted to SLNB. Among these, 171 cases were thin melanomas and 15 of them (8.8%) showed SLNB positivity. Today, the scientific community is precisely focusing on the clinical significance of different histologic subtypes of thin melanoma. The current staging system for melanoma of the American Joint Committee on Cancer uses Breslow thickness as the primary attribute and up to 1-mm-thick melanoma is defined as "thin" because it shows good prognosis after surgical excision, with 10-year survival of 85% to 90% in case of tumor-free margin of at least 1 cm.

http://ift.tt/2gJ6e8M

Total body skin exams (TBSEs): Saving lives or wasting time?

The central ethical issue raised by this scenario is whether it is morally obligatory to perform TBSEs, or at least offer them, to all new dermatology patients and at routine screening visits for patients at risk for skin cancer. Those supporting TBSEs make claims that the practice increases detection of skin cancer (general beneficence or utility), represents a professional duty to patients (deontology), and upholds patient preferences (autonomy). Those supporting lesion-directed exams over TBSEs suggest that the time saved from more focused exams permits seeing more patients while only making a small sacrifice in skin cancer detection, a utilitarian claim.

http://ift.tt/2h0GPU0

A proactive approach to ending the use of university debit cards for indoor tanning

To the Editor: Indoor tanning is associated with increased risk of melanoma, particularly when used during adolescence and early adulthood.1 The ability of young adults to use indoor tanning is partially limited by the cost of purchasing these services.2 Many universities sponsor debit cards that parents can fund to support student expenses. Students can use these debit cards at various vendors that have entered into an agreement with the university, including tanning salons.3 Recently, a review of the top 125 colleges ranked by US News and World Report found that 14.4% of universities have a campus debit card that can be used to purchase tanning services.

http://ift.tt/2gJazc6

Percutaneous ligature of the superficial temporal artery: A simple technique to reduce bleeding

Excision of skin lesions within close proximity of the branches of the superficial temporal artery can be challenging because bleeding from severed arteries readily results in a loss of visibility.

http://ift.tt/2h0LpSb

Deliberate chemical dermatoglyphic burns in a political refugee

Publication date: Available online 14 December 2016
Source:Annales de Dermatologie et de Vénéréologie
Author(s): P. Charlier, A. Haroun, C. Hervé




http://ift.tt/2gITHSL

Inequalities in access to biological treatments for psoriasis: Results from the Italian Psocare Registry

Abstract

Background

Limited evidence is available on the impact of socioeconomic factors in drug prescriptions for psoriasis.

Objectives

To investigate factors influencing prescription of conventional versus biological treatment for psoriatic patients, based on the Psocare registry with a special focus on socioeconomic factors.

Methods

This was a cross-sectional study evaluating the baseline data of patients included in the Italian Psocare Registry. All of the consecutive adult patients with a diagnosis of chronic plaque psoriasis (Ps) or psoriatic arthritis and who were prescribed a systemic treatment for Ps at the participating centres were included in this study. Univariate and multivariate analyses of the baseline factors associated with a biologics prescription were performed.

Results

From September 2005 to September 2009, 12,838 patients were identified. A multivariate analysis revealed that, among other factors, completing a level of education higher than lower secondary school and being employed as a manager or a professional were independent factors associated with a biologics prescription at entry in the registry. Additional analyses on the association between these two variables and a severe Ps condition (i.e., psoriasis area and severity index [PASI] score > 20) revealed a significant increasing trend of severe disease towards lower educational attainment, while unemployed patients were more likely to have a more severe condition as compared to the other categories of workers.

Conclusions

We documented inequalities of drug prescriptions for Ps in Italy, with a trend towards a higher frequency of prescription for more expensive biologics in higher socio-economic sectors of the population.

This article is protected by copyright. All rights reserved.

http://ift.tt/2gAQH68

Amianto. Cáncer de laringe

Publication date: Available online 14 December 2016
Source:Acta Otorrinolaringológica Española
Author(s): Luis Sánchez Galán




http://ift.tt/2hNxVJz

Electrocauterización endoscópica para el tratamiento de las fístulas congénitas del seno piriforme en pediatría. Serie de casos

Publication date: Available online 14 December 2016
Source:Acta Otorrinolaringológica Española
Author(s): Giselle Cuestas, Flavia Doormann, Verónica Rodríguez, Patricio Bellia Munzón, Gastón Bellia Munzón
Las fístulas del seno piriforme son anomalías infrecuentes de los arcos branquiales. La mayoría se localizan en el lado izquierdo y se extienden desde el ápex del seno piriforme de la hipofaringe hasta la glándula tiroides o el espacio peritiroideo.El diagnóstico se sospecha ante la presencia de tiroiditis aguda supurada o abscesos cervicales laterales recurrentes, y se confirma mediante la visualización endoscópica del orificio de la fístula. El tratamiento clásico consiste en la exéresis del trayecto fistuloso por vía cervical, con o sin lobectomía tiroidea. Sin embargo, se han desarrollado alternativas menos invasivas y con menos riesgos de complicaciones que obliteran el trayecto de la fístula, como la electrocauterización endoscópica.Describimos nuestra experiencia con 7 pacientes que presentaban esta afección, tratados con cauterización endoscópica utilizando electrobisturí de radiofrecuencia, y evaluamos la eficacia y la seguridad del tratamiento realizado.Pyriform sinus fistulas are rare anomalies of the branchial arches. Most of them are located on the left side. They extend from the apex of the pyriform sinus of the hypopharynx to the thyroid gland or adjacent tissues.The diagnosis is suspected in the presence of acute suppurative thyroiditis or recurrent cervical abscesses, and is confirmed by endoscopic visualization of the fistula hole. The traditional treatment consists of excision of the fistulous tract, with or without thyroid lobectomy, by cervical approach. However, less invasive alternatives that obliterate the path of the fistula have been developed, such as endoscopic electrocautery.We describe our experience with 7 patients with this condition, who were treated with endoscopic cauterization using radiofrequency electrocautery, and we evaluate the effectiveness and safety of the treatment performed.



http://ift.tt/2gL2rWN

Use of thromboelastography in the management of liver cirrhosis and accelerated intravascular coagulation and fibrinolysis (AICF)

In the presented case, the authors describe an obese middle-aged man that presented to the emergency department for persistent oedema, scleral icterus and fatigue. He was admitted to the hospital and diagnosed with liver cirrhosis via transjugular liver biopsy. He continued to bleed from the biopsy site for 5 days from accelerated intravascular coagulation and fibrinolysis (AICF) requiring multiple transfusions of packed red blood cells, fresh-frozen plasma and cryoprecipitate. The authors then used thromboelastography (TEG) to further characterise the patient's coagulopathy, which revealed platelet inhibition. The results of the TEG significantly changed future transfusion management. Finally, the authors conducted a literature review to summarise the current literature available for the use of TEG in the management of liver cirrhosis with AICF.

http://ift.tt/2hELpLR

Combined central retinal vein and branch retinal artery occlusion in hyperhomocysteinaemia

Description

A woman aged 30 years reported of blurred vision in the right eye (RE) for 2 days. Visual acuity was 6/24 in the RE and 6/6 in the left eye (LE). Funduscopy of RE showed combined non-ischaemic central retinal vein occlusion (CRVO) and supero-temporal branch retinal artery occlusion (BRAO) (figure 1A). LE examination was normal. Optical coherence tomography (OCT) of the RE showed thickening of inner retinal layers corresponding to the area of BRAO (figure 1A: white arrow). Thorough systemic investigations and cardiac workup revealed raised serum homocysteine levels (37.21 μmol/L). She was started on oral folic acid and pyridoxine. Over the next 6 months, her visual acuity improved to 6/12 with clearing of retinal whitening and resolution of retinal haemorrhages (figure 1B–D).

Figure 1

Funduscopy of the right eye (RE) showing dilated torturous retinal veins with multiple retinal haemorrhages in all four quadrants...

http://ift.tt/2gAqODf

Iliopsoas abscess caused by chronic urolithiasis and pyelonephritis

Description

A man aged 45 years, with a history of recurrent urolithiasis and pyelonephritis, presented with a 3-month history of fever. Physical examination revealed a nodule in his right inguinal area. CT with contrast showed a right iliopsoas abscess that extended to the inguinal area and a right urethral stone (figure 1). Drainage under fluoroscopic guidance was performed, and the contrast was injected into the cavity from the drainage tube to assess the abscess cavity. The contrast study demonstrated a connection between the urethra and abscess cavity (figure 2). The patient was administered 1 g cefotiam every 8 hours. Blood, urine and fluid cultures from the abscess were positive for Escherichia coli. Surgical drainage and right nephrectomy was performed. The patient was discharged 3 months after the surgery without any complication. The penetration of an iliopsoas abscess into the urinary tract is extremely rare, while the symptoms...

http://ift.tt/2hEU5Sc

Vertical muscle transposition with silicone band belting in VI nerve palsy

A woman aged 60 years developed a Millard-Gubler syndrome after a diagnosis of a cavernous angioma in the median and paramedian areas of the pons. In this context, she presented a right VI nerve palsy, right conjugate gaze palsy, facial palsy and left hemiparesis. To improve the complete VI nerve palsy, we planned a modified transposition approach, in which procedure we made a partial transposition of vertical rectus with a silicone band that was fixated posteriorly. After the procedure, the patient gained the ability to slightly abduct the right eye. We found no compensatory torticollis in the primary position of gaze. There was also an improvement of elevation and depression movements of the right eye. We obtained satisfactory results with a theoretically reversible technique, which is adjustable intraoperatively with no need of muscle detachment, preventing anterior segment ischaemia and allowing simultaneous recession of the medial rectus muscles, if necessary.

http://ift.tt/2gAxbXn

Indian Journal of Medical and Paediatric Oncology (Indian J Med Paediatr Oncol)

EDITORIAL COMMENTARY

Classical or pylorus-preserving pancreatoduodenectomy in pancreatic and periampullary cancer: "The jury is still out!" [pg. 209]
Savio George Barreto
[ABSTRACT]   [HTML FULL TEXT]   [PDF]   [Mobile HTML Full text ]   [EPub]

REVIEW ARTICLES

Should every patient with pancreatic cancer receive perioperative/neoadjuvant therapy? [pg. 211]
Ulrich Nitsche, Bo Kong, Alexander Balmert, Helmut Friess, Jörg Kleeff
[ABSTRACT]   [HTML FULL TEXT]   [PDF]   [Mobile HTML Full text ]   [EPub]

Skin: A mirror of internal malignancy [pg. 214]
Rita V Vora, RahulKrishna S Kota, Nilofar G Diwan, Nidhi B Jivani, Shailee S Gandhi
[ABSTRACT]   [HTML FULL TEXT]   [PDF]   [Mobile HTML Full text ]   [EPub]

Status of barium studies in the present era of oncology: Are they a history? [pg. 223]
Abhishek Mahajan, Subash Desai, Nilesh Pandurang Sable, Meenakshi Haresh Thakur
[ABSTRACT]   [HTML FULL TEXT]   [PDF]   [Mobile HTML Full text ]   [EPub]

ORIGINAL ARTICLES

Protection behaviors for cytotoxic drugs in oncology nurses of chemotherapy centers in Shiraz hospitals, South of Iran [pg. 227]
Khadijeh Abbasi, Maryam Hazrati, Abolfazl Mohammadbeigi, Jasem Ansari, Mahboubeh Sajadi, Azam Hosseinnazzhad, Esmail Moshiri
[ABSTRACT]   [HTML FULL TEXT]   [PDF]   [Mobile HTML Full text ]   [EPub]

Outcomes, cost comparison, and patient satisfaction during long-term central venous access in cancer patients: Experience from a Tertiary Care Cancer Institute in South India [pg. 232]
K Govind Babu, MC Suresh Babu, D Lokanatha, Gita R Bhat
[ABSTRACT]   [HTML FULL TEXT]   [PDF]   [Mobile HTML Full text ]   [EPub]

Effect of areca nut chewing and maximal mouth opening in schoolgoing children in Ahmedabad [pg. 239]
Azizfatema Munawer Khan, Megha S Sheth, Romsha R Purohit
[ABSTRACT]   [HTML FULL TEXT]   [PDF]   [Mobile HTML Full text ]   [EPub]

Clinicopathological features and outcomes in advanced nonsmall cell lung cancer with tailored therapy [pg. 242]
Stalin Bala, Sadashivudu Gundeti, Vijay Gandhi Linga, Lakshmi Srinivas Maddali, Raghunadha Rao Digumarti, Shantveer G Uppin
[ABSTRACT]   [HTML FULL TEXT]   [PDF]   [Mobile HTML Full text ]   [EPub]

Clinicopathological profile of gastrointestinal lymphomas in Kashmir [pg. 251]
Mehnaaz Sultan Khuroo, Summyia Farooq Khwaja, Ajaz Rather, Zhahid Hassan, Ruby Reshi, Naira Sultan Khuroo
[ABSTRACT]   [HTML FULL TEXT]   [PDF]   [Mobile HTML Full text ]   [EPub]

Metabolic toxicities in patients undergoing treatment for nonhematological malignancy: A cross-sectional study [pg. 256]
Subhash Gupta, Kunhi Parambath Haresh, Soumyajit Roy, Lakhan Kashyap, Narayan Adhikari, Rambha Pandey, Dayanand Sharma, Pramod Kumar Julka, Goura Kishor Rath
[ABSTRACT]   [HTML FULL TEXT]   [PDF]   [Mobile HTML Full text ]   [EPub]

Managing metastatic renal cell carcinoma-challenges, pitfalls, and outcomes in the real world [pg. 260]
Karnam Ashok Kumar, Gundeti Sadashivudu, KV Krishnamani, Vijay Gandhi Linga, Lakshmi Srinivas Maddali, Raghunadha Rao Digumarti
[ABSTRACT]   [HTML FULL TEXT]   [PDF]   [Mobile HTML Full text ]   [EPub]

Evaluation of thyroid lesions by fine-needle aspiration cytology based on Bethesda system for reporting thyroid cytopathology classification among the population of South Bihar [pg. 265]
Richa Bhartiya, Mahasweta Mallik, Nawanita Kumari, Brijendra Narayan Prasad
[ABSTRACT]   [HTML FULL TEXT]   [PDF]   [Mobile HTML Full text ]   [EPub]

Oxaliplatin-related neuropathy in Indian patients – no difference between generic and original molecules [pg. 271]
Bhawna Sirohi, Vikas Ostwal, Shaheenah Dawood, Gilberto Lopes, Sanjay Talole, Chaitali Nashikkar, Shailesh Shrikhande
[ABSTRACT]   [HTML FULL TEXT]   [PDF]   [Mobile HTML Full text ]   [EPub]

Burden of cervical cancer and role of screening in India [pg. 278]
Saurabh Bobdey, Jignasa Sathwara, Aanchal Jain, Ganesh Balasubramaniam
[ABSTRACT]   [HTML FULL TEXT]   [PDF]   [Mobile HTML Full text ]   [EPub]

Cognizance and utilization about breast cancer screening among the health professional female students and staffs of University Kuala Lumpur, Royal College of Medicine Perak, Malaysia [pg. 286]
ATM Emdadul Haque, Muhammad Afif Bin Mohd Hisham, Noor Azwa Laili Binti Ahmad Adzman, Nur Atiqah Binti Azudin, Nursakinah Binti Shafri, Mainul Haque
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CASE REPORTS

Juvenile granulosa cell tumor associated with Ollier disease [pg. 293]
Abhilasha Ashok Sampagar, Rahul R Jahagirdar, Vibha Sanjay Bafna, Sandip P Bartakke
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Thymoma masquerading as transfusion dependent anemia [pg. 296]
Javvid Muzamil, Aejaz Aziz Shiekh, Gull Mohammad Bhat, Abdul Rashid Lone, Shuaeb Bhat, Firdousa Nabi
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PRACTITIONER SECTION

A rare case of lung cancer presenting as an ischioanal fossa mass [pg. 300]
Nishitha Shetty, Ranvijay Singh, Maryam Naveed, Ashwini M Ronghe, Falguni Shashikant Barot
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Multiple solitary extramedullary anaplastic plasmacytomas [pg. 303]
Sandesh Madi, Vishnu Senthil, Monappa Naik, Sandeep Vijayan
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LETTERS TO EDITOR

Folate supplementation in transfusion-dependent thalassemia: Do we really need such high doses? [pg. 305]
Gaurav Tripathi, Manas Kalra, Amita Mahajan
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Early tumor shrinkage as an "on-treatment" clinical predictor of long-term outcome in solid organ cancers [pg. 306]
Pratishtha Banga Chaudhari
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Cancer risk of general people due to using joss stick for religious worshiping [pg. 307]
Beuy Joob, Viroj Wiwanitkit
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A rare case of hepatoid carcinoma of the ovary with pancytopenia and hypocellular marrow [pg. 307]
Manoj Lakhotia, Hans Raj Pahadiya, Akanksha Choudhary, Ronak Gandhi, Ramesh Chand Purohit
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Multiple cutaneous malignancies in a child with xeroderma pigmentosum: A case report [pg. 309]
Rita V Vora, RahulKrishna SureshKumar Kota, Nilofar G Diwan
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The masquerading splenic lesion [pg. 311]
Mansoor C Abdulla, Jemshad Alungal, Ram Naryan, Neena Mampilly
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ASCO 2016 GI CANCER UPDATE

Focused update on Gastrointestinal (GI) Oncology from ASCO 2016 [pg. 314]
Ravi Kumar Paluri
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ERRATUM

Erratum: Evaluation of myeloid cells (tumor associated tissue eosinophils and mast cells) infiltration in different grades of oral squamous cell carcinoma [pg. 319]

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Erratum: Isolated humeral recurrence in endometrial carcinoma [pg. 320]

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Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

A connection between neurovascular conflicts within the cerebellopontine angle and vestibular neuritis, a case controlled cohort study.

A connection between neurovascular conflicts within the cerebellopontine angle and vestibular neuritis, a case controlled cohort study.

Acta Otorhinolaryngol Ital. 2016 Oct;36(5):421-427

Authors: Loader B, Linauer I, Korkesch S, Krammer-Effenberger I, Zielinski V, Schibany N, Kaider A, Vyskocil E, Tscholakoff D, Franz P

Abstract
This retrospective, observer blinded case-control study aims to compare the prevalence of neurovascular conflicts (NVCs) of the vestibulocochlear nerve and the anterior inferior cerebellar artery (AICA) in patients presenting with clinical signs of acute vestibular neuritis with and without subsequent objective vestibular function loss (VFL). 58 acute cases of clinically suspected acute vestibular neuritis were investigated with same day cranial MRI at a tertiary referral centre and compared to 61 asymptomatic controls. The prevalence of NVCs in cases with objective VFL were also compared to cases without VFL. Radiologists described the NVC as "no contact" (Grade 0), "contact < 2 mm" (Grade 1), "contact > 2 mm" (Grade 2) and "vascular loop presence" (Grade 3) without knowledge of neurotological data. Neurotological data was collected without knowledge of MRI findings. Vestibular function was tested by bithermic caloric irrigation. 26 cases (45%) showed caloric VFL (Group A), whereas 32 (55%) exhibited no VFL (Group B). Group A included 13 cases with NVCs (50%), Group B included 26 NVC cases (82%) (p = 0.012) and the control group included 16 individuals (26%) (p < 0.001 for comparison of all 3 groups). Group B had a significantly higher NVC-Grading than Group A (p = 0.009). There was no statistically significant association between NVCs and either SNHL or tinnitus (p > 0.05). Our results suggest that patients presenting with clinical signs of acute vestibular neuritis who show symmetrical caloric vestibular function test results have a significantly higher NVC prevalence in the cerebellopontine angle.

PMID: 27958603 [PubMed - in process]

http://ift.tt/2hsssvm

Severe to profound deafness may be associated with MYH9-related disease: report of 4 patients.

Severe to profound deafness may be associated with MYH9-related disease: report of 4 patients.

Acta Otorhinolaryngol Ital. 2016 Oct;36(5):415-420

Authors: Canzi P, Pecci A, Manfrin M, Rebecchi E, Zaninetti C, Bozzi V, Benazzo M

Abstract
MYH9-related disease (MYH9-RD) is a rare genetic syndromic disorder characterised by congenital thrombocytopenia and is associated with the risk of developing progressive sensorineural hearing loss, nephropathy and presenile cataracts during childhood or adult life. All consecutive patients enrolled in the Italian Registry for MYH9-RD with severe to profound deafness were included in a retrospective study. The study population involved 147 Italian patients with MYH9-RD: hearing loss was identified in 52% of cases and only 4 patients (6%) presented severe to profound deafness at a mean age of 33 years. Deafness was associated with mild spontaneous bleeding in all patients and with kidney involvement in 3 cases. Cochlear implantation was carried out in 3 cases with benefit, and no major complications were observed. Diagnosis was performed about 28 years after the first clinical manifestation of MYH9-RD, which was never suspected by an otolaryngologist. The clinical and diagnostic aspects of 4 patients with severe to profound deafness are discussed with a focus on therapeutic implications.

PMID: 27958602 [PubMed - in process]

http://ift.tt/2huxAfv

Open partial horizontal laryngectomies: is it time to adopt a modular form of consent for the intervention?

Open partial horizontal laryngectomies: is it time to adopt a modular form of consent for the intervention?

Acta Otorhinolaryngol Ital. 2016 Oct;36(5):403-407

Authors: Giordano L, Di Santo D, Crosetti E, Bertolin A, Rizzotto G, Succo G, Bussi M

Abstract
Nowadays, open partial horizontal laryngectomies (OPHLs) are well-established procedures for treatment of laryngeal cancer. Their uniqueness is the possibility to modulate the intervention intraoperatively, according to eventual tumour extension. An OPHL procedure is not easy to understand: there are several types of procedures and the possibility to modulate the intervention can produce confusion and lack of adherence to the treatment from the patient. Even if the surgery is tailored to a patient's specific lesion, a unified consent form that discloses any possible extensions, including a total laryngectomy, is still needed. We reviewed the English literature on informed consent, and propose comprehensive Information and Consent Forms for OPHLs. The Information Form is intended to answer any possible questions about the procedure, while remaining easy to read and understand for the patient. It includes sections on laryngeal anatomy and physiology, surgical aims and indications, alternatives to surgery, complications, and physiology of the operated larynx. The Consent Form is written in a "modular" way: the surgeon defines the precise extension of the lesion, chooses the best OPHL procedure and highlights all possible expected extensions specific for the patient. Our intention, providing these forms both in Italian and in English, is to optimise communication between the patient and surgeon, improving surgical procedure arrangements and preventing any possible misunderstandings and medico-legal litigation.

PMID: 27958601 [PubMed - in process]

http://ift.tt/2hst6Jl

Comparison between videofluoroscopy, fiberoptic endoscopy and scintigraphy for diagnosis of oro-pharyngeal dysphagia.

Comparison between videofluoroscopy, fiberoptic endoscopy and scintigraphy for diagnosis of oro-pharyngeal dysphagia.

Acta Otorhinolaryngol Ital. 2016 Oct;36(5):395-402

Authors: Fattori B, Giusti P, Mancini V, Grosso M, Barillari MR, Bastiani L, Molinaro S, Nacci A

Abstract
The purpose of this study was to compare videofluoroscopy (VFS), fiberoptic endoscopic evaluation of swallowing (FEES) and oro-pharyngo- oesophageal scintigraphy (OPES) with regards to premature spillage, post-swallowing residue and aspiration to assess the reliability of these tests for detection of oro-pharyngeal dysphagia. Sixty patients affected with dysphagia of various origin were enrolled in the study and submitted to VFS, FEES and OPES using a liquid and semi-solid bolus. As a reference, we used VFS. Both the FEES and the OPES showed good sensitivity with high overall values (≥ 80% and ≥ 90% respectively). The comparison between FEES vs VFS concerning drop before swallowing showed good specificity (84.4% for semi-solids and 86.7% for liquids). In the case of post-swallowing residue, FEES vs VFS revealed good overall validity (75% for semi-solids) with specificity and sensitivity well balanced for the semi-solids. OPES vs. VFS demonstrated good sensitivity (88.6%) and overall validity (76.7%) for liquids. The analysis of FEES vs. VFS for aspiration showed that the overall validity was low (≤ 65%). On the other hand, OPES demonstrated appreciable overall validity (71.7%). VFS, FEES and OPES are capable of detecting oro-pharyngeal dysphagia. FEES gave significant results in the evaluation of post-swallowing residues.

PMID: 27958600 [PubMed - in process]

http://ift.tt/2gzVRPw

Association between oral habits, mouth breathing and malocclusion.

Association between oral habits, mouth breathing and malocclusion.

Acta Otorhinolaryngol Ital. 2016 Oct;36(5):386-394

Authors: Grippaudo C, Paolantonio EG, Antonini G, Saulle R, La Torre G, Deli R

Abstract
The ratio of bad habits, mouth breathing and malocclusion is an important issue in view of prevention and early treatment of disorders of the craniofacial growth. While bad habits can interfere with the position of the teeth and normal pattern of skeletal growth, on the other hand obstruction of the upper airway, resulting in mouth breathing, changes the pattern of craniofacial growth causing malocclusion. Our crosssectional study, carried out on 3017 children using the ROMA index, was developed to verify if there was a significant correlation between bad habits/mouth breathing and malocclusion. The results showed that an increase in the degree of the index increases the prevalence of bad habits and mouth breathing, meaning that these factors are associated with more severe malocclusions. Moreover, we found a significant association of bad habits with increased overjet and openbite, while no association was found with crossbite. Additionally, we found that mouth breathing is closely related to increased overjet, reduced overjet, anterior or posterior crossbite, openbite and displacement of contact points. Therefore, it is necessary to intervene early on these aetiological factors of malocclusion to prevent its development or worsening and, if already developed, correct it by early orthodontic treatment to promote eugnatic skeletal growth.

PMID: 27958599 [PubMed - in process]

http://ift.tt/2huDCwK

Advanced oxidation protein product levels as a marker of oxidative stress in paediatric patients with chronic tonsillitis.

Advanced oxidation protein product levels as a marker of oxidative stress in paediatric patients with chronic tonsillitis.

Acta Otorhinolaryngol Ital. 2016 Oct;36(5):381-385

Authors: Ozbay I, Kucur C, Koçak FE, Savran B, Oghan F

Abstract
We aimed to determine whether advanced oxidation protein product (AOPP) levels can serve as a marker of oxidative stress in paediatric patients with chronic tonsillitis. Thirty children with chronic tonsillitis and 30 healthy children (control group) were recruited from the Otorhinolaryngology (ORL) and Paediatric Surgery departments, respectively, of Dumlupinar University Hospital. In the patient group, blood samples were collected before tonsillectomy, and tonsil tissue was sampled during the operation. Blood samples were also obtained from the control subjects. AOPP levels in the serum and tonsil tissue were measured by the spectrophotometric method. Serum AOPP levels were significantly higher in the patient group (13.1 ± 3.3 ng/ml) than in the control group (11.6 ± 2.3 ng/ml; P < 0.05). In addition, the mean AOPP level (41.9 ± 13.5 ng/mg protein) in the tonsil tissue in the patient group was significantly higher than the mean serum AOPP levels in the control and patient groups (P < 0.05). AOPP levels are elevated in the tonsil tissue and serum of patients with chronic tonsillitis compared to the serum AOPP levels in healthy controls. AOPPs may represent a novel class of pro-inflammatory molecules that are involved in oxidative stress in chronic tonsillitis. AOPPs may be used as a marker of oxidative stress in paediatric patients with chronic tonsillitis.

PMID: 27958598 [PubMed - in process]

http://ift.tt/2hssrri