Clinical efficacy of utilizing Ultrapulse CO2 combined with fractional CO2 laser for the treatment of hypertrophic scars in Asians—A prospective clinical evaluation

Summary

Background and Objective

Hypertrophic scarring is seen regularly. Tissue penetration of laser energy into hypertrophic scars using computer defaults from some lasers may be insufficient and penetration not enough. We have developed a treatment with an interrupted laser "drilling" by the Ultrapulse CO₂ (Manual Fractional Technology, MFT) and, a second pass, with fractional CO₂. The MFT with fractional CO₂ lasers to treat hypertrophic scars is evaluated.

Study Design/Materials and Methods

A total of 158 patients with hypertrophic scars had three sessions of MFT with fractional CO₂ laser at 3-month intervals. Evaluations made before and 6 months after the 3rd treatment: (1) the Vancouver Scar Scale (VSS), (2) the University of North Carolina (UNC) Scar Scale, and (3) a survey of patient satisfaction.

Results

All data were analyzed using a t-test before and after treatment. The VSS score decreased from 9.35 to 3.12 (P<.0001), and the UNC Scar Scale score decreased from 8.03 to 1.62 (P<.0001). The overall satisfaction rate was 92%. No long-term complications occurred in the clinical trial.

Conclusion

The interrupted laser drilling by MFT and a fractional CO2 laser had profound effects on the hypertrophic scars treated. It works by increasing the penetration depth of the CO₂ laser in the scar tissue, exerting more precise effects on the hypertrophic scars. MFT combined with fractional CO₂ laser has the potential to be a major advance in the treatment of hypertrophic scars.

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Issue Information - TOC

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BJD Snippet

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JCD Editorial – June, 2017

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Ouder worden is geen ziekte

"Nieuwe methode om leververvetting te bestrijden: 'verjong 'de weefsels" las ik vanmorgen op DeMorgen.be. In het artikel (dat werd overgenomen uit de Volkskrant) werd vol enthousiasme gesproken over het terugdraaien van veroudering. Verouderingsexpert Andrea Maier van de Universiteit van Amsterdam stelde zelfs dat het jammer was dat de Wereldgezondheidsorganisatie veroudering nog niet als een ziekte erkent. Sommige onderzoekers lijken te vergeten dat ouder worden gaat over meer dan enkel het fysiek ouder worden. Heel wat studies waarschuwen zelfs voor het gelijkstellen van ouder worden met ziekte1. Toch wordt er over ouder worden en ouderen steeds meer in termen van ziekte en medische behandelingen gesproken. In wetenschappelijke termen wordt dit als de 'medicalization of aging'2 omschreven. Het eerder vernoemde artikel, maar ook de 'anti-aging' industry met hun botox, plastische chirurgie en anti-rimpelcrèmes, zijn hier een mooi voorbeeld van. Het laten erkennen van veroudering als een ziekte brengt heel wat risico's met zich mee. Naast een te eenzijdig focus op het verouderingsproces, toont onderzoek aan dat deze medische visie op ouder worden sterk geassocieerd is met negatieve stereotypes over ouderen3. Sinds 1810 zijn we steeds negatiever gaan denken over ouderen en ouder worden. Vandaag de dag spreken we vooral over ouderen als we het hebben over de vergrijzing, het toegenomen aantal rusthuisbedden, onbetaalbare pensioenen en stijgende kosten binnen de gezondheidszorg. Bij deze een omroep om meer aandacht te hebben voor andere aspecten van het ouder worden in plaats van enkel het medische verhaal en het daar bijhorende kostenplaatje. We mogen niet vergeten dat ouder worden een natuurlijk proces is waarbij men zowel op fysiek als op sociaal, emotioneel en financieel vlak heel wat veranderingen ondergaat. Ouder worden is bijgevolg geen ziekte, maar de overgang naar een nieuwe levensfase. We omschrijven de pubertijd toch ook niet als een ziekte?

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Effect of gels containing chlorhexidine or epigallocatechin-3-gallate on the protein composition of the acquired enamel pellicle

Publication date: October 2017
Source:Archives of Oral Biology, Volume 82
Author(s): Cíntia Maria de Souza-e-Silva, Talita Mendes da Silva Ventura, Luiza de Pau, la Silva Cassiano, Aline de Lima Leite, Marília Afonso Rabelo Buzalaf
ObjectiveThis study evaluated changes in protein profile of the acquired enamel pellicle (AEP) formed in vivo, after application of gels containing chlorhexidine or EGCG and further challenge with citric acid.DesignAEP was formed in 9 volunteers for 2h and then treated with one of the following gels: placebo, 400μM EGCG or 0.012% chlorhexidine. A thin layer of gel was applied and after 1min the excess was removed. One hour after gel application, the AEP was collected from the buccal surface (upper and lower jaw) of one of the sides with filter paper dipped in 3% citric acid. On the other side, erosive challenge was performed through gentle application of 1% citric acid (pH 2.5) for 20s (using a pipette) followed by washing with deionized water. The AEP was collected as mentioned before. Proteomic analysis was performed through liquid chromatography-electrospray ionization tandem mass spectrometry (LC-ESI–MS/MS). The MS/MS spectra obtained were compared with human protein databases (SWISS-PROT). Label-free quantitation was done using the PLGS software.ResultsIn total, 223 proteins were identified. After treatment with EGCG and CHX gels, proteins with potential functions to protect against caries and erosion such as PRPs, calcium-bind proteins and Statherin were increased. When EGCG and CHX-treated AEPs were challenged with citric acid, there was increase in cystatins and Profilin-1.ConclusionCHX- and EGCG-treated AEPs, submitted to challenge with citric acid or not, had remarkable changes in their proteomic profiles.



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Histologic features of chronic cutaneous lupus erythematosus of the scalp using horizontal sectioning: Emphasis on follicular findings

Chronic cutaneous lupus erythematosus (CCLE) often affects the scalp resulting in scarring alopecia. While histopathologic findings of CCLE have been well described, there is little written on the morphologic changes to the hair follicles in this condition.

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Skin-infiltrating, interleukin-22–producing T cells differentiate pediatric psoriasis from adult psoriasis

Evidence from adult psoriasis studies implicates an imbalance between regulatory and effector T cells, particularly TH-17–producing T cells, in the pathogenesis of psoriasis. Little is known about the immunopathology of psoriasis in children.

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Quality of Life and Dysphagia Following Palliative Stenting in Esophageal Cancer

Condition:   Esophageal Cancer
Intervention:  
Sponsor:   Centre hospitalier de l'Université de Montréal (CHUM)
Recruiting - verified June 2017

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Erratum to: Early gastric adenocarcinoma arising within foveolar-type dysplasia in a patient with Muir-Torre variant Lynch syndrome

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Squamous cell carcinoma of the retromolar trigone: Treatment outcomes

Squamous cell carcinoma (SCC) of the retromolar trigone is uncommon, accounting for 1.4% of all oral cancer cases in Japan. Few studies have examined the optimal treatment for this cancer. The aim of this study was to evaluate the outcome of treatment for primary SCC of the retromolar area.

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Undifferentiated sarcoma of the sphenoid sinus

Paranasal sinuses sarcomas are rare and no treatments have been established. We report a young-adult case of sphenoid sinus sarcoma treated by carbon-ion radiotherapy. The patient presented with progressive left-sided visual impairment. A tumor was then identified and partial resection by transnasal approach was performed. The resected mass showed typical morphology of mesenchymal tumor, and morphological and molecular analyses ruled out a predominant-differentiation phenotype. The pathological diagnosis was undifferentiated sarcoma.

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A case grafted with polyglycolic acid sheets and fibrin glue for protection after temporary resection of a metastatic cervical skin tumor

The aim of this case report was to evaluate the usefulness of a grafting with polyglycolic acid sheet and a fibrin glue spray (PGA sheet grafting) after resection of a cervical skin tumor. A 61-year-old woman presented with left cervical skin tumor resistance to chemo-radiotherapy. She had been undergoing multimodal therapy for ovarian serous papillary adenocarcinoma for the previous six years. Although she had a poor general condition and a cervical skin tumor of 9cm in diameter, which was painful and easy bleeding, had offensive smell, she hoped to return to her job.

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Evaluation of the myringosclerotic tympanic membrane with wideband tympanometry

Suat Terzi, Abdulkadir Özgür, Zerrin Özergin Coşkun, Özlem Çelebi Erdivanlı, Metin Çeliker, Münir Demirci, Engin Dursun

Indian Journal of Otology 2017 23(2):117-120

Objective: The purpose of this study is to evaluate the effects of myringosclerosis (MS) localized to the tympanic membrane (TM) on the mechano-acoustics of hearing using wideband tympanometry (WBT). Materials and Methods: In this prospective case-controlled study, 86 ears of 54 patients who were found to have MS localized to the TM were compared to 40 healthy eardrums in 20 patients. Thirty-seven ears which had a MS ratio to the whole TM of <25% were classified as Group 1, 33 ears with a ratio of 25–50% were classified as Group 2, and 16 ears with a ratio of >50% were classified as Group 3. Peak acoustic compliance, resonant frequency (RF), and frequency-specific absorbance results of WBT were compared among the MS groups and the control group. Results: When the amplitudes of peak acoustic compliance of the MS groups and control group were compared, the MS groups were found to have lower amplitudes, and the difference was statistically significant (P < 0.05). There was no difference in frequency-specific absorbance values (250, 500, 1000, 2000, 4000, 8000, and 375–2000 Hz averaged absorbance) among the groups (P > 0.05). The RF of Groups 1, 2, and 3 were 1062, 1154, and 1166 Hz, respectively, and the RF of the control group was 1077 Hz. There was no significant difference among the groups with regard to resonant frequencies. Conclusion: This study showed that although MS localized to the TM decreased the amplitude of peak acoustic compliance of the tympanogram, it did not affect the RF or the wideband acoustic absorbance.

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Investigating a patient of vertigo: Where do we stand today?

Chetana Naik

Indian Journal of Otology 2017 23(2):63-66



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Efficacy of an eccentric osteopathic manipulation treatment in somatic tinnitus

Manu Goyal, Sorabh Sharma, Nitish Baisakhiya, Kanu Goyal

Indian Journal of Otology 2017 23(2):125-127

Tinnitus is the ringing in the ears heard by the patients in the absence of external sounds. The potential causes for the tinnitus could be the vascular, temporal bone dysfunction, inflammation in the ear, idiopathic, muscular spasms of the middle ear and palatal muscles, functional impairment of the eustachian tube, functional disorders of the jaw, and cervical spine. The author reported a 30-year-old female case who presented with the complaint of buzzing and hissing in the right ear accompanied by the stiffness in the head and neck. Patient had no past medical and surgical history of any ear problem. On otoscopic examination of the tympanic membrane by otolaryngologist no abnormality was detected. In the present case, the diagnosis was made as somatic tinnitus accompanied by reduced cranial sacral motion. The craniosacral osteopathic manipulation was performed which remains the only choice in such cases. In follow-up of 1 month, patient was doing well and is asymptomatic.

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To study the anatomy of tympanomastoid segment of facial nerve and its variations in human cadaveric temporal bone

Nitika Gupta, Rohan Gupta, IP Singh, Sunil Kotwal, Anil Suri, Sunanda Raina

Indian Journal of Otology 2017 23(2):108-112

Introduction: The facial nerve is one of the most significant and vulnerable structures in the temporal bone. Its dysfunction affects both voluntary and voluntary motion leading to noticeable disfigurement and emotional distress to those suffering from it. Iatrogenic facial paralysis is known to be a feared complication of ear surgery, and its incidence is reported to be 0.6–3.6% in all otologic surgical procedures, which increases to 4–10% in revision cases. Objective: The aim of this study is to study the anatomical aspects of tympanomastoid segment of the facial nerve. Materials and Methods: Thirty wet human cadaveric temporal bones were dissected in the temporal bone dissection laboratory in the Department of ENT, Government Medical College, Jammu. The length of the tympanomastoid segment of the facial nerve, its relationship with important bony landmarks, and the presence of any anomaly or variation in its course were studied. Observations and Results: The mean length of the tympanic segment of the facial nerve was 10.44±1.428 mm while that of the mastoid segment was 13.33±2.202 mm. The angle formed between the tympanic and mastoid segments of the facial nerve varied between 95°and 120°with the mean angle being 104.66°±7.760°.

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Screening of auditory acuity in patients with type 2 diabetes mellitus

Netra A Pathak, Vidya V Rokade, Kiran J Shinde

Indian Journal of Otology 2017 23(2):67-70

Diabetes mellitus (DM) is a multifunctional metabolic disorder affecting almost all the systems of the body. There is a strong relation between DM and hearing. The three main theories of pathogenesis of hearing impairment in patients with diabetes are microangiopathy, neuropathy, and combination of both. Even though studies have proved the occurrence of sensorineural hearing loss in DM, disagreement still exists among some about their relation. Material and Methods: This study was a prospective design. Aim: The present study aimed (1) to focus on and evaluate the interrelation between Type 2 DM and hearing loss; (2) to screen the degree of auditory acuity in patients with Type 2 DM using pure tone audiometry; and (3) to analyze the effect of age, glycemic status (fasting blood sugar and postprandial blood sugar), glycemic control (glycosylated hemoglobin), and duration of Type 2 diabetes on auditory acuity. Results: In the present study, it was found that the patients with Type 2 diabetes had a higher hearing threshold than the healthy controls. The patients with diabetes showed significant high-frequency, bilateral, mild-to-moderate SNHL. Conclusion: The glycemic status had significant correlation with hearing loss may be explained by diabetic microangiopathy of the inner ear, and the hearing was affected in both sexes equally.

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Effect of postauricular sulcus incision for myringoplasty on auricle protrusion: 5 years' experience

Mohammad Waheed El-Anwar, Ahmed Shaker ElAassar

Indian Journal of Otology 2017 23(2):71-73

Objective: The objective of this study was to investigate the effect of postauricular incision (sulcus incision) during myringoplasty using conchal perichondrial graft with or without conchal cartilage on the ear protrusion. Patients and Methods: A prospective study was conducted on 243 patients who underwent myringoplasty using small postauricular sulcus incision. The distances from postauricular area to the lateral aspects of helical rim and ear lobule at three different levels and the maximum ear protrusion were measured pre- and post-operatively. Results: There were no statistically significant differences between the measures of the auricle position preoperatively and 2 weeks, 1 month, and 3 months postoperatively. Conclusion: There was no effect of the short postauricular sulcus incisions for myringoplasty on the ear position. It does not affect or annoy the glasses wearers with highly satisfactory cosmetic results without reported persistent complications.

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Vestibular dysfunction in children with sensorineural hearing loss: A cross-sectional study

Poonam Raj, Atul Gupta

Indian Journal of Otology 2017 23(2):74-77

Introduction: The cochlea and vestibule are anatomically and functionally related to each other and any dysfunction in each or both of them may result in vestibular functional derangement and subsequent deficit in the function of balance. This is especially true in children where the two systems are still evolving. Vestibular dysfunction has been reported in approximately 20-70 % of children with hearing loss of different causes. This study was aimed to detect and evaluate the prevalence of vestibular dysfunction in children with SNHL. Methods and Materials: Vestibular function assessment was done with monothermal warm air caloric test on 50 children less than 12 years of age with bilateral severe to profound SNHL. Recordings were made using a head band camera on SYNAPSYS Ulmer VNG software. "Monothermal Caloric Asymmetry" (MCA) was depicted in the recording software as unilateral weakness. MCA of >15 % was taken as evidence of canal paresis. Results: The mean age of the children was 5.48 years. Of the 48 children who successfully completed the test, 09 children had vestibular dysfunction indicative of canal paresis. Prevalence was 18.75 % with 95% CI (7.3, 30.2). Correlation between compensated vestibular function results with age and severity of SNHL was not significant. Conclusions: Children with SNHL should be evaluated for occult compensated vestibular dysfunction. It may also be relevant in the context of any further vestibular pathology the child may develop and should be kept in mind when surgical procedures like cochlear implantation are being contemplated.

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Nitinol piston versus conventional teflon piston in the management of otosclerosis: A comparative study

Poonam Raj, Atul Gupta, Ruchika Mittal

Indian Journal of Otology 2017 23(2):78-82

Introduction: Otosclerosis is a primary metabolic localized disease characterized by conductive deafness. The mainstay of treatment of this condition remains surgical. Several techniques and approaches are commonly used with largely excellent results. A newly developed piston made of Nitinol has the property of crimping by heat activation rather than manually. This study, carried out at a tertiary care centre of the armed forces, proposed to evaluate the efficacy and complications of the Nitinol Smart piston in comparison to the conventional pistons currently being used. Methods and Materials: 50 patients of otosclerosis were evaluated with Pure tone audiometry and randomized into test and control groups of 25 each. The control group underwent stapedotomy by the conventional Teflon piston and in the test group Nitinol smart pistons were used. Pure tone Audiometry for hearing thresholds and AB gap was performed at 06 weeks after surgery and repeated at 06 months, 01 year and 02 years after surgery. Results: Results show an almost identical outcome in terms of improvement of hearing thresholds with the two kinds of prosthesis used with the 'Smart' piston showing marginally better results. There was no significant difference in the postoperative ABG (P < .23) or ABG closure (P < .09). Conclusion: The nitinol piston prosthesis represents the latest advancement in stapes prosthesis design in that incorporates heat-sensitive crimping to preclude the technically difficult step of manual crimping. It is at least as effective as a standard prosthesis in closing the ABG in patients with otosclerosis.

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Glomus tympanicum: A radiological dilemma

A Karunagaran, VJ Niranjana Bharathi, Anand Karthikeyan

Indian Journal of Otology 2017 23(2):131-133

Glomus tumors are non chromaffin paraganglionomas, a vascular tumor arising in the middle ear, presents with tinnitus and aural block with radiological supportive findings. Diagnosis is made easy by the radiological investigations. Even in this modern era, the role played by clinical examination is vital and as we present in this case report, played an important role in management of the disease.

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Effect of mastoid pneumatization on myringoplasty success: A radiological study

Hazem Saeed Amer, Mohammad Waheed El-Anwar, Mohammad Abdelhady, Ghada Abdulmonaem, Khaled Mohammad Elgerby

Indian Journal of Otology 2017 23(2):104-107

Objectives: The objective of the study was to evaluate the effect of mastoid pneumatization on myringoplasty success. Patients and Methods: Forty-two adult patients with dry central tympanic membrane perforation scheduled for myringoplasty were included in the study. Computed tomography (CT) scans of the temporal bone coronal and axial cuts were done 1–2 days before surgery. The patients were evaluated on the basis of postoperative graft taking. Results: Success rate was 85.7% while failure rate was 14.3%. The mean longitudinal diameter of the mastoid was found to be 2.35 cm in succeeded cases and 1.43 cm in failed cases with near significant difference (P = 0.0636). The mean transverse diameter was 1.44 cm in succeeded cases and 0.83 cm in failed cases with a significant difference (P = 0.0476). The mean depth of the mastoid was 0.4 in both succeeded and failed cases. The mean total mastoid volume was 2.832 ml in succeeded cases and 1.13 ml in failed cases with nonsignificant difference (P = 0.1218). The mean mastoid surface area was 516.9 cm2 in succeeded cases and 448.5 cm2 in failed cases with a significant difference (P = 0.0087). Conclusions: Success rate of myringoplasty is higher in patients with chronic suppurative otitis media (CSOM) having large mastoid system than those having small one. Preoperative CT scans in patients with CSOM undergoing myringoplasty are advisable.

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Effect of inter-stimulus interval on the acoustic change complex elicited with tone-complex and speech stimuli

Mohan Kumar Kalaiah, Anjali Jude, Vinaya Palora Malayil

Indian Journal of Otology 2017 23(2):83-88

Background: Acoustic change complex (ACC) is an auditory-evoked cortical potential elicited for a change in the physical properties of the sound. It can be elicited for a change in frequency, amplitude, or periodicity in the ongoing speech and nonspeech stimuli. Earlier investigations have established a significant effect of stimulus-related factors on the cortical auditory-evoked potentials. However, investigations to understand the effects of stimulus factors on the ACC are rare. Purpose: This study aimed to investigate the effect of inter-stimulus interval (ISI) between the stimuli on the ACC elicited for speech and tone-complex stimuli. Research Design: This is a cross-sectional study. Method: A total of 12 young adults aged between 18 and 22 years with normal hearing in both ears participated in the study. The ACC was elicited using a consonant-vowel syllable/sa/and frequency-changing tone-complex. Tone-complex had an onset frequency of 1000 Hz and changed its frequency to 2000 Hz at 120 ms after the onset. Both stimuli had a total duration of 350 ms and changed their characteristics at 120 ms after the onset. The stimulus was presented monaurally with ISIs of 500, 1000, 1500, and 2000 ms, and the ACC was recorded from Cz to Fz. Results: The present study showed a significant effect of ISI on peak latencies and peak-to-peak amplitudes. Shorter ISI was found to elicit peaks with smaller amplitude and slightly longer latency, whereas longer ISI elicited peaks with larger amplitude and shorter latency. Further, the amplitude of response for tone-complex was larger than response for syllable/sa/. Conclusions: ISI is one of the stimulus-related factors which significantly affects the ACC. Longer ISIs (≥1500 ms) should be used to elicit the ACC.

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Effect of duration of diabetes mellitus on hearing threshold among type 2 diabetics

Stephen Semen Yikawe, Kufre Robert Iseh, Anas Ahmad Sabir, Joseph Hassan Solomon, Caleb Manya, Nasiru Aliyu

Indian Journal of Otology 2017 23(2):113-116

Background: Diabetes mellitus (DM) is a syndrome of chronic hyperglycemia due to relative insulin deficiency or resistance. The risk of complications of diabetes has been observed to increase as a function of the duration of hyperglycemia. Objective: The objective of this study is to determine the effect of duration of DM on hearing thresholds among type 2 diabetics. Methodology: This was a cross-sectional descriptive study conducted between October 2015 and May 2016 in Usmanu Danfodiyo University Teaching Hospital Sokoto among type 2 diabetic patients attending the Endocrine Clinic of the hospital. Patients had their blood sugar and hearing thresholds measured. Results: A total of 170 type 2 diabetics were recruited into the study, out of which 98 (57.6%) were females and 72 (42.4%) were males. The mean age was 46.49±10.02 years. One hundred and twenty-two (71.8%) had elevated hearing thresholds. The mean duration of diabetes among participants was 7.81±5.34 years, with durations ranging from <1 year to 30 years. The mean pure tone average increased with increase in duration of diabetes (P < 0.001). Simple linear regression showed that increase in duration of diabetes was positively related with hearing threshold (P < 0.0001). For every year increase in duration of type 2 DM, a 1.036 dB HL increase in pure tone average is to be expected. Conclusion: This study demonstrated a relationship between duration of diabetes and hearing threshold. It has shown that as the duration of hyperglycemia increased, the hearing threshold among participants also increased.

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Test-retest reliability of contralateral suppression of acoustic middle ear muscle reflex

Sandeep Maruthy, G Nike Gnanateja, M Shamantha, M Nayana

Indian Journal of Otology 2017 23(2):89-93

Background and Objective: The role of efferent system in auditory perception is very important. To assess this, a reliable measure of efferent functioning is necessary. The efferent suppression of otoacoustic emission lacks good test-retest reliability, and there is a need to look for the reliability of other measures of efferent auditory functioning. The current study evaluated the test-retest reliability of contralateral suppression of acoustically evoked middle ear muscle reflexes (MEMR). Method: Nineteen normal hearing adults in the age range of 18–24 years participated in the study. A Repeated measures design was used to establish the reliability of the contralateral suppression of MEMR. Measurements were spaced 1 h and 1 day apart. Results: The results showed acceptable test-retest reliability of contralateral suppression of acoustically evoked MEMR in terms of its Cronbach's alpha. However, inspection of the individual data did not support the impression to call it a reliable tool to assess efferent auditory functioning. The findings of the study are discussed in light of its clinical utility. Conclusion: Contralateral suppression of acoustically evoked MEMR has questionable reliability to be used as a clinical tool.

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Enterococcus brain abscess with lateral sinus thrombophlebitis as a complication of chronic otitis media

Manu Malhotra, Shubhankur Gupta, Saurabh Varshney, Poonam Joshi, Rashmi Malhotra

Indian Journal of Otology 2017 23(2):121-124

With widespread use of antibiotics, the occurrence of brain abscess and lateral sinus thrombosis together is rare these days, especially with enterococcus as the causative organism. We here present a case of pediatric case of brain abscess and lateral sinus thrombosis which developed an additional complication of postoperative cerebrospinal fluid leakage. The case was successfully treated by excision of the abscess, canal wall down mastoidectomy with partial obliteration of cavity, and Type III tympanoplasty with umbrella graft.

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Effects of ethnicity and gender on the middle ear function in Asian adults

Aw Cheu Lih, Mohd Normani Zakaria, Ridwan Afif Mohamad, Mohd Fadzil Nor Rashid

Indian Journal of Otology 2017 23(2):94-97

Introduction: Tympanometry is a standard clinical test to measure the middle ear function objectively. Ethnicity and gender may affect tympanometric results, and specific normative data are required for diagnosing middle ear disorders accurately. Aim: This study aimed to determine the effects of ethnicity (Malay vs. Chinese) and gender on tympanometric results among Asian adults. Materials and Methods: A total of 72 young adults aged 20–25 years participated in this comparative study. They comprised two ethnic groups: Malay (n = 31 [14 males and 17 females]) and Chinese (n = 41 [20 males and 21 females]) participants. All participants fulfilled the inclusion criteria (no history of ear and hearing difficulties and normal findings in routine audiological assessments) and underwent a standard 226 Hz tympanometric testing. Tympanometric parameters including static admittance (SA), ear canal volume (ECV), tympanometric peak pressure (TPP), and tympanometric width (TW) were recorded from each participant. Results: No significant differences in all tympanometric parameters were found between Chinese and Malay participants (P > 0.05). However, statistically higher SA and ECV values were noted in males than in females (P < 0.05). No gender effect was observed in TPP and TW (P > 0.05). Conclusions: For a more accurate middle ear evaluation in Malay and Chinese young adults, gender-specific tympanometric normative data derived from this study are recommended.

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Migrated guidewire: An unusual cause for recurrent aural polyps

Kong Yew Liew, Aun Wee Chong

Indian Journal of Otology 2017 23(2):128-130

Aural polyps are secondary to multiple ear pathologies, most commonly inflammatory or cholesteatoma related. Here, we present a rare case of recurrent aural polyps caused by guidewire migration into the middle ear with serious systemic complications and our attempts at removal.

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Comparison of performance across transcranial contralateral routing of signal, trimmer digital and digital bone-anchored hearing implant (with headbands) in children with unilateral hearing loss

N Devi, Suma Chatni, K. J. S. Ramadevi, D Baba Fakruddin

Indian Journal of Otology 2017 23(2):98-103

Background: Children with unilateral hearing loss (UHL) of severe profound degree find it challenging to locate a sound source and to comprehend speech in the presence of noise, like in classrooms. The objectives of the present study were to compare the available rehabilitative options for children with UHL and arrive at a probably appropriate option. Methods: Fifteen children with unilateral severe sensorineural or profound hearing loss participated in the study. The sound field thresholds, speech perception in the presence of noise and in quiet were assessed with the digitally programmable bone-anchored hearing implant (BAHI), the trimmer digital BAHI and the transcranial contralateral routing of signal (T-CROS). Results: BAHI and T-CROS both provide significant benefit for the children with UHL. However, the children performed better with the BAHIs than the T-CROS both in quiet and noise in most of the measures. It was also noted that the digitally programmable and the trimmer digital BAHI both gave similar performance. Conclusions: BAHI was a better option in both quiet and noise than the T-CROS as a rehabilitation option for children with UHL. The current study helps in prioritizing the rehabilitation options while considering trial and also helps in narrowing down at the appropriate rehabilitative option for the children with UHL.

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Erratum: Influence of channel and channelfree™ processing technology on the vocal parameters in hearing-impaired individuals

Indian Journal of Otology 2017 23(2):134-134



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Structural Basis for CD4+ T Cell Epitope Dominance in Arbo-Flavivirus Envelope Proteins: A Meta-Analysis

Viral Immunology , Vol. 0, No. 0.


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Poets and the City: Locating the Political in Soviet and Post-Soviet Russian Poetry

This essay summarizes the political and theoretical backgrounds of poetry of the twentieth century and provides an overview of the contributions to this special triple issue on Poetry and Politics. Taking the Platonic idiosyncrasy towards poetry and the State ('Republic') as its dialectical departure point, the substance and matter of the volume encompasses several characteristic case studies which appear to be highly relevant in this context. This special volume deals with the oeuvre of such iconic Russian poets as Velimir Khlebnikov, Vladimir Maiakovskii, Daniil Kharms, Dmitrii Prigov, Arkadii Dragomoschenko and many others. Special attention is paid to the general issue of ideology and the Russian Avant-Garde pragmatics of shocking action related to Futurism and early Soviet culture.

http://ift.tt/2suiXBH

Imiquimod-induced cutaneous lupus erythematosus with antinuclear antibodies showing a homogenous pattern

http://ift.tt/2tognd1

Lichen striatus following yellow fever vaccination in an adult woman

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Vocal palsy increases the risk of lower respiratory tract infection in low-risk low-morbidity patients undergoing thyroidectomy for benign disease: a big data analysis

Abstract

Objectives

Thyroidectomy is the commonest and most rapidly-growing operation which places normally-functioning laryngeal nerves at risk of injury. Laryngeal palsy is a major risk-factor for dysphonia, dysphagia, and less commonly, airway obstruction. We investigated the association between post-thyroidectomy vocal palsy and long-term risks of pneumonia and laryngeal failure.

Design

An N=near-all analysis of the English administrative dataset using a previously-validated informatics algorithm to identify young and otherwise low-risk patients undergoing thyroidectomy for benign disease. Information about age, sex, morbidities, social deprivation, and postoperative and late complications were derived.

Main Outcome Measures

Between 2004 and 2012, 43,515 patients between the ages of 20 and 69 who had no history of cancer, neurological, or respiratory disease underwent first-time elective total or hemithyroidectomy without concomitant or late neck dissection, parathyroidectomy, or laryngotracheal surgery for benign thyroid disease. Information about age, sex, morbidities, and in-hospital and late complications was recorded.

Results

Mean age at surgery was 46±12. There was a strong female preponderance (85%) and most patients (89%) had no recorded Charlson morbidities. Most patients (65%) underwent hemithyroidectomy. Late vocal palsy was recorded in 449 (1.03%) patients and its occurrence was an independent risk factor for emergency hospital readmission (n=7113; Hazard Ratio 1.52; 95% Confidence interval 1.21-1.91), hospitalisation for lower respiratory tract infection (n=944; HR 2.04; 95% CI 1.07-3.75), dysphagia (n=564; HR 3.47; 95% CI 1.57-7.65) and gastrostomy/tracheostomy placement (n=80; HR 20.8; 95% CI 2.5-171.2). Independent risk-factors for late vocal palsy were age, burden of morbidities, total thyroidectomy, and postoperative bleeding. Female sex and annual surgeon volume >30 were independently protective.

Conclusions

There is a significant association between post-thyroidectomy vocal palsy and long-term risks of hospital readmission, dysphagia, pneumonia, and gastrostomy/tracheostomy tube placement. This adds weight to the need, from a thyroid surgical perspective, to undertake universal post-thyroidectomy laryngeal surveillance with a focus on postoperative dysphagia and aspiration, and from a medical/respiratory perspective, to initiate investigations to identify occult vocal palsy in patients who present with pneumonia, who have a history of thyroid surgery.

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Long-term outcomes of central neck dissection for cN0 papillary thyroid carcinoma

Publication date: Available online 14 June 2017
Source:American Journal of Otolaryngology
Author(s): Davide Giordano, Andrea Frasoldati, Enrico Gabrielli, Carmine Pernice, Michele Zini, Andrea Castellucci, Simonetta Piana, Alessia Ciarrocchi, Silvio Cavuto, Verter Barbieri
Objective.The risk-benefit ratio of central neck dissection (CND) in patients affected by papillary thyroid carcinoma (PTC) without clinical or ultrasonographic (US) evidence of neck lymph node metastasis (cN0) is currently debated. The aim of this study was to evaluate long-term outcome of CND on locoregional recurrence, distant metastasis, survival, and postoperative complications in a large series of patients with cN0-PTC.Study Design.Observational retrospective controlled study.MethodsClinical records of patients (n=610) surgically treated for cN0-PTC at the Otolaryngology Unit of the Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy, from January 1984 to December 2008, were retrospectively reviewed. Study population was divided into three groups according to surgical treatment: Group A, total thyroidectomy (n=205); Group B, total thyroidectomy and elective ipsilateral CND (n=281); Group C, total thyroidectomy and bilateral CND (n=124).ResultsOf a total of 610 patients, 305 (50%) were classified as low-risk, 278 (45.57%) as intermediate-risk, and 27 (4.43%) as high-risk. Response to initial therapy was excellent in 567 patients (92.95%), acceptable in 21 (3.44%), and incomplete in 22 (3.61%), with no significant differences among groups. Locoregional recurrence was detected in 32 (5.2%) out of 610 patients. Distant metastasis was found in 15 patients (2.5%). Statistical analysis showed no significant differences in the rates of locoregional recurrence (p=0.890) or distant metastasis (p=0.538) among groups. Disease-specific mortality and overall survival did not significantly differ among groups (p=0.248 and 0.223, respectively). Rate of permanent hypoparathyroidism was significantly higher in Group C patients compared to those in Groups A and B.ConclusionCND does not confer any clear advantage in the treatment of low-risk patients, regardless of surgical procedure. Instead, bilateral CND may be effective in limiting disease relapse and/or progression in patients at higher prognostic risk. Our data indicate that elective CND does not confer any clear advantage in terms of locoregional recurrence and long-term survival, as demonstrated by outcomes of the study Groups, regardless of their different prognostic risk. Elective CND allows a more accurate pathologic staging of central neck lymph nodes, despite its increasing the risk of permanent hypoparathyroidism. Intraoperative pathologic staging is a valuable tool to assess the risk of controlateral lymph node metastasis in the central neck compartment and to limit more aggressive surgery only to cases, otherwise understaged, with lymph node metastasis.



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Neck dissection for unknown cancer of the head and neck in the era of chemoradiation

Publication date: Available online 14 June 2017
Source:American Journal of Otolaryngology
Author(s): Mark J. Amsbaugh, Mehran Yusuf, Jeremy Gaskins, Craig Silverman, Kevin Potts, Jeffrey Bumpous, Rebecca Redman, Cesar Perez, Neal Dunlap
PurposeTo report outcomes for patients with cervical lymph node metastases from an unknown primary site of the head and neck treated with either non-operative therapy or neck dissection followed by adjuvant therapy.Materials and MethodsAll patients with squamous cell carcinoma of an unknown primary site of the head or neck seen between 2003 and 2013 were reviewed. The Kaplan-Meier method was used to estimate overall survival, local recurrence free survival, loco-regional recurrence free survival, and progression free survival. The log-rank test and proportional hazards regression were used to analyze factors influencing outcomes.ResultsOf 2258 patients with a new diagnosis of head and neck cancer, no primary site was identified in 66 patients. Twenty-nine patients were treated with definitive non-operative therapy (15 with chemoradiation and 14 with radiation alone). Thirty-seven patients received an upfront neck dissection followed by adjuvant radiation or chemoradiation. Three-year loco-regional recurrence free survival, progression free survival, and overall survival were 55.9%, 55.4%, and 69.4% respectively. Patients treated with preoperative neck dissection had improved local recurrence free survival (96.7% vs 54.1%, p=0.003) and loco-regional recurrence free survival (82.2% vs 46.4%, p=0.068) compared to patients treated with definitive chemoradiation with no difference in overall survival (p=0.641).ConclusionsNeck dissection improved local and regional control but not overall survival in patients with unknown primary squamous cell carcinoma of the head and neck over non-operative therapy alone.



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Temporal bone computed tomography findings associated with feasibility of endoscopic ear surgery

Publication date: Available online 14 June 2017
Source:American Journal of Otolaryngology
Author(s): Dunia Abdul-Aziz, Elliott D. Kozin, Brian M. Lin, Kevin Wong, Parth V. Shah, Aaron K. Remenschneider, Lukas D. Landegger, Amy F. Juliano, Michael S. Cohen, Daniel J. Lee
PurposeThere are no formal radiologic criteria to stratify patients for transcanal (TEES) or transmastoid endoscopic ear surgery for resection of cholesteatoma. We aim to determine 1) whether standard preoperative computed tomography (CT) findings are associated with the need for conversion to a transmastoid approach and 2) the amount of time added for conversion from TEES to transmastoid techniques.Materials and methodsRetrospective chart review of consecutive pediatric and adult cases of TEES for primary cholesteatoma from 2013 through 2015 (n=52). TEES cases were defined as endoscope-only procedures that did not require a transmastoid approach (n=33). Conversion cases were defined as procedures that began as TEES however, required conversion to a transmastoid approach due to the inability to complete cholesteatoma removal (n=19). Preoperative CT findings and total operating room (OR) times of TEES and conversion cases were compared.ResultsPreoperative CT scan characteristics that were associated with conversion included tegmen erosion (p=0.026), malleus erosion (p<0.001), incus erosion (p=0.009), mastoid opacification (p=0.009), soft tissue opacification extending into the aditus ad antrum (p=0.009) and into antrum (p=0.006). Total OR time for TEES cases was significantly shorter than conversion cases (median 143min versus 217min, p<0.001).ConclusionsPreoperative CT findings, notably extension of soft tissue in the aditus ad antrum, antrum and mastoid, are associated with need for conversion to transmastoid technique to achieve removal of cholesteatoma. Endoscope-only cases were significantly faster than cases that required conversion to a transmastoid approach.



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The effects of fibroblast growth factor-2 delivered via a Gelfoam patch on the regeneration of myringosclerotic traumatic eardrum perforations lying close to the malleus

Publication date: Available online 14 June 2017
Source:American Journal of Otolaryngology
Author(s): Zhong-hai Jin, Yi-Han Dong, Zi-Han Lou
ObjectiveWe evaluated the effects of fibroblast growth factor-2 (FGF-2) delivered via a Gelfoam patch on the regeneration of myringosclerotic traumatic tympanic membrane perforations (TMPs) lying close to the malleus.Study designA prospective, randomized, controlled clinical study.SettingA university-affiliated teaching hospital.Subjects and methodsWe prospectively analyzed, in a randomized manner, the outcomes of treatment for traumatic TMPs constituting >25% of the tympanic membrane. The closure rates, closure times, and otorrhea rates were compared among patients treated via FGF-2-containing Gelfoam patches, Gelfoam patches alone, and observation only.ResultsWe analyzed data from 138 patients. The perforation closure rates in the FGF-2 plus Gelfoam patch, Gelfoam patch, and observation alone groups were 97.9, 89.8, and 70.7%, respectively. Both the FGF-2 plus Gelfoam and Gelfoam alone groups exhibited significantly higher closure rates than the observational group (both p<0.05).The mean closure times were 15.7±5.1, 24.8±4.9, and 35.7±9.2days in the FGF-2 plus Gelfoam patch, Gelfoam patch alone, and observation alone groups, respectively. The FGF-2 plus Gelfoam patch group exhibited a significantly shorter closure time than the Gelfoam patch alone and observation alone groups (p<0.05). The incidences of purulent otorrhea were 14.6, 6.1, and 4.9% in the FGF-2 plus Gelfoam patch, Gelfoam patch alone, and observation alone groups, respectively. Surprisingly, 7 of 7 (100.0%) perforations associated with purulent otorrhea completely closed in the FGF-2 plus Gelfoam patch group; however, no such perforation healed in either the Gelfoam alone or observation alone group.ConclusionsFGF-2 plus Gelfoam patching significantly shortened the closure time compared to observation and Gelfoam patching alone, and it significantly improved the closure rate (compared to observation alone) of myringosclerotic perforations lying close the malleus. FGF-2 plus Gelfoam patching is a valuable, minimally invasive alternative treatment that may be readily applied to outpatient settings.



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Der Patient mit Thoraxtrauma

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 406-407
DOI: 10.1055/s-0043-112229

Georg Thieme Verlag KG Stuttgart · New York

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Ultraschallgeräte in Rettungshubschraubern

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 403-403
DOI: 10.1055/s-0043-110838

Georg Thieme Verlag KG Stuttgart · New York

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Erstes Netzwerk zur Angehörigenbetreuung von Organspendern

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 403-404
DOI: 10.1055/s-0043-110993

Georg Thieme Verlag KG Stuttgart · New York

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Scheinbare Allergie auf Lokalanästhetika bestätigt sich kaum

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 397-398
DOI: 10.1055/s-0043-105631

Georg Thieme Verlag KG Stuttgart · New York

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Protektive Beatmung während der Anästhesie: Sinn oder Unsinn?

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 395-396
DOI: 10.1055/s-0043-112101

Georg Thieme Verlag KG Stuttgart · New York

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Kleinhirninfarkt nach CO-Intoxikation und hyperbarer Sauerstofftherapie

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 463-470
DOI: 10.1055/s-0043-105146

Es wird von einem Patienten berichtet, der nach einem Suizidversuch mittels Kohlenmonoxidintoxikation einen raumfordernden Kleinhirninfarkt und konsekutiven okklusiven Hydrozephalus entwickelte. Durch das rechtzeitige Detektieren der intrazerebralen Läsion konnte ein Überleben des Patienten ohne schwerwiegendes neurologisches Defizit ermöglicht werden.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Konvulsiver Status epilepticus: Therapeutische Hypothermie bietet keinen Vorteil

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 396-397
DOI: 10.1055/s-0043-105623

Georg Thieme Verlag KG Stuttgart · New York

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Outcome nach Reanimation: Fibrin(ogen)-Spaltprodukte als Prädiktor

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 396-396
DOI: 10.1055/s-0043-109604

Georg Thieme Verlag KG Stuttgart · New York

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Neue Empfehlungen zur präoperativen Diagnostik

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 389-389
DOI: 10.1055/s-0043-111887

Georg Thieme Verlag KG Stuttgart · New York

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Weaning erhöht Lebensqualität und senkt Kosten

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 402-403
DOI: 10.1055/s-0043-110837

Georg Thieme Verlag KG Stuttgart · New York

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Surviving Sepsis Campaign 2016 – nichts Neues?

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 398-399
DOI: 10.1055/s-0043-112098

Georg Thieme Verlag KG Stuttgart · New York

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Blick in die Lunge kann Leben retten

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 403-403
DOI: 10.1055/s-0043-110992

Georg Thieme Verlag KG Stuttgart · New York

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Grundwissen zur Lagerung im OP

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 400-400
DOI: 10.1055/s-0042-116381

Georg Thieme Verlag KG Stuttgart · New York

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3-D-Mikroroboter für minimalinvasive Chirurgie

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 404-404
DOI: 10.1055/s-0043-110995

Georg Thieme Verlag KG Stuttgart · New York

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Effiziente Prüfungsvorbereitung

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 400-400
DOI: 10.1055/s-0042-120972

Georg Thieme Verlag KG Stuttgart · New York

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Der Patient mit Thoraxtrauma: präklinische Versorgung

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 408-421
DOI: 10.1055/s-0042-118056

Etwa jeder 10. Traumapatient in den Notaufnahmen weist ein stumpfes Thoraxtrauma auf, aus dem lebensbedrohliche Verletzungen wie Spannungspneumothorax oder Perikardtamponade resultieren können. Zeitkritische Diagnostik und Therapie stehen bei der Versorgung im Vordergrund. Die Durchführung lebensrettender therapeutischer Maßnahmen muss jedem Notarzt geläufig sein, und das Verletzungsmuster entscheidet über die Auswahl der Zielklinik.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Eritrea sucht Kollegen für Entwicklungshilfe

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 402-402
DOI: 10.1055/s-0043-110836

Georg Thieme Verlag KG Stuttgart · New York

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Der Patient mit Thoraxtrauma: chirurgische Versorgung

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 436-445
DOI: 10.1055/s-0042-118058

Bei Thoraxtraumata reicht das Spektrum von Verletzungen des Herzens und der großen Gefäße über Parenchymläsionen mit Pneumothorax, Blutungen aus den Interkostalgefäßen, bis hin zu chronischen Hämatothoraces und sekundären Empyemen. Die Anlage einer Thoraxdrainage stellt oft eine suffiziente Therapie dar, in bestimmten Fällen ist aber eine weitergehende chirurgische Therapie in minimalinvasiver Technik (VATS) oder via Thorakotomie erforderlich.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Der Patient mit Thoraxtrauma: anästhesiologisches Management

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 422-435
DOI: 10.1055/s-0042-118055

In der anästhesiologischen Praxis ist das Thoraxtrauma eine große Herausforderung. Verletzungen von Atemwegen, Lunge, Zwerchfell, Herz und großen thorakalen Gefäßen sind die vorherrschenden Probleme. Art und Ausmaß des chirurgischen Eingriffs sowie Wirkungen von Anästhetika und mechanischer Ventilation auf die pulmonale und kardiale Funktion sind besonders zu beachten.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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ATA announces new impact factor for journal Thyroid is 5.515, a 46% increase over last year’s impact factor of 3.784

Thyroid
The Official Journal of: American Thyroid Association

New Impact Factor 5.515 — An Increase of 46%!

Thyroid is proud to announce our new impact factor of 5.515*, a 46% increase over last year! This achievement upholds the Journal's position as the leading peer-reviewed journal in its field. The Journal has also had a 32% increase in full-text article downloads year-to-date and has global visibility in over 170 countries worldwide.

Make sure your manuscript has the impact and gets the attention it deserves by submitting your article to Thyroid today. For complete instructions for authors, click here.

The post ATA announces new impact factor for journal Thyroid is 5.515, a 46% increase over last year's impact factor of 3.784 appeared first on American Thyroid Association.

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A quality study of family-centered care coordination to improve care for children undergoing tracheostomy and the quality of life for their caregivers

Publication date: August 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 99
Author(s): Christopher Hartnick, Gillian Diercks, Vanessa De Guzman, Elizabeth Hartnick, Jeanne Van Cleave, Kevin Callans
ImportanceApproximately 4000 U.S. children undergo tracheostomy yearly [1], and these surgeries often result in hospital re-admissions that have definite cost and caregiver burdens due to complications that are avoidable with proper training and support.ObjectiveTo assess the impact of a Family-Centered Care Coordination (FCCC) program on the quality of care received by children undergoing tracheostomy and their caregivers.DesignCaregivers of children undergoing tracheostomies from January 2012 to January 2013 and then a different set of caregivers of children undergoing tracheostomies from January 2015 to January 2016 completed both the Pediatric Tracheostomy Health Status Instrument (PTHSI) 1 month after discharge and the Medical Complications Associated with Pediatric Tracheostomy (MCAT) questionnaire 6 months after initial tracheostomy. To assess complication rates, these same sets of caregivers were asked to complete the MCAT and only those who provided complete medical data for all 6 months were included for comparative analysis.SettingThe PTHSI and MCAT were administered at Massachusetts Eye and Ear in a hospital setting.ParticipantsTen caregivers of children undergoing tracheostomies completed the PTHSI before FCCC program implementation and12 caregivers then completed the PTHSI after FCCC implementation. For each of the 2 groups, 5 caregivers provided complete data on the MCAT questionnaires.ExposuresFCCC is a collection of programs, policies, and tools designed to ensure safe transition home for children undergoing tracheostomies, reduce re-admission rates, and minimize "caregiver burden".Main outcomes and measuresThe PTHSI is a validated caregiver quality of life instrument that was supplemented by the MCAT which records post-discharge medical issues following tracheostomy that relate specifically to the tracheotomy placement.ResultsThe time to first follow-up appointment decreased from 6.4 weeks (SD = 1.52) to 6 days (SD = 0.18) with FCCC implementation. The total MCAT scores decreased from 15.2 (SD = 1.1) to 1.3 (SD = 1.3) (Wilcoxon sum rank test: P < 0.016) whereas neither PTHSI scores (P = 0.32) nor the specific caregiver burden domain (P = 0.18) demonstrated a significant change.Conclusionsand Relevance: By reducing the time to first follow-up after tracheostomy and by optimizing caregiver tracheostomy tube care and teaching, children's quality of care and caregiver burden can be significantly improved.



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Pediatric invasive fungal rhinosinusitis: An investigation of 17 patients

Publication date: August 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 99
Author(s): Daniel Vinh, Michael Yim, Ankhi Dutta, John K. Jones, Wei Zhang, Matthew Sitton
PurposeTo investigate outcomes of pediatric patients at a single institution with invasive fungal rhinosinusitis (IFRS) and to determine variables that impact overall survival.MethodsAll pediatric patients at a large tertiary children's hospital diagnosed with IFRS confirmed by surgical pathology from 2009 to 2015 were retrospectively reviewed. Demographics, underlying diseases, symptoms, antifungal therapy, absolute neutrophil count (ANC), surgical management,and outcomes were analyzed.ResultsSeventeen patients were identified with IFRS with an average age of 8.7 years and 53% male. Hematologic malignancy was the most common (n = 13) underlying disease. The most common presenting symptoms were fever (82%) and congestion (41%). 15 patients had severe neutropenia (Absolute Neutrophil Count (ANC) < 500) within 2 weeks prior to diagnosis. The average ANC at time of diagnosis was 1420 cells/uL. 16 patients were treated with serial nasal endoscopy and debridement, while 1 patient was treated with an open approach. 16 received combination antifungals while 1 was treated with amphotericin monotherapy. The most common genus cultured was Fusarium (n = 6). The average number of surgical interventions was 3.4, with the average interval between interventions 6.2 days. 13 of 17 (76%) were cleared of IFRS. Overall survival at 6 months was 41%.ConclusionPediatric IFRS is a life-threatening disease that requires a coordinated surgical and medical approach. Despite a relatively high local control rate, overall mortality remains disappointingly high, reflecting the disease's underlying pathogenesis - lack of host defense and risk of disseminated fungal infection. Further investigation is necessary to reveal optimal management with regards to antifungal therapy, surgery, and utility of labs.



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Hearing aids for otitis media with effusion: Do children use them?

Publication date: August 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 99
Author(s): Richard Wei Chern Gan, Parisa Overton, Claire Benton, Matija Daniel
IntroductionENT surgeons may refer children with otitis media with effusion (OME) to audiology for consideration of hearing aids. They are an option for the treatment of OME, but are only effective if the child actually wears them. Our study investigated what proportion of children referred for hearing aids actually receive them, and whether children use them.MethodRetrospective study of children referred to audiology from November 2013 to August 2014, including 70 children referred by ENT for hearing aids for OME, plus a further 5 children with OME given hearing aids through direct access audiology service.ResultsDuring the study period, there were 202 referrals of children to audiology, of which 70 (34.7%) were for consideration of hearing aids for OME. Of these 70 referred children, 37 (52.9%) were not fitted with hearing aids due to normal audiometry (23), asymptomatic mild hearing loss (7), nonattendance (3), clinical decision to just monitor hearing (1), parental decline (2), and unrecorded reason (1). A total of 38 children (including direct access patients) were fitted with hearing aids for OME. Majority (36/38) of children issued aids used them, 16 all day, 7 only at school, 1 only at home, 3 only when needed, and 9 used them for an unspecified duration; 1 child's use of hearing aids was unrecorded, and 1 child refused to use it. 21 were fitted bilaterally and 17 unilaterally. 37 were behind the ear aids and 1 a BAHA softband.ConclusionsA third of referrals to paediatric audiology by ENT are for consideration of hearing aids for OME. Only about half of children referred to audiology for hearing aids for OME actually receive them, as by the time they see audiology the hearing loss has frequently resolved or is asymptomatic so that aiding is unwarranted. Once fitted, they appear to be well accepted. Hearing aids have fair utilization in children fitted with them for OME.



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Combination of Radiation Therapy and Anti-PD-1 Antibody SHR-1210 in Treating Patients With Esophageal Cancer

Conditions:   Esophageal Neoplasms;   Esophageal Diseases;   Gastrointestinal Diseases;   Gastrointestinal Neoplasms
Interventions:   Drug: Radiation;   Drug: SHR-1210
Sponsors:   Hangzhou Cancer Hospital;   Jiangsu HengRui Medicine Co., Ltd.
Recruiting - verified June 2017

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Anti-HER2 Therapy in Patients of HER2 Positive Metastatic Carcinoma of Digestive System

Conditions:   Targeted Therapy;   HER2;   Biliary Tract Cancer;   Esophageal Squamous Cell Carcinoma
Interventions:   Drug: chemotherapy in combination with trastuzumab;   Drug: chemotherapy in combination with trastuzumab;   Drug: chemotherapy in combination with trastuzumab
Sponsor:   Shen Lin
Not yet recruiting - verified June 2017

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Incorrect Figure

In the Original Investigation titled "Comparison of Posttransplant Dermatologic Diseases by Race," published online March 8, 2017, some of the bar heights in Figure 1 were incorrect. Figure 1 has been replaced. This article has been corrected online.

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Molecular Profiling of Multiple Primary Merkel Cell Carcinoma

This case series evaluates genetic relatedness in 4 cases with the clinical diagnosis of multiple primary Merkel cell carcinomas.

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BRAF V600E Mutation in Involuting Nevus in a Patient Treated With Vemurafenib

This case report describes a BRAF V600E mutation in involuting nevus in a patient treated with vemurafenib.

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Diversity in Dermatology

This Viewpoint focuses on underrepresented minorities in the field of dermatology and presents 5 actions endorsed by the Association of Professors of Dermatology to grow a more diverse dermatology workforce.

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Cutaneous T-Cell Lymphomas

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Targeted Therapy for Advanced Cutaneous Cancers

Now is an exciting time in the field of cutaneous oncology. More advances in the treatment of metastatic melanoma, advanced basal and squamous cell carcinomas, and Merkel cell carcinoma have been made in the past 5 years than in the previous 5 decades. As in other fields of oncology, the discovery of targeted therapies has revolutionized our treatment of patients with advanced disease. Older cytotoxic agents with substantial morbidity have been replaced with therapies directed at specific aberrant pathways to minimize the adverse-effect profile and maximize efficacy. Drugs are no longer selected via trial and error; specific pretreatment genetic testing can alert the clinician to the driving mutation(s), and a personalized treatment plan can be based on each patient's particular profile. As a result, patients with metastatic skin cancer are living longer, sometimes even achieving complete remission. A diagnosis of metastatic melanoma, advanced basal or squamous cell carcinoma, or Merkel cell carcinoma is no longer a death sentence. Patients and their families can have greater hope. And while each therapy may extend a patient's life expectancy by only a few months, as new therapeutic options become available, patients may live long enough for the next great breakthrough. The future of cutaneous oncology is quite promising.

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Detection of Occult Invasion in Melanoma in Situ—Reply

In Reply We thank Rodic and Glusac for their insightful comments on our article. First, we would like to emphasize that in all cases reclassified as microinvasive melanoma, the dermal cells possessed cytopathologic features of melanoma cells (large size, ample cytoplasm, and/or visible nucleoli) appreciable on melan-A stain alone or in conjunction with hematoxylin-eosin (H&E) stain.

http://ift.tt/2oDmueK

Tinea in the Time Before Modern Antifungal Agents

Modernity enjoys a broad and effective arsenal against superficial mycoses. However, the history of social stigma attached to dermatophyte infections, their unusual and often harmful treatments, and the controversial public health efforts designed to limit their spread before the discovery of safe and efficacious antifungal agents is worthy of reflection.

http://ift.tt/2sbH1q0

Systemic Immunomodulating Therapies for SJS/TEN

This systematic review and meta-analysis provides an overview on possible immunomodulating treatments for Stevens-Johnson syndrome and toxic epidermal necrolysis and estimates their effects on mortality compared with supportive care.

http://ift.tt/2mtgV2f

Dermoscopy for Melanoma Diagnosis in the Miami VA Medical Center

This study determines the rates of dermoscopy in melanoma detection at the Miami Veterans Affairs Medical Center where dermatology residents are the frontline clinicians.

http://ift.tt/2mG7ADb

Dermatology Consultations in Patients With Inflammatory Skin Diseases

This study investigates the association of dermatology consultations with outcomes of hospitalized patients with skin diseases.

http://ift.tt/2naNpOi

Dermoscopic Features of Circumscribed Palmar Hypokeratosis

This case report describes the dermoscopic features found in 3 cases of circumscribed palmar hypokeratosis.

http://ift.tt/2mUF9OY

Efficacy and Safety of Propranolol vs Steroid for Infantile Hemangioma

This randomized clinical trial compares propranolol vs steroid therapies for efficacy and safety in the treatment of infantile hemangioma.

http://ift.tt/2oOXFtJ

Estimated Cost of Emergency Sunburn Visits—Reply

In Reply We appreciate the interest in our analysis by Xia and colleagues and their discussion of our use of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) for code validation. As they have indicated, the positive predictive values of ICD-9-CM codes 692.71 (first-degree sunburn) and 692.76 (second-degree sunburn) support our search criteria. The remaining code used in our search criteria, ICD-9-CM code 692.77, is for third-degree sunburn. This event is highly unusual, so it is not a surprise that they found no cases with this code in their data set. Although we did not analyze our data by specific codes, we did note that there were only 11 (0.15%) visits in our data set with a code of 692.77.

http://ift.tt/2oXY5RE

Expanding the Genotypic Spectrum of Bathing Suit Ichthyosis

This cohort study uses targeted sequencing of the TGM1 gene to evaluate mutations for their specificity to bathing suit ichthyosis and their temperature sensitivity.

http://ift.tt/2p8LGao

The Fugates of Troublesome Creek

The beautiful and bountiful hues that decorate the human body range widely. Blue-colored skin is not relegated to the realm of fantasy, as illustrated by the peculiar case of the Fugate family of Eastern Kentucky.

http://ift.tt/2sbBkbo

Dermoscopic Clues for Diagnosing Seborrheic Keratosis–like Melanomas

This observational study reports the dermoscopic examination of 134 cases of melanoma that clinically mimics seborrheic keratosis.

http://ift.tt/2ohlvh3

Albert Ludwig Sigesmund Neisser

Albert Ludwig Sigesmund Neisser, MD (1855-1916), was a Prussian dermatologist and bacteriologist known for both his discoveries and controversies. His strict physician father would often tell Albert to "work" whenever they entered the same room. His father did this so much, in fact, that Albert's little brother began calling him "Work," thinking it was his first name.

http://ift.tt/2sbSdCX

Comparison of Posttransplant Dermatologic Diseases by Race

This medical record review compares the incidence of cutaneous disease between white and nonwhite organ transplant recipients.

http://ift.tt/2mjltVf

June 2017 Issue Highlights

http://ift.tt/2sc1fA5

Pulmonary adenocarcinoma diagnosed by incisional skin metastasis in an old scar from a non-neoplastic surgery

http://ift.tt/2tnnsdP

Urticaria pigmentosa with concomitant polycythaemia vera in a 3-year-old boy

http://ift.tt/2spthtO

Influence of interradicular and palatal placement of orthodontic mini-implants on the success (survival) rate

Abstract

Background

The purpose of this retrospective cohort study was to investigate the success rates of orthodontic mini-implants (OMIs) placed in different insertion sites and to analyse patient and site- related factors that influence mini-implant survival.

Methods

Three hundred eighty-seven OMIs were inserted in 239 patients for orthodontic anchorage and were loaded with a force greater than 2 N. Two different insertion sites were compared: 1. buccal inter-radicular and 2. palatal, at the level of the third palatal ruga. Survival was analysed for location and select patient parameters (age, gender and oral hygiene). The level of statistical significance was set at p < 0.05.

Results

The overall success rate was 89.1%. There were statistically significant differences between insertion sites; success rate was 98.4% for OMIs placed in the anterior palate and 71% for OMIs inserted buccal between roots (p < 0.001).

Conclusions

Success rate of OMIs was primarily affected by the insertion site. The anterior palate was a more successful location compared to buccal alveolar bone.

http://ift.tt/2t1M6ku

Novel methodologies and technologies to assess mid-palatal suture maturation: a systematic review

Abstract

Introduction

A reliable method to assess midpalatal suture maturation to drive clinical decision-making, towards non-surgical or surgical expansion, in adolescent and young adult patients is needed. The objectives were to systematically review and evaluate what is known regarding contemporary methodologies capable of assessing midpalatal suture maturation in humans.

Methods

A computerized database search was conducted using Medline, PubMed, Embase and Scopus to search the literature up until October 5, 2016. A supplemental hand search was completed of references from retrieved articles that met the final inclusion criteria.

Results

Twenty-nine abstracts met the initial inclusion criteria. Following assessment of full articles, only five met the final inclusion criteria. The number of subjects involved and quality of studies varied, ranging from an in-vitro study using autopsy material to prospective studies with in vivo human patients. Three types of evaluations were identified: quantitative, semi-quantitative and qualitative evaluations. Four of the five studies utilized computed tomography (CT), while the remaining study utilized non-invasive ultrasonography (US). No methodology was validated against a histological-based reference standard.

Conclusions

Weak limited evidence exists to support the newest technologies and proposed methodologies to assess midpalatal suture maturation. Due to the lack of reference standard validation, it is advised that clinicians still use a multitude of diagnostic criteria to subjectively assess palatal suture maturation and drive clinical decision-making.

http://ift.tt/2t2av9P

Demyelination, strokes, and eculizumab: Lessons from the congenital CD59 gene mutations

Publication date: Available online 13 June 2017
Source:Molecular Immunology
Author(s): Adi Tabib, Netanel Karbian, Dror Mevorach
Neurological symptoms of patients with p.Cys89Tyr mutation in the CD59 gene include recurrent peripheral neuropathy resembling Guillain-Barré syndrome, characterized by sensory-motor demyelinating neuropathy with secondary axonal damage and moderate enhancement of the nerve roots on spine MRI, together with recurrent strokes and retinal involvement. Three additional mutations in CD59, leading to loss of function, have been described, and overall, 12/12 (100%) of patients with any mutation presented with neurological symptoms; 11/12 (92%) patients presented with recurrent peripheral neuropathy, 6/12 (50%) with recurrent strokes, and 1/12 (8%) with retinal involvement. We review the possible thrombophilic profile associated with the mutations. In these patients, excessive intravascular hemolysis saturates scavenger mechanisms resulting in free hemoglobin in plasma that irreversibly reacts with nitric oxide to form nitrate and methemoglobin, leading to arterial thrombosis. CD59 loss of function is also one of the major thrombophilic mechanisms in patients with paroxysmal nocturnal hemoglobinuria. We then describe the relationship with demyelination. The lack of CD59 allows uncontrolled complement amplification following low-level spontaneous-, viral-, or post viral-induced complement activation, resulting in severe demyelination in the peripheral nervous system. It is interesting, and certainly encouraging, that after 3 years, following 4 patients with Cys89Tyr mutations who are treated with eculizumab, no strokes occurred and non-permanent neurological insults underwent resolution without any new neurological exacerbations.



http://ift.tt/2sp0HJc

Development and validation of a 3D-printed model of the ostiomeatal complex and frontal sinus for endoscopic sinus surgery training

Background

Endoscopic sinus surgery poses unique training challenges due to complex and variable anatomy, and the risk of major complications. We sought to create and provide validity evidence for a novel 3D-printed simulator of the nose and paranasal sinuses.

Methods

Sinonasal computed tomography (CT) images of a patient were imported into 3D visualization software. Segmentation of bony and soft tissue structures was then performed. The model was printed using simulated bone and soft tissue materials. Rhinologists and otolaryngology residents completed 6 prespecified tasks including maxillary antrostomy and frontal recess dissection on the simulator. Participants evaluated the model using survey ratings based on a 5-point Likert scale. The average time to complete each task was calculated. Descriptive analysis was used to evaluate ratings, and thematic analysis was done for qualitative questions.

Results

A total of 20 participants (10 rhinologists and 10 otolaryngology residents) tested the model and answered the survey. Overall the participants felt that the simulator would be useful as a training/educational tool (4.6/5), and that it should be integrated as part of the rhinology training curriculum (4.5/5). The following responses were obtained: visual appearance 4.25/5; realism of materials 3.8/5; and surgical experience 3.9/5. The average time to complete each task was lower for the rhinologist group than for the residents.

Conclusion

We describe the development and validation of a novel 3D-printed model for the training of endoscopic sinus surgery skills. Although participants found the simulator to be a useful training and educational tool, further model development could improve the outcome.

http://ift.tt/2tmzUKP

Prevalence of atopic disease in patients with eosinophilic esophagitis

Background

The objective of this work was to evaluate prevalence of eosinophilic esophagitis (EoE) in the United States, and analyze prevalence of atopic disease in patients with EoE. The study design was a retrospective administrative database analysis in U.S.-based outpatient settings.

Methods

A retrospective claims analysis in the inpatient and outpatient setting (using MarketScan) was conducted to analyze prevalence of atopic disease diagnoses in patients with EoE in 2012, and timing of those diagnoses vs EoE.

Results

From published evidence, prevalence of EoE was estimated at 1 to 5 patients per 10,000 and prevalence of asthma, allergic rhinitis (AR), and atopic dermatitis (AD) concurrent to EoE ranged from 20% to 50%, 50% to 75%, and 2% to 19% cases, respectively. From 2009 and 2013, the estimated prevalence of EoE in MarketScan increased from 2.7 to 5.6 per 10,000 enrollees age 34.5 ± 18.43 years (mean ± standard deviation). Age followed a bimodal distribution with peaks at 12 and 41 years. Women accounted for 35.6% cases. Prevalence of asthma, AR, AD, and food allergies up to 12 months post-EoE diagnosis reached 44.7%, 27.1%, 25.2%, and 16.9%, respectively, with 63.5% of all patients suffering from at least 1 of these 4 diseases and 3.0% suffering from all 4.

Conclusion

The diagnosis of EoE is associated with the diagnoses of asthma, AR, AD, and food allergies. The high prevalence of these conditions in EoE patients further strengthens the hypothesis of a common pathogenesis.

http://ift.tt/2speZtj

Epidemiologie akuter Leukämien in Deutschland

Zusammenfassung

Der Beitrag gibt einen Überblick über die Epidemiologie akuter Leukämien in Deutschland, basierend auf den Daten aus 8 deutschen epidemiologischen Krebsregistern und dem deutschen Kinderkrebsregister. Von den gut 1000 jährlichen Neuerkrankungen an akuter lymphatischer Leukämie (ALL) betreffen etwa 45 % Kinder unter 15 Jahren, während die jährlich rund 4100 Erkrankungen an akuter myeloischer Leukämie (AML) vor allem im höheren Lebensalter auftreten; das mediane Erkrankungsalter liegt bei 72 Jahren. In den letzten 10 Jahren zeigten sich insgesamt keine wesentlichen Veränderungen der Inzidenzraten. Die Fünfjahresüberlebenswahrscheinlichkeiten liegen im Kindesalter bei etwa 92 % (ALL) bzw. 74 % (AML), gehen aber mit steigendem Diagnosealter deutlich zurück. Die altersstandardisierten Inzidenzraten für Deutschland sind mit Ergebnissen aus Europa, den USA und Australien vergleichbar, während die entsprechenden Überlebenswahrscheinlichkeiten innerhalb Europas im oberen Bereich und auch höher als in den USA liegen.

http://ift.tt/2tmvmno

Treatment of Cutaneous Small Vessel Vasculitis With Leflunomide

This case report describes a case of cutaneous small vessel vasculitis treated successfully with leflunomide.

http://ift.tt/2ssC5Qq

Patient Willingness to Use Injectable Medication in Psoriasis

This study examines the association of anchoring with patient willingness to use a monthly injectible medication for psoriasis.

http://ift.tt/2t2FdQi

Histiocytoid Sweet Syndrome and Myelodysplastic Syndrome

To the Editor We read with interest the article by Alegría-Landa et al in a recent issue of JAMA Dermatology reporting on 33 patients with histiocytoid Sweet syndrome (HSS). Their novel immunohistochemical findings clearly show that the dermal infiltrate in HSS is mostly composed of myeloid nuclear differentiation antigen–positive and myeloperoxidase–positive (MPO⁺) immature myeloid cells, and not of histiocytes or M2 macrophages. We support that the skin-infiltrating myeloid nonblastic cells in HSS should not be interpreted as leukemia cutis, ie, as an infiltrate of blastic myeloid cells.

http://ift.tt/2st4eXR

Histiocytoid Sweet Syndrome and Myelodysplastic Syndrome—Reply

In Reply We appreciate the interest of Vignon-Pennamen et al in our study on histiocytoid Sweet syndrome (HSS). Like us, they consider the cells of the infiltrate as immature myeloid cells rather than M2 macrophages, and for them, too, this histopathologic variant of Sweet syndrome should not be considered a form of leukemia cutis; these were the 2 main goals of our study.

http://ift.tt/2t2dIGt

Erythropoietic Protoporphyria and X-linked Protoporphyria

This cohort study describes the clinical characteristics, genotypes, and determinants of disease severity among patients with erythropoietic protoporphyria or X-linked protoporphyria.

http://ift.tt/2ssO4O9

Laryngotracheal Involvement in Systemic Light Chain Amyloidosis

Abstract

Laryngotracheal amyloid deposition is an uncommon manifestation of systemic light chain amyloidosis. Diagnostic imaging, such as CT, is useful for suggesting the possibility of amyloidosis and delineating the extent of the lesions for surgical management; however, the diagnosis is confirmed with the histologic finding of amorphous eosinophilic material which stains positively for Congo red and may show apple green birefringence on polarization. These features are exemplified in this sine qua non radiology-pathology correlation article.

http://ift.tt/2s0H09J

Laryngotracheal Involvement in Systemic Light Chain Amyloidosis

Abstract

Laryngotracheal amyloid deposition is an uncommon manifestation of systemic light chain amyloidosis. Diagnostic imaging, such as CT, is useful for suggesting the possibility of amyloidosis and delineating the extent of the lesions for surgical management; however, the diagnosis is confirmed with the histologic finding of amorphous eosinophilic material which stains positively for Congo red and may show apple green birefringence on polarization. These features are exemplified in this sine qua non radiology-pathology correlation article.

http://ift.tt/2s0H09J

Crusted plaques on the right face

A 46-year-old man with a history of biopsy-proven pemphigus presented with progressive crusted plaques across his right face. The physical examination revealed multiple large, erythematous, crusted plaques across the right malar cheek and forehead with sharp demarcation at the midline forehead, sparing the entire left side of the face (Fig 1). The patient described the eruption as intensely pruritic. The eruption coincided with riding in the passenger seat of a car for many hours of the day. A family history revealed multiple relatives with lupus erythematosus.

http://ift.tt/2ssrqVN

Preapplication of white petroleum jelly to adjacent skin to prevent aluminum chloride–induced irritant dermatitis

Topical aluminum chloride is a commonly prescribed first-line treatment for primary hyperhidrosis. Although aluminum chloride is safe, effective, and inexpensive, a large proportion of patients discontinue treatment because of associated irritant dermatitis.1

http://ift.tt/2t2jurI

Reduction of early nodules after injection of hyaluronic acid filler

Early, noninflammatory filler nodules (those that appear within 1 week after injection) are isolated in such a way that they do not diffuse into surrounding tissue even with massage. The formation of nodules can result in an undesirable cosmetic appearance and can cause discomfort.1 Nodules rarely form when applying proper injection techniques; however, the risk still exists even with experienced physicians.

http://ift.tt/2sslc8y

Change of Address

http://ift.tt/2t1WXLw

Slow-growing, pink, indurated plaque on the arm

A 73-year-old man with a history of erythrodermic psoriasis treated with cyclosporine and adalimumab presented for evaluation of a slowly growing lesion on the left arm. The physical examination revealed a solitary 18-cm × 7-cm pink indurated plaque on the left antecubital fossa with scattered ulcerations (Fig 1). Punch biopsy specimens were obtained and sent for routine pathology and tissue culture. Periodic acid-Schiff stain was performed (Fig 2). A complete blood cell count and comprehensive metabolic panel were within normal limits, and an HIV assay was negative.

http://ift.tt/2sskaJC

Iotaderma #281

http://ift.tt/2t1D7jB

Current and emerging treatments for vitiligo

Clinicians should be aware that vitiligo is not merely a cosmetic disease and that there are safe and effective treatments available for vitiligo. It is important to recognize common and uncommon presentations and those with active disease, as well as their implications for clinical management; these were discussed in the first article in this continuing medical education series. Existing treatments include topical and systemic immunosuppressants, phototherapy, and surgical techniques, which together may serve to halt disease progression, stabilize depigmented lesions, and encourage repigmentation.

http://ift.tt/2ssk98w

Imprinting lesion size and surgical margins to facilitate patient education

Without adequate education, patients often underestimate the extent of surgical procedures and resulting scar lengths. Effective preoperative management of patient expectations is essential for informed consent and patient satisfaction.1 Communicating the extent and size of cutaneous surgery is especially challenging when the surgical site is on the posterior aspect of the body or outside of the patient's field of vision. Discussing measurements is often insufficient, and digital photography often fails to convey appreciable size.

http://ift.tt/2t1YrFq

CME examination

http://ift.tt/2ssKa7H

Answers to CME examination

http://ift.tt/2t24qdC

Answers to CME examination

http://ift.tt/2ssqWiA

June iotaderma (#280)

http://ift.tt/2t1Q0Ki

New discoveries in the pathogenesis and classification of vitiligo

Vitiligo is a common autoimmune disease that progressively destroys melanocytes in the skin, resulting in the appearance of patchy depigmentation. This disfiguring condition frequently affects the face and other visible areas of the body, which can be psychologically devastating. The onset of vitiligo often occurs in younger individuals and progresses for life, resulting in a heavy burden of disease and decreased quality of life. Presentation patterns of vitiligo vary, and recognition of these patterns provides both diagnostic and prognostic clues.

http://ift.tt/2ssrq8f

Commentary: Clinical registries

Clinical registries are good and important potential sources for enhancing our knowledge of diseases, therapy outcomes, and the effect of diseases on our patients. Physicians who volunteer to enroll their patients in these registries must be willing to spend the time obtaining patient consent, filling out questionnaires, and obtaining photographs for documentation. Participation in such a registry does not bring academic kudos or authorship in most cases. It has been my experience that most dermatologists who participate are doing so because they want to contribute to our base of knowledge.

http://ift.tt/2t1WVTU

Evidence-based recommendations for the management of acne fulminans and its variants

Acne fulminans (AF) is a severe variant of inflammatory acne. It typically manifests as an explosive worsening and ulceration of skin lesions, and can be associated with systemic symptoms. However, there is a paucity of evidence-based information and no clear guidelines concerning the classification and treatment of AF.

http://ift.tt/2ssK9AF

Ingenol mebutate for the management of genital warts in sensitive anatomic locations

Genital warts (GW) are highly prevalent in sexually active populations and have a severe impact on patient quality of life.1 Ablative therapy in sensitive anatomic areas such as the external urethral orifice, the corona of glans penis, and the anal mucosa is challenging and painful and can often only be administered under general anaesthesia.

http://ift.tt/2t1SU1A

(Not) losing out from Brexit

Schrauwen, Annette; (2017) (Not) losing out from Brexit. Europe and the World: A Law Review , 1 (1) pp. 1-18. 10.14324/111.444.ewlj.2017.04 . Gold open access

http://ift.tt/2t29QVS

The EU and international dispute settlement

Rosas, Allan; (2017) The EU and international dispute settlement. Europe and the World: A Law Review , 1 (1) pp. 1-29. 10.14324/111.444.ewlj.2017.03 . Gold open access

http://ift.tt/2sslyMq

Of Presidents, High Representatives and European Commissioners – the external representation of the European Union seven years after Lisbon

Hoffmeister, Frank; (2017) Of Presidents, High Representatives and European Commissioners – the external representation of the European Union seven years after Lisbon. Europe and the World: A Law Review , 1 (1) pp. 1-46. 10.14324/111.444.ewlj.2017.02 . Gold open access

http://ift.tt/2t1QaBy

Impact of Hepatitis C Treatment as Prevention for People Who Inject Drugs is sensitive to contact network structure

Metzig, C; Surey, J; Francis, M; Conneely, J; Abubakar, I; White, PJ; (2017) Impact of Hepatitis C Treatment as Prevention for People Who Inject Drugs is sensitive to contact network structure. Scientific Reports , 7 , Article 1833. 10.1038/s41598-017-01862-6 . Green open access

http://ift.tt/2ss0llL

Identifying specific language impairment in deaf children acquiring British Sign Language: Implications for theory and practice

Mason, K; Rowley, K; Marshall, CR; Atkinson, JR; Herman, R; Woll, B; Morgan, G; (2010) Identifying specific language impairment in deaf children acquiring British Sign Language: Implications for theory and practice. British Journal of Developmental Psychology , 28 (1) 33 - 49. 10.1348/026151009X484190 .

http://ift.tt/2t22zoP

Energy failure in multiple sclerosis and its investigation using MR techniques

Paling, D; Golay, X; Wheeler-Kingshott, C; Kapoor, R; Miller, D; (2011) Energy failure in multiple sclerosis and its investigation using MR techniques. [Review]. Journal of Neurology , 258 (12) pp. 2113-2127. 10.1007/s00415-011-6117-7 .

http://ift.tt/2ssKoM5

Making transnational markets: the institutional politics behind the TTIP

Bartl, Marija; (2017) Making transnational markets: the institutional politics behind the TTIP. Europe and the World: A Law Review , 1 (1) pp. 1-37. 10.14324/111.444.ewlj.2017.01 . Gold open access

http://ift.tt/2t1QfoG

Informational masking of speech in dyslexic children

Calcus, A; Colin, C; Deltenre, P; Kolinsky, R; (2015) Informational masking of speech in dyslexic children. Journal of the Acoustical Society of America , 137 (6) EL496-EL502. 10.1121/1.4922012 .

http://ift.tt/2ssrqW0

An Efficient Metadynamics-Based Protocol To Model the Binding Affinity and the Transition State Ensemble of G-Protein-Coupled Receptor Ligands

Saleh, N; Ibrahim, P; Saladino, G; Gervasio, FL; Clark, T; (2017) An Efficient Metadynamics-Based Protocol To Model the Binding Affinity and the Transition State Ensemble of G-Protein-Coupled Receptor Ligands. Journal of Chemical Information and Modeling , 57 (5) pp. 1210-1217. 10.1021/acs.jcim.6b00772 .

http://ift.tt/2t21c9Y

Comorbidities in patients with psoriasis: The role of the dermatologist

Psoriasis, the most common dermatologic immune-mediated disease, affects 2% of the population and is associated with a higher prevalence of chronic pulmonary disease, diabetes mellitus, reduced bone density, peptic ulcer disease, and liver, cardiovascular, and renal disease.1,2 Health care providers should accurately interpret and communicate these comorbidities with concerned patients. Journals, books, and media often communicate these associations using relative risk. Unfortunately, doctors and patients overestimate risk when presented on a relative basis, which may lead to anxiety and inappropriate emphasis or attention on a comorbidity.

http://ift.tt/2rhcLc3

Unusual patterns of presentation of frontal fibrosing alopecia: A clinical and trichoscopic analysis of 98 patients

To the Editor: Frontal fibrosing alopecia (FFA) is a primary lymphocytic scarring alopecia that mainly affects postmenopausal women.1 In the past 2 decades, an increasing number of cases have been reported.2 Recognizing FFA may be a challenge when it manifests with unusual features.

http://ift.tt/2szXHtU

Dermatology Calendar

http://ift.tt/2rhyQqM

Laryngotracheal Involvement in Systemic Light Chain Amyloidosis

Abstract

Laryngotracheal amyloid deposition is an uncommon manifestation of systemic light chain amyloidosis. Diagnostic imaging, such as CT, is useful for suggesting the possibility of amyloidosis and delineating the extent of the lesions for surgical management; however, the diagnosis is confirmed with the histologic finding of amorphous eosinophilic material which stains positively for Congo red and may show apple green birefringence on polarization. These features are exemplified in this sine qua non radiology-pathology correlation article.

http://ift.tt/2s0H09J

Changes in lower limb muscle function and muscle mass following exercise-based interventions in patients with chronic obstructive pulmonary disease: A review of the English-language literature

Chronic obstructive pulmonary disease (COPD) patients often experience lower limb muscle dysfunction and wasting. Exercise-based training has potential to improve muscle function and mass, but literature on this topic is extensive and heterogeneous including numerous interventions and outcome measures. This reviewuses a detailed systematic approach to investigate the effect of this wide range of exercise-based interventions on muscle function and mass. PUBMED and PEDro databases were searched. In all, 70 studies (n ¼ 2504 COPD patients) that implemented an exercise-based intervention and reported muscle strength, endurance, or mass in clinically stable COPD patients were critically appraised. Aerobic and/or resistance training, high-intensity interval training, electrical or magnetic muscle stimulation, whole-body vibration, andwater-based training were investigated. Muscle strength increased in 78%, muscle endurance in 92%, and muscle mass in 88% of the cases where that specific outcome was measured. Despite large heterogeneity in exercise-based interventions and outcome measures used, most exercise-based trials showed improvements in muscle strength, endurance, and mass in COPD patients. Which intervention(s) is (are) best for which subgroup of patients remains currently unknown. Furthermore, this literature review identifies gaps in the current knowledge and generates recommendations for future research to enhance our knowledge on exercise-based interventions in COPD patients.

http://ift.tt/2rvLBxh

Optimising configuration of a hyperspectral imager for on-line field measurement of wheat canopy

http://ift.tt/2s0VpDb

Indoor concentrations and emissions factors of particulate matter, ammonia and greenhouse gases for pig fattening facilities

http://ift.tt/2rvyXyt

Clinical Outcome of OsseoSpeed™ Immediately Loaded Single Implants in Healed Ridges: Non-smoker versus Smoker

It is commonly accepted that smoking is one of the risk factors for maintaining stable periodontal tissues around oral implants. The primary goal of this prospective clinical study was to compare the overall outcome of immediately loaded single implants (OsseoSpeedTM, Astra Tech Implant SystemTM) placed in healed ridges of non-smokers and smokers. The aim was to evaluate those groups for bone adaptation and soft tissue dimensions. Ninety-four patients in need of a single implant in the anterior maxilla (15-25) were treated in three different centers. The patients were divided into two groups depending on their smoking habits; smoker (n=47) or non-smiler (n=47). Smokers had to smoke 10 or mor cigarettes a day. The implants were placed in healed ridges. If regeneration was necessary or the implant could not be loaded, patients were allocated to another group or the exit group. 85 patients (46 smokers and 39 non-smokers) were included in the analysis. Patients were immediately provisionalized and permanent crowns were placed after 8 weeks ± 5 days. Marginal bone level, Gingival zenith score and Papilla Index were registered at different time points. 3 implants failed (6.5%) in the smoker group and non in the non-smoker group. The mean change in marginal bone level 1 year and 2 years after implant placement were - 0.39 (1.15) (loss) and -0.42 (1.16) in the non-smoker group and - 0.36 (0.75) and -0.44 (0.88) in the smoker group. The Gingival Zenith Score change was -0.14 (0.29) after 1 year and 0.1 (0.82) (loss) after 2 years, -0.72 (1.08) and -0.76 (0.96) for the medial papillae and -0.51 (0.71) and -0.63 (1.02) for the distal papillae. The smoker group showed recession in both medial en distal papillae after 2 years, 0.21 (1.31) and 0.14 (1.52). After 2 years the marginal bone level of the implant in both groups is comparable. A tendency for re-growth of the mid facial gingiva is seen in the non-smoker group. In the smoker group, there is a tendency of papillae loss after two years comparing with re-growht in the non-smoker group. The differences between the two groups may be due to the smoking habits.

http://ift.tt/2s0IvEY

Comparison of efficacy of transversus abdominis plane block and iliohypogastric/ilioinguinal nerve block for postoperative pain management in patients undergoing inguinal herniorrhaphy with spinal anesthesia: a prospective randomized controlled open-label study

Abstract

Purposes

The purpose of this study was to compare the effects of lateral abdominal transversus abdominis plane block (TAP block) and iliohypogastric/ilioinguinal nerve block (IHINB) under ultrasound guidance for postoperative pain management of inguinal hernia repair. Secondary purposes were to compare the complication rates of the two techniques and to examine the effects of TAP block and IHINB on chronic postoperative pain.

Methods

This was a prospective randomized controlled open-label study. After approval of the Research Ethics Board, a total of 90 patients were allocated to three groups of 30 by simple randomized sampling as determined with a priori power analysis. Peripheral nerve blocks (TAP block or IHINB) were administered to patients following subarachnoid block according to their allocated group. Patient pain scores, additional analgesic requirements and complication rates were recorded periodically and compared.

Results

Pain scores were significantly lower in the study groups (p < 0.001, p < 0.001, p < 0.001, p = 0.002, p < 0.001, p < 0.001 for 1, 2, 4, 6, 24, and 48 h and at 1 and 6 months, respectively). First pain declaration times were significantly longer in the study groups (TAP block group [GT] 266.6 ± 119.7 min; IHINB group [GI] 247.2 ± 128.7 min; and control group [GC] 79.1 ± 66.2 min; p < 0.001). At 24 h, the numeric rating scale scores of GT were significantly lower than GI (p = 0.048). Additional analgesic requirements of GT and GI patients were found to be significantly lower than GC patients (p = 0.001, p < 0.001, p = 0.006, p = 0.002, p = 0.001, p < 0.001 for 1, 2, 4, 6, 24, and 48 h, respectively).

Conclusion

We conclude that administration of TAP block or IHINB for patients undergoing inguinal herniorrhaphy reduces the intensity of both acute and chronic postoperative pain and additional analgesic requirements.

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Risk of Fungal Infection to Dental Patients

Fungi can cause various diseases, and some pathogenic fungi have been detected in the water of dental equipment. This environment offers suitable conditions for fungal biofilms to emerge, which can facilitate mycological contamination. This study verified whether the water employed in the dental units of two dental clinics at the University of Franca was contaminated with fungi. This study also evaluated the ability of the detected fungi to form biofilms. The high-revving engine contained the largest average amount of fungi, 14.93 ± 18.18 CFU/mL. The main fungal species verified in this equipment belonged to the genera Aspergillus spp., Fusarium spp., Candida spp., and Rhodotorula spp. Among the isolated filamentous fungi, only one fungus of the genus Fusarium spp. did not form biofilms. As for yeasts, all the Candida spp. isolates grew as biofilm, but none of the Rhodotorula spp. isolates demonstrated this ability. Given that professionals and patients are often exposed to water and aerosols generated by the dental procedure, the several fungal species detected herein represent a potential risk especially to immunocompromised patients undergoing dental treatment. Therefore, frequent microbiological monitoring of the water employed in dental equipment is crucial to reduce the presence of contaminants.

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Philanthropist Sidney Kimmel Elected to American Academy of Arts and Sciences

Sidney Kimmel, leading cancer philanthropist, has been elected a Fellow in the American Academy of Arts and Sciences, a distinction widely viewed as a mark of excellence in research and education. The Academy is one of the nation's oldest societies and independent policy research centers, convening leaders from academia, business and government to address critical challenges facing global society.

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Application of LoRaWAN for smart metering: an experimental verification

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Body size ideals and dissatisfaction in Ghanaian adolescents : role of media, lifestyle and well-being

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Outcome after laparoscopic and open resections of posterosuperior segments of the liver

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Spaces of Exception and Spaces of Normality. Towards a Relational Understanding of Violence and Peace in Muslim Mindanao

This article argues for a relational and historical understanding of the violent confict in Muslim Mindanao, the Philippines that goes beyond treating this region as a violent "space of exception," but instead points at similarities and congruities with other parts of the Philippines. Te consequences of this observation are discussed in relation to the ongoing peace negotiations in the region. Rather than seeing these as efforts potentially transforming Muslim Mindanao into a peaceful "space of normality," it is argued that the impact of these negotiations will remain confned, as they solely tackle the national confict scale and remain confned to only one type of armed organization.

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The effect of food insecurity on health status of adolescents in Ethiopia : longitudinal study

Background: The effect of food insecurity on health and wellbeing of a population has been the subject of much research. Yet, limited research has investigated its effect on adolescents' health and wellbeing in Ethiopia. Method: We used data from the Jimma Longitudinal Family Survey of Youth which began tracking a cohort of adolescents in 2005 to examine the social, behavioral and economic determinants of their health and well-being. A total of 1,919 sample were included in the main analyses. All youths provided data related to their food insecurity experiences and their health status. A mixed effect logistic regression using random intercept and trend model was used to examine the relationship between food insecurity and their health status. Fixed effects estimates were also computed to check the parsimoniousness of the random intercept and trend model. Results: The results indicated that the mean (+/- SD) age of adolescents was 18.6(+/- 1.4). Nine hundred twenty three (48.1%) of them were female. The magnitude of self-rated health status was relatively unstable ranging from 18.9%, 34.7% to 37.3% in each round. Similarly, 20.4%, 48.4% and 20.6% of adolescents were food insecure during each consecutive round of the survey respectively. Exposure to food insecurity is strongly associated with self-rated health status (beta = 0.28, P < 0.001) and poor self-rated health was also more pronounced for some time (beta = 2.11, P < 0.001) and decline after a turning point (beta = -0.38, P < 0.001). Conclusions: These findings imply that any social, nutrition and public health interventions designed to improve adolescent health should consider underlying social determinants of health such as food insecurity.

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