Assessment of dynamic variables of fluid responsiveness to predict desufflation-induced hypotension during paediatric laparoscopic surgery

Abstract

Background: During laparoscopic surgery in paediatric patients, sudden hypotension may occur following peritoneal desufflation due to hypovolaemia or an acute increase in gastrointestinal venous capacitance by the release of intra-abdominal pressure. This study examined whether dynamic variables of fluid responsiveness during pneumoperitoneum can predict the occurrence of hypotension following desufflation.Methods: A total of 120 paediatric subjects were prospectively enrolled. A predictor was derived from the initial 83 subjects and validated thereafter in 37 high-risk subjects. The pleth variability index, respiratory variation in the pulse oximetry plethysmographic waveform (ΔPOP), systolic pressure variation and pulse pressure variation during pneumoperitoneum were obtained 1 min before desufflation. Predictors of desufflation-induced hypotension were investigated using the multivariable logistic regression analysis. Predictability was assessed using the area under the receiver-operating characteristic curve (AUC).Results: In the derivation cohort, 27% (n=23) of subjects developed hypotension. Only ΔPOP was found to be a predictor, and showed high predictability of desufflation-induced hypotension [AUC 0.87, P<0.0001, 95% confidence interval (CI): 0.78–0.93]. A ΔPOP cut-off point of 38% predicted hypotension with a sensitivity of 83% and a specificity of 90%. In the validation cohort, 43% (n=16) of subjects developed hypotension, and ΔPOP was verified to be highly predictive of the occurrence of hypotension (AUC 0.90, P<0.0001, 95% CI: 0.76–0.98). The sensitivity and specificity of a ΔPOP cut-off point of 38% to predict hypotension was 88% and 90%, respectively.Conclusions: The ΔPOP during pneumoperitoneum is useful in predicting desufflation-induced hypotension during paediatric laparoscopic surgery.Clinical trial registration: NCT02536521.

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Clinical Similarity of the Biosimilar ABP 501 Compared With Adalimumab After Single Transition: Long-Term Results From a Randomised, Double-Blind, 52-Week, Phase 3 Study in Moderate-to-Severe Plaque Psoriasis Patients

Abstract

Background

ABP 501, an FDA- and EMA-approved biosimilar, is highly similar to adalimumab in structure, function, and pharmacokinetics.

Objective

Demonstrate similarity in efficacy, safety, and immunogenicity of ABP 501 versus adalimumab for moderate-to-severe plaque psoriasis.

Methods

Patients were randomised (1:1) to receive ABP 501 or adalimumab 40 mg every 2 weeks for 16 weeks. At Week 16, patients with ≥50% improvement from baseline in psoriasis area-and-severity index score (PASI) were eligible to continue to Week 52. Patients receiving ABP 501 continued; adalimumab patients were re-randomised (1:1) to continue adalimumab or undergo a single transition to ABP 501. Key efficacy assessments included % PASI improvement from baseline, PASI responders, and mean change in affected body surface area (BSA) from baseline to Weeks 16, 32, and 50. Safety was monitored via adverse events (AEs) and antidrug antibodies (ADAs) were assessed.

Results

308 patients were re-randomised at Week 16 (ABP 501/ABP 501, n=152; adalimumab/adalimumab, n=79; adalimumab/ABP 501, n=77). PASI percent improvements from baseline were similar across groups for Weeks 16, 32, and 50 (range: 85.8%-88.2%), with no significant differences detected across groups in percentages of PASI 50, 75, 90, and 100 responders. Changes from baseline in %BSA affected were similar across groups and timepoints. No new safety signals were detected. AEs were balanced between groups. Percentages of patients with binding and neutralizing ADAs were similar across treatments.

Conclusions

ABP 501 and adalimumab have similar clinical efficacy, safety, and immunogenicity profiles over 52 weeks, including after single transition, in this patient population.

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An index for the evaluation of 3D masticatory cycles stability

Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Claudia Lúcia Pimenta Ferreira, Matteo Zago, Cláudia Maria de Felício, Chiarella Sforza
ObjectivesTo introduce an index (Masticatory Stability Index, MSI) to analyze the stability of chewing cycles in standardized conditions and test it in a group of patients with subclinical mild temporomandibular disorder (TMD).Design23 subjects with mild subacute TMD and 21 healthy subjects were involved; they all responded to a questionnaire about signs and symptoms of TMD (ProTMDmulti) and underwent a myofunctional orofacial evaluation with scores, using the protocol of orofacial myofunctional evaluation with scores (OMES). Their mandibular kinematics was assessed with a 3D motion capture system during deliberate unilateral gum chewing. The MSI was computed synthesizing the information contained in nine kinematics parameters into a single global figure. Patients' and controls' MSI were compared considering the preferred and non-preferred chewing side using a 2-way ANOVA (factors: group, side).ResultsTogether with a lower total score of myofunctional orofacial status, the TMD group showed a reduced stability based on MSI (p<0.05).ConclusionsThe MSI is an efficient method to measure the stability of the masticatory cycles. These preliminary results encourage validating the index on a larger sample. The variability in the motor behavior of chewing can impair the objectivity of its evaluations in several types of patients, including those with TMD. The MSI could be useful to complement clinical assessments, providing data for planning the rehabilitation of masticatory function in these patients.



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Obturator hernia: a rare cause of bowel obstruction

An obturator hernia is a rare condition and an unusual cause of intestinal obstruction. With a challenging diagnosis, it has one of the highest mortality rates of all abdominal wall hernias. The authors present a case of an elderly woman with bowel obstruction secondary to an incarcerated obturator hernia. An 80-year-old woman presented at the emergency room with complaints for the last 2 days of nausea, vomiting, constipation and lower right abdominal pain that radiated down to the right medial thigh. Abdominal tenderness to deep palpation of the right iliac fossa and mildly distention were noted. A CT scan demonstrated bowel obstruction secondary to an incarcerated obturator hernia. The patient underwent emergency exploratory laparotomy. The incarcerated bowel was reduced and the defect was repaired with a plug of polypropylene mesh covered with peritoneum. The patient had an uneventful postoperative period and was discharged on the fifth postoperative day.

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A case of deep infection after instrumentation in dorsal spinal surgery: the management with antibiotics and negative wound pressure without removal of fixation

Until today the role of spinal instrumentation in the presence of a wound infection has been widely discussed and recently many authors leave the hardware in place with appropriate antibiotic therapy. This is a case of a 65-year-old woman suffering from degenerative scoliosis and osteoporotic multiple vertebral collapses treated with posterior dorsolumbar stabilisation with screws and rods. Four months later, skin necrosis and infection appeared in the cranial wound with exposure of the rods. A surgical procedure of debridement of the infected tissue and package with a myocutaneous trapezius muscle flap was performed. One week after surgery, negative pressure wound therapy was started on the residual skin defect. The wound healed after 2 months. The aim of this case report is to focus on the utility of this method even in the case of hardware exposure and infection. This may help avoid removing instrumentation and creating instability.

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Thrombolytic therapy for the treatment of acute ischaemic stroke in adults with homozygous sickle cell disease

Stroke is a significant cause of morbidity and mortality in patients with homozygous sickle cell disease (SCD). A specific large-vessel vasculopathy is often responsible for both haemorrhagic and ischaemic strokes in patients with SCD. Although intravenous thrombolysis has been considered as a therapeutic option for acute ischaemic strokes in SCD, its use remains debated because of an increased risk of spontaneous intracranial haemorrhage reported in this disease. This risk of haemorrhage is mainly supported by the presence of a Moyamoya syndrome often associated with the specific vasculopathy in patients with homozygous SCD. We report two cases of patients with homozygous SCD treated with intravenous thrombolysis for an acute ischaemic stroke without haemorrhagic transformation. Our cases suggest that reperfusion strategy in acute ischaemic stroke in patients with homozygous SCD can be considered once associated Moyamoya syndrome has been ruled out. An international registry would be of interest as these situations are rare.

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Longitudinal Midline Sacral Split Fracture - A Rare Entity

Fractures involving the central canal of the sacrum are rare injuries and can be transverse or longitudinal. Transverse fractures are by far common and associated with high incidence of neurological injuries. On the contrary, longitudinal midline split fracture is an extremely rare injury with minimal or no neurological injury. They are always associated with anterior pelvic ring fracture and are vertically stable needing only fixation of the anterior pelvic injury. Plating of the anterior pelvic ring in two planes would be beneficial than single plate to prevent gradual loss of reduction.

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Thalamic and cerebellar hypermetabolism and cortical hypometabolism during absence status epilepticus

We report on a 17-year-old girl with absence status epilepticus who developed recurrent motionless confusional state and continuous generalised 3–4 Hz rhythmic delta waves on electroencephalogram (EEG). The patient had no history of absence, myoclonus or generalised convulsion. Her seizure was resistant to a combination of antiepileptic drugs including carbamazepine. Ictal positron emission tomography using [¹⁸F]fluorodeoxyglucose ([¹⁸F]FDG-PET) revealed hypermetabolism of the bilateral thalamus and cerebellum and hypometabolism of the frontal, parietal and posterior cingulate cortices. We diagnosed her seizure as absence status and obtained remission by changing medication. The findings of ictal metabolic alteration in previous studies and in our case confirm the pathogenic importance of the thalamus in absence status and that associated cortical deactivation and cerebellar activation may be related to the generation or maintenance of epileptic EEG discharges.

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Acquired haemophilia A with a recalcitrant high-titre factor VIII inhibitor in the setting of interstitial lung disease

Acquired haemophilia A (AHA) is a bleeding disorder that results from autoantibodies against factor VIII (FVIII). A 70-year-old man with a history of interstitial lung disease presented with spontaneous bleeding into his thigh. He had undetectable FVIII levels and a high-titre FVIII inhibitor (>2000ââ'¬â°Bethesda units/mL) and was diagnosed with AHA. He had several relapses, required multiple haemostatic and immunosuppressive treatments but eventually achieved a stable remission after 2ââ'¬â°years of therapy.

Our patient matches the typical elderly male demographic of AHA. His relapsing course with remarkably high and persistent inhibitor titre highlights the need for close monitoring and aggressive upfront treatment. Whereas cyclophosphamide and steroids are often used first line in AHA, rituximab has also shown efficacy in refractory patients with high inhibitor levels. The FVIII and inhibitor concentration on presentation have been associated with treatment response and may be used as prognostic factors to tailor immunosuppressive regimens.

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Intraoperative image guidance in transoral robotic surgery: A pilot study

Abstract

Background

Intraoperative image guidance during transoral robotic surgery (TORS) is hampered by imaging-friendly instrumentation and intraoperative positioning. The purpose of this study was to develop and validate an accurate image-guidance system for TORS.

Methods

A custom radiolucent mouth retractor was fabricated from biocompatible material (Med-610; Stratasys, Minneapolis, MN). Teflon beads were placed in the oropharynx and carotid arteries of 3 cadavers. CT scans were obtained in the preoperative and intraoperative positions. Displacement of targets between preoperative and intraoperative scans was measured. Surgical navigation was based on the open-source Image-Guided Surgery Toolkit. Target registration error (TRE) was determined by measuring the distance between the tracker and bead registered to preoperative versus intraoperative scans.

Results

The inferior oropharyngeal targets demonstrated the greatest displacement between positions. A significant reduction in TRE was observed when registering the tracker to the intraoperative compared to the preoperative scan.

Conclusion

This study describes an accurate intraoperative image-guidance system for TORS.

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Clinicopathological characteristics and prognosis of patients with multiple primary melanomas

Abstract

This narrative review provides an evidence-based overview of existing literature on the epidemiology, clinicopathological characteristics and prognostic outcomes of tumours arising in patients with multiple primary melanomas (MPM). PubMed and MEDLINE were searched for original research papers and review articles from 2000 to 2016 using the term 'multiple primary melanoma.' Population-wide increases in life expectancy, advances in early detection and increasing incidence of melanoma give rise to an expanding group of patients that are at an increased risk of developing subsequent primary tumours.

This article is protected by copyright. All rights reserved.

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Vitamin D, high-sensitivity C-reactive protein, and airway hyperresponsiveness in infants with recurrent respiratory symptoms

Vitamin D insufficiency might be associated with biased T-cell responses resulting in inflammatory conditions such as atopy and asthma. Little is known about the role of vitamin D in low-grade systemic inflammation and airway hyperresponsiveness (AHR) in young children.

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The applicability of new TNM classification for humanpapilloma virus-related oropharyngeal cancer in the 8th edition of the AJCC/UICC TNM staging system in Japan: A single-centre study

The purpose of this study is to validate the applicability of new TNM classification for human papillomavirus (HPV)-related oropharyngeal cancer (OPC) in the 8th edition of the American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) TNM staging system in Japan.

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Evidence of surgical treatments for intractable Meniere’s disease

Meniere's disease is an inner ear disease, characterized by recurrent rotatory vertigo, sensorineural hearing loss and tinnitus. There are some with frequent vertigo attacks, progressive hearing loss and persistent annoying tinnitus even through the continuous standard medical treatments. These cases are thought to account for 10%–20% of all cases of Meniere's disease. In this review article, we would like to demonstrate the evidences for surgical treatments according to the previous papers, and consider the next therapeutic strategies including surgical options according to the international guidelines.

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Lateral Wall Insufficiency after Septal Reconstruction

Facial plast Surg 2017; 33: 451-452
DOI: 10.1055/s-0037-1603786

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The Nose and Its Function

Facial plast Surg 2017; 33: 365-366
DOI: 10.1055/s-0037-1604176

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Do Patients Access Appropriate Information Online?

Facial plast Surg 2017; 33: 428-433
DOI: 10.1055/s-0037-1603782

Health care providers should be aware of information available on the Internet to ensure proper patient care. The current analysis assesses the reliability, quality, and readability of internet information describing rhytidectomy. Previously validated survey instruments to assess the reliability, quality, and readability of online websites describing rhytidectomy were used. An internet search using Google with the search term "facelift" was conducted. The first 50 search results were reviewed, and 36 were deemed appropriate to be included in this analysis. Websites were divided based on type of authorship into professional organization, academic, physician based, and unidentified. The validated DISCERN instrument was used to determine reliability, quality, and overall rating of each site. The Flesch Reading Ease Score (FRES) and Flesch–Kincaid Grade Level (FKGL) were used to measure readability. A 1 to 3 point scale was used to rate websites, with a higher number indicating a website that possessed either greater reliability or greater quality. Mean scores for reliability ranged from 1.7 (±0.99) in the academic group to 2.0 (±0.12) in the unidentified group. Mean scores for quality ranged from 1.5 (±0.13) in the unidentified group to 1.7 (±0.38) in the physician-based group. The highest overall rating was 1.4 (±0.22 and ± 0.31, respectively) in the unidentified and physician-based groups. The lowest overall rating was 1 (±0.58) in the academic group. FRESs ranged from 21.6 to 74.6. FKGLs ranged from 6.9 to 13.9. Information available online regarding rhytidectomy may be significantly deficient in reliability, quality, and readability. These deficiencies are present in articles with all types of author affiliations. This underscores the clinicians' duty to provide patients with high-quality information at an adequate level of comprehension.
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Nose and Identity

Facial plast Surg 2017; 33: 367-371
DOI: 10.1055/s-0037-1603787

This article explores the significance of the nose in daily human life. It presents examples of how a person's nose may dominate his/her life, how it is used as a nickname, considered an expression of his/her character, and may be a symbol of pride and wisdom. Also, examples from the literature and the arts are discussed. Cutting off the nose is the most severe humiliation as it deprives a person from his/her identity. In some cases in history the nose has been a means of identification.
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Claus Walter—A Pioneer in the Field of Facial Plastic Surgery (1927–2016)

Facial plast Surg 2017; 33: 355-364
DOI: 10.1055/s-0037-1603981

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Determinants and Evaluation of Nasal Airflow Perception

Facial plast Surg 2017; 33: 372-377
DOI: 10.1055/s-0037-1603788

The sensation of nasal airflow, or nasal airway patency, is an important consideration in the treatment outcome of nasal airway obstruction. Clinicians striving to optimize the nasal passageway have relied on techniques aimed at decreasing peak airway resistance across nasal valves. Nonetheless, the evaluation of the nasal airway is multifaceted, and the objective determinants of subjective nasal patency remain incompletely elucidated. While rhinomanometry, peak nasal inspiratory airflow, and acoustic rhinometry have traditionally been used in research to focus on resistance as a measure of patency, an emerging body of evidence suggests that subjective nasal patency is more significantly correlated to the dynamic change of nasal mucosal temperature. The objective of this review is to provide the technical background on nasal airflow perception and intranasal trigeminal function as crucial to those performing functional and aesthetic rhinosurgery.
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Platelet-Rich Plasma for the Aesthetic Surgeon

Facial plast Surg 2017; 33: 437-443
DOI: 10.1055/s-0037-1604240

Platelet-rich plasma (PRP) is an autogenously harvested blood plasma containing concentrated levels of platelets and growth factors. PRP has been identified as a promising treatment for enhancing wound healing and has been used for decades in multiple medical specialties including cardiac surgery, oral surgery, ophthalmology, and orthopedic surgery. Growing evidence for multiple aesthetic surgery applications has recently been developed, particularly for hair restoration and skin rejuvenation. The goal of this article is to review the current medical literature on PRP and identify promising applications that may be integrated into a modern aesthetic surgery practice. The evidence for the use of PRP technology is rapidly expanding as a powerful therapy for select cosmetic surgery patients.
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Objective Assessment of Nasal Patency

Facial plast Surg 2017; 33: 378-387
DOI: 10.1055/s-0037-1604356

The aim to objectify nasal airflow and patency is ongoing—many methods have been suggested, often lacking clinical relevance or showing weak correlations with patients' symptoms. It is crucial to thoroughly consult our patients presenting with nasal obstruction—and to inform them about realistic possible surgical outcomes. Often, a perfect-looking internal nose with a straight septum and normal-appearing turbinates does not guarantee a happy, symptom-free "owner." A review of the literature and the current technical market is presented here to facilitate the rhinosurgeon's decision to perform pre- and postoperative objective measurements of nasal airflow. Recommendations by the societies have been included.
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Flap Delay or Not? A Technical Detail for Nasal Reconstruction with a Forehead Flap

Facial plast Surg 2017; 33: 454-454
DOI: 10.1055/s-0037-1603785

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Numerical Analysis of Nasal Breathing: A Pilot Study

Facial plast Surg 2017; 33: 388-395
DOI: 10.1055/s-0037-1603789

Currently, there is no fully sufficient way to differentiate between symptomatic and normal nasal breathing. Using the nose's total resistance is disputed as a valid means to objectify nasal airflow, and the need for a more comprehensive diagnostic method is increasing. This work's aim was to test a novel approach considering intranasal wall shear stress (WSS) as well as static pressure maps obtained by computational fluid dynamics (CFD). X-ray computed tomography (CT) scan data of six symptom-free subjects and seven symptomatic patients were used. Patient-specific geometries of the nasal cavity were segmented from these datasets. Inspiratory and expiratory steady airflow simulations were performed using CFD. Calculated static pressures and WSSs were mapped onto a common template of the nasal septum, allowing for comparison of these parameters between the two patient groups. Significant differences in WSS distributions during the inspiratory phase could be identified between the two groups, whereas no differences were found for the expiratory phase. It is assumed that one essential feature of normal nasal breathing probably consists of distinctively different intranasal flow fields for inspiration and expiration. This is in accordance with previous investigations. The proposed method seems to be a promising tool for developing a new kind of patient-specific assessment of nasal breathing. However, more studies and a greater case number of data with an expanded focus would be ideal.
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Is Selfie a New Cause of Increasing Rhinoplasties?

Facial plast Surg 2017; 33: 423-427
DOI: 10.1055/s-0037-1603781

The digital world and social media are becoming increasingly important. Social media connect people together in a visual manner. Profile photographs are required by most social networking sites. A trend toward the increasing popularity of selfies on social media has rendered people more aware of their appearance. A selfie is a photograph that one takes of oneself, usually employing a smartphone or webcam, which is then shared on social media. Thus, the demand for aesthetic procedures correcting imperfections such as a prominent nose has increased, for which the technique is a rhinoplasty. Patients with reasonable expectations, treated by skilled surgeons, are usually very happy with the results. Rhinoplasty does not cure low self-esteem, but does correct more visible imperfections of the face. Although some hope that a rhinoplasty will resolve many unwanted facial features besides nose problems, it can only change the size and shape of the nose, improving its form. However, in the age of the selfie, everyone wants to look better. Self-consciousness is increasing, as are concerns over grooming and appearance at work and social events. These issues have become more important in recent years with the increase in selfie-taking; people are now more aware of how their nose appears to others. In this review, we discuss whether selfie-taking has triggered a rise in rhinoplasties along with a detailed survey of the literature.
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The Human Sense of Olfaction

Facial plast Surg 2017; 33: 396-404
DOI: 10.1055/s-0037-1603828

The sense of olfaction is important not only for the detection of potential dangers such as fire or spoilt food, but also for the quality of life of human beings. In this article, we review the characteristics of the sense of smell and give a short overview about possible olfactory dysfunctions and their therapy.
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Minimally Invasive Aesthetic Procedures: An Update on a Decade-Old Prediction

Facial plast Surg 2017; 33: 434-436
DOI: 10.1055/s-0037-1603948

In 2007, the senior author (G.S.K.) published a commentary on the importance of incorporating minimally invasive aesthetic procedures into facial plastic surgery practices and training programs. The now decade-old prediction suggested that failing to perform minimally invasive aesthetic procedures placed facial plastic surgeons at risk of practice "phase out." By not providing the most current options that patients' desire, we may lose patients to outside providers willing to perform those procedures. The aim of this article is to provide an update on this perspective by putting forth the results of the most up-to-date data on practice patterns with regard to minimally invasive aesthetic procedures.
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Auricular Composite Grafting in Functional Rhinoplasty

Facial plast Surg 2017; 33: 405-410
DOI: 10.1055/s-0037-1604107

Surgical correction of defects of the internal nasal valve, ala, vestibule, and sill is widely regarded as a challenge due to concerns of poor outcomes of facial aesthetics and nasal function. Auricular composite grafting is a reliable method of reconstruction of deformities of the nasal vestibule and sill. A classification system of types of defects may help surgeons in understanding the indications for composite grafting. Furthermore, we have developed surgical techniques that enhance survival of composite grafts of larger size. Composite grafting is an effective technique to repair a wide range of defects of the internal nasal valve, nasal sill/ala, and vestibule with excellent functional and aesthetic results.
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Geometric Modeling of the Nasal Valve

Facial plast Surg 2017; 33: 444-450
DOI: 10.1055/s-0037-1604290

We have used a simple geometric model to examine forces affecting the nasal valve after dorsal reduction and spreader graft placement. The study was designed on the geometric modeling of the internal nasal valve (INV). Published measurements of the leptorrhine nose were used to construct a geometric model of the INV. The changes in the cross-sectional area (CSA) occurring after reduction rhinoplasty were calculated algebraically, as was the effect of these changes on the tendency of the lateral wall of the INV to collapse. The effect of spreader grafting on the CSA was determined, and the total change in CSA of the INV in various scenarios was determined and compared with the reported normal CSA. Relative to published norms, the gain in CSA from spreader grafting can be significant if thick grafts are used. When the lateral wall of the INV is conceptualized as a cantilevered beam fixed medially, the reduction of length reduction of the lateral segment of the INV can significantly reduce the tendency for the inward collapse of the lateral wall. The reduction in CSA of the INV associated with dorsal nasal reduction can be ameliorated through the placement of spreader grafts. Moreover, the reduction in length of the INV sidewall also limits inward collapse, assuming it is firmly reattached to the dorsal septum. An enhanced appreciation of the physical properties of the INV anticipated through a simplified geometric analysis will be invaluable to the rhinological surgeon interested in enhancing nasal function.
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Care of the Cocaine User with Nasal Deformity

Facial plast Surg 2017; 33: 411-418
DOI: 10.1055/s-0037-1603791

Cocaine is the most commonly used stimulant in the Western world, and its use is increasing not only in young people but also in people older than 40 years. Intranasal use is associated with several pathologies, ranging from crusting and blockage, to fibrosis and scarring, to destruction of the osteocartilaginous structures of the midface. As its use becomes more prevalent in society, the reconstructive surgeon can accordingly expect to be faced with an increasing number of patients with cocaine-related nasal deformity. However, the use of cocaine adds a significant layer of complexity to the perioperative and operative care that requires careful consideration by the whole health care team. We present a practical evidence-based guide to management of reconstruction of the cocaine nose, taking in all aspects of periprocedural care. Finally, we present a model for surgical approach based on best evidence and the experience of the senior author. A search was performed of the Medline, Embase, and Cochrane Collection database using both MeSH keywords and free text words, identifying key articles on the epidemiology, pathophysiology, and medical and psychiatric comorbidities of cocaine users. Both case series and case reports reporting cocaine-associated defects and their reconstruction were reviewed together with the senior authors (A.D.S., A.J.), and a series of recommendations synthesized based on these recommendations. The nasal deformities associated with cocaine use represent only the tip of the iceberg of underlying associated pathology. The surgeon who embarks upon reconstruction of the cocaine nose should be aware of possible coexisting medical and psychiatric comorbidities that may complicate both the patient's motivations for surgery and their fitness to undergo anesthesia. Ultimately, successful reconstructive outcomes are critically dependent on holistic perioperative care and the surgeon's ability to be flexible in their surgical approach.
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Classification of Spreader Flap Techniques

Facial plast Surg 2017; 33: 453-453
DOI: 10.1055/s-0037-1604175

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Facial Defect Reconstruction with Scalp Skin Grafts

Facial plast Surg 2017; 33: 419-422
DOI: 10.1055/s-0037-1603783

The objective of this study is to demonstrate the benefits of scalp-based split-thickness skin grafts as a reconstructive modality for facial skin defects, noting advantages relative to traditional harvest sites. The study is presented as a case series with chart review set in a tertiary referral center. We reviewed the charts of patients with facial skin defects whose reconstruction required more skin than could be harvested with standard full-thickness skin grafting techniques and, accordingly, included a split-thickness skin graft from the adjacent scalp. Preoperative and postoperative photographs, along with operative and postoperative records, were used to evaluate final cosmetic results and complications. We reviewed 15 patients, with ages ranging from 6 to 90 years. Common indications were skin cancer resection, avulsive skin trauma, and ear reconstruction. While patients generally had good cosmetic outcomes, with excellent color matching relative to traditional distant donor sites, a major advantage of the scalp donor site was low donor-site morbidity. Scalp donor sites were commonly reepithelialized at 7 to 10 days postoperatively and had low reported pain scores. There were no major complications. Reconstruction of facial skin defects that require skin coverage with split-thickness skin grafts can optimally be harvested from adjacent scalp skin, providing adequate cosmesis but, perhaps most importantly, much lower donor-site morbidity than with traditional nonhair-bearing donor sites.
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Visual Assessment and the Use of the Scar Cosmesis Assessment and Rating Scale (SCAR Scale) for Facial Linear Scars

Facial plast Surg 2017; 33: 455-456
DOI: 10.1055/s-0037-1603784

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
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Erratum: Effects of Tumescent Solution on Fat Survival

Facial plast Surg 2017; 33: 457-458
DOI: 10.1055/s-0037-1604164

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Full text

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Alternaria toxins in South African sunflower seeds: cooperative study

Abstract

Sunflower seed samples (N = 80) from different sunflower cultivars originating from different localities in South Africa were analyzed for 15 toxins produced by fungi of the genus Alternaria by means of a simple one-step extraction dilute-and-shoot HPLC-MS/MS approach. References for valine-tenuazonic acid (Val-TeA), altenusin (ALTS), and altenuisol (ALTSOH) were isolated from fungal culture extracts and spectroscopically characterized. Additionally, valine-tenuazonic acid was tested regarding its cytotoxicity in comparison with tenuazonic acid (TeA) and showed less activity on HT-29 cells. Furthermore, alternariol monomethyl ether-3-O-ß-D-glucoside (AME-3G) was produced by fermentation of alternariol monomethyl ether (AME) with the fungus Rhizopus oryzae. The seed samples were analyzed both with and without hulls. The method covers the AAL toxins TA₁ and TA₂, altenuene (ALT) and iso-altenuene (iso-ALT), altenuisol, altenusin, altertoxin I (ATX-I) and altertoxin II (ATX-II), alternariol (AOH) and alternariol monomethyl ether, alternariol monomethyl ether-3-O-ß-D-glucoside, tenuazonic acid, allo-tenuazonic acid (allo-TeA) and valine-tenuazonic acid, and tentoxin (TEN). More than 80% of the samples were positive for one or more analytes above the respective limit of detection (0.2–23 μg/kg). Alternariol, its monomethyl ether, tentoxin, tenuazonic acid, altenuisol, and valine-tenuazonic acid were found in quantifiable amounts. The highest prevalences were found for tentoxin (73% positive, mean content 13.2 μg/kg, maximum level 130 ± 0.9 μg/kg) followed by tenuazonic acid (51% positive, mean content 630 μg/kg, maximum level 6300 ± 560 μg/kg). The obtained data were further analyzed statistically to identify quantitative or qualitative relationships between the levels of Alternaria toxin in the samples.

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Fear Keeps Many Eczema Patients From Using Steroid Creams

Many people with eczema may avoid creams and ointments that can help ease symptoms like itching and inflammation because they're afraid to try topical corticosteroids, a recent study suggests.
Reuters Health Information

http://ift.tt/2uEBGKI

Effect of Context on the Contribution of Individual Harmonics to Residue Pitch

Abstract

There is evidence that the contribution of a given harmonic in a complex tone to residue pitch is influenced by the accuracy with which the frequency of that harmonic is encoded. The present study investigated whether listeners adjust the weights assigned to individual harmonics based on acquired knowledge of the reliability of the frequency estimates of those harmonics. In a two-interval forced-choice task, seven listeners indicated which of two 12-harmonic complex tones had the higher overall pitch. In context trials (60 % of all trials), the fundamental frequency (F0) was 200 Hz in one interval and 200 + ΔF0 Hz in the other. In different (blocked) conditions, either the 3rd or the 4th harmonic (plus the 7th, 9th, and 12th harmonics), were replaced by narrowband noises that were identical in the two intervals. Feedback was provided. In randomly interspersed test trials (40 % of all trials), the fundamental frequency was 200 + ΔF0/2 Hz in both intervals; in the second interval, either the third or the fourth harmonic was shifted slightly up or down in frequency with equal probability. There were no narrowband noises. Feedback was not provided. The results showed that substitution of a harmonic by noise in context trials reduced the contribution of that harmonic to pitch judgements in the test trials by a small but significant amount. This is consistent with the notion that listeners give smaller weight to a harmonic or frequency region when they have learned that this frequency region does not provide reliable information for a given task.

http://ift.tt/2tJBC9v

Spatial Selectivity in Cochlear Implants: Effects of Asymmetric Waveforms and Development of a Single-Point Measure

Abstract

Three experiments studied the extent to which cochlear implant users' spatial selectivity can be manipulated using asymmetric waveforms and tested an efficient method for comparing spatial selectivity produced by different stimuli. Experiment 1 measured forward-masked psychophysical tuning curves (PTCs) for a partial tripolar (pTP) probe. Maskers were presented on bipolar pairs separated by one unused electrode; waveforms were either symmetric biphasic ("SYM") or pseudomonophasic with the short high-amplitude phase being either anodic ("PSA") or cathodic ("PSC") on the more apical electrode. For the SYM masker, several subjects showed PTCs consistent with a bimodal excitation pattern, with discrete excitation peaks on each electrode of the bipolar masker pair. Most subjects showed significant differences between the PSA and PSC maskers consistent with greater masking by the electrode where the high-amplitude phase was anodic, but the pattern differed markedly across subjects. Experiment 2 measured masked excitation patterns for a pTP probe and either a monopolar symmetric biphasic masker ("MP_SYM") or pTP pseudomonophasic maskers where the short high-amplitude phase was either anodic ("TP_PSA") or cathodic ("TP_PSC") on the masker's central electrode. Four of the five subjects showed significant differences between the masker types, but again the pattern varied markedly across subjects. Because the levels of the maskers were chosen to produce the same masking of a probe on the same channel as the masker, it was correctly predicted that maskers that produce broader masking patterns would sound louder. Experiment 3 exploited this finding by using a single-point measure of spread of excitation to reveal significantly better spatial selectivity for TP_PSA compared to TP_PSC maskers.

http://ift.tt/2v6ISA3

Core Body Temperature Effects on the Mouse Vestibulo-ocular Reflex

Abstract

Core body temperature has been shown to affect vestibular end-organ and nerve afferents so that their resting discharge rate and sensitivity increase with temperature. Our aim was to determine whether these changes observed in extracellular nerve recordings of anaesthetized C57BL/6 mice corresponded to changes in the behavioural vestibulo-ocular reflex (VOR) of alert mice. The VOR drives eye rotations to keep images stable on the retina during head movements. We measured the VOR gain (eye velocity/head velocity) and phase (delay between vestibular stimulus and response) during whole-body sinusoidal rotations ranging 0.5–12 Hz with peak velocity 50 or 100 °/s in nine adult C57BL/6 mice. We also measured the VOR during whole-body transient rotations with acceleration 3000 or 6000 °/s² reaching a plateau of 150 or 300 °/s. These measures were obtained while the mouse's core body temperature was held at either 32 or 37 °C for at least 35 min before recording. The temperature presentation order and timing were pseudo-randomized. We found that a temperature increase from 32 to 37 °C caused a significant increase in sinusoidal VOR gain of 17 % (P < 0.001). Temperature had no other effects on the behavioural VOR. Our data suggest that temperature effects on regularly firing afferents best correspond to the changes that we observed in the VOR gain.

http://ift.tt/2tK44Ir

Erratum

In the article entitled "Modern challenges of allergic bronchopulmonary aspergillosis diagnosis and management: Finding from a case study with a history of rituximab use" (Ann Allergy Asthma Immunol 2017;119:83-97), the authors' names appear incorrectly. The authors' correct names are as follows:

http://ift.tt/2tJSBZj

Prenatal particulate matter exposure and wheeze in Mexican children: effect modification by prenatal psychosocial stress

Air pollution exposure in childhood is associated with greater incidence and exacerbation of asthma, particularly in children whose parents report high levels of psychological stress. However, this interaction has not been completely elucidated in pregnancy.

http://ift.tt/2v7a1T7

Carbon dioxide narcosis due to inappropriate oxygen delivery: a case report

Oxygen delivery to patients with chronic obstructive pulmonary disease may be challenging because of their potential hypoxic ventilatory drive. However, some oxygen delivery systems such as non-rebreathing fac...

http://ift.tt/2v76Rig

Renal damage induced by pemetrexed causing drug discontinuation: a case report and review of the literature

Pemetrexed maintenance therapy holds tremendous potential in improving the survival of patients with advanced pulmonary adenocarcinoma. Major side effects include myelosuppression and cutaneous reactions. Howe...

http://ift.tt/2tKhfJb

The 22-item Sino-Nasal Outcome Test accurately reflects patient-reported control of chronic rhinosinusitis symptomatology

Background

Patient-reported control of chronic rhinosinusitis (CRS) symptoms is associated with the quality of life impact of CRS. We sought to determine if 22-item Sino-Nasal Outcome Test (SNOT-22) score is predictive of patient-perceived CRS symptom control.

Methods

Prospective cross-sectional study of 202 patients with CRS. Participants were asked to rate their CRS symptom control as "not at all," "a little," "somewhat," "very," and "completely." The severity of patient CRS symptomatology was measured using the SNOT-22. The relationship between SNOT-22 score and patient-reported CRS symptom control was determined using regression, analysis of variance (ANOVA), and receiver operating characteristic (ROC) curve analysis.

Results

SNOT-22 was negatively associated with patient-reported CRS symptom control (adjusted β = −0.03; 95% CI, −0.04 to −0.02; p < 0.001), after controlling for demographic and clinical characteristics. There was a significant difference in SNOT-22 scores of participants reporting each level of symptom control (p < 0.001) with the greatest differences between participants who rated their CRS symptom control as "not at all," "a little," and "somewhat," which we deem poor CRS symptom control, and the group who described their level of CRS symptom control described as "very" and "completely," which we deem well-controlled CRS symptoms. These results were true across all SNOT-22 subdomains scores as well. Using ROC analysis, a SNOT-22 score of 35 identified patients reporting poor vs well-controlled CRS symptom control with 71.4% sensitivity and 85.5% specificity.

Conclusion

SNOT-22 score is associated with how well patients feel their CRS symptomatology is controlled. Moreover, SNOT-22 score can be used to accurately distinguish patients with poor vs well-controlled CRS symptoms.

http://ift.tt/2v3MvqQ

Six years' experience of tolerance induction in renal transplantation using stem cell therapy

Publication date: Available online 27 July 2017
Source:Clinical Immunology
Author(s): Aruna V. Vanikar, Hargovind L. Trivedi, Umang G. Thakkar
Tolerance induction (TI) has been attempted with chimerism/clonal deletion. We report results of TI protocol (TIP) using stem cell therapy (SCT) included adipose derived mesenchymal stem cells (AD-MSC) and hematopoietic stem cells (HSC) in 10 living-donor related renal transplantation (LDRT) patients under non-myeloablative conditioning with Bortezomib, Methylprednisone, rabbit-anti-thymoglobulin and Rituximab, without using conventional immunosuppression. Transplantation was performed following acceptable lymphocyte cross-match, flow cross-match, single antigen assay and negative mixed lymphocyte reaction (MLR). Monitoring included serum creatinine (SCr), donor specific antibodies (DSA) and MLR. Protocol biopsies were planned after 100days and yearly in willing patients. Rescue immunosuppression was planned for rejection/DSA/positive MLR. Over mean 6±0.37year follow-up patient survival was 80% and death-censored graft survival was 90%. Mean SCr was 1.44±0.41mg/dL. This is the first clinical report of sustained TI in LDRT for 6years using SCT.

Graphical abstract

http://ift.tt/2uFFtYe

Effect of Context on the Contribution of Individual Harmonics to Residue Pitch

Abstract

There is evidence that the contribution of a given harmonic in a complex tone to residue pitch is influenced by the accuracy with which the frequency of that harmonic is encoded. The present study investigated whether listeners adjust the weights assigned to individual harmonics based on acquired knowledge of the reliability of the frequency estimates of those harmonics. In a two-interval forced-choice task, seven listeners indicated which of two 12-harmonic complex tones had the higher overall pitch. In context trials (60 % of all trials), the fundamental frequency (F0) was 200 Hz in one interval and 200 + ΔF0 Hz in the other. In different (blocked) conditions, either the 3rd or the 4th harmonic (plus the 7th, 9th, and 12th harmonics), were replaced by narrowband noises that were identical in the two intervals. Feedback was provided. In randomly interspersed test trials (40 % of all trials), the fundamental frequency was 200 + ΔF0/2 Hz in both intervals; in the second interval, either the third or the fourth harmonic was shifted slightly up or down in frequency with equal probability. There were no narrowband noises. Feedback was not provided. The results showed that substitution of a harmonic by noise in context trials reduced the contribution of that harmonic to pitch judgements in the test trials by a small but significant amount. This is consistent with the notion that listeners give smaller weight to a harmonic or frequency region when they have learned that this frequency region does not provide reliable information for a given task.

http://ift.tt/2tJBC9v

Spatial Selectivity in Cochlear Implants: Effects of Asymmetric Waveforms and Development of a Single-Point Measure

Abstract

Three experiments studied the extent to which cochlear implant users' spatial selectivity can be manipulated using asymmetric waveforms and tested an efficient method for comparing spatial selectivity produced by different stimuli. Experiment 1 measured forward-masked psychophysical tuning curves (PTCs) for a partial tripolar (pTP) probe. Maskers were presented on bipolar pairs separated by one unused electrode; waveforms were either symmetric biphasic ("SYM") or pseudomonophasic with the short high-amplitude phase being either anodic ("PSA") or cathodic ("PSC") on the more apical electrode. For the SYM masker, several subjects showed PTCs consistent with a bimodal excitation pattern, with discrete excitation peaks on each electrode of the bipolar masker pair. Most subjects showed significant differences between the PSA and PSC maskers consistent with greater masking by the electrode where the high-amplitude phase was anodic, but the pattern differed markedly across subjects. Experiment 2 measured masked excitation patterns for a pTP probe and either a monopolar symmetric biphasic masker ("MP_SYM") or pTP pseudomonophasic maskers where the short high-amplitude phase was either anodic ("TP_PSA") or cathodic ("TP_PSC") on the masker's central electrode. Four of the five subjects showed significant differences between the masker types, but again the pattern varied markedly across subjects. Because the levels of the maskers were chosen to produce the same masking of a probe on the same channel as the masker, it was correctly predicted that maskers that produce broader masking patterns would sound louder. Experiment 3 exploited this finding by using a single-point measure of spread of excitation to reveal significantly better spatial selectivity for TP_PSA compared to TP_PSC maskers.

http://ift.tt/2v6ISA3

Core Body Temperature Effects on the Mouse Vestibulo-ocular Reflex

Abstract

Core body temperature has been shown to affect vestibular end-organ and nerve afferents so that their resting discharge rate and sensitivity increase with temperature. Our aim was to determine whether these changes observed in extracellular nerve recordings of anaesthetized C57BL/6 mice corresponded to changes in the behavioural vestibulo-ocular reflex (VOR) of alert mice. The VOR drives eye rotations to keep images stable on the retina during head movements. We measured the VOR gain (eye velocity/head velocity) and phase (delay between vestibular stimulus and response) during whole-body sinusoidal rotations ranging 0.5–12 Hz with peak velocity 50 or 100 °/s in nine adult C57BL/6 mice. We also measured the VOR during whole-body transient rotations with acceleration 3000 or 6000 °/s² reaching a plateau of 150 or 300 °/s. These measures were obtained while the mouse's core body temperature was held at either 32 or 37 °C for at least 35 min before recording. The temperature presentation order and timing were pseudo-randomized. We found that a temperature increase from 32 to 37 °C caused a significant increase in sinusoidal VOR gain of 17 % (P < 0.001). Temperature had no other effects on the behavioural VOR. Our data suggest that temperature effects on regularly firing afferents best correspond to the changes that we observed in the VOR gain.

http://ift.tt/2tK44Ir

Érythème kératolytique hivernal familial : une cathepsine est aux commandes

Publication date: Available online 28 July 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): O. Dereure




http://ift.tt/2v4BqWp

Myofibromatose infantile sporadique : mutations avec gain de fonction de PDGFRB

Publication date: Available online 28 July 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): O. Dereure




http://ift.tt/2uJ0Nud

Fluid Shift on Obstructive and Central Sleep Apnea

Condition:   Apnea (Central and Obstructive)
Intervention:   Other: no interventions
Sponsor:   Nanjing Medical University
Recruiting - verified July 2017

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Forthcoming Meetings

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Issue Information

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A new approach to specific IgE testing, asthma and auto-injectors in schools

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Cover Image

The cover image, by H. Sunadome et al., is based on the Original Article IL4Rα and ADAM33 as genetic markers in asthma exacerbations and type-2 inflammatory endotype, DOI 10.1111/cea.12927

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Erratum

Publication date: Available online 27 July 2017
Source:Annals of Allergy, Asthma & Immunology





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Prenatal particulate matter exposure and wheeze in Mexican children: effect modification by prenatal psychosocial stress

Publication date: Available online 27 July 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Maria José Rosa, Allan C. Just, Itai Kloog, Ivan Pantic, Lourdes Schnaas, Alison Lee, Sonali Bose, Yueh-Hsiu Mathilda Chiu, Hsiao-Hsien Leon Hsu, Brent Coull, Joel Schwartz, Sheldon Cohen, Martha María Téllez Rojo, Robert O. Wright, Rosalind J. Wright
BackgroundAir pollution exposure in childhood is associated with greater incidence and exacerbation of asthma, particularly in children whose parents report high levels of psychological stress. However, this interaction has not been completely elucidated in pregnancy.ObjectiveTo examine whether the association between prenatal exposure to particulate matter no larger than 2.5 μm in diameter (PM2.5) and wheeze in children is modified by prenatal stress.MethodsMexican women were recruited during pregnancy (N = 552). Residential prenatal daily exposure to PM2.5 was estimated using a satellite-based spatiotemporally resolved prediction model and averaged over trimesters. Maternal stress was indexed by maternal negative life events (NLE) score (range 0–11) ascertained during mid to late pregnancy. NLE scores were dichotomized at the median as low (NLE score ≤ 3) and high (NLE score > 3) stress. Reports of ever wheeze and wheeze in the past 12 months (current wheeze) for children were obtained using the International Study of Asthma and Allergies in Childhood survey at 48 months. The association between prenatal PM2.5 and wheeze was analyzed using a modified Poisson regression and stratified by low vs high stress.ResultsGreater PM2.5 exposure during the first trimester was associated with increased risk of current wheeze among children with mothers reporting high prenatal stress (relative risk 1.35, 95% confidence interval 1.00–1.83, per interquartile range increase 3.8 μg/m³) but not among those reporting low stress (relative risk 0.84, 95% confidence interval 0.61–1.16, per interquartile range increase 3.8 μg/m³; P for interaction = .04).ConclusionIncreased prenatal stress enhanced the association between PM2.5 exposure in early pregnancy, and child wheeze at 48 months of age. It is important to consider chemical and nonchemical stressors together to more comprehensively characterize children's environmental risk.



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Vitamin D, high-sensitivity C-reactive protein, and airway hyperresponsiveness in infants with recurrent respiratory symptoms

Publication date: Available online 28 July 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Anette M. Määttä, Anne Kotaniemi-Syrjänen, Kristiina Malmström, L. Pekka Malmberg, Jouko Sundvall, Anna S. Pelkonen, Mika J. Mäkelä
BackgroundVitamin D insufficiency might be associated with biased T-cell responses resulting in inflammatory conditions such as atopy and asthma. Little is known about the role of vitamin D in low-grade systemic inflammation and airway hyperresponsiveness (AHR) in young children.ObjectiveTo evaluate whether vitamin D insufficiency and increased serum high-sensitivity C-reactive protein (hs-CRP) are linked to AHR in symptomatic infants.MethodsSeventy-nine infants with recurrent or persistent lower respiratory tract symptoms underwent comprehensive lung function testing and a bronchial methacholine challenge test. In addition, skin prick tests were performed and serum 25-hydroxyvitamin D (S-25-OHD), hs-CRP, total immunoglobulin E, and blood eosinophil levels were determined.ResultsS-25-OHD was lowest in infants with blood eosinophilia and AHR (n = 10) compared with those with eosinophilia only (n = 6) or AHR only (n = 50) or those with neither (n = 13; P = .035). Moreover, vitamin D insufficiency (S-25-OHD <50 nmol/L) was most common in infants with blood eosinophilia and AHR (P = .041). Serum hs-CRP was lower in infants with recurrent physician-diagnosed wheezing (P = .048) and in those with blood eosinophilia (P = .015) than in infants without these characteristics and was not associated with S-25-OHD or AHR. S-25-OHD levels were significantly lower (median 54 nmol/L) during the autumn-winter season than in the spring-summer season (median 63 nmol/L; P = .026).ConclusionVitamin D insufficiency could underlie eosinophilia and AHR in infants with troublesome lung symptoms, whereas hs-CRP–mediated low-grade systemic inflammation is rare in early childhood wheezing.



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Oncogenic signalling pathways in benign odontogenic cysts and tumours

Publication date: September 2017
Source:Oral Oncology, Volume 72
Author(s): Marina Gonçalves Diniz, Carolina Cavalieri Gomes, Sílvia Ferreira de Sousa, Guilherme Machado Xavier, Ricardo Santiago Gomez
The first step towards the prevention of cancer is to develop an in-depth understanding of tumourigenesis and the molecular basis of malignant transformation. What drives tumour initiation? Why do most benign tumours fail to metastasize? Oncogenic mutations, previously considered to be the hallmark drivers of cancers, are reported in benign cysts and tumours, including those that have an odontogenic origin. Despite the presence of such alterations, the vast majority of odontogenic lesions are benign and never progress to the stage of malignant transformation. As these lesions are likely to develop due to developmental defects, it is possible that they harbour quiet genomes. Now the question arises – do they result from DNA replication errors? Specific candidate genes have been sequenced in odontogenic lesions, revealing recurrent BRAF mutation in the case of ameloblastoma, KRAS mutation in adenomatoid odontogenic tumours, PTCH1 mutation in odontogenic keratocysts, and CTNNB1 (Beta-catenin) mutation in calcifying odontogenic cysts. Studies on these benign and rare entities might reveal important information about the tumorigenic process and the mechanisms that hinder/halt neoplastic progression. This is because the role of relatively common oncogenic mutations seems to be context dependent. In this review, each mutation signature of the odontogenic lesion and the affected signalling pathways are discussed in the context of tooth development and tumorigenesis. Furthermore, behavioural differences between different types of odontogenic lesions are explored and discussed based on the molecular alteration described. This review also includes the employment of molecular results for guiding therapeutic approaches towards odontogenic lesions.



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Outcome following radiotherapy for head and neck basal cell carcinoma with ‘aggressive’ features

Publication date: September 2017
Source:Oral Oncology, Volume 72
Author(s): Anupam Rishi, Shao Hui Huang, Brian O'Sullivan, David P Goldstein, Lin Lu, Jolie Ringash, John Waldron, Woody Wells, Alex Sun, Andrew Hope, Peter Chung, Meredith Giuliani, Anna Spreafico, Li Tong, Wei Xu, Andrew Bayley
ObjectivesThe literature demonstrates that 'aggressive' head-and-neck basal cell carcinomas (HN-BCC) have a higher than expected relapse rate with unfavorable outcomes. We report outcomes following definitive (dRT) or post-operative radiotherapy (PORT) for these tumors.MethodsWe reviewed all HN-BCC patients with 'aggressive' features (primary lesions diameter >10mm, >2 recurrences, or extra-cutaneous extension), treated with megavoltage dRT or PORT between 1998 and 2013. Loco-regional control (LRC) and relapse-free survival (RFS) were estimated using the competing risk method, and overall survival (OS) by Kaplan-Meier method. Univariable analysis explored factors associated with relapse.ResultsA total of 108 histologically confirmed 'aggressive' HN-BCC patients were identified, including 38 (35%) presenting de novo and 70 (65%) treated for recurrence (rBCC). dRT was offered to 72 (66.7%) patients and PORT to 36 (33.3%). Median follow-up was 3.5years. Actuarial 3-year LRC, RFS, and OS were 87% (95% confidence interval: 77–92), 82% (72–89), and 87% (80–94), respectively. LRC rates for dRT and PORT were similar [hazard ratio (HR) 0.61 (0.17–2.23), p=0.46]. Factors associated with higher risk of relapse were: rBCC [HR 7.96 (1.03–61.71), p=0.047], 'H-zone' (mid face, eyes, and ears) location [HR 3.13 (1.07–9.19), p=0.04], tumor size [HR 1.32 (1.08–1.6), p=0.006], nodal involvement [HR 3.68 (1.11–12.2), p=0.03] and stage [HR 3.13 (1.19–8.26), p=0.02].ConclusionRT is an effective treatment for 'aggressive' HN-BCC when used as a definitive modality or as PORT. Non-surgical management with definitive radiotherapy provides an alternative effective option if surgery is not used.



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Prognostic factors and occult nodal disease in mucoepidermoid carcinoma of the oral cavity and oropharynx: An analysis of the National Cancer Database

Publication date: September 2017
Source:Oral Oncology, Volume 72
Author(s): Mark A. Ellis, Evan M. Graboyes, Terry A. Day, David M. Neskey
ObjectivesMucoepidermoid carcinoma (MEC) is an uncommon malignancy that most commonly occurs in the parotid gland followed by the minor salivary glands of the upper aerodigestive tract, most notably in the oral cavity (OC) and oropharynx (OP). Because of its rarity, few studies have been performed that are specific to MEC within the OC and OP. The objective of this study is to describe the tumor characteristics and prognostic features for MEC of the OC and OP.Materials and MethodsThe National Cancer Database (NCDB) was used for this study. The primary outcome measure was 5-year overall survival (OS). The secondary outcome measure was occult nodal disease. Fischer's exact tests, chi-square tests, log-rank tests and Cox proportional hazards analyses were performed.ResultsWe identified 3005 patients with MEC of the OC/OP. The 5-year overall survival for MEC of the OC and OP was 87%. Increasing age, male sex, Charlson/Deyo comorbidity score of 2+, clinical T3-4 tumors, nodal+disease, high grade tumors and positive margins were independently associated with decreased 5-year OS. Occult nodal disease occurred in 14.1% and 17.3% of high grade and clinical T3-T4 tumors respectively.ConclusionMEC of the OC/OP has an excellent survival as the majority of these patients have low/intermediate grade and early stage disease. Negative prognosticators include increasing age, male sex, Charlson/Deyo comorbidity score of 2+, clinical T3-4 tumors, nodal+ disease, high grade tumors and positive margins. Our findings justify strong consideration of prophylactic neck dissection for high grade and clinical T3-4 tumors.



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Metastatic malignant PEComa of the leg with identification of ATRX mutation by next-generation sequencing

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An unusual cysteine VL87 affects the antibody fragment conformations without interfering with the disulfide bond formation

Publication date: October 2017
Source:Molecular Immunology, Volume 90
Author(s): Carolina Attallah, María Fernanda Aguilar, A. Sergio Garay, Fernando E. Herrera, Marina Etcheverrigaray, Marcos Oggero, Daniel E. Rodrigues
The Cys residues are almost perfectly conserved in all antibodies. They contribute significantly to the antibody fragment stability. The relevance of two natural contiguous Cys residues of an anti-recombinant human-follicle stimulation hormone (rhFSH) in a format of single-chain variable fragment (scFv) was studied. This scFv contains 5 Cys residues: VH22 and VH92 in the variable heavy chain (VH) and VL23, VL87 and VL88 in the variable light chain (VL). The influence of two unusual contiguous Cys at positions VL87 and VL88 was studied by considering the wild type fragment and mutant variants: VL-C88S, VL-C87S, VL-C87Y. The analysis was carried out using antigen-binding ability measurement by indirect specific ELISA and a detailed molecular modeling that comprises homology methods, long molecular dynamics simulations and docking. We found that VL-C87 affected the antibody fragment stability without interfering with the disulfide bond formation. The effect of mutating the VL-C87 by a usual residue at this position like Tyr caused distant structural changes at the VH region that confers a higher mobility to the VH-CDR2 and VH-CDR3 loops improving the scFv binding to the antigen.



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de Garengeot hernia with appendicitis treated by two-way-approach surgery: a case report

Abstract

de Garengeot hernia is a rare subtype of a femoral hernia with incarceration of the appendix. This type of hernia usually presents with therapeutic dilemmas, especially because of the risk of surgical site infection (SSI). Our patient was a 74-year-old woman with a bulging mass and tenderness in the right inguinal area. Computed tomography revealed an incarcerated appendix, with appendicitis in the femoral hernia. Laparoscopic appendectomy was initially performed, followed by hernioplasty via the anterior approach to prevent properitoneal contamination. Some authors have recently reported cases successfully treated by laparoscopy. However, this type of hernia has a higher risk for SSI, compared with the risk involved in usual hernioplasty. Therefore, selection of the appropriate surgical approach to prevent wound infection is important, especially in the presence of appendicitis. We would like to highlight the usefulness of hybrid surgery, laparoscopic appendectomy and hernioplasty via the anterior approach to prevent SSIs.

http://ift.tt/2uJ5YdE

Acute presentation of congenital diaphragmatic hernia requiring damage control laparotomy in an adult patient

Abstract

Congenital diaphragmatic hernias constitute an infrequent but potentially serious presentation of bowel obstruction in the adult patient. Herein, we present a rare case of an adult patient with strangulation of colon within a Morgagni's hernia where timely recognition and intervention were life-saving. An 18-year-old female presented with an acute abdomen, respiratory failure, and shock secondary to a strangulated, previously undiagnosed Morgagni hernia requiring emergency laparotomy, reduction of hernia contents and resection of non-viable colon. The patient underwent repair of the hernia with restoration of bowel continuity and reconstruction of her abdominal wall in sequential fashion. Although congenital diaphragmatic hernias have been previously described in the adult population, there are few if any reports of such pathology presenting in such an acute, life-threatening fashion. This case highlights the importance of a high index of suspicion, early recognition, and timely surgical intervention for this rare, potentially fatal condition.

http://ift.tt/2uIT6nJ

Dislocation of a mandibular condyle in the middle cranial fossa, diagnosed 54 years after trauma

Abstract

Dislocation of the mandibular condyle into the middle cranial fossa is a rare complication of mandibular trauma. We report the remarkable case of a 63-year-old patient in whom trauma 54 years prior to consultation resulted in intrusion of the right mandibular condyle into the middle cranial fossa. The diagnosis was missed because of insufficient data provided by conventional radiographies. Failure of timely diagnosis and lack of appropriate treatment resulted in temporomandibular joint ankylosis with functional impairment, disturbance of mandibular growth and dentofacial asymmetry. We emphasize the need for careful radiological investigation in case of a suspected condylar fracture or dislocation, especially when the mechanism of injury is likely to facilitate condylar intrusion. The use of CT and MR-imaging is therefore advocated.

http://ift.tt/2uIVo6w

Congenital lipomatous tumour, presented as a polypoidal projection on upper eyelid

Abstract

A Japanese baby was born with a polypoidal projection with hair, on the lateral corner of upper eyelid. The tumour had extent to bulbar sub-conjunctival area. He presented no other malformation nor pathological symptoms. There was no sign of association with Goldenhar, hemifacial macrosomia, epidermal nevus or linear nevus sebaceous syndromes. The tumour was resected at his age of 4 months. The ocular conjunctiva was incised but not excised. Histopathologically, it was mainly consisted of multi-lobuled mature adipose tissue, dense fibrous tissue was observed at the centre of mass, assumed to be the link of palpebral tarsal plate to lateral canthal ligament. As for the location and component, the tumour was diagnosed as a lipomatous hamartoma. Detached tarsal plate was reattached to the lateral canthal ligament. Satisfactory result was achieved aesthetically and functionally. Congenital lipomatous hamartoma, with protuberant appendage appearance on eyelid, without syndromic association, is presented.

http://ift.tt/2uIvZK7

Diabetic ketoacidosis in a postoperative gastric bypass patient

Abstract

We report a case of postoperative life threatening metabolic acidosis in a young Type-2 diabetic woman who had no history of diabetic ketoacidosis. The patient underwent a non-complicated laparoscopic Roux-en-Y gastric bypass 6 days earlier. We discuss her clinical features, pathogenesis, management and outcome. We would like to make the surgical field aware of this potentially fatal diabetic complication since bariatric procedures are now indicated for the management of diabetic m'orbid obesity and Type-2 diabetes prevalence is on the rise, particularly in young individuals.

http://ift.tt/2uIzPmm

Intra-scrotal testicular torsion of a classical seminoma in an elderly patient: a case report and literature review

Abstract

Intra-scrotal testicular torsion of a seminoma is extremely rare and has been reported scarcely in literature. On the other hand testicular torsion by itself is rare in old age as well. We report a 63-year-old male who was presented to our Emergency Department with a right scrotal swelling and pain for 1 week. The patient had intra-scrotal testicular torsion of a seminoma which was overlooked initially by Doppler ultrasound, progression of symptoms led to a computed tmomgraphy scan which showed a testicular torsion. Intra-operative findings showed a torsed right testis with completely engorged cord. Right radical orchiectomy was done and indecently histopathology revealed a classical seminoma. Urologist should be aware and more vigilant of testicular torsion as a presentation of malignancy in old age especially with the presence of diagnostic limitations.

http://ift.tt/2v4e3Mu

Osteochondral fracture in weight-bearing portion of lateral femoral condyle associated with patellar dislocation

Abstract

Osteochondral fracture (OCF) in the weight-bearing surface of the lateral femoral condyle, associated with patellar dislocation, is an uncommon lesion. We report three cases of acute lateral patellar dislocation with large OCF in the weight-bearing portion of the lateral femoral condyle. In patients with lateral patella dislocation or lateral femoral condyle OCF, careful physical examination, radiography and MRI are recommended to rule out any associated injury.

http://ift.tt/2v3LZcd

Invasive Paget’s disease of the male nipple: a case report

Abstract

Male mammary Paget's disease (MPD) is extremely rare. Furthermore, MPD with invasion downward into the dermis of the male nipple has been reported rarely. A 56-year-old Japanese man presented with a lump and eczema in the right nipple–areola area. Ultrasonography revealed only a cystic lesion below the right areola. With a diagnosis of MPD with invasion into the dermis associated with ductal carcinoma in situ, mastectomy and sentinel lymph node biopsy were performed. MPD with dermal invasion is extremely rare, and only one male case has been reported in the English literature; therefore, the current case is the second case of male MPD with dermal invasion.

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Pneumomediastinum and subcutaneous emphysema after successful laparoscopic supra-cervical hysterectomy

Abstract

Laparoscopic hysterectomy is a commonly performed gynecological procedure. Although the outcomes are favorable, severe life threatening complications such as pneumothorax, pneumomediastinum and subcutaneous emphysema can occur during laparoscopy secondary to carbon dioxide insufflation. We report a 46-year-old female who was scheduled for laparoscopic-assisted supra-cervical hysterectomy for uterine fibroids. Patient tolerated the procedure and there were no intra-operative complications. Post operatively she developed hypercarbia, subcutaneous emphysema and pneumomediastinum. She was managed conservatively. This case demonstrates a rare occurrence of subcutaneous emphysema and pneumomediastinum after supra-cervical hysterectomy.

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Pylephlebitis with splenic abscess following transrectal prostate biopsy: rare complications of intra-abdominal infection

Abstract

Pylephlebitis is a rare complication of intra-abdominal infection involving septic thrombosis of the portal system. If the splenic vein is compromised, this can lead to a splenic abscess, an extremely rare complication of pylephlebitis. The pathophysiology behind these clinical entities remains unclear. In both cases, symptoms are highly nonspecific and include fever, malaise and abdominal pain. Here, we discuss a case in which a patient develops both pylephlebitis and a subsequent splenic abscess following a transrectal prostate biopsy. Diagnosis was made by computerized tomography scan; the treatment included broad spectrum antibiotics and laparoscopic splenectomy, after which the patient made a full recovery.

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Salivary duct carcinoma arising from the inferior turbinate

ABSTRACT

Salivary duct carcinoma (SDC) is an uncommon, aggressive tumour, which carries a poor prognosis. SDC affects the major salivary glands, usually occurring in the parotid gland. A 76-year-old male patient presented with right-sided nasal obstruction and rhinorrhoea. A polypoidal mass was seen in the right inferior turbinate mimicking a benign neoplasm. Histological examination following wide excision led to a diagnosis of SDC. There are no therapeutic guidelines and management is based on experience with SDC of the major salivary glands. Given the aggressive nature and poor prognosis of the disease, it is a rare but important differential to consider in patients with unilateral nasal mass.

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Acute GI bleed due to leiomyoma of the jejunum: a case report

Abstract

Neoplasms of the small intestine are rare. Leiomyomas are the one of the benign neoplasms that can be found in the small intestine. These lesions usually remain asymptomatic and are often found incidentally; however, they can become symptomatic if obstruction occurs or the tumor outgrows its blood supply resulting mucosa. Their clinical manifestations can include abdominal pain, diarrhea, melena, a palpable abdominal mass and weight loss. Due to their vague presentation, leiomyomas of the small intestine are typically diagnosed after failed conservative therapy for other pathologies such as duodenal ulcers and diverticulosis. This case report describes a 34-year-old male who developed an acute GI bleed due to a symptomatic leiomyoma of the jejunum. He was initially treated with non-operative conservative management; however, his symptoms remained unresolved and he went on to require surgical intervention.

http://ift.tt/2v3NXcA

Update on the Diagnosis and Treatment of Spontaneous Intracranial Hypotension

Abstract

Purpose of Review

The purpose of this study is to provide an update on recent developments in the understanding, diagnosis, and treatment of spontaneous intracranial hypotension (SIH).

Recent Findings

SIH is an important cause of headaches caused by spinal cerebrospinal fluid (CSF) leaks, with an increasingly broad spectrum of clinical presentations and diagnostic findings. A simple conception of the condition as being defined by the presence of low CSF pressure is no longer sufficient or accurate. A number of etiologies for spinal CSF leaks have been identified, including the recent discovery of CSF-venous fistulas, and these various etiologies may require different diagnostic and therapeutic pathways in order to affect a cure.

Summary

Familiarity with the spectrum of presentations and causes of SIH is critical to accurate and timely diagnosis and management. Challenges exist in both diagnosis and treatment, and require understanding of the underlying pathogenesis of the condition in order to appropriately select testing and treatment. Prospective studies are needed going forward in order to inform workup and guide treatment decisions.

http://ift.tt/2h81MB9

Prevalence of Hearing Loss Among Children 9 to 11 Years Old: The Generation R Study.

Prevalence of Hearing Loss Among Children 9 to 11 Years Old: The Generation R Study.

JAMA Otolaryngol Head Neck Surg. 2017 Jul 27;:

Authors: le Clercq CMP, van Ingen G, Ruytjens L, Goedegebure A, Moll HA, Raat H, Jaddoe VWV, Baatenburg de Jong RJ, van der Schroeff MP

Abstract
Importance: Hearing loss (HL), a major cause of disability globally, negatively affects both personal and professional life.
Objective: To describe the prevalence of sensorineural hearing loss (SNHL) among a population-based cohort of 9- to 11-year-old children, and to examine potential associations between purported risk factors and SNHL in early childhood.
Design, Setting, and Participants: The study was among the general, nonclinical, pediatric community within the city of Rotterdam, the Netherlands, and was conducted between 2012 and 2015 as a cross-sectional assessment within the Generation R Study, a population-based longitudinal cohort study from fetal life until adulthood. Participants are children of included pregnant women in the Generation R Study with an expected delivery date between April 2002 and January 2006. They form a prenatally recruited birth cohort.
Main Outcomes and Measures: Pure-tone air-conduction hearing thresholds were obtained at 0.5, 1, 2, 3, 4, 6, and 8 kHz, and tympanometry was performed in both ears. Demographic factors and parent-reported questionnaire data, including history of otitis media, were also measured.
Results: A total of 5368 participants with a mean age of 9 years 9 months (interquartile range, 9 years 7 months-9 years 11 months) completed audiometry and were included in the analyses. A total of 2720 were girls (50.7%), and 3627 (67.6%) were white. Most of the participants (4426 children [82.5%]) showed normal hearing thresholds 15 dB HL or less in both ears. Within the cohort, 418 children (7.8%) were estimated to have SNHL (≥16 dB HL at low-frequency pure-tone average; average at 0.5, 1, and 2 kHz or high-frequency pure-tone average; average at 3, 4, and 6 kHz in combination with a type A tympanogram) in at least 1 ear, most often at higher frequencies. In multivariable analyses, a history of recurrent acute otitis media and lower maternal education were associated with the estimated SNHL at ages 9 to 11 years (odds ratio, 2.0 [95% CI. 1.5-2.8] and 1.4 [95% CI, 1.1-1.7], respectively).
Conclusions and Relevance: Within this cohort study in the Netherlands, 7.8% of the children ages 9 to 11 years had low-frequency or high-frequency HL of at least 16 dB HL in 1 or both ears. A history of recurrent acute otitis media and lower maternal education seem to be independent risk factors for presumed SNHL in early childhood.

PMID: 28750130 [PubMed - as supplied by publisher]

http://ift.tt/2v3kAqY

Variations in the Prevalence of Hearing Loss in Children: Truth or Artifact?

Variations in the Prevalence of Hearing Loss in Children: Truth or Artifact?

JAMA Otolaryngol Head Neck Surg. 2017 Jul 27;:

Authors: Lieu JEC

PMID: 28750124 [PubMed - as supplied by publisher]

http://ift.tt/2tOYcSn

Prevalence of Hearing Loss in US Children and Adolescents: Findings From NHANES 1988-2010.

Prevalence of Hearing Loss in US Children and Adolescents: Findings From NHANES 1988-2010.

JAMA Otolaryngol Head Neck Surg. 2017 Jul 27;:

Authors: Su BM, Chan DK

Abstract
Importance: There have been concerns about increasing levels of hearing impairment in children and adolescents, especially in relation to noise exposure, because even mild levels of hearing loss can affect educational outcomes.
Objective: To further characterize changes in prevalence of hearing loss and noise exposures in the US pediatric population over time.
Design, Setting, and Participants: This is a retrospective analysis of demographic and audiometric data from the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994), NHANES 2005-2006, NHANES 2007-2008, and NHANES 2009-2010. The NHANES are nationally representative survey data sets collected and managed by the US National Center for Health Statistics, and this study includes a total of 7036 survey participants ages 12 to 19 years with available audiometric measurements.
Exposures: Hearing-related behaviors and risk factors such as history of ear infections, noise exposures, firearm use, and hearing protection use.
Main Outcomes and Measures: Level of hearing loss measured by pure-tone audiometry, as well as high-frequency and low-frequency hearing loss and noise-induced threshold shifts.
Results: Overall, data from 7036 survey participants ages 12 to 19 years with available audiometric measurements were analyzed. The prevalence of hearing loss increased from NHANES III to NHANES 2007-2008 (17.0% to 22.5% for >15 dB hearing loss; absolute difference, 5.5%; 95% CI, 6.1%-10.3%) but decreased in the NHANES 2009-2010 to 15.2% (absolute difference, 7.2%; 95% CI, 2.0%-12.4%) with no significant overall secular trend identified. There was an overall rise in exposure to loud noise or music through headphones 24 hours prior to audiometric testing from NHANES III to NHANES 2009-2010. However, noise exposure, either prolonged or recent, was not consistently associated with an increased risk of hearing loss across all surveys. The most recent survey cycle showed that nonwhite race/ethnicity and low socioeconomic status are independent risk factors for hearing loss.
Conclusions and Relevance: This analysis did not identify significant changes in prevalence of hearing loss in US youth ages 12 to 19 years over this time period despite increases in reported noise exposures. No consistent associations were shown between noise exposure and hearing loss, though there was an association between racial/ethnic minority status and low socioeconomic status and increased risk of hearing loss. Ongoing monitoring of hearing loss in this population is necessary to elucidate long-term trends and identify targets for intervention.

PMID: 28750123 [PubMed - as supplied by publisher]

http://ift.tt/2v3CzgN

Exercise-Induced Vertigo in Vestibular Schwannoma.

Exercise-Induced Vertigo in Vestibular Schwannoma.

JAMA Otolaryngol Head Neck Surg. 2017 Jul 27;:

Authors: Foster E, Chen L

PMID: 28750117 [PubMed - as supplied by publisher]

http://ift.tt/2u4qV0E

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

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

http://ift.tt/2v5zdtt

Inflammatory Bowel Disease in Primary Immunodeficiencies

Abstract

Purpose of Review

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

Recent Findings

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

Summary

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

http://ift.tt/2uItJ5G

Superior Semicircular Canal Dehiscence: Pathophysiology and Surgical Outcomes

Abstract

Purpose of Review

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

Recent Findings

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

Summary

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

http://ift.tt/2vOUYvl

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

Abstract

Background/Objectives

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

Methods

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

Results

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

Conclusion

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

http://ift.tt/2eSZAN2

Dermoscopy of lymphangioma circumscriptum: A morphological study of 45 cases

Abstract

Background/Objectives

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

Methods

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

Results

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

Conclusions

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

http://ift.tt/2h8jF2t

Preliminary evaluation of reflectance confocal microscopy features of scalp melanoma

http://ift.tt/2eSZu88

Three cases of lymphocytic thrombophilic arteritis presenting with an annular eruption

Abstract

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

http://ift.tt/2h8bbZn

The color of cancer: Margin guidance for oral cancer resection using elastic scattering spectroscopy

Objectives/Hypothesis

To evaluate the usefulness of elastic scattering spectroscopy (ESS) as a diagnostic adjunct to frozen section analysis in patients with diagnosed squamous cell carcinoma of the oral cavity.

Study Design

Prospective analytic study.

Methods

Subjects for this single institution, institutional review board–approved study were recruited from among patients undergoing surgical resection for squamous cell cancer of the oral cavity. A portable ESS device with a contact fiberoptic probe was used to obtain spectral signals. Four to 10 spectral readings were obtained on each subject from various sites including gross tumor and normal-appearing mucosa in the surgical margin. Each reading was correlated with the histopathologic findings of biopsies taken from the exact location of the spectral readings. A diagnostic algorithm based on multidimensional pattern recognition/machine learning was developed. Sensitivity and specificity, error rate, and area under the curve were used as performance metrics for tests involving classification between disease and nondisease classes.

Results

Thirty-four (34) subjects were enrolled in the study. One hundred seventy-six spectral data point/biopsy specimen pairs were available for analysis. ESS distinguished normal from abnormal tissue, with a sensitivity ranging from 84% to 100% and specificity ranging from 71% to 89%, depending on how the cutoff between normal and abnormal tissue was defined (i.e., mild, moderate, or severe dysplasia). There were statistically significant differences in

malignancy scores between histologically normal tissue and invasive cancer and between noninflamed tissue and inflamed tissue.

Conclusions

This is the first study to evaluate the effectiveness of ESS in guiding mucosal resection margins in oral cavity cancer. ESS provides fast, real-time assessment of tissue without the need for pathology expertise. ESS appears to be effective in distinguishing between normal mucosa and invasive cancer and between "normal" tissue (histologically normal and mild dysplasia) and "abnormal" tissue (severe dysplasia and carcinoma in situ) that might require further margin resection. Further studies, however, are needed with a larger sample size to validate these findings and to determine the effectiveness of ESS in distinguishing visibly and histologically normal tissue from visibly normal but histologically abnormal tissue.

Level of Evidence

NA Laryngoscope, 2017

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