Αρχειοθήκη ιστολογίου

Τρίτη 29 Αυγούστου 2017

How Short is Short, and Why? A Probable Case of Proportionate Dwarfism from Egypt's 3rd Intermediate Period in the Dakhleh Oasis, Egypt

Abstract

This study describes a probable proportionate dwarf from a Third Intermediate Period cemetery at Ain Tirghi in the Dakhleh Oasis, Egypt. The skeleton (Burial 22 or B22) is an adult female estimated to be in her mid to late thirties. Most medical literature defines an adult stature of 2 standard deviations below the population mean as an indicator for clinically short stature, with some bioarchaeologists and clinicians identifying severe short stature at 3 standard deviations below the population mean. B22 satisfies either criteria when compared with the Ain Tirghi adult female population mean for measurements of the radii and femora, as well as the summed measurements of the femora and tibiae. Her limb proportions were normal and this, with a lack of morphological abnormalities, eliminated several possible causes of small stature (e.g. achondroplasia). The differential diagnosis for an individual with short stature and normal proportions indicates that she represents a probable case of pituitary dwarfism, or hypopituitarism. B22 was buried in the same fashion as adjacent burials in a family group burial and showed no differential indication of physiological stress or illness. Contextualized with the Egyptological and archaeological evidence of dwarfism in Egypt, this case study considers the social perceptions of dwarfism in ancient Egypt and suggests that pituitary dwarfs, like disproportionate dwarfs, likely led normal, if not privileged lives. Therefore, according to the social theory of disability, B22 was not necessarily disabled despite her impairment.



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Authors' Reply: "Organ Transplantation in Australia: Inequities in Access and Outcome for Indigenous Australians".

No abstract available

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Organ Transplantation in Australia: Inequities in Access and Outcome for Indigenous Australians.

No abstract available

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Lung Retransplantation: Practical and Ethical Considerations Raised by the Hannover Protocol.

No abstract available

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Midterm Outcomes of 12 Renal Transplant Recipients Treated With Eculizumab to Prevent Atypical Hemolytic Syndrome Recurrence.

Background: Atypical hemolytic uremic syndrome (aHUS) is an orphan disease with a high rate of recurrence after kidney transplantation. However, reports of successful prevention of posttransplant aHUS recurrence with eculizumab emerged a few years ago. To further delineate its optimal use, we describe the largest series of kidney transplant recipients treated with prophylactic eculizumab. Methods: Twelve renal transplant recipients with aHUS-related end stage renal disease received eculizumab: 10 from day 0 and 2 at the time of recurrence (days 6 and 25). Clinical and histological features, complement assessment and free eculizumab measurements were analyzed. The median follow-up was 24.6 months. Results: 5 patients had failed at least 1 previous renal transplant from aHUS. A genetic mutation was identified in 9 patients, anti-H antibodies were found in 2. No patient demonstrated biological recurrence of thrombotic microangiopathy (TMA) under treatment. Three antibody-mediated rejections (ABMRs) occurred without detectable C5 residual activity. ABMR was associated with subclinical TMA in 2 patients. One patient lost his graft after several complications, including ABMR. One patient experienced post-transplant C3 glomerulonephritis. The last median serum creatinine was 128.2 +/- 40.8 [mu]mol/l. Conclusions: These data confirm that eculizumab is highly effective in preventing posttransplantation aHUS recurrence, yet may not fully block ABMR pathogenesis. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Treatment of cutaneous iatrogenic Kaposi sarcoma with topical timolol



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Issue Information - JEB



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Neutrophilic dermatosis of hands preceding extensive small cell lung cancer



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Issue Information - TOC



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Digit ratio 2D:4D is a possible indicator for androgenetic alopecia in males

Summary

Background

Androgenetic alopecia (AGA) is the most common hair loss. The 2D:4D digit ratio refers to the ratio of the length of the second finger to that of the fourth finger and is thought as a marker of prenatal androgen exposure.

Objectives

There are many studies which have examined the relationship between 2D:4D ratio and some other diseases. In this study, we evaluated the relationship between digit ratio 2D:4D and AGA.

Methods

The study group was composed of a male with AGA and healthy controls. The lengths of patients' second and fourth fingers were measured using a digital caliper with a resolution of 0.01 mm. Finger length was measured on the palmar side of the hand from the basal metacarpophalangeal crease. The 2D:4D ratio was obtained by dividing the length of the second finger by the length of the fourth finger.

Results

A total of 99 males who have androgenetic alopecia with a score of grade III or more and 90 controls were included. The mean age of AGA group was 29.72 ± 5.53, and the mean age of control group was 19.63 ± 5.05. The left-hand 2D:4D ratios of AGA group (0.893 ± 0.267) were significantly lower than healthy controls (0.971 ± 0.028). No significant relationships were found between AGA severity, age of onset,and digit ratios.

Conclusions

The left-hand digit ratio 2D:4D is lower in AGA patients, and therefore, left-hand digit ratio 2D:4D can be used as an estimation tool for AGA development in future. There is not any correlation between digit ratio and age of onset. Also, there is no correlation between digit ratio 2D:4D and AGA severity.



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Immune development and environment: lessons from Amish and Hutterite children



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Gender difference and laterality of sleep position

A higher incidence in women (approximately 7:3) and a predominant involvement of the right ear (approximately 7:5) are interesting features of BPPV (benign paroxysmal positional vertigo). It is speculated that these features are related to sleep position. The first aim of this study was to compare the frequency of position shifts during sleep between men and women. The second aim was to elucidate any differences in sleep position between men and women. The third aim was to clarify the laterality of sleep position.

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Detection of hereditary hearing loss gene by DNA microarray

OBJECTIVE: Screening genes in patients suffering clinically sporadic deafness, using DNA microarray, and evaluating the application value of the clinical detection.

PATIENTS AND METHODS: DNA extracted from patients' venous blood was amplified by PCR, and hybridization was carried out in a myriad class clean room. Nine mutation sites of four deaf genes commonly seen in Chinese people were tested.

RESULTS: Among 24 patients, 7 cases with mutations were detected, with a positive rate of 29.17%. These include 4 cases with GJB2 gene mutation (16.67%), of which 1 case with 176 del 16 site heterozygous mutation; 1 with 235 del C site homozygous mutation; 2 with 299 del AT site heterozygous mutation; 1 with SLC26A4 gene IVS7-2A>G site heterozygous mutation (4.17%), 2 with mitochondrion 12SrRNA gene1555A>G site homogeneous mutation (8.33%). No GJB3 gene mutation was detected.

CONCLUSIONS: Gene chip technology of hereditary hearing loss can detect related mutation sites of hearing loss rapidly and with high-throughput, which meets the demands of clinical deaf gene detection.

L'articolo Detection of hereditary hearing loss gene by DNA microarray sembra essere il primo su European Review.



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Evolution of gender representation among Canadian OTL-HNS residents: a 27-year analysis

The proportion of females enrolling into medical schools has been growing steadily. However, the representation of female residents among individual specialties has shown considerable variation. The purpose of...

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Most Melanomas Not Malignant Transformation of Moles

The majority of melanomas arise as new lesions on the skin, not from preexisting nevi, as is commonly believed.
Medscape Medical News

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Response to: Letter to the Editor regarding “Changing the surgical dogma in frontal sinus trauma: transnasal endoscopic repair”



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Pediatrics Will Keep You Young

Dr Alok Patel meets with a 12-year-old expert to explore the latest tween craze.
Medscape Pediatrics

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Remove Physician Statue From NYC Park: Right or Wrong?

J. Marion Sims is called the 'father of modern gynecology' for such innovations as being the first to treat vesicovaginal fistula. But this advance was the result of experiments conducted on slaves.
Medscape

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Do TV Drug Ads Say Too Much About Risks? FDA Wants to Know

Recent research suggests that limiting the list of adverse events in DTC ads to the most important ones would help consumers better remember them.
Medscape Medical News

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No Effect of Levothyroxine and Levothyroxine-Induced Subclinical Thyrotoxicosis on the Pharmacokinetics of Sorafenib in Healthy Male Subjects

Thyroid , Vol. 0, No. 0.


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Home Ventilation in South African Children: Do Socioeconomic Factors Matter?

Pediatric Allergy, Immunology, and Pulmonology , Vol. 0, No. 0.


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Home Ventilation in South African Children: Do Socioeconomic Factors Matter?

Pediatric Allergy, Immunology, and Pulmonology , Vol. 0, No. 0.


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Dermoscopy prior to Mohs Micrographic surgery does not improve tumour margin assessment and lead to fewer Mohs stages

Abstract

Dermoscopy prior to Mohs Micrographic surgery does not improve tumour margin assessment for basal cell carcinoma of the head and neck and lead to fewer Mohs stages Mohs micrographic surgery (MMS) is a time consuming and expensive gold standard treatment for difficult to treat basal cell carcinoma (BCC). One factor that contributes significantly to the expense and duration is the number of stages required to obtain clear excision margins.

This article is protected by copyright. All rights reserved.



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Implantation of a Multifocal Toric Intraocular Lens after Radial Keratotomy and Cross-Linking with Hyperopia and Astigmatism Residues: A Case Report

Radial keratotomy is a refractive surgical technique, widely used in the 80s and early 90s to correct myopia and astigmatism, but now overcome by more recent laser techniques. Important consequences, often in patients with more than 45 years of age, are progressive hyperopic shift and/or an increase in corneal astigmatism, whose main cause seems to be an increase in the curvature radius of the central portion of the cornea. This seems to be due to radial keratotomy incisions – with the consequent need for cross-linking – intraocular pressure, and corneal biomechanical parameters. The authors propose phacoemulsification with a customized multifocal toric intraocular lens implantation to correct the induced shift and hyperopic astigmatism. A decent postoperative visual acuity was observed with good patient satisfaction. A specific protocol must be applied to optimize the correct diagnosis, presurgical evaluation and postsurgical outcomes that are to be maintained over time, without regressions.
Case Rep Ophthalmol 2017;8:440–445

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Correction: Primary malignant melanoma of the cervix: a rare disease

Julião I, Carvalho SD, Patricio V, Raimundo A. Primary malignant melanoma of the cervix: a rare disease. BMJ Case Rep. Published Online: 21 Apr 2017. doi:10.1136/bcr-2017-219361

The following 'Acknowledgements' section should have been included at the end of the article:

We would like to acknowledge:

Amália Pacheco, head of Cervical Pathology Unit at Centro Hospitalar do Algarve

José Luiz Henriques, head of the Pathology Department at Centro Hospitalar do Algarve

Juliana Rocha, Gynecology resident

Joana Loureiro, Pathology consultant at Instituto Português de Oncologia do Porto



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Disseminated Pseudomonas aeruginosa sepsis as presenting diagnosis of X-linked agammaglobulinaemia in a previously well 16-month-old child

We report a previously healthy 16-month-old child who presented to us with membranous pharyngitis and ecthyma gangrenosum. In this patient, Pseudomonas aeruginosa was isolated from throat swab, cerebrospinal fluid, skin swab, urine, blood and synovial fluid in a single admission. In further workup, this child was diagnosed as a case of X-linked agammaglobulinaemia. The child was treated successfully with antipseudomonal antibiotics for 6 weeks and intravenous immunoglobulin.



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Cysticercosis of the eyelid

Description

A 26-year-old male patient complained of well-defined cystic swelling on the conjunctival aspect of his left lower eyelid for the past 2 months. His medical history was not significant. Visual acuity was 20/20 in each eye with unremarkable anterior and posterior segments, without any extraocular movement restriction. Examination of the left lower lid on its conjunctival aspect revealed a well-defined cystic lesion with soft to firm in consistency and it was completely preseptal (figure 1A). A complete excision biopsy was performed under local anaesthesia. Histopathology showed a multilayered cyst with minimal surrounding fluid around the invaginated scolex (figure 1B, Yellow  arrow), four visible eccentric suckers (red arrow) and near central double layered hooklets (green  arrow) suggestive of cysticercosis of the eyelid. Non-contrast enhanced CT of the brain and orbit did not reveal any additional foci of infection. The patient was prescribed oral prednisolone 1 mg/kg tapered over...



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Evolution of gender representation among Canadian OTL-HNS residents: a 27-year analysis

Abstract

Background

The proportion of females enrolling into medical schools has been growing steadily. However, the representation of female residents among individual specialties has shown considerable variation. The purpose of this study was to compare the trends of gender representation in Otolaryngology – Head and Neck Surgery (OTL-HNS) residency programs with other specialty training programs in Canada. In order to contextualize these findings, a second phase of analysis examined the success rate of applicants of different genders to OTL-HNS residency programs.

Method

Anonymized data were obtained from the Canadian Residency Matching Service (CaRMS) and from the Canadian Post-M.D. Education Registry (CAPER) from 1988 to 2014. The differences in gender growth rates were compared to other subspecialty programs of varying size. Descriptive analysis was used to examine gender representation among OTL-HNS residents across years, and to compare these trends with other specialties. Bayesian hierarchical models were fit to analyze the growth in program rates in OTL-HNS based on gender.

Results

CaRMS and CAPER data over a 27 year period demonstrated that OTL-HNS has doubled its female representation from 20% to 40% between 1990 and 1994 and 2010-2014. The difference in annual growth rate of female representation versus male representation in OTL-HNS over this time period was 2.7%, which was similar to other large specialty programs and surgical subspecialties. There was parity in success rates of female and male candidates ranking OTL-HNS as their first choice specialty for most years.

Conclusions

Female representation in Canadian OTL-HNS residency programs is steadily increasing over the last 27 years. Large variation in female applicant acceptance rates was observed across Canadian universities, possibly attributable to differences in student body or applicant demographics. Factors influencing female medical student career selection to OTL-HNS require further study to mitigate disparities in gender representation and identify barriers to prospective female OTL-HNS applicants.



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Expressing Personalized Tumor Antigens Study

Conditions:   Colon Cancer Metastatic;   Head and Neck Cancer Metastatic;   Metastatic Non-Small Cell Lung Cancer
Intervention:   Biological: ADXS-NEO
Sponsors:   Advaxis, Inc.;   Amgen
Not yet recruiting - verified August 2017

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Contribution of the ENT (Ear, Nose, and Throat) Surgeon's Clinical Evaluation to the Contouring of Target Volumes and Organs Eligible for Radiotherapy in Head and Neck Cancers

Conditions:   Radiotherapy, Conformal (IMRT);   Head and Neck Cancer;   Otolaryngology;   Surgeons;   Radiation Oncologists
Intervention:   Other: Systematic consideration of the advice of the ENT surgeon in the determination of the radiotherapy target volumes in head and neck cancers.
Sponsor:   Fondation Ophtalmologique Adolphe de Rothschild
Not yet recruiting - verified July 2017

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Evaluation of Video Laryngoscopy in Patients With Head and Neck Pathology

Condition:   Difficult Intubation
Intervention:   Device: Indirect Laryngoscopy
Sponsor:   Icahn School of Medicine at Mount Sinai
Recruiting - verified August 2017

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Familial Investigations of Childhood Cancer Predisposition

Conditions:   Acute Leukemia;   Adenomatous Polyposis;   Adrenocortical Carcinoma;   AML;   BAP1 Tumor Predisposition Syndrome;   Carney Complex;   Choroid Plexus Carcinoma;   Constitutional Mismatch Repair Deficiency Syndrome;   Diamond-Blackfan Anemia;   DICER1 Syndrome;   Dyskeratosis Congenita;   Emberger Syndrome;   Familial Acute Myeloid Leukaemia;   Familial Adenomatous Polyposis;   Fanconi Anemia;   Familial Cancer;   Familial Wilms Tumor;   Familial Neuroblastoma;   GIST;   Hereditary Breast and Ovarian Cancer;   Hereditary Paraganglioma-Pheochromocytoma Syndrome;   Hodgkin Lymphoma;   Juvenile Polyposis;   Li-Fraumeni Syndrome;   Lynch Syndrome;   MDS;   Melanoma Syndrome;   Multiple Endocrine Neoplasia Type 1;   Multiple Endocrine Neoplasia Type 2;   Neuroblastoma;   Neurofibromatosis Type 1;   Neurofibromatosis Type II;   Nevoid Basal Cell Carcinoma Syndrome;   Non Hodgkin Lymphoma;   Noonan Syndrome and Other Rasopathy;   Overgrowth Syndromes;   Pancreatic Cancer;   Peutz-Jeghers Syndrome;   Pheochromocytoma/Paraganglioma;   PTEN Hamartoma Tumor Syndrome;   Retinoblastoma;   Rhabdoid Tumor Predisposition Syndrome;   Rhabdomyosarcoma;   Rothmund-Thomson Syndrome;   Tuberous Sclerosis;   Von Hippel-Lindau Disease
Intervention:  
Sponsor:   St. Jude Children's Research Hospital
Recruiting - verified August 2017

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Bullous systemic lupus erythematosus in a 6-year-old boy

Abstract

Bullous systemic lupus erythematosus (BSLE) is a rare subepidermal blistering disorder characterized by an acute vesiculobullous eruption in a subset of individuals with systemic lupus erythematosus. BSLE most commonly affects young women and only rarely affects children. Herein we report a rare case of BSLE in a 6-year-old boy.



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Median canaliform dystrophy of Heller after cryotherapy

Abstract

Cryotherapy, widely used in the treatment of common warts, can cause long-term side effects when used in the treatment of warts near the nail bed. Here we present the case of a 11-year-old girl who developed canaliform dystrophy and long-term hypopigmentation following cryotherapy of warts on the proximal nail folds.



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Immunologic properties and therapeutic efficacy of a multivalent epitope-based vaccine against four Helicobacter pylori adhesins (urease, Lpp20, HpaA, and CagL) in Mongolian gerbils

Abstract

Background

Therapeutic vaccination is a desirable alternative for controlling Helicobacter pylori (H. pylori) infection. Attachment to the gastric mucosa is the first step in establishing bacterial colonization, and adhesins, which are on the surface of H. pylori, play a pivotal role in binding to human gastric mucosa.

Materials and Methods

In the present study, we constructed a multivalent epitope-based vaccine named CFAdE with seven carefully selected antigenic fragments from four H. pylori adhesins (urease, Lpp20, HpaA and CagL). The specificity, immunogenicity and ability to produce neutralizing antibodies of CFAdE were evaluated in BALB/c mice. After that, its therapeutic efficacy and protective immune mechanisms were explored in H. pylori-infected Mongolian gerbils.

Results

The results indicated that CFAdE could induce comparatively high levels of specific antibodies against urease, Lpp20, HpaA and CagL. Additionally, oral therapeutic immunization with CFAdE plus polysaccharide adjuvant (PA) significantly decreased H. pylori colonization compared with oral immunization with urease plus PA, and the protection was correlated with IgG and sIgA antibody and antigen-specific CD4+ T cells.

Conclusions

This study indicated that the multivalent epitope-based vaccine, which targeted multiple adhesins in adherence of H. pylori to the gastric mucosa, is more effective than the univalent vaccine targeting urease only. This multivalent epitope-based vaccine may be a promising therapeutic candidate vaccine against H. pylori infection.



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A nationwide registry-based cohort study of incidence of tonsillectomy in Denmark, 1991-2012

Abstract

Objective

To update tonsillectomy incidence rates in Denmark and identify whether the incidence rates vary between geographical areas in the country during the period 1991-2012.

Design

This was a retrospective nationwide cohort study using data from the comprehensive Danish patient registries. Data included surgical code, gender and date of birth, date and place of surgery.

Setting

Hospitals and private oto-, rhino-, laryngology (ORL) offices.

Participants

Danes who underwent tonsillectomy in the period 1991-2012.

Main outcome measure

Tonsillectomy.

Results

In the 22-year period 177,211 tonsillectomies were conducted, and the overall incidence of tonsillectomy decreased significantly over time. The overall annual incidence of tonsillectomies decreased from 155.7 per 100,000 inhabitants in 1991 to 129.4 per 100,000 inhabitants in 2012. In 1991 5.5% of tonsillectomies were performed in office settings, while in 2012 it had increased to 26.6% (p<0.01). The highest incidence of tonsillectomy was found in children between 3-4 years of age (predominance of males, p<0.01) and in 15-19 year-olds (predominance of females, p<0.01). Each year 0.44% of children underwent tonsillectomy, and by the age of 20, 7.7% of the Danish people has had a tonsillectomy. There were significant regional differences in the number of tonsillectomies.

Conclusion

The incidence rate of tonsillectomies in Denmark decreased significantly in the study period, but with great regional variance.

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Botulinum toxin in management of synkinesis in patients with unilateral and bilateral vocal fold paralysis



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Basal cell carcinoma of the temporal bone and external auditory canal

Objectives/Hypothesis

To review the presenting features, treatment, and outcomes for patients with basal cell carcinoma (BCC) involving the temporal bone or external auditory canal (EAC).

Study Design

Retrospective case series.

Methods

Presenting characteristics, treatment strategies, and outcomes for patients with BCC involving the temporal bone or EAC were reviewed. Main outcome measures included rates of overall and disease-free survival at 5 years.

Results

Forty-two patients met the inclusion criteria (mean age, 67 years). The most common presenting symptoms were hearing loss (15 patients, 36%) and otorrhea (11 patients, 26%). The 5-year overall survival rate was 78%, and the 5-year disease-free survival rate was 77%. Patients who had undergone surgery elsewhere and presented with facial weakness had significantly worse overall survival (P = .004). Ten patients (24%) underwent sacrifice of at least a portion of the facial nerve at the time of their initial procedure at our institution. Two patients (5%) developed regional nodal disease. There was a trend toward better disease-free survival for patients who received adjuvant radiation therapy after surgery at our institution (P = .06).

Conclusions

BCC originating from or extending to the temporal bone can exhibit a wide range of behavior, ranging from superficial lesions readily managed with surgery to extensive locally invasive tumors with propensity for recurrence, treated with multimodality therapy. BCC may be associated with better prognosis than other temporal bone malignancies.

Level of Evidence

4. Laryngoscope, 2017



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Minimally elevated preoperative parathyroid hormone level influences the management of primary hyperparathyroidism

Objectives/Hypothesis

To determine the effect of preoperative parathyroid hormone (PTH) level on the extent of surgery and the accuracy of parathyroid imaging in primary hyperparathyroidism.

Study Design

Retrospective cohort.

Methods

Final diagnosis of single-gland adenoma and its location versus multigland disease was established in this retrospective cohort study. Positive predictive value, negative predictive value, and accuracy of imaging were analyzed in relation to preoperative PTH levels.

Results

Eighty-seven percent of the 218 patients enrolled in the study underwent unilateral targeted operation and had a 97.9% (95% confidence interval: 95.8%–100%) success rate. However, in patients with PTH <65 pg/mL, 28.6% had bilateral exploration compared to 10.3% in those with PTH ≥65 pg/mL (P = .042). In patients with PTH <65 pg/mL, 7/21 (33.3%) had inaccurate sestamibi findings compared to 24/174 (13.8%) in patients with PTH ≥65 pg/mL (P = .047).

Conclusions

Accuracy of sestamibi drops significantly, by threefold, in patients with mild primary hyperparathyroidism and PTH <65 pg/mL. Patients with PTH < 65 pg/mL have a 2.5-fold higher rate of bilateral operation to identify the hypersecreting gland(s) compared to patients with PTH ≥65 pg/mL.

Level of Evidence

4. Laryngoscope, 2017



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A randomized controlled trial of corticosteroids for pain after transoral robotic surgery

Objective

To determine if an extended perioperative course of corticosteroids will improve pain control following transoral robotic surgery (TORS).

Study Design

Randomized, double-blind, placebo-controlled trial.

Methods

Patients undergoing TORS for initial treatment of oropharyngeal squamous cell carcinoma received a single intraoperative dose of 10-mg dexamethasone and then were randomized to receive 8-mg dexamethasone every 8 hours, or placebo, for up to 4 days after surgery. Pain, measured by visual analog scale (VAS), was the primary outcome measure. Secondary outcome measures included length of stay, dysphagia assessments, and complications.

Results

VAS pain scores were similar between steroid and placebo cohorts on postoperative day (POD) 1, 2, and 7 through 21, although they significantly improved in the steroid cohort on POD 3. The steroid cohort also demonstrated a decreased hospital length of stay (median 1 day) and improvement in diet consistency, as measured by the performance status scale on POD 7 through 21. There was no difference in complications between the steroid and placebo cohorts.

Conclusion

Extended perioperative corticosteroids after TORS is safe and may allow earlier improvement in diet consistency and decreased length of hospital stay, although postoperative pain appears minimally affected.

Level of Evidence

1b. Laryngoscope, 2017



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Risk factors for thirty-day readmission following flap reconstruction of oncologic defects of the head and neck

Objectives

Unplanned 30-day readmission rate following hospital discharge is an important metric of healthcare quality. This study sought to characterize the rate, risk factors, and common causes of readmission in head and neck cancer patients following free or pedicled flap reconstruction.

Study Design

Retrospective cohort study.

Methods

Charts were reviewed of all patients who underwent free or pedicled flap reconstruction following resection of head and neck cancer at the Massachusetts Eye and Ear Infirmary 2009 to 2014. Readmission risk factors were evaluated by univariate and multivariate analysis.

Results

Of 682 patients with free (76%) or pedicled flap reconstruction, 135 patients (19.8%) were readmitted. Factors not associated with readmission included age, gender, American Society of Anesthesiologists status, operative time, prior radiation therapy, primary cancer site, and free (vs. pedicled) flap type. Significant readmission risk factors included surgical site infections (SSI) (45.2% vs. 9.9%), use of hardware (18.5% vs. 11.3%), and clean–contaminated or contaminated surgery (15.2% vs. clean 8.2%). Surgical site infections (P < 0.001) and use of hardware (P = 0.03) remained predictive of readmission on multiple regression analysis. Primary reasons for readmission included wound complications (61.5%) and supportive care (15.6%). The median time to readmission was 8 days, and 41% of readmissions occurred within 1 week. Seventy percent of readmissions occurred within 2 weeks, including 77% of readmissions for SSIs and 86% for supportive care.

Conclusion

Readmissions occurred in nearly one-fifth of patients following flap surgery. SSIs and use of hardware were risk factors, whereas wound complications were the most common cause of readmission.

Level of Evidence

4. Laryngoscope, 2017



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A population-based analysis of verrucous carcinoma of the oral cavity

Objectives

To describe the incidence and determinants of survival of patients with verrucous carcinoma (VC) of the oral cavity between the years of 1973 and 2012 using the Surveillance, Epidemiology, and End Results (SEER) database.

Study Design

Retrospective cohort study using a national database.

Methods

The SEER registry was utilized to calculate survival trends for patients with VC of the oral cavity between 1973 and 2012. Patient data was then analyzed with respect to histopathology, age, sex, race, stage, grade, and treatment modalities (surgery and radiation therapy). Overall survival (OS) and disease-specific survival (DSS) were calculated.

Results

A total of 1,481 cases of VC of the oral cavity were identified. The cohort was composed of 50.5% males. The mean age at diagnosis was 69.5 years. The oral tongue was the most common primary site (28.9%), followed by the alveolar ridge (21.4%) and buccal mucosa (19.0%). The vast majority of cases (79.1%) presented with stage I and stage II disease. Nodal disease was present in only 1.6% of cases. The median OS was 94.6 months. Eighty-seven percent of cases underwent surgery, and 11.5% received both surgery and radiation therapy. Overall survival at 2, 5, and 10 years was 83%, 64%, and 42%, respectively. On multivariate analysis, advanced age (P < 0.001) and stage (P < 0.001) were associated with worse OS, whereas surgery improved OS (P = 0.047).

Conclusion

We provide the first population-based analysis of prognostic factors affecting survival outcomes in patients with oral cavity VC. Verrucous carcinoma of the oral cavity is associated with a generally favorable prognosis. Age, stage, nodal status, and surgical therapy are independent predictors of OS.

Level of Evidence

4. Laryngoscope, 2017



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A longitudinal simulation-based ethical–legal curriculum for otolaryngology residents

Objective

To develop, implement, and evaluate a longitudinal, simulation-based ethics and legal curriculum designed specifically for otolaryngology residents.

Methods

Otolaryngology residents were recruited to participate in a yearly half-day ethical–legal module, the curriculum of which spanned 4 years. Each module included: three simulated scenarios, small-group multisource feedback, and large-group debriefings. Scenarios involved encounters with standardized patients. Residents' ethical–legal knowledge was assessed pre- and postmodule with multiple-choice questions, and ethical reasoning was assessed by a variety of evaluators during the simulated scenario using a locally developed assessment tool. Participants completed an exit survey at the end of each module.

Results

Eighteen residents completed four modules from the academic years of 2008 to 2009 to 2011 to 2012. The first year was considered a pilot module, and data were collected for the following 3 years. Knowledge of legal issues improved significantly among residents (mean at pre = 3.40 and post = 4.60, P < 0.05). Residents' ethical reasoning skills also improved across years (mean 3.60/5 in 2009–2010, 3.76/5 in 2010–2011, and 4.33 in 2011–2012, P < 0.05). Survey results revealed a statistically significant self-perceived improvement in ethics reasoning skills (mean pre = 3.62, post = 4.86, P < 0.05). Participants reported that the curriculum was relevant to their practice (85%), that the debriefings were of high quality (83%), and that they would recommend this module to others (88%).

Conclusion

To our knowledge, this is the first study exploring a longitudinal simulation-based ethical–legal curriculum tailored to otolaryngology–head and neck surgery residents. This educational program resulted in a both objective and subjective improvement in legal and ethics knowledge and skills.

Level of Evidence

NA. Laryngoscope, 2017



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Identifying gaps in consumer knowledge about sunscreen

To the Editor: In June 2011, the US Food and Drug Administration updated regulations to emphasize the importance of both ultraviolet A (UVA) and ultraviolet B (UVB) protection, allowing only sunscreens that sufficiently protected against both to be designated as broad-spectrum.1 However, a study of patients seen in a single academic dermatology clinic found current sunscreen labels to be poorly understood.2 The purpose of this study is to further assess sunscreen knowledge, use, and purchasing practices among adults nationwide and to evaluate an alternative sunscreen labeling method.

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A meta-analysis of nevus-associated melanoma: Prevalence and practical implications

The reported prevalence of nevus-associated melanoma varies substantially. We performed a systematic review and meta-analysis to determine the incidence and prevalence of this disease; we also performed subanalyses considering age, tumor thickness, and nevus-type classification. In 38 observational cohort and case–control studies, 29.1% of melanomas likely arose from a preexisting nevus and 70.9% de novo. Any given melanoma was 64% less likely to be nevus-associated than de novo (risk ratio 0.36, 95% confidence interval [CI] 0.29-0.44; P < .001; I2 = 99%); nevus-associated melanomas had a lower mean Breslow thickness than de novo melanomas (mean difference –0.39 mm; 95% CI –0.60 to –0.18; P = .0003; I2 = 66%).

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The Role of β-blockers in Dermatological Treatment: A Review

Abstract

Many systemic medications have been used off-label in cutaneous diseases. Use of β-adrenergic blocking agents has risen in popularity among dermatologists since the discovery of their efficacy in treating infantile hemangioma. There has also been an increase in the interest of the applications of β-blockers in other skin disorders. Overall, β-blockers are effective in treating diseases of vascular origin and promote wound healing. They are relatively safe and inexpensive medications that could be included in the armamentarium against skin diseases.

This article is protected by copyright. All rights reserved.



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Skin Findings of 21st Century Movie Characters

Abstract

In a recent article "Dermatologic Features of Classic Movie Villains", the authors found that dermatological findings, such as alopecia and scars, are associated with villainous characters in movies1. Their work suggested that dermatological diseases are used as convenient cues to imply the internal moral degeneracy of movie villains. There is a concern that such depiction of dermatological diseases in movies may facilitate the prejudice against dermatological diseases. However, the study is based on the "AFI's top 100 movie heroes and villains of all time" list, which contains only one movie released in the 21st century.

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Teledermoscopy images acquired in primary health care and hospital settings - a comparative study of image quality

Abstract

Background

The incidence of melanoma and non-melanoma skin cancer is increasing, which has also lead to an increase in referrals between primary health care (PHC) and dermatology departments, putting a strain on health care services. Teledermoscopy (TDS) referrals from PHC can improve the triage process for patients with suspicious skin tumours, but the quality of the images included could potentially affect its usefulness.

Objective

To critically appraise the quality of the dermoscopic images of a smartphone TDS system, by comparing the TDS referral images with images of the same tumours acquired at the department of dermatology.

Methods

Two dermatologists rated the image quality of two image sets from 172 skin tumours separately. The dermatologists also decided on a main diagnosis, differential diagnoses and described the visible dermoscopic structures.

Results

The images acquired in PHC were rated as having slightly lower quality but there was no significant difference. PHC images and dermatology images were of intermediate to high quality in 95.5-97.7% and 96.5-98.8%, respectively. There was no difference in agreement between the TDS diagnosis based on the two image sets with the final clinical or histopathological diagnosis. Most image pairs (81.4% and 83.7%) received the same main diagnosis by the two evaluators. When this was not the case, the most common reasons were: poor focus, excessive pressure applied when acquiring the image or inadequate amount of zoom.

Conclusion

TDS performed in PHC with a smartphone-based system does not seem to negatively affect the usefulness of TDS referrals. Thus, physicians at PHC do not necessarily need to be trained photographers to ensure adequate TDS image quality. Knowledge about technical difficulties could however be used when training PHC staff, in order to improve the image quality further.

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Rupioid lesions, PLEVA and superposition phenomenon in malignant syphilis: two case reports in HIV- infected patients

Abstract

We present two case reports in HIV-infected patients exhibiting unusual manifestations with rupioid lesions, pityriasis lichenoides et varioliformis acuta (PLEVA) and superposition phenomenon opening differential diagnoses for many other diseases that differs on treatment from syphilis.

Case 1: A 42-year-old male patient, HIV diagnosed at 31, in irregular antiretroviral therapy (ART), reported skin lesions, fever, myalgia, and headache for two months. Physical examination demonstrated submandibular lymphadenomegaly, hepatomegaly, infiltrated papules and erythematous plaques, rupioid lesions, some with ulcers and central necrosis over the face, trunk and body extremities, including palmoplantar regions, oral and genital mucosa (Fig. 1).

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Pyogenic granuloma of the penis following chancre

Abstract

Pyogenic granuloma (PG) is a common, acquired, benign vascular lesion of the skin and mucous membranes that can develop both spontaneously and traumatically. The lesion is usually solitary and rapidly growing and bleed easily, often occurring at the site of minor trauma of the skin. It most typically occurs on the exposed skin surfaces such as the hands (especially the fingers and forearms), the feet, face, oral mucosa but it has been rarely reported on the anogenital region (1).

A 44-year-old "men having sex with men" (MSM) patient presented to our Department with two weeks duration of painless ulcerations on the coronary sulcus and shaft of the penis with unilateral inguinal lymphadenopathy (Fig. 1).

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Demystifying a thickened and calcified gall bladder in the era of multimodality imaging

Description

A 74-year-old woman presented with a 6-month history of significant postprandial nausea and mild abdominal discomfort. She was fit and well with a surgical history of appendicectomy.

Routine blood tests including full blood examination and liver biochemistry were normal. Ultrasonography (US) demonstrated a thickened and calcified gall bladder. This was also confirmed on CT which showed concentric thickening and calcification of the gall bladder wall that was equivocal for an underlying malignancy associated with a large gallstone (figure 1).

Figure 1

CT in the (A) axial and (B) coronal sections show concentric thickening of the gall bladder wall with minor calcifications associated with cholelithiasis (indicated by the white arrow).

Interestingly, further imaging by MRI demonstrated an unexpected but definitive diagnosis of an 8 cm gallstone within a thin-walled gall bladder (figure 2). Based on the above investigations, an underlying malignant process was considered...



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Delayed extrusion of embolic coils into the airway after embolization of an external carotid artery pseudoaneurysm

Carotid blowout syndrome (CBS) is a known devastating complication of head and neck surgery. The risk of developing CBS increases in the setting of radiation therapy, wound breakdown, or tumor recurrence. Traditionally, the treatment of choice for CBS is surgical ligation of the bleeding artery; however, recently, endovascular occlusion has become a more common option. If a pseudoaneurysm is present, treatment consists of trapping with endovascular coils or occlusion with a liquid embolic agent. Delayed migration of embolization coils into the airway causing acute respiratory distress is a rare occurrence. This report presents a case of a 57-year-old woman who presented to her otolaryngologist after experiencing an episode of acute respiratory distress which resolved when she expectorated embolization coil material from her tracheostomy tube. Three months prior to the episode she underwent coil embolization of an external carotid artery pseudoaneurysm for life-threatening hemorrhage.



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Challenges in the implementation of the EAACI AIT guidelines: A situational analysis of current provision of allergen immunotherapy

Abstract

Purpose

The European Academy of Allergy and Clinical Immunology (EAACI) has produced Guidelines on Allergen Immunotherapy (AIT). We sought to gauge the preparedness of primary care to participate in the delivery of AIT in Europe.

Methods

We undertook a mixed-methods, situational analysis. This involved a purposeful literature search, and two surveys: one to primary care clinicians and the other to a wider group of stakeholders across Europe.

Results

The 10 papers identified all pointed out gaps or deficiencies in allergy care provision in primary care. The surveys also highlighted similar concerns, particularly in relation to concerns about lack of knowledge, skills, infrastructural weaknesses, reimbursement policies and communication with specialists as barriers to evidence-based care. Almost all countries (92%) reported the availability of AIT. In spite of that, only 28% and 44% of the countries reported the availability of guidelines for primary care physicians and specialists, respectively. Agreed pathways between specialists and primary care physicians were reported as existing in 32-48% of countries. Reimbursement appeared to be an important barrier as AIT was only fully reimbursed in 32% of countries. Additionally, 44% of respondents considered accessibility to AIT and 36% stating patient costs were barriers.

Conclusions

Successful working with primary care providers is essential to scaling-up AIT provision in Europe, but to achieve this the identified barriers must be overcome. Development of primary care interpretation of guidelines to aid patient selection, establishment of disease management pathways and collaboration with specialist groups are required as a matter of urgency.

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Erratum to: The Burden of Chronic Urticaria from Brazilian Patients’ Perspective



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Simulating the life course of psoriasis patients: The interplay between therapy intervention and marital status

Abstract

Background

psoriasis, a chronic relapsing inflammatory disease affecting primarily the skin, shows multiple comorbidities including depression, cardiovascular diseases and other relevant conditions. Psoriasis patients experience social isolation, job loss, financial difficulties, and partnership problems. Inversely, psychosocial impairments may negatively influence the disease course.

Objective

To explore the feasibility of a model describing the interaction of psychosocial and clinical factors over the life course of patients.

Methods

we considered only seven states for members of a hypothetical population: single and healthy, single and having a psoriasis flare, single and "cured", coupled and healthy, coupled and having a psoriasis flare, coupled and "cured", and dead. Transition probabilities between states were taken from the Norwegian Population Register for the healthy population and from epidemiological research articles. Clinical experience allowed adjustments on the assumed parameters.

Results

Our macro-model, which simulates the effect of therapy intervention on patients' partnership status, yields a description of the transitions between the seven states. Treatment efficacy shows only a negligible effect on the chances of living with a partner.

Conclusions

Mathematical modelling of interactions between social and health variables is in principle feasible. However complex models, comprising more variables (for instance: employment status, depression level, obesity etc.) are needed for more realistic simulations for the interactions studied. Since increasing the number of variables leads to an exponential increase of the model's state space, switching to micro-modelling (representing each individual separately) may be necessary.

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Nail Apparatus Melanoma: dermoscopic and histopathologic correlations on a series of 23 patients from a single center

Abstract

Background

Nail apparatus melanoma is an uncommon tumor and there are few studies focused on its dermoscopic features.

Objective

the aims of our study was to evaluate the diagnostic accuracy of dermoscopy in nail apparatus melanoma. A diagnostic algorithm for adult patients with suspected nail apparatus melanoma is proposed.

Methods

We collected nail apparatus melanoma dermoscopic images of patients with a proven histopathology from 2008 until 2015. Clinical and dermoscopic images were blindly examined by 2 dermatologists and correlations between histopathological aspects and dermoscopic features were investigated.

Results

We retrospectively collected nail apparatus melanoma dermoscopic images associated to a proven histopathology of 23 Caucasian patients. Only cases with available both pre-operative dermoscopic images and bioptic specimens were included. 17 women and 6 men were included. The mean age at diagnosis was 63 years (range 18–92).

Conclusion

we created an algorithm to indicate the correct way to follow an adult patient with suspected nail apparatus melanoma. This algorithm may ameliorate management in case of suspected nail apparatus melanoma and possibly facilitate an early diagnosis.

This article is protected by copyright. All rights reserved.



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