Future Horizons in Allergy

There are several advances in diagnosis and management for the otolaryngologist treating allergy. These include new technologies and the refinement of current techniques, and reflect overall trends in health care toward personalized medicine. Local immunoglobulin, urinary leukotriene E4, lipidomics, microRNA within extracellular vesicles, and optical rhinometry all offer to improve the diagnostic accuracy of allergy and related nonallergic conditions. New delivery systems for intranasal steroids and antihistamines, recombinant allergens, advances in allergen immunotherapy delivery, and biologics will improve current management options. These developments will aid the otolaryngologist in diagnosing and treating allergy and related diseases.

http://ift.tt/2z53vMf

The Role of Allergy in Otologic Disease

Allergy is commonly associated with conditions such as rhinitis, sinusitis, and asthma, but the relationship between allergy and otologic diseases is less clear. This article examines the evidence for a relationship between allergic disease and several common otologic conditions, including otitis media with effusion, eosinophilic otitis media, and Ménière's disease.

http://ift.tt/2y0J2KO

Poor early response to methotrexate portends inadequate long-term outcomes in patients with moderate-to-severe psoriasis: Evidence from 2 phase 3 clinical trials

Most methotrexate-treated psoriasis patients do not achieve a long-term PASI75 (75% reduction from baseline Psoriasis Area and Severity Index score) response. Indications of nonresponse can be apparent after only 4 weeks of treatment.

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The Wood’s Lamp as a Tool in the Evaluation of Morphea

http://ift.tt/2gjpAPH

Promoting sunscreen use and sun-protective practices in NCAA athletes: Impact of SUNSPORT educational intervention for student-athletes, athletic trainers, and coaches

Student-athletes (SAs) have an increased skin cancer risk on account of significant ultraviolet exposure; however, their sun-protective practices are suboptimal. A novel program, Stanford University Network for Sun Protection, Outreach, Research, and Teamwork (SUNSPORT), was designed to target SAs, coaches, and athletic trainers (ATs).

http://ift.tt/2fYqCUa

Epidemiology of Hyperhidrosis in Two Population-Based Healthcare Databases

Hyperhidrosis has a range of reported prevalence estimates with the most often cited equal to 2.8%.We describe methods using a combination of diagnosis, symptom, and prescription codes from healthcare databases to ascertain hyperhidrosis cases.This study estimates population prevalences of 1% - 1.6% for patients seeking healthcare for hyperhidrosis.

http://ift.tt/2y5OLOR

Adalimumab for nail psoriasis: Efficacy and safety from the first 26 weeks of a phase 3, randomized, placebo-controlled trial

Previous clinical trials have not evaluated improvement in nail psoriasis as a primary end point.

http://ift.tt/2yOeM2N

Diagnosis and management of diaper dermatitis in infants with emphasis on skin microbiota in the diaper area

Abstract

Diaper dermatitis is the most common inflammatory skin eruption within the diaper area in infants and toddlers. Although it rarely causes problems for prolonged periods of time, it causes considerable distress for both infants and parents. Diapered skin is exposed to friction, excessive hydration, varying pH, and is in constant contact with urine and feces, both of which are highly irritant to the skin. The three most common types of diaper dermatitis include chaffing dermatitis, irritant contact dermatitis, and diaper candidiasis. However, a variety of other skin conditions may manifest in the diaper area. Candida albicans and Staphylococcus aureus are most frequently isolated from the affected area and are thought to have a predominant role in diaper dermatitis. The review includes an overview of the epidemiology, etiology, and common skin microbiota in the diaper area. State-of-the-art strategies for diagnosis, management, and prevention of diaper dermatitis are also included. Appropriate skin care can help in the prevention of diaper dermatitis and can aid the reparation of the skin. This review discusses common causes, skin microbiota within the diapered area, differential diagnosis, and finally possible prevention and treatment recommendations. Recent findings have proven that the key to efficient eradication of irritant diaper dermatitis lies in its prevention.

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Comparative Study of Head and Neck Mucosal Melanoma in 66 patients vs. 226 patients with Cutaneous Melanoma: A survival analysis

Abstract

Sixty-six patients (22%) had HNMM and 226 (78%) HNCM and the higher prevalence was seen in females with a similar distribution amongst the two diagnoses (p=0.8).

Symptoms were present in all patients with HNCM and in only 15% of patients with HNMM (p=0.000).

Lymph node involvement at diagnosis was present in 51% of HNMM vs. 33% of HNCM (p=0.007) and were bilateral in 44% of HNMM while in HNCM they were only ipsilateral (p=0.000).

Metastatic disease at diagnosis was similar in both groups (p=0.9).

Relapses were more frequent in the HNMM group in ~70% of the cases compared with 23% in HNCM group (p=0.000).

When comparing HNCM vs. HNMM, Overall Survival is similar, without statistical difference.

This article is protected by copyright. All rights reserved.

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Correction to: Breast cancer metastases to the thyroid gland - An uncommon sentinel for diffuse metastatic disease: A case report and literature review

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Cardiac cycle efficiency and dicrotic pressure variations: new parameters for fluid therapy: An observational study

BACKGROUND: During a fluid challenge, the changes in cardiac performance and peripheral circulatory tone are closely related to the position of the ventricle on the Frank–Starling curve. Some patients have a good haemodynamic response to a fluid challenge, others hardly any response. The early haemodynamic effects of a fluid challenge could predict the final response before the entire fluid volume has been administered. OBJECTIVE: To assess whether a multivariate logistic regression model, including pulse pressure variation (PPV), cardiac cycle efficiency (CCE), arterial elastance and the difference between the dicrotic pressure and both systolic and mean arterial pressure (SAP − Pdic and MAP − Pdic) can predict cardiac responsiveness early during a fluid challenge in comparison with the standard procedure described elsewhere. DESIGN: Observational study. SETTING: Elective surgical patients undergoing laparotomy, enrolled in two Italian University Hospitals. PATIENTS: Fifty adult surgical patients, ventilated with a lung protective strategy, were enrolled and data from 46 were analysed. INTERVENTIONS: A fluid challenge consisting of 500 ml of crystalloid infused over 10 min. MAIN OUTCOME MEASURES AND ANALYSIS: The changes in CCE, arterial elastance, SAP − Pdic and MAP − Pdic were compared using analysis of variance. A multivariate logistic regression analysis utilising baseline values and the first minute measuring a variation statistically significant for the considered variables. RESULTS: At baseline, PPV correctly identified 70% of patients (89% of non-responders; 42% of responders). The model, including baseline PPV, ΔCCE and ΔSAP − Pdic, correctly identified the efficiency of fluid challenge in 87% of patients (84.2% of responders; 92.5 of non-responders) after 5 min from fluid challenge infusion. CONCLUSION: In this pilot study conducted in a population of surgical patients mechanically ventilated with a VT less than 8 ml kg−1, a dynamic model of fluid challenge assessment, including PPV, ΔCCE and ΔSAP − Pdic, enhances the prediction of fluid challenge response after 5 min of a 10-min administration. TRIAL REGISTRATION: ACTRN12616001479493.

http://ift.tt/2y1D9KW

Continuous non-invasive haemodynamic monitoring: a beneficial impact on patient outcome is needed to gain ‘confidence in the technology’

No abstract available

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Reply to: comparing C-MAC videolaryngoscope with direct laryngoscopy for emergency intubation

No abstract available

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The impact of continuous non-invasive arterial blood pressure monitoring on blood pressure stability during general anaesthesia in orthopaedic patients: A randomised trial

BACKGROUND: In patients undergoing general anaesthesia, intraoperative hypotension occurs frequently and is associated with adverse outcomes such as postoperative acute kidney failure, myocardial infarction or stroke. A history of chronic hypertension renders patients more susceptible to a decrease in blood pressure (BP) after induction of general anaesthesia. As a patient's BP is generally monitored intermittently via an upper arm cuff, there may be a delay in the detection of hypotension by the anaesthetist. OBJECTIVE: The current study investigates whether the presence of continuous BP monitoring leads to improved BP stability. DESIGN: Randomised, controlled and single-centre study. PATIENTS: A total of 160 orthopaedic patients undergoing general anaesthesia with a history of chronic hypertension. INTERVENTION: The patients were randomised to either a study group (n = 77) that received continuous non-invasive BP monitoring in addition to oscillometric intermittent monitoring, or a control group (n = 83) whose BP was monitored intermittently only. The interval for oscillometric measurements in both groups was set to 3 min. After induction of general anaesthesia, oscillometric BP values of the two groups were compared for the first hour of the procedure. Anaesthetists were blinded to the purpose of the study. MAIN OUTCOME MEASURE: BP stability and hypotensive events. RESULTS: There was no difference in baseline BP between the groups. After adjustment for multiple testing, mean arterial BP in the study group was significantly higher than in the control group at 12 and 15 min. Mean ± SD for study and control group, respectively were: 12 min, 102 ± 24 vs. 90 ± 26 mmHg (P = 0.039) and 15 min, 102 ± 21 vs. 90 ± 23 mmHg (P = 0.023). Hypotensive readings below a mean pressure of 55 mmHg occurred more often in the control group (25 vs. 7, P = 0.047). CONCLUSION: Continuous monitoring contributes to BP stability in the studied population. TRIAL REGISTRATION: NCT02519101.

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Effects of dexamethasone on early cognitive decline after cardiac surgery: A randomised controlled trial

BACKGROUND: Postoperative cognitive decline (POCD), a very common complication after cardiac surgery, is characterised by impairment of both memory function and intellectual ability as well as being associated with increased use of healthcare resources. The investigators focused on the role of the inflammatory response to a surgical procedure as a potential factor involved in the pathogenesis of POCD. OBJECTIVE: The use of prophylactic dexamethasone to attenuate the inflammatory response was hypothesised to reduce the risk of POCD. DESIGN: Randomised controlled study. SETTING: Single university teaching hospital, from March 2015 to January 2016. PATIENTS: A total of 169 patients scheduled for elective cardiac surgery were enrolled, and 161 patients were included in the analyses. INTERVENTION: Patients were randomised to receive a single intravenous bolus of 0.1 mg kg−1 dexamethasone (n = 85) or placebo (n = 84) 10 h before the surgery. MAIN OUTCOME MEASURES: The primary outcome measure in both groups was the incidence of POCD on the 6th day after surgery. The investigators also evaluated the effect of dexamethasone on the incidence of systemic inflammatory response syndrome, postoperative C-reactive protein levels and postoperative serum S100β protein levels. RESULTS: Compared to the placebo group, the dexamethasone group showed statistically significant reductions in the incidence of POCD (relative risk, 0.43; 95% confidence interval, 0.21 to 0.89; P = 0.02), the incidence of systemic inflammatory response syndrome (30.0 versus 58.0%, P 

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Validation of radial artery-based uncalibrated pulse contour method (PulsioFlex) in critically ill patients: A observational study

BACKGROUND: Because of their simplicity, uncalibrated pulse contour (UPC) methods have been introduced into clinical practice in critical care but are often validated with a femoral arterial waveform. OBJECTIVE: We aimed to test the accuracy of cardiac index (CI) measurements and trending ability from a radial artery with one UPC. DESIGN: An observational study. SETTING: Tertiary care mixed-surgical ICU. Data were obtained from April 2015 to July 2016. PATIENTS: We studied 20 critically ill mechanically ventilated patients monitored by UPC (PulsioFlex; Pulsion Medical Systems SE, Feldkirchen, Germany). We used transpulmonary thermodilution (PiCCO2) as a reference. MAIN OUTCOME MEASURES: Bland–Altman-analyses with percentage errors were calculated to assess the accuracy of CI values from radial pulse contour analysis (CIRAD), autocalibration (CIAC) and femoral pulse contour analysis (CIFEM). All were compared with a reference (CITD) at 4-h intervals for 24 h. Trending ability was assessed by polar-plots and four-quadrant-plots. CI is given in l min−1 m−2. RESULTS: Bland–Altman-analyses: for CIRAD, the mean bias was −0.1 with limits of agreement (LOA) of −2.9 to 2.7 and a percentage error of 70%; for CIAC, the mean bias was 0 with LOA −2.8 to 2.7 and a percentage error of 70%; for CIFEM, the mean bias was 0 with LOA −1.2 to 1.2 and a percentage error of 30%, respectively. Polar plots for trending: for CIRAD, the angular bias was 12° with radial LOA of 39°, a polar concordance rate of 73% and a concordance rate of 67% in the four-quadrant-plot; for CIAC, the angular bias was 4° with radial LOA of 41°, polar concordance rate of 79% and a concordance rate of 74% in the four quadrant plot; for CIFEM, the angular bias was −2° with radial LOA of 50°, polar concordance rate of 74% and a concordance rate of 81%. CONCLUSION: In critically ill patients, the PulsioFlex system connected to a radial arterial catheter is inaccurate for CI measurements and does not track changes in CI adequately. We therefore recommend using validated thermodilution techniques for monitoring in the critical care setting.

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Re-evaluation of peri-operative cardiac risk (the MET REPAIR study): Study protocol of a prospective, multicentre cohort study sponsored by the European Society of Anaesthesiology

No abstract available

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The relative effects of dexmedetomidine and propofol on cerebral blood flow velocity and regional brain oxygenation: A randomised noninferiority trial

BACKGROUND: Dexmedetomidine constricts cerebral blood vessels without a concomitant reduction in cerebral metabolic oxygen consumption. Its safety as a sedative in patients with neurological diseases thus remains uncertain. OBJECTIVE: Our primary objective was to test the hypothesis that dexmedetomidine is noninferior to propofol as regards cerebral blood flow (CBF) velocity and brain oxygenation. DESIGN: Unblinded randomised trial. SETTING: Cleveland Clinic Hospital, Cleveland, from November 2010 to July 2013. PATIENTS: Forty-four patients scheduled for insertion of a deep-brain stimulating electrodes. INTERVENTIONS: Patients were randomised to receive either dexmedetomidine or propofol sedation during deep-brain stimulating electrode insertion. MAIN OUTCOME MEASURES: Intraoperative CBF velocity was measured with transcranial Doppler, and brain oxygenation was assessed with near-infrared spectroscopy. Noninferiority of dexmedetomidine to propofol was defined as a less than 20% difference in means. RESULTS: Twenty-three patients were given dexmedetomidine and 21 propofol. Baseline characteristics and operative management were similar in each group. Dexmedetomidine was noninferior to propofol on both CBF and brain oxygenation, confirming our primary hypothesis. For cerebral flood flow, the estimated ratio of means (dexmedetomidine/propofol) was 0.94 [90% CI: 0.84 to 1.05], P = 0.011 for noninferiority. For brain oxygenation, the estimated ratio of means was 0.99 [90% CI: 0.96 to 1.02], P 

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Sevoflurane attenuates systemic inflammation compared with propofol, but does not modulate neuro-inflammation: A laboratory rat study

BACKGROUND: Septic encephalopathy is believed to be a result of neuro-inflammation possibly triggered by endotoxins, such as lipopolysaccharides (LPS). Modulation of the immune system is a property of volatile anaesthetics. OBJECTIVE: We aimed to investigate the systemic and cerebral inflammatory response in a LPS-induced sepsis model in rats. We compared two different sedation strategies, intravenous propofol and the volatile anaesthetic sevoflurane, with the hypothesis that the latter may attenuate neuro-inflammatory processes. DESIGN: Laboratory rat study. SETTING: Basic research laboratories at the University Hospital Zurich and University Zurich Irchel between August 2014 and June 2016. PATIENTS: A total of 32 adult male Wistar rats. INTERVENTIONS: After tracheotomy and mechanical ventilation, the anaesthetised rats were monitored before sepsis was induced by using intravenous LPS or phosphate-buffered saline as control. Rats were sedated with propofol (10 mg kg−1 h−1) or sevoflurane (2 vol%) continuously for 12 h. MAIN OUTCOME MEASURES: Systemic inflammatory markers such as cytokine-induced neutrophil chemo-attractant protein 1, monocyte chemo-tactic protein-1 and IL-6 were determined. The same cytokines were measured in brain tissue. Cellular response in the brain was assessed by defining neutrophil accumulation with myeloperoxidase and also activation of microglia with ionised calcium-binding adaptor molecule-1 and astrocytes with glial fibrillary acidic protein. Finally, brain injury was determined. RESULTS: Animals were haemodynamically stable in both sedation groups treated with LPS. Blood cytokine peak values were lower in the sevoflurane-LPS compared with propofol-LPS animals. In brain tissue of LPS animals, chemoattractant protein-1 was the only significantly increased cytokine (P = 0.003), however with no significance between propofol and sevoflurane. After LPS challenge, cerebral accumulation of neutrophils was observed. Microglia activation was pronounced in the hippocampus of animals treated with LPS (P = 0.006). LPS induced prominent astrogliosis (P 

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Evaluation of preoperative oral carbohydrate administration on insulin resistance in off-pump coronary artery bypass patients: A randomised trial

BACKGROUND: In fasting cardiac surgery patients, preoperative carbohydrate (CHO) drink intake attenuated insulin resistance and improved cardiac metabolism, although its beneficial effects were not evident after cardiac surgery possibly due to cardiopulmonary bypass-related extreme systemic inflammation. OBJECTIVE: We aimed to evaluate whether preoperative CHO intake affected insulin resistance and free-fatty acid (FFA) concentrations in off-pump coronary revascularisation. DESIGN: A randomised controlled trial. SETTING: Primary care in a university hospital in Korea from January 2015 to July 2016. PATIENTS: Sixty patients who underwent elective multi-vessel off-pump coronary revascularisation were randomised into two groups. Three patients were excluded from analysis and 57 patients completed study. INTERVENTION: The CHO group received oral CHO (400 ml) the prior evening and 2 to 3 h before surgery, and the control group was fasted from food and water according to standard protocol. MAIN OUTCOME MEASURES: Insulin resistance was assessed twice, after anaesthetic induction and after surgery via short insulin tolerance test. FFA, C-reactive protein and creatine kinase-myocardial band concentrations were determined serially for 48 h after surgery. RESULTS: Insulin sensitivity was greater (P = 0.002) and plasma FFA concentrations were lower (P = 0.001) after anaesthetic induction in the CHO group compared with the Control group, although there were no intergroup differences after surgery. The postoperative peak creatine kinase-myocardial band concentration was significantly lower in the CHO group compared with the Control group [8.8 (5.4 to 18.2) vs. 6.4 (3.5 to 9.7) ng ml−1, P = 0.031]. CONCLUSION: A preoperative CHO supplement significantly reduced insulin resistance and FFA concentrations compared with fasting at the beginning of the surgery, but these benefits were lost after off-pump coronary revascularisation. Despite their transient nature, these beneficial effects resulted in less myocardial injury, mandating further studies focused on the impact of preoperative CHO on myocardial ischaemia and cardiac function after coronary revascularisation. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT 02330263.

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Comparing C-MAC videolaryngoscope with direct laryngoscopy for emergency intubation

No abstract available

http://ift.tt/2yuaQIc

Echocardiography and passive leg raising in the postoperative period: A prospective observational study

BACKGROUND: Signs of hypovolaemia are frequent in the postoperative period, but not all patients need or respond to fluid administration. An increase in cardiac output (CO) after passive leg raising (PLR) has been demonstrated to be useful as a volume response predictor in non-surgical, spontaneously breathing patients. OBJECTIVE: The objective of this study was to evaluate the accuracy of transthoracic echocardiography after PLR to predict fluid responsiveness in post-surgical patients. DESIGN: A prospective observational study. SETTING: A tertiary hospital between January and July 2015. PATIENTS: Fifty-one spontaneously breathing postoperative patients with suspected hypovolaemia (arterial hypotension, oliguria, tachycardia or delayed capillary refill) were considered for the study. INTERVENTION: Demographic and personal data were collected, as well as heart rate variations, mean arterial pressure during PLR and after administering 500 ml of Ringer's lactate solution. CO was measured by transthoracic echocardiography. MAIN OUTCOME MEASURES: The primary outcome was measurement of CO before and after PLR and Ringer's lactate administration. RESULTS: Forty-one patients were included in the study (six patients were excluded because of a poor echocardiographic window and four because of misalignment of the Doppler and outflow tract of the left ventricle). Twenty-two patients (54%) were considered responders to fluid therapy, with an increase of stroke volume greater than or equal to 15% after 500 ml lactated Ringer's infusion. The highest area under the curve was found for an increase in CO (0.91 ± 0.05; 95% confidence interval 0.78 to 0.97). An increase in CO greater than 11% after the PLR manoeuvre predicts a volume response with 68% sensitivity and 100% specificity. CONCLUSION: This is the first study showing that measurement of CO after PLR can predict volume response in spontaneously breathing postoperative patients.

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Oh Excellent Air Bag - Under the influence of Nitrous Oxide, 1799–1920

No abstract available

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Expanding horizons in complement drug discovery: challenges and emerging strategies

Abstract

The complement system is best known for its role in innate immunity, providing a first line of defence against infection, maintaining tissue homeostasis by flagging apoptotic cells and debris for removal, and orchestrating crosstalk between adaptive and innate immunity. In a growing number of diseases, complement is known to drive pathogenesis or to contribute as an inflammatory amplifier of a disease trigger. Association of complement with common and devastating diseases has driven an upsurge in complement drug discovery, but despite a wealth of knowledge in the complexities of the cascade, and many decades of effort, very few drugs have progressed to late-stage clinical studies. The reasons for this are becoming clear with difficulties including high target concentration and turnover, lack of clarity around disease mechanism and unwanted side effects. Lessons learnt from drugs which are either approved, or are currently in late-stage development, or have failed and dropped off the drug development landscape, have been invaluable to drive a new generation of innovative drugs which are progressing through clinical development. In this review, the challenges associated with complement drug discovery are discussed and the current drug development landscape is reviewed. The latest approaches to improve drug characteristics are explored and those agents which employ these technologies to improve accessibility to patients are highlighted.

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Diluted Polidocanol Bests Hypertonic Glucose Alone for Reticular Veins

Reuters Health Information

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Propranolol May Delay Progression of Cutaneous Melanoma

Reuters Health Information

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Independent association among suicidal ideation, asthma, and bronchial hyperresponsiveness in adolescents

Abstract

Asthma is a known risk factor for suicide-related behaviors in adolescents.¹ In particular, an association between asthma and suicidal behaviors has been reported in US high school students² and Taiwanese³ adolescents. However, most previous studies have used self-reported questionnaires to determine whether asthma was present², and others used hospital registries.³ Moreover, the role of potential confounders has not been fully investigated.

This article is protected by copyright. All rights reserved.

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Selective blood sampling for FGF-23 in tumor-induced osteomalacia

Summary

Tumor-induced osteomalacia (TIO) is caused by the hormone fibroblast growth factor 23 (FGF-23). It is mainly produced in the tissue of mesenchymal tumors. Patients with TIO frequently suffer from a chronic decompensated pain syndrome and/or muscle weakness with postural deformity. Despite the severity of the disease, the diagnosis is frequently established late. In some cases, it takes several years to establish the condition. This case report concerning a 68-year old woman demonstrates the selective blood sampling for FGF-23 as path-breaking diagnostics to confirm the diagnosis of a neuroendocrine tumor.

Learning points:

Tumor-induced osteomalacia is a rare condition compared to other paraneoplastic syndromes.

It causes complex symptoms such as progressive reduction of physical capacity, exhaustion, fatigue, a decompensated pain syndrome of the musculoskeletal system and fractures of several bones.

Elevated serum levels of FGF-23 implicate massive phosphate elimination and resulting hypophosphatemia.

The diagnosis is often established over a period of several years because the localization of small FGF-23-producing tumors is complicated.

It is the combination of MRI and selective blood sampling for FGF-23 which permits reliable identification of tumors causing TIO and leads to accurate localization.

In a patient with generalized pain and reduced physical capacity, osteological parameters such as phosphate, 25-OH vitamin D₃ and 1,25-(OH)₂D₃, as well as bone-specific alkaline phosphatase levels in serum should be determined. Hypophosphatemia should always lead to further diagnostic investigations aiming at the detection of an FGF-23-producing tumor.

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The effect of restorative materials on cytokines in gingival crevicular fluid

Publication date: December 2017
Source:Archives of Oral Biology, Volume 84
Author(s): Neslihan Celik, Seda Askın, Mehmet Ali Gul, Nilgun Seven
ObjectiveComposition of the restorative materials may cause inflammatory responses by monocyte activation and changes in the levels of cytokine released from different cells. Interleukin-6 (IL-6), interleukin-8 (IL-8) and Tumor necrosis factor alpha (TNF-α) are important cytokine for evaluating of the inflammatory process. The aim of this study was to evaluate the different restorative materials used in class V cavities effect on gingival crevicular fluid inflammatory cytokine levels.Design60 individuals having Class V carious cavities participated in the study. Cavities were restored with FiltekZ250, DyractXP, Fuji IX, Cavex avalloy restorative materials. Changes in clinical and biochemical parameters were evaluated before restorations, seven and 21days after restorations. Contralateral tooth intact enamel surface was determined as control side. Periotron8000 device was used for detection of GCF volume. Cytokine level of GCF was evaluated by Human ELISA kits. Data were analyzed using Mann-Whitney U test and Wilcoxon signed ranks test. The correlations between clinical parameters and biochemical parameters were examined by Spearman's rank correlation analysis.ResultsAfter restorative treatments PI and GI scores were decreased compared with baseline evaluations. There was a significant difference in GCF levels between experimental and control sites in all groups. GCF IL-6 levels in all groups except Filtek Z250, GCF IL-8 levels in all groups except Fuji IX, GCF TNF-α level in only Fuji IX showed significant differences between experimental and control sites.ConclusionsThe obtained data supported that all of the tested materials caused changes in GCF cytokine levels.



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Association of tongue brushing with the number of fungiform taste buds and taste perception: A preliminary study using confocal laser scanning microscopy in combination with a filter-paper disc method

Publication date: December 2017
Source:Archives of Oral Biology, Volume 84
Author(s): Junichi Kobayashi, Takehisa Saito, Tetsufumi Ito, Hitoshi Yoshimura, Shinpei Matsuda, Hisato Yoshida, Ryousuke Fujita, Kazuo Sano
ObjectiveThe aim of this study was to investigate the association of tongue brushing with the number of fungiform taste buds and taste perception using a confocal laser scanning microscopy in combination with a filter-paper disc method (FPDM).MethodsTwenty-four subjects with or without a habit of tongue brushing (11 males and 13 females, 20–46 years old) participated in this study. Nine of the 24 subjects had no habit of tongue brushing (Group 1, n=9). Fifteen subjects had a habit of tongue brushing, and the brushing regions of the tongue were as follows: central region (Group 2, n=7), or entire region (Group 3, n=8) of the tongue dorsum. Using confocal laser scanning microscopy, the average number of taste buds per fungiform papilla (FP) was counted. Taste perception was evaluated using an FPDM. These observations were performed in the midlateral region of the tongue since the distribution of fungiform papillae is large in the midlateral region compared to that in the central region.ResultsThe subjects in Group 3 showed a significantly decreased number of fungiform taste buds compared to Group 1 and Group 2. Group 3 also showed significantly higher FPDM scores than the other two groups.ConclusionsExcessive tongue brushing of the entire tongue dorsum, including the midlateral region, may have an association with the decreased number of FP and taste buds and decreased taste sensation. To avoid these conditions, instituting proper tongue brushing methods, such as limiting it to the central region of the tongue and using a light touch, is suggested and is important for the subjects who are eager to participate in tongue brushing.



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Postoperative sinonasal morbidity in sellar reconstruction: mucosal autograft versus acellular dermal allograft

Background

Sellar pathology is increasingly addressed using the expanded endonasal approach (EEA). Although avascular graft reconstruction is an acceptable means to prevent cerebrospinal fluid leak, there are few data regarding sinonasal morbidity in these patients. In this study we compare rates of persistent postoperative crusting (PPC) and rhinosinusitis in patients undergoing sellar reconstruction with mucosal autografting and acellular dermal allografting (ADA).

Methods

Patients undergoing the EEA between 2008 and 2014 were categorized into 2 subgroups: mucosal reconstruction and ADA reconstruction. Univariate analyses were performed to compare differences in PPC and rhinosinusitis in these groups and to identify risk factors for sinonasal morbidity. Multivariate propensity matching analysis was performed to match ADA and mucosa reconstruction groups with respect to age, race, gender, smoking status, diabetes status, tumor type, tumor size, and revision vs primary surgery.

Results

A total of 149 patients were identified. There were 105 patients reconstructed with autologous mucosa (70.5%) and 44 reconstructed with ADA (29.5%). Overall, PPC was seen in 20 patients (13.4%) and rhinosinusitis in 10 patients (6.7%). Propensity matching generated 39 patients reconstructed with ADA and 39 reconstructed with mucosa. There was a significant increase in PPC in patients reconstructed with ADA compared to those reconstructed with mucosa (8 of 39 [20.5%] vs 2 of 39 [5.1%], p = 0.04). There was no association between reconstruction with ADA and increased rhinosinusitis (3 of 39 [7.7%] vs 4 of 39 [10.3%], p = 0.64).

Conclusion

Sinonasal morbidity is not uncommon after sellar reconstruction. Patients undergoing sellar reconstruction with ADA may be at increased risk of postoperative crusting compared with those undergoing reconstruction with mucosa.

http://ift.tt/2z3Cjh2

Trends in sinusitis research: a systematic review of extramural funding

Background

Innovation represents a core value of the American Rhinologic Society (ARS), with multiple efforts to promote research in the advancement rhinologic care. We therefore sought to identify trends in extramural sinusitis funding and underutilized sources of support to facilitate future efforts.

Methods

A systematic review of the National Institutes of Health (NIH) Research Portfolio Online Tools (RePORTER) database (fiscal year 1993 to 2017) was completed with the search strategy: ("chronic sinusitis" OR rhinosinusitis). All identified studies were accepted for review, with comparison to ARS membership rolls to identify studies supported by ARS investigators. Foundation awards were surveyed to identify and characterize additional sources of support.

Results

The systematic review identified 958 projects receiving NIH funding, of which 120 remain active. The percentage of sinusitis-related awards and total funding relative to all NIH awards increased over the past 10 years (2006 to 2016) from 0.06% (8 / 9128) and 0.09% ($2,151,152 / $3,358,338,602) to 0.87% (86 / 9540) and 0.90% ($37,201,095 / $4,300,145,614). Among active studies, 9 investigators maintain membership in the ARS and serve as principal investigator or project leader in 12 (10%) studies. ARS investigators received the greatest number of awards from the National Institute on Deafness and Other Communication Disrders (n = 8,66.7%), while only receiving 2.2% of awarded funding from the National Institute of Allergy and Infectious Diseases ($607,500/$26,873,022), the largest source of awards for sinusitis research.

Conclusion

Support for sinusitis research is significantly growing, with the largest source of active funding not being fully utilized by members of the ARS. Further efforts to promote funding priorities among extramural sources is necessary to facilitate increased funding for ARS member initiatives.

http://ift.tt/2xYf0HE

Flexible Laryngoscopy in Management of Congenital Stridor

Abstract

The incidence of congenital stridor is on rise due to improved neonate and infant survival rate. The gold standard investigation for evaluation of stridor is rigid laryngotracheobronchoscopy, but this is invasive and requires general anesthesia. Flexible fibreoptic laryngoscopy, a relatively simple and less invasive procedure can be done under topical anaesthesia for evaluation of stridor. In this study, we have presented our experience of flexible laryngoscopy in children with congenital stridor, their results and management. Laryngomalacia was the commonest cause of stridor accounting for 80% of cases. 15% (6) patients required tracheostomy for relieving airway obstruction and 22.5% (9) patients required a definitive surgical procedure for correcting the cause. Flexible laryngoscopy is safe and gives a comprehensive analysis of airway including its dynamic functions. We also recommend flexible laryngoscopy as a frontline investigation for evaluation of stridor.

http://ift.tt/2xYXBfx

An open-label study to evaluate the long-term safety and efficacy of lanadelumab for prevention of attacks in hereditary angioedema: design of the HELP study extension

Hereditary angioedema (HAE) is characterized by recurrent attacks of subcutaneous or submucosal edema. Attacks are unpredictable, debilitating, and have a significant impact on quality of life. Patients may be...

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Long-term treatment outcomes and prognosis of mucosal melanoma of the head and neck: 161 cases from a single institution

Publication date: November 2017
Source:Oral Oncology, Volume 74
Author(s): Junlin Yi, Shiran Sun, Li Gao, Xiaodong Huang, Ye Zhang, Jingwei Luo, Shiping Zhang, Kai Wang, Yuan Qu, Runye Wu, Qingfeng Liu, Jianping Xiao, Guozhen Xu
ObjectivesThis study aimed to evaluate the clinical features, treatment outcomes and prognostic factors of mucosal melanoma of the head and neck (MMHN) in patients who were treated at our institution.Materials and methodsBetween Jan. 1981 and Oct. 2015, 161 patients with non-metastatic MMHN were treated at our institution. The patients' clinical characteristics, treatment modalities, outcomes, prognostic factors, and failure patterns were retrospectively analysed.ResultsWith a median follow-up time of 74months, the 5-year overall survival rate (OS), local control rate (LC), distant metastasis-free survival (DMFS) were 44.4%, 59.4%, and 49.3%, respectively. Regarding the different treatment modalities, the 5-year OS was 50.0% in the surgery group and 43.1% in the surgery combined with radiotherapy group, while, the 5-year LC rate was 42.5% in the surgery group and 75.3% in the surgery combined with radiotherapy (p<0.001). According to the AJCC 7th edition staging system for MMHN, the 5-year OS for patients with stage III, stage IVA, and stage IVB MMHN were 65.2%, 33.1% and 14.3%, respectively (p<0.001). In the multivariate analysis, the T stage, neck lymph node involvement, and surgical margins were independent prognostic factors for OS; surgical margins and adjuvant radiotherapy were independent prognostic factors for LC.ConclusionThe addition of radiotherapy improves the local control rate of MMHN. T stage, neck lymph node status, and surgical margins are independent prognostic factors for the OS in patients with MMHN. The AJCC 7th edition staging system for MMHN appears to effectively stage this disease.



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Novel method for intraoperative assessment of cerebral autoregulation by paced breathing

Abstract

Background

Cerebral autoregulation (CA) is the mechanism that maintains constancy of cerebral blood flow (CBF) despite variations in blood pressure (BP). Patients with attenuated CA have been shown to have an increased incidence of peri-operative stroke. Studies of CA in anaesthetized subjects are rare, because a simple and non-invasive method to quantify the integrity of CA is not available. In this study, we set out to improve non-invasive quantification of CA during surgery. For this purpose, we introduce a novel method to amplify spontaneous BP fluctuations during surgery by imposing mechanical positive pressure ventilation at three different frequencies and quantify CA from the resulting BP oscillations.

Methods

Fourteen patients undergoing sevoflurane anaesthesia were included in the study. Continuous non-invasive BP and transcranial Doppler-derived CBF velocity (CBFV) were obtained before surgery during 3 min of paced breathing at 6, 10, and 15 bpm and during surgery from mechanical positive pressure ventilation at identical frequencies. Data were analysed using frequency domain analysis to obtain CBFV-to-BP phase lead as a continuous measure of CA efficacy. Group averages were calculated. Values are means (sd), and P<0.05 was used to indicate statistical significance.

Results

Preoperative vs intraoperative CBFV-to-BP phase lead was 43 (9) vs 45 (8)°, 25 (8) vs 24 (10)°, and 4 (6) vs −2 (12)° during 6, 10, and 15 bpm, respectively (all P=NS).

Conclusions

During surgery, cerebral autoregulation indices were similar to values determined before surgery. This indicates that CA can be quantified reliably and non-invasively using this novel method and confirms earlier evidence that CA is unaffected by sevoflurane anaesthesia.

Clinical trial registration

NCT03071432.

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Tolerance of Chemoradiation in Advanced Head and Neck Cancers: Comparison Between Inpatients and Outpatients

Abstract

Concurrent chemoradiation (CCRT) is the mainstay of treatment for majority of locally advanced head and neck carcinomas (LAHNC). Addition of chemotherapy to radiotherapy increases the probability of local control and improved disease-free survival but at the cost of acute and delayed toxicities. A retrospective observational study. To compare the tolerance of CCRT and its toxicity profile amongst two groups, first arm (Arm A) being outdoor patients and the second group (Arm B) was hospitalized patients of LAHNC in an oncology centre of a tertiary care hospital. A total of 100 patients were enrolled, 50 in each arm. Overall, the most common site was oropharynx, followed by larynx and hypopharynx. 38 patients in Arm A received full 6 cycles of weekly chemotherapy with Inj Cisplatin infusion. 39 of the hospitalized patients completed 6 cycles of weekly Cisplatin, 04 patients also received 3 weekly Cisplatin. Average duration of treatment was 49.18 days in arm A and 50.92 days in arm B. Incidence of Grade II onwards dysphagia was 48 and 45 (96 and 90%) in Arm A and Arm B respectively; Chi Square value—0.6 (Yate's corrected); P value—0.43. Grade III oral mucositis was seen in 14% patients in Arm A and 34% patients in Arm B. 3 patients (6%) in Arm A and 14 patients (28%) in Arm B has Grade II and III hematological toxicities and nephrological toxicities. Aspiration pneumonia was seen in 2 patients (4%) in Arm A and in 4 patients (8%) in Arm B, Chi Square value—0.2 (Yate's corrected) P value—0.67. The incidence of febrile neutropenia was 3 and 10 in Arms A and B (6 and 20%) respectively. The tolerance of CCRT in hospitalized patients is marginally better, with relatively few associated complications as compared to outdoor setting. Every institute should promulgate its own guidelines regarding hospitalization of such patients.

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Psychische Begleiterkrankungen beim Knochen- und Weichteilsarkom

Abstract

Hintergrund

Sarkome umfassen eine seltene und histologisch heterogene Gruppe solider maligner Tumoren. Patienten mit Sarkom sind eine bisher vergleichsweise wenig untersuchte Patientengruppe.

Ziel der Arbeit

Die Arbeit gibt einen Überblick über psychische Komorbiditäten von Patienten mit Knochen- und Weichteilsarkom.

Material und Methoden

Im Rahmen des Artikels wurde eine umfassende Literaturrecherche zum Thema psychische Komorbiditäten und emotionale Belastungen beim Sarkom durchgeführt und narrativ zusammengefasst. Dabei wurden auch entsprechende Determinanten sowie mögliche Ursachen berücksichtigt. Darüber hinaus werden Möglichkeiten zur Nutzung von „patient-reported outcomes" (PRO, Therapiebeurteilungen aus Patientensicht) zur Identifizierung psychischer Komorbiditäten diskutiert.

Ergebnisse

Bei Patienten mit Sarkom zeigen sich deutlich erhöhte psychosoziale Belastungen und psychische Komorbiditäten bei Diagnosestellung, während der Therapie und im weiteren Lebensverlauf. Besonders häufig werden dabei Depressionen (Prävalenz: 23–30%) und Angststörungen (Prävalenz: 13–19%) beschrieben. Zudem sind Sarkompatienten bereits vor der Diagnosestellung häufiger von psychischen Erkrankungen betroffen als krebsfreie Personen. Einschränkungen der Lebensqualität sind insbesondere unmittelbar bei Diagnosestellung und während der Therapie häufig.

Schlussfolgerung

Zur frühzeitigen Identifikation und Behandlung von psychischen Begleiterkrankungen sollten Patienten mit Sarkom sorgfältig und regelmäßig bezüglich emotionaler Belastungen und psychischer Erkrankungsmuster gescreent werden. Außerdem sollte eine adäquate psychoonkologische Betreuung sichergestellt sein. Die routinemäßige Erfassung und Integration von PRO in den Versorgungsalltag kann dabei zu einer deutlichen Verbesserung der Versorgung von Patienten mit Sarkomerkrankungen führen.

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Teilchenstrahltherapie in der Radioonkologie

Zusammenfassung

Die Protonentherapie ist eine Form der Teletherapie in der Radioonkologie, welche verwendet wird, um maligne Tumoren zu behandeln. Die Protonen werden im Zyklotron oder Synchrotron beschleunigt, um die Tumoren mit hochenergetischen Partikeln von bis zu 230 Megaelektronenvolt (MeV) mittels Passive-Scattering- oder aktivem Scanning-Beam-Verfahren zu bestrahlen. Durch die spezifischen physikalischen Eigenschaften der Protonen kann mit hochpräziser Planung das Zielvolumen bestrahlt und die hinter dem Zielvolumen liegenden Risikoorgane i. Allg. besser geschont werden als mit Photonen. Neben erwachsenen Patienten mit Tumoren der Schädelbasis oder Chordomen/Chondrosarkomen profitieren v. a. Kinder von dieser Therapie, da mit Protonen die integrale Körperdosis sowie die Dosis auf heranwachsende strahlensensible Organe reduziert werden kann. Die Protonentherapie umfasst ein breites Forschungsgebiet, daher sollten momentan alle Patienten in Studien behandelt werden.

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Recalcitrant chronic rhinosinusitis in the setting of fucosidosis, a rare lysosomal storage disorder

Publication date: December 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 103
Author(s): Tiffany Peng, Vikash K. Modi, Aaron N. Pearlman
Fucosidosis is an autosomal recessive lysosomal storage disorder caused by the deficiency of alpha-L-fucosidase. We present the case of an affected female in the second decade of life with chronic rhinosinusitis (CRS) including recalcitrant polypoid inflammation, which has not been previously reported in the literature. With the advancement of life-prolonging measures, children with lysosomal storage disorders may suffer increasingly from CRS due to the lymphohistiocytic and macrophage infiltrate of the paranasal sinus mucosa that resembles severe polypoid inflammation.



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Cranial MRI in a young child with cochlear implants after bilateral magnet removal

Publication date: December 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 103
Author(s): Silke Helbig, Timo Stöver, Iris Burck, Sabine Kramer
A young bilateral cochlear implant (CI) user required magnetic resonance imaging (MRI) to determine the cause of hydrocephalus. The images obtained with the CIs in place were not diagnostically useful due to large artefacts generated by the CI magnets. We obtained useful images by bilaterally explanting the CI-magnets and replacing them with non-magnetic placeholder dummies then conducted the imaging. The artefact in the new images was greatly reduced and the images were diagnostically useful. Lastly, we explanted the dummies and reimplanted the CI-magnets. This procedure should be useful to obtain useful images in CI users.



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Corneal Collagen Cross-Linking Combined with an Artiflex Iris-Fixated Anterior Chamber Phakic Intraocular Lens Implantation in a Patient with Progressive Keratoconus

We present here the case of a 24-year-old male who experienced progressive keratoconus and vision loss which adversely affected his ability to carry out everyday tasks. This landed him in the Hashmanis Hospital for consultation. He had a preoperative best corrected visual acuity of 6/12. He underwent multiple Oculus Pentacam examinations, which showed progressive keratoconus. Corneal collagen cross-linking (CXL) was performed to stabilize his cornea and, subsequently, an Artiflex anterior chamber iris-fixated phakic intraocular lens (ACIF-PIOL) was implanted to alleviate his refractive errors. The patient achieved a postoperative uncorrected visual acuity of 6/12. This report shows that CXL combined with ACIF-PIOL can be safe and effective in those with progressive keratoconus.
Case Rep Ophthalmol 2017;8:482–488

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Facial nerve neuroma in the geniculate ganglion extending into the internal auditory canal: A case report

Facial nerve schwannoma is a very rare benign tumor representing less than 1% of intrapetrous lesions. Our patient is a forty-one year old female who has suffered from recurrent right facial palsy for the last six years. She was first misdiagnosed as having Bell's palsy and received corticosteroids which resulted in little improvement. She then had facial nerve decompression surgery which resulted in a partial improvement. Since then, she has suffered from recurrent attacks of facial palsy. Two years ago, she came to our hospital seeking further treatment options.

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Asthma Management for the Otolaryngologist

Asthma is a chronic inflammatory disease that will frequently be encountered by otolaryngologists as they manage their patients with upper respiratory diseases. Symptoms such as cough should alert otolaryngologists to consider more broadly the potential role of asthma in the differential diagnosis. It is critical for otolaryngologists to appreciate that patients with allergic rhinitis and chronic rhinosinusitis will often have asthma, and that many of them may not be diagnosed at the time of presentation. Appropriate diagnosis of the patient with asthma, as well as effective treatment for its symptoms, will improve patient function and enhance quality of life.

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The Role of the Sinonasal Epithelium in Allergic Rhinitis

The sinonasal epithelial barrier is comprised of tight and adherens junction proteins. Disruption of epithelial barrier function has been hypothesized to contribute to allergic disease such as allergic rhinitis through increased passage of antigens and exposure of underlying tissue to these stimuli. Several mechanisms of sinonasal epithelial barrier disruption include antigen proteolytic activity, inflammatory cytokine-mediated tight junction breakdown, or exacerbation from environmental stimuli. Mechanisms of sinonasal epithelial barrier stabilization include corticosteroids and nuclear erythroid 2-related factor 2 (Nrf2) cytoprotective pathway activation. Additional studies will aid in determining the contribution of epithelial barrier function in allergic rhinitis pathophysiology and treatment.

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Advancements and Dilemmas in the Management of Allergy

Recent advances in the diagnosis and management of allergic disease also lead to new clinical decisions for providers. Advances in component (or molecular) diagnostic testing for allergy continue to build in the literature, but diagnosing inhalant allergy remains largely unchanged clinically. Prevention of allergy has been demonstrated by preventing peanut allergy in high-risk infants by intentional oral exposure to promote tolerance. Immunotherapy options have increased, with literature supporting sublingual drops, sublingual tablets, and subcutaneous immunotherapy. Expanded options create clinical questions such as the role of monotherapy in polysensitized patients. This article explores recent advances and their clinical implications.

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Outline of guidelines for the management of vasculitis and vascular disorders in Japan, 2016 revised edition

Abstract

The proposal by the 1994 International Chapel Hill Consensus Conference on the Nomenclature of Systemic Vasculitides (CHCC1994) and by the CHCC2012 markedly influenced the classification and way of considering cutaneous vasculitis. In the proposal by the CHCC1994, hypersensitivity angiitis was defined as an equivalent pathological condition to microscopic polyangiitis or cutaneous leukocytoclastic angiitis (CLA), and it was not adopted as a disease name. However, CLA which was positioned as a type of small-vessel vasculitis is only a pathological name. In the proposal by the CHCC2012, a new category of single-organ vasculitis included CLA and cutaneous arteritis. Vasculitis allergica cutis (Ruiter) corresponded to CLA and cutaneous polyarteritis nodosa corresponded to cutaneous arteritis. The Japanese Dermatological Association (JDA) prepared guidelines for the management of vasculitis and vascular disorders in 2008 based on the proposal by the CHCC1994 and their original viewpoint of dermatology. The JDA subsequently revised the 2008 edition guidelines in 2016 following publication of the proposal of the CHCC2012 in Japanese. We presented the outline of the 2016 edition guidelines and propose a treatment algorithm for primary vasculitides based on the evaluation of the cutaneous symptoms for cases suspected as primary cutaneous vasculitides, which integrates the 2008 JDA guideline and CHCC2012 classification. This is the secondary English version of the original Japanese manuscript for the guideline for management of vasculitis and vascular disorders published in the Japanese Journal of Dermatology 127(3); 299–415, 2017.

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Epidemiology and comorbidities of patients with chronic urticaria in Korea: A nationwide population-based study

Abstract

Few population-based studies have focused on the epidemiology and comorbidities of chronic urticaria (CU) or chronic spontaneous urticaria (CSU). The objective of this study was to obtain information on the epidemiology and comorbidities associated with CU and CSU in Korea. We conducted a cross-sectional analysis using a national health insurance database. An algorithm based on the International Classification of Diseases, 10th revision, was used for the identification of patients with CU and CSU, and an age–sex adjusted logistic regression model was used to assess the risk of comorbidities in these patients. The average annual prevalence rates of CU and CSU during the 4-year period between 2010 and 2013 were 3.08% and 1.40%, respectively. The prevalence rates of CU and CSU were higher in women than men (1:1.39 and 1:1.34, respectively) and peaked at 0–9 and 70–79 years, respectively. After adjustment for age and sex, the patients with CU and CSU were found to have a significantly higher prevalence rate of CU/CSU-related diseases, compared with those without CU (mean adjusted odds ratio, 8.46; 95% confidence interval, 8.10–8.83). Allergic rhinitis, drug allergies, asthma, thyroid diseases and cancers were the most common comorbidities. Stomach, thyroid, liver and prostate cancers were the most prevalent cancers. This study provides large epidemiological data on the prevalence rates of CU and CSU, and their comorbidities, in Korea. Patients with CU and CSU impose a higher burden, in terms of specific comorbidities, than those without CU.

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Unexpected hypotension in catecholamine reversal: a case report

Catecholamine agents are commonly used to support circulation; however, they may cause unexpected hypotension in a special situation. Here we describe the first unexpected case of hypotension in response to ca...

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Clinicopathological Significance of Tumor Lymphatic Vessel Density in Head and Neck Squamous Cell Carcinoma

Abstract

Various studies have demonstrated that the lymphatic system is the additional route for solid tumor metastasis. Lymph nodes metastasis in Head and neck squamous cell carcinoma (HNSCC) is a major prognostic indicator for disease progression and a guide for therapeutic strategies. We conducted a study to compare intratumoral (IT) and peritumoral (PT) lymphatic vessel density (LVD) in HNSCC using lymphatic marker D2-40 and its correlation with lymph node metastasis, histological grading and other clinicopathological parameters. Fifty specimen of HNSCC with modified radical neck dissection tissue were included in the study group. Tissue from tumor, peritumoral tissue, tumor margin and all the lymph nodes were processed for paraffin wax blocks and histopathological diagnosis. Immunohistochemical profile of lymphatic vessels in intratumoral and peritumoral tissue was assessed by subjecting one section each from the tumor and peritumoral tissue to D2-40 immunostain. To determine LVD, four fields with the highest LVD (hot spots) were identified. The mean values were calculated by taking an average of all the measurements. The comparison of LVD between peritumoral and intratumoral area revealed significantly higher PT-LVD (P = 0.001). No significant association was seen between LVD, IT-LVD and PT-LVD and different age groups, gender, site of tumor, risk factors, size of tumor, tumor inflammation, pushing/infiltrating margin and stage of tumors. Significantly higher LVD, IT-LVD and PT-LVD was seen in association with lymph node metastasis. Both high intratumoral and peritumoral LVD were found significantly associated with the presence of lymph node metastasis, however lymphatic vessels were found to be significantly more numerous and larger in peritumoral areas as compared to intratumoral lymphatics. The specificity of D2-40 as a lymphatic endothelial marker was also confirmed. The results of our study support the possibility of using the determination of tumor lymphangiogenesis to identify patients of HNSCC who are at risk of developing the lymph node metastasis.

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Novel uses of bilateral advancement flaps for tip defects on the nose part II

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Comparison of Cyclic and Continuous 308-nm Excimer Laser Treatments for Vitiligo: A Randomized Controlled Non-Inferiority Trial

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Azathioprine and risk of multiple keratinocyte cancers

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Machine Learning and Melanoma: The Future of Screening

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Epidemiology of Malignant Cutaneous Granular Cell Tumors: A United States Population-Based Cohort Analysis using the Surveillance, Epidemiology, and End Results (SEER) Database

Malignant cutaneous granular cell tumors (mcGCT) are rare and associated with substantial morbidity and mortality. The literature includes single-institution studies.

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Efficacy and tolerance profile of thalidomide in cutaneous lupus erythematosus: a systematic review and meta-analysis

Thalidomide has shown excellent results for severe cutaneous lupus Erythematosus (CLE) but its prescription is limited by potentially severe adverse events.

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Antimalarial drug toxicities in patients with cutaneous lupus and dermatomyositis: a retrospective cohort study

Antimalarials are effective for rheumatic skin diseases, but have been associated with retinopathy.We investigated the toxicity risk of antimalarials alone and in combination.Antimalarials were generally well tolerated and had similar risk profiles. Risk of retinopathy seems to be lowest for quinacrine, then hydroxychloroquine, and highest for chloroquine.

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Novel uses of bilateral advancement flaps for tip defects on the nose part I

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A comparison of apremilast monotherapy and combination therapy for plaque psoriasis in clinical practice: a Canadian multicenter retrospective study

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Demographic and Healthcare Service Utilization by 4,417 Patients with Hidradenitis Suppurativa

What is already known on this topic?Hidradenitis suppurativa (HS) is associated with increased burden of healthcare utilization.What does this article add to our knowledge?Patients with HS impose an increased burden on the healthcare system compared to patients with psoriasis and to the general population.How does this information affect clinical practice and/or change patient care?These results should encourage policy-makers and healthcare providers to explore more cost-effective treatments for HS patients.

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Utilization patterns and survival outcomes after wide local excision or Mohs micrographic surgery for Merkel cell carcinoma in the United States, 2004-2009

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Migration dermatology: an issue to consider?

Abstract

The recent waves of migration across Europe have resulted in a rapid change of the patient population in many major cities in Europe, affecting the demand for health care and specifically dermatological care, as highlighted recently in an editorial of this journal. The psychosocial burden of the migrant population is often considerable, with stressful living conditions and reduced access to health care, however there is still little research on the health of migrant populations, probably because of methodological challenges and the lack of international consensus on the definition of migration status.

This article is protected by copyright. All rights reserved.

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Three cases of facial erythema with dryness and pruritus in psoriasis patients during treatment with IL-17 inhibitors

Abstract

The development of psoriasis, a common, chronic inflammatory skin disease, significantly depends on interleukin (IL)-17 (1). Anti-IL-17 inhibitors, such as ixekinumab (anti-IL-17A antibody), secukinumab (anti-IL-17A antibody) and brodalumab (anti-IL-17 receptor A (IL-17RA) antibody) exert excellent therapeutic effects on psoriasis (2). On the other hand, since IL-17 is an important cytokine for preventing fungal infections, skin side effects such as cutaneous candidiasis are occasionally seen during the administration of IL-17 inhibitors (3).

This article is protected by copyright. All rights reserved.

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Quality of Dutch dermatological guidelines according to AGREE II

Abstract

The number of clinical practice guidelines is increasing, but their quality is variable.¹ However, healthcare professionals/users should be able to rely on methodologically sound guidelines that are helpful and applicable in practice. To objectively assess (methodological) guideline quality, experts developed the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument.

This article is protected by copyright. All rights reserved.

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Painful interdigital lesion: could it be syphilis?

Abstract

Syphilis is a sexually transmitted infection (STI) caused by the spirochete Treponema pallidum (1). Low and medium-income countries are overburdened, nonetheless high-income countries also face an increasing incidence since the year 2000 (2). In Brazil, syphilis is a grave public health problem, with an incidence of 42.7 per 100.000 in 2015 (3).

This article is protected by copyright. All rights reserved.

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Granuloma annulare associated with immune checkpoint inhibitors

Abstract

Recent developments in cancer immunology have ushered in immunotherapy as a new era in anti-cancer therapy. The cytotoxic T lymphocyte antigen-4 (CTLA-4) and programmed cell death receptor-1(PD-1)/ PD ligand-1 (PD-L1) signaling pathway are immune checkpoints of tumour-induced immunosuppression. Immune checkpoint inhibitors (ICIs) activate cytotoxic T cells to attack tumour cells, leading to durable antitumour responses. By unbalancing the immune system, ICIs may induce autoimmunity that results in organ dysfunction, referred to as immune-related adverse events (irAEs).

This article is protected by copyright. All rights reserved.

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Cervicopectoral flap as an adequate decision for advanced ameloblastic carcinoma

Abstract

Management of advanced head and neck cancers are often complicated by challenging anatomy, complex reconstructions and long surgical procedures (1). The leading clinical manifestations of patients with ameloblastic carcinomas are large, often painless and rapidly growing mass, swelling, paresthesis, mucosal ulceration, bleeding and tooth mobility (2,3). The tumor may arise from preexistent cysts or develop de novo (2).

This article is protected by copyright. All rights reserved.

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Carney complex revealed by a cerebellar ischemic stroke in a six-year-old girl

Abstract

Carney complex (CNC, OMIM 160980) is a rare dominantly inherited syndrome characterized by the presence of skin pigmentation, myxomas and endocrine tumors. Two-thirds of patients are found to have an inactivating heterozygous germline mutation of the PRKAR1A gene, which encodes the R1alpha regulatory subunit of cyclic-Amp-dependent protein kinase A (1). Approximately 160 index case have been identified (2).

This article is protected by copyright. All rights reserved.

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Novel PNPA1 mutations in two Italian siblings with autosomal recessive congenital ichthyosis

Abstract

Autosomal recessive congenital ichthyoses (ARCI) are a clinically and genetically heterogeneous group of non-syndromic ichthyoses due to mutations in at least 9 genes, including PNPLA1 (1). PNPLA1 (Patatin-Like Phospholipase Domain-Containing Protein 1) is strongly expressed in the epidermal granular cell layer (1), and has been recently shown to play a crucial role in epidermal ω-O-acylceramide biosynthesis and skin barrier integrity both in mice and humans (2-5). Concomitantly several ARCI families carrying PNPLA1 mutations have been described confirming that most mutations occur in the highly conserved patatin core domain (1, 5-10). We report the identification of two novel missense mutations in PNPLA1 in two Italian sisters affected with ARCI characterized by a cyclic disease course.

This article is protected by copyright. All rights reserved.

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Unusual post-patch testing erythema: a late, granulomatous, non-eczematous reaction to gold sodium thiosulfate

Abstract

In patch testing, delayed reactions at day 7 or later are regarded as "late reactions".¹ Neomycin, corticosteroids, paraphenylendiamin and gold are well-known allergens of late reactions.^1,2 Of these, reactions to gold sodium thiosulfate (GSTS) can be significantly delayed, and some cases have been reported to be accompanied with granulomatous changes.^3,4 Clinical reports of this reaction to GSTS are very limited. Here, we report a case of granulomatous reaction to GSTS, and we review the literature to reveal the features of this phenomenon.

This article is protected by copyright. All rights reserved.

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Sprachaudiometrie und Datalogging bei CI-Patienten

Zusammenfassung

Hintergrund

Im Rahmen der postoperativen Cochleaimplantat(CI)-Diagnostik werden Messungen des Sprachverstehens zur audiologischen Erfolgskontrolle durchgeführt. In den letzten Jahren wird ein Trend für verbessertes überschwelliges Sprachverstehen in Ruhe und eine Erweiterung des Sprachverstehens zu leiseren Pegeln beobachtet. Parallel zu den audiometrischen Daten kann eine Erhebung der akustischen Lebenswirklichkeit der Patienten erfolgen, welche in modernen CI-Systemen mittels Datalogging möglich ist.

Fragestellung

Welche Sprachpegel spiegeln vor dem Hintergrund aktueller Versorgungsergebnisse die individuelle Hörumgebung praxisrelevant wider, und wie kann dies in der klinischen Audiometrie reflektiert werden?

Patienten und Methoden

Im Rahmen einer retrospektiven Datenanalyse wurden die Datalogs von 263 erwachsenen CI-Patienten hinsichtlich Schallpegel und Hörsituation (Ruhe, Sprache in Ruhe, Lärm, Sprache im Störlärm, Musik, Wind) ausgewertet. Parallel wurde das Einsilberverstehen in Ruhe für Pegel von 40–80 dB für erfahrene CI-Nutzer analysiert.

Ergebnisse

Für Lautstärke der Hörumgebung von postlingual ertaubten erwachsenen CI-Patienten zeigt das Datalogging für Sprachsignale ein Maximum im Pegelbereich 50–59 dB. Dies belegt die Alltagsrelevanz des Sprachverstehens bei Pegeln <60 dB.

Schlussfolgerungen

Die individuelle Optimierung des Sprachverstehens mit einem CI-Sprachprozessor sollte nicht nur im Bereich 65–70 dB, sondern zusätzlich bei geringeren Pegeln erfolgen. Derzeit erscheinen Messungen bei 50 dB als eine sinnvolle Ergänzung.

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The future of nonoperating room anesthesia in the 21st century: emphasis on quality and safety.

Purpose of review: Nonoperating room anesthesia (NORA) has grown from an insignificant percentage of total anesthesia cases into a major percentage of anesthesia workload over the past 30 years. This trend evidences no signs of abating. Recent findings: With the rapid development of novel interventional techniques in cardiology, radiology, gastroenterology and pulmonary medicine and other areas, the core responsibilities of the anesthesia provider will no longer be confined to delivering care in traditional operating rooms. This change presents challenges for the profession on several fronts. Efficient staffing of multiple locations poses challenges. The demand for anesthesia services continues to increase, but underutilization is a major problem. Each clinical area presents unique patient care issues. New interventional techniques are continually developed with which anesthesiologists need to be familiar in each specific area. NORA patients are older and medically complex, yet many are treated on an outpatient basis. Consequently, anesthetic management for NORA will of necessity require techniques that allow patients to recover quickly. Summary: It may be anticipated that in the next decade that NORA cases will constitute over 50% of the number of cases performed with anesthesia involvement. As the last century belonged to invasive surgery, the next century will belong to interventionalists. There is also an increasing national emphasis on quality measurement and metrics reporting. Future anesthesia payment models under Medicare Access and CHIP Reauthorization Act, such as merit-based incentive payment system (MIPS), emphasize various process and outcomes measures. Anesthesiologists will be evaluated based on a composite performance score consisting of four components: quality, resource use, clinical practice improvement activities and meaningful use of certified electronic health record technology. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Disseminated erythema with intense and selective inflammation of sweat gland and lichenoid drug eruption during nivolumab therapy

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Severe erythema exudative multiforme developing from advanced melanoma treated with dabrafenib and trametinib followed by nivolumab

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Case of phenylephrine hydrochloride-induced periorbital contact dermatitis with fulminant keratoconjunctivitis causing pseudomembrane formation

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Associations between anti-melanoma differentiation-associated gene 5 antibody and demographics, clinical characteristics and laboratory results of patients with dermatomyositis: A systematic meta-analysis

Abstract

Anti-melanoma differentiation-associated gene 5 (MDA5) antibody is a specific biomarker in patients with dermatomyositis (DM). Results from several studies that examined the relationship between anti-MDA5 antibody and the demographics, clinical characteristics and laboratory results of DM patients have been conflicting. The purpose of this study was to identify the relationship, if any, of anti-MDA5 antibody with demographics, clinical characteristics and laboratory results of DM patients. PubMed, Web of Science, Embase and the Cochrane Library databases were searched for studies without language restrictions conducted before 16 March 2017. Stata version 12.0 software was used to calculate pooled odds ratios or weighted mean differences and corresponding 95% confidence intervals to determine the relationship between anti-MDA5 antibody and patient characteristics. Twenty studies comprising 1500 cases were included in this meta-analysis. Anti-MDA5 antibody was strongly associated with clinically amyopathic DM (CADM) and rapidly progressive interstitial lung disease (RPILD). Anti-MDA5 antibody also increased the risk of developing eight characteristics comprising Gottron's sign or papules, mechanic's hand, V rash, skin ulcers, panniculitis, alopecia, arthritis/arthralgia and pneumomediastinum, but reduced the risk of muscle weakness, classic DM (CDM) and elevated creatine kinase (CK). Our meta-analysis indicated that anti-MDA5 antibody is related to muscle weakness, Gottron's sign or papules, mechanic's hand, V rash, skin ulcers, panniculitis, alopecia, arthritis/arthralgia, pneumomediastinum, RPILD, CDM, CADM and elevated CK in patients with DM.

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Effects of moisturizing skincare on skin barrier function and the prevention of skin problems in 3-month-old infants: A randomized controlled trial

Abstract

An effective newborn skincare protocol has not been established. We aimed to evaluate the effects of moisturizing skincare, including using lotion and reducing routine bathing. Our hypothesis was that moisturizing skincare would improve skin barrier function. This randomized controlled trial included 227 healthy Asian newborns between 1 week and 3 months old. We compared moisturizing skincare (bathing every 2 days and using lotion daily; intervention, n = 113) to daily bathing without lotion (control, n = 114). We assessed the skin barrier function (transepidermal water loss [TEWL], stratum corneum hydration [SCH], skin pH and sebum secretion) as a primary outcome at 3 months old. We also assessed the incidence of skin problems according to parents' diary reports. Compared with the control, the intervention group had a lower face TEWL (mean ± standard deviation, 14.69 ± 7.38 vs 17.08 ± 8.26 g/m² per h, P = 0.033), higher face SCH (60.38 ± 13.66 vs 53.52 ± 14.55, P = 0.001) and higher body SCH (58.89 ± 12.96 vs 53.02 ± 10.08, P < 0.001). Compared with the control, newborns in the intervention group had significantly lower rates of diaper dermatitis between birth and 1 month old (6.3% vs 15.9%, P = 0.022), and tended to have lower rates of body skin problems between 1 and 3 months (42.1% vs 55.2%, P = 0.064). Moisturizing skincare was effective for improving skin barrier function and preventing newborns' diaper dermatitis. The results of our study may help parents make informed decisions about newborn skincare.

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Human papillomavirus type 6/11 identified in an epidermoid cyst of the scrotum

Abstract

To date, epidermoid cysts associated with human papillomavirus (HPV) infection have been described mainly in palmoplantar locations, and have involved HPV types 60 and 57. In contrast, HPV-6/11 is a major cause of condyloma acuminatum. Here, we report the case of a healthy 31-year-old man who presented to our clinic with a 1-month history of a 1-cm, reddish-brown, cystic scrotal tumor with a punctum. The lesion was studied histologically, immunohistochemically and by DNA–DNAin situ hybridization. Histology revealed an epidermoid cyst with vacuolated keratinocytes with shrunken nuclei (koilocytes) in the cyst wall. Immunostaining was positive for HPV antigens and in situ hybridization revealed HPV-6/11 DNA in the koilocytes. This is the first report of an HPV-6/11-associated epidermoid cyst in the anogenital skin of an immunocompetent individual.

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Case of engraftment syndrome appearing as scratch dermatitis

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Emerging techniques in assessment and treatment of muscle tension dysphonia.

Purpose of review: The purpose of this review is to summarize current evidence regarding treatment for muscle tension dysphonia (MTD) and to present recent advances in evaluation and management. Recent findings: It is generally accepted that voice therapy for MTD is effective, but current systematic reviews report limited evaluation specific to MTD patients with moderate evidence, at best, available to support voice therapy techniques. Individual studies are difficult to compare because of heterogeneity. Considerable work is underway to identify most important metrics to include in assessment, and to advance and define direct voice therapy approaches. Summary: Further standardization of assessment and treatment protocols for MTD will improve future research. Novel therapeutic techniques are under investigation. In small studies, these have found value in improving voice outcomes and measures compared with pretreatment values but have not met success greater than existing therapeutic methods. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Vocal tremor: where are we at?.

Purpose of review: Vocal tremor in movement disorders is often overlooked, although it has a significant impact on quality of life. Careful observation of tremor phenomenology allows for accurate diagnosis and tailored treatment. Recent findings: The central pathways associated with various vocal tremor-associated diseases have been further elucidated. Summary: Patients are likely to benefit from a combination of medical and interventional treatments delivered within a multidisciplinary setting Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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