Baerveldt Scleral Patch Graft Abscess Secondary to Coagulase-Negative Staphylococcus

We report the case of a 69-year-old female who underwent a Baerveldt implant placement for severe-stage primary open-angle glaucoma and developed a bacterial infection of the conjunctiva and abscess of the scleral patch graft with subsequent tube exposure. The infection was identified 3 weeks postoperatively and a topical antibiotic was immediately initiated. A concurrent systemic staphylococcal infection was discovered by an outside physician and oral cephalexin was initiated. Despite antibiotic treatment, the conjunctival erosion progressed, and tube revision was required. Culture of the abscess revealed coagulase-negative Staphylococcus. As alluded to above, the patient also had multiple abscesses on the skin that cultured positive for Staphylococcus aureus. To our knowledge, this is the first case in the literature of coagulase-negative Staphylococcus causing an early postoperative abscess of the scleral patch graft following glaucoma drainage device placement.
Case Rep Ophthalmol 2017;8:521–526

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How does sinus surgery affect topical irrigation distribution?.

Purpose of review: The current article reviews the literature on the distribution of nasal irrigation in the treatment of chronic sinusitis, especially in how sinus surgery and irrigation techniques affect its delivery to the nasal cavity and paranasal sinuses. Recent findings: Nasal irrigation has become a useful tool in the treatment of chronic sinusitis. Used after endoscopic surgery of the paranasal sinuses, irrigation has shown to be effective in improving edema and removing crusts and secretions in that place. However, some relevant points have been considered in the surgical technique and in the postoperative period to improve irrigation access to the paranasal sinuses such as the amplitude of the sinus ostial opening, irrigation volume and device used, as well as head position during irrigation. Summary: Postoperative lavage of the paranasal sinus is a recognized adjuvant in the treatment of chronic rhinosinusitis, reducing morbidity and improving local healing, besides allowing the association of topical medications that can be carried to the paranasal sinuses along with the saline increasing the reach of these drugs. Detailed attention to the techniques described in this review improves the distribution of irrigation in the paranasal sinuses after sinus surgery and considerably increases the efficacy of this therapy. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Asthma biomarkers in the age of biologics

The heterogeneous nature of asthma has been understood for decades, but the precise categorization of asthma has taken on new clinical importance in the era of specific biologic therapy. The simple categories ...

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Potential Effect of Leukocyte-Platelet-Rich Fibrin in Bone Healing of Skull Base: A Pilot Study

Background. Reconstruction of surgical defects following cranial base surgery is challenging. Others have demonstrated that leukocyte-platelet-rich fibrin (L-PRF) stimulates tissue healing and bone regeneration. However, these studies have addressed mostly maxillofacial surgical wounds. Objective. The objective of this study was to assess the possible adjuvant role of L-PRF in inducing neoossification of the surgical bone defect in anterior skull base surgery. Methods. We identified patients who had undergone an endoscopic endonasal surgery of the anterior skull base in which L-PRF membranes were used for the reconstruction of the bone defect and who were followed up with postoperative CT scans. CT findings were then correlated with baseline scans and with the CT scans of a patient who had undergone imaging and histologic analysis after maxillofacial surgery in which L-PRF was used and in which we demonstrated bone formation. Results. Five patients fulfilled the inclusion criteria. In four patients, the CT scan demonstrated closure of the bony defect by neoosteogenesis; however, the bone appeared less dense than the surrounding normal bone. A comparison with the control patient yielded similar radiological features. Conclusion. This case series suggests that L-PRF may induce bone healing and regeneration at the surgical site defect. Multi-institutional studies with a larger series of patients are required to confirm this possibility.

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Comprehensive Geriatric Assessment and Head and Neck Elderly Cancer Patients

Condition:   Head and Neck Squamous Cell Carcinomas (HNSCCs)
Intervention:   Other: CGA and geriatric follow-up
Sponsors:   Assistance Publique - Hôpitaux de Paris;   National Cancer Institute (NCI);   Cancéropole Ile De France
Recruiting

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Exercise Protects Skeletal Muscle during Chronic Doxorubicin Administration

Purpose: This study aimed to assess the ability for exercise training performed before and during biweekly doxorubicin (DOX) administration to attenuate adverse effects of DOX on skeletal muscle. We hypothesized that DOX treatment would increase REDD1, impair mammalian target of rapamycin (mTOR) signaling, and reduce muscle fiber size, and that exercise training would attenuate these responses. Methods: Eight-week-old ovariectomized female Sprague–Dawley rats were randomized to one of four treatments: exercise + DOX (Ex-Dox), Ex + vehicle (Ex-Veh), sedentary + DOX (Sed-Dox), and Sed + Veh (Sed-Veh). DOX (4 mg·kg−1) or vehicle (saline) intraperitoneal injections were performed biweekly for a total of three injections (cumulative dose, 12 mg·kg−1). Ex animals performed interval exercise (4 × 4 min, 85%–90% V˙O2peak) 5 d·wk−1 starting 1 wk before the first injection and continued throughout study duration. Animals were euthanized ~5 d after the last injection, during which the soleus muscle was dissected and prepared for immunoblot and immunohistochemical analyses. Results: REDD1 mRNA and protein were increased only in Sed-Dox (P 0.05). LC3BI was higher, and the LC3BII/I ratio was lower in Sed-Dox versus Sed-Veh (P 0.05). Conclusion: These data suggest that DOX may inhibit mTORC1 activity and reduce MHCI and MHCIIa fiber size, potentially through elevated REDD1, and that exercise may provide a therapeutic strategy to preserve skeletal muscle size during chronic DOX treatment.

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Bioenergetics and ATP Synthesis during Exercise: Role of Group III/IV Muscle Afferents

Purpose: The purpose of this study was to investigate the role of the group III/IV muscle afferents in the bioenergetics of exercising skeletal muscle beyond constraining the magnitude of metabolic perturbation. Methods: Eight healthy men performed intermittent isometric knee-extensor exercise to task failure at ~58% maximal voluntary contraction under control conditions (CTRL) and with lumbar intrathecal fentanyl to attenuate group III/IV leg muscle afferents (FENT). Intramuscular concentrations of phosphocreatine (PCr), inorganic phosphate (Pi), diprotonated phosphate (H2PO4−), adenosine triphosphate (ATP), and pH were determined using phosphorous magnetic resonance spectroscopy (31P-MRS). Results: The magnitude of metabolic perturbation was significantly greater in FENT compared with CTRL for [Pi] (37.8 ± 16.8 vs 28.6 ± 8.6 mM), [H2PO4−] (24.3 ± 12.2 vs 17.9 ± 7.1 mM), and [ATP] (75.8% ± 17.5% vs 81.9% ± 15.8% of baseline), whereas there was no significant difference in [PCr] (4.5 ± 2.4 vs 4.4 ± 2.3 mM) or pH (6.51 ± 0.10 vs 6.54 ± 0.14). The rate of perturbation in [PCr], [Pi], [H2PO4−], and pH was significantly faster in FENT compared with CTRL. Oxidative ATP synthesis was not significantly different between conditions. However, anaerobic ATP synthesis, through augmented creatine kinase and glycolysis reactions, was significantly greater in FENT than in CTRL, resulting in a significantly greater ATP cost of contraction (0.049 ± 0.016 vs 0.038 ± 0.010 mM·min−1·N−1). Conclusion: Group III/IV muscle afferents not only constrain the magnitude of perturbation in intramuscular Pi, H2PO4−, and ATP during small muscle mass exercise but also seem to play a role in maintaining efficient skeletal muscle contractile function in men.

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Greater Effect of East versus West Travel on Jet Lag, Sleep, and Team Sport Performance

Purpose: This study aimed to determine the recovery timeline of sleep, subjective jet lag and fatigue, and team sport physical performance after east and west long-haul travel. Methods: Ten physically trained men underwent testing at 0900 h and 1700 h local time on four consecutive days 2 wk before outbound travel (BASE), and the first 4 d after 21 h of outbound (WEST) and return (EAST) air travel across eight time zones between Australia and Qatar. Data collection included performance (countermovement jump, 20-m sprint, and Yo-Yo intermittent recovery level 1 [YYIR1] test) and perceptual (jet lag, motivation, perceived exertion, and physical feeling) measures. In addition, sleep was measured via wrist activity monitors and self-report diaries throughout the aforementioned data collection periods. Results: Compared with the corresponding day at BASE, the reduction in YYIR1 distance after EAST was significantly different from the increase in WEST on day 1 after travel (P

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Use of enzyme-linked immunosorbent assay to screen for aflatoxins, ochratoxin A, and deoxynivalenol in dry pet foods

Abstract

The objective of this study was to perform a market survey on dry pet foods using enzyme-linked immunosorbent assay (ELISA) to detect total aflatoxins (AFs), ochratoxin A (OTA), and deoxynivalenol (DON). Pet food products (n = 58) marketed for dogs, cats, birds, and rabbits were tested in duplicate with ELISA, and results above the limit of quantitation were confirmed using liquid chromatography tandem mass spectrometry (LC-MS/MS). OTA was detected in one product (rabbit food) and AFs were detected in two products (one dog treat and one bird treat). In contrast, DON was detected in the majority (74%) of products tested. Bird and rabbit products were the most affected by DON, with levels above 0.5 μg/g in 50 and 80% of samples, respectively. One rabbit sample tested positive for both OTA and DON. Overall, the findings of this study revealed a low incidence of AFs and OTA in commercial pet food. Although DON was detected in numerous products, the levels were well below those associated with acute toxic effects.

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Production of fumonisins by endophytic strains of Tolypocladium cylindrosporum and its relation to fungal virus infection

Abstract

Fumonisins were first discovered in Fusarium verticillioides, a fungus associated to disease and asymptomatic infections in maize. Afterwards, other fungal taxa have been found to produce fumonisins. The entomopathogenic ascomycete Tolypocladium cylindrosporum has been isolated from soil and also as an endophyte from leaves of grasses. The objectives of this work were to determine the in vitro production of fumonisin B (FB) mycotoxins and the immunosuppressive compound cyclosporine A (CyA) in several strains of T. cylindrosporum, and to examine the effect of fungal virus infection and temperature in FB production. FB₁ was detected in 30% of the strains, ranging from 0.16 to 5.52 μg cm⁻² in solid media, and FB₂ was detected in 78% of the strains, ranging from 0.764 to 40.92 μg cm⁻². CyA was not detected in any strain. The mean FB₂ concentration of the endophytic strain Tc37W was three times greater (p < 0.05) than that of any other strain. Up to 34% more of FB₂ was detected in strains infected by the virus TcV3 than in the corresponding virus-free versions. The effect of temperature on FB₂ content was interactively significantly dependent on fungal strain and growth medium; in the YES medium, the FB₂ of virus-infected strains Tc37-1V and Tc37W increased by 67 and 16%, respectively, at 26 °C as compared to 20 °C. The FB concentration in some fungal strains was similar to that in fungi associated to food and feed intoxications.

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Blood plasma biomarkers of citrinin and ochratoxin A exposure in young adults in Bangladesh

Abstract

Citrinin (CIT) and Ochratoxin A (OTA) are nephrotoxic mycotoxins which can co-occur in food commodities, resulting in internal exposure. Studies in many countries reported on the presence of OTA in human blood; however, such biomonitoring data for CIT is still scarce. This study was conducted to characterize both CIT and OTA biomarker levels in plasma of volunteers since food analysis data are insufficient to assess human exposure in Bangladesh. In total 104 blood samples were collected from university students in 2013 (sampling 1: n = 64, midsummer) and 2014 (sampling 2: n = 40, end winter) for analysis of CIT and OTA and their metabolites HO-CIT and OTα by LC-MS/MS and HPLC-FD techniques, respectively. CIT and HO-CIT were detected in 90% (max 2.70 ng/mL) and 85% (max 1.44 ng/mL) of all samples. Mean levels in sampling 2 (CIT 0.47 ng/mL; HO-CIT 0.40 ng/mL) were higher than in sampling 1 (0.25 ng/mL; 0.37 ng/mL) indicative of variable CIT exposure. OTA was present in all (max 6.63 ng/mL) and OTα in 98% (max 0.99 ng/mL) of the samples. In sampling 1, mean OTA (0.85 ng/mL) was higher than in sampling 2 (0.51 ng/mL); the reverse situation was found for OTα mean levels. The calculated dietary OTA intake among the students (mean 9.9; max 91.7 ng/kg bw/week) was lower than the tolerable weekly intake for this mycotoxin (120 ng/kg bw/week) set by EFSA. But frequent co-exposure to CIT should be considered, and the results of this study indicate the necessity to identify major sources of CIT and OTA intake in the Bangladeshi population.

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Monoclonal gammopathy of renal significance presenting as monotypic plasma cell interstitial nephritis in two patients with Sjögren’s syndrome

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Forthcoming Issues

Controversies in Facial Plastic Surgery

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Cosmetic Otoplasty

Otoplasty for prominent ears is a rewarding yet exacting surgery that demands the precise application of anatomic knowledge, anthropometric norms, and surgical creativity. The practitioner must be able to use a variety of different techniques to provide durable and acceptable cosmetic results to patients. This article provides an in-depth description of normal and abnormal auricular anatomy, the historical context for modern otoplasty, and describes in detail the common otoplastic procedures currently performed.

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Contents

Scott Stephan

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Autologous Rib Microtia Construction

Nagata technique becomes most popular method of autologous rib microtia construction. To achieve successful outcome, 3 keys must be perfect: skin envelope, 3D cartilage framework, and proper location of the construct. The first step of the surgery is to identify "auricular rectangle." Relationship between the auricular rectangle and the vestige will determine if the vestige is usable for surgery. Rib cartilage must be harvested without perichondrium to prevent chest deformity. Lobule split technique is the hallmark of the Nagata technique, which allows skin envelope expansion, and allows deeper conchal cavity. Surgeons must master 3D framework construct before clinical cases.

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Contributors

J. REGAN THOMAS, MD, FACS

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Surgical Otoplasty

Otoplasty is one of the first procedures learned during residency. A myriad of surgical techniques and nuances exist. Many have merit, some are ineffective, some destructive, and some frankly fanciful. Adopting an effective and safe technique should be based on proven efficacy and effectiveness to avoid early disappointments. We present a review of traditional otoplasty techniques and more recent innovations. Their pros and cons are discussed in view of the relative risks/benefits balance. Recurrence rates are low for most techniques. Some techniques carry a higher risk of significant complications. A ladder approach preferring techniques that minimize cartilage damage appears advisable.

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Copyright

ELSEVIER

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Auricular Prostheses in Microtia

The progress made in the development of the silicones and percutaneous titanium implants allow for rehabilitation of patients with microtia with an inconspicuous auricular prosthesis. The art of making the prosthesis by the dedicated anaplastologist is the key for the success of this approach. Most patients with microtia desire camouflage. The greatest advantage of the auricular prosthesis is that it can be manufactured as a mirrored replica of the opposite side. The outcome is predictable. Computer science with virtual planning and rapid prototyping is about to revolutionize the process of prosthetic auricular rehabilitation.

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Atresiaplasty in Congenital Aural Atresia

Patients with microtia and congenital aural atresia should have a comprehensive hearing assessment early in life. Options for hearing habilitation should be presented, and children with bilateral aural atresia should be fitted with a bone conducting hearing device to support normal speech and language development. If atresia surgery is pursued, the microtia surgeon must be aware of certain principles. This article presents recommendations on options for potentially improving hearing in children with congenital aural atresia: assessing surgical candidacy; chronology and timing of surgeries; functional importance of certain ear structures; and understanding the possible locations of an aberrant facial nerve to avoid injury in these patients.

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Auricular Reconstruction Using Porous Polyethylene Implant Technique

Alloplast-based ear reconstruction has become more popular over the years because it offers many advantages compared with the traditional staged autologous costal cartilage approach. Advantages include earlier reconstruction in the setting of microtia, fewer procedures, less donor site morbidity, shorter surgeon learning curve, and improved consistency in the final aesthetic result. Although other implantable materials have been used in auricular reconstruction with variable success, porous high-density polyethylene frameworks combined with recent advances in the creation of the soft tissue coverage have significantly improved outcomes with minimal complications and long-term viability. This article describes the authors' technique.

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Otoplasty for Congenital Auricular Malformations

Among the less common congenital auricular anomalies are cryptotia, Stahl ear, constricted ear, and macrotia. The vast majority of these occur spontaneously without accompanying syndromes or other deformities. This article provides a comprehensive overview of these anomalies, as well as common techniques to correct these anomalies.

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Pediatric Microtia Reconstruction with Autologous Rib

Reconstruction of the microtic ear is one of the most challenging, yet gratifying surgical experiences. Careful planning, attention to detail, and conservative tissue management are necessary for excellent results. Technologies continue to evolve; with the advancement of cartilage tissue engineering, the future of ear reconstruction is very promising.

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Nonsurgical Management of Congenital Auricular Anomalies

Congenital auricular deformities often can be corrected by neonatal ear molding techniques, which have evolved significantly over a 25-year period with commercially available molding systems now available. Indications for molding and methodology for best optimizing results have been well described in the literature, although recent studies have explored methodology for reduction in the cost of technique and also called for increased awareness among pediatric practitioners of the importance of early institution of therapy.

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Psoriasis Tied to Higher Risk of Serious Liver Disease

People with chronic inflammatory disorders like psoriasis and rheumatoid arthritis may have an increased risk of developing serious liver damage, a recent study suggests.
Reuters Health Information

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Metastasis in the mandibular condyle: a case report

Most bone metastases are observed in the trunk of the body. Metastasis in the mandibular condyle is rare. In many case reports, temporary common temporomandibular joint disorder-like symptoms can be a sign of ...

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Denguefieber

Zusammenfassung

Dengueinfektionen gehören zu den häufigsten Ursachen fieberhafter Erkrankungen im tropischen Umfeld. Die Infektion wird durch ein Flavivirus verursacht, das durch Aedes-Moskitos übertragen wird. Hauptüberträger für Dengueviren sind die weltweit in den Tropen verbreiteten Aedes-aegypti-Stechmücken. Da diese einerseits tagaktiv und andererseits sog. „container breeder" sind, bedarf es besonderer Vorbeugungs- und Bekämpfungsmaßnahmen. Die Schwere der Symptomatik variiert und kann vom milden grippeähnlichen klinischen Bild bis hin zu schweren Hämorrhagien und Schock reichen. Zu den häufigsten Symptomen bei Reisenden gehören Fieber, Muskelschmerzen, Kopfschmerzen und Hautausschlag. Zur Diagnostik kommen, in Abhängigkeit vom Stadium der Infektion, patientennah einsetzbare Schnellteste oder – in der virämischen Phase – molekulare Erregerdirektnachweise infrage. Die serologische Diagnostik ist aufgrund von serologischen Kreuzreaktionen mit anderen Flaviviren hinsichtlich ihrer Interpretation anspruchsvoll.

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Anti-aminoacyl-tRNA synthetase-related myositis and dermatomyositis: clues for differential diagnosis on muscle biopsy

Abstract

Anti-synthetase syndrome is an autoimmune disease characterized by autoantibodies toward amino acyl-tRNA synthetases (ARS), anti-Jo 1 being the most commonly detected. Muscle damage develops in up to 90% of ARS-positive patients, characterized by a necrotizing myositis restricted to the perifascicular region. This topographic distribution of muscle damage may lead to a misdiagnosis of dermatomyositis (DM) at muscle biopsy. We compared morphological, immunohistochemical, and histoenzymatic features of muscle from ARS-positive patients (n = 11) with those of DM (n = 7) providing clues for their differential diagnosis. In addition, we evaluated markers of mitochondrial damage to provide a further distinction between these two entities. Necrosis occurred in the majority of ARS patients, mainly located in the perifascicular region. It was often limited to small foci of fibers, always associated with myocyte regeneration. This last often overwhelmed necrosis, representing occasionally the main finding. In DM, necrosis/regeneration was scarce while the peculiar feature was a diffuse atrophy of perifascicular fibers. These last showed decreased cytochrome c oxidase (COX) stain and mitochondrial DNA depletion, consistent with mitochondrial dysfunction. In contrast to DM, ARS displayed scattered COX-deficient fibers, not restricted to the perifascicular region. This feature occurred in up to 91% of patients, being prominent only in two.

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Peak Airflow Measurement in Patients With Glottic Insufficiency After Vocal Fold Augmentation

This case series study evaluates changes in peak airflow after vocal fold augmentation among patients with glottic insufficiency.

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Implementing Quality Improvement and Patient Safety in Residency Education

This Viewpoint discusses practical strategies for implementing successful resident-led patient safety and quality improvement initiatives in otolaryngology–head and neck surgery residency education.

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Association of Enrollment in an Aerodigestive Clinic With Reduced Hospital Stay

This study examines the association of enrollment in a multidisciplinary aerodigestive clinic with comprehensive and coordinated care with reduced frequency of inpatient admissions and overall hospital days for children with special health care needs.

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Anesthesia Exposure and Neurotoxicity in Children

This Viewpoint discusses the implications for otolaryngologists of a recent US Food and Drug Administration warning about the association between anesthesia exposure and neurocognitive deficits in children.

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November 2017 Issue Highlights

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The End of the Road

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Survival Outcomes for T3N0M0 Squamous Cell Carcinoma of the Glottic Larynx

This cohort study defines outcomes in patients with clinical T3N0M0 glottic laryngeal cancer treated with definitive surgical and radiotherapy-based approaches.

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Reporting of Effect Size and Confidence Intervals

This study evaluates the frequency of reporting effect sizes and confidence intervals in the results of analytical studies from JAMA Otolaryngology–Head & Neck Surgery.

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Error in Byline

In the Observation titled "Double Parathyroid Adenomas in Monozygotic Twins," published online September 28, 2017, there was an error in the byline. Where it previously read Brendan R. Stack, it now correctly reads Brendan C. Stack Jr. This article was corrected online.

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Laryngoscopic Findings and Response to Gabapentin

This cohort study examines the use of gabapentin in patients with chronic cough when vocal fold motion asymmetry is noted on videostroboscopy.

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Measuring Institutional Quality in Head and Neck Surgery Using Hospital-Level Data

Using data from the National Cancer Database, this study examines the association of negative margin rate and lymph node yield with survival in patients with head and neck squamous cell carcinomas at the hospital level.

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Prognosis of 5-Year Survival of Chemoradiotherapy-Treated Patients With Nasopharyngeal Carcinoma

This cohort study evaluates outcomes data and the American Joint Committee on Cancer staging system to improve the accuracy of the 5-year survival prognosis for patients with nasopharyngeal carcinoma who underwent chemoradiotherapy.

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Nationwide Variation in Rates of Thyroidectomy Among US Medicare Beneficiaries

This cross-sectional analysis of Medicaid data examines variability across US regions for rates of thyroid surgery among Medicaid beneficiaries.

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Extracapsular Dissection vs Superficial Parotidectomy

This study reviews all parotidectomies at a single institution conducted by head and neck surgeons to compare extracapsular dissection with superficial parotidectomy for benign parotid tumors with respect to surgical outcomes and cost-effectiveness.

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Interferon-γ Treatment of Human Laryngotracheal Stenosis–Derived Fibroblasts

This in vitro controlled study assesses whether the helper T cell 1 cytokine interferon-γ inhibits laryngotracheal stenosis–derived fibroblast function in patients undergoing surgical subglottic and tracheal dilation.

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Minimal Important Difference in Voice Handicap Index–10

This cohort study estimates the minimal important difference in the Voice Handicap Index–10 total score among patients at a university voice clinic.

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Double Parathyroid Adenomas in Monozygotic Twins

This is a report of a case of primary hyperparathyroidism in a pair of genetically identical individuals.

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Krouse Classification for Sinonasal Inverted Papilloma With Recurrence

This systematic review and meta-analysis evaluates the existing literature on sinonasal inverted papilloma to assess the association between the Krouse classification and the rate of recurrence.

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JAMA Otolaryngology–Head & Neck Surgery

Mission Statement:JAMA Otolaryngology–Head & Neck Surgery provides timely information for physicians and scientists concerned with diseases of the head and neck. Given the diversity of structure and function based in this anatomic region, JAMA Otolaryngology–Head & Neck Surgery publishes clinical, translational, and population health research from an array of disciplines. We place a high priority on strong study designs that accurately identify etiologies, evaluate diagnostic strategies, and distinguish among treatment options and outcomes. Our objectives are to (1) publish original contributions that will enhance the clinician's understanding of otolaryngologic disorders, benefit the care of our patients, and stimulate research in our field; (2) forecast important advances within otolaryngology—head and neck surgery, particularly as they relate to the prevention, diagnosis, and treatment of disease through clinical and translational research, including that of the human genome and novel imaging techniques; (3) address questions of clinical outcomes and cost-effectiveness that result from clinical intervention, which grow in importance as health care providers are increasingly challenged to provide evidence of enhanced survival and quality of life; (4) provide expert reviews of topics that keep our readers current with true advances and also to provide a valuable educational resource for trainees in the several disciplines that treat patients with diseases of the head and neck; (5) serve as a forum for the concerns of otolaryngologists such as socioeconomic, legal, ethical, and medical issues; (6) provide helpful critiques that enable contributing authors to improve their submissions. We encourage a concise presentation of information and employ an abstract format that efficiently assesses validity and relevance from a clinical perspective. This approach promotes succinct yet complete presentation for our readers and electronic information resources. We believe this approach typifies the commitment of JAMA Otolaryngology–Head & Neck Surgery to providing important information that is easily interpreted by its diverse readership.

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Unusual Cause of Recurrent Meningitis

This case report describes a synchronous cerebrospinal fluid fistulae through the oval and round window membranes in a patient with recurrent meningitis.

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Analysis of the Growth Pattern of Thyroid Cancer in Young Patients

This observational study evaluates the change in diameter and volume of malignant thyroid tumors in children after a nuclear accident in Fukushima, Japan.

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Rethinking the Growth Pattern of Thyroid Cancer in Young Patients Based on the Fukushima Database

In response to public concern over radiation exposure after the Fukushima Daiichi nuclear power plant accident of March 11, 2011, the Health Survey of Fukushima Prefecture offered thyroid ultrasonography screening to the 360 000 residents 18 years or younger living in the prefecture at the time of the accident. Approximately 300 000 patients underwent preliminary screening in the 2011 to 2013 period during which radiation effects on thyroid nodules development were expected to be nonexistent. Approximately 2000 individuals in the initial screening met criteria for subsequent screening and approximately 550 of those met criteria for fine-needle biopsy. With biopsy results, approximately 110 patients were identified with cancer or suspected cancer and most of these patients underwent surgery. Consistent with published series of pediatric thyroid cancer, the majority of pathologic diagnoses were papillary carcinoma. The prevalence of carcinoma in this largest-to-date pediatric screening series was 37 cases per 100 000 patients—a number far larger than expected from previous published estimates of pediatric thyroid carcinoma. The overall radiation exposure from the Fukushima accident was much less than that from the Chernobyl accident in 1986 and the high incidence of carcinoma detected was believed to be a result of the unprecedented scope of the ultrasonography screening program rather than from any radiation effects. These findings potentially create cancer risk anxiety in the affected region and possibly imply that a significant proportion of pediatric well-differentiated thyroid carcinomas become dormant or quiescent and never present with clinical disease.

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Editorial Board

Publication date: November–December 2017
Source:American Journal of Otolaryngology, Volume 38, Issue 6





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Table of Contents

Publication date: November–December 2017
Source:American Journal of Otolaryngology, Volume 38, Issue 6





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Guidelines for Contributing Authors

Publication date: November–December 2017
Source:American Journal of Otolaryngology, Volume 38, Issue 6





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Proceedings of the 2017 WAO Symposium on Hot Topics in Allergy: Pediatric & Regulatory Aspects

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Cutaneous squamous cell carcinomas (SCC) associated with cosmetic skin whitening: 8 cases reported in Senegal

Publication date: Available online 15 November 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): F. Ly, P. Diousse, C. Ndiaye, A. Déme, B.A. Diatta, M.T. Ndiaye, M. Diallo, A. Diop, A.D. Kebe, F. Fall, A. Kane
BackgroundThe cosmetic use of bleaching products is common among women from sub-Saharan Africa. The most frequently used products are highly potent corticosteroids (clobetasol propionate) and hydroquinone. Herein, we report 8 cases of SCC in women using skin bleaching products for cosmetic purposes. Our aim is to describe the epidemiological, clinical and pathological aspects of the carcinomas observed during the course of skin lightening.MethodsWe conducted a descriptive multicentre study from August 2005 to January 2016 in three dermatology units in Senegal. We included all patients consulting for cutaneous squamous cell carcinoma associated with skin bleaching. Sociodemographic, clinical, paraclinical and therapeutic data were recorded.ResultsA total of 8 female patients were included. The mean age was 48.1 years (37–63 years). Topical hydroquinone and highly potent corticosteroids were the main products used over the whole body, for an average duration of 20.3 years. No pre-neoplastic skin disease was found in our patients. The clinical aspects of tumours were as follows: cauliflower-like (n=4), ulcerated (n=3) and nodular (n=1). The average development time before consultation was 6.75 months. All the cutaneous squamous cell carcinomas were localized to lichenoid lesions or exogenous ochronotic lesions on photo-exposed areas: face (n=1), neck (n=3) or upper back (n=4). The most common histopathological type was the infiltrating form and there was one case of in situ carcinoma. The outcome was favourable in six of eight patients after surgical resection. Two deaths occurred: one through tumour recurrence and the other through haemorrhagic shock.ConclusionsFrom 2005 to 2016, eight cases of cutaneous squamous cell carcinomas associated with cosmetic use of bleaching products were reported in Senegal. The mechanism was not fully elucidated and further studies are necessary. These observations provide an additional argument for combating this practice and including skin bleaching among known risk factors for squamous cell carcinoma.



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Source estimation of epileptic activity using eLORETA kurtosis analysis

Exact low-resolution brain electromagnetic tomography (eLORETA) is a technique for three-dimensional representation of the distribution of sources of electrical activity in the brain. Kurtosis analysis allows for identification of spiky activity in the brain. To evaluate the reliability of eLORETA kurtosis analysis, the results of the analysis were compared with those of equivalent current dipole (ECD) and synthetic aperture magnetometry (SAM) kurtosis analysis of magnetoencephalography (MEG) data in a patient with epilepsy with elementary visual seizures in a 6-year follow-up.

The results of electroencephalography (EEG) eLORETA kurtosis analysis indicative of a right superior temporal spike source partially overlapped with MEG ECD/SAM kurtosis results in all recordings, with a total overlapping at the end of the follow-up period. Overall findings suggest that eLORETA kurtosis analysis of EEG data may aid in the localisation of spike activity sources in patients with epilepsy.

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Endovascular rescue treatment through stent positioning after surgical clipping of intracranial aneurysms complicated by parent artery obstruction

During aneurysm clipping, ischemic complications may occur and require a rescue treatment, usually surgical. We present two such cases that required urgent rescue treatment, performed through an endovascular route. Our first case presented with a non-ruptured right posterior inferior cerebellar artery (PICA) aneurysm. After permanent clip positioning, occlusion of the PICA occurred. An unsuccessful attempt of clip repositioning was performed. We therefore positioned a stent obtaining complete flow restoration. Our second case was that of a ruptured giant left middle cerebral artery aneurysm with focal critical stenosis of the parent vessel, likely due to an underlying dissection. Initially, the aneurysm was secured through coiling. However, after permanent clip positioning, parent artery occlusion occurred. DSA showed occlusion of the parent artery downstream to the clip and persistence of the preaneurismatic stenosis. We achieved full recanalization through stent positioning. In both cases, there were no ischemic or hemorrhagic complications.

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Rare cause of adrenal insufficiency

A 72-year-old man presented with weight loss, night sweats and haemoptysis and was hypotensive. CT imaging showed rapidly enlarging bilateral adrenal masses, and he was found to have primary adrenal insufficiency. An adrenal gland biopsy revealed the rare diagnosis of primary adrenal lymphoma. This unique case highlights possible rare causes of adrenal masses and adrenal insufficiency, their investigation and management principles.

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Primary intraventricular haemorrhage due to rupture of giant varix of the basal vein of Rosenthal in a patient with long-standing direct CCF: angiographic features and treatment considerations

Direct carotid cavernous fistulae (CCF) are often detected early and treated promptly resulting in a paucity of literature regarding its long-term evolution. We present a case of high flow post-traumatic direct CCF that was neglected for over 6 years and presented with a rare manifestation of primary intraventricular haemorrhage. Occlusions of the primary venous outlets likely resulted in engorgement of the deep venous system. The segmental anatomy of the shunting basal vein is critical to the clinical presentation and may range from basal ganglia or brainstem oedema/infarctions to uniquely, as in our case, isolated intraventricular haemorrhage secondary to variceal rupture. Treatment in such chronic cases requires a consideration of cerebral hyperperfusion syndrome necessitating deconstructive techniques with subsequent anticoagulation to avoid accelerated thrombosis of the venous varices.

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Keratoderma blennorrhagica

Description

A 26-year-old woman, previously healthy, that a month ago started complaining of pain in the soles of both feet, which followed, additionally, to the right knee, the left knee, left elbow and right shoulder. She reported morning stiffness exceeding 1 hour that decreased with physical activity, worsened with rest, but improved with administration of non-steroidal anti-inflammatory drugs (NSAIDs). Three weeks later, skin lesions appeared on the soles of the feet.

Seven to 8 weeks before, the patient would have had two successive episodes of a urinary tract infection, treated, respectively, with fosfomycin and ciprofloxacin. The patient did not present gastrointestinal symptoms, previous weight loss or sweating.

On physical exam , it was verified pain at knee mobilisation, more intense in the left, where it presented articular effusion.

The cutaneous lesions were about 0.5 cm in diameter, were maculopapular, on a background of diffuse erythema and of desquamation on large blades (

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Reply to Letter to the Editor regarding “Systematic review and meta-analysis of venous thromboembolism in otolaryngology-head and neck surgery”

http://ift.tt/2z739sn

NEOSCOPE: a randomised Phase II study of induction chemotherapy followed by either oxaliplatin/capecitabine or paclitaxel/carboplatin based chemoradiation as pre-operative regimen for resectable oesophageal adenocarcinoma

Mukherjee, S; Hurt, CN; Gwynne, S; Bateman, A; Gollins, S; Radhakrishna, G; Hawkins, M; ... Crosby, T; + view all Mukherjee, S; Hurt, CN; Gwynne, S; Bateman, A; Gollins, S; Radhakrishna, G; Hawkins, M; Canham, J; Lewis, W; Grabsch, HI; Sharma, RA; Wade, W; Maggs, R; Tranter, B; Roberts, A; Sebag-Montefiore, D; Maughan, T; Griffiths, G; Crosby, T; - view fewer (2015) NEOSCOPE: a randomised Phase II study of induction chemotherapy followed by either oxaliplatin/capecitabine or paclitaxel/carboplatin based chemoradiation as pre-operative regimen for resectable oesophageal adenocarcinoma. BMC Cancer , 15 , Article 48. 10.1186/s12885-015-1062-y . Green open access

http://ift.tt/2il6ABc

Patch-based anisotropic diffusion scheme for fluorescence diffuse optical tomography-part 1: technical principles

Correia, T; Arridge, S; (2016) Patch-based anisotropic diffusion scheme for fluorescence diffuse optical tomography-part 1: technical principles. Physics in Medicine & Biology , 61 (4) pp. 1439-1451. 10.1088/0031-9155/61/4/1439 . Green open access

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A critque of hegemonic masculinity and developing an alternative approach using ethnographic evidence

Brown, BJ; (2015) A critque of hegemonic masculinity and developing an alternative approach using ethnographic evidence. In: (Proceedings) Male Psychology Conference 2015. Male Psychology Network

http://ift.tt/2iohhTu

Biomimetic heterogenous elastic tissue development

Tsai, KJ; Dixon, S; Hale, LR; Darbyshire, A; Martin, D; de Mel, A; (2017) Biomimetic heterogenous elastic tissue development. npj Regenerative Medicine , 2 , Article 16. 10.1038/s41536-017-0021-4 . Green open access

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Comparison of different strategies for using fossil calibrations to generate the time prior in Bayesian molecular clock dating

Barba-Montoya, J; dos Reis, M; Yang, Z; (2017) Comparison of different strategies for using fossil calibrations to generate the time prior in Bayesian molecular clock dating. Molecular Phylogenetics and Evolution , 114 pp. 386-400. 10.1016/j.ympev.2017.07.005 . Green open access

http://ift.tt/2inVn2F

Social Media in Trinidad

Sinanan, J; Social Media in Trinidad. [Book]. Why We Post. UCL Press: London, UK. Green open access

http://ift.tt/2AKRVGa

A CRISPR/Cas9-based method and primer design tool for seamless genome editing in fission yeast

Rodríguez-López, M; Cotobal, C; Fernández-Sánchez, O; Borbarán Bravo, N; Oktriani, R; Abendroth, H; Uka, D; ... Bähler, J; + view all Rodríguez-López, M; Cotobal, C; Fernández-Sánchez, O; Borbarán Bravo, N; Oktriani, R; Abendroth, H; Uka, D; Hoti, M; Wang, J; Zaratiegui, M; Bähler, J; - view fewer (2017) A CRISPR/Cas9-based method and primer design tool for seamless genome editing in fission yeast. Wellcome Open Research , 1 , Article 19. 10.12688/wellcomeopenres.10038.2 . Green open access

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Thymus transplantation for complete DiGeorge syndrome: European experience

Davies, G; Cheung, M; Gilmour, K; Maimaris, J; Curry, J; Furmanski, A; Sebire, N; ... Thrasher, A; + view all Davies, G; Cheung, M; Gilmour, K; Maimaris, J; Curry, J; Furmanski, A; Sebire, N; Halliday, N; Mengrelis, K; Adams, S; Bernatoniene, J; Bremner, R; Browning, M; Devlin, B; Erichsen, HC; Gaspar, B; Hutchison, L; Ip, W; Ifversen, M; Leahy, R; McCarthy, E; Moshous, D; Neuling, K; Malgorzata, P; Papadopol, A; Parsley, K; Poliani, L; Ricciardelli, I; Sansom, D; Voor, T; Worth, A; Crompton, T; Markert, ML; Thrasher, A; - view fewer (2017) Thymus transplantation for complete DiGeorge syndrome: European experience. Journal of Allergy and Clinical Immunology 10.1016/j.jaci.2017.03.020 . (In press). Green open access

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H-ATLAS: a candidate high redshift cluster/protocluster of star-forming galaxies

Clements, DL; Braglia, F; Petitpas, G; Greenslade, J; Cooray, A; Valiante, E; De Zotti, G; ... van der Werf, P; + view all Clements, DL; Braglia, F; Petitpas, G; Greenslade, J; Cooray, A; Valiante, E; De Zotti, G; O'Halloran, B; Holdship, J; Morris, B; Perez-Fournon, I; Herranz, D; Riechers, D; Baes, M; Bremer, M; Bourne, N; Dannerbauer, H; Dariush, A; Dunne, L; Eales, S; Fritz, J; Gonzalez-Nuevo, J; Hopwood, R; Ibar, E; Ivison, RJ; Leeuw, LL; Maddox, S; Michalowski, MJ; Negrello, M; Omont, A; Oteo, I; Serjeant, S; Valtchanov, I; Vieira, JD; Wardlow, J; van der Werf, P; - view fewer (2016) H-ATLAS: a candidate high redshift cluster/protocluster of star-forming galaxies. Monthly Notices of the Royal Astronomical Society , 461 (2) pp. 1719-1733. 10.1093/mnras/stw1224 . Green open access

http://ift.tt/2inwHrg

When politics prevails: Parties, elections and loyalty in the European Parliament

Reh, C; Koop, C; Bressanelli, E; (2017) When politics prevails: Parties, elections and loyalty in the European Parliament. European Journal of Political Research 10.1111/1475-6765.12252 . (In press). Green open access

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Developing and Piloting a New Parent-Report Measure of Executive Function for Children with Autism Spectrum Disorder (ASD)

Ledger-Hardy, Laurie; (2017) Developing and Piloting a New Parent-Report Measure of Executive Function for Children with Autism Spectrum Disorder (ASD). Doctoral thesis (D.Clin.Psy), UCL (University College London).

http://ift.tt/2inwHaK

Self-management and peer support interventions for people with Severe Mental Illness

Lean, ML; (2017) Self-management and peer support interventions for people with Severe Mental Illness. Doctoral thesis (D.Clin.Psy), UCL (University College London).

http://ift.tt/2ALYrMP

Expansion of the known distribution of Asiatic mouflon (Ovis orientalis) in the Late Pleistocene of the Southern Levant

Yeomans, L; Martin, L; Richter, T; (2017) Expansion of the known distribution of Asiatic mouflon (Ovis orientalis) in the Late Pleistocene of the Southern Levant. Royal Society Open Science , 4 (8) , Article 170409. 10.1098/rsos.170409 . Green open access

http://ift.tt/2imzIrF

Guided Internet-based Cognitive Behavioural Therapy for Perfectionism, and its Impact on Self-esteem and Intolerance of Uncertainty: A Randomised Controlled Trial

Kothari, Radha; (2017) Guided Internet-based Cognitive Behavioural Therapy for Perfectionism, and its Impact on Self-esteem and Intolerance of Uncertainty: A Randomised Controlled Trial. Doctoral thesis (D.Clin.Psy), UCL (University College London). Green open access

http://ift.tt/2ALYCYv

Mapping synergies and trade-offs between energy and the Sustainable Development Goals

Tomei, J; Fuso-Nerini, F; To, LS; Bisaga, I; Parikh, P; Black, M; Borrion, A; ... Mulugetta, Y; + view all Tomei, J; Fuso-Nerini, F; To, LS; Bisaga, I; Parikh, P; Black, M; Borrion, A; Spataru, C; Castan-Broto, V; Anandarajah, G; Milligan, B; Mulugetta, Y; - view fewer (2018) Mapping synergies and trade-offs between energy and the Sustainable Development Goals. Nature Energy (In press).

http://ift.tt/2inPVgn

Outcomes of cancer bereavement therapeutic support groups

Jerome, Hannah; (2017) Outcomes of cancer bereavement therapeutic support groups. Doctoral thesis (D.Clin.Psy), UCL (University College London). Green open access

http://ift.tt/2ANT8fX

Behavioural and Emotional Outcomes for Children and Adolescents with ADHD traits and Social Communication Difficulties

Hollingdale, Jack; (2017) Behavioural and Emotional Outcomes for Children and Adolescents with ADHD traits and Social Communication Difficulties. Doctoral thesis (D.Clin.Psy), UCL (University College London).

http://ift.tt/2inPOkX

Whole-genome sequencing of nine esophageal adenocarcinoma cell lines

Contino, G; Eldridge, MD; Secrier, M; Bower, L; Fels Elliott, R; Weaver, J; Lynch, AG; ... Fitzgerald, RC; + view all Contino, G; Eldridge, MD; Secrier, M; Bower, L; Fels Elliott, R; Weaver, J; Lynch, AG; Edwards, PAW; Fitzgerald, RC; - view fewer (2016) Whole-genome sequencing of nine esophageal adenocarcinoma cell lines. F1000Research , 5 , Article 1336. 10.12688/f1000research.7033.1 . Green open access

http://ift.tt/2ANT1kx

An interpretive thematic analysis of the p-factor literature and an empirical investigation of the relationship between the p-factor and childhood trauma and reflective function

Gibbon, Laura; (2017) An interpretive thematic analysis of the p-factor literature and an empirical investigation of the relationship between the p-factor and childhood trauma and reflective function. Doctoral thesis (D.Clin.Psy), UCL (University College London). Green open access

http://ift.tt/2im97es

Constructing Soviet and Post-Soviet Sexualities

Mole, RCM; (2018) Constructing Soviet and Post-Soviet Sexualities. Slavic Review (In press).

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Assessing the clinical applicability of prior head imaging in patients with chronic rhinosinusitis

Background

Patients often have received some modality of head imaging prior to being evaluated for chronic sinonasal complaints, and the clinical significance of these scans on current sinonasal symptomatology is unknown.

Methods

We performed a retrospective, cohort study of 578 patients with chronic sinonasal indications for maxillofacial computed tomography scans (CTs) in 2016. Patients were included if previous head cross-sectional imaging had been performed. Lund-McKay (LM) scores were calculated on the prior CT scan for each patient and compared to LM scores of the most recent scan. Scans with LM scores ≤3 were deemed normal, scores >3 were deemed positive, and Δ >3 was deemed a significant change.

Results

Of 578 patients, 153 (26.5%) patients had previous imaging. Overall, a strong correlation was noted between scans (r = 0.791, p < 0.001). Significant correlations remained with the subset of positive prior scans (r = 0.743, p < 0.001). The 3 most common prior imaging modalities were maxillofacial CT, head CT, and brain magnetic resonance imaging (MRI). Correlations between these modalities and subsequent maxillofacial CTs range from strong to moderately strong. Women were significantly more likely to have negative prior imaging (p = 0.048). Patients with negative prior imaging (80/153) were significantly more likely to remain unchanged (71/80) compared to patients with positive prior scans (56/73) (p = 0.023).

Conclusion

Prior head imaging highly correlates to future maxillofacial CT in patients with chronic sinonasal complaints, and patients with prior negative scans are likely to remain negative on future imaging. If prior head scans exist, practitioners may want to avoid ordering additional scans in the absence of changing symptoms.

http://ift.tt/2mxSFft

Eustachian tube dysfunction symptoms in patients treated in a tertiary rhinology clinic

Background

Ear symptoms are common among patients presenting to a rhinology clinic. Validated inventories are available for patient quality-of-life in sinonasal disease and Eustachian tube dysfunction (ETD). This study sought to determine the extent of ETD symptoms, using validated metrics, in a large population of patients presenting to a tertiary rhinology clinic.

Methods

Seven-item Eustachian Tube Dysfunction Questionnaires (ETDQ-7) and 22-item Sino-Nasal Outcome Tests (SNOT-22) were prospectively collected from 492 patients treated in a tertiary rhinology clinic. Patient diagnoses were retrospectively determined from the medical record. Correlation between reported SNOT-22 and ETDQ-7 scores were analyzed, in addition to the number of patients meeting the criterion score for ETD.

Results

A total of 213 patients reported mean ETDQ-7 scores >2.1, consistent with a diagnosis of ETD. Overall SNOT-22 scores were strongly correlated with ETDQ-7 scores (r = 0.679, p < 0.001). The SNOT-22 ear subdomain was very strongly correlated with the ETDQ-7 score (r = 0.847, p < 0.001), while there was a moderate correlation with the SNOT-22 rhinologic subdomain (r = 0.486, p < 0.001). Patients with allergic fungal sinusitis had decreased ETDQ-7 scores compared to patients with other rhinologic diagnoses (p = 0.010).

Conclusion

Symptoms of ETD are common in patients treated in a rhinology clinic, with 43.3% of patients reporting symptom scores consistent with a formal diagnosis of ETD. Increased SNOT-22 scores are correlated with increased ETDQ-7 scores, even when only the SNOT-22 rhinologic subdomain is considered. Patients presenting for treatment of rhinologic symptoms likely have an increased prevalence of otologic symptoms and ETD.

http://ift.tt/2z82tmo

The Johns Hopkins University and Deerfield Announce Collaboration to Catalyze Early Stage Therapeutic Research

The Johns Hopkins University and Deerfield Management announced today the creation of Bluefield Innovations, a collaboration designed to catalyze the development of early stage therapeutics. Funded by Deerfield, an investment management firm committed to advancing health care, Bluefield Innovations will provide up to $65 million in initial funding over five years to support the commercialization of early stage therapeutic research at Johns Hopkins, with additional funding available to advance research that shows strong commercial potential.

http://ift.tt/2z8Bzuy

Multiple annular plaques on a 9-year-old boy

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Fibroadipose vascular anomaly treated with sirolimus: Successful outcome in two patients

Abstract

Fibroadipose vascular anomaly (FAVA) is a rare, complex mesenchymal malformation combining fibrofatty replacement of the affected muscles and slow-flow vascular malformation. The condition is characterized by localized swelling, severe pain, phlebectasia, and contracture of the affected limb. Treatment paradigms are not well established for this rare, recently recognized condition. We report two cases of FAVA in which treatment with sirolimus produced rapid, dramatic improvement in pain and quality of life.

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Comment on “Case Series Study of the Efficacy of Compounded Antibacterial, Steroid, and Moisturizer in Atopic Dermatitis”

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Considerations in surgical management of a Buschke–Lowenstein tumor in Netherton syndrome: A case report

Abstract

Netherton syndrome is an autosomal recessive ichthyosis caused by mutations in SPINK5, with the classic triad of linearis circumflexa, trichorrhexis invaginata, and atopy. There are few reports of surgical management in individuals with Netherton syndrome and clinicians may be reluctant to operate for fear of wound-healing complications. This report describes a pediatric case of a Buschke–Lowenstein tumor of the natal cleft in a patient with Netherton syndrome that had failed to respond to medical management. We reviewed the literature for previous cases of surgery in individuals with Netherton syndrome using MEDLINE and PubMed searches. Our patient underwent surgery to remove the lesion without complication. Using conventional dressings and topical negative-pressure therapy, the wound was managed and healed within a reasonable time frame despite the underlying skin condition. This case indicates that surgery and topical negative-pressure therapy is a safe and reasonable treatment for individuals with Netherton syndrome.

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A 15-year-old boy with convoluted folds and furrows on the scalp

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Response to “Case series study of the efficacy of compounded antibacterial, steroid, and moisturizer in atopic dermatitis”

http://ift.tt/2hEf4GA

Infantile hemangiomas with conjunctival involvement: An underreported occurrence

Abstract

Background/Objectives

Infantile hemangiomas (IHs) involving the conjunctiva are only anecdotally reported in the literature and little is known about their clinical course. In a retrospective case series we aimed to better delineate the clinical presentation, complications, and response to treatment of this uncommon subtype of IH. A classification of conjunctival IH is proposed.

Methods

Medical charts at three academic pediatric dermatology institutions were retrospectively analyzed. Data were collected on the clinical characteristics, ophthalmologic findings, treatments, and outcomes of 22 individuals with conjunctival IH.

Results

Growth characteristics of conjunctival IH closely mirrored those of their cutaneous counterparts. Ophthalmologic abnormalities were associated with the IH in six individuals (27%); in three, they were considered severe. Seventeen subjects (77%) required treatment, most commonly because of risk of ocular compromise. All treated individuals responded favorably to topical timolol or systemic propranolol.

Conclusion

Conjunctival IH have clinical characteristics similar to those of cutaneous IH and respond readily to beta-blocker treatment. Ocular complications may occur in a minority of individuals receiving treatment.

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Comment on “Prevention of flares in children with atopic dermatitis with regular use of an emollient containing glycerol and paraffin: A randomised controlled study”

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Acute induration of the neck in a 16-year-old girl

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The triad of pruritus, xanthomas, and cholestasis: Two cases and a brief review of the literature

Abstract

When encountered in children, xanthomas are most commonly associated with a group of disorders known as familial hyperlipidemias. Aside from cosmetic concerns, these xanthomas are typically asymptomatic, but when generalized pruritus is a prominent associated symptom, clinicians should consider a different set of diagnoses that includes cholestasis of the liver. In this article we present two illustrative cases of children with cholestatic disease, pruritus, and xanthomas and discuss other disorders that may include this triad.

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A 15-year-old girl with a funky-looking great toenail

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Teenage boy with thickened dorsal hands and feet

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Evaluation of patient satisfaction in pediatric dermatology

Abstract

Background/Objectives

There remains a lack of investigation into which factors patients and families value the most in their experience at pediatric dermatology clinics. Most of the current literature on quality improvement in dermatology does not encompass the pediatric population. To determine the drivers that are most predictive of a positive patient experience, we observed the indirect relationship between several factors of the patient experience and their role in patient satisfaction.

Methods

Patient satisfaction surveys were distributed after their visits to patients at four pediatric dermatology clinics in one children's academic health system. Data were collected and organized into the top 30 survey variables with which patients expressed satisfaction on a 5-point Likert scale. Pearson product-moment correlation coefficients (r) for each variable with regard to "likelihood of your recommending our practice to others" were calculated.

Results

A total of 516 families completed patient satisfaction surveys. Analyses of top box scores showed that the strongest predictors of patient satisfaction were the likelihood of recommending care provider (r = .77, P = <.001), cheerfulness of practice (r = .76, P = <.001), care provider spoke using clear language (r = .73, P = <.001), patient confidence in care provider (r = .70, P = <.001), and our sensitivity to patient needs (r = .70, P = <.001).

Conclusion

The patient-physician relationship, along with the environment of the practice and its sensitivity to patients' personal needs, contributes most to the patient experience in pediatric dermatology. Identifying such variables that shape patients' assessments of their experience can guide future quality improvement plans in the specialty.

http://ift.tt/2zMTnZh

Issue Information

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Characterization of children with recurrent eczema herpeticum and response to treatment with interferon-gamma

Abstract

Background/Objectives

Interferon gamma (IFN-γ) has been used treat severe atopic dermatitis, with equivocal results. Recurrent eczema herpeticum is an underappreciated, therapeutically challenging complication of severe atopic dermatitis. Defects in IFN-γ and other cytokine pathways have been identified in individuals with confirmed eczema herpeticum. This suggests possible benefit from IFN-γ treatment for confirmed eczema herpeticum. The objective of the current study was to evaluate immunologic and microbial parameters and response to IFN-γ treatment in children with confirmed eczema herpeticum.

Methods

We performed a retrospective review of medical records from eight children with confirmed eczema herpeticum and two children with severe atopic dermatitis without a history of eczema herpeticum treated with subcutaneous IFN-γ.

Results

Our cohort of children with confirmed eczema herpeticum was predominantly male and had high total serum immunoglobulin E, evidence of insufficient toll-like receptor responses, and streptococcal skin and pharyngeal colonization. The duration of IFN-γ administration was 4.5-25 months. Five children had initial control and then relapse. Three had interval flares. Two had no improvement. Injections were well tolerated, without significant adverse effects. Treatment was associated with an increase in total immunoglobulin E. Poor adherence complicated therapy in five patients. All 10 discontinued IFN-γ for poor perceived efficacy.

Conclusion

Children with confirmed eczema herpeticum have evidence of impaired innate and adaptive immunity. IFN-γ did not result in dramatic improvement in either subset. Specific evaluation for IFN-γ production, function, or receptor defects may help predict response.

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A 7-year-old boy with pustules on the upper eyelid

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Chronic plaque on the great toe of a 10-year-old boy

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Persistent pruritic subcutaneous nodules and hypopigmentation in a young boy

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Patient Perspectives: What is papular urticaria?

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Multiple ulcerated lesions in a child

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Reply to Letter to Editor regarding “Economic impact of intraoperative parathyroid hormone assay in primary hyperparathyroidism”

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Letter to the Editor regarding “Systematic review and meta-analysis of venous thromboembolism in otolaryngology-head and neck surgery”

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Letter to the Editor regarding “Does it have a negative economic impact the intraoperative parathyroid hormone assay in primary hyperparathyroidism?”

http://ift.tt/2z84uyQ

Acute appendicitis presenting as a complicated inguinal hernia: a case of left-sided Amyand’s hernia in an elderly man

Abstract

Amyand's hernia (AH) is characterized by the presence of the vermiform appendix in an inguinal hernia sac. Typically presenting on the right side and with manifestations similar to those seen in complicated hernias, it presents a diagnostic challenge and is frequently only diagnosed intraoperatively. We present the case of a left-sided AH on a 75-year-old man treated with appendicectomy, orchidectomy and hernioplasty without mesh.

http://ift.tt/2AKRYll

Colon adenocarcinoma after jejunoileal bypass for morbid obesity

Abstract

Jejunoileal bypass (JIB) was developed as a surgical treatment for morbid obesity in the early 1950s. However, this procedure is now known to be associated with multiple metabolic complications and has subsequently been abandoned as a viable bariatric procedure. Some of these known complications include renal stone formation, liver failure, migratory arthritis, fat-soluble deficiencies, blind-loop syndrome and severe diarrhea. Additionally, there have been animal models suggesting colon dysplasia after JIB. To our knowledge however, in humans, no colon cancers have been attributed to JIB in the literature. Here we report a 63-year-old morbidly obese female who had a JIB surgery in 1973 and subsequently was found to have numerous sessile colonic polyps throughout her colon and adenocarcinoma of the ascending colon without any family history of colonic polyposis syndromes or colon cancer.

http://ift.tt/2AKNpaQ

Repair of giant inguinoscrotal hernia with loss of domain

Abstract

A massive inguinoscrotal hernia extending below the midpoint of the inner thigh, in a standing position, constitute a 'giant' inguinoscrotal hernia. A 74-year-old male presented with giant left sided inguinal hernia for the last 30 years. Patient underwent open repair under general anesthesia after perioperative respiratory exercise. Standard hernia repair identified a sliding hernia containing entire omentum, small and large bowel, and the appendix. Giant hernias pose a challenging problem because reduction of the hernia contents inside the abdominal cavity may increase intra-abdominal and thoracic pressures. Recurrence remains an issue for these patients after successful meshoplasty and debulking of abdominal contents. We describe a simple reduction with biological mesh repair, omentectomy, small bowel resection and sigmoidopexy as a viable technique for patients with greater than 50% of abdominal contents in the inguinoscrotal region with complete loss of domain.

http://ift.tt/2ALyehH

Tips on How to Store Baby Food Properly

 

Whether you made it in your own kitchen or bought it at the grocery story, do you know how to properly store baby food? Here are some tips to consider.

The post Tips on How to Store Baby Food Properly appeared first on ChildrensMD.

http://ift.tt/2imheHN

Predicting the atopic march: Results from the Canadian Healthy Infant Longitudinal Development Study

Publication date: Available online 15 November 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Maxwell M. Tran, Diana L. Lefebvre, Christoffer Dharma, David Dai, Wendy Y.W. Lou, Padmaja Subbarao, Allan B. Becker, Piush J. Mandhane, Stuart E. Turvey, Malcolm R. Sears
BackgroundThe atopic march describes the progression from atopic dermatitis during infancy to asthma and allergic rhinitis in later childhood. In a Canadian birth cohort we investigated whether concomitant allergic sensitization enhances subsequent development of these allergic diseases at age 3 years.MethodsChildren completed skin prick testing at age 1 year. Children were considered sensitized if they produced a wheal 2 mm or larger than that elicited by the negative control to any of 10 inhalant or food allergens. Children were also assessed for atopic dermatitis by using the diagnostic criteria of the UK Working Party. At age 3 years, children were assessed for asthma, allergic rhinitis, food allergy, and atopic dermatitis. Data from 2311 children were available.ResultsAtopic dermatitis without allergic sensitization was not associated with an increased risk of asthma at age 3 years after adjusting for common confounders (relative risk [RR], 0.46; 95% CI, 0.11-1.93). Conversely, atopic dermatitis with allergic sensitization increased the risk of asthma more than 7-fold (RR, 7.04; 95% CI, 4.13-11.99). Atopic dermatitis and allergic sensitization had significant interactions on both the additive (relative excess risk due to interaction, 5.06; 95% CI, 1.33-11.04) and multiplicative (ratio of RRs, 5.80; 95% CI, 1.20-27.83) scales in association with asthma risk. There was also a positive additive interaction between atopic dermatitis and allergic sensitization in their effects on food allergy risk (relative excess risk due to interaction, 15.11; 95% CI, 4.19-35.36).ConclusionsAtopic dermatitis without concomitant allergic sensitization was not associated with an increased risk of asthma. In combination, atopic dermatitis and allergic sensitization had strong interactive effects on both asthma and food allergy risk at age 3 years.



http://ift.tt/2hDITH6

The All In Award: A feasibility study of an intervention to improve children’s attitudes towards peers with intellectual disabilities

Fitzgerald, Sophie; (2017) The All In Award: A feasibility study of an intervention to improve children's attitudes towards peers with intellectual disabilities. Doctoral thesis (D.Clin.Psy), UCL (University College London).

http://ift.tt/2z7zAHa

Stabilizing the thermal lattice Boltzmann method by spatial filtering

Gillissen, JJJ; (2016) Stabilizing the thermal lattice Boltzmann method by spatial filtering. Physical Review E , 94 (4) , Article 043302. 10.1103/PhysRevE.94.043302 . Green open access

http://ift.tt/2mwSNfi

Support Following Miscarriage

Elfer, AF; (2017) Support Following Miscarriage. Doctoral thesis (D.Clin.Psy), UCL (University College London). Green open access

http://ift.tt/2z7zvTS

Exogenous testosterone enhances cortisol and affective responses to social evaluative stress in dominant men

Knight, EL; Christian, CB; Morales, PJ; Harbaugh, WT; Mayr, U; Mehta, PH; (2017) Exogenous testosterone enhances cortisol and affective responses to social evaluative stress in dominant men. Psychoneuroendocrinology , 85 pp. 151-157. 10.1016/j.psyneuen.2017.08.014 .

http://ift.tt/2muR1LL

Compassion Focused Therapy for People with Dementia: A Feasibility Study

Craig, Catriona; (2017) Compassion Focused Therapy for People with Dementia: A Feasibility Study. Doctoral thesis (D.Clin.Psy), UCL (University College London). Green open access

http://ift.tt/2z6X5Ad

Oscillating electric-field effects on adsorbed-water at rutile- and anatase-TiO2 surfaces

Futera, Z; English, NJ; (2016) Oscillating electric-field effects on adsorbed-water at rutile- and anatase-TiO2 surfaces. Journal of Chemical Physics , 145 (20) , Article 204706. 10.1063/1.4967520 .

http://ift.tt/2mwOf8T

Evidence of raised levels of autistic traits in a homeless population.

Churchard, AJ; (2017) Evidence of raised levels of autistic traits in a homeless population. Doctoral thesis (D.Clin.Psy), UCL (University College London). Green open access

http://ift.tt/2z7zLC4

Perturbation of hydration layer in solvated proteins by external electric and electromagnetic fields: Insights from non-equilibrium molecular dynamics

Nandi, PK; Futera, Z; English, NJ; (2016) Perturbation of hydration layer in solvated proteins by external electric and electromagnetic fields: Insights from non-equilibrium molecular dynamics. Journal of Chemical Physics , 145 (20) , Article 205101. 10.1063/1.4967774 .

http://ift.tt/2mtjfGG

Who uses foodbanks and why? Exploring the impact of financial strain and adverse life events on food insecurity

Prayogo, E; Chater, A; Chapman, S; Barker, M; Rahmawati, D; Waterfall, T; Grimble, G; (2017) Who uses foodbanks and why? Exploring the impact of financial strain and adverse life events on food insecurity. Journal of Public Health 10.1093/pubmed/fdx133 . (In press).

http://ift.tt/2z7zFKI

Surgical interventions for the management of chronic groin pain after hernia repair (postherniorrhaphy inguinodynia) in adults

Zwaans, WAR; Koning, GG; Gurusamy, KS; van Kleef, M; Scheltinga, MRM; Roumen, RMH; (2017) Surgical interventions for the management of chronic groin pain after hernia repair (postherniorrhaphy inguinodynia) in adults. Cochrane Database of Systematic Reviews , 2017 (4) , Article CD012630. 10.1002/14651858.CD012630 .

http://ift.tt/2mvUb1L

A spectroscopic search for AGN activity in the reionization era

Laporte, ; Nakajima, K; Ellis, R; Zitrin, A; Stark, DP; Mainali, R; Roberts-Borsani, ; (2017) A spectroscopic search for AGN activity in the reionization era. Astrophysics (In press).

http://ift.tt/2z8p81T

Structure and lattice dynamics of the wide band gap semiconductors MgSiN2 and MgGeN2

Rasander, M; Quirk, JB; Wang, T; Mathew, S; Davies, R; Palgrave, RG; Moram, MA; (2017) Structure and lattice dynamics of the wide band gap semiconductors MgSiN2 and MgGeN2. Journal of Applied Physics , 122 (8) , Article 085705. 10.1063/1.4985775 .

http://ift.tt/2mvVazc

The journey of weight loss maintenance: behaviour change programmes and processes

Campbell-Danesh, Aria; (2017) The journey of weight loss maintenance: behaviour change programmes and processes. Doctoral thesis (D.Clin.Psy), UCL (University College London).

http://ift.tt/2z7zorq

Prospective Memory and Future Event Simulation in Frequent Cannabis Users

Braidwood, Ruth; (2017) Prospective Memory and Future Event Simulation in Frequent Cannabis Users. Doctoral thesis (D.Clin.Psy), UCL (University College London). Green open access

http://ift.tt/2mvUUQK

A Mixed Methods Exploration of How Hospital Inpatients Understand and Use the Verbal Rating Scale of Pain

Bosdet, Luke; (2017) A Mixed Methods Exploration of How Hospital Inpatients Understand and Use the Verbal Rating Scale of Pain. Doctoral thesis (D.Clin.Psy), UCL (University College London). Green open access

http://ift.tt/2z7zak4

Social participation and mortality: does social position in civic groups matter?

Ishikawa, Y; Kondo, N; Kondo, K; Saito, T; Hayashi, H; Kawachi, I; JAGES group, .; (2016) Social participation and mortality: does social position in civic groups matter? BMC Public Health , 16 , Article 394. 10.1186/s12889-016-3082-1 . Green open access

http://ift.tt/2mxt723

Correlated multi-state models for multiple processes: An application to renal disease progression in systemic lupus erythematosus

O'Keeffe, AG; Su, L; Farewell, VT; (2018) Correlated multi-state models for multiple processes: An application to renal disease progression in systemic lupus erythematosus. Journal of the Royal Statistical Society: Series C (In press).

http://ift.tt/2z7BreU

'Between a rock and a hard place': family members' experiences of supporting a relative with bipolar disorder

Baruch, Ella; (2017) 'Between a rock and a hard place': family members' experiences of supporting a relative with bipolar disorder. Doctoral thesis (D.Clin.Psy), UCL (University College London). Green open access

http://ift.tt/2mxsWnp

Non-invasive and wearable early fever detection system for young children

Garcia-Souto, MDP; Dabnichki, P; (2018) Non-invasive and wearable early fever detection system for young children. Measurement , 116 pp. 216-229. 10.1016/j.measurement.2017.08.025 .

http://ift.tt/2z7BKGA

Learning to self-soothe without food: Emotion regulation, self-compassion and eating disorders

Amey, Rebecca; (2017) Learning to self-soothe without food: Emotion regulation, self-compassion and eating disorders. Doctoral thesis (D.Clin.Psy), UCL (University College London).

http://ift.tt/2mxsOUX

Collagen: A review on its sources and potential cosmetic applications

Summary

Collagen is a fibrillar protein that conforms the conjunctive and connective tissues in the human body, essentially skin, joints, and bones. This molecule is one of the most abundant in many of the living organisms due to its connective role in biological structures. Due to its abundance, strength and its directly proportional relation with skin aging, collagen has gained great interest in the cosmetic industry. It has been established that the collagen fibers are damaged with the pass of time, losing thickness and strength which has been strongly related with skin aging phenomena [Colágeno para todo. 60 y más. 2016. http://ift.tt/2hEKgFt.]. As a solution, the cosmetic industry incorporated collagen as an ingredient of different treatments to enhance the user youth and well-being, and some common presentations are creams, nutritional supplement for bone and cartilage regeneration, vascular and cardiac reconstruction, skin replacement, and augmentation of soft skin among others [J App Pharm Sci. 2015;5:123-127]. Nowadays, the biomolecule can be obtained by extraction from natural sources such as plants and animals or by recombinant protein production systems including yeast, bacteria, mammalian cells, insects or plants, or artificial fibrils that mimic collagen characteristics like the artificial polymer commercially named as KOD. Because of its increased use, its market size is valued over USD 6.63 billion by 2025 [Collagen Market By Source (Bovine, Porcine, Poultry, Marine), Product (Gelatin, Hydrolyzed Collagen), Application (Food & Beverages, Healthcare, Cosmetics), By Region, And Segment Forecasts, 2014 – 2025. Grand View Research. http://ift.tt/2sgOUco. Published 2017.]. Nevertheless, there has been little effort on identifying which collagen types are the most suitable for cosmetic purposes, for which the present review will try to enlighten in a general scope this unattended matter.

http://ift.tt/2hC5ow2

High plasma 25-hydroxyvitamin D and high risk of non-melanoma skin cancer: a Mendelian randomisation study of 97849 individuals

Abstract

Background

High plasma 25-hydroxyvitamin D (25 (OH)D) concentration has been associated observationally with high risk of non-melanoma skin cancer, while many studies suggest that vitamin D could have a protective effect on cancer. The true association between vitamin D and risk of skin cancer remains unclear.

Objectives

In this Mendelian randomisation study we tested the hypothesis that genetically high plasma 25(OH)D protects against non-melanoma skin cancer.

Methods

We included 103084 individuals from the Danish general population, of whom 35 298 had plasma 25(OH)D measured and 97849 were genotyped for four genetic variants near the DHCR7 and CYP2R1 genes associated with 25(OH)D concentrations. We tested the association between plasma 25(OH)D levels and non-melanoma skin cancer observationally, and between genetically determined 25(OH)D levels and non-melanoma skin cancer through an instrumental variable approach.

Results

Multivariable adjusted hazard ratios of non-melanoma skin cancer were 3.27 (95%CI: 2.22;4.84) for plasma 25(OH)D≥50 nmol/L versus <25 nmol/L. Genetic variants around DHCR7 and CYP2R1 genes were associated with up to 8.2 nmol/L higher 25(OH)D concentrations (F=314). The odds ratio for a genetically determined 20 nmol/L higher plasma 25(OH)D was 1.11 (0.91-1.35) for non-melanoma skin cancer, with a corresponding observational multivariable adjusted odds ratio of 1.13 (1.10-1.17).

Conclusion

Genetically determined high 25(OH)D did not appear to protect against non-melanoma skin cancer, while high plasma 25(OH)D concentrations were associated with high risk of non-melanoma skin cancer in observational analysis. Thus, the observational association likely reflects confounding by sun exposure rather than causality.

This article is protected by copyright. All rights reserved.

http://ift.tt/2z7x7fO

Analysis of anti-TNF-induced skin lesions reveals strong Th1 activation with some distinct immunological characteristics

Abstract

Background

Psoriasiform and eczematous eruptions are the most common dermatological adverse reaction linked to anti-TNF-α therapy. Yet, a detailed characterization of their immune phenotype is lacking.

Objectives

We sought to characterize anti-TNF-α induced inflammatory skin lesions on a histopathologic, cellular and molecular level, compared to psoriasis, eczema (atopic dermatitis), and healthy control skin.

Methods

Histopathologic evaluation, gene expression (quantitative RT-PCR) and computer-assisted immunohistologic studies (TissueFAXS) were performed on 19 skin biopsies from IBD (n=17) and rheumatoid arthritis (n=2) patients with new-onset inflammatory skin lesions during anti-TNF-α-therapy.

Results

While most biopsies showed a psoriasiform and/or spongiotic (eczematous) histopathologic architecture, these lesions were inconsistent with either psoriasis or eczema on a molecular level using an established CCL27/iNOS classifier. Despite some differences in immune skewing depending on the specific histopathologic reaction pattern, all anti-TNF-α-induced lesions showed strong IFN-γ activation, at higher levels than in psoriasis or eczema. IFN-γ was most likely produced by CD3/CD4/Tbet-positive Th1 lymphocytes.

Conclusions

New-onset anti-TNF-α-induced eruptions previously classified as psoriasis or spongiotic dermatitis (eczema) exhibit a molecular profile that is different from either of these disorders.

This article is protected by copyright. All rights reserved.

http://ift.tt/2mw9847

Don’t crush the sensitive snout. Reply to: Sensitivity is not enough

Editor—We entirely agree with Wilson's comments on our paper¹ that sensitivity and positive predictive value (PPV) cannot be equated,² and appreciate the opportunity to clarify this point. Indeed, it is important to highlight that a sensitive test often has a low PPV (Table 1).³ In the editorial, we did not in fact liken sensitivity to PPV, but rather related sensitivity to negative predictive value (NPV), using the acronym SNOUT (a negative result in a sensitive test rules out the disease). Table 1NPV, negative predictive value. PPV, positive predictive value. This table illustrates that a sensitive test (e.g.≥90%) has a high NPV (e.g.≥80%), except when the prevalence of a disorder is high and the specificity of the test is lowPrevalence %Sensitivity %Specificity %PPV %NPV %190908.399.9190501.899.8190201.199.520909069.297.320905031.095.220902022.088.950909090.090.050905064.383.350902052.966.7

http://ift.tt/2ASoHG8

Landmarks in UK anaesthesia

The celebrations in 2017 marking the award of a Royal Charter to the College of Anaesthetists 25 yr ago have been wide ranging and highly successful. They have acknowledged the significant contributions that the Royal College of Anaesthetists (RCoA) has since made to postgraduate education and training, to healthcare quality and patient safety, and to acute medical care both in hospital and beyond. Meetings have been held around the UK to demonstrate the commitment and accomplishments of the RCoA to all its fellows. A major part of the celebrations was the RCoA Anniversary Meeting organized under the leadership of Dr Ramana Alladi in London in March 2017. That scientific meeting entitled 'Landmarks in UK Anaesthesia' highlighted the major contributions that fellows of the RCoA have made to clinical and translational research, teaching and training, and healthcare quality improvement in the last 25 yr.

http://ift.tt/2yM12WJ

Limitations of clinical studies evaluating tertiary hyperalgesia

Editor—Shin and colleagues¹ suggested that magnesium sulphate attenuates increased pain intensity at sites remote from the surgical site (tertiary hyperalgesia), based on the observation of reduced pain in a magnesium-administered group vs controls after a second total knee arthroplasty (TKA) during staged bilateral total knee arthroplasty. This may serve as a basis for further studies of tertiary hyperalgesia, a topic that has not been studied extensively to date. Potential confounding factors or possible misinterpretations associated with this study should be discussed to enhance its influence on future studies.

http://ift.tt/2ARIAx0

Intraoperative permissive oliguria – how much is too much?

Acute kidney injury (AKI) after general surgery is a serious complication. In abdominal surgery the incidence is around 13%, and it is associated with increased postoperative morbidity, length of hospital stay and a 13-fold increase in the relative risk of in-hospital or 30-day mortality.¹²

http://ift.tt/2ARIrcW

Author's reply to Thomas et al.

Editor—We are pleased that Thomas and colleagues¹ agree with many of the conclusions in our Editorial and audit²³ of suboptimal laryngeal mask airway (LMA) placement. We agree with several points they make in their letter. If initial attempts fail, Magill forceps can be used to guide the flexible LMA beyond the epiglottis, or the cuff can be deflated even further, or more jaw thrust can be applied. All of these are included in our proposals. It is self-evident that there should be adequate levels of anaesthesia, but it would have been unnecessary to repeat such a fundamental point, as that necessity has been emphasized elsewhere.⁴

http://ift.tt/2yKMJl7

Cerebral blood flow and its autoregulation - when will there be some light in the black box?

When considering autoregulation, it is interesting to first consider the cerebral perfusion of a giraffe. Although their necks are about 2.5 m long, they must be able to drink water from the ground level of the oasis and then eat leaves from trees, causing large changes in cerebral perfusion pressure. Fortunately nature has provided them with several cardiovascular, anatomical and physiological adaptions to enable them to do so without fainting.¹

http://ift.tt/2AR1WCB

Reply to: Pulse oximeter perfusion index for assessment of brachial plexus block: a holy grail or a design fail?

Editor—We thank Daoud for his interest in our study¹ and are pleased to address the two concerns raised in his letter.²

http://ift.tt/2ASb0ak

Correlational studies of unconsciousness under anaesthesia: how far can preclinical studies take us?

Determining the electrophysiological correlates of loss of consciousness (LOC) and recovery of consciousness (ROC) under anaesthesia is a holy grail of biomedical science.¹ From a purely practical perspective, a non-invasive metric that tracks sensory awareness and is robust to the combination of anaesthetic drugs and patient factors would be a welcome addition to the anaesthetist's perioperative tool kit.² From a theoretical perspective, such a metric would prove invaluable for endeavours to understand the neural basis of consciousness, and in particular, sensory awareness.² The contribution by Plourde and Arseneau³ in this month's British Journal of Anaesthesia provides evidence towards that end. The authors report that the α₂-agonist dexmedetomidine attenuates high-frequency oscillations in the cortex and thalamus at doses that induce loss of the righting reflex. By comparing these results with their previous work on the thalamocortical effects of isoflurane and propofol,⁴⁵ the authors conclude that changes in thalamic γ-band signals may be electrophysiological correlates of LOC and ROC. It is interesting to note that some of the results presented here differ from previous studies, in which low γ (∼40 Hz) band power increased under anesthesia.⁶ In contrast, the effects on high γ (>80 Hz) signals observed by Plourde and Arseneau³ are likely to represent the suppression of spontaneous spiking activity under anaesthesia, which is well supported in the literature.⁷

http://ift.tt/2yL8Ho2

New nomenclature: Clarion call or siren song. Reply to: perioperative cognitive disorders

Editor—We thank Evered and Eckenhoff¹ for their great interest in our editorial.² We agree entirely with their perspective that much previous research into postoperative cognitive decline (POCD) is tainted, and that methodological weaknesses have led to incorrect conclusions. For example, the most reliable evidence (e.g. from randomized controlled trials) suggests that persistent POCD (both mild and major neurocognitive disorders [postoperative]) is likely to be a post hoc ergo propter hoc (after this therefore because of this) misattribution fallacy.³ We hope, as they do, that future research into this topic will be more rigorous.

http://ift.tt/2yMo5Re

In the December issue…

The final issue of 2017 is accompanied by a special bonus issue freely available on line: the Royal College of Anaesthetists 25^th Anniversary Special Issue (see editorial by Hemmings & Hunter, pages 1073--4). This collection of narrative reviews and special articles is based on presentations from the "Landmarks in UK Anaesthesia" meeting held in London in March 2017.

http://ift.tt/2yMVknx

25th Annual Meeting of Chinese Society of Anesthesiology

Zhengzhou China, September 7-10, 2017 

http://ift.tt/2AQNAlT

Why has NHS England introduced an innovation and technology tariff to improve safer arterial systems in England?

Editor—Arterial transducer infusion sets are associated with complications such as bacterial contamination and accidental arterial injection, potentially leading to bacteraemia, tissue necrosis and limb loss.¹ In recognition of reported complications, the NHS England National Patient Safety Agency (NPSA)² has issued warnings on the risks associated with accidental arterial injection, and the Joint Commission and the World Health Organization (WHO) have stated that injection ports on arterial catheters should be avoided.³ In England, after the 2008 National Awareness Alert, the NPSA required NHS hospitals to take immediate action and introduce safety systems that included training, audit, labeling of the arterial line and using red coloured transducer sets. Whilst these measures are helpful in reducing error, they do not prevent accidental arterial injection of medication intended for venous administration. Seven years after the NPSA alert we conducted a simulation study which illustrated mis-injection into the arterial line where, despite colour coding and labeling of standard arterial transducer sets, 2/3 study participants made this error in an emergency situation.⁴ From January 2008 to August 2015, there have been 155 reports of this error to NHS England (Keogh B, Medical Director and Durkin M, National Director of Patient Safety, NHS England, personal communication, 2015). However, it is likely that the error is under-reported as ischaemic complications are delayed for hours in the unconscious patients by which time the incident is forgotten, denied or obscured, and national reporting is not mandatory.

http://ift.tt/2yLN470

Pulse oximeter perfusion index for assessment of brachial plexus block: a holy grail or a design fail?

Editor—I read with interest the recently published article by Abdelnasser and colleagues¹ regarding prediction of successful supraclavicular brachial plexus block using the pulse oximeter perfusion index (PI). The article represents an addition to other articles evaluating the usefulness of the pulse oximeter perfusion index in objective assessment of brachial plexus blocks.^2–4

http://ift.tt/2ARzoJh

Formulation of a National Surgical Plan in Rwanda: a model for integration of physician and non-physician anaesthetists

Editor—Many low-income countries that have relied upon non-physician anaesthetists are now developing their own anaesthesia training programs for physician anaesthetists. Rwanda's experience of integrating and educating NPAs and PAs might serve as a model to other countries.

http://ift.tt/2yLMTsm

Sensitivity is not enough. Response to: Postoperative delirium portends descent to dementia

Editor—I welcome the thoughtful discussion by Aranake-Chrisinger & Avidan about testing for postoperative cognitive decline.¹ However, the penultimate paragraph is potentially misleading because it makes two common statistical errors. Firstly, there is confusion about the meaning and importance of test sensitivity. In addition to sensitivity, a test's utility needs to be evaluated in the context of its specificity and the disease prevalence. A test with 99% sensitivity can be clinically useless if it has poor specificity, or is used in a low prevalence population.²³ Their equating of a 50% sensitivity with a 50% positive predictive value is another commonly made mistake. The SNOUT (negative result in a sensitive test rules out the disease) acronym is unhelpful for the same reasons. Secondly, the article states that repetition of a test can help its sensitivity. This is only true if repeated testing produces results with some degree of conditional independence.⁴ There is no benefit from repeated testing if keeps giving the same result.

http://ift.tt/2ATwrrK

The role of propofol for remote ischaemic preconditioning in the setting of cardiac surgery – a Cochrane systematic review †

Editor—The concept of remote ischaemic preconditioning (RIPC) is an easy, readily available and inexpensive strategy to increase resistance to myocardial ischaemia/reperfusion injury. Within the past decade, RIPC has been translated from experimental studies with promising results to proof-of-principle randomized controlled trials (RCTs) in the setting of cardiac surgery. Despite some beneficial effects in terms of reduced myocardial injury as expressed by blood markers,¹ most RCTs failed to show a benefit of RIPC on short or long-term clinical outcome in patients undergoing cardiac surgery.²³ In this context, use of the i.v. anaesthetic propofol has been repeatedly discussed as potential confounding factor that significantly interferes and inhibits RIPC's cardioprotective effects.⁴⁵ We recently performed a Cochrane Systematic Review¹ to evaluate the benefits and harms of RIPC in patients undergoing coronary artery bypass grafting, with or without valve surgery. However, the potential influence of volatile anaesthetics compared with propofol anaesthesia was only part of a subgroup analysis and has not been fully evaluated yet. There is still a need to either confirm or exclude propofol as a confounding factor.

http://ift.tt/2yNrJud

Perioperative cognitive disorders. Response to: Postoperative delirium portends descent to dementia

Editor—We read with great interest the recent editorial by Aranake-Chrisinger & Avidan.¹ We were pleased to see that this editorial contains terminology developed over several yr by the multi-disciplinary International Perioperative Cognition Nomenclature Working Group. At the same time, we were surprised and disappointed that the terminology is presented before the official release (in the British Journal of Anaesthesia as well as Anesthesia & Analgesia, Canadian Journal of Anesthesiology, Acta Anaesthesiologica Scandinavica, Journal of Alzheimers Disease and Anesthesiology),² without the necessary definitions or attributions. This was particularly surprising given the senior author of the editorial was privy to the work of this group and reviewed final drafts of the manuscript. We presume this oversight simply reflects enthusiasm for adopting this new nomenclature.

http://ift.tt/2yO6zvF

Does intraoperative magnesium lessen pain after knee replacement surgery?

Editor—I write in response to the paper by Shin and colleagues¹ regarding the use of magnesium sulphate as an analgesic in staged knee arthroplasty. Whilst the study appears well-planned and presents some convincing results, my colleagues and I were left with a few questions.

http://ift.tt/2yKkDX3

Response to: ‘Failed supraglottic airway’: an algorithm for suboptimally placed supraglottic airway devices based on videolaryngoscopy

Editor—We read with interest the editorial by van Zundert and colleagues¹ in the recent issue of British Journal of Anaesthesia. We strongly commend the authors for highlighting the problem of suboptimal laryngeal mask airway (LMA) placement. As a single specialty ear, nose, and throat hospital, we are perhaps in a unique position in that the majority of our caseload is shared airway using first-generation flexible LMAs. Since the flexible LMA was introduced at our hospital in 1990, we estimate that we have performed >135 000 ENT operations, with 80–85% performed with flexible LMAs. This includes a large number of shared airway procedures, such as tonsillectomy. These procedures, in themselves, are a good test of LMA function, requiring the maintenance of optimal ventilation whilst also protecting the larynx from blood and debris.

http://ift.tt/2yKA8OL

Reply to: Does intraoperative magnesium lessen pain after knee replacement surgery?

Editor—We greatly thank. Buswell & Fregene¹ for their interest in our article.² We are pleased to respond to their comments below.

http://ift.tt/2yMUsiL

Headache in Resource-Limited Settings

Abstract

Purpose of Review

This review summarizes the unmet need of headache burden and management in resource-limited settings. It provides a general overview of the nuances and peculiarities of headache disorders in resource-limited settings. The review delivers perspectives and explanations for the emerging burden of both primary and secondary headache disorders. Important discussion on demographic and epidemiologic transition pertinent to low-resource settings is included. A critical analysis of headache disorders is made within the context of growing burden non-communicable disorders in low-resource countries. Challenges are examined and prospective feasible solutions tailored to existing resources are provided to address headache disorders in resource-limited settings.

Recent Findings

Many low-resource countries are entering into the third epidemiological transition featuring increasing burden of non-communicable disorders of which headache disorders contribute a significant proportion. Exponential population growth involving youthful demographic and massive rural-urban migration is taking place in low-resource countries. Youthful demographic is the natural cohort for primary headache such as migraine. Socioeconomic mobility and lifestyle changes are leading to higher levels of physical inactivity and obesity, both of which are related to headache. Life expectancy is rising in some resource-restricted countries; this increases prevalence of secondary headache attributed to neurovascular causes. Many low-resource countries are still burdened with tropical infectious causes of secondary headache. Health care facilities are primarily designed to respond to infectious epidemic and not to chronic burden such as headache. Many low-resource-restricted settings are plagued by poor and corrupt governance, ill-equipped regimes with malfunctioning health policies, war, and poverty. Many low-resource settings do not have access to generic headache medications such as triptans. Headache training and expertise is low. Healthy lifestyle changes emphasizing on improving regular exercise can be inexpensive method to reducing primary headache burden and its comorbidities (e.g. obesity).

Summary

Addressing the increasing burden of headache disorders in resource-limited settings is important to avert accrued disability which in turn lowers productivity and socioeconomic performance in a young booming population.

http://ift.tt/2zLnAKf

Patterns of allergic sensitization and atopic dermatitis from 1 to 3 years: effects on allergic diseases

Abstract

Background

While allergic sensitization and atopic dermatitis (AD) are known to increase the risk for allergic diseases, the impact of different temporal and clinical patterns of sensitization and AD is less well defined.

Objective

We investigated patterns of sensitization and AD from early infancy to age 3, and the differential risk for developing allergic diseases within each pattern in a general cohort.

Methods

Children (n=2629) from the Canadian Healthy Infant Longitudinal Development (CHILD) Study underwent skin prick tests and were assessed clinically for AD at ages 1 and 3 years. We applied an unsupervised latent class analysis (LCA) to the following 5 factors at these ages: AD, food sensitization, inhalant sensitization, poly-sensitization to foods, and poly-sensitization to inhalants. The risks for developing asthma, allergic rhinitis and food allergy at 3 years were evaluated for each identified group.

Results

Five distinct classes were revealed by LCA: healthy (81.8%), atopic dermatitis (7.6%), inhalant sensitization (3.5%), transient sensitization (4.1%), and persistent sensitization (3.2%). Using healthy children as the baseline, children in the "atopic dermatitis" group had the next lowest risk for all allergic outcomes at 3 years; those in the "inhalant sensitization" group had the highest risk for allergic rhinitis; children in the "transient sensitization" group were at an increased risk for food allergy; while children in the "persistent sensitization" group had the highest risk for all allergic diseases.

Conclusion and Clinical Relevance

There is substantial heterogeneity among allergen-sensitized children. Researchers and clinicians need to be aware of the non-specificity associated with labelling children simply as "atopic" and "non-atopic" without considering the timing of their atopic history, type of sensitization, and AD status. Children with AD who were poly-sensitized to foods at an early age appear to be at greatest risk of developing other allergic diseases.

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Asthma and Lung Function in Adulthood after a Viral Wheezing Episode in Early Childhood

Abstract

Background

Viral etiology of infection has a significant role in the long-term outcome of early-childhood wheezing.

Objective

This study examines asthma and lung function in adulthood after early-childhood wheezing induced by respiratory syncytial virus (RSV) and rhinovirus (RV).

Methods

A total of 100 children were hospitalized for a wheezing episode at less than 24 months of age from 1992 to 1993 in Kuopio University Hospital (Finland). Adenovirus, influenza A and B virus, parainfluenza (1-3) virus, and RSV were tested on admission using antigen detection and antibody assays, and RSV and RV were tested by polymerase chain reaction (PCR). In 2010, 49 cases and 60 population controls attended a follow-up study, which included spirometry with bronchodilation test and fractionally exhaled nitric oxide (FE_NO) measurements.

Results

Current asthma was present in 64% of the cases with RV-induced wheezing [OR 17.0 (95%CI 3.9-75.3) vs. controls], in 43% of the cases with RSV-induced wheezing episode [6.1 (1.5-24.9) vs. controls], and in 12% of the controls. The RV group showed significantly higher mean FE_NO values than the RSV group and controls. RV-positive cases had lower MEF50 before bronchodilation and higher MEF50, FEV1, and FEV1/FVC bronchodilation responses than controls. RSV-positive cases had lower FVC than controls before bronchodilation.

Conclusion

Cases with RV- and RSV-induced early-childhood wheezing had increased risk for asthma in adulthood, and RV-positive cases had significantly higher FE_NO values than RSV-positive cases and controls. Compared to controls RV-positive cases showed more bronchial reactivity, and RSV-positive cases showed lower FVC before bronchodilation in lung function testing.

Clinical relevance

Children with RV- or RSV-induced wheezing in early childhood have an increased risk for asthma and lung function abnormalities in adulthood.

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