Veronika Horn | Antigoni Triantafyllopoulou
http://ift.tt/2iaYcUg
Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Σάββατο 2 Δεκεμβρίου 2017
DNA damage signaling and polyploid macrophages in chronic inflammation
Food Allergy: Update on Prevention and Tolerance
Source:Journal of Allergy and Clinical Immunology
Author(s): George Du Toit, Hugh Sampson, Marshall Plaut, Wesley Burks, Cezmi Akdis, Gideon Lack
Of the many possible hypotheses which explain the recent rise in childhood food allergy, the dual allergen exposure hypothesis has been the most extensively investigated. This chapter serves as a review and update on the prevention of food allergy, and focuses on recently published Randomized Controlled Trials (RCTs) exploring the efficacy of oral tolerance induction in infancy for the prevention of food allergy. As a result of these RCTs, National Institutes of Health (NIH) recommendations now actively encourage the early introduction of peanut for the prevention of peanut allergy and other countries/settings recommend the inclusion of potential common food allergens including peanut and egg in complementary feeding regimens commencing at approximately 6 months of age, but not before 4 months.1-3 Further studies which explore the efficacy of oral tolerance induction to other common food allergens, and which focus on optimal timing, duration and adherence are required.
http://ift.tt/2ASu5fG
Dual loss of p110δ PI3-kinase and SKAP (KNSTRN) expression leads to combined immunodeficiency and multisystem syndromic features
Source:Journal of Allergy and Clinical Immunology
Author(s): Nigel Sharfe, Ariana Karanxha, Harjit Dadi, Daniele Merico, David Chitayat, Jo-Anne Herbrick, Spencer Freeman, Sergio Grinstein, Chaim M Roifman
BackgroundWe previously reported a novel syndrome characterized by combined immunodeficiency associated with severe developmental defects - subsequently known as Roifman-Chitayat Syndrome (RCS; OMIM 613328). Linkage analysis identified two disease-associated loci.ObjectiveTo identify the genetic defect in these patients and characterize their immunological cellular abnormalities.MethodsGenetic, immunological, protein and cellular functional analyses were used to identify and characterize patient genetic deficiencies and aberrant patient cell behaviour.ResultsDeleterious variants were found at both loci identified by linkage analysis: a homozygous stop codon in PI3-kinase p110δ (PIK3CD) and a homozygous frame shift mutation in SKAP (KNSTRN), both ablating protein expression. RCS patients display aberrant B cell development, similar to p110δ deficient mice, but also aberrant T cell spreading, cell-cell interaction and migration. Patients also display significant developmental abnormalities not seen in p110δ knockouts (e.g. optic nerve atrophy, skeletal anomalies) that we ascribe to loss of SKAP. Aberrant SKAP expression can prolong anaphase and this may contribute to developmental defects. However, we also identified MAP4 microtubule-binding protein as a novel SKAP-binding partner and show it undergoes re-localization in patient T cells, with associated areas of aberrant microtubule hyper-stabilization, likely contributing not only to the altered properties of RCS lymphoid cells but also developmental defects.ConclusionsThe complex Roifman-Chitayat Syndrome presentation, with combined developmental and immunological defects, is associated with a combined deficiency of two genes products, PI3-kinase p110δ and SKAP, both of which appear to play a significant role in the disease.
Teaser
Patients with Roifman-Chitayat syndrome suffer repeated infections due to combined immunodeficiency and display a wide array of syndromic features encompassing developmental delay, optic nerve atrophy and skeletal anomalies. We show here for the first time that complete SKAP and PI3K p110δ deficiencies lead to this complex syndrome.http://ift.tt/2zYxhXi
Self-reported adverse food reactions and anaphylaxis in the SchoolNuts study: A population-based study of adolescents
Source:Journal of Allergy and Clinical Immunology
Author(s): Vicki L. McWilliam, Jennifer J. Koplin, Michael J. Field, Mari Sasaki, Shyamali C. Dharmage, Mimi L.K. Tang, Susan M. Sawyer, Rachel L. Peters, Katrina J. Allen
BackgroundAdolescents are at the highest risk of death from anaphylaxis, yet few population-based studies have described the frequencies and risk factors for allergic reactions caused by accidental allergen ingestion in this group.MethodsWe describe the prevalence, frequency, and associated risk factors for recent adverse food reactions in 10- to 14-year-olds in Melbourne, Australia, recruited from a stratified, random, population-based sample of schools (SchoolNuts, n = 9663; 48% response rate). Self-reported food allergy and adverse reaction details, including anaphylaxis, were identified by using a student questionnaire over the past year.ResultsOf 547 students with possible IgE-mediated food allergy, 243 (44.4%; 95% CI, 40.3% to 48.7%) reported a reaction to a food. Fifty-three (9.7%; 95% CI, 7.2% to 12.2%) students reported 93 anaphylaxis episodes. Peanut and tree nuts were the most common food triggers. Among students with current IgE-mediated food allergy, those with resolved or current asthma (adjusted odds ratio [aOR], 1.9 [95% CI, 1.1-1.3] and 1.7 [95% CI, 1.1-2.6]) and those with more than 2 food allergies (aOR, 1.9 [95% CI, 1.1-3.1]) were at greatest risk of any adverse food reaction, and those with nut allergy were most at risk of severe reactions (aOR, 2.9 [95% CI, 1.1-4.4]). Resolved or current asthma was not associated with increased risk of severe reactions (aOR, 0.8 [95% CI, 0.3-2.2] and 1.6 [95% CI, 0.7-3.7]).ConclusionsAdolescents with food allergy are frequently exposed to food allergens. Those with asthma and more than 2 food allergies were at the greatest risk for adverse food reactions. Those with nut allergies were most at risk of severe reactions.
http://ift.tt/2A04MID
Food Allergy in the developing world
Source:Journal of Allergy and Clinical Immunology
Author(s): Agnes SY. Leung, Gary WK. Wong, Mimi LK. Tang
http://ift.tt/2ASu0so
Food Allergy: A review and update on epidemiology, pathogenesis, diagnosis, prevention and management
Source:Journal of Allergy and Clinical Immunology
Author(s): Scott H. Sicherer, Hugh A. Sampson
This review provides general information to serve as a primer for those embarking on understanding food allergy and also details advances and updates in epidemiology, pathogenesis, diagnosis and treatment that have occurred over the four years since our last comprehensive review. Although firm prevalence data are lacking, there is a strong impression that food allergy has increased, and rates as high as ∼10% have been documented. Genetic, epigenetic and environmental risk factors are being increasingly elucidated, opening the potential for improved prevention and treatment strategies targeted to those at risk. Insights on pathophysiology are revealing a complex interplay of epithelial barrier, mucosal and systemic immune response, route of exposure and microbiome among other influences resulting in allergy or tolerance. The diagnosis of food allergy is largely reliant on the medical history, tests for sensitization, and oral food challenges, but emerging use of component resolved diagnostics are improving diagnostic accuracy. Additional novel diagnostics such as basophil activation tests, determination of epitope binding, DNA methylation signatures and bioinformatics approaches will further change the landscape. A number of prevention strategies are under investigation, but early introduction of peanut has been advised as a public health measure based on existing data. Management remains largely based on allergen avoidance, but a panoply of promising treatment strategies are in phase 2 and 3 studies, giving immense hope that better treatment will be imminently and widely available, while numerous additional promising treatments are in the preclinical and clinical pipeline.
http://ift.tt/2zYsvsE
Bedroom allergen exposures in US households
Publication date: Available online 30 November 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Päivi M. Salo, Jesse Wilkerson, Kathryn M. Rose, Richard D. Cohn, Agustin Calatroni, Herman E. Mitchell, Michelle L. Sever, Peter J. Gergen, Peter S. Thorne, Darryl C. Zeldin
BackgroundBedroom allergen exposures contribute to allergic disease morbidity because people spend considerable time in bedrooms, where they come into close contact with allergen reservoirs.ObjectiveWe investigated participant and housing characteristics, including sociodemographic, regional, and climatic factors, associated with bedroom allergen exposures in a nationally representative sample of the US population.MethodsData were obtained from National Health and Nutrition Examination Survey 2005-2006. Information on participant and housing characteristics was collected by using questionnaires and environmental assessments. Concentrations of 8 indoor allergens (Alt a 1, Bla g 1, Can f 1, Fel d 1, Der f 1, Der p 1, Mus m 1, and Rat n 1) in dust vacuumed from nearly 7000 bedrooms were measured by using immunoassays. Exposure levels were classified as increased based on percentile (75th/90th) cutoffs. We estimated the burden of exposure to multiple allergens and used multivariable logistic regression to identify independent predictors for each allergen and household allergen burden.ResultsAlmost all participants (>99%) had at least 1 and 74.2% had 3 to 6 allergens detected. More than two thirds of participants (72.9%) had at least 1 allergen and 18.2% had 3 or more allergens exceeding increased levels. Although exposure variability showed significant racial/ethnic and regional differences, high exposure burden to multiple allergens was most consistently associated with the presence of pets and pests, living in mobile homes/trailers and older and rental homes, and living in nonmetropolitan areas.ConclusionsExposure to multiple allergens is common. Despite highly variable exposures, bedroom allergen burden is strongly associated with the presence of pets and pests.
Graphical abstract
http://ift.tt/2AStXNe
Obesity, asthma, and vitamin D deficiency in pregnancy: Cause or consequence?
Source:Journal of Allergy and Clinical Immunology
Author(s): Marcos Pereira-Santos, Lucas Luê Bispo Pereira, Denise Santana de Oliveira
http://ift.tt/2AStWc8
Reply
Source:Journal of Allergy and Clinical Immunology
Author(s): Hooman Mirzakhani, Scott T. Weiss, Augusto A. Litonjua
http://ift.tt/2zXbijw
Endolysosomal protease susceptibility of Amb a 1 as a determinant of allergenicity
Publication date: Available online 20 November 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Martin Wolf, Lorenz Aglas, Teresa E. Twaroch, Markus Steiner, Sara Huber, Michael Hauser, Maria A. Parigiani, Heidi Hofer, Christof Ebner, Barbara Bohle, Peter Briza, Angela Neubauer, Frank Stolz, Michael Wallner, Fatima Ferreira
In the absence of extrinsic adjuvants, purified Amb a 1 induced a strong Th2-polarized immune response in mice. This high allergenic activity seems to be linked to the allergen's susceptibility to endolysosomal proteolysis.
http://ift.tt/2APp5Zx
Enhancement of cutaneous immunity during ageing by blocking p38 MAPkinase induced inflammation
Publication date: Available online 17 November 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Milica Vukmanovic-Stejic, Emma S. Chambers, Mayte Suarez- Farinas, Daisy Sandhu, Judilyn Fuentes-Duculan, Neil Patel, Elaine Agius, Katie E. Lacy, Carolin T. Turner, Anis Larbi, Veronique Birault, Mahdad Noursadeghi, Neil A. Mabbott, Malcolm H.A. Rustin, James Krueger, Arne N. Akbar
BackgroundImmunity declines with age that leads to re-activation of varicella zoster virus (VZV). In humans, age associated immune changes are usually measured in blood leukocytes however this may not reflect alterations in tissue-specific immunity.ObjectivesWe used a VZV antigen challenge system in the skin to investigate changes in tissue specific mechanisms involved in the decreased response to this virus during ageing.MethodsWe assessed cutaneous immunity by the extent of erythema and induration after intradermal VZV antigen injection. We also performed immune histology and transcriptomic analyses on skin biopsies taken from the site of challenge in young (<40 yrs) and old (>65 yrs) subjects.ResultsOld humans exhibited decreased erythema and induration, CD4+ and CD8+ T cell infiltration and attenuated global gene activation at the site of cutaneous VZV antigen challenge compared to young subjects. This was associated with elevated sterile inflammation in the skin in the same subjects, related to p38 MAPK-related pro-inflammatory cytokine production (p <0.0007). We inhibited systemic inflammation in old subjects by pre-treatment with an oral small molecule p38 MAP kinase inhibitor (Losmapimod), which reduced both serum C reactive protein (CRP) and peripheral blood monocyte secretion of IL-6 and TNF-α. In contrast, cutaneous responses to VZV antigen challenge was significantly increased in the same individuals (p <0.0006).ConclusionExcessive inflammation in the skin early after antigen challenge retards antigen-specific immunity. However this can be reversed by inhibition of inflammatory cytokine production that may be utilized to promote vaccine efficacy and the treatment of infections and malignancy during ageing.
Graphical abstract
Teaser
Capsule summary: Elevated cutaneous inflammation retards VZV-specific immunity. Inhibiting inflammatory cytokine production with p38 MAPkinase inhibitors enhances VZV-specific cutaneous immunity. Targeting inflammation may be used to promote vaccine efficacy and the treatment of malignancy during ageing.http://ift.tt/2zYsvc8
Vascular endothelial specific IL-4Rα–ABL1 kinase signaling axis regulates severity of IgE-mediated anaphylactic reactions
Publication date: Available online 17 November 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Amnah Yamani, David Wu, Lisa Waggoner, Taeko Noah, Anthony J. Koleske, Fred Finkelman, Simon P. Hogan
BackgroundSevere IgE-mediated, food-induced anaphylactic reactions are characterized by pulmonary venous vasodilatation and fluid extravasation, which is thought to lead to the life-threatening anaphylactic phenotype. The underlying immunological and cellular processes involved in driving fluid extravasation and the severe anaphylactic phenotype are not fully elucidated.ObjectiveTo define the interaction and requirement of IL-4 and vascular endothelial (VE) IL-4Rα chain signaling in histamine-ABL1–mediated VE dysfunction and fluid extravasation in the severity of IgE-mediated anaphylactic reactions in mice.MethodsMice deficient in VE IL-4Rα and models of passive and active oral antigen– and IgE-induced anaphylaxis were employed to define the requirements of VE IL-4Rα and ABL1 pathway in severe anaphylactic reactions. Human VE cell line (EA.hy926 cells) and pharmacologic (imatinib) and genetic approaches (shRNA knockdown of IL4RA and ABL1) were used to define the requirement of this pathway in VE barrier dysfunction.ResultsIL-4 exacerbation of histamine-induced hypovolemic shock in mice was dependent on VE expression of the IL-4Rα. IL-4 and histamine induced ABL1 activation in human VE cells and VE barrier dysfunction was ABL1 dependent. Development of severe IgE-mediated hypovolemia and shock required VE-restricted ABL1 expression. Treatment of mice with a history of food-induced anaphylaxis with the ABL kinase inhibitor imatinib protected the mice from developing severe IgE-mediated anaphylaxis.ConclusionIL-4 amplifies IgE- and histamine-induced VE dysfunction, fluid extravasation, and severity of anaphylaxis via a VE IL-4Rα-ABL1–dependent mechanism. These studies implicate an important contribution by the VE compartment in the severity of anaphylaxis and identify a new
Graphical abstract
Teaser
Capsule Summary: IL-4-Histamine induced vascular endothelial cell ABL1 kinase signaling controls severity of IgE-mediated anaphylactic reactions.http://ift.tt/2zYQYy8
Drug hypersensitivity: we need to do more
Source:Journal of Allergy and Clinical Immunology
Author(s): Werner J. Pichler, Daniel Yerly
http://ift.tt/2zXb3oC
Mycology of chronic suppurative otitis media-cholesteatoma disease: An evaluative study
Source:American Journal of Otolaryngology
Author(s): Gautam Bir Singh, Medozhanuo Solo, Ravinder Kaur, Rubeena Arora, Sunil Kumar
Aims & objectivesTo detect the prevalence of fungus in chronic suppurative otitis media-cholesteatoma disease and to evaluate its clinical significance.Study designProspective observational study conducted in a sample size of 46 patients at a tertiary care university teaching hospital.Materials & methodsForty six patients suffering from chronic suppurative otitis media-cholesteatoma disease were recruited in this prospective study. Data was duly recorded. Cholesteatoma sample was procured at the time of mastoid surgery and microbiologically analysed for fungal infestation. Clinical correlation to fungus infestation of cholesteatoma was statistically analysed.ResultsOut of the recruited 46 patients, post-operatively cholesteatoma was seen in 40 cases only. Seventeen i.e. 42.5% of these cases had fungal colonization of cholesteatoma. Further a statistically significant correlation between persistent otorrhoea and fungal infestation of cholesteatoma was observed. Three cases of fungal otomastoiditis were also recorded in this study, but a statistically significant correlation between complications and fungus infestation of cholesteatoma could not be clearly established.ConclusionsThere is fungal colonization of cholesteatoma which is pathogenic and can cause persistent otorrhoea.
http://ift.tt/2BuAVnV
Commentary to letter to the editor to manuscript “Effects of surgical treatment of hypertrophic turbinates on the nasal obstruction and the quality of life”
Source:American Journal of Otolaryngology
Author(s): Katharina Stölzel
http://ift.tt/2jbgYMj
Symptomatic unilateral vocal fold paralysis following cardiothoracic surgery
Unilateral vocal fold paralysis (UVFP) is a complication associated with cardiothoracic procedures that presents clinically as dysphonia and/or dysphagia with or without aspiration. The literature lacks both data on recovery of mobility and consensus on best management. Herein, our goals are to 1) Identify cardiothoracic procedures associated with symptomatic UVFP at our institution; 2) Review timing and nature of laryngology diagnosis and management; 3) Report spontaneous recovery rate of vocal fold mobility.
http://ift.tt/2j9Qs5M
Intestinal permeability and Ménière's disease
Ménière disease (MD) is a multifactorial chronic disabling condition characterized by episodic vertigo, ear fullness, and hearing loss. MD patients often complain of aspecific gastrointestinal symptoms associated with autonomic dysregulation, frequently outweighed by the otological manifestations. Dietary modifications have been reported to improve the typical MD symptoms in some cases. Our purpose was to test the urinary levels of lactulose and mannitol (double sugar test) and the fecal calprotectin, both markers of altered intestinal permeability, in subjects with definite MD in an active and inactive stage.
http://ift.tt/2BtQxbm
Factors influencing recurrent emergency department visits for epistaxis in the elderly
Our objective is to determine the risk factors associated with recurrent epistaxis requiring emergency department (ED) visits in the elderly.
http://ift.tt/2BEl7jl
Statin Use and Risk of Skin Cancer
Previous studies demonstrated higher keratinocyte carcinoma risk with statin use, but lacked adjustment for important confounders.In this study, longer duration of statin use was associated with higher basal cell carcinoma risk in men only.The relation between statins and skin cancer risk may differ by sex.
http://ift.tt/2jFBwfc
Prevention of Mucositis in Patients With Head and Neck Cancer Treated With Radiotherapy
Conditions: Radiation- Induced Mucositis; Adverse Effect of Radiation Therapy; Head and Neck Cancer
Interventions: Other: Normal saline with salt/Soda; Other: Clinacanthus nutans; Other: Boesenbergia rotunda
Sponsor: Chulabhorn Hospital
Recruiting
http://ift.tt/2Buprki
Interventions: Other: Normal saline with salt/Soda; Other: Clinacanthus nutans; Other: Boesenbergia rotunda
Sponsor: Chulabhorn Hospital
Recruiting
http://ift.tt/2Buprki
Salvage surgery for recurrence of laryngeal and hypopharyngeal squamous cell carcinoma: A retrospective study from 2005 to 2013
Publication date: Available online 2 December 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): K. Pujo, P. Philouze, A. Scalabre, P. Céruse, M. Poupart, G. Buiret
ObjectivesSalvage surgery is the gold-standard treatment for locoregional recurrence of laryngeal and hypopharyngeal cancer following radiation therapy. Imperfect oncologic and functional results, however, require patient selection. The main objective of the present study was to determine preoperative factors for survival. Secondary objectives were to study 5-year overall and disease-free survival, general and locoregional complications, and functional results in terms of feeding and tracheotomy closure.Patients and methodA retrospective multicenter study included 52 patients treated by salvage surgery for recurrence of laryngeal or hypopharyngeal squamous cell carcinoma after radiation therapy between 2005 and 2013.ResultsFactors associated with improved 3-year overall survival on univariate analysis comprised laryngeal primary (P=0.001), laryngeal recurrence (P=0.026), rT1, rT2 or rT3 rather than rT4 tumor (P=0.007), previous chemotherapy (P=0.036), and neck dissection during salvage surgery (P=0.005), the last of these being confirmed on multivariate analysis. Five-year overall survival was 36.0% (range, 27.6–44.4%), for a median 23.04 months (95% CI, 19.44–26.64). Five-year disease-free survival was 23.5% (range, 16.0–31.0%), for a median 8.04 months (95% CI, 2.04–14.04).ConclusionSalvage surgery for laryngeal or hypopharyngeal cancer is difficult, and survival is not good. Laryngeal primary and recurrence location, moderate tumor volume and extension (<T4), prior chemotherapy and neck dissection during salvage surgery were associated with better overall and disease-free survival, which should enable better patient selection.
http://ift.tt/2BE0UdI
Let's not twist and spin-doctor our articles
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): O. Laccourreye, H. Maisonneuve
http://ift.tt/2khUMn5
Association of Lymph Node Density With Survival of Patients With Papillary Thyroid Cancer.
Association of Lymph Node Density With Survival of Patients With Papillary Thyroid Cancer.
JAMA Otolaryngol Head Neck Surg. 2017 Nov 30;:
Authors: Amit M, Tam S, Boonsripitayanon M, Cabanillas ME, Busaidy NL, Grubbs EG, Lai SY, Gross ND, Sturgis EM, Zafereo ME
Abstract
Importance: Lymph node metastases are common in papillary thyroid cancer (PTC), yet the impact of nodal metastases on survival remains unclear. Lymph node density (LND) is the ratio between the number of positive lymph nodes excised and the total number of excised lymph nodes. Lymph node density has been suggested as a prognostic factor in many types of cancer.
Objective: To evaluate the prognostic role of LND in PTC.
Design, Setting, and Participants: This cohort study reviewed medical records of patients with PTC who were treated at the University of Texas MD Anderson Cancer Center between January 1, 2000, and December 31, 2015. Survival and recurrence outcomes were calculated by using the Kaplan-Meier method. Significant variables on univariate analysis were subjected to a Cox proportional hazards regression multivariate model.
Main Outcomes and Measures: Primary study outcome was disease-specific survival (DSS); other measurements included overall survival (OS).
Results: The study cohort included data for 2542 patients (1801 [71%] male; median age, 48 years [range, 18-97 years]) with a median follow-up of 55 months (range, 4-192 months). The 10-year disease-specific survival rate was 98% for patients with LND of 0.19 or less, compared with 90% for those with LND greater than 0.19 (effect size, 8%; 95% CI, 4%-15%). The 10-year overall survival was 87% for patients with LND of 0.19 or less, compared with 79% for patients with LND greater than 0.19 (effect size, 8%; 95% CI, 3%-15%). Multivariable analysis revealed that LND greater than 0.19 was independently associated with an adverse DSS (hazard ratio [HR], 4.11; 95% CI, 2.11-8.97) and OS (HR, 1.96; 95% CI, 1.24-4.11). Subgroup analysis of patients with 18 or more lymph nodes analyzed revealed that LND greater than 0.19 remained a significant marker for DSS (HR, 2.94; 95% CI, 1.36-9.81) and OS (HR, 2.26; 95% CI, 1.12-5.34). Incorporating LND into the current American Joint Committee on Cancer staging system successfully stratified risk groups compared with the traditional TNM staging system.
Conclusions and Relevance: This single-institute study demonstrates the reproducibility of LND as a predictor of outcomes in PTC. Lymph node density can potentially assist in identifying patients with poorer survival who may benefit from more aggressive adjuvant therapy.
PMID: 29192312 [PubMed - as supplied by publisher]
http://ift.tt/2AOjdQa
Asymptomatic Septal Mass.
Asymptomatic Septal Mass.
JAMA Otolaryngol Head Neck Surg. 2017 Nov 30;:
Authors: Arden RL, Griggs ZH, Wey EA
PMID: 29192306 [PubMed - as supplied by publisher]
http://ift.tt/2nltMUR
Association of Hearing Loss and Otologic Outcomes With Fibrous Dysplasia.
Association of Hearing Loss and Otologic Outcomes With Fibrous Dysplasia.
JAMA Otolaryngol Head Neck Surg. 2017 Nov 30;:
Authors: Boyce AM, Brewer C, DeKlotz TR, Zalewski CK, King KA, Collins MT, Kim HJ
Abstract
Importance: Fibrous dysplasia (FD) and McCune-Albright syndrome (MAS) are rare bone and endocrine disorders in which expansile fibro-osseous lesions result in deformity, pain, and functional impairment. The effect of FD on hearing and otologic function has not been established.
Objectives: To characterize audiologic and otologic manifestations in a large cohort of individuals with FD/MAS and to investigate potential mechanisms of hearing loss.
Design, Setting, and Participants: In this natural history study, individuals with craniofacial FD seen at a clinical research center underwent clinical, biochemical, computed tomographic, audiologic, and otolaryngologic evaluations.
Main Outcomes and Measures: Clinical and radiologic features associated with hearing loss and otologic disease were evaluated. Conductive hearing loss was hypothesized to be associated with narrowing of the external auditory canal (EAC), FD involving the epitympanum, and FD crowding the ossicular chain. Sensorineural hearing loss was hypothesized to be associated with FD affecting the internal auditory canal (IAC) and otic capsule.
Results: Of the 130 study participants with craniofacial FD who were evaluated, 116 (89.2%) had FD that involved the temporal bone (median age, 19.6 years; range, 4.6-80.3 years; 64 female [55.2%]), whereas 14 (10.8%) had craniofacial FD that did not involve the temporal bone. Of the 183 ears with temporal bone FD, hearing loss was identified in 41 ears (22.4%) and was conductive in 27 (65.9%), sensorineural in 12 (29.3%), and mixed in 2 (4.9%). Hearing loss was mild and nonprogressive in most participants. Whereas EACs were narrower in ears with FD (mean difference [MD], 0.33 mm; 95% CI, 0.11-0.55 mm), this finding was associated with conductive hearing loss in only 4 participants. Fibrous dysplasia crowding of the ossicles was associated with conductive hearing loss (odds ratio [OR], 5.0; 95% CI, 2.1-11.6). The IAC length was not different between ears with and without FD (MD, -0.37; 95% CI, -0.95 to 0.211); however, canals were elongated in ears with sensorineural hearing loss (MD, -1.33; 95% CI, -2.60 to -0.07). Otic capsule involvement was noted in only 4 participants, 2 of whom had sensorineural hearing loss. Both MAS-associated growth hormone excess (OR, 3.1; 95% CI, 1.3-7.5) and neonatal hypercortisolism (OR, 11; 95% CI, 2.5-55) were associated with an increased risk of hearing loss .
Conclusions and Relevance: Hearing loss in craniofacial FD is common and mild to moderate in most individuals. It typically arises from FD crowding of the ossicular chain and elongation of the IAC, whereas EAC stenosis and otic capsule invasion are less common causes. Individuals with craniofacial FD should undergo otolaryngologic evaluation and monitoring, including assessment to identify those with high-risk features.
PMID: 29192304 [PubMed - as supplied by publisher]
http://ift.tt/2zJjJed
Population-level effect of molecular testing and targeted therapy in patients with advanced pulmonary adenocarcinoma: a prospective cohort study
Abstract
Large cancer centres in the USA demonstrated that molecular diagnosis and targeted therapy improved overall survival of patients with advanced pulmonary adenocarcinoma. We validated this finding in a rural area of Switzerland, served by private practices, community hospitals and a tertiary referral centre. We conducted a prospective cohort study with the Cancer Registry of Central Switzerland, covering 4 cantons and 517,000 inhabitants. All residents newly diagnosed with stage IV pulmonary adenocarcinoma from 2010 to 2014 were enrolled. We obtained information on patients, tumour, molecular testing, therapy and survival. Three hundred forty-eight patients were included in the study. Molecular testing was performed in 279 (80%); 132 (38%) had oncogenic driver mutations: Kirsten rat sarcoma (KRAS, 16%), epidermal growth factor receptor (EGFR, 11%), anaplastic lymphoma kinase (ALK, 5%), human epidermal growth factor receptor 2 (HER2, 2%), B rapidly accelerated fibrosarcoma (BRAF, 1%), rearranged during transfection (RET, 0.5%), MET proto-oncogene (0.5%) and multiple mutations (2%). Fifty-six patients with an oncogenic driver mutation, mostly epidermal growth factor receptor (34) and anaplastic lymphoma kinase (12), received genotype-matched targeted therapy, at least 25 (45%) of whom in a clinical trial or named patient programme. Median overall survival was 18 months for patients with driver mutations and targeted therapy, 8 months for patients with driver mutations and conventional therapy and 10 months for patients with no driver mutation and conventional therapy. For patients with driver mutations and targeted therapy, overall survival was significantly better than that for patients with driver mutations and conventional therapy (HR 0.64, p = 0.04). Rigorous testing combined with optimal access to targeted therapy in clinical trials improved the prognosis of patients with advanced pulmonary adenocarcinoma in Central Switzerland. This effect was mainly driven by therapies targeting epidermal growth factor receptor and anaplastic lymphoma kinase.
http://ift.tt/2APL81V
Angiomatosis of the uterus, cervix and fallopian tubes: a rare and benign cause of intractable, heavy menstrual bleeding
Angiomatosis of the uterus, cervix and fallopian tubes is a rare and benign entity that has not been reported in the literature previously. We present a case of a 27-year-old patient with severe and intractable heavy menstrual bleeding unresponsive to all conservative and conventional forms of treatment. Following a laparoscopic hysterectomy, the histopathological finding of angiomatosis, a vascular abnormality in the uterus, cervix and fallopian tubes, provided a plausible explanation in this situation.
http://ift.tt/2j86InY
Severe recurrent hypothermia in an elderly patient with refractory mania associated with atypical antipsychotic, valproic acid and oxcarbazepine therapy
Hypothermia is a rare but serious condition that has been associated with various psychiatric medications. We present a 76-year-old woman with refractory mania who developed multiple episodes of severe hypothermia associated with several psychiatric medications including olanzapine, quetiapine, valproic acid and oxcarbazepine. These episodes resolved following discontinuation of the agents. The patient had never experienced hypothermia before, despite having been on these or similar agents for many years. With traditional treatments for mania not feasible, other medications were used to treat her including lithium, clonazepam, gabapentin and the novel protein kinase c inhibitor tamoxifen. The regimen resulted in some success and importantly, without triggering hypothermia. This case alerts clinicians to the rare side effect of hypothermia in response to various psychiatric medications, the fact that patients can suddenly develop this intolerance and suggests possible medications that may be used safely without triggering hypothermia.
http://ift.tt/2BtsXeZ
Bilateral ocular surface squamous neoplasia with bilateral periocular basal cell carcinoma in a case of xeroderma pigmentosum
Xeroderma pigmentosum (XP) is an autosomal recessive disorder associated with multiple oculocutaneous manifestations.We discuss a unique case of XP having bilateral ocular surface squamous neoplasia (OSSN) and periocular basal cell carcinoma. In the right eye, a large OSSN mass involving the ocular surface extensively along with intraocular invasion was noted, whereas in the left eye, the tumour mass was involving the limbus, and extending up to three clock hours. Because of extensive disease in the right eye, orbital exenteration was performed, and for the left eye, a wide excision of the mass with triple freeze thaw cryo application to the margins followed by amniotic membrane grafting was done. Basal cell carcinoma was noted around the medial canthus on both sides. The right-sided basal cell carcinoma was treated by wide excision followed by a forehead rotation flap and the left-sided lesion was managed with topical 5% imiquimod cream.
http://ift.tt/2j9BSLJ
Volvulus of a wandering pelvic spleen: CT diagnosis with 3D reformatted illustration
Description
A 55-year-old woman was admitted at the hospital for acute abdominal pain, nausea, vomiting and loss of appetite. The unique relevant information of her previous clinical story was an aberrant location of the spleen in the pelvis. This was detected with sonography (US), 24 years before, in relation to the same clinical presentation followed by a rapid spontaneous resolution. Present blood tests were normal. An abdominal US of the abdomen was then performed, confirming the pelvic location of the spleen. The ectopic spleen was homogeneous, and any other relevant findings were noted. A multislice CT of the abdomen was required to exclude splenic infarct and to detect another cause of the abdominal pain missed with US.
The CT showed a whirloop configuration of the splenic vascular pedicle, with absence of ischaemic changes of the splenic parenchyma (figure 1). Volvulus of a wandering pelvic spleen (WS)...
http://ift.tt/2BsXQjB
Leg length discrepancy: the importance of a complete history and examination
A 26-year-old woman with a 1-year history of right knee pain had failed to respond to analgesia and activity modification in the community. Her general practitioner referred her to the orthopaedic department for specialist review. A thorough history revealed that she had multiple orthopaedic interventions as a child. The patient had significant postoperative infection of the left knee following knee surgery at 7 years of age. Examination demonstrated the presence of a limp, scoliosis and suspected leg length discrepancy. Plain film radiography confirmed the presence of leg length discrepancy, with the right limb measuring 30 mm longer than the left. The leg length discrepancy was likely secondary to a growth arrest of the left knee following the postoperative infection in childhood. The patient was managed with physiotherapy and heel raises and received regular orthopaedic follow-up.
http://ift.tt/2j92893
Challenging and uncommon diagnosis of long-evolution ascites
This is a case report of a 45-year-old Caucasian man with chronic alcoholism. No history of liver disease or asbestos exposure. He complained of ascites during the last 3 years with worsening in the last year with severe ascites development. Diagnostic paracentesis showed SAAG 1.1 and high cellularity with neutrophil count >250 cells/µL. Ascitic fluid cytology revealed reactive mesothelial hyperplasia. Thoracoabdominopelvic ultrasonography/CT/MRI and fludeoxyglucose positron emission tomography/CT showed 'omental cake' pattern suggesting peritoneal carcinomatosis. An exploratory laparoscopy revealed moderate interloop adhesions and necrosis with whitish exudate in the right pelvic excavation. Biochemical/cytological/histological/microbiological study only revealed reactive mesothelial cells, necrosis and lymphohistiocytic inflammatory infiltrate. A second exploratory laparoscopy with liver and peritoneal biopsies and appendectomy/mesoappendix excision showed a well-differentiated tubulopapillary mesothelioma. The patient was referred for intraperitoneal chemotherapy and is undergoing monthly therapeutic paracentesis.
http://ift.tt/2BsXPMz
Rupture of the posterior cul-de-sac during trial of labour after caesarean section
Rupture of the vaginal wall in unobstructed labour is a rare entity in the developed world. This case report describes rupture of the posterior cul-de-sac in a healthy 34-year-old multiparous woman attempting trial of labour after caesarean section. The woman presented to the labour ward at term with spontaneous onset of contractions. In the second stage of labour, the woman experienced sudden severe abdominal pain, different in character from the contraction pain. Therefore, the baby was delivered by ventouse extraction. As the woman continued to experience severe immobilising abdominal pain during the hospital stay, a CT scan was performed which revealed a haematoma and free fluid at the right side of the uterus. A laparotomy was performed 3 days postdelivery, during which a rupture of the posterior cul-de-sac was found and closed with a continuous suture. The woman was discharged 3 days after laparotomy in good clinical condition.
http://ift.tt/2j94yVh
Carcinoma en cuirasse
We present a case of carcinoma en cuirasse as a presentation of advanced lobular breast carcinoma. On further investigation, she was found to have metastasis to her liver and bone. We report this case to highlight the phenomenon of cutaneous metastasis. It is important to consider this diagnosis as an initial manifestation of breast cancer, but rarely, it can also be associated with other adenocarcinomas, for example, carcinoma of lung, kidney or gastrointestinal tract.
http://ift.tt/2BsXNUX
The telescoping aorta: a case of circumferential aortic dissection with intimo-intimal intussusception into the left ventricle
Description
A 67-year-old man with history of tobacco smoking presents to the emergency department with sudden onset, retrosternal chest pain radiating to the neck and associated with diaphoresis and nausea. On examination, his blood pressure was 106/42 mm Hg, pulse of 73 beat/min. He was pale, diaphoretic with IV/VI diastolic blowing murmur of unknown chronicity heard at the left sternal border. His distal pulses were faint but symmetric in all extremities. No marfanoid features. ECG showed sinus rhythm with ST segment elevation in leads aVR and V1, with widespread ST segment depression (figure 1). He underwent emergent coronary angiogram with initial diagnosis of acute coronary syndrome and impending cardiogenic shock. Angiogram revealed type-A aortic dissection extending to the aortic arch with concomitant aortic regurgitation (AR) (videos 1 and 2). On prompt recognition of aortic dissection, he was transferred to the operating room for emergent surgical repair. Intraoperative transoesophageal...
http://ift.tt/2j94xkb
Neck mass: an obstructive cause of respiratory distress with medical management
Congenital goitre is a known cause of hypothyroidism in newborn. Congenital goitre can be due to defective synthesis of thyroxine or administration of antithyroid drugs to the mother during pregnancy. In this case report, we report an instance of a preterm male infant with antenatally detected goitre presenting as a neck mass with congenital hypothyroidism. Hormonal replacement therapy was started immediately after birth which lead to resolution of the mass and normalisation of thyroid function.
http://ift.tt/2BsXMjR
Haemorrhagic conversion of infectious myelitis in an immunocompromised patient
A 28-year-old man recently diagnosed with HIV (CD4 19 cells/mm3, viral load 3.6 million copies/mL, not on highly active antiretroviral therapy on initial diagnosis at outside hospital), disseminated histoplasmosis, shingles and syphilis presented with paraplegia developing over 3 days. Spine MRI demonstrated a longitudinally extensive cord lesion extending from C3 to the tip of the conus. Brain MRI was consistent with meningoencephalitis. Cerebrospinal fluid findings were notable for positive varicella zoster virus (VZV) and cytomegalovirus (CMV) PCRs as well as a Venereal Disease Research Laboratory titre of 1:2. Patient was started on treatment for VZV and CMV meningoencephalitis, neurosyphilis and high-dose steroids for infectious myelitis. Repeat spine MRI demonstrated subacute intramedullary haemorrhage of the cervical cord. He was ultimately discharged to a skilled nursing facility for long-term intravenous antiviral therapy and rehabilitation. After 59 days in the hospital, his neurological exam remained grossly unchanged, with flaccid paraplegia and lack of sensation to fine touch in his lower extremities.
http://ift.tt/2j9JC0t
Perforated neuroenteric cyst masquerading as congenital pulmonary airway malformation
A 3-month-old child was presented with haemoptysis with respiratory distress. Imaging was suggestive of a cavitary lesion in the lung with surrounding consolidation. Diagnosis of a primary lung pathology like congenital pulmonary airway malformation was considered. Based on clinical suspicion and prior experience, a Tc-99m pertechnetate radionuclide study was performed, which clinched the diagnosis of foregut duplication cyst. Intraoperative findings confirmed the presence of a neuroenteric cyst. The child remains asymptomatic on follow-up awaiting neurosurgical intervention for the intraspinal component of the cyst.
http://ift.tt/2Bt6Tkv
Retrovesical malignant fibrous histiocytoma: a rare tumor
Malignant fibrous histiocytoma (MFH) originating from the retrovesical space is a very rare tumour. A 61-year-old man presented to our hospital with complaints of retention of urine and burning sensation during micturition since 6 months. CT scan abdomen showed a large retrovesical mass between the urinary bladder and rectum, measuring 11x9x12 cm, displacing the urinary bladder. Serum PSA (Prostate Specific Antigen) value was within normal range. Biopsy from retrovesical mass and immunohistochemistry was suggestive of MFH. Wide excision of the retrovesical mass was done. Histopathology confirmed the diagnosis of MFH. He received adjuvant radiotherapy. He is on regular follow-up since the last 2 years after radiotherapy with no signs and symptoms of disease recurrence.
http://ift.tt/2j7g2bW
Deadly combination: Clostridium septicum and colorectal malignancy
Gas gangrene is a life-threatening, necrotising soft tissue infection. Colorectal malignancy-associated Clostridiumsepticum is a rare cause of gas gangrene. This case outlines an initial presentation of colonic malignancy as gas gangrene from C.septicum infection.
A 69-year-old man presented with abdominal pain, vomiting and constipation. Abdominal X-ray revealed dilated small bowel loops. Lactate was elevated. A diagnosis of small bowel obstruction was made. Subsequent CT revealed caecal thickening and subcutaneous emphysema overlying the left flank. Clinically, he became haemodynamically unstable. Examination revealed crepitus overlying the left flank in keeping with gas gangrene. The patient required immediate surgical debridement. Tissue specimens cultured C.septicum. Following a complicated postoperative period, he was transferred to the plastic surgery team for further tissue debridement and reconstruction. A colonoscopy was later performed which was suspicious for malignancy. Colorectal multidisciplinary team discussion is awaited.
http://ift.tt/2BuyBgD
Atrial myxoma: an unusual aetiology for exertional dyspnoea and palpitation
Description
A 67-year-old woman had recently emigrated from the Dominican Republic where, many years prior, she had been evaluated for 'tachycardias' and had unrevealing monitors. She was well until 6 months prior to admission when she started to experience unpredictable, generally exertional palpitations, dyspnoea and left arm discomfort. There was no history of antecedent anxiety. Examination was notable for a 3/6 systolic murmur heard from apex to base and radiating to the neck that ultimately decreased with Valsalva manoeuvre, consistent with aortic sclerosis that was also seen on her echocardiogram. ECG showed normal sinus rhythm, significant left ventricular hypertrophy with strain and question of a right atrial abnormality. Transthoracic echo, for the murmur, showed a 3 cm highly mobile atrial mass, sometimes crossing the mitral valve, and aortic sclerosis (online ). Catheterisation showed unremarkable coronary arteries and no vascular attachments to the mass. Cardiac MRI showed a large mobile and multilobulated...
http://ift.tt/2j7g03O
Preoperative simulation unveiled undetected surgical difficulties in a case of cochlear implantation
We herein report a case in which extensive preparation changed a difficult-to-treat patient into an easy one. We performed a revision cochlear implantation on a patient whose first procedure had been aborted due to unidentified difficulties. During a series of thorough three-dimensional simulations, we found that the patient in question had a normal cochlea but the cochlea was placed in an unusual position and orientation. This condition is difficult to detect on standard preoperative radiographic images. Through this simulation, we were able to propose a surgical plan to avoid making the same mistakes as the first surgeon. We present this case not as a rare difficult case of an unfortunate patient but instead emphasise the importance of performing surgical simulation and looking for non-obvious difficulties. This case is an example of the success that can be achieved with such extensive preparation.
http://ift.tt/2BrPE30
Artery of Percheron ischaemic stroke revealed by brain MRI DWI/ADC sequences
Description
A 71-year-old Caucasian female patient presented with acute onset of visual disturbance, gait difficulties and fluctuation of consciousness.
Her medical history included artery hypertension, previous cardiac valve replacement with mechanical prosthesis, in treatment with oral anticoagulant.
An emergency CT scan resulted negative for acute lesions, haematological exams were normal, international normalised ratio (INR) was >2.5. The EKG revealed high-frequency atrial fibrillation, not previously known.
At the neurological examination, the patient presented drowsiness, easily resolved by verbal stimulus, bilateral divergent diplopia, with eye movements possible only horizontally and severe postural instability with retropulsion.
On the day after the onset of neurological symptoms, the patient underwent brain MRI without gadolinium. Axial fluid attenuation inversion recovery (FLAIR) sequences revealed diffuse cerebral vasculopathy in the bilateral white matter without evidence of acute lesions (figure 1). Diffusion-weighted imaging (DWI) sequences revealed the presence of recent ischaemic lesions in the territory of the artery...
http://ift.tt/2j7fUJu
Nivolumab-induced polyarthritis
Description
A 48-year-old Japanese woman with non-small cell lung adenocarcinoma (cT3N2M1b) received nivolumab (an immune checkpoint inhibitor) at a dosage of 3 mg/kg every 2 weeks. Treatment with nivolumab was effective. The primary tumour as well as metastases to the lymph nodes and spine almost completely disappeared, as shown on positron emission tomography-CT before treatment (figure 1A) and 4 months after treatment (figure 1B). However, she developed sustained pain and swelling in the shoulders and knees bilaterally after only one infusion of nivolumab, and active inflammation was detected in the shoulder joints bilaterally (figure 1B). She had no personal and family histories of autoimmune disease. Serum C-reactive protein level was 2.1 mg/L. Serum matrix metalloproteinase-3 was elevated at 209 ng/mL (normal <60). Antinuclear antibody, rheumatoid factor and anti-cyclic citrullinated peptide antibody were negative. Ultrasonography confirmed shoulder tenosynovitis and bursitis (figure 2). The arthritis responded...
http://ift.tt/2BuhuMi
Systemic lupus erythematosus (SLE): an unusual cause of ileocolic intussusception
Intussusception is a rare diagnosis in adults. Gastrointestinal involvement is not unusual in systemic lupus erythematosus (SLE).1 A case of intussusception as first presenting symptom of SLE is described. A 50-year-old woman of Chinese origin came to the emergency room with symptoms of high fever, nausea, vomiting and weight loss of 10 kg. Three months before, an episode with abdominal pain due to ileal invagination in the colon occurred. Laboratory analysis showed: thrombocytopaenia, lymphopaenia, positive antinuclear antibody, antidouble-stranded DNA, Coombs tests and low C3 in combination with an active urine sediment and proteinuria. CT and positron emission tomography scan showed lymphadenopathy, but no other abnormalities. Axillar lymph node biopsy showed no abnormalities. The diagnosis new-onset SLE was made. Prednisone treatment was started and soon thereafter tapered, azathioprine and hydroxychloroquine were added. During follow-up, the SLE remained in remission. SLE is a rare cause of ileocolic intussusception and ileocolic intussusception may be the first presenting symptom.
http://ift.tt/2j7fPpa
Prediction and prevention of allergy and asthma in EAACI journals (2016)
The European Academy of Allergy and Clinical Immunology (EAACI) owns three journals: Allergy, Pediatric Allergy and Immunology and Clinical and Translational Allergy. One of the major goals of EAACI is to supp...
http://ift.tt/2iBHC41
Application of Platelet Rich Fibrin Matrix to Repair Traumatic Tympanic Membrane Perforations: A Pilot Study
Abstract
Trauma in the form of instrumentation, slap, blast, accident, and sporting injury can result in tympanic membrane (TM) perforations which spontaneously recover in 53–94%. The closure rates of TM perforation due to above causes do not vary greatly; however, some otolaryngologists prefer to perform immediate microsurgical procedures to accelerate the recovery process. Our aim is to study the efficacy of Trichloroacetic acid (TCA) Chemical Cauterization (50%) and Platelet rich fibrin (PRF) Plug Myringoplasty technique in healing traumatic tympanic membrane perforations. To evaluate the preoperative and postoperative hearing outcome from the procedure and compare them. Study design is prospective study. A pilot study was carried out amongst selected 25 patients with central perforations in the Department of ENT, for duration of 2 years from July 13 to July 15. All 25 patients underwent PTA assessment & TCA (50%) and Autologous PRF Plug Myringoplasty technique done and follow up to 6 months postoperatively. The success rate traumatic tympanic membrane closure was found to be 92%. Pre- and post-operative hearing assessments of each patient were done & showed statistically significant air–bone gap closure with success rate of 88% (p < 0.05). From this study, the closure rate in traumatic tympanic membrane perforation by TCA (50%) and PRF Plug Myringoplasty technique was 92% with statistically significant hearing improvement (88%). This technique can be recommended as a time and cost effective office based procedure for treatment of traumatic tympanic membrane perforations.
http://ift.tt/2iC17t8
Application of Platelet Rich Fibrin Matrix to Repair Traumatic Tympanic Membrane Perforations: A Pilot Study
Abstract
Trauma in the form of instrumentation, slap, blast, accident, and sporting injury can result in tympanic membrane (TM) perforations which spontaneously recover in 53–94%. The closure rates of TM perforation due to above causes do not vary greatly; however, some otolaryngologists prefer to perform immediate microsurgical procedures to accelerate the recovery process. Our aim is to study the efficacy of Trichloroacetic acid (TCA) Chemical Cauterization (50%) and Platelet rich fibrin (PRF) Plug Myringoplasty technique in healing traumatic tympanic membrane perforations. To evaluate the preoperative and postoperative hearing outcome from the procedure and compare them. Study design is prospective study. A pilot study was carried out amongst selected 25 patients with central perforations in the Department of ENT, for duration of 2 years from July 13 to July 15. All 25 patients underwent PTA assessment & TCA (50%) and Autologous PRF Plug Myringoplasty technique done and follow up to 6 months postoperatively. The success rate traumatic tympanic membrane closure was found to be 92%. Pre- and post-operative hearing assessments of each patient were done & showed statistically significant air–bone gap closure with success rate of 88% (p < 0.05). From this study, the closure rate in traumatic tympanic membrane perforation by TCA (50%) and PRF Plug Myringoplasty technique was 92% with statistically significant hearing improvement (88%). This technique can be recommended as a time and cost effective office based procedure for treatment of traumatic tympanic membrane perforations.
http://ift.tt/2iC17t8
Debridement of facial necrotizing fasciitis via bicoronal flap
Publication date: Available online 2 December 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Ahmad Hafiz Ali, Zulkiflee Salahuddin, Hashimah Ismail, Afiza Izura Mohd Sofi, Irfan Mohamad
Facial necrotizing fasciitis is a very rare disease with a very high mortality rate. Early diagnosis with extensive surgical debridement must be done once the diagnosis is made. The technique of wound debridement depends on the individual case, bearing in mind the post operative wound care must be addressed well upon starting the debridement itself, as early as the skin incision is made. We present a case of an extensive facial necrotizing fasciitis that require a bicoronal flap incision with a modified drainage technique using a nasogastric tube for dressing. Our patient was successfully recovered from the dreadful illness and was discharged well.
http://ift.tt/2kgNPTa
Outcomes of facial artery musculomucosal flap for closure of small and medium sized fistula after clefts
Publication date: Available online 1 December 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Abdel Aziz Yehya, Ibrahem Gamaan, Mohamed Abd El Monem, Ahmed Fathy
Aim of the workThe aim of the present study is to evaluate the use of FAMM for closure of small and medium sized fistula regarding reliability, success rates and associated complications and to present a 2 years follow up for patients reconstructed by FAMM flap technique.Patients and methodsThis prospective study was carried out during the period from June 2014 to June 2016 on 24 children; 10(41.66%) boys and 14 (58.33%) girls, attending the outpatient clinic of pediatric surgery department, Al-Azhar University hospitals. Their ages ranged from 2 to 9 years with a mean 4 ± 2 years. All patients were complaining from palatal fistula after palatoplasty due to cleft palate. Written consents were taken from all patients of the children. All patients were subjected to FAMM flap technique. Data regarding surgical technique, success rate and complications were recorded with a 2 years follow up for those patients.ResultsThe fistulas were between 2 and 5 mm in size (small and medium sized). 9(37.5%) were having small fistula (<2 mm) and 15 (62.5%) were having medium sized fistula (5–10 mm). The anterior palatal fistula [14 (58.33%) patients] were reconstructed by superiorly based buccinator flap while fistula at the junction of the soft and hard palate [10 (41.66%) patients] were reconstructed by inferiorly based flap. Satisfactory closure of the fistula was achieved in all patients except in one patient (4.16%). 3 flaps (12.5%) developed venous congestion and resolved spontaneously without any active intervention. One flap (4.16%) developed suture line dehiscence. Flap revision was necessary. Differences in flap patterns, fistula location and size of palatal defect has no significant effect on flap survival.ConclusionFAMM flap is appropriate for reconstruction of small and medium sized fistula because of its reliability and versatility. The flap presents few complications and ensures adequate functional results after palatal fistula repair because of its nearly the same tissue like the palatal tissue.
http://ift.tt/2BCYLyU
Noise-induced hearing loss in grass-trimming workers
Publication date: Available online 2 December 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Nabeel Ibraheem Jaafar, Mohd Khairi Md Daud, Irfan Mohammad, Normastura Abd Rahman
IntroductionNoise-induced hearing loss results from accumulated repetitive noise exposure of high amplitude. Grass-trimming workers are exposed to a noisy motorized machine that is carried on their back. We studied the prevalence of noise-induced hearing loss and its characteristics among the workers.MethodsA comparative cross sectional study was conducted on a group of grass-trimming workers. Ear examination was conducted, followed by pure tone audiometry in a soundproof room at least 48 h after the subjects were free from the noise exposure. Noise-induced hearing loss was defined as failed definitive threshold at frequencies 3, 4 or 6 kHz of more than 20 dB with the loss at the two nearest frequencies on both sides of the dip amounting to at least 5 dB less. The intensity levels of the grass-trimming machines were measured by using a sound level meter by putting the probe near the external ear of the worker about 12 cm apart from his pinna.ResultsA total of 75 grass-trimming workers and a similar number of clerks participated in this study. The range of noise level of the machines was in between 91.3 dB and 100.7 dB with the mean of 95.0 dB. There was a significant correlation of noise-induced hearing loss in the grass-trimming workers (p value = .010) with the prevalence of 82.6%. The dip in PTA at 3, 4 and 6 kHz significantly occurred in the subjects with the p value of 0.001, 0.009 and 0.036 respectively.ConclusionIt is warranted to give continuing education on the grass-trimming workers about the risk and how to protect them from noise-induced hearing loss. While the diagnosis should be made in the presence of exposure, the possibility of noise-induced hearing loss is highest when the dip occurs at 3 kHz followed by 4 and 6 kHz.
http://ift.tt/2kgNPm8
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