Health-related quality of life in elderly hearing aid users vs. non-users

Publication date: Available online 8 December 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Eman A. Said
Background and aimPresbycusis, is usually a harbinger of aging. The negative consequences are not limited to an auditory impairment but influences a range of psychosocial and physical health concerns. The cornerstone of audiologic intervention is the use hearing aids. Optimal management should include an evaluation of quality of life (QoL) status and its assessment. Aim of this work: To quantify the quality of life of hearing impaired elderly individuals (HIEI) and to assess hearing aids impact on QoL.SubjectsElderly patients (1 2 7) above 60 years had sensorineural hearing loss ranged from mild to severe degree of hearing loss, only 24 of them (21.1%) were fitted with monaural hearing aid.MethodsEach subject of this study underwent basic audiologic evaluation, speech perception in noise, aided tonal sound field threshold and aided speech tests. Generic WHOQOL-BREF and hearing handicap inventory for the elderly (HHIE).ResultsThere were significant lower aided tonal sound field thresholds (ATSFTs) at 0.5, 1, 2 and 4 kHz of hearing aid users when compared with values of non-users at all tested frequencies. Hearing aid users perform better in all domains of WHO QOL-BREF with significant reductions in emotional, social and total scores of HHIE in users group compared with non-users indicated improvement in their QOL. There were no significant differences between scores of males and scores of females. The severity of the hearing loss had statistically significant effects on these scores for non-users but not in users group.



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Unusual pathological fracture of the clavicle revealing primary hyperparathyroidism: a case report

Primary hyperparathyroidism revealed by a pathological fracture is very uncommon; in the majority of cases the discovery of lytic bone lesions on imaging examinations evokes in the clinician first a neoplastic...

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Severe drug-induced kidney injury in acute generalized exanthematous pustulosis

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Association of HLA-DQB1*03:03 with pityriasis rosea in Chinese patients

Summary

Background

The association of human leucocyte antigen (HLA) with a variety of diseases has been described, especially with various autoimmune diseases. However, there are few studies on the association between HLA and pityriasis rosea (PR).

Aim

To investigate the relevance of HLA II alleles with the development of PR.

Methods

Typing for HLA-DRB1, HLA-DQA1 and HLA-DQB1 typing was performed in 55 patients with PR and 90 healthy controls (HCs), using sequence-based typing (SBT) and PCR with sequence-specific primers (PCR-SSP), respectively.

Results

We found that the frequency of HLA-DQB1*03:03 was significantly higher in the PR compared with the HC group [P = 0.001; relative risk (RR) = 2.24; 95% CI 1.38–3.6], while suggestive evidence for a protective effect of HLA-DQB1*06:06 was observed in the study cohort (P < 0.02; RR = 0.40; 95% CI 0.17–0.90).

Conclusions

The HLA-DQB1*03:03 allele may be a susceptible factor in patients with PR. In addition, the association of HLA-DQB1*03:03 with PR suggests participation of immunity in the pathogenesis of PR.

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Dabrafenib-induced pemphigoid-like reaction

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Lichen planus in a patient treated with pembrolizumab for metastatic malignant melanoma

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Effect of age and body mass index on the yield of stromal vascular fraction

Summary

Objective

The aim of this study was to determine the influence of age, body mass index, and site of liposuction on the cell yield of SVF.

Methods

A prospective study was performed on 58 patients. The average age was 39 years old, with BMI ≤ 25 or BMI ≥ 25. Fat tissue was harvested from the abdominal region, flanks, or thighs and SVF was isolated.

Results

The yield of viable SVF was evaluated by trypan blue, and the markers of stem cells were evaluated by flow cytometry. The cells were positive for stem cells markers, the age, sex of the patient had no impact on SVF cell yield with an average of 1.17 × 10^8. However, the BMI > 25 had resulted in higher cell numbers, and the harvest site had a significant impact on cell yield with abdomen being the site of interest.

Conclusion

These data demonstrate that the age of the person does not affect the cell yield of SVF; nevertheless, the donor site and BMI might be important factors in affecting cell number.

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Cardiovascular risk and severity factors in patients admitted to hospital for spontaneous epistaxis

Publication date: Available online 8 December 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): N. André, N. Klopp-Dutote, A. Biet-Hornstein, V. Strunski, C. Page
ObjectivesTo assess the role of cardiovascular risk factors, intake of drugs altering hemostasis and severity signs in patients admitted with spontaneous epistaxis.Material and methodsA single-center retrospective study covering a 7-year period in a university hospital center included 205 patients admitted with spontaneous epistaxis. Study variables comprised: cardiovascular risk factors (cardiovascular disease or history of cardiovascular disease with hemorrhagic or thromboembolic risk, high blood pressure, type-2 diabetes, dyslipidemia), intake of drugs altering hemostasis, blood pressure and minimum hemoglobin level during hospital stay. Groups of serious and non-serious epistaxis were distinguished.ResultsThere were no significant inter-group differences for mean age, sex ratio, history of high blood pressure or number of cardiovascular risk factors. Serious epistaxis was associated with significantly lower blood pressure and hemoglobinemia. Number of cardiovascular risk factors correlated with probability of blood transfusion.ConclusionThe real influence of the various study factors, including severity factors, on onset of spontaneous epistaxis remains to be elucidated.



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Impact of allergy on phenotypic and endotypic profiles of nasal polyposis

Publication date: Available online 8 December 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): G. Mortuaire, I. Gengler, M. Balden, M. Capron, G. Lefèvre
ObjectivesTo assess the impact of allergy on clinical presentations (phenotypes) and inflammatory patterns (endotypes) of chronic rhinosinusitis with nasal polyps (CRSwNP).MethodsA single-center prospective study was conducted over an 18-month period. Fifty-seven patients with refractory CRSwNP were included. The diagnosis of allergy was based on concordant skin prick tests and symptoms. Phenotypes were determined on symptom severity score, polyp size classification and Lund-Mackay CT staging. Inflammatory endotypes were determined on biomarker analysis (IgE, IgA, IL-5, IL-9, ECP, EDN) in blood and nasal secretions. Eosinophil counts were obtained in blood, nasal secretions and polyps.ResultsPhenotype and endotype profiles were comparable in patients with (n=15) or without (n=42) allergy. Only asthma with high total IgE blood concentration showed association with allergy.ConclusionsThe present results suggest that allergy is not directly involved in the clinical expression and specific inflammatory pathways of CRSwNP. New therapies target inflammation signaling pathways, and identifying accurate blood and tissue biomarkers will be the line of research most likely to improve treatment of CRSwNP.



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Circulating allergen-specific Th2 lymphocytes: CCR4+ rather than CLA+ is the predominant phenotype in peanut allergic subjects

Publication date: Available online 8 December 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Lars H. Blom, Nanna Juel-Berg, Lau Fabricius Larsen, Kirsten S. Hansen, Lars K. Poulsen

Teaser

The skin and airway homing chemokine CCR4, but not CLA, emerged as the primary discriminating homing factor, of Th2 lymphocytes, suggesting that peanut sensitization occurs both via the skin and airways.


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In response to Letter to the Editor entitled ‘Is an endoscopic or a microscopic approach optimal for management of attic cholesteatoma?’

Publication date: Available online 8 December 2017
Source:American Journal of Otolaryngology
Author(s): Giuseppe Magliulo, Giannicola Iannella




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Anti-mumps IgM antibody positive rate with sudden sensorineural hearing loss using second-generation enzyme immunoassay: A retrospective, multi-institutional investigation in Hokkaido, Japan

Publication date: Available online 8 December 2017
Source:Auris Nasus Larynx
Author(s): Atsushi Fukuda, Shinya Morita, Yuji Nakamaru, Kimiko Hoshino, Keishi Fujiwara, Shigeru Akazawa, Tomohiro Sakashita, Nobuyuki Obara, Akihiro Homma
ObjectiveAlthough elevated anti-mumps IgM antibody levels were reported in 5.7%–7.2% of Japanese patients with sudden sensorineural hearing loss (SSNHL), there were several reports of false-positive cases, such as the continually IgM positive case and the IgM positive case in normal adults. To improve specificity, the new enzyme immuno assay (EIA) anti-mumps IgM antibody measurement kit was introduced in December 2009. This study re-examined the frequency of anti-mumps IgM antibody test positivity with SSNHL using the new measurement kit and compared the results with those from a previous report that used old kit.MethodsThis is a retrospective multi-institutional study involving patients diagnosed with SSNHL who exhibited the anti-mumps IgM antibody. We compared the positive rate of anti-mumps IgM antibody and the annual average number of mumps cases per sentinel in Hokkaido between the patients in the present study and patients previously evaluated.ResultsOverall, 100 patients with SSNHL were enrolled. One case (1.0%) was positive for anti-mumps IgM antibody. Of the 69 patients evaluated in the previous study, 5 cases (7.2%) were positive for anti-mumps IgM antibody. The positive rate of the anti-mumps IgM antibody in the present cases was significantly lower than that previously reported (p=0.042). The annual average number of mumps cases per sentinel in Hokkaido of the present and previous surveillance period was 34.47 and 42.77, respectively; no significant difference was seen in these data (p=0.4519).ConclusionThe present study revealed that 1.0% of SSNHL was positive for the anti-mumps IgM antibody using the new EIA-IgM measurement kit. After the introduction of the new EIA-IgM measurement kit, anti-mumps IgM antibody positive rate with SSNHL significantly decreased, indicating that the proportion of asymptomatic mumps among etiology of SSNHL may be lower than those previously reported.



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Results of a systematic literature review of treatment modalities for jugulotympanic paraganglioma, stratified per Fisch class

Abstract

Objective

Key for successful jugulotympanic paraganglioma management is a personalized approach aiming for the best practice for each individual patient. To this end, a systematic review is performed, evaluating the local control- and complication rates for the different treatment modalities stratified by the broadly accepted Fisch classification.

Design

A systematic literature review according to the PRISMA statement was performed. A detailed overview of individual treatment outcomes per Fisch class is provided.

Main outcome measures

local control, cranial nerve damage, complications, function recovery.

Results

Eighteen studies were selected, resembling 83 patients treated with radiotherapy and 299 with surgery. Excellent local control was found post surgery for class A and B tumours and risk of cranial nerve damage was <1%. For class C1-4 tumours, local control was 80-95% post surgery (84% post radiotherapy) and, cranial nerve damage was found in 71-76% (none post radiotherapy; p < 0.05). There was no difference in treatment outcomes between tumours of different C class. For class C1-4De/Di tumours, local control was 38-86% (98% post radiotherapy; p < 0.05), cranial nerve damage/complication rates were 67-100% (3% post radiotherapy; p < 0.05). C1-4DeDi tumours showed lesser local control and cranial nerve damage rates when compared to C1-4De tumours.

Conclusions

An individual risk is constituted for surgery and radiotherapy, stratified per Fisch class. For class A and B tumours surgery is a suitable treatment option. For class C and D tumours radiotherapy results in lower complication rates and similar or better local control rates when compared to the surgical group.

This article is protected by copyright. All rights reserved.

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Elevated levels of the antimicrobial peptide LL-37 in hidradenitis suppurativa are associated with a Th1/Th17 immune response

Summary

Hidradenitis suppurativa (HS) is an inflammatory skin disease with poorly understood immunopathogenic mechanisms. LL-37 is an antimicrobial peptide, which is transcribed from the CAMP (cathelicidin antimicrobial peptide) gene. Previous reports showed upregulated levels of CAMP and LL-37 in HS lesions and therefore the aim of this study was to compare levels of LL-37 in HS to other inflammatory skin diseases and to establish immunomodulatory functions of LL-37 in HS. We confirm an upregulation of the LL-37 peptide in lesional HS skin with comparable levels as in psoriasis patients and are able to positively correlate the presence of LL-37 in HS with the presence of T cells, macrophages, neutrophils, IFNγ, IL-17, IL-23, TNFα, IL-32 and IL-1β. Mechanistically, LL-37 boosts the proliferation of unspecifically activated CD4⁺ T cells via an increased calcium signalling independent of antigen presenting cells. Targeting LL-37 may therefore represent a new therapeutic option for the treatment of this recalcitrant disease, but it has to be kept in mind that LL-37 also has an antimicrobial function.

This article is protected by copyright. All rights reserved.

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Monocytes enhance neutrophil-induced blister formation in an ex vivo model of bullous pemphigoid

Abstract

Background

Lesions of bullous pemphigoid (BP), an autoimmune subepidermal blistering disease characterized by the presence of tissue-bound and circulating autoantibodies to hemidesmosomal antigens, harbour a mixed inflammatory cellular infiltrate. In various models, neutrophils, eosinophils, mast cells, monocytes as well as B and T cells have been shown to be involved in the pathogenesis of BP. However, their interactions with and effective role in blister formation remains uncertain. This study was aimed at investigating the effect of monocyte/neutrophil interaction on blister formation in an ex vivo BP model.

Methods

Skin cryosections were incubated with purified human neutrophils and monocytes, in the presence or absence of BP autoantibodies. Production of reactive oxygen species (ROS), degranulation, mediator release (neutrophil elastase (NE), myeloperoxidase (MPO), matrix metalloproteinase-9 (MMP-9)), binding of Fcγ receptor (CD16, CD32, CD64), and cell adhesion (CD18, ICAM-1) were investigated using appropriate inhibitors. Dermal-epidermal separation (DES) was assessed by light microscopy and quantified by Fiji software.

Results

Monocytes and neutrophils synergistically interact resulting in a significantly higher DES compared to either monocytes or neutrophils separately (P < 0.0001). Monocyte/neutrophil-induced DES was associated with increased ROS production and was dependent on adhesion and FcγRIII binding. Upon stimulation by the granule-poor fraction of monocyte supernatants, neutrophils increased their release of MMP-9, thereby also DES at the dermal-epidermal junction of skin cryosections.

Conclusion

Our observations suggest that the interaction of cells, as shown here for monocytes and neutrophils, enhances mediator release resulting in an increased subepidermal blister formation. Thus, blocking intercellular cross-talk promises a new therapeutic approach for blocking tissue damage in BP.

This article is protected by copyright. All rights reserved.

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In response to Letter to the Editor entitled ‘Is an endoscopic or a microscopic approach optimal for management of attic cholesteatoma?’

We are grateful to Zhengcai-Lou et al. for having appreciated our study entitled 'Endoscopic versus microscopic approach in attic cholesteatoma surgery [1].

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A Hat-Trick Knock-Reversible Triple Organ Injury in a New Mother With HELLP Syndrome

No abstract available

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Mannitol Shower: The Artefactual Air Embolism!

No abstract available

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Sodium Bicarbonate for Control of ICP: A Systematic Review

Objective: Our goal was to perform a systematic review of the literature on the use of intravenous sodium bicarbonate for intracranial pressure (ICP) reduction in patients with neurologic illness. Methods: Data sources: articles from MEDLINE, BIOSIS, EMBASE, Global Health, Scopus, Cochrane Library, the International Clinical Trials Registry Platform (inception to April 2015), reference lists of relevant articles, and gray literature were searched. Data extraction: 2 reviewers independently extracted data including population characteristics and treatment characteristics. The strength of evidence was adjudicated using both the Oxford and Grading of Recommendation Assessment Development and Education methodology. Results: Our search strategy produced a total 559 citations. Three original articles were included in the review. There were 2 prospective studies, 1 randomized control trial and 1 single arm, and 1 retrospective case report. Across all studies there were a total of 19 patients studied, with 31 episodes of elevated ICP being treated. Twenty-one of those episodes were treated with sodium bicarbonate infusion, with the remaining 10 treated with hypertonic saline in a control model. All elevated ICP episodes treated with sodium bicarbonate solution demonstrated a significant drop in ICP, without an elevation of serum partial pressure of carbon dioxide. No significant complications were described. Conclusions: There currently exists Oxford level 4, Grading of Recommendation Assessment Development and Education D evidence to support an ICP reduction effect with intravenous sodium bicarbonate in TBI. No comments on its impact in other neuropathologic states, or on patient outcomes, can be made at this time.

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Intraoperative Blood Pressure Discrepancy Between Arms During Prone Position!

No abstract available

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Perioperative and Anesthetic Considerations for Neurosurgical Laser Interstitial Thermal Therapy Ablations

Objective: To describe the anesthetic considerations in patients undergoing laser interstitial thermal therapy (LITT) for neurosurgical procedures. Background: LITT for neurosurgical procedures is being increasingly used in a variety of central nervous system diseases. Several studies have demonstrated promising results including a shorter hospital stay. Given the rising trend for the use of LITT, anesthesiologists need to be familiar with the anesthetic considerations to provide care for patients undergoing these types of procedures. Materials and Methods: PubMed was searched in April 2016 using different combinations of the following MeSH terms: "Central nervous System," "laser therapy," "Ablation Techniques," "Anesthesia," and "Spinal Cord Neoplasms." A total of 54 relevant manuscripts were included in this review article. Conclusions: LITT is a promising therapeutic approach for multiple central nervous system disorders. Anesthesiologists must be familiar with the anesthetic considerations and the technical aspects of the procedure when providing care for patients undergoing LITT. The literature is scarce on the impact of different anesthesia and analgesia techniques on clinical outcomes. Therefore, studies comparing different anesthetic regimens and the impact on outcomes are needed to make relevant recommendations on the anesthesia care of these patients.

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Editorial

No abstract available

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Innovations in Functional Neurosurgery and Anesthetic Implications

Functional neurosurgery has undergone rapid growth over the last few years fueled by advances in imaging technology and novel treatment modalities. These advances have led to new surgical treatments using minimally invasive and precise techniques for conditions such as Parkinson's disease, essential tremor, epilepsy, and psychiatric disorders. Understanding the goals and technological issues of these procedures is imperative for the anesthesiologist to ensure safe management of patients presenting for functional neurosurgical procedures. In this review, we discuss the advances in neurosurgical techniques for deep brain stimulation, focused ultrasound and minimally invasive laser-based treatment of refractory epilepsy and provide a guideline for anesthesiologists caring for patients undergoing these procedures.

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Complementary Use of Effect Site-Target Controlled Infusion and SmartPilot View for Anesthetic Management in Semi-awake Craniotomy Near BIS 85

No abstract available

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Ultra–low-dose Naloxone as an Adjuvant to Patient Controlled Analgesia (PCA) With Morphine for Postoperative Pain Relief Following Lumber Discectomy: A Double-blind, Randomized, Placebo-controlled Trial

Background: Lumbar discectomy is one of the most commonly performed neurosurgical procedures. Many patients experience postoperative pain after lumbar discectomy. This study evaluated the effect of ultra–low-dose naloxone infusion on pain intensity after lumbar discectomy in individuals receiving patient-controlled analgesia (PCA) with morphine. Materials and Methods: In a double-blind, randomized, controlled trial, a total of 80 patients scheduled for open discectomy was randomly assigned to receive naloxone (group N) or placebo (group P). After surgery, all patients were connected to a morphine PCA pump. Both groups received 500 mL of normal saline using a continuous infusion pump through a separate intravenous line for 24 hours. However, group N received a total dose of 0.25 μg/kg/h naloxone, which was added to the normal saline infusion. All patients were asked to grade the intensity of their pain, severity of nausea, vomiting, and pruritus on a 0 to 10 visual analog scale before being discharged from the postanesthesia care unit and at 1, 6, 12, and 24 hours postoperatively. Results: It was observed that both groups had a statistically significant (P

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Propofol Pharmacodynamics and Bispectral Index During Key Moments of Awake Craniotomy

Background: During awake craniotomy, the patient's language centers are identified by neurological testing requiring a fully awake and cooperative patient. Hence, anesthesia aims for an unconscious patient at the beginning and end of surgery but an awake and responsive patient in between. We investigated the plasma (Cplasma) and effect-site (Ceffect-site) propofol concentration as well as the related Bispectral Index (BIS) required for intraoperative return of consciousness and begin of neurological testing. Materials and Methods: In 13 patients, arterial Cplasma were measured by high-pressure liquid chromatography and Ceffect-site was estimated based on the Marsh and Schnider pharmacokinetic/dynamic (pk/pd) models. The BIS, Cplasma and Ceffect-site were compared during the intraoperative awakening period at designated time points such as return of consciousness and start of the Boston Naming Test (neurological test). Results: Return of consciousness occurred at a BIS of 77±7 (mean±SD) and a measured Cplasma of 1.2±0.4 μg/mL. The Marsh model predicted a significantly (P

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Posterior Reversible Encephalopathy Syndrome Triggered by Vertebral Artery Angiogram

No abstract available

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The Correlation Between Recordable MEPs and Motor Function During Spinal Surgery for Resection of Thoracic Spinal Cord Tumor

Background: Motor evoked potentials (MEPs) are commonly used during surgery for spinal cord tumor resection. However, it can be difficult to record reliable MEPs from the muscles of the lower extremities during surgery in patients with preoperative weakness due to spinal cord compression. In this study, motor function of patients' lower extremities and their association with intraoperative MEP recording were compared. Patients and Methods: Patients undergoing thoracic spinal cord tumor resection were studied. Patients' motor function was checked immediately before the surgical procedure. MEP responses were recorded from the tibialis anterior and foot muscles, and the hand muscles were used as control. Electrical current with train of eight pulses, 200 to 500 V was delivered through 2 corkscrews placed at C3' and C4' sites. Anesthesia was maintained by total intravenous anesthesia using a combination of propofol and remifentanil after induction with intravenous propofol, remifentanil, and rocuronium. Rocuronium was not repeated. Bispectral Index was maintained between 40 to 50. Results: From 178 lower limbs of 89 patients, myogenic MEPs could be recorded from 100% (105/105) of the patients with 5 of 5 motor strength in lower extremity; 90% (36/40) from the patients with 4/5 motor strength; only 25% (5/20) with 3/5; and 12.5% (1/8) with 2/5 motor strength; none (0/5) were able to be recorded if the motor strength was 1/5. Summary: The ability to record myogenic MEPs is closely associated with the patient's motor function. They are difficult to obtain if motor function is 3/5 motor strength in the lower extremity. They are almost impossible to record if motor function is worse than 3/5.

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A Survey of Incidence of Postoperative Visual Loss Associated With Spine Surgery Outside the United States

No abstract available

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Airway Management With a Stereotactic Headframe In Situ—A Mannequin Study

Background: Stereotactic headframe-based imaging is often needed for target localization during surgery for insertion of deep brain stimulators. A major concern during this surgery is the need for emergency airway management while an awake or sedated patient is in the stereotactic headframe. The aim of our study was to determine the ease of emergency airway management with a stereotactic headframe in situ. Materials and Methods: We conducted an observational study using a mannequin. A Leksell stereotactic headframe was placed on a mannequin in the operating room and the frame was fixed to the operating room table. Anesthesia personnel were asked to insert a #4 laryngeal mask and then to intubate the mannequin, using both direct (DL) and video laryngoscopy (VL). In addition, participants were asked to perform the same airway techniques in the mannequin without the headframe. Data were analyzed for time taken for airway management using different devices with and without the headframe. In addition, we compared the time taken to secure the airway between different participant groups. Results: Thirty anesthesia personnel (7 residents, 12 fellows, and 11 consultants) participated in the study. With the headframe in situ, 97% of participants were able to insert a laryngeal mask on their first attempt; 93% and 97% of participants were able to intubate the mannequin using DL and VL respectively on their first attempt. Without the stereotactic headframe, all participants were able to insert the laryngeal mask and intubate on the first attempt. The average time taken to insert a laryngeal mask and intubate the mannequin using DL and VL with the headframe in situ was 39.3, 58.6, and 54.8 seconds, respectively. Conclusions: Our study showed that both laryngeal mask insertion and tracheal intubation can be performed with a stereotactic headframe in situ. A laryngeal mask is the quickest airway device to insert and can be inserted while the mannequin is in the standard surgical position. Further study is needed to validate the results in patients.

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Cortical Arousal With Deep Brain Stimulation After General Anesthesia for Laparoscopic Cholecystectomy

No abstract available

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Hemodynamic Disturbances in the Early Phase After Subarachnoid Hemorrhage: Regional Cerebral Blood Flow Studied by Bedside Xenon-enhanced CT

Background: The mechanisms leading to neurological deterioration and the devastating course of delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) are still not well understood. Bedside xenon-enhanced computerized tomography (XeCT) enables measurements of regional cerebral blood flow (rCBF) during neurosurgical intensive care. In the present study, CBF characteristics in the early phase after severe SAH were explored and related to clinical characteristics and early clinical course outcome. Materials and Methods: Patients diagnosed with SAH and requiring mechanical ventilation were prospectively enrolled in the study. Bedside XeCT was performed within day 0 to 3. Results: Data from 64 patients were obtained. Median global CBF was 34.9 mL/100 g/min (interquartile range [IQR], 26.7 to 41.6). There was a difference in CBF related to age with higher global CBF in the younger patients (30 to 49 y). CBF was also related to the severity of SAH with lower CBF in Fisher grade 4 compared with grade 3. rCBF disturbances and hypoperfusion were common; in 43 of the 64 patients rCBF

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Analgosedation With Dexmedetomidine in a Patient With Superior Vena Cava Syndrome in Neurosurgery

No abstract available

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Neonatal Sevoflurane Exposure Induces Adulthood Fear-induced Learning Disability and Decreases Glutamatergic Neurons in the Basolateral Amygdala

Background: Neonatal mice exposed to sevoflurane show certain cognitive and behavioral impairments in adulthood. However, the mechanisms underlying long-term cognitive deficits induced by sevoflurane exposure remain unknown. The present study was performed to investigate whether there is differential neuronal activation between naive mice and sevoflurane-exposed neonates in fear-conditioning tests based on immediate early gene (c-Fos) expression. Methods: Male mice were exposed to 3% sevoflurane (SEVO group) or carrier gas alone (no anesthesia, NA group) for 6 hours on postnatal day 6. The mice were allowed to mature before performing the contextual fear-conditioning test. A reduced freezing response was confirmed in the SEVO group. Neural activation in the regions of the medial prefrontal cortex, hippocampus, and amygdala was investigated using c-Fos immunostaining 2 hours after the test. The types of neurons activated were also identified. Results: The number of c-Fos-positive cells decreased by 27% in the basolateral amygdala in the SEVO group, while no significant changes were observed in other regions. Furthermore, glutamatergic, but not γ-aminobutyric acid (GABA)ergic, neurons expressed c-Fos after the contextual fear-conditioning test in both groups. The number of glutamatergic neurons in the basolateral amygdala in the SEVO group was reduced by 27%. Conclusions: Decreased neural activation in the basolateral amygdala may be associated with reduced freezing time in neonatal sevoflurane-exposed mice. Fewer glutamatergic neurons responding to fear stimuli in the basolateral amygdala may contribute to decreased neural activation and learning deficits in mice exposed to sevoflurane as neonates.

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Intravenous Clevidipine for Inducing Hypotensive Challenge During Carotid Balloon Test Occlusion

No abstract available

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‘‘Intralesional Drainage Injection’ of Triamcinolone acetonide for Epidermal Cyst’

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Anti-melanoma differentiation-associated gene 5 (MDA5) dermatomyositis: a concise review with an emphasis on distinctive clinical features

Anti-MDA5 dermatomyositis exhibits unique clinical features including mucocutaneous ulceration, palmar papules, non-scarring alopecia, panniculitis, arthritis, and interstitial lung disease.Early intervention may reduce disease-related morbidity and improve survival in affected individuals.Knowledge of the salient features of anti-MDA5 dermatomyositis enhances its recognition and facilitates treatment.

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Merkel Cell Carcinoma: an Update and Review Part 1. Pathogenesis, Diagnosis, and Staging

Capsule Summary: word count not required for CME articles; please note that bulleted points appear at the start of each section but are not included in the total word count

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Dermoscopy as an evolving tool to assess vitiligo activity

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Comparison of Elliptical Excision versus Punch Incision for the Treatment of Epidermal Inclusion Cysts: A Prospective, Randomized Study

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Merkel Cell Carcinoma: An Update and Review. Part II: Current and Future Therapy

Capsule Summary: word count not required for CME articles as these appear before each section and are included in the text word count

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“Omics” in oral cancer: New approaches for biomarker discovery

Publication date: Available online 8 December 2017
Source:Archives of Oral Biology
Author(s): Vertika Rai, Rashmi Mukherjee, Ananta K. Ghosh, Aurobinda Routray, Chandan Chakraborty
ObjectivesIn this review paper, we explored the application of "omics" approaches in the study of oral cancer (OC). It will provide a better understanding of how "omics" approaches may lead to novel biomarker molecules or molecular signatures with potential value in clinical practice. A future direction of "omics"-driven research in OC is also discussed.MethodsStudies on "omics"-based approaches [genomics/proteomics/transcriptomics/metabolomics] were investigated for differentiating oral squamous cell carcinoma,oral sub-mucous fibrosis, oral leukoplakia, oral lichen planus, oral erythroplakia from normal cases. Electronic databases viz., PubMed, Springer, and Google Scholar were searched.ResultsOne eighty-one studies were included in this review. The review shows that the fields of genomics, transcriptomics, proteomics, and metabolomics-based marker identification have implemented advanced tools to screen early changes in DNA, RNA, protein, and metabolite expression in OC population.ConclusionsIt may be concluded that despite advances in OC therapy, symptomatic presentation occurs at an advanced stage, where various curative treatment options become very limited. A molecular level study is essential for detecting an OC biomarker at an early stage. Modern "Omics" strategies can potentially make a major contribution to meet this need.



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Genetic markers of nasolabial morphology

Publication date: Available online 7 December 2017
Source:Archives of Oral Biology
Author(s): Tarek El-Bialy




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Interleukin-21 receptor signaling is not critically required for imiquimod-induced psoriasiform dermatitis in mice

Abstract

Psoriasis is largely mediated by interleukin (IL)-23/ T helper (Th) 17 axis, and IL-21 is a pleiotropic cytokine expressed by Th17 cells. Despite previously reported possible pathogenic roles of IL-21 in human psoriasis, we found that IL-21 receptor (IL-21R) signaling was not crucial for imiquimod-induced psoriatic inflammation, using IL-21R^−/− mice. The severity of imiquimod-induced psoriatic manifestation and pro-inflammatory Th17 cytokine levels, IL-17A-producing γδ T cells and CD4+ T cells, and in vitro IL-17A production by γδ T cells after IL-23 stimulation was comparable between wild-type and IL-21R^−/− mice. Collectively, IL-21R signaling was not critically involved in IMQ-induced psoriatic inflammation despite an increased IL-21 expression in the IMQ-treated mouse skin. Our data may represent the significant differences between human psoriasis and murine psoriasis model, and further studies using other models will be required to elucidate the role of IL-21 in psoriasis pathogenesis.

This article is protected by copyright. All rights reserved.

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Skin Cancer Prevention Campaign in Childhood: Survey based on 3,676 children in Brazil

Abstract

Background and Objectives

Primary skin cancer prevention campaigns are essential and more effective among children, not only because of the importance of sun exposure effects during this period, but also because at this age is when individuals are developing behaviors. The Brazilian Society of Dermatology - Regional State of Sao Paulo developed and conducted, the program named "The Sun, Friend of Childhood", a school health education and disease prevention project for children and parents. Our objective was to evaluate the cognitive and behavioral effects of the children and parents before and after an education model-based intervention of sun protection.

Methods

We carried out a study on a school population of Social Service of Industry – Regional State of São Paulo, from the first to the fifth years of the regular course (6-10 years). Our educational project was planned to be based on two children's learning tools (comic magazine and a DVD cartoon). Questionnaires in relation to habits and knowledge in sun exposure where applied to the children (3,776) before and (2,748) after the intervention. A questionnaire was applied to 3,663 parents regarding personal details and habits of their children.

Results

According to the McNemar′s statistical test, all changes in the children in acquire new knowledge about good practices for sun exposure were statistically significant.

Conclusions

Educative sun exposure programs in childhood are a relevant tool to modify the history of life for next generations, to concern the skin cancer and good health practices.

This article is protected by copyright. All rights reserved.

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Safety and Efficacy of Apremilast Through 104 Weeks in Patients With Moderate to Severe Psoriasis Who Continued on Apremilast or Switched From Etanercept Treatment: Findings From the LIBERATE Study

Abstract

Background

Apremilast, an oral phosphodiesterase 4 inhibitor, has demonstrated efficacy in patients with moderate to severe psoriasis.

Objective

To evaluate long-term efficacy and safety of apremilast in biologic-naive patients with moderate to severe plaque psoriasis and safety of switching from etanercept to apremilast in the phase 3b LIBERATE trial.

Methods

Two hundred fifty patients were randomized to placebo, apremilast 30 mg BID, or etanercept 50 mg QW through Week 16; thereafter, all patients continued or switched to apremilast through Week 104 (extension phase). Skin, scalp, and nail involvement at Weeks 16, 52, and 104 were assessed using the Psoriasis Area and Severity Index (PASI; 0–72), Scalp Physician Global Assessment (ScPGA; 0–5), and Nail Psoriasis Severity Index (NAPSI; 0–8); patient-reported outcomes (PROs) were assessed using the Dermatology Life Quality Index (DLQI; 0–32) and pruritus visual analog scale (VAS; 0–100 mm).

Results

The apremilast-extension phase (Weeks 16–104) included 226 patients in the placebo/apremilast (n=73), apremilast/apremilast (n=74), and etanercept/apremilast (n=79) groups, and at Week 104, 50.7%, 45.9%, and 51.9% of these patients, respectively, maintained ≥75% reduction from baseline in PASI score (based on last observation carried forward analysis). Across treatment groups, ScPGA 0 (clear) or 1 (minimal) was achieved by 50.0%–59.2% of patients; NAPSI mean change from baseline was −48.1% to −51.1%; DLQI score ≤5 was achieved by 66.0%–72.5% of patients; and pruritus VAS mean change from baseline was −24.4 to −32.3. AEs in ≥5% of patients (diarrhea, nausea, nasopharyngitis, upper respiratory tract infection, and headache) did not increase with prolonged apremilast exposure.

Conclusions

Apremilast demonstrated significant and sustained improvements in skin, scalp, nails, and PROs (pruritus and quality of life) over 104 weeks in patients with moderate to severe plaque psoriasis. Safety was consistent with the known safety profile of apremilast.

This article is protected by copyright. All rights reserved.

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Consensus on the management of patients with psoriatic arthritis in a dermatology setting

Abstract

Background

Psoriatic arthritis (PsA) is a chronic inflammatory disease associated with psoriasis (PsO). Early diagnosis and prompt therapeutic intervention are crucial for limiting PsA progression and prevention of disability. Dermatologists are in a privileged position to detect early PsA. The management of patients with PsA in the dermatology setting is widely variable.

Objective

To provide practical recommendations for the management of patients with PsA in the dermatology setting including early diagnosis and treatment.

Methods

A consensus document was written by an expert panel composed by dermatologists (n=12) and rheumatologists (n=6). Eleven highly relevant questions were selected and elaborated with answers/statements based on a narrative literature review. The resulting document was discussed in a face-to-face meeting adopting a nominal group technique to reach consensus (i.e. 100% agreement) by using the Delphi method.

Results

A consensus was achieved in defining the following: the clinical characteristics differentiating inflammatory and non-inflammatory signs and symptoms of joint disease; the most important differential diagnoses of PsA in clinical practice; the most useful screening questionnaires, serum laboratory tests and imaging techniques for the detection of early PsA; the criteria for dermatologist to refer patients with PsO to rheumatologist; the criteria for the diagnosis of PsA; the selection of the indices that the dermatologist could use for measuring the activity and severity of PsA in clinical practice; when systemic steroids and/or intra-articular steroid injections are indicated in the treatment of PsA. Finally, systemic treatments including synthetic and biological disease modifying anti rheumatic drugs to be considered for the treatment of PsA have been reported.

Conclusions

The implementations of these practical recommendations could be very helpful for the management of patients with PsA in the dermatology setting including early diagnosis and treatment.

This article is protected by copyright. All rights reserved.

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Early stage mycosis fungoides screening investigations: a retrospective analysis of 440 cases

Abstract

Early stages of mycosis fungoides (MF stages IA and IB) carry similar long-term life expectancies as an age-, sex-, and race- matched control population (1-3). Despite this, the ten-year disease progression risk in stage IA and IB MF has been reported to be between 10% and 39% (4); hence, investigative screening is frequently performed at presentation. We conducted a retrospective chart review of screening investigations performed on 440 patients with stage T1/IA (52%) and T2/IB (48%) MF.

This article is protected by copyright. All rights reserved.

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Reflectance Confocal Microscopy evaluation of Trichobacteriosis Axilaris

Abstract

We read with great interest the paper by Navarrete-Dechent et al recently published on the Journal of European Academy of Dermatology¹, in which the authors detail the dermoscopic findings of trichobacteriosis and highlight the importance of dermoscopy in these cases. We present the case of a 44-year-old man, who emanated an unpleasant axilary odor during a routine check-up. Close examination of the axillary hair shafts showed soft, brown to yellow irregular masses adherent to the central segment of the hairs, suggesting the diagnosis of trichobacteriosis axilaris (TA).

This article is protected by copyright. All rights reserved.

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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.

http://ift.tt/2zLOge0

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.

http://ift.tt/2xQyb20

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.

http://ift.tt/2yzBLkW

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.

http://ift.tt/2zLfmC2

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.

http://ift.tt/2yzJLCi

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.

http://ift.tt/2hwyk55

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.

http://ift.tt/2zO6s4M

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.

http://ift.tt/2xQihow

Double Parathyroid Adenomas in Monozygotic Twins

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

http://ift.tt/2xQjYSX

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.

http://ift.tt/2yzNSOO

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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First-Generation Deescalation Trials in HPV-Positive Oropharyngeal Cancer

This Viewpoint discusses the limitations of precision medicine in patients with human papillomavirus–positive oropharyngeal cancer.

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Immunotherapy and Overall Survival in Elderly Patients With Melanoma

This cohort study evaluates if age influences clinical outcome and immune adverse events in patients treated by immunotherapy for `metastatic melanoma.

http://ift.tt/2AvI769

Practicing Safe Dermatology—Screening Out Liability

The article "Characteristics of Medical Liability Claims Against Dermatologists From 1991 Through 2015" by Kornmehl and colleagues is a welcome addition in our quest to understand how to reduce dermatology practice risk. The study confirms much of what we already knew or suspected but also provides some new interesting insights. It is reassuring to see that most malpractice cases against dermatologists are "abandoned, withdrawn or dismissed." Similarly, it is comforting to know that there has been a net reduction of 29.2% in paid claims for dermatologists. Is this secondary to improved patient care? The changing landscape of tort reform? Or both?

http://ift.tt/2AA5YzF

Trends in Medical Liability Claims Against Dermatologists

This study analyzes 24 years of data through 2015 from a nationally representative liability claims registry to compare the medical liability claims against dermatologists vs nondermatologists.

http://ift.tt/2ACBRaw

Optical Coherence Tomography Features of Dermatophytoma

This case report illustrates the optical coherence tomography features of dermatophytoma.

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Knowledge to Detect Scalp and Neck Melanoma

This study tests the association between a video intervention and hairdresser knowledge of melanoma and self-confidence in skin lesion detection.

http://ift.tt/2AxE0X7

Preference-Based QOL Measures for Economic Evaluations in Early Melanoma

This study uses randomized clinical trial data to compare utility scores from the AQoL-8D and the FACT-M and evaluate the sensitivity of both instruments in identifying the influence of fear of cancer recurrence on health-related quality of life in patients with early-stage melanoma.

http://ift.tt/2zBoM03

Topical Tacalcitol for a Family With Follicular Keratosis of the Chin

This case report describes the use of topical tacalcitol to treat follicular keratosis of the chin in 2 brothers.

http://ift.tt/2njjjcK

Allergen Concerns and Popular Skin Care Products—Reply

In Reply We thank Hamann and Thyssen, as well as Harview and Hsiao, for their interest in our work and thoughtful commentaries. We agree that the safety and affordability of cosmetics and personal care products explicitly marketed toward the pediatric population is important to public health. In a recent publication of all adverse events (AE) submitted to the US Food and Drug Administration surrounding cosmetics and personal care products from 2004 to 2016, baby products were associated with the highest percentage of self-reported serious AEs (eg, death, serious injury, or hospitalization).

http://ift.tt/2njiTmG

Allergen Concerns and Popular Skin Care Products

To the Editor We read with great interest the Original Investigation by Xu et al titled "Consumer Preferences, Product Characteristics, and Potentially Allergenic Ingredients in Best-Selling Moisturizers" and published in a recent issue of JAMA Dermatology. In discussions with dermatology colleagues regarding this article, we noticed another disturbing marketing trend: the labeling of skin care products marketed for babies.

http://ift.tt/2zBoYwj

Laboratory Monitoring During Systemic Terbinafine Therapy for Pediatric Onychomycosis

This retrospective medical record review examines the prevalence of laboratory monitoring and laboratory abnormalities during systemic terbinafine therapy in pediatric onychomycosis.

http://ift.tt/2zBXKpt

Dermatologist Density and Volume and Costs of Dermatology Procedures

This cross-sectional study uses the 2013 Medicare Provider Utilization and Payment Database to characterize the effect of geographic variations in dermatologist density on the provision of dermatology procedures within Medicare.

http://ift.tt/2zBY1sv

Allergen Concerns and Popular Skin Care Products

To the Editor We read with great interest the article by Xu et al published in a recent issue of JAMA Dermatology highlighting the high prevalence of contact allergens in common moisturizers. Their data mirror similar results in our recent study investigating contact allergens in pediatric personal care products marketed as hypoallergenic, dermatologist recommended and/or tested, fragrance free, or paraben free. Similar to the study by Xu et al, which found that 88% of common moisturizers contained at least 1 common contact allergen, we found that 167 of 187 of our selection of pediatric products (89%) contained at least 1 allergen.

http://ift.tt/2njj9lE

Reticular Hyperpigmented Eruption in a Young Woman

A woman in her 20s was seen with a 6-year history of recurrent, pruritic skin eruptions involving the middle and lower back. Physical examination showed several discrete, erythematous, scaly papules admixed with light brown reticulated macules and patches. What is your diagnosis?

http://ift.tt/2hTu5nW

Cutaneous Squamous Cell Carcinoma in Organ Transplant Recipients

This cohort study addresses whether current skin surveillance intervals and threshold for biopsy of suspicious lesions are adequate for the increased tendency of solid organ transplant recipients to develop potentially aggressive cutaneous squamous cell carcinomas.

http://ift.tt/2hW3C9v

Hair Repigmentation With Anti–PD-1 and Anti–PD-L1 Immunotherapy—Reply

In Reply We read with interest the letter by Manson et al. They describe another case of hair repigmentation (HR) in a male patient with concomitant advanced colorectal cancer and Hodgkin lymphoma treated with nivolumab and showing a good response. Interestingly, this new case seems to support the association between a good response and HR.

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Treatment of Refractory Mycosis Fungoides With Brentuximab Vedotin

This case report describes the treatment of CD30-negative refractory mycosis fungoides with brentuximab vedotin.

http://ift.tt/2jMkkZj

Hair Repigmentation With Anti–PD-1 and Anti–PD-L1 Immunotherapy

To the Editor We read with great interest the article by Rivera and colleagues reporting on hair repigmentation in patients receiving immunotherapy with anti–programmed cell death 1 (PD-1) and anti–programmed cell death 1 ligand 1 (PD-L1) immunotherapy.

http://ift.tt/2jMSX1k

Geographic Distribution of Nonphysicians Who Billed Medicare for Dermatologic Services

This study uses Medicare and US Census data to discover which dermatology-related services are independently billed by nonphysician clinicians treating Medicare beneficiaries, and where these clinicians are located.

http://ift.tt/2jRq9ox

Hair Repigmentation With Anti–PD-1 and Anti–PD-L1 Immunotherapy

To the Editor The article by Rivera et al is the first report of a previously undescribed side effect of checkpoint inhibitors: hair repigmentation (HR). In this significant case series of 14 patients, all patients received an anti–programmed cell death 1 (PD-1) and anti–programmed cell death 1 ligand 1 (PD-L1) antibody for the treatment of a lung cancer.

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Dermatology Practice Consolidation Fueled by Private Equity Investment

This Viewpoint discusses the consolidation of dermatology practices facilitated by private equity investment and the potential consequences for the specialty and patients.

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ICON Intimidation and Predatory Behavior: From Hollywood, “to the Newsroom,” to the Halls of Congress

Violence and Gender , Vol. 0, No. 0.


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Descriptive Error in the Text

In the Original Investigation titled "Prevalence of Pubic Hair Grooming–Related Injuries and Identification of High-Risk Individuals in the United States," published online August 16, 2017, there was a descriptive error in the text. The term vagina was used rather than the more accurate labia majora in 4 instances. This article has been corrected online.

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Patient Perceptions of Primary Care–Based Skin Cancer Screening

This analysis of a series of interviews seeks to better understand patient perceptions of primary care–based skin cancer screening.

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Prior Authorizations for Diagnostic Skin Biopsies

This Viewpoint outlines how managed care policies on prior authorization for diagnostic skin biopsies are affecting costs, access to care, and quality of care for patients.

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November 2017 Issue Highlights

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Attempting to Define “Hypoallergenic”

The North American Contact Dermatitis Group (NACDG) commends Xu et al for bringing attention to challenges facing dermatologists and consumers. Their original approach of using sales data provides a snapshot of what consumers are actually using (lotions!), and their assessment of commonly used marketing terms and their connection to cost and product composition are innovative.

http://ift.tt/2zr3hzR

Purpura Annularis Telangiectodes of Majocchi Associated With Apremilast

This case report describes a patient with purpura annularis telangiectodes of Majocchi associated with the initiation and rechallenge of apremilast for psoriasis vulgaris

http://ift.tt/2yhTg6D

Delay and Disparity in Time to Surgical Treatment for Melanoma

The relationship between patient health insurance status, health care use, and outcomes has been explored in great depth and detail over decades for myriad diseases in the United States. Likewise, health services research has become increasingly relevant within the specialty of dermatology, especially as the emergence of "big data" and advanced analytics continue to transform overall health care delivery.

http://ift.tt/2yzv4z2

Robert Chesebrough and the Dermatologic Wonder of Petroleum Jelly

Robert Chesebrough (1837-1933) was an American chemist whose serendipitous discovery and scientific tenacity led to one of the most common and enduring treatments in dermatology. He began his career in Brooklyn isolating kerosene from whale oil, but in 1858, his business's viability was threatened by the first successful American oil well, located in Titusville, Pennsylvania.

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Performance Characteristics of and Allergens in Best-selling Moisturizers

This cohort study examines the product performance characteristics and ingredients of best-selling moisturizers.

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Coverage of IVIG for Autoimmune Blistering Diseases by US Insurers

In this study, the authors examine coverage for IVIG to treat autoimmune blistering diseases by public and private insurers in the United States.

http://ift.tt/2yjJpgo

Association of Delays in Surgery for Melanoma With Insurance Type

This cohort study investigates whether patients with Medicaid are more likely than patients with Medicare or private insurance to experience delays in surgery for melanoma.

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Secukinumab-Induced Psoriasiform Eruption

This case report describes a patient with secukinumab-induced psoriasiform eruption.

http://ift.tt/2yiU1MK

Pubic Hair Grooming Injuries and Identification of High-Risk Individuals

This cross-sectional study of US adults identifies demographic and behavioral risk factors associated with pubic hair grooming–related injuries to characterize individuals at high risk for injury and develop recommendations for safe grooming practices.

http://ift.tt/2ztr5Ts

The Treatment of Actinic Keratoses—The Rule Rather Than the Exception

To the Editor We read with great interest the article by Berry et al entitled "Influence of Information Framing on Patient Decisions to Treat Actinic Keratosis." This work highlights a critical aspect of the physician-patient relationship—communication. As expected, the findings suggest that the verbiage used to describe actinic keratoses (AKs) can affect the patient's decision to pursue treatment. Interestingly, regardless of how the question was framed, most patients preferred to treat these lesions.

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Improvement of Genetic Testing for Cutaneous Melanoma

This study evaluates the efficiency of using the "rule of 3" vs the widely accepted "rule of 2" for the detection of melanoma-prone mutations in France, a country with low to moderate melanoma incidence.

http://ift.tt/2ztslpZ

The Black Panther, From Politics to Popular Culture

Although the black panther is not a true animal species, the term is used to describe black pigmentation in a number of large feline species, including jaguars and leopards. Studies show that their dark pigmentation patterns are linked to polymorphisms in 2 genes, the melanocortin-1 receptor (MC1R) and the agouti-signaling protein (ASIP). The melanocortin-1 receptor is activated by binding of α-melanocyte–stimulating hormone, leading to the production of eumelanin, which is responsible for dark pigmentation. Conversely, the melanocortin-1 receptor is inhibited by the antagonist ASIP, leading to the production of pheomelanin, which is responsible for light pigmentation. Therefore, activating mutations in MC1R and inactivating mutations in ASIP are thought to underlie the melanization of the captivating black panther. In 1966, these striking animals became a symbol for one of the most influential civil rights groups, as well as the inspiration for Marvel Comics' first black superhero.

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Risk Factors for Melanoma in Renal Transplant Recipients

This cohort study uses data from the United States Renal Data System to investigate risk factors and characteristics of renal transplant recipients who develop melanoma.

http://ift.tt/2zsN7pv

Nathaniel Hawthorne’s “The Birthmark”

A short story titled "The Birthmark," written by Nathaniel Hawthorne in 1843, revolves around none other than a prominent birthmark. The main character, Aylmer, is an intelligent, retired scientist whose love of science is only matched by his love for his spectacularly beautiful new wife, Georgiana. But soon after the two wed, Aylmer becomes obsessed with a crimson, hand-shaped mark on his bride's left cheek, a mark Georgiana had considered a "charm" prior to Aylmer's mention. Georgiana's perception of her mark turns to disgust with each passing day of her husband's obsession. Aylmer believes he can liberate his wife from this mark, her only flaw, and he spends the length of the story seeking a method to do so.

http://ift.tt/2yfRv9T

Pneumocystis Pneumonia in Patients With Autoimmune Blistering Diseases

This analysis assesses the incidence of Pneumocystis pneumonia in patients with autoimmune blistering diseases receiving no routine prophylaxis.

http://ift.tt/2zsFnUw

Erythema With Nonscarring, Tense Blisters and No Anti-BP180 Antibodies

A woman in her 80s had scaly erythematous plaques with nonscarring, tense blister formation without circulating anti-BP180 antibodies. What is your diagnosis?

http://ift.tt/2yiTryy

An unusual presentation of eosinophilic angiocentric fibrosis

Abstract

Eosinophilic angiocentric fibrosis (EAF) is a rare, benign condition affecting the respiratory mucosa and is generally characterized by a locally destructive growth. We present a case of a lady with a saddle nose deformity that had for many years been treated as granulomatosis with polyangiitis (GPA), of which saddle nose deformity is a classic feature. At the time of surgery, she was found to have subglottic stenosis another classic feature of GPA, however, histology demonstrated EAF. We discuss the difference between the two conditions and highlight the importance of making the correct diagnosis.

http://ift.tt/2nI0Qqm

Hepatic portal venous gas: acute deterioration in an elderly patient

Abstract

A 91-year-old female presented to the Emergency Department with a 10-day history of constipation and abdominal pain. Abdominal examination was normal and rectal examination showed faecal loading. A phosphate enema was given and the patient was admitted. Overnight, the patient's GCS dropped from 15/15 to 3/15 and an arterial blood gas showed a lactate of 8 mmol/L (1.5 on admission). Abdomen remained soft throughout. A CT scan showed a large amount of free air and free fluid within the abdomen and pelvis, highly suspicious for perforation. Hepatic portal venous gas (HPVG) was visible, with portal venous air fluid levels noted. The patient was treated palliatively and died shortly thereafter. HPVG is a recognized but rarely identified radiological sign, which is a poor prognostic indicator, with most cases subsequently proving terminal, often due to subsequent bowel necrosis.

http://ift.tt/2kc2RpC

Severe Fournier’s gangrene—a conjoint challenge of gynaecology and plastic surgery

Abstract

Necrotizing fasciitis (NF) is a rare soft tissue infection characterized by rapidly progressing necroses and a high mortality. Prompt diagnosis and immediate medical treatment including radical debridement and broad spectrum antibiotics are the key to successful management. We report on a 46-year-old diabetic female who developed extensive, deep necroses in the perineal area and proximal thighs within a few days. After initial gynaecological consultation, she was transferred directly to our department. Due to the suspicion of NF, an immediate radical debridement was performed. Two more debridements were necessary to control the infection. After stabilization, the extensive soft tissue defect was reconstructed using a combination of plastic reconstructive procedures. Due to early diagnosis, direct referral and immediate surgical treatment, the patient survived.

http://ift.tt/2kcKsZJ

Hairdressers Doing Scalp Exams Could Save Lives

On self-examination, 50% of melanomas go undetected. They frequently show up on the head and neck. Could hairdressers be trained to conduct frontline population-based screening?
Medscape Medical News

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Eating out with a food allergy in the UK: Change in the eating out practices of consumers with food allergy following introduction of allergen information legislation

Abstract

Background

Strict allergen avoidance is important in day-to-day management of food allergy and avoidance when eating outside the home can present particular difficulties. EU legislation (EU FIC) introduced in December 2014 aimed to improve food allergen information provision for customers by requiring retailers of non-prepacked foods to provide information related to the content of one or more of 14 specified food allergens within their foods.

Objectives

To investigate the impact of EU FIC on the behaviours, experiences and attitudes of consumers with food allergy when eating out.

Methods

As part of longitudinal research, participants with food allergy from across the UK took part in either A) pre and post legislation in-depth interviews, or B) pre and post legislation surveys. In-depth interviews were carried out with 28 participants pre and post legislation, and analysed using the framework approach. Self-report surveys were completed by 129 participants pre and post legislation, and responses were subject to quantitative analyses.

Results

Improvements in allergen information provision and raised awareness of food allergy in eating out venues was reported following introduction of EU FIC. Whilst participants favoured written allergen information, they expressed greater confidence in communicating with eating out staff and in trusting the allergen information that they provided. Improvements were judged to be gradual, sporadic or inconsistent in implementation.

Conclusion & clinical relevance

For many participants, the 'ideal' eating out experience was one in which a range of information resources were available, and where written allergen information was complemented by proactive and accommodating staff within an allergy-aware environment. Whilst the onus is on legislators and food providers to ensure that adequate allergen information is provided, clinicians play an important role in encouraging patients with food allergy to pursue their legal right to make allergen enquiries in order to avoid accidental allergen ingestion when eating out.

This article is protected by copyright. All rights reserved.

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Odontoblast-like differentiation and mineral formation of pulpsphere derived cells on human root canal dentin in vitro

Abstract

Background

The revitalization or regeneration of the dental pulp is a preferable goal in current endodontic research. In this study, human dental pulp cell (DPC) spheres were applied to human root canal samples to evaluate their potential adoption for physiological tissue-like regeneration of the dental root canal by odontoblastic differentiation as well as cell-induced mineral formation.

Methods

DPC were cultivated into three-dimensional cell spheres and seeded on human root canal specimens. The evaluation of sphere formation, tissue-like behavior and differentiation as well as mineral formation of the cells was carried out with the aid of optical light microscopy, immunohistochemical staining and scanning electron microscopy (SEM).

Results

Spheres and cells migrated out of the spheres showed an intense cell-cell- and cell-dentin-contact with the formation of extra cellular matrix. In addition, the ingrowth of cell processes into dentinal tubules and the interaction of cell processes with the tubule walls were detected by SEM-imaging. Immunohistochemical staining of the odontoblast specific matrix proteins, dentin matrix protein-1, and dentin sialoprotein revealed an odontoblast-like cell differentiation in contact with the dentin surface. This differentiation was confirmed by SEM-imaging of cells with an odontoblast specific phenotype and cell induced mineral formation.

Conclusions

The results of the present study reveal the high potential of pulp cells organized in spheres for dental tissue engineering. The odontoblast-like differentiation and the cell induced mineral formation display the possibility of a complete or partial "dentinal filling" of the root canal and the opportunity to combine this method with other current strategies.

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Identification of a 62 kDa major allergen from Artemisia pollen as a putative galactose oxidase

Abstract

Background

Around 20 years ago, a 60-70 kDa protein was reported as a major allergen of mugwort (Artemisia vulgaris) pollen. This study was to identify and characterize its molecular properties.

Methods

Sera from 113 Chinese and 20 Dutch Artemisia allergic/sensitized subjects (and pools thereof) were used to identify the 60-70 kDa allergen. Pollen extracts of seven Artemisia species were compared by immunoblotting. Transcriptomics and proteomics (mass spectrometry) of A. annua pollen were used to identify the putative 60-70 kDa Artemisia allergen. Both the natural purified and recombinant allergens were evaluated for IgE reactivity by ImmunoCAP. Fourteen Chinese Artemisia allergic patients were tested intradermally with purified natural allergen.

Results

Immunoblots revealed two major bands at 12 and 25 kDa, and a weak band at 70 kDa for all seven Artemisia species. Using a combined transcriptomic and proteomic approach, the high molecular mass allergen in A. annua pollen was shown to be a 62 kDa putative galactose oxidase, with a putative N-glycosylation site. More than 94% of Artemisia pollen allergic patients had IgE response to this allergen. Although recognition of a non-glycosylated recombinant version was only confirmed in a minority (16%) and at much lower IgE levels, this discrepancy cannot be explained simply by reactivity to the carbohydrate moiety on the natural allergen. Intradermal testing with the natural allergen was positive in five out of nine sensitized patients.

Conclusions

The previously reported 60-70 kDa allergen of Artemisia pollen is most likely a 62 kD putative galactose oxidase here designated Art an 7.

This article is protected by copyright. All rights reserved.

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Dreidimensionale Analyse nasaler Physiologie

Zusammenfassung

Die menschliche Nase übernimmt einen großen Teil der Präkonditionierung eingeatmeter Luft. Zahlreiche pathologische Veränderungen können die Physiologie der Nase beeinträchtigen. Die Anfänge der Strömungsanalysen wurden mit dreidimensionalen Abgussmodellen und farbig markierten Flüssigkeiten durchgeführt. Temperatur und Feuchtigkeit konnten hierbei nicht berücksichtigt werden. Heute sind wesentlich komplexere Analysen mittels „computational fluid dynamics" (CFD) möglich, die auf dreidimensionalen Modellen basieren, welche aus Datensätzen der Computertomographie (CT) oder Magnetresonanztomographie (MRT) erstellt werden. Hierbei können Strömungsgeschwindigkeiten, Temperatur, Feuchtigkeit und Druckdifferenzen in Abhängigkeit von multiplen Randbedingungen simuliert und hochauflösend dargestellt werden. Die Analyse pathologischer Veränderungen oder operativer Eingriffen ist dadurch möglich.

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Entscheidungen zwischen Leben und Tod

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Das Recht am eigenen Bild

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Introduction to the special issue on dietary control of immunometabolism

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Paclitaxel, Cisplatin,5-FU vs. Radiotherapy Plus Paclitaxel, Cisplatin as Preoperative Therapy for Locally Advanced ESC

Conditions:   Esophageal Cancer Stage IIB;   Esophageal Cancer Stage III
Interventions:   Combination Product: Paclitaxel, Cisplatin Plus 5-FU (TCF);   Radiation: radiochemotherapy
Sponsors:   Tianjin Medical University Cancer Institute and Hospital;   Shanghai Chest Hospital;   Henan Cancer Hospital;   The First Affiliated Hospital with Nanjing Medical University;   First Affiliated Hospital of Chongqing Medical University;   The First Affiliated Hospital of Anhui Medical University
Not yet recruiting

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Rapid Assessment of Esophageal Adenocarcinoma Risk Test

Conditions:   Barrett Esophagus;   Esophageal Adenocarcinoma
Intervention:   Device: Cytosponge
Sponsor:   Columbia University
Not yet recruiting

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Sequential or Concurrent Chemoradiotherapy in Patients With Locoregionally Advanced NPC

Condition:   Nasopharyngeal Carcinoma
Interventions:   Drug: gemcitabine and cisplatin (Induction and adjuvant chemotherapy);   Radiation: IMRT;   Drug: gemcitabine and cisplatin (Induction chemotherapy);   Radiation: IMRT and concurrent cisplatin
Sponsors:   Chaosu Hu;   Zhejiang Cancer Hospital;   Jiangxi Provincial Cancer Hospital;   First Affiliated Hospital of Wenzhou Medical Univeristy;   Affiliated Hospital of Jiangnan University;   Fujian Cancer Hospital
Not yet recruiting

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Survival study of treatment adherence by patients given oral oxibutynin for hyperhidrosis

Abstract

Introduction

In recent years, increasing use has been made of oral anticholinergics such as oxybutynin for the management of hyperhidrosis. The primary aim of this study is to determine the variables associated with adherence to this treatment, and secondarily to obtain data on its effectiveness, safety and adverse effects.

Material and methods

Prospective study of patients with hyperhidrosis, at any location, receiving treatment with oral oxybutynin in the period 2007-2016. Epidemiological variables, treatment details, effectiveness and adverse effects were recorded. Effectiveness was determined according to the Hyperhidrosis Disease Severity Scale (HDSS) at baseline, at 3 and 12 months and in successive visits. A descriptive analysis was performed, and Cox's bivariate and multivariate regressions were calculated to determine the variables associated with treatment adherence.

Results

201 patients (140 women) with a mean age of 34 years were included. The mean initial HDSS score was 3.8 and the median follow-up period was 29 months. At 3 months, 84.57% of the patients had responded to treatment (excellent response: 72.94%), but adverse effects were reported by 68.2%. At 12 months, 54.23% had responded (excellent response: 79.82%), with adverse effects in 75.2%. The main variable associated with greater adherence was affected areas: palms of the hands and soles of the feet. The following variables were associated with poorer adherence: onset of hyperhidrosis in adolescence, failure to provide an incrementally increasing, individualised dose, initial HDSS score of 3, and partial initial response. The multivariate analysis confirmed the association between the onset of hyperhidrosis during adolescence, the failure to provide a progressively increasing dose, and palmar affectation.

Discussion

This study was conducted to identify the variables associated with adherence to treatment by hyperhidrosis patients treated with oral oxybutynin. This information would facilitate selection of patients for this treatment and enhance our understanding of the biological behaviour of such anticholinergics when used to treat hyperhidrosis.

This article is protected by copyright. All rights reserved.

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Improved adductor function after canine recurrent laryngeal nerve injury and repair using muscle progenitor cells

Objective

Muscle progenitor cells (MPCs) can be isolated from muscle samples and grown to a critical mass in culture. They have been shown to survive and integrate when implanted into rat laryngeal muscles. In this study, the ability of MPC implants to enhance adductor function of reinnervated thyroarytenoid muscles was tested in a canine model.

Study Design

Animal study.

Methods

Sternocleidomastoid muscle samples were harvested from three canines. Muscle progenitor cells were isolated and cultured to 10⁷ cells over 4 to 5 weeks, then implanted into right thyroarytenoid muscles after ipsilateral recurrent laryngeal nerve transection and repair. The left sides underwent the same nerve injury, but no cells were implanted. Laryngeal adductor force was measured pretreatment and again 6 months later, and the muscles were harvested for histology.

Results

Muscle progenitor cells were successfully cultured from all dogs. Laryngeal adductor force measurements averaged 60% of their baseline pretreatment values in nonimplanted controls, 98% after implantation with MPCs, and 128% after implantation with motor endplate-enhanced MPCs. Histology confirmed that the implanted MPCs survived, became integrated into thyroarytenoid muscle fibers, and were in close contact with nerve endings, suggesting functional innervation.

Conclusion

Muscle progenitor cells were shown to significantly enhance adductor function in this pilot canine study. Patient-specific MPC implantation could potentially be used to improve laryngeal function in patients with vocal fold paresis/paralysis, atrophy, and other conditions. Further experiments are planned.

Level of Evidence

NA. Laryngoscope, 2017

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The development of the human hyoid–larynx complex revisited

Objectives/Hypothesis

The hyoid–larynx complex is highly prone to anatomical variation. The etiology of anatomical variants such as Eagle's syndrome and the aberrant hyoid apparatus can be explained from embryonic development. Modern textbooks state that the hyoid bone body develops from the second and third pharyngeal arch cartilages, and that thyroid cartilage derives from the fourth and sixth arch cartilages. This description, however, is incompatible with various anatomical variants, and it is unclear whether it was based on observations in human embryos or on comparative embryology.

Study Design

14 human embryos from the Carnegie collection between Carnegie stage 17 and 23 (42–60 days) were selected based on their histological quality.

Methods

Histological sections of the selected embryos were examined. Three-dimensional models were prepared in an interactive format. These anatomical models provide crucial spatial information and facilitate interpretation.

Results

We observed a less-complicated development of the hyoid–larynx complex than is currently described in textbooks. The body of the hyoid bone originates from a single growth center, without overt contributions from second and third pharyngeal arch cartilages. The fourth and sixth arch cartilages were not detected in human embryos; the thyroid and cricoid cartilages develop as mesenchymal condensations in the neck region.

Conclusions

Despite new research techniques, theories about hyoid–larynx complex development from the beginning of the 20th century have not been refuted properly and can still be found in modern literature. Based on observations in human embryos, we propose a new and relatively simple description of the development of the hyoid–larynx complex to facilitate better understanding of the etiology of anatomical variants.

Level of Evidence

NA Laryngoscope, 2017

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The development and validation of the speech quality instrument

Objective

Although speech perception tests are available to evaluate hearing, there is no standardized validated tool to quantify speech quality. The objective of this study is to develop a validated tool to measure quality of speech heard.

Study Design

Prospective instrument validation study of 35 normal hearing adults recruited at a tertiary referral center.

Methods

Participants listened to 44 speech clips of male/female voices reciting the Rainbow Passage. Speech clips included original and manipulated excerpts capturing goal qualities such as mechanical and garbled. Listeners rated clips on a 10-point visual analog scale (VAS) of 18 characteristics (e.g. cartoonish, garbled).

Results

Skewed distribution analysis identified mean ratings in the upper and lower 2-point limits of the VAS (ratings of 8–10, 0–2, respectively); items with inconsistent responses were eliminated. The test was pruned to a final instrument of nine speech clips that clearly define qualities of interest: speech-like, male/female, cartoonish, echo-y, garbled, tinny, mechanical, rough, breathy, soothing, hoarse, like, pleasant, natural. Mean ratings were highest for original female clips (8.8) and lowest for not-speech manipulation (2.1). Factor analysis identified two subsets of characteristics: internal consistency demonstrated Cronbach's alpha of 0.95 and 0.82 per subset. Test–retest reliability of total scores was high, with an intraclass correlation coefficient of 0.76.

Conclusion

The Speech Quality Instrument (SQI) is a concise, valid tool for assessing speech quality as an indicator for hearing performance. SQI may be a valuable outcome measure for cochlear implant recipients who, despite achieving excellent speech perception, often experience poor speech quality.

Level of Evidence

2b. Laryngoscope, 2017

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Phenomenology, genetics, and CNS network abnormalities in laryngeal dystonia: A 30-year experience

Objective

Laryngeal dystonia (LD) is a functionally specific disorder of the afferent–efferent motor coordination system producing action-induced muscle contraction with a varied phenomenology. This report of long-term studies aims to review and better define the phenomenology and central nervous system abnormalities of this disorder and improve diagnosis and treatment.

Methods

Our studies categorized over 1,400 patients diagnosed with LD over the past 33 years, including demographic and medical history records and their phenomenological presentations.

Patients were grouped on clinical phenotype (adductor or abductor) and genotype (sporadic and familial) and with DNA analysis and functional magnetic resonance imaging (fMRI) to investigate brain organization differences and characterize neural markers for genotype/phenotype categorization. A number of patients with alcohol-sensitive dystonia were also studied.

Results

A spectrum of LD phenomena evolved: adductor, abductor, mixed, singer's, dystonic tremor, and adductor respiratory dystonia. Patients were genetically screened for DYT (dystonia) 1, DYT4, DYT6, and DYT25 (GNAL)–and several were positive. The functional MRI studies showed distinct alterations within the sensorimotor network, and the LD patients with a family history had distinct cortical and cerebellar abnormalities. A linear discriminant analysis of fMRI findings showed a 71% accuracy in characterizing LD from normal and in characterizing adductor from abductor forms.

Conclusion

Continuous studies of LD patients over 30 years has led to an improved understanding of the phenomenological characteristics of this neurological disorder. Genetic and fMRI studies have better characterized the disorder and raise the possibility of making objective rather than subjective diagnoses, potentially leading to new therapeutic approaches. Laryngoscope, 128:S1–S9, 2018

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Toxicity trial of canine posterior cricoarytenoid intramuscular vincristine injections

Objectives/Hypothesis

In animal studies, intramuscular vincristine injections have been shown to block reinnervation of the denervated target muscle. This application could be used selectively to influence recovery patterns following injury of recurrent laryngeal nerves (RLNs). However, vincristine is currently Food and Drug Administration approved only for intravenous use. A formal toxicity trial of intramuscular injections was performed.

Study Design

Animal study.

Methods

Sixteen female canines underwent direct laryngoscopy with injection of moderate- (0.4 mg, n = 8) or high-dose (0.6 mg, n = 8) vincristine into the posterior cricoarytenoid (PCA) muscles. Plasma samples were collected at various time points postinjection and vincristine levels determined. At 24 hours (n = 7) or 14 days (n = 9) postinjection, animals were anesthetized and videolaryngoscopy documented vocal fold mobility and mucosal appearance. Adductor function was measured during stimulation of the RLN. Larynges were processed for histology.

Results

Fifteen minutes after injection, plasma vincristine levels averaged 10.2% ± 6.7% of the intravenous maximum, suggesting about 90% of the vincristine remained within the PCA muscle. Plasma levels were usually below detectable limits within 24 hours. At the end points, all animals had grossly normal-appearing mucosa and full range of motion. Laryngeal adductor strength was normal in all cases. Histology showed moderate to severe acute inflammation in the submucosa only in the high-dose group at 24 hours. There was no necrosis of muscle or mucosa.

Conclusions

Intramuscular vincristine injections into the canine PCA muscles resulted in no significant local toxicity, even at the maximum dose. It would be reasonable to evaluate this treatment strategy in a phase I human trial.

Level of Evidence

NA Laryngoscope, 2017

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Minimal clinically important difference of voice handicap index-10 in vocal fold paralysis

Objectives/Hypothesis

The Voice Handicap Index-10 (VHI-10) is commonly used to measure patients' perception of vocal handicap. Clinical consensus has previously defined clinically meaningful improvement as a decrease ≥5. This study determines the minimal clinically important difference (MCID) for VHI-10 in patients with unilateral vocal fold paralysis (UVFP) using anchor-based methodology.

Study Design

Prospective cohort questionnaire analysis.

Methods

Two hundred eighty-one UVFP patients completed the VHI-10 on two consecutive visits (within 3 months). At the follow-up visit, patients answered an 11-point Global Rating of Change Questionnaire (GRCQ) scored from −5 to +5. Relationship between the GRCQ and change in VHI-10 was quantified using analysis of variance, and MCID for the VHI-10 was determined using receiver operating characteristic (ROC) curve analysis.

Results

Overall mean VHI-10 change was −3.71 (standard deviation [SD] = 8.89) and mean GRCQ was 1.37 (SD = 2.51). Average interval between measurements was 1.73 months (SD = 0.83). Mean changes in VHI-10 scores were −7.45, −0.53, and +4.40 for patients whose GRCQ scores indicated improvement, no change, and worsening, respectively. Differences between mean scores were statistically significant (P < .001). Area under the ROC curve was 0.80, demonstrating the classification accuracy of VHI-10 change scores. A VHI-10 change of −4 was determined to be the optimal threshold that discriminated between improvement and no improvement (sensitivity and specificity 0.62 and 0.88, respectively).

Conclusions

The MCID for improvement in VHI-10 in UVFP patients is a decrease of 4. This information improves understanding of patients' response to treatment and allows comparison between different treatments. Future research should determine MCID for VHI-10 across all voice disorders.

Level of Evidence

4 Laryngoscope, 2017

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What is the appropriate timing for endoscopic and radiographic surveillance following treatment for sinonasal malignancies?

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Objektive Audiometrie und klinische Anwendung

Zusammenfassung

Zur Diagnostik mannigfaltiger Hörstörungen werden neben den subjektiven Hörprüfungen v. a. objektive Testverfahren eingesetzt. Zu den objektiven Hörprüfungen gehören die Impedanzmessung mit Tympanometrie und Stapediusreflexmessung, die otoakustischen Emissionen (OAE) sowie die akustisch evozierten Potenziale (AEP). Durch die Einführung von „auditory steady-state responses" (ASSR) und in Verbindung mit statistischen Nachweismethoden kommen objektive Hörverfahren auch beim Neugeborenen-Hörscreening und bei der automatisierten Hörschwellenbestimmung zum Einsatz. Durch die Anwendung der genannten Methoden kann zwischen den verschiedenen Hörstörungen differenziert und der Grad einer Hörminderung bestimmt werden. Bei sorgfältiger Interpretation der Messergebnisse lässt sich mithilfe dieser Verfahren auch eine auditorische Synapto‑/Neuropathie von einer klassischen sensorineuralen Schwerhörigkeit unterscheiden.

http://ift.tt/2BhGqKI

Dapsone for Recalcitrant Eosinophilic Annular Erythema: A Case Report and Literature Review

Abstract

Eosinophilic annular erythema (EAE) is a rare entity of unknown etiology that is possibly related to a hypersensitivity reaction and presents as annular erythematous plaques with tissue eosinophilia. It is classified as a figurate erythema with a controversial relationship to Wells syndrome (WS) in the literature, where it is generally considered a separate entity or subset based on clinical and histopathologic differences. EAE typically presents with recurrent, erythematous, arcuate, and annular plaques on the trunk and proximal extremities. The course of the disease is often chronic, recurrent, and relapsing. Responses to treatment are variable but are typically best with systemic steroids and antimalarials. We report a patient refractory to other therapies who had a striking response to dapsone.

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Pyoderma gangrenosum récidivant du post-partum et cardiomyopathie fatale

Publication date: Available online 7 December 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): I. Naciri, M. Meziane, L. Benzekri, M. Ghaouti, K. Senouci, B. Hassam
IntroductionNous rapportons l'observation d'un pyoderma gangrenosum (PG) récidivant du post-partum, associé à une cardiomyopathie du post-partum (CMPP).ObservationUne femme de 23 ans signalait avoir eu un abcès du sein gauche lors de sa quatrième grossesse. Cette lésion avait évolué, après drainage chirurgical, vers une ulcération inflammatoire traitée par des soins locaux atraumatiques. Lors de sa cinquième grossesse, la patiente développait une ulcération large et douloureuse en regard d'une cicatrice de césarienne, malgré l'introduction d'une antibiothérapie à large spectre. Les prélèvements bactériologiques étaient négatifs. L'examen histologique était en faveur d'un PG. Une semaine après l'introduction d'une corticothérapie générale, elle présentait brutalement des signes d'insuffisance cardiaque. L'échocardiographie trans-thoracique permettait de retenir le diagnostic de CMPP, dont l'évolution était fatale.DiscussionCette observation soulève la question de la relation entre PG et grossesse, et décrit l'association d'un PG et d'une CMPP. La survenue du PG lors de la grossesse est rare ; elle pourrait être induite par l'élévation des taux de G-CSF constatée chez les femmes enceintes. L'association à une CMPP chez notre patiente pourrait être expliquée par le développement d'un climat anti-angiogénique en fin de grossesse, auquel s'ajouterait une agression myocardique inflammatoire neutrophilique en lien avec le PG.BackgroundWe report a case of recurrent post-partum pyoderma gangrenosum (PG) complicated by post-partum cardiomyopathy (PPCM).Patients and methodsA 23-year-old woman presented with a previous medical history of aseptic abscess of the left breast in her fourth pregnancy, which developed after surgical drainage of an inflammatory ulceration treated by atraumatic topical care. During her fifth pregnancy, the patient presented a large and painful ulceration in relation to the scar of the Caesarean section, despite the introduction of broad-spectrum antibiotic therapy. Bacteriological samples were negative. Histological examination militated in favor of PG. One week after initiation of corticosteroid therapy, the patient suddenly showed signs of heart failure. Based on trans-thoracic echocardiography PPCM was diagnosed, and the outcome was fatal.DiscussionThis observation raises the question of the relationship between PG and pregnancy and describes the association of PG and PPCM. PG occurs rarely during pregnancy and it may be induced by the rise in G-CSF levels found in pregnant women. The association with PPCM seen in our patient could have been due to the development of an anti-angiogenic climate at the end of pregnancy, together with inflammatory myocardial aggression linked to the PG.



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First evidence of bacterial translocation from the intestinal tract as a route of Helicobacter cinaedi bacteremia

Abstract

Background

The route of Helicobacter cinaedi bacteremia has not yet been clarified. Although bacterial translocation from the intestinal tract into the circulation has been suggested, it has not been demonstrated thus far. The objective of this study was to investigate the port of entry of this bacterium.

Material and Methods

We conducted a retrospective study on patients with H. cinaedi bacteremia between March 2009 and May 2013. Records of patients in whom H. cinaedi was detected in both blood and stool cultures were extracted. H. cinaedi was identified using gyrB-targeted PCR. Pulse-field gel electrophoresis was used to investigate the consistency of the genotypes.

Results

Seventy-one patients were diagnosed with H. cinaedi bacteremia during the study period. H. cinaedi was detected in both blood and stool samples of 21 patients. Pulse-field gel electrophoresis was used to investigate the consistency of the genotypes in 18 evaluable strains (from 9 patients). The pulse-field gel electrophoresis patterns of the stool- and blood-derived strains of H. cinaedi were consistent among all 9 patients. Most of the 9 patients analyzed were immunocompromised and being treated with anticancer drugs or steroids, which suggests reduced intestinal immunity.

Conclusions

This is the first study to demonstrate that bacterial translocation from the intestinal tract could represent one route of H. cinaedi bacteremia.

http://ift.tt/2AGC26T