Hypophosphatasia (HPP) is a rare, inherited metabolic bone disorder characterized by low serum alkaline phosphatase activity and impaired bone mineralization. Clinical manifestations and severity of symptoms vary widely in HPP, ranging from in utero death to isolated dental manifestations in adults. Treatment with enzyme replacement therapy has been reported to improve outcomes in perinatal, infantile, and childhood forms of HPP. Here, we present a case of a boy with poor linear growth, mild limb bowing, and radiographic rickets who was diagnosed with HPP before 6 months of age. Treatment with enzyme replacement therapy was initiated at 7 months of age, after which significant improvements in radiographic findings and linear growth were demonstrated. This case highlights several important challenges in the diagnosis, classification, and management of HPP.
https://ift.tt/2GDJGCD
Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Σάββατο 31 Μαρτίου 2018
Brief Clinical Report: Hypophosphatasia—Diagnostic Considerations and Treatment Outcomes in an Infant
A Rare Case of Lemierre-Like Syndrome: A Case Report and Literature Review
Lemierre's syndrome (LS) is a serious rare complication of oropharyngeal infections. It is characterized by thrombosis of internal jugular vein that rapidly progresses into sepsis and is typically caused by anaerobes. Most of the reported cases have been linked to Fusobacterium necrophorum; however, there are a handful of reported cases due to aerobes. It is primarily the disease of healthy young adults and can present in school-aged children. The early recognition and treatment of this complication results in resolution of the illness; nevertheless, there have been some concerns about chronic venous insufficiency as a long-term complication. We report a case of a 6-year-old boy, who presented with fever and headache with a history of sore throat. His blood culture was positive for group A Streptococcus (GAS) and was subsequently found to have internal jugular vein, sigmoid, and transverse sinus vein thrombosis.
https://ift.tt/2uDRGP6
Infectious Aortitis: A Life-Threatening Endovascular Complication of Nontyphoidal Salmonella Bacteremia
A 65-year-old Japanese man living in the United States presented with pyrexia and chills associated with intermittent lower abdominal and back pain for 5 days. He denied recent travel, rash, diarrhea, or rectal bleeding. Physical examination revealed spiking pyrexia, and routine laboratory tests revealed mild leukocytosis and neutrophilia. Abdominal CT with contrast showed findings highly compatible with aortitis. Comprehensive autoimmune evaluation was negative. Salmonella enterica serotype Enteritidis was isolated from blood cultures. IV antibiotics were administered, but the patient continued to experience low-grade pyrexia and mild leukocytosis, and follow-up abdominal CT showed progressive aortic inflammation. The patient therefore underwent resection of the affected aortic segment with in-situ graft replacement and lifelong suppressive antibiotics. The patient is asymptomatic with no complications at 18 weeks of follow-up. This case report illustrates that patients with infectious aortitis from nontyphoidal Salmonella may (1) present with nonspecific and nonlocalizing symptoms and signs except for sepsis; (2) have diagnostic blood cultures and abdominal CT findings; and (3) typically require aggressive, prolonged IV antibiotic therapy and surgery for potential cure of this life-threatening infection.
https://ift.tt/2J939cF
A Large Grade 5 Mobile Aortic Arch Atheromatous Plaque: Cause of Cerebrovascular Accident
Aortic atheromas (aortic atheromatous plaques) are defined by an irregular thickening of the intima ≥2 mm, and a complex plaque is defined as a protruding atheroma ≥4 mm with or without an attached mobile component. Stroke incidence is approximately 25% in patients with mobile plaques of the aortic arch and 2% in patients with quiescent nonmobile plaques. Antiplatelet agents, oral anticoagulants, and statins have been suggested in the management of atheromas. We present an 80-year-old male, with non-ST-segment elevation myocardial infarction (NSTEMI) and chronic dysarthria, found to have an acute cerebrovascular accident (CVA) secondary to embolism from a large 12 mm aortic arch plaque, treated medically with oral antiplatelet therapy, anticoagulation, and statin therapy.
https://ift.tt/2E91lNd
Multiple roles of lymphatic vessels in tumor progression
Qiaoli Ma | Lothar C Dieterich | Michael Detmar
https://ift.tt/2pTZNlS
Next generation natural killer cells for cancer immunotherapy: the promise of genetic engineering
May Daher | Katayoun Rezvani
https://ift.tt/2GspGzm
The safety and risk factors of revision adenoidectomy in children and adolescents: A nationwide retrospective population-based cohort study
To investigate the safety of adenoidectomy and risk factors of re-adenoidectomy, and intend to provide evidence-based information to clinicians for further consideration.
https://ift.tt/2pWg8pW
Multimodality Surgical Approach in Management of Laryngotracheal Stenosis
Introduction. Postintubation laryngotracheal stenosis requires a precise diagnosis and an experienced operator in both endoscopic and surgical treatment. This report presents surgically treated cases of laryngotracheal stenosis secondary to long-term intubation/tracheostomy with review of the literature. Materials and Methods. In this retrospective study, we present 5 cases (a 23-year-old male, 13-year-old male, 22-year-old male, 19-year-old male, and 33-year-old female) of postintubation/tracheostomy laryngotracheal (glottic/subglottic) stenosis in the years 2016 and 2017. Each patient was managed differently. Intubation characteristics, localization of stenosis, surgical technique and material, postoperative complications, and survival of patients were recorded. Results. The site of stenosis was in the subglottis in 4 patients and glottis in 1 patient. The mean length of the stenosis was greater in the postintubation group. Postintubation stenosis had a mean duration of intubation of 6.8 days, compared to 206.25 days of cannulation following tracheostomies. Each patient underwent an average of 2 procedures during their treatment course. One patient underwent open surgical anastomosis because of recurrent subglottic stenosis after multiple treatments. Phonation improved immediately in almost all except in the patient who underwent only endoscopic dilatation. Discussion. The reasons for laryngeal stenosis and its delayed diagnosis have been reviewed from the literature. Suture tension should be appropriate, and placement of the suture knot outside the trachea minimizes formation of granulation tissue. The published reports suggest that resection by endoscopy with laser and open technique resection and primary anastomosis are the best treatment modality so far as the long-term results are concerned. Conclusion. Resection of stenotic segment by open surgical anastomosis and laser-assisted resection is a safe option for the treatment of subglottic stenosis following intubation without the need for repeated dilation. Endoscopic dilation can be reserved for unfit patients.
https://ift.tt/2GMy4xf
Spinal Accessory Nerve Duplication: A Case Report and Literature Review
Aim of the present study is to expand our knowledge of the anatomy of the 11th cranial nerve and discuss the clinical importance and literature pertaining to accessory nerve duplication. We present one case of duplicated spinal accessory nerve in a patient undergoing neck dissection for oral cavity cancer. The literature review confirms the extremely rare diagnosis of a duplicated accessory nerve. Its clinical implication is of great importance. From this finding, a further extension to our knowledge of the existing anatomy is proposed.
https://ift.tt/2uCOanZ
Safety and Efficacy of a Halobetasol/Tazarotene Fixed Combination in the Treatment of Moderate-to-Severe Plaque Psoriasis: Results of two Phase 3 randomized controlled trials
Topical corticosteroids are the mainstay of psoriasis treatment; long-term safety concerns limit use. Combination with tazarotene may optimize efficacy, minimizing safety/tolerability concerns, In patients with moderate-to-severe plaque psoriasis treated with HP/TAZ lotion, improvement is noted within 2 weeks with few adverse effects observed after 8 weeks., HP/TAZ lotion may provide a realistic topical option for psoriasis management
https://ift.tt/2J9TjHF
An audiological evaluation of syndromic and non-syndromic craniosynostosis in pre-school going children
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): Liang Chye Goh, Ali Azman, Hufaidah binti Konting Siti, Wee Vien Khoo, Premala a/p Muthukumarasamy, Meow Keong Thong, Zulkiflee Abu Bakar, Anura Michelle Manuel
ObjectiveTo study the audiological outcome and early screening of pre-school going children with craniosynostosis under follow-up at the University of Malaya Medical Center(UMMC), Kuala Lumpur, Malaysia over a 10 year period.MethodsA retrospective descriptive cohort study on the audiological findings detected during the first hearing assessment done on a child with craniosynostosis using otoacoustic emissions, pure tone audiometry or auditory brainstem response examination. The main aim of this study was to evaluate the type and severity of hearing loss when compared between syndromic and non-sydromic craniosynostosis, and other associated contributory factors.ResultsA total of 31 patients with 62 ears consisting of 14 male patients and 17 female patients were evaluated. Twenty two patients (71%) were syndromic and 9 (29%) were non-syndromic craniosynostosis. Amongst the syndromic craniosynostosis, 9 (41%) had Apert syndrome, 7 (32%) had Crouzon syndrome, 5 (23%) had Pfieffer syndrome and 1 (4%) had Shaethre Chotzen syndrome. Patients with syndromic craniosynostosis were more likely to present with all types and severity of hearing loss, including severe to profound sensorineural hearing loss while children with non-syndromic craniosynostosis were likely to present with normal hearing (p < 0.05). In addition, when the first hearing test was done at a later age, a hearing loss including sensorineural hearing loss is more likely to be present in a child with syndromic craniosynostosis (p < 0.05).ConclusionOur study suggested that children who are born with syndromic craniosynostosis were more likely to suffer from a hearing loss, including that of a severe to profound degree compared to children with non-syndromic craniosynostosis. In addition to that, hearing loss is more likely to be detected when the first hearing test is done at a later age, and this can be an irreversible sensorineural hearing loss. We would like to advocate the need for early audiological screening and follow up in children with syndromic craniosynostosis.
https://ift.tt/2JblGFm
Surgical timing for bilateral simultaneous cochlear implants: When is best?
Publication date: June 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): Sebastiano Franchella, Roberto Bovo, Luigia Bandolin, Flavia Gheller, Silvia Montino, Daniele Borsetto, Sara Ghiselli, Alessandro Martini
IntroductionHearing loss is considered the most common congenital disease and the prevalence of neonatal deafness can be estimated between 1 and 2 cases per 1000 live births.Infant deafness must be diagnosed as early as possible and an effective therapeutic intervention needs to be carried out in order to avoid the serious consequences of hearing deprivation during the evolutionary period: alterations in the development of central auditory pathways and lack of language acquisition.The cochlear implant (CI) has proved to be the best instrument to solve the problem of auditory deprivation. In particular, the bilateral CI gives the patient access to binaural hearing which results in benefits in terms of sound localisation and discrimination.The optimal age of application of the CI is a widely discussed topic in the scientific community and the current guidelines indicate a period between 12 and 24 months of age, even though the supporters of the application before 12 months of age are nowadays increasing.Materials and methodsThe study is observational, retrospective, monocentric. 49 paediatric patients (<18 years) with simultaneous bilateral CIs were included. The audiometric threshold and speech tests were carried out during the follow-up 3, 6 and 12 months after the CIs activation and when the patient reached 2 years of age.ResultsThe statistical analysis showed that undergoing bilateral implantation surgery before 2 years of age allows a satisfactory audiometric performance, while there are no particular benefits in performing the surgery before 1 year of age. As far as the speech outcome is concerned, the statistical analysis didn't show significant correlation between the earlier age of implantation and better speech performance if the operation is carried out before 2.5 years of age.ConclusionsThe results of the study indicate that the optimal age to perform the simultaneous bilateral CIs surgery is between 12 and 24 months, without demonstrating any particular benefit in carrying out the procedure before 1 year of age. This may be clinically relevant in terms of avoiding the risks of diagnostic mistakes and reducing the related surgical risk in children under 1 year of age.
https://ift.tt/2pSV3fx
Editorial board
Source:Annales de Dermatologie et de Vénéréologie, Volume 145, Issue 3
https://ift.tt/2J9mvhZ
Actinomycose révélée par une ulcération du palais et de la gencive
Source:Annales de Dermatologie et de Vénéréologie, Volume 145, Issue 3
Author(s): F. Dessirier, J.-P. Arnault, J. Denamps, H. Sevestre, C. Attencourt, C. Lok
IntroductionL'actinomycose est une infection bactérienne granulomateuse chronique extensive. Elle est rarement révélée par une ulcération buccale.ObservationUne femme diabétique de 76 ans était traitée par dabrafenib pour un mélanome stade IV. Lors d'une consultation de suivi, on constatait deux lésions ulcérées du palais dur et de la gencive, infiltrées et hyperalgiques. Il n'y avait pas de signe associé. Le bilan biologique était sans particularité. La première hypothèse diagnostique évoquée était celle d'un carcinome épidermoïde muqueux survenu sous inhibiteurs de BRAF, bien que cette situation soit très peu décrite dans la littérature. L'examen histologique montrait un grain actinomycosique. La tomodensitométrie du massif facial ne montrait pas d'ostéite. Une antibiothérapie par amoxicilline était instaurée pendant quatre mois, avec une évolution favorable.DiscussionLes actinomycètes sont des bactéries filamenteuses Gram positif, saprophytes de la cavité buccale et du tractus gastro-intestinal, qui deviennent pathogènes sous l'influence de plusieurs facteurs. L'atteinte cervico-faciale, sous la forme d'un nodule inflammatoire péri-mandibulaire avec fistulisation secondaire à la peau ou dans la bouche, est la présentation la plus classique de l'actinomycose. Aucun cas d'infection opportuniste n'a été décrit à notre connaissance sous inhibiteurs de BRAF ; seuls deux cas de tuberculose ont été rapportés avec le sorafenib. Chez notre patiente, les soins dentaires et le diabète sont les deux facteurs favorisants retenus. Nous rappelons par ailleurs l'importance de l'examen des muqueuses chez les patients traités par inhibiteurs de BRAF.BackgroundActinomycosis is a chronic and extensive granulomatous, bacterial infection. Revelation by oral ulceration is rare.Patients and methodsA 76-year-old patient with diabetes was treated with dabrafenib for stage IV melanoma. A follow-up visit revealed two ulcerated, infiltrated and hyperalgesic lesions of the palate and gingiva. There were no associated signs. The laboratory findings were normal. The possibility of squamous cell carcinoma occurring with BRAF inhibitors was discussed, despite the rarity of such cases in the literature. Histological examination showed an actinomycotic grain. A scan of the facial mass showed no osteitis. Antimicrobial therapy was initiated with amoxicillin for four months, with a favorable outcome.DiscussionActinomycetes are Gram-positive filamentous saprophytic bacteria of the oral cavity and the gastrointestinal tract. They can become pathogenic under the influence of several factors. Cervicofacial involvement in the form of a peri-mandibular inflammatory nodule with secondary fistulation on the skin or in the mouth is the classic presentation. To our knowledge, no cases of opportunistic infection under BRAF inhibitors have been described. Only two cases of tuberculosis have been reported with sorafenib. The initial presentation led to suspicion of squamous cell carcinoma. In our patient, poor oral hygiene and diabetes were the two key factors considered. Moreover, this is the first case reported under dabrafenib, which does not appear to be a favoring factor. We would stress the importance of mucosal examination in patients treated with BRAF inhibitors.
https://ift.tt/2E6N0AB
Hydrochlorothiazide et cancers cutanés
Source:Annales de Dermatologie et de Vénéréologie, Volume 145, Issue 3
Author(s): J.-L. Schmutz
https://ift.tt/2J6RRFI
Thyroid Cartilage Window Approach to Extract a Foreign Body after Migration into the Paraglottic Space
We report a case of fish bone impaction in the paraglottic space, which caused palsy of the left vocal cord. The patient was a 45-year-old man. He presented with throat pain and hoarseness of voice for approximately one week. The diagnosis was made after careful history taking and confirmed by the use of computed tomography scan as the fish bone was not visible endoscopically under local and general anaesthesia. The patient underwent thyroid cartilage window approach, and the fish bone was retrieved. His symptoms have improved significantly, and he did not require tracheostomy. Other cases reported the removal of foreign bodies by other techniques such as laryngofissure and posterolateral approach. Our case is different in that we used a modification of thyroplasty type 1 technique as it has less reported complications than other approaches that were published in literature.
https://ift.tt/2J83vQL
Soft Palate Pleomorphic Adenoma of a Minor Salivary Gland: An Unusual Presentation
Approximately 10% of pleomorphic adenomas occur in the minor salivary glands with the palate being the most common site. Pleomorphic adenomas account for the majority of palatal tumours; however, minor salivary gland tumours have a higher risk of malignancy compared to tumours of the major salivary glands, so appropriate diagnostic evaluation should be prompt. We present a case of a 52-year-old man with a longstanding history of a soft palate pleomorphic adenoma which required excision under general anaesthetic via a mandibular swing approach. As well as the surgical approach to access this tumour; this case is unique as it is the largest soft palate pleomorphic adenoma reported in the literature. We discuss the appropriate preoperative investigations and airway considerations for this patient, as well as the factors to consider when planning operative management of palatal tumours.
https://ift.tt/2pSZTcw
Correction to: Esophagus perforation and myocardial penetration caused by swallowing of a foreign body leading to a misdiagnosis of acute coronary syndrome: a case report
In the publication of this article [1], the Acknowledgements section was missing.
https://ift.tt/2pPGEBC
Coronary artery fistula with associated Takotsubo cardiomyopathy: a case report
Coronary artery fistula, first described by Krause in 1865, is an abnormal communication between the coronary artery and one of the four chambers of the heart or one of the great vessels. The communications ar...
https://ift.tt/2GpAtuh
Induction of a central memory and stem cell memory phenotype in functionally active CD4 + and CD8 + CAR T cells produced in an automated good manufacturing practice system for the treatment of CD19 + acute lymphoblastic leukemia
Abstract
Relapsed/refractory B-precursor acute lymphoblastic leukemia (pre-B ALL) remains a major therapeutic challenge. Chimeric antigen receptor (CAR) T cells are promising treatment options. Central memory T cells (Tcm) and stem cell-like memory T cells (Tscm) are known to promote sustained proliferation and persistence after T-cell therapy, constituting essential preconditions for treatment efficacy. Therefore, we set up a protocol for anti-CD19 CAR T-cell generation aiming at high Tcm/Tscm numbers. 100 ml peripheral blood from pediatric pre-B ALL patients was processed including CD4+/CD8+-separation, T-cell activation with modified anti-CD3/-CD28 reagents and transduction with a 4-1BB-based second generation CAR lentiviral vector. The process was performed on a closed, automated device requiring additional manual/open steps under clean room conditions. The clinical situation of these critically ill and refractory patients with leukemia leads to inconsistent cellular compositions at start of the procedure including high blast counts and low T-cell numbers with exhausted phenotype. Nevertheless, a robust T-cell product was achieved (mean CD4+ = 50%, CD8+ = 39%, transduction = 27%, Tcm = 50%, Tscm = 46%). Strong proliferative potential (up to > 100-fold), specific cytotoxicity and low expression of co-inhibitory molecules were documented. CAR T cells significantly released TH1 cytokines IFN-γ, TNF-α and IL-2 upon target-recognition. In conclusion, partly automated GMP-generation of CAR T cells from critically small blood samples was feasible with a new stimulation protocol that leads to high functionality and expansion potential, balanced CD4/CD8 ratios and a conversion to a Tcm/Tscm phenotype.
https://ift.tt/2pYofmf
Stability of allergens
Source:Molecular Immunology
Author(s): Judith Pekar, Davide Ret, Eva Untersmayr
For proteins to cause IgE-mediated allergic reactions, several common characteristics have to be defined, including small molecular size, solubility and stability to changing pH levels and enzymatic degradation. Nevertheless, these features are not unique for potent allergens, but are also observed in non-allergenic proteins. Due to the increasing awareness by regulatory authorities regarding the allergy pandemic, definition of characteristics unique to potent allergens would facilitate allergenicity assessment in the future. Despite major research efforts even to date the features unique for major allergens have not been elucidated so far. The route of allergen entry into the organism determines to a great extent these required characteristics. Especially orally ingested allergens are exposed to the harsh milieu of the gastrointestinal tract but might additionally be influenced by food processing. Depending on molecular properties such as disulphide bonds contributing to protein fold and formation of conformational IgE epitopes, posttranslational protein modification or protein food matrix interactions, enzymatic and thermal stability might differ between allergens. Moreover, also ligand binding influences structural stability. In the current review article, we aim at highlighting specific characteristics and molecular pattern contributing to a stabilized protein structure and overall allergenicity.
https://ift.tt/2J6KiPu
Nebulized lidocaine ameliorates allergic airway inflammation via downregulation of TLR2
Source:Molecular Immunology, Volume 97
Author(s): Lixia Wang, Muzi Wang, Shuai Li, Huimei Wu, Qiying Shen, Shihai Zhang, Lei Fang, Rongyu Liu
Nebulized lidocaine has been suggested to be beneficial in asthma therapy, but the underlying mechanisms are little known. We aimed to investigate whether Toll-like receptor (TLR) 2 was involved in the protective effect of lidocaine on allergic airway inflammation. Female C57BL/6 mice were sensitized and challenged with ovalbumin (OVA). Meanwhile, some of the mice were treated with TLR2 agonist (Pam3CSK4, 100 μg) intraperitoneally in combination with OVA on day 0. Just after allergen provocation, mice were treated with inhaled lidocaine or vehicle for 30 min. In this model, we found that lidocaine markedly attenuated OVA-evoked airway inflammation, leukocyte recruitment and mucus production. Moreover, lidocaine abrogated the increased concentrations of T cytokines and TNF-α in bronchoalveolar lavage fluid (BALF) of allergic mice, as well as reducing the expression of phosphorylated nuclear factor (P-NF)-κBp65 and the NOD-like receptor pyridine containing 3 (NLRP3), which are important for the production of pro-inflammatory cytokines. In addition, our study showed that lidocaine dramatically decreased OVA-induced increased expression of TLR2 in the lung tissues. Furthermore, activation of TLR2 aggravated OVA-challenged airway inflammation, meanwhile, it also elevated OVA-induced expression of P-NF-κBp65 and NLRP3 in the lungs. However, lidocaine effectively inhibited airway inflammation and counteracted the expression of P-NF-κBp65 and NLRP3 in allergic mice pretreated with Pam3CSK4. Taken together, the present study demonstrated that lidocaine prevented allergic airway inflammation via TLR2 in an OVA-induced murine allergic airway inflammation model. TLR2/NF-κB/NLRP3 pathway may serve as a promising therapeutic strategy for allergic airway inflammation.
https://ift.tt/2pY3PsK
New insights into the structure of the MHC class I peptide-loading complex and mechanisms of TAP inhibition by viral immune evasion proteins
Source:Molecular Immunology
Author(s): Patrique Praest, A. Manuel Liaci, Friedrich Förster, Emmanuel J.H.J. Wiertz
Several hundred million years of co-evolution of vertebrates and invading pathogens have shaped the adaptive immune system to fight back the unwanted invaders through highly sophisticated defense mechanisms. Herpesviruses manage to dodge this immune response by hampering one of the central hinges of human adaptive immunity, the major histocompatibility complex (MHC) class I antigen presentation pathway. One of the bottlenecks of this pathway is the loading of pathogen-derived peptides onto MHC-I molecules in the endoplasmic reticulum (ER). This task is accomplished by the MHC class I peptide-loading complex (PLC), of which the transporter associated with antigen-processing (TAP) is a central component. In this review, we summarize recent structural and functional insights into the molecular architecture of the PLC, how TAP accomplishes the transport of peptides across the ER membrane, and how herpes- and poxviruses inhibit TAP-mediated peptide translocation and subsequent antigen presentation.
https://ift.tt/2J3KL4Z
Pre-diagnostic dynamic HPV16 IgG seropositivity and risk of oropharyngeal cancer: Methodologic issues
Source:Oral Oncology
Author(s): Karen S. Anderson, Jon Mork, Hilde Langseth, Garrick Wallstrom
https://ift.tt/2GXSG32
Παρασκευή 30 Μαρτίου 2018
Transoral endoscopic thyroid surgery via the tri‐vestibular approach with a hybrid space‐maintaining method: A preliminary report
Head &Neck, EarlyView.
https://ift.tt/2Go3JBt
Systematic review evaluating randomized controlled trials of smoking and alcohol cessation interventions in people with head and neck cancer and oral dysplasia
Head &Neck, EarlyView.
https://ift.tt/2GDXSLT
Immune privilege disruption in folliculotropic mycosis fungoides: investigation of major histocompatibility complex antigen expression
International Journal of Dermatology, EarlyView.
https://ift.tt/2GHwYm9
Paederus dermatitis – touched by champion flies – three clinical manifestations of pederin toxin‐inflicted dermatitis
International Journal of Dermatology, EarlyView.
https://ift.tt/2GnV6a3
Editorial Board
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 135, Issue 2
https://ift.tt/2E7RLKn
Contents
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 135, Issue 2
https://ift.tt/2GZUMiT
Effect of IFN-λ2 on combined allergic rhinitis with nasal polyps
OBJECTIVE: This study sought to investigate the expression of interferon-λ2 (IFN-λ2) in patients with combined allergic rhinitis and nasal polyps (AR+NP), analyze the correlation between IFN-λ2 and tryptase, interleukin 10 (IL-10), and interleukin 12 (IL-12), and identify its peripheral blood cell origins.
PATIENTS AND METHODS: ELISA kits were used to investigate plasma levels of IFN-λ2, tryptase, IL-10, and IL-12 in AR+NP patients and healthy controls (HC). Flow cytometry analysis was carried out to detect IFN-λ2 expression in peripheral blood leukocytes. Immunocytochemical staining was performed to detect nasal polyp IFN-λ2 expression in AR+NP patients.
RESULTS: Elevated plasma IFN-λ2 levels and positive correlations between plasma IFN-λ2 and tryptase levels in AR+NP patients indicated that IFN-λ2 likely contributes to AR+NP pathogenesis. IFN-λ2 expression was upregulated in cytotoxic T cells and eosinophils in AR+NP patients. Nasal polyp mast cells and macrophages in AR+NP patients expressed IFN-λ2.
CONCLUSIONS: The close correlation between IFN-λ2 expression and AR+NP may provide experimental evidence for a possible effect of IFN-λ2 against the allergic inflammatory reaction. Therefore, IFN-λ2 actions may have a potential utility for the treatment and prevention of AR+AP.
L'articolo Effect of IFN-λ2 on combined allergic rhinitis with nasal polyps sembra essere il primo su European Review.
https://ift.tt/2Gp4ydt
Cost‐effectiveness of sialendoscopy versus medical management for radioiodine‐induced sialadenitis
The Laryngoscope, EarlyView.
https://ift.tt/2GrvER7
Post‐acute care use after major head and neck oncologic surgery with microvascular reconstruction
The Laryngoscope, EarlyView.
https://ift.tt/2GK7yV8
Allergic phenotype of chronic rhinosinusitis based on radiologic pattern of disease
The Laryngoscope, EarlyView.
https://ift.tt/2GrXJHN
Transoral resection of extensive pediatric supraglottic neurofibroma
The Laryngoscope, EarlyView.
https://ift.tt/2GK7vsq
Optimizing outcomes with polymethylmethacrylate fillers
Journal of Cosmetic Dermatology, EarlyView.
https://ift.tt/2GEPJqq
Biologics for pityriasis rubra pilaris treatment: a review of the literature
Pityriasis rubra pilaris (PRP) is a rare inflammatory papulosquamous skin disease, often refractory to conventional therapies. The off-label use of biologics, such as anti-TNF, -IL-12/IL-23, -IL-17 agents, has been proven successful, in the last two decades, in PRP treatment.Our aim was to analyse the literature for the use of biologics in PRP treatment. We conducted a review by "Pubmed" and "clinicaltrial.gov" searches. 68 articles met our selection criteria and were herein discussed. Out of 86 PRP patients, the vast majority of which treated with anti-TNF, -IL-12/IL-23, and -IL-17 biologics, either alone or in combination therapy, a marked-to-complete response (50-78%), a partial response (11-25%) or no/poor response (11-25%) was observed.
https://ift.tt/2Gm2UgD
Dual neutralization of both IL-17A and IL-17F with bimekizumab in patients with psoriasis: results from BE ABLE 1, a 12-week randomized, double-blinded placebo-controlled phase 2b trial
Neutralizing interleukin (IL)-17F in addition to IL-17A may provide a more complete and specific approach to inhibiting inflammation.
https://ift.tt/2Gm2S8v
Flu Shots for Kids | Is it Too Late?
Though spring is here and the number of influenza cases are on the decline, it's not too late for your kids to receive the flu vaccine. The flu vaccine is still beneficial and reduces your little one's chances of becoming sick. Here's why your kids should get the vaccine and what you should do if they start experiencing influenza symptoms.
The post Flu Shots for Kids | Is it Too Late? appeared first on ChildrensMD.
https://ift.tt/2E7t8O2
How to treat whiteheads on the nose
Whiteheads are stubborn acne lesions that develop just under the skin. The nose is a common site for whiteheads to form, as this part of the face produces a lot of oil and is touched frequently throughout the day. We look at several ways to treat whiteheads on the nose, as well as how to prevent them in the future.
https://ift.tt/2GlOxF6
Comparison of MRI in pediatric cochlear implant recipients with and without retained magnet
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): Walker Brian, Norton Susan, Phillips Grace, Christianson Erin, Horn David, Ou Henry
ObjectiveTo report and compare medical, radiological, and audiological outcomes in pediatric cochlear implant recipients who underwent 1.5 and 3 Tesla strength MRI with and without retained magnet.MethodsRetrospective chart review at a tertiary care pediatric hospital and review of literature. Patients were identified via electronic medical records database search and were included if they had MRI after cochlear implant.ResultsOf twelve instances of MRI in pediatric cochlear implant recipients at our institution, two minor complications and one major complication were recorded. The rate of complication was equal between patients who underwent MRI with and without retained magnet. All minor complications resulted from MRI with retained magnet whereas the only major complication resulted from magnet removal. Two novel complications are reported, including: magnet removal resulting in silastic tear necessitating reimplantation and magnet dislocation with spontaneous reduction. Magnet removal significantly decreased the size of artifact, but did not alter the diagnostic utility of the MRI. While audiological measures varied chronologically from MRI scans, they did not appear to be appreciably altered by MRI.ConclusionMRI with and without magnet retention appear to carry risks of both major and minor complications. For the regions of interest for each scan, MRI quality was not appreciably altered by magnet status. Audiological measures appear unaffected by magnet status during MRI however, this may reflect natural variation.
https://ift.tt/2Gn8JWR
Oncologic outcomes of surgical treatment for T3 glottic laryngeal squamous cell carcinoma
Head &Neck, EarlyView.
https://ift.tt/2GjZhYl
New MRI Biomarkers in Head and Neck Cancers
Intervention: Other: MRI examinations
Sponsor: Memorial Sloan Kettering Cancer Center
Recruiting
https://ift.tt/2pNJmrd
Combat zone exposure and respiratory tract disease
International Forum of Allergy &Rhinology, EarlyView.
https://ift.tt/2GoyshY
Lacrimal sac exposure and a superior lateral anterior pedicle flap to improve outcomes of Draf type II and III procedures
International Forum of Allergy &Rhinology, EarlyView.
https://ift.tt/2pQgvSS
Comparing the efficacy of Silastic and gloved‐Merocel middle meatal spacers for functional endoscopic sinus surgery: a randomized controlled trial
International Forum of Allergy &Rhinology, EarlyView.
https://ift.tt/2Ig2fcV
High-dose thiamine and essential tremor
Essential tremor is a common neurological disease. The medical treatment of this affection currently involves the use of propranolol, primidone and other drugs. These drugs, however, are often not effective in reducing tremor and cause side effects in a large share of the patients treated. The treatment with intramuscular high-dose thiamine has led to a rapid, remarkable and persistent improvement of the symptoms in two patients with essential tremor. This result suggests the possibility that high doses of intramuscular thiamine may be an affordable alternative, highly effective and long-lasting medical treatment that has shown no relevant side effect.
https://ift.tt/2GoYEZN
Acute brainstem compression
Description
A 34-year-old African woman, whose medical history was unremarkable, presented to the emergency room with severe headache and vomiting. Temperature, blood cells count, plasma electrolytes and chest X-ray were normal. Clinical conditions were rapidly deteriorating and neurological exam disclosed drowsiness, opisthotonus and decerebrate response to pain. Brain CT scan showed a 'full' posterior fossa, mild supratentorial hydrocephalus and herniation of cerebellar tonsils: after contrast, a nodule with ring enhancement and conspicuous perilesional oedema was disclosed in the right cerebellar hemisphere.
The patient was given diuretics and steroids with no success. Since the neurological conditions were worsening, a neurosurgical operation was then performed in emergency: posterior fossa was decompressed, the cerebellar nodular lesion was removed en bloc with microsurgical technique and a transient ventricular drain was placed. Neurological conditions promptly recovered after surgery.
Possible differential diagnosis:
Metastasis
Pyogenic abscess
Primitive brain tumour
Abscess from non-pyogenic agents.
...https://ift.tt/2pQmKGj
Rapid onset of multiple concurrent squamous cell carcinomas associated with the use of an arsenic-containing traditional medicine for chronic plaque psoriasis
We report a case of a 46-year-old Vietnamese man who developed widespread, numerous and concurrent cutaneous squamous cell carcinomas (SCCs) in non-sun exposed skin areas after taking a traditional medicine (TM) formulation for chronic plaque psoriasis. The SCC lesions began to develop within 12–15 months after beginning the arsenic-containing TM. The patient experienced both acute and chronic symptoms consistent with arsenic exposure. Laboratory investigation of a collected hair sample showed a significant arsenic level. The TM formulation used by the patient was tested and demonstrated an extremely high concentration of arsenic.
https://ift.tt/2IgXikm
Beckwith-Weidemann syndrome with IC2 (KvDMR1) hypomethylation defect: a novel mutation
The Beckwith-Wiedemann syndrome (BWS) is a rare genetic syndrome. However, this is one of the most common overgrowth syndromes. This is a genetically and clinically heterogeneous syndrome. Here, we report a case of Beckwith-Weidemann syndrome without macrosomia, visceromegaly and hemihyperplasia but having macroglossia, omphalocele and anterior linear ear lobe creases. The diagnosis was confirmed by gene analysis suggestive of imprinting centre 2 (KvDMR1) hypomethylation defect.
https://ift.tt/2pQmJ5d
Proximal tibiofibular joint dislocation treated using flexible and permanent syndesmosis fixation
We present the case of a 40-year-old man who suffered an isolated proximal tibiofibular dislocation of the left knee after a trauma during a soccer game. Physical examination and radiographic imaging revealed an anterolateral dislocation of the proximal fibula. The diagnosis was confirmed by MRI. The treatment choice was open reduction and internal fixation under direct visualisation using flexible and permanent internal fixation. Postoperative treatment includes knee immobilisation during the first week, and partial weight was allowed for 2 weeks progressing to full weight bearing over 4 weeks. The patient started a gradual and progressive physical therapy programme with range of motion exercises, muscle strengthening and gait training. Full knee range of motion was achieved after 4 weeks. No complaint of pain or hardware discomfort was reported, and the patient is back to daily life and sports activities after 6 months of surgical treatment.
https://ift.tt/2IeLIWM
Childhood obesity in Mexico: social determinants of health and other risk factors
Approximately 50 million children and adolescents in Latin America are affected by the childhood obesity pandemic. We present the case of a 5-year-old Mexican girl with obesity and gastro-oesophageal reflux disease (GORD), in whom prenatal, lifestyle and environmental risk factors were identified. Here, we demonstrate how childhood obesity is rooted since pregnancy and the perinatal stage, and how the social determinants of health like unsafe outdoor conditions, lack of infrastructure to exercise and a suboptimal physical activity curriculum in government schools strongly influence the development and maintenance of childhood obesity and complicate management.
https://ift.tt/2pQA65y
Pseudotumor cerebri as the presentation of Lyme disease in a non-endemic area
Intracranial hypertension is a rare entity in prepubertal children, and its differential diagnosis includes a number of systemic diseases, drugs, vitamin deficiencies and excesses, and hereditary conditions. Infectious aetiology is rare. The case of a 9-year-old boy with intracranial hypertension secondary to acute neuroborreliosis is described. He presented with daily pulsatile frontotemporal headache, pallor, photophobia and phonophobia. His neurological examination revealed papilledema with no nuchal rigidity. The lumbar puncture showed increased pressure (50 cm H2O) and lymphocytic pleocytosis. Serum and cerebrospinal fluid (CSF) Borrelia burgdorferi antibodies were positive. This kind of infection is rare in Portugal but a trip to an endemic area was identified. A careful history, considering the exposure to rural areas together with the intracranial hypertension and inflammatory CSF, are important clues to the diagnosis, allowing the institution to select appropriate treatment.
https://ift.tt/2GoYce3
Essential thrombocytosis 40 years after splenectomy
Description
A 69-year-old man presented at our Department of Neurology in December 2016 with acute aphasia. His medical history was notable of splenectomy after a spleen rupture due to a car accident at the age of 25, a subarachnoidal haemorrhage (SAH) without evidence of cerebral aneurysm at the age of 35 and a non-ST elevation myocardial infarction at the age of 63. For this vascular event, a drug-eluting stent was placed into the ramus interventricularis anterior, followed by combined antiplatelet treatment for 2 years, and up to admission acetylsalicylic acid was given at a dose of 100 mg per day.
Now MRI revealed a left hemispheric ischaemic stroke (figure 1A). No major vascular risk factors were found. The only pathological finding was a thrombocytosis of 1700x103 per µL, reference value 150–450x103 per µL. A post-splenectomy syndrome was suspected. However, previous thrombocyte levels as documented during the SAH...
https://ift.tt/2pQGj1j
Adult scurvy associated with psychiatric disorders and breast feeding
Scurvy is a nutritional disease caused by ascorbic acid deficiency and is potentially fatal. It was originally described in the 18th century by James Lind and associated with long sea voyages and insufficient citrus consumption. Its prevalence has declined markedly over the years but has still been described sporadically in certain countries. A 22-year-old woman with an anxiety disorder and anorexia nervosa, recent pregnancy and ongoing breast feeding, presented with a 10-day history of spontaneous haematomas in the lower limbs, gingivorrhagia and fatigue. The examination was remarkable for signs of minor bleeding without haemodynamic compromise, gonalgia and pale skin. Work-up studies revealed the presence of anaemia. Direct anamnesis identified a diet based solely of tea and carbohydrates due to distorted body image. With the working diagnosis of scurvy, nutritional support and oral vitamin C supplementation was initiated. Her symptoms and anaemia resolved in 30 days and the diagnosis was confirmed biochemically.
https://ift.tt/2Goj2u2
Apixaban-induced subdural bleeding: case presentation and literature review
Apixaban is a factor Xa inhibitor which is a non-vitamin K dependent oral anticoagulant known tocause the lowest rate of intracranial bleeding among the same kind of inibitors. In this paper, we report a rare case in a 60-year-old man with a history of hypertension and oligodendroglioma on apixaban for deep venous thrombosis who presented to our hospital with decreased level of consciousness and slurred speech with rapid deterioration. We highlight the risk of subdural bleeding requiring immediate neurosurgical intervention due to apixaban, with literature review.
https://ift.tt/2pPrHPS
Synovial sarcoma of the transverse colon: a rare cause of intussusception
We report a third case of a primary intramural synovial sarcoma of the lower gastrointestinal tract. A 50-year-old woman presented with hematochezia, dizziness and shortness of breath. CT imaging revealed a transverse colo-colonic intussusception with a colonic mass serving as a lead point. A subtotal colectomy was performed with oncologic resection of a sausage-like mass in the mid-transverse colon. Pathological assessment showed a biphasic synovial sarcoma. The postoperative hospital course was without complications and the patient was discharged home with plans for postoperative surveillance.
https://ift.tt/2Ihyvwe
Postoperative Facial Baroparesis While Flying: A Rare Complication of Decompressing a Facial Nerve Schwannoma.
Postoperative Facial Baroparesis While Flying: A Rare Complication of Decompressing a Facial Nerve Schwannoma.
JAMA Otolaryngol Head Neck Surg. 2018 Mar 29;:
Authors: Kung RW, Roche JP, Gantz BJ
PMID: 29596587 [PubMed - as supplied by publisher]
https://ift.tt/2IjvzzA
Pulsatile Tinnitus With Imaging.
Pulsatile Tinnitus With Imaging.
JAMA Otolaryngol Head Neck Surg. 2018 Mar 29;:
Authors: Truesdale CM, El-Kashlan HK
PMID: 29596564 [PubMed - as supplied by publisher]
https://ift.tt/2J8xwzR
Tubular Neck Mass.
Tubular Neck Mass.
JAMA Otolaryngol Head Neck Surg. 2018 Mar 29;:
Authors: McSpadden RP, Orsini M, Higgins K
PMID: 29596558 [PubMed - as supplied by publisher]
https://ift.tt/2pSOkD1
Standardized Margin Assessment Is Needed Before Implementing Negative Margin as a Quality Measure.
Standardized Margin Assessment Is Needed Before Implementing Negative Margin as a Quality Measure.
JAMA Otolaryngol Head Neck Surg. 2018 Mar 29;:
Authors: Duvvuri U, Johnson JT, Chiosea SI
PMID: 29596555 [PubMed - as supplied by publisher]
https://ift.tt/2Idy46s
A Novel Approach to the National Resident Matching Program-The Star System.
A Novel Approach to the National Resident Matching Program-The Star System.
JAMA Otolaryngol Head Neck Surg. 2018 Mar 29;:
Authors: Salehi PP, Benito D, Michaelides E
PMID: 29596554 [PubMed - as supplied by publisher]
https://ift.tt/2IingE5
Thyroidectomy Practice After Implementation of the 2015 American Thyroid Association Guidelines on Surgical Options for Patients With Well-Differentiated Thyroid Carcinoma.
Thyroidectomy Practice After Implementation of the 2015 American Thyroid Association Guidelines on Surgical Options for Patients With Well-Differentiated Thyroid Carcinoma.
JAMA Otolaryngol Head Neck Surg. 2018 Mar 29;:
Authors: Hirshoren N, Kaganov K, Weinberger JM, Glaser B, Uziely B, Mizrahi I, Eliashar R, Mazeh H
Abstract
Importance: The recommended extent of surgery for well-differentiated thyroid carcinoma has been modified considerably in the updated 2015 American Thyroid Association guidelines published in January 2016. To date, the changes in clinical practice after publication of these new guidelines have not been demonstrated.
Objective: The aim of this study was to evaluate clinical practice changes associated with implementation of the updated guidelines on the surgical procedure rates of total thyroidectomy, thyroid lobectomy, and completion thyroidectomy at a single tertiary medical center.
Design, Setting, and Participants: This is a retrospective cohort study of 169 patients at the Hadassah-Hebrew University Medical Center, Jerusalem, Israel. Patients with pathologically proved, well-differentiated thyroid carcinoma who underwent surgery between January 1, 2013, and December 31, 2014, were compared with patients who underwent surgery from January 1 to December 31, 2016. A total of 434 thyroidectomy procedures were performed during the study period, and 251 had pathologically proved, well-differentiated thyroid carcinoma. Patients with tumors larger than 4 cm, involved lymph nodes, or bilateral nodules were excluded.
Main Outcomes and Measures: Primary outcomes were the rate of up-front total thyroidectomy vs lobectomy and the rates of completion thyroidectomy before and after the implementation of the new guidelines.
Results: Of the 169 patients in the final analysis, 118 (69.8%) were included from 2013 to 2014 and 51 (30.2%) in 2016. The mean (SD) age for the entire cohort was 44 (13.8) years, and 129 (76.3%) were women. Up-front total thyroidectomy was performed in 72 of 118 patients (61.0%) prior to the 2015 American Thyroid Association guidelines and 16 of 51 (31.4%) following their implementation (odds ratio, 0.29; 95% CI, 0.14-0.59). The rate of completion thyroidectomy also significantly decreased between these periods (73.9% vs 20.0%; odds ratio, 0.09; 95% CI, 0.04-0.19).
Conclusions and Relevance: The updated 2015 American Thyroid Association guidelines implementation was associated with a significant decrease in the rates of both up-front total thyroidectomy and completion thyroidectomy. According to these findings, only 1 of 5 patients who undergoes thyroid lobectomy will require a completion procedure.
PMID: 29596551 [PubMed - as supplied by publisher]
https://ift.tt/2pQvHiX
Preoperative Facial Nerve Mapping to Plan and Guide Pediatric Facial Vascular Anomaly Resection.
Preoperative Facial Nerve Mapping to Plan and Guide Pediatric Facial Vascular Anomaly Resection.
JAMA Otolaryngol Head Neck Surg. 2018 Mar 29;:
Authors: Bly RA, Holdefer RN, Slimp J, Kinney GA, Martinez V, Manning SC, Perkins JA
Abstract
Importance: Facial vascular anomalies are surgical challenges due to their vascularity and facial nerve distortion. To assist facial vascular anomaly surgical treatment, presurgical percutaneous facial nerve stimulation and recording of compound motor action potentials can be used to map the facial nerve branches. During surgery, the nerve map and continuous intraoperative motor end plate potential monitoring can be used to reduce nerve injury.
Objective: To investigate if preoperative facial nerve mapping (FNM) is associated with intraoperative facial nerve injury risk and safe surgical approach options compared with standard nerve integrity monitoring (NIM).
Design, Setting, and Participants: This investigation was a historically controlled study at a tertiary vascular anomaly center in Seattle, Washington. Participants were 92 pediatric patients with facial vascular anomalies undergoing definitive anomaly surgery (from January 1, 1999, through January 1, 2015), with 2 years' follow-up. In retrospective review, a consecutive FNM patient cohort after 2005 (FNM group) was compared with a consecutive historical cohort (1999-2005) (NIM group).
Main Outcomes and Measures: Postoperative facial nerve function and selected surgical approach. For NIM and FNM comparisons, statistical analysis calculated odds ratios of nerve injury and operative approach, and time-to-event methods analyzed operative time.
Results: The NIM group had 31 patients (median age, 3.3 years [interquartile range, 2.2-11.4 years]; 20 [65%] male), and the FNM group had 61 patients (median age, 4.4 years [interquartile range, 1.5-11.0 years]; 26 [43%] male). In both groups, lymphatic malformation resection was most common (19 of 31 [61%] in the NIM group and 32 of 61 [52%] in the FNM group), and the median anomaly volumes were similar (52.4 mL; interquartile range, 12.8-183.3 mL in the NIM group and 65.4 mL; interquartile range, 18.8-180.2 mL in the FNM group). Weakness in the facial nerve branches at 2 years after surgery was more common in the NIM group (6 of 31 [19%]) compared with the FNM group (1 of 61 [2%]) (percentage difference, 17%; 95% CI, 3%-32%). Anterograde facial nerve dissection was used more in the NIM group (27 of 31 [87%]) compared with the FNM group (28 of 61 [46%]) (percentage difference, 41%; 95% CI, 24%-58%). Treatment with retrograde dissection without identification of the main trunk of the facial nerve was performed in 21 of 61 (34%) in the FNM group compared with 0 of 31 (0%) in the NIM group. Operative time was significantly shorter in the FNM group, and patients in the FNM group were more likely to complete surgery sooner (adjusted hazard ratio, 5.36; 95% CI, 2.00-14.36).
Conclusions and Relevance: Facial nerve mapping before facial vascular anomaly surgery was associated with less intraoperative facial nerve injury and shorter operative time. Mapping enabled direct identification of individual intralesional and perilesional nerve branches, reducing the need for traditional anterograde facial nerve dissection, and allowed for safe removal of some lesions after partial nerve dissection through transoral or direct excision.
PMID: 29596549 [PubMed - as supplied by publisher]
https://ift.tt/2Igv0X6
Standardized Margin Assessment Is Needed Before Implementing Negative Margin as a Quality Measure-Reply.
Standardized Margin Assessment Is Needed Before Implementing Negative Margin as a Quality Measure-Reply.
JAMA Otolaryngol Head Neck Surg. 2018 Mar 29;:
Authors: Schoppy DW, Divi V
PMID: 29596548 [PubMed - as supplied by publisher]
https://ift.tt/2pQvCvF
Patients with integrated HPV16 in head and neck cancer show poor survival
Publication date: May 2018
Source:Oral Oncology, Volume 80
Author(s): Tara J. Nulton, Nak-Kyeong Kim, Laurence J. DiNardo, Iain M. Morgan, Brad Windle
ObjectivesWe previously reported identifying three categories of HPV16-positive head and neck tumors based on The Cancer Genome Atlas (TCGA) RNA and DNA sequence data. Category 1 had truly integrated HPV16 genomes, category 2 had simple episomal genomes, and category 3 had novel episomes that were a hybrid between viral and human DNA. Using our categorization, we investigated in this study survival of patients with integrated HPV16 tumors versus patients with episomal HPV16 tumors.Materials and methodsThe TCGA RNA-Seq sequence reads were used to quantify HPV E2 and E7 gene expression, which was used as a marker for HPV integration.ResultsThe results demonstrate that integration is associated with poor survival; those patients with integrated HPV tumors fared no better than non-HPV tumors in their five-year survival. Integrated HPV in tumors was found strikingly to be prevalent in patients born earlier while episomal HPV was prevalent in patients born later. We also observed a fairly constant incidence of all HPV forms among head and neck cancer patients over the last eight years of this study (2006–2013).ConclusionWe propose our characterization of HPV integrated and episomal state is more accurate than previous studies that may have mischaracterized the hybrid HPV-human DNA episomes as integrated. The state of integrated HPV is associated with a poor clinical outcome. Results suggest that the incidence of integrated HPV among all HPV forms peaked and is decreasing. We discuss the importance of our findings for the management of HPV positive head and neck cancer.
https://ift.tt/2J8M0jo
The opioid epidemic and pregnancy: implications for anesthetic care
https://ift.tt/2pQoEH3
Drug error in paediatric anaesthesia: current status and where to go now
https://ift.tt/2GoD1Zw
Developing drugs for treatment of atopic dermatitis in children (≥3 months to <18 years of age): Draft guidance for industry
Pediatric Dermatology, EarlyView.
https://ift.tt/2pQTY8F
Hyper‐immunoglobulin D syndrome with novel mutations in an afebrile infant
Pediatric Dermatology, EarlyView.
https://ift.tt/2IglpPW
Evolution in the Surgical Management of Chronic Rhinosinusitis: Current Indications and Pitfalls
Publication date: Available online 29 March 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Michael A. Kohanski, Elina Toskala, David W. Kennedy
Chronic rhinosinusitis (CRS) consists of a range of inflammatory conditions in the sinuses that may result in clinical symptoms and the underlying pathophysiology and its relationship to lower airway disease is complex. Current definitions of CRS may serve more as an indication for potential surgical intervention rather than a marker of disease state. CRS can be asymptomatic and may require medical management to avoid disease progression and to minimize the risk of lower airway disease. Endoscopic surgery has undergone a significant evolution and refinement but the most common surgical complication remains persistent inflammation and recurrence of disease. It is important to recognize that surgery alone rarely cures CRS and patients require long-term medical therapy for continued asymptomatic inflammation. Careful post-operative care and endoscopic follow-up to ensure resolution of inflammation is key to ensuring optimal surgical outcomes and reduce the risk of revision surgery. Future work on CRS endotypes will allow for discovery of new therapies to treat CRS as well as refine indications for medical or surgical intervention as well as post-operative care.
https://ift.tt/2E6dL8x
The association between Helicobacter pylori infection and the risk of advanced colorectal neoplasia may differ according to age and cigarette smoking
Helicobacter, EarlyView.
https://ift.tt/2Gjdfty
Application of precision medicine to the treatment of anaphylaxis
https://ift.tt/2J6qegf
How to diagnose food allergy
https://ift.tt/2J5vOz7
How to predict and improve prognosis of food allergy
https://ift.tt/2pShNMF
Phenotypes/endotypes-driven treatment in asthma
https://ift.tt/2J6hyq2
How to prevent food allergy during infancy: what has changed since 2013?
https://ift.tt/2pShGRf
Kite surfing: epidemiology of trauma
Kite surfing has become an increasingly popular recreational activity worldwide. Thrill seekers can span the water at high speeds and reach great heights risking injury and death. We report the case of a young kite surfer who sustained a fracture dislocation of the right acetabulum that required specialised surgical management. We present this case with a review of the literature outlining the incidence of pelvic and acetabular fractures in the kitesurfing community. Overall, there is a low incidence of pelvic fractures in comparison with other orthopaedic traumas reported among kite surfers, and the most commonly injured sites are the foot and ankle. Emergency departments should be alert to this activity and its associated injury patterns due to its ever-increasing popularity.
https://ift.tt/2pQeYMG
Amelanotic melanoma: a unique case study and review of the literature
Amelanotic melanoma (AM) is a rare form of melanoma which lacks visible pigment. Due to the achromic manifestation of this atypical cutaneous malignancy, it has been difficult to establish clinical criteria for diagnosis. Thus, AM often progresses into an invasive disease due to delayed diagnosis. In this report, we describe the case of a 72-year-old Caucasian woman who had been diagnosed with AM after 3 years of failed treatments for what presented as a periorbital dermatitis. Her Clark's level 4, 1.30 mm thick melanoma required nine surgeries for successful resection and reconstruction. This case exemplifies the diagnostic pitfall of AM and the need for new criteria for early detection and management.
https://ift.tt/2GkLs8g
Πέμπτη 29 Μαρτίου 2018
Microanatomical Nerve Architecture of 6 Mammalian Species: Is Trans-Species Translational Anatomic Extrapolation Valid?
https://ift.tt/2pSsIpB
Application of precision medicine to the treatment of anaphylaxis
https://ift.tt/2J6qegf
How to diagnose food allergy
https://ift.tt/2J5vOz7
How to predict and improve prognosis of food allergy
https://ift.tt/2pShNMF
Phenotypes/endotypes-driven treatment in asthma
https://ift.tt/2J6hyq2
How to prevent food allergy during infancy: what has changed since 2013?
https://ift.tt/2pShGRf
Effect of Epley, Semont Maneuvers and Brandt–Daroff Exercise on Quality of Life in Patients with Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo (PSCBPPV)
Abstract
Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause in patients with vertigo (Pereira et al. in Braz J Otorhinolaryngol (Impr) 76(6):704–708, 2010; Dix and Hallpike in Ann Otol Rhinol Laryngol 6:987–1016, 1952). Posterior Semicircular Canal BPPV (PSCBPPV) has more incidence and prevalence then Lateral, and Anterior Semicircular Canal BPPV (Alghwiri et al. in Arch Phys Med Rehabil 93:1822–1831, 2012). Quality of life (QoL) is significantly impaired by vertigo (Sargent et al. in Otol Neurotol 22:205–209, 2001; World Health Organization in International classification of functioning, disability and health, World Health Organization, Geneva, 2001). To study the effect and compare Epley, Semont maneuvers and Brandt–Daroff Exercise on QoL in patients with PSCBPPV. 90 individuals with unilateral PSCBPPV were selected based on positive Dix–Hallpike test. 3 groups Epley, Semont, and Brandt–Daroff were formed and 30 individuals were selected in each group randomly. Dix–Hallpike test and Vestibular Activities and Participation (VAP) Scale based on International Classification of Functioning were administered before and after Epley, Semont maneuvers, and Brandt–Daroff Exercise to fulfill the aim. VAP Scale results revealed significant difference between pre and post treatment score in all 3 groups, suggestive of positive effect on QoL in patients with PSCBPPV. Improvements in VAP Score between 3 groups were compared and significant difference was observed. Dix–Hallpike test results revealed that 90, 73.33, and 50% patients improved in Epely, Semont, and Brandt–Daroff group respectively. Epely maneuver found to be the best choice and then Semont and Brandt–Daroff should be least preferred in treatment of patients with PSCBPPV.
https://ift.tt/2GCZ41Y
Treatment of Radiation and Cisplatin Induced Toxicities With Tempol
Interventions: Drug: Tempol; Drug: Placebo Solution
Sponsors: Matrix Biomed, Inc.; University of Maryland
Not yet recruiting
https://ift.tt/2E58XA8
Postoperative aRCH With Cisplatin Versus aRCH With Cisplatin and Pembrolizumab in Locally Advanced Head and Neck Squamous Cell Carcinoma
Interventions: Drug: Pembrolizumab 25 MG/1 ML Intravenous Solution [KEYTRUDA]; Other: adjuvant radiochemotherapy
Sponsor: University of Leipzig
Not yet recruiting
https://ift.tt/2GVMpVn
Proton Beam Therapy in the Treatment of Esophageal Cancer
Interventions: Radiation: Proton beam therapy; Other: Patient-Reported Outcome Measures
Sponsor: Washington University School of Medicine
Not yet recruiting
https://ift.tt/2uw4YNH
Evaluation of an Oral Care Programme for Head and Neck Cancer Patients
Intervention: Procedure: Oral care programme
Sponsors: Göteborg University; Ryhov County Hospital; FUTURUM, Academy of Health and Science; Swedish Cancer Foundation
Recruiting
https://ift.tt/2GXCO0D
The Inclined Position in Case of Respiratory Discomfort in the One Year Less Infant : Study on the Profits and the Risks in the Home
Intervention: Other: Questionnaires
Sponsor: Hospices Civils de Lyon
Not yet recruiting
https://ift.tt/2E3IToV
Effect of Epley, Semont Maneuvers and Brandt–Daroff Exercise on Quality of Life in Patients with Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo (PSCBPPV)
Abstract
Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause in patients with vertigo (Pereira et al. in Braz J Otorhinolaryngol (Impr) 76(6):704–708, 2010; Dix and Hallpike in Ann Otol Rhinol Laryngol 6:987–1016, 1952). Posterior Semicircular Canal BPPV (PSCBPPV) has more incidence and prevalence then Lateral, and Anterior Semicircular Canal BPPV (Alghwiri et al. in Arch Phys Med Rehabil 93:1822–1831, 2012). Quality of life (QoL) is significantly impaired by vertigo (Sargent et al. in Otol Neurotol 22:205–209, 2001; World Health Organization in International classification of functioning, disability and health, World Health Organization, Geneva, 2001). To study the effect and compare Epley, Semont maneuvers and Brandt–Daroff Exercise on QoL in patients with PSCBPPV. 90 individuals with unilateral PSCBPPV were selected based on positive Dix–Hallpike test. 3 groups Epley, Semont, and Brandt–Daroff were formed and 30 individuals were selected in each group randomly. Dix–Hallpike test and Vestibular Activities and Participation (VAP) Scale based on International Classification of Functioning were administered before and after Epley, Semont maneuvers, and Brandt–Daroff Exercise to fulfill the aim. VAP Scale results revealed significant difference between pre and post treatment score in all 3 groups, suggestive of positive effect on QoL in patients with PSCBPPV. Improvements in VAP Score between 3 groups were compared and significant difference was observed. Dix–Hallpike test results revealed that 90, 73.33, and 50% patients improved in Epely, Semont, and Brandt–Daroff group respectively. Epely maneuver found to be the best choice and then Semont and Brandt–Daroff should be least preferred in treatment of patients with PSCBPPV.
https://ift.tt/2GCZ41Y
Toward universal influenza virus vaccines: from natural infection to vaccination strategy
Chen Zhao | Jianqing Xu
https://ift.tt/2GXlXLp
Butterfly cartilage tympanoplasty outcomes: A single-institution experience and literature review
In 1998, Dr. Eavey described the trans-canal inlay butterfly cartilage tympanoplasty technique, also known as cartilage button tympanoplasty. Many retrospective studies have since demonstrated its efficacy and decreased operative time when compared to underlay and overlay tympanoplasty techniques. The butterfly cartilage tympanoplasty approach uses only a cartilage graft to repair tympanic membrane perforations. The aim of this study was to review the literature for studies that examined butterfly cartilage tympanoplasty success rates and outcomes and compare them to outcomes from our cohort.
https://ift.tt/2GmYL81
Tube patency: Is there a difference following otic drop administration?
Many surgeons instill peri-operative otic drops to maintain tube patency. A post-hoc analysis of three randomized, controlled studies involving a one-time administration of ciprofloxacin (OTO-201) given instead of otic drops perioperatively was conducted to evaluate tube patency in patients who did and did not receive otic drops as defined within the study protocol.
https://ift.tt/2GEXrRb
Differential diagnoses of diaper dermatitis
Pediatric Dermatology, Volume 35, Issue S1, Page s10-s18, March/April 2018.
http://bit.ly/2GW2avw
Introduction: Hot topics in neonatal skin care from the 13th World Congress of Pediatric Dermatology (Chicago, IL – July 6‐9, 2017)
Pediatric Dermatology, Volume 35, Issue S1, Page s3-s4, March/April 2018.
http://bit.ly/2E61Pn0
Issue Information ‐ Table of Contents
Pediatric Dermatology, Volume 35, Issue S1, Page s2-s2, March/April 2018.
http://bit.ly/2GW28Uq
Prevention and treatment of diaper dermatitis
Pediatric Dermatology, Volume 35, Issue S1, Page s19-s23, March/April 2018.
http://bit.ly/2E5eAy4
Issue Information ‐ Editorial Board
Pediatric Dermatology, Volume 35, Issue S1, Page s1-s1, March/April 2018.
http://bit.ly/2GUMKrE
Skin barrier in the neonate
Pediatric Dermatology, Volume 35, Issue S1, Page s5-s9, March/April 2018.
http://bit.ly/2uBoeJk
Subclassification of Bethesda Atypical and Follicular Neoplasm Categories According to Nuclear and Architectural Atypia Improves Discrimination of Thyroid Malignancy Risk
Thyroid, Ahead of Print.
http://bit.ly/2GZQGaJ
Getting Your Toddler to Eat
Parenting is hard work. One of the most common challenges we face is teaching our kids to be healthy eaters. As obesity rates in children and adolescents rise, we've seen a large focus on the importance of teaching healthy eating with lots of "dos" and "don'ts." Quite frankly it can be overwhelming.
In my psychology practice, I treat children and adolescents with feeding difficulties ranging from your typical picky eating to more extreme restrictive eating that leads to medical concerns.
I hear parents share their challenges, frustrations, and sometimes feelings of defeat. Parents come to me for help with feeding difficulties, and as a new mom embarking on my own journey of teaching my daughter to eat well, I never fathomed I would face some of these same challenges and frustrations. I figured I know how to shape a health eater, right? Well, what I forgot is that my 18-month old daughter is no different than any other kid!
My title at home is Mom, not Dr. Shelton, and I find myself veering from the very advice I provide every day to my patients and families. One of the most important we talk about, and what I must remind myself of, is what Ellyn Satter, a dietitian and feeding expert, coined as the division of responsibility in feeding – Parents are responsible for what is presented to eat and the manner in which it is presented. Kids are responsible for how much and even whether they eat. As a parent, this is sometimes a hard rule to follow because of our own parenting worries about our children's growth and nutrition. However, this rule truly helps avoid unnecessary food battles with your toddler. Here are some other important mealtime strategies to keep in mind if you have a picky eater.
- Have scheduled meals and snacks. Typically we recommend 3 meals and 2-3 snacks throughout the day so your toddler has an opportunity to eat every 2 or 3 hours. Keeping a consistent daily schedule is important, too. Scheduled meals and snacks help avoid grazing throughout the day. You want your toddler to come to the table hungry and ready to eat. Otherwise, they won't be motivated to eat much or try new foods.
- Plan ahead. You're in charge of choosing the food for meals and snacks. Provide a variety of foods during the meal/snack so your toddler can pick and choose what she wants to eat.
- Don't short-order cook. If you child refuses a meal or snack, don't get up and make them something else. That gives your kiddo the message that they are not expected to eat what the family eats. It may seem like you're wasting food if your toddler doesn't eat very much, but in the long run you will teach you little one to eat what the rest of the family eats.
- Limit mealtimes to 20-30 minutes and snacks to 15 minutes. Keeping a kiddo at the table until they have finished their plate can lead to more food battles. Many parents worry that their kids will starve if they don't eat their meal. But rest assured that your little one has 5-6 chances to each throughout the day. If they don't eat much at one meal/snack, they'll probably be hungrier for the next meal/ snack.
- Be realistic about portions. Toddlers don't need to eat very much to meet their nutritional needs. If you're worried about whether he's eating enough, talk with your pediatrician.
- Expose, expose, expose. Toddlers can take a long time to warm up to new foods. If you don't expose them to foods, they'll never have the opportunity to warm up to it. Continuing to offer a new food leaves it as an option. One of those times, she might take you up on it! Consider it a success if she tastes the food but then takes it back out of her mouth. The more she does this, the more likely it is she might eat the food.
- Tolerate some mess. This is a hard one for parents, my husband included. Toddlers use their fingers and tend to be messy. Or if your toddler is like my daughter, she spends more time smashing her food between her fingers or tossing it around on her tray than actually eating. She tells us she does not like a food or is all done by dropping food on the floor. I have to remember that she is not trying to annoy us. She's simply learning about her food and how to communicate with us. We have to teach our kids expectations for mealtime. It's okay to set limits and say "no" to teach your kiddos to keep their food on their plate. Model other ways your kiddo can tell you she's all done with mealtime. If they continue to misbehave, you can end mealtime.
- Don't let your kiddo fill up on juice or milk. Many toddler love to drink juice and milk. If they fill up on those, they will be less interested in eating at meals because they've already gotten enough calories from their drinks. Limit juice and milk to meals/ snacks and offer water between meals/ snacks. Talk with your pediatrician about how much juice or milk to offer each day.
- Make mealtimes pleasant. Most importantly, take the focus off of eating. Meals are a time to spend with your family and to enjoy each other. Talk about your day, something fun ahead, anything! Leave electronics somewhere else and turn off the TV!
The post Getting Your Toddler to Eat appeared first on ChildrensMD.
http://bit.ly/2pShl0L
Butterfly cartilage tympanoplasty outcomes: A single-institution experience and literature review
Source:American Journal of Otolaryngology
Author(s): Mejd Jumaily, Joel Franco, Jim Gallogly, Joshua L. Hentzelman, Dary J. Costa, Alan P.K. Wild, Anthony A. Mikulec
PurposeIn 1998, Dr. Eavey described the trans-canal inlay butterfly cartilage tympanoplasty technique, also known as cartilage button tympanoplasty. Many retrospective studies have since demonstrated its efficacy and decreased operative time when compared to underlay and overlay tympanoplasty techniques. The butterfly cartilage tympanoplasty approach uses only a cartilage graft to repair tympanic membrane perforations. The aim of this study was to review the literature for studies that examined butterfly cartilage tympanoplasty success rates and outcomes and compare them to outcomes from our cohort.Materials and methodsButterfly cartilage tympanoplasties were performed in 23 pediatric patients and 7 adult patients. We evaluated the tympanic membrane perforation closure rate and hearing results measured by closure of the air-bone gap.ResultsThe reviewed studies evaluating butterfly cartilage tympanoplasties demonstrated perforation closure rates between 71%–100%. The hearing outcomes in the reviewed literature varied, although the majority reported improved hearing. In our cohort, 21 of the 32 repaired tympanic membrane perforations demonstrated complete perforation closure. The mean follow-up length was 13.4 months. The mean air-bone gap decreased from 13.4 dB to 6.9 dB.ConclusionsThe butterfly cartilage/cartilage button technique is effective in closing tympanic membrane perforations and decreasing the air-bone gap in both adults and children.
https://ift.tt/2GyTnlN
Tube patency: Is there a difference following otic drop administration?
Source:American Journal of Otolaryngology
Author(s): Joseph E. Dohar, Chung H. Lu
PurposeMany surgeons instill peri-operative otic drops to maintain tube patency. A post-hoc analysis of three randomized, controlled studies involving a one-time administration of ciprofloxacin (OTO-201) given instead of otic drops perioperatively was conducted to evaluate tube patency in patients who did and did not receive otic drops as defined within the study protocol.Materials and methodsPost-hoc, retrospective analysis from three prospective, randomized, double-blind trials, (Phase 1b study [n = 83] and two Phase 3 studies [n = 532]) which enrolled children with confirmed middle ear effusion on the day of tympanostomy tube surgery and then randomized to placebo/sham (tubes alone) or OTO-201 and studied over a 28-day observation period. Patients with observed otorrhea post-tube were provided otic drops in the studies. An analysis was performed on the combined studies to evaluate tube patency, determined by pneumatic otoscopy and tympanometry, at four defined study visits over 28 days after the initial tube placement.ResultsThe analysis included 591 total patients with similar baseline demographics across groups. Tube patency ranged from 87 to 95% for patients who received otic drops, and from 96 to 99% for patients who did not receive otic drops.ConclusionBased on a retrospective post-hoc analysis from three randomized controlled trials in nearly 600 patients, tympanostomy tube occlusion rates was not increased in patients who did not receive otic drops. From this analysis, occlusion is likely caused primarily by peri-operative otorrhea since patency rates approached 99% in the absence of this complication.
https://ift.tt/2pQJRjd