Dermoscopy of arteriovenous tumour: A morphological study of 39 cases

Abstract

Background/Objectives

Arteriovenous tumour is a distinct, benign, acquired vascular lesion that can be misdiagnosed.

Methods

A dermoscopic examination of 39 cases of arteriovenous tumours collected from four Spanish hospitals was performed to evaluate specific dermoscopic criteria and patterns.

Results

The most common structures found were vascular, 95% of cases (37/39); 90% (35/39) were non-arborising telangiectasia. All the lesions except two (95%) had a homogeneous pigmentation background that was red in 30 cases (77%), bluish-red in three (8%), brown in two (5%) and blue or multicoloured in one case each. Lacunae were seen in only three cases (8%). Non-arborising telangiectasia on a reddish background was identified in 72% of cases.

Conclusions

Dermoscopy is helpful in improving the diagnosis of arteriovenous tumours and allows the observer to differentiate them from other cutaneous lesions such as other vascular tumours, basal cell carcinomas and melanomas.

http://ift.tt/2qsnft2

Programmed cell death 1 blockade-induced cutaneous sarcoid-like epithelioid granulomas in advanced melanoma: A case report

Abstract

Sarcoidosis is a chronic, systemic inflammatory disorder of unknown etiology that is characterized by the formation of noncaseating granuloma in affected organs, most commonly the lung.¹ In pulmonary sarcoidosis patients, the T helper 1 (Th1) cytokine profile of CD4⁺ as well as CD8⁺ T cells was demonstrated in bronchoalveolar lavage fluid.² However, there has been no detailed description of a lymphocyte profile in cutaneous sarcoid-like epithelioid granulomas. Here, we report a case of sarcoid-like epithelioid granulomas induced by nivolumab in a patient with advanced melanoma and we performed functional lymphocyte analysis of the granuloma lesions. All studies were performed in accordance with the ethical principles of the Declaration of Helsinki.

This article is protected by copyright. All rights reserved.

http://ift.tt/2CEcVmO

Mosaic NRASopathy n a child with giant melanocytic congenital naevus, epidermal hamartoma and bilateral nephroblastomatosis: clinical implication for follow-up

Abstract

Various nevoid proliferations result from postzygotic mutation in genes within the RAF/RAS/MAPK pathway, supporting the term "mosaic RASopathy"(1). Giant congenital melanocytic naevus (GCMN) and neurocutaneous melanosis are rare mosaic RASopathies mainly known to be at risk for the development of melanoma and skeletal anomalies are variably recorded (2,3).

This article is protected by copyright. All rights reserved.

http://ift.tt/2lYxeB5

Neutrophilic superficial eccrine ductitis: Proposal of a new disease concept

Abstract

A 3-year-old Japanese boy presented with a 3-month history of itchy erythematous papules on his trunk and forearms, the histologic findings of which were characterized by predominantly neutrophilic inflammation within and around the eccrine sweat ducts and obliteration and disruption of the superficial eccrine sweat ducts. Although the skin disorder had some clinical and histopathologic similarity to miliaria and neutrophilic eccrine hidradenitis, it was ultimately conformed to be neither disorder. Based on this and a case report in the Japanese literature of a 1-year-old boy with erythematous eruptions whose clinical and histopathologic findings were similar to those in our case, we propose the skin disorder in our case, referred to as "neutrophilic superficial eccrine ductitis," as a unique entity.

http://ift.tt/2CHqpOA

A young girl with severe cerebral fungal infection due to card 9 deficiency

Publication date: Available online 4 January 2018
Source:Clinical Immunology
Author(s): Pinar Gur Cetinkaya, Deniz Cagdas Ayvaz, Betül Karaatmaca, Rahsan Gocmen, Figen Söylemezoğlu, Wayne Bainter, Janet Chou, Talal A. Chatila, Ilhan Tezcan
Pattern recognition receptors (PRRs), receptors of the innate immune system, are important in interaction with pathogens. Caspase Recruitment Domain-containing protein 9 (CARD9), a member of PRRs, is an intracellular adaptor protein important in fungal defense. CARD9 deficiency causes a rare primary immunodeficiency (PID) characterized by superficial and deep fungal infections. We report a 17year-old female with a homozygous nonsense mutation in CARD9, who presented with severe cerebral fungal infection of the central nervous system. She was also found to have an heterozygous NLRP12 mutation, which may have had add-on effect on the severity of the infection.



http://ift.tt/2m0tZJS

Augmentation surgery on the cartilaginous portion of the vocal fold in a patient with cricoarytenoid joint ankylosis

Publication date: Available online 5 January 2018
Source:Auris Nasus Larynx
Author(s): Mioko Fukahori, Shun-ichi Chitose, Kiminori Sato, Hiroyuki Kamimura, Kiminobu Sato, Ririko On, Hirohito Umeno
Surgical management of cricoarytenoid joint (CAJ) ankylosis is challenging and has the risk of worsening voice quality. In the present case, augmentation surgery was performed on the cartilaginous portion of the vocal fold in a patient with CAJ ankylosis. A 24-year-old man sustained blunt trauma to the anterior neck three years prior to developing severe breathiness. Posterior glottal insufficiency resulting from lateral fixation of the right vocal fold was observed during phonation under laryngoscopy. In addition, electromyography and CT scan revealed severe ankylosis of the right CAJ. Type I thyroplasty performed on the right vocal fold did not improve postoperative vocal function. Therefore, augmentation surgery on the cartilaginous portion of the right vocal fold was performed via endolaryngeal microsurgery under general anesthesia with jet ventilation. A piece of temporalis fascia was autotransplanted into the submucosal space created at the posterior cartilaginous portion of the right vocal fold. This resulted in the narrowing of the posterior glottal gap during phonation, leading to improvement in hoarseness. Microsurgical management with autologous fascia augmentation of the cartilaginous portion of the vocal fold can be effective in patients with lateral vocal fold fixation due to CAJ ankylosis.



http://ift.tt/2CTvxwL

The global impact of the DRACMA guidelines cow’s milk allergy clinical practice

The 2010 Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) guidelines are the only Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines for cow's milk aller...

http://ift.tt/2F18uRk

Delayed facial nerve decompression for severe refractory cases of Bell’s palsy: a 25-year experience

This study aims to assess the effectiveness of delayed facial nerve decompression for Bell's palsy (BP).

http://ift.tt/2CGuQK7

Pediatric psoriasis: Evolving perspectives

Abstract

Background/Objectives

Childhood-onset psoriasis is a common skin disorder that has recently received increasing attention, particularly because of its significant medical, social, financial, and psychological burdens and its associated comorbidities. With limited data available and lack of standardized management guidelines for pediatric psoriasis, an expert panel desired to provide an updated critical overview and practical guidance for management of the affected population.

Methods

A panel of pediatric dermatologists with extensive experience in pediatric psoriasis defined and prioritized a core set of topics, performed an English-language literature review, prepared critical evaluations and presentations of topic areas, and carried out a consensus meeting and follow-up consensus manuscript.

Results

The summation of evolving perspectives in pediatric psoriasis includes epidemiology and natural history of the disease, precipitating factors and comorbidities, quality of life and burden of disease, clinical features and disease presentation, differential diagnosis, pathogenesis and treatment, including topical, photo, and systemic therapies.

Conclusion

Pediatric psoriasis is an important immune-mediated inflammatory skin disease with potential for significant impact on affected individuals and their caregivers. Current state-of-the-art care is based primarily on experience and expert consensus, but pediatric data are accumulating and therapeutic options are rapidly evolving.

http://ift.tt/2EYKcHJ

Quality of life outcomes after endoscopic approaches to intracranial tumors

Purpose of review To review the literature on quality of life (QOL) in endoscopic approaches to anterior and central intracranial skull-base disease. As endoscopic surgical techniques have gained widespread acceptance and complications and morbidity remain low and comparable with microscopic and open approaches, a shift to focusing on patients' perception of their own well being as an important outcome parameter has been made. In addition to the traditional measurements of surgical outcomes (extent of resection, recurrence rate, morbidity, survival, and complication rate), the success of a surgery can now be assessed using QOL measures. Recent findings The main tools for assessing QOL in endoscopic skull-base surgery (anterior skull-base questionnaire and 22-item sinonasal outcome test) were not specifically designed for endoscopic skull-base approaches, and recently, a new tool was introduced and validated, the skull-base inventory, adding to our armamentarium, but it has not yet been widely employed. Endoscopic skull-base surgery leads to improved or sustained long-term QOL overall but it is significantly influenced by tumor disease. Specific endoscopic surgical technique (such as nasoseptal flap closure) appears to have less impact on QOL. Summary It is becoming critical to assess therapeutic interventions in terms of impact on a patient's QOL. QOL can be useful in comparing efficacy of surgical interventions, and in the future, it will likely become a reportable indicator of surgical outcome and guide our surgical technique recommendations. Large-scale prospective multicenter trials would be beneficial.

http://ift.tt/2ql9igq

Risks and management of long-term corticosteroid use in chronic rhinosinusitis

Purpose of review The purpose of this review is to provide an update on the use and risks of long-term corticosteroids in the management of chronic rhinosinusitis (CRS). Recent findings Long-term use of systemic corticosteroids is not indicated in the management of CRS due to the associated side effects and potential complications. Therefore, recent research has focused on the safety and efficacy of topical corticosteroid, particularly second-generation corticosteroids, and their modes of administration. Second-generation corticosteroids are more potent and have less systemic bioavailability than their first-generation counterparts. However, caution must be taken with concomitant use of more than two types of corticosteroids (topical, systemic, inhaled etc.) and also with their dosage and frequency of administration to avoid adrenal suppression, growth suppression in children, elevated intraocular pressure or epistaxis. Research is ongoing into therapies that may reduce corticosteroid resistance which has been demonstrated in some nasal polyps. Summary Corticosteroids play an essential role in the management of CRS; however, use must be tailored to the patient-specific disease and requires ongoing review and regular reevaluation by their physician.

http://ift.tt/2qmYq1O

Long-term management and outcomes after repair of cerebrospinal fluid rhinorrhea related to idiopathic intracranial hypertension

Purpose of review To identify long-term management strategies and outcomes for the treatment of spontaneous cerebrospinal fluid (CSF) rhinorrhea related to idiopathic intracranial hypertension (IIH). Recent findings Adjuvant treatments following surgical repair of spontaneous CSF leaks are aimed at normalizing intracranial pressure (ICP) to minimize the risk of recurrence. IIH is closely linked to obesity, and growing evidence suggests that weight loss, both through conservative and surgical approaches, is effective at addressing the root cause of this disorder. Recent data also support the use of acetazolamide and dural venous sinus stenting as adjuncts for reducing ICP. Summary Spontaneous CSF rhinorrhea associated with IIH represents a challenging clinical entity, with an increased risk of recurrence compared to CSF leaks because of other causes. Adjunct therapies intended to reduce ICP likely improve outcomes after surgical repair, but further research is necessary to better characterize the effects of these treatment modalities.

http://ift.tt/2qnEzPX

Current opinions in office-based rhinology

Purpose of review The care of rhinologic patients has undergone a remarkable transformation in recent years. With the advent of endoscopic sinus surgery and high-tech image-guided computer systems, the surgical care of patients with benign sinonasal disease has successfully transitioned from the main hospital operating room to the outpatient ambulatory surgical center. Currently, there is yet another movement underway, in an attempt to care for these patients in the office setting. Recent findings As the medical device sector continues to innovate at rapid speed, new technologies such as the radiofrequency ablator, microdebrider, balloon sinus dilator, and steroid-eluting stent have propelled the care of rhinologic patients into the clinic setting. Summary In conjunction with an overall increased attention toward cost and time savings, the push to modernize instrumentation is now enabling the otolaryngologist to keep both the medical and surgical treatment of rhinologic patients, particularly those with chronic disease, within the office setting.

http://ift.tt/2qoU9ee

Editorial introductions

No abstract available

http://ift.tt/2qqsPMr

New instrumentations in the operating room for sinus surgery

Purpose of review The article reviews the advancements in instrumentation in the operating room that augment the speed, safety or outcomes of endoscopic sinus surgery (ESS). The article aims to update the Rhinologist on recent perioperative instruments that may benefit their practice. Recent findings The greatest advancements in the recent years have been in the field of visualization and optics. The introduction of high definition and ultra high definition 4K camera and screens supported by improvements with three-dimensional and variable angled endoscopes have greatly enhanced the quality and range of the visual information available to the sinus surgeon. This is closely supported by flexibility and enhanced functionality of the powered instrumentation with bipolar, monopolar and malleable blades and ever increasing more powerful burs. Summary Recent years have seen notable developments in the areas of optics, cameras and powered instruments to support the sinus surgeon. This article summarizes these developments and highlights the major benefits of these developments.

http://ift.tt/2qqsEkf

Review and update on postoperative opioid use after nasal and sinus surgery

Purpose of review We examine the current literature on pain management after sinus and nasal surgery. The goal after surgery is to provide effective pain management without having too many 'leftovers', as leftover medications are an important source of opioids that are fueling the current prescription narcotic epidemic in the United States. There are more than 250 000 sinus operations and 260 000 septoplasties performed annually, and surgeons commonly prescribe a narcotic pain medication for postoperative pain management. Recent findings The literature suggests that an evidence-based approach may lead surgeons to prescribe significantly less narcotic pain medication for these procedures without affecting pain management. Summary An evidence-based approach to pain management can result in unchanged pain control and a significant positive impact on the narcotic abuse epidemic.

http://ift.tt/2qoTPMy

Updates in the management of sinonasal mucosal melanoma

Purpose of review Sinonasal mucosal melanoma (SNMM) is an aggressive cancer with a poor prognosis. Although there is significant study surrounding the treatment of sinonasal malignancies and cutaneous melanomas, the rarity of this tumor has largely precluded robust outcomes analyses. The authors of this review seek to provide an overview of the recent literature related to the treatment of SNMM with added context from our institutional experience with this disease. Recent findings In the surgical management of sinonasal malignancies and SNMM specifically, resection via endoscopic endonasal technique appears to offer comparable oncologic outcomes versus an open approach. The role of adjuvant therapy continues to be debated, but there is strong evidence for improved rates of local control with radiotherapy after complete resection. In the last few years, significant developments have been made in the study of systemic therapies for cutaneous melanoma. The identification of genetic mutations common to mucosal melanoma has allowed for early trials of targeted therapies, but study is ongoing. Summary Although the study of SNMM is largely limited to small retrospective case series, treatment continues to evolve. Until effective systemic therapies can be identified, endoscopic resection with adjuvant radiotherapy may offer the best disease-free survival with acceptably low morbidity.

http://ift.tt/2qqsgSP

Odontogenic sinusitis: developments in diagnosis, microbiology, and treatment

Purpose of review Odontogenic causes of sinusitis are frequently missed; clinicians often overlook odontogenic disease whenever examining individuals with symptomatic rhinosinusitis. Conventional treatments for chronic rhinosinusitis (CRS) will often fail in odontogenic sinusitis. There have been several recent developments in the understanding of mechanisms, diagnosis, and treatment of odontogenic sinusitis, and clinicians should be aware of these advances to best treat this patient population. Recent findings The majority of odontogenic disease is caused by periodontitis and iatrogenesis. Notably, dental pain or dental hypersensitivity is very commonly absent in odontogenic sinusitis, and symptoms are very similar to those seen in CRS overall. Unilaterality of nasal obstruction and foul nasal drainage are most suggestive of odontogenic sinusitis, but computed tomography is the gold standard for diagnosis. Conventional panoramic radiographs are very poorly suited to rule out odontogenic sinusitis, and cannot be relied on to identify disease. There does not appear to be an optimal sequence of treatment for odontogenic sinusitis; the dental source should be addressed and ESS is frequently also necessary to alleviate symptoms. Summary Odontogenic sinusitis has distinct pathophysiology, diagnostic considerations, microbiology, and treatment strategies whenever compared with chronic rhinosinusitis. Clinicians who can accurately identify odontogenic sources can increase efficacy of medical and surgical treatments and improve patient outcomes.

http://ift.tt/2qoTrh4

Delayed complications from expanded endonasal surgery for intracranial tumors

Purpose of review Delayed complications after endoscopic endonasal approaches to the skull base, defined as complications greater than 1 month postoperatively, are uncommon. These complications are divided into categories including sinonasal, neuroanatomic, endocrine and vascular. This review highlights the most up-to-date advancements and reviews the management of delayed complications for skull base patients. Recent findings Over the last 10 years, the field of endoscopic endonasal skull base surgery has expanded with new data highlighting the long-term patient outcomes. The majority of patients experience increased quality of life (QOL) after these interventions. However, delayed complications including alterations to sinonasal function, delayed encephaloceles from the bony skull base defect and resulting endocrinopathies can significantly impact patient's QOL. Awareness of these complications and their current management is valuable for endoscopic surgeons. Summary Endonasal approaches to the skull base are safe and well tolerated in properly selected patients. This article highlights the delayed complications that require recognition and management by skull base surgeons to ensure the best possible care for patients.

http://ift.tt/2qqs6Ld

Vitiligoid variant of lichen sclerosus in young girls with darker skin types

Abstract

Background/Objectives

Vitiligo and lichen sclerosus are autoimmune disorders characterized by white discoloration, and both frequently affect the anogenital region. Vitiligoid lichen sclerosus refers to a superficial variant of lichen sclerosus in which the lesion appears clinically to be vitiligo based on the predominant presentation of depigmentation and minimal inflammation and sclerosis but histologically is consistent with lichen sclerosus. A limited number of reports have described vitiligoid lichen sclerosus, and from these reports, it appears to primarily affect darker-skinned people.

Methods

We retrospectively reviewed the records of 7 girls with darker skin types seen in our pediatric dermatology clinic who presented with a clinical overlap of vitiligo and lichen sclerosus. All had primarily well-demarcated, depigmented patches characteristic of vitiligo, but the lesions were symptomatic (pruritus, pain, bleeding, constipation), a presentation more consistent with lichen sclerosus.

Results

The girls were all treated with high-potency topical steroids, calcineurin inhibitors, or both. The associated symptoms improved or resolved, but most had minimal improvement of the depigmentation.

Conclusions

The girls presented in this series appear to have had vitiligoid lichen sclerosus, given the clinical overlap of lichen sclerosus and vitiligo affecting the anogenital region, particularly given that they did not have depigmented patches elsewhere on their body. Previous cases of vitiligoid lichen sclerosus have been reported in darker skin types, and our findings support this possible predisposition. It is important for clinicians to assess patients presenting with genital depigmentation for overlapping features of vitiligo and lichen sclerosus and determine appropriate management.

http://ift.tt/2CtcxE3

Potassium iodide in refractory, recurrent pediatric Sweet syndrome: Guidance in dosing and monitoring

Abstract

We describe a 5-month-old boy with clinical and histopathologic presentation of Sweet syndrome. He responded to systemic corticosteroids, with multiple flares on tapering; potassium iodide was added, which provided complete resolution of Sweet syndrome. Potassium iodide has been used in only a few cases, and no standard dosage has been established in children. We discuss calculation of a pediatric dosage for potassium iodide in Sweet syndrome.

http://ift.tt/2CSuwox

Isotretinoin-induced acne fulminans without systemic symptoms with concurrent exuberant granulation tissue

Abstract

Acne fulminans is a severe form of acne characterized by painful, inflammatory nodules that progress into ulcers and concurrent systemic symptoms. Treatment of acne with isotretinoin can precipitate a syndrome called isotretinoin-induced acne fulminans without systemic symptoms. An exuberant granulation tissue response, another known adverse event associated with isotretinoin, can occur concurrently, inhibiting wound repair and complicating treatment. We report a case of isotretinoin-induced acne fulminans without systemic symptoms with exuberant granulation tissue response that was treated successfully with topical clobetasol ointment.

http://ift.tt/2Cvg30E

Acral pigmented Spitz nevus in a child with transepidermal migration of melanocytes: Dermoscopic and reflectance confocal microscopic features

Abstract

Acral pigmented Spitz nevi are seldom reported in the literature. We report a new case on the palm of a 4-year-old girl that demonstrated correlation between features observed on dermoscopy and reflectance confocal microscopy (RCM). Histopathology revealed a benign intraepidermal Spitz nevus with transepidermal elimination of melanocytes that showed on RCM as focal atypical bright cells concerning for malignancy. This case is one of few reports in the literature combining dermoscopy, reflectance confocal microscopy, and histology for an acral Spitz nevi, which are rarely evaluated by RCM given the thickness of the stratum corneum in acral sites.

http://ift.tt/2CVpJ5T

Clinical features and nail clippings in 52 children with psoriasis

Abstract

Background/Objectives

Nail clipping, the act of cutting the distal portion of a nail for microscopic analysis, can complement the diagnosis of skin diseases with nail involvement, such as psoriasis. This study aimed to describe histopathologic findings on 81 nails from 52 children and adolescents with skin psoriasis and to determine whether these changes correlated with the severity of skin and nail involvement.

Methods

Children with psoriasis were enrolled in this cross-sectional study to obtain Psoriasis Area and Severity Index (PASI) and Nail Psoriasis Severity Index (NAPSI) scores. The most altered nails were processed using periodic acid-Schiff with diastase staining.

Results

Fifty-two patients with a median age of 10.5 years were included. The median Nail Psoriasis Severity Index score of the 20 nails from these patients was 17 (range 3-80). The most common findings were pitting (94.2%), leukonychia (73.0%), and longitudinal ridges (63.5%). Eighty-one nail fragments were collected by clipping. Neutrophils were found in 6 samples (7.6%) and serous lakes in 15 (19%). Median nail plate thickness was 0.3 mm (range 0.1-0.63 mm). Patients whose nails had neutrophils had a higher median PASI score (6.1 vs 2.0, P = .03). Patients whose nails had serous lakes had higher median PASI (5.3 vs 1.9, P = .008) and NAPSI (median 45.0 vs 18.0, P = .006) scores.

Conclusion

There seems to be a correlation between some microscopic nail features in children with psoriasis and their PASI and NAPSI scores, so nail clippings from children with suspected psoriasis may help with diagnosis, especially in the presence of neutrophils, and in excluding onychomycosis.

http://ift.tt/2CrlvBZ

Delayed-type hypersensitivity to vaccine aluminum adjuvant causing subcutaneous leg mass and urticaria in a child

Abstract

A 3-year-old girl presented with a 7-month history of a waxing and waning left thigh mass associated with pruritus and erythema at the site of two previous DTaP-HepB-IPV vaccinations. Patch testing was positive to aluminum chloride, supporting a diagnosis of vaccine granuloma secondary to aluminum allergy; her symptoms had been well controlled with antihistamines and topical steroids. Injection site granulomas are a benign but potentially bothersome reaction to aluminum-containing immunizations that can be supportively managed, and we encourage strict adherence to the recommended vaccine schedule in this setting. Patch testing is a sensitive, noninvasive diagnostic tool for patients presenting with this clinical finding, and dermatologist awareness can prevent unnecessary medical examination and provide reassurance.

http://ift.tt/2CUAXYp

Approach to the jewelry aficionado

Abstract

Children's and teens' frequent use of inexpensive "costume" jewelry exposes them to a variety of contact allergens. Greater use heightens the risk of developing allergic contact dermatitis, especially in the setting of body piercings. Several clinical pearls, prevention strategies, and avoidance alternatives are provided in this article to guide clinicians and patients in the management of jewelry-related allergic contact dermatitis.

http://ift.tt/2CsEDzg

Robust Neuronal Discrimination in Primary Auditory Cortex Despite Degradations of Spectro-temporal Acoustic Details: Comparison Between Guinea Pigs with Normal Hearing and Mild Age-Related Hearing Loss

Abstract

This study investigated to which extent the primary auditory cortex of young normal-hearing and mild hearing-impaired aged animals is able to maintain invariant representation of critical temporal-modulation features when sounds are submitted to degradations of fine spectro-temporal acoustic details. This was achieved by recording ensemble of cortical responses to conspecific vocalizations in guinea pigs with either normal hearing or mild age-related sensorineural hearing loss. The vocalizations were degraded using a tone vocoder. The neuronal responses and their discrimination capacities (estimated by mutual information) were analyzed at single recording and population levels. For normal-hearing animals, the neuronal responses decreased as a function of the number of the vocoder frequency bands, so did their discriminative capacities at the single recording level. However, small neuronal populations were found to be robust to the degradations induced by the vocoder. Similar robustness was obtained when broadband noise was added to exacerbate further the spectro-temporal distortions produced by the vocoder. A comparable pattern of robustness to degradations in fine spectro-temporal details was found for hearing-impaired animals. However, the latter showed an overall decrease in neuronal discrimination capacities between vocalizations in noisy conditions. Consistent with previous studies, these results demonstrate that the primary auditory cortex maintains robust neural representation of temporal envelope features for communication sounds under a large range of spectro-temporal degradations.

http://ift.tt/2CBnw1I

Robust Neuronal Discrimination in Primary Auditory Cortex Despite Degradations of Spectro-temporal Acoustic Details: Comparison Between Guinea Pigs with Normal Hearing and Mild Age-Related Hearing Loss

Abstract

This study investigated to which extent the primary auditory cortex of young normal-hearing and mild hearing-impaired aged animals is able to maintain invariant representation of critical temporal-modulation features when sounds are submitted to degradations of fine spectro-temporal acoustic details. This was achieved by recording ensemble of cortical responses to conspecific vocalizations in guinea pigs with either normal hearing or mild age-related sensorineural hearing loss. The vocalizations were degraded using a tone vocoder. The neuronal responses and their discrimination capacities (estimated by mutual information) were analyzed at single recording and population levels. For normal-hearing animals, the neuronal responses decreased as a function of the number of the vocoder frequency bands, so did their discriminative capacities at the single recording level. However, small neuronal populations were found to be robust to the degradations induced by the vocoder. Similar robustness was obtained when broadband noise was added to exacerbate further the spectro-temporal distortions produced by the vocoder. A comparable pattern of robustness to degradations in fine spectro-temporal details was found for hearing-impaired animals. However, the latter showed an overall decrease in neuronal discrimination capacities between vocalizations in noisy conditions. Consistent with previous studies, these results demonstrate that the primary auditory cortex maintains robust neural representation of temporal envelope features for communication sounds under a large range of spectro-temporal degradations.

http://ift.tt/2CBnw1I

Subglottische Stenose

Laryngo-Rhino-Otol 2018; 97: 12-13
DOI: 10.1055/s-0043-123960

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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http://ift.tt/2CHeGQP

Aus der Gutachtenpraxis: Gehörschäden durch Cabrio fahren?

Laryngo-Rhino-Otol 2018; 97: 50-55
DOI: 10.1055/s-0043-121720

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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http://ift.tt/2CHdLzR

Bogengangsdehiszenz: Verschlussoperationen mit niedriger Komplikationsrate

Laryngo-Rhino-Otol 2018; 97: 7-8
DOI: 10.1055/s-0043-121845

Xie Y et al. Surgical Complications from Superior Canal Dehiscence Syndrome Repair: Two Decades of Experience. Otolaryngol Head Neck Surg 2017; 157: 273–280 Die Bogengangsdehiszenz ist eine seltene Erkrankung des Gleichgewichtsorgans und kann chirurgisch durch eine Verschlussoperation behandelt werden. Wie oft es dabei zu allgemeinen Komplikationen kommt, und welche Risikofaktoren diese beeinflussen, haben Xie und Kolleginnen/Kollegen auf Basis von 242 Fallberichten aus zwei Jahrzehnten ausgewertet.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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http://ift.tt/2lY9UEm

Salvage-Chirurgie bei Tumorrezidiven der Mundhöhle – Einfluss der vorherigen Behandlung und des Patientenalters

Laryngo-Rhino-Otol 2018; 97: 8-10
DOI: 10.1055/s-0043-121838

Tam S et al. Estimating Survival After Salvage Surgery for Recurrent Oral Cavity Cancer. JAMA Otolaryngol Head Neck Surg 2017; 143:685–690 Loko-regionäre Rezidive eines Plattenepithelkarzinoms der Mundhöhle sind lebensbedrohlich und eine klinische Herausforderung. Welche Rolle spielt in diesen Fällen die Salvage-Chirurgie?
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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http://ift.tt/2lZ7lBG

Medikamentöse Therapiemöglichkeiten bei vestibulären Störungen, Nystagmus und zerebellären Ataxien

Laryngo-Rhino-Otol 2018; 97: 14-23
DOI: 10.1055/s-0043-123487

Zur Pharmakotherapie von vestibulären Erkrankungen kommen im Wesentlichen folgende Wirkstoffgruppen zum Einsatz: Antivertiginosa, Antikonvulsiva, Antidepressiva, Antiphlogistika, Anti-Menière-wirksame Substanzen, Migräneprophylaktika, Aminopyridine (Kaliumkanalblocker) und Acetyl-DL-Leucin (eine modifizierte essenzielle Aminosäure). Die Behandlung des Symptoms Schwindel und der begleitenden vegetativen Beschwerden wie Übelkeit, Brechreiz oder Erbrechen sollte zeitlich stets begrenzt werden. Bei einem akuten einseitigen Vestibularisausfall verbessern Kortikosteroide die Erholung der peripher vestibulären Funktion, ohne ausreichende Evidenz für eine allgemeine Empfehlung.Für die Wirksamkeit von Betahistin (16 mg dreimal täglich oder 48 mg dreimal täglich) bei Morbus Menière gibt es bislang keine ausreichende Evidenz, ggf. sollten hierbei höhere Dosierungen angestrebt werden – insbesondere, da in tierexperimentellen Studien eine Verbesserung der Durchblutung des Innenohrs nachgewiesen wurde. Bei der Vestibularisparoxysmie sind Carbamazepin/Oxcarbazepin wahrscheinlich wirksam, es fehlen aber noch randomisierte kontrollierte Studien (RCTs) dazu. Bei der vestibulären Migräne gibt es bislang keine RCTs zur Wirksamkeit von Betablockern oder Topiramat, so dass hier aufgrund von klinischen Erfahrungen die Therapie in Analogie zur Migräne ohne Aura empfohlen wird.Aminopyridine werden für die Behandlung von Patienten mit Downbeat-Nystagmus (2 RCTs) und der episodischen Ataxie Typ 2 (EA2, 1 RCT) empfohlen. Die Wirksamkeit von Aminopyridinen wurde in tierexperimentellen und funktionellen Bildgebungsstudien evaluiert. Acetyl-DL-Leucin, eine modifizierte essenzielle Aminosäure, verbessert die klinischen Symptome der zerebellären Ataxie (bisher 3 Beobachtungsstudien). Nach tierexperimentellen Studien beschleunigt es auch die zentrale Kompensation vestibulärer Störungen; randomisierte klinische Studien dazu waren negativ. Derzeit werden die folgenden klinischen RCTs zu verschiedenen Erkrankungen durchgeführt: Vestibularisparoxysmie (Carbamazepin, VesPa), akute einseitige Vestibulopathie/Neuritis vestibularis (Betahistin, BETAVEST), vestibuläre Migräne (Metoprolol, PROVEMIG), BPPV (Vitamin D, VitD@BPPV), EA2 (Aminopyridin vs. Acetazolamid, EAT-2-TREAT) und zerebelläre Ataxien (Acetyl-DL-Leucin, ALCAT).
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

http://ift.tt/2lY8wBh

Facial Volumization: An Anatomic Approach

Laryngo-Rhino-Otol 2018; 97: 11-11
DOI: 10.1055/s-0043-121767

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

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Milbenallergie im HNO-Bereich: Bedeutung, Diagnostik und Therapieoptionen

Laryngo-Rhino-Otol 2018; 97: 56-69
DOI: 10.1055/s-0043-121086

Die allergische Rhinitis betrifft ca. 20 % der Gesamtpopulation in Deutschland, ca. ein Drittel dieser Patienten ist von einer persistierenden Rhinitis aufgrund einer Milbenallergie betroffen 2. Bei Patienten mit perennialer Rhinitis allergica ist die Erkrankung besonders häufig mit anderen allergisch bedingten Komorbiditäten wie Asthma bronchiale, atopischem Ekzem, Schlafstörungen, chronischer Sinusitis oder Tubenfunktionsstörungen assoziiert.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Otolaryngology Cases. The University of Cincinnati Clinical Portfolio

Laryngo-Rhino-Otol 2018; 97: 11-11
DOI: 10.1055/s-0043-122248

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

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Rhinoplastik

Laryngo-Rhino-Otol 2018; 97: 72-74
DOI: 10.1055/s-0043-124382

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

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59 years old male with local advanced adenoid cystic carcinoma of the hypopharynx – A case report and a review of the literature

Publication date: February 2018
Source:Oral Oncology, Volume 77
Author(s): Amr Muhammed, Ahmed Mohamed, Esraa Elnakib, Amal Omar, Nahawand Elnakib
Minor Salivary Gland tumours are rare, representing 2% of the head and neck tumours and less than 1% of hypopharyngeal cancers. The most common subtype of minor salivary gland tumours is adenoid cystic carcinoma. Although there are several case reports discussed it, there are only two reports discussing hypopharyngeal presentation in the literature, and they were treated by surgical resection. Despite that, our case report still to be unique as it presents a case of irresectable locally advanced tumour subjected to a trial of induction therapy.



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Reconnoitre ameloblastic carcinoma: A prognostic update

Publication date: February 2018
Source:Oral Oncology, Volume 77
Author(s): Tajindra Singh Saluja, Rashmi Hosalkar
AimMalignant odontogenic tumor, ameloblastic carcinoma (AC) is challenging to study owing to its rarity, complexity and limited availability of literature. This further makes it difficult to establish its clinical characteristics and prognosis. Our study aimed to evaluate AC's clinico-demographic factors and their relation with prognosis and survival.Materials and MethodsLiterature was systematically reviewed for cases pertaining to AC, starting from January 2000 to December 2016. All the required data was obtained, arranged and analysed using Cox regression ratio and Kaplan Meir survival analysis. From the database, 153 cases were retrieved as per the inclusion/exclusion criteria.ResultsThe results demonstrated that age of patient, mode of treatment and metastasis affects overall survival. The categorisation of AC as primary or secondary type does not have any role in determining prognosis.ConclusionOverall survival of AC patient depends upon age, site, treatment and metastasis. For a better prognosis early surgical management of the tumor appears to be the most favourable mode of treatment.



http://ift.tt/2CqjWEq

Late radiation-associated dysphagia in head and neck cancer patients: evidence, research and management

Publication date: February 2018
Source:Oral Oncology, Volume 77
Author(s): F. De Felice, M. de Vincentiis, V. Luzzi, G. Magliulo, M. Tombolini, G. Ruoppolo, A. Polimeni
In head and neck cancer (HNC) scenario, newer radiotherapy (RT) techniques, such as intensity modulated RT (IMRT), aim to reduce acute and late toxicity without impair tumor response and loco-regional control rates. However, late radiation-associated dysphagia (RAD) remains a major clinical problem and has gained a growing importance in the last few years, especially due to human papilloma virus (HPV)-related HNC favorable prognosis.The aim of this review was to provide clinical information about late RAD. The main anatomical structures involved in swallowing were described, in order to define potential organ at risk and available radiation-dose constraints in IMRT plan. Finally, possible rehabilitation strategies were proposed. This is expected to represent an opportunity for improved multidisciplinary management in HNC patients.



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Reader performance in the ultrasonographic evaluation of oropharyngeal carcinoma

Publication date: February 2018
Source:Oral Oncology, Volume 77
Author(s): Farhoud Faraji, Ericka S. Padilla, Dana Blitz, Meghan B. Wenderoth, Ray G. Blanco, Satomi Kawamoto, Sheila Sheth, Ulrike M. Hamper, Carole Fakhry
ObjectiveTo examine reader performance in evaluating oropharyngeal anatomy on ultrasonography.Materials and methodsUltrasound images of the oropharynx comprising normal and malignant anatomic variants were organized into slideshows. Slideshows were administered to 6 readers blinded to participant tumor status and with varying experience reading oropharyngeal sonograms. A training slideshow oriented readers to images of the oropharynx with and without malignant lesions. Readers then evaluated images in a test slideshow for tumor presence and marked orthogonal long and short dimensions of the tumor. Results were analyzed for accuracy, sensitivity, specificity, inter-reader agreement, and measurement error relative to prospectively-identified reference measurements.ResultsEighty-seven percent of base of tongue (BOT) sonograms were identified correctly by a majority of readers. In identifying BOT tumors, median accuracy, sensitivity, specificity, and Fleiss's kappa were 79%, 73%, 85%, and 0.51, respectively. Median measurement error in the long and short axes for BOT tumors was −2.6% (range: −40% to 29%) and −2.6% (range: −56% to 156%), respectively. Eighty-four percent of palatine tonsil sonograms were identified correctly by a majority of readers. In identifying tonsil tumors, median accuracy, sensitivity, specificity, and Fleiss's kappa were 77%, 74%, 78%, and 0.41, respectively. Median measurement error in the long and short axes for tonsil tumors was 3.8% (range: −45% to 32%) and −6.5% (range: −83% to 42%), respectively.ConclusionsOverall, US has clinically useful sensitivity for identification of oropharyngeal carcinoma among readers of diverse clinical backgrounds and experience. US may be useful for the evaluation of features such as tumor dimensions.



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Mandibular reconstruction

Publication date: February 2018
Source:Oral Oncology, Volume 77
Author(s): Kiran Kakarala, Yelizaveta Shnayder, Terance T. Tsue, Douglas A. Girod
Mandibular reconstruction presents unique functional and aesthetic challenges to the reconstructive surgeon. This review will cover current techniques for mandibular reconstruction, including the various plating strategies for rigid fixation, the choice of osseous donor site, and the concurrent reconstruction of associated soft tissue defects. Recent developments and future horizons in mandibular reconstruction including the use of virtual surgical planning and tissue engineering will also be addressed.



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Commentary on letter to the editor on manuscript “Image analysis of interarytenoid area to detect cases of Laryngopharyngeal Reflux: An objective method”

We would like to thank Dr. Lechien and his team for their interest in our article and are grateful to them for their analysis. We would now take this opportunity to comment on their observations.

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A rare presentation of congenital syphilis: Pemphigus syphiliticus in a newborn infant with extensive desquamation of the extremities

Abstract

Congenital syphilis is an infection transmitted from mother to fetus and can present with early but variable cutaneous manifestations. In rare situations, a bullous eruption known as pemphigus syphiliticus may develop. We present an unusual case of broad desquamation of the extremities in a newborn infant who was found to have congenital syphilis. Pemphigus syphiliticus should be considered in the differential diagnosis of neonatal bullous eruptions and erosions.

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Wound infection after inpatient pediatric skin biopsy

Abstract

Punch and shave biopsies are important dermatologic procedures in the inpatient setting but have a risk of wound infection. Data on the incidence of infection in this setting are limited and conflicting. This retrospective study of 127 pediatric inpatients at two tertiary care centers who underwent biopsy demonstrated a low overall risk of infection (n = 1, 0.8%). Twenty-five (19.7%) were neutropenic, and 51 (40.2%) were not taking systemic antibiotics at the time of biopsy; none of these patients developed a wound infection. The overall low rate of infection should reassure physicians who are balancing the risks and benefits of performing a skin biopsy in children in the inpatient setting and suggests that physicians should not defer clinically indicated biopsies because of concern about infection.

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Rapid, successful treatment of atopic dermatitis recalcitrant to topical corticosteroids

Abstract

Atopic dermatitis is responsive to midpotency topical corticosteroids, which are the mainstay of treatment, yet many patients have disease that is "resistant" to triamcinolone prescribed for outpatient use. Such resistance is often due to poor adherence, but patients and caregivers may remain adamant that the steroid was ineffective and assure the physician that it was applied as recommended. We describe the case of a young girl with a 2-year history of atopic dermatitis resistant to triamcinolone whose condition rapidly improved with continued use of triamcinolone. Our case raises the ethical dilemma of whether physicians should base treatment plans on what patients report or what evidence on adherence suggests.

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Lost in Translation: Caring for Limited English Proficiency Patients

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Combination of ligation and timolol before surgical excision of pyogenic granuloma

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Predictive value of basal cell carcinoma biopsies with negative margins: A retrospective cohort study

Pathology reports of basal cell carcinoma (BCC) biopsies often contain comments of positive or negative margins, with only 1-2% of the margin evaluated. The negative predictive value (NPV) of biopsy margin status on residual BCC is unknown.

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“Sweetheart, you should have that looked at”: Ethical Implications of Treating Family Members

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The Vitiligo Extent Score (VES) and the VESplus are responsive instruments to assess global and regional treatment response in patients with vitiligo

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Subsequent non-melanoma skin cancers and impact of immunosuppression in liver transplant recipients

Non-melanoma skin cancers (NMSC) are the most frequent cancers in solid organ transplant recipients, with a high rate of subsequent tumors.

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Management Strategies of Academic Pigmented Lesion Clinic Directors in the United States

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Progression of undiagnosed cutaneous lymphoma after anti-tumor necrosis factor alpha therapy

Cutaneous lymphoma (CL) diagnosed after anti-tumor necrosis factor (TNF)α therapy has been reported in the literature, yet a clear link between both events remains elusive.

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Is there a doctor onboard? The ethical conundrum of a specialist asked to provide in-flight medical assistance

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Dermatology faculty and residents’ perspectives on the dermatology residency application process: A nationwide survey

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The association between dermoscopic features and BRAF mutational status in cutaneous melanoma: significance of the blue-white veil

The genetic basis of melanoma affects its clinicopathological characteristics and increasingly influences its management. BRAF-mutated melanoma may present with specific dermoscopic features.

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Efficacy and safety of switching to ixekizumab in secukinumab non-responders with plaque psoriasis: a multicenter retrospective study of interleukin (IL)-17A antagonist therapies

http://ift.tt/2lWsMU6

TOPICAL CHLORHEXIDINE, POVIDONE-IODINE AND ERYTHROMYCIN IN THE REPAIR OF TRAUMATIC ULCERS ON THE RAT TONGUE: CLINICAL, HISTOLOGICAL AND MICROBIOLOGICAL EVALUATION

Publication date: Available online 4 January 2018
Source:Archives of Oral Biology
Author(s): Dieni da Silveira Teixeira, Maria Antonia Zancanaro de Figueiredo, Karen Cherubini, Maria Claudia Rosa Garcia, Sílvia Dias de Oliveira, Fernanda Gonçalves Salum
ObjectiveThis study investigated the effect of topical application of 0.12% chlorhexidine, 10% povidone-iodine and 50% erythromycin on the optimization of healing process of traumatic ulcers made on ventral tongue of rats.DesignForty-Eight Wistar rats were randomly divided into four groups: control, chlorhexidine (Chx), povidone-iodine (PvI) and erythromycin (Er). An ulcer of 5 mm in diameter was made on the ventral tongue of the animals. After 24 h, a microbiological sample was taken and daily application of the substances started. Six animals each group were euthanized at 4 days and the others at 8 days postoperative, totaling three and seven days of treatment. Prior to euthanasia, a new microbiological collection was performed.ResultsThe experimental groups showed less area of residual ulcer. A significant difference was seen between the PvI and Chx in relation to the control after three days of treatment (p<0.05). Although the experimental groups displayed greater newly formed epithelial area, there was no significant difference compared to the control (p>0.05). Er exhibed the lowest inflammation scores after seven days of treatment (p = 0.05). PvI showed reduction of microorganisms at both times and under aerobic (p < 0.01 at 3 days and p < 0.001 at 7 days) and microaerophilic (p<0.05) conditions. Er significantly reduced the count of microorganisms in aerobic condition when compared to control group (p<0.05 at 3 days and p<0.01 at 7 days).ConclusionsAll drugs promoted reduction of the microorganisms at the site of the injury, which may have a direct effect on the tissue repair process.



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Association between developmental defects of enamel and celiac disease: A meta-analysis

Publication date: March 2018
Source:Archives of Oral Biology, Volume 87
Author(s): Débora Souto-Souza, Maria Eliza da Consolação Soares, Vanessa Silva Rezende, Paulo César de Lacerda Dantas, Endi Lanza Galvão, Saulo Gabriel Moreira Falci
ObjectivesStudies have observed the presence of extra-intestinal manifestations of celiac disease (CD), including involvement of the oral cavity, such that developmental defects of enamel (DDE) occur. Thus, the aim of this review was to access the polled prevalence of DDE in individuals with CD, and to establish the strength of the association between these two variables.MethodsTo carry out the systematic review, four electronic databases and the Grey Literature were searched, complemented by a manual search of reference lists within the selected articles. Two pairs of independent reviewers selected the articles, and perform the data extractions and bias risk assessment Studies evaluating the presence of DDE in individuals with CD as well as in healthy individuals and which performed the DDE diagnosis by direct visualization of tooth enamel changes and the CD diagnosis were included. Meta-analyses were performed using the software R.ResultsOf 557 studies, 45 were selected for review, encompassing 2840 patients. The prevalence of DDE in people with CD was 50% (95% CI 0.44–0.57, I² = 88%). In a general analysis, it was observed that patients with CD had a significantly higher prevalence of enamel defects compared to healthy people (RR: 2.31, 95% CI: 1.71–3.12, I² = 98%). Only developmental defects of enamel diagnosed using Aine's method were associated with the disease (RR: 3.30, 95% CI 2.39–4.56, I² = 75%). In a sensitivity analysis involving the deciduous, mixed and permanent dentitions, only individuals with deciduous dentition were observed to have association with the disease (RR: 2.34, 95% CI 1.25–4.39, I² = 39%).ConclusionsPatients with enamel developmental defects should be screened for the possibility of their having celiac disease.



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Histological and chemical analyses of mesiodens development and mineralization

Publication date: March 2018
Source:Archives of Oral Biology, Volume 87
Author(s): Awady Muhamad, Moskovitz Moti, Cohen Ornit, Zilberman Uri
ObjectiveThis study aimed to compare the developmental timing and mineralization quality of mesiodentes, i.e., supernumerary teeth located mainly in the midline of the maxilla between the central incisors, with the developmental timing and mineralization quality of permanent and primary central incisors.DesignSixteen mesiodentes, nine permanent and seven primary central incisors were collected. The location of the neonatal line was determined using a light microscope at 10× or 20× enlargements. Chemical composition of the enamel at two locations was analyzed using energy dispersive X-ray spectrometer.ResultsNeonatal lines were observed in eight out of 16 mesiodentes, in all primary central incisors and in none of the permanent central incisors. Chemical analyses showed that mesiodentes mineralization was impaired, resulting in higher amount of organic ions and reduced inorganic ions. Discriminant analysis showed minimal overlap of mesiodentes with either primary or permanent centrals.ConclusionsMesiodentes development begins before birth in 50% of the cases but later than the primary centrals. Mineralization of mesiodens is impaired with less mineral content and higher organic content. The results showed that mesiodentes are a special group of teeth with defective morpho-differentiation and mineralization, with little similarity to primary or permanent central incisors.



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Unilateral Nasal Obstruction

A woman presented with constant right-sided nasal obstruction; computed tomographic scan showed complete opacification of the right paranasal sinuses with mass effect on the medial maxillary wall with mild hyperostosis posterolaterally. What is your diagnosis?

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A Possible Association Between Hearing Loss and Zika Virus Infections

This Viewpoint summarizes what is currently known about Zika virus infection associated with hearing loss in both children and adults and points out areas where further research is needed.

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Jan 2018 Issue Highlights

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Unusual Cause of Recurrent Meningitis

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

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The Epidemic of Guns

The shooting in Las Vegas, Nevada, that left 59 people dead, 10 times that number wounded, and thousands of people with the psychological distress from being present at the scene during and after the massacre has once again raised the issue of what we as a nation can and should do about guns. The solution lies in not just focusing on Las Vegas and the hundreds of other mass shootings that have occurred in the United States in the last 14 months, but rather to underscore that on average almost 100 people die each day in the United States from gun violence. The 36 252 deaths from firearms in the United States in 2015 exceeded the number of deaths from motor vehicle traffic crashes that year (36 161). That same year, the US Centers for Disease Control and Prevention reported that 5 people died from terrorism. Since 1968, more individuals in the United States have died from gun violence than in battle during all the wars the country has fought since its inception.

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Frontal Sinus Drug-Eluting Implants—Effective, but for Which Patients and at What Cost?

Surgical intervention for chronic rhinosinusitis (CRS) is an important treatment option for patients refractory to medical therapy. Despite advances in surgical techniques and operative technology, revision endoscopic sinus surgery (ESS) is necessary in 6% to 19% of patients. Reasons for revision surgery include scarring and adhesion formation, recurrent polyposis, and persistent inflammation. These issues are especially problematic in the frontal recess given the narrow anatomic boundaries that limit the size of the surgical sinusotomy that can be created. Long-term patency rates are reported in the range of 67% to 92%. Attempts to improve the success of frontal sinus surgery by decreasing scarring and inflammation have been long standing and a variety of stenting options exist. Recent advancements in bioabsorbable and drug-eluting stents provide a new possibility for improving postoperative sinus surgery outcomes.

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Outcomes After Transoral Robotic Surgery for Oropharyngeal Cancer

This study compares functional speech, swallowing, and quality-of-life outcomes between patients with oropharangeal cancer who underwent transoral robotic surgery onlyand those who underwent transoral robotic surgery and received adjuvant radiotherapy or chemoradiotherapy.

http://ift.tt/2iBOca8

Worsening Respiratory Distress in a 7-Month-Old Infant

A 7-month-old male presented with noisy breathing; he fed poorly from the bottle with frequent choking, grunting, and irritability; nasopharyngolaryngoscopy showed no laryngomalacia, laryngeal lesions, or cord paralysis. What is your diagnosis?

http://ift.tt/2B3BWmI

Bioabsorbable Steroid-Releasing Implant in the Frontal Sinus After Endoscopic Sinus Surgery

This randomized clinical trial assess the safety and efficacy of an hourglass-shaped, bioabsorbable, steroid-releasing sinus implant in improving postoperative outcomes when placed in the frontal sinus ostia following endoscopic sinus surgery in patients with chronic rhinosinusitis.

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Treatment of Acute Upper Airway Obstruction—Reply

In Reply We are delighted that Dr Deeb and his colleagues see applicability for use with adults as well as children of our 10 commandments for management of acute upper airway obstruction. Hopefully, our 10 rules have validity based on many years of collective experience, and we know that few otolaryngologists have more experience or wisdom than Dr Ziad Deeb. So, we agree that heart rate should be monitored closely as an indicator of changes in severity of upper airway obstruction and we fully agree that vertical incision for tracheotomy is the quickest and safest kind of incision to make.

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Hypoglossal Nerve Stimulation for Children With Down Syndrome and Sleep Apnea

This case series examines whether hypoglossal nerve stimulation is safe and effective in children with Down syndrome and obstructive sleep apnea.

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Risk of Venous Thromboembolism Among Otolaryngology Patients

This cohort study examines the rate of venous thromboembolism for various otolaryngology procedures compared with an established average-risk field (general surgery) and low-risk field (plastic surgery).

http://ift.tt/2l0oyN9

Association Between Head and Neck Squamous Cell Carcinoma Survival, Smoking at Diagnosis, and Marital Status

This cohort study examines the association between survival and smoking status at the time of diagnosis of head and neck squamous cell carcinoma and the association between marital status and smoking in these same patients.

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

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

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Weaning Children With Aspiration From Thickened Fluids

This case series describes the experience of a systematic weaning process in children who received thickened liquids due to oropharyngeal dysphagia and identified risk of aspiration.

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Aggressive-Appearing Pediatric Parotid Mass

A young boy had an enlarging right facial mass; a computed tomographic scan showed a discrete necrotic mass in the right parotid gland, and fine-needle aspirate yielded a cellular sample with spindloid features. What is your diagnosis?

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Analysis of the Growth Pattern of Thyroid Cancer in Young Patients

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

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Association of Treatment at High-Volume Facilities With Survival in Nasopharyngeal Cancer

Using the National Cancer Database, this study examines the association of treatment at high-volume facilities with survival in patients receiving chemotherapy for nasopharyngeal cancer.

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Hearing Difficulty in the United States

This survey study analyzes the epidemiologic features and treatment patterns of hearing difficulty in the United States using data from responses from the 2014 National Health Interview Survey.

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Stem Cell Transplant Improves Severe Scleroderma Survival

Among patients with severe scleroderma, stem cell transplant significantly improved survival compared with cyclophosphamide but was associated with higher mortality and short-term side effects, a study found.
Medscape Medical News

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The first report of a 5-year period cancer registry in Greece (2009–2013): a pathology-based cancer registry

Abstract

Cancer registries are essential in health care, since they allow more accurate planning of necessary health services and evaluation of programs for cancer prevention and control. The Hellenic Society of Pathology (HSP) having recognized the lack of such information in Greece has undertaken the task of a 5-year pathology-based cancer registry in Greece (2009–2013). In this study, > 95% of all pathology laboratories in the national health system hospitals and 100% of pathology laboratories in private hospitals, as well as > 80% of private pathology laboratories have contributed their data. The most common cancer types overall were as follows: breast cancer (18.26%), colorectal cancer (15.49%), prostate cancer (13.49%), and lung cancer (10.24% of all registered cancers). In men, the most common neoplasms were as follows: prostate cancer, colorectal cancer, lung cancer, and gastric cancer. In women, the most common neoplasms were as follows: breast cancer, colorectal cancer, thyroid cancer, and lung cancer. The data on cancer burden in Greece, presented herein, fill the void of cancer information in Greece that affects health care not only nationally but Europe-wise.

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Obstructive sleep apnoea in adults: peri-operative considerationsA narrative review

Obstructive sleep apnoea (OSA) is a common breathing disorder of sleep with a prevalence increasing in parallel with the worldwide rise in obesity. Alterations in sleep duration and architecture, hypersomnolence, abnormal gas exchange and also associated comorbidities may all feature in affected patients. The peri-operative period poses a special challenge for surgical patients with OSA who are often undiagnosed, and are at an increased risk for complications including pulmonary and cardiovascular, during that time. In order to ensure the best peri-operative management, anaesthetists caring for these patients should have a thorough understanding of the disorder, and be aware of the individual's peri-operative risk constellation, which depends on the severity and phenotype of OSA, the invasiveness of the surgical procedure, anaesthesia and also the requirement for postoperative opioids. The objective of this review is to educate clinicians in the epidemiology, pathogenesis and diagnosis of OSA in adults and also to highlight specific tasks in the preoperative assessment, namely to select a suitable intra-operative anaesthesia regimen, and manage the extent and duration of postoperative care to facilitate the best peri-operative outcome. Correspondence to Martin Roesslein, MD, University Medical Center, Department of Anesthesiology and Critical Care Medicine, Hugstetter Str. 55, D - 79106 Freiburg, Germany Tel: +49 761 270 23 470; fax: +49 761 270 23 930; e-mail: martin.roesslein@uniklinik-freiburg.de © 2018 European Society of Anaesthesiology

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An historical examination of nurse anaesthesia practice in the United States and other Group of 7 countries

Many factors determine whether nurses, physicians or both administer anaesthesia in any country. We examined the status of nurse-administered anaesthesia in the Group of 7 nations and explored how historical factors, mixing global and local contexts (such as professional relations, medical and nursing education, social status of nurses, demographics and World Wars in the 20th century), help explain observed differences. Nearly equal numbers of physicians and nurses are currently engaged in the delivery of anaesthesia care in the United States but, remarkably, although the introduction or re-introduction of nurse anaesthesia in the 20th century was attempted in all the other Group of 7 countries (except Japan), it has been successful only in France because of the cooperation with the United States during World War II. Correspondence to Sukumar P. Desai, MD, Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts, USA; Brigham and Women's Hospital, Boston, Massachusetts, USA E-mail: sdesai@bwh.harvard.edu © 2018 European Society of Anaesthesiology

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Self-confidence and level of knowledge after cardiopulmonary resuscitation training in 14 to 18-year-old schoolchildren: A randomised-interventional controlled prospective study in secondary schools in Germany

BACKGROUND Education of schoolchildren in cardiopulmonary resuscitation (CPR) is a strategic goal for improvement of bystander CPR in society. OBJECTIVE(S) The primary objective was to analyse the impact of CPR training on the resuscitation knowledge and self-confidence of secondary schoolchildren. In addition, independent predictors of improved CPR knowledge and self-confidence were investigated. DESIGN Prospective, randomised-interventional controlled study. SETTING Four secondary schools in Germany. PARTICIPANTS Four hundred and twenty-four schoolchildren aged from 14 to 18 years were included into the study. Fifty-one percent were female, and 33% had an immigrant background. INTERVENTION The intervention group received a 90-min CPR training session, whereas controls had no intervention. Levels of knowledge and self-confidence in initiating CPR were analysed by a study questionnaire before (t0), 90 min after (t1) and 6 months after training (t2). MAIN OUTCOME MEASURES Based on the evaluation of study questionnaires, the primary endpoint was to determine the development of resuscitation knowledge and self-confidence in initiating cardiopulmonary resuscitation at survey time-points t0, t1 and t2. RESULTS Schoolchildren in the intervention group (n=207) showed a significantly higher level of knowledge (P 

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Foodborne botulism due to ingestion of home-canned green beans: two case reports

Foodborne botulism is a life-threatening, rapidly progressive disease. It has an incidence of less than 10 cases per year in Germany and mostly affects several previously healthy people at the same time. The o...

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Treatment for food allergy

Publication date: January 2018
Source:Journal of Allergy and Clinical Immunology, Volume 141, Issue 1
Author(s): A. Wesley Burks, Hugh A. Sampson, Marshall Plaut, Gideon Lack, Cezmi A. Akdis
Information for Category 1 CME CreditCredit can now be obtained, free for a limited time, by reading the review articles in this issue. Please note the following instructions.Method of Physician Participation in Learning Process: The core material for these activities can be read in this issue of the Journal or online at the JACI Web site: www.jacionline.org. The accompanying tests may only be submitted online at www.jacionline.org. Fax or other copies will not be accepted.Date of Original Release: January 2018. Credit may be obtained for these courses until December 31, 2018.Copyright Statement: Copyright © 2018-2019. All rights reserved.Overall Purpose/Goal: To provide excellent reviews on key aspects of allergic disease to those who research, treat, or manage allergic disease.Target Audience: Physicians and researchers within the field of allergic disease.Accreditation/Provider Statements and Credit Designation: The American Academy of Allergy, Asthma & Immunology (AAAAI) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The AAAAI designates this journal-based CME activity for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.List of Design Committee Members: A. Wesley Burks, MD, Hugh A. Sampson, MD, Marshall Plaut, MD, Gideon Lack, MB, BCh, FRCPCH, and Cezmi A. Akdis, MD (authors); Zuhair K. Ballas, MD (editor)Disclosure of Significant Relationships with Relevant CommercialCompanies/Organizations: A. W. Burks reports personal fees from NIH AITC Review Panel, Allertein, American Society for Microbiology, Elsevier, FARE, World Allergy Organization, Adept Field Solutions, Aimmune Therapeutics, Inc, Astellas Pharma Global Development, Inc, Biomerica, Inc, Evelo Biosciences, Inc/Epiva Biosciences, Inc, First Manhattan Co, Genentech, GLG Research, Inc, Insys Therapeutics, Intrommune Therapeutics, PPD Development, LP, Regeneron Pharmceuticals, Inc, Sanofi US Services, SRA International, Stallergenes, UKKO, Inc, and Valeant Pharmaceuticals North America, LLC and reports grants from Food Allergy Research and Education (FARE), National Institutes of Health, and Wallace Research Foundation. H. A. Sampson has received grants from the National Institute of Allergy and Infectious Diseases (AI-44236, CoFar, ITN); has consultant arrangements with Allertein Therapeutics, LLC, Hycor, and UCB; is Chief Scientific Officer of DBV Technologies; has received royalties from UpToDate; and has stock/stock options with DBV Technologies. G. Lack has received grants from the National Institutes of Allergy and Infectious Diseases (NO1-AI-15416 [contract] and UM1AI109565 [grant]), Food Allergy Research and Education (FARE), MRC & Asthma UK Centre, UK Department of Health through the National Institute for Health Research, the National Peanut Board, and Osem; and has consultant arrangements and stock/stock options with DBV Technologies. C. A. Akdis has received grants from Actellion, the European Union projects Medall and Predicta, Allergopharma, the Swiss National Science Foundation, and the Christine Kühne Center for Allergy Research and Education. M. Plaut declares no relevant conflicts of interest. Z. K. Ballas (editor) disclosed no relevant financial relationships.Activity Objectives:1. To understand the relative advantages and drawbacks of each of the 3 main forms of immunotherapy for food allergy (oral immunotherapy [OIT], sublingual immunotherapy [SLIT], and epicutaneous immunotherapy [EPIT]).2. To become familiar with the general protocol design for the different forms of food allergy immunotherapy.3. To know the difference in the commonly used terms in food allergy treatment: desensitization, sustained unresponsiveness, oral tolerance, and remission.Recognition of Commercial Support: This CME activity has not received external commercial support.List of CME Exam Authors: Amy CaJacob, MD, Miranda Curtiss, MD, PhD, Suthida Kankirawatana, MD, Njeri Maina, MD, PhD, Cali Reynolds, MD, and T. Prescott Atkinson, MD, PhDDisclosure of Significant Relationships with Relevant CommercialCompanies/Organizations: The exam authors disclosed no relevant financial relationships.The prevalence of IgE-mediated food allergy is an increasing public health concern effecting millions of persons worldwide. The current standard of treatment is strict avoidance of the offending food or foods, and to date, there are no regulatory approved treatments for food allergy. A significant amount of research has been directed at various forms of food immunotherapy, including oral, sublingual, and epicutaneous delivery routes. Although oral immunotherapy has shown the greatest promise for efficacy in terms of the amount of protein that can be ingested, it has also demonstrated less tolerability and a less favorable safety profile compared with sublingual immunotherapy and epicutaneous immunotherapy, which offers the least protection but has the best safety and tolerability profile. Studies have been conducted with adding adjuvants and anti-IgE to enhance either the efficacy or safety of food immunotherapy. Multiple concepts of food immunotherapy beyond these first-generation treatments are in either animal or early phase 1 studies.



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Treatment for food allergy

Publication date: January 2018
Source:Journal of Allergy and Clinical Immunology, Volume 141, Issue 1





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Mechanisms of food allergy

Publication date: January 2018
Source:Journal of Allergy and Clinical Immunology, Volume 141, Issue 1
Author(s): Hugh A. Sampson, Liam O'Mahony, A. Wesley Burks, Marshall Plaut, Gideon Lack, Cezmi A. Akdis
Although oral tolerance is the normal physiologic response to ingested antigens, a breakdown in this process appears to have occurred in the past 2 decades, leading to an increasing prevalence of sensitization to food allergens. Over the past decade, basic research has intensified in an attempt to better understand the mechanisms leading to sensitization and disease versus desensitization and short- and long-term tolerance. In this review we assess various factors that can influence tissue and immune responses to food antigens, the current understanding of immune tolerance development, the role of the gastrointestinal microbiota, and current knowledge regarding immunologic mechanisms involved in desensitization and sustained unresponsiveness, although perhaps the latter is more appropriately termed remission.



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Food allergy and omics

Publication date: January 2018
Source:Journal of Allergy and Clinical Immunology, Volume 141, Issue 1
Author(s): Gopal Krishna Dhondalay, Efren Rael, Swati Acharya, Wenming Zhang, Vanitha Sampath, Stephen J. Galli, Robert Tibshirani, Scott D. Boyd, Holden Maecker, Kari Christine Nadeau, Sandra Andorf
Food allergy (FA) prevalence has been increasing over the last few decades and is now a global health concern. Current diagnostic methods for FA result in a high number of false-positive results, and the standard of care is either allergen avoidance or use of epinephrine on accidental exposure, although currently with no other approved treatments. The increasing prevalence of FA, lack of robust biomarkers, and inadequate treatments warrants further research into the mechanism underlying food allergies. Recent technological advances have made it possible to move beyond traditional biological techniques to more sophisticated high-throughput approaches. These technologies have created the burgeoning field of omics sciences, which permit a more systematic investigation of biological problems. Omics sciences, such as genomics, epigenomics, transcriptomics, proteomics, metabolomics, microbiomics, and exposomics, have enabled the construction of regulatory networks and biological pathway models. Parallel advances in bioinformatics and computational techniques have enabled the integration, analysis, and interpretation of these exponentially growing data sets and opens the possibility of personalized or precision medicine for FA.



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The Editors' Choice

Publication date: January 2018
Source:Journal of Allergy and Clinical Immunology, Volume 141, Issue 1
Author(s): Cezmi A. Akdis, Zuhair K. Ballas




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News Beyond Our Pages

Publication date: January 2018
Source:Journal of Allergy and Clinical Immunology, Volume 141, Issue 1
Author(s): Marc E. Rothenberg, Jean Bousquet




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Early Postoperative Neutrophil Gelatinase Associated Lipocalin Predicts the Development of Chronic Kidney Disease Following Liver Transplantation

AbstractBackgroundUrinary NGAL (uNGAL)-associated acute kidney injury (AKI) is common following liver transplant (LT), but whether early AKI predicts chronic kidney disease (CKD) and mortality remains uncertain.MethodsAdults with LT from 2008-2010 in a previously published prospective cohort evaluating serial uNGAL pre- and post-LT were retrospectively assessed to evaluate uNGAL as a predictor of long-term outcomes post-LT. The primary outcomes were post-LT CKD, defined as MDRD estimated glomerular filtration rate (GFR)

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Microbial contamination during kidney ex vivo normothermic perfusion

No abstract available

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Long-term Nonhuman Primate Renal Allograft Survival Without Ongoing Immunosuppression in Recipients of Delayed Donor Bone Marrow Transplantation

ABSTRACTBackgroundWe have previously reported successful induction of renal allograft tolerance in nonhuman primates (NHP) following an initial posttransplant period of conventional immunosuppression (delayed tolerance) using a nonmyeloablative conditioning regimen consisting of anti-CD154 and anti-CD8 mAbs plus equine ATG (Atgam) and donor bone marrow transplantation (DBMT). Since these reagents are not currently clinically available, the protocol was revised to be applicable to human recipients of deceased donor allografts.MethodFour cynomolgus monkeys received MHC-mismatched kidney allografts with conventional immunosuppression for 4 months. The recipients were then treated with a nonmyeloablative conditioning regimen consisting of thymoglobulin, belatacept, and DBMT. The results were compared with recipients treated with conditioning regimen consisting of Atgam and anti-CD154 mAb, with and without anti-CD8 mAb.ResultsIn 4 consecutive NHP recipients treated with the modified conditioning regimen, homeostatic recovery of CD8+ TEM was delayed until after day 20 and multilineage chimerism was successfully induced. Three of the 4 recipients achieved long-term allograft survival (>728, >540, >449 days) without ongoing maintenance immunosuppression. Posttransplant MLR showed loss of anti-donor CD8+ T cell and CD4+ IFNγ responses with expansion of CD4+FOXP3+ regulatory T cells. However, the late development of DSA in NHP recipients confirms the need for additional anti-B cell depletion with agents, such as rituximab, as has been shown in our clinical trials.ConclusionThis study provides proof of principle that induction of mixed chimerism and long-term renal allograft survival without immunosuppression after delayed donor bone marrow transplantation is possible with clinically available reagents. Background We have previously reported successful induction of renal allograft tolerance in nonhuman primates (NHP) following an initial posttransplant period of conventional immunosuppression (delayed tolerance) using a nonmyeloablative conditioning regimen consisting of anti-CD154 and anti-CD8 mAbs plus equine ATG (Atgam) and donor bone marrow transplantation (DBMT). Since these reagents are not currently clinically available, the protocol was revised to be applicable to human recipients of deceased donor allografts. Method Four cynomolgus monkeys received MHC-mismatched kidney allografts with conventional immunosuppression for 4 months. The recipients were then treated with a nonmyeloablative conditioning regimen consisting of thymoglobulin, belatacept, and DBMT. The results were compared with recipients treated with conditioning regimen consisting of Atgam and anti-CD154 mAb, with and without anti-CD8 mAb. Results In 4 consecutive NHP recipients treated with the modified conditioning regimen, homeostatic recovery of CD8+ TEM was delayed until after day 20 and multilineage chimerism was successfully induced. Three of the 4 recipients achieved long-term allograft survival (>728, >540, >449 days) without ongoing maintenance immunosuppression. Posttransplant MLR showed loss of anti-donor CD8+ T cell and CD4+ IFNγ responses with expansion of CD4+FOXP3+ regulatory T cells. However, the late development of DSA in NHP recipients confirms the need for additional anti-B cell depletion with agents, such as rituximab, as has been shown in our clinical trials. Conclusion This study provides proof of principle that induction of mixed chimerism and long-term renal allograft survival without immunosuppression after delayed donor bone marrow transplantation is possible with clinically available reagents. Correspondence author: Tatsuo Kawai, M.D., PhD., White 521, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, E-mail: TKAWAI@mgh.harvard.edu Authorship: K.H. designed and performed the experiments, analyzed the data, and wrote the manuscript. T.O. contributed to the design of experiments and interpretation of results. A.B. performed pre- and posttransplant care of the animals. S.B. designed and performed the experiments and analyzed data. M.M. performed the experiments. I.R., R.N.S., and R.B.C. performed pathological studies. A.B.C designed the study and edited the manuscript. T.K. conceived and directed the study, performed experiments, and wrote the manuscript. Disclosure: The authors have no conflicts of interest to disclose. Funding: The present work was supported in part by Grant 5U19AI102405, part of the NIH NHP Transplantation Tolerance Cooperative Study Group and sponsored by the National Institute of Allergy and Infectious Diseases, the National Institute of Diabetes and Digestive and Kidney Diseases, and the Canadian Foundation for Innovation. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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An X-linked agammaglobulinemia contiguous gene syndrome with metachronous coprimary testicular cancers

This report describes an association between the X-linked agammaglobulinemia (XLA) contiguous BTK, TIMM8A, TAF7L gene syndrome and repeated testicular cancers. A previous Annals report described an association of XLA and Mohr-Tranebjaerg syndrome (MTS) in this now 28-year-old man first diagnosed at 11 months of age.1 The patient was diagnosed with XLA when he presented with acute bilateral flaccid paralysis subsequent to a varicella vaccination and was found to have hypogammaglobinemia (IgG, <7 mg/dL; IgA, <7 mg/dL; and IgM, 21 mg/dL) and absent B cells.

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Unplugging From Electronics as a Family

 

If you're anything like me, you're on your kids regularly to get off the screens! But no sooner do I reprimand them, than do I find myself absentmindedly reaching for my own smartphone to check e-mails. This year, we're making a family resolution to cut down on screen time, and this is the plan we're ALL going to follow.

The post Unplugging From Electronics as a Family appeared first on ChildrensMD.

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An X-linked agammaglobulinemia contiguous gene syndrome with metachronous coprimary testicular cancers

Publication date: Available online 4 January 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Marcus Shaker, Ting-Jia Lorigiano, Alexandra Lucas, Sergey Devitskiy, Youdinghuan Chen, Brock Christensen




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Issue Information

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Teaching & Learning Tips 3: Active learning strategies

Abstract

Challenge: It takes practice and thoughtful planning to inspire trainees to actively process new information instead of passively receive it. In fact, research suggests "active teaching" does not always lead to "active learning," so what are some general principles to encourage trainees to engage in active learning in any teaching context?

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Epstein-Barr Virus-Positive Large Cell Neuroendocrine Carcinoma of the Nasopharynx: Report of a Case with Complete Clinical and Radiological Response After Combined Chemoradiotherapy

Abstract

Neuroendocrine carcinomas of the head and neck are rare and are classified as well differentiated, moderately differentiated, and poorly differentiated carcinomas with the latter category being subdivided into small cell and large cell neuroendocrine carcinoma (LCNEC). While most carcinomas in the nasopharynx are associated with Epstein-Barr virus (EBV), there has been only one previous report demonstrating a link between EBV and LCNEC of the nasopharynx. In this report we describe a second case of EBV-positive LCNEC arising in the nasopharynx with bilateral cervical metastases. The patient was treated with a combination of radiation and chemotherapy which resulted in a complete clinical and radiological response. The patient is still disease free 3 years after presentation. The results of this case suggest that EBV-positive LCNEC is sensitive to chemoradiotherapy and as a result may have better prognosis than EBV-negative LCNEC arising in the nasopharynx or other sites.

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Systemic Non-Hodgkin T Cell Lymphomas Presenting in the Head and Neck Region: An Institutional Experience of a Rare Entity

Abstract

T cell lymphoma (TCL) is a group of rare and aggressive diseases. TCL primary to head and neck organs often present as extranodal NK/T cell lymphoma, nasal type. Systemic TCL with initial head and neck presentation is extremely rare. Here we report our institutional experience. Clinicopathologic data was collected from patients diagnosed with TCL and treated at the University of Alabama at Birmingham between 2002 and 2012. Eleven cases of systemic TCL initially presented at head and neck region were identified. The median age was 54 years and male:female ratio was 1.8. The most common sites involved were sinonasal tissue, tonsil, tongue and larynx. Most patients presented with a mass lesion without systemic symptoms. The presentation of TCL primary to the head and neck region is often non-specific. A misdiagnosis of undifferentiated tumor or chronic inflammation due to ambiguous morphology is not uncommon. TCL should be considered in differential diagnosis and a thorough evaluation is warranted for accurate diagnosis.

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Salivary Duct Carcinoma and Invasive Ductal Carcinoma of the Breast: A Comparative Immunohistochemical Study

Abstract

Salivary duct carcinoma (SDC) is a high-grade salivary gland malignancy with great morphological resemblance to invasive ductal carcinoma (IDC) of the breast. Rarely, female patients may have a past history of both SDC and IDC. When these patients present with distant metastasis, accurate identification of the primary tumor is particularly difficult. Additionally, rare metastasis of SDC to the breast and IDC to the salivary (parotid) gland can also present a diagnostic challenge. Our aim was to develop an immunohistochemical panel that reliably distinguishes SDC from IDC. We included all SDCs diagnosed from 1989 to 2016 (23 cases) and 29 treatment naïve and histologically similar IDCs. All cases were stained with androgen receptor (AR), estrogen receptor-alpha (ER-α), progesterone receptor (PR), HER-2, CK5/6, p63, and beta-catenin. The great majority (> 90%) of both SDCs and IDCs reacted positively to AR. The main discrepancy in the immunohistochemical profiles was a distinctly different reactivity to ER-α, PR and HER-2. While 28 IDCs (96.6%) reacted positively to ER-α and/or PR, the majority expressing both (82.8%) with a moderate to strong staining intensity, only 2 SDCs expressed ER-α (8.7%) and 5 others expressed PR (21.7%) with only one case expressing both (P value < 0.05). On the other hand, 8 SDC (34.8%) were positive for HER-2 while none of the IDCs were positive (P value < 0.05). ER-α, PR, and HER-2 may be helpful to distinguish SDC from IDC. Positive reactivity to ER-α, PR or both and negative HER-2 favors a diagnosis of IDC while ER-α, PR negative, HER-2 positive tumors are more likely SDC.

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Application of the endoscopic prelacrimal recess approach to the maxillary sinus in unilateral maxillary diseases

Background

The endoscopic endonasal prelacrimal recess approach to the maxillary sinus provides wide access to the walls and recesses of the maxillary sinus, and its use has been reported in many maxillary sinus and skull base diseases. The objective of this study was to determine the indication and feasibility of endoscopic sinus surgery using the prelacrimal recess approach in unilateral maxillary sinus diseases.

Methods

We reviewed 192 cases of unilateral maxillary sinus diseases; over 2 years, 15 cases underwent endoscopic surgery via the prelacrimal recess approach. Data regarding preoperative computed tomography scans, operative findings, postoperative pathological diagnoses, postoperative complications, and disease recurrences were obtained from medical records.

Results

Patients who underwent surgery via the prelacrimal recess approach did so mostly because tumors were present in the maxillary sinuses (12/15; 80%), while most of the patients in this study underwent surgery because of chronic inflammation (122/177; 68.9%) and fungal infections (40/177; 22.6%). Among 15 patients undergoing surgery via the prelacrimal recess approach, 9 were cases of inverted papilloma. The mean follow-up period was 16.5 months (range, 6 to 28 months). No postoperative complications occurred after the prelacrimal recess approach. One out of the 15 cases undergoing the prelacrimal recess approach had tumor recurrence

Conclusion

Most chronic inflammation and fungal infections of the unilateral maxillary sinuses can be managed through a middle meatal antrostomy. The endoscopic prelacrimal recess approach is a reliable and effective method used to approach maxillary sinus diseases.

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On the application of a nature-inspired stochastic evolutionary algorithm to constrained multi-objective beer fermentation optimisation

Rodman, AD; Fraga, ES; Gerogiorgis, D; (2017) On the application of a nature-inspired stochastic evolutionary algorithm to constrained multi-objective beer fermentation optimisation. Computers & Chemical Engineering , 108 pp. 448-459. 10.1016/j.compchemeng.2017.10.019 .

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Meeting Current Challenges in School Psychology Training: The Role of Problem-Based Learning

Dunsmuir, SM; Frederickson, N; Lang, J; (2018) Meeting Current Challenges in School Psychology Training: The Role of Problem-Based Learning. School Psychology Review (In press).

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Response to: The PNPLA3 SNP rs738409:G allele is associated with increased liver disease-associated mortality but reduced overall mortality in a population-based cohort

Atkinson, SR; Way, MJ; McQuillin, A; Morgan, MY; Thursz, MR; (2017) Response to: The PNPLA3 SNP rs738409:G allele is associated with increased liver disease-associated mortality but reduced overall mortality in a population-based cohort. Journal of Hepatology 10.1016/j.jhep.2017.12.005 . (In press).

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Critical research gaps and recommendations to inform research prioritisation for more effective prevention and improved outcomes in colorectal cancer

Lawler, M; Alsina, D; Adams, RA; Anderson, AS; Brown, G; Fearnhead, NS; Fenwick, SW; ... Tomlinson, I; + view all Lawler, M; Alsina, D; Adams, RA; Anderson, AS; Brown, G; Fearnhead, NS; Fenwick, SW; Halloran, SP; Hochhauser, D; Hull, MA; Koelzer, VH; McNair, AGK; Monahan, KJ; Nathke, I; Norton, C; Novelli, MR; Steele, RJC; Thomas, AL; Wilde, LM; Wilson, RH; Tomlinson, I; - view fewer (2018) Critical research gaps and recommendations to inform research prioritisation for more effective prevention and improved outcomes in colorectal cancer. GUT , 67 (1) pp. 179-193. 10.1136/gutjnl-2017-315333 . Green open access

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Identifying populations and areas at greatest risk of household food insecurity in England

Smith, DM; Thompson, C; Harland, K; Parker, S; Shelton, N; (2018) Identifying populations and areas at greatest risk of household food insecurity in England. Applied Geography (In press).

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Domesticated animals as hosts of henipaviruses and filoviruses: A systematic review

Glennon, EE; Restif, O; Garnier, R; Cunningham, AA; Suu-Ire, RD; Osei-Amponsah, R; Wood, JLN; Glennon, EE; Restif, O; Garnier, R; Cunningham, AA; Suu-Ire, RD; Osei-Amponsah, R; Wood, JLN; Peel, AJ; - view fewer (2018) Domesticated animals as hosts of henipaviruses and filoviruses: A systematic review. The Veterinary Journal 10.1016/j.tvjl.2017.12.024 . (In press).

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GLP-1 action in the mouse bed nucleus of the stria terminalis

Williams, DL; Lilly, NA; Edwards, IJ; Yao, P; Richards, JE; Trapp, S; (2017) GLP-1 action in the mouse bed nucleus of the stria terminalis. Neuropharmacology , 131 pp. 83-95. 10.1016/j.neuropharm.2017.12.007 . Green open access

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Robust, domain specific effects of prior context in risk preferences for pension choice

Bird, S; Harris, AJL; (2018) Robust, domain specific effects of prior context in risk preferences for pension choice. Journal of Behavioral Decision Making (In press).

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Tertiary Lymphoid Structures in Cancer: Drivers of Antitumor immunity, immunosuppression, or Bystander Sentinels in Disease?

Colbeck, EJ; Ager, A; Gallimore, A; Jones, GW; (2017) Tertiary Lymphoid Structures in Cancer: Drivers of Antitumor immunity, immunosuppression, or Bystander Sentinels in Disease? Frontiers in Immunology , 8 (ARTN 183) , Article 1830. 10.3389/fimmu.2017.01830 . Green open access

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Characterising youth with callous-unemotional traits and concurrent anxiety: evidence for a high-risk clinical group

Cecil, CAM; McCrory, EJ; Barker, ED; Guiney, J; Viding, E; (2017) Characterising youth with callous-unemotional traits and concurrent anxiety: evidence for a high-risk clinical group. European Child & Adolescent Psychiatry 10.1007/s00787-017-1086-8 . (In press). Green open access

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SNPs reveal geographical population structure of Corallina officinalis (Corallinaceae, Rhodophyta)

Yesson, C; Jackson, A; Russell, S; Williamson, C; Brodie, J; (2018) SNPs reveal geographical population structure of Corallina officinalis (Corallinaceae, Rhodophyta). European Journal of Phycology (In press).

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Determining threatened species distributions in the face of limited data: spatial conservation prioritization for the Chinese giant salamander (Andrias davidianus)

Chen, S; Cunningham, AA; Wei, G; Yang, J; Liang, Z; Wang, J; Wu, M; ... Turvey, ST; + view all Chen, S; Cunningham, AA; Wei, G; Yang, J; Liang, Z; Wang, J; Wu, M; Yan, F; Xiao, H; Harrison, XA; Pettorelli, N; Turvey, ST; - view fewer (2018) Determining threatened species distributions in the face of limited data: spatial conservation prioritization for the Chinese giant salamander (Andrias davidianus). Ecology and Evolution (In press).

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Comparing simulations and test data of a radiation damaged charge-coupled device for the Euclid mission

Skottfelt, J; Hall, DJ; Gow, JPD; Murray, NJ; Holland, AD; Prod'homme, T; (2017) Comparing simulations and test data of a radiation damaged charge-coupled device for the Euclid mission. Journal of Astronomical Telescopes, Instruments, and Systems , 3 (2) , Article 028001. 10.1117/1.JATIS.3.2.028001 . Green open access

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Cone-based Joint Sparse Modelling for Hyperspectral Image Classification

Wang, Z; Zhu, R; Fukui, K; Xue, J-H; (2018) Cone-based Joint Sparse Modelling for Hyperspectral Image Classification. Signal Processing , 144 pp. 417-429. 10.1016/j.sigpro.2017.11.001 .

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Increased Physical Fitness Is Associated with Higher Executive Functioning in People with Dementia

Hollamby, A; Davelaar, EJ; Cadar, D; (2017) Increased Physical Fitness Is Associated with Higher Executive Functioning in People with Dementia. Frontiers in Public Health , 5 , Article 346. 10.3389/fpubh.2017.00346 . Green open access

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Causes and timing of mortality and morbidity among late presenters starting ART in the REALITY trial

Post, FA; Szubert, AJ; Prendergast, AJ; Johnston, V; Lyall, H; Fitzgerald, F; Musiime, V; ... Pett, SL; + view all Post, FA; Szubert, AJ; Prendergast, AJ; Johnston, V; Lyall, H; Fitzgerald, F; Musiime, V; Musoro, G; Chepkorir, P; Agutu, C; Mallewa, J; Rajapakse, C; Wilkes, H; Hakim, J; Mugyenyi, P; Walker, AS; GIbb, DM; Pett, SL; - view fewer (2019) Causes and timing of mortality and morbidity among late presenters starting ART in the REALITY trial. Clinical Infectious Diseases (In press).

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On-ground and in-orbit characterisation plan for the PLATO CCD normal cameras

Gow, JPD; Walton, D; Smith, A; Hailey, M; Curry, P; Kennedy, T; (2017) On-ground and in-orbit characterisation plan for the PLATO CCD normal cameras. Journal of Instrumentation , 12 , Article C11035. 10.1088/1748-0221/12/11/C11035 .

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Feeling pleasures: the sense of touch in renaissance England, by Joe Moshenska, Oxford, OUP, 2014, 408 pp., £60.00 (hardback), ISBN 978-0-19-871294-7

Langley, EF; (2015) Feeling pleasures: the sense of touch in renaissance England, by Joe Moshenska, Oxford, OUP, 2014, 408 pp., £60.00 (hardback), ISBN 978-0-19-871294-7. [Review]. The Seventeenth Century , 30 (3) pp. 356-358. 10.1080/0268117X.2015.1043332 .

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APD811 (ralinepag), a novel non-prostanoid IP receptor agonist, has potent antiproliferative and vasorelaxant properties in human pulmonary artery

Shen, L; Patel, J; Norel, X; Behan, D; Adams, J; Clapp, LH; (2017) APD811 (ralinepag), a novel non-prostanoid IP receptor agonist, has potent antiproliferative and vasorelaxant properties in human pulmonary artery. Presented at: ESC Congress 2017, Barcalona.

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Mental health and accessibility

Mackett, RL; (2017) Mental health and accessibility. Presented at: Healthy Mobility: 2017 TRL Academy Symposium, London, UK. Green open access

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Delayed facial nerve decompression for severe refractory cases of Bell’s palsy: a 25-year experience

Abstract

Background

This study aims to assess the effectiveness of delayed facial nerve decompression for Bell's palsy (BP).

Methods

We performed a retrospective case review of all patients having undergone facial nerve decompression for severe refractory BP between 1984 and 2009 at our tertiary referral center. Demographics, timing between onset of symptoms and surgical decompression, degree of facial nerve dysfunction pre- and post-operatively, follow-up length after surgery and postoperative complications were recorded. Facial nerve dysfunction was assessed using the House-Brackmann (HB) scale. Electroneuronography, electromyography and imaging results were assessed when available.

Results

Eighteen patients had surgery between 21 and 60 days after onset of BP (group I), and 18 patients had surgery more than 60 days after onset of symptoms (group II). In group II, 11 patients had surgery between 61 and 89 days and 7 patients after 90 days. Groups I and II showed similar functional gain and rates of improvement to HB 3 or better (11/18 vs. 11/18, p > 0.05). In group II, patients operated 60 to 89 days after onset of BP showed a significantly higher rate of improvement to HB 3 or better (9/11 vs. 2/6, p = 0.049) with higher functional gain compared to those operated after 90 days (p = 0.0293).

Conclusions

When indicated, facial nerve decompression for BP is usually recommended within the first 2 weeks of onset of facial paralysis. Nonetheless, our results suggest that patients with severe BP could benefit from decompression surgery within 90 days after onset of symptoms in the absence of an opportunity to proceed earlier to surgery. Further investigation is still required to confirm our findings.

Trial registration

Retrospective registered. IRB# 2016–6154, CE 15.154 – CA

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