A 21-year-old male was admitted to our department with headache and drowsiness. CT scan and MRI revealed acute obstructive hydrocephalus caused by a pineal region mass. The serum and CSF levels of beta-human chorionic gonadotropin (beta-hCG) were 215 IU/L and 447 IU/L, respectively, while levels of alpha-fetoprotein (AFP) were normal. A germ cell tumor (GCT) was suspected, and the patient underwent endoscopic third ventriculostomy (ETV) with biopsy. After four days from surgery, the tumor bled with mass expansion and ETV stoma occlusion; thus, a ventriculoperitoneal shunt was positioned. After ten months, the tumor metastasized to the thorax and abdomen with progression of intracerebral tumor mass. Despite the aggressive nature of this tumor, ETV remains a valid approach for a pineal region mass, but in case of GCT, the risk of bleeding should be taken into account, during and after the surgical procedure.
http://ift.tt/2txSuV0
Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Σάββατο 10 Μαρτίου 2018
A Case of Nongerminomatous Germ Cell Tumor of the Pineal Region: Risks and Advantages of Biopsy by Endoscopic Approach
Inflammatory arthritis in pediatric patients with morphea
Pediatric morphea is associated with joint contractures and arthralgia. The findings of this study support the association of inflammatory arthritis with pediatric morphea. Understanding of the relationship between morphea and arthritis in children should lead to increased musculoskeletal vigilance and appropriate systemic therapy.
http://ift.tt/2IheQgZ
Immune Dysregulation in the Pathogenesis of Atopic Dermatitis
http://ift.tt/2FGC5T6
Patch Testing for the Evaluation of Metal Hypersensitivity in the Nuss Procedure
The Nuss procedure has become the predominant reason for the use of metal implants by pediatric general and thoracic surgeons. Current guidelines recommend preimplant testing for all patients undergoing the Nuss procedure, which differs from the guidelines for all other orthopedic procedures. This review was done to further evaluate this discrepancy.http://ift.tt/2FHN9zy
Rubber Accelerators in Medical Examination and Surgical Gloves
Background Rubber accelerators play a significant role in glove-related occupational contact dermatitis, especially among health care workers. Currently, there is limited information readily available outlining the accelerators used in specific medical examination and surgical gloves. Objective The aim of this study was to ascertain the accelerators used in medical examination and surgical gloves for major glove manufacturers within the United States. Methods An initial Internet-based search was performed to establish relevant manufacturers and product lines, with subsequent inquiry with each corresponding company regarding accelerators used in each medical and surgical glove line. Results Eleven glove manufacturers were identified and contacted. Responses were obtained from all manufacturers, but because of legal limitations, changes in product lines, or inability to supply necessary data, only 8 companies were able to be included in the final analysis, totaling data for 190 gloves. Carbamates were the most common accelerator, used in 90.5% (172/190) of gloves, whereas thiurams were used in only 11 gloves (5.8%). Eight companies surveyed are now advertising and offering touted accelerator-free gloves. Conclusions Accelerators are used in most examination and surgical gloves; however, manufacturers are now expanding their product offerings to include accelerator-free options.http://ift.tt/2FGywMJ
The Role of Cleaning Products in Epidemic Allergic Contact Dermatitis to Methylchloroisothiazolinone/Methylisothiazolinone
Background Sensitivity to methylchloroisothiazolinone (MCI)/methylisothiazolinone (MI) has increased rapidly over recent years. This increase is mainly related to the extensive use of high concentrations of MI in cosmetic products, although a growing number of cases of occupational allergic contact dermatitis are caused by MCI/MI. Objective The aim of this study was to examine the association between the increase in MCI/MI sensitization and the work performed by the patients in our area. Methods A retrospective study was undertaken of the records of a total of 1179 patients who had undergone contact skin patch tests for MCI/MI from January 2005 to December 2015. A multivariate logistic regression analysis was performed to identify the factors independently associated with sensitivity to MCI/MI. Results A constant increase in MCI/MI sensitization was observed over the observation period. The only work associated with a significant increase in the prevalence of MCI/MI sensitization was cleaning, with 38.5% of the cleaning professionals with MCI/MI sensitization consulting for cosmetics-related dermatitis. Conclusions Occupational sensitization to MCI/MI in cleaning professionals is worryingly increasing. This, in turn, could possibly account for many cases of cosmetics-associated contact dermatitis. Our findings suggest that a review of the regulations with regard to isothiazolinone concentrations in industrial and household detergents is necessary.http://ift.tt/2FKAtbf
Prevalence of Contact Allergens in Personal Care Products for Babies and Children
Background Personal care products marketed for babies and children are often regarded as "safe" or "gentle." However, little is known about the prevalence of contact allergens in these types of products. Objective This study assessed the prevalence of important sensitizers in personal care products marketed for babies and children. A secondary objective of this study was to determine whether a product's cost correlates with content of sensitizing ingredients. Methods The ingredient lists of 533 unique personal care products were analyzed for presence of fragrance, betaines, propylene glycol, methylchloroisothiazolinone, methylisothiazolinone, formaldehyde, lanolin, and neomycin. Price per ounce was determined for each product as well. Conclusions Most personal care products for babies and children contain 1 or more sensitizers. Products containing more sensitizers tend to cost less than those without any sensitizing ingredients.http://ift.tt/2FGBT6k
Carmine Red: A Potentially Overlooked Allergen in Children
No abstract availablehttp://ift.tt/2tB5Lwh
Survey of Patch Test Business Models in the United States by the American Contact Dermatitis Society
Background Allergic contact dermatitis (ACD) remains a significant burden of disease in the United States. Patch testing is the criterion standard for diagnosing ACD, but its use may be limited by reimbursement challenges. Objective This study aimed to assess the current rate of patch test utilization among dermatologists in academic, group, or private practice settings to understand different patch testing business models that address these reimbursement challenges. Methods All members of the American Contact Dermatitis Society received an online survey regarding their experiences with patch testing and reimbursement. Results A "yes" response was received from 28% of survey participants to the question, "Are you or have you been less inclined to administer patch tests or see patients needing patch tests due to challenges with receiving compensation for patch testing?" The most commonly reported barriers include inadequate insurance reimbursement and lack of departmental support. Conclusions Compensation challenges to patch testing limit patient access to appropriate diagnosis and management of ACD. This can be addressed through a variety of innovative business models, including raising patch testing caps, negotiating relative value unit compensation, using a fixed salary model with directorship support from the hospital, and raising the percentages of collection reimbursement for physicians.http://ift.tt/2FCRsfx
Allergic Contact Stomatitis Associated With Sweet Vermouth
No abstract availablehttp://ift.tt/2FHN7Ys
A questionnaire to assess olfactory rehabilitation for laryngectomized patients (Provox voice prosthesis users) in Japan
Source:Auris Nasus Larynx
Author(s): Yukinobu Ishikawa, Yukiko Yanagi, Michi Suzuki, Ujimoto Konomi
ObjectiveWe used a questionnaire to investigate olfactory function and the present state of olfactory rehabilitation for laryngectomized patients in Japan.MethodsThis study was conducted using a questionnaire survey. We mailed questionnaires to 190 members of a Japanese laryngectomized patient group (the nonprofit organization YOUSAY-KAI). The survey queried the following items: (1) basic information (age, sex, alaryngeal speech method, etc.); (2) questions about olfactory rehabilitation, such as the individual's experience of olfactory rehabilitation, the number of days from laryngectomy to the start of olfactory rehabilitation, and the location of rehabilitation (i.e., hospital or patient association); (3) free comments; and (4) the self-administered Odor Questionnaire (SAOQ).ResultsWe received 121/190 questionnaires by the submission deadline. Of these, 105 questionnaires were valid. All 105 responders used the Provox voice prosthesis as the alaryngeal speech method. Only 4.7% (5/105) of the patients received olfactory rehabilitation in hospitals. Many comments in the free comment column included demands for olfactory rehabilitation such as "I want to know where we can have olfactory rehabilitation" and "I want to have rehabilitation if olfaction recovers." The SAOQ score was significantly higher in the rehabilitation group (mean, 42.5%) compared to the nonrehabilitation group (mean, 22.1%) (p<0.05). There was no correlation between the SAOQ score and the number of days from laryngectomy to the start of rehabilitation (r=0.08, p=0.76)．ConclusionPatient demand for olfactory rehabilitation is strong, but this therapy is not widely offered to laryngectomized patients in Japan. Notably, the SAOQ scores showed that olfactory rehabilitation may have an effect, even if it is initiated after laryngectomy. We believe that when patients choose voice prosthesis for speech, their olfaction deteriorates unless they undergo olfactory rehabilitation separately from speech rehabilitation. It is therefore necessary to administer olfactory rehabilitation for laryngectomized patients who have never received olfactory rehabilitation, as well as for patients scheduled to undergo laryngectomy.
http://ift.tt/2oZswVI
ANALYSIS OF PROTEOGLYCAN EXPRESSION IN HUMAN DENTAL PULP
Source:Archives of Oral Biology
Author(s): Ana Carla Raphaelli Nahás-Scocate, Gabrielle Ferrante Alves de Moraes, Helena Bonciani Nader, Carolina Meloni Vicente, Leny Toma
Proteoglycans are glycosylated proteins which have covalently attached highly anionic glycosaminoglycans. They can be located on the extracellular matrix, cell membrane or intracellular granules. To date, few studies have reported the presence of proteoglycans in human dental pulp.ObjectiveThe aim of this study was, therefore, to analyze the expression of lumican, versican and glypican proteoglycans in deciduous and permanent human dental pulp by real-time polymerase chain reaction (q-PCR) and immunofluorescence.DesignHealthy human dental pulps were used: 13 from permanent teeth (group 1) and eight from deciduous teeth (group 2). Versican, lumican and glypican (glypican-1 to 6) gene expressions were quantitatively evaluated by real-time PCR technique, using the expression of the endogenous gene GAPDH as control. Pulp sections were submitted to immunostaining procedure with fluorescence labelling, the tissues being fixed and incubated with well-characterized monoclonal and polyclonal antibodies against proteoglycan epitopes, including anti-versican and anti-lumican. Comparisons among the groups of the quantitative scores for each proteoglycan were analyzed using the t-test and ANOVA (P < 0.05).ResultsThe real-time PCR analysis showed expression of versican and lumican proteoglycans in the two groups, with significant predominance of lumican gene (P = 0.03). Considering the glypican genes, glypican-3 was the proteoglycan most significantly expressed in permanent pulps (P < 0.001), while glypican-2 was not expressed in this tissue. The immunofluorescence quantification exhibited no significant differences between lumican and versican among the pulps and groups.ConclusionsThe lumican gene was more expressed than versican and glypican-3 was the isoform more expressed in permanent pulp compared to deciduous.
http://ift.tt/2IfK1t6
Introduction: Interactions Between the Immune System and Parasites Special Issue
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Host immune responses to Toxoplasma gondii
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Host responses to intestinal nematodes
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Unforeseen pathologies caused by malaria
http://ift.tt/2oYRqF3
How to master the host immune system? Leishmania parasites have the solutions!
http://ift.tt/2p4hcqL
Spinal meningioma, aortic aneurysms and the missing link of observation: the anchoring heuristic approach
Over the last three decades, the development of systematic and protocol-based algorithms, and advances in available diagnostic tests have become the indispensable parts of practising medicine. Naturally, despite the implementation of meticulous protocols involving diagnostic tests or even trials of empirical therapies, the cause of one's symptoms may still not be obvious. We herein report a case of chronic back pain, which took about 5 years to get accurately diagnosed. The case challenges the diagnostic assumptions and sets ground of discussion for the diagnostic reasoning pitfalls and heuristic biases that mislead the caring physicians and cost years of low quality of life to our patient. This case serves as an example of how anchoring heuristics can interfere in the diagnostic process of a complex and rare entity when combined with a concurrent potentially life-threatening condition.
http://ift.tt/2Fr551Z
Imatinib-induced fulminant liver failure in chronic myeloid leukemia: role of liver transplant and second-generation tyrosine kinase inhibitors: a case report
There is a worldwide problem of acute liver failure and mortality associated with remaining on the waiting for a liver transplant. In this study, we highlight results published in recent years by leading trans...
http://ift.tt/2GdLK1q
Radiofrequency Technology in Face and Neck Rejuvenation
Three doctors discuss the current issues and controversies involving the use of radiofrequency and energy-based devices for skin tightening, facial contouring, and other indications. The use of transcutaneous monopolar-, bipolar-, multipolar-, subcutaneous-, and microneedle-based delivery methods are discussed. The controversies involved in the various devices are discussed.
http://ift.tt/2FpbLxv
Lactate gap as a tool in identifying ethylene glycol poisoning
Ethylene glycol toxicity is a known cause of anion gap metabolic acidosis, with the presence of an osmolar gap and the right clinical context suggesting to the diagnosis. Rapid recognition and early treatment is crucial. Unfortunately, ethylene glycol levels are not readily available and must be performed at a reference laboratory. We present a case where recognising the significance of the 'lactate gap' assisted in identifying ethylene glycol poisoning.
http://ift.tt/2IheOFU
Pancytopenia: a rare complication of Graves disease
A 27-year-old male patient who presented to the emergency room with complaints of sweating, palpitations, heat intolerance, insomnia and weight loss for the last 3 months. His medical history was significant for hypertension. On examination, he was tachycardic, hypertensive, had tremors of the upper extremities and a smooth goitre with a thyroid bruit. Laboratory assessment revealed a suppressed thyroid-stimulating hormone, high free thyroxine and positive thyroid receptor antibodies. Complete blood count showed pancytopenia. As part of the work-up for pancytopenia, haptoglobin, ferritin, Coombs test, reticulocyte count hepatitis B and C antibodies were done, all of which were normal. Patient was started on methimazole, propranolol and hydrocortisone. His symptoms improved through the hospital course and he was subsequently discharged. Thyroidectomy was done once the patient's hyperthyroidism was controlled. Levothyroxine was started for the control of postsurgical hypothyroidism. Six months after thyroidectomy, the patient was euthyroid and the pancytopenia resolved.
http://ift.tt/2DhcP0l
Renocolic fistula secondary to urothelial carcinoma
A 77-year-old man presented with watery, bloody diarrhoea, symptomatic anaemia and signs of sepsis. He was well known to our unit with a history of extensive low-grade urothelial carcinoma involving a solitary kidney. CT performed on admission demonstrated a new finding of renocolic fistula. Due to his multiple medical and surgical comorbidities conservative management was elected. He passed away after 1 year of follow-up.
http://ift.tt/2IeWo8R
The novel use of botulinum toxin A for the treatment of Raynauds phenomenon in the toes
Raynaud's phenomenon is a vasospastic disorder of the digital vessels triggered by exposure to cold or stress. It is most commonly observed in the hands, but also frequently affects the toes. We present three cases of patients with severe Raynaud's phenomenon in the toes, secondary to scleroderma. The diagnosis of Raynaud's syndrome and scleroderma was established according to the 2010 American College of Rheumatology and European League Against Rheumatism criteria. Patients were treated with 10 units of botulinum toxin injected into each foot. Two millilitres was injected into the base of each toe in both the left and right feet. Six weeks postinjection into the toes, patients reported an improvement of cold intolerance, colour change and frequency and severity of Raynaud's attacks. The effects were reported to last up to 5 months. To our knowledge, these are the first reported cases of the treatment of Raynaud's phenomenon in the toes with botulinum toxin A.
http://ift.tt/2p3rJT3
Atrial myxoma presenting as infective endocarditis
A 23-year-old Asian student presented to our service with a 1-month history of fever, weight loss of 10 kg, night sweats, fatigue and general malaise. He was previously well with no significant medical or family history. He had a low-grade pyrexia and cardiac auscultation revealed a diastolic murmur consistent with 'tumour plop'. He had no sequelae of endocarditis. He had low-grade pyrexia of 37.7°C, and ECG showed sinus tachycardia at 130 bpm. He had raised inflammatory markers and was started on broad spectrum antibiotics. Blood cultures grew Streptococcus viridans twice. Transthoracic and transo-oesophageal echocardiography revealed a large mobile mass attached to the interatrial septum, suspicious for atrial myxoma, flopping into the left ventricle but not causing left ventricular outflow tract obstruction. All valves looked normal in appearance. He was treated with antibiotics for 2 weeks until inflammatory markers normalised. The patient was referred for cardiothoracic surgery where a large atrial myxoma (5 cmx3 cm) was excised just superior to the mitral valve. It had areas of necrosis and was colonised with S. viridans. He had an unremarkable postoperative course and made a complete recovery.
http://ift.tt/2IcUMw5
Rare case of thoracic endometriosis presenting with lung nodules and pneumothorax
We present the case of a 34-year-old Nigerian woman who was referred to the Respiratory team with a 12-month history of breathlessness. She was concurrently being investigated for an abdominal mass and rectal and vaginal bleeding. Consequently, she underwent cross-sectional imaging of her chest, abdomen and pelvis, revealing a small right-sided pneumothorax and right lower lobe pleural-based lesion. Shortly thereafter, she was admitted to the hospital with chest pain and required chest drain insertion. This partially treated her pneumothorax but she required referral to a cardiothoracic centre for definitive diagnosis and to manage her non-resolving pneumothorax. Biopsies from the video-assisted thoracoscopic surgery confirmed the very rare diagnosis of thoracic endometriosis.
http://ift.tt/2DhcJ8Z
Spontaneous renal infarct heralding bowel ischaemia in an adult male: lessons to learn from a rare clinical association
Spontaneous renal artery dissection (SRAD) is a rare entity with less than 200 cases reported in literature. It usually affects middle-aged men and the clinical presentation is non-specific. Many times it is associated with conditions such as hypertension, fibromuscular dysplasia or vasculitides. We report the case of a patient who initially had renal infarct due to SRAD and then progressed to have bowel ischaemia. The renal infarct preceded bowel ischaemia in this patient and to the best of our knowledge this is the first such association reported in literature. Our report emphasises the point that whenever this condition is diagnosed in a patient one should be vigilant for other vascular disorders.
http://ift.tt/2IeWihv
Brexit and Competition Law
Lianos, I; Mantzari, D; Wagner Von Papp, F; Thepot, F; (2017) Brexit and Competition Law. (CLES Policy Papers 02/2017). Centre for Law, Economics and Society, UCL Faculty of Laws: London, UK. Green open access
http://ift.tt/2HizImw
Merger Activity in the Factors of Production Segments of the Food Value Chain: - A Critical Assessment of the Bayer/Monsanto merger
Lianos, I; Katalevsky, D; (2017) Merger Activity in the Factors of Production Segments of the Food Value Chain: - A Critical Assessment of the Bayer/Monsanto merger. (CLES Policy Papers 01/2017). Centre for Law, Economics and Society, UCL Faculty of Laws: London, UK. Green open access
http://ift.tt/2GdgOOC
Counteracting effects of treprostinil and endothelin (ET-1) receptor antagonists (ETRAs) on endothelin-1, ETB receptor and ECE-1 levels in pulmonary smooth muscle cells (PASMCs) derived from patients with pulmonary arterial hypertension (PAH)
Patel, J; Hall, S; Clapp, LH; (2013) Counteracting effects of treprostinil and endothelin (ET-1) receptor antagonists (ETRAs) on endothelin-1, ETB receptor and ECE-1 levels in pulmonary smooth muscle cells (PASMCs) derived from patients with pulmonary arterial hypertension (PAH). Presented at: Thirteenth International Conference on Endothelin (ET-13), Tokyo, Japan. Green open access
http://ift.tt/2HoRK6X
A Regulatory Theory of IP. Implications for Competition Law
Lianos, I; (2008) A Regulatory Theory of IP. Implications for Competition Law. (CLES Research Paper series 1/2008). Centre for Law, Economics and Society, UCL Faculty of Laws: London, UK. Green open access
http://ift.tt/2oXulmm
"Judging" Economists. Economic Expertise in Competition Law Litigation. A European View
Lianos, I; (2009) "Judging" Economists. Economic Expertise in Competition Law Litigation. A European View. (CLES Research Paper series 1/2009). Centre for Law, Economics and Society, UCL Faculty of Laws: London, UK. Green open access
http://ift.tt/2DfPufI
"Lost in Translation"? Towards a Theory of Economic Transplants
Lianos, I; (2009) "Lost in Translation"? Towards a Theory of Economic Transplants. (CLES Research Paper series 2/2009). Centre for Law, Economics and Society, UCL Faculty of Laws: London, UK. Green open access
http://ift.tt/2p1fFCz
Efficient Restrictions of Trade in the EU Law of the Internal Market. Trust, Distrust and the Nature of Economic Integration
Lianos, I; (2010) Efficient Restrictions of Trade in the EU Law of the Internal Market. Trust, Distrust and the Nature of Economic Integration. (CLES Research Paper series 1/2010). Centre for Law, Economics and Society, UCL Faculty of Laws: London, UK. Green open access
http://ift.tt/2DhDWbF
Shifting Narratives in European Economic Integration. Trade in Services, Pluralism and Trust
Lianos, I; Gerard, D; (2011) Shifting Narratives in European Economic Integration. Trade in Services, Pluralism and Trust. (CLES Research Paper series 1/2011). Centre for Law, Economics and Society, UCL Faculty of Laws: London, UK. Green open access
http://ift.tt/2Fp1XUg
Trust, Distrust and Economic Integration. Setting the Stage
Lianos, I; Le Blanc, J; (2011) Trust, Distrust and Economic Integration. Setting the Stage. (CLES Research Paper series 2/2011). Centre for Law, Economics and Society, UCL Faculty of Laws: London, UK. Green open access
http://ift.tt/2DfXAF1
Competition Law Remedies. In Search of a Theory
Lianos, I; (2011) Competition Law Remedies. In Search of a Theory. (CLES Research Paper series 3/2011). Centre for Law, Economics and Society, UCL Faculty of Laws: London, UK. Green open access
http://ift.tt/2FqWooa
Accountability, evaluation and the role of evidence for charitable funders
Hinds, KS; Mackenzie-Davey, K; (2014) Accountability, evaluation and the role of evidence for charitable funders. In: (Proceedings) BAM 2014: The Role of the Business School in Supporting Economic and Social Development, 9–11 September 2014, Belfast, Northern Ireland. British Academy of Management: London, UK.
http://ift.tt/2DfQmBb
Development Economics and Competition. A Parallel Intellectual History
Lianos, I; Mateus, A; Raslan, A; (2012) Development Economics and Competition. A Parallel Intellectual History. (CLES Research Paper series 1/2012). Centre for Law, Economics and Society, UCL Faculty of Laws: London, UK. Green open access
http://ift.tt/2oZkMmV
Market Dominance and Quality of Search Results in the Search Engine Market
Lianos, I; Motchenkova, E; (2012) Market Dominance and Quality of Search Results in the Search Engine Market. (CLES Research Paper series 2/2012). Centre for Law, Economics and Society, UCL Faculty of Laws: London, UK. Green open access
http://ift.tt/2DfXxJl
Towards a Bureaucracy Theory of the Interaction between Competition Law and State Action
Lianos, I; (2012) Towards a Bureaucracy Theory of the Interaction between Competition Law and State Action. (CLES Research Paper series 3/2012). Centre for Law, Economics and Society, UCL Faculty of Laws: London, UK. Green open access
http://ift.tt/2Fr5ZeM
Market Power in Online Search and Social-Networking: A Matter of Two-Sided Markets
Thepot, F; (2012) Market Power in Online Search and Social-Networking: A Matter of Two-Sided Markets. (CLES Research Paper series 4/2012). Centre for Law, Economics and Society, UCL Faculty of Laws: London, UK. Green open access
http://ift.tt/2Dg15ew
Econometric Evidence in EU Competition Law: An Empirical and Theoretical Analysis
Lianos, I; Genakos, C; (2012) Econometric Evidence in EU Competition Law: An Empirical and Theoretical Analysis. (CLES Research Paper series 6/2012). Centre for Law, Economics and Society, UCL Faculty of Laws: London, UK. Green open access
http://ift.tt/2Ft5yR2
The Consequences of Neoclassical Price Theory for U.S. Predatory Pricing Law
Strader, JM; (2012) The Consequences of Neoclassical Price Theory for U.S. Predatory Pricing Law. (CLES Research Paper series 7/2012). Centre for Law, Economics and Society, UCL Faculty of Laws: London, UK. Green open access
http://ift.tt/2DfnFUP
Abuses of Dominance in Developing Countries: A View from the South with an Eye on Telecoms
Roberts, S; Tapia, J; (2013) Abuses of Dominance in Developing Countries: A View from the South with an Eye on Telecoms. (CLES Research Paper series 1/2013). Centre for Law, Economics and Society, UCL Faculty of Laws: London, UK. Green open access
http://ift.tt/2oYxRg3
Competition Law Remedies in Europe. Which Limits for Remedial Discretion?
Lianos, I; (2013) Competition Law Remedies in Europe. Which Limits for Remedial Discretion? (CLES Research Paper series 2/2013). Centre for Law, Economics and Society, UCL Faculty of Laws: London, UK. Green open access
http://ift.tt/2DexL8s
Some Reflections on the Question of the Goals of EU Competition Law
Lianos, I; (2013) Some Reflections on the Question of the Goals of EU Competition Law. (CLES Research Paper series 3/2013). Centre for Law, Economics and Society, UCL Faculty of Laws: London, UK. Green open access
http://ift.tt/2FpUeVZ
Segregation analysis revealed hemizygotic causative mutations in a pseudoxanthoma elasticum patient
Abstract
Pseudoxanthoma elasticum (PXE, OMIM 264800) is an autosomal recessive disorder in which elastic fibers of skin, eyes, and cardiovascular system become progressively calcified, causing a spectrum of manifestations with a variable phenotype. The proposed prevalence of PXE is 1/25 000, but this might be an underestimate. PXE is associated with mutations in the ABCC6 (ATP binding cassette subtype C number 6) gene.
This article is protected by copyright. All rights reserved.
http://ift.tt/2oXrJ82
Vulvar Neoplasms in 275 Women With Genital Lichen Sclerosus and Impact of Treatment: A Retrospective Chart Review
Abstract
Lichen sclerosus (LS) is a chronic inflammatory disease most commonly affecting the genital area of women. LS-associated vulvar neoplasms are known to occur (1). Treatment of LS is thought to possibly reduce malignancy risk. However, whether medical treatment of LS can prevent vulvar neoplasms is unclear (2,3). We performed a single-institution, retrospective chart review to identify vulvar neoplasm occurrence in women with biopsy-proven genital LS and to determine whether a correlation exists between LS treatments and vulvar neoplasm occurrence.
This article is protected by copyright. All rights reserved.
http://ift.tt/2HmizZm
Patient-dermatologist agreement in psoriasis severity, symptoms and satisfaction: results from a real-world multinational survey
Abstract
Background
Psoriasis is a chronic immune-mediated inflammatory disease, which often requires lifelong treatment. A strong partnership between the patient and healthcare practitioners should help to achieve effective treatment outcomes.
Objective
To assess concordance of views between psoriasis patients and their treating dermatologists relative to psoriasis severity, presence of symptoms and satisfaction with disease control achieved.
Methods
We used data from the Growth from Knowledge (GfK) Disease Atlas real-world evidence programme, a syndicated, retrospective, cross-sectional survey among dermatologists and their systemic therapy eligible psoriasis patients, conducted across 9 countries. Concordance was measured through patients and their dermatologist's identical answers to the same survey questions. Concordance was evaluated using percentage agreement between dermatologists and their patients, and Cohen's kappa (κ) statistic. The level of concordance was defined as "none" (κ≤0), "none to slight" (0.01-0.20), "fair" (0.21-0.40), "moderate" (0.41-0.60), "substantial" (0.61-0.80) and "almost perfect" (>0.8). The analysis was conducted for the overall population and for each participating country.
Results
Overall, 524 dermatologists and 3,821 psoriasis patients were included in the survey. Concordance of patient and dermatologist perceptions of psoriasis severity was fair both at diagnosis, and at the time of the survey (61% agreement, κ = 0.326 and 55% agreement, κ = 0.370, respectively). Higher levels of concordance were reported when patients assessed their psoriasis as moderate-to-severe (using Investigator's Global Assessment/Physician's Global Assessment [IGA/PGA] 5-point scale of 3 or 4). Concordance regarding symptoms ranged from fair to moderate (κ = 0.241-0.575). Satisfaction with psoriasis control was fair (39% agreement, κ = 0.213). Results showed different patterns of concordance across the participating countries although a low concordance was observed on the satisfaction with psoriasis control in all of them.
Conclusion
Results from this multinational real-world survey indicate different perceptions between psoriasis patients and their dermatologist with respect to psoriasis severity, symptoms and disease control.
This article is protected by copyright. All rights reserved.
http://ift.tt/2Fprrkq
Efficacy and safety of cryotherapy versus electrosurgery in the treatment of cherry angioma
Abstract
Cherry angioma (CA) is one of the most common types of acquired vascular proliferation of the skin [1]. The most commonly recommended treatment modalities in the past have been electrosurgery and cryotherapy. These treatment modalities usually show acceptable cosmetic results with minimal discomfort [2,3]. However, there is no study in the literature that compares these treatment modalities. Herein, we plan to assess the efficacy and safety of cryotherapy versus electrosurgery in the treatment of cherry angioma.
This article is protected by copyright. All rights reserved.
http://ift.tt/2HmizIQ
Epidermal necrolysis and autoimmune diseases: two more observations supporting the concept that “toxic” epidermal necrolysis can be “non-toxic”
Abstract
Toxic epidermal necrolysis (TEN, Lyell syndrome) and Stevens-Johnson syndrome are severe cutaneous adverse reactions to drugs characterized by epidermal necrolysis (EN). However, in 15% of cases, no causative drug is identified. In these cases, other triggers such as Mycoplasma pneumoniae have been described. Furthermore, the role of lupus as triggering factor has been suggested. We report 2 cases of EN without any drug causality, revealing autoimmune diseases as a cause.
This article is protected by copyright. All rights reserved.
http://ift.tt/2oYBliO
Cutaneous pseudolymphoma caused by Poly Implant Prothèse breast implants
Abstract
We present a 41-year-old woman with itching polymorphic skin lesions involving the trunk and extremities which first appeared in September 2011 (7 years ago). Physical examination revealed multiple erythematous, scaly macules and patches, indurated red plaques and purplish red and smooth surfaced nodules (Fig. 1a). Over the period of seven years, the skin lesions grew slowly and spread across the body but sometimes they regressed either spontaneously or after insolation.
This article is protected by copyright. All rights reserved.
http://ift.tt/2DfMwbc
Sinecatechins ointment 10% (Veregen®) for genital warts: percutaneous penetration of Epigallocatechin Gallate concentrations in the stratum corneum collected by adhesive tape stripping method
Abstract
Camellia sinensis extract/Sinecatechins/10% ointment is a registered topical therapy for the treatment of external and perianal genital warts, to be applied thrice daily. Pharmacokinetic studies elucidating the most optimal frequency of application have not been undertaken, and a less frequent (more convenient) application schedule might also be effective. Here, we measured epigallocatechin gallate (EGCG) concentrations, the main Camellia sinensis extract component, in the stratum corneum (SC) over time after one application.
This article is protected by copyright. All rights reserved.
http://ift.tt/2FpAd1Z
Dermatomyositis panniculitis: A clinico-pathologic and immunohistochemical study of 18 cases
Abstract
Background
Panniculitis occurring in dermatomyositis is uncommon, with only a few cases described in the literature, most of them as case reports.
Objective
This report describes the clinico-pathological and immunohistochemical findings in a series of 18 patients with panniculitis associated to dermatomyositis.
Methods
In each patient we collected the clinical data of the cutaneous lesions as well as the characteristic clinical and laboratory findings. A series of histopathologic findings was recorded in the biopsy of each patient. A panel of antibodies was used in some cases to investigate the immunophenotype of the infiltrate. Data of treatment and follow-up were also collected.
Results
Of the 18 patients, 13 were female and 5 were male, ranging in age from 13 to 74 years (median, 46,4 years). In addition to panniculitis, all patients presented pathognomonic cutaneous findings of DM and reported proximal muscle weakness prior to the diagnosis of panniculitis. Muscle biopsy was performed in 17 patients and MRI in one, all with the diagnosis of inflammatory myopathy. None of the patients presented any associated neoplasia. Panniculitis lesions were located in the upper or lower limbs. Histopathology showed a mostly lobular panniculitis with lymphocytes as the main component of the infiltrate. Most cases showed also numerous plasma cells and lymphocytes surrounding necrotic adipocytes (rimming) were frequently seen. Lymphocytic vasculitis and abundant mucin interstitially deposited between collagen bundles of the dermis were also frequent findings. Late stage lesions showed hyaline necrosis of the fat lobule and calcification. Immunohistochemistry demonstrated that most lymphocytes of the infiltrate were T-helper lymphocytes, with some B-lymphocytes in the lymphoid aggregates and small clusters of CD-123 positive plasmacytoid dendritic cells in the involved fat lobule.
Conclusion
Panniculitis in dermatomyositis is rare. Histopathologic findings of panniculitis dermatomysositis are identical to those of lupus panniculitis. Therefore, the final diagnosis requires clinic-pathologic correlation.
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Cytokine patterns in vitro, in particular IL-5/IL-8-ratio, to detect patients with nickel contact allergy
Abstract
Background
Patch test (PT) is the gold standard to reveal Nickel (Ni) allergy. In vitro tests are under discussion. We aimed to establish a cytokine based in-vitro assay to detect Ni sensitization.
Methods
From 15 patients with positive (13f, 42-78yrs) and 15 with negative PT to Ni (controls, 3f, 31-82yrs) within a consecutive patient series peripheral blood mononuclear cells (PBMC) were obtained. 6 days stimulation with 3 concentrations of NiSO4 was done. Proliferative response (uptake of tritiated thymidine) and production of the cytokines IL-1β, IL-4, IL-5, IL-6, IL-8, IL-10, IL-17A, TNFα, IFNγ (cytometric bead array) were assessed.
Results
12/15 Ni PT positive patients also had positive LTT, all control patients were PT and LTT negative. The mean SI differed between Ni allergics and controls (p<0.01). Upon Ni stimulation, PBMC of the allergic patients showed (i) enhanced IL-5 response (p<0.0001) and (ii) reduced IL-8 production (p<0.01). The IL-5/IL-8-ratio best distinguished allergics from non-allergics in all 3 Ni concentration with a sensitivity and specificity of 93%.
Conclusion
Assessment of the ratio of Ni induced IL-5 and reduced IL-8 production in vitro is a helpful tool for a better characterization of Ni allergic patients.
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Review and clinical experience exploring evidence, clinical efficacy, and safety regarding nonsurgical treatment of feminine rejuvenation
Summary
Introduction
The use of energy-based devices for the treatment of vaginal laxity, orgasmic dysfunction, and stress incontinence, such as minimally ablative fractional laser and radiofrequency, is gaining momentum. This review aims to answer clinical questions on the application of energy-based devices for feminine genital rejuvenation.
Methods
The target group includes physicians involved in esthetic medicine and feminine genital rejuvenation. A literature review was conducted on technologies in use for feminine rejuvenation to explore their safety, efficacy, tolerability, patient satisfaction, and clinical usability. A panel of physicians with clinical experience conducting these types of treatment reviewed and discussed the results of the literature search and gave clinical evidence-based recommendations.
Results
Energy-based devices may induce wound healing, stimulating new collagen, and elastin fiber formation. Radiofrequency treatment may also increase small nerve fiber density in the papillary dermis, improving nerve sensitivity, sexual function, including arousal and orgasmic dysfunction. Both minimally ablative fractional laser and radiofrequency has been shown to be effective when treating mild to moderate primary or secondary vulvovaginal laxity and associated secondary conditions. These treatments are reported to be safe, effective, and well tolerated with a rapid return to activities of daily living.
Conclusions
As this is an evolving medical field, clinical evidence often lacks robustness. Studies and clinical experience suggest that feminine genital rejuvenation using energy-based devices seems an attractive option for patients with mild-to-moderate medical conditions. The treatment can be safely and effectively delivered by trained staff as part of the comprehensive care, that is, currently available to women.
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Effect of narrow-band ultraviolet B on the serum of 25-hydroxyvitamin D in vitiligo patients
Summary
Background
Narrow-band ultraviolet B (NB-UVB) is the gold standard in the treatment of vitiligo. 25-hydroxyvitamin D (25-OH- vitamin D) might play a physiological role in photo-induced melanogenesis in human skin so the association between vitamin D levels and vitiligo still needs to be investigated more thoroughly.
Objective
we aim to investigate the influence of cumulative doses of NB-UVB phototherapy on vitamin D in patients with vitiligo and their correlation with NB-UVB-induced pigmentation.
Methods
Eighty patients of vitiligo and twenty number of age and sex matched controls were recruited in a case-control study. Patients with vitiligo were treated with NB-UVB twice weekly for 24 weeks. 25-hydroxy vitamin D levels were measured at 0, 12, and 24 weeks in the cases and at 0 only in control by enzyme-linked immunosorbent assay (ELISA) and Vitiligo Area Severity Index (VASI) were calculated at 0 (baseline) and 24 weeks.
Results
The mean baseline level of 25-hydroxyvitamin D (at 0 week) was significantly lower in patients than the control group. Levels of 25(OH) vitamin D at 12 and 24 weeks showed significant improvement and Patients show significant reduction in VASI score after 24 weeks of therapy.
Conclusions
Cumulative doses of NB-UVB therapy improve low vitamin D levels in patients with vitiligo, which might have a significant role in NB-UVB-induced repigmentation and may contribute to its therapeutic efficacy but further studies with larger sample size are needed to prove the complete mechanisms of NB-UVB-induced pigmentations and vitamin D in vitiligo.
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