Medicine by Sfakianakis Alexandros: 05/06/18

Κυριακή 6 Μαΐου 2018

Treatment outcome and prognostic factors of tonsillectomy for palmoplantar pustulosis and pustulotic arthro‐osteitis: A retrospective subjective and objective quantitative analysis of 138 patients

The Journal of Dermatology, EarlyView.

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β-catenin ( CTNNB1 ) mutation and LEF1 expression in sinonasal glomangiopericytoma (sinonasal-type hemangiopericytoma)

Abstract

Sinonasal glomangiopericytoma (SN-GPC) is an uncommon mesenchymal tumor with myoid differentiation. Recently, mutations in exon 3 of the gene coding for β-catenin (CTNNB1) and its nuclear expression were discovered in SN-GPC. β-catenin protein is a key regulatory molecule of the canonical Wnt signaling pathway. The expression of β-catenin target proteins is not well characterized in SN-GPC. We examined three SN-GPCs by immunohistochemistry and CTNNB1 mutation analysis. All cases expressed nuclear β-catenin. We identified CTNNB1 exon 3 mutations in two analyzable cases. Lymphoid enhancer-binding factor 1 (LEF1), a protein downstream from β-catenin, was also expressed in all cases. Our results further characterized the activation of the Wnt signaling pathway caused by CTNNB1 exon 3 mutation and suggest the utility of LEF1 immunohistochemistry in the differential diagnosis of SN-GPC.

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Notalgia paresthetica: cryolipolysis as a novel potential treatment

International Journal of Dermatology, EarlyView.

https://ift.tt/2jzhFyM

Violence targeting children or violent society? Craniofacial injuries among the pre‐Hispanic subadult population of Gran Canaria (Canary Islands)

International Journal of Osteoarchaeology, EarlyView.

https://ift.tt/2wjdRej

Acquired idiopathic generalised anhidrosis: A rare cause of sweating deficiency

Australasian Journal of Dermatology, EarlyView.

https://ift.tt/2wj4Mlt

Lipids hide or step aside for CD1-autoreactive T cell receptors

Rachel N Cotton | Adam Shahine | Jamie Rossjohn | D Branch Moody

https://ift.tt/2HZOTSw

Complete response to orally administered melphalan in malignant pleural effusion from an occult female genital organ primary neoplasm with BRCA1/2 mutations: a case report

Definite diagnosis of metastasis from unknown primary depends on a comprehensive immunohistochemical investigation of tumor specimen. Accurate identification of the origin site usually helps a lot in choosing ...

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The Denominator in Value-Based Health Care: Porter’s Hidden Costs

No abstract available

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In Response

No abstract available

https://ift.tt/2HSElIM

Brown’s Atlas of Regional Anesthesia, 5th ed

No abstract available

https://ift.tt/2roRyOC

Incidence and Risk Factors for Perioperative Cardiovascular and Respiratory Adverse Events in Pediatric Patients With Congenital Heart Disease Undergoing Noncardiac Procedures

BACKGROUND: While mortality and adverse perioperative events after noncardiac surgery in children with a broad range of congenital cardiac lesions have been investigated using large multiinstitutional databases, to date single-center studies addressing adverse outcomes in children with congenital heart disease (CHD) undergoing noncardiac surgery have only included small numbers of patients with significant heart disease. The primary objective of this study was to determine the incidences of perioperative cardiovascular and respiratory events in a large cohort of patients from a single institution with a broad range of congenital cardiac lesions undergoing noncardiac procedures and to determine risk factors for these events. METHODS: We identified 3010 CHD patients presenting for noncardiac procedures in our institution over a 5-year period. We collected demographic information, including procedure performed, cardiac diagnosis, ventricular function as assessed by echocardiogram within 6 months of the procedure, and classification of CHD into 3 groups (minor, major, or severe CHD) based on residual lesion burden and cardiovascular functional status. Characteristics related to conduct of anesthesia care were also collected. The primary outcome variables for our analysis were the incidences of intraoperative cardiovascular and respiratory events. Univariable and multivariable logistic regressions were used to determine risk factors for these 2 outcomes. RESULTS: The incidence of cardiovascular events was 11.5% and of respiratory events was 4.7%. Univariate analysis and multivariable analysis demonstrated that American Society of Anesthesiologists (≥3), emergency cases, major and severe CHD, single-ventricle physiology, ventricular dysfunction, orthopedic surgery, general surgery, neurosurgery, and pulmonary procedures were associated with perioperative cardiovascular events. Respiratory events were associated with American Society of Anesthesiologists (≥4) and otolaryngology, gastrointestinal, general surgery, and maxillofacial procedures. CONCLUSIONS: Intraoperative cardiovascular events and respiratory events in patients with CHD were relatively common. While cardiovascular events were highly associated with cardiovascular status, respiratory events were not associated with cardiovascular status. Accepted for publication March 5, 2018. Funding: None. J. A. DiNardo and K. Yuki contributed equally and share senior authorship. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Koichi Yuki, MD, Department of Anesthesiology, Perioperative and Pain Medicine, Cardiac Anesthesia Division, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115. Address e-mail to koichi.yuki@childrens.harvard.edu. © 2018 International Anesthesia Research Society

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Pediatrics and Beyond

No abstract available

https://ift.tt/2HSE5JO

In Response

No abstract available

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World Health Organization-World Federation of Societies of Anaesthesiologists (WHO-WFSA) International Standards for a Safe Practice of Anesthesia

The International Standards for a Safe Practice of Anesthesia were developed on behalf of the World Federation of Societies of Anaesthesiologists (WFSA), a nonprofit organization representing anesthesiologists in 150 countries, and the World Health Organization (WHO). The recommendations have been approved by WHO and the membership of WFSA. These Standards are applicable to all anesthesia providers throughout the world. They are intended to provide guidance and assistance to anesthesia providers, their professional organizations, hospital and facility administrators, and governments for maintaining and improving the quality and safety of anesthesia care. The Standards cover professional aspects; facilities and equipment; medications and intravenous fluids; monitoring; and the conduct of anesthesia. HIGHLY RECOMMENDED standards, the functional equivalent of mandatory standards, include (amongst other things): the continuous presence of a trained and vigilant anesthesia provider; continuous monitoring of tissue oxygenation and perfusion by clinical observation and a pulse oximeter; intermittent monitoring of blood pressure; confirmation of correct placement of an endotracheal tube (if used) by auscultation and carbon dioxide detection; the use of the WHO Safe Surgery Checklist; and a system for transfer of care at the end of an anesthetic. The International Standards represent minimum standards and the goal should always be to practice to the highest possible standards, preferably exceeding the standards outlined in this document. Accepted for publication March 22, 2018. WHO ePub clearance: WHO ePub-IP-00090890-EC. This article is jointly published in the Canadian Journal of Anesthesia and Anesthesia & Analgesia. Address correspondence to Adrian W. Gelb, Department of Anesthesia & Perioperative Care, University of California San Francisco, 500 Parnassus Ave, MUE 404, San Francisco, CA 94143. Address e-mail to adrian.gelb@ucsf.edu. © 2018 International Anesthesia Research Society

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Factors Affecting Inpatient Mortality in Elderly People with Acute Kidney Injury

Background. Acute Kidney Injury (AKI) is common in elderly people (EP). There is paucity of data on predictor of mortality in EP with AKI. Objective. This study was done to know more about factors associated with inpatient mortality in EP with AKI. Methods. We retrospectively reviewed medical records of patients aged 65 years or above hospitalized with a diagnosis of AKI at Aga Khan University Hospital, Karachi, between January 2005 and December 2010. Binary logistic regression models were constructed to identify factors associated with mortality in EP with AKI. Results. 431 patients had AKI, with 341 (79.1%) having stage I AKI, 56 (13%) having stage II AKI, and 34 (7.9%) having stage III AKI. Out of 431 patients, 142 (32.9%) died. Mortality increased with increasing severity of AKI. Mortality was 50% (17/34) in AKI stage III, 44.6% (25/56) in AKI stage II, and 29.3% (100/341) in AKI stage I. Factors associated with increased inpatients mortality were presence of stage III AKI (OR: 3.20, , 95% CI: 1.05–9.72), presence of oliguria (OR: 3.42, , 95% CI: 1.42–8.22), and need for vasopressors (OR: 6.90, , 95% CI: 2.42–19.65). Median bicarbonate 18 versus 17 between those who survived and those who died was associated with less mortality (OR: 0.94, , 95% CI: 0.89–0.99). History of hypertension (OR: 0.49, , 95% CI: 0.25–0.95) and high admission creatinine (OR: 0.68, , 95% CI: 0.50–0.91) were also associated with less mortality. Conclusion. Mortality in EP increases with increasing severity of AKI. Presence of stage III AKI, oliguria, and hemodynamic instability needing vasopressor are associated with increased mortality. Increased median bicarbonate, presence of hypertension, and high admission creatinine were various factors associated with decreased inpatient mortality. Increasing age and need for dialysis did not increase mortality in elderly population.

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Improved lung recruitment and oxygenation during mandatory ventilation with a new expiratory ventilation assistance device: A controlled interventional trial in healthy pigs

BACKGROUND In contrast to conventional mandatory ventilation, a new ventilation mode, expiratory ventilation assistance (EVA), linearises the expiratory tracheal pressure decline. OBJECTIVE We hypothesised that due to a recruiting effect, linearised expiration oxygenates better than volume controlled ventilation (VCV). We compared the EVA with VCV mode with regard to gas exchange, ventilation volumes and pressures and lung aeration in a model of peri-operative mandatory ventilation in healthy pigs. DESIGN Controlled interventional trial. SETTING Animal operating facility at a university medical centre. ANIMALS A total of 16 German Landrace hybrid pigs. INTERVENTION The lungs of anaesthetised pigs were ventilated with the EVA mode (n=9) or VCV (control, n=7) for 5 h with positive end-expiratory pressure of 5 cmH2O and tidal volume of 8 ml kg−1. The respiratory rate was adjusted for a target end-tidal CO2 of 4.7 to 6 kPa. MAIN OUTCOME MEASURES Tracheal pressure, minute volume and arterial blood gases were recorded repeatedly. Computed thoracic tomography was performed to quantify the percentages of normally and poorly aerated lung tissue. RESULTS Two animals in the EVA group were excluded due to unstable ventilation (n=1) or unstable FiO2 delivery (n=1). Mean tracheal pressure and PaO2 were higher in the EVA group compared with control (mean tracheal pressure: 11.6 ± 0.4 versus 9.0 ± 0.3 cmH2O, P 0.99). Minute volume was lower in the EVA group compared with control (5.5 ± 0.2 versus 7.0 ± 1.0 l min−1, P = 0.02) with normoventilation in both groups (PaCO2 5.4 ± 0.3 versus 5.5 ± 0.3 kPa, P > 0.99). In the EVA group, the percentage of normally aerated lung tissue was higher (81.0 ± 3.6 versus 75.8 ± 3.0%, P = 0.017) and of poorly aerated lung tissue lower (9.5 ± 3.3 versus 15.7 ± 3.5%, P = 0.002) compared with control. CONCLUSION EVA ventilation improves lung aeration via elevated mean tracheal pressure and consequently improves arterial oxygenation at unaltered positive end-expiratory pressure (PEEP) and peak inspiratory pressure (PIP). These findings suggest the EVA mode is a new approach for protective lung ventilation. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. https://ift.tt/OBJ4xP Correspondence to Johannes Schmidt, MD, Department of Anesthesiology and Critical Care, Medical Centre – University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany Tel: +49 761 270 26390; fax: +49 761 270 23280; e-mail: johannes.schmidt@uniklinik-freiburg.de Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (https://ift.tt/2ylyqmW). © 2018 European Society of Anaesthesiology

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General Anesthetic Use in Fragile X Spectrum Disorders

The fragile X premutation is characterized by a repeat expansion mutation (between 55 to 200 CGG repeats) in the fragile X mental retardation 1 (FMR1) gene, which leads to RNA toxicity at the cellular level. This may cause patients with the premutation to be particularly susceptible to environmental toxins, which could manifest clinically as new or worsening ataxia and memory loss. Multiple published case reports have also suggested general anesthetics as a potential toxin leading to negative side effects when used in patients with fragile X- associated disorders. However, at this time, there have been no formal research studies regarding cellular changes or long-term clinical manifestations after general anesthetic use in this population. This review aims to highlight previous case reports regarding sequelae related to general anesthetic use in fragile X-associated disorders. New case reports related to this phenomenon are also included. Supported through NICHD grant HD036071, the MIND Institute Intellectual and Developmental Disabilities Research Center (grant U54 HD079125) and the National Center for Advancing Translational Sciences and National Institutes of Health (grant UL1 TR001860). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. R.H. has received support from Novartis, Alcobra, Neuren, and Marinus for studies in fragile X syndrome. She has also consulted with Zynerba, Fulcrum, and Ovid regarding studies in fragile X syndrome. The remaining authors have no conflicts of interest to disclose. Address correspondence to: Randi Hagerman, MD, MIND Institute, UCDMC, 2825 50th Street, Sacramento, CA 95817 (e-mail: rjhagerman@ucdavis.edu). Received August 23, 2017 Accepted April 10, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved

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Safety of Sodium Bicarbonate for Control of ICP (Letter)

No abstract available

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Minimally invasive approach to suppurated cervical lymphadenitis in children: Our experience on 60 patients

Clinical Otolaryngology, EarlyView.

https://ift.tt/2rq7hwI

Transcanal Approach for Type 2 Tympanoplasty with Incus Interposition Ossiculoplasty: Our Experience on 134 Patients

Clinical Otolaryngology, EarlyView.

https://ift.tt/2KGd2PY

Experimental butchery study investigating the influence of timing of access and butcher expertise on cut mark variables

International Journal of Osteoarchaeology, EarlyView.

https://ift.tt/2FOoBAK

Dyke–Davidoff–Masson syndrome in the Late Bronze and Early Iron Ages Armenia—a cause of trepanation?

International Journal of Osteoarchaeology, EarlyView.

https://ift.tt/2KAVFzL

A case of generalized acquired cutis laxa

International Journal of Dermatology, EarlyView.

https://ift.tt/2FPnHUy

Stress and psoriasis

International Journal of Dermatology, EarlyView.

https://ift.tt/2KCokEG

Paraneoplastic arthritis in a patient with Sézary syndrome

International Journal of Dermatology, EarlyView.

https://ift.tt/2FNWuBQ

Is tonsillectomy mandatory for asymmetric tonsils in children? A review of our diagnostic tonsillectomy practice and the literature

Publication date: July 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 110
Author(s): Gareth Huw Jones, Girvan Burnside, Joanna McPartland, Anne Markey, Michael Fallon, Sujata De
IntroductionDiagnostic tonsillectomy is performed to exclude malignancy. It is associated with a post-operative hemorrhage rate of 3.5%, (1) which is more dangerous in small children. No previous case series for asymmetrical tonsils have detected tonsil lymphoma.(2–6) We aimed to review our local diagnostic tonsillectomy practice.MethodThe authors reviewed the clinical notes and histological results for all diagnostic tonsillectomies carried out from June 2013 to June 2016.ResultsWe recorded data for 168 patients. There were four post-operative bleeds and one return to theatre. Bilateral tonsillectomies accounted for 152 operations (90.5%). Lymphoid hyperplasia accounted for 95% of histological diagnosis with no malignancies found. Pre-operative tonsil grading demonstrated no statistically significant association with histological tonsil weight difference (ANOVA p = 0.10). Actinomyces colonisation had little affect on tonsil weight difference when we compared patients with bilateral colonisation and no colonisation (t-test p = 0.540) and between tonsils in patients with unilateral tonsil Actinomyces colonisation (paired t-test p = 0.448). Recurrent tonsillitis was more prevalent in patients with Actinomyces colonisation than OSA/sleep disordered breathing (39% vs 15%).ConclusionA literature search yielded five smaller case series of palatine tonsil asymmetry in children with no malignancy found.(2–6) Case-control studies report tonsillar asymmetry as the most common presenting symptom (73%) in tonsillar lymphoma.(7) This enlargement usually occurs rapidly within 6 weeks with new obstructive or systemic B-type symptoms.(3) A Turkish epidemiological study found asymmetrical tonsils in 1.7% of the healthy paediatric population.(8) We therefore estimate there to be over 210,000 children with asymmetrical tonsils in the UK. With an unreliable grading system, we believe asymmetrical tonsils in isolation, unchanged for over 6 weeks may not warrant tonsillectomy.

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