Atypical Cutaneous Presentations of Sarcoidosis: Two Case Reports and Review of the Literature

Abstract

Purpose of Review

The goal of this review is to provide the reader with an updated summary of the cutaneous manifestations of systemic sarcoidosis, with a particular emphasis on the predilection of sarcoidosis for scars, tattoos, and other areas of traumatized skin.

Recent Findings

While the mechanism underlying the propensity for traumatized skin to develop sarcoidosis lesions remains unclear, several theories have been proposed including the idea that cutaneous sarcoidosis represents an exuberant, antigen-driven foreign-body response, as well as the theory that traumatized skin represents an immunocompromised district with altered local immune trafficking and neural signaling.

Summary

In this review, we present two cases in which the development of cutaneous lesions in scars and tattoos was integral to the diagnosis of systemic sarcoidosis. We then review the various cutaneous manifestations of systemic sarcoidosis, the clinical characteristics and differential diagnosis of scar and tattoo sarcoidosis, the proposed mechanism by which traumatized skin is prone to developing sarcoidosis lesions, and current treatments for cutaneous sarcoidosis.

https://ift.tt/2JQkjip

Food-Induced Anaphylaxis: an Update

Abstract

Purpose of Review

This review aims to provide an update of recent advances in the epidemiology, clinical features and diagnosis, and management of food-induced anaphylaxis (FIA).

Recent Findings

Food allergy prevalence and FIA rates continue to rise, but FIA fatalities are stable. Basophil and mast cell activation tests promise more accurate identification of food triggers. Oral, sublingual, and epicutaneous immunotherapy can desensitize a significant portion of subjects. Epinephrine use for FIA remains sub-optimal.

Summary

As the burden of food allergy continues to increase, it appears that the corresponding increase in research focused on this epidemic is beginning to bear fruit. The stable number of FIA fatalities in the face of an ongoing epidemic indicates lives have already been saved. The emergence of new diagnostic tests and interventional therapies may transform the management of FIA in the coming years.

https://ift.tt/2LOBoXn

Fever of unknown origin: a rare presentation of giant hepatic hemangioma

Abstract

Hepatic hemangioma is mostly asymptomatic and incidental finding on imaging. Fever of unknown origin as a sole presentation is rare. We present an interesting case report of a 49-year-old female, who presented with fever for three months. Extensive blood investigations and infectious workup failed to reveal the cause. Contrast computed tomography of abdomen revealed a giant (15 × 11 cm) hemangioma arising from left lateral segment of liver, and was attributed as a cause for fever. Surgical excision of hemangioma completely ameliorated the fever.

https://ift.tt/2sWpsM7

DEPOT EXTRACTS FOR RUSH VENOM IMMUNOTHERAPY: A NEW THERAPEUTIC OPPORTUNITY FOR HYMENOPTERA STING ALLERGY

Publication date: Available online 13 June 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Stefano Pucci, Fedra Ciccarelli, Tiziana De Pasquale, Ilenia Illuminati, Simona D'Alò




https://ift.tt/2JNben5

Erratum: Validierung der deutschen Version des Eating Assessment Tool bei Kopf-Hals-Tumor-Patienten

Laryngo-Rhino-Otol
DOI: 10.1055/a-0623-6772

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

https://ift.tt/2HMEado

ASSOCIATION OF FREE VITAMIN D3 CONCENTRATIONS AND ASTHMA TREATMENT FAILURES in the VIDA Trial

Vitamin D (vitamin D2 and vitamin D3) derived from sunlight exposure, diet or supplementation are converted to vitamin D2 (calciferol) and vitamin D3 (cholecalciferol) (25 (OH) D3) by vitamin D-25 hydroxylase (CYP2R1) in the liver, and subsequently converted to the biologically active 1,25-dihydroxyvitamin D2 and 1,25-dihydroxyvitamin D3 (25 (OH)2 D3) by CYP27B1 in the kidney and other tissue.1,2 Circulating total concentrations of vitamin D3 but not concentrations of active 1,25-dihydroxyvitamin D3 are used to define vitamin D status in part because of differences in total concentrations and half-life between the two metabolites.

https://ift.tt/2HLgtlm

DEPOT EXTRACTS FOR RUSH VENOM IMMUNOTHERAPY: A NEW THERAPEUTIC OPPORTUNITY FOR HYMENOPTERA STING ALLERGY

Stings by Hymenoptera insects are relatively common in the general population and may cause different symptoms ranging from mild and local reactions to life-threatening and fatal anaphylaxis.1

https://ift.tt/2JOV0NI

Decreased interleukin-35 serum levels in patients with chronic spontaneous urticaria

Chronic spontaneous urticaria (CSU), a mast cell-driven disease, is defined as the spontaneous appearance of wheals, angioedema or both for > 6 weeks for unknown or known causes.1 Mast cells, as one of the major effector cells in the immune response system, play important roles in the pathogenesis of CSU. Interleukin (IL)-35 is a new anti-inflammatory cytokine which belongs to the IL-12 family and is composed of two subunits: Epstein-Barr virus-induced gene 3 (EBI3) and IL-12p35. IL-35 is widely recognized as a definite immune suppressor with a huge potent of suppression.

https://ift.tt/2LNiekN

Immunotherapy and Skin Side Effects

This Patient Page defines the cancer treatment immunotherapy and describes its potential side effects, particularly of the skin.

https://ift.tt/2Mo2HZu

Good to Begin Well, Better to End Well

https://ift.tt/2rg5cU2

Sulfur Ointment Treatment of Cutaneous Myiasis Caused by the Tumbu Fly

This case report describes a patient treated with sulfur ointment for cutaneous myiasis caused by the tumbu fly.

https://ift.tt/2KbiHwS

Quality of Life and the Dermatologist

This Editorial discusses factors that affect quality of life in those with vascular malformations, and dermatologists' goal of improving these aspects for patients.

https://ift.tt/2ptLTqd

Carvedilol for Treatment of Red Vulva Syndrome

This case report describes 2 patients with red vulva syndrome treated with carvedilol.

https://ift.tt/2FfOKIB

Minoxidil for Endocrine Therapy–Induced Alopecia in Women With Breast Cancer

https://ift.tt/2v8nHz0

Thomas Hindson and Discovery of Ascorbic Acid to Treat Prickly Heat

Dr Thomas Hindson was born in northern England in 1934. After attending St John's College in Cambridge for medical school, he worked as a dermatologist at St Bartholomew's Hospital. In 1960, he enlisted as a serviceman in the Royal Army Medical Corps and was later commissioned to the Armed Services in 1963.

https://ift.tt/2Mo2GEU

Vascular Malformations and Health-Related Quality of Life

This systematic review and meta-analysis uses validated health-related quality-of-life instruments to compare the health-related quality of life of patients with vascular malformations with that of the US general population.

https://ift.tt/2ptFJGK

Mogamilizumab Prior to HSCT and GVHD in Patients With CTCL

This case series describes the occurrence of graft-vs-host-disease (GVHD) in patients with cutaneous T-cell lymphomas (CTCLs) treated with the CC chemokine receptor 4 (CCR4) antibody mogalizumab prior to allogeneic hematopoietic stem cell transplantation (HSCT).

https://ift.tt/2GIcSV3

Endocrine Therapy–Induced Alopecia in Patients With Breast Cancer

This cohort study describes clinical features, quality of life, and response to minoxidil among female patients with breast cancer who have endocrine therapy–induced alopecia.

https://ift.tt/2HeRESM

Recurrent Unilateral Periorbital Edema Associated With Subcutaneous Cysticercosis

This case report describes a patient with recurrent unilateral periorbital edema caused by subcutaneous cysticercosis.

https://ift.tt/2rwXO6N

Efficacy of Guselkumab Compared With Adalimumab and Placebo for Psoriasis in Specific Body Regions

This secondary analysis of 2 randomized clinical trials evaluates the effect of guselkumab vs adalimumab or placebo on psoriasis in specific difficult-to-treat body regions.

https://ift.tt/2Glki09

Knowledge Removes Discomfort—Reply

In Reply We thank Dr Nwabudike for replying to our publication on the Patient Health Questionnaire-2 (PHQ-2) in Dermatology. We address his inquiries in chronological order:

https://ift.tt/2KumcP6

Interest and Uptake of MC1R Testing for Melanoma Risk in a Diverse Primary Care Population

This randomized clinical trial examines the prevalence of interest in and uptake of MC1R testing in the general population and examines patterns across demographic and skin cancer risk factors.

https://ift.tt/2rwXQLX

Endurance—Frostbite, Then and Now

The 2018 Olympics remind us of what it means to truly brave the odds.

https://ift.tt/2JzyF7r

Cost-effectiveness of Skin Cancer Referral and Consultation Using Teledermoscopy in Australia

This study uses a decision-analytic model to assess the cost-effectiveness of teledermoscopy as a referral mechanism for skin cancer diagnosis and management in Australia.

https://ift.tt/2KNLS9C

June 2018 Issue Highlights

https://ift.tt/2MonJra

Association of Nodal Metastasis With Vermilion Lip Location in Cutaneous SCC of the Lip

This cohort study of patients with cutaneous squamous cell carcinomas of the lip evaluates the risk differences for recurrence, metastasis, and death in tumors of the vermilion vs cutaneous lip locations.

https://ift.tt/2rgAaeP

Teaching Intuitive Visual Diagnosis of Melanoma

This diagnostic study compares the training efficacy of a novel web-based application to the publicly available Internet Curriculum For Melanoma Early Detection Skin Education Series to determine if intuitive visual diagnosis training is superior to a traditional rule-based algorithm in the diagnosis of melanomas.

https://ift.tt/2rKNtVS

Frontalis Myocutaneous Transposition Flap for Forehead Defect Reconstruction

This case series of 12 patients with large, deep forehead defects secondary to Mohs surgery assesses whether the frontalis myocutaneous transposition flap represents a good alternative for the reconstruction of forehead defects.

https://ift.tt/2L7Towm

Moyamoya disease in a Moroccan baby: a case report

A stroke in a baby is uncommon, recent studies suggested that their incidence is rising. Moyamoya disease is one of the leading causes of stroke in babies. This condition is mostly described in Japan. In Moroc...

https://ift.tt/2HNxtaF

Association between Breslow Thickness and Dermoscopic Findings in Acral Melanoma

Dermoscopy is a useful tool for the diagnosis of acral melanomas (AM). However, little is known about the influence of tumor thickness on the dermoscopic findings of AM.

https://ift.tt/2LOTV5E

Successful treatment of eosinophilic otitis media associated with severe bronchial asthma with an anti-IL-5 monoclonal antibody, mepolizumab

Eosinophilic otitis media (EOM), which is characterized by the accumulation of eosinophils in middle ear effusion and the middle ear mucosa, is a refractory type of otitis media that is often associated with asthma. Although an early diagnosis and appropriate treatment are necessary to prevent the progression of hearing loss in patients with EOM, there are currently no well-established treatments for this condition. We treated a 60-year-old male patient with asthma and EOM. The patient's asthma was poorly controlled, despite the use of high-dose inhaled corticosteroids, long-acting beta-agonist treatment, and the regular use of systemic corticosteroids.

https://ift.tt/2JGTaeh

Re: “Concurrent Milk Ingestion Decreases Absorption of Levothyroxine” by Chon et al. (Thyroid 2018;28:454–457)

Thyroid, Ahead of Print.


https://ift.tt/2JSMJbB

Does Reverse Triiodothyronine Testing Have Clinical Utility? An Analysis of Practice Variation Based on Order Data from a National Reference Laboratory

Thyroid, Ahead of Print.


https://ift.tt/2HLjPoH

Problematic End Points in a Keratinocyte Carcinoma Chemoprevention Trial—Reply

In Reply We appreciate the close scrutiny of our published work and the opportunity to elaborate on the end points we used for analysis of the trial data. The VAKCC Trial primary end point was the rate of occurrence of keratinocyte carcinoma (KC) over the course of the 4-year trial. In the process of creating and executing this trial, however, the study team explicitly discussed that there were other important outcomes. In particular, while we did not have evidence to guide our estimation of the timing and duration of the effect of our intervention, if any, on the occurrence of KC, basal cell carcinoma, or squamous cell carcinoma (SCC), we realized that a short-term effect on risk (eg, during the first year) could be of considerable clinical importance even if the effect did not persist for the entire duration of the trial. We further recognized that even if there was a substantial effect in the first year, it could be lost in the 4-year results unless specifically examined. Hence, when analysis plans were discussed prior to unblinding the data, it was explicitly stated by the study chair, and summarized in the form of email guidance to the study statistician, that outcomes at 1 year were important to calculate and report. With the focus on completing the report, we chose not to officially amend the statistical analysis plan. This was an administrative decision that did not prevent appropriate analysis and should not prevent appropriate scientific interpretation. The final analyses, as reported, revealed a clinically and statistically significant 75% reduction in SCC risk in the first year. It is appropriate for this finding to influence the clinical care of those at high risk of face and ear SCC.

https://ift.tt/2Mq2ntB

An Elderly Woman With Painful Buttock and Vulvar Ulcers

A woman in her 80s presented with somnolence, fatigue, lower urinary tract symptoms, and progressively worsening vulvar and buttock pain. What is your diagnosis?

https://ift.tt/2y50QWB

Association of RARβ Expression With Lichen Sclerosus–Associated Vulvar Squamous Cell Carcinoma

This case-control study examines the association of retinoic acid receptor β tumor-suppressor gene with the onset and progression of lichen sclerosus–associated vulvar squamous cell carcinoma.

https://ift.tt/2MlY42a

Problematic End Points in a Keratinocyte Carcinoma Chemoprevention Trial

To the Editor Treatment with topical fluorouracil, 5%, compared with placebo reduced risk of surgically treated squamous cell carcinoma (SCC) and Mohs surgery for keratinocyte carcinoma (KC) for 1 year, according to a randomized clinical trial (RCT) report. However, because neither of these outcomes was prespecified, these findings should be interpreted very cautiously and should not sway clinical practice.

https://ift.tt/2y8mCIY

Efficacy and Safety of Ozenoxacin for Treatment of Patients With Impetigo

This randomized clinical trial evaluates the efficacy, safety, and tolerability of ozenoxacin cream vs placebo in children and adults with impetigo.

https://ift.tt/2MlurOt

Contributions by MC1R Variants to Melanoma Risk in Males and Females

This case-control study evaluates the association of melanocortin-1-receptor (MC1R) with melanoma risk in males vs females, adjusting for risk factors such as age, pigmentation, phenotype, signs of skin damage, and sun exposure.

https://ift.tt/2y47494

Stent-induced compression necrosis for the endoscopic removal of a partially eroded Lap-Band

Endoscopic removal of eroded Lap-Bands is a minimally invasive alternative to surgical removal that prerequires sufficient erosion through the gastric wall, that is, ≥180° of the gastro-oesophageal wall circumference. A 69-year-old woman presented with dysphagia due to a long-standing Lap-Band erosion, currently of a 60° circumference. Adhesions due to her extensive surgical history rendered surgical treatment undesirable, so a self-expanding stent was placed endoscopically to induce sufficient erosion for subsequent endoscopic removal. During therapy, the patient complained of ructus and dysphagia, probably related to an overly proximally (oesophageal) positioned stent. After a total of 12 weeks, far longer than the described stenting duration in the literature, the Lap-Band was found free in the gastric lumen and was successfully removed using an endoscopic loop. Stent-induced compression necrosis should be considered as a minimally invasive treatment option for Lap-Bands eroded for <180°, with caution in the context of extensive fibrosis.

https://ift.tt/2JGbRPl

Phlegmasia cerulea dolens presenting with acute compartment syndrome and pulmonary embolism

Description 

A 50-year-old woman, a known diabetic and hypertensive with poor compliance to treatment, presented with fever, dyspnoea and left-sided pleuritic chest pain for 15 days and left lower limb swelling worsening over the past 1 week. On examination, her vitals were stable, and she had significant left lower limb oedema extending up to the upper thigh with livedo reticularis (figure 1). The left lower limb pulses were not palpable. There was excruciating pain on light touch and passive flexion of the toes and ankle. Urgent arterial and venous Doppler sonography of the lower limbs revealed a left-sided iliofemoral venous thrombus. With the clinical diagnosis of acute compartment syndrome, urgent single incision four compartment fasciotomy was performed.

Figure 1

(A) Clinical examination at the time of admission showing lower limb oedema with livedo reticularis, (B) left lower leg livedo reticularis with superficial blistering (white arrow) and (C)...

https://ift.tt/2Mmz4YR

Spontaneous tumour lysis syndrome in small cell lung cancer: a rare phenomenon

Tumour lysis syndrome (TLS) is an oncological emergency. It is caused by cellular death occurring secondary to cancer therapy or spontaneously in rapidly dividing tumours. More common in haematological malignancies, it has also been reported in solid tumours. Out of 14 cases of small cell lung cancer (SCLC) with TLS, only three cases of spontaneous TLS have been reported in literature to date. Here we report a case of SCLC presenting as a spontaneous TLS.

https://ift.tt/2y7nwpc

Fulminant pulmonary embolism with fatal outcome in a patient with low clinical prediction scores

We present a case of a 72-year-old man with submassive acute pulmonary thromboembolism. Pulmonary embolism severity index Score and common clinical risk stratification recommended systemic anticoagulation and a clinical course without complications was expected. A primary reperfusion strategy was not indicated by the current guidelines. Under established anticoagulation, the patient was found in cardiac arrest immediately after mobilisation from the bed the next morning. Right heart catheterisation under ongoing resuscitation revealed a complete obstruction of the right pulmonary artery by a big thrombus. Catheter-directed intervention trying to bypass the thrombus with interventional guidewires failed. Ultimately, the patient died from acute right heart failure. The current case raises concern that the prediction scores available for pulmonary embolism may insufficiently predict short-term outcome in isolated patients.

https://ift.tt/2MiGbBv

Giant choledochal cyst presenting during third trimester of pregnancy

Biliary cystic disease is a rare entity. Twenty-five per cent of cases are diagnosed during adulthood and only a few reports have described this condition during pregnancy, where it represents a therapeutic challenge for both obstetricians and surgeons with regard to the risks it entails for the patient and the fetus.

Definitive management is surgical resection, as cysts may progress to malignancy if untreated. During pregnancy, resection is generally deferred to after delivery, especially in the context of suspected cholangitis.

A 19-year-old young woman with no previous prenatal control, presented to the emergency department on her 32nd week of gestation with abdominal pain and jaundice. A giant Todani I biliary cyst was observed on imaging along with dilation of the proximal biliary tree suggesting acute cholangitis. Fetal compromise prompted immediate delivery after which percutaneous biliary drainage was performed. Following recovery, the cyst was surgically resected.

https://ift.tt/2JLufql

Circumcaval ureter/retrocaval ureter

Description  

A 33-year-old non-diabetic married woman from rural background presented with complaints of dull intermittent right flank pain since 1 year. She had no history of fever, dysuria, haematuria or weight loss. Clinical examination of the abdomen was within normal limits. Complete laboratory evaluation including urinalysis, complete blood picture, urea, creatinine and electrolytes were within normal limits. Ultrasonography (USG) of kidney, ureters and bladder showed moderate hydroureteronephrosis (HDUN) until right midureter. Intravenous pyelography (IVP) revealed dilated right renal pelvicalyceal system and upper ureter with abrupt S-shaped turn of ureter at the level of L4 vertebrae.

The appearance on IVP was strongly suspicious of retrocaval ureter and hence a contrast-enhanced CT urography was performed to confirm the diagnosis, which showed dilated right proximal ureter (figure 1) coursing medially and lying posterior to inferior vena cava (IVC). Three-dimensional reconstruction from CT urography showed proximal HDUN and classical S-shaped loop of the ureter behind the IVC...

https://ift.tt/2MiG88N

Aortopulmonary window with pumonary atresia with ventricular septal defect with D-transposition of great arteries: extremely rare anomaly

Aortopulmonary window (APW) is rare a congenital heart disease accounting for 0.1%–0.2% of all congenital heart defects. The 35% of the APW has been associated with wide variety of other structural heart diseases such as ventricular septal defect, persistent ductus arteriosus, arch anomalies and coronary artery anomalies. To the best of our knowledge, only six cases of APW with pulmonary atresia with ventricular septal defect has been described in the literature. It resembles the type 1 truncus arteriosus, and differentiation from this condition is important prior to surgical correction. We present a case of 14-year-old girl child; she was diagnosed with APW with pulmonary atresia with ventricular septal defect and D transposition of great arteries with the help of echocardiography, cardiac catheterisation and cardiac CT.

https://ift.tt/2JGbHrd

Incontinentia Pigmenti Misdiagnosed as Neonatal Herpes Simplex Virus Infection

Incontinentia pigmenti (IP) is an X-linked dominant neurocutaneous syndrome with ophthalmologic, neurologic, cutaneous, and dental manifestations and in most cases antenatally lethal in boys. Occasionally, typical IP may occur in boys due to Klinefelter syndrome or a genomic mosaicism. Skin lesions are observed in 4 stages: blistering, verrucous linear plaques, swirling macular hyperpigmentation, followed by linear hypopigmentation that develop during adolescence and early adulthood. Neonatal herpes simplex virus (HSV) infection can be manifested in 3 forms: localized, disseminated, and central nervous system (CNS) involvement. Timely diagnosis and treatment of neonatal HSV infection is critical. In this case report, we present a 12-day female newborn with a history of maternal genital HSV in second trimester and vesicular lesions on the upper and lower limbs that was appeared at first hours of life. She was admitted in the maternity hospital that was born and was treated by antibiotic and acyclovir for 11 days. Then, she readmitted for her distributed vesicular lesions. The results of blood and CSF for HSV PCR were negative. Eventually the diagnosis for incontinentia pigmenti was made by consultation with a dermatologist, and skin biopsy confirmed the diagnosis.

https://ift.tt/2JHK29w

Adenotonsillectomy in children with sickle cell disease and obstructive sleep apnea

Publication date: August 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 111
Author(s): Annie N. Farrell, Steven L. Goudy, Marianne E. Yee, Roberta M. Leu, April M. Landry
IntroductionObstructive sleep apnea (OSA) is prevalent and may be more severe in children with Sickle Cell Disease (SCD) compared to the general pediatric population.ObjectivesThe objective of this study was to describe the therapeutic effects and complications of tonsillectomy and adenoidectomy (T&A) for treatment of OSA in children with SCD.MethodsA comprehensive database of pediatric SCD patients was reviewed to identify all patients who underwent T&A between 2010 and 2016. An IRB-approved, retrospective review of laboratory values, perioperative course, pre- and post-T&A hospital utilization, and polysomnography was conducted.ResultsThere were 132 SCD children (108 HbSS) who underwent T&A. Mean age was 7.6 ± 4.6 years. The mean baseline hemoglobin of these patients was 9.3 ± 1.4 g/dL; 72.7% of patients had pre-operative transfusion, such that the mean Hb at time of T&A was 11.4 ± 1.0 g/dL. The average admission length surrounding T&A was 3.5 ± 1.2 days. Complications were documented in 11.4% of operative cases. Polysomnography was available in 104 pre-T&A and 45 post-T&A. The Apnea-Hypopnea Index decreased on post-T&A polysomnogram (7.6 ± 8.7 vs. 1.3 ± 1.9, p = 0.0001). The O2 nadir improved on post-T&A polysomnogram (81.2 ± 10.8 vs. 89.3 ± 7, p = 0.0003). Emergency room visits (mean events per year) decreased post-operatively (2.6 ± 2.8 vs. 1.8 ± 2.2, p = 0.0002).ConclusionsT&A can be a safe and effective option to treat OSA in pediatric patients with SCD and was significantly associated with reduced AHI and fewer ER visits post-operatively.



https://ift.tt/2sU59iz

CytID Analysis of Oral Lesions

Conditions:   Oral Cavity Cancer;   Oropharyngeal Cancer
Interventions:   Other: Oral examination with incandescent light;   Other: Oral examination with OralID;   Diagnostic Test: Biopsy;   Diagnostic Test: CytID;   Diagnostic Test: hpvID
Sponsors:   The University of Texas Health Science Center, Houston;   M.D. Anderson Cancer Center
Recruiting

https://ift.tt/2JUDY0R

Vestibular Treatment in Adolescents Following Sport Related Concussion

Condition:   Vestibular Disorder
Interventions:   Behavioral: Vestibular Exercise Intervention;   Behavioral: Standard of Care
Sponsor:   University of Pittsburgh
Not yet recruiting

https://ift.tt/2LKGnZ2

Ocular Basidiobolomycosis: A Case Report

Background: Ocular basidiobolomycosis is an unusual infection caused by fungus of the order Entomophthorales. This fungus has been previously reported as a common cause of skin, subcutaneous, and gastrointestinal tract infection. The fungus isolation and its typical characteristics are clues for diagnosis of this uncommon pathogen. Case Report: A 47-year-old male patient with nodular scleritis in the left eye after an eye injury from sawdust was treated as bacterial scleritis. The lesion improved with early surgical drainage and antibacterial therapy; then, he was discharged from the hospital. Thereafter, the patient was re-admitted due to progression of infectious scleritis with keratitis and orbital cellulitis. Surgical abscess drainage was performed again. The microbiological study demonstrated Basidiobolus ranarum. The patient was treated with topical ketoconazole, subconjunctival fluconazole injection, and oral itraconazole with partial response to the treatment. However, the patient eventually denied any further treatment and did not return for follow-up. Conclusions: B. ranarum is a rare pathogen of ocular infection in which a definite diagnosis requires isolation of the causative organism. Delay in diagnosis and appropriate treatment can lead to extension of the infection and poor outcomes.
Case Rep Ophthalmol 2018;9:315–321

https://ift.tt/2sTN3gq

CD300c co-stimulates IgE-mediated basophils activation and its expression is increased in cow´s milk allergy

Publication date: Available online 12 June 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Olatz Zenarruzabeitia, Joana Vitallé, Iñigo Terrén, Ane Orrantia, Itziar Astigarraga, Leire Dopazo, Carlos Gonzalez, Laura Santos-Díez, Carlos Tutau, Pedro M. Gamboa, Agurtzane Bilbao, Francisco Borrego
BackgroundBasophils express high-affinity IgE receptors (FcεRI), which play an essential role in allergic diseases. To design promising immunomodulatory therapies, it is important to characterize new cell surface receptors that modulate immunoglobulin (Ig)E-mediated basophil activation threshold.ObjectivesTo analyze the expression of CD300 receptors on human basophils and their implication in IgE-mediated basophil activation processes.MethodsBlood samples from healthy and cow´s milk allergic patients were collected through the Basque Biobank under an institutional review board-approved protocol. Peripheral blood mononuclear cells (PBMCs) were obtained by density centrifugation, basophils were purified using a specific isolation kit, and phenotypical and functional studies were performed by flow cytometry.ResultsWe demonstrate that basophils express the activating receptor CD300c, which is specifically up-regulated in response to interleukin (IL)-3. CD300c works as a co-stimulatory molecule during IgE-mediated basophil activation, as shown by a significant increase in degranulation and cytokine production when basophils are activated in the presence of CD300c cross-linking compared with the activation through the IgE/FcεRI axis alone. Co-ligation of FcεRI and CD300c increased intracellular calcium mobilization and phosphorylation of signalling intermediates evoked only by FcεRI ligation. We show that the natural ligands of CD300c, phosphatidylserine and phosphatidylethanolamine, modulate IgE-mediated basophils activation. Furthermore, we have observed that the expression of CD300c in cow´s milk allergic children is increased compared to healthy controls, and that the intensity of expression correlates with the severity of the hypersensitivity symptoms.ConclusionCD300c could be considered as a biomarker and therapeutic target in IgE-mediated allergic diseases as it seems to be involved in the modulation of IgE-mediated basophils activation.



https://ift.tt/2LM1o5P

Treatment of Atopic Dermatitis with Tralokinumab, an Anti–IL-13 Monoclonal Antibody

Publication date: Available online 12 June 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Andreas Wollenberg, Michael D. Howell, Emma Guttman-Yassky, Jonathan I. Silverberg, Christopher Kell, Koustubh Ranade, Rachel Moate, René van der Merwe
BackgroundInterleukin (IL)-13 has an important role in atopic dermatitis (AD) pathogenesis. Tralokinumab is a fully human monoclonal antibody that potently and specifically neutralizes IL-13.ObjectiveTo evaluate the efficacy and safety of tralokinumab in adults with moderate to severe AD.MethodsIn this phase 2b study (NCT02347176), 204 adults were randomized 1:1:1:1 to receive subcutaneous tralokinumab 45 mg, 150 mg, or 300 mg, or placebo, every 2 weeks for 12 weeks, with concomitant topical glucocorticoids. Co-primary endpoints were change from baseline in Eczema Area Severity Index (EASI) and percentage of participants with an Investigator's Global Assessment (IGA) response (0/1 score and reduction of two grades or more from baseline) at week 12.ResultsAt week 12, tralokinumab 300 mg significantly improved change from baseline in EASI versus placebo (adjusted mean difference [95% confidence interval]: −4.9 [–8.76 to –1.13]; P = 0.01), and a greater percentage of participants achieved an IGA response: 26.7% versus 11.8%. Greater responses were found in participants with higher concentrations of biomarkers of increased IL-13 activity. Tralokinumab 300 mg-treated participants demonstrated improvements in Scoring of Atopic Dermatitis, Dermatology Life Quality Index, and pruritus numeric rating scale (7-day mean score) versus placebo. Upper respiratory tract infection was the most frequent treatment-emergent adverse event reported as related to study drug in the placebo (3.9%) and pooled tralokinumab groups (3.9%).ConclusionsTralokinumab treatment was associated with early and sustained improvements in AD symptoms, and an acceptable safety and tolerability profile, thereby providing evidence for targeting IL-13 in AD.

Teaser

Our data provide evidence for targeting IL-13 alone in atopic dermatitis. Tralokinumab demonstrated meaningful improvements in Eczema Area and Severity Index and Investigator's Global Assessment responses, with additional benefits in participants with increased IL-13 activity.


https://ift.tt/2JOt1xM

Induction of bystander tolerance and immune deviation following Fel d 1 Peptide Immunotherapy

Publication date: Available online 12 June 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Daniel M. Moldaver, Mantej S. Bharhani, Christopher D. Rudulier, Jennifer Wattie, Mark D. Inman, Mark Larché
BackgroundTreatment of cat allergic subjects with peptides derived from Fel d 1 (the major cat allergen) ameliorated symptoms of cat allergy in phase 2 clinical trials.ObjectiveTo demonstrate that the tolerance induced by Fel d 1 peptide immunotherapy can be exploited to reduce allergic responses to a second allergen, ovalbumin (OVA), in mice dually sensitized to OVA and Fel d 1.MethodsThe induction of tolerance to OVA was achieved via a simultaneous exposure to both allergens following peptide treatment. Functional tolerance to each allergen was assessed in a model of allergic airways disease, wherein treated mice were protected from eosinophilia, goblet cell hyperplasia and Th2 cellular infiltration.ResultsSuppression of allergic responses to cat allergen challenge was associated with significant increases in CD4+CD25+Foxp3+ T cells, IL-10+ cells and CD19+IL-10+ B cells, whereas the response to OVA was associated with a marked reduction of Th2 cytokine-secreting T cells and less prominent changes in outcomes associated with immune regulation.ConclusionsThese observations suggest that immune tolerance induced by peptide immunotherapy can be used experimentally to treat an allergic response to another allergen, and that the molecular mechanisms underlying the induction of tolerance to a treatment-specific allergen and a bystander allergen may be different.

Graphical abstract

Teaser

Allergen immunotherapy is generally considered to be antigen-specific. Here we show that treatment with components of one allergen can be manipulated to induce functional tolerance to a second allergen, through subtly different mechanisms.


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PROMIDISα: a TCRα signature associated with immunodeficiencies caused by V(D)J recombination defects

Publication date: Available online 12 June 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Aurélie Berland, Jérémie Rosain, Sophie Kaltenbach, Vincent Allain, Nizar Mahlaoui, Isabelle Melki, Alice Fievet, Catherine Dubois d'Enghien, Marie Ouachée-Chardin, Laurence Perrin, Nathalie Auger, Funda Erol Cipe, Andrea Finocchi, Figen Dogu, Felipe Suarez, Despina Moshous, Thierry Leblanc, Alexandre Belot, Claire Fieschi, David Boutboul, Marion Malphettes, Lionel Galicier, Eric Oksenhendler, Stéphane Blanche, Alain Fischer, Patrick Revy, Dominique Stoppa-Lyonnet, Capucine Picard, Jean-Pierre de Villartay
- BackgroundV(D)J recombination ensures the diversity of the adaptive immune system. While its complete defect causes Severe Combined Immunodeficiency (T-B-SCID), its suboptimal activity, is associated with a broad spectrum of immune manifestations such as late onset combined immunodeficiency and autoimmunity. The earliest molecular diagnosis of these patients is required to adopt the best therapy strategy, in particular when it involves myelo-ablative conditioning regimen for hematopoietic stem cell transplantation (HSCT).- ObjectiveWe aimed at developing biomarkers based on the analysis of TCRα repertoire to assist in the diagnosis of primary immunodeficient patients (PID) with V(D)J recombination and DNA repair deficiencies.- MethodsWe used flow cytometry (FACS) analysis to quantify TCR-Vα7.2 expressing T lymphocytes in peripheral blood and developed PROMIDISα, a multiplex RT-PCR/NGS assay, to evaluate a subset of the TCRα repertoire in T lymphocytes.- ResultsThe combined FACS and PROMIDISα analyses revealed specific signatures in patients with V(D)J recombination defective PIDs or Ataxia telangiectasia/Nijmegen breakage syndromes (AT/NBS).- ConclusionAnalysis of the TCRα repertoire is particularly appropriate, in a prospective way, to identify patients with partial immune defects caused by suboptimal V(D)J recombination activity and/or DNA repair defect. It also constitutes a valuable tool for the retrospective in vivo functional validation of variants identified through exome or panel sequencing. Its broader implementation may be of interest to assist early diagnosis of patients presenting with hypomorphic DNA repair defects inclined to develop acute toxicity during pre-HSCT conditioning.



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The emerging roles of the protease allergen Der p 1 in house dust mite-induced airway inflammation

Publication date: Available online 12 June 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Andy Chevigne, Alain Jacquet




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Atypical Presentation of IgA Nephropathy Mimicking Acute Pyelonephritis

Background. IgA glomerulonephritis may present with hematuria, flank pain, and fever. This clinical presentation may be easily confused with acute pyelonephritis. Case Report. We present the case of a 25-year-old female with a typical clinical presentation for acute pyelonephritis (high fever, left flank pain, left costovertebral angle tenderness, hematuria, elevated inflammatory markers, and a hypoenhancing region in the left kidney on contrast-enhanced computed tomography). However, urine and blood cultures were both negative, the serum creatinine was elevated, and the urinalysis revealed significant proteinuria and dysmorphic red blood cells. A kidney biopsy confirmed a diagnosis of IgA nephropathy. She was treated with a combination of lisinopril and methylprednisolone, with good response. Conclusion. Gross hematuria, especially in the absence of pyuria or bacteriuria, should raise the suspicion for underlying IgA nephropathy, even if the rest of the clinical presentation is typical for a urinary tract infection. The presence of significant proteinuria, red blood cell casts, and dysmorphic red blood cells are useful clues suggesting glomerular disease.

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Gastric inlet obstruction from oesophageal cancer with internalized gastric band: a worrisome outcome?

Abstract

Band erosion is one late complication of laparoscopic adjustable gastric banding (LAGB), with the reported incidence between 1% and 28%. Far less common is oesophageal adenocarcinoma after LAGB, with only three cases previously described. Here we report a single case of complete gastric inlet obstruction with oesophageal adenocarcinoma and complete internalization of a gastric band 19 years after its placement.

https://ift.tt/2y9XiSY

Enlargement of papillary glioneuronal tumor in an adult after a follow-up period of 10 years: a case report

Abstract

Papillary glioneuronal tumor (PGNT) is a rare brain tumor grouped under mixed glioneuronal tumors according to the World Health Organization Classification of the Central Nervous System. The natural history of this pathology is not yet well documented. We report a case of PGNT that increased in size after a follow-up period of 10 years. An enlarged cyst wall and nodule showed a low intensity signal on T2*-weighted, suggesting hemorrhage during the clinical course. Characteristic pathological findings along with absence of BRAF^V600E mutation identified the tumor as PGNT. The tumor characteristics of PGNT are discussed based on the presented case, with reference to the existing literature.

https://ift.tt/2JCrgEF

Extracorporeal cardiopulmonary resuscitation in a neonate after air embolism during insufflation for laparoscopic peritoneal dialysis catheter placement

Abstract

Laparoscopy is increasingly utilized in neonatal surgery with safe and effective outcomes. Air embolism from insufflation for pneumoperitoneum is a rare but known risk of laparoscopy. Here we present a rare case of air embolism during insufflation for laparoscopic peritoneal dialysis catheter placement treated with extracorporeal cardiopulmonary resuscitation.

https://ift.tt/2JFJRvm

Perforation of a mesenteric Meckel’s diverticulum

Abstract

Meckel's diverticulum is a remnant of the embryologic omphalomeseteric duct and is a common congenital anomaly found in ~2% of the population. The clinical significance of this anomaly is that the persistent diverticulum can lead to intestinal obstruction or diverticulitis and may contain ectopic tissue which can lead to bleeding, ulceration or perforation. The classic location of a Meckel's diverticulum has been described ~40 cm from the ileocecal valve on the antimesenteric side of the distal ileum. There have only been a few documented cases of a Meckel's diverticulum found on the mesenteric border of the ileum. In this report, we describe a patient who presented with a perforated Meckel's diverticulum which was found on the mesenteric border and performed a review to determine the significance of this finding.

https://ift.tt/2JzcxdB

Surgical management of iatrogenic left main coronary artery dissection

Abstract

This is the case of a 40-year-old female diagnosed with NSTEMI. She underwent coronary angiography and suffered from type F left main coronary artery dissection. After hemodynamic stabilization, she was transferred to the nearest cardiothoracic surgery unit and underwent emergency coronary artery bypass graft (CABG) surgery. This report highlights important concepts in the management of a rare complication and emphasizes the surgical treatment decision-making, underlying an unusual but effective treatment approach.

https://ift.tt/2y70I8S

Delayed central nervous system manifestation of Chikungunya virus with magnetic resonance T2 weighted imaging high signal changes—a case report

Abstract

CHIKV is a relatively new virus and we are still learning about the illness. Very little is known about CNS its involvement and even less about its delayed or long-term manifestations if any. It therefore behoves us to consider delayed CNS involvement when assessing patients with CHIKV infections that may not have had an acute neurological manifestation at the time of diagnosis coupled with new onset neurological manifestations and MRI abnormalities. It seems likely that patients with CHIKV may experience delayed CNS manifestation of the viral infection. This report highlights the importance of a travel history when assessing patients with a neurological complaint. The pathway to best manage such cases is with repeated imaging to assess if the signal changes either progress, resolve or more importantly if there is any MRI correlation should changes in neurology develop during the surveillance period.

https://ift.tt/2Mpk2BF

Transparent Pricing Boosts Business at Outpatient Surgical Centers, Study Suggests

In a small study of ambulatory surgical centers across the country, Johns Hopkins quality care researchers found that publicly listing the prices of common operations, such as uncomplicated labor and delivery and tonsillectomies, generally increased business, revenue and patient satisfaction.

https://ift.tt/2l4NiAU

The Challenges of Cervicogenic Headache

Abstract

Purpose of Review

The purpose of this manuscript is to illuminate the diagnostic challenges in patients who present with both headache and neck pain.

Recent Findings

The differential diagnosis for headache and neck pain includes many conditions. Furthermore, cervical musculoskeletal abnormalities including head forward posture and myofascial trigger points may play an overlapping role in many of these conditions.

Summary

Multiple headache disorders may be present within the same patient. A multidisciplinary team approach addressing all components of the headache may lead to better outcomes for these patients.

https://ift.tt/2sYSmdM

Stenotrophomonas maltophilia Meningitis in a Term Healthy Neonate: A Case Report and Literature Review

Stenotrophomonas maltophilia is an environmental bacterium of growing concern due to its multidrug resistance and pathogenic potential. It is considered an opportunistic pathogen of nosocomial origin most of the time, targeting a specific patients' population. We describe a case of a previously healthy full-term neonate who was found to have S. maltophilia meningitis and was successfully treated with a combination of Trimethoprim-Sulfamethoxazole and Ciprofloxacin.

https://ift.tt/2ygRR4T

Management of adverse reactions to first-line tuberculosis antibiotics

Purpose of review Tuberculosis (TB) is the commonest infectious cause of death globally. Adverse reactions to first-line tuberculosis antibiotics are common and have a major impact on the outcomes of patients as second-line antibiotics are less effective and more toxic. The present review addresses the most recent literature regarding epidemiology, investigating reactions, and reintroducing treatment in patients who have had their treatment interrupted. Recent findings Studies have demonstrated that up to 60% of patients experience adverse reactions to TB treatment; around a third of these are idiosyncratic and may relate to immune sensitization. There is an increased risk in patients with HIV. For patients with severe cutaneous reactions patch testing has an important role; however, systemic reactions to patch testing are common in patients with HIV. In-vitro testing remains limited to specialist centers but studies have identified drug-specific lymphocyte responses in patients with cutaneous and liver reactions. Desensitization of patients with severe cutaneous reactions have been demonstrated to be possible, albeit at high risk. Summary Management of these patients remains suboptimal. Better identification of predisposing factors, such as HLA alleles, are needed to identify patients at risk. Improved in-vitro diagnostics will reduce the need to re-expose the patient to the drug and optimized desensitization regimens will improve patient safety when drugs have to be re-introduced. Correspondence to Paul Whitaker, Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, UK. Tel: +44 113 2067170; fax: +44 113 2069106; e-mail: p.whitaker@nhs.net Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Diagnostic accuracy of inferior vena caval respiratory variation in detecting fluid unresponsiveness: A systematic review and meta-analysis

BACKGROUND The accuracy of respiratory variation of the inferior vena cava (rvIVC) in predicting fluid responsiveness, particularly in spontaneously breathing patients is unclear. OBJECTIVES To consider the evidence to support the accuracy of rvIVC in identifying patients who are unlikely to benefit from fluid administration. DESIGN Systematic review and meta-analysis. DATA SOURCE We searched MEDLINE, EMBASE, Cochrane Library, KoreaMed, LILCAS and WHO Clinical Trial Registry from inception to June 2017. ELIGIBILITY CRITERIA Case–control or cohort studies that evaluated the accuracy of rvIVC in living adult humans were included. A study was included in the meta-analysis if data enabling construction of 2 × 2 tables were reported, calculated or could be obtained from authors and met the above cited criteria. RESULT A total of 23 studies including 1574 patients were included in qualitative analysis. The meta-analysis involved 20 studies and 761 patients. Pooled sensitivity and specificity of rvIVC in 330 spontaneously breathing patients were 0.80 [95% confidence interval (CI) 0.68 to 0.89] and 0.79 (95% CI 0.60 to 0.90). Pooled sensitivity and specificity of rvIVC in 431 mechanically ventilated patients were 0.79 (95% CI 0.67 to 0.86) and 0.70 (95% CI 0.63 to 0.76). CONCLUSION Decreased inferior vena caval respiratory variation is moderately accurate in predicting fluid unresponsiveness both in spontaneous and mechanically ventilated patients. The findings of this review should be used in the appropriate clinical context and in conjunction with other clinical assessments of fluid status. IDENTIFIER CRD 42017068028. Correspondence to Dr Saurabh K. Das, Department of Critical Care, Artemis Hospital, Gurgaram, Haryana, India E-mail: drsauravdas1977@gmail.com 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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Clinical and microbiological properties of Staphylococcus lugdunensis skin infections

The Journal of Dermatology, EarlyView.


https://ift.tt/2sTtPYv

Case of Gianotti–Crosti syndrome following varicella zoster virus vaccination

The Journal of Dermatology, EarlyView.


https://ift.tt/2LMXGsC

Analysis of possible structures of inducible skin‐associated lymphoid tissue in lupus erythematosus profundus

The Journal of Dermatology, EarlyView.


https://ift.tt/2sRtlSm

Impact of chronic urticaria on quality of life and work in Japan: Results of a real‐world study

The Journal of Dermatology, EarlyView.


https://ift.tt/2HK0sw9

Procalcitonin as a diagnostic indicator for systemic bacterial infections in patients with Stevens–Johnson syndrome/toxic epidermal necrolysis

The Journal of Dermatology, EarlyView.


https://ift.tt/2JCq2sL

What causes webbed toes in humans?

Some people are born with extra skin between their toes. This is called webbing, and it can be a genetic condition, although sometimes the cause is unknown. The treatment to correct webbed toes usually involves surgery to remove the extra skin. In this article, learn more about webbed toes and how to treat them.

https://ift.tt/2l7NJe3

Adverse effects of chemotherapy on the teeth and surrounding tissues of children with cancer: A systematic review with meta-analysis

Publication date: August 2018
Source:Oral Oncology, Volume 83
Author(s): Dan Mike Busenhart, Juliane Erb, Georgios Rigakos, Theodore Eliades, Spyridon N. Papageorgiou
ObjectiveThe aim of this systematic review was to assess evidence on dental adverse effects associated with chemotherapy (CH) administered to children with cancer.Material and methodsEight databases were searched without restrictions up to March 2017 for studies reporting on dental effects of CH administered for childhood cancer. After elimination of duplicates, data extraction, and risk of bias assessment according to the Cochrane guidelines, random-effects meta-analyses of Relative Risks (RR) and Mean Differences (MD) and their 95% Confidence Intervals (CI) were performed, followed by meta-regression and sensitivity analyses.ResultsThe literature search identified a total of 15 non-randomized case-control studies including at least 2315 patients (mean age at diagnosis or CH of 6.6 years; 36% male) followed for up to 22.9 years after CH. Meta-analysis indicated that CH was associated with increased risk for tooth agenesis compared to healthy controls (RR = 2.47; 95% CI = 1.30–4.71; P = 0.006). This translated to every seventh child with CH having agenesis of at least one tooth that would not otherwise have. Additionally, CH was significantly associated with increased risk of tooth discoloration, arrested tooth development, enamel hypoplasia, microdontia, premature apexification, and decreased salivary flow rate, as well as worse oral hygiene and greater caries experience compared to controls. However, the strength of evidence was very low due to the inclusion of non-randomized study designs with high risk of bias.ConclusionsCurrent evidence from childhood cancer survivors indicates that chemotherapy is associated with considerable dental adverse effects that might be associated with greater burden of disease and treatment costs.



https://ift.tt/2Mo5vWQ

Swallowing beyond six years post (chemo)radiotherapy for head and neck cancer; a cohort study

Publication date: August 2018
Source:Oral Oncology, Volume 83
Author(s): J.M. Patterson, E. McColl, P.N. Carding, J.A. Wilson
ObjectiveThe objective of this prospective study is to report on long-term swallowing outcomes in a group of head and neck cancer patients following (chemo) radiotherapy treatment, assess for changes over time and identify any predictor variables of outcome.Materials and methods42 survivors were assessed on four swallowing measures and followed up from pre-treatment to six years post 3D (chemo) radiotherapy. Measures included a swallowing specific QOL questionnaire, penetration-aspiration scale, dietary restrictions and a timed water swallow test.ResultsAt six years, 71% reported swallowing difficulties on the questionnaire. One fifth of patients had aspiration, with a raised risk of chest infection. Seven percent required a laryngectomy for a dysfunctional larynx. Despite this, half the group reported having a normal diet. There was variation in the pattern of change between one and six years. A significant deterioration was only observed in the timed water swallow test (p < 0.0001). Larger radiotherapy volume predicted this outcome. None of the variables tested predicted outcome for the other three swallow measures.ConclusionPatients continue to report swallowing difficulties at six years, with a proportion having persistent aspiration. Further work on identifying the risk factors associated with aspiration tolerance, aspiration pneumonia, prevention and management is warranted. Long-term dysphagia remains a significant and serious concern following (chemo) radiotherapy for HNC and swallowing outcomes should continue to be monitored over time.



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Risk and survival of patients with medullary thyroid cancer: National perspective

Publication date: August 2018
Source:Oral Oncology, Volume 83
Author(s): Zaid Al-Qurayshi, Helmi Khadra, Kristi Chang, Nitin Pagedar, Gregory W. Randolph, Emad Kandil
BackgroundMedullary thyroid carcinoma (MTC) is a neuroendocrine tumor account for 1–2% of thyroid cancer. In this study, we aim to examine the characteristics and survival of patients with MTC.MethodsA retrospective cohort study utilizing the National Cancer Data Base, 2004–2014. The study population included adults with either MTC (cases) or with differentiated thyroid cancer (DTC) (controls).ResultsA total of 2,776 MTC and 171,631 DTC patients were included. The median follow-up time for MTC was 55.5 months (interquartile range: 31.2–84.6 months). As compared to DTC, patients with MTC were more likely to be ≥ 45-year old, male, and Black (p < 0.001). Neck dissection improved survival in patients with stage III [HR: 0.26, 95%CI: (0.10, 0.64), p = 0.004]. In patients with stages I and II, neck dissections did not add significant survival benefit to thyroidectomy [stage I, HR: 1.00, 95%CI: (0.54, 1.86), p = 0.99],[stage 2, HR: 0.72, 95%CI: (0.40, 1.29), p = 0.27]. However, neck dissections upgraded staging to N1A and N1B in 17.7% and 14.3% of patients with clinically N0 neck, respectively. In stage IV, thyroidectomy with neck dissection had the highest 5-year survival (84.9%), but this was not significantly different from thyroidectomy alone (84.1%); Patients who had thyroidectomy and EBRT with or without neck dissection had a lower survival than thyroidectomy alone (p < 0.01).ConclusionsNeck dissection performed on patients with clinically N0 neck, is important for accurate staging and associate with improved survival in advanced stages. Thyroidectomy and neck dissection in stage IV not only have palliative role but also add survival advantage.



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Intramural Bowel Hematoma Presenting as Small Bowel Obstruction in a Patient on Low-Molecular-Weight Heparin

There is increasing use of low-molecular-weight heparin (LMWH) for treatment of pediatric thromboembolic disease as it has been shown to be safe and effective. It has several advantages over unfractionated heparin, such as reduced need for monitoring, easier route of administration, decreased risk of heparin-induced thrombocytopenia, and lack of drug-drug interactions. Nevertheless, LMWH still poses a bleeding risk as with any anticoagulant therapy. We present the case of a 4-year-old boy who was placed on LMWH for a catheter-related deep venous thrombosis in the setting of intractable seizures and subsequently developed a small bowel obstruction secondary to a suspected intussusception. He underwent exploratory laparotomy and was found to have an intramural bowel hematoma. Prior to this bleed, the patient had been monitored daily, and his anti-Xa levels were found to be in the therapeutic range. This case highlights the need for a high index of suspicion for spontaneous bleeding even in the setting of therapeutic anti-Xa levels.

https://ift.tt/2y2IOnM

Mechanisms of fibronectin-binding protein A (FnBPA110–263) vaccine efficacy in Staphylococcus aureus sepsis versus skin infection

Publication date: Available online 12 June 2018
Source:Clinical Immunology
Author(s): Rui Zhang, Sun Li, Xiao-Kai Zhang, Yu Wang, Liu-Yang Yang, Hao Zeng, Da-Peng Yan, Quan-Ming Zou, Qian-Fei Zuo
Increasing rates of life-threatening infections and decreasing susceptibility to antibiotics urge an effective vaccine targeting Staphylococcus aureus. Here we investigate the role of cellular immunity in FnBPA110–263 mediated protection in Staphylococcus aureus infection. This study revealed FnBPA110–263 broadly protected mice from seven FnBPA isotypes strains in the sepsis model. FnBPA110–263 immunized B-cell deficient mice were protected against lethal challenge, while T-cell deficient mice were not. Reconstituting mice with FnBPA110–263 specific CD4+ T-cells conferred antigen specific protection. In vitro assays indicated that isolated FnBPA110–263 specific splenocytes from immunized mice produced abundant IL-17A. IL-17A deficient mice were not protected from a lethal challenge by FnBPA110–263 vaccination. Moreover, neutralizing IL-17A, but not IFN-γ,reverses FnBPA110–263-induced protective efficacy in sepsis and skin infection model. These findings suggest that IL-17A producing Th17 cells play an essential role in FnBPA110–263 vaccine-mediated defense against S. aureus sepsis and skin infection in mice.



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