Atypical chest pain in a patient with hydatid cyst of the interventricular septum

We report a 57-year-old man presenting with symptoms of sharp pricking, exertional retrosternal chest pain multiple times, each episode lasting for a few seconds. On evaluation, the ECG of the patient showed normal sinus rhythm with T wave inversions in leads V1–V3. Troponin T test was negative. Transthoracic echocardiography showed a globular mass in the interventricular septum. Cardiac MRI was suspicious of the lesion to be a hydatid cyst. Surgical excision of the lesion followed by histopathology was confirmatory of hydatid cyst.

https://ift.tt/2LTh4UI

Dengue fever with encephalitis: a rare phenomenon

The clinical profile and presentation of patients with dengue fever may differ from asymptomatic infection to the dreadful complications like dengue shock syndrome. However, neurological complications are very rare. Dengue encephalitis occurs by a direct involvement of central nervous system by the dengue virus which is an extremely rare complication. A 33-year-old man presented with fever, vomiting and severe headache. He had one episode of generalised tonic-clonic seizure followed by an altered sensorium on the day of admission to the hospital. The diagnosis of dengue fever was confirmed by dengue serology (IgM) and (NS1) antigen assay. MRI brain was suggestive of encephalitis. Thus, the patient was treated symptomatically and discharged in stable condition with minimal neurological deficit.

https://ift.tt/2t1hfXb

Rotator cuff tear following long-standing axillary neuropathy in a female motocross racer

A 'terrible triad' of anterior shoulder dislocation, axillary nerve damage and rotator cuff tear has been previously described. However, we are unaware of any report of anterior shoulder dislocation, humeral fracture, axillary neuropathy and subsequent rotator cuff tear requiring surgery when the axillary neuropathy was deemed permanent. We report the case of a 20-year-old woman who fell in a motocross accident and had an anterior shoulder dislocation, humeral fracture and axillary neuropathy. The fracture was treated surgically with open reduction and internal fixation. The axillary nerve injury was ultimately permanent. Thirteen months after the motocross accident, the patient sustained a rotator cuff tear from seemingly minor trauma. However, several months of aggressive physical therapy preceded the rotator cuff tear. The tear was repaired and the patient was followed for 5 years after the initial injury. She returned to competing in motocross, even though the axillary neuropathy remained complete and permanent.

https://ift.tt/2LVOBxG

Thiazide diuretics-associated skin rash

Description 

A 50-year-old man with a history of hypertension and dyslipidaemia, both controlled with oral medications, was admitted to the emergency department due to a sudden onset of pruritus 2 days before, which would not improve with the application of topic antihistamines prescribed by his family doctor. A maculopapular, symmetric rash with plaques located on sun-exposed areas (hands, forearms, face and upper torso, sparing the abdomen, lower limbs and arm flexures) had appeared a few hours before coming to the emergency department (figures 1 and 2). The patient denied any sort of respiratory distress, as well as prolonged exposure to sunlight, history of drug allergies or having seen anyone in his family with the same problem before. The only recent change had been to his hypertension medication in the last 13 days, when hydrochlorothiazide was combined with his usual medication (losartan), which he had been taking for the...

https://ift.tt/2t0O0Uk

Transdermal rotigotine patch in Parkinsons disease with a history of intestinal operation

A 42-year-old Japanese man with a history of small intestine resection and familial Mediterranean fever was referred to our hospital for a second opinion on parkinsonism. At the age of 35, the patient attended a hospital due to impaired left-hand movement and resting tremor. He was previously diagnosed with multiple system atrophy based on the lack of effectiveness of levodopa treatment. With suspicion of malabsorption due to his history of ileostomy, a levodopa challenge test with levodopa intravenous infusion was conducted, and revealed a 65% improvement in Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale part III. Therefore, diagnosis of Parkinson's disease was made and a transdermal rotigotine patch was selected as a treatment. This treatment dose-dependently improved the patient's symptoms. The transdermal drug delivery should be considered when patients show dose failure due to malabsorption.

https://ift.tt/2LUyuAf

Delayed presentation of iatrogenic splenic injury 21 days after laparoscopic donor left nephrectomy

We report the case of a 46-year-old woman who had presented with left-sided abdominal pain 21 days after undergoing a left-sided laparoscopic nephrectomy for donation. Initial haemoglobin and haematocrit levels were within normal range, and vital signs on admission were unremarkable. Significant intra-abdominal pathology was not suspected; however, inpatient CT scan of the abdomen showed a posterolateral subcapsular splenic haematoma with free abdominal fluid. Initial trial of conservative management was not successful as the patient became hypotensive on the third day of admission with a sudden decrease in haemoglobin and haematocrit. The patient was immediately taken to theatre for laparotomy and splenectomy. Recovery was uneventful and was discharged home on the fifth postoperative day. In this article, we aim to discuss several important clinical lessons involving iatrogenic injury of the spleen, its management, and diagnosis of acute and severe haemorrhage.

https://ift.tt/2JHrWbP

Paraneoplastic cerebellar degeneration in a patient with anaplastic non-Hodgkins lymphoma

A 31-year-old man presented with a subacute cerebellar syndrome of unknown aetiology. Investigations including a paraneoplastic antibody screen were negative and a working diagnosis of possible vasculitis was concluded. After 1 month, he re-presented with worsening of his symptoms and a neck lump. He was diagnosed with anaplastic lymphoma kinase, negative non-Hodgkin's lymphoma and paraneoplastic cerebellar syndrome. A more extensive paraneoplastic antibody screen found patient to be Tr (delta/notch-like epidermal growth factor-related receptor) antibody positive. After a period of chemotherapy and steroid treatments, his symptoms are now stable in terms of cerebellar function. This case report summarises a very rare diagnosis of paraneoplastic cerebellar degeneration with a positive onconeuronal antibody associated with anaplastic non-Hodgkin's lymphoma.

https://ift.tt/2LXgVjh

Ectopic varices: a potential cause of gastrointestinal bleeding in patients with portal hypertension

A newly diagnosed 53-year-old woman with cirrhosis has repeated gastrointestinal bleeding with resulting symptomatic anaemia. She underwent routine diagnostic endoscopic evaluation without localisation of the aetiology of her bleed. Ultimately, she was found to have ectopic varices in the small bowel as a result of underlying high portal pressures. She underwent transjugular intrahepatic portosystemic shunt for portal system decompression with resolution in her bleeding.

https://ift.tt/2JDRHcO

Lymphedema secondary to limited cutaneous systemic sclerosis

Systemic sclerosis (SSc) is an autoimmune connective tissue disease characterised by vascular abnormalities, immune system activation and fibrosis. Lymphatic involvement in SSc was described more recently and starts in early stages. This report describes a 46-year-old patient who developed over the last 2 years asymmetric lymphedema in lower extremities. Compromise in lymphatic drainage was confirmed by lymphoscintigraphy. She also presented Raynaud's phenomenon, a scleroderma pattern in nailfold capillaroscopy, cutaneous thickening and anticentromere antibodies, which together resulted in a new diagnosis of limited cutaneous SSc. Treatment with methotrexate, prednisolone and lymphatic drainage resulted in lymphedema improvement. To our knowledge, this is the first case of grade 2 lymphedema in the setting of anticentromere-positive limited cutaneous SSc. We highlight the importance of considering rheumatic diseases in the differential diagnosis of lymphedema.

https://ift.tt/2LRgXcj

Graves disease presenting as severe postpartum pruritus

A 39-year-old multigravida woman presented 3 weeks postpartum with worsening generalised pruritus without primary rash. Workup was significant for cholestasis and undiagnosed Graves' disease. She began to have symptomatic relief after starting methimazole, and liver function tests normalised as she became euthyroid.

https://ift.tt/2t0NOV6

Closed-loop small bowel obstruction from lateral trocar site hernia following robotic sigmoid resection

Description

A 67-year-old man with medical history significant for hypertension and hyperlipidaemia was found on screening colonoscopy to have a large, polypoid adenomatous polyp of the distal descending colon not amenable to colonoscopic resection. He underwent a robotic sigmoid colon resection with primary anastomosis. Postoperatively the patient developed persistent abdominal distention, nausea and had no passage of flatus or bowel movements after 7 days which was initially attributed to ileus. Cross-sectional CT revealed a closed-loop small bowel obstruction secondary to an incarcerated hernia at the right lateral 8 mm robotic trocar site with surrounding subcutaneous emphysema (figure 1). On physical examination, there was no palpable bulge or overlying erythema along the previous incision. The patient was brought back to the operating room and underwent a diagnostic laparoscopy utilising the prior robotic incisions. On exploration, the incarcerated small bowel loop was easily reduced with gentle traction and appeared...

https://ift.tt/2LWCqR0

Common femoral artery aneurysm repair using bifurcated graft

Common femoral artery aneurysms are rare, and surgical repair is indicated if they are significantly large, or if they are symptomatic (thrombosis causing limb ischaemia and compression of surrounding structures). Synthetic grafts are preferred, especially in cases involving large aneurysms, or the bifurcation of the common femoral artery. We present a case of bilateral common femoral artery aneurysms extending into the bifurcation repaired using a synthetic graft which is traditionally used for an axillobifemoral bypass. This technique was employed due to the specific anatomical relationship between the profunda femoris and the superficial femoral artery in our patient. We will also review the current literature on the operative approaches to repair of common femoral artery aneurysms.

https://ift.tt/2t0NHZG

Prenatal omega-3 LCPUFA and symptoms of allergic disease and sensitization throughout early childhood – a longitudinal analysis of long-term follow-up of a randomized controlled trial

Randomized controlled trials of prenatal omega (ω-3) long chain polyunsaturated fatty acid (LCPUFA) supplementation are suggestive of some protective effects on allergic sensitization and symptoms of allergic ...

https://ift.tt/2JHpK45

Debates in Allergy Medicine: Does oral immunotherapy shorten the duration of milk and egg allergy? The pro argument

The development of oral tolerance or food allergy is an active process, related to dynamic interactions between host immune cells, microbiome, dietary factors, and food allergens. Oral tolerance is the default...

https://ift.tt/2LV9jh7

Debates in Allergy Medicine: Oral immunotherapy shortens the duration of milk and egg allergy - the con argument

Oral immunotherapy (OIT) has been shown to be effective for inducing desensitization in children with cow's milk and egg allergy. In contrast, there is limited evidence that OIT can induce tolerance or sustain...

https://ift.tt/2JHMf90

Effects of anti-allergic drugs on T cell-mediated nasal hyperresponsiveness in a murine model of allergic rhinitis

Publication date: Available online 15 June 2018
Source:Allergology International
Author(s): Tomoe Nishimura, Osamu Kaminuma, Mayumi Saeki, Noriko Kitamura, Minoru Gotoh, Akio Mori, Takachika Hiroi
BackgroundWe have recently demonstrated that T cell-mediated nasal hyperresponsiveness (NHR) is a representative pathophysiological feature of allergic rhinitis (AR). Although several anti-allergic drugs are used for the treatment of AR, the efficacy of these drugs on T cell-mediated NHR have not been elucidated. In these studies we investigated the effects of dexamethasone (Dex), montelukast (Mk), and chlorpheniramine (Chl) on NHR in antigen-immunized and antigen-specific Th2 cell-transferred mice.MethodsOVA-immunized BALB/c mice were treated with Dex, Mk, or Chl and challenged intranasally with OVA. We then assessed NHR, the number of inflammatory cells in the nasal lavage fluid (NALF), mRNA expression of Th2 cytokines in the nasal tissue, the population of CD3⁺CD4⁺ cells in the nasal lymphoid tissue (NALT), and antigen-specific serum IgE and IgG levels. Antigen-induced NHR and changes in antigen-specific T cells in the NALT were investigated in OVA-specific Th2 cell-transferred mice.ResultsDex significantly suppressed antigen-induced NHR, inflammatory cell infiltration, and IL-4, IL-5, IL-6, and IL-13 expression in immunized mice. Chl was completely ineffective, and only IL-13 expression was suppressed by Mk. None of these drugs affected IgE and IgG production. Antigen-induced NHR and the increase in antigen-specific T cells in the NALT of Th2 cell-transferred mice were inhibited by Dex, but not by Mk or Chl.ConclusionsSteroids are effective for the reduction of NHR in AR by suppressing the accumulation of inflammatory cells, especially antigen-specific T cells.



https://ift.tt/2HRBz1z

A questionnaire using vocal symptoms in quality control of phonosurgery: vocal surgical questionnaire

Quality control after phonosurgery is important and may be time consuming. Often questionnaires focusing on quality of life are applied. We aimed at investigating the use of organ specific symptoms, such as ho...

https://ift.tt/2LWt47Q

Association Between Thyroid Dysfunction and Lipid Profiles Differs According to Age and Sex: Results from the Korean National Health and Nutrition Examination Survey

Thyroid, Ahead of Print.


https://ift.tt/2HRZpdO

Identification of complement inhibitory activities of two chemotherapeutic agents using a high-throughput cell imaging-based screening assay

Publication date: September 2018
Source:Molecular Immunology, Volume 101
Author(s): Lingjun Zhang, Yuriy Fedorov, Drew Adams, Feng Lin
Excessive complement activation contributes significantly to the pathogeneses of various diseases. Currently, significant developmental research efforts aim to identify complement inhibitors with therapeutic uses have led to the approval of one inhibitor for clinical use. However, most existing complement inhibitors are based on monoclonal antibodies, which have many drawbacks such as high costs and limited administration options. With this report, we establish an inexpensive, cell imaging-based high-throughput assay for the large-scale screening of potential small molecule complement inhibitors. Using this assay, we screened a library containing 3115 bioactive chemical compounds and identified cisplatin and pyridostatin as two new complement inhibitors in addition to nafamostat mesylate, a compound with known complement inhibitory activity. We further demonstrated that cisplatin and pyridostatin inhibit C5 convertases in the classical pathway of complement activation but have no effects on the alternative pathway of complement activation. In summary, this work has established a simple, large-scale, high-throughput assay for screening novel complement inhibitors and discovered previously unknown complement activation inhibitory activities for cisplatin and pyridostatin.



https://ift.tt/2JOhYRH

Regulatory T cell subsets are differentially dependent on CD28 for their proliferation

Publication date: September 2018
Source:Molecular Immunology, Volume 101
Author(s): Ei Wakamatsu, Hiroki Omori, Shizuka Ohtsuka, Shuhei Ogawa, Jonathan M. Green, Ryo Abe
It is thought that CD28 plays a crucial role in the maintenance of regulatory T cell (Treg) pool size through promoting the development and proliferation of these cells. However, recently we found that the dependency on CD28 co-stimulation for their development is different between Treg subsets, thymus-derived Tregs (tTregs, CD28-dependent) and peripherally-derived Tregs (pTregs, CD28-independent), suggesting that CD28 may also have differential influences on the homeostasis of each Treg subset. Here, we demonstrated that both Treg subsets were reduced in secondary lymphoid organs of CD28 deficient mice, and that this reduction was due to impaired proliferation in both Treg subsets by the intrinsic CD28 defect. However, we found that the massive proliferation of both Treg subsets under lymphopenic condition was regulated by CD28, whereas the proliferative activity of tTregs but not pTregs in the steady state was dependent on CD28. Also, experiments using mutant CD28 knock-in mice revealed that proliferation of pTregs under lymphopenic condition required only the Lck-NFκB pathway of CD28, whereas tTregs required an additional unknown pathway. These findings indicate that the dependency on CD28 for proliferation in each Treg subset differs depending on the environment.



https://ift.tt/2MubWHL

Orexin A prevents degradation of the articular matrixes in human primary chondrocyte culture

Publication date: September 2018
Source:Molecular Immunology, Volume 101
Author(s): Dong Wang, Hui Ren, Chunlong Li, Fanghe Liu, Guangzhi Wang, Fengjun Shi, Yuanxin Sun
Excessive production of pro-inflammatory cytokines such as interleukin-1β (IL-1β) plays a key role in the pathophysiological development of osteoarthritis (OA). Orexin A is an important peptide of hypothalamic origin, which has displayed its multiple biological functions in several chronic diseases via activation of its specific G-protein coupled receptors, orexin-1 receptor (OX1R) and orexin-2 receptor (OX2R). In this study, we aimed to characterize the protective effects of orexin A against IL-1β-induced degradation of articular cartilage matrixes in human chondrocytes. Our results indicate that OX1R but not OX2R was expressed in human chondrocytes. We also found that the expression of OX1R was significantly lower in chondrocytes from OA patients, and that treatment with IL-1β decreased the expression of OX1R in a dose-dependent manner. The presence of orexin A ameliorated IL-1β-induced degradation of type II collagen and aggrecan, the two major components of articular cartilage matrixes. Our results also show that orexin A prevented IL-1β-induced expression of catabolic enzymes such as MMP-3, MMP-13, ADAMTS-4, and ADAMTS-5. Mechanistically, orexin A treatment abolished activation of the transcriptional factor NF-κB via inhibition of KKα/IκB-α phosphorylation and IκB-α degradation. These findings suggest that orexin A might act as an effective therapeutic agent for the treatment of OA.



https://ift.tt/2tegTLQ

The Challenges of Preventing Food Allergy: lessons learned from LEAP and EAT

Publication date: Available online 15 June 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Helen Fisher, George Du Toit, Henry T. Bahnson, Gideon Lack




https://ift.tt/2JFNwgx

Hymenoptera Venom Immunotherapy: Past, Present, and Future

Publication date: Available online 15 June 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): John Oppenheimer MD, David BK Golden MD




https://ift.tt/2yeUDr9

Vitamin D insufficiency, TH2 cytokines, and allergy markers in Puerto Rican children with asthma

Publication date: Available online 15 June 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Yueh-Ying Han, Erick Forno, Nadia Boutaoui, Glorisa Canino, Juan C. Celedón




https://ift.tt/2MstjIV

Treatment of giant cervico-mediastinal lymphatic malformations: a case series

Lymphatic malformations are histologically benign vascular structures that vary in anatomic lesion and size. Extensive head and neck lymphatic malformations may be life-threatening. In the present study, we de...

https://ift.tt/2JVCGlT

A pilot study to investigate the therapeutic effect of Valsalva maneuver on otitis media with effusion in adults

This pilot study was performed to investigate the therapeutic effect of Valsalva maneuver on otitis media in adults and to evaluate the prognostic factors for the good response.

https://ift.tt/2taZYKo

Hydrochlorothiazide use and risk of Merkel cell carcinoma and malignant adnexal skin tumors: A nationwide case-control study

Hydrochlorothiazide use has been associated with markedly increased risk of squamous cell carcinoma. No previous studies have investigated the association between hydrochlorothiazide use and the risk of Merkel cell carcinoma (MCC) and malignant adnexal skin tumors (MAST).

https://ift.tt/2JNtgFR

Fibroproliferative Genes are Preferentially Expressed in Central Centrifugal Cicatricial Alopecia

CCCA and FPDs both commonly affect patients of African descent.Critical genes implicated in FPDs are upregulated in CCCA affected scalp tissue.Anti-fibrotic therapies may play a role in the treatment of CCCA.

https://ift.tt/2sZI4ec

Motorized 0.8 mm micro-punch grafting for refractory vitiligo: A retrospective study of 230 cases

Punch grafting for vitiligo has been time-consuming and may result in cobblestone-like appearances. We devised a motorized 0.8 mm micro-punch grafting procedure to overcome these limitations.

https://ift.tt/2tcxArn

Lipofibromas are not related to diabetes mellitus or obesity

https://ift.tt/2t0URx4

Reply to “Wound Management Strategies in Stevens-Johnson syndrome/Toxic Epidermal Necrolysis: An unmet need”

https://ift.tt/2t9CgOB

Wound Management Strategies in Stevens-Johnson syndrome/Toxic Epidermal Necrolysis: An unmet need

https://ift.tt/2Mviar4

Regional Anesthesia: What We Need to Know in the Era of Enhanced Recovery After Surgery Protocols and the Opioid Epidemic

Publication date: Available online 15 June 2018
Source:Anesthesiology Clinics
Author(s): Lee A. Fleisher




https://ift.tt/2lekK8k

Minimizing the Effects of Stress in Kids

Some of the joys of childhood are going to school, participating in fun activities, and attending sporting events. However, a hectic pace can take a toll on a child. Here are some of the warning signs that indicate your child may be suffering from toxic stress and some preventative measures proven to be effective.

The post Minimizing the Effects of Stress in Kids appeared first on ChildrensMD.

https://ift.tt/2Mr8jCm

Triple thrombophilic simultaneous mutations in patients after bariatric surgery: is there a role for screening in the Eastern Mediterranean?

Abstract

Background and purpose: Thrombophilia is a hypercoagulable state that predisposes to thrombosis. Several genetic risk factors have been shown to predispose to thromboembolic events. Homozygosity to a thrombophilic mutation certainly predisposes the affected patient to more serious symptoms. Materials and methods: Here we present a case of a 56-year-old male patient who underwent sleeve gastrectomy for morbid obesity, presenting to our institution with abdominal pain. Investigations revealed thrombosis of the splenic, axillary vein as well as the right pulmonary artery. The patient was found to have triple thrombophilic mutations. Results: To our knowledge, this is the first reported case of three specific simultaneous thrombophilic mutations in a patient from the Eastern Middle East. Conclusion: We suggest a role for screening for thrombophilic mutations in the Eastern Mediterranean patients undergoing bariatric surgeries for morbid obesity due to the increased risk of thrombosis in this group of patients

https://ift.tt/2ye6Z2R

Diagnosis of human immunodeficiency virus following femoral head harvest post-total hip arthroplasty

Abstract

Elective total hip arthroplasty (THA) is a routine procedure. Intraoperative harvesting of excised femoral heads for the purpose of donation during this procedure has become standard practice, in response to increasing bone allograft demand. Robust patient screening and femoral head analysis typically occurs, to minimize the risk of disease transmission to any potential recipient. Screening for human immunodeficiency virus (HIV), a virus normally first diagnosed through serological testing, makes up part of this process. This case describes a 43-year-old male who underwent elective THA, with subsequent analysis of the excised femoral head at time of screening revealing a diagnosis of HIV, a condition previously never detected in the donor. First diagnosis of HIV from bone is exceedingly rare, with this case illustrating an unusual diagnostic pathway of a well-understood condition, as well as representing an unfamiliar outcome following a common surgical intervention.

https://ift.tt/2Mr4zki

Benign inverted papilloma at bladder neck causing acute urinary retention

Abstract

Inverted papilloma of the urinary tract is a rare benign lesion. A 59-year-old male who presented with the chief complaint of gross hematuria and acute urinary retention is described. Cystoscopy revealed a solitary, papillary tumor at the bladder neck. Transurethral resection was performed, and histological examination revealed a pathological diagnosis of inverted papilloma. Following resection, the patient was able to void without difficulty. This is an interesting case of acute urinary retention secondary to an inverted papilloma at the bladder neck causing intermittent outlet obstruction, and we review the literature on inverted papilloma of the bladder.

https://ift.tt/2JNeMpo

Management of dermatofibrosarcoma protuberans of the face using lower trapezius musculocutaneous pedicle flap reconstruction: a case report

Abstract

Dermatofibrosarcoma protuberans (DFSP) is a rare neoplasm which represents <0.1% of all tumors but it is considered the most common skin sarcoma. It is a slow-growing tumor that arises from the dermis and invades deeper tissues. The precise origin of DFSP is not well known. It is most frequently seen on the trunk, extremities, and head and neck. The standard treatment of the localized huge DFSP consists of a wide local surgical resection with recommended surgical margins of 2–3 cm. Local recurrence after incomplete excision is common. We present a case of 35-year-old man with enormous bulky mass on the face. Upon histological examination, the diagnosis of DFSP was made, and the patient underwent en bloc wide local excision of the mass followed by the use of Trapezius musculocutaneous pedicle flap reconstruction. On 32 months follow-up, no recurrence has been reported.

https://ift.tt/2MuzbSc

Unique surgical approach to a twisted ileal-anal pouch

Abstract

Total proctocolectomy with ileal pouch-anal anastomosis can restore gastrointestinal continuity in patients requiring colectomy for ulcerative colitis, however, it can be associated with high morbidity. Reoperation for pouch-related complications is technically challenging and often leads to deterioration of pouch function or need for permanent stoma. We report a case of acute on chronic small bowel obstruction secondary to a 360-degree twist in the small bowel introduced during creation of the ileal-anal pouch. Our novel approach at repair has not been reported in past literature which included resection and re-anastomosis of the small bowel proximal to the pouch allowing for pouch salvage with return to function.

https://ift.tt/2JOjRy1

A Registry to Evaluate the Flexitouch System and Flexitouch Plus for Treatment of Head and Neck Lymphedema

Condition:   Head and Neck Lymphedema
Intervention:   Device: Flexitouch System with Head and Neck Garments
Sponsor:   Tactile Medical
Not yet recruiting

https://ift.tt/2sX3bhs

Metallic Taste Before, During and After Treatment of Head and Neck Cancer

Condition:   Metallic Taste
Intervention:   Biological: bovine lactoferrin
Sponsor:   Centre Hospitalier de Valence
Recruiting

https://ift.tt/2JOiwXS

Fluorescence Endoscopy of Esophageal Carcinoma

Condition:   Esophageal Cancer
Interventions:   Drug: Bevacizumab-IRDye800CW;   Device: Molecular Fluorescence Endoscopy platform
Sponsor:   University Medical Center Groningen
Not yet recruiting

https://ift.tt/2sZKYje

Hypnosis and Meditation for Cancer Pain

Conditions:   Pain Related to Cancer;   Cancer of Head and Neck
Interventions:   Behavioral: Hypnosis;   Behavioral: Mindfulness
Sponsor:   VA Puget Sound Health Care System
Recruiting

https://ift.tt/2JNG2UR

New Strategy of Improving Treatment Outcome and Larynx-preservation Rate in Locally Advanced Hypopharyngeal Carcinoma

Condition:   Hypopharyngeal Cancer
Interventions:   Drug: Induction CT+ CRT group;   Radiation: Concurrent CRT group
Sponsor:   Chinese Academy of Medical Sciences
Recruiting

https://ift.tt/2sXmdUy

SHR-1210 in Recurrent/Metastatic Nasopharyngeal Carcinoma Who Have Received Previous At Least Two Lines of Chemotherapy.

Condition:   Nasopharyngeal Carcinoma
Intervention:   Drug: SHR-1210
Sponsor:   Jiangsu HengRui Medicine Co., Ltd.
Not yet recruiting

https://ift.tt/2takPxf

The Efficacy and Safety of UGN-102 as a Chemical Ablation Agent in Patients With LG NMIBC at Intermediate Risk of Recurrence

Conditions:   Bladder Cancer;   Urothelial Carcinoma;   Urothelial Carcinoma Bladder
Intervention:   Drug: UGN-102
Sponsor:   UroGen Pharma Ltd.
Not yet recruiting

https://ift.tt/2MvNt4H

Muscle Fiber Hypertrophy and Myonuclei Addition: A Systematic Review and Meta-analysis

Introduction The myonuclear domain theory postulates that myonuclei are added to muscle fibers when increases in fiber cross-sectional area (i.e., hypertrophy) are ≥26%. However, recent studies have reported increased myonuclear content with lower levels (e.g., 12%) of muscle fiber hypertrophy. Purpose This study aimed to determine whether a muscle fiber hypertrophy "threshold" is required to drive the addition of new myonuclei to existing muscle fibers. Methods Studies of resistance training endurance training with or without nutrient (i.e., protein) supplementation and steroid administration with measures of muscle fiber hypertrophy and myonuclei number as primary or secondary outcomes were considered. Twenty-seven studies incorporating 62 treatment groups and 903 subjects fulfilled the inclusion criteria and were included in the analyses. Results Muscle fiber hypertrophy of ≤10% induces increases in myonuclear content, although a significantly higher number of myonuclei are observed when muscle hypertrophy is ~22%. Additional analyses showed that age, sex, and muscle fiber type do not influence muscle fiber hypertrophy or myonuclei addition. Conclusions Although a more consistent myonuclei addition occurs when muscle fiber hypertrophy is >22%, our results challenge the concept of a muscle hypertrophy threshold as significant myonuclei addition occurs with lower muscle hypertrophy (i.e.,

https://ift.tt/2ykd1iy

The Immediate Effect of Foot Orthoses on Subtalar Joint Mechanics and Energetics

Purpose Foot orthoses maybe used in the management of musculoskeletal disorders related to abnormal subtalar joint (STJ) pronation. However, the precise mechanical benefits of foot orthoses for preventing injuries associated with the STJ are not well understood. The aim of this study was to investigate the immediate effect of foot orthoses on the energy absorption requirements of the STJ and subsequently tibialis posterior (TP) muscle function. Methods Eighteen asymptomatic subjects with a pes planus foot posture were prescribed custom-made foot orthoses made from a plaster cast impression. Participants walked at preferred and fast velocities barefoot, with athletic footwear and with athletic footwear plus orthoses, as three-dimensional motion capture, force data, and intramuscular electromyography of the TP muscle were simultaneously collected. Statistical parametric mapping was used to identify time periods across the stride cycle during which footwear with foot orthoses significantly differed to barefoot and footwear only. Results During early stance, footwear alone and footwear with orthoses significantly reduced TP muscle activation (1%–12%), supination moments (3%–21%), and energy absorption (5%–12%) at the STJ, but had no effect on STJ pronation displacement. Conclusions The changes in TP muscle activation and STJ energy absorption were primarily attributed to footwear because the addition of foot orthoses provided little additional effect. We speculate that these results are most likely a result of the compliant material properties of footwear. These results suggest that athletic footwear may be sufficient to absorb energy in the frontal plane and potentially reducing any benefit associated with the addition of foot orthoses.

https://ift.tt/2LQ13Py

Let the Pleasure Guide Your Resistance Training Intensity

Purpose The purpose of this study was to evaluate the feasibility and reliability of the Feeling Scale (FS) to self-regulate resistance training (RT) intensity. Methods Sixteen sedentary men (39.7 ± 7.5 yr) performed 3 familiarization sessions, 2 one-repetition maximum (1RM) testing, and 16 RT sessions (four sessions for each FS descriptor; randomized). The FS descriptors were "very good" (FS + 5), "good" (FS + 3), "fairly good" (FS + 1), and "fairly bad" (FS − 1). Resistance exercises were leg press, chest press, knee extension, and seated biceps curl. Participants were instructed to select a load associated with the verbal/numerical descriptor of the FS to perform three sets of 10 repetitions. Results Participants lifted a significantly greater %1RM as the FS level decreased from FS + 5 to FS − 1 (P

https://ift.tt/2lc1LLH

Obstructive sleep apnea in children with Marfan syndrome: Relationships between three-dimensional palatal morphology and apnea-hypopnea index

Publication date: September 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 112
Author(s): V. Paoloni, E. Cretella Lombardo, F. Placidi, G. Ruvolo, P. Cozza, G. Laganà
ObjectiveTo evaluate the relationship between the severity degree of OSA (apnea/hypopnea index AHI>1) and palatal area and volume, measured by 3D analysis of digital casts in Marfan children.MethodsTwenty children with a clinical diagnosis of MS were recruited from a tertiary medical center. All the subjects underwent standard nocturnal polygraphy testing. Sixteen Marfan patients (7F,9 M; mean age 8.8yy ± 1.5yy) with AHI>1 were enrolled. Marfan Group (MG) was compared with a control group (CG) of 17 children without Marfan syndrome (9F,8 M; mean age 8.5yy ± 1.7yy) presenting with nose-breathing pattern. For each subject maxillary digital casts were taken and palatal area and volume were measured. Unpaired t-test was used to test significant differences between MG and CG for area and volume measurements. Pearson correlation coefficient (PCC) was used to measure the linear correlation between the degree of OSA (AHI index) and palatal volume and palatal area.Results80% of Marfan children presented an AHI>1 and a diagnosis of OSA. MG presented statistically significant lower values of palatal surface area (662.68 mm²; P < 0.0001) and palatal volume (2578.1 mm³; P < 0.0001) with respect to CG (923.0 mm² and 3756.6 mm³, respectively). Correlation analysis showed that AHI index had no linear correlation with palatal area (r = - 0,07) and with palatal volume (r = − 0,11).ConclusionOSA is highly prevalent in children with Marfan's syndrome (80%). Marfan children present a reduction of palatal area and volume when compared to healthy subjects. OSA in Marfan children is not linear correlated to the palatal morphology and it shows a multifactorial aetiology.



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Incidence and associated risk factors for platinum-induced ototoxicity in pediatric patients

Publication date: August 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 111
Author(s): Sofia Waissbluth, Álvaro Del Valle, Angela Chuang, Ana Becker
ObjectivesPlatinum-based chemotherapy is effective against a variety of pediatric malignancies. Unfortunately, the use of cisplatin and carboplatin can lead to permanent and progressive sensorineural hearing loss which can affect the quality of life of cancer survivors. The objectives of this study were to evaluate the incidence of platinum-induced ototoxicity in children and analyze potential risk factors.MethodsProspective cohort study. All pediatric patients receiving chemotherapy with cisplatin and/or carboplatin from 01/2012 until 10/2017 were included. Hearing evaluations were performed before every chemotherapy cycle, and following the end of chemotherapy, with auditory brainstem response, otoacoustic emissions and/or audiometry. Demographics, cumulative doses, cranial irradiation and exposure to other ototoxic agents were analyzed.ResultsTwenty-eight patients were included, with a mean age of 7.2 years at the beginning of chemotherapy (range 5 months–15 years 2 months); twenty-one patients received cisplatin, four received carboplatin, and three received both agents. Twelve patients had cranial irradiation and seven received another ototoxic medication. The most frequent malignancies were germ cell tumors, medulloblastoma and gliomas. Sensorineural hearing loss occurred in 28.6% of the patients with a mean follow-up period of 21.5 months (range: 1–53 months). All patients evaluated with audiometry had ≥ Chang 2b ototoxicity. Risk factors include age less than 5 years, cranial irradiation, and cisplatin cumulative dose greater than 400 mg/m².ConclusionSensorineural hearing loss is a potential side effect of platinum-based chemotherapy. Pediatric patients receiving cisplatin chemotherapy with a cumulative dose exceeding 400 mg/m², cranial irradiation as well as patients younger than 5 years are at greater risk of developing hearing loss.



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The Sinus and Nasal Quality of Life Survey (SN-5) in the Management of Pediatric Chronic Rhinosinusitis: A systematic review and meta-analysis

Publication date: August 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 111
Author(s): Jonathan S. Ni, Anvesh R. Kompelli, Shaun A. Nguyen, Rodney J. Schlosser, Clarice Clemmens, Zachary M. Soler
ObjectivesPediatric chronic rhinosinusitis (CRS) is a prevalent condition with quality of life (QoL) impacts that are seldom reported in the literature. We aimed to conduct a systematic review and meta-analysis on studies using the Sinus and Nasal Quality of Life Survey (SN-5), the only validated symptom questionnaire in pediatric CRS.MethodsA literature search was conducted to identify studies that used the SN-5 to measure QoL before and after medical or surgical interventions for pediatric CRS. Comparison of means and standard deviations was performed between pre- and post-intervention SN-5 scores.ResultsA total of 10 studies, consisting of 13 separate treatment arms of either medical therapy, adenoidectomy, balloon catheter sinuplasty (BCS), or functional endoscopic sinus surgery (FESS) were identified. The vast majority (92.3%) of the treatment arms demonstrated minimal clinically important differences between baseline and post-intervention SN-5 scores. Rates of treatment success and minimal clinically important difference among all treatment arms ranged from 43.2% to 94.0%. Comparison of means showed an improvement in SN-5 score of 1.97 [95% CI, 1.18 to 2.76; p < 0.00001] for BCS, 1.83 [95% CI, 1.47 to 2.19; p < 0.00001] for FESS, and 1.15 [95% CI, 0.36 to 2.66; p = 0.13) for medical treatment.ConclusionThere is a paucity of literature on QoL outcomes in pediatric CRS. More studies using the SN-5, particularly those controlling for baseline patient characteristics, are necessary to fully elucidate the impact of various interventions on QoL in pediatric CRS.



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Genetic heterogeneity of congenital hearing impairment in Algerians from the Ghardaïa province

Publication date: September 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 112
Author(s): Sonia Talbi, Crystel Bonnet, Zied Riahi, Farid Boudjenah, Malika Dahmani, Jean-Pierre Hardelin, Fabienne Wong Jun Tai, Malek Louha, Fatima Ammar-Khodja, Christine Petit
BackgroundConsanguinity rate is high in Algeria, and the population is thus at high risk for genetic diseases transmitted on an autosomal recessive mode. Inherited congenital hearing impairment (HI) is a highly heterogeneous disorder, which affects approximately 1 in 800 Algerian newborns. Several hundreds of genes responsible for deafness have been reported among which more than one hundred are responsible for isolated deafness, of which 19 have already been reported to be involved in the Algerian population. This study focuses on patients from the Ghardaïa province, an ethnically and geographically isolated region of Southern Algeria that has the highest consanguinity rate in the country (56%).MethodsEleven families, with at least two related members experiencing moderate to profound congenital HI, were recruited and screened for mutations in known HI genes.ResultsA preliminary screening for common mutations in GJB2 and GJB6 identified the prevalent GJB2:c.35delG mutation in four families. Targeted exome sequencing further identified the causal mutations in the remaining seven families: CIB2:c.97C > T; p.(Arg33*), MYO7A:c.470+1G > A; p.(?), and SLC26A4:c.410C > T; p.(Ser137Leu) biallelic mutations in two families each, and a TECTA:c.2743 A > G; p.(Ile915Val) monoallelic mutation in the only family with autosomal dominant transmission of the HI. Of note, the missense mutations of SLC26A4 and TECTA had not been previously reported.ConclusionThese results further substantiate the genetic heterogeneity of HI, even in reportedly isolated populations. However, several families may harbor the same mutations as a result of a long history of marriages between relatives. This study has important implications for the HI molecular diagnosis strategy, and to develop genetic counseling for families originating from the Ghardaïa province of Algeria.



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Electrical dynamic range is only weakly associated with auditory performance and speech recognition in long-term users of cochlear implants

Publication date: August 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 111
Author(s): So Young Kim, Seul-Ki Jeon, Seung Ha Oh, Jun Ho Lee, Myung-Whan Suh, Sang-Yub Lee, Hyun-Jung Lim, Moo Kyun Park
ObjectiveThe electrical dynamic range (EDR) has been suggested to be related to auditory performance in cochlear implant (CI) users. However, few reports have evaluated postlingual CI users who have used CIs for long periods in comparison with prelingual CI users. Here, we evaluated auditory perception and speech performance in terms of the EDR in long-term CI users. The EDR, and auditory and speech performances, were compared between pre- and post-lingual CI users.MethodsWe enrolled all patients who received CIs from April 2000 to December 2010 at Seoul National University Hospital, and who had ≥5 years of experience with CIs. The EDRs affording subjective responses at the threshold level (T-level) and comfortable level (C-level) were analyzed in terms of their relationships with pure tone audiometry levels, speech evaluation scores, including those on the Phonetically Balanced (PB) Word List test, vowel and consonant tests, a sentence test, and the Korean version of the Central Institute for the Deaf (K-CID) test; we also calculated Category in Auditory Performance (CAP) scores.ResultsWe found no significant difference in the average EDR, CAP, K-CID, PB word, consonant, or vowel scores between pre- and post-lingual CI users. The EDR was weakly associated with the PB word (P = 0.003, r = 0.462) and consonant scores (P = 0.005, r = 0.438). Other speech evaluations, such as the CAP, K-CID, and vowel scores, were not significantly associated with the EDR T-level. We found no association between pure tone thresholds at 0.5, 1, or 2 kHz, and the speech evaluation scores or EDRs of low-, middle-, or high-frequency channels.ConclusionsThe EDR was only weakly associated with speech performance, such as scores on consonant and PB word tests in long-term CI users, irrespective of pre- or post-lingual deafness status.



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Congenital right bronchial stenosis with high bifurcation: Successful management with side to side tracheobronchial anastomosis

Publication date: August 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 111
Author(s): Rachel Georgopoulos, Courtney Hill, Jeffrey S. Heinle, Deepak Mehta
Congenital bronchial stenosis is a rare entity [1,2]. While there are some reports of congenital bronchial anomalies and their repair in the thoracic literature this is first report in the literature of a bronchial take off just below the larynx managed with surgical success. Here we present a case of a former 33-weeker born with a tracheoesophageal fistula, Tetralogy of Fallot, and a high bifurcation of the right mainstem bronchus with a concomitant long segment bronchial stenosis. Preoperative planning included printing 3-D reconstructed models of the airway to analyze various treatment options. At 3 months of age the patient was taken to the operating room for surgical repair of the Tetralogy of Fallot and side-to-side tracheobroncheoplasty. The patient was extubated on postoperative day 3 and was discharged home without need for any ventilatory support.



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Changes in utilization and discard of HCV-antibody positive deceased-donor kidneys in the era of direct-acting antiviral therapy

Abstract Background The availability of direct-acting antiviral (DAA) therapy might have impacted use of HCV-infected (HCV+) deceased-donor kidneys for transplantation. Methods We used 2005-2018 SRTR data to identify 18 936 candidates willing to accept HCV+ kidneys and 3348 HCV+ recipients of HCV+ kidneys. We compared willingness to accept, utilization, discard, and posttransplant outcomes associated with HCV+ kidneys between 2 treatment eras (Interferon [IFN] era: 1/1/2005-12/5/2013 versus DAA era: 12/6/2013-8/2/2018). Models were adjusted for candidate, recipient, and donor factors where appropriate. Results In the DAA era, candidates were 2.2-times more likely to list as willing to accept HCV+ kidneys (aOR: 2.072.232.41, P

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Long-term outcomes and risk factors after adult living donor liver transplantation

Background Although risk factors for the long-term mortality of liver transplantation are well described, there is a lack of detailed study regarding these factors for adult living donor liver transplantation (LDLT). Methods We retrospectively analyzed 528 adult LDLT recipients in our hospital. The risk factors were analyzed for overall deaths >5 years post-LDLT. Results Over the 20-year follow-up, 137 patients died. Patient survival at 1, 3, 5, and 10 years post-LDLT was 87.8%, 81.8%, 79.4%, and 72.8%, respectively. The independent risk factors for >5 years post-LDLT overall death were hepatocellular carcinoma recurrence (hazard ratio [HR] = 38.9, P

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Liver Perfusate Natural Killer Cells from Deceased Brain Donors and Association with Acute Cellular Rejection after Liver Transplantation: a Time-To-Rejection Analysis

Background The ability to predict which recipients will successfully complete their posttransplant clinical course, is crucial for liver transplant (LT) programs. The assessment of natural killer (NK) cell subset determined by flow cytometry from a monocentric series of consecutive liver perfusates (LPs) could help identify risk factors portending adverse LT outcomes. Methods LPs were collected during the back-table surgical time after the procurement procedures for donors after brain death (DBDs). Lymphocytic concentrations and phenotypes were matched with DBD characteristics and indications, timing, surgical techniques, outcomes, and biopsy-proven acute cellular rejections (ACRs) in 46 adult recipients who underwent LT between 2010 and 2014 at our institute. Cox regression models were used to study relevant risk factors in order to estimate hazard ratios (HRs) for episodes of rejection after LT. Results Percentage of NK cells was significantly associated with donor age (P = 0.05) and the percentage of NKT cellular subset (P = 0.001). The length of follow-up after LT was 41.0 ± 20.9 months, and 11 (23.9%) recipients experienced biopsy-proven ACR. At time-to-rejection (TTR) proportional regression analysis, A cut-off value of 33.7% was optimal, with a sensitivity of 1, specificity of 0.57, and positive and negative predictive values of 0.42 and 1, respectively. LP NK cell subset was strongly associated with biopsy-proven ACR (HR = 10.7, P = 0.02). Conclusions LP cytofluorimetric phenotyping may contribute as a targeted preoperative tool to predict the risk of ACR, and as clinical test in translational studies that aim to improve donor allograft procurement and transplant outcomes. Authors' contributions: Duilio Pagano*: Concept/design, Data analysis/interpretation, Drafting article. Ester Badami*: Concept/design, Data analysis/interpretation, Drafting article. Pier Giulio Conaldi: Critical revision of article, Approval of article. Aurelio Seidita and Fabrizio di Francesco: Critical revision of article. Alessandro Tropea: Data collection. Rosa Liotta and Gaia Chiarello: Histology revision. Fabio Tuzzolino and Marco Barbàra: Statistics. Angelo Luca: Critical revision of article, Approval of article. Salvatore Gruttadauria: Critical revision of article, Approval of article. *These authors contributed equally to this study. The first author has been selected to receive a Young Investigator Award for the the 2018 Joint International Congress of ILTS, ELITA & LICAGE being held from 23-26 May 2018 in Lisbon, Portugal. Corresponding author: Salvatore Gruttadauria, IRCCS-ISMETT, Via E. Tricomi 5, 90127 Palermo, Italy. Phone +39 091 21 92 111. Fax +39 091 21 92 400. E-mail: sgruttadauria@ismett.edu Disclosure The authors of this manuscript have no conflicts of interest to disclose as described by Transplantation. We hereby certify that all the authors whose names are listed immediately below certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or nonfinancial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Acute Macular Neuroretinopathy following Oral Intake of Adrenergic Flu Treatments

Purpose: The purpose of this study was to report a case series of patients with acute macular neureretinopathy in which patients concomitantly used ephedrine or pseudo-ephedrine. Methods: This is a retrospective case review. Results: Two patients with retinal findings consistent with acute macular neuroretinopathy are presented. Conclusion: Acute macular neuroretinopathy should be considered in any young patient with unexplained loss of vision and exposed to direct or indirect adrenergic stimulation.
Case Rep Ophthalmol 2018;9:322–326

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Olfactory Dysfunction in Neurodegenerative Diseases

Abstract

Purpose of Review

The sense of smell is today one of the focuses of interest in aging and neurodegenerative disease research. In several neurodegenerative diseases, such as Parkinson's disease and Alzheimer's disease, the olfactory dysfunction is one of the initial symptoms appearing years before motor symptoms and cognitive decline, being considered a clinical marker of these diseases' early stages and a marker of disease progression and cognitive decline. Overall and under the umbrella of precision medicine, attention to olfactory function may help to improve chances of success for neuroprotective and disease-modifying therapeutic strategies.

Recent Findings

The use of olfaction, as clinical marker for neurodegenerative diseases is helpful in the characterization of prodromal stages of these diseases, early diagnostic strategies, differential diagnosis, and potentially prediction of treatment success. Understanding the mechanisms underlying olfactory dysfunction is central to determine its association with neurodegenerative disorders. Several anatomical systems and environmental factors may underlie or contribute to olfactory loss associated with neurological diseases, although the direct biological link to each disorder remains unclear and, thus, requires further investigation.

Summary

In this review, we describe the neurobiology of olfaction, and the most common olfactory function measurements in neurodegenerative diseases. We also highlight the evidence for the presence of olfactory dysfunction in several neurodegenerative diseases, its value as a clinical marker for early stages of the diseases when combined with other clinical, biological, and neuroimage markers, and its role as a useful symptom for the differential diagnosis and follow-up of disease. The neuropathological correlations and the changes in neurotransmitter systems related with olfactory dysfunction in the neurodegenerative diseases are also described.

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Editorial Board/Aims & Scope

Publication date: July 2018
Source:Oral Oncology, Volume 82





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Clinical Presentation and Management of Headache in Pituitary Tumors

Abstract

Purpose of Review

This article provides an overview of headache in the setting of pituitary adenoma. The purpose of this article is to educate providers on the association, possible pathophysiology, and the clinical presentation of headache in pituitary tumor.

Recent Findings

Recent prospective evaluations indicate that risk factors for development of headache in the setting of pituitary adenoma include highly proliferative tumors, cavernous sinus invasion, and personal or family history of headache. Migraine-like headaches are the predominant presentation. Unilateral headaches are often ipsilateral to the side of cavernous sinus invasion.

Summary

In summary, this paper describes how the size and type of pituitary tumors play an important role in causation of headaches. Pituitary adenoma-associated headache can also mimic primary headache disorders making recognition of a secondary process difficult. Therefore, this paper highlights the association of between trigeminal autonomic cephalgias and pituitary adenomas and urges practitioners to maintain a high index of suspicion when evaluating patients with these uncommon headache presentations. However, on balance, given the prevalence of both primary headache disorders and pituitary adenomas, determining causality can be challenging. A thoughtful and multidisciplinary approach is often the best management strategy, and treatment may require the expertise of multiple specialties including neurology, neurosurgery, and endocrinology.

https://ift.tt/2lb0YdF

Syncope and Headache

Abstract

Purpose of Review

We review the literature on co-occurrence of syncope and headache and share clinical experience.

Recent Findings

Headache in relation to syncope has been the subject of recent interest.

Summary

Orthostatic intolerance has an expanding spectrum with three well-defined entities: orthostatic hypotension (OH), neurally mediated hypotension (NMH), and postural tachycardia syndrome (PoTS). Syncope occurs in patients with OH as well as in patients with episodically occurring NMH. Headache of OH is called coat-hanger ache (CHA) because it affects the neck and shoulders in a coat-hanger pattern. It can serve as a warning symptom of OH as well as a parameter to gauge the benefit of treatment. Awareness of CHA avoids inappropriate tests. Headache type occurring in NMH has not been fully delineated. A questionnaire-based study describes migraine leading to syncope and treatment of migraine to reduce syncope. Laboratory studies in NMH patients provide evidence for only short-duration headache. The author's approach to such patients is presented.

https://ift.tt/2ydi1VW

Virtual Reality as a Clinical Tool for Pain Management

Abstract

Purpose of Review

To evaluate the use of virtual reality (VR) therapies as a clinical tool for the management of acute and chronic pain.

Recent Findings

Recent articles support the hypothesis that VR therapies can effectively distract patients who suffer from chronic pain and from acute pain stimulated in trials. Clinical studies yield promising results in the application of VR therapies to a variety of acute and chronic pain conditions, including fibromyalgia, phantom limb pain, and regional specific pain from past injuries and illnesses.

Summary

Current management techniques for acute and chronic pain, such as opioids and physical therapy, are often incomplete or ineffective. VR trials demonstrate a potential to redefine the approach to treating acute and chronic pain in the clinical setting. Patient immersion in interactive virtual reality provides distraction from painful stimuli and can decrease an individual's perception of the pain. In this review, we discuss the use of VR to provide patient distraction from acute pain induced from electrical, thermal, and pressure conditions. We also discuss the application of VR technologies to treat various chronic pain conditions in both outpatient and inpatient settings.

https://ift.tt/2lcsRSX

Multiple diversity concepts and their ethical-epistemic implications

Abstract

A concept of diversity is an understanding of what makes a group diverse that may be applicable in a variety of contexts. We distinguish three diversity concepts, show that each can be found in discussions of diversity in science, and explain how they tend to be associated with distinct epistemic and ethical rationales. Yet philosophical literature on diversity among scientists has given little attention to distinct concepts of diversity. This is significant because the unappreciated existence of multiple diversity concepts can generate unclarity about the meaning of "diversity," lead to problematic inferences from empirical research, and obscure complex ethical-epistemic questions about how to define diversity in specific cases. We illustrate some ethical-epistemic implications of our proposal by reference to an example of deliberative mini-publics on human tissue biobanking.

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