Table of Contents

Publication date: July 2018
Source:Annals of Allergy, Asthma & Immunology, Volume 121, Issue 1





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Information for Authors

Publication date: July 2018
Source:Annals of Allergy, Asthma & Immunology, Volume 121, Issue 1





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Mepolizumab in the treatment of severe eosinophilic asthma

Publication date: July 2018
Source:Annals of Allergy, Asthma & Immunology, Volume 121, Issue 1
Author(s): Ronald A. Strauss, Nesreen Jawhari




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Editorial Board

Publication date: July 2018
Source:Annals of Allergy, Asthma & Immunology, Volume 121, Issue 1





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A march by any other name

Publication date: July 2018
Source:Annals of Allergy, Asthma & Immunology, Volume 121, Issue 1
Author(s): David A. Hill, Carlos A. Camargo, Amy S. Paller, Jonathan M. Spergel




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Information for Readers

Publication date: July 2018
Source:Annals of Allergy, Asthma & Immunology, Volume 121, Issue 1





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Meat reintroduction in a patient with α-gal allergy

Publication date: July 2018
Source:Annals of Allergy, Asthma & Immunology, Volume 121, Issue 1
Author(s): Teresa Pelletier, Santiago Alvarez-Arango, F.N.U. Sameeta, Ellen Manos, Elina Jerschow




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Children & Environment Toxins: What Everyone Needs to Know

Publication date: July 2018
Source:Annals of Allergy, Asthma & Immunology, Volume 121, Issue 1
Author(s): Anita Sivam




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Leaving the nest

Publication date: July 2018
Source:Annals of Allergy, Asthma & Immunology, Volume 121, Issue 1
Author(s): Ashley A. Dyer, Amy O'Keefe, Madeleine K. Kanaley, Lauren M. Kao, Ruchi S. Gupta
BackgroundThe transition from adolescence to young adulthood marks a developmental period in which responsibility for management of chronic conditions such as food allergy shifts from the caregiver to the young adult. Fatal food-induced anaphylaxis is most common among adolescents and young adults. However, colleges are currently not well positioned to provide integrated support for students with food allergies.ObjectiveThe study objective was to explore the systems, structures, and policies that currently support students with food allergies at college, assess unmet needs, and develop pilot interventions through the use of patient-centered design processes.MethodsKey informant interviews were conducted with stakeholders in the campus management of food allergies (n = 26) between April and May 2016. Data were coded and assessed for relative frequencies of each code to determine challenges and potential solutions.ResultsThe convergence of stakeholder-identified themes indicated that the transition to college for students with food allergy would be improved by providing support for: (1) Notification of others in the student's campus network about food allergy; (2) Establishing clearly defined roles/responsibilities; and (3) Increasing campus awareness of food allergy signs, symptoms, and lethality. To better provide comprehensive support for students, 5 interventions—collectively called Spotlight—were developed.ConclusionThe use of qualitative research methods, patient-centered design processes, and collaborations with diverse stakeholders—including pediatricians that care for adolescents—can provide a framework for designing coordinated systems and policies to provide comprehensive support to college students with food allergy. Next steps include rigorously testing implementation of the Spotlight intervention prototypes.



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Congenital nevus comedonicus complicated by a hidradenitis suppurativa‐like lesion: Report of a childhood case

Pediatric Dermatology, EarlyView.


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Mannitol in Critical Care and Surgery Over 50+ Years: A Systematic Review of Randomized Controlled Trials and Complications With Meta-Analysis

Objective: Despite clinical use spanning 50+ years, questions remain concerning the optimal use of mannitol. The published reviews with meta-analysis frequently focused on mannitol's effects on a specific physiological aspect such as intracranial pressure (ICP) in sometimes heterogeneous patient populations. A comprehensive review of mannitol's effects, as well as side effects, is needed. Methods: The databases Medline (OvidSP), Embase (OvidSP), and NLM PubMed were systematically searched for randomized controlled trials (RCTs) comparing mannitol to a control therapy in either the critical care or perioperative setting. Meta-analysis was performed when feasible to examine mannitol's effects on outcomes, including ICP, cerebral perfusion pressure, mean arterial pressure (MAP), brain relaxation, fluid intake, urine output, and serum sodium. Systematic literature search was also performed to understand mannitol-related complications. Results: In total 55 RCTs were identified and 7 meta-analyses were performed. In traumatic brain injury, mannitol did not lead to significantly different MAP (SMD [95% confidence interval], CI)=−3.3 [−7.9, 1.3] mm Hg; P=0.16) but caused significantly different serum sodium concentrations (SMD [95% CI]=−8.0 [−11.0, −4.9] mmol/L; P

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A pilot split‐scalp study of combined fractional radiofrequency microneedling and 5% topical minoxidil in treating male pattern hair loss

Clinical and Experimental Dermatology, EarlyView.


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A case of scalp necrosis

Clinical and Experimental Dermatology, EarlyView.


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Pandemic influenza vaccines: what they have taught us about B cell immunology

David J Topham | Phuong Nguyen | Mark Y Sangster

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Combined Ex Vivo Hypothermic and Normothermic Perfusion for Assessment of High-Risk Deceased Donor Human Kidneys for Transplantation

Background Despite careful clinical examination, procurement biopsy and assessment on hypothermic machine perfusion (HMP), a significant number of potentially useable deceased donor kidneys will be discarded because they are deemed unsuitable for transplantation. Ex vivo normothermic perfusion (EVNP) may be useful as a means to further assess high-risk kidneys to determine suitability for transplantation. Methods From June 2014 to October 2015, 7 kidneys (mean donor age 54.3 years and KDPI 79%) that were initially procured with the intention to transplant were discarded based on a combination of clinical findings, suboptimal biopsies, long cold ischemia time and/or poor hypothermic perfusion parameters. They were subsequently placed on EVNP using oxygenated packed red blood cells and supplemental nutrition for a period of 3 hours. Continuous hemodynamic and functional parameters were assessed. Results After a mean cold ischemia time (CIT) of 43.7 hours, all 7 kidneys appeared viable on EVNP with progressively increasing renal blood flow over the 3-hour period of perfusion. Five of the 7 kidneys had excellent macroscopic appearance, rapid increase in blood flow to 200-250 ml/min, urine output of 40-260 ml/hr and increasing creatinine clearance. Conclusions Favorable perfusion characteristics and immediate function after a 3 hour course of EVNP suggests that high-risk kidneys subjected to long CIT may have been considered for transplantation. The combined use of ex vivo hypothermic and normothermic perfusion may be a useful strategy to more adequately assess and preserve high-risk kidneys deemed unsuitable for transplantation. A clinical trial will be necessary to validate the usefulness of this approach. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. *Author contributed equally to the work presented in this paper Corresponding author: Richard V. Perez, MD, University of California, Davis Health, 2315 Stockton Blvd, OP 152, Sacramento, CA 95817. Phone: (703) 371 4330. Email: rvperez@ucdavis.edu Author contribution -Substantial contributions to the conception or design of the work: SKK, IPP, JS, RVP -Acquisition of data for the work: SKK, IPP, YS, IP, TB -Analysis and interpretation of data: SKK, IPP, YS, JS, MN, KYJ, RVP -Drafting of the work: SKK and IPP -Revising the work critically for important intellectual content: SKK, IPP, YS, JS, CT, CS, JPM, RVP -Final approval of the version to be published and agreement to be accountable for all aspects of the work: SKK, IPP, YS, TB, IP, JS, CT, CS, JPM, MN, KYJ, RVP Disclosures The authors declare no conflicts of interest Disclosures Dr. Perez is a member of the clinical advisory board for XOR Labs, Toronto, Canada. Funding No funding was received to complete this study Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Regional Anesthesiology and Acute Pain Medicine in the Era of Value-Based Health Care

Publication date: Available online 27 June 2018
Source:Anesthesiology Clinics
Author(s): Edward R. Mariano, Nabil M. Elkassabany




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FDA Approves New Targeted Combo Therapy for Melanoma

Survival advantages are unprecedented, says expert. Encorafenib and binimetinib are a late-stage BRAF and MEK inhibitor combination for metastatic disease.
FDA Approvals

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Travel distance: Impact on stage of presentation and treatment choices in head and neck cancer

The objective was to examine the impact of travel distance on stage of presentation and treatment choices in head and neck squamous cell carcinoma in the rural setting.

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Part I: Onychomycosis: Clinical Overview and Diagnosis

Onychomycosis is a fungal nail infection caused by dermatophytes, non-dermatophytes, and yeast and is the most common nail disorder seen in clinical practice. It is an important problem, as it may cause local pain, paresthesias, difficulties performing activities of daily life, and impair social interactions. In the following continuing medical education manuscript, we review the epidemiology, risk factors, and clinical presentation of onychomycosis and demonstrate current and emerging diagnostic strategies.

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Part II: Onychomycosis: Treatment and Prevention of Recurrence

Onychomycosis is a fungal nail infection caused by dermatophytes, non-dermatophytes, and yeast and is the most common nail disorder seen in clinical practice. It is an important problem, as it may cause local pain, paresthesias, difficulties performing activities of daily life, and impair social interactions. The epidemiology, risk factors, and clinical presentation and diagnosis of onychomycosis were discussed in the first article in this continuing medical education series. In this article, we review the prognosis and response to onychomycosis treatment, Food and Drug Administration approved medications for onychomycosis, as well as, off-label therapies and devices.

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Acute skin allergy to thermoplastic mask used for patient immobilization during radiation therapy: a case report

Radiosurgical treatments of brain tumors, vascular malformations, and functional disorders are more and more frequently used. Gamma Knife irradiation with the Icon system necessitates the use of a thermoplasti...

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Successful treatment following early recognition of a case of Fournier’s scrotal gangrene after a perianal abscess debridement: a case report

Fournier's gangrene is an acute surgical emergency characterized by high mortality rates ranging from approximately 13% to 45%. Therefore, aggressive multidisciplinary management is necessary.

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Is substance P a nasal epithelial neuropeptide?

Publication date: Available online 27 June 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Steven D. Douglas, Susan E. Leeman




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Clinical and Laboratory Markers of Relapse in Cutaneous Polyarteritis Nodosa

This case series identifies clinical and laboratory markers that may be associated with relapse among patients with cutaneous polyarteritis nodosa.

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Targeting Tropomyosin Receptor Kinase in Cutaneous CYLD Defective Tumors With Pegcantratinib

This phase 2 randomized clinical trial investigates if topical targeting of topical tropomyosin receptor kinase (TRK) inhibitor, pegcantratinib, is safe and efficacious in treating tumors in patients with CYLD cutaneous syndrome.

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Cutavirus Infection in Primary Cutaneous B- and T-Cell Lymphoma

This virological study examines the association of cutavirus DNA with different types of cutaneous B-cell lymphoma and cutaneous T-cell lymphoma in lesional skin samples.

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Strengthening the Case for the Role of Thrombophilia in Calciphylaxis

In Reply We thank Hickson and colleagues for their interest in our Original Investigation titled "Association Between Hypercoagulable Conditions and Calciphylaxis in Patients With Renal Disease: A Case-Control Study" on the role of hypercoagulable conditions in the development of calciphylaxis in patients with renal disease.

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Strengthening the Case for the Role of Thrombophilia in Calciphylaxis

To the Editor We read with interest the article by Dobry et al, whose findings support our research group's prior investigations, thus underscoring the central role of congenital and acquired thrombophilia in the pathogenesis of calciphylaxis. There were methodologic differences between these studies that improve our understanding of this complex disease.

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Decision Tree Model vs Traditional Measures for Associations of Sun-Protective Behaviors

This cross-sectional national survey assesses whether decision-based modeling can identify patterns of sun-protective behaviors and sun sensitivity associated with the likelihood of sunburn among US adults.

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Assessing the Competence of Aging Physicians Who Are Young at Heart

This Viewpoint discusses the issues involved in assessing the professional competence of aging physicians as increasing numbers of physicians continue to work past the age of 65 years.

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Erratum to “Fat Embolism Syndrome: A Case Report and Review Literature”

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AHR signaling in the development and function of intestinal immune cells and beyond

Abstract

The intestinal immune system is challenged daily with the task of recognizing and eliminating pathogens while simultaneously tolerating dietary and commensal antigens. All components must effectively coordinate to differentiate a continual barrage of environmental cues and mount appropriate responses dependent on the nature of the stimuli encountered. Playing a pivotal role, the aryl hydrocarbon receptor (AHR) is a chemical sensor that detects both dietary and microbial cues and is important for development, maintenance, and function of several types of intestinal immune cells, particularly innate lymphoid cells (ILCs) and T cells. In this review, we will highlight recent advances in our knowledge of the role of AHR signaling in ILCs, T cells, B cells, and dendritic cells.

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Innate lymphoid cells: key players in tissue-specific immunity

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Food Allergens: An Update on Analytical Methods

Publication date: 2018
Source:Reference Module in Food Science
Author(s): Michael J. Walker
Food allergy is an increasing public health problem, particularly in developed nations. This article discusses the nature of food allergy, the risk management strategies adopted by regulators and the need for allergen analysis. An overview is given of the different approaches to allergen analysis currently adopted. The article concentrates on enzyme linked immunosorbent assay, ELISA, since this is currently the technique most applied in routine allergen analysis. The history and main formats (sandwich and direct ELISAs) are described along with practical advice on extraction, validation and reporting results. Research proteomics, polymerase chain reaction for amplification and detection of allergen species DNA and liquid chromatography-mass spectrometry approaches are described.



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Brown-Vialetto-Van Laere syndrome: a novel diagnosis to a common presentation

Brown-Vialetto-Van Laere syndrome (BVVLS) or riboflavin transporter deficiency (OMIM 211530) is a rare treatable autosomal recessive neurodegenerative disorder. This condition is associated with progressive pontobulbar palsy. We describe the clinical course of a 16-month-old boy with BVVLS and a novel homozygous mutation from Pakistan. Our patient presented with stridor and respiratory insufficiency. Hearing loss which is the most common sign of this condition was absent, making it an unusual presentation of BVVLS. His examination revealed ptosis and tongue fasciculation. His riboflavin receptor mutational analysis showed the homozygous mutation in the SLC52A3 gene. Per oral riboflavin was administered, and subsequently, he was able to be weaned off the ventilator. Now the child is improving and attaining developmental milestones.

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New headaches with normal inflammatory markers: an early atypical presentation of giant cell arteritis

An 80-year-old man presented repeatedly to his general practitioner with 3 months of unexplained persistent frontal headaches. CT head revealed no diagnosis. His dentist diagnosed his co-existing jaw pain as bruxism. Three months later, the patient happened to attend a routine ophthalmology follow-up appointment. During this routine appointment, features of giant cell arteritis (GCA) including worrying visual complications were first noted. His inflammatory markers (C-reactive protein and erythrocyte sedimentation rate) were not significantly raised—contrary to the norm. A temporal artery ultrasound and biopsy were performed, in light of the history. This confirmed GCA. He was commenced on high-dose oral prednisolone and was managed by ophthalmology and rheumatology. At 4 weeks, symptoms resolved with no permanent visual loss despite a prolonged initial symptomatic period. Multiple symptomatic presentations to different specialties should therefore alert clinicians to a unifying diagnosis, for example, vasculitis. Serious illnesses may present with severe symptoms despite normal screening investigations.

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Perioperative continuous glucose monitoring in a preterm infant

Surgery in the neonatal period presents challenges, especially in preterm infants weighing <1 kg. Their small size, minimal reserves and physiological immaturity means attention to detail and careful monitoring is critical to avoid cardiovascular instability; maintaining fluid balance and metabolic stability is also problematic due to often limited vascular access and small blood volumes. Developments in technology have meant that cardiovascular parameters such as heart rate, blood pressure and oxygen saturations are all routinely and continuously monitored before and during surgery.

We have been exploring the role of continuous glucose monitoring (CGM) for metabolic monitoring and management of glucose control in very preterm infants (24–32 weeks gestation). In this paper, we report on a preterm infant who uniquely underwent surgery while wearing a continuous glucose monitor, blinded to the clinical team. This case highlights the metabolic vulnerability of these babies and a possible role for real-time CGM during surgical procedures.

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Possible SAMe-induced mania

This paper describes a patient who presented with mania with psychotic features in the context of concomitant use of S-adenosyl-L-methionine (SAMe) and selective serotonin reuptake inhibitor (SSRI). The aim of this case report is to provide medical practitioners with a greater awareness of the possibility of a psychotic episode and/or mania manifesting with concurrent use of SAMe and SSRI.

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Correction: Primary malignant melanoma of the ascending colon

Miliaras S, Ziogas IA, Mylonas KS, et al. Primary malignant melanoma of the ascending colon. BMJ Case Rep 2018. doi: 10.1136/bcr-2017-223282. 

In the 'Summary' and 'Discussion' sections, it is stated that 36 previous cases have been reported, while in fact this number is incorrect: the correct number of cases that have been previously reported is 15.

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Intravenous immunoglobulin for severe thrombocytopenia in secondary dengue

A 30-year-old woman with severe dengue presented on the sixth day of her illness with life-threatening thrombocytopenia, refractory to multiple platelet transfusions. Dengue IgM antibody and the non-structural-1 antigen tests as of day 3 were negative. The IgG antibody against the same was positive, suggesting a past episode of dengue. Since she had a history of menorrhagia prior to the current illness, a working diagnosis of idiopathic thrombocytopenic purpura was made, for which intravenous immunoglobulin (IVIg) was administered that led to a rapid rise in the platelet count with no adverse events. Subsequently, dengue IgM antibody repeated on day 6 came back positive, confirming dengue. This case report re-emphasises the potential use of IVIg in patients with severe thrombocytopenia in dengue.

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Pyopericardium presenting with echocardiographic features of pericardial tamponade in an elderly man

A 72-year-old Chinese man presented with mild symptoms of heart failure. Transthoracic echocardiography showed signs of cardiac tamponade though clinically he was relatively well. The option of pericardiocentesis was not carried out due to a narrow window for aspiration with only a thin layer of effusion seen surrounding the apex and right ventricle on subcostal view.

Pericardial window was done via a left anterolateral thoracotomy. Intraoperatively, 500 cm³ of purulent fluid was drained. Microbiology screens were all negative. We present the atypical clinical course of this elderly man presenting with a large pyopericardium.

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Cloudy Cornea with Arcus Juvenilis in a Case of Dense Deposit Disease

A 25-year-old male patient presented with complaints of blurred vision in both eyes since 2 years. The patient was a known case of nephrotic syndrome with dyslipidaemia for which he was on diuretics and lipid-lowering agents for 3 years. On examination, his visual acuity was 6/9 in both eyes with cloudy cornea and arcus juvenilis. Fundus examination was within normal limits. On systemic work-up, his lipid profile was deranged with increased serum total cholesterol, very low density lipoprotein, low density lipoprotein and triglyceride. The serum high density lipoprotein was decreased. Renal function test revealed elevated serum creatinine with significant proteinuria. Renal biopsy was suggestive of dense deposit disease on immunofluorescence and transmission electron microscopy. Ocular manifestation of dense deposit disease is characterised by retinal drusen, pigmentary atrophy, choroidal neovascular membrane and atypical serous retinopathy. To the best of our knowledge, anterior segment changes in dense deposit disease has not been reported. This is the first case reporting cloudy cornea with arcus juvenilis in a case of dense deposit disease.

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Craniovertebral junction cord compression due to neurofibroma

Description

A 26-year-old man with premorbid cutaneous neurofibromatosis presented with history of insidious onset, slowly progressive, bilaterally asymmetrical quadriparesis along with incontinence of urine since 4 weeks. Simultaneous to the onset of motor symptoms, he also complained of paraesthesias in all four limbs. On examination, multiple cutaneous neurofibromas were noticed all over his trunk, abdomen and all the limbs (figure 1). The upper and lower limbs were spastic. Motor power as per Medical Research Council grading was 3/5 in all four limbs. The deep tendon reflexes were brisk. The plantar response on both sides was extensor. The sensory level was clinically around C3/C4 dermatome.

Figure 1

Multiple cutaneous neurofibromas of varying sizes on the lower chest and abdomen (red arrows).

In view of the premorbid neurofibromata, a possibility of compressive cervical myelopathy was thought of. MRI of cervical spine T2-weighted sagittal view...

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Dural arteriovenous fistula presenting with acute subdural haematoma showing impending cerebral herniation

A dural arteriovenous fistula (DAVF) presenting with acute subdural haematoma (ASDH), which were not related to head injury, is rare. A 61-year-old woman was transported by ambulance because of deterioration of consciousness. On admission, she was comatose with anisocoria. Emergent CT demonstrated a severe midline shift associated with a left ASDH and an additional left occipital intracerebral haematoma, both of which had no continuity with each other. MRI showed flow void signs in the left occipital lobe. Because of the impending cerebral herniation, an emergent evacuation of the ASDH and external decompression was performed. Subsequent evaluation revealed a DAVF at the left occipital convexity near the confluence with retrograde leptomeningeal venous reflux and venous ectasia (Cognard type III DAVF). The patient underwent endovascular treatment for the DAVF involving transarterial embolisation using coils and N-butyl cyanoacrylate with complete obliteration. Her further clinical course was uneventful and discharged after cranioplasty.

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The immunobiology of ubiquitin-dependent B cell receptor functions

Publication date: September 2018
Source:Molecular Immunology, Volume 101
Author(s): James R. Drake
MHC class II-restricted antigen presentation by dendritic cells is necessary for activation of naïve CD4 T cells, whereas class II-restricted antigen presentation by B lymphocytes and macrophages is important for the recruitment of CD4+ helper and regulatory T cells. Antigen presentation by B cells is also important for induction of T cell tolerance. B cells are unique among these three types of MHC class II-expressing antigen presenting cells (APC) as they constitutively express high levels of cell surface class II molecules and express a clonally restricted antigen specific receptor, the B cell receptor (BCR). Here, I review our current understanding of three major steps that underlie the processing and presentation of BCR-bound cognate antigen: (1) endocytosis of antigen-BCR (Ag-BCR) complexes, (2) Ag-BCR trafficking to intracellular antigen processing compartments and (3) generation of antigenic peptide-MHC class II complexes, with a particular focus on the role of BCR ubiquitination in each. I will highlight potential topics for future research and briefly discuss the impact of the cell biology of BCR-mediated antigen processing on the response of the B cell and T cell to the cell-cell interactions mediated by B cell-expressed peptide-class II complexes.



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Role of MAIT cells in pulmonary bacterial infection

Publication date: September 2018
Source:Molecular Immunology, Volume 101
Author(s): Nadine Hartmann, Melanie J. Harriff, Curtis P. McMurtrey, William H. Hildebrand, David M. Lewinsohn, Mitchell Kronenberg
Mucosal-associated invariant T (MAIT) cells represent a population of innate T cells that is highly abundant in humans. MAIT cells recognize metabolites of the microbial vitamin B pathway that are presented by the major histocompatibility complex (MHC) class I-related protein MR1. Upon bacterial infection, activated MAIT cells produce diverse cytokines and cytotoxic effector molecules and accumulate at the site of infection, thus, MAIT cells have been shown to be protective against various bacterial infections. Here, we summarize the current knowledge of the role of MAIT cells in bacterial pulmonary infection models.



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Complement C3a receptor modulates embryonic neural progenitor cell proliferation and cognitive performance

Publication date: September 2018
Source:Molecular Immunology, Volume 101
Author(s): Liam G. Coulthard, Owen A. Hawksworth, Jacinta Conroy, John D. Lee, Trent M. Woodruff
The complement system of innate immunity is emerging as a novel player in neurodevelopmental processes. The receptor for C3a, C3aR, shares a close evolutionary and functional relationship with C5a receptors. Whilst the C5a receptor, C5aR1, has been demonstrated to promote embryonic neural stem cell proliferation, little is known about the role of C3aR in this process. Here we show that C3aR is expressed in a similar manner to C5aR1 in mice, at the apical pole of the embryonic ventricular zone, though it has an opposing function. Using in utero delivery of C3aR agonist and antagonist compounds to the embryonic ventricle, we demonstrate that C3aR functions to decrease proliferation of apical neural progenitor cells (NPC). Intriguingly, C3aR^-/- animals also have altered NPC proliferation, but demonstrate an opposing phenotype to animals subjected to pharmacological blockade of C3aR. Finally, despite a grossly normal development of C3aR^-/- animals, cognitive behavioural testing of adult mice showed subtle deficits in recall memory. These data demonstrate that in addition to C5a, C3a also has a critical role in the normal development of the mammalian brain.



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A Trial Comparing Transversus Abdominis Plane Catheter Versus Epidural After Esophagectomy

Conditions:   Esophageal Cancer;   Pain, Postoperative
Interventions:   Procedure: Esophagectomy;   Procedure: Transversus abdominis plane catheter;   Procedure: Epidural
Sponsor:   Swedish Medical Center
Recruiting

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Prognosis of subglottic carcinoma: Is it really worse?

Head &Neck, EarlyView.


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Racial disparities in the choice of definitive treatment for squamous cell carcinoma of the oral cavity

Head &Neck, EarlyView.


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Association of E‐cadherin methylation with risk of nasopharyngeal cancer: A meta‐analysis

Head &Neck, EarlyView.


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AHNS Series: Do you know your guidelines? AHNS Endocrine Section Consensus Statement: State‐of‐the‐art thyroid surgical recommendations in the era of noninvasive follicular thyroid neoplasm with papillary‐like nuclear features

Head &Neck, EarlyView.


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Children & Environment Toxins: What Everyone Needs to Know

This book provides a broad overview of common toxins that children may encounter in their daily environment. The book is divided into 12 sections. The first chapters describe the current chemical environment and its potential negative effects on children's health, whereas subsequent chapters detail specific toxins, such as lead, allergens, pesticides, and herbicides. The book's question-and-answer format facilitates quick reference of a particular subject.

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A march by any other name

The allergic (or atopic) march refers to the natural history of allergic diseases as they develop during infancy and childhood. The march conventionally begins with atopic dermatitis (AD) and progresses to IgE-mediated food allergy (IgE-FA), asthma, and allergic rhinitis (AR).1 The observation that allergic manifestations tend to develop in this stereotyped progression stems from decades of observational research, including birth cohort studies. It has also been the basis for large, longitudinal studies of individual disease associations.

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Information for Authors

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Editorial Board

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Information for Readers

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Table of Contents

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Pituitary 'pseudotumor: an under-recognised complication of undertreated primary hypothyroidism

Description 

A woman in her 30s with medical history notable for hypothyroidism due to Hashimoto's thyroiditis had a brain MRI ordered by her neurologist due to change in chronic headache pattern. This had an incidental finding of enlarged pituitary gland. She was referred at that time to an endocrinologist but was not seen. Eighteen months later, she presented with worsening headaches, blurry vision, weight gain and galactorrhoea. Repeat brain MRI showed a 9x10x13 mm sellar mass extending superiorly, with mass effect on optic chiasm (figure 1A). Thyroid-stimulating hormone (TSH) was 185 mIU/mL with low free T3, low free T4, normal prolactin, normal FSH and normal LH. She was then referred to a neurosurgeon and an ophthalmologist. Visual field testing initially showed mild constriction of bilateral visual fields. The neurosurgeon referred her to an endocrinologist for preoperative hormonal evaluation, but the operation date was advanced when subjective visual...

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'Toxic ST elevation

Description 

A young man was admitted to the emergency department after consuming zinc phosphide, with severe drug refractory hypotension. ECG (refer figure 1) revealed ST segment elevation involving anterior, lateral and inferior leads. Serum levels of potassium, calcium, magnesium and phosphorous were normal; serum troponin-T was 1126 ng/nL (upper limit of normal 14 ng/nL), with associated metabolic acidosis. Echocardiogram revealed severe left ventricular systolic dysfunction. Severe myocardial depression with histopathological evidence of myocyte vacuolation and myocytolysis has been occasionally described with aluminium phosphide toxicity, primarily mediated by phosphine. The absence of an antidote makes the mortality high, once refractory shock ensues. Our patient succumbed to this condition. Zinc phosphide toxicity mediated by phosphine can have similar multisystem involvement, though dramatic electrocardiographic changes are uncommon.1 2 However, as evidenced by our report, ST segment elevation involving multiple leads on the ECG, though rare, maybe a hazardous manifestation...

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Unusual foreign body impacted in the upper oesophagus: original technique for transoral extraction

Foreign body ingestion is a common event; in the adult population, most ingestions occur in patients with mental disability, psychiatric disorders, alcohol intoxication or in prisoners seeking secondary gain. Removal through flexible endoscopy is generally the first-line approach but rescue oesophagotomy may be necessary for foreign bodies impacted in the upper oesophagus. A 27-year-old man was admitted in the emergency room after intentional ingestion of a wooden spherical object with a central hole. A total body CT scan showed that the object was completely obstructing the upper oesophageal lumen but there were no signs of perforation. In the operating room, a Weerda diverticuloscope and a 5 mm 0° telescope were used to visualise the foreign body under general anaesthesia. A standard endoscopic biopsy forceps was passed through the hole of the sphere and was retracted with the jaws open allowing transoral extraction without complications.

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Hidden burden of osteoporosis in alpha-1 antitrypsin deficiency

This is a reminder of a rare cause of osteoporosis that remains widely underdiagnosed and lacks specific evidence on its optimal management. We bring a case report of a patient presenting with erectile dysfunction and high testosterone level but also elevated sex-hormone binding globulin hence low free androgen index as well as evidence of organ specific hypogonadal side effects such as osteoporosis. A unifying diagnosis of alpha-1 antitrypsin deficiency (AATD) brought together his coexistent mild chronic obstructive pulmonary disease as well as a new finding of previously unrecognised liver disease. This case highlights the uncertainties over the mechanism of osteoporosis in AATD as well as the controversies over best way to manage it. The efficacy of testosterone replacement in managing osteoporosis in the context of AATD remains untested. National registries for AATD would be best placed at gathering further evidence in this area.

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Late-onset TNF receptor-associated periodic syndrome presenting as recurrent urticarial rash and lymph nodes

Description 

A 35-year-old Caucasian woman was referred by a general practitioner to our medical ward because she was suffering from recurrent arthralgia, urticarial rash with mild pruritus and cervical lymph nodes. There was no sign of arthritis, any fever, chills or night sweats, but she had lost 2.5 kg in 3 months. The average lengths of symptoms were more than 6 weeks.

She presented the same symptoms with cervical lymph nodes when she was 24 years old. She received doxycycline for a suspicion of Lyme disease and the evolution was favourable after 2 weeks of treatment. However, serology was not compatible with recent Lyme disease. Since then, the frequencies of the attacks were rare but occurred once a year.

The routine blood tests were normal except a slightly elevated C reactive protein at 12 mg/L (normal value <5 mg/L). Infectious serologies for Cytomegalovirus, Epstein-Barr virus, HIV, hepatitis C and B, Brucella, Bartonella henselae and...

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Severe, reversible dysphagia and malnutrition in a patient with tumour-induced hypophosphataemia

Up to 20% of hospitalised patients may have low serum phosphate concentrations. In certain groups, such as patients with chronic alcohol overconsumption, severe trauma or sepsis, the prevalence may be 30%–50%. Profound hypophosphataemia is less common, but may lead to severe physiological disturbances. In rare cases, hypophosphataemia is caused by phosphaturic substances excreted from a tumour. Osteomalacia with chronic bone pain and fractures, as well as muscle weakness, is common in such patients. The tumours are often small and difficult to detect. Studies suggest that fibroblast growth factor 23 is a reliable marker for detection of these tumours. Persistent hypophosphatemia unresponsive to supplements should raise clinical alertness. With complete resection of the neoplasm, the symptoms rapidly reverse. If the tumour cannot be removed, treatment relies on supplementation with phosphate and active vitamin D compounds. We present a case report of a patient with severe hypophosphataemia, osteomalacia, dysphagia and malnutrition.

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Stage 1 small cell cancer of the vagina

This is the case of a 56-year-old white woman with a medical history significant for chronic obstructive pulmonary disease, migraine, hypertension, tobacco abuse and hypercholesterolaemia. Her surgical history is significant for total hysterectomy and bilateral salpingo-oophorectomy for diffuse endometriosis. The patient presented with a vaginal lesion. The biopsy was positive for primary vaginal small cell carcinoma and human papilloma virus (HPV). Initial staging positron emission tomography (PET) scan confirmed stage 1 disease. The patient was started on chemotherapy with cisplatin and etoposide for four cycles, followed by concurrent chemotherapy with cisplatin/taxol and radiation therapy.

https://ift.tt/2lDq2u6

Successful treatment of intractable visual hallucinations with 5-HT2A antagonist ketanserin

Hallucinations, visual, auditory or in another sensory modality, often respond well to treatment in patients with schizophrenia. Some, however, do not and can be very chronic and debilitating. We present a patient with schizophrenia with intractable hallucinations despite state of the art care, including high-dose clozapine and transcranial magnetic stimulation. Based on the possible role of the 5-HT_2A receptor in hallucinations, we treated her with the antihypertensive drug ketanserin, a 5-HT_2A receptor antagonist.

This significantly reduced her visual but not her auditory hallucinations, suggesting a possible role of the 5HT_2A receptor in the pathophysiology of specifically visual hallucinations. This is the first time ketanserin has been described to successfully reduce visual hallucinations in a patient with schizophrenia.

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Use of indocyanine green dye clearance in a patient with liver cirrhosis undergoing hepatectomy: a clinical image

Description 

Indocyanine green (ICG) is a water-soluble, non-toxic tricarbocyanine dye extracted exclusively from the hepatic parenchyma. Measurement of ICG clearance using pulse spectrophotometry is a simple, reproducible and non-invasive test, easily performed in the operating room. ICG plasma disappearance rate (PDR) and the retention rate at 15 min (R15) produce real-time metrics to aid assessment and decision-making before, during and after complex liver surgery. ICG clearance has also been used to suggest the presence of postoperative complications, including thrombosis of the hepatic artery and graft dysfunction following liver transplantation. We present a case of 65-year-old Caucasian man, with Child-Pugh A liver cirrhosis undergoing complex right hepatectomy for metastatic colorectal liver cancer where ICG clearance impacted on the extent of surgical resection.

Given the concerns about marginal postoperative liver function of the residual left hepatic lobe, we used pulse spectrometry intraoperatively to predict the risk of postoperative liver dysfunction. Immediately preoperatively, a...

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Post-traumatic pseudoaneurysm of brachial artery in multiple hereditary exostoses

Pseudoaneurysms adjacent to exostoses have been commonly reported in the femoral and popliteal arteries and only rarely in the upper extremity. We describe a case of an 18-year-old man with multiple hereditary exostoses who developed a brachial artery pseudoaneurysm after minor trauma to his right upper arm, adjacent to a known lesion. He was referred to a vascular surgeon who removed the pseudoaneurysm and repaired the artery with a saphenous vein graft. We encourage a high suspicion of vascular injury even after minor trauma when an osteochondroma is adjacent to a vascular structure.

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Perforated caecal carcinoma masquerading as lower limb necrotising fasciitis: lessons learnt

A 69-year-old man was admitted with non-resolving right leg cellulitis. Subsequent skin changes over the calf and discharging pus suggested necrotising fasciitis. After several wound debridements of the leg and imaging, the patient was found to have an iliopsoas abscess due to a metastatic perforated caecal tumour extending along the medial thigh to the calf. No micro-organisms indicative of typical necrotising fasciitis were isolated from the wound. The patient had an ileocaecal resection, and his leg was reconstructed with a split thickness skin graft. He continues to do well postoperatively. This case highlights key lessons when dealing with an unusual presentation leading to challenges in diagnosis such as: (1) the need for good interspecialty liaison, (2) prompt senior review and plan, and (3) 'thinking outside the box' when faced with a diagnostic challenge.

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Total hip arthroplasty infection caused by an unusual organism, Salmonella; its successful management and literature review

Prosthetic joint infection due to Salmonella spp is rare. Here we report an acute case of Salmonella enteritidis infection of a total hip arthroplasty in a man taking immunosuppressant medication. He was managed with antibiotics and two-stage revision surgery.

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Steroid-induced protracted severe ocular hypertension in a 14-year-old girl

Steroid-induced ocular hypertension (SIOH) is a challenging entity in paediatric age, with many being refractory to medical therapy. Literature is scarce about surgical options in these cases. A 14-year-old girl with bilateral uveitis and macular oedema had received an intravitreal and subconjunctival triamcinolone injection in the right (OD) and left (OS) eye, respectively. While the steroid was effective in resolving the oedema, intraocular pressure (IOP) increased to about 40 mm Hg OD and 34 mm Hg OS, despite being under maximal IOP-lowering therapy. An initial conservative approach was preferred due to the young patient age and given that most cases of SIOH are transient. However, progressive structural changes were documented, and bilateral sequential minimally invasive glaucoma surgery (MIGS: XEN gel stent) was taken. With a follow-up of 6 months, the patient is drug-free with IOP around 14 mm Hg. This report discusses the role and efficacy of MIGS in a paediatric case of SIOH.

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Long-term complete remission of a patient with high grade neuroendocrine carcinoma of ampulla of Vater

We describe a case report of a 53-year-old man with a 5-months history of progressive jaundice and upper abdominal pain. The patient was further evaluated and finally diagnosed with a high-grade ampullary neuroendocrine tumour (based on endoscopic-guided biopsy). Thereafter, he underwent pancreatoduodenectomy and adjuvant platinum-based chemotherapy. This extremely rare case presents his long-lasting disease-free survival compared with similar cases; this case report exemplifies a new, potentially efficient method for treating high-grade papillary neuroendocrine tumour and may pave the way for further clinical trials utilising this blueprint in the treatment of related conditions.

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Solid pseudopapillary neoplasm of pancreas: an unusual aetiology for haematochezia

Solid pseudopapillary neoplasm of the pancreas is a rare condition. It is mostly seen among young women, with abdominal pain as the presenting complaint. This is a case of a young woman who presented with haematochezia, and was found to have splenic vein thrombosis and left-sided portal hypertension as a result of mass lesion at the tail of the pancreas which was diagnosed as solid pseudopapillary neoplasm.

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Giant arachnoid granulation with a thrombosed dural arteriovenous fistula

Arachnoid granulations are common incidentally detected small dural lesions which are usually asymptomatic and follow cerebrospinal fluid density/signal intensity on CT/MRI. Such lesions reaching a size of more than 1 cm are termed as giant arachnoid granulations (GAGs) which have been previously reported to cause venous hypertension and headaches. We report a case of GAG involving the proximal half of the superior sagittal sinus in a 45-year-old male patient which was associated with left temporal thrombosed dural arteriovenous fistula (AVF) whose thrombosed draining veins were seen converging towards the site of GAG. The patient presented with three episodes of generalised tonic-clonic seizures and improved with conservative treatment. No reports of such association of GAG with AVF is available in the literature, and we believe it could have occurred due to venous hypertension induced by GAG.

https://ift.tt/2tIfQUO

Acute torsion of a wandering spleen: a paediatric emergency

Description

A 5-year-old boy presented to the emergency department with intense dull aching pain in the left lower abdomen. On physical examination, his vitals were stable. A well-defined, tender, firm, 10x6 cm sized mass was palpable in the left lower abdomen occupying the left hypochondrium, left lumbar and umbilical regions. Urgent ultrasound revealed the absence of spleen in the normal position with a hypoechoic encapsulated mass in the left lower abdomen while Doppler study showed the absence of internal vascularity in it. Contrast-enhanced CT (CECT) of the abdomen (figure 1A,B) confirmed the presence of an enlarged, minimally enhancing and inferiorly displaced spleen with characteristic 'whirled appearance' of the splenic hilum. The diagnosis of splenic torsion was confirmed and an exploratory laparotomy was performed. Intraoperatively, the spleen was torsed 720 degrees on its pedicle with an engorged and thrombosed splenic vein (figure 2A,B). The ligamentous attachments (gastrosplenic, splenocolic,...

https://ift.tt/2lDejfj

Ciliary body tumour as the presenting manifestation of metastatic non-small cell adenocarcinoma of lung

We report a rare case of ciliary body metastasis from adenocarcinoma of the lung. Although the metastatic nodule was seen over the surface of the iris near the angle of anterior chamber, ultrasonography confirmed its origin from the ciliary body. Uveal metastasis may be the first sign of lung cancer.

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Spontaneous bilateral perirenal and splenic haematoma in childhood onset polyarteritis nodosa

Spontaneous bilateral perirenal haematoma, as well as splenic haematoma, are rare occasions in polyarteritis nodosa (PAN). We report a case of a young man, who suffered from various typical and atypical manifestations of PAN since childhood. The diagnosis was delayed due to symptoms mimicking with other clinical conditions. Finally, the diagnosis was confirmed when presented with perirenal and splenic haematoma and was managed successfully.

https://ift.tt/2lzRQ2B

Non-arteritic anterior ischaemic optic neuropathy secondary to menorrhagia in a young healthy woman

Non-arteritic anterior ischaemic optic neuropathy (NAION) may develop due to severe anaemia and hypotension which is seen in acute blood loss. The devastating visual loss is often irreversible. We report a case of NAION in a 20-year-old healthy woman, who presented on the third day of a heavy menstrual cycle with hypovolaemic shock. On day 2 of admission, she had sudden right eye blurring of vision at the superior field on awakening from sleep. Funduscopy revealed a pale and swollen right optic disc. There was a dense right superior altitudinal visual field defect. Her haemoglobin level was low (3.6 g/dL), but she refused blood transfusion due to her religious belief (Jehovah's Witness) and opted for conservative management. She later developed right optic atrophy with persistent visual field defect despite an improved haemoglobin level of 10.5 g/dL.

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A meta‐analysis of survival factors in rhino‐orbital‐cerebral mucormycosis – Has anything changed in the past 20 years?

Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.


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CXCL13 produced by macrophages due to Fli1 deficiency may contribute to the development of tissue fibrosis, vasculopathy, and immune activation in systemic sclerosis

Experimental Dermatology, Volume 0, Issue ja, -Not available-.


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Type 2 immunity in asthma

Type 2-immunity represents the typical adaptive response to allergen exposure in atopic individuals. It mainly involves Th2 cells and immunoglobulin E, as the main orchestrators of type 2-inflammation. Recentl...

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