Fwd: contrast media-induced nonrenal adverse drug reactions

Contrast media-induced nonrenal adverse drug reactions
To:

contrast media-induced nonrenal adverse drug reactions over the last three decades: A systematic review p. 131
Maurizio Sessa, Claudia Rossi, Annamaria Mascolo, Antonella Scafuro, Rosanna Ruggiero, Gabriella di Mauro, Salvatore Cappabianca, Roberto Grassi, Liberata Sportiello, Concetta Rafaniello
DOI:10.4103/jpp.JPP_92_18  
The aim of this study was to investigate the scientific contribution of Italian clinical research for contrast media-induced nonrenal adverse drug reactions over the last three decades. Ovid Embase, Ovid MEDLINE, Web of Science, and Cochrane Methodology Register were used as data sources to identify Italian descriptive studies, observational studies, meta-analyses, and clinical trials assessing contrast media-induced nonrenal adverse drug reactions as a safety outcome. The population of interest was men and women exposed to a contrast medium. Between 1990 and 2017, 24 original articles investigating contrast-induced nonrenal adverse drug reactions were identified. The cohort study was the most representative study design (10/24; 41.7%). The 24 studies were conducted mainly as monocenter studies (14/24; 58.3%) and without receiving funding (17/24; 70.8%). Seventeen out of 24 studies provided a level of evidence ranging from III-2 (11/24; 45.8%) to IV (6/24; 25.0%) on a Merlin scale. In total, 14 of 24 (58.3%) studies were published in a scientific journal ranked in the first quartile of their subject area. The 24 original articles mainly focused on adverse drug reactions already observed during clinical trials (i.e., idiosyncratic systemic reactions). In conclusion, during the last three decades and a burst was not observed in the Italian clinical research investigating contrast-induced nonrenal adverse drug reactions. High-quality clinical research is needed especially for procedures to prevent the onset of the aforementioned events, to identify risk factors, to minimize the risk of their occurrence, and to optimize their related prognosis.
http://www.jpharmacol.com/currentissue.asp?sabs=y

Fwd: Gujarati hypertensives

Gujarati hypertensives
To:

: A cross-sectional study p. 153
Jayesh Dalpatbhai Solanki, Hemant B Mehta, Sunil J Panjwani, Hirava B Munshi, Chinmay J Shah
DOI:10.4103/jpp.JPP_59_18  
Objective: To study the effect of different classes and combinations of antihypertensive agents on arterial stiffness and central hemodynamic parameters. Materials and Methods: A cross-sectional study was conducted in 446 treated apparently healthy hypertensives. Oscillometric PWA was performed by Mobil-o-Graph (IEM, Germany) to derive cardiovascular parameters that were further analyzed in groups stratified by antihypertensive used. Study parameters were brachial hemodynamics (blood pressure (BP), heart rate, and rate pressure product); arterial stiffness (augmentation pressure, augmentation index, pulse wave velocity, total arterial stiffness, and pulse pressure amplification); and central hemodynamics (central BP, cardiac output, and stroke work). Statistical significance was kept at P < 0.05. Results: All groups were selected by matching of age, gender, and body mass index. They were comparable with major confounding factors. There was no difference between study parameters in hypertensives taking exclusive angiotensin-converting enzyme inhibitor (ACEI), calcium channel blocker (CCB), or angiotensin II receptor blocker. Multitherapy showed better hemodynamics and monotherapy showed better stiffness parameters. Addition of CCB to ACEI did not make a difference except with diastolic BP. For most comparisons, most of the results lacked statistical significance. Conclusion: Discrete PWA parameters showed no class difference in hypertensives, treated by conventional monotherapy or combination, ACEI appears to be the best drug. This also indicates that early diagnosis and blood pressure control are more important than antihypertensive used.
http://www.jpharmacol.com/currentissue.asp?sabs=y

Fwd: Precontrast T1 signal measurements of normal pituitary and microadenoma

The dynamic contrast enhanced magnetic resonance imaging (DCE MRI),Precontrast T1 signal measurements of normal pituitary and microadenoma
To:

:

 A retrospective analysis through DCE MRI signal time curves p. 380
Ishan Kumar, Tanya Yadav, Ashish Verma, Ram C Shukla, Surya K Singh
DOI:10.4103/ijri.IJRI_104_18  
Background: The dynamic contrast enhanced magnetic resonance imaging (DCE MRI) has currently become the most utilized technique for the detection of pituitary microadenoma. However, owing to differential enhancement of normal pituitary, high rate of false positivity remains a concern in its interpretation. Purpose: Our aim was to assess the utility of precontrast T1 signal intensity ratio (SIR) of the lesions suspected on DCE MRI, in prediction of presence of microadenoma. Materials and Methods: We retrospectively reviewed MRI of 23 patients referred for DCE MRI of pituitary (group 1, 15 patients with diagnosis of pituitary microadenoma; and group 2, patients not clinically labeled as microadenoma). STC were plotted and T1-SIR at t = 0 s was obtained at the suspicious zone of differential enhancement (SIR T) and normal pituitary (SIR P). SIR difference (SIR P − SIR T) and relative SIR difference (SIR P − SIR T/SIR P) were calculated for each patient and was compared between the two groups. Results: Mean T1 SIR is lower in patients with microadenoma than those without (P = 0.065). SIR difference and relative SIR difference was higher in patients with microadenoma (P = 0.003 and 0.005, respectively). Receiver-operated characteristic curve analysis demonstrated that a cut-off of 26 and 0.107 for SIR difference and relative SIR difference, respectively, could diagnose microadenoma with 100% specificity and reasonable sensitivities. Conclusion: The baseline precontrast T1 SIR evaluation of the lesion suspected to be microadenoma on DCE MRI, derived through STC curve, can increase diagnostic confidence in diagnosis of microadenoma.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: 3D SPACE sequence and susceptibility weighted imaging in the evaluation of hydrocephalus and treatment-oriented refined classification of hydrocephalus

The evaluation of hydrocephalus : 3D SPACE sequence and susceptibility weighted imaging in the evaluation of hydrocephalus and treatment-oriented refined classification of hydrocephalus

To:

Role of 3D SPACE sequence and susceptibility weighted imaging in the evaluation of hydrocephalus and treatment-oriented refined classification of hydrocephalus p. 385
Amarnath Chellathurai, Komalavalli Subbiah, Barakath Nisha Abdul Ajis, Suhasini Balasubramaniam, Sathyan Gnanasigamani
DOI:10.4103/ijri.IJRI_161_18  

Objective: The aim of our study was to evaluate the diagnostic utility of three-dimensional sampling perfection with application optimized contrast using different flip angle evolution (3D SPACE) sequence and Susceptibility Weighted Imaging (SWI) in hydrocephalus and to propose a refined definition and classification of hydrocephalus with relevance to the selection of treatment option. Materials and Methods: A prospective study of 109 patients with hydrocephalus was performed with magnetic resonance imaging (MRI) brain using standardized institutional sequences along with additional sequences 3D SPACE and SWI. The images were independently read by two senior neuroradiologists and the etiopathogenesis of hydrocephalus was arrived by consensus. Results: With conventional sequences, 46 out of 109 patients of hydrocephalus were diagnosed as obstructive of which 21 patients showed direct signs of obstruction and 25 showed indirect signs. In the remaining 63 patients of communicating hydrocephalus, cause could not be found out in 41 patients. Whereas with 3D SPACE sequence, 88 patients were diagnosed as obstructive hydrocephalus in which all of them showed direct signs of obstruction and 21 patients were diagnosed as communicating hydrocephalus. By including SWI, we found out hemorrhage causing intraventricular obstruction in three patients and hemorrhage at various sites in 24 other patients. With these findings, we have classified the hydrocephalus into communicating and noncommunicating, with latter divided into intraventricular and extraventricular obstruction, which is very well pertaining to the selection of surgical option. Conclusion: We strongly suggest to include 3D SPACE and SWI sequences in the set of routine MRI sequences, as they are powerful diagnostic tools and offer complementary information regarding the precise evaluation of the etiopathogenesis of hydrocephalus and have an effective impact in selecting the mode of management.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: Olfactory fossa depth: CT analysis

Olfactory fossa depth: CT analysis

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Olfactory fossa depth: CT analysis of 1200 patients p. 395
Ashok Chirathalattu Babu, Mattavana Ramakrishna Pillai Balachandran Nair, Aneesh Mangalasseril Kuriakose
DOI:10.4103/ijri.IJRI_119_18  

Background: Olfactory fossa (OF) is a depression in anterior cranial cavity whose floor is formed by cribriform plate of ethmoid. Lateral lamella, which forms its lateral boundary, is a thin plate of bone and is at risk of injury during functional endoscopic sinus surgery, especially when fossa is deep/asymmetric. Aims: To measure the variations in the depth of OF and categorize Kerala population as per Keros classification using computed tomography (CT). Settings and Design: This study was conducted in our institution from January 2016 to August 2017. Patients >16 years of age undergoing CT scan of paranasal sinuses (PNS) were included. Materials and Methods: Coronal PNS CT scan studies of 1200 patients were reviewed. The depth of OF was measured from vertical height of lateral lamella. Statistical Methods: Results were analyzed according to gender and laterality using independent sample t-test and Chi-square test. Results: The mean depth of OF was 5.26 ± 1.69 mm. Statistically significant difference was seen in the mean depth of OF between males and females but not between right and left sides. Keros type I was found on 420 sides (17.5%), type II in 1790 (74.6%), and type III on 190 sides (7.9%). Type III Keros was more on the right (9%) than left (6.8%) side, more in males (9.5%) than females (5.9%), and more among males on the right side (11.4%). Asymmetry in OF depth between two sides was seen in 75% of subjects. Conclusion: Prevalence of the dangerous type III OF, even though low, is significant especially among males and on the right side. Therefore, preoperative assessment of OF depth must be done to reduce iatrogenic complications.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: High-altitude cerebral edema

High-altitude cerebral edema
To:

Neuroimaging features of fatal high-altitude cerebral edema p. 401
Gorky Medhi, Tsella Lachungpa, Jitender Saini
DOI:10.4103/ijri.IJRI_296_18  
Acute high-altitude cerebral edema can occur in an unacclimatised individual on exposure to high altitudes and sometimes it can be fatal. Here we have described the neuroimaging features of a patient who suffered from fatal high altitude cerebral edema. Available literature is reviewed. Probable pathogenesis is discussed. The risk of acute mountain sickness is reported up to 25% in individuals who ascend to an altitude of 3500 meter and in more than 50% subjects at an altitude of 6000 meter. The lack of availability of advanced imaging facilities at such a higher altitude makes imaging of such condition a less described entity.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: Isolated spontaneous cerebrospinal fluid rhinorrhoea as a rare presentation of idiopathic intracranial hypertension

Isolated spontaneous cerebrospinal fluid rhinorrhoea as a rare presentation of idiopathic intracranial hypertension
To:

: Case reports with comprehensive review of literature p. 406
Priti Soin, Umer M Afzaal, Pranav Sharma, Puneet S Kochar
DOI:10.4103/ijri.IJRI_228_18  
Isolated cerebrospinal fluid (CSF) rhinorrhoea as a sole presenting symptom of idiopathic intracranial hypertension (IIH) is extremely rare. IIH typically presents with headache, pulsatile tinnitus, dizziness, nausea, vomiting, and visual disturbance. We report two cases which presented with acute onset spontaneous CSF rhinorrhoea without any other symptom. In addition, we discuss in detail imaging features of IIH with review of its literature.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: Ultrasound elastography findings in piriformis muscle syndrome

Piriformis muscle syndrome (PMS),Ultrasound elastography findings
To:

 p. 412
Adnan Demirel, Murat Baykara, Tuba Tülay Koca, Ejder Berk
DOI:10.4103/ijri.IJRI_133_18  
Background: Piriformis muscle syndrome (PMS) is relatively less known and underestimated because it is confused with other clinical pathological conditions. Delays in its diagnosis may lead to chronic somatic dysfunction and muscle weakness. Objective: Here, we aimed to evaluate the diagnostic performance of the ultrasound elastography (UE) as an easy, less-invasive, and cost-effective method for early diagnosis of PMS. Materials and Methods: Twenty-eight cases clinically diagnosed as PMS at the outpatient clinic were evaluated by UE. The elastographic strain ratio was calculated by dividing the strain value of the subcutaneous fat tissue by the mean stress value of the muscle beneath. The diagnostic performances of the strain rate measures were compared using the receiver operating characteristic curve analysis. Results: Twenty-one (N = 21) cases were female, and seven (N = 7) of the cases were male. The mean age was 45 years (ranged 24–62 years). The strain rates of piriformis muscle (PM) and gluteus maximus (GM) muscles were significantly higher on the PMS-diagnosed side (P < 0.001). The cutoff value of UE strain ratio for the PM and GM were 0.878 [95% confidence interval (CI) 0.774–0.981] and 0.768 (95% CI 0.622–0.913), respectively, and the sensitivity and specificity values were, respectively, 80.95% and 85.71% for the PM, and they were, respectively, 85.71% and 66.67% for the GM. Conclusion: We showed that the muscle elasticity and tissue hardening increased on the problematic side both on PM and GM. UE may provide early diagnosis of PMS, thereby increasing the possibility of treatment with less invasive methods.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: Magnetic resonance imaging of ankle ligaments

Magnetic resonance imaging of ankle ligaments
To:

: A pictorial essay p. 419
Yogini Nilkantha Sawant, Darshana Sanghvi
DOI:10.4103/ijri.IJRI_77_16  
Ankle trauma is commonly encountered and is most often a sprain injury affecting the ligaments. Accurate diagnosis and appropriate treatment rest on knowledge of complex ligamentous anatomy of ankle and the entire spectrum of pathologies. Magnetic resonance imaging (MRI) is the imaging modality of choice for diagnosing ligament pathologies because of its multiplanar capability and high soft tissue contrast. With MRI, it is possible to triage and attribute the cause of post traumatic ankle pain to bone, ligament, or tendon pathologies, which otherwise overlap clinically. In this pictorial essay, emphasis is given to the intricate and unique anatomy and orientation of ankle ligaments. Pathologies of ankle ligaments have been elaborated.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: An accurate tool to detect cardiac amyloidosis

An accurate tool to detect cardiac amyloidosis

To:

Myocardial nulling pattern in cardiac amyloidosis on time of inversion scout magnetic resonance imaging sequence – A new observation of temporal variability p. 427
Harshavardhan Mahalingam, Binita Riya Chacko, Aparna Irodi, Elizabeth Joseph, Leena R Vimala, Viji Samuel Thomson
DOI:10.4103/ijri.IJRI_84_18  
Context: The pattern of myocardial nulling in the inversion scout sequence [time of inversion scout (TIS)] of cardiac magnetic resonance imaging (MRI) is an accurate tool to detect cardiac amyloidosis. The pattern of nulling of myocardium and blood at varying times post gadolinium injection and its relationship with left ventricular mass (LVM) in amyloidosis have not been described previously. Aims: The aim is to study the nulling pattern of myocardium and blood at varying times in TIS and assess its relationship with LVM and late gadolinium enhancement (LGE) in amyloidosis. Materials and Methods: This was a retrospective study of 109 patients with clinical suspicion of cardiac amyloidosis who underwent MRI. Of these, 30 had MRI features of amyloidosis. The nulling pattern was assessed at 5 (TIS5min) and 10 (TIS10min) minutes (min) post contrast injection. Nulling pattern was also assessed at 3min (TIS3min) in four patients and 7min (TIS7min) in five patients. Myocardial mass index was calculated. Mann-Whitney U test was done to assess statistical difference in the myocardial mass index between patients with and without reversed nulling pattern (RNP) at TIS5min. Results: RNP was observed in 58% at TIS5minand 89.6% at TIS10min. Myocardial mass index was significantly higher in patients with RNP at TIS5min[mean = 94.87 g/m2; standard deviation (SD) =17.63) when compared with patients with normal pattern (mean = 77.61 g/m2; SD = 17.21) (U = 18; P = 0.0351). Conclusion: In cardiac amyloidosis, TIS sequence shows temporal variability in nulling pattern. Earlier onset of reverse nulling pattern shows a trend toward more LVM and possibly more severe amyloid load.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: Pulmonary atresia and ventricular septal defect,Coronary artery as the primary source of pulmonary blood flow

Pulmonary atresia and ventricular septal defect,Coronary artery as the primary source of pulmonary blood flow

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Collateral or fistula? Coronary artery as the primary source of pulmonary blood flow in a patient with pulmonary atresia and ventricular septal defect p. 433
Anurag Yadav, Salil Bhargava, T B S Buxi, Krishna Sirvi
DOI:10.4103/ijri.IJRI_489_17  
In patients with pulmonary atresia and ventricular septal defect (PA/VSD), a coronary artery being the primary source of pulmonary blood flow is a rare entity. We describe two cases of PA/VSD with coronary-to-pulmonary artery fistula with emphasis on the role of Computed Tomographic Angiography (CTA) in depicting all the sources of pulmonary blood supply, to predict surgical management and need for unifocalization of Major Aortopulmonary Collateral Arteries (MAPCA's).
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: Evaluation of lung transplant perfusion using iodine maps from novel spectral detector computed tomography

Evaluation of lung transplant perfusion using iodine maps from novel spectral detector computed tomography
To:

p. 436
Nils Große Hokamp, Amit Gupta
DOI:10.4103/ijri.IJRI_35_18  
We report the case of a 51-year-old patient who underwent bilateral lung transplantation and presented with an unstable condition and sepsis 6 days after transplantation. The performed contrast enhanced spectral detector computed tomography (CT) using a dual-layer detector showed absence of perfusion in the left lung on iodine maps, although branches of the pulmonary artery were patent. This prompted retrospective evaluation of CT images and total venous occlusion of the left pulmonary veins was found. Here, iodine maps helped in raising conspicuity of loss of lung perfusion.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: Atypical alveolar proteinosis

Atypical alveolar proteinosis
To:

 p. 439
Lova Hasina Rajaonarison Ny Ony Narindra, Emmylou Gabrielle Andrianah, Volahasina Francine Ranaivomanana, Christian Tomboravo, Hasina Dina Ranoharison, Jean Noel Bruneton, Ahmad Ahmad
DOI:10.4103/ijri.IJRI_170_18  
Alveolar proteinosis is a rare pulmonary disease characterized by intra-alveolar accumulation of surfactant composed of lipoproteinaceous material, related to a lack of surfactant resorption by alveolar macrophages. Crazy paving pattern is characteristic, but not specific. The multinodular forms of this affection remain exceptional.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: The normal pancreatic dimensions in pediatric age groups

The normal pancreatic dimensions in pediatric age groups
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Percentile reference curves for normal pancreatic dimensions in Indian children p. 442
Dhanraj S Raut, Dhananjay V Raje, Vithalrao P Dandge, Dinesh Singh
DOI:10.4103/ijri.IJRI_189_18  
Objectives: This study aims at determining the normal pancreatic dimensions in pediatric age groups considering demographic parameters and thus developing percentile reference curves for normal pancreatic dimensions in Indian children. Setting and Design: It is a cross-sectional study. Materials and Methods: A hospital-based cross-sectional study was planned at a children hospital during July 2016–December 2017, in which the pancreatic dimensions of 1078 normal children in the age range of 1 month to 19 years were obtained through abdominal ultrasonography (USG). The demographic details like age and gender were obtained for each child. Statistical Analysis Used: Percentile reference curves were obtained with reference to age for each gender type independently. Generalized additive models for location, scale, and shape were used to obtain percentile plots for each pancreatic part. Results: The mean age of children was 6.65 ± 4.43 years and the male-to-female ratio was 1.63:1. The head, body, and tail dimensions increased with the age. For head, up to 25th percentile, the curves were similar for both genders, while subsequent curves were higher in males as compared to females. Similar was the observation for body of pancreas. For tail, up to 75th percentile, the curves were similar for both genders. Conclusion: The normal ranges can be supportive in diagnosis of illness related to pancreas. The dimensions within 5–95th percentile along with iso-echogenicity can be regarded as normal, while the dimensions beyond these limits along with change of echogenicity can be suspected for pancreatic disorders.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: Secretory carcinoma (juvenile carcinoma) is one of the very rare breast malignancy reported to be prevalent in pediatric age group

Secretory carcinoma (juvenile carcinoma) is one of the very rare breast malignancy reported to be prevalent in pediatric age group

To:

Clinicoradiologicial aspects of secretory carcinoma breast: A rare pediatric breast malignancy p. 448
Aanchal Bhayana, Ritu N Misra, Sunil K Bajaj, Himani Bankhar
DOI:10.4103/ijri.IJRI_46_18  
Secretory carcinoma (juvenile carcinoma) is one of the very rare breast malignancy reported to be prevalent in pediatric age group. We report imaging and clinicopathological features of secretory carcinoma breast with distant and axillary metastasis, in an 11-year-old girl, who presented with a painful lump in right breast. Ultrasound revealed a well-defined, partially microlobulated hypoechoic mass with skin and pectoralis muscle involvement and a suspicious morphology right axillary lymph node. Color Doppler revealed increased vascularity in both the breast mass and suspicious axillary node. Magnetic resonance imaging helped in better evaluation of pectoralis muscle involvement. Computed tomography (CT) neck, chest, and abdomen revealed multiple fibronodular opacities in bilateral lung fields. 18 Flouro-Deoxy-Glucose Positron Emission Tomography (FDG PET-CT) showed a hypermetabolic retroareolar breast mass with multiple hypermetabolic bilateral lung nodules suggesting lung metastasis. The histopathology confirmed the diagnosis of secretory carcinoma. The patient was offered chemotherapy for 2 years and put on follow-up since then.
http://www.ijri.org/currentissue.asp?sabs=y

Closed loop small bowel obstruction due to paracaecal internal herniation: a lesson in rarity

A 40-year-old man presented to the emergency department of our tertiary hospital with acute abdominal pain since 1 day, which responded to conservative measures initially. On further investigation and abdominal CT, he was diagnosed with closed loop small bowel obstruction with an encapsulated lesion with small bowel loops within, in the right iliac fossa, which was initially missed. On exploration, the patient had a sac in the right iliac fossa (paracaecal incarcerated internal hernia) with distended bowel loops within, the sac was excised after reduction of the contents. Postoperative recovery was uneventful.

https://ift.tt/2T1YFZv

Tumour lysis syndrome following eribulin for metastatic uterine leiomyosarcoma

A middle-aged woman with a history of leiomyosarcoma of the uterus treated with surgery and adjuvant chemotherapy suffered a bulky metastatic recurrence 1 year later. She elected treatment with palliative eribulin, presenting with acute renal failure and electrolyte abnormalities consistent with tumour lysis syndrome on cycle 1 day 8. Despite aggressive supportive care and treatment including intravenous hydration, bicarbonate and rasburicase, she continued to decline, ultimately foregoing haemodialysis in favour of palliative care and passed away in the hospital.

https://ift.tt/2CoTwoF

Fwd: Vertebral or vascular anomalies, anal atresia, cardiac defects, tracheoesophageal – fistula/esophageal atresia, renal defects, and limbs defects

Vertebral or vascular anomalies, anal atresia, cardiac defects, tracheoesophageal – fistula/esophageal atresia, renal defects, and limbs defects

To:

VACTERL association – Ultrasound findings and autopsy correlation p. 452
Naman Kumar Gaur, Sudheer Gokhale
DOI:10.4103/ijri.IJRI_115_18  
VACTERL (vertebral, anal, cardiac, tracheoesophagus, renal, and limbs) is an abbreviation for the congenital group of abnormalities, including vertebral or vascular anomalies, anal atresia, cardiac defects, tracheoesophageal – fistula/esophageal atresia, renal defects, and limbs defects. It is a rare association and not accidental event where several organs are affected by developmental defects during blastogenesis. The exact cause is unknown; however, several environmental and genetic factors are included in literature. Three components out of seven are used to label as VACTERL. The combination is necessary, but the patient may have other congenital malformations as well. We present here an antenatal scan with autopsy correlation of one of the forms of VACTERL association spectrum.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: Campomelic dysplasia with 10 pairs of ribs

Campomelic dysplasia with 10 pairs of ribs

To:

Campomelic dysplasia with 10 pairs of ribs in a preterm neonate: A case report p. 456
Laxman Basani, Roja Aepala, Naresh Macha
DOI:10.4103/ijri.IJRI_173_18  
Campomelic dysplasia (CD) is a rare form of skeletal dysplasia (incidence 1:200,000 births) which is associated with characteristic phenotypes including bowing of the limbs, a narrow thoracic cage, 11 pairs of ribs, hypoplastic scapulae, macrocephaly, flattened supraorbital ridges and nasal bridge, cleft palate, and micrognathia. In addition to the skeletal abnormalities, hydrocephalus, hydronephrosis, and congenital heart disease have been reported. We describe a preterm neonate who presented with respiratory failure and clinical features of CD. Our case had only 10 pairs of ribs, and to the best of our knowledge this is the first case report of CD with 10 pairs of ribs.
http://www.ijri.org/currentissue.asp?sabs=y

Identifying the aetiology of sudden acute abnormal involuntary movements in a primigravid

A 20-year-old primigravid experienced sudden stiffening of the neck, upper and lower extremities and trunk associated with joint pains. She was generally well before hospital admission with no history of attacks, except for her inflammatory bowel disease that was treated more than a year ago. During physical examination, the patient manifested neck flexion deviated to the right, deviation of the eyes downward and to the right, spooning of the upper extremities, exhibition of milkmaid's grip, extension of both lower extremities and jerky speech. She also showed uncontrollable tremors of the neck and occasional flailing of upper extremities. Her preliminary laboratory tests were within normal range. It was worth noting here that her family's medical history was unremarkable. In this article, the process of arriving at the final diagnosis and treatment would be discussed.

https://ift.tt/2T3pzjN

An autopsy report of basilar artery aneurysm flow diversion complicated by postoperative day 3 hemorrhage from vessel rupture

A middle-aged patient presented with posterior circulation symptoms attributable to a large eccentric basilar trunk aneurysm. The planned treatment was flow diversion with loose coil packing which was successfully performed using a Pipeline Flex device deployed from the basilar to the left posterior cerebral artery. The complete procedure including live biplane fluoroscopy was digitally recorded. The patient had symptomatic improvement postoperatively and was discharged on day 1. The patient suffered a cardiac arrest on postoperative day 3 secondary to massive intraventricular and subarachnoid hemorrhage. An aneurysm rupture was suspected; however, postmortem examination showed an intact aneurysm sac. The hemorrhage was attributed to a small focal rent in the distal basilar artery next to an atheromatous plaque. The Pipeline device was visible through the rent. This is an autopsy report documenting an injury to the parent artery and not the aneurysm as a source of fatal delayed subarachnoid hemorrhage following flow diversion.

https://ift.tt/2CnNp4a

Extrapulmonary tuberculosis: a debilitating and often neglected public health problem

We report a case of a 33-year-old woman from Nepal who presented to a hospital with paraplegia. She was found to have pulmonary tuberculosis (TB) with lumbar spine involvement, and bilateral psoas abscesses. She had no initial symptoms attributable to pulmonary involvement. Her delayed presentation to the hospital led to complication of TB spine, which compromised the life of this woman working as a labourer. Early diagnosis and treatment of extrapulmonary TB is essential. Awareness regarding symptoms of different forms of extrapulmonary TB and making diagnostic modalities such as CT scan, MRI or biopsy readily available through insurance schemes are some important measures to minimise the problem so that complications like paraplegia as in our patient with spinal TB can potentially be avoided.

https://ift.tt/2T3v2XP

Froins syndrome associated with spinal tuberculosis

https://ift.tt/2CpJxzO

Primary cutaneous 'ulcerative tuberculosis of the scrotum: a rare occurrence

Tuberculosis (TB) is a global disease and if not adequately treated can lead to morbidity and mortality. Though genitourinary TB is common and only next to pulmonary TB, cutaneous 'ulcerative' tuberculosis of the scrotum is not reported so far in the literature. We present a 32-year-old man with a non-healing scrotal ulcer and underwent excision. Histopathology was consistent with TB. Antitubercular therapy was given and at the end of a year's follow-up, there has been no recurrence. TB of the scrotum should be considered in the differential diagnosis of scrotal ulcers. Proper diagnosis and adequate treatment will offer a cure to such patients.

https://ift.tt/2T1YJIJ

Repair of the ulnar collateral ligament of the elbow with internal brace augmentation: a 5-year follow-up

The ulnar collateral ligament (UCL) is the primary restraint to valgus angulation at the elbow. Injury to the UCL is increasingly common and can lead to instability, especially in athletes involved in overhead throwing. Conventional treatment is reconstruction using tendon autograft but performance levels are often restricted after long periods of rehabilitation. Modern surgical techniques have led to renewed interest in repair of the ligament, with the aim of restoring native anatomy. This has the benefit of retained proprioception and no graft harvest morbidity. Furthermore, augmentation of the repair with an Internal Brace protects the healing ligament, while allowing early rehabilitation and accelerated return to play. Here we present the first patient treated with this technique who achieved excellent recovery with return to college level American Football after 4 months. Five years later he has good elbow function and plays at the same level.

https://ift.tt/2CpxJNY

The risky side of weight-loss dietary supplements: disrupting arrhythmias causing sudden cardiac arrest

The worldwide increasing prevalence of obesity has led to a corresponding increase in consumption of weight-loss dietary supplements. The limited de novo regulatory oversight and under-reported toxicity profile of these products reflect as a constellation of newer adverse events. We chronicle here the case of an otherwise healthy woman who developed ventricular fibrillation-related cardiac arrest secondary to the use of Hydroxycut and Metaboost preparations. Published medical literature has a handful of case reports associating these products with potentially life-threatening cardiac arrhythmias. The proposed hypothesis implicates ingredients of these diet aids to have proarrhythmogenic effects. Physicians should remain vigilant for possible cardiotoxicity associated with the use of dietary supplements. Individuals who are at risk of developing cardiac arrhythmias should avoid herbal weight-loss formulas, given the serious clinical implications. Additionally, this paper highlights the need for a proper framework to delineate the magnitude and scope of this association.

https://ift.tt/2T3oKHJ

Where is the orogastric tube going in this preterm neonate?

https://ift.tt/2CpJyDS

Pseudo-Wellens syndrome in pulmonary embolism

Wellens' syndrome is described as characteristic biphasic or symmetrical T-wave inversion with normal precordial R-wave progression and the absence of Q waves in the right precordial leads. It is seen during chest pain-free interval in a subset of patients with unstable angina. Wellens' syndrome is associated with critical stenosis of proximal left anterior descending (LAD) coronary artery. Similar characteristic ECG changes associated with causes other than LAD stenosis have been described as pseudo-Wellens' syndrome. In this case report, we present a young 22-year-old man who presented with characteristic Wellens' ECG changes in the setting of pulmonary embolism with right ventricular strain. T-wave inversion in right precordial leads is a well-recognised ECG manifestation of right ventricular strain; however, biphasic T waves in the setting of pulmonary embolism are rare. Pulmonary embolism was seen in our patient a week after starting risperidone. There is a reported association between antipsychotic drugs and increased risk of thromboembolism. Risperidone could have potentially contributed to the pulmonary embolism in our patient given the temporal association and absence of risk factors.

https://ift.tt/2T1J7Vp

Dantrolene is not the answer to 2,4-dinitrophenol poisoning: more heated debate

There has been a resurgence in the use of 2,4-dinitrophenol, C₆H₄N₂O₅ (DNP) recently as an illegal weight loss drug. We present a case of a healthy 25-year-old girl who took two tablets of DNP, purchased from an overseas online retailer. She was managed with aggressive, invasive cooling measures and 2.5 mg kg^–1 dantrolene. Despite this, her temperature continued to rise exponentially to 41.5°C. Cardiac arrest occurred and resuscitation was unsuccessful. To our knowledge, this is the first reported case of the ineffective use of dantrolene in acute DNP poisoning. We review the pathophysiology of DNP toxicity and argue that the use of dantrolene therapy is biochemically implausible, based on poor evidence and likely to be futile. We have contacted the UK National Poisons Information Service (NPIS/TOXBASE) to propose changes to the management of acute DNP toxicity.

https://ift.tt/2Co0gDw

Fwd: Preoperative differentiation of benign from malignant thyroid nodules,Diffusion-weighted imaging (DWI) is highly accurate for discrimination between benign and malignant thyroid nodules.

Preoperative differentiation of benign from malignant thyroid nodules,Diffusion-weighted imaging (DWI) is highly accurate for discrimination between benign and malignant thyroid nodules.

To:

Differentiation between benign and malignant thyroid nodules using diffusion-weighted imaging, a 3-T MRI study p. 460
Leila Aghaghazvini, Hashem Sharifian, Nasrin Yazdani, Melina Hosseiny, Saina Kooraki, Pirouz Pirouzi, Afsoon Ghadiri, Madjid Shakiba, Soheil Kooraki
DOI:10.4103/ijri.IJRI_488_17  
Background: Preoperative differentiation of benign from malignant thyroid nodules remains a challenge. Aims: This study assessed the accuracy of diffusion-weighted imaging (DWI) for differentiation between benign and malignant thyroid nodules. Materials and Methods: Preoperative DWI was performed in patients with thyroid nodule by means of a 3-T scanner magnetic resonance imaging (MRI). Images were obtained at b value of 50, 500, and 1000 mm2/s to draw an ADC (apparent diffusion coefficient) map. Findings were compared with postoperative histopathologic results. Receiver operating characteristic curve was used to assess the accuracy of different cutoff points. Results: Forty-one thyroid nodules (26 benign and 15 malignant) were included in this study. None of static MRI parameters such as signal intensity, heterogeneity, and nodule border was useful to discriminate between benign and malignant lesions. Mean ADC value was (1.94 ± 0.54) × 10-3 mm2/s and (0.89 ± 0.29) × 10-3 mm2/s in benign and malignant nodules, respectively (P-value < 0.005). ADC value cutoff of 1 × 10-3 mm2/s yielded an accuracy, sensitivity, and specificity of 93%, 87%, and 96% to discriminate benign and malignant nodules. Conclusion: DWI is highly accurate for discrimination between benign and malignant thyroid nodules.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: Normal adrenal gland thickness on computerized tomography

Normal adrenal gland thickness on computerized tomography

To:

 in an Asian Indian adult population p. 465
Reetu John, Tharani Putta, Betty Simon, Anu Eapen, Felix Jebasingh, Nihal Thomas, Simon Rajaratnam
DOI:10.4103/ijri.IJRI_129_18  

Context: The size and morphology of the adrenal glands are affected by several physiological and pathological conditions. Radiologists need to be aware of the normal thickness of adrenal gland to accurately assess patients with suspected adrenal pathology. However, there is limited data on the normal size of the adrenal glands. Moreover, this has not been studied in our population. Aims: To study the normal thickness of adrenal gland on computerized tomography (CT) in Indian adult population. Settings and Design: Retrospective study in a tertiary care hospital in Southern India. Subjects and Methods: Our study included 586 adults who underwent a CT abdominal angiogram over 15 months, and excluding patients with clinical or imaging evidence of adrenal disease. The measurements made included: the maximum thickness of the body, medial and lateral limbs, measured perpendicular to the long axis. Results: The median age was 51 (range: 18–85) years. The mean maximum thickness of the adrenal body, medial, and lateral limbs were 7.2 ± 1.8, 4.1 ± 1.1, and 4.3 ± 1.1 mm on the right side and 8.8 ± 1.9, 4.7 ± 1.1, and 4.9 ± 1.3 mm on the left. The cumulative thickness of the body and the limbs were 15.6 ± 3.7 mm and 18.4 ± 3.8 mm on the right and left sides, respectively. There was a statistically significant difference in all the measurements between the right and left adrenal glands (all P values = 0.000) and between men and women, being larger in men (P value <0.05). Among our patients 27% had at least one adrenal gland body measuring ≥10 mm in thickness. Conclusions: Our study has defined the normal range of adrenal gland thickness in an Asian Indian adult population, which may be used as a baseline reference for future research and as a reference for radiological reporting.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: Bronchial artery embolization is an established intervention for management of recurrent massive hemoptysis

Bronchial artery embolization is an established intervention for management of recurrent massive hemoptysis

To:

Dealing with technical challenges in embolization of a rare aberrant left inferior bronchial artery arising from the left gastric artery in a patient with massive hemoptysis p. 476
Gaurav Gangwani, Ajit Yadav, Amit Dhamija, Arun Gupta
DOI:10.4103/ijri.IJRI_162_18  
Bronchial artery embolization is an established intervention for management of recurrent massive hemoptysis in a majority of patients. The source of bleeding in a majority of cases is systemic arteries – orthotopic bronchial arteries, anomalous bronchial arteries, or nonbronchial systemic collaterals. We report a case of an aberrant left inferior bronchial artery arising from the left gastric artery (LGA) in a patient with massive hemoptysis. Such origin from infradiaphragmatic vessels and specially left gastric arteries is very rare and needs to be considered by interventional radiologists and pulmonologists in case with hemoptysis disproportionate to supply by orthotopic arteries. Technical challenges were present in the present case in the form of an aneurysm in the aberrant artery and nontarget hepatic and gastric branches arising from LGA. Appropriate selection of hardware and embolic agents was done to deal with the clinical situation.
http://www.ijri.org/currentissue.asp?sabs=y

Fwd: Ganglion impar injection approaches and outcomes for coccydynia Foye PM, Sajid N, D'Onofrio GJ - Indian J Radiol Imaging

Ganglion impar injection approaches and outcomes for coccydynia Foye PM, Sajid N, D'Onofrio GJ - Indian J Radiol Imaging
To:

We praise your journal and authors Gonnade et al., on the excellent recent publication titled, "Ganglion impar block in patients with chronic coccydynia."[1] Their study of patients with chronic coccydynia (coccyx pain) showed that ganglion impar injections with local anesthetic block and corticosteroid significantly decreased pain and disability scores even at the maximum length of study follow-up, which was 6-month postinjection.

The authors clearly described injecting the ganglion impar via the sacrococcygeal junction. We would like to point out that other needle approaches can also be done, depending on the patient's anatomy. Specifically, interventional physicians should be aware of alternative approaches via the first[2] or second[3] intracoccygeal joint (between coccygeal vertebral bodies one and two, or between coccygeal vertebral bodies three and fourth, respectively). These approaches have been referred to as being transcoccygeal, intracoccygeal, or coccygeal transdiscal. These newer approaches have some potential advantages. First, since the sacrococcygeal joint is fused in 51% of humans,[4] these newer approaches provide access through joints that are more likely to be patent. Second, human cadaver studies have shown that the ganglion impar is usually located at the upper coccyx, rather than at the sacrococcygeal joint.[5]

We noted that the authors excluded from treatment any patients who had imaging abnormalities that would explain their tailbone pain. This surprised us since our experience is that coccydynia patients often respond extremely well to these impar injections, regardless of whether they do or do not have coccygeal imaging abnormalities. We would be very interested in the authors' thoughts on their exclusion criteria.

We hope our comments and the authors' reply will provide even more insights on relieving pain via these injections.
http://www.ijri.org/article.asp?issn=0971-3026;year=2018;volume=28;issue=4;spage=482;epage=483;aulast=Foye

Fwd: Drug-induced changes in dentate nuclei of cerebellum Aswani Y, Aswani N, Sharma R - Indian J Radiol Imaging

We read with great interest the article titled "Sequential MR imaging (with diffusion-weighted imaging) changes in metronidazole-induced encephalopathy" by Singh et al. in the April–June 2017 issue of the Indian Journal of Radiology and Imaging.[1] The article is highly informative and describes signal changes in splenium and dentate nuclei following metronidazole ingestion. In this article, we describe a few drugs that cause similar signal changes in the cerebellar dentate nuclei
http://www.ijri.org/article.asp?issn=0971-3026;year=2018;volume=28;issue=4;spage=480;epage=480;aulast=Aswani

Fwd: Role of proton MR spectroscopy in spinal cord lesions: A guarded espousal Agarwal A - Indian J Radiol Imaging

I read with great interest the article titled "3T proton MR spectroscopy evaluation of spinal cord lesions" by Sathyanathan et al. published in the July–September, 2018 issue of the Indian Journal of Radiology and Imaging.[1] The manuscript is well written and informative. The authors have narrated the MR spectroscopy (MRS) protocol and patterns in various intramedullary spinal lesions in a very efficient manner. However, I would like to make the following contributions and observations pertinent to the study.

In their study cohort of 50 patients, the authors have investigated spectral pattern on intramedullary spinal cord lesions. They designated four of them as schwannoma, which is an extramedullary lesion. Literature shows very few case reports of intramedullary schwannoma, which may be found in neurofibromatosis.[2],[3] Even in the subsequent discussion, the MRS pattern of these lesions is not elaborated. So, it will be of great help if authors could clarify my doubts in this regard.

The present study[1] defines the changes in the metabolites in different spinal lesions based on the deviation in their peak values from the normal spectra. In the previous few studies,[4],[5] the results have been expressed in terms of metabolite ratios, which is an absolute quantification method. Therefore, I would like to know about the authors' experience in evaluating the metabolite ratios and their feasibility pertaining to the study.

High signal-to-noise ratio is addressed in the present study[1] by the use of high magnetic field strength (3 T). However, there are spectral reliability indices such as Cramér–Rao lower bounds of each metabolite, mean, and standard deviation of the spectral line width, the coefficient of variations of the measurements, and the group average of the spectra.[5] These quality indicators can be used in future studies for enhancing the spectral quality and dependability.
http://www.ijri.org/article.asp?issn=0971-3026;year=2018;volume=28;issue=4;spage=481;epage=481;aulast=Agarwal

Hepatic Critical Care

No abstract available

https://ift.tt/2QJmrgc

Hospital-Based Acute Care Within 7 Days of Discharge After Outpatient Arthroscopic Shoulder Surgery: Erratum

No abstract available

https://ift.tt/2Bzq1Pl

Alternatives for Pediatric Anticoagulation: The Case for Bivalirudin

No abstract available

https://ift.tt/2UVwpcI

In Response

No abstract available

https://ift.tt/2QJmkRO

Are Peripheral Nerve Blocks Indicated in Ambulatory Knee Surgery?

No abstract available

https://ift.tt/2Bsa6lS

Psychometrics: Trust, but Verify

There is a continued mandate for practicing evidence-based medicine and the prerequisite rigorous analysis of the comparative effectiveness of alternative treatments. There is also an increasing emphasis on delivering value-based health care. Both these high priorities and their related endeavors require correct information about the outcomes of care. Accurately measuring and confirming health care outcomes are thus likely now of even greater importance. The present basic statistical tutorial focuses on the germane topic of psychometrics. In its narrower sense, psychometrics is the science of evaluating the attributes of such psychological tests. However, in its broader sense, psychometrics is concerned with the objective measurement of the skills, knowledge, and abilities, as well as the subjective measurement of the interests, values, and attitudes of individuals—both patients and their clinicians. While psychometrics is principally the domain and content expertise of psychiatry, psychology, and social work, it is also very pertinent to patient care, education, and research in anesthesiology, perioperative medicine, critical care, and pain medicine. A key step in selecting an existing or creating a new health-related assessment tool, scale, or survey is confirming or establishing the usefulness of the existing or new measure; this process conventionally involves assessing its reliability and its validity. Assessing reliability involves demonstrating that the measurement instrument generates consistent and hence reproducible results—in other words, whether the instrument produces the same results each time it is used in the same setting, with the same type of subjects. This includes interrater reliability, intrarater reliability, test–retest reliability, and internal reliability. Assessing validity is answering whether the instrument is actually measuring what it is intended to measure. This includes content validity, criterion validity, and construct validity. In evaluating a reported set of research data and its analyses, in a similar manner, it is important to assess the overall internal validity of the attendant study design and the external validity (generalizability) of its findings.

https://ift.tt/2QGTxNO

Enhanced Recovery Pathways: Looking Into the Future

No abstract available

https://ift.tt/2BtQYnB

Perioperative Considerations and Positioning for Neurosurgical Procedures: A Clinical Guide

No abstract available

https://ift.tt/2QGsge9

Foretelling Right Ventricular Failure After Left Ventricular Assist Device Implantation: The Tale of the Pulmonary Artery Pulsatility Index

No abstract available

https://ift.tt/2Bs9Vac

In Reply: Encouraging a Bare Minimum While Striving for the Gold Standard: A Response to the Updated WHO-WFSA Guidelines

No abstract available

https://ift.tt/2QDPZf0

Predatory Journals Undermine Peer Review and Cheapen Scholarship

No abstract available

https://ift.tt/2BtQPR5

Repeated Morphine Prolongs Postoperative Pain in Male Rats

BACKGROUND: Opioids are effective postoperative analgesics. Disturbingly, we have previously reported that opioids such as morphine can worsen inflammatory pain and peripheral and central neuropathic pain. These deleterious effects are mediated by immune mediators that promote neuronal hyperexcitability in the spinal dorsal horn. Herein, we tested whether perioperative morphine could similarly prolong postoperative pain in male rats. METHODS: Rats were treated with morphine for 7 days, beginning immediately after laparotomy, while the morphine was tapered in a second group. Expression of genes for inflammatory mediators was quantified in the spinal dorsal horn. In the final experiment, morphine was administered before laparotomy for 7 days. RESULTS: We found that morphine treatment after laparotomy extended postoperative pain by more than 3 weeks (time × treatment: P

https://ift.tt/2QHI1l1

Total Intravenous Anesthetic Versus Inhaled Anesthetic: Pick Your Poison

No abstract available

https://ift.tt/2BtQL3N

Should Total Intravenous Anesthesia Be Used to Prevent the Occupational Waste Anesthetic Gas Exposure of Pregnant Women in Operating Rooms?

No abstract available

https://ift.tt/2QHHZJV

The More You Know: Identifying Factors Associated With Inpatient Mortality Related to Opioid Overdose Can Drive Progress in the Opioid Health Crisis

No abstract available

https://ift.tt/2Bs9Fbe

Liver Anesthesiology and Critical Care Medicine, 2nd ed

No abstract available

https://ift.tt/2QDO3Dn

Clinical Practice Improvement: Mind the Gap or Fall Into the Chasm

No abstract available

https://ift.tt/2BuAjR5

Labor Pain’s Relationship With Depression: From Whence, and What Shall be Done?

No abstract available

https://ift.tt/2QKUFQj

Intraoperative Hemodynamic and Echocardiographic Measurements Associated With Severe Right Ventricular Failure After Left Ventricular Assist Device Implantation

BACKGROUND: Severe right ventricular failure (RVF) after left ventricular assist device (LVAD) implantation increases morbidity and mortality. We investigated the association between intraoperative right heart hemodynamic data, echocardiographic parameters, and severe versus nonsevere RVF. METHODS: A review of LVAD patients between March 2013 and March 2016 was performed. Severe RVF was defined by the need for a right ventricular mechanical support device, inotropic, and/or inhaled pulmonary vasodilator requirements for >14 days. From a chart review, the right ventricular failure risk score was calculated and right heart hemodynamic data were collected. Pulmonary artery pulsatility index (PAPi) [(pulmonary artery systolic pressure − pulmonary artery diastolic pressure)/central venous pressure (CVP)] was calculated for 2 periods: (1) 30 minutes before cardiopulmonary bypass (CPB) and (2) after chest closure. Echocardiographic data were recorded pre-CPB and post-CPB by a blinded reviewer. Univariate logistic regression models were used to examine the performance of hemodynamic and echocardiographic metrics. RESULTS: A total of 110 LVAD patients were identified. Twenty-five did not meet criteria for RVF. Of the remaining 85 patients, 28 (33%) met criteria for severe RVF. Hemodynamic factors associated with severe RVF included: higher CVP values after chest closure (18 ± 9 vs 13 ± 5 mm Hg; P = .0008) in addition to lower PAPi pre-CPB (1.2 ± 0.6 vs 1.7 ± 1.0; P = .04) and after chest closure (0.9 ± 0.5 vs 1.5 ± 0.8; P = .0008). Post-CPB echocardiographic findings associated with severe RVF included: larger right atrial diameter major axis (5.4 ± 0.9 vs 4.9 ± 1.0 cm; P = .03), larger right ventricle end-systolic area (22.6 ± 8.4 vs 18.5 ± 7.9 cm2; P = .03), lower fractional area of change (20.2 ± 10.8 vs 25.9 ± 12.6; P = .04), and lower tricuspid annular plane systolic excursion (0.9 ± 0.2 vs 1.1 ± 0.3 cm; P = .008). Right ventricular failure risk score was not a significant predictor of severe RVF. Post-chest closure CVP and post-chest closure PAPi discriminated severe from nonsevere RVF better than other variables measured, each with an area under the curve of 0.75 (95% CI, 0.64–0.86). CONCLUSIONS: Post-chest closure values of CVP and PAPi were significantly associated with severe RVF. Echocardiographic assessment of RV function post-CPB was weakly associated with severe RVF.

https://ift.tt/2Bs9wVe

In Response

No abstract available

https://ift.tt/2QHAPpj

Non-operative management of iatrogenic colonic perforation after percutaneous cholecystotomy

Abstract

The management of iatrogenic colonic perforation encountered during percutaneous cholecystotomy tube placement is not well reported. It is unclear as to whether an operative versus a conservative approach is ideal for this complication. We therefore present our case report to spur a discussion on patient selection, interval follow-up and call for future studies regarding this uncommon complication.

https://ift.tt/2rMGyuT

A rare eyelid tumour in an elderly man

https://ift.tt/2T0FvTM

Bullous pemphigoid in adolescence

Abstract

Bullous pemphigoid (BP) is the most common autoimmune blistering disease affecting the elderly but is quite rare in childhood. The majority of pediatric cases have been reported during early childhood. Adolescence is divided into three phases: early (10‐13 years), middle (14‐17), and late (18‐21). This review aimed to identify BP cases in adolescence and demonstrate their clinical features and course. Our literature search was performed in Medline with the terms "bullous pemphigoid in childhood and adolescence," "childhood bullous pemphigoid," "juvenile bullous pemphigoid," and "autoimmune blistering and autoimmune bullous diseases in childhood." The data extraction for late adolescence was limited by the fact that this age group is included in adult BP registries. We identified nine cases in early adolescence. Mucosa were affected in 5 of 9 cases. Treatment consisted of systemic prednisone (8/9), in combination with dapsone (2/9), azathioprine (2/9), or erythromycin/nicotinamide (1/9). Relapses were reported in 3 of 9 cases. We identified five cases occuring in middle adolescence. Mucosa were not affected. Treatment consisted of systemic prednisone (5/5), in combination with dapsone (3/5), azathioprine (2/5), doxycycline/nicotinamide (1/5), or mycophenolate mofetil (1/5). Relapses were reported in two of five cases. No case of BP in the late adolescence was included in the results, as only one case met the search criteria, and overlapped with pemphigus vulgaris. With only 14 cases found in our review, BP in adolescence appears even rarer than in earlier childhood. Despite its low prevalence, BP should be included in the differential diagnosis of autoimmune blistering diseases in adolescents.

https://ift.tt/2SbG0KO

Comparison of Primary and Secondary Anterior Septal Reconstruction: A Cohort Study

Facial plast Surg
DOI: 10.1055/s-0038-1667154

This article compares outcomes in patients presenting for either primary or secondary (revision) anterior septal reconstruction (ASR) to treat caudal septal deviation. Patients undergoing ASR by senior author (S. P. M.) between January 1, 2012 and September 1, 2017, with both preoperative and postoperative Nasal Obstruction Symptom Evaluation (NOSE) scores documented in the chart were included. Data were compared between patients undergoing primary and secondary ASR by univariable and multivariable logistic regression. A total of 199 patients were included in this study; 128 (64%) underwent primary ASR and 71 (36%) underwent secondary ASR. After multivariable analysis, a greater ratio of females and autologous rib graft harvest in the secondary compared with primary ASR, and decreased odds of inferior turbinate reduction in the secondary group was found. There was no significant difference in NOSE scores between the primary and secondary group, and there were very few complications or revision surgeries. While outcomes are similar between primary and secondary (revision) ASR to treat caudal septal deviation, there was a significantly higher rate of autologous rib harvest, highlighting the importance of addressing deviations of the caudal septum at the primary procedure to reduce morbidity related to rib graft harvest and revision surgery.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

https://ift.tt/2EuyruJ

Disparities in NOSE Scores and Surgical Approaches among Patients Undergoing Functional Rhinoplasty

Facial plast Surg
DOI: 10.1055/s-0038-1676051

Social determinants of health have been widely studied throughout medicine; however, their role relating to functional rhinoplasty has not been previously evaluated. The records of 178 patients who underwent functional rhinoplasty in a single health network from 2013 to 2016 were reviewed. The Nasal Obstruction Symptom Evaluation (NOSE) score was used to assess patient-reported symptoms, and patients with both preoperative and postoperative NOSE scores were included in this study. Basic demographics and surgical techniques were also collected. Differences between NOSE scores and surgical approaches to functional rhinoplasty on the basis of insurance type were measured. One hundred and sixteen patients were included for analysis, the mean age was 34.7 years (standard deviation [SD] = 16.2) and 57 (49.1%) were female. Twenty-one (18.1%) patients had public insurance and, of these, 18 patients had Medicaid. Patients (mean, SD) with Medicaid insurance (56.39, 15.6) had a slightly greater improvement in NOSE scores compared with patients with non-Medicaid insurance (47.90, 25.6) (p = 0.067). There was no statistically significant difference in preoperative NOSE scores or postoperative improvement in NOSE scores between patients with different health insurance. Furthermore, there was no statistically significant difference in surgical approaches. The majority of patients receiving functional rhinoplasty had private insurance. Medicaid patients trended toward a greater NOSE score improvement after functional rhinoplasty, but also had a closer association with a history of nasal trauma and prior surgery. Future study is needed to better understand the association between socioeconomic status and disparities in care. Understanding how social determinants of health affect patients may reveal potential inherent biases, improve delivery of care, and translate to better patient outcomes.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

https://ift.tt/2EF4VTF

Use of Tissue Expander for Contracted Scarred Saddle Deformity Rhinoplasty

Facial plast Surg
DOI: 10.1055/s-0038-1675632

The main purpose of this article is to present an alternative technique for the reconstruction of saddle nose deformity in patients with severely scarred or contracted soft tissue envelopes. In this single surgeon case series, the authors present a two-staged reconstruction performed on four adult patients with saddle nose deformities and contracted soft tissue envelope stemming from a variety of etiologic factors including vasculitis, sarcoidosis, and trauma. Stage one involved placement of a 1 × 4 cm tissue expander along the nasal dorsum through anterior scalp and endonasal incisions. The tissue expander port was positioned under the anterior scalp and injected with saline over 3 weeks in-office. Stage two involved removal of the tissue expander and rhinoplasty using osteocartilaginous rib grafts. All four patients had successful expansion of the contracted soft tissue envelope, creating adequate space for the newly reconstructed nasal framework. One patient developed exposure of the tissue expander through the endonasal incision, which did not lead to any adverse outcome. All patients in this series tolerated expansion well, without complaints of pain or external skin breakdown. The use of soft tissue expanders along the nasal dorsum can successfully expand contracted and scarred soft tissue envelopes prior to reconstructive rhinoplasty. This technique may be an effective alternative to the use of interpolated flaps in treating these patients.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

https://ift.tt/2EyVhRN

Contemporary Trends in the Surgical Management of Nasal Septal Perforations: A Community Survey

Facial plast Surg
DOI: 10.1055/s-0038-1676049

There currently exists an overabundance of publications advocating different septal perforation repair methods. The objective of this article was to examine the preponderance of techniques and trends in the surgical management of septal perforations in the practices of otolaryngologists, rhinologists, and facial plastic surgeons. The study was designed as a multicenter cross-sectional survey. The participants were members of the American Academy of Facial Plastic and Reconstructive Surgery and the American Rhinologic Society. Septal perforation closure rates and perforation repair approach, technique, and interposition graft material preferences were the main outcomes. A total of 320 respondents completed the survey, of whom 75% performed perforation repairs. The success rates in closing perforations < 1 cm, 1–2 cm, and > 2 cm were 84%, 64%, and 31%, respectively. The respondents had a similar preference for the endoscopic (52%) and external rhinoplasty (49%) approaches, followed by the endonasal approach (43%). Bilateral intranasal mucosal advancement flaps (79%) and unilateral intranasal mucosal rotational or advancement flaps (60%) were the favored repair techniques. Most respondents (84%) incorporated an interposition graft and intranasal splints (89%) for the repair, and the most popular interposition graft material was acellular dermis (63%). The self-reported perforation closure success rates in this survey were lower than those published in the literature, a phenomenon possibly explained by the premise that surgeons with favorable outcomes are more apt to share their results. The preferred surgical approach was evenly distributed between the external rhinoplasty and endoscopic approaches and influenced by a surgeon's training, perforation size and location, and the need for concomitant rhinoplasty. This study is the first to characterize contemporary community trends in the surgical closure of septal perforations and demonstrates that while preference for perforation repair approach among the respondents varied, surgeons favored septal perforation repair using bilateral intranasal mucosal advancement flaps with an interposition graft.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

https://ift.tt/2EDNxih

“Asthma Biologics: Underuse, Overuse, and Best Use?”

Uncontrolled asthma is a significant problem worldwide . It is important to acknowledge that many patients with uncontrolled asthma can be brought under control using medications that have been available now for decades. Unfortunately, nonadherence to regular use of ICS/LABA is incredibly common and solving the complex reasons for nonadherence is not straightforward. Recently, we have the addition of 5 injected asthma biologic medications which are intended for patients who are not controlled with ICS/LABA and specific features such as IgE-high (omalizumab), Eosinophils-high (benralizumab, mepolizumab, and reslizumab), and/or Th2-high (dupilumab).

https://ift.tt/2ExRsMK

Vaccine delivery by precipitation (VDBP) induces tolerance to poison ivy.

Previous poison ivy vaccines, comprising urushiol in sterile vegetable oils injected SQ, were withdrawn in 1994 for failure to demonstrate statistical efficacy (personal communication J.Slater). We'd found them anecdotally safe and effective in some patients. For highly allergic patients for whom avoidance was not practical we offered immunotherapy with home-made vaccines in accordance with Declaration of Helsinki guidelines for ethical use of "unproven interventions"1. Informed consent was obtained from all patients.

https://ift.tt/2EE1tZx

Severe uncontrolled eosinophilic asthma, which responded to benralizumab after failure to respond to mepolizumab

We present the case of eosinophilic asthma of a 55-year-old female, who was initially diagnosed bronchial asthma by the author in February 2008. The diagnosis was confirmed using the Global Initiative for Asthma guidelines.1 She showed forced expiratory volume in 1 second (FEV1) was 63.9 % of the predicted value with an increase of 12.9 % in FEV1 after 180 μg salbutamol inhaler. She had no history of smoking. She met the American Thoracic Society criteria for a diagnosis of refractory asthma.2 She had non-allergic asthma, diagnosed with serum total IgE level 94 IU/mL and negative results of serum specific IgE for common inhaled allergens including mold, and Dermatophagoides farinae and pteronyssinus.

https://ift.tt/2EAloIh

Seasonal exacerbation of eosinophilic esophagitis histologic activity in adults and children implicates role of aeroallergens

Eosinophilic esophagitis (EoE) is a chronic immune/antigen-mediated disorder characterized histologically by eosinophilic-predominant esophageal inflammation and clinically by esophageal dysfunction. The condition is diagnosed when there are at least 15 eosinophils per high-power field (eos/hpf) on esophageal biopsies following the exclusion of alternative etiologies of esophageal eosinophilia.1–4 EoE contributes significantly to esophageal morbidity and represents the second-leading cause of esophagitis.

https://ift.tt/2EFkJWH

The Gut Microbiome in Food Allergy

To review observational human, murine, and interventional trial studies that have examined the gut microbiome in food allergy, and to provide perspective on future investigations in this field.

https://ift.tt/2Evreum

Detection of circulating HPV16 DNA as a biomarker in the blood of patients with human papillomavirus‐positive oropharyngeal squamous cell carcinoma

Abstract

Background

Development of biomarker analysis using the circulating cell‐free DNA (cfDNA) methodology is a challenge for noninvasive cancer diagnosis. In this study, a comparison between the plasma and tumor tissue HPV16 DNA viral loads (VLs) has been presented.

Methods

Real‐time polymerase chain reaction was performed for quantitating of HPV16 DNA in the plasma and tumor samples of patients with oropharyngeal cancer.

Results

Among the tissues, HPV16‐positive patients with oropharyngeal squamous cell carcinoma, nonsmoking patients, displayed significantly higher HPV16 DNA VLs in their tissue. No smoking and advanced N disease were the most important predictors for cHPV16 DNA (circulating HPV16 DNA) detection. The cHPV16‐positive women displayed significantly higher VLs in their tumor tissues compared to the men, although without notable impact on the blood detection.

Conclusions

Many factors were responsible for human papillomavirus DNA circulation in blood. As a result of the small size of the analyzed group, some observed discrepancies need to be proven on a larger cohort.

https://ift.tt/2A4diEn

Ex Vivo Confocal Microscopy Of Basal Cell Carcinoma On A 3-Color Scale

https://ift.tt/2A9XOil

Optimal Concentration Range Of Ustekinumab In Patients With Plaque-Type Psoriasis

https://ift.tt/2rNVEjH

“Retraction of the cheek to enhance visualization of the nasolabial fold region”

https://ift.tt/2S9qU8p

Delayed cutaneous knot for closing defects located in the retroauricular fold

https://ift.tt/2A9LfDF

Mutual Recognition in Human-Robot Interaction: a Deflationary Account

Abstract

Mutually adaptive interaction involves the robot as a partner as opposed to a tool, and requires that the robot is susceptible to similar environmental cues and behavior patterns as humans are. Recognition, or the acknowledgement of the other as individual, is fundamental to mutually adaptive interaction between humans. We discuss what recognition involves and its behavioral manifestations, and describe the benefits of implementing it in HRI.

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High burden of the metabolic syndrome and its component disorders in South Africans with psoriasis

Abstract

Background

Psoriasis is associated with cardiometabolic diseases (CMDs) in Caucasians, but no data is available from sub‐Saharan populations on either CMD prevalence or psoriasis risk factors. Our aim was to investigate the prevalence of CMDs in a predominantly non‐Caucasian cohort of South Africans with psoriasis and to determine the principal risk factors associated with psoriasis.

Methods

This was a cross‐sectional case‐control study of adult psoriasis patients (n = 103) and controls (n = 98), comparing sociodemographic, anthropometric, clinical, and biochemical characteristics. The groups were matched for gender, ethnicity, and body mass index (BMI).

Results

The prevalence of metabolic syndrome (MetS) (52.4% vs. 33.7%; P = 0.007), type 2 diabetes (T2D) (25.2% vs. 4.1%; P < 0.0001), and hypertension (70.9% vs. 46.6%; P = 0.001) were all higher in the psoriasis group. High‐sensitivity CRP was higher in psoriasis patients than controls (4.70 (2.00, 10.9) vs. 2.00 (1.10, 4.80) ng/ml; P < 0.0005). Multivariable logistic regression analysis showed that severe psoriasis was independently associated with MetS (odds ratio [95% CIs]: 4.42 [1.72, 11.4]; P = 0.002), T2D (11.3 [3.07, 41.3]; P = 0.0002), and hypertension (2.48 [0.97, 6.32]; P = 0.05), whilst for psoriasis the principal risk factors were smoking (3.87 [1.97, 7.63]; P < 0.0001) and hsCRP (1.05 [1.00, 1.10]; P = 0.029), with completion of high school (0.23 [0.11, 0.48]; P < 0.0001) being protective.

Conclusions

In this population, psoriasis is characterized by a high burden of CMDs, particularly in those subjects with severe psoriasis. Inflammation plays a role in the etiology of psoriasis, whilst smoking and poor education further increase disease risk.

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Issue Information

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Controversies in drug allergy: consensus documents from the world experts

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Important questions in drug allergy and hypersensitivity: consensus papers from the 2018 AAAAI/WAO international drug allergy symposium

This article is one of a series of international consensus documents developed from the International Drug Allergy Symposium held at the Joint Congress of the American Academy of Allergy, Asthma & Immunology/W...

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Dose omission to shorten methacholine challenge testing: clinical consequences of the use of a 10% fall in FEV1 threshold

In methacholine challenge testing (MCT), skipping a methacholine dose is suggested if FEV1 falls by 

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Developmental delays assessed using the Enjoji Scale in children with cochlear implants who have intellectual disability with or without autism spectrum disorder

Intellectual disability (ID) and autism spectrum disorder (ASD) are common among children who are candidates for cochlear implants. However, the implications of these comorbidities for cochlear implant placement have been not fully established. This study sought to identify these implications by comparing developmental delays among children with these conditions.

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Post-transplantation laryngeal actinomycosis

A case of laryngeal actinomycosis occurred after bone marrow transplantation was reported. The patient was a 14-year-old girl who had a history of bone marrow transplantation for the treatment of acute lymphocytic leukemia 4month before the onset of the disease. She was referred to our hospital complaining persistent sore throat since 2weeks ago. Fiberscopic observation proved the presence of white tumor-like mass on her right arytenoid of the larynx. As CT image demonstrated that the mass was localized at the arytenoid region with central low-density area surrounded by granulation tissue, we underwent biopsy under local anesthesia.

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Therapeutic potential of topically administered γ‐AlOOH on 2,4‐dinitrochlorobenzene‐induced atopic dermatitis‐like lesions in Balb/c mice

Abstract

Boehmite (γ‐AlOOH) has a wide range of applications in a variety of industrial and biological fields. However, little is known about its potential roles in skin diseases. The current study investigated its effect on atopic dermatitis (AD). Following characterization, cytotoxicity, pro‐inflammatory response, and oxidative stress associated with boehmite were assessed, using TNF‐α‐induced keratinocytes and mast cells. In addition, therapeutic effects of boehmite, topically administered to Balb/c mice induced by 2,4‐dinitrochlorobenzene (DNCB), were evaluated. Expression of cytokines (TLSP, IL‐25, and IL‐33) and the generation of ROS from keratinocytes induced by TNF‐α, were significantly inhibited by boehmite without affecting cell viability. MAPKs (ERK, JNK, and p38) required for cytokine expression were suppressed by boehmite treatment. Up‐regulation of cytokines (TSLP, IL‐4, IL‐5, IL‐13, RANTES) in human mast cells treated with phorbol 12‐myristate 13‐acetate and calcium ionophore (PMACI) was also suppressed by boehmite. Boehmite improved the AD‐severity score, epidermal hyperplasia, and transepidermal water loss in DNCB‐induced atopic dermatitis‐like lesions. Moreover, Th2‐mediated cytokine expression, mast cell hyperplasia, and destruction of the skin barrier were improved by boehmite treatment. Overall, we demonstrated that boehmite may potentially protect against atopic dermatitis.

This article is protected by copyright. All rights reserved.

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Tissue microenvironment initiates an immune response to structural components of S. aureus

Abstract

Cell‐to‐cell communication in skin participates to the maintenance of homeostatic responses to foreign substances. Certain strains of Staphylococcus (S) aureus are vicious pathogens that cause deleterious effects in host cells and tissues. Both secreted toxins and structural components of S. aureus trigger an immune response, though how S. aureus stimulates host immune responses is poorly understood. We explored here how keratinocytes and fibroblasts initiate the first steps of an immune response by activating dendritic cells (DCs) through recognition of structural components of S. aureus. We treated monocyte‐derived Langerhans cells (moLCs) and monocyte‐derived DCs (moDCs) with conditioned media from keratinocytes (K‐CM) and fibroblasts (F‐CM) treated with heat killed S. aureus (HKSA) respectively, or directly with HKSA. Immune and inflammatory responses from keratinocytes, fibroblasts, moLCs and moDCs were assessed by analysis of cell surface markers and cytokine production using flow cytometry, real‐time PCR and ELISA assays. K‐CM and F‐CM increased the expression of CD86 and HLA‐DR on moLCs and moDCs, in association with a specific cytokine profile. K‐CM upregulated TNFA, IL‐1B and GM‐CSF mRNA expression in moLCs, while F‐CM upregulated IL‐12 and downregulated TNFA and TGFB mRNA expression in moDCs. Additionally, F‐CM attenuated the induction of an inflammatory profile in monocytes. The recognition of structural components from S. aureus by cutaneous microenvironment induces the activation and the expression of specific cytokines from LCs and DCs.

This article is protected by copyright. All rights reserved.

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Bullous artificial dermatitis due to aerosol sprays masquerading as fixed drug eruption

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G59S mutation in the GJB2 gene in a Chinese family with classic Vohwinkel syndrome

Abstract

Vohwinkel syndrome (VS) is a rare autosomal dominant condition, also known as mutilating palmoplantar keratoderma accompanied by sensorineural deafness. The LOR and GJB2 genes are reported to be responsible for VS. The GJB2 gene encodes connexin 26, a component of intercellular gap junctions expressed in various tissues. We report the case of a 31‐year‐old Chinese woman with classic VS characterized by sensorineural deafness and mutilating palmoplantar keratoderma. Further genetic studies demonstrated a nucleotide change (c.175G>A) in the GJB2 gene, leading to an amino acid alteration (G59S). This identical missense mutation (G59S) has also been reported in a patient with Bart–Pumphrey syndrome. Together with our findings and previous studies, we conclude that the identical mutation (G59S) in the GJB2 gene contributes to various manifestations.

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Usefulness of ulceration and hyperkeratosis as clinical predictors of Merkel cell polyomavirus‐negative and combined Merkel cell carcinoma: A retrospective study

Abstract

Merkel cell carcinoma is a rare neuroendocrine carcinoma of the skin that is associated with Merkel cell polyomavirus (MCPyV). The clinical appearance and demographic characteristics of this tumor have been described using the mnemonic AEIOU: asymptomatic, expanding rapidly, immune suppression, older than 50 years, and ultraviolet‐exposed fair skin. In addition, MCC can be categorized based on morphology as pure MCC or combined MCC that exhibits neuroendocrine and other phenotypic elements. There is limited information regarding the clinical characteristics and prognosis of combined MCC. This retrospective study aimed to identify factors, such as ulceration or hyperkeratosis, that could predict MCPyV status and morphological variants. Twenty patients with MCC were divided into groups based on MCPyV status and morphology: MCPyV‐positive or MCPyV‐negative MCC and pure or combined MCC. The patients' MCPyV status was immunohistochemically determined using the CM2B4 antibody to the MCPyV large T‐antigen. The patients' clinicopathological characteristics were evaluated to identify predictors of MCPyV‐negative MCC and combined MCC. The presence of ulceration/hyperkeratosis predicted the presence of MCPyV‐negative MCC (80% of cases) and combined MCC (50% of cases). None of the 10 patients with MCPyV‐positive MCC had ulceration/hyperkeratosis. The clinical presence of ulceration/hyperkeratosis may help guide the diagnosis of MCPyV‐negative MCC and combined MCC.

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The orphan nuclear receptor NR4A1 promotes FcεRI‐stimulated mast cell activation and anaphylaxis by counteracting the inhibitory LKB1/AMPK axis

Abstract

Background

NR4A1, an orphan nuclear receptor, has been implicated in several biological events such as metabolism, apoptosis, and inflammation. Recent studies indicate a potential role for NR4A1in mast cells, yet its role in allergic responses remains largely unknown.

Objectives

The aim of this study was to clarify the role of NR4A1in mast cell activation and anaphylaxis.

Methods

To evaluate the function of NR4A1in mast cells, the impacts of siRNA knockdown, gene knockout, adenoviral overexpression, and pharmacological inhibition of NR4A1on FcεRI signaling and effector functions in mouse bone marrow‐derived mast cells (BMMCs) in vitro and on anaphylactic responses in vivo were evaluated.

Results

Knockdown or knockout of NR4A1 markedly suppressed degranulation and lipid mediator production by FcεRI‐crosslinked BMMCs, while its overexpression augmented these responses. Treatment with a NR4A1 antagonist also blocked mast cell activation to a similar extent as NR4A1 knockdown or knockout. Moreover, mast cell‐specific NR4A1‐deficient mice displayed dampened anaphylactic responses in vivo. Mechanistically, NR4A1 promoted FcεRI signaling by counteracting the liver kinase B1 (LKB1)/AMP‐activated protein kinase (AMPK) axis. Following FcεRI crosslinking, NR4A1 bound to the LKB1/AMPK complex and sequestered it in the nucleus, thereby promoting FcεRI downstream signaling pathways. Silencing or knockout of LKB1/AMPK largely abrogated the effect of NR4A1 on mast cell activation. Additionally, NR4A1 facilitated Syk activation independently of LKB1/AMPK.

Conclusions

NR4A1 positively regulates mast cell activation by antagonizing the LKB1‐AMPK‐dependent negative regulatory axis. This finding may provide a novel therapeutic strategy for the development of anti‐allergic compounds.

This article is protected by copyright. All rights reserved.

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Exogenous estrogen therapy, testicular cancer, and the male to female transgender population: a case report

Over the last 40 years, there has been a significant increase in the incidence of testicular cancer. The epidemiologic evidence to understand this phenomenon is unclear, however exogenous estrogen exposure is ...

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Female urethral dilatation (bougierung): a case report

Primary bladder neck obstruction is a rare clinical entity, reported to be responsible for 2.7–8% of lower urinary tract symptoms. It can lead to various urinary storage and voiding symptoms. The mainstay of t...

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Ulcerative Sarcoidosis

This case report describes a woman in her 50s with a 2-year history of a large, shallow ulcer of the scalp.

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Genotype-Guided Medical Treatment of an Arteriovenous Malformation in a Child

This case report describes the use of genotype-guided medical treatment of an arteriovenous malformation in a child.

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Trends in Medicare Utilization by Dermatologists, 2012-2015

This analysis uses 4 years of publicly available Centers for Medicare & Medicaid Services data to identify changes in Medicare payments to dermatologists from 2012 through 2015.

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Risk Factors of Subsequent Primary Melanomas in Austria

This case-control study assesses the risk factors for multiple primary melanomas in a cohort of patients with a histologically confirmed diagnosis of first melanoma.

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Preoperative Nerve Block for Rhinoplasty/Septoplasty

Conditions:   Nasal Fracture;   Deviated Nasal Septum
Intervention:   Drug: Nerve block
Sponsor:   University of Southern California
Not yet recruiting

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