Une consultation d’anthropologie médicale ouverte aux migrants : pour quoi faire ?

Publication date: Available online 15 December 2016
Source:Annales de Dermatologie et de Vénéréologie
Author(s): P. Charlier




http://ift.tt/2hxDtvu

Obstructive ectopic intratracheal thyroid

Publication date: Available online 14 December 2016
Source:Acta Otorrinolaringológica Española
Author(s): Miguel Mayo Yáñez, Gonzalo Nemecio Esquía Medina, Juan Carlos Vázquez Barro




http://ift.tt/2hzKitG

Emphysematous pancreatitis: classic findings

Description

A 55-year-old man with diabetes presented to our hospital with recent onset acute abdominal pain and recurrent vomiting. He was immediately admitted to the intensive care unit for ionotropic and invasive respiratory support. He had an acutely tender abdomen with distension. Haematological examination showed leucopenia (880/mm³), thrombocytopenia (64 000/mm³), elevated C reactive protein (68 mg/mL), metabolic acidosis (pH: 6.88) with a severely elevated blood lactate (14 mmol/L), estimated creatinine clearance <14 mL/min, hyperlipidaemia (1280 U/L) and serum amylase levels of 5134 U/L. Plain CT revealed extensive gas in the pancreatic bed extending into the lesser sac and adjacent retroperitoneal space (figure 1A, B). A diagnosis of acute severe emphysematous pancreatitis was made; although the patient was aggressively treated, unfortunately he died. Retrospective blood cultures were positive for Enterobacter aerogenes.

Figure 1

(A) CT image showing the presence of air lucencies in the epigastric region at the level of L1–L2 vertebral...

http://ift.tt/2hxtciy

Unexplained lymphadenopathies: autoimmune lymphoproliferative syndrome in an adult patient

Autoimmune lymphoproliferative syndrome (ALPS) is characterised by massive enlargement of the lymphoid organs, autoimmune cytopenias and a predisposition to develop lymphoid malignancies. The basic defect is a disturbance of the lymphocyte apoptosis, and a high number of circulating TCRab CD3⁺CD4^–CD8^– T-cells (double-negative T cells (DNT cells)). We describe a case of a 41-year-old man with fever, hepatosplenomegaly, multiple lymphadenopathy, autoimmune haemolytic anaemia and severe thrombocytopenia. Peripheral blood immunophenotyping revealed elevation of the characteristic DNT cells in 8% and high levels of interleukin 10. Histopathological analysis of lymph nodes showed lymphadenitis with paracortical hyperplasia. It was assumed as a probable diagnosis of ALPS, and the procedure was to medicate the patient with steroids. As a result, a significant clinical improvement was achieved, and he has been in remission for 2 years. To our knowledge, this is the first case reported in a Portuguese adult patient.

http://ift.tt/2hAoON9

Concomitant multiple myeloma, gastric adenocarcinoma and Evan's syndrome in a patient presenting with anaemia

An association between multiple myeloma (MM) and solid tumours has been previously described.¹ Furthermore, autoimmune disorders can precede plasma cell dyscrasias, and the pathogenesis of MM maybe linked to chronic immune stimulation. ² We describe a case of concomitant MM and gastric adenocarcinoma preceded by Evan's syndrome. A previously healthy woman presented to the emergency room with symptomatic anaemia. Her initial workup was compatible with autoimmune haemolytic anaemia and monoclonal gammopathy of undetermined significance. On progression of the anaemia and development of thrombocytopenia, she was diagnosed with Evan's syndrome. Two months later, she presented with severe back pain and her MRI revealed L4–5 vertebral collapse. The clinical picture was compatible with MM. Occult blood was repeatedly positive in stools, and she underwent oesophagogastroduodenoscopy and was found to have gastric adenocarcinoma. The patient refused surgical resection of the adenocarcinoma and refused active treatment for MM.

http://ift.tt/2hxztuV

Rare cause of neck pain: tumours of the posterior elements of the cervical spine

Here we present two cases of primary bone tumours of the cervical spine in patients who had persistent neck pain—in one case, lasting 8 years. In each case, there was a delay in diagnosis and referral to a spine specialist was prolonged. Primary bone tumours of the spine are rare, which is in contrast to the wide prevalence of cervical neck pain. Many primary care providers may go an entire career without encountering a symptomatic primary cervical spine tumour. In this paper, we discuss the clinical course and treatment of each patient and review the current literature on primary bone tumours of the spine. Owing to the subtle roentgenographic findings of primary cervical tumours, we highlight the importance of advanced imaging in the clinical work-up of simple axial neck pain lasting >6 weeks to avoid misdiagnosis of serious pathology.

http://ift.tt/2hApNgr

Boari flap reconstruction in a male infant with solitary kidney and associated megaureter

A 1-year-old male infant presented with fever and abdominal lump for 3 months with increased leucocyte count (15 300/mm³) and serum creatinine (0.83 mg%). Abdominal ultrasound and renal scan demonstrated solitary left kidney with dilated tortuous left ureter. Voiding cystourethrogram was unequivocal. Left percutaneous nephrostomy was placed after poor response to perurethral catheterisation. His serum creatinine dropped to 0.58 mg/dL. Subsequent percutaneous nephrostogram and CT nephrostogram showed dilated left pelvicalyceal system, dilated, tortuous left ureter. A diagnosis of obstructed megaureter was made and ureteric plication and reimplantation planned. Intraoperatively, there were primitive ureteral valves until proximal one-third of the ureter. The distance between the upper ureter and bladder was ~6 cm. This defect was bridged by Boari flap. The postoperative period was uneventful and now after 6 months of follow-up, he is doing fine.

http://ift.tt/2hxwHFS

Unusual case of bilateral maxillary fungus ball

An otherwise healthy 34-year-old man was referred to our ear, nose and throat (ENT) clinic for a bilateral maxillary radiologic opacity. This condition was accidentally discovered with a panoramic radiography performed during a follow-up visit after a bilateral endodontic treatment. The patient did not report any specific sinonasal symptom such as purulent nasal discharge, loss of smell and cough, apart from an unspecific sinus pressure. The CT scans showed a bilateral inflammatory process into the maxillary-ethmoidal sinuses and an iron-like density within the maxillary sinuses, while nasal endoscopy showed purulent discharge in the ostiomeatal complex. The patient underwent functional endoscopic sinus surgery under general anaesthesia and the inflammatory material collected was histologically diagnosed as a rare case of bilateral fungus ball. The patient was dismissed the following day with no complications; there were not any sign of recurrence or symptoms during a 4 month follow-up.

http://ift.tt/2hAmrdk

Large intraocular foreign body following a firecracker injury

Description

An 8-year-old girl child presented with the history of firecracker injury to the right eye. There was a sudden loss of vision associated with pain, redness and watering. Primarily, she was diagnosed as panophthalmitis and started of intravenous antibiotics, but as the condition worsened she was referred to a tertiary eye hospital. Initial examination was painful tense upper and lower eyelid oedema (figure 1A) along with severely chemosed conjunctiva and with severely restricted extraocular motility in all the gazes; the child denied any perception of light in the right eye, whereas left eye was normal. Ultrasonography showed a large high-amplitude opacity filling almost two-third of the vitreous cavity with shadowing posterior. (figure 1B). Subsequent CT of the orbit showed large hyperdense foreign body almost filling the entire vitreous cavity. (figure 1C). The patient was started on intravenous antibiotics injection vancomycin 40 mg/kg...

http://ift.tt/2hxyHOA

Pulmonary sarcoidosis: calcification within the galaxy sign

Description

A 34-year-old woman had breathlessness, dry cough and low-grade fever for 6 months. Chest X-ray showed bilateral hilar lymphadenopathy and patchy alveolar right mid-zone shadows along with bilateral lower zone nodular opacities (figure 1A). Contrast-enhanced high-resolution CT(HRCT) of thorax demonstrated enlarged, non-necrotic right paratracheal, subcarinal and bilateral hilar lymph nodes. The lung window in right upper lobe revealed a large nodule with irregular margins encircled by multiple small nodules suggestive of 'galaxy' sign (figure 1B). In addition, mediastinal window divulged dense calcification within the nodule and mediastinal lymphnodes (figure 1C). Fibreoptic bronchoscopy visualised multiple endobronchial granulomatous lesions throughout the tracheobronchial tree (figure 2A) and was confirmed on biopsy (figure 2B). The diagnosis of pulmonary sarcoidosis was based on (1) chest imaging, (2) elevated serum ACE levels (126 IU/mL [8–65 IU/mL]), (3) negative tuberculin test and (4) visible endobronchial lesions and...

http://ift.tt/2hAkJIR

Melphalan-induced cardiotoxicity: ventricular arrhythmias

Description

A 61-year-old man, with multiple myeloma (IgA lambda), was planned for autologous stem cell transplantation (ASCT). He also suffered a left thalamic haemorrhagic stroke in 1998 secondary to aneurysmal bleed. Following melphalan infusion of 200 mg at 45 mL/min, he developed acute onset rhythm abnormalities (intermittent ventricular ectopic and ventricular tachycardia). The patient's premelphalan evaluation was unremarkable with normal ECG (1A), ejection fraction (55%) and renal/hepatic function. He was evaluated by sequential 2D echocardiography and troponin I (immediately, 2, 4, 12 and 24 hours) which were normal excluding acute STEMI. These rhythm abnormalities were dynamic probably secondary to the plasma melphalan concentrations and normalised by 18 h postinfusion (figure 1B–F). There has been no recurrence of these rhythm abnormalities thereafter. He was transplanted with abbreviated melphalan conditioning.

Figure 1

(A) Normal ECG before starting melphalan infusion. (B) ECG after 200 mg of melphalan infusion, showing acute onset ventricular rhythm...

http://ift.tt/2hxz6R3

Rare case of glioblastoma multiforme located in posterior corpus callosum presenting with depressive symptoms and visual memory deficits

Most of the primary brain tumours are located in the supratentorial region, and it is uncommon to see tumour growth on deep brain structures such as posterior corpus callosum (PCC). In addition, lesions in PCC are also difficult to recognise, because construction apraxia, visuospatial perception and attentional capacity impairment may be the only presenting symptoms. Here, we represent a rare case of gliobastoma multiforme located in PCC, which solely presents with depressive symptoms and visual memory deficits. Initial manifestations of primary brain tumours with psychiatric symptoms and memory disturbances, in addition to headaches and seizures, should be kept in mind.

http://ift.tt/2hxtQgf

Case 38-2016: A 52-Year-Old Woman with Recurrent Oligodendroglioma

Presentation of Case. Dr. Andrew S. Chi: A 52-year-old woman with a history of oligodendroglioma was seen in the outpatient neuro-oncology clinic of this hospital for routine follow-up. Twelve years earlier, the patient presented with a generalized tonic–clonic seizure 4 days after she had…

http://ift.tt/2gO4YzJ

Desmoid tumours of the head and neck in children: Review of management

Publication date: Available online 14 December 2016
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): M. Risoud, G. Mortuaire, X. Leroy, P. Leblond, P. Fayoux
ObjectiveDesmoid tumours of the head and neck in children are rare, local invasive and potentially fatal tumours. The purpose of this review is to discuss the management of these tumours in the light of a case series and a review of the literature.Material and methodsThis retrospective study summarised the medical data of children treated for desmoid tumours of the head and neck between 1976 and 2014.ResultsFive of the 6 children were treated by radical surgical resection, with positive surgical margins (R1) in 2 cases, followed by recurrence requiring further resection. One child with a very advanced lesion was treated by weekly methotrexate and vinorelbine chemotherapy for 18months, allowing 93% reduction of tumour volume without recurrence.ConclusionsDesmoid tumours of the head and neck in children are more aggressive than their adult counterparts and are associated with high morbidity and mortality and a high recurrence rate. CT and MRI imaging assessment should preferably be performed before biopsy. External beam radiotherapy must be avoided in children as it is less effective than in adults, and is responsible for long-term cosmetic and functional sequelae and even a risk of second tumours. Treatment is surgical whenever radical resection is possible. In patients presenting an excessive risk of morbidity and mortality, chemotherapy devoid of long-term adverse effects (such as methotrexate in combination with a Vinca alkaloid) can be proposed. Long-term follow-up must be ensured due to the risk of recurrence.



http://ift.tt/2hzsvml

Primary total laryngectomy and pharyngolaryngectomy in T4 pharyngolaryngeal cancers: Oncologic and functional results and prognostic factors

Publication date: Available online 14 December 2016
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): M. Roux, O. Dassonville, M. Ettaiche, E. Chamorey, G. Poissonnet, A. Bozec
ObjectivesThe aims of this study were to assess oncologic and functional outcome in primary total laryngectomy or pharyngolaryngectomy (TL/TL/TPL) for laryngeal or hypopharyngeal cancer with extra-laryngeal extension (T4) and to determine the predictive factors of these results.Material and methodsA retrospective analysis was performed on the computerized medical records of all patients undergoing primary TL/TPL for T4 larynx or hypopharynx squamous cell carcinoma between 2000 and 2014 at our institution. Predictive factors of oncologic and functional outcome were investigated on univariate and multivariate analysis.ResultsSixty-three patients (58 men, 5 women; mean age, 68.8±9.7 years) were included. Overall and disease-specific survivals were 69% and 80% at 3 years, and 56% and 69% at 5 years, respectively. On multivariate analysis, gender (female, P<0.001), ASA score (ASA≥3; P=0.006) and vascular embolism (P=0.006) had significant pejorative impact on overall survival. Six months after end of treatment, 90% of patients had recovered independent oral feeding and 83% of those with tracheoesophageal voice prostheses had recovered an intelligible voice.ConclusionPrimary TL/TPL remains the gold standard treatment for T4 larynx or hypopharynx cancer. It provides satisfactory oncologic and functional outcomes.



http://ift.tt/2gO9mhU

The effect of non-diabetic chronic renal failure on olfactory function

Publication date: Available online 14 December 2016
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): S. Koseoglu, S. Derin, B. Huddam, M. Sahan
ObjectivesIn chronic renal failure (CRF), deterioration of glomerular filtration results in accumulation of metabolites in the body which affect all organs. This study was performed to investigate the olfactory functions, and determine if hemodialysis or peritoneal dialysis improves olfactory function in non-diabetic CRF patients.Materials and methodsThe olfactory functions were analyzed in CRF patients not on a dialysis program and had a creatinine level≥2mg/dL, in CRF patients on hemodialysis or peritoneal dialysis, and in healthy controls. Diabetic patients were excluded since diabetes alone is a cause of olfactory dysfunction. The study group consisted of a total of 107 individuals including 38CRF patients on a hemodialysis program, 15 CRF patients on peritoneal dialysis, 30 patients with a creatinine level ≥ 2mg/dL without any need for dialysis, and 24 healthy controls with normal renal functions. Olfactory functions were analyzed with "Sniffin' sticks" test, and the groups were compared for the test results.ResultsAll test parameters were impaired in patients with CRF. The median TDI scores of the patients with CRF and the healthy subjects were 24.75 (13–36) and 32.5 (27.75–37.75), respectively, with a statistically significant difference in between (P<0.001). The olfactory functions for the dialysis patients were better than those for the CRF patients not on a dialysis program (P=0.020).ConclusionNon-diabetic CRF affects olfactory functions negatively. Dialysis improves olfactory functions in those patients.



http://ift.tt/2hwKInd

A rare mandibular tumour

Publication date: Available online 14 December 2016
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): H. Touil, J. Hamila, M. Bouzaiene




http://ift.tt/2hzuaIf

An unusual prenatal laryngeal image

Publication date: Available online 14 December 2016
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): J. Chevreau, C. Rieu, C. Page




http://ift.tt/2gE405J

Evaluation of salicylic acid peeling in comparison with topical tretinoin in the treatment of postinflammatory hyperpigmentation

Summary

Background

Postinflammatory hyperpigmentation (PIH) is an acquired hyperpigmentation that involves areas of prior cutaneous inflammation. In addition to prevention, there are a variety of medications and procedures used to treat PIH.

Aim of the work

The aim of this work was to evaluate the efficacy, tolerability, and safety of salicylic acid peeling in comparison with topical tretinoin in the treatment of PIH.

Patients and Methods

This study included forty-five patients with PIH lesions. The patients were divided into three groups, group I was treated with salicylic acid peeling 20–30%, group II was treated with topical tretinoin 0.1%, and group III was treated with combination of salicylic acid peel and topical tretinoin. The patients were assessed clinically to evaluate the efficacy, tolerability, and safety of the treatment. Dermoscopy was carried out to the recurrent or nonimproved cases only.

Results

Combination of salicylic acid peel and topical tretinoin treatment showed significant clinical improvement of PIH than each treatment alone with no complications. There was no significant difference in the recurrence rate between the three groups. There was nonsignificant difference between the efficacy of the treatment and the PIH type in the studied groups. There was nonsignificant difference between the efficacy of the treatment and the duration of the PIH except for group III.

Conclusion

Combination treatment modality is believed to be preferred in the treatment of PIH due to its higher efficacy than single treatment alone, with well tolerability, less side effects, and low recurrence rate.

http://ift.tt/2hQYuxF

Monitoring structural changes in Demodex mites under topical Ivermectin in Rosacea by means of Reflectance confocal microscopy: a case series

Abstract

Rosacea is a common inflammatory disease, mainly affecting the face and with significant impact on patients' life quality. Just recently, topical Ivermectin (Soolantra^® 10mg/g Crème) has been introduced in the treatment of rosacea thanks to its double anti-parasitic and anti-inflammatory activity, resulting in a reduction of papulo-pustular manifestations, blepharitis and cutaneous demodicosis.¹ Although the role of the human skin commensal Demodex folliculorum (DF) in the pathogenesis of the disease is still debated², numerous studied reported an abnormal increase in the density of mites (>5 mites/cm²) in patients affected by papulo-pustular rosacea, measured by regular and standardized superficial skin biopsy, skin scraping, PCR or reflectance confocal microscopy (RCM)^3-6.

This article is protected by copyright. All rights reserved.

http://ift.tt/2hQOLaG

Determination of the nail psoriasis severity index (NAPSI) improvement rate standards for nail psoriasis treatment in a phase IV clinical trial of ustekinumab: the MARCOPOLO study

Clinical trials of psoriasis use efficacy assessment tools including the psoriasis area and severity index (PASI), body surface area, physicians' global assessment (PGA) score, and Dermatology Life Quality Index (DLQI). A 75% improvement in the PASI score (PASI75) is generally accepted as an indicator of therapeutic effectiveness, and a 90% improvement (PASI90) is thought to depict almost complete clearance. Nail psoriasis is also the target of biologics trials. The nail psoriasis and severity index (NAPSI) is used to evaluate nail improvement.¹ However, NAPSI-specific target improvement rates like PASI75 or PASI90 have not been established. Establishing standard rates would be helpful because they can be used to compare efficacy across trials and evaluate individuals objectively.

This article is protected by copyright. All rights reserved.

http://ift.tt/2gNZPaO

Prospective multicentre cohort study on 9,154 surgical procedures to assess the risk of postoperative bleeding – A DESSI-Study

Abstract

Background

To date, there is still a debate how to deal with patients receiving antithrombotic agents prior to surgical procedures on the skin.

Objective

To prospectively assess complications after dermatosurgical interventions, especially bleeding, depending on anticoagulation therapy.

Methods

Patients underwent surgery consecutively as scheduled, without randomization, whether or not they were currently taking anticoagulants. Nine institutions of the DESSI (DErmatoSurgical Study Initiative) working group documented patient data prospectively on a standardized study sheet prior to and after 9154 dermatosurgical interventions.

Results

Bleeding complications were observed in 7.14% of cases (654/9,154 surgeries). A severe bleed requiring intervention by a physician occurred in 83 surgeries (0.91%). In multivariate analysis INR, length of the defect, perioperative antibiotic treatment, current treatment with anticoagulation therapy, age and surgery on hidradenitis suppurativa / acne inversa (HS/AI) were significant parameters independently influencing the risk of bleeding.

Discontinuation of phenprocoumon therapy and subsequent switching to low-molecular-weight heparin was associated with the highest risk of bleeding (9.26%).

Conclusion

Bleeding complications in skin surgery are generally rare. Even if slightly increased complication rates are found in patients taking anticoagulants during skin surgery, platelet inhibitors should not be stopped prior to surgery. If a surgical procedure in patients on a combination therapy of 2 or more antiplatelet cannot be postponed, it should be conducted with the patient remaining on combination therapy.

Discontinuation of DOACs is recommended 24 hours prior to surgery.

Bridging of phenprocoumon should be abolished. In patients with a bleeding history, the INR value should be within the therapeutic range.

This article is protected by copyright. All rights reserved.

http://ift.tt/2hQVC3S

Trichobacteriosis axillaris caused by Dermabacter hominis

Trichobacteriosis is a frequent superficial bacterial infection of the hair, mainly affecting sweat gland bearing areas such as axillae and genital region, and also rarely the scalp.^1-3 The disease is characterized by bacterial overgrowth forming nodular concretions, usually of yellow color (infrequently black or reddish), which are firmly attached to the hair shaft.^1,4 Clinical hallmarks are rancid, acidic odor, unpleasant "dirty" sensation, and staining of clothes. Although most cases have been associated to different species of corynebacteria, the full etiologic spectrum of this infection is uncertain .^1,5 Here we report the first case of trichobacteriosis caused by Dermabacter hominis.

This article is protected by copyright. All rights reserved.

http://ift.tt/2gO4CZH

Mohs micrographic surgery of rare cutaneous tumors

Abstract

Background

Recurrence rates after Mohs micrographic surgery (MMS) for rare cutaneous tumors are poorly defined.

Objective

Investigate the recurrence rate after MMS for rare cutaneous tumors at a university center.

Methods & Materials

Retrospective review of all rare cutaneous tumors treated with MMS at a large university center between January 2008 and December 2012. To detect all recurrences, patients were linked to The nationwide network and registry of histo- and cytopathology (PALGA).

Results

In total, 80 patients with 80 tumors were included. Tumor types included dermatofibrosarcoma protuberans (27), atypical fibroxanthoma (22), Merkel cell carcinoma (8), microcystic adnexal carcinoma (9), sebaceous carcinoma (6), extramammary Paget's disease (2), and other (6). Mean follow-up time was 3.7 years (standard deviation 1.4) during which two atypical fibroxanthomas recurred (2.5%).

Conclusion

This large case series shows that MMS is an appropriate treatment for rare cutaneous tumors with a recurrence rate less than 3%. Preferably, MMS for rare cutaneous tumors is performed in experienced multidisciplinary centers to further improve the quality of treatment.

This article is protected by copyright. All rights reserved.

http://ift.tt/2hQKpA0

Treatment of Primary Hyperhidrosis with Oral Anticholinergic Medications: A Systematic Review

Abstract

Background

Primary hyperhidrosis is a condition characterised by excessive sweating. Patients are treated off-license with oral anticholinergic medications, and report adverse events associated with systemic anticholinergic interactions.

Objectives

This review assesses clinical evidence of efficacy, impact on quality of life and adverse events associated with oral anticholinergic therapy for primary hyperhidrosis.

Methods

PRISMA guidelines were implemented to complete a systematic review (PROSPERO:CRD42016036326). MEDLINE, EMBASE and PubMed were searched from 1946-2015. Inclusion criteria included: observational and experimental studies; anticholinergic medication use in primary hyperhidrosis; oral therapy; clear diagnostic and outcome measures.

Results

Twenty-three articles relevant to the inclusion criteria were analysed. Oxybutynin therapy improved symptoms in an average of 76.2% (range 60-97%) patients and improved QOL in 75.6% (range 57.6-100%) of patients. Methantheline bromide therapy was associated with a 41% reduction in axillary sweating, 16.4% reduction in palmar sweating, 25% decrease in HDSS score and 40.9% increase in DLQI score. Outcome measures of glycopyrrolate therapy were too variable to collate. Dry mouth was reported in 73.4% (range 43.3-100%) of participants taking oxybutynin 10 mg/d, 38.6% (range 27.8-63.2%) of patients taking glycopyrrolate and 68.8% of patients taking methantheline bromide. Nine studies reported that patients stopped therapy due to adverse events. In eight of these studies a mean of 10.9% of total participants ceased treatment due to dry mouth.

Conclusion

Evidence of oral anticholinergic therapy for hyperhidrosis is limited. However, its use is associated with improvement in quality of life and clinical symptoms but at the cost of considerable adverse events.

This article is protected by copyright. All rights reserved.

http://ift.tt/2gO4WI4