Medicine by Sfakianakis Alexandros: 05/25/17

Πέμπτη 25 Μαΐου 2017

Primary Cutaneous B-Cell Lymphoblastic Lymphoma Arising from a Long-Standing Lesion in a Child and Review of the Literature

Abstract

Precursor B-cell lymphoblastic lymphoma (B-LBL) is a rare entity and primary cutaneous B-LBL is an even more uncommon diagnosis that typically affects children. A 4-year-old boy presented with a persistent rash on his left cheek for almost 2 years and was found to have primary cutaneous B-LBL. We report this case to emphasize that B-LBL should be in the differential diagnosis for an otherwise unimpressive persistent lesion in the head and neck region and review all reported pediatric cases of primary cutaneous B-LBL without extracutaneous involvement.

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Lymphocytic Thrombophilic Arteritis: A Possible Association with Minocycline

Abstract

We describe a case of lymphocytic thrombophilic arteritis in a 15-year-old girl who had previously taken minocycline for a year. Cutaneous polyarteritis nodosa and lymphocytic thrombophilic arteritis share many features and may both be triggered by minocycline. There may be a long latency between drug exposure to minocycline and development of disease.

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Flu-like illness, fever, malaise and chills, followed by severe nonpleuritic chest pain and shortness of breath

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

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Food transit duration is associated with the number of stage II transport cycles when eating solid food

Publication date: September 2017
Source:Archives of Oral Biology, Volume 81
Author(s): Takashi Hiraoka, Jeffrey B. Palmer, Martin B. Brodsky, Mitsumasa Yoda, Haruhi Inokuchi, Akio Tsubahara
ObjectiveWhen eating solids, stage II transport (St2Tr) propels triturated food into the pharynx for bolus formation and storage before swallowing. Although the existence of St2Tr is acknowledged, the reason for its existence remains unclear. Understanding it may facilitate development of food appropriate for individuals with dysphagia. The purpose of this study was to explore how measures of duration of eating and swallowing affect the number of St2Tr cycles.DesignVideofluorography was performed on 13 healthy subjects eating 6-g squares of banana, tofu, and cookies. Measurements included the number of St2Tr cycles, duration of processing (from food entering the mouth to onset of swallowing), pre-upper esophageal sphincter (UES) transit duration (from onset of swallowing to onset of UES transit), UES transit duration (leading edge to trailing edge passing the UES), and total sequence duration (from onset of swallowing to terminal swallow). Principal component (PC) analysis was used to identify factors affecting the number of St2Tr cycles. Analysis of covariance was performed using the 1st PC as an independent variable for predicting the number of St2Tr cycles.ResultsAll four duration measures were significantly positively correlated with the number of St2Tr cycles. Analysis revealed two orthogonal PCs with variable loading. The 1st PC was a function of the timing variables. The 2nd PC was a function of the number of swallows.ConclusionsThe number of St2Tr cycles was associated with measures of food transit duration and was greater with harder foods before processing and more viscous foods just before swallowing.

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Flu-like illness, fever, malaise and chills, followed by severe nonpleuritic chest pain and shortness of breath

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

13. Akademia Dermatologii i Alergologii Słupsk − Ustka − Dolina Charlotty 09−12 lutego 2017 roku

Publication date: Available online 24 May 2017
Source:Alergologia Polska - Polish Journal of Allergology
Author(s): Maciej Kaczmarski

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A Story in Black and White

Strong engagement from expert radiologists is essential in ensuring the optimal function of a multidisciplinary group focused on the treatment of head and neck cancer. Active participation in multidisciplinary conference can be among the most rewarding roles for radiologists. Despite many benefits to radiologist involvement in multidisciplinary teams, there are obstacles and challenges that can prevent full participation. This article highlights the key issues that should be considered by radiologists and multidisciplinary team leaders when planning participation in a new or existing multidisciplinary group that focuses on the care of patients with head and neck cancer.

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Effectiveness of hemostatic gelatin sponge as a packing material after septoplasty: A prospective, randomized, multicenter study

Publication date: Available online 25 May 2017
Source:Auris Nasus Larynx
Author(s): Sung-Dong Kim, Sung-Lyong Hong, Min-Jung Kim, Joo-Yeon Kim, Yong-Wan Kim, Soo-Kweon Koo, Kyu-Sup Cho
ObjectiveAlthough hemostatic gelatin sponge is a gelatin-based packing material with a powerful hemostatic effect, there were no studies in regard to its efficacy for packing material after septoplasty. The purpose of this study was to investigate the efficacy of hemostatic gelatin sponge nasal packing on patient's subjective symptoms, hemostasis, and wound healing following septoplasty.Subjects and methodsSeventy six adult patients with nasal septum deviation requiring septoplasty were included. Following surgery, one nasal cavity was packed with hemostatic gelatin sponge and the other one with polyvinyl acetate. Patients' subjective symptoms while the packing was in situ, hemostatic properties, patients' pain on removal, degree of bleeding on removal of the packing, time for hemostasis after removal, postoperative wound healing, and the cost of the pack were evaluated.ResultsBoth packs were equally effective in the control of postoperative bleeding following septoplasty. However, hemostatic gelatin sponge packing was significantly more comfortable while in situ and less painful on removal of the pack. The polyvinyl acetate packing was associated with significantly more bleeding on removal, therefore much time was needed to control hemorrhage. There was no significant difference in the cost of the pack used and outcome of wound healing.ConclusionThe use of hemostatic gelatin sponge after septoplasty results in significantly less discomfort and greater patient satisfaction with no adverse reactions when compared with polyvinyl acetate packing. Therefore, hemostatic gelatin sponge may be a useful packing material after septoplasty.

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Evaluation of Penicillin Allergy in the Hospitalized Patient: Opportunities for Antimicrobial Stewardship

Abstract

Purpose of Review

Penicillin allergy is often misdiagnosed and is associated with adverse consequences, but testing is infrequently done in the hospital setting. This article reviews historical and contemporary innovations in inpatient penicillin allergy testing and its impact on antimicrobial stewardship.

Recent Findings

Adoption of the electronic medical record allows rapid identification of admitted patients carrying a penicillin allergy diagnosis. Collaboration with clinical pharmacists and the development of computerized clinical guidelines facilitates increased testing and appropriate use of penicillin and related β-lactams. Education of patients and their outpatient providers is the key to retaining the benefits of penicillin allergy de-labeling.

Summary

Penicillin allergy testing is feasible in the hospital and offers tangible benefits towards antimicrobial stewardship. Allergists should take the lead in this endeavor and work towards overcoming personnel limitations by partnering with other health care providers and incorporating technology that improves the efficiency of allergy evaluation.

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Middle ear adenomatous neuroendocrine tumors: a 25-year experience at MD Anderson Cancer Center

Abstract

Neuroendocrine tumors are extremely rare in the middle ear. We reviewed our institutional experience with middle ear adenomatous neuroendocrine tumors (MEANTs). We searched our institution's pathology files to identify patients treated from 1990 to 2015 who had lesions classified as middle ear adenomas, adenomatous tumors, adenomatous tumors with neuroendocrine differentiation, carcinoid tumors of the middle ear, low-grade neuroendocrine tumors of the middle ear, and neuroendocrine carcinomas of the middle ear and identified 14 such patients for whom follow-up information was available. Herein, we review the pathology and differential diagnosis of these patients' tumors and discuss the management and follow-up of these patients. Our report adds to the series cases of MEANTs with recurrences, lymph node involvement, distant metastases, and tumor-related deaths. Our experience suggests that, although these tumors have long been considered to be low-aggression neoplasms, long-term follow-up studies to ascertain this supposed benignity are warranted.

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Évaluation fonctionnelle du traitement de l’insuffisance glottique par injection d’acide hyaluronique : étude rétrospective à propos de 20 cas

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): C. Dorbeau, F. Marmouset, E. Lescanne, D. Bakhos, S. Morinière
ObjectifsDécrire la technique d'injection de l'acide hyaluronique dans les plis vocaux pour traiter une insuffisance glottique, en évaluer les indications ainsi que les résultats vocaux à 1 mois, et au-delà de 6 mois postopératoires.Patients et méthodesÉtude monocentrique rétrospective de mars 2012 à août 2015. Les critères d'inclusion étaient : paralysie récurrentielle unilatérale ou défaut d'affrontement cordal à mobilité conservée. Les critères d'exclusion étaient : thyroplastie préalable, troubles de déglutition majeurs, troubles cognitifs gênant l'évaluation vocale subjective. L'injection de Restylane^® était réalisée sous anesthésie générale ou locale. On évaluait le Voice Handicap Index (VHI), le temps maximum phonatoire (TMP) et le score GRBAS en préopératoire, puis à 1, et plus de 6 mois postopératoires.RésultatsVingt patients ont été inclus, 14 avaient une paralysie récurrentielle unilatérale et 6 un défaut d'affrontement. L'injection de Restylane^® a été faite sous anesthésie générale pour 16 patients et sous anesthésie locale pour 4 (20 %). À 1 mois postopératoire, on retrouvait une diminution significative du VHI (–36 points, p=0,0001) et du GRBAS (–6,95 points, p=0,0001) et une augmentation significative du TMP (+4,95sec, p=0,0001). À 6 mois, le VHI, le TMP et le GRBAS étaient toujours significativement améliorés (respectivement p=0,0002, p=0,001 et p=0,0001) ; et il n'y avait pas de différence significative entre VHI, TMP et GRBAS à 1 et 6 mois. Trois patients ont présenté une complication mineure, et deux patients ont récupéré une mobilité cordale normale.ConclusionL'injection d'acide hyaluronique est une technique efficace pour la prise en charge des insuffisances glottiques. Elle permet une amélioration des paramètres vocaux objectifs et subjectifs qui reste satisfaisante même à 6 mois du geste.

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Laryngectomie et pharyngo-laryngectomie totale première dans les cancers pharyngolaryngés de stade T4 : résultats carcinologiques et fonctionnels et facteurs pronostiques

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): M. Roux, O. Dassonville, M. Ettaiche, E. Chamorey, G. Poissonnet, A. Bozec
ObjectifsLes objectifs de cette étude étaient d'évaluer les résultats carcinologiques et fonctionnels de la laryngectomie ou pharyngo-laryngectomie totale (PLT) première pour cancer du larynx ou de l'hypopharynx avec extension tumorale extra-laryngée (T4), ainsi que de déterminer les facteurs prédictifs de ces résultats.Matériel et méthodesAnalyse rétrospective des dossiers informatisés de tous les patients ayant bénéficié d'une (P)LT première pour un carcinome épidermoïde du larynx ou de l'hypopharynx de stade T4 dans notre institution entre 2000 et 2014. Les facteurs prédictifs des résultats carcinologiques et fonctionnels ont été recherchés en analyse univariée et multivariée.RésultatsAu total, 63 patients (58 hommes et 5 femmes) d'âge moyen égal à 68,8±9,7 ans ont été inclus dans cette étude. Les survies globale et spécifique étaient de 69 % et 80 % à 3 ans et de 56 % et 69 % à 5 ans respectivement. En analyse multivariée, le sexe féminin (p<0,001), le score ASA (ASA≥3 ; p=0,006) et la présence d'emboles vasculaires (p=0,006) avaient un impact significatif péjoratif sur la survie globale. Six mois après la fin du traitement, 90 % des patients avaient retrouvé une alimentation orale autonome et 83 % de ceux appareillés d'une prothèse phonatoire avaient récupéré une voix intelligible.ConclusionLa (P)LT première reste le traitement de référence des cancers de stade T4 du larynx et de l'hypopharynx. Elle permet d'obtenir des résultats carcinologiques et fonctionnels satisfaisants.

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Tumeurs desmoïdes cervico-faciales de l’enfant : mise au point sur la prise en charge

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): M. Risoud, G. Mortuaire, X. Leroy, P. Leblond, P. Fayoux
ObjectifLes tumeurs desmoïdes cervico-faciales de l'enfant sont des tumeurs rares à agressivité locale potentiellement létales. L'objectif est de discuter la prise en charge de ces tumeurs à partir d'une série de cas et de l'analyse de la littérature.Matériel et méthodesL'étude rétrospective reprenait les données médicales des enfants traités pour tumeur desmoïde cervico-faciale entre 1976 et 2014.RésultatsSur les 6 enfants traités, 5 ont bénéficié d'une chirurgie d'exérèse large dont 2 avaient une invasion microscopie des berges (R1) avec récidive nécessitant une nouvelle exérèse. Un enfant présentant une lésion trop étendue a bénéficié d'une chimiothérapie par méthotrexate et vinorelbine hebdomadaire pendant 18 mois, permettant une régression du volume lésionnel de 93 % sans récidive.ConclusionsLes tumeurs desmoïdes cervico-faciales de l'enfant sont plus agressives que chez l'adulte, avec une morbi-mortalité élevée et un taux élevé de récidive. Un bilan d'imagerie par scanner et IRM est préférable avant biopsie. Bien qu'efficace chez l'adulte, la radiothérapie externe doit être évitée chez l'enfant compte tenu d'une moins bonne efficacité que chez l'adulte, et des séquelles esthétiques, fonctionnelles voire néoplasiques qu'elle comporte à long terme. Le traitement est chirurgical à chaque fois qu'une exérèse radicale large est possible. En cas de risque vital ou fonctionnel trop important, une chimiothérapie sans effet indésirable à long terme (type méthotrexate associé à un vinca-alcaloïde) pourra être proposée. Un suivi prolongé doit être réalisé compte tenu du risque de récidives.

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L’effet de l’insuffisance rénale chronique non diabétique sur la fonction olfactive

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): S. Koseoglu, S. Derin, B. Huddam, M. Sahan
ObjectifsDans l'insuffisance rénale chronique (IRC), la détérioration de la filtration glomérulaire résulte de l'accumulation de métabolites dans le corps, qui affecte tous les organes. Cette étude a été réalisée pour étudier les fonctions olfactives, et déterminer si l'hémodialyse ou la dialyse péritonéale améliore l'odorat chez les patients atteints d'IRC non diabétiques.Matériel et méthodesL'odorat a été analysé chez des patients atteints d'IRC ayant une créatininémie≥2mg/dL et non dialysés, chez des patients atteints d'IRC hémodialysés ou sous dialyse péritonéale, et chez des témoins sains. Les patients diabétiques ont été exclus puisque le diabète à lui seul est une cause de dysfonctionnement olfactif. L'échantillon étudié se composait d'un total de 107 personnes, dont 38 patients atteints d'IRC sous hémodialyse, 15 patients atteints d'IRC sous dialyse péritonéale, 30 patients avec une créatininémie≥2mg/dL sans nécessité de dialyse, et 24 témoins sains avec une fonction rénale normale. L'odorat a été analysé à l'aide du test Sniffin' Stick, et les groupes ont été comparés sur leurs résultats au test.RésultatsTous les paramètres du test Sniffin' Stick ont été altérés chez les patients atteints d'IRC. Les scores médians TDI des patients atteints d'IRC et des sujets sains étaient de 24,75 (13–36) et de 32,5 (27,7–37,75), respectivement, avec une différence statistiquement significative entre les deux (p<0,001). Les fonctions olfactives chez les patients en dialyse étaient meilleures que chez ceux atteints d'IRC non dialysés (p=0,020).ConclusionL'IRC non diabétique affecte négativement les fonctions olfactives. La dialyse améliore l'odorat chez ces patients.

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Efficacité de la radiothérapie « volumetric modulated arc therapy » dans les cancers épidermoïdes ORL : données de la « vraie vie »

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): C. Moncharmont, A. Vallard, J.-B. Guy, J.-M. Prades, C. Rancoule, N. Magné
ObjectifsIl existe peu de données concernant l'efficacité de la radiothérapie en modulation d'intensité volumétrique par arc thérapie (VMAT), délivrée dans le cadre du traitement des cancers épidermoïdes (CE) ORL. L'objectif était d'étudier les résultats et les modes de récidive des patients traités par VMAT à l'encontre d'un CE ORL localement avancé.MéthodesLes données de tous les patients, traités en intention curative par VMAT à l'encontre d'un CE ORL stade III ou IV, ont été rétrospectivement étudiées.RésultatsEntre 2010 et 2013, 130 patients furent traités pour un CE localement avancé de l'oropharynx (n=55 ; 42 %), de l'hypopharynx (n=38 ; 29 %), du larynx (n=22 ; 17 %), ou de la cavité buccale (n=15 ; 12 %). L'âge médian était de 60 ans (39–85). La durée de suivi médiane était de 18,1 mois (0–43,7). À la fin du suivi, 60 patients étaient décédés (46 %). La survie sans progression (SSP) et la survie globale (SG) à 2 ans étaient de 63,6 % et 77,3 % pour les tumeurs laryngées, 60 % et 60 % pour les tumeurs de la cavité buccale, 52,6 % et 57,6 % pour les tumeurs oropharyngées, et 38,8 % et 54,7 % pour les tumeurs hypopharyngées. La plupart des récidives étaient situées dans les champs, ou en bordure de champs de la radiothérapie.ConclusionCette analyse rétrospective est, à notre connaissance, la plus large étude s'intéressant à l'efficacité du VMAT dans les CE ORL. Les résultats et les modes de récidive constatés semblent concorder avec ceux rapportés en radiothérapie conformationnelle par modulation d'intensité (IMRT).

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Editorial Board

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3

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Troubles de l’équilibre post-traumatique

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): M. Elzière, A. Devèze, C. Bartoli, G. Levy
Les causes responsables de troubles de l'équilibre sont multiples et le syndrome subjectif des traumatisés crâniens reste un diagnostic d'élimination. Néanmoins, avec l'avancée des différentes explorations fonctionnelles oto-neurologiques et de l'imagerie cérébrale, il est maintenant possible d'objectiver le plus souvent cette plainte fonctionnelle. Ces dernières années, de nouveaux diagnostics ont été mis en évidence, ce qui a permis une meilleure reconnaissance de ces pathologies dans le domaine de la réparation du dommage corporel. Nous tenterons de préciser l'ensemble de ces étiologies et de déterminer, grâce à une synthèse de la littérature, les éléments pertinents pouvant modifier la prise en charge de ces patients, particulièrement dans le domaine expertal.

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Fonctionnement du système tubotympanique

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): C. Martin, A. Karkas, J.-M. Prades
La trompe d'Eustache (tube auditif) et les cavités tympanomastoïdiennes forment un ensemble anatomique et fonctionnel difficilement dissociable, d'où l'appellation « système tubotympanique ». L'étude de ce système a fait l'objet de nombreux travaux dont les résultats complexes et parfois contradictoires rendent difficile une vue d'ensemble de son fonctionnement. L'objectif cet article est d'en synthétiser les connaissances actuelles, préalable indispensable à la compréhension de son dysfonctionnement et notamment de la genèse de l'otite chronique. L'ensemble du système est tapissé par une muqueuse qui en assure la continuité, bien qu'elle comporte certaines particularités selon la zone concernée, et y joue un rôle primordial. Ainsi, dans des conditions physiologiques, la diffusion gazeuse à travers la muqueuse tympanomastoïdienne assure l'essentiel de l'équilibre pressionnel régnant entre l'oreille moyenne (OM) et le monde extérieur, l'ouverture tubaire n'intervenant que très peu. Lors des changements rapides et importants de la pression atmosphérique, la fonction ventilatoire de la trompe est alors mise en jeu, sous l'effet d'un mécanisme réflexe. Le système possède en outre d'autres fonctions indispensables au bon fonctionnement de l'OM, une fonction de protection vis-à-vis des sécrétions et agents pathogènes en provenance du rhinopharynx, mais aussi de certains bruits physiologiques, une fonction de clairance des cavités de l'OM dépendant du transport mucociliaire des pathogènes, liée en partie à la sécrétion des glandes sous-muqueuses et une fonction de défense immunitaire.

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Recommandation de la SFORL. Prise en charge des épistaxis de l’adulte en première intention

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): E. Bequignon, B. Vérillaud, L. Robard, J. Michel, V.P. Escabasse, L. Crampette, O. Malard
ObjectifLes auteurs exposent les recommandations de la Société française d'oto-rhino-laryngologie et de chirurgie de la face et du cou (SFORL) concernant la prise en charge des épistaxis en première intention.MéthodesÀ partir d'une revue de la littérature scientifique par un groupe de travail multidisciplinaire, des recommandations ont été rédigées, fondées sur les articles et l'expérience individuelle des membres, puis relues par un groupe de lecture indépendant afin d'aboutir au texte de synthèse. Les recommandations proposées ont été classées en grade A, B, C ou accord professionnel selon un niveau de preuve scientifique décroissant.RésultatsEn première intention, le mouchage, le nettoyage des fosses nasales et une compression bidigitale sont recommandés. En cas de saignement persistant, l'anesthésie locale avec vasoconstriction précède les gestes nasaux à visée diagnostique et thérapeutique. Quand l'origine des saignements n'est pas antérieure, l'endoscopie est essentielle, et localise l'origine des saignements dans la plupart des cas. En cas de saignement actif, une cautérisation est réalisée si le site de saignement est identifié. S'il n'est pas visualisé ou si échec des premières mesures, un tamponnement antérieur pourra être réalisé par un médecin non spécialiste ORL. La survenue d'une épistaxis impose, au décours, la réalisation d'une endoscopie des fosses nasales par un médecin ORL. Les patients doivent être informés des gestes à réaliser en cas d'épistaxis à domicile et des risques des différents traitements.

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Recommandation de la SFORL. Prise en charge des épistaxis de l’adulte en deuxième intention

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): B. Verillaud, L. Robard, J. Michel, V. Prulière Escabasse, E. Béquignon, L. Crampette, O. Malard
ObjectifLes auteurs exposent les recommandations de la Société française d'oto-rhino-laryngologie et de chirurgie de la face et du cou (SFORL) concernant la prise en charge des épistaxis en deuxième intention, c'est-à-dire après échec du tamponnement antérieur et/ou du tamponnement antéro-postérieur.MéthodesUn groupe de travail multidisciplinaire a été chargé d'effectuer une revue de la littérature scientifique sur la thématique étudiée. À partir de ces textes et de l'expérience de chacun, des recommandations ont été rédigées, puis relues par un groupe de lecture indépendant du groupe de travail. Une réunion de synthèse a permis d'aboutir au texte final. Les recommandations proposées ont été classées en grade A, B, C ou accord professionnel selon un niveau de preuve scientifique décroissant.RésultatsIl est recommandé que l'embolisation artérielle soit effectuée par un neuroradiologue expérimenté disposant d'un plateau technique dédié et du matériel adapté afin de limiter le risque de complications. Il est recommandé d'effectuer une angio-TDM du crâne et des TSA avant embolisation dans le cas d'une épistaxis post-traumatique avec suspicion de lésion de l'artère carotide interne. En cas d'épistaxis persistante malgré l'hémostase endoscopique sphéno-palatine, il est recommandé d'effectuer l'hémostase de l'artère ethmoïdale antérieure par voie canthale interne, avec éventuellement une progression assistée par l'endoscope. Il est recommandé en cas d'épistaxis résistante aux procédures chirurgicales et neuroradiologiques habituelles d'effectuer une exploration chirurgicale des fosses nasales et de l'ethmoïde, avec une coagulation élective en cas de saignement en provenance d'une branche artérielle secondaire, voire une ethmoïdectomie en cas de saignement non systématisé. Un arbre décisionnel a été élaboré pour orienter la stratégie thérapeutique de prise en charge d'une épistaxis en deuxième intention.

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Recommandation de la SFORL. Prise en charge des épistaxis dans le cadre des troubles de la coagulation liés aux antithrombotiques

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): V. Escabasse, E. Bequignon, B. Vérillaud, L. Robard, J. Michel, O. Malard, L. Crampette
ObjectifLes auteurs exposent les recommandations de la Société française d'oto-rhino-laryngologie concernant la prise en charge des épistaxis liés aux traitements antithrombotiques.MéthodesUne revue de la littérature scientifique a été effectuée par un groupe de travail multidisciplinaire. À partir de ces textes, des recommandations ont été rédigées, puis relues par un groupe de lecture indépendant du groupe de travail afin d'aboutir au texte final. Les recommandations proposées ont été classées en grade A, B, C ou accord professionnel selon un niveau de preuve scientifique décroissant.RésultatsAvant toute décision de modification du traitement antithrombotique, il est recommandé de rechercher un surdosage et d'évaluer le risque thrombotique. Chez un patient porteur d'un stent, la bi-antiagrégation doit être maintenue durant le mois suivant la pose du stent et si possible pendant 3 mois. En cas d'épistaxis contrôlée par tamponnement avec un surdosage en antivitamine K (AVK), les mesures correctives sont fonction de l'INR. En cas d'épistaxis non contrôlée, il est recommandé d'arrêter les AVK, d'administrer des antidotes et de suivre régulièrement l'évolution de l'INR. En cas d'embolisation par voie endovasculaire, il n'est pas recommandé de modifier le traitement par anticoagulant.

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Comment libérer les évidements : rôle du triangle inter-spino-jugulaire

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): S. Périé, M. Lesnik, S. Samaha, J. Lacau St Guily
La technique des évidements ganglionnaires cervicaux est bien codifiée. Elle permet l'exérèse des groupes ganglionnaires, qui comporte au moins les groupes IIa, IIb, III et IV selon la classification de Robbins pour les cancers des voies aérodigestives supérieures. L'évidement est classiquement réalisé de bas en haut et d'arrière en avant, mais varie en fonction de la localisation des adénopathies. Pour permettre de faciliter l'évidement du groupe IIb, sans traction sur le nerf spinal accessoire, et le contrôle précoce de la veine jugulaire interne en haut, cette libération de la veine facilitant aussi la dissection ultérieure du tronc thyro-linguo-facial et le repérage du XII, le rôle pivot de la libération du triangle inter-spino-jugulaire au début de l'évidement cervical est décrit. La littérature ne distingue pas cette dissection spécifique et son importance. Ce triangle constitue la partie postérieure du groupe IIa, mais est intimement lié anatomiquement à la libération du groupe IIb.

http://ift.tt/2qhuiUY

Kératoaméloblastome mandibulaire

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): S. Anajar, A. Lakhbal, R. Allah Abada, M. Mahtar
IntroductionLe kératoaméloblastome est une tumeur odontogène extrêmement rare, 18 cas seulement ont été rapportés dans la littérature.ObservationNous rapportons un cas de kératoaméloblastome chez une patiente âgée de 32 ans, avec revue de la littérature sur les caractéristiques cliniques, l'aspect radiologique, les résultats histopathologiques et les options de traitement.DiscussionLe kératoaméloblastome est une tumeur rare observée plus fréquemment chez l'homme (sex-ratio de 3:1) et caractérisée par la production de kératine dans les îlots odontogéniques ainsi que dans le stroma fibreux.

http://ift.tt/2r1rfxi

Goitre ectopique parapharyngé gauche coexistant avec une thyroïde eutopique et syndrome de Claude Bernard-Horner postopératoire

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): W. Foma, E. Pegbessou, B. Amana, E. Kpemissi
IntroductionLe but de cette observation est de rapporter un cas de goitre ectopique parapharyngé gauche dont l'exérèse a été marquée par un syndrome de Claude Bernard-Horner postopératoire tout en relevant les difficultés de prise en charge.ObservationIl s'agissait d'une femme de 25 ans, qui a consulté pour dysphagie haute et qui présentait une masse parapharyngée gauche bien limitée refoulant les gros vaisseaux en dehors et en arrière. Une cervicotomie exploratrice a permis l'exérèse de cette masse. L'examen anatomopathologique de la pièce a noté un parenchyme thyroïdien hyperplasique. Le contrôle postopératoire a montré une glande thyroïde eutopique et euthyroïdienne. Les suites opératoires ont été marquées par un syndrome de Claude Bernard-Horner persistant avec un an de recul.DiscussionL'ectopie thyroïdienne parapharyngée coexistant avec une thyroïde fonctionnelle est extrêmement rare. Les masses parapharyngées sont le plus souvent d'origine parotidienne et nerveuse. La chirurgie de l'espace parapharyngé peut entraîner une lésion du sympathique cervical à l'origine du syndrome de Claude Bernard-Horner, comme chez notre patiente.ConclusionL'ectopie thyroïdienne devrait être évoquée dans le diagnostic des masses de l'espace parapharyngé. Bien que rare, le syndrome de Claude Bernard-Horner est à redouter dans la chirurgie de ces masses.

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Plaques érythémateuses sur le pavillon de l’oreille

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): G. Serarslan, C. Arlı, E. Atik

http://ift.tt/2qhpf72

Leishmaniose laryngée, une manifestation rare d’une maladie émergente

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): L. Silva, E. Damrose, A.-M.-F. Fernandes

http://ift.tt/2r1BEZR

Correction

Reich K, Leonardi C, Langley RG, et al. Inflammatory bowel disease among patients with psoriasis treated with ixekizumab: A presentation of adjudicated data from an integrated database of 7 randomized controlled and uncontrolled trials. J Am Acad Dermatol. 2017:76:441-448.e2.

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Malignant external otitis: The shifting treatment paradigm

Malignant external otitis (MEO) is an aggressive infection occurring in immunocompromised hosts. Increasing antimicrobial resistance is making the disease more difficult to treat.

http://ift.tt/2r1u0i5

Effectiveness of hemostatic gelatin sponge as a packing material after septoplasty: A prospective, randomized, multicenter study

Although hemostatic gelatin sponge is a gelatin-based packing material with a powerful hemostatic effect, there were no studies in regard to its efficacy for packing material after septoplasty. The purpose of this study was to investigate the efficacy of hemostatic gelatin sponge nasal packing on patient's subjective symptoms, hemostasis, and wound healing following septoplasty.

http://ift.tt/2rVY92f

Delayed type of allergic skin reaction to Candida albicans in eosinophilic rhinosinusitis cases

Eosinophilic chronic rhinosinusitis (ECRS) is frequently complicated by asthma, and recognized as refractory and persistent rhinosinusitis. However, the detailed pathophysiology of ECRS has not been elucidated yet. In this study, we investigated the association between recurrent ECRS and intradermal testing to multi-antigens including Candida albicans.

http://ift.tt/2rmS2as

Identifying high quality medical education websites in Otolaryngology: a guide for medical students and residents

Cole congênito, PF, deiscência tegmem e região petrosa

http://ift.tt/2r1yzsH

Identifying high quality medical education websites in Otolaryngology: a guide for medical students and residents

Abstract

Background

Learners often utilize online resources to supplement formalized curricula, and to appropriately support learning, these resources should be of high quality. Thus, the objectives of this study are to develop and provide validity evidence supporting an assessment tool designed to assess the quality of educational websites in Otolaryngology- Head & Neck Surgery (ORL-HNS), and identify those that could support effective web-based learning.

Methods

After a literature review, the Modified Education in Otolaryngology Website (MEOW) assessment tool was designed by a panel of experts based on a previously validated website assessment tool. A search strategy using a Google-based search engine was used subsequently to identify websites. Those that were free of charge and in English were included. Websites were coded for whether their content targeted medical students or residents. Using the MEOW assessment tool, two independent raters scored the websites. Inter-rater and intra-rater reliability were evaluated, and scores were compared to recommendations from a content expert.

Results

The MEOW assessment tool included a total of 20 items divided in 8 categories related to authorship, frequency of revision, content accuracy, interactivity, visual presentation, navigability, speed and recommended hyperlinks. A total of 43 out of 334 websites identified by the search met inclusion criteria. The scores generated by our tool appeared to differentiate higher quality websites from lower quality ones: websites that the expert "would recommend" scored 38.4 (out of 56; CI [34.4–42.4]) and "would not recommend" 27.0 (CI [23.2–30.9]). Inter-rater and intra-rater intraclass correlation coefficient were greater than 0.7.

Conclusions

Using the MEOW assessment tool, high quality ORL-HNS educational websites were identified.

http://ift.tt/2s0oFHb

A novel frameshift mutation of SMPX causes a rare form of X-linked nonsyndromic hearing loss in a Chinese family

by Zhijie Niu, Yong Feng, Lingyun Mei, Jie Sun, Xueping Wang, Juncheng Wang, Zhengmao Hu, Yunpeng Dong, Hongsheng Chen, Chufeng He, Yalan Liu, Xinzhang Cai, Xuezhong Liu, Lu Jiang

X-linked hearing impairment is the rarest form of genetic hearing loss (HL) and represents only a minor fraction of all cases. The aim of this study was to investigate the cause of X-linked inherited sensorineural HL in a four-generation Chinese family. A novel duplication variant (c.217dupA, p.Ile73Asnfs*5) in SMPX was identified by whole-exome sequencing. The frameshift mutation predicted to result in the premature truncation of the SMPX protein was co-segregated with the HL phenotype and was absent in 295 normal controls. Subpopulation screening of the coding exons and flanking introns of SMPX was further performed for 338 Chinese patients with nonsydromic HL by Sanger sequencing, and another two potential causative substitutions (c.238C>A and c.55A>G) in SMPX were identified in additional sporadic cases of congenital deafness. Collectively, this study is the first to report the role of SMPX in Chinese population and identify a novel frameshift mutation in SMPX that causes not only nonsyndromic late-onset progressive HL, but also congenital hearing impairment. Our findings extend the mutation and phenotypic spectrum of the SMPX gene.

http://ift.tt/2r0on3z

Evaluation of type-specific antibodies to high risk-human papillomavirus (HPV) proteins in patients with oropharyngeal cancer

Publication date: July 2017
Source:Oral Oncology, Volume 70
Author(s): Martina A. Broglie, Wolfram Jochum, Angelika Michel, Tim Waterboer, Diana Foerbs, René Schoenegg, Sandro J. Stoeckli, Michael Pawlita, Dana Holzinger
ObjectivesHigh risk human papillomavirus (HR-HPV) infection leads to a subgroup of oropharyngeal cancer (OPSCC) characterized by improved treatment response. However an universally accepted definition of an HR-HPV-attributable cancer is lacking.MethodsDetailed, type-specific HPV antibody responses were analyzed by multiplex serology in HR-HPV-attributable OPSCC patients, defined by p16^INK4A overexpression and HR-HPV DNA detection by PCR amplification and sequencing.ResultsFifty patients were prospectively enrolled. 26/50 (52%) tumor samples were positive for both p16^INK4A expression and HR-HPV DNA (22 HPV16, 4 HPV33). Seropositivity was present in 26/26 HPV-attributable OPSCC and one p16^INK4A-positive/HPV DNA-negative case. The sensitivity and specificity to diagnose an HR-HPV-attributable tumor was 100% and 96%, respectively for anti-E6 reactivity, 82% and 100%, respectively for anti-E2 reactivity, and clearly lower for anti-E7, anti-E1, anti-E4 and anti-L1-reactivity. 3yr-overall (OS) and disease specific survival (DSS) was higher in patients with HR-HPV-attributable tumors (OS 88% vs 64%, p=0.02; DSS 90% vs 80%, p=0.07) and seropositive patients (OS 88% vs 62%, p=0.01; DSS 92% vs 78%, p=0.05) than HR-HPV-negative or seronegative patients.ConclusionsDetection of HR-HPV type-specific antibodies highly correlated with HPV-attributable OPSCC and was associated with better survival. HR-HPV antibodies are promising diagnostic, prognostic and potentially screening markers in HR-HPV-attributable OPSCC.

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Relative susceptibility of airway organisms to antimicrobial effects of nitric oxide

Background

Nitric oxide (NO) is released in the airway as a critical component of innate immune defense against invading pathogenic organisms. It is well documented that bacteriostatic and bactericidal effects of NO are concentration-dependent. However, few data exist comparing relative susceptibility of common pathogens to NO at physiologic concentrations. In this study we evaluated the effects of NO on 4 common airway bacteria and 1 fungus, and examined the potential implications of discrepancies in sensitivity.

Methods

Staphylococcus epidermis, Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Candida albicans cultures were adjusted to a uniform optical density (OD) and grown in log phase at 37°C with varying concentrations of NO formed by DETA NONOate. Both OD readings and colony forming units (CFUs) were measured at varying time-points to evaluate for inhibitory effects of NO.

Results

P aeruginosa and C albicans were significantly more sensitive to NO at physiologic concentrations typical of the human airway. S aureus was attenuated by NO to a lesser degree, and K pneumoniae and S epidermis were more resistant to NO at all concentrations tested. Air surface liquid from cultured human sinonasal epithelial cells had an additive effect in bacterial killing of P aeruginosa, but not in S aureus.

Conclusion

Common airway pathogens have varying levels of susceptibility to NO at physiologic concentrations of innate immune defense. Relative sensitivity of P aeruginosa and relative resistance of S epidermis may help explain the composition of the healthy microbiome, as well as opportunistic infection in the absence of induced NO release.

http://ift.tt/2rDvv90

Defining a diagnostic marker: a pragmatic requirement

http://ift.tt/2qkucI8

Household pet exposure, allergic sensitization, and rhinitis in the U.S. population

Background

The effect of animal dander exposure on allergic sensitization may be age-dependent. A comparison between the association of the levels of exposure to pet allergen with rhinitis symptoms and allergic sensitization in children and adults is yet to be performed in the U.S. population.

Methods

Cross-sectional study of 3034 adults (age, 20 to 85 years) and 2104 children (age, 6 to 19 years) in the National Health and Nutrition Examination Survey, 2005–2006. Samples of household dust were collected to measure the amounts of indoor allergens in the participants' homes. Self-reported rhinitis was based on symptoms during the past 12 months, and allergen sensitization was defined as a positive response to any of the 19 specific immunoglobulin E (IgE) antigens tested.

Results

Higher levels of exposure to dog dander were associated with a higher prevalence of any allergic sensitization in adults (prevalence ratio [PR] 1.19; 95% confidence interval [CI], 1.01 to 1.39), but a lower prevalence in children (PR 0.84; 95% CI, 0.73 to 0.096), p-interaction by age group 0.02. Cat exposure was associated with an increased prevalence of rhinitis symptoms in adults (PR for the 3rd vs lowest tertile of cat dander concentrations: 1.14; 95% CI, 1.05 to 1.23) but not in children (PR for the 3rd vs lowest tertile of cat dander IgE concentrations: 0.86; 95% CI, 0.70 to 1.07), p-interaction 0.01.

Conclusion

Allergic sensitization and symptomatic response to pet dander exposure may vary based on age. Further studies are necessary to assess the mechanisms for these apparent differences.

http://ift.tt/2rDNTyC

Perspectives on the Otolaryngology Residency Application Process

This survey study evaluates the perceptions of 2016 otolaryngology–head and neck surgery residency applicants regarding the application process and offers suggestions for reform.

http://ift.tt/2rZdWNd

Rethinking Pain Management in Endoscopic Sinus Surgery

For years, opioid medications have been the centerpiece of perioperative pain management with endoscopic sinus surgery. This approach provides surgeons with the comfort that their patients will experience adequate pain control following their operation. Rarely, however, have we asked if we are overtreating pain. Certainly patients will take only the medication they need, and what's the harm with a few unused pills? Furthermore, are we not better off prescribing beyond the likely needs of our patients to ensure their comfort and minimize postoperative phone calls?

http://ift.tt/2r0Wk6i

Bilateral Hearing and Vestibular Loss in a Patient With Untreated CML

This case study describes a man in his 40s with uncontrolled chronic myeloid leukemia who presented with sudden-onset positional vertigo and profound sensorineural hearing loss.

http://ift.tt/2rZkKuc

Analgesic Effects of Intravenous Acetaminophen vs Placebo for Endoscopic Sinus Surgery

This randomized clinical trial examines the use of intravenous acetaminophen vs placebo in patients undergoing endoscopic sinus surgery for chronic rhinosinusitis.

http://ift.tt/2r11CyK

Partial Resection in Microsurgical Management of Vestibular Schwannomas

This Viewpoint discusses selective use of partial tumor resection, in particular near total resection, over gross total resection when there is concern for imminent facial nerve compromise in the management of vestibular schwannomas.

http://ift.tt/2rYT6xl

Über 5 Jahre hinaus verlängerte endokrine Therapie

http://ift.tt/2qgcYjh

Cahiers inlichtingenstudies/Cahiers d'études de renseignement

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Risk factors for daytime or combined incontinence in children with cerebral palsy

http://ift.tt/2rDoLYV

Feeding management strategies among the early Neolithic pigs in the NE of the Iberian Peninsula

Abstract

The socio-economic relevance of domesticated animals during the Early Neolithic in the Iberian Peninsula is indisputable, yet we essentially know little about the way they were managed. Among domesticated animals, pig (Sus domesticus) was a common food source and previous studies have shown the potential of stable isotopes for assessing variability in pig diet in relation to husbandry practices. Nevertheless, this approach has never been applied to the earliest pigs in the Iberian Peninsula. We analyzed the carbon and nitrogen stable isotope composition of pig bone collagen from several Early Neolithic sites in the NE Iberian Peninsula. While pig δ13C values were similar across different populations, there were significant differences in δ15N values between sites. These are attributed to different pig husbandry systems, which may reflect distinct social and spatial organization and interaction with environmental conditions during the Early Neolithic in this region.

http://ift.tt/2qnyMof

Human-aided movement of viral disease and the archaeology of avian osteopetrosis

Abstract

The term avian osteopetrosis is used to describe alterations to the skeletal elements of several species of domestic bird, most typically the chicken, Gallus gallus domesticus (L. 1758). Such lesions are routinely identified in animal bones from archaeological sites due to their distinctive appearance, which is characterised by proliferative diaphyseal thickening. These lesions are relatively uncomplicated for specialists to differentially diagnose, and are caused by a range of avian leucosis viruses in a series of subgroups. Only some avian leucosis viruses cause the development of such characteristic lesions in osteological tissue. Viraemia is necessary for the formation of skeletal pathology, and avian osteopetrosis lesions affect skeletal elements at different rates. Lesion expression differs by the age and sex of the infected individual, and environmental conditions have an impact on the prevalence of avian leucosis viruses in poultry flocks. These factors have implications for the ways in which diagnosed instances of avian osteopetrosis in archaeological assemblages are interpreted. By integrating veterinary research with archaeological evidence for the presence of avian leucosis viruses across Western Europe, this paper discusses the nature of these pathogens, outlines criteria for differential diagnosis, and offers a fresh perspective on the human-aided movement of animal disease in the past through investigation of the incidence and geographic distribution of avian osteopetrosis lesions from the first century BC to the post-medieval period.

http://ift.tt/2qSZPv2

ORBS and the Limits of Static Slicing

Binkley, D; Gold, N; Harman, M; Islam, S; Krinke, J; Yoo, S; (2015) ORBS and the Limits of Static Slicing. In: Proceedings of the 15th IEEE International Working Conference on Source Code Analysis and Manipulation (SCAM). (pp. pp. 1-10). IEEE: Bremen, Germany. Green open access

http://ift.tt/2qfE4Hn

Robust CT Synthesis for Radiotherapy Planning: Application to the Head and Neck Region

Burgos, N; Cardoso, MJ; Guerreiro, F; Veiga, C; Modat, M; McClelland, J; Knopf, A-C; Burgos, N; Cardoso, MJ; Guerreiro, F; Veiga, C; Modat, M; McClelland, J; Knopf, A-C; Punwani, S; Atkinson, D; Arridge, SR; Hutton, BF; Ourselin, S; - view fewer (2015) Robust CT Synthesis for Radiotherapy Planning: Application to the Head and Neck Region. In: Navab, N and Hornegger, J and Wells, WM and Frangi, AF, (eds.) Proceedings of the 18th International Conference on Medical Image Computing and Computer-Assisted Intervention (MICCAI). (pp. pp. 476-484). Springer, Mach: Munich, Germany. Green open access

http://ift.tt/2qZUgJH

Subject-specific Models for the Analysis of Pathological FDG PET Data

Burgos, N; Cardoso, MJ; Mendelson, AF; Schott, JM; Atkinson, D; Arridge, SR; Hutton, BF; Burgos, N; Cardoso, MJ; Mendelson, AF; Schott, JM; Atkinson, D; Arridge, SR; Hutton, BF; Ourselin, S; - view fewer (2015) Subject-specific Models for the Analysis of Pathological FDG PET Data. In: Navab, N and Hornegger, J and Wells, WM and Frangi, AF, (eds.) Proceedings of the 18th International Conference on Medical Image Computing and Computer-Assisted Intervention (MICCAI). (pp. pp. 651-658). Springer, Cham: Munich, Germany. Green open access

http://ift.tt/2qg8TeR

Participatory mapping for transformation: multiple visual representation of foodscapes and environment in informal settlements in Nairobi

Ahmed, S; Haklay, ME; Allen, A; Tacoli, C; Simiyu, E; Davila, J; (2015) Participatory mapping for transformation: multiple visual representation of foodscapes and environment in informal settlements in Nairobi. In: Malleson, N and Addis, N and Durham, H and Heppenstrall, A and Lovelace, R and Norman, P and Oldroyd, R, (eds.) Proceedings of GIS Research UK (GISRUK). (pp. pp. 14-19). GIS Research UK (GISRUK): Leeds, UK. Green open access

http://ift.tt/2qZLZW4

Making Sigma-Protocols Non-interactive Without Random Oracles

Chaidos, P; Groth, J; (2015) Making Sigma-Protocols Non-interactive Without Random Oracles. In: Katz, J, (ed.) Proceedings of Public-Key Cryptography -- PKC 2015. (pp. pp. 650-670). Springer: Gaithersburg, MD, USA. Green open access

http://ift.tt/2qfVuU9

Industrial real estate investment:does the contrarian strategy work?

Addae-Dapaah, K; (2010) Industrial real estate investment:does the contrarian strategy work? Journal of Real Estate Finance and Economics , 41 (2) pp. 193-227. 10.1007/s11146-008-9147-x . Green open access

http://ift.tt/2qg1Rqg

MPV17L2 is required for ribosome assembly in mitochondria

Dalla Rosa, I; Durigon, R; Pearce, SF; Rorbach, J; Hirst, EMA; Vidoni, S; Reyes, A; Dalla Rosa, I; Durigon, R; Pearce, SF; Rorbach, J; Hirst, EMA; Vidoni, S; Reyes, A; Brea-Calvo, G; Minczuk, M; Woellhaf, MW; Herrmann, JM; Huynen, MA; Holt, IJ; Spinazzola, A; - view fewer (2014) MPV17L2 is required for ribosome assembly in mitochondria. Nucleic Acids Research , 42 (13) pp. 8500-8515. 10.1093/nar/gku513 . Green open access

http://ift.tt/2r00vgA

Evaluation of the use of Pycnoporus sanguineus fungus for phenolics and genotoxicity decay of a pharmaceutical effluent treatment

Watanabe, RAM; Sales, PTF; Campos, LC; Garcia, TA; Vladares, MC; Schmidit, F; Santiago, MF; (2012) Evaluation of the use of Pycnoporus sanguineus fungus for phenolics and genotoxicity decay of a pharmaceutical effluent treatment. Revista Ambiente & Água - An Interdisciplinary Journal of Applied Science , 7 (3) pp. 41-50. 10.4136/1980-993X . Green open access

http://ift.tt/2qg2FeP

Identification of novel PTEN-binding partners: PTEN interaction with fatty acid binding protein FABP4

Gorbenko, O; Panayotou, G; Zhyvoloup, A; Volkova, D; Gout, I; Filonenko, V; (2010) Identification of novel PTEN-binding partners: PTEN interaction with fatty acid binding protein FABP4. Molecular and Cellular Biochemistry , 337 (1) pp. 299-305. 10.1007/s11010-009-0312-1 .

http://ift.tt/2qZw3mT

Scattering contribution to the double-pass PSF using Monte Carlo simulations

Christaras, D; Ginis, H; Pennos, A; Artal, P; (2017) Scattering contribution to the double-pass PSF using Monte Carlo simulations. Ophthalmic and Physiological Optics , 37 (3) pp. 342-346. 10.1111/opo.12375 .

http://ift.tt/2qfDZn3

Evaluation of Penicillin Allergy in the Hospitalized Patient: Opportunities for Antimicrobial Stewardship

Abstract

Purpose of Review

Recent Findings

Summary

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PREDICTIVE FACTORS FOR DAYTIME URINARY INCONTINENCE IN CHILDREN WITH CEREBRAL PALSY

http://ift.tt/2qfZN1I

Urotherapie: specifieke aanpak van kin-deren met een ontwikkelingsstoornis

http://ift.tt/2qZUikV

The posterior-based buccinator myomucosal flap (Bozola's flap)

Publication date: Available online 24 May 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): A. Rahpeyma, S. Khajehahmadi

http://ift.tt/2r0cSeN

Impact of a multimedia support on the understanding of medical information by hearing-impaired patients before cochlear implantation

Publication date: Available online 24 May 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): C.-E. Rouf, E. Lescanne, A. Villeneuve, K. Reffet, S. Kim, D. Bakhos
IntroductionThe medical information provided in medical consultations is exhaustive but poorly assimilated by patients and relatives. Hearing loss seems to be a further obstacle. The main objective of this study was to compare medical information about cochlear implantation delivered in oral and written form ("standard" group) versus oral, written and digital form ("multimedia" group). The secondary objective was to assess hearing loss as a negative factor for understanding medical information, by comparing understanding in patients with unilateral versus bilateral profound hearing loss.Patients and methodA prospective single-center single-blind study was carried out from September 29, 2015 to June 22, 2016. Twenty-nine CI candidates were included: 11 in the "standard" group, 12 in the "multimedia" group and 6 in the "unilateral hearing loss" group. The primary endpoint was the result on a validated questionnaire (score from 0 to 14) assessing memorization of medical information. Patient satisfaction regarding the information delivered was assessed on a Likert scale.ResultsMemorization scores were 4.6±2.7 and 9.7±2.4 respectively for the "standard" and the "multimedia" group (P=0.0006) and 9.05±1.9 for the "unilateral hearing loss" group. Comparison between the "standard" and "unilateral hearing loss" groups showed a significant difference (P=0.01). Satisfaction scores were highest for digital compared to the other forms of medical information delivery.ConclusionThis study showed that a digital support improved understanding of medical information by candidates for cochlear implantation and that hearing loss was an obstacle to understanding medical information.

http://ift.tt/2rYpkcg

Cardiovascular risk assessment: more sex please

George, J; (2016) Cardiovascular risk assessment: more sex please. European Heart Journal - Quality of Care and Clinical Outcomes , 2 (2) pp. 64-65. 10.1093/ehjqcco/qcw006 . Green open access

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Case 16-2017 — A 69-Year-Old Woman with Urinary Incontinence

Presentation of Case. Dr. John O. Schorge: A 69-year-old woman was evaluated at the gynecologic oncology clinic of this hospital because of persistent urinary incontinence. Seven years before this evaluation, the patient had received a diagnosis of superficial bladder cancer (low grade), for which…

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VIRTUAL MICROSCOPY IN MORPHOLOGICAL SCIENCES

http://ift.tt/2qZzUSU

Congenital Herpes Simplex Virus Type 1 Infection Mimicking Congenital Erosive and Vesicular Dermatosis: Possible Pathogenic Insights

Abstract

Congenital erosive and vesicular dermatosis (CEVD) is a rare entity of unknown etiology. We report a case of congenital herpes simplex virus (HSV) type 1 infection that healed with reticulated and supple scarring, similar to that seen in CEVD. Twenty percent of previously reported cases of CEVD had recurrent HSV infection throughout the first year of life. We postulate that at least some previous cases of CEVD may have been due to undiagnosed congenital HSV infection.

http://ift.tt/2qRQEuO

CD4+ T cells from HIV-1 patients with impaired Th1 effector responses to Mycobacterium tuberculosis exhibit diminished histone and nucleoprotein signatures

Publication date: Available online 25 May 2017
Source:Clinical Immunology
Author(s): Lillian Seu, James A. Mobley, Paul A. Goepfert
HIV+ patients have an increased risk for tuberculosis disease despite clinical management with ARTs. We established a culture model of Mtb-infection in PBMCs from HIV+ PPD+ donors on suppressive ART (median 6.4years) with negligible viral loads (median<50copies/mL) and stable CD4+ T cell counts (517cells/mm^3). We observed that HIV+ patient lymphocytes harbored a recruitment defect to Mtb-infected macrophages. To investigate these immune defects on a per cell basis, purified CD4+ T cells from HIV patients were assessed by label-free quantification protein mass spectrometry. CD4+ T cells from HIV patients displayed diminished nucleoprotein levels – notably of histone variant H2a.Z and ribonucleoprotein A1. Only within healthy donors, transcriptional regulatory histone variant H2a.Z expression was correlated to the extent of IFN-γ induction upon Mtb-infection. Our findings may explain why HIV patients exhibit prolonged immune cell dysfunction despite suppressive ART, and implicate a per cell defect of CD4+ T cells.

Graphical abstract

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Mediterranean pottery at the castle of Middelburg-in-Flanders

http://ift.tt/2rkbjJy

Indications for Opioid Antagonists

Abstract

Purpose of Review

As opioids have become more common in clinical practice for the treatment of both acute and chronic pain, so too has the need for a deeper understanding of the clinical applications of opioid antagonists. The purpose of this review is to present both the longstanding and potential new indications for the use of drugs that block the effects of opioid receptors.

Recent Findings

There is a growing body of data demonstrating the modulation of pain by opioid antagonists. Additional clinical studies that show their direct antinociceptive effects and/or enhancement of the analgesic potency of opioid agonists are warranted.

Summary

We briefly discuss the well-established role that these agents play in the reversal of life-threatening opioid toxicity and explore both existing and expanding clinical applications, including their apparent paradox that they may themselves be associated with analgesia.

http://ift.tt/2rTqZR1

Ghrelin Protects the Thymic Epithelium From Conditioning-Regimen-Induced Damage and Promotes the Restoration of CD4+ T Cells in Mice After Bone Marrow Transplantation.

Background: The delay in immune reconstitution after hematopoietic stem cell transplantation (HSCT), especially a delay in central immune reconstitution, leads to opportunistic infections and disease relapse after transplantation and affects the long-term outcome of HSCT. This delay is mainly attributable to thymic damage after myeloablative chemotherapy and radiotherapy Methods: We established a model of allogeneic bone marrow transplantation (BMT) in mice and administered ghrelin (GRL) 7 days before the conditioning regimen or the day after BMT. Results: All the GRL-treated mice, especially those administered GRL prior to the conditioning regimen, exhibited more intact thymic architecture and a more rapid restoration of CD4+ T lymphocytes after BMT than those of the corresponding control mice. Moreover, the levels of T cell receptor excision circles (TRECs) were significantly higher in the mice treated with GRL prior to the conditioning regimen than in the control mice at 28 days after BMT. Conclusions: Our findings suggest that GRL may be a novel potential therapeutic approach to protecting the thymic epithelium from conditioning-regimen-induced damage and promoting rapid and durable thymic and peripheral CD4+ T cell recovery after HSCT. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2qZjiZH

Expectations and experiences of follow up and self-care after living kidney donation: a focus group study.

Background: Ensuring donor wellbeing warrants ongoing monitoring following living kidney donation. However, there is considerable variability in donor follow up processes, including information provided to donors regarding self-care. Loss to follow up is common, suggesting that the aims and benefits of monitoring and follow up may not be apparent. We aimed to describe the experiences and expectations of living kidney donors regarding follow up and self-care after donation. Methods: Participants from 3 transplant centers in Australia and Canada participated in 14 focus groups (n=123). Transcripts were analyzed thematically. Results: We identified 4 four themes: lacking identification as a patient (invincibility and confidence in health, immediate return to normality, avoid burdening specialty services, redundancy of specialist attention, unnecessary travel); empowerment for health (self-preservation for devastating consequences, self-advocacy and education, needing lifestyle advice, tracking own results); safety net and reassurance (availability of psychosocial support, confidence in kidney-focused care, continuity and rapport, and access to waitlist priority); and neglect and inattention (unrecognized ongoing debilitations, primary focus on recipient, hospital abandonment, overlooking individual priorities, disconnected from system, coping with dual roles, and lacking support for financial consequences). Conclusions: Living kidney donors who felt well and confident about their health regarded specialist follow up as largely unnecessary. However, some felt they did not receive adequate medical attention, were prematurely detached from the health system, or held unresolved anxieties about the consequences of their decision to donate. Ongoing access to healthcare, psychosocial support, and education may reassure donors that any risks to their health are minimized. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2qeUPCg

Centenarian Livers: Very Long-Term Outcomes of Very Old Grafts.

No abstract available

http://ift.tt/2qZjfgt

Recht op expressievrijheid en wobben door journalisten, ngo’s en bloggers,

http://ift.tt/2qexi4h

Catalase (CAT) promoter and 5′-UTR genetic variants lead to its altered expression and activity in vitiligo

Summary

Background

Oxidative stress is considered to be the initial event during the course of vitiligo. Catalase is mainly involved in the defense against oxidizing agents in the cell through detoxifying H₂O₂.

Objectives

Aims of the present study were 1) to assess the erythrocyte catalase activity and LPO levels, as well as CAT mRNA expression in skin and blood; 2) to investigate CAT promoter rs7943316, rs1001179; 5′-UTR rs1049982 and exon (rs17886350, rs11032709, rs17880442, rs35677492) polymorphisms and; 3) to perform genotype-phenotype/ haplotype correlation analyses, in vitiligo patients and controls from Gujarat.

Methods

Catalase activity and lipid peroxidation levels were measured spectrophotometrically. CAT mRNA levels were estimated using Real-time PCR by SYBR-Green method. SNP genotyping was performed using PCR-RFLP/ ARMS-PCR methods.

Results

Vitiligo patients showed significantly decreased CAT mRNA-expression in lesional, non-lesional skin and in blood with reduced catalase activity compared to that of controls. CAT -89A/T and -20T/C polymorphisms were significantly associated with patients, especially with active and generalized vitiligo whereas, no association was observed for -262G/A and exon polymorphisms. 'A_-262T_-89C_-20′ haplotype with variant alleles was found to be associated with 6.4-fold risk of vitiligo. Genotype/ haplotype-phenotype correlation analyses revealed that individuals with susceptible genotypes/ haplotype for CAT -89 A/T and -20 T/C polymorphisms showed significantly decreased catalase mRNA/activity, and only -89 A/T polymorphisms showed significantly increased lipid peroxidation levels, as compared to wild type genotypes/ haplotype.

Conclusions

In conclusion, the present study proposes the crucial role of catalase and its allelic variants in oxidative stress mediated pathogenesis of vitiligo.

http://ift.tt/2qmw7v4

Integrative analyses reveal biological pathways and key genes in psoriasis

Abstract

Background

Psoriasis is a complex disease that is influenced by both genetic and environmental factors with abnormal gene expression in lesional skin. However, no studies are available on genome-scale gene expression of psoriatic lesions in the Chinese population. In addition, systematic studies on the biological pathways, pathogenicity and interaction networks of psoriasis-related genes with abnormal expression profiles require further investigation.

Objectives

To further explore the associated pathways in psoriasis by functional analysis and to identify the key genes by gene pathogenicity analysis.

Methods

We performed RNA sequencing on 60 skin biopsy samples from psoriasis patients and healthy controls to identify the primary differentially expressed genes in psoriatic lesional skin. We retrieved all reported psoriasis-associated genes and performed integrative analyses covering gene expression profiling, pathway analysis, gene pathogenicities and protein-protein interaction networks.

Results

We found that internal and external stimuli may activate immuno-inflammatory responses to promote the development of psoriasis. Pathways associated with infectious diseases and cancers were identified by functional and pathway analyses. The gene pathogenicity analysis revealed five key genes in psoriasis, including PPARD, GATA3, TIMP3, WNT5A and PTTG1.

Conclusions

Our analyses showed that genes contributed to the pathogenesis of psoriasis by activating risk pathways with components abnormality in expression. We identified five potentially pathogenic genes for psoriasis that may serve as important biomarkers for the diagnosis and treatment.

http://ift.tt/2qSdwdJ

Less-Conventional Low-Consumption Galvanic Separated MOSFET-IGBT Gate Drive Supply

A simple half-bridge, galvanic separated power supply which can be short circuit proof is proposed for gate driver local supplies. The supply is made while hacking a common mode type filter as a transformer, as the transformer shows a good insulation, it has a very low parasitic capacitance between primary and secondary coils, and it is cost-effective. Very low standby losses were observed during lab experiments. This makes it compatible with energy efficient drives and solar inverters.

http://ift.tt/2rT1vDj

Coloring outside the lines of the nation. An iconological analysis of the Tunisian Revolution

http://ift.tt/2rk57kT

Perceptions and Practices Regarding Atopic Dermatitis: A Survey

Abstract

Parents (N = 392) completed a survey at the Minnesota State Fair in August and September 2015 addressing knowledge regarding the pathogenesis of atopic dermatitis (AD), basic skin care practices, and the perceived role of infection and food allergies in AD. Of participating parents, 82% identified food allergy or sensitivity in AD pathogenesis, whereas only 42% identified bacterial infection as an important factor in AD severity. Participants most often received education on skin health from their pediatrician (49%), followed by Internet-based sources (23%), rather than a dermatologist or pediatric dermatologist. Parents of children with AD overestimate the role of food allergies in this condition and are not as aware of the role of bacterial infection. Future educational directions from our specialty should focus on resources for pediatricians and families that emphasize these factors.

http://ift.tt/2qmEPtd

Molluscum Contagiosum of the Gluteal Cleft: Observations and Implications for Management in Five Children

Abstract

Molluscum contagiosum (MC) is a common, self-limited skin infection caused by a double-stranded DNA virus of the family Poxviridae. Although the morphology of the disease is well described, MC presenting at unusual sites can exhibit atypical morphology, resulting in misdiagnosis. This observational, retrospective case series discusses the novel morphology of MC presenting in the intergluteal cleft of five children seen in the outpatient dermatology clinic of an academic medical center. We present this case series to highlight this novel presentation of MC in children and to emphasize a conservative approach to management given the sensitive location and the self-limited nature of the infection.

http://ift.tt/2qRYPaI

Epidemiology and Predisposing Factors for Erythema Toxicum Neonatorum and Transient Neonatal Pustular: A Multicenter Study

Abstract

Background/Objectives

Erythema toxicum neonatorum (ETN) and transient neonatal pustular melanosis (TNPM) are benign pustular skin conditions that are relatively common in newborns, but the predisposing factors for these conditions are unknown. Our goal was to verify the prevalence of ETN and TNPM and their predisposing factors in a large sample of neonates.

Methods

In this prospective 1-year multicenter study, 2,831 neonates (age ≤72 hours) born in southern Brazil were randomized to undergo skin examination by a dermatologist.

Results

Most were Caucasian (of European descent). There were 602 cases of ETN (21.3% prevalence) and 97 cases of TNPM (3.4% prevalence). ETN was more prevalent in Caucasian neonates, male neonates, those with 1-minute Apgar scores from 8 to 10, those who had no gestational risk factors, and those not admitted to a neonatal intensive care unit (NICU). Positive correlations were observed between ETN and gestational age and birthweight. ETN was least frequent in the winter. No NICU admission or birth during the spring was associated with TNPM.

Conclusions

At least in the region where this study was conducted, seasonality affects these benign pustular skin conditions. The health of the child at birth, gestational age, and birthweight influenced the development of ETN. This finding may indicate a role of immune system maturity in ETN, but additional studies are needed to confirm this.

http://ift.tt/2rjSFl8

Comparison of Two Formulations of Topical Timolol for the Treatment of Infantile Hemangiomas

Abstract

This report compares the efficacy of timolol maleate 0.5% eyedrops (TM) with that of timolol maleate 0.5% ophthalmic gel-forming solution in the treatment of infantile hemangiomas (IHs). Sixty-six patients undergoing treatment with topical timolol were retrospectively reviewed; our results revealed similar therapeutic efficacies for both types of timolol formulations. Early treatment initiation (<3 mos) and superficial lesions correlated with better treatment response. TM eyedrops may be a more cost effective, equally efficacious modality of treatment for IHs.

http://ift.tt/2qZ990Z

Cutaneous Granular Cell Tumors in Children: Case Series and Review of the Literature

Abstract

Granular cell tumors (GCTs) are uncommon benign neoplasms thought to originate from Schwann cells. They most commonly present in adults as papules or nodules on mucosal sites. The clinical spectrum of GCT in children is not well delineated, although mucosal and cutaneous presentations have been reported. We present three children with cutaneous GCTs and review the literature in an attempt to further characterize this rare pediatric neoplasm.

http://ift.tt/2rSOYQh

Fever and Multiple Eschars After an African Safari: Report of Three Cases

Abstract

African tick-bite fever (ATBF), a tickborne disease endemic in rural areas of sub-Saharan Africa and the West Indies caused by Rickettsia africae, has been recognized as an emerging health problem in recent years. ATBF has been reported as the second most commonly documented etiology of fever, after malaria, in travelers who return ill from sub-Saharan Africa. Most cases reported in the literature occurred in middle-aged adults, so the incidence of ATBF in children is unclear. We report a cluster of three cases of ATBF that occurred in children ages 7 to 16 years after returning from a game-hunting safari in South Africa.

http://ift.tt/2rC7xuK

An Atopic Dermatitis Management Algorithm for Primary Care Providers and Assessment of Its Usefulness as a Clinical Tool

Abstract

Background/Objectives

There is a lack of primary care provider (PCP) understanding of atopic dermatitis (AD) treatments and topical steroid use. We designed an AD management algorithm for pediatric PCPs. We hypothesized that the algorithm would improve pediatric PCPs' knowledge of AD diagnosis and management.

Methods

Pediatric primary care resident and attending physicians at three residency programs were invited to participate in an electronic AD algorithm survey that contained demographic and 19 knowledge-based questions. Participants were randomized to intervention and control groups, with the intervention group receiving a short lecture and copy of our algorithm to use in an inpatient or outpatient setting for 2 months. Changes in scores between preintervention and postintervention surveys were compared.

Results

Of the 54 participants, those in the intervention group (n = 26) performed significantly better than those in the control group (n = 28) after controlling for pretest scores (β = 1.19 [95% confidence interval 0.07, 2.32], p = 0.04). The intervention group had a higher average score on the posttest knowledge questions (71% correct) than the control group (65% correct) (p = 0.06). The majority of physicians who received the algorithm agreed or strongly agreed that they liked using the algorithm.

Conclusion

The use of a management algorithm improved physician knowledge about the diagnosis and treatment of AD and was well accepted by physicians. Use of this management algorithm may lead to better recognition and management of AD, particularly earlier recognition of and therapy for superinfection, improving treatment outcomes and quality of life for patients and families.

http://ift.tt/2qiR2Qw

CpG oligodeoxynucleotides enhance airway epithelial barrier integrity

Publication date: Available online 24 May 2017
Source:Allergology International
Author(s): Yasuhiro Gon, Sotaro Shikano, Shuichiro Maruoka, Kenji Mizumura, Yutaka Kozu, Kazumichi Kuroda, Eriko Tsuboi, Ikuko Takeshita, Hiroyuki Kishi, Yasuyuki Nomura, Takeshi Oshima, Shu Hashimoto

http://ift.tt/2rka4tL

A case of paediatric rectal prolapse without spontaneous reduction on arrival

Description

Most cases of rectal prolapse in children are naturally reduced; thus, cases without spontaneous reduction are extremely uncommon.1 We report a girl (aged 2 years 8 months) with paediatric rectal prolapse without spontaneous reduction on arrival at the emergency department.

Although the patient had not been diagnosed with any specific disease, she had a history of hard stools and difficulty defecating. Four days before arriving at the hospital, she began toilet training to stop using diapers. She came to the hospital at night with her parents who described 'gut escaping from her anus'. On examination, she showed prolapse of the entire circumference of the rectum from the anus with mucosal bleeding (figure 1). Manipulative reduction was performed and she returned home, but the escape recurred several times. Considering her age and underlying constipation, we started outpatient management of constipation before referral to paediatric surgeon....

http://ift.tt/2qRO8F0

A case of confusion: paraneoplastic encephalomyelitis in an elderly patient suspected of having urinary tract infection-associated delirium

Acute confusion is a common symptom of physical illness in the older patient. In the majority, it is transient and resolves on treatment of precipitants. In a subset of patients, however, neurological decline is progressive, raising concern about a serious underlying cause. We describe the case of a 71-year-old woman who developed progressive cognitive impairment following insertion of a permanent pacemaker for sinoatrial arrests. An initial diagnosis of delirium secondary to a urinary tract infection was suspected; however, the patient became increasingly confused despite treatment. Laboratory tests revealed serum anti-Hu paraneoplastic antibodies, and CT chest identified an occult lung tumour. Cervical lymph node histopathology confirmed a diagnosis of small cell carcinoma of the lung. Although a rare cause of confusion, paraneoplastic encephalomyelitis should be recognised early to allow timely identification and treatment of the associated cancer.

http://ift.tt/2qmjWOY

Multiplex PCR-based detection of Mycobacterium tuberculosis and Mycobacterium avium in a single host: One coloniser or dual infection?

Description

A 65-year-old male, chronic smoker with chronic obstructive pulmonary disease on steroids, presented to the emergency services with decreased urine output and altered sensorium for a day. However, soon after admission, the patient sustained cardiorespiratory arrest and died. On autopsy, the lungs were heavy and consolidated with randomly distributed miliary nodules of 0.2–0.5 cm on the pleural and the cut surface of the lung parenchyma (figure 1). Perihilar, paratracheal and subcarinal lymph nodes were enlarged with caseous necrosis. Microscopically, these were composed of aggregates of macrophages along with neutrophilic infiltrates and nuclear debris (figure 2). No well-formed epithelioid cell granulomas were seen. Ziehl Neelsen stain showed numerous intracellular aggregates of acid-fast bacilli in the macrophages (figure 3). Based on histopathological features of macrophage-rich infiltrate with intracellular AFB, atypical mycobacterial infection was suspected. Multiplex PCR was performed by using IS6110 primers specific for...

http://ift.tt/2qRIjap

Therapeutic effect of anti-IL-5 on eosinophilic myocarditis with large pericardial effusion

Eosinophilic myocarditis (EM) is a rare myocardial disease that results from various eosinophilic diseases, such as idiopathic hypereosinophilic syndrome, helminth infection, medications and vasculitis. Patients with EM may present with different severities, ranging from mild symptoms to a life-threatening condition. Diagnosis of EM is a challenge and requires an extensive workup, including endomyocardial biopsy. Treatment options are limited because EM is rare and there is a lack of randomised controlled trials. We report a case of EM that presented as cardiac tamponade, which was initially treated with high-dose prednisone and immunosuppressant medications without significant improvement. Mepolizumab (anti-interleukin (IL)-5 antibody) was then applied, leading to an increased ejection fraction and stabilised cardiac function. This case report shows, for the first time, that mepolizumab has novel effects in treating EM. Our findings suggest that mepolizumab can be used as a steroid-sparing agent for treating EM.

http://ift.tt/2qmmbS4

Extraocular retinoblastoma: a neglected case

Description

A 13-month-old female child was brought to our tertiary eye hospital with a history of a rapidly enlarging mass in the right eye for 4 months. Her medical history was suggestive of leukocoria in the right eye, noted 6 months ago, for which medical attention was sought elsewhere. At that time, a diagnosis of group E retinoblastoma in the right eye was made. The left eye was normal. The caretakers were explained about the advanced nature of the disease in the right eye and the need for enucleation surgery. The parents denied surgery despite counselling and opted for neoadjuvant chemotherapy and regular follow-up. However, they did not comply with the treatment and the child presented to our hospital 5 months later with a huge mass involving the right eye and a deteriorating systemic condition. Local examination showed a large extraocular mass measuring approximately 14x16 cm along its greatest dimensions, with superficial...

http://ift.tt/2qRT2C1

Persistent fetal lobulation of kidney mimicking renal tumour

Renal pseudotumour is a term coined to describe conditions of renal anatomic variants that simulate focal renal pathology like a tumour on ultrasonography. These include persistent fetal lobulation, hypertrophy of Bertin columns and dromedary humps. We report a case of a 30-year-old nulliparous woman who was managed in gynaecology clinic for menorrhagia and was subsequently referred to us for management of recurrent urinary tract infections. The clinical examination was normal and on ultrasound scan, she was found to have multiple enlarged heterogeneous solid masses in both kidneys with significantly increased vascularity, suspicious for neoplastic lesions. She subsequently underwent a CT urogram and her case was discussed in uro-radiology meeting where a diagnosis of persistent fetal lobulation was made excluding other diagnoses. She was managed conservatively. We also present grey scale and Doppler ultrasound and CT urogram findings of this condition along with the literature review.

http://ift.tt/2qmL4wW

Cervicofacial and mediastinal emphysema complicating tooth extraction in an elderly patient: a preventable complication

Subcutaneous emphysema is widely documented in the literature and well known by doctors and dentists. However, subcutaneous emphysema following tooth extraction is not very common.

We report the case of a 72-year-old female who presented to the emergency department of the Bunbury Hospital in Bunbury in the state of Western Australia in Australia, with subcutaneous emphysema of the face and neck with extension into the mediastinum, following a complicated tooth extraction in 2016. It was a dramatic and scary occurrence for both the patient and dentist, but totally preventable. The investigations and treatment could have been very invasive. However, with limited and essential management, the process was kept simple and safe for the patient.

http://ift.tt/2qRV4Ss

Human skin gene expression doesn't correlate with protein expression? Unless both parameters are quantified

Summary

Many cosmetic companies utilize in vitro gene array studies to display significant stimulation or inhibition of various human skin biomarkers to validate in vivo actions that are reported to enhance dermal health. This follows the central dogma of DNA-to-RNA results in protein expression; however, gene and protein expressions do not usually correlate. Unless both gene and protein expressions are quantified which require further investigational time and investment. Where data are available, this short commentary displays the in vitro comparison of four human skin biomarkers for the gene and protein expressions of the stimulation of collagen type I and elastin and the inhibition of matrix metalloproteinases 1 and 3, when equol was tested. The results demonstrate a good correspondence between gene and protein expressions for the human skin biomarkers tested.

http://ift.tt/2qROziq

The Evolution of Firm Growth Dynamics in the US Pharmaceutical Industry

Demirel, P; Mazzucato, M; (2010) The Evolution of Firm Growth Dynamics in the US Pharmaceutical Industry. Regional Studies , 44 (8) pp. 1053-1066. 10.1080/00343400903241469 .

http://ift.tt/2qeswnp

Sintering-Induced Phase Transformation of Nanoparticles: A Molecular Dynamics Study

Mao, Q; Ren, Y; Luo, KH; Li, S; (2015) Sintering-Induced Phase Transformation of Nanoparticles: A Molecular Dynamics Study. Journal of Physical Chemistry C , 119 (51) pp. 28631-28639. 10.1021/acs.jpcc.5b08625 .

http://ift.tt/2qYIu2n

Sample attrition in the RLMS: 2001–101 Lessons for longitudinal analysis and an application in health

Gerry, CJ; Papadopoulos, G; (2015) Sample attrition in the RLMS: 2001–101 Lessons for longitudinal analysis and an application in health. Economics of Transition , 23 (2) pp. 425-468. 10.1111/ecot.12063 .

http://ift.tt/2qexxg0

Continuous uniform finite time stabilization of planar controllable systems

Oza, HB; Orlov, YV; Spurgeon, SK; (2015) Continuous uniform finite time stabilization of planar controllable systems. SIAM Journal on Control and Optimization , 53 (3) pp. 1154-1181. 10.1137/120877155 . Green open access

http://ift.tt/2qYQ39c

Simultaneous fNIRS and thermal infrared imaging during cognitive task reveal autonomic correlates of prefrontal cortex activity

Pinti, P; Cardone, D; Merla, A; (2015) Simultaneous fNIRS and thermal infrared imaging during cognitive task reveal autonomic correlates of prefrontal cortex activity. Scientific Reports , 5 , Article 17471. 10.1038/srep17471 . Green open access

http://ift.tt/2qelDma

Virus-specific T lymphocytes home to the skin during natural dengue infection

Rivino, L; Kumaran, EA; Thein, T-L; Too, CT; Hao Gan, VC; Hanson, BJ; Wilder-Smith, A; Rivino, L; Kumaran, EA; Thein, T-L; Too, CT; Hao Gan, VC; Hanson, BJ; Wilder-Smith, A; Bertoletti, A; J. Gascoigne, NR; Lye, DC; Leo, YS; Akbar, AN; Kemeny, DM; MacAry, PA; - view fewer (2015) Virus-specific T lymphocytes home to the skin during natural dengue infection. Science Translational Medicine , 7 (278) , Article 278ra35. 10.1126/scitranslmed.aaa0526 .

http://ift.tt/2qZhJuI

Molecular diagnostics and lack of clinical allergy in helminth-endemic areas in Indonesia

Publication date: Available online 24 May 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Firdaus Hamid, Serge A. Versteeg, Aprilianto E. Wiria, Linda J. Wammes, Sitti Wahyuni, Taniawati Supali, Erliyani Sartono, Ronald van Ree, Maria Yazdanbakhsh
Allergen microarray characterization of sensitization to common allergen sources in a helminth-endemic area of Indonesia shows that helminth induced cross-reactivity to cross-reactive carbohydrate determinants (CCD), and not primary sensitization to their major allergens, is the dominant feature.

http://ift.tt/2qZ5w99

Excessive gestational weight gain in first trimester is a risk factor for exacerbation of asthma during pregnancy: A prospective study of 1283 pregnancies

Publication date: Available online 24 May 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Zarqa Ali, Lisbeth Nilas, Charlotte Suppli Ulrik
BackgroundAcute exacerbation during pregnancy is the most important risk factor for an unfavorable outcome of pregnancy in women with asthma.ObjectiveWe sought to identify pregnancy-related risk factors for acute exacerbations of asthma during pregnancy.MethodsSince 2007, all pregnant women referred to give birth at Hvidovre Hospital, Denmark, have been offered participation in the prospective Management of Asthma during Pregnancy (MAP) program. Women were included in the present analysis if they fulfilled the following criteria: (1) diagnosed with asthma, (2) prescribed at least rescue bronchodilator, and (3) had the first visit to the respiratory outpatient clinic within the first 18 weeks of pregnancy. Data were analyzed using multiple logistic regression models with backward stepwise elimination (Proc Logistic procedure in SAS).ResultsOver an 8-year study period, a total of 1283 pregnancies in 1208 women fulfilled the criteria for inclusion in the MAP cohort. Women with asthma exacerbation(s) had larger gestational weight gain (GWG) in the first trimester of pregnancy (P < .001) and increased total GWG (P < .001) compared with women without exacerbation. More than 5 kg first-trimester weight gain was associated with an increased risk of asthma exacerbation (odds ratio, 9.35; 95% CI, 6.39-13.68; P < .001), and the risk increased in a dose-dependent manner with additional weight gain in excess of 5 kg.ConclusionsExcessive GWG in the first trimester is a risk factor for asthma exacerbation during pregnancy and the risk increases in a dose-dependent manner with increasing GWG.

Graphical abstract

http://ift.tt/2qes5th

Safety and outcomes of aspirin desensitization for aspirin-exacerbated respiratory disease: a single center study

Publication date: Available online 25 May 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Jeremy Waldram, Kristen Walters, Ronald Simon, Katherine Woessner, Jill Waalen, Andrew White
BackgroundAspirin desensitization is an effective treatment option for aspirin-exacerbated respiratory disease (AERD). Aspirin desensitization protocol modifications have improved the safety and efficiency of this procedure, yet some providers remain reluctant to perform it.ObjectiveThe primary objective of this study was to evaluate the safety and outcomes of outpatient aspirin desensitization procedures. A secondary objective was to assess for clinical characteristics that might predict reaction severity during aspirin desensitization.MethodsTwo hundred seventy-five patients underwent aspirin desensitization at Scripps Clinic between January 2009 and August 2015. Baseline patient characteristics and reaction results were analyzed in the 167 patients who reacted during desensitization.ResultsAll of the 167 reactors, including 23 who were classified as severe reactors, were successfully desensitized in the outpatient setting. The average desensitization duration among reactors was 1.67 days, and the average duration for GI reactors was 2.29 days. Mean baseline SNOT-22 score was higher in severe reactors compared to non-severe reactors (p=.05). Overall, patients on omalizumab had a similar reaction profile to those not on omalizumab.ConclusionsMost patients undergoing aspirin desensitization will develop symptoms. It remains difficult to predict the severity of these symptoms. However, desensitization can be done safely and efficiently in an appropriately equipped outpatient setting. This treatment option should be made available to all patients with AERD. The SNOT-22 score may be able to predict more severe reactions and merits further study. Eight of the 9 patients on omalizumab reacted during desensitization, suggesting that it does not block reactions during aspirin desensitization.Clinical implicationsAspirin desensitization is a relatively safe procedure that may be performed in a properly equipped outpatient setting and it is a treatment option that should be made available to all patients with AERD.

http://ift.tt/2qYMfEY

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Πέμπτη 25 Μαΐου 2017

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