Rare cause of colonic intussusception in an adult

Colonic intussusception is an uncommon phenomenon in adults. Advanced imaging has facilitated the increase in awareness of this rare disease. When present, the lead point is most often secondary to a malignancy with primary adenocarcinoma being the most frequent cause. Current surgical management involves oncologic resections for this reason. This is a report of the third ever-reported case of colonic intussusception secondary to an angiolipoma and the first in the western hemisphere. We also demonstrate that these masses are amenable to minimally invasive resection for definitive management.

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Successful twice interrupted therapy of HCV infection in patients with cirrhosis with hepatocellular carcinoma before and after liver transplantation

We are presenting the case study of the patient diagnosed at the age of 37 with liver cirrhosis due to genotype 1b hepatitis C virus infection. At the age of 46, he was diagnosed with hepatocellular carcinoma with subsequent resection of the tumour in May 2015. In December 2015, the treatment was started with ombitasvir, paritaprevir/ritonavir and dasabuvir (3D) with ribavirin (RBV) 1000 mg per day. After 24 days of this treatment, the patient received a deceased donor liver transplantation, followed by 18-day interruption of 3D therapy. Due to the anaemia, RBV dose was reduced to 600 mg per day for the rest of the treatment. At the 11th week of 3D+RBV treatment, there was another 8-day long discontinuation of therapy due to the postoperative wound infection. In total, the patient received 24 weeks of 3D+RBV treatment, achieving sustained virological response at week 24 post-treatment.

http://ift.tt/2xGuEI1

Combined caesarean with splenectomy in pregnancy with portal hypertension: defining plausibility

24-year-old woman at 28 weeks gestation was referred from peripheral hospital with diagnosis of pregnancy with portal hypertension. She had received multiple transfusion for pancytopaenia in the past and had undergone endoscopic sclerotherapy for oesophageal varices. Initially, she was admitted in our hospital at 28 weeks gestation for blood transfusion and was evaluated by multispecialty team of doctors. She was advised splenectomy for transfusion-dependent pancytopaenia secondary to hypersplenism in non-cirrhotic portal hypertension. She was readmitted at 36 weeks gestation. A decision for caesarean was taken owing to failed induction of labour at 38 weeks gestation. She underwent combined caesarean with splenectomy. Mother and child had an uneventful postoperative recovery and were discharged on ninth postoperative day. Preconceptional counselling, treatment of oesophageal varices and multispecialty approach was paramount in the management. Combined caesarean with splenectomy is feasible and cost-effective treatment associated with improved quality of life. Prospective clinical trials are essential to prove safety and efficacy of treatment.

http://ift.tt/2jw2E3w

Renal cell carcinoma with isolated metastasis to sigmoid mesentery: a rare resectable combination

Renal cell carcinoma accounts for 2%–3% of all malignancies in adults. It spreads via direct extension, lymphatic route as well as haematogenous route. Lymph nodes, lungs, bone, liver and brain are the usual sites for its metastatic spread. In the presence of limited metastatic disease with potentially resectable metastases, surgery offers the best chances of cure. In the present case, we describe a case of renal cell carcinoma with a solitary metastasis to the sigmoid mesentery in a patient with Von Hippel-Lindau syndrome. There was no retroperitoneal lymphadenopathy or tumour thrombus in the renal vein. The patient was managed with laparoscopic radical nephrectomy and excision of the sigmoid mesentery mass. At 6 months of follow-up, there is no evidence of recurrent disease.

http://ift.tt/2xGiwXC

Rare case of primary leiomyosarcoma of sigmoid mesocolon

We experienced a rare case of primary leiomyosarcoma of sigmoid mesentery. A 45-year-old woman was presented to us with left iliac fossa mass and discomfort for 4-month duration. CT scan of abdomen and pelvis revealed a huge mass 14 cmx14 cmx16 cm occupying left iliac fossa mimicked having a large left ovarian carcinoma. She was subsequently planned for elective total abdominal hysterectomy and bilateral salpingo-oophorectomy by gynaecology team. During laparotomy, a huge mass was revealed arising from sigmoid mesentery invaded to the left lower ureter. Curative resection was done and pathological findings show the tumour being leiomyosarcoma with immunohistochemistry tests on caldesmon, desmin, smooth muscle actin and CD34 reagent all positive. Clinicopathological and literature review of this rare primary leiomyosarcoma of mesocolon was discussed in our case presentation

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18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography May Exclude Malignancy in Sonographically Suspicious and Scintigraphically Hypofunctional Thyroid Nodules and Reduce Unnecessary Thyroid Surgeries

Thyroid , Vol. 0, No. 0.


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Long-Term Antithyroid Drug Treatment: A Systematic Review and Meta-Analysis

Thyroid , Vol. 0, No. 0.


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Comparison of Core-Needle Biopsy and Fine-Needle Aspiration for Evaluating Thyroid Incidentalomas Detected by 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography: A Propensity Score Analysis

Thyroid , Vol. 0, No. 0.


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An undergraduate Otolaryngology curriculum comparison in the United Kingdom using a curriculum evaluation framework

http://ift.tt/2xGiRcJ

Bile acids: a potential role in the pathogenesis of pharyngeal malignancy

http://ift.tt/2jwHsdL

Assessment of carotid artery intima‐media thickness in patients with obstructive sleep apnoea

http://ift.tt/2xGDnde

Single‐sided deafness affects language and auditory development – a case–control study

http://ift.tt/2jvYqJh

Local extension staging of sinonasal tumours: retrospective comparison between CT/MRI assessment and pathological findings

http://ift.tt/2xFnLXl

Adaptation and validation of the Singing Voice Handicap Index into Polish

http://ift.tt/2jxUXK3

An evaluation of the quality of evidence available to inform current bone conducting hearing device national policy

http://ift.tt/2xEPckl

Effect on mortality of elective parathyroid surgery in one hundred and three patients with chronic kidney disease: our experience

http://ift.tt/2jxqA6P

The value of direct audiology access for magnetic resonance imaging: an audit of 40 cases

http://ift.tt/2xGea2r

Dura and sinus compression with a transcutaneous bone conduction device – hearing outcomes and safety in 38 patients

http://ift.tt/2jxJr1z

Congenital anosmia: our experience of eleven patients with aplasia or hypoplasia of the olfactory tract

http://ift.tt/2xG546b

UK tertiary centre experience of outcomes from osseointegrated transcutaneous magnetic bone conduction hearing system implanted in twenty‐five patients using a linear incision technique

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Short‐term results from seventy‐six patients receiving a bone‐anchored hearing implant installed with a novel minimally invasive surgery technique

http://ift.tt/2xETOql

Squamous cell carcinoma associated with inverted papilloma of the maxillary sinus: our experience with 21 patients

http://ift.tt/2jwDnq8

Functional magnetic resonance imaging in seven borderline cochlear implant candidates: a preliminary research study

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Balloon tuboplasty in patients with Eustachian tube dysfunction: a prospective study in 39 patients (55 ears)

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A retrospective analysis of seven patients with acquired immunodeficiency syndrome and pharyngeal and/or laryngeal Talaromyces marneffei infection

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Workload and costs of audiological assessment on tertiary settings: Data analysis and audit

http://ift.tt/2xGf7bl

The role of sentinel lymph node biopsy in the management of laryngeal carcinoma

http://ift.tt/2jy6A41

Insulin effect on hearing recovery in idiopathic sudden sensorineural hearing loss: Retrospective study of 145 patients

http://ift.tt/2xFnK5J

For Irritating Itch, a Promising Option Under Scrutiny

Investigational serlopitant afforded clinical trial patients quick relief for a variety of pruritis-characterized diseases.
Medscape Medical News

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Testing Potential Uses for Light Therapy

Green and red light therapies explored to treat migraines and skin conditions.
WebMD Health News

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Erratum to: Allergen immunotherapy for allergic asthma: protocol for a systematic review

Unfortunately this article [1] was published with an error in the Funding section. The BM4SIT project is not acknowledged. This section should be corrected to the below:

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Erratum to: Allergen immunotherapy for allergic rhinoconjunctivitis: protocol for a systematic review

Unfortunately this article [1] was published with an error in the Funding section. The BM4SIT project is not acknowledged. This section should be corrected to the below:

http://ift.tt/2xF69uK

Erratum to: Allergen immunotherapy for IgE-mediated food allergy: protocol for a systematic review

Unfortunately this article [1] was published with an error in the Funding section. The BM4SIT project is not acknowledged. This section should be corrected to the below:

http://ift.tt/2jzeev1

Erratum to: Allergen immunotherapy for insect venom allergy: protocol for a systematic review

Unfortunately this article [1] was published with an error in the Funding section. The BM4SIT project is not acknowledged. This section should be corrected to the below:

http://ift.tt/2xFFvC7

Guselkumab (Tremfya) Gets CHMP Backing for Plaque Psoriasis

The drug selectively targets IL-23, a key driver of the immune inflammatory response in patients with psoriasis.
International Approvals

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Does the Mole Always Come Before the Melanoma?

Dr Arefa Cassoobhoy highlights one of the week's important news stories for primary care.
Medscape Internal Medicine

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Topical Antibiotics: Yes or No for Surgical-Site Infections?

Dr Lowenfels reviews the conflicting evidence on whether topical antibiotics should be used to prevent wound infections.
Medscape General Surgery

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Pseudo-anévrisme de l’artère temporale superficielle : deux cas

Publication date: Available online 14 September 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): D. Lebas, P. Modiano, T. Wiart
IntroductionLe pseudo-anévrisme de l'artère temporal superficielle est une cause de tuméfaction de la région temporale. Nous en rapportons deux observations.ObservationsCas 1 : un homme de 32 ans présentait une formation nodulaire de 2cm de la région temporale droite, légèrement pulsatile, apparue 9 mois après un traumatisme. Le diagnostic de pseudo-anévrisme de l'artère temporal superficielle était évoqué. Une exérèse était pratiquée après ligature de l'artère afférente et efférente. L'examen histopathologique confirmait le diagnostic clinique. Cas 2 : un homme de 24 ans présentait une tuméfaction sous-cutanée non pulsatile de la tempe gauche. Dans l'hypothèse d'un kyste épidermique, une prise en charge chirurgicale était proposée. L'aspect peropératoire évoquant une lésion d'origine artérielle. Une exérèse était pratiquée après ligature de l'artère afférente et efférente.ConclusionLe pseudo-anévrisme de l'artère temporale superficielle doit être évoqué devant toute formation sous-cutanée temporale, surtout en cas de notion de traumatisme. L'échographie Doppler confirmera le diagnostic évoqué cliniquement. La prise en charge chirurgicale est le traitement de référence.BackgroundPseudoaneurysm of the superficial temporal artery causes tumefaction in the temporal region. Herein, we report two cases.Patients and methodsCase 1 : a 32-year-old man presented with a slightly pulsatile nodular formation measuring 2 cm in the right temporal region that had appeared nine months after traumatic injury. A diagnosis of superficial temporal artery pseudoaneurysm was considered. Excision was performed with ligation of the afferent and efferent artery. The clinical diagnosis was confirmed by histopathology. Case 2 : a 24-year-old man presented with a nonpulsatile subcutaneous tumefaction on his left temple. Surgery was proposed based on a supposed epidermal cyst. However, the perioperative aspect suggested a lesion of arterial origin and excision was performed following ligation of the afferent and efferent artery.ConclusionPseudoaneurysm of the superficial temporal artery must be considered for all temporal cutaneous formations, particularly when there is a history of trauma. The clinical diagnosis may be confirmed by Doppler ultrasound. Surgery is the treatment of reference.



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Monitoring the response of urothelial precancerous lesions to Bacillus Calmette-Guerin at the proteome level in an in vivo rat model

Abstract

Intravesical Bacillus Calmette-Guerin (BCG) is the best treatment modality for progression of non-muscle invasive bladder cancer. We aimed to monitor changes at the proteome level to identify putative protein biomarkers associated with the response of urothelial precancerous lesions to intravesical BCG treatment. The rats were divided into three groups (n = 10/group): control, non-treated, and BCG-treated groups. The non-treated and BCG-treated groups received N-methyl-N-nitrosourea intravesically. BCG Tice-strain was instilled into bladder in BCG-treated group. At the endpoint of experiment, all surviving rat bladders were collected and equally divided into two portions vertically from dome to neck. Half of each bladder was assessed immunohistopathologically and the other half was used for 2D-based comparative proteomic analysis. Differentially expressed proteins were validated by Western blot analysis. Precancerous lesions of bladder cancer were more common in non-treated group (77.8%) than in BCG-treated group (50%) and the control group (0%). Greater than twofold changes occurred in the expression of a number of proteins. Among them, Rab-GDIβ, aldehyde dehydrogenase 2 (ALDH2) and 14-3-3 zeta/delta were important since they were previously reported to be associated with cancer and their expression levels were found to be lower in BCG-treated group in comparison to the non-treated group. ALDH2 and 14-3-3 zeta/delta were also found to be highly expressed in the non-treated group compared to the control group. The down-regulation of these proteins and Rab-GDIβ was achieved with BCG; this result indicates that they may be used as putative biomarkers for monitoring changes in bladder carcinogenesis in response to BCG immunotherapy.

http://ift.tt/2juGdvF

Mucocutaneous Inflammation in the Ikaros Family Zinc Finger 1 (IKZF1) - keratin 5 specifc transgenic mice

Abstract

Background

Our genome-wide association study documented an association between cold medicine related Stevens-Johnson syndrome / toxic epidermal necrolysis (CM-SJS/TEN) and Ikaros Family Zinc Finger 1 (IKZF1). Few studies examined biological and pathological functions of IKZF1 in mucosal immunity. We hypothesized that IKZF1 contributes to the mucocutaneous inflammation.

Methods

Human skin and conjunctival tissues were obtained for immunohistological studies. Primary human conjunctival epithelial cells (PHCjECs) and adult human epidermal keratinocytes (HEKa) also used for gene expression analysis. We also generated K5-Ikzf1-EGFP transgenic mice (Ikzf1 Tg) by introducing the Ik1 isoform into cells expressing keratin 5, which is expressed in epithelial tissues such as the epidermis and conjunctiva and then examined them histologically and investigated gene expression of the epidermis. Moreover, Ikzf1 Tg were induced allergic contact dermatitis.

Results

We found that human epidermis and conjunctival epithelium expressed IKZF1, and in PHCjECs and HEKa, the expression of IKZF1 mRNA was up-regulated by stimulation with polyI:C, a TLR3 ligand. In Ikzf1 Tg, we observed dermatitis and mucosal inflammation including the ocular surface. In contact dermatitis model, inflammatory infiltrates in the skin of Ikzf1 Tg were significantly increased compared with wild type. Microarray analysis showed that Lcn2, Adh7, Epgn, Ifi202b, Cdo1, Gpr37, Duoxa1, Tnfrsf4, and Enpp5 genes were significantly up-regulated in the epidermis of Ikzf1 Tg compared with wild-type.

Conclusion

Our findings support the hypothesis that Ikaros might participate in mucocutaneous inflammation.

This article is protected by copyright. All rights reserved.

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Hidradenitis Suppurativa is Associated with Myocardial Infarction, but Not Stroke or Peripheral Arterial Disease of Lower Extremities

Abstract

We performed a comparative cross-sectional study of the potential association of HS and the three outcome events: self-reported MI, self-reported stroke, and PAD measured by ankle-brachial index (ABI) ≤ 0.9. We included a self-reported HS group (n=430) identified in the general suburban population study (GESUS) using a validated questionnaire ²(Table 1).The control group comprised participants from GESUS without HS, n=20,780.

This article is protected by copyright. All rights reserved.

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Graublaue Flecken am Körper eines Säuglings

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Reply to “Clinical and pathologic factors associated with subclinical spread of invasive melanoma”: Statistical and methodological issues

To the Editor: We were interested to read the article authored by Shin et al that was published in the Journal of the American Academy of Dermatology in 2017.1 The authors purposed to determine clinical and histologic factors related to the subclinical spread of invasive melanoma.

http://ift.tt/2x4jvxz

Postinflammatory hyperpigmentation: A comprehensive overview

Postinflammatory hyperpigmentation (PIH) commonly occurs after various endogenous and exogenous stimuli, especially in dark-skinned individuals. PIH is one of the most common complications of procedures performed using laser and other light sources. The severity of PIH is determined by the inherent skin color, degree and depth of inflammation, degree of dermoepidermal junction disruption, inflammatory conditions, and the stability of melanocytes, leading to epidermal and dermal melanin pigment deposition.

http://ift.tt/2x5UtOK

JAAD Case Reports Article List

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Postinflammatory hyperpigmentation: A comprehensive overview

Postinflammatory hyperpigmentation (PIH) occurs after various dermatoses, exogenous stimuli, and dermatologic procedures. The clinical course of PIH is chronic and unpredictable, although the probability of resolution of epidermal hyperpigmentation is better than those of dermal hyperpigmentation. PIH can be prevented or alleviated. When it does occur, the underlying inflammatory conditions should be sought and treated as the first step to reduce the progression of inflammation and PIH (which is an inflammatory consequence).

http://ift.tt/2x4fBVt

Reply to: “Prognosis and management of Stevens-Johnson syndrome and toxic epidermal necrolysis”

To the Editor: We read the editorial by Schneider and Cohen with great interest.1 We appreciate the authors' affirmation that malignancy and renal failure are important predictors of mortality in pediatric Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS-TEN), as we previously demonstrated.2 The authors cited their recent publication highlighting the importance of supportive care.3 We could not agree more. It is of utmost importance that both children and adults with SJS-TEN receive multispecialty supportive care that includes dermatology, critical care, skilled nursing, nephrology, ophthalmology, wound care, nutrition support, respiratory therapy, pain management, infectious disease, hematology-oncology, and hepatology.

http://ift.tt/2wfiVQt

Use of Wood's lamp to diagnose progressive macular hypomelanosis

Progressive macular hypomelanosis (PMH) (Fig 1) is not uncommon, but it is frequently misdiagnosed as tinea versicolor or postinflammatory hypopigmentation, or else multiple biopsy samples are collected to rule out hypopigmented mycosis fungoides. Accurate diagnosis is very important, as treatment of this condition is readily available, is easy, and may have a huge impact on patient quality of life. What can be done to prevent this misdiagnosis?

http://ift.tt/2wfMHEF

The impact of skin hyperpigmentation and hyperchromia on quality of life: A cross-sectional study

To the Editor: An accumulating amount of literature illustrates that skin disease can profoundly and negatively impact quality of life (QoL).1 In this study, we sought to evaluate the impact of hyperpigmented and hyperchromic disorders on QoL.

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Answers to CME examination

http://ift.tt/2x4fmK3

Journal Based CME Instructions and Information

http://ift.tt/2wgezIV

“Two-step phototherapy” for treatment-resistant psoriasis on the lower extremities

Psoriasis on the distal lower extremities is notoriously treatment-resistant. Patients receiving phototherapy may achieve only partial response on the lower extremities even though the rest of the body has responded well.

http://ift.tt/2wfiEwV

Lack of efficacy of apremilast in 9 patients with severe alopecia areata

To the Editor: Alopecia areata (AA) is a T-cell–mediated autoimmune disease of nonscarring hair loss. A mouse model of AA suggests that interleukin-15 and interferon (IFN)-γ are mediators of AA.1 This model has led to the successful use of Janus kinase (JAK) inhibitors for the treatment of AA, likely via inhibition of both interleukin-15 activation of T cells and subsequent IFN-γ feedback on the hair follicle.1,2 The phosphodiesterase 4 inhibitor, apremilast, suppresses IFN-γ production.3 We hypothesized that apremilast would be a targeted treatment for AA.

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CME examination

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CME examination

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Assessment of adjuvant therapy in resected head and neck cancer with high-risk features

Publication date: November 2017
Source:Oral Oncology, Volume 74
Author(s): Gaurav S. Ajmani, Cheryl C. Nocon, Chi-Hsiung Wang, Mihir K. Bhayani
ObjectivesSubgroup analysis from two randomized trials showed a survival benefit for adjuvant chemoradiation (CRT) over radiation alone (RT) in patients with extracapsular spread (ECS) of involved lymph nodes and/or positive margins (PM) in resected head and neck cancer (HNSCC). However, results were not analyzed separately for patients with ECS or PM and were not stratified by tumor subsite/HPV status. We therefore sought to determine whether adjuvant CRT is associated with a survival benefit, separately among patients with ECS or PM and stratified by subsite/HPV status.MethodsUsing the National Cancer Database (NCDB), we identified 6948 patients diagnosed with HNSCC between 2010 and 13 who underwent surgical resection and had either ECS or PM. The impact of adjuvant therapy on OS from surgery was evaluated using Cox proportional hazards regression adjusting for clinical and demographic factors.ResultsAdjuvant CRT was associated with a significant survival benefit over RT alone among patients with ECS (aHR 0.83, 95%CI 0.71–0.97) but not among those with PM (aHR 0.89, 95%CI 0.77–1.04). In patients with HPV-negative tumors, CRT was associated with a benefit over RT alone in the setting of ECS (aHR 0.83, 95%CI 0.70–0.98) but not PM (aHR 0.91, 95%CI 0.78–1.06). However, in patients with HPV-positive oropharynx tumors, CRT was not associated with a benefit over RT in ECS (aHR 0.94, 95%CI 0.47–1.88) but appeared beneficial in PM (aHR 0.54, 95%CI 0.32–0.90).ConclusionsCRT appears beneficial over RT in ECS among patients with HPV-negative tumors, and beneficial in PM among patients with HPV-positive tumors.

Graphical abstract

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Recognizing and overcoming phototherapy-induced initiation burn

"Initiation burn" is a phenomenon in which the patient unexpectedly experiences burn very early in the course of phototherapy at a very low dose.1 This is especially common in patients with atopic dermatitis.2 Clinicians often conclude that the patient who suffers from initiation burn is not a candidate for phototherapy or has "failed" phototherapy, when in fact, the patient is able to tolerate ultraviolet (UV) light if dosimetry is adjusted and titrated skillfully.

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Medication nonadherence in dermatology: Divergent ethical implications for patient care

This case shows the dermatologist's ethical challenge in managing a patient who is not adherent to therapy. The patient in this scenario demonstrates primary nonadherence when he fails to refill the methotrexate prescription. He also exhibits secondary nonadherence by not using the topical corticosteroids and methotrexate as prescribed.

http://ift.tt/2foFiIR

Recalcitrant chronic leg ulcer: An indication for patch testing for hydrocolloid dressing

Chronic leg ulcers are commonly encountered in dermatologists' daily practices. As modern wound dressings become more popular among clinical practitioners and caregivers, allergic contact dermatitis reactions to these dressings emerge. Previous reports have indicated that as much as 40% to 80% of patients with chronic leg ulcers had hypersensitivity to different topical treatment products.1,2 A patient's risk of contact sensitization can be overlooked secondary to failure of patient disclosure or oversight.

http://ift.tt/2x526Vs

Potential impact of biologics and emerging therapies for psoriasis and atopic dermatitis on future fertility: Reassurance to patients but more data are needed

To the Editor: For young patients suffering from atopic dermatitis, plaque psoriasis, and alopecia areata, new targeted therapies offer significant promise. The majority of these conditions present in individuals of reproductive age.1 Thus, there is a need to understand how new systemic drugs affect future fertility. In oncology, adverse effect on fertility is an important consideration for treatment selection. In dermatology, established systemic medications such as methotrexate and cyclosporine have known fertility risks, including impaired spermatogenesis and sperm motility in humans.

http://ift.tt/2wgvRW5

A phase 2a, open-label pilot study of the galectin-3 inhibitor GR-MD-02 for the treatment of moderate-to-severe plaque psoriasis

To the Editor: GR-MD-02 is a novel investigational drug that inhibits galectin-3, a member of the lectin protein family that binds to galactose containing glycoproteins and modulates inflammatory responses. Galectins have been shown to be linked to the expression of interleukins 23 and 17A, 2 cytokines that are targets of current psoriasis therapeutics.1,2 GR-MD-02, which is derived from US Pharmacopeia apple pectin, was previously used to treat nonalcoholic steatohepatitis in a clinical trial3 in which 1 subject who coincidentally had psoriasis noted complete resolution of her skin lesions.

http://ift.tt/2wgcCfu

Answers to CME examination

http://ift.tt/2fnzejF

Use of capsule endoscopy to identify lesions suggestive of Crohn's disease in patients with moderate to severe psoriasis

To the Editor: Psoriasis is a common immune-mediated disease that is associated with several comorbidities, including inflammatory bowel disease (IBD). The prevalence of Crohn's disease (CD) in the general population has been reported to range from 214 to 319 cases per 100,000 in the United States and Canada, respectively.1 The relative risk of CD has been reported to be 2 to 4 times higher in patients with psoriasis.2,3 However, the prevalence of subclinical IBD, such as CD, in patients with psoriasis is unknown.

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Passive blood anaphylaxis: subcutaneous immunoglobulins are a cause of ongoing passive anaphylactic reaction

Allergic, especially anaphylactic, reactions during immunoglobulin replacement therapy are rare, but their pathophysiology and classification remain ambiguous. Recent findings show positive results of skin tes...

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Alcohol-Related Mortality in Patients With Psoriasis

This cohort study investigates whether patients with psoriasis have an elevated risk of alcohol-related mortality.

http://ift.tt/2fod1Ss

Effect of Monochromatic Light on Incidence of Emergence Delirium in Children

Conditions:   Emergence Delirium;   Anesthesia Emergence Delirium
Intervention:   Device: Monochromatic blue light
Sponsor:   Baylor College of Medicine
Not yet recruiting - verified September 2017

http://ift.tt/2wfCkkm

Fraxel Laser for Alopecia

Condition:   Alopecia
Intervention:   Device: Fractional erbium-glass 1550 nm laser
Sponsor:   Northwestern University
Not yet recruiting - verified September 2017

http://ift.tt/2wuqi1w

Botox for Gummy Smile

Condition:   Gingival Exposure
Intervention:   Drug: Botulinum toxin type A
Sponsor:   Northwestern University
Recruiting - verified September 2017

http://ift.tt/2wfC2dg

Cryolipolysis Versus ATX-101 (Deoxycholic Acid) for Upper Back Fat

Condition:   Upper Back Fat
Interventions:   Device: CoolCurve;   Drug: ATX-101
Sponsor:   Northwestern University
Recruiting - verified September 2017

http://ift.tt/2wuNgFU

Assessment in Patients With Cryotherapy and Chemotherapy for Unresectable Esophageal or Gastroesophageal Cancer

Condition:   Esophageal Cancer
Intervention:   Procedure: cryotherapy
Sponsor:   Western Regional Medical Center
Recruiting - verified September 2017

http://ift.tt/2wu800C

Antibodies against citrullinated alpha enolase peptides in primary Sjogren's syndrome

Publication date: Available online 14 September 2017
Source:Clinical Immunology
Author(s): Adrianos Nezos, Ilir Cinoku, Clio P. Mavragani, Haralampos M. Moutsopoulos
Citrullinated alpha enolase (CEP-1) has been designated as a major antigenic target of antibodies against citrullinated proteins (ACPA) in patients with rheumatoid arthritis (RA). Our aim is to determine the prevalence of anti-CEP-1 in a cohort of ACPA positive (ACPA+) primary Sjogren's syndrome (pSS) patients. Anti-CEP1 titers were determined by ELISA in sera from 15 ACPA+ and 45 ACPA- age/sex matched pSS; 12 ACPA+ RA patients and 30 healthy controls (HC). Increased anti-CEP-1 antibody titers were detected in nine out of the 15 (60%) ACPA+ pSS patients and 5 out of 12 (41.7%) ACPA+ RA patients; no reactivities were detected in ACPA- pSS patients and HC. Anti-CEP-1 antibodies in the setting of pSS were associated with higher urine pH levels at baseline. CEP-1 is a major antigenic target of ACPA in patients with pSS characterizing a subgroup with distinct laboratory features.



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Severe Toxoplasma gondii infection in a member of a NFKB2-deficient family with T and B cell dysfunction

Publication date: Available online 14 September 2017
Source:Clinical Immunology
Author(s): Maria-Elena Maccari, Alessia Scarselli, Silvia Di Cesare, Matteo Floris, Andrea Angius, Annalisa Deodati, Maria Chiriaco, Paola Cambiaso, Stefania Corrente, Giovanna Stefania Colafati, Paul J. Utz, Federica Angelini, Alessandra Fierabracci, Alessandro Aiuti, Rita Carsetti, Jacob M. Rosenberg, Marco Cappa, Paolo Rossi, Rosa Bacchetta, Caterina Cancrini




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A Hebrew Adaptation of the Tinnitus Functional Index

Abstract

Tinnitus is the perception of sounds, when no external stimuli exists. Its prevalence has been estimated to be between 8% and 30% in the general population (1). Some patients describe intrusive tinnitus which affects many aspects of their lives, while others describe an insignificant disturbance caused by the tinnitus (2). Since tinnitus is a subjective symptom in most cases, defining its effect on patients' lives can be challenging. Several questionnaires have been developed in order to characterize the effects of tinnitus on patients' lives.

This article is protected by copyright. All rights reserved.

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Bacterial etiology of recalcitrant acute otitis media in sixty two children – high risk of pathogen colonization after treatment

Abstract

Acute otitis media (AOM), common childhood infection that is one of leading cause of antibiotic prescriptions for children, is diagnosed at least once in approximately 80% of preschool children and 30-40% of them have recurrent episodes. Antibiotic treatment of AOM is usually empiric, without isolation of otopathogens from middle ear fluid and their antibiotic susceptibility testing. Due to the improper antibiotic use, the infection can persist in some cases, termed AOM treatment failure.

This article is protected by copyright. All rights reserved.

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Unilateral Laryngoscopic Findings Associated With Response to Gabapentin in Patients With Chronic Cough.

Unilateral Laryngoscopic Findings Associated With Response to Gabapentin in Patients With Chronic Cough.

JAMA Otolaryngol Head Neck Surg. 2017 Sep 14;:

Authors: Giliberto JP, Dibildox D, Merati A

Abstract
Importance: Chronic cough is a debilitating, often multifactorial problem. Vagal neuropathy has been proposed as a cause for a fraction of these cases. There are certain features that support the clinical diagnosis of vagal neuropathy. It is hypothesized that patients with neurogenic cough who have vocal fold motion asymmetry (VFMA) on laryngoscopy will be more likely to respond to gabapentin.
Objective: To evaluate the association between the history, physical and videostroboscopic examinations, and clinical response to gabapentin.
Design, Setting, and Participants: In a retrospective cohort study, patients with chronic cough visiting an academic tertiary laryngology clinic from January 1, 2013, to September 1, 2015, were identified through International Classification of Diseases, Ninth Revision. Of those who had a chronic cough (>8 weeks), 27 patients who received a prescription for gabapentin were included. Patients without videostroboscopy, who did not complete voice therapy, or those without a follow-up examination more than 1 month from the initial evaluation were excluded. Initial history, physical and videostroboscopic examinations, and follow-up evaluations, were performed in a multidisciplinary laryngology clinic including a speech-language pathologist. Documented VFMA by a multidisciplinary team was decided by consensus after review of videostroboscopy recording at the time of the visit.
Main Outcomes and Measures: Response to gabapentin was defined by physician-documented subjective patient report of improvement in cough symptoms.
Results: Follow-up data were available on 25 of the 27 patients (15 [60%] women; mean [SD] age, 57 [11.8] years). Therapy was initiated in patients with chronic cough with gabapentin, 100 mg twice daily, which was titrated to response or adverse effects. The maximum daily dose was 1800 mg. Partial or complete response to gabapentin was noted in 16 (64%) patients. Vocal fold motion asymmetry was noted in 20 (80%) patients. Fifteen of 16 (94%) responders had VFMA compared with 5 of 9 (56%) nonresponders. The difference in the frequency of VFMA between responders and nonresponders was 38% (95% CI, 18%-58%). Adverse effects limited the gabapentin dose in 4 of 9 (44%) nonresponders and 4 of 16 (25%) responders (odds ratio, 2.5; 95% CI, 0.42-13.6).
Conclusions and Relevance: In patients with chronic cough suspected to be related to vagal neuropathy, the odds of response to gabapentin are higher with the presence of VFMA noted on videostroboscopy.

PMID: 28910442 [PubMed - as supplied by publisher]

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Anesthesia Exposure and Neurotoxicity in Children-Understanding the FDA Warning and Implications for the Otolaryngologist.

Anesthesia Exposure and Neurotoxicity in Children-Understanding the FDA Warning and Implications for the Otolaryngologist.

JAMA Otolaryngol Head Neck Surg. 2017 Sep 14;:

Authors: Grover LA, Mitchell RB, Szmuk P

PMID: 28910434 [PubMed - as supplied by publisher]

http://ift.tt/2ybjKHc

Reporting of Effect Size and Confidence Intervals in JAMA Otolaryngology-Head & Neck Surgery.

Reporting of Effect Size and Confidence Intervals in JAMA Otolaryngology-Head & Neck Surgery.

JAMA Otolaryngol Head Neck Surg. 2017 Sep 14;:

Authors: Karadaghy OA, Hong H, Scott-Wittenborn N, Sinha P, Suko J, Tait S, Wamkpah NS, Kallogjeri D, Piccirillo JF

Abstract
Importance: Effect sizes and confidence intervals (CIs) are critical for the interpretation of the results for any outcome of interest.
Objective: To evaluate the frequency of reporting effect sizes and CIs in the results of analytical studies.
Design, Setting, and Participants: Descriptive review of analytical studies published from January 2012 to December 2015 in JAMA Otolaryngology-Head & Neck Surgery.
Methods: A random sample of 121 articles was reviewed in this study. Descriptive studies were excluded from the analysis. Seven independent reviewers participated in the evaluation of the articles, with 2 reviewers assigned per article. The review process was standardized for each article; the Methods and Results sections were reviewed for the outcomes of interest. Descriptive statistics for each outcome were calculated and reported accordingly.
Main Outcomes and Measures: Primary outcomes of interest included the presence of effect size and associated CIs. Secondary outcomes of interest included a priori descriptions of statistical methodology, power analysis, and expectation of effect size.
Results: There were 107 articles included for analysis. The majority of the articles were retrospective cohort studies (n = 36 [36%]) followed by cross-sectional studies (n = 18 [17%]). A total of 58 articles (55%) reported an effect size for an outcome of interest. The most common effect size used was difference of mean, followed by odds ratio and correlation coefficient, which were reported 17 (16%), 15 (13%), and 12 times (11%), respectively. Confidence intervals were associated with 29 of these effect sizes (27%), and 9 of these articles (8%) included interpretation of the CI. A description of the statistical methodology was provided in 97 articles (91%), while 5 (5%) provided an a priori power analysis and 8 (7%) provided a description of expected effect size finding.
Conclusions and Relevance: Improving results reporting is necessary to enhance the reader's ability to interpret the results of any given study. This can only be achieved through increasing the reporting of effect sizes and CIs rather than relying on P values for both statistical significance and clinically meaningful results.

PMID: 28910425 [PubMed - as supplied by publisher]

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Akute Hautinfektionen und deren Imitatoren im Kindesalter

Zusammenfassung

Hintergrund

Pädiatrisch-dermatologische Notfallkonsultationen betreffen in 40 % infektiöse Hautbefunde. Es gilt, potenziell komplikationsreiche Hautinfektionen prompt zu erkennen und zu behandeln. Einige charakteristische Hautbefunde imitieren akute Hautinfektionen und werden regelmäßig fehlinterpretiert.

Ziel der Arbeit

Häufige pädiatrische Hautinfektionen sollen hier dargestellt und Fallstricke in Bezug auf Imitatoren und Differenzialdiagnose hervorgehoben werden.

Material und Methode

In Form eines Bilderquiz wird eine Auswahl akuter kindlicher Hautinfektionen in Gegenüberstellung zu infektiösen oder nichtinfektiösen Imitatoren und Differenzialdiagnosen diskutiert.

Ergebnisse

Folgende infektiöse Hautbefunde und deren Imitatoren sind hier unter Hervorhebung von klinischen Merkmalen zur Unterscheidung beschrieben: Eczema herpeticatum und bakteriell superinfizierte atopische Dermatitis, exanthematische Hand-Fuß-Mund-Krankheit und Varizelleninfektion, Erythema chronicum multilocularis und anuläre Urtikaria; Gianotti-Crosti-Syndrom und Gianotti-Crosti-artige Reaktion, bakterielle Follikulitis der Kopfhaut und Kerion Celsi respektive eosinophile pustulöse Follikulitis des Skalps, kutane Leishmaniose und idiopathisches faziales aseptisches Granulom, allergische und bakterielle Lymphangitis, bullöse Impetigo contagiosa und nichtakzidentelle Verbrühung.

Schlussfolgerungen

Eine sorgfältige Anamnese- und Hautstatuserhebung mit geübtem Blick für die hier illustrierten Differenzialdiagnosen ist essenziell, um Fallstricke bei der Beurteilung von Hautinfektionen in der pädiatrischen Notfallstation zu umgehen.

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Breast reconstruction surgery: Options and what to expect

In this article, we look at the process of breast reconstruction surgery, the reasons for choosing this surgery, alternative options, and recovery outlook.

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Some women may benefit from delaying breast reconstruction following mastectomy

Some patients with a combination of risk factors, such as being obese and having diabetes or being a smoker, may benefit from delayed rather than immediate breast implant reconstruction after a...

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Deviated septum: Causes, symptoms, and treatment

It is quite common for people to not have a straight septum. What is a deviated septum, what causes it, and how is a deviated septum diagnosed?

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Three things I wish I'd known: Looking back at residency life

What do young doctors wish they had known before starting residency, the notoriously tough specialty training? One plastic surgeon shares his experience.

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Double chin: Causes and how to get rid of one

Excess fat under the chin can be caused by a number of factors, including age, weight, and genetics. Learn how to reduce the appearance of a double chin.

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Breast implants may cause false ECG diagnosis of heart attack

A new study suggests that ECG recordings, which are used to diagnose heart attack and other disorders, can be abnormal in patients with breast implants.

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Penn physician pioneers new reconstructive surgery for female genital mutilation

There is new hope for the hundreds of millions of women worldwide who have been subjected to genital mutilation.

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Older women may not be offered breast reconstruction after mastectomy

A national study from England indicates that older women are often not offered immediate breast reconstruction following a mastectomy, even though guidelines state that surgeons should discuss...

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Body dysmorphic disorder may be under-diagnosed in patients seeking cosmetic procedures

Plastic surgeons and other cosmetic professionals are familiar with the challenges posed by patients with body dysmorphic disorder (BDD) seeking cosmetic procedures, reports a survey study in...

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Aesthetic nurses to take stand on Botox being administered by beauticians

An emergency motion condemning the injection of Botox and dermal fillers by non-health professionals, such as beauty therapists and hairdressers, is to be proposed at this year's 6th National...

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Advances in reconstruction of congenital deformities of the ear

Ear reconstruction for microtia, or underdeveloped ears, remains a clinical challenge for plastic and reconstructive surgeons.

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Round or 'shaped' breast implants? Even plastic surgeons can't tell the difference

Looking at before-and-after photos, plastic surgeons and nurses can't tell whether breast augmentation surgery was done using conventional round implants or newer anatomically shaped implants...

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Is patient satisfaction relevant? Plastic surgeons call for better rating tools

Patient satisfaction has become an important quality measure in the US healthcare system.

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What's the best way to match the implant to the breast? Evidence on implant size selection systems reviewed

How should plastic surgeons choose the best implant type and size for women undergoing breast augmentation surgery?

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Older and younger women benefit equally from breast reconstruction after mastectomy

The most comprehensive study of its kind to date found that older women enjoy the same benefits from breast reconstruction following mastectomy for breast cancer as younger women without a...

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Medical tattooing improves perception of scar/graft appearance, quality of life

Medical tattooing, also known as dermatography, is routinely used by plastic surgeons for nipple reconstruction after mastectomy.

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Anticellulite Creams: Are They Worth Your Money?

The idea of being able to reduce cellulite with an over-the-counter cream is an attractive one, but do they work? Find out about them and other treatments.

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Receding Gums: Treatment Options and Causes

Gingival recession is when the gum tissue covering the root of the tooth is pushed back. Learn about its causes and forms of treatment with this article.

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Stretch Mark Removal: Treatments and Home Remedies

Stretch marks are a common problem affecting men and women of nearly all ages and skin types. Learn about the treatments and home remedies for them here.

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Effect of swallowing maneuver on fentanyl-induced coughing

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In reply: Sevoflurane in patients at risk of ventricular dysrhythmias

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High primary antibiotic resistance of Helicobacter Pylori strains isolated from dyspeptic patients: A prevalence cross-sectional study in Spain

Abstract

Background

The rate of H. pylori resistance to different antibiotics is increasing and determines the selection of eradication therapy. The aim of this study was to determine the resistance patterns of H. pylori strains in our area.

Methods

Biopsies from gastric corpus for microbiological culture and antibiotic resistance were obtained in patients undergoing upper gastrointestinal endoscopy for dyspepsia. Selective Agar Pylori for isolation of the bacteria and Agar Mueller-Hinton supplemented with blood to test the sensitivity to antibiotics were used. Presence of H. pylori was confirmed using direct observation with phase-contrast microscopy and/or smears stained with acridine orange. In vitro bacterial susceptibility to amoxicillin, clarithromycin, rifampicin, tetracycline, metronidazole, and levofloxacin was tested using diffusion MIC test strips. Minimum inhibitory concentration values were determined based on the 6th version of the EUCAST (European Committee on Antimicrobial Susceptibility Testing) Clinical Breakpoint (2016).

Results

Two hundred and seventeen patients were included (58.1% female, median age 64 years, range 25-92). H. pylori was identified in 108 patients (49.8%); culture and antibiogram were completed in 77 of them (71.3% of H. pylori-positive patients). The resistance rates were as follows: levofloxacin 38.7%, rifampicin 33.3%, metronidazole 27% and clarithromycin 22.4%. No case of amoxicillin or tetracycline resistance was identified. Dual clarithromycin-metronidazole resistance was observed in 10% of strains, whereas multiple drug-resistant was observed in 14.2%.

Conclusions

Resistance rate of H. pylori to antibiotics is high in the northwest of Spain. The high resistance to levofloxacin and clarithromycin advises against their wide empirical use of these antibiotics in eradication regimens.

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Managing Asthma in Low-Income, Underrepresented Minority, and Other Disadvantaged Pediatric Populations: Closing the Gap

Abstract

Purpose of Review

In this article, we review current understanding of the epidemiology and etiology of disparities in asthma. We also highlight current and emerging literature on solutions to tackle disparities while underscoring gaps and pressing future directions.

Recent Findings

Tailored, multicomponent approaches including the home, school, and clinician-based interventions show great promise.

Summary

Managing asthma in disadvantaged populations can be challenging as they tend to have disproportionately worse outcomes due to a multitude of factors. However, multifaceted, innovative interventions that are sustainable and scalable are key to improving outcomes.

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Effect of an Intravenous Dexamethasone Added to Caudal Local Anesthetics to Improve Postoperative Pain: A Systematic Review and Meta-Analysis With Trial Sequential Analysis.

BACKGROUND: Caudal anesthesia has been used for postoperative pain control in pediatric surgical patients, but the duration of the analgesic effect is occasionally unsatisfactory. Intravenous steroids have been shown to be effective for postsurgical pain management after certain surgeries. The aim of this meta-analysis with trial sequential analysis (TSA) was to evaluate the analgesic effect of steroids in patients administered with caudal anesthesia. METHODS: This study was a systematic review and meta-analysis. A search of published literature was conducted in the MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials databases and in trial registration sites. Randomized controlled trials that compared intravenous steroids with a placebo in pediatric patients who had received caudal anesthesia for surgery were included in the study. The primary outcomes from the present meta-analysis were the analgesic duration and the number of patients who required rescue analgesics. The analgesic duration and incidence of rescue use were summarized using mean difference or risk ratio with a 97.5% confidence interval (CI), respectively. If the 97.5% CI of the mean difference or risk ratio included a value of 0 or 1, respectively, we considered the difference not to be significant. We used the random effects model to combine the results. Heterogeneity was quantified with the I2 statistic. The quality of the trials was evaluated using the Cochrane methodology. Moreover, a TSA with a risk of type 1 error of 2.5% and power of 90% was performed. We established the minimum clinically meaningful difference of analgesic duration as 3 hours. The target sample size for meta-analysis was also calculated in the TSA. We also assessed adverse events. RESULTS: Six trials with 424 patients were included; 211 patients received intravenous steroids. All trials compared dexamethasone of at least 0.5 mg/kg dose with a placebo. Dexamethasone prolonged the duration of caudal analgesia (mean difference, 244 minutes; 97.5% CI, 188-300). Heterogeneity was considerable with an I2 value of 94.8%. Quality of evidence was very low. The TSA suggested that only 17.0% of the target sample size had been reached, but the cumulative Z score crossed the trial sequential monitoring boundary to indicate a benefit. Rescue use was reported in 4 studies with 260 patients. Rescue use was not significantly reduced in the dexamethasone group (risk ratio, 0.53; 97.5% CI, 0.09-3.30; I2, 98.7%). No increase in adverse events was reported. CONCLUSIONS: Intravenous dexamethasone prolongs the analgesic duration of caudal anesthesia. Trials to investigate the effectiveness of a lower dose of the dexamethasone in prolonging analgesic effects would be of interest. Further trials with a low risk of bias are necessary. (C) 2017 International Anesthesia Research Society

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Dexmedetomidine Maintains Its Direct Cardioprotective Effect Against Ischemia/Reperfusion Injury in Hypertensive Hypertrophied Myocardium.

BACKGROUND: Dexmedetomidine (DEX) has a direct cardioprotective effect against ischemia/reperfusion injury through endothelial nitric oxide synthase (eNOS) phosphorylation via [alpha]2-adrenoreceptor ([alpha]2-AR). By using spontaneously hypertensive rat (SHR) and Wistar-Kyoto (WKY) rat models, the cardioprotective effect of DEX in hypertrophied myocardium and the differential characteristics of cardiac [alpha]2-AR and the I1 imidazoline receptor (I1R) were examined. METHODS: Langendorff-perfused rat hearts underwent 40 minutes of global ischemia followed by 120 minutes of reperfusion in the presence or absence of DEX before ischemia. Infarct size was measured, and eNOS phosphorylation was assessed by Western blotting. The presence and expression of the receptors were assessed by immunohistochemistry, real-time reverse transcriptase polymerase chain reaction, and Western blotting. RESULTS: In WKY, DEX significantly decreased infarct size and increased phosphorylated-eNOS/eNOS. These effects were counteracted by yohimbine ([alpha]2-AR antagonist) and efaroxan ([alpha]2-AR and I1R antagonist). In SHR, DEX significantly decreased infarct size, and the effect was counteracted by efaroxan but not yohimbine. DEX did not alter phosphorylated-eNOS/eNOS in SHR. [alpha]2-AR and I1R were observed in WKY and SHR hearts. Although alpha2A-AR and alpha2B-AR messenger RNA and protein levels were upregulated in SHR, I1R expression was comparable between the 2 species. CONCLUSIONS: In the hypertrophied heart, DEX maintains its direct cardioprotective effect against ischemia/reperfusion injury via I1R in an eNOS-nondependent manner despite upregulation of [alpha]2-AR. (C) 2017 International Anesthesia Research Society

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Meanings of Pain.

No abstract available

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Assessing the Utility of Fluoroscopy for Epidural Catheter Placement: What End Points Are Important?.

No abstract available

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Sedation After Cardiac Surgery With Propofol or Dexmedetomidine: Between Scylla and Charybdis?.

No abstract available

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In Response: Sedation After Cardiac Surgery With Propofol or Dexmedetomidine: Between Scylla and Charybdis?.

No abstract available

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Surveying the Literature: Synopsis of Recent Key Publications.

No abstract available

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