Medicine by Sfakianakis Alexandros: 02/14/18

Τετάρτη 14 Φεβρουαρίου 2018

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Masthead

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Open Access: Is There a Predator at the Door?

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Hyperglycemia and risk of adverse outcomes following microvascular reconstruction of oncologic head and neck defects

Publication date: April 2018
Source:Oral Oncology, Volume 79
Author(s): Anaeze C. Offodile, Hsuan-Yu Chou, Jennifer An-Jou Lin, Charles Yuen Yung Loh, Kai-Ping Chang, Mario A. Aycart, Huang-Kai Kao
IntroductionOur aim is to examine the correlation between perioperative hyperglycemia and post-operative outcomes following microvascular reconstruction of head and neck defects.Patients and methodsRetrospective review of a prospectively collected database of 350 consecutive patients who underwent microvascular reconstruction of malignant head and neck defects over a 2 year period. The relationship between perioperative hyperglycemia (≥ 180 mg/dL) and the incidence of the following complications was evaluated: flap loss, flap-related complications and surgical site infections (SSI). Sub-group analysis based on timing of hyperglycemia was also performed.ResultsWe identified 313 patients (89.4%) in the normoglycemic group and 37 patients (10.6%) in the hyperglycemic group. Baseline demographics, tumor stage, operative variable were comparable. There were no significant differences in flap-related complications and overall mortality. SSI were significantly higher in the hyperglycemic cohort (48% vs. 28%, p = 0.01). On multivariate analysis, hyperglycemia [OR 2.07; 95% CI, 1.87–4.89], perioperative insulin administration [OR 4.805; 95% CI, 2.18–10.60], prolonged operative time [OR 1.003; 95% CI, 1.002–1.025] and higher Charlson co-morbidity indices [II: OR 2.286 & III: OR 2.284] were independent predictors of SSI. On sub-group analysis, only patients with early (POD 1) post-operative hyperglycemia had a significant OR for SSI (OR 1.88; 95% CI, 1.07–3.29).ConclusionOur findings suggest that perioperative hyperglycemia, specifically during the first 24 h post-operatively, is associated with SSI in microvascular head and neck reconstruction. This association highlights the need for strict screening of head and neck patients for hyperglycemia especially in the immediate post-operative period.

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Dipeptidyl peptidase-4 inhibitor-associated bullous pemphigoid in a patient with acquired reactive perforating collagenosis

Abstract

Bullous pemphigoid (BP) is a common autoimmune blistering disorder with unknown etiology. Recently, increasing numbers of BP cases which developed under the medication with dipeptidyl peptidase-4 inhibitors (DPP4i), widely used antihyperglycemic drugs, have been reported in published works. Here, we report a case of DPP4i (teneligliptin)-associated BP that developed in a 70-year-old Japanese man. Interestingly, the patient had acquired reactive perforating collagenosis (ARPC), which is also known to be associated with the onset of BP. In the present case, clinical, histopathological and immunological findings suggested that DPP4i rather than ARPC was associated with the onset of BP.

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Efficacy of low-dose 5-fluorouracil/cisplatin therapy for invasive extramammary Paget's disease

Abstract

Extramammary Paget's disease (EMPD) is one of the cutaneous adenocarcinomas. The effective chemotherapy for advanced EMPD has not been established. This study was designed to evaluate the efficacy of combination 5-fluorouracil (500 mg/body, 7 days/week) and cisplatin (5 mg/body 5 days/week) for invasive EMPD. Seventeen EMPD patients with multiple metastases who visited our dermatology clinic between October 2004 and May 2016 (mean age, 76.9 years; 10 men, seven women) were retrospectively analyzed. Eight EMPD patients underwent low-dose 5-fluorouracil/cisplatin therapy and nine patients chose best supportive care. The average number of treatment cycles was 12.3. All patients had a confirmed response, four (50%) showed a partial response, two (25%) stable disease and two progressive disease. The median times to progression-free and overall survival were 25.0 and 77.4 weeks, respectively. There was no severe (grade 3 and 4) adverse event. Although not significant, the survival of the patients treated with low-dose 5-fluorouracil/cisplatin therapy showed a trend toward improved survival as compared with best supportive care (P = 0.08, log–rank test). This regimen had low risk and relatively high disease control rate, suggesting that this regimen be recommended as one of the treatment options for advanced EMPD.

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Successful treatment of chronic intractable pain with risperidone in a patient with acquired idiopathic generalized anhidrosis

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Pyogenic granuloma-like Kaposi's sarcoma on the first toe

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Seltene Differentialdiagnose einseitiger, frontotemporaler Cephalgien

Laryngo-Rhino-Otol
DOI: 10.1055/s-0044-100516

Article in Thieme eJournals:
Table of contents | Full text

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Skalenübergreifende Auswertung des Fragebogens zur Erfassung des stimmlichen Selbstkonzepts (FESS)

Laryngo-Rhino-Otol
DOI: 10.1055/s-0044-101837

Hintergrund Der Fragebogen zur Erfassung des stimmlichen Selbstkonzepts (FESS) bildet in drei Skalen das persönliche Erleben der eigenen Stimme ab. Dabei werden die Beziehung zur eigenen Stimme, die Bewusstheit im Umgang mit der Stimme und der Zusammenhang zwischen Stimme und Emotion bestimmt. Für die Auswertung des Fragebogens fehlte bisher eine skalenübergreifende Betrachtungsweise, um eine vereinfachte Interpretation der Ergebnisse zu ermöglichen. Material und Methoden Der FESS Fragebogen wurde bei 536 Lehrkräften eingesetzt und mittels einer Diskriminanz analyse auf gemeinsame Ausprägungsmerkmale in den Skalen untersucht. Für eine differenzierte Betrachtung von Zusammenhängen mit Stimmgesundheit, psychischer und körperlicher Gesundheit wurden ebenfalls der Voice Handicap Index (VHI), der Fragebogen zum arbeitsbezogenen Verhaltens- und Erlebensmuster (AVEM) und der Fragebogen zur gesundheitsbezogenen Lebensqualität (SF-12) herangezogen. Ergebnisse Die Analyse ergab vier verschiedene Gruppen des stimmlichen Selbstkonzepts: die Gruppe 1) mit stimmlich und psychisch gesunden Werten, die Gruppe 2) mit einem eher wenig ausgeprägtem stimmlichen Selbstkonzept und durchschnittlicher psychischer Gesundheit, die Gruppe 3) mit einer hohen Bewusstheit im Umgang mit der Stimme und durchschnittlicher psychischer Gesundheit und die Gruppe 4) mit hohen stimmlichen und psychischen Belastungen. Schlussfolgerung Die Ergebnisse zeigen, dass für eine Gesamtauswertung des Fragebogens zur Erfassung des stimmlichen Selbstkonzepts eine gemeinsame Betrachtung aller drei Skalen in Betracht gezogen werden kann. Die dargestellten Gruppen stellen dafür eine geeignete Herangehensweise zur Unterstützung in der Diagnostik zur Verfügung.
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Article in Thieme eJournals:
Table of contents | Abstract | Full text

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Reliability and construct validity of the Ottawa valve collapse scale when assessing external nasal valve collapse

Bilateral Piriform sinus fistulas: a case study and review of management options

Usefulness of reconstructed 3D images for cochlear implantation in a case with a facial nerve anomaly

Facial nerve anomalies are a potential problem in patients with cochleovestibular malformations. A case of cochlear implant (CI) surgery in the presence of intra-temporalbone facial nerve bifurcation is presented. During the first surgery, the facial nerve bifurcation obscured the promontory and round window. It was difficult to perform cochleostomy because of the lack of landmarks of the basal turn of the cochlea, and the first surgical attempt at cochleostomy was abandoned. A repeat CT scan was performed after the first surgery with reconstructed 3D images of the temporal bone and the cochlea, and then the cochlea was successfully opened at revision surgery.

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Eczema’s Big Break in Hollywood

The Night Of, an HBO miniseries released in 2016, made waves as a social commentary of racial prejudices plaguing the American criminal justice system. As a dermatology resident, I was equally struck by the amount of attention paid to John Turturro's character's (Jack Stone) eczema. Stone is an attorney desperate to show off his legal prowess in a big case, and he gets his chance after Nasir Khan (Riz Ahmed) is convicted of murdering a young girl he met earlier that night. A total of 15 minutes of the show over 8 episodes focus on Stone's eczema. Richard Price, a writer for the show, used eczema as "a metaphor for the frustrations of finding a solution and the entire judicial system." Patients affected by atopic dermatitis can relate to Stone's constant battle with the disease, and the scenes are accurate portrayals of the experience of many patients with eczema.

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Cutaneous Diphtheria Mimicking Pyoderma Gangrenosum

This case report describes a patient with cutaneous diphtheria mimicking pyoderma gangrenosum.

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Standardized Screening for Depression and Suicidal Ideation

This Viewpoint examines the role of the Patient Health Questionnaire-2 in dermatology concerning secondary psychiatric disorders that involve emotional disturbances and manifest in response to the psychologic stress caused by dermatologic conditions.

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Diameter of Skin Lesions With and Without a Ruler

This analysis of survey results examines the accuracy with which medical students, internal medicine residents, and dermatology residents, fellows, and faculty can estimate the diameter of skin lesions in clinical photographs.

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Practicing Safe Dermatology—Screening Out Liability

The article "Characteristics of Medical Liability Claims Against Dermatologists From 1991 Through 2015" by Kornmehl and colleagues is a welcome addition in our quest to understand how to reduce dermatology practice risk. The study confirms much of what we already knew or suspected but also provides some new interesting insights. It is reassuring to see that most malpractice cases against dermatologists are "abandoned, withdrawn or dismissed." Similarly, it is comforting to know that there has been a net reduction of 29.2% in paid claims for dermatologists. Is this secondary to improved patient care? The changing landscape of tort reform? Or both?

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Colors Beyond the Visible

The process of painting restoration is in open view to all visitors at the Boston Museum of Fine Arts. Here, multiple techniques for analysis of painting damage caused by time and environmental conditions are openly displayed. One of those involves scanning under UV light. UV light, particularly at 360 nm, reveals what is on the surface of the painting, such as the quality of the top layer and any overlaid fungal growth. Furthermore, using a UV filter, the conservator is able to photograph what is underneath the paint, beyond what visible light can show. UV fluorescence photography is able to reveal the presence of natural resin varnishes and can also help in identifying any retouching and overpainting. Such studies are about contrasts and colors.

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Trends in Medical Liability Claims Against Dermatologists

This study analyzes 24 years of data through 2015 from a nationally representative liability claims registry to compare the medical liability claims against dermatologists vs nondermatologists.

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Herpes Zoster Rates in a Large Cohort of Patients With Systemically Treated Psoriasis

This cohort study examines estimated herpes zoster incidence rates among systemically treated patients with psoriasis in a community-based health care delivery setting.

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Fluorouracil for Prevention of Keratinocyte Carcinoma

This randomized, double-blind, placebo-controlled trial examined the use of topical fluorouracil, 5%, to prevent keratinocyte carcinoma.

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Newborn Treated With Drug That Triggered Maternal SJS During Pregnancy

This case report of a woman who developed Stevens-Johnson syndrome during pregnancy describes the treatment of her newborn with the culprit drug.

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Tumor Classifications in 7th and 8th Editions of AJCC Cancer Staging Manual

This retrospective cohort study compares the tumor classifications for head and neck squamous cell carcinoma using the 7th vs 8th editions of the AJCC Cancer Staging Manual for head amd neck cutaneous csquamous cell carcinomas.

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Error in Data in the Results Section

In the article titled "Management of Morgellons Disease With Low-Dose Trifluoperazine," an error occurred in the last paragraph of the Results section concerning the number of patients who achieved at least partial responses and baseline function with median dosages of the study treatment. The sentence now reads, "Among patients with median dosages of 2 mg/d, 10 (71%) achieved at least partial responses and 7 (50%) achieved baseline function…". The article was corrected online.

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Hypercoagulable Conditions and Calciphylaxis in Renal Disease

This case-control study compares the hypercoagulability status of patients with calciphylaxis and renal disease with controls to identify conditions that are risk factors for developing calciphylaxis while controlling for chronic kidney disease.

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Harvey, Irma, and Maria—The Dermatologic Risks of Hurricanes and Floods

Hurricane Harvey and Irma may be behind us, but many of the effects of the storms continue to unfold. Harvey dumped a record of 51 inches of rainfall over Texas and Louisiana in 6 days. Irma remained a category 5 hurricane for 3 days, making it the strongest Atlantic-basin hurricane recorded outside the Gulf of Mexico. More recently, Hurricane Maria hit the Dominican Republic and Puerto Rico.

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Digital Photographic Assessment of Acne Vulgaris Using NORA Technology

This pilot validation study determines whether acne scoring through digital self-photographs is accurate and reliable compared with in-person examination findings in patients with acne vulgaris.

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February 2018 Issue Highlights

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Treatment for Livedoid Vasculopathy

This systematic review uses the MEDLINE and EMBASE databases to identify the available therapies for livedoid vasculopathy and their clinical outcomes.

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Firefighter Skin Cancer and Sun Protection Practices

This survey study examines skin cancer history, skin cancer screening, and sun protection habits among active Florida firefighters.

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Nongenital Molluscum Contagiosum in Persons Without Immune Deficiency

This Clinical Evidence Synopsis summarizes an updated Cochrane review that assessed effectiveness and safety of treatments for nongenital molluscum contagiosum in persons without immune deficiency.

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Noninvasive Gene Expression Testing in Amelanotic Melanoma

This case report describes noninvasive gene expression testing in a patient with amelanotic melanoma.

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Sialic Acid Binding Immunoglobulin-Like Lectin-1 mRNA in Peripheral Blood Leukocytes Is Related to Chance of Relapse in Graves’ Disease

Clinical Thyroidology Feb 2018, Vol. 30, No. 2: 69-73.

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RAI Ablation Has Decreased for Low-Risk Thyroid Cancers in California

Clinical Thyroidology Feb 2018, Vol. 30, No. 2: 85-87.

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Patient Age Is Associated with Papillary Thyroid Cancer Mortality Only in Patients with BRAF V600E Mutation

Clinical Thyroidology Feb 2018, Vol. 30, No. 2: 53-55.

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Surgeon-Performed Ultrasound Is Important in the Preoperative Nodal Assessment of Patients with Potential Thyroid Malignancy

Clinical Thyroidology Feb 2018, Vol. 30, No. 2: 77-79.

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Current ATA Thyroid Cancer Guidelines Are Poor Predictors of the Extent of Thyroidectomy

Clinical Thyroidology Feb 2018, Vol. 30, No. 2: 56-58.

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Editorial: What's Ahead for Clinical Thyroidology in 2018

Clinical Thyroidology Feb 2018, Vol. 30, No. 2: 51-52.

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Does a Patient with a Normal FT4 but a TSH of 7 or Higher Have An Increased Risk of Cardiac Complications After Percutaneous Coronary Artery Interventions?

Clinical Thyroidology Feb 2018, Vol. 30, No. 2: 59-61.

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Levothyroxine May Decrease the Risk of Miscarriage in Women with High TPOAb Titers, Older Age, and Female Infertility Cause

Clinical Thyroidology Feb 2018, Vol. 30, No. 2: 74-76.

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Targeted Therapy Offers a Glimmer of Hope for Patients with Anaplastic Thyroid Cancer Even Outside of a Clinical Trial

Clinical Thyroidology Feb 2018, Vol. 30, No. 2: 62-65.

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Ultrasound Shear Wave Elastography May Help Reduce Frequency of Fine-Needle Biopsy in Low-Risk Thyroid Nodules

Clinical Thyroidology Feb 2018, Vol. 30, No. 2: 80-84.

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A Low-Iodine Diet During Methimazole Treatment Worsens Graves’ Disease Outcomes

Clinical Thyroidology Feb 2018, Vol. 30, No. 2: 66-68.

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U.S. Newborn Screening Programs for Congenital Hypothyroidism Vary Widely

Clinical Thyroidology Feb 2018, Vol. 30, No. 2: 88-89.

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Regarding the Use of the Term “Cementum” in Pathologic Proliferations

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Two EDA Gene Mutations in Chinese Patients with Hypohidrotic Ectodermal Dysplasia

Abstract

Hypohidrotic (anhidrotic) ectodermal dysplasia (HED) is an inherited disorder and generally characterized by the diminution or absence of eccrine sweat glands, oligodontia, peg shaped teeth, and sparse hair.¹ X-linked Hypohidrotic (anhidrotic) ectodermal dysplasia (XLHED) is the most frequent inheritance patterns, though in some cases autosomal dominant and recessive inheritance patterns were also reported.^2,3 4 genes (EDA, EDAR, EDARADD and WNT10A) account for more than 90% of HED cases and the mutations in Ectodysplasin-A (EDA) gene are the most prevalent (58%).⁴

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Secukinumab Demonstrates High Sustained Efficacy and a Favorable Safety Profile in Patients with Moderate to Severe Psoriasis through 5 Years of Treatment (SCULPTURE Extension Study)

Abstract

Background

Secukinumab, a fully human monoclonal antibody that selectively neutralizes IL-17A, has been shown to have significant efficacy and a favorable safety profile in the treatment of moderate to severe psoriasis and psoriatic arthritis.

Objective

To assess the efficacy and safety of secukinumab through 5 years of treatment in moderate to severe psoriasis.

Methods

In the core SCULPTURE study, Psoriasis Area and Severity Index (PASI) 75 responders at Week 12 continued receiving subcutaneous secukinumab until Year 1. Thereafter, patients entered the extension phase and continued treatment as per the core trial. Treatment was double-blinded until the end of Year 3 and open-label from Year 4. Here we focus on the 300 mg fixed-interval (every 4 weeks) treatment, the recommended per label dose. Efficacy data are primarily reported as observed but multiple imputation (MI) and last observation carried forward (LOCF) techniques were also undertaken as supportive analyses.

Results

At Year 1, 168 patients entered the extension study and at the end of Year 5, 126 patients completed 300mg (every 4 weeks) treatment. PASI 75/90/100 responses at Year 1 (88.9%, 68.5% and 43.8%, respectively) were sustained to Year 5 (88.5%, 66.4% and 41%). PASI responses were consistent regardless of the analysis undertaken (as observed, MI, or LOCF). The average improvement in mean PASI was approximately 90% through 5 years compared to core study baseline. DLQI (dermatology life quality index) 0/1 response also sustained through 5 years (72.7% at Year 1 and 65.5% at Year 5). The safety profile of secukinumab remained favorable, with no cumulative or unexpected safety concerns identified.

Conclusion

Secukinumab 300 mg treatment delivered high and sustained levels of skin clearance and improved quality of life through 5 years in patients with moderate to severe psoriasis. Favorable safety established in the secukinumab phase 2/3 program was maintained to 5 years.

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Numbers on injectable treatments in the Netherlands in 2016

Abstract

Objective data on the number of cosmetic injectable treatments (Botulinum Toxin A and fillers) performed annually is lacking. These numbers would be helpfull in establishing the importance of this area in medicine from a medico-social perspective and to determine the incidence of side-effect. Numbers on the number of treatments or global volumes used provided by the American Society of Plastic Surgeons (ASPS) and the International Society of Aesthetic Plastic Surgery are erestricted to their members.^1,2

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The use of JAK inhibitors in the treatment of Progressive Systemic sclerosis

Abstract

Systemic sclerosis is a connective tissue disorder characterized by fibrosis. Patients may have restricted movement of the joints, Raynaud's phenomenon, self-amputation of the digits, dyspnea, and upper gastrointestinal symptoms. Excessive production of extracellular matrix (ECM) proteins such as type I collagen via transforming growth factor β (TGF β) are thought to be responsible for the fibrosis.¹

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If it's red and scaly look for fungus: remember cutaneous protothecosis

Abstract

A 34-year-old woman presented with a 5-year old history of unilateral facial erythematous plaque and scattered papules. The lesions continue to spread slowly. She complains mild pruritus. No medical history including diabetes or immunosuppression were recorded. Physical examination showed large area of well-demarcated erythematous plaque on the right cheek(Fig.A) with infiltrating pinpointed-flesh papules at the margin with less scales(Fig.B).

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Whole-exome sequencing for diagnosis of hereditary ichthyosis

Abstract

Background

Hereditary ichthyosis constitutes a diverse group of cornification disorders. Identification of the molecular cause facilitates optimal patient care.

Objective

We wanted to estimate the diagnostic yield of applying whole-exome sequencing (WES) in the routine genetic work-up of inherited ichthyosis.

Methods

During a 3-year-period, all ichthyosis patients, except X-linked and mild vulgar ichthyosis, consecutively admitted to a university hospital clinic were offered WES with subsequent analysis of ichthyosis-related genes as a first-line genetic investigation. Clinical and molecular data have been collected retrospectively.

Results

Genetic variants causative for the ichthyosis were identified in 27 out of 34 investigated patients (79.4%). In all, 31 causative mutations across 13 genes were disclosed, including 12 novel variants. TGM1 was the most frequently mutated gene, accounting for 43.7% of patients suffering from autosomal recessive congenital ichthyosis (ARCI).

Conclusion

WES appears an effective tool in disclosing the molecular cause of patients with hereditary ichthyosis seen in clinical practice, and should be considered a first-tier genetic test in these patients.

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Is atopic dermatitis associated with obesity? A systematic review of observational studies

Abstract

Obesity has been associated with atopic dermatitis (AD), however the results have been conflicting. Our aim was to provide an update on current knowledge from observational studies addressing the possible association between obesity and AD.

Systematic literature review was performed by identifying studies addressing a possible link between AD and overweight/obesity from PubMed, Embase, and the Cochrane Library in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)-guidelines. The quality of the included studies was assessed using the Newcastle-Ottawa Scale.

A total of 45 studies (comprising more than 90.000 individuals with AD) fulfilled the criteria and were included in the present review. The available studies revealed inconsistencies, but the majority indicated that obesity is associated with AD. Studies addressing obesity in infancy or early childhood (age < 2 years) and AD reported a positive association. From childhood into adulthood, there is a discrepancy in the observations, as the more recent prospective studies found a positive association, whereas this was not observed in older cross-sectional studies. The inconsistency might be explained by the difference in study design, the diagnostic criteria of AD, regional differences, and by the varied definitions of overweight and obesity used in the studies.

In Conclusion, overweight/obesity is associated with an increased risk of AD. Large prospective cohort studies are required to confirm the association between AD and obesity and the possibility that weight control in childhood may help to mitigate or reverse AD symptoms.

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The efficacy and safety of non-pharmacological therapies for the treatment of acne vulgaris: A systematic review and best-evidence synthesis

Abstract

Background

Acne vulgaris is a multifaceted skin disorder, affecting more than 85% of young individuals worldwide. Pharmacological therapy is not always desirable because of the development of antibiotic resistance or the potential risk of adverse effects. Non-pharmacological therapies can be viable alternatives for conventional therapies. However, sufficient evidence based support in the efficacy and safety of non-pharmacological therapies is lacking.

Objective

To assess the efficacy and safety of several non-pharmacological therapies in the treatment of acne vulgaris.

Methods

A systematic literature review, including a best-evidence synthesis was performed to identify literature. Three electronic databases were accessed and searched for studies published between January 2000 and May 2017.

Results

Thirty three eligible studies were included in our systematic review. Three main types of non-pharmacological therapies were identified: laser and light-based therapies, chemical peels and fractional microneedling radiofrequency. The majority of the included studies demonstrated a significant reduction on acne lesions. However, only 7 studies had a high methodologic quality. Based on these 7 trials, a best-evidence synthesis was conducted. Strong evidence was found for glycolic acid (10-40%). Moderate evidence was found for amino fruit acid (20-60%), IPL (400–700nm and 870 – 1200nm) and the diode laser (1450nm). Initially, conflicting evidence was found for pulsed dye laser (585-595nm). The most frequently reported side-effects for non-pharmacological therapies included erythema, tolerable pain, purpura, oedema and a few cases of hyperpigmentation, which were in most cases mild and transient.

Conclusion

Circumstantial evidence was found for non-pharmacological therapies in the treatment of acne vulgaris. However, the lack of high methodological quality among included studies prevented us to draw clear conclusions, regarding a stepwise approach. Nevertheless, our systematic review including a best-evidence synthesis did create order and structure in resulting outcomes in which a first step towards future research is generated.

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A prospective right–left comparative study to evaluate the efficacy and tolerability of combination of NB-UVB and topical bimatoprost 0.03% eye drops versus NB-UVB given alone in patients of vitiligo vulgaris

Abstract

The treatment of vitiligo has been a tough challenge for dermatologists. Phototherapy, apart from being first line monotherapy,¹ has also been used in combination with topical therapies like corticosteroids, khellin, phenylalanine, calcineurin inhibitors etc, with the aim of hastening and enhancing repigmentation and reducing side-effects.^2,3 Recent reports have highlighted darkening of iris, and eyelash and periocular hyperpigmentation induced by latanoprost (prostaglandin F2α analogue) used for treatment of glaucoma.⁴ Extrapolating these findings in treatment of vitiligo, we assessed the outcome of NB- UVB and topical bimatoprost 0.03% combination versus NB-UVB alone in a prospective right–left comparative study.

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Drug survival and post-drug survival of first-line immunosuppressive treatments for atopic dermatitis: comparison between methotrexate and cyclosporine

Abstract

Introduction

Cyclosporine and methotrexate are the two preferred first-line immunosuppressive treatments in atopic dermatitis. The aim of this study was to compare the treatment profiles of methotrexate and cyclosporine in daily practice as the first-line immunosuppressive treatment in atopic dermatitis, using two survival analyses, "drug survival" (time on the drug) and "post-drug survival" (time between two drugs).

Methods

Retrospective study including patients with moderate-to-severe atopic dermatitis treated with methotrexate or cyclosporine as the first-line immunosuppressive treatment. The reasons for discontinuation of treatment were collected: controlled disease, treatment failure, side event pregnancy and non-compliance. "Drug survival" and "post-drug survival" analyses were performed using the Kaplan Meier method and predictive factors were analyzed using uni- and multivariate Cox regression analyses.

Results

56 patients, among whom 25 patients treated with cyclosporine and 31 with methotrexate (median age: 34 ± 15 years) were included between 2007 and 2016. Reasons for discontinuation were not significantly different between "controlled disease" and other reasons (p=0.11). The median "drug survival" was significantly longer for methotrexate (23 months) than for cyclosporine (8 months) (p<0.0001). Six months from baseline, 93% of patients treated with methotrexate were still being treated vs 63% among patients treated with cyclosporine. The median of "post-drug survival" was significantly longer for methotrexate (12 months) than for cyclosporine (2 months). Only treatment with CYC was a predictive factor for decreased "drug survival" and "post-drug survival".

Conclusion

This is the first direct comparison between methotrexate and cyclosporine as first-line immunosuppressive treatments for moderate to severe atopic dermatitis in daily practice. We evidenced two different treatment profiles: the duration of methotrexate administration is longer than that of cyclosporine. "Post-drug survival" could be a new tool to assess the maintenance of effect of a drug after withdrawal in atopic dermatitis, and more broadly in chronic skin disease.

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Utility of whole exome sequencing in the diagnosis of Usher syndrome: Report of novel compound heterozygous MYO7A mutations

Publication date: Available online 14 February 2018
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Khushnooda Ramzan, Mohammed Al-Owain, Rozeena Huma, Selwa A.F. Al-Hazzaa, Sarah Al-Ageel, Faiqa Imtiaz, Moeenaldeen Al-Sayed
Next generation sequencing (NGS), such as targeted panel sequencing, whole-exome sequencing and whole-genome sequencing has led to an exponential increase of elucidated genetic causes in both rare diseases, and common but heterogeneous disorders. NGS is applied in both research and clinical settings, and the clinical exome sequencing (CES), which provides not only the sequence variation data but also clinical interpretation, aids in reaching a final conclusion with regards to a genetic diagnosis.Usher syndrome is a group of disorders, characterized by bilateral sensorineural hearing loss, with or without vestibular dysfunction and retinitis pigmentosa. The index patient, a 2-year-old child was initially diagnosed with nonsyndromic hearing impairment. Homozygosity mapping followed by CES was utilized as a diagnostic tool to identify the genetic basis of his hearing loss. A paternally inherited novel insertion, c.198_199insA (p.Val67Serfs*73) and a maternally inherited novel deletion, c.1219_1226del (p.Phe407Aspfs*33) in gene MYO7A were found in compound heterozygous state in the index patient. The result expands the mutational spectrum of MYO7A. In addition it helped in early diagnosis of the syndrome, for planning and adjustments for the patient, and as well as for future family planning. This study highlights the clinical effectiveness of CES for Usher syndrome diagnosis in a child presented with congenital hearing loss.

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Clinician surveys – time to make better use of this valuable resource for dermatologists

Abstract

Clinician surveys can be a useful resource to identify uncertainties in practice, determine expert or current opinion, define research priorities (as part of a priority setting partnership) and demonstrate feasibility of undertaking randomised clinical trials (RCT). Online survey programs such as SurveyMonkey^™ or Google surveys provide a simple step-by-step process to develop electronic surveys at little or no cost. These can be distributed using an email link to a nationwide audience via society membership groups.

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Primary cutaneous small/medium-sized pleomorphic T-cell lymphoproliferative disorder shows a common vascular pattern at dermoscopy

Abstract

Primary cutaneous small/medium-sized pleomorphic T-cell lymphoproliferative disorder (PCSM-TCLPD) is a rare and indolent primary cutaneous T-cell lymphoma variant [1], usually presenting as a solitary nodule or plaque in the head and neck [2] or rarely as multiple lesions in anatomic areas apart from head and neck [2]. Histology reveals the presence of a dense dermal infiltrate of CD4+, CD8-, small/medium pleomorphic cells [2] intermingled with reactive cells. Surgical or radiotherapic approach are the preferred option, while oral doxycycline has been suggested in cases with multiple lesions [2-3].

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A case of atypical eosinophilic pustular folliculitis that emerged following the administration of capecitabine

Abstract

A 66-year-old man presented with aggregated pruritic follicular papulopustules on the forearms and thighs (Figure A). Each papulopustule was 1 mm in size, and arose from the hair follicle area (Figure B). The patient had undergone laparoscopic colectomy one month prior, and had been given a course of chemotherapy with capecitabine at 4,200 mg per day orally for 14 days followed by a 7-day washout period.

http://ift.tt/2BXzAuh

A cross-sectional analysis of the effects of increased resident autonomy on practice patterns and patient satisfaction

Abstract

The appropriate balance between autonomy and supervision in graduate medical education remains an understudied question within dermatology. A recent survey of residents in a large academic dermatology residency program revealed concerns over inadequate autonomy in outpatient clinics. Residents in this program rotate through general and specialty clinics as well as two continuity clinics, but the degree of autonomy remains attending dependent, with most clinics following an "apprenticeship model" where residents function as assistants to their attending.

http://ift.tt/2BtF130

Diagnosis uPGrade—Advances in Pyoderma Gangrenosum

In this issue of JAMA Dermatology, 2 large, well-constructed studies remind dermatologists that even though pyoderma gangrenosum (PG) is a quintessential disease in medical dermatology, we still need data to better define the disease and reduce the risk of cognitive biases. We know the results of these biases well; even at referral centers and in clinical trials, alternative diagnoses can prevail 7% to 20% of the time. In these articles, one of the largest retrospective PG databases and a new tool for PG diagnosis validation are presented.

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Age and Pyoderma Gangrenosum Presentation and Comorbidities

This cohort study evaluates the association of age with the clinical presentation and disease associations of pyoderma gangrenosum.

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Diagnostic Criteria of Ulcerative Pyoderma Gangrenosum

This consensus statement proposes and validates diagnostic criteria for ulcerative pyoderma gangrenosum.

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Lenalidomide Treatment for Recurrent Erythema Multiforme

This case report describes 3 patients treated with lenalidomide as an alternative to thalidomide for recurrent erythema multiforme.

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Dermatologists Should Speak Out Against a Word Ban at CDC

This Viewpoint details why dermatologists must speak out against the current US political administration's word ban at the Centers for Disease Control and Prevention.

http://ift.tt/2EplnUw

Gray-Brown Patches on the Face of a 62-Year-Old Woman

A 62-year-old woman with a history of rosacea and melasma presented with worsening gray-brown patches on the face; no oral or other cutaneous lesions were reported. What is your diagnosis?

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The functional and psychological burden of empty nose syndrome

Background

Empty nose syndrome (ENS) is a debilitating disorder thought to arise as a postsurgical phenomenon from excessive loss of nasal tissues. Affected patients often report a profound impact on all aspects of life, but the extent of this burden has not been quantified. We sought to determine the association of ENS with mental health and functional impairments.

Methods

A cross-sectional study was performed of individuals with ENS recruited from online ENS forums. ENS status was validated based on a positive 6-item Empty Nose Syndrome Questionnaire (ENS6Q) score and sinus computed tomography imaging or supporting medical documentation. Subjects completed the ENS6Q, the 9-item Patient Health Questionnaire (PHQ-9) for depression, the 7-item Generalized Anxiety Disorder questionnaire (GAD-7), the Epworth Sleepiness Scale for daytime somnolence (ESS), the Work Productivity and Impairment questionnaire (WPAI), and the 5-dimension EuroQol General Health State Survey (EQ-5D-5L). Pearson correlation analysis was performed with α = 0.05 to determine significance.

Results

Fifty-three ENS individuals were included in the study. Overall, participants reported symptoms consistent with moderate anxiety (μ = 12.7; standard deviation [SD], 5.9) and moderately severe depression warranting treatment (μ = 17.9; SD, 6.8). Participants also noted a 62% reduction in productivity at work (n = 24) and 65% in all other activities (n = 53). ENS6Q symptom severity was correlated with more severe depression (p < 0.001), anxiety (p < 0.001), overall pain/discomfort (p = 0.002), and impairment in activities of daily living (p = 0.003).

Conclusion

ENS individuals carry a clinically significant psychological burden and experience marked difficulties with many activities of daily living. A multimodal approach to address the tissue loss with surgery and cognitive-behavioral therapy for the psychological burden may provide the most optimal outcome.

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Effectiveness of Indoor Allergen Reduction in the Management of Asthma: A Systematic Review

Publication date: Available online 13 February 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Brian F. Leas, Kristen E. D'Anci, Andrea J. Apter, Tyra Bryant-Stephens, Marcus P. Lynch, Janice L. Kaczmarek, Craig A. Umscheid
BackgroundThis review will inform updated National Asthma Education and Prevention Program clinical practice guidelines.ObjectiveTo evaluate the effectiveness of allergen reduction interventions on asthma outcomes.MethodsWe systematically searched the gray literature and five bibliographic databases. Eligible studies included systematic reviews, randomized controlled trials, and nonrandomized interventional studies. Risk of bias was assessed using the Cochrane Risk of Bias instrument and the Newcastle-Ottawa scale. The evidence base was assessed using the approach of the Agency for Healthcare Research and Quality's Evidence-based Practice Center program.ResultsFifty-nine randomized and 8 non-randomized trials addressed 8 interventions: acaricide, air purification, carpet removal, high-efficiency particulate air-filtration (HEPA) vacuums, mattress covers, mold removal, pest control, and pet removal. Thirty-seven studies evaluated single component interventions, and 30 studies assessed multicomponent interventions. Heterogeneity precluded meta-analysis. For most interventions and outcomes, the evidence base was inconclusive or showed no effect. No interventions were associated with improvement in validated asthma control measures or pulmonary physiology. Exacerbations were diminished in multicomponent studies that included HEPA vacuums or pest control (moderate strength of evidence [SOE] for both). Quality of life improved in studies of air purifiers (low SOE), and in multicomponent studies that included HEPA vacuums (moderate SOE) or pest control (low SOE).ConclusionsSingle interventions were generally not associated with improvement in asthma measures, with most strategies showing inconclusive results or no effect. Multicomponent interventions improved various outcomes, but no combination of specific interventions appears to be more effective. The evidence was often inconclusive because of a lack of studies. Further research is needed comparing the effect of indoor allergen reduction interventions on validated asthma measures, with sufficient population sizes to detect clinically meaningful differences.

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The nasal microbiome in chronic rhinosinusitis: analyzing the effects of atopy and bacterial functional pathways in 111 patients

Publication date: Available online 13 February 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Mahboobeh Mahdavinia, Phillip A. Engen, Phillip S. LoSavio, Ankur Naqib, Rafsa J. Khan, Mary C. Tobin, Arpita Mehta, Raj Kota, Nailliw Preite, Christopher D. Codispoti, Bobby A. Tajudeen, Robert P. Schleimer, Stefan J. Green, Ali Keshavarzian, Pete S. Batra

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Identification of Clinically Relevant Chronic Rhinosinusitis Endotypes using Cluster Analysis of Mucus Cytokines

Publication date: Available online 13 February 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Justin H. Turner, Rakesh K. Chandra, Ping Li, Kemberlee Bonnet, David G. Schlundt

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Establishment of the Nasal Microbiota in the first 18 Months of Life – Correlation with Early Onset Rhinitis and Wheezing

Publication date: Available online 13 February 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Le Duc Huy Ta, Gaik Chin Yap, Carina Jing Xuan Tay, Alicia Shi Min Lim, Chiung Hui Huang, Collins Wenhan Chu, Paola Florez De Sessions, Lynette P. Shek, Anne Goh, Hugo P.S. Van Bever, Oon Hoe Teoh, Jian Yi Soh, Biju Thomas, Mahesh Babu Ramamurthy, Daniel Y.T. Goh, Christophe Lay, Shu-E. Soh, Yiong Huak Chan, Seang-Mei Saw, Kenneth Kwek, Yap-Seng Chong, Keith M. Godfrey, Martin Lloyd Hibberd, Bee Wah Lee
BackgroundThe dynamic establishment of the nasal microbiota in early life influences local mucosal immune responses and the susceptibility to childhood respiratory disorders.ObjectiveThe aim of this case-control study was to monitor, evaluate and compare the development of the nasal microbiota of infants who developed rhinitis and wheeze in the first 18 months of life with those of healthy controls.MethodsAnterior nasal swabs of 122 subjects belonging to the GUSTO birth cohort were collected longitudinally over seven time points in the first 18 months of life. The nasal microbiota signatures were analyzed using 16S rRNA multiplexed pair-end sequencing from three clinical groups (1) rhinitis alone (n=28), (2) rhinitis with concomitant wheeze (n=34) and (3) healthy controls (n=60).ResultsThe maturation of the nasal microbiome followed distinctive patterns in infants from both rhinitis groups compared to controls. Bacterial diversity increased over the period of 18 months of life in control infants, whilst infants with rhinitis showed a decreasing trend (p<0.05). An increase in abundance of Oxalobacteraceae family (Proteobacteria phylum) and Aerococcaceae family (Firmicutes phylum) was associated with rhinitis and concomitant wheeze (adj p<0.01) whilst Corynebacteriaceae family (Actinobacteria phylum) and early colonization with Staphylococcaceae family (Firmicutes phylum) (3 weeks till 9 months) was associated with controls (adj p<0.05). The only difference between the rhinitis group and controls was a reduced abundance of Corynebacteriaceae family (adj p<0.05). Determinants of nasal microbiota succession included gender, mode of delivery, presence of siblings and infant care attendance.ConclusionOur results support the hypothesis that nasal microbiome is involved in the development of early onset rhinitis and wheeze in infants.

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Biodiversity: the new kid on the block?

Publication date: Available online 14 February 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Erika von Mutius

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Shingrix: Is the Hype Justified?

Dr Paul Offit compares Shingrix with Zostavax® and lays out the recommendations for the new vaccine.
Medscape Infectious Diseases

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Immune Modulation in the Spotlight at AAD 2018

Immunomodulators for inflammatory diseases and cancer will be among the hot topics at the upcoming American Academy of Dermatology meeting.
Medscape Medical News

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Surgeons, Patients See Surgical Scarring Differently

Patients and physicians often disagree about the final outcomes of surgical scars, a systematic review confirms.
Reuters Health Information

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Comprehensive assessment of the donor-site of the anterolateral thigh flap: A prospective study in 33 patients

Abstract

Background

The anterolateral thigh (ALT) free flap has been an extremely versatile flap. The purpose of this study was to propose comprehensive functional assessments of the donor site.

Methods

A total of 33 ALT flaps were enrolled prospectively. Objective assessments included isokinetic testing of the knee, and electromyographic examination of the lateral femoral cutaneous nerve (LFCN). The Patient and Observer Scar Assessment Scale (POSAS) was used to subjectively assess the donor-site scar.

Results

On the donor side, a significant decrease in most isokinetic muscle strength values was obvious 1 year postoperatively (P < .01). The normal side showed a compensatory increase 1 year postoperatively in the majority of isokinetic muscle strength values (P < .05). The majority of patients (70%) showed decreased sensory conduction velocity of the LFCN or no response to the microcurrent stimulation postoperatively. The aesthetic outcome was satisfactory.

Conclusion

The decline in functional parameters at the donor-site was common. However, much more research is needed.

http://ift.tt/2GdN1nM

Sarcomas of the sinonasal tract

Abstract

Background

Sinonasal sarcomas are rare and heterogeneous in nature. Continuously collecting data influencing the prognosis is fundamental for optimizing therapeutic assessment of this highly destructive neoplasm.

Methods

We conducted a single-institution retrospective cohort study considering 27 patients with sinonasal sarcoma.

Results

The overall survival (OS) rates for 1 year and 5 years were calculated as 74% and 36%, respectively. Extent of the primary tumor (P = .010), nodal spread (P = .009), and age (P = .004) significantly reduced the OS. Disease-free survival (DFS) was significantly reduced by age (P = .003), extent of the primary (P = .006), nodal (P = .004), and hematogenous (P = .048) spread. Multimodal therapy including surgery improved the OS and DFS rates (P < .05).

Conclusion

Prognosis is poor due to late disease recognition. However, multimodal therapeutic regimens, including surgery, may improve the outcome.

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Bilateral Piriform sinus fistulas: a case study and review of management options

Abstract

Background

Piriform sinus fistulas occur due to developmental abnormalities of the third and fourth branchial arches, and almost always occur unilaterally. They generally present as recurrent abscesses in the anterior-inferior neck, with concurrent thyroiditis. They have conventionally been managed with complete removal of the sinus tract, and thyroidectomy if required; however, endoscopic approaches have been increasingly favored. Herein we describe a case of bilateral piriform sinus fistulas, and present a review of the literature concerning their endoscopic management.

Case presentation

Our patient was determined to have bilateral piriform sinus fistulas based on computer tomography, magnetic resonance imaging and microlaryngoscopy. We performed electrocauterization of the proximal fistula tracts, followed by injection of fibrin sealent. Our patient has not had a recurrence in the ten months since his procedure. There were no complications.

Twenty-three articles describing an endoscopic approach to these fistulas were identified through PubMed, and a search through the references of related articles was completed.

Conclusion

Of one hundred and ninety-five patient cases we reviewed, an endoscopic procedure success rate of 82% and complication rate of 5.6% was determined. Piriform sinus fistulas that occur bilaterally are a rare congenital abnormality of the neck. Endoscopic approaches are an acceptable alternative option to open procedures, with similar success and a lower rate of complications.

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Reliability and construct validity of the Ottawa valve collapse scale when assessing external nasal valve collapse

Abstract

Background

Nasal valve collapse is a common cause of nasal obstruction in otolaryngology practice. Common examination methods, such as the Cottle Maneuver and modified Cottle Maneuver are available. However, these methods are dichotomous and do not provide ordinal severity information. The Ottawa Valve Collapse Scale (OVCS) is a grading system for assessing and easily grading external nasal valve collapse in patients with a septal deviation. The primary objective was to assess the test-retest reliability and construct validity of the OVCS grading scale. A secondary objective was to perform the same assessments on the Cottle Maneuver.

Methods

Patients with a septal deviation who were requesting surgical correction were prospectively enrolled in the study. All patients were assessed using both the Cottle Maneuver and the OVCS by one otolaryngologist at two visits separated by one month. The phi coefficient was calculated to assess the test-retest reliability of the instruments. Results of the Nasal Obstruction Symptom Evaluation (NOSE) Score was compared to determine construct validity.

Results

Ninety-two patients met our inclusion criteria. The phi coefficient was 0.62 for the OVCS and 0.32 for the Cottle Maneuver. The scores on the NOSE instrument were positively associated with the OVCS scores (p = 0.01) while there was no association with the Cottle Maneuver (p = 047).

Conclusion

This current preliminary analysis suggests that the novel Ottawa Valve Collapse Scale has good test-retest reliability and construct validity. This scale may help clinicians grade external nasal valve collapse in patients with a septal deviation. Future studies are required to determine if this scale assists surgeons in determining which patients need formal nasal valve surgery in addition to a standard septoplasty.

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Voice quality outcomes of idiopathic Parkinson disease medical treatment: a systematic review

Abstract

Introduction

To investigate voice quality (VQ) impairments in idiopathic Parkinson's disease (IPD) and to explore the impact of medical treatments and L-Dopa challenge testing on voice.

Methods

Relevant studies published between January 1980 and June 2017 describing VQ evaluations in IPD were retrieved using PubMed, Scopus, Biological Abstracts, BioMed Central, and Cochrane databases. Issues of clinical relevance, including IPD treatment efficiency and voice quality outcomes, were evaluated for each study. The grade of recommendation for each publication was determined according to the Oxford Centre for Evidence-Based Medicine evidence levels.

Results

The database research yielded 106 relevant publications, of which 33 studies met the inclusion criteria, for a total of 964 IPD patients. Data were extracted by 3 independent physicians who identified 21, 11, and 1 trials with IIIb, IIb, and IIa evidence levels, respectively. The main VQ assessment tools used were acoustic testing (N=27), aerodynamic testing (N=10), subjective measurements (N=8), and videolaryngostroboscopy (N=3). The majority of trials (N=32/33) identified subjective or objective VQ improvements after medical treatment (N=10) or better VQ evaluations in healthy subjects compared to patients with IPD (N=22). Especially, our analysis supports that VQ overall improves during the L-Dopa challenge testing, making the VQ evaluation an additional tool for the IPD diagnosis. The methodology used to assess subjective and objective VQ substantially varied from one study to another. All of the included studies took into consideration the patient's clinical profile in the VQ analysis.

Conclusion

The majority of studies supported that VQ assessments remain useful as outcome measures of the effectiveness of medical treatment and could be helpful for the IPD diagnosis based on L-Dopa challenge testing. Further controlled studies using standardized and transparent methodology for measuring acoustic parameters are necessary to confirm the place of each tool in both IPD diagnosis and treatment evaluation.

http://ift.tt/2EsfJVP

Human Papillomavirus-Related Multiphenotypic Sinonasal Carcinoma: A Case Report Documenting the Potential for Very Late Tumor Recurrence

Abstract

Human papillomavirus (HPV)-related multiphenotypic sinonasal carcinoma is a peculiar sinonasal tract tumor that demonstrates features of both a surface-derived and salivary gland carcinoma. Implicit in its name, this tumor has a consistent association with high-risk HPV, particularly type 33. It was first described in 2013 under the designation of HPV-related carcinoma with adenoid cystic carcinoma-like features. However, since its initial description additional cases have emerged which demonstrate a wide morphologic spectrum and relatively indolent clinical behavior. Herein we report our experience with a case of HPV-related multiphenotypic sinonasal carcinoma that was initially classified as adenoid cystic carcinoma in the 1980s. The patient recurred after a 30-year disease free interval. RNA in situ hybridization confirmed the presence of high-risk HPV in both her recurrence and her initial tumor in the 1980s, which allowed for reclassification as HPV-related multiphenotypic sinonasal carcinoma. Our case adds to the literature of this relatively newly described entity and supports the indolent clinical behavior of this neoplasm but also demonstrates a potential for very late local recurrence.

http://ift.tt/2EIjeqc

Utilidad de la evaluación por otorrinolaringología en atención primaria de salud: Evaluación piloto

RESUMEN Introducción: En Atención Primaria de Salud (APS), las consultas por causas otorrinolaringológicas alcanzan hasta el 40%-50%. De éstos, muchos son enviados para evaluación al nivel secundario de salud. Objetivo: Evaluar la utilidad de una atención de otorrinolaringología en APS para tamizar el número de interconsultas al especialista. Explorar estrategias que permitan replicar la experiencia. Material y método: Se consideran las consultas de otorrinolaringología realizadas en dos escenarios diferentes, donde se evaluaron pacientes que se encontraban a la espera de atención formal por el nivel secundario. Resultados: Se evaluaron 201 pacientes. El 60,9% fueron de sexo femenino y el 39,1% masculino. La mediana de tiempo de espera para la derivación fue de 20 meses, con un rango intercuartil de 8-29 meses. El tiempo máximo de espera de interconsulta fue de 6 años (73 meses). Del total de interconsultas, 71,7% fueron dadas de alta con tratamiento según la causa, mientras que sólo en el restante 28,3% de las interconsultas se consideró necesario mantener la interconsulta al nivel secundario. Conclusión: Los resultados de la presente evaluación permiten plantear la utilidad de una evaluación otorrinolaringológica en APS. Esto permitiría reducir el flujo de derivaciones y listas de espera hacia el sector secundario, descongestionar el sistema, priorizar las derivaciones más pertinentes, crear canales de comunicación expeditos entre los niveles de atención, contribuir a la capacitación continua en ambos equipos y niveles.

ABSTRACT Introduction: In primary health care, medical appointments for otorhinolaryngological causes reach up to 40%-50%. Of these cases, many are referred for the evaluation of the tertiary level of health. Aim: Assess the usefulness of an otorhinolaryngology evaluation at the primary health care level to screen the number of referrals to specialist. Explore strategies to replicate the experience. Material and method: Attention by otorhinolaryngologist is considered in two different scenarios, where patients who were waiting for formal care by the secondary level were evaluated. Results: 201 patients were evaluated. 60.9% of the patients were females and 39.1% were males. The median waiting time for referral was 20 months, with an interquartile range of 8 - 29 months. The maximum waiting time for consultation was 6 years (73 months). Of the total number of consultations, 71.7% were discharged with treatment according to the cause, while only the remaining 28.3% of the consultations were considered necessary to maintain consultation at the tertiary level. Conclusion: The results of this evaluation allow us to propose the usefulness of an otorhinolaryngological evaluation in primary health care. This would reduce the flow of referrals and waiting lists to the secondary sector, decongest the system, prioritize the most relevant referrals, create expedited channels of communication between levels of care, contribute to continuous training in both teams and levels.

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Rescue Flap: Alternativa de colgajo en cirugía de base de cráneo

RESUMEN Introducción: La elaboración de colgajos ha representado un cambio en reconstrucción de defectos resultantes de exéresis de tumoraciones de base de cráneo. No siempre indispensables, existen circunstancias, planificados o no, donde debemos emplearlos. Preservando los pedículos de la mucosa, damos cobertura a urgencias intraquirúrgicas, como fístula LCR no sospechada, así como reintervenciones. Objetivo: Presentar nuestra experiencia en pacientes, a quienes hemos realizado colgajo tipo rescue flap. Material y método: Se diseña este colgajo, sin comprometer su pedículo. En caso de fístula, sospecha de ésta o herniación del diafragma selar, se extiende, cubriendo el defecto. Resultados: De 34 pacientes intervenidos de patología hipofisaria endoscópicamente, en 18 diseñamos colgajo tipo rescue flap. 12 casos se elaboraron, no utilizándolos. En 4 pacientes con extenso tumores lo empleamos preventivamente. En 1 caso, de reintervención, previamente con colgajo Hadad izquierdo, realizamos colgajo de mucosa contralateral. En otro, diseñamos un rescue flap derecho, al objetivar salida de LCR, sellamos con este colgajo. No evidenciamos fístulas. Discusión: Esta técnica consiste en levantar parcialmente mucosa del potencial colgajo, preservando su pedículo, pudiendo utilizarse en casos de fístula LCR no programada, o reintervenciones. Sin realizar colgajos innecesariamente. Conclusión: La técnica rescue flap favorece un corredor quirúrgico, menos invasivo, manteniendo mucosa para eventuales reintervenciones.

ABSTRACT Introduction: The development of flaps has represented a change in reconstruction of defects resulting from excision of skull base tumors. It not always indispensable, there are circumstances, planned or not, where we must use them. Preserving the pedicles of the mucosa, we cover intraoperative emergencies, such as unsuspected CSF fistula, as well as reinterventions. Aim: We present our experience where we performed rescue flap. Material and method: This flap is designed without compromising its pedicle. In case of fistula, suspicion of this or herniation of the selar diaphragm, it extends, covering the defect. Results: Of 34 patients who underwent endoscopic surgery for pituitary pathology, in 18 we designed a rescue flap. 12 cases were made, not using them. In 4 patients with extensive tumors we used it preventively. In 1 case, of reintervention previously with left Hadad flap, we performed contralateral mucosa flap. In another, we designed a right rescue flap, when we observed LCR output, we seal with this flap. We did not show fistulas. Discussion: This technique consists in partially lifting the mucosa of the potential flap, preserving its pedicle, and may be used in cases of unscheduled CSF fistula, or reinterventions. Without flapping unnecessarily. Conclusions: The Rescue Flap technique favors a less invasive surgical corridor, maintaining mucosa for posible reinterventions.

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Adherencia y caracterización de la población de adultos mayores usuarios de audífonos atendidos en el Servicio de Otorrinolaringología del Hospital Regional de Talca

RESUMEN Introducción: En Chile se ha descrito una baja adherencia al uso de audífonos en la población de adultos mayores, sin embargo, existe escasa información acerca de la realidad actual en regiones. Objetivo: Determinar la adherencia al uso de audífonos y caracterizar a la población de adultos mayores beneficiarios de éstos mediante GES (Garantías Explícitas en Salud) del Hospital Regional de Talca (HRT). Asimismo, determinar las principales variables que se relacionan con la adherencia en este grupo. Material y método: Estudio descriptivo, transversal, correlacional y analítico. Se evaluó a 78 usuarios con CIRUA presencialmente, índice de Barthel y cuestionario complementario. Además, se realizó una visita domiciliaria. Para el análisis de los datos se utilizó estadística descriptiva y pruebas de proporciones. El programa estadístico empleado fue STATA versión 11. Resultados: La adherencia fue del 75%. La edad tuvo una correlación significativa in-versa con la adherencia, las demás variables estudiadas no estarían asociadas. No existe diferencia significativa entre la adherencia arrojada en el HRT versus la visita domiciliaria. Conclusiones: Se sugiere reformular el abordaje al grupo de beneficiarios que tienen mayor edad, enfatizando el rol evaluativo y terapéutico del fonoaudiólogo. Se proponen futuras investigaciones en otras regiones, utilizando metodologías similares e instrumentos validados.

ABSTRACT Introduction: In Chile, a low adherence to the use of hearing aids in the elderly population has been described, however, there is a lack of information regarding the current situation in locations outside the capital city. Aim: To determine the adherence to the use of hearing aids, and to characterize the population of elderly people that benefit from the use of the same through the Explicit Guarantees in Health (GES), in the Regional Hospital of Talca (HRT). Furthermore, evaluate the main variables related to adherence in this group. Material and method: Descriptive, cross-sectional, correlational and analytical study. 78 users were evaluated with CIRUA, Barthel Index and a complementary questionnaire in person. Furthermore, a home visit was carried out. For the data analysis, descriptive statistics and proportions tests. Statistical software used was STATA 11. Results: The adherence described was 75%. Age had a significant inverse correlation with adherence, without an association of the other variables studied. There is no significant difference between adherences in the HRT compared with home visits. Conclusions: It is suggested that the approach to elderly beneficiaries be reformulated, emphasizing the evaluative and therapeutic role of the speech therapist. Future research is proposed in other regions of the country, using similar methodologies and instruments validated.

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Manejo de epistaxis posterior en el Hospital Clínico de la Universidad de Chile entre los años 2013 y 2016

RESUMEN Introducción: La epistaxis corresponde a una de las causas más frecuentes de consulta otorrinolaringológica en los servicios de urgencia. La epistaxis posterior es menos frecuente pero su presentación más severa. Existen varias alternativas terapéuticas, en las últimas décadas el manejo quirúrgico endoscópico de la arteria esfenopalatina (AEP) ha ido en aumento dado las ventajas en comodidad para el paciente y reducción de costos asociados. Objetivo: Revisar el manejo realizado en los cuadros de epistaxis posterior en el Hospital Clínico de la Universidad de Chile (HCUCh). Material y método: Estudio descriptivo en el Servicio de Otorrinolaringología del HCUCh de pacientes que presentaron epistaxis posterior entre el año 2013 y 2016. Resultados: Se revisó un total de 33 casos. La edad promedio de los pacientes fue 61,6 años siendo las comorbilidades más frecuentes la hipertensión arterial (36,3%) y fibrilación auricular (18,1%). Se realizó tratamiento quirúrgico en 57,6% de los pacientes siendo el clipaje de AEP la intervención quirúrgica más frecuente. Discusión y conclusiones: Tanto el manejo tradicional como las técnicas quirúrgicas presentaron eficacia similar en la serie revisada.

ABSTRACT Introduction: Epistaxis corresponds to one of the most frequent causes of otorhinolaryngological consultation in the emergency services. Posterior epistaxis is less frequent but more severe. There are several therapeutic alternatives, in recent decades the surgical endoscopic management of the sphenopalatine artery (AEP) has been increasing given the advantages in comfort for the patient and reduction of associated costs. Aim: To review the management of posterior epistaxis in the Clinical Hospital of the University of Chile (HCUCh). Material and method: Descriptive study in the Otorhinolaryngology Service of the HCUCh of patients who presented posterior epistaxis between the years 2013 and 2016. Results: A total of 33 cases were reviewed. The mean age of the patients was 61.6 years, with the most frequent comorbidities being hypertension (36.3%) and atrial fibrillation (18.1%). Surgical treatment was performed in 57.6% of the patients, with AEP clipping being the most frequent surgical intervention. Conclusion: Both traditional management and surgical techniques presented similar efficacy in the revised series.

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Aproximación diagnóstica de patología otológica mediante imágenes, en médicos APS, de la I y II Región de Chile

RESUMEN Introducción: La otoscopía corresponde a la herramienta principal que muchos médicos deben utilizar durante la evaluación de patologías otorrinolaringológicas, cuya enseñanza se realiza durante la formación del médico general en un tiempo acotado. Objetivo: En este trabajo se pretende evaluar el diagnóstico correcto de imágenes características de otoscopía por médicos de APS. Material y método: Se realizó un estudio no experimental, descriptivo, cuantitativo y de corte transversal donde se aplicó un test a médicos no especialistas de APS de la I y II región de Chile. Resultados: Se encuestó a un total de 89 médicos. El porcentaje total de respuestas correctas correspondió a 24,8%. La imagen más reconocida corresponde a la perforación timpánica. Sólo 20,2% reconoció la imagen correspondiente a un tímpano normal. Conclusión: Estos resultados se pueden atribuir a la falta de conocimientos y entrenamiento adquirido por los médicos generales, por lo que se debe trabajar en un mejor entrenamiento en otoscopía en el pregrado.

ABSTRACT Introduction: Otoscopy is the main tool used by general practitioners for the assesment of ENT patologies, wich is taught during a short period in medicine schools. Aim: The intention of this study is to evaluate the accurate diagnosis of characteristic otoscopy images by primary health physicians. Material and method: A non-experimental, descriptive, quantitative and cross-cut study was carried out; A survey was applied to general practitioners who were working on primary health care of I and II region of Chile. Results: A total of 89 physicians were surveyd. The total percentage of correct answers was 24.8%. The most recognized image was timpanic perforation. Just a 20.2% recognized the image corresponding to a normal timpanic membrane. Conclusion: This results can be attributed to the lack of knowledge and training acquired by the general practitioners, So we must work on a better training in otoscopy in the undergraduate.

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Resonancia magnética con secuencia HASTE de carcinoma epidermoide del hueso temporal

RESUMEN El carcinoma epidermoide del hueso temporal es una neoplasia derivada de células epidérmicas del estrato espinoso, y que dado su baja incidencia, y presentación clínica similar a un cuadro de otitis media crónica colesteatomatosa, su diagnóstico es habitualmente tardío. El estudio del carcinoma epidermoide del hueso temporal se realiza con tomografía computarizada, la que evidencia erosión ósea. Sin embargo, existen distintos diagnósticos diferenciales, tanto malignos como benignos, que pueden provocar hallazgos similares en la tomografía computarizada. La resonancia magnética (RM) es un método de exploración de gran valor complementario para el estudio del carcinoma de oído medio. La RM con secuencia de difusión HASTE ha surgido como herramienta de estudio en patología de hueso temporal, tales como colesteatomas y teratomas de oído medio, pese a esto, no existen reportes en la literatura de la presentación imagenológica del carcinoma epidermoide de hueso temporal utilizando este método. En este artículo se presenta un caso clínico de una paciente con carcinoma epidermoide de oído medio, cuyo estudio preoperatorio incluyó RM-HASTE. Aun cuando se requiere un mayor número de casos para establecer el patrón imagenológico, se concluye que esta técnica es de utilidad para diferenciar este tumor de otitis media crónica colesteatomatosa.

ABSTRACT Squamous cell carcinoma of the temporal bone (SCC) is a malignancy originated from epidermis spinous cells. Its low incidence and similar presentation to cholesteatomas, contributes to its late diagnosis. The most widely used study for this tumor is computed tomography (CT), which mainly evidences erosion of the temporal bone. There are several other diagnoses, malignant and benign, that could provoke similar findings at the CT. Magnetic resonance imaging (MRI) is a method of great value to study SCC. MRI with HASTE diffusion sequence has recently emerged as an important tool in the study of temporal bone pathologies, such as cholesteatoma and middle ear teratoma, despite this, there are no reports in the literature of the imaging presentation of SCC using this method. This article presents a clinical case of a patient with SCC, in whose preoperative study was performed HASTE-MRI. Although a larger number of cases are required to establish an imaging pattern, it is concluded that this technique is useful to differentiate this tumor from middle ear cholesteatomas.

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Quiste de segundo arco branquial del espacio parafaríngeo en recién nacido: Reporte de un caso

RESUMEN Dentro de los quistes cervicales congénitos los quistes branquiales son los segundos en frecuencia luego del quiste tirogloso, representando el 24% de los casos. De éstos, los quistes de segundo arco branquial son los más frecuentes con 90%-95% de los casos. Se presentan en un amplio rango de edad siendo comúnmente diagnosticados en niños mayores y adultos, cuya primera manifestación clínica puede ser un aumento de volumen relativamente brusco por infección. Se presenta el caso clínico de un recién nacido (RN) que debuta a las 48 horas de vida con estridor y dificultad para la alimentación oral. El estudio de imágenes con tomografía computarizada (TC) y resonancia magnética (RM) muestran una lesión quística del espacio parafaríngeo derecho que se proyecta hacia nasofaringe y orofaringe. Se realiza la exéresis de la lesión vía transoral. Biopsia rápida y diferida confirman diagnóstico de quiste branquial. Se revisa literatura sobre quistes de segundo arco branquial de ubicación en el espacio parafaríngeo siendo muy pocos los casos reportados.

ABSTRACT Within the congenital cervical necks, the branchial cleft cyst are the second in the frequency after the shooting, accounting for 24% of the cases. Of the Second branchial cleft cyst are with the most frequent with 90-95% of the cases. It occurs in a wide range of ages and is commonly diagnosed in older children and adults, whose first clinical manifestation may be an increase in volume after infection. We present a clinical case of newborn that debuts at 48 hours of life with stridor and difficulty for oral feeding. The imaging study with Computed Tomography (CT) and Magnetic Resonance imaging (MRI) show a cystic lesion of the right parapharyngeal space projecting into the nasopharynx and oropharynx. The excision of the transoral lesion is performed. Frozen biopsy and diagnostic biopsy demonstrating a branchial cyst. We review the literature on the second branchial cleft cyst of the location in the parapharyngeal space with very few reported cases.

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Laberintectomía quirúrgica

RESUMEN El tratamiento quirúrgico del vértigo se puede dividir en dos grandes grupos: no ablativos y ablativos, dentro de éstos últimos se encuentra la laberintectomía quirúrgica, técnica con la cual se produce cofosis. Su principal indicación es la sintomatología vestibular periférica invalidante, unilateral, que no mejora con medidas farmacológicas ni con terapia psiquiátrica, asociado a hipoacusia sensorioneural severa a profunda. Existen dos tipos de abordajes para realizar la laberintectomía quirúrgica: transmastoidea y transcanal, siendo la primera el gold standard para eliminar la función vestibular. Se presentarán dos casos clínicos de pacientes sometidos a estos procedimientos, uno por vía transmastoidea y otro por vía transcanal.

ABSTRACT The surgical treatment of vertigo can be classified into two main groups: non-ablative and ablative. The surgical labyrinthectomy is an ablative treatment in which no hearing is preserved. Its main indication is the disabling peripherical and unilateral vestibular symptoms that do not improve with pharmacological measures or with psychiatric therapy, in patients with severe to profound sensorineural hearing loss. There are two types of approaches for labyrinthectomy, transmastoid and transcanal, the first is the gold standard to eliminate the vestibular function. Here, we present two cases of patients undergoing these procedures, one by transmastoid approach and the other by transcanal approach.

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Carcinoma escamoso de cavidad oral en paciente menor de edad

RESUMEN El objetivo de este caso es profundizar en el conocimiento del cáncer de lengua en pacientes jóvenes. Se trata de un caso clínico: Mujer de 17 años sin antecedentes ni hábitos tóxicos, que acude por presentar tumoración en hemilengua izquierda con biopsia de carcinoma escamoso. En TAC: Lesión en hemilengua izquierda que afecta al suelo de la boca. Adenopatías bilaterales. Estadío IVA. Se decide quimioterapia de inducción seguido de quimioradioterapia. Presentó recidiva tras 5 meses de seguimiento, y se realizó glosectomía parcial. Tras 12 meses libre de enfermedad presentó nueva recidiva local que se intervino quirúrgicamente. Actualmente en seguimiento y sin signos de enfermedad. Existen estudios que indican que la prevalencia del cáncer de cabeza y cuello está aumentando en pacientes jóvenes; comportándose de forma diferente entre unos grupos de edad y otros. Concluimos que los factores epidemiológicos, genéticos, etiológicos y clinicopatológicos de los pacientes jóvenes con cáncer de cabeza y cuello sugieren una divergencia biológica frente a lo que ocurre con dichos cánceres en pacientes añosos. La mejora del conocimiento de la biología molecular es necesaria para establecer el éxito en la prevención y el tratamiento de dichos pacientes.

ABSTRACT To delve into the knowledge of tongue cancer in young patients. Case We presented a 17 years-old female, without tobacco and alcohol exposure, referred to Oral and Maxillofacial department with a squamous cell carcinoma in the tongue with bilateral cervical metastasis. We decided, in a multidisciplinary team, to treat her with chemotherapy followed by chemoradiotherapy. She had two local recurrences 5 and 12 months after the treatment which we treated with surgery both. Afher that, we follow her every month and she is without recurrences. Several reports suggest increasing incidence trends of head and neck cancer in young patients, disproportional to the patients above 45 years old. Moreover, the majority of young non-smoking non-drinking head and neck cancer patients is female. This disparity suggests that the pathogenesis of head and neck cancer in young patients differs from head and neck cancer development in old patients. Conclusion: The unique epidemiologic, genetic, etiologic, and clinicopatho- logic characteristics of young-onset HNSCC suggests a divergent biology from HNSCC occurring in older patients. Improved definition of this biology is needed to establish successful preventive and treatment de intensification efforts.

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Parálisis de cuerda vocal secundaria a intubación endotraqueal y su manejo. Revisión en relación a dos casos clínicos

RESUMEN La parálisis de cuerda vocal secundaria a intubación endotraqueal es una complicación poco frecuente de la anestesia general. Se manifiesta con disfonía precoz luego de la extubación, y en ocasiones se asocia a aspiración. A continuación se presenta el reporte de dos pacientes sometidos a cirugía abdominal con anestesia general e intubación endotraqueal, que presentan una parálisis cordal unilateral en el posoperatorio inmediato. En ambos pacientes se realiza una laringoplastía de inyección con ácido hialurónico (Restylane®), con buenos resultados vocales. Uno de los casos tiene seguimiento a lo largo de dos años. Se describe esta patología y su manejo mediante una revisión bibliográfica.

ABSTRACT Vocal fold paralysis posterior to endotracheal intubation is a very uncommon complication of the general anestesia. The symptoms includes hoarseness posterior to the extubation, and some times aspiration occurs. In this paper we present the report of two cases of abdominal surgery with general anesteshia and endotraqueal intubation procedures. Both subjects developed unilateral vocal fold paralysis after the process. The patients were treated with wedilization injection with Restylane ®, satisfactory voice's results were achieved. One of them has an observational time of two years. We describe this infrequent pathology and the treatment through literature review.

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Meningioma extradural de oído medio: Reporte de un caso y revisión de la literatura

RESUMEN Los meningiomas son los tumores no gliales más comunes del sistema nervioso central constituyendo el 24%-30% de los tumores intracraneales y el 25% de los tumores de médula espinal. Se originan de células de la aracnoides y en general presentan un comportamiento benigno. Existe un subtipo llamado meningioma extracraneal primario o extradural que es poco frecuente y afecta principalmente el área de cabeza y cuello. Debido a su baja prevalencia y síntomas poco característicos son a menudo diagnosticados por fortuna, siendo la inmunohistoquímica fundamental. Se presenta el caso de una mujer adulta con una lesión tumoral en oído medio diagnosticada inicialmente mediante una biopsia incisional como un granuloma de colesterol. Luego del tratamiento quirúrgico y estudio de inmunohistoquímica se concluye el diagnóstico definitivo de meningioma extradural de oído medio. Se analiza la literatura al respecto y se discute sobre su epidemiología, clínica, estudio y manejo.

ABSTRACT Meningiomas are the most common non-glial tumors of the central nervous system constituting 24-30% of intracranial tumors and 25% of spinal cord tumors. They originate from arachnoid cells and generally exhibit benign behavior. The subtype primary extracranial meningioma or extradural meningioma that is uncommon and affects the head and neck area. Due to their low prevalence and uncharacteristic symptoms are often diagnosed by fortune, being the immunohistochemistry fundamental. We present the case of an adult woman with a tumor lesion in the middle ear initially diagnosed by an incisional biopsy such as a cholesterol granuloma. After the surgical treatment and immunohistochemical study, the definitive diagnosis of extradural meningioma of the middle ear is concluded. The literature on this subject is analyzed and its epidemiology, clinical practice, study and management are discussed.

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Absceso retrofaríngeo en lactante menor. Reporte de caso y revisión de la literatura

RESUMEN El absceso retrofaríngeo corresponde a una complicación infrecuente de las infecciones de tracto respiratorio superior, asociada a una potencial pero significativa morbimortalidad. Posee mayor incidencia en la edad pediátrica, siendo la media de presentación los 3 años. En la literatura se le atribuyen diferentes factores de riesgo, destacando como factores endógenos enfermedades crónicas como diabetes mellitus y otros estados de inmunodeficiencia, y como factor exógeno las infecciones de vía aérea superior, dentarias y el traumatismo por cuerpo extraño. Si bien es difícil aislar un solo agente etiológico, se describe con mayor frecuencia la participación de Streptococcus pyogenes. El diagnóstico es eminentemente clínico, con confirmación imagenológica con tomografía computarizada como gold standard. El tratamiento es controversial, existiendo defensores de un tratamiento quirúrgico precoz versus un manejo expectante con antibióticos endovenosos. Se presenta a continuación el caso de una lactante menor de 1 año 4 meses hospitalizada en el Servicio de Pediatría en Hospital San Camilo en San Felipe por un cuadro febril agudo, catalogado inicialmente como meningitis, resultando en un absceso retrofaríngeo con extensión hacia mediastino superior, el cual fue resuelto de manera exitosa con tratamiento quirúrgico precoz asociado a antibióticos endovenosos de amplio espectro.

ABSTRACT Retropharyngeal abscess corresponds to an uncommon complication of upper respiratory tract infections, associated with a potential but significant morbidity and mortality. It has a greater incidence in the pediatric age, being the average of presentation the 3 years. Different risk factors are attributed to the disease in the literature, standing out endogenous chronic diseases such as diabetes mellitus and other immunodeficiency states, and exogenous factors such as upper airway infections, dental infections and foreign body trauma. Although it is difficult to isolate a single etiologic agent, the involvement of Streptococcus pyogenes is more frequently described. The diagnosis is eminently clinical, with confirmed imaging with Tomography computed as gold standard. Treatment is controversial, with advocates of early surgical treatment versus expectant management with intravenous antibiotics. Is presented below the case of a toddler girl of 1 year and 4 months hospitalized in the Pediatrics service at San Camilo's Hospital in San Felipe by an acute febrile condition, initially classified as meningitis, resulting in a retropharyngeal abscess with extension towards the upper mediastinum, which was successfully solved with early surgical treatment associated with broad-spectrum intravenous antibiotics.

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Válvula nasal en rinoplastía

RESUMEN La obstrucción dependiente de la vía aérea nasal representa un gran impacto en la calidad de vida de los pacientes. Las causas de ésta son múltiples, donde aquellas de tipo estructural son las que requieren frecuentemente cirugía. La obstrucción nasal debido a la disfunción de la válvula nasal puede ser olvidada como única causa de una obstrucción nasal. La decisión sobre qué técnica quirúrgica utilizar para solucionar una insuficiencia valvular es compleja y muchas veces la bibliografía utiliza conceptos anatómicos muy variados que no ayudan a seleccionar una técnica en particular. Se realizó una revisión bibliográfica del tema destacando anatomía, diagnóstico y tratamiento; las técnicas quirúrgicas más frecuentemente utilizadas son descritas.

ABSTRACT Nasal airway obstruction represents a major impact on patients' quality of life. The causes are multiple, where those of a structural type, frequently require surgery. Nasal obstruction due to nasal valve dysfunction may be overlooked as a cause of nasal obstruction. The decision about which surgical technique to use in order to solve a valvular insufficiency is complex and often the literature uses diverse anatomical concepts that do not help to select a particular technique. A literature review of the subject was carried out, highlighting anatomy, diagnosis and treatment; The most frequently used surgical techniques are described.

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Fístula de líquido cefalorraquídeo del receso lateral de seno esfenoidal. ¿Es el canal de Sternberg un defecto real?

RESUMEN Las fístulas de líquido cefalorraquídeo (LCR) corresponden a una comunicación anómala entre el espacio subaracnoideo y la cavidad nasal. El origen de las fístulas laterales del seno esfenoidal se encuentra en un defecto congénito de la base del cráneo, con una incompleta o prematura fusión de los componentes óseos implicados en el complejo proceso de osificación del esfenoides. Ello origina un canal sin cobertura ósea, solo cubierto por tejido conectivo, denominado canal craneofaríngeo lateral o de Sternberg. Este es un punto débil donde pueden aparecer encefaloceles y/o fístulas, su ubicación lateral en el seno constituyen una zona de difícil abordaje quirúrgico. La reparación quirúrgica de fístulas de LCR ha progresado drásticamente con el desarrollo de ópticas endoscópicas y la mejora en el conocimiento de la anatomía de la base de cráneo. Los endoscopios permiten una visualización directa, localización del defecto y por ende una reparación precisa que traduce menos recidivas y menor morbilidad asociada a accesos transcraneales realizados previamente. El propósito de este artículo es presentar el caso de paciente con fístula del receso lateral del seno esfenoidal, su reparación endoscópica y discusión del origen de la persistencia del canal de Sternberg como causa del defecto.

ABSTRACT Fístulas liquid cerebrospinal (CSF) correspond to an abnormal communication between the subarachnoid space and the nasal cavity. The origin of lateral fístulas of the sphenoid sinus is a congenital defect of the skull base, with an incomplete or premature fusion of bone components involved in the complex process of ossification of sphenoid. This originates a channel without bone coverage, only covered by connective tissue, called channel craneofaringeo or Sternberg channel. This is a weak point where may appear encephaloceles and/or fístula, the lateral location in sinus is a difficult surgical approach. Surgical repair of fístulas of CSF has progressed dramatically with the development of endoscopic optics and the improvement in the knowledge of the anatomy of the skull base. Endoscopes enable a direct visualization, location of the defect and thus accurate reparation and less morbidity associated with transcraneales accesses made previously. The purpose of this article is to present the case of patient with fístula of the lateral recess of the sphenoid sinus, endoscopic repair and discussion of the origin of the persistence of the channel of Sternberg as a cause of the defect.

http://ift.tt/2BZVCwD

Tos en otorrinolaringología: Revisión actualizada del enfoque clínico

RESUMEN La tos ocurre por la compleja acción del arco de la tos. En condiciones normales es esencial para proteger la vía aérea. Es un síntoma muy frecuente, con un gran número de etiologías posibles. El enfrentamiento diagnóstico de los pacientes con tos crónica, puede resultar un desafío diagnóstico. Deben considerarse las patologías más prevalentes, que incluyen el reflujo faringolaríngeo y la descarga posterior: ambas condiciones que son parte del área otorrinolaringológica. En el presente artículo de revisión se pretende entregar un enfoque actualizado de su enfrentamiento y manejo, con la finalidad de aportar información que resulte relevante para la práctica clínica diaria.

ABSTRACT Cough occurs due to the complex action of the coughing arch. Under normal conditions it is essential to protect the airway. It is a very frequent symptom with a large of possible etiologies. The diagnosis process of patients with chronic cough can be a challenge. The most prevalent pathologies must be considered. Thus includes pharyngolaryngeal reflux and posterior discharge: both conditions that are part of the otorhinolaryngolocical area. In the present article review, we pretend to provide an updated approach and management to this condition, in order to asses relevant information to daily clinical practice.

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Presbilaringe. Revisión de la literatura

RESUMEN La voz senil o presbifonía es una condición que se produce por cambios fisiológicos que se generan con los años y que alteran el sistema fonatorio, a nivel de cartílagos, músculos, vías nerviosas y otras alteraciones estructurales lo que, en su conjunto, se denomina presbilaringe. El diagnóstico de presbifonía es un diagnóstico de exclusión, debiendo previamente descartarse causas patológicas de disfonia. En el presente artículo se realiza una revisión de presbilaringe, enfocándose en epidemiología, anatomía, fisiología, histología, diagnóstico y manejo.

ABSTRACT The senile voice or presbyphonia it is a condition that is produced by physiological changes that affects the fonatory system in the cartilage, muscles, nerves and other structural alterations, the latter is what is called presbylarynx. Presbyphonia is a diagnosis of exclusion, other pathological causes of dysphonia must be previously ruled out. In this article we made a review of the literature on presbylarynx, focusing on epidemiology, anatomy, physiology, histology, diagnosis and treatment.

http://ift.tt/2BZVCg7

Aplicaciones clínicas del análisis acústico de la voz

RESUMEN El análisis acústico de la voz es un método de evaluación vocal objetivo y no invasivo, utilizado con fines diagnósticos, terapéuticos e investigativos. Utiliza registros acústicos obtenidos directamente de la voz del paciente mediante el uso de un micrófono profesional. Existe una gran variedad de programas y métodos de graficación disponibles, que favorecen la versatilidad y especificidad del proceso. Esta revisión muestra los métodos de graficación de la voz más utilizados.

ABSTRACT The acoustic voice analysis is an objective and non invasive vocal assessment method, used for voice diagnosis, therapy and research. It uses acoustic records obtained from the patient's voice using professional microphones. There is a variety of softwares and graphing programs available that allows process versatility and specificity. This review presents the most utilized methods of voice graphing.

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Is yoghurt an acceptable alternative to raw milk for reducing eczema and allergy in infancy?

Abstract

We have recently completed a randomised controlled trial of maternal supplementation of the probiotic Lactobacillus rhamnosus HN001 (HN001), exploring effects on maternal and infant health. The methodology(1) and the maternal outcomes, gestational diabetes and symptoms of postnatal depression and anxiety have recently been published(2) (3). Briefly, mothers were randomised at 14-16 weeks gestation to receive HN001 (6x 10⁹ cfu) or placebo daily during pregnancy and for 6 months postpartum while breast feeding.

http://ift.tt/2GdlqU1

Intravenous Immunoglobulins for Rituximab-resistant Mucous Membrane Pemphigoid

Abstract

Mucous membrane pemphigoid (MMP) is an autoimmune blistering disease that is notoriously difficult to treat. Rituximab (anti-CD20) and high-dose intravenous immunoglobulins (IVIG) have both been reported to be effective in refractory MMP.^1,2 Furthermore, treatment regimens based on the concomitant use of rituximab and IVIG in ocular MMP have been published.^3,4In the current report, we present 5 patients with treatment-resistant MMP who failed to respond to rituximab but rapidly achieved remission on IVIG.

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Optical Coherence Tomography Examination of the Anterior Segment in a Case of Corneal Perforation and Lens Trauma by Chestnut Burr

Chestnut burrs, the thorny encapsulation of chestnut fruit, can sometimes cause corneal injuries and ulceration, with poor prognoses. We report a case of corneal perforation and damaged anterior lens capsule due to a chestnut burr, using anterior segment optical coherence tomography (AS-OCT). A 67-year-old woman with a chestnut burr injury in her right eye was referred to our hospital. Her right best-corrected visual acuity (BCVA) was 0.8. Slit-lamp examination and AS-OCT showed perforation involving the endothelial layer at the center of the cornea. The iris and anterior lens capsule were damaged. Cell infiltration was observed around the wound. Bacterial examination showed gram-positive cocci but no fungi. The patient was diagnosed with a corneal perforation and bacterial keratitis. Levofloxacin 1.5% and cefmenoxime treatments were initiated and a soft contact lens was placed to seal the wound. On day 3, there was no improvement in the corneal cell infiltration, but AS-OCT suggested that the inner wound had closed. A culture test revealed the presence of Propionibacterium acnes, which was sensitive to both levofloxacin and cefmenoxime. Therefore, we continued the same antibiotic treatment. On day 26, the opacification and cell infiltration at the center of the cornea had improved. AS-OCT showed healing of the corneal wound with reduction in the central corneal thickness. Her BCVA improved to 1.0. AS-OCT was a valuable tool to noninvasively observe wound shape and detect the presence of any intracorneal foreign bodies.
Case Rep Ophthalmol 2018;9:154–159

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Rapid Capsular Contraction with Secondary Intraocular Lens Dislocation Associated with Unspecified Rod-Cone Dystrophy: A Case Report

Purpose: We report an unusual case of rapid and severe anterior capsular contraction associated with secondary intraocular lens (IOL) dislocation following cataract surgery in a patient with unspecified rod-cone dystrophy. Case Report: A 68-year-old woman with a history of uncharacterized bilateral rod-cone dystrophy presented with blurry vision 1 month after cataract surgery. Best corrected visual acuity was 20/40 in the operative eye. Slit-lamp exam showed severe anterior capsular phimosis limiting view of the fundus. Our patient underwent 2 sessions of Nd:YAG anterior capsulotomy with limited success. Limited anterior vitrectomy was then performed without success due to densely adherent capsular tissue to the anterior surface of the IOL and additional secondary IOL dislocation. She ultimately underwent pars plana vitrectomy, removal of the capsular bag, and IOL exchange with a scleral fixated IOL. Conclusion: Rapid and severe anterior capsular contraction following cataract surgery is rare but appears to be associated with rod-cone dystrophy.
Case Rep Ophthalmol 2018;9:149–153

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Uneventful Anterior Migration of Intravitreal Ozurdex Implant in a Patient with Iris-Sutured Intraocular Lens and Descemet Stripping Automated Endothelial Keratoplasty

Purpose: We report here the case of a patient with anterior segment migration of intravitreal dexamethasone implant as well as its management and outcome. Methods: The patient had the following sequence of events: complicated cataract surgery, iris-sutured intraocular lens implant, followed by cystoid macular edema treated with intravitreal Avastin, retinal vein occlusion treated with intravitreal dexamethasone implant, corneal decompensation treated with Descemet stripping automated endothelial keratoplasty (DSAEK), and finally recurrence of macular edema treated with repeated intravitreal dexamethasone implant. Results: Dexamethasone implant had completely dissolved from the eye 12 weeks after insertion without any complication. Conclusion: A conservative approach with regular monitoring in the situation of a quiet anterior segment without any corneal decompensation can provide enough time for the implant to dissolve without causing any complication to the involved eye, avoiding any additional surgical intervention, as presented in this case report. Despite the fact that the implant was left for natural dissolution, there were no adverse effects related to the graft or the eye.
Case Rep Ophthalmol 2018;9:143–148

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Use of an Autologous Bony Crossbar Graft for the Management of Caudal Septal Deviation: Our Experience in Twenty-Two Patients

Abstract

Septoplasty for a deviated caudal septum is a technique challenging surgery. The two goals of surgery are adequate correction of the deviated septum and maintenance of the nasal tip structural support.

Use of an autologous bony crossbar graft to correct a deviate caudal septum offers the following advantages. No difficult drilling or suturing procedure is needed because the graft was kept in place by the elastic properties of the buttonhole cartilage incisions. Second, a simple endonasal approach is sufficient to expose the entire surgical field. Third, the small strip-shaped bone graft can help preserve the natural mobility of nose.

Bone resorption and subsequent recurrence is one concern of this technique, however, previous reports have shown the reliability and persistence of bone graft in caudal septoplasty.

Correction of a deviated caudal septum with an autologous bony crossbar graft has the potential to be a useful option for the management of caudal septal deviation.

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Agenesis of dorsal pancreas in a young adult: a rare cause of diabetes mellitus

Dorsal pancreatic agenesis is an extremely rare entity characterised by absence of body and tail of pancreas, while there are so many other developmental anomalies of the pancreas that have been reported. Here we report a 25-year-old young man who presented with pain in the abdomen, recurrent loose stools and hyperglycaemia. On radiological imaging study, there was complete agenesis of the dorsal pancreas except for thin stripe of tissue at the level of the uncinate process. Both exocrinedysfunction and endocrine dysfunction were present in this patient. Patient was supplemented with pancreatic enzyme preparation and insulin.

http://ift.tt/2o6057z

Isolated bladder schwannoma: a rare presentation

Bladder schwannoma is a rare tumour arising from Schwann cells in nerve sheaths. It is usually more common in patients diagnosed with neurofibromatosis. However, isolated cases of urinary bladder schwannoma is incredibly rare, attributing to <0.1% of bladder tumours. A literature review and analysis revealed that it presents in adulthood, is mostly symptomatic and diagnosis is established histologically. We report a case of isolated bladder schwannoma in 25 year-old female who presented with dyspareunia.

http://ift.tt/2o0D0nr

Localised nasopharyngeal amyloidosis: the importance of postoperative follow-up

Localised nasopharyngeal amyloidosis is rare. Findings on physical examination and invasive pattern on CT scan can be misleading as it can resemble nasopharyngeal carcinoma. A 64-year-old man presented with left aural fullness for 6 months. The physical examination showed straw-coloured fluid in the left middle ear and irregular reddish mass at the left side of the nasopharynx. The CT scan showed a lobulated heterogeneous mass at the left side of the nasopharynx involving the left Eustachian tube opening. Pathology report was amyloidosis, thus, surgery was done. After a year, there were new foci of amyloidosis at the right side of the nasopharynx, and a repeat surgery was performed. Two years later, the systemic amyloidosis with underlying IgG4-related disease was suspected due to multiple organ involvement. Surgery is the treatment for localised amyloidosis with compressive symptoms. Close follow-up is important after surgical excision due to its recurrence and progression to systemic amyloidosis.

http://ift.tt/2o2uofc

Αρχειοθήκη ιστολογίου

Ετικέτες

Τετάρτη 14 Φεβρουαρίου 2018

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