Head &Neck, EarlyView.
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Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Παρασκευή 30 Μαρτίου 2018
Transoral endoscopic thyroid surgery via the tri‐vestibular approach with a hybrid space‐maintaining method: A preliminary report
Systematic review evaluating randomized controlled trials of smoking and alcohol cessation interventions in people with head and neck cancer and oral dysplasia
Head &Neck, EarlyView.
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Immune privilege disruption in folliculotropic mycosis fungoides: investigation of major histocompatibility complex antigen expression
International Journal of Dermatology, EarlyView.
https://ift.tt/2GHwYm9
Paederus dermatitis – touched by champion flies – three clinical manifestations of pederin toxin‐inflicted dermatitis
International Journal of Dermatology, EarlyView.
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Editorial Board
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 135, Issue 2
https://ift.tt/2E7RLKn
Contents
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 135, Issue 2
https://ift.tt/2GZUMiT
Effect of IFN-λ2 on combined allergic rhinitis with nasal polyps
OBJECTIVE: This study sought to investigate the expression of interferon-λ2 (IFN-λ2) in patients with combined allergic rhinitis and nasal polyps (AR+NP), analyze the correlation between IFN-λ2 and tryptase, interleukin 10 (IL-10), and interleukin 12 (IL-12), and identify its peripheral blood cell origins.
PATIENTS AND METHODS: ELISA kits were used to investigate plasma levels of IFN-λ2, tryptase, IL-10, and IL-12 in AR+NP patients and healthy controls (HC). Flow cytometry analysis was carried out to detect IFN-λ2 expression in peripheral blood leukocytes. Immunocytochemical staining was performed to detect nasal polyp IFN-λ2 expression in AR+NP patients.
RESULTS: Elevated plasma IFN-λ2 levels and positive correlations between plasma IFN-λ2 and tryptase levels in AR+NP patients indicated that IFN-λ2 likely contributes to AR+NP pathogenesis. IFN-λ2 expression was upregulated in cytotoxic T cells and eosinophils in AR+NP patients. Nasal polyp mast cells and macrophages in AR+NP patients expressed IFN-λ2.
CONCLUSIONS: The close correlation between IFN-λ2 expression and AR+NP may provide experimental evidence for a possible effect of IFN-λ2 against the allergic inflammatory reaction. Therefore, IFN-λ2 actions may have a potential utility for the treatment and prevention of AR+AP.
L'articolo Effect of IFN-λ2 on combined allergic rhinitis with nasal polyps sembra essere il primo su European Review.
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Cost‐effectiveness of sialendoscopy versus medical management for radioiodine‐induced sialadenitis
The Laryngoscope, EarlyView.
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Post‐acute care use after major head and neck oncologic surgery with microvascular reconstruction
The Laryngoscope, EarlyView.
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Allergic phenotype of chronic rhinosinusitis based on radiologic pattern of disease
The Laryngoscope, EarlyView.
https://ift.tt/2GrXJHN
Transoral resection of extensive pediatric supraglottic neurofibroma
The Laryngoscope, EarlyView.
https://ift.tt/2GK7vsq
Optimizing outcomes with polymethylmethacrylate fillers
Journal of Cosmetic Dermatology, EarlyView.
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Biologics for pityriasis rubra pilaris treatment: a review of the literature
Pityriasis rubra pilaris (PRP) is a rare inflammatory papulosquamous skin disease, often refractory to conventional therapies. The off-label use of biologics, such as anti-TNF, -IL-12/IL-23, -IL-17 agents, has been proven successful, in the last two decades, in PRP treatment.Our aim was to analyse the literature for the use of biologics in PRP treatment. We conducted a review by "Pubmed" and "clinicaltrial.gov" searches. 68 articles met our selection criteria and were herein discussed. Out of 86 PRP patients, the vast majority of which treated with anti-TNF, -IL-12/IL-23, and -IL-17 biologics, either alone or in combination therapy, a marked-to-complete response (50-78%), a partial response (11-25%) or no/poor response (11-25%) was observed.
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Dual neutralization of both IL-17A and IL-17F with bimekizumab in patients with psoriasis: results from BE ABLE 1, a 12-week randomized, double-blinded placebo-controlled phase 2b trial
Neutralizing interleukin (IL)-17F in addition to IL-17A may provide a more complete and specific approach to inhibiting inflammation.
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Flu Shots for Kids | Is it Too Late?
Though spring is here and the number of influenza cases are on the decline, it's not too late for your kids to receive the flu vaccine. The flu vaccine is still beneficial and reduces your little one's chances of becoming sick. Here's why your kids should get the vaccine and what you should do if they start experiencing influenza symptoms.
The post Flu Shots for Kids | Is it Too Late? appeared first on ChildrensMD.
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How to treat whiteheads on the nose
Whiteheads are stubborn acne lesions that develop just under the skin. The nose is a common site for whiteheads to form, as this part of the face produces a lot of oil and is touched frequently throughout the day. We look at several ways to treat whiteheads on the nose, as well as how to prevent them in the future.
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Comparison of MRI in pediatric cochlear implant recipients with and without retained magnet
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): Walker Brian, Norton Susan, Phillips Grace, Christianson Erin, Horn David, Ou Henry
ObjectiveTo report and compare medical, radiological, and audiological outcomes in pediatric cochlear implant recipients who underwent 1.5 and 3 Tesla strength MRI with and without retained magnet.MethodsRetrospective chart review at a tertiary care pediatric hospital and review of literature. Patients were identified via electronic medical records database search and were included if they had MRI after cochlear implant.ResultsOf twelve instances of MRI in pediatric cochlear implant recipients at our institution, two minor complications and one major complication were recorded. The rate of complication was equal between patients who underwent MRI with and without retained magnet. All minor complications resulted from MRI with retained magnet whereas the only major complication resulted from magnet removal. Two novel complications are reported, including: magnet removal resulting in silastic tear necessitating reimplantation and magnet dislocation with spontaneous reduction. Magnet removal significantly decreased the size of artifact, but did not alter the diagnostic utility of the MRI. While audiological measures varied chronologically from MRI scans, they did not appear to be appreciably altered by MRI.ConclusionMRI with and without magnet retention appear to carry risks of both major and minor complications. For the regions of interest for each scan, MRI quality was not appreciably altered by magnet status. Audiological measures appear unaffected by magnet status during MRI however, this may reflect natural variation.
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Oncologic outcomes of surgical treatment for T3 glottic laryngeal squamous cell carcinoma
Head &Neck, EarlyView.
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New MRI Biomarkers in Head and Neck Cancers
Condition: Head and Neck Cancer
Intervention: Other: MRI examinations
Sponsor: Memorial Sloan Kettering Cancer Center
Recruiting
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Intervention: Other: MRI examinations
Sponsor: Memorial Sloan Kettering Cancer Center
Recruiting
https://ift.tt/2pNJmrd
Combat zone exposure and respiratory tract disease
International Forum of Allergy &Rhinology, EarlyView.
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Lacrimal sac exposure and a superior lateral anterior pedicle flap to improve outcomes of Draf type II and III procedures
International Forum of Allergy &Rhinology, EarlyView.
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Comparing the efficacy of Silastic and gloved‐Merocel middle meatal spacers for functional endoscopic sinus surgery: a randomized controlled trial
International Forum of Allergy &Rhinology, EarlyView.
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High-dose thiamine and essential tremor
Essential tremor is a common neurological disease. The medical treatment of this affection currently involves the use of propranolol, primidone and other drugs. These drugs, however, are often not effective in reducing tremor and cause side effects in a large share of the patients treated. The treatment with intramuscular high-dose thiamine has led to a rapid, remarkable and persistent improvement of the symptoms in two patients with essential tremor. This result suggests the possibility that high doses of intramuscular thiamine may be an affordable alternative, highly effective and long-lasting medical treatment that has shown no relevant side effect.
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Acute brainstem compression
Description
A 34-year-old African woman, whose medical history was unremarkable, presented to the emergency room with severe headache and vomiting. Temperature, blood cells count, plasma electrolytes and chest X-ray were normal. Clinical conditions were rapidly deteriorating and neurological exam disclosed drowsiness, opisthotonus and decerebrate response to pain. Brain CT scan showed a 'full' posterior fossa, mild supratentorial hydrocephalus and herniation of cerebellar tonsils: after contrast, a nodule with ring enhancement and conspicuous perilesional oedema was disclosed in the right cerebellar hemisphere.
The patient was given diuretics and steroids with no success. Since the neurological conditions were worsening, a neurosurgical operation was then performed in emergency: posterior fossa was decompressed, the cerebellar nodular lesion was removed en bloc with microsurgical technique and a transient ventricular drain was placed. Neurological conditions promptly recovered after surgery.
Possible differential diagnosis:
Metastasis
Pyogenic abscess
Primitive brain tumour
Abscess from non-pyogenic agents.
...https://ift.tt/2pQmKGj
Rapid onset of multiple concurrent squamous cell carcinomas associated with the use of an arsenic-containing traditional medicine for chronic plaque psoriasis
We report a case of a 46-year-old Vietnamese man who developed widespread, numerous and concurrent cutaneous squamous cell carcinomas (SCCs) in non-sun exposed skin areas after taking a traditional medicine (TM) formulation for chronic plaque psoriasis. The SCC lesions began to develop within 12–15 months after beginning the arsenic-containing TM. The patient experienced both acute and chronic symptoms consistent with arsenic exposure. Laboratory investigation of a collected hair sample showed a significant arsenic level. The TM formulation used by the patient was tested and demonstrated an extremely high concentration of arsenic.
https://ift.tt/2IgXikm
Beckwith-Weidemann syndrome with IC2 (KvDMR1) hypomethylation defect: a novel mutation
The Beckwith-Wiedemann syndrome (BWS) is a rare genetic syndrome. However, this is one of the most common overgrowth syndromes. This is a genetically and clinically heterogeneous syndrome. Here, we report a case of Beckwith-Weidemann syndrome without macrosomia, visceromegaly and hemihyperplasia but having macroglossia, omphalocele and anterior linear ear lobe creases. The diagnosis was confirmed by gene analysis suggestive of imprinting centre 2 (KvDMR1) hypomethylation defect.
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Proximal tibiofibular joint dislocation treated using flexible and permanent syndesmosis fixation
We present the case of a 40-year-old man who suffered an isolated proximal tibiofibular dislocation of the left knee after a trauma during a soccer game. Physical examination and radiographic imaging revealed an anterolateral dislocation of the proximal fibula. The diagnosis was confirmed by MRI. The treatment choice was open reduction and internal fixation under direct visualisation using flexible and permanent internal fixation. Postoperative treatment includes knee immobilisation during the first week, and partial weight was allowed for 2 weeks progressing to full weight bearing over 4 weeks. The patient started a gradual and progressive physical therapy programme with range of motion exercises, muscle strengthening and gait training. Full knee range of motion was achieved after 4 weeks. No complaint of pain or hardware discomfort was reported, and the patient is back to daily life and sports activities after 6 months of surgical treatment.
https://ift.tt/2IeLIWM
Childhood obesity in Mexico: social determinants of health and other risk factors
Approximately 50 million children and adolescents in Latin America are affected by the childhood obesity pandemic. We present the case of a 5-year-old Mexican girl with obesity and gastro-oesophageal reflux disease (GORD), in whom prenatal, lifestyle and environmental risk factors were identified. Here, we demonstrate how childhood obesity is rooted since pregnancy and the perinatal stage, and how the social determinants of health like unsafe outdoor conditions, lack of infrastructure to exercise and a suboptimal physical activity curriculum in government schools strongly influence the development and maintenance of childhood obesity and complicate management.
https://ift.tt/2pQA65y
Pseudotumor cerebri as the presentation of Lyme disease in a non-endemic area
Intracranial hypertension is a rare entity in prepubertal children, and its differential diagnosis includes a number of systemic diseases, drugs, vitamin deficiencies and excesses, and hereditary conditions. Infectious aetiology is rare. The case of a 9-year-old boy with intracranial hypertension secondary to acute neuroborreliosis is described. He presented with daily pulsatile frontotemporal headache, pallor, photophobia and phonophobia. His neurological examination revealed papilledema with no nuchal rigidity. The lumbar puncture showed increased pressure (50 cm H2O) and lymphocytic pleocytosis. Serum and cerebrospinal fluid (CSF) Borrelia burgdorferi antibodies were positive. This kind of infection is rare in Portugal but a trip to an endemic area was identified. A careful history, considering the exposure to rural areas together with the intracranial hypertension and inflammatory CSF, are important clues to the diagnosis, allowing the institution to select appropriate treatment.
https://ift.tt/2GoYce3
Essential thrombocytosis 40 years after splenectomy
Description
A 69-year-old man presented at our Department of Neurology in December 2016 with acute aphasia. His medical history was notable of splenectomy after a spleen rupture due to a car accident at the age of 25, a subarachnoidal haemorrhage (SAH) without evidence of cerebral aneurysm at the age of 35 and a non-ST elevation myocardial infarction at the age of 63. For this vascular event, a drug-eluting stent was placed into the ramus interventricularis anterior, followed by combined antiplatelet treatment for 2 years, and up to admission acetylsalicylic acid was given at a dose of 100 mg per day.
Now MRI revealed a left hemispheric ischaemic stroke (figure 1A). No major vascular risk factors were found. The only pathological finding was a thrombocytosis of 1700x103 per µL, reference value 150–450x103 per µL. A post-splenectomy syndrome was suspected. However, previous thrombocyte levels as documented during the SAH...
https://ift.tt/2pQGj1j
Adult scurvy associated with psychiatric disorders and breast feeding
Scurvy is a nutritional disease caused by ascorbic acid deficiency and is potentially fatal. It was originally described in the 18th century by James Lind and associated with long sea voyages and insufficient citrus consumption. Its prevalence has declined markedly over the years but has still been described sporadically in certain countries. A 22-year-old woman with an anxiety disorder and anorexia nervosa, recent pregnancy and ongoing breast feeding, presented with a 10-day history of spontaneous haematomas in the lower limbs, gingivorrhagia and fatigue. The examination was remarkable for signs of minor bleeding without haemodynamic compromise, gonalgia and pale skin. Work-up studies revealed the presence of anaemia. Direct anamnesis identified a diet based solely of tea and carbohydrates due to distorted body image. With the working diagnosis of scurvy, nutritional support and oral vitamin C supplementation was initiated. Her symptoms and anaemia resolved in 30 days and the diagnosis was confirmed biochemically.
https://ift.tt/2Goj2u2
Apixaban-induced subdural bleeding: case presentation and literature review
Apixaban is a factor Xa inhibitor which is a non-vitamin K dependent oral anticoagulant known tocause the lowest rate of intracranial bleeding among the same kind of inibitors. In this paper, we report a rare case in a 60-year-old man with a history of hypertension and oligodendroglioma on apixaban for deep venous thrombosis who presented to our hospital with decreased level of consciousness and slurred speech with rapid deterioration. We highlight the risk of subdural bleeding requiring immediate neurosurgical intervention due to apixaban, with literature review.
https://ift.tt/2pPrHPS
Synovial sarcoma of the transverse colon: a rare cause of intussusception
We report a third case of a primary intramural synovial sarcoma of the lower gastrointestinal tract. A 50-year-old woman presented with hematochezia, dizziness and shortness of breath. CT imaging revealed a transverse colo-colonic intussusception with a colonic mass serving as a lead point. A subtotal colectomy was performed with oncologic resection of a sausage-like mass in the mid-transverse colon. Pathological assessment showed a biphasic synovial sarcoma. The postoperative hospital course was without complications and the patient was discharged home with plans for postoperative surveillance.
https://ift.tt/2Ihyvwe
Postoperative Facial Baroparesis While Flying: A Rare Complication of Decompressing a Facial Nerve Schwannoma.
Postoperative Facial Baroparesis While Flying: A Rare Complication of Decompressing a Facial Nerve Schwannoma.
JAMA Otolaryngol Head Neck Surg. 2018 Mar 29;:
Authors: Kung RW, Roche JP, Gantz BJ
PMID: 29596587 [PubMed - as supplied by publisher]
https://ift.tt/2IjvzzA
Pulsatile Tinnitus With Imaging.
Pulsatile Tinnitus With Imaging.
JAMA Otolaryngol Head Neck Surg. 2018 Mar 29;:
Authors: Truesdale CM, El-Kashlan HK
PMID: 29596564 [PubMed - as supplied by publisher]
https://ift.tt/2J8xwzR
Tubular Neck Mass.
Tubular Neck Mass.
JAMA Otolaryngol Head Neck Surg. 2018 Mar 29;:
Authors: McSpadden RP, Orsini M, Higgins K
PMID: 29596558 [PubMed - as supplied by publisher]
https://ift.tt/2pSOkD1
Standardized Margin Assessment Is Needed Before Implementing Negative Margin as a Quality Measure.
Standardized Margin Assessment Is Needed Before Implementing Negative Margin as a Quality Measure.
JAMA Otolaryngol Head Neck Surg. 2018 Mar 29;:
Authors: Duvvuri U, Johnson JT, Chiosea SI
PMID: 29596555 [PubMed - as supplied by publisher]
https://ift.tt/2Idy46s
A Novel Approach to the National Resident Matching Program-The Star System.
A Novel Approach to the National Resident Matching Program-The Star System.
JAMA Otolaryngol Head Neck Surg. 2018 Mar 29;:
Authors: Salehi PP, Benito D, Michaelides E
PMID: 29596554 [PubMed - as supplied by publisher]
https://ift.tt/2IingE5
Thyroidectomy Practice After Implementation of the 2015 American Thyroid Association Guidelines on Surgical Options for Patients With Well-Differentiated Thyroid Carcinoma.
Thyroidectomy Practice After Implementation of the 2015 American Thyroid Association Guidelines on Surgical Options for Patients With Well-Differentiated Thyroid Carcinoma.
JAMA Otolaryngol Head Neck Surg. 2018 Mar 29;:
Authors: Hirshoren N, Kaganov K, Weinberger JM, Glaser B, Uziely B, Mizrahi I, Eliashar R, Mazeh H
Abstract
Importance: The recommended extent of surgery for well-differentiated thyroid carcinoma has been modified considerably in the updated 2015 American Thyroid Association guidelines published in January 2016. To date, the changes in clinical practice after publication of these new guidelines have not been demonstrated.
Objective: The aim of this study was to evaluate clinical practice changes associated with implementation of the updated guidelines on the surgical procedure rates of total thyroidectomy, thyroid lobectomy, and completion thyroidectomy at a single tertiary medical center.
Design, Setting, and Participants: This is a retrospective cohort study of 169 patients at the Hadassah-Hebrew University Medical Center, Jerusalem, Israel. Patients with pathologically proved, well-differentiated thyroid carcinoma who underwent surgery between January 1, 2013, and December 31, 2014, were compared with patients who underwent surgery from January 1 to December 31, 2016. A total of 434 thyroidectomy procedures were performed during the study period, and 251 had pathologically proved, well-differentiated thyroid carcinoma. Patients with tumors larger than 4 cm, involved lymph nodes, or bilateral nodules were excluded.
Main Outcomes and Measures: Primary outcomes were the rate of up-front total thyroidectomy vs lobectomy and the rates of completion thyroidectomy before and after the implementation of the new guidelines.
Results: Of the 169 patients in the final analysis, 118 (69.8%) were included from 2013 to 2014 and 51 (30.2%) in 2016. The mean (SD) age for the entire cohort was 44 (13.8) years, and 129 (76.3%) were women. Up-front total thyroidectomy was performed in 72 of 118 patients (61.0%) prior to the 2015 American Thyroid Association guidelines and 16 of 51 (31.4%) following their implementation (odds ratio, 0.29; 95% CI, 0.14-0.59). The rate of completion thyroidectomy also significantly decreased between these periods (73.9% vs 20.0%; odds ratio, 0.09; 95% CI, 0.04-0.19).
Conclusions and Relevance: The updated 2015 American Thyroid Association guidelines implementation was associated with a significant decrease in the rates of both up-front total thyroidectomy and completion thyroidectomy. According to these findings, only 1 of 5 patients who undergoes thyroid lobectomy will require a completion procedure.
PMID: 29596551 [PubMed - as supplied by publisher]
https://ift.tt/2pQvHiX
Preoperative Facial Nerve Mapping to Plan and Guide Pediatric Facial Vascular Anomaly Resection.
Preoperative Facial Nerve Mapping to Plan and Guide Pediatric Facial Vascular Anomaly Resection.
JAMA Otolaryngol Head Neck Surg. 2018 Mar 29;:
Authors: Bly RA, Holdefer RN, Slimp J, Kinney GA, Martinez V, Manning SC, Perkins JA
Abstract
Importance: Facial vascular anomalies are surgical challenges due to their vascularity and facial nerve distortion. To assist facial vascular anomaly surgical treatment, presurgical percutaneous facial nerve stimulation and recording of compound motor action potentials can be used to map the facial nerve branches. During surgery, the nerve map and continuous intraoperative motor end plate potential monitoring can be used to reduce nerve injury.
Objective: To investigate if preoperative facial nerve mapping (FNM) is associated with intraoperative facial nerve injury risk and safe surgical approach options compared with standard nerve integrity monitoring (NIM).
Design, Setting, and Participants: This investigation was a historically controlled study at a tertiary vascular anomaly center in Seattle, Washington. Participants were 92 pediatric patients with facial vascular anomalies undergoing definitive anomaly surgery (from January 1, 1999, through January 1, 2015), with 2 years' follow-up. In retrospective review, a consecutive FNM patient cohort after 2005 (FNM group) was compared with a consecutive historical cohort (1999-2005) (NIM group).
Main Outcomes and Measures: Postoperative facial nerve function and selected surgical approach. For NIM and FNM comparisons, statistical analysis calculated odds ratios of nerve injury and operative approach, and time-to-event methods analyzed operative time.
Results: The NIM group had 31 patients (median age, 3.3 years [interquartile range, 2.2-11.4 years]; 20 [65%] male), and the FNM group had 61 patients (median age, 4.4 years [interquartile range, 1.5-11.0 years]; 26 [43%] male). In both groups, lymphatic malformation resection was most common (19 of 31 [61%] in the NIM group and 32 of 61 [52%] in the FNM group), and the median anomaly volumes were similar (52.4 mL; interquartile range, 12.8-183.3 mL in the NIM group and 65.4 mL; interquartile range, 18.8-180.2 mL in the FNM group). Weakness in the facial nerve branches at 2 years after surgery was more common in the NIM group (6 of 31 [19%]) compared with the FNM group (1 of 61 [2%]) (percentage difference, 17%; 95% CI, 3%-32%). Anterograde facial nerve dissection was used more in the NIM group (27 of 31 [87%]) compared with the FNM group (28 of 61 [46%]) (percentage difference, 41%; 95% CI, 24%-58%). Treatment with retrograde dissection without identification of the main trunk of the facial nerve was performed in 21 of 61 (34%) in the FNM group compared with 0 of 31 (0%) in the NIM group. Operative time was significantly shorter in the FNM group, and patients in the FNM group were more likely to complete surgery sooner (adjusted hazard ratio, 5.36; 95% CI, 2.00-14.36).
Conclusions and Relevance: Facial nerve mapping before facial vascular anomaly surgery was associated with less intraoperative facial nerve injury and shorter operative time. Mapping enabled direct identification of individual intralesional and perilesional nerve branches, reducing the need for traditional anterograde facial nerve dissection, and allowed for safe removal of some lesions after partial nerve dissection through transoral or direct excision.
PMID: 29596549 [PubMed - as supplied by publisher]
https://ift.tt/2Igv0X6
Standardized Margin Assessment Is Needed Before Implementing Negative Margin as a Quality Measure-Reply.
Standardized Margin Assessment Is Needed Before Implementing Negative Margin as a Quality Measure-Reply.
JAMA Otolaryngol Head Neck Surg. 2018 Mar 29;:
Authors: Schoppy DW, Divi V
PMID: 29596548 [PubMed - as supplied by publisher]
https://ift.tt/2pQvCvF
Patients with integrated HPV16 in head and neck cancer show poor survival
Publication date: May 2018
Source:Oral Oncology, Volume 80
Author(s): Tara J. Nulton, Nak-Kyeong Kim, Laurence J. DiNardo, Iain M. Morgan, Brad Windle
ObjectivesWe previously reported identifying three categories of HPV16-positive head and neck tumors based on The Cancer Genome Atlas (TCGA) RNA and DNA sequence data. Category 1 had truly integrated HPV16 genomes, category 2 had simple episomal genomes, and category 3 had novel episomes that were a hybrid between viral and human DNA. Using our categorization, we investigated in this study survival of patients with integrated HPV16 tumors versus patients with episomal HPV16 tumors.Materials and methodsThe TCGA RNA-Seq sequence reads were used to quantify HPV E2 and E7 gene expression, which was used as a marker for HPV integration.ResultsThe results demonstrate that integration is associated with poor survival; those patients with integrated HPV tumors fared no better than non-HPV tumors in their five-year survival. Integrated HPV in tumors was found strikingly to be prevalent in patients born earlier while episomal HPV was prevalent in patients born later. We also observed a fairly constant incidence of all HPV forms among head and neck cancer patients over the last eight years of this study (2006–2013).ConclusionWe propose our characterization of HPV integrated and episomal state is more accurate than previous studies that may have mischaracterized the hybrid HPV-human DNA episomes as integrated. The state of integrated HPV is associated with a poor clinical outcome. Results suggest that the incidence of integrated HPV among all HPV forms peaked and is decreasing. We discuss the importance of our findings for the management of HPV positive head and neck cancer.
https://ift.tt/2J8M0jo
The opioid epidemic and pregnancy: implications for anesthetic care
Purpose of review This review summarizes evolving knowledge regarding adverse maternal, fetal, and neonatal effects of opioid exposure during pregnancy, and current treatment options for opioid use disorder (OUD). Maternal and fetal implications of maternal opioid maintenance with methadone and buprenorphine are described. Finally, acute and chronic pain management strategies in opioid-tolerant parturients are reviewed. Recent findings Opioid use among parturients has risen dramatically, with opioid use during pregnancy as high as 20%. Of women with chronic pain, most continue to take opioids during pregnancy. Medication-assisted therapy with methadone or buprenorphine is currently the standard for treatment of opiate use disorder. Buprenorphine has unique pharmacologic properties that account for its preference over methadone. It has also been shown to produce more favorable neonatal outcomes compared with methadone. Increased clearance and volume of distribution associated with pregnancy require adjustment of dosing regimens of both medications. Multimodal adjuncts can be important alternatives for treatment of pain in opioid-tolerant parturients. Summary The dramatic rise in OUD in pregnancy has had staggering socioeconomic consequences, carrying with it profound maternal and fetal health problems. Medication-assisted treatment utilizing either methadone, or more commonly buprenorphine, is considered the standard of care for OUD during pregnancy. Peripartum pain management for opioid-tolerant patients is challenging and requires consideration for regional anesthesia along with multimodal pharmacotherapy. Correspondence to Michael G. Richardson, Division of Obstetric Anesthesiology, Department of Anesthesiology, 4202 VUH, Vanderbilt University Medical Center, Nashville, TN 37232-7580, USA. Tel: +1 615 322 8476; e-mail: Michael.g.richardson@vanderbilt.edu Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2pQoEH3
https://ift.tt/2pQoEH3
Drug error in paediatric anaesthesia: current status and where to go now
Purpose of review Medication errors in paediatric anaesthesia and the perioperative setting continue to occur despite widespread recognition of the problem and published advice for reduction of this predicament at international, national, local and individual levels. Current literature was reviewed to ascertain drug error rates and to appraise causes and proposed solutions to reduce these errors. Recent findings The medication error incidence remains high. There is documentation of reduction through identification of causes with consequent education and application of safety analytics and quality improvement programs in anaesthesia departments. Children remain at higher risk than adults because of additional complexities such as drug dose calculations, increased susceptibility to some adverse effects and changes associated with growth and maturation. Major improvements are best made through institutional system changes rather than a commitment to do better on the part of each practitioner. Summary Medication errors in paediatric anaesthesia represent an important risk to children and most are avoidable. There is now an understanding of the genesis of adverse drug events and this understanding should facilitate the implementation of known effective countermeasures. An institution-wide commitment and strategy are the basis for a worthwhile and sustained improvement in medication safety. Correspondence to Professor Brian J. Anderson, PhD, FANZCA, FCICM, Department of Anaesthesiology, University of Auckland, Faculty of Medical and Health Sciences, Auckland 1023, New Zealand. Tel: +64 9 3074903; fax: +64 9 3078986; e-mail: briana@adhb.govt.nz Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2GoD1Zw
https://ift.tt/2GoD1Zw
Developing drugs for treatment of atopic dermatitis in children (≥3 months to <18 years of age): Draft guidance for industry
Pediatric Dermatology, EarlyView.
https://ift.tt/2pQTY8F
Hyper‐immunoglobulin D syndrome with novel mutations in an afebrile infant
Pediatric Dermatology, EarlyView.
https://ift.tt/2IglpPW
Evolution in the Surgical Management of Chronic Rhinosinusitis: Current Indications and Pitfalls
Publication date: Available online 29 March 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Michael A. Kohanski, Elina Toskala, David W. Kennedy
Chronic rhinosinusitis (CRS) consists of a range of inflammatory conditions in the sinuses that may result in clinical symptoms and the underlying pathophysiology and its relationship to lower airway disease is complex. Current definitions of CRS may serve more as an indication for potential surgical intervention rather than a marker of disease state. CRS can be asymptomatic and may require medical management to avoid disease progression and to minimize the risk of lower airway disease. Endoscopic surgery has undergone a significant evolution and refinement but the most common surgical complication remains persistent inflammation and recurrence of disease. It is important to recognize that surgery alone rarely cures CRS and patients require long-term medical therapy for continued asymptomatic inflammation. Careful post-operative care and endoscopic follow-up to ensure resolution of inflammation is key to ensuring optimal surgical outcomes and reduce the risk of revision surgery. Future work on CRS endotypes will allow for discovery of new therapies to treat CRS as well as refine indications for medical or surgical intervention as well as post-operative care.
https://ift.tt/2E6dL8x
The association between Helicobacter pylori infection and the risk of advanced colorectal neoplasia may differ according to age and cigarette smoking
Helicobacter, EarlyView.
https://ift.tt/2Gjdfty
Application of precision medicine to the treatment of anaphylaxis
Purpose of review Recognize the presentation of anaphylaxis for prompt management and treatment and to provide tools for the diagnosis of the underlying cause(s) and set up a long-term treatment to prevent recurrence of anaphylaxis. Recent findings The recent description of phenotypes provides new insight and understanding into the mechanisms and causes of anaphylaxis through a better understanding of endotypes and biomarkers for broad clinical use. Summary Anaphylaxis is the most severe hypersensitivity reaction and can lead to death. Epinephrine is the first-line treatment of anaphylaxis and it is life-saving. Patients with first-line therapy-induced anaphylaxis are candidates for desensitization to increase their quality of life and life expectancy. Desensitization is a breakthrough novel treatment for patients with anaphylaxis in need of first-line therapy, including chemotherapy, mAbs, aspirin and others. Ultrarush with venom immunotherapy should be considered in patients who present with life-threatening anaphylaxis after Hymenoptera sting with evidence of IgE-mediated mechanisms. Food desensitization is currently being expanded to provide increased safety to adults and children with food-induced anaphylaxis. Correspondence to Mariana Castells, MD, PhD, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, The Building for Transformative Medicine, 5th floor, Room 5002N, 60 Fenwood Road, Boston, MA 02115, USA. Tel: +1 617 525 1265; fax: +1 617 525 1310; e-mail: mcastells@bwh.harvard.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2J6qegf
https://ift.tt/2J6qegf
How to diagnose food allergy
Purpose of review To assess the recent studies that focus on specific immunoglobulin E (sIgE) testing and basophil activation test (BAT) for diagnosing IgE-mediated food allergies. Recent findings The sIgE to allergen extract or component can predict reactivity to food. The cutoff value based on the positive predictive value (PPV) of sIgE can be considered whenever deciding whether oral food challenge (OFC) is required to diagnose hen's egg, cow's milk, wheat, peanut, and cashew nut allergy. However, PPV varies depending on the patients' background, OFC methodology, challenge foods, and assay methodology. Component-resolved diagnostics (CRD) has been used for food allergy diagnosis. Ovomucoid and omega-5 gliadin are good diagnostic markers for heated egg and wheat allergy. More recently, CRD of peanut, tree nuts, and seed have been investigated. Ara h 2 showed the best diagnostic accuracy for peanut allergy; other storage proteins, such as Jug r 1 for walnut, Ana o 3 for cashew nut, Ses i 1 for sesame, and Fag e 3 for buckwheat, are also better markers than allergen extracts. Some studies suggested that BAT has superior specificity than skin prick test and sIgE testing. Summary The sIgE testing and BAT can improve diagnostic accuracy. CRD provides additional information that can help determine whether OFCs should be performed to diagnose food allergy. Correspondence to Sakura Sato, MD, Department of Allergy, Clinical Research Center for Allergology and Rheumatology, Sagamihara National Hospital, 18-1 Sakuradai, Minami-ku, Sagamihara, Kanagawa 252-0392, Japan. Tel: +81 42 742 8311; fax: +81 42 742 5314; e-mail: s-satou@sagamihara-hosp.gr.jp Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2J5vOz7
https://ift.tt/2J5vOz7
How to predict and improve prognosis of food allergy
Purpose of review The prevalence of food allergy is increasing. More children are being diagnosed with food allergies, and it is taking longer to outgrow them, among those who develop tolerance. The aim of this review is to draw the profile of the persistent food allergic, so that prevention strategies can be developed and active treatment set up. Recent findings Many determinants are involved in food allergy prognosis: ethnicity and sex, type of food, innate immune system, eliciting dose, sensitization status and other biomarkers determination, gut microbiome composition, and the presence of comorbidities. Once identified, a persistent food allergy could be conveyed to active treatments, such as oral immunotherapy or the use of biologics, always taking into account their experimental nature. Summary A better understanding of prognostic factors and phenotypes of food allergy is crucial in decision-making when it comes to food allergy prevention and management. A good classification of the allergic patient allows to determine the degree of exclusion diets and the timing of the reintroduction of avoided food when possible. In the cases of persistent and severe food allergy, many promising interventions are emerging which could improve prognosis and quality of care. Correspondence to Lamia Dahdah, MD, University Department of Pediatrics, Division of Allergy, Pediatric Hospital Bambino Gesù, Piazza di Sant'Onofrio 4, Rome 00100, Vatican City, Italy. Tel: +39 046 6859 4777; fax: +39 046 6859 2020; e-mail: lamiaantanios.dahdah@opbg.net Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2pShNMF
https://ift.tt/2pShNMF
Phenotypes/endotypes-driven treatment in asthma
Purpose of review Target therapy is the necessary step towards personalized medicine. The definition of asthma phenotypes and underlying mechanisms (endotypes) represent a key point in the development of new asthma treatments. Big data analysis, biomarker research and the availability of monoclonal antibodies, targeting specific cytokines is leading to the rapid evolution of knowledge. In this review, we sought to outline many of the recent advances in the field. Recent findings Several attempts have been made to identify asthma phenotypes, sometimes with contrasting results. More success has been obtained concerning the pathogenetic mechanism of specific asthma patterns with the consequent identification of biomarkers and development of effective ad hoc treatment. Summary We are in the middle of an extraordinary revolution of our mode of thinking about and approaching asthma. All the effort in the identification of clusters of patients with different disease clinical patterns, prognosis and response to treatment is closely linked to the identification of endotypes (Th2-low and Th2-high). This approach has allowed the development of the specific treatments (anti IgE, Anti IL5 and IL5R) that are now available and is leading to new ones. Correspondence to Angelica Tiotiu, MD, PhD, Pulmonology Department, CHRU Nancy, EA 3450 DevAH – Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, University of Lorraine, 9 Avenue de la Forêt de Haye, F- 54505 – Vandoeuvre-les-Nancy, France. Tel: +33 3 83 15 43 72; fax: +33 3 83 15 35 41; e-mail: a.tiotiu@chru-nancy.fr Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2J6hyq2
https://ift.tt/2J6hyq2
How to prevent food allergy during infancy: what has changed since 2013?
Purpose of review The purpose of this review is to summarize recent studies and emerging consensus guidelines regarding food allergy prevention in infants of the past 5 years. Recent findings Prior to 2013, the general consensus regarding prevention of food allergy in infants was to recommend delayed introduction or complete avoidance of commonly allergenic foods, such as milk, egg and peanut. However, in the past 5 years, several landmark studies have been conducted, particularly with peanut. The results of these studies have led to a paradigm shift from recommending delayed introduction to early introduction and frequent feeding of highly allergenic foods such as peanut, with hopes of achieving primary and secondary prevention of food allergy in infants. Summary Recent clinical trials have demonstrated that early introduction and frequent feeding, rather than delayed introduction or complete avoidance, of commonly allergenic foods plays a critical role in preventing food allergy in infants. More studies are required to risk-stratify infants by personal and family atopic history to tailor guidelines for groups with inherently different risks. The universal acceptance of the guidelines and their application outcome are still to be determined. Correspondence to Amal Assa'ad, MD, Professor of Pediatrics, Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Mail Location 2000, Cincinnati, OH 45229, USA. Tel: +1 513 636 6771; fax: +1 513 636 5835; e-mail: amal.assaad@cchmc.org Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2pShGRf
https://ift.tt/2pShGRf
Kite surfing: epidemiology of trauma
Kite surfing has become an increasingly popular recreational activity worldwide. Thrill seekers can span the water at high speeds and reach great heights risking injury and death. We report the case of a young kite surfer who sustained a fracture dislocation of the right acetabulum that required specialised surgical management. We present this case with a review of the literature outlining the incidence of pelvic and acetabular fractures in the kitesurfing community. Overall, there is a low incidence of pelvic fractures in comparison with other orthopaedic traumas reported among kite surfers, and the most commonly injured sites are the foot and ankle. Emergency departments should be alert to this activity and its associated injury patterns due to its ever-increasing popularity.
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Amelanotic melanoma: a unique case study and review of the literature
Amelanotic melanoma (AM) is a rare form of melanoma which lacks visible pigment. Due to the achromic manifestation of this atypical cutaneous malignancy, it has been difficult to establish clinical criteria for diagnosis. Thus, AM often progresses into an invasive disease due to delayed diagnosis. In this report, we describe the case of a 72-year-old Caucasian woman who had been diagnosed with AM after 3 years of failed treatments for what presented as a periorbital dermatitis. Her Clark's level 4, 1.30 mm thick melanoma required nine surgeries for successful resection and reconstruction. This case exemplifies the diagnostic pitfall of AM and the need for new criteria for early detection and management.
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