Head &Neck, EarlyView.
https://ift.tt/2HKpzAQ
Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Τρίτη 17 Απριλίου 2018
Pretreatment neurocognitive function and self‐reported symptoms in patients with newly diagnosed head and neck cancer compared with noncancer cohort
Chemokine Receptor 5 Has No Major Role in the Severity of Hepatitis C Virus-Related Liver Damage
Viral Immunology, Ahead of Print.
https://ift.tt/2H88mnF
Characterisation of DOG-1 Expression in Salivary Gland Tumours and Comparison with Myoepithelial Markers
Abstract
DOG1 is an established diagnostic marker for gastrointestinal stromal tumours (GIST), but has been reported in salivary gland tumours (SGT) as an acinar and intercalated duct marker. However, its specificity and distribution is not well established. The aim of this study was to evaluate the diagnostic utility of DOG-1 expression in SGT in addition to comparing it with myoepithelial markers. Normal salivary tissue and SGT (n = 184) were examined for expression of DOG1 and a range of myoepithelial markers. SGT included: acinic cell carcinoma (ACC, n = 15), secretory carcinoma (SC, n = 9), pleomorphic adenoma (PA, n = 49), carcinoma ex-PA (Ca ex-PA, n = 11), adenoid cystic carcinoma (AdCC, n = 20), polymorphous adenocarcinoma (PAC, n = 6), myoepithelioma (n = 6), myoepithelial carcinoma (MC, n = 2), basal cell adenoma (BCA, n = 14), canalicular adenoma (CA, n = 19), mucoepidermoid carcinoma (MEC, n = 11), oncocytoma (n = 2), adenocarcinoma NOS (AdNOS, n = 4), basal cell adenocarcinoma (BCAC, n = 2), salivary duct carcinoma (SDC, n = 3) and papillary cystadenocarcinoma (PCAC, n = 1). Normal acini and ACC (14/15) showed strong luminal DOG1 staining; SC were largely negative with only focal expression in 3/9 cases. Luminal staining was seen in PA (14/49), PAC (4/6), Ca ex-PA (4/11) and AdCC (6/20). 8/11 MEC showed luminal and/or mucous cell staining. No staining was seen in myoepithelioma, MC, CA, adNOS and BCAC. BCA showed strong staining of myoepithelial cells in some cases (5/14). Variable myoepithelial DOG1 staining was seen in PA, Ca ex PA, BCA, SDC and PCAC which was not as consistent as myoepithelial markers such as calponin, p63 and αSMA. Absence of DOG1 can differentiate ACC from SC, but staining is variable in PA, PLGA and Ca ex-PA. Myoepithelial staining in some tumours but not in normal gland suggests a wider distribution in SGT than originally envisaged.
https://ift.tt/2H7hHw5
Fungal Suppurative Otitis Media (Histopathology) Among Patients in North India
Abstract
Chronic suppurative otitis media (CSOM) has a substantial worldwide prevalence and is a major cause of hearing impairment. In cases of CSOM unresponsive to local antibiotics, superimposed fungal infection should be suspected. The aim of the present study was to study the spectrum of cases with fungal otitis media. The study was conducted over a period of 12 years (2006–2017). Fifteen cases of CSOM clinically not suspected to be of fungal etiology that underwent surgery with identification of fungal organisms on histopathology were included in the study. Age of the patients ranged from 12 to 75 years (mean age: 37.1 ± 22.7 years). Of 15 cases, 9 (60.0%) were males and 6 (40.0%) were females. It was a unilateral presentation in all. The complaints observed were ear discharge in all followed by itching (86.7%), pain (46.7%), decreased hearing (26.7%) and blocking sensation (13.3%). Histomorphologic typing of fungus was possible in 13/15 patients. Isolated aspergillus was identified in eight patients while mucor alone was seen in three patients. Mixed infection with Aspergillus + Candida and Aspergillus + Mucor was seen in one patient each. Categorization of fungus could not be done in rest of the two patients due to paucity of fungal profiles. Histopathological identification of fungal organisms in otomycosis provides a quick and fairly reliable diagnosis. Culture is considered the gold standard but it may not always be available or fruitful. Less turnaround time and accurate diagnosis facilitates prompt and optimal therapy in fungal otitis media thus preventing adverse outcomes.
https://ift.tt/2qHaOq5
Sternocleidomastoid Flap in Parotid Surgery: A Case Series
Abstract
Superficial and deep parotidectomies are known treatments for benign and malignant neoplasms of parotid glands. Due to the gland's proximity to facial nerve and other vital structures, this surgery carries the highest risk of facial nerve palsy. Another frequently overlooked complication, which can be detrimental to patient's life style is Frey's syndrome, or gustatory sweating. Other complications include flap necrosis and various contour deformities. We conducted this study on a group of 40 patients of parotid swellings to assess usage of sternocleidomastoid flap in prevention of Frey's syndrome, contour deformities, flap necrosis, salivary fistula and drain related injuries. We divided the patients in two groups based on the usage of sternomastoid flap. In Group A, the patients underwent superficial or total parotidectomies with a partial thickness, superiorly based sternomastoid flap. In Group B, no sternomastoid flap was placed. The incidence of Frey's syndrome was seen to be 3 times in Group B, while a visible contour deformity was seen in a third of patients in Group B, with Group A reporting no incidence. Also Group A, did not see any cases of flap necrosis or salivary fistula, while Group B saw 3 and 2 cases respectively. Also, among the two revision cases done in Group A, the one with previously placed sternomastoid flap (done by us 3 years back) had an excellent plane preserved, while another revision case without sternomastoid flap saw a complete adherence of facial nerve to overlying skin, resulting in Grade II permanent facial palsy. Parotidectomy is a technically challenging surgery in regards to important structures in the vicinity. Even with ostensibly perfect technique, facial nerve injury can occur for unknown reasons. All in all, sternomastoid flap is an acceptable modality to fill the parotidectomy defect, improve the facial contour and reduce the incidences of Frey's syndrome and skin necrosis.
https://ift.tt/2qCN6eG
Sternocleidomastoid Flap in Parotid Surgery: A Case Series
Abstract
Superficial and deep parotidectomies are known treatments for benign and malignant neoplasms of parotid glands. Due to the gland's proximity to facial nerve and other vital structures, this surgery carries the highest risk of facial nerve palsy. Another frequently overlooked complication, which can be detrimental to patient's life style is Frey's syndrome, or gustatory sweating. Other complications include flap necrosis and various contour deformities. We conducted this study on a group of 40 patients of parotid swellings to assess usage of sternocleidomastoid flap in prevention of Frey's syndrome, contour deformities, flap necrosis, salivary fistula and drain related injuries. We divided the patients in two groups based on the usage of sternomastoid flap. In Group A, the patients underwent superficial or total parotidectomies with a partial thickness, superiorly based sternomastoid flap. In Group B, no sternomastoid flap was placed. The incidence of Frey's syndrome was seen to be 3 times in Group B, while a visible contour deformity was seen in a third of patients in Group B, with Group A reporting no incidence. Also Group A, did not see any cases of flap necrosis or salivary fistula, while Group B saw 3 and 2 cases respectively. Also, among the two revision cases done in Group A, the one with previously placed sternomastoid flap (done by us 3 years back) had an excellent plane preserved, while another revision case without sternomastoid flap saw a complete adherence of facial nerve to overlying skin, resulting in Grade II permanent facial palsy. Parotidectomy is a technically challenging surgery in regards to important structures in the vicinity. Even with ostensibly perfect technique, facial nerve injury can occur for unknown reasons. All in all, sternomastoid flap is an acceptable modality to fill the parotidectomy defect, improve the facial contour and reduce the incidences of Frey's syndrome and skin necrosis.
https://ift.tt/2qCN6eG
Association Between Voice Handicap Index and Praat Voice Analysis in Patients with Benign Vocal Cord Lesion Before and After Microscopic Laryngeal Surgery
Abstract
Benign vocal cord lesion is a benign mass formed in vocal cord in form of vocul nodule, vocal cord polyp, vocal cord cyst and vocal cord granuloma. Voice handicap index (VHI) is one of subjective voice analyses. This study aimed to analyse correlation between VHI score and praat voice analysis in benign vocal cord lesion before and after microscopic laryngeal surgery. This study was carried out from November 2009 to December 2010 at Outpatient Unit of Otorhinolaryngology, Head and Neck Surgery and Integrated Oncology Center of Dr. Soetomo General Hospital, Surabaya, Indonesia. Pearson's correlation test found a negative correlation between total VHI score with base frequency and harmonic-to-noise ratio (HNR) (r = − 0.186, p = 0.689; r = − 0.650, p = 0.114). On the other hand, there was a positive correlation between total VHI score with jitter and shimmer (r = 0.812, p = 0.027; r = 0.638, p = 0.123). It could be inferred that base frequency, shimmer and HNR after surgery had no significant correlation (p > 0.05), while VHI total score significantly correlated with jitter after surgery (p < 0.05). We found no correlation between VHI score and Praat voice analysis in patients with benign vocal cord lesion before and after surgery, except correlation between VHI functional subscale with HNR and VHI total score with jitter.
https://ift.tt/2HbM3xe
Correlation Between β-Catenin Expression and Staging in Nasopharyngeal Carcinoma Patients
Abstract
Nasopharyngeal carcinoma (NPC) is a malignant disease derived from nasopharyngeal epithelial cells that have a higher tendency for invasion and metastasis to the cervical lymph nodes than other head–neck malignancies. NPC patients with the same stages often show different progressions and prognoses. This suggests that clinical stages are not sufficient to predict progressivity, so biomarkers are required to provide better progression predictions. Some literature shows that the development and progression of NPC is a complex mechanism involving various components of signal paths, it plays a role in regulating the process of proliferation, angiogenesis and apoptosis. One of the most studied is β-catenin protein that is a key component of the canonical Wnt signal pathway. The β-catenin protein is reported to have roles in increasing the proliferative pathway of c-Myc and cyclin D1, increasing the expression of IL-8 proangiogenesis factor, decreasing expression of RASSF1A tumor suppressor and inhibiting apoptosis through the barriers of caspace-9 activity. To determine the association of β-catenin expression and staging in nasopharyngeal carcinoma patients. The research design used was analytic observational research with cross sectional approach. Samples were enrolled using consecutive sampling. The β-catenin expression was examined from the NPC tissue paraffin block with the immunohistochemical cracking technique, using an anti-β-catenin rabbit polyclonal antibody from Boster Biotechnology, California, USA. The β-catenin expression was assessed visually using a binocular light microscope and a scoring method according to the Allred scale index by an Anatomical Pathology consultant. Statistical analysis was performed using Spearman's test to determine the association between β-catenin expression and staging in NPC patients. The significance level was α = 0.05. The study was conducted from May to December 2015 at Otolaryngology Unit of Dr. Soetomo General Soetomo, Surabaya. There were 40 patients who fulfilled the inclusion criteria. Spearman test results obtained p value = 0.060. The correlation of β-catenin expression with staging in NPC patients was found to be non-significant (p > 0.05). There was no correlation between β-catenin expression and staging in NPC patients.
https://ift.tt/2qInWeD
Chronic respiratory rhinitis
Publication date: Available online 17 April 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): R. Jankowski, P. Gallet, D.T. Nguyen, C. Rumeau
The clinical distinction of chronic respiratory rhinitis appears to confirm the evo-devo theory of the three noses. The authors report two cases of advanced allergic rhinitis, in which chronic inflammation had induced a violaceous colour of the mucosa of the respiratory nose and a whitish polypoid appearance of the free edge of the middle turbinate. Nose and paranasal sinus CT scan revealed, beyond the virtual nasal cavities observed on nasal endoscopy and CT imaging, normal radiolucency or only minor opacities of the ethmoid (i.e. olfactory nose) and paranasal sinuses that could not explain the severity of the chronic nasal dysfunction. The hypothesis of non-allergic chronic respiratory rhinitis is developed according to these two observations. The differential diagnosis between chronic respiratory rhinitis and dysfunction of the cavernous plexuses of the respiratory nose is discussed. A precise diagnosis appears to be a prerequisite for appropriate and effective management. Surgery of the respiratory nose can associate septoplasty to inferior turbinoplasty, but must be preceded and combined with medical treatment adapted to the underlying inflammatory process.
https://ift.tt/2qEWNJC
Maxillofacial brown tumours: Series of 5 cases
Publication date: Available online 17 April 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): F. Antin, D. Bakhos, F. Jegoux, M. Merkouza, L. Laccourreye
ObjectivesBrown tumours are benign bone tumours secondary to hyperparathyroidism. The authors describe the various clinical features, diagnostic methods and treatment modalities for maxillofacial brown tumours.Material and methodsThis multicentre retrospective study comprised 5 patients (four women and one man, between the ages of 29 and 70 years) with one or several maxillofacial brown tumours observed over a 16-year period from January 2000 to December 2016.ResultsFour patients presented secondary hyperparathyroidism in a context of chronic renal failure, one patient presented primary hyperparathyroidism due to parathyroid adenoma. Three patients presented a mandibular brown tumour, and two patients presented a maxillary brown tumour. The diagnosis was based on histological examination and laboratory tests. Brown tumours were treated either surgically or conservatively. A favourable outcome was observed in all cases.ConclusionBrown tumours are rare lesions. This diagnosis must be considered in a context of giant cell tumour associated with hyperparathyroidism. Brown tumours should be treated conservatively.
https://ift.tt/2H6EHLr
Association Between Voice Handicap Index and Praat Voice Analysis in Patients with Benign Vocal Cord Lesion Before and After Microscopic Laryngeal Surgery
Abstract
Benign vocal cord lesion is a benign mass formed in vocal cord in form of vocul nodule, vocal cord polyp, vocal cord cyst and vocal cord granuloma. Voice handicap index (VHI) is one of subjective voice analyses. This study aimed to analyse correlation between VHI score and praat voice analysis in benign vocal cord lesion before and after microscopic laryngeal surgery. This study was carried out from November 2009 to December 2010 at Outpatient Unit of Otorhinolaryngology, Head and Neck Surgery and Integrated Oncology Center of Dr. Soetomo General Hospital, Surabaya, Indonesia. Pearson's correlation test found a negative correlation between total VHI score with base frequency and harmonic-to-noise ratio (HNR) (r = − 0.186, p = 0.689; r = − 0.650, p = 0.114). On the other hand, there was a positive correlation between total VHI score with jitter and shimmer (r = 0.812, p = 0.027; r = 0.638, p = 0.123). It could be inferred that base frequency, shimmer and HNR after surgery had no significant correlation (p > 0.05), while VHI total score significantly correlated with jitter after surgery (p < 0.05). We found no correlation between VHI score and Praat voice analysis in patients with benign vocal cord lesion before and after surgery, except correlation between VHI functional subscale with HNR and VHI total score with jitter.
https://ift.tt/2HbM3xe
Correlation Between β-Catenin Expression and Staging in Nasopharyngeal Carcinoma Patients
Abstract
Nasopharyngeal carcinoma (NPC) is a malignant disease derived from nasopharyngeal epithelial cells that have a higher tendency for invasion and metastasis to the cervical lymph nodes than other head–neck malignancies. NPC patients with the same stages often show different progressions and prognoses. This suggests that clinical stages are not sufficient to predict progressivity, so biomarkers are required to provide better progression predictions. Some literature shows that the development and progression of NPC is a complex mechanism involving various components of signal paths, it plays a role in regulating the process of proliferation, angiogenesis and apoptosis. One of the most studied is β-catenin protein that is a key component of the canonical Wnt signal pathway. The β-catenin protein is reported to have roles in increasing the proliferative pathway of c-Myc and cyclin D1, increasing the expression of IL-8 proangiogenesis factor, decreasing expression of RASSF1A tumor suppressor and inhibiting apoptosis through the barriers of caspace-9 activity. To determine the association of β-catenin expression and staging in nasopharyngeal carcinoma patients. The research design used was analytic observational research with cross sectional approach. Samples were enrolled using consecutive sampling. The β-catenin expression was examined from the NPC tissue paraffin block with the immunohistochemical cracking technique, using an anti-β-catenin rabbit polyclonal antibody from Boster Biotechnology, California, USA. The β-catenin expression was assessed visually using a binocular light microscope and a scoring method according to the Allred scale index by an Anatomical Pathology consultant. Statistical analysis was performed using Spearman's test to determine the association between β-catenin expression and staging in NPC patients. The significance level was α = 0.05. The study was conducted from May to December 2015 at Otolaryngology Unit of Dr. Soetomo General Soetomo, Surabaya. There were 40 patients who fulfilled the inclusion criteria. Spearman test results obtained p value = 0.060. The correlation of β-catenin expression with staging in NPC patients was found to be non-significant (p > 0.05). There was no correlation between β-catenin expression and staging in NPC patients.
https://ift.tt/2qInWeD
Realidad nacional de los programas de detección auditiva temprana con miras a la cobertura universal
ABSTRACT Introduction: 50% of hearing-impared newborns do not have any associated risk factors; so early universal detection programs can change the prognosis of these patients. Universal newborn hearing screening consists in studying all newborns in a particular area, regardless of the presence of risk factors. Aim: Describe and analyze the presence of universal newborn hearing screening programs in Chile and its characteristics. Material and method: We identify establishments that have universal newborn hearing screening programs and sent them An electronic survey focusing on the structure of each program. Results: 34 hospitals have universal newborn hearing screening. Of these, 31 answered the survey. 73% begun the program after 2010. The Ministry of Health provides financing in 46%. Audiologists and medical technicians majoring in otolariyngology are in charge of the vast majority of the programs. Available screening methods are distortion product otoacoustic emissions (90%) and automated Brainsteam evoked response audiometry (67.8%). As for the definitive diagnosis, 71% use Brainsteam evoked response audiometry click plus impedanciometry. Conclusion: 50% of the hospitals with maternities have universal hearing screening; most of them are in Chile's central area. Even though some hospitals show interest and have made advances in this regard, there is still much to be done, being universal coverage the main objective.
https://ift.tt/2vmda3t
Carcinoma adenoide quístico de cavidad nasal y senos paranasales: Experiencia de 5 años en Clínica Las Condes de Santiago de Chile
ABSTRACT Introduction: Adenoid Cystic Carcinoma is a neoplasm originating in exocrine glands throughout the body, mainly in the major salivary glands. In the nasal cavity and paranasal sinuses is rare and characterized by a high frequency of recurrence and distant metastasis after remission and despite its treatment. Aim: To describe characteristics of a series of patients with operated adenoid cystic carcinoma of the nasal cavity and paranasal sinuses. Material and method: Descriptive-retrospective study. Period January 2012 and January 2017. The information was obtained from the electronic tabs of the Las Condes Clinic. It describes origin, age and sex, clinical characteristics, anatomopathological findings, diagnostic methods, treatment, evolution. Results: Total 5 patients operated, 3 women and 2 men. The average age was 63 years, ranging from 33 years to 90 years of age. 100% of the cases without associated factors. The most frequent clinical presentation was unilateral nasal obstruction, followed by facial pain. 2 patients presented with initial diagnosis, 2 due to recurrence and 1 due to persistence. In 3 cases the tumor originates from the maxillary sinus and in 2 in the ethmoidal sinus. All had advanced disease, stage IV and III. 3 patients were histologically low grade and 2 high grade. In all 5 cases, the primary treatment was surgical, 60% endoscopic, 20% open and 20% combined. In 4 cases, postoperative radiotherapy was used and in 3 of this concomitant chemotherapy. All are without signs of tumor recurrence in the last control. Conclusion: Adenoid Cystic Carcinoma of the nasal cavity and paranasal sinuses is quite infrequent; its incidence is less than 1/100,000 cases per year. It is more common in women between 40 and 50 years. It is identified more with its origin in the maxillary sinus (50%) and cribriform pattern. Clinically it presents in advanced stages since at an early stage, it is asymptomatic or it presents nonspecific inflammatory clinic. Diagnosis is performed with biopsy supplemented with imaging. The most commonly used treatment is endoscopic or open surgery associated with postoperative radiotherapy, despite which, they present with high recurrence in the long term.
https://ift.tt/2HuBk0y
Cirugía endoscópica nasosinusal: ¿Un procedimiento ambulatorio?
RESUMEN Introducción: La cirugía endoscópica nasosinusal (CEN) ha aumentado progresivamente debido a que brinda un gran acceso quirúrgico mediante un abordaje mínimamente invasivo. Debido a que tiene un posoperatorio reducido y con pocas complicaciones se puede realizar como cirugía ambulatoria (CA). Esta modalidad es ampliamente aceptada a nivel internacional, sin embargo, no se ha masificado en nuestra realidad nacional. Objetivo: Describir la incidencia y causas de estadía no programada pos CEN ambulatoria en el Servicio de Otorrinolaringología del Hospital del Salvador. Material y método: Revisión retrospectiva de fichas de pacientes operados de CEN por el mismo equipo quirúrgico (Dra. Constanza J. Valdés y Dra. Paula Ruz) entre agosto 2013 y diciembre 2015. Se registraron datos demográficos, cirugías y complicaciones perioperatorias. Resultados: De un total de 75 CEN programadas para realizarse en forma ambulatoria, la incidencia de estadía no programada fue de 15%. Las principales causas fueron problemas administrativos (6 casos) seguido de complicaciones perioperatorias (5 casos). Conclusión: Excluyendo causas administrativas de estadía no programada, el 93% de los procedimientos lograron realizarse como CA. Esta modalidad es plausible y recomendable en el sistema de salud donde los recursos son escasos.
ABSTRACT Introduction: Endoscopic sinus surgery (ESS) has an increase trend because it provides wide surgical access through a minimally invasive approach. It can be performed on a day surgery basis because it has a fast postoperative recovery and a low complication rate. This method has worldwide acceptance, however it has not been established in our national practice. Aim: Describe incidence and unplanned admission causes of ESS in the Otolaryngology service of the Hospital del Salvador. Material and method: Retrospective review of patient medical records undergoing ESS by the same surgical team (Dra. Constanza J. Valdés y Dra. Paula Ruz) between August 2013 and December 2015. Patient demographic information, surgery and perioperative complications were recorded. Results: 75 ESS procedures were scheduled to be performed on an outpatient basis. The incidence of unplanned stay was 15%. Fifteen patients had an unplanned admission, due to administrative problems (6) and perioperative complications (5). Conclusions: Fifteen percent of the patients who underwent ESS on a day surgery basis had an unplanned stay; its main cause is due to administrative problems. Excluding administrative causes of unplanned admission, 93% of the procedures performed were ambulatory procedures. This mode is plausible and desirable in the health system where resources are scarce.
https://ift.tt/2EViVEw
Timpanoplastía endoscópica: Experiencia en el Hospital del Salvador
RESUMEN Introducción: La técnica endoscópica para la cirugía de oído ha presentado un gran avance en los últimos años, debido al avance de las ópticas de alta resolución e instrumental quirúrgico. El uso de endoscopio en timpanoplastías facilita la visualización de zonas de difícil acceso, como es el caso de pacientes con pared anterior del conducto auditivo externo prominente y perforaciones timpánicas anteriores, además permite la revisión de la caja timpánica y de las vías de ventilación del oído medio. Objetivo: Mostrar la timpanoplastía endoscópica (TE) como alternativa en pacientes con otitis media crónica y analizar el éxito anatómico y funcional. Material y método: Revisión de fichas clínicas de pacientes sometidos a TE en el Hospital del Salvador. Resultados: Catorce pacientes fueron operados entre octubre de 2015 y agosto de 2016. La edad promedio fue de 45 años. Todos fueron sometidos a TE unilateral. Once de 14 perforaciones comprometía alguno de los cuadrantes anteriores. De éstas, en el 82% el borde anterior de la perforación no era visible con otomicroscopía. Se realizó otoendoscopía y audiometría 2 meses poscirugía, logrando un éxito anatómico de 92,8%, y mejoría en el PTP posoperatorio en todos los pacientes. Conclusión: Los resultados obtenidos son similares a los descritos utilizando microscopio. La TE permite mejor visualización convirtiendo esta técnica en una alternativa quirúrgica y de docencia atractiva. Es necesario realizar seguimiento a estos pacientes y aumentar el número de pacientes en el futuro.
ABSTRACT Introduction: The endoscopic ear surgery technique has been a great advance in the last years due to the developments in high resolution optics and surgical instruments. The use of an endoscope provides the visualization of difficult access zones in the middle ear, such as patients with prominent anterior wall of the external auditory canal and anterior tympanic perforations. Aim: To describe the endoscopic tympanoplasty (ET) as an alternative treatment for patients who suffer from chronic otitis media, and to analyze the functional and anatomic outcome. Material and method: Clinical record review of patients submitted to a ET in Hospital del Salvador. Results: 14 patients were operated during October 2015 and August 2016. The average age was 45 years. All of them where submitted to a unilateral ET. 11 of 14 perforations compromised some of the anterior quadrants. In 82% of the latter the anterior edge of the perforation was not visible with otomicroscopy. An otomicroscopy and audiometry were performed 2 months after surgery, anatomic outcome success was of 92,8%, and PTA improved after surgery in all patients. Conclusion: The obtained results are similar to those described using microscope. ET allows improved visualization making this technique an attractive surgery and teaching choice. It is necessary to evaluate these results with a higher number of patients.
https://ift.tt/2qFEeWF
Estudio clínico y micológico de otomicosis en diabéticos: Una serie de 17 casos
ABSTRACT Introduction: Otomycosis in immunocompromised patients is characterize by its bilateral course and the predominant etiologic agent is Candida. Few studies compare the mycological features between microscopic direct exam and culture. Aim: To identify the clinical and mycological characteristics of otomycosis in diabetic patients. Material and method: Transversal study. Secondary care center. Inclusion criteria: diabetic patients with clinical diagnosis of otomycosis. Intervention: Direct examination under a microscope of the ear sample and culture. Results: We included 17 patients, 10 women, 7 men with a mean age of 47.5 years. Symptoms were hearing loss 94.1% (n = 16), pruritus 82.4% (n =14) otorrhoea 76.5% (n =13) and otalgia 70.6% (n =12). Bilateral involvement was found in 47.1% (n =8). Direct microscopic study found 94.1% of yeast (n =16) and 5.9% of Aspergillus (n =1). Candida was the most common fungal genus in culture and microscopic exam with 94.1% (n =16) of cases and Candida albicans was the most common species in 88.2% (n =15) cases. Conclusion: Candida albicans is the most common etiologic agent in diabetic patients with otomycosis. Main symptoms were hearing loss, itching and otorrhea. Direct exam correctly identified the fungal genus.
https://ift.tt/2vqTrj2
Manejo endoscópico del meningoencefalocele de base de cráneo anterior
ABSTRACT Endoscopic management of anterior skull base meningoencephalocele. The cerebrospinal fluid leak (CSF) is an abnormal communication between the subaracnoid space and the pneumatic portion of the anterior cranial base which is related to the paranasal cavities. The persistent leak requires surgery due to the potential complications such as meningitis, cerebral abscess or pneumoencephalus. Extracranial endoscopic approach is the gold standard procedure. One of the most important risk of the surgery is to damage noble intracranial structures. This situation can be ameliorated by using image guided surgery. We present two cases of CSF in anterior cranial base associated with meningoencephalocele that were treated in our center using nasal image guided endoscopic surgery.
https://ift.tt/2EWf763
Hábitos auditivos recreacionales y umbral tonal en la frecuencia audiométrica 6.000 Hz en jóvenes universitarios
ABSTRACT Introduction: Noise exposure is one of most common causes of hearing loss according to the World Health Organization (WHO). The use of personal music players is one of the sources of this harmful noise, which has been demonstrated to constitute a risky habit. Previous studies have found hearing loss produced by noise in users of music players compared to subjects who do not used them. Aim: The present study aimed to investigate the relationship between recreational hearing habits and hearing performance at 6000 Hz frequency in university students. Material and method: Fifty subjects (age range of 18-26 years), without history of otologic disorders were assessed. The CHAR questionnaire and an air conduction pure tone audiometry (125 Hz-8000 Hz) were administered to each participant. Results: Findings from pure tone audiometry demonstrated the presence of hearing scotoma at 6000 Hz frequency in fifty-two percent of subjects. Moreover, statistically significant differences were found when comparing subjects with normal threshold and subjects with threshold greater than 20 dB at 6000 Hz. This was related to years and intensity of noise exposure. Conclusion: Recreational noise exposure may cause hearing loss in early stages of lifespan. Prevention strategies to avoid early hearing loss in young subjects are required.
https://ift.tt/2qAAvcP
Cirugía endoscópica de oído para el manejo del colesteatoma atical
ABSTRACT The cholesteatoma is the presence of keratinized squamous epithelium in pneumatized areas of the temporal bone, its most frequent location is the attic. In the 1990s the development of the ear endoscopic surgery begins, offering a new perspective for cholesteatoma treatment. Two clinical cases of patients who present attic cholestatoma are described. A transcanal endoscopic approach with complete macroscopic resection was accomplished. Post-surgical audiometry shows improvement of the conductive hearing loss.
https://ift.tt/2Hz0pHL
Telangiectasia hemorrágica hereditaria: A propósito de un caso clínico
ABSTRACT Epistaxis is a common symptom in the otorhinolaryngology consultation. Among the possible causes are hereditary hemorrhagic telangiectasia (Rendu Osler Weber syndrome), which corresponds to an autosomal dominant disorder characterized by nasal and gastrointestinal bleeding associated with systemic arteriovenous malformations. Its most frequent manifestation is epistaxis, presenting more frequently in people over 40 years of age, without gender preference. We present the case of a male patient of 46 years old who consults for recurrence and severe epistaxis. During hospitalization, conventional treatment of epistaxis, retroactive diagnosis of Rendu Osler Weber syndrome and multidisciplinary management of pathology are performed. We review the literature and discuss the management of patients with this disease.
https://ift.tt/2EUN1Io
Dehiscencia del canal semicircular superior como causa de tinnitus pulsátil
ABSTRACT Tinnitus occurs chronically in about 10% of adults, being pulsatile tinnitus a 4% of these cases (TP). TP is characterized by being rythmic and sychronous to the heart beat. There are many described causes, but in a significant group of cases it is not possible to determine its origin. Our aim is present clinical cases of superior semicircular canal dehiscence (SSCD) as the cause of pulsatile tinnitus and its study. Clinical cases: Two patients present pulsatile tinnitus in her right ear. System causes were discarded, normal Carotid Doppler ultrasonography, Anglo CT scan and MRI without findings. In Pöschl reconstruction SSCD can be observed. Evoked myogenic potentials (VEMPs) by suspicion of SSCD Syndrome, cVEMP and oVEMP with a elevated amplitudes and lower thresholds ipsilateral response. In the cases exposed, tinnitus appears as a single symptom associated with the presence of SSCD which was confirmed with imaging studies and VEMPs. The AngioTAC allows to investigate several associated causes. The VEMPs confirm the diagnosis, with oVEMP having a greater sensitivity. The SSCD is an entity to have in my mind as a differential diagnosis of pulsatile tinnitus and, if suspected, should be explored with VEMPs.
https://ift.tt/2HyXZsr
Amiloidosis laríngea: A propósito de un caso
ABSTRACT Amyloidosis is a rare disease of unknown etiology, characterized by the presence of extracellular acumulations of fibrillar proteins in a variety of organs and tissues, with a wide range of clinical manifestations depending on the location and size of the deposits. In head and neck, the most common site of presentation is the larynx. It usually presents with dysphonia and / or progressive dyspnea, whose definitive treatment, without being standardized, is usually surgical resection. A case of a 78-year-old patient with a history of dyspnea at rest and mild laryngeal stridor of 6 months of evolution is presented, whose nasofibroscopy showed a subglottic mass at the cricoid level, determining a critical upper airway lumen. Biopsy revealed extensive amyloidosis of the upper respiratory tract mucosa, being successfully treated with tumoral excision under direct laryngoscopy.
https://ift.tt/2EWeA43
Hemangioma cavernoso laríngeo en adultos: Reporte de un caso y revisión de la literatura
ABSTRACT Hemangiomas are one of the most frequent head and neck tumors. Clinically, they can be divided into childish and adult forms. In children it is a frequent pathology, whereas in adults it is very rare. In adults, it has a higher incidence in men and its more frequent location is supraglottic. Its most frequent histology is the cavernous hemangioma, which corresponds to a malformation of venous origin, with thin walls and dilated vessels. The most common presentation is with the disphony or hoarseness lasting from months to years of evolution and suspicion is made through nasofibroscopy or the imaging study (CT and / or MRI). There are different forms of treatment, including observation, corticotherapy, radiotherapy, laser surgery, open surgery, etc., without a consensus on the best option. We present the case of a 43 year old male with a history of smoking who consulted for dysphonia of a year of evolution. A large supraglottic mass was diagnosed through nasofibroscopy and CT of the neck, which is removed by a laryngopharyngeal approach. Deferred biopsy reported a cavernous hemangioma.
https://ift.tt/2Hz087H
Actualización en abuso de drogas por vía nasal
RESUMEN La vía nasal, ya sea mediante la inhalación o aspiración, se ha convertido en una ruta atractiva para quienes abusan de sustancias, principalmente por la fácil accesibilidad y la rápida absorción sistémica, además de evitar las consecuencias asociadas al uso de drogas intravenosas (enfermedades de transmisión). El objetivo de esta revisión es presentar una actualización de diversas sustancias que son utilizadas por esta vía, enfocándose en aquellas en las que se ha documentado daños en la anatomía nasal.
ABSTRACT The nasal route, either by inhalation or aspiration, has become an attractive route for substances abusers, mainly because of its easy accessibility, rapid systemic absorption and also to avoid the consequences associated with intravenous drug use (transmitted diseases). The objective of this review is to present an update of various substances that are used by this route, focusing on those in which damage to the nasal anatomy has been documented.
https://ift.tt/2EUwhRH
Abordaje endoscópico transeptal de tumores benignos de cavidades paranasales
ABSTRACT Endoscopic sinus surgery is a frequent procedure in Otorhinolaryngology practice, in the last decade new techniques have been introduced to help the resection of tumors in regions traditionally considered of difficult access. One of these techniques is the trans-septal approach, which allows the approach of the anterior and lateral wall of the maxillary sinus, as well as four-handed work for approach of these tumors. The aim of this review is to describe the transeptal endoscopic approach as a complementary technique in the endoscopic surgery of benign nasal tumors, specifically inverted papilloma and juvenile nasopharyngeal angiofibroma.
https://ift.tt/2Hz0kUt
Mecanismos de comunicación en pacientes laringectomizados
RESUMEN El cáncer laríngeo representa el 25% de las neoplasias de cabeza y cuello. Para los carcinomas laríngeos T1 tratados con radioterapia o cirugía láser, no existe diferencia significativa en cuanto a la calidad de voz percibida por el paciente entre ambas formas terapéuticas. La laringectomía total sigue siendo utilizada como la alternativa terapéutica en carcinomas avanzados. La pérdida de la capacidad de fonación es una consecuencia de esta cirugía, por lo que existe un variado abanico de mecanismos de comunicación que ofrecerle al paciente. Las alternativas clásicas comprenden: erigmofonación, laringe electrónica y válvula traqueoesofágica. Dentro de este escenario, han surgido nuevas alternativas en los últimos años como son conversión estadística de voz GMM (Gaussian Mixture Model), proyecto SWARA y el proyecto "Mi propia voz".
ABSTRACT Laryngeal cancer accounts for 25% of head and neck cancers. For T1 laryngeal carcinomas treated with radiotherapy or laser surgery, there is no significant difference in terms of quality of voice perceived by the patient between both therapeutic forms. The total laryngectomy is still used as the therapeutic alternative in advanced carcinomas. The loss of the phonation ability is a consequence of the surgery, so there is a diverse range of communication mechanisms to offer to the patient. Classical approaches include: esophageal speech, electrolarynx and tracheoesophageal valve. In this scenario, new alternatives have emerged: statistical voice conversion GMM (Gaussian Mixture Model), SWARA project and "Mi propia voz" project.
https://ift.tt/2vnqXGQ
Tiroides ectópica dual hiperfuncionante: Abordaje quirúrgico dual
RESUMEN Paciente de 36 años en tratamiento de leucemia mieloide crónica con nilotinib a quien se le diagnostica hipertiroidismo por síntomas clínicos y exámenes de laboratorio. Se inicia tratamiento con metimazol más propanolol. Los estudios imagenológicos muestran un tejido ectópico tiroideo cervical infrahiodeo lateralizado a la izquierda y un nódulo en la base de la lengua. Presentó toxicidad hepática atribuida al tratamiento por lo que se decide extirpación quirúrgica de tiroides ectópica dual. Por la edad de la paciente y preocupación acerca del resultado estético, se realiza una tiroidectomía videoasistida por via axilar de la tiroides ectópica cervical y una resección transoral de la tiroides ectópica lingual. La patología confirma tejido tiroideo en ambas localizaciones sin signos de malignidad. La paciente se recuperó sin complicaciones y sin cicatriz cervical.
ABSTRACT A 36-year-old female patient with chronic myeloid leukemia being treated with nilotinib who was diagnosed with hyperthyroidism both on clinical and laboratory examination is presented. Imaging studies found left lateralized ectopic thyroid tissue of infrahyoid localization and a nodule at the base of the tongue. Hepatic toxicity was attributed to medical treatment, surgical removal of the dual thyroid ectopia was proposed. Due to the patients age and cosmetical concerns, a minimally invasive surgery was undertaken thru a video assisted transaxillary thyroidectomy for the cervical thyroid ectopia and a video assisted trans oral approach for the lingual thyroid ectopia. Post op pathology confirmed thyroid tissue at both locations and also excluded malignancy. The patient fully recovered without any complicaction and witout a residual cervical scar.
https://ift.tt/2qFDHnD
Flushes, neurodermatology, and surroundings
To the Editor: As a dermatologist engaged in consultations in neurologic settings for almost 2 decades, I have read the review about cutaneous flushing by Sadeghian et al,1 and this compels me to put forward some specifications.
https://ift.tt/2HHCxiy
Reply to: “Facial erythromelalgia?”
To the Editor: A few predominantly facial cases of potential erythromelalgia have been described, but these appear to be exceedingly rare.1-4 In 1 of the case reports, the condition was mistaken for other dermatologic conditions (rosacea and contact dermatitis) for years until the patient developed symptoms of erythromelalgia elsewhere.1 Another case report highlights the importance of keeping this in the differential diagnosis to avoid confusion with dermatologic connective tissue disorders that involve the face.
https://ift.tt/2J1oKTC
Activated mTORC1 signaling: The common driving force of type 2 diabetes and hidradenitis suppurativa
To the Editor: The results of the recent meta-analysis by Bui et al have confirmed that hidradenitis suppurativa (HS) is significantly associated with an increased prevalence of type 2 diabetes mellitus (T2DM).1 According to the authors, this association could be due to the fact that HS patients tend to be more obese.1 In this regard, we think that altered mechanistic target of rapamycin complex 1 (mTORC1) signaling might contribute and explain the connection between HS and T2DM. mTOR is the core constituent of the phosphatidylinositol 3-kinase–related kinase protein family that forms at least 2 multiprotein complexes known as mTORC1 and mTORC2.
https://ift.tt/2HJBaQr
Introducing a curriculum in ethics and professionalism for dermatology residencies
There is general agreement on what constitutes ethical reasoning and professional behavior, but standardized methods to teach these skills in dermatology residency are currently unavailable. We introduce a model curriculum designed to impart the knowledge and skills to meet the Accreditation Council for Graduate Medical Education Dermatology Milestones for Professionalism over a 3-year cycle.
https://ift.tt/2J7KgGm
Performance of a computer-aided digital dermoscopic image analyzer for melanoma detection in 1,076 pigmented skin lesion biopsies
Digital dermoscopic image analysis of pigmented skin lesions (PSLs) has become increasingly popular, despite its unclear clinical utility. Unbiased, high-powered studies investigating the efficacy of commercially available systems are limited.
https://ift.tt/2Hc3r0P
Facial erythromelalgia?
To the Editor: I enjoyed reading the excellent reviews of the many causes of cutaneous flushing by Sadeghian et al.1,2 One cause of facial flushing mentioned is erythromelalgia. I write to suggest that the term erythromelalgia be restricted to patients with additional flushing of their feet and/or hands.
https://ift.tt/2HHh3T5
Treatment of pincer nail deformity using dental correction principles
To the Editor: Pincer nail deformity (PND) is characterized by excessive transverse curvature of the nail plate. There is no treatment of choice. Superelastic nickel-titanium has been used to bend PND to its normal shape in previous reports, and the procedure involves drilling a hole in the nail plate or applying a hook structure to fix the material to the nail.1-3 In this study, we used dental correction methods to improve PND.
https://ift.tt/2HGgbxW
Desquamative gingivitis
Desquamative gingivitis is a clinical finding with several potential etiologies. Among the most common are oral lichen planus, cicatricial pemphigoid, and pemphigus vulgaris, though various other differential diagnoses exist. The presence of desquamative gingivitis often results in poor oral hygiene, which can have downstream consequences, including periodontitis and tooth loss. Though certain mucosal findings may be suggestive of a particular diagnosis, a thorough history, physical examination, and appropriate dermato- and immunopathologic assessment is necessary for narrowing this broad differential diagnosis.
https://ift.tt/2HJyQZM
Comment on “The role of the ugly duckling sign in patient education”
To the Editor: There are important caveats regarding the study by Ilyas et al regarding the role of the ugly duckling sign in patient education, both in the design and conclusions of the study itself, as well as in the premise of ugly duckling identification and melanoma recognition.1
https://ift.tt/2H6Wcav
Desquamative gingivitis
Desquamative gingivitis is a clinical finding with several potential etiologies, and therefore histologic examination should be performed to confirm the diagnosis before the implementation of systemic therapy. The best methods for obtaining a mucosal biopsy specimen are discussed to aid the dermatologist in approaching these patients, and indications for additional testing, such as immunofluorescence studies, are reviewed. Desquamative gingivitis is uncommon, and there are no systematic guidelines to assist the physician in treatment, producing a practice gap in management.
https://ift.tt/2HJdYlx
Sub-lethal ultraviolet B irradiation and Poly I:C treatment synergistically induced apoptosis of HaCaT cells through NF-κB pathway
Source:Molecular Immunology, Volume 99
Author(s): Wuxiyar Otkur, Weiwei Liu, Jinda Wang, Xingfan Jia, Dianchao Huang, Fang Wang, Toshihiko Hayashi, Shin-ichi Tashiro, Satoshi Onodera, Takashi Ikejima
Ultraviolet B (UVB) irradiation exerts multiple effects on skin cells, inducing apoptosis, senescence and carcinogenesis. Toll-like receptor 3, a member of pattern recognition receptors, is reported to initiate inflammation by recognizing double-strand RNA (dsRNA) released from UVB-irradiated cells. It has not been studied, however, whether apoptosis induction in UVB irradiation is attributed to TLR3 activation. Here, we report on the pro-apoptotic role of TLR3 in UVB-irradiated epidermal cells. Poly I:C, an analogue of dsRNA that activates TLR3, was used in combination with sub-lethal UVB (4.8 mJ/cm2) irradiation for investigating the effects of TLR3 activation on human immortalized keratinocyte HaCaT cells. Although sub-lethal dose of either Poly I:C or UVB alone did not induce cell death, UVB-Poly I:C co-treatment synergistically induced cell death by activation of caspase-3 and cleavages of ICAD and PARP, with apoptotic features when stained with Annexin V/PI or Hoechst 33342. Treatment with pan-caspase inhibitor, Z-VAD, attenuated UVB-Poly I:C-induced cell death. Silencing TLR3 by siRNA rescued HaCaT cells from UVB-Poly I:C-induced apoptosis. NF-κB, a major downstream component of TLR3 pathway, that usually negatively regulates the classical TLR3 apoptotic pathway, was analyzed by western blotting and immunofluorescence confocal microscopy. The results indicate to our surprise that NF-κB is translocated to nucleus in the cells co-treated with UVB-Poly I:C. The nuclear translocation of NF-κB is attenuated by TLR3 silencing. Treatment with BAY, an inhibitor of NF-κB pathway, blocked UVB-Poly I:C-induced apoptosis. Therefore, we conclude that NF-κB pathway plays a cytotoxic role in UVB-Poly I:C-treated HaCaT cells, mediating TLR3-related apoptosis.
https://ift.tt/2HHgnNx
Molecular pathways for antigenic peptide generation by ER aminopeptidase 1
Source:Molecular Immunology
Author(s): Anastasia Mpakali, Zachary Maben, Lawrence J. Stern, Efstratios Stratikos
Endoplasmic Reticulum aminopeptidase 1 (ERAP1) is an intracellular enzyme that can generate or destroy potential peptide ligands for MHC class I molecules. ERAP1 activity influences the cell-surface immunopeptidome and epitope immunodominance patterns but in complex and poorly understood manners. Two main distinct pathways have been proposed to account for ERAP1's effects on the nature and quantity of MHCI-bound peptides: i) ERAP1 trims peptides in solution, generating the correct length for binding to MHCI or overtrimming peptides so that they are too short to bind, and ii) ERAP1 trims peptides while they are partially bound onto MHCI in manner that leaves the peptide amino terminus accessible. For both pathways, once an appropriate length peptide is generated it could bind conventionally to MHCI, competing with further trimming by ERAP1. The two pathways, although not necessarily mutually exclusive, provide distinct vantage points for understanding of the rules behind the generation of the immunopeptidome. Resolution of the mechanistic details of ERAP1-mediated antigenic peptide generation can have important consequences for pharmacological efforts to regulate the immunopeptidome for therapeutic applications, and for understanding association of ERAP1 alleles with susceptibility to autoimmune disease and cancer. We review current evidence in support of these two pathways and discuss their relative importance and potential complementarity.
https://ift.tt/2H8ySJn
Carbonic anhydrase 9 expression in well-differentiated pancreatic neuroendocrine neoplasms might be associated with aggressive behavior and poor survival
Abstract
Well-differentiated pancreatic neuroendocrine neoplasms/tumors (PanNETs) are rare neoplasms with diverse clinical behavior. Biomarker discovery is important for predicting clinical course and prognosis of PanNET patients. Carbonic anhydrase 9 (CA9) and vimentin are hypoxia and epithelial-mesenchymal transition-related proteins of which expression in many carcinomas has been associated with poor prognosis, but their significance in PanNET has yet to be determined. We assessed CA9 and vimentin expression in 164 PanNETs and compared this with clinicopathologic characteristics. CA9 expression was observed in normal islets, while neuroendocrine microadenomas and small (< 1 cm) PanNETs showed loss of CA9 expression. CA9 and vimentin expression was observed in 38 (23%) and 36 (22%) of PanNETs, respectively. CA9 expression was associated with larger size (p = 0.001), higher grade (p < 0.001), higher pT category (p < 0.001), lymph node (p = 0.003) and distant (p = 0.047) metastases, higher AJCC stage (p < 0.001), and lymphovascular (p < 0.001) and perineural (p = 0.002) invasion. PanNET patients with CA9 expression had a shorter recurrence-free survival (5-year survival rate 47%) than those without CA9 expression (76%) by univariate (p = 0.001) but not multivariate analysis. Vimentin expression correlated with CA9 expression (p < 0.001) but not with other clinicopathologic factors. In conclusion, CA9 expression was observed in normal islets, while neuroendocrine microadenomas and small (< 1 cm) PanNETs showed CA9 expression loss. CA9 expression gradually reappeared in larger PanNETs, and this was associated with clinical progression and decreased patient survival by univariate but not multivariate analysis.
https://ift.tt/2J3Shfb
Neuraminidase as an influenza vaccine antigen: a low hanging fruit, ready for picking to improve vaccine effectiveness
Maryna C Eichelberger | David M Morens | Jeffery K Taubenberger
https://ift.tt/2Hr3dXh
Editorial overview: Innate immunity: The finely tuned STING of innate immunity
Gwendalyn J Randolph
https://ift.tt/2EUIvty
Examining the influence of hide processing on Native American upper limb morphology
International Journal of Osteoarchaeology, EarlyView.
https://ift.tt/2Hrdgvk
Analysis of Host and Viral-Related Factors Associated to Direct Acting Antiviral Response in Hepatitis C Virus Patients
Viral Immunology, Volume 31, Issue 3, Page 256-263, April 2018.
https://ift.tt/2Hbx1Ic
Phase 1 studies to assess the safety, tolerability and pharmacokinetics of JTE‐052 (a novel Janus kinase inhibitor) ointment in Japanese healthy volunteers and patients with atopic dermatitis
The Journal of Dermatology, EarlyView.
https://ift.tt/2qEUI0h
Continuing medical education activities for improved management of allergy patients
Allergy, EarlyView.
https://ift.tt/2vncef5
Issue Information ‐ Cover and Editorial Board
Allergy, Volume 73, Issue 4, Page 733-733, April 2018.
https://ift.tt/2qEqUSh
Issue Information ‐ TOC
Allergy, Volume 73, Issue 4, Page 735-736, April 2018.
https://ift.tt/2EV4pg4
Heterogeneity among hospitals statewide in percentage shares of the annual growth of surgical caseloads of inpatient and outpatient major therapeutic procedures
Suppose that it were a generalizable finding, in both densely populated and rural states, that there is marked heterogeneity among hospitals in the percentage change in surgical caseload and/or in the total change in caseload. Then, individual hospitals should not simply rely on federal and state forecasts to infer their expected growth. Likewise, individual hospitals and their anesthesiology groups would best not rely on national or US regional surgical trends as causal reasons for local trends in caseload.
https://ift.tt/2Hbiyfm
Locoregionally advanced oral cavity cancer: A propensity‐score matched analysis on overall survival with emphasis on the impact of adjuvant radiotherapy
Head &Neck, EarlyView.
https://ift.tt/2Hu5QaJ
Genetic variation in VAC14 is associated with bacteremia secondary to diverse pathogens in African children [Biological Sciences]
Performing a genome-wide association study of Salmonella enterica serovar Typhi (S. Typhi) invasion, Alvarez et al. (1) identify a trait-associated SNP, rs8060947, in VAC14. rs8060947 is an expression quantitative trait locus for VAC14 RNA expression, and carriage of the A allele is associated with reduced VAC14 RNA and protein expression,...
https://ift.tt/2HJMEmQ
Does selecting ligand shape {gamma}{delta}-TCR repertoire? [Biological Sciences]
In a recent publication entitled "Role of a selecting ligand in shaping the murine γδ-TCR repertoire," Fahl et al. (1) report that the expression of nonclassic MHC T10 and its related molecule T22 influences the T10/T22 specific γδ-T cell receptor (TCR) repertoire. We maintain that caveats in their experimental approaches...
https://ift.tt/2HuFdlW
Reply to Chien: Clarification of the effect of ligand on {gamma}{delta}-TCR repertoire selection [Biological Sciences]
In our recent publication (1), we report that the EGYEL motif, previously found to promote T22-reactivity, was depleted from the mature CD24low pool of γδ-T cells that developed in H-2T–deficient mice, indicating that ligand was influencing the γδ-T cell receptor (TCR) repertoire (1). In her letter, Chien (2) suggests that...
https://ift.tt/2HcvVI8
Molecular structural diversity of mitochondrial cardiolipins [Biochemistry]
Current strategies used to quantitatively describe the biological diversity of lipids by mass spectrometry are often limited in assessing the exact structural variability of individual molecular species in detail. A major challenge is represented by the extensive isobaric overlap present among lipids, hampering their accurate identification. This is especially true...
https://ift.tt/2Hb2Ro4
Reply to Gilchrist et al.: Possible roles for VAC14 in multiple infectious diseases [Biological Sciences]
Our studies of the SNP rs8060947 determine that the A allele is associated with increased invasion of Salmonella enterica serovar Typhi and increased susceptibility to typhoid fever (1). Gilchrist et al. (2) now provide evidence that the A allele is also associated with increased risk for bacteremia, and the association...
https://ift.tt/2Hbc6AR
Label-free and charge-sensitive dynamic imaging of lipid membrane hydration on millisecond time scales [Biophysics and Computational Biology]
Biological membranes are highly dynamic and complex lipid bilayers, responsible for the fate of living cells. To achieve this function, the hydrating environment is crucial. However, membrane imaging typically neglects water, focusing on the insertion of probes, resonant responses of lipids, or the hydrophobic core. Owing to a recent improvement...
https://ift.tt/2H6kyoQ
Structural dynamics is a determinant of the functional significance of missense variants [Biophysics and Computational Biology]
Accurate evaluation of the effect of point mutations on protein function is essential to assessing the genesis and prognosis of many inherited diseases and cancer types. Currently, a wealth of computational tools has been developed for pathogenicity prediction. Two major types of data are used to this aim: sequence conservation/evolution...
https://ift.tt/2qFVnyl
Evolutionary emergence of the rac3b/rfng/sgca regulatory cluster refined mechanisms for hindbrain boundaries formation [Developmental Biology]
Developmental programs often rely on parallel morphogenetic mechanisms that guarantee precise tissue architecture. While redundancy constitutes an obvious selective advantage, little is known on how novel morphogenetic mechanisms emerge during evolution. In zebrafish, rhombomeric boundaries behave as an elastic barrier, preventing cell intermingling between adjacent compartments. Here, we identify the...
https://ift.tt/2H9FHe2
Multiple nuclear-replicating viruses require the stress-induced protein ZC3H11A for efficient growth [Microbiology]
The zinc finger CCCH-type containing 11A (ZC3H11A) gene encodes a well-conserved zinc finger protein that may function in mRNA export as it has been shown to associate with the transcription export (TREX) complex in proteomic screens. Here, we report that ZC3H11A is a stress-induced nuclear protein with RNA-binding capacity that...
https://ift.tt/2HvGEAt
Thermodynamic limits of energy harvesting from outgoing thermal radiation [Applied Physical Sciences]
We derive the thermodynamic limits of harvesting power from the outgoing thermal radiation from the ambient to the cold outer space. The derivations are based on a duality relation between thermal engines that harvest solar radiation and those that harvest outgoing thermal radiation. In particular, we derive the ultimate limit...
https://ift.tt/2qEfmhT
Targeting galectin-1 inhibits pancreatic cancer progression by modulating tumor-stroma crosstalk [Medical Sciences]
Pancreatic ductal adenocarcinoma (PDA) remains one of the most lethal tumor types, with extremely low survival rates due to late diagnosis and resistance to standard therapies. A more comprehensive understanding of the complexity of PDA pathobiology, and especially of the role of the tumor microenvironment in disease progression, should pave...
https://ift.tt/2qDu34M
Roll maneuvers are essential for active reorientation of Caenorhabditis elegans in 3D media [Biophysics and Computational Biology]
Locomotion of the nematode Caenorhabditis elegans is a key observable used in investigations ranging from behavior to neuroscience to aging. However, while the natural environment of this model organism is 3D, quantitative investigations of its locomotion have been mostly limited to 2D motion. Here, we present a quantitative analysis of...
https://ift.tt/2H9PWin
Phytophthora palmivora establishes tissue-specific intracellular infection structures in the earliest divergent land plant lineage [Plant Biology]
The expansion of plants onto land was a formative event that brought forth profound changes to the earth's geochemistry and biota. Filamentous eukaryotic microbes developed the ability to colonize plant tissues early during the evolution of land plants, as demonstrated by intimate, symbiosis-like associations in >400 million-year-old fossils. However, the...
https://ift.tt/2HaK2la
Molecular excitonic seesaws [Chemistry]
The breaking of molecular symmetry through photoexcitation is a ubiquitous but rather elusive process, which, for example, controls the microscopic efficiency of light harvesting in molecular aggregates. A molecular excitation within a π-conjugated segment will self-localize due to strong coupling to molecular vibrations, locally changing bond alternation in a process...
https://ift.tt/2Hx6Ivh
Interrelated role of Klotho and calcium-sensing receptor in parathyroid hormone synthesis and parathyroid hyperplasia [Medical Sciences]
The pathogenesis of parathyroid gland hyperplasia is poorly understood, and a better understanding is essential if there is to be improvement over the current strategies for prevention and treatment of secondary hyperparathyroidism. Here we investigate the specific role of Klotho expressed in the parathyroid glands (PTGs) in mediating parathyroid hormone...
https://ift.tt/2qA5MN1
Word embeddings quantify 100 years of gender and ethnic stereotypes [Computer Sciences]
Word embeddings are a powerful machine-learning framework that represents each English word by a vector. The geometric relationship between these vectors captures meaningful semantic relationships between the corresponding words. In this paper, we develop a framework to demonstrate how the temporal dynamics of the embedding helps to quantify changes in...
https://ift.tt/2J2b5eO
Plasticity in early immune evasion strategies of a bacterial pathogen [Microbiology]
Borrelia burgdorferi is one of the few extracellular pathogens capable of establishing persistent infection in mammals. The mechanisms that sustain long-term survival of this bacterium are largely unknown. Here we report a unique innate immune evasion strategy of B. burgdorferi, orchestrated by a surface protein annotated as BBA57, through its...
https://ift.tt/2Hseu9I
Fluctuations uncover a distinct class of traveling waves [Physics]
Epidemics, flame propagation, and cardiac rhythms are classic examples of reaction–diffusion waves that describe a switch from one alternative state to another. Only two types of waves are known: pulled, driven by the leading edge, and pushed, driven by the bulk of the wave. Here, we report a distinct class...
https://ift.tt/2Hykb5Z
Identification of long-lived synaptic proteins by proteomic analysis of synaptosome protein turnover [Neuroscience]
Memory formation is believed to result from changes in synapse strength and structure. While memories may persist for the lifetime of an organism, the proteins and lipids that make up synapses undergo constant turnover with lifetimes from minutes to days. The molecular basis for memory maintenance may rely on a...
https://ift.tt/2Hb2RV6
Soft self-assembly of Weyl materials for light and sound [Physics]
Soft materials can self-assemble into highly structured phases that replicate at the mesoscopic scale the symmetry of atomic crystals. As such, they offer an unparalleled platform to design mesostructured materials for light and sound. Here, we present a bottom-up approach based on self-assembly to engineer 3D photonic and phononic crystals...
https://ift.tt/2H6Prpc
The role of Syk in peripheral T cells
Source:Clinical Immunology
Author(s): Jeoung-Eun Park, Sirshendu Majumdar, David D. Brand, Edward F. Rosloniec, Ae-Kyung Yi, John M. Stuart, Andrew H. Kang, Linda K. Myers
The aim of this study was to understand how Syk affects peripheral T cell function. T cells from Syk−/− chimeric mice and DR1 Sykfl/fl CD4cre conditional mice gave strong CD3-induced Th1, Th2, and Th17 cytokine responses. However, an altered peptide ligand (APL) of human CII (256–276) with two substitutions (F263N, E266D), also called A12, elicited only Th2 cytokine responses from Sykfl/fl T cells but not Sykfl/fl-CD4cre T cells. Western blots revealed a marked increase in the phosphorylation of Syk, JNK and p38 upon A12/DR1 activation in WT or Sykfl/fl T cells but not in Sykfl/flCD4-cre cells. We demonstrate that Syk is required for the APL- induction of suppressive cytokines. Chemical Syk inhibitors blocked activation of GATA-3 by peptide A12/DR1. In conclusion, this study provides novel insights into the role that Syk plays in directing T cell activity, and may shape therapeutic approaches for autoimmune diseases.
https://ift.tt/2ESIvKw
La/SSB chimeric autoantibody receptor modified NK92MI cells for targeted therapy of autoimmune disease
Source:Clinical Immunology
Author(s): Huimin Meng, Xue Sun, Yanhui Song, Jianxuan Zou, Gangli An, Zeming Jin, Lin Yang
It has been long sought to specifically eliminate B-cell clones that generate autoreactive antibodies, while sparing the immune system when combating autoimmune disease. Although it was impossible to achieve this goal before, newly developed techniques have made it feasible today. Autoantibodies against La/SSB were involved in several autoimmune diseases. Here, we aimed to introduce La/SSB epitope-based chimeric autoantibody receptors (CAAR) into NK92MI cells enabled it to destroy the corresponding La/SSB-specific B cell receptor (BCR) -bearing lymphoma cells (LaA-BCR-Romas, LaA-BCR-Maver-1, and LaA-BCR-Jurkat cells). Such cell lines could eliminate a part of the B-cells in the blood of patients positive for anti-La/SSB antibodies. The CAAR we used in this study was constructed by fusing fragments from the nucleus protein, La/SSB, with the TCR signaling molecules, CD28, CD137, and CD3ζ. Thus, this method could specifically destroy the La/SSB autoreactive B-cell clones. Our results might provide a new strategy to combat antibody-mediated autoimmune diseases.
https://ift.tt/2JSKT7L
Treatment for moderate to severe atopic dermatitis in alpine and moderate maritime climates differentially affects helper T cells and memory B cells in children
Clinical &Experimental Allergy, EarlyView.
https://ift.tt/2H7d4SH
Deficiency of the interleukin‐36 receptor antagonist dramatically improved by secukinumab
The Journal of Dermatology, EarlyView.
https://ift.tt/2HtNO8G
Pilot study on the correlation between dermoscopic patterns and fluorescence in situ hybridization findings using whole‐slide digital imaging for acral volar melanocytic lesions
The Journal of Dermatology, EarlyView.
https://ift.tt/2vsq6F4
Pitfall in interpretation of kappa coefficients, in reference to the disagreement between Dr Shinichi Watanabe and Drs Tsunemi and Hiruma concerning the efficacy of the Dermatophyte Test Strip
The Journal of Dermatology, EarlyView.
https://ift.tt/2Hy74Sj
Konservatives Management der Varikose und des postthrombotischen Syndroms
Zusammenfassung
Sowohl die Varikose als auch das postthrombotische Syndrom sind Manifestationen eines chronischen Venenleidens – einer Volkskrankheit. Bereits frühzeitig finden sich sichtbare Gefäßzeichnungen, Schweregefühl und Schwellneigung. In fortgeschrittenen Stadien folgen Hautveränderungen und chronische Wunden. Die chronisch-venöse Insuffizienz kann als progredientes Leiden zu erheblichen Einschränkungen der Lebensqualität führen. Eine suffiziente Diagnostik und Therapie sind daher essenziell. Primär sollte, wann immer möglich, eine kausale Therapie angestrebt werden, die Varizen oder okkludierende Prozesse beseitigt. Begleitend oder wenn eine kausale Therapie nicht gewünscht oder möglich ist, kommt eine symptomorientierte Behandlung in Frage. Der Therapieplan ist individuell und abhängig von der federführenden Symptomatik, dem klinischen Bild, den Komorbiditäten und den Patientenwünschen zusammenzustellen. Die konservative Therapie ist dabei Basismaßnahme und sollte jedem Behandler bekannt sein.
https://ift.tt/2J5f8Hx
Pre-Distribution of Potassium Iodide (KI) and Maintenance of KI Stockpile Called for in Advance of Multi-Organizational Meeting
ATA supports dialogue on the international harmonization of radiological emergency preparedness around nuclear power stations
The American Thyroid Association® is the leading organization devoted to thyroid biology and to the prevention and treatment of thyroid disease through excellence in research, clinical care, education, and public health. It has come to our attention that several organizations to include Greenpeace Canada, Beyond Nuclear and a coalition of Michigan civil society organizations jointly hold a meeting at the University of Detroit Mercy in Detroit, Michigan for a dialogue on the international harmonization of radiological emergency preparedness around nuclear power stations. One issue of particular concern is in regard to ensuring appropriate potassium iodine distribution within the emergency planning zone (EPZ) surrounding Fermi Unit 2 at the nuclear power station in Monroe, Michigan.
As stated in the American Thyroid Association® (ATA®) Scientific Statement on the Use of Potassium Iodide Ingestion in a Nuclear Emergency which was published in the journal Thyroid® in 2017 (Vol 27, Number 7; Pages: 865-877), the American Thyroid Association calls for pre-distribution of potassium iodide (KI) to individual households residing within a minimum of the 10-mile emergency planning zone (EPZ) of an actively operating U.S. nuclear power plant. The ATA also calls for maintenance of a stockpile of potassium iodine in a greater than 10 out to 50-mile ring out from nuclear power points and is to be held in local public facilities such as schools, hospitals, Clinics, post offices, and police as well as fire stations for distribution upon notification by local health officials.
The effectiveness of KI for protection of the thyroid from radioiodine fallout from a nuclear emergency is predicated on prompt use that at the same time does not delay evacuation from the affected area. It is therefore somewhat disconcerting that a study by the Michigan Department of Community Health published in 2012 found that only 5.3% of eligible residences in the EPZ of one of three nuclear power plants in MI had redeemed KI vouchers and of those individuals who had redeemed KI vouchers ~ 50% were unaware of when to take KI or that it could protect the thyroid from radiation exposure. Of those identified as not having utilized a KI voucher, 48% were either unaware or had forgotten that such a program exists.
The ATA® would like to again emphasize that prophylactic KI administrator should be part of a nuclear emergency plan that includes evacuation, sheltering, and the avoidance of contaminated food, milk and water ingestion in the event of a nuclear emergency. The ATA calls for ready access to KI for the U.S. population living in nuclear power EPZs from the U.S. Department of Health and Human Services' National Pharmaceutical Stockpile under appropriate regulatory guidance. The ATA also supports attempts to harmonize KI distribution strategies with Canada particularly in US-Canadian border localities that fall within EPZs from the same nuclear power plant.
###
The American Thyroid Association (ATA) is the leading worldwide organization dedicated to the advancement, understanding, prevention, diagnosis, and treatment of thyroid disorders and thyroid cancer. ATA is an international, individual membership organization for over 1,700 clinicians and researchers from 43 countries around the world, representing a broad diversity of medical disciplines. It also serves the public, patients and their families through education and awareness efforts.
Celebrating its 95th anniversary, ATA delivers its mission through several key endeavors: the publication of highly regarded monthly journals, Thyroid®, Clinical Thyroidology®, VideoEndocrinology™, and Clinical Thyroidology for the Public; annual scientific meetings; biennial clinical and research symposia; research grant programs for young investigators; support of online professional, public, and patient educational programs; and the development of guidelines for clinical management of thyroid disease.
Find out more about ATA at www.thyroid.org.
The post Pre-Distribution of Potassium Iodide (KI) and Maintenance of KI Stockpile Called for in Advance of Multi-Organizational Meeting appeared first on American Thyroid Association.
https://ift.tt/2qD2SqB
Clinical Thyroidology®High-Impact Articles
FREE ACCESS through April 30, 2018.
Read Now:
Circulating BRAF V600E Levels Correlate with Treatment State in Thyroid Cancer
Brian W. Kim
During Active Surveillance of Papillary Thyroid Microcarcinomas Higher Serum TSH Is Associated with Nodule Growth
Jerome M. Hershman
Patients with Advanced Papillary Thyroid Cancer Have Fewer Recurrences after Undergoing Surgery by High-Volume Surgeons
Masha J. Livhits, Michael W. Yeh
Extent of Initial Surgery May Impact Overall Survival, Even for Low-Risk Papillary Thyroid Cancers
Tracy S. Wang
The post Clinical Thyroidology<sup>®</sup>High-Impact Articles appeared first on American Thyroid Association.
https://ift.tt/2ETS5wR
Our experience of the necessity of adenoidectomy or adenotonsillectomy at the time of ventilation tube insertion in 11 941 children with middle ear effusion
Clinical Otolaryngology, EarlyView.
https://ift.tt/2JVllXI
The correlation between active anterior rhinomanometry results and nasal obstruction symptoms scores after inferior turbinate reduction: A prospective cohort study about sixty‐five patients
Clinical Otolaryngology, EarlyView.
https://ift.tt/2vnfVkN
Surgical management of ascending aortic pseudoaneurysm in a 2-year-old boy: a case report
Aortic pseudoaneurysms are rare but life-threatening complications usually seen after cardiac surgery. The causes could be multifactorial such as infection or trauma.
https://ift.tt/2HtvEUw
Novel association of a papuloerythroderma of Ofuji phenotype with dermatitis herpetiformis
International Journal of Dermatology, EarlyView.
https://ift.tt/2qDJeeb
The management of livedoid vasculopathy focused on direct oral anticoagulants (DOACs): four case reports successfully treated with rivaroxaban
International Journal of Dermatology, EarlyView.
https://ift.tt/2EVqxqy
Clinical practice guidelines for the diagnosis and treatment of cutaneous leishmaniasis in Turkey
International Journal of Dermatology, EarlyView.
https://ift.tt/2qCT289
Knee joint instability after total knee replacement in a patient with Ehlers-Danlos syndrome: the role of insert changes as practical solution
Treatment of knee joint instability in patients with hypermobile Ehlers-Danlos syndrome (EDS) can be challenging. A 53-year-old woman with hypermobile EDS underwent bilateral total knee replacement (TKR) due to valgus osteoarthritis. During follow-up, she developed hypermobility of both knee replacements. Revision of the insert resolved the issue in her left knee; however, the right TKR required two insert exchanges and unfortunately instability persisted. Therefore, a revision to a constrained prosthesis was performed. Insert exchanges in an unstable TKR can give short-term benefits, but for the long-term, we would recommend a constrained prosthesis.
https://ift.tt/2vjdQ9H
Chorionic bump in a pregnant patient with a history of infertility
Chorionic bump is a rare condition in the first trimester of pregnancy. It appears as a bulge from the choriodecidual surface into the gestational sac. So far, there have been no ultrasound or clinical markers that can predict a difference in outcome
We report a case of a pregnant woman with history of infertility, diagnosed in the first trimester with a chorionic bump. It disappeared spontaneously at 23 weeks of gestation. The pregnancy went well and she delivered a healthy baby.
The aetiology and clinical significance of the chorionic bump remains unclear.
https://ift.tt/2JS4p4f
Tc-99m sestamibi scintigraphy and primary hyperparathyroidism: uptake beyond parathyroid glands
Description
Brown tumours (BTs) are one of the complications of long-standing hyperparathyroidism, being rare in developed countries. Tc-99m sestamibi scintigraphy (MIBI) is currently the gold standard for eutopic/ectopic parathyroid tissue localisation in primary hyperparathyroidism (PH). There are only a few reports showing BT uptake in whole-body MIBI.1–3
The first case is a 72-year-old caucasian woman, with a history of right nephrectomy for renal lithiasis at the age of 49 and a left clavicle fracture at the age of 70, who presented with an enlarging mass in the fracture site (~6 cm). Laboratory data showed an elevated serum level of calcium (sCa) of 12.8 mg/dL [normal range (NR): 8.4–10.2], alkaline phosphatase (ALP) of 264 UI/L (NR: 9–36) and parathyroid hormone (PTH) of 1056 pg/mL (NR: 12–65), and decreased serum phosphorus (sPi) of 2.1 mg/dL (NR: 2.3–4.7) with 25-OH vitamin D of 33 ng/mL (NR 9–45), consistent with PH. MIBI showed uptake in the inferior pole...
https://ift.tt/2EUkuTc
Floating kidney
Description
A 28-year-old, healthy woman with a history of abdominal pain of almost 6 years came to see us in our clinic after having seen several physicians at several different hospitals over the years. The chief presenting complaint had remained consistent—it was intermittent right abdominal pain that tended to exacerbate in the upright position and improve in the supine position. The change in position was also associated with a feeling of 'a ball rolling' inside of her. There were no other symptoms. Of note, during enquiry into her obstetrical history, the patient recalled that her pain always seemed to be less during pregnancy, especially in the later trimesters.
Physical exam revealed a thin woman with no acute findings on abdominal exam. Prior lab testing and imaging work-ups, including computed abdominal tomography, had been normal.
Given the nature of her complaints, we performed intravenous pyelography—a simplistic imaging test that lends...
https://ift.tt/2JS4mp5
Persistent left superior vena cava and absence of innominate vein during coronary artery bypass surgery
Description
A 56-year-old man presented with acute left-sided chest pain at rest with associated dyspnoea. His heart rate was 35 beats/min and ECG revealed a complete heart block. A temporary cardiac pacing was implemented on the right side via transcutaneous leads. He was also diagnosed with non-ST elevation myocardial infarction due to raised cardiac enzymes and was managed with medical therapy. The pacemaker was removed after 3 days when he reverted to sinus rhythm. Coronary angiogram was subsequently performed and revealed a critically obstructed triple coronary vessel disease. Echocardiography revealed an ejection fraction of 40%, competent valves and normal chamber size. Coronary artery bypass graft (CABG) surgery was performed via median sternotomy. Interestingly, there were no innominate veins identified intraoperatively and a dilated coronary sinus was seen on transoesophageal echocardiography. Cardiopulmonary bypass was initiated following aortic and two-stage right atrial venous cannulation. The heart was cooled and intentionally...
https://ift.tt/2EU7sVT
Natural history of luminal A breast invasive ductal carcinoma in an elderly
An elderly woman, with no clinically palpable breast lump, presented with an initially benign-appearing lesion on ultrasound. She was followed up to reveal the natural history of luminal A breast cancer.
https://ift.tt/2JS4kNZ
Persistent respiratory distress in a neonate: a diagnostic dilemma
We present a 17-day-old term, female baby who was referred to our centre for persistent respiratory distress. She was managed for pneumonia and pneumothorax at the primary care centre. On detailed clinical examination at admission, a possibility of congenital lobar emphysema (CLE) was considered. A CT chest was performed, and diagnosis of CLE was confirmed. The infant was managed with lobectomy. The respiratory distress settled within a few hours after the surgery, and the baby was discharged in stable condition.
https://ift.tt/2ERhnvf
Oral superficial haemosiderotic lymphovascular malformation: a rare presentation
We present an extremely rare case of a 53-year-old woman with an intraoral superficial haemosiderotic lymphovascular malformation (SHLM), also known as hobnail haemangioma. SHLM is a rare, benign, vascular tumour first described as targetoid haemosiderotic haemangioma, with only a handful of cases reported to present in the oral cavity. The diagnosis was established following complete surgical excision of the lesion, and after 14 months, there are still no signs of recurrence. Although SHLM is an uncommon condition, accurate and timely diagnosis is valuable in distinguishing these lesions from their more serious competing differential diagnoses.
https://ift.tt/2JS4jJV
Solitary cardiac metastasis from primary oral squamous cell carcinoma presenting as ST-elevation MI
Cardiac metastases from oral squamous cell carcinoma (SCC) are rare, especially in the absence of systemic metastasis. We describe a case of a patient presenting with chest pain and ECG abnormalities concerning for ST-elevation myocardial infarction that eventually was found to have an incidental right ventricular mass on chest CT angiogram. Ultimately, she had an intracardiac echocardiography-assisted biopsy diagnosis of isolated cardiac metastasis from primary oral SCC. The extent of the disease precluded any surgical intervention, and the patient subsequently transitioned to hospice care. Most cardiac metastases remain clinically silent until widespread systemic disease leads to death. Thus, cardiac metastasis should be considered in a patient with SCC who develops new cardiovascular symptoms or conduction abnormalities.
https://ift.tt/2ERhlDD
Eye for an eye: near-fatal outcome of fungal infection in a young, diabetic girl
In this report, we describe the case of a young, diabetic girl with ketoacidosis who suffered sudden loss of vision of the right eye. The loss of vision was caused by an invasive rhino-orbital-cerebral fungal infection (mucormycosis) with extensive periorbital thrombosis. Despite maximal antifungal and surgical treatment (including exenteration of the right orbit), the clinical situation deteriorated. It was only after overcoming the difficulties of managing her hyperglycaemia that the patient's condition stabilised and her life was saved. Another factor contributing to this girls' survival was the swift diagnosis of mucormycosis, which was made soon after the onset of symptoms. Because of this, treatment could be started almost immediately.
https://ift.tt/2JS3MYr
Mantle cell lymphoma presenting as bilateral adrenal huge masses
We present a middle-aged woman complaining of weakness, lethargy and weight loss for 6 months. Positron emission tomography (PET)/CT scan revealed huge bilateral adrenal masses with intense 18F-fluorodeoxyglucose avidity. Biopsy and immunohistochemical staining were compatible with mantle cell lymphoma (MCL). The patient received six cycles of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) followed by four cycles of intrathechal methotrexate chemotherapy. Bone marrow aspiration biopsy was performed for initial staging and also before bone marrow transplantation. Follow-up PET/CT scan after completion of chemotherapy and before bone marrow transplantation demonstrated complete metabolic response with no evidence of abnormal metabolic activity in either adrenal gland or bone marrow. MCL has an aggressive nature and is usually considered incurable; however, there have been a few reports indicating favourable treatment response when MCL is rarely arising from the adrenal glands. Dramatic response of a primary adrenal MCL to R-CHOP is documented in this case.
https://ift.tt/2ERh4AB
Idiopathic scrotal fat necrosis: an unusual cause of scrotal pain
The clinical differential diagnosis of scrotal pain with a mass in a prepubertal boy is difficult. Often conditions such as testicular torsion and epididymo-orchitis are diagnosed. We present a rare cause of scrotal pain, idiopathic scrotal fat necrosis. This condition has a typical clinical presentation and ultrasound findings that have been described in a limited number of case reports. However, if it is diagnosed correctly and confirmed with ultrasound, we hope that people will be treated without surgical intervention. We present a case of scrotal wall necrosis and a literature review.
https://ift.tt/2JS4g0H
Collapse in the elderly: rivastigmine-induced heart block and a literature review of the pharmacology of acetylcholinesterase inhibitors used in Alzheimers disease
Falls resulting in neck of femur fractures are common in the elderly. Often multiple comorbidities can make management and diagnosis of such a polyfactorial condition difficult, particularly with Alzheimer's dementia (AD). Indeed, poorly managed AD may contribute to falls. We present our management of an 87-year-old woman, on rivastigmine for AD, who presented with a collapse episode—attributed to rivastigmine—resulting in a neck of femur fracture. Furthermore, we perform a literature review of the pharmacology of acetylcholinesterase inhibitors and how their use in AD may contribute to bradyarrhythmias.
https://ift.tt/2JS4cxZ
Intraluminal mesh migration causing enteroenteric and enterocutaneous fistula: a case and discussion of the 'mesh problem
The use of synthetic mesh in the abdominal compartment has recently become a topic of debate as high profile public cases have called into question their safety. Several case reports have demonstrated significant complications due to intra-abdominal mesh. Furthermore, some studies have suggested that the rates of these severe complications are underestimated. We present the case of a patient who developed an enteroenteric and enterocutaenous fistulae, an abdominal wall collection and an intraperitoneal inflammatory mass from intraluminal migration of a synthetic mesh inserted during laparoscopic incisional hernia repair. We discuss the considerations and complications of using synthetic mesh for ventral hernia repair and discuss the scientific evidence behind the increasingly apparent 'mesh problem'.
https://ift.tt/2ERhdnD
Εγγραφή σε:
Αναρτήσεις (Atom)