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- Combo-VAS: an integrated outcome for assessing the...
- Mary Hewitt Loveless, MD, and the origin of venom ...
- Association between pre-operative biological pheno...
- Postpartum Care for Mom
- Economic Analysis of Using Free Fat Graft or Acell...
- Intraoperative Mapping of the Subfascial Plexus Us...
- Direct Excision of the Lower Eyelid: A Safe and Ef...
- Platelet-Rich Plasma for the Treatment of Androgen...
- A New Hybrid Technique for Performing a Safer Bila...
- Stellenwert der Tubendilatation bei Mittelohradhäs...
- “Dealing with the changeable and blurry edges of l...
- Comprehensive review of the extended middle crania...
- Rare variability in adrenoleukodystrophy: a case r...
- Fine needle non-aspiration cytology for the diagno...
- The efficacy and safety of multiple sessions of mu...
- Chitins and Chitinase Activity in Airway Diseases
- Speech and Communicative Participation in Patients...
- Restrictions in Communicative Participation
- The Pathogenesis of Choanal Atresia
- Association of Video Head Impulse Test With Improv...
- Guideline for Management of Pediatric Gastroesopha...
- Abdominal pain leading to incidental finding of po...
- Tip of the iceberg: congenital cataract with pre-e...
- Rare case of Gordon Holmes syndrome
- Cavum vergae and psychiatric illness: substantive ...
- 'A snake and a crescent moon in a coronary angiogram
- Acute subclavian artery occlusion with associated ...
- A case of oligodendroglioma and multiple sclerosis...
- Early onset necrotising enterocolitis in associati...
- Orbital blowout fracture from nose blowing
- Post-transplant erythrocytosis refractory to ACE i...
- Acute COPD exacerbation presenting with pronounced...
- Large cell neuroendocrine carcinoma and adenocarci...
- Acute liver failure due to liver parenchymal infil...
- Regressive pyridoxine-induced sensory neuronopathy...
- Disseminated histoplasmosis mimicking relapsed chr...
- Breast cancer metastasis to the bladder: a literat...
- Untreated Congenital Hypothyroidism Mimicking Hirs...
- Aprepitant for CINV Induced by Chemoradiotherapy i...
- Surgical treatment of mucocele of the appendix: a ...
- Adenoid size by drug induced sleep endoscopy compa...
- Oropharyngeal cancer is no longer a disease of you...
- Perioperative considerations in free flap surgery:...
- The in-principle inconclusiveness of causal eviden...
- Successful treatment of erythematotelangiectatic r...
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- Prolonged growth of infantile hemangioma after pul...
- Psoriasiform dermatitis associated with common var...
- Identification of a missense mutation causing exon...
- Effets indésirables des soins capillaires chez les...
- Plasminogen gene mutation with normal C1Inhibitor‐...
- Alteration of Serum Lipid in Oral Sub Mucous Fibro...
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Ετικέτες
Πέμπτη 28 Ιουνίου 2018
Combo-VAS: an integrated outcome for assessing the perception of allergen immunotherapy effectiveness in clinical practice.
Source:Annals of Allergy, Asthma & Immunology
Author(s): Giorgio Ciprandi, Michela Silvestri, Maria Angela Tosca
https://ift.tt/2N7Sp09
Mary Hewitt Loveless, MD, and the origin of venom immunotherapy
Publication date: Available online 28 June 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Stephen J. Galli
https://ift.tt/2yVstBY
Association between pre-operative biological phenotypes and postoperative pulmonary complications: An unbiased cluster analysis
https://ift.tt/2Kvp5Pz
Postpartum Care for Mom
Your motherly instincts are in full swing by the time you bring your baby home from the hospital. New moms pour their heart and soul into taking care of their newborn. While newborns require a lot of love and attention, it is essential for new moms to prioritize their own health as well. Here are a couple of ways to keep yourself healthy after delivery.
The post Postpartum Care for Mom appeared first on ChildrensMD.
https://ift.tt/2Kf2c6N
Economic Analysis of Using Free Fat Graft or Acellular Dermis to Prevent Post-parotidectomy Frey Syndrome
Facial plast Surg
DOI: 10.1055/s-0038-1666871
A decision tree was constructed to determine the incremental cost-effectiveness ratio (ICER) of grafting techniques used to prevent Frey Syndrome. The authors performed a sensitivity analysis to calculate what the probability of preventing Frey Syndrome would have to be and maximum costs associated with using grafting techniques to warrant their use as more "cost-effective" choice than using neither. Decision pathways utilized were uses of (1) free fat graft (FFG), (2) acellular dermis, and (3) no grafting. The probability of developing Frey syndrome and costs were extracted from previous studies to construct the decision tree. The primary effectiveness was the ICER of FFG or acellular dermis to prevent Frey syndrome. The initial outcomes included preventing Frey syndrome (effectiveness = 1) or developing Frey syndrome (effectiveness = 0). Compared with not using a graft, the ICER of using FFG and acellular dermis were $10,628 and $50,813, respectively. Frey syndrome was found in 2.6% of patients postoperatively in FFG group, 9.8% of patients in acellular dermis group, and 30.7% of patients who did not have a graft. The ICER shows absolute dominance of FFG with lower cost and high effectiveness over acellular dermis. This economic evaluation strongly supports the use of FFG over acellular dermis as cost-effective approach for prevention of postparotidectomy Frey syndrome.
[...]
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Article in Thieme eJournals:
Table of contents | Abstract | Full text
https://ift.tt/2N3ucrT
Intraoperative Mapping of the Subfascial Plexus Using the Transillumination Method for Head and Neck Reconstruction with Free Style Anterolateral Thigh Flaps
Facial plast Surg
DOI: 10.1055/s-0038-1666783
Without well recognizing the vascular territories of the perforator, surgery might damage the pedicle and diminish flap survival. This study described a transillumination method for intraoperative mapping of the subfascial plexus of the perforator in the head and neck reconstruction with an anterolateral thigh (ALT) flap and also compared the perioperative outcomes and complications of the method with those of the conventional two-pedicle ALT flap. Between January 2011 and December 2017, 26 patients who underwent head and neck reconstruction with ALT flaps were evaluated as follows: 13 underwent the transillumination method (case group), and 13 (age- and sex-matched) underwent standard two-pedicle flap procedures (control group). Demographic factors, diagnosis, flap size, recipient site, perioperative data, and postoperative complications were compared between the two groups. There was no significant difference in age, sex, diagnosis, recipient sites, and flap size between the case and control groups. Regarding the perioperative outcomes, the harvesting time was significantly shorter in the case group than in the control group (60 vs. 100 minutes, p < 0.001). The operative time was shorter in the case group than in the control group, but this difference was not statistically significant (300 vs. 420 minutes, p = 0.058). The transillumination method can allow plastic surgeons to easily identify the perforator vascular plexus of the ALT flap, which facilitates intraoperative flap design in head and neck reconstruction.
[...]
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Article in Thieme eJournals:
Table of contents | Abstract | Full text
https://ift.tt/2tMVvOk
Direct Excision of the Lower Eyelid: A Safe and Effective Method for Treating Dermatochalasis and Pigmentation
Facial plast Surg
DOI: 10.1055/s-0038-1666787
The subciliary and skin pinch approaches are the most widely accepted techniques for treating dermatochalasis of the lower eyelid. Direct excision (DE) is an accepted method for treating festoons; however, it is not a popular technique for the treatment of dermatochalasis and pigment of the lower lid. DE of the lower lid offers a safe and excellent aesthetic result for dermatochalasis and pigment of the lower lid, without causing lower lid malposition, which can occur with more traditional methods. In addition to being able to remove significantly more skin without risking lower lid malposition, this procedure allows for removal of the most pigmented and poorly textured skin overlying the nasojugal groove. It is an effective alternative to the conventional subciliary and skin pinch approaches.
[...]
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Article in Thieme eJournals:
Table of contents | Abstract | Full text
https://ift.tt/2N6Yh9S
Platelet-Rich Plasma for the Treatment of Androgenic Alopecia: A Systematic Review
Facial plast Surg
DOI: 10.1055/s-0038-1660845
The use of platelet-rich plasma (PRP) has become increasingly commonplace in facial plastic surgery for the treatment of androgenic alopecia (AGA). However, this treatment remains novel with a range of application techniques and outcomes described in the literature. Herein, the authors systematically review the existing literature on the use and efficacy of PRP for AGA. Systematic review of PubMed, Embase, and Cochrane databases was performed. Case reports were excluded. Twenty-four papers met inclusion criteria for this study: 8 randomized control trials and 16 prospective cohort studies. Twenty-one studies used clinical criteria to diagnose AGA, while three used confirmatory biopsies. PRP was injected with or without the use of a numbing agent, and most studies performed multiple injections (three or more separated by several weeks). Twenty-one studies reported positive outcomes by objective criteria (88%), while three suggested that there was no clinical improvement, although in two of these studies patients still reported increased satisfaction. There were no complications reported other than transient edema/erythema and pain/headache associated with the procedure. The existing literature suggests that PRP is a low-risk intervention to treat AGA associated with good patient satisfaction and objective improvements in outcomes. Further research is needed to optimize preparation and delivery methods as well as standardize measurements of clinical outcomes.
[...]
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Article in Thieme eJournals:
Table of contents | Abstract | Full text
https://ift.tt/2yYJ0oq
A New Hybrid Technique for Performing a Safer Bilateral Sagittal Split Osteotomy: Combining Reciprocating Saw and Piezoelectric Devices
Facial plast Surg
DOI: 10.1055/s-0038-1666788
The sagittal split osteotomy (SSO) is an indispensable tool in the correction of dentofacial abnormalities. In elective orthognathic surgery, it is important that surgeons inform patients about the risk of complications related to inferior alveolar nerve damage and unfavorable split. The purpose of this article is to describe a novel, hybrid technique to SSO by combining a reciprocating saw and piezoelectric devices with several advantages over traditional "pure" methods (osteotomies performed by reciprocating saw or piezoelectric devices only) in terms of precision, rapidity, easier splitting, and decreased complications related to inferior alveolar nerve damage and bad split with reduced overall morbidity. The level of evidence was Level IV, therapeutic study.
[...]
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Article in Thieme eJournals:
Table of contents | Abstract | Full text
https://ift.tt/2MyI4sZ
Stellenwert der Tubendilatation bei Mittelohradhäsivprozess
Laryngo-Rhino-Otol
DOI: 10.1055/a-0640-9270
Hintergrund Eine gestörte Tubenfunktion stellt einen häufigen Befund bei Patienten dar und kann verschiedene Mittelohrerkrankungen begünstigen. Mit Einführung der Ballondilatation wurde ein Verfahren zur Therapie der chronischen Tubenfunktionsstörung etabliert. In der vorliegenden Studie wurde der Stellenwert der Methode unter der speziellen Fragestellung des Erfolgs bei Mittelohradhäsivprozessen untersucht. Material und Methoden In einer retrospektiven Studie im Zeitraum 2011 bis 2016 wurden die Daten von 81 Patienten, die aufgrund einer chronischen Tubenventilationsstörung einer Tubendilatation unterzogen wurden hinsichtlich des präoperativen Vorliegens eines Adhäsivprozesses, ausgewertet. Der Erfolg der Tubendilatation wurde anhand der postoperativen Fähigkeit zur Durchführung des SVT-Tests sowie der Selbsteinschätzung der Patienten beurteilt. Bei einem mittleren Nachuntersuchungszeitraum von vier Monaten konnten bei insgesamt 13 Patienten mit Adhäsivprozess Daten zur prä- und postoperativen Tubenfunktion einbezogen werden. Ergebnisse Das Verfahren verlief in allen Fällen komplikationslos. Patienten mit einer Tubenventilationsstörung zeigten in 46 % postoperativ ein besseres Ergebnis, während es bei 31 % der Patienten mit Adhäsivprozess zu einer Besserung der Mittelohrbelüftung kam. Subjektiv gaben 54 % der Patienten eine Besserung ihrer Beschwerden an. Schlussfolgerung Trotz einer subjektiven Besserung der angegebenen Beschwerden in 54 % der Fälle, kam es in unserer Studie nur bei 31 % der Patienten mit einem Adhäsivprozess zu einem objektiv messbaren Erfolg. Zur Klärung der Frage, in wieweit die Kombination mit anderen mittelohrchirurgischen Eingriffen günstigere Therapierfolge hat, sind zukünftige Studien mit größeren Patientenkollektiven erforderlich.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
https://ift.tt/2MxF3Jy
“Dealing with the changeable and blurry edges of living things: a modified version of property-cluster kinds”
Abstract
Despite many attempts to achieve an adequate definition of living systems by means of a set of necessary and sufficient conditions, the opinion that such an enterprise is inexorably destined to fail is increasingly gaining support. However, we believe options do not just come down to either having faith in a future success or endorsing skepticism. In this paper, we aim to redirect the discussion of the problem by shifting the focus of attention from strict definitions (in terms of necessary and sufficient conditions) towards a philosophical framework that allows conceiving of living systems as a natural kind, but whereby natural kinds are not to be defined by fixed necessary and sufficient conditions. We argue for a property-cluster kind approach according to which living systems constitute a natural kind with vague boundaries, capable of changing, and whose members do not need to instantiate every property. We draw from Boyd's homeostatic property-cluster theory and introduce two modifications, one regarding homeostatic mechanisms and another related to the scientific role of kinds. Thus, our view overcomes some difficulties of Boyd's theory and we are able to account for the natural kindhood of living things. We also emphasize the most appealing features of our approach for specific research fields and address three objections to this sort of approach.
https://ift.tt/2KvT8Xp
Comprehensive review of the extended middle cranial fossa approach
https://ift.tt/2Ki3M84
Rare variability in adrenoleukodystrophy: a case report
X-linked adrenoleukodystrophy is a genetic disorder with diverse clinical phenotypes. Of these phenotypes, the cerebral form usually manifests during early childhood with rapid cognitive and neurological deter...
https://ift.tt/2z1X5Sr
Fine needle non-aspiration cytology for the diagnosis of cervical lymph node tuberculosis: a single center experience
Publication date: Available online 28 June 2018
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Moncef Sellami, Slim Charfi, Mohamed Amine Chaabouni, Salma Mrabet, Ilhem Charfeddine, Lobna Ayadi, Souha Kallel, Abdelmonem Ghorbel
IntroductionThe fine-needle cytology is being used as a first line of investigation in the diagnosis of head and neck swellings, as it is simple, cost effective and less invasive as compared to biopsy.ObjectiveThe aims of this study were to evaluate the results of the fine-needle non-aspiration cytology of cervical lymphadenopathy and to study the factors influencing the rate of non-diagnosis results.MethodsThis retrospective study was conducted on selected patients with cervical lymphadenopathy that had undergone a fine-needle non-aspiration cytology followed by a histological biopsy. The sensitivity, specificity, positive predictive value and negative predictive value of fine-needle non-aspiration cytology for diagnosing tuberculosis were estimated. The risk factors of non-diagnosis results were evaluated.ResultsThe sensitivity, specificity, positive predictive value rates of fine-needle non-aspiration cytology for tuberculosis were 83.3%, 83.3%, 78.9% and 86.9% respectively. In total, 47 out of the 131 samples (35.8%) were considered non-diagnosis. Of the non-diagnosis samples, 84.2% (38 out of 47) were benign mostly due to tuberculosis (30 cases). Among the studied factors, only tuberculosis (confirmed by histopathological examination) was significantly associated with non-diagnosis cytology (p=0.02, Odds-Ratio=2.35).ConclusionTuberculosis is currently the commonest cause of cervical lymphadenopathy in North Africa. Fine-needle non-aspiration cytology is safe and accurate in the diagnosis of cervical tuberculous lymph node that is associated with the risk of non-diagnosis cytology.
https://ift.tt/2IB4t6r
The efficacy and safety of multiple sessions of multisite transcranial random noise stimulation in treating chronic tinnitus
Publication date: Available online 28 June 2018
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Samer Mohsen, Akram Pourbakht, Mohammad Farhadi, Saeid Mahmoudian
IntroductionRandom noise stimulation was reported as the more effective and safer type of electrical stimulation techniques in relieving tinnitus symptoms. The multisite protocol of transcranial random noise stimulation has shown additional favorable effects.ObjectiveHere we will discuss the role of applying eight sessions of multisite transcranial random noise stimulation in decreasing tinnitus loudness and annoyance without exerting additional adverse effects.MethodsTwenty-nine subjects (8 female), the mean age of (45.34±9.57) with chronic tinnitus received transcranial random noise stimulation in the multisite protocol, 10min of auditory-transcranial random noise stimulation applied over the T3, T4 preceded by 10min of prefrontal-transcranial random noise stimulation applied over F4, FP1. In the first group, only one session was applied and the multiple-sessions group contained eight repeated sessions. Visual analog scale scores for loudness and distress were recorded before and immediately after the treatment. Multivariate repeated measure ANOVA test was used and minimal detectable change calculated.ResultsThere was a statistically and clinically significant reduction in tinnitus loudness and annoyance in both groups (p<0.05, effect size (η2)>0.8), while the amount of annoyance suppression in the multiple-sessions group was significantly greater than the single-session group. The patients of the multiple-sessions transcranial random noise stimulation group reported an improvement in their sleep and lower tinnitus handicap inventory scores without experiencing any additional adverse effects of the intervention.ConclusionsThe results of this study showed a substantial improvement in tinnitus symptoms by using the multiple sessions of transcranial random noise stimulation in the multisite protocol without producing any additional side effects. We suggest further clinical trials with long-term follow-up be investigated.
https://ift.tt/2KjQoQw
Chitins and Chitinase Activity in Airway Diseases
Publication date: Available online 28 June 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Steven J. Van Dyken, Richard M. Locksley
Chitin, one of the most abundant biopolymers on earth, is bound and degraded by chitinases, specialized enzymes that are similarly widespread in nature. Chitin catabolism impacts global carbon and nitrogen cycles through a host of diverse biological processes, but recent work has focused attention on systems of chitin recognition and degradation conserved in mammals, connecting an ancient pathway of polysaccharide processing to human diseases influenced by persistent immune triggering. Here, we review current advances in our understanding of how chitin-chitinase interactions impact mucosal immune feedback mechanisms essential to maintaining homeostasis and organ heath.
https://ift.tt/2Kxhvnh
Speech and Communicative Participation in Patients With Facial Paralysis
https://ift.tt/2tIVz1u
Restrictions in Communicative Participation
https://ift.tt/2lHCp8M
The Pathogenesis of Choanal Atresia
https://ift.tt/2z0YTuX
Association of Video Head Impulse Test With Improvement of Dynamic Balance and Fall Risk
https://ift.tt/2lI91iG
Guideline for Management of Pediatric Gastroesophageal Reflux
https://ift.tt/2tIVn2g
Abdominal pain leading to incidental finding of polyarteritis nodosa
Description
A 51-year-old man with new-onset hypertension presented with mild epigastric pain that started 3 days ago. The pain was associated with emesis, subjective fevers and diaphoresis. He denied haematemesis, haematochezia, melena, fatigue, night sweats, abnormal bowel movements, weight change, skin changes or neuropathy.
His vitals were significant for heart rate of 120 bpm. He appeared pale with peripheral cyanosis. Abdomen was diffusely tender with normal bowel sounds. There was no rebound tenderness. Complete blood count, comprehensive metabolic panel, amylase and lipase levels were normal. CT of the abdomen demonstrated an abdominal haematoma centred ventral to the third portion of the duodenum and bilateral renal wedge-shaped infarcts (figures 1–3). Abdominal angiogram showed irregular pancreaticoduodenal arcade with microaneurysms originating from a branch of the proximal superior mesenteric artery (figure 4). The rupture of one of the microaneurysms was presumed to be the...
https://ift.tt/2KgKkbx
Tip of the iceberg: congenital cataract with pre-existing posterior capsule defect (PPCD): how vital is the role of ultrasound biomicroscopy?
Description
A 14-month-old female child presented to the outpatient clinic with abnormal white reflex of the left eye (LE) noticed by parents for the last 6 months. The right eye (RE) had similar history and was operated for a white cataract at an outside hospital 3 months before. Intraoperatively, pre-existing posterior capsule defect (PPCD) was noted in the RE with inadvertent lens matter drop, which occurred after hydrodissection and was removed subsequently. The PPCD was quite large and the RE had to be left aphakic. Anterior segment examination of the LE with fully dilated pupil showed total cataractous lens with invisible posterior capsular details (figure 1A). Ultrasound biomicroscopy (UBM) of the LE showed a large posterior capsular defect with subluxation of the lens into the vitreous cavity1 beyond the capsule (figure 1B). Care was taken to avoid lens drop during irrigation–aspiration. Viscoat can be used to coat the area of the PPCD to temporarily seal the defect....
https://ift.tt/2Mqa3uI
Rare case of Gordon Holmes syndrome
Young-onset cerebellar syndromes are quite interesting and challenging for treating clinicians. While dealing with such cases, a clinician should be aware of rare possible causes too. We report a rare case of Gordon Holmes syndrome—an autosomal recessive cerebellar ataxia with endocrinal abnormalities.
https://ift.tt/2KuclvD
Cavum vergae and psychiatric illness: substantive or serendipity?
Description
A 38-year-old woman presented with 1-month history of restlessness, decreased sleep, religious song auditory hallucination and delusion of persecution and reference. She had no insight into her illness. She was not on any long-term medications. There was no history of head trauma or exposure to toxins. She suffered from postpartum psychosis during both her pregnancies (8 and 11 years ago) which warranted inpatient treatment with antipsychotics and mood stabilisers. She defaulted treatment both times once she got better and did not experience any recurrence of symptoms until current episode. She had no other comorbidities or significant family history. Her general medical and neurological examination findings were within normal limits. Routine laboratory tests did not reveal any abnormality. A brain MRI diffusion weighted imaging sequence demonstrated cavum vergae (CV, figure 1A) and MRI brain apparent diffusion coefficient sequence showing CV and thinned out cavum septum pellucidum (CSP, figure 1B). She was initially...
https://ift.tt/2KxglYU
'A snake and a crescent moon in a coronary angiogram
Description
A coronary artery fistula (CA F) is a direct connection between a coronary artery and any one of the cardiac chambers, the coronary sinus or superior vena cava, or a pulmonary artery or pulmonary vein close to the heart. CAF accounts for 48.7% of all congenital coronary anomalies.1 The most common drainage sites in a decreasing frequency are the right ventricle (41%), right atrium (26%), pulmonary artery (17%), coronary sinus (7%), left atrium (5%), left ventricle (3%) and superior vena cava (1%).2 Further occurrence of this CAF along with the presence of aortic sinus to pulmonary artery fistula is very rare.
We present a case of a 53-year-old, hypertensive man who had presented with a first episode of chest pain of 8 hours' duration. At presentation in the emergency department, his heart rate was 90/min and blood pressure measured 158/85 mm Hg. His cardiac and chest examinations were...
https://ift.tt/2KqSzRD
Acute subclavian artery occlusion with associated clavicle fracture managed with bypass graft alone
Subclavian artery injury is a rare consequence of clavicle fracture. It most often results from penetrating trauma but can result from blunt trauma with adjacent bone fragments causing rupture, pseudoaneurysm, dissection or thrombosis of the artery. If flow through the subclavian artery is compromised there is a risk of ipsilateral upper limb ischaemia. Life-threatening haemorrhage may result in cases of laceration, and cerebral infarction may result from dissection. Vascular injury in association with clavicle fracture is typically regarded as an indication for internal fixation of the fracture. We present a case of subclavian artery thrombosis in association with a comminuted midshaft clavicle fracture causing limb ischaemia managed by carotid to brachial artery bypass without internal fracture fixation. The fracture united at 4 weeks and there was no sustained vascular or neurological impairment at follow-up. We advocate urgent vascular intervention in subclavian artery injury. There is little discussion in the literature regarding non-operative management of clavicle fractures with subclavian artery injury. We suggest that select clavicle fractures with subclavian artery injury can be safely managed non-operatively.
https://ift.tt/2KuYUbu
A case of oligodendroglioma and multiple sclerosis: Occams razor or Hickams dictum?
Tumefactive appearing lesions on brain imaging can cause a diagnostic dilemma. We report a middle-aged man who presented with right-sided optic neuritis. A brain MRI showed enhancement of the right optic nerve, and non-enhancing white matter lesions including a 3 cm right frontal lesion with adjacent gyral expansion. Cerebrospinal fluid analysis showed five oligoclonal bands not present in serum. Glatiramer acetate was started for suspected tumefactive multiple sclerosis (MS). A follow-up brain MRI 6 months later showed persistence of the frontal gyral expansion. A brain biopsy led to the diagnosis of an oligodendroglioma, isocitrate dehydrogenase-mutant and 1 p/19q co-deleted (WHO grade II), managed with surgical resection and radiotherapy. Postoperative brain MRI showed a new enhancing periventricular lesion, making the choice of optimal disease-modifying therapy for MS challenging. This case highlights the possibility of coexistence of MS and oligodendroglioma, and emphasises the importance of a tissue diagnosis when atypical MS imaging features are present.
https://ift.tt/2KeWZM5
Early onset necrotising enterocolitis in association with congenital diaphragmatic hernia in a term baby
We report a case of a male, term newborn with known left congenital diaphragmatic hernia (CDH) who presented with circulatory compromise requiring maximal inotropic support in the first 24 hours of life. Repeat X-ray at 24 hours showed pneumatosis intestinalis. Emergency laparotomy was performed for suspected necrotising enterocolitis. The terminal ileum to the sigmoid colon were frankly necrotic with multiple perforations. Subtotal colectomy was performed. Although the recovery was protracted, the baby had a favourable outcome with progressive weight gain on follow-up at 3, 6 and 9 months of age.
This case of CDH had a postnatal systemic instability that was more severe than predicted, and as well as assessing for persistent pulmonary hypertension of newborn should trigger immediate suspicion for other organ involvement.
https://ift.tt/2Mx9gbo
Orbital blowout fracture from nose blowing
Orbital blowout fractures are nearly always caused by acute trauma. Non-traumatic cases of orbital blowout fractures have only been rarely described. In this case study, we discuss an orbital blowout fracture directly caused by nose blowing. The patient developed unilateral eye swelling and orbital emphysema. It is important for the clinician to investigate all suspected orbital blowout fractures with imaging and full ophthalmological examination regardless of a trauma history. Most cases of orbital emphysema resolve spontaneously, however one must always exclude compression of the central retinal artery. This may present as acute loss of vision and/or ophthalmoplegia.
https://ift.tt/2Ki9Opd
Post-transplant erythrocytosis refractory to ACE inhibitors and angiotensin receptor blockers
Post-transplant erythrocytosis (PTE) is a condition with elevated haematocrit (hct) in renal allograft recipients. The mainstay of treatment is ACE inhibitors (ACEi) or angiotensin II receptor blockers (ARB), but seldom phlebotomy. PTE must be recognised early to prevent major thromboembolic events. We present a case of PTE that was refractory to blockade of renin–angiotensin system (RAS) by ACEi and ARB and required phlebotomy for control of hct. Our review of medical literature about prevalence and pathophysiology of PTE suggests that approximately 22% of patients with PTE are refractory to ACEi/ARB treatment. There are four plausible pathways that appear to play a role in causing PTE: disruption of erythropoietin regulation, mitogenic effect of the RAS on erythroid lineage, insulin-like growth factor 1 and androgenic stimulation. Presently, there is no unifying hypothesis involving these factors, but refractoriness to ACEi/ARB may represent a distinct subcategory of PTE.
https://ift.tt/2KrmF4s
Acute COPD exacerbation presenting with pronounced intrabullous haemorrhage and haemoptysis
A 54-year-old man with history of chronic obstructive pulmonary disease (COPD) presented with subacute onset of chest pain, shortness of breath, productive cough with haemoptysis and night sweats. There were no fever or recent weight loss reported. The chest radiograph showed right upper lobe bullae with adjacent opacification and an emphysematous lung. Due to worsening haemoptysis and persistent chest pain, CT of the chest with contrast was performed, which revealed moderate to severe emphysema and numerous blood-filled bullae. Cardiac work-up for chest pain was negative for myocardial ischaemia and for aortic dissection. Further infectious work-ups for mycobacterial and invasive fungal infection were negative. The patient was treated for acute COPD exacerbation and responded well to the antibiotics with the resolution of haemoptysis. Follow-up CT of the chest revealed the gradual resolution of the haemorrhage, while the patient remained asymptomatic.
https://ift.tt/2Ke6jjm
Large cell neuroendocrine carcinoma and adenocarcinoma of gallbladder with concomitant hepatitis C infection
Neuroendocrinetumour (NET) of the gallbladder is an extremely rare tumour and with coexisting adenocarcinoma an even rarer occurrence. Mixed NETs have the tendency to invade the lymph nodes and the hepatic tissue from their high malignant potential, leading to poor prognosis. Survival rates of the patients with mixed NET can be improved with wide excision, adjuvant chemotherapy and radiation. We present a case of 62-year-old woman with history of hepatitis C infection, a risk factor for both hepatic and extrahepatic gastrointestinal malignancies. Patient underwent exploratory laparotomy with resection of the gallbladder and partial hepatectomy. Pathology showed high-grade larger cell neuroendocrine carcinoma 5x4x3 cm along with two separate lesions found out to be adenocarcinomas. In our patient, hepatitis C infection can be an inciting factor for the development of these carcinomas. We will discuss the presentation, treatment modalities and outcomes with this kind of coexisting tumours.
https://ift.tt/2MuSVnF
Acute liver failure due to liver parenchymal infiltration with acute myelogenous leukaemia in a patient with myelodysplastic syndrome
Liver involvement by acute leukaemia is rare and has a high mortality rate despite treatment. We report a case of a 66-year-old woman undergoing treatment for myelodysplastic syndrome with Vidaza (azacitidine) who presented with abnormal liver function tests. Despite negative serologic testing and unremarkable abdominal MRI, she continued to have significant elevation in bilirubin and international normalised ratio and worsening mental status. Liver biopsy was obtained and consistent with acute myelogenous leukaemia. The patient had rapid demise due to acute liver failure and was unable to undergo treatment.
https://ift.tt/2Kg0fHe
Regressive pyridoxine-induced sensory neuronopathy in a patient with homocystinuria
Pyridoxine (vitamin B6) is an essential vitamin playing a crucial role in amino acid metabolism. Pyridoxine is used for isoniazid side-effects prevention, pyridoxine-dependent epilepsy treatment and cystathionine beta-synthase deficiency (homocystinuria) treatment. However, vitamin B6 hypervitaminosis is neurotoxic and may provoke a progressive sensory neuronopathy (sensory ganglionopathy), usually when daily uptake is above 50 mg. We describe the case of a 30-year-old patient with homocystinuria who was treated with pyridoxine 1250–1750 mg/day for 20 years and developed progressive sensory neuropathy with ataxia and impaired sensation in the extremities. Electrodiagnostic testing demonstrated non-length-dependent abnormalities of sensory nerve potentials, and sensory ganglionopathy was diagnosed. Pyridoxine dosage was reduced to 500 mg/day, resulting in the disappearance of sensory symptoms and ataxia, and the normalisation of sensory nerve potentials. Our case indicates that pyridoxine-induced sensory ganglionopathy may be reversible, even after prolonged ingestion of high doses of vitamin B6 for more than 20 years.
https://ift.tt/2Kuw0sj
Disseminated histoplasmosis mimicking relapsed chronic lymphocytic leukaemia
Histoplasma microconidia when inhaled are presented in antigenic form to T cells, limiting the extent of infection; however, defects in cellular immunity results in disseminated disease. Chronic lymphocytic leukaemia (CLL) is a lymphoproliferative disorder resulting in functionally impaired lymphocytes, predisposing patients to various opportunistic infections. The author reports a recently treated patient with CLL presenting with constitutional symptoms accompanied by hepatosplenomegaly and diffuse adenopathy. Considering the recent diagnosis and treatment of CLL, initial suspicion was relapsed disease. However, considering the immune deficiency associated with CLL and its treatment, infectious aetiologies were strongly considered. Further investigation revealed a case of disseminated histoplasmosis mimicking CLL in this reported patient. Considering appropriate diagnosis and timely therapy, the reported patient had good prognosis despite being diagnosed with disseminated histoplasmosis. This case highlights consideration of disseminated histoplasmosis in patients presenting with diffuse adenopathy along with hepatomegaly and/or splenomegaly in the right clinical setting.
https://ift.tt/2KvJS8G
Breast cancer metastasis to the bladder: a literature review
Given the prevalence of breast cancer and the mortality associated with metastatic disease, it is imperative for physicians to not only be aware of common sites but also of rare metastatic destinations such as the bladder. A postmenopausal woman with a medical history of stage 2 invasive ductal carcinoma, oestrogen receptor/progesterone receptor positive and human epidermal growth factor receptor 2 negative, in remission for 9 years, presented to her primary care physician with concerns of increased urinary urgency, frequency and incontinence. The patient underwent cystoscopy with biopsy of an area of granulation tissue. Biopsy revealed adenocarcinoma consistent with breast primary. The common sites of metastases from breast cancer are lung, bone and liver. This case is unique where breast cancer was found to metastasise to the bladder. It is important for physicians to consider further investigation when a breast cancer survivor develops urinary symptoms even without haematuria.
https://ift.tt/2MuekNP
Untreated Congenital Hypothyroidism Mimicking Hirschsprung Disease: A Puzzling Case in a One-Year-Old Child
Congenital hypothyroidism is a clinical emergency due to its potential risk of mental retardation. Constipation might be present in hypothyroid children. However, Hirschsprung disease is rarely associated with congenital hypothyroidism. Herein, a case of congenital hypothyroidism in a one-year-old child mimicking Hirschsprung disease is described. Adequate treatment with levothyroxine sodium tablets controlled intestinal dysmotility that mimicked congenital intestinal aganglionosis due to the critical influence of thyroid hormones on bowel motility.
https://ift.tt/2tKO2iz
Aprepitant for CINV Induced by Chemoradiotherapy in HNSCC
Intervention: Drug: Aprepitant
Sponsor: Chinese Academy of Medical Sciences
Recruiting
https://ift.tt/2yOkRRJ
Surgical treatment of mucocele of the appendix: a systematic review and case report
https://ift.tt/2tzjC3s
Adenoid size by drug induced sleep endoscopy compared to nasopharyngeal mirror exam
Source:International Journal of Pediatric Otorhinolaryngology, Volume 112
Author(s): Habib G. Zalzal, Michele Carr, William Kohler, Steven W. Coutras
ObjectiveTo establish how assessment of adenoid size is correlated between drug-induced sleep endoscopy (DISE) with indirect mirror nasopharyngoscopy (IMN).Study DesignRetrospective chart review.SettingTertiary care academic hospital.MethodsOver a 6-year period, 154 pediatric patients underwent DISE for obstructive sleep apnea and had IMN. DISE videos were assessed by one reviewer, blinded to results of mirror exams. IMN findings were taken from operative notes recorded by one attending physician. Demographic data, co-morbidities, and sleep study results were also recorded.ResultsNinety-three (58.5%) males and 66 (41.5%) females were included. Mean age at DISE was 7.34 ± 3.99 years, with an average of 29 days after DISE until nasopharyngeal mirror examination. The mean initial adenoid size based on DISE assessment was 2.62 + 0.99, and on nasopharyngeal mirror assessment was 2.56 + 0.97. DISE and IMN assessment of adenoid size correlated well (Spearman's Rho = 0.82, P < 0.00001; Kendal tau = 0.764, P < 0.00001).ConclusionsDISE has proven to be an excellent tool to assess adenoid size prior to adenoidectomy in children with OSA.
https://ift.tt/2KpxW8u
Oropharyngeal cancer is no longer a disease of younger patients and the prognostic advantage of Human Papillomavirus is attenuated among older patients: Analysis of the National Cancer Database
Source:Oral Oncology, Volume 83
Author(s): Eleni M. Rettig, Munfarid Zaidi, Farhoud Faraji, David W. Eisele, Margueritta El Asmar, Nicholas Fung, Gypsyamber D'Souza, Carole Fakhry
ObjectivesHPV-positive oropharyngeal cancer (OPC) patients have been observed to be younger than patients with HPV-negative OPC at diagnosis. We evaluated recent trends in age at OPC diagnosis, and whether older age attenuates the survival benefit of HPV-positive tumor status.Materials and methodsPatients diagnosed with OPC from 2004 to 2014 represented in the National Cancer Database were included. HPV tumor status was available after 2010. Trends in age by calendar year were compared using linear regression. Overall survival was compared using Cox Proportional Hazards models.ResultsThe mean age of OPC patients (N = 119,611) increased significantly from 2004 to 2014 (ß = 0.21 years of age per calendar year, 95% confidence interval [CI] = 0.19–0.23). The increase in age from 2010 to 2014 was similar for HPV-positive (N = 21,880; ß = 0.63, 95%CI = 0.53–0.72) and HPV-negative (N = 11,504; ß = 0.59, 95%CI = 0.45–0.74) patients. Between 2010 and 2014, the proportion of OPCs that were HPV-positive increased significantly for all age groups, including for patients ≥70 years old (from 45% to 60%, ptrend < 0.001). Although patients ≥70 years with HPV-OPC had improved survival compared to those with HPV-negative OPC (adjusted hazard ratio [aHR] = 0.65, 95%CI = 0.55–0.76), the survival benefit of HPV-positive tumor status was significantly attenuated compared to younger HPV-OPC patients (50–59 years: aHR = 0.45, 95%CI = 0.39–0.51; pinteraction < 0.001).ConclusionThe age at OPC diagnosis is increasing for both HPV-positive and HPV-negative patients, and a rising proportion of older patients have HPV-positive tumors. These findings dispel the notion that HPV-positive OPC is a disease of younger patients, identify a growing elderly population of HPV-positive OPC patients with reduced survival, and have implications for evolving treatment paradigms.
https://ift.tt/2tKtLJZ
Perioperative considerations in free flap surgery: A review of pressors and anticoagulation
Source:Oral Oncology, Volume 83
Author(s): Mark K. Wax, James Azzi
Given the high stakes for microvascular reconstruction, the majority of reconstructive surgeons have developed paradigms for pre, intra, and postoperative management that have proven to result in individual high success rates. Much has been done to identify and avoid perioperative factors that could potentially increase flap failure rates. Two example of this practice has been the generalized use of anticoagulation in free tissue transfer and the prohibition against vasopressor use in patients that are undergoing free tissue transfer. This manuscript will discuss these issues.
https://ift.tt/2N9dNCi
The in-principle inconclusiveness of causal evidence in macroeconomics
Abstract
The paper analyzes the methods that macroeconomists can use to provide evidence in support of causal hypotheses: the instrumental variable (IV) method and econometric causality tests. It argues that the evidence that macroeconomists provide when using these methods is in principle too inconclusive to support the hypothesis that X directly type-level causes Y, where X and Y stand for macroeconomic aggregates like the real interest rate and aggregate demand. The evidence provided by the IV method is too inconclusive because it derives from conditions requiring that there be no confounders of I and X and X and Y (where I is an instrumental or intervention variable that typelevel causes X), and because in macroeconomics, confounders that cannot be controlled for or measured are likely to be present. The evidence provided by econometric causality tests is too inconclusive because they can be shown to rely on the conditions of the IV method at least tacitly.
https://ift.tt/2yZSVuj
Successful treatment of erythematotelangiectatic rosacea with intense pulsed light: Report of 13 cases
The Journal of Dermatology, EarlyView.
https://ift.tt/2KwwX2Y
Numerous plasmacytoid dendritic cell infiltration in HIV‐associated psoriasis relieved only with antiretroviral therapy
The Journal of Dermatology, EarlyView.
https://ift.tt/2N4rjad
Sézary syndrome in an anti‐human T‐cell lymphotropic virus type 1 seropositive carrier
The Journal of Dermatology, EarlyView.
https://ift.tt/2KuOSHE
Mycoplasma pneumoniae‐associated mucositis with severe blistering stomatitis and pneumonia successfully treated with azithromycin and infusion therapy
The Journal of Dermatology, EarlyView.
https://ift.tt/2tBkjt6
Prolonged growth of infantile hemangioma after pulsed dye laser and oral propranolol treatment
The Journal of Dermatology, EarlyView.
https://ift.tt/2IyYVJK
Psoriasiform dermatitis associated with common variable immunodeficiency 10 due to an Arg853* mutation in the NFKB2 gene
The Journal of Dermatology, EarlyView.
https://ift.tt/2tAUZDR
Identification of a missense mutation causing exon skipping in a neurofibromatosis type 1 patient
The Journal of Dermatology, EarlyView.
https://ift.tt/2IAivVZ
Effets indésirables des soins capillaires chez les utilisateurs
Source:Annales de Dermatologie et de Vénéréologie
Author(s): D. Tennstedt, A. Herman, J.-M. Lachapelle
La panoplie des produits utilisés par les professionnels pour laver, modifier la couleur ou la forme ou embellir la chevelure n'est pas dénuée d'effets indésirables. Ces effets sont essentiellement des dermatites d'irritation et des eczémas de contact allergiques pouvant affecter le cuir chevelu mais aussi la nuque, la face antérieure du cou, le front et les régions périorbitaires, les joues. Parmi les allergènes les plus cités, il convient de mentionner la paraphénylènediamine (PPD) des teintures capillaires, le monothioglycolate de glycérol (GMTG) des permanentes acides, le persulfate d'ammonium des décolorations (ce dernier est responsable principalement d'urticaires de contact). Mais il ne faut pas oublier d'autres allergènes comme la cocamidopropylbétaïne parmi les tensioactifs, et aussi certains constituants de la formulation tels les conservateurs et les parfums (voire le minoxidil, si fréquemment utilisé par les patients).The panoply of products used by hair care professionals to wash, dye, shape and beautify hair is not entirely free from adverse events. Such effects consist mainly of irritation dermatitis and allergic contact eczema affecting the scalp, as well as the back and front of the neck, the forehead and periorbital areas, and the cheeks. The most frequently cited allergens include paraphenylenediamine (PPD) in hair dyes, glycerol monothioglycolate (GMTG) in acid perm lotions, and ammonium persulphate in hair lighteners (the latter substance being responsible primarily for contact urticaria). However, care should also be paid to other allergens such as cocamidopropyl betaine among surfactants, as well as certain components in hair formulations such as preservatives and fragrances (as well as minoxidil, frequently used by patients).
https://ift.tt/2IyCtjX
Plasminogen gene mutation with normal C1Inhibitor‐hereditary angioedema: Three additional French families
Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2MxGZll
Alteration of Serum Lipid in Oral Sub Mucous Fibrosis in Central India
Abstract
Oral sub mucous fibrosis is the most common precancerous lesion in India. Lipids are the major cell membrane components essential for various biological function including cell growth and division for the maintenance of cell integrity of normal and malignant tissue. Low levels of lipids serves as a marker and prognostic indicator in the early detection of oral precancerous and cancerous states. In spite of high prevalence and its potential to undergo malignant transformation, this condition has not widely been investigated with respect to serum lipid levels. In present study an attempt is made to analyze the complete serum profile, total cholesterol, triglycerides, high density lipoprotein. Low density lipoprotein, and very low density lipoprotein in oral precancerous lesion and control. Study was conducted in 30 clinically and histopathologically diagnosed cases of premalignant lesion and 30 age and sex match controls. The complete lipid profile including TC, TG, HDL, LDL, and VLDL was analyzed. Serum lipid levels were significantly lower in patients with oral lesion than in controls. From the finding it appears that the decreases in the lipid levels may be considered as useful marker in the early diagnosis of oral premalignant lesion.
https://ift.tt/2MuNwwX