Functional Endoscopic Sinus Surgery of Nasal Polyposis: The Vexing Question of Whether to Resect or Preserve Middle Turbinate

Abstract

Functional endoscopic sinus surgery is the mainstay of surgical management of nasal polyposis since 1975. The decision between the partial resection and preservation of the middle turbinate (MT) has stirred up considerable debate. Partial MTR permits easy access to the affected paranasal sinuses intraoperatively and postoperatively. However, there may be alteration of nasal function, frontal sinusitis and anosmia. Preservation of middle turbinate is precludes these complications, and allows the MT to serve as a vital anatomical landmark for revision surgery. Therefore, our study compared the outcomes of the two approaches to aid surgeons in deciding the best possible approach. Randomized control trial. 31 patients (60 sides of nasal cavity) with nasal polyposis were divided into two groups. Group I consisted of 30 sides of nasal cavity with middle turbinate resection, while group II consisted of 30 sides of nasal cavity without middle turbinate resection. Both the groups were compared postoperatively for 6 months. In group I and group II, 5 sides (16.6%) and 11 sides (36.6%) showed polypoidal changes respectively. 3 sides (10%) in group I and 8 sides (26.6%) in group II showed blockage of maxillary sinus ostia. All the sides in group I had patency of frontal sinus. In group II, 5 sides (16.6%) showed blockage of frontal sinus ostia. The maxillary antrostomy patency in group I and group II were 90% (27) and 73.33% (22) respectively. Assessment of symptomatic improvements for nasal obstruction, hyposmia, headache and rhinorrhoea was done using questionnaires. Symptomatic improvement was higher in group I compared to group II with statistical significance (p = 0.001). Our study demonstrated that partial resection of middle turbinate decreased the chances of recurrence of disease and post-operative complications and resulted in significantly better symptomatic improvements.

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JAAD Case Reports article List

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August iotaderma (#294)

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Answers to CME examination

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Fat reduction

Despite the favorable safety profile of liposuction, complications occur that need to be appropriately managed. In the second article in this continuing medical education series, the range of complications that may arise from liposuction are described, and the latest best practices to manage them are discussed. Specific technical strategies to prevent and minimize the risk of complications are also presented. Early recognition, accurate diagnosis, and proper clinical management can ensure an optimal outcome and patient satisfaction in individuals who are investing in fat reduction procedures.

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July iotaderma (#293)

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Answers to CME examination

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Fat reduction

The advances in understanding the pathophysiology and anatomy of adipose tissue together with the emergence of technological innovations in procedures and devices for fat reduction have led to a dramatic rise in patient demand for this procedure. The objective of this continuing medical education series, which is intended for the novice or experienced dermatologist, is to provide an update of the pathophysiology and anatomic considerations of adipose tissue, and detail the liposuction procedure, from patient selection/management to the latest developments in liposuction devices.

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CME examination

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Dermatology Calendar

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CME examination

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Journal Based CME Instructions and Information

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Information for Readers

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Editorial Board

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Adult supraglottitis: a life-threatening disease and potential airway emergency

Description 

An 87-year-old woman was brought by ambulance to the emergency department (ED) with fever and dyspnoea. There was audible stridor, and the patient was noted to have a large left-sided submandibular swelling. She was in respiratory distress with a respiratory rate of 30. She was administered 100% oxygen. The on-call anaesthetics and ear, nose and throat (ENT) team were called emergently on arrival of the patient due to concern regarding possible impending airway compromise. A portable anteroposterior chest X-ray was performed on the patient on arrival to the ED as the cause of her dyspnoea was initially unclear. This showed marked upper airway narrowing (detail from the chest X-ray is depicted in figure 1). Only a venous blood gas was taken from the patient prior to intubation which showed acidosis with a pH of 7.31 and hypercarbia of 7.62 kilopascals.

Figure 1

Anteriorposterior radiograph...

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Table of Contents

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Two cases of high-output heart failure as initial presentation of iliac arteriovenous fistula

We present two cases of females in their 40s presenting with biventricular heart failure being the consequence of a large arteriovenous fistula. Both patients had undergone abdominal surgery several years prior to the heart failure event with the initial finding of moderate pulmonary hypertension and high-output heart failure. CT revealed a large arteriovenous fistula between the common iliac artery and vein which subsequently was closed percutaneously.

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Re-evaluating pyoderma gangrenosum patients for Behçet disease before initiating any invasive procedures is essential

To the Editor: I would kindly like to remind your readers that pyoderma gangrenosum–like lesions also occur in Behçet disease, as is stated in a comment on the study "Risk of developing pyoderma gangrenosum after procedures in patients with a known history of pyoderma gangrenosum—A retrospective analysis."1 As the authors mentioned, the pathergy phenomenon is associated with pyoderma gangrenosum, but pathergy can also be seen in other conditions such as Behçet disease.2 Although very rare, pyoderma gangrenosum–like lesions are one of the clinical manifestations of Behçet disease.

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Port-wine stain as a clue for two rare coexisting entities

Phakomatosis pigmentovascularis (PPV) is an uncommon dermatosis characterised by the presence of both pigmentary and vascular abnormalities.¹ Its pathogenesis is not elucidated, and the prognosis is mainly determined by the presence of extracutaneous manifestations, such as Klippel-Trenaunay syndrome (KTS), that is defined by the triad of a port-wine stain (PWS), anomalous veins and progressive overgrowth of the affected extremity. Herein, we report a case of an adult patient, who presented with a large PWS, nevus of Ota, ocular melanosis, and limb hypertrophy and varicosities. These findings represented a rare association of PPV type IIb and KTS.

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Response to “Comment on: ‘When does atopic dermatitis warrant systemic therapy? Recommendations from an expert panel of the International Eczema Council’”

To the Editor: We thank Drs Daunton and Goulding1 for their interest in our article2 and for their comments. Naturally, we agree that "a holistic assessment is needed" in patients with atopic dermatitis, including consideration of "existent comorbidities," as stated in our article. It was beyond the scope of our recommendation to discuss in detail the many comorbidities of AD, including the associated neuropsychiatric issues that the International Eczema Council recently reviewed.3

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Recurrent inflammatory myofibroblastic tumour of the lung: FDG PET/CT scan findings

Inflammatory myofibroblastic tumour (IMT) is a rare neoplasm, occurring most often in children and young adults. IMTs have intermediate biological behaviour with the chance of local invasion, recurrence and even distant metastasis. Wide range of clinical presentations makes the precise diagnosis of IMT more challenging. The best method for definitive diagnosis is tissue biopsy and newer imaging modalities including fleurodeoxyglucose (FDG) positron emission tomography (PET)/CT are useful tools in detection of disease recurrence or distant metastasis. Complete surgical resection is the best-known treatment for this tumour. Here we are presenting an IMT case in a 12-year-old girl in which her recurrent pulmonary IMT was diagnosed based on FDG PET/CT findings and referred for further salvage treatment. Overall imaging modalities are not specific, but PET/CT scan can be useful tool for evaluation of IMT regarding initial staging and restaging to assess treatment response and recurrence.

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Reply to: “Re-evaluating pyoderma gangrenosum patients for Behçet disease before initiating any invasive procedures is essential”

To the Editor: We would like to thank Dr Aksoy1 for drawing attention to the unique challenges facing patients with Behçet syndrome in the perioperative setting. Her comments serve as an important reminder for physicians who are translating research into the clinical setting: we must consider the representativeness of the study sample when we generalize results to other settings or populations. Our patients' disease was diagnosed by using the Su criteria, and the overall demographics of our cohort are consistent with the known epidemiology of the disease in the United States.

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Neonatal facial palsy, a case series: is CPAP the culprit?

We report a case series of three idiopathic unilateral facial nerve palsies in neonates with no identified risk factors. Neuroimaging done was normal. All the neonates had complete spontaneous recovery within a month, with no residual deficits. As per our knowledge, there are very few case reports of facial palsy in a neonate reported in literature and are often labelled as idiopathic.

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Bullous pemphigoid and diabetes mellitus: Are we missing the larger picture?

To the Editor: We read with interest the study by Benzaquen et al1 reporting an increased risk for development of bullous pemphigoid (BP) in patients who are receiving a dipeptidyl peptidase-4 inhibitor (DPP4i). Their findings are supported by previous studies showing a significant signal of increased risk for development of BP during exposure to a DPP4i in the European and French pharmacovigilance databases.1

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T-wave alternans: a harbinger for malignant ventricular arrhythmias

Description

A 50-year-old male chronic alcoholic presented to our emergency department with seizures and loss of consciousness after an alcoholic binge. He had no other significant medical history and was not on any regular medications. On examination, his pulse was 90 beats/min and his blood pressure was 80/60 mm Hg. His resting ECG showed sinus rhythm with QT prolongation. His serum sodium was 133 mmol/dL, potassium was 3.5 mmol/dL, magnesium was 1.4 mmol/dL and calcium was 6.6 mg/dL. The ECG demonstrated wide QRS tachycardia with a heart rate of approximately 200 beats/min and mild irregularity and morphology suggestive of polymorphic ventricular tachycardia initiated by a ventricular premature contraction falling on the terminal part of the T wave of the preceding sinus beat (figure 1A, black arrows). The postelectroversion tracing showed sinus rhythm at a rate of 55 beats/min, with alternating small, narrow (figure 1B, red arrows) and broad deep T-wave inversions (figure 1B, black...

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Reply to: “Bullous pemphigoid and diabetes mellitus: Are we missing the larger picture?”

To the Editor: We read with interest the letter titled "Bullous pemphigoid and diabetes mellitus—are we missing the larger picture?" by Geller et al1 and have several comments. The authors discuss the claimed association between diabetes mellitus (DM) and bullous pemphigoid (BP) and speculate about its underlying mechanisms.

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Acute presentation of a partially obstructing laryngeal tumour: adjuvant agents to gaseous induction of anaesthesia

We present the case of a 53-year-old man who attended our emergency department with stridor. He had recently undergone investigation for possible glottic cancer. We discuss the airway management of such a case. We believe this to be the first description of propofol target controlled infusion and clonidine to supplement a sevoflurane gas induction, in order to obtund response to intubation while maintaining spontaneous ventilation. We also consider how airway interventions may impact prognosis and need to be considered.

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Comment on: “When does atopic dermatitis warrant systemic therapy? Recommendations from an expert panel of the International Eczema Council”

To the Editor: We read with interest the recent expert panel recommendations by Simpson et al on when systemic therapies may be indicated in the management of atopic dermatitis (AD).1 The authors rightly highlight the importance of identifying and addressing potential biologic exacerbating factors such as infection or contact allergy, as well as the role of patient education in improving adherence to topical therapy. However, we believe that the recommendations offered are narrow in scope. AD, like so many other chronic skin diseases, is a condition in which a holistic biopsychosocial approach must be used to allow the clinician to fully understand the patient, so as to optimize treatment outcomes and patient well-being.

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FDA Approves Tecovirimat, First Drug for Smallpox Treatment

Tecovirimat (TPOXX) provides a treatment option should smallpox ever be used as a bioweapon and is the first product to be awarded a material threat medical countermeasure priority review voucher.
FDA Approvals

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Merkelzellkarzinome der Kopf-Hals-Region

Laryngo-Rhino-Otol
DOI: 10.1055/a-0588-9400

Merkelzellkarzinome (MCC) sind hochmaligne neuroendokrine Tumore der Haut. Auch wenn sie sehr selten sind, hat sich ihre Inzidenz in den letzten 20 Jahren verdoppelt. Ihre Mortalität ist höher als die des malignen Melanoms. Risikofaktor ist neben UV-Exposition eine iatrogene oder anderweitige Immunsuppression. MCC betreffen vor allem Menschen jenseits des 70. Lebensjahrs und treten in der Hälfte der Fälle in der Kopf-Hals-Region auf.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Marked attenuation of the amplitude of transcranial motor-evoked potentials after intravenous bolus administration of ketamine: a case report

It is believed that ketamine does not affect motor-evoked potential amplitude, whereas various anesthetic drugs attenuate the amplitude of transcranial motor-evoked potential. However, we encountered a patient...

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Gliotoxin penetrates and impairs the integrity of the human blood-brain barrier in vitro

Abstract

Cerebral fungal infections represent an important public health concern, where a key element of pathophysiology is the ability of the fungi to cross the blood-brain barrier (BBB). Yet the mechanism used by micro-organisms to cross such a barrier and invade the brain parenchyma remains unclear. This study investigated the effects of gliotoxin (GTX), a mycotoxin secreted by Aspergillus fumigatus, on the BBB using brain microvascular endothelial cells (BMECs) derived from induced pluripotent stem cells (iPSCs). We observed that both acute (2 h) and prolonged (24 h) exposure to GTX at the level of 1 μM or higher compromised BMECs monolayer integrity. Notably, acute exposure was sufficient to disrupt the barrier function in iPSC-derived BMECs, resulting in decreased transendothelial electrical resistance (TEER) and increased fluorescein permeability. Further, our data suggest that such disruption occurred without affecting tight junction complexes, via alteration of cell-matrix interactions, alterations in F-actin distribution, through a protein kinase C-independent signaling. In addition to its effect on the barrier function, we have observed a low permeability of GTX across the BBB. This fact can be partially explained by possible interactions of GTX with membrane proteins. Taken together, this study suggests that GTX may contribute in cerebral invasion processes of Aspergillus fumigatus by altering the blood-brain barrier integrity without disrupting tight junction complexes.

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Epitope Mapping of Anti-Telomerase Reverse Transcriptase Monoclonal Antibodies

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy, Ahead of Print.


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Effect of Prior Biologic Use on Cost-Effectiveness of Brodalumab vs. Ustekinumab for Treatment of Moderate-to-Severe Psoriasis in the United States

Abstract

Introduction

Clinical trials have shown brodalumab to have better efficacy than ustekinumab for the treatment of moderate-to-severe psoriasis. An estimation of the cost-effectiveness of brodalumab vs. ustekinumab is warranted and may be useful for treatment decision-making processes, especially in the context of the cost considerations of the current US healthcare system. Therefore, we compared the cost-effectiveness of brodalumab with ustekinumab for treatment of moderate-to-severe psoriasis in biologic-naïve and biologic-experienced patients in the USA.

Methods

An Excel-based economic model was developed to estimate and compare total annual costs to health plans associated with treatment with brodalumab vs. ustekinumab per achievement of Psorasis Area and Severity Index (PASI) 75, 90, and 100 for patients with moderate-to-severe psoriasis.

Results

For treatment with brodalumab vs. ustekinumab, total annual treatment costs per PASI 75, 90, and 100 were $31,106, $57,776, and $163,069, respectively, lower for a patient naïve to prior biologic treatment; they were $40,535, $65,472, and $223,610, respectively, lower for a patient experienced with prior biologic treatment. In an additional analysis among patients with and without prior biologic failure, they were $52,822, $93,309, and $365,606, respectively, lower for a patient with failure and they were $31,660, $57,128, and $164,996, respectively, lower for a patient without failure.

Conclusion

Compared to ustekinumab, treatment with brodalumab was associated with better cost-effectiveness ratios for biologic-naïve and experienced-patients and also patients with and without prior biologic treatment failure. The greater cost-effectiveness of brodalumab was most prominent for biologic-experienced and prior biologic treatment failure patients.

Funding

Ortho Dermatologics.

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Raltitrexed Concurrent With Radiotherapy for Elderly Chinese Patients With Squamous Cell Carcinoma of Esophagus

Condition:   Esophagus Squamous Cell Carcinoma
Intervention:   Drug: raltitrexed
Sponsor:   Huai'an First People's Hospital
Not yet recruiting

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Pseudomyxoma peritonei presenting as irreducible epigastric hernia

Abstract

Abdominal wall hernia is a common and usually straightforward pathology presenting in surgery clinics. On occasion, the surgeon is faced with unexpected findings requiring difficult intraoperative decision. We present a case of pseudomyxoma peritonei incidentally found during surgery for epigastric hernia. The patient complained of a long lasting epigastric hernia with recent onset pain and growth. Surgery was limited to laparoscopic incisional biopsy of mucinous peritoneal deposit, confirming the diagnosis and suggesting an appendiceal origin. The patient was subsequently referred to a specialized peritoneal cancer unit for definitive treatment which consisted of cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy, which can be compromised by previous organ resection. This case highlights the importance of maintaining a high level of suspicion before unusual clinical courses of common pathology.

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Case series of two falciform ligament incisional hernias and their laparoscopic repair

Abstract

Incisional hernias involving the falciform ligament have only been reported in two case reports in the English literature. This is the first reported case series of two falciform ligament incisional hernias. Both patients had undergone a prior cholecystectomy. Laparoscopic transabdominal pre-peritoneal repair was performed with an uneventful recovery in both patients. In the previously published reports both patients underwent an open herniorrhaphy with an underlay mesh repair. These are the first two documented laparoscopic repairs of a falciform ligament incisional hernia. The laparoscopic repair also included intra-corporeal suturing of the hernia necks with a non-absorbable suture. We extrapolated this data from the component separation technique which reconstituted the abdominal musculature in their normal anatomical position resulting in a reduced hernia recurrence rate.

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Laparoscopic approach for a presacral myelolipoma resembling a liposarcoma

Abstract

Myelolipomas are rare benign tumors that are commonly found in the adrenal glands. Extra-adrenal locations are rare, and presacral myelolipomas represent the most common extra-adrenal location. The differential diagnosis of malignant presacral neoplasms is very challenging. We present a case of a presacral neoplasm that was completely removed with a laparoscopic approach and diagnosed as a myelolipoma only after pathological examination.

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Patients with urticaria are at a higher risk of anaphylaxis: A nationwide population‐based retrospective cohort study in Taiwan

The Journal of Dermatology, EarlyView.


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Coexistence of X‐linked ichthyosis and Nagashima‐type palmoplantar keratosis: A case report

The Journal of Dermatology, EarlyView.


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Serum interleukin‐34 levels in patients with systemic sclerosis: Clinical association with interstitial lung disease

The Journal of Dermatology, EarlyView.


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Effects of tumor necrosis factor‐α, interleukin‐23 and interleukin‐17A inhibitors on bodyweight and body mass index in patients with psoriasis

The Journal of Dermatology, EarlyView.


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Does patient age influence anti-cancer immunity?

Abstract

Geriatric oncology, important for the ever-increasing numbers of elderly cancer patients, has thus far focused primarily on tolerance to chemotherapy. With the advent of breakthrough immunomodulatory antibody treatments relying on the patient's own immune system to control the tumor, the issue of immunosenescence becomes extremely important. There is increasingly a valid concern that anti-cancer immunity may be compromised in the elderly due to (i) their low amounts of naïve T cells (potentially leading to holes in the repertoire for neoantigens), (ii) "exhaustion" of potentially tumor-specific memory T cells, and (iii) higher amounts of suppressive cells. Encouragingly, but only anecdotally, accumulated clinical experience suggests that advanced age does not result in poorer responses or greater toxicity in elderly patients treated with anti-CTLA-4 or anti-PD-1/PD-L1 antibodies. Here, I briefly contrast immune features of the elderly with the young, commonly referred to as "immunosenescence," and the influence of patient age on the outcome of checkpoint blockade. As newer agents are licensed, and new combinations tested, broader and more detailed studies focusing on the age question will be crucial and should be taken into consideration when designing clinical trials.

https://ift.tt/2uvTINL

Cancer immune therapy for lymphoid malignancies: recent advances

Abstract

Immunotherapy has played an important part in improving the life of patients with lymphoproliferative diseases especially since the addition of rituximab to chemotherapy in the CD20-positive neoplasms in the 1990s. While this field of passive immunotherapy is continuously evolving, several breakthroughs will expand the treatment modalities to include more active immunotherapy. With the approval of immune checkpoint-blocking antibodies for Hodgkin lymphoma and bispecific antibodies for acute lymphoblastic leukemia (ALL), activation of endogenous T cells already plays a role in several lymphoid malignancies. With the approval of cellular therapies with CAR-T cells for ALL and diffuse large B cell lymphoma, the impact of the manipulation of immune responses is taken even further. Vaccines are cellular therapies in the opposite end of the spectrum in terms of side effects, and while the big breakthrough is still to come, the prospect of a very low-toxic immunotherapy which could be applicable also in premalignant states or in frail patients drives a considerable research activity in the area. In this review, we summarize the mechanisms of action and clinical data on trials in the lymphoid neoplasms with chimeric antigen receptor T cells, bispecific antibodies, immune checkpoint-blocking antibodies, and antineoplastic vaccination therapy.

https://ift.tt/2mdZtfq

Differential expression of E-cadherin and P-cadherin in pT3 prostate cancer: correlation with clinical and pathological features

Abstract

Cadherins seem to play and important role in prostate cancer (PCa) progression. E-cadherin loss of expression has been associated with poor prognosis; P-cadherin's role is still elusive. Although pT3 PCa is often considered "high-risk cancer," it does not exhibit an uniformly poor prognosis. Herein, we assessed the prognostic value and survival impact of E-cadherin and P-cadherin immunoexpression in pT3 PCa. Radical prostatectomy (RP) specimens from 102 pT3 PCa patients treated between 1991 and 2014 in a single institution were designated for E-cadherin and P-cadherin immunoexpression analysis. A representative block from each specimen was selected for tissue micro-array (TMA) construction, using 3 cores per case. E-cadherin immunoexpression was assessed via a digital image analysis system. For P-cadherin, scoring criteria for HER2 in gastric cancer were used. Clinical records of all patients were reviewed for baseline clinical/pathologic characteristics and follow-up data. E-cadherin-low PCa patients displayed worse disease-specific survival (DSS), although not reaching statistical significance (HR 2.65, 95%CI 0.81–7.88). However, considering the pT3b group only, those with low E-cadherin immunoexpression displayed significantly worse overall-survival (OS) and DSS (HR 3.69, 95%CI 1.18–11.50; HR 5.90, 95%CI 1.40–24.81). No significant differences in survival were found for P-cadherin differential immunoexpression. Furthermore, an association between E-cadherin and P-cadherin immunoexpression (p = 0.019) was found, as among E-cadherin-low PCa, 96.6% were P-cadherin negative. We demonstrated that low E-cadherin immunoexpression discriminates among pT3b PCa patients those with poorer survival and which might benefit from specific therapy. The role of P-cadherin in PCa seems context-dependent deserving further investigation.

https://ift.tt/2uqFqxS

Stellenwert der Phototherapie in der Behandlung des chronischen Pruritus

Zusammenfassung

Die Phototherapie und Photochemotherapie (PUVA) sind wichtige Säulen in der Behandlung von entzündlichen Hauterkrankungen wie Psoriasis und atopischer Dermatitis sowie des kutanen T‑Zell-Lymphoms (z. B Mycosis fungoides/Sezary-Syndrom). Viele dieser Hauterkrankungen gehen mit quälendem Pruritus einher. Auch bei systemischen Erkrankungen der Niere und Leber sowie des endokrinen und blutbildenden Systems kann Pruritus ein belastendes Symptom der betroffenen Patienten sein. Die Behandlung mit ultraviolettem Licht kann nicht nur spezifische Hautveränderungen bessern, sondern auch den Pruritus vieler Hautkrankheiten sowie vieler systemischer Erkrankungen reduzieren. Die meist sehr gute antipruritische Wirkung, die bekannten und bei richtiger Durchführung geringen Nebenwirkungen sowie die Möglichkeit des Einsatzes bei Erwachsenen jeden Alters, Schwangeren/Stillenden und unter bestimmten Bedingungen auch bei Kindern machen die Phototherapie zu einer wertvollen Behandlungsmöglichkeit bei chronischem Pruritus unterschiedlicher Ursache. Der Einsatz der Phototherapie sollte daher früh erwogen werden, wenn lokaltherapeutische Maßnahmen nicht ausreichen, um den Pruritus zu lindern.

https://ift.tt/2Lah0TM

Akute neurale Schwerhörigkeit nach Injektionsbehandlung der Halswirbelsäule

Zusammenfassung

Beschrieben wird der Fall einer 39-jährigen Patientin, die bei Zervikalgien eine Injektionsbehandlung der Halswirbelsäule erhielt. Durch eine akzidenzielle Injektion in das Zervikalmark kam es zu einer Synkope mit sensomotorischem Defizit und beidseitiger neuraler Schwerhörigkeit. Injektionsbehandlungen der Wirbelsäule werden trotz geringer Evidenzlage und teils gravierendem Komplikationsspektrum regelhaft bei Wirbelsäulenbeschwerden durchgeführt. Bei neurootologischen Komplikationen sollte eine zeitnahe HNO-ärztliche Untersuchung und ggf. Rehabilitation angestrebt werden.

https://ift.tt/2NdqM58

Role of Electronystagmography in Diagnosis of Secondary BPPV in Elderly Patients with Vertigo: A Retrospective Study

Abstract

Elderly population is frequently affected by vertigo which affects their mobility and makes them vulnerable to fall and other morbidities. Often these patient visit neurologist and are often subjected to CT scan, MRI brain etc. to rule out a central cause of vertigo; whereas majority of these patients suffer from vestibular cause of vertigo. A schematic approach by detailed history, simple tests for vestibular functions like Dix Hallpike, supine roll and head impulse test give important clue to diagnosis. Often the diagnosis is benign paroxysmal positional vertigo (BPPV) which is treated by repositioning maneuver. There are often other vestibular causes which may be diagnosed by Electronystagmography (ENG), electrocochleography and other tests. This study was undertaken to study occurrence of secondary BPPV utilizing various parameters of ENG. The study group comprised of 131 patients from the neuro-otology proforma data base at ENT centre and vertigo clinic from January 2015 to December 2017. Inclusion criterion was male and female aged 51 years and above presenting with dizziness, imbalance, rotational vertigo, unsteadiness as the chief complaint. Exclusion criterion was BPPV relieved after Epley's maneuver, Otitis externa, acute Otitis media, Suppurative Otitis media, pre existing neurological condition and history of ear surgery. Neuro-otology Data obtained and the ENG findings were tabulated in the master chart and the observations interpreted and transferred to Claussen's butterfly chart. The study group comprised of 58 male (44.27%) and 73 female (55.73%) with a male female ratio of 1:1.25. ENG exhibited 36 patients (27.49) to have recurrent BPPV, 53 (40.45%) were found to have unilateral/bilateral canal paresis. Meniere's disease was diagnosed in 39 (29.77%) patients and brain stem pathology identified in 3 (2.29%) cases.

https://ift.tt/2L6xFYs

Surgical Management of Parapharyngeal Space Tumours in a Single Tertiary Care Center

Abstract

Because of the inaccessibility and overcrowding of the vital neurovascular structures, management of the parapharyngeal space (PPS) tumour is always a challenge to the surgeons. Here we have discussed the clinical findings and management of the PPS tumours with special concern to the surgical approaches. It is a retrospective study containing 14 patients of PPS tumour from June 2015 to January 2018 in the department of Otorhinolaryngology and Head Neck Surgery in a tertiary care referral hospital. 14 consecutive patients with PPS tumours were included in the study. The retrospective clinical data, diagnostic procedures, surgical approaches and the complications were analyzed after 12 months of surgery. Of 14 patients included in the study, 10 patients were males and 4 were females. Prestyloid and poststyloid spaces were involved in 28.57% and 71.42% cases respectively. Transcervical excision of the tumours were performed in 10 patients, 2 patients had undergone transcervical-transoral approach. Transcervical transmandibular and transcervical transparotid excision of tumours were performed in one patient each. Facial nerve injury was detected in 3(21.42%) patients. Injury to the internal carotid artery and wound infection were detected in one patient each. Radiological imaging, especially the MRI helps by narrowing the spectrum of the differential diagnosis distinguishing the benign from malignant lesions, especially in cases where FNAC is contraindicated. Although the transcervical approach is commonly practiced, the combined surgical approach can be effectively applied specially for extensive PPS tumours associated with satisfactory clinical outcomes.

https://ift.tt/2JkEnVF

Hand gesture classification using 24 GHz FMCW dual polarised radar

Ritchie, M; Jones, A; Brown, J; Griffiths, HD; (2017) Hand gesture classification using 24 GHz FMCW dual polarised radar. In: International Conference on Radar Systems (Radar 2017). IET Green open access

https://ift.tt/2ujpJtd

Target detection in bistatic radar sea clutter using stationary wavelet transforms

Duk, V; Rosenberg, L; Ng, B; Ritchie, M; Palama, R; Griffiths, H; (2018) Target detection in bistatic radar sea clutter using stationary wavelet transforms. In: International Conference on Radar Systems (Radar 2017). IET Green open access

https://ift.tt/2uvmv58

Gait classification based on micro-Doppler features

Yang, L; Li, G; Ritchie, M; Fioranelli, F; Griffiths, H; (2017) Gait classification based on micro-Doppler features. In: 2016 CIE International Conference on Radar (RADAR). IEEE Green open access

https://ift.tt/2uk0neP

Corrigendum: Visible‐Light‐Driven Hydrogen Evolution Using Planarized Conjugated Polymer Photocatalysts

Sprick, RS; Bonillo, B; Clowes, R; Guiglion, P; Brownbill, NJ; Slater, BJ; Blanc, F; ... Cooper, AI; + view all Sprick, RS; Bonillo, B; Clowes, R; Guiglion, P; Brownbill, NJ; Slater, BJ; Blanc, F; Zwijnenburg, MA; Adams, DJ; Cooper, AI; - view fewer (2018) Corrigendum: Visible‐Light‐Driven Hydrogen Evolution Using Planarized Conjugated Polymer Photocatalysts. [Corrigendum]. Angewandte Chemie International Edition , 57 (10) p. 2520. 10.1002/anie.201800571 .

https://ift.tt/2utrpQk

Review by Hui-Yuen etal. Targeted B-cell therapies in the treatment of adult and paediatric systemic lupus erythematosus

Isenberg, DA; (2016) Review by Hui-Yuen etal. Targeted B-cell therapies in the treatment of adult and paediatric systemic lupus erythematosus. Lupus , 26 (8) p. 900. 10.1177/0961203316680894 . Green open access

https://ift.tt/2ukcQit

The translation of cuatro learning in open and closed systems of transmission in Colombia: Towards an aural/oral approach in higher education

Samper Arbeláez, Andrés; (2018) The translation of cuatro learning in open and closed systems of transmission in Colombia: Towards an aural/oral approach in higher education. Doctoral thesis (Ph.D), UCL (University College London). Green open access

https://ift.tt/2uvT82N

Alzheimer's disease cerebrospinal fluid biomarkers predict cognitive decline in lewy body dementia

Abdelnour, C; Van Steenoven, I; Londos, E; Blanc, F; Auestad, B; Kramberger, MG; Zetterberg, H; ... Aarsland, D; + view all Abdelnour, C; Van Steenoven, I; Londos, E; Blanc, F; Auestad, B; Kramberger, MG; Zetterberg, H; Mollenhauer, B; Boada, M; Aarsland, D; - view fewer (2016) Alzheimer's disease cerebrospinal fluid biomarkers predict cognitive decline in lewy body dementia. Movement Disorders , 31 (8) pp. 1203-1208. 10.1002/mds.26668 .

https://ift.tt/2uk0mYj

Exploring the structure function relation of the glycine receptor with hyperekplexia mutations

Safar, Fatemah; (2018) Exploring the structure function relation of the glycine receptor with hyperekplexia mutations. Doctoral thesis (Ph.D), UCL (University College London). Green open access

https://ift.tt/2utSmDj

Taking part and playing parts: Musical identities, roles, participation, and inclusion at Dartington International Summer School

Ruck Keene, Hermione; (2018) Taking part and playing parts: Musical identities, roles, participation, and inclusion at Dartington International Summer School. Doctoral thesis (Ph.D), UCL (University College London). Green open access

https://ift.tt/2uiblS9

Progovernment Militias

Carey, SC; Mitchell, NJ; (2017) Progovernment Militias. Annual Review of Political Science , 20 (1) pp. 127-147. 10.1146/annurev-polisci-051915-045433 .

https://ift.tt/2utScMd

Three Essays on Debt

Rostom, M; (2018) Three Essays on Debt. Doctoral thesis (Ph.D), UCL (University College London).

https://ift.tt/2ujpI8D

Optimisation of planning and delivery methods for Gamma Knife Stereotactic Radiosurgery

Rojas Villabona, Alvaro Alexander; (2018) Optimisation of planning and delivery methods for Gamma Knife Stereotactic Radiosurgery. Doctoral thesis (Ph.D), UCL (University College London).

https://ift.tt/2uvSzGb

Bone Health in Eating Disorders: Outcomes and Treatment Options

Robinson, Lauren; (2018) Bone Health in Eating Disorders: Outcomes and Treatment Options. Doctoral thesis (Ph.D), UCL (University College London).

https://ift.tt/2uheYrq

Jeremy Bentham and the Utility of History

Riley, CP; (2018) Jeremy Bentham and the Utility of History. Doctoral thesis (Ph.D), UCL (University College London).

https://ift.tt/2zBgxp3

Cardiovascular Magnetic Resonance in Acute ST-Segment-Elevation Myocardial Infarction: Recent Advances, Controversies, and Future Directions

Bulluck, H; Dharmakumar, R; Arai, AE; Berry, C; Hausenloy, DJ; (2018) Cardiovascular Magnetic Resonance in Acute ST-Segment-Elevation Myocardial Infarction: Recent Advances, Controversies, and Future Directions. Circulation , 137 (18) pp. 1949-1964. 10.1161/CIRCULATIONAHA.117.030693 .

https://ift.tt/2uizIiF

Selective Induction of Homeostatic Th17 Cells in the Murine Intestine by Cholera Toxin Interacting with the Microbiota

Zhao, Q; Harbour, SN; Kolde, R; Latorre, IJ; Tun, HM; Schoeb, TR; Turner, H; ... Elson, CO; + view all Zhao, Q; Harbour, SN; Kolde, R; Latorre, IJ; Tun, HM; Schoeb, TR; Turner, H; Moon, JJ; Khafipour, E; Xavier, RJ; Weaver, CT; Elson, CO; - view fewer (2017) Selective Induction of Homeostatic Th17 Cells in the Murine Intestine by Cholera Toxin Interacting with the Microbiota. Journal of Immunology , 199 (1) pp. 312-322. 10.4049/jimmunol.1700171 .

https://ift.tt/2zxY3WL

Orthokeratinized odontogenic cysts: a Spanish tertiary care centre study based on HPV DNA detection

Abstract

Background

The role of human papillomavirus (HPV) in orthokeratinized odontogenic cysts (OOCs) has rarely been studied. The objective is to describe the clinicopathological findings in a series of OOCs from a Spanish population that were investigated in relation to the possible presence of HPV.

Methods

A clinicopathological retrospective analysis followed by a molecular analysis of 28 high- and low-risk HPV genotypes was performed in OOC samples of patients seen during the last 15-years in a Spanish tertiary care center.

Results

Of 115 odontogenic cysts with keratinization, 16 cases of OOCs were confirmed and evaluated. OOCs occurred predominantly in the mandible of males (mean age 36.06 ± 13.16 years). Swelling of the jaw followed by pain were the most common clinical symptoms, and 56.5% of the OOC cases were associated with an unerupted tooth. After a mean post-cystectomy follow-up of 3.8 years, only one recurrent case was observed, resulting in a verrucous cystic lesion that was considered premalignant after immunohistological examination. DNA extraction was successful from 14 of the 16 OOC cases. None of the primary OCCs or the single recurrent OOC were positive for HPV in the molecular analysis.

Conclusions

OOCs show a very limited potential for recurrence. Our results suggest that neither high- or low-risk HPV subtypes are likely to play a role in the etiology or neoplastic transformation of OOC, at least in the Spanish population.

https://ift.tt/2mcFhKP