Medicine by Sfakianakis Alexandros: 09/23/18

Κυριακή 23 Σεπτεμβρίου 2018

An observational cohort study of the use of five-grass-pollen extract sublingual immunotherapy during the 2015 pollen season in France

Allergic rhinitis affects around one quarter of the Western European population. Prophylactic allergen immunotherapy may be useful to reduce the risk of acute symptomatic attacks (hayfever). A five-grass polle...

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Cutaneous leishmaniasis in Sri Lanka: effect on quality of life

International Journal of Dermatology, EarlyView.

https://ift.tt/2IclghW

Goblet cell carcinoid of the appendix – diagnostic challenges and treatment updates: a case report and review of the literature

Goblet cell carcinoid is a rare but distinct entity of appendiceal tumors which is a hybrid or mixed tumor consisting of both epithelial (glandular) and neuroendocrine elements containing goblet cells. This en...

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Varicella causing remission of Cushings disease

An 18-year-old male with Cushing's disease presented with generalised skin eruptions and backache. He was diagnosed with varicella infection. During the course of the illness, he developed persistent vomiting. Hormonal evaluation suggested adrenal insufficiency. MRI of brain showed features of pituitary apoplexy. Initially, he required hydrocortisone replacement. Later on his hypothalamic–pituitary–adrenal axis recovered and he is currently asymptomatic without any treatment.

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Extreme scoliosis from CKD-MBD resulting in respiratory failure and death

Description

A 64-year-old man presented to our hospital because of dyspnoea. Twenty years ago, he had started peritoneal dialysis (PD) for chronic kidney disease. He had been diagnosed with secondary hyperparathyroidism 7 years before his presentation to our hospital, with an intact parathyroid hormone (PTH) 1227 pg/mL (normal range 10–60 pg/mL), calcium level of 10.1 mg/dL (normal range 8.8–10.5 mg/dL), phosphorus level of 5.5 mg/dL (normal range 2.4–4.1 mg/dL) and alkaline phosphatase level of 377 IU/L (normal range 140–338 IU/L). His medications included cinacalcet. Ultrasonography showed a 5-milimetre nodule at the lower pole of the parathyroid, but 99mTc-hexakis2- methoxyisobutylisonitrile (MIBI)scintigraphy revealed no abnormal accumulation.

The patient's intact PTH increased to 2606 pg/mL 6 years prior to presentation. At that time, the patient deferred parathyroidectomy. A year later, he switched from PD to haemodialysis. Intact PTH remained elevated to more than 4000 pg/mL. His thorax became scoliotic curving to the left. He had experienced dyspnoea on...

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Barriers to healthcare for female patients in Papua New Guinea

A 25-year-old woman presented to hospital in the remote highlands of Papua New Guinea (PNG) with a 3-year history of increasing abdominal distension, amenorrhoea and syncope. Ultrasound showed a large unilocular ovarian cyst. During her work-up, she was found to be HIV positive. She was treated with antiretroviral therapy, and once her CD4 count improved, she underwent a laparotomy and removal of the ovarian cyst with immediate improvement in symptoms. PNG has high levels of HIV particularly in young women and children.¹ This is partly due to a lack of screening and treatment facilities and partly due to significant gender discrimination. PNG is considered one of the most dangerous places in the world for females; women are treated as second-class citizens with few human rights or access to services such as healthcare.² Rape, sexual assault and domestic violence are common, and their lives are dictated to them by their husbands or male relatives.^{2 3} The lack of healthcare resources and significant levels of gender discrimination meant that this patient had a delayed presentation resulting in potentially grave complications.

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Uncommon cause of pelvic inflammatory disease leading to toxic shock syndrome

A 44-year-old Caucasian female with a history of endometriosis is admitted to the intensive care unit due to severe left lower quadrant abdominal pain, nausea and vomiting. With patients' positive chandelier sign on pelvic examination, leucocytosis, elevated erythrocyte sedimentation rate and elevated C-reactive protein indicated that she had pelvic inflammatory disease (PID). PCR tests were negative for Neisseria gonorrhoeae and Chlamydia trachomatis; however, her blood and urine cultures grew Group A streptococci (GAS) with a negative rapid Streptococcus throat swab and no known exposure to Streptococcus. On further review, patient met criteria for GAS toxic shock syndrome based on diagnostic guidelines. The patient was promptly treated with intravenous antibiotics and supportive care, and she acutely recovered. This case demonstrates a rare cause of PID and an atypical aetiology of severe sepsis. It illuminates the importance of considering PID as a source of infection for undifferentiated bacteraemia.

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On a knife-edge: clinical uncertainty with an extensive knife blade in situ in the craniofacial region

A 25-year-old man presented to the trauma department following a penetrating stab wound to his left infraorbital margin with retained knife blade causing superoposterior displacement of the globe. Plain skull X-ray revealed an extensive retained blade with subsequent CT imaging revealing the tip of the blade had reached the right styloid process with no neurovascular compromise. Initial concern was primarily for the left eye leading to ophthalmology being the first specialty requested to review the patient. However, once the extent of the injury was established, ophthalmology requested further review from maxillofacial, ENT and neurosurgery. This resulted in an 84 hours wait between the initial injury and the removal of the knife blade. Incredibly, the patient had no initial sequelae from such an extensive injury and had an unremarkable recovery with no further complications aside from a laceration to the left inferior rectus muscle that was conservatively managed.

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Mast cell deposition and activation may be a new explanation for epiploic appendagitis

Epiploic appendagitis is as an acute painful condition of the fat on the outside of the intestine. Thus far, there have been no publications to our knowledge that appendagitis can be caused by mast cells or can be associated with chronic pain. A patient with multisystemic disorders suffered with both chronic and acute attacks of abdominal pain for a year. The worst attack led to surgical resection of an enlarged sigmoid colon epiploic appendage. Careful review of her complex medical history and mast cell stains of gastrointestinal biopsies led to the diagnosis of mast cell activation syndrome. Re-examination of the resected appendage using an immunohistochemical stain demonstrated a high mast cell density which is a new histopathological finding. Treatment of mast cell activation syndrome and other related syndromes led to marked improvement in her health, including all types of chronic abdominal pain.

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Spontaneous resolution of a 'ping-pong fracture at birth

'Ping-pong' fractures are depressed skull fractures in newborn infants that occur as inward buckling of the calvarial bones, forming a cup shape. These fractures are often associated with maintenance of bone continuity. These fractures may occur spontaneously during the intrauterine period or secondary to birth trauma. Currently, there is no standard protocol for the management of depressed skull fractures. Neurosurgical or non-surgical approaches may be administered depends on the severity of the fracture. Most untreated ping-pong fractures resolve spontaneously within 6 months. Therefore, it is recommended to reserve surgical elevation or non-surgical techniques for infants not demonstrating spontaneous resolution during this period. In addition, neurosurgical interventions are usually considered for cases with intracranial pathology or neurological deficits or for infants who do not respond to conservative treatment. Herein, we report a case of a newborn infant with a spontaneous intrauterine ping-pong fracture, which spontaneously resolved, without surgical or non-surgical intervention.

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External auditory canal lesion: colorectal metastatic adenocarcinoma

The patient presented to the ear, nose and throat clinic with failed conservative treatment of persistent right otitis externa. On examination, the roof of the right ear canal was polypoid and the tympanic membrane could not be visualised. There was a fragile mass noted in the external auditory canal (EAC) which on microsuction started to bleed. CT internal auditory meatus and MRI internal auditory meatus identified soft tissue mass in the EAC. The patient underwent urgent examination under anaesthetic of the ear and biopsies were taken. He had a background of ascending colon cancer; Duke's C1, pT4, N1 M0, R0 resection and had undergone laparoscopic right hemicolectomy with adjuvant chemotherapy, in the previous year. The biopsy results proved that the mass in the EAC was due to metastatic deposit of colorectal primary tumour. The patient also had a full body CT which revealed other new metastases. The patient is being treated with palliative chemotherapy.

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Delusional infestation in the treatment of ADHD with atomoxetine

The case describes an adult diagnosed with attention deficit hyperactivity disorder and treated with atomoxetine who quickly developed a florid case of delusional infestation. The patient described very distressing experiences that were significantly impacting her daily life. The symptoms improved with the withdrawal of atomoxetine and resolved completely with antipsychotic medications. Atomoxetine is proposed as the putative causative agent in this case.

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Novel mutation in the CHST14 gene causing musculocontractural type of Ehlers-Danlos syndrome

Musculocontractural type of Ehlers-Danlos syndrome (MC-EDS) is a recently recognised connective tissue disorder. MC-EDS is caused by homozygous or compound heterozygous mutation in the carbohydrate sulfotransferase 14 (CHST14) gene on chromosome 15q15. Herein, we report a case of a 3-year-old boy with MC-EDS in whom a novel mutation in the CHST14 gene was discovered. Besides being the second report of this rare disorder from India, the child till 3 years has not had any bleeding tendency as described in the earlier reports of this disorder.

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Expand the differential...think beyond rheumatoid arthritis

A 31-year-old male patient with severe, migratory arthralgias presented to our academic medical centre after being erroneously diagnosed and treated for rheumatoid arthritis for over 1 year. Multiple immunomodulatory therapies for rheumatoid arthritis were attempted with no relief of symptoms. Eventually, the pain was so bothersome that the patient became bedridden for 1 month prior to presenting to our facility. Our assessment revealed that the patient met the diagnostic criteria, known as the Yamaguchi criteria, needed to diagnose adult-onset Still's disease. Yamaguchi criteria include migratory inflammatory arthritis, quotidian fevers, leucocytosis and a salmon-coloured maculopapular rash. These signs and symptoms may go unnoticed or overlooked if adult-onset Still's disease is not considered. The patient was treated with anakinra (a recombinant human IL-1 receptor antagonist) and had rapid improvement in his symptoms, with the restoration of mobility.

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Posterior urethral valve associated with a foreign body in posterior urethra: a first of its kind report

Posterior urethral valve and foreign body are among the important causes of male urethral obstruction. Although one is congenital and the other is acquired, both entities are rare in children with only a few reported cases. Because of myriad of symptoms associated with both conditions, a conclusive diagnosis requires both physical examination and radiological imaging. We report a first of its kind association of posterior urethral valve with foreign body in the posterior urethra in a 6-year-old male child which was eventually managed by endoscopic intervention.

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Management of C-shaped root canal configuration in mandibular second molar

Description

The C-shaped root canal configuration is an anatomical variation of root fusion and a type of taurodontism commonly seen in the mandibular second molar with prevalence ranging from 2.7% to 45.5% in different populations.1 In this configuration, the root canals are connected by slit or web with varying anatomy along the root length which makes thorough debridement obstacle for the clinician.2 Cone-beam CT (CBCT) is a three-dimensional imaging technique that facilitates and improves understanding the complex morphology. This article presents a case of C-shaped root canal configuration of mandibular second molar managed by using CBCT and modification in obturation techniques.

A 40-year-old female patient reported with pain in the lower left back teeth region. Medical history of the patient was unremarkable. Intraoral examination revealed deep class I carious lesion on tooth 37 with tenderness on percussion. Thermal test was performed to check the vitality...

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Over-the-counter drug-induced lung injuries with both diffuse alveolar haemorrhage and diffuse alveolar damage

Description

A 41-year-old Japanese man with no underlying disease was admitted to our hospital with haemoptysis and dyspnoea. Two weeks prior to admission, he had caught a cold and took an over-the-counter drug (topikku GX), subsequently general fatigue and cough were worsening progressively. Hence, he presented to another hospital, owing to acute onset of dyspnoea on effort and haemoptysis, where chest X-ray was taken and revealed bilateral abnormal shadow in the middle lung fields, after that he was referred to our hospital.

On examination, his general appearance was moderately ill; blood pressure was 126/72 mm Hg, heart rate was 90 beats/min, oxygen saturation was 90% under ambient air, respiratory rate was 20 breath/min and body temperature was 38.2°. Chest auscultation revealed bilateral inspiratory mid to late crackles. Laboratory blood test showed mild elevation of liver function tests (Aspartate aminotransferase 42 IU/L, Alanine aminotransferase 34 IU/L), Lactate dehydrogenase 379 IU/L, C-reactive protein 28.2 mg/L, the rest of...

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Skin metastasis: a rare presentation in testicular germ cell tumour

A 35-year-old man presented with a history of cough, haemoptysis, weight loss for 2 months along with ulceroproliferative lesions on the chin and the scalp. On evaluation he was found to have non-seminomatous germ cell tumour, stage 3 c, poor risk with Eastern Cooperative Oncology Group Performance Status of 4. The skin lesions were proven to be metastasis by fine-needle aspiration cytology. He showed significant improvement with a 3-day protocol of abbreviated etoposide and cisplatin chemotherapy and is planned for 4 cycles of VIP. This case describes an uncommon presentation of germ cell tumour in the form of skin metastasis with excellent response to chemotherapy.

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Chronic cutaneous lupus erythematosus and topical clindamycin

Description

A 64-year-old Caucasian woman was seen in our office for several years for management of her chronic cutaneous lupus erythematosus (CCLE). Her condition consisted of violaceous papules and plaques with some focal atrophy distributed over the upper arms, face and scalp. Histopathology from two 4 mm punch biopsies performed on separate occasions demonstrated features on H&E stain consistent with CCLE: epidermal atrophy and interface dermatitis with superficial perivascular, deep dermal and periadnexal lymphohistiocytic infiltrates containing some plasma cells. Her rash had frustrated her for over 5 years, worsening with increased sun exposure. Her collagen vascular serologies were negative. She had been managed with potent topical corticosteroids with improvement, however, the patient preferred to reserve this for flares of her condition. Interestingly, the patient had correlated dramatic clearing of her CCLE inadvertently after 3 months of applying topical clindamycin gel 1% twice daily (figures 1 and 2),...

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Primary tonsillar tuberculosis

Upper aerodigestive tract involvement with tuberculosis is relatively rare and may be seen in up to 2% of patients with pulmonary tuberculosis. Isolated tonsil involvement with tuberculosis is not commonly seen in clinical practice. We report a case of a 22-year-old postpartum mother who presented with odynophagia, fever, loss of weight and submandibular swelling of 3 months' duration. Clinical examination revealed a submandibular node, and oropharyngeal examination revealed necrotic slough overlying an enlarged left tonsil. Fine-needle aspiration cytology of the node and histopathological examination of the left tonsillectomy specimen revealed necrotising epithelioid cell granulomas, and stain for acid-fast bacilli was positive in the latter. She was diagnosed with tonsillar tuberculosis and was started on antituberculous treatment following which she improved clinically. This case serves to demonstrate an uncommon presentation of primary tuberculosis and reminds us to consider tuberculosis also as a microbiological aetiology for tonsillitis.

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Microbiota — an amplifier of autoimmunity

Alexis Vogelzang | Matteo M Guerrini | Nagahiro Minato | Sidonia Fagarasan

https://ift.tt/2I7K36A

Extracellular matrix and the maintenance and loss of peripheral immune tolerance in autoimmune insulitis

Carlos O Medina | Nadine Nagy | Paul L Bollyky

https://ift.tt/2I7K22w

Role of Helicobacter pylori infection in cancer‐associated fibroblast‐induced epithelial‐mesenchymal transition in vitro

Helicobacter, EarlyView.

https://ift.tt/2QT6gcz

Subcutaneous nodules at progesterone injection sites after fertility treatment

Australasian Journal of Dermatology, EarlyView.

https://ift.tt/2OGKE1n

IgG/IgA pemphigus: Report of a rare subtype of pemphigus

Australasian Journal of Dermatology, EarlyView.

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Clinical and dermoscopic features of pleomorphic dermal sarcoma

Australasian Journal of Dermatology, EarlyView.

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Use of a lumbar puncture needle to reduce the number of needle insertions in infiltration local anaesthesia of large areas in dermatologic surgery

Australasian Journal of Dermatology, EarlyView.

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Tanning, selfies and social media

Australasian Journal of Dermatology, EarlyView.

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Facial trauma reconstruction with polymethyl methacrylate—A case report

Journal of Cosmetic Dermatology, EarlyView.

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Assessment of practice efficacy by retrospective analysis of long‐term patient outcomes: A proposed method

Journal of Cosmetic Dermatology, EarlyView.

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Appearance‐based vs health‐based sun protective messages: A randomized, double‐blind controlled study

Journal of Cosmetic Dermatology, EarlyView.

https://ift.tt/2QNzJER

Effects of contrast cryolipolysis on flank region adiposity: Case study

Journal of Cosmetic Dermatology, EarlyView.

https://ift.tt/2xI0vFT

Three‐dimensional nail imaging by optical coherence tomography: a novel biomarker of response to therapy for nail disease in psoriasis and psoriatic arthritis

Clinical and Experimental Dermatology, EarlyView.

https://ift.tt/2MZLYet

Local Recurrence and Quality of Life After Adjuvant Radiation Therapy in High‐Risk Squamous Cell Carcinoma

British Journal of Dermatology, Volume 0, Issue ja, -Not available-.

https://ift.tt/2zoU6Bo

Could the biomarker levels in saliva help distinguish between healthy implants and implants with peri-implant disease? A systematic review

Publication date: Available online 22 September 2018

Source: Archives of Oral Biology

Author(s): Alex Martins Gomes, Dhelfeson Willya Douglas-de Oliveira, Fernando Oliveira Costa

Abstract

Background

The most accurate data help to minimize possible mistakes on a patient´s evaluation, as more robust findings are necessary to establish a correct diagnosis, prognosis and, consequently, better treatment.

Purpose

Could biomarker levels in the saliva help to distinguish between healthy implants and implants with peri-implant disease?

Materials and Methods

An electronic database search of Pubmed/MEDLINE, Web of Science, the Cochrane Library, OVID and Scielo was performed. The articles and abstracts identified were considered relevant if they compared cytokine levels in saliva from patients with healthy implants to those in saliva from patients with untreated peri-implantitis.

Results

Lower salivary levels of interleukin 1β were found in healthy implants than in inflamed implants. A significantly positive correlation was found between the salivary levels of IL-6 and peri-implant inflammatory conditions. The salivary concentrations of total antioxidants, urate and ascorbate were higher in healthy implants than in inflamed implants. The data extracted from the 6 studies evaluated in this review revealed heterogeneity in relation to the clinical parameters assessed, implant restoration, bone loss and peri-implant disease definitions.

Conclusions

There was no clear, developed basis for using any specific biomarker in a clinical setting to distinguish between healthy implants and those with peri implant disease.

https://ift.tt/2PYzk0R

Immunohistochemistry profile of p75 neurotrophin receptor in oral epithelial dysplasia and oral squamous cell carcinoma induced by 4-nitroquinoline 1-oxide in rats

Publication date: Available online 22 September 2018

Source: Archives of Oral Biology

Author(s): Marina Gabriela Teixeira Buck, Priscila Souza Cabral Tuci, Flávia Cristina Perillo Rosin, Ana Rita Pinheiro Barcessat, Luciana Corrêa

ABSTRACT

Objective

The 4-nitroquinoline 1-oxide (4-NQO) model for carcinogenesis has been used to investigate cancer stem cells (CSC), but no study has addressed the role of the p75 neurotrophin receptor (p75^NTR) in 4-NQO-induced oral dysplasia and oral squamous cell carcinoma (OSCC). The aim of this study was to evaluate the immunohistochemistry profile of the p75^NTR during 4-NQO-induced oral carcinogenesis in rats and to verify whether this profile has an association with proliferating cell nuclear antigen (PCNA) immunolabeling.

Design

For 28 weeks, rats were exposed to 4-NQO, which was diluted in the drinking water. After 3, 5, 7, 16, and 28 weeks, the animals were euthanized and their tongues were histologically analyzed using p75^NTR and PCNA immunolabeling.

Results

In animals without 4-NQO exposure, the p75^NTR and PCNA were expressed only in the basal epithelial layer and in a clustered manner. The oral epithelium showed dysplasia and a significant increase in the number of p75^NTR- and PCNA-positive cells, which were localized mainly in the basal and suprabasal epithelial layers during weeks 5–16 of 4-NQO exposure. When the epithelium invaded the lamina propria and well-differentiated OSCC began, the p75^NTR-positive cell frequency drastically decreased in epithelial cords and nests, showing a negative correlation with PCNA expression. p75^NTR immunolabeling during 4-NQO-induced carcinogenesis was similar to that described for human head and neck dysplasia and neoplasia.

Conclusions

p75^NTR immunolabeling observed in 4-NQO-induced oral dysplastic and OSCC lesions were related to the early phases of oral carcinogenesis and may help predict cell dysplasia and malignant transformation.

https://ift.tt/2O2tGxG

Prognostic factors and survival outcomes for head and neck cutaneous adnexal cancers

Publication date: Available online 22 September 2018

Source: American Journal of Otolaryngology

Author(s): Danny B. Jandali, Ashwin Ganti, Samer Al-Khudari, Bobby A. Tajudeen, Peter C. Revenaugh

Abstract

Objectives

Malignant cutaneous adnexal tumors (MCAT) are rare and comprise a heterogeneous group of cancers. There have been several studies reviewing prognostic factors of these tumors, but no studies focusing on the head and neck. This study aimed to review a large population based database to evaluate prognostic factors that could impact survival.

Methods

The Surveillance, Epidemiology, and End Results (SEER) database was utilized to identify patients with MCAT of the head and neck. Both overall and disease specific survival were the main outcome measures for the study. Univariate and multivariate analyses were performed to evaluate the association of suspected prognostic factors with survival.

Results

The five-year OS and DSS were 72.6 and 95.5%, respectively. A favorable factor for OS was surgical resection ([HR] 0.324; P = 0.001), while unfavorable factors for OS include older age (1.051; P < 0.001), higher tumor grade (1.254; P = 0.049), larger tumor size (1.293; P = 0.003), and positive nodal involvement (3.323; P = 0.002). A favorable factor for DSS was surgical resection (0.026; P < 0.001). Unfavorable factors for DSS include older age (1.058; P = 0.046), larger tumor size (2.528; 1.565–4.085; P < 0.001), and positive nodal involvement (4.761; P = 0.022).

Conclusion

Review of the SEER database shows good 5-year OS and DSS rates, similar to those cited in other studies. We identified several prognostic factors associated with survival, while histologic sub-type does not seem to be associated with survival. Surgical resection is the mainstay of treatment.

https://ift.tt/2xwXGbx

Severity scales of non-IgE-mediated gastrointestinal food allergies in neonates and infants

Publication date: Available online 22 September 2018

Source: Allergology International

Author(s): Hisako Yagi, Takumi Takizawa, Koichiro Sato, Takaharu Inoue, Yutaka Nishida, Takashi Ishige, Maiko Tatsuki, Reiko Hatori, Yasuko Kobayashi, Yoshiyuki Yamada, Hirokazu Arakawa

Abstract

Background

Non-IgE-mediated gastrointestinal food allergies (non-IgE-GI-FAs) are one type of food allergy found in neonates and infants. Few reports have defined the severity of non-IgE-GI-FAs in these populations.

Methods

Grading scales of the severity of non-IgE-GI-FAs according to extra-GI symptoms, such as poor weight gain, as well as systemic symptoms, including fever and shock, were developed and retrospectively applied to patients with non-IgE-GI-FAs. The relationship between the severity of non-IgE-GI-FAs and both clinical and laboratory findings were examined.

Results

Elevation of C-reactive protein levels and a decrease in total protein and albumin were observed in accordance with allergy severity. In an endoscopic examination, inflammatory findings were confirmed in large areas of the colonic mucosa in case of higher severity levels, and infiltration of inflammatory cells other than eosinophils was found in the severest grade. Extensively hydrolyzed milk or amino acid-based milk was required for all patients with the severest grade. In addition, the timing of acquiring tolerance tended to be late for this grade.

Conclusions

Classification and determination of the severity of non-IgE-GI-FAs in neonates and infants may not only contribute to elucidation of the pathogenesis but may also be useful in the clinical setting.

https://ift.tt/2MXI6KE

Resolution of eosinophilia and elevated immunoglobulin E with ibrutinib for chronic lymphocytic leukemia

Publication date: Available online 22 September 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Kaoru Harada, Joel P. Brooks, Francis M. Lobo

https://ift.tt/2xMjkaK

Subacute cutaneous lupus erythematosus and dermatomyositis associated with anti‐programmed cell death (PD)‐1 therapy

British Journal of Dermatology, Volume 0, Issue ja, -Not available-.

https://ift.tt/2OKfI0r

Excision‐release of oxidatively‐induced DNA base lesions from the lung genome by cat dander extract challenge stimulates allergic airway inflammation

Clinical &Experimental Allergy, Volume 0, Issue ja, -Not available-.

https://ift.tt/2MYAt6K

In utero exposure to cigarette smoke and effects across generations: a conference of animals on asthma

Clinical &Experimental Allergy, Volume 0, Issue ja, -Not available-.

https://ift.tt/2xwaVJA

Bronchoscopic mucosal cryobiopsies as a method for studying airway disease

Clinical &Experimental Allergy, Volume 0, Issue ja, -Not available-.

https://ift.tt/2MSRbo1

Middle ear lipoma mimicking a congenital cholesteatoma: A case report and review of the literature

Publication date: Available online 22 September 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Floyd Buen, Chia-Huei Chu, Akira Ishiyama

Abstract

Objective

To describe a case of middle ear lipoma, review the current literature, and discuss the surgical approach.

Methods

Published case reports in the English literature of lipomas restricted to the middle ear were reviewed. The presentation, location, and management of the middle ear lipomas were analyzed.

Results

Histological examination of the resected lesion was compatible with lipoma. Review of the literature suggests middle ear lipomas are rare and involve the epitympanum.

Conclusion

Lipomas should be included in the differential diagnosis for middle ear lesions. Adequate surgical exposure can be achieved through a transcanal approach, with particular attention to carefully elevate the tympanic membrane off the malleus, preserving the integrity of the ossicular chain.

https://ift.tt/2Q0GGkJ

Does intratympanic xylitol administration have ototoxic effects in a mouse ear model?

Publication date: Available online 22 September 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Eda Tuna Yalcinozan, Ebru Kösemihal, Mehmet Ates Aksit, Remzi Tinazli, Hasan Safakogullari, Kadir Cagdas Kazikdas, Mustafa Asim Safak

Abstract

Objective

To research the ototoxicity of xylitol after intratympanic injection in mice ear model.

Methods

24 female mice Balb/c mice (48 ears) included in the study. The mice were divided into 4 groups as 6 mice were found (12 ears) in each group. Solutions of 0.9 % NaCl solution (Group A), 155 mg/ml (Group B), 310 mg/ml (Group C) and 620 mg/ml (Group D) xylitol, were applied into the middle ear cavity. Microscopic ear examination and auditory brainstem response test were done for each mouse before application of xylitol and on the 1st, 3rd and 10th day of injection.

Results

There are some statistically significant alterations found in the treshold values at 8000, 12000, 16000, 24000 Hz frequencies when each group were compared in itself on day 0, 1,3 and 10, which were independent from the increasing dosage.

Conclusion

According to our findings intratympanic xylitol injection does not have any ototoxic effect in the inner ear. To evaluate the effects of xylitol more clinical studies are need to carried out.

https://ift.tt/2O1iKQO

Association Between Symptomatic Submucous Cleft Palate and Otologic Disease: A Retrospective Review

Publication date: Available online 22 September 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Adam Kwinter, Ann Dworshcak-Stokan, Josee Paradis, Murad Husein

Abstract

Introduction

Submucous cleft palate (SMCP) is the most common congenital malformation of the posterior palate and characterized in part by palatal muscle diastasis. Patients with SMCP are considered symptomatic when suffering from velopharyngeal insufficiency which leads to hypernasality of speech and excess nasal air emission. SMCP results from defects in the muscles thought to be responsible for regulating the patency of the eustachian tube which can lead to a number of middle ear pathologies and ultimately hearing loss. Hearing loss, especially at a young age, can make speech acquisition a challenge. The purpose of this study was to review patients with symptomatic SMCP (SSMCP) who have presented to our center and report on the association between SSMCP and otologic disease.

Methods

This study was a retrospective review of all patients presenting to our center between 2004 and 2016. Patients with SSMCP were identified through a patient database maintained on site. Inclusion criteria were diagnosis of SMCP and documentation of the presence or absence of otologic disease. Once identified patient records were reviewed and various demographic and patient factors were recorded. Patients were then grouped into cohorts of those with and without otologic disease and those requiring tympanostomy tubes and not. T-tests were then used to compare various factors between cohorts.

Results

A total of 73 patients were identified and 58 met inclusion criteria (mean age 5.8 years, male:female 36:22). 27.5% of patients were diagnosed with a genetic condition. 69% of patients had otologic disease and 47% required at least one set of bilateral tympanostomy myringotomy tubes. The cohort with ear disease tended to have worse scores on ACPA testing though this was not statistically significant. There were no significant demographic differences between the cohorts.

Conclusions

Patients with symptomatic SMCP suffer from a higher incidence of otologic disease and bilateral myringotomy tube placement than the general population. This is an important potential comorbidity in SSMCP patients as it can act as a further barrier to speech acquisition. Further research is needed to determine if OD can be used for prognostication or treatment purposes.

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Issue Information

Helicobacter, Volume 23, Issue 5, October 2018.

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Neuropsychiatric Disorder Associated with Group G Streptococcus Infection

Immune-mediated central nervous system manifestations of group A β-hemolytic Streptococcus (GABHS) infection include Sydenham's chorea, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS)—which includes tic and obsessive compulsive disorders—and a variety of neurobehavioral disorders. We report a case of Streptococcus dysgalactiae subspecies equisimilis (group G Streptococcus) (GGS) infection associated with involuntary movements, complex tics, and emotional lability in an 11-year-old Japanese girl. Serum IgM and IgG antibodies to lysoganglioside were positive, and she responded rapidly to intravenous immunoglobulin treatment. Neuropsychiatric disorder associated with GGS infection was ultimately diagnosed. The present findings suggest that neuropsychiatric disorders can result from GGS infection and that the pathogenic mechanism is similar to that of GABHS infection. Future large-scale studies should examine the relation between GGS infection and onset of neuropsychiatric disorder.

https://ift.tt/2OKLiuQ

Is Improved Insurance Coverage a Fleeting Opportunity?

Is Improved Insurance Coverage a Fleeting Opportunity?

JAMA Otolaryngol Head Neck Surg. 2018 Sep 13;:

Authors: Li RJ, McConnell J

PMID: 30242398 [PubMed - as supplied by publisher]

https://ift.tt/2pwgSBR

Association of Fludeoxyglucose F 18-Labeled Positron Emission Tomography and Computed Tomography With the Detection of Oropharyngeal Cancer Recurrence.

Association of Fludeoxyglucose F 18-Labeled Positron Emission Tomography and Computed Tomography With the Detection of Oropharyngeal Cancer Recurrence.

JAMA Otolaryngol Head Neck Surg. 2018 Sep 13;:

Authors: Sivarajah S, Isaac A, Cooper T, Zhang H, Puttagunta L, Abele J, Biron V, Harris J, Seikaly H, O' Connell DA

Abstract
Importance: No guidelines at present describe when fludeoxyglucose F 18-labeled positron emission tomography and computed tomography (FDG PET-CT) should be used in the initial posttreatment period for evaluation of oropharyngeal squamous cell carcinoma treatment outcome and recurrence.
Objective: To compare accuracies of the initial posttreatment PET-CT between primary treatment groups and to define indicators of false-positive findings.
Design, Setting, and Participants: This retrospective cohort study identified adults with a new diagnosis of oropharyngeal squamous cell carcinoma who received treatment with curative intent from October 1, 2006, through November 30, 2016, using the Alberta Cancer Registry (n = 380). Patients who underwent PET-CT within 1 year of treatment completion were included (n = 190). Of these, 103 patients (54.2%) had PET-CT findings positive for residual or recurrent disease, and 61 (32.1%) had false-positive findings. Among the 61 patients, 42 (68.9%) had received chemoradiotherapy (CRT) and 19 (31.1%) had primary surgery. Forty-two patients had true-positive findings, indicating a prevalence rate of disease of 22.1%. Data were analyzed from July through October 2017.
Exposures: One of 2 primary treatment modalities (surgery with or without adjuvant therapy vs CRT). All patients had posttreatment FDG PET-CT.
Main Outcomes and Measures: Primary outcome measures included the diagnostic odds ratio, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of PET-CT for detecting residual and/or recurrent disease. A multivariate analysis determined indicators of false-positive findings. Discriminative ability was assessed using receiver operating characteristic curve analysis of maximum standardized uptake value (SUVmax) metabolic data.
Results: Of the 190 participants, 77.9% were men, with a mean (SD) age at diagnosis of 58.5 (8.5) years. The diagnostic odds ratio was 19.3 (95% CI, 5.7-65.1); pooled sensitivity, 93.3% (95% CI, 80.7%-98.3%); and pooled specificity, 57.9% (95% CI, 49.4%-66.0%). The PPV of detecting disease was 54.7% (95% CI, 38.8%-69.8%) for primary surgery and 31.1% (95% CI, 20.2%-44.4%) for CRT. The NPV was 100% (95% CI, 94.7%-100%) for primary surgery and 96.6% (95% CI, 89.5%-99.1%) for CRT. Multivariate analysis identified treatment type, p16 disease, and smoking status as indicative of false-positive findings. In the receiver operating characteristic curve analysis for primary tumors, the optimal cutoff SUVmax for indicating true- vs false-positive results was 5.1 for surgically treated patients (area under the curve, 0.729; 95% CI, 0.570-0.888) and 5.3 for patients treated with CRT (area under the curve, 0.844; 95% CI, 0.700-0.989).
Conclusions and Relevance: The results indicate a higher specificity for FDG PET-CT for initial posttreatment surveillance imaging among patients treated with primary surgery compared with nonsurgical management. Both sets of patients with posttreatment FDG PET-CT findings with an SUVmax greater than 5.0 should undergo close evaluation for possible residual or recurrent disease.

PMID: 30242338 [PubMed - as supplied by publisher]

https://ift.tt/2pumIn9

Ultrasonographic Evaluation of Upper Airway Structures in Children With Obstructive Sleep Apnea.

Ultrasonographic Evaluation of Upper Airway Structures in Children With Obstructive Sleep Apnea.

JAMA Otolaryngol Head Neck Surg. 2018 Sep 13;:

Authors: Lin CY, Chen CN, Kang KT, Hsiao TY, Lee PL, Hsu WC

Abstract
Importance: Adenotonsillar hypertrophy is an important cause of obstructive sleep apnea (OSA) in children. However, residual OSA and abnormal polysomnographic findings have been reported in up to 75% of cases after adenotonsillectomy. Other anatomical and functional factors that influence upper airway structures, including the lateral pharyngeal wall, have rarely been studied in children with OSA.
Objective: To determine whether the upper airway structures can be evaluated using head and neck ultrasonography and if there is an association between the ultrasonographic measurements for these structures and severity of OSA seen on polysomnography in children.
Design, Setting, and Participants: Prospective, single-center, observational study of 82 children younger than 18 years with a diagnosis of sleep-disordered breathing (20 with primary snoring, 62 with OSA, as determined by the apnea-hypopnea index) and admitted to a tertiary teaching hospital for adenotonsillectomy.
Exposures: Ultrasonography and polysomnography.
Main Outcomes and Measures: Ultrasonographic measurements of upper airway structures.
Results: Of the 82 children studied, 62 (76%) were boys; mean (SD) age, 7.7 (6.2). There was no significant difference found in tonsillar dimensions or volume between the children with OSA and those with primary snoring. However, the mean (SD) total lateral pharyngeal wall and the total neck thicknesses at the retropalatal level were both greater in children with OSA than in those with primary snoring at rest (24.9 [4.4] mm vs 21.3 [2.6] mm; difference, 3.61 mm; 95% CI of difference, 1.48-5.74 mm for lateral pharyngeal wall; and 59.9 [14.4] mm vs 49.9 [11.2] mm; difference, 10.9 mm, 95% CI of difference, 3.8-17.9 mm for the total neck).
Conclusions and Relevance: Estimated tonsillar volume measured using ultrasonography had no relationship with the apnea-hypopnea index in childhood sleep-disordered breathing. However, the lateral pharyngeal wall was significantly thicker in children with OSA than in those with primary snoring at rest.

PMID: 30242332 [PubMed - as supplied by publisher]

https://ift.tt/2QSWWWc

Atypical Infraglottic Lesion.

Atypical Infraglottic Lesion.

JAMA Otolaryngol Head Neck Surg. 2018 Sep 13;:

Authors: Martz TG, McGarey PO, Daniero JJ

PMID: 30242330 [PubMed - as supplied by publisher]

https://ift.tt/2IaTd2o

A Parathyroid Hemangioma of the Retropharynx.

A Parathyroid Hemangioma of the Retropharynx.

JAMA Otolaryngol Head Neck Surg. 2018 Sep 13;:

Authors: Snyder V, Bayrak S, Woodroof J, Kakarala K

PMID: 30242327 [PubMed - as supplied by publisher]

https://ift.tt/2pwPfbQ

Association of the Patient Protection and Affordable Care Act With Insurance Coverage for Head and Neck Cancer in the SEER Database.

Association of the Patient Protection and Affordable Care Act With Insurance Coverage for Head and Neck Cancer in the SEER Database.

JAMA Otolaryngol Head Neck Surg. 2018 Sep 13;:

Authors: Cannon RB, Shepherd HM, McCrary H, Carpenter PS, Buchmann LO, Hunt JP, Houlton JJ, Monroe MM

Abstract
Importance: Patients with head and neck squamous cell cancer (HNSCC) are often uninsured or underinsured at the time of their diagnosis. This access to care has been shown to influence treatment decisions and survival outcomes.
Objective: To examine the association of the Patient Protection and Affordable Care Act (ACA) health care legislation with rates of insurance coverage and access to care among patients with HNSCC.
Design, Setting, and Participants: Prospectively gathered data from the Surveillance, Epidemiology, and End Results (SEER) database were used to examine rates of insurance coverage and access to care among 89 038 patients with newly diagnosed HNSCC from January 2007 to December 2014. Rates of insurance were compared between states that elected to expand Medicaid coverage in 2014 and states that opted out of the expansion. Statistical analysis was performed from January 1, 2007, to December 31, 2014.
Main Outcomes and Measures: Rates of insurance coverage and disease-specific and overall survival.
Results: Among 89 038 patients newly diagnosed with HNSCC (29 384 women and 59 654 men; mean [SD] age, 59.8 [7.6] years), there was an increase after implementation of the ACA in the percentage of patients enrolled in Medicaid (16.2% after vs 14.8% before; difference, 1.4%; 95% CI, 1.1%-1.7%) and private insurance (80.7% after vs 78.9% before; difference, 1.8%; 95% CI, 1.2%-2.4%). In addition, there was a large decrease in the rate of uninsured patients after implementation of the ACA (3.0% after vs 6.2% before; difference, 3.2%; 95% CI, 2.9%-3.5%). This decrease in the rate of uninsured patients and the associated increases in Medicaid and private insurance coverage were only different in the states that adopted the Medicaid expansion in 2014. No survival data are available after implementation of the ACA, but prior to that point, from 2007 to 2013, uninsured patients had reduced 5-year overall survival (48.5% vs 62.5%; difference, 14.0%; 95% CI, 12.8%-15.2%) and 5-year disease-specific survival compared with insured patients (56.6% vs 72.2%; difference, 15.6%; 95% CI, 14.0%-17.2%).
Conclusions and Relevance: Access to health care for patients with HNSCC was improved after implementation of the ACA, with an increase in rates of both Medicaid and private insurance and a 2-fold decrease in the rate of uninsured patients. These outcomes were demonstrated only in states that adopted the Medicaid expansion in 2014. Uninsured patients had poorer survival outcomes.

PMID: 30242321 [PubMed - as supplied by publisher]

https://ift.tt/2I7a1qW

Pediatric Laryngeal Expression and Surgical Treatment of IgG4-Related Disease.

Pediatric Laryngeal Expression and Surgical Treatment of IgG4-Related Disease.

JAMA Otolaryngol Head Neck Surg. 2018 Sep 13;:

Authors: Jordan VA, Herrera Hernandez LP, Cofer SA, Roby BB

PMID: 30242320 [PubMed - as supplied by publisher]

https://ift.tt/2ptenjy

Alfred William (Bill) Frankland

Allergy, Volume 0, Issue ja, -Not available-.

https://ift.tt/2OIvk4s

Legends of Allergology/Immunology: Gunnar Johansson

Allergy, Volume 0, Issue ja, -Not available-.

https://ift.tt/2zofA1f

Surgical Excision of the Submandibular Gland

Publication date: Available online 22 September 2018

Source: Operative Techniques in Otolaryngology-Head and Neck Surgery

Author(s): Travis P. Schrank, Yana Mikhaylov, Adam M. Zanation

Abstract

A variety of pathology commonly affects the salivary glands including both benign and malignant tumors as well as infectious and inflammatory disease. Although newer techniques including sialo-endoscopy are emerging for the treatment of inflammatory and obstructive disorders, excision of the submandibular gland remains the treatment of choice for tumors of the submandibular gland and remains an important option for the treatment of refractory inflammatory disease. Relevant surgical anatomy, perioperative management, surgical technique, and possible complications are discussed.

https://ift.tt/2QPYzDT

Deep Lobe Parotidectomy

Publication date: Available online 22 September 2018

Source: Operative Techniques in Otolaryngology-Head and Neck Surgery

Author(s): Kathryn M. Van Abel, Kerry D. Olsen

Abstract

Deep lobe parotidectomy (DLP) is a critical procedure to master for any head and neck oncologic surgeon. This procedure is indicated for any deep lobe malignancy, a superficial lobe malignancy with extension into the deep lobe, refractory inflammatory conditions, and the presence of metastatic disease within a superficial or periparotid lymph node. This article describes the relevant anatomy and steps required to perform a DLP with and without facial nerve sacrifice. In addition, the history of the procedure, patient work up, indications, and possible complications are discussed.

https://ift.tt/2xJ6Ctr

Identification and Dissection of the Facial Nerve During Parotidectomy

Publication date: Available online 22 September 2018

Source: Operative Techniques in Otolaryngology-Head and Neck Surgery

Author(s): Guy J. Petruzzelli

Abstract

Facial nerve injury during parotidectomy remains one of the most significant complications associated this operation. Preventing facial nerve injury begins with a detailed understanding of the extra-temporal course of the facial nerve beginning with identification of the main trunk at the stylomastoid foramen. Reliable anatomic landmarks are present which facilitate identification and preservation of the main trunk of the facial nerve and facilitate antegrade dissection and preservation of the facial nerve distally. This article reviews the skeletal, cartilaginous, and muscular landmarks necessary for the reliable identification of the main trunk of the facial nerve during parotid surgery. Meticulous identification of these landmarks and attention to surgical detail we'll facilitate safe identification and dissection of the facial nerve and contributes significantly to successful parotid surgery.

https://ift.tt/2QTyGmB