Presence of varicella zoster virus in zosteriform leukaemia cutis

Summary

Leukaemia cutis is a relatively rare manifestation in chronic lymphocytic leukaemia, characterized by a diverse morphology of skin lesions. We report two patients who developed zosteriform skin symptoms; however, the histological analysis revealed leukaemia infiltration as the cause of their symptoms. Contrary to previous reports, varicella zoster virus DNA was detectable in the lesions. These findings suggest that varicella zoster virus plays an active role in the development of zosteriform leukaemia cutis.

http://bit.ly/2RjBY6O

Impact of smoking on imiquimod response in patients with vulval intraepithelial neoplasia

Summary

Background

Vulval intraepithelial neoplasia (VIN) is a precancerous condition that may progress to invasive malignancy. VIN is associated with human papillomavirus (HPV) infection in most cases, and with inflammatory skin disorders in a smaller proportion of patients. Treatment of VIN has traditionally been surgical excision; however, topical treatments, including imiquimod cream, are becoming increasingly used. Patient factors influencing response to imiquimod therapy, in particular smoking, have not yet been published.

Aim

To assess the impact of smoking and other patient characteristics that may influence the treatment response to topical imiquimod for VIN.

Methods

This was a retrospective cohort study of 46 women treated with topical imiquimod for VIN in a single centre dermatology unit from January 2011 to July 2017.

Results

Complete clinical resolution of VIN was observed in 28 of 46 patients (61%), but was significantly reduced in the smoking cohort.

Conclusions

Smoking may impair response to imiquimod for VIN, and should be considered when discussing VIN treatment options with patients.

http://bit.ly/2C8VmJ8

Two cases of perniosis in a free flap and a graft site of the hands

http://bit.ly/2H4koiq

Effects of a simulated system of straw phonation on the complete phonatory range of excised canine larynges

Abstract

Purpose

This study investigated the effects of straw phonation therapy on the aerodynamic and acoustic parameters of the vocal folds at different levels of elongation and subglottal pressure.

Methods

20 excised canine larynges were used in both experimental (straw phonation therapy simulation) and control conditions. Aerodynamic parameters, including phonation threshold pressure (PTP), phonation instability pressure (PIP), phonation pressure range (PPR), phonation threshold flow (PTF), phonation instability flow (PIF), phonation flow range (PFR), were obtained at different levels of vocal fold elongation (0%, 10%, 20%). Acoustic parameters, including fundamental frequency (F0), jitter, shimmer, signal noise ratio (SNR) were detected at different levels of vocal fold elongation (0%, 10%, 20%) and subglottal pressure (15 cmH₂O, 20 cmH₂O, 25 cmH₂O).

Results

Significant decreases in PTP and PTF and significant increases in PIP, PIF, PPR, and PFR occurred in experimental condition at all levels of elongation when compared with control condition. However, no significant changes of acoustic parameters were obtained between conditions at all levels.

Conclusion

At different levels of vocal fold elongation, straw phonation not only lowered the onset of normal voice, but also elevated the onset of chaotic voice, indicating a better voice economy and voice control. Moreover, the improved phonatory range demonstrated that straw phonation had the potential to prevent voice users who have high voice demand from voice fatigue and vocal damage.

http://bit.ly/2TIhscJ

Comment on “Soft Mappings Space”

http://bit.ly/2H5QElj

The effect of various primers improving adhesiveness of gel polish hybrids on pH, TOWL and overall nail plates condition

Summary

Background

Hybrid manicure is now a popular method of nail care and nail art, which is associated with its durability. Unfortunately, it has an adverse effect on pH, TOWL and overall nail plates condition and has not been investigated in detail so far.

Aims

The aim of this study was to compare the pH and TOWL of the hand nails after using different primers. The effect of application time, breaks between applications and the method of curing and removal on those parameters and overall nail plates condition were evaluated.

Patients/Methods

An evaluation survey was conducted among 116 women. pH and TOWL measurements of the nail plate in 35 women were taken using the Courage & Khazaka. Clinical photos were made using the Fotomedicus system.

Results

The measured pH values of the nail plate in the test group with gel polish hybrid on the nails were from 5.50 to 6.65, while after removal of the gel polish hybrid, the values ranged from 5.63 to 6.68. TOWL of the nail plate covered with gel polish hybrid ranged from 2.9 to 33.2 g/m²/h, whereas after removal of hybrids—from 1.9 to 45.7 g/m²/h.

Conclusion

Different forms of acid‐free primers maintain a lower pH of the nail plate covered with a gel polish hybrid, while the acidic primer maintains higher values of the nail plate pH. The significant decrease in the nail plate TOWL following the application of gel polish hybrid indicates a reduced loss of water from the surface of the nail to the atmosphere.

http://bit.ly/2FnnRWD

A Novel Mutation in the Adult-Onset Alexander’s Disease GFAP Gene

The case describes a 25-year-old Caucasian female diagnosed with Alexander's disease (AxD) as an outpatient after extensive inpatient workup. Her presenting complaints included incontinence, clumsiness, seizures, dysphagia, and dysarthria. She was also found to have pancytopenia and dysautonomia. A full neurologic and hematologic workup yielded very little results, until a thorough literature search of her presenting complaints and radiologic findings pointed to adult-onset Alexander's Disease. Alexander's disease is a rare genetic leukodystrophy with a broad variety of presentations. Despite its infrequency in adults and the difficulty in diagnosis, the prevalence of AxD has been increasing due to ease of genetic analysis and identification of key clinical and radiological findings. This case illustrates the necessity of vigilance and persistence in the face of unusual patient presentations; occasionally, the sound of hoofbeats is zebras.

http://bit.ly/2AE9z0N

Hauptsymptome und Elternerwartung bei Adenotomie und Adenotonsillotomie im Vorschulalter

Laryngo-Rhino-Otol
DOI: 10.1055/a-0816-5807

Hintergrund Um eine realistische Aufklärung vor Adeno(tonsillo)tomie zu leisten, wurden im Rahmen dieser Studie die kindliche Symptombelastung und die elterliche Erwartung an den Operationserfolg prospektiv erfasst. Material und Methoden Es wurden n = 111 Kinder (3–6 Jahre, ♂ 65 % ♀ 35 %) rekrutiert, welche an der HNO-Universitätsklinik Ulm eine Adenotomie (AT 66 %) oder Adenotonsillotomie (ATT 34 %) erhielten. In der fragebogenbasierten Befragung wurden die häufigsten Symptome und der Hauptgrund zur Operation aus Elternsicht erfasst (Operationstag, follow-up: 3,5 Mo.) und in Balkendiagrammen jeweils für Gesamtkollektiv und die Operationsgruppen AT und ATT visualisiert (Signifikanzniveau auf α = 5 %). Ergebnisse Am häufigsten wurden von den Eltern Zeichen einer Atemproblematik (Mundatmung 87 %, Nasenatmungsbehinderung 86 %, Schnarchen 78 %), Hörminderung (68 %) und vermehrter Infektneigung (66 %) beobachtet. Als Hauptgrund zur Operation wurden Nasenatmungsbehinderung (77,5 %) und Hörminderung (53,2 %) genannt. Bei reiner Rachenmandelhyperplasie dominierten Hörprobleme, während bei zusätzlich indizierter Tonsillotomie nächtlichen Apnoen als Operationsgrund am häufigsten genannt wurden. Bei allen abgefragten Symptomen konnte postoperativ eine wesentliche Verbesserung erzielt werden. Schlussfolgerungen Bei differenzierter Indikationsstellung ist es möglich, die Eltern über eine sehr gute und realistisch zu erwartende, effektive Symptomreduktion nach AT und ATT zu informieren.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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

http://bit.ly/2VzO4qG

Clinical Communication: Systemic Capillary Leak Syndrome Due to Mast Cell Activation?

Clinical Communication: Idiopathic Anaphylaxis Masquerading as Systemic Capillary Leak Syndrome

http://bit.ly/2M2inlr

Anaphylaxis to amoxicillin-clavulanate, differenitiating the components

Drug hypersensitivity skin testing (ST) has been standardized only when referring to penicillin. However, this method remains a common practice for other drugs and while being a practical tool, oral provocation tests (OPT) are the gold standard in diagnosis of drug hypersensitivity and should be used when available.1 β-lactams remain the most frequently reported cause of adverse drug reactions.2 Isolated adverse drug reactions to clavulanate, a β-lactamase inhibitor added to amoxicillin to form amoxicillin-clavulanate, remain rarer but have been reported.

http://bit.ly/2sjKH9V

The Microbiome and Allergic Diseases: A struggle between good and bad microbes

Disclosures:

http://bit.ly/2M1DjZX

IgE Testing Can Predict Food Allergy Status in Patients with Moderate-Severe Atopic Dermatitis

Atopic dermatitis (AD) is the most common chronic inflammatory disease of the skin in pediatric populations, affecting up to 20% of children in industrialized countries.1-4 AD is frequently associated with other atopic diseases.5, 6 Up to two-thirds of AD patients are sensitized to food antigens, and 15-40% have clinical food allergy.7-11 Children with severe and persistent AD are at highest risk for having coexistent food allergy.5, 12, 13

http://bit.ly/2slgPdw

Incidence of Pneumocystosis Among Patients Exposed to Immunosuppression

•This population analysis add to the limited data that guides dermatologists on need to administer prophylaxis against pneumocystosis with trimethoprim/sulfamethoxazole. Benefit of prophylaxis with trimethoprim/sulfamethoxazole appears to outweigh risk of severe drug reaction for patients receiving combination corticosteroid and immunosuppressant therapy.

http://bit.ly/2VDMbt6

Mohs micrographic surgery for eyelid sebaceous carcinoma: a multicenter cohort of 360 patients

Whether to perform Mohs micrographic surgery or wide local excision as the primary resection for eyelid sebaceous carcinoma remains controversial. Compared with wide local excision, Mohs micrographic surgery exhibited lower recurrence rate, but comparable chances of metastasis and tumor-related mortality. Patients with pagetoid invasion may require adjuvant measures.

http://bit.ly/2QAl8Lz

Supplementing Resident Education in Vasculitis and Autoimmune Connective Tissue Disease

This prospective study examines the influence of an online curriculum in residents' knowledge of cutaneous manifestations of vasculitis and autoimmune connective tissue diseases.

http://bit.ly/2siZTEn

Endemic Human Cutaneous Leishmaniasis Incidence in the United States

To the Editor The recently published article by McIlwee and colleagues provides valuable insight into a protozoal disease the transmission of which within the United States (predominantly Texas) has been largely underrecognized by the US medical community. We would like to commend the authors for publishing this work and briefly expand on some topics presented that we believe warrant clarification and further discussion.

http://bit.ly/2LZoszj

Bullous Pemphigoid and Dipeptidyl Peptidase-4 Inhibitors in Patients With Diabetes

This case-control study examines the association between the use of dipeptidyl peptidase 4 inhibitors and the risk of developing bullous pemphigoid in patients with diabetes.

http://bit.ly/2slBu0Z

Evaluation of Unresectable Primary Cutaneous Melanoma Response to Immunotherapy Using Reflectance Confocal Microscopy

This case report study describes 2 patients with locally advanced primary melanomas and the use of reflectance confocal microscopy for imaging of cutaneous involvement and disease monitoring.

http://bit.ly/2M1bZen

Assessment of Diagnostic Strategy for Pemphigoid

This study analyzes the direct immunofluorescence and serologic data from 1125 consecutive patients for diagnosing pemphigoid, a cutaneous autoimmune disease that primarily affects older people.

http://bit.ly/2sspOtv

Understanding Perceived Barriers of Minority Medical Students Pursuing a Career in Dermatology

This survey study evaluates the perceived barriers of minority medical students pursuing a career in dermatology.

http://bit.ly/2M7DumJ

Endemic Human Cutaneous Leishmaniasis Incidence in the United States—Reply

In Reply We appreciate the comments of Mr Kipp and Dr Hergert and thank them for their observations regarding our study. Specifically, when discussing endemic human cutaneous leishmaniasis in the United States, we concur with the importance of making a distinction between anthropophagic and non-anthropophagic sand flies.

http://bit.ly/2siiAba

Assessment of the Prevalence of Mucosal Involvement in Bullous Pemphigoid

This cohort study examines the prevalence and distribution of mucosal involvement among patients with bullous pemphigoid.

http://bit.ly/2LYWcgb

Diagnostic Criteria and Phenotypes of Pemphigoid and the Association With Gliptins

In this issue, there are 2 excellent large retrospective studies from single centers in Groningen, The Netherlands, and Haifa, Israel of patients referred for possible bullous pemphigoid (BP). In addition, there is a nationwide population-based study from Korea evaluating the risk of BP in patients with diabetes receiving dipeptidyl peptidase 4 inhibitors (gliptins).

http://bit.ly/2slYT25

Immediate Use of Continuous Positive Airway Pressure in Patients With Obstructive Sleep Apnea Following Transsphenoidal Pituitary Surgery: A Case Series

Background: Patients who undergo transsphenoidal pituitary resection have an elevated risk of obstructive sleep apnea (OSA) yet their outcomes and the safety of continuous positive airway pressure (CPAP) remains unclear. Our study objective was to determine the incidence of complications related to the use of early positive airway pressure following pituitary resection. Methods: We retrospectively identified all patients who underwent endoscopic transsphenoidal pituitary tumor resection between January 1, 2005 and March 24, 2016 at our institution, including those with diagnosed or suspected OSA. We compared characteristics and postoperative complications of OSA patients who did and did not receive CPAP postoperatively. Results: In total, 427 patients underwent transsphenoidal pituitary resection. Of these, 64 (15%) had OSA. Acromegaly was more common in patients with OSA (42% vs. 10%; P

http://bit.ly/2RkwF74

JNA Journal Club

No abstract available

http://bit.ly/2Cdd6D9

SNACC Is Moving and We Are Really Excited!

No abstract available

http://bit.ly/2RlvwMz

Improving Severe Traumatic Brain Injury Observational Research: Not All Questions Need an RCT

No abstract available

http://bit.ly/2Cg3FCS

JAMA Dermatology

Mission Statement: JAMA Dermatology publishes information concerning the skin, its diseases, and their treatment. Its mission is to explicate the structure and function of the skin and its diseases and the art of using this information to deliver optimal medical and surgical care to the patient. We attempt to enhance the understanding of cutaneous pathophysiology and improve the clinician's ability to diagnose and treat skin disorders. This journal has a particular interest in publishing clinical and laboratory studies that reveal new information pertinent to the interests and needs of the medical dermatologist, dermatologic surgeon, and all those concerned with state-of-the-art care of cutaneous disease. We believe that knowledge derived from well-designed clinical trials and studies of cost-effectiveness are especially important for improving the practice of dermatology. Studies that increase the understanding of the outcome of treatment or the means by which the burden of dermatologic disease can be measured and reduced to promote the health of patients with skin disease will receive special priority. The journal regularly publishes reports on clinical investigations, editorials, and reviews. It also features reports and discussions on clinicopathologic correlations; clinical disorders of unique didactic value; pharmacologic, medical and surgical therapeutics; and ethical, moral, socioeconomic, and political issues.

http://bit.ly/2M36ZFT

January 2019 Issue Highlights

http://bit.ly/2sk0CVQ

Cutaneous Sensitization to Peanut in Children With Atopic Dermatitis

This Viewpoint discusses recent findings associating atopic dermatitis in infants with increased sensitization to peanut protein and how those findings are informing new guidelines and efforts to prevent peanut allergy.

http://bit.ly/2M3baBy

Use of Combination Systemic-Intratumoral HPV Vaccine to Treat Cutaneous Basaloid Squamous Cell Carcinomas—Reply

In Reply We thank Dr Brunet-Possenti and her colleagues for their interest and thoughtful comments on our article. In that report, we described using a combination of systemic and intratumoral delivery of the 9-valent human papillomavirus (HPV) vaccine to treat a woman in her 90s with multiple cutaneous squamous cell carcinomas (SCCs). This novel approach was followed by complete regression of all tumors 11 months after the first intratumoral injection of the vaccine. This readily available vaccine was well tolerated, and at last follow-up, the patient remained free of tumors. To our knowledge, this is the first report suggesting that the HPV vaccine may have therapeutic utility for SCCs.

http://bit.ly/2sh2xKN

A Meta-analysis of Benefits and Harms of Omalizumab in Patients With Chronic Idiopathic Urticaria

This meta-analysis of 67 observational studies analyzes the effectiveness and adverse event rate of omalizumab therapy in patients with chronic idiopathic urticaria and compares these findings with those of randomized clinical trials conducted among similar patients.

http://bit.ly/2LZ76CF

Use of Combination Systemic-Intratumoral HPV Vaccine to Treat Cutaneous Basaloid Squamous Cell Carcinomas

To the Editor We read with great interest the article by Nichols et al regarding the use of combined systemic and intratumoral human papillomavirus (HPV) vaccine to treat a woman in her 90s with multiple cutaneous squamous cell carcinomas. This article drew our attention because of the difficulties encountered in the management of such lesions in elderly patients. In the reported case, it seems clear that neither surgery nor chemotherapy would have been suitable for the patient.

http://bit.ly/2sk0plw

Association Between Psoriasis and Sexual and Erectile Dysfunction in Epidemiologic Studies

This systematic review evaluates the main characteristics of the studies of psoriasis and sexual dysfunction (SD) or erectile dysfunction (ED), including level of evidence, tools used to assess SD or ED, and prevalence and incidence of SD or ED.

http://bit.ly/2LZJoWQ

Use of Big Data to Estimate Defective DNA Repair Variants in the US Population

This molecular epidemiologic study examinsd 3 large exome sequence databases totaling more than 200 000 alleles to correlate disease-associated allele frequencies with the expected and reported prevalence of clinical disease.

http://bit.ly/2sk0iGC

Use of Dapsone in the Treatment of Chronic Idiopathic and Autoimmune Urticaria

This medical record review evaluates the efficacy and safety of dapsone as second-line therapy in patients with chronic spontaneous urticaria.

http://bit.ly/2M7nfGh

Aggressive Squamous Cell Carcinoma in Organ Transplant Recipients

This case series describes the clinicopathologic features of and identifies factors associated with aggressive squamous cell carcinoma in solid organ transplant recipients.

http://bit.ly/2shJPT8

Reduced Itch Associated With Dupilumab Treatment In 4 Patients With Prurigo Nodularis

This case report describes itch reduction in 4 patients with prurigo nodularis following treatment with dupilumab.

http://bit.ly/2M1htFX

Comparison of Injuries From Sharps Among Residents Within Dermatology and Other Medical Specialties

This study assesses whether the nature of injuries from sharps among dermatology residents is demonstrably different compared with injuries from sharps among residents in other medical and surgical specialties.

http://bit.ly/2shcrw5

Clinical Features of Neutrophilic Dermatosis Variants Resembling Necrotizing Fasciitis

This case series examines 6 previously unreported patients and published reports of 48 patients with necrotizing neutrophilic dermatosis to identify the traits and infection-mimicking features of a new subset of necrotizing neutrophilic dermatosis.

http://bit.ly/2LYEZn5

Expert-Level Diagnosis of Nonpigmented Skin Cancer by Combined Convolutional Neural Networks

This study compares the accuracy of a convolutional neural network–based classifier with that of physicians with different levels of experience at classifying dermoscopic and close-up images of nonpigmented lesions.

http://bit.ly/2sjiP5N

A Child With Multiple Hypopigmented Macules on the Abdomen

A child presented with multiple, asymptomatic, scattered white macules on the lower abdomen and pubic area, which were present at birth and had gradually increased in size and number; there was no history of any systemic disorder and no family history of similar lesions. What is your diagnosis?

http://bit.ly/2RDmpWM

Creating a Partnership Between Dermatologists and Geriatricians—Reply

In Reply We thank Drs Mundluru and Lee for their thoughtful response to our Viewpoint titled "Geriatric Dermatology—A Framework for Caring for Older Patients With Skin Disease." We agree that we need to create practical collaborations that simultaneously support increased knowledge of dermatology in the field of geriatrics while also broadening the knowledge and application of geriatrics in the field of dermatology. We share a common goal—to improve the care of older adults with skin disease. Collaboration is essential. We support the proposed approach to improving the content of dermatology in geriatrics fellowships.

http://bit.ly/2HcvIJs

Pricing a Year of Progression-Free Survival

What is a reasonable price for society to pay to give a patient with cancer 1 extra year of life without tumor growth?

http://bit.ly/2RCFBUI

Patch Testing and Allergen-Specific Inhibition in a Patient Taking Dupilumab

This case report describes changes in repeated patch test results in a patient receiving dupilumab therapy.

http://bit.ly/2H30aW5

Factors Associated With Persistent Atopic Dermatitis in Children

This clinical birth cohort study evaluates the association of genetic, environmental, clinical, and social factors with the persistence of atopic dermatitis at age 13 years among children born to parents with asthma.

http://bit.ly/2RGCM4O

Creating a Partnership Between Dermatologists and Geriatricians

To the Editor We read with great interest and enthusiasm the recent Viewpoint by Linos et al about the need to create a coherent framework to address geriatric dermatologic issues. We agree that older adults are a rapidly expanding and vulnerable segment of the population who require special attention by dermatologists.

http://bit.ly/2H3RPSa

Lack of consensus on the peri-operative management of patients with diabetes mellitus

No abstract available

http://bit.ly/2FlnWtW

Thromboprophylaxis in the obese surgical patient

No abstract available

http://bit.ly/2FhRv0e

Intra-operative heart rate and postoperative outcomes – rowing against the tide?

No abstract available

http://bit.ly/2FnNfvl

Noninvasive continuous arterial pressure monitoring with Clearsight during awake carotid endarterectomy: A prospective observational study

BACKGROUND Continuous noninvasive blood pressure (CNBP) measurement using the volume-clamp method is a less invasive alternative compared with invasive intra-arterial monitoring for awake patients during carotid endarterectomy (CEA) under regional anaesthesia. OBJECTIVE We investigated the agreement of blood pressure (BP) recorded with invasive and CNBP methods during awake CEA. DESIGN A prospective observational study for assessing agreement with Bland–Altman plots, agreement-tolerability indices (ATI), concordance and interchangeability. SETTING Azienda Ospedaliera Universitaria G. Martino, Messina, a University tertiary referral centre in Italy. PATIENTS In 30 consecutive patients, we recorded continuously ipsilateral invasive and noninvasive BPs, from 3 min before carotid cross-clamping to 5 min after unclamping. MAIN OUTCOME MEASURES Primary outcome was bias, 95% limits of agreement, ATI, concordance and interchangeability for mean arterial pressure (MAP). Secondary outcomes were agreements for systolic arterial pressure and diastolic arterial pressure. Tracking of changes was assessed with four-quadrant polar plots and the trend interchangeability method. Optimal bias was defined as 5 mmHg or less. RESULTS A total of 2672 invasive and CNBP paired measurements (93% of overall data) were analysed, with a median of 92 readings per patient [IQR 76 to 100]. Mean (SD) bias for MAP, systolic arterial pressure and DAP were −6.8 (6.7), −3.0 (9.7) and −9.0 (5.4) mmHg, respectively. The ATIs were 0.88, 0.95 and 0.71, respectively, where ATI of 1.0 or less and at least 2.0 defined acceptable, marginal and unacceptable agreements. The four-quadrant plot analysis for beat-to-beat differences showed concordance rates of 97.3%, 99.98% and 96.4%, respectively. Polar plot analysis showed 95% limits of agreement of −3 to 3, −2 to 2 and −2 to 2 mmHg respectively. Trend interchangeability method showed an interchangeability rate of 95% for MAP. CONCLUSION During CEA performed under regional anaesthesia, CNBP offers a less invasive approach for BP monitoring. We found acceptable agreement for MAP defined by an ATI of 0.88 and an excellent 95% global interchangeability rate. A suboptimal bias of 7 mmHg was found with CNBP for MAP.

http://bit.ly/2Fib7Bs

Development of a prediction model for postoperative pneumonia: A multicentre prospective observational study

BACKGROUND Postoperative pneumonia is associated with increased morbidity, mortality and costs. Prediction models of pneumonia that are currently available are based on retrospectively collected data and administrative coding systems. OBJECTIVE To identify independent variables associated with the occurrence of postoperative pneumonia. DESIGN A prospective observational study of a multicentre cohort (Prospective Evaluation of a RIsk Score for postoperative pulmonary COmPlications in Europe database). SETTING Sixty-three hospitals in Europe. PATIENTS Patients undergoing surgery under general and/or regional anaesthesia during a 7-day recruitment period. MAIN OUTCOME MEASURE The primary outcome was postoperative pneumonia. Definition: the need for treatment with antibiotics for a respiratory infection and at least one of the following criteria: new or changed sputum; new or changed lung opacities on a clinically indicated chest radiograph; temperature more than 38.3 °C; leucocyte count more than 12 000 μl−1. RESULTS Postoperative pneumonia occurred in 120 out of 5094 patients (2.4%). Eighty-two of the 120 (68.3%) patients with pneumonia required ICU admission, compared with 399 of the 4974 (8.0%) without pneumonia (P 

http://bit.ly/2FmgCOU

Six-minute walk test in pre-operative evaluation of patients for upper abdominal surgery

No abstract available

http://bit.ly/2FhZ9rt

Intra-operative tachycardia is not associated with a composite of myocardial injury and mortality after noncardiac surgery: A retrospective cohort analysis

BACKGROUND Myocardial injury after noncardiac surgery (MINS) is a major contributor to peri-operative morbidity and mortality with a reported incidence of about 8%. Tachycardia increases myocardial oxygen demand, and decreases oxygen supply, and is therefore a potential cause of MINS. OBJECTIVE We tested the hypothesis that there is an association between intra-operative area above a heart rate (HR) of 90 bpm and a composite of MINS and in-hospital all-cause mortality. DESIGN Retrospective analyses. SETTING Major tertiary care hospital, Cleveland, USA. PATIENTS Adults having elective or nonelective noncardiac surgery and scheduled troponin monitoring during the first 3 postoperative days between 2010 and 2015. MAIN OUTCOME MEASURES All-or-none composite of myocardial injury (MINS), defined by a peak postoperative generation 4 troponin T concentration at least 0.03 ng ml−1, and in-hospital all-cause mortality. RESULTS Among 2652 eligible patients, 123 (4.6%) experienced MINS within 7 days after surgery and 6 (0.2%) died before discharge. Intra-operative area above HR more than 90 bpm was not associated with the all-or-none composite of MINS and in-hospital mortality, with an estimated odds ratio (95% confidence interval) of 0.99 (0.97 to 1.01) per 1 h bpm increase in area above HR more than 90 bpm. Secondary outcomes were also unrelated to the composite, with estimated odds ratios (98.3% confidence interval) of 0.99 (0.98 to 1.00) for area above HR more than 80, 0.98 (0.92 to 1.04) for area above HR more than 100 bpm, and 0.96 (0.88 to 1.05) for maximum HR. CONCLUSION There was no apparent association between various measures of tachycardia and a composite of MINS and death, a result that contradicts previously reported associations between other measures of intra-operative tachycardia and MINS/mortality.

http://bit.ly/2FjGr21

Postoperative pneumonia: Can this important complication be predicted and anticipated?

No abstract available

http://bit.ly/2FiaRCu

Relevance of peripheral cholinesterase activity on postoperative delirium in adult surgical patients (CESARO): A prospective observational cohort study

BACKGROUND The cholinergic system is considered to play a key role in the development of postoperative delirium (POD), which is a common complication after surgery. OBJECTIVES To determine whether peri-operative acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE) activities are associated with the development of POD in in-hospital surgical patients, and raise hypotheses on cholinergic regulatory mechanisms in POD. DESIGN A prospective multicentre observational study by the Peripheral Cholinesterase-activity on Neurocognitive Dysfunctions in Surgical Patients (CESARO) study group. SETTING Nine German hospitals. PATIENTS Patients of at least 18 years of age scheduled for inpatient elective surgery for a variety of surgical procedures. A total of 650 patients (mean age 61.5 years, 52.8% male) were included. METHODS Clinical variables, and peripheral AChE and BuChE activities, were assessed throughout the peri-operative period using bedside point-of-care measurements (one pre-operative and two postoperative measurements). POD screening was conducted postoperatively for at least 24 h and up to the third postoperative day using a validated screening tool (nursing delirium screening scale). RESULTS In all, 179 patients (27.5%) developed POD within the early postoperative phase. There was a lower BuChE activity in patients with delirium compared with patients without delirium pre-operatively (Cohen's r = 0.07, P = 0.091), on postoperative day 1 (Cohen's r = 0.12, P = 0.003) and on postoperative day 2 (Cohen's r = 0.12, P = 0.002). In contrast, there was a significantly higher AChE activity in patients with delirium compared with patients without delirium pre-operatively (Cohen's r = 0.10, P = 0.012), on postoperative day 1 (Cohen's r = 0.11, P = 0.004) and on postoperative day 2 (Cohen's r = 0.13, P = 0.002). After adjusting for covariates in multiple logistic regression, a significant association between both BuChE and AChE activities and POD was not found. However, in the multivariable analysis using the Generalized Estimating Equation, cholinesterase activities showed that a decrease of BuChE activity by 100 U L−1 increased the risk of a delirium by approximately 2.1% (95% CI 1.6 to 2.8%) and for each 1 U g−1 of haemoglobin increase in AChE activity, there was a 1.4% (95% CI 0.6 to 2.2%) increased risk of POD. CONCLUSION Peri-operative peripheral cholinesterase activities may be related to the development of POD, but the clinical implications remain unclear. Further studies, in homogeneous patient groups with a strict protocol for measurement time points, are needed to investigate the relationship between cholinesterase activities and POD. TRIAL REGISTRATION www.clinicaltrials.gov. Identifier NCT01964274.

http://bit.ly/2FmpKmy

Goal-directed therapy during transthoracic oesophageal resection does not improve outcome: Randomised controlled trial

BACKGROUND Goal-directed therapy (GDT) is expected to be of highest benefit in high-risk surgery. Therefore, GDT is recommended during oesophageal resection, which carries a high risk of postoperative complications. OBJECTIVES The aim of this study was to confirm the hypothesis that GDT during oesophageal resection improves outcome compared with standard care. DESIGN A randomised controlled study. SETTING Two Swedish university hospitals, between October 2011 and October 2015. PATIENTS Sixty-four patients scheduled for elective transthoracic oesophageal resection were randomised. Exclusion criteria included colonic interposition and significant aortic or mitral valve insufficiency. INTERVENTION A three-step GDT protocol included stroke volume optimisation using colloid boluses as assessed by pulse-contour analysis, dobutamine infusion if cardiac index was below 2.5 l min−1 m−2 and norepinephrine infusion if mean arterial blood pressure was below 65 mmHg. MAIN OUTCOME MEASURE The incidence of complications per patient at 5 and 30 days postoperatively as assessed using a predefined list. RESULTS Fifty-nine patients were available for analysis. Patients in the intervention group received more colloid fluid (2190 ± 875 vs. 1596 ± 759 ml, P 

http://bit.ly/2Fhax73

Orthostatic intolerance following hip arthroplasty: incidence, risk factors and effect on length of stay: A prospective cohort study

BACKGROUND Early postoperative mobilisation is important for enhanced recovery, but can be hindered by orthostatic intolerance, characterised by dizziness, nausea, vomiting, feeling of heat, blurred vision and ultimately syncope. Although the incidence of orthostatic intolerance following total hip arthroplasty has been identified, few studies have yet investigated potential risk factors for developing orthostatic intolerance after hip arthroplasty. OBJECTIVES The aim of this study was to assess the incidence of orthostatic intolerance on the first postoperative day after total hip arthroplasty, potential predisposing risk factors for developing orthostatic intolerance and its effect on length of stay. DESIGN A prospective observational study. SETTING Tertiary hospital, Auckland, New Zealand, May to September 2015. PATIENTS One hundred and seventeen consecutive patients undergoing unilateral total hip arthroplasty. Patients were excluded if they had revision surgery. MAIN OUTCOME MEASURES Incidence of orthostatic intolerance during mobilisation on the first postoperative day. Significant peri-operative risk factors for developing orthostatic intolerance were identified using logistic regression. Length of stay was compared between orthostatic intolerant and orthostatic tolerant patients using the Mann–Whitney U-test. RESULTS On the first postoperative day, 22% of patients failed mobilisation due to orthostatic intolerance. Factors independently associated with orthostatic intolerance were female sex; OR (95% CI), 3.11 (1.01 to 9.57), postoperative use of gabapentin; OR 3.55 (1.24 to 10.15) and high peak pain levels (≥5/10) during mobilisation; OR 4.05 (1.30 to 12.61). Overall, 78% of patients were correctly identified. The model was more accurate at predicting those who would not get orthostatic intolerance (89% correct), compared with those who did have orthostatic intolerance (39% correct). Length of stay was longer in patients with orthostatic intolerance (P = 0.019). CONCLUSION Orthostatic intolerance is common after total hip arthroplasty. Optimising pain control prior to mobilisation and limiting gabapentin use may modify the risk of developing postoperative orthostatic intolerance. Although personalised recovery pathways appear attractive, at present, the ability to predict at-risk individuals is still limited.

http://bit.ly/2FmpJPw

Reply to: thromboprophylaxis in the obese surgical patient

No abstract available

http://bit.ly/2FhZ8DV

Peri-operative endothelial dysfunction in patients undergoing minor abdominal surgery: An observational study

BACKGROUND Myocardial injury after noncardiac surgery is common and associated with major adverse cardiac events. Surgery induces acute endothelial dysfunction, which might be central in the pathophysiology of myocardial injury; however, the relationship between surgical stress and endothelial function remains incompletely understood. OBJECTIVES This study aimed to assess the acute peri-operative changes in endothelial function after minor elective abdominal surgery. DESIGN A prospective, observational, single-centre study. SETTING A university hospital from February 2016 to January 2017. PATIENTS Sixty patients undergoing elective minor abdominal surgery. MAIN OUTCOME MEASURES The change in endothelial function, expressed as the reactive hyperaemia index (RHI), was assessed by non-invasive digital pulse tonometry. RHI, biomarkers of nitric oxide bioavailability and oxidative stress were assessed prior to and 4 h after surgery. RESULTS RHI decreased significantly from 1.93 [95% confidence interval (95% CI 1.78 to 2.09)] before surgery to 1.76 (95% CI 1.64 to 1.90), P = 0.03, after surgery. The nitric oxide production, L-arginine/asymmetric dimethylarginine, decreased significantly from a ratio of 213.39 (95% CI 188.76 to 241.2) to a ratio of 193.3 (95% CI 171.82 to 217.54), P = 0.03. Plasma biopterins increased significantly after surgery, while the ratio between tetrahydrobiopterin and dihydrobiopterin was unchanged. Total ascorbic acid decreased significantly after surgery (P 

http://bit.ly/2FllVOq

Anaesthesiology residents have no significant effect on anaesthesia or procedure times

No abstract available

http://bit.ly/2Fhayb7

Monitoring haemodynamic response to fluid-challenge in ICU: comparison of pressure recording analytical method and oesophageal Doppler: A prospective observational study

BACKGROUND The ability of the pressure recording analytical method (PRAM) in tracking change in cardiac output (ΔCO) after a fluid challenge in ICU needs to be evaluated with the most contemporary comparison methods recommended by experts. OBJECTIVE Our objective was to report the trending ability of PRAM in tracking ΔCO after a fluid challenge in ICU and to compare this with oesophageal Doppler monitoring (ODM). DESIGN Prospective, observational study. SETTING Hôpital Lariboisière and Hôpital Européen George Pompidou, Paris, France, from April 2016 to December 2017. PATIENTS Critically ill patients admitted to ICU with monitoring of CO monitored by ODM and invasive arterial pressure. INTERVENTION ΔCO after fluid challenge was simultaneously registered with ODM and PRAM connected to the arterial line. MAIN OUTCOME MEASURE Polar statistics (mean angular bias, radial limits of agreement and polar concordance rate) and clinical concordance evaluation (error grid and clinical concordance rate). Predictors of bias were determined. RESULTS Sixty-eight fluid challenge were administered in 49 patients. At the time of fluid challenge, almost all were mechanically ventilated (99%), with 85% receiving norepinephrine. Admission diagnosis was septic shock in 70% of patients. Patients had a Sequential Organ Failure Assessment score of 10 [7 to 12] and a median Simplified Acute Physiology Score II of 61 [49 to 69]. Relative ΔCO bias was 7.8° (6.3°) with radial limits of agreement of ±41.7°, polar concordance rate 80% and clinical concordance rate 74%. ΔCO bias was associated with baseline bias (P = 0.007). Baseline bias was associated with radial location of the arterial line (P = 0.03). CONCLUSION When compared with ODM, PRAM has insufficient performance to track ΔCO induced by fluid challenge in ICU patients. Baseline bias is an independent predictor of trending bias. TRIAL REGISTRATION IRB 00010254-2016-033.

http://bit.ly/2Flbz0Z

European paediatric anaesthesia e-learning platform pearls and challenges

No abstract available

http://bit.ly/2Fj3sCO

Nasofacial Anthropometric Study Among Students of Shiraz University of Medical Sciences, Iran: A Population Based Study

Abstract

Anthropometry is a scientific study of linear dimensions and angles of living subjects. Knowing the details and anthropometric properties of nasofacial for each specific ethnic group is important for cosmetic operation as well as identifying individuals. In this study, facial and nasal anthropometric factors were studied in students of Shiraz University of Medical Sciences. In a cross-sectional study, 200 students of Shiraz University of Medical Sciences (100 male and 100 female and age range of 18–30 years) were selected. Nasal width (NW), nasal length (NL), nasal height (NH), face height (FH) and face width (FW) were measured in and the nasal (NI) and facial index (FI) were calculated for each case. Then, the data were analyzed using SPSS-22. The mean age was 21.84 ± 3.18 years. There were significant differences in the facial and nasal measurements including FH (P = 0.0001), FW (P = 0.0001), FI (P = 0.0001), NL (P = 0.002), NH (P = 0.001), NW (P = 0.0001) and NI (P = 0.0001) of sex groups. The most common types of face were mesoprosopic (36%) and hyperleptoprosopic (38%) types and and platyrrhine (63%) were mostly frequent. Based on the findings, all students of Shiraz University of Medical Sciences had mesoprosopic (36%) and hyperleptoprosopic (38%) types of face and platyrrhine type of nose. As well, a sexual dimorphism was recorded according to the nasofacial measurements in Iranian population that should be considered in the cosmetic operations. Sexual dimorphism and differences between different populations were recorded.

http://bit.ly/2ACbgM0

Nasofacial Anthropometric Study Among Students of Shiraz University of Medical Sciences, Iran: A Population Based Study

Abstract

Anthropometry is a scientific study of linear dimensions and angles of living subjects. Knowing the details and anthropometric properties of nasofacial for each specific ethnic group is important for cosmetic operation as well as identifying individuals. In this study, facial and nasal anthropometric factors were studied in students of Shiraz University of Medical Sciences. In a cross-sectional study, 200 students of Shiraz University of Medical Sciences (100 male and 100 female and age range of 18–30 years) were selected. Nasal width (NW), nasal length (NL), nasal height (NH), face height (FH) and face width (FW) were measured in and the nasal (NI) and facial index (FI) were calculated for each case. Then, the data were analyzed using SPSS-22. The mean age was 21.84 ± 3.18 years. There were significant differences in the facial and nasal measurements including FH (P = 0.0001), FW (P = 0.0001), FI (P = 0.0001), NL (P = 0.002), NH (P = 0.001), NW (P = 0.0001) and NI (P = 0.0001) of sex groups. The most common types of face were mesoprosopic (36%) and hyperleptoprosopic (38%) types and and platyrrhine (63%) were mostly frequent. Based on the findings, all students of Shiraz University of Medical Sciences had mesoprosopic (36%) and hyperleptoprosopic (38%) types of face and platyrrhine type of nose. As well, a sexual dimorphism was recorded according to the nasofacial measurements in Iranian population that should be considered in the cosmetic operations. Sexual dimorphism and differences between different populations were recorded.

http://bit.ly/2ACbgM0

BRCA Exchange aggregates data on thousands of BRCA variants to inform understanding of cancer risk

The BRCA Exchange, a global resource that includes data on thousands of inherited variants in the BRCA1/BRCA2 genes, is available to the public through a website and new smartphone app.

http://bit.ly/2FgO75W

Bedeutung des follikulären Penetrationswegs für den Wirkstofftransport mittels Nanocarriern

Zusammenfassung

Hintergrund

Der Haarfollikel stellt einen bedeutenden Penetrationsweg für topisch applizierte Substanzen dar.

Fragestellung

Die perkutane Absorption von bestimmten Substanzen kann durch die Beteiligung der Haarfollikel deutlich gesteigert und beschleunigt werden. Ferner haben Nanopartikel die Eigenschaft, besonders tief und effektiv in die Haarfollikel hinein zu penetrieren.

Material und Methoden

Dies bietet die Möglichkeit, den Wirkstofftransport für topisch applizierte Substanzen zu optimieren, indem die Nanocarrier allein als Transporter für die Wirkstoffe in den Haarfollikel fungieren. Innerhalb des Haarfollikels muss nach erfolgter Penetration eine Freisetzung des Wirkstoffs vom Nanocarrier erfolgen. Dies kann durch verschiedene Mechanismen getriggert werden.

Ergebnisse

Die freigesetzten Nanocarrier können somit unabhängig vom Nanopartikel in das den Haarfollikel umgebende lebende Gewebe übergehen. Mithilfe dieser innovativen Strategie kann die Bioverfügbarkeit von topisch applizierten Substanzen deutlich verbessert werden.

Schlussfolgerung

Ein Transport von Wirkstoffen in die Haarfollikel mithilfe von Partikeln und die dortige Wirkstofffreisetzung stellen eine sehr effektive neue Methode dar, Wirkstoffe durch die Hautbarriere zu transportieren.

http://bit.ly/2C6FIhe

Genderaspekt bei Angioödemen

Zusammenfassung

Hintergrund

Angioödeme können durch die Mediatoren Bradykinin oder durch Histamin ausgelöst werden. Dabei sind geschlechtsspezifische Unterschiede sowie mögliche Biomarker zur Verlaufskontrolle/Therapieüberwachung weitgehend unbekannt.

Fragestellung

Inwieweit unterscheiden sich, bezogen auf das Geschlecht, Gendefekte, Prodromi, Triggerfaktoren, klinische Parameter wie Attackenzahl, -frequenz, -lokalisation, Laborwerte, Hormone und Therapieansprechen bei den verschiedenen Angioödemtypen.

Material und Methode

Es erfolgten eine Literaturrecherche in PubMed mit den Stichworten „angioedema" und „sex" oder „gender" sowie gezieltes Screening von Übersichtsarbeiten, Leitlinien und Zulassungsstudien mit Angioödem-relevanten Medikamenten.

Ergebnisse

Bei histaminvermittelten Angioödemen sind kaum geschlechtsspezifische Unterschiede zu erkennen. Bei bradykininvermittelten hereditären Angioödemen, insbesondere mit FXII-Mutation, aber auch bei ACE(„angiotensin-converting enzyme")-Inhibitor-bedingten Angioödemen sind Frauen häufiger und stärker betroffen und hormonelle Einflüsse dokumentiert. Auch die Lokalisation der bradykininvermittelten Angioödeme ist genderspezifisch unterschiedlich. Der Anteil der Frauen in Zulassungsstudien bei HAE(hereditäres Angioödem)-Therapien beträgt etwa zwei Drittel.

Schlussfolgerungen

Grundsätzlich scheint eine Differenzierung zwischen östrogenabhängigen, östrogensensitiven und -insensitiven Angioödemen sinnvoll. Die Charakterisierung dieser Untergruppen führt zu einem besseren Verständnis des Pathomechanismus der Hormoneffekte auf die Angioödeme. Dies könnte zur Entwicklung von dringend benötigten Biomarkern für eine schnellere und gezieltere Diagnostik sowie für die Vorhersage von Attacken führen, um mittels individualisierter genderspezifischer Therapie Gesundheit und Lebensqualität der Angioödempatienten signifikant zu verbessern.

http://bit.ly/2Rgu8uu

Nachruf auf Herrn Prof. Dr. Hansotto Zaun

http://bit.ly/2C9yARs

Luftverschmutzung (Feinstaub, Stickstoffdioxid) und Hautalterung

Zusammenfassung

Vor einigen Jahren wurde entdeckt, dass Luftverschmutzung die menschliche Haut altern lässt. Diese Schlussfolgerung gründet auf epidemiologischen und mechanistischen Studien. Konkret tragen Schwebstaubpartikel, aber auch eine Stickstoffdioxidbelastung (NO₂) zu einer verstärkten Pigmentfleckenbildung insbesondere in der Gesichtshaut bei. Genetische Studien haben zudem gezeigt, dass daran auch Gen-Umwelt-Interaktionen beteiligt sind. So weisen Frauen, die bestimmte genetische Varianten des AHR(Arylkohlenwasserstoffrezeptor)-Signalweges aufweisen, ein deutlich erhöhtes Risiko auf, mehr Lentigines auf den Wangen nach einem Anstieg der Schwebstaubbelastung (PM2,5 [Feinstaub mit einem aerodynamischen Durchmesser kleiner als 2,5 µm]) zu entwickeln. Mechanistische Studien belegen einen direkten Zusammenhang zwischen einer topischen Belastung der menschlichen Haut ex vivo sowie in vivo mit umweltrelevanten, nichttoxischen Konzentrationen etablierter Dieselabgasgemische und einer verstärkten Pigmentierung der Haut, die auf einer Melaninneusynthese beruht und durch eine oxidative Stressantwort ausgelöst wird. Entsprechend erweisen sich topisch in kosmetischen Anti-Pollution-Produkten applizierte, ausgewählte Antioxidanzien, aber auch AHR-Antagonisten als geeignet, diese Pigmentierungsreaktion zu reduzieren bzw. zu verhindern. Ein weiterer wichtiger Aspekt ist die mögliche Interaktion von Luftverschmutzungsbestandteilen mit dem natürlichen Sonnenlicht, das ebenfalls zur Hautalterung und zur Pigmentfleckenbildung beiträgt. In einer realen Expositionssituation ist die menschliche Haut simultan beiden Umweltnoxen ausgesetzt. Entsprechende umweltepidemiologische Untersuchungen zeigen, dass in der Troposphäre vorhandener Schwebstaub und solare UV-Strahlung sich gegenseitig beeinflussen und die umweltinduzierte Hautalterung somit ein hochkomplexer Prozess ist.

http://bit.ly/2RgtQDU

Early-Onset Neonatal Meningitis Caused by an Unusual Pathogen‐Moraxella catarrhalis

Introduction. Moraxella catarrhalis are part of the normal flora of the human respiratory tract and are known to have low pathogenic potential. The organism is rarely reported in the literature as the causative agent of meningitis. We report the first case of early-onset neonatal meningitis associated with M. catarrhalis from Nepal. Case Report. A 3-day-old baby with fever and yellowish discolouration of the body since 48 hrs was admitted to the neonatal ward. The baby developed 3 episodes of seizures in the form of uprolling of eyes on the first day of admission during phototherapy course for raised serum bilirubin. Sepsis screen was positive, and meningitis was confirmed as the cerebrospinal fluid culture grew M. catarrhalis. Cranial ultrasound scan was normal. The baby received a 21-day course of intravenous cefotaxime and amikacin. Recovery has been uneventful to date. Conclusion. Neonatal meningitis is a life-threatening infection. This case report presents an uncommon aetiology of neonatal meningitis which can be misidentified in the diagnostic bacteriology laboratory in resource constraints area like ours.

http://bit.ly/2CZJs6c

Outcome prediction for Bonebridge candidates based on audiological indication criteria

To re-evaluate current indication criteria and to estimate the audiological outcomes of patients with Bonebridge bone conduction implants based on preoperative bone conduction thresholds.

http://bit.ly/2VH59Pp

A nail in the appendix, accidental discovery on an asymptomatic patient

Abstract

Inadvertent ingestion of foreign bodies is a common condition within clinical practice. It rarely produces any symptoms. The diagnosis is difficult since most patients do not recall having swallowed any object. Needles, pins, keys, nails and bones are among the most commonly ingested foreign bodies. Severe complications are uncommon, but if present they can put patients' lives at risk. Although extremely rare, the ingested foreign body may end lodging in the appendix, posing a challenge for the clinical team. Once the exact location of the object is confirmed, the extraction of the foreign object must be performed to avoid complications. The present report describes a case of a young adult patient, who presented to the emergency room after a routine medical examination. A 30 mm metallic nail was discovered in the tip of the appendix. After a failed endoscopic approach an appendectomy was performed, and the patient underwent a complete recovery.

http://bit.ly/2Qza9Sp

Spontaneous regression as a ‘burned-out’ non-seminomatous testicular germ cell tumor: a case report and literature review

Abstract

Testicular germ cell tumors (TGCTs) are the most frequent type of cancer in young adults. An exceptional event is the spontaneous regression (SR) of the primary tumor. Herein, we describe a burned-out non-seminomatous TGCT case and relevant literature review. A 34-year-old male presenting with low back pain was found to have a retroperitoneal mass upon urotomography. During workup, a heterogeneous testicular mass was evident, and its biopsy showed findings that support the diagnosis of spontaneous tumoral regression. The patient underwent unilateral orchiectomy and a chemotherapy protocol was later initiated, with 85% regression of the retroperitoneal metastatic mass. No progression of the primary tumor has been found. The etiology of SR across different cancer types appears to be associated with the host's immune response and an angiogenic disturbance of the tumor microenvironment. The burned-out phenomenon is a rare event that needs further research into its molecular sequencing.

http://bit.ly/2VCinxb

Complete duplication of left and right external iliac vein: two case reports and review of the literature

Abstract

The femoral vein is named as external iliac vein as it progresses in the cranial direction. In the current case report, a rare variation of the left external iliac vein that was found incidentally during pelvic lymph node dissection in a 36-year-old woman is presented. We also found the same variation at the right side in a 55-year-old woman during laparoscopic pelvic lymph node dissection. Duplication of left external iliac vein throughout its entire length was detected during the operation of the patient with diagnosis of malignant ovarian serous tumor. The other patient with duplication of the right external iliac vein was diagnosed as stage IA, grade 3 endometrial cancer. These rare variations of external iliac veins are of great importance in gynecologic oncologic surgery and other operations requiring pelvic lymph node dissection. Here, we presented and discussed the importance of this variation with the photographs taken during the operation.

http://bit.ly/2QzHCME

Madelung’s disease: long-term follow-up

Abstract

Madelung's disease (MD) is a rare lipid metabolic disorder of adipose tissue overgrowth, which has been reported to be related to alcohol abuse. Although it does not affect survival itself, alcoholism and metabolic disorders associated with MD can be life-threatening. Although surgical procedures and classifications have been reported, long-term follow-up has rarely been reported. Here, we report a 61-year-old Japanese man with MD who has been followed-up for 12 years. Lipectomy was performed three times over the first 3 years and a total of 4 kg of adipose tissue was excised. Relapse has not been observed. He was diagnosed with multiple hepatocellular carcinomas (MHC) and placed on dialysis due to hepatorenal syndrome caused by alcoholism. Moreover, one of the MHC ruptured resulting in hemorrhagic shock. The cause of death in MD is not fat proliferation but comorbidities. Long-term observation and multidisciplinary systemic management are necessary for MD patients.

http://bit.ly/2VDhELX

Primary hydatid cyst localized in soft tissue during pregnancy

Abstract

Hydatid cyst in pregnancy is a rare condition. Moreover, it is very rare that it is in the soft tissue other than the liver. In this case, there are no data in the literature on treatment options, but only experience in case presentations. We present a patient who had severe pain during pregnancy due to isolated soft tissue hydatid cyst disease in this case report.

http://bit.ly/2QzHvRe

Literature review and case series of haemorrhagic cholecystitis

Abstract

A diagnosis of haemorrhagic cholecystitis is difficult to make as it is rare and mimics other common disorders. We present three patients who presented with haemorrhagic cholecystitis, two of whom were on anti-coagulation at presentation. All 3 patients were treated conservatively, 2 with percutaneous cholecystostomy drainage and 1 patient with intravenous antibiotics. There are few guidelines on the management of such a condition.

http://bit.ly/2VDhFiZ

Predictors of Initiating Hormone Replacement Therapy in Postmenopausal Women: A Cross-Sectional Study

Objectives. Some of the social factors were related to hormone replacement therapy. The purpose of this study is to determine hormone replacement therapy (HRT) rates and to illustrate social factors affecting hormone replacement therapy in postmenopausal women. Material and Methods. This study comprised a total of 1052 postmenopausal women, 926 of whom were reported menopausal symptoms and sought for the treatment. 432 of these 926 participants had treated their symptoms by receiving HRT. The data was collected with a data collection form prepared by the researcher by using face-to-face interview technique. In these analyses, chi-square and Backward Logistic regression analyses were used. Results. The multivariate analyses indicated that the decision to seek treatment was influenced by a multitude of factors. These factors included location of hormone replacement therapy (OR: 12.32 3.21-44.46 in university hospital and OR: 5.42 2.43–13.26 in private hospital), information received about HRT (OR: 7.25 2.14,-30.80), physicians' counselling and involvement (OR: 5.24 2.82-9.86), knowledge of complications associated with HRT (OR: 6.21 3.28-16.62), and employment status (OR: 3.42 1.86-5.58). The current study identifies these factors affecting the HRT process in postmenopausal women. Conclusion. This study suggests that although the results do not demonstrate an exhaustive list of factors affecting the HRT process, they nonetheless provide evidence that the location participants applied for, physicians' counselling and involvement, participant employment status, and knowledge surrounding HRT may affect a woman's intent to receive HRT. Therefore, these results indicate that health professional influence and HRT awareness are important for HRT use. Suggestions for health care include informing women of the advantages and disadvantages of HRT to encourage popularity.

http://bit.ly/2FhmTMn

Evaluating Dermatology Curricula in US Medical Schools

http://bit.ly/2QyieqH

Appropriate use of Mohs surgery in immunocompromised patients is high and published indications for Mohs decrease inappropriate use

http://bit.ly/2VDF6c6

Contaminated Sharps Injuries: A Survey Among Dermatology Residents

http://bit.ly/2QyFc0W

Severity of disease and quality of life in parents of children with alopecia areata, totalis, and universalis: a prospective, cross-sectional study

•Chronic disease impacts parent's quality of life. Awareness of the impact of alopecia areata on the emotional health of parents should lead to more family centered care for this disease. Parent needs support systems as much as children do.

http://bit.ly/2VEEaEh

SEVERE OSAS CAUSES SYSTEMIC MICROVASCULAR DYSFUNCTION. CLINICAL EVALUATION OF NINETY‐EIGHT OSAS PATIENTS

Abstract

Obstructive sleep apnea syndrome is described as "Sleep disorder characterized by recurrent episodes of upper respiratory tract obstruction (apnea) and decreased blood‐oxygen saturation occurring during sleep".

The assessment of systemic microvascular density and reactivity is important for cardiovascular disease pathophysiology and cardiovascular risk classification.

Cutaneous microcirculation which can be demonstrated via nailfold capillaroscopy is an easily accessible and acceptable non‐invasive method for the assessment of systemic microcirculation.

OSAS was also explained with various physiopathological mechanisms which may cause microvascular dysfunction.

Capillary density and reactivity in patients with severe OSAS (AHI≥30) are the predictors of systemic microvascular dysfunction and they should be considered as the cause of future cardiovascular events.

This article is protected by copyright. All rights reserved.

http://bit.ly/2H3M0nA

Vitamin D modulates the allergic phenotype of dendritic cells in children with atopic dermatitis

Abstract

Vitamin D (VD) deficiency has been associated with increased incidence and severity of atopic dermatitis (AD), but the mechanisms through which VD may ameliorate AD are unclear. We compared the phenotypic characteristics of circulating myeloid and plasmacytoid dendritic cells (mDCs and pDCs, respectively) of children with AD vs. healthy controls (HC), and evaluated if VD can modulate the allergic phenotype of circulating DCs in AD patients. Although there was no difference in frequency of circulating DCs between groups, among children with AD there was an inverse correlation between SCORAD and circulating total DCs and mDCs. In AD, serum IgE concentration correlated with FcεRI and surface‐bound IgE expression on mDCs and pDCs; pDCs expressing FcεRI and IgE were significantly increased compared to HC. Ex vivo, 1,25(OH)₂D₃ significantly decreased FcεRI expression on mDCs and surface‐bound IgE on mDCs and pDCs. Oral VD supplementation reduced expression of surface‐bound IgE on pDCs in children with AD. In summary, VD decreases the allergic phenotype of circulating DCs in children with AD, a potential mechanism for how VD supplementation may improve AD severity. Future studies are needed to further assess the role of VD supplementation as an immunomodulatory therapy for AD.

This article is protected by copyright. All rights reserved.

http://bit.ly/2Cd7wAy

Epigenetic control in skin development, homeostasis and injury repair

Abstract

Cell‐type and cell‐state specific patterns of covalent modifications on DNA and histone tails form global epigenetic profiles that enable spatiotemporal regulation of gene expression. These epigenetic profiles arise from coordinated activities of transcription factors and epigenetic modifiers, which result in cell‐type specific outputs in response to dynamic environmental conditions and signaling pathways. Recent mouse genetic and functional studies have highlighted the physiological significance of global DNA and histone epigenetic modifications in skin. Importantly, specific epigenetic profiles are emerging for adult skin stem cells that are associated with their cell fate plasticity and proper activity in tissue regeneration. We can now begin to draw a more comprehensive picture of how epigenetic modifiers orchestrate their cell‐intrinsic role with microenvironmental cues for proper skin development, homeostasis, and wound repair. The field is ripe to begin to implement these findings from the laboratory into skin therapies.

This article is protected by copyright. All rights reserved.

http://bit.ly/2Rnd1aE

Cigarette smoking reduces the efficacy of intralesional vitamin D in the treatment of warts

Abstract

Cigarette smoking may decrease serum levels of vitamin D and reduce its efficacy. We aimed to evaluate the safety and efficacy of intralesional vitamin D in the treatment of warts and to investigate the effect of smoking on its efficacy in these cases. The study included 20 patients with verruca vulgaris and deep palmoplantar warts. The wart to be injected was cleaned by alcohol and then injected with 0.1 mL of prilocaine (20 mg/mL). 0.2 mL of vitamin D3 (7.5 mg/mL) solution was slowly injected into the base of each wart. The maximum total amount of vitamin D3 injected into a patient in 1 session was 7.5 mg. The injection was done at 4 weeks interval until clearance or for a maximum of two sessions.Clinical and dermoscopic follow‐up of the treated and distant warts was carried out. Forty percent of the treated lesions showed complete clearance and the rate of distant wart response was 17.65%. Among different demographic and clinical variables in the studied patients, smoking and older age seemed to decrease the therapeutic response Intralesional vitamin D is effective in the treatment of warts, however, smoking and ageing may reduce its efficacy.

This article is protected by copyright. All rights reserved.

http://bit.ly/2M1gLIF

Mucosal involvement is a risk factor for poor clinical outcomes and relapse in patients with pemphigus treated with rituximab

ABSTRACT

Many studies have reported the outcome of rituximab use in pemphigus but studies regarding the clinical risk factors for poor clinical outcomes or relapse are lacking. To clarify the risk factors for poor clinical outcomes or relapse in patients with pemphigus treated with rituximab, a retrospective chart analysis was performed on patients with pemphigus who were treated with rituximab in the dermatology clinic of Seoul National University Hospital. Forty patients with pemphigus were treated with rituximab, of which 39 (97.5%) experienced remission and 19 (48.7%) experienced relapse. Patients with mucosal lesions demonstrated poor clinical outcomes. The risk for relapse was 4.626 (confidence interval: 1.126‐19.001, P = 0.034) times higher in patients with mucosal lesions than in those without lesions. In patients with pemphigus treated with rituximab, the presence of mucosal lesions resulted in poor clinical outcomes and frequent recurrence.

This article is protected by copyright. All rights reserved.

http://bit.ly/2sj6m1X

The role of serum lactate dehydrogenase (LDH) level as a prognostic indicator in resected, high risk melanoma

http://bit.ly/2M6HN1D

Metabolic Syndrome in Dermatology: Treatment and Management for Dermatologists

http://bit.ly/2sj6jDj

Anti interleukin 12/23 in the treatment of erythema nodosum and Crohn disease: A case report

Abstract

Erythema nodosum is one of the most common dermatologic conditions associated with Inflammatory Bowel Disease (IBD) such as Crohn disease and it is characterized by hypodermic connectival septs inflammation. Crohn disease is an IBD that may interest any part of the gastrointestinal tract from mouth to anus. Nowadays biological drugs as anti tumor necrosis factor alpha (adalimumab) and more recently, anti interleukin 12/23 (ustekinumab) antibodies are utilized in the treatment of IBD with good results. We present a case of a 43 y.o. woman affected by Crohn disease with extra intestinal manifestations (Erythema nodosum) treated with ustekinumab. The patient showed a complete remission of both the dermatological and gastroenterological symptoms.

This article is protected by copyright. All rights reserved.

http://bit.ly/2LZ07cQ

Issue Information

http://bit.ly/2sjb1Bi

Surgical management of suprastomal tracheal collapse in children

Publication date: Available online 8 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Ali Tawfik, Hisham Atef Ebada, Ahmed Musaad Abd El-Fattah, Elsharawy Kamal

Abstract

Objective

Suprastomal collapse is a complication of pediatric tracheotomy with a potential impact on decannulation success. The aim of this study was to review the experience in the management of pediatric suprastomal collapse in a tertiary-care center, detailing the surgical technique employed.

Methods

This study included 12 tracheotomised children with the diagnosis of suprastomal collapse in the last 5 years. All patients of the study underwent surgical intervention to manage suprastomal collapse to achieve tracheotomy decannulation. The surgical procedure entailed dissection of the pre-existing tracheotomy tract down to the trachea, then excision of the tract flush with the anterior tracheal wall. The tracheal opening was closed transversely with 3-4 interrupted absorbable sutures placed in craniocaudal direction.

Results

At the end of treatment all patients were decannulated successfully. No intraoperative complications were reported. Minor postoperative complications were reported in 3 children in the form of mild surgical emphysema (n=2) and wound infection (n=1). Those patients were successfully managed conservatively.

Conclusion

This technique is a simple and effective procedure enabling immediate decannulation with very low morbidity. In a long term follow up period, no recurrence has been reported and all patients returned to their usual quality of life.

http://bit.ly/2QyGJUt

Racial disparities in asthma-related health care use in the National Heart, Lung, and Blood Institute's Severe Asthma Research Program

Publication date: Available online 8 January 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Anne M. Fitzpatrick, Scott E. Gillespie, David T. Mauger, Brenda R. Phillips, Eugene R. Bleecker, Elliot Israel, Deborah A. Meyers, Wendy C. Moore, Ronald L. Sorkness, Sally E. Wenzel, Leonard B. Bacharier, Mario Castro, Loren C. Denlinger, Serpil C. Erzurum, John V. Fahy, Benjamin M. Gaston, Nizar N. Jarjour, Allyson Larkin, Bruce D. Levy, Ngoc P. Ly

Background

Despite advances in asthma care, disparities persist. Black patients are disproportionally affected by asthma and also have poorer outcomes compared with white patients.

Objective

We sought to determine associations between black and white patients and asthma-related health care use, accounting for complex relationships.

Methods

This study was completed as part of the National Heart, Lung, and Blood Institute's Severe Asthma Research Program, a prospective observational cohort. Between November 2012 and February 2015, it enrolled 579 participants 6 years and older with 1 year of observation time and complete data. Inverse probability of treatment weighting was used to balance racial groups with respect to community and family socioeconomic variables and environmental exposure variables. The primary outcome was emergency department (ED) use for asthma. Secondary outcomes included inhaled corticosteroid use, outpatient physician's office visits for asthma, and asthma–related hospitalization.

Results

Black patients had greater odds of ED use over 1 year (odds ratio, 2.19; 95% CI, 1.43-3.35) but also differed in the majority (>50%) of baseline variables measured. After statistical balancing of the racial groups, the difference between black and white patients with respect to ED use no longer reached the level of significance. Instead, in secondary analyses black patients were less likely to see an outpatient physician for asthma management (adjusted odds ratio, 0.57; 95% CI, 0.38-0.85).

Conclusions

The disparity in ED use was eliminated after consideration of multiple variables. Social and environmental policies and interventions tailored to black populations with a high burden of asthma are critical to reduction (or elimination) of these disparities.

Graphical abstract

http://bit.ly/2H3PTsV

IL-16 regulates macrophage polarization as a target gene of mir-145-3p

Publication date: March 2019

Source: Molecular Immunology, Volume 107

Author(s): Ying Huang, Kai Li Du, Pei Yu Guo, Run Min Zhao, Bing Wang, Xue Lin Zhao, Chun Qiang Zhang

Abstract

Background

Interleukin 16 is an immunomodulatory chemokine that signals through CD4 + T cells, monocytes, macrophages and dendritic cells. Its expression in immune-related cells enhances the antimicrobial effect and inhibits HIV replication in macrophages. However, the role of IL-16 in macrophage polarization is uncertain. Mir-145 was reported to regulate IL-10 expression by targeting histone deacetylase 11 and promotes alternatively activated macrophage (M2) polarization. Mir-145 was also predicted to target IL-16 mRNA. We aimed to explore the roles of IL-16 and mir-145 in macrophage polarization and antimicrobial functions.

Methods

THP1 monocytes were employed in this study, and their cell activity when incubated with different concentrations of IL-16 was evaluated using the CCK-8 cell counting kit. To obtain polarized macrophages, THP-1 cells were induced by IL-4 and IL-13 following PMA incubation (M2 polarized macrophages) or induced by IFN-gamma and LPS (M1 classical macrophage activation). The influence of IL-16 on macrophage phagocytosis was quantified by the amount of chicken red blood cell phagocytized. IL-16, IL-10 and miR-145 expression in THP1 monocytes and induced macrophages was quantified by quantitative PCR. The miR-145 and IL-16 targeting relationship was verified by the dual luciferase reporter assay. The influence of IL-16 and mir-145 on macrophage polarization was evaluated by M1 and M2 macrophage characterized marker gene expression.

Results

The M0 macrophage subtype was induced by PMA. The M1 and M2 subtypes of macrophage were successfully induced by M1- and M2-specific induction. M1 macrophages express higher levels of IL-16 than M2 macrophages but express lower levels of IL-10 and mir-145 than M2 cells. IL-16 with a concentration up to 150 ng/mL has no influence on THP-1 cell proliferation but improves macrophage phagocytosis ability with the down-expression of IL-10 and up-expression of pro-inflammatory cytokines such as IL-1a and IL-6. Knockdown with its target siRNA is beneficial for macrophage maintenance but reduces phagocytosis ability. Mir-145 specifically targets the IL-16 3'UTR verified by the dual luciferase reporter assay. Mir-145 downregulates IL-16 expression and upregulates IL-10 expression, thereby promoting M2 macrophage polarization.

Conclusion

IL-16 modulates macrophage polarization through regulating IL-10, IL-1a and IL-6 expression. Mir-145 is involved in M2 macrophage polarization by targeting IL-16 and enhancing IL-10 expression.

http://bit.ly/2RjPE1i

Establishment of an immortalized human subglottic epithelial cell line

Objective

Translational research into subglottic disease is restricted by the availability of primary human tissue originating from this subsite. Primary epithelial cells are also limited by their inability to survive beyond several divisions in culture outside of the body. Specific subglottic cell lines, useful for in vitro studies, have not yet been described. We therefore demonstrate what we believe to be the first immortalized subglottic epithelial cell line.

Methods

Subglottic tissue was derived from a single adult patient's neoplasia‐free human subglottic brushing specimen. Cells were immortalized using a lentiviral vector expressing simian virus 40 T antigen. Karyotyping was performed on the transformed cells using single nucleotide polymorphism array comparative genomic hybridization. Transformed cells were phenotypically characterized by light microscopy, immunohistochemistry, and electrophysiology studies.

Results

The immortalized subglottic cell line (SG01) was able to divide successfully beyond 20 passages. Karyotyping demonstrated no significant genomic imbalance after immortalization. The cells demonstrated normal epithelial morphology and cytokeratin expression throughout. SG01 cells were also successfully cultured at air–liquid interface (ALI). At ALI cells demonstrated cilia, mucus production, and relevant ion channel expression.

Conclusion

The novel SG01 subglottic epithelial cell line has been established. This cell line provides a unique resource for researchers to investigate subglottic diseases, such as subglottic stenosis.

Level of Evidence

NA. Laryngoscope, 2018

http://bit.ly/2Fm0Raz

Tumor growth rate: A new prognostic indicator of hearing preservation in vestibular schwannoma surgery

Background

The management of small‐ to medium‐size (< 20 mm) sporadic vestibular schwannomas (VSs) continues to inspire debate. Preoperative pure tone thresholds and tumor size are recognized prognostic features of hearing preservation after surgery.

Objective

To investigate what preoperative characteristics were associated with nonserviceable hearing after surgery for VSs.

Methods

We retrospectively reviewed the audiological results of 92 patients treated with the middle cranial fossa (MCF) approach for resection of VSs (< 20 mm). Sex, age, symptoms, tumor site, tumor size, growth rate, and hearing class according to American Academy of Otolaryngology–Head and Neck Surgery guidelines were evaluated. Negative outcome was progression after surgery to nonserviceable hearing according to Gardner‐Robertson classification. We included only patients with preoperative serviceable hearing.

Results

After surgery, 48 patients (52.2%) had nonserviceable hearing. At univariate analysis, sex age, symptoms, tumor site, and size were not associated to hearing outcome. Tumor growth rate ≥ 2.16 mm/year (P = 0.02, odds ratio 8.5) and preoperative hearing class B (P = 0.03, OR 5.89) were statistically associated to nonserviceable hearing after VSs resection. Tumor growth rate ≥ 2.16 mm/year was also significantly associated to preoperative hearing class B (P = 0.01). At multivariate analysis, the only independent prognostic factor of progression to nonserviceable hearing in operated VSs was tumor growth rate ≥ 2.16 mm/year (P = 0.01, OR = 4.15).

Conclusion

We found a new prognostic indicator of hearing preservation after VS surgery with the MCF approach: the tumor growth rate. This feature should be further investigated before being considered in the decision‐making process of VS treatment.

Level of Evidence

4. Laryngoscope, 2019

http://bit.ly/2CZR4VW

Audiologic and surgical outcomes in endoscopic revision stapes surgery

http://bit.ly/2TBvNri

Laryngeal fracture presentation and management in United States emergency rooms

Objectives/Hypothesis

There are limited data on laryngeal fracture presentation and management in US emergency departments (EDs). We aimed to characterize patients who are diagnosed with laryngeal fractures in the ED and identify management patterns.

Study Design

Retrospective review of the Nationwide Emergency Department Sample (NEDS) from 2009 to 2011.

Methods

The NEDS was queried for patient visits with a primary diagnosis of open or closed laryngeal fracture (International Classification of Diseases, Ninth Revision codes 807.5 and 807.6). Patient demographics, comorbidities, ED management, and hospital characteristics were extracted.

Results

There were 3,102 ED visits with a diagnosis of laryngeal fracture during the study period. Mean patient age was 40.9 years (range, 3–93 years). The majority of patients were male (85.5%) and sustained a closed (vs. open) fracture (91.4%), with an overall mortality rate of 3.8%. The majority of patients were treated for more than one injury during the same visit (76.2%). Most patients were evaluated at a trauma hospital (53.9%), and most patients were admitted to the hospital (71.9%). Emergent intubation or tracheostomy was rarely reported (2.6% and 0.1% of all cases), and a minority of patients underwent fiberoptic flexible laryngoscopy in the ED (1.9%). Laryngeal fractures occurred more frequently during summer months (28.2%). Mean charge for the entirety of the ED stay was $4,957.34.

Conclusions

Laryngeal fracture is rare and frequently associated with other injuries. The frequency of emergent airway procedure, imaging, and flexible fiberoptic laryngoscopy is lower than expected, raising concerns about appropriate workup and management or recognition of injury in the ED setting.

Level of Evidence

NA Laryngoscope, 2019

http://bit.ly/2CYCfmy

Evaluating the impact of adenotonsillectomy for pediatric sleep‐disordered breathing on parental sleep

Objectives/Hypothesis

To evaluate the impact of adenotonsillectomy for pediatric sleep‐disordered breathing (SDB) on parental sleep quality, daytime sleepiness, and child quality of life.

Study Design

Prospective cohort study.

Methods

Pediatric patients aged 2 to 10 years with SDB and suspected obstructive sleep apnea (OSA) requiring adenotonsillectomy were identified at a single tertiary‐care pediatric otolaryngology hospital. Parental daytime sleepiness and quality of sleep were evaluated pre‐ and postoperatively using the Epworth Sleepiness Scale (ESS) and Pittsburg Sleep Quality Index (PSQI), respectively. Child quality of life, in the context of suspected OSA, was evaluated by the Obstructive Sleep Apnea Quality of Life Survey (OSA‐18), pre‐ and postoperatively. Paired‐samples t tests were conducted to analyze data.

Results

Forty‐seven patients with a mean (standard deviation [SD]) age of 4.9 (2.2) years, participated. Mean (SD) parental age was 35.5 (4.6) years. Statistically significant decreases of 2.1 points were observed between preoperative and postoperative parental mean global ESS (P = .007; 95% confidence interval [CI]: 0.6‐3.6) and mean total PSQI (P = .001; 95% CI: 0.9‐3.1) scores. A statistically significant improvement (41.6 points) was observed between preoperative and postoperative on mean OSA‐18 scores (P < .0001; 95% CI: 35.7‐47.6).

Conclusions

Adenotonsillectomy performed in the pediatric population for SDB, with suspected OSA, can positively impact parental daytime sleepiness and sleep quality in addition to pediatric quality of life.

Level of Evidence

2 Laryngoscope, 2019

http://bit.ly/2TBvFrO

Is epiglottis surgery necessary for obstructive sleep apnea patients with epiglottis obstruction?

Objectives/Hypothesis

To examine the effect of epiglottis obstruction during drug‐induced sleep endoscopy (DISE) on the surgical results of multilevel sleep surgery without epiglottic intervention.

Study Design

Cross‐sectional study.

Methods

This investigation involved patients diagnosed with severe obstructive sleep apnea (OSA) based on preoperative polysomnography (PSG), who underwent DISE followed by multilevel OSA surgery without epiglottic intervention at Kyung Hee Medical Center (Seoul, South Korea) between March 2013 and July 2016. During DISE, obstruction patterns of the upper airway were evaluated using the velum, oropharynx, tongue base, epiglottis classification method. Follow‐up PSG was performed 3 months after surgery to determine the success rate of multilevel surgery without epiglottic intervention. A comparison was done between the group with epiglottis obstruction and the group without epiglottis obstruction.

Results

Epiglottis obstruction was observed during DISE in 43.7% of patients. After application of exclusion criteria, 54 subjects were included (27 with and 27 without epiglottis obstruction). DISE revealed an association between epiglottis obstruction and tongue base collapse (P = .02). Comparing pre‐ and postoperative PSG findings, both groups exhibited improvement postoperatively. The success rate was 44.4% in the epiglottis obstruction group and 40.7% in the non–epiglottis obstruction group (P = .80). There was no difference in surgical success rates between the two groups.

Conclusions

The prevalence of epiglottis obstruction requiring epiglottic surgery was lower than what was found during DISE. Sleep surgeons may consider staged epiglottic surgery in patients with epiglottis obstruction.

Level of Evidence

3b Laryngoscope, 2019

http://bit.ly/2FoMGBs

Recovery of olfaction after sinus surgery for chronic rhinosinusitis: A review

Objective

Investigation of the postoperative olfactory function after sinus surgery for chronic rhinosinusitis (CRS) with and without polyps in a review.

Data Sources

PubMed.

Review Methods

A comprehensive literature search was conducted through June 2018 using relevant keywords. The titles/abstracts were reviewed to identify studies evaluating the sense of smell in CRS‐patients pre‐ and postoperatively by either using the whole or parts of the University of Pennsylvania Smell Identification Test or the Sniffin' Sticks test. Study characteristics and outcome data of the included studies were extracted.

Results

In total, 106 studies were retrieved. Twenty‐four studies comprising 1,956 patients were included after quality assessment. The number of patients investigated per study was 19 to 206. In the 24 studies, 959 patients with nasal polyps and 516 without nasal polyps were described. The follow‐up times varied between 0.5 and 28 months. Twenty‐three studies reported an improved sense of smell, at least in certain subgroups. An overall improvement was seen in approximately 50% of the included patients. Nasal polyposis and preoperative anosmia were associated with a higher chance of improvement in olfaction. In those studies that commented on deterioration after sinus surgery, a decrease in olfaction was found in a range from 0% to 10% of cases.

Conclusion

Olfaction can be improved by sinus surgery in about every second patient, especially if the patient had chronic rhinosinusitis with polyps, was anosmic, and had no prior surgery. A deterioration of sense of smell after surgery is rare. Laryngoscope, 2019

http://bit.ly/2CWomW0

Unizentrische, retrospektive Analyse der praktischen Durchführung der extrakorporalen Photopherese

Zusammenfassung

Hintergrund

Die extrakorporale Photopherese (ECP) ist als effektive und nebenwirkungsarme Therapieform bei kutanen T‑Zell-Lymphomen (CTCL) und Graft-versus-Host-Erkrankungen (GvHD) gut untersucht. Die praktische ECP-Durchführung wird allerdings nur in wenigen Studien beleuchtet.

Methodik

Ausgewertet wurden die Protokolle von 2038 ECP-Behandlungen, die 52 Patienten (CTCL, n = 29; GvHD, n = 15; andere, n = 8) in der Zeit zwischen 2001 und 2010 mit dem UVAR® XTS™-ECP-System (Therakos, Inc. Johnson & Johnson, Raritan, NJ, USA) erhielten. Initial erfolgte bei allen Patienten die Behandlung über einen periphervenösen Zugang. Im Verlauf erhielten 7 Patienten einen Port und 4 einen zentralvenösen Katheter.

Ergebnisse

Es erfolgten 1765 (86,6 %) Behandlungen über einen periphervenösen Zugang, 239 (11,7 %) über Port und 34 (1,7 %) über Katheter. Der periphervenöse Zugang zeigte eine höhere Durchflussrate und längere Photoaktivierungszeit, während Behandlungen mit Port zu einem größeren bestrahlten Volumen, einer längeren Behandlungszeit und höheren systolischen Blutdruckdifferenzen führten. Folgende Nebenwirkungen traten auf: Unwohlsein (n = 13), Hypotension (n = 13), Hypertension (n = 7), Schwindel, Kopfschmerzen, Dyspnoe (jeweils n = 4), Fieber und ein metallischer Geschmack im Mund (jeweils n = 3). Technische Komplikationen wie Probleme mit dem vaskulären Zugang (9,6 %) traten bei 385 (18,9 %) Behandlungen auf.

Schlussfolgerung

Ein peripherer Zugang ist für die ECP zu bevorzugen.

http://bit.ly/2LYznZT

Outcome prediction for Bonebridge candidates based on audiological indication criteria

Publication date: Available online 8 January 2019

Source: Auris Nasus Larynx

Author(s): Wilhelm Wimmer, Moritz von Werdt, Georgios Mantokoudis, Lukas Anschuetz, Martin Kompis, Marco Caversaccio

Abstract

Objective

To re-evaluate current indication criteria and to estimate the audiological outcomes of patients with Bonebridge bone conduction implants based on preoperative bone conduction thresholds.

Methods

We assessed the outcome of 28 subjects with either conductive or mixed hearing loss (CMHL) or single-sided deafness (SSD) who were undergoing a Bonebridge implantation. We used linear regression to evaluate the influence of preoperative bone conduction thresholds of the better/poorer ear, indication group, and language (German- and French-speaking patients) on aided sound field thresholds. In addition, aided word recognition scores at 65 dB sound pressure level were fit with a logistic model that included preoperative bone conduction thresholds of the better/poorer ear, indication group, and language as effects.

Results

We found that both aided sound field thresholds and word recognition were correlated with the preoperative bone conduction thresholds of the better hearing ear. No correlation between audiological outcomes and the preoperative bone conduction thresholds of the poorer ear, language, or indication group was found.

Conclusion

Bone conduction thresholds of the better hearing ear should be used to estimate the outcome of patients undergoing Bonebridge implantation. We suggest the indication criteria for Bonebridge candidates considering maximal bone conduction thresholds of the better ear at 38 dB HL to achieve an aided sound field threshold of at least 30 dB hearing level and an aided word recognition score of at least 75% for monosyllabic words.

http://bit.ly/2SKFfbN

An anomalous band originating from the fabella causing semimembranosus impingement presenting as knee pain: a case report

The presentation of patients with knee injuries which can have a significant impact on their ability to work and perform activities of daily living is constantly rising. The posterolateral corner of the knee h...

http://bit.ly/2RjvxAm

Dietary supplement product composed of natural ingredients as a suspected cause of erythema multiforme: A case report and identification for the confident false positivity of lymphocyte transformation test

Abstract

Growing and sustainable consumption of health‐care products raises a controversial issue underlying the reliability of an in vitro diagnostic approach for adverse skin reaction. This report aimed to: (i) discuss the causative nature of a commercial dietary supplement composed of natural ingredients, particularly an Euglena‐containing product, suspicious for erythema multiforme in our exemplified case; and (ii) to address the assay suitability of the lymphocyte transformation test (LTT) for identifying allergic reaction to any ingredient(s) of the product. A Japanese elderly man developed erythema multiforme after intake of a commercially available natural dietary product, whose LTT was positive. His clinical course and positive LTT suggested a provisional diagnosis of natural dietary product‐induced eruption. We conducted an inquiry survey for the standard LTT with any commercial products containing Euglena in three major Japanese laboratory services and identified 22 subjects, almost all of whom (21/22, 95.6%) showed a positive LTT for any Euglena‐containing products as a suspected causative. Seven normal healthy volunteers who had no intake history of Euglena‐containing products showed an equivalent LTT positivity rate with the same product taken by our case; culprit components of the product included Euglena, Angelica keiskei, Barley grass and Chlorella. A cell‐free culture system and enzyme‐linked immunoassay suggest that the high LTT positivity relies on the non‐specific lymphoproliferative activity, and not contamination of uncharacterized microorganisms and endotoxins. Because of the constitutive false positivity of LTT, this assay is unreliable for in vitro supportive diagnosis of adverse skin events caused by dietary products containing particular natural ingredients, as well as herbal materials.

http://bit.ly/2Ff9YdT

Non-infectious Granulomatous Lesions of the Orofacial Region

Abstract

Granulomatous lesions of the orofacial region are a heterogeneous group of disorders characterized by a granulomatous reaction to a variety of stimuli. Infectious agents, foreign material, systemic inflammation and metabolic disorders can all be associated with granulomatous inflammation. In the orofacial region primary causes of granulomatosis include foreign body reaction, delayed hypersensitivity to topical agents and idiopathic orofacial granulomatosis. Secondary causes of granulomas include infectious agents, sarcoid, and Crohn disease. For this review, infectious causes of orofacial granulomatosis (OFG) including bacteria, parasites and fungi will not be discussed.

http://bit.ly/2FhtsOp

Non-infectious Granulomatous Lesions of the Orofacial Region

Abstract

Granulomatous lesions of the orofacial region are a heterogeneous group of disorders characterized by a granulomatous reaction to a variety of stimuli. Infectious agents, foreign material, systemic inflammation and metabolic disorders can all be associated with granulomatous inflammation. In the orofacial region primary causes of granulomatosis include foreign body reaction, delayed hypersensitivity to topical agents and idiopathic orofacial granulomatosis. Secondary causes of granulomas include infectious agents, sarcoid, and Crohn disease. For this review, infectious causes of orofacial granulomatosis (OFG) including bacteria, parasites and fungi will not be discussed.

http://bit.ly/2FhtsOp

Apremilast as a new treatment option for Acrodermatitis continua of Hallopeau

http://bit.ly/2QBc757

Heerfordt syndrome developing in a patient with cutaneous sarcoidosis

http://bit.ly/2VDGHyv

Ibrutinib‐associated T‐cell pseudolymphoma

http://bit.ly/2QvqSGo

Paediatric vulval lichen sclerosus: a retrospective study

Summary

Background

Lichen sclerosus (LS) is a chronic inflammatory dermatosis with a predilection for the anogenital region, which mainly affects prepubertal girls and postmenopausal women. The cause is unknown, but a number of potential aetiological factors have been identified.

Aim

To examine a cohort of patients with prepubertal‐onset vulval LS (VLS) and assess baseline characteristics, clinical presentation, potential precipitating and predisposing factors, and response to treatment.

Methods

Data were collected from case notes on patients aged < 18 years diagnosed with prepubertal‐onset VLS attending a specialist vulval dermatology service. Data included clinical presentation, comorbidities, family history, therapy and response to treatment.

Results

In total, 26 paediatric patients were identified. The median age at onset of symptoms was 5 years (range 2–8.5 years). Many previously identified potential aetiological factors for the development of VLS were identified, including family history, trauma, autoimmune disease and hormonal factors. A significant proportion of patients had a history of urinary tract symptoms, including incontinence and urinary tract infection. Most patients responded well to a standard course of induction topical therapy followed by maintenance therapy, but some, including three patients with ongoing urinary incontinence and three postpubertal patients, continued to have active disease.

Conclusion

A detailed assessment is essential in patients with VLS so that potential predisposing factors and comorbidities can be identified and managed. Urinary incontinence may be implicated in the development of paediatric VLS and may prevent adequate disease control. Paediatric VLS can persist through puberty, thus long‐term follow‐up is advised.

http://bit.ly/2VErHAo

GJB6 mutation A88V for hidrotic ectodermal dysplasia in a Chinese family

http://bit.ly/2VyVzhL

An interesting case of coincidental epidermolytic hyperkeratosis and erythema annulare centrifugum in the setting of latent tuberculosis in a 12‐year‐old female

http://bit.ly/2QvjUBb

A tale of subcutaneous nodules, broad thumbs, supernumerary teeth, and intellectual disability in a patient

http://bit.ly/2VEGX0g

In‐transit melanoma metastases

http://bit.ly/2QtvL2N

The first observation of the association of Merkel cell polyomavirus and Merkel cell carcinoma in Brazil

Abstract

Background

Merkel cell carcinoma (MCC) is a rare but aggressive primary cutaneous carcinoma with high mortality rates. The present study intends to delineate the epidemiological profile of patients with MCC seen at the Clinics Hospital of the Medical School at the University of São Paulo, Brazil, and its association with Merkel cell polyomavirus (MCPyV).

Methods

This is a retrospective study. A search was performed in the hospital's medical index for all cases of MCC from January 1994 to December 2012. Among patients with MCC, the available tumoral skin specimens were analyzed with two different techniques of polymerase chain reaction (PCR) (conventional and real‐time) for detection of MCPyV DNA. Additionally, paraffin‐embedded samples of patients with non‐MCC skin cancers were also analyzed. Analyses suitable for categorical data (i.e., x² of Fisher) were used to compare the proportion of patients in each group.

Results

Nineteen patients with MCC and 20 patients with non‐MCC skin cancers entered the study. All MCC samples available (13) tested positive for the presence of MCPyV DNA; however, in the non‐MCC skin cancer samples, the MCPyV DNA was detected in 4 of 20 samples (20%). MCPyV DNA detection rate was higher in patients with MCC than in the other group, and its analysis was statistically significant (P < 0.01).

Conclusions

This study demonstrates the association of MCPyV in Brazilian patients with MCC. However, further studies are necessary to determine the exact involvement of MCPyV in MCC pathogenesis and to define the significance of viral DNA detection in non‐MCC skin cancers.

http://bit.ly/2VDoMbf

Existence of Neural Stem Cells in Mouse Spleen

Pluripotent stem cells are used in regenerative medicine and exist in various internal organs. However, there are a small number of reports of neural cells or neural stem cells existing in the spleen. In this study, we sought to identify possible neural stem cells in the mouse spleen. The spleens of ICR mice were removed and small specimens were incubated in Dulbecco's modified Eagle's medium with Nutrient Mixture F-12 containing either 10% fetal bovine serum (FBS), 20% FBS, 10% neonate bovine serum, or 10% fetal calf serum. Neural cell medium was also used. The cultured cells were investigated for expression of the neural cell markers neuron-specific enolase (NSE) and neurofilament 150 kDa (NF-150) by immunocytochemistry. Mouse spleens were also examined by immunohistochemistry for NSE, NF-150, NF-200, peripherin, and glial fibrillary acidic protein. Cells morphologically resembling neural cells were obtained and were positive for neural cell markers. Some of the cells generated sphere-like formations, which may have been neurospheres. Cell proliferation was best in medium containing 10% FBS. Cells positive for neural markers were observed in the subcapsular and perivascular regions of the spleen. The cells were round and present in much lower numbers than in cell culture. These cells are suspected neural stem cells and would be expected to differentiate into neural cells in cell culture. This report suggests the existence of neural stem cells in the mouse spleen.

http://bit.ly/2CZ8zWv

Formation of papillary mucosa folds and enhancement of epithelial barrier in odontogenic sinusitis

Background

Odontogenic sinusitis (OS) presents more satisfactory therapeutic effect after endoscopic surgery compared with chronic rhinosinusitis (CRS) of other origin. The aim of the present study was to investigate the clinical characteristics, morphological features, and epithelial barrier function of sinus mucosa of OS and discuss the possible relationship with good prognosis.

Methods

A total of 25 subjects with OS, 7 CRS without nasal polyps (CRSsNP), 10 CRS with nasal polyps (CRSwNP), and 9 control subjects were recruited. The biopsy specimens were stained with hematoxylin and eosin for general observation of cytomorphologic features. Epithelial tight junctions (TJs) protein claudin‐4 expression was determined to evaluate the epithelial barrier integrity by using immunofluorescence and Image‐Pro Plus software analysis. The representative cytokine profiles regarding T helper 1 (Th1) (interferon [IFN]‐γ), Th2 (interleukin [IL]‐5), and Th17 (IL‐17) were examined by reverse transcription–polymerase chain reaction (RT‐PCR).

Results

Extensively small papillary protrusions could be seen in the maxillary sinus mucosa of OS patients under nasal endoscopy, similar to the morphological behavior, which also presented as papillary folds in the surface of the epithelium. The epithelium in OS kept an increased claudin‐4 expression compared with that seen in CRSsNP, CRSwNP, and control subjects. The inflammatory pattern analysis demonstrated that OS belonged to the lymphocyte and plasma cell‐dominant cellular phenotypes, whereas IL‐17 was dominant compared with IFN‐γ as well as IL‐5.

Conclusion

The odontogenic infections might induce the formation of papillary mucosa folds and enhance the epithelial TJ barrier function. OS exhibited as lymphocyte and plasma cell–dominant cellular phenotypes and Th17 cytokine profiles.

http://bit.ly/2H4kkz3