Epistaxis complicating treatment by anti-vitamin K and new oral anticoagulants

Publication date: Available online 4 May 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): V. L'Huillier, C. Badet, L. Tavernier
ObjectivesTo assess any differences in severity and management of epistaxis when complicating treatment by anti-vitamin K (AVK) or by new oral anticoagulants (NOAC).Materials and methodAll patients admitted to the ENT department of a University Hospital Center for epistaxis under oral anticoagulation therapy between January 2010 and June 2015 were included in a retrospective study. Severity was assessed in terms of management and of hemoglobin level at admission. Two groups were distinguished: treatment by AVK or by NOAC.ResultsOne hundred and thirty-four patients were included: 126 under AVK and 8 under NOAC. There was a significant difference in mean hospital stay: 4.5 days for AVK versus 3.5 days for NOAC (P=0.019; 95% CI [0.1921; 0.8907]). There were no significant differences for the other severity criteria. None of the patients died.ConclusionAdmission rates for epistaxis complicating NOAC therapy was low, and much lower than in case of AVK. Bleeding severity was equivalent with both treatments. NOACs significantly reduce hospital stay. Contrary to the study hypothesis, epistaxis is less serious when complicating NOAC than AVK therapy.



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Fronto-orbital feminization technique. A surgical strategy using fronto-orbital burring with or without eggshell technique to optimize the risk/benefit ratio

Publication date: Available online 4 May 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): A. Villepelet, A. Jafari, B. Baujat
The demand for facial feminization is increasing in transsexual patients. Masculine foreheads present extensive supraorbital bossing with a more acute glabellar angle, whereas female foreheads show softer features. The aim of this article is to describe our surgical technique for fronto-orbital feminization. The mask-lift technique is an upper face-lift. It provides rejuvenation by correcting collapsed features, and fronto-orbital feminization through burring of orbital rims and lateral canthopexies. Depending on the size of the frontal sinus and the thickness of its anterior wall, frontal remodeling is achieved using simple burring or by means of the eggshell technique. Orbital remodeling comprises a superolateral orbital opening, a reduction of ridges and a trough at the lateral orbital rim to support the lateral canthopexy. Frontal, corrugator and procerus myectomies, plus minimal scalp excision, complete the surgery. Our technique results in significant, natural-looking feminization. No complications were observed in our series of patients. The eggshell technique is an alternative to bone flap on over-pneumatized sinus. Fronto-orbital feminization fits into a wider surgical strategy. It can be associated to rhinoplasty, genioplasty, mandibular angle remodeling, face lift and laryngoplasty. Achieving facial feminization in 2 or 3 stages improves psychological and physiological tolerance.



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The tolerogenic peptide hCDR1 immunomodulates cytokine and regulatory molecule gene expression in blood mononuclear cells of primary Sjogren's syndrome patients

Publication date: Available online 4 May 2018
Source:Clinical Immunology
Author(s): Zev Sthoeger, Amir Sharabi, Ilan Asher, Heidy Zinger, Rafael Segal, Gene Shearer, Ori Elkayam, Edna Mozes
Primary Sjogren's syndrome (pSS) is an autoimmune disease characterized by lymphocytic infiltration of exocrine glands. We investigated whether the tolerogenic peptide, hCDR1, that ameliorates lupus manifestations would have beneficial effects on pSS as well. The in vitro effects of hCDR1 on gene expression of pro-inflammatory cytokines and regulatory molecules were tested in peripheral blood mononuclear cells (PBMC) of 16 pSS patients. hCDR1, but not a control peptide, significantly reduced gene expression of IL-1β, TNF-α, MX-1 and BlyS and up-regulated immunosuppressive (TGF-β, FOXP3) molecules in PBMC of pSS patients. hCDR1 did not affect gene expression in patients with rheumatoid arthritis and anti-phospholipid syndrome. Further, hCDR1 up-regulated the expression of Indoleamine 2,3-dioxygenase (IDO) via elevation of TGF-β. IDO inhibition led to a significant decrease in the expression of FOXP3 which is crucial for the induction of T regulatory cells. Thus, hCDR1 is potential candidate for the specific treatment of pSS patients.



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A Qualitative Analysis of Disclosing Sexual Victimization by #NotOkay During the 2016 Presidential Election

Violence and Gender, Ahead of Print.


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Thalidomide and thromboprophylaxis in dermatological indications: An unmet need for more evidence

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Ethnic differences and comorbidities of 909 Prurigo Nodularis patients

•Prurigo nodularis (PN) is a pruritic dermatosis of unknown etiology.•PN is associated with an increased risk of chronic kidney disease, diabetes, Hepatitis C, HIV, and several psychiatric comorbidities•Clinicians should be aware of psychiatric, metabolic, and infectious disease associations when treating PN patients.

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Steroid-Induced Changes Noted On Trichoscopy Of Patients With Frontal Fibrosing Alopecia

https://ift.tt/2KFs73U