Exophthalmos or pseudo-exophthalmos in the Last Judgement (1535–1541) by Michelangelo Buonarroti (1475–1564)

https://ift.tt/2RkHTog

Effects of metabolic abnormalities, hyperandrogenemia and clomiphene on liver function parameters among Chinese women with polycystic ovary syndrome: results from a randomized controlled trial

Abstract

Purpose

To investigate the effects of metabolic abnormalities, hyperandrogenemia and ovulation induction by clomiphene/acupuncture on liver function parameters among women with polycystic ovary syndrome (PCOS).

Methods

This is a secondary analysis of a randomized controlled trial. All 1000 subjects were diagnosed as PCOS by modified Rotterdam criteria. Liver function parameters, metabolic panel and hormone profile were measured at baseline and after treatment. The relationship between liver parameters with metabolic, hormonal parameters and ovulation induction was examined.

Results

PCOS women with metabolic syndrome had higher liver enzyme levels but lower bilirubin and bile acid levels than without. PCOS women with hyperandrogenemia had higher liver enzyme, bilirubin levels than without. Correlation analyses showed that worsening of metabolic parameters was associated with higher liver enzyme levels but lower bilirubin and bile acid levels, while increased androgen levels were associated with higher liver enzyme, bilirubin and bile acid levels. Ovulation induction with clomiphene citrate could decrease bilirubin and bile acid levels, while acupuncture had no obvious effect on liver function.

Conclusions

Among PCOS women, metabolic abnormalities and hyperandrogenemia impaired different liver function parameters. Clomiphene could decrease the bilirubin and bile acid levels while acupuncture had no obvious effect on liver function.

https://ift.tt/2OvwaVj

Platelet-Rich Plasma Therapy for Male and Female Pattern Hair Loss

No abstract available

https://ift.tt/2Rll3wU

Sporadic pemphigus foliaceus and class II human leucocyte antigen allele associations in the white British and Indo‐Asian populations in the UK

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2Pdt9pG

Sporadic pemphigus foliaceus and class II human leucocyte antigen allele associations in the white British and Indo‐Asian populations in the UK

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2Pdt9pG

Vitamin B12 deficiency-induced pseudothrombotic microangiopathy without macrocytosis presenting with acute renal failure: a case report

Vitamin B12 deficiency-induced thrombotic microangiopathy, known as pseudothrombotic microangiopathy, is a rare condition which resembles the clinical features of thrombotic thrombocytopenic purpura but requires ...

https://ift.tt/2Njclfb

Swept source optical coherence tomography and optical coherence tomography angiography in pediatric enhanced S-cone syndrome: a case report

Enhanced S-cone syndrome is an autosomal recessive retinal dystrophy related to a defect in a nuclear receptor gene (NR2E3) that leads to alteration in cells development from rod to S-cone. This retinal dystrophy...

https://ift.tt/2O1qXW4

Screening and diagnosis of oral cancer: a critical quality appraisal of clinical guidelines

Abstract

Objectives

To assess the quality of clinical practice guidelines (CPGs) on screening and diagnosis of oral cancer and to describe the characteristics of their recommendations.

Materials and methods

We systematically searched EMBASE, MEDLINE, CPG' websites, and dentistry and oncology scientific societies to identify CPGs that were related to screening and diagnosis of oral cancer. The quality of selected CPGs was independently assessed by four appraisers using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. The inter-appraiser agreement was assessed. We performed a descriptive analysis of the recommendations included in the selected CPGs.

Results

Eight CPGs were selected. The overall agreement among reviewers was considered very good (ICC: 0.823; 95% CI: 0.777–0.861). The median scores of the six AGREE II domains were as follows: "scope and purpose" 97.9% (IQR: 96.2–100.0%); "stakeholder involvement" 86.1% (IQR: 69.8–93.1%); "rigor of development" 75.3% (IQR: 64.2–94.3%); "clarity of presentation" 91.7% (IQR: 82.6–94.4%); "applicability" 53.1% (IQR: 19.3–74.2%); and "editorial independence" 83.3% (IQR: 67.2–93.8%). Four CPGs were assessed as "recommended", four "recommended with modifications", and none "not recommended". Twenty-three recommendations were provided, mostly with a low or very low level of evidence.

Conclusion

The methodological quality of CPGs on screening and diagnosis of oral cancer is moderate. The "applicability" domain scored the lowest. Most recommendations were based on a low o very low level of evidence.

Clinical relevance

Greater efforts are needed to provide healthcare based on high-quality evidence-based CPGs in this field.

https://ift.tt/2O08qZX

Phytohormones enhanced drought tolerance in plants: a coping strategy

Abstract

Drought stress is a severe environmental constraint among the emerging problems. Plants are highly vulnerable to drought stress and a severe decrease in yield was recorded in the last few decades. So, it is highly desirable to understand the mechanism of drought tolerance in plants and consequently enhance the tolerance against drought stress. Phytohormones are known to play vital roles in regulating various phenomenons in plants to acclimatize to varying drought environment. Abscisic acid (ABA) is considered the main hormone which intensifies drought tolerance in plants through various morpho-physiological and molecular processes including stomata regulation, root development, and initiation of ABA-dependent pathway. In addition, jasmonic acid (JA), salicylic acid (SA) ethylene (ET), auxins (IAA), gibberellins (GAs), cytokinins (CKs), and brassinosteroids (BRs) are also very important phytohormones to congregate the challenges of drought stress. However, these hormones are usually cross talk with each other to increase the survival of plants in drought conditions. On the other hand, the transgenic approach is currently the most accepted technique to engineer the genes responsible for the synthesis of phytohormones in drought stress response. Our present review highlights the regulatory circuits of phytohormones in drought tolerance mechanism.

https://ift.tt/2O3TQRh

Co-contamination of antibiotics and metals in peri-urban agricultural soils and source identification

Abstract

To identify the dominant sources of contamination in peri-urban land, this study investigated the concentrations and distributions of antibiotics and metals in agricultural soil of this area. An index of landscape development intensity (LDI) was used to characterize the distribution of human disturbance-related land use. The results showed that total antibiotic concentration in the soil reached 395.55 μg/kg and that chlortetracycline was the predominant antibiotic compound, with a relatively high mean concentration of 30.62 μg/kg. In soils, the mean concentrations of Cu, Zn, and Pb were 38.41, 127.88, and 56.61 mg/kg and those of Al, Fe, and K were 83.73, 24.17, and 23.42 g/kg, respectively. A redundancy analysis showed that the landscape pattern in a 300-m buffer zone can well explain the variation in the concentrations of antibiotics and metals (24%, p < 0.05). The LDI in the 300-m buffer zone significantly correlated with the concentrations of total antibiotics and total amounts of Cu and Zn in the soil, suggesting that the risk of soil contamination increases with the intensity of anthropogenic activities. A structural equation modeling analysis indicated that Al, Cu, and Zn could significantly aggravate accumulation of tetracycline antibiotics in the soil, whereas there were only significantly direct paths from Cu to ciprofloxacin and norfloxacin. Overall, the results showed that aggravated co-contamination of antibiotics and metals occurs in agricultural soil under intensive human disturbance.

https://ift.tt/2QsEx1q

Keratosis Pilaris Rubra with Mucin Deposition

Journal of Cutaneous Pathology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2xVsJhj

Are spinal deformities in ancient dogs related to weight‐bearing? The importance of Fluctuating Asymmetry

International Journal of Osteoarchaeology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2xWbcFT

Self-injurious behaviour in patients with anorexia nervosa: a quantitative study

Abstract

Background

Many patients with an eating disorder report difficulties in regulating their emotions and show a high prevalence of self-injurious behaviour. Several studies have stated that both eating disorder and self-injurious behaviour help emotion regulation, and are thus used as coping mechanisms for these patients. We aimed to determine the prevalence of self-injurious behaviour, its characteristics and its emotion-regulation function in patients with anorexia nervosa or an eating disorder not otherwise specified (n = 136).

Methods

A cross-sectional design using a self-report questionnaire. Mann–Whitney U-tests were conducted to compare the background and clinical variables between patients with self-injurious behaviour and patients without this type of behaviour. Changes in emotional state before and after self-injurious behaviour were tested by Wilcoxon signed rank tests.

Results

Our results showed a 41% prevalence of self-injurious behaviour in the previous month. Patients who performed self-injurious behaviour had a statistically significant longer treatment history for their eating disorder than those who did not. Whereas 55% of self-injuring patients had a secondary psychiatric diagnosis, only 21% of participants without self-injurious behaviour did. Regarding the impact of self-injurious behaviour, our results showed a significant increase in "feeling relieved" and a significant decrease in "feeling angry at myself", "feeling anxious" and "feeling angry at others". This indicates that self-injurious behaviour can be regarded as an emotion-regulation behaviour. Participants were usually aware of the causes of their self-injurious behaviour acts.

Conclusions

Professionals should systematically assess the occurrence of self-injurious behaviour in eating disorder patients, pay special attention to patients with more severe and comorbid psychopathology, and those with a long treatment history. This assessment should be followed by a functional analysis of the self-injurious behaviour and by effective therapeutic interventions alongside the eating disorder treatment.

https://ift.tt/2QqEaV8

Assessment of elemental composition and properties of copper smelter-affected dust and its nano- and micron size fractions

Abstract

A comprehensive approach has been developed to the assessment of composition and properties of atmospherically deposited dust in the area affected by a copper smelter. The approach is based on the analysis of initial dust samples, dynamic leaching of water soluble fractions in a rotating coiled column (RCC) followed by the determination of recovered elements and characterization of size, morphology and elemental composition of nano-, submicron, and micron par ticles of dust separated using field-flow fractionation in a RCC. Three separated size fractions of dust (<0.2, 0.2–2, and >2 μm) were characterized by static light scattering and scanning electron microscopy, whereupon the fractions were analyzed by ICP-AES and ICP-MS (after digestion). It has been evaluated that toxic elements, which are characteristics for copper smelter emissions (As, Cu, Zn), are accumulated in fraction >2 μm. At the same time, up to 2.4, 3.1, 8.2, 6.7 g/kg of As, Cu, Zn, Pb, correspondently, were found in nanoparticles (<0.2 μm). It has been also shown that some trace elements (Sn, Sb, Ag, Bi, and Tl) are accumulated in fraction <0.2, and their content in this fraction may be one order of magnitude higher than that in the fraction >2 μm, or the bulk sample. It may be assumed that Sn, Sb, Ag, Bi, Tl compounds are adsorbed onto the finest dust particles as compared to As, Cu, Zn compounds, which are directly emitted from the copper smelter as microparticles.

https://ift.tt/2IylMqx

The legacy of pesticides and POPs stockpiles—a threat to health and the environment

https://ift.tt/2OvnkqG

Factors associated with false‐negative pathologic diagnosis of calciphylaxis

Journal of Cutaneous Pathology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2IyL9Zr

Investigation of high‐frequency hearing loss and outer hair cell function of the cochlea in patients with psoriasis: a case–control study

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2NdzIqJ

Efficacy of localized hand and foot phototherapy: a review of patients treated in a teaching hospital setting

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2xTorXS

Differential expression of interferon‐induced genes and other tissue‐based biomarkers in acute graft‐versus‐host disease vs. lupus erythematosus in skin

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2Ndzv6V

Public engagement lectures targeting prospective medical students: an opportunity for dermatology

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2xVhN3k

Risk factors for development of systemic lupus erythematosus in patients with cutaneous lupus: a retrospective review

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2Nh3ivq

Cutaneous hyperpigmentation and familial gastrointestinal stromal tumour associated with KIT mutation

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2xVhtBE

Acitretin as a successful treatment for Hailey–Hailey disease

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2Nhv1w3

The nose as the predominant site for pemphigus foliaceous

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2xVbEnH

Systematic review and meta‐analysis of prevalence of dermatological toxicities associated with vemurafenib treatment in patients with melanoma

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2NjpFR1

Penile necrobiosis lipoidica: case report and literature review

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2xTU4R8

A rare case of a tattoo‐induced morphoea reaction

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2NlgVdf

Cutaneous chromoblastomycosis effectively treated with local heat monotherapy

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2xTKgpU

Homocysteine plasma levels in patients affected by hidradenitis suppurativa: an Italian experience

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2NiSJrI

Investigation of high‐frequency hearing loss and outer hair cell function of the cochlea in patients with psoriasis: a case–control study

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2NdzIqJ

Efficacy of localized hand and foot phototherapy: a review of patients treated in a teaching hospital setting

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2xTorXS

Differential expression of interferon‐induced genes and other tissue‐based biomarkers in acute graft‐versus‐host disease vs. lupus erythematosus in skin

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2Ndzv6V

Public engagement lectures targeting prospective medical students: an opportunity for dermatology

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2xVhN3k

Risk factors for development of systemic lupus erythematosus in patients with cutaneous lupus: a retrospective review

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2Nh3ivq

Cutaneous hyperpigmentation and familial gastrointestinal stromal tumour associated with KIT mutation

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2xVhtBE

Acitretin as a successful treatment for Hailey–Hailey disease

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2Nhv1w3

The nose as the predominant site for pemphigus foliaceous

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2xVbEnH

Systematic review and meta‐analysis of prevalence of dermatological toxicities associated with vemurafenib treatment in patients with melanoma

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2NjpFR1

Penile necrobiosis lipoidica: case report and literature review

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2xTU4R8

A rare case of a tattoo‐induced morphoea reaction

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2NlgVdf

Cutaneous chromoblastomycosis effectively treated with local heat monotherapy

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2xTKgpU

Homocysteine plasma levels in patients affected by hidradenitis suppurativa: an Italian experience

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2NiSJrI

The effect of NB‐UVB on noncultured melanocyte and keratinocyte transplantation in treatment of generalized vitiligo using two different donor‐to‐recipient ratios

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2xVMuVZ

Effect of platelet‐rich plasma on proliferation and migration in human dermal fibroblasts

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2Nirldl

Effectiveness of short‐pulse width Nd:YAG in laser hair reduction

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2xVSkH3

Low‐fluence Q‐switched Nd:YAG laser for the treatment of melasma in Asian patients

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2NffQDr

Skin surface lipid differences in sensitive skin caused by psychological stress and distinguished by support vector machine

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2xUbddg

The effect of NB‐UVB on noncultured melanocyte and keratinocyte transplantation in treatment of generalized vitiligo using two different donor‐to‐recipient ratios

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2xVMuVZ

Effect of platelet‐rich plasma on proliferation and migration in human dermal fibroblasts

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2Nirldl

Effectiveness of short‐pulse width Nd:YAG in laser hair reduction

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2xVSkH3

Low‐fluence Q‐switched Nd:YAG laser for the treatment of melasma in Asian patients

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2NffQDr

Skin surface lipid differences in sensitive skin caused by psychological stress and distinguished by support vector machine

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2xUbddg

Hypereosinophilia successfully treated with the novel antihistamine bilastine

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2IwWmcK

Reprogramming of mitochondrial metabolism by innate immunity

Johan Garaude

https://ift.tt/2NWVfJr

Hypereosinophilia successfully treated with the novel antihistamine bilastine

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2IwWmcK

Competitive adsorption and desorption of arsenate, vanadate, and molybdate onto the low-cost adsorbent materials alum water treatment sludge and bauxite

Abstract

When low-cost adsorbents are being used to remove contaminant ions (e.g. arsenate, vanadate, and molybdate) from wastewater, competitive adsorption/desorption are central processes determining their removal efficiency. Competitive adsorption of As, V, and Mo was investigated using equimolar oxyanion concentrations in single, binary, and tertiary combinations in adsorption isotherm and pH envelope studies while desorption of previously adsorbed oxyanions was examined in solutions containing single and binary oxyanion combinations. The low-cost adsorbent materials used were alum water treatment sludge (amorphous hydroxy-Al) and bauxite ore (crystalline Al oxides). Adsorption isotherm and pH envelope studies showed that Mo had only a small effect in decreasing adsorption of As and V but V and As had substantial and similar effects in reducing adsorption of the other. As had a greater effect than V in reducing adsorption of Mo and it was concluded that the affinity of oxyanions for the surfaces of water treatment sludge and bauxite followed the order As > V >> Mo. In 0.3 M NaCl electrolyte, desorption of previously adsorbed oxyanions amounted to 0.3–3.4% for V and As, and 11–20% for Mo. As had approximately four times greater effect than Mo in increasing desorption of V while V had about three times the effect of Mo in increasing desorption of As. Thus, the order of oxyanions in inducing desorption of the other oxyanions (i.e. As on V and As) was the same as that for adsorption selectivity: As > V >> Mo. Water treatment sludge was a more effective adsorbent than bauxite because it had a greater adsorption capacity for all three anions and, in addition, they were held more strongly so desorption in the background electrolyte was proportionately less. It was concluded that at similar molar concentrations, arsenate would tend to reduce adsorption of vanadate as well as displace vanadate already held on adsorbent surfaces while both anions will compete effectively with molybdate. The limiting factor for simultaneous removal of As, V, and Mo from multielement solutions by adsorption will therefore be the removal of Mo.

https://ift.tt/2zO27A6

Sublethal effects of chronic exposure to CdO or PbO nanoparticles or their binary mixture on the honey bee ( Apis millefera L.)

Abstract

Cadmium and lead-based nanotechnologies are increasingly used in agricultural, industrial, and biological processes; however, potential adverse effects of nanomaterials on honey bees had not been assessed. In this study, effects of exposures to sublethal concentrations of PbO and CdO nanoparticles (NPs), either separately or in combination on honey bee (Apis mellifera) workers, were assessed. Honey bee workers were orally exposed for 9 days under laboratory conditions to sublethal concentrations (20% of LC₅₀) of CdO (0.01 mg/ml⁻) and PbO (0.65 mg/ml⁻) NPs either separately or combined. Effects on survival, feeding rate, activity of acetylcholinesterase (AChE), and expression of selected stress-related detoxifying enzymes were quantified. Survival and feeding rates decreased particularly in bees fed sugar syrup containing CdO NPs or binary mixtures of NPs of both metal oxides. Expressions of genes involved in detoxification of xenobiotics were affected by various combinations. Expression of catalase was 13.6-fold greater in bees consumed sugar syrup diet containing binary mixture of sublethal concentrations of both CdO and PbO NPs than it was in unexposed, control bees. AChE activity in heads of honey bees was inhibited by 3.8-, 3.0-, and 2.8-fold relative to control, respectively, in response to exposure to Cd or/and Pb oxide NPs. This result indicates potential neurotoxic effects of these NPs to honey bees. CdO NPs exhibited greater potency to honey bees. Overall, sublethal concentrations of CdO or/and PbO NPs resulted in detrimental effects on honeybee workers.

https://ift.tt/2ycBYJ5

Combined effects of new complete denture fabrication and simplified dietary advice on nutrient intake in edentulous elderly patients for 6 months

Abstract

Objective

The aim was to evaluate the combined effects of a new complete denture fabrication and simple dietary advice (using unique pamphlets) by dentists on nutrient intake in edentulous elderly patients.

Materials and methods

A randomized controlled trial was performed on edentulous elderly patients who were randomly allocated to either an intervention or a control group. The intervention group received a new complete denture and simple dietary advice, whereas the control group received a new complete denture and denture care advice. The outcomes of this trial (nutrient intakes) were calculated using a brief-type self-administered diet history questionnaire (BDHQ) and assessed at three time points (pretreatment and 3 and 6 months post-treatment).

Results

At 3 months post-treatment, the intake of several nutrients such as proteins (p = 0.004), magnesium (p < 0.001), and vitamin B1 (p = 0.014) was significantly higher in the intervention group than the control group, whereas at 6 months post-treatment, plant protein (p = 0.028) intake was significantly higher in the intervention group than the control group. On the contrary, animal protein (p = 0.049) and vitamin B12 (p = 0.028) intakes were significantly higher in the control group.

Conclusions

New complete denture fabrication with simple dietary advice might improve nutrient intake in elderly edentulous patients; however, the effect is probably short term.

Clinical significance

New complete denture fabrication along with simple dietary advice by dentists might improve nutrient intake in edentulous elderly patients. Therefore, regular use of these interventions in the dental setting might have long-term effects on nutrient intake in elderly edentulous patients.

Trial registration

UMIN-CTR Clinical Trial, unique trial number: UMIN000017879

https://ift.tt/2zO7Vd3

Quantitative evaluation of skin shrinkage associated with non-invasive skin tightening: a simple method for reproducible linear measurement using microtattoos

Abstract

Non-invasive skin-tightening devices can induce thermal denaturation and skin shrinkage via externally applied radiofrequency emissions or high-frequency ultrasound. Therefore, the purpose of this study is to develop and test a method for measurement of skin reduction associated with application of such energy devices. Twenty-five healthy participants with mild to moderate skin laxity of the arms were enrolled. Pinpoint microtattoos were placed at each of the treatment sites to delineate two 6 × 12 cm rectangles per subject. A non-stretchable filament, tape and marking pen apparatus was used to measure the size of each rectangle before treatment and at follow-up visit by two blinded investigators. After randomization, one side received a single pass with a radiofrequency device (6.78 MHz), while the contralateral side received multiple passes. Participants underwent two treatment sessions to each side 2 weeks apart, and returned for follow-up 4 weeks after the second treatment. Length and area measurement were analyzed to assess precision and accuracy of measurements and to compare efficacy of treatment between pre- and post-treatment. Concordance correlation coefficients (CCC) demonstrated substantial inter-investigator reliability and precision in length measurements (CCC, 0.94 to 0.98 in pre-treatment; 0.95 to 0.98 in post-treatment). Measurements at the 6-week post-treatment follow-up demonstrated a statistically significant skin reduction in all six of the measured parameters. A simple skin measurement method requiring minimal instrumentation can quantitatively evaluate skin shrinkage associated with non-invasive skin-tightening devices.

https://ift.tt/2IwGzux

Alan F. Weissman (Ed). Top Score for the Radiology Boards. Q&A for the Core and Certifying Exams

https://ift.tt/2E08yo2

Inpatient Rehabilitation for Children and Adolescents With Diabetes in Germany Between 2006 and 2013

Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-0741-6801

Introduction In Germany, inpatient rehabilitation is a well-established additive option in the therapeutic concept for children and adolescents with diabetes. However, its contribution in pediatric diabetes care is not known exactly. Our objective was to analyze inpatient rehabilitation in pediatric diabetes over eight years in Germany. Methods We requested secondary data from the German Statutory Pension Insurance Scheme to evaluate all completed inpatient rehabilitations for children and adolescents with diabetes (ICD-code E10-14) reimbursed by this institution between 2006 and 2013. For each type of diabetes, we analyzed the distribution of admissions by year, age-group, sex, nationality, and other documented diagnoses. All analyses were conducted via remote computing with IBM SPSS Version 24. Results Between 2006 and 2013, 5,403 admissions to inpatient rehabilitation for 4,746 children and adolescents with diabetes were documented. For type 1 diabetes (T1D; 88.5% of admissions), the number of yearly admissions increased from 458 in 2006 to 688 in 2013 (p=0.013), especially for age-group>5-10. The increase for type 2 diabetes (T2D) was not significant. Admissions were more frequent for girls (53.6%, p≤0.001), age>10-15 years (42.8%, p=0.001), and German nationality (98.5%). Obesity (T1D: 11.1%; T2D: 87.9%) and mental disorders (T1D: 11.6%; T2D: 27.4%) were the most frequent documented diagnoses in addition to diabetes. Conclusion This study provides a comprehensive overview of inpatient rehabilitation for children and adolescents with diabetes over many years in Germany. Until 2013, inpatient rehabilitation remained important in pediatric diabetes care, especially for children with mental disorders or obesity.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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

https://ift.tt/2zNdsAu

Association of benzene exposure with insulin resistance, SOD, and MDA as markers of oxidative stress in children and adolescents

Abstract

Benzene is a ubiquitous environmental pollutant with various health effects. It is reported that benzene exposure might be associated with insulin resistance in elderly adults. The aim of this study is to investigate the association between urinary benzene metabolite, trans, trans-muconic acid (t,t-ma) and markers of oxidative stress and insulin resistance in children and adolescents. This cross-sectional study was conducted in 2017 among 86 children and adolescents, aged 6–18 years, living in Isfahan, Iran. t,t-ma was measured as urinary benzene metabolite and homeostasis model assessment (HOMA-IR) was determined as an index of insulin resistance. Moreover, malondialdehyde (MDA) and superoxide dismutase (SOD) were assessed as oxidative stress markers. We found significant association between insulin resistance, fasting blood glucose, and fasting blood insulin with t,t-ma (p values = 0.002, 0.03, and 0.001, respectively). Results of this study indicate that benzene metabolite in higher concentrations in comparison with lower concentrations is associated with increased risk of insulin resistance. Moreover, after adjustment for age, sex, and household passive smoking, statistically significant increase were documented in SOD and MDA (4.49- and 3.54-fold, respectively) in intermediate levels of t,t-ma vs. low levels of t,t-ma (p values = 0.01 and 0.034, respectively). To the best of our knowledge, this is the first study in its kind in the pediatric age group. It showed that benzene exposures, even in environmental levels, might be associated with insulin resistance and oxidative stress in children and adolescents. Further longitudinal studies are necessary to assess the clinical impacts of this finding.

https://ift.tt/2xUOIoo

Catheter-Based Computed Tomography Angiography in Anterolateral Thigh Perforator Mapping of Chinese Patients

J reconstr Microsurg
DOI: 10.1055/s-0038-1672129

Background During reconstructive surgery, anterolateral thigh (ALT) flap harvest is challenging due to variation and uncertainty in perforator distribution. We performed a pilot study to identify the predictive value of catheter-based computed tomography angiography (C-CTA) and traditional CTA (T-CTA) in ALT perforator mapping for patients whose ALT perforators were difficult to identify. Methods Thirty-four consecutive T-CTA/C-CTA-mapped ALT flaps were evaluated for extremity reconstruction. The perforator location, origin, and course were compared between T-CTA/C-CTA imaging and intraoperative findings. The mapping efficiency of T-CTA and C-CTA was compared thoroughly. Results Among the 34 ALT thigh flaps, 117 (36) of the 130 perforators identified intraoperatively were visible on C-CTA (T-CTA) in a subgroup of Chinese limb trauma patients with limited activity. C-CTA showed a satisfactory efficiency in perforator mapping, which was much better than the efficiency of T-CTA. C-CTA also showed a much better sensitivity (90.00 vs. 27.69%), specificity (94.74 vs. 66.67%), and accuracy (91.07 vs. 36.69%), and a much lower false-positive (1.68 vs. 26.53%), and false-negative rate (10.00 vs. 72.31%). Moreover, C-CTA could accurately predict the origin and septocutaneous or intramuscular course in all identified perforators. All flaps were elevated successfully and survived. Conclusions C-CTA outperforms T-CTA in the preoperative perforator mapping of ALT flaps in a subgroup of Chinese limb trauma patients. C-CTA should be the method of choice for perforator mapping in patients whose ALT flaps are intended for extremity reconstruction.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

https://ift.tt/2y9JC7d

The effect of age, gender, and time between blood draw and start of centrifugation on the size outcomes of platelet-rich fibrin (PRF) membranes

Abstract

Objectives

Platelet-rich fibrin (PRF) has been utilized in regenerative dentistry as a supra-physiological concentrate of autologous growth factors capable of stimulating tissue regeneration. Due to the variability in the macroscopic morphology/size of PRF membranes observed between patients, we were interested in studying the effects of patient age, gender, and time between blood draw and the start of centrifugation on the size outcomes of PRF membranes. Despite PRF therapy being increasingly more popular in private practice, to date, no study has investigated the effects of the delay between blood draw and the start of centrifugation in a clinical setting.

Materials and methods

A total of 60 patients enrolled in this study were divided into 6 groups of 10 patients each, including male and female patients categorized into age groups 21–40, 41–60, and 61–80 years. From each patient, a total of five PRF membranes were fabricated from 10-mL tubes following centrifugation starting after 0, 30, 60, 90, and 120 s. In total, 300 PRF membranes were produced in this study to investigate the effects of patient age, gender, and time on the size outcomes of PRF membranes.

Results

A longer delay by the clinician before starting centrifugation following blood draw led to a smaller final size of PRF membranes. At 90 s following blood draw, a significant (13%) reduction in PRF membrane size was observed. After 120 s, a significant (23%) reduction was observed. Additionally, female patients had on average 17% larger membranes compared to men (p < 0.05, 300 samples). Lastly, the size outcomes of the PRF membranes was largest in patients aged 61–80, followed by those aged 41–60 and 21–40. However, no statistically significant differences in PRF membrane sizes were reported between age groups.

Conclusions

The time at which a centrifugation procedure begins following blood draw is critical to optimize the size outcomes of PRF membranes. In general, approximately 15 s is required per tube to harvest 9–10 cc of blood. Therefore, a 60- to 90-s interval between blood draw and the start of centrifugation should be a parameter that is respected by clinicians to avoid significant changes in the macroscopic morphology/size of fabricated PRF membranes. Furthermore, females and older patients produced larger membranes, likely due to lower red blood cell counts derived from their peripheral blood.

Clinical relevance

The findings from the present study demonstrate that on average, a clinician has approximately 60–90 s between blood draw and the start of the centrifugation cycle to produce standard-sized PRF membranes. Shortly thereafter, a significant reduction in size is observed. Additionally, females and older patients were found to produce larger PRF membranes. Centrifugation protocols may therefore be adapted accordingly.

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Penile cutaneous horn: still an enigma

Ajay Aggarwal<br />Sep 10, 2018; 2018:bcr-2018-225930-bcr-2018-225930<br />Images in...

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Biomechanical response of a submerged, rosette-forming macrophyte to wave action in a eutrophic lake on the Yungui Plateau, China

Abstract

Few studies have focused on the biomechanical responses of submerged, rosette-forming macrophytes to wave action, water depth, or their co-occurrence in naturally eutrophic systems. The plant architecture, root anchorage strength-related traits, leaf morphology, and biomechanics of Vallisneria natans inhabiting a range of water depths were examined along three transects (T1, T2, and T3) in a eutrophic lake, Lake Erhai, in Yunnan Province, China. These transects were exposed to weak wave action and hyper-eutrophication (T1), moderate wave action and eutrophication (T2), or strong wave action and eutrophication (T3). The results showed that V. natans was mainly distributed at intermediate depths, with the widest colonization depth in T1. The values of plant architecture, root anchorage strength-related traits, leaf morphology, and biomechanics were generally highest in T3 and smallest in T2. Along the depth gradient, these values were generally highest at 3.5, 2.5, and 2.5 m for the plants growing in T1, T2, and T3, respectively. These findings suggest that V. natans adopts a "tolerance" strategy to cope with the effects of strong wave action in eutrophic habitats and an "avoidance" strategy when exposed to moderate wave action in eutrophic areas. Since the absence of an avoidance strategy increases the resistance to low-light stress at the expense of increased drag forces, there is a limit to the wave action that V. natans can withstand. This study indicates that biomechanics could be important when determining the distribution pattern of V. natans in Lake Erhai.

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Effects of site-specific climatic conditions on the radial growth of the lichen biomonitor Xanthoria parietina

Abstract

The protocols commonly applied in surveys with lichens as biomonitors of airborne trace elements require analyses of samples derived from thalli or parts of thalli grown in the last year before sampling, under the postulation that samples of the same size are of the same age. Unfortunately, the influence of ecological site-specific factors on lichen growth is still largely ignored, so that samples of the same size collected in environmentally and climatically diverse sites might actually differ in age. This work aims at quantifying the influence of climatic conditions on the radial growth rates (RaGRs) of Xanthoria parietina, one of the most popular lichen biomonitors. RaGR was monitored in seven populations distributed along an altitudinal transect of 30 km in the Classical Karst (NE Italy), from 20 to 500 m above sea level. For c. 17 months, lobe growth was measured seasonally with a digital calliper, and site-specific climatic variables were monitored by means of thermo-hygrometric sensors and implemented by meteorological data. Finally, the lobe growth of X. parietina was modelled as a function of 18 environmental variables. Results revealed that thalli of relatively dry sites had significantly lower seasonal RaGR with respect to moister ones. Considering that cumulative precipitations were equally distributed along the transect, it was concluded that RaGR of X. parietina is affected negatively by high air temperatures and positively by high relative humidity. The importance of RaGR variation in lichen bioaccumulation studies is critically discussed.

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FDA Approves Sarecycline for Moderate to Severe Acne

The FDA has approved sarecycline (Seysara, Almirall) for patients aged 9 years and older with inflammatory lesions associated with non-nodular moderate to severe acne vulgaris.
FDA Approvals

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Issue Information

Molecular Oral Microbiology, Volume 33, Issue 5, Page i-iv, October 2018.


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Birch pollen‐related foods can cause late eczematous reactions in patients with atopic dermatitis

Allergy, EarlyView.


https://ift.tt/2zMu0sh

Aryl hydrocarbon receptor activation by diesel exhaust particles mediates epithelium‐derived cytokines expression in severe allergic asthma

Allergy, EarlyView.


https://ift.tt/2DQASJi

IgG4 anti‐infliximab in treated patients: Clinical impact and temporal evolution

Allergy, EarlyView.


https://ift.tt/2zM8wvK

Issue Information

International Forum of Allergy &Rhinology, Volume 8, Issue 10, Page 1077-1079, October 2018.


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Efficient water decontamination using layered double hydroxide beads nanocomposites

Abstract

Ni-Al-CO₃-layered double hydroxide (LDH) with Ni:Al ratio (3:1) and their nanocomposites with alginate and chitosan beads were prepared and examined for their efficiency in removal of Cd²⁺ and Cu²⁺ ions from wastewater. Different parameters such as contact time, pH value, adsorbent weight, and heavy metal ion concentration on the removal efficiency were examined and reported. The prepared beads were examined using X-ray diffraction (XRD), TEM, SEM, and FTIR. Our results revealed a successful preparation of the LDH in rhombohedral hexognal crystal form and the alginate-LDH-chitosan beads. The optimized batch experiment conditions in ambient room temperature were found to be 2 g/L adsorbent dose, 50 mg/L initial concentration of meal, contact time of 2 h, and pH ~ 5 and 6 for removal of Cu²⁺ and Cd²⁺, respectively. The adsorption process was well fitted with Langmuir and Freundlich isotherm models (higher R²), with trivial advantage for Freundlich approach. Kinetic studies showed that the adsorption of both Cd²⁺ and Cu²⁺ followed the pseudo-second-order. The current study demonstrated that the Ni-Al-CO₃ LDH and their novel alginate-chitosan-based nanocomposite could be further tailored and used as efficient adsorbents for the uptake of heavy metals from wastewater.

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Une masse faussement silencieuse

Publication date: October 2018

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 5

Author(s): X. Dubernard, E. Brenet, M. Makeieff

https://ift.tt/2y7W4Vb

Vers un nouveau seuil de la valeur de p ?

Publication date: October 2018

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 5

Author(s): O. Laccourreye, H. Maisonneuve

https://ift.tt/2y8mqWX

Tumeur ethmoïdal et ostéomalacie oncogène : cas clinique et revue de la littérature

Publication date: October 2018

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 5

Author(s): A. Villepelet, O. Casiraghi, S. Temam, A. Moya-Plana

Résumé

Introduction

L'ostéomalacie oncogène est une pathologie très rare. Elle est causée le plus souvent par une tumeur mésenchymateuse phosphaturiante variante « tissu conjonctif mixte », sécrétant l'hormone FGF-23.

Objectif

Présenter le cas d'une tumeur ethmoïdale associée à une ostéomalacie oncogène et discuter la prise en charge en s'appuyant sur une revue de la littérature.

Résumé du cas clinique

Chez une patiente de 41 ans présentant des fractures multiples avec une impotence fonctionnelle majeure, le diagnostic d'ostéoporose précoce avait été posé. En raison d'une obstruction nasale concomitante, un scanner puis une IRM ont montré une lésion ethmoïdale droite venant au contact de la dure-mère et de la péri-orbite sans les envahir. Une exérèse par voie endoscopique avec reconstruction du défect basicrânien par lambeau naso-septal a été effectuée. Dans les suites on notait une disparition des symptômes rhinologiques et rhumatologiques. L'examen histologique a conclu à une tumeur mésenchymateuse phosphaturiante.

Discussion

Il existe à ce jour douze autres cas rapportés de tumeurs ethmoïdales mésenchymateuses associées à une ostéomalacie oncogène. Le dosage du FGF-23 et l'IRM corps entier en séquence STIR sont utiles pour le diagnostic. Dans la majorité des cas, l'évolution est très favorable après un traitement chirurgical.

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Corps étranger inhabituel transfixiant de la face : une approche chirurgicale multidisciplinaire

Publication date: October 2018

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 5

Author(s): A. Villarmé, C. Savoldelli, E. Jean-Baptiste, N. Guevara

Résumé

Introduction

Les traumatismes cervico-faciaux par corps étrangers transfixiants sont rares et associés à un risque important de lésions vasculo-nerveuses. Ils nécessitent une prise en charge chirurgicale pluridisciplinaire.

Observations

Ce travail rapporte le cas d'un homme de 20 ans, empalé par un morceau de bois, et la stratégie adoptée pour extraire le corps étranger sans causer de lésions irréversibles. Le projectile traverse la fosse infra temporale, avec un point d'entrée sous l'œil droit et un orifice de sortie au niveau cervical au contact de l'artère carotide interne gauche. La localisation du corps étranger implique une stratégie chirurgicale adaptée. L'artère carotide interne est contrôlée afin de suivre le projectile jusqu'à son entrée dans la base du crâne. La proximité avec l'œil et les vaisseaux jugulo-carotidiens ainsi que le trajet facial profond nécessite l'intervention des radiologues interventionnels, de chirurgiens cervico-faciaux, vasculaires et ophtalmologistes.

Discussion

La localisation du corps étranger, déterminée de façon précise en préopératoire, justifie la présence d'une équipe multidisciplinaire en vue d'une extraction rapide, qui limite le risque de lésion surajoutée. À 6 mois de suivi, le patient ne souffre d'aucune séquelle de son traumatisme facial.

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Correction de l’ensellure nasale par greffe semi-lunaire de cartilage de conque

Publication date: October 2018

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 5

Author(s): Ivan Rašić, Andro Košec, Alan Pegan

Résumé

Introduction

L'ensellure nasale se reconnaît facilement par la perte du support cartilagineux septal et la diminution de hauteur du dorsum nasal avec des conséquences fonctionnelles et esthétiques.

Technique

Nous avons traité une femme âgée de 50 ans et un homme âgé de 54 ans qui présentaient pour l'une une ensellure nasale modérée suite à une précédente septorhinoplastie, et pour l'autre une ensellure nasale sévère post-traumatique. Les deux patients ont été traités par rhinoplastie ouverte sous anesthésie générale, et l'ensellure nasale a été corrigée par une greffe semi-lunaire de cartilage de conque. Cette greffe tire son nom de la forme semi-lunaire du cartilage de conque prélevé. Une plus petite partie de cartilage est prélevée en forme de feuille et suturée à l'envers avec des points de PDS 5-0 en face du cartilage de sorte que les surfaces concaves soient face à face. La greffe ainsi formée est alors suturée sur le dorsum nasal dans la zone de l'ensellure au niveau de la supra-pointe au-dessus des cartilages triangulaires afin d'élargir l'angle de la valve nasale interne. Les extrémités latérales de la greffe semi-lunaire sont placées sous la crus latérale du cartilage alaire afin d'améliorer la fonctionnalité de la valve nasale externe.

Discussion

Cette greffe de cartilage de conque modifiée constitue une excellente option de reconstruction, en raison notamment de sa faible morbidité, de sa disponibilité et de sa capacité à récupérer une quantité de cartilage appropriée pour la vaste majorité des patients. Ces modifications du cartilage de conque n'ont jamais été rapportées auparavant et offrent la hauteur et l'élasticité nécessaires dans la correction de l'ensellure nasale sans nécessiter de greffes ultérieures. Il est important de souligner que, lorsque la greffe est positionnée correctement, on peut observer une amélioration du pic de flux inspiratoire nasal, ce qui s'ajoute aux bénéfices fonctionnels et esthétiques.

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Technique de féminisation fronto-orbitaire. Une stratégie chirurgicale par fraisage fronto-orbitaire ± technique de la coquille d’œuf pour optimiser le rapport bénéfice/risque

Publication date: October 2018

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 5

Author(s): A. Villepelet, A. Jafari, B. Baujat

Résumé

La demande de féminisation faciale augmente au sein de la population des patients transsexuels. Le front masculin a des bosses supra-orbitaires avec un angle glabellaire plus aigu tandis que le front féminin a des traits plus doux. L'objectif de cet article est de décrire notre technique chirurgicale de féminisation fronto-orbitaire. La technique du mask-lift est un lifting de la partie supérieure de la face. Il permet un rajeunissement en corrigeant les traits effondrés et une féminisation fronto-orbitaire par un fraisage des rebords orbitaires et des canthopexies latérales. Selon la taille du sinus frontal et l'épaisseur de sa paroi antérieure, le remodelage frontal est effectué par fraisage simple ou par la technique de la coquille d'œuf. Le remodelage orbitaire comprend une ouverture supéro-externe de l'orbite, une réduction des rebords et un tunnel sur le rebord latéral pour guider la canthopexie. Des myectomies frontales du corrugateur et du procerus, ainsi qu'une excision minimale du scalp, complètent la chirurgie. Notre technique permet une féminisation significative et d'aspect naturel. Aucune complication n'a été observée dans notre série de patients. La technique de la coquille d'œuf est une alternative au volet osseux en cas de sinus frontal très pneumatisé. La féminisation fronto-orbitaire est au cœur d'une large stratégie chirurgicale. Elle peut être associée à une rhinoplastie, une génioplasie, un remodelage des angles mandibulaires, un lifting facial et une laryngoplastie. Entreprendre la féminisation faciale en 2 ou 3 étapes permet une meilleure tolérance physiologique et psychologique.

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Ponction trachéo-œsophagienne secondaire en consultation et pose d’implant phonatoire chez les laryngectomisés

Publication date: October 2018

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 5

Author(s): E. Ricci, G. Riva, F. Dagna, E. Seglie, A.L. Cavalot

Résumé

La ponction trachéo-œsophagienne secondaire (PTO) avec mise en place d'un implant phonatoire est l'une des possibilités pour restaurer la fonction vocale après une laryngectomie totale. Cependant, certains patients ont des comorbidités qui contre-indiquent l'anesthésie générale. Dans notre service, une procédure de PTO en consultation pour mise en place d'un implant phonatoire par voie rétrograde a été développée. Celle-ci permet de mettre en place immédiatement la prothèse et d'éviter l'utilisation de dilatateurs. Nous avons décrit notre technique avec ses avantages et ses inconvénients. Le set de ponction Provox Vega a été utilisé. Notre technique de PTO secondaire en consultation sans anesthésie générale ni anesthésie à objectif de concentration était une procédure sûre et efficace. Elle permet d'utiliser le set de PTO traditionnel, avec possibilité de mettre en place un implant phonatoire après fermeture de la précédente PTO.

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Consensus formalisé de la SFORL (version courte) : audiométrie de l’adulte et de l’enfant

Publication date: October 2018

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 5

Author(s): V. Favier, C. Vincent, É. Bizaguet, D. Bouccara, R. Dauman, B. Frachet, F. Le Her, C. Meyer-Bisch, S. Tronche, F. Sterkers-Artières, F. Venail

Résumé

Introduction

Consensus de la SFORL concernant les bonnes pratiques de la réalisation d'un examen audiométrique chez l'adulte et l'enfant.

Méthodes

Un groupe de travail multidisciplinaire a effectué une revue de la littérature. Des recommandations ont été érigées, relues par un groupe de lecture indépendant du groupe de travail et finalisées lors d'une réunion de synthèse.

Résultats

Il est recommandé de réaliser les examens audiométriques dans un environnement sonore maîtrisé (< 30 dBA), de contrôler l'étalonnage de l'audiomètre régulièrement et de suivre systématiquement les règles de l'assourdissement adaptées au sujet. Il est recommandé de s'assurer que le niveau d'assourdissement n'est pas retentissant. Il est recommandé d'interpréter l'audiométrie tonale de l'adulte en la confrontant avec les données cliniques, l'audiométrie vocale et l'impédancemétrie. En cas de discordance entre les données cliniques et audiométriques tonales et vocales, il est recommandé de réaliser des tests auditifs objectifs. Il est recommandé chez tout enfant de 2 ans ou moins, de réaliser l'audiométrie subjective avec les tests d'audiométrie comportementale adaptés à l'âge de l'enfant. Dès la suspicion d'une atteinte auditive, compléter systématiquement l'audiométrie comportementale par la réalisation de tests objectifs de l'audition pour préciser et confirmer le niveau et le type de l'atteinte auditive.

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Exploration de la discrimination auditive chez le sujet malentendant

Publication date: October 2018

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 5

Author(s): E. Legris, M. Gomot, J. Charpentier, J.M. Aoustin, C. Aussedat, D. Bakhos

Résumé

Un déficit auditif peut entraîner une altération de la discrimination auditive notamment dans un environnement bruyant. Il en découle une augmentation de l'effort d'écoute qui peut avoir des conséquences sur la vie socioprofessionnelle. Pour évaluer l'impact de la surdité en environnement bruyant, le clinicien peut avoir recours à des techniques subjectives ou objectives. Les techniques subjectives, telles que l'audiométrie vocale dans le bruit, sont utilisées en pratique clinique pour évaluer la gêne décrite par le patient. Les techniques objectives, comme les potentiels évoqués auditifs corticaux (PEAc), sont essentiellement utilisées en recherche. Les méthodes subjectives correspondent principalement à l'audiométrie vocale dans le bruit où le rapport signal sur bruit est modifié, ce qui permet de déterminer le seuil d'intelligibilité du patient, avec et sans réhabilitation auditive. Le but de cet examen est de mettre en évidence une amélioration des performances auditives. Une analyse de la discrimination fréquentielle peut également être effectuée. Les méthodes objectives consistent à évaluer la discrimination auditive sans avoir recours à la participation du sujet. Une des techniques utilisées chez les patients avec une réhabilitation auditive est l'étude des réponses auditives par les PEAc. Cet examen électrophysiologique permet d'étudier la discrimination auditive corticale en utilisant des paradigmes oddball. Cela permet le recueil des ondes telles que la Mismatch Negativity, la P300 ou la N400, et l'étude de marqueurs neurophysiologiques en lien avec les performances auditives. Cette revue retrace l'ensemble de ces méthodes, dans le but de pouvoir mieux appréhender et évaluer l'impact d'une surdité dans la vie quotidienne des patients.

https://ift.tt/2RkjKOB

Actualisation de la nasalisation du concept à la technique et aux résultats

Publication date: October 2018

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 5

Author(s): R. Jankowski, C. Rumeau, D.T. Nguyen, P. Gallet

Résumé

La nasalisation est une technique chirurgicale proposée dans le traitement la polypose nasale en 1995. La description initiale de la technique reposait sur l'ouverture large des sinus maxillaires, sphénoïdaux et frontaux et sur la résection des cornets moyens dans le but de permettre une exérèse aussi complète que possible de la muqueuse des masses latérales de l'ethmoïde dans des conditions de sécurité maximale. Les données récentes sur l'évolution et le développement de l'organe naso-sinusien et sur la physiologie sinusienne permettent d'actualiser le concept et la technique de nasalisation. Dans la théorie évo-dévo, l'ethmoïde n'est pas considéré comme un sinus paranasal mais comme le squelette basi-crânien dans lequel se loge la muqueuse olfactive, qui chez l'humain peut être décomposée en muqueuse olfactive fonctionnelle dans le récessus supérieur des fentes olfactives et en muqueuse olfactive vestigiale dans le reste de l'ethmoïde. La polypose nasale apparaît cliniquement comme une maladie spécifique de la muqueuse olfactive vestigiale de l'ethmoïde humain (et non pas comme une forme particulière de rhinosinusite chronique). Le but du traitement chirurgical de la polypose devient ainsi l'exérèse aussi complète que possible de la muqueuse olfactive vestigiale et la conservation aussi longtemps que possible de l'olfaction. La fabrication, le stockage et la libération en bolus du monoxyde d'azote grâce à la fonction sphinctérienne de l'ostium des sinus paranasaux (maxillaires, frontaux et sphénoïdaux) leur confèrent un rôle respiratoire qui mérite d'être préservé autant que possible. La technique de nasalisation a été modifiée pour permettre l'éradication de la muqueuse olfactive vestigiale tout en préservant les différents ostiums sinusiens. La chirurgie du cornet moyen reste à évaluer. Sa résection concourt à une exérèse maximale de muqueuse olfactive vestigiale. Sa préservation respecterait l'intégrité de la fente olfactive. L'actualisation du concept de nasalisation permet ainsi l'intégration de la technique dans le concept évo-dévo de la rhinologie.

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Hydrops retardé. Aspect du nystagmus en crise et intérêt de la labyrinthectomie chimique

Publication date: October 2018

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 5

Author(s): P. Reynard, A. Karkas, M. Gavid, Y. Lelonge, P. Bertholon

Résumé

Objectifs

L'objectif principal était de décrire les caractéristiques du nystagmus pendant une crise de vertiges d'hydrops endolymphatique retardé (HER), en particulier l'observation d'un nystagmus initial essentiellement vertical supérieur. L'objectif secondaire était de souligner l'intérêt de la labyrinthectomie chimique.

Méthodes

Le développement retardé de vertiges chez des patients présentant une surdité de perception, au moins profonde d'un côté, caractérisait l'HER de forme ipsilatérale, associé à une surdité de perception apparue secondairement de l'autre côté dans la forme controlatérale.

Résultats

Dix patients correspondaient aux critères d'un HER, dont sept de forme ipsilatérale et trois de forme controlatérale. Trois patients (HER ipsilatéral) ont été examinés pendant une crise de vertiges dont deux présentaient un nystagmus horizonto-rotatoire battant vers l'oreille saine. Un autre patient présentait un nystagmus atypique car vertical supérieur avec une petite composante rotatoire, devenu secondairement horizonto-rotatoire battant vers l'oreille saine. Quatre patients souffrant de vertiges invalidants dans un contexte de cophose unilatérale (HER ipsilatéral) ont été guéris par 1 à 3 injections transtympaniques de Gentalline.

Conclusion

Les caractéristiques du nystagmus pendant le vertige peuvent être très variables avec la possibilité d'un nystagmus initial essentiellement vertical supérieur qui, à notre connaissance, n'avait jamais été rapporté dans l'HER ou la maladie de Menière. Ce nystagmus pourrait correspondre à une inhibition du canal semi-circulaire supérieur (du côté de la cophose), suggèrant un hydrops débutant au niveau de ce canal. La labyrinthectomie chimique est une technique simple et efficace dans l'HER unilatéral, d'autant que le patient est souvent porteur d'une cophose du côté traité.

https://ift.tt/2Rj2rO3

Audiométrie vocale dans le bruit : mise au point du test VRB (vocale rapide dans le bruit)

Publication date: October 2018

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 5

Author(s): F. Leclercq, C. Renard, C. Vincent

Résumé

Introduction

La compréhension de la parole dans le bruit est un défi majeur pour la plupart des malentendants qu'ils soient appareillés ou non. Pour pallier l'insuffisance de tests francophones évaluant cette aptitude, un nouveau matériel vocal équilibré en difficulté a été développé.

Matériel et méthodes

Le matériel vocal est composé de 127 phrases du corpus « Marginal Benefit from Acoustical Amplification » (MBAA) contenant chacune trois mots-clés. Le bruit a été créé à partir de l'onde vocale globale (OVG) décrite par Dodelé. Les 127 couples phrase/bruit ont été enregistrés individuellement avec égalisation du niveau quadratique moyen. Dans une première expérience menée sur 10 adultes normo-entendants utilisant une méthode ascendante avec le bruit fixé à 73 dB SPL, le rapport signal bruit (RSB) permettant l'identification de 50 % des mots-clés dans chaque phrase (RSB-50) a été déterminé. Le niveau relatif entre les phrases et le bruit a alors été ajusté phrase par phrase pour amener les RSB-50 à 0 dB RSB. Une seconde expérience portant sur 12 normo-entendants a ensuite validé l'égalisation en difficulté des phrases.

Résultats

La moyenne des RSB-50 est de −6,64 dB RSB (σ = 1,47). La moyenne des RSB-50 ajustés est de +0,08 dB RSB (σ = 0,55). La moyenne des pentes des courbes psychométriques de 19,3 %/dB et les faibles écarts-types observés attestent de la sensibilité du matériel vocal.

Conclusion

Le test VRB (vocal rapide dans le bruit) utilisant des listes élaborées avec des phrases issues du corpus « Marginal Benefit from Acoustical Amplification » et un bruit type « onde vocale globale » à différents niveaux de rapport signal/bruit est réalisable et apte à refléter des variations subtiles de performance auditive dans le bruit entre sujets.

https://ift.tt/2y8mJ43

Tumeurs de la fosse infratemporale : quand suspecter une tumeur maligne ? Étude rétrospective d’une série de 62 cas

Publication date: October 2018

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 5

Author(s): Q. Lisan, N. Leclerc, R. Kania, J.-P. Guichard, P. Herman, B. Verillaud

Résumé

Objectifs

Les tumeurs de la fosse infratemporale (FIT) sont rares et leur épidémiologie mal connue. Il est parfois difficile pour le clinicien, rarement confronté à ces lésions, de distinguer une tumeur bénigne d'une tumeur maligne sur les seules données de l'examen clinique et de l'imagerie. Les objectifs de cette étude étaient, à partir d'une série rétrospective : (i) de décrire la prévalence des différents types histologiques de tumeurs de la FIT et (ii) d'étudier l'association entre certains signes cliniques et/ou radiologiques et la présence d'une tumeur maligne.

Matériel et méthodes

Il s'agit d'une étude rétrospective monocentrique, menée dans un centre hospitalier universitaire. Tous les nouveaux cas consécutifs de tumeur de la FIT pris en charge entre janvier 2000 et décembre 2016 ont été inclus. Le type histologique, les données démographiques, la présentation clinique ainsi que les données radiologiques ont été analysés.

Résultats

Un total de 62 patients ont été inclus. Il s'agissait de tumeurs bénignes dans 74 % des cas (n = 46) et de tumeurs malignes dans 26 % des cas. Le fibrome nasopharyngien, le carcinome adénoïde kystique et le schwannome étaient les types histologiques les plus fréquents (47 %, 16 % et 10 % respectivement). La présence d'un trismus, d'une douleur faciale, d'une hypoesthésie faciale et l'invasion nerveuse visualisée à l'IRM étaient significativement associées à la présence d'une tumeur maligne (valeur de p < 0,05).

Conclusion

Cette étude fournit des données épidémiologiques générales concernant les tumeurs de la FIT et identifie plusieurs signes cliniques et radiologiques devant faire suspecter une tumeur maligne.

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Évaluation du dysfonctionnement naso-sinusien chronique avec adaptation transculturelle de l’auto-questionnaire DyNaChron

Publication date: October 2018

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 5

Author(s): K. Choukry, J. Hasnaoui, Z. Chafiki, M. Khdim, R. Abada, M. Mahtar

Résumé

Objectif

Les pathologies rhino sinusiennes génèrent six symptômes principaux, avec un retentissement organique et psychosocial majeur, que nous proposons de mesurer grâce à un auto-questionnaire évaluant les dysfonctionnements naso-sinusiens chroniques indépendamment de leurs étiologies. Le but de notre travail est de réaliser une adaptation transculturelle en version arabe dialectale et de valider l'auto-questionnaire DyNaChron afin de l'utiliser pour la population maghrébine.

Méthode

La traduction – adaptation marocaine du DyNaChron a été réalisée selon des recommandations internationales pour la traduction. Environ, 164 patients ont rempli le questionnaire à j0, j7 (sans traitement) et j60 après traitement. La validation statistique du questionnaire a été évaluée au cours d'une étude prospective multicentrique incluant la validité de convergence et la sensibilité au changement.

Résultats

L'âge moyen était de 35 ans. Le sexe masculin est prédominant (63 %). L'obstruction nasale représente le symptôme le plus fréquent (97,6 %). La cohérence interne a été confirmée avec un coefficient alpha de Cronbach élevé (0,97). Le coefficient de corrélation intra classe évaluant la reproductibilité était de 0,84. Une sensibilité au changement excellente chez la majorité de nos patients (taille d'effet = 0,97–6,69 ; RMS = 2,47–6,74)

Conclusion

Cette étude portant sur l'adaptation transculturelle du DyNaChron en version marocaine a montré une bonne validité, reproductibilité et sensibilité aux changements ainsi qu'une meilleure représentation de l'ensemble des symptômes générés par le DNSC. Il peut être utilisé pour évaluer l'impact psychosocial, organique et le traitement du DNSC.

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Amygdalectomie chez l’enfant et chez l’adulte : évolution des pratiques après ouverture d’une unité de chirurgie ambulatoire avec bloc opératoire dédié

Publication date: October 2018

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 5

Author(s): S. Bartier, I. Gharzouli, N. Kiblut, H. Bendimered, L. Cloutier, D. Salvan

Résumé

Buts

Étudier l'impact de l'ouverture d'une unité de chirurgie ambulatoire sur la pratique de l'amygdalectomie chez l'adulte et chez l'enfant à travers l'expérience de notre service ; et évaluer les complications en ambulatoire par rapport à l'hospitalisation conventionnelle.

Matériel et méthodes

Revue rétrospective de toutes les amygdalectomies pratiquées depuis l'ouverture d'un bloc opératoire dédié à la chirurgie en ambulatoire, à partir des bases de données ORL et urgences.

Résultats

D'octobre 2013 à décembre 2014, réalisation de 179 amygdalectomies (51 adultes et 128 enfants) dont 108 en ambulatoire. Entre 2012 et 2014, croissance de 12,7 % du nombre total d'amygdalectomies (+ 18,29 % enfants, stabilité du nombre d'adultes). La programmation en ambulatoire est devenue majoritaire en moins d'un an chez les enfants (73,19 %) et à part égale avec l'hospitalisation conventionnelle chez les adultes (47,22 %). La quasi-totalité des patients gardés à j0 le sont pour des raisons organisationnelles ou de défaut d'orientation (comorbidités ou environnement inadapté). L'amygdalectomie en ambulatoire chez l'enfant a un taux de complication dans les 30 jours similaire à la littérature (8,3 % de chute d'escarre) ; taux plus élevé chez l'adulte (35,3 %). Les complications postopératoires apparaissent en moyenne à j6 pour les adultes et j9 pour les enfants ; seuls 2 patients ont eu une complication survenue entre H6 et H24.

Conclusion

Cette étude montre que l'ouverture d'une unité de chirurgie ambulatoire entraîne une modification des pratiques avec une majorité des amygdalectomies maintenant pratiquée en ambulatoire, sans observer un accroissement des complications, notamment des complications immédiates. L'amygdalectomie en ambulatoire apparaît donc comme une solution de choix par rapport à l'hospitalisation conventionnelle, en termes de bénéfice économique et de confort pour le patient sans perdre en sécurité. L'existence d'un bloc dédié permet une facilité de gestion de programmation, permettant ainsi une augmentation de l'activité en UCA (amélioration des délais).

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Editorial Board

Publication date: October 2018

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 135, Issue 5

Author(s):

https://ift.tt/2RgyQ7U

Issue Information

Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue S3, Page 1-2, October 2018.


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Safety and Efficacy of Nivolumab in Treating Oral Proliferative Verrucous Leukoplakia

Condition:   Leukoplakia, Oral
Intervention:   Drug: Nivolumab
Sponsors:   Dana-Farber Cancer Institute;   Bristol-Myers Squibb
Not yet recruiting

https://ift.tt/2Iw4WIQ

Durvalumab (MEDI4736) With Cetuximab in Previously Treated Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma

Conditions:   Recurrent Head and Neck Cancer;   Head and Neck Cancer;   Head and Neck Neoplasms;   Metastatic Cancer
Interventions:   Drug: Durvalumab;   Drug: Cetuximab
Sponsors:   Trisha Wise-Draper;   AstraZeneca
Recruiting

https://ift.tt/2Ri9jLs

A Study of Several Radiation Doses for Patients With Progression on Immunotherapy/Checkpoint Inhibitors

Conditions:   Metastatic Cancer;   Melanoma Cancer;   Lung Cancer;   Bladder Cancer;   Renal Cancer;   Head/Neck Cancers
Interventions:   Radiation: Stereotactic Body Radiotherapy;   Biological: checkpoint inhibitor
Sponsor:   Memorial Sloan Kettering Cancer Center
Recruiting

https://ift.tt/2IxYD7A

Safety and Efficacy of Nivolumab in Treating Oral Proliferative Verrucous Leukoplakia

Condition:   Leukoplakia, Oral
Intervention:   Drug: Nivolumab
Sponsors:   Dana-Farber Cancer Institute;   Bristol-Myers Squibb
Not yet recruiting

https://ift.tt/2Iw4WIQ

Durvalumab (MEDI4736) With Cetuximab in Previously Treated Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma

Conditions:   Recurrent Head and Neck Cancer;   Head and Neck Cancer;   Head and Neck Neoplasms;   Metastatic Cancer
Interventions:   Drug: Durvalumab;   Drug: Cetuximab
Sponsors:   Trisha Wise-Draper;   AstraZeneca
Recruiting

https://ift.tt/2Ri9jLs

A Study of Several Radiation Doses for Patients With Progression on Immunotherapy/Checkpoint Inhibitors

Conditions:   Metastatic Cancer;   Melanoma Cancer;   Lung Cancer;   Bladder Cancer;   Renal Cancer;   Head/Neck Cancers
Interventions:   Radiation: Stereotactic Body Radiotherapy;   Biological: checkpoint inhibitor
Sponsor:   Memorial Sloan Kettering Cancer Center
Recruiting

https://ift.tt/2IxYD7A

Dr. Kimishige Ishizaka 1926-2018 The discovery of IgE and the revolution in the study of allergic disease

Publication date: Available online 2 October 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Thomas A.E. Platts-Mills, Oscar Swineford

https://ift.tt/2Ix9wqp

Concordance of skin prick test and serum specific-IgE to locally produced-component-resolved diagnostics for cockroach allergy

Publication date: Available online 2 October 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Nitat Sookrung, Pichade Jotikaprasardhna, Chaweewan Bunnag, Wanpen Chaicumpa, Anchalee Tungtrongchitr

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Haematometrocolpos due to transverse vaginal septum with distal atretic vagina

Description 

A 15-year-old girl presented with cyclical pelvic, lower abdominal pain and cramping beginning at age 13. She had not yet had onset of menarche and no history of sexual intercourse. On examination, she presented with lower abdominal distension, which felt like a firm mass extending up to the umbilicus and into the pelvic cavity. Abdominal ultrasound showed an ectopic right kidney in the paramedian position at the level of the umbilicus. Ultrasound also showed a large midline cystic structure located between the urinary bladder and rectum, containing low-level homogenous echoes suggestive of blood products. MRI confirmed the ultrasound findings as it showed the endometrial, endocervical and vaginal canal were distended by low-signal material (T2 and short-tau inversion recovery). Images appeared hyperintense on T1W1, suggestive of haematometrocolpos due to a complete transverse vaginal septum at the level of the pubic symphysis, distal portion of vagina was atretic (

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Autoimmune autonomic ganglionopathy associated with Sjögrens syndrome presenting with recurrent abdominal distension

A 65-year-old woman with Sjögren's syndrome presented with recurrent abdominal distension, constipation, weight loss, orthostatic dizziness, loss of sweating and incomplete emptying of the bladder. Gastrointestinal dilatation but no evidence of malignancy or obstruction was found on CT of the abdomen, oesophagogastroduodenoscopy or colonoscopy. Postvoiding residual urine volume was increased. Antiganglionic acetylcholine receptor antibody was positive. We diagnosed as autoimmune autonomic ganglionopathy. The patient responded to corticosteroid treatment. One year after treatment, she continued to have mild gastrointestinal symptoms, but overall condition was stable without further intervention.

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Spontaneous rupture of a pancreatic pseudocyst

Description 

This is a case of a 50-year-old woman with medical history significant for chronic pancreatitis secondary to alcohol abuse who initially presented with a 3-week history of progressively worsening epigastric pain. The patient described the pain as sharp, radiating to the back, worsened with intake of both solid foods and liquids and relieved with self-induced emesis. On admission, the patient was hypertensive, but other vitals were within normal limits. The abdomen was soft; however, there is a firm palpable mass extending from the epigastric to the right and left upper quadrants. Labs were remarkable for hypokalaemia with potassium (K) 3 meq/L (normal range 3.5–4.9 meq/L), mildly elevated lipase 132 U/L (7–60 U/L) and an elevated alkaline phosphatase of 164 U/L (41–108 U/L). CT of the abdomen with contrast (figures 1 and 2) showed a large cystic structure measuring 12.9x21.2 cm directly adjacent to the body of the pancreas and...

https://ift.tt/2ICmhA5

Olmesartan-induced enteropathy

Olmesartan-induced enteropathy (OIE) typically presents with a constellation of signs and symptoms including chronic diarrhoea, weight loss and villous atrophy on biopsy. We describe a 68-year-old Caucasian woman with a history of hypothyroidism and hypertension who presented to our hospital with recurrent episodes of acute intermittent diarrhoea, nausea, vomiting, renal failure and 15 lbs weight loss. After an extensive workup, she was diagnosed with possible OIE. Cessation of the offending drug resulted in improvement of clinical symptoms and also hospital admissions for severe diarrhoea reinforcing the diagnosis of OIE. Among the adverse effects of drug therapy, diarrhoea is a relatively frequent adverse event accounting for about 7%. This report serves as an addition to existing literature and to increase the awareness of olmesartan-induced sprue-like enteropathy among the primary care physicians and gastroenterologists.

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Saccular internal carotid artery aneurysm masquerading as a pituitary macroadenoma

Description 

An 84-year-old woman presented to the emergency department with a 3-day history of progressive binocular diplopia on right-sided horizontal gaze, accompanied with gradual-onset right-sided periorbital headache, vomiting and diarrhoea. Medical history consisted of hypertension and chronic kidney disease, stage 2.

Clinical examination demonstrated right-sided VI cranial nerve palsy, normal pupillary light reaction, visual acuity and fields. No other neurological deficits elicited. No clinical features of hypercortisolism, growth hormone excess or adrenal insufficiency were displayed.

Initial blood tests revealed an acute-on-chronic kidney injury (AKI). Admission estimated glomerular filtration rate was 42 mL/min, baseline 74; admission creatinine 180 μmol/L, baseline 142. An urgent CT head, non-contrast in view of the AKI, was performed. Intravenous fluids were administered. CT revealed a 39x18x14 mm sellar mass, involving the pituitary fossa, extending into the left and right cavernous sinus, sphenoid sinus and posterior sella turcica.

On the next day, MRI of the pituitary (figure...

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Miliary tuberculosis and herpes pharyngitis after a trip to a developing country: dangers of biologics

The use of biologic drugs has expanded since its introduction in the late 1990s. With growing medical use and newer biologic drugs in development, opportunistic infections like Mycobacterium tuberculosis remain important adverse effects. It carries major public health concerns, yet evidence-based clinical guidelines for more routine interval screening in patients taking immunosuppressants and exposed to tuberculosis (TB) are lacking. We illustrate a case of an elderly Indian-born man living in the USA with psoriatic arthritis who was on adalimumab for 10 years. He presented with disseminated TB and herpes simplex virus type 1 (HSV-1) pharyngitis, a year after an innocuous trip to India. Our case draws attention to the adverse effects of biologic drugs and highlights the importance of regular rescreening for a high-risk population. As the use of biologic treatment increases, physicians must be vigilant in more frequent screening, monitoring and identifying related opportunistic infections, notably M. tuberculosis infections.

https://ift.tt/2xVAXpw

Ace the case: a 14-year-old with lower extremity weakness and blurry vision

Description 

A 14-year-old girl presented with progressive upper and lower extremity weakness. Symptoms started 5 months prior with intermittent bilateral calf pain coincident with onset of lower extremity weakness. Initial evaluation revealed normal complete blood count, complelete metabolic panel, inflammatory markers, muscle enzymes and MRI brain and spine with/without contrast. Electromyography demonstrated an acute to subacute polyradiculitis affecting the upper and lower extremities.

She was admitted for expedited evaluation. Examination was significant for lower extremity weakness and absent reflexes. Lumbar puncture (LP) showed lymphocytic pleocytosis and markedly elevated protein. Thorough infectious, oncological and rheumatological evaluations were all unremarkable. Most notable was that CSF Neuromyelitis Optica IgG and paraneoplastic antibody panel were negative, and serum ACE was normal. She was started on intravenous immunoglobulin for empiric treatment of chronic inflammatory demyelinating polyneuropathy (CIDP).

While hospitalised, she developed left eye blurred vision. Ophthalmological examination demonstrated bilateral optic nerve oedema. Repeat MRI...

https://ift.tt/2IwqwNr

Unusual and rare case of generalised lymphadenopathy: Kimuras disease

We report a case of Kimura's disease in a 65-year-old woman who presented with generalised itching, abdominal pain, facial puffiness, difficulty in swallowing and loss of appetite. She was found to have generalised lymphadenopathy and a fine-needle aspiration cytology initially done revealed 'reactive lymphadenitis' which was inconclusive. PET-CT done showed features suggestive of lymphoma. Hence, lymph node biopsy was done for confirmation and incidentally after immunohistochemistry staining it turned out to be Kimura's disease. High-dose steroid therapy was started and patient showed dramatic clinical and symptomatic improvement. Kimura's disease almost always presents as cervical lymphadenopathy and usually never causes compressive symptoms. Our patient presented with compressive symptoms and generalised lymphadenopathy which is a rarity.

https://ift.tt/2xRTW4e

Third-degree burns associated with transcutaneous pacing

A 69-year-old severely obese diabetic woman developed nausea, vomiting and diarrhoea which caused multiple metabolic alterations leading to hypotension and bradycardia due to slow atrioventricular junctional rhythm. Transcutaneous pacing (TCP) was initiated and maintained until the underlying heart rate and blood pressure normalised. TCP gel pads were kept in place prophylactically after pacing was terminated. Gel pads remained attached to the anterior thorax and back for a total of 36 hours. During this time the patient developed third-degree burns at the side of gel pad attachment. With appropriate wound care and after a long hospitalisation, the patient was discharged in stable condition. This case demonstrates that prolonged use of TCP gel pads without frequent replacement may lead to third-degree burns. It also suggest that prophylactic use of TCP gel pads should be avoided.

https://ift.tt/2IytReS

Dual ectopic thyroid gland

Description 

Ectopic thyroid tissue (ETT) occurs due to a disorder in the embryonic development of the thyroid gland with incomplete migration of the thyroid tissue from the median plate of the floor of the pharyngeal gut to its usual site. ETT is a rare entity, with an estimated prevalence of 1/100 000–300 000 in the general population, increasing to 1/4000–8000 in patients with thyroid dysfunction. The mechanisms responsible for thyroid morphogenesis have not yet been fully elucidated but certain transcription factors such as TITF1/NKX2-1, PAX8, HHEX or FOXE1 play a key role in this process. ETT mainly affects young women and is often asymptomatic.1 In 90% of the cases, ETT is located at the base of the tongue. The occurrence of two ectopic foci simultaneously is particularly rare.2 The authors present the case of a 30-year-old female patient under endocrinology's care due to autoimmune subclinical hypothyroidism. She...

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Giant right coronary artery aneurysm complicated by a fistula to the right atrium, mimicking a ruptured sinus of Valsalva aneurysm

Patients with a coronary aneurysm alone do not generally exhibit continuous murmurs; however, murmurs may be detected in the presence of a fistula. A 57-year-old woman with chest pain was referred to us with a suspected diagnosis of a ruptured sinus of Valsalva aneurysm owing to the presence of a continuous murmur that was detected on physical examination. However, CT revealed a giant right coronary artery aneurysm draining into the right atrium. Consequently, surgery was performed. This case highlights the importance of implementing multiple imaging modalities for adequate differential diagnoses of patients presenting with continuous murmurs.

https://ift.tt/2IytJMq

Beliefs and reality of e-cigarette smoking

In this global health case study, we describe a case of nicotine addiction due to chronic use of electronic cigarettes (e-cigarette) and discuss the beliefs on safety and awareness of their side effects. Many people believe that smoking an e-cigarette (vaping) does not have any side effects, especially among teenagers and young adults. Teenagers using an e-cigarette at a young age are twice as likely to try cigarettes later in their life because of nicotine dependency or other social factors. More recent studies have shown long-term systemic side effects of vaping regardless of traditional cigarette smoking history. This report was done for further assessing their risk and to clear out misconceptions of this large-scale condition.

https://ift.tt/2y0VXeT

Advancement of the Harrington technique for reconstruction of pathological fractures of the acetabulum

A 59-year-old man presented with hip pain secondary to metastatic prostate carcinoma affecting multiple sites, including his left acetabulum. The patient's prognosis was good, he was active, independent, with a good quality of life, so was offered surgical reconstruction. The Harrington method involves passing metal rods from the ileum to the ischium and pubis to create a scaffold for hip replacement. This is the gold standard for reconstruction of acetabular metastatic defects. However, this method is prone to failure by medialisation of the construct in the long term. We present our technique of employing a novel modification to the Harrington reconstruction that offers additional support medially with a suprapectineal plate. This construct is strong and durable enough to facilitate immediate weight-bearing and prevent long-term medialisation.

https://ift.tt/2IyIEpI

Troubleshooting a dialysis line: when blue runs red

We present the case of a critically ill woman whose dialysis line was noted to be circulating bright red blood. Located in the right internal jugular vein, the line had previously been working normally with the change occurring shortly after the patient was liberated from positive pressure mechanical ventilation. An arterial malposition was ruled out and subsequent investigations revealed the presence of a left-sided partial anomalous pulmonary venous connection (PAPVC) that had been previously undiagnosed. The identification of a left-sided PAPVC from blood gas measurements taken from a right internal jugular vein dialysis catheter in this case provides an informative opportunity to consider the intricate physiological relationship between the respiratory and cardiovascular systems in critically ill patients requiring invasive procedures and treatments.

https://ift.tt/2xPaolW

Ehrlichiosis masquerading as thrombotic thrombocytopenic purpura

Ehrlichiosis is a rare tickborne illness that can manifest from an asymptomatic, self-limiting disease to a severe presentation with encephalopathy and renal failure. Ehrlichiosis is diagnosed largely based on patient history with confirmatory tests including peripheral blood smear, serology and PCR. Empiric treatment is warranted in patients with suspected tick bites as a delay in treatment can result in multiorgan failure. We discuss a case of ehrlichiosis that presented with the classic pentad of thrombotic thrombocytopenic purpura (TTP). A history of a tick bite was elicited and intravenous doxycycline 100 mg two times a day was initiated. Tick panel results revealed a positive Ehrlichia chaffeensis IgG and IgM titres, consistent with human monocytic ehrlichiosis. Autoimmune workup and antibodies to Borreliaburgdorferi were negative, and ADAMTS13 activity assay results were inconsistent with TTP. The patient completed 14 days of intravenous doxycycline and had an uneventful recovery.

https://ift.tt/2IyIu1A

Diabetic ketoalkalosis: misnomer or undiagnosed variant of diabetic ketoacidosis

Usually, hyperglycaemia crisis presents with acidotic pH, but ketoalkalosis is a rare and unheard entity presenting in diabetic ketoacidosis. We describe three unique cases where the patients present with hyperglycaemia >250 mg/dL, normal or alkalotic pH, and bicarbonate >20 meq/L, which does not meet criteria for diabetic ketoacidosis. However, once these patients were supplemented with intravenous fluids, diagnosis of diabetic ketoacidosis was evident in laboratory analysis. These case series provide a learning opportunity in diagnosing and management of this rare phenomenon.

https://ift.tt/2xRXKmq

Pancake kidney: an incidental finding in a young man

Description 

An 18-year-old man presented to the surgery emergency department with signs and symptoms of acute intestinal obstruction. There was a previous history of exploratory laparotomy for intestinal obstruction 8 years ago. Abdominal examination revealed a healthy transverse scar in the right lumbar region extending to the umbilical region, abdominal distension and no tenderness or guarding. The patient was managed conservatively by nasogastric tube decompression and intravenous fluids support. A contrast-enhanced computed tomography (CECT) of the abdomen was done. The patient responded well to the conservative management, and the intestinal obstruction was relieved. The CECT abdomen reported an ectopic location of bilateral kidneys, lying in the lower abdomen. The kidneys were para-median in location and extending between L4 and S2 vertebrae. Upper and mid-pole of both kidneys were fused across the midline (figures 1 and 2). No evidence of any calculus or hydronephrosis was seen. Opacification of bilateral...

https://ift.tt/2IAZEfi

First-line ibrutinib for Bing-Neel syndrome

The authors present a case of an elderly man with a history of Waldenstrom macroglobulinaemia in remission who presented with progressively worsening gait abnormalities and falls for several months. His examination was notable for bilateral lower extremity weakness and an unsteady gait. Brain and spinal MRI showed focal leptomeningeal enhancement in the brain and spinal column. Lumbar puncture was performed and cerebrospinal fluid flow cytometry demonstrated a monoclonal CD5/CD10-negative, CD20-positive B-cell lymphocyte population consistent with a diagnosis of Bing-Neel syndrome. He was started on ibrutinib, an oral Bruton's tyrosine kinase inhibitor, and had marked improvement in his weakness and gait. Repeat imaging 2 months after starting ibrutinib showed improvement in his leptomeningeal enhancement. During subsequent follow-up, he continued to tolerate ibrutinib and had a sustained clinical response.

https://ift.tt/2xRTUt8

Case of pneumomediastinum due to alveolar rupture following endotracheal intubation

Description 

A 57-year-old woman presented to the outpatient department with complaints of shortness of breath and fever for the past 2 days. She had no known comorbidities. She was admitted in intensive care unit (ICU) in view of type 1 respiratory failure. Initial chest X-ray showed bilateral lower zone non-homogenous opacity (figure 1A). She was initially managed with antibiotics and non-invasive ventilation. However, due to worsening respiratory failure and metabolic acidosis, patient was intubated. Postintubation, patient was connected to a ventilator in volume control mode with fraction of inspired oxygen of 90%, Positive end expiratory pressure (PEEP) of 10, tidal volume of 350 mL, respiratory set rate of 20 and the ratio of duration of inspiration to the duration of expiration (I:E ratio) of 1:3.3. Chest X-ray repeated following intubation showed features suggestive of pneumomediastinum (figure 1B). The CT thorax done post intubation showed pneumoprecardium (

https://ift.tt/2IyIej8

Pigmentary retinopathy in Kearns-Sayre syndrome

Description 

An 11-year-old girl with moderate ptosis and chronic progressive ophthalmoplegia (figure 1) was referred for retinal evaluation in view of nyctalopia. Visual acuity on presentation was 20/40 OU. Slit-lamp examination revealed a normal anterior segment. There was no similar family history. Multicolour scanning laser photographs (figure 2A, B) showed retinal pigment granularity in OU that was better appreciated on autofluorescence imaging as speckled hypoautofluorescence and hyperautofluorescence (figure 2C, D). Horizontal spectral domain optical coherence tomography scans through fovea revealed hyper-reflective deposits above the retinal pigment epithelium (figure 2E, F). Systemic workup revealed the gross motor weakness of both upper and lower limbs, mild hearing loss and no cardiac conduction defects. The patient was referred to a paediatric neurologist for further evaluation. Cerebrospinal fluid tap was done which showed elevated lactate (3.10 mg/dL) and protein levels (96 mg/dL). ECG showed no conduction blocks. A muscle biopsy showed...

https://ift.tt/2xVATWO

Micropapular Cutaneous Sarcoidosis Reviewed

Background: Micropapular cutaneous sarcoidosis (MPCS) is a rare variant of sarcoidosis. Herein we review the literature and include a recent case of MPCS discussing pathogenesis, diagnosis, treatment, and prognosis. Method: A review was conducted using the terms "micropapular sarcoidosis" and "micropapular sarcoid." A recent case of a 50-year-old male patient with biopsy-identified MPCS was also included in the review. Results: In total, 12 cases with an aggregate of 18 patients were included in the review. Presentation among all patients was consistent, with scattered, occasionally pruritic, faintly erythematous shiny white papules. Skin biopsy demonstrated noncaseating granulomas. Systemic prednisone, oxytetracycline, and hydroxychloroquine, as well as topical betamethasone, were used for therapy. Conclusion: In our review there does not seem to be a clear link as to the definite cause of the MPCS. While the relationships to tuberculosis and autoimmunity seem to be often emphasized, there was no clear association with either etiology.
Dermatology

https://ift.tt/2RhSP62

Anaesthesia and Perioperative Care for Transoral Robotic Surgery

Minimally invasive surgical techniques have gained increasing interest in recent years for their conferred recovery and postoperative advantages. Robot-assisted surgery requires special consideration for anaesthetic and perioperative management. The introduction of robot- assisted intra-oral surgery has important implications on anaesthesia provision, airway management and patient safety. Due to its relatively novel use we explore these considerations alongside our own experience in this field.
ORL 2018;80:125–133

https://ift.tt/2DQxQou

Pediatric Head and Neck Fibrosarcomas: A Demographical, Treatment, and Survival Review and Review of a Rare Case

Publication date: Available online 2 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Tyler A. Janz, Ramamoorthy Nagasubramanian, Julie L. Wei

Abstract

Objective

To examine pediatric head and neck fibrosarcoma cases and review the demographics, management, and survival for these patients.

Methods

Pediatric patients in the Surveillance, Epidemiology, and End Results (SEER) database were included from 1973-2014 based on a diagnosis of a head and neck fibrosarcoma using ICD-O-3 head and neck primary sites and histology codes. Patients were included from ages 0-18 years. Additionally, a pediatric case of a head and neck infantile fibrosarcoma treated at the Nemours Children's hospital in Orlando, Florida is presented.

Results

One hundred-thirteen pediatric head and neck fibrosarcomas were identified within the SEER database over the study period. The mean age at diagnosis was 9.8 years (SD: 6.2, range: 0.0-18.0). The mean age at diagnosis for infantile fibrosarcomas was 1.7 years (SD: 3.2, range: 0.0-12.0). Fifty-one (45.1%) patients were female. A majority (N=67, 59.3%) of patients had dermatofibrosarcoma followed by 18 (15.9%) who had infantile fibrosarcomas. Nearly all patients (N=107, 94.7%) received surgical intervention. 27.5% of patients with an infantile fibrosarcoma received chemotherapy as a part of their care compared to 1.5% of patients with a dermatofibrosaroma (p=.004). The 5-year disease-specific survival was 97%.

Conclusions

and Relevance: Pediatric patients with head and neck fibrosarcomas are most likely to present in Caucasian males or female during late childhood or early adolescence. Infantile fibrosarcomas present in pediatric patients at a much earlier age. Surgical management is common for pediatric head and neck fibrosarcomas. Additionally, chemotherapy may be used for infantile fibrosarcomas of the head and neck. Survival rates for pediatric patients with a head and neck fibrosarcoma are excellent.

https://ift.tt/2IwpMrF

Endoscopic Cricopharyngeal Myotomy in Infants

Publication date: Available online 2 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Keith J. Basler, Catherine Swanson, Steven M. Andreoli

Abstract

Cricopharyngeal achalasia is a rare cause of dysphagia in young children. Conservative treatments involve medical therapy and serial dilations or injections. Definitive cure can be achieved with cricopharyngeal myotomy. We report two cases of young children, each less than one year of age, who underwent endoscopic laser-assisted cricopharyngeal myotomy. Following surgery, both infants were able to advance to age appropriate diets prior to discharge. Post-operative modified barium swallow demonstrated complete resolution of achalasia in both patients. To the best of our knowledge, this is the first case series of infants undergoing successful endoscopic cricopharyngeal myotomy.

https://ift.tt/2NUvIjY

Autologous Cartilage Microtia Reconstruction: Complications and Risk Factors

Publication date: Available online 2 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Yao-yao Fu, Chen-long Li, Jun-li Zhang, Tian-yu Zhang

Abstract

Background

The Brent or Nagata techniques of microtia reconstruction and their modifications involve complicated frameworks; therefore, complications are inevitable. The authors aimed to provide comprehensive knowledge regarding the occurrence, development, prognosis, risk factors, and treatment of complications.

Methods

This study was a retrospective review of patients who underwent autologous cartilage microtia reconstruction at a single auricular plastic and reconstructive center between March 2005 and June 2016. Custom database software was used to process data from patients with microtia. Details of postoperative complications were collected during follow-up for analysis.

Results

A total of 470 procedures (stage I) were performed on 429 patients. The mean (±SD) age at surgery was 12.27±5.01 years (range, 6–32 years). The mean time to follow-up was 3.67±2.45 years (range, 1–11 years). The complication rate was 2.98% (4/134) with the Brent technique and 12.2% (38/311) with the Nagata technique. A multivariate logistic regression analysis of complications of microtia reconstruction revealed that age, sex, and laterality were not associated with postoperative complications (p > 0.05). Surgical technique affected the incidence of complications. The Nagata technique resulted in a higher risk for complications (OR 6.14 [95% CI 1.63–23.19]; p < 0.01).

Conclusion

The development of complications was a dynamic process. There was a learning curve associated with autologous cartilage microtia reconstruction. Orthopedists or otologists aspiring to master microtia reconstruction should have a fundamental understanding of the procedure and be aware of possible complications.

https://ift.tt/2IwoSeL

Versatility of iron-rich steel waste for the removal of high arsenic and sulfate concentrations in water

Abstract

The aim of this work is to evaluate the application of a steel waste, basic oxygen furnace sludge (BOFS), rich in iron, to treat water contaminated with elevated arsenic and sulfate concentrations. In the first step, three doses (10, 60, and 80 g L⁻¹) of BOFS were tested to investigate the removal of As(III) and As(V) (67 mg L⁻¹) and sulfate (3700 mg L⁻¹) separately from an aqueous solution. In the second step, the efficacies of BOFS (10 g L⁻¹) and commercial ZVI (5 g L⁻¹) were compared to simultaneously remove arsenic and sulfate. The pH of the feed solution was adjusted to 2.5 and monitored during the experiment. The use of BOFS achieved arsenic removal up to 92% and sulfate removal of nearly 40% after 72 h of contact time. Use of BOFS also increased the solution pH to 12. Similar removal levels were achieved with both BOFS and ZVI. These results confirm the potential application of BOFS to remove high arsenic and sulfate concentrations from acidic solutions. The data obtained here should be used as a basis for further studies on the remediation of acid mine drainage with high concentrations of arsenic and sulfate using an abundant and low-cost steel waste.

https://ift.tt/2zKMTvC

NMR characterizing mixed wettability under intermediate-wet condition

Publication date: Available online 2 October 2018

Source: Magnetic Resonance Imaging

Author(s): Jie Wang, Lizhi Xiao, Guangzhi Liao, Yan Zhang, Yushi Cui, Zhe Sun, Yu Dong, Lin Hu

Abstract

Applying the concept of effective relaxivity to characterize wettability is based on the configuration of fluid distributions in porous media. However, in mixed-wet porous media with intermediate-wet patches (homogeneous wetting region), effective surface relaxivity cannot fully characterize wettability because fluid distributions are not directly corresponding to wetting patch distributions. Patches with different wettability interact with the same fluid differently, which leads to different surface relaxivity. The distribution of this kind surface relaxivity from porous media saturated with single fluid matches mixed wettability distribution. Here, we apply decay due to diffusion in internal field plus Carr-Purcell-Meiboom-Gill (DDIF-CPMG) method to obtain T₂ and the pore size distribution correlation. The variation of surface relaxivity obtained from the correlation map is used to characterize wettability distributions of mixed-wet porous media. In this paper, we also redefine a parameter based on surface relaxivity distribution to evaluate mixed wettability under intermediate-wet condition. The experiment results with limestones show that, after wettability alteration of the sample, the distribution of the surface relaxivity is changed and closely correlated with pore size distribution, which demonstrates the features of mixed wettability under intermediate-wet conditions.

https://ift.tt/2ygvOrN

Dynamics of ionic liquids in poly(vinyl alcohol) porous scaffold. Low field NMR study

Publication date: Available online 1 October 2018

Source: Magnetic Resonance Imaging

Author(s): Carlos Mattea, Bulat Gizatullin, Siegfried Stapf

Abstract

In this study molecular dynamics of ionic liquids in poly(vinyl alcohol) scaffolds were investigated. The binary poly(vinyl alcohol) – ionic liquid (PVA-IL) compound was prepared from initial solutions of water, ionic liquid (IL) and poly(vinyl alcohol) (PVA) at different concentrations. Subsequently water was evaporated under open conditions, leaving the scaffold/IL system of interest. Low field nuclear magnetic resonance (NMR) relaxation and diffusion measurements, as well as 2D T₁-T₂ correlated NMR experiments were performed to determine specific local and translational dynamics properties at different time scales. Data suggest that during water evaporation, partial demixing of IL from the polymeric matrix leaves the remaining solvent confined in the porous structure formed by the PVA polymer. The results show that the translational diffusion, as well as the local rotational molecular dynamics is comparable to the bulk liquid state. Moreover, in partial saturation conditions, diffusion shows enhancements relative to the bulk.

https://ift.tt/2Rlrd0b