Head and Neck Diseases by Alexandros G.Sfakianakis: 04/07/17

Παρασκευή 7 Απριλίου 2017

Ten-year survival outcomes for patients with nasopharyngeal carcinoma receiving intensity-modulated radiotherapy: An analysis of 614 patients from a single center

Publication date: June 2017
Source:Oral Oncology, Volume 69
Author(s): Li-Rong Wu, Ya-Tian Liu, Ning Jiang, Yan-Xin Fan, Jing Wen, Sheng-Fu Huang, Wen-Jie Guo, Xiu-Hua Bian, Fei-Jiang Wang, Feng Li, Dan Song, Jian-Feng Wu, Xue-Song Jiang, Ju-Ying Liu, Xia He
ObjectivesIntensity-modulated radiotherapy (IMRT) has been applied in nasopharyngeal carcinoma (NPC) for nearly twenty years, while little is known about the ten-year survival outcomes. This study aimed at evaluating the 10-year survival outcomes for patients with NPC receiving IMRT.Materials and methodsData on 614 patients with newly diagnosed, non-disseminated NPC treated by IMRT between 2004 and 2008 were retrospectively reviewed. Survival outcomes stratified by tumor stage were compared.ResultsThe median follow-up duration was 112.7months (range, 7.6–156.8months) for the entire cohort. The 10-year local relapse-free survival rates for T1, T2 and T3 were 94.2%, 92.5% and 91.4% (P>0.05), respectively, and significantly higher than that of T4 disease (79.3%, P<0.05 for all rates). As N category increased from N0 to N3, the 10-year distant metastasis-free survival rates significantly decreased accordingly (P<0.01 for all rates). Furthermore, the 10-year overall survival rates were 100%, 87.1%, 75.5% and 55.6% for stage I, II, III and IV, respectively (P<0.05 except stage I and II). Multivariate analysis established tumor stage and age as independent prognostic factors. Late toxicities were assessable for 495 (80.6%) patients and most were Grade I/II damages. Xerostomia (387 of 489, 79.1%) and hearing impairment (212 of 495, 42.8%) remained the most troublesome.ConclusionIMRT could achieve satisfactory survival outcomes for NPC patients with acceptable late toxicities. However, distant control still remains poor, especially for patients with N3 disease.

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Viral Reactivations and Associated Outcomes in Context of Immune Reconstitution after Pediatric Hematopoietic Cell Transplantation

Publication date: Available online 7 April 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Rick Admiraal, Coco de Koning, Caroline A. Lindemans, Marc B. Bierings, Annemarie M.J. Wensing, A. Birgitta Versluys, Tom F.W. Wolfs, Stefan Nierkens, Jaap Jan Boelens
BackgroundViral reactivations (VR) following hematopoietic cell transplantation (HCT) contribute to significant morbidity and mortality. Timely immune reconstitution (IR) is suggested to prevent VR.ObjectivesWe studied the relation between IR (as a continuous over-time-predictor) and VR (as time-varying-predictor), and the relation between VR and other clinical outcomes.MethodsIn this retrospective analysis, all patients receiving a first HCT between January-2004 and September-2014 were included. IR (CD3/CD4/CD8 T-cells, NK- and B-cells) was measured bi-weekly until 12 weeks, and monthly thereafter. Main outcomes of interest were VR of adenovirus (AdV), Epstein-Barr-virus (EBV), human-herpesvirus 6 (HHV6), cytomegalovirus (CMV), and BK-virus, screened weekly. Clinical outcomes included overall-survival (OS), event-free-survival, non-relapse-mortality (NRM), and graft-versus-host-disease (GvHD). Cox-proportional-hazard- and Fine-Gray-competing-risk-models were used.Results273 patients (0.1-22.7 years; median follow-up 58 months) were included. Delayed CD4-reconstitution predicted reactivation of AdV (HR 0.995; p=0.022), EBV (HR 0.994, p=0.029), and HHV6 (HR 0.991, p=0.012), but not CMV (p=0.31) and BK (p=0.27). Duration of AdV-reactivation was shorter with timely CD4-reconstitution, defined as ≥50*10⁶ cells/L within 100-days. AdV-reactivation predicted lower OS (HR 2.17, p=0.0039) and higher NRM (HR 2.96, p=0.0008). Concomitant CD4-reconstitution abolished this negative effect of AdV-reactivation: OS (p=0.67) and NRM (p=0.64). EBV- and HHV6-reactivations were predictors for occurrence of GvHD, while CMV- and BK-reactivations did not predict clinical outcomes.ConclusionThese results stress the importance of timely CD4-reconstitution. Strategies to improve CD4-reconstitution may improve HCT-outcomes, including survival, and reduce the need for toxic anti-viral therapies.

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Outcome of Hematopoietic Cell Transplantation for DNA-Double Strand Breakage Repair Disorders

Publication date: Available online 7 April 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): James Slack, Michael H. Albert, Dmitry Balashov, Bernd H. Belohradsky, Alice Bertaina, Jack Bleesing, Claire Booth, Jochen Büchner, Rebecca H. Buckley, Marie Ouachée-Chardin, Elena Deripapa, Katarzyna Drabko, Mary Eapen, Tobias Feuchtinger, Andrea Finocchi, H Bobby Gaspar, Sujal Ghosh, Alfred Gillio, Luis I. Gonzalez-Granado, Eyal Grunebaum, Tayfun Güngör, Carsten Heilmann, Merja Helminen, Kohei Higuchi, Kohsuke Imai, Krzysztof Kalwak, Nubuo Kanazawa, Gülsün Karasu, Zeynep Y. Kucuk, Alexandra Laberko, Andrzej Lange, Nizar Mahlaoui, Roland Meisel, D. Moshous, Hideki Muramatsu, Suhag Parikh, Srdjan Pasic, Irene Schmid, Catharina Schuetz, Ansgar Schulz, Kirk R. Schultz, Peter J. Shaw, Mary A. Slatter, Karl-Walter Sykora, Shinobu Tamura, Mervi Taskinen, Angela Wawer, Beata Wolska-Kuśnierz, Morton J. Cowan, Alain Fischer, Andrew R. Gennery
BackgroundRare DNA breakage-repair disorders predispose to infection and lympho-reticular malignancies. Hematopoietic cell transplantation (HCT) is curative but co-administered chemo- or radio-therapy is damaging due to systemic radio-sensitivity. We collected HCT outcome data for Nijmegen Breakage syndrome (NBS), DNA ligase IV deficiency (LIG4), Cernunnos-XLF deficiency and ataxia-telangiectasia.MethodsData from 38 centres worldwide, including indication, donor, conditioning regimen, graft-versus-host disease (GvHD) and outcome were analyzed. Conditioning was classified as myeloablative (MAC) if it contained radiotherapy or alkylators and reduced intensity (RIC) if no alkylators and/or fludarabine ≤150 mg/m² and cyclophosphamide ≤ 40 mg/kg were used.Results55 new, 14 updated and 18 previously published patients were analyzed. Median age at HCT was 48 (range 1.5 – 552) months. 29 were transplanted for infection, 21 malignancy, 13 bone marrow failure, 13 pre-emptively, 5 had multiple indications, and 6 had no information. 22 received MAC, 59 RIC, 4 were infused;- information unavailable for 2. 73/77 patients with LIG4, Cernunnos-XLF deficiency or NBS received conditioning. Survival was 53/77 (69%), worse for MAC than RIC (p=0.006). Most deaths occurred early post-transplant suggesting poor tolerance of conditioning. Survival in ataxia-telangiectasia patients was 25%. 41/83 patients experienced aGvHD (49%): less in RIC compared to MAC, 26/56 (46%) vs 12/21 (57%) (p=0.45). Median follow-up was 35 (range 2-168) months. No secondary malignancies were reported during 15 years follow-up. Growth and developmental delay remained post-HCT; immune-mediated complications resolved.ConclusionRIC-HCT resolves DNA repair disorder-associated immunodeficiency. Long-term follow-up is required for secondary malignancy surveillance. Routine HCT for ataxia-telangiectasia is not recommended.

Teaser

Hematopoietic cell transplant cures DNA breakage-repair disorders. Cernunnos-XLF deficiency, LIG4 and Nijmegen breakage syndrome patients receiving alkylator or radiotherapy pre-conditioning have worse survival than those receiving reduced intensity conditioning.

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Interplay Between the Skin Barrier and Immune Cells in Patients with Atopic Dermatitis Unraveled by Means of Mathematical Modeling

Publication date: Available online 7 April 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): David Bending, Masahiro Ono

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Is IL-1β inhibition the next therapeutic target in asthma?

Publication date: Available online 8 April 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): R. Stokes Peebles

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Masseteric Nerve for Gracilis Muscle Re-Innervation in Unilateral Facial Palsy: Impact on Quality of Life

Unilateral established or congenital facial palsies are usually treated with neuromuscular transplantation to reanimate the impaired side of the face. One of the most debated points is the motor nerve to choose for the reinnervation of the transplant. Contra-lateral healthy facial nerve is usually preferred, but in selected cases motor nerve to masseter is considered a valuable option. However only a few clinical studies focused on quality of life in this subset of patients are available in literature.

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The effect of early fusion of the spheno-occipital synchondrosis on midface hypoplasia and obstructive sleep apnea in patients with Crouzon syndrome

he investigators hypothesized that patients with Crouzon syndrome and premature fusion of the spheno-occipital synchondrosis (SOS) more often have, or have more severe midface hypoplasia and obstructive sleep apnea (OSA).

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Is fine-needle aspiration a reliable tool in the diagnosis of malignant salivary gland tumors?

Salivary gland tumors occur very infrequently. In the Western world they have an annual incidence of 2.5–3 cases per 100,000 people. 1They are divided into major gland (parotid, submandibular and sublingual) and minor gland neoplasms. Histologically, this is a heterogeneous group of tumors, with several different patterns that often overlap, making differentiation between benign and malignant nature difficult.2, 3

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Taking the endochondral route to craniomaxillofacial bone regeneration: A logical approach?

The current golden standard for treatment of craniomaxillofacial critical size bone defects, autologous bone grafting,is associated with several disadvantages which have prompted an increased demand for alternatives. New solutions are emerging in the form of bone tissue engineering. This involves harvesting of multipotent mesenchymal stromal cells (MSCs), after which they can be differentiated towards the osteogenic lineage mimicking intramembranous bone formation. However, translating this approach from laboratory to clinic has met with limited success.

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Efficacy of Voice Therapy for Patients With Early Unilateral Adductor Vocal Fold Paralysis

Although a variety of therapeutic techniques have been suggested for patients with unilateral adductor vocal fold paralysis (UAVFP), they were not aimed specifically at determining the efficacy of early intervention for these patients. The purposes of this study are to explore a protocol of voice therapy and to investigate its efficacy in voice therapy for patients with early UAVFP. A 12-week planned voice therapy protocol, including vocal function exercise, hard attack, and resonance voice therapy, was given to 10 patients within 6 months of initial diagnosis.

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Does Even Low-Grade Dysphonia Warrant Voice Center Referral?

Data regarding the referral of dysphonic patients to specialty voice clinics are limited. The objective of this study is to examine the relationship between low perceptual dysphonia severity and subtle laryngeal findings to discern if this can help guide referral.

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Proposal for a new bone marker for maxillofacial surgery

The use of ink or dye to outline surgical approaches on the skin is common in plastic and reconstructive operations.1 However, marking bone with ink or dye before an osteotomy is difficult because of the need for irrigation. Some surgeons use burs, which we do not recommend, because it could compromise thin bones, it is time consuming, and irreversible.2

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Non-contrast MRI diagnosis of adhesive capsulitis of the shoulder

Publication date: Available online 7 April 2017
Source:Clinical Imaging
Author(s): Andrew S. Chi, John Kim, Suzanne S. Long, William B. Morrison, Adam C. Zoga
PurposeTo investigate non-contrast MRI findings of clinical adhesive capsulitis.Methods31 non-contrast, non-arthrographic, shoulder MRIs were evaluated for coracohumeral ligament thickness, rotator interval infiltration, and axillary recess thickening/edema.ResultsIn detection of adhesive capsulitis, sensitivity is 76.7% and specificity is 53.3% for coracohumeral ligament thickening, sensitivity is 66.7% and specificity is 55.2% for coracohumeral ligament thickening and rotator interval infiltration, and sensitivity is 23.3% and specificity is 86.7% for coracohumeral ligament thickening, rotator interval infiltration, and axillary recess thickening/edema.ConclusionsAdhesive capsulitis can be accurately diagnosed on non-contrast MRI shoulder examinations with appropriate clinical criteria without direct MR arthrography.

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Low dose computed tomography pulmonary angiography protocol for imaging pregnant patients: Can dose reduction be achieved without reducing image quality?

Publication date: Available online 7 April 2017
Source:Clinical Imaging
Author(s): Darragh Halpenny, Brian Park, Jeffrey Alpert, Larry Latson, Nancy Kim, James Babb, Maria Shiau, Jane Ko
ObjectiveTo assess the effect of low dose computed tomography pulmonary angiography (CTPA) on radiation dose in pregnant patients.Materials and methodsAn old CTPA protocol for pregnant patients was compared to a new protocol. Protocol changes included: decreased kVp; increased contrast injection rate; imaging after shallow inspiration. Patients undergoing CTPA before (phase 1 group) or after (phase 2 group) the protocol change, were assessed.ResultsEffective dose was lower in the phase 2 group (0.95 v 1.66 mSv; p<0.001). Quantitative noise was lower in the phase 1 group (p<0.001).ConclusionLow dose CTPA tailored for pregnancy reduces dose in pregnant patients.

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Efficacy of tofacitinib for the treatment of nail psoriasis: Two 52-week, randomized, controlled phase 3 studies in patients with moderate-to-severe plaque psoriasis

Tofacitinib is an oral Janus kinase inhibitor. Efficacy and safety of tofacitinib in patients with moderate-to-severe plaque psoriasis have been demonstrated.

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The effectiveness of treatments for androgenetic alopecia: A systematic review and meta-analysis

Androgenetic alopecia, or male pattern hair loss, is a hair loss disorder mediated by dihydrotestosterone, the potent form of testosterone. Currently, minoxidil and finasteride are Food and Drug Administration (FDA)–approved, and HairMax LaserComb, which is FDA-cleared, are the only treatments recognized by the FDA as treatments of androgenetic alopecia.

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Multiple hyperthermia-mediated release of TRAIL/SPION nanocomplex from thermosensitive polymeric hydrogels for combination cancer therapy

Publication date: July 2017
Source:Biomaterials, Volume 132
Author(s): Zhi-Qiang Zhang, Soo-Chang Song
Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) possesses strong anti-cancer potential because of its ability to specifically kill cancer cells. However, clinical use of TRAIL is impeded by its short in vivo half-life and native TRIAL-resistant cancer cell populations. To overcome these limitations, we designed a multiple magnetic hyperthermia (MHT)-mediated TRAIL release system for combination therapy using an injectable, biodegradable and thermosensitive polymeric hydrogel. In this system, positively charged TRAIL and hydrophobic superparamagnetic iron oxide nanoparticles (SPIONs) are complexed with negatively charged poly(organophosphazene) polymers via ionic and hydrophobic interactions, respectively. Transmission electron microscopy images showed a nano-sized core-shell structure of the TRAIL/SPION polymeric nanocomplex in aqueous solution that transformed into a hydrogel at body temperature. Hyperthermia can enhance the release of TRAIL from hydrogels through temperature-sensitive hydrogel dissolution. TRAIL-resistant U-87 MG cells were killed by the combination of TRAIL and multiple hyperthermia via caspase-3 and -8 active apoptosis. The hyperthermia-enhanced cytotoxicity of TRAIL was dependent on the hyperthermia cycle number and corresponding TRAIL release. Significant in vivo tumor reduction was observed by combining 2 cycles of mild MHT and TRAIL release using a single injection of TRAIL/SPION nanocomplex hydrogels without damage to main organs. Furthermore, the therapeutic outcomes can be monitored by long-term magnetic resonance imaging.

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Molecular imaging based on metabolic glycoengineering and bioorthogonal click chemistry

Publication date: July 2017
Source:Biomaterials, Volume 132
Author(s): Hong Yeol Yoon, Heebeom Koo, Kwangmeyung Kim, Ick Chan Kwon
Metabolic glycoengineering is a powerful technique that can introduce various chemical groups to cellular glycan by treatment of unnatural monosaccharide. Particularly, this technique has enabled many challenging trials for molecular imaging in combination with click chemistry, which provides fast and specific chemical conjugation reaction of imaging probes to metabolically-modified live cells. This review introduces recent progress in molecular imaging based on the combination of these two cutting-edge techniques. First, these techniques showed promising results in specific tumor cell imaging for cancer diagnosis and therapy. The related researches showed the surface of tumor cells could be labeled with bioorthogonal chemical groups by metabolic glycoengineering, which can be further conjugated with fluorescence dyes or nanoparticles with imaging probes by click chemistry, in vitro and in vivo. This method can be applied to heterogeneous tumor cells regardless of genetic properties of different tumor cells. Furthermore, the amount of targeting moieties on tumor cells can be freely controlled externally by treatment of unnatural monosaccharide. Second, this sequential use of metabolic glycoengineering and click chemistry is also useful in cell tracking to monitor the localization of the inoculated therapeutic cells including chondrocytes and stem cells. This therapeutic cell-labeling technique provided excellent viability of chondrocytes and stem cells during the whole process in vitro and in vivo. It can provide long-term and safe therapeutic cell imaging compared to traditional methods. These overall studies demonstrate the great potential of metabolic glycoengineering and click chemistry in live cell imaging.

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Gingival esthetics and oral health-related quality of life in patients with cleft lip and palate

While the oral health-related quality of life (OHRQoL) is known to be reduced in patients with cleft lip and palate (CLP), its inter-dependency with the soft tissue characteristics of the CLP area remains unclear. This study aimed to evaluate the soft tissue characteristics in the treated cleft area in order to investigate whether gingival esthetics correlate with OHRQoL. Thirty-six patients with unilateral or bilateral CLP (46 cleft areas) were investigated after secondary/tertiary alveolar bone grafting and orthodontic/prosthetic implant treatment using an adapted score to rate gingival esthetics (clinical esthetic score, CES).

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Negatively regulation of tumor-infiltrating NK cell in clear cell renal cell carcinoma patients through the exosomal pathway.

Negatively regulation of tumor-infiltrating NK cell in clear cell renal cell carcinoma patients through the exosomal pathway.

Oncotarget. 2017 Mar 18;:

Authors: Xia Y, Zhang Q, Zhen Q, Zhao Y, Liu N, Li T, Hao Y, Zhang Y, Luo C, Wu X

Abstract
Natural killer cells are the key components in tumor immunity and defects in function are necessary for tumor immune escape. Emerging studies on tumor cell-derived exosomes have shown the biological significance in tumor microenvironment, but the underlying role of exosomes in regulating natural killer cells functions in clear cell renal cell carcinoma patients remains unknown. Firstly, we precisely characterized the phenotype and function of natural killer cells in clear cell renal cell carcinoma patients vs healthy controls. With an inhibitory phenotype, tumor-infiltrating natural killer cells exhibited poor cytotoxic capacity and deficient potential to produce cytokines compared with natural killer cells from tumor margin tissue and non-tumor tissue. Next, we revealed that primary tumor cells trigged natural killer cell dysfunction in an exosome-dependent manner. Interestingly, exosomes from primary tumor cells were preferentially enriched with TGF-β1 which acted as important mediator of natural killer cell functional deficiency. In vitro culture of exosomes induced natural killer cell dysfunction mediated by activation of the TGF-β/SMAD signaling pathway, and abrogated by knockdown TGF-β. Our data indicate that exosomes from clear cell renal cell carcinoma induce natural killer cells dysfunction by regulating the TGF-β/SMAD pathway to evade innate immune surveillance.

PMID: 28384121 [PubMed - as supplied by publisher]

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Autoimmune-related nasal septum perforation: A case report and systematic review.

Autoimmune-related nasal septum perforation: A case report and systematic review.

Allergy Rhinol (Providence). 2017 Mar 01;8(1):40-44

Authors: Guntupalli L, Patel K, Faraji F, Brunworth JD

Abstract
BACKGROUND: Inflammatory injury of nasal respiratory mucosa is a common feature of multisystem autoimmune disease. Certain autoimmune disorders are associated with nasal septum perforation (NSP). We performed a systematic review of the literature to better understand the association of NSP with specific autoimmune disorders. This is a case report of a 29-year-old woman with a history of arthralgia, autoreactive antibody titers, platelet dysfunction, and NSP. The constellation of symptoms and potential familial involvement indicated that the NSP in this patient was an early sign of an autoimmune disorder, an unknown autoimmune disorder, or a known disease with incomplete penetrance.
METHODS: A systematic review of the literature was performed by two independent reviewers. Relevant articles were reviewed, and data that pertained to autoimmune-related NSP were extracted and analyzed.
RESULTS: Overall, 140 cases of autoimmune-associated NSPs were reported. Granulomatosis with polyangiitis (48%), relapsing polychondritis (26%), and cocaine-induced midline lesions (15%) constituted 89.3% of the reported cases.
CONCLUSION: NSP is a potential sign of systemic disease. The identification of an NSP, especially in the context of other unexplained symptoms or workup suggestive of an autoimmune disorder, should prompt clinical evaluation for multisystem autoimmune disease with consideration of granulomatosis with polyangiitis, relapsing polychondritis, or cocaine-induced midline lesions.

PMID: 28381327 [PubMed]

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Intrasinus penetration of a silastic malar implant, which resulted in chronic sinusitis: A case report and literature review.

Intrasinus penetration of a silastic malar implant, which resulted in chronic sinusitis: A case report and literature review.

Allergy Rhinol (Providence). 2017 Mar 01;8(1):37-39

Authors: Kim LY, Schwartz JS, Tajudeen BA, Adappa ND, Palmer JN

Abstract
BACKGROUND: Malar augmentation is a common cosmetic procedure utilizing silastic materials. We describe an uncommon complication of a silastic implant eroding into the anterior maxillary sinus wall resulting in chronic rhinosinusitis (CRS).
METHODS: A literature review is presented describing the presentation, surgical management and outcome of this uncommon adverse event.
RESULTS: An 80 year old female with a history of bilateral cosmetic malar implants placed approximately 25 years ago presented to our office with a 4-5 month history of left-sided symptoms consistent with chronic sinusitis, and was found to have intrasinus penetration of her left malar implant. Only one other case series of 5 cases in 4 patients is reported in the literature.
CONCLUSIONS: Intrasinus malar implant migration is a rare complication of malar augmentation. The present experience suggests that removal of the offending foreign body often results in successful symptom resolution.

PMID: 28381326 [PubMed]

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Ossifying fibroma of the maxilla and sinonasal tract: Case series.

Ossifying fibroma of the maxilla and sinonasal tract: Case series.

Allergy Rhinol (Providence). 2017 Mar 01;8(1):32-36

Authors: Liu JJ, Thompson LD, Janisiewicz AM, Shibuya TY, Keschner DB, Garg R, Lee JT

Abstract
BACKGROUND: Head and neck ossifying fibroma (OF) is a rare, benign, locally aggressive, fibro-osseous tumor. The mandible is the most common site of involvement, followed by the maxilla, and, less frequently, the sinonasal cavities, orbit, skull base, and calvarium. In this study, we aimed to expand our understanding of this entity by presenting a case series of OF that involved the maxilla and sinonasal tract.
METHODS: A multicenter retrospective review was performed on all the patients with a diagnosis of OF from 2004 to 2013. Data were collected with respect to age, sex, clinical presentation, treatment, and outcome.
RESULTS: A total of 13 patients were identified. The mean age was 37 years, with a female predominance (69%). The maxillary sinus was most frequently involved site (46%). Eighty-five percent underwent open surgical resection. After a mean follow-up time of 47.3 months, three patients (23%) developed recurrent disease; all of whom were treated with an open approach.
CONCLUSION: OF of the maxilla and sinonasal tract is an uncommon clinicopathologic entity. Although a timely diagnosis may obviate the need for external approaches, open surgical resection is often still necessary for management of extensive lesions. Close follow-up and additional surgery may also be required to treat recurrent disease.

PMID: 28381325 [PubMed]

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Quality-of-life improvement after endoscopic sinus surgery in patients with obstructive sleep apnea.

Quality-of-life improvement after endoscopic sinus surgery in patients with obstructive sleep apnea.

Allergy Rhinol (Providence). 2017 Mar 01;8(1):25-31

Authors: Tajudeen BA, Brooks SG, Yan CH, Kuan EC, Schwartz JS, Suh JD, Palmer JN, Adappa ND

Abstract
BACKGROUND: There is preliminary evidence that patients with chronic rhinosinusitis (CRS) and comorbid obstructive sleep apnea (OSA) have reduced quality-of-life (QOL) improvements after functional endoscopic sinus surgery (FESS) compared with patients without OSA. The effect of OSA severity on QOL improvement after FESS is unknown.
OBJECTIVES: To better characterize the QOL improvement after FESS for patients with comorbid OSA and to assess whether QOL improvement is dependent on OSA severity.
METHODS: This multi-institution, retrospective cohort study evaluated adult patients with CRS who underwent FESS between 2007 and 2015. Preoperative, 1-month, 3-month, 6-month, and 1-year postoperative 22-Item Sino-Nasal Outcome Test scores were used to evaluate QOL. We compared patients without OSA with patients with stratified OSA based on the preoperative apnea-hypopnea index. A multilevel, mixed-effects linear regression model was used for the analysis.
RESULTS: Of 480 participants, 83 (17%) had OSA, and 47 of these patients had polysomnography results available for review. Both patients with OSA and patients without OSA reported significant QOL improvement after surgery (p < 0.0001) relative to baseline. In the unadjusted model, the subjects with OSA demonstrated a statistically worse outcome in 22-Item Sino-Nasal Outcome Test scores at each time point (2.4 points higher per time point, p = 0.006). When controlling for covariates, the adjusted model showed no difference in QOL outcome based on OSA status (p = 0.114). When stratified by OSA disease severity, the adjusted model showed no difference in the QOL outcome.
CONCLUSIONS: Patients with CRS and comorbid OSA had worse QOL outcomes after FESS; however, when controlling for patient factors, there was no difference in QOL outcome. OSA disease severity did not seem to predict QOL improvement after FESS.

PMID: 28381324 [PubMed]

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Flexible microsensor technology for real-time navigation tracking in balloon sinus ostial dilation.

Flexible microsensor technology for real-time navigation tracking in balloon sinus ostial dilation.

Allergy Rhinol (Providence). 2017 Mar 01;8(1):20-24

Authors: Lam K, Bigcas JL, Luong A, Yao W, Citardi MJ

Abstract
BACKGROUND: Microsensor navigation has the potential to aid balloon sinus ostial dilation by providing real-time tracking of balloon devices within the complex anatomy of the sinonasal cavities.
OBJECTIVE: This feasibility study evaluated the incorporation of a new microsensor technology into a flexible guidewire for use with current instruments in balloon sinus ostial dilation.
METHODS: A retrospective study was conducted to include seven men and one woman (age range, 33-68 years), who underwent balloon sinus ostial dilation with flexible microsensor navigation in the operating room setting. All the procedures were performed at target sinuses with the patient under general anesthesia, in conjunction with subsequent endoscopic sinus surgery.
RESULTS: Balloon dilation was attempted at the maxillary (n = 3), frontal (n = 14), and sphenoid (n = 1) sinuses. In all the cases, the surgical navigation system displayed the flexible wire tip as it was advanced to the target sinus ostia; this visual feedback for wire position guided the balloon placement. Successful balloon dilation with assistance of flexible microsensor navigation was performed on most sinuses, except a single frontal sinus with adjacent type 2 frontal cells.
CONCLUSION: Flexible navigation technology may be combined with balloon sinus technology to facilitate localization of instruments in the sinus anatomy. Additional optimization of both the device and software technology is warranted.

PMID: 28381323 [PubMed]

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Efficacy and safety of an intravenous C1-inhibitor concentrate for long-term prophylaxis in hereditary angioedema.

Efficacy and safety of an intravenous C1-inhibitor concentrate for long-term prophylaxis in hereditary angioedema.

Allergy Rhinol (Providence). 2017 Mar 01;8(1):13-19

Authors: Craig T, Shapiro R, Vegh A, Baker JW, Bernstein JA, Busse P, Magerl M, Martinez-Saguer I, Riedl MA, Lumry W, Williams-Herman D, Edelman J, Feuersenger H, Machnig T, Rojavin M

Abstract
BACKGROUND: The plasma-derived, pasteurized, nanofiltered C1-inhibitor concentrate (pnfC1-INH) is approved in the United States as an intravenous (IV) on-demand treatment for hereditary angioedema (HAE) attacks, and, in Europe, as on demand and short-term prophylaxis.
OBJECTIVE: This analysis evaluated Berinert Patient Registry data regarding IV pnfC1-INH used as long-term prophylaxis (LTP).
METHODS: The international registry (2010-2014) collected prospective and retrospective usage, dosing, and safety data on individuals who used pnfC1-INH for any reason.
RESULTS: The registry included data on 47 subjects (80.9% female subjects; mean age, 44.8 years), which reflected 4082 infusions categorized as LTP and a total of 430.2 months of LTP administration. The median absolute dose of pnfC1-INH given for LTP was 1000 IU (range, 500-3000 IU), with a median time interval between infusion and a subsequent pnfC1-INH-treated attack of 72.0 hours (range, 0.0-166.4 hours). Fifteen subjects (31.9%) had no pnfC1-INH-treated HAE attacks within 7 days after pnfC1-INH infusion for LTP; 32 subjects (68.1%) experienced 246 attacks, with rates of 0.06 attacks per infusion and 0.57 attacks per month. A total of 81 adverse events were reported in 16 subjects (34.0%) (0.02 events per infusion; 0.19 events per month); only 3 adverse events were considered related to pnfC1-INH (noncardiac chest pain, postinfusion headache, deep vein thrombosis in a subject with an IV port).
CONCLUSION: In this international registry, IV pnf-C1-INH given as LTP for HAE was safe and efficacious, with a low rate of attacks that required pnfC1-INH treatment, particularly within the first several days after LTP administration.

PMID: 28381322 [PubMed]

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The impact of total immunoglobulin E levels on outcomes of maximal medical therapy for chronic rhinosinusitis.

The impact of total immunoglobulin E levels on outcomes of maximal medical therapy for chronic rhinosinusitis.

Allergy Rhinol (Providence). 2017 Mar 01;8(1):5-12

Authors: Lemos-Rodriguez AM, Farzal Z, Sreenath SB, Thorp BD, Senior BA, Zanation AM, Ebert CS

Abstract
INTRODUCTION: The goal of this project was to evaluate the impact of immunoglobulin E (IgE) levels on outcomes in patients with chronic rhinosinusitis (CRS) who received maximal medical therapy (MMT).
STUDY DESIGN: Prospective cohort study.
METHODS: Thirty-eight patients who underwent MMT for CRS were assigned to three different cohorts based on their IgE levels: low IgE (<25 IU), moderate (>25 to <149 IU), and high (≥150 IU). The primary outcome evaluated was MMT failure with a surgical recommendation within each IgE cohort. Secondary outcomes included changes in pre- and post-MMT scores for the Rhinosinusitis Disability Index, Chronic Sinusitis Survey, and computed tomography-based Lund-Mackay evaluation. The cohorts were substratified based on the presence of nasal polyps and nasal allergies.
RESULTS: No significant difference was found when MMT failure was compared between the cohorts in terms of quality of life. When substratified based on the presence of nasal polyps and nasal allergies, there was no significant difference between the cohorts. In the high-IgE cohort, all patients regardless of presence of nasal polyps and nasal allergic disease, frequently failed MMT and were recommended for surgery.
CONCLUSIONS: Overall, IgE levels did not seem to have a significant effect on the quality of life or outcomes of MMT in the patients with CRS. However, the presence of nasal allergies regardless of IgE levels seemed to result in more frequent recommendations for surgery after MMT. In the patients with higher-IgE levels (≥150 IU), MMT seemed to fail at high rates with or without the presence of polyps or allergic disease.

PMID: 28381321 [PubMed]

http://ift.tt/2nNtHEf

Allergen-specific immunoglobulin E and allergic rhinitis severity.

Allergen-specific immunoglobulin E and allergic rhinitis severity.

Allergy Rhinol (Providence). 2017 Mar 01;8(1):1-4

Authors: Corsico AG, De Amici M, Ronzoni V, Giunta V, Mennitti MC, Viscardi A, Marseglia GL, Ciprandi G

Abstract
BACKGROUND: Allergic rhinitis (AR) is a common disorder. The diagnosis is based on the concordance between allergy sensitization and history. Serum allergen specific immunoglobulin E (sIgE) assessment allows characterization of the relevant sensitizing allergens. Presently, Allergic Rhinitis and its Impact on Asthma (ARIA) classification subdivides AR based on symptoms severity and duration. However, the relationship between sIgE levels and symptom severity is still a matter of debate.
OBJECTIVE: Therefore, this study aimed at relating sIgE levels with symptom severity assessed by ARIA classification in a group of patients with AR.
METHODS: We enrolled 217 patients with AR (123 women; median age, 39.5 years). The sIgE levels (expressed in kUA/L) to house-dust mite were detected by the fluorescence enzyme immunoassay in peripheral blood samples. The IgE calibrators were traceable to the second international reference preparation 75/502 of human serum IgE from the World Health Organization. Symptom severity was assessed by ARIA classification.
RESULTS: We found a significant difference in sIgE levels in patients with mild intermittent versus mild persistent symptoms (p < 0.05), mild intermittent versus moderate-to-severe persistent symptoms (p < 0.001), moderate-to-severe intermittent versus moderate-to-severe persistent symptoms (p < 0.01), and mild persistent versus moderate-to-severe persistent symptoms (p < 0.05).
CONCLUSION: Analysis of these findings indicated that the sIgE level to house-dust mite might be a reliable biomarker for symptom severity in patients with AR. This outcome might be clinically relevant, particularly in candidates for immunotherapy.

PMID: 28381320 [PubMed]

http://ift.tt/2nNuq8q

Autoimmune-related nasal septum perforation: A case report and systematic review.

Autoimmune-related nasal septum perforation: A case report and systematic review.

Allergy Rhinol (Providence). 2017 Mar 01;8(1):40-44

Authors: Guntupalli L, Patel K, Faraji F, Brunworth JD

PMID: 28381327 [PubMed]

http://ift.tt/2nNAo9n

Intrasinus penetration of a silastic malar implant, which resulted in chronic sinusitis: A case report and literature review.

Intrasinus penetration of a silastic malar implant, which resulted in chronic sinusitis: A case report and literature review.

Allergy Rhinol (Providence). 2017 Mar 01;8(1):37-39

Authors: Kim LY, Schwartz JS, Tajudeen BA, Adappa ND, Palmer JN

PMID: 28381326 [PubMed]

http://ift.tt/2nNtMrQ

Ossifying fibroma of the maxilla and sinonasal tract: Case series.

Ossifying fibroma of the maxilla and sinonasal tract: Case series.

Allergy Rhinol (Providence). 2017 Mar 01;8(1):32-36

Authors: Liu JJ, Thompson LD, Janisiewicz AM, Shibuya TY, Keschner DB, Garg R, Lee JT

PMID: 28381325 [PubMed]

http://ift.tt/2oLQHIA

Quality-of-life improvement after endoscopic sinus surgery in patients with obstructive sleep apnea.

Quality-of-life improvement after endoscopic sinus surgery in patients with obstructive sleep apnea.

Allergy Rhinol (Providence). 2017 Mar 01;8(1):25-31

Authors: Tajudeen BA, Brooks SG, Yan CH, Kuan EC, Schwartz JS, Suh JD, Palmer JN, Adappa ND

PMID: 28381324 [PubMed]

http://ift.tt/2nNuntD

Flexible microsensor technology for real-time navigation tracking in balloon sinus ostial dilation.

Flexible microsensor technology for real-time navigation tracking in balloon sinus ostial dilation.

Allergy Rhinol (Providence). 2017 Mar 01;8(1):20-24

Authors: Lam K, Bigcas JL, Luong A, Yao W, Citardi MJ

PMID: 28381323 [PubMed]

http://ift.tt/2nNwPjx

Efficacy and safety of an intravenous C1-inhibitor concentrate for long-term prophylaxis in hereditary angioedema.

Efficacy and safety of an intravenous C1-inhibitor concentrate for long-term prophylaxis in hereditary angioedema.

Allergy Rhinol (Providence). 2017 Mar 01;8(1):13-19

Authors: Craig T, Shapiro R, Vegh A, Baker JW, Bernstein JA, Busse P, Magerl M, Martinez-Saguer I, Riedl MA, Lumry W, Williams-Herman D, Edelman J, Feuersenger H, Machnig T, Rojavin M

PMID: 28381322 [PubMed]

http://ift.tt/2nNwTQi

The impact of total immunoglobulin E levels on outcomes of maximal medical therapy for chronic rhinosinusitis.

The impact of total immunoglobulin E levels on outcomes of maximal medical therapy for chronic rhinosinusitis.

Allergy Rhinol (Providence). 2017 Mar 01;8(1):5-12

Authors: Lemos-Rodriguez AM, Farzal Z, Sreenath SB, Thorp BD, Senior BA, Zanation AM, Ebert CS

PMID: 28381321 [PubMed]

http://ift.tt/2nNtHEf

Allergen-specific immunoglobulin E and allergic rhinitis severity.

Allergen-specific immunoglobulin E and allergic rhinitis severity.

Allergy Rhinol (Providence). 2017 Mar 01;8(1):1-4

Authors: Corsico AG, De Amici M, Ronzoni V, Giunta V, Mennitti MC, Viscardi A, Marseglia GL, Ciprandi G

PMID: 28381320 [PubMed]

http://ift.tt/2nNuq8q

Yellow Fever Virus Modulates the Expression of Key Proteins Related to the microRNA Pathway in the Human Hepatocarcinoma Cell Line HepG2

Viral Immunology , Vol. 0, No. 0.

http://ift.tt/2oMlxkt

Macrophage Immunometabolism: Where Are We (Going)?

Publication date: Available online 7 April 2017
Source:Trends in Immunology
Author(s): Jan Van den Bossche, Luke A. O'Neill, Deepthi Menon
A growing number of findings highlight the crucial role of metabolic reprogramming in macrophage activation. Metabolic pathways are closely interconnected and recent literature demonstrates the need for glucose metabolism in anti-inflammatory as well as inflammatory macrophages. Moreover, fatty acid oxidation (FAO) not only supports anti-inflammatory responses as described formerly but also drives inflammasome activation in inflammatory macrophages. Hence, defining glycolysis as proinflammatory and FAO as anti-inflammatory may be an oversimplification. Here we review how the rapid growth of the immunometabolism field has improved our understanding of macrophage activation and at the same time has led to an increase in the appearance of contradictory observations. To conclude we discuss current challenges in immunometabolism and present crucial areas for future research.

http://ift.tt/2oM2irs

Significance of interfacial interaction and agglomerates on electrical properties of polymer-carbon nanotube nanocomposites

Publication date: 5 July 2017
Source:Materials & Design, Volume 125
Author(s): Amir Hosein Ahmadian Hoseini, Mohammad Arjmand, Uttandaraman Sundararaj, Milana Trifkovic
The ability to control the dispersion state of carbon nanotubes (CNTs) in polymer matrices is closely related to the electrical tunability of polymer-CNT nanocomposites. In this study, the effect of polymer-CNT interactions at the molecular level on the extent of CNT dispersion and consequent electrical properties of the developed nanocomposites are investigated. Two polymer models with dissimilar affinities towards CNTs are studied: polyamide-6 (PA6) having high, and polystyrene (PS) having low affinity towards CNTs. Experiments demonstrate that enhanced polymer-filler interactions in PA6-CNT system lead to improved CNT dispersion at the nanoscopic level. However, PS-CNT system, having higher number density of micro-agglomerates, has approximately ten times lower percolation threshold (0.3wt% versus 2.9wt%) and significantly enhanced electrical properties. High affinity of PA6 towards CNTs is proposed to adversely influence electrical properties via encapsulation of CNTs by PA6 through possible wrapping and interfacial crystallization of polymer chains. On the other hand, enhanced electrical properties in PS-CNT nanocomposites are attributed to higher number density of micro-agglomerates, contributing to secondary internal electric field.

Graphical abstract

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Novel Fe-TiO2 composite driven dual effect for reduction in treatment time of pentoxifylline: Slurry to immobilized approach

Publication date: 5 July 2017
Source:Materials & Design, Volume 125
Author(s): Palak Bansal, Anoop Verma
Attempts have been made to reduce the treatment time for degradation of pentoxifylline (PEN) using novel Fe-TiO2 composite by incorporating dual effect (photocatalysis and photo-Fenton). Waste foundry sand (FS) and fly ash (FA) was used as alternative iron source along with TiO2 either in suspended or supported form. Initially, dual effect was executed in slurry mode where 49% synergy was obtained for degrading PEN along with reduction in treatment time from 90 to 30min. In the subsequent experiments, FA/FS was entrapped in small pockets made of fine cotton cloth keeping TiO2 either in suspension or immobilized on clay beads. Significant improvements over the first order rate constant (k) were achieved for the dual process along with reduction in treatment time. Even two to threefold increase in 'k' was observed using novel Fe-TiO2 composite for the degradation of PEN confirming in-situ dual effect. The existence of TiO2 as well as iron on the composite surface even after 45 recycles was confirmed through SEM/EDS, XRD and diffuse reflectance spectroscopy. The mineralization of PEN was validated by reduction in COD and TOC along with the production of several anions. While intermediates formed during the degradation of PEN were identified through GC–MS analysis.

Graphical abstract

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Characterization of a protein-bound polysaccharide from Herba Epimedii and its metabolic mechanism in chronic fatigue syndrome

Publication date: 5 May 2017
Source:Journal of Ethnopharmacology, Volume 203
Author(s): Aiping Chi, Zhimei Shen, Wenfei Zhu, Yuliang Sun, Yijiang Kang, Fei Guo
ObjectivesHerba Epimedii is one of the famous Traditional Chinese Medicines used to treat the chronic fatigue syndrome (CFS). The polysaccharides are the main active components in H. epimedii. The aim of this study is to discover the therapeutic effect and metabolic mechanism of H. epimedii polysaccharides against CFS.MethodsThe polysaccharide conjugates named HEP2-a were isolated from the leaves of H. epimedii using a water extraction method, and the general physicochemical properties of HEP2-a were analysed. In addition, a CFS rat model was established, and then, urinary metabonomic studies were performed using gas chromatography time-of-flight mass spectrometry (GC-TOF-MS) in combination with multivariate statistical analysis.ResultsThe physicochemical properties revealed that HEP2-a had an average molecular weight of 13.6×10⁴Da and consisted of mannose (4.41%), rhamnose (5.43%), glucose (31.26%), galactose (27.07%), arabinose (23.43%), and galacturonic acid (8.40%). The amino acids in HEP2-a include glutamate, cysteine, leucine, tyrosine, lysine, and histidine. Molecular morphology studies revealed many highly curled spherical particles with diameters of 5–10µm in solids and 100–200nm for particles in water. Five metabolites in the HEP2-a group were oppositely and significantly changed compared to the CFS model group.ConclusionTwo metabolic pathways were identified as significant metabolic pathways involved with HEP2-a. The therapeutic effects of HEP2-a on CFS were partially due to the restoration of these disturbed pathways.

Graphical abstract

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Development of mPMab-1, a Mouse–Rat Chimeric Antibody Against Mouse Podoplanin

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy , Vol. 0, No. 0.

http://ift.tt/2oSonBe

LpMab-23: A Cancer-Specific Monoclonal Antibody Against Human Podoplanin

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy , Vol. 0, No. 0.

http://ift.tt/2oby8fG

The association of Enamelin, Lactoferrin, and Tumour necrosis factor alpha gene polymorphisms with high caries susceptibility in Chinese children under 4 years old

Publication date: August 2017
Source:Archives of Oral Biology, Volume 80
Author(s): Mengchen Wang, Man Qin, Bin Xia
ObjectiveThe aim of this study was to assess the role of ENAM rs3796703, LTF rs1126478, and TNF-α rs1800629 in high caries susceptibility.DesignThe present case–control study included 1005 unrelated children under 4 years old: 505 with severe caries (dmft index ≥4) and 500 who were caries-free (dmft index=0 and without white-spot lesions). Questionnaires were obtained from parents and gardians about the children's diet and oral behavioural habits. All the children received dental examinations and oral swabbing for human genomic DNA collection. ENAM rs3796703, LTF rs1126478, and TNF-α rs1800629 were genotyped by Sanger sequencing.ResultsThe frequency of the ENAM rs3796703T allele (6.7% in the caries group and 4.2% in the caries-free group), CT genotype (12.7% in the caries group and 8.4% in the caries-free group), TNF-α rs1800629 A allele (4.8% in the caries group and 6.8% in the caries-free group), and AG genotype (8.7% in the caries group and 13.2% in the caries-free group) were significantly different between the caries and caries-free groups (p<0.05). No significant difference was found in the LTF rs1126478 allele frequency and genotype distribution between the two groups. The ENAM rs3796703 CT genotype increased caries susceptibility by 60.9% compared to the CC genotype (β=0.746, OR=1.609), and the TNF-α rs1800629 AG genotype reduced caries susceptibility by 47.4% compared to the GG genotype (β=−0.642, OR=0.526). In terms of habits covariates, prolongation of night feeding time by 1 month increased caries susceptibility by 3.3% (β=0.033, OR=1.033); additionally, sweets and acidic drinks consumption 1–2 times per day increased caries susceptibility by 218.2% (β=1.158, OR=3.182), and consumption 3 or more times pe/r day increased susceptibility by 883.5% (β=2.286, OR=9.835) compared to non-consumption. Topical fluoride application decreased caries susceptibility by 43.0% (β=−0.562, OR=0.570).ConclusionsThe ENAM and TNF-α genes are likely associated with caries experience in Chinese children. The ENAM rs3796703 CT genotype might be involved in caries susceptibility, while TNF-α rs1800629 AG genotype might be involved in caries protection.

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Complementary effect of hydroquinone and retinoic acid on corneocyte desquamation with their combination use

Publication date: Available online 7 April 2017
Source:Journal of Dermatological Science
Author(s): Kyung Ah Cheong, Tae Ryong Lee, Ai-Young Lee
BackgroundRetinoic acid (RA) enhances skin-lightening capabilities of hydroquinone (HQ), at least in part, by facilitating desquamation which leads to increase penetration of HQ. The desquamation also affects skin irritation levels. The mechanism of RA-induced desquamation, however, has not been completely explored and no such data has been available for HQ uses.ObjectiveTo examine the role of HQ, RA, and their combination in the desquamation.MethodsPrimary cultured normal human keratinocytes, which were treated with HQ and/or RA in presence or absence of serine-specific inhibitor Kazal type5 (SPINK5)/lympho-epithelial Kazal-type-related inhibitor (LEKTI) knockdown or recombinant human SPINK5/LEKTI, and biopsied skin samples applied with HQ or RA were examined. Expression levels of corneodesmosin (CDSN), desmocollin1 (DSC1), kallikrein5 (KLK5), KLK7, and SPINK5/LEKTI, and proteolysis activity against extracted human skin epidermal protein were determined using time-course real-time PCR, Western blotting, ELISA, and immunofluorescence staining.ResultsHQ increased but RA decreased the synthesis of CDSN and DSC1. HQ reduced corneodesmosome degradation by the upregulation of SPINK5/LEKTI, whereas RA showed opposite results without upregulation of SPINK5/LEKTI. The combination of HQ and RA was close to the sum of the individual components.ConclusionsHQ reduced corneocyte desquamation. However, RA enhanced desquamation. The combination induced more desquamation than HQ but less than RA.

http://ift.tt/2oLUOES

The ovariectomized mouse simulates the pathophysiology of postmenopausal female pattern hair loss

Publication date: Available online 7 April 2017
Source:Journal of Dermatological Science
Author(s): Yujiro Endo, Masato Takahashi, Yuko Obayashi, Tetsushi Serizawa, Michiaki Murakosh, Manabu Ohyama

http://ift.tt/2oSth1q

Emerging trends in the epidemiological pattern of head and neck cancers in Lagos, Nigeria

OA Erinoso, E Okoturo, OM Gbotolorun, OA Effiom, NA Awolola, SS Soyemi, RT Oluwakuyide

Annals of Medical and Health Sciences Research 2016 6(5):301-307

Background: Unfortunately, despite an increase in medical knowledge, survival rates of head and neck cancers (HNCs) have not been observed to improve greatly. This is true, especially in tumors located in obscure primary sites or late presentation. Aim: The purpose of this study is to assess the epidemiologic pattern of HNCs and to evaluate its emerging trends and patterns in Lagos state. Subjects and Methods: A retrospective study was conducted from 2003 to 2013 that analyzed histologically diagnosed cases of HNC at the Pathology Departments of the two tertiary teaching hospitals in Lagos. Data analysis was performed using the Statistical Package for the Social Sciences (version 20) statistical software. Results: One thousand and eighty-three cases of head and neck malignancies were recorded. A female: male ratio of 1.01:1 was reported with mean age of 39.6 (standard deviation 21.1) years. The oral cavity was the most affected anatomic site (21.2%, 230/1083) in the period under review. Malignant epithelial tumors accounted for 72% (779/1083) of cases seen. Carcinomas were the most common histological variant seen (67%, 726/1083) and squamous cell carcinoma accounted for 58% (421/726) of carcinomas recorded. Oral cavity malignancies (21.8%, 118/540) were the most common in males while thyroid malignancies (28.5%, 155/543) were the most seen in females. In children (≤15 years), the most common histologic findings were carcinomas (42.3%; 77/182) and retinoblastomas (23.6%; 43/182). Conclusion: Epithelial malignancies were the most common malignancy in the study, and the oral cavity appears to be the increasingly predominant site for HNCs. A changing pattern in gender predominance, age distribution, and frequency with histological variants and anatomical sites was also observed in this study.

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Wasting of extensor digitorum brevis as a decisive preoperative clinical indicator of lumbar canal stenosis: A single-center prospective cohort study

S Munakomi, BM Kumar

Annals of Medical and Health Sciences Research 2016 6(5):296-300

Background: The dilemma in managing patients with low back ache lies in differentiating radiculopathy from lumbar canal stenosis. This has a huge bearing in patients being planned for surgical intervention as underperforming leads to failed back syndrome whereas over-doing leads to instability. There still remains a loophole in clinically diagnosing lumbar canal stenosis. Aim: We opt to utilize a simple bedside clinical examination in routinely assessing patients presenting with low back ache in ruling out underlying canal stenosis. Subjects and Methods: We performed a prospective study on 120 consecutive patients presenting with low back ache in the spine clinic. Each of them was neurologically examined and thoroughly assessed for wasting of extensor digitorum brevis (EDB) muscles. These were then correlated with the radio-imaging and the intraoperative findings. Results: Lumbar canal stenosis was mostly observed in the age group of 50–60 years. Diagnosis for L3/4 canal stenosis was made in 44/120 (36.6%), L5-S1 in 52/120 (43.3%), and L3/L4/L5 level in 48/120 (40%) of patients. EDB wasting was seen unilaterally in 72/120 (60%) and bilaterally in 36/120 (30%) of the study group. Conclusion: This study appraises the clinical implication of observing for the wasting of EDB muscle so as to aid in the diagnosis of lumbar canal stenosis. This simple bedside clinical pearl can help us in predicting the need of further imaging studies and also in taking right therapeutic decision.

http://ift.tt/2oLY5Uq

Subtrochanteric and distal femur fractures in a patient with femoral shaft fracture malunion and knee disarticulation: A rare and challenging case report

RE Pires, EO Santana, PJ Labronici, IA Almeida Filho

Annals of Medical and Health Sciences Research 2016 6(5):328-331

This study aims to describe a rare and challenging case of a patient who presented ipsilateral subtrochanteric and distal femur fractures due to low-energy trauma. The peculiarity of this case is the presence of femoral shaft fracture malunion and knee disarticulation in the same limb resulting from an accident suffered 30 years ago. The patient underwent femoral diaphyseal osteotomy and fixation of the subtrochanteric and distal femur fractures with a long cephalomedullary nail and distal femur locking plate, respectively. Despite the magnitude of the surgical procedure, all fractures healed, preserving the femoral length with the absence of infection and clinical complications. There was an improvement of the preinjury function attributed to the osteotomy of the femoral diaphyseal, which alleviated the anterior thigh discomfort.

http://ift.tt/2o7rdm1

Phenotypic detection and antibiogram of β-lactamase-producing proteus species in a tertiary care hospital, India

N Pal, S Hooja, R Sharma, RK Maheshwari

Annals of Medical and Health Sciences Research 2016 6(5):267-273

Background: Proteus species cause a variety of community- and hospital-acquired illnesses. Synthesis of β-lactamases is the predominant mechanism for resistance to β-lactam antibiotics. Among the β-lactamases, extended spectrum β-lactamases (ESBLs) and AmpC β-lactamases are the most common. Aim: The objective of this study was to determine the occurrence of ESBL and AmpC β-lactamases in Proteus species among various clinical isolates at a tertiary care hospital, India. Materials and Methods: This study was done to identify various species of Proteus from clinical samples (n = 3922). Antimicrobial susceptibility was performed by Kirby–Bauer disc diffusion method. ESBL production was detected by modified double-disc synergy test and indirect modified three-dimensional tests and AmpC β-lactamase production by AmpC disc test and modified Hodge test. Results: Proteus species were isolated in 5.4% (101/1876) specimens. Three Proteus species isolated were Proteus mirabilis 62.4% (63/101), Proteus vulgaris 29.7% (30/101), and Proteus penneri 7.9% (8/101). ESBL producers confirmed by both tests were of 88.1% (89/101). Only AmpC β-lactamase was produced by four isolates. Coproduction of ESBL and AmpC β-lactamase was observed in 58.4% (52/89) of isolates. Twelve isolates were non-β-lactamase producers. Multidrug resistance (MDR) was found in 95.1% (96/101) of isolates, 50.5% (51/101) were possibly extensively drug resistant and none were pan drug resistant. None of the isolates were resistant to piperacillin-tazobactam. P. penneri isolates exhibited high resistance to most of the antibiotics. Conclusions: A high prevalence of ESBL and AmpC β-lactamases was found that concurrently showed MDR. Phenotypic methods for the detection of β-lactamases are easy and simple and can be implemented in routine diagnostic laboratories along with susceptibility testing. These data will assist the clinicians in the management and control of infections.

http://ift.tt/2oLLkJM

Medial malleolar fractures: An anatomic survey determining the ideal screw length

PJ Labronici, RE Pires, MV Franco, R Freitas, GC Araújo, RS Pires e Albuquerque, VS Gameiro, K Jeray

Annals of Medical and Health Sciences Research 2016 6(5):308-310

Background: Medial malleolar fractures are frequent, and their treatment is familiar to the orthopedic surgeon. Lag screw fixation using partially threaded screws remains the standard treatment method for medial malleolar fractures. However, the literature lacks a defined method for selecting lag screw length, relying more so on the empiric choice of the surgeon. Aim: The aim of this study is to help define the ideal lag screw length for medial melleolar fracture fixation. Materials and Methods: One hundred and sixteen anatomic specimens were included in the study. A transverse cut was performed in the distal third of the tibia, roughly 1 and a half times the distal tibial plafond width from the ankle joint. A coronal cut was then performed using the center of the medial malleolus. Three observers measured the distance between the medial malleolus tip and beginning of the medullary canal in all anatomic specimens. Differences in measurements were statistically compared, level of (P ≤ 0.05). Interclass correlation coefficient (ICC) significance level was set at P < 0.05. Results: Measurement average was 55 mm between the medial malleolus tip and the medullary canal, with a standard deviation of 10 mm. High concordance (ICC: 0.819) was achieved among all pairs of observers (P < 0.01). The systematic difference among measurements was absent, and random distribution around general measurements was observed. Conclusion: The authors recommend a screw length of no more than 45 mm to optimize the location of the screw threads in the best cancellous bone in an effort to obtain the most compression.

http://ift.tt/2o7Ahao

Evaluation of serum and urinary neopterin levels as a biomarker for occupational exposure to crystalline silica

H Mohammadi, SF Dehghan, F Golbabaei, M Ansari, M Yaseri, S Roshani, R Divani

Annals of Medical and Health Sciences Research 2016 6(5):274-279

Background: Crystalline silica is a commonly used mineral in various industries and construction activities, and it is so important introducing potential biomarkers to identify early indicators of biological effects in its high-risk occupational exposures. Aim: The present study was aimed to assess the blood and urinary neopterin as an early biomarker of exposure in the workers of an insulator manufacturing plant who are exposed to crystalline silica. Subjects and Methods: This analytical descriptive study was done among two groups of exposed workers (n = 55) and unexposed office workers (n = 38) of an insulator manufacturing plant. Statistical software R was used to determine sample size and select the participants by random sampling among nonsmoker workers. Sampling of airborne silica in breathing zone of participants was done based on the National Institute for Occupational Safety and Health method 7601. The urinary and blood samples were collected and prepared for analysis by high-performance liquid chromatography to determine the level of urinary and serum neopterin. All of the statistical analyses were carried out using SPSS 22. Results: The airborne silica concentration was significantly different between two exposed and unexposed groups (P < 0.001, 0.27 [0.11] vs. 0.0028 [0.0006] mg/m3, respectively). The urinary neopterin in exposed group is significantly higher than the unexposed one (P < 0.001, 97.67 [30.24] vs. 55.52 [2.18] μmol/mol creatinine, respectively). Neopterin level of serum in exposed group is higher than the unexposed group, and there is a significant difference between them (P < 0.001, 6.90 [2.70] vs. 2.20 [1.20] nmol/l, respectively). The positive significant correlations were found between silica exposure concentration with urinary and serum neopterin (P < 0.001, r = 0.36 and 0.59, respectively). Conclusions: Considering the sensitively and easily measurement of neopterin in biological fluid and also the statistically significant positive relationships which were found between the airborne silica concentration and neopterin levels in the present study, the serum and urinary neopterin levels can be considered the potential biomarkers of silica exposure for doing further comprehensive studies in this area.

http://ift.tt/2oLLdOq

Peripheral and central nervous system involvement in recently diagnosed cases of hypothyroidism: An electrophysiological study

N Gupta, M Arora, R Sharma, KS Arora

Annals of Medical and Health Sciences Research 2016 6(5):261-266

Background: Hypothyroidism, one of the most common endocrine disorders, may induce neurological abnormalities at an early stage of the disease. Aim: The study was designed to assess the electrophysiological alterations of some selected variables of nerve conduction, brainstem auditory evoked potentials (BAEPs), and visual evoked potentials (VEPs) in hypothyroid patients. Subjects and Methods: Sixty patients of newly diagnosed hypothyroidism and an equal number of age-matched controls were selected for the study. Nerve conduction studies that included parameters as latencies, conduction velocities, and amplitude of motor nerves, i.e., median, ulnar, common peroneal, tibial nerve, and sensory nerves, i.e., median and sural nerves was performed in both hypothyroid patients and controls. Further, BAEPs and VEPs of all the patients were done. The data were compiled and statistically analyzed using Student's unpaired t-test to observe any electrophysiological alterations in hypothyroid patients as compared to healthy controls. Results: On comparative evaluation, statistically significant increase in latency of median, ulnar, tibial, and sural nerves; decrease in conduction velocities of all the tested nerves and decrease in amplitude of median, tibial, and sural nerves was observed in hypothyroid patients. Statistically significant increase in latencies, interpeak latencies, and decrease in amplitudes of BAEP waves and statistically significant increase in P100 latency of VEP was seen in hypothyroid patients. Conclusion: The results of our study suggest that peripheral and central neuropathy develops in patients of hypothyroidism at an early stage of disease and the electrophysiological investigations of such patients can help in timely detection and treatment of neurological disorders that occur due to thyroid hormone deficiency.

http://ift.tt/2oNZUAb

Adnexal tumors of skin: An experience at a tertiary care center at Delhi

M Pujani, GB Madaan, ZS Jairajpuri, S Jetley, MJ Hassan, S Khan

Annals of Medical and Health Sciences Research 2016 6(5):280-285

Background: Adnexal skin tumors are a heterogeneous group of uncommon tumors usually misdiagnosed clinically due to a huge variety of types and their variants. Histopathology usually helps in establishing the diagnosis. Aims: The study was undertaken to analyze the morphological, clinical, and histological features of adnexal tumors (ATs) of the skin at our center over a period of 4 years. Subjects and Methods: retrospective study was conducted over a period of 4 years (April 2010–March 2014), comprising 25 ATs of skin diagnosed in the Department of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi. All the consecutively reported AT cases were reviewed and reclassified as AT arising from sebaceous glands, hair follicles, or sweat glands. The concordance of clinical and histopathological diagnosis was also assessed. Results: Most of the ATs were benign (24/25) with head and neck being the most common location (72%). Nearly 56% of the tumors exhibited sweat gland differentiation, 28% hair follicle differentiation, and sebaceous gland tumors accounted for 16%. The most common varieties of tumors encountered in the present study included hidradenoma papilliferum and pilomatricoma. The concordance between clinical and histopathological diagnosis was found to be 50% approximately. Conclusions: ATs of the skin are rare neoplasms with benign tumors being far more common. They are often misdiagnosed clinically, so histopathology remains the gold standard for establishing an accurate diagnosis of skin ATs.

http://ift.tt/2o7KUdE

Awareness and attitudes toward organ donation in rural Puducherry, India

KL Balajee, N Ramachandran, L Subitha

Annals of Medical and Health Sciences Research 2016 6(5):286-290

Background: For many of the end-stage organ diseases, organ transplantation is the most preferred treatment. The need for the organ transplantation is higher than the availability. For the transplantation program to be successful, awareness regarding organ donation is needed and people must have a positive attitude toward donating organs. Aim: This study aims to assess the awareness and attitudes regarding organ donation among the rural population and to evaluate the sociodemographic factors associated with their awareness. Subjects and Methods: This community-based cross-sectional study was conducted among 360 people living in 4 villages of Puducherry. Face-to-face interviews were carried out using pretested questionnaire, which included the sociodemographic data. Data were entered into Excel and analyzed using Statistical Package for Social Sciences. Results: Of 360 participants, 88% (317/360) were aware of organ donation. Among these 317 participants, awareness was highest in the age group 18–30 years 98.8% (87/88), male 91% (147/161), higher secondary and above 100% (58/58), and Class 1 socioeconomic status 92% (13/14). Source of awareness about organ donation was primarily through media 83% (263/317). The majority of the participants 88% (281/317) felt that the purpose of organ donation was to save life. Most of the participants 91% (290/317) said that all healthy adults are eligible organ donors and 87% (275/317) of the participants said that monetary benefits could not be accepted for organ donation. Most of the participants 70% (223/317) were willing to donate their organs after death. Among the participants who refused to donate their organs, family refusal 57% (25/44) was the most common reason. Conclusion: This study shows that there is a high level of awareness about organ donation among rural people and most of the participants are willing to donate their organs.

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Clinicoradiologic profile of involvement and healing in tuberculosis of the spine

R Singh, NK Magu, RK Rohilla

Annals of Medical and Health Sciences Research 2016 6(5):311-327

Background: There is no much information about how tuberculous lesions of the spine progress/heal; what clinical and radiological features suggest progression/healing; what is the optimal duration of antitubercular treatment; and what clinical, laboratory, and radiological investigations and their frequency should be done to monitor the disease course. Aims: The present study aimed to evaluate what specific clinicoradiologic features suggest involvement and healing in tuberculosis of the spine. Subjects and Methods: Fifty spinal tuberculosis patients (30 males and 20 females) diagnosed clinicoradiologically were enrolled in the study. Patients were evaluated clinically, radiographically, and by magnetic resonance imaging (MRI) at regular intervals to monitor the disease course till 24 months of the initial presentation. Results: Wedge/collapse (23/50 cases), soft tissue mass (29/50 cases), disc narrowing (45/54 discs), and endplate erosions (89/107 endplates) were the plain radiological findings of tubercular spinal involvement. Earliest sign of healing on plain radiography was decrease in fuzziness of endplate, ultimately leading to either sclerosis of endplate or fusion of adjacent vertebrae. Initial MRI findings included bone marrow edema (50/50 cases), discitis (53/62 discs), endplate erosions (105/123 endplates), pre- and para-vertebral collections (45/50 cases), epidural involvement (26/50 cases), epidural spread (77/109 vertebrae), and subligamentous spread (42/50 cases). Earliest feature of healing on magnetic resonance (MR) examination was decrease in inflammatory soft-tissue masses and reduction in marrow edema. Conclusions: Salient features of spinal involvement in tuberculosis on plain radiograph were paradiscal involvement, endplate destruction, and soft tissue masses. Marrow edema, paravertebral collections, subligamentous spread, extradural component, endplate erosion, and discitis suggested tubercular involvement of the spine on MRI. A decrease in these was observed to have prognostic value both in monitoring disease course and response to chemotherapy. Based on the clinicoradiologic findings of the present study, we propose decision-making algorithm, follow-up algorithm, and MR examination protocol for spinal tuberculosis.

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Color stability of heat-cure acrylic resin subjected to simulated short-term immersion in fast-acting denture cleansers

K Lohitha, M Prakash, A Gopinadh, AJ Sai Sankar, CH Sandeep, B Sreedevi

Annals of Medical and Health Sciences Research 2016 6(5):291-295

Background: Regular usage of denture cleansers is recommended in complete denture wearers for effective plaque control, and these cleansers alter the physical properties of acrylic resin over a period of time. Thus, an in vitro study was carried out to assess the effect of denture cleansers on the color stability of heat-cure denture base resin. Aim: The aim of the present study was to evaluate the effect of commercially available fast-acting denture cleansers on the color stability of heat-cure denture base resin at different time intervals. Materials and Methods: Thirty-six heat-cure acrylic resin (Ivoclar Triplex Hot-V) specimens are randomly allocated into four groups - Group A (distilled water as control); Group B (polident - 3 min); Group C (fixodent scope plus); and Group D (stain away plus) comprising of nine samples each. After recording the baseline values, the specimens were immersed in their respective cleansing solutions for a prescribed time interval. This procedure was repeated daily, and the color change (ΔE) was evaluated after 90 and 180 days interval using a colorimeter in a standard "Commission International de l'Eclairage" color system. Statistical Analysis Used: Paired t-test and Dunnett's T3 test. Results: All the groups exhibited a variable color change (ΔE) for an immersion period of 90 days. However, significant color differences (P = 0.001) were noticed among the test groups after 180 days. Conclusion: The color change of denture base resin was greater for Group D followed by Groups B, C, and A respectively after 180 days of immersion. The ΔE values of all test groups increased with time.

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Serum adiponectin levels are associated with microcirculatory function, but not with coronary artery disease in the young

A De Lorenzo, ASB Moreira, E Guimaraes, GMM Oliveira, E Maia, EV Tibirica

Annals of Medical and Health Sciences Research 2016 6(5):332-333

http://ift.tt/2o7Ieg5

Differential roles of PKC isoforms (PKCs) in GnRH stimulation of MAPK phosphorylation in gonadotrope derived cells

Publication date: Available online 6 April 2017
Source:Molecular and Cellular Endocrinology
Author(s): Shany Mugami, Masha Dobkin-Bekman, Liat Rahamim–Ben Navi, Zvi Naor
The role of protein kinase C (PKC) isoforms (PKCs) in GnRH-stimulated MAPK [ERK1/2, JNK1/2 and p38) phosphorylation was examined in gonadotrope derived cells. GnRH induced a protracted activation of ERK1/2 and a slower and more transient activation of JNK1/2 and p38MAPK. Gonadotropes express conventional PKCα and PKCβII, novel PKCδ, PKCε and PKCθ, and atypical PKC-ι/λ. The use of green fluorescent protein (GFP)-PKCs constructs revealed that GnRH induced rapid translocation of PKCα and PKCβII to the plasma membrane, followed by their redistribution to the cytosol. PKCδ and PKCε localized to the cytoplasm and Golgi, followed by the rapid redistribution by GnRH of PKCδ to the perinuclear zone and of PKCε to the plasma membrane. The use of dominant negatives for PKCs and peptide inhibitors for the receptors for activated C kinase (RACKs) has revealed differential role for PKCα, PKCβII, PKCδ and PKCε in ERK1/2, JNK1/2 and p38MAPK phosphorylation in a ligand-and cell context-dependent manner. The paradoxical findings that PKCs activated by GnRH and PMA play a differential role in MAPKs phosphorylation may be explained by persistent vs. transient redistribution of selected PKCs or redistribution of a given PKC to the perinuclear zone vs. the plasma membrane. Thus, we have identified the PKCs involved in GnRH stimulated MAPKs phosphorylation in gonadotrope derived cells. Once activated, the MAPKs will mediate the transcription of the gonadotropin subunits and GnRH receptor genes.

http://ift.tt/2nod5aU

kMucormicosys due to Saksenaea vasiformis in a dog

Publication date: June 2017
Source:Medical Mycology Case Reports, Volume 16
Author(s): Francisco J. Reynaldi, Gabriela Giacoboni, Susana B. Córdoba, Julián Romero, Enso H. Reinoso, Ruben Abrantes
A 2-year-old female Border collie was examined for dermatitis with a partial alopecic zone around her left front member. Six months later the lesion became swollen, alopecic with ulcerated areas. Microscopy analysis of samples showed numerous non-septate, branching, thin-walled and irregular shaped hyphal elements. Fungal cultures and molecular studies identified Saksenaea vasiformis. Treatments with griseofulvin, itraconazole and surgical debridement were used, however, fourteen months later the dog was euthanatized because of the unfavorable clinical outcome.

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Successful treatment of azole-resistant invasive aspergillosis in a bottlenose dolphin with high-dose posaconazole

Publication date: June 2017
Source:Medical Mycology Case Reports, Volume 16
Author(s): Paulien E. Bunskoek, Seyedmojtaba Seyedmousavi, Steven J.M. Gans, Peter B.J. van Vierzen, Willem J.G. Melchers, Cornelis E. van Elk, Johan W. Mouton, Paul E. Verweij
Invasive aspergillosis due to azole-resistant Aspergillus fumigatus is difficult to manage. We describe a case of azole-resistant invasive aspergillosis in a female bottlenose dolphin, who failed to respond to voriconazole and posaconazole therapy. As intravenous therapy was precluded, high dose posaconazole was initiated aimed at achieving trough levels exceeding 3mg/l. Posaconazole serum levels of 3–9.5mg/l were achieved without significant side-effects. Follow-up bronchoscopy and computed tomography showed complete resolution of the lesions.

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Coccidioidal meningitis complicated by central nervous system vasculitis in a patient with leukemia

Publication date: June 2017
Source:Medical Mycology Case Reports, Volume 16
Author(s): Dany Tager, Anne Hatch, Jennifer Segar, Brentin Roller, Mayar Al Mohajer, Tirdad T. Zangeneh
Central Nervous System (CNS) vasculitis is the most common life-threatening complication of coccidioidal meningitis. It is manifested by cerebral ischemia, hemorrhage, and infarction. We report a case of CNS vasculitis in a patient receiving chemotherapy and review of the literature on coccidioidal meningitis. The patient was treated with combination antifungal therapy and a short course of high dose corticosteroids with a modest improvement in her neurological examination after initiation of steroids.

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First case of invasive Magnusiomyces capitatus infection in Slovakia

Publication date: June 2017
Source:Medical Mycology Case Reports, Volume 16
Author(s): Dominika Tanuskova, Julia Horakova, Peter Svec, Ivana Bodova, Martina Lengerova, Matej Bezdicek, Miroslava Poczova, Jozef Koppl, Alexandra Kolenova
Magnusiomyces capitatus (previously known as Geotrichum capitatum or Blastoschizomyces capitatus or Trichosporon capitatum) is a rare cause of fungal infection in immunocompromised patients. Most of these cases (87%) have been reported from the Mediterranean region, as it is extremely rare to recognize it in other regions. Here we report a first case of disseminated M. capitatus infection in Slovakia. The patient – 19 year old woman with myelodysplastic syndrome was diagnosed with M. capitatus fungemia after allogeneic stem cell transplantation. The infection occurred despite antifungal prophylaxis with micafungin, which was in vitro sensitive to the yeast. The treatment according to minimal inhibitory concentrations (micafungin, voriconazol) and granulocyte transfusions were administered. M. capitatus was cleared out from the bloodstream. However, patient died of multiple organ failure. Autopsy showed multiple lesions in organs, but did not prove presence of yeast by histopathology. M. capitatus was confirmed by polymerase chain reaction from all tested organs: heart, brain, lungs, spleen, liver and kidneys. We present the post mortem pictures showing the yeast lesions in affected organs. 2012 Elsevier Ltd. All rights reserved.

http://ift.tt/2obmy46

Melanized fungus as an Epidural abscess: A diagnostic and therapeutic challenge

Publication date: Available online 6 April 2017
Source:Medical Mycology Case Reports
Author(s): Adesh shrivastava, Karuna Tadepalli, Garima Goel, Kajal Gupta, Pradeep Kumar Gupta
Curvularia a dematiaceous fungus is ubiquitously found in soil around the world. We report an epidural abscess due to Curvularia lunata in a 48 years male farmer who underwent decompressive laminectomy as primary modality of treatment followed by isolation, identification and confirmation of the isolate from tissue by ITS sequencing. Antifungal therapy with voriconazole and amphotericin B for 3 and 2 weeks respectively improved patient's condition and is presently on regular follow up with no sequelae since last 7 months.

http://ift.tt/2obJWP5

A case of breakthrough Candida parapsilosis fungemia during micafungin therapy for a Candida glabrata bloodstream infection

Publication date: June 2017
Source:Medical Mycology Case Reports, Volume 16
Author(s): Yuta Norimatsu, Daiichi Morii, Asako Kogure, Taeko Hamanaka, Yoshihiro Kuwano, Takayuki Yokozawa, Toshimi Oda
We describe a case of breakthrough Candida parapsilosis fungemia in an 80-year-old woman with pyoderma gangrenosum and rheumatoid arthritis. C. parapsilosis was detected in blood culture while the patient was treated with micafungin for a Candida glabrata bloodstream infection. The breakthrough infection was successfully treated with liposomal amphotericin B.

http://ift.tt/2oRZYMh

Acquired Angioedema: A Rare Manifestation of Angioimmunoblastic T Cell Lymphoma

Abstract

The clinical presentation except age of onset is similar in different types of angioedema. A lymphoproliferative disorder like angioimmunoblastic T cell lymphoma (AITL) rarely presents with symptoms of angioedema. We present extremely rare case of elderly male with recurrent tongue swelling, pruritus with normal levels of complements and C1 esterase inhibitor protein featuring as acquired angioedema, a rare manifestation of AITL. Initial response to corticosteroids may be misleading and occurs as a result of immunosuppression of AITL. High index of suspicion may prompt need for histopathological diagnosis of lymph node biopsy. Definitive chemotherapeutic treatment may achieve long term remission.

http://ift.tt/2o7kHM9

The Rosai–Dorfman Disease: A Differential Diagnosis in Cervical Swelling

Abstract

Rosai–Dorfman disease also known as sinus histiocytosis with massive lymphadenopathy is a rare benign disorder of unknown etiology. It is a benign condition which causes significant cervical lymphadenopathy in children and young adults. These cases are frequently misdiagnosed as lymphoma, and thus it is important to distinguish Rosai–Dorfman disease from other causes of neck swelling because of different treatment modalities. We report here a case of Rosai–Dorfman disease presenting with massive right cervical lymphadenopathy.

http://ift.tt/2oNMJiw

A Rare Case of Basal Cell Adenocarcinoma of Parotid Gland with Intracranial Extension

Abstract

Basal cell adenocarcinoma (BCAC) is a rare tumour entity. Despite its tendency to be infiltrative and destructive tumour with propensity to recur, it rarely metastasizes and long-term outcome following surgery is favourable. This paper presents a 42-year-old male with residual BCAC of parotid gland that had extended into infratemporal fossa and intracranial. The important aspect of this case is the rarity occurrence of BCAC of parotid with intracranial extension and its surgical approaches to achieve tumour clearance.

http://ift.tt/2nm5NEP

The Rosai–Dorfman Disease: A Differential Diagnosis in Cervical Swelling

Abstract

http://ift.tt/2oNMJiw

Acquired Angioedema: A Rare Manifestation of Angioimmunoblastic T Cell Lymphoma

Abstract

http://ift.tt/2o7kHM9

A Rare Case of Basal Cell Adenocarcinoma of Parotid Gland with Intracranial Extension

Abstract

http://ift.tt/2nm5NEP

Managing the Dorsum in Rhinoplasty

Facial plast Surg 2017; 33: 119-119
DOI: 10.1055/s-0037-1598032

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

Article in Thieme eJournals:
Table of contents | Full text

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Cartilage Scales Embedded in Fibrin Gel

Facial plast Surg 2017; 33: 225-232
DOI: 10.1055/s-0037-1598184

Multiple techniques have been described for dorsal nasal augmentation in rhinoplasty. In this article, we review common surgical techniques for raising the dorsum or eliminating dorsal irregularities, by highlighting inherent advantages and disadvantages of each method. Within the past few years, the use of diced cartilage grafts has become the workhorse in this field of interest. To overcome drawbacks of methods based on diced cartilage, we present a new concept for autologous augmentation, using regenerative medicine protocols. A mix of cartilage scales with cartilage pâté was embedded in platelet-rich fibrin (PRF). Since December 2015, a total of 48 patients were treated with this technique. Based on our preliminary results, cartilage scales in PRF appear to be a promising and reliable alternative to existing procedures for dorsal nasal augmentation.
[...]

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

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

http://ift.tt/2nMORTe

Dorsal Augmentation Using Autologous Costal Cartilage or Microfat-Infused Soft Tissue Augmentation

Facial plast Surg 2017; 33: 162-178
DOI: 10.1055/s-0037-159914

Costal cartilage grafting is increasing in popularity with increased demand for augmentation rhinoplasty and increased need for grafting material for structure rhinoplasty techniques. Use of costal cartilage for dorsal grafting is both art and science. The art is demonstrated in the act of carving a dorsal graft that will reflect the actual contour of the nasal dorsum. The science is linked to the methodology of how the grafts are contoured to match the patient's desires and how the graft is fixed to the bony dorsum to minimize the risk of warping and displacement. Variations in dorsal graft design and methods of fixation are described. Use of the perichondrial interface between dorsal graft and perforated/rasped nasal dorsum acts to ossify the dorsal graft to the underlying bone, creating an immobile and natural appearing nasal dorsum. The fixation of the dorsal graft limits movement and hence decreases the likelihood of warping or deformity. Use of microfat in rhinoplasty has tremendous potential for camouflage and to promote healing of compromised tissues. Using microfat-infused soft tissue augmentation (MISTA), the surgeon is able to deliver microfat to an open surgical field, promote healing, and provide soft tissue augmentation. In this technique, microfat is injected into soft tissue carriers (perichondrium, temporalis fascia, etc.) and then implanted into the surgical field. MISTA has tremendous potential utility in many areas of cosmetic and reconstructive surgery.
[...]

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

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

http://ift.tt/2nMZXrn

Αρχειοθήκη ιστολογίου

! # Ola via Alexandros G.Sfakianakis on Inoreader

Η λίστα ιστολογίων μου

Παρασκευή 7 Απριλίου 2017

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